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Medical Forum / General / General / February 2005Health Canada warning EZETIMIBE
http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/ezetrol_hpc_e.html February 1, 2005 Subject: Association of Ezetrol® (ezetimibe) with myalgia, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia Dear Health Care Professional, Merck Frosst/Schering Pharmaceuticals, following discussions with Health Canada, would like to inform you of new safety data for Ezetrol® (ezetimibe), used alone or in combination with a statin. Ezetimibe is a cholesterol absorption inhibitor that is classified as a systemic drug, because of the enterohepatic recirculation of one of its metabolites1. The Product Monograph for Ezetrol® (ezetimibe) ----more------ Zee, Thanks very much for posting this. This drug is called Zetia in the U.S. A friend recently asked if muscle pain could be the result of Zetia, which he was taking post-statins due to massive adverse effects. Jus a few weeks ago there was little information to relate the muscle side effects to the Zetia. Now this. Perhaps it is time for the medical community to reconsider that, if the body needs Cholesterol to make up 2/3 of the brain, and if the body needs Cholesterol to sheath the nerves, and if the body needs Cholesterol to make up steroids in the mitochondria of the muscle cells, and if the body needs Cholesterol to repair inflammation-induced damage to the arteries, maybe, just maybe, the body needs Cholesterol. http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/ezetrol_hpc_e.html February 1, 2005 Subject: Association of Ezetrol? (ezetimibe) with myalgia, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia Dear Health Care Professional, Merck Frosst/Schering Pharmaceuticals, following discussions with Health Canada, would like to inform you of new safety data for Ezetrol? (ezetimibe), used alone or in combination with a statin. Ezetimibe is a cholesterol absorption inhibitor that is classified as a systemic drug, because of the enterohepatic recirculation of one of its metabolites1. The Product Monograph for Ezetrol? (ezetimibe) ----more------ >>Perhaps it is time for the medical community to reconsider that, if the body needs Cholesterol to make up 2/3 of the brain, and if the body needs Cholesterol to sheath the nerves, and if the body needs Cholesterol to make up steroids in the mitochondria of the muscle cells, and if the body needs Cholesterol to repair inflammation-induced damage to the arteries, maybe, just maybe, the body needs Cholesterol. << COMMENT: The medical community is well aware that the body needs cholesterol. The medical community is also aware than in countries where the average total blood cholesterol is 150 or lower (it was something like 90 in rural China), there is next to no atherosclerosis, and a lot less stroke. Nor do these populations seem to pay for it by having their nerves, brain cells, and muscles fall apart. So whatever cholesterol we need in our blood, it's less than that. I'd be rather suprised if Zetia proves to have the side effects of the statins. All it does is return your blood levels of cholesterol to those that humans have lived with more millions of years. Now, the next question is where or not this will get rid of most atherosclerosis. I suspect it won't be nearly as effective as doing it by calorie restriction and a high polyunsaturated diet (ie, what they eat in those countries where heart disease is rare). Obesity itself is an inflammatory state, and some of atherosclerosis is caused by an inflammatory component, not just high blood cholesterol. Statins are antiinflammatory, and Zetia isn't. For that matter, the side effects of statins are not due simply to their lowering of blood cholesterol, but go in part to mechanisms much deeper. SBH > >>Perhaps it is time for the medical community to reconsider that, > [quoted text clipped - 34 lines] > > SBH The Chinese are many peoples. Just for a start do you mean the rice eaters of the south, or the wheat eaters of the north? Do you have some idea of just how much calorie restriction we should aim for? For example: I am 62, and 5 foot 2 and a bit. So my normal intake would be about 1500 a day, I think. What should I aim for? You must have data on this. Zee The data's from the Chinese Health study, and comes from all over China. I can't answer your question without access to the thing, which was one gigantic tome of tables, last I looked at it. According to the following epidemiologic study from California Adventists (a nonsmoking clean-living semi-vegetarian lot), you should aim for a BMI (wt in Kg divided by height in meters squared) of 21 to 27 or so. Your height is 1.575 kg, and the square of that is 2.48. If you aim for a BMI less than 27, you need to be less than 27 = wt/(2.48) or wt = 27 * (2.48) = 6.70 = 147 lbs. If you aim for 24 in the middle of the best range that gives you (24/27) 147 = 131 lbs. ============================= Am J Epidemiol 1999 Dec 1;150(11):1152-64 Body weight and mortality among adults who never smoked. Singh PN, Lindsted KD, Fraser GE. Center for Health Research, Loma Linda University, CA 92350, USA. In a 12-year prospective study, the authors examined the relation between body mass index (BMI) and mortality among the 20,346 middle-aged (25-54 years) and older (55-84 years) non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1988) who had never smoked cigarettes and had no history of coronary heart disease, cancer, or stroke. In analyses that accounted for putative indicators (weight change relative to 17 years before baseline, death during early follow-up) of pre-existing illness, the authors found a direct positive relation between BMI and all-cause mortality among middle-aged men (minimum risk at BMI (kg/m2) 15-22.3, older men (minimum risk at BMI 13.5-22.3), middle-aged women (minimum risk at BMI 13.9-20.6), and older women who had undergone postmenopausal hormone replacement (minimum risk at BMI 13.4-20.6). Among older women who had not undergone postmenopausal hormone replacement, the authors found a J-shaped relation (minimum risk at BMI 20.7-27.4) in which BMI <20.7 was associated with a twofold increase in mortality risk (hazard ratio (HR) = 2.2, 95% confidence interval (CI) 1.3, 3.5) that was primarily due to cardiovascular and respiratory disease. These findings not only identify adiposity as a risk factor among adults, but also raise the possibility that very lean older women can experience an increased mortality risk that may be due to their lower levels of adipose tissue-derived estrogen. PMID: 10588076 > The data's from the Chinese Health study, and comes from all over > China. I can't answer your question without access to the thing, which [quoted text clipped - 55 lines] > to their lower levels of adipose tissue-derived estrogen. > PMID: 10588076 Ok I know about that. But what I am asking is, if we are to under eat, by what percentage approximately? Because what you are saying, if I understand you, is that we should be far under that North American BMI. All of us. Zee Since your BMI is set by your caloric intake and excercise level, there's no answering that question. There are an infinite number of combinations of calories and exercise that will deliver the needed body composition. Give yourself at least the minimum 20 min 3x/kw of light aerobics, and adjust intake to keep you where you need to be. I can only tell you what does NOT work, and that's cutting calories alone. If you do no exercise, your body will defend your present BMI vigorously, by making you so tired you never move. And in that mode, you can survive on very lower calorie consumptions. A woman your size in a warm climate might be able to get by on 1000 kcal a day, even, without losing at all. Dieting without exercise DOES NOT WORK unless you have the willpower to frankly starve below 1000 kcal. WHich almost no-one does. There is no royal road to getting to optimal BMI. SBH > Since your BMI is set by your caloric intake and excercise level, > there's no answering that question. There are an infinite number of [quoted text clipped - 14 lines] > > SBH My pre-statin workout was 2 1/2 hours a day. I absolutely must exercise. I think that may partly be my problem with statins. As you know there is some literature about statins, exercise and athletes. I am just intrigued by this idea of eating a very limited diet. Have been reading about it. It seems to me the NA BMI is too high for anyone. I think we do not try diet and exercise hard enough (most of us) before we give over to statins. One month or three seems to be what physicians advise before whipping out the prescription pad. I think one year would be more realistic. Physicians should be able to "prescribe" gym, dietary counselling. Money that would be used on bypass surgery could be moved to this. One Canadian province is talking about giving tax credits for gym memberships. Zee > > Since your BMI is set by your caloric intake and excercise level, > > there's no answering that question. There are an infinite number of [quoted text clipped - 34 lines] > > Zee No gym membership or other fees are required for the 2PD Approach: http://www.heartmdphd.com/wtloss.asp At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 > Since your BMI is set by your caloric intake and excercise level, > there's no answering that question. There are an infinite number of [quoted text clipped - 14 lines] > > SBH There is a way: http://www.heartmdphd.com/wtloss.asp At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 > > The data's from the Chinese Health study, and comes from all over > > China. I can't answer your question without access to the thing, [quoted text clipped - 69 lines] > > Zee Would suggest you read my answers to the updated list of FAQs for the 2PD Approach: http://www.heartmdphd.com/wtlossfaqs.asp At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 >>27 = wt/(2.48) or wt = 27 * (2.48) = 6.70 = 147 lbs. Uh, pardon the slipped decimal; it came from reading off scientific notation. 147 lbs is right, but obviously that's 67.0 kg, not 6.70. So you should be below 147 lbs, and the closer you get to 130, the better. The low BMI of 20.7 is 113 lbs. Interestingly, that's close to the rule of thumb "ideal weight" from estimating at 100 lbs for 5 ft women, and adding 5 lbs per inch over that (110 lbs). But that's for young and athletic women, and doesn't serve them well, mortality-wise, in middle age and over. In geriatrics if you add 15 or 20% to the "absolutely ideal model body weight target" you're still just fine. It's those people carrying around 50% more, or even 100% more, than their ideal weight, who are going to pay for it. SBH > >>27 = wt/(2.48) or wt = 27 * (2.48) = 6.70 = 147 lbs. > [quoted text clipped - 12 lines] > > SBH GERIATRICS?? I hope you don't think you're still middle-aged at 62. <g> > I hope you don't think you're still middle-aged at 62. <g> Middle aged, elderly, geriatric: Where does middle age end and elderly begin? I think elderly is generally thought to refer to people over 75, perhaps over 80. But not early 60s. If middle aged is 37-38 (middle, right?) then someone who is 50 is elderly. Geriatric is even more specific. In our culture it means old ill. And you better change your tune boyo or you're going down with the *last* generation. Zee...listening to techno pop Sigh, remember when our age group swore to "never trust anyone over 30"? >> I hope you don't think you're still middle-aged at 62. <g> > [quoted text clipped - 11 lines] > > Zee...listening to techno pop Of course these words are not well defined. Geriatric means aged or aging or old. But to the young, over 30 is old. During my lifetime, "old person" got politicized to "senior citizen." Are you a senior citizen, Zee? Do you qualify for discounts? US social security used to define "senior"--- it was when they retired you. A standard (65) first set by Bismark in the 19th century. But now in the US they keep upping this number, like in Catch 22. While at the same time the AARP, seeking to expand their base, keeps trying to sell retirement living interests to younger and younger sets, down into the 50's. Would Dell Webb let you in? Geriatricians haven't exactly defined their age-cutoff either. But the general feeling is that it has to do with people who have problems like those of the aged who need a lot of assistance, like dementia, incontinence, walking problems. The "frail elderly." Whereas the merely chronological elderly who (if lucky) drive their own motorhomes at 75 and aren't fail (yet), might not really be appropriate geriatric patients at all. Satchel Page's "How old would you be if you didn't know how old you was?" is a very good question. <<Where does middle age end and elderly begin? << Senescence begins and middle age ends The day your decendents outnumber your friends --Ogden Nash > Of course these words are not well defined. Geriatric means aged or > aging or old. But to the young, over 30 is old. During my lifetime, > "old person" got politicized to "senior citizen." Are you a senior > citizen, Zee? Do you qualify for discounts? I have never been offered them. Never asked about them either. But if you don't quit I'm gonna hunt you down and hurt you. > US social security used to define "senior"--- it was when they retired > you. A standard (65) first set by Bismark in the 19th century. But now > in the US they keep upping this number, like in Catch 22. While at the > same time the AARP, seeking to expand their base, keeps trying to sell > retirement living interests to younger and younger sets, down into the > 50's. Would Dell Webb let you in? > Geriatricians haven't exactly defined their age-cutoff either. But the > general feeling is that it has to do with people who have problems like [quoted text clipped - 11 lines] > > --Ogden Nash Thanks. Oh look....the Lawrence Welk show is on. ta ta. Zee >>I have never been offered them. Never asked about them either. But if you don't quit I'm gonna hunt you down and hurt you. << With what? I'm not saying you're old, but I wouldn't be surprised if some of those projects you had in grade school involved learning to chip your own flint weapons for use against critters we only find in tar pits nowadays.... > Geriatricians haven't exactly defined their age-cutoff either. But the > general feeling is that it has to do with people who have problems like [quoted text clipped - 11 lines] > > --Ogden Nash A lot of this is made possible by our choices about how to live in this world. Some luck and some bad luck aka risk. My sister who is 2 years younger than I opted for some fancy knee surgery and can hardly get about. She is a 54 year old MD. I?m two years older refused drugs until bypass and can do one leg deep knee bends. Can?t run to save my a.s though and think meds may hinder me and help at the same time. Double edge sword comes to mind. The price and awareness concerning this challenge I have is my path. Anyway Thanks !! for the Ogden Nash quote. No Decendents yet many friends have pasted. Anyone who keeps the ability to see beauty never grows old. --Franz Kafka Bill  SignatureZone 5 S Jersey USA Shade Serious Vision Problems like Stargard?s ? --> http://www.ocutech.com/ > I hope you don't think you're still middle-aged at 62. <g> No? Then what is a 62-year-old? Certainly not "old," which traditionally began at 65, and now more like 75. I'm the same age as you, and I don't consider myself to be middle-aged yet. SignatureKeith F. Lynch - http://keithlynch.net/ Please see http://keithlynch.net/email.html before emailing me. > > I hope you don't think you're still middle-aged at 62. <g> > [quoted text clipped - 3 lines] > I'm the same age as you, and I don't consider myself to be > middle-aged yet. Naw, IMO. Middle age begins about 40 and ends about 60. And 60 to 70 is old/early elderly and from 70 a person is in the death curve and both the inflection point and the midway point is 83. Those beyond the age of 93 are the super elderly. On the other hand, a T1 diabetic is clearly elderly at 60. Depending if a person takes cares and is lucky or the reverse, the individual functional age will vary somewhat from the norm.. > The data's from the Chinese Health study, and comes from all over > China. I can't answer your question without access to the thing, which [quoted text clipped - 10 lines] > If you aim for 24 in the middle of the best range that gives you > (24/27) 147 = 131 lbs. Actually, because Zee has profoundly elevated lipids, her weight probably should ideally be closer to 108 lbs for a BMI that is about 20. At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 > > >>Perhaps it is time for the medical community to reconsider that, > > [quoted text clipped - 52 lines] > > Zee Ime, calorie counting is not useful in helping people eat less to lose weight. Reason: People are neither able to measure nor sense calories with enough accuracy to allow meaningful "counting." At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 :: Ime, calorie counting is not useful in helping people eat less to :: lose weight. So, if true, calorie counting should not lead to weight loss, right? :: Reason: People are neither able to measure nor sense calories with :: enough accuracy to allow meaningful "counting." Uh-huh. > :: Ime, calorie counting is not useful in helping people eat less to > :: lose weight. > > So, if true, calorie counting should not lead to weight loss, right? ## He may be right since so few people STOP eating when they run out of calories (or points for WW followers) for the day. If everyone could stick to say 1100 or 1200 c. a day there would be little obesity. > :: Reason: People are neither able to measure nor sense calories with > :: enough accuracy to allow meaningful "counting." ## To a point that's true, as 2 bananas or 2 pork chops may be different in size and calorie content. One chop may contain more fat then another or be an ounce heavier, bringing the calories up quite a bit. SignatureWysong Age 60. Height 5'6" Starting date: 1/8/05 171/ 165 / 140 lb Starting date LC 7/01 at 207lbs Stopped losing on LC 11/01 at 165lbs ========================================== :: X-No-Archive: yes :: [quoted text clipped - 9 lines] :: everyone could stick to say 1100 or 1200 c. a day there would be :: little obesity. But he says the reason is because calorie counting is not accurate....not that people don't stop eating. I, for one, stop eating once I get the number I'm shooting for. As a result, I'm eating less and I'm also losing weight. ::::: Reason: People are neither able to measure nor sense calories with ::::: enough accuracy to allow meaningful "counting." [quoted text clipped - 3 lines] :: fat then another or be an ounce heavier, bringing the calories up :: quite a bit. -- One can account for weight. The differences in fat content are likely small, and if you use something like fitday, you can trim fat according to available selections. The only reason Chung thinks calorie counting doesn't work is because he is pushing his 2 pound diet. Perhaps you should try it. :: Wysong :: Age 60. Height 5'6" [quoted text clipped - 3 lines] :: Stopped losing on LC 11/01 at 165lbs :: ========================================== > :: X-No-Archive: yes > :: [quoted text clipped - 9 lines] > :: everyone could stick to say 1100 or 1200 c. a day there would be > :: little obesity. > But he says the reason is because calorie counting is not accurate....not > that people don't stop eating. > I, for one, stop eating once I get the number I'm shooting for. As a > result, I'm eating less and I'm also losing weight. $$ I understand. My reply was badly worded. Sorry. It's difficult to get an accurate calorie count for everything on your plate due to factors mentioned above. One chop a little fattier or thicker than another. One chicken leg an ounce heavier than another, one banana an inch longer than another, etc. *BUT* people may weigh and measure everything and not be able to stop eating at X number of calories - if they still feel hungry or empty. It's a two prong problem. Their calorie counts may be off somewhat and other folks may not have the willpower to not eat that last small piece of steak in the kitchen. When I add up my food intake each day I have no way to be very accurate in calorie counting - all I hope for is to be within 100 either way. > One can account for weight. The differences in fat content are likely > small, and if you use something like fitday, you can trim fat according to > available selections. $$ I tried Fitday when I started low-carb 2 years ago. Not everyone has the time and patience to spend on that website. I didn't find it helpful since I have no idea what the exact fat content of a certain slice of pork or turkey leg contained. Finding how many calories was in 3 oz. of peeled banana was also a problem. Unless they changed their format and are easier to use I hesitate to use that service again. Are those of us who don't like sites like Fitday going to hear how it's necessary to use such a thing? > The only reason Chung thinks calorie counting doesn't work is because he is > pushing his 2 pound diet. Perhaps you should try it. $$ Perhaps YOU should try it and save hours and hours and hours here on diet NGs and on Fitday..... SignatureWysong Age 60. Height 5'6" Starting date: 1/8/05 171/ 165 / 140 lb Starting date LC 7/01 at 207lbs Stopped losing on LC 11/01 at 165lbs ========================================== > X-No-Archive: yes > [quoted text clipped - 23 lines] > another. One chicken leg an ounce heavier than another, one banana > an inch longer than another, etc. If you go by weight, you can minimize this variance. *BUT* people may weigh and measure > everything and not be able to stop eating at X number of calories - > if they still feel hungry or empty. Two points. 1) if they can't stop eating it is not the fault of calorie counting - if weight loss doesn't follow, then they simply ate more calories then they need to to produce weight loss. 2) if they are still hungry, then perhaps they can eat more and still lose weight. It's a two prong problem. Their > calorie counts may be off somewhat and other folks may not have the > willpower to not eat that last small piece of steak in the kitchen. Then they will suffer the same problems on Chung's 2PD. > When I add up my food intake each day I have no way to be very > accurate in calorie counting - all I hope for is to be within 100 > either way. But if you find that you don't lose at 1500, decrease to 1400. If that doesn't work after a while, move to 1300. Weight loss will eventually start, if with slight errors in counting. What is harder to control with calorie counting is the rate of weight loss, and that is due to these inaccuracies. Also what's hard to figure we what your calorie expendature is, so since you never really know it, you just have to set your calorie intake so as to produce weight loss. My point is that even if calorie counting is not accurate, it can produce weight loss in those who really do it and make small changes upon feedback from the scale, over time. >> One can account for weight. The differences in fat content are >> likely small, and if you use something like fitday, you can trim fat >> according to available selections. > > $$ I tried Fitday when I started low-carb 2 years ago. Not everyone > has the time and patience to spend on that website. Then they don't have time and patience to lose weight, or they can use some other method. Fitday for me only takes a few seconds to use. I didn't find it > helpful since I have no idea what the exact fat content of a certain > slice of pork or turkey leg contained. Finding how many calories was > in 3 oz. of peeled banana was also a problem. Unless they changed > their format and are easier to use I hesitate to use that service > again. Are those of us who don't like sites like Fitday going to > hear how it's necessary to use such a thing? Fitday is simply one means to track calories. If you don't like it, no one is forcing you to use it. It is no wonder you couldn't achieve further weight loss. You cann't count carbs in veggies and now I find you can't track calories. Anyone who thinks you need to have the exact fat content in a pork chop to use calorie counting to lose weight simply hasn't the mental capacity to use calorie counting as a tool to lose weight. >> The only reason Chung thinks calorie counting doesn't work is >> because he [quoted text clipped - 3 lines] > $$ Perhaps YOU should try it and save hours and hours and hours here > on diet NGs and on Fitday..... You really should consider Chung's 2PD, Wysong. > > X-No-Archive: yes > > [quoted text clipped - 25 lines] > > If you go by weight, you can minimize this variance. Yes, the weight of the food is more useful than the calorie estimate. The former is sensed whereas the latter is not. > *BUT* people may weigh and measure > > everything and not be able to stop eating at X number of calories - [quoted text clipped - 3 lines] > counting - if weight loss doesn't follow, then they simply ate more calories > then they need to to produce weight loss. Ime, hungry people tend to make more errors in estimating calories that favor surplus. This explains the failure that most people have with calorie counting as a method of monitoring intake amount. > 2) if they are still hungry, then > perhaps they can eat more and still lose weight. If they eat more, they will *not* lose weight. > It's a two prong problem. Their > > calorie counts may be off somewhat and other folks may not have the > > willpower to not eat that last small piece of steak in the kitchen. The calorie counts tend to be more off as a function of increasing hunger. > Then they will suffer the same problems on Chung's 2PD. No. The food scale will not change measurements as a function of increasing hunger. > > When I add up my food intake each day I have no way to be very > > accurate in calorie counting - all I hope for is to be within 100 [quoted text clipped - 7 lines] > is, so since you never really know it, you just have to set your calorie > intake so as to produce weight loss. Calorie estimates vary with the estimator from moment to moment as a function of hunger. This remains the reason for the failure of calorie counting. > My point is that even if calorie counting is not accurate, it can produce > weight loss in those who really do it and make small changes upon feedback > from the scale, over time. In my experience, calorie counting does not work for most people who try it. On the other hand, the 2PD Approach works for *everyone* who tries it with *zero* drop out. > >> One can account for weight. The differences in fat content are > >> likely small, and if you use something like fitday, you can trim fat [quoted text clipped - 5 lines] > Then they don't have time and patience to lose weight, or they can use some > other method. Enter the 2PD Approach: http://www.heartmdphd.com/wtloss.asp > Fitday for me only takes a few seconds to use. N=1 > I didn't find it > > helpful since I have no idea what the exact fat content of a certain [quoted text clipped - 6 lines] > Fitday is simply one means to track calories. If you don't like it, no one > is forcing you to use it. Nor is anyone forcing you to try the 2PD Approach. > It is no wonder you couldn't achieve further weight loss. You cann't count > carbs in veggies and now I find you can't track calories. Anyone who thinks > you need to have the exact fat content in a pork chop to use calorie > counting to lose weight simply hasn't the mental capacity to use calorie > counting as a tool to lose weight. It seems you choose to blame others for their lack of success with counting when the blame should be directed at the flawed method. > >> The only reason Chung thinks calorie counting doesn't work is > >> because he [quoted text clipped - 5 lines] > > You really should consider Chung's 2PD, Wysong. That is a thoughtful and considerate suggestion, Roger. At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 > > > >>Perhaps it is time for the medical community to reconsider that, This is an interesting discussion between obviously knowledgeable individuals that the rest of us can't really follow since everyone but Dr. Chung is using relies to author. Is it possible to reply to the group please. > This is an interesting discussion between obviously knowledgeable > individuals that the rest of us can't really follow since everyone but > Dr. Chung is using relies to author. Is it possible to reply to the > group please. Better yet, let those interested go to the appropriate medical and fantasy (i.e., diet) groups, and stop cross-posting this to rec.food.cooking. -aem > COMMENT: > [quoted text clipped - 5 lines] > nerves, brain cells, and muscles fall apart. So whatever cholesterol we > need in our blood, it's less than that. A sign at the medical laboratory I go to urges patients to have a CRP test because in THEIR words "Half the people who have coronary artery disease have normal or below normal cholesterol" "Half" sounds like a 50 / 50 crap shoot to me. According to the sign in the Laboratory, above normal cholesterol is NOT related to cardio vascular disease any more than normal or below normal cholesterol. I believe this has been verified by other researchers - especially if people with hypercholestermia (sp?) are culled from the population in the study. >A sign at the medical laboratory I go to urges patients to have a CRP test >because in THEIR words "Half the people who have coronary artery disease >have normal or below normal cholesterol" They wouldn't happen to be offering CRP tests (and not for free either)? >"Half" sounds like a 50 / 50 crap shoot to me. According to the sign in the >Laboratory, above normal cholesterol is NOT related to cardio vascular >disease any more than normal or below normal cholesterol. I believe this >has been verified by other researchers - especially if people with >hypercholestermia (sp?) are culled from the population in the study. This is a common error in interpreting statistics. It's only 50 / 50 if half the population has above normal cholesterol. I don't know what the actual incidence of above normal cholesterol is in the general population, but just for example, let's say it's 10%. Then people with high cholesterol would have a five times higher incidence of CAD than those with normal or below normal cholesterol. It's the difference between people with the condition and people without it, or the general population, that makes a correlation significant or not. Note that if there's a 1% incidence of condition X in the general population, but it's 10% in people with disease Y, people with condition X are ten times more likely to get disease Y, even if 90% of people with disease Y don't have condition X. >>This is a common error in interpreting statistics. It's only 50 / 50 if half the population has above normal cholesterol. I don't know what the actual incidence of above normal cholesterol is in the general population, but just for example, let's say it's 10%. Then people with high cholesterol would have a five times higher incidence of CAD than those with normal or below normal cholesterol. It's the difference between people with the condition and people without it, or the general population, that makes a correlation significant or not. << COMMENT: Yes. More than half the drivers involved in auto accidents haven't been drinking. We cannot conclude from this that the idea that drinking causes auto accidents, is false. SBH "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in part: >>>Perhaps it is time for the medical community to reconsider that, > [quoted text clipped - 34 lines] > >SBH There's always the question of whether restoring some variable to its proper level by method X will accomplish the same result overall as restoring the various causal variables might do. For instance, does restoring lipid levels to their normal levels by using a statin or Zetia do what a calorie-restricted diet and levels of nutrients more in keeping with our evolutionary past would do? Certainly not exactly... -- Jim Chinnis Warrenton, Virginia, USA Nope, that's why we need prospective trials to see if lab numbers correlate with clinical outcome. Which in the case of Zetia we do not have. But the doofuses approved it anyway. Despite the fact that, if we look outside of statin therapy and diet, other methods of lowering cholesterol by pharmacological means have show a clinical outcome track record that is either bad or (at best) very very uninteresting. Find me the evidence that niacin, bile acid binders, or fibrates save lives. The FDA's been burned before on using proxy markers in approving drugs. They killed a lot of people with Mexilitine, for example. Nobody apologized. And apparently nobody learned anything, either. Going by near-term risk factor modification is a good paradigm for blood pressure pills and even antidiabetic drugs, but that doesn't necessarily mean it carries over into all other aspects of medicine. The reverse is also true, to some extent. If you look at the effects of beta blocker drugs or fish oil on PVDs in routine monitoring, you might predict that both would be worthless as preventives in keeping people from dying of sudden cardiac arrest due to malignant dysrhymias. And in both cases you'd be wrong. Nothing substitutes for a good long prospective clinical with real clinical endpoints. Of course, these are fiendishly expensive. So the problem is the same as with all other things in society: everybody wants the results of such trials, but nobody wants to pay for them. I have in mind Harvard president David Starr Jordan's aphorism: "If you think education is expensive, try ignorance." To some extent the same is true of clinical trials. They're expensive, sure. But the trillions we waste in medicine by NOT doing them.....! SBH "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in part: >I have in mind Harvard president David Starr Jordan's aphorism: "If you >think education is expensive, try ignorance." To some extent the same >is true of clinical trials. They're expensive, sure. But the trillions >we waste in medicine by NOT doing them.....! Absolutely. And I note that despite the enormous cost of poor health, governments by and large do not fund the studies (with meaningful endpoints) that could truly help improve things. The US forces pharmaceutical firms to study proposed drugs, but often not to clinical endpoints that make sense, and also fails to determine effects of detailed diet and exercise patterns on clinical morbidity and mortality! -- Jim Chinnis Warrenton, Virginia, USA jchinnis@alum.mit.edu >>>Perhaps it is time for the medical community to reconsider that, > [quoted text clipped - 18 lines] > nerves, brain cells, and muscles fall apart. So whatever cholesterol we > need in our blood, it's less than that. IME statin use in results in having to "pay for it by having their nerves, brain cells, and muscles fall apart" - 3 years out and still disabled on all the counts you list. > I'd be rather suprised if Zetia proves to have the side effects of the > statins. All it does is return your blood levels of cholesterol to [quoted text clipped - 7 lines] > inflammatory component, not just high blood cholesterol. Statins are > antiinflammatory, and Zetia isn't. Exactly. Cholesterol is downstream of whatever the culprit is. As the THINCS put it so well, the current anti-cholesterol issue makes as much sense as concluding that firemen cause fires because they have been observed to be present at most fires. People in countries with low cholesterol have other differences as well. The cholesterol level may be as a result of something that causes the body to mount a defense with an inflammatory response. Eliminating the two markers, cholesterol and inflammation, for that attacking entity makes as much sense as "fixing" your car by disconnecting the idiot light so it doesn't keep flashing. Just this week it was "discovered" that adipose tissue causes inflammation in the liver (by a mechanism not yet understood), which causes the liver to mount a defense - the results of that defense is actually what causes diabetes. Now, they can either stop the liver from defending itself (similar to 'fighting' arteriosclerosis by using anti-inflammatories and drastically reducing cholesterol - simply eliminating the warning signs/idiot lights), or they can go find out what the actual source of the liver irritant is and fix or prevent that. >For that matter, the side effects of > statins are not due simply to their lowering of blood cholesterol, but > go in part to mechanisms much deeper. > > SBH > >>Perhaps it is time for the medical community to reconsider that, > [quoted text clipped - 34 lines] > > SBH I would concur with your comments. At His service, Andrew -- Andrew B. Chung, MD/PhD Board-Certified Cardiologist ** Suggested Reading: (1) http://makeashorterlink.com/?L26062048 (2) http://makeashorterlink.com/?O2F325D1A (3) http://makeashorterlink.com/?X1C62661A (4) http://makeashorterlink.com/?U1E13130A (5) http://makeashorterlink.com/?K6F72510A (6) http://makeashorterlink.com/?I24E5151A (7) http://makeashorterlink.com/?I22222129 |
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