by Tanada » Tue 13 Mar 2018, 05:45:05
More information for those who choose to be involved in their own health care rather than blindly following standard medical advice despite the fact that every patient is an individual who needs treatment tailored to their genetics and lifestyle. Very long article at link below the quote.
$this->bbcode_second_pass_quote('', ' ')DR ASEEM MALHOTRA is on holiday in India but KEEN TO talk by phone. He’s not holding back, either. The obsession with lowering LDL cholesterol is “unscientific nonsense”, he says.
“Absolutely, please quote me on this, it’s unscientific nonsense. All this fear of cholesterol and these adverts and all these vegetable oils and margarines to lower cholesterol, it’s unscientific nonsense. There’s a whole industry developed primarily on people being told to get their cholesterol down to prevent heart disease when, actually, it’s a very weak risk factor.”
There’s no question statins lower LDL, he says. But it’s the wrong target. To reduce the incidence of CVD, emphasis should be on insulin resistance. Malhotra is a world-leading campaigner against sugar, calling it “public health enemy number one”, and argues saturated fat is not the bogeyman it’s been painted.
In fact, in April this year, he, Redberg and Dr Pascal Meier, a cardiologist at University Hospital Geneva and University College London, wrote in the British Journal of Sports Medicine (part of the BMJ stable) that “the conceptual model of dietary saturated fat clogging a pipe is just plain wrong”. It created a frenzy of debate.
They claimed: “It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat. Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 minutes a day and eating real food.” In a nod to their belief that vested interests are pushing the low LDL cholesterol message, they concluded: “There is no business model or market to help spread this simple yet powerful intervention.”
He’s just released a book, The Pioppi Diet, which has gained traction in the UK. The basis of the diet, borrowing from the lifestyle in the Italian village of Pioppi, is to stay away from sugar and refined carbohydrates rather than fat, to eat vegetables, nuts and extra virgin olive oil daily, get seven hours’ sleep, walk regularly and avoid stress.
Malhotra argues adopting this way of life is a more effective prescription for heart health but the message is drowned out by the statin chorus, aided and abetted by pharmaceutical companies – and researchers funded by them. Patients like the idea of taking a pill, which then – they think, falsely and dangerously – allows them to eat what they want.
“We’ve completely lost perspective and the reason we have this whole crisis in healthcare in Australia, the UK and the US is that we are over prescribing drugs without giving complete information to patients, (and) at the same time neglecting the impacts of lifestyle,” Malhotra says. “Looking at all the industry-sponsored data, roughly, taking a statin every day for the next five years, there is about a one per cent chance it will prevent you from having a non-fatal heart attack or stroke but there is a one in 50 chance it will give you type 2 diabetes.
“That’s before you get into the conversation about things like muscle pain and fatigue.”
Still, he does prescribe statins to people with heart disease but who haven’t had a heart attack. But unlike many doctors, he says, he baldly describes the risks as well as benefits. He makes it clear “there is no overall mortality benefit” and leaves it to the patient to choose. If they decide on statins and return with aches and pains, fatigue or memory issues, he will un-prescribe to test improvement in well-being. There are no special steps to coming off statins, he says, and rejects the suggestion that quitting them would elevate the chances of a CVD event.
That’s a complaint that was made against Maryanne Demasi after her Catalyst piece aired. It’s “complete nonsense designed to smear”, says Malhotra. In July this year, he co-authored a piece with Demasi, published in the UK’s Pharmaceutical Journal, headlined “The cholesterol and calorie hypotheses are both dead – It’s time to focus on the real culprit: insulin resistance”.
A number of high-profile doctors came out in support, including Sir Richard Thompson, a Royal College of Physicians past president and the Queen’s personal physician for 21 years, who said: “The seductive theory that cholesterol in blood and the diet is the enemy and therefore must be lowered at all cost has diverted attention away from the unnatural increase in sugar intake that has a greater influence on obesity, diabetes and CVD. Time for a rethink and a change in our diets.”
In an email exchange, I ask Demasi how she responds to the allegation that she and protagonists such as Malhotra cherry-pick data to suit their thesis. Demasi turns the tables: “We highlighted (in the journal article) the multitude of studies which have been ignored by those who are vigorously defending the cholesterol hypothesis. There are 44 randomised controlled trials of drug and dietary interventions to lower LDL cholesterol in the primary and secondary prevention literature which show no benefit on mortality. Most of these trials did not reduce cardiovascular events, and several reported substantial harm.”
Demasi says Australia has an “incurious” attitude towards the statin therapy debate. “There’s a lack of public discourse about statins,” she says.
“Dissenting views can be met with personal attacks rather than scientific rebuttals … Some doctors have turned to social media and blogging to follow international media coverage and take part in the debate.”
The author prepares to undergo a CT scan to assess her coronary calcium score. Electrodes are attached to my chest, the machine slides me inside a hi-tech imaging circle and a robotic voice asks me to hold my breath. Ten minutes later, I’m dressed and waiting outside for the results of my CT scan.
It’s with some trepidation I slide the report out of the envelope. Has my love affair with bacon and hate-love relationship with cigarettes compromised my arteries and left me with a serious decision to make about lifelong medication? I’m confused by the pros and cons, despite Colquhoun’s insistence I shouldn’t be. The cholesterol and statin debate has made me acutely aware of one thing – medicine is a science, but not an exact one. In the end, the decision about treatment will come down to me. As it should.
My decision is made simpler when I read the report. The result is good; my coronary artery calcium score is 29. In fact, says Dr Colquhoun in an email, it’s very good. “Not perfect, but very good”. “Your risk of a cardiovascular event over the next 10 years is less than one per cent,” he writes. “Your number is well below the cut point to require drug therapy, according to the Cardiac Society of Australia and the American Heart Association. The Americans have clearly stated 300 and above requires lipid-lowering drug therapy.”
Yet, here’s the twist. My cholesterol has barely changed. Despite a much-increased intake of almonds and kale, more sardines and tuna in my diet than a baby shark and a chocolate intake over six weeks that I can count on one hand, my total cholesterol is down a minuscule 0.2 mmol/L, my LDL by 0.35 and my triglycerides have actually increased to 2.4 mmol/L, now putting it just above the target level. But I do feel better; more energetic, and a few kilos have disappeared. At last, I think I can commit to some permanent changes. A symptom of getting older is no longer taking good health for granted, and this swath of tests has brought my mortality into sharp focus. In ways I had not anticipated.
The coronary calcium score was a revelation that has averted me from wrangling with a statin decision that, for me, was going to be difficult. But before dashing out to get one, be warned – you may discover more than you bargained for. My CT scan showed a small nodule on my lung. A more detailed CT detected two others. I now have a lung specialist.
For the next three months, as I endure an agonizing wait before another scan to see if the spots have grown, which would suggest cancer, I cling to the fact that nodules are relatively common, most are non-cancerous and the radiologist’s report says they “are likely to represent granulomata”. Which means they would be benign. If not, it’s been caught early, which, hopefully, would mean a good prognosis.
Believe me, you don’t want to be in this position.
LINK