Thursday, 20 May 2010
There is so much twaddle talked about its level in the blood, that it would be useful to explode a few myths and get things into some sort of proportion. First of all; you cannot have a cholesterol level. Absolutely not, Nada, zilch, zero. What you are being told, and you need to bear with me here; is your overall plasma lipoproteins level. In other words, the sum total of your, HDL, IDL, VLDL and LDL. Oh and they might add in the largest molecule in the lipoprotein family as well, the chylomicron. So first myth; cholesterol level is in fact, nothing of the sort. You will also find in the bewildering world of cholesterol that nothing is called what it is, and that's by so-called scientists!
Lipoproteins are the means of conveyance of numerous nutrients around the body that are not soluble, such as (hushed tone) fat and cholesterol, and no, fat is not cholesterol, it's fat. Others that are water soluble can be carried in the blood without this need, but fat soluble vitamins, hormones etc have to have a means of transport and generally speaking that's a lipoprotein. There are quite a few other divisions in this category, but no-one will measure them or likely have any clue what they are, especially your doctor. You will have your LDL and HDL measured also and these will be called 'bad' and 'good' cholesterol respectively, even though they are nothing of the sort and HDL, so called 'good', has in fact the largest amount of cholesterol contained within, than any other lipoprotein in the human circulatory system. Confusing isn't it? And we are only just getting started!
OK, wake up at the back! We are moving on. Second of all, now I've told you what the test is really measuring, I have to say that any measurement of these myriad 'transporters', is and of itself, not that accurate. It's usually an approximation and is not really something that a whole industry should be founded upon, to moderate, but nonetheless it has been. So moving swiftly on, these little packets of fat soluble items are being transported around the body but why? Well as you eat, your gut, (general name for intestines), removes the proteins, fats, vitamins and minerals, that is in your food and then they are sent to keep you alive. Your gut makes the largest lipoprotien, chylomicron, and that then transports the fat consumed (now called a triglyceride) and some cholesterol (not a lot), to the adipose tissue for storage
Sorry but it gets complicated now. Both your gut and liver also make a molecule called a very low density lipoprotein-VLDL. This also transports fat and as it transfers it to tissue it shrinks, and becomes the low density lipoprotein (LDL), we all call 'bad'. Well I don't because I cannot attribute any behaviour pattern to a molecule, but still, moving on. Oh sorry, I missed out on the IDL (intermediate etc etc) which is what it's called, before it gets small enough to become LDL. I've added a diagram, which may help.
We now get to HDL or high density lipoprotein, or the good guy at the feast. There has to a feast doesn't there? Well HDL is made in the liver, well mainly, er probably, well we're not really sure.... yet. It is alleged that HDL sucks up cholesterol from plaques in the arteries thus making it all better, so if you have lots more of it say more than 2.0 mmol/L then you're going to live forever! Yippee! Even though we don't really know quite how it's made, or how it achieves this miracle vacuum cleaner act on cholesterol, we can set a level which is good or bad. Talk about building a hypothesis on a dream, of an idea, of a thought while you were on the loo' one day. It's all complete and utter Tosh! You can't state that a molecule can cross both ways through a concentration slope, it defies the laws of well, just about everything in Biology, but what the hell, lets not the truth get in the way of good story, and this reads pretty much like a fairy tale. Shame it's such a dangerous one!
So here we are then, you all know exactly what cholesterol is or actually what it isn't, but what the medics or more importantly Big Pharma, call it, outwith what it actually, scientifically is! How any Doctor can peddle this nonsense with a straight face I know not but, sadly they do. So, now we have established what one may be tested for and more importantly what it actually is, rather than the nomenclature that has been attributed to it, for reasons I cannot explain with any conviction, except stupidity or an over weaning need to treat people as idiots, that does seem to pervade the medical profession. "You don't need to understand your condition Mrs Smith, just take my word for it, it's essential for you to take these pills to lower your cholesterol".
Next important fact is that you will be told that eating any form of saturated fat, is the reason your level of cholesterol is high especially your LDL. LDL isn't cholesterol and fat isn't it either. What you now need to know is that diet, will not substantially make any difference to the levels of cholesterol in your body, because any deficiency in your diet will be made up by your own system (what treachery, from our own bodies!). So your liver, in fact all your cells, except neurones, will just crank up the volume and produce more of the stuff to cover the deficit. 'Quantitive easing' for cholesterol.
So then, cholesterol is hard to lower, in fact almost impossible unless we interrupt its manufacture at cellular level but why on earth would we want to do this? It is important for most processes and those people who have extremely low levels suffer from serious disorders that can often be fatal. To illustrate this I would cite Smith-Lemli-Opitz Syndrome. Lets call it SLOS for the sake of space. Details of this are here. As you will see it's pretty awful and is largely due to an inability to synthesise cholesterol. Not so sure about lowering now, I bet.
So eating fat will not lower, raise or otherwise alter your cholesterol. And one aside, whilst I'm here; when your body decides it needs to access your stores of energy in the adipose tissue (body fat) it has stored as triglyceride it distributes them in lipoproteins, and what sort of fat is triglyceride; yes it's a saturated one. The molecule is fully saturated with hydrogen atoms without any double bonds so it is straight, as are all in nature. So your own body only produces saturated fats. The liver then picks up the glycerol and combines two molecules to form glucose and the fat goes to the muscles for energy use.
The liver is in fact the most amazing biochemical factory there is. It constantly changes, stores, reforms and manufactures most of the molecules we use in our bodies every moment in our lives and cholesterol is just one. But because it is present in virtually very cell and is needed for numerous functions we lower it, I believe at our peril. Peril of quite a few dangers to our well being. In my next diatribe I will outline how the myth attached to this evil substance, has brought about the rise and rise of the 'statin' or HMG-CoA Reductase Inhibitor and what it can do to your well being for little to no reward.
Tuesday, 18 May 2010
Now the nights are light and the need great, both to burn off the excess of glucose that my love has in abundance, and to cleanse both our souls of the stress of life, we walk. Walk, through this strange place of hill and valley, with trees cladding steep and precipitous gardens, terraced to avoid them sliding into houses at the bottom of the valley. It's all lush and green now. Some wild, but most pruned and manicured to a perfection only achievable with wealth. As you walk down the hill from the crumbling pile where I domicile, which has yet to receive the developers stamp of 'renewal', you arrive at the 'Harley Street' of the Town. Perfect, restored Georgian townhouses, where some still have their Consulting rooms, although most have moved these into out of town private hospitals, where the land is cheap, the building new, and the taxes low.
Most do however still live there, and the change from the Victorian mansions, converted to luxury apartments, to these stuccoed, rows of tiered perfection is quite dramatic. You leave behind the Gothic splendour of the Victorian folly and come upon the brightly painted, perfectly proportioned remnants, of the Georgian era. Grade 1 and 2 listed all, they have been restored to within an inch of their long lives, with front doors straight out of Downing Street, gleaming black, with gold numerals. You walk on York pavers laid down two hundred or more years before, still lit by the gas lamps (sic), which is the main reason not to walk in the dark hours, along this route.
The wealth is extraordinary. Smeg kitchens viewed through basement windows or skylights at street level. Casements that slide as well as they did two hundred and fifty years before and wrought ironwork, black and shiny as the day it was forged. That people even live here seems unreal, it's like some set straight from a costume drama, and I am told, is used as such on occasion. But the expected clatter of horse's hooves is missing; long gone. Of course you do have to request the occupants to remove the symbols of their wealth from the roadside, if you wish to film, in the form of the Rolls Royce's, Mercedes and Range Rovers that crowd at the kerb or, occasionally, sit in a little enclave created on a forecourt that squeezed by the planners, without despoiling the street scene.
You then get to the Hospital, not the one in use anymore, but that Georgian edifice, created to care for the poor of the Parish in the 1780's and is the reason these houses were built in the first place, to shelter the Doctors that served in it's echoing halls. Now a boutique hotel, apartments for the wealthy and a little further on, flats for those aspiring to be future occupants of the Townhouses; the Doctors of tomorrow. So much has changed and yet stays the same. Each day we walk to help mend the ravages of the disease of today, Diabetes, we do so in a time warp of years before. We traverse through a landscape of privilege and wealth created by those same people for whom the Hospital was built, all those years ago, but now so far from their grasp.
The system that created these riches, is largely the NHS. The descendant's of those that fought long and hard against its coming, are now the recipients of its largess. Tristram and Cassandra, with their 'yummy mummy' ensconced in their Volvo for their journey to the private prep' school are products of the life we have made available to them by gist of our labours. Their spouses, these superannuated, be suited products of our profligacy of taxation, have risen far above the station, of those upon which they are meant to bestow their tender mercies; the populace who fund them. Yet they are failing consummately to fulfill the bargain of that funding.
They run the system as if it was their inalienable right to riches, instead of as the servants of the people, they should be. And yes I do know, there are those who are not at all like this this; some I even call friends. But overwhelmingly they are. Many, that have not yet achieved these standards of wealth, aspire to it and will get there in the fullness of time; it is a souless goal. Close by is the home of God, or that is his servants on earth, the Nuns. They live cheek by jowl with the Hospital, where they once nursed the great unwashed that were the majority of the day, now reduced to serving meals that cost more than a labourer's day wage, and providing shelter for the overnight businessmen and women on expenses.
It is beautiful, incongruous and privileged. It is unlikely ever that those who were treated at this place would ever aspire to live in the these nearby palaces, except perhaps to work 'below stairs'. In todays world the gap now is wider still, and the liklihood even further from the common man's grasp to walk these few streets as an owner. Unless of course your name be Dave or Nick or even Gordon, or better still the letters after it are FRCP, FRCS or some other concoction of initials, and you work for the NHS
Monday, 10 May 2010
I hadn't written much for public consumption for a few years prior to that; just dusty dry reports. Security doesn't lend itself much to humour especially the analytical side. So writing for possible scrutiny by a public eye was quite daunting, especially with my rather fragile well being only just starting to show signs of healing. Anyway despite misgivings I did it. As we teeter on the edge of perhaps a new political landscape it is perhaps good to reflect on that which has occurred since then
I made some new friends as a Blogger and a few enemies, sadly some of the friends became enemies, which actually hurt quite a lot at the time and still does. As a chronic (but well concealed, except here) depressive, I take too much to heart and am probably ill prepared for criticism, but I'll get over it. I marvelled at the strength, eloquence and beauty of much that was written by Bloggers and indeed remain in awe of many, even now. I still wish that I could match the power of their writing; it is a good stimulant. One to make me attempt better things than I have thus far.
I have been ill, quite seriously in fact but hopefully not terminal, although life itself is, and has no cure. Well the tests say I'm normal despite J's assertion that has to be a mistake, if only as a statement of her viewpoint. She continues in robust health despite her disability, her Diabetes and hatred of the snails she constantly wages war on as they munch through her young plants. Oh and not forgetting the squirrel, whom she constantly rants at, for digging up her bulbs and leaving them neatly at the side of the the hole in which she placed them, covered in soil, the day before. She implores me to shoot it and then relents, before thankfully, I would have to tell her, that my shooting of anything is now over. Her rude health is also confirmed by the tests, although I do have some concern, that her beta cells may have become completely exhausted, despite the very low carbohydrate diet. It's not the end of the world even if true, but it does make things a little more difficult to manage.
The NHS has got no better, in fact to view the writings of the medibloggers, consummately worse. The Complaints system rumbles on like some wheezing steam engine in a world of super trains; not fit for purpose. The 'Bolam Test' still exists and it is still legal for doctors to lie about treatments and errors and even forge documents without any legal retribution. My friend Jan Ooms explains this, for those who may be unfamiliar, here, somewhat better than I have thus far. That in itself is an anathema to any civilised and just society; an affront to those who have lost loved one's, who now live in limbo for want of redress. As a consequence, good and decent people, have their lives blighted in such a way as to damage their futures, perhaps to the end of their days.
'Big Pharma' is still peddling it's wares to a naive (or stupid) Health care system for conditions they have invented or at least subverted. It now seems that we all need a 'polypill' to ensure our vascular parameters fit into a closely defined algorithm, set of course by them, to generate a profit. Never mind that in the process, this morally bankrupt protocol, could endanger the health of all at enormous cost, for no good or useful purpose. They have given us vaccines' that do not work, that endanger life and can cost us our futures. Drugs that are little better than placebos but generate vast sums for their bottom lines. Protocols that enrich Doctors by gist of the Quality Outcome Framework but do little to make their patient cohort healthier or longer lived.
There is paucity of compassion or indeed empathy with a populace unfortunate enough to find themselves in Hospital or in the Consulting room. Medic's have become like their masters; the politicians. So far removed from the society they serve, that they have little or no understanding of the simple needs of dignity, honesty or integrity in their treatments. Integrity has been traded for a checklist, that yields rewards to them for dogmatic goals, alleged to be for the health of their patients, that does little or nothing to advance that goal, just to cow and bewilder them. Five-a-day has been proven as being substantially worthless (2.5% less risk of cancer in ten years) with the fruit portion actually that; worthless, or in my view quite dangerous. But despite this the sales pitch of the Food Standards Agency still continues to pander to this misguided notion as well as the wholly unscientific view about fat making you fat.
One of the more rewarding aspects of the year to date is the launch of the NHS Justice website by my talented friend George Kuchanny, who is building a site for all who seek help, advice or just to reveal to others, how bad things happen to good people in the name of Medicine. For those of a nervous disposition it may be best to take it in small bites. The exposition of what is really going on is not to be feasted upon for fear of emotional exhaustion.
There is hope, so he tells me, that Will Powell may at last get some sort of Justice for his son Robbie. After nearly twenty years, his determination and sheer bloody minded obstinacy, to not let the books be closed, is an example to us all. One I hope and trust will be rewarded. Or as Jan would say 'there is no such thing as failure, just delayed sucess'.
And so I thank them, my friends all, for keeping me at least moderately sane, reasonably sober, and most of all alive. So George, Charlotte, Jan, Will, Rita, Rohan, Angus, Nikki, Julie and those who I cannot name, either to protect them like me, or simply because I don't know who you are (see blog roll) thank you.
Normal service will be resumed as soon as possible (whoops that's Gordon's line).
Wednesday, 5 May 2010
If we are to use the example of history, as a guide for either of the 'mainstream' political parties efficiencies in health care, we would be sadly deluded, because it has been a pawn in the game of one-upmanship for successive Governments since 1948. The 'Thatcher' years spawned a whole new breed of bureaucracy dedicated to billing various sections of the care chain for its services to each other. And of course the invention of PFI and the concept of Private Healthcare to contract to the NHS. Most of this vast 'iceberg' of beancounters remains still, busily engaged in dubious duties, invented to avoid the loss of empires built by powerful managers whose tenure became enshrined almost in statute.
The New Labour agenda was to improve from this low point, to give us all healthcare, unfettered by cost, but as it incorporated the worst of the Tories errors, so much continued as before. But, now the Trust and worse, the Foundation Trust came into being. New Labour believed it could bring about a new tomorrow by codifying responsibilities in the form of protocols, contracts, and regulations to govern care and charter compassion. All it achieved was the stifling of freedoms, the loss of integrity and worst the inability of patients to be seen as people, only a group of symptoms to be treated. It fed into the ego of the Consultants and later the GP's, to construct lucrative arrangements whereby they could get more for doing less. We have ended up with the largest employer in Europe, possibly the World to achieve a system that is incapable of providing out of hours care at Primary or Hospital level, with Nurses who no longer provide front line care to patients, Junior Doctors being given responsibilities far above their pay scale or abilities and Managers salaries exceeding that of senior doctors.
Along the way they have meddled with the Complaints System on serial occasions, with no obvious improvement, failed to support the 'Whistleblowers' of the consummate failings in the system, stopped short in curtailing the appalling conduct of some doctors and denied justice and candour to the legion of aggrieved patients and their loved ones who have been harmed. Hospital beds have diminished in number, as have Nurses. ISTC's have been paid for work they have not done. Hospitals have been forced to build new facilities on contracts that tie up budgets for thirty years or more with nothing in assets at the end of the term. Mortgaging their futures for the political dogma of a despotic DofH
Society is now so cowed by the dogma of 'rights balanced by responsibilities' forged by the Blairites that it expects to be treated with disdain, even condescension as a matter of course. Our paucity of freedom is now so ingrained in the physche that we rarely rail against our regimentation to seek a personal role outwith that allowed to us by our job description or the petty rules of society in the 'brave new world' of New Labour. A hung Parliament will do little to foster any spirit of freedom, just even more consensus politics. The role of Politics itself hangs in the balance as those of us who seek to exercise integrity in our lives and in our Health care system stand and watch in horror, as two freshfaced young men and one old, one eyed fat bloke attempt to galvanise us into placing a cross on a piece of paper in their favour.
If one of them can offer me liberty and the chance to conduct my life without referring to a code of conduct and give credence to the claim of Doctors to 'do no harm' he will have my vote. I suspect however, as always, that I will have to choose the lesser of a number of evils