In this study looking at high dose vitamin D and blood vessel health (endothelial dysfunction), I’d like to point out the dosages used. I have previously brought up the concept of overdose of Vitamin D, but look at the levels used in this study!! 10,000 / day for 3 months with no problems… I know that I personally don’t usually exceed 6,000 / day, but the results of this study are pretty impressive.
Heart Disease
Aspirin to Prevent Heart Disease; Are You STILL Taking It?
Everyone’s doin’ it. TV ads say you should be doin’ it. Your doctor says you should be doin’ it. But should you really take aspirin for your heart?
For a very long time, this answer was a strong, positive “YES.” After all-aspirin thins the blood so it would make sense for aspirin to lower your risk of a heart attack, right?
Yes, and hormone replacement therapy for women was a great idea as well. At least until someone decided to really look at this multi-billion dollar drug industry and found that HRT actually caused everything you were told it would help. Oops.
So for decades, doctors and advertising messages bombarded you with the idea that aspirin will protect your heart. The problem is that this was largely a theory that was promoted to you as fact. But, over a decade ago (2001 to be exact), studies were published finding no benefit to taking aspirin in low-risk individuals. That means that, for the average person, he or she was taking a drug well-known to lead to bleeding ulcers, kidney damage, strokes, macular degeneration and even pancreatic cancer, all with the idea that it was good for his or her heart.
It took another decade for further studies to make it to the limelight, but in 2010 another study was published and again found no benefit to using aspirin to protect the heart. Two large meta-analysis of multiple studies published in 2011 also found no benefit to using aspirin to prevent a first heart attack (primary prevention).
At this point, I was SURE that this was the death of aspirin to prevent a first heart attack (the data is a little stronger if you’ve already had a heart attack), but I still have patients taking aspirin for their heart. And they seemed shocked to hear that it really has no benefits (ok…if you treat 1000 patients with aspirin for 5 years, 2.9 less people with have a heart attack, although 2.8 will experience a major bleed due to the aspirin. Net gain of 1 person out of 10,000 patients. So I guess I can’t say that there is NO benefit to aspirin..).
Just in case you still aren’t convinced, this particular study should put your confusion to rest. In it, researchers looked at 22,576 patients who were at least 50 years of age with stable heart disease that required high blood pressure medications. These patients were grouped into an “ischemic” group if they had a history of unstable angina, myocardial infarction, transient ischemic attack, or stroke while all others were grouped as “non-ischemic.” Here’s what they found:
- 56.7% of all participants used aspirin, which increased to 69.3% by the end of the study.
- In the “non-ischemic” group aspirin actually INCREASED the risk of a heart attack, stroke or dying by 11%.
- However, in the “ischemic” group aspirin did lower the risk of a heart attack, stroke or death by 13%.
For those of us who have NOT had a heart attack, this is NOT good news. Given the previous studies on aspirin over the past 14 years or so, the results of this study are no surprised at all.
What I will suggest is what I have suggested to all my patients–relying on a single drug (with side effects) to try to change your risk of heart attack instead of making wise lifestyle choices is just plain stupid. And yet sadly, this is what society promotes.
If you’d like to get a good start on protecting your heart without aspirin, feel free to check out my heart disease eBook on Amazon by clicking here.
Preventing Heart Disease: Do Cardiologists Help?
Don’t get me wrong. I don’t inherently have a problem with cardiologists. But, for heart disease to be almost entirely preventable and remain the #1 killer in the industrialized world, we’ve absolutely dropped the ball.
I just don’t see any excuse for a clearly preventable disease to be the #1 killer.
And I cannot accept the fact that medicine is doing better at preventing cardiac deaths (largely due to technology saving lives when the fecal matter hits the fan). We are doing absolutely awful at preventing cardiovascular disease.
This is in the face of a truly massive amount of evidence on how to prevent cardiovascular disease using lifestyle. Maybe cardiologists are really spending the time needed to educate their patients about the best lifestyles to drastically lower the risk of having a heart attack or stroke and patients just aren’t listening. Or maybe mainstream medicine is so caught up in procedures and prescriptions that they have let lifestyle advice to patients fall to the wayside.
The answer likely lies somewhere in between. I think society is just as heavily to blame because we have created an illusion where medicine actually fixes things. You do not need to exercise or change your diet because the drug you are taking has lowered your blood pressure, stopped your irregular heartbeat or lowered your cholesterol. And when that doesn’t work you can go in for a quick in-and-out Roto-rooter procedure and you’re good to go.
If society really knew just how little these approaches really help things might change. And I think that the foundation for this perceptual change needs to begin with the cardiologists. It is a profession that needs to stand up and work as hard as possible to destroy itself.
While destroying itself sounds a wee bit, well…self-destructive, this is the way our office functions when it comes to chiropractic care. I tell patients that it is our job to destroy the practice by pushing for patients to become more active, eat right, treat injuries appropriately and engage in positive musculoskeletal behaviors like yoga.
While it don’t think it will ever happen, it’s still the attitude that we maintain every day.
Cardiologists need to hop on board with this attitude and take a good hard look at what kind of information they are giving their patients. It would be hard for any professional to look at a client, customer or patient and tell them straight on that he or she has little to offer.
Certainly cardiologists have procedures they can offer to patients. And, at the end of it all, there is absolutely no doubt that cardiologists are amazing at saving lives. But they just seem to have a hard time diverting current patients from needing that end-of-the-line lifesaving procedure.
I thought all of this would be a good primer for this particular study. In it, researchers looked at cardiac outcomes during 2 large, national cardiology conferences over the course of 9 years. They then compared these same outcomes to 3 weeks before and 3 weeks after the conferences to see how rates compared.
One would think that, with hospital cardiologists being out of town during these big conferences, it would spell trouble for patients who have heart disease during these time periods.
But here’s what they found:
- In teaching hospitals, risk of high risk patients dying from heart failure during the meeting times was lower (17.5% vs 24.8%).
- Deaths from cardiac arrest were also lower during meeting times (59.1% vs 69.4% ).
- Rates of percutaneous coronary intervention (PCI–the procedure used to put stents in blocked arteries) were, as expected, lower during meetings (20.8% vs 28.2%;). However, lower rates of PCI did not affect a high-risk heart attack patient’s chance of dying (39.2% vs 38.5%–in other words, despite not having cardiologists to do these procedures, no one was dying any faster).
- On the flipside, in nonteaching hospitals, there was no difference in the risk of dying or having a procedure (both high- and low-risk patients ).
- There was also no higher risk of dying in teaching hospitals for low-risk patients.
Wow.
Not sure that there’s any other way to look at this other than saying that there is a chance that teaching hospitals may be doing slightly more harm than good when it comes to the cardiovascular departments.
As an example, it is estimated that half of the non-emergency cardiac stenting procedures are unnecessary. Considering that these procedures have risks associated with them, it would not be a surprise to see less procedures leading to less deaths.
In an area that has several teaching hospitals, I can assure you that the perception of these teaching hospitals by patients is very high and many will bend over backwards trying to get into them for their problems.
That just may not always be the best idea. The bottom line is that, even in prestigous teaching hospitals, your cardiovascular health may be better off where it has always been–inside you.
Prediabetes, Exercise and Cholesterol; Does it Help?
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.
Low T Symptoms: Should you Believe the Commercials?
Despite the complete lack of evidence about whether it has any benefit, a day does not go by that I don’t hear a commercial on the radio for male sexual dysfunction.
By the end of the commercial, you are led to believe that the only reason for male sexual dysfunction is low T. Even worse, this low testosterone level seems to come out of nowhere and there is nothing you can do about it. Except, of course, come in for an appointment for testosterone cream, pills or injections.
Regular readers of the Rantings of course know that low testosterone levels are merely a symptom of a poor quality lifestyle and not the problem itself.
To put it plainer, smoke (while not good for you to inhale) is not the problem—the house fire is. The local fire department doesn’t rush to the scene of a house fire only to suck out the smoke and leave the fire raging.
And yet this is what the “testosterone movement” has led you to believe. There really is no other way to describe it. The past few years have seen a massive increase in the prescriptions for testosterone replacement therapy given to men (and women) based purely on low testosterone levels found on bloodwork.
Personally, it is incredibly rare for me to check testosterone levels in the blood, despite knowing a substantial amount about what contributes to low testosterone levels and how to fix low T problems.
Just because I don’t check for low testosterone does not mean that I don’t feel that low T is a problem. This particular study drives this point home. In it, researchers looked at 115 male patients with type 2 diabetes and divided them up between normal (≥12.1 nmol/L) and low (≤12.1 nmol/L) testosterone levels. They then compared levels of several markers of heart disease, including hsCRP, carotid artery carotid intima-media thickness (IMT) and atherosclerotic plaque by high-resolution B-mode ultrasound as well as assessing the health of the blood vessels (endothelial function) by brachial artery flow-mediated dilation.
Here’s what they found:
- Lower testosterone was linked to poorer carotid IMT.
- Those with low T had a 641% higher likelihood of a carotid IMT of 0.1 cm or greater (80% vs 39%).
- Low T patients had a 260% higher risk of having plaques in the arteries (68.5% vs 44.8%).
- Those with low T were 577% more likely to have endothelial dysfunction (80.5% vs 42.3%).
- Low T patients had higher hsCRP levels (2.74 vs 0.89 mg/L).
While some of this may be a little technical, the bottom line is that low levels of testosterone is a marker of incredibly bad health, especially as it relates to heart disease.
But this does NOT mean that supplementing with testosterone is the answer. Rather, the entire spectrum of lifestyle changes that include exercise, diet and stress management is the answer. As a matter of fact, the most recent concerns over the use of testosterone replacement therapy had to do with actually increasing the risk of heart disease. And this is on top of the well-accepted increased risk of developing prostate cancer.
This alone should YET again prove that we cannot find a single marker in the bloodstream and treat just that marker using artificial means (drugs, hormone therapy, surgery, etc…).
Have Arthritis? Then You’re Likely at Risk for This Disease
As a chiropractor, I deal with patients who have arthritis pretty much every day. Some want answers, some want reasons. In most cases, we can provide both of these.
Many seem to think that past trauma is a factor in developing arthritis. While this is definitely the case, it’s not the cause of most patients’ arthritis. Rather, the bigger cause of arthritis is something that most of us are not aware of but way too many of us in society today are at a high risk for.
But first, a quick overview on the structure of your joints. The surface of all your joints are covered with cartilage that acts as a type of shock absorber to cushion the impact of bone and bone when you move. Cartilage is made up of about 5% chondrocytes (these are the cells that make cartilage), 65-85% water, 15-25% Type II collagen and 2-10% proteoglycans (sugar-protein molecules that bind with water to form a shock-absorbing gel). Since the cartilage-making chondrocytes are sitting inside this cartilage-gel layer, it does not have its own blood supply and needs to get nutrition in and waste products out by diffusion. I describe the situation as a sponge sitting in a puddle. You can stare at it all day long and it’s not going to do any tricks. It’s not until you start stepping on and off of the sponge that you get fluid exchange into the sponge.
This is exactly why exercise is so good for your joints–it keeps the fluid pumping so the chondrocytes have new nutrients to work with. So long as you give your joints good nutrition and combine it with exercise the cartilage in your joints can turn over, although this is a very slow process. On the flip side, give your joints poor nutrition and clog up the arteries that deliver blood flow near the cartilage and it can and will break down faster.
With this understanding of how you can damage your joints, can you think of what other chronic diseases may develop with poor nutrition and a sedentary lifestyle? While the list is quite long, heart disease is way up at the top. Which brings us to this particular study.
In it, researchers looked at the relationship between osteoarthritis of the hand (which included arthritis in more than a single joint in the hand) and heart disease. Specifically, they looked at 1348 patients with an average age of 62 and asked about painful and stiff joints of the hand backed up by osteoarthritis on X-ray as well arthritis of the hand but with no pain. These patients were then evaluated for their risk of dying as well as vascular events (coronary heart disease, congestive heart failure and/or ischemic stroke). Here’s what they found:
- There was no link between death and arthritis of the hand.
- There was no link between arthritis on X-ray (without pain) and heart disease.
- However, in those who had painful arthritis had a 226% higher risk of having heart disease (as measured by a heart attack or coronary insufficiency syndrome).
These numbers are not anything to downplay. Why there was an association only with painful arthritis of the hand may have to do with the amount of inflammation present, but for now the researchers were not able to pinpoint the reason.
It is far more likely that the lifestyle that leads to heart disease is also a lifestyle that will destroy the cartilage of your joints than the reverse. Because of this, if you are worried about developing arthritis in your future, rather than focusing on your joints, you should start with protecting your heart.
Nuts to Lower Cholesterol
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!
Pregnancy Weight Gain and Childhood Health
BREAKING THE CYCLE OF CHRONIC DISEASE BEGINS HOW EARLY?
Based on previous posts, this shouldn’t be a trick question. The answer is before pregnancy. In this study, women who gained excess weight during pregnancy had children that, at 9 years of age, had pretty much EVERY risk factor for heart disease elevated. A literal time bomb that will explode decades before it exploded for the parents. I’ve said it before and I’ll say it again, we need to stand up for the health of our children by taking better care of ourselves during pregnancy. This goes for BOTH the dad and the mom. The decisions you make today are either helping your child grow up healthier, or you are loading a bullet in the chamber. Decide. You can’t sit on the fence.