More reasons not to worry about your cholesterol

As I mentioned in an earlier post, I don’t care what my cholesterol levels are and refuse to have it checked. Your liver manufactures cholesterol for a reason: for one thing, it’s a major building material of our nervous systems. I say leave it alone. Pharmaceutical companies, and many (most?) doctors continue to press for cholesterol-lowering drugs in the questionable belief that they protect you from cardiovascular disease.

Recently a new cholesterol-lowering drug (evacetrapib) was rigorously tested on 12,000 patients (actually, half of those patients received a placebo). The hope was that this new drug could replace statins, which have nasty side effects--such as muscle cramping, muscle weakness, and mental disturbance. The new drug lowered the “bad” LDL levels by 37 percent and doubled the level of the “good” HDL cholesterol. The result: 434 people taking the drug died from cardiovascular disease, such as a heart attack or stroke, compared with 444 who were taking a placebo. In other words, dramatically changing cholesterol levels had no effect on heart disease. As one of the investigators said: “How can a drug that lowers something that is associated with benefit not show any benefit?” To me it shows that all this cholesterol-lowering business has no benefit.

As to statins, Professor Harumi Okuyama of Nagoya City University in Japan, reports that industry-sponsored studies that purportedly show the benefits of statins are “unreliable.” “We have collected a wealth of information on cholesterol and statins from many published papers and find overwhelming evidence that these drugs accelerate hardening of the arteries and can cause, or worsen, heart failure. I cannot find any evidence to support people taking statins and patients who are on them should stop.” The researchers found that patients taking the drugs were more likely to have calcium deposits in their arteries, a phenomenon directly linked to heart attacks. The reason for this is that statins block a molecule needed for the body to produce a vital K vitamin, which prevents calcification of the arteries.

I think it’s a particular shame that otherwise healthy people are turned into sick people who need drugs simply because their cholesterol numbers don’t measure up to some questionable standard. Leave me out of it.

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Prefer to skip breakfast? It's OK.

We’ve always heard that “breakfast is the most important meal of the day.” That old saw appears to have had a number of origins—but they all point to breakfast food companies. Apparently it first appeared in a 1917 issue of “Good Health,” a magazine edited by Dr. John Harvey Kellogg (I’m sure you’ll recognize that name). In the 20’s, a public relations guru led a nation-wide campaign on the importance of eating a hearty breakfast, which was spun as doctors’ advice. This guru, by the way, was Sigmund Freud’s nephew and is considered the father of public relations. The campaign was on behalf of his client, Beech-Nut Packing Company, which sold bacon and other pork products.

More recently breakfast food companies have promoted the claim that skipping breakfast causes weight gain. Rigorous scientific studies have found no evidence to support that claim. The most recent experimental study, published in February, found no difference “in weight change and most health outcomes between people assigned to eat breakfast for six weeks and those assigned to skip it.” So skip breakfast if you can’t face it in the morning.

The New York Times Magazine did a poll asking their readers how many days of the week they eat breakfast. Surprisingly (to me), 75% ate breakfast every day; 6% never ate breakfast; the rest were in between (they ate breakfast some days). I'm not sure what the results mean: Times readers believe it's "the most important meal of the day"?  Breakfast eaters were more likely to respond to the poll? Most people eat breakfast every day?

I’m not particularly hungry first thing, but I crave orange juice or grapefruit. Normally I eat grapefruit, a couple of eggs and buttered toast for breakfast. (We go through two or three dozen eggs a week.) Nevertheless, by 10:30 I’m hungry again. Healthy appetite.

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Back pain again: new studies

Sixty-rive million Americans suffer from chronic lower back pain. Recurring back pain often creates what researchers call “spiral of decline:” you take to your bed or couch because of the pain. This inactivity weakens muscles and joints, leaving your back and core even more feeble which then leads to more pain and more inactivity—and so on.

A new study of back pain, published in JAMA Internal Medicine, began by looking at 6000 previously-published studies on the topic of back pain prevention. Of this number, they found only 23 studies that they considered to be reliable. Those 23 studies looked at 30,000 people with back pain. The prevention techniques under review included education about lifestyle changes, shoe orthotics, back belts, various types of exercise programs, and exercise programs that also included some type of education about back pain prevention. 

Here’s what they found: educational efforts alone, back belts, and orthotics were almost completely ineffective. But exercise programs, either with or without an educational element, proved to be effective in preventing recurrences of back pain. In fact, according to one researcher, “the size of the protective effect” from exercise “was quite large.”  Exercise combined with education reduced the risk of an episode of low back pain in the next year by 45 percent. “Of all the options currently available to prevent back pain, exercise is really the only one with any evidence that it works.”

Interestingly, the type of exercise program didn’t matter: some regimens focused on strengthening muscles in the core and back; others combined aerobic conditioning with strength and balance training. But here’s the rub: stopping the exercise regimen will also halt its protective effects.

A technique called “mindfulness-based stress reduction” also works for some people. It’s a combination of meditation, body awareness and yoga and focuses on increasing awareness and acceptance of one’s experiences, whether they involve physical discomfort or emotional pain. The trick with this one is to find a certified instructor.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Getting the diagnosis right

So this man can’t breathe; he feels like he’s drowning; he’s coughing and his chest is painful. At the hospital, doctors can’t find the source of his problem. He doesn’t appear to have an infection and has no fever. But an X-ray does show cloudy white patches over both lungs. The docs decide he has congestive heart failure and they begin treating him for that. But his coughing and chest pain continue. He decides to go to a big university hospital for a second opinion. There, the docs talk with one another about what this could be. One doc has an idea.

It turns out he is having an allergic reaction (pneumonia) to an antibiotic (Cubicin) he’s taking for an infection following knee surgery. The allergic reaction is caused by his own white blood cells, called eosinophils (don’t ask me how to pronounce it). Normally, these cells play a central role in defending our bodies against parasites, but sometimes they run amok. Diseases, such as asthma and eczema are caused by eosinophils overacting to environmental triggers and releasing an excess of chemicals such as histamines. Eosinophilic pneumonia can be triggered by medications, including non-steroidal-anti-inflammatories, such as Advil, and also by drugs of abuse such as cocaine. It can also be triggered by chemicals including cigarette smoke and sulfites. Who knew? I certainly didn’t.

The reasons I’m sharing this with you are these: I think it’s interesting; it shows how the delicate mechanisms in our bodies can be thrown out of whack; it shows the importance of information sharing—of asking others for help.

Speaking of getting help: it’s on the way. IBM’s Watson, the program that beat Ken Jennings in Jeopardy, is accumulating tons of medical data for making diagnoses. So far, according to Forbes, “Watson has analyzed 605,000 pieces of medical evidence, 2 million pages of text, 25,000 training cases and had the assist of 14,700 clinician hours fine-tuning its decision accuracy." Considering that one in twenty adults are misdiagnosed every year, I think Watson will be a terrific asset.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.