Thanksgiving

This is going to be a quick post because it is the holiday and I’m with dear friends and family.

I know this comes a day late but I hope that everyone is not overdoing it. I think it’s ok to pig out once in a while and Thanksgiving is most definitely not exception. However my main message of moderation is still in force today as it’s ever been. I thought it was funny yesterday after dinner as many were complaining that they had overeaten. The groans permeated the house. Too many people seem to gain weight around this time and just over a month from now are making that new year’s resolution to get back in shape and keep the weight off, only to repeat the cycle for the next holiday season. Remember that diet and exercise is lifestyle, just as much as watching movies and eating junk. What you choose to do regularly constitutes your lifestyle and only you can change it. With that said, I hope everyone had an awesome thanksgiving.

Don't eat like this.....

and think you'll look like this by February

CIAO

The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Women and Statins

This post is dedicated to my mom and she is the reason I’m blogging about this subject today.

Statins make money. Lipitor is the biggest one. Just go to the following site and see;

http://www.drugs.com/top200.html

You can look back to 2003. Lipitor was on top every single year until 2010 when Nexium, a drug used for acid reflux, finally dominated. I write this post because Lipitor is going generic very soon. Nov 30 2011 and the patent expires, meaning other companies can finally start bringing atorvastatin (the generic name of the drug) to market. I’m not a fan of statins and because of this new development I felt it was time to say something about it.

Here’s a quick note about cholesterol. Cholesterol isn’t bad. it is vitally important for everything to function properly in your body. Period. Hormones, nerve conduction, cell membranes (the things that are essentially the wall of every cell) etc. cannot function properly without cholesterol. If you disagree with this you know nothing about anatomy and physiology or are paid way too much by the drug companies. Cholesterol is carried around in the blood by small particles called lipoproteins. Since cholesterol doesn’t dissolve in water, which is a good percentage of what the blood is made of, the body needs another mode of transport. Lipoproteins and proteins that also contain things like fatty acids and antioxidants and carry cholesterol around inside of them. It is the measurement of these particles that typically are referred to when someone says they have and LDL of 150.

Atorvastatin is a potent statin. It lowers LDL in the body about the same as simvastatin but at half the dose and 10x the price. The NCEP (National Cholesterol Education Program) recommends an LDL level of ≤160mg/dL. Total cholesterol levels should be less than 200. Meh.

Ladies, cholesterol is good for you! That’s right cholesterol is good for you. Anthony Colpo, an independent researcher and trainer, discusses the results of a trial at his website here. The link to the study can be found at his website or here. I also highly recommend Anthony’s book The Great Cholesterol Con for additional information about cholesterol and you. It is an incredibly well researched book.

This study showed that as women age they tend have decreased all cause death risk from increased cholesterol and trended the same way for CHD mortality risk. For men it seemed to follow a U-shape curve meaning that you don’t want you cholesterol too high or too low.

This backs what some other studies have showed, that LDL is not the boogy man that everyone makes it out to be, especially in you ladies. A meta-analysis (a study looking at a bunch of studies to get a better picture of what they all mean) was done looking at women and cholesterol reduction. The study reported the following, “For the trials reporting total mortality, lipid lowering did not appear to have a beneficial effect for women with or without previous cardiovascular disease over the 2.8- to 6-year study period in the available trials”.¹ They of course said that they probably needed more time and older women to show any benefit for overall mortality. So if you are a women and do have or do not have cardiovascular disease, your going to die either way. Surprise! Now they did show reductions for women who have history of cardiovascular disease for non-fatal MI’s, CHD events, and revascularization, but your still going to die, just probably not of a heart attack.

How does atorvastatin tie in to all of this. Soon insurance companies are going to be more likely to cover the drug once the price comes down. Some times docs will choose atorvastatin over simvastatin or pravastatin because of its ability to lower LDL so much. With the price reduction some doctors may feel they should just put it on the regimen for a woman whose cholesterol levels are over 200. I don’t think this necessary. I believe there are other ways to manage cardiovascular risk that leaves your cholesterol to do what it’s supposed to do.

Ladies if you have a family history of CHD start looking at you diet and activity levels. Are you filling your mouths full of refined grains and/or vegetable oils? If you are then stop. Do you need to lose some weight? Then do it. For you diabetics out there, find whole foods that help control your blood sugar. With time, diet and the right kind of exercise, you can and should be able to reduce the need for medication. I counsel people daily about the need to get simple things out of their life (corn oil, daily soda drinks and junk food etc.) and get good simple things INTO their lives like rest, good exercise and whole foods. I also recommend Coenzyme Q10 or ubiquinol for many people taking or not taking medication. It is a great supplement with documented heart health benefits. We’ll have to discuss that one in another post.

If yoga grandma can do it, so can you!

So ladies, if your doctor wants to put you on atorvastatin, especially now that it is going to be generic, ask him about these studies and see what happens. I think education is a great tool and knowledge is readily available. Use the internet to access primary articles and learn how to read them. Ask questions constantly. Knowledge ceases when one stops asking and the mind begins to dull.

Ciao

The Brute

1.Walsh JM, Pignone M. Drug Treatment of Hyperlipidemia in Women. JAMA. 2004; 291 (18): 2243-52

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Your Pharmacist

Something on my mind lately had been the idea of who people use for the healthcare. Most people think first of their doctor. Usually when something goes wrong with the body the doc is the first one to hear about it, barring loved ones of course. I’ve heard from some people over the years about how they weren’t that impressed with a certain doctor or nurse practitioner and the only thing I can tell them is, “FIND SOMEONE ELSE!”

Some people already have figured this out and they will search a doctor they like and works with them. Unfortunately for some insurance dictates which doctor and/or pharmacy one can use. For those of you…keep a stiff upper lip and start learning about health and diet through reading. It takes time and effort, a whole lot of effort, but it can be done.

If your doctor/pharmacist looks like this and gives you the time of day, more power to ya!

             

To the rest of you I would ask you consider the following; choose your pharmacist like you would choose your doctor. Go to a pharmacy where you can talk with your pharmacist like you would talk to your doctor. You might even get a few minutes more over your doctor. What a benefit to be able to talk with a healthcare professional without the hassle of an appointment. Some pharmacists will not oblige this very much. Some want to fill your script as fast as they can and say as little as possible because they have so much to do. Pharmacists like doctors have become very busy in the last 15 years. I know some people like to go to Walmart of other pharmacies where they have the $4 dollar generic list. I urge against this unless there is a pharmacist there that you can talk with and that is interested in you and not how fast they can get you outta there.

Where I work it can get crazy busy. So busy in fact that I seem to have time to do nothing because I’m being pulled in 3 or 4 ways at once. It’s not very fun at times. No matter what happens though, I think it important to give my patients the time of day. Some of them have been waiting for 30 min while we figure out where their script is, get insurance problems corrected and fill it to be able to dispense. I think it fair to give them some of my time if that is what they need.

One example of how spending a little time with a patient helped them enormously was with a diabetic patient who was having problems with her glucose meter. She had gone through almost 40 strips trying to get the thing to work properly, not to mention all the times she poked herself in the fingers to get all that blood. I couldn’t find anything wrong with the meter whatsoever. She said it just wouldn’t work. Everything looked good when I used. Not one problem but she insisted something was wrong. After spending  a good 5 min with her I finally asked how she was using it. After watching I noticed the problem; she was putting the blood on top of the strip where it couldn’t get into the sensors. After explaining it needed to go on the side, she thought herself a bit dumb for not knowing this. I reassured her it was fine and we refilled her strips because she was out.

The aforementioned was just one example of what I get to do everyday. Some patients don’t seem to give a rat’s behind about any of their meds. The doctor told them to take them and that’s the end of it. I find this unfortunate. Know what a medication is and why you’re taking it. If the doctor won’t tell you, then get a new one. If the pharmacist won’t talk with you about it, then get a new one. If two pharmacists are on duty and you want to talk with one specifically, then request it and don’t give up till you talk with him/her.

Remember, it’s your health that is being treated not your providers’. Got to someone that you feel is competent and helpful (they don’t go hand in hand). If your doc/pharmacist makes others or you look/feel like this:

then it’s time to fire his butt!

CIAO

The Brute

Exercise and Diabetes

So today I want to talk about something that should be common sense and everyone knows but few seem to practice.

Back in the 70’s and 80’s movies like Rocky , Commando, Predator, Rambo and the like came to be very popular movies. I watched myself as a kid and was amazed at the awesome physiques of these bigger than life men. Gyms began to be more and more popular, fitness magazines began to really take off and the supplement industry flourished. The fitness industry was in full swing. Passing fad or ingrained culture? I argue a bit of both. Unfortunately I think some of those that advocate exercise sometimes overdo it and those that don’t exercise probably should.

                                                                                                          

It was movies like Predator and Rocky IV that first got me interested into lifting weights and being fit

Diabetes is a growing problem not only in the United States but around the world. According to the US Dept. of Health and Human Services, about 25.8 million people of all ages have diabetes in the US, or about 8.3% of the population. That figure is 18.8 million people with an actual diagnosis and 7 million or so who they consider undiagnosed. The following is also reported at the website:

  • Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.
  • About 215,000 people younger than 20 years had diabetes—type 1 or type 2—in the United States in 2010.
  • About 1.9 million people ages 20 years or older were newly diagnosed with diabetes in 2010 in the United States.
  • In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had pre-diabetes—50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with pre-diabetes.
  • Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the United States.
  • Diabetes is a major cause of heart disease and stroke.
  • Diabetes is the seventh leading cause of death in the United States.①

The following chart shows incidence of diabetes mellitus (DM for the rest of this post)

Caucasians have the lowest incidence while American Indians have the highest.

I work with diabetics all the time in the pharmacy. Some seem only to care about getting their insulin or oral medications and care little for the lifestyle that could reduce or even eliminate their need for medication. One patient doesn’t even care about his blood glucose (BG) readings or the impact the disease will have on his life. It will take his life because he doesn’t care.

For many the reality of diabetes doesn’t hit home until a toe is amputated or vision becomes a serious problem. Kidneys can be ravaged by high BG levels and let us not forget the all important arteries. DM is a major risk factor for heart disease.

So why bring up exercise and diabetes? The association is brutally obvious. At least it better freaking be! In one study done in older males aged 60-80 years, hemoglobin A1c (essentially the measure of how much sugar has been hanging around in your blood for the last 3 months) fell significantly in a group of subjects who were using weight training and weight loss vs a group who used only weight loss. The decrease was 1.2±1 vs 0.4±0.8% respectively.③ A drop like that can be seen in drugs like metformin.

Brisk walking can also bring great health benefits. In one analysis, “Minimal adherence to current physical activity guidelines, which yield an energy expenditure of about 1000 kcal·wk-1 (4200 kJ·wk-1), is associated with a significant 20-30% reduction in risk of all-cause mortality.”④

Medical Studies like the UKPDS have shown that over time, conventional therapy vs intensive therapy with insulin and sulfonylureas (a class of drugs that increase insulin secretion in the pancreas) found that no significant difference was found in macrovascular disease (disease of the major blood vessels in the body such aorta, coronary arteries etc). In the study it was found that after 15 years of following over 3000 patients, A1c increased over time.⑤ That seems to imply that even with treatment, BG control dwindles. The tighter control also had more incidence of hypoglycemia, which is a problem in and of itself. Maybe they should have implemented some exercise routines in with that tight BG control and they would have had some better outcomes.

Exercise is nature’s answer to DM, along with good diet. I do not…..I repeat, I DO FREAKING NOT recommend fad diets. Waste of time and money. Eat whole foods and nutrient dense foods such as vegetables, lean meats, and good sources of fat such as butter and coconut oil. If you’re trying to lose weight, try eating less than you burn. Yes there is some merit to the whole “calories in vs calories out”. I will probably address this concept in a later post.

Another note about exercise; it has to be done to keep the benefit. When you stop, the benefit goes away. It annoys me when people tell me what they could do and now can do nothing. I fell into that trap myself with weight lifting and aerobic health. What I could do just 3 short years ago I can’t do now. I’m back on the road to get my fitness back to where it was. (don’t get me wrong, I’m no slouch and have no problem tossing my wife around when we dance and I can still grapple my 16 year old nephew and make him tap out), but I’m not where I should be and I think that is part of the impetus of writing this post.

If somebody is beginning exercise to increase their health, please do so with supervision of a doctor or trainer who can help prevent injuries and create a diet that works for you. One size doesn’t fit all with diet and exercise and what works well for one, doesn’t always work well for another.

CIAO

The Brute

  1. http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#fast   Retrieved  11/6/11
  2. http://www.aacc.org/publications/cln/2007/Oct/Pages/newsbrief_1007.aspx  Retrieved 11/6/11
  3. Dunstan DW, Daly RM, Owen N, Jolley D, de Courten M, Shaw J, Zimett P: High-intensity resistance training improves glycemic control in older persons with type 2 diabetes. Diabetes Care 25:1729–1735, 2002
  4. Lee IM, Skerrett PJ. Physical activity and all-cause mortality; what is the dose-response relation. Medicine and Science in Sports and Exercise, 2001; 33 (6 Suppl): S459-71
  5. UKPDS Group. (1991) UK Prospective Diabetes Study VIII: Study design, progress and performance. Diabetologia 34, 877–890

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.