Statin Risks

As a population we’re living longer. Generally speaking, older individuals are more prone to chronic conditions such as heart disease. With statin drugs continuing to be a mainstream mainstay in the prevention of heart disease, the elderly represent a growing market for these drugs.

While this may be lucrative for pharmaceutical companies, are there any real benefits to be had from prescribing statins to elderly individuals?

One of the most significant trials of statin therapy in the elderly is known as the PROSPER study [1]. In this study, almost 6,000 men and women aged 70-82 were treated with a statin (pravastatin) or placebo for over three years. Each of the individuals in this trial had either a history of cardiovascular disease (e.g. a previous heart attack) or significant risk factors for cardiovascular disease. In this sense, the individuals were deemed to be at relatively high risk of cardiovascular events such as heart attack or stroke. This is relevant as relatively high-risk individuals stand to gain more from statin therapy compared to low-risk individuals.

Risk reduction of non-fatal and fatal heart attacks (added together) was 19 per cent in the group taking the statin. Stroke incidence was not affected. Cancer rates were 25 per cent higher in the group taking pravastatin.

Read the Full Article here: http://www.thecholesteroltruth.com/statins-associated-with-significantly-increas

Risk trade offs are a factor to consider.

Thin Equals Well?

Many overweight and obese people are metabolically healthy, while large numbers of slim people have health problems typically associated with obesity, a new study shows.

The findings, based on national health data collected from 5,440 adults, shows that weight often is not a reliable barometer for health. In addition to looking at height and weight, the study, published this week in The Archives of Internal Medicine, tracked blood pressure, “good” cholesterol, triglycerides, blood sugar and an inflammatory marker called c-reactive protein, all of which are viewed as indicators of cardiovascular health.

Overall, thin people were still metabolically healthier than people who were overweight or obese. But being a normal weight was not a reliable indicator of health. In the study, about 24 percent of thin adults, or about 16 million people, posted unhealthy levels for at least two of the risk factors.

By comparison, among the overweight, about half the people had two or more of the risk factors. But half of them were also metabolically healthy. And nearly one out of three obese people were also metabolically fit.

While it’s long been known that it’s better to be fit and fat than being thin and sedentary, the new data are believed to be the first time researchers have documented the unreliability of body size as an indicator for overall health.

http://well.blogs.nytimes.com/2008/08/13/for-health-body-size-can-be-misleading/?pagemode=print

This is another report documenting the "fat but healthy" population, which has been reported on in various studies for at least five years.  The challenge is that with epidemiological studies - the assumption define the results.  If you decide that people with blue warts are more likely to die, aka blue warts are a risk factor, then fat people with blue warts are not "healthy".  Does that mean they are really more likely to die?  Who knows  - because most of the "risk factors" are the results of sophisticated calculations that are very rarely confirmed via intervention studies.  That said, Mike Eades (www.proteinpower.com/drmike) published a post recently that explains how the "skinny fat/unhealthy" idea could very well be true.

The basic idea is that we each become insulin resistant on a different genetic template.  Suppose a person's fat cells are the last part to become insulin resistant - if they are eating poorly, they can continue to sock away excess blood sugar in their fat cells (after conversion, by the action of insulin, to fat).  In fact, these folks can and will accumulate more fat than the rest of us, and it seems to have almost a protective effect - because they can continue to sequester excess blood sugar long after many of us would not be able to.

On the other end of the spectrum, imagine a person who's fat cells become insulin resistant at essentially the same time as other tissues - these folks will not be able to buffer their excess blood sugars, and will wind up with a large quantity of visceral fat, which is "associated" with higher mortality.  They will suffer more damage from their overconsumption of carbs and the resulting high blood glucose.

What's the bottom line?  There's no getting around the fact that a large abdomen and high blood sugars are signals of damage and causes of damage respectively.  This is why carb restriction is such a powerful tool for those already wrestling with the damage the results from too many years of a typical neolithic diet.

Many Ways Up The Mountain

Before he embraced natural movement, the founder of R. E. Taylor Associates Inc., a sales and consulting firm for the hospitality furniture- and fixture-manufacturing industry, logged about 70 miles a week training for marathons and ultramarathons (races longer than 26.2 miles). After nearly seven years of marathon training, Mr. Taylor had developed plantar fasciitis, an irritation of the thick tissue on the bottom of the foot that causes heel pain. He also had constant pain in his shins.
In December, Mr. Taylor got a wake-up call after a pick-up basketball game with friends. "I had crazy blisters, and my legs were killing me," he says. Despite his prime cardiovascular shape, he realized the long-distance running only worked a few muscles. "If I wanted to be a well-rounded athlete, I had to focus more on the rest of my body," he says."
http://online.wsj.com/article_email/SB10001424052702303745304576357341289831146-lMyQjAxMTAxMDAwNjEwNDYyWj.html

MovNat is hardly part of CrossFit, but what is clear from the post above is that there are many ways up the mountain, but eventually they all converge - as my martial arts instructor used to like to say.

The Plate

http://blogs.wsj.com/health/2011/06/02/does-the-plate-give-better-dietary-advice-than-the-pyramid/

While I agree that the plate is a better means to represent a desired meal than was the pyramid, especially when the message sender is the US Government who by definition must design a message that can be digested by that 50% of the population which has a below average intelligence, if the message is a bastardization of the science, it should still not be sent.  IOW, this is just "lipstick on a pig".  (I do not mean to belittle the appearance of pigs, but would note that I find the idea of lipstick on bacon is not appealing to the eye or the palate.  Editor's note). 

Please indulge me, dear reader, in a not so bold prediction:  This "plate" will have zero effect on the propensity of the US population to gain an unhealthy amount of body fat, no matter how much money our government, via the USDA, has paid for this product's development, or will pay for its marketing. 

Here's another:  If our Surgeon General follows this eating plan, she will be just as heavy when she leaves office is as she was when she took office.  However, she will actually deserve this fate because she's educated enough to know better.

Here's a third:  at some point, someone in the government will be presented with the fact that grains rapidly raise blood sugars, regardless of their "wholeness" or lack thereof.  Someone will, eventually, announce that grains of any kind have a glycemic impact which is deleterious and particularly to diabetics and pre-diabetics who already have glycemic control issues as their most significant health driver.  No one will be required to take responsibility for the fact that our government has proclaimed all these years that so called whole grains are 'heart healthy.'  Perhaps some will realize how much of the "health care crisis" was created and perpetuated by the USDA driven low fact dogma, but the damage will have been done.

Four Hour Body

Tim Ferriss' latest is the Four Hour Body and it is a fat tome with a fascinating premise - you can learn something from many years and many episodes of an creatively OCD man's experiments in human performance.

Ferriss loves to discover a premise, quantify it in an experimental protocol, and observe/measure the outcomes in his own or others' bodies.

There's a bunch in Ferriss' book into which a nutrition junkie could delve, including how to binge with damage control, how to "cheat" the NFL combine, how to swing a bat for power, and how to execute Ferriss' "slow carb" diet.  Truly, that only scratches the surface of the book's goodies.  But after digging through nearly 400 fascinating pages, there's only a little that I'm willing to apply to myself.

Short list:  cold showers; a super low volume strength protocol designed by a sprint coach for sprint athletes and thus quite applicable to a guy like me who's doing strength to be a better CrossFitter vice a strength guy; why cinnamon can help your blood sugar levels; why spinach really was helping Popeye get strong; and how you can use ten reps a day for rapid improvement.

At the macro level, the book's biggest lesson is how to design and execute an "N=1" experiment.

I'm working on the application of several of TF's ideas, focusing on those ideas that might have an application to continued improvement of work capacity across broad time and modal domains.  I'm looking forward to seeing how they work!

There's no part of the book that wasn't interesting to me, and don't think that I've in any way summed up all that could be learned from "The Four Hour Body".  If you have the time and inclination, it's worth the $$ to buy/read.

Eat Fat, Stay Healthy

With the memory of Memorial Day cheeseburgers and bratwursts still lingering, many of us may be relieved to hear that a new study suggests that a meaty, high-fat, Atkins-style diet can do more than contribute to rapid weight loss. It may also be less unhealthy for the heart than many scientists had feared — provided you chase the sausage with a brisk walk.  http://well.blogs.nytimes.com/2011/06/01/eating-fat-staying-lean/?pagemode=print

What's the news?  Another group on a high fat diet fares well?  Hardly.  What's news is this is commented on with a fairly even handed tone in the NYT.
“It took people less time to lose 10 pounds” on a high-fat diet-and-exercise program, about 45 days on average, than the 70 days it took for those who exercised and followed a high-carbohydrate, low-fat diet constructed using guidelines from the American Heart Association, said Kerry J. Stewart, director of clinical and research exercise physiology at Johns Hopkins University School of Medicine and lead author of the report. And at least in the short term, there were no apparent harmful effects. 

Here's where the article goes where most mainstream articles go when discussing science and food - to the junk bin:
To date, however, scientific data have been inconsistent. Some studies have reported that such diets contribute to cardiovascular disease, while others found no increased risk. 
Show me those studies, and I'll show you that the "studies" they cite are observational studies, which as most of you know, is only useful for establishing a hypothesis (really, only useful for establishing a baby hypothesis, a conjecture).  When tested via intervention study, high fat diets virtually always win, as is the high fat diet in this still ongoing study.

These comments can only be considered amusing, though:
And like most of the recent studies about the health effects of low-carbohydrate diets, “these are very short-term results,” said Dr. Dena Bravata, an internist and research associate at the Center for Primary Care and Outcomes Research at Stanford University, who was not involved with this experiment but has conducted dietary studies. “Those on the high-fat diets showed no harmful impacts” after 45 days or so, she said. “But what about in 5 or 10 years, if they remain on the diet?”

Where was all this scientific rigor and skepticism about the long term impacts of diets when the government and many non profits - like the AHA and ADA - jumped "whole hog" on the low fat fad diet?  If there's one thing that's certain in the science of diet and health it is that there was no scientific basis or long term evaluation of the effects of eliminating fat from the diet and substituting carbohydrates.  And there still is not!

Interestingly, one of the conjectures Gary Taubes introduces in Good Calories Bad Calories, and Why We Get Fat, is that those on a high carb diet will exercise less when in caloric restriction, because low fat low cal low protein diets induce the starvation response much more quickly than protein adequate and fat adequate diets.  In other words, they get lazy because of their diet.  The same thing happens with a high carb diet which is not calorie restricted when people exercise - if the exercise puts them into caloric restriction, they will eat more.  

Lucky for us, we don't need a billion dollar long term study to evaluate the health impact of a high fat, adequate protein, carb restricted plan.  Give yourself an N=1 experiment, which will be more convincing than any number of NYT articles.

Measuring Health

Friday's post addressed how difficult it is to quantify what causes the diseases of the West, and how to measure whether one is more or less likely to suffer that variety of afflictions.  Summary:  discrete biomarkers may be manipulated via drugs or even just vitamins or foods (e.g. niacin or olive oil), but those manipulations do not seem to change disease risks.  

So what biomarker can you manipulate and measure that WILL control your health?

Glucose, thanks to the epidemic of diabetes in our country, which has created such a demand for glucose meters that you and I can get one for $50 with a month's worth of strips.

If you control your glucose, your BP will normalize (lose those BP meds), your lipid profile will normalize (no more statins), you'll lose weight from around your belly (innumerable benefits from this), you will most likely eliminate the need for gout meds if you use them, and in short - it'll all be good.  

If you eat meat and vegetables, some nuts and seeds, little fruit and starch and no sugar/no wheat, you will control your blood glucose, and when you confirm that with a glucose meter (take a measure just before you eat and one hour later) if will reinforce your choices.  It will also reinforce which foods that send your glucose levels into the stratosphere.

What's the downside?  The G meters are not perfect.  It's not fun poking holes in your fingers.  In other words, very little compared to the power the tool gives you to evaluate your health.  As with everything, there's a caveat.  If you are over-consuming fructose, your short term glucose readings won't necessarily be high, but long term, as the fructose accelerates your insulin resistance, the G readings will always be higher than you would hope for.   

Tim Ferriss illustrates in the Four Hour Body just how much you can do with a G meter, but all you really need to know is less G is better for your health.