I know what many of you are already thinking: where do I sign up? Let’s face it: we organize much of our lifestyles contrary to CW specifically to live healthier and feel better. When it’s check up time, however, we find ourselves back in foreign territory. If it’s just an annual ritual, we can grit our teeth through the usual advice and make the best of it. On the other hand, if we’re receiving care for on ongoing condition and using the Primal Blueprint to get on top of our health – or if we’re just looking for more from our health care – it’s harder to skirt the Primal issue. Some practitioners will listen and offer gentle, cautionary advice. Others will agree to give your approach “a chance” before going back to their prescribed route. A few will unfortunately fly off the handle and tell you they will need to sever the treatment relationship if you continue on this ill-advised course. It can be a tricky, awkward situation to handle: living out your Primal principles while trying to garner benefit and help from your conventional (a.k.a. insurance covered) health care providers. A less explored question is this: what is it like to be on the other side of the fence? What is it like to be a Primal-minded medical practitioner swimming against a wholly un-Primal mainstream?
I came across an interesting statin study the other day. It’s from last year, but I hadn’t seen it until recently. The study, entitled “Statins Do Not Decrease Small, Dense Low Density-Lipoprotein,” sought to understand the effect of statin therapy on small, dense LDL, the truly “bad” kind of “bad” cholesterol, the stuff that’s strongly associated with increased heart disease risk in many studies. We know that statins reduce LDL cholesterol – they are extremely effective at curtailing the cholesterol-synthesizing hydroxy-methyl-glutaryl-coenzyme A reductase, if you’re into that sort of thing – but their effectiveness at lowering sdLDL is unknown. They reduce the rate at which cholesterol is produced and that’s as specific as it gets.
An alarming new health trend has medical professionals scurrying around issuing dire warnings of impending doom and death. As a recent piece in the Wall Street Journal relays, consumers are taking their health into their own hands by foregoing expensive, redundant doctor’s visits in favor of mail order lab tests. Blood lipids, A1C, vitamin D, C-reactive protein – you can get just about any lab value tested online, no insurance required. Lipids run between $30 and $50, A1c between $25 and $40. Even people with (overpriced) insurance and high deductibles are skipping the doctor. This is part of an overall larger worldwide trend toward going it alone. The home blood glucose monitoring industry, for example, grew from $3.8 billion worldwide in 2000 to $8.8 billion in 2008.
What should we make of it?
Dairy resides in a murky area for some of you guys, but I think most of us can appreciate a good slab of grass-fed butter, maybe a bit of raw cheese, and some fermented dairy, either kefir or yogurt. A select few may not. If dairy makes you feel bad, don’t use it – it’s unnecessary – but if your avoidance stems purely from principle (ie, “it’s a little too Neolithic for me; I’ll just play it safe and avoid it altogether”), the latest study on dairy fat might nudge you toward its thick, viscous, white embrace. Researchers found that patients who ate the most dairy fat, from things like cream, whole milk, and butter, had a 60% lower risk of developing diabetes than patients eating the least dairy fat.
Those who ate the most dairy fat also showed the highest plasma levels of a fatty acid called trans-palmitoleic acid, prompting the study’s authors to zero in on that particular fatty acid as the potentially causative factor. There is a tendency to reduce foods to their individual constituents. Individual constituents, after all, can be “candidates for potential enrichment… and supplementation,” which makes a doctor’s job that much easier, and makes it easy to explain away “paradoxes.” Just wait: trans-palmitoleic acid is gonna be the new red wine when it comes to explaining the “French paradox.” At the end of the day, though, they do admit that “efforts to promote exclusive consumption of low-fat and nonfat dairy products … may be premature.” Hey, it ain’t much, but I’ll take it.
Overburdened doctors sure do love tangible targets, like lipid numbers. They’re easy to hit with drugs. There’s no guesswork – statins and the like actually do lower cholesterol (whether that’s helpful or harmful is the question) – and that makes a physician’s life simpler. Oh, sure, lifestyle changes work, but most patients won’t bother trying them (especially when the changes you prescribe are founded in faulty science and no fun following). Doctors can usually get patients to take a pill.
There’s yet another cholesterol-busting wonder drug on the coming horizon called anacetrapib. A recent eighteen-month trial found that it boosted HDL (from 40 to 101) 138% greater than placebo and slashed LDL (from 81 to 45) 40% better than placebo in patients already taking statins by hampering the effects of the CETP enzyme. Another potent CETP-inhibitor – torcetrapib – made similar headlines in 2006 when it boosted HDL and reduced LDL like nothing else before it, but those headlines were overshadowed when 60% excess mortality occurred in people taking the drug versus those on placebo. So far, anacetrapib seems safe enough, but I’m not holding my breath. I tend to get a little uneasy when we change a single variable and mess with enzymatic pathways in a very complex closed system, with a single goal (raise that HDL, drop that LDL!) in mind. Focusing on numbers that are largely an indication of your lifestyle without doing anything about the lifestyle itself is like pissing into the wind: quite often, it’ll splash all over you, and you’re lucky if it’s just the shoes.
© 2014 Mark's Daily Apple