High cholesterol problem

[TromboneAl]

How many of you spent more time choosing a doctor than choosing a car?

 

[Bluemoon]

So how do we explain my MIL who had high cholesterol (around 300) and lived to nearly 95 with no indication of heart disease? There is much more going on that we understand when it comes to heart disease and cholesterol.

This article pretty much sums up my and my doc's opinion on cholesterol numbers and there relevance to heart attack risk.

What your cholesterol number really says - CNN.com

The article also states "A class of drugs called statins lowers LDL cholesterol."

 

[Mulligan]

So how do we explain my MIL who had high cholesterol (around 300) and lived to nearly 95 with no indication of heart disease? There is much more going on that we understand when it comes to heart disease and cholesterol.

This article pretty much sums up my and my doc's opinion on cholesterol numbers and there relevance to heart attack risk.

What your cholesterol number really says - CNN.com

There was another link inside the article that said what ED says about your heart. I was hoping to find if you dont have ED your heart is great. But unfortunately the link didnt even mention ED in it! Still it was interesting reading and mentioned a few rather inexpensive tests. It does seem to keep appearing more often in articles that " the numbers alone" do not tell the whole story.

 

[ERD50]

How many of you spent more time choosing a doctor than choosing a car?

It's easy to find comparative info on automobiles, both subjective and objective. Not so with doctors.

So yes, for me the answer is more time choosing a car.

I wonder which choice has more influence on your health? A safer car and safer driving habits might be more important than anything else you do regarding exercise and diet ? I don't know, just wondering aloud.

-ERD50

 

[HawkeyeNFO]

It seems to me that we all need to eat healthy and get some exercise. And it also seems that doctors are quick to prescrbe drugs for every little thing that could be a problem, partially because the drug companies have a very good sales force who persuade them to push their products. And statins are the best example of this that I can think of.

In contrast: The Cholesterol Myths

 

[Katsmeow]

It seems to me that we all need to eat healthy and get some exercise. And it also seems that doctors are quick to prescrbe drugs for every little thing that could be a problem, partially because the drug companies have a very good sales force who persuade them to push their products. And statins are the best example of this that I can think of.

In contrast: The Cholesterol Myths

The problem that I see with this list at the above link is simply that it is a list of assertions that I have no reason to believe or not believe. I think that at times we can be eager to go against the "conventional wisdom" and just assume that contrarian positions are correct.

You can certainly go on the Internet and find plenty of stuff that says that statins are unnecessary and that high cholesterol, etc. doesn't matter. The problem is that you can certainly find plenty of stuff to the contrary.

For example some studies talking about the benefits of statins for some people:

Statins: Are these cholesterol-lowering drugs right for you? - MayoClinic.com

Medical News:Both Sexes Enjoy Statin Benefits - in Cardiovascular, Dyslipidemia from MedPage TodayStatin Benefits Patients With Low LDL Cholesterol

The benefits of statins in people without established ca... [BMJ. 2009] - PubMed - NCBI

 

[obgyn65]

Hi ERD50

Clinical guidelines, protocols, and recommendations can be found at AAFP, Epocrates, or at the National Guideline Clearinghouse. For example try National Guideline Clearinghouse | Home and search "diabetes" to find Screening and Management details. You can also find guidelines and protocols at associations' websites, i.e.
https://www.aace.com/publications/guidelines

I also use sometimes emedicine or 5 minute consult to find additional information re: latest treatment protocols. I am sorry that the situation looks like a mess to you.

Which ones are those, and how do we know that the 'right protocols and recommendations' are really what is best?

 

[haha]

Hi ERD50

Clinical guidelines, protocols, and recommendations can be found at AAFP, Epocrates, or at the National Guideline Clearinghouse. For example try National Guideline Clearinghouse | Home and search "diabetes" to find Screening and Management details. You can also find guidelines and protocols at associations' websites, i.e.
https://www.aace.com/publications/guidelines

I also use sometimes emedicine or 5 minute consult to find additional information re: latest treatment protocols. I am sorry that the situation looks like a mess to you.

These are documents hammered out by committees, which may have members who just like congressmen have their constituencies. The protocols are not the original journal papers, and they may not very faithfully reflect all the evidence, including the unpopular evidence.

The studies are usually easy enough to find, although it takes an excellent medical library to carry paper copies of even all the main journals, and sometimes various journals restrict electronic access to subscribers.

At any rate, the large, randomized clinical studies mostly show some improvement in both all cause mortality, and specifically cardiovascular mortality. But it is small, and given the various side effects and occasional disasters it seems like a rational decision to at least consider sitting out this game.

OTOH, statins are very good at treating LDL numbers, and doctors are very good at focusing on LDL numbers. So it's kind of a marriage made in heaven from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.

Ha

 

[ERD50]

Hi ERD50

Clinical guidelines, protocols, and recommendations can be found at ...

Thanks for the reply, but it leaves me hungry. Haha's post echoes my sentiments.

And specifically:

OTOH, statins are very good at treating numbers, and doctors are very good at focusing on numbers. So it's kind of a marriage made in heaven, from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.

Ha

Yes, exactly! And I have a lot of empathy for the Doctors on this. Let's be real - they have a job to do, and are pressed for time, and with all these variables and the inability to really control the environment of the patient, it's tough to really know what is best. But if a number is considered 'bad', and prescribing a drug makes that number 'better', it makes the Doctor look good (and he/she may well be doing good). Who wouldn't want to do something that makes them appear to be doing good? So I suspect there is some built in bias on the Doctor's part to prescribe these statins. The numbers come down (they almost always do), so it all looks good, everyone (Doctor & patient) appears to be happy. As haha says 'a marriage made in heaven'.

But, did fixing the 'number' really improve the patients (on average) quality of life? That's not so clear to me. My doctor has me on statins, but he did give me 6 months to try exercise/diet, so I'll give him some credit there, it wasn't a totally automatic reaction. But I also know it means coming back every six months for Lab work, and that means regular $ in his pocket. That's fine if it is needed, but does it cloud his judgement? A little? A lot? Not at all? Who knows?

My son is in his third year of Pharmacy school, I guess I should challenge him on this, see what he's got.

-ERD50

 

[Mulligan]

Thanks for the reply, but it leaves me hungry. Haha's post echoes my sentiments.

And specifically:

Yes, exactly! And I have a lot of empathy for the Doctors on this. Let's be real - they have a job to do,and are pressed for time, and with all these variables and the inability to really control the environment of the patient, it's tough to really know what is best. But if a number is considered 'bad', and prescribing a drug makes that number 'better', it makes the Doctor look good (and he/she may well be doing good). Who wouldn't want to do something that makes them appear to be doing good? So I suspect there is some built in bias on the Doctor's part to prescribe these statins. The numbers come down (they almost always do), so it all looks good, everyone (Doctor & patient) appears to be happy. As haha says 'a marriage made in heaven'.

But, did fixing the 'number' really improve the patients (on average) quality of life? That's not so clear to me. My doctor has me on statins, but he did give me 6 months to try exercise/diet, so I'll give him some credit there, it wasn't a totally automatic reaction. But I also know it means coming back every six months for Lab work, and that means regular $ in his pocket. That's fine if it is needed, but does it cloud his judgement? A little? A lot? Not at all? Who knows?

My son is in his third year of Pharmacy school, I guess I should challenge him on this, see what he's got.

-ERD50

I wonder how many doctors maybe actually would like to have their patients try diet and exercise first, but think its inevitable they wont change and follow through, so they figure better just start the statin since they wont change their lifestyle in any appreciable manner. I do have a few friends on statins and they gladly state they would just rather take a pill "to fix the problem" than change their lifestyle.

 

[obgyn65]

Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

These are documents hammered out by committees, which may have members who just like congressmen have their constituencies. The protocols are not the original journal papers, and they may not very faithfully reflect all the evidence, including the unpopular evidence.

The studies are usually easy enough to find, although it takes an excellent medical library to carry paper copies of even all the main journals, and sometimes various journals restrict electronic access to subscribers.

At any rate, the large, randomized clinical studies mostly show some improvement in both all cause mortality, and specifically cardiovascular mortality. But it is small, and given the various side effects and occasional disasters it seems like a rational decision to at least consider sitting out this game.

OTOH, statins are very good at treating LDL numbers, and doctors are very good at focusing on LDL numbers. So it's kind of a marriage made in heaven from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.

Ha

 

[obgyn65]

See my answer to Ha. It's ok to disagree, ERD50

Haha's post echoes my sentiments.

 

[Moscyn]

The more I read, the more confuse I become. What do my numbers really mean? In any case, I don't want my bad cholesterol to go higher and I know I won't want to go on medication for high cholesterol. Someone in the thread asked me to check my triglycerides which is ok standing at 0.9 mmol/L. I guess I need to heed the doctor's advice to limit the high cholesterol food I take. So, here's my action plan:-

Food Intake - (a) take oatmeal with almond flakes/bananas (great suggestion from some of the contributors in this thread). Unfortunately, DH bought 2 large bags of instant oatmeal - so will finish those before I buy the non-instant ones. (b) Include fenugreek in my diet - I have friends who swear that this will work. (c) Cut down (but not eliminate) on red meat (which I love), animal skin, liver, egg yolks, sausages, cheese and similar high cholesterol products. (d) Eat more fish, vegetables, fruits and nuts. (e) Hopefully, very hopefully, eat less carbohydrate.

Exercise - increase my exercise level to ensure my heart gets a good cardiovascular exercise. I already exercise 6 days a week. Now, I will push myself at each exercise session - just bought a new pair of running shoes - it's time to start serious jogging again to replace the usual brisk walk.

My medical report suggests I take my blood test again in 4 months time - wonder whether this is really necessary. Will check with the doctor in due course. Hope all this will work!

 

[obgyn65]

Sounds good. Also avoid tobacco, drugs, alcohol (the usual culprits). What you write in your post is a good start. Keep us informed and good luck.

I guess I need to heed the doctor's advice to limit the high cholesterol food I take.

 

[Ronstar]

DW and I had advanced lipids testing done by the same doctor at the same time in December. We got a call to come to the doctor's office for a consultation. My numbers were good - DW's not so good. She has a better diet than I, but gets less exercise. DW asked the doctor why her numbers were not as good as mine, and the doctor said heredity and amount of cardio. So the doctor put her on Lipofen and told her to do some hard cardio.

 

[Buckeye]

The more I read, the more confuse I become. What do my numbers really mean? In any case, I don't want my bad cholesterol to go higher and I know I won't want to go on medication for high cholesterol. Someone in the thread asked me to check my triglycerides which is ok standing at 0.9 mmol/L. I guess I need to heed the doctor's advice to limit the high cholesterol food I take. So, here's my action plan:-

Food Intake - (a) take oatmeal with almond flakes/bananas (great suggestion from some of the contributors in this thread). Unfortunately, DH bought 2 large bags of instant oatmeal - so will finish those before I buy the non-instant ones. (b) Include fenugreek in my diet - I have friends who swear that this will work. (c) Cut down (but not eliminate) on red meat (which I love), animal skin, liver, egg yolks, sausages, cheese and similar high cholesterol products. (d) Eat more fish, vegetables, fruits and nuts. (e) Hopefully, very hopefully, eat less carbohydrate.

Exercise - increase my exercise level to ensure my heart gets a good cardiovascular exercise. I already exercise 6 days a week. Now, I will push myself at each exercise session - just bought a new pair of running shoes - it's time to start serious jogging again to replace the usual brisk walk.

My medical report suggests I take my blood test again in 4 months time - wonder whether this is really necessary. Will check with the doctor in due course. Hope all this will work!

Start with (e).

 

[braumeister]

More and more, I'm becoming convinced that this is a religious dispute. Those that subscribe to the cholesterol hypothesis and those of the low carb persuasion are just practicing different religions. Neither is likely to convince the other to cross over to the dark side (although it happens).

This is probably my final post on the topic, because I really don't see the value in further discussion of it.

 

[obgyn65]

I agree. There is one side that understands, interprets, accepts and applies medical science. The other side does not. And it's ok - part of my job is to educate my patients too...

More and more, I'm becoming convinced that this is a religious dispute.

 

[JOHNNIE36]

Very interesting thread. It tells me one thing--people are thinking about their health. I take a statin myself to keep my LDL as close to 100 as I can get. However, I recently dropped my dosage to 40mg/day instead of the 80 I was taking. Going for a blood test next week to see how the numbers stack up. I have read too many articles lately about the damage statins can do the muscles and that article said to stay from the 80mg simvastatin. So I'm trying it.

I used to play golf with a cardiologist who told me there are 5 things that contribute to heart trouble. Genetics, obesity, high blood pressure, smoking and cholestrol. Genetics is #1 by a big margin. If you have good genes but also one of the other factors, no problem. Good genes and two of the other factors, be concerned. Good genes and three of the other factors you are in trouble and need to be under the care of a cardiologist.
You can't do anything about the genes but you can control all the others. It's up to you.

That was 20 years ago. Studies and information and drugs now make it easier to control the variables.

 

[rgarling]

these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

There is one side that understands, interprets, accepts and applies medical science. The other side does not.

Assuming you actually understand, interpret and accept "medical science" correctly, how can you apply it to your patients situation? What we learn today will not show its face in the conventional wisdom (and your treatment protocols) for many years. In the interim, your patients suffer.

 

[REWahoo]

these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

Sometimes you frighten me.

 

[Bestwifeever]

It's too bad some people here don't seem to have a good enough relationship with their doctors that they can't ask them to explain exactly why something is prescribed and what the alternatives would be and why the alternatives might or might not be better/equal/worse. DH has such a relationship with his doctor and is on statins (his MD doctor, a department head at a major teaching hospital also "prescribes" things like saw palmetto and practices acupuncture). Would DH ever not follow his doc's directions? No.

 

[haha]

Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

I completely understand what you are saying. It has much to do with the point I was trying to make. There are constraints on a doctor's freely derived opinions of evidence. You can't get picked off if you are in the middle of the herd. That is one reason why it may be naive to believe that doctor always knows best, at least as judged by what he says which as you point out might be different from his unfettered judgment.

Like ERD50 says, it's a mess.

Ha

 

[TromboneAl]

Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

This, for me, explains why good doctors can give bad advice. I've heard many say that the doctor may feel that the conventional wisdom is wrong, but he/she still follows it because not doing so would put him/her at risk of a lawsuit. Thanks for the direct confirmation. Wow.

 

[TromboneAl]

More and more, I'm becoming convinced that this is a religious dispute. Those that subscribe to the cholesterol hypothesis and those of the low carb persuasion are just practicing different religions. Neither is likely to convince the other to cross over to the dark side (although it happens).

This is probably my final post on the topic, because I really don't see the value in further discussion of it.

That is exactly right. As Martha once pointed out, once someone has taken a position, arguments against it simply harden his views.

I often ask myself whether this is the case for me. However (1) I used to be very anti-low-carb pro whole grains and (2) I would much rather believe what most people believe. Being a low carber can be very inconvenient.