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Sunday, September 21, 2014

Be critical of what you hear...

We hear all sorts of messages about our health, and many of them are conflicting.  However, it is important to see who and where those messages are coming from and what context they are in.

I am going to give a couple examples.

1) "People with lower cholesterol die earlier."

This is true -- sort of.

I was recently told this by a patient with coronary artery disease who cut the dose of his statin on his own, for fear of increasing his risk of death because his cholesterol numbers were too low.

Several groups of people have low cholesterol -- people with advanced cancer, liver disease, or anyone with severe calorie malnutrition.  And yes, these people are more likely to die sooner.  But, I think it's obvious to say that they aren't dying because their cholesterol is too low, they are dying of their underlying disease.

And it is that underlying disease that is causing the low cholesterol numbers.

However, on the converse, among the majority of people, those people who don't have terrible life-threatening diseases like those described above, lower total cholesterol numbers are not associated with increased mortality.

In fact, in those patients who have coronary or vascular disease, we use statin medications to drive the cholesterol numbers down.  But, as we are learning, more important than making the numbers look nice, statins perform an important role to stabilize and potentially reverse the plaque that is in the arteries, improve endothelial function which is the functioning of the lining of the arteries, and reduce risk of heart attack and stroke.

And, in this patient population, problems with cholesterol numbers being driven "too low" have not been identified in the large randomized controlled trials.  Further, there is a population of people with a genetic PCSK9 mutation which leads to extremely low cholesterol numbers, and these people have very low risk of cardiovascular events.


2) "Are Himalayan salts good for my health"?

Interesting question.  I've done a little research on this question.  When you enter "Himalayan salt" into a search engine, the vast majority of sources of information come from places that want to sell you Himalayan salt.  So, anything you read on those pages you need to take with a grain of salt, so to speak.

What I can tell you about Himalayan salt is that it is not processed like standard table salt, and naturally contains many minerals including iodine.  Himalayan salt is also lower in sodium than table salt.

I do not know that there are specific health benefits to using Himalayan salt.  Specifically, I do not know of any type of clinical trial that supports any health benefit of Himalayan salt over any other type of salt.  But, if you can cite a study that would say otherwise, please leave it in the comments, as I am eager to learn.

That said, regardless of the source of the salt, it contains sodium.  Sodium does not need to be supplemented in our diet, and in fact diets higher in sodium are associated with higher blood pressure and higher risk of cardiovascular disease.  


Bottom line is this -- do not believe everything you hear about health.  Question everything.  And if I'm your doctor, question me too!!!  When a patient asks questions, I know he is processing what I have told him, and a knowledgeable patient is a powerful patient who has the tools to make good choices for his health.

3 comments:

Catie Hardiman-Berger said...

frequently, the information is thrown at me so quickly at doctor appointments (mine and the kids) that 9 times out of 10, he is out the door before I even have a chance to ask or I'm half way home before it all sinks in.

ATS said...

Great blog post and great examples! Thank you!

Henson Clan of the North said...

Do your dogs enjoy a vegan diet?