Wednesday, January 17, 2007

Just for fun, let's brag about the pills we take

Talk about getting old! Each and every day I take 11 different drugs and supplements for a total of 19 pills to fight my heart disease. Anybody else who wants bragging rights feel free to comment and claim your throne as the king of pill takers. If nothing else it will make the rest of us feel better. So, just what is old HeartHawk taking? Well, here is the list with a little descriptive commentary on why. As always, consult your physician before taking any new drug or supplement

Niacin: Perhaps the most underappreciated supplement niacin lowers bad cholestrol (LDL), raises good cholestrol (HDL - probably better than any prescription agent), lowers triglycerides, and is about the only good agent for lowering lipoprotein(a) (lp(a) is what's trying to kill me) and it is cheap. It also shifts LDL particle size toward the less deadly large size. I choke down 3, 1 gram horse pills every day. I take a prescription brand called Niaspan because I take so much and it has a lower incidence of side effects.

Rosuvastatin: Sold under the brand name Crestor, it is one of the newest and most effective statin drugs available for lowering LDL. It also modestly raises HDL. I buy it in 10mg form but split the pills and take 5mg per day (it's that effective and cheaper)

Ezetimibe: Sold under the brand name Zetia, it works differently from statins (which work in the liver) by blocking cholesterol in the intestines. When used in combination with statins it is especially effective in lowering LDL (mine was down to 25 at my last blood test but that is the subject of a future rant). 20mg is the standard dose.

Fenofibrate: I take the Tricor brand. This is the latest in a new class of drugs called fibrates that are PPAR-alpha (peroxisome proliferator-activated receptor - say that 10 times real fast) activators. Fenofibrate seems to have a lower incidence of side effects than other fibrate drugs. It lowers LDL, raises HDL, lowers triglycerides, lowers lp(a) and shifts cholesterol particles toward the better large size. I take 145mg daily as I prepare to take a "niacin vacation." I seem to be exhibiting an interesting and anecdotally noted effect where the niacin fails to be effective against lipoprotein(a) after extended use. Stopping then restarting niacin seems to restore the anti-lp(a) effect (theoretically). I have completely stopped the progression of heart disease during periods when my lp(a) is reduced to about 30mg/dl.

Esomeprazole: You know, the little purple pill -Nexium. Here is what sucks! I take 40mg of Nexium daily because all that other crap upsets my stomach. Great, I take pills to counteract the other pills. Wait, it gets better! Read the next entry.

Co-Q10: Good old Co-enzyme Q10. I take 120mg per day to counteract the muscle pain and weakness induced by statins. Hey, it works and is generally good for you anyway.

Fish Oil (Omega-3 Fatty Acids): This is the motherlode of all supplements and I take four honking 1200mg pills per day. It does everything - reduces inflammation, clotting, lowers triglycerides and small LDL particles. If you take only one supplement, make sure it's this one. In one study it lowered risk of heart attack death by 45%.

Aspirin: Need I say more. Unless your doctor advises against it - take it.

Vitamin B Complex: I take this mostly as a hedge against homocysteine. The link here is growing tenuous but heck, I've been taking it for 6 six years. It's a habit.

Vitamin C: The same goes for Vitamin C. Despite the shaky claims of Drs. Linus Pauling and Mathias Rath (kinda kooky in my opinion) the evidence for Vitamin C is just not that strong. But, it is a cheap anti-oxidant and at least I know I won't get scurvy! I take 1000mg per day.

Vitamin D: There is growing evidence that Vitamin D may be the newest "must have" supplement for heart disease sufferers (especially if you live in a region without a lot of sun). I know Dr. Davis of Track Your Plaque swears he is seeing more and more clinical evidence of plaque reduction in his practice among Vitamin D takers. I am a little more skeptical but his success is hard to argue with. I take 4000IU per day. 'Nuff said!

So there is my laundry list. Any challengers?



Neil said...

Hi HeartHawk, What about the arginine, l-carnitine, and magnesium citrate,? I think those are also part of the "Dr. Davis package"...Best, Neil

Michael said...

Over the past 4.5 years, I have been taking Niaspan 2000, Zocor 40, B vitamins, folic acid, and fish oil 6000. This reduced my total C from 235 to 120, raised my HDL from 45 to 55, lowered LP(a) from 40 to 13, lowered triglycerides from 90 to 28 and LDLc from 164 to 50. During that time I have continued my 5x/week strenuous exercise and lowered my BMI a bit to 22.

Despite all this my calcium score went from 1,400 4.5 years ago, to 1,700 2 years ago, to 2,400 recently. Fortunately, I am still asymptomatic and stress tests have been negative (although showing some ST-segment horizontal depression)

Based on what I have read here, I have recently added CoQ10, L-carnitine, Vitamin D, and pomegranate juice to the daily intake.

I certainly will discuss the other meds you are taking with my cardiologist.

Neil said...

Michael, This is not my blog, and I'm certainly not a doctor by any stretch of the imagination, but I will chime in anyway.

I see you just added vitamin D into your supplement mix. According to Dr. Davis on the website and his free blog (that you can access through his main web site), vitamin D can really be the key to allowing something he calls a "permissive effect", allowing your supplements you already take to finally work in controlling your personal rate of plaque growth. In some individuals he talks about perfectly achieving lipid targets but the patients are still experiencing plaque growth. With the addition of oil based vitamin D supplements, and no other changes, they achieve plaque arrestment or even regression!

It's interesting to see an evolution of thinking of Dr. Davis through his book and blog. In his 2004 book, Track Your Plaque, I don't believe vitamin D is mentioned anywhere (I could be wrong). Later he mentions it a bit in his blog here and there, now it is mentioned multiple times per week and now is often the key topic in blog entries. From what I understand he tests all his patients for blood levels of this vitamin.

Anyway, you probably already know this, but it is critical that the vitamin D capsules be oil based, and that if you exceed something like 2,000 IU daily that you get your blood levels of vitamin D tested. You can get tested through . One patient Dr. Davis wrote about took wild amounts of vitamin D based on another Dr’s prescription (like 20,000iu daily), and really messed herself up by calcifying her arteries or organs or something. Disturbing when you really think about it….

Anyway, if you get a breakthrough please post it everywhere!


Michael said...

Thanks for your comments, Neil.

I have found a Vitamin D, 25-hydroxy test on line and am ordering it.

I have started taking Vitamin D3 in solid pill form. I wonder if simultaneously taking omega3 fish oil (3g morning and night) will give similar results to taking the oil-based D that you suggest? I read that the fish oil helps potentiate the effect of D.

Neil said...

Hi Michael, That question is out of my league. But I guess the only thing that matters is following your 25-OH vitamin D3 level and getting as close to year around 50 ng/ml (125 nmol/L) as you can. So you could take it for around maybe six weeks and then test?

But look at it this way; you know you will eventually have to test pretty much twice a year, right? I mean there is no way to know if you will need 2,000iu or 6,000iu, so you have to test. So that is around $70 per test. If you have doubts about the dry vitamin D tablets, it might be wasting the $70 test 'cause your blood levels might be zilch and you have to start over. I think it might end up cheaper to pick up some oil based vitamin D (since you know they work for sure), take something like 3,000iu for six weeks, then test. You can fine tune a bit, if necessary, and re-test in six months. You might be money ahead because the oil based should dial in your blood level much more confidently.

I would switch to a really trusted brand like Now, Healthy Origins, or Carlson that is oil based. It is honestly about the cheapest of all the supplements I take. It maybe costs $3 bucks a month for a great brand of oil based vitamin D., your triglycerides of 28 and your BMI of 22! You have tremendous discipline in your routine! But something must be explaining your plaque growth; I would so be interested in knowing what it is when you find out.


Anonymous said...

Why no vitamin k?


David said...

RE: Ezetimibe

There's a "new" product vegapure ( which seems to have the same m.o. as ezetimibe as you describe it here.

Anonymous said...

RE: "Good old Co-enzyme Q10. I take 120mg per day to counteract the muscle pain and weakness induced by statins. "

I'm curious about the negative side-effects of statins. What kind of muscle pain are you referring to here. A colleague cautioned me that "statins are poison to the liver" and in some cases can cause irreversible damage.


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