March 8, 2010
Institute For Medical Wellness Healthy Living Report
HDL Cholesterol- Is something fishy??
HDL, otherwise known as the good cholesterol, is one of the types of cholesterol that makes up your total cholesterol measurement. Unlike certain types of LDL (type-B small dense LDL's), HDL cholesterol is generally good for you! While small dense LDL's can go through your bloodstream and get taken into the vessel wall, where it can cause blockages, HDL does the opposite. HDL cholesterol, due to its even smaller size, is able to get through the vessel walls, and acts as a transport vehicle, or bus, to takes the bad cholesterol out of the wall and recirculate it back to the liver for processing. That is why I call HDL, the Happy Cholesterol!!!
So that brings up a nice math problem that I do almost every day at the office.
Almost on Monday, almost on Tuesday, almost on Wednesday.
Sorry bout that. I always liked that joke ; )
One of the first things I look at when reviewing cholesterol values is what I call the Total/HDL ratio. This ratio is defined as the Total Cholesterol divided by the HDL cholesterol. A good ratio is 4 or below, which indicates a less than average risk of developing heart disease. A ratio greater than 5 puts you at above average risk for heart disease.
So who do you think has the lower risk of heart disease based on the below cholesterol levels?
Patient #1)
Total Cholesterol = 240
HDL Cholesterol = 60
LDL Cholesterol = 145
Triglycerides = 110
Patient #2)
Total Cholesterol = 180
HDL Cholesterol = 30
LDL Cholesterol = 115
Triglycerides = 100
Patient #1 has higher levels of all the cholesterol components and triglycerides. Patient #1 also has a ratio of 240/60 = 4.0
Patient #2 has lower levels of all the cholesterol components and triglycerides. Patient #1 has a ratio of 180/30 = 6.0
Patient #1 has a lower risk of heart disease based on the ratio of 4.0 .
As already mentioned, the HDL or good cholesterol, goes through the body and scavenges up or cleans up after the bad cholesterol or LDL. So the more HDL you have, the better. Some medications have been shown to raise HDL. Niacin, sold as prescription Niaspan, has some very good studies showing just this effect. Unfortunately for niacin, the high doses needed to exert this effect, has some very annoying flushing, itching and other skin side effects, and is rarely tolerated. Niacin also has an annoying habit of raising diabetics and prediabetics sugar levels.
My advice on the best way to improve your ratio is to lower your processed carbohydrate intake, increase your healthy fat, protein and fiber intake, increase your exercise, and if able, supplement with fish oils. This will raise the amount of good cholesterol (HDL) and lower your ratio to healthier levels. Our Healthy Weight Program is one way to help you lower your overall risk. A new Healthy Weight Program-Lite edition, will soon be available to help you further.
--------------------------------------------------------------------------------
Fish Oils and PCB's
That leads to a perfect segway into our next subject.
Fish oil supplements, when used correctly, have been proven beneficial in prevention of heart disease, arthritis and some mood disorders. Other benefits have been reported, but I like to wait for more data to come in before making any recommendations.
I was asked to comment about a recent news story from Good Morning America (GMA) concerning fish oil supplements and PCB content. PCB's have been proven in the past to increase one's risk of cancer. A lawsuit has been filed against some fish oil manufacturers related to PCB's in fish oil supplements.
What is my take on this?
The GMA segment appeared to be well balanced, and the physician interviewed stated that only ten fish oil supplements were studied, which is a very small sample size. Concluding that all fish oil supplements are hazardous, from that sample size, would be equivalent to throwing out all the eggs at your supermarket due to a dozen or so bad eggs. Still, it will be interesting to see how this lawsuit plays out.
I can also take a conspiratorial view of this lawsuit. There is presently talk in Congress about further government regulations on the nutritional supplement industry. This lawsuit may be the trial balloon, pun intended, to drum up support for further government regulations. These regulations would put a big damper on individuals freedom to purchase supplements on their own.
The Institute For Medical Wellness, for the past seven years, has had available for purchase, Carlson's Fish Oil. Here is what is written on the Carlsons Fish Oil label.
THIS PRODUCT is regularly tested (using AOAC international protocols) for freshness, potency and purity by an independent, FDA-registered laboratory and has been determined to be fresh, fully potent and free of detectable levels of mercury, cadmium, lead, PCB's and 28 other contaminants.
I would not let the GMA story scare you away from fish oil supplements. But you should, as I always recommend, do your homework before starting or purchasing a supplement for use.
The Institute For Medical Wellness has a select list of supplements available, chosen based on efficacy, reliability, safety and cost. If a supplement does not meet those specifications, I do not recommend it.
--------------------------------------------------------------------------------
Funny Times at The Institute For Medical Wellness:
We all have days when we get tongue-tied, myself probably more than others. But here is a funny that I need to mention.
When I asked a long-time patient, who I shall anonymously refer to as "The Man", what insurance he had, for laboratory testing purposes only, the response given was,
"Blue Cross- Blue Cheese"
Maybe I caught him after lunch at Salad Works ????
Special thanks to "The Man" for his good wit and great sense of humor!!
And for all the hassles of health insurance today, maybe they should change their name to Blue Cross-Blue Cheese !!!
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
Showing posts with label cholesterol. Show all posts
Showing posts with label cholesterol. Show all posts
Monday, March 08, 2010
Thursday, March 04, 2010
LDL Cholesterol- Is it truly a villain?
Institute For Medical Wellness Healthy Living Report
LDL Cholesterol- Is it truly a villain?
In my previous newsletter, I discussed the meaning of a Total Cholesterol reading as it relates to your risk of vascular disease. If you missed that newsletter, I'll update you.
LDL Cholesterol- Is it truly a villain?
In my previous newsletter, I discussed the meaning of a Total Cholesterol reading as it relates to your risk of vascular disease. If you missed that newsletter, I'll update you.
Total Cholesterol is meaningless.
I'll say that again.
Total Cholesterol is meaningless!!
You see, total cholesterol is made up of many subfractions.
There are two common subfractions we usually hear about.
One that we measure is called LDL, otherwise known as low density cholesterol or BAD cholesterol. A simple way to remember LDL is bad is that L is lousy or bad.
A second that we measure is called HDL, otherwise known as high density cholesterol, or GOOD cholesterol. A simple way to remember that HDL is good is that H is happy or good.
So while two individuals may have the same Total Cholesterol, the amounts of the HDL and LDL may differ.
Today I will focus on LDL which has long been blamed for heart and vascular disease. What you may not know is that just as Total Cholesterol has subfractions that are both good and bad, LDL cholesterol also has subfractions. These subfractions are not all bad for you. Unfortunately, a routine cholesterol or lipid panel does not break down LDL into its subfractions. That is why at the Institute For Medical Wellness, we order a more detailed lipid panel to include these measurements. These added LDL subfractions enable us to better stratify your risk for heart and vascular disease and guide you towards a healthier diet and lifestyle to match your levels.
The first LDL subfraction I will call Type B LDL, otherwise known as small and dense. The small dense Type B LDL's tend to be more problematic. A simple way to understand this is to imagine a cholesterol doorway that is only 25 nanometers wide. Only LDL cholesterol particles smaller than 25 nanometers can fit through the doorway. Type B LDL tends to be 25 nanometers or less and can fit easily through the doorway. Unfortunately this doorway leads the cholesterol towards increased plaque formation and a higher risk of heart disease.
The second LDL subfraction I will call Type A LDL, otherwise known as large buoyant or big and fluffy. These big fluffy Type A LDL's tend to be much less problematic, as they tend to be larger than 25 nanometers in size, and do not fit easily through the cholseterol doorway. This makes the Type A LDL's not as dangerous.
OK. Now let me put this all together for you. Just as measuring a Total Cholesterol level by itself tends to be meaningless, measuring a total LDL is not very helpful without the subfractions we now call big fluffy and small dense.
So, I know people do not like to be call big and fluffy. But when we are talking about LDL cholesterol, big and fluffy is what you want to be.
For more information about this type of cholesterol testing, please visit the following website.
Unfortunately, there is a caveat. One insurance company, Aetna, is way behind the eight ball when it comes to lipid measurements, and refuses to allow payment for this testing. But I am always looking for a way to guide you through or around the health insurance quagmire. Presently I am in discussion to get this special testing at a reduced price for Aetna patients.
Stay tuned.
Next in the cholesterol series, in an upcoming newsletter, will be HDL.
--------------------------------------------------------------------------------
Healthcare Reform Update:
Yes, here we go again!
First let me say that my views on healthcare reform are not meant to be political, as healthcare should never be held hostage to politics. Your healthcare and the decisions you make about your health should be yours to make, and yours alone. Unfortunately too many outside interests (insurers and politicians) have gotten in the way. It was not always like this.
My whole life has been centered around healthcare. I started my medical education in 1988, but I grew up in my father's medical office. My father was an independent family doctor who practiced for 25 years, before the insurance companies or the government took over control of the system. Insurance premiums were much more affordable during that period. The doctor-patient relationship was paramount when I would visit my father's office and see the interaction between him and his patient's. There was no concern for what insurance a patient had. So the problem, as I see it now, is not that there is not enough government and third party control of your healthcare, but too much. Way, way too much!!
So when I discuss the healthcare reform debate, it is personal. Healthcare costs, as I see it, have skyrocketed due to government and insurance control, so how will giving them more control of the system lower costs?
I am not part of any political party. I am not a republican or democrat, and I do not belong to a tea party. I am proud to be just as independent politically as I am independent in my practice of medicine. My views on this healthcare reform issue gravitate towards what I personally feel gives the most control of healthcare decisions to patient's and their physicians. Any reforms that try to intrude on the doctor-patient relationship, I will oppose, and oppose strongly.
--------------------------------------------------------------------------------
Institute For Medical Wellness Planning Stages or what we hope to offer in the near future.
I'll say that again.
Total Cholesterol is meaningless!!
You see, total cholesterol is made up of many subfractions.
There are two common subfractions we usually hear about.
One that we measure is called LDL, otherwise known as low density cholesterol or BAD cholesterol. A simple way to remember LDL is bad is that L is lousy or bad.
A second that we measure is called HDL, otherwise known as high density cholesterol, or GOOD cholesterol. A simple way to remember that HDL is good is that H is happy or good.
So while two individuals may have the same Total Cholesterol, the amounts of the HDL and LDL may differ.
Today I will focus on LDL which has long been blamed for heart and vascular disease. What you may not know is that just as Total Cholesterol has subfractions that are both good and bad, LDL cholesterol also has subfractions. These subfractions are not all bad for you. Unfortunately, a routine cholesterol or lipid panel does not break down LDL into its subfractions. That is why at the Institute For Medical Wellness, we order a more detailed lipid panel to include these measurements. These added LDL subfractions enable us to better stratify your risk for heart and vascular disease and guide you towards a healthier diet and lifestyle to match your levels.
The first LDL subfraction I will call Type B LDL, otherwise known as small and dense. The small dense Type B LDL's tend to be more problematic. A simple way to understand this is to imagine a cholesterol doorway that is only 25 nanometers wide. Only LDL cholesterol particles smaller than 25 nanometers can fit through the doorway. Type B LDL tends to be 25 nanometers or less and can fit easily through the doorway. Unfortunately this doorway leads the cholesterol towards increased plaque formation and a higher risk of heart disease.
The second LDL subfraction I will call Type A LDL, otherwise known as large buoyant or big and fluffy. These big fluffy Type A LDL's tend to be much less problematic, as they tend to be larger than 25 nanometers in size, and do not fit easily through the cholseterol doorway. This makes the Type A LDL's not as dangerous.
OK. Now let me put this all together for you. Just as measuring a Total Cholesterol level by itself tends to be meaningless, measuring a total LDL is not very helpful without the subfractions we now call big fluffy and small dense.
So, I know people do not like to be call big and fluffy. But when we are talking about LDL cholesterol, big and fluffy is what you want to be.
For more information about this type of cholesterol testing, please visit the following website.
Unfortunately, there is a caveat. One insurance company, Aetna, is way behind the eight ball when it comes to lipid measurements, and refuses to allow payment for this testing. But I am always looking for a way to guide you through or around the health insurance quagmire. Presently I am in discussion to get this special testing at a reduced price for Aetna patients.
Stay tuned.
Next in the cholesterol series, in an upcoming newsletter, will be HDL.
--------------------------------------------------------------------------------
Healthcare Reform Update:
Yes, here we go again!
First let me say that my views on healthcare reform are not meant to be political, as healthcare should never be held hostage to politics. Your healthcare and the decisions you make about your health should be yours to make, and yours alone. Unfortunately too many outside interests (insurers and politicians) have gotten in the way. It was not always like this.
My whole life has been centered around healthcare. I started my medical education in 1988, but I grew up in my father's medical office. My father was an independent family doctor who practiced for 25 years, before the insurance companies or the government took over control of the system. Insurance premiums were much more affordable during that period. The doctor-patient relationship was paramount when I would visit my father's office and see the interaction between him and his patient's. There was no concern for what insurance a patient had. So the problem, as I see it now, is not that there is not enough government and third party control of your healthcare, but too much. Way, way too much!!
So when I discuss the healthcare reform debate, it is personal. Healthcare costs, as I see it, have skyrocketed due to government and insurance control, so how will giving them more control of the system lower costs?
I am not part of any political party. I am not a republican or democrat, and I do not belong to a tea party. I am proud to be just as independent politically as I am independent in my practice of medicine. My views on this healthcare reform issue gravitate towards what I personally feel gives the most control of healthcare decisions to patient's and their physicians. Any reforms that try to intrude on the doctor-patient relationship, I will oppose, and oppose strongly.
--------------------------------------------------------------------------------
Institute For Medical Wellness Planning Stages or what we hope to offer in the near future.
•Healthy Weight Program- Lite edition- pun intended!
•New Heart and Vascular Wellness to focus even more on prevention of heart disease.
•More In-Depth Nutritional Testing
If you have any ideas for future newsletters please let me know!
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
Friday, February 12, 2010
President Clinton and Heart Disease
February 12, 2010
President Clinton and Heart Disease
With Presidents Day just a few days away, former President Bill Clinton is not celebrating. Unfortunately, he is having heart issues again. About six years after having quadruple bypass surgery, he went back to the operating room. This time he avoided open heart surgery, but did have 2 cardiac stents placed to open a blocked artery. I wish him well and a speedy recovery. But I also hope he does not listen to the advice I heard from the media pundits and television docs. These TV docs have decided to blame the former president's high cholesterol levels as the cause of his recent heart trouble. Furthermore they advise that he go on cholesterol reducing medications to lower his risk of further problems.
But before we condemn cholesterol, perhaps we should first understand the role of cholesterol in our bodies. Cholesterol performs many important functions in the body including:
*forming and maintaining cell walls and structures
*helping cells adjust to changes in temperature, as well as being used by nerve cells for insulation.
*Cholesterol is also essential for synthesizing a number of critical hormones, including testosterone, progesterone and estrogen.
*Bile, a fluid produced by the liver from cholesterol, aids in the processing and digestion of fats.
*My favorite vitamin, Vitamin D, is made from cholesterol and sunlight.
It sometimes makes me want to bang my head against a wall that the majority of doctors still believe that the lowering of cholesterol, by pharmaceutical means, is helpful.
Why???
I'll tell you. While cholesterol is present in cardiac blockages, so are other inflammatory substances. A very important, but not well known fact is that heart disease is influenced by many factors other than cholesterol including:
*age
*gender
*smoking
*physical inactivity
*obesity
*low serum antioxidant levels
*elevated levels of inflammatory substances
*among many other more technical factors.
But we do not always hear much about these!! All we ever hear about is cholesterol is bad, cholesterol is bad!! Too many people in the healthcare field have been brainwashed by Big Pharma and their demonization of cholesterol.
Now let's get back to former President Clinton. After going through bypass surgery, don't you think his cardiologist already placed him on cholesterol lowering medications, as that was and still is the standard of care?
It worked real well for him, didn't it??
The standard of care needs some fixing!! Lowering cholesterol by pharmaceutical means may make lab reports look pretty, but it does not prevent heart disease. To get my point across, I'll use a high school SAT tactic.
Elevated cholesterol on a lab report is to seeing a blizzard on radar
as
the use of cholesterol medication to lower cholesterol is to turning off the radar.
The blizzard or snow storm is still approaching, but with the radar turned off, we just no longer see the warning sign. So when we use cholesterol lowering medications, we no longer see a risk factor as most medications are potent enough to "normalize" our levels,
So why do we even check cholesterol levels?
Cholesterol levels are important and should be used, but as a marker for heart disease, as opposed to a cause of heart disease.
If cholesterol levels are at an unhealthy level, we should try to lower them, but by dietary and lifestyle changes, not with medication. At the Institute For Medical Wellness, we have been successful in teaching and promoting these dietary changes, and have seen many lab results improve dramatically. I will be sharing some of these results with you in a future newsletter. If you wish to get started on lowering your risk of heart disease, without the use of medications, please consider our Healthy Weight program, which provides in depth analysis of your diet patterns, to help lower your future risk of disease.
Many of you reading this newsletter may believe I am skeptical about cholesterol causing heart disease. You are probably correct. But I am not alone. Please consider the following link, The International Network of Cholesterol Skeptics, composed of a society of cholesterol skeptics who have been around a lot longer than I.
--------------------------------------------------------------------------------
Wellness Network Update:
Just a reminder. Everyone enrolled in a Wellness Program can receive one therapeutic massage at half price. That is $35 for a one hour massage, and $50 for an hour and a half.
--------------------------------------------------------------------------------
Institute For Medical Wellness New Offers:
Our supplement of the month for February 2010 is Revitalize. Revitalize is our once daily multivitamin that contains an abundance of vitamins and minerals, along with small amounts of antioxidant, and liver detoxifying herbs. Revitalize comes in a bottle of 90 capsules, with most people taking 1-3 a day. I find that one a day is sufficient for most, and also allows the bottle to last for 3 months. Through the end of this month, Revitalize will be available for $5 off its regular price. For more information on Revitalize and the other supplements we offer, please visit here.
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
President Clinton and Heart Disease
With Presidents Day just a few days away, former President Bill Clinton is not celebrating. Unfortunately, he is having heart issues again. About six years after having quadruple bypass surgery, he went back to the operating room. This time he avoided open heart surgery, but did have 2 cardiac stents placed to open a blocked artery. I wish him well and a speedy recovery. But I also hope he does not listen to the advice I heard from the media pundits and television docs. These TV docs have decided to blame the former president's high cholesterol levels as the cause of his recent heart trouble. Furthermore they advise that he go on cholesterol reducing medications to lower his risk of further problems.
But before we condemn cholesterol, perhaps we should first understand the role of cholesterol in our bodies. Cholesterol performs many important functions in the body including:
*forming and maintaining cell walls and structures
*helping cells adjust to changes in temperature, as well as being used by nerve cells for insulation.
*Cholesterol is also essential for synthesizing a number of critical hormones, including testosterone, progesterone and estrogen.
*Bile, a fluid produced by the liver from cholesterol, aids in the processing and digestion of fats.
*My favorite vitamin, Vitamin D, is made from cholesterol and sunlight.
It sometimes makes me want to bang my head against a wall that the majority of doctors still believe that the lowering of cholesterol, by pharmaceutical means, is helpful.
Why???
I'll tell you. While cholesterol is present in cardiac blockages, so are other inflammatory substances. A very important, but not well known fact is that heart disease is influenced by many factors other than cholesterol including:
*age
*gender
*smoking
*physical inactivity
*obesity
*low serum antioxidant levels
*elevated levels of inflammatory substances
*among many other more technical factors.
But we do not always hear much about these!! All we ever hear about is cholesterol is bad, cholesterol is bad!! Too many people in the healthcare field have been brainwashed by Big Pharma and their demonization of cholesterol.
Now let's get back to former President Clinton. After going through bypass surgery, don't you think his cardiologist already placed him on cholesterol lowering medications, as that was and still is the standard of care?
It worked real well for him, didn't it??
The standard of care needs some fixing!! Lowering cholesterol by pharmaceutical means may make lab reports look pretty, but it does not prevent heart disease. To get my point across, I'll use a high school SAT tactic.
Elevated cholesterol on a lab report is to seeing a blizzard on radar
as
the use of cholesterol medication to lower cholesterol is to turning off the radar.
The blizzard or snow storm is still approaching, but with the radar turned off, we just no longer see the warning sign. So when we use cholesterol lowering medications, we no longer see a risk factor as most medications are potent enough to "normalize" our levels,
So why do we even check cholesterol levels?
Cholesterol levels are important and should be used, but as a marker for heart disease, as opposed to a cause of heart disease.
If cholesterol levels are at an unhealthy level, we should try to lower them, but by dietary and lifestyle changes, not with medication. At the Institute For Medical Wellness, we have been successful in teaching and promoting these dietary changes, and have seen many lab results improve dramatically. I will be sharing some of these results with you in a future newsletter. If you wish to get started on lowering your risk of heart disease, without the use of medications, please consider our Healthy Weight program, which provides in depth analysis of your diet patterns, to help lower your future risk of disease.
Many of you reading this newsletter may believe I am skeptical about cholesterol causing heart disease. You are probably correct. But I am not alone. Please consider the following link, The International Network of Cholesterol Skeptics, composed of a society of cholesterol skeptics who have been around a lot longer than I.
--------------------------------------------------------------------------------
Wellness Network Update:
Just a reminder. Everyone enrolled in a Wellness Program can receive one therapeutic massage at half price. That is $35 for a one hour massage, and $50 for an hour and a half.
--------------------------------------------------------------------------------
Institute For Medical Wellness New Offers:
Our supplement of the month for February 2010 is Revitalize. Revitalize is our once daily multivitamin that contains an abundance of vitamins and minerals, along with small amounts of antioxidant, and liver detoxifying herbs. Revitalize comes in a bottle of 90 capsules, with most people taking 1-3 a day. I find that one a day is sufficient for most, and also allows the bottle to last for 3 months. Through the end of this month, Revitalize will be available for $5 off its regular price. For more information on Revitalize and the other supplements we offer, please visit here.
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
Thursday, February 04, 2010
Heart and Vascular Disease: Is cholesterol the culprit?
February 4, 2010
Institute For Medical Wellness Healthy Living Report
Heart and Vascular Disease: Is cholesterol the culprit?
For those of you who have had an Institute For Medical Wellness full history and physical, along with complete lab testing, you have had the honor of hearing my speech on cholesterol and heart disease. For those of you who have not, what are you waiting for??
Just kidding.....
Regardless of what you hear from the media, government, insurance companies, or other less than stellar pundits, cholesterol does NOT cause heart disease.
Let me repeat myself.
Cholesterol does NOT cause heart disease.
As with most government-industry partnerships in our country, the advice they have given us about cholesterol is just plain wrong. Now, don't take home the wrong message. It is still important to measure your cholesterol levels. In fact, I prefer to use a more sensitive type of cholesterol test, to better stratify your risk of disease. But the key is not to lower your cholesterol, but whether you need to, and if so, how you lower your cholesterol in the safest and most effective manner.
More on the above is part of our yearly wellness plan physical, which is structured for real life results, instead of the propaganda, fear tactics and rhetoric you hear from the government-insurance partnerships. There are many so called experts out there. Make sure you choose your experts wisely, as not everyone fits into the same mold.
For information on what some of the more likely risks of vascular and heart disease, please visit here, for a very informative article.
-----------------------------------------------------------------------------
Healthcare Reform Update:
Speaking of heart and vascular disease...................
There are many healthcare reform advocates who complain and complain again about our healthcare system. We spend too much! There are too many uninsured. Healthcare should be government run or non-profit! We should use Canada as a model for our healthcare system, after all, healthcare is free up there, and no one is turned away!!
To all the people who claim Canada has better healthcare than the United States, I highly recommend you read the following article, about a Canadian Premier, would be a state governor?? in the USA, who will be undergoing heart surgery later this week. Now I do not live in Canada, and for all I know, their doctors and hospitals may be wonderful. A Canadian Premier should be able to attest to the fact that his country's healthcare system can provide all the necessary care for its citizens.
So what I am getting at??
The Canadian Premier is having his heart surgery in the United States !!!
What does that tell you?
I'll speak for myself instead. When a high ranking elected official of a nation with a government run healthcare system, crosses the border into our country to obtain healthcare, I would say that our doctors and hospitals, stuck in a flawed system, is still the best place to receive the most advanced care in the world!!!
----------------------------------------------------------------------------
Interesting Article:
Autism article retraction..
I need to reread this article again. I would advise anyone who has lingering questions on the safety of vaccines to also read this article. On my first read through, I became angry. If a doctor fudged data to help a legal case against a vaccine manufacturer, the doctor should have his license revoked, at a minimum. The study results suggesting an autism link to a vaccine set up an enormous fear of vaccines in general, that may have been unfounded. Parents are always looking to protect their children. Prior to the perceived autism link, vaccines were considered a parent's duty to protect their children. That all changed when the fear of autism arose. Talk about unintended consequences!!
I have seen many vaccines come and go. Most vaccines that have been around for ten years or more are safe for use. Postmarketing surveillance of vaccines has taken many vaccines off the market. But the vaccine fight will not end with the apparent autism retraction. There are still other factors we need to think about before getting a vaccine. Even if an autism link is proven false, other factors such as chemicals and preservatives in vaccines, spacing of vaccines in infants, and proper regulation of the vaccine production will always be an issue. That is why, regardless of the above autism retraction, I only recommend vaccines once they have been available long enough to prove their safety and efficacy.
-----------------------------------------------------------------------
Healthy Weight Program Update:
One of the unique aspects of our Healthy Weight Program is our use of a private shared internet document. This document allows for increased communication between our office and you. The document is used for food diaries, diet and nutrition articles, as well as links to other research and helpful dietary information. My hope is that each Healthy Weight Program enrollee, with the use of this document, will learn enough about proper nutrition, that this will be the last weight program they need to enroll in.
------------------------------------------------------------------------------
Wellness Network Update:
Just a reminder. Everyone enrolled in a Wellness Program can receive one therapeutic massage at half price. That is $35 for a one hour massage, and $50 for an hour and a half.
--------------------------------------------------------------------------
Institute For Medical Wellness New Offers:
Our supplement of the month for February 2010 is Revitalize. Revitalize is our once daily multivitamin that contains an abundance of vitamins and minerals, along with small amounts of antioxidant, and liver detoxifying herbs. Revitalize comes in a bottle of 90 capsules, with most people taking 1-3 a day. I find that one a day is sufficient for most, and also allows the bottle to last for 3 months. Through the end of this month, Revitalize will be available for $5 off its regular price. For more information on Revitalize and the other supplements we offer, please visit here.
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
Institute For Medical Wellness Healthy Living Report
Heart and Vascular Disease: Is cholesterol the culprit?
For those of you who have had an Institute For Medical Wellness full history and physical, along with complete lab testing, you have had the honor of hearing my speech on cholesterol and heart disease. For those of you who have not, what are you waiting for??
Just kidding.....
Regardless of what you hear from the media, government, insurance companies, or other less than stellar pundits, cholesterol does NOT cause heart disease.
Let me repeat myself.
Cholesterol does NOT cause heart disease.
As with most government-industry partnerships in our country, the advice they have given us about cholesterol is just plain wrong. Now, don't take home the wrong message. It is still important to measure your cholesterol levels. In fact, I prefer to use a more sensitive type of cholesterol test, to better stratify your risk of disease. But the key is not to lower your cholesterol, but whether you need to, and if so, how you lower your cholesterol in the safest and most effective manner.
More on the above is part of our yearly wellness plan physical, which is structured for real life results, instead of the propaganda, fear tactics and rhetoric you hear from the government-insurance partnerships. There are many so called experts out there. Make sure you choose your experts wisely, as not everyone fits into the same mold.
For information on what some of the more likely risks of vascular and heart disease, please visit here, for a very informative article.
-----------------------------------------------------------------------------
Healthcare Reform Update:
Speaking of heart and vascular disease...................
There are many healthcare reform advocates who complain and complain again about our healthcare system. We spend too much! There are too many uninsured. Healthcare should be government run or non-profit! We should use Canada as a model for our healthcare system, after all, healthcare is free up there, and no one is turned away!!
To all the people who claim Canada has better healthcare than the United States, I highly recommend you read the following article, about a Canadian Premier, would be a state governor?? in the USA, who will be undergoing heart surgery later this week. Now I do not live in Canada, and for all I know, their doctors and hospitals may be wonderful. A Canadian Premier should be able to attest to the fact that his country's healthcare system can provide all the necessary care for its citizens.
So what I am getting at??
The Canadian Premier is having his heart surgery in the United States !!!
What does that tell you?
I'll speak for myself instead. When a high ranking elected official of a nation with a government run healthcare system, crosses the border into our country to obtain healthcare, I would say that our doctors and hospitals, stuck in a flawed system, is still the best place to receive the most advanced care in the world!!!
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Interesting Article:
Autism article retraction..
I need to reread this article again. I would advise anyone who has lingering questions on the safety of vaccines to also read this article. On my first read through, I became angry. If a doctor fudged data to help a legal case against a vaccine manufacturer, the doctor should have his license revoked, at a minimum. The study results suggesting an autism link to a vaccine set up an enormous fear of vaccines in general, that may have been unfounded. Parents are always looking to protect their children. Prior to the perceived autism link, vaccines were considered a parent's duty to protect their children. That all changed when the fear of autism arose. Talk about unintended consequences!!
I have seen many vaccines come and go. Most vaccines that have been around for ten years or more are safe for use. Postmarketing surveillance of vaccines has taken many vaccines off the market. But the vaccine fight will not end with the apparent autism retraction. There are still other factors we need to think about before getting a vaccine. Even if an autism link is proven false, other factors such as chemicals and preservatives in vaccines, spacing of vaccines in infants, and proper regulation of the vaccine production will always be an issue. That is why, regardless of the above autism retraction, I only recommend vaccines once they have been available long enough to prove their safety and efficacy.
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Healthy Weight Program Update:
One of the unique aspects of our Healthy Weight Program is our use of a private shared internet document. This document allows for increased communication between our office and you. The document is used for food diaries, diet and nutrition articles, as well as links to other research and helpful dietary information. My hope is that each Healthy Weight Program enrollee, with the use of this document, will learn enough about proper nutrition, that this will be the last weight program they need to enroll in.
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Wellness Network Update:
Just a reminder. Everyone enrolled in a Wellness Program can receive one therapeutic massage at half price. That is $35 for a one hour massage, and $50 for an hour and a half.
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Institute For Medical Wellness New Offers:
Our supplement of the month for February 2010 is Revitalize. Revitalize is our once daily multivitamin that contains an abundance of vitamins and minerals, along with small amounts of antioxidant, and liver detoxifying herbs. Revitalize comes in a bottle of 90 capsules, with most people taking 1-3 a day. I find that one a day is sufficient for most, and also allows the bottle to last for 3 months. Through the end of this month, Revitalize will be available for $5 off its regular price. For more information on Revitalize and the other supplements we offer, please visit here.
To Good Health!
Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com
Tuesday, October 14, 2008
Jupiter Study- What does it really mean??
Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!
The following is part of the abstract from the New England Journal of Medicine.
The following is part of the abstract from the New England Journal of Medicine.
You will be hearing alot of information in the press about the benefits of cholesterol drugs, otherwise known as statins, especially Crestor, which was the drug used in this study.
From the New England Journal Of Medicine:
n engl j med 359;21 www.nejm.org november 20, 2008
Background
Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein
predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment.
Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein
predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment.
Methods
We randomly assigned 17,802 apparently healthy men and women with low-density
lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per
liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to
rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the
combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.
Conclusions
In this trial of apparently healthy persons without hyperlipidemia but with elevated
high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681.)
In this trial of apparently healthy persons without hyperlipidemia but with elevated
high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681.)
ANALYSIS
The Jupiter (Justification for the Use of Statins in Prevention) study, another multimillion dollar study paid for by a pharmaceutical company, this time AstraZenaca.
AstraZeneca wants to justify that Crestor, a statin cholesterol lowering drug, be used in people with normal cholesterol as well as high cholesterol by the outcomes data in the Jupiter study.
Let's take a closer look.
The Jupiter study focused more on testing for inflammation in arteries, via high-sensitivity C-reactive protein as a criteria for inclusion. They want to prove that Crestor would lower inflammation in the arteries and thereby lower major cardiovascular events.
For each year of treatment out of 100 people, 0.17 in the Crestor group versus 0.37 in the placebo group had a heart attack, or an absolute difference of 0.2%. So it would take 500 people a year to take the drug to prevent one heart attack each year. Yet, up to 3% of people may get muscle or liver damage from the drug. That is 1 out of every 33 people.
So every year, 1 in 500 benefit, and 1 in 33 get side effects.
I would also like to follow the money trail and find out who is paying for the interpretations of the study. Below is the long list of consulting agreements to the pharmaceutical industry engaged in by the authors of the study and the funding by AstraZeneca below. This can also be found at the end of study. I have highlighted and underlined pertinent areas for emphasis.
Dr. Ridker reports receiving grant support from AstraZeneca, Novartis, Merck, Abbott, Roche, and Sanofi-Aventis; consulting fees or lecture fees or both from AstraZeneca, Novartis, Merck, Merck–Schering-Plough, Sanofi-Aventis, Isis, Dade Behring, and Vascular Biogenics; and is listed as a coinventor on patents held by Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease, including the use of high-sensitivity C-reactive protein in the evaluation of patients’ risk of cardiovascular disease. These patents have been licensed to Dade Behring and AstraZeneca.
Dr. Fonseca reports receiving research grants, lecture fees, and consulting fees from AstraZeneca, Pfizer, Schering-Plough, Sanofi-Aventis, and Merck;
Dr. Genest, lecture fees from AstraZeneca, Schering-Plough, Merck–Schering-Plough, Pfizer, Novartis, and Sanofi-Aventis and consulting fees from AstraZeneca, Merck, Merck Frosst, Schering- Plough, Pfizer, Novartis, Resverlogix, and Sanofi-Aventis.
Dr.Gotto reports receiving consulting fees from Dupont, Novartis, Aegerion, Arisaph, Kowa, Merck, Merck–Schering-Plough, Pfizer, Genentech, Martek, and Reliant; serving as an expert witness; and receiving publication royalties.
Dr. Kastelein reports receiving grant support from AstraZeneca, Pfizer, Roche, Novartis,
Merck, Merck–Schering-Plough, Isis, Genzyme, and Sanofi-Aventis; lecture fees from AstraZeneca, GlaxoSmithKline, Pfizer, Novartis, Merck–Schering-Plough, Roche, Isis, and Boehringer Ingelheim; and consulting fees from AstraZeneca, Abbott, Pfizer, Isis, Genzyme, Roche, Novartis, Merck, Merck–Schering-Plough, and Sanofi-Aventis.
Dr. Koenig reports receiving grant support from AstraZeneca, Roche, Anthera, Dade Behring and GlaxoSmithKline; lecture fees from AstraZeneca, Pfizer, Novartis, GlaxoSmithKline, DiaDexus, Roche, and Boehringer Ingelheim; and consulting fees from GlaxoSmithKline, Medlogix, Anthera, and Roche.
Dr. Libby reports receiving lecture fees from Pfizer and lecture or consulting fees from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Pfizer, Sanofi-Aventis, VIA
Pharmaceuticals, Interleukin Genetics, Kowa Research Institute, Novartis, and Merck–Schering-Plough.
Dr. Lorenzatti reports receiving grant support, lecture fees, and consulting fees from Astra-Zeneca, Takeda, and Novartis;
Dr. Nordestgaard, lecture fees from AstraZeneca, Sanofi-Aventis, Pfizer, Boehringer Ingelheim, and Merck and consulting fees from AstraZeneca and BG Medicine;
Dr. Shepherd, lecture fees from AstraZeneca, Pfizer, and Merck and consulting fees from AstraZeneca, Merck, Roche, GlaxoSmithKline, Pfizer, Nicox, and Oxford Biosciences; and
Dr. Glynn, grant support from AstraZeneca and Bristol-Myers Squibb.
So do you think there may be a potential conflict of interest relevant to the Jupiter study?
There is more to heart disease than cholesterol and inflammation. While they may be useful markers for potential disease, they do not necessarily become the main cause of disease. If they were, then you would expect much better outcomes.
An analogy I use is that cholesterol is like smoke, and heart disease is like the fire. Cholesterol, like smoke is a warning sign we can spot easily. Using Crestor and other statin drugs can lower cholesterol, or "blow away the smoke". But it does very little to put out the fire or reduce heart disease. When I see alot of smoke, I try to find natural lifestyle changes in diet and exercise to put out the fire. When that occurs the smoke goes away!!
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
Thursday, July 17, 2008
Study: Low-carb diet best for weight, cholesterol
By MIKE STOBBE, AP Medical WriterThu Jul 17, 7:23 AM ET
The Atkins diet may have proved itself after all: A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.
A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.
"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.
However, all three approaches — the low-carb diet, a low-fat diet and a so-called Mediterranean diet — achieved weight loss and improved cholesterol.
The study is remarkable not only because it lasted two years, much longer than most, but also because of the huge proportion of people who stuck with the diets — 85 percent.
Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.
Other experts said the study — being published Thursday in the New England Journal of Medicine — was highly credible.
"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
The research was done in a controlled environment — an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.
"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.
In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.
As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.
The low-fat diet — no more than 30 percent of calories from fat — restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.
The low-carb diet set limits for carbohydrates, but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein.
"So not a lot of butter and eggs and cream," said Madelyn Fernstrom, a University of Pittsburgh Medical Center weight management expert who reviewed the study but was not involved in it.
Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.
Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.
More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.
But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.
Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.
The ratio declined by 20 percent in people on the low-carb diet, compared to 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.
The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.
The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted the Mediterranean diet has also proven safe and effective.
The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.
It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.
The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.
Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.
"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz, of the Centers for Disease Control and Prevention.
"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads CDC's nutrition unit.
___
On the Net:
New England Journal: http://nejm.org
The Atkins diet may have proved itself after all: A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.
A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.
"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.
However, all three approaches — the low-carb diet, a low-fat diet and a so-called Mediterranean diet — achieved weight loss and improved cholesterol.
The study is remarkable not only because it lasted two years, much longer than most, but also because of the huge proportion of people who stuck with the diets — 85 percent.
Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.
Other experts said the study — being published Thursday in the New England Journal of Medicine — was highly credible.
"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
The research was done in a controlled environment — an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.
"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.
In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.
As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.
The low-fat diet — no more than 30 percent of calories from fat — restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.
The low-carb diet set limits for carbohydrates, but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein.
"So not a lot of butter and eggs and cream," said Madelyn Fernstrom, a University of Pittsburgh Medical Center weight management expert who reviewed the study but was not involved in it.
Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.
Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.
More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.
But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.
Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.
The ratio declined by 20 percent in people on the low-carb diet, compared to 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.
The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.
The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted the Mediterranean diet has also proven safe and effective.
The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.
It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.
The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.
Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.
"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz, of the Centers for Disease Control and Prevention.
"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads CDC's nutrition unit.
___
On the Net:
New England Journal: http://nejm.org
Finally, some validation that a low carbohydrate diet is not only effective but safe longterm.
As many of you know, I have long been a proponent of low processed carbohydrate diets. I have seen many beneficial effects including weight loss- especially around the waistline, increased energy level, decrease in appetite, better sugar levels for diabetics, and much improved cholesterol levels. Almost all of these benefits have been linked to a lower risk of cardiovascular disease.
As many of you know, I have long been a proponent of low processed carbohydrate diets. I have seen many beneficial effects including weight loss- especially around the waistline, increased energy level, decrease in appetite, better sugar levels for diabetics, and much improved cholesterol levels. Almost all of these benefits have been linked to a lower risk of cardiovascular disease.
When I think of diet, I try to think of what makes sense by how our bodies react to what we put into them. Our ancestors ate more of a low processed carbohydrate diet, as it was before industrialization and food processing began. They seemed to have had lower rates of what I called DRD, or diet related disorders. Some DRD’s include obesity, heart disease, diabetes and arthritis.
We need to eat more like our ancestors and stop believing that our modern food processing systems know more about how we can stay healthy than our individual bodies! If you have any further questions on how your diet can affect your health, then I encourage you to come in for an evaluation. As Benjamin Franklin once said, "An ounce of prevention is worth a pound of cure."
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.
Wednesday, July 09, 2008
Cholesterol drugs recommended for some 8-year-olds
By LINDSEY TANNER, AP Medical WriterMon Jul 7, 7:26 AM ET
For the first time, an influential doctors group is recommending that some children as young as 8 be given cholesterol-fighting drugs to ward off future heart problems.
It is the strongest guidance ever given on the issue by the American Academy of Pediatrics, which released its new guidelines Monday. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing.
Dr. Stephen Daniels, of the academy's nutrition committee, says the new advice is based on mounting evidence showing that damage leading to heart disease, the nation's leading killer, begins early in life.
It also stems from recent research showing that cholesterol-fighting drugs are generally safe for children, Daniels said.
Several of these drugs are approved for use in children and data show that increasing numbers are using them.
"If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life ... and avoid some of these heart attacks and strokes in adulthood," Daniels said. He has worked as a consultant to Abbott Laboratories and Merck & Co., but not on matters involving their cholesterol drugs.
Drug treatment would generally be targeted for kids at least 8 years old who have too much LDL, the "bad" cholesterol, along with other risky conditions, including obesity and high blood pressure.
For overweight children with too little HDL, the "good" cholesterol, the first course of action should be weight loss, more physical activity and nutritional counseling, the academy says.
Pediatricians should routinely check the cholesterol of children with a family history of inherited cholesterol disease or with parents or grandparents who developed heart disease at an early age, the recommendations say. Screening also is advised for kids whose family history isn't known and those who are overweight, obese or have other heart disease risk factors.
Screening is recommended sometime after age 2 but no later than age 10, at routine checkups.
The academy's earlier advice said cholesterol drugs should only be considered in children older than 10 after they fail to lose weight. Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.
Because obesity is a risk factor for heart disease and often is accompanied by cholesterol problems, the academy recommendations say low-fat milk is appropriate for 1-year-olds "for whom overweight or obesity is a concern."
Daniels, a pediatrician in the Denver area, agreed that could include virtually all children. But he said doctors may choose to offer the new milk advice only to 1-year-olds who are already overweight or have a family history of heart problems.
The academy has long recommended against reduced-fat milk for children up to age 2 because saturated fats are needed for brain development.
"But now we have the obesity epidemic and people are thinking maybe this isn't such a good idea," said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, which appears in the July edition of Pediatrics, the group's medical journal.
Very young children are increasingly getting fats from sources other than milk and Greer said the updated advice is based on recent research showing no harm from reduced-fat milk in these youngsters.
With one-third of U.S. children overweight and about 17 percent obese, the new recommendations are important, said Dr. Jennifer Li, a Duke University children's heart specialist.
"We need to do something to stem the tide of childhood obesity," Li said.
Li said that 15 years ago most of her patients with cholesterol problems had an inherited form of cholesterol disease not connected to obesity.
"But now they're really outnumbered" by overweight kids with cholesterol problems and high blood pressure, she said.
Dr. Elena Fuentes-Afflick, a pediatrics professor at the University of California at San Francisco, also praised the new advice but said some parents think their kids will outgrow obesity and cholesterol problems, and might not take it seriously.
"It's hard for people to really understand" that those problems in childhood can lead to serious health consequences in adulthood, Fuentes-Afflick said.
___
On the Net:
American Academy of Pediatrics: http://www.aap.org/
When I first heard of this recommendation I was stunned, then outraged. Then I came to my senses and realized this is just another step in the direction of medicalizing our society, however this time with our children.
The theory is that adults already have some coronary artery blockages, and cholesterol lowering will slow this down. I do not buy into that theory as I have not seen it to work.
For an excellent website that refutes the cholesterol hypothesis please visit www.spacedoc.net .
Lets look at some numbers. You need to treat 50 adults with a statin cholesterol lowering drug to prevent 1 heart attack or death over 5 years. To simplify that means that there is a 1 in 50, or 2% chance that taking the drug will help, and a 49 in 50, or 98% chance that it will not help.
Now lets extrapolate that out to children who rarely have any coronary blockages and that even if they did would take a minimum of 30-40 years to exert any effect. So how many children would need to be treated with statin medications to prevent heart disease or death over 5, 10 or even 20 years? How bout the potential side effects that these drugs cause?
This recommendation is extremely misguided and I hope the American Academy of Pediatrics will change these recommendations.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.
Thursday, February 14, 2008
The side effects of statins: Heart healthy and head harmful?
February 14, 2008 - This article from the heart.org is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.
The side effects of statins: Heart healthy and head harmful?
February 12, 2008 Michael O'Riordan
New York, NY - The cognitive side effects, especially memory loss, associated with statins resurfaced again this week with an article in the February 12, 2008 issue of the Wall Street Journal, in which some doctors voiced concerns that the cholesterol-lowering medications, specifically atorvastatin (Lipitor, Pfizer), might be helping patients' hearts but actually putting their memory in jeopardy [1]. To date, evidence for this effect is only anecdotal.
In the article, Dr Orli Etingin, vice chair of medicine at New York Presbyterian Hospital, is quoted as saying that atorvastatin, the best-selling drug on the market, "makes women stupid." Etingin told the Journal that 24 of her female patients taking atorvastatin lost the ability to concentrate or recall words. While tests showed nothing irregular, the women regained full cognitive capacity when the statin was stopped, and some women did better on other statins.
The examples cited by Etingin, founder and director of the Iris Cantor Women's Health Center (New York), are anecdotal, but she said more studies are needed to assess the cognitive effects of statins, especially in women.
These concerns, despite their observational nature, are not new and have surfaced in medical journals and meetings, as well as the mainstream media, for a number of years. As the Journal notes, "Lowering cholesterol could slow the connections that facilitate thought and memory. Statins may also lead to the formation of abnormal proteins seen in the brains of Alzheimer's patients."
The evidence, however, linking statin use to declines in cognitive function or to the development of diseases such as amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, as well as to the possible protection from Alzheimer's and Parkinson's, are scattershot at best. In the Journal, reporter Melinda Beck notes that Pfizer, the maker of atorvastatin, states the drug has been tested in 400 clinical trials, with no evidence establishing a causal link between atorvastatin and memory loss. Cardiologist Dr Antonio Gotto (Weill-Cornell Medical School, NY) believes the benefits of the drugs outweigh the risks, telling Beck that he "would hate to see people frightened off taking statins because they think it's going to cause memory loss."
Dr Michael Miller (University of Maryland Medical School, Baltimore) commented to heartwire that he has heard anecdotal reports of cognitive declines with statin use but pointed to a recently published paper in Neurology, with lead investigator Dr Zoe Arvanitakis (Rush University Medical Center, Chicago, IL), showing that in nearly 1000 patients the use of statins was not related to incident Alzheimer disease, changes in cognition, or continuous measures of Alzheimer's pathology or infarction [2]. Numerous other articles, many covered by heartwire, show conflicting data supporting and not supporting a link between statin use and cognitive decline.
Speaking with heartwire, Arvanitakis said that her study involved both men and women and the results do not contradict the observational findings but simply do not support the anecdotal evidence seen in clinical practice.
"There is a lot of interest right now with respect to statins and cognitive decline and Alzheimer's, so we need to be aware of the anecdotal evidence," she said. "There are some people who do believe that statins have a negative effect on cognitive function, and others who believe it has a beneficial or protective effect, but right now we just don't know. . . . The bottom line is that the evidence is mixed."
Asked about the cognitive side effects, Dr Roger Blumenthal (Johns Hopkins University Medical Center, Baltimore) told heartwire he has had some patients "who think that they are not as sharp mentally on statins, but the numerator is very small and the denominator is very large." If there is a good reason to treat a patient with a statin, he'll try another drug or every-other-day dosing, but he noted that he does not need to do this frequently, as 90% or more patients "have no problems with statins."
Still, anecdotally, "the chronology can be very telling," Dr Gayatri Devi (New York University School of Medicine) told the Journal. She has treated six patients with memory loss traceable to statin use, with the changes occurring within six weeks of starting the cholesterol-lowering drug. "It's a handful of patients, but for them, it made a huge difference."
While cognitive declines occur in men, too, women are affected particularly harder because they are losing estrogen in menopause, something that can also cause changes in cognitive function, writes Beck. She quotes Women's Heart Program director Dr Nieca Goldberg (New York University School of Medicine) who prescribes statins only to women with elevated LDL cholesterol and who have already had an MI. For others, including those with high LDL cholesterol but no risk factors, Goldberg recommends dietary changes and exercise.
With the evidence all over the map and with observational reports not going away, studies are being conducted to examine the effects of statins on "thinking, mood, behavior, and quality of life," writes the Journal. The researchers, led by Dr Beatrice Golomb (University of California, San Diego), are collecting anecdotal experiences of patients on statins. Muscle aches are the most commonly reported side effect, thus far, with memory problems the second most common side effect, in approximately 5000 reports to date.
Sources
Beck M. Can a drug that helps hearts be harmful to the brain? Wall Street Journal, February 12, 2008. Available at: http://online.wsj.com/public/us.
Arvanitakis Z, Schneider JA, Wilson RS, et al. Statins, incident Alzheimer disease, change in cognitive function, and neuropathology. Neurology 2008; DOI:10.1212/01.wnl.0000288181.00826.63. Available at: http://www.neurology.org.
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Yet more information now being released about possible side effects of statin drugs which lower cholesterol. The experts mentioned above claim that there is only anecdotal evidence about statins and memory loss. I have seen memory loss in a small number of patients on these drugs. I have also seen other side effects, the most common being muscle aches and pains.
Statins are not the panacea to heart disease that the pharmaceutical industry has claimed. In the years to come I believe we will be using less of these medications as we find their effectiveness at preventing heart disease has been overstated.
Previous newsletters have discussed this topic.
February 6, 2008 : Cholesterol May Help Build Muscle
January 15, 2008 : Cholesterol Drug Zetia Doesn't Cut Heart Attack Risk: Study
I would also recommend www.spacedoc.net for more information on statin side effects.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
Wednesday, February 06, 2008
Cholesterol May Help Build Muscle
February 6, 2008
This medical news about health and wellness is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.
Cholesterol May Help Build Muscle
Low cholesterol levels may be good for your heart, but cholesterol levels that are too low may negate exercise-related muscle gain, says a Texas A&M University study of 50 men and women, ages 60 to 69.
Participants took part in a 12-week exercise program that included stretching, riding a stationary bike and weightlifting. They all ate similar meals, CBC News reported.
The most impressive gains in muscle strength occurred in those with the highest cholesterol levels, rather than those with the lowest levels.
The study authors said cholesterol may play an important role in muscle tissue repair, which is critical in building muscle mass, CBC News reported.
"As you exercise, your muscles can become sore because they are rebuilding muscle mass. More cholesterol may result in a more robust inflammatory response. We know that inflammation in some areas, such as near the heart, is not good, but for building muscles it may be beneficial, and cholesterol appears to aid in this process," lead investigator Steven Riechman, assistant professor of health and kineisiology at Texas A&M, said in a prepared statement.
The study was published in the Journal of Gerontology.
The hypothesis that cholesterol is bad for your health and should be lowered at all costs is starting to unravel. As many of my patients know, I have not been a fan of cholesterol lowering medications. I view cholesterol as a marker for human health and disease, but not as a cause of disease.
Cholesterol is made by our body, in our liver, whether we eat cholesterol and fat in our diets or not. Obviously cholesterol must have some positive actions in our bodies. The article you just read appears to be one positive action. Hopefully in the near future more medical studies will be conducted and published showing more beneficial actions of cholesterol.
Achieving good cholesterol levels is important. But how you achieve those levels is more important. Using medications to improve your cholesterol levels is like painting a car with a rusty engine. The cholesterol and paint will look wonderful, but the car engine, heart and vascular system do not always benefit. A good analysis of cholesterol lowering medications was written and appears in Business Week magazine, Jan 28, 2008 edition.
I would like to provide a link to another site that reviews cholesterol lowering treatments with a slightly different analysis than you usually hear on the news. I am providing this link as fuel for thought and I would welcome any comment or feedback.
Steven Horvitz, D.O.
Board Certified Family Medicine
Your Partner in Health!
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