The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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I quickly looked up statin side effects, and I know they tend to exaggerate in a lawsuit-happy society, but liver damage, muscle damage and type 2 diabetes do not sound like nothing. Most of currently available medicine are kind of blunt tools, which mess with many extremely complex chemical processes in the body, some of which may be beneficial for us, but other may be not. So I think being careful about messing with one's body chemistry is a prudent approach. Sometimes you don't have a choice - if somebody has cancer, mediterranean diet and exercise is not going to save them, but modern drugs might. But there are costs to that. I think we should not be dismissing those costs lightly.
I am not saying they are nothing. But statins are the annoying kind of drug where the benefits are hard to perceive on an individual basis, but we have strong evidence does help at a population level. And the harms are even more rare, barring the more common transient stuff like muscle aches.
In more formal terms, the NNT is high, and so is the NNH. But the former is still significantly smaller than the latter, almost by an OOM. Both are diminished by his age and reasonably good health, at least on the basis of information provided, but I would be rather surprised if it came out to a complete wash or net harm (however small).
(I have neglected to specify that NNT and NNH require specific metrics or endpoints to assess, but I'm talking about the serious stuff, like number of cardiovascular events avoided in expectation or new onset T2DM/rhabdomyolysis)
As it stands, I think that @DirtyWaterHotDog is an intelligent sensible individual, and that their doctor has done due diligence before making the recommendation. I'd love to see an explicit QALY calculation, but let's be honest and admit that those are desirable but not strictly necessary, assuming a competent doctor exercising clinical judgement. I'm sure he's going to do his own research instead of deferring entirely to an argument I made while suffering from a serious migraine (even if I think that my advice is fine). I see no significant risk from initiating them, since they're easy to start and easy to stop if the most likely side-effects become annoying. The benefits are also probably small, but I think his actual doctor has a better picture than I do, and I see no real reason to disagree with them.
(If I was his actual doctor instead of a friendly stranger on the internet, I would be poring over the reports and calculating QRISK scores.)
I agree that trusting one's doctor, by default, makes a lot of sense, at least where data and empirical knowledge is concerned. However, there is one more methodological problem that is often missed - the unknown unknowns. Let's consider the following scenario - and I am making it completely ridiculous on purpose, to emphasize the point and not get bogged in the details. Let's assume we have a miracle drug that reduces your cholesterol with no noticeable side effects. Except in 10 years after you start taking it, your dick falls off. Obviously, no reasonable test can detect it - who runs 10 years of tests before putting the drug on the market? There's no way to know it, until people start noticing a suspicious increase in dicks falling off, try to make various statistical correlations and hopefully after several years of vigorous bickering zero in on the miracle drug and remove it from the market. In the meantime, people who took it in those 10+X years are preparing lawsuits and regretting their choices.
There's no reasonable way to prevent it - nobody can run enough tests to predict every effect and every drug+patient+environment combination. And nobody tries to, because trying to do it would paralyze any innovation way beyond the best efforts of FDA to do it. No doctor, no matter how diligent and educated, can know everything and predict everything. So there's always a risk. Often it's worth it, and I am not arguing against any intervention. I am just arguing for remembering there's always this unquantifiable risk component lurking in the background, and one has to remember it too.
If the doctor says "you have to do it, or you're going to be in serious trouble, the pills are the only way" - fine, do it. But if they say "you may try to change your lifestyle, or if it sounds too hard there are pills, your choice" I'd personally choose to try the non-pills way first.
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Thanks for information btw.
As it stands, I have updated by priors. Reduced my apprehension towards them and calibrated the urgency to get on them.
I am setting a concrete deadline for end-of-year to get my cholesterol & weight in control. If it doesn't work, I'll take my doctors advice on statins.
I'm skipping GLP-drugs because I want to solve the root cause, not just the symptoms. Sleep, diet and work outs first. Rest will follow.
Note that I'm not strongly endorsing the statins. But your actual doctor probably knows your situation better than I do, and I trust them by default. More importantly, in a way, you can just quit if the side effects are more nuisance than the (small) benefits are worth.
Why not both? Seriously, even if you don't "need" them like someone with someone who is outright obese and diabetic, they'll help. There is no reason to think that you can't also make lifestyle modifications alongside them, and those are laudable goals anyway. You'll almost certainly lose weight, and it'll help the cardiovascular stuff. If your sleep is hampered by something like sleep apnea (which I do not know you have, but is not unlikely), then the weight loss will help with that too. It's easier to exercise and diet if you've already lost some weight and don't feel as hungry. The drugs should be easily affordable for you, you make a lot more money than I do.
If you had to choose between statins and semaglutide on my recommendation, then I would rather you pick the latter. Just talk about it with your doctor, as and when you see them again. If they advise against it, eh, that's fine by me.
'Never waste a good crisis' ?
The weight creates shame. The shame motivates effort. Helps my system hit terminal
velocitywillpower. Thankfully, my mental health is a good place, so I use shame productively.I like the point about GLPs. I'm lucky to easy access to cheap GLP drugs. Then there is story about when the CEO of one of the largest GLP startups tried to sleep with a thinner me, but that's for another day.
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There are many types of statin. Japan certifies I believe six, one of which is rosuvastatin, which I have been taking (one small pill a night) for about three years, due to elevated serum cholesterol. The standard dose in the US is about 5-10mg.
My pill is 2mg, well on the low side. But the lowered serum cholesterol levels are clear. I have never had any side effects that I noticed. Zero. My HbA1c is and has always been within healthy zones. My liver values (AST/ALT, bilirubin, albumin) are within healthy zones and haven't changed in any significant way since I began keeping close records of yearly health checks (about 12 years).
I have also started drinking 5mg of psyllium husk dissolved in water twice a day, though only for about a month and that's not long enough to see the possible effects (at least in terms of cholesterol levels, the digestive effects were pretty clear almost immediately.)
I get that people are wary of drugs. I personally have doubts about semaglutide, which has not had the long-term testing of statins. (roughly forty years for statins with hundreds of randomized controlled trials and meta analyses. Less than 10 years for GLP receptor 1 agonists like semaglutide). But statins are among the most studied of drugs. This doesn't guarantee complete safety for everyone, but then neither is aspirin safe for everyone.
The good news is that low doses to begin with can do a lot of work toward detection of side effects, if they're going to occur.
I am not a medical doctor.
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