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 Grapefruit Affects Prescription Drugs

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Does grapefruit in particular help people lose weight?

If someone eats half of a grapefruit three times a day before each meal for a couple months, they may lose about two pounds -- but that's no more than if they ate three apples or pears a day. In one study, the grapefruit eaters not only saw their weight go down, but their waist got slimmer, and their body fat melted away. If, however, we repeat the experiment and instead ask people to drink a half cup of water before each meal, we get the same result. So this belief that grapefruit has some special fat-burning quality appears to be just a long-held myth.

The researchers reported that grapefruit consumers had a drop in weight, a significant drop in cholesterol, and a significant drop in blood pressure. They concluded that consumption of grapefruit daily for six weeks does not significantly decrease body weight, cholesterol, or blood pressure, though. That made me do a little double take, but again, it's because the grapefruit didn't do any better than placebo.

Other studies have found a legitimate cholesterol-lowering benefit of grapefruit, and even a little dip in triglycerides, especially eating red as opposed to white . For example, one study showed a decrease in cholesterol, but only from one life-threatening cholesterol level to another life-threatening cholesterol level. To prevent heart disease, we really have to get down to a total cholesterol of around 150, which is the average cholesterol of those eating diets composed exclusively of plant foods, not just grapefruits (See, for example, One in a Thousand: Ending the Heart Disease Epidemic).

Even though grapefruits alone don't do much, the researchers suggest that people might be more likely to stick with them than cholesterol lowering drugs, noting that most people with heart disease stop taking their statin drugs within a couple years because of the adverse side effects (see Statin Muscle Toxicity). While grapefruits alone don't have any side effects, ironically, combining grapefruits and drugs can make drug side effects even worse.

If we eat lots of fruits and vegetables, we hopefully won't need a lot of drugs (Say No to Drugs by Saying Yes to More Plants), but certain phytochemicals in plants can affect the metabolism of drugs in the body. Grapefruit is the poster child, described as a "pharmacologist's nightmare." Natural phytochemicals in grapefruit suppress the enzymes that help clear more than half of commonly prescribed drugs, and less drug clearance means higher drug levels in the body. This may actually be good if we want a better caffeine buzz from our morning coffee, or our doctors want to help us save thousands of dollars by boosting the effects of expensive drugs instead of just peeing them away.

But higher drug levels may mean higher risk of side effects. Women taking the Pill are normally at a higher risk of blood clots, but even more so, perhaps, if they have been consuming grapefruit. Taking the Pill with grapefruit juice may increase blood drug concentrations by 137 percent.

If suppressing our drug clearance enzymes with grapefruit juice elevates levels of ingested estrogen, what might it be doing to our own estrogen levels? A study associating grapefruit consumption with breast cancer freaked out the medical community, but subsequent studies on even larger groups of women found no evidence of a link. The Harvard Nurses' Study even found a decreased risk of the scariest breast cancer type, so it doesn't look like we have to worry about grapefruit affecting our natural chemistry.

For those prescribed unnatural chemistries, it may be a good idea to discontinue grapefruit consumption for 72 hours before use of a drug that may interact with it. If you don't want to give up your grapefruit, you can ask your doctor about switching from a grapefruit-affected drug like Lipitor to one of the citrus-proof alternatives (the replacement drug chart can be seen in my video, Tell Your Doctor If You Eat Grapefruit).

Other videos on citrus include:

And another video on the risks associated with taking estrogens: Plant-Based Bioidentical Hormones.

Can't eat grapefruit without sprinkling sugar on top? Try erythritol instead to avoid so many empty calories: Erythritol May Be a Sweet Antioxidant.

-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 and More Than an Apple a Day.

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