Tuesday, January 29, 2013

Diet, Not Drugs

As a society we spend so much money that is absolutely wasted on medication. The disease is not high cholesterol or even obesity. The disease is our diet and our lifestyle. When we address these issues then all the symptoms, yes - all, disappear and we can lead a healthy long life. 

A recent randomized controlled study (NORDIET) on 88 mildly people with elevated cholesterol showed how simple the solution is. 1One group had a diet rich in high-fibre plant foods: fruits, berries, vegetables, whole grains, grapeseed oil, nuts, fish and low-fat milk products, but low in salt, added sugars and saturated fats. The other group had the average western processed diet. Compared with controls, those on the healthy Nordic diet (ND. similar to the Mediterranean diet) had a decrease in plasma cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, LDL/HDL and apolipoprotein (apo)B/apoA1. The ND also had reduced insulin and systolic BP by compared with the control diet. Body weight decreased after 6 weeks in the ND compared with the control group. The conclusions after 6 weeks in the study was that a healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinically relevant levels in people with elevated cholesterol without any medication. 

While cholesterol is not a health problem it is an indicator of poor health, primarily stress on the liver and growing research is also showing that cholesterol may actually be protective. 


A study of 6984 patients aged 65 years or older found mortality was inversely related to cholesterol levels. That is low cholesterol levels were associated with in-hospital mortality 2. The study concluded that among older hospitalized adults, low serum cholesterol levels appear to be an independent predictor of short-term mortality.  

In another study of more than 52,000 Norwegians over a 10-year period the overall risk of death was the same in men with cholesterol levels of 7.0 mmol/l or higher than in individuals with levels of less than 5.0 mmol 3. In the individuals with cholesterol levels in the 5.0 – 5.9 mmol/l the risk of death was 23 per cent lower than in men with the lowest cholesterol levels. In women, the higher the cholesterol level the lower the overall risk of death. The third study of 82,000 adults in the UK over 8 years again found that higher total cholesterol levels were actually associated with a reduced risk of death due to stroke and that higher cholesterol levels are not a risk factor for heart disease 4 

There is no valid reason to focus on lowering cholesterol and especially no valid reason to take statin medication which has serious side effects, when the solution really is so simple.  


References: 

1 
Adamsson, et al 2011. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). 
DOI: 10.1111/j.1365-2796.2010.02290.Journal of Internal Medicine 
Volume 269, Issue 2, pages 150–159, February 2011 

2 
The American Journal of Medicine [2003, 115(4):265-271]  
DOI: 10.1016/S0002-9343(03)00354-1 Image 

3 
Petursson H, et al. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract. 25 Sept 2011 [Epub ahead of print] 

4 
Hamer M, et al. Comparison of risk factors for fatal stroke and ischemic heart disease: A prospective follow up of the health survey for England. Atherosclerosis epub 22 August 2011. 

Complimentary and Sustainable Medicine

Complimentary and Sustainable Medicine 

A recent study of 14,329 employed adults in the US found that doctors and nurses use complimentary medicine more than the general population 1. They found 76 percent of healthcare workers use complementary and alternative medicine (CAM) compared to 63 percent of the general population. 

On the one hand this is positive, but on the other this is concerning given not only the lack of encouragement from the medical establishments to use CAM, but also their willingness to dish out drugs which could otherwise be treated by CAM. However, this is understandable given that the doctors know more about the toxic, even deadly side effects of drugs. There are more than 400 000 adverse reactions to pharmaceutical drugs in Australia each year and probably more than 10 000 people die as a result of these drugs (although true numbers are not available). Government information from the US shows that there were 3,764,698,318 prescription drugs filled in the US in 2011. The average American aged between 19 and 64 used 12 prescriptions a year and those over 65 used 28 prescriptions each year. Males used 9.7 prescriptions on average while females used 14.3. 

The study shows that most doctors and nurses who operate in mainstream medicine actually have more knowledge and appreciation for alternative medicine than most people suspect. 

Another study in the UK in 2010 2 showed growing numbers of people are turning to alternative medicines and that sales of alternative medicines are booming 2. The market has reportedly grown by 18 per cent in two years and they predict sales will increase by 33 per cent over the next four years as more patients reject prescription drugs in favour of natural remedies. This growth can be explained by the acceptance of many treatments such as acupuncture, which is available on the NHS as well as a move away from potentially dangerous prescription drugs. 

There are many other additional benefits of using CAM in Australia, including financial ones. The study found herbal preparations and omega-3s are effective treatments against an array of illnesses including osteoarthritis, heart disease and depression and could save the country more than $220m every year. However, the real benefit is that these supplements have no negative side effects and can help with multiple conditions. Omega 3 oils can assist in more than 50 different health conditions from asthma, cancer, CVD to depression and Alzheimer’s.  

The researchers found omega-3s were effective against heart disease and that St John’s Wort could save $50m annually in anti-depression pharmaceutical spending 

The clinical evidence showing complementary medicine can play a vital role in improving an individual's health has been clear for some time and needs to be considered as a serious part of the health care system in Western nations. 


References  
1) Johnson, Pamela Jo, Andrew Ward, Lori Knutson, Sue Sendelbach4 
Personal Use of Complementary and Alternative Medicine (CAM) by U.S. Health Care Workers. Health Services Research. Volume 47, Issue 1pt1, pages 211–227, February 2012 
Article first published online: 22 AUG 2011 
DOI: 10.1111/j.1475-6773.2011.01304.x 

2) Alternative medicine sales soar as consumers shake off cynicism By Daily Mail Reporter. 26th January 2010 

Thursday, January 10, 2013

Stress: The Silent Killer. Chronic Stress and CVD


“Not everything that matters can be measured, and not everything that is measured matters.” – Elliot Eisner

Cardiovascular diseases (CVDs) are the number one cause of death globally. In 2008, more than 17 million people died from them. On a national level, based on the 2004-2005 National Health Survey, 3.7 million Australians are estimated to have existing cardiovascular problems; CVDs were the direct cause of 35% of total mortality in 2005, again the number one cause of death 1,2. This is despite the billions of dollars spent on medications to reduce the risk and intensity of cardiovascular diseases 3. CVD is no longer considered a disorder of lipid (fat) accumulation, but rather a disease process characterized by low-grade inflammation of the vascular (artery) lining and an inappropriate wound healing of the blood vessels. The answer is to treat the cause of inflammation not cholesterol.
A study in 2004 known as the INTERHEART study found that 90% of all myocardial infarctions (heart attacks) could be attributed to nine potentially modifiable risk factors 4,5. These factors include tobacco use, atherosclerosis, hypertension, diabetes, abdominal obesity, psychosocial factors, alcohol consumption, physical inactivity and poor diets 4,6.
Despite convincing evidence linking psychosocial factors such as chronic and acute stress to the risks of cardiovascular disease 7,8,9, there remains a lack of focus on stress reduction for the prevention and treatment of cardiovascular disease. Risk reduction for stress is low-cost, simple to administer, and “non-pharmaceutical” 10.
Stress is the failure of an individual to cope with an emotional or physical threat. It results in both psychological and physical effects on individuals by means of two main stress groups: acute stress and chronic stress. Chronic stress occurs from exposure to stressors such as family, society (traffic, population, etc.) and, almost all the time, the workplace. When the body is stressed, a large number of biological and chemical processes can occur that put the body at increased risk of CVD. Chemical mediators are released, which cause the prolonged activation of the sympathetic nervous system 7 and increase heart rate and blood pressure, which puts a lot of strain on the heart and cardiovascular system 11. Over time, the strain on the system leads to deterioration of the heart muscle, arteries and vessels 11. Chemical mediators can also result in sleep deprivation, elevated cortisol levels, elevated insulin and blood glucose levels and increases in ghrelin, the hormone that increases appetite 11.

Chronic stress, which is what we are often confronted with in our daily busy lives, plays a huge role in these increases, as it can cause the prolonged activation of the sympathetic nervous system 7. This results in an increase in blood pressure and heart rate, which remain elevated, leading to an increased risk of cardiovascular disease. In extreme circumstances this is also linked with endothelial dysfunction (inability of arteries to dilate) and possible necrosis of artery walls 7.
Stress increases the release of hormones like cortisol, adrenaline and noradrenaline, which act to increase the heart rate and contractile volume, as well as constricting arteries in the gastrointestinal tract, whilst dilating those in the periphery. Aldosterone and vasopressin, two lesser hormones in the stress response, are also released and act to increase blood volume through increased water retention. One of the functions of cortisol is to increase the concentration of fatty acids carried by lipoproteins and sugars in the bloodstream, leading to more damage to the arterial wall, producing excessive levels of cholesterol that may then bond to the artery walls (and lead to high cholesterol readings by your doctor), a process called atherosclerosis 12. Atherosclerosis is the process in which a blood vessel wall thickens due to a build-up of fatty substances. The combined effect of these hormones is a marked increase in blood pressure, which may over time result in damage to the vascular tissue in the form of small micro-tears in the vessel walls. These minute tears heal by bonding with molecules floating in the blood (that is, cholesterol acts as a Bandaid). This cholesterol then forms a hard fibrous plaque with calcium, which may build up over time, constricting blood flow in the artery. Stress also causes the blood to become stickier in preparation of potential injury, increasing the likelihood of an artery‑clogging blood clot 13. One study found that those who expressed feeling high levels of stress and despair had a 20% greater chance of developing atherosclerosis over a four-year period. This was the same magnitude of increased risk as seen in a pack-a-day smoker.  Studies on animals have shown similar results. A study on hypertensive rats and normal rats found that the hypertensive rats suffering from stress had a higher rate of these events 14.
There is a large body of evidence demonstrating the relationship between increased stress and increased CVD. A study commenced before the terrorist attacks in the U.S. on September 11, 2001 examined the degree to which acute stress reactions as a result of the terrorist attacks could predict future cardiovascular outcomes through follow-up surveys over three years 15. In a sample of 2,592 adults, researchers found that the acute stress response was associated with a 53% increased incidence of cardiovascular ailments 15. Those individuals who had high levels of acute stress following the attacks also reported a two-fold increase in physician-diagnosed hypertension and a three-fold increase in other heart-related problems over the three-year period.
In a study of 11,119 patients found that those patients who had experienced a myocardial infarction reported a higher prevalence of all four stress factors: stress at home, stress at work, financial stress and major life events in the prior year 16. The study also found that the four stress factors worsened coronary atherosclerosis and endothelial dysfunction and increased inflammation 16.
The Whitehall II study found a 2.15-fold (215%) increased risk for cardiovascular disease in men who experienced a disparity between effort and reward at work 17. The study also concluded that high-risk individuals included those who were overcommitted at work, had poor promotion prospects, blocked or stalled careers as well as competitive and hostile work environments. Similarly, in a study of nearly two thousand male workers over a six-year period, researchers found that those who experienced chronic work-related stress were four times more likely to experience cardiovascular ailments 16. A study at the Beth Israel Deaconess Medical Centre in Boston found evidence that managers who fire someone run twice the usual risk of heart attack in the week following the dismissal; the greatest danger occurred to those who had conducted the firing while working under a high-pressure deadline. Another study found that chronic work stress and divorce increased the risk of cardiovascular mortality 17.
In a study of 791 patients, researchers reported that high-pressure deadlines increased the risk of heart attacks by 2.3 times within the seven days after the stress of the deadlines. Specific time pressures dramatically increase the risk of heart attack and early death. In a study of 60 women ages 30 to 45, researchers found that those under stress who secreted the highest levels of cortisol were also the ones who turned to high-fat foods in attempts to cope with their stress.
The results are similar for younger populations. In a study of 158 healthy adolescents who undertook self-report measures of chronic stress over 3.3 years, adolescents exposed to chronic, negative stressors that worsened over time demonstrated heightened cardiovascular risk 18. In a study investigating the responses of university students to stressful situations, researchers found that students exposed to stressful laboratory tasks displayed high levels of cardiovascular responses, which extended into a continued increase in blood pressure during instances of perceived stress in everyday life situations 19.
Being angry more than doubles the risk of cardiac arrest. In a study of 1,500 people who had suffered heart attacks who were surveyed and asked what their feelings were a few hours prior to the heart attack, it was found that the heightened risk appears to last for about two hours after the episode of anger. 
Psychosocial stress also results in changes in physiological behaviours 5,7,11, which can put a person at increased risk of CVD. These behaviours include increased smoking and drinking, unhealthy eating and reductions in physical activity 20,21,22. In addition, chronic stress can lead to constrained appetites or overeating, leading to problems of anorexia or obesity 23. In extreme cases, anorexia or extreme weight loss can have an effect on heart rhythms and even lead to heart failure 2010, while overeating may lead to obesity that has significant health risks associated with coronary heart disease, hypertension and type 2 diabetes 25.
Stress is our great silent killer. Despite the growing body of evidence of this, we continue to focus on pharmaceutical treatments to reduce CVD and we continue to fail. The mechanisms behind stress being such a large contributing factor are now understood and numerous major studies have shown that the effects of chronic stress increase the risk from two to nine times. By contrast, medication to reduce cholesterol reduces the risk by 1% or 0.001 times (that is more than 2,000 times less important than stress). The next stage then is to invest in stress management practices. It’s that simple. Or is it?
1.     NHMRC 2009
2.     Bonthuis et al. 2010
3.     Ademi et al. 2009
4.     Yusef et al. 2004
5.     Dimsdale 2008
6.     Begg et al. 2008).
7.     Rozanski et al. 1999
8.     Black and Gabutt 2002
9.     Siegrist 1995
10.  Cade et al. 2010).
11.  McEwen 2008
12.  Brotman et al. 2007
13.  Newton et al. 1990
14.  Hallb├Ąck and Folkow 2008
15.  Holam et al. 2008
16.  Rosengren et al. 2004
17.  Dimsdale 2007
18.  Low et al. 2009
19.  Loft et al. 2007
20.  Sturmer et al. 2006
21.  Logan and Barksdale 2008
22.  Hamer, Bates and Mishra 2011
23.  Rutledge and Linden 1997
24.  Bell 2010
25.  Rapoport, Clark and Wardle 2000

Acknowledgements. Brigitta Curley, Amy Williams