If high cholesterol is not a disease, why are you taking medicine(s) every day for the rest of your life because of it? If you want to know the answer to that question, read on.
Lipitor, also known as atorvastatin, is made by Pfizer. It has been a blockbuster drug for them, a real bases-loaded home run. In fact, it is one of the biggest selling drugs in history. Total sales are in the range of 7 to 12 billions of dollars per year. In the USA it costs about $100 a month to lower your blood cholesterol into a safer range with this “statin” drug. Over a 10-year period (not an unreasonable frame of time for someone in their fifties), that would amount to $12,000. Double it for a 20-year time frame, again not unreasonable. You’d hope you would make it into your 70’s if you’re taking those #%$&* pills every day to keep your cholesterol down!
The statin is supposed to lower your cholesterol and prevent heart attacks and stroke, so that should make you live longer, right? On average yes, but not necessarily in every single person who takes Lipitor, even if they never miss a dose. As we will see shortly, statins actually help only a minority of patients who take it, even if they take it properly for many, many years. Problem is, when you take a statin for high cholesterol, you are trading one problem for another. Over a long period of time, say 15 to 20 years, it is debatable which is worse: high cholesterol or chronic liver problems.
Lipitor is heavily advertised to the doctors and also the general public via prime time TV ads. These ads in a real sense serve a useful purpose, to inform and motivate all adults to be aware of their cholesterol levels and to take steps to lower the levels if too high. However, I want to show you that there are better ways to lower cholesterol than to take a pill costing that much money every day for the rest of your life. $100 a month and various assorted side effects for the rest of your life! I’m not kidding. If you’re in your 40’s or 50’s, that could mean 30 or 40 years of taking pills, every day.
Lipitor, like all statins, is a poison, which in a low dose has one beneficial effect. It blocks a vital enzyme system which facilitates the production of cholesterol in the liver for use in the rest of the body. Ah, you thought cholesterol was just some junk that more often than not clogs up your arteries as you get older. In fact, cholesterol is a vital substance that has multiple important roles to play in the normal body from the time you were developing in utero. You never outgrow your need for cholesterol. The trick is, to keep the amount in the blood stream at a normal, healthy level.
For example, cholesterol is a major structural component of nervous tissue, including the brain. In fact, early on there were reports that the first statin on the market might have altered unfavorably the personalities of some of the patients taking it. Years later, when there were already several copycat statins for sale, one of the statins got into trouble and was pulled from the market. Baycol, as it was called, had too small a market share to handle the liability suits brought against Bayer because quite a few patients taking Baycol had died from kidney failure. All the other statins out now (there are 6 or 7 of them) have the same side effect, muscle breakdown and kidney failure. I have seen 4 or 5 cases myself, one of whom died. It is not a very common side effect, but tends to occur more often in patients over 70. When it occurs, it is deadly. There is a simple blood test that tells your doctor if it is happening to you. The latest statin to be released is called Crestor®. It is the strongest one and already has some authorities calling for it to be pulled off the market because of serious side effects. We’ll see.
Bottom line: High blood cholesterol does not indicate a Lipitor deficiency. It is the consequence of, well, the title of a recent study from the Mayo Clinic says it all:
Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome
Cholesterol is not bad per se. It is just that on the typical American diet our blood level of cholesterol is about 100 points higher than it should be. 100 points! This very high level of cholesterol has health consequences unanticipated by Paleolithic “doctors” since they had virtually no experience with coronary heart disease. That’s right, 1000’s of years ago Paleolithic humans had a diet high in veggies and fruit, whole grains and low fat meat, obviously wild game and fish. They were also very physically active, daily. They had to be in order to survive. Humans still living this lifestyle now a days have blood cholesterol levels below 150, and no risk factors for coronary heart disease as they age. Wouldn’t you like to have that kind of luck? Wouldn’t we all?
Well we can. Just by eating a Paleolithic human diet or its close facsimile. It’s available now at your local supermarket, but certainly not at your local fast food joint. That’s right, no more French fries, no more pizza and roast beef sandwiches, no more Big Macs and no more Hagen Daz. (Well, maybe low fat Hagen Daz occasionally if you’re really good the rest of the time.)
Now I’ve seen the ads on TV that correctly point out that a part of the problem of high cholesterol is the diet and part is the family, which means you inherited the tendency to have high cholesterol, i.e. its in your genes too. The genes dictate how much you have to change (read restrict) your diet, how much you have to exercise, how much weight you have to lose if your tummy is too big, and how important stress management will be in your program. Yes, all these factors may have some influence on your blood cholesterol levels. Persistent high blood cholesterol despite optimizing all of these lifestyle factors can happen but it is very, very rare. Most all of us can drop our cholesterol levels with lifestyle optimization. And the beneficial changes in cholesterol can occur quite rapidly. I did this myself in 1978-80 when I changed from a typical American diet to the Pritikin very low fat diet while gradually increasing my daily jogging from 1 or 2 miles several days a week to 5 to 10 miles daily. On that lifestyle I dropped my total cholesterol from 240 to 140. 100 points! That virtually stopped any atherosclerosis going on in my coronary and other arteries. In fact ten years later, on a screening CT heart scan, I had no coronary artery calcium, a result almost unheard of in an American male in his mid-50’s. If I can do it, so can you. It’s probably going to take some major adjustments in your dietary preferences however. You may need to become a hunter-gatherer.
Many’s the patient I have told: “OK, you like red meat, so here’s what I suggest.
Beef, lamb and pork in the stores have been feedlot fattened and so are much too high in saturated fats, which only raise your cholesterol. You really, really want red meat? Okay, buy a bow and arrow, go hiking in the woods (it’s great exercise) and stalk a deer (in season), or maybe a wild pig. When you kill it, say a blessing, and thank the animal for feeding you and the family. (You want to show God you appreciate nature’s bounty.)
Oh, you say you’ve gone out hunting 3 days in a row and failed to shoot anything. Welcome to the Paleolithic Reality Program. If hunting was unproductive they had to live for days on roots and shoots and/or maybe trap a snake or a rabbit. They did not have supermarkets the size of football fields every few blocks. They were (and we still are) designed to survive scarcity, and store excess calories as fat in rare times of plenty.
Going fishing is not so dramatic, but it is even healthier, because of the abundance of omega-3 fatty acids in the oilier fishes. Those are the kind of fats that actually lower your blood cholesterol. Don’t forget to thank the fish before you eat him.
Former President Bill Clinton, arguably one of the more youthful, vigorous men to hold that office, got sick and tired of taking his Lipitor, stopped it and soon ended up at the Bethesda Naval Hospital with a heart attack. (doctors call it an acute MI). OK, he did several things that might have set him up for this. He apparently had been taking a statin for some time and probably thought he didn’t need it anymore. While taking the statin, like most folks he assumed that he could eat anything he wanted. After he stopped the statin he did not go on a strict diet. And this is one of the more clever, successful persons around, with instant access, 24/7, to the best medical care in the world.
So what can we expect from the poor folks on Medicaid, or all those Americans with no health insurance at all? There are lots of people who don’t graduate from high school and know little about their own health. How are we to convince them to take pills every day for the rest of their lives that don’t make them feel any better?
There is no evidence that stopping the statin caused his heart attack. Mr. Clinton might have had the MI even had he continued taking the statin. Certainly there are a lot of men who have done the same thing, and after being yelled at by their doctor likely started taking their statin again. Such are the many uncertainties associated with preventive medicine using medications instead of lifestyle optimization. Read on. It gets even worse, a lot worse. Especially for our confidence in the beneficial effects of Lipitor.
Like high blood pressure, high cholesterol causes no unpleasant symptoms at all. You have no weakness, you’re not sick to your stomach, you don’t feel tired all the time, you don’t even have any pain. The terrible damage going on inside to your arteries as they harden and close off is silent and unsuspected for years, even decades.
Until one day, maybe you’re in your late 40’s or early 50’s, good job, long hours, kids getting ready to go off to college. You’re right in the middle of everything and, most inconveniently, lightning strikes. One night after dinner you have some chest pain, not too bad at first. So, thinking it could be heartburn, you try taking an antacid. That doesn’t help much; in fact now it’s getting worse. You’re nauseated and need to lie down because you feel weak and dizzy. Your heart seems to be pounding. The wife says you look pale.
The pain gets even worse, someone calls 911, and pretty soon 5 or 6 huge guys in fireman outfits and big boots, looking ready to put out a fire except they don’t have any hoses, are surrounding you. Their walkie-talkies dangled from their shoulders, squawking and hissing like demented parrots. One of them is taking your blood pressure, one is starting an IV, one is putting EKG leads on your arms and legs, another is talking to the hospital on his 2 way radio (“Ah, we have a 51 year old Caucasian male with chest pain, BP 156 over 93, pulse 107, EKG shows ST depression V3 through 6, bigeminy rhythm……). And those 2 guys off to the side talking and laughing. Are they telling jokes? You can see your poor wife in the background looking pale and worried. You try to smile at her, but the pain’s just too bad. An acute MI has been described by some as like having an elephant step on your chest. IV morphine takes the edge off the pain. You immediately feel nauseated. You gag a few times weakly but nothing comes up.
One fireman gives you an aspirin, they plop you on a collapsible stretcher and in a moment you’re in their ambulance on the way to the hospital, sirens wailing and lights flashing. You hope that everyone up ahead is pulling over to let you pass, worrying that you yourself have not always been so prompt in that department. You are not someone who prays to God all that often, but what the heck, it can’t hurt to try. You close your eyes and try to remember a prayer from Sunday school, maybe 40 years ago. Has it been that long since you, well, prayed? (Maybe you’d better apologize to God at this point.)
In just a few minutes you’re at the hospital, the staff is well trained (but incredibly busy), the lights are too bright and the paging system is pretty much continuous. The number and complexity of electronic devices attached to your body rises abruptly. A young doctor asks some questions, your vital signs seem to be stable, and it’s off to the Coronary Care Unit where the nurse to patient ratio is only 1 to 2 (unlike the general wards where it is more like 1 nurse for 6 patients). Even if there were 50 or 60 patients in the ER waiting around, all ahead of you, chest pain takes you to the front of the line. Chest pain indicating an acute myocardial infarction (MI) represents a failure of pill directed preventive medicine. Now you are in the hands of the heart specialist doctors. The cost and complexity of your medical care skyrockets.
The purpose of taking statins, blood pressure pills and the like is to avoid that life-altering scenario. In America, it happens more than a million times a year. Often the story ends before you make it to the hospital, sometimes before you even make it into the ambulance. Almost all sudden deaths are due to heart attacks, and more often than not they occur in persons who had no idea that there was anything seriously wrong with their arteries. Atherosclerosis is a silent process until it gets pretty far along. And the high levels of blood pressure and blood cholesterol that contribute to the process are likewise completely silent and asymptomatic.
Author: Cleaves M. Bennett MD FACP
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