Category Archives: 2. The Economics of Wellness

Calcium Heart CT Scoring Can Improve your Statin Decision Making

Heart Calcium Scoring and Statin Use

Reference: New York Times, Journal of the American College of Cardiology Oct 2015

The use of statins for reduction of risk in coronary artery disease is controversial, in part because of the appearance of commercial conflict of interest.   It is BIG business in BIG medicine. And lots of folks have pretty horrible side effects.   And you have to treat 1000 people to prevent 7 heart attacks a year, for which you have one death.   Hmmm.   Math seems to be a bit dubious at times.   And your doctor is graded and paid “quality assurance” bonuses based on the percentage of patients in his or her practice that are taking statins when they meet guidelines.   It is all well intentioned, as a method of promoting quality, but it results in a certain intensity of persuasion and coercion when you say you don’t like the side effects.

With all that emotion and coercion, is there a better tool that might refine the ability to make a decision?   What would happen if you could get an additional risk scoring procedure done for $ 99 that showed you didn’t need to be on a statin? Wouldn’t that be handy?

That’s what this study asked.  The MESA study is 6,814 multiethnic folks between 45 and 84 without evidence of coronary artery disease who were whittled down to a pure group of 4,758 folks without confounding items like missing data, or complete lack of lousy LDLs, etc.   They were followed for 10.3 years and observed for the development of coronary artery disease events.   The new cholesterol/statin guidelines were applied to this group, of whom 2,377 qualified to be on them.   The majority of them (77%)qualified because according to the ACC risk calculation tables, they had a greater than 7.5% risk of having a heart attack/event over 10 years.   Was that really their risk?   From that group who were supposedly meant to be on statins, 41% had a calcium score on CT scan of “0”. That was ZERO.   No calcium in their arteries.     They did have heart attacks.   Yes, they did. At a rate of 1.5% per 1,000 years. Pretty small.   More than lightning, or shark attacks.  But not enough to take on the risk of statins.     And not at the 7.5% rate that is the acknowledged rate for being enough risk for taking a statin.

What are the risks of taking statins? Well, Mayo’s opinion is measured and valid. At the other end is Dr. Mercola, who would be less measured, but possibly more honest because he’s not in the system and there by maybe speaks a bit more honestly, albeit off the walls.   Or just read the FDA’s concerns.

What does the CT scan find?   Well, it can add up the calcium in plaque in your arteries and actually find calcium that is in the wall of the arteries rather than just bulging out. It takes years for calcium to build up, so it is old plaque. Recent new, raw dangerous plaque is not seen on calcium scanning. It get missed. And the CT does find all sorts of other tidbits, like lung nodules that you don’t know what to do with. But on balance, it’s information.

WWW. What will work for me. I’m dancing a jig. I’m thrilled. I’ve been doing this for four years and I now have literature support that what I’m doing makes sense. Now, if you have risk, you want to know how to turn it off.   That’s were it gets really interesting.   The fine art of getting rid of LDL’s actually isn’t that hard. I can show you how in about a month. And then there is TNF-α, CRP, sdLDL, HDLs and other blood cytokine and risk factors that can show you how to improve your score and get out of risk, without the statins. If you are interested, start by not eating sugar and white flour, and come let me show you how. I’ve been on vacation for a week here in Italy. The gelato has been wonderful. I’m going to measure my HDLs when I get home. I think I just accumulated a bit of risk. Stay tuned.   I’m back in the saddle.

 

 

Pop Quiz

  1. You can measure your risk of heart attack by an inexpensive CT scan of your heart that measures your calcium load? T or F

That’s it.

  1. If your score is zero you have a greater than 10 % risk of having a heart attack in 10 years. T or F

Are you kidding? You didn’t read the column. Go back. Read it again. Score of zero means your have a 1.5% chance in 1,000 years. That’s low.

  1. Current ACC guidelines say it is worthwhile to treat you is your risk is greater than 7.5% chance in 1,000 years.

Yup

  1. About 50% of people who currently meet the current guidelines for statins have a calcium score of zero.   T or F

True. (Makes you feel pretty confident in those guidelines, doesn’t it)

  1. You get some radiation from a CT scan of your chest.

Also true. But in the world of risk benefit, I’ll take that risk over taking statins for 1,000 years.

 

 

 

How to Raise Your HDLs and Lower your Heart Disease Risk

High HDLs and Risk of Heart Disease

Reference:   Wilkins JAHA 2014

We hear all this stuff about LDLs and statins, but no one ever talks about HDLs and how protective they are.   They are protective.   Ostensibly their duty is to scour around and pick up extra fatty acids that they can bring back to the liver for processing.   Small, dense HDLs are just as problematic is small, dense LDLs. You want to have big, fluffy HDLs just like you want to have big, fluffy LDLs.   Now, that’s the traditional medical interpretation of HDLs.   It markedly underestimates their role and their value. You want higher HDLs. It should be one of your health goals.

What this study shows is an elegant demonstration of the inverse relationship between heart disease risk and HDLs.   Following 11,515 men and 12,925 women for 307,245 people years of follow-up, the researchers were able to show that HDLs inversely correlated with heart disease risk. The higher your HDLs, the less heart disease risk you have. The lower your HDL, the deeper you are in doo-doo. Look at the graphs in the article (it’s open access) and you will see the decrease in heart disease risk in both men and women as you increase your HDLs. Men keep decreasing risk up to about 90 HDLs, and women up to about 75.   That’s great!

Eric Westman, of Duke University, and one of America’s leading weight loss experts uses HDLs in his weight loss clinic.   If someone’s HDLs are rising, they are losing weight and on track. We’ve known this phenomenon for years. But if you look over the studies in the literature, it has been masked and hard to see the pattern because most of the diets for weight loss are low fat. Eric Westman claims that when HDLs stop rising, he investigates precise dietary diaries and usually finds someone has started eating more carbohydrates, usually in the form of nuts.   The client thought nuts were basically all fat, but in fact have enough carbs to sabatoge both their weight loss and their HDLs rising.   After a year of dieting on a low carb diet, Westman claims that many will achieve HDLs of 100 – thereby reaching a peak of cardiovascular risk reduction.   Hmmm. That’s the opposite of what the American Heart says.

Ok, explain a simpler theory.   Here is mine. I believe that LDLs are simply transport tools in your body taking fats manufactured in your liver out to fat cells to be stored.   HDLs are their remnant and essentially reflect unused LDLs.   In the world of modern analogies, I call LDLs full 18 wheelers taking manufactured inventory from the factory (your liver) to the warehouse (your fat cell).   HDLs are empty 18 wheelers, sitting in the parking lot waiting for the dispatcher to give them something to do.   Throughout all of human history, we had carbs only seasonally at the end of the growing season, when we gorged on them, put on weight and had a seasonal rise in our LDLs. The rest of the year, we ate fat and protein, lost weight and had our HDLs climb.   HDLs will climb when you are on a high fat, low carb diet.   They will keep climbing as you lose weight and progressively decrease the biological demand for LDLs to transport fats.   You want more HDLs and a lower Total Cholesterol/HDL ratio. The Quebec Study proves that. The Lower your TC/HDL ratio, the lower your risk for heart disease.

WWW. What will work for me.   Ok, I was intruiged with this data. I’ve spent my entire career trying to raise my own miserable HDLs of 28. My father had heart disease and was diabetic. With running 2 miles a day and taking 1000 mg of Niacin (until my face flushed bright red) – the two recommendations to raise your HDL from American Heart), I got my own HDLs all the way up to 32.   Whoop dee doo! Now, since January 1 I have averaged a 70% fat, under 15% carb diet. I have lost 25 pounds and my HDLS just got in. I hit 61 in just 3 months. My LDLs didn’t fall but my ratio is now under 3, for the first time EVER.   If this was just me, I would keep private. But I’ve demonstrated this same phenomenon on dozens of folks willing to stick with it and get measured twice. In fact, it has worked on everyone so far.   Must be something to it.   Your enemy is not fat, it’s extra carbs. If you have high LDLs, it simply means you have overwhelmed the ability of your body to burn and process them, so your liver is turning them into fat and your body is transporting that fat to your fat cells. (No ifs, ands or butts!).

 

Pop Quiz

  1. High HDLs should be one of my health goals.   T or F

Yup

  1. The only way to reliably get high HDLs is to eat fat, stop eating carbs. T or F

Trick question.   It’s not the only way.   Getting yourself born into the right family helps. Good genes are useful. But diet can do it for those of us with lousy genes.

  1. I can change my lousy HDLS in three months more effectively than with a statin. T or F

Slam dunk true

  1. There is more money in statins than in effective weight loss and that has a huge effect on public policy. T or F

You guess

  1. Losing weight and eating differently is more effective than taking pills.

Four to one.

 

 

Cholesterol Explained – A Unified Theory – 18 Wheelers and You

Cholesterol Explained – A Unified Theory

Reference:   The Art and Science of Low Carb Living by Volek and Phinney

You don’t understand how cholesterol works. It seems so complicated. Your doctor has so many urgent, compelling reasons why you should take statins, but you don’t feel bad and you don’t get any information about how to fix it on your own. Here is that fix. I want you to understand it in just 250 words.

One key, indisputable principle. Your body can only store 1,500 calories as carbs. After that, you make fat with extra carbs. Now, presume that your carb storage tank is full – all 1,500 calories. You eat another bowl of pasta, or rice or potatoes. Now what happens? Your blood glucose goes up. You make insulin in response to the higher blood glucose. You have to start making fat. You do that to a large part in your liver. That’s the factory. Your turn on that factory by making insulin that rises in response to those extra carbs you ate that filled your tank over the top. But your liver is in your stomach and your fat tissue is ….where___________(fill in the blank).   How do you get from the liver to the fat tissue? You have to transport the fat in your blood system. Your blood is largely made up of water.   Does fat dissolve in water? NO! So, our bodies have developed an ingenious packaging system that takes a globule of fat and wraps a coat around it that makes it water-soluble. We call that globule an LDL. Onto that LDL, we add a protein called Apo-B that is essentially the docking station for the little transporter to attach to a fat cell and empty itself into a fat cell. Just like the space shuttle, we have to transport stuff from our liver to our fat cells, and we need a docking mechanism.

Now, another clear set of principles. Big fat LDLs are safe and don’t cause trouble. Little small, dense ones cause a heap of hurt. They are the ones that get into blood vessels and start making stiff arteries and filled with plaque. That happens particularly when glucose sticks to them- called glycation, and makes them act like inflammatory signals. What is the fastest, most efficient way to make a big, safe LDL? Eat bacon (or butter, or other saturated animal fat). What’s the fastest way to make a dangerous little LDL? Eat cookies, bread, cereal, pasta, rice, potatoes, donuts, bagels, sugared sodas……all the isles in the grocery store filled with packaged food. You want big, fluffy LDLs.

So, here is my simple analogy. Your LDL is really just a delivery truck, an 18 wheeler, bringing its manufactured product (fat) from the liver where it was made (the factory) to your fat cell where it is stored (the warehouse). Your blood is the free way system.

HDLs, the good cholesterol, is the stuff that is supposedly safer for you. Do you know the fastest way to raise your HDLs and keep them up?   Bacon and saturated animal fat. And a diet with less than 20 grams of carbs in it. By one year, a person on that diet will have an HDL of 100 and a total cholesterol/HDL ratio of about 2.0 – making them ridiculously safe and unable to make a heart attack.   What’s the analogy for HDLs? They are empty 18 wheelers, waiting for you to eat some carbs so they can fill up and turn back into LDLs. But when you are on a high fat, low carb diet, you don’t have anything to transport so the 18 wheelers just hang out, parked, with nothing to do.

WWW. What will work for me. Buy Eric Westmans book. But summarize the analogy again.   Understanding cholesterol is simple. If you have high LDLs, it is simply a marker that you are overwhelming your bodies ability to process and digest carbs. Same message if your HDLs are low. If you want to change that, stop eating carbs and start eating saturated fat from animals. This is exactly opposite, diametrically opposite, completely and utterly opposite to the teaching of the American Heart Association and the American Diabetes Association. And they have had 50 years to get it right, and continue to be diametrically, astoundingly, utterly wrong. That’s why you have failed, and they have failed. Our health authorities keep telling your to eat with carbohydrates.   We didn’t evolve eating carbs. We discovered them only 5,000 years ago with the advent of agriculture.   Prior to that, we had carbs only at the end of the growing season, just before the starvation season (winter in Asia, dry season in Africa).   Carbs are your internal bodily signal that starvation is coming, you better eat up, gain weight and get ready for winter.

 

Pop Quiz

  1. The fastest way to make big, safe LDLs is to eat what kind of food?

Saturated animal fat – bacon and butter – while eating NO carbs.

  1. The fastest way to raise your good cholesterol, your HDL, is how?

Eat bacon and butter – while eating NO carbs..

  1. The fastest way to make deadly, dangerous small LDLs is to eat?

Bread, donuts, cake, potatoes, rice – easily digested carbs

  1. So, LDLs sensibly represent your body’s equivalent of 18 wheelers delivering fat from the factory to the warehouse (liver to fat cell). T or F

Yup. That simple

  1. And your HDLs are simply the equivalent of empty 18 wheelers with nothing to do, sitting around on empty parking lots. Indicating you must have not eating any carbs for months (must be January in hunter gatherer season)! T or F

Yup again

  1. Knowing all this, it makes perfect sense for you to take a statin to lower your cholesterol? T or F

Are you insane. You can fix it completely if you want. Get your cholesterol checked at AnyLabTestNow. Go on the Atkins Diet. Go back in two weeks and do it again. Prove it to yourself.   Don’t pay any attention to anyone who tells you otherwise. They are all in the pocket of big pharma that wants to sell you junk and big medicine that is perfectly happy to keep you sick.

Cleveland Clinic Leads American Health Care the Right Way

Cleveland Clinic Leads America Again – Adds Functional Medicine Clinic

Reference:   Cleveland Plain Dealer Sept 22, 2014

The Cleveland Clinic has been one of the most admired clinics in America. It was the birthplace of open heart surgery and for many years has been one of if not the premier destination for open heart surgery for international clients. But it has also always fostered a climate of innovation and creativity.

For example, Dr Roizen has been intimately involved in the Wellness Institute at the Cleveland Clinic. He was the best selling author of many wellness books but the most well known is probably You, The Owner’s Manual. (At least that’s the one I have). With that, the climate was created for Dr Esselstyn to start innovation. With his diet, he established the first study to show that coronary artery disease could be reversed!   Reversed! Imagine, a clinic that makes the most money in the country from open heart surgery nourishes and helps develop a physician who undercuts their most lucrative income source. You can come to the Cleveland Clinic and find a “Disease Reversal Program” and not only reverse coronary artery disease, but sign up for a variety of programs to help reverse other chronic disease.   Why would the Cleveland Clinic invest in technologies that undercut it’s most lucrative lines of business? Because it’s the right thing to do.

Now, the clinic has moved another step forward to make itself a leader in American health thinking. Mark Hyman is the chairman of the board of the Functional Medicine Institute. Patrick Hanaway, another blockbuster leading advocate for functional care. Dr Hanaway will be the actual “boots on the ground” medical director, as Mark Hyman will only be spending three days a month in Cleveland.

To quote the Plain Dealer: Hyman first broached the idea of functional medicine to Cosgrove a few years ago.

Hyman’s pitch to Cosgrove: “What would you say if I created a program that would cut the number of angioplasties and bypass operations in half, and cut hospital admissions in half?”

To Hyman’s surprise, Cosgrove was receptive to the idea. In turn, Cosgrove reached out to Hyman with an offer to join the Clinic and help launch a center for functional medicine.

“You probably don’t want me there,” was Hyman’s initial reluctant response. After all, functional medicine is a paradigm that challenges the traditional practice of medicine, he said.

“Instead of where the symptom is in the body, we’re looking at underlying mechanisms,” Hyman said. “It’s the difference between treating the soil and treating the plant, which is what functional medicine does.”

WWW. What will work for me. This is what I want for me. I want doctors who address and help me reverse my illnesses. Don’t treat my diabetes, show me how to reverse it. Don’t push a statin on me, help me eat differently so that I don’t even need one. Don’t encourage me to have open heart surgery, show me Esselstyn’s diet.

What incredible bravery! Can you imagine this happening in Milwaukee?

 

Pop Quiz

  1. Functional Medicine focuses on how your body functions? T or F

Perfect. It’s that simple

  1. More than 70% of what’s wrong with you comes from your lifestyle: what you eat, your stress, your sleep, your hormones, your exercise – NOT your genes. T or F

True as it can be

  1. The reason we get fat is because our health institutions have had it wrong and teach us to eat the wrong food, and we haven’t been brave enough to name it. T or F

True

  1. The Health Care Emperor has no clothes.

About time someone named it. Thank you Cleveland Clinic

  1. American Health Care is decidedly not the best in the world anymore. T or F

True.