• Archives

  • Dec2

    Statins on Sale: Is Generic Lipitor a Bargain?

    Posted in: High Cholesterol, Vitamins and Supplements, Wellness and Health

    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

    It’s Time for Some Q and As

    Posted in: Diabetes, Food FAQ's, High Cholesterol, Vitamins and Supplements, Wine and Tea

    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!

     

  • Aug9

    Do Statins Raise Diabetes Risk?

    Posted in: Aging and Costs of Aging, Diabetes, High Cholesterol, Vitamins and Supplements, Wellness and Health

    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.

     

  • May31

    Food Lowers Cholesterol: New Studies

    Posted in: Aging and Costs of Aging, Food FAQ's, High Cholesterol, Vitamins and Supplements, Wellness and Health

    Wayward cholesterol levels are some of the easiest labs to treat with the right foods: I help my patients do it here in the office, have taped ChefMD videoblogs and spoken with journalists about it.

    And the research continues to mount.

    Last week, an Australian meta-analysis of 14 studies showed that, on average, the equivalent of 5 ounces of tomato sauce (25 milligrams of lycopene) or 2.5 ounces of tomato paste (ditto) lowered LDL cholesterol as much as small doses of statins–about 10%.

    Lycopene from tomatoes is 4x better absorbed if the tomatoes are cooked, and eaten with a drop of luscious oil, btw. Thus, sauce and paste.

    Two other studies which Katherine Hobson highlighted last week in the Wall Street Journal suggest that medication for this purpose, well, may not be all it is cracked up to be.

    One found that extended release niacin (Niaspan, a form of vitamin B3, available only by Rx for raising HDL) didn’t protect against heart attacks when added to statins.

    The other found that a fibrate called Tricor, also by Rx, didn’t prevent heart attacks and strokes, also when added to a statin.

    These are, individually, multi-billion dollar drugs.

    Studies like these make me think there should be a cholesterol registry– a place where the best natural approaches to lowering cholesterol can shine.

     

  • Apr18

    Is Sugar Toxic? Gary Taubes’ Lab Reports

    Posted in: High Cholesterol, Obesity and Weight Loss, Wellness and Health

    Gary Taubes blew the top off the New York Times readership with his carefully researched “What if it’s all been a big fat lie?” about fat and heart disease in 2002 (translation: it’s the type of fat that matters, not total fat).Sugar through your life (NYTimes.com)

    He’s doing it again with “Is Sugar Toxic? (translation: yes, it’s poisoning you now).

    Now he posts his state-of-the-art lipid lab results (which I also order for patients) to prove his minimal heart disease risk. He eats primarily meat and eggs.

    Any of my patients would be proud: (except one thing: the CO2 of 19, which is probably because he’s often ketotic, and has to blow off CO2 to normalize his blood pH).

    Three questions:

    a. What is  the effect of sustained ketosis on heart disease risk?.

    Ketosis mimics starvation, pushing the body to burn fats rather than carbs (because there are no carbs!) for fuel. Fatty acids and ketones result.

    Ketogenic diets work in about 50% of kids with specific seizure conditions.  They reduce appetite but are difficult to sustain (Atkins is a modified ketogenic diet).  In a small study in kids, there were worrisome cardiac changes: I don’t know of adult cardiac data.

    b. What are the other heart disease risk factors? Smoking, high blood pressure, diabetes and pre-diabetes, sedentariness, family history of early heart disease, high waist-to-hip ratio.

    Let’s assume these are not a problem for Mr. Taubes. But not so for everyone else. Some of these have to do with food, and some not. Even if sugar is the problem.  And it might be.

    c. Is it practical?

    To eat without most carbs and sugar, especially fructose, is virtually impossible in the U.S. and even more so abroad.

    But Taubes’ idea that “we all respond to the carbohydrate/insulin effect differently”, and for weight loss “getting rid of all the grains and much or most of the fruit, and then eating more of whatever foods they happen to eat or like that provide protein and fat” deserve exploration.

    People with celiac disease learn to cook, to read labels, to avoid gluten, because it’s toxic to them.  Will we see the same for obesity, heart disease and sugar? Let’s hope so.

     
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