HoldsUp

Mark Hyman, MD · 2026-07-01 · Mark Hyman (host), Cindy Geyer, Aseem Malhotra, Eric Topol

It's Not Cholesterol. Inflammation Is What's Actually Causing Heart Disease

48 research-tied claims examined: 6 contradicted 6 overstated 1 context 34 supported 1 unverified

6

Overstated

0:27:20Eric Topoloverstatedmoderate

Artificial intelligence analysis of retinal photographs can predict the onset of Alzheimer's disease 5 to 7 years in advance.

"You can do a retina AI exam. So I have a picture of the retina and you do AI on it, and it tells you when you're going to have Alzheimer's, if you're going to have Alzheimer's 5 to 7 years in advance." (said at 0:27:20)

Large prospective cohort studies (including data from the UK Biobank) demonstrate that artificial intelligence and deep-learning models applied to retinal photographs or optical coherence tomography can identify retinal structural features and biological aging markers associated with an increased relative risk of developing Alzheimer's disease or dementia years (e.g., 5 to 12 years) before clinical diagnosis. However, framing this as a ready clinical exam that deterministically "tells you when you're going to have Alzheimer's, if you're going to have Alzheimer's" significantly overstates the evidence. Current AI retinal models quantify statistical risk and biological vulnerability in research cohorts; they are not clinically diagnostic or deterministic prognostic tests for individual patients.

0:32:24Eric Topoloverstatedhigh

Statins cause severe leg cramps and muscle-related symptoms in patients.

"Some of the data that comes out of these big meta-analyses, which say, "Oh, people don't get any leg cramps." That's not true. You and I know that's not true. People do get severe leg cramps where they can't even sleep at night, you know, uh, and and all sorts of other, you know, leg, uh, and muscle-related symptoms." (said at 0:32:24)

While statin therapy is causally associated with a small excess rate of muscle pain or weakness, the severity and frequency attributed to statins are significantly overstated. A comprehensive individual participant data meta-analysis of 19 large double-blind, placebo-controlled randomized trials (n=123,940) by the Cholesterol Treatment Trialists' Collaboration found that statins caused a small excess of mostly mild muscle symptoms during the first year of treatment (absolute excess of 11 events per 1,000 person-years; rate ratio 1.07). However, after the first year, there was no significant excess risk, and more than 90% of all muscle symptom reports among statin-treated participants were not attributable to the drug, occurring at near-identical rates in the placebo groups (nocebo/drucebo effect and background prevalence). Severe muscle damage (such as rhabdomyolysis or severe myopathy) is very rare.

0:33:00Eric Topoloverstatedmoderate

Failing to lower LDL cholesterol below 100 mg/dL or 70 mg/dL places individuals at higher risk for dementia.

"if you don't have the LDL lowered to let's say less than 100, less than 70, you're going to be at higher risk for dementia." (said at 0:33:00)

While some observational cohort analyses find that individuals with LDL cholesterol levels below 70 mg/dL have lower rates of incident dementia compared to those with higher levels, randomized controlled trial evidence does not support the claim that actively lowering LDL cholesterol to specific targets (e.g., <100 or <70 mg/dL) reduces dementia risk. Cochrane systematic reviews of randomized trials evaluating statin-induced LDL lowering found no significant reduction in the incidence of dementia or Alzheimer's disease, and trial data from PCSK9 inhibitor studies similarly show no significant effect on dementia outcomes.

0:38:16Mark Hyman (host)overstatedlow

NAD+ levels decline by approximately 50% by the time a person reaches middle age.

"The problem is NAD+ levels drop by about 50% by the time you hit middle age." (said at 0:38:16)

The popular claim that human NAD+ levels drop by approximately 50% by middle age originates from small observational studies in specific tissues (notably Massudi et al., 2012, examining human pelvic skin biopsies from 49 participants, which showed an age-dependent reduction). However, applying a universal ~50% decline across the human body by middle age is overstated. Human studies across different tissues and blood show substantial variability: large-scale studies measuring whole-blood NAD+ show modest declines that vary by sex or find that whole-blood NAD+ levels remain largely stable across age cohorts.

0:42:10Mark Hyman (host)overstatedhigh

Approximately 20% of statin users experience muscle damage, muscle symptoms, or an increased risk of diabetes.

"And if statins cause side effects, which they do for a lot of people, probably 20% get some muscle damage or some symptoms or increased risk of diabetes" (said at 0:42:10)

The claim that statins cause muscle damage or symptoms in approximately 20% of users significantly overstates the evidence from randomized controlled trials. A large-scale individual participant data meta-analysis of 19 double-blind trials (n=123,940) published by the Cholesterol Treatment Trialists' (CTT) Collaboration found that while 27.1% of statin users reported muscle pain or weakness, 26.6% of placebo users did as well (rate ratio 1.03), indicating that over 90% of reported muscle symptoms were not caused by the statin. The true statin-attributable excess of muscle symptoms was only about 11 events per 1,000 person-years in the first year, and actual muscle damage (clinically significant creatine kinase elevation or rhabdomyolysis) is exceedingly rare. A comprehensive meta-analysis of over 4 million patients found the pooled prevalence of statin intolerance was 9.1% overall and 4.9% in randomized trials, though reaching 17% in unblinded observational cohort studies driven largely by background symptoms and the nocebo effect.

0:49:46Aseem Malhotraoverstatedhigh

Approximately 1 in 100 (or up to 1 in 50) people prescribed statins develop type 2 diabetes as a result of the medication.

"What else do statins do? They cause insulin resistance. Say 1 in 100 people get type 2 diabetes because of statins. ... Some some studies say 1 in 50, right? Will get type 2 diabetes because of the statin." (said at 0:49:46)

The claim that 1 in 100 (or up to 1 in 50) people develop type 2 diabetes because of statins overstates the excess risk attributable to the medication. In large collaborative meta-analyses of randomized controlled trials, statin therapy was associated with a modest 9% relative increase in incident diabetes (odds ratio 1.09), corresponding to an absolute risk of 1 additional case of diabetes for every 255 patients treated over an average of 4 years (approximately 1 in 255, or ~0.4%). Even when comparing intensive-dose statin therapy to moderate-dose therapy, the number needed to harm per year was 498 (approximately 2.0 additional cases per 1,000 patient-years).

Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.