Cholesterol and the fight with my GP

Discussion in 'The Lamp and Sandbag II - The Tall Story Strikes B' started by udipur, Apr 4, 2010.

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  1. udipur

    udipur LE Book Reviewer

    I had to go and see the quack (thankfully she is older than me so it didn't make me feel too aged) about something or other and she decided to test my blood for all sorts of goodies. Apparently the GPs get money for hitting targets for testing for cholesterol and I agreed to the test.

    Everything came back fine apart from the cholesterol and that was considered high (7.0). I went back a couple of weeks later and it was 7.8.

    So, according to many, I should be worried.

    My doctor was a bit concerned because I started asking questions. Apparently this is not something that they are used to and she was less than forthcoming with details. For instance:

    "Your cholesterol reading is high"
    "What does that mean?"
    "It means that you have a high level of cholesterol"

    Therefore I started to do some research.

    Conventional wisdom will have you believe that high cholesterol will lead to heart disease and that saturated fat is associated and therefore a killer. I won't bore you with the data but it's frightening how this has taken hold - just look up Dr Malcolm Kendrick and start reading.

    Unfortunately, there is no evidence anywhere to support this hypothesis and we are subjected to treatments of ridiculous natures, not least the harmful statins which make billions for the pharmaceutical industry.

    I'm happy that I'm healthy (my heart rate is low and constant, my body fat is low and I exercise regularly and not excessively) but when I tried to show the lack of evidence to others, I was pooh-poohed.

    Why do people believe doctors so blindly without doing their research?
    • Like Like x 1
  2. Blind faith, I went to my Doctor for results from a blood test. My bullshit detector went off, soon as he said results fine but no donating for 6 months.
    Blood bank happy with test results so donating away.
  3. seaweed

    seaweed LE Book Reviewer

    No research? There is a Leeds University model which takes in cholesterol, blood pressure, age and other data and churns out a risk factor for heart disease. GPs use this to recommend medication (probably been updated since I first encountered this). Statins got my cholesterol well within spec but the blood test needs to include fasting glucose so as to watch for diabetes. The body is so complicated that's it's a wonder to my mind that it works at all.
  4. Number of years I was diagnosed as having Type 2 Diabetes .... now diet controlled . At the same time I had a very interesting talk with a young Hospital Doctor who went through risk / Diabetes / age etc . Anyway I immediately agreed to star taking a soluble Aspirin daily but we agreed to differ concerning Statins and I decided not to take them . Couple of years later when I was attending my annual Diabetes review at my GP the subject of Choleterol was raised although mine was not particularly high . The Diabetic nurse then suggested a daily doseage of four times that originally suggested by the Hospital Doctor . However in the intervening period I had been reading of some of the positive aspects of Statins and agreed to take the original level suggested by the Hospital Doctor . There was no real problem . It was all quite open and in fact there are two types of Cholesterol which were measured .... one for good and one for bad fats . I was told that a small diet change could reduce the bad and exercise increase the good .

    So to summarise ... yes I also believe they get paid for this sort of testing .... I agreed to take a low level of Statins medication because it is proactive and reduces risk of long term heart / circulation problems ... but patients should have an element of ownership as to what risk / level of doseage they want to take in preventative medication .

    Edited ... minor text mod .
  5. Of course, don't forget that the people who are saying that statin drugs should be prescribed are... the drug companies.

    Does lowering the cholesterol have any effect of outcomes?:
    Depends on what kind of heart disease.

    Damage limitation going on here
  6. udipur

    udipur LE Book Reviewer

    To throw some facts into the mix:

    1: Statins lower cholesterol synthesis in the liver.
    2: The liver starts running out of the cholesterol needed to make VLDLs (very low density lipoproteins - the molecules that carry cholesterol around the blood).
    3: The liver then has to increase the number of LDL (low density lipoproteins - so called 'bad' cholesterol) receptors to pull
    cholesterol back in to make more VLDLs.
    4: More LDL is dragged back into the liver, as a result of which ...
    5: The LDL level in the blood falls.

    That's the result of statins working.

    However you need about 4-5 times as much cholesterol every day than the amount you consume. The liver produces the missing amounts. We are told of good and bad cholesterol and that purely relates to the size of the molecule which carries it around.

    Somehow the smaller molecules are able to attack the artherosclerotic plaque (hardening of the arteries), break through a carboniferous outer layer, attract all the solid cholesterol inside, retreat back through the solid wall and take it all back to the liver for processing into healthier stuff.

    Sounds a bit far fetched...?!?
  7. Where to start , it was in last months Lancet there is a link between statins and diabetes which Doctors consider to be an acceptable effect. Acceptable to whom not me, I started on statins and had major problems finding one that did not give me any significant side effects and controlled my cholesterol it took almost a year and a half and as my cholesterol came down my blood sugar went up to the extent I now have to take injections twice daily and an extra 4 tablets. I left the Army 2002 fit and well never having taken as much as a Bruffen for a hang over, now I’m on 14 tablets and 2 injections every day and I feel like shite most of the time.

    Check out Google for the side effects of statins they can cause every thing from stomach cramps through to death including a very interesting (and if believed) serious side effect of muscle wastage. If I could go back 5 years and I know what I do now I would have knocked out my GP even for suggestion statins.
    • Like Like x 2
  8. Not the way most GPs treat it straight to statins i now go to the lipid clinic and they are worse.

    Read this
  9. Two points to consider here, firstly medical studies are always based on the statistics of a, hopefully large, number of trial subjects. Each of us is an individual so we may always turn out to be the odd one out. This doesn't make the overall conclusion invalid.

    Secondly the list of possible side effects of a drug includes virtually anything negative reported during clinical trials and/or early patient use even if there is no proof that it was caused by the drug. The assumption is that might = put it on the side effects list. These lists can thus be frankly meaninglessly pessimistic. Try reading the ones for Aspirin or Paracetamol to see what I mean.

    I'd suggest that it is fair to say that this is an area where there is room for doubt, trial results don't all agree and thus some doctors will take different approaches to others, and some may not be keen to discuss the issue in detail as a result of this.

    If you want to read round the subject be prepared to read a number of papers because the first one you find may not be the only answer and try to read original scientific work if you can rather than secondary reviews, which can easily misrepresent the original work.
  10. Firstly your overall cholesterol score is pretty meaningless. There are two kinds of cholesterol LDL (bad) cholesterol, HDL (good) cholesterol. I've got a similar cholesterol score but I'm very high in the HDL which actually lowers my risk of a heart attack. Get it fully tested.

    Statins have only been solidly proven to be clinically effective (following there actual use over decades) in a very narrow demographic, middle aged men after or at high risk of a heart attack. They do sometimes have severe side effects such as liver damage. They are also effective in a broader range of indications.

    Statins are valuable drugs but probably over proscribed in the US and UK with its daffy Pharma led system of giving doctors a bung for lowering the populations cholesterol. A bike subsidy is a far better idea in terms of health and much cheaper. We are rather over focused on the cholesterol ju ju, its just one indicator of risk.

    The Mayo Clinic has some details here.
  11. Doctors get paid to check, and lower, your cholesterol because it can be life threatening. Doctors should check this anyway but the target system makes sure they do it. In udipur's case, meeting the target meant they checked it and found a problem so can't see anything wrong with that. If the target wasn't there, they probably wouldn't have done it unless they had suspicions.
    If your cholesterol level is high (over 5) on a regular basis, then statins will probably be the best way to reduce it. If, however, it is up and down with over 5 just now and again, then changing your diet would probably be the best way. I like butter but, unfortunately, it is one of the main causes. I have been using olive oil (a la the Spanish way) for over a year now and it appears to be working. Also, again unfortunately, ice cream after every meal. Now just have it once a week and stick to fruit for dessert. Fish can be good but only fatty fish such as salmon and sardines. Absolutely bloody hate sardines but do have salmon once a week.
    My cholesterol, in UK, was regularly above 6. After just over a year in Spain, it is a regular 4.8. Then again, I don't get the burgers, fried breakfasts etc as I used to in UK. Plus things like tomatoes (which are tasteless and insipid in UK) form a large part of my lunchtime diet here in Spain.
    Statins would be good if your cholesterol is a regular problem. Diet (the type, not so much the amount) works for me and would probably be the best way to go unless you have a serious problem.
  12. I take it that you have been advised of the benefits of a low GI diet? beneficial in helping to control both weight and diabetes.
  13. GPs are "remunerated" the Quality and Outcomes Framework (QOF). The DoH sets GPs targets in accordance with nice guidelines and what the ministers want to see and GPs earn points against the targets and the more points you get, the more money you earn.

    Here is a link to the clinmical indicators for QOF

    A lot of it is gathering statistics and if the DoH say check everyone for diabetes,COPD,CHD etc GPs will do it, because they are being measured and paid against this target and of course this means that the following year the number of people with diabetes,COPD,CHD will of course go through the roof, because primary care has spent a year looking for it.

  14. QOF exists to make sure that doctors check things that they ought to be doing anyway. They don't get paid EXTRA for meeting QOF targets, they get penalised if they don't. Its not your doctor who has decided this, its the government and the public health bods at NICE.

    oh and
    ...bollocks. Hundreds of RCTs and meta-analyses disagree with you.
    And has previously been pointed out to you, most statins are now generic so your 'ooh, evil drug companies' argument doesn't really hold much water.

    Tell you what, if you have a problem, go and speak to a cardiologist instead of gobbing off on a website like an uninformed loon. He'll gladly bore you to death with the benefit of his medical education and years of experience over your few days of googling.