Steaks and Statins – weight gain and cholesterol management

Recently there have been several news stories with contradictory  health information; obesity has reached a peak, obesity is still rising.  Running leads to a longer life, but marathon runners don’t live longer.  Supplements don’t work, except when they do.

One of the latest stories is that people who take statins are gaining weight faster than those who don’t.    Have statins become a crutch or do statins cause weight gain?  Are we healthier now that we can have our steaks with a side of statins?

What did the study look at?

To assess the question of statins and weight gain the authors used a large database called the National Health and Nutrition Examination Survey (NHANES) which was a large study conducted from 1999-2010 that collected data on tens of thousands of Americans, looking at illnesses, medication use, diet, supplement use and other  items.

For this study, 28,000 people were evaluated:

  • those with high cholesterol and taking statins
  • those with high cholesterol and not on statins
  • those without high cholesterol and not on statins

They compared calorie and fat intake between statin users and nonusers in 1999-2000 and 2009-2010.  In 2010, statin users were eating almost 250 calories more a day than they did in 2000.  They were eating more fat, as well as having gained more weight than non-statin users.  However, statin users did have lower cholesterol.

What the study did not assess was if the rate of heart attacks changed in the groups – the study wasn’t designed to answer that question.  But is that the only question that matters?

The reason why it matters is that diabetes rates, linked to weight gain and obesity are still on the rise.  Are people being helped if they lower heart disease risk by taking statins but raise their risk of developing diabetes?

Possible explanations of the data

  • Doctor effect – are doctors advocating medication over healthy lifestyles?  It is easier and takes less time.
  • Patient effect – are patients interpreting taking statins as a free pass to keep the same lifestyle they had before medication?  Again taking a pill a day is easier than maintaining a healthy lifestyle.

The truth is probably a little bit of both.

How does this affect my practice?

I’m a strong proponent of preventing disease.  We prevent heart disease by not smoking, controlling blood pressure and reducing the Low Density Lipoproteins that clog our arteries with statins.  Central to this, and what I recommend with or without medication is lifestyle – a healthy and active one!  Doing so may avoid the need for medication or allow us to use a lower dose – reducing side effects!

What we don’t know from this study is if people had an increase in heart attacks despite their lower overall cholesterol levels – meaning the increase in calories, fat and weight offset the benefit of taking a statin.  Or, did the statin allow people to safely lead a more permissive lifestyle?  Can you have your steak if you have your statin too?

The study did show an increase in diabetes  – presumably related to the weight gain in the statin users.  They consumed about 250 calories a day more in 2010 than in 2000 – which can lead to almost 10 pounds a year in weight gain!

So when I discuss taking statins with my patients, I always frame it as a component of a plan to reduce the risk of heart disease.  If diet and exercise reduce risk enough, medication can be stopped and risk reassessed.  Even if lifestyle does not reduce risk enough to stop medication, it may minimize the need for dosage increases.

For those that do not alter their lifestyle, they run the risk of developing diabetes.  While statins will reduce some of the risk of heart disease, diabetes carries its own risks – kidney, nerve and eye damage – which statins won’t protect against.

My role as an Internist is to look at a person as  a whole – evaluate all their risks and how they relate to each other.  So this study serves as an example that we can treat a singular problem, but if that is our whole focus, we lose sight of the person and may not truly improve their health.

The path to wellness begins with a proper diagnosis

Exercise – The Power to Heal Yourself

 

exercise - the power to heal yourself
Visualizations are provided by www.theVisualMD.com

New Year’s is a time of resolution, renewal and rejuvenation.  People resolve to stop smoking, lose weight and exercise.  More gym memberships are sold in January than any other time of the year, and many go unused.  We all have this sense that we should exercise more – but have you ever wondered why that is such a universal sentiment?  What is it about exercise that makes it hard to maintain but remain so high on our wish lists?  What does exercise do for us?

Exercise impacts not only our muscles but almost every body function we have – it changes multiple hormone levels, insulin sensitivity, pain perception, hunger, sex drive and mood.  Exercise gives you the power to heal yourself.  Regular exercise promotes the following changes in the body:
  • increases the development of new blood vessels (can help in heart disease)
  • improves the functioning of multiple immune system aspects
  • decreases anxiety and depression
  • decreases inflammation
  • decreases pain in osteoarthritis
  • improves blood pressure
  • improves cholesterol
  • improves diabetes beyond weight loss
  • decreases the cravings for cigarettes
  • strengthens muscle fibers as well as promotes the development of more muscle tissue
  • improves digestion
  • stimulates the reward centers in the brain with substances called endorphins
  • and many other functions
These effects are separate from and in addition to the usual weight loss that accompanies exercise.

So what is exercise?

Exercise is any activity that maintains or improves physical fitness, health and wellness.  Studies have shown moderate activity will begin to show the benefits of exercise.  Moderate exercise is defined as 150 minutes per week (30 minutes/5 days per week) of brisk walking or similar activity.  The more intense your activity, the less total time you need – 75 minutes per week of intense activity will give similar benefits to the 150 minutes of moderate activity.
recent study in the journal Lancet  showed that in people with a high risk of heart disease and pre-diabetes decreased their risk of a heart attack by 10% just by increasing their walking by 2000 steps per day.   Another study in the British Medical Journal demonstrated that regular exercise was as effective as medication in preventing death from second heart attacks, rehabilitation from a stroke, improving heart failure and preventing diabetes.
The trick is maintaining the activity to continue reaping the benefits – if you don’t use it, you lose it.  Another way of looking at it is stated very well by Jim Rohn, an author and self development coach.  “Motivation is what gets you started, habit is what keeps you going.”

What do I recommend in my practice?

So, should everyone stop their medications if they exercise?  No, and certainly not without discussing your plans with your doctor.  Not every condition can be controlled with exercise, and not every medication can be safely stopped abruptly.  What I try to emphasize with my patients is that medication begins to correct a problem immediately – for example – lowering cardiovascular risk with a statin; adding an exercise program helps manage the long term risk.  We can then decide if immediate action is necessary, and set a goal – say losing a certain amount of weight.  When the goal is reached, stop the medication and reassess the condition.
By re-evaluating your diagnosis the effect of medication and the effect of your actions on your diagnosis can be measured, and your treatment plan revised.  You become an equal partner on your journey to wellness by revising your diagnosis!
Personally, I reconnected with running about 3 years ago. While there have been some ups and downs, I’ve managed to keep about 20 pounds off, and will be running my 7th half marathon next weekend. If you’d like to read about my own story on how I started maintaining a program, see this post – Exercise for a Cause, originally posted on TheVisualMD.com in 2011.

The path to wellness begins with a proper diagnosis