NNT, NNH, & Statins
Would love to hear a discussion RE: NNT & NNH in Statins for the various populations (low-med-high risk, primary prevention, secondary prevention, etc.) https://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ is an interesting site that deep dives some of these categories. Looking at the data here does not impress me much in terms of what statins can do. There is some benefit for higher risk patients for sure but just not that much. It just feels like we are barking up the wrong tree - all of this flowing out of the cholesterol heart hypothesis - like we are still banging on Ancel Keys' drum. There are some partial truths here for sure (sterols are obviously in the plaques) but all of these studies (serious genetic aberrations aside - FH, etc - and excluding LpA patients) are done in insulin resistant populations correct? I don't think we have any studies in truly insulin sensitive/metabolically healthy individuals showing that an isolated elevation in LDL-C or P does harm? If LDL-C/P were the true beating heart of atherogenic dyslipidemia (as modern medicine has been fearfully worshipping at this altar for decades) then statins really should have a massive absolute risk reduction...but they just don't. Feels like we have been studying and understanding this problem by basing our entire medical research/diagnostic/treatment paradigm of atherosclerotic vascular disease at the fruit of the problem (atherogenic dyslipidemia, elevated blood sugar, etc) and not the root of it (i.e. insulin resistance-hyperinsulinemia and inflammation)...and despite massive elevation in statin prescriptions, more aggressive treatment indications...the American public is really not getting any better in this category of morbidity and mortality
When does back surgery become necessary?
I've had progressive low back pain for over six months. The MRI shows a L4/L5 disc herniation with annular tear and bilateral abutment to the L5 nerve. All conservative therapy has failed (physical therapy, diet, medications, cortisone injections). At this point I need a walker just to get to the bathroom due to leg weakness and severe pain (I'm 42), and I can’t work, but the surgeons I've seen seem reserved about surgery because "it doesn't look so bad on the MRI", despite my symptoms being severe. Is there any way I can communicate with them to convince them that I've done everything and surgery is the only remaining option? Or am I jumping the gun on this one?
Type 1 Diabetes Recommendations and Protocols
Hi Dr. Attia, Are there any recommendations or protocols that you can provide to your Type-1 Diabetic listeners around exercise, nutrition, fasting, longevity, etc., especially if said recommendations diverge significantly from your general recommendations? Thanks for all the great content!