The Knock On Niacin – Big Pharma At It Again

Two new reports recently came out that said niacin, vitamin B3, is not effective for the prevention of heart disease or stroke. And, in fact, it might be dangerous. The studies also concluded that it might be so dangerous is shouldn’t be recommended at all. This is not an uncommon response when nutrients are studied, especially ones that reduce the market share for billion dollar statin medications.

Two studies recently published in the New England Journal of Medicine found that while niacin does reduce triglycerides, raise “good” (HDL) cholesterol, and reduce “bad” (LDL) cholesterol, it did not reduce the risk of heart attack or stroke.

Big PharmaI have several problems with the new information that’s been plastered all over the media recently about the recent studies:

Problem #1:

While two studies were performed, the largest of the two was funded by Merck Pharmaceuticals. It had over 25,000 participants while the other study, funded by the NIH, had just over 3,000 people. Merck clearly has an interest in driving down the sales of niacin as it would likely increase the sales of their cholesterol lowering drugs Zocor and Zetia. As an added note, niacin sales have tripled since 2002. Wouldn’t it be a perfect time to get a study that shows it’s dangerous or ineffective?

Problem #2:

These published trials do not reflect the clinical experience of doctors around the country who’ve been recommending niacin for decades. Research and a doctor’s clinical observations are often different. Which one do you believe?

Problem #3:

These trials focused on high-risk patients, almost all of whom were already taking statins and had low LDL levels. Would you see more benefit in clinical trials if these patients had different lipid profiles, or in those who did not already have heart disease? The populations they studied were already being treated intensively. It’s unlikely they were going to benefit by just one more treatment (niacin in this case).  As a matter of fact, in the Merck funded study they clearly state they cannot say whether niacin might be beneficial for patients at even higher risk of having a heart attack or stroke or those with higher LDL levels.

Problem #4:

Statins are particularly ineffective with potentially serious side effects, yet we don’t see reports on the news telling us to stay away from them. This is likely the powerful pull Big Pharma has on media and medicine. A full 98% of people who take statins see no benefit. Zero percent avoid death by taking a statin and only 1.6% avoid a survivable heart attack, and 0.4% are helped by preventing a stroke. Compare that to the side effects where 2% develop diabetes and 10% develop muscle damage as a result of taking that statin and the numbers don’t add up.

I think the real lesson of these studies (both on niacin and ones published on statins) is that inflammation, not necessarily the cholesterol itself, is the problem. If you address those factors, you will live a long, cardiovascular disease-free life.

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Health Doesn’t Come In A Pill

PillsWe live in an instant gratification society. It permeates every aspect of our lives. From the way we consume our news with 24 hours news networks or online surfing, to the way we gossip with Facebook, our desire for things to be done now(!) is staggering.

The same applies to our health. We want results, and we want it yesterday. The problem? There is no quick fix for anything in terms of your health. We’ve become accustomed to seeing the ads on TV that promise results with just one simple pill per day. We’re so accustomed to it, we’re starting to believe it. Heck, some people believe it so much, they demand it! Unfortunately, health doesn’t come in a pill.

But my doctor promises me that if I take my high blood pressure medication, my statin, and my baby aspirin just once per day, I’ll live a long, healthy life!

Yes, yes. That is a comforting thought isn’t it? The problem is it isn’t true. Check out this information:

Statins: For those who took statins for at least 5 years with no history of heart disease:*

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 1.6% were helped by preventing a heart attack
  • 0.4% were helped by preventing a stroke
  • 2% were harmed by developing diabetes
  • 10% were harmed by muscle damage

Aspirin: For those who took it daily for a year with no history of heart disease:*

  • 99.94% saw no benefit
  • 0% were helped by avoiding death
  • 0.05% were helped by preventing a non-fatal heart attack
  • 0.01% were helped by preventing a non-fatal stroke
  • 0.03% were harmed by developing a major bleeding event

Blood Pressure Medications: For those who took them for mild hypertension:*

  • 100% saw no benefit
  • 9% were harmed by medication side effects and stopped the drug

(*Statistics gathered from www.thennt.com)

Isn’t it amazing that you’re more likely to be harmed by these medications than you are to be helped? So, given that these drugs are so popular and prescribed so widely, why don’t they work? Health doesn’t come in a pill. Our medical model is flawed and flawed greatly. There are too many factors to assume one can take a pill and live longer or healthier. And most medical doctors receive very little, if any, training in nutrition.

You must fuel your body properly. This means a healthy diet and exercise. Those things work. Those things take time and effort. Obviously, time and effort don’t fit with our current lifestyle of “I want it now.” We need to change our lifestyle.

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Muscle Mass Beats BMI as Longevity Predictor – Who Knew!?

Fit at 70!I’ve written a couple of times (here and here) about my dislike of the imperfect science of body mass index. In particular, I’ve stated that it does not accurately assess the elderly because of low muscle mass. The elderly are likely to have a “healthy” BMI despite being anything but. As people age they lose weight through muscle loss. This brings their BMI down and may even bring it into what is considered an optimal range. The problem is muscle mass loss reduces strength, which increases the likelihood of falls and a reduced ability to exercise. The last point is particularly problematic.

Now new research shows that when it comes to longevity, a focus on weight loss may be misplaced. Because BMI isn’t actually a very reliable indicator of life span. A more useful measure, some physicians say, might be muscle mass. Researchers analyzed BMI and muscle mass data from more than 3,600 seniors in a long-term study. And they tracked which seniors had died, a decade later. Turns out BMI wasn’t much good at predicting chance of death.

But muscle mass was: more muscle meant better odds of survival. The study appears in The American Journal of Medicine. [Preethi Srikanthan and Arun S. Karlamangla,Muscle Mass Index as a Predictor of Longevity in Older-Adults]. For more information see here.

Critics argue that it’s nearly impossible for the elderly to build muscle. I think they are missing the point. It’s not necessarily that the elderly need to bulk up. It’s that they need to minimize muscle loss. This is done through resistance training. Anyone, yes even the elderly, can resistance train. By doing so muscle loss is minimized. This may mean you don’t fit into the BMI scale perfectly, however, it does mean you are healthier. So, here’s to weight lifting!

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Why Your Pants Shouldn’t Fit!

Have you heard about a metric used by health professionals called the waist to hip ratio? It’s a measure of abdominal obesity. Abdominal obesity is strongly associated with an increased risk of type 2 diabetes, cardiovascular disease and death, even after controlling for other factors like overall weight. In the waist to hip ratio, waist circumference and waist size are compared to hip size. Several organizations have defined cut points for abdominal obesity with different cut points for men and women. 

According to the World Health Organization (WHO) the waist circumference should be measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, using a stretch‐resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. Practically, however, the waist is more conveniently measured simply at the smallest circumference of the natural waist, usually just above the belly button, and the hip circumference may likewise be measured at its widest part of the buttocks or hip. The WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.86 for females. In layman’s terms, if your belly is bigger than your butt, you’ve got a problem.

I recently measured my waist to hip ratio. It was about 0.83 – well within the healthy range. Here’s how I found it. My waist measures about 34 inches. My hips measure about 41 inches. If you divide 34 by 41 you get 0.82926 repeating or about 0.83. For reference I’m about 5’11”, 187 pounds and about 18% body fat.

So what the heck does this have to do with my pants?

Everything! It’s a quick, down and dirty way to assess your waist to hip ratio. When I buy pants, the waist NEVER fits. It’s ALWAYS too big. This is a good thing. The reason it’s too big is I have to be able to fit them over my legs and butt. If you talk to anyone who works out or is athletic, they’ll tell you the same thing. If a pair of pants fits on the waist, it’s super tight in the legs and butt. If it fits the butt and legs, the waist is enormous. It’s a good, if not maddening, problem to have. Here’s what I mean:

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

This is what you don’t want:

This man's waist is clearly larger than his hips.

This man’s waist is clearly larger than his hips.

Everyone should have an idea of what their waist to hip ratio is. It’s a simple and easy metric for assessing your general health. Don’t want to take the time to measure it? Fine, how do your pants fit? Are the waists too big but legs and butt just fine? GREAT. Are you having trouble finding pants to fit your waist because when they fit your waist they fall off the rest of you? Uh-oh. Time to make some lifestyle changes and get healthy!

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I’m Overweight.

Dr. C

Or at least you would think so if you looked at my body mass index (BMI). I have written about the very imperfect science of the BMI scale before here on my blog, but I thought it deserved to be revisited. BMI is basically a height to weight ratio that comes up with a number designed to make it easy for clinicians to decide if a person is overweight or obese. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight. BMI combined those two.

Calculating BMI is relatively simple. You need your weight in pounds and your height in inches. Take your weight and multiply it by 703. Take your height and multiply it by itself (height squared). Now divide the first number by the second number and you have your BMI. To see my calculations or do your own click this link. My BMI falls in the “overweight category” with a score of 26.2. However, my body fat percentage is about 18%. This is well within the acceptable range for a 33-year-old man. (And I clearly do not look overweight!)

BMI misses many things when calculating whether someone is at the proper weight.

The problem for some people, like athletes, it does not take into account muscle mass. A person that is heavily muscled will always be overweight according to the BMI. As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape. If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete. What about the elderly? BMI is not ideal for them either. In the United States that equates to about 43 million people. Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height. This can be significantly misleading. Why? In the elderly muscle mass begins to drop. It happens to all of us. However, with this drop in muscle mass comes a drop in weight. As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss. This loss in muscle mass causes a loss in strength and stability, increasing the risk of falls and increasing the risk of osteoporosis. Another problem with muscle loss is the change in your body composition. As muscle mass is lost one’s body fat percentage increases. Body fat percentage is a great indicator of health. The lower it is (within reason) the healthier you are, generally speaking.

BMI also fails to take into account many other health factors like diet, exercise, inflammatory markers, nutrient status, stress load, chemical exposure, social well-being, mood stability, and a whole host of other things we know have a large impact on our health. However, it is still widely used as a primary assessment of one’s health. As I said, it’s an imperfect science. In my opinion, it’s so imperfect it should be eliminated.

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35 Points From A Body Transformation Contest

Recently, I entered into a 6-week body transformation challenge at the gym I belong to. It’s called KDR Fitness. Great place. It began February 10th and ended March 22nd. It was technically 41 days long. I decided to enter because I needed a kick in the butt to get back to the gym. In the previous year gym days were hard to come by. With a brand new baby and practice, my gym time was way down. To top it off, I had a neck injury that took me completely out of the gym for 3 months at the end of the year. As a consequence my body fat had increased to 21.7%. Not ideal for me. During the contest, I recorded my diet and exercised in order to lose body fat and gain lean mass. I wore a heart rate monitor for all of my workouts to calculate my calories burned and generally keep track of my workouts. Here are the things I learned:

  1. I started at 21.7% body fat.
  2. By the 4th week I was down to 19.4%
  3. By the end of the 6th week, I was down to 18.4%
  4. I gained 3.7 pounds of muscle in 6 weeks.
  5. I lost 7 pounds of fat in 6 weeks.
  6. I missed the gym.
  7. I worked out 25 times in 41 days.
  8. That’s 4 workouts per week with an occasional 5th thrown in.
  9. I ate MORE food than I had been eating and was able to lose fat and gain muscle.
  10. I burned 15,655 calories in 25 workouts.
  11. Each workout was about 1 hour.
  12. Each workout burned an average of 626.2 calories.
  13. The range of calories burned was 273 all the way up to 958.
  14. It is not that hard for me to avoid grain.
  15. I can count on one hand how many times I ate grain in 41 days (and it’s less than the whole hand).
  16. Cheat meals are important.
  17. This was a typical day in terms of food intake:
    Wake Up: 6:15
    Food for the day:
    Breakfast: 6:45 – 3 eggs, mixed veggies, and cheese cooked in butter. Coffee with organic half and half.
    Snack: 10:15 – 3 large beef and veggie meatballs, carrots, celery, and hummus.
    Lunch: 12:20 – Chicken breast, mixed peppers, 1 whole avocado.
    Snack: 3:30 – Protein shake, steamed broccoli.
    Workout – 60 minutes – protein/carbohydrate workout drink
    Dinner: 6:45 – Meatloaf, steamed broccoli and cauliflower with olive oil.
    Snack: 9:15 – Greek yogurt and banana.
  18. Food preparation is key.
  19. Eating 6 times per day isn’t that hard IF you’re prepared.
  20. Eating a lot of vegetables is fairly easy IF you’re prepared.
  21. You don’t necessarily have to count calories if the quality of your food is good.
  22. You can eat A LOT of food if you are working out hard and still lose weight.
  23. Burpees get easier the more you do them.
  24. Working out more consistently makes you want to workout more consistently.
  25. Using the scale to measure your progress is a bad idea.
  26. My weight changed from 190.9 to 187.6 in 6 weeks. Hardly encouraging if you’re just looking at the scale.
  27. Body fat analysis is far more informative.
  28. You only have time for the gym if you make time for the gym.
  29. You don’t need to be in the gym 7 days/week.
  30. Two busy people (my wife and I) can each take turns working out during the week and get great results.
  31. You should be willing and able to do an extra workout or two from home if you need to.
  32. You can turn snow blowing and shoveling your driveway into a workout quite easily.
  33. Body mass index (a measure of height to weight) is a terrible health assessment tool. According to it, I am “overweight.” This is because my lean mass is high, not because I am actually overweight.
  34. My basal metabolic rate (calories I burn at rest over 24 hours) increased from 1,835 to 1,870 over six weeks.
  35. The area of my body that gained the most muscle (as percent growth) was my left arm.

I was on a team of three and our entire team (Bro’s before Hoho’s) did very well. The winning team will win $3,000. I’ll find out in a couple of days which of the 18 teams won the contest. That’s not the important part, but it sure would be nice!

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5 Foods You Should Never Eat!

Have you heard the news? There are five foods you should never eat. And here they are for your viewing pleasure.

1. There

2. Is

3. No

4. Such 

5. Thing

Confused? You shouldn’t be. There is no such thing as a food you should never eat. There are a lot of foods that you should eat sparingly. Ice cream, bread, pasta, white potato, potato chips, french fries, and any fast food come to mind. But even those can be eaten every great once in a while without fear. However, you shouldn’t have ice cream on Monday, pasta on Tuesday, french fries on Wednesday, etc. and expect to feel healthy, lose weight, avoid chronic disease or whatever your goal is. That kind of thing can add up. 

Eating food that is bad for us once in a while will never cause you to be unhealthy. It has no more potential to cause you to be unhealthy than eating healthily every great once in a while does to make you healthy. It’s the consistency that matters.

The exception to the rule:

There’s always one, right? If you have a food sensitivity or food allergy it is best to avoid those foods all the time. Do not cheat with those. Cheat with something else. For some this can be a life or death thing (i.e. an anaphylactic allergy or celiac disease). 

I think this is an important concept as we all can be consumed by the information we see in the media and from health gurus telling us to “eat this” and “don’t eat that.” We have to remember, they have an agenda – it’s to sell books, get ratings, and generally be as polarizing as possible. That’s what gets attention and sometimes the information is lost. 

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