Ready… Set… Flow!

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Time to make your new year plans? Or maybe you’ve already made a list, and you’re checking it twice. If so, now’s the time to make sure that your new year’s plans will flow:

“Flow”, as you may be aware, is the psychological state generally defined as “a state in which we feel good about what we’re doing, and just keep doing it, at a peak performance level”; the term was coined by psychologist Mihaly Csikszentmihalyi and has risen to popularity since.

We wrote about it a little before, here:

Morning Routines That Just Flow

The above article details how to start the perfect day, but how to start the perfect year? Firstly, it’s good to get the jump on the new year a little; see:

The Science Of New Year’s Pre-Resolutions

…and we also agree with Dr. Faye Bate, who preaches taking the path of least resistance when it comes to healthy habits:

How To Actually Start A Healthy Lifestyle In The New Year

Because…

Getting into the flow

The most hydrating drink is the one that [contains adequate water and] you will actually drink. The best exercise is the one you’ll do. The best sleep is the sleep you can actually get. And so on.

We see this—or rather its evil counterpoint—a lot in diet culture. People frame their willpower against the temptations of donuts and whatever, and make Faustian bargains whereby they will eat food they find boring in the hopes it will bring them good health. And it won’t. Because, they’ll give up quickly.

Instead, each part of our healthy life has to be engaged with with a sense of flow. Again, that’s: “a state in which we feel good about what we’re doing, and just keep doing it, at a peak performance level”

So we need to find healthy recipes we like (check out our recipe section!), we need to find exercise that we like, we need to find an approach to sleep that the Geneva Convention wouldn’t consider a kind a torture, and so forth. And, ideally, not just “like” in the sense of “this is tolerable” but “like” in the sense of “I am truly passionate about this thing”.

And that’s going to look different for each of us.

Running is a great example of something that some people truly love, whereas others will do almost anything to avoid.

And food? We’ve written before about the usefulness of a “to don’t” list; it’s like a “to do” list, but it’s things we’re not going to even try to do. For example, a person with two addictions is usually advised to quit one at a time, so quitting the other would go on a “to don’t” list for now. The same goes for food; you need to enjoy what you’re eating or you won’t “feel good about what we’re doing, and just keep doing it”, per flow. So, do not deprive yourself; it won’t work anyway; just pick one healthy change to make, and then queue up any other changes for once the first one has started feeling natural to you.

For more on “to don’t” lists and other such tricks, see: How To Keep On Keeping On… Long Term!

Staying in the flow

…is not usually a problem, you would think, because “…and just keep doing it, at peak performance level” but the fact is, sometimes we get kicked out of our flow by something external. We covered some of that in the above-linked “How To Keep On Keeping On” article, such as figuring out showstoppers in advance (for example, “if I get an injury, I will rest until it is healed”) and ideally, back-up plans.

For example, let’s say you have your dietary plan all worked out, then you are invited to someone’s birthday celebration a couple of weeks in, and you don’t want to rain on their parade, so you figure out for yourself in advance how you are going to mitigate any harm to your plans, e.g. “I will simply choose the healthiest option available, and not worry if it doesn’t meet my usual standards” or “I will simply fast” if that’s an appropriate thing for you (for some it might be, for some it might not be).

For more on this, see:

How To Avoid Slipping Into (Bad) Old Habits

Take care!

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  • Healthy Habits for Managing & Reversing Prediabetes – by Dr. Marie Feldman

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    The book doesn’t assume prior knowledge, and does explain the science of diabetes, prediabetes, the terms and the symptoms, what’s going on inside, etc—before getting onto the main meat of the book, the tips.

    The promised 100 tips are varied in their application; they range from diet and exercise, to matters of sleep, stress, and even love.

    There are bonus tips too! For example, an appendix covers “tips for healthier eating out” (i.e. in restaurants etc) and a grocery list to ensure your pantry is good for defending you against prediabetes.

    The writing style is very accessible pop-science; this isn’t like reading some dry academic paper—though it does cite its sources for claims, which we always love to see.

    Bottom line: if you’d like to proof yourself against prediabetes, and are looking for “small things that add up” habits to get into to achieve that, this book is an excellent first choice.

    Click here to check out Healthy Habits For Managing & Reversing Prediabetes, and enjoy the measurable health results!

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  • Younger Next Year: The Exercise Program – by Chris Crowley & Dr. Henry Lodge

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    We previously reviewed the same authors’ original “Younger Next Year”, and now here’s the more specific book about exercise for increasing healthspan and reversing markers of biological aging, going into much more detail in that regard.

    How much more? Well, it’s a very hand-holding book in the sense that it walks the reader through everything step-by-step, tells not only what kind of exercise and how much, but also how to do, what things to do to prepare, how to avoid not erring in various ways, what metrics to keep an eye on to ensure you are making progress, and more.

    There are also whole sections on specific common age-related issues including osteoporosis and arthritis, as well as how to train around injuries (especially of the kind that basically aren’t likely to ever fully go away).

    As with the previous book, there’s a blend of motivational pep talk and science—this book is heavily weighted towards the former. It has, however, enough science to keep it on the right track throughout. Hence the two authors! Crowley for motivational pep and training tips, and Dr. Lodge for the science.

    Bottom line: if you’d like to be biologically younger next year, that exercise will be an important component of that, and this book is really quite comprehensive for its relative brevity (weighing in at 176 pages).

    Click here to check out Younger Next Year: The Exercise Program, and make that progress!

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  • Women don’t have a ‘surge’ in fertility before menopause – but surprise pregnancies can happen, even after 45

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    Every now and then we see media reports about celebrities in their mid 40s having surprise pregnancies. Or you might hear stories like these from friends or relatives, or see them on TV.

    Menopause signals the end of a woman’s reproductive years and happens naturally between age 45 and 55 (the average is 51). After 12 months with no periods, a woman is considered postmenopausal.

    While the chance of pregnancy is very low in the years leading up to menopause – the so called menopausal transition or perimenopause – the chance is not zero.

    So, what do we know about the chance of conceiving naturally after age 45? And what are the risks?

    IKO-studio/Shutterstock

    Is there a spike in fertility before menopause?

    The hormonal changes that accompany perimenopause cause changes to the menstrual cycle pattern, and some have suggested there can be a “surge” in fertility at perimenopause. But there’s no evidence this exists.

    In the years leading up to menopause, a woman’s periods often become irregular, and she might have some of the common symptoms of menopause such as hot flushes and night sweats.

    This might lead women to think they have hit menopause and can’t get pregnant anymore. But while pregnancy in a woman in her mid 40s is significantly less likely compared to a woman in her 20s or 30s, it’s still possible.

    The stats for natural pregnancies after age 45

    Although women in their mid- to late 40s sometimes have “miracle babies”, the chance of pregnancy is minimal in the five to ten years leading up to menopause.

    The monthly chance of pregnancy in a woman aged 30 is about 20%. By age 40 it’s less than 5% and by age 45 the chance is negligible.

    We don’t know exactly how many women become pregnant in their mid to late 40s, as many pregnancies at this age miscarry. The risk of miscarriage increases from 10% in women in their 20s to more than 50% in women aged 45 years or older. Also, for personal or medical reasons some pregnancies are terminated.

    According to a review of demographic data on age when women had their final birth across several countries, the median age was 38.6 years. But the range of ages reported for last birth in the reviewed studies showed a small proportion of women give birth after age 45.

    Having had many children before seems to increase the odds of giving birth after age 45. A study of 209 women in Israel who had conceived spontaneously and given birth after age 45 found 81% had already had six or more deliveries and almost half had had 11 or more previous deliveries.

    A couple outdoors smiling. The woman is pregnant.
    Conceiving naturally at age 45 plus is not unheard of. pixelheadphoto digitalskillet/Shutterstock

    There’s no reliable data on how common births after age 45 are in Australia. The most recent report on births in Australia show that about 5% of babies are born to women aged 40 years or older.

    However, most of those were likely born to women aged between 40 and 45. Also, the data includes women who conceive with assisted reproductive technologies, including with the use of donor eggs. For women in their 40s, using eggs donated by a younger woman significantly increases their chance of having a baby with IVF.

    What to be aware of if you experience a late unexpected pregnancy

    A surprise pregnancy late in life often comes as a shock and deciding what to do can be difficult.

    Depending on their personal circumstances, some women decide to terminate the pregnancy. Contrary to the stereotype that abortions are most common among very young women, women aged 40–44 are more likely to have an abortion than women aged 15–19.

    This may in part be explained by the fact older women are up to ten times more likely to have a fetus with chromosomal abnormalities.

    There are some extra risks involved in pregnancy when the mother is older. More than half of pregnancies in women aged 45 and older end in miscarriage and some are terminated if prenatal testing shows the fetus has the wrong number of chromosomes.

    This is because at that age, most eggs have chromosomal abnormalities. For example, the risk of having a pregnancy affected by Down syndrome is one in 86 at age 40 compared to one in 1,250 at age 20.

    A woman in hospital holding a newborn baby.
    There are some added risks associated with pregnancy when the mother is older. Natalia Deriabina/Shutterstock

    Apart from the increased risk of chromosomal abnormalities, advanced maternal age also increases the risk of stillbirth, fetal growth restriction (when the unborn baby doesn’t grow properly), preterm birth, pre-eclampsia, gestational diabetes and caesarean section.

    However, it’s important to remember that since the overall risk of all these things is small, even with an increase, the risk is still small and most babies born to older mothers are born healthy.

    Multiple births are also more common in older women than in younger women. This is because older women are more likely to release more than one egg if and when they ovulate.

    A study of all births in England and Wales found women aged 45 and over were the most likely to have a multiple birth.

    The risks of babies being born prematurely and having health complications are higher in twin than singleton pregnancies, and the risks are highest in women of advanced maternal age.

    What if you want to become pregnant in your 40s?

    If you’re keen to avoid pregnancy during perimenopause, it’s recommended you use contraception.

    But if you want to get pregnant in your 40s, there are some things you can do to boost your chance of conceiving and having a healthy baby.

    These include preparing for pregnancy by seeing a GP for a preconception health check, taking folic acid and iodine supplements, not smoking, limiting alcohol consumption, maintaining a healthy weight, exercising regularly and having a nutritious diet.

    If you get good news, talking to a doctor about what to expect and how to best manage a pregnancy in your 40s can help you be prepared and will allow you to get personalised advice based on your health and circumstances.

    Karin Hammarberg, Adjunct Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Escape Self-Sabotage

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    Stop Making The Same Mistakes

    It’s easy to think that a self-destructive cycle is easy to avoid if you have no special will to self-destruction. However, the cycle is sneaky.

    It’s sneaky because it can be passive, and/or omissions rather than actions, procrastinations rather than obvious acts of impulse, and so forth.

    So, they’re often things that specifically aren’t there to see.

    How to catch them

    How often do you think “I wish I had [done xyz]” or “I wish I had [done yxz] sooner”?

    Now, how often have you thought that about the same thing more than once? For example, “I should have kept up my exercise”.

    For things like this, habit-trackers are a great way to, well, keep track of habits. If for example you planned to do a 10-minute exercise session daily but you’ve been postponing it since you got distracted on January the 2nd, then it’ll highlight that. See also:

    How To Really Pick Up (And Keep!) Those Habits

    Speaking of habits, this goes for other forms of procrastination, too. For example, if you are always slow to get medical check-ups, or renew your prescriptions, or get ready for some regularly-occurring thing in your schedule, then set a reminder in your preferred way (phone app, calendar on the wall, whatever) and when the appointed time arrives (to book the check-up, renew the prescription, do your taxes, whatever), do it on the day you set your reminder for, as a personal rule for you that you keep to, barring extreme calamity.

    By “extreme calamity” we mean less “running late today” and more “house burned down”.

    Digital traps

    Bad habits can be insidious in other ways too, like getting sucked into social media scrolling (it is literally designed to do that to you; you are not immune modern programming hijacking evolutionary dopamine responses).

    Setting a screentime limit (you can specify “just these apps” if you like) will help with this. On most devices, this feature includes a sticky notification in the notification bar, that’ll remind you “27 out of 30 minutes remaining” or whatever you set it for. That’ll remind you to do what you went there to do, instead of getting caught in the endless scroll (and if you went there to just browse, to do so briefly).

    Here’s how to set that:

    Instructions for iOS devices | Instructions for Android devices

    Oh, and on the topic of social media? If you find yourself getting caught up in unproductive arguments on the Internet, try the three-response rule:

    1. You reply; they reply (no progress made)
    2. You reply; they reply (still no progress made)
    3. You reply; they reply (still yet no progress made)

    You reply just one more time: “I have a personal rule that if I’m arguing on the Internet and no progress has been made after three replies, I don’t reply further—I find this is helpful to avoid a lot of time lost to pointless arguing that isn’t going anywhere. Best wishes.”

    (and then stick to it, no matter how they try to provoke you; best is to just not look until at least the next day)

    When “swept up in love” gets to one of those little whirlpools…

    The same works in personal relationships, by the way. If for example you are arguing with a loved one and not making progress, it can be good if you both have a pre-arranged agreement that either of you can, up to once on any given day, invoke a “time-out” (e.g. 30 minutes, but you agree the time between you when you first make this standing policy) during which you will both keep out of the other’s way, and come back with a more productive head on (remembering that things go best when it’s you both vs the problem, rather than vs each other).

    See also:

    Seriously Useful Communication Skills: Conflict Resolution

    What if the self-sabotaging cycle is active and apparent?

    Well, that is less sneaky, but certainly no less serious, and sometimes moreso. An obvious example is drinking too much; this is often cyclical in nature. We wrote about this one previously:

    How To Reduce Or Quit Alcohol

    That article’s alcohol-specific, but the same advices go for other harmful activities, including other substance abuse (which in turn includes binge-eating), as well psychological addictions (such as gambling, for example).

    Finally…

    If your destructive cycle is more of a rut you’ve got stuck in, a common advice is to change something, anything, to get out of the rut.

    That can be very bad advice! Because sometimes the change you go for is absolutely not the change that was needed, and is rather just cracking under pressure and doing something impulsive.

    Here’s one way to actively get out of a slump:

    Behavioral Activation Against Depression & Anxiety

    Note: you do not have to be depressed or anxious to do this. But the point is, it’s a tool you can use even if you are depressed and/or anxious, so it’s a good thing to try for getting out of most kinds of slumps.

    And really finally, here’s a resource for, well, the title speaks for itself:

    When You Know What You “Should” Do (But Knowing Isn’t The Problem)

    Take care!

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  • Older Americans Say They Feel Trapped in Medicare Advantage Plans

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    In 2016, Richard Timmins went to a free informational seminar to learn more about Medicare coverage.

    “I listened to the insurance agent and, basically, he really promoted Medicare Advantage,” Timmins said. The agent described less expensive and broader coverage offered by the plans, which are funded largely by the government but administered by private insurance companies.

    For Timmins, who is now 76, it made economic sense then to sign up. And his decision was great, for a while.

    Then, three years ago, he noticed a lesion on his right earlobe.

    “I have a family history of melanoma. And so, I was kind of tuned in to that and thinking about that,” Timmins said of the growth, which doctors later diagnosed as malignant melanoma. “It started to grow and started to become rather painful.”

    Timmins, though, discovered that his enrollment in a Premera Blue Cross Medicare Advantage plan would mean a limited network of doctors and the potential need for preapproval, or prior authorization, from the insurer before getting care. The experience, he said, made getting care more difficult, and now he wants to switch back to traditional, government-administered Medicare.

    But he can’t. And he’s not alone.

    “I have very little control over my actual medical care,” he said, adding that he now advises friends not to sign up for the private plans. “I think that people are not understanding what Medicare Advantage is all about.”

    Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans’ share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers’ aggressive sales tactics and misleading coverage claims.

    Enrollees, like Timmins, who sign on when they are healthy can find themselves trapped as they grow older and sicker.

    “It’s one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing,” said Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

    “But it’s when they actually need to use it for these bigger issues,” Huberty said, “that’s when people realize, ‘Oh no, this isn’t going to help me at all.’”

    Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses, which the insurers can use to provide supplemental benefits. Huberty said those extra benefits work as an incentive to “get people to join the plan” but that the plans then “restrict the access to so many services and coverage for the bigger stuff.”

    David Meyers, assistant professor of health services, policy, and practice at the Brown University School of Public Health, analyzed a decade of Medicare Advantage enrollment and found that about 50% of beneficiaries — rural and urban — left their contract by the end of five years. Most of those enrollees switched to another Medicare Advantage plan rather than traditional Medicare.

    In the study, Meyers and his co-authors muse that switching plans could be a positive sign of a free marketplace but that it could also signal “unmeasured discontent” with Medicare Advantage.

    “The problem is that once you get into Medicare Advantage, if you have a couple of chronic conditions and you want to leave Medicare Advantage, even if Medicare Advantage isn’t meeting your needs, you might not have any ability to switch back to traditional Medicare,” Meyers said.

    Traditional Medicare can be too expensive for beneficiaries switching back from Medicare Advantage, he said. In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care, Meyers said.

    To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or a private Medigap policy. If they are low-income, Medicaid may provide that supplemental coverage.

    But, Meyers said, there’s a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.

    Only four states — Connecticut, Maine, Massachusetts, and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.

    Paul Ginsburg is a former commissioner on the Medicare Payment Advisory Commission, also known as MedPAC. It’s a legislative branch agency that advises Congress on the Medicare program. He said the inability of enrollees to easily switch between Medicare Advantage and traditional Medicare during open enrollment periods is “a real concern in our system; it shouldn’t be that way.”

    The federal government offers specific enrollment periods every year for switching plans. During Medicare’s open enrollment period, from Oct. 15 to Dec. 7, enrollees can switch out of their private plans to traditional, government-administered Medicare.

    Medicare Advantage enrollees can also switch plans or transfer to traditional Medicare during another open enrollment period, from Jan. 1 to March 31.

    “There are a lot of people that say, ‘Hey, I’d love to come back, but I can’t get Medigap anymore, or I’ll have to just pay a lot more,’” said Ginsburg, who is now a professor of health policy at the University of Southern California.

    Timmins is one of those people. The retired veterinarian lives in a rural community on Whidbey Island just north of Seattle. It’s a rugged, idyllic landscape and a popular place for second homes, hiking, and the arts. But it’s also a bit remote.

    While it’s typically harder to find doctors in rural areas, Timmins said he believes his Premera Blue Cross plan made it more challenging to get care for a variety of reasons, including the difficulty of finding and getting in to see specialists.

    Nearly half of Medicare Advantage plan directories contained inaccurate information on what providers were available, according to the most recent federal review. Beginning in 2024, new or expanding Medicare Advantage plans must demonstrate compliance with federal network expectations or their applications could be denied.

    Amanda Lansford, a Premera Blue Cross spokesperson, declined to comment on Timmins’ case. She said the plan meets federal network adequacy requirements as well as travel time and distance standards “to ensure members are not experiencing undue burdens when seeking care.”

    Traditional Medicare allows beneficiaries to go to nearly any doctor or hospital in the U.S., and in most cases enrollees do not need approval to get services.

    Timmins, who recently finished immunotherapy, said he doesn’t think he would be approved for a Medigap policy, “because of my health issue.” And if he were to get into one, Timmins said, it would likely be too expensive.

    For now, Timmins said, he is staying with his Medicare Advantage plan.

    “I’m getting older. More stuff is going to happen.”

    There is also a chance, Timmins said, that his cancer could resurface: “I’m very aware of my mortality.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Statins: His & Hers?

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    The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

    This is Dr. Barbara Roberts. She’s a cardiologist and the Director of the Women’s Cardiac Center at one of the Brown University Medical School teaching hospitals. She’s an Associate Clinical Professor of Medicine and takes care of patients, teaches medical students, and does clinical research. She specializes in gender-specific aspects of heart disease, and in heart disease prevention.

    We previously reviewed Dr. Barbara Roberts’ excellent book “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs”. It prompted some requests to do a main feature about Statins, so we’re doing it today. It’s under the auspices of “Expert Insights” as we’ll be drawing almost entirely from Dr. Roberts’ work.

    So, what are the risks of statins?

    According to Dr. Roberts, one of the biggest risks is not just drug side-effects or anything like that, but rather, what they simply won’t treat. This is because statins will lower LDL (bad) cholesterol levels, without necessarily treating the underlying cause.

    Imagine you got Covid, and it’s one of the earlier strains that’s more likely deadly than “merely” debilitating.

    You’re coughing and your throat feels like you gargled glass.

    Your doctor gives you a miracle cough medicine that stops your coughing and makes your throat feel much better.

    (Then a few weeks later, you die, because this did absolutely nothing for the underlying problem)

    You see the problem?

    Are there problematic side-effects too, though?

    There can be. But of course, all drugs can have side effects! So that’s not necessarily news, but what’s relevant here is the kind of track these side-effects can lead one down.

    For example, Dr. Roberts cites a case in which a woman’s LDL levels were high and she was prescribed simvastatin (Zocor), 20mg/day. Here’s what happened, in sequence:

    1. She started getting panic attacks. So, her doctor prescribed her sertraline (Zoloft) (a very common SSRI antidepressant) and when that didn’t fix it, paroxetine (Paxil). This didn’t work either… because the problem was not actually her mental health. The panic attacks got worse…
    2. Then, while exercising, she started noticing progressive arm and leg weakness. Her doctor finally took her off the simvastatin, and temporarily switched to ezetimibe (Zetia), a less powerful nonstatin drug that blocks cholesterol absorption, which change eased her arm and leg problem.
    3. As the Zetia was a stopgap measure, the doctor put her on atorvastatin (Lipitor). Now she got episodes of severe chest pressure, and a skyrocketing heart rate. She also got tremors and lost her body temperature regulation.
    4. So the doctor stopped the atorvastatin and tried rosovastatin (Crestor), on which she now suffered exhaustion (we’re not surprised, by this point) and muscle pains in her arms and chest.
    5. So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
    6. So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
    7. So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
    8. So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
    9. She did her own research, and went back to the doctor to ask for cholestyramine (Questran), which is a bile acid sequestrent and nothing to do with statins. She also asked for a long-acting niacin. In high doses, niacin (one of the B-vitamins) raises HDL (good) cholesterol, lowers LDL, and lowers tryglycerides.
    10. Her own non-statin self-prescription (with her doctor’s signature) worked, and she went back to her life, her work, and took up running.

    Quite a treatment journey! Want to know more about the option that actually worked?

    Read: Bile Acid Resins or Sequestrants

    What are the gender differences you/she mentioned?

    Actually mostly sex differences, since this appears to be hormonal (which means that if your hormones change, so will your risk). A lot of this is still pending more research—basically it’s a similar problem in heart disease to one we’ve previously talked about with regard to diabetes. Diabetes disproportionately affects black people, while diabetes research disproportionately focuses on white people.

    In this case, most heart disease research has focused on men, with women often not merely going unresearched, but also often undiagnosed and untreated until it’s too late. And the treatments, if prescribed? Assumed to be the same as for men.

    Dr. Roberts tells of how medicine is taught:

    ❝When I was in medical school, my professors took the “bikini approach” to women’s health: women’s health meant breasts and reproductive organs. Otherwise the prototypical patient was presented as a man.❞

    There has been some research done with statins and women, though! Just, still not a lot. But we do know for example that some statins can be especially useful for treating women’s atherosclerosis—with a 50% success rate, rather than 31% for men.

    For lowering LDL itself, however, it can work but is generally not so hot in women.

    Fun fact:

    In men:

    • High total cholesterol
    • High non-HDL cholesterol
    • High LDL cholesterol
    • Low HDL cholesterol

    …are all significantly associated with an increased risk of death from CVD.

    In women:

    …levels of LDL cholesterol even more than 190 were associated with only a small, statistically insignificant increased risk of dying from CVD.

    So…

    The fact that women derive less benefit from a medicine that mainly lowers LDL cholesterol, may be because elevated LDL cholesterol is less harmful to women than it is to men.

    And also: Treatment and Response to Statins: Gender-related Differences

    And for that matter: Women Versus Men: Is There Equal Benefit and Safety from Statins?*

    Definitely a case where Betteridge’s Law of Headlines applies!

    What should women do to avoid dying of CVD, then?

    First, quick reminder of our general disclaimer: we can’t give medical advice and nothing here comprises such. However… One particularly relevant thing we found illuminating in Dr. Roberts’ work was this observation:

    The metabolic syndrome is diagnosed if you have three (or more) out of five of the following:

    1. Abdominal obesity (waist >35″ if a woman or >40″ if a man)
    2. Fasting blood sugars of 100mg/dl or more
    3. Fasting triglycerides of 150mg/dl or more
    4. Blood pressure of 130/85 or higher
    5. HDL <50 if a woman or <40 if a man

    And yet… because these things can be addressed with exercise and a healthy diet, which neither pharmaceutical companies nor insurance companies have a particular stake in, there’s a lot of focus instead on LDL levels (since there are a flock of statins that can be sold be lower them)… Which, Dr. Roberts says, is not nearly as critical for women.

    So women end up getting prescribed statins that cause panic attacks and all those things we mentioned earlier… To lower our LDL, which isn’t nearly as big a factor as the other things.

    In summary:

    Statins do have their place, especially for men. They can, however, mask underlying problems that need treatment—which becomes counterproductive.

    When it comes to women, statins are—in broad terms—statistically not as good. They are a little more likely to be helpful specifically in cases of atherosclerosis, whereby they have a 50/50 chance of helping.

    For women in particular, it may be worthwhile looking into alternative non-statin drugs, and, for everyone: diet and exercise.

    Further reading: How Can I Safely Come Off Statins?

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