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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...

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November 22 2010

Monday Musings: Torcetrapib Part Deux? and Keto Diets Seize the Day

By Mark Sisson
22 Comments

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.

Next on the musings list, the NY Times Magazine recently published a story by the father of a child with severe epilepsy who’s been keeping it in check with a ketogenic diet. This is great. I mean, this is common knowledge in informed circles, but, as you’ll read in the op-ed, most folks are completely unaware of the efficacy of the keto diet in dealing with epilepsy. The author himself is (or initially was) a bit skeptical of all the fat his kid has to eat. But it works. More than 150 hospitals now offer keto programs to epileptic children, up from just 15 in 1997. The mainstream is successfully implementing a treatment that doesn’t involve prescriptions – and researchers are looking into ketogenic diets for other ailments, including certain cancers (tumors love glucose, after all) and various neurological disorders (Parkinson’s, Alzheimer’s). And now, it’s being discussed (up to more than 250 comments, mostly supportive, though I didn’t read ‘em all and I’m sure I missed a few “lol, Atkins” type responses) and passed around (5th most emailed story) in one of the biggest papers around.

See? There’s hope. They’ll come around.

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22 thoughts on “Monday Musings: Torcetrapib Part Deux? and Keto Diets Seize the Day”

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  1. Amazing that some of these prescription drugs actually increase mortality rates and yet they approved and presecribed by health professionals. What a system.

    Also, I find that fascinating that a Keto diet could control epilepsy. Does this mean they can play crazy video games again?

    1. Patients are part of reinforcing that system too, unfortunately. Lots of demand for the “simple pill” as a solution, in lieu of actually making lifestyle changes. Great for drug companies, but as for the effect on people’s actual bodies…

      I mean, I wouldn’t want to be a doctor right now — it must be exhausting to continually say “Oh, you feel like crap? Well you could lose weight, eat better, and exercise” and having patients just give them the equivalent of blank looks.

      The only patient population where I’ve heard of at least some people occasionally bothering to do that are heart patients, but by then, they’re already extremely damaged and scared. (and following a CW approach of tons of grains, tons of chronic cardio…)

    2. It wasn’t an “prescription drug”, it was an experimental being tested in a trial. Since it increased mortality it will never be approved for use in humans.

  2. Just a comment about the cholesterol treatment. I am a physician in Southern California area and I have had my own personal resevations about treating a lab value. I come from a family with very high cholesterol and the statin drugs have not performed well with my brothers and cousins. Sure thier numbers went down but the side effects were so severe that they all stopped excercising and gained weight. For that reason, I have resisted that form of treatment. My imediate family has been living “primal” for years( we even shop the Malibu Farmers Market weekly). Time will tell if I live longer but there is no debate that my quality of life (age 52) is much richer. As a physician, I am happy when we as a population continue to think, research and live out healthier lifestyles. None of this is simple and we know so little about our complex physiology.

    1. “None of this is simple and we know so little about our complex physiology.”

      Very refreshing statement to read from a physician.

      That is the thing we know so little and yet the big companies and a large number of doctors assume they know so much and the public, being in a far lesser position viz a viz information/knowledge assume what the Doctor says is unassailable.

      The body knows how to heal itself we just need to give it the right environment.

  3. I loved that article- but was kind of completely horrified by the comments. People actually believe it’s somehow abusive to deprive a child of a “normal” SAD diet, and that it’s impossible to alter one’s diet even if that change might save your brain. People even suggested surgery to remove much of the child’s brain would be less abusive than increasing his cholesterol level.

    HOW did we get to this place?

    1. People are just doing their best. That they have that reaction is an indication that they just can’t fathom that they have it THAT wrong. Totally understandable reaction, I think.

      1. Interesting article. I find it interesting that overwhelmingly the diet itself is considered terrible, even by the dad of the epileptic boy. Also that when their daughter was recently diagnosed they went for the meds first and not the food.

  4. Having seemingly spent a whole weekend defending myself and my primal lifestyle against people who see it as ‘hippie-Atkins’ and others who consider McD and their toys ‘a treat’ for their kids, I have to come back here for some sanity and a breather.

  5. My favorite line: “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.”

    Unfortunately that’s what most people want… fix the problem without me making any changes. Today survival of the fittest means going against the majority. Good thing I’ve always been good at that.

  6. it seems like they thought the diet was “terrible” because of the inflexibility of it, not the actual food. I wonder if it really is necessary for them to weigh out every ounce like they say?

    1. I don’t know, the reference to gross recipes, worrying about poisoning due to all the fat, and just calling it a lousy diet, made me think it was pretty terrible all around. I think the inflexibility of it is extreme and do think there would be success with variations on a theme. They mentioned similar diets with low gi carbs as an optional diet employed by others.

    1. The anti-epileptic medications need even more monitoring, I can guarantee it Terry, and would have killed far more people through side effects. The risks of AED’s would far outweigh the risks of a ketogenic diet.

  7. Excellent point Jenny. The patients are definitely part of the intensification loop that keeps drug research going. It’s a very hard time to be a physician and most patients seem to be completely uninterested in dietary and lifestyle changes.

    Whenever we end up with an ‘inhibitor’ drug tx, there are unintended – and negative – consequences. Modulation is the answer, not inhibition.

    1. The modulation of gene expression produced by dietary and lifestyle changes may also produce unintended negative consequences. Both drugs and lifestyle changes have risks and benefits.

      For example, eating more oily fish to get more omega-3, with the aim of reducing your risk of CVD. If you do this you will also increase your intake of mercury and persistent organic pollutants. At the moment the benefit seems to outweigh the risks, but what if we do not understand all the risks?

      No health decision is without risks, you can’t put things into mental boxes based on the simplistic terms of “mudulation” and “inhibition”.

  8. “Focusing on numbers that are largely an indication of your lifestyle without doing anything about the lifestyle itself is like pissing into the wind.”

    I love this! People want measurable results, however much of the time we need to ask are we measuring the right thing.