The Statin Guidelines: Looking at the Whole Cardiovascular Spectrum

by Michael Jorrin, "Doc Gumshoe" | December 11, 2013 12:15 pm

Latest thoughts from Doc Gumshoe on the new Statin Guidelines and cardiovascular health

[ed. note: We feature the writings of Doc Gumshoe, our favorite medical scribe, every few weeks here at Stock Gumshoe. He is not a doctor, but we value his insight, research, contrariness and skepticism … and, most importantly, his ability to explain complex health issues for our readers. You can see all of Michael’s previous commentaries here.[1]]

By now nearly everyone has heard about these controversial new statin guidelines, announced on Tuesday, November 12, by the American Heart Association and the American College of Cardiology. In the event that you have been paying attention to far more important matters, such as whether Alex Rodriguez will ever play baseball again, I will briefly summarize the main points. And, to give you an advance peek at where I stand: no, I don’t go with the narrative that holds that this is a conspiracy by the AHA and the ACC to throw more business to Big Pharma. But, also, no, I emphatically don’t believe this is the best way to address the huge issue of interlinked cardiovascular diseases.

Here are the essentials of what these AHA/ACC guidelines do:

There’s more, but those are the essentials.

As soon as AHA/ACC announced the guidelines, the fur began to fly. Many of the most eminent cardiologists in the country registered vigorous exceptions. One in particular, Dr Paul Ridker, of the Harvard Medical School, examined the algorithm used to calculate the CV event risk, and came to the conclusion that it tended to overestimate risks by a very large percentage, from about 75% to 150%. This would mean that some people would erroneously be placed in the category deemed to need statins when they probably did not need statins at all.

Another critic is Dr Steven Nissen, of the Cleveland Clinic. Dr Nissen did a couple of calculations in men who would be considered healthy by any usual standard – normal blood pressure, normal total cholesterol and HDL-cholesterol, not diabetics or smokers – and the algorithm in both cases (one African American, one white, both age 60) put their risk factors as 7.5%, therefore recommending statins for both men.

A specific criticism leveled at the risk calculator is that it is excessively quantitative – for example, it gives equal weight to a 30 point difference in systolic blood pressure, whether it’s between 100 and 130 mm Hg or 150 and 180 mm Hg. The risk calculator just factors in the number and spits out the answer.

And how about not monitoring cholesterol once the patient is started on the statin? Is the patient supposed to take it on blind faith that the statin is good for him or her? The AHA/ACC folks essentially say “yes – don’t just go by the numbers” (having put the patient on the statin by the numbers in the first place.) But if you’re the patient, what do you go by? In the opinion of many top cardiologists, this would result in low patient compliance, i.e., patients would just not take their pills. And, cardiologists will realize that and not follow the guidelines.

By the way, as these guidelines were being developed, the National Heart, Lung, and Blood Institute – the body that includes the National Cholesterol Education Program (NCEP) – took itself out of the picture. That should tell us something! NCEP has in the past issued treatment guidelines including guideline for statin therapy, and these guidelines have included risk assessment algorithms, i.e., the Framingham Risk Calculator. But those guidelines were much, much more conservative with regard to recommending statin treatment.

What I can say about the new guidelines is that they constitute an attempt to address the entire spectrum of cardiovascular disease (CVD). That’s one thing that I strongly agree needs to be done. Let’s take a look at the whole CVD spectrum.

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Cardiovascular disease and homeostasis

Diseases, illnesses, maladies, disorders, conditions … whatever we call them, have origins that can be grouped under different headings. There are infections caused by invaders such as microbes, bacteria, viruses. There are the maladies caused by nothing more complex than wear and tear, such as osteoarthritis. There are many highly complex diseases of genetic origin. There are the conditions caused by malfunctions in our immune system, such as allergies and autoimmune disorders. Among the diseases and disorders that arise out of disregulation of our own homeostatic mechanisms, cardiovascular disease stands out.

Homeostasis encompasses all the mechanisms of the organism to keep operating in an optimal range. If you build up too much carbon dioxide in your bloodstream, sensors take notice and send a message to your lungs to take a really deep breath. If you get too hot, you sweat, and the evaporation of the perspiration from your skin cools you off very effectively. Those are only two of the multitude of homeostatic mechanisms that are constantly operating in our bodies.

So, let’s look at three homeostatic mechanisms that keep critical body functions operating on an even keel: those that maintain levels of glucose and lipids in the blood and also blood pressure itself at optimal levels. All of these mechanisms are complex and several employ highly sensitive negative feedback processes that keep the physiologic functions that they might be said to supervise within fairly narrow bounds.

It would be natural to suppose that disregulation of these homeostatic mechanisms would occur one at a time. In other words, if the regulation of glucose levels in your blood goes off the track, you tend to develop diabetes, and the effects on your health are limited to that particular disease. Unfortunately, it isn’t that easy. When any one of those three homeostatic mechanisms is not operating as it’s supposed to, the others are affected also, with the result that there is a great deal of overlap among the conditions that these mechanisms are supposed to prevent.

What are these homeostatic mechanisms and how do they work?

Blood pressure

It may help to think of our circulatory system as a kind of irrigation machine for our bodies. The heart is the pump, the blood is the fluid in the system, and the arteries and veins are the hoses that carry this fluid to where it’s needed – i.e., everywhere in our bodies. The pressure in the system depends on how much fluid the pump is pushing into the system, but also on the total quantity of fluid in the system, and on how much flexibility, or resistance, the hoses exert on the fluid. If the pump is pushing too hard, if the amount of fluid in the system is too great, or if the hoses have no flexibility, – if any of those three is happening, the result is an increase in the pressure within the system.

The pumping action of the heart and the pressure in our circulatory system is mostly controlled by the autonomic nervous system. It goes up when we’re more active, or under stress. It goes down as we relax.

The quantity of blood in our circulatory system largely depends on the salt concentration in the blood. This is being monitored constantly and exquisitely, so that if the concentration is too high, we’re thirsty and take in more water to bring it to optimal levels. Then, when the salt concentration is back to normal levels, we get rid of the excess fluid in the usual way.

All of these mechanisms are interlinked, and a number of physiologic agents play a part. One of the most important is called angiotensin II, which is converted from renin, a substance that we make in a gland near our kidneys. Angiotensin II triggers increases in blood pressure by raising cardiac output and also tightens the muscles in our circulatory system.

Cholesterol and blood lipids

Let me say it right off the bat: there’s no such thing as “bad” versus “good” cholesterol. Those are terms adopted by the simplifiers who thought that describing the reality would be beyond the great majority of the public, and what they wanted people to latch onto was those two easy adjectives, “bad” vs. “good.”

Cholesterol is a fairly simple molecule, solid at body temperature, and not soluble in water. Therefore, in order to be transported in our bloodstream, it has to hitch a ride with substances that can be carried around in blood. These are lipoproteins – little particles containing both proteins and lipids, not in any fixed chemical combination, but bundles of varying sizes. Cholesterol attaches to the lipid part of these bundles, and the protein part permits them to be transported in blood.

These particles range in size and density. The low-density, loosely packed bundles, called low-density lipoprotein cholesterol, or LDL-cholesterol, are the ones nicknamed “bad” cholesterol, because they are the ones that are apt to shed the cholesterol molecules themselves, which can attach to the walls of the arteries. But, we have to remember, the LDL-C is absolutely essential to our lives, because those particles are the ones that convey cholesterol to where it’s needed, which is pretty nearly everywhere in our bodies.

The smaller, denser bundles, called high-density lipoprotein cholesterol, or HDL-cholesterol, carries cholesterol back to the liver, where it is taken up by the bile and carried in the bile duct to the colon for excretion in the feces. Therefore, HDL-C is dubbed “good cholesterol.”

It’s worth just mentioning that only about 15% to 20% of the total cholesterol in our bodies enters our digestive systems as cholesterol. The rest we make ourselves. Some of the foods we eat are more easily transformed into cholesterol, such as solid fats, especially partially hydrogenated fats (transfats). But no matter what we eat or don’t eat, we’ll go on making cholesterol, because we need it.

In the case of cholesterol, the homeostatic mechanism is exactly that balance between LDL-C and HDL-C. Those two types of particles have properties beyond their role as cholesterol delivery systems. LDL-C appears to be highly susceptible to oxidative damage, and may also inhibit the synthesis of nitric oxide, which is thought to be one of the body’s natural mechanisms to combat atherosclerosis. And HDL-C has the opposite effect. Its principal lipoprotein, apo A-1, plays a part in preventing particles involved in atherosclerosis from adhering to arterial walls.

So, not only do LDL-C and HDL-C play different roles in cholesterol transport, they do the same with regard to arterial damage. We could say that the nicknames “bad” and “good” cholesterol are fully justified.

Blood glucose

Any sugar we eat, as well as starches, and parts of other foods, is converted to glucose. The more complex the food is, the more work the body has to do to convert it to glucose, but glucose is where a lot of our food intake winds up, because it’s our chief source of energy. The conversion from sugar to glucose is easy as pie and happens very, very quickly. When we eat that piece of pie, a lot of the sugar in it goes into our bloodstream as glucose in minutes. When we drink soda pop, it’s even faster.

But that glucose by itself is useless to our bodies. It has to be metabolized to be converted to energy, and this metabolism can’t take place unless there is insulin present in our system to activate insulin receptors in our cells and trigger the metabolic process.

Insulin is produced in beta cells in the pancreas, partly in response to the presence of food in our stomachs, but also at a fairly constant background rate. The insulin response is the homeostatic mechanism that keeps blood glucose within optimal levels – enough for an energy reserve, but not so much that it can harm our bodies.

And glucose in our bloodstream can indeed harm our bodies, mostly by damaging our smaller blood vessels. Excess glucose in the bloodstream, as in diabetes, is a major cause of organ failure, especially kidney failure, of damage to the retina sometimes causing blindness and also of gangrenous infections leading to amputation.

The progression of diabetes is gradual and, unfortunately, insidious. The disease might be oversimplified as exhaustion of the entire glucose metabolism process. As a person consumes foods that contain or can be converted to glucose, the pancreatic beta cells respond by producing insulin. But the glucose in the circulation can overwhelm the capacity of the system. Insulin receptors throughout the body don’t respond the way they’re supposed to – they are, in effect, worn out. The person develops a condition termed insulin resistance and then hyperinsulinemia – too much insulin in the circulation, which in itself can have bad consequences. In the meantime, glucose levels keep rising.

The reason I said the disease is insidious is that most people who are going through these stages have no idea what’s going on. They mostly feel just fine. In fact, many people who have passed the line defining frank type 2 diabetes – a fasting plasma glucose level of at least 126 milligrams per deciliter – aren’t aware of symptoms severe enough to seek treatment. Thus, although about 14 million adults in the US have received a diagnosis of diabetes, it’s thought that about 6 million more have diabetes but are undiagnosed.

Clustering of risk factors associated with cardiovascular disease

A rational assumption would be that risk factors for cardiovascular disease (CVD) would be additive – that is, that having two risk factors would double one’s risk, having three would triple it, and so forth. Unfortunately, the increased risk is more than additive. And, on top of that, the evidence is fairly strong that these risk factors don’t come along singly. If you have one, you’re more than likely to have at least two, and quite possibly three or four. Here’s some statistics, gathered by the Framingham Study, which has been tracking CVD statistics on several hundred thousand subjects for more than three decades. The risk factors tracked by the Framingham investigators are hypertension (HTN), high levels of triglycerides or LDL-cholesterol, low levels of HDL-cholesterol, impaired glucose tolerance, hyperinsulinemia, obesity, and left ventricular hypertrophy. For persons with HTN, here are the percentages of persons with additional risk factors:

Men Women
No additional risk factors 19% 17%
One additional risk factor 26% 27%
Two additional risk factors 25% 24%
Three additional risk factors 22% 20%
Four or more additional risk factors 8% 12%

So the majority of both men and women with HTN have at least two additional risk factors for CVD, and fewer than 20% have HTN with no additional risk factors.

When we look at the combination of HTN and elevated cholesterol, what we find is that having both conditions increases mortality from coronary heart disease exponentially. These data come from a study called MRFIT, which followed more than 300,000 white men for 12 years. The blood pressure and total cholesterol values for these subjects were divided into quintiles, and the mortality risk was assessed.

As we might suppose, when the mortality risks for HTN and elevated cholesterol alone were calculated, persons in the higher quintiles had higher risks. But in the unfortunate group that was in the highest quintile for both HTN and elevated cholesterol, the mortality risk was 11 times higher – 33.7 per 10,000 patient-years –than in the lucky persons in the lowest quintiles, whose mortality risk was about 3.1 per 10,000 patient years.

Let’s look at diabetes as a risk factor for heart disease and stroke. These data are from the Centers for Disease Control, and they echo the evidence cited above. Persons with diabetes are 3.2 times more likely to have coronary heart disease, 2.9 times more likely to have a stroke, and 1.9 times more likely to experience another type of heart condition. About two-thirds of persons with diabetes die of heart disease or stroke.

Why do we need cut points for defining disease?

Cut points for defining disease are attempts to guide clinicians in the important decision-making process regarding when to initiate treatment.

A major reason why guidelines are out there is to publicize the need for treatment. And why does the need for treatment need to be publicized? Because, in contrast with diseases/conditions/disorders that produce symptoms, most people with hypertension, dyslipidemia, or diabetes experience no symptoms until the disease has progressed to the point of causing real, irreversible damage. Or, sometimes, death.

So, there have to be guidelines, and the public has to be made aware of them. The underlying question is, how closely should they be followed?

Returning to the AHA/ACC guidelines, they seem to me to have one major virtue: they call attention to the clustering of cardiovascular risk factors – not just total cholesterol or LDL-C levels, but the whole spectrum of risk factors, including smoking, nutrition, obesity, gender, age, and race. It’s good for all of us to know this.

But it’s not good for a treatment plan to be calculated by a one-size-fits-all algorithm. An algorithm, or a set of guidelines, should not be a substitute for the clinical acumen, experience, and judgment of a physician who has closely examined and interacted with a patient.

So, what’s to be done?

I suggest that all this brouhaha about the AHA/ACC guidelines may turn out to be a good thing – not that the guidelines themselves are a good thing, but that the discussion may bring more attention to the clustering of risk factors. In other words, individual patients with any of those risk factors may become more aware of the total risks that they run.

That certainly doesn’t mean that doctors should go along with the one-size-fits-all AHA/ACC guidelines, or that great numbers of people should demand prescriptions for statins based on the publicity. Many people clearly have benefited from taking statins; the evidence is the large decrease in the rate of cardiovascular events. A huge decrease in cardiovascular mortality happened in the years from 1963 to 1999, largely due to better treatment for high blood pressure and also to people taking prophylactic aspirin for stroke prevention. And there has been a continuation of this decrease since the introduction of statins in the mid 1990s, so statins are clearly good for lots of people. But that doesn’t mean they’re good for all the people that would be swept under the AHA/ACC guidelines.

A risk factor that I suspect the new AHA/ACC algorithm overweighs is age. (This was also true of the Framingham risk calculator.) Thus, even if you have no other risk factors at all, age by itself could put you over that 7.5% cut point and recommend you for statin treatment.

Doc Gumshoe doesn’t buy that.

* * * * * * *

Many thanks for all your comments. I’ll try to save up questions and answer them in a future piece. Right now, I’m trying to collect some more cheerful tidbits so I can send along some good news before the holidays. Best to all, Michael Jorrin (aka Doc Gumshoe)


Endnotes:
  1. You can see all of Michael’s previous commentaries here.: http://stockgumshoe.com/author/mjorrin/

Source URL: https://www.stockgumshoe.com/2013/12/the-statin-guidelines-looking-at-the-whole-cardiovascular-spectrum/


    • karma swim swami
      karma swim swami
      Dec 17 2013, 04:56:27 pm

      Leo S, I agree with Dave. You have decided that doctors and prescriptions are bad. The problem Leo is that we do not see the world as it is. We see it as we are. Regardless of what you see, you will construe it as supporting your beliefs. There’s now data that the vitaminmongers and supplement takers may die younger. All cause mortality is clearly far higher in users of that erstwhile panacea, vitamin E. 2013 was the year that fish oil died completely as regards vascular benefits. I really don’t think most doctors believe in belief. We go where the data leads us.

  1. 1251 |
    Avatar
    Franklin White
    Dec 17 2013, 06:05:07 pm

    karma swim swami, there have been 2 examples listed as comments on this board above.
    If your profession and that of the pharmaceutical industry is so great at “following the
    data”, why do the side effects associated with prescription drugs “sound” worse than
    the disease you are trying to cure?
    Frank

  2. Avatar
    Leo S
    Dec 17 2013, 07:31:26 pm

    Wow! Karma, talk about bias. You even know what I believe. Wrong. I take antibiotics only when absolutely needed and preferably after a culture.
    What I believe and apparently you have a hard time with is any industry is populated with all types of people. Some corporate heads are interested in the greater good and advancement of mankind, and some have only dollar signs in their eyes. Wake up and have a healthy questioning perspective. The CDC gets millions of dollars from big pharma and takes marching orders from the IDSA. The IDSA has or has had many former insurance executives on their board. Some of these conflicts need to be straightened out.

  3. Avatar
    Leo S
    Dec 17 2013, 07:37:48 pm

    Karma, can we all say, “Let’s make a good thing better.” We can start with the doctors who write prescriptions for colds 60% of the time even though its only strep 10% of the time. Regards. Leo S

  4. Avatar
    Marian Mundy
    Dec 17 2013, 10:28:20 pm

    You rightly call for “data” in regard to statin drugs. I don’t have reams of data, just personal experience. My husband was prescribed a statin (Zocor) and let me tell you he had such a bad reaction he nearly died. We were terrified. I’ve been told, well, all drugs have side effects. Yes, but they’re not supposed to kill you, are they?

    • 416 |
      Myron Martin, Special to Stock Gumshoe
      Myron Martin, Special to Stock Gumshoe
      Dec 19 2013, 12:11:38 am

      Unfortunately Marian your personal experience will simply be dismissed as anecdotal, which does not count with the medical fraternity. Only double blind studies, (manipulated as they may be) are considered reliable. Unfortunately no statistics are available as to how many people experience similar reactions such as your observed, because to document and report them could scare people away from taking these drugs thus reducing profits.

      It is true that ALL drugs have side effects, some worse than others and some whose side effects are not documented for many years, but only a small percentage of drugs make it past 10 years before they are pulled from the market, frequently because of serious side effects while the cover is newer and better drugs have replaced them, (of course the long term side effects of the newer drugs are not yet known. I hope you were terrified enough to take an open minded look at natural solutions that are completely safe and actually more effective than these dangerous drugs. Now that your eyes have been opened to how dangerous drugs can be, pay attention to the mandated side effects that must be reported in any advertisements on television, radio or print media. Saw another one to day which unfortunately I did not jot down, but must be at least the 6th I have seen in the past month where severe liver and kidney damage (the bodies primary filters) was mentioned along with DEATH as a possible side effect. People must be either ignorant of any alternative, or scared into compliance by doctors if they would even consider taking something into their bodies with such potential deadly side effects.

      Yes indeed, “food should be your medicine and medicines should be food” i.e. plants that offer natural ingredients the body can use to build healthy cells and tissues. Europe and the Chinese are leaders in having focussed their research on the benefits of natural plant based medicines instead of the deadly concoctions of western medicine.

  5. Avatar
    Deborah
    Dec 18 2013, 11:52:55 am

    Ahhh, this is such a complicated subject with no one right answer. Let me start by quoting Hippocrates
    Life is short, [the] art long, opportunity fleeting, experiment dangerous, judgment difficult.” also, “Let food be thy medicine and medicine be thy food”
    ― Hippocrates
    According to some studies, Education levels are an accurate predictor of health and longevity in Americans.
    I have many friends that take no responsibility for their health choices. Whatever their health care provider suggests, they follow along like sheep. However we choose to manage our health care choices, I think that it requires us to have inquiring minds and to take responsibility for not only life style choices, but health care choices.

    If I break a bone or have influenza, my first choice would be to see a doctor. My husband is an ER nurse and I appreciate and admire the skill, intelligence and heart of the folks who work in that environment.
    I do believe that doctors, working for Medical Services organizations, no longer have full control of their practice. There is a tremendous amount of pressure to move their clients through the system quickly, write some scripts and move on to the next patient. I don’t know how much time the average PA or MD has to read the latest studies and to update their own personal knowledge base. There’s an enormous amount of information to be digested.

    I really like the PA I see once a year. But I do want to research and do my own due diligence when it comes to taking any drugs she might suggest. It’s too important a subject to follow blindly along and give up my personal responsibility!
    From the FDA website regarding Adverse Drug Effects:
    Over 2 MILLION serious ADRs yearly
    100,000 DEATHS yearly
    ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths
    Ambulatory patients ADR rate—unknown
    Nursing home patients ADR rate— 350,000 yearly
    Over 2 MILLION serious ADRs yearly
    Since the absolute worst case scenario(with extremely few exceptions) is they do no good, they also probably do no harm, I’m comfortable in continuing. Wish that could be said for the drug industry, although without a doubt there are benefits to be gained there too, depending on the issue. However, I do want to avoid having to take any drugs when there might be a more natural alternative without side effects.

    At 61, I take no prescription drugs, but I do take supplements and I try to eat healthy, avoid all processed foods and keep my body moving.
    It’s such a personal choice, that I could never judge an individual for whatever decisions they make.
    I do appreciate the discussion. It’s fascinating to hear people’s opinons! Thank you all.

  6. Avatar
    Helen H
    Dec 28 2013, 04:23:55 pm

    I will be cancelling my subscription to Stock Gumshoe. I feel that this has been a largely irrelevant and pseudoscientific discussion in which those advocating for data, for sound decisions based on randomized clinical trials, and not quack pseudoscience, are being ridiculed. Myron Martin, your comments are unprofessional, leering, unctuous and ingratiating, and you seem to use this as an abusive stomping ground for your crackpot ideas, which you circulate under the imprimatur of “Special to Stock Gumshoe.” Shame on Travis Johnson for having an oleaginous lout like you on his team. Reason and logic do not come from you, and I do not trust a newsletter that would let a hooligan like you run wild on it. Your ideas are unschooled nonsense, and you are a rotten writer.

    • Michael Jorrin (aka Doc Gumshoe)
      Michael Jorrin (aka Doc Gumshoe)
      Jan 2 2014, 11:01:58 am

      I deeply regret that my Doc Gumshoe postings have become a forum for a war between “establishment” and “alternative” health practices, and that the disagreement has descended to the level of blistering personal attacks. The underlying premise that there is a conspiracy involving physicians, pharmaceutical companies, and Federal regulators, whose objective it is to supress information about healthful natural healing practices while promoting harmful drugs, all in the service of profits, is delusional. I would point out that the FDA and Big Pharma are frequently highly adversarial, and that the diversity of opinion among physicians is immense. I would also point out that there is ample evidence of harms resulting from so-called natural or alternative health practices, and that the alternative sector has so-far successfully resisted the kind of regulation to which pharmaceuticals are subjected, with sometimes clearly adverse effects. My apologies to anyone who has been personally attacked in these exchanges.

      • karma swim swami
        karma swim swami
        Jan 2 2014, 12:53:32 pm

        Michael: I appreciate you, as a member of the Stock Gumshoe editorial staff, posting this. I certainly will not stoop to the debased level of a delusional meme-intoxicated stooge like Myron Martin to reply to him.

        What troubles me above all other considerations is that, writing under the banner of Stock Gumshoe, turned his postings into a personal bully pulpit and forum for ad hominem attacks. I would have expected far better from this newsletter. I believe that the newsletter has enormous editorial responsibility to see that things its staff posts are legitimate, sound, and not misleading. Martin has gone so far as to use his posts to tout an execrable book by Suzanne Somers. Martin has the usual tropes of the supplement-deluded: he tosses about words such as “natural” and “balance.” He claims to be an autodidact, which means he is under the spell of uncritical, unscientific books. Autodidact is a euphemism for lacking or shunning formal education, and the idiocies and errors in his writing confirm this. All-cause mortality is much higher with vitamin E supplementation, and as the SELECT trial showed, vitamin E raises prostate cancer risk. Martin alleges irresponsibly that this is because it is “synthetic” vitamin E “made in a laboratory,” not “natural.” This is astoundingly defective reasoning, as the structures in question are the same, and molecular mechanisms by which vitamin E may be causing harm are well known (it inanely promotes telomerase activity, which extends telomeres, which allows DNA damage and aneuploidy to set in. Telomeres exist to protect cells, and extending them is fatuous and dangerous.) He may refer to a paper or two, disingenuously, without noting the full spectrum of studies. He will appeal to authority now and again by claiming some or another vitamin advocate who seems respectable, eschewing the hundreds of other respectable and credible people who disdain vitamin nonsense. Yes, Myron, it is that Western diet…a diet so deadly that Western longevity is at an all time high and rising. My suspicion runs deep that Martin takes these positions because in some way he has a vested interest in them, that he is a seller for some outfit such as Herbalife, Shaklee, or Life Extension. He would lack the character to disclose these conflicts of interest.

        I know five people who have told me they will no longer read this newsletter because it cannot be a credible publication if it allows the ravings and screeds of Myron Martin to run with a tagline of Special to Stock Gumshoe. It appalls me that he is allowed to do this, to subvert discussion, to appeal to the basest most ignoble instincts and people, and to be unctuous and ingratiating with people who are mistaken and misguided and using supplements that at best give them expensive urine or at worst kill.

        Mr. Martin is free to have his opinions, but should absolutely not be disseminating them in the guise that he is speaking for Stock Gumshoe. Either Travis Johnson is unaware of this, and plans to fix it, or else he is aware of it, and condones it, in which case people should not be reading Stock Gumshoe.

        It is thanks to people like Myron Martin that the following publications exist:

        Schoepfer, AM; Engel, A; Fattinger, K; Marbet, UA; Criblez, D; Reichen, J; Zimmermann, A; Oneta, CM (2007). “Herbal does not mean innocuous: Ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products”. Journal of Hepatology 47 (4): 521–6

        Jóhannsson, M; Ormarsdóttir, S; Olafsson, S (2010). “Hepatotoxicity associated with the use of Herbalife”. Laeknabladid 96 (3): 167–72.

        Stickel, F; Droz, S; Patsenker, E; Bögli-Stuber, K; Aebi, B; Leib, SL (2009). “Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis”. Journal of Hepatology 50 (1): 111–7.

        Elinav, E; Pinsker, G; Safadi, R; Pappo, O; Bromberg, M; Anis, E; Keinan-Boker, L; Broide, E et al. (2007). “Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity”. Journal of Hepatology 47 (4): 514–20.

        Manso, Gloria; López-Rivas, Laureano; Duque, José María; Salgueiro, Esther (2008). “Spanish reports of hepatotoxicity associated with Herbalife® products”. Journal of Hepatology 49 (2): 289–90.

        Toxic hepatitis by consumption Herbalife products a case report]”. Acta Gastroenterol. Latinoam. 38 (4): 274–7. December 2008

        As a hepatologist, it is my organ that these decoctions trash, and the nonsense, the delusion, the anti-intellectualism, and the conspiracy-theorizing need to STOP. It is up to those who publish this newsletter to not be condoning and enabling of deception. Maybe I will be back, and maybe I won’t. I resent the personal attacks, but then when I consider their source, I am genuinely delighted that another vitaminmongering altie is showing his true colors, true intentions, and true vacuousness.

        • 416 |
          Myron Martin, Special to Stock Gumshoe
          Myron Martin, Special to Stock Gumshoe
          Jan 2 2014, 07:06:56 pm

          Well Mr. Swami, whoever you are, let me set the record straight, I do not speak for Stock Gumshoe in an editorial sense. on any matters not related to my investment column, and I am not staff. The tag line “Special to Stock Gumshoe” was attached to my name when I became a junior mining columnist, long before this brouhaha erupted over vaccination. Apparently it comes up automatically when ever I post, and maybe Travis will choose to fix that (I agree he should to resolve your “above all considerations” complaint) , that way in any postings on other matters it will restore my independence to express my opinions, to which you say I am entitled like anyone else, as indeed I am. It is unfortunate that things have descended to name calling, however I see that you are still at it, “”delusional meme-intoxicated stooge” adding to the pile of insults you have heaped on me, mostly to the exclusion of people of similar views posting factual material you choose to ignore.

          You have the audacity from your “holier than thou, intellectually superior posture” to pontificate that I am posting “idiocies and errors” – – “ravings and screeds” and using this forum as a “personal bully pulpit and forum for ad hominem attacks” and exactly what are you doing? I quote: “He would lack the character to disclose these conflicts of interest” and you think you don’t have a conflict of interest being a medical doctor defending the profession against publicly available statistics as posted by Deborah 57 for which you obviously had no answers, at least no comment, condemning yourself based on your comment about me: “He may refer to a paper or two, disingenuously, without noting the full spectrum of studies” really, and where is your posting of a study comparing synthetic DL isolated tocopherol Vit. E. with Wheat Germ derived full spectrum Vit. E from which you could claim there “is no difference”! if I am wrong? If you are as thorough as you claim to be, and have no bias, you must surely know they exist?’ As posted by Deborah 57: (unknown to me) as are all other posters that have been at least partially supportive of my views.
          “From the FDA website regarding Adverse Drug Effects:
          Over 2 MILLION serious ADRs yearly
          100,000 DEATHS yearly
          ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths
          Ambulatory patients ADR rate—unknown
          Nursing home patients ADR rate— 350,000 yearly
          Over 2 MILLION serious ADRs yearly”

          I have not read the report on Herbalife, (and NO I have never been a distributor, or Shaklee either for that matter), though I used a few products briefly but stopped because I discovered they were using synthetic Vit. E which is much cheaper and not as effective, so I concluded they were not as dedicated to the health of their customers as they were to the bottom line, not that that is that unusual. YES, there are studies that prove there is a great difference in absorption and efficacy between the natural Vit. E being a complex of 8 “tocopherols” as they occur naturally in food and the synthetically synthesized dL tocopherol indicating levo rotary as opposed to dextro rotary, so there is a difference. Either SWAMI is ignorant of the difference or chooses to ignore it because the average consumer, (and medical doctors for that matter) are not aware of the difference, or choose to ignore it to hide their bias. As far as disclosure is concerned, my father and I were pioneers in the organic farming movement begun by Rodale et al and others in the 50’s and as a result I have direct experience with cattle nutrition and disease as a lack of it, in fact I could write a book on it. I was also a wholesaler to the Health Food Store trade for at least 5 years in the 70’s plus about the same for a book wholesaler and publisher of a Canadian health magazine called ALIVE, still publishing today, so how that disclosure helps anyone decide if I know what I am talking about I am not sure. While I will not deny that there are companies in the health food industry that are just as unscrupulous as pharmaceutical companies, I would bet my last dollar that if toxic results from Herbalife products approached even 10% of cases of the medical professions ADR’s they would have been history long ago. And let it be noted that as posted by the Swami, the harm came not from the herbs themselves, as implied, but as in may cases, as quoted by “STICKEL” ingredients were “contaminated with Bacillus subtilis” as are many food products with that and other pathogens. There is very obviously a “double standard” (and maybe attempt to deceive) by subterfuge implying herbs and/or Herbalife are bad, when unfortunately an ingredient became contaminated. This obvious “double standard” given the many bad vaccines and drugs far exceeds any of “the nonsense, the delusion, the anti-intellectualism” alleged by the SWAMI.
          I don’t know what this audience thinks of Suzanne Somers the actress, but I feel very confident most know who she is and having had cancer herself and going through the “establishment” doctor process and then having the intellectual curiosity to dig into all the available literature, and once having studied BOTH SIDES writing a book about her experiences, the good Doc hides behind a word that I bet is not in the vocabulary of most readers. I admit I had to look “execrable” up. The dictionary says it means damnable, detestable, abominable, horrifying, (crimes) very bad, wretched, so now you know what the good unbiased Doc thinks of a book he may not even have read, but rejects just by reputation among the medical profession. You can either take that judgement at face value or if you have someone in your circle of friends who has cancer, or has it themselves, you might want to read it and make their own judgement on whether it should be banned.
          So based on the Swami’s reasonings of responsibilities here; “things its staff posts are legitimate, sound, and not misleading” is he suggesting Travis Johnson should vet every posters opinion, including what Michael/Doc Gumshoe writes in his column? That would be quite a formidable task, and even then you would have to decide whose “opinion” to give the most credence, which is what I thought this whole forum was all about. As Michael notes: “the diversity of opinion among physicians is immense” but it seems to me that the SWAMI is not open to that truth, I feel certain I could name at least a dozen medical professionals whose views he would dismiss out of hand. It is not me that is “subverting discussion” and as for nonsensical statements, this takes the cake; “respectable and credible people who disdain vitamin nonsense”. VITAMIN NONSENSE the position of “creditable people” give me a break, vitamins are “essential to life” otherwise why not just eat sawdust, I am sure the chemical engineers could make a palatable and very cheap food, and the way we are going, maybe that is where we are headed, laboratory synthesized so we don’t have to go to the trouble of growing healthy fruits and vegetables, and those deadly herbs people have been using successfully for thousands of years.

          Now what do the rest of you think about this charge?
          Did you know that if you disagree with some medical practices and are deluded into choosing some other path to healing you are being among the most “basest of people” and I should not be allowed to mention the benefits of food supplements, of which I have a considerable and long life knowledge! Quote; appeal to the basest most ignoble instincts and people, and to be unctuous and ingratiating with people who are mistaken and misguided and using supplements” so if you use any supplements you are “mistaken and misguided” which is fine as an “opinion” but rather short sighted and arbitrary and the “BIAS” stands out like a sore thumb. Do those of you like me who have and are taking supplements like being called the “basest of people” I am not the villan here, millions of people around the world have maintained their health and cured themselves of diseases without the help (?) of the medical profession, they need to compete with competitors based on RESULTS like any other business would.
          I would suggest that anyone who suggests the Standard American Diet (SAD) is responsible for Western improved longevity, (“Western diet…a diet so deadly that Western longevity is at an all time high and rising” is taking a pretty jaundiced view of things. The fact that the average life span has increased is not nearly as important in the scheme of things as the quality of life that people experience, and I hardly thing people going through transplants of failed lungs, livers, kidneys, hearts, what have you, would think that is the most desirable way to experience life. Of course the medically inclined will see transplants as a big break-through, but I see it as a gigantic defeat that they should even be necessary. Progress would be PREVENTING the myriad of lifestyle diseases that are inflicting obesity and preventable diseases on people who are simply nutritionally ignorant and making bad food choices? The medical profession may indeed be able to keep people alive longer, but at what cost? Can we with our socialized medicine afford to pay $10,000 (or more) per dose of some exotic drug, or $25,000 to $100,000 for a transplant to keep people alive a few more months, just because it is now possible does not make it desirable or affordable.
          I have stated for years, and so far see no facts that would change my viewpoint, that if we continue on the path we are on in terms of healthcare, it will eventually bankrupt the country. Obamacare may just prove me right. I had some idea of what “vacuousness” means, but just to be sure I looked it up in the dictionary and basically what the Swami is calling me is “empty headed” now be honest, have I ever been that nasty with someone else’s comments? As far as 5 people deciding to stop reading Gumshoe, it says more about them than it does about me and a quick guess without actually counting them up, there are probably more people at least partially agreeing with me than support the SWAMI’s extreme position that anybody daring to question medical orthodoxy is apparently “empty headed” ! In case of broken bones, accidents etc. I am glad trained professionals are available to help, but when it comes to actual disease conditions, I would rather put my faith in people whose training is focussed on working with bodies natural defences and immune system rather than trying to outwit the bodies natural processes with alien substances the body can not use to build healthy cells and tissues.

          • Avatar
            helen h
            Jan 2 2014, 07:15:38 pm

            The more you open your ranting mouth Myron, the more you confirm and corroborate exactly what KSS is saying about you.

            “Blow winds! Rage, blow! Strike flat the thick rotundity of the world!” (King Lear)

  7. Avatar
    Leo S
    Dec 28 2013, 09:09:57 pm

    Helen, such a temper!!! Relax, this is a discussion, not a place to vent if you don’t persuade someone. BTW, that was a pretty “rotten” paragraph you wrote, even though you obviously passed English with flying colors. C’mon Man!!! I mean Lady!!! Regards.

  8. Avatar
    Leo S
    Jan 2 2014, 02:21:11 pm

    C’mon everyone! We are all subject to the human condition. Good and bad, biased and unbiased. Can’t we have a little fun listening to other peoples biases. Sure Swami has science on his side but it is not perfect and people do sometimes abuse data to their advantage, especially financially. Discussion is all good if you are willing to dissect it. Don’t quit just because everyone does not agree with you. You just may win them over. I know I have changed some of my thinking since reading all the responses. Cheers and happy new year.

  9. Avatar
    Rusty Brown in Canada
    Jan 2 2014, 03:28:38 pm

    I am enjoying all the high-energy discussion on this forum, notwithstanding the occasional vituperation on both sides.
    I must admit I see much merit in Myron’s side of the argument. I have had personal – and, yes, anecdotal – experience with vitamin C, for example. I started taking it for my cardio-vascular situation, and my varicose veins disappeared! I was amazed, and looked up “vitamin C collagen veins” and found out why. Vitamin C makes collagen which strengthens your veins, arteries and skin. I won’t elaborate here. Check it out for yourself.
    Same with B-complex. I got hit with shingles real bad at age 52. Doc was no help and after a month of suffering I read that B-vitamins sometimes help, and in my case they sure did. Turns out they are an important part of your immune system, and when they get depleted by stress and fatigue, too much red wine to self-medicate the stress, and inadequate diet (I was gradually moving from one apartment to another) the virus can emerge, reproduce like crazy and have a field day. Which it did.
    Please don’t be too quick to judge those of us who have discovered the benefits of supplements and nutrition as a viable alternative to Big Pharma’s expensive concoctions and the Dr’s narrow approach to health matters.
    . . . . . . . . . . .
    “Every truth passes through three stages before it is recognized:
    In the first it is ridiculed, in the second it is opposed, in the third it is regarded as self-evident”
    Arthur Schopenhauer
    (1788 – 1860)

  10. 1251 |
    Avatar
    Franklin White
    Jan 2 2014, 07:50:54 pm

    Folks, I’ve been taking supplements for over 20 years and they have helped me considerably, especially with knee pain. I have been able to avoid statins for years even
    though my doctor has prescribed them for me, due to the ADR’s. Helen, quoting Shakespeare isn’t going to cut any ice on either side of this argument. KSS, just because
    someone disagrees with the “hallowed” medical profession and big pharma doesn’t make
    them wrong, it just means they don’t agree with you. It seems to me that Myron has tried
    to represent a pragmatic approach to this whole discussion and someone heaping a
    vitriolic barrage upon him does nothing to convince us he’s not right.
    Can we please forget about trying to impress people with our vocabulary (medical or
    otherwise) and get back to the intent of this site, i.e., financial investments!
    Frank

  11. Avatar
    Sharon R
    Jan 2 2014, 10:37:28 pm

    This thread apparently caused a lot of heatburn, but I found it very enlightening. On matters of prescription drugs vs. OTC pills and supplements I start with the assumption that neither industry has my best interests at heart. Thus, it’s up to me to try to overcome their clever propaganda and do such anaysis as I can. Since I’m an over-indulgent foodie, it’s obvious that the sensible thing to do would be to adopt a healthy lifestyle involving sensible portions of healthy, natural foods, as Myron passionately espouses. However, my doctor realizes that just isn’t going to happen, so naturally he prescribes pills to try to overcome the more obvious problems stemming from overeating and poor food choices. Debates such as this one are useful in helping us analyze exactly what choices we are willing to make. For example, diuretics are annoying, but they seem like a sensible choice for me to reduce high blood pressure. Allapurinol works to counteract gout attacks for most people who are subject to gout, and I’ve seen no side effects. But, I’ve avoided statins, and certainly the puffed-up medical establishment’s new statin guidelines are anything but persuasive to me. I’ve enjoyed reading science history since elementary school, and the one clear take-away was the observation that the scientific establishment just got it wrong so many times and in such a belligerant manner. It’s best to approach these matters with a healthy scepticism, just as we approach the investment establishment with scepticism.

  12. 347
    Avatar
    gummydave
    Jan 2 2014, 11:27:42 pm

    I love the Gumshoe reviews and I’ve found Myron’s insight into mining stocks to be extremely informative. I’m sure Myron’s passion helps him be so effective in analyzing a company, but this is Stockgumshoe so I really don’t want Myron or anyone else giving me health advice here.
    It’s sad that some subscribers are so annoyed they’re planning to leave. Perhaps this sort of discussion could be moved to a separate area of the website to keep it away from the rest of us!

  13. 416 |
    Myron Martin, Special to Stock Gumshoe
    Myron Martin, Special to Stock Gumshoe
    Jan 2 2014, 11:51:23 pm

    Well Rusty, I would guess the “Limies” would agree with you on Vitamin C, and yes many conditions disappear when nutritional deficiencies are satisfied, whether with fresh fruits and vegetables or appropriate supplements to meet the need. That the vast majority of people on the (SAD) diet of the average consumer has vitamin deficiencies has been well established by many studies, and all the “huffing, puffing and posturing” by some elements of the radical medical profession will not change that fact. We would probably make far more progress in establishing a healthier population if we spent even a fraction of the money now devoted to research to develop ever more dangerous drugs and antibiotics to replace those to which germs and viruses have adapted and become resistance if we simply spent it on education on cause and effect that would get people to adopt healthier lifestyles. Looking for that illusive “magic pill” that will cure diseases that are virtually 100% preventable is an exercise in futility and a financial millstone around our necks.

  14. karma swim swami
    karma swim swami
    Jan 3 2014, 12:31:18 pm

    Hi Richard. Thanks for asking. Red yest rice contains monacolin K, which is identical to lovastatin, an older HMGCoA reductase inhibitor that was marketed as Mevacor. So, yes, it will lower lipids, but does so by a statin mechanism. Because it contains lovastatin, the FDA has at various times tried to regulate its sale. It can definitely be beneficial,

    As to statin therapy, I will reiterate a point I made earlier. There is primary therapy and there is secondary therapy. The former is preventing the first MI or CVA. It remains a field in flux, and we will see revisions in guidelines. But the former, preventing a second vascular event after you’ve had a first, is a different matter altogether. The data that statins are beneficial and save lives is overwhelming in secondary prevention. No one, doctors included, is saying statins don’t have side effects. They do. IT’s just that their benefits mostly outweigh the risks. Too many people focus on the numerator….the number of people who have had a complication, and ignore the denominator, the masses who have benefitted. Statins can rarely kill, by causing rhabdomyolysis and consequent renal failure. This is why one starts with low doses and advances gradually. The idea that statins cause liver damage is utterly false. They may raise ALT and AST, which are enzymes made in liver, but statins do this because of their effects on muscle, which are also rich physiologic sources of ALT and AST. Biopsy-proven histologic damage to liver from statins just doesn’t happen.

    I think it is fairly clear that statins do deplete coenzyme Q and that use of that in sustained statin therapy is reasonable. It is important to note that this agent does have some downsides, insomnia being an important one. I think it is important to not have unrealistic expectations of what coenzyme Q administration can do, however. Without getting too gratuitously complex, coQ is a cofactor for electron transport enzymes in mitochondria. I am not sure that supplementation with it necessarily helps vascular disease patients. Where coQ administration really shines is in the mitochondrial cytopathies such as MELAS syndrome, Leigh syndrome, Friedrich ataxia, and hereditary spastic paraparesis. Here coQ, by salvaging mitochondrial respiratory activity, can abrogate disease progression.

  15. karma swim swami
    karma swim swami
    Jan 3 2014, 05:11:23 pm

    Two good studies examining effects of coenzyme Q 10 supplementation on quality of life in patients without mitochondrial cytopathies. As you can see, the effects are at best mild, and perhaps non-existent:
    http://www.ncbi.nlm.nih.gov/pubmed/21370966
    http://www.ncbi.nlm.nih.gov/pubmed/19096110

    CoQ does augment VO2max in mitochondrial cytopathy patients:
    http://www.ncbi.nlm.nih.gov/pubmed/21370966

    I have reviewed approximately 50 studies looking at effects of CoQ10 on lipids, blood flow, endothelial function, blood pressure, inflammation, fatigue, glycohemoglobin and lipid peroxidation. While some studies show mild benefit, the preponderance of studies show no benefit on parameters.

  16. karma swim swami
    karma swim swami
    Jan 3 2014, 08:18:05 pm

    The alternative/supplement/natural crowd is aggressively pushing arginine these days as a panacea for vascular issues. It does absolutely nothing.

    Arginine does not improve muscle performance:
    http://1.usa.gov/1gpPXvC

    Arginine is of no benefit in peripheral artery disease: Study
    http://1.usa.gov/1lBUUSx

    Oral arginine does not improve blood pressure: Study
    http://1.usa.gov/KlYNPQ

    Arginine does not improve athletic performance: Study
    http://1.usa.gov/1lBVNKI

    Arginine does not improve exercise hemodynamics: Study
    http://1.usa.gov/1gpQFcs

  17. Avatar
    Leo S
    Feb 7 2014, 11:38:24 am

    Heeelp!!! After changing my irregular profile page back to my original handle I can no longer access Stockgumshoe. In desperation I have sifted thru 30 or 40 old postings to re-establish contact with Gumshoe on this thread. I cannot log in. It is BTW unclear how to get to the log-in page. Please help.

  18. 416 |
    Myron Martin, Junior Mining Columnist
    Myron Martin, Junior Mining Columnist
    Feb 9 2014, 05:59:08 pm

    Have been too busy to keep up with the dialogue but when I run across articles in my daily research like this that is a report from the American Medical Assoc. itself I feel compelled to weigh in regardless of the abuse I get from the medical establishment.

    http://articles.mercola.com/sites/articles/archive/2008/09/27/fda-announces-20-dangerous-drugs-you-should-not-be-on.aspx

    Remember the source is not Dr.Mercola himself, he is just reporting what is out in the public domain, so don’y shoot the messengers, just take heed for your own sake.

  19. Avatar
    Mark Krupka
    Feb 13 2014, 01:13:09 pm

    I have a family history of CVD, also a risk factor. With me background in microbiology and biochemical engineering I research any information that comes out in this area. My sister was a cardiac nurse practitioner. She confirmed that 50% of people who have CVD have normal cholesterol, so cholesterol is not the answer in and of itself. More and more people believe inflammation is a major factor. That is the reason they now monitor for cardio c-reactive protein, which is a mediator of inflammation. The inflammation predisposed the arterial walls for deposition of the cholesterol, not on the wall, but just beneath the surface of the arterial wall. It is when these deposits lead to a rupturing of the arterial wall that most cardiac events occur as blood clots form at the site of the damage, clogging the already narrowed artery. I agree with the gumshoe that following these guidelines would lead to many people who do not need statins taking them. I am taking a low level statin due to a risk factor not mentioned, family history. However, before I started taking the stating, I started taking policosanol, which lowered my cholesterol, both total and LDL, much more than the statin did when I started taking it. And there are no side effects to taking policosanol. Other people I know who were seeing their cholesterol rise even while on a statin, saw lower cholesterol but increases in HDL cholesterol. Not even mentioned is the recent discovery that statins may lead to Type II diabetes, further complicating ones risk factors, especially if they really don’t need the statins in the first place.

  20. 416 |
    Myron Martin, Junior Mining Columnist
    Myron Martin, Junior Mining Columnist
    May 16 2014, 04:51:10 pm

    gotta protect those profits rather than advising people to make “lifestyle changes” that would solve the problem naturally without dangerous side effects, no profit in that.

  21. 347
    Avatar
    gummydave
    May 16 2014, 07:07:44 pm

    I don’t see that Myron. If the articles are incorrect then surely it’s appropriate they’re withdrawn and investigated?
    Lifestyle changes may help some, but aren’t going to cure every illness, and when government tries to encourage healthier eating, etc., they’re accused of being a socialist nanny state.

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