“Metabolical” by Robert Lustig is a compelling deep dive into the pitfalls of modern nutrition and healthcare systems. Lustig, a pediatric endocrinologist, exposes how processed foods, loaded with sugar and devoid of fiber, are the root cause of many metabolic diseases, including obesity and type 2 diabetes. He argues persuasively that the food industry and healthcare system are more invested in profit than in public health, leading to a widespread neglect of the underlying causes of these diseases.

The book is a clarion call to rethink our approach to food and health, emphasising the need to shift from a focus on treating symptoms to addressing the root causes. Lustig advocates for a return to real, whole foods and a systemic overhaul to prioritise metabolic health. One of the book’s striking quotes encapsulates his message: “It’s not about obesity; it’s about metabolism. The food we eat determines our health.”

In chapter 9, he goes into detail about how the medical approach to testing cholesterol is flawed and leads to the overprescribing of statins to lower the body’s level of LDL cholesterol. He says:

“The current mindset among clinicians is to downshift everyone’s LDL-C through low-fat diet and drugs. Because that’s what they’re trained to do. I would know. I’m one of them. But really how beneficial are statins, and for what? Despite governmental recommendations to eat low-fat and despite a high prescription rate of statins, at a population level LDL-C levels haven’t change appreciably. It isn’t just the pill that’s the problem. The recommendation of a low-fat diet is just as bad.

It’s true that fewer people are actually dying of heart attacks in the US and other high-income countries (although low-income countries still have high mortality rates). But that statistic belies the truth. While fewer are dying of heart attacks, more people are suffering them. Of course rising numbers could be due to improved recognition, ambulance response time, emergency room functioning, the clot buster tissue plasminogen activator (tPA), and heart attack post-care.

But the real story is that more people are suffering heart attacks with lower LDL-Cs than before, because the standard fasting lipid profile–the blood test ordered by your practitioner to test your cholesterol–assumes that all LDL particles are the same. There are two different LDLs, but the lipid profile test measures them together.

The majority (80 percent) of circulating LDL species are called large buoyant or type A LDL, which are increased by dietary fat consumption. This is the species reduced by eating low-fat or by taking statins. However, large buoyant LDL is cardiovascularly neutral–meaning it’s not the particle driving the accumulation of plaque in the arteries leading to heart disease. Then there’s a second, less common (only 20 percent) LDL species called small dense or type B LDL. There is some debate as to whether or not it’s the actual perpetrator of the plaque, but it doesn’t matter; small dense LDL is predictive of risk for a heart attack. The problem is that statins will lower your LDL-C because they’re lowering the type A LDL, which is 80 percent of the total; but they’re not doing anything to the type B LDL, which is the problematic particle.”

Statins such as Atorvastatin (Lipitor)⁠, Fluvastatin (Lescol XL)⁠, Lovastatin (Altoprev)⁠, Simvastatin (Zocor)⁠ are some of the drugs prescribed for menopausal women with high cholesterol, yet many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. And these trials have not been validated by independent sources, which means that the data, and reasons for prescribing, are questionable.⁠

In the meantime, research shows that for women in menopause, statin drugs can increase the risk of diabetes by 48%! In tandem, diabetes is associated with dementia, and when combined with HRT, pushes the risk of dementia even higher. 75% of people with dementia are women. ⁠

How high should our cholesterol be as we get older? The research has not been done, but it is known that the higher the cholesterol as we get older, the lower risk of death. ⁠

The truth is – as laid out in Metabolical – that fundamental factor in the development of various metabolic diseases, including type 2 diabetes, obesity, and heart disease is a diet rich in sugar and poor in fibre, contributing to insulin resistance. This condition impairs the body’s ability to manage blood sugar effectively, leading to a host of health issues. Lustig emphasises the importance of a diet rich in real, whole foods to combat insulin resistance and improve overall metabolic health.

Throughout the book, Lustig’s focus remains on addressing the underlying causes of metabolic diseases rather than just treating symptoms. He advocates for a holistic approach to health that includes dietary changes, lifestyle modifications, and a critical evaluation of how the healthcare system and food industry impact our overall well-being.