Nick M writes:
...On a loosely related note, the same cardiologist did advocate caution with endurance sport, specifically with high intensity exercise of longer than two hours or so (largely due to the inflammatory response that gets triggered). He referred me to a book written by a cardiologist (and keen cyclist) called ’The Haywire Heart’ (by John Mandrola and Chris Case) which you might be interested in.
WIND: my primary comment is that I’m going to live. That means doing things I love, which means endurance cycling and all-day hikes, and feeling fantastic because of it.
I am not afraid to die, but I am very much afraid of not living, and no one can tell anyone else what that means—so if “crazy Lloyd” wants to ride double centuries... well other people have far more damaging passions (or no passions or meaningless passions).
Cardiologists are spot-on in expressing some concern about the issue of extreme exercise—they would be remiss not to. But the research is still in its infancy. My best is that extreme exercise carries some risks (why wouldn’t it?) but a risk analysis has to weight that against the benefits, which are physical, psychological, hormonal, and spiritual. No medical study will ever do that properly.
To speak to the research, there is evidence that endurance athletes incur hard plaques from their excess activity. But these hard plaques have a much lower cardiac risk than soft plaques and recent research finds that there is NO INCREASED RISK of cardiovascular events.
Mayo Clinic Proceedings: Extreme Physical Activity May Increase Coronary Calcification, But Fitness Still Prevails.
...high levels of PA and CRF are extremely protective against CVD events and mortality, making it possible for individuals to perform high doses of running and exercise safely even with high CAC and "hearts of stone."
Nick M writes:
I’ve been interested by your recent posts touching on heart health and diet. I became interested in the topic of diet a few years ago when a prominent South African sports scientist, Tim Noakes, came out strongly in favour of a low carb, high fat diet for general health (and not least heart health). This was a 180 degree shift for Noakes who had been involved in driving the popularity of sports drinks in South Africa some years ago. His position was that having spent a couple of years reviewing the scientific literature he felt that the evidence pointed towards the ‘conventional wisdom’ of the past 60-70 years being wrong (ie pro carb and anti fat, especially saturated fats). Noakes has been vilified by much of the conventional medical establishment, but has stood firm with his position.
I adopted a non-obsessive low carb, high fat diet and have found it has helped me regulate my blood sugar very significantly. But after growing up hearing the high carb, low fat story, I remained slightly concerned about which of the opposing ’truths’ to believe. At a routine visit to a cardiologist a couple of years ago, I made the point that as a layman I have found it hard to know what to believe, but have found success with the low carb, high fat approach. His response was interesting! In essence he said that the science is clear and strongly in support of low carb, high fat. He went on to say that he made a decision some years ago to stop going to cardiology conferences since his experience was that they were peddling a story based on questionable research sponsored in large part by the (processed) food and pharmaceutical industries.
There is obviously lots of literature on all this stuff. The challenge is that much of it is conflicting - hence, my question to the cardiologist. I did read a couple of the more ‘populist’ books on the subject. The one that made the most sense to me overall - despite finding the writing style rather painful - was ’The Primal Blueprint’ by Mark Sisson. The book does lay out the case for low carb, high fat in layman’s terms and it makes suggestions around diet and exercise.
On a loosely related note, the same cardiologist did advocate caution with endurance sport, specifically with high intensity exercise of longer than two hours or so (largely due to the inflammatory response that gets triggered). He referred me to a book written by a cardiologist (and keen cyclist) called ’The Haywire Heart’ (by John Mandrola and Chris Case) which you might be interested in.
WIND: as far as I can tell, the whole cholesterol vs cardiac health thing is one huge scam based on no hard science (hard science shows direct links by varying one factor while holding others fixed). Instead we see mass statistical data correlations masquerading as science. The reason that statins lower reduce heart attack risk modestly has NOT been proven to result from lowering LDL. It is almost certainly an incorrect assumption, the body being far more complex.
That’s right—the reason is NOT known—it’s just a correlation. And there things sit stopped in their tracks as “knowledge” when even the basics remain unknown, such as whether (making up an example) putting 1000 people on a strict Mediterranean diet can not just beat a statin for CVD events, but improve health and avoid all the nasty side effects of statins. The state of this medical pseudo science is pathetic to any objective outside observer.
The only good hard science I have found so far is by a layman—a non-medical person, an engineer like myself, who correctly points out that what passes for science in medicine wouldn’t pass muster in engineering. And directly refutes the accepted link between a high fat diet and LDL cholesterol.
In general, “low carb” makes a lot of sense (30% or less seems about right, less when not active perhaps) and I’d agree with it. I suspect that it will be shown to be harmful over time to aim for 5% or less carbs (Keto diet) as this almost certainly has negative aspects coming from the failure to eat fruits and vegetables and the incorporation of a lot more saturated fat. The body did NOT evolve to subsist that way and there is real risk of nutrient deficiency.
My guess is that much of “low carb” craze (fad) results from the reduction or elimination of excess quantities of poor food choices, e.g., lots of bread/pasta/etc—those largely SUCK and yet such bad choices drive fads/fanatic diets. Throwining the baby out with the bathwater: it makes no sense to stop eating moderate amounts of oranges/strawberries/blueberries/bananas/etc in pursuit of fad diets like Keto—fruits like that are full of nutrition. Ditto for vegetables, especially kohlrabi, cabbage, cauliflower, bell peppers, radishes, carrots, kale, etc.
I’m a believer in moderation, which is to say I enjoy lots of fruits and vegetables (mostly carbs) and See’s candy (mostly nuts but a good amount of carbs) and very limited amounts of bread and sweet potatoes and ric. But zero soft drinks, no fruit juice, very little processed food, no fast food, I rarely eat out, etc.
Athletes and carbs
As an athlete, my favorite competitor is someone on a Keto diet which guarantees poor performance because the multiple energy pathways of the body cannot be used when the required effort rises. You MUST be able to create energy from glucose, and it is literally DANGEROUS if glucose gets low (brain fade). Ride 50 double centuries as I have and learn that fat metabolism is the primary energy source, BUT failure to take in carbs like Tailwind will result in horribly slow and unpleasant day.
Worse, those on a Keto diet are subject to catabolic muscle loss. During a double century for example, the body will eat its own muscle tissue to the tune of 10% to 15% of required energy. That equates to 1/3 to 1/2 POUND of muscle “eaten” as an energy source. Those on a Keto diet might see much higher losses, with the body deprived of adequate carbohydrate stores. Seems like a dumb move to me.
When I complete the Southern Inyo Double Century on March 7, I will burn about 7000 calories. Probably at least another 1000 calories are needed for repair. I will need to take in at least 2000 calories, mostly carbohydrate, from 5 PM to 5 AM before I do the Sunday March 8 double century.
Carbohydrate and 10% to 15% protein together are essential for athletic recovery, for driving the carbs into muscles to be stored as glycogen together with the protein for repair. The Keto diet maniac will NOT recover properly or repair muscle even if doing my paltry baseline 1000 calorie per day ride (7000 calories or 100 MET-hours per week), unless tht pace is kept low.
Tere are times when my athletic recovery cries out for carbs, I go on a binge eating day, which I have found to be effective in losing body fat and dropping weight, believe it or not. Limiting this to one day per week seems about right and highly effective in keeping the body from trying to make itself more and more calorie efficient.
Try riding 60 miles a day for two weeks and see how much cabs matter! An excellent binge day is a bottle of champagne and a half pound of dark chocolate caramel pecan clusters—works wonders and I have had some of my best workouts following that!
High intensity exercise of longer than two hours
See Mayo Clinic: Extreme Physical Activity May Increase Coronary Calcification, But Fitness Still Prevails.
First, do no harm
Swearing a modified form of the Hippocratic oath remains a rite of passage for medical graduates in many countries. Its simplified form is:
First do no harm.
Statins have numerous risks, some severe and life-changing so much so as to destroy lives. Professors, attorneys, etc have had their lives destroyed by statins, as discussed in The Truth About Statins by Barbara H Roberts, MD. So we are not talking about some internet tripe, but actual experiences seen by a cardiologist. And there are numerous other sources of such adverse reaction issues. Numerous risks whose odds ratio rises dramatically with statin use, increasing over time.
Yet I have had two primary care physicians and one cardiologist recommend a statin to me in the past two years. The cardiologist might have briefly discussed diet, but the main thing I remember is the statin recommendation.
In my view, these doctors all have violated their oath because they all went right to a statin that raises the odds ratio for numerous risks, some severe and debilitating. In my case, the recommendations are particularly egregious given multiple risk factors: (1) history of neuropathy (2) concussion and brain issues, (3) extreme exercise which greatly increases the risk of muscle damage and liver and kidney issues. How the hell can a body under physical duress repair itself properly when a key system function is suppressed? How can suppressing a key biological function for one single-minded goal (suppressing LDL) be a tenable proposition?
By what metric is it not medical malpractice to recommend a statin to a patient without first insisting that a patient follows a Mediterranean diet for at least a year?
In my view, doctors who to not first demand their patients change diet and lifestyle for at least two years are in fact violating the “do no harm” oath directly. At best, this is ethically and professionally dubious. It places the doctor first (“who can blame me, I followed the guidelines”) versus the patient (risk-free alternatives).
There are studies showing that a Mediterranean diet can work as well as a statin, with numerous other benefits and no risk. But who will pay for good studies showing diet vs statins? Big Pharma won’t! When there isn’t money to be made, the money-making alternative wins, hands down.
Odds ratios, flawed studies, poor followup, financial corruption
Statistical data analysis measures are irrelevant to any individual and particularly an out-of-bounds individual like me. No doctor can tell any particular patient if a statin will have any benefit whatsoever. But it is highly likely that at least one side effect will emerge. And how many patients get liver tests, cognitive tests, muscle biopsies, etc as follow up? In other words, the side effects are largely ignored unless they stand out in obvious life-changing ways.
Using a statin causes the odds ratio to spike dramatically for numerous risks, some of which are debilitating, some less obvious (cognitive) or just suffering (constant muscle pain). Oh, if you are pregnant, how about a severely deformed newborn?
As just one example, if my risk of neuropathy rises by 2600% over a few years of statins, is that worth reducing my risk of cardiac events over ten years from 4% to 3% ( a relative risk reduction of 25%)? Along with greatly increased risk of numerous other problems? What about the cost of all the tests for liver malfunction and the costs of the statin, the psychological toll when something feels wrong, etc?
Look at the actual real risk reduction for statins—it’s a joke. Then consider all the hugely heightened risks in other areas.
Severely flawed and financially corrupt research
The alleged benefits of statins are poorly understood—we have data analysis studies showing reduced cardiac events, but the studies have so many obvious flaws that even a layperson of average intelligence could understand the ridiculous bias involved:
- Assuming that women are little more than men with breasts and different gonads. Women respond very differently and may in fact take on all the risks of statins with ZERO benefit.
- Including those who drop out of studies in study results. In computers this is known as GIGO (garbage in = garbage out).
- Assuming that certain types of endpoint results (death or serious issues) are relevant.
- Assuming that certain “soft” endpoints are the same as “hard” like death.
- Assuming that the reduction in LDL is what drives the lower cardiac event profile. No science actually proves that key supposition! All we have is correlation by data analysis, not causation. Real science on this matter should give anyone pause.
- Failing to perform risk analysis for all sorts of debilitating side effects.
- Minimizing, ignoring, or just not looking for side effects.
- Trials lasting two years or less, when there is strong evidence that statin damage can occur years later.
- Failure to disclose all study data to interested parties (Jupiter study).
- HUGE financial incentives in play (billions of dollars), with studies funded by Big Pharma, data collected and controlled by Big Pharma, lead doctors for the study having financial conflicts of interest, an FDA that colludes with Big Pharma and is subject to political influence.
Deeply flawed studies* funded and run by drug companies driven by data analysis are junk science. Financial incentives always corrupt.
We will see in a decade or so just how badly public health was damaged by statin use, in two ways: (1) first, in not using superior approaches like dietary intervention that improve health in myriad ways without side effects and (2) in saving lives from cardiac events better than a statin. That is the real shame here, which doctors should take to heart: the emphasis on statins is damaging people and taking lives. Shame on everyone who toes the line on statins.
The American Heart Association (AHA) recommended a low fat “heart healthy” diet for years, damaging untold millions of people. Yet a high fat Mediterranean diet is proven to have numerous benefits including heart health. You cannot trust these “experts”, who have a financial and authoritative axe to grind*.
Why does the FDA issue a statement calling red rice yeast “harmful to health” (!!!) for its potentially serious side effects when the active ingredient is a statin (lovastatin)? Perhaps because it *is* dangerous, and drug companies have poison to peddle for profit. But in a food, that’s bad and it needs to be outlawed?
We are told to take statins as some sort of risk-free miracle pill. And now the drug industry and the medical establishment are pushing statins on healthy women, who take on all the risks but in most all cases get zero benefit. Outrageous drug pushers.
Statins are recommended for lifelong use, yet side effects can take months or years to emerge and can then be so damaging as to render a person incompetent to lead a useful life. How can dishing out statins willy-nilly like Halloween candy before demanding dietary interventions be considered anything but a grotesque perversion of medicine?
Doctors have no skin in the game in the right way. The liability of a doctor for failing to prescribe a statin violates guidelines and thus makes the doctor a target of litigation. A doctor who prescribes a statin that causes pain and suffering and life-damaging events has essentially no liability (“I just followed the guidelines”). This is an ethical cesspool.
Under-reporting of side effects, minimal research
Statin risks guaranteed to be under-reported for several reasons. First, too often they will simply not be diagnosed as related to the statin, for all sorts of obvious reasons. Second, there is huge financial and professional pressure to toe the line. Third and perhaps most important: no one gives a damn: very little research money is going to pop up to show just how bad statins are—who would pay for that?
This in spite of life-destroying side effects that can occur with statins and many less significant but still damaging risks, those risks growing in relative terms far more than any relative risk reduction for a single risk (cardiac events).
Anon physician writes:
I am a physician in a specialty that sees the effects of statin use but does not prescribe them. As an ophthalmologist retina specialist I see tons of very elderly patients with macular degeneration. Over the decades of my practice I am seeing a larger and larger number of these elderly patients. They just don’t die like they used to. Yes, they depart eventually, but I am convinced it’s the statins and improvement in cardiac care that keeps these folks going on for virtually forever. The quality of life often isn’t so good, though. Something eventually does eventually get them: cancer, dementia, diabetes, COPD, pneumonia, influenza, stroke, etc.
I have seen the side effects of statin use and I agree they seem to get swept under the rug. Understand that statins are a multi-billion dollar global business and that business will do anything to keep this profit machine going. Advertise the Hell out of the product to patients. Advertise to physicians, sponsor the studies, kill the studies that show adverse results. No, it’s not 100% control but with the proverbial thumb on the scale you can tip the business in your favor.
Also understand that population-based statin recommendation is a macro phenomenon. If you look at a population of a million and put half of them on statins statistically you will see the reduction in cholesterol, reduction in plaque and drop in atherosclerotic events. But prescribing statins by an individual physician is a micro phenomenon. The individual prescriber, if they are tuned in to their patients, will see the variable anti-cholesterol effect and they will also see the side effects. The challenge is that not all patients are going to have a given statin side effect. But when they do, then it becomes a project to explain to the patient the pros and cons, the “are you willing to put up with this in exchange for that.” Or can we try a different drug or a different dose in order to minimize the side effects while maximizing the benefit.
And of course in the background are all the studies showing global statin benefits that make it harder and harder for a physician to ignore the pressure to prescribe. And in many areas of practice, treatment of heart and atherosclerotic disease now follows protocols. As a doc, if you follow the protocol and an adverse event ensues, you’re covered. The other way around and you are potentially screwed. The pressure to simply follow the protocol is enormous.
And on top of this you have to consider the fact that all of this is based on statistical data and the quality and granularity of the results depends enormously on the quality and granularity of the study. Since drug companies and researchers are under enormous pressure to achieve “positive” results as quickly as possible, most studies are as nongranular as possible. If there is money and time, the granular parsing of data may come later. But it may ever come at all.
Has anyone ever done an in-depth study on statin use in top drawer aerobic-sport male athletes and looked at longevity, serious adverse events (stroke, heart attack, etc) and also compiled data on side effects, including effects on performance, etc? I seriously doubt it for two reasons. First, the study may not show what you the sponsoring drug company want it to show. Second, the number of subjects you would be able to enroll would be really limited and may not be enough to demonstrate statistical significance. There just aren’t enough of you folks out there.
And I think it is folly to try to extrapolate mass study data results to small subsets of patients without actually doing a study. A doc can certainly quote the results of the mass study to their patient and forget to mention that it may have little or no bearing on you, the individual. Ultimately, you need to have a really good physician who understands the data and its pitfalls and who understands you and your needs.There are a few of them out there, but not many. Good luck finding one. And when you do find one, stick with them.
WIND: longer life can be a cruel thing, especially if it is degraded by pain and suffering.