Lipitor-ologist

One of the things I do in practice is consult in complex hyperlipidemias, the collection of lipoprotein disorders that usually, but not always, lead to atherosclerosis.

First order of business: Make the diagnosis--familial combined hyperlipidemia, hypoalphalipoproteinemia, lipoprotein(a), familial heterozygous hypercholesterolemia, familial hypertriglyceridemia, hyperapoprotein B with metabolic syndrome, etc. These are the disorders that start with a genetic variant, e.g., a missing or dysfunctional enzyme or signal protein, such as lipoprotein lipase or apo C3.

I then ask: What can be done that is easy and safe and preferably related to diet and lifestyle?

By following an effective diet, many of these abnormalities can be dramatically corrected, sometimes completely. Familial hypertriglyceridemia, for instance, an inherited disorder of lipoprotein lipase in which triglyceride levels can exceed 1000 mg/dl, high enough to cause pancreatic damage, responds incredibly well to carbohydrate restriction and over-the-counter fish oil. I have a number of these people who enjoy triglyceride levels below 100 mg/dl--unheard of in conventionally treated people with this disorder.

Then why is it that, time after time, I see these people in consult, often as second or third opinions from lipidologists (presumed lipid specialists) or cardiologists, when the only solutions offered are 1) Lipitor or other statin drug, and 2) a low-fat diet? Occasionally, an aggressive lipidologist might offer niacin, a fibrate drug (Tricor or fenofibrate), or Lovaza (prescription fish oil).

Sadly, the world of lipid disorders has been reduced to prescribing a statin drug and little else, 9 times out of 10.

I don't mean to rant, but I continue to be shocked at the incredible influence the drug industry has over not just prescribing patterns, but thinking patterns. Perhaps I should say non-thinking patterns. The drugs make it too easy to feel like the doctor is doing something when, in truth, they are doing the minimum (at best) and missing an opportunity to provide true health-empowering advice that is far more likely to yield maximum control over these patterns with little to no medication.

All in all, I am grateful that there is a growing discipline of "lipidology," a specialty devoted to diagnosing and treating hyperlipidemias. Unfortunately, much of the education of the lipidologist is too heavily influenced by the pharmaceutical industry. Not surprisingly, the drug people favor "education" that highlights their high-revenue products.

Seeing a lipidologist is still better than seeing most primary care physicians or cardiologists. Just beware that you might be walking into the hands of someone who is simply the unwitting puppet of the pharmaceutical industry.

Comments (30) -

  • Anonymous

    9/22/2010 5:42:28 PM |

    ". . .someone who is simply the unwitting puppet of the pharmaceutical industry."

    Unfortunately this seems to be the case with the three primary care doctors I've recently tried to establish a relationship with.  You know you're in trouble when you walk into their exam rooms and the walls are plastered with drug company posters.

  • Jonathan

    9/22/2010 5:58:25 PM |

    Are the pharmaceutical people just getting to the doctors or do they go to the top and influence authority and then the doctor is scared of liability and only follows "best practice" guidelines and nothing more.  How many pharmaceutical employees are expert witnesses in court for cases against doctors who do not give statins?
    Thanks for being brave Dr. Davis.

  • Lucy

    9/22/2010 6:10:45 PM |

    @Jonathan

    I don't know about the docs, but I can speak for myself and several of my RD colleagues that we are scared of liability and Big Brother.  A lot of us believe that there should not be an emphasis on "healthy" whole grains and that saturated fat is not the enemy, but we tend to follow "best practice" guidelines and provide "evidenced-based" recommendations for fear of losing our jobs.  The most frustrating part of all of it is that most of those "evidenced-based" recommendations come from pharmaceutical and agrigulturally funded research!!!

  • Anonymous

    9/22/2010 6:44:10 PM |

    How many people seeking medical advice just want a pill?  Brain washed, indentured wage slaves are loathe to change their diets or exercise much less budget, garden or cook their own food!  The problem(s) are HUGE and by design imo.  What a social experiment these corporations have wrought!

  • Tommy

    9/22/2010 6:58:25 PM |

    Before my heart attack last Oct. I was in great shape, I have never been overweight in my life and my cholesterol/triglycerides were all good.  I had a collapsed artery from some ruptured plaque and left the hospital with another 40-60% blockage in an artery at the bottom of my heart that they said they were leaving alone. Why did this happen when I was in what seemed like good health by the numbers? Who knows. I'm mystified.  I was given Plavix, Lopressor and Simvastatin. I stopped the plavix due to a reaction a few months down the road. I have now decided that when I see my cardiologist in December (I have a stress test scheduled) I will tell him to take me off the statin.
    My lab work a few weeks ago was Triglycerides/43, HD/46 and LDL 74.  I think it's my diet more than the statin and I also think the statin may be keeping my HDL down. It was 65 before my heart attack. I think I can do just as good and possibly get my HDL higher without the statin and also adding niacin.

  • Anonymous

    9/22/2010 7:46:42 PM |

    I heart another presumably valid reason why many doctors go directly to statins.  It was from a journalist (I can't remember what publication) but he had bad lipids, corrected them on his own with low carb, D, fish oil, etc.. and went back to his doctor and said, 'look see... it CAN be done with diet'.

    The doctor smiled knowingly and said, 'yes, I know it can be done.  I can advise 100/100 patients to do this and 2 years from now 99/100 will be right back where they started.  Or I can prescribe a statin and have a far better chance of improving their profile.'

    Most people don't care enough about their health to make the change on their own.

  • Kevin

    9/22/2010 8:27:02 PM |

    The sales reps are up to speed on all the newest medications.  They can rattle off statistics as to why one drug is better than another.  That's their job.  

    In my veterinary practice I can't keep up with the newest surgical techniques and medications.  The drug reps keep my practice from becoming dangerously out of step. And similar to what anonymous said, I can lecture clients on how to best feed their animals but 90% goes in one ear and out the other.

    kevin

    kevin

  • Anonymous

    9/22/2010 9:28:46 PM |

    Kevin,

    Speaking of pet diets, we took in a stray cat three years ago and tried everything to get him to stop attacking birds to no avail.  We went on a low carb diet and decided he should too.  He eats ground up chicken sold as pet food.  He is no longer tempted by birds - he prefers mice!

  • Anonymous

    9/23/2010 1:15:24 AM |

    I COULDN'T AGREE MORE. I AM A LIPIDOLOGIST AND    WAS TRAINED AND BRAINWASHED TO BE A HIGH END DRUG REP AND GET AS MANY PEOPLE AS POSSIBLE ON STATINS. THAT IS THE DIRTY SECRET OF THE NLA WHICH TRAINS LIPIDOLOGISTS WHICH IS REALLY A PUPPET ORGANIZATION BOUGT AND PAID FOR BY BIG PHARMA....AND THEY KNOW IT....WATCH THEM CHANGE THEIR NAME IN THE NEXT FEW YEARS ONCE STATINS GO OFF PATENT AND THE TRUTH ABOUT THE LIPID HYPOTHESIS BEING A COMPLETE FAILURE GETS OUT TO THE PUBLIC

  • Larry

    9/23/2010 2:09:46 AM |

    I can understand that the Drug companies have a huge influence.
    I can also see how many people would rather take a magic pill with their Big Mac and Fries.
    But... some of the Drug commercials on TV tonight mention Cancer as a possible side effect.
    I think it was for an RA drug ?
    I don't think I'd be willing to risk some form of Cancer as a trade-off for another illness.
    Others mention Suicidal potential.
    How can their CEO's sleep at night ?
    And not for nothing... but the Medical Community - Doctors,etc - have to know the harm being done also.

  • Steve

    9/23/2010 4:01:50 AM |

    I find the statin rants a little tiring; there are some of us out there who truly benefit from drug treatment where diet alone cannot get our lipid numbers in order.  I am of normal weight, exercise, eat no grains,sugar or cornstarch and without statins cannot get my NMR particle count below 1300 with 66% small particles.  Niacin not good due to eczema and seb dermatitis. With Statin and Zetia my particles are 609, BP, throid and D3 all normal( in line with Dr. Davis recommendations) and HDL is 59 with TRGS of 28. I clearly have an issue as TRGS were always low(no higher than 75) before elimination of grains,etc.  So, i am thankful for statins and my Lipidoligist

  • Fran

    9/23/2010 4:15:36 AM |

    Reply for: Anonymous said...
    I COULDN'T AGREE MORE...
    ...ONCE STATINS GO OFF PATENT AND THE TRUTH ABOUT THE LIPID HYPOTHESIS BEING A COMPLETE FAILURE GETS OUT TO THE PUBLIC

    The truth is "out there" but it keeps getting buried by the press and Big Pharma. I read emails from those damaged by statins every day. Their stories may be anecdotal, but it's what's happening in the real World and no one is listening. My husband has persistent cognitive decline, Parkinson's hand tremor, numerous nutritional deficiencies, heavy metal toxicity... all of which I feel were "triggered" (over time) by 8 years of statin drugs; 1st Zocor, then Lipitor. He continuously complained about muscle/joint - pain/stiffness only to be told, "You're getting older, what did you expect?" "Statins provide more benefit than any discomfort you are experiencing." At that time he was in his mid 50's. There was a long list of other side effects too: visual disturbances, unexplained anger, muscle atrophy, dark skin pigmentation, etc. The final incident was TGA (transient global amnesia). So almost 7 years after stopping statins we're still trying to improve his quality of life. The most unfortunate and frustrating thing is trying to find a doctor or doctors that 1st, understand that by simply stopping statins doesn't stop the damage and 2nd, trying to find someone to guide the patient and caregiver with HELP and not just more drugs to cover-up statin damage.
    There's a lot in the press lately that so many thousands of people will contract Alzheimer's in the next decade... well, I feel the 1st thing they should suspect is "statin drugs"... just do a search on "statins memory loss"... the evidence is OUT THERE.

  • medeldist

    9/23/2010 8:06:23 AM |

    Some pictures from the Stockholm EASD conferende on diabetes:

    http://www.kostdoktorn.se/big-business

    Big business indeed. Quite tragic...

  • Jonathan

    9/23/2010 2:11:17 PM |

    "there are some of us out there who truly benefit from drug"

    You have no idea if you will benefit from statins.  Yeah, it lowers your cholesterol.  It doesn't mean you'll not have a heart attack or not get cancer or not loose your mind.  The only benefit you are getting is peace of mind by skewing numbers that don't really have anything to do with heart disease.  Cholesterol doesn't cause heart disease, it is trying to repair the damage of what really is causing heart disease.

  • Apolloswabbie

    9/23/2010 2:11:24 PM |

    I think anon's point is a good one - as a fitness trainer I see folks who can and will change their diets to improve their health, the ones that won't go to see doctors.  The doctors don't believe the dietary change will help, for two reasons - it doesn't help if you recommend the USDA/ADA/AHA diets, and, 2, most of the folks they see don't want to change, they want a pill. A third reason is that even if a person changes their diet and gets healthy, once healthy, they revert to eating in the way that those they are around eat.  Eating is a social behavior.  It's a rare individual that can sustain the focus necessary to eat well in a world of mis-information and cheap, low quality food.

  • Apolloswabbie

    9/23/2010 2:25:14 PM |

    Thanks for your work, Dr. D, I feel like your posts are one of the most effective ways to communicate the significance of a smart approach to carbohydrate consumption.

  • Kent

    9/23/2010 3:09:46 PM |

    Tommy,

    Make sure to have your small LDL pattern and LP(a) checked.

  • Bill

    9/23/2010 4:02:51 PM |

    Dr. Davis I respect what you have said and the way you say it, but the worst result of prescribing statins isn't simply that people are not given the best options - the fact is people die as a result of taking statin drugs.

    Does anyone with any understanding of statins really believe that Lipitor or Zocor is any different than Baycol?

    Given that Baycol was taken off the market after numerous reports of deaths from rhabdomyolysis - it astounds me that there is still a restrained yet positive viewpoint towards them. It would benefit doctors to get a few facts straight and begin to dig deeper than a summary of studies on pharmaceuticals. Consider that 94% of the drug advertising claims are not supported by scientific evidence - BMJ 2004;328:485 (28 February) http://www.bmj.com/content/328/7438/485.2.extract

    Consider also that there are over 900 studies showing serious side effects of statin drugs and many other dangers related to their use:
    http://articles.mercola.com/sites/articles/archive/2010/07/20/the-truth-about-statin-drugs-revealed.aspx

    Then get back to the heart of the issue for the "use of statins" - cholesterol lowering and consider the work of Uffe Ravnskov who decimated the idea:
    http://articles.mercola.com/sites/articles/archive/2009/12/05/Does-High-Cholesterol-REALLY-Cause-Heart-Disease.aspx

    When it comes down to it Dr. Davis there are hundreds of thousands of victims of the medical communities "practice" of medicine and millions who owe their deaths or the death of their loved ones to the ignorance of the medical community to use available information and long ago written pieces on safer more effective methods of care for a patient - Max Gerson wrote on cancer cures back in the 50's and yet he is ridiculed by ignorant doctors who sell expensive non-cures to their cancer patients - these patients are numbered by the uncontested study of Gary Null, PhD and Carolyn Dean, M.D., et al - "Death By Medicine" http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

    Kudos for being brave Dr. Davis - but a failure to recognize the damage done by medicine as practiced in America will result in an unwillingness to change - and cause the continued deaths of over 1 MILLION PEOPLE PER YEAR AT THE HANDS OF MAINSTREAM MEDICINE - people following medical advice, in institutions - not on their own and not following medical advice.

  • Bill

    9/23/2010 4:03:26 PM |

    Dr. Davis I respect what you have said and the way you say it, but the worst result of prescribing statins isn't simply that people are not given the best options - the fact is people die as a result of taking statin drugs.

    Does anyone with any understanding of statins really believe that Lipitor or Zocor is any different than Baycol?

    Given that Baycol was taken off the market after numerous reports of deaths from rhabdomyolysis - it astounds me that there is still a restrained yet positive viewpoint towards them. It would benefit doctors to get a few facts straight and begin to dig deeper than a summary of studies on pharmaceuticals. Consider that 94% of the drug advertising claims are not supported by scientific evidence - BMJ 2004;328:485 (28 February) http://www.bmj.com/content/328/7438/485.2.extract

    Consider also that there are over 900 studies showing serious side effects of statin drugs and many other dangers related to their use:
    http://articles.mercola.com/sites/articles/archive/2010/07/20/the-truth-about-statin-drugs-revealed.aspx

    Then get back to the heart of the issue for the "use of statins" - cholesterol lowering and consider the work of Uffe Ravnskov who decimated the idea:
    http://articles.mercola.com/sites/articles/archive/2009/12/05/Does-High-Cholesterol-REALLY-Cause-Heart-Disease.aspx

    When it comes down to it Dr. Davis there are hundreds of thousands of victims of the medical communities "practice" of medicine and millions who owe their deaths or the death of their loved ones to the ignorance of the medical community to use available information and long ago written pieces on safer more effective methods of care for a patient - Max Gerson wrote on cancer cures back in the 50's and yet he is ridiculed by ignorant doctors who sell expensive non-cures to their cancer patients - these patients are numbered by the uncontested study of Gary Null, PhD and Carolyn Dean, M.D., et al - "Death By Medicine" http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

    Kudos for being brave Dr. Davis - but a failure to recognize the damage done by medicine as practiced in America will result in an unwillingness to change - and cause the continued deaths of over 1 MILLION PEOPLE PER YEAR AT THE HANDS OF MAINSTREAM MEDICINE - people following medical advice, in institutions - not on their own and not following medical advice.

  • Bill

    9/23/2010 4:03:48 PM |

    Dr. Davis I respect what you have said and the way you say it, but the worst result of prescribing statins isn't simply that people are not given the best options - the fact is people die as a result of taking statin drugs.

    Does anyone with any understanding of statins really believe that Lipitor or Zocor is any different than Baycol?

    Given that Baycol was taken off the market after numerous reports of deaths from rhabdomyolysis - it astounds me that there is still a restrained yet positive viewpoint towards them. It would benefit doctors to get a few facts straight and begin to dig deeper than a summary of studies on pharmaceuticals. Consider that 94% of the drug advertising claims are not supported by scientific evidence - BMJ 2004;328:485 (28 February) http://www.bmj.com/content/328/7438/485.2.extract

    Consider also that there are over 900 studies showing serious side effects of statin drugs and many other dangers related to their use:
    http://articles.mercola.com/sites/articles/archive/2010/07/20/the-truth-about-statin-drugs-revealed.aspx

    Then get back to the heart of the issue for the "use of statins" - cholesterol lowering and consider the work of Uffe Ravnskov who decimated the idea:
    http://articles.mercola.com/sites/articles/archive/2009/12/05/Does-High-Cholesterol-REALLY-Cause-Heart-Disease.aspx

    When it comes down to it Dr. Davis there are hundreds of thousands of victims of the medical communities "practice" of medicine and millions who owe their deaths or the death of their loved ones to the ignorance of the medical community to use available information and long ago written pieces on safer more effective methods of care for a patient - Max Gerson wrote on cancer cures back in the 50's and yet he is ridiculed by ignorant doctors who sell expensive non-cures to their cancer patients - these patients are numbered by the uncontested study of Gary Null, PhD and Carolyn Dean, M.D., et al - "Death By Medicine" http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

    Kudos for being brave Dr. Davis - but a failure to recognize the damage done by medicine as practiced in America will result in an unwillingness to change - and cause the continued deaths of over 1 MILLION PEOPLE PER YEAR AT THE HANDS OF MAINSTREAM MEDICINE - people following medical advice, in institutions - not on their own and not following medical advice.

  • Dr. William Davis

    9/23/2010 10:22:51 PM |

    Anonymous lipidologist--

    I'd love to hear more about your perspective. Rarely do we hear directly from the "inside."

    I've suspected as much about the NLA, but wasn't sure. Judging by the prescribing habits of the lipidology community, I figured that "education" was slanted in this direction.

  • Martin Levac

    9/24/2010 1:47:06 AM |

    Maybe you have the same thinking pattern, Dr Davis. You speak of "inherited" yet continue with "dietary intervention". It's not inherited when the solution is to stop eating what causes it. It might have a genetic factor but only because our genes are not adapted to eating that crap. That trigs can go as high as 1000 mg merely shows that some have an extreme response to the same stimuli, not that their genes are somewhat less adapted to eating the same crap. The others who's trigs still go up but not as high aren't adapted either, they're just sturdier.

    It's like comparing strong vs weak. He's not strong because he's got good genes. He's strong because he lifted heavy weights for 10 years. The other guy just didn't bother to do that. Ergo, one guy can lift heavy weights today while the other can't lift the same heavy weights today. But back when they were both weak, neither could lift heavy weights.

    In the same line with diet and trigs. His trigs don't go high because of his genes. His trigs go that high because he's been eating more crap for longer than the other guy. But back when neither was eating so much crap, they had the same response amplitude to the same stimuli, i.e. they were both weak.

    I'm just saying.

  • Tommy

    9/24/2010 3:42:20 AM |

    So I have a family history of heart problems. My father had his first heart attack at age 49 and it was similar to mine in symptoms and artery. He wasn't eating a healthy diet as I was and he wasn't in the shape I was either as I kept myself fit. Yet I had my heart attack at age 52, just 3 years difference. Coincidence? Now my cardiologist says that I don't fall into the same guidelines as everyone else as far as cholesterol etc. Is this true? Does family history make me a special case? Diet and exercise didn't work for me the first time around.

  • Anonymous

    9/24/2010 3:01:31 PM |

    Dr. Davis I have been following your blog with interest as I am trying to combat high LDL as much as possible via diet (low carb)  and exercise.  I am female, age 48 with early menopause, hypertension under control with lisinopril, and TSH normal. My HDL averages 85, triglycerides average 45 (stable over 10 years), but my LDL particles have ranged from 1600 to 2000 over this last year, corresponding to LDL of 160 to 200.  LDL seems to go up on low carb for me, while my HDL and triglycerides are fine  with or without diet intervention.  The NMR indicates that I am highly insulin sensitive, with the type "A" profile. My endocronoligist has been willing to work with me regarding diet and exercise but we have seen little change, and he now thinks that I really need to go on a statin.  I just had my arterial wall thickness measured, which showed no signs of plaque or narrowing. My CRP has been elevated but is going down ( I am also recovering from plantar fascitis -- so it is not clear what is causal here), and I take 1 81 mg aspirin a day.  He has not pursued genetic testing, due to costs (other than lipo A which is fine), but believes that my high LDL is genetic.  My grandfather had a non-fatal heart attack, and both sides of the family have high cholesterol.   I will keep working at exercise (I need to take off 10 to ideally 20 pounds more).

    Would you please comment  more on the best diets for various genetic  causes for LDL?  Even within the low carb group there seem to be so many variations.  Are there situations where statins should be used in women?

    Thanks!

  • Jonathan

    9/24/2010 9:32:17 PM |

    @Anonymous LDL
    You're numbers look good.  Stop worrying about the LDL so much.
    Looks like you are following a good diet as long as you are avoiding veg oils.  I highly suggest reading some cholesterol books like the one by Uffe Ravnskov.

  • Dr. William Davis

    9/27/2010 11:56:05 AM |

    Anonymous with lipoproteins--

    Allow me to make one point: Calculated LDL will often misleadingly go up with a low-carbohydrate diet. This is GOOD.

    It means that LDL size is increasing. But it provides the false impression of an increasing calculated LDL. That's why a repeat measure by NMR LDL particle number or apoprotein B is required.

  • Anonymous

    9/27/2010 7:59:32 PM |

    I agree that not enough doctors think deeply enough about what they are doing.

    Reminds me of the old saying, 'Whenever you see a doctor lost in thought its usually because he's in unfamiliar territory'

  • Laura

    9/29/2010 6:37:17 PM |

    Great comments.

  • Anonymous

    9/30/2010 3:44:08 PM |

    NPA is most definitely a front for the drug companies.  I've attended many of there scientific meetings and most of what I hear is brainwashing at it's best.  I once had a discusstion with the group head and told him how I felt about their pro-statin bias and he couldn't even fathom where I was coming from he was in so deep.  When I presented my concerns about low LDL and cancer, he actually spouted off some industry funded research indicating that statins actually lowered cancer risk.  Unbelievable....

  • Paleo Power

    10/10/2010 2:22:03 AM |

    It's easy to be an unwitting puppet when it's making you lots and lots of cash.

    Hell I'd even do it if I didn't have morals.

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