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The Importance of Vitamin D for Normalizing Your Cholesterol Levels


Article Source: Health And Fitness Journal

By Dr. Mercola

The video above is a nice confirmation from the traditional media of the importance of vitamin D. However, they still get it wrong by stating that you can get the vitamin D you need from foods. Appropriate sun exposure can easily provide over 20,000 units per day, while food rarely provides over 400 units.

Back in 2011, I published a series of interviews with Dr. Stephanie Seneff, a senior MIT research scientist who, more recently, rocked the world with her discovery of glyphosate’s mechanism of harm.

Three years ago, however, she was one of the first to point out the links between cholesterol and vitamin D, presenting a hypothesis that made me even more convinced that raising your vitamin D levels through sun exposure may be far more critical than previously thought.

Now, research published in the journal Menopause1, 2 appears to offer support for Dr. Seneff’s theories on the cholesterol-vitamin D link. But first, a quick review of cholesterol, and why your body actually needs it.

What Is Cholesterol, and Why Do You Need It?

That’s right, you do need cholesterol. This soft, waxy substance is found not only in your bloodstream but also in every cell in your body, where it helps to produce cell membranes, hormones, vitamin D, and bile acids that help you digest fat.

Cholesterol also helps in the formation of your memories and is vital for neurological function. Your liver makes about three-quarters or more of your body’s cholesterol, and according to conventional medicine, there are two types:

  1. High-density lipoprotein or HDL: This is the “good” cholesterol that helps keep cholesterol away from your arteries and remove any excess from arterial plaque, which may help to prevent heart disease.
  2. Low-density lipoprotein or LDL: This “bad” cholesterol circulates in your blood and, according to conventional thinking, may build up in your arteries, forming plaque that makes your arteries narrow and less flexible (a condition called atherosclerosis). If a clot forms in one of these narrowed arteries leading to your heart or brain, a heart attack or stroke may result.

Also making up your total cholesterol count are:

  • Triglycerides: Elevated levels of this dangerous fat have been linked to heart disease and diabetes. Triglyceride levels are known to rise from eating too many grains and sugars, being physically inactive, smoking cigarettes, drinking alcohol excessively, and being overweight or obese.
  • Lipoprotein (a) or Lp(a): Lp(a) is a substance that is made up of an LDL “bad cholesterol” part plus a protein (apoprotein a). Elevated Lp(a) levels are a very strong risk factor for heart disease. This has been well established, yet very few physicians check for it in their patients. (Lp(a) also was not assessed in the featured study.)

Study Finds Vitamin D + Calcium Supplementation Improves Lipid Profiles

The featured study sought to evaluate whether increased serum 25-hydroxyvitamin D3 (25OHD3) concentrations are associated with improved lipid profiles in postmenopausal women.

The study had over one million people so it was a big deal. The test group received a daily dose of 1,000 mg of elemental calcium along with 400 IUs of vitamin D3. Please note that this dose of vitamin D is ridiculously low and will not provide help for most people. The control group received a placebo.

Blood levels of vitamin D, fasting plasma triglycerides, HDL, and LDL cholesterol levels were assessed at the beginning and end of the trial. After two years, women who received the vitamin D and calcium supplements had a 38 percent increased mean vitamin D level compared to the placebo group.

They also had a 4.46-mg/dL mean decrease in LDL. Furthermore, higher vitamin D concentrations were associated with higher HDL combined with lower LDL and triglyceride levels. According to the authors:


“These results support the hypothesis that higher concentrations of 25OHD3, in response to [calcium/vitamin D3] supplementation, are associated with improved LDL cholesterol.”

After discussing the link between vitamin D and cholesterol with Dr. Seneff, I became convinced that raising your vitamin D levels through sun exposure may have far greater benefits than taking a supplement. I’ve even warned that vitamin D supplementation might not achieve optimal health results, the reason for which I’ll discuss in just a moment.

Remember that this study used a virtually insignificant dose of vitamin D that will not increase levels to optimum in anyone. Yet despite this nearly homeopathic dose, it still led to small, yet noticeable, improvements in lipid profile (i.e. increased HDL, in combination with reduced LDL and triglycerides).

Imagine what they would have found had they given doses 10 to 20 times higher that we know will put people into optimum ranges? In my view, this strengthens the hypothesis that naturally-acquired vitamin D, created by your skin in response to UV exposure, would likely have an even greater effect, and here’s why.

Cardiovascular Disease—A Compensatory Mechanism for Cholesterol Sulfate Deficiency?

Through her research, Dr. Seneff has developed a theory in which the mechanism we call “cardiovascular disease” (of which arterial plaque is a hallmark) is actually your body’s way to compensate for not having enough cholesterol sulfate. To understand how this works, you have to understand the interrelated workings of cholesterol, sulfur, and vitamin D from sun exposure.

Cholesterol sulfate is produced in large amounts in your skin when it is exposed to sunshine. When you are deficient in cholesterol sulfate from lack of sun exposure, your body employs another mechanism to increase it, as it is essential for optimal heart and brain function. It does this by taking damaged LDL and turning it into plaque.

Within the plaque, your blood platelets separate out the beneficial HDL cholesterol, and through a process involving homocysteine as a source of sulfate, the platelets go on to produce the cholesterol sulfate your heart and brain needs. However, this plaque also causes the unfortunate side effect of increasing your risk of cardiovascular disease. So how do you get out of this detrimental cycle?

Dr. Seneff believes that high serum cholesterol and low serum cholesterol sulfate go hand-in-hand, and that the ideal way to bring down your LDL (so-called “bad” cholesterol, which is associated with cardiovascular disease) is to get appropriate amounts of sunlight exposure on your skin. She explains:


“In this way, your skin will produce cholesterol sulfate, which will then flow freely through the blood—not packaged up inside LDL—and therefore your liver doesn’t have to make so much LDL. So the LDL goes down. In fact… there is a complete inverse relationship between sunlight and cardiovascular disease – the more sunlight, the less cardiovascular disease.”

What this also means is that when you artificially lower your cholesterol with a statin drug, which effectively reduces the bioavailability of cholesterol to that plaque but doesn’t address the root problem, your body is not able to create the cholesterol sulfate your heart needs anymore, and as a result you end up with acute heart failure.

Total Video Length: 1:29:57

Download Interview Transcript

Heart Disease Is the Number One Killer Worldwide

According to the World Health Organization (WHO), heart disease was the leading cause of death, globally, in 2011 and 2012. Even children are becoming increasingly at risk.3, 4 Recent research suggests as many as one-third of children have or are at risk for high cholesterol, which conventional medicine views as a risk factor for heart disease.

Bear in mind that, contrary to the conventional ideology, your total cholesterol level—which includes HDL, LDL, triglycerides, and Lp(a)—is just about worthless in determining your risk for heart disease, unless it is above 300. Still, high total cholesterol can in some instances indicate a problem, provided it’s your LDL and triglycerides that are elevated and you have a low HDL. I have seen a number of people with total cholesterol levels over 250 who actually were at low heart disease risk due to their high HDL levels. Conversely, I have seen even more who had cholesterol levels under 200 that were at a very high risk of heart disease based on the following additional tests:

  • HDL/Cholesterol ratio. This is a very potent heart disease risk factor. Just divide your HDL level by your cholesterol. That ratio should ideally be above 24 percent
  • Triglyceride/HDL ratio. Here, you divide your triglyceride level by your HDL. This ratio should ideally be below 2

That said, these are still simply guidelines, and there’s a lot more that goes into your risk of heart disease than any one of these numbers. In fact, it was only after word got out that total cholesterol is a poor predictor of heart disease that HDL and LDL cholesterol were brought into the picture. They give you a closer idea of what’s going on, but they still do not show you everything. Additional risk factors for heart disease include:

  • Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat accumulation and makes it more difficult for your body to shed excess weight. Excess fat, particularly around your belly, is one of the major contributors to heart disease
  • Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increase higher risk of having coronary heart disease than people with a level below 79 mg/dl
  • Your iron level: Iron can be a very potent cause of oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible, you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body

Beware of Treating Elevated Cholesterol in Childhood with Drugs

Getting back to the study in question,5 a research team at Texas Children’s Hospital examined the medical records of more than 12,000 children between the ages of nine and 11, and found that 30 percent of them were at risk of elevated cholesterol levels. Elevated LDL and triglyceride levels were found to be more common among boys. Not surprisingly, obesity and lifestyle were deemed to be significant factors.

Universal cholesterol screening guidelines6 were issued in 2011, which strongly recommend all children be screened between the ages of nine and 11, and again between 17 and 21. The authors of the featured study say they hope their findings will give added weight to these guidelines. However, there are serious concerns that universal screening will simply place children on cholesterol-lowering medications, which do absolutely nothing to address the underlying problem… As reported by Eurekalert:7


“‘There is concern by some in the medical community that children will be started on medication unnecessarily,’ [
lead investigator, Dr. Thomas] Seery said, emphasizing that adopting a healthy diet and engaging in routine physical activity are first-line therapies for children with abnormal cholesterol levels.


He adds that cholesterol-lowering medications are typically needed in one to two percent of children with dyslipidemia, primarily in those with very high cholesterol resulting from a genetic lipoprotein disorder. Genetic lipoprotein disorders, such as familial hypercholesterolemia, result in very high cholesterol levels that can be detected in childhood but are felt to be underdiagnosed, he said. ‘Kids need to have their cholesterol panel checked at some point during this timeframe [9 to 11 years old],’ Seery said. ‘In doing so, it presents the perfect opportunity for clinicians and parents to discuss the importance of healthy lifestyle choices on cardiovascular health.’”

To Save Our Kids, We Must Address Their Lifestyle

It is indisputable that childhood obesity is placing an increasing number of people at risk of an early death. I address this topic in my book Generation XL. If the childhood obesity epidemic is not reversed, we will, for the first time in history, see children living shorter lives than their parents! Clearly, something must be done about escalating childhood obesity and “adult” diseases showing up in our children. But placing kids on statins8 is certainly NOT the answer. The cause of the problem is unhealthy lifestyle choices—and drugs do nothing to address this. On the contrary, statins have been linked to a wide range of devastating side effects, including but not limited to:

Muscle problems and muscle damage (including the heart muscle)

Neurological problems, including memory loss and Lou Gehrig’s disease

Nerve damage

Liver enzyme derangement

Kidney failure

Elevated blood glucose

Tendon problems

Anemia

Sexual dysfunction

Recent research,9, 10 which followed subjects for 25 years, suggests there’s a very important relationship between your heart health and your brain function, and that this relationship starts much earlier in life than previously thought. The study links late-teen to early adulthood blood pressure, blood sugar, and cholesterol levels with mental acuity in your mid-life years:

  • People with higher blood pressure and/or higher blood glucose early in life scored lower on all tests devised to assess memory and learning, brain aging, and decision processing speed
  • People with higher cholesterol early in life scored lower on the learning and memory tests

Now, when you consider the negative effects statins have on your heart muscle, combined with their detrimental neurological impact and their tendency to elevate blood glucose, it would seem like these drugs might actually significantly speed up the onset of dementia when given to young children, thereby doing more damage than simply living with health risk factors such as high blood pressure, blood sugar, and cholesterol.

Vitamin D Also Plays a Role in Alzheimer’s Prevention

Your brain function, as your heart health, is also dependent on both appropriate amounts of cholesterol and healthy vitamin D levels — a fact that again ties heart and brain health together. A recent article in the Daily Herald,11 written by Dr. Patrick B. Massey, MD, Ph.D., medical director for complementary and alternative medicine at Alexian Brothers Hospital Network, discusses the importance of vitamin D for the prevention of Alzheimer’s disease.


“‘Not by coincidence, vitamin D deficiency exists in 70-90 percent of patients diagnosed with Alzheimer’s disease,’ he writes. ‘Medical studies have demonstrated that increased vitamin D levels either through sun exposure or supplementation improves cognitive function in the elderly. These positive results have been seen in those diagnosed with Alzheimer’s disease as well as those who do not have this illness.


The benefits of vitamin D supplementation may appear in four weeks resulting in enhanced processing speed as well as cognitive abilities. Indeed, one recent medical trial demonstrated that taking vitamin D and the Alzheimer’s medication memantine resulted in better outcomes than either memantine or vitamin D alone. Vitamin D supplementation is a simple and effective way of treating and preventing Alzheimer’s disease and may be the best option at this time.’”

As you can see, vitamin D and cholesterol are integral players in both heart disease and Alzheimer’s disease, and that while statins can dramatically reduce your cholesterol, these drugs tend to have a detrimental effect on both your heart and brain. According to Dr. Seneff, insufficient fat and cholesterol in your brain play a critical role in the disease process, and she makes a compelling case for how statin drugs promote the disease. For more in-depth information about this, please refer to Dr. Seneff’s MIT paper, “APOE-4: The Clue to Why Low Fat Diet and Statins May Cause Alzheimer’s.”12

Tying It All Together

All in all, Dr. Seneff’s research makes a very compelling case for getting appropriate sun exposure in order to normalize your cholesterol levels, thereby promoting both heart and brain health. While you can take oral vitamin D pills, there is virtually no doubt in my mind that future research (likely 20-30 years from now) will show that increasing your vitamin D levels through sensible sun exposure or a safe tanning bed is far superior to swallowing vitamin D. To summarize Dr. Seneff’s research into layman’s terms the two inter-related disease processes described earlier would look something like this:

Lack of sun exposure ? cholesterol sulfate deficiency ? plaque formation (to produce cholesterol sulfate that protects your heart) ? cardiovascular disease (which places you at greater risk for decreased brain function)

Furthermore, Dr. Seneff and many others also stress the importance of reducing your refined sugar and processed fructose consumption to prevent heart disease. While not specifically addressed in this article, as I chose to focus on cholesterol and vitamin D, fructose consumption also significantly contributes to cardiovascular disease in the following manner:

High fructose consumption ? over-taxed liver ? impaired cholesterol formation ? cholesterol deficiency ? plaque formation to compensate for cholesterol sulfate deficiency ? cardiovascular disease

The reversal of these disease processes would then look like this:

Appropriate sun exposure + low-sugar diet = optimal cholesterol production in your liver + optimal cholesterol sulfate production in your skin ? healthy cholesterol levels and absence of arterial plaque

Naturally, while sun exposure and a low-sugar diet are important, if not critical, for optimizing your heart health, there are many other lifestyle factors that can make or break your cardiovascular health. For more suggestions on how to optimize your cholesterol levels without drugs, please see my previous article, “Statin Nation: The Great Cholesterol Cover-Up.”


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Why Do We Overeat, and How Can We Stop?


Article Source: Health And Fitness Journal

By Dr. Mercola

Today’s featured video is a lecture by obesity researcher and neurobiologist Dr. Stephan Guyenet.1 In it, he discusses some helpful and practical tips about the neurobiological underpinnings of our eating habits that can help you better understand why you gain weight.

He starts off by noting that the obesity epidemic closely parallels an increase in daily calorie consumption in the US. Compared to 1960, Americans eat an average of 363 calories more per day today. But why do Americans eat so much more now compared to previous decades?

Guyenet goes on to review some of the alterations to the US food system that promote overeating, stating that the human “brain’s hardware may not be up to the task of constructively navigating the modern food environment.”

Research does show that what you eat can make a big difference in how much you eat. As noted by Christy Matta in a previous article:2

“One study,3 for example, found that obese subjects ate 81 percent more total calories after eating two meals of instant oatmeal than they did after eating two meals with the same calories in the form of a vegetable omelet and fruit.”

In a nutshell, research shows that calories gleaned from bread, refined sugars, and processed foods promote overeating, whereas calories from whole vegetables, protein, and fiber decrease hunger.

While Guyenet reviews the role of your brain in all of this, other researchers have clearly demonstrated how your body’s metabolism is altered by the foods you eat—as well as the impact of synthetic and toxic chemicals.

Not All Calories Have the Identical Effect

The dogmatic belief that “a calorie is a calorie” has done much to contribute to the ever-worsening health of the Western world. It’s one of the first things dieticians learn in school, and it’s completely false.

Calories are not created equal, and as just mentioned, the source of the calories makes all the difference in the world. Groundbreaking research by Dr. Robert Lustig shows that calories from fructose are of particular concern.

According to Dr. Lustig, fructose is “isocaloric but not isometabolic.” What this means is that identical calorie counts from fructose or glucose, fructose and protein, or fructose and fat, will cause entirely different metabolic effects.

However, Dr. Guyenet counters that although this is true at high levels, most of the human studies have found little difference in the effects of sugar versus starch at more normal levels of consumption, as long as excess calories are not consumed.

The reason for the difference in metabolic effects is  largely because different nutrients provoke different hormonal responses, and those hormonal responses determine how much fat your body will accumulate and hold on to.

This is why the idea that you can lose weight by counting calories simply doesn’t work. After fructose, other sugars and grains are among the most excessively consumed foods that promotes weight gain and chronic disease.

Another dogmatic belief that simply isn’t true is the idea that obesity is the end result of eating too much and exercising too little; i.e. consuming more calories than you’re expending.

Here, research by the likes of Dr. Richard Johnson clearly demonstrates that this too is a complete fallacy. Like Dr. Lustig, Dr. Johnson places most of the blame on excessive fructose consumption, and his book The Fat Switch shatters the myth that obesity is the result of eating too many calories and not exercising enough.

Here again Dr. Guyenet disagrees. He believes that developing obesity is impossible without consuming more calories than are expended. If the energy content of your body is increasing, that means ‘energy in’ has to be increasing, and/or ‘energy out’ has to be decreasing.   It’s just that many things influence how much is coming in vs. out, for example what type of food you eat.

Although this may be technically correct the wild card here that is frequently overlooked is your body’s ability to burn fat as its primary fuel. Due to insulin and leptin resistance, most people have impaired enzymes to burn fat which lends credence to Dr. Lustig’s and Johnson’s assertions.

The Science of Obesity

While the first law of thermodynamics does apply to humans, in order to actually gain a significant amount of weight, Dr. Johnson’s research shows that you have to do two things:

  1. Block your sensation of fullness, and
  2. Impair your body’s ability to burn fat by downregulating the enzymes responsible for metabolizing fat.

What this means is that in order for you to become severely overweight you must first become leptin resistant. Leptin is a hormone that helps you regulate your appetite. When your leptin levels rise, it signals your body that you’re full, so you’ll stop eating. Refined sugar (in particular fructose) is exceptionally effective at causing leptin resistance in animals, and it’s also very effective at blocking the burning of fat…

Guyenet also disagrees with this concept. He believes the most effective way to cause leptin resistance in rodents is a refined high-fat diet. Please note that these are not the healthy fats I advocate like coconut oil, avocados, butter and olive oil, but highly processed and refined industrialized soy, corn and canola oils.

He also discusses the impact of leptin sensitivity loss in the featured lecture. He notes that once your brain has lost its sensitivity to leptin, it will perceive the situation as normal, and will therefore defend that fat mass.

Another interesting tidbit is that if you’re insulin resistant and obese, it doesn’t take much fructose to activate the processes that will keep you fat. Some of Dr. Johnson’s most recent research shows that the more high-fructose corn syrup you eat, the more you absorb and the more you metabolize it. Thus, eating fruits may be more of an issue if you are insulin resistant, whereas fruit intake is likely safer or even beneficial if you are lean and healthy. This helps explain the paradox of how some very fit people can eat a lot of fruit—which is rich in natural fructose—without gaining any weight.

Toxic Foods and Bad Habits Hamper Proper Metabolic Function

Over the past 60 years or so, a confluence of dramatically altered foods combined with reduced physical exertion and increased exposure to toxic chemicals have created what amounts to a perfect storm. The extensive use of sugar—primarily in the form of high fructose corn syrup, which is added to virtually all processed foods—is at the heart of it all. But one also cannot underestimate the impact of chemistry, and the creation of truly addictive foods.

If you think about it, it’s quite revealing that, in contrast to third-world countries, the poorest people in the US have the highest obesity rates. This seeming contradiction is, I believe, a clear indication that the problem stems from the diet itself. Something in the cheapest and most readily available foods is creating metabolic havoc, and indeed that’s what studies are finding.

Research into the addictive nature of processed foods reveals that food companies have perfected the art of creating addictive foods4 through the masterful use of salt, fat, sugar, and a wide variety of proprietary flavorings—most of which are far from natural. As a general rule, “food” equals “live nutrients.” Nutrients, in turn, feed your cells, optimize your health, and sustain life. Obesity, diabetes, high cholesterol, hypertension, and heart attacks are all diseases associated with a processed food diet – a CLEAR indication that it does not provide the appropriate nutrition for your body.

How to Regain Your Lean Body

So if you are carrying more body fat than your ideal, what’s the answer? I believe there are two primary dietary recommendations that, if widely implemented, could help you regain your lean body and reverse our current obesity trend. This kind of diet will naturally shift your body from burning sugar to burning fat as its primary fuel, which will automatically help you shed excess weight, and counteract disease processes associated with a processed, high-sugar diet:

  1. Avoid, sugar, refined fructose, grains, and processed foods
  2. Eat a healthful diet of whole foods, ideally organic, and replace the grain carbs with:
    • Large amounts of vegetables
    • Low-to-moderate amount of high-quality protein (think organically raised, pastured animals). As a general guideline, I recommend limiting your protein to about one gram of protein per kilogram of lean body mass, or one-half gram of protein per pound of lean body weight. (If your body fat mass is 20 percent, your lean mass is 80 percent of your total body weight)
    • As much high-quality healthful fat as you want (saturated and monounsaturated). For optimal health, most people need upwards of 50-85 percentof their daily calories in the form of fat
    • While this may sound excessive, consider that, in terms of volume, the largest portion of your plate would be vegetables, since they contain so few calories. Fat, on the other hand, tends to be very high in calories. For example, just one tablespoon of coconut oil is about 130 calories—all of it from healthful fat. Good sources of fat include coconut and coconut oil, avocados, butter, nuts, and animal fats. Also take a high-quality source of animal-based omega-3 fat, such as krill oil

The Case for Intermittent Fasting

Another strategy that works really well in combination with this kind of diet is intermittent fasting. In fact, intermittent fasting, or “scheduled eating,” is one of the most powerful interventions I know of to shed excess weight, as it effectively jump starts your body to burn fat instead of sugar as its primary fuel. There are many different variations of intermittent fasting, but my personal recommendation is to fast every day until you reach your ideal body fat.

You do this by scheduling your eating into a narrow window of time each day. For example, you could restrict your eating to the hours of 11am and 7pm. Essentially, you’re just skipping breakfast and making lunch your first meal of the day instead. This equates to a daily fasting of 16 hours—twice the minimum required to deplete your glycogen stores and start shifting into fat burning mode.

By increasing insulin sensitivity and mitochondrial energy efficiency, fasting helps slow down disease processes typically associated with insulin resistance—which includes metabolic syndrome. Fasting also benefits your body by reducing oxidative stress, and inducing a cellular stress response (similar to that induced by exercise) in which your cells up-regulate the expression of genes that increase their capacity to cope with stress and resist damage.

Intermittent fasting also has the near-magical side effect of eliminating sugar and junk food cravings. While most people will successfully switch over to burning fat after several weeks of intermittent fasting, it may take up to several months for those that are seriously insulin/leptin resistant. Their body needs to learn how to turn on the fat-burning enzymes that allow it to effectively use fat as its primary fuel. So don’t get discouraged. Just keep at it. Once you’ve become fat adapted and are of a normal weight, without high blood pressure, diabetes or high cholesterol, you really only need to do scheduled eating occasionally.  As long as you maintain your ideal body weight, you can go back to eating three meals a day if you want to.

Quit ‘Dieting’ and Start Living Healthily

If you want to shed excess weight and protect your health, my most urgent recommendation is to replace processed foods with homemade meals, made from whole, ideally organic, ingredients. Remember to replace the grain carbs with vegetables, small amounts of high quality protein, and plenty of healthful fats. For step by step instructions and guidance, please see my optimized nutrition plan.

Intermittent fasting can further boost your weight loss efforts once you’re eating right, as it effectively helps shift your body into fat-burning mode. Last but not least, exercise acts in tandem with and boosts the benefits derived from a proper diet. For maximum benefits, you’ll want to make sure to include high-intensity interval training, which is at the heart of my Peak Fitness program. To learn more, please see my previous article: “The Major Exercise Mistake I Made for Over 30 Years.”


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Why Don’t Patients Fill Their Primary Care Physician’s New Prescriptions?


Article Source: Health And Fitness Journal

A Canadian study published today in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions.

In short, patients were less likely to fill a prescription if the treatment was expensive, but certain types of drug indications had consistently higher non-fill rates:

  • Headache (51% not filled)
  • Ischemic heart disease (51.3% not filled)
  • Thyroid agents (49.4% not filled)
  • Depression (36.8% not filled)

Overall, hormonal (especially Synthroid), ENT (especially Flonase), skin, and cardiovascular drugs (especially statins) had the highest non-fill rates.

As far as those prescriptions more likely to be filled, antibiotics (especially for urinary tract infections) ranked number one.

Trends towards prescription compliance were seen among older, healthier patients, and those who were switching medications within a class rather than starting an entirely new drug. Patients who received prescriptions from a doctor that they visited regularly (rather than a new provider) were also more likely to fill their prescriptions.

This study was not designed to elucidate the exact rationale behind prescription non-adherence, but I am willing to speculate about it. In my experience, patients are less likely to fill a prescription if a reasonable over-the-counter alternative is available (think headache or allergy relief). I also suspect that they are less likely to fill a prescription if they believe it won’t help them (skin cream) or isn’t treating a palpable symptom (statin therapy for dyslipidemia). Finally, patients are probably nervous about starting a medicine that could effect their metabolism or cognition (thyroid medication or anti-depressant) without a full explanation of the possible benefits and side effects.

I was surprised to see how compliant patients seem to be with antibiotic agents (at least, filling the initial prescriptions). Given the increasing rates of antibiotic resistance, this reinforces the need to limit prescriptions to those agents truly indicated, and to analyze bacterial sensitivities during the treatment process to optimize medical management.

My take home message from this study is that providers need to do a better job of explaining the reasoning behind new prescriptions (their necessity, consequences of non-compliance, and risk/benefit profiles) and reviewing the overall cost to the patient. If a cheaper, effective alternative is available (whether OTC or generic), we should consider prescribing it. Providers can likely improve medication compliance rates with a little patient education and price consciousness. Extra time should be spent with patients at higher risk for non-compliance due to their personal situation (age, degree of illness, income level) or if a specific drug with lower compliance rates is being introduced (Synthroid, statins, etc.) Regular follow up (especially with the same prescriber) to ensure that prescriptions are filled and taken as directed is also important.

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