Bempedoic acid is a relatively new drug that lowers cholesterol.  It’s taken once daily in pill form and works through the same enzymatic pathways in the liver as statins do. 

But because it affects a different part of the pathway as compared to statins, it does not share the same side effect profile. It has been touted as a great alternative for patients who need to lower cholesterol but can’t tolerate statin drugs.

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But is it?

Bempedoic acid was all over the news recently because a new study showed that in 4,200 patients with high cholesterol that had not yet been diagnosed with heart disease, bempedoic acid reduced rates of heart attack and death from heart disease by 39 percent and all causes of death by 27 percent. 

Those are BIG effects. Blockbuster level.

The superlatives from the trial investigators came pouring out. “Frankly startling” and “a wakeup call” regarding the need to put many more people on cholesterol-lowering medications — especially bempedoic acid.

Not much was spoken about the fact that bempedoic acid can cause gout, gallstone attacks and tendon ruptures — admittedly rare but highly unpleasant side effects that are not all necessarily reversible (a ruptured tendon is a ruptured tendon).

The other thing that was left out of the story was that these 4,200 people were plucked out for analysis out of another, already published trial designed to look at something else.

And this is where everything gets messy

And a little complicated — but stick with me…

The original, larger trial was designed to see if patients with high cholesterol who can’t tolerate statins would see an overall outcome benefit by going on bempedoic acid instead. 

And the answer was yes – looking at everyone enrolled, 14,000 people in all, bempedoic acid reduced the combined chance of someone experiencing a heart attack or stroke or needing bypass surgery/stent or dying of heart disease by about 13 percent. 

Not blockbuster level for a drug, but meaningful for sure. And that’s where the analysis should have ended. But it didn’t.

Let the mess begin…

The original trial included mostly people who had already developed heart disease. Mixed in there were also the 4,200 who hadn’t yet.

And if you know anything about statistics and event risks, right about now your skepticism about that “frankly startling” result in the subset of 4,200 patients should be rising. 

As a proven fact, people with established heart disease are at MUCH higher risk of experiencing a heart event during follow-up than those that only have high cholesterol. This means that ANY intervention that reduces event rates would be expected to have an outsize effect in people starting at a higher risk of experiencing those events to begin with. 

So why would a lower-risk population of 4,200 people have better results with bempedoic acid than the overall group they came from that included many more people at higher average risk?

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Seems odd, right?

Part of that answer lies in the fact that the investigators chose different outcomes to study in this smaller group. The big trial was designed to look at a composite of four endpoints. When the investigators looked at the smaller subset they decided to look at only two of the original four — heart attacks and death due to heart disease alone — while ignoring stroke and bypass surgery/stent.

Would the result be as dramatic if the other two components had also been included? We will never know.

Another part of the answer lies in the act of cutting up the study population into subsets after the fact.  Weird things can happen when you do that — including chance events. 

One famous published example of the perils of post-hoc subset analysis involved aspirin.  In the main trial of nearly 18,000 people the benefit of using aspirin after a heart attack was huge and clear. But when you broke down the studied population into astrological signs, everyone benefited except Geminis and Libras. 

As a Libra myself, I know that’s a chance finding. So was the outsize prevention effect of bempedoic acid in the 4,200 subset a chance finding? That is absolutely possible.   

Finally, we can’t forget motivation. Every drug company wants to create a blockbuster.  And every investigator wants to be famous for their work.  Finding ways to slice and dice data such that you come up with an eye-popping result (even if it could be a chance finding) is one way to get there. 

For my part, I’m not blown away by the results of this trial — because I can see the flaws. Frankly, I’m mostly dispirited by the whole thing. This is potentially more spin than truth and that’s not how we should be conducting ourselves if we are scientists in the business of truly helping people.

Plus, as mentioned above, bempedoic acid is not side-effect free.  And it’s certainly not cheap. 

At around $400/month it comes in at a price tag that can only be justified in very select patients. 

Lest we forget, $400/month buys a lot of beautiful, delicious, health-promoting food (Step One is just one humble example). Food that can help prevent gout attacks, support strong bones and tendons and lower cholesterol too. All the while reducing the risk of heart disease, stroke, and dying from any cause.

The post Nexletol for cholesterol: Blockbuster or just bust appeared first on Easy Health Options®.

Or, surely you’ve heard the phrase, “life is just a bowl of cherries,” meaning that life is sweet and pleasant.

It’s no accident that the small, sweet cherry has found its way into idioms that express how good life is.

That’s because there are few downsides to eating cherries, and a lot of benefits to be had.

Not only are they sweet, but they’re also rich in natural compounds that can improve your health in a variety of ways. All that said, there is one kind you should definitely avoid…

Cherries are packed with nutrition

Believe it or not, there are more than 1,000 varieties of cherries grown around the world. Some are sweet and some are tart. It’s the sweet cherries that we like to pop into our mouths when they’re in season during the summer.

Both sweet and sour cherries are incredibly nutritious for their size.

One cup of raw, pitted sweet red cherries has only 97 calories, but packs a wallop in terms of nutrition:

• Protein: 1.6 gr
• Fiber: 3.2 gr
• Sugar: 19.7 gr (we’ll talk about this in a minute)
• Vitamin A: 2% of the recommended Daily Value (DV)
• Vitamin C: 18% DV
• Vitamin K: 4% DV
• Vitamin B6: 4% DV
• Potassium: 10% DV (almost as much as a banana, which has 12% DV)
• Copper: 5% DV
• Manganese: 5% DV
• Magnesium: 4% DV

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4 benefits of eating cherries

1. Cherries may help treat inflammatory arthritis gout. Like many other foods, cherries may reduce inflammatory markers if eaten regularly.

The research at Oregon Health & Science University presented at an American College of Sports Medicine Conference (ACSM) in San Francisco suggested that tart cherries have the “highest anti-inflammatory content of any food” and can help people with osteoarthritis manage their disease.

When a similar intervention was tried with adults with gout, eating around 16 cherries a day resulted in lower uric acid levels and a 35 percent lower risk of gout attacks.

2. Cherries support heart health. Cherries are especially high in flavonoids. Flavonoids reduce endothelial inflammation (inflammation in the lining of the arteries). Thus, they protect against high blood pressure, stroke and heart disease.

3. Cherries may improve your sleep. Both sweet and tart cherries have a significant amount of melatonin, the “sleep hormone.”

Not only does melatonin promote longer and deeper sleep. Research has found that it also protects brain cells from amyloid beta and tau proteins that play a key role in the brain destruction of Alzheimer’s disease.

4. Cherries help regulate blood sugar. You may think that a sweet fruit like cherries can only harm your blood sugar. But in fact, cherries have among the lowest glycemic index and glycemic load values of all fruit. The glycemic index for cherries is 22, and the glycemic load is three.

Their low glycemic load means that a small portion of cherries (about 14) will not drastically raise a person’s blood sugar.

And on top of that, the antioxidant compounds found in cherries, including chlorogenic acid, flavanols and anthocyanins (like berries), work to prevent blood sugar spikes. Research has shown that tart Montmorency cherry juice can stop or even reverse many known risk factors for diabetes.

Cherry juice works, too!

Although cherries are not in season right now, cherry juice is just as potent for giving you the health benefits we’ve discussed here.

And don’t be fooled by those bright red Maraschino cherries that come in a jar. They are anything but healthy! They are highly processed and preserved using high fructose corn syrup, artificial colors and preservatives. Stay away from them and stick to the real thing!

If you’re having trouble sleeping, here’s a Sleepy Time Smoothie you can whip up in minutes.

• ½ c. tart cherry juice
• ½ c. coconut milk
• 2 Tbsps. creamy almond butter
• ½ c. ice

Blend until smooth.

Sources:

Top health benefits of cherries and how to enjoy them — Food Revolution Network

Gout Treatment with a Cherry on Top — Nutrition Facts.org

What to know about cherries — Medical News Today

A Review of the Health Benefits of Cherries — Nutrients

The post 4 ways cherries make you feel better appeared first on Easy Health Options®.

It’s true that famous leaders such as Henry VIII and Alexander the Great endured this disease, but it’s definitely not limited to royalty…

Today, more than 8.3 million Americans are suffering the pain and bodily damage of this condition. That’s seven times the number of sufferers in the late 1960s.

Why should that be, when there are numerous natural remedies and lifestyle changes that can help prevent it?

And that’s something we should all be interested in doing, since gout can be a painful sign of heightened stroke risk. So, clearly, this is a painful condition with real consequences…

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Gout: the common man’s (and woman’s) disease

The word gout is derived from Latin and means ‘a drop.’ It was thought that excess amounts of ‘humors,’ or body fluids, said to determine a person’s well-being, ‘dropped’ into a particular joint and caused pain.

Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. It’s usually the foot that’s affected, since it has numerous joints. But the pain and swelling of gout can also occur in the ankles, hands, wrists, knees, fingers or elbows.

Uric acid is part of the body’s waste, the product of diet as well as normal cell breakdown. It is normally excreted in urine.

But when gout is present, the body does not excrete enough. Nor does it metabolize protein properly. So, a buildup of uric acid in the blood occurs. Hard crystals build up in the joints and appear as nodules called tophi.

Who gets gout?

The majority of people who have gout are men aged forty to fifty. For women, diagnosis usually occurs after menopause. Estrogen levels drop, and the body is less able to remove uric acid from the blood.

Aside from age, other factors put you at higher risk for gout. These include:

• Type 2 diabetes (the prevalence is 2 to 3 times higher than in non-diabetics)
• Insulin resistance
• Obesity
• Taking diuretics (‘water pills’ to reduce blood pressure)
• Receiving a transplanted organ
• A joint injury
• Eating red meat and shellfish
• Family history of gout
• Dehydration

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How do I know I have gout?

More often than not, gout begins in the big toe or other foot joints. It involves a sudden, severe episode of pain, accompanied by:

• Stiffness
• Swelling
• Redness
• Tenderness

Flare-ups usually occur at night and can get so severe that even the lightest touch to the skin is agonizing. Fever can also be part of a gout attack.

In a person who has gout, a flare-up can be triggered by:

• Drinking alcohol
• Eating purine-rich foods such as red meat
• Long periods of sitting or lying, such as after surgery or illness
• Chemotherapy

Progress of the disease

Doctors use four stages to classify the severity of gout.

Stage 1 – Asymptomatic hyperuricemia. As the name implies, no symptoms have appeared, but uric acid levels are above the desired 6.0 mg/dl. At this stage, healthy lifestyle choices and monitoring of uric acid levels may prevent an eventual attack.

Stage 2 – Acute gout attack. Crystals have begun developing in joints, causing intense pain, swelling and redness. The pain normally resolves in three to ten days.

After a first attack, it’s crucial to seek medical attention for a diagnosis. This is also the time to make changes to your diet and routine that can help head off another flare up, which may not occur for months or years.

Stage 3 – Intercritical gout. This is the symptom-free period between gout flares when uric acid crystals are silently building up in preparation for the next attack. Another more severe attack is certain, unless uric acid levels are controlled.

Stage 4 – Chronic tophaceous gout. A chronic, debilitating condition now exists. Destruction of bone and cartilage causes deformed joints. In addition, the chronic inflammation of gout can lead to kidney damage.

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Treating gout pain naturally

Doctors normally recommend NSAIDs or corticosteroids or prescribe allopurinol (a uric acid reducer) or colchicine (an anti-inflammatory).

NSAIDs will only increase the likelihood of kidney disease already present in gout sufferers, so they are not the best choice. Fortunately, there are numerous natural alternatives for treating gout pain.

Capsaicin cream. Capsaicin is a natural anti-inflammatory and pain reducer found in chili peppers

Krill oil. Studies show that this oil derived from sea animals is rich in Omega 3 and can reduce arthritic symptoms.

Ginger. This root is well-known for its anti-inflammatory properties. Ginger tea or raw ginger work best.

Bromelain. Eating fresh pineapple will give you a good dose of this anti-inflammatory enzyme.

Essential oils. Borage, evening primrose and black currant oils contain gamma-linolenic acid (GLA), a fatty acid known to provide pain relief.

Here are a few other natural arthritis relievers you can try.

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The gout diet: what to eat, what to avoid

When you have gout, certain foods are absolutely crucial, while others should be avoided at all costs.

Do NOT eat:

• Sugar or high-fructose corn syrup can raise the levels of uric acid in your body. Higher uric acid can decrease the body’s natural production of nitric oxide, a substance that helps your blood vessels relax throughout your body, as well as in your kidneys. Blood vessel constriction in your kidneys activates the renin angiotensin aldosterone system, which plays a key role in regulating your blood volume and the balance of electrolytes like sodium. The resulting problem is high blood pressure–a factor that can lead to stroke.
• Processed foods. They’re just bad for you in every way, but if you have gout, the high-fructose corn syrup and additives they contain will set you up for gout flare-ups and added dangers.
• Foods high in purine. Purine is a protein found in your body and in many foods. It breaks down into uric acid, so if you have gout, you don’t want to overdo these otherwise healthy foods: shellfish, liver, mushrooms, asparagus, cauliflower, lentils and spinach.

DO eat:

• Blueberries, cherries and blackberries. These and other dark or purple fruits and vegetables contain anthocyanins, powerful antioxidants that fight inflammation naturally.
• Healthy fats. Coconut oil, olives and olive oil and avocados as well as many nuts will help regulate your insulin levels. People with type 2 diabetes are more likely to get gout, and vice versa.
• Ginger, cinnamon, rosemary, turmeric and ashwagandha are potent anti-inflammatory herbs.
• Potassium-rich foods. Potassium citrate, found in foods like avocados, papayas, Brussels sprouts and broccoli may help neutralize uric acid.
• Beets or beetroot juice to ensure adequate production of nitric oxide.

The post The painful condition that increases your heart, stroke and kidney risks appeared first on Easy Health Options®.

It’s swollen, red and tender to the touch. You didn’t injure it. So what the heck’s going on?

Well, it’s gout — an uncomfortable form of arthritis caused by too much uric acid in your body. More than 8 million Americans have it, and it can strike at any time targeting any joint (but it usually starts in the big toe).

And if your doctor may have given you some advice that’s inadvertently contributed to this painful condition…

If you have gout, you’ll likely get woken up by one of these middle-of-the-night gout attacks at some point or another. You may also feel little lumps under your skin near your inflamed joint. These are deposits of uric acid crystals that will erode your joint if you don’t act quickly.

The best way to get rid of your body’s excess uric acid and save your joints from permanent damage is through your diet. In fact, researchers from the Johns Hopkins University School of Medicine recently identified a diet that can lower your uric acid levels and prevent painful gout flare-ups almost as effectively as prescription gout medications. If you stick to it, this diet may even get rid of your gout for good…

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The gout-fighting diet

This gout-fighting diet is the Dietary Approaches To Stop Hypertension (DASH) diet. It’s already been shown to lower blood pressure. And now it’s been found to significantly lower uric acid levels too…

Researchers watched as the DASH diet lowered blood uric acid levels as much as 1.3 milligrams per deciliter. Just as a point of reference, the current go-to gout medication, allopurinol, lowers blood uric acid levels by about 2 milligrams per deciliter.

The effects of the DASH diet were most dramatic for people with the highest uric acid levels… like people with gout. If you’re a gout-sufferer yourself, all you need to do to start this diet is eat:

• Whole grains
• Fruits and veggies
• Low-fat or nonfat dairy products
• Lean meat, fish and poultry
• Nuts and beans

It’s basically a high-fiber diet that includes low to moderate fat intake. You can take a look at the DASH diet website for more detailed diet plans.

The DASH diet may be a godsend for gout sufferers. But researchers also uncovered one other interesting little dietary tidbit for people with gout…

For a long time, doctors thought eating too much salt could also cause gout flare-ups. But this time around researchers found the exact opposite. People with high sodium levels had lower uric acid levels. And people with low sodium levels had higher uric acid levels… putting them at a greater risk for gout.

So salt can still be part of a healthy diet if you have gout. Just remember to steer clear of the processed table salt and stick to natural sea salt that’s filled with minerals that will benefit your health… and maybe even your gout.

Sources:

“What Is Gout?” National Institute of Arthritis and Muskuloskeletal and Skin Diseases. http://www.niams.nih.gov. Retrieved August 15, 2016.

P. Juraschek et al, Effects of the Dietary Approaches To Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid, Arthritis & Rheumatology (2016).

“What is the DASH Diet?” The DASH Diet Eating Plan. http://dashdiet.org. Retrieved August 15, 2016.

The post Why, what and how to get rid of painful gout appeared first on Easy Health Options®.