Thursday, November 28, 2019

Retrospective #285: “When diet and exercise aren’t enough…”


This copywriter should get a raise, or at least a bonus. The statin drug’s advertising slogan is the very definition of a red herring: an “idiom…used to refer to something that misleads or distracts from the relevant or important issue. It may be either a logical fallacy or a literary device that leads readers or characters towards a false conclusion.” Wiki goes on to say, “The expression is mainly used to assert that an argument is not relevant to the issue being discussed.”
If you’re reading this blog, you probably have been advised ad nauseum by your doctor to “diet and exercise” to lose weight. And if you’re well read and up to date, you know that exercise is not an effective way to lose weight (in spite of all the TV advertisements). Mind you, I’m not knocking exercise; both aerobic and anaerobic exercise have myriad health benefits, but reducing unwanted body fat is not one of them. Besides, it makes me hungry and sweaty.
So, “when diet and exercise aren’t enough,” what’s a person to do? We starve ourselves, lose a few pounds, are hungry, our body responds to restore energy balance and we gain it all back. Then, rinse and repeat. We’re desperate and depressed. We lack the “will power” to “eat less.”  We are susceptible to almost any suggestion.
The ad now has you hooked. It goes on to suggest you should take a statin. And your doctor will surely suggest it, after noting that you failed to lose weight by his “diet and exercise” prescription. And since the diet most doctors pitch is the one the AHA/ACC/AMA/ADA/USDA/HHS/Archer Daniels Midland/Cargill/Quaker Oats and Kellogg’s recommends, you probably are suffering from co-morbidities and exhibit risk factors for CVD and Metabolic Syndrome.
As with most people eating the Standard American diet, besides being overweight or obese, you probably have or are developing hypertension (high blood pressure), and high cholesterol. And your fasting blood sugar may be “slightly high” (“We’ll have to watch that.”) What often isn’t mentioned is that your triglycerides are also borderline high (≥150mg/dL)and your HDL cholesterol (HDL-C) is borderline low (≤40mg/dL for men; ≤50mg/dL for women). 
To the medical/pharmaceutical community it’s this combination of “risk factors” that justifies the statin prescription. After all, even though you’re taking your blood pressure meds, you’ve failed to follow doctor’s orders to lose weight by eating less (on a balanced LOW-FAT diet); now it’s his (or her) turn to treat you effectively by writing a statin prescription. All you have to do is fill the prescription and take it faithfully. Your Total Cholesterol (TC) and LDL-C will go down, and your TC/HDL ratio will improve, and your doctor will write it all down in your chart. And your doctor will feel good, and by extension, you will too.
And that’s the best that “medical science” can do. “When diet and exercise aren’t enough…,” take a pill. Chart notes: 1) patient non-compliant (failed) with “diet and exercise” advice, 2) patient taking BP and cholesterol medications; 3) patient showed improvement in TC, LDL-C and TC/HDL ratio, and 4) follow-up visit for elevated (pre-diabetic) A1c.
Of course, so long as you eat a low-fat, high carb diet, your broken glucose metabolism will get progressively worse. You will continue to gain weight (because you’re Insulin Resistant and therefore Carbohydrate Intolerant, not because you’re eating too much and exercising too little). And your fasting blood sugars or A1c will continue to rise.
Eventually, you are likely to develop Type 2 diabetes. By then you should already have been started on Metformin (another pill). You may, in time, take a “cocktail” of three pills for diabetes alone. I did. Or maybe you’ll start with a SGLT-2 inhibitor and/or injecting a GLP-1 receptor agonist, or go directly to basal and then bolus (mealtime) insulin.
And don’t forget the complications. Microvascular: peripheral neuropathy (amputations), nephropathy (end-stage kidney disease, with dialysis), and retinopathy (blindness). Or Macrovascular: CVD, MI (heart attack), and stroke.
OR, YOU COULD JUST CHANGE WHAT YOU EAT. Take charge of your health. I think Very Low Carb could work for you, but regardless, try something. A change in diet can give you valuable information. There’s so little your doc can do, and so much YOU can do for yourself.  Very Low Carb is how I did it. If you’d like to see how changing what you eat can affect your health, or how it affected mine, read Retrospectives #281, #282 and #283, just published on this blog.

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