LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

HDL

Cholesterol Lowering Drugs & Your Good Cholesterol–Bad News

by

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.

 

Did YOUR Doctor Talk About Prediabetes?

by

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?

by

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.

 

 

HDL raising effect of orange juice in hypercholesterolemia – (11-27-00)

by

HDL raising effect of orange juice in hypercholesterolemia

There are several ways to lower cholesterol levels safely, and increasing intake of fruits and veggies is such a wonderful way. In addition to helping with cholesterol, it will also lower your risk of many other diseases. Adding exercise will also increase HDL levels, as well as the addition of soy to your diet. Want a great cholesterol fighter? How about a smoothie made at home? Frozen yogurt, toss in some probiotics, filitered water, ice and several servings of fruit. Drink it on your way to work!!

AJCN — Abstracts: Kurowska et al. 72 (5): 1095

Read entire article here

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

by

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.

Cholesterol from eggs increases the ratio of total cholesterol to HDL – (05-28-01)

by

Cholesterol from eggs increases the ratio of total cholesterol to HDL

It is very likely that all the press about eggs being fine for cholesterol levels was promoted and propelled by the egg industry. I’ve never been a great fan of eggs and this does have a tendency to solidify my opinions. However, egg whites are a very good source of high quality protein, along with whey, soy and certain rice proteins. If you do like eggs, try to eliminate the yolks and keep the whites.

AJCN — Abstracts: Weggemans et al. 73 (5): 885

Read entire article here

Elevating HDL in Mice Remodels Advanced Atherosclerotic Lesions – (11-19-01)

by

Elevating HDL in Mice Remodels Advanced Atherosclerotic Lesions

This is an interesting concept that needs to be followed up on. This study suggest that HDL cholesterol actually has the potential to begin to clean up some of the plaguing in arteries. This would be a remarkable achievement, and would definitely impact cardiac surgeries and procedures as well as further support the work of Dr. Dean Ornish in reversing heart disease. Remember that the medication used to lower LDLs but has a relatively small impact on raising HDL. On the other hand, exercise, monounsaturated fats (i.e. olive oil…), niacin and phytoestrogens can increase HDL levels safely.

Circulation — Abstracts: Rong et al. 104 (20): 2447

Read entire article here

Effective and Safe Modification of Multiple Atherosclerotic Risk Factors – (02-12-01)

by

Effective and Safe Modification of Multiple Atherosclerotic Risk Factors

This article looks at the lowering of multiple risk factor for atherosclerosis simultaneously. As far as I’m concerned, this is the ONLY way to address this problem. Of interesting note in this study was the use of niacin, 500mg twice daily (a very reasonable dose) to raise HDL levels 30%. Add some exercise and avoidance of saturated fat and your LDL/HDL ratios will be looking pretty good!!

Am Heart J 140(5):792-803, 2000 Patients with peripheral arterial disease (PAD) are at an increased risk of cardiovascular mortality and morbidity and thus are an excellent group in whom to evaluate the feasibility and the effect of an aggressive multifactorial intervention on atherosclerotic vascular disease risk factors. The Arterial Disease Multiple Intervention Trial (ADMIT) was designed to determine the efficacy, safety, and compliance of an multifactorial therapy on selected atherosclerotic disease risk factors in patients with PAD. Niacin increased HDL cholesterol levels by 30%, with the majority of effect achieved at a dosage of 500 mg twice daily. Warfarin had an anticoagulant effect. The antioxidant vitamins resulted in a significant increase in vitamin E, C, and beta-carotene plasma levels. Overall, compliance was high and few adverse effects were reported. ADMIT demonstrates that it is both feasible and safe to modify multiple atherosclerotic disease risk factors effectively with intensive combination therapy in patients with PAD.