LifeCare Chiropractic

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statins

SHOULD WE BE LOOKING AT CHOLESTEROL AT ALL?

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Everyone not living in a cave understands that total cholesterol is linked to heart disease.  We understand this almost entirely thanks to the development of the class of drugs called statins, of which Lipitor is king.  But is this REALLY true?

Let’s take a moment a review the process by which drug therapies are developed, researched and marketed.  We identify a condition such as heart disease.  Then we study a large group of people and look at their rates of heart disease and try to find lab values that correlate with disease risk.  In thas case, researchers found that those with low rates of heart disease had low total cholesterol levels.  This is called an observational study and we use it to determine associations.

Then we find a drug that can modify the risk factor that we found.  The drug than lowers the level of the risk factor (in this case, cholesterol) and the drug gets approved to lower risk of death for the disease.  Did you notice that we skipped a step?  These drugs were NOT approved based on their ability to lower the risk of the disease, but rather the RISK FACTOR for the disease. 

So what if we were wrong in the observational study in the first place?

What if this $20 billion + a year drug class is based on weak data?

This particular study looks at how close the observational studies were to what is seen in the studies done later when statins were used in clinical trials.  The conclusions of the authors are pretty powerful….

“If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom  moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.”

Still want to refill your prescription for your statins, which, by the way, increase your risk of diabetes…?

 

PROTECTING OUR ARTERIES WITH GARLIC

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PROTECTING OUR ARTERIES WITH GARLIC.  I always remind patients that cholesterol all by itself does NOT cause damage to our arteries.  It is not until cholesterol becomes oxidatively damaged (now called an oxysterol) that it becomes to cause damage to our arteries.  So, regardless of what your cholesterol level is, we need to protect our cholesterol.  How do we do this?  (hint:  statins DON’T protect cholesterol)  Shockingly, it’s a high phytonutrient, plant based diet.

In this particular study, researchers looked at the use of garlic to protect cholesterol and protect our blood vessels.

 

USE PLANT STEROLS FOR CHOLESTEROL PROBLEMS

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CHOLESTEROL PROBLEMS? SKIP STATINS AND USE PLANT STEROLS.  For some strange reason, mainstream medicine seems absolutely enthralled with the use of statins for “prevention,” although this is a disturbing definition of the term.  However, we know, without a doubt, that a plant based diet with lower cholesterol equally as well.

Here’s the difference…a plant based diet improves physiology.  The body is happier.  All systems and all markers (blood pressure, cholesterol, triglycerides, blood sugar, HbA1c, hsCRP, etc…) get better.  These markers get better because the dietary changes have improved the way the body is working.  The improvement in the numbers is merely a side effect.  Statins, on the other hand, ONLY fix the number (in this case, cholesterol) in an artificial manner.  This increases chance for risks (of which there are many) and does NOT make the physiology happier.  Good sources of phytosterols?  Beans, whole grains, nuts, oranges, flaxseed.

ARE YOUR TRIGLYCERIDES ELEVATED?

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Triglycerides elevated? Statins AREN’T the answer. Time and time and time again I see patients come into my office that have been given a statin (Lipitor, Crestor, etc..) for their cholesterol. However, while most know their cholesterol numbers, few know their triglycerides. If the triglycerides are elevated and HDL (good) cholesterol is low, there is a very, very good chance you’re pre-diabetic.  And guess what? That drug will make your numbers look better, but will do ZIP to change your progression to diabetes.  Tens of billions of dollars per year and it ain’t fixing the problem…

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.

Read more…

HOW WELL ARE WE MANAGING HEART DISEASE RISK FACTORS?

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Let’s face it.  If you are willing to make changes, managing cardiac risk factors is a piece of cake (or rather…avoiding that piece of cake…).  Lifestyle changes are not difficult, but require commitment.  Society does not easily support healthy lifestyle and requires a shift from what you’ve been doing.  But the payoffs are massive for you and your family.

I continue to contend that lifestyle changes are the ONLY way to manage chronic diseases.  Maybe if we did not live under the false pretense that, because our “numbers” look better (cholesterol, HbA1c, blood pressure, blood glucose, etc…), we’ve dodged the bullet of early death.  I cannot stress enough that this is just not true.  We live in a society dominated by surrogate end markers.  We think that because our cholesterol has magically been lowered by the coveted, mystical statin that we’ve lowered our risk for a heart attack or stroke.  Ok–so maybe you have, but only by a SMIDGEN (which, in medical terminology, is about 1%).  This is NOT prevention, it is false hope.  Lifestyle changes, on the other hand, have true global health benefits that are unquestionable.

This particular study just reinforces how pathetic “we” are when it comes to cardiac risk factors.  We can’t even do it right using drugs!  In shooting for lower LDL levels AND optimal CRP levels (a marker of inflammation) only 12% of the patients in this large study managed to achieve the desired numbers.  You will hopefully note that they were looking at LDL levels and not total cholesterol.  Hopefully, we are finally abandoning the futility of checking total cholesterol in lieu of better markers.

The authors’ suggestions?  “Smoking cessation, weight reduction, and the greater use of more potent statins at higher doses might be able to improve these outcomes.”  We just don’t get it.  It’s almost laughable how sickeningly dependent we have become on medication to “protect” our health.  Even with a society heavily dependent on meds, we still can’t get 88% of the population to target levels.

http://www.sciencedirect.com/science/article/pii/S0002914911004632