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- Statins: His & Hers?
Statins: His & Hers?
Plus: Mediterranean Diet cooking... in an air fryer!
The 10almonds Team
April 11, 2023
Loading Screen Tip: You cannot do kindness too soon, as you never know how soon it will be too late.
⏰ IN A RUSH?
Today’s Key Learnings:
Flying by? Here are some key take-away ideas from today’s newsletter:
Framework thinking can help you to “think before you speak... but quickly” (see today’s video)
Statins are powerful drugs that lower LDL (bad) cholesterol
Doing so can mask underlying problems that need treatment, which can be counterproductive
Men and women present different symptoms related to cardiovascular disease, and also respond differently to statins
Statins are more likely helpful to men, for whom high LDL levels are more of a risk factor than they are for women
Statins are not only less likely helpful to women, for whom high LDL levels are less of a risk factor, but also, are more likely to cause unwanted serious side effects
A vitamin deficiency may be behind 'double-jointedness' and hypermobile Ehlers-Danlos syndrome (link below)
There's a link between gut microbiota, Alzheimer's, and the central nervous system (link below)
You can cook Mediterranean with an air-fryer too!
Read on to learn about these things and more…
👀 WATCH AND LEARN
How to Think Fast Before You Speak: Framework Thinking
“Think before you speak” is all well and good, but to do that justice can feel like it depends on other people being in no rush for you to speak. It’s fine if you’re in a group… not so good in a one-to-one conversation that requires quick responses! Vicky Zhao has tips to deliver replies that are prompt and good:
Key moments:
0:00 Articulate your thoughts with 4 questions
01:10 Why it's hard to think fast
01:53 Example 1
03:01 Goal of framework thinking
03:30 Example 2
05:10 Where to find frameworks - source 1
05:23 Example 3 - Apple
06:20 Example 4: Business Storytelling
07:03 Where to find frameworks - source 2
07:44 Example 5 - Ikigai
🫀 MAIN FEATURE
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?
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 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?
🌍 AROUND THE WEB
What’s happening in the health world…
More to come tomorrow!
📖 ONE-MINUTE BOOK REVIEW
Mediterranean Air Fryer Cookbook: 200 Effortless Healthy Recipes to fry, grill, Bake and Roast, even for One & Two - by Naomi Lane
There are Mediterranean Diet cookbooks, and there are air fryer cookbooks. And then there are (a surprisingly large intersection of!) Mediterranean Diet air fryer cookbooks. We wanted to feature one of them in today's newsletter... And as part of the selection process, looked through quite a stack of them, and honestly, were quite disappointed with many. This one, however, was one of the ones that stood out for its quality of both content and clarity, and after a more thorough reading, we now present it to you:
Naomi Lane is a professional dietician, chef, recipe developer, and food writer... And it shows, on all counts.
She covers what the Mediterranean diet is, and she covers far more than this reviewer knew it was even possible to know about the use of an air fryer. That alone would make the book a worthy purchase already.
The bulk of the book is the promised 200 recipes. They cover assorted dietary requirements (gluten-free, dairy-free, etc) while keeping to the Mediterranean Diet.
The recipes are super clear, just what you need to know, no reading through a nostalgic storytime first to find things. Also no pictures, which will be a plus for some readers and a minus for others. The recipes also come complete with nutritional information for each meal (including sodium), so you don't have to do your own calculations!
Bottom line: this is the Mediterranean Diet air fryer cook book. Get it, thank us later!
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Wishing you all the best in your heart and home,
The 10almonds Team