LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

triglycerides

THE ROLE OF SKELETAL MUSCLE INSULIN RESISTANCE – (02-04-08)

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The role of skeletal muscle insulin resistance in the pathogenesis of the Metabolic Syndrome

Metabolic syndrome is unquestionably the health scourge of our time. However, unlike the Plague in Europe, we don’t seem quite aware yet that something is happening. Until the medical community wakes up and learns to identify and manage insulin resistance, this scourge will continue.

This study adds further understanding to MetS by looking at what happens to the muscles and liver in patients with insulin resistance fed a high carbohydrate diet. It also explains why patients with elevated triglycerides and lowered HDL do NOT have a cholesterol problem!! I can’t tell you how frustrating it is to have a patient with severe insulin resistance be told by their PCP to cut back on saturated fat!! So, normally, if someone ingests carbs, the level of glycogen storage in the muscles will increase.

However, in patients with insulin resistance, we don’t see this–instead we see a drastic reduction in glycogen synthesis. Worse yet, instead we see the liver increase its production of triglycerides and reduce production of HDL. Bad combo. This really does add some heavy understanding to my approach to patients with IR. There needs to be a consistent, strong focus on increasing muscle mass and glycogen storage. Dr. Alan Sears’ PACE program is a program that I personally recommend for this approach from an exercise standpoint.

Read entire article here

WHY DO WE STILL USE STATIN CLASS OF DRUGS? – (02-11-08)

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DHA supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men

It never ceases to amaze me the bias in medicine today against Mother Nature. We see clinical trials with statin drugs that lower levels of triglycerides maybe 20% and the medical community bows down before the might of the HMG CoA reductase inhibitors. Well, here we see good ‘ole DHA drastically lowering both triglycerides (24%) and lowered large VLDL (the worst of the worst for lipids) and incredible 92%. So why on Earth do we still use the statin class of drugs?

Incidentally, this study found that all the changes occurred up to 45 days and not beyond.

Read entire article here

STATINS–THE WONDER DRUG THAT ISN’T

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In 1997, Pfizer partnered with Warner-Lambert to release the drug atorvastain calcium, or Lipitor. It quickly rose to become one of the best selling drugs in history. It’s pretty well accepted that statins cut the rate of heart attacks in half. Sounds pretty good at the surface. But when you dig deeper, this 50% number will make you a little heartsick.

The class of statin drugs has reached godly status among drugs used in America, as exemplified by the ridiculous assertion by some cardiologists that statins should be added to the water supply. I would argue that not a single doctor in favor of the use of statins actually understands a shred of statistics. You see, there is a difference between absolute risk reduction and relative risk reduction.

If I told you that 2 people in the US per year got carcinoma of the tip of the pinky finger (fictional…) and someone found a drug that, when given to the entire population of the US would cut that number down to 1 person per year. Just how many would be in line to pop this pretty little pill down their throats, especially if there was a long list of side effects? I’m thinking few of us would.

However, if you are marketing this drug, you would stand proudly in the waiting room of every doctor’s office and proclaim that this drug will reduce the rate of carcinoma of the tip of the pinky by a whopping 50%. Patients, doctors and staff alike would listen in awe, jaws lowered, at how amazing this drug would be. After all–who wants to experience carcinoma of the pinky? The line to get the prescription would remind many of us the 1979 deaths of people crushed to death while attending a Who concert..

But if that same rep stood up on the Today show and stated that this fantastic new drug would cut the absolute risk by 1% when taken by 100 people for 3 years, the yawns and disinterest would be legendary. But this is the consistent data we see with all the statins. Treat 100 patients for 3 years and you’re lucky if one less person has a heart attack. Not death. Heart attack. You can eat a walnut per day and beat this.

So, we have a class of drug that is the best selling in history and, quite frankly, it sucks at preventing a heart attack. What’s worse is that the list of side effects has gotten quite long and include:

  • Potential increase in the risk of cancer
  • Increased risk of chronic muscle diseases
  • Problems with the functioning of the heart
  • Reduction in cognitive function
  • Increases the risk of your muscles melting, a condition called rhabdomyolosis
  • Increases risk of long term muscle damage, even after discontinuation
  • Nullifies–YES, nullifies, the positive effects of exercise on the heart

The list is actually longer. This particular study actually looked at the production of oxidative stress in the muscles of patients taking statins. Overall, the damage was enough to begin to cause the deaths of muscle cells. Not a good thing.

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…

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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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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DO YOU ADD THIS TO YOUR FOOD?

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Variety is the spice of life.  They certainly got the spice part right on this one.  It amazes me how many people miss an opportunity to add culinary delight to meal after meal by adding spices.

When we talk “spice” it does not necessarily mean “spicy,” although it certainly could.  Spices like rosemary, thyme and basil do not make a dish spicy, but they absolutely liven up the flavor.  The list of spices and spice combinations are limited only by your imagination, palate, and occasionally, your sense of adventure.

The beautiful thing about spices is that they pack a massive wallop of phytonutrients for almost zero calories.  AND they taste great!  What more could you ask for?

This particular study looked at how a spiced up meal affected both markers of glucose metabolism and antioxidant status in the bloodstream.  Those eating the high spice meal had lower levels of insulin and triglycerides after the meal and twice the antioxidant level in the bloodstream.  This would unquestionably be part of an anti-diabetic lifestyle.

So load up on the spices on everything you eat.  You organic, grass few meats.  Your veggies.  Maybe just stick your tongue out and drop it directly on there..

A few notes, however.  Avoid MSG containing spice mixes at all costs.  And don’t waste the spices by taking them in a supplement (such as cinnamon).  Why miss out on what the spice can do to your meal?  And if you’re planning on grilling the veggies, lightly spray them with some olive oil so the spices with stick better..

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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