One of the common misconceptions out there is that cholesterol is "bad". The truth is that cholesterol is essential to life. Each of our cells is surrounded by a cell membrane that is composed of a "lipid bilayer". Cholesterol is a one of the key components of this membrane. Cholesterol also serves as a vital component in the production of vitamins and hormones including testosterone, estradiol, cortisol, and aldosterone. These hormones are essential to life. See the figure below for a visual representation of how cholesterol serves as a precursor for these key hormones. Because there is poor understanding about the critical role of cholesterol in our bodies we have been led to believe that there is "good" cholesterol and "bad" cholesterol. Nothing is farther from the truth. Cholesterol is good.
However, cholesterol can lead to "poor" outcomes when it gains access to the wrong places in our body like our arteries. From a clinical perspective this is especially pertinent when we are talking about coronary artery disease (CAD) which is by far and away the leading cause of death in this country. Cholesterol, I guess, is much like money. Money has been critical to the development of efficient and effective trade. Without it we would be bartering all day long for what we need. At the same time investment of money in the wrong areas can lead to unfavorable financial conditions. Likewise, when cholesterol gains entrance into our arteries it leads to an inflammatory cascade which can lead to narrowing and obstruction. This can eventually lead to heart attacks or strokes. So the next logical question is how can we determine if and when cholesterol will invade our arteries? Since CAD is the number #1 killer in America this question is pertinent to almost everyone. The problem lies in the fact that when you get your cholesterol measured we are actually measuring the total cholesterol amount in the blood. This doesn't necessarily tell us if and when these molecules will get into our arteries. And that is where I will leave off for now. Stay tuned for the next article in a few days. Also, I would like to acknowledge that I have gotten much of this information from Dr. Attia and his excellent blog. If you would like a personalized assessment of your cardiac risk factors and cholesterol numbers feel free to schedule a consultation. Of course, each individual case is different and the advice in this post should not substitute for getting a consultation with your doctor.
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While we were promised affordable and stable health care insurance coverage options under the "Affordable Care Act" (ACA) we have seen the exact opposite. Not only have health care premiums been going up but deductibles have been going up as well.
I have noticed that many patients that have purchased insurance through the health care exchanges have had trouble finding doctors that accept their insurance. When they do find someone that will take their insurance they often get hit with high visit charges due to pre-negotiated insurance rates. These additional charges often show up as a bill in the mail 2-3 months later. As a result of this I often get asked about what other options are out there for patients. One of the options that is gaining more popularity are medical co-ops. These are often Christian based. A few of the larger ones that I have seen include Medishare, Christian Health Ministries, and Samaritan Ministries. Under these co-ops members share medical costs above certain deductible limits depending on what plan is signed up for by the patient. These co-ops typically come at much more affordable rates than Obamacare plans and fulfill the requirements of the ACA. Often these plans are designed for covering more catastrophic illnesses which is the real point of insurance any way. Combining a christian co-op that will cover expensive medical bills with seeing a doctor that charges low cash rates for routine medical care is perhaps the most affordable option for the majority of patients. For example, if you see a doctor like me for about $55/visit 2-3 times a year and then get coverage from a co-op for around $100/month than your total medical bill will in all likelihood be thousands of dollars less per year than an Obamacare insurance plan. These Obamacare insurance plans can run several hundred dollars per month with a high deductible to boot. The same is also true of insurance that is obtained through your employer. Even though your employer may be covering some of the cost, the christian co-op options may still be much cheaper and have lower deductibles. But what about surgeries? There are cash-only surgical centers like the Surgery Center of Oklahoma that post their rates on line and typically the majority of their surgeries are only two to three thousand dollars which includes the facility expenses. Finally, don't forget that you can typically negotiate with hospitals and doctors to reduce your medical bills. This can help you get significant discounts on bills accrued from an unexpected ER visit or hospital stay. If you have questions about the above options don't hesistate to email me at drmurdock@murdockhealth.com. Placebos or “dummy pills” do work. When they do work placebos produce similar effects in the brain as the “real” drugs. This is not only the case for drugs but also surgery as well. Interestingly, in some cases “sham surgery” produces similar effects as actual surgery. The placebo effect seems to be especially potent in the American population. This may be due to the trust that Americans seem to have in traditional treatments and surgery.
In a film about the placebo effect an experiment was performed where bicyclists were given a placebo supplement pill that would supposedly enhance their performance. Up to half the racers road their bikes faster after receiving the fake “placebo” pill which was nothing more than corn flour. A 2002 study of knee surgery revealed that fake surgery for knee arthritis worked just as well as the real surgery. According to the authors of the paper “the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.” This shows the power of our minds to heal us when we believe we should get better. Another study in 2013 found that knee surgery for degenerative meniscal tears also had no more benefit than “sham surgery”. Anti-depressants are also on a long list of drugs that have minimal additional benefit above placebo. The placebo effect works better when people believe a medicine or treatment is going to work. If people are skeptical than the affects are not as pronounced. The appearance of a pill also makes a difference. Pills that are expensive, bigger in size, and come in capsules have a bigger placebo affect. That being said this doesn't mean that the placebo effect is bad. Harnessing the placebo affect can potentially help a lot of people. In the future it may be that we are treated with placebo where no alternative exists. On March 15th the CDC issued guidelines to address the opioid epidemic which is now two decades or more in the making.
According to the CDC "the United States is in the midst of an epidemic of prescription opioid overdoses. The amount of opioids prescribed and sold in the US quadrupled since 1999, but the overall amount of pain reported by Americans hasn’t changed. This epidemic is devastating American lives, families, and communities." Also from the CDC: "More than 40 people die every day from overdoses involving prescription opioids. Since 1999, there have been over 165,000 deaths from overdoses related to prescription opioids. 4.3 million Americans engaged in non-medical use of prescription opioids in the last month." They summarize their findings by saying that while many American suffer from chronic pain, prescription opioids should only be used short term in most cases. Long term opioid use is associated with serious risks including overdose and opioid use disorder. This is quite a turnaround from what the government and medical institutions have largely advocated over the past decade or two. When I was a medical student the big focus in my pain management training was on increasing our use of opioid medications and not to be afraid to prescribe these medications. We often got catered drug rep lunchs from various pain medication manufacturers. In addition, numerous medical and governmental organization board members, who have made recommendations that have resulted in the loosening up of the use of opioids, were receiving generous contributions from opioid manufacturers at the same time. Just take the example of the American Geriatric Society (AGS). In 2009 the AGS made recommendations that physicians prioritize the use of opioid pain medications for all patients with moderate to severe pain in lieu of traditional anti-inflammatory medications like Ibuprofen. It was later reported that half of the AGS panel experts had financial ties to the drug manufacturers of these medications. Finally, it is important to put things into perspective. Just take the number of pediatric deaths related to the flu virus. In 2014-2014 there was around 128 flu-related pediatric deaths according to the CDC. It is disturbing that the media and the CDC constantly obsess about getting yearly flu shots while in 3 days prescription opioids kill the same number of people as the number of children that died as a result of the flu all of last flu season. In my mind opioid overdose is also far more preventable than the the flu. Are there alternatives to opioids? In most cases there are. These includes natural anti-inflammatories like curcumin and traditional NSAIDS. More importantly I believe chronic pain can be largely avoided through a proper anti-inflammatory diet high in vegetables and low in carbs, weight loss, appropriate exercise, proper sleep, and stress/anxiety management. Of course, each individual case is different and the advice in this post should not substitute for getting a consultation with your doctor. Yogurt can be a healthy food rich in protein, probiotics, calcium, and vitamins.
Unfortunately, most yogurts and especially low-fat yogurts that are purchased in the grocery store more closely resemble desserts than health foods. These yogurts, which are sugar-sweetened and fruit-flavored, are full of carbohydrates and are not healthy. In my experience a good portion of the patients I speak with feel that low-fat yogurt is healthy for them. According to the Mintel report the largest percentage of yogurt consumers (44 %) eat yogurt for health reasons and because they think it is a healthy food choice. But are the commonly bought store brands actually healthy? Yoplait yogurt, a popular yogurt brand, contained 100 % more sugar when it was created per serving than the same company's Lucky Charms cereal. Even today if you review their products you will typically find about 20 grams of carbs per serving. According to The Cornucopia Institute's Yogurt Report many yogurt products may not even meet the standards for real yogurt. They list brands such as Yoplait, Dannon, and many store brands as possible products that "do not meet yogurt's current legal standard of identity." The good news is that you can review recommendations on the Cornucopia website for high-quality yogurt suggestions and you can even make your own yogurt if you have a high-quality culture starter and a quart of raw whole milk. At Murdock Health we are happy to help you in reaching your health and weight goals. Feel free to call 214-929-2411 if you would like to schedule a consultation today, |
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June 2022
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