Andy’s Story – Part 3: His hospital treatment
In Part Three of Andy’s story (see Parts One and Two if you missed them), we’ll review the treatment he received in hospital for his three main conditions and explore whether it was adequate to prevent serious complications such as a heart attack and to reinstate his health and allow him to enjoy his life fully.
According to his records, Andy presented at hospital with metabolic syndrome which had progressed to diabetes, high blood pressure and stomach acid reflux.
Andy also had a high cholesterol level of 7.18 (normal is under 5.3). This broken down as high LDL (bad) cholesterol at 5.61 (normal: under 2.0) and low HDL (good) cholesterol at 0.93 (normal: over 1.0).
Sitting on a time bomb
You might wonder why we should be so worried about Andy while he felt generally OK with no major symptoms? This is because serious complications can strike at any moment, even in patients with only mild artery disease.
Heart attack is the first indication of heart disease in a staggering 62% of cases. And 68% of heart attacks strike individuals with only mildly thickened coronary arteries. Just 1 to 5% of heart attacks happen in patients with severe atherosclerotic arteries.
So Andy’s conditions, while largely symptom-free, put him at serious risk of an acute vascular event such as a heart attack. He was effectively sitting on a time bomb and could progress at any moment to a medical catastrophe.
He needed a decisive intervention to reduce this risk.
Variety of pills
So let’s review the treatment Andy received in hospital to find out if it identified his vascular risk and took adequate action.
He had been to see three hospital specialists – attending diabetic, cardiology and gastroenterology clinics and being given a variety of pills including a high dose (80mg) of simvastatin to address his cholesterol problems.
Andy was also given tablets to control his blood pressure and blood sugar. I expect the hospital would have been keen to start him on aspirin too, but didn’t because of his stomach acid reflux.
Three clinical studies
I’m sure each hospital department did its best to help him according to its current protocols. But to review whether this course of treatment was adequate to prevent an acute cardiac event, I referred to three robust clinical studies.
A large-scale study, JUPITOR, found that lowering LDL (bad) cholesterol gives no protection against acute vascular conditions, while lowering both LDL and the inflammatory marker CRP does.
Another study, NAVIGATOR, discovered that tight control of cholesterol, blood glucose and blood pressure does not reduce the mortality and morbidity associated with heart disease.
A third major study, ACCORD, showed that intense blood glucose lowering actually resulted in heightened cardiovascular risk.
These studies clearly indicate the treatment Andy received in hospital was poorly designed and really only directed to the tip of his risk ‘iceberg’.
Contrary to the hospital’s shallow approach, he needed an alternative system which would dig much deeper to find the bulk of his risks and their underlying causes and then deal with them in a holistic manner – an approach known as ‘functional medicine’.
So Andy was at a T-junction where he needed to make some serious decisions. He had to choose between continuing with conventional medicine which focused on risk factors ‘down-stream’ (LDL, glucose and blood pressure) or functional medicine which would focus on his underlying ‘up-stream’ risks.
Andy chose the latter and attended our clinic.
What we found
We identified that Andy had the following problems:
- High inflammation
- Insulin resistance
- Gut dysfunction
- Stomach acid reflux
- Nutritional deficiencies
- High cholesterol (LDL)
- Low HDL
- Abdominal obesity
- Metabolic syndrome
- Athlete’s foot
- Work-related stress
- Adrenal exhaustion
- High uric acid (gout)
- High mercury toxicity
- Possible food sensitivity
- Middle age body changes
- Confirmed genetic defects
Battery of tests
We then ran a battery of tests to quantify his risk. Special blood tests revealed a very high level of inflammation (hs-CRP at 1.92, whereas normal is under 1.0) and very high homocysteine at 28.20 (normal: 5 to 11).
We found his inflammation was due to multiple factors:
- – a poor diet of simple sugars, refined carbohydrates and fast food
- – nutritional deficiencies including the vitamin B group, vitamin C and D and iron
- – subtle genetic defects related to activation of vitamin B12 and folate, an effect you can visualise as ‘greasing the metabolic machine’
- – a genetic weakness in his liver detoxification process
- – a high level of mercury due to multiple amalgam dental fillings which were triggering inflammation in his body
As we see from the JUPITOR study, lowering both bad cholesterol (LDL) and inflammation provides prevention against vascular disease and confirms that inflammation is a decisive factor which should be dealt with.
Interestingly, medical studies indicate it’s not the cholesterol level itself but the number and quality of cholesterol particles which are behind acute vascular events. After all, 50% of heart attacks occur in patients with a normal fat profile. This again underlines the limitation of the conventional treatment Andy had received.
Two types of cholesterol
Most significantly, we’ve been led to believe cholesterol is the most serious risk factor to be targeted in any preventative programme. But the reality is there are two types of cholesterol particles: a small, dense, ‘golf ball’ type and larger, fluffy ‘beach balls’. The larger ones occur in fewer numbers and are less likely to form clots, but the smaller ‘golf balls’ readily stick together to form clots and hence pose serious risk.
Unfortunately, Andy’s blood test confirmed he had the dangerous golf ball LDL particles in high numbers.
Whereas the large beach balls usually come from dietary fat, the dense golf balls are generally related to dietary carbohydrate – especially simple sugars and refined carbs (see more on this in my blog about metabolic syndrome).
Change of diet
So, Andy clearly needed to change his diet to cut down on simple sugars and refined carbohydrates.
Table sugar is bad for you, but the worst is high fructose corn syrup (HFCS), which is now added to every processed food and found in particularly high concentrations in soda drinks and fruit juice.
White bread and white ‘polished’ rice are also bad for your health because their glycaemic index is nearly 100%, while they contain no nutrients or fibre. This damages your metabolic process and causes high levels of inflammation and insulin resistance.
Andy needed to replace these foods with healthy fats, fresh vegetables and fresh fruits – particularly those such as celery and cucumber which are high in fibre and low in calories.
Natural foods neutralise inflammation while man-manipulated foods encourage inflammation. You can use George Orwell’s Animal Farm approach to classify food in pretty simple terms into ‘good’ and ‘bad’.
Good food is the kind your great grandmother would recognise, while most food that comes in a box, can or tin is bad for your health – apart from ‘real’ food such as canned sardines (but not tuna, which is high in mercury). Items like sugar, crisps, bagels, chocolates and soda are a real danger.
Sticking to this simple principle would greatly help Andy to reduce his level of inflammation and help his recovery in the long term. But what about the dangerous sticky golf ball particles revealed in his blood test?
Despite my general concern about how many drugs people are typically prescribed, I felt Andy should continue with the cholesterol pills prescribed by the hospital. He needed to supplement them with COQ10 to mitigate the statin’s effect on lowering cellular energy production. I also prescribed Niacin (vitamin B3) to improve the quality of LDL cholesterol particles.
Andy needed to stay on anti-inflammatory agents such as fish oil (Omega 3) and supplement these with the nutrients in which we found him to be deficient: the vitamin B group, vitamin C and D plus iron.
Part Four to follow …
In Part Four of Andy’s story, which will follow soon, I’ll elaborate further on the dietary interventions we took to reduce his inflammation and reinstate balance within his body systems.
I’ll also deal with the rest of the problems we identified.