Thursday, March 20, 2014

Are Statins Really Your Best Solution? Please Consider the Alternative

About two years ago, I wrote a blog titled, Selenium, Statins and Super Fish Oils, Oh My (here is the link: In that blog, I described what I consider the growing enchantment between the medical community and the use of statins. It's kept growing since then.

Back in November 2013, the the American Heart Association and the American College of Cardiology issued new guidelines regarding who should take a statin. This week a new study calculated that based on these guidelines, an additional 13 million Americans should be taking a statin, bringing the total to over 56 million users, representing over one out of six Americans. It is estimated that about one-quarter of U.S. adults age 45 and older already take such drugs

Even though the FDA issued a warning two years ago that statins may raise the risk for diabetes by 9%, a subsequent study that compared the increased risk for diabetes versus the benefits of statins, concluded that the benefits won. The study found that only among those who already had the highest risk for diabetes was the risk greatest for developing diabetes from statin use.  (That's kind of funny in a very sad way as those at greatest risk of developing type two diabetes are the same as those with increased risk factors for having a heart attack such as elevated blood sugar, and obesity.) In addition, although other side effects, like liver dysfunction and leg cramping, and in more severe cases, muscle necrosis has been reported with statin use, these side effects are generally dismissed as irrelevant when compared to the 'great' benefits associated with taking statins.

So what are those great benefits? The primary endpoint is preventing a heart attack.  According to the recent study, it was calculated that if an additional 13 million people took stains, there could be 475,000 fewer heart events.  Wow, that's almost a half million fewer people suffering a life threatening event.  So that's a good thing, right?  It's really not that clear to me.

If you calculate what percent of people taking the statin would presumably (I say presumably, because it is not proven) benefit, it comes out to about 3%.  That means that 97% or over an additional twelve and a half million people would have taken the stain for no benefit, but still possibly suffered some side effect(s) along the way, such side effects estimated at higher than 3% than those deriving benefit to as high as 20% side effects among users by some reports.

To be fair, I had this discussion multiple times with my recently deceased brother, the cardiologist, who felt that if 100 people took a stain with 99 of those people deriving no benefit, but one life being spared a heart attack, than the use for all 100 was justified. How can one argue against saving a life if no real harm (let's just say that muscle necrosis and liver damage, because they are relatively infrequent don't count) is done to the others?

I'll tell you how.  People taking statins to reduce cholesterol and now based on the new guidelines, to reduce inflammation, are subject to a "licensing effect" bestowed upon them by their statin use. Before I address this "licensing effect," first let's consider some other relevant points.  Heart attacks still occur even among statin users so it's no absolute panacea.  Second, a number of heart attacks are delayed or prevented among statin users by other physician actions such as the placing of stents and bypass surgery. In almost all cases of high cholesterol and inflammation, other than familial hypercholesteremia, a genetic disorder that runs in families that results in high cholesterol levels, the overwhelming majority of people's cholesterol and vascular inflammation is under the influence of diet and lifestyle and statins buy some relatively short period of time, at best a few years,  of reprieve.

In other words, if a person taking a statin continues to consume foods and live a lifestyle that is conducive to having a heart attack, the effects of the statin are by and large mostly neutralized and nearly twice as many statin users will have a heart attack than will not. 

Unfortunately, it appears that many statin users feel like they have a "license" to keep eating all the artery clogging and inflammatory foods they want, live as sedentary life as they can comfortably endure, and not take any responsibility for what happens inside their body because they are comforted by the knowledge that they are under the care of a physician who prescribed a statin for them.

(Let's ignore for a moment that there are other major reasons we die such as cancer and strokes that are also affected by our lifestyle choices.  True, you may say, death is inevitable today so does it really matter how you go?  That's a personal preference, but I vote for avoiding such a fate and letting heaven wait for as long as possible.)

The question then remains, do we really want to have a vast majority of Americans taking pills, absolved of any personal responsibility, instead of confronting the difficult lifestyle choices that will have a far more profound affect on their overall health?

Now some reading this post may argue that most Americans are either unwilling or incapable to make the changes necessary to preserve good health and therefore pills like statins are a viable alternative.  It is difficult, albeit painful, to argue with this logic.  Nevertheless, I write to inform people taking statins that they would ultimately be better off making tough lifestyle changes than placing their bets solely on pills as such pills are not the best answer for most of you. 

No one should discontinue their use of a stain based on this post. If my words, however, resonate with you, please consider speaking with your physician and discussing how you may discontinue your statin by making some changes to your lifestyle and diet that may make such pills irrelevant and superfluous. 

Choices really do have consequences when it comes to good health.  It's your health. It's your life. Take control.

Friday, March 14, 2014

Vitamin D and Breast Cancer: Are they married or just acquaintances?

With recent headlines like Vitamin D Enhances Breast Cancer Survival, a woman could hardly be faulted for running out and stacking up on Vitamin D pills.  The meta-analysis study (a compilation of studies) upon which this headline and similar ones are based, was published in Anticancer Research and showed that the higher the Vitamin D level at the time of diagnosis, the better the prognosis. On the surface, this would suggest a cause and effect relationship.  To the untrained eye, one might conclude that raising Vitamin D levels has some type of anti-cancer effect.

However, the evidence to date would suggest that this is not the case. First, even in this study, even women with very high levels of Vitamin D were still diagnosed with breast cancer.  The higher levels of vitamin D simply meant average longer survival. So what do I think is going on?

I believe, and a recent study, which I will discuss in a moment, supports my tentative conclusion, that this is a matter of correlation between vitamin D levels and one's state of health..  As correlation does not imply causation, raising vitamin D levels artificially high with Vitamin D supplements will neither prevent cancer, as the first study clearly showed, nor improve its prognosis. Why?

In a study published in the Lancet, the British medical journal, titled,  The effect of Vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta analysis, the researchers compiled a representative group of Vitamin D studies and divided them into two groups. The first group included studies such as the breast cancer study above that showed consistently that higher levels of vitamin D correlated well with better health and disease outcomes. The second group of studies were double.blind randomized controlled studies that showed that Vitamin D supplementation versus placebo had little effect on overall health.

The authors of this study proffered what they believe to be the plausible explanation for the inconsistencies between the two groups of studies.  They tentatively concluded that raising Vitamin D levels above a certain threshold of adequacy doesn't prevent disease; rather, disease lowers Vitamin D levels.  as applied to the breast cancer study, this means that the women with the highest level of Vitamin D at the time of breast cancer diagnosis were healthier than those with lower Vitamin D levels and therefore had a better prognosis.  The worse the breast cancer, the unhealthier the patient, the lower the Vitamin D level, the poorer the prognosis.

As with all studies, one can reach no conclusive decisions from either of these studies. They merely add to our knowledge. My take-away from these studies is that Vitamin D is essential to human health and having levels above 20 mcg is essential and some say above 30 mcg. is ideal. 

The best way to get your Vitamin D remains 15 minutes of daily sun exposure to your torso/extremities. Alternatively, consuming food products with high concentration of Vitamin D like unsweetened Almond Milk and wild Alaskan Salmon are second, with Vitamin D pills coming in third. If you are taking pills because you absolutely can't do the first two then the recommended daily allowance (RDA) if you are below age 70 is 600 iu. and above age 70 it's 800 iu. That's not a typo. By the way, RDAs were developed to cover 97% of the population's needs. 

Supplementing with levels above these numbers has not been shown to have any benefit so save your money.  Again, this is what the current preponderance of evidence shows.  I'll let you know if something changes. Some large population studies are underway with expected publication in 2016 and 2017 so stay tuned.