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:
- 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…
- 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.
- 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.
- 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.
- So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
- So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
- So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
- So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
- 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.
- 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:
- Abdominal obesity (waist >35″ if a woman or >40″ if a man)
- Fasting blood sugars of 100mg/dl or more
- Fasting triglycerides of 150mg/dl or more
- Blood pressure of 130/85 or higher
- 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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No-Exercise Exercise!
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Do you love to go to the gym?
If so, today’s article might not be for you so much. Or maybe it will, because let’s face it, exercise is fun!
At least… It can be, and should be 😎
So without further ado, here’s a slew of no-exercise exercise ideas; we’re willing to bet that somewhere in the list there’s at least some you haven’t tried before, and probably some you haven’t done in a while but might enjoy making a reprise!
Walking
No surprises here: walking is great. Hopefully you have some green spaces near you, but if you don’t, [almost] any walking is better than no walking. So unless there’s some sort of environmental disaster going on outside, lace up and get stepping.
If you struggle to “walk for walking’s sake” give yourself a little mission. Walk to the shop to buy one item. Walk to the park and find a flower to photograph. Walk to the library and take out a book. Whatever works for you!
See also: The Doctor Who Wants Us To Exercise Less, And Move More
Take the stairs
This one doesn’t need many words, just: make it a habit.
Treat the elevators as though they aren’t there!
See also: How To Really Pick Up (And Keep!) Those Habits
Dance
Dance is amazing! Any kind of dance, whatever suits your tastes. This writer loves salsa and tango, but no matter whether for you it’s zouk or zumba, breakdancing or line dancing, whatever gets you moving is going to be great for you.
If you don’t know how, online tutorials abound, and best of all is to attend local classes if you can, because they’re always a fun social experience too.
Make music
Not something often thought of as an exercise, but it is! Most instruments require that we be standing or siting with good posture, focusing intently on our movements, and often as not, breathing very mindfully too. And yes, it’s great for the brain as well!
Check out: This Is Your Brain on Music: The Science of a Human Obsession – by Dr. Daniel Levitin
Take a stand
If you spend a lot of time at a desk, please consider investing in a standing desk; they can be truly life-changing. Not only is it so much better for your back, hips, neck, and internal organs, but also it burns hundreds more calories than sitting, due to the no-exercise exercise that is keeping your body constantly stabilized while on your feet.
(or, if you’re like this writer: on your foot. I do have two feet, I just spend an inordinate amount of time at my desk standing on one leg at a time; I’m a bit of a flamingo like that)
See also: Deskbound: Standing Up to a Sitting World – by Kelly Starrett and Glen Cordoza
Sit, but…
Sit in a sitting squat! Sometimes called a Slav squat, or an Asian squat, or a resting squat, or various other names:
Click Here If The Embedded Video Doesn’t Load Automatically!
Alternatively, sitting in seiza (the traditional Japanese sitting position) is also excellent, but watch out! While it’s great once your body is accustomed to it, if you haven’t previously sat this way much, you may cut off your own circulation, hurt your knees, and (temporarily) lose feeling in your feet. So if you don’t already sit in seiza often, gradually work up the time period you spend sitting in seiza, so that your vasculature can adapt and improve, which honestly, is a very good thing for your legs and feet to have.
Breathe
Perhaps the absolute most “no-exercise exercise” there is. And yes, of course you are (hopefully) breathing all the time, but how you are breathing matters a lot:
The Inside Job Of Fixing Our Breathing: Exercises That Can Fix Sinus Problems (And More)
Clean
This doesn’t have to mean scrubbing floors like a sailor—even merely giving your house the Marie Kondo treatment counts, because while you’re distracted with all the objects, you’re going to be going back and forth, getting up and down, etc, clocking up lots of exercise that you barely even notice!
PS, check out: The Life-Changing Manga Of Tidying Up – by Marie Kondo
Garden
As with the above, it’s lots of activity that doesn’t necessarily feel like it (assuming you’re doing more pruning and weeding etc, and less digging ditches etc), and as a bonus, there are a stack of mental health benefits to being in a green natural environment and interacting with soil:
Read more: The Antidepressant In Your Garden
Climb
Depending on where you live, this might mean an indoor climbing wall, but give it a go! They have color-coded climbs from beginner to advanced, so don’t worry about being out of your depth.
And the best thing is, the beginner climbs will be as much a workout to a beginner as the advanced climbs will be to an advanced climber, because at the end of the day, you’re still clinging on for dear life, no matter whether it’s a sizeable handhold not far from the ground, or the impression of a fingernail crack in an overhang 100ft in the air.
Video games (but…)
Less in the category of Stardew Valley, and more in the category of Wii Fit.
So, dust off that old controller (or treat yourself to one if you didn’t have one already), and get doing a hundred sports and other physical activities in the comfort of your living room, with a surprisingly addictive gaming system!
Sex!
You probably don’t need instructions here, and if you do, well honestly, we’re running out of space today. But the answer to “does xyz count?” is “did it get your heart racing?” because if so, it counts
Take care!
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5 Ways To Make Your Smoothie Blood Sugar Friendly (Avoid the Spike!)
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
At 10almonds, we are often saying “eat whole fruit; don’t drink your calories”. Whole fruit is great for blood sugars; fruit juices and many smoothies on the other hand, not so much. Especially juices, being near-completely or perhaps even completely stripped of fiber, but even smoothies have had a lot of the fiber broken down and are still a liquid, meaning they are very quickly and easily digestible, and thus their sugars (whatever carbs are in there) can just zip straight into your veins.
However, there are ways to mitigate this…
Slow it down
The theme here is “give the digestive process something else to do”; some things are more quickly and easily digestible than others, and if it’s working on breaking down some of the slower things, it’s not waving sugars straight on through; they have to wait their turn.
To that end, recommendations include:
- Full-fat Greek yogurt which provides both protein and fat, helping to slow down the absorption of sugar. Always choose unsweetened versions to avoid added sugars, though!
- Coconut milk (canned) which is low in sugar and carbs, high in fat. This helps reduce blood sugar spikes, as she found through personal experimentation too.
- Avocado which is rich in healthy fats that help stabilize blood sugar. As a bonus, it blends well into smoothies without affecting the taste much.
- Coconut oil which contains medium-chain triglycerides (MCTs) that are quickly absorbed for energy without involving glucose, promoting fat-burning and reducing blood sugar spikes.
- Collagen powder which is a protein that helps lower blood sugar spikes while also supporting muscle growth, skin, and joints.
For more on all of these, enjoy:
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Want to learn more?
You might also like to read:
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The Sprout Book – by Doug Evans
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Sprouting seeds are more nutritious than most people think, and “seeds” is also a much broader category than people think. Beyond even chia and sunflower and such, this book bids us remember that onions do not just appear on supermarket shelves fully formed (to give just one example of many); most plants come from seeds and of those, most can be usefully sprouted.
The author, most well-known for his tech companies, here is selling us a very low-tech health kick with very little profit to be found except for our health. By sprouting seeds of many kinds at home, we can enjoy powerful superfoods that are not only better than, but also cheaper than, most supplements.
Nor are the benefits of sprouting things marginal; we’re not talking about a 1–10% increase in bioavailable so much as what’s often a 100–1000% increase.
After explaining the science and giving a primer on sprouting things for oneself, there is a wide selection of recipes, but the biggest benefit of the book is in just getting the reader up-and-running with at-home sprouting.
Bottom line: if you like the idea of letting food be your medicine and even like the idea of essentially growing your own food with zero gardening skills, then this is an excellent book for you.
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How To Unfatty A Fatty Liver
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How To Unfatty A Fatty Liver
In Greek mythology, Prometheus suffered the punishment of being chained to a rock, where he would have his liver eaten by an eagle, whereupon each day his liver would grow back, only to be eaten again the next day.
We mere humans who are not Greek gods might not be able to endure quite such punishment to our liver, but it is an incredibly resilient and self-regenerative organ.
In fact, provided at least 51% of the liver is still present and correct, the other 49% will regrow. Similarly, damage done (such as by trying to store too much fat there due to metabolic problems, as in alcoholic or non-alcoholic fatty liver disease) will reverse itself in time, given the chance.
The difference between us and Prometheus
In the myth, Prometheus had his liver regrow overnight every night. Ours don’t recover quite so quickly.
Indeed, the science has good and bad news for us:
❝Liver recolonization models have demonstrated that hepatocytes have an unlimited regenerative capacity. However, in normal liver, cell turnover is very slow.❞
~ Michalopoulos and Bhusan (2020)
Read more: Liver regeneration: biological and pathological mechanisms and implications
If it regenerates, why do people need transplants, and/or die of liver disease?
There are some diseases of the liver that inhibit its regenerative abilities, or (as in the case of cancer) abuse them to our detriment. However, in the case of fatty liver disease, the reason is usually simple:
If the lifestyle factors that caused the liver to become fatty are still there, then its regenerative abilities won’t be able to keep up with the damage that is still being done.
Can we speed it up at all?
Yes! The first and most important thing is to minimize how much ongoing harm you are still doing to it, though.
- If you drink alcohol, stop. According to the WHO, the only amount of alcohol that is safe for you is zero.
- You might like our previous article: How To Reduce Or Quit Alcohol
- Consider your medications, and find out which place a strain on the liver. Many medications are not optional; you’re taking them for an important reason, so don’t quit things without checking with your doctor. Medications that strain the liver include, but are by no means limited to:
- Many painkillers, including acetaminophen/paracetamol (e.g. Tylenol), and ibuprofen
- Some immunosuppresent drugs, including azathioprine
- Some epilepsy drugs, including phenytoin
- Some antibiotics, including amoxicillin
- Statins in general
Note: we are not pharmacists, nor doctors, let alone your doctors.
Check with yours about what is important for you to take, and what alternatives might be safe for you to consider.
Dietary considerations
While there are still things we don’t know about the cause(s) of non-alcoholic fatty liver disease, there is a very strong association with a diet that is:
- high in salt
- high in refined carbohydrates
- e.g. white flour and white flour products such as white bread and white pasta; also the other main refined carbohydrate: sugar
- high in red meat
- high in non-fermented dairy
- high in fried foods.
So, consider minimizing those, and instead getting plenty of fiber, and plenty of lean protein (not from red meat, but poultry and fish are fine iff not fried; beans and legumes are top-tier, though).
Also, hydrate. Most people are dehydrated most of the time, and that’s bad for all parts of the body, and the liver is no exception. It can’t regenerate if it’s running on empty!
Read more: Foods To Include (And Avoid) In A Healthy Liver Diet
How long will it take to heal?
In the case of alcoholic fatty liver disease, it should start healing a few days after stopping drinking. Then, how long it takes to fully recover depends on the extent of the damage; it could be weeks or months. In extreme cases, years, but that is rare. Usually if the damage is that severe, a transplant is needed.
In the case of non-alcoholic fatty liver disease, again it depends on the extent of the damage, but it is usually a quicker recovery than the alcoholic kind—especially if eating a Mediterranean diet.
Read more: How Long Does It Take For Your Liver To Repair Itself?
Take good care of yourself!
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- If you drink alcohol, stop. According to the WHO, the only amount of alcohol that is safe for you is zero.
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Kumquat vs Persimmon – Which is Healthier?
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Our Verdict
When comparing kumquat to persimmon, we picked the kumquat.
Why?
In terms of macros, kumquats have more protein, though like most fruits, it’s unlike anybody’s eating them for the protein content. More importantly, they have a lot more fiber, for less than half the carbs. It bears mentioning though that (again, like most fruits) persimmon isn’t bad for this either, and both fruits are low glycemic index foods.
When it comes to vitamins, it’s not close: kumquats have more of vitamins A, B1, B2, B3, B5, B6, B9, E, and choline, while persimmon has more vitamin C. It’s worth noting that kumquats are already a very good source of vitamin C though; persimmon just has more.
In the category of minerals, kumquats again lead with more calcium, copper, magnesium, manganese, and zinc, while persimmon has more iron, phosphorus, and potassium.
In short, enjoy both, and/or whatever fruit you enjoy the most, but if looking for nutritional density, kumquats are bringing it.
Want to learn more?
You might like to read:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
Take care!
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Red Lentils vs Green Lentils – Which is Healthier?
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Our Verdict
When comparing red lentils to green lentils, we picked the green.
Why?
Yes, they’re both great. But there are some clear distinctions!
First, know: red lentils are, secretly, hulled brown lentils. Brown lentils are similar to green lentils, just a little less popular and with (very) slightly lower nutritional values, as a rule.
By hulling the lentils, the first thing that needs mentioning is that they lose some of their fiber, since this is what was removed. While we’re talking macros, this does mean that red lentils have proportionally more protein, because of the fiber weight lost. However, because green lentils are still a good source of protein, we think the fat that green lentils have much more fiber is a point in their favor.
In terms of micronutrients, they’re quite similar in vitamins (mostly B-vitamins, of which, mostly folate / vitamin B9), and when it comes to minerals, they’re similarly good sources of iron, but green lentils contain more magnesium and potassium.
Green lentils also contain more antixoidants.
All in all, they both continue to be very respectable parts of anyone’s diet—but in a head-to-head, green lentils do come out on top (unless you want to prioritize slightly higher protein above everything else, in which case, red).
Want to get some in? Here are the specific products we featured today:
Enjoy!
Want to learn more?
You might like to read:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Eat More (Of This) For Lower Blood Pressure ← incidentally, the potassium content of green lentils also helps minimize the harm done by sodium in one’s diet
Take care!
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