How Well Do Cholesterol-Lowering Drugs Actually Work?

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One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things like mammograms and colonoscopies to prevent deaths from breast and bowel cancer, or the power of drugs like Fosamax to prevent hip fractures, or the power of cholesterol drugs to prevent fatal heart attacks. Patients believe statin drugs like Lipitor are about 100 times more effective than they actually are in preventing heart attacks. Studies show most people wouldn't take multiple blood pressure medications if they knew the truth.

For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients don't want to take drugs unless they have at least a one in five chance--even those who just had a heart attack. It's no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.

For the individual, this is unlikely to be detrimental; after all, there's a 95 percent chance it won't do anything for them. But for the population at large, it would make a difference, so doctors and drug companies oversell the benefits by conveniently not mentioning how tiny they actually are, knowing most patients wouldn't take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.

The best that cholesterol-lowering statin drugs appear to do is an absolute risk reduction of 3.1 percent over six years. If Dr. Esselstyn's work can be replicated in a randomized, controlled trial, then a whole foods plant-based diet will have been shown to work twenty times better, an absolute risk reduction of 60 percent after less than four years. In Esselstyn's study, 99.4 percent of high-risk patients that stuck with the diet avoided major cardiac events, such as death from heart attack.

When we have to decide whether we want to go diet versus drugs, we're not making a choice between eating healthy to prevent a heart attack or taking a pill to prevent a heart attack. Because in 97 percent of cases in the near-term, pills don't do anything. We're risking side effects for nothing, whereas if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet, we may even reverse the progression of the disease, as seen in my video The Actual Benefit of Diet vs. Drugs.

If we stop eating an artery-clogging diet, our bodies can start dissolving that plaque away, opening up arteries in some cases without drugs or surgery. A healthy whole food plant-based diet by itself may work 20 times better than drugs to combat our #1 killer.

Now that's something doctors may want to tell their patients.

Yes, an ounce of prevention is worth a pound of cure, but a pound isn't that heavy--why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my video Why Prevention is Worth a Ton of Cure.

Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I've previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment, Optimal Diet: Just Give it To Me Straight, Doc and Disclosing Conflicts of Interest in Medical Research. What should we be saying? See: What Diet Should Physician's Recommend?

So why don't more doctors do it? See Barriers to Heart Disease Prevention and Find Out If Your Doctor Takes Drug Company Money.

More on Dr. Esselstyn's heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course then there's just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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How Beans Help Our Bones

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Health authorities from all over the world universally recommend increasing the consumption of whole grains and legumes--beans, split peas, chickpeas, and lentils--for health promotion. But what about the phytates?

Phytate is a naturally occurring compound found in all plant seeds (like beans, grains, and nuts) that over the decades has been maligned as mineral absorption inhibitors. That's why, for example, one hears advice to roast, sprout, or soak your nuts to get rid of the phytates so we can absorb more minerals, like calcium.

The concern about phytates and bone health arose from a series of laboratory experiments performed on puppies published in 1949, which suggested that high phytate diets have a bone softening and anti-calcifying effect. Subsequent studies on rats, in which they fed them the equivalent of ten loaves of bread a day, "confirmed" phytate's status as a so-called anti-nutrient. But more recently, in the light of actual human data, phytate's image has undergone a makeover.

A recent study published in the Journal of Medicinal Food asked a simple question: Do people who avoid high phytate foods--legumes, nuts, and whole grains--have better bone mineral density? No. Those that consumed more high-phytate foods actually had stronger bones, as measured in the heel, spine and hip. The researchers conclude that dietary phytate consumption had protective effects against osteoporosis and that low phytate consumption should actually be what's considered an osteoporosis risk factor.

A follow-up study, measuring phytate levels flowing through women's bodies and following bone mass over time, found the same thing: women with the highest phytate levels had the lowest levels of bone loss in the spine and hip. Those who ate the most phytates were also estimated to have a significantly lower risk of major fracture, and a lower risk of hip fracture specifically.

This is consistent with reports that phytate can inhibit the dissolution of bone similar to anti-osteoporosis drugs like Fosamax. Phytates don't have the side effects, though, such as osteonecrosis (bone death) associated with that class of drugs. People take these drugs to protect their bones, but by doing so may also risk rotting them away (See Phytates for the Prevention of Osteoporosis).

Eating healthy can help us avoid other drugs as well. See, for example:

Beans might not just help our skeleton last longer, but the rest of us as well. See Increased Lifespan From Beans.

How might one boost mineral absorption? See New Mineral Absorption Enhancers Found.

Alkaline Diets, Animal Protein, & Calcium Loss is another surprising video on bone health.

And more on the benefits of phytates can be found in my videos:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: Asja Boros / Flickr

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