The popular story of how low-carb diets work goes something like this: Reducing your carbohydrate...
Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...Tell Me More
For today’s edition of Dear Mark, I’m answering one question. It’s a good one. A reader (many, actually) wrote in to get my opinion on the latest blockbuster cholesterol-lowering drug. A new study appears to show that the drug in question—Repatha—reduced LDL to unprecedented levels and protected patients against the primary cardiovascular disease endpoints they were measuring. What does it all mean? Should we all start taking Repatha?
Let’s dig into it:
As a Primal lifer, I recognize that purity has a certain allure, just as I know it has its decided limitations. I frequently find myself wondering, “Would my paleolithic forebears have done/said/eaten that?” and choosing my course of action based on this line of educated assumption. It’s the WWGD lens on modern living. In a Primal-perfect world, that would be sufficient to ensure continued health and happiness. But things don’t always work out as planned…
Let’s say you hurt your back in an unfortunate turn of events. Primal dictates can certainly help with healing you over the long term, but if you want to get out of bed in the morning you’re likely stuck with the doc’s prescriptions. Similar situation if you’ve suffered physical damage to your eyesight, hearing, brain, or any number of your less robust anatomical sectors. Sometimes to get life done, you’ve just got to suck it up and take your meds.
It’s possible, however, that this may soon change. In my recent post on the vagus nerve, I touched upon an emerging curiosity in the medical world: electroceuticals. While still in comparative infancy, electroceuticals may end up revolutionizing a health care model currently dominated by the drug industry.
I’m not a drug denier. For the most part, at the base level, pharmaceuticals do what they’re supposed to do. Statins lower cholesterol. Beta-blockers lower blood pressure. Antibiotics kill bacteria. Whether those changes save lives or reverse disease is another question entirely. But we can all agree that pharmaceuticals deserve a place in modern medicine. And even if we don’t, they objectively have a place, and we must acknowledge reality.
We can also agree that many of the most common prescription drugs affect the way we absorb, metabolize, utilize, and excrete vitamins, minerals, and other important health co-factors. People taking them deserve nutritional counseling. This is my quick and dirty attempt to encourage that.
Long before humans interacted with the numinous through intermediaries and holy books, we experienced it in other ways. All night drumming and dancing sessions, extended fasts, exposure to extreme temperatures, steam lodges, and week-long wilderness forays, and other rituals have all been used to produce visions and transcend normal waking consciousness. There’s even a theory that early Christian baptisms were actually simulated drownings that produced near-death experiences and the direct sensation of being in the presence of a higher power.
But perhaps the oldest, most reliable way to directly experience the divine is through the use of psychedelics.
The future prospects of antibiotics look grim. Headline after headline proclaims the mounting resistance to antibiotics among pathogenic bacteria and the impending inefficacy of our best drugs to fight them. Antibiotic-resistant “pig MRSA” has been documented moving from pigs to people in several countries, including Denmark and Holland. That same MRSA has also been found in the US, England, and is likely brewing wherever pigs and other animals are intensively raised. And just recently, researchers discovered that MCR-1, the gene responsible for resistance to the “last line of defense” antibiotic—polymixin, the one we use when everything else has failed—is transferable between different strains of E. coli. Formerly relegated to pigs, E. coli and K. pneumoniae bacteria with the MCR-1 mutation have appeared in human subjects in several Chinese hospitals. Transferring the gene between different bacterial species is theoretically harder, but that it’s possible at all has raised alarms in the scientific community.
It’s not just industrial farms and antibiotic overuse causing the resistance. Even the scientists studying the problem and running experiments with antibiotics could very well be promoting antibiotic resistance on a larger scale.
Although statins get a lot of flak in the Primal health community, you have to hand it to them. They may not cure cancer, or single-handedly save the economy and bring back all the jobs, or render entire populations totally immune to cardiovascular disease, but they do exactly what they’re meant to do: lower cholesterol. And they’re very good at what they do. You want lower LDL without changing what you eat or how much you exercise, or trying that crazy meditation stuff? Take a statin. Do you want to hit the target lipid numbers to lower your insurance premium? Take a statin.
Except that statins lower cholesterol by inhibiting HMG-CoA reductase, a crucial enzyme located upstream on the cholesterol synthesis pathway. If that were all HMG-CoA reductase did for us, that’s one thing. At least we’d know what we were getting ourselves into when we filled the prescription. But the “cholesterol pathway” isn’t isolated. Many other things happen along and branch off from the same pathway.
It’s a common refrain that living healthily costs an arm and a leg. The food bills, in particular, garner the biggest sighs and frustration: the price of pastured meats, eggs (and dairy for those who partake), of wild-caught fish, of organic this and that, of healthier nuts and nut butters, of just about any whole food. For some folks that doesn’t take into account the extra travel schlepping from place to place. Shopping for healthy food can be a long-range foraging expedition in some parts. Internet suppliers can help, but they don’t cover all the bases. The time, expense, and inconvenience of healthy food shopping (and preparation) add up, and some days we can wonder if it’s worth all the trouble. What if we just gave in? Gave up? What if we went back to buying the typical processed food products that seem to colonize nine-tenths of the country? Just think of the convenience – and the savings? Seriously, what would we do with all that money? For a while, it might seem like a financial boon. Over time, however, I think we’d be looking at another story.
It’s official: 1 out of every 2 Americans has a chronic health condition. Additionally, twenty-five percent have more than one chronic condition. In a new series initiated by the Centers for Disease Control (the first paper recently published in The Lancet), researchers note that chronic diseases have, in fact, overtaken the human health scene, with noncommunicable conditions causing two-thirds of global deaths. In the U.S., we likewise see the impact in terms of mortality but also in terms of personal disability as well as health care expenditures. Previous reports from the CDC claim a staggering 84% of health care costs go toward treatment of chronic conditions. Is there a way off of this sick merry-go-round? How about the old adage about prevention being worth a pound of cure? For all its seeming practicality, is the prevention mindset – and protocol – the best answer, let alone the panacea?
For today’s edition of Dear Mark, we’ve got a three question roundup. First, I hear from a nursing, weight-lifting, child-chasing mother of four who’s concerned about the amount of food she’s craving – even though she’s already at her pre-baby weight. I (hopefully) allay her concerns in my response. Next, I discuss the ridiculous nature of the conventional dietary advice we give to type 2 diabetics, as well as how there may be a light at the end of the tunnel. I also issue a formal invitation to Tom Hanks, who’s just been diagnosed with the disease. Finally, I explore whether or not DHA truly is bad for adults. Should we only give it to our kids after all?
I realized recently I’ve never written this kind of open letter. I figure if kids and Taco Bell got the benefit, maybe primary care physicians could as well. Kidding aside, there’s a genuine mismatch these days between standard medical advice and effective lifestyle practices. I think we can all do better. I’m not letting patients off the hook here either. (Maybe that’s fodder for another letter.) However, we naturally look to our physicians as our healers, as the experts, as our guides. Unfortunately, we’re not always well served by that kind of faith. I’m of course not talking about any one doctor or set of doctors. I happen to know a great many primary care doctors and other medical practitioners who are incredibly forward and critical thinking professionals. They balance their perspectives with the likes of medical logic, broad based study of existing research and close attention to real life results. While I think I’m not the only one who would have much to say to many specialists out there as well, let me specifically address primary care physicians here. They’re on the front lines – for all the good and ugly that goes with it. More than any specialist, they have the whole picture of our health (and a fair amount of our life stories to boot). It’s more their job (and billing categorization) to provide general health and lifestyle counseling to their patients. It’s with great respect that I offer these thoughts. As my readers can guess, this could easily be a tale of ninety-nine theses, but let me focus on a few central points.