Friday, May 27, 2011

Magic Pills? Not Really

Niacin Doesn't Improve Mortality
This study examined the effect of taking a dose of niacin, to raise HDL, with a statin, which lowers LDL.  It proved to be more dangerous than not taking the niacin, even though the two drugs had the expected effects of raising/lowering HDL/LDL respectively.  The doctors and scientists reportedly said about this - "We don't know why." 

Consider this perspective.  If you have LDL levels outside of the so called norms, and take a statin to lower the LDL, you get largely a tradeoff between risk of cardiovascular death and other deaths - but mortality is about the same, unless you've already had a heart attack and you are under the age of 65.  In the later case, your all cause mortality is improved by taking the statin. 

If you take a statin with another compound that lowers LDL by an independent mechanism (the combined drug was called Vytorin), you get a massively reduced LDL number but no improvement in mortality.

If you reduce triglycerides by taking a spoonful of oil after each meal, you change the triglycerides but don't appear to get a better mortality rate.

If you eat a low fat diet, you can reduce your cholesterol numbers - but you can't improve your mortality.

In short, you can manipulate the biomarker, but doing so does not interrupt the disease process.

In other words, there does not seem to be a causal connection between the discrete levels of these markers in the blood and the damage that is recognized as heart disease, CVD, etc.  Having high triglycerides, low HDL and high LDL is recognizable as a pattern of markers that indicates a greater liklihood of future illness and reduced longevity.  However, ttreatments aimed at manipulating these easy and cheap to measure bio markers do not restore health, or interrupt disease processes.

So if you are thinking, "If high levels of these biomarkers do not cause disease, what does?!?"  you are onto the million dollar question.  The short answer is, if you eat the neolithic agents of disease - excessive carbohydrate/fructose intake and imbalanced intake of omega 3 and omega 6 fatty acids, resulting in metabolic derrangement (excess blood glucose) and imbalanced inflammatory response - you create the underlying disease states that result in all of the manifestations of the "Diseases of the West": cancer, heart disease, gout, diabetes (type II, and probably type I), hypertension, obesity, osteoporosis, tooth and gum disease, Parkinson's, Alzheimer's, ALS, etc (some of which are caused by others on the list).  The underlying disease processes are well understood in the case of gout, for example, but not as well for others.

If you are eating a paleo diet, most or all of your bio markers will improve.  It's a reasonable assumption that you are dodging the bullets we know as "Diseases of the West."  There's no doubt in my mind eating some version of the Paleo diet is your best bet on wellness.  But the frustrating truth is - it is still just a well informed risk/reward curve we're living on, we don't know for sure what the outcomes for longevity will be.  Therefore, seems like we should chase a version of the Paleo diet that makes our lives better here and now, that aligns with living a life of activity and enjoyment and accomplishment.  The OCD perfect Paleo diet with no joy and no fun and no love misses the point.

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