The Older Middle Aged Man: Part 3 - The Cholesterol Issue
In my last blog entry I covered the hormonal issues pertaining to my older middle aged man and how the therapy that he received was not only inadequate for his situation, but actually worked to do him harm. And in keeping with the concept of the Hippocratic Oath as “first do no harm,” I thought it best to now describe how this man was hurt with respect to his moderately high cholesterol.
As you may recall from my first blog entry when describing the older middle aged man I mentioned that his cholesterol was elevated and he was given Lipitor. There was no exit strategy given for this man. Most often people put on this medication are told to take it for the rest of their lives. This is often done without concern for the drug’s damaging effects to the liver or its depleting effects on Co Q-10 levels in the body which can lead to muscle pain and even cardiac abnormalities. Not to mention its questionable use at all with respect to any actual effect on mortality rates. These drugs are among the most widely prescribed medications in the country. So let’s explore this a little further and decide if it is even necessary.
I had mentioned that the cholesterol lowering model for heart disease is outdated and here’s why… Cholesterol is carried around the body contained within small bubbles called lipo-proteins. Namely High Density Lipo-protein (HDL) and Low Density Lipo-protein (LDL). This refers to the bubble carrying cholesterol and not the cholesterol itself. Most people do not realize this. It is the size and number of these carrier bubbles that determines true cardiac risk. Quite often these bubbles will be empty of cholesterol but will still lead to heart disease. That is why approximately 50% of people who die of heart disease have normal cholesterol. Simply looking at cholesterol numbers isn’t adequate to determine risk. So why then is there a multi billion dollar industry based on this model? Why are older middle aged men like the one I have described getting put on these dangerous medications. In fact, why are women, young men, people who have had heart problems, and anyone who has cholesterol over 200 getting put on these medications for life? In my opinion it is profit and profit only. Current research shows that simply lowering your cholesterol does not have any dramatic effect on mortality rates. Don’t just take it from me, look it up yourself and then look at all of the side effects of statin drugs. You will make up your own mind. And when you do, consider the risk to benefit ratios here.
So what can be done then you ask? Now that you have mustered up the nerve to challenge the medical establishment, what will you do then? The answer is plenty. One of the easiest ways to regulate your cholesterol balance is through aerobic exercise. This will work to lower the “bad” types of lipo-proteins and elevate the “good.” Finding the proper form of Niacin will lower the most dangerous type and elevate the good much more effectively than any statin can ever hope to achieve! Fish oils work very effectively to lower Triglycerides and certain types of bad cholesterol. There are also several herbal formulas that can be very helpful as well without the damaging side effects of medications.
The bottom line here is that people are being given medications without regard for their dangerous side effects. As I mentioned before, according to the CDC, MD’s are the fourth leading cause of death in America for people over 65. It is the use of medications like these that can have this effect. In the case of this older middle aged man we went into it knowing of his already depressed liver function. It is a known fact that these medications will stress the liver. So why give them to someone with already depressed liver function? In this way all by itself you have to consider the “first do no harm,” oath of medicine. But not only that, consider the implications of misleading this man into taking a medication that will probably have no effect on his risk factors anyway!
At what point did mainstream medicine loose sight of this promise to the people? Oh the poor older middle aged man!
As you may recall from my first blog entry when describing the older middle aged man I mentioned that his cholesterol was elevated and he was given Lipitor. There was no exit strategy given for this man. Most often people put on this medication are told to take it for the rest of their lives. This is often done without concern for the drug’s damaging effects to the liver or its depleting effects on Co Q-10 levels in the body which can lead to muscle pain and even cardiac abnormalities. Not to mention its questionable use at all with respect to any actual effect on mortality rates. These drugs are among the most widely prescribed medications in the country. So let’s explore this a little further and decide if it is even necessary.
I had mentioned that the cholesterol lowering model for heart disease is outdated and here’s why… Cholesterol is carried around the body contained within small bubbles called lipo-proteins. Namely High Density Lipo-protein (HDL) and Low Density Lipo-protein (LDL). This refers to the bubble carrying cholesterol and not the cholesterol itself. Most people do not realize this. It is the size and number of these carrier bubbles that determines true cardiac risk. Quite often these bubbles will be empty of cholesterol but will still lead to heart disease. That is why approximately 50% of people who die of heart disease have normal cholesterol. Simply looking at cholesterol numbers isn’t adequate to determine risk. So why then is there a multi billion dollar industry based on this model? Why are older middle aged men like the one I have described getting put on these dangerous medications. In fact, why are women, young men, people who have had heart problems, and anyone who has cholesterol over 200 getting put on these medications for life? In my opinion it is profit and profit only. Current research shows that simply lowering your cholesterol does not have any dramatic effect on mortality rates. Don’t just take it from me, look it up yourself and then look at all of the side effects of statin drugs. You will make up your own mind. And when you do, consider the risk to benefit ratios here.
So what can be done then you ask? Now that you have mustered up the nerve to challenge the medical establishment, what will you do then? The answer is plenty. One of the easiest ways to regulate your cholesterol balance is through aerobic exercise. This will work to lower the “bad” types of lipo-proteins and elevate the “good.” Finding the proper form of Niacin will lower the most dangerous type and elevate the good much more effectively than any statin can ever hope to achieve! Fish oils work very effectively to lower Triglycerides and certain types of bad cholesterol. There are also several herbal formulas that can be very helpful as well without the damaging side effects of medications.
The bottom line here is that people are being given medications without regard for their dangerous side effects. As I mentioned before, according to the CDC, MD’s are the fourth leading cause of death in America for people over 65. It is the use of medications like these that can have this effect. In the case of this older middle aged man we went into it knowing of his already depressed liver function. It is a known fact that these medications will stress the liver. So why give them to someone with already depressed liver function? In this way all by itself you have to consider the “first do no harm,” oath of medicine. But not only that, consider the implications of misleading this man into taking a medication that will probably have no effect on his risk factors anyway!
At what point did mainstream medicine loose sight of this promise to the people? Oh the poor older middle aged man!
The Older Middle Aged Man: Part 2 - Oh The Hormones
Ok... So now I have done my best to describe to you one way that a health care scenario can go. I would now like to tell you how I might approach the same problem from a "functional medicine" approach.
The first thing to be done would be to get some tests of our own. I would probably use both blood and salivary hormone tests. I find the ones that are ordered by docs are full of holes and don’t usually offer the whole picture. In this case it is best to do it yourself and avoid the managed system as much as possible. After all, why should an insurance company tell you what is medically necessary? These tests are easy to order, and I would be more than happy to make sense of them for you.
So first I would like to rule out any blood sugar disorders, anemia, adrenal disorders and obvious signs of liver dysfunction. All of which can stop the body from being able to regulate itself. A very likely scenario with this man is that there will be high blood sugar in the mix.
There occurs a nasty cycle with high blood sugar/insulin and the conversion of testosterone into estrogen in men. (The opposite for women) This is well documented and happens more than you want to know. What we are seeing clinically with this older middle aged man is a swelling prostate, weight gain in the hips and breasts, low libido and some mild depression. All of which are symptoms that can occur when the testosterone/estrogen balance is shifted away from testosterone dominance. Afterall, he is a man and should be testosterone doninant. Without correcting the blood sugar problem first there is no way to correct the hormone problem. It simply does not matter how much hormone you give him. The problem will not go away.
In fact, giving that man more testosterone in the form of gels or patches is basically like giving him estrogen, which of course will make the problem even worse. The shift of testosterone to estrogen occurs in the fat tissue. The fatter and higher the blood sugar the man has the more estrogen he will create. This very basic and well documented fact is overlooked on a grand scale in mainstream medicine and men are being given hormones anyway. These men are being injured. And the more estrogen a man has, the more other hormones like DHT are going to end up ‘stuck’ in the prostate, further stimulating it to grow and possibly to develop cancer. So by injured, I really mean injured.
The harm done by exogenous hormone use is really quite staggering, which is why I chose to write about this particular problem with this man's treatment first. Hormone therapy often times makes you feel much better at first but can then give way to a "crash and burn" situation really quickly. And getting off of the stuff can be really uncomfortable.
Stay tuned for my next installment as I discuss the cholesterol problem, and how people are getting outdated information as a cornerstone for their cholesterol management.
Oh that poor older middle aged man....
The first thing to be done would be to get some tests of our own. I would probably use both blood and salivary hormone tests. I find the ones that are ordered by docs are full of holes and don’t usually offer the whole picture. In this case it is best to do it yourself and avoid the managed system as much as possible. After all, why should an insurance company tell you what is medically necessary? These tests are easy to order, and I would be more than happy to make sense of them for you.
So first I would like to rule out any blood sugar disorders, anemia, adrenal disorders and obvious signs of liver dysfunction. All of which can stop the body from being able to regulate itself. A very likely scenario with this man is that there will be high blood sugar in the mix.
There occurs a nasty cycle with high blood sugar/insulin and the conversion of testosterone into estrogen in men. (The opposite for women) This is well documented and happens more than you want to know. What we are seeing clinically with this older middle aged man is a swelling prostate, weight gain in the hips and breasts, low libido and some mild depression. All of which are symptoms that can occur when the testosterone/estrogen balance is shifted away from testosterone dominance. Afterall, he is a man and should be testosterone doninant. Without correcting the blood sugar problem first there is no way to correct the hormone problem. It simply does not matter how much hormone you give him. The problem will not go away.
In fact, giving that man more testosterone in the form of gels or patches is basically like giving him estrogen, which of course will make the problem even worse. The shift of testosterone to estrogen occurs in the fat tissue. The fatter and higher the blood sugar the man has the more estrogen he will create. This very basic and well documented fact is overlooked on a grand scale in mainstream medicine and men are being given hormones anyway. These men are being injured. And the more estrogen a man has, the more other hormones like DHT are going to end up ‘stuck’ in the prostate, further stimulating it to grow and possibly to develop cancer. So by injured, I really mean injured.
The harm done by exogenous hormone use is really quite staggering, which is why I chose to write about this particular problem with this man's treatment first. Hormone therapy often times makes you feel much better at first but can then give way to a "crash and burn" situation really quickly. And getting off of the stuff can be really uncomfortable.
Stay tuned for my next installment as I discuss the cholesterol problem, and how people are getting outdated information as a cornerstone for their cholesterol management.
Oh that poor older middle aged man....
The Older Middle Aged Man: Part 1
To begin this blog on “Functional Medicine” I would like to first describe to you an experience of which many of you are probably already well versed.
The story begins with an older middle aged man who has been noticing that he is beginning to gain weight around his midsection and hips and seems to be developing breasts. This might be easy enough for him to ignore, which he has for some time now, but he is also getting tired and depressed and it is starting to affect his golf game. Not to mention that his wife is complaining of his lack of stamina in bed. In fact, let’s just go a step further and say that his wife makes the doctors appointment for him and tells him if he doesn’t go she’ll leave him and take the dog with her! In my experience this is often the way it goes. But nonetheless, an appointment with a doctor has been made and he actually attended though the older middle aged man is filled with dread of what he might be told. After all, his manhood is on the line! The following is a likely scenario of what might occur at the appointment.
Once he is admitted into the exam room he is told to undress and put on this loose gown. He never did like wearing gowns. Meanwhile the man’s eyes are darting left to right, ever scrutinizing each and every drawer looking for some offending instrument that will most definitely occupy his body and feed the ever growing anxiety of what’s to come. In comes the doctor. Blood pressure 155/80, pulse 80, weight 210 lbs, height 5’9”. “Now bend over please.” Oh boy, here we go! Prostate slightly hardened and enlarged. “Any trouble urinating?” The doctor asks a few more questions, glares down his nose a little and decides to order a blood test. He wants to know about this man’s cholesterol, testosterone, and some other stuff. Now for the needle. Two vials should do the trick. At least the nurse is good at taking blood!
Exactly seven minutes after the doctor entered the room he was gone again. Besides a little small talk to break the ice the older middle aged man didn’t know much more than when he walked in and he leaves not feeling any better about himself to say the least.
The tests are in. Total Cholesterol 210. Some slightly decreased liver function. And slightly low testosterone. The doctor prescribed Lipitor, Androgel (a testosterone replacement gel), and what the hell some good old Prozac to fend off the mild depression. Done… Case solved right? As far as the medical establishment is concerned that’s what this older middle aged man needs. He will continue on this course of therapy until death. And if he is a really good patient he won’t ask any questions.
That tends to be the story for a lot of people. The same is also true for women and children. I just used the story of the older middle aged man because I wanted to work in the prostate exam somehow. It is a fun topic! But the bottom line is that this patient’s needs have not been met. Care was not given to find out what was going on “functionally” to lead to these apparently unrelated issues. He has been made yet another victim of “replacement medicine.” And I say victim because in my practice I see people harmed this way all of the time. And by harm I mean that these people are often made dependant of these medicines with no easy way to get off of them. What people need to realize is that these types of medicines work to weaken the body’s natural ability to regulate itself and then they end up weaker than before starting the treatment. Hint: Why do you think there is no exit strategy for a lot of these medications?
So that's my first blog entry... I will follow this entry with a follow up on why this patient's needs were not met, and offer some of my own opinions of how to better address the situation. Please stay tuned for more info on this older middle aged man as I pick apart the problem and explore what the root of the problem really is.
I look forward to starting my blog. I can only see wide open skys for different concepts and interactions with people pertaining to health. I hope to be a great resource for you. Enjoy and learn! And for heaven's sake... comment!
The story begins with an older middle aged man who has been noticing that he is beginning to gain weight around his midsection and hips and seems to be developing breasts. This might be easy enough for him to ignore, which he has for some time now, but he is also getting tired and depressed and it is starting to affect his golf game. Not to mention that his wife is complaining of his lack of stamina in bed. In fact, let’s just go a step further and say that his wife makes the doctors appointment for him and tells him if he doesn’t go she’ll leave him and take the dog with her! In my experience this is often the way it goes. But nonetheless, an appointment with a doctor has been made and he actually attended though the older middle aged man is filled with dread of what he might be told. After all, his manhood is on the line! The following is a likely scenario of what might occur at the appointment.
Once he is admitted into the exam room he is told to undress and put on this loose gown. He never did like wearing gowns. Meanwhile the man’s eyes are darting left to right, ever scrutinizing each and every drawer looking for some offending instrument that will most definitely occupy his body and feed the ever growing anxiety of what’s to come. In comes the doctor. Blood pressure 155/80, pulse 80, weight 210 lbs, height 5’9”. “Now bend over please.” Oh boy, here we go! Prostate slightly hardened and enlarged. “Any trouble urinating?” The doctor asks a few more questions, glares down his nose a little and decides to order a blood test. He wants to know about this man’s cholesterol, testosterone, and some other stuff. Now for the needle. Two vials should do the trick. At least the nurse is good at taking blood!
Exactly seven minutes after the doctor entered the room he was gone again. Besides a little small talk to break the ice the older middle aged man didn’t know much more than when he walked in and he leaves not feeling any better about himself to say the least.
The tests are in. Total Cholesterol 210. Some slightly decreased liver function. And slightly low testosterone. The doctor prescribed Lipitor, Androgel (a testosterone replacement gel), and what the hell some good old Prozac to fend off the mild depression. Done… Case solved right? As far as the medical establishment is concerned that’s what this older middle aged man needs. He will continue on this course of therapy until death. And if he is a really good patient he won’t ask any questions.
That tends to be the story for a lot of people. The same is also true for women and children. I just used the story of the older middle aged man because I wanted to work in the prostate exam somehow. It is a fun topic! But the bottom line is that this patient’s needs have not been met. Care was not given to find out what was going on “functionally” to lead to these apparently unrelated issues. He has been made yet another victim of “replacement medicine.” And I say victim because in my practice I see people harmed this way all of the time. And by harm I mean that these people are often made dependant of these medicines with no easy way to get off of them. What people need to realize is that these types of medicines work to weaken the body’s natural ability to regulate itself and then they end up weaker than before starting the treatment. Hint: Why do you think there is no exit strategy for a lot of these medications?
So that's my first blog entry... I will follow this entry with a follow up on why this patient's needs were not met, and offer some of my own opinions of how to better address the situation. Please stay tuned for more info on this older middle aged man as I pick apart the problem and explore what the root of the problem really is.
I look forward to starting my blog. I can only see wide open skys for different concepts and interactions with people pertaining to health. I hope to be a great resource for you. Enjoy and learn! And for heaven's sake... comment!