The real take home here is that we fail to measure for the size of the
cholesterol particles and do not properly treat the underlying issue which is
metabolic syndrome. Quite simply a
prognosis of diabetes just happens to generate small particles of the bad
cholesterol which promotes heart disease.
That throws the obvious doctrines into the trash can. Tackling the incipient metabolic syndrome is
the actual lifesaving priority.
Read this carefully.
THE SINGULAR FOCUS on treating cholesterol as
a means to prevent heart attacks is leading to the deaths of millions of people
because the real underlying cause of the majority of heart disease is not being
diagnosed or treated by most physicians.
For example, I recently saw a patient named
Jim who had “normal” cholesterol levels yet was taking the most powerful statin
on the market, Crestor. Despite this aggressive pharmaceutical treatment, this
man was headed for a serious heart attack.
Jim’s doctors had
missed his real disease risks by focusing on and treating his cholesterol
levels. All the while they were ignoring the most important condition that put
him at dramatically higher risk of heart attacks, diabetes,
cancer, and dementia.
In a moment I will explain what this condition is and what you can do about it.
This craze for treating cholesterol has lead
to an onslaught of pharmaceuticals designed to “lower cholesterol.” Statins are
now the number one selling class of drugs in the nation and new cholesterol
medications are produced every day.
The latest in a new
class of “super” cholesterol drugs, CETP inhibitors, now in the drug approval
pipeline from Merck (anacetrapib) burst into the news recently with
exclamations from typically restrained scientists. Data on this new drug was
recently published in the New
England Journal of Medicine and presented at the American Heart
Association conference in Chicago.
The study found a 39.8
percent reduction in LDL (or bad cholesterol) and a 138 percent increase in HDL
or good cholesterol.(i) Sure, the
medications lowered cholesterol. However, the study was not large enough or
long enough to answer the most important question: Did the drug results in
fewer heart attacks and deaths.
Despite this glaring
omission, the scientists reporting on these results used words such as
“spectacular”, “giddy”, “enormous”, “most excited in decades” to describe their
enthusiasm over the medication. Of course, the researchers (as I described in a
recent post “Dangerous Spin Doctors”)
were on the payroll of Merck who funded the study.
Metabolic
syndrome is the leading cause of heart disease, diabetes, and a variety of
other chronic illnesses in this country.
Why Lowering Cholesterol May
Not Lower the Risk of Death
Unfortunately, these scientists seemed to have
short-term memory loss. Just three short years ago in 2007, another new
“wonder” drug from Pfizer (torcetrapib) which worked on the same mechanism that
anacetrapib does, was found to dramatically lower LDL and raise HDL
cholesterol, just like this new drug from Merck.
There was only one
small problem—in those taking the drug, deaths from heart attacks increased 25
percent, deaths from heart disease increased 40 percent and overall deaths
increased 200 percent.(ii)
After spending $800 million in development Pfizer had to walk away from the
drug.
Oops. How can a drug that does all the right
things (dramatically lowering bad cholesterol and raise good cholesterol)
actually cause MORE heart disease and deaths?
The answer is simple. Drugs don’t treat the
underlying causes of chronic illness. It is not our genes which haven’t changed
much in 20,000 years, although they may predispose us to environmental and
lifestyle triggers of illness. The causes of chronic disease are rooted in what
we eat, how much we move, how we face stress, how connected we are to our
communities, and toxic chemicals and metals in our environment.
A wry editorial in
the New England Journal of Medicine many
years ago remarked that doctors should use new drugs as soon as they come on
the market before side effects develop. Perhaps that’s what the authors of this
study are proposing what we do with anacetrapib.
At best this new “super cholesterol” drug will
lower cholesterol numbers without killing too many people while increasing
health care costs by billions of dollars as millions of new prescriptions are
written. Worse it may end up in the same garbage dump Pfizer’s drug from 3
years ago did. Even worse scenarios exist … and the reason is startling simple
…
These drugs do not
address the fundamental underlying cause of heart disease. Heart
disease is not a Lipitor, Crestor or even an
“anacetrapib” deficiency. It is a complex end result of multiple factors driven
by our diet, fitness level, stress, and other lifestyle factors such as
smoking, social connections, and, increasingly, environmental toxins.
Taking a pill won’t fix these problems that
push our biology steadily along the trajectory of disease. The idea of putting
statins at the check out counter of MacDonald’s is the epitome of reductionist
thinking. The problem isn’t cholesterol — it’s all the stuff we are putting in
our mouths!
Jim, my patient, is a perfect example of how
doctors treat the symptoms, not the cause of disease. As I have written about,
in a previous blog, most doctors focus on the wrong target for preventing and
treating heart disease.
Abnormal cholesterol
levels are just a downstream problem that is mostly a result of “diabesity” or the continuum of blood sugar and insulin
imbalances that range from pre-diabetes to full-blown end stage diabetes.
Taking a statin or a CETP inhibitor cannot reverse
this change in our biology. We cannot use a drug to correct what happens to our
biology because of a high sugar and refined flour, low fiber, processed diet, a
sedentary lifestyle, excessive stress, lack of sleep, or the harmful effects of
pollution.
Let’s take a closer look at Jim. On 10 mg of
Crestor, the most powerful statin on the market, his total cholesterol was a
beautiful 173, and his LDL was a respectable 101. But the good news ended there.
His triglycerides were 176 (normal is less than 100), and his HDL was 37
(normal is greater than 50).
Jim’s numbers belie a deeper truth about
cholesterol that most conventional doctors are ignoring today: Given the
current state of scientific understanding, the cholesterol numbers doctors
measure today are increasingly irrelevant.
The Real Cause of Heart Disease
Instead of looking
just at the cholesterol numbers, we need to look at the cholesterol particle size. The
real question is: Do you have small or large HDL or LDL particles? Small,
dense particles are more atherogenic (more likely to cause the plaque in
the arteries that leads to heart attacks), than large buoyant, fluffy
cholesterol particles.
Small particles are
associated with pre-diabetes (or metabolic syndrome) and diabetes and are
caused by insulin resistance. Recent research (see my blog “Do
Statins Cause Diabetes and Heart Disease”) indicates that
statins may actually increase diabetes.
While measuring cholesterol particle size is a
simple blood test that can be done at Labcorp, most doctors do not look at it,
even though it is the only meaningful way to evaluate cholesterol numbers. You
can have a LDL cholesterol that looks normal, like Jim did at 101, but you may
have over 1,000 small LDL particles which are very dangerous.
On the other hand, you can have the same LDL
number of 101, and it may be made up of 400 large particles which cause
no real health risk. Your health risk
has less to do with your cholesterol numbers than it does the quantity and size
of your cholesterol particles.
Again, we can take Jim as an example. His
cholesterol particles were all small and dense because he had severe
pre-diabetes. This is also not hard to diagnose. Jim was obese at 285 pounds
with a BMI (body mass index) of 36. You are considered obese if your BMI is
greater than 30. His waist-to-hip ratio was 1.04 (normal is less than 0.9 for
men).
He had very high insulin and blood sugar
levels after we gave him a test drink of glucose (sugar). All this added up to
tell us he had severe pre-diabetes or metabolic syndrome. As I mentioned
before, he also had high triglycerides and low HDL — another clue that
he had metabolic syndrome. We also found he had very low testosterone and
growth hormone, further symptoms of pre-diabetes or metabolic syndrome.
Jim reported that despite working with a
trainer he kept losing muscle and he was always hungry. This is why.
Let me
reiterate: These are measurements and tests that
can be done in any doctor’s office, but are rarely done. These are not esoteric or expensive labs that can only
be done at specialty clinics.
The condition that Jim
suffered from, metabolic syndrome, is the most common medical condition in
America, but the most rarely diagnosed. It affects over half the population. It
is the major cause of heart
disease, diabetes, and aging, and it is one of the major causes of dementia and
cancer, not to mention infertility and sexual dysfunction.
Yet it is mostly ignored by doctors. Why? The
answer is simple and tragic: There are no drugs to treat it effectively, and
doctors tend to focus on what they can treat with medications, even if it is
the wrong target. This is one of the reasons statins are so popular in America
despite the vast research against them.
Seven Tips to Fix Your
Cholesterol and Reverse Metabolic Syndrome without Medication
Luckily, this doesn’t mean you are doomed,
even if you are already suffering from metabolic syndrome and heart problems.
High cholesterol and pre-diabetes, or metabolic syndrome, can be successfully
diagnosed and treated. I have reviewed this in previous blogs but here are 7
tips to help you get large, fluffy cholesterol particles and reverse metabolic
syndrome.
1.
Get the right cholesterol tests. Check
NMR particle sizes for cholesterol by asking your doctor for this test at Labcorp or LipoScience.
You want to know if you have safe, light, and fluffy cholesterol particles, or
small, dense, artery damaging cholesterol particles. A regular cholesterol test
won’t tell you this.
2.
Check for metabolic syndrome.
1. Do
you have a fat belly? Measure you waist at the belly button and your hips at
the widest point—if your waist/hip is greater than 0.8 if you are a woman or
0.9 if you are man, then you have a problem
2. If
you have small LDL and HDL particles, you have metabolic syndrome.
3. If
your triglycerides are greater than 100 and your HDL is less than 50, or the
ratio of triglycerides to HDL is greater than 4, then you have metabolic
syndrome.
4. Do
a glucose insulin challenge test. This is very important and most physicians do
not test for insulin and glucose.
5. Check
your hemoglobin A1c, which measures blood sugar over the last 6 weeks. If it is
greater than 5.5, you may have metabolic syndrome
3.
Eat a healthy diet. Eat
a diet with a low glycemic load, high in fiber, and phytonutrient and omega-3
rich. It should be plant based, and you should consume plenty of good quality
protein such as beans, nuts, seeds, and lean animal protein (ideally organic or
grass fed). I have described specific diets that abide by these parameters in
my book UltraMetabolism.
4.
Exercise. Enough said.
5.
Get good quality sleep. Sleep
is essential for healing your body, maintaining balanced blood sugar, and your
overall health.
0.
A multivitamin including at least 500 mcg of
chromium, 2 mg of biotin, and 400 mg of lipoic acid. For most you will take 3
capsules twice a day.
1.
1000 mg of omega-3 fats (EPA/DHA) twice a day.
2.
2000 IU of vitamin D3 twice a day.
3.
1200 mg of red rice yeast twice a day.
4.
2-4 capsules of glucomannan 15 minutes before meals with a glass
of water.
5.
Broad-range, balanced concentration of plant
sterols. You will usually take 1 capsule with each meal.
7.
Consider using high dose niacin or vitamin B3. This
can only be done with a doctor’s prescription. It is useful to help raise HDL
cholesterol, lower LDL cholesterol and triglycerides, and increase particle
size.
8.
Use low-dose statins ONLY if you have had
heart disease or are a male with multiple risk
factors, while carefully monitoring for muscle and liver damage.
For the vast majority of people this approach
is better than simply taking a cholesterol medication. To reduce your risk of
heart disease you need to address metabolic syndrome, and that can ONLY be done
effectively with a comprehensive diet and lifestyle approach like the one
outlined above.
Now I’d like to hear from you …
Have you taken statins? What has been the
effect and do you have muscle pain or any neurologic side effects?
Do you think metabolic syndrome is an
important factor to address to reduce the risk of heart disease? Why or why
not? Has your doctor ever said, your sugar is a little high and we will watch
it? Watch for what — until it is so bad you are eligible to take diabetes
medication?
What do you think of conventional medicine’s
tendency to prescribe medications over dietary and lifestyle change for chronic
health conditions?
I would love to hear your thoughts. Share them
by leaving a comment below.
To your good health,
Mark Hyman, MD
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