Went to the doctor with my husband today, he's type 2 diabetic and probably about 30 pounds overweight. He had a health screening at work yesterday for a discount on our health insurance premiums and here are his stats. Total cholesterol 224, HDL 50, non-HDL 174, no trigs, non-fasting glucose 160 (this was an hour after lunch)BP, 121/74. He takes metformin daily and a low dose blood pressure med, not because he has high BP but because the doctor says it protects from damage due to the diabetes.
So this new doctor today of course wants to put him on a statin, I need to know if statins are ever the best option? The doctor says "you have diabetes, it is a genetic defect, you are not going to be able to counter or cure it with diet and exercise, it will never go away and if your cholesterol is high you will eventually get heart disease and die". I'm not sure if it's best for him to stay away from the statins or not.
Get a new doctor. Stat.
No matter what kind of diabetes it is, all diabetes has a cause. Type 1 is generally held to be an autoimmune disorder, but it always has a triggering event. Type 2 comes from metabolic damage, primarily insulin resistance. No one is born with either kind of diabetes the way they are born with cystic fibrosis or sickle-cell anemia. Not only did your doctor lie to you (or is so misinformed he needs to not be working in medicine), he insulted your husband too, by implying that his genes are faulty when they're not.
There's some pretty strong evidence that even when a familial line has a greater tendency to type 2 diabetes later in life, that tendency is largely epigenetic, not genetic. In short, if you eat like crap and get type 2 later in life, you're more likely to have a kid who gets type 2 from eating like crap--but you can push that tendency in the opposite direction if you make good choices and encourage your kids to do so as well. Every person has the potential to become diabetic if they abuse themselves enough. For all your husband's doc knows, he's on his way to it as well.
If I were a doc I would not be concerned about your husband's cholesterol. Normal total cholesterol is 200 and he's barely above that and his HDL is 50. 60 is considered cardioprotective in both genders; less than 40 is considered low for men. See? He's only got another 10 mg/dl to go before he's perfect, and he's already above normal. Since this was a health insurance screening, his LDL was probably calculated. He can get a direct count of his LDL but that tends to be more expensive; check with your health insurance to make sure it'd be covered. At the least get a VLDL count--that's the small particles that are a sign of poor health. (I'm not convinced they cause it but they do seem to have an association with it.)
I'd get a triglyceride number if I were you. That's more important than cholesterol.
Personally, I'm more concerned about his blood sugar. Ideally your glucose would not go above 140 mg/dl an hour or more after you stop eating. More than that and you get glucose-related damage. But there's a simple fix. He's type 2 diabetic, not type 1; he's still making insulin. All he has to do is reduce the sources of sugar in his diet, which include all digestible carbohydrates, and he'll get that under control. He's already on metformin which is supposed to increase insulin sensitivity. If he's still getting high sugars then he definitely needs to watch his diet. And if he changes his diet then he needs to watch his sugars closely because of the metformin he's on. It wouldn't do any good to bring his sugars down only to bring them down too far.
Don't be fooled by glycemic index or glycemic load. Even if something provokes less of a blood sugar response it can still have too much fructose in it and be affecting the liver, which will aggravate his diabetes in the long run. Sugar is sugar, and the less sugar, the better.
Your doc is right about one thing: the diabetes will never go away. But the diabetes itself is not what's important. What's important is maintaining a normal blood sugar response. High sugar is what kills a diabetic. As long as your husband eats in a way that manages his disease, he should be fine. It's not a death sentence unless he refuses to change his behavior.
The only real benefit they've found for statins is their anti-inflammatory activity. Your husband would be better served adopting an anti-inflammatory diet than taking a pill. Especially given all the wicked side-effects of statins. They've been implicated in the cause or worsening of type 2 diabetes, increased cancer risk, decreased mental function, and muscular pain. Not worth it. It's more fun to cut grains and eat more beef, if you ask me--and a lot healthier too.
I think that's a very dis-empowering thing for a doctor to say to a patient. Your husband isn't even that much over-weight. I would think he'd be a perfect candidate for the diet/exercise approach for managing his diabetes and high BP.
i know there is a feirce debate from people on statins. even some paleo folk advise that, in some obscure circumstances, statins might be an option. fundamentally, i disagree. i do not believe that messing with the cholesterol functionality in the body with manmade drugs could ever be the best option. if a doc believes that a patient's life actually is down to one option, statins or die... then i would say show me the proof that statins will actually save that person. because what if the statins cause additional unforseen complications? as we know, most of the time, that is exactly what happens. statins have been shown to reduce inflammation, but cause other issues while doing so.
maybe dr davis or dr harris have seen situations where they would actually say statins is the best answer at a certain moment, but i am not aware of any such situations.
but i could be wrong. anybody seen davis, harris, masterjohn, guyenet, kresser actually recommend statins in any particular scenario?
hcantrall - please check out Dr Grapevine's web site on statins. He is a medical doctor and former astronaut. He was on statins and found it all but ruined his memory (which came back when he stopped taking statins). Statins deplete the bodies CoQ10 (which messes up the memory). If the doctor did not also recommend supplementing with COq10, I suggest you find another doctor.
NB - Statin use often RESULTS in 2 diabetes
Here is a link to Grapevine's web page on diabetes http://www.spacedoc.net/statins_diabetes
Before I started Paleo, again, my LDL was too high according to blood tests and my doctor. He said to look into statins, and arranged another blood test for six or seven months later. I went Paleo and lost some weight; after the next blood test my LDL was way down, and in the "normal" range.
The doctors are recommending statins based on the traditional cholesterol panel readings which are notorously inaccurate and it is outmoded thinking to use those cholesterol numbers to access risk of heart disease. It just does not prove out in reality.
It does sound like from the numbers you gave that there are reasons to be concerned about health being diabetic etc.
From personal experience to access the real risk of coronary artery plaque build up I would recommend a coronary calcium scan. This non-invasive test actually measures the quantity of calcium in the arteries which is directly indicative of plaque and thus a measurement of heart disease progression. The scan gives a score which if it is zero means no coronary artery plaque. If greater than zero there is some. This is a real quantifiable measure of heart disease not a ficticious and unlikely indicator like the typical cholesterol numbers you received.
Check out "Track Your Plaque" for more information.
The question is are they appropriate for ANYONE, not your or me.
I think that surely there is someone out there who could benefit, perhaps a person who has heart disease and might benefit from the established anti-inflammatory properties of a statin. At least it's worth being in the discussion, irrespective of Dr. Grapevine's experience. Remember, the question was about ANYONE.
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