Thursday, November 21, 2013

New Recommendations for Statin Therapy

Harvard professors claim the new online cholesterol calculator is flawed and overstates a person’s risk of heart disease.
Monday, November 18, 2013

The new guidelines were developed by the American Heart Association (AHA) and the American College of Cardiology (ACC).

Under the new guidelines, people will be advised to take statins based on a number of different health risk factors. These risk factors include if they already have heart disease, if their LDL cholesterol is extremely high (180mg/dl) or if they’re middle aged with type 2 diabetes.

In addition, people between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5% or more are advised to take a statin. Experts say this new rule could greatly increase the number of patients who will now be advised to take these drugs.

Forty-nine percent of Americans over the age of 60 currently take statin drugs. Statins are the most commonly written prescription in the United States. Statistically, statin drugs reduce the risk of sudden heart attack by one third. That seems like pretty compelling evidence to support statin use. However, the risk of sudden heart attack is only three percent and statin drugs reduce it all the way down to two percent. That’s a whopping decrease of one percent! Furthermore, more than half the population’s suffering their first heart attack have normal or even low cholesterol. The ACC has countered that statistic by suggesting that statin drugs should be added to our drinking water so everyone will be treated.

Statin drugs work (when they work) because they reduce inflammation, not because they lower total cholesterol and LDL cholesterol. In fact, the disruption of cholesterol metabolism by statin drugs causes cardiac myopathy (heart muscle disease) in ten percent of patients. Cholesterol is the raw material necessary for the body to create sex hormones, vitamin D, and a host of other complex chemicals needed for the body to function properly.

The most common cause of high cholesterol is an excess of saturated fat and trans-fats in the diet. Although the AHA and ACC both claim that dietary changes are the cornerstone of treatment, little or no attention to diet occurs in practice. The second major cause is an underactive thyroid. Synthroid (synthetic thyroid hormone) is the second most commonly prescribed medication in the United States. It is estimated that at least one third of cases of hypothyroidism are autoimmune in nature. Clinically, I estimate that number is closer to half of all cases. Although Synthroid alleviates some symptoms, it does not treat the underlying cause or reduce the cardiac risk associated with hypothyroidism.

The number three cause of high cholesterol is an imbalance in the flora of the digestive tract. Unhealthy bacteria can produce an estrogen analog, a chemical that resembles estrogen. The body absorbs this estrogen look-a-like and it stimulates cholesterol production. Overproduction of cholesterol from genetic flaws is the forth most common cause of high cholesterol. This can be determined by a simple blood test, the L(p)a. Elevation of the L(p)a is the only lipid blood test that does correlate with an increased risk of heart disease. The test is seldom run before placing a patient on statin drugs. Despite being genetically controlled, both niacin and gingko leaf extract have been shown to be very effective in reducing the L(p)a in several studies.

Talk to your doctor about truly implementing a serious program of diet and exercise before resorting to statin drugs. You must be an active participant in your health care. Have through laboratory testing to include a thyroid profile, glycohemoglobin A1c, fibrinogen, homocysteine, and CRP (high sensitivity C reactive protein) in addition to the serum lipids. If you and your physician still decide you need to take a statin, add Co Q 10 to your supplements to offset some of the side effects of this drug.

Thursday, November 14, 2013

The SMART Ride 10

This is a departure from my typical blog format. It’s a discussion about my health and well being. On Friday, November 15th, my wife and I will get on our bikes and pedal from Miami to Key West for The SMART Ride. The course is 165 miles over the course of two days and is rated as the “best ride in Florida”. If you’ve ever driven the overseas highway to Key West you can imagine how beautiful it is viewed from a bicycle at 18 miles an hour.

The obvious health benefits of training for four months can not be overstated. I rode over 1500 miles in preparation for this event. My training was basically two spinning classes a week and a long road trip every weekend. On the road, I varied the mileage from 40 to 65 miles, gradually building my stamina, then giving my body a break by dropping the distance once every 3 or 4 weeks.

The spinning classes added intensity. I found using a heart rate monitor invaluable, in addition to monitoring my RPMs, calorie burn, and distance over time. My goal each class was to get my heart rate above my aerobic zone (> 130 bpm) but below my Vmax (159 bpm), my maximum recommended heart rate.

Setting goals and then developing a plan to reach those goals also has health benefits. It is an ongoing process that forces you to frequently evaluate your performance against the standard you have developed. Increased interaction between the mind and physical body has been shown to delay or even reverse senile dementia.

However, I believe the most important aspect of this kind of endeavor is the selfless act of giving. SmartRide 10 is a charity event that benefits those living in Florida with HIV/AIDS. We were required to raise a minimum of $1250 per person to qualify for this ride. The cost of the ride is totally underwritten so 100% of the donations each rider raises go to specific organizations approved by a volunteer board. Everyone knows someone affected by this disease. In my case, I just remember close friends of mine who died way too young as I watched them waste away. In my mind, I see them smiling at me in support of my efforts. That feeling of love and caring, of working to help others, does more for my health and well being, than all the exercise of a life time. How fortunate am I, to have found a way to put it all into one package? – SmartRide 10.

Wednesday, November 13, 2013

Inflammation – Friend or Foe?

A vast majority of medical care is aimed at reducing inflammation. It’s not just the anti-inflammatory drugs like cortisone, Aleve, and Advil. Pain killers, anti-histamines, like Benadryl, and even some chemotherapy drugs all target inflammation. Inflammation has five characteristics – pain, swelling, heat, redness of the overlying skin, and loss of motion. Reducing inflammation will improve some or all of these symptoms.

Inflammation is the body’s first response to injury. It is protective in nature, brings attention to the injury and forces you to support the healing process. Without inflammation, damage would continue unabated as evidenced by the progressive damage in leprosy. Lepers are unaware of minor injuries because of the infection in their nervous system (Hansen’s Bacillus). Simple cuts and bruises go unattended causing the severe damage that horribly disfigures the victims.

Today, however, inflammation runs unchecked. Our bodies are losing the basic chemistry designed to curb and control inflammation. There are six well identified inflammatory pathways in the human body. Prostaglandins (PG2) are the most common. When an injury occurs, arachadonic acid is released by the damaged cells. This produces PG2 both in the injury site and in the liver to stimulate body wide inflammation. Once the inflammation has served its purpose, the body releases other prostaglandins (PG1 and PG3) to reduce the inflammation. PG1 & 3s are made by the body from essential fatty acids, PG1 from omega 6 fatty acids and PG3 from omega 3 fatty acids. They are considered essential because we can not manufacture omega 3 and 6 fatty acids in our body. They must be in the diet. However, omega 3 fatty acids are the most common nutritional deficiency in the US today. Although we still have a lot of omega 6 fatty acids in our diet, common health issues have altered the chemistry of the body. Most of us now convert healthy omega 6 fatty acids into arachadonic acid, creating more inflammation rather than less.

The overuse of NSAIDS, like Aleve and Advil compounds this problem. NSAIDS block PG2 reducing inflammation. However, within 3 days of use, they also block the PG1 and PG3 series that control inflammation. The result – 16,500 people in the US die every year from the unbridled inflammation caused by taking NSAIDS. Most of them bleed to death internally, the rest die from liver failure or heart attack.

Red meat used to be a source of omega 3 fatty acids. But when you feed cattle grains rather than grass, they can no longer produce omega 3 fatty acids. The same thing has happened to farm raised fish. Tilapia contain little or no omega 3 fatty acids because they are raised on corn meal.

Taking 2,000mg of omega 3 fatty acids every day can be a great benefit. Avoid NSAIDS. If they must be used limit the use to three days or less and increase your omega 3 fatty acids. If you have any signs of metabolic syndrome – overweight, insulin resistance, high blood pressure, or high serum lipids, consider talking to your doctor or nutritionist about taking some sesame seed oil daily. This will block the conversion of omega 6 fatty acids into PG2 and encourage production of PG1.

Monday, November 11, 2013

Evidence Based Medicine

Healthcare Leadership Forum Examines Implementation of Evidence-Based Medicine in Daily clinical Practice.
October 29, 2013 – Philadelphia

Evidence based medicine (EBM) is a common catch phrase used by physicians when discussing patient procedures and outcomes. What does it mean and how is it currently used by your doctor? EBM evolved from clinical epidemiology in the 1980s. In 1996, David Sackett, MD, wrote that “evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” This definition has since been adopted by major health organizations.

Evidence-based decision making certainly has a place in clinical practice. However, it is only one side of a triangle that forms the cornerstone that drives daily practice decision making. The second aspect is clinical experience and the third, and in my opinion, most important is patient preference. Unfortunately, these last two factors are often ignored or even belittled in consultation with health care providers.

Since the use of the term EBM became widespread, I find physicians using it as a blockade to avoid entertaining alternative therapies. The term for this behavior is hypocognition (the absence of a simple, consolidated mental framework that new information can be placed into). Vitamin D is a classic example. Several years ago a well constructed, double-blind, placebo controlled study was performed using a once a week dose of 50,000IU of vitamin D. The study showed good benefits from vitamin D supplementation and has become the “gold standard” for prescribing vitamin D. Every week in my practice, I see patients taking this massive overdose of 50,000IU of vitamin D, once per week, prescribed by their physician. They come to me with multiple joint pain, muscle pain, and muscle spasm. If this practice is questioned, the immediate response is “that’s evidence-based medicine” because that’s what was done on the study. The physician never asks why the study was constructed is this manner or if this protocol is safe or effective for the patient, because it’s EBM and is now the standard of practice.

In truth, the massive, once-a-week dose was done for the sole purpose of making it possible to actually monitor the test subject to ensure that they swallowed the pill. Daily doses of a more reasonable, safer, better utilized vitamin D supplement just were not practical for study purposes. The Nutrition Board recommends doses up to 4,000IU per day without laboratory testing and confirmation of serum levels of vitamin D to recommend daily dosing above 4000IU. That is a simple framework to incorporate the knowledge gleaned from this landmark study.

Your preference as a patient is a least as important as the evidence-based recommendation by your physician. Stand your ground and ask them to relate their recommendation to their clinical experience and your specific situation. If they can not do both, then seek another opinion.

Wednesday, November 6, 2013

Testosterone Treatments Linked To Heart Risks

USA Today reports on a recent study published in the Journal of the American Medical Association.
November 6, 2013

Testosterone treatments may increase risks for heart attacks, stokes and death in older men with low hormone levels and other health problem, a big Veterans Affairs study suggests.

The results raise concerns about the widely used testosterone gels, patches, or injections that are heavily marketed for low sex drive, fatigue and purported anti-aging benefits, the authors and other doctors said.

Men who used testosterone were 30 percent more likely to have a heart attack or stroke or to die during a three-year period than men with low hormone levels who didn’t take the supplements. Hormone users and nonusers were in their early 60s on average, and most had other health problems including high blood pressure, unhealthy cholesterol and diabetes.

This is not the first study to show increased risk from using testosterone as HRT (hormone replacement therapy). It’s making big news because of the dramatic increase in prescriptions for testosterone in the past few years. Over 5 million men used testosterone in the US with sales totaling 1.6 billion dollars in 2011. Just look at the recent television ads and you know those numbers are much higher today.

More than 50% of men over the age of 45 suffer some form of sexual dysfunction. This is really a statement about our declining health as a nation and the generally accepted idea that we can just cover up some of the symptoms with drugs (in this case hormones) and the problem will go away. As men age, testosterone production shifts from the testicles to the adrenals. However, many men do not have the good general health to make the transition. Long term adrenal stress, poor liver function, and subclinical hypothyroidism are behind this and many of our chronic, degenerative diseases. Metabolic syndrome is the name given to the list of predisposing factors that ultimately lead to diabetes, heart disease, and death.

Several herbs are commonly used to support healthy adrenal function. Clinical studies have showed marked improvement in both testosterone and sexual function with the use of Tribulus, Korean Ginseng, Ashwaganda, and Rehmannia. The South American herb Maca also shows great promise, but needs more research. These herbs are all adaptogens, not only supporting repair and regeneration of the adrenal glands, they also repair DNA as shown by DNA fragmentation studies on human sperm.

If you suffer from low testosterone levels, have an evaluation with a qualified nutritionist. First address your general health. It’s quite possible that improving your health will resolve the hormone deficiency.