Preventative care: Not all it’s cracked up to be

For the second time in as many days I’ve been inspired by a New York Times column.  Everywhere you turn it seems, you hear people lamenting that we could reduce health care costs so much if only we were more in tune with preventative care.  Everyone pays it lip service, including the two candidates for president who both pride themselves on straight talk.  Writes Dr. H. Gilbert Welch, professor of medicine at Dartmouth in today’s paper:

Senator John McCain argues that “the best care is preventative care,” and his health care reform plan claims that “by emphasizing prevention” and other measures “we can reduce health care costs.” Senator Barack Obama’s plan says, “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.”

It may sound like common sense. But it is still a myth.

The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.

But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.

Like most platitudes spouted by politicians, it sounds good.  But is it?  The idea is, of course, that with all these early checkups, tests and screenings, doctors will discover serious disease in its early stages when treatment is easier and less expensive. Were that all that happened, preventative medicine might be worthwhile.  But that’s not all that happens.  Unfortunately, today’s doctors use physicals, tests and screenings to pinpoint diseases that aren’t really diseases.  And these non-diseases are not inexpensive to treat.  Let me give you an example.

I have a friend who recently turned 49.  He is to all outwards appearances health as a horse.  He hikes, he works out, he plays a lot of golf, always walking and carrying his bag, he isn’t overweight, and he has a good family history.  His father died in his late 70s and his mother, age 84, is still living and drives her car everywhere.  This guy is your basic active healthy middle-aged male with no obvious problems.  Then he goes to the doctor to get a physical exam.

All the tests and screenings come out normal except for one.  You probably guessed it.  His cholesterol was a little high.  At 215 mg/dl it came in over the magic cutoff of 200.  And like all ‘good’ doctors, his recommended that he go on a statin drug.  So he went on Lipitor.  And promptly got muscle aches and felt lousy.  He called his doctor about the pain, and his doctor told him to keep on taking the Lipitor.  He said the aches should subside with time.  So my friend soldiered on and took his medicine.  But his pain continued.  After several months of this aggravating pain, my friend asked me about it.  I was stunned to learn that with his age, condition, and family history, his doctor had started him on a statin.  I suggested that he discontinue the drug and load up on some CoQ10, which he did.  His muscle pain went away and he was soon back to his old self.

But, he had had the fear of high cholesterol laid upon him.  He asked me about it and told me that he was a little worried.  I gave him the talk that I have given ad nauseum on the pages of this blog about the lipid hypothesis being only a hypothesis and that cholesterol doesn’t mean squat and that a statin wouldn’t help him improve his overall chances of not dying.  He was reassured but not totally convinced.  I suggested an EBT scan of his heart for a calcium score, an actual indicator of coronary plaque.  We went for it and ended up with a calcium score of zero, which indicates virtually no coronary plaque.  The doctor who gave him his physical was treating him for a non-existent disease.  An elevated cholesterol isn’t a disease – it’s a lab value.

So, we have a healthy guy who goes in for a little preventative care and comes out with coronary angst and a prescription for a medicine that does him absolutely no good and that even may have been doing him harm.  He then underwent yet another screening procedure to allay the fears that had been created by the first round of preventative care.  He (or his insurance company: read you and I) paid several hundred dollars for the first go round, another couple of hundred for the three month’s worth of Lipitor, and another $700 for the heart scan.  After at least $1500 of someone’s money, the guy isn’t any better off than he was before he went for his physical exam.  In fact, he would have been much better off had he never gone to the doctor in the first place.

The above example is preventative care as we know it today.  And it doesn’t save money overall; it costs money.  A lot of money.  Had I not entered the picture, this guy may have been on Lipitor for years at God only knows what cost. Preventative medicine today doesn’t reduce medical spending – it increases it.

As Dr. Welch confirms:

Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being “at risk.” Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick.

Likewise, recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.

These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients — and paying customers.

Many of whom pay through the nose for a long, long time.

In a brilliant analogy, Dr. Welch compares early screening for disease to the ‘check engine’ light in your car. When it comes on, it may indicate that a problem exists, but more often than not it comes on due to some trivial cause

like one sensor’s recognizing that another sensor isn’t sensing.

I’ve made many a trip to the mechanic to get my car looked at after the annoying ‘check engine’ light came on, and most of those trips resulted in the mechanic resetting the ‘check engine’ light.  Many times the light came on simply because it was programmed to come on when the car reached a certain mileage.  Just like we are encouraged to have certain screening procedures when we reach a certain mileage.

If when our own ‘check engine’ light comes on, and we head to our doctor, we would be time and money ahead were we given advice to cut the carbs, get more sleep, and quit stressing.  But that’s not what happens.  We get our cholesterol checked and thus begins a life-long fight to get it lower, when all it is is a lab result.  If you don’t believe me about this, search the comments of this blog using the word ‘statin’ and you’ll see how many people write telling me that their cholesterol was found to be a little high, and their doctor wants them to go on a statin.  It’s pitiful.  In fact, it’s an outrage.

I’m not saying you should never go to the doctor or never have a screening to see what’s going on.  But I do say that you should undertake these procedures only when they provide some value.  Colonoscopies are worthwhile because colon cancer, caught early, can be successfully treated.  Same with PAP smears and cervical cancer. An EBT scan of the heart for a calcium score is valuable because it measures plaque.  If you see a mole that is changing in shape or color, it’s good to get it checked.  There are a few other screening tests that are of value, most routine lab tests can only steer your doctor wrong.  And put you at odds with him/her.

Take the time to read the full New York Times article.  You’ll never look at the idea that preventative care is the panacea for all that ails us the same again.  Now, if only the candidates could get the message.

Monthly Book Reviews

Reading recommendations

I have been writing a series of book reviews each month that I email to subscribers. If you're interested and want to get on the list, sign up here (or above where it says Get free email alerts in the upper right). I'll send you an email notice of all new blog posts plus all my monthly book reviews. Also, you will get a link to all the previous month's book reviews I've sent. Hope to see you aboard.

Powered by ConvertKit

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

60 thoughts on “Preventative care: Not all it’s cracked up to be

  1. Hi Dr Eades,
    Thanks again for a spot-on post, as usual. The subject matter, though, did put me in mind of the other aspect of health care that figured in the Prez Debates: Universal Health Care. And it’s worth stating my views — I’m lucky enough to live in a country (Australia) that not only has a Universal Health Care scheme, but one that was recently rated by whichever UN body as being 3rd best on the planet (1st place, France, 2nd, Japan). You Americans seem to hate the idea and bring up Canada or the UK as counter-examples. But these are acknowledged awful examples.
    I can tell you, as a parent, that living under A GOOD universal health care system is a blessing. A bad one is hell on earth.

    BTW, did you see the latest Aussie Federal Government health reports whose figures lay to rest the myth that our kids are inactive, obese or that their lifespans are shortening?
    The report:
    http://www.aihw.gov.au/publications/phe/mp-thdawoacayp/mp-thdawoacayp.pdf
    Comments:
    http://www.news.com.au/adelaidenow/story/0,22606,24439057-5006301,00.html
    http://junkfoodscience.blogspot.com/2008/10/another-myth-exposed-epidemic-of.html
    Excerpt from the latter:
    “Overweight. According to this report, 6% of Australia’s children aged 6–11 years were at or above the 95th percentile on BMI growth curves in 2006, and 5% fell below the 5th percentile. Among adolescents (13-19 years of age), 5% were at or above the 95th percentile on BMI growth curves in 2004–05.
    “Those who believe there’s an epidemic of gargantuan children as seen in media, have been taken in by confirmation bias.”

    Another zombie myth!
    Michael Richards

    Problem is with universal health care that no one knows beforehand whether it will be a blessing or a hell on earth. And most here have seen the results of government intervention (the TSA, for example) and don’t want to take the chance. Of the top three countries you listed, you don’t see people swarming there from all over the world for treatment nor do you see much cutting edge medical innovation. That pretty much all comes from the US, which has no universal health coverage.

  2. In addition to the questionable value of cholesterol numbers to begin with is the changing threshold at which there is a “problem.” I know the “magic cutoff” used to be higher than 200. Wasn’t it 225 or 250 at one time? Someone with a total cholesterol of 260 looks much sicker when then cutoff is 200 than when it is 250.

    I’ve wondered when that changed, and why, but my cynical suspicion is that some research “showed” that the cutoff should be lower, and it was therefore changed, with the happy result (for the pharmaceutical companies) that more statins could then be prescribed.

    It used to be 300 then dropped to 250. Usually the ranges for lab values that are considered normal at those that span two standard deviations from the mean, which incorporates 90+ percent of people. It’s only the outliers (i.e., those beyond the two standard deviations) that are considered abnormal. So to develop normals, one looks at a lot of lab tests, calculates the mean (average), and sets the normals at two standard deviations from that mean. But there is a difference between what is healthy and what is normal. For example, if we took two standard deviations from the mean in looking at weight, we would have much higher limits on what is considered normal verses what is considered obese. But we know excess weight isn’t good, so we set the limits not at what is within a normal range but to what is in a healthful range. Same with cholesterol. But the difference is that the idea that elevated cholesterol is bad has never been proven. We have reduced the normal limits – with drug company encouragement – based on an idea, a guess, not on fact.

  3. I see your caveat at the end of the post, but still wonder about your actual conclusion in this way: do you think physicals are a waste of time and/or money? Is there any age when these can help if there are no outward signs of problems?

    My doc gave me the biz last week because I hadn’t been in (for the routine check-ups or anything else) in about two years (I have had a cholesterol screen and minor physical for insurance purposes, which I passed with flying colors!) and wanted me to come in. I’m 35 and she said that I don’t need one every year, but every couple years, at least for now. I take it you disagree??

    I probably do disagree. There are some things that can be picked up early while still treatable but others that can be picked up that ought to be left alone. The latter can cause untold grief, angst, expense and their treatment can sometimes be a detriment to health. If you’re a person who goes to the doctor for a routine physical and has an early melanoma discovered, which is treated successfully, then the routine physical paid off. If you’re a person who goes to the doctor for a routine physical and is diagnosed with elevated cholesterol and put on a statin then dies from a liver complication, you may not feel the same.

    The only way to decide the argument is to do a study. But even that is fraught with problems because you can’t randomize people into those who get routine physicals and those who don’t. If you could, then both groups could be followed for life to see which group lived the longest. People self select who goes for routine physicals and who doesn’t, and there may be something in that process that sends people who will live longer into one group or the other. The only way to really know is with a randomized study, which will never be done.

  4. It’s not the idea of prevention that is wrong–PP is largely about prevention. It is the errors of current medical practice, either due to greed or stupidity, that are the problem.

  5. When I think of “preventitive” medicine, I think of sound diet and exercise…period. No conventional or “cam” intervention should be considered “preventitive” (although CAM practitioners usually promote their philosophies as such).

  6. I think the problem starts as soon as we aim for “disease prevention” instead of “health promotion”

    Let’s face it: None of us is going to get out of here alive.

    But, if we are always looking over our shoulder, watching out for some disease creeping up behind us, are we not creating a self fulfilling prophecy?

    You hit the nail right on the head in your final paragraph:

    I’m not saying you should never go to the doctor or never have a screening to see what’s going on. But I do say that you should undertake these procedures only when they provide some value. Colonoscopies are worthwhile because colon cancer, caught early, can be successfully treated. Same with PAP smears and cervical cancer. An EBT scan of the heart for a calcium score is valuable because it measures plaque. If you see a mole that is changing in shape or color, it’s good to get it checked. There are a few other screening tests that are of value, most routine lab tests can only steer your doctor wrong.

    And put you at odds with him/her.

  7. Wow, that’s a good read Dr. Mike! What about these virtual exams they keep advertising on the radio. They say that in just a few minutes they can scan for pretty much everything. Is that worth doing, or is it just another Ronco tomato slicer?

    Cheers,

    George

    No, the scans work, especially the calcium scoring scans. Make sure if you get one that it is done on an EBT machine – the others dose you with way too much radiation.

    But even with the calcium scoring scans, what are you going to do if you find you have a calcium score in the 75th percentile for your age? Often people are then sent for other types of more invasive scans and even coronary arteriography, none of which are totally benign. And even if you aren’t sent for all these other procedures, you begin to worry. You will for sure be put on a statin even though there is no evidence that a statin will decrease your risk of dying. If such a finding would make you buckle down and take your diet seriously, then it would probably be worthwhile. But if it launches you into a round of expensive and risky therapies, it may not be as worthwhile.

  8. Excellent post! I completely agree and am thrilled that some are starting to say out loud what we’ve thought for ages.

    I watched my mother’s health decline to the point that she was in a wheelchair from months & months of statin POISONING (my term) for her “dangerously high” cholesterol (315). By the time she was virtually crippled and had endured months of pain and agony (and her cholesterol stayed 250 or higher), he finally took her off. But he STILL INSISTS that the statins did NOT cause her physical problems. He swears that she’s just getting older and would have had the muscle and joint problems anyway (grrrrr!).

    Interesting that she feels incredibly better now taking only a daily multi-vitamin and niacin. (I will tell her about the COQ-10 from your post) And for the record (which her doc has ignored)….her father is 94 years old, has cholesterol over 300 (and has forever), but he takes NO MEDICATION at all–he just eats real food, works in his garden, and walks a lot. He “medicates” with good, healthy food, and his eyesight and reflexes are good enough that he still drives–in Southern California traffic!!

    Oh, and by the way….Mom’s doctor reminds her at ever visit that her “dangerous” cholesterol level will probably result in a STROKE soon. Great bedside manner, don’t you think?? Scare tactics to guilt trip her into taking a drug that nearly killed her…UGH!

    Might be time to change Mom’s doctor. All the studies show that in the elderly elevated levels of cholesterol correlate with longevity. And elevated cholesterol isn’t a risk factor for stroke, anyway. I hate to hear tales like this one.

  9. Your example of the 49 year-old strikes a chord. A year and a half ago, a doctor put me on Zocor because I broke the 200 barrier (I think it was around 230 but it actually may have been a little lower). A little over a year ago, prompted mainly by Mark Sisson’s writings on his blog, as well as others (including this one), I made the transition from a die-hard carboholic to the low-carb lifestyle. I know you wouldn’t recommend this, but I just flushed the Zocor on my own. Well, yesterday I got the results of a lipid panel and my total cholesterol was 157, LDL 100.2, HDL 50,0, and triglicerides 39!! And that’s on a diet that gets 50% or better of its calories from fat on a daily basis. I eat 12-15 eggs a week, snack on almonds and macadamias, and thorougly enjoy a medium rare ribeye!! I also have a daily salad that includes lots of leafy and cruciferous veggies. So no more pasta loading for me, and NO MORE STATINS!!

    Problem is, what if you had done all this and your cholesterol had stayed at 230 or gone even higher, a situation I’ve seen many times? Would you have panicked and gone back on the statin, which I can guarantee is what your physician would have recommended, or would you continue to avoid statins? You would still be healthy even with a cholesterol of 250, but you wouldn’t think so because you would be focusing on a fairly meaningless lab result rather than all the other signs of health.

  10. Dr. Eades,

    There is one condition VERY important to your readership where early diagnosis and treatment makes the difference between pain, misery, and possibly survival: Type 2 Diabetes.

    In particular, if a person is eating your low carb diet and still getting blood sugar that are above normal, they should be treated aggressively.

    One reason is because there appears to be a growing amount of adult onset autoimmune diabetes (LADA) which is misdiagnosed as Type 2. It is slower in onset than typical Type 1, but people who have it require insulin. If the diagnosis is delayed until their blood sugars have been high enough to add to beta cell destruction, control becomes much harder.

    People with ordinary insulin resistant Type 2 who cannot get truly normal blood sugars with a low carb diet alone must also demand aggressive treatment from their doctors. The typical family doctor does not start a patient on an oral drug until they have had an A1c over 8% for an entire year. That translates into an AVERAGE blood sugar of 183 mg/dl (10 mmol/l) which is high enough on its own to kill beta cells.

    If a person who has been on a typical low carb diet (60 grams per day) for more than a few weeks who is not seeing fasting blood sugars under 100 mg/dl and post meal numbers under 140 mg/dl does need aggressive drug treatment. Delaying leads to neuropathy and retinopathy, and almost guaranteed heart disease.

    –Jenny Ruhl

    I agree with the proviso that drugs aren’t the first line of therapy. Diet must be tried first, and, preferably, a good quality, whole-food, low-carb diet.

  11. Dr. Eades,

    just wanted to say thank you for taking the time to write this blog.

    Thank you for taking the time to read it and comment.

  12. Do you have any specific recommendations of “preventative care” we should follow through on? For example, you mentioned colonoscopy, but at what age, and how frequently? Same for prostate exams and mammography/breast exams. Are they worth the time, cost and effort, and if so, under what circumstances. I am willing to pay for care that has benefit, but I don’t trust modern medicine to give me the REAL answers. The above tests seem to be the most frequently suggested. So, where do you stand, realizing that patient specifics could make it difficult to give blanket replies? Thanks for all you do to educate us!

    Rodney

    Hey Rodney–

    This is too complex a question for an answer in the comments section. I can’t come up with such a list off the top of my head, which is how I deal with comments. I would need to put some thought and effort into it to make sure I didn’t leave something critical out. Might work for a blog post in the future, though.

    Best–

    MRE

  13. Amen! I’ve often suspected this, but never had anything to back up my suspicions. Recently the ranges for thyroid function were changed so that millions of women are now considered hypothyroid and thus candidates for costly medication.

    Anyone who has ever spent any amount of time on the various low-carb boards knows that there are tons of posts (mostly from women) about being hypothyroid. Some even (unjustly) blame low-carb eating. The most commonly cited medication is Armour thyroid, which is at least “natural,” but still costly … especially when you have to take it for years upon years.

    Remember when they did this for BMI? Suddenly elite athletes were considered obese because of their high BMI. Trouble was, their weight was muscle, not fat.

    It seems like every time you turn around they’re lowering the “normal” reading so that more and more people are “in danger.”

    And the more people in danger, the more drugs that can be sold to remove them from danger. It’s a great racket.

  14. Could you give is the links again to the crucial studies we could take to our doctors regarding cholesterol. I went through the same thing as your friend, told the stress people they would get bored before I was ready to quit running (at the time my sprints may have been national class for my 68 year old age). Then because my triglycerides were high my doctor doubled my statins. I think I got hit with statin poisoning, and am only slowly getting those sprint numbers where I want. I am losing doctors over not panicking about 260 cholesterol, my last A1C was 4.9, and I had to put myself on insulin after 2 sessions of retinopathy because the Internist said I wasn’t diabetic (most FBGs were about 100).

    The problem is that is an absence of studies showing that cholesterol is harmful. Ask your doctor to show you a study that proves that statins improve overall mortality. He/she can’t because they don’t exist. Ask him/her to show you the studies proving that cholesterol causes heart disease. It can’t be done because there aren’t any. The best way to bone up on all this is to read Gary Taubes Good Calories, Bad Calories or Dr. Malcolm Kendrick’s The Great Cholesterol Con. Both will give you plenty of ammunition. But whether you have studies or not, you don’t have to prove squat to your doctor – he/she works for you, not the other way around.

  15. Dr. Eades,

    Heartened to read your rec of Ca scoring. I read Wm. Davis’ book and found it very interesting. Do you have a pref for EBT rather than MDCT? What do you think of Davis’ heavy use of statins and fear of sat fat (as found in the book; he may have attenuated that view on his blog?)? Have you ever spoken with (argued-ha!) Dr. Davis?

    Thanks,

    RWC
    MSIV, OHSU
    Portland, OR

    I prefer EBT. I did read Dr. Davis’ book, which I enjoyed. He has commented on this blog, and I have answered, but we have never spoken. One of the things I found interesting about his book was that the first third of it is spent discussing the case histories of people who had normal to low cholesterol levels yet had horrible calcium scores, meaning that they had plaque despite normal or low cholesterol. Dr. Davis makes much of the fact that one can’t use cholesterol levels to diagnose heart disease because there is no correlation. All of which I believe. Then he spends the last third of the book describing his treatment regimen, which focuses on lowering cholesterol, which simply doesn’t make sense to me. I’ve read a number of the studies he cites, and, based on these studies, it looks like statins do indeed reduce calcium scores. But at what expense? The double-blind, placebo-controlled studies of statins show pretty clearly that there is no decrease in all-cause mortality in those who take the drugs. A couple of conclusions can be drawn from this data. Maybe a reduction in calcium and plaque doesn’t really correlate with a reduction in heart disease. Or more likely, the rates of death from heart disease are decreased but are made up for by other diseases caused by the statins. I would suspect the latter, but whatever the case, the name of the game is living longer, and there is no evidence that statins help people do that.

  16. Thank you for all your real preventive work! I say Dr Eades for President or at least a secretary of Health! At least you get my vote and at least thousands of others who follow your blog. I am not sure you would want to take on Presidents job, way too stressful, but may be secretary of Health? Dr Eades I have a question also. I have read numerous studies which indicate potency of vitamin D in preventing and even some cases reversing heart diseases. I have even heard anecdotal stories that vit D alone is capable of reducing calcium score up to 50 percent along with exercise. From your experience have you noticed any if such benefit form vit D supplementation? Thanks

    Dr. Davis (see a couple of comments previous to this one) has had tremendous success in using vitamin D to reverse lower calcium scores. Read his blog and learn all about it.

  17. As I live in England I have to challenge the idea that our health service is an “acknowledged awful example”! I don’t believe that is the opinion of most people who rely on it. Having had the experience of being with someone taken ill in the US while on holiday (in Las Vegas of all places), I can say I am very, very glad that we have a healthcare system in the UK that is not only universal but free at the point of access.

    My friend was taken ill while we were walking around a casino, with what later appeared to have been some kind of allergic reaction. I should mention that he has mild asthma but had never experienced anything like this before. As he was having difficulty breathing (and his lips, face and throat visibly swelling up) I approached a security guard and asked for help. I was handed a list of health centres in Las Vegas and basically told “you’re on your own”! I won’t go into what a struggle it was to get my friend to the nearest hospital – just to say it was awful and I really thought he might die if I couldn’t get him there quickly enough. Anyway, as you can probably tell by this mini-rant, I found it a shocking experience.

    Had the same thing happened in the UK, say in a large department store (I’m trying to come up with an equivalent to the casino!) I or the member of staff would have called 999 for an ambulance and that would have been that. We also have a thing called “NHS direct” which one can call for immediate medical advice – if one can’t get to the doctor, or if uncertain whether the situation is (or may turn into) an emergency.

    Just to continue with the annecdote, once we got to the hospital it was hard to get anyone’s attention until I made it very clear that we had insurance. Then we were whisked away into the high-tech depths, and my friend had a whole night’s worth of unnecessary tests (X-rays, a CAT scan!). He recovered with oxygen and re-hydration and an inflated bill to the insurance company.

    Personally, I’m a utilitarian. All the “best” medicine in the world is worthless if you can’t access it or if it loads you up with unnecessary tests and medications for the sake of making a profit (to finally get back to Dr Eades’ point!).

    I apologize for your friend’s bad experience here. He (or a security guard) could have called 911 and he would have been dealt with quickly.

    I have to say, however, that I have had friends tell me of nightmare experiences they have suffered at the hands of the NHS, so I don’t think we can judge either system based upon how they have mishandled a few specific situations.

    I’m sure when you’re used to getting healthcare for free it is grating to have to pay for it. But it’s a cultural thing – we’re used to it over here. We would go ballistic if the government here tried to charge us $500 per year (or whatever it is you’re charged in the UK) to simply own a television, whereas over there, everyone just seems to accept it.

  18. What about getting your genes looked at by 23andme to see if you are at risk for certain disease?

    It’s probably a fun exercise, but I don’t think the technology has developed to the point at which I would put much stock in the data. But that’s just me. Others may feel differently.

  19. This post brings to mind the mindless rounds of testing I was subjected to at around 20 weeks into each of my pregnancies, including the blood testing as well as the glucose tolerance testing. The blood testing does not reveal a single TREATABLE condition when positive, and are fraught with false positives which subject the mother to weeks of further testing and stress only to confirm or deny a condition that cannot be changed! I attempted to refuse the blood test in my 2nd pregnancy and was actually bullied into complying with the nurse (she was at the sonogram facility, not my ob’s). It seems the mindset of many medical professionals drives them to categorize conditions even when there is no ability to change the outcome. When they can do something as easy as prescribe a statin in response to categorizing a patient as having “elevated cholesterol”, I think it greatly reduces their cognitive dissonance (MUST….TREAT….EVERYTHING….IDENTIFIED…- said in a breathy-movie-lab-assistant-voice).

    The full glucose tolerance testing is a singularly miserable experience for a pregnant woman. I was someone who had to eat virtually around the clock to avoid nausea, including setting alarms in the middle of the night, and this test required fasting and then consuming a glucose solution with multiple blood draws over a period of 3 hours. If you vomited, the test had to be redone. The diet recommended for patients is, you guessed it, very low fat and low calorie. I know that expectant mothers who experience gestational diabetes need treatment, but this form of testing seems unnecessary and the recommended diet seems dangerous. Is this “preventative care” really helping a statistically significant amount of people or has it just become the norm?

    I read a quote from John Stossel mentioned in a recent issue of Forbes. Here is a link to the original article they are referencing:
    http://www.nysun.com/opinion/bad-medicine-2007-09-21/63163/

    He posits that the skyrocketing cost of healthcare is directly related to the fact that the true cost of tests or treatments is hidden by insurance coverage. They don’t compare prices from different doctors and hospitals because they’re not really paying. I would suggest that a similar midset applies in the consideration of which tests or treatments to actually pursue. Since the out-of-pocket cost of a particular test tends to be low, patients don’t dispute its’ necessity. Then, when the test reveals a “problem”, they are more likely to go along with the standard treatment since they already “agreed” to the test being necessary! People need to wake up and take responsibility for making health DECISIONS, not being swept along with the status quo.

    I think you and John Stossel are right.

  20. I am the person who was the subject of the “Statin Disaster” blog post back in January 2008 so I will not bore you with the details http://www.proteinpower.com/drmike/statins/statin-disaster/. I have been off of statins now for 10 months. I am pain free at last, have almost regained my preordeal strength and have almost reached my preordeal mental health and capabilities. I am left with a somewhat weird continous bout with flu like symptoms (no temperature) that mysteriously come and go with sudden onset and just as sudden relief.

    Every doctor that I have seen since my ordeal in trying to adress the flu symptoms, muscle paralysis and pain has taken the stance that statins could not possibly be the culprit. They administered MRI’s, eltromyograms and xrays trying to explain the cause with no luck.

    With no intervention the pain and paralysis have finally totally gone away. My hope, and now belief, is that the other symptoms will eventually go away as well.

    The cost to me of a simple, popular “preventative” measure has basically been more devastating than I believe any out fall of high triglycerides could ever have caused. Many thousands of dollars have been spent resulting in not one positive intervention. My life has been permantly scarred preventing what?

    I have come to believe that fear brokering and “preventative medicine” is the new money maker for the industry. Sadly, I have become the great cynic of the state of professional standards in our world today.

    Doug

    I trust that you are taking CoQ10, right? If not, you need to start.

    I’m glad you’re doing better.

  21. The only good thing that regular check-ups did for me was to reveal my pre-diabetic condition, FBG of 125 in Dec. 2006. It prompted me into action to halt and reverse the condition with PP. I had dabbled with PP before, but I now know that this is a way of life for me (PPLP). I am still getting lab tested avery 6 months. Keep getting FBG levels of 102-104, thus I am still officially pre-diabetic–although my HbA1c is less than 5.6. Also, I suffer from hyperlipidimia-).

    Let’s hope your blood sugars continue to improve with time. Too bad about the hyperlipidemia.

  22. I think it would be good to treat people early who really were at risk for cardiovascular disease… treating IGT with low carb diet/lower calories, weight loss, education to reduce stress, smoking elimination programs, etc… even medicine could be very useful for early signs of diabetes with an autoimmune component like Jenny said. This sort of real honest preventative care would be very beneficial for the health of american people, and our pockets.

    The problem isn’t preventative care, but how medicine wants to define preventative care. The solution isn’t to forget preventative care but to bring to task the runaway health care industry, which along with pharma and insurance companies have been swindling people for decades now.

    You are right…it’s all in the definition. Preventative care isn’t wrong – the definition of preventative care in the minds of those in the medical profession is wrong. Statins aren’t preventative care.

  23. Michael Richards – I’m not that familiar with the UK system but every canadian I’ve ever heard seems satisfied with their health care system. All agree it is worlds better than what we have in America (which is thieving insurance companies denying treatments, pharma industry “educating” doctors to giving toxic antipsychotics to 2 year olds with “bipolar disorder”, and statin drugs to healthy middle aged people with “high cholesterol disease”, and a good chunk of the population without any health care at all). In other countries, it’s not like that at all. People aren’t overmedicated, because the government is the one paying for all of this… the problem we have now with out of control pharma greed could only have occurred in a country like this.

  24. with regards to your comment earlier in this thread:

    “Of the top three countries you listed, you don’t see people swarming there from all over the world for treatment nor do you see much cutting edge medical innovation. That pretty much all comes from the US, which has no universal health coverage”

    i am canadian working in the health care industry and while we do not posses the level of innovation and international acclaim of the United states, we are for a nation 1/10 the size a centre of excellence and innovation in many areas and have done so independant of a socialized medical system that most opponents would claim could never attract and retain talented doctors w/ better prospects in the US.

    Toronto’s Sick Children’s Hospital is often cited as a cutting edge pediatrics hospital w/ recent acclaim for attempted separation of conjoined twins from asia.

    We are also among several nations who contribute greatly to stem-cell therapy.

    We are smaller but are not lacking in innovation while constantly trying to best serve our populace in context of a public system w/ has its own host of problems.

    thank you for this blog, i always look forward to reading it every week.

    C

    My intent wasn’t to denigrate Canadian physicians; it was simply to point out that market-driven healthcare is not without its own advantages.

  25. Dr. Eades,

    I agree with what you’re saying. Although nobody has mentioned it yet, the medical community seems intent on dealing with symptoms rather than underlying causes.

    High cholesterol reading. Statins.

    Never mind that a. statins don’t cure CHD or that b. high cholesterol doesn’t casue CHD. How can you fault someone for helping reduce a patient’s cholesterol.

    Same with blood pressure.

    Too many doctors today are simply following a recipe.

    Sad.

    Tony

    Very sad.

  26. Hi Dr Eades,
    I can’t let that last comment go through to the keeper (cricket talk, look it up). People DO come here to Australia for treatment in large numbers. Flocks of them, you might say. Especially from the affluent parts of Asia. Plus quite a few Noble Prizes for medicine. Look up Sir Howard Florey for one of our all-time health care heroes. I won’t labour the point with other examples. And our level of care is higher than yours, so I know where I would prefer to get sick! And, for what it’s worth, we currently have the longest lifespan of any developed country, something that was certainly not the case before our health care scheme with implemented.
    But — other than that — love what you do!
    Michael Richards

    Hey Michael–

    How do you know that your level of care is higher than ours? Just curious. I’m not trying to disparage your healthcare system, which may be wonderful. But other types have their advantages as well. And the entire population of your country is less than half the population of California, and your population is much more homogeneous than ours. It’s much easier to administer a system of nationalized health care under those circumstances. I’m sure Sweden has a good nationalized healthcare system for the same reasons.

    Cheers–

    MRE

  27. “If when our own ‘check engine’ light comes on, and we head to our doctor, we would be time and money ahead were we given advice to cut the carbs, get more sleep, and quit stressing. But that’s not what happens.”

    Great analogy. I would go a bit further. When an engine warning light does come on that really does indicate a problem doctors typically prescribe a drug that has the effect of turning off the warning light instead of initiating a treatment protocol that identifies and addresses the underlying cause.

    For example, if you are diagnosed with T2 diabetes as typically indicated by an elevated 12 hour fasting BG here in Canada (not a great test) you will probably get prescription right then and there for at least one drug and maybe a handout from the CDA on a high carb, low fat diet. If your blood pressure is even slightly elevated you will probably also get a script for an anti-hypertensive. And since your diabetes puts you at risk of heart disease a script for a statin is a given. If you were to ask your MD why your BP was elevated you would probably be told that the cause is not important, that you have ‘essential hypertension’ which means “I have no idea what’s causing your elevated BP and I could care less”.

    I happen to think it is important to know as much as can be ascertained about the underlying cause of a problem, any problem. Otherwise, one has no idea of whether the ‘solution’ is addressing the cause or simply causing a new problem that is masking the presenting problem.

    The first thing I wanted to know when I as diagnosed with T2 was how much insulin I was producing. I also wanted some tests that are pretty standard in your country but that my MD had never heard of and that the local medical lab told me were not available in Canada (which I read as “the test results have no drug indications”). My test results showed that my pancreas was producing more insulin than normal. So it was reasonable to assume that my high blood insulin levels resulting from a very high carb diet were causing or contributing to my mildly elevated BP. So the first step to me was to reduce blood insulin levels by reducing my carb intake. Eventually my BP came down to lower than normal. But had I taken a prescription for an anti-hypertensive and stuck to a high carb diet I think my BP would have gotten worse.

    But it is the subject matter of this blog that really gets my blood boiling. I live in Canada which is known in your country for our great social health care system. What you may not be hearing about is the long waits for hospital care and surgeries Canadians are enduring these past few years. There are horror stories in our media about patients being put in janitor’s rooms and hallways because of a lack of beds or being turned away at admissions. The reason for this appalling situation is that the pharmaceutical industry and MDs acting as their consultants pitched our bureaucrats on the cost effectiveness of preventative care over hospitalization. Sounds good, at least in principle. But their idea of preventative care was drugs for anyone they could show has even the slightest risk of any disease, but especially CVD. All that has to happen under our health care format is for committees to write treatment protocols for such things as cholesterol or BP that set test results that guarantee the pharmaceutical industry massive sales.

    And boy did our preventive plan ever get results, at least in drug sales. The cost of drugs to the plan has gone into earth orbit. The province I live in it has projected that by 2017 the cost of our health care system will consume most of our provincial budget. The solution? Stay the course and try and get a better deal from big pharma.

    Since you’re the Candadian and I’m not, I’ll let you carry the banner for bashing your country’s socialized medicine, and I’ll stay out of the fray.

    Cheers–

    MRE

  28. Excellent post: I would however say that part of the problem is with those administering the prevention. Any doctor who prescribes drugs solely on the basis of cholesterol levels without doing a lipid profile such as NMR to see particle size is practicing medicine in an ignorant way. As i see it prevention is not really the problem: You yourself cite areas where it makes sense. Instead, it is physicians who prescribe drugs/treatments who are not up to date, and yet prescribe tratment based on old useless information/modalities.

    I agree, but, still, what good does it do to know particle size unless you’re going to treat with diet? Statins don’t accomplish anything.

  29. I’m going to jump in here quickly to let everyone know that I’ll get to comments a little later. For whatever reason they are stacking up like cord wood for this post and we are having a power outage. A giant tower is being worked on right down the street, and the power keeps going out for 45 minutes at a time. It’s supposed to be back on for good by early this evening. I have to go out for a bit, but I wanted to take this opportunity while the power was back on briefly to let everyone know what’s going on.

    Thanks–

    MRE

  30. A few of us here recently had lipid profiles done through a lab associated with the local hospital. The most interesting thing on the lab sheet was that LDL was defined as “high” if it was above 100mg/dl. NCEP guidelines define “high” as at or above 160, so what the #$*(&#? (note that other acceptable lab values were in line with the NCEP guidelines). Sure looks like fishing for patients to me.

    It’s more fishing for statin users.

  31. To answer your question, I would not have gone back on the statins. I had already decided when I knew my cholesterol was “elevated” before that I wasn’t going to take them…getting the same result a second time wouldn’t have changed anything. I guess I didn’t adequately identify myself in the comment as being a lipid hypothesis skeptic–but I am. Speaking of which, you made the following statement in another comment:

    But the difference is that the idea that elevated cholesterol is bad has never been proven. We have reduced the normal limits – with drug company encouragement – based on an idea, a guess, not on fact.

    I just finished reading The Paleo Diet and it appears Cordain does not agree. Am I reading that wrong or is this an area where you have differing opinions?

    No, you’re not reading wrong. That’s a bone of contention between Loren and me. We’ve spoken about it many times, and he believes what he believes. We’ve decided to agree to disagree on this issue.

  32. Comedian Larry Miller once described his plan to prevent Americans working overseas from being kidnapped and tortured by Islamic fanatics: “Shut up, and get on the plane.”

    “But the company picnic is next week, and I want to–”

    “Shut up, and get on the plane.”

    We need to find a way for doctors and hospitals to make a profit from a similar form of preventative medicine: “Shut up, and put down the cereal spoon. That’ll be $200, pay on the way out.”

    By the way, I think the neighborhood power outage may be caused by those flickering lights in your (impressive) library. The guy doing the color-correction at the post-production facility looked at a couple of interview sequences and said, “What was up with your lights when you shot this?”

    Fortunately, fixing those little issues is what they get paid to do.

    Sorry for the hassle with the lights, but they really do light up the bookshelves. I hate to hunt for books in the dark.

    Cheers–

    Mike

  33. $700 for a heart scan??!!!!!!

    Here in Seattle, the price I was quoted, at Swedish Medical Center, was $200.

    Yes, the price has fallen. I was using an old price. (It still is $700 or higher in some areas.) Before the $700 they were $1000. Long story about the technology involved that I may post on sometime.

    MRE

  34. Reading this reminds me that it’s time to do what I can for my own preventative medicine: buy more glucose testing strips!

  35. Thanks Dr. Eades, this gives me a lot to think about. I have a request – I’m reading the protein power lifeplan, I think it’s a fantastic book, but I was wondering if you could blog a few lines about your upcoming book? It sounds fascinating, since I have a middle aged middle myself.
    Dan

    As soon as the publisher will let me, I’ll blog about it. It basically focuses on the causes of the abdominal obesity that comes with middle age and how that’s different from the (ever-increasing in incidence) abdominal obesity of youth. It also delves into the other disorders that go along with an increased middle-aged middle. It contains a little historical perspective (I couldn’t be involved in the writing of a book that doesn’t go into ancient history a little 😉 ). And it lays out an effective treatment plan.

  36. It’s me again.
    I am dashing off these replies from the kitchen table just before I toddle off to work, so I don’t have the opportunity to research references. Hope you understand.
    1) Level of care in Australia is higher? That’s according to a number of UN surveys. I know this does not guarantee truth, but it will do as a benchmark for the moment.
    2) Our population is no longer homogeneous. In my own immediate family I have half-Tibetan nephews & nieces, half-Chinese same, another cousin is married to a lovely Korean lady, and my own immediate blood relatives are Jews, Scottish Presbyterians and Welsh. This is no longer unusual. at least 30% of the current population was born overseas. For example, this radio program is coming up:
    http://blogs.abc.net.au/nsw/2008/10/the-world-in-sy.html?program=702_breakfast
    3) Anecdote time: Our second child was born at the same hospital used by Cate Blanchett and Nicole Kidman for their babies. Same facilities, same treatment. Also, same hospital used by former Prime Minister Howard (not to have a baby, obviously) while still PM. The only thing I had to pay was for a gym class for my wife for her back. 30 bucks! For movie-star treatment! At a private hospital, not a public!!
    So our health system is not bad at all. And it costs us less of our GDP than yours. I think we got a bargain!
    And lastly: our medicine not innovative?? What about that good-looking Aussie doctor on House? How’s that for innovation!
    I don’t know why I’m replying a third time to this thread. Maybe I should get out more! It’s because I think that you blog is the best health blog going and I’m happy to contribute to it in a tiny way.

    Warmest Regards,
    Michael Richards

    Hey Michael–

    If we could guarantee that we could have universal healthcare over here that could match yours, I would be all for it. But we can’t. I, and a lot of others, fear that it would become a government boondoggle of immense proportions. Just the Medicare (government insurance for the elderly) that we’ve got over here is a failure, so I can’t imagine how they could make it right for all of us. And dealing with a population of over 300 million with a huge underclass is a little different than dealing with 21 million (which is the stat I have for Australia’s population) with much less of an underclass. The real problem is that we can’t just try it to see if it works, then abandon it when it doesn’t. Once these things become part of the system, they stay forever. Year after year the politicians promise to fix them, but invariably they make the situation worse. I can’t for the life of me figure out why so many people who have seen our government in action (witness the TSA and the outfit that dealt with Katrina) continue to believe that these clowns could somehow manage to manage nationalized healthcare. It beggars belief.

    Your comments are always welcomed, so don’t worry about replying a third, forth or fifth time to anything.

    Cheers–

    MRE

  37. Thanks for your website! It has taught me a lot. I have a question related to lab tests. My Mom’s triglycerides are relatively low (99) and her A1C is high (almost 8). She has type 2 diabetes and is on statins and oral meds for diabetes. I’m not sure how to interpret these numbers, since I thought the two would normally be related. Can you explain what this means? BTW, she won’t agree to a low carb diet, even though being on one for only a few days before a surgery when she wasn’t permitted to take her oral meds resulted in nearly normal glucose readings.

    Some of the new statin drugs lower triglycerides, so if she is on one of these, that may explain the low triglycerides in the face of high blood sugar.

    As to her refusal to go on a low-carb diet despite a demonstration of its benefits, that’s not unusual. I read recently about a study using low-carb, high-fat diets to successfully treat people in the last stages of cancer. Despite many of the people showing benefit, many dropped out of the study because they missed carbs and sweets. Apparently eating carbs was more important than survival.

  38. Oh no, not again!
    But not about the above. Off topic, because this is the only to communicate this to you.
    This gem just dropped into my mail box. Significant?
    (Requires login):
    http://www.theheart.org/viewArticle.do?primaryKey=908435&nl_id=tho09oct08
    Reproduced below:
    Pfizer to drop development of drugs for hyperlipidemia, atherosclerosis, and heart failure
    OCTOBER 2, 2008 | Shelley Wood
    New York, NY – Pfizer is getting out of the cholesterol-lowering game to focus on what it perceives to be more lucrative diseases, according to an internal memo obtained by Forbes [1]. And for the most part, the chosen “disease areas” don’t include the heart.

    In the memo, Martin Mackay, president of Pfizer Global Research & Development (R&D), informed his staff that the company plans to “exit” the fields of atherosclerosis/hyperlipidemia, heart failure, obesity, and peripheral arterial disease.

    Instead, the company, whose cholesterol-lowering drug atorvastatin (Lipitor) is the world’s top-selling drug, says it is turning its attention and R&D dollars to cancer, diabetes, Alzheimer’s, pain remedies, and mental health as its “higher-priority areas.”

    The news comes in the wake of the flop of Pfizer’s hoped-for new flagship, torcetrapib, a CETP inhibitor that was widely predicted to be the company’s next blockbuster drug. While CV drugs have been the major moneymakers for Pfizer in recent years, those days are drawing to a close. In addition to Lipitor, which will lose patent protection in 2011, Pfizer’s other major player in the CV drug arena is Norvasc (amlodipine), which came off patent in 2007.

    Among the lower-priority “disease areas” where the company says it will continue working are thrombosis and transplant, the memo notes.

    Contacted by heartwire, a handful of leaders for some of the major Pfizer-sponsored trials in cardiovascular disease over the past decade declined to comment on the company’s announcement or speculate on what it might mean to the field of CV drug development—with one exception. Dr John Kastelein (Academic Medical Center, Amsterdam, the Netherlands), who was an investigator in the Pfizer-sponsored ASAP, TNT, and IDEAL trials, called Pfizer “a real powerhouse” in the CV drug arena.

    “I kind of knew this was coming, but when you see it in print, it still hits hard,” he told heartwire. “I think this is very, very significant both for the company itself and for the whole field of CV drug development. Pfizer had truly excellent people in the development arm of their company for CV and metabolic drugs, and they’ve contributed to this whole notion that you need more robust LDL lowering and that that’s better than mild LDL lowering, which has become one of the axioms of CV prevention. And if they’re stepping out now, that not only signifies their own problems, but it also signifies the problems in CV drug development, and how incredibly difficult and costly it has become to bring new drugs forward. And that’s not good for patients.”

    Kastelein predicts that drug companies, having “lost faith” somewhat in HDL-raising therapies, will need to look more closely at anti-inflammatory drugs in the setting of coronary artery disease. “But there, the problem is, if you have no biomarkers whatsoever to do even dose-finding studies, you need to move from relatively small phase 2 trials to incredibly large, hard-outcome studies, which is taking quite a risk,” he said. And that, at least for Pfizer, is too much risk.

    “Everyone, not just Pfizer, is realizing that the days of the really big blockbuster drugs are over. And what is going to replace that are drugs in a class that are 10 times or 100 times more difficult to develop, so the risks are much higher. And these days, after Avandia and ezetimibe, everything is about safety. This means the FDA is forced, by public and colleague pressure, to demand even larger databases before drugs are going to market, which is of course making it more expensive. It’s a cycle that’s very hard to break.”

    Calls to Pfizer were not returned before this story was published.

    Source
    Herper M. The Pfizer memo. Forbes, September 30, 2008. Available at: http://www.forbes.com/business/2008/09/30/pfizer-drug-agenda-biz-bizhealth-cx_mh_0930pfizermemo.html.

    My comment: they made their hay while the sun shone. Now it’s time for them to move on and no doubt they know more about the adverse effects of Lipitor et al than we know and the excretum is about to hit the fan.

    All the Best,
    Michael Richards

    They may well see the wring on the wall. But although they may be abandoning research into new CV drugs, they’re certainly not backing off the promotion of their workhorse Lipitor. Full page ads in all the major papers and TV ads out the yang.

    What I found interesting in this article is the following quote:

    But there, the problem is, if you have no biomarkers whatsoever to do even dose-finding studies…

    Being able to modulate a biomarker – LDL-cholesterol – is what has made the statins so successful. Not for patients, mind you, but for the drug companies. First you persuade everyone that a lab measurement correlates with disease, then you get everyone to focus on that lab measurement. Then you come up with a drug that changes the lab measurement by a large amount. Finally, you make billions of dollars selling the drug to people who are worried about their lab values. That’s why biomarkers are so important. If the statin folks had had to demonstrate that statins reduced actual disease, they would have been in trouble. But it was easy for them to show that statins altered a biomarker. And who cares if the biomarker is really a biomarker of disease?

  39. Dr. Eades, do you have a way of us submitting an interesting article to you?

    Sure. Just link to it and send it through the comments. People do it all the time.

  40. Two questions you might have covered before:

    1) Do you think we are missing out on any vital nutrients by eating only (or mostly) muscle meats and not more brains, organs and bone marrow like our ancestors probably did? If so, can supplementation rectify this issue?

    2) What supplements do you currently take and why? (I know you have mentioned Vitamin D and CoQ10 and krill oil in the past.)

    Thanks.

    P.S. In order to suck up properly and earn a reply to my rather brusque questions, I have just preordered a copy of your new book.

    You have to neither suck up nor preorder the new book to earn a reply, but I’m glad you did. Would it be too much to hope that you actually placed your preorder through this site? If so, I’ll make an extra 25 cents or so. 🙂

    1) Probably not, especially if you throw in a little liver from time to time as I do. And if you’re worried, supplementation can indeed rectify the issue.

    2) I take one of our Dr. Eades daily vitamin packs daily. I add magnesium (about 300 mg) and vitamin D (5,000 IU) to that. I throw in a CoQ10 and alpha lipoic acid from time to time (there is some in the vitamin pack I take, but I add extra every now and then). I take krill oil, curcumin, and fish oil daily so that I don’t ever use Advil or other NSAIDS. And I throw in some extra vitamin E to stabilize the fish oil. That’s about it, although occasionally I’ll throw this or that supplement back just for the hell of it. But on no regular schedule. I’ll look in my supplement cabinet and see selenium, so I’ll take one once in a while. Or I’ll see a bottle of resveratrol that I got as a sample at some convention, and I’ll throw one back. Stuff like that. It keeps my body off balance, wondering what’s going to come next.

  41. I’m responding to Kathy of Maine’s comment that the recommendation to lower the upper “normal” limit for TSH levels makes millions of women officially in the hypothyroid category and forced to take expensive medication.

    I say, “it’s about time!”. Unfortunately, not enough labs have adjusted their reference ranges yet, so millions of women are still uffering from a variety of hypothyroid symptoms, like infertility, cold intolerance, low resistance to infection, extreme fatigue, sleep disturbances, memory and concentration problems, and more. But they often being told their TSH isn’t abnormal, so it must be something else, or isn’t bad enough to treat. Worse yet, they are considered hypochondriacs, referred to psychiatrists, prescribed a multitude of other drugs to suppress symptoms, instead of addressing the root cause, mild low thyroid function. Thyroid hormone is the master hormone. If it isn’t at an optimal level, none of the cells through out the body work at an optimal level.

    I’m one of those age 40+ (premenopausal) women who had a gradually increasing TSH for more than 13 years (also increasing total cholesterol, with the same graph curve as TSH), but my TSH still in the upper half of the “old” reference range (considered normal). TSH tests were run many, many times (during regular exams, two infertility investigations, and exams when I had problematic symptoms), but always in the reference range, so it was ruled out. No one ever looked at the labs over the years to see the slow upward trend. I didn’t realize it until two years ago, but I also had had multiple symptoms of hypothyroidism the entire time and they increased in severity over time – very low body temp, infertility, constant fatigue, sleep disturbances and sleep apnea (despite not being obese and sleeping on my side with my mouth closed), memory and concentration problems, and more. Many of the most bothersome symptoms had prompted numerous doctor visits, with several Rx written, to manage symptoms, and eventually I was advised to get used to getting old and being a tired mother – everyone was (I was 44yo and knew plenty of other mothers who could run rings around me). Even when I mentioned my suspicions about hypothyroidism to my doctor, she said the TSH ruled it out and I should try some antidepressant samples to see if they would help. I looked that medication up and the potential side effects looked as bad or worse than what I was experiencing, plus I didn’t feel they were more than a band-aid solution.

    I did some research, went to a new doctor out of network who specializes in hypothyroidism and he prescribed a moderate dose of T4 (very inexpensive, BTW) and compounded timed release natural thyroid extract (not cheap, but a bargain IMO) to provide a small amount of T3 (less than the non-physiological % in Armour thyroid). Before long, I felt quite a bit better, most of the physical symptoms resolved, and I finally had a normal body temperature and was no longer wearing wool socks and sweaters during warm So California summers. My husband noticed I no longer woke abruptly with violent coughing fits (apnea) and my son noticed I could read aloud without yawning (that had been a joke since he was a baby – I couldn’t stop yawning when reading aloud,. but not when talking). I got more housework done, and bit by bit, began to dig myself out of the hole I had sunk into.

    Now 2.5 years later, with some minor seasonal adjustments to my thyroid dose, I am nearly myself again. Yes, I have to take a daily medication, but I do it gladly, because I know it is simply a supplement for something my body just can’t make enough of. Most truly euthyroid (healthy thyroid function) people have a rather low TSH, between 1.0-2.0 – higher than that really is suspicious for low thyroid function, even if still in the reference range (like Dr. Eades’ says about the difference between normal and healthy) especially if TSH raises over time.

    I’ve read about the idea that hypothyroidism is connected to LC diets in some cases, but I doubt my LC diet, started almost 5 years ago, caused the thyroid problem, because there were symptoms and increasing TSH results that predate the diet change. Though the LC diet may have unmasked the hypothyroidism. Perhaps the adjustment to burning fatty acids for energy instead of glucose all the time is much more difficult when the thyroid function is low or T4 to T3 conversion isn’t adequate. Environmental factors are sometimes considered (fluoride, mercury, PERC in water supplies, etc.) as well as autoimmune issues. I don’t know what caused my my thyroid to peter out, but I do know that the out-dated reference range prolonged a lot of misery and anguish for myself and my family, not to mention perhaps prevented us from being able to have more children (we only have one, despite 7 years of trying).

    So I am one who is glad to see the upper TSH reference range finally adjusted downward in more labs, because most doctors these days look primarily at the lab values (if it isn’t flagged you’re fine) and ignore the patient and their history (similar to Dr. Eades’ healthy friend who was prescribed Lipitor and unnecessarily worried). Hypothyroidism isn’t something one wants, believe me, but letting it go untreated or mistreated isn’t a good idea, either.

    Hi Anna–

    Good to hear from you. You have an interesting, but, unfortunately, all too common history. I’ve noticed over the years that people in the upper range of what was reported as normal TSH often had many of the symptoms you describe. And I wasn’t shy about treating these symptoms. Just like getting reproductive hormones stabilized, treating thyroid dysfunction is required to help people lose weight successfully and keep it off, even though that wasn’t really a problem for you. Had you come to me as a patient, given your symptoms and your high-normal TSH, I would have probably done an iodine challenge test first. If that had been abnormal, which it almost always is because the vast majority of people don’t get enough iodine, I would have started you on iodine supplements first just to see what happened, then fiddled with thyroid replacement a little later. I’m glad you’re doing so well, but it might still be worth it to add a little iodine.

    Cheers–

    MRE

  42. Um, I forgot one point about the changes in TSH reference range limits. No one is forced to take meds based simply on one lab value; if they feel that way they either need to reconsider their choice of doctor or their understanding of what info the lab provides and what it doesn’t. Yes, that could even mean more tests. It’s a judgement call, and all the judgement isn’t on the doctor’s shoulders.

    If one has a TSH lab test value that suggests hypothyroidism, but the patient feels fine, with plenty of energy and able to function fully, then he/she doesn’t have to take or do anything, even if the doc recommends it. I know some people in that situation. There may be some other things going on, such as a pituitary issue that doesn’t accurately provide feedback function (Thyroid Stimulating Hormone (TSH) is made by the pituitary gland to prod the thyroid gland into production). So, no matter what the lab ref range, no one is forced to take meds if they don’t want to or they don’t think they need to.

    The problem is a lab range and a doctor that arbitrarily rules out treatment for patients who have a lab using the old range, but are suffering from symptoms (I do understand that many hypothyroid symptoms overlap with other situations, such as menopause, etc.). If the TSH and other thyroid tests look less than really euthryroid, a couple of month’s trial on thyroid hormone will safely determine if that will help or not (though it often takes more than a couple months of “tinkering” to get a good dose level sorted out for optimum results – or even addition of some T3 for residual symptoms, especially memory and concentration issues).

    And if the vast majority of normal (euthyroid) people have a TSH value of around 1-2 and medical protocol insists on only treating those inside the “reference range” of .03-5.5 (based on a number of symptom-free test subjects minus the highest and lowest 2.5% values), then that is like fitting a size 10 shoe (normal) on a person with a size 6 (normal) foot and expecting everything to be honky-dory. It’s not. Limiting the upper limit of the reference range to 2.5 or 3.0 (AACE and NACL differ a bit on this) gets the range to more truly reflect normal thyroid function.

  43. Thanks for the followup comment, Dr. Eades. I’ve stayed current with your blog, but I do try to resist commenting so much (except this time!) because I know you can’t help but comment in return ;-).

    I didn’t have the iodine challenge test, but I certainly would have been open to it. I did try manage things nutritionally first, but with no improvement (the best I could figure how on my own, but I was reluctant to follow the supplement dept clerk’s DIY recommendation to load up on iodine).

    As I’ve probably mentioned before, most of my family’s food I now prepare from scratch with many very old-fashioned recipes and I source a lot of the produce locally and most of our meat, dairy, and eggs are pastured and directly sourced, too. Good food for myself and my family is a priority, even if that is the only significant thing I get done in a day. And it isn’t as hard as most people think it is.

    I do make broth with kombu (seaweed) regularly, use unrefined sea salt (but not iodine-enriched), and sprinkle kelp granules on my morning eggs and other foods. Not sure if that is enough iodine though. I’ve just found a new primary care doc (family medicine) within my network who seemed to demonstrate a nice blend of conventional and holistic views during my short “get-acquainted” appt last month (works with bioidentical hormones and compounded Rx – yeah!), so I’ll ask him about my iodine levels next appt (the highly recommended PCP I saw for just a short time last year was let go from the network for being too much of a square peg in a round hole, which of course, is why I liked him).

    My total cholesterol did not go down after starting thyroid treatment (my triglycerides were already low from LC diet), but the HDL went up significantly and my total/HDL ratio “improved” even more. Being a lipid hypothesis skeptic for at least 5 years now, I don’t pay much attention to such tests anymore, but my endocrinologist does focus on those labs and I have to reassure him that I’m familiar with the issues and my numbers don’t concern me (unless cholesterol was too low). I pay more attention to my glucose and HbA1c tests and the direction in which they are heading (IGT).

    Dr. William Davis, of the Heart Scan blog, has mentioned several times mild hypothyroidism as a risk factor for CAD in his posts. Just today, he posted another one, specifically regarding the updated TSH reference range and his patients: http://heartscanblog.blogspot.com/2008/10/thyroid-perspective-update.html

    BTW, I think Dr. Davis may be backing away from as much use of statins and fear of naturally saturated fats.

    Hope you’re right on Dr. Davis backing away from statins and sat fats.

    Iodine deficiency is rampant in this country, and probably worldwide. MD and I follow a pretty good low-carb diet, much like the one you describe as preparing for your family. When we took the iodine challenge test, we were both deficient. We starting taking iodine supplements. For what it’s worth, I couldn’t tell a lot of difference, but MD felt a lot better.

  44. “Despite many of the people showing benefit, many dropped out of the study because they missed carbs and sweets. Apparently eating carbs was more important than survival.”

    As a former carboholic who kicked my carb habit as soon as I found out I have T2 diabetes I find the lack of a survival instinct in people who are in what I call a ‘death spiral’, puzzling. Diabetics are in a virtual minefield when it comes to risks on every side of serious complications and even early death. The Canadian Medical Association recently published a study that found that diabetics with some form of CHD have a life expectancy of 18 years less than non-diabetics. Other studies have shown that diabetics live anywhere from 12-14 years less than non-diabetics. According to my math this means diabetics can expect to live to around 65 years of age. Not great for one’s retirement years. This should be more than enough to motivate diabetics to break their carb addiction. But apparently not.

    Three years ago I had significant loss of tactile sensation in my feet. The feeling has now almost all returned after adopting a low carb diet. Yet when I told diabetic I met recently who has lost most of the feeling in both his feet and is starting to get infections about my results he told me there is no way he is ever going to give up carbs, not for anything.

    Even more amazing was a study I came across recently that found that some teenagers with insulin dependent T1 diabetes are stopping their insulin injections for a period of time and eating pizza, burgers and fries with their non-diabetic friends so they “can be normal”. Scary!

    It beggars belief. See today’s post for even worse examples.

  45. Quote from ‘Diagnosis Greed’ (article today in New York Times Online)

    Scientists in government agencies aren’t above suspicion, either: Angell cites a study of 200 government panels that issued practice guidelines, which found that more than a third of the authors had some financial interest in drugs they recommended. And “perhaps most importantly,” she writes, many members of 16 standing committees that advise the Food and Drug Administration on drug approvals also have financial ties to drug companies. “Although these individuals are supposed to recuse themselves from participating in decisions about drugs made by specific companies with which they have a financial relationship, that requirement is frequently waived by F.D.A. authorities,” Angell writes.

  46. OK, so maybe picking on hypothyroid was a bad example.

    Maybe I’m just jealous because I keep getting high TSH readings (4.89 at my last test in February) and yet can’t get anyone to treat me for it.

    I was given a take-home iodine test, but never did it because I read that iodine deficiency is extremely rare these days since they started putting iodine in salt. Granted, I eat VERY little salt, but still. Gee, maybe I should pursue this again.

    Dr. Eades, would you PLEASE go back into private practice? I swear I’d travel from Maine to California if you’d agree to take me on as a patient!

    Actually, iodine deficiency is very common. And even increasing consumption of salt won’t help much because the kind of iodine found there isn’t all that absorbable.

    If the economy keeps going the way it’s going, you may get your wish about our going back into practice.

    Cheers–

    MRE

  47. res glucose tolerance tests. I often wonder why doctors don’t simply alternate fasting blood glucose tests with tests two hours after a carby breakfast or lunch. For a pregnant mother it could be by the month, for annual physicals it could be done by the year. And further, why send it off to a lab, unless a problem shows up. Just use a good brand meter in the office. Home blood meters are typically within 5% accuracy which is enough. People can see, preferable do it themselves, how to test blood. Us diabetics are often asked to test friends and relatives blood. The only downside is that if someone is high their chances of their doctor doing anything useful is close to zero.

    ps – and when we test someone else, it needs to be always lancet.

  48. also re: glucose tolerance tests–why don’t doctors simply check A1c? Since that’s a sure-fire indicator of a person’s average blood glucose over time, and since it’s relatively cheap and easy.

  49. “Actually, iodine deficiency is very common. And even increasing consumption of salt won’t help much because the kind of iodine found there isn’t all that absorbable.”

    Some medical researchers are making a very good case for widespread iodine deficiency and are recommending a daily supplement in the order of 10 or more milligrams. But I have had a hard time finding an absorbable, high potency iodine supplement. The only one I have found so far is called Iodoral. Do you know of a good iodine supplement?

    Iodoral is a good supplement. It’s the one we use. There are a couple of companies that have sent me info on new iodine supplements they’re making, but I haven’t used the products yet. I’ll probably do a post on the whole iodine deficiency issue after I’ve done a little more product evaluation.

  50. Re: Iodine.

    How much should one aim for in a day? I came across some kelp capsules.

    Iodoral is a pretty good supplement that’s well absorbed. You can find it online. Kelp capsules contain some iodine, but not as much, I don’t think, as Iodoral.

  51. Dr Donald W. Miller, Jr, MD – Professor of Surgery at the University of Washington in Seattle (www.donaldmiller.com) has written a number of articles on iodine deficiency and supplementation. Miller claims that, taken in greater doses than the recommended dietary allowance, iodine has a record of success in reversing fibrocystic breast disease and preventing breast cancer. Miller claims the average iodine intake of Americans is 240 micrograms per day whereas the Japanese consume an average of more than 12 milligrams per day.

    Former professor of obstetrics gynaecology at UCLA, Dr. Guy Abraham, started a study in 1997 called The Iodine Project based on the hypothesis that maintaining whole body sufficiency of iodine requires 12.5 mg per day. According to Abraham whole body sufficiency exists when a person given a 50 mg load of iodine excretes 90% of the iodine load. The iodine project has found that iodine reverses fibcrocystic disease, diabetic patients require less insulin, hypothyroid patients require less thyroid medication, symptoms of fibromyalgia subside and patients with migraines stop having them.

    In the area where I live there appears to be a cluster fibromyalgia. I have spoken with some of the patients. They told me that their symptoms come and go and are often debilitating. Drugs prescribed by their MDs do not help. Since the treatment of this group is managed by a regional chronic illness coordinator for our health care system I passed along one of Miller’s articles on iodine and fibromylagia to her. She dismissed out of hand any possible role of iodine in fibromyalgia by stating that iodine deficiency does not exist in North America because “iodine is added to salt”. Despite the fact that the iodine in salt is not readily absorbed, she and other health care professionals are pushing for a reduction in salt intake which would also reduce the intake of iodine. Perhaps this concept was exceedingly difficult for her to grasp. She went on to state that diseases like fibromyalgia are “far too complicated to be treated with simple things like iodine” (read: fibromyalgia needs lots of pharmaceuticals).

    Insofar as your invitation to bash our socialized health care in Canada I would be more than happy to oblige. However, if I really get started it would take a blog of its own. So I will limit my comments to one of my biggest gripes; a set fee per consult.

    Social medicine is a numbers game for MDs working the system. MDs get a fixed fee which is not based on results (which don’t matter a whit so long as MDs follow established treatment protocols), but on consults. I don’t care how altruistic or humanitarian an MD is when he or she first starts to practice if they can do basic maths it is only a matter of time before they make the connection that the more patients they run through their practice, the more money they make. It is dead simple. And the fastest way to run patients through is to write a script every 4 or 5 minutes. Some MDs excel at speed writing.

    Patients are usually happy because they think scripts represent good treatment. They are also happy because they believe our social health care system is free and they are entitled to free treatment for anything that ails them right up until time they die. If health care costs keep rising at the current rate, Canadians are in for a very nasty surprise. My health care plan says that I have a maximum life time limit of $100,000 after which I pay everything myself. And I have a premium plan with all the bells and whistles. If I get hit with a big one like a transplant and post operative treatment I think $100 K would not go very far.

  52. Thanks for the excuse I need to eat more sushi. Currently I’ve been eating it once a week, maybe that’s not enough. Maybe my problem is that I order mostly sashimi, since maki generally has rice in it. I get one maki order with minimal rice (either uni or ikura), and a spider roll which the chef at my usual place makes without rice for me, and the rest is sashimi. So not a lot of seaweed there. Guess I’ll have to go more often.

  53. My doc has religion – in his mind the ONLY acceptable values for total cholesterol are between 0 and 199. So, we are at odds, as my last check showed 207, and he really wants me on statins. Even if you thought these drugs worked, it seems to require at least a lack of perspective to justify the expense and the side-effects for what looks like margin of error on a lab test. Whatever, not for me.

    However, my question relates to our 17 year-old son who may have just the opposite situation – a real problem that isn’t widely recognized as such. After donating blood, he received a total cholesterol reading back from the blood bank – just 114 (no breakdown). Step 1 is to have the result checked. If we confirm that he’s this low, what additional steps do you recommend? Do you know of anyone in the Dallas medical community who would have a healthy perspective on this?

    Thanks for your books and good work

    I wouldn’t worry about it as long as everything else is okay. Adolescents and young adults often have cholesterol levels in this range. I remember when I was in medical school and we all got our labs checked. Almost everyone had cholesterol levels in the very low range.

  54. Is their a conflict with one’s 1] limiting intake of alpha linolenic acid and 2] taking fish oil capsules (or the alternative cod liver oil capsules)?

    Not as far as I’m concerned.

  55. I have been on the PP diet since the start of the year and have lost about 35 pound. I am stuck at about 205, so I going to try “Boot Camp” from your maintenance book. I started with a new doctor at the end of September. He wanted to know why I had stopped my statin. I explained my memory problems. I have an appointment in December to check my blood values. He did recommend a calcium scan. Since you encouraged this too, I did it this week. I expected a low score due to low carbing, but I blew the top off 3483. (The cost was $250) The nurse who gave me the results seemed to think that I was a walking time bomb. I am sure that the doctor will want to start me on statins again in December. I am 68 and no symptoms. My BP was 140/85 in September in the doctor’s office with my current medications. So now I have this information and don’t know how to use it. I plan to keep on the pp diet, keep up my exercise (45 minutes three times a week on the treadmill). I am listing my supplements, do you have any suggestions?
    Morning (with Tomato Juice)
    Triam/Hctz 37.5/25
    Lisinopril 10 mg.
    CoQ10 100mg.
    TwinLab Krill Oil 500mg
    Alpha Lipoic Acid 100 mg
    Dinner
    Fish Oil 1200 mg
    Turmeric Curcumin 450/50 mg
    Acetyl L-Carnitine 250 mg
    Vitamin D3 1000 mg
    Spectravite Senior alternate with Vision Formula
    Evening
    Magnesium Oxide 250 mg.
    Enteric Aspirin 325 mg.
    Xalatan 0.005% Solution (both eyes)

    Feel free to edit this long post.

    If I were you I wouldn’t wait until December to go back to the cardiologist – I would try to go ASAP. There is some indication that statins do reduce calcium scores, but at what cost? The studies on all-cause mortality for men over 65 show no difference whether on a statin or not, which means that any improvement in heart disease risk if offset by an increase in other risk factors. The studies of the Masai by George Mann showed that these tribesmen who ate a high-meat, high-dairy low-carb diet had fairly significant coronary arterial plaque but no actual heart disease. Their plaque was stable. Stable plaque isn’t all that risky – it’s the unstable plaque that is problematic. It would be nice to have known what your calcium score was a year or two ago. No change between then and now would indicate stable plaque.

    You should spend some time on Dr. Davis blog (see particularly his recent post on Scare Tactics before you see your cardiologist) and join his Track your plaque program. He has had great experience with increasing vitamin D intake in his patients with high calcium scores, so read about that. The 1000 IU your taking falls far short of his recommendation.

    Keep me posted

  56. I took statins for 11 years, finally woke up to the fact that they made me feel awful (depressed and in pain). Quit, and then looked for something better.

    Coronary calcium scoring is a much better way to go. Several points here. You are unlikely to find an EBT machine to do this in New England. New 64 slice CT machines can do the job just fine, with low radiation if prospective gating is used. I paid $150 out of my own pocket for it. (One lab wanted $3,501 for the same procedure – shop around or go to the Track Your Plaque website for help finding one.) I am in the 80th % ile for my age, not good but not devastating.

    I can work my problem for a lot less than the annual cost of my Lipitor. I can measure success with a coronary calcium scan every couple of years. Not cheap, but a great investment in longevity. Plus, I feel so much better, stronger, more athletic, better in the sack, etc. since pitching the Lipitor and correcting some nutritional problems, it is amazing.

    Glad to hear you’re doing so well.

  57. I still want universal health coverage. They have it in the military, and it’s worked out fine. No, I’m not talking about the VA. I was a brat, then a soldier, then an Army wife in the first 25 years of my life, thus a beneficiary of the only single-payer system in the United States. Did you know it takes up less than one-fifth of the Department of Defense budget as of 2007? That’s including all the spouses, kids, and elderly that are also cared for in the system, and by 2007 they were seeing IED survivors from Iraq and Afghanistan as well.

    What I want is for the middlemen to be cut out, the government to be footing the bill and for us to have a lot more choice in what treatments we choose and for what. But it’s no different than having a military or police or firefighters, and we all pay for those, and they still help people too poor to pay taxes. Illness and injury kill more people than war does. Time to look at medicine as a form of national defense.

    It’s not enough to have private insurance. People lose their jobs when they become too sick to work, then they lose their insurance and then they have pre-existing conditions that won’t be covered for too long a time, if ever. Or the only treatment available is “experimental,” so isn’t covered. Or the patient uses up their lifetime maximum on the policy.

    Cutting out insurance isn’t going to help. I once thought as you probably do, that insurance has driven up the cost of care and that we could all afford a doctor when we could pay him cash. Before insurance was invented, medicine was a lot more basic and crude than it is now. And even then there were too many people who couldn’t afford the doctor, which is why insurance was created to begin with. There was already a market for it because people were already getting in over their heads.

    This is just one of those issues on which we’re going to have to bite the bullet and distribute the risk. And I hate to say it, too, because I know the government is capable of overstepping its bounds and often willing to do so to boot. But I hate the idea of people dying unnecessarily even more.