• Dec2

    The most popular Rx’d drug in America, Lipitor, went generic this week as atorvastatin. Lipitor sales were $8.7 billion last year, and 3.3 million people take it. If you have insurance, request the generic. Watch your copayment drop from $25 per month to a generic copayment to $10.

    If you don’t have insurance and pay out-of-pocket, your cost will go from ~$150 a month to maybe $15, in about 6 months.

    But is Lipitor a bargain at 90% off? Yes and no.

    Yes: if you have diagnosed heart disease, statins prevent one death for every 48 patients treated for 3 to 5 years. I recommend them.

    No: if you don’t have heart disease, statins taken daily, as directed, prevent one heart attack (a nonfatal one) for every 60 patients treated for 4 years.  Because the reason to improve cholesterol is to prevent heart attack and death from heart disease.

    Statins do cause many extra costs: liver testing every 3 months, worries about calf and thigh pain and myopathy, and for a few unfortunates, rhabdomyolysis: basically, liquid muscles and kidney failure.  Lipitor especially interacts with beer, wine, chapparal, comfrey, grapefruit and St. Johns wort.  And antifungal meds, calcium channel blockers, cyclosporine, niacin, fibrates and digoxin.

    What could you do instead?

    You could take an effective dietary supplement, like Cholest-Off or Benecol Smart Chews (Caramel). You could read about lowering cholesterolt in Controlling Cholesterol for Dummies, or learn what the Wall Street Journal and New York Times advise, highlighted on this blog.  You could discover other ways to save on prescription drugs.

    Maybe smartest of all, you could check your own cholesterol, at home, with CardioChek…minimizing statins and taking control of your own health.  Because you are your own best investment.

     
  • Aug23

    I am taking a short break from farming activities (avocados, anyone?) and newsletter writing to answer some reader questions. You can also post these on Facebook or Google Plus and I will try to answer there.

    Q.  I am wondering if you think it is a good idea to minimize the cheese, chicken and fish animal proteins? The research I have read suggests that the positive qualities of those products can be found in plant based foods, and without the saturated fat, cholesterol or mercury.  My understanding is that type 1 diabetes has been linked to the casein in cows milk when given to infants, and that animal protein may be related to auto-immune diseases.

    A: In general, yes, about animal proteins–moderate more than minimize.

    I think most of the problem is in overprocessing and some of the hormones and toxins with which they are raised/to which they are subjected, instead of the saturated fat and cholesterol.

    Cholesterol in food (unless you eat 2# of shrimp or 3 egg yolks daily) doesn’t raise cholesterol in the blood.

    Most saturated fat probably raises the risk of heart disease but food is a mix of nutrients, and I think its source is the main thing.

    The other question is harder: type I diabetes has been linked to casein, but so has latitude, and the confounding factor may be vitamin D levels: http://www.ncbi.nlm.nih.gov/pubmed/19100644.

    Infants exposed to casein early in life may be at increased risk for diabetes, but the data are not conclusive.

    So I would not avoid milk because of diabetes risk, but I would want to know where the milk came from, whether the cow received rBGH, growth promoters and so on.

    Of concern, Japanese cattle recently ate radioactive rice straw; whether it harms people to eat radioactive milk is unknown, except in high doses…but the yuck factor is pretty high.

    Q.  Hi, I saw you for the first time on PBS yesterday and was intrigued. I recently lost my job and health insurance and figured since I eat everyday, I might as well eat better. It has to be cheaper than healthcare insurance. I’m Mormon and don’t drink alcohol. Is there a non-alcoholic drink that has the benefits of wine?

    A.  Red grape juice, pomegranate juice and other dark fruit juices do provide many of the benefits of wine.

    However, alcohol raises HDL, which juices do not, but they do provide tannins, flavonoids and anti-inflammatory chemicals which are helpful with inflammation.

    Q:  You seem to be looking at and using a variety of ways to share your information to as many people as will listen. Which I think is fantastic. Have you considered a weekly or monthly conference call for people using a service, like go-to-meeting.com, where you can have interactive discussions or presentations?  I have no clue what is required on the presenter’s part, however.

    A: I have thought about it and like the idea. I’ll send out a poll to newsletter subscribers and ask if they would like that, and how much it should cost.

    I think I would likely use Skype (Kris Carr uses it for her coaching, apparently) and I think it would be fun.  Let’s see!

     
  • Aug19

    Omega-3 fatty acids are powerful: with vitamin D, they’re something that almost everyone needs to supplement, no matter how good your diet.

    Why?

    Because people with heart disease who just had a coronary artery bypass graft (CABG) had a 49% lower risk for dying 30 days after their CABG than those who didn’t take 882mg of EPA and DHA (in a 1:2 ratio) after their surgery.

    That means extra DHA, and pure DHA is hard to find. Look for Thorne DHA and Thorne Super EPA Pro: molecularly distilled, no contaminants, pure, concentrated and as above and below, powerful.  To read more or to purchase, click “My Account” in the top right; and then enter the access code HCP1028244 to create a “Personal Account”.

    Because kids with fatty liver disease (the most common liver disease in kids, and pretty soon, adults) had a 99% lower chance of severe fatty liver if they took 250 mg/day of DHA than those who did not…and improved insulin sensitivity.

    And because omega-3s, especially DHA, can protect your eyesight and prevent AMD, the leading cause of blindness in people over 55 by protecting the nerves in your eyes and reducing inflammation..

    DHA is responsible for most of the heart-healthy benefits of fish oil, and gets transformed into EPA if you are short of EPA. Check with your doc before taking extra EPA: it can interact with other drugs.

     
  • Aug9

    Probably, in higher doses.

    A study of 18000 people without heart disease, called JUPITER, shows that Crestor (rosuvastatin) 20 mg showed that for every 1000 patients on high dose (40mg and up) statins, there are 6 more cases of new diabetes over 2 years.

    Crestor also prevented 11 cases of heart attack, stroke, arterial revascularization, hospitalization or death from heart disease, in that 1000 patients.

    The newest study includes 32,752 patients without heart disease.  Again, 2 cases of diabetes, versus 6 or more cardiac events prevented in a 1000 people over 5 years.

    If you actually have heart disease or angina, then the numbers for taking a statin are different.

    • 1 in 83 life saved
    • 1 in 39 prevented a non-fatal heart attack
    • 1 in 125 prevented stroke
    • 1 in 167 developed diabetes

    Is that worth the trade-off?

    I try to find ways for my own patients to get off high doses of statins, especially 80mg doses, because of myopathy and pain.

    A cholesterol registry can chronicle how people control cholesterol naturally.

    I suggest that any patient 40 and over get screened every 3 years, and make sure they don’t suffer from abnormal lab test syndrome.  And I help them make lifestyle changes that help them reduce their need for cholesterol medication.

    Statins can be important medications, and their benefits can be greater in diabetics than nondiabetics.

    But there’s no sense in tempting fate. Let’s enjoy life, and avoid getting diabetes in the first place. Lower your cholesterol with what you eat.

     
  • Aug2

    As a physician and professionally trained chef, I write recipes on prescription slips. I try to practice what Mark Bittman of the New York Times eloquently preaches in Tax Soda, Subsidize Vegetables.

    Yet a healthy diet is like penicillin–simple, powerful, and with increasing rates of resistance, from physicians.

    Physicians are not trained to speak with patients about diet and nutrition, much less cooking and food shopping.

    Physicians are also better paid to prescribe medication and do procedures than to ask patients to switch from soda to water.

    Writing recipes on prescription slips changes this dynamic.

    Putting foods, recipes and meals in pharmacies and on managed care and hospital formularies might help patients get the food and health care they need, economically.

    Healthy hospital food, like that at Planetree’s New Milford Hospital is a good start.