LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Cholesterol

Statin Side Effects Solved with an Apple a Day

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Sometimes the old adages contain much deeper wisdom than many given them credit for. “An apple a day keeps the doctor away” may prove more accurate than previously thought.

Apples are a rich source of polyphenols; plant based protective compounds that have been shown to be very protective for your blood vessels. Protect your blood vessels and you lower your risk of having a heart attack, stroke or developing dementia. Quite a bit of bang for your buck. And this protection is outside of whatever level of cholesterol you may or may not have.

This particular study takes an interesting look at what would happen if we through statins in the garbage (if you ask me, is where they belong) and replaced the drug with the adage’s “apple a day.” The results are really not that surprising. Here are the details:

  • The study assumed treatment of 17.6 million people over the age of 50 with either statins or an apple / day.
  • Statins would prevent 9400 vascular deaths.
  •  An apple a day would prevent 8500 deaths.
  •  Statins would lead to 1200 excess cases of myopathy (muscle pain).
  •  Statins would lead to 200 cases of rhabdomyolysis (a frequently fatal destruction of all muscles, leading to kidney failure).
  •  Statins would lead to 12,300 diagnoses of diabetes (yes—this number is correct).
  •  All of this was at 70% compliance. With 90% compliance, all of these numbers (benefits and side effects) would increase.

There were no estimates for side effects of apple consumption, for obvious reasons (in other words–there weren’t any).

The bottom line is that we have put statins on a pedestal, but they are barely more effective than even the most basic lifestyle recommendations (an apple a day) and with far, far, far more dangerous and common side effects.

 

Plasma oxidized LDL: a predictor for acute myocardial infarction? – (03-31-03)

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Plasma oxidized LDL: a predictor for acute myocardial infarction?

Remember that LDL cholesterol itself does not do damage to the body until it gets damaged itself through oxidation (sometimes termed oxysterols). Here we see the development of yet another tool to assess heart disease risk. Keep in mind that, even with high cholesterol, high intakes of antioxidants can serve to protect the LDL particle from being damaged.

Synergy Abstract

Click here for more information.

The NEW Statin Guidelines: This is the Best We Got?

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I keep thinking that I’m missing something here.  Some magical number that makes these drugs to lower cholesterol worth the hype.

I’ve read all the studies and I’ve seen the numbers, but I don’t read ALL of the medical literature that gets published on statins.   So maybe I missed the one that showed that statins are worth all the hype and the new recommendations.

There has been much pushback on the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on reducing atherosclerotic cardiovascular disease risk.  The arguments include conflict of interest (8/15 panelists had financial ties) and overzealous interpretation of the data.  Here are the scenarios when moderate to high dose statins should be used:

  • Anyone with low-density lipoprotein (LDL) cholesterol levels >190 mg/dL.
  • Anyone from 40 to 75 years or age with type 1 or 2 diabetes.
  • Anyone aged 40 to 75 years with LDL cholesterol levels between 70 and 189 mg/dL and 7.5% or higher estimated 10-year risk of atherosclerotic cardiovascular disease.
  • Moderate-dose statin treatment in anyone with an estimated 10-year risk between 5% and 7.5%.

This pretty much covers everyone.

But this  aren’t the problem.  Or rather, the problems.

First, the queen of all twisting of the data has to do with cholesterol.  If you remember how this all started years ago, it was all about total cholesterol.  Everyone needed their total cholesterol checked so that we could see whether or not they needed drugs.  The entire, laser-like focus on preventing heart disease kept total cholesterol in the crosshairs.  We did this, spending mass amounts of money on “educating” doctors and patients that total cholesterol = heart disease = statins.

It got embedded deep.  Really deep.

It was not until 10 years later that anyone asked whether lower total cholesterol with drugs was preventing heart attacks and deaths.  Turns out they didn’t work really well.  Actually, they sucked.  So much that these new guidelines do not even take total cholesterol into account.  Basically, the suggestions were that we don’t need to look at markers anymore, but we just treat for the sake of treating because the research shows that these drugs help to reduce deaths.

Which brings us to the second problem.  They suck at preventing death.

And they did not hide this in the recommendations, as you can see in this review article on the subject.  The numbers are given as “NNT,” or number needed to treat over 5 years to see a benefit.  This number helps us to understand how many patients need to be treated to benefit a single patient.  As an example, using steroids in an acute asthma attack will save 1 person from going to the hospital for every 8 treated, so a NNT of 8.  This is considered pretty darn good.  Acid blocking drugs in a bleeding stomach ulcer to prevent another episode of bleeding?  15.  Probiotics for preventing C. diff infections?  25.

You get the idea.

So what about the use of statins?  Here’s the numbers:

  1. Dying from all causes NNT 138
  2. Having a cardiac event NNT 49
  3. Dying from cardiac causes NNT 88
  4. Having a stroke NNT 155
  5. Developing diabetes NNT 98

The saddest part about all of this is that society and medicine has degenerated to the point where we are willing to accept a treatment that is so poor that we have to treat 88 people for 5 years to prevent a single death.  And the costs to prevent that single heart attack are staggering (think about the costs of 5,280 months of statin drugs).

With these recommendations, we have given up on the hope that the American public can and will make the necessary lifestyle changes to protect their hearts and have instead leaned more heavily on the use of drugs for “prevention” of heart disease.

That is the saddest part of all of these recommendations.

 

How Compliant are You with Your Heart Meds?

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Let’s face it.  The general public sucks at taking their meds the way they are supposed to.  But it’s still going to help, right?

Studies have shown that upwards of 75% of patients taking medications are not fully compliant.  In other words, the vast majority of medicated patients do not take drugs as prescribed.

With this in mind, understand that trials on medications are done under Ivory Tower-like conditions.  And the results on trials for a large chunk of available medications show a paltry benefit at best (anti-depressants, high blood medications and cholesterol medications are just a few examples).  We can extrapolate that, if the benefits of drugs like those mentioned above are a  hair above non-existent with high compliance, that with low compliance the chance that benefits of the drug will outshine side effects becomes akin to finding the winning Powerball ticket walking through a parking lot.

Just in case you think I’m being dramatic (ok…so maybe the Powerball comment was a wee bit dramatic–but not by much), I present this particular study.  In it, researchers looked at several different drugs, the statins or blood pressure medications (beta-blocker, ACE inhibitor or ARB), to see what the benefits of the drugs looked like if someone was compliant versus non-complaint.   High compliance was considered to be someone taking his or her drug at least 80% of the time they were supposed to be.  Here’s what they found:

  1. Highly compliant patients were 19-36% less likely to have a heart attack or need a heart stent procedure.
  2. Everyone else who did not take the meds as prescribed basically had no benefit.
  3. Even those who were partially adherent had no reduction in heart attacks or cardiac procedures.

This means that, with statins (my favorite class of drugs) or the most commonly used blood pressure medications, only a small percentage of those patients taking them will ever see a benefit.  Even if they do see a benefit, many times that benefit is small.  None of this takes into account the long list of side effects from these classes of drugs.

THIS is what we call “medicine” today.

 

Thirty-Eight Studies Find Soy Products Lower Cholesterol – (07-31-00)

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Thirty-Eight Studies Find Soy Products Lower Cholesterol

It seems that soy’s effect on cholesterol may actually be better researched than many of the pharmaceutical drugs on the market. As a side note, it is important to mention that soy is not ALL good. It does have a tendency to interact with other essential nutrients. It is important to not fall prey to every soy product on the market.

Increasing evidence supports the use of soy products to lower blood cholesterol, a heart-health publication edited by cardiologists reports. Heart and Health Reports cited a summary of 38 recent studies of the effect of soy on cholesterol: “This summary found that an average intake of 46 grams of soy protein per day reduced total cholesterol by an average of 9 percent, [low-density lipoprotein (LDL)] cholesterol by l3 percent, and triglycerides by 11 percent,” the publication said. Patients who had the highest cholesterol to start with had the greatest cholesterol-lowering benefit from soy, with some studies showing that soy raised high-density lipoprotein cholesterol.

Cholesterol Lowering Drugs and HDL—Do They Work?

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It’s pretty well established that, despite drug companies mounting a massive push and “educational” effort for years, total cholesterol by itself has little to do with heart disease rates.

However, I still have to educate people in the community and my practice on this little tidbit.  The focus away from total cholesterol was made quietly, most likely as an effort to save face by those who had been pushing cholesterol levels as THE answer to heart disease.

The research on HDL (the “good” cholesterol), LDL (the “bad” cholesterol), VLDL (the “worst of the worst”) and triglycerides, however, is stronger.

In my opinion, the HDL:triglyceride ratio is the most valuable, but overall it’s the entire picture painted by all the lipids that give us the best picture.  This viewpoint, however, is not what drug research and use is about.  Since drugs can usually only affect one blood value at a time (i.e. statins will lower LDL but won’t have a big impact on triglycerides), researchers have to push hard to find a relationship between a value and a disease (such as total cholesterol and heart disease) and then find a drug that affects that value.

Miraculously, despite all my Rantings on cholesterol lowering drugs as well as an eBook on cholesterol lowering drugs, I still have patients come in who think that the drugs they’re on will actually protect them from heart disease and stroke.  Needless to say, I’m not a fan of cholesterol lowering medication and will not hesitate to point out the research related to cholesterol.

Which leads me into this particular study.  In it, researchers looked at two types of lipids, HDL cholesterol and apoA-1.  Most know that HDL is generally considered the “good” cholesterol and lifestyles that promote higher levels will be strongly protective against heart disease and stroke.  ApoA-1, however, is less well-known.  Apolipoprotein A-1 is one of the major proteins that makes up the HDL molecule and helps to shuttle cholesterol around the bloodstream.  Having higher levels is more protective to the heart.

This study looked at the effect that HDL and ApoA-1 levels had on heart disease.  Then, they looked at what effect statins had on these relationships.  Here’s the specifics:

  1. HDL lowered the risk of a major cardiovascular event by 17%,
  2. ApoA-I level lowered risk 21%.
  3. In those patients taking statins whose LDL cholesterol levels were lowered to at least 50 mg/dL, an increase of HDL-C did not lower heart disease risk.
  4. However, in the statin responders, a rise in apoA-I did lower the risk of heart disease by 7%.

So what does this mean?  Higher levels of HDL and ApoA-1 are good for your heart.  But when those levels are artificially raised by a cholesterol lowering drug, it either didn’t help at all or the benefit was far less than higher levels occurring naturally.

When we find, from observational studies, that some lab value protects against some disease, it is LIFESTYLE that gives the benefit.  Cheating by using drugs to lower the value, if it works and doesn’t kill you from the side effects, will never produce the same benefit.

My Doctor Told Me I’m NOT Prediabetic–Is He Right?

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I have certainly made it clear that diabetes is the beast we all fight against.  But how do you tell if you’re on your way?

Just in case you don’t have a good answer to this question, it seems that many doctors get confused on this question as well.  I recently had a new patient who told me that her primary care doctor had told her she was prediabetic.   A little confused myself, I asked her some questions.  She had told her primary that she had been dealing with fatigue over the past few months, so she had blood work done.  Nothing terribly off, but her doctor, concerned about prediabetes, ordered a post-prandial glucose tolerance test (can’t remember, but I think it was the 2 hour variety).  From this, he told her she was prediabetic and needed to go on a special low glycemic index diet.  No problems with fasting glucose, triglycerides, HDL or total cholesterol.

Basically, fatigue was the only thing he was running with and looking hard to find prediabetes.  By the end of a new patient interview I can tell someone with a high degree of certainty just how fast they are running towards diabetes.  This women wasn’t it.  Incidentally, her fatigue is a pretty clear-cut case of adrenal fatigue, further confirmed by medication for anxiety.  Fatigue is not a common symptom of prediabetes.

On the flip side, I’ve had many patients over the years who had been told that they were NOT prediabetic and yet they clearly were.  Most doctors seem to only look at the sugar / glucose markers:  fasting glucose, HbA1c and maybe fasting insulin.  But long, long before insulin has a problem getting sugars out of the bloodstream there is going to be a problem with getting fats out of the blood (refer to the glucose-fatty acid cycle of Randle from 1963 if you’d like more info on this).

In other words, do not waste time looking at glucose and HbA1c in the early part of the spectrum–they’re going to be normal.  Instead, look at the triglyceride and HDL level.  THIS is probably one of the best screening tools to get a quick guess about where you are (or are not) on the diabetic spectrum.  Which brings us to this particular article.  In it, researchers looked to see what ratios between HDL and triglycerides were of concern in 2,244 healthy college students (17–24 years old) of Mexican Mestizo ancestry.  Here’s what they found:

  1. The highest 25% TG/HDL-C ratio was used to identify those with prediabetes who were at increased risk of heart disease.
  2. Heart disease risk factors were greatest in those whose TG/HDL-C ratios exceeded 3.5 (men) and 2.5 (women).

Personally, I don’t like to see the ratio get much above 2, but I’m pretty picky.  Normal triglycerides are considered below 150 mg/dl and normal HDL should be greater than 40 mg/dL (men) and 50 mg/dL (women).  As an example, a man having “normal” levels could have a ratio of 3.75–way too high.  But if your doctor does not recognize this fact, you’ll be sent away with mistaken reassurances that everything is doing ok.

As a side note, don’t confuse this ratio with the “good” to “bad” cholesterol ratio–the triglyceride to HDL ratio is far more important.