Garlic and cholesterol--Does everyone now need Lipitor?

Garlic May Not Lower Cholesterol
Study Shows No Improvement in Cholesterol Levels From Raw Garlic or Garlic Supplements

Lots of reports continue to hit the press about a small study that hoped to determine whether garlic as whole cloves (4 to 6), an aqueous extract of garlic called Kyolic, or an oil extract called Garlicin (high in allicin), or placebo. No differences in lipid numbers including LDL cholesterol were observed.

(Full text at WebMD at http://www.webmd.com/cholesterol-management/news/20070226/garlic-may-not-lower-cholesterol?ecd=wnl_chl_030507. You may be required to log in or register.)

I believe that the researchers were sincere in their effort to follow an honest, scientfically sound clinical trial design. I'm personally not that surprised. The effect in prior studies has been modest, sometimes none. Does that mean that we should ignore the other studies that suggest there may be modest blood-thinning, anti-inflammatory, blood pressure-reducing, and cancer-preventing properties? No, it does not. Dr. Matt Budoff at UCLA even published a very small study in about 20 people that suggested a slowing of plaque growth by using Kyolic in persons tracked by CT heart scans.

Nonetheless, garlic is, at best, probably no more than a source of small benefits. The biggest fallout from this kind of report, however, is not the neutral results from garlic, but from the open door the drug companies sense when this happens.

If you read the WebMD report, you'll notice all sorts of advertisements from drug companies for statin cholesterol drugs ("Cholesterol health center"; "Understanding Cholesterol Numbers"; "There are two sources of cholesterol: food and family"), Niaspan (which I used to support but have been discouraged by the Kos companies excessively profiteering methods and recent big Wall Street sellout).

It doesn't follow. The failure of one nutritional strategy to reduce LDL does nothave to trigger a run to the drugs. Don't fall for it. Drugs have their place. So do supplements and food choices, which can be very powerful. Drug manufacturers and their marketing people salivate when something like this comes along, an open invitation to say, "If garlic doesn't work, _____ sure does."

Comments (1) -

  • buy jeans

    11/3/2010 4:57:40 PM |

    If you read the WebMD report, you'll notice all sorts of advertisements from drug companies for statin cholesterol drugs ("Cholesterol health center"; "Understanding Cholesterol Numbers"; "There are two sources of cholesterol: food and family"), Niaspan (which I used to support but have been discouraged by the Kos companies excessively profiteering methods and recent big Wall Street sellout).

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Scare tactics

Scare tactics

Does the media engage in scare tactics?

Read the headlines in local newspapers, and you'd believe that your friends and neighbors are dropping like flies, all victims of heart attacks.

I occasionally peruse the headlines run in newspapers and magazines around the U.S. by subscribing to a feed service through Google. For the phrase, "heart attack," you can get a sample of what is being said around the country about people having heart attacks.

What continues to impress me is just how far off a truly constructive and helpful message the media provides every day. Not only are they guilty of delivering a flawed message, they also favor headlines and stories that scare the heck out of people. "This could happen to you!"

Is it just the quest for headlines that grab readers' attentions? Is there some complicity with the medical systems that pay significant advertising revenues for their heart disease programs and hospitals?

I doubt such complicity exists to any substantial degree. But the fact remains: Every day across the U.S., the media does an effective job of scaring the heck out of the public--enough for you to run to your doctor or hospital to find out if you, too, could fall victim to heart disease. A stress test, perhaps heart catheterization, three stents or bypass often results.

In effect, these headlines make great hospital PR, an inducement that flushes out the patient highly motivated to pursue further costly heart testing--whether or not it's needed.

A sampling:

Stress test could help prevent sudden heart attack

DAWN ZERA Times Leader Correspondent

Bob Schultz, 67, was feeling a persistent pain in his back, which he was pretty sure was caused by working on a deck for his son’s home.

But after the deck was finished, the pain was still there.

“It was nagging, but not enough to hurt,” Schultz said.

He visited his primary care physician, thinking maybe some muscle relaxants would be prescribed. The doctor sent him to a clinic in Tunkhannock to do a complete body CAT scan, and then had Schultz do a stress test. The on-site cardiac stress testing at a Geisinger Medical Group office in Tunkhannock showed that things did not look good: Schultz had a blockage. He was scheduled for a cardiac catheterization.

It was a surprise; a heart problem had not even crossed Schultz’s mind as a possible cause of his back pain.

“I had good cholesterol, have been the same weight for years, and had excellent blood pressure,” Schultz said.

He went for the catheterization at Geisinger Wyoming Valley, and there doctors discovered Schultz’s condition was even more serious. He had three blockages – 99 percent, 95 percent and between 80 and 90 percent.

“It shocked the living daylights out of everyone. It was surreal,” Schultz said.

The catheterization turned into open heart surgery that very same day.

The surgery was on a Tuesday, and he was home by Sunday. He never even had time to fully think about having the operation. And he had never experienced the typical warning signs of a heart problem, such as chest pain or shortness of breath.

“The doctors said I had the worst alarm system they’d ever seen,” Schultz said. “They probably saved my life, with me not knowing I had a problem.”

It also made him think about his brother, who had had been in good health but suddenly died in his 40s of a suspected heart attack.

“We never had any heart problems in our family, so we never believed it. But now I think, geez, it probably was true,” Schultz said.

His experience has served as a cautionary tale for friends and family. Just this past month, a friend specifically requested a stress test for himself.

“It sets off alarms in your circle. People think ‘if it can happen to him, it could happen to me,’ ” Schultz said. “It triggered people to think about what could happen to them.”



Firefighter Saves Heart-Attack Victim on D.C. Court

ABC News

A 30-year-old man suffered a heart attack while playing basketball on a D.C. court.

That's when a Brian Long's firefighter training kicked into action. The 25-year-old D.C. firefighter's team had just finished their pick-up league game Friday evening at Lafayette Elementary School's basketball court when the man stumble to the ground.

"He ran a few feet and collapsed again so I turned him over and I looked at him his eyes rolled back and he just stopped breathing," Long said.

Long began performing chest compressions and soon he was joined by Anthony Gadson, a pharmaceutical sales representative, who learned CPR years ago and starting assisting with mouth to mouth resuscitation.

"If that were me, somebody would've done the same thing for me, so I feel like I did what I was supposed to do," Gadson explained.

While Long and Gadson worked to keep the victim's heart going, all the players and spectators, including teammate and league commissioner Bob Johnson, gathered around the lifesaving effort.

"We gathered in a circle and one of the wives of one of the players just led us in this huge prayer," said Johnson.

"It makes me feel great," Long told ABC 7/NewsChannel 8. "I am just glad that I am a D.C. Firefighter."



Free Drugs After Heart Attack Would Save Money, Lengthen Lives
More patients would take recommended medications, study says


By Ed Edelson

MONDAY, Feb. 18 (HealthDay News) -- Eliminating the cost of medications for people who have heart attacks would lead to longer lives and lower overall medical costs, new research suggests.

"These are highly effective medications that are relatively inexpensive, and the events they are designed to prevent are extremely expensive," said study author Dr. Niteesh K. Choudhry, a researcher in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston and an assistant professor at Harvard Medical School. His report is published in the Feb. 19 issue of Circulation.

The study covered four drugs commonly prescribed after heart attacks -- aspirin, beta blockers, ACE inhibitors or angiotensin receptor blockers (ARBs), and statins. Use of those drugs is relatively low under the current system, in which people share the cost with Medicare or other health insurance plans, Choudhry said. For example, only 46 percent of people take beta blockers after heart attacks, and only 50 percent take cholesterol-lowering statins. Less than 20 percent of heart patients used all four of the medications, according to the study.

The model set up by Choudhry and his colleagues doesn't assume a major increase in compliance with prescriptions, because "cost is just one reason why patients do not take medications," he said, adding that relying on previous studies of drug cost and use, the model assumes an increase of about 14 percent, with perhaps 64 percent of people taking the medicines if they were free.

The result would be an increase in average survival after a heart attack, from the present 8.21 quality-adjusted life years to 8.56 years. "That is small in an absolute sense, but in an aggregate sense, it is very large," Choudhry said.

And medical costs over a lifetime would go down, from the current $114,000 to $111,600, the study added.

"This study adds to a growing body of research showing how important it is to reduce or eliminate patient co-payment for drugs," said Robert M. Hayes, president of the Medicare Rights Center in New York. "Medicare should take the lead in forging the creation of drug coverage that allows patients to get the medications their doctors consider vital."

"It certainly makes sense from the medical point of view," said Dr. Richard A. Stein, a professor of medicine at New York University. "Studies have shown that giving even middle-income people free drugs improves outcome. The greatest benefit will go to people in the lower socioeconomic and immigrant population."

But the study is theoretical, Stein noted. "One would like to see some real-world trial to determine whether this works in fact, whether providing free drugs without co-payment would make a difference, he said.

Such a study has begun at Harvard, Choudhry noted. His group is working with a major health insurer, not Medicare, in a trial that assigns some people to get medications without cost, while others will get the standard co-payment.

"It will take several years for us to get answers," Choudhry said. But similar investigations are being started by other medical insurers and corporations, he added.

The idea is potentially applicable to some other chronic conditions, such as congestive heart failure and diabetes, Choudhry noted. And, if the use of recommended medications after a heart attack goes up more than predicted by the model, "the cost savings would be phenomenal," he said.

More information

To learn about how to stay on your statins, consult the National Heart, Lung, and Blood Institute.




Heart Attack Threatens Young, Old

BAKERSFIELD, Calif. -- Nearly 1.2 million men and women suffer a heart attack every year in the United States, according to the American Heart Association. However, not all of the victims are old.

Brian Connell considers himself a lucky guy. At the age of 39, he's physically active, he has a high-level job, and he is also a heart attack survivor. "I know I was overweight and obviously had some other risk factors against me," said Connell. "I wish I did more to prevent it, certainly."

Connell is doing plenty of things now. He met with a nutritionist and changed his diet. He gets regular exercise and takes medication to control his cholesterol. He also gets regular checkups.
Click here to find out more!

Cardiologist Jeffrey Popma said it's not unusual to see younger heart attack patients. "We have dozens of patients in our system every year who have been under 40 years old who have suffered a major heart attack," said Dr. Popma.

Popma said getting medical help quickly is the key to survival. Connell said that is what made all the difference for him. And when people ask him if that was his first heart attack, Connell said he is quick to tell them it was his last heart attack.

Copyright 2008 by TurnTo23.com. The Associated Press contributed to this report. All rights reserved.


The messages I take from such stories:

1) Get yourself to a hospital ASAP for any symptoms even vaguely suspicious of heart disease, because they will know what to do. You'll be doomed if you don't.

2) Hospitals and doctors are expert at saving you from the brink of disaster. The process, once you enter, is rapid and smooth and you will be eternally grateful.

3) Medicines save lives. You're going to die if you don't take medication.


As I've often said, one of the toughest battles of all in health and heart disease is sorting out fact from fiction. Unfortunately, the media continues to propagate the scare tactics that support the status quo of procedural heart care. Wittingly or unwittingly, they serve a $400 billion dollar a year gargantuan industry that remains hungry for growth.

Lost in the headlines are the messages that could have been included, like:

Heart disease detectable decades before disaster

Or:

"Heart disease preventable, reversible, and--curable?"



Copyright 2008 William Davis, MD

Comments (17) -

  • Knight

    2/19/2008 3:46:00 PM |

    I believe the media does over-hype almost all health related issues, including drug drug interactions and adverse reactions.  With regards to taking your medication though, there have been several reports that confirm if you are non-adherent to your medication, you raise the risk of having another heart attack and possibly dying.

  • Anonymous

    2/20/2008 1:43:00 AM |

    Since I am the subject of your blog, I'd be happy to comment.  The point of the story is that there are things you can do to prevent heart disease and an MI.  I don't believe this was spun by the media and I was happy to be part of it.  In fact I am confident that if people take this advice on warning signs seriously they have a better chance of survival and it could even save lives.  I'm happy I took part in the article, you should stop your scare tactics of the industry that albeit profitable is saving lives.

    Brian Connell

  • Dr. Davis

    2/20/2008 2:05:00 AM |

    I'll be damned if I stop criticizing the status quo in heart care.

    You are entitled to your opinions. People are entitled to continue submitting their lives and health to the endless appetites of a procedure-obsessed health care system. I personally would rather seize control over my health and be provided truly effective preventive strategies. You clearly have not been provided this information.

  • stress

    2/20/2008 6:26:00 AM |

    I felt that your post was highly enlightening. http://www.howtorelievestress.org
    has a lot of tips on managing your stress! I find this website very useful.It definitely helped me, and I can see an improvement in my condition already.

  • Bob

    2/20/2008 4:56:00 PM |

    Yes - the media hypes almost everything to excess whether it be the weather, economy or health related procedures. I find it highly unlikely that prevention will ever be hyped in the mainstream since prevention is not a money maker and is not "exciting". Too much pharma revenue would be lost even if people took the simple step of normalizing vitamin D levels let alone any other "provocative" measures such as reducing sugar intake etc.


    Bob

  • mike V

    2/20/2008 5:13:00 PM |

    Surely there is a place for education in both prevention and emergency treatment. The problem is achieving a balance of emphasis.
    While I have clearly benefited from the preventive approach, (0  score at 72) my wifes maternal uncles all died of MI in their 40's and 50's except for the one who made it to 60's inspite of a stroke. Her mother made it to 90following two MI's and with conventional treatment including two cabg's.
    Until the better preventive approaches are given equal time, and a couple of generations have benefited, we will need both kinds of awareness.
    Typical media articles (and cardiac advice) reflect the lifestyles, errors and distortions of the past 30 years. Dr D's advice is excellent, and I appreciate his frustrations at the long uphill battle.
    mikeV

  • g

    2/20/2008 7:31:00 PM |

    Mr. Connell,

    (You're the second Brian to blog and start some *umm* drama) I'm sorry to hear about your event but I agree with you, it's good to get the news out.  

    By generous measures, according to the statistics, you life will require 'saving' yet again in approx 15 yrs if you follow 'conventional' wisdom and your docs in Bakersfield (no doubt there adequate but not as good as DR. Davis and TYP -- Track Your Plaque program).  

    (you are aware i hope that statins won't save your life, right?)

    Good luck.

    (FYI ask your Bakerfield docs to check: lipoprotein (a), homocysteine, and glucose -- you need to improve these to prevent those native vessels, bypassed vessels and stents from clogging up)

    g

  • Anonymous

    2/20/2008 9:55:00 PM |

    Hey Mike V., what have your preventitive measures been these past 72 years?

    Thanks, Daniel

  • Anonymous

    2/21/2008 2:35:00 AM |

    Hello g,

    Not trying to start controversy, quite the opposite. My doctors are in Boston, not California, and the article that was posted by this ABC affiliate was never viewed by me, it was their edit of the AP.

    Here's the real story URL:

    http://www.cnn.com/2008/HEALTH/conditions/02/18/hm.young.heart.attack/

    I participated in this article to provide a hopeful message which I believe is a much more positive headline and message and aired on CNN Headline news this past week.

    All the best to all of you with your efforts for heart health and heart disease prevention.

    Brian Connell

  • Dawn Zera

    2/21/2008 7:13:00 PM |

    Dr. Davis --
    Interesting discussion.
    I assure you that I take my job as a journalist as seriously as you take your job as a doctor. I would never presume to assume that your motives were anything other than to do your job well.
    While I may agree with many of your points (i.e. procedure-obsessed health care system, preventive health care strategies), I take issue with your assumptions of how I go about my work as member of "the media" -- IN NO WAY was my intention to over-hype anything.
    The area we live in has an unusually high number of people with heart problems and heart attack deaths.
    Is there no value in this story?

  • mike V

    2/23/2008 3:49:00 AM |

    Nothing too surprising Daniel.

    About 10 years ago I lost faith in the 'prevention' of the time which was low fat. I needed gall bladder surgery inspite of my 15 to 20 miles per week walking/running to offset sedentary profession.
    Moved away from excessive carbs, and towards whole foods. Supplement a few places where diet and lifestyle still don't quite make it. Independently ended up surprisingly close to Dr D's recommendations emphasizing fish oil (3Gm), vitamin D3 (4000iu  depending on season), magnesium citrate, CO Q10.  
    Diet leans toward mediterranean.
    Oils: Limited to ev olive 20%, light olive and canola 40% ea. No other.
    Wine: Pinot Noir. Tea: green and black.

    Plenty of greens, small berry fruit, citrus.
    Big on cheeses. Esp strong flavored, fermented varieties.
    Omega 3 eggs
    Throw in some spices, cocoa, walnuts, p-nuts,
    I try to maintain variety, and not to get too hung up on any one nutrient.
    My HDL moved from low 30's in my 40's to about 50 now.
    No long term meds. except thyroid. Have not had a cold or flu this year. Tendency to tendonitis sometimes limits excercise to treadmill. Resting pulse 50.

    FWIW My father passed with MI @ 76 (had signs of prior MI) Mother passed @ 92. Chief complaints: CHF, ARMD

    Hope this is helpful.
    MikeV

  • jpatti

    2/23/2008 6:19:00 PM |

    You summarized one of the main ideas propogated by this type of media: "1) Get yourself to a hospital ASAP for any symptoms even vaguely suspicious of heart disease, because they will know what to do. You'll be doomed if you don't."

    I had "heartburn" for a week before I went to the ER, got an EKG and blood workup and was sent home with some antacids, feeling foolish for overreacting.  Two days later, after spending the whole night alternating puking and screaming, hubby took me back to the ER and they decided to transport me in an ambulance to another hospital for an emergency angio, which was followed up by a CABG.  In short, two days after a "good" EKG, I needed two surgeries to repair my heart.

    I asked our internist to refer my husband for a heart scan and he wrote referrals for an EKG and stress test instead.  We skipped them and the heart scan is next month.  

    A stress test doesn't show anything unless there's an actual *blockage* - a heart scan shows arteriosclerosis before it gets to that point.  And my own experience is that an EKG doesn't show anything even two days before an MI.  To hell with that.  

    If hubby gets anything other than a zero calcium score, next step is a VAP lipid test to begin correcting his issues.

    The whole *point* of the exercise is for him to *avoid* what happened to me.  Yes, it's wonderful they can do angios and bypasses, but... it's been EIGHT MONTHS since mine, and I still can't go back to work!

    So yes, I'm alive and all, but it'd be damned preferable had I gone at it from a prevention standpoint a few years earlier.

  • Anonymous

    2/24/2008 8:16:00 AM |

    Thanks Mike V, That's intersting - but it sounds like until you were 62 you practiced the low fat diet? Daniel

  • Rick O'Shay

    11/4/2008 7:25:00 PM |

    I didn't really have the scare tactics.  My heart attack was out of the blue.  I was in perfect health.  Or so I thought.  My PCP did say I had High cholesterol and was on meds for that.
    2 weeks before I had my first MI(in the gym no less ) I had been going to my PCP with nausea.
    I've been wondering if this was a precursor to the MI.
    2 months latter I had a massive heart attack (the widow maker as you say ) causing a lot of damage to the heart muscle.  My EF was 25 it is now around 30.  My cardiologist reccomended an ICD which I have now.
    I have devoted my blogg to helping people with their feelings in dealing with CHF and other heart problems, by telling my story.  It's very theraputic for me.
    But I may be giving wrong advise.
    I am no Dr. just a patient with heart problems.
    Thank you for taking time with your blogg and for the information.
    Some time when you have nothing to do, which I'm sure is rare. Check out my blog @ www.richosea.blogspot.com
    I might have a lot of missinformation.  I also have an article coming out this month in EP Digest.  "A patient's perspective"
    Thanks again
    Rick O'shea

  • Mark D.

    8/18/2012 8:00:56 PM |

    Over a decade ago, I was diagnosed with coronary artery disease.  I was told I needed a multiple bypass operation.   I was threatened with likely death if I did not agree to surgery.  Actually, I probably was close to having a plaque rupture, but I knew that surgery was not the answer.  I knew I had to get my dietary habits under control.  Because of metabolic syndrome, I also needed some additional medication.  

    I got my diet under control.  My wife and I focused on home cooking with fresh foods rather than processed foods.  I have taken a truckload of pills during the past decade.  I began exercising regularly.  I changed careers to reduce my stress levels.  I had my cardiologist do check-ups on me quarterly.  But, I have been steadfast about declining stents and bypass surgery.  

    Most recently, my wife and I have eliminated wheat and wheat flour from our diets, after reading Dr. Davis' book, "Wheatbelly".  This step actually substantially eliminated my exercise induced angina!  

    I look forward to many more years of improved health.  I particularly enjoy sending some of my early interventional cardiologists annual Christmas cards containing greetings along the lines of the old Timex commercials, "Takes a licking and keeps on ticking."

  • Dr. Davis

    8/23/2012 2:02:11 PM |

    That's excellent, Mark!

    You bucked the hungry revenue-generating medical system.

  • Bill Treat

    6/19/2013 3:04:04 AM |

    Hi Mark:  Bravo on your choices.  I am being pressured to have a cath by a pushy cardio nurse.  My choice at this point is to have a C-RP test, since I have NO symptoms, just what the cardio MD SAYS showed up on the EKG, and 2 short episodes when I was wearing the heart monitor.  I don't like fear-mongering.  Not my style, and I'm inclined to push against that.

    Any comments/suggestions will be appreciated.  I have, since a stroke @ 59, 14 years ago, made a living as a very active, ladder climbing painting contractor.

    Bill in Charlotte

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