On Tuesday I had a blood test done. This morning, the cardiologist assigned to me called with the results. "In general, very good. LDL cholesterol is down significantly, but still needs to be lower". Saying this, she prescribed me yet another (ninth!) drug to be taking daily. This is Etibax (ezetimibe). It will be working together with a statin, Roswera, which I've been taking since my heart attack. The statin reduces the amount of cholesterol the body produces; the ezetimibe works by blocking absorption of cholesterol from the small intestine. Taken together, the two mean that less cholesterol makes it into the bloodstream to clog up the heart.
So – after my heart attack, my LDL (that's the 'bad cholesterol') level was 151mg/dl. It's now down to 80mg/dl. But as someone at high risk of further heart attacks, it needs to be below 55mg/dl. By adding ezetimibe to my daily drug intake, the cardiologist expects that I will reach that target.
Then what? Am I condemned to swallowing nine pills a day at the current dosages? I've started looking at my diet like never before.
Stuff that's bad: saturated fats, found in red meat, butter and cheese. Red meat is something I've relegated to 'rare treat' status years ago; butter I've just quit (replacing it with ProActiv cholesterol-reducing spread; 30g a day can reduce LDL cholesterol by 7% to 10% within a few weeks). Google Gemini says that it works differently to statins or ezetimibe; "plant sterols/stanols can provide an additional LDL-lowering benefit complementing the effects of the meds. I have stepped up porridge consumption from two to seven bowls a week, one every morning. It will, confirms Gemini, "definitely contribute to your LDL cholesterol reduction goals." Oatmeal, it says, "provides a very significant and scientifically proven dose of beta-glucan". To the porridge I add pumpkin and sunflower seeds, which provide more beneficial fats, fibre, plant sterols and antioxidants, all of which contribute to better lipid profiles and overall cardiovascular health. And sprinkled with ground milk-thistle (ostropest), which offers "liver-support properties and general antioxidant content". Otherwise, more fruit, more veg, more legumes (kidney beans, lentils and chickpeas). And avoid the fatty skin of duck (another favourite).
Exercise? The cardiologist said I should avoid exercises that exceed my safe limit for heartbeats per minute, which she said was 175 minus my age, so 108. Using my pulse-oximeter clipped to my right index finger while holding the plank, I could see the BPM steadily rising minute after minute; I quit at five minutes, at which time my heart rate was 90 beats per minute. So that's comfortably safe. Back extensions ditto. Slowly, I shall add more and varied exercises to the daily routine.
Walking? Best thing possible. Since leaving hospital, I've increased my daily average to over 13.5k paces a day, though walking slower than before and usually doing two shorter loops rather than straying too far from home. Faster paces, with the Nordic walking poles, will resume after further consultation with the cardiologist.
Below: in such a landscape, in spring, it's impossible not to heed the call of a decent, healthy walk.
And a side point: AI has really stepped in as a trusted health advisor. This is not an area where it is prone to hallucinate – large language models have been trained on a vast corpus of medical literature (plenty of links to clinical trials and academic studies). As well as plenty of sober caveats. All in all, really helpful stuff, the promise of expert systems (which my brother was telling me about 40 years ago as he did his postgrad studies in AI) finally arrives.
Drugs, diet or exercise? All three. Can I do without the drugs? I'd like to reduce my intake to the minimum, but cutting them out altogether is not a realistic goal, I fear. Belief in the power of belief is vital. Overarching. A positive expectation, optimism, mind over matter. If I believe in the pills, they will work. If I believe they are harming me, they might well end up doing just that.
So – the key over the next few months will be to get that LDL cholesterol level down to around 50mg/dl – and keep it there – for life!
This time last year:
Świnoujście – slight return
S7 extension progress
This time two years ago:
Town and country
This time nine years ago:
Beautiful May Sunday
This time ten years ago:
Three days – three Polish cities
This time 13 years ago:
Part two of short story The Devil Is In Doubt
This time 14 years ago:
"A helpful, friendly people"
This time 15 years ago:
A familiar shape in the skies
This time 16 years ago:
Feel like going home
This time 17 years ago:
Mr Hare comes to call
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13 comments:
To me, the science you’re talking about is where madness lies. My cholesterol is 300 (I don’t want to know of what units). It was 200 thirty-seven years ago, when I was first put on notice by a university doctor. My father died of a heart attack. So did his mother. You can do the maths where that puts me! My answer – the solution to a problem is another problem. As I am amply endowed in that department, and I don’t even count the risk of being run over by a cyclist, I have made it to where I am today, at the time or writing. How else can I put it – if you’re in the trenches and shells are landing left and right of you, it’s no use worrying about your gangrenous foot, if you’re in a concentration camp, why worry about your cancer, etc, etc, etc.
The last time I had a cholesterol test done, medical science hadn't yet distinguished LDL (bad) from HDL (good) cholesterol. So I got one number, and that number was OK, so I didn't worry. Until it was too late...
Very sorry to hear about your recent cardiac event. Great that you have pretty much fully recovered. A quick question though: Why are you so anxious to to work on limiting future medication intake? I’ve been on an anti-hypertensive for 10 years now, starting in my mid-fifties. BP controlled beautifully. Exercise and diet could *never* control BP so consistently.
I understand you’re on 9 medications. But unless there are major side-effects from those pills, why fret about taking them?
I've read all the side effects on the leaflets, and short term, I'm not experiencing any side effects. But long term? I'd like to see the amount of pills I guzzle cut to the minimum. If a daily bowl of porridge oats (150g) can cut LPL cholesterol by 10-12 mg/dl, then I'd expect the dosage of statins can be significantly reduced...
Maybe. But it seems you carry a fair genetic load for Coronary Artery Disease (CAD). I believe your Mom had 3 heart attacks and a paternal uncle succumbed to heart disease as a younger man. Wondering if a cup of daily porridge oats will *really* help to outperform significantly turned on plasma cholesterol LDL genes, on a consistent and reliable level?
@ Teresa
Very interesting. Genetic load vs. diet & lifestyle and positive mindset – the 'Father, Son and Holy Spirit' of my health trinity.
Starting with the genetics; my mother survived for nearly 30 years after her first heart attack; my paternal uncle died at the age of 53, as did my paternal grandfather (also heart).
I'm taking a 40mg dose of Rosuvastatin – the maximum dose, considered high-intensity, typically reserved for patients with very high cholesterol or risk who haven't achieved goals on lower doses. This (plus dietary changes!) has cut my LDL level by 47% in six weeks. Now 10mg of ezetymib has been added; I'd be surprised if by September my LDL level isn't down to 55mg/dl or below. On top of the drugs: the beta glucan content of a daily bowl of 150g of porridge oats can result in LDL reductions ranging from 10% up to 15% (2014 meta-analysis by Whitehead et al.); in my case taking it down from 80 to 72mg/dl. On top of the porridge there are the plant stenols in my Pro-Activ spread, which claim to be able to shave a further 7% off the LDL level.
Whilst feeling no current adverse reaction to the nine (!) drugs I'm now taking, I would like to see them reduced, especially the statin. Getting the balance right between drugs, diet, exercise and mindset is key.
Science walks gingerly around the subject of placebo effect.
Totally agree that a balance between drugs, diet, exercise and mindset is key.
Placebo effect? As a person of science, the placebo effect seems to me to be completely anecdotal. Impossible to measure accurately. Therefore, doesn’t rate high for me as scientific evidence.
Cancer patients in clinical trials will never be given a placebo, for example. It is not ethical.
@ Teresa
I put this to Google Gemini AI and got the following (backed up with links to papers by the NIH, Frontiers, Michigan Medicine)
"Studies and meta-analyses have reported that placebo response rates can range from 21% to 40% in some studies, with some estimates suggesting that up to 35% of the overall therapeutic effect in clinical practice could be attributed to placebo responses. In trials for antidepressants, some analyses have indicated that the placebo response can duplicate a significant portion of the active drug's effect. For instance, one analysis of FDA licensing data for new antidepressants suggested that 82% of the drug effect was duplicated by placebo. For pain relief, studies have shown that placebos can sometimes achieve around 50% of the effect of an active pain medication, particularly when patients are informed that the tested drug could reduce pain."
And... "There is an ongoing scientific discussion and some evidence suggesting that placebo responses in clinical trials, particularly in the United States, may be increasing over time, especially for certain conditions like pain and depression."
Agree about it being unethical to give placebos in clinical trials for cancer.
Placebo effect for pain and depression? Could be. But still anecdotal. And only descriptive. ‘I feel less pain and am less depressed’. What does ‘less’ mean? Different things to different people. Is it sustainable? What about intractable pain? What about a suicidally depressed patient?
My worry has always been that firm supporters of the ‘wellness community’
who value only diet, exercise and mindset over dreaded Pharma when they or their children are diagnosed with bad things are harming themselves. Anti-vaxxers belong to this group. Take a look at the ‘wellness’ garbage RFK Jr. is touting in the US. It is unconscionable. People will die. Measles is making a comeback. We MUST value science. We must value medical experts.
Completely agree with you on RFK Jr. An absolute nutcase. As is US Surgeon-General Casey Means. Fruitcakes. [In case the American Consulate in Warsaw is trawling through my social-media feed, I'm not in the least bit interested in visiting 21st- century USA] These people are extremists. I am not negating medical science in the least. I have had my Covid shots (and when Covid finally got me it was neither Severe nor Acute nor Respiratory). Measles , smallpox shots – obligatory if you want to live in society. My issue is this. We may not have a clue how consciousness works. It could be the fundamental property of the Cosmos, from which derives spacetime and matter/energy. Or not. We simply don't know. In the meantime, things like placebo effect are brushed away by the scientific mainstream not because it doesn't really exist (it clearly does), but because there is no framework within the current paradigm to explain it. There a scores of paranormal phenomena that are shown in scores of experiments to be present (above chance to six sigma), yet there are no meaningful theories or hypotheses as to why these things are observed. So science chooses to ignore the results and pretend they didn't happen, or just to use ad hominems against any scientist that dares dabble in these areas.
Some scientists do indeed study the placebo effect. In one study, 50% of patients put in the placebo arm in a clinical trial for pain management were found to respond, while 50% did not. Authors of this study posited that certain psychological/ psycho-social factors divided the group into responders and non-responders. For example, a positive, capable and optimistic view of illness management was found to be present in placebo responders. Placebo non-responders were negative, despondent and pessimistic about their illness outcomes. Or perhaps it simply comes down to the fact they were in more physical pain?
If we just look at this one study, why would busy physicians count on the placebo effect for pain management? A psychological work up for every pain patient is time consuming and unrealistic. So, painkillers are prescribed. Everything from NSAIDS to opiates. Because *biologically* we know how they work. And they work for everyone.
I agree that placebo works better for some than for others. I am not suggesting that placebos should be given to all. I do believe in the power of belief; I don't know how it works but over my lifetime it has been effective for me thus far. Big pharma has absolutely no interested in researching the placebo effect. State-funded healthcare systems most certainly do! But the biggest obstacle is in the reductionist-materialist mindset of science; if it can't be boiled down to a formal equation and an interaction between particles, it's dismissed as pseudoscience, even if the effect is clearly there. Something more fundamental than quarks and gluons is going on at the deepest substrate of reality. We can only posit that it has something to do with consciousness, though we have no clue as to how to tap into it. We can but intuit.
I’d say economic self-interest guides who studies the placebo effect. Less profit for Pharma, if placebos work better than Pharma drugs. And state-funded healthcare would prefer to pay for inexpensive placebos over high-priced Pharma drugs.
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