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As we know heart disease is the number 1 cause of death in this country at over 450,000 people in 2008 accounting for $448.5 billion spent.  Since the eighties we have been taught that the primary cause of heart disease is high cholesterol levels causing plaque in the arteries.  Because of this belief, statin drugs have become the highest selling drugs in history, of which Lipitor is the most popular.  Today, though, we are starting to see a shift in this thinking as more and more people are coming to the realization that while the high cholesterol=heart disease connection is great marketing for the drug companies, we continue to see staggering levels of heart disease even as millions of people take these medications. 

If high cholesterol was the cause of heart disease and millions of people are on medications to lower it, shouldn’t we see less and less levels of heart disease? 

Why do we see countries with high average cholesterol levels have comparatively low rates of heart disease?

The good news is more and more attention is starting to be placed on what I believe is the real cause of heart disease (and many other chronic diseases including cancer and diabetes): a pro-inflammatory state in the body as the result of a pro-inflammatory lifestyle.  MSNBC recently had an article outlining a new $20 million study sponsered by the Federal government that is going to take a look at Fish Oil and Vitamin D supplementation and their effect on heart disease rates.  I suspect that this study will show a decrease in those populations supplementing with Fish Oil and Vitamin D as these supplements have anti-inflammatory properties which help to offset the damage done by the typical American lifestyle.

Let’s take a look at what we mean by a pro-inflammatory state in the body.  We cause a pro-inflammatory state in two ways:  our body’s stress response and food we eat.  First we’ll talk about the stress response.  The autonomic nervous system is the part of your nervous system that controls sub-conscious, visceral function.  It can be divided into two parts, the parasympathetic and sympathetic.  You may have heard the sympathetic nervous system called the “flight or fight response.”  Basically what happens is this:  when we are stressed, whether by a tiger jumping out at us, by a fight with our spouse, or any other negative stimulus, the sympathetic nervous system sends signals to organs and glands causing an increase in catabolic activites (heart rate, blood pressure) and a decrease in anabolic activities (sex glands, digestion, growth, cellular immunity).  The sympathetic nervous system also stimulates the adrenal glands to release catecholamines (adrenaline, epinephrine, etc) and cortisol.  These hormones cause a cascade of actions that, in a short-term stress situation are necessary, but if allowed to continue unchecked can have devastating effects.   Some (but not all) of these effects include:

• increased blood glucose levels and increased insulin resistance
• increase blood lipid and cholesterol levels (LDL up, HDL down)
• increase in body adipose (fat) tissue
• increased clotting factors
• increased vasoconstriction
• increased feelings of stress, fear, anxiety
• and much more.

The chronic accumulation of these effects is the pro-inflammatory state, leading to what is termed high Allostatic Load.  A high allostatic load causes your body to not be able to adapt to stress properly, leading to chronic disease.

The other way we cause a pro-inflammatory state is by the food we eat.  Dr. David Seaman writes extensively on how certain foods we eat are converted into inflammatory products in the body.  His book, Clinical Nutrition for Pain, Inflammation, and Tissue Healing, is a great resource for exactly how this happens.  To summarize, we need to stay away from grains, white sugar, white flour, and especially corn products.  These foods are converted into pro-inflammatory products in the body (we need these products to heal properly, the problem is that most of us have way too much).  One example of how this happens is with Omega-6 fatty acids.  Omega-6 fatty acids are ingested and then converted in the body to pro-inflammatory products.  This conversion is increased in the presense of trans fat and insulin (whose levels are raised due to the Stress Response).  We ingest Omega-6 fatty acids when we eat corn and corn derived products, which is present in almost every processed food we eat as well as most of our meat (beef, chicken, and pork).  A great book on our food supply and its components is “The Omnivores Delimma” by Michael Pollen.

How does a pro-inflammatory state lead to heart disease? The pro-inflammatory state causes the perfect storm when it comes to heart disease.  All of the effects, and then some, that we listed above contribute to damage to our vessel walls.  In a nutshell this is what happens:  the chronic inflammatory products (including free radicals) that are rushing through the blood vessels cause the walls of those vessels to become weak.  The body rushes to fix them using clotting factors.  Fat also becomes trapped in the walls.  Over time this happens enough that the vessels eventually become clogged, leading to a heart attack.

Looking at this process you may ask:  If my vessels walls are becoming clogged with fat (cholesterol) doesn’t it make sense to lower my cholesterols levels?  Furthermore, don’t studies show a correlation between cholesterol levels and heart disease rates? The answer to the first questions is no.  The level of cholesterol in your blood doesn’t matter, the level of damage caused by inflammation does.  You can have high levels of cholesterol in your blood, but if your vessels walls are not being damaged then you will not develop plaque in the arteries.  This is the reason countries like France, despite having high average cholesterol levels, have comparatively low rates of heart disease.  Conversely, lower levels of cholesterol due no good if the vessels wall are damaged due to inflammation.  This goes back to the question we posed in the beginning:  why is our rate of heart disease so high if so many people are taking cholesterol meds?  The answer:  because the cholesterol level doesn’t matter! It’s a fancy number, but unless you’re making lifestyle change to prevent a pro-inflammatory body state you’re still going to be at risk.

The answer to second question,”don’t studies show a correlation between cholesterol levels and heart disease rates?”, is actually true.  The reason is simple, one of the effects of chronically high catecholamine and cortisol levels is an increase in the body’s production of LDL (and decrease in HDL).  Furthermore, people who live a pro-inflammatory lifestyle consume high levels of omega-6 fatty acids, cholesterol, and trans-fat.  In the end though, as we outlined, the problem is not the high cholesterol damaging the blood vessels, it’s the chronically high levels of inflammatory products circulating as a result of lifestyle.

As you can see, heart disease is a completely preventable disease caused by your lifestyle.  You don’t have to be enslaved by a number.  In our next post we’ll talk about what you can do to prevent heart disease in yourself and your loved ones. 

MSNBC just posted an article on the upcoming FDA decision to approve new pyschiatric drugs for children.

For this discussion I’m going to leave aside the questions of 1.) whether these drugs are safe and effective (many groups are questioning whether enough studies have been done to determine the long term effects of the drugs), and 2.) do children need to be taking them or is there a better way to help them?

Just like efforts to promote Lipitor for children, we are again seeing drug manufactures attempting to push medicine designed for adults onto younger and younger children.  This time it is a drug that many studies show has no greater effectiveness, or less side effects, then current drugs on the market.  What is the motivation behind this push then?  Well these older drugs were first developed in the 1950s, meaning that they can be bought as generic.  The cost for them is around $100/month.  The newer drugs cannot be bought as generic, they sell for between $300/month and $500/month.  These drugs had combined sales of $14.6 billion last year.  With approval for use in children that number could conceivably double.  My question is what motive beyond money could there be to approve new drugs (that haven’t been long term tested, even beyond 6 weeks) for children, and promote there use over older, known drugs when there is basically no difference in effectiveness between the two?

If these new drugs are approved by the FDA, there are two groups of people I feel sorry for.  The first, of course, is the children who take it, especially if these drugs turn out like so many others who are not properly tested (or are and those test results are buried), and have dangerous long term effects that we don’t know about now.

The second group is the doctors who perscribe these drugs.  In many cases all the information that doctors receive about a drug, its effectiveness, side effects, etc.  are from the manufactures themselves.  Most doctors, especially general practitioners, simply do not have the time to do due diligence and study every single drug they prescribe.  There are too many.  They are forced to rely many times on marketing materials they receive from drug reps, whose job it is to convince the doctors to prescribe their medication, in the case of these psychiatric drugs cost 2-3 times more but show little to no increased effectiveness.  For a more indepth view of the lengths that drug reps go to sell their products check out this article from ABC News.  It interviews a former rep for Eli Lily who sold Zypraxa, one of the drugs we’re discussing here.  He describes the lengths he went to sell doctors on drugs.  In another article a chiropractor from Michigan posts a blog describing his interaction with some pharmaceutical reps.

In the end we all pay the price if these drugs are approved.  The children who take them unknowingly face the unknown consequences of long term use of these drugs.  We, the public, have to pick up the tab on the increased cost of using these medications over the ones currently prescribed.

Update:  The panel voted to OK the psychiatric drugs just a couple hours ago.  The FDA doesn’t have to take the recommendation, but does anyone think that they won’t?  Again, there is too much money riding on it for them not to.  Don’t forget, many of these same folks who determine supposedly impartially determine what drugs get approved eventually leave the FDA to work at the drug companies themselves in high paying positions.  They definitely don’t want to endanger that golden parachute.

In a completely related note, the Wall Street Journal reports another research psychiatrist has been accused of not disclosing the fact that he receives money from the drug company, GlaxoSmithKline, which make the drug Paxil.  He was researching on a NIH grant the effects of Paxil on pregnant women.  /sarcasm| I’m sure that GSK was paying him out of the goodness of their heart and expecting nothing in return in regards to his research, even though it could be worth billions to them if her returns the “correct” outcome. /sarcasm\