Announcement

Collapse
No announcement yet.

ANY DOCTORS/MED STUDENTS HERE? Need medical cholesterol evidence

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • ANY DOCTORS/MED STUDENTS HERE? Need medical cholesterol evidence

    I just had a long discussion with a medical student about cholesterol and statins, and she said that there is evidence supporting high cholesterol intake/blood levels and heart disease mortality. Also, that statins effectively reduce mortality (mentioned 4S study). I looked at Mark's post, but he didn't put any references on his cholesterol guide.

    Does anyone know of solid evidence refuting these claims? Also, does the liver produce less cholesterol when you eat more cholesterol?

    How does atherosclerosis START? Looking online yielded varied results. From my understanding, it appears that a lesion or injury can become inflamed, then come the LDL which get oxidised, etc. What causes this lesion or injury? Basically, what's the first step. The person I talked to said that in med school you learn that it starts with high levels of LDL in the blood which build up in arteries, which I believe to be utter BS. How can something the liver produces in vast quantities be so harmful to you?

    Help appreciated!

  • #2
    CHeck out spacedoc.com for some good info on why you do NOT want to take a statin.

    Comment


    • #3
      Bullshit.

      Check out this study which shows that it's a U-shaped curve for men and a straight line for women. And especially with women, the higher your cholesterol, the lower your risk of mortality. For men, there's a sweet spot. If you want a simpler explanation of the study, you can look here. It isn't a simple "high cholesterol is bad".

      Also, triglyceride levels and the type of LDL (small and dense or large and fluffy) seem to be better predictors of heart disease over total cholesterol anyway.
      Durp.

      Comment


      • #4
        The Blog of Michael R. Eades, M.D. Truth versus hype in the Jupiter study
        The Blog of Michael R. Eades, M.D. Statin panic

        I searched Dr. Eades' blog for 4S and here's a comment that pretty much sums it up:
        busy, January 17, 2008 at 9:29 am

        I really enjoy your blogs. Thank you. With 4S, LIPID, HPS studies on statins ( http://www.rxfiles.ca/acrobat/cht-li...r%20trials.pdf ) trials showing reduced mortality in secondary prevention, is there still no room in your arsenal to prescribe these?

        Hey Busy–

        This says exactly what I wrote in my post a while back (The Blog of Michael R. Eades, M.D. Statin panic). Statins have been shown to bring about some slight reduction in all cause mortality in men under the age of 65 with established heart disease. Were I such a person or if I had one in my practice I might consider a statin drug only after I had tried every dietary and supplement regimen I could put together without effect.

        Cheers–

        MRE
        Female, 5'3", 50, Max squat: 202.5lbs. Max deadlift: 225 x 3.

        Comment


        • #5
          My understanding it is the small dense LD,L which eating vegetable oils encourage, cause the real problems. Eating saturated fat encouraged the fluffy LDL.
          Eating primal is not a diet, it is a way of life.
          PS
          Don't forget to play!

          Comment


          • #6
            I am a third year medical student, so I will try to do the best I can

            First of all, the answer to the question of "what causes atherosclerosis?" is, for most anyone that takes in all the evidence is a resounding "no one knows". The current understaning is that it is a sequela of several vascular pathologies, with components involved in chronic inflammation, low HDL over many years, etc. It is within this multi-faceted etiology that I believe a paleo diet, which will generally reduce systemic inflammation caused by gluten, leptin, and the like, shows promise.

            One key point that I would make about statins, high cholesterol diets, and vascular disease is to isolate a single word in the article cited above, that being "secondary" prevention. That has a very specific meaning in medicine. It means, in short, what preventative steps can be taken to lessen the advancement of a disease that is already present. So yes, a statin is a good tx for someone with already advanced arteriosclerosis, but this is very different than saying that it should be given to a healthy person. Someone with coronary artery disease (which we assume in most any male over 55) should most certainly not be on a paleo diet, because by definition this condition implies that their regulatory system has lost its moorings. At this point, your options are a DASH diet (all fruit and veg, lean meats only, low salt) and drugs.

            So overall, I think the discussion gets mottled in the fact that there are really TWO questions that we should be asking. First of course is, "what is good for you?", but the second is at least as important, "for who?"....because anyone that acts as if it is one size fits all, a facet that I must say this community is generally very good at recognizing, does not understand our physiology.
            "The soul that does not attempt flight; does not notice its chains."

            Comment


            • #7
              Don't forget that medical schools get a lot of $$ from big pharma. And you know what that means...

              Comment


              • #8
                TheyCallMeLazarus, from your post is evident that medicine still hasn't changed their teaching techniques. A primal diet isn't age specific nor condition specific.

                Comment


                • #9
                  Originally posted by bionicsamm View Post
                  TheyCallMeLazarus, from your post is evident that medicine still hasn't changed their teaching techniques. A primal diet isn't age specific nor condition specific.
                  A primal diet isn't age specific but eating a high fat diet might not be the healthiest option for everyone.

                  Comment


                  • #10
                    These are some studies that came up in google scholar when searching for statins + mortality. They side with your med student friend. In fact, I haven't seen any studies that say that statins seem to do anything other than prevent death...funny how that works, huh?

                    Effect of Statins on Risk of Coronary Disease, December 22/29, 1999, LaRosa et al. 282 (24): 2340

                    Statin Therapy, Cardiovascular Events, and Total Mortality in the Heart and Estrogen/Progestin Replacement Study (HERS)

                    Statin Therapy May Be Associated With Lower Mortality in Patients With Diastolic Heart Failure

                    ScienceDirect - Journal of Cardiac Failure : Statins Associated With Reduced Mortality in Patients Admitted for Congestive Heart Failure

                    Comment


                    • #11
                      I would be the first to say that my education propagates a lot of completely outdated and in some cases, certifiably wrong info when it comes to nutrition. There is a general feeling of "play it safe" when it comes to giving nutritional advice that I find pretty dishonest, and spend a good deal of my time instructing patients that a lot of our conventional wisdom stands on very old and shaky science.

                      With all of this said, I think it is is over-simplification to say that as a profession we think of a drugs only approach.....so I will put it this way: I was asked by several first years at a symposium we had recently, "What is your biggest shock or adjustment you've had to make in dealing with patients?"....my answer was very easy, "That a lot of people really dont care all that much if they die young."

                      I rotated through internal med several months ago, and you see that first hand. You get used to seeing 40 year olds that are on 12 meds and look 65. You get used to people that have food snuck in for them in baby strollers, that kind of thing...so yes, many times meds are our only option for people like that...

                      Contrast this to a 51 year old man I saw last week....I am always following a resident around at this point, but the pt began to ask me what I do to stay in shape. He himself was doing pretty well, low body fat, good BP, etc, so I told him "I eat plants and animals. If it had to go anywhere before my plate to get anything but sliced up, I dont eat it." this made a lot of sense to the guy, and we continued to talk about paleo, exercise, etc.

                      So in most patients, I am extremely anti-medication. Seem doctors, especially the old guard, are much less so. Many of them recommend statins and cutting cholesterol in totally healthy people that are over the age of about 50, and I think that is terrible medicine and driven by their pocketbooks, but even more by wanting their pts to like them. Telling someone that age that most of our knowledge about nutrition is old an bogus makes you come off like a wingbat, even if I can give them 100 studies to prove my point. Like I said, a lot of people prefer it this way. The conventional wisdom allows them to take a pill, eat a little fewer eggs, and somehow have a healthy vascular system. Saying something like "ok, you need to be under 100-150 carbs a day, nothing processed, workout twice a week and walk every day."' which I would call the real prescription to help, does not endear someone to you. I have decided that I dont care and tell people anyway, but many doctors will not do this. I like to be the beginner of the awful truth sometimes, and in diet I am especially opinionated

                      With all of that said, statins are what I have heard called a "drain circles drug", because there is very little proof that they actually improve long-term survival rates. We can easily prove that they lower the "risk-factors" that are supposed to be red flags (which themselves often have very weak science behind them, ala LDL levels), but 5 or 10 year survival rates are pretty unimpressive.

                      So for me, the argument is about what will prevent coronary artery disease, prevent atherosclerosis, prevent looking 60 when you are really 45....to that answer, I believe that primal is the way to go....if the argument is that people on 12 meds should be taken off all of them and start eating paleo, and that this will somehow cure decades of damage, then I think that is wrong. I think that we do a massive disservice to people in many times deciding to medicate before even trying to change things through diet, but I will never be a doctor like that. At some point that is all I can control.
                      Last edited by TheyCallMeLazarus; 11-08-2011, 09:47 AM.
                      "The soul that does not attempt flight; does not notice its chains."

                      Comment


                      • #12
                        Originally posted by TheyCallMeLazarus View Post
                        I am a third year medical student, so I will try to do the best I can

                        First of all, the answer to the question of "what causes atherosclerosis?" is, for most anyone that takes in all the evidence is a resounding "no one knows". The current understaning is that it is a sequela of several vascular pathologies, with components involved in chronic inflammation, low HDL over many years, etc. It is within this multi-faceted etiology that I believe a paleo diet, which will generally reduce systemic inflammation caused by gluten, leptin, and the like, shows promise.

                        One key point that I would make about statins, high cholesterol diets, and vascular disease is to isolate a single word in the article cited above, that being "secondary" prevention. That has a very specific meaning in medicine. It means, in short, what preventative steps can be taken to lessen the advancement of a disease that is already present. So yes, a statin is a good tx for someone with already advanced arteriosclerosis, but this is very different than saying that it should be given to a healthy person. Someone with coronary artery disease (which we assume in most any male over 55) should most certainly not be on a paleo diet, because by definition this condition implies that their regulatory system has lost its moorings. At this point, your options are a DASH diet (all fruit and veg, lean meats only, low salt) and drugs.

                        So overall, I think the discussion gets mottled in the fact that there are really TWO questions that we should be asking. First of course is, "what is good for you?", but the second is at least as important, "for who?"....because anyone that acts as if it is one size fits all, a facet that I must say this community is generally very good at recognizing, does not understand our physiology.
                        I disagree with this. The science tells us what it is......medical school teaches consensus opinion. You the doctor have to think for yourself and your patients. you learn this in residency. Med school has very little time to develop clinical judgement. That is why residency is mandatory.

                        Comment


                        • #13
                          Statins have never been shown to improve mortality in primary treatments only in secondary prevention cases and that data is pretty weak......and all your google scholar papers are secondary prevention events. This person is talking primary prevention so its an apples to oranges link.

                          Is the use of cholesterol lowering meds in mortality rising?... [J Eval Clin Pract. 2011] - PubMed - Share this with your doctor. In women, death rates go UP as cholesterol goes down with statins, and death rates go DOWN as cholesterol goes up. This same result was found in the Framingham Heart Study but it appears most doctors dont read the data and only remember what they learned in medical school. In men, the same thing happens, until you get to a certain number, then the rates go the other way.
                          Last edited by DigitalSurgeon; 11-08-2011, 10:42 AM.

                          Comment


                          • #14
                            I wish the standard calculated LDL testing would go away. I much prefer VAP or NMR. Would never want someone on a drug without at least that testing.

                            Not a statin fan to begin with, but if a doc is going to prescribe them- I think it is criminal not to mentioning supplementing with CoQ10 while on them.

                            Just my 2 cents!

                            Comment

                            Working...
                            X