By Dr. Chris Magryta
For the Salisbury Post
The cholesterol/statin debate has raged recently and likely will continue to do so as doctors and patients continue to weigh the risks and benefits of cholesterol-lowering statin drugs. Recently, children have been thrust into the debate on statin drug use as their markers of coronary artery disease risk rise.
I find this prospect sad and an indictment of our medical system that is pursuing drug use in children with no clear safety profile without having a nationwide debate about the preventable root cause of this disease. Whether it is poor quality food at home, at restaurants, in school or subsidized through our national farm bill, we have big issues nationally that are driving our children to disease and secondarily enriching big Pharma.
In two recent columns in the Post, we have seen two opposing views by excellent physicians that truly have more in common than they appear. Dr. Chris Agner very strongly stated the position of the county’s adult primary care physicians who struggle with patients who suffer heart disease caused by lifestyle and genetic factors. Their plight is real and sad. In contrast, Dr. Chris Nagy is stating the position that lifestyle alterations can and will in most cases protect patients from disease and that the safety of these statins are in question.
The commonality of these positions is the desire to help patients survive and live disease free. It would make good sense to take this argument a bit further and unify the two sides for the safety and health of the county’s adults, and now children.
Recently I received an email from Fred Stanback, philanthropist and humanist, regarding new epidemiologic data with statins and the risk of cataracts and diabetes that spurred my desire to tackle this issue. The articles appeared in Optometry & Vision and The Lancet and show that statins can increase the risk of cataracts and diabetes.
These articles are just a piece of the puzzle that defines your health.
For those of us with the genetic risk factors for heart disease, diabetes and cataract formation, we have a lot of thinking to do. Do you take statin medicine for the remainder of your life or change the known lifestyle problems, or a combination of both?
Being a person with all of these risk factors, I took all of the options over a four-year period. I initially started with a statin in my early 30s. The early signs were good. My total cholesterol dropped from over 250 to less than 170. Unfortunately, I was one of the patients that had severe side effects, including extreme muscle aches and fatigue. I felt like an old man. Shifting gears, I tried Niacin and again had side effects.
Next stop: The anti-inflammatory diet and plant sterols. With this approach, I regained some moderate success. My total cholesterol hovered around 180, not perfect, but OK. The concern was that my good cholesterol, called the HDL, was only 42. Unsatisfied, I searched for more answers.
Ultimately, I arrived at the decision to try a low-refined carbohydrate/gluten-free diet. Voila! Success. My cholesterol analysis came back as if I had no genetic dysfunction anymore.
The common themes of lifestyle medicine – diet, exercise and stress reduction – were perfect for me. My story is simply that, my story. Yet if I can change my risk of disease without medicine, then why shouldn’t patients be counseled to try the same before embarking on medical management? I am 100 percent in favor of this approach for children. The data regarding lifestyle modifications and their efficacy in reducing coronary artery disease exists and is strong.
Let’s now look at Dr. Agner’s argument. In his position, I agree that statins may be necessary in those patients that refuse to do the hard work of diet, exercise and stress reduction. The data is stronger for secondary prevention in patients who have already had a heart attack than for primary prevention in those who have no heart attack history. At least in that case they have some chance of improved survival. I would not wish to watch your loved one die of heart disease if I had a medicine that may prevent it, even if it is not perfect.
On the other hand, Dr. Nagy is asking you to weigh the side effects and disease morbidity risks against known risk reduction through lifestyle modifications. There is no free lunch. If you choose medicine over diet, then you must be comfortable with the inherent risks of the medicine and the outcomes. I am fully aware of how difficult it is to exercise daily, eat healthy and relax.
For children, I don’t find the pharmaceutical approach to be reasonable unless all other avenues of risk reduction are exhausted. The emerging data on adult side effects raises many concerns about the risks of prolonged drug use in naive children.
We should be screaming from the rooftops at our elected officials to change public policy in favor of promoting vegetables and fruits over subsidized wheat, corn and soy processed food. We should be admonishing and educating parents who consistently feed their children processed food. We need to change the culture of America and Rowan County where it is OK to eat in an unhealthy way and expect the drugs to save our lives. It does not and will never work that way.
The drugs will only delay the inevitable for those who are lucky enough to have a beneficial effect. With children now going on to develop adult-type diseases in the teen years, we are in for a rude awakening to our laissez-faire attitude about lifestyle education and the inherent burden that their healthcare is going to place on society.
Can you fathom the cost involved in keeping children on statins for 60-plus years? According to the research, a percentage of these statin users would then develop diabetes or cataracts or both. Where and when do we wake up? We are killing ourselves through poor quality food, stress and sedentary behavior.
I sympathize with Dr. Agner and all of his colleagues. With most patients not interested in Dr. Nagy’s approach, what choice does a physician have? But ultimately the data supports a dramatic shift toward lifestyle medicine and not statins. Statins are truly a zero sum game for children.
We are at a crossroads in medicine and humanity. I hope that more people desire lifestyle medicine. I hope that our reliance on drugs becomes a thing of the past and that we all can laugh at how silly we were to treat chicken wing abuse with antacids.