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

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 [1] (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 [2] 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 [3] 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 [4] 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.