ofonorow wrote:I agree that high Lp(a) may also be a risk factor, but I don't understand why you deny that high LDL-cholesterol is also a risk factor.
Because it isn't. (If you can find evidence that children with hypercholesterolemia - with low to normal Lp(a) - exhibit advanced signs of CVD, that would be solid evidence in your favor.) To repeat, researchers at Framingham and elsewhere, who "reevaluated" their findings by separating Lp(a) from LDL found a significant difference/increased risk w/r to Lp(a). The mistake before taking Lp(a) into account, was lumping Lp(a) (which is an LDL) in to the risk group. You can separate it. Unfortunately, statins do not lower Lp(a).
Again, I don't disagree that Lp(a) is a risk factor. However, the evidence does show that high LDL and high Lp(a) carry an additive risk. For instance, see
this epidemiological study (using the cohort from the Women's Health Study), which was published in JAMA a few years ago. They found that high levels of Lp(a) do increase cardiovascular risk, but only in patients with higher than average LDL-cholesterol, not in those with below average cholesterol.
I don't know if there are studies in people with primary hypercholesterolemia where they do a similar analysis - it would definitely be interesting to see. In any case, do you deny that statins have a benefit in these patients?
By the way, are you positive that statins do not lower Lp(a)?
Based on what evidence?
Suppose I told you that an extract from a plant found in E. Africa could cure every disease, and that the earliest humans would use this plant as a panacea. Humans evolved in this environment and so the active ingredients are in some sense "well known" to the body. Suppose I also told you that there were case reports and anecdotes of this extract curing a variety of illnesses. Would you take my word for it? Let's also suppose I have THREE Nobel Prizes.
As far as I'm concerned, science is the best tool at our disposal for figuring out what works and what doesn't. So wherever possible, any claim - no matter how plausible - should be investigated using this tool. As far as I'm aware, there are relatively few rigorous studies showing that micronutrients can cure a disease, given the number of diseases that afflict us. For the diseases where micronutrients have been shown to have a preventitive or curative role, they are prescribed by mainstream practitioners.
On the surface, the orthomolecular theory is very appealing - almost too good to be true. It offers interventions with minimal toxicity and promises miraculous efficacy. Yet for some reason, very few studies exist that show this to be the case. And I think the premise is also flawed because it is essentially a false dichotomy. Vitamins and essential minerals aren't the only substances that the body recognizes. We consume all sorts of substances in our diet (and have done so for millenia), and our body for the most part "recognizes" such substances. For instance, the body recognizes cyanide in small quantities and even has enzymes that can convert it into less harmful substances that are excreted. But even though cyanide is a substance the body essentially recognizes, I wouldn't be surprised if it wasn't classifed as being "orthomolecular".
Well, if your hypothetical substance had over 80,000 studies and papers published since the early 1900s, I would certainly take it seriously. (Only aspirin (prostaglandins) have more papers published than vitamin C - of course you wouldn't know that using today's libraries and databases. Again, thank you Linus Pauling. I agree with you about science, unfortunately, medical science is more politics than real science lately. )
Okay, let's suppose that the hypothetical substance had over 80,000 studies since the early 1900s, but that most of these were in lab animals or cell cultures, and that relatively few were in humans.
Out of the 80,000 studies done on Vitamin C, how may rigorous studies show a substantial benefit in treating heart disease?
You say orthomolecular medicine is "almost too good to be true", yet you are willing to accept that fact that poison after poison, in rather small amounts, can have miraculous effects on the human body? Which one of us is more off base?
I don't look at substances as being "orthomolecular" or "toximolecular", because it creates a false dilemma. Substances regarded as orthomolecular can also be poisonous, and substances which fit the definition (as I understand it) are also potentially poisonous. As far as miraculous effects are concerned, I don't know of any intervention that is considered a cure-all. I wouldn't consider the benefit of statins for prevention of heart disease to be "miraculous" even as a figure of speech.
But I would also take your substance seriously if I could read a substantial number of case reports, and spoke with enough people.
How many people would be enough?
If vitamin C could be shown to reduce cholesterol as well as statins, I would become a strong advocate for it.
[color=#4000BF]Well, it does work better, (in my opinion because it regulates cholesterol in a range) but cholesterol-lowering is a side effect of the body becoming healthier. There is no evidence that lowering cholesterol,
per se, has any health benefits - other than the contrived studies funded by drug companies.
Vitamin C dosage is important, and yes far less statin is required than vitamin C for the cholesterol-lowering effect.
As I've pointed out before, there are studies that are not industry-supported, and there are others jointly supported by public funding agencies.
If your opinion is more than just that, that would be fantastic. I would seriously become a fan of vitamin C if studies showed that it was as good as or better than statins in terms of lowering cholesterol, or even better, reducing cardiovascular events.
Fair enough, but this [CoQ10 depletiong] is inconsequential unless vitamin C actually works as well as or better than statins in preventing CV disease.
Inconsequential???!! The incidence of heart failure (heart transplant) has at least tripled since statins have been introduced, and the epidemic correlates with the dosage. The higher the dosage, the more likely is heart failure.
Inconsequential,
unless vitamin C can be shown to work as effectively. To me, that's the important part of the equation that is missing - convincing scientific evidence that vitamin C works as you claim it does. If there were such evidence available, I agree that it would be a no-brainer - the cheaper, safer alternative would be preferred.
As far as heart failure is concerned, what kinds of studies are you referring to? It wouldn't be surprising if non-randomized studies showed a correlation between higher dose of statin use and heart failure, since it doesn't imply causation. In fact, it would probably be expected considering patients who are prescribed higher doses of statins are likely to be sicker and probably at higher risk to begin with. If you know of any randomized studies which eliminate this inherent bias, that would lend more strength to your claim that statins lead to heart failure.
You keep stressing prevention. I do not claim vitamin C prevents the disease, because how could we prove it? (I'm sure it does, but our reports are with very ill persons.) We have been dealing with end-stage, serious CVD, people with constant pain who have trouble walking across the room, and usually people whose doctor has told them there is little else that can be done.
How do we "prove" it? Randomized controlled trials, of course. It's the same way it was shown that vitamin D and calcium supplementation prevents fractures in elderly patients.
Likewise, it vitamin C does in fact prevent cardiovascular disease we would be able to see that in any rigorous and well-designed study that randomizes people to receive either vitamin C or something else, and following them over a long period of time.
You admit that statins are not helpful for these patients.
I do? I don't recall saying that - I said that statins won't necessarily make people feel better in the same way analgesics do. That's not how statins work.
These are the people who experience relief in two weeks, or less, and many paint their houses in a month. These are the people that medical professionals can and should encourage to try Pauling's therapy, and see the miracle for themselves. Why don't they? What have doctors got to lose if there is nothing else to try?
Again, why aren't alternative doctors pushing for even small, pilot clinical trials in such patients who are refractory to standard treatments? Many clinical trials for a variety of illnesses investigate experimental treatments in such patients.
There are currently studies being done for things like acupuncture and homeopathy. Are you telling me that Big Medicine condones these trials, yet will want nothing to do with Vitamin C?
There is a huge body of research that supports a mechanism for how LDL contributes towards atherotic plaques.
?? This is an interesting statement, because the Brown/Goldstein Nobel prize identified the mechanism by which lesions form in arteries - from the Lysine Binding Sites - and these "receptors" occur on Lp(a) molecules, not ordinary LDL! This fact has been brushed under the rug, but you can find a lot of research that has explored the mechanism by which plaques form in arteries. It revolves around "kringles" on apo(a) ... Anyway, the error in the "huge body of research" is lumping the sticky and atherogenic Lp(a) with LDL. I am interested in ANY evidence that LDL (without Lp(a)) has any risk what-so-ever.
See above - the JAMA study shows that LDL carries a risk independent of Lp(a).
What "receptors" on Lp(a) molecules are you referring to? Brown and Goldstein's research focused on LDL-receptors on cells, and they showed that a dearth of these receptors due to a genetic mutation is what results in high cholesterol in people with primary hypercholesterolemia. This research helped to establish a role for statins in lowering cholesterol by increasing the number of LDL-receptors expressed by cells.
Any sane person would choose vitamin C if it were shown to work. We can lament all the hurdles facing vitamin C research, but it still doesn't change the fact that very few rigorous studies exist showing that vitamin C will work better than standard treatments in humans.
We know of Dr. Vita (I hope he is tenured. There is a story of the head of the Harvard cardiology department at Harvard Medical school who was forced to resign after trying to pursue the Pauling/Rath theory. I can look it up if it matters.) Again, if medicine runs out of options, cannot control the pain, what possible reason is there at that point to not try vitamin C and lysine? If you must wait for the outcome of a study (which is of course ridiculous in the case of vitamin C and lysine which are completely nontoxic) then you (medicine) is under the control of those who can fund such studies, the patients be damned.
If there are other options, then that's a different story. But people come on this forum saying they have just been prescribed a statin by their doctor, and you advise them to come off it. I don't think that's always justified.
I don't buy it - doctors are humans too, and have families and friends who suffer the same diseases as their patients. If they knew of a way to magically cure diseases, why would they withhold it? I think its wishful thinking to assume that there exists a simple cure for virtually every disease, but that big pharma and big medicine are suppressing it.
In my opinion, this is your best argument to date! However, I have been to school and have received the nutrition "training" doctors in the USA receive. I have written elsewhere about this obvious "brainwashing." It is absurd to believe that Big Pharma can be controlling medicine in this manner - until you realize there would be no Big Pharma if the truth won out.
What "truth"?
It seems as though you're arguing that disease is a complete fabrication of pharmaceutical companies, even though sickness has afflicted our species for much longer than they've been around.
I agree that your opinion might be shaped because of a sort of "channeling bias", i.e. people who turn to "alternative" medicine often do so because they feel that mainstream practitioners have failed them.
I don't know if you are aware, but JAMA commissioned researchers at Stanford to examine why people select Alternative Medicine. (There were something like 400 million visits to Alternative doctors that year, while 350 to regular doctors.) The results were surprising - at least to the researchers; the number one claim was that alternative treatments worked! So yes, mainstream poison therapy often fails, but the "absurd" alternatives seem to work! This was published in JAMA and I can look it up if you would like.
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This reminds me of a newsstory I read recently about use of complementary therapies in the UK - they did a survey with cancer patients and found that only about 20% used complementary therapies - much lower than surveys done in the US. I think part of the discrepancy could be explained by the fact that many people are uninsured in the US, whereas in the UK patients have fewer concerns about being able to afford mainstream treatment.
By the way, is this the study you are referring to:
http://www.ncbi.nlm.nih.gov/pubmed/9605899 I don't see anything in the conclusion about patients using alternative therapies because they necessarily work.