LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Cholesterol

PRESCRIPTION FISH OILS?

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Everyone is aware of fish oils and the benefits to human physiology.  Did you know that they are available by a prescription?  I really shouldn’t got into this topic because it gets my blood boiling…

This is certainly not the first time that the drug companies have tried to ride the tide of popular natural approaches and monopolize on them, but this may be the most nausea-inspiring.  Why?

We can easily argue that the drug companies are about 30 years behind the research on the benefits of fish oils (the early studies came out in the 70’s).  GlaxoSmithKline has done very little research on the efficacy of fish oils and the conditions they can treat.

What is the excuse most drugs companies give for the exceedingly high cost of their drugs?  You guessed it– Research and Development.  So, we’ve established that GSK did very little of this and are merely riding the coattails of decades of research.  Sure–they’ve done some simple studies on their product Lovaza (formerly known as Omacor), but just enough to satisfy the FDA.

So what’s the problem?  At GSK’s prices for Lovaza, at recommended dosages (4 grams per day…more on that later), even budget conscious Costco is $182 / month.  yes–that is one hundred and eighty dollars for omega 3 fatty acids that for an arguably superior product that we sell in our office the cost is under $30.  Over 6 TIMES the cost.  And it’s certainly not about the R & D and it’s not about the quality.  That’s what’s so sickening.

And worse, some of your insurance is actually picking up the bill.  Yup.  Your insurance wouldn’t pay $30, but they’re willing to pay over $200.  And we wonder why there’s problems with healthcare costs…

Back to this particular study that looked at the cost effectiveness of the massively overpriced Lovaza being used at 4 grams / day and found that the cost per quality adjusted life year (QALY–a standard approach to determining if an intervention is worth the cost…anything under $50K is considered worth the cost) was $47K, or just under the margin.  A little funny when you back out of the data and look at how much the drug costs…..(I’d say it sounds “fishy,” but that would be too punnish..)

If we were looking at a reasonably priced OTC fish oil, this would be closer to $7800.  Ironically, when you take the most recent review of statin (in)effectiveness by the Cochrane Group, the cost of QALY was over $62K.  Not even in the same ballpark.

Of course, none of this addresses the massive benefits and cost savings with you couple healthy lifestyle changes like avoiding refined carbohydrates with a lower dose omega 3 use…

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DID LIPITOR LOWER YOUR CHOLESTEROL?

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If you took a statin and it lowered your cholesterol, my first response would be “So what?”  What does that REALLY mean?  And does anyone really give a squat about their cholesterol, or is it really that they don’t want to have a heart attack or stroke?

I’ve written before about the folly of using surrogate endmarkers like cholesterol in medicine today.  Our entire system is a house of cards built upon this concept.  So what is a surrogate end marker?

Basically, we take a population and look at some value.  To be consistent in this case we’ll look at cholesterol.  Those with lower cholesterol had less risk of heart attacks.  Makes sense.  It is likely that those who take better care of themselves have lower cholesterol.  But it is NOT the lower cholesterol that protects their heart.  Their heart is protected because of the choices they have made.  These choices lower cholesterol.  AND raise HDL.  AND lower blood pressure.  And maintain ideal body composition.  And improve gut health.  And lower uric acid…  The list is endless.

So how do we manage to find a single item on a long list (cholesterol) and decide that, if we lower that single value artificially through drugs, that it will be good for the patient????  It is a concept that has built the foundation of pharmaceutical intervention and it is a failed model.  Society just doesn’t know it yet.

(Just in case you think that my opinion is an isolated one and that using a drug to change a single marker is a great idea, you might want to read Dr. Ray Moynihan’s commentary in BMJ…)

So why do I bring it up?  Looking at this particular study, you see no reference at all to risk of heart disease or death in patients.  It is all about whether the drugs were effective and lowering cholesterol.  There is no doubt these drugs lower cholesterol, but do you want to place the full weight of your life on a surrogate endmarker? 

So this study is a perfect example of how we can use a study to promote the use of a drug…We wave the study high in the air, pound our fists on our chest and proclaim how it saves lives.  But we didn’t look at lives saved.  We looked at whether a single solitary number got better.  Pretty weak.

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ERECTILE DYSFUNCTION?

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Need I say more?  You’d think that this problem, above almost any other besides kidney stones, would drive a male to change their lifestyle.  Unfortunately, I think that there is, once again, an education gap in society today.

Erectile dysfunction IS heart disease (or rather, vascular disease…).  How is that?  Healthy blood flow is required for an erection.  When the blood vessels begin to plaque up, you will have reduced blood flow and inability to maintain an erection.  So if the blood vessels are plaquing, it is only a matter of time before a heart attack or stroke occurs.

This article refers to ED as the “canary” of cardiovascular health.  I love this!  I just wish I had coined it myself, but alas…I’m merely the messenger.

So the use of meds like Viagra, Cialis and Levitra do nothing to fix the problem.  Ironically, these meds can’t be used by a patient currently under treatment for heart disease, which is arguably the reason the ED is present in the first place.

So what does one with ED do?  And, before you ladies shut out the recommendations, decreased libido could arguably be put into the same category…so pay attention.

Once again, lifestyle changes to lower your risk of diabetes and heart disease will help with ED.  That means avoidance of refined carbs, hydrogenated oils and processed foods as well as no drinking our calories.  Increased intake of healthy fats, whole grains, fruits and veggies, tea and exercise.  All on top of a calorie reduced diet.  The list is long to help in this process…

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BUT I DON’T HAVE DIABETES, RIGHT?

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I know I’ve covered this ad nauseam in previous posts, but it’s important enough to stress again.  It doesn’t matter if you have or have not been diagnosed with diabetes.  A large chunk of the US population (likely >60%) are prediabetic or diabetic.  So what’s the difference between the two?

Nothing as far as your blood vessels (and that means your heart and brain) are concerned.  I wish we’d get rid of the term “diabetes” and just tell patients if they are headed towards better or worse glucose control.  That’s all that matters. 

I would have to say that approximately ZERO percent of my patients who are prediabetic truly understand just how dangerous this physiological state is.  Some may never become diabetic because they will die of a heart attack or stroke first.  The others will acquire the diabetic label and then die of a heart attack or stroke (unless they are the lucky few that get kidney failure or Alzheimer’s instead).

Stop thinking you’re ok just because your blood sugar has not passed that magical number.  If you have abdominal obesity, elevated cholesterol or triglycerides, decreased HDL, high blood pressure, PCOS, menstrual irregularity, sleep apnea, elevated liver enzymes….the list can be quite long…you’re likely prediabetic and at the same risk as a diabetic.

We really, really, really need to bring the general public up to speed on just how dangerous the prediabetic state.  Mainstream medicine has failed miserably in this task.  This is also the optimal time to intervene with healthier lifestyles.  Of course, the REAL optimal time is before you ever have any problems so that your never develop the problems…

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WANT TO LOSE WEIGHT? DON’T EXERCISE…

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Ok.  So maybe that’s not the best way to title the post.  For some reason, maybe because of society, we like to lean towards exercise to lose weight.  While this is important, diet plays a much stronger role.

That’s not to say that exercise is NOT important–it absolutely is and needs to be a part of healthy lifestyle changes.  But exercise without diet is worthless (think of the new direction McDonald’s took with Ronald promoting exercise…was again missing the diet boat).

Schools stress physical activity in our kids but then feed them refined carbs, dairy and sugar laded snacks and drinks.  Maybe it’s because getting more active makes companies money, but healthy dietary choices will cost them..?

Regardless, this review of studies found only small benefits on weight loss from 3-12 months using only aerobic exercise.  This just further confirms that muscle building exercises, aerobic and diet all need to be part of a weight loss routine.  This is no different for those patients who “tried everything” to lower their cholesterol (what they really meant was that they started walking around the block and it didn’t change their cholesterol).

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DRINK THIS TO LOWER CHOLESTEROL

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I know most of you were hoping the answer here was beer, but to date no one has developed a high-resveratrol beer.  Sorry.  If any company gets close to developing one–buy stock.  And although wine has been shown to raise HDL levels, that’s not the subject of this post either.

Green tea has been shown consistently across studies to have positive impacts on any number of chronic diseases.  When I’m asked, most people assume that it is green tea with all the benefits.  While many of the studies are done on green tea, that does not mean that black tea is without benefit and certainly white tea probably has more.  Personally, I shift between all types on a very frequent basis.

While this particular study focuses on the ability of green tea to lower cholesterol, I would never recommend tea as a sole means to lower cholesterol.  Rather, it is part of a comprehensive package of lifestyle changes all geared to improve physiology, which would, of course, also lower cholesterol.

As would be expected, I’m an avid tea drinker and our household goes through about a pitcher of tea per day.  Since everyone seems to be under the false impression that living healthier has to be expensive, let’s squash that notion right now.

I have a reverse osmosis filter on the sink and fill up a stainless steel crock pot that sits on the stove that is only used for this reason.  Teas come from a variety of locations: Tazo from Target, some 30 flavors from Teavana (teavana.com), tons of flavors from Maya Tea, flavors from Republic of Tea, flavors from China Mist.

The tea goes in the pot:

1)  loose leaf goes in an infuser….http://www.teavana.com/tea-products/tea-makers-infusers/p/perfect-tea-ball is my favorite and easy to use

2)  Republic of Tea – 5 of the circle tea bags per pot

3)  China Mist – one package per pot

I bring the pot to a boil and let it cool down.  Takes maybe 2 hours to cool down.  After this the tea gets poured into a glass picture and into the fridge.  While you can make tea any way you’d prefer, this type of an approach, drinking over a pitcher per day costs around $10-15 / month.  Can’t beat this cost with anything other than tap water.

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AVOIDING THIS IN FOODS WILL RAISE CHOLESTEROL

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It’s funny.  We think about what foods to add to lower cholesterol such as raw nuts and fish oils.  We think about what foods to avoid to lower cholesterol such as omega-6 containing oils (sunflower, soybean, peanut, cottonseed, etc..), hydrogenated oils and refined carbs.  This article adds yet another dimension–the elevation of lipid levels when a certain mineral is NOT present in the diet.

Sulfur, as a mineral, does all kinds of good things for the body.  It is essential for the maintanence of healthy joints.  It supports the sulfation pathway of detoxification in the liver.  And, looking at this study, diets that are low in sulfur will result in elevations in blood lipids such as cholesterol and triglycerides.

Foods high in sulfur include the cruciferous veggies like broccoli and cauliflower (of course!), onions, garlic and eggs.  And, as expected, these types of foods are good for us in a variety of ways and not just limited to their sulfur content.  So make sure you add these foods into your anti-diabetic lifestyles.

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STATINS PRODUCE MORE HARM THAN GOOD

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It should come as no big shock that I am certainly not an advocate of the statin class of drugs to lower cholesterol.  There are many reasons why I am so vehemently opposed to the use of this drugs.  How could this be, when it cuts the risk of a cardiac event by 50%??

For primary prevention (meaning we are trying to prevent a first heart attack), in almost all studies I’ve read, regardless of what value you look at (cholesterol, hsCRP, LDL), a statin will cut the RELATIVE RISK down by 50%.  If you are a physician that does not understand research and take the drug company’s headline as gospel, this seems like a godsend.  Every patient walking through the door is going to get their blood pressure checked and get a prescription for a statin, thinking that you are doing wonders for your patients.

However, before we jump up and down in excitement, we need to understand relative vs absolute risk.  In most of the studies, the numbers are pretty consistent.  Treat 100 people for 3 years and, instead of 2 people having a heart attack, only 1 does.  The RELATIVE drop from 2 to 1 is a 50% reduction and sounds great.  But since the overall risk is pretty low in this population (typically referred to as a 10 yr risk), the absolute risk reduction is a paltry 1%.  This flat out sucks.

There are some lifestyle interventions or supplements that fall into the same category.  The relative risk reductions may appear more powerful than if you put it into absolute risk reductions.  Here’s the difference.  Statins are very expensive (although with the loss of the patent on Lipitor the prices will drop substantially) and have a long list of side effects.  Muscle damage (the damage is present even if someone taking statins does not have muscle pain).  Depletion of CoQ10.  Probably the greatest scare is the increased risk of diabetes.

But, the biggest, staring you right in the face, answer is that I have NEVER not had a patient bring their cholesterol levels in line with the right lifestyle choices.  This is and will always be the only appropriate way to handle lipid issues.  The vast majority of patients with lipid (total cholesterol, triglycerides, HDL, VLDL) problems are pre-diabetic.  So giving these patients a drug that will worsen the physiological state that is making the number off kilter is just plain bad medicine.

http://jama.ama-assn.org/content/305/24/2556.abstract