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?

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, 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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  • Afterwork – by Joel Malick and Alex Lippert

    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.

    Regular 10almonds readers may remember that one of the key unifying factors of Blue Zones supercentenarians is the importance of having purpose, sometimes called ikigai (borrowing the Japanese term, as a nod to the Okinawan Blue Zone).

    The authors are financial advisors by profession, but don’t let that fool you; this book is not about retirement financial planning, but rather, simply addressing a problem that was often presented to them while helping people plan their retirements:

    A lot of people find themselves adrift without purpose at several points in life. Often, these are: 1) early twenties, 2) some point in the midlife, and/or 3) retirement. This book addresses the third of those life points.

    The authors advise cultivating 10 key disciplines; we’ll not keep them a mystery; they are:

    1. Purpose
    2. Calendar
    3. Movement
    4. Journaling
    5. Faith
    6. Connection
    7. Learning
    8. Awareness
    9. Generosity
    10. Awe

    …which each get a chapter in this book.

    A note on the chapter about faith: the authors are Christians, and that does influence their perspective here, but if Christianity’s not your thing, then don’t worry: the rest also stands on its own feet without that.

    The general “flavor” of the book overall is in essence, embracing a new period of enjoying what is in effect the strongest, most potentially impactful version of you you’ve ever been, as well as avoiding the traps of retirement “sugar rush” and “retirement drift”, to define, well, a more purposeful life—with what’s most meaningful to you.

    The style of the book is self-help in layout, with occasional diagrams, flowcharts, and the like; sometimes we see well-sourced stats, but there’s no hard science here. In short, a simple and practical book.

    Bottom line: if your retirement isn’t looking like what you imagined it to be, and/or you think it could be more fulfilling, then this book can help you find, claim, and live your ikigai.

    Click here to check out Afterwork, and indeed live a future that’s worthy of dreams!

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  • The Vagina Bible – by Dr. Jen Gunter

    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.

    The vagina is mysterious to most men, and honestly, also to a lot of women. School education on this is minimal, if even extant, and as an adult, everyone’s expected to “just know” stuff. However, here in reality, that isn’t how knowledge works.

    To remedy this, gynecologist Dr. Jen Gunter takes 432 pages to give us the low-down and the ins-and-outs of this remarkable organ that affects, and is affected by, a lot of the rest of our health.

    (On which note, if you think you already know it, ask yourself: could you write 432 pages about it? If not, you’ll probably still learn some things from this book)

    Stylistically, this book is more of a textbook in presentation, but the writing is still very much easy-reading. The focus is mostly on anatomy and physiology, though she does give due attention to relevant healthcare options; what’s good, what’s bad, and what’s just plain unnecessary. In such cases, she always has plenty of science to hand; it’s never just “one woman’s opinion”.

    If the book has a downside, it’s that (based on other reviews) it seems to upset some readers with unwelcome truths, but that’s more in the vein of “she’s right, of course, but I didn’t like reading it”.

    Bottom line: if you have a vagina, or spend any amount of time in close proximity to one, then this is a great book for you.

    Click here to check out The Vagina Bible, and upgrade your knowledge!

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  • Are Electrolyte Supplements Worth It?

    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.

    When To Take Electrolytes (And When We Shouldn’t!)

    Any sports nutrition outlet will sell electrolyte supplements. Sometimes in the form of sports drinks that claim to be more hydrating than water, or tablets that can be dissolved in water to make the same. How do they work, and should we be drinking them?

    What are electrolytes?

    They’re called “electrolytes” because they are ionized particles (so, they have a positive or negative electrical charge, depending on which kind of ion they are) that are usually combined in the form of salts.

    The “first halves” of the salts include:

    • Sodium
    • Potassium
    • Calcium
    • Magnesium

    The “second halves” of the salts include:

    • Chloride
    • Phosphate
    • Bicarbonate
    • Nitrate

    It doesn’t matter too much which way they’re combined, provided we get what we need. Specifically, the body needs them in a careful balance. Too much or too little, and bad things will start happening to us.

    If we live in a temperate climate with a moderate lifestyle and a balanced diet, and have healthy working kidneys, usually our kidneys will keep them all in balance.

    Why might we need to supplement?

    Firstly, of course, you might have a dietary deficiency. Magnesium deficiency in particular is very common in North America, as people simply do not eat as much greenery as they ideally would.

    But, also, you might sweat out your electrolytes, in which case, you will need to replace them.

    In particular, endurance training and High Intensity Interval Training are likely to prompt this.

    However… Are you in a rush? Because if not, you might just want to recover more slowly:

    ❝Vigorous exercise and warm/hot temperatures induce sweat production, which loses both water and electrolytes. Both water and sodium need to be replaced to re-establish “normal” total body water (euhydration).

    This replacement can be by normal eating and drinking practices if there is no urgency for recovery.

    But if rapid recovery (<24 h) is desired or severe hypohydration (>5% body mass) is encountered, aggressive drinking of fluids and consuming electrolytes should be encouraged to facilitate recovery❞

    Source: Fluid and electrolyte needs for training, competition, and recovery

    Should we just supplement anyway, as a “catch-all” to be sure?

    Probably not. In particular, it is easy to get too much sodium in one’s diet, let alone by supplementation.And, oversupplementation of calcium is very common, and causes its own health problems. See:

    To look directly to the science on this one, we see a general consensus amongst research reviews: “this is complicated and can go either way depending on what else people are doing”:

    Well, that’s not helpful. Any clearer pointers?

    Yes! Researchers Latzka and Mountain put together a very practical list of tips. Rather, they didn’t put it as a list, but the following bullet points are information extracted directly from their abstract, though we’ve also linked the full article below:

    • It is recommended that individuals begin exercise when adequately hydrated.
      • This can be facilitated by drinking 400 mL to 600 mL of fluid 2 hours before beginning exercise and drinking sufficient fluid during exercise to prevent dehydration from exceeding 2% body weight.
    • A practical recommendation is to drink small amounts of fluid (150-300 mL) every 15 to 20 minutes of exercise, varying the volume depending on sweating rate.
      • During exercise lasting less than 90 minutes, water alone is sufficient for fluid replacement
      • During prolonged exercise lasting longer than 90 minutes, commercially available carbohydrate electrolyte beverages should be considered to provide an exogenous carbohydrate source to sustain carbohydrate oxidation and endurance performance.
    • Electrolyte supplementation is generally not necessary because dietary intake is adequate to offset electrolytes lost in sweat and urine; however, during initial days of hot-weather training or when meals are not calorically adequate, supplemental salt intake may be indicated to sustain sodium balance.

    Source: Water and electrolyte requirements for exercise

    Bonus tip:

    We’ve talked before about the specific age-related benefits of creatine supplementation, but if you’re doing endurance training or HIIT, you might also want to consider a creatine-electrolyte combination sports drink (even if you make it yourself):

    Creatine-electrolyte supplementation improves repeated sprint cycling performance: a double-blind randomized control study

    Where can I get electrolyte supplements?

    They’re easy to find in any sports nutrition store, or you can buy them online; here’s an example product on Amazon for your convenience

    You can also opt for natural and/or homemade electrolyte drinks:

    Healthline | 8 Healthy Drinks Rich in Electrolytes

    Enjoy!

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  • Is thirst a good predictor of dehydration?

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    Water is essential for daily functioning and health, and we can only survive a few days without it. Yet we constantly lose water through sweat, urination and even evaporation when we breathe.

    This is why we have evolved a way to regulate and maintain water in our bodies. Like other animals, our survival relies on a strong biological drive that tells us to find and drink water to balance fluid loss.

    This is thirst – a sensation of dryness in the mouth signalling we need to have a drink. This basic physiological mechanism is controlled mainly by part of the brain’s “control centre”, called the hypothalamus. The hypothalamus receives signals from various regions of the body and in return, releases hormones that act as a messenger to signal the thirst sensation.

    KieferPix/Shutterstock

    What is dehydration?

    Staying hydrated (having enough water in our bodies) is important for several reasons, including:

    • regulating body temperature through sweat and respiration
    • lubricating joints and eyes
    • preventing infections
    • digesting and absorbing nutrients
    • flushing out waste (via the kidneys)
    • preventing constipation
    • brain function (including memory and concentration)
    • mood and energy levels
    • physical performance and recovery from exercise
    • skin health.

    Dehydration occurs when our body doesn’t have enough water. Even slight drops in fluid levels have noticeable consequences, such as headaches, feeling dizzy, lethargy and struggling to concentrate.

    Chronic dehydration can pose more serious health risks, including urinary tract infections, constipation and kidney stones.

    What does the evidence say?

    Despite thirst being one of the most basic biological drivers for good hydration, science suggests our feelings of thirst and subsequent fluid intake don’t always correlate with hydration levels.

    For example, a recent study explored the impact of thirst on fluid intake and hydration status. Participants attended a lab in the morning and then later in the afternoon to provide markers of hydration status (such as urine, blood samples and body weight). The relationship between levels of thirst in the morning and afternoon hydration status was negligible.

    Further, thirst may be driven by environmental factors, such as access to water. For example, one study looked at whether ample access to water in a lab influenced how much people drank and how hydrated they were. The link between how thirsty they felt and how hydrated they were was weak, suggesting the availability of water influenced their fluid intake more than thirst.

    Exercise can also change our thirst mechanism, though studies are limited at this stage.

    A man standing in a kitchen drinking a glass of water.
    Being thirsty doesn’t necessarily mean we’re dehydrated. puhhha/Shutterstock

    Interestingly, research shows women experience thirst more strongly than men, regardless of hydration status. To understand gender differences in thirst, researchers infused men and women with fluids and then measured their thirst and how hydrated they were. They found women generally reported thirst at a lower level of fluid loss. Women have also been found to respond more to feeling thirsty by drinking more water.

    Other ways to tell if you need to drink some water

    While acknowledging some people will need to drink more or less, for many people, eight cups (or two litres) a day is a good amount of water to aim for.

    But beyond thirst, there are many other ways to tell whether you might need to drink more water.

    1. urine colour: pale yellow urine typically indicates good hydration, while darker, concentrated urine suggests dehydration

    2. frequency of going to the toilet: urinating regularly (around four to six times a day) indicates good hydration. Infrequent urination can signal dehydration

    3. skin turgor test: gently pinching the skin (for example, on the back of the hand) and observing how quickly the skin returns to its normal position can help assess hydration. Slow return may indicate dehydration

    A woman's index finger and thumb pinch the skin on the back of her other hand.
    If skin stays elevated after pinching it may be a sign of dehydration. SusaZoom/Shutterstock

    4. mouth and lips: a dry mouth or cracked lips can be early signs of dehydration

    5. headaches and fatigue: frequent headaches, dizziness, or unexplained fatigue can be signs of inadequate hydration

    6. sweating: in physically active people, monitoring how much they sweat during activity can help estimate fluid loss and hydration needs. Higher levels of sweat may predispose a person to dehydration if they are unable to replace the fluid lost through water intake

    These indicators, used together, provide a more comprehensive picture of hydration without solely depending on the sensation of thirst.

    Of course, if you do feel thirsty, it’s still a good idea to drink some water.

    Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Kiara Too, PhD candidate, School of Human Movement and Nutrition Sciences, The University of Queensland

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

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  • How Jumping Rope Changes The Human Body

    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.

    Most popularly enjoyed by professional boxers and six-year-old girls, jumping rope is one of the most metabolism-boosting exercises around:

    Just a hop, skip, and a jump away from good health

    Maybe you haven’t tried it since your age was in single digits, so, if you do…

    What benefits can you expect?

    • Improves cardiovascular fitness, equivalent to 30 minutes of running with just 10 minutes of jumping.
    • Increases bone density and boosts immunity by aiding the lymphatic system.
    • Enhances explosiveness in the lower body, agility, and stamina.
    • Improves shoulder endurance, coordination, and spatial awareness.

    What kind of rope is best for you?

    • Beginner ropes: licorice ropes (nylon/vinyl), beaded ropes for rhythm and durability.
    • Advanced ropes: speed ropes (denser, faster materials) for higher speeds and more difficult skills.
    • Weighted ropes: build upper body muscles (forearms, shoulders, chest, back).

    What length should you get?

    • Recommended rope length varies by height (8 ft for 5’0″–5’4″, 9 ft for 5’5″–5’11”, 10 ft for 6’0″ and above).
    • Beginners should start with longer ropes for clearance.

    What should you learn?

    • Initial jump rope skills: start with manageable daily jump totals, gradually increasing as ankles, calves, and feet adapt.
    • Further skills: learn the two-foot jump and then the boxer’s skip for efficient, longer sessions and advanced skills. Keep arms close and hands at waist level for a smooth swing.

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    How To Do High Intensity Interval Training (Without Wrecking Your Body)

    Take care!

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  • Retrain Your Brain – by Dr. Seth Gillihan

    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.

    15-Minute Arabic”, “Sharpen Your Chess Tactics in 24 Hours”, “Change Your Life in 7 Days”, “Cognitive Behavioral Therapy in 7 weeks”—all real books from this reviewer’s shelves.

    The thing with books with these sorts of time periods in the titles is that the time period in the title often bears little relation to how long it takes to get through the book. So what’s the case here?

    You’ll probably get through it in more like 7 days, but the pacing is more important than the pace. By that we mean:

    Dr. Gillihan starts by assuming the reader is at best “in a rut”, and needs to first pick a direction to head in (the first “week”) and then start getting one’s life on track (the second “week”).

    He then gives us, one by one, an array of tools and power-ups to do increasingly better. These tools aren’t just CBT, though of course that features prominently. There’s also mindfulness exercises, and holistic / somatic therapy too, for a real “bringing it all together” feel.

    And that’s where this book excels—at no point is the reader left adrift with potential stumbling-blocks left unexamined. It’s a “whole course”.

    Bottom line: whether it takes you 7 hours or 7 months, “Cognitive Behavioral Therapy in 7 Weeks” is a CBT-and-more course for people who like courses to work through. It’ll get you where you’re going… Wherever you want that to be for you!

    Click here to check out “Cognitive Behavioral Therapy in 7 Weeks” on Amazon and start learning today!

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