Statins, cholesterol, a trip to the doctor

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Good evening, 66.1ers.

Two weeks ago, I wrote about taking an active role in your own medical care. Sooner than expected, I’ve had to take a bit of my own advice. Going to share today in the hopes that something here will be instructive on your own journey through the healthcare system?

Apologies in advance if some big, SAT-sounding words sneak into today’s newsletter. I maintain the view that language like that is the foundation of a “healthcare” (“sickcare”, according to one 66.1 reader?) system in which the patient is disempowered and not in control of their care. Not OK. I might use them, but I’ll do my best to define them.

All started a couple weeks ago when I went for my annual physical. Doctor asked if there was anything special going on, told her not really but when people in my family die, it seems to be from heart disease, nearly unanimously, think we could dig deeper? Sure, no sweat. A few lab tests we’ll run and then we can debrief. Sounds like a plan. Drew my blood, got a lot of numbers, here are the interesting ones: 

Liver enzymes (ALT and AST): 

High, but my doctor said nowhere near the danger zone? Doctor said maybe it's just a result of having had a cold a couple weeks ago, we’ll re-check in a month. 

Total cholesterol: 

High. Everything from here on out will be about cholesterol. 

Went in to see my doctor again this week for the debrief. She said there’s a couple weird things going on, but Marcus should be very worried about his LDL cholesterol levels. Doc wanted to put me on a statin right then and there. Said that a guy could take Red Yeast Rice if statin didn’t sound fun. Red Yeast Rice has a similar cholesterol-lowering effect as a statin. Doesn’t, however, seem to have the same effect on reducing cardiac events as statins do.

I asked a few questions…

1. Might the lack of evidence for Red Yeast Rice in comparison to statins be partly due to the fact that there’s not a pharmaceutical company with a vested interest in proving its efficacy?
   

2. Can we check my cardiac calcium score, see if there’s any actual damage to my heart before starting a medication? Please?
   

3. How’d we get here?
   I’m 32, healthy, eat clean, exercise, yada yada yada.
   Doctor: you can’t eat your way to levels like this, not at your age. Gotta be genetic (PS research says this is called “familial hypercholesterolemia”. Sounds like a bad band name, really just means that high cholesterol runs in the family. Why can’t we just say it like that?)

At this point, my doctor said Marcus is clearly a critical examiner, maybe he wants to see the cardiologist? Yes, please. Kudos to my doctor for having no ego, not trying to convince me to do something I didn’t want to do. Thank you. Seriously. 

So we’ll do that on Monday. In the meantime, I’ve been reading like my life depends on it (doesn’t it??). Peter Attia’s Outlive says there’s no downside to getting LDL cholesterol below 20 mg/dL, take a statin if you have to. Get a CT scan of your heart, too. 

Casey Means’ Good Energy says if LDL is below 200 mg/dL, LDL alone isn’t going to kill you, according to the Framingham Heart Study. If LDL is below 300, you’ve got to look at triglycerides, if they’re high, we’re looking at metabolic disorder (insulin resistance). If LDL is above 300, Dr. Robert Lustig’s suggestion is that it runs in the family. I’m in the middle of these. Not sure what’s going on. Going to talk with the cardiologist on Monday, see what he has to say, will report back.

BTW, anyone else wondering about these?

1. 300 years ago, before we had unlimited access to Doritos, was my body’s knack for keeping LDL out in the bloodstream somehow useful?
   

2. How does the sheer excess of food available in the modern world factor into all of this? Can too much of even “good” foods be bad?
   

3. How many people in the US are on a statin after 1 blood test and 1 conversation with their doctor? Other medications?
   

4. Most common side effect of the most common statin is “unexplained” muscle pain, weakness, or cramping. How many people are walking around, thinking they’re “getting old” because their joints hurt, when in reality, it’s the statin?

Do you have a question about navigating your own healthcare?