One cardiologist's mission to reduce statin use for cholesterol
Dr. Elizabeth Klodas is a practicing cardiologist in Minneapolis and the creator of Step One Foods. This piece represents her views and not necessarily those of CNN.
(CNN)High
cholesterol? Here's a pill. High blood pressure? Here's two pills.
High blood sugar? Here's two pills and an injection. This is what many doctors routinely do without ever addressing why the cholesterol, blood pressure or blood sugar is abnormal in the first place.
I
used to practice this way until I realized that all I was doing was
covering up the downstream effects of poor diet with a bunch of drugs,
instead of changing the food.
I
am a practicing cardiologist. I trained at some of the finest medical
institutions in the world, including Mayo Clinic and Johns Hopkins, and
have been repeatedly recognized for great patient care. But what I
really want to achieve professionally is to put myself out of work.
Unfortunately,
cardiologists have endless job security. And that's because we're
treating the wrong thing. My waiting room was full of patients whose
numbers I had made perfect but who still looked sick and felt terrible.
Some even felt worse with all the drugs I had put them on. No cures,
just a neverending revolving door of follow-up visits. This is not why I
went to medical school.
Yet
no one seemed to be doing anything about this or even acknowledging it.
So I became obsessed with finding a better solution and founded a
company that formulates foods to help lower cholesterol, backed by
pharmaceutical-level science.
There
may be 30,000 food items in the average grocery store, but none of them
has been subjected to any real scientific scrutiny. They bear all sorts
of checkmarks and heart symbols, but that tells only part of the story.
For example, a cereal might contain fiber -- and boldly tout the
ability of this nutrient to lower cholesterol -- but the fine print
reveals that a serving of the cereal also delivers the added sugar
equivalent of three cookies. Any positive health effect of the fiber is
completely negated. But how is the average consumer supposed to know
this? They're not. They're just supposed to like the taste and feel
good about buying that cereal. My patients may have been trying to "eat
better," but they were getting duped.
Two decades ago, the National Institutes of Health cholesterol guidelines
mandated that changing diet should be tried for three months as the
first step in treating high cholesterol, before putting anyone on drugs.
But today, many of my peers expressed skepticism that a food-based
solution could work.
It took more
than 80,000 hours of training for me to become a cardiologist. How much
of that time was spent on nutrition? Zero.
Treatment guidelines, representing the
standard of care, only pay lip service to nutrition. For example, the
American Heart Association's latest cholesterol management guideline is 120 pages long.
How much of that is devoted to diet? One paragraph. The guideline
mostly instructs providers on which patient to put on which drug and at
what dose. Children as young as 10, according to the guidelines, can be
started on statin medications such as Lipitor and Crestor.
In
addition, physicians know only the prescription model. They are taught
that the only truly valid proof of efficacy is a clinical trial and that
everything else is conjecture. That's why pharma rules, even though the
literature is full of data about the health benefits of various foods.
Food does not have "dosing data."
Did
you know that doctors are monitored according to whether they prescribe
medications? If I don't follow the cholesterol guidelines by
prescribing statins, insurers will send letters scolding me. If I don't
talk to you about the cholesterol-lowering effects of walnuts and oat
bran, nobody cares.
Physicians even get paid more when a drug is prescribed. A medical encounter that generates a prescription is considered more complex, which qualifies for higher reimbursement. In contrast, if a physician uses some of the very limited time with patients to talk about antioxidants and omega-3 fatty acids, they get nothing more.
Physicians even get paid more when a drug is prescribed. A medical encounter that generates a prescription is considered more complex, which qualifies for higher reimbursement. In contrast, if a physician uses some of the very limited time with patients to talk about antioxidants and omega-3 fatty acids, they get nothing more.
My solution is to
give physicians, insurers and especially patients an alternative
food-based option for cholesterol lowering that could compete with drugs
on every level. These foods taste great and are formulated using only
health-promoting ingredients. They are dosed and measured and as easy
to prescribe and use as medications. Most important, they yield
clinically meaningful cholesterol reductions as confirmed by a clinical
trial.
Given that 70 million
Americans have high cholesterol, I approached big food companies and
investors, naively thinking they would love my idea and want to help.
They did not. Food manufacturers thought our ingredients (such as real
almonds, walnuts, pecans and blueberries) were too expensive. They
wanted to replace them with flavorings, artificial sweeteners and "fruit
bits." Investors thought the clinical trial we proposed doing to
confirm efficacy was too uncertain. They told us we needed to have
patents so we could charge prices like the pharmaceutical companies. No
wonder this had never been done before. There was simply not enough
profit in it. Patient health, it seems, is not very valuable.
Undeterred,
my supporters and I pushed forward and, supported by grant funding,
conducted a trial in two countries testing our foods in statin
intolerant individuals. These were people who are candidates for statin
drugs but either can't or won't take the medications due to side
effects, such as muscle aches. The only instruction to the study
participants was: "Eat these foods twice per day instead of something
you're eating already," without making any other lifestyle changes.
Literally as simple as "take this pill twice per day."
The result was that 20%, 30%, even close to 40% cholesterol reductions were found in many individuals
in just 30 days. This data was submitted at an American Heart
Association meeting and will be submitted for publication. These
medication-level cholesterol responses were obtained with food, without
the need for dietary overhauls or exercise routines. They don't just
represent an option for the estimated 20 million Americans who are
statin intolerant and have no other solutions but for millions more who
need to lower their cholesterol but don't need stains.
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As
with medications, not everyone's cholesterol will respond equally to a
food intervention. Some people should be on statins even if their
cholesterol is perfect. But given that it takes only a month of dietary
change to determine whether you're a food responder, doesn't it make
sense to give people the chance to at least try a validated food
intervention before assigning them to a lifetime of pills?
Especially since food doesn't have any side effects, just side benefits such as lower blood pressure, better blood sugar control, weight loss and feeling better.
Especially since food doesn't have any side effects, just side benefits such as lower blood pressure, better blood sugar control, weight loss and feeling better.
Food is the
comprehensive solution to a complex problem. And it just might put me
-- and pharmaceutical companies -- out of business.
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