LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Cholesterol

Cholesterol Lowering Drugs and Diabetes: Just How Bad is It?

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aspirin to protect your heart
Sergey Yarochkin/Dollar Photo Club

It is now clear that cholesterol lowering drugs cause diabetes. But the proponents have clearly stated that the risk was in those already at risk.

Ironically, pretty much everyone with cholesterol issues is, to some degree, already on his or her way to developing diabetes. Giving a drug that is now proven to push patients along this pathway faster just seems a wee bit on the crazy side.

This article is not about the fact that statins suck at preventing heart disease. Because they do. Across the board statins pretty much lower your risk of having a heart attack by a paltry, sad 1%. High cholesterol, low cholesterol high CRP….doesn’t matter. One percent is the magic number. Your protection from heart disease will really not go above this level of protection.

Patients will respond by saying that the cholesterol drug he or she is taking lowered his or her cholesterol. Big deal. Do you REALLY care what your cholesterol is??? No. You just don’t want to have a heart attack or stroke. Well guess what—your cholesterol level dropping has very little to do with whether or not you are going to have a heart attack.

THAT is the big problem with statins. This delusional idea that artificially lowering your cholesterol with a drug (as opposed to lifestyle changes) will protect the heart is dangerous.

For those of you who would like to know more, I elaborate quite a bit in my Cholesterol Lowering eBook that can be found on Amazon by clicking here.

Back to this particular study. In it, researchers looked at the statin / diabetes link in greater detail. They looked at 4,645 patients who already had vascular disease but no diabetes. Of this group, 3,057 of them were taking statins at the beginning of the study, and 1,608 of these were on high-doses (intensive statin therapy–statin therapy theoretically lowering LDL cholesterol more than 40%).

Here’s what they found:

  • Statin use increased the risk of developing diabetes by 63%.
  • Those on intensive statin therapy had an even higher 22% risk of developing diabetes.
  • Here’s the shocker: the increase in risk had NO relationship to whether or not the statin user was already at risk for diabetes or not.
  • As a matter of fact, the greatest risk was in those patients who were LESS likely to on their way to diabetes (baseline glucose levels less than <120 mg/dl or 5.6 mmol/L).

Less just review this a second. People with elevated cholesterol are, in almost all cases, already on the way to developing diabetes. These patients are then put on drugs to lower cholesterol levels but do almost nothing to actually prevent a heart attack or stroke (which, BTW, is the main reason that diabetics leave this planet).

These drugs will then, paradoxically, further increase the risk of diabetes that the patient already had.

But, if you’re one of the luckier ones who was NOT on your way to diabetes but had high cholesterol, the drug you are put on will now pretty much ensure that you ARE on your way to diabetes.

Umm…am I the only one who seems to think this is a problem? Especially considering that the new ACC/AHA guidelines will drastically increase the number of patients who will be given prescriptions for statins.

No wonder heart disease is still the #1 killer in the industrialized world.

Cholesterol Lowering Drugs & Your Good Cholesterol–Bad News

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aspirin to protect your heart
Sergey Yarochkin/Dollar Photo Club

Despite all the less-than-stellar research on cholesterol lowering drugs, the powers-that-be want us to take even more of it.

The latest “cholesterol guidelines” released late in 2013 have drastically increased the number of patients who would potentially be given a statin.  They have finally dropped the fallacy that total cholesterol has any value (you know–total cholesterol–that lab value that you were taught to pay attention to so doctors would know when to put you on a cholesterol lowering medication..) and basically state that you should be given a statin if your doctor THINKS you might be at risk for a heart attack.

I have certainly been a vocal opponent of the statin class of drugs because the numbers just don’t make any sense.  Treat 1,000 people for 5 years to prevent 11 heart attacks (instead of 22 people who would’ve had heart attackes without the drugs), while at the same time causing diabetes in 8 more.  A net gain of 3.  Out of a thousand.  In 5 years.

That just sucks in my book.

And “they” think we should use it more on more patients.  None of this takes into account the very long list of side effects from this class of drugs (other then the already mentioned increased risk of diabetes).

And, as we treat more and more patients with cholesterol lowering drugs, the amount of people experiencing side effects is just going to skyrocket.  But at least they are not going to have a heart attack because of the statin drugs.

Right?

I guess that all depends.

This particular study looks at one of those little-known secrets about drugs to lower cholesterol.  While they all lower cholesterol levels (for whatever that is worth), in some individuals the drugs also lower HDL (the “good”) cholesterol.  This is generally not a good thing.  Specifically, researchers looked at 724 patients who had just started treatment with statins after having a heart attack and followed for 6 to 9 months.

Eighty-six percent (620) of these patients had his or her HDL-C level increase during the course of the study, while 14% (104) of patients had his or her HDL cholesterol go down.  Here’s what the researchers found when they looked closer at the group that had HDL levels drop:

  • Both groups had their LDL cholesterol levels drop below 100 mg/dl.
  • Adverse cardiovascular events (including death from all causes, heart attacks and stroke) happened more frequently in the decreased HDL group.
  • To be precise, this lower HDL group had these events at over TWICE the rate (15.4% vs 7.1%).
  • Overall, those who had lowered HDL as a result of the statin drugs (to protect the heart, I might add) were 95% more likely to have a cardiac event.

Let’s get this straight.  A drug given to lower cholesterol levels actually lowered good cholesterol levels in 14% of those patients taking them.  In this 14%, they were 95% MORE likely to have a cardiac event??

THIS is the wonder drug that seemingly all of medicine is hanging their hats on to save the world from heart disease?  I‘ll take lifestyle changes, thank you.

 

Diabetes and Drugs to Lower Cholesterol

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DO THE DRUGS THAT LOWER CHOLESTEROL ACTUALLY MAKE THE CONDITION WORSE?

It is a sad state that most cases of elevated cholesterol are actually due to being pre-diabetic.  How do we know?  Look for lowered HDL and elevated triglycerides.  Clear sign.  So, enter mainstream medicine and respond with knee-jerk reaction.  Give statins.  Numbers look better.  Doctor is very happy.  Patient is deluded into thinking everything is OK.  Numbers great, no need for lifestyle changes.  Everyone’s happy.  Including the OTHER drug company that makes diabetic drugs, because more evidence is mounting that statins INCREASE THE RISK OF DIABETES, WHICH IS WHAT WAS WRONG IN THE FIRST PLACE!!!!!!!  UGH!!!  This, more than anything, is one of the most frustrating “fixes” in mainstream medicine to me.  And stay tuned for the next update, which finally begins to admit that statins do nothing to protect against that first heart attack..

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Did YOUR Doctor Talk About Prediabetes?

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IS YOUR DOCTOR EDUCATING YOU?
The latin interpretation of “doctor” is “teacher” and this should be first and foremost our jobs.  Patients generally do not have the background in physiology that is needed to more clearly understand what is happening to them and help them make the right changes to improve health.  Unfortunately, this is not happening.  In this particular study, patients with low levels of HDL (which is a pre-diabetic scenario) who saw their PCP or cardiologist left the office visit woefully uneducated.  Only 6% of the visit was related to the problem at hand.  This is absolutely unacceptable.  How can patients understand that lifestyle changes absolutely can impact their condition??  I can tell you, that in my office, I make it VERY clear that these types of patients are well on their way to diabetes.  Whether they choose to make the changes is up to them.  It is MY job to educate the patient and make sure that they understand the severe consequences that ignoring their lifestyle will create.

Prediabetes, Exercise and Cholesterol; Does it Help?

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exercise for cholesterol
McCarony/Dollar Photo Club

 

You can’t see a cholesterol lowering drug commercial without hearing some poor guy saying he tried everything, but diet and exercise just wasn’t enough.

Once I finish yelling at the TV and vomiting the remnants of my lunch in disgust, I’m reminded that this is just marketing.

The reality, however, is that exercise will not change cholesterol levels very much in the short run (pun intended).  I remind patients of this frequently when we have discussions on cholesterol levels.  If you want to bring your cholesterol back under control quickly, diet is the only answer.

But for many, the exercise component is much easier to adopt.  Dietary changes are perceived as far more invasive.  Walk around the block a few days per week?  No problem.  Avoid refined carbohydrates and processed foods?  No way.

Exercise is the LONG term solution to cholesterol levels.  This is because the vast majority of cholesterol issues are caused by being prediabetic.  There are very few instances where prediabetes is NOT an issue, but it’s a pretty rare situation.  Unfortunately, this little tidbit is rarely explained to patients by their doctors.  Maybe it’s because most doctors don’t understand the relationship.

This does not mean that exercise is not important for short term management of cholesterol issues because it absolutely is.  But all too often the benefits of exercise are not what you would expect them to be.

Patients get frustrated when they exercise and do not take off weight.  I have covered the problem with this thought process in a previous blog post that can be read by clicking here.

(A quick note on my recommendations for exercise.  I am a huge fan of short-burst aerobic exercise consisting of some variation of 30 second all-out bursts performed in 10 sets.  I strongly do NOT feel that the standard “walk-30 minutes a few times per week” recommendations cut it.  Hitting that anaerobic zone is very, very important and the straight walking for exercise protocols do not do it.  This is likely why most studies on exercise do not have a short term effect on cholesterol levels.  To read more about this feel free to read a prior blog article by clicking here.)

HDL (the “good”) cholesterol is not a single molecule.  The reality is that there are some 100+ different forms of HDL cholesterol.  But the biggest classification of HDL molecules is into types 1, 2 and 3.  HDL (3) is generally considered the most protective form of HDL.

This has to do with an enzyme called paraoxonase-1 (PON1) that has very strong antioxidant properties.  PON1 levels are higher in HDL (3) molecules, which likely accounts for the strength of the protection of this type of HDL molecule.

This means that even if you have a high total HDL number, it may not be as protective as you think if most of the HDL is made up of the 1 or 2 subtypes.  Although more specific lab testing that includes these HDL subtypes is available, I have found a need to order these because the information from standard lipid profiles is enough for me to understand where your cardiovascular risk lies.

This particular study puts the concepts of exercise, prediabetes and HDL cholesterol subtypes into perspective.  In it, researchers studied a group of 39 patients with prediabetes and put them into two groups: a control group and an exercise group who followed a 10-week walk/run training program.

Here’s what the researchers found:

  • Exercise did NOT affect cholesterol levels.
  • Exercise did, however, increase the activity of the antioxidant paraoxonase-1 (PON1).
  • Exercise also decreased the levels of an oxidative stress marker called malondialdehyde.
  • Even better, the HDL3 the exercising prediabetic patients protected the blood vessel walls from damage by the high-powered inflammatory molecule tumor necrosis factor-a (TNF-a).
  • Exercise also decreased the ability of damaging immune cells to stick to the blood vessel lining (markedly decreased monocyte chemotactic protein-1, vascular cell adhesion molecule-1 expression as well as TNF-alpha-induced monocyte adhesion).
  • Lastly, exercise also increased levels of endothelial nitric oxide synthase (leading to higher levels of nitric oxide, a molecule that relaxes the blood vessels).

These are all pretty darn potent and beneficial effects that have been shown to greatly protect against heart disease and stroke.  If I had to balance the beneficial effects of these changes against a lower cholesterol level on protection from heart disease, they are not even on the same plane.

In other words, exercising led to very powerful effect on protecting your blood vessels from damage.  Given that the bulk of the evidence suggests that statin drugs to lower cholesterol pretty much suck at preventing heart attacks, the review suggests that exercising, whether or not it results in lower cholesterol levels, is far, far more powerful at preventing heart attacks and stroke.

Remember this–you are not exercising to lose weight or to lower your cholesterol.  You are exercising BECAUSE IT IS THE RIGHT THING TO DO.

 

 

Nuts to Lower Cholesterol

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NUTS ABOUT GOOD HEART HEALTH??

Nuts have consistently been shown to be very protective for the heart, and this review of multiple studies just cements this further.  Interestingly enough, the average positive change in lipids for 67 g of nuts / day (less than 1/2 cup) was better than that of statins.  And statins don’t contain the high levels of phytonutrients that nuts do that are also good for the heart.  Not much of a contest….  Two notes.  Use raw or roasted /salted nuts with NO ADDED OILS.  That means canned and some bulk nuts are out.  Second, walnuts and pecans are known to have the highest levels of antioxidants, so make sure they’re in the mix.  For a snack in between patients, I get a small handful of mixed up nuts and a small square of dark chocolate…perfect combination for heart health!

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Effects of dietary fructose on plasma lipids in healthy subjects – (11-27-00)

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Effects of dietary fructose on plasma lipids in healthy subjects

With the increased intake of high-fructose containing soda and drinks, this is definitely a contributing factor in the rise in cholesterol levels in certain patients. Remember that fruit also contains fructose, but the additional nutrients (fiber, bioflavenoids…) far override any effects on lipid levels.

AJCN — Abstracts: Bantle et al. 72 (5): 1128

Read entire article here

The New Statin Guidelines: Surprisingly Inferior Compared to this

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No one has ever accused me of being a friend of the statin class of drugs to lower cholesterol.

An entire eBook devoted to the side effects of statins and natural ways to lower cholesterol that do not involve statins pretty much cinches that.

Despite all the continued evidence that statin drugs are only minimally effective at saving lives, the powers-that-be are perpetually trying to jam more of them down our throats.  The latest guidelines, if interpreted loosely enough, could lead to millions more patients being eligible for statin prescriptions.

What a windfall for the drug companies at the expense of unsuspecting patients.

I will be the first to admit that statin drugs are effective at lowering cholesterol.  Quite frankly, NO ONE cares what his or her cholesterol is; we just don’t want to have a heart attack or stroke.  And we’ve been brainwashed to believe that lowering cholesterol with drugs is the way to get this done.

But it’s just not true and we’ve seen it time and time again.  At the bottom line, for the average patient, you have to treat 1,000 patients for 5 years to prevent a measly 11 heart attacks.  Eight of these unfortunate souls will develop diabetes (and will then die of a heart attack or stroke from the diabetes).

It took years for the drug companies to realize this.  Or maybe, it just took years for them to let the unsuspecting patients know that they knew that statins sucked at saving lives.  Regardless, this leaves them with a conundrum.  A multi-billion dollar engine that needs to be fed before the world wakes up to the fact that you have to treat 100 patients to prevent a single heart attack (leaving the other 99 with side effects and costs).

What would you do if you had a product that would soon have no use?

You got it—re-purpose it.

Just think if the guy who created the pet rock later marketed it as a paperweight.  He’d own a small island by now.  Or if the VHS cassette tape people could’ve later marketed the tapes as mini-storage device to hide money and valuables in bookcases…  You get the idea.

So, the latest attempt to prove value to drugs to lower cholesterol is to see if they can reverse plaguing in the arteries of your heart.  Sounds like a good idea, right?  Less plaque in your arteries would be a good indicator that the statin drugs were doing something positive for your cardiovascular health.

That’s what researchers did in this particular study.  They looked across multiple studies to see if high dose statin therapy could lead to shrinking of the plaque in the arteries of the heart regardless of what your cholesterol levels were or how much inflammation you had (as measured by CRP).  And they looked at high dosages because the side effects and costs are going to be greater so they need a stronger justification for the use of these drugs.

In other words, they are looking for a rationale to treat patients carte blanche without needing to worry about pesky reasons like high cholesterol or high inflammation.  They want to create a rationale to treat patients with high dose statins because it protects the heart, NOT because you have a risk factor that has been shown to be lowered with statins (since we saw how poorly that worked out using just total cholesterol).

They found 8 studies in all that included 1,881 who maintained or switched to 18- to 24 months of high-intensity statin therapy (rosuvastatin 40 mg or atorvastatin 80 mg) and were evaluated using coronary intravascular ultrasound to look at the plaque in the arteries of the heart.

As expected, lipids levels changed for the better.  Here’s where it gets exciting:

  • The plaque in the heart arteries dropped by 0.7%.
  • The total volume of the plaque dropped by 8.2 mm3.

For the icing on the cake, the effect was seen regardless of what the cholesterol or CRP levels were.

BUT…

Before we pop the cork on the champagne bottle, let’s saunter on over across the hall to this particular study published in the same issue of the same journal.

In this much smaller study (because hundreds of billions of dollars were not at stake), researchers looked at the effects aerobic exercise on this same parameter—plaque regression.

They compared aerobic interval training (my favorite) to moderate continuous training in 36 patients who had significant coronary artery disease who were already optimal medical treatment (i.e. “fully drugged up”).

The interval training used intervals at 90% of peak heart rate and the moderate continuous training used 70% of peak heart rate) 3 times a week for 12 weeks after they had a cardiac procedure to put a stent in. Here’s what they found:

  • The necrotic core inside the plaque (that nasty, dead tissue just waiting to break off and cause a heart attack) shrunk in both exercise groups by 3.2% with the interval and 2.7% with the continuous.
  • Overall plaque was reduced by a respectable 10.7% in both groups.

Now compare the two.  Which would prefer—0.7% or 10.7% less plague ready to explode in the blood vessels of your heart?  And one was done in 3 months instead of 2 years.

While you can’t make an exact direct comparison, it is clear that exercise is far more effective in a shorter period of time, with NO side effects and no cost (outside the cost of the study).

And yet, when the time comes for your doctor to give you your options, which do you think he was told about?  The one that is going to make the drug companies untold billions but has a small effect on your blood vessels, or the more powerful one that no one is making a buck off of?