Proton Pump Inhibitors (PPIs) – Kidney Stones & Other Complications of Use

Medications to reduce acid in the stomach and duodenum are now available as prescription strength or over the counter at half the prescription strength. These are taken for heartburn, indigestion, gastroesophageal reflux disease, gastritis, gastric erosions, ulcers and other gastric inflammatory conditions. They work by inhibiting a parietal cell (stomach cell) hydrogen potassium ATPase (an enzyme) thus reducing the production of acid.

These medications work well and patients who take them regularly at times cannot tolerate the symptoms that return after stopping their PPI. You know the commercial names of these drugs such as Nexium, Prilosec, Protonix, Dexilant. Their use has been hypothesized to improve GI symptoms but put you at risk for a long list of medical illnesses.

In a recent publication in the British Medical Journal online edition, PPIs increased the risk of developing kidney stones in over 27,000 patients followed while taking them. They increased the risk of an initial stone and for each year you continued the therapy they increased the risk by about 4%. PPIs do this by reducing the absorption of the minerals magnesium and citrate. Low citrate levels lead to more acidic urine (lower pH) and this leads to increased calcium crystallization in the urine and stones.  

In the online journal Primary Care editorial is provided by David Rakel MD, FAAFP commenting on the original research of Timothy Overton, MD, MPH. Dr. Rakel notes that when he tries to wean his patients off PPI medications, and they just cannot tolerate the heartburn and gastric distress that returns, he will ask them to collect a 24-hour urine specimen and measure a citrate level. If the citrate level comes back “low” he restarts the PPI but supplements their diet with potassium citrate. The goal is to make the urine pH less acidic and greater than 7.0.

In Dr. Rakel’s review, he discusses all the illnesses that might increase in frequency and intensity by taking PPIs and reducing the acid level of the digestive juices in the stomach. The acidic digestive juices are an infection protector by destroying bacteria, viruses and parasites. Taking PPIs increases your risk of community acquired pneumonias, viral gastroenteritis, clostridia difficult colitis, small bowel intestinal bacterial overgrowth syndrome and the severity of Covid 19.  These same medications can interfere with the absorption of iron, vitamin B12, calcium and magnesium. There is a loose evidence-based association with long term PPI use and chronic kidney disease, stroke and dementia.

It isn’t easy to just stop the PPI medications. If you do, the acid production often rebounds and produces more severe and prolonged symptoms.

Dr. Rakel presents a plan for gradually stopping PPIs.  He gradually reduces the dosage every 10 days initially by 50% and then going to every other day. Prior to beginning the tapering of the drug, he requests that you taper your caffeine intake and consumption of acidic foods.

Instead of PPIs he prescribes sucralafate (carafate) one-gram tablets before meals and at bedtime for two weeks. Another option is substituting licorice (DGL) which coats and soothes the stomach. It is sold over the counter.

For nighttime symptoms he suggests using melatonin 1- 3 mg starting one half hour before going to bed. If that fails, he recommends a trial of acupuncture every 3 – 4 days for 3 weeks. Research has shown that acupuncture works better in symptom relief of heartburn and GERD than doubling the PPI dosage.  His last resort for treating continuing symptoms is to add back an H2 receptor blocker such as Famotidine plus ordering a fiber optic endoscopy to inspect visually what exactly is causing the problem.

Proton Pump Inhibitors work very well in reducing symptomatic acid related GI illnesses. Like all medications, they come with potential side effects. Prior to starting them or stopping them please speak to your doctor about the pros and cons and make the best decision for your individual situation.

Cannabis Use and Medical Issues

Marijuana has been legalized in many nations and several states for both recreational casual usage and for medical usage. In the State of Florida, it is available as a medicine. It requires a prescription from a physician who took a short continuing education course for a fee with the script taken to a cannabis dispensary. 

Unlike other prescription drugs, the Food and Drug Administration (FDA) has not been asked to evaluate it as it does for every other prescribed medication. There is no published data on the most effective way to deliver the medication (smoking? vaping? edible?).  There is no data on drug-to-drug interactions and adverse effects. There is no data on which blends of marijuana are best for which situations.

The sale of medical marijuana generates income for the industry and the State of Florida.

Medical research studies have begun to shed light on the pros and cons of legal availability of the product as a medicine and for social recreational usage. A recent study in the British Medical Journal discussed how cannabis usage resulted in fewer seizures in patients suffering from epilepsy with up to a 50% reduction in seizures. Chronic pain patients saw a reduction in pain by 30%. Quality of life was judged to be improved in patients with inflammatory bowel disease (Ulcerative Colitis and Crohn’s Disease). Patients suffering from multiple sclerosis noted less spasticity and pain but increased risk of dizziness, dry mouth and somnolence. The same study pointed out that pregnant women had smaller children earlier. Side effects such as nausea, diarrhea and psychiatric crises were frequently  noted as well.

A study published in JAMA Network Open researched by Owen Hamilton, MD looked at the number of traffic accidents and visits to the emergency department related to the legalization and commercialization of marijuana in Canada. They noted an increase of 475.3% of marijuana-related traffic accidents after legalization. They additionally noted a dramatic increase in visits to emergency rooms for marijuana associated physical and mental issues.

A study in JAMA examined the effects of recreational marijuana usage on adolescents and found that teenagers who use marijuana recreationally are 2  -3 times more likely to have depression and suicidal thoughts than those who do not use it. The study linked recreational marijuana usage by teens with poor performance in school, skipping school and increased run-ins with law enforcement.

As a physician I have no problem with use of cannabis as a medicine under certain circumstances. I want to know how to best deliver it for the different conditions involved. With so many different blends of cannabis available in dispensaries, I want to know which ones work best for which situations. I want to know how marijuana will affect patients with other medications. Should we be avoiding prescribing it in some instances or should we be adjusting dosages of other meds when cannabis is prescribed? It’s clear from the emerging studies that usage by adolescents and pregnant patients is neither harmless nor benign.

Let’s treat medical marijuana as a medicine and provide physicians with the data which is available, and they need, for every other prescribed medication to ensure the most effective and safe usage of this popular product.

Hope For Brittle Type I Diabetic Patients Using Pancreatic Cell Therapy

Type I diabetes mellitus is a chronic autoimmune disease that destroys the pancreatic islet cell’s ability to normally control blood sugar levels by secreting insulin. To control blood sugar within normal levels, most Type I diabetic patients require frequent daily blood sugar monitoring either by drawing blood from a vein or by a finger stick and/or with continuous glucose monitoring systems. To control their blood sugar within a near normal range they often require multiple daily injections of short acting, mid-range acting insulins and long-acting insulins. Often to control the high glucose levels the administration of insulin leads to overcompensation with the blood glucose levels plummeting, resulting in loss of consciousness and serious life-threatening emergencies.

Type I diabetic patients and their loved ones undergo extensive nutritional and educational instruction to assist with their care. Despite this, when conditions change such as when exercising, ill with a viral upper respiratory illness or undergoing a medical or surgical procedure, the safety zone for administering insulin and preventing low blood sugar complications becomes much more complicated.

Researchers have been searching for years for ways to help type I diabetics. Recently, the Food and Drug Administration (FDA) announced initial progress in this process with the administration of Lantidra. Lantidra is an accumulation of pancreatic insulin producing islet cells which are placed directly into the patient’s hepatic vein. The islet cells are harvested from deceased donors. Recipients are then considered transplant recipients and must take immunosuppressive drugs to prevent their bodies from rejecting these foreign cells.

This procedure was performed on a small group of 30 patients who, despite expert management and supervision of their medications, experienced repetitive low blood sugar episodes threatening their health and lives. Of the 30 participants who received one or more infusions of pancreatic islet cells, 21 did not require using insulin for a year or more. Eleven participants went without requiring insulin for one to five years and 10 participants did not need insulin for more than five years. Five of the patients continued to require insulin.

Adverse effects included nausea, fatigue, low blood count, abdominal pains and diarrhea. The recipients will require the use of immunosuppressive medications forever and this can cause several well-known medical issues such as susceptibility to certain types of infection. This study, revealing that there will be a safe and effective way to replace nonfunctioning insulin producing islet cells someday to relieve type I diabetics, is a great first step towards the cure of a devastating metabolic disease.

Heartburn and Indigestion. Alternatives to Protein Pump Inhibitors

Many of us develop heartburn, indigestion and sometimes mild regurgitation of food and stomach contents short of emesis regularly. When the symptoms become repetitive, we refer patients to gastroenterologists who evaluate the lining of the stomach (gastric mucosa), and the lining of the esophagus, for growths, narrowing, inflammation, erosions and even deeper wounds or ulcers.

The EGD (esophagogastroduodenoscopy) is a fiber optic exam which can view the anatomy and take samples and biopsies to look for the bacteria H Pylori which is associated with inflammation. Often, none of these maladies are present and you still have bloating, belching, burning and indigestion.

Quick-acting Alka Seltzer was the mainstay of “the Greatest Generation.”  The baby boomers started on Maalox, Mylanta, Rolaids and Gaviscon. They then graduated to Tagamet, an H2 receptor blocker. Next came the proton pump inhibitors (PPI) including Nexium, Prilosec etc.

Many patients made these PPI’s a staple of their daily medication administration routine until the whispers started about adverse effects of chronic use. Did chronic use make you more likely to develop an infection by inhibiting the production of stomach acid? Did these meds lead to dementia.? Did daily chronic use lead to Gastrointestinal cancer? The consensus is that they are safe but still doubts exist.

For this reason, researchers in Italy decided to look for alternatives to PPIs for chronic indigestion and GERD (gastrointestinal esophageal reflux disease). They conducted a study in hospitalized patients in Italy between 2017 and 2021 and published their data in the American Journal of Gastroenterology.

The Italian researchers compared the effects of Omeprazole (Prilosec) which is a PPI  with a mucosal protective agent called Poliprotect. The stomach cells are normally coated with mucous which acts as a protective layer against inflammation, erosion, and ulceration. Drugs like aspirin and non-steroidal inflammatory medications can pierce this layer and cause stomach lining inflammation and injury. Mucosal protective agents such as Poliprotect were designed to coat the areas of inflammation much like a band aid covers a cut. This prevents the acid and digestive juices from further irritating the stomach lining cells and producing symptoms.

The study looked at a group of 275 adults with heartburn and indigestion who did not have erosions or ulcers, or erosive esophagitis based on their EGD exam. They were then given either the Poliprotect five times a day for the first two weeks and then only upon demand for symptoms of heartburn while the others took Omeprazole (20 mg) four times a day for four weeks and then on demand.

At the end of the study, the Poliprotect group did as well as the Omeprazole group at the two-week mark. When they stopped the Poliprotect and only accessed it for recurrent heartburn they had fewer and less severe recurrences of symptoms than the Omeprazole group. As part of the study, researchers looked at the composition of the digestive healthy bacteria or biome before and after the study. The Poliprotect did not alter the bacterial structure or composition.

Poliprotect is not available as a medication in the United States. The bismuth in Pepto Bismol is considered a mucosal protective agent as is Carafate (sucralfate). When heartburn strikes and recurs, and is not associated with apparent lesions in the stomach or esophagus, these two products are available as alternatives to the PPIs and are effective. The Carafate is costly with a one-month supply costing about $530 dollars for 120 one-gram pills. Pepto Bismol is an over-the-counter medication with 30 chewable tablets costing about $6.

“They Told Me There Are So Many Sides Effects”

I have a long-time friend, almost like family, who was born overseas and immigrated to America with his wife and children almost 50-years ago. Our children were school mates and friends for life. Our spouses are friends and coworkers. We have a great relationship. At times I have been their family doctor and at times their friend and second opinion consultant when asked. My friends now qualify as senior citizens as do I.

Saturday morning, I received a text message with a picture of an at-home COVID test from him that looked positive. The accompanying message asked, ”When you are free and alone can you give me a phone call please?”  I honored that request learning about his elevated temperature and cold like symptoms that started that day and suggested a confirming test. Fifteen minutes later a new picture arrived showing a positive at home COVID Antigen test.  I called him and told him I thought it was positive.  He said, “What now?”   I explained to him that the current recommendations for an individual over 65 years of age, vaccinated against COVID and current with the bivalent boosters with high blood pressure, high cholesterol, and multiple minor chronic ailments of aging was to take either Paxlovid for five days or molnupiravir (Lagrevio) for five days.  I reminded him that if he took the Paxlovid he would need to take a holiday from his cholesterol medication, reduce his blood pressure medicine and take a holiday from his prostate medicine until he completed the treatment.

He asked me what I would do and I explained that I would take the Paxlovid because it seems to be more effective. I mentioned to him that Paxlovid gives you a metallic taste that goes away in 11 hours reminding you it is time to take the next dosage. I told him the goal is to prevent illness severe enough to be hospitalized or risk of dying.

He asked me about Paxlovid and rebound. Rebound referring to a clearing of symptoms with the COVID test turning negative and then symptoms returning along with a positive test for COVID. Early after the introduction of Paxlovid this rebound was blamed on the drug. Later in the pandemic, a well-done research study showed that 14% of adults with COVID clear the symptoms and test negative and then rebound whether they take Paxlovid or not.  He asked me if I would call it in to his pharmacy while he decided and I complied.

I called him later that day and he told me that that after consulting friends that had taken Paxlovid, “They told me there are terrible side effects that they all got. “ He called his current primary care physician who agreed with the Paxlovid anti-viral therapy but under questioning about adverse effects said, “Well I guess you can wait to see how you feel tomorrow before starting it.”  It is recommended that individuals start the drug within five days of the onset of symptoms. 

The next day I phoned my friend to see how he was doing. He still had cold symptoms and it was his second day with a temperature over 101 degrees and a cough. While I had told no one about his illness word of mouth from his children to my children made his illness well known.  His wife said he was not taking the Paxlovid because, “They thought it was a bad idea with the medication making them sicker than the disease.”  “They” refers to a tight knit group of friends from the old country with no medical training or expertise.

Not once have I questioned my friend about whether he decided to take the medication or not. I explained the risks and benefits of taking the medication in detail and it is his choice to make.

In my professional practice in the era of “shared decision-making”  I would shrug it off as I did the best I could. With a friend I care about, it’s much more difficult to accept misinformation and folly as science and fact.

Connection Between Air Pollution & Loss of Smell?

In recent years, medical researchers have explored the possibility that loss of smell is one of the early signs of developing dementia or cognitive dysfunction. Several recent research studies have evaluated whether air pollution is a major cause of loss of smell (anosmia) and possibly dementia.  Our sense of smell is dependent on the olfactory bulbs which are nerve rich and sit on the underside of the brain.

Air pollution from the burning of carbon-based fuels produces microscopic particles known as small airborne pollution particles (PM2.5). These contaminants containing minute metal particles gain access to the brain through the olfactory bulbs and have been shown to result in producing plaque in the brain associated with dementia.

There are few studies looking at the quantity of PM2.5 particles in the air in a community and loss of smell. In 2006 a study performed in Mexico City, known for its poor air quality, revealed that its occupants smell was significantly worse than Mexicans of similar age living in less polluted rural areas.

When a large number of residents of Baltimore were discovered to have anosmia researchers investigated the quality of the air and its relationship to loss of smell. To evaluate this problem, research epidemiologist Zhenyu Zhang looked at air pollution levels in the Baltimore area using 2,690 patient records from visits to the Johns Hopkins Medical Center. The rate of loss of smell was noted to be significantly higher  in patients who lived in the most polluted areas with the highest number of PM2.5 particles. The loss of smell in 20% of this patient population was much higher than expected when they matched it against similar age groups with similar body types and similar smoking history. Yes, smoking leads to an increased risk of loss of smell as well.

In a study in Northern Italy, the smell of teenagers was put to the test. Those that lived in neighborhoods with high levels of nitrogen dioxide had a less sensitive sense of smells. Nitrogen dioxide is a product of the burning of fossil fuels.

Burning fossil fuels can also produce particles far smaller than PM2.5 particles which enter the brain through the olfactory bulb. A study in Britain looking at autopsies in patients from highly air polluted communities found minute metal particles in the brains of patients. According to some studies, air pollution contributes to 25% of all heart and lung related deaths in addition to its known relationship to stroke.

The World Health Organization (“WHO”) recognized the effect of air pollution, loss of smell and increased risk of death and lowered its acceptable rate of PM2.5 particles from 10 to 5 micrograms per cubic meter. The hope is that with less pollution there will be less loss of smell and less loss of life.  The WHO’s efforts have been hampered by global warming, multiple major worldwide wildfires and, for economic reasons, a slow conversion from fossil fuels to more environmentally friendly methods of producing energy.

With loss of smell now being associated with dementia, heart, lung and cerebrovascular disease, plus increased risks of depression and anxiety, it may be time to rethink our economic priorities.

I Told My Daughter “Find Another Doctor!”

I have three adult daughters, all college graduates.  All are in long-term relationships with men,  children, dogs and careers.  I am “dad” and will always be dad.  I additionally happen to be a physician who cares for adult patients.  If they are ill or have a medical problem their first phone call is to my cell phone. If its not a phone call it’s a text message. I do not bring this up to give the impression that I am complaining about it. They are my children, I love them and always will.  Anything I can do to comfort or help them is always fine with me. 

I have stressed to them that they need to find a family physician or internist to handle their medical care  who is compassionate, available, caring, accessible and will advocate on their behalf. The older two are financially secure enough to find a concierge physician and I have encouraged that. My younger adult daughter lives about one hour south of my home and practice. She has a primary care physician under contract and on the panel of her Blue Cross Blue Shield PPO. That internist is an employee of the large medical health system that recently purchased my local community hospital. They have been purchasing doctors’ practices and putting in place hospital employed physicians with the speed and rapidity that a wildfire spreads in the dry California brush propelled by the Santa Anna winds.

My daughter called me this morning at 6:15 a.m. with a 102-degree fever, sudden onset of body aches, chills, sweats and “ a killer sore throat”   She is vaccinated against influenza but had a Flu Assay positive case in December 2022. She wondered if she could catch flu again.   

My toddler grandchildren attend daycare and pre-school and bring home febrile viral illnesses in abundance almost weekly.  Bacterial Streptococcal infections and Respiratory Syncytial Virus are epidemic locally along with flu and high risk of COVID, per the CDC and not our Florida Department of Public Health.  Her COVID home antigen test was negative so after taking some Tylenol and throat lozenges she called her family physician.  She was told to, “Go to Urgent Care.  We Don’t see sick people in the office.”

At the beginning of the Sars 2 Coronavirus pandemic most physicians were unvaccinated and unprotected against COVID-19 and we followed the advice of the CDC in referring patients to COVID-19  test sites for testing. We conducted phone calls with patients and telehealth visits. With five COVID vaccines, and an abundance of at-home quick tests available locally, most of us are now seeing sick patients in our offices again as long as we know their COVID test status. 

In my practice, pre-COVID and pre-Concierge Medicine, we always adjusted our schedules to include patients who had an acute febrile illness and were not in respiratory distress. I knew most of these illnesses were caused by viruses and required nothing more than fluids, Tylenol, cough syrup and tincture of time.  Most did have multiple medical and metabolic conditions as well which exacerbated with the infection. The purpose of the visit was to make sure the other conditions, exacerbated by the viral infection, didn’t exacerbate. To accommodate our sick patients, we started the day earlier, worked through lunch at times and stayed late if need be.

When my daughter called me from the urgent care center facing a 90-minute wait, she asked me what she should do.  I suggested she wait it out, see the physician and when she felt better find another doctor. I understand the reason for not bringing an acute COVID patient into the office. For everything else there is no excuse for only seeing “well” patients. Our job is to keep our patients healthy.  What value are we if we don’t see them when they are ill?

Universal Flu Vaccine in Development

It’s been a more serious flu season than I have seen in the recent past. The flu season began much earlier than expected here in South Florida and was more severe even in young healthy individuals. We administered the quadrivalent flu shot to all our patients younger than 65 years old and the high dose vaccine to seniors far earlier in the season than in previous years due to the flu’s early arrival.

There has been a great deal of conjecture that in senior citizens the vaccines protection begins to decline at 90 days. With this in mind, and influenza still raging in the community, we are requesting information from the CDC on whether we should be administering a second flu shot to seniors in January 2023. The viral makeup of the flu shot is determined by research and surveillance done in Asia a year in advance of our flu season. There are 30 different subtypes and this year’s vaccine is directed against four of them. Ongoing surveillance is trying to determine the most likely strains to travel to the USA next season so they can prepare next year’s flu shots

Researchers at the University of Pennsylvania are trying to prevent the guessing game and develop a universal vaccine that protects against all 20 subtypes. They have developed a vaccine using the same mRNA technology used to develop the Pfizer and Moderna COVID vaccines. It was recently tested on ferrets and mice and was successful in preventing infection against all 20 of the possible variants. The results were published in Science as plans for human trials begin.

Dr. Ofer Levy, MD, PhD, director of the precision Vaccines Program at Boston’s Children’s Hospital, feels this new mRNA vaccine may be given to children to prime their T and B cells to react quickly and fight off a flu virus they are exposed to. The new vaccine will hopefully protect humans against any strain of vaccine.

The mRNA COVID-19 vaccines have been the source of much political backlash with “anti-vaccine advocates”, some politicians and their health care appointees using opposition to the vaccine to appeal to certain voter populations. Is it possible that a miraculous new scientific advance will again be met by inappropriate resistance?

Home with COVID

Had the entire family in from out of town this Thanksgiving. Awoke Thanksgiving Day, turned to get out of bed and felt something snap in my lower back. Since I have been fortunate to never have had back issues before, I just stretched it out over several minutes on the floor and went about my business as best I could. Walking produced sciatic pain down my right leg. I walked the dog in pain, stretched again, took some acetaminophen and let my younger relatives provide the physical work I usually do to set up tables and clean up after dinner.

It was a long weekend and while my energy level was down, I had no symptoms of an upper respiratory tract infection. None of my adult kids were ill on arrival the week before. My toddler age grandchildren, now back at preschool, are always sick with viral illnesses but their COVID tests were negative.

The last visitor left for home Sunday and that afternoon my wife said she ached all over and felt like she had been suddenly hit by a truck. A quick COVID test was negative. The next morning, a bit more tired than usual, I returned to my office to see patients. At lunch time I ran home with an influenza test and a few home COVID antigen tests. Her influenza test was negative. Her COVID test immediately showed positive, so we repeated it and it was still positive. At that point I tested myself and sure enough it was immediately positive.

Four weeks prior I would have contacted my local hospital monoclonal antibody program and we would have received bebtelivamib without having to worry about drug/drug interactions or adverse reactions. That drug is no longer available due to the virus mutating and developing resistance.

We called our internist and he prescribed Paxlovid for five days to prevent progression to serious illness in high-risk patients. My wife had to stop her calcium channel blood pressure pill, stop her cholesterol lowering pill and reduce her anti-anxiety medications to take Paxlovid. For me it required stopping a blood pressure pill and realizing that maybe my back pain was the first sign of COVID and that put me at Day 5 of symptoms which is the latest you can effectively start Paxlovid. The drug leaves a persistent metallic taste in your mouth. It wears away at about twelve hours just when it is time to take the next dosage.

I cancelled my office patients for the week knowing that my associate would see anyone that required an in-person visit. I can still return phone calls and perform telehealth visits if a patient requests it. I just do not want to transmit a disease to a healthy patient in for a routine checkup.

Some tasks you cannot hand off. I was up walking the dog this morning when I met a long-time neighbor who I respect but differ with on politics drastically. He asked how I was, and I told him I had COVID and asked him to please safely keep his distance for his safety. With that he coughed repeatedly, told me he was sick for several days and thought there was no point in testing for COVID. He clearly sounded far more symptomatic from some viral illness than I was. He said after his walk he was going to synagogue and then to work. He asked me why I bothered to take the test at all.

I referred him to an article in the day’s Wall Street Journal that claims that nine out of ten COVID related deaths are occurring in men and women 65 years of age and older and my wife and I fit into that category. There are still 300 deaths per day from COVID in the USA .

With a positive test I wanted to have every opportunity to prevent serious illness in my wife. Since I live and work in a senior citizen rich community, I didn’t want to spread the disease to others either.

Somehow as a nation we have lost our moral compass regarding age and this disease. The death toll from COVID in the older age group far exceeds that from influenza despite the claims of Florida freedom politicians. The tradeoff of keeping everything open, with no protection for seniors on buses, planes , airports, subways and office buildings seems like age discrimination to me. Changes in public policy by the national administration, CDC and public health officials in advance of the midterm elections may have helped “ save democracy” but certainly are not protecting elders like my patient population.

My wife and I will survive. After five days of Paxlovid we will start retesting with a quick antigen test. I fear for my neighbors over 65 years old who don’t have the knowledge, access or experience to recognize and treat this disease.

Low Dose Statin More Effective at Lowering Cholesterol Than Advertised OTC Supplements

At the Scientific Session of the American Heart Association, researchers presented the SPORT study (Supplement, Placebo or Rosuvastatin Clinical Trial). The study compared .5 mg of Rosuvastatin (Crestor) to multiple over the counter products advertised to lower cholesterol without the ill effects of a statin.

The products included:

1. Placebo
2. Fish Oil( Nature Made Fish Oil 240 mg)
3. Cinnamon ( Nutriflair 2400 mg)
4. Garlic ( Garlique 5000 mcg Allison)
5. Turmeric ( BioSchwarrtz Brand 4500 mcg)
6. Red Yeast Rice ( Amazon 2400 mg)
7. Plant Sterols ( Nature Made Cholestoff Plus 1600 mcg plant sterols)

Nineteen-hundred adults aged 40-75 years, with no history of cardiovascular disease, were randomized to receive one of the products for 28 days. These individuals had pre-study LDL cholesterols between 70 – 189 and a 5-20% risk of developing atherosclerotic disease within 10 years.

The results showed that Rosuvastatin decreased LDL cholesterol by 37% with the supplements having no more effect than the placebo. Rosuvastatin also reduced total cholesterol by 24% and Triglycerides by 19%. LDL is the adverse cholesterol. It’s helpful to remember the phonic, L stands for “lousy”.

Plant Sterols lowered protective HDL cholesterol and garlic increased the LDL cholesterol when compared to placebo.

This study indicated OTC (over the counter) products just do not work to effectively lower cholesterol and protect against heart attack or stroke. Vitamins, minerals, herbs and supplements are treated as foods in the USA and are not inspected to ensure that what is on the label is in the bottle. Also, there is no assurance that there are no contaminants such as lead, arsenic or mercury in these OTC products.

Some will say that the length of the study was too short for the supplements to show their effectiveness. That may be a valid criticism, but it plays into the anti-science attitude being promoted which encourages sales and marketing of products over scientific testing and results.