Sunday, March 18, 2012

Response to letter I received. Edited for confidentiality.

The letter received:

"Hey Dr. Charlap,

I had a chance to read some of your blogs. We are on the same page with many things. As I said before I am not a supplement pusher. I only carry about 5 or 6 products on my site. I liked your post about the depletion of nutrients in soil as this claim never really made sense to either.

I wanted to get your thoughts on a couple of things.

I just read Dr. David Brownstein's book called Iodine, Why you need it, why you can't live without it. It is a very compelling book about how much iodine the body really needs, especially for breast and ovarian health in women. He and his colleagues have done a lot of research to support their claims. I am wondering if you have read the book and what your opinion of supplementing with iodine is.

I also wanted to know if you have heard of a cardiologist by the name of Peter Langsjohen. He has been studying the effects of CoQ10 on heart muscle function as well as the effects of CoQ10 depletion from statins. Here is a 40 minute video where he explains these effects. . Thought it might interest you. I wrote about in my latest blog post. My thoughts are that this a very big deal that not too many practitioners take seriously. I'd love to get your opinion.

Another book that may interest you is the Great cholesterol con written by Dr. Malcom Kendrick. I can't say that I agree with everything he says, but he makes a good case that cholesterol and saturated fat are not the cause of heart disease.

I'm glad I found you on Linked in. Have a great weekend!"

My response:

I am unfamiliar with the books cited, so I familiarized myself with them through Amazon and read all the related reviews--positive, neutral and negative--that are posted on Amazon.

Here's my take.

As to iodine, it doesn't matter what is myth or real about the general population's levels of iodine. People need to be treated as individuals. If there is any suspicion of an iodine deficiency, then it should be tested for, and if found, then treated. In the absence of such evidence, I don't believe that routinely supplementing with iodine, or with any supplement for that matter, makes any real sense. First test, then treat.

As to Dr. Langsjoen, here's my take. According to his own research, COQ10
absorption diminishes as we age. Accordingly, it would seem to be a normal part of aging. In a review of his published studies, they seem to be mostly biochemical journals. He has not published a single valid clinical trial in a peer reviewed journal to support his claims Also, it seems his research has no affiliation with any respected scientific research center, university, or major medical center. Both are red flags.

That said, he may be perfectly right about his assertions. Some scientists are truly ahead of their time. To put our health in their hands is a different story. If I was on a statin, I would probably take COQ10. However, to routinely supplement with it does not make sense to me without proof of known deficiency or valid study.

Finally, statins are very controversial and rightfully so. 100 people must take them for one to get a benefit. They can cause some serious side effects. Patients with low cholesterol, low LDL and high HDL still have heart attacks. As with most drugs, they should be avoided when possible and should be taken when clearly indicated. I weaned myself off a stain and now enjoy a "normal" lipid profile based on changes in my lifestyle.

Yesterday, I saw a new patient with a previous CT Scan showing coronary artery disease and cholesterol near 400. I'm not sure that any prudent physician would not initiate statin therapy in such a case. Will it help her? Only time will tell. Another new patient I saw yesterday came in on 40 mg simvastatin and a cholesterol of 120. I cut the simvastatin dose in half and will retest in a few months with an eye towards discontinuing it altogether.

Doctors can not afford to experiment with patients and their lives. Our first rule must be do no harm. The standard of practice is to treat elevated cholesterol with statins and elevated triglycerides with fenofibrate. However, it is also important and appropriate to review lifestyle factors that are contributing to heart disease, such as diet, physical activity, stress, sleep, etc. and to encourage change as needed.

In conclusion, my clinical premise is to treat a patient not a statistic; avoid prescription and supplement pills unless clearly indicated and to prescribe them when appropriate; encourage a healthy lifestyle at all times.

I hope this is helpful.

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