“Good cholesterol” not that great; “bad cholesterol not so bad”

Supposedly you want your HDL cholesterol level to be high and your LDL cholesterol level to be low.  HDL is supposedly the “good cholesterol” and LDL is the “bad cholesterol.” Doctors knock themselves out trying to raise their patients’ HDL levels and lower their LDL levels. This is looking to be misguided (as I’ve said all along). A recent study in the European Heart Journal followed more than 116,000 men and women for an average of six years. They found that men with an HDL level of 73 milligrams per deciliter had the lowest all-cause mortality; those with a level of 97 to 115 had a 36 percent increase risk for death. That is, those with the lower level were less likely to die than those with the higher level. This is the reverse of what we’ve been told (although if your HDL is very low—under 39—that’s not a good thing either).

LDL cholesterol is supposedly the “bad” cholesterol. In a systematic review of studies that looked at mortality of people over 60 found an inverse relationship between the level of LDL cholesterol and mortality. “We didn´t find any study having shown that high LDL-cholesterol is a risk factor for elderly people.”   In other words, those people over 60 with high LDL lived the longest.

Well, some studies have shown you can prolong your life by taking statin drugs—by about four days. Researchers from the University of Southern Denmark did a systematic review of all statin trials that compared statin treatment to a placebo. For people who were treated as a preventive measure, the average postponement of death was 3.2 days; for people who had already had a heart attack, death was postponed by an average of 4.1 days. The trial that showed the longest postponement of death, that postponement was 27 days. In the trial with the worst outcome, life was shortened by an average of 10 days.

Just forget the whole business and don’t worry about your cholesterol.

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Medical tourism: Dang! Why didn’t I think of that?

A while back I had a tooth implant. It cost me thousands of dollars out of pocket. I could have saved a lot of money and had a vacation by having the work done in another country. It never occurred to me to do that. Recently, my friend Donna mentioned that a friend of hers was considering this option. It turns out that, in 2016, 1,400,000 Americans traveled abroad for medical treatment—just nobody I know.

The most popular places are Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, and Turkey. The most popular procedures are cosmetic surgery, dentistry, cardiovascular, orthopedics, cancer, weight loss surgery, and reproductive treatments, such as in vitro fertilization.

You can find lots of information on this topic. A good Web site is Patients Beyond Borders. They have vetted the places they recommend, and the criteria include “successful adoption of best practices and state-of-the-art medical technology,” as well as international accreditation, quality assurance, transparency of outcomes, and internationally-trained, experienced medical staff. People typically spend $3,800-6,000 for such a trip, including medical costs, transportation, inpatient stay, and accommodations. The savings range from 20-30% (Brazil) 65-90% (India).

Accommodations can be fabulous, especially if you’re having cosmetic surgery in Costa Rica, as this photograph from Conde Naste Traveler magazine shows.

“Chetica Ranch resort offers...personal cottages that overlook 80 acres of lush tropical forest and mountains home to wild horses. Meals are made with organic produce and local meat is smoked in the outdoor barbecue pit. Guests can sign up for daily lymphatic massages.”

Julie Munro is president of the Medical Travel Quality Alliance, an international organization that evaluates and monitors medical standards at hospitals around the world. She notes, and I would agree, that “Quality of care is not nearly as good in America as we tend to think.” You can go elsewhere. One medical tourist writes, “It is hard to recommend taking a 19-hour flight with a toddler to get a root canal with a straight face. But after going on just such a mission in December, I will aim to get all future dental work done in Thailand.” I wish I’d thought of that for my implant.

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Get thin by eating big breakfasts!

In an earlier post, I wrote that the old saw “breakfast is the most important meal of the day” was created by Kellog as a way to promote his breakfast cereals. In that same post, I said that research had shown that skipping breakfast does not promote weight gain. Now, I discover that making breakfast the biggest meal of the day has all kinds of health and weight benefits.

A study of 50,000 Seventh Day Adventists over seven years showed that you’re better off eating big breakfasts, then tapering off to a small lunch and light dinner—or no dinner at all. The people who ate their largest meal early in the day were more likely to have a lower body mass index (BMI) than those who ate a big lunch or dinner. Those with the lowest BMI finished lunch by early afternoon and did not eat again until the next morning—that is, they fasted for 18 or 19 hours.

In another study, obese and overweight women were all put on an identical 1,400-calorie-a-day diets. Half the women ate most of their calories at breakfast and half ate most of them at dinner. Those who ate the large meal in the morning lost two and a half times as much weight as those eating a large dinner. Plus they lost more body fat and had better glucose levels. One researcher notes, “We observed that the time of the meal is more important than what you eat and how much you eat.”

Our bodies are built to feast and fast. (See my post on fasting.) For one thing, the digestive process and the action of insulin are at peak performance early in the day. That is, our bodies use the nutrients most efficiently at that point. At night, your pancreas is literally sleeping. So if you eat late at night, you don’t have enough insulin to handle the glucose, and your blood glucose stays high up to three hours. It’s called “evening diabetes.”

All very convincing, but tough to pull off. Can you imagine eating a huge meal in the morning? And what happens to cocktail hour?

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Oops! Maybe you don’t need to take that full course of antibiotics after all

You know how the doctor tells you to take all the antibiotic pills he/she prescribes? That advice may be all wrong. Supposedly the point of taking the full course of pills is to kill off any bugs that may have developed resistance to the antibiotic. That is, you’ll be sure to kill off the tougher bugs if you take all the pills in the bottle.

That doesn’t make sense. Why would some of the bugs develop resistance if you stop taking your antibiotics? A biological engineer from MIT says “The risk you run,” he said, is that “the longer you use antibiotics, you increase your risk of developing resistance.” More bugs have more opportunities to develop resistance and those bugs proliferate.  

Current experiments on streptococcus have shown that the susceptible bugs were killed by antibiotics within three days of taking the drug. But the bugs that were resistant to the antibiotic were still hanging around in low numbers six months after the initial treatment. In Darwinian terms, this amounts to survival of the fittest.

It turns out that the medical community doesn’t really know the optimal dose required to kill off various pathogens. (Exceptions: if you have tuberculosis or a staph blood infection, take all the pills.) As one researcher says, the idea of taking a full course of antibiotics “has come down from our forefathers and is not based on modern scientific evidence.”

Apparently, not much research has been done to determine the optimal dosing for killing bad bugs and at the same time avoiding the development of resistance. Some scientists are now trying to figure this out. But it’s very tricky business. As another researcher says, “It’s a very complex relationship between antibiotic use and resistance, and every antibiotic has selection potential” (that is, the potential to encourage the growth of resistant bugs). To get it right, they have to do experiments with each bad bug to get the right antibiotic and right dose.

Sounds like right now it’s a bit of a crap shoot.

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