Friday, November 01, 2013


After I came back from work I received an email which had a video series attached, and I was asked for my comments.
You may find the videos interesting.

Looks like there is a very strong movement to challenge the saturated fat theory for atherosclerosis and also the role of statins in the management of coronary artery disease.

So I had a look at the two videos, viz "Heart of the Matter - Diet" and "Heart of the Matter - statins". Below are my comments. I wrote it in point forms as the thoughts came.

1, Heart of the matter - Diet

Interesting. Let me summarise what I think

1. Nothing must be taken to the extreme. Moderate is best.
2. There is some truth in saturated fat as a pro-atherogenic diet. That is how we do our animal experiments to induce cholestrol blockage. But it may not be the same in all individuals.
3. Inflammation is an important part of building cholesterol blockage.
4. Transfat is bad.
5. Polyunsaturated fat is good, but they do defer in their evel of inflammation induced.
6. Omega-3 fatty acid is good. Omega 6 fatty acid may be bad.
7. Mediterranean diet is good. Diets full of fruits veges, grains and nuts is good
8. Olive oil and wine is good
9. The Framingham data is correct and forms the basis for many of our understanding of coronary artery disease.
10. All major coronary risk factors should be modified. Of all the major coronary risk factors ( cigarette, diabetes, hypertension, cholesterol ), cholesterol ranks the lowest in importance.
11. LDL-cholesterol is not the real culprit. It is oxidised LDL-c that is the main culprit, but oxidised LDL-c comes from LDL-C after oxidative stress.
12. We must also exercise, stop smoke, lose weight and control BP, and prevent diabetes.
13. Many ( 50% ) of patients wuith heart attacks have normal cholesterol.

I hope I did not miss anything.

2. Heart of the Matter - statins.

This is easier. There is a lot of pharma biase and many of our American Opinion leaders are paid by pharmas. Many of the clinical drug trials are biased as they use selective data for analysis, publishing whatever suits pharmas and ignoring or hidding data that does not suit them. I am a firm believer there. What you may not know is that I was invited to sit in the expert panel for "clinical Practice Guidelines on Hyperlipidemias" for the first CPG. Of course I voice my views. I was never included again. Of course CPG meetings are sponsored by pharmas. Anyway, my views,

Less than 50% of clinical trials carried out by pharmas were never reported as they were not favourable. Just about 40% are reported. About 50% of clinical trials sponsored by government are reported. Pharmas hide a lo of bad data. That is why the expert say that to know the right picture, you have to access the Pharma hard disc.

1. Moderate is best. Extremes are bad.
2. Statins for secondary prevention is well supported by data.
3. Statins for primary prevention has weak data and may or may not be true, especially in females.
4. Statin side effects are grossly under reported. Muscle aches are usually ignored and pass off as normal.
5. We should work hard to modify all coronary risk factors and not just concentrate on one.
6. The " lower is better" cholesterol theory is probably incorrect for most people. It is probably pharma driven with compliant doctors in support.
7. Too low cholesterol may be carcinogenic.
8. There is an increase risk of diabetes with the use of statins.

Those are my views all these years. But pharmas are very powerful and can influence medical practice. Many are afraid to go against guidelines because if they are sued, they cannot stand.


Winston said...

I would like to comment as follows:
1. It's true that many drugs with dangerous side
effects are on the market.
Still they are pushed by doctors even though the
risks far outweigh the benefits.
Perhaps there are "benefits" for such doctors
for doing so!
Some local doctors are no exception; money is the
main motive.
Most of these drugs have been approved by the
FDA in America.
It's also a fact that this organisation has been
collaborating with big drug companies to pass
such drugs.
2. With regard to cholestrol,I understand that it
can block blood vessels.
So, if one's blood vessels are blocked, what can
one to rid the blockage other than exercise?
It must be remembered that not all persons can
exercise because of mobility problems.
3. As for high blood sugar, cutting down on sugar
and excercising is best for the young.
But for the elderly, cutting down on sugar
may offer little help as the body has an
inability to utilise sugar when one gets older.
So, for these folks, perhaps the main solution
is to exercise.
But then again, mobility can be a problem.
There was a recent article that Japanese
scientists have invented an oral pill to treat
diabetes, although it may be a few years before
it's on the market.
4. Agreed, moderation is best where diet and even
where exercise is concerned.
However, as far as diet is concerned, the
Mediterranean diet, although excellent, is way
too expensive for most Malaysians.
By the way, I think that a blog is too restrictive.
May I suggest a forum (the old style type where topics are all listed under different headings) instead of a blog so that visitors can also post their articles and have a greater interchange of views.
Thank you.

hmatter said...

Hi Winston, thanks for your comments.
I honestly donot know how to start a web forum.
Maybe you can d=start one and I will be more than happy to participate.
Thanks for your comments.