Sunday, December 30, 2012

Preventing Heart Disease: What We Thought We Knew Is Wrong

The word is out.  I first learned about it in a “Sound Medicine” interview last July with science writer Sharon Begley, a follow-up to an article she had written in April. In it she discussed research showing that giving statins to healthy people to lower their cholesterol does not help to prevent a first heart attack.  It turns out that cholesterol numbers are not a good predictor of heart attack risk and that lowering your cholesterol is unlikely to improve your odds.  (See my post, “Statins – Whoops!”)

More recently, Drs. Stephen Sinatra and Jonny Bowden were on “Dr. Oz” discussing the new approach and promoting their new book, The Great Cholesterol Myth:  Why Lowering Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will.  Here is a synopsis by Dr. Joseph Raffaele:

“Dr. Sinatra explains that cholesterol is a vital substance, necessary for the proper functioning of our bodies. To name just a few: it keeps our cells flexible, is essential for hormone production, and is turned into vitamin D in the skin.  He believes it has been vilified as the cause of heart disease because of a longstanding misinterpretation of the studies often cited to support its role.  He rightly states that about half the people who have high cholesterol never get a heart attack and half who do have a heart attack have normal cholesterol.  The message is clear:  total cholesterol, the number we’ve all been obsessing about for the past few decades, is meaningless.  It’s not the cause of heart disease.”

If cholesterol numbers don’t matter, what does? Cholesterol is still in the picture but the issue is the particle size of your LDL cholesterol.  Small LDL particles are more likely to get into arterial walls and cause inflammation.  Inflammation is now thought to be a contributing factor in many illnesses, not just heart disease.  Obesity, insulin resistance, and a diet high in sugar and processed carbohydrates are factors that contribute to this condition.  Sinatra and Bowden recommend an anti-inflammatory diet with plenty of fruits and vegetables.  They note that only one group of patients has been shown to be helped by statins: middle-aged men who have already had one heart attack. 

“New Thinking on Heart Disease Prevention,” a blog post by Dr. Ryan Sweeney, provides a clear and concise summary of the new approach.  In addition to particle size and inflammation, Dr. Sweeney names oxidative stress as a factor contributing to heart disease.  The summary at the end includes the names of the tests that are needed to monitor the three factors:  CRP-hs, Homocysteine, Oxidized HDL and LDL, and LDL subtractions (for particle size).

In his blog post about the Dr. Oz show mentioned above, Dr. Joseph Raffaele takes all three doctors to task for not mentioning the benefits of hormone therapy in reducing the risk of heart disease for women who take it.  

“What if I told you there is natural therapy that reduces your risk of having a cardiovascular event by 41% and your chance of dying of any cause by 27%, while also being free of any of the side effects commonly seen with statins?   Would you take it?  In addition to heart disease prevention, this therapy’s common “side effects” include a reduction in hot flashes, vaginal dryness, depression, brain fog, insomnia, and vaginal dryness.  Serious “side effects” include a 23% reduction in breast cancer (yes, reduction) and improved bone density. If you are a menopausal woman between 50 and 60 years old, you can expect all these benefits from estrogen replacement.”

So here’s the situation:  millions of patients are currently taking statins with no benefit to their health and some potential hazards.  Statins can cause muscle weakness and memory loss,  as well as other physical and cognitive problems.  For a more extensive list of possible side effects take a look at “How Statins Really Work Explains Why They Don’t Really Work” by MIT scientist Stephanie Seneff.  All of us are paying for this useless and possibly harmful treatment through our insurance premiums and our taxes.  We will also be paying to treat whatever damage is done to patients who take statins.  At the same time, the use of hormone therapy, which has repeatedly been shown to reduce the risk of heart disease and to be safe for most women, is being discouraged by Medicare and insurance companies.  I have been on hormone therapy for thirty-three years, half my life, and I consider myself amazingly lucky.

Saturday, December 8, 2012

7 Things I Try to Do to Stay Healthy

1. Drink juice; commercial tomato juice is an especially good choice.  A large study has shown that people who drink juice several times a week are 76% less likely to get Alzheimer's disease.  Recent research from Finland has linked tomato products with a reduced risk of stroke because of their lycopene content.  Store-bought sauce, paste, and juice are are concentrated and have more lycopene than fresh tomatoes.

2. Look up, not at my feet, especially when going up or down stairs.  This encourages my brain to use my sense of balance, a tip from Dr. Michael Merzenich, the neuroscience behind PositScience, which produced the Brain Fitness Program and other brain games.  As an added benefit, looking up is supposed to improve your mood.

3. Know my blood pressure.  I take mine at home but there are machines in pharmacies and lots of other public places.  For an accurate reading you should sit quietly for a few minutes beforehand.  At doctors' offices, staff members often skip this step so that my normally lowish numbers are high instead.  I wonder how many people end up unnecessarily taking blood pressure medication as a result of situations like this.

4. Use a heart rate monitor for cardio workouts.  Until you know what your cardiovascular system can do, how can you tell whether you're working too hard or not enough? How do you know what particular type of workout will be effective for you?  You get the answers to these questions by trying different routines and watching what your heart rate does in each situation.  (I never took notes, but that's probably not a bad idea.)  In my case, there is a sweet spot at about 80-85% of maximum heart rate, somewhere in the vicinity of 130 beats per minute,  where I'm working just hard enough.  (Maximum heart rate = 220 - 66, my age, = 154 x .85 = 131.)  I also like knowing my resting heart rate.  If I'm doing a new routine and resting heart rate goes up, I'm not getting enough of a cardio workout.

5. Take care of small problems right away.  If I get a little cut or a torn cuticle I immediately put a band-aid and antiseptic on it so that it will heal quickly.  If a faucet starts to drip I call the plumber.  Any trouble sign that I ignore or push to the back of my mind will lead to anxiety and a worse situation in the future.

6. Practice empathy; keep in mind that there is a person at the other end of any transaction.  This is not for the sake of altruism but because behaving this way gets me through exasperating situations more easily.  If I give someone a hard time I end up feeling bad myself.  Also, you never know when you're going to pick up a valuable new insight.

7. Be an honest moral bookkeeper.  If I've made a mistake I try to acknowledge it.  Ongoing avoidance and denial sap energy from the rest of life.  Letting go of illusions about yourself can be a great relief.