Use This to Remove Splinters — and to Address Many Other Health Needs.

Baking soda, or sodium bicarbonate, is a staple in many homes for baking and cleaning purposes – but there’s a good chance you’re not taking full advantage of all that baking soda has to offer.

For instance, did you know there’s a whole gamut of medicinal uses for baking soda, such as safely removing splinters from your fingers, or just brushing your teeth?

It rates right up there with hydrogen peroxide as one of the most inexpensive and safe health tools around (you can buy an entire box of baking soda for about $1), so it makes sense to learn all you can about the many, many uses of baking soda.

A Brief Baking Soda History

In its natural form, baking soda is known as nahcolite, which is part of the natural mineral natron. Natron, which contains large amounts of sodium bicarbonate, has been used since ancient times. For instance, the Egyptians used natron as a soap for cleansing purposes. Later, anecdotal reports throughout history suggest that many civilizations used forms of baking soda when making bread and other foods that required rising.

However, it wasn’t until 1846 when Dr. Austin Church and John Dwight began to manufacture and sell the compound we know as baking soda today. By the 1860s, baking soda was featured in published cookbooks, and in the 1930s was widely advertised as a “proven medical agent.”1 Come 1972, the idea to keep a box of baking soda in your fridge to keep food fresh was born, and it really caught on … raise your hand if you have a box in your fridge right now!

Baking soda was popularized by Arm & Hammer more than 150 years ago, and while many are aware of its versatile qualities for cooking and household use, few people realize that baking soda also has potent medicinal properties.

Baking Soda May Help Fight Colds and the Flu

Some people believe that when taken internally, baking soda can help maintain the pH balance in your bloodstream. This is likely the basic premise behind its recommended uses against both colds and influenza symptoms. In their booklet “Arm & Hammer Baking Soda Medical Uses,” published in 1924, Dr. Volney S. Cheney recounts his clinical successes with sodium bicarbonate in treating cold and flu:2

“In 1918 and 1919 while fighting the ‘flu’ with the U. S. Public Health Service it was brought to my attention that rarely anyone who had been thoroughly alkalinized with bicarbonate of soda contracted the disease, and those who did contract it, if alkalinized early, would invariably have mild attacks.

I have since that time treated all cases of ‘cold,’ influenza and LaGripe by first giving generous doses of bicarbonate of soda, and in many, many instances within 36 hours the symptoms would have entirely abated.

Further, within my own household, before Woman’s Clubs and Parent-Teachers’ Associations, I have advocated the use of bicarbonate of soda as a preventive for ‘colds,’ with the result that now many reports are coming in stating that those who took ‘soda’ were not affected, while nearly everyone around them had the ‘flu.’

Not too certain though about how valid the pH optimizing is as to baking soda’s mechanism of action, as clinically I have frequently used diluted hydrochloric acid intravenously to also help people nearly instantly recover from acute infections. Obviously this is pushing the pH in the opposite direction, yet both appear to work, suggesting that the mode of action may be other than pH mediated.

The administration is easy enough, and is relatively harmless even if you should not experience relief from your cold symptoms. Simply dissolve the recommended amount of baking soda in a glass of cold water and drink it. Recommended dosages from the Arm & Hammer Company for colds and influenza back in 1925 were:

  • Day 1 — Take six doses of ½ teaspoon of baking soda in glass of cool water, at about two-hour intervals
  • Day 2 — Take four doses of ½ teaspoon of baking soda in glass of cool water, at the same intervals
  • Day 3 — Take two doses of ½ teaspoon of baking soda in glass of cool water morning and evening, and thereafter ½ teaspoon in glass of cool water each morning until cold symptoms are gone

11 More Medicinal Uses for Baking Soda

You’ll be amazed at the myriad of remedies you can whip up if you have a box of baking soda handy. Among them:

  • Ulcer Pain: I have personally recommended this to many including family members and have been surprised how remarkably effective it is. This would make sense, as the baking soda would immediately neutralize stomach acid. Dosing is typically 1-2 teaspoons in a full glass of water.
  • Splinter removal: Add a tablespoon of baking soda to a small glass of water, then soak the affected area twice a day. Many splinters will come out on their own after a couple of days using this treatment.
  • Sunburn remedy: Add ½ cup of baking soda to lukewarm bathwater, then soak in the tub for natural relief. When you get out, let your skin air dry, rather than toweling off the excess baking soda, for extra relief. You can also add a mixture of baking soda and water to a cool compress and apply it to the sunburn directly.
  • Deodorant: If you want to avoid the parabens and aluminum found in many deodorants and antiperspirants, try a pinch of baking soda mixed with water instead. This simple paste makes an effective and simple natural deodorant.
  • Enhanced sports performance: Distance runners have long engaged in a practice known as “soda doping” – or taking baking soda capsules — before races to enhance performance,3 a measure that’s thought to work similarly to carbohydrate loading. While I don’t suggest you try this at home, it’s another example of baking soda benefits.
  • Plaque-busting tooth and gum paste: For an incredibly effective tooth and gum paste, use a mixture of six parts of baking soda to one part of sea salt. Place them in a blender and mix for 30 seconds, then place in a container to use. Wet the tip of your index finger and place a small amount of the salt and soda mixture on your gums. Starting with the upper outside gums and then the inside of the upper, followed by the lower outside of the gums then the lower inside, rub the mixture onto your teeth and gums. Spit out the excess. After 15 minutes rinse your mouth. This mixture is incredibly effective at killing bacteria.
  • Insect bites: Apply a paste made of baking soda and water to insect bites to help relieve itching. You can also try rubbing the dry powder onto your skin. This is also effective for itchy rashes and poison ivy.
  • Teeth whitener: For a natural way to whiten your teeth, crush one ripe strawberry and mix it with 1/2 teaspoon of baking soda. Spread the mixture onto your teeth and leave on for five minutes. Then brush your teeth and rinse. This method should be used no more than once a week, as excessive use could potentially damage your tooth enamel.
  • Foot soak: Add three tablespoons of baking soda to a tub of warm water for an invigorating foot soak.
  • Exfoliator: A paste made from three parts of baking soda combined with 1 part water can be used as an exfoliator for your face and body. It’s natural, inexpensive and gentle enough to use every day.
  • Detox bath: Baking soda and apple cider make a wonderful spa-like bath for soaking away aches and pains and detoxing. It also cleans the tub and the drain, as a bonus!

Baking Soda is an Excellent Household Cleaner, Too

After you’ve stashed a box of baking soda in your medicine cabinet, put one under your kitchen sink, in your bathroom and with your cleaning supplies too …

  • Baking soda is great to scrub your bath and kitchen with. Put it in a glass grated cheese container with a stainless steel top that has holes in it, and just sprinkle the baking soda on the surfaces and scrub. You may add a few drops of your favorite essential oil to this. Lavender and tea tree oil have potent anti-bacterial qualities.
  • Baking soda mixed with apple cider vinegar is a bubbly combination that has many uses. As a drain cleaner, sprinkle baking soda down the drain, then add apple cider vinegar and let it bubble for 15 minutes, then rinse with hot water. This is a safer alternative to dangerous drain cleaners.
  • Soak pots and pans in hot water and baking soda for 15 minutes to easily wipe away baked-on food.
  • Use baking soda to scrub your barbecue grill.
  • Clean baby toys in a mixture of 4 tablespoons of baking soda and 1 quart of water.
  • Baking soda can also be used as a fabric softener in your laundry, or to get your clothes whither and brighter (add one cup to your laundry load).
  • Baking soda is a natural carpet cleaner. Sprinkle it onto carpets, let it sit for 15 minutes, then vacuum it up.
  • To polish silver without using toxic silver polish, fill your kitchen sink with hot water, add a sheet of aluminum foil and baking soda, and let the silver pieces soak until clean. It is an easy and fun way to clean silver.
  • Sprinkle baking soda in your shoes for a natural deodorizer.
  • In the event of a minor grease fire in your kitchen, use baking soda to help smother out the flames.

Not bad for around $1 a box, right?

Source: Dr. Mercola

What Does It Mean to Be Fat Adapted?

When describing someone that has successfully made the transition to the Primal way of eating I often refer to them as “fat-adapted” or as “fat-burning beasts”. But what exactly does it mean to be “fat-adapted”? How can you tell if you’re fat-adapted or still a “sugar-burner”?

I get these and related questions fairly often, so I thought I’d take the time today to attempt to provide some definitions and bring some clarification to all of this. I’ll try to keep today’s post short and sweet, and not too complicated. Hopefully, med students and well-meaning but inquisitive lay family members alike will be able to take something from it.

As I’ve mentioned before, fat-adaptation is the normal, preferred metabolic state of the human animal. It’s nothing special; it’s just how we’re meant to be. That’s actually why we have all this fat on our bodies – turns out it’s a pretty reliable source of energy! To understand what it means to be normal, it’s useful examine what it means to be abnormal. And by that I mean, to understand what being a sugar-dependent person feels like.

Are You a Sugar-Burner?

  1. A sugar-burner can’t effectively access stored fat for energy. What that means is an inability for skeletal muscle to oxidize fat. Ha, not so bad, right? I mean, you could always just burn glucose for energy. Yeah, as long as you’re walking around with an IV-glucose drip hooked up to your veins.

What happens when a sugar-burner goes two, three, four hours without food, or – dare I say it – skips a whole entire meal (without that mythical IV sugar drip)? They get ravenously hungry. Heck, a sugar-burner’s adipose tissue even releases a bunch of fatty acids 4-6 hours after eating and during fasting, because as far as it’s concerned, your muscles should be able to oxidize them[1]. After all, we evolved to rely on beta oxidation of fat for the bulk of our energy needs. But they can’t, so they don’t, and once the blood sugar is all used up (which happens really quickly), hunger sets in, and the hand reaches for yet another bag of chips.

  1. A sugar-burner can’t even effectively access dietary fat for energy. As a result, more dietary fat is stored than burned. Unfortunately for them, they’re likely to end up gaining lots of body fat. As we know, a low ratio of fat to carbohydrate oxidation is a strong predictor of future weight gain.
  2. A sugar-burner depends on a perpetually-fleeting source of energy. Glucose is nice to burn when you need it, but you can’t really store very much of it on your person (unless you count snacks in pockets, or chipmunkesque cheek-stuffing). Even a 160 pound person who’s visibly lean at 12% body fat still has 19.2 pounds of animal fat on hand for oxidation, while our ability to store glucose as muscle and liver glycogen are limited to about 500 grams (depending on the size of the liver and amount of muscle you’re sporting). You require an exogenous source, and, if you’re unable to effectively beta oxidize fat (as sugar-burners often are), you’d better have some candy on hand.
  3. A sugar-burner will burn through glycogen fairly quickly during exercise. Depending on the nature of the physical activity, glycogen burning could be perfectly desirable and expected, but it’s precious, valuable stuff. If you’re able to power your efforts with fat for as long as possible, that gives you more glycogen – more rocket fuel for later, intenser efforts (like climbing a hill or grabbing that fourth quarter offensive rebound or running from a predator). Sugar-burners waste their glycogen on efforts that fat should be able to power.

The Benefits of Being Fat Adapted

Being fat-adapted, then, looks and feels a little bit like the opposite of all that. A fat-burning beast:

  1. Can effectively burn stored fat for energy throughout the day. If you can handle missing meals and are able to go hours without getting ravenous and cranky (or craving carbs), you’re likely fat-adapted.
  2. Is able to effectively oxidize dietary fat for energy. If you’re adapted, your post-prandial fat oxidation will be increased, and less dietary fat will be stored in adipose tissue.
  3. Has plenty of accessible energy on hand, even if he or she is lean. If you’re adapted, the genes associated with lipid metabolism will be upregulated in your skeletal muscles. You will essentially reprogram your body.
  4. Can rely more on fat for energy during exercise, sparing glycogen for when he or she really needs it. As I’ve discussed before, being able to mobilize and oxidize stored fat during exercise can reduce an athlete’s reliance on glycogen. This is the classic “train low, race high” phenomenon, and it can improve performance, save the glycogen for the truly intense segments of a session, and burn more body fat. If you can handle exercising without having to carb-load, you’re probably fat-adapted. If you can workout effectively in a fasted state, you’re definitely fat-adapted.

Furthermore, a fat-burning beast will be able to burn glucose when necessary and/or available, whereas the opposite cannot be said for a sugar-burner. Ultimately, fat-adaption means metabolic flexibility. It means that a fat-burning beast will be able to handle some carbs along with some fat. A fat-burning beast will be able to empty glycogen stores through intense exercise, refill those stores, burn whatever dietary fat isn’t stored, and then easily access and oxidize the fat that is stored when it’s needed. It’s not that the fat-burning beast can’t burn glucose – because glucose is toxic in the blood, we’ll always preferentially burn it, store it, or otherwise “handle” it – it’s that he doesn’t depend on it.

I’d even suggest that true fat-adaptation will allow someone to eat a higher carb meal or day without derailing the train. Once the fat-burning machinery has been established and programmed, you should be able to effortlessly switch between fuel sources as needed.

How Can You Tell if You’re Fat Adapted?

There’s really no “fat-adaptation home test kit.” I suppose you could test your respiratory quotient (RQ), which is the ratio of carbon dioxide you produce to oxygen you consume. An RQ of 1+ indicates full glucose-burning; an RQ of 0.7 indicates full fat-burning. Somewhere around 0.8 would probably mean you’re fairly well fat-adapted, while something closer to 1 probably means you’re closer to a sugar-burner.

The obese have higher RQs. Diabetics have higher RQs. Nighttime eaters have higher RQs (and lower lipid oxidation). What do these groups all have in common? Lower satiety, insistent hunger, impaired beta-oxidation of fat, increased carb cravings and intake – all hallmarks of the sugar-burner.

It’d be great if you could monitor the efficiency of your mitochondria, including the waste products produced by their ATP manufacturing, perhaps with a really, really powerful microscope, but you’d have to know what you were looking for. And besides, although I like to think our “cellular power plants” resemble the power plant from the Simpsons, I’m pretty sure I’d be disappointed by reality.

Yes?Then you’re probably fat-adapted. Welcome to normal human metabolism! No, there’s no test to take, no simple thing to measure, no one number to track, no lab to order from your doctor. To find out if you’re fat-adapted, the most effective way is to ask yourself a few basic questions:

  • Can you go three hours without eating? Is skipping a meal an exercise in futility and misery?
  • Do you enjoy steady, even energy throughout the day? Are midday naps pleasurable indulgences, rather than necessary staples?
  • Can you exercise without carb-loading?
  • Have the headaches and brain fuzziness passed?

Fat Adaption versus Ketosis

A quick note about ketosis: Fat-adaption does not necessarily mean ketosis. Ketosis is ketosis. Fat-adaption describes the ability to burn both fat directly via beta-oxidation and glucose via glycolysis, while ketosis describes the use of fat-derived ketone bodies by tissues (like parts of the brain) that normally use glucose.

A ketogenic diet “tells” your body that no or very little glucose is available in the environment. The result? “Impaired” glucose tolerance and “physiological” insulin resistance, which sound like negatives but are actually necessary to spare what little glucose exists for use in the brain. On the other hand, a well-constructed, lower-carb (but not full-blown ketogenic) Primal way of eating that leads to weight loss generally improves insulin sensitivity.

About the Author:

Mark Sisson is the author of a #1 bestselling health book on, The Primal Blueprint, as well as The Primal Blueprint Cookbook and the top-rated health and fitness blog He is also the founder of Primal Nutrition, Inc., a company devoted to health education and designing state-of-the-art supplements that address the challenges of living in the modern world. You can visit Mark’s website by visiting

Source: Dr. Mercola



Surprise! Vitamin D Can Help or Hinder Your Weight Management.

Vitamin D, once thought to influence little more than bone diseases such as rickets and osteoporosis, is now recognized as a major player in overall human health. Most recently, new studies suggest that your vitamin D status can even help or hinder your weight management, which I’ll review below.

It’s a tragedy that dermatologists and sunscreen manufacturers have done such a thorough job of scaring people out of the sun. Their widely dispersed message to avoid the sun as much as possible, combined with an overall cultural trend of spending more time indoors during work and leisure time has greatly contributed to the widespread vitamin D deficiency seen today.

Vitamin D is actually not a vitamin at all but a potent neuroregulatory steroidal hormone, shown to influence about 10 percent of all the genes in your body. We now know this is one of the primary reasons it can impact such a wide variety of diseases, including:

Cancer Hypertension Heart disease
Autism Obesity Rheumatoid arthritis
Diabetes 1 and 2 Multiple Sclerosis Crohn’s disease
Flu Colds Tuberculosis
Septicemia Aging Psoriasis
Eczema Insomnia Hearing lossex
Muscle pain Cavities Periodontal disease
Athletic performance Macular degeneration Myopia
Pre eclampsia Seizures Fertility
Asthma Cystic fibrosis Migraines
Depression Alzheimer’s disease Schizophrenia

Vitamin D Deficiency Contributes to Weight Gain in Older Women

A new study of more than 4,600 women age 65 and older shows that having low vitamin D levels can contribute to mild weight gain1. Previous research has already showed that obese individuals tend to have low vitamin D levels. Women who had insufficient levels of vitamin D gained about two pounds more compared to those with adequate blood levels of vitamin D during the 4.5-year long study. Those with insufficient levels also weighed more at the outset of the study.

According to Medicine.net2:

“The study can’t say whether low vitamin D is causing the weight gain or just reflecting it.”The study is the first step that we need to evaluate whether vitamin D might be contributing to weight gain,” [lead researcher Erin] LeBlanc says. But there are some theoretical ways that low vitamin D could contribute to weight gain, she says. Fat cells do have vitamin D receptors. “Vitamin D could affect where fat cells shrink or get bigger.”

Here, vitamin D levels above 30 nanograms per milliliter (ng/ml) were considered “sufficient.” As I’ve previously reported, based on the latest vitamin D research this is still far below optimal, so it’s difficult to say what the outcome might be if you were to actually optimize your levels by getting your blood level above 50 ng/ml. Still, despite this low “sufficient” level, 80 percent of the women in the study were found to have insufficient levels, meaning below 30 ng/ml. This gives you an idea of just how widespread this problem really is.

Vitamin D Deficiency Common among Adolescents Evaluated for Weight Loss Surgery

A second study found that more than half of obese adolescents seeking weight loss surgery are deficient in vitamin D. Eight percent were found to have severe deficiencies, and teens with the highest BMIs were the most likely to be vitamin D deficient. Less than 20 percent had adequate vitamin D levels. The research correlates with previous studies showing vitamin D deficiency in adults seeking bariatric surgery. (The results were presented at The Endocrine Society‘s 94th Annual Meeting in Houston on June 26.)

According to Science Daily3:

“This is particularly important prior to bariatric surgery where weight loss and decreased calcium and vitamin D absorption in some procedures may place these patients at further risk,” said study lead author Marisa Censani, M.D., pediatric-endocrinology fellow at Columbia University Medical Center, in New York City.

… “These results support screening all morbidly obese adolescents for vitamin D deficiency, and treating those who are deficient, particularly prior to bariatric procedures that could place these patients at further risk,” Censani said.”

In the US, bariatric weight-loss surgery, such as gastric bypass surgery, is becoming increasingly common among all age groups, including children. Gastric-bypass surgery involves surgically removing a section of your stomach, which limits the amount of food it can hold. However, this procedure is fraught with risks, and maintaining proper nutrition post-surgery is a common challenge that can result in malabsorption syndromes. It’s important to remember that vitamin D, as well as vitamin A, E, and K are fat-soluble, and need a certain amount of healthy fat to be absorbed properly.

What is the OPTIMAL Level of Vitamin D?

The ideal way to optimize your vitamin D levels is through adequate, safe sun exposure or using a safe tanning bed. However, whether you’re tanning or using a vitamin D supplement, it’s important to get your vitamin D levels tested to ensure you’re within the optimal range of 50-70 ng/ml. For more information about proper sun exposure and how to determine whether you can actually get enough vitamin D from the sun at your location during different times of year, please see this previous article.As mentioned earlier, the “normal” 25-hydroxyvitamin D lab values are typically between 20-56 ng/ml. “Sufficient” levels are often considered to be around 30 ng/ml, as in the studies above.

However, this range is too broad to be ideal, and too low to support optimal health.

Beware that any level below 20 ng/ml is considered a serious deficiency state, increasing your risk of as many as 16 different cancers and autoimmune diseases like multiple sclerosis and rheumatoid arthritis. The OPTIMAL value that you’re looking for is 50-70 ng/ml. Keeping your level in this range, and even erring toward the higher numbers in this range, is going to give you the most protective benefit.

But how do you get within that range?

While vitamin D experts typically recommend 35 IU’s of vitamin D per pound of body weight, it’s important to understand that there’s no one dosage recommendation that will be applicable for everyone. The only way to determine how much vitamin D you really need is to get your levels tested at regular intervals to make sure you’re staying within the optimal range of 50-70 ng/ml, and adjust your dosage accordingly. If you’re supplementing, you may find that you don’t need to supplement during the summer, if you’re getting sufficient amounts of sun exposure, for example. But you won’t know if you don’t get your levels tested.

What is the OPTIMAL Way to Obtain Vitamin D?

There is simply no question in my mind that you were designed to receive your vitamin D from ultraviolet B exposure on your exposed skin and ideally this should come from the sun. For virtually the entire history of the human race this is how vitamin D was obtained.  Although vitamin D is in some animal foods it is in relatively low quantities and to my knowledge there are no known ancestral populations that thrived on oral vitamin D sources. Although we can absorb vitamin D orally because it is a fat soluble vitamin, there is strong emerging research that suggests this lacks many of the benefits of vitamin D.

The majority of the research documenting the benefits of optimized vitamin D levels was done with those that had not taken oral vitamin D but had increased their levels naturally through exposure to the sun. I personally have not taken any oral vitamin D for over two years and have been able to consistently keep my levels over 60 ng/ml.   This is partly related to the fact that I work in a sub-tropical environment in the winter.

If I could not do that there is no question that I would still not use oral vitamin D but would use a high quality safe tanning bed that used electronic ballasts that did not emit any dangerous EMF.

How to Know if You’re Getting Vitamin D from Your Sun Exposure

The caveat here is that not all sun exposure will allow for vitamin D production. The key point to understand is that sunlight is composed of about 1500 wavelengths, but the only wavelength that makes your body produce vitamin D are UVB-rays, when they hit exposed skin. The UVB-rays from the sun must pass through the atmosphere and reach where you are on the earth in order for this to take place. This obviously does not occur in the winter for most of us, but the sun’s rays are also impeded during a fair amount of the year for people living in temperate climates.

So how do you know if you have entered into the summer season and into the time of year, for your location, where enough UVB is actually able to penetrate the atmosphere to allow for vitamin D production in your skin?

Due to the physics and wavelength of UVB rays, they will only penetrate the atmosphere when the sun is above an angle of about 50° from the horizon. When the sun is lower than 50°, the ozone layer reflects the UVB-rays but let through the longer UVA-rays.

So the first step is to determine the latitude and longitude of your location. You can easily do this on Google Earth, or if you are in the U.S. you can use the TravelMath Latitude Longitude Calculator to find your latitude and longitude. Once you have obtained that you can go to the U.S. Navy site to calculate a table to determine the times and days of the year that the sun is above 50 degrees from the horizon.

Translated to the date and time of some places on the globe, it means for example: In my hometown of Chicago, the UVB rays are not potentially present until March 25, and by September 16th it is not possible to produce any vitamin D from the sun in Chicago. Please understand it is only theoretically possible to get UVB rays during those times. If it happens to be cloudy or raining, the clouds will also block the UVB rays.

Even Easier if You Have Apple System

Alternatively, if you have an iPhone or iPad you can download a free app called D Minder, which will make all the calculations for you. It was made by an Apple developer who was motivated to simplify the process after he watched the video above.

From a health perspective it doesn’t make much sense to expose your skin to the sun when it is lower than 50 degrees above the horizon because you will not receive any valuable UVB rays, but you will expose yourself to the more dangerous and potentially deadly UVA rays. UVA’s have a longer wavelength than UVB and can more easily penetrate the ozone layer and other obstacles (like clouds and pollution) on their way from the sun to the earth. UVA is what radically increases your risk of skin cancer and photoaging of your skin. So while it will give you a tan, unless the companion UVB rays are available you’re likely doing more harm than good and should probably stay out of the sun to protect your skin.

During the times of the year when UVB rays are not present where you live you essentially have two options: You can use a safe tanning bed or you can swallow oral vitamin D3.

During the summer months, you can generally get enough vitamin D from just spending some time outside every day. Under optimal environmental exposures your body can produce about 20,000 IU of vitamin D per day with full body exposure, about 5,000 IU with 50 percent of your body exposed, and as much as 1,000 IU with just 10 percent of your body exposed.

In the winter months however, and/or times of the year when insufficient amounts of UVB rays reach your location, you will most likely not get enough vitamin D. In that case, I recommend using a safe tanning bed, which is still better than oral vitamin D.

One of the caveats here is to make sure you’re not being exposed to harmful EMF exposure. Most tanning equipment, and nearly all of the early beds from which these studies were conducted, use magnetic ballasts to generate light. These magnetic ballasts are well known sources of EMF fields that can contribute to cancer. If you hear a loud buzzing noise while in a tanning bed, it has a magnetic ballast system. I strongly recommend you avoid these types of beds and restrict your use of tanning beds to those that use electronic ballasts.

Warning: Newer Vitamin D Tests Often Inaccurate, Study Finds

Doctors are becoming increasingly aware of the importance of vitamin D,According to Medscape, vitamin D testing has increased six- to 10-fold over the last decade, and has become one of the most frequently ordered lab tests. However, it’s important to know that there can be significant differences between available vitamin D tests, and according to a recent study, two newer tests appear to be inaccurate more than 40 percent of the time.

The findings are still preliminary and have not yet been peer-reviewed. The study was presented at the annual meeting of The Endocrine Society in Houston on June 23-264. According to Medscape.com5:

“Researchers say newer tests tend to overestimate the number of people who are deficient in vitamin D… The new tests, made by Abbott and Siemens, were approved by the FDA last fall. They’re part of a wave of faster, less expensive tests designed to help laboratories keep up with a boom in demand for vitamin D testing… Holmes and his team wanted to see how well the new tests performed compared to an older, more expensive, and more time-consuming reference method… They ran blood samples from 163 patients on all three tests.

The Abbott Architect test was outside an acceptable margin of error — meaning that the results were either 25% too high or too low, about 40% of the time.

The Siemens Centaur2 test was either too high or too low in 48% of samples.

… The new tests use blood proteins called antibodies that bind to vitamin D. They’re faster because they look for vitamin D in samples of whole blood. In the older, reference method, vitamin D is separated from the blood and measured. The older test can also measure two different forms of vitamin D: Vitamin D2… found in fortified foods and… high-potency supplements that doctors prescribe… and Vitamin D3, the form of the vitamin that the body makes naturally after skin is exposed to sunlight.

The newer test can’t distinguish between the two different types of D.

Holmes says vitamin D2 seems to confuse the tests. He says the tests’ inability to accurately measure that form of the vitamin means that doctors can’t tell if their patients are getting any benefit from it or if they’re taking their supplements as directed.

… In absolute numbers, the reference test showed 33 patients out of 163 were deficient in vitamin D, while the Abbott test showed 45 people were vitamin D deficient, and the Siemens test pointed to deficiency in 71 patients.” [Emphasis mine]

Your Best Bet for Regular Testing: Sign Up with the D*Action Project

To avoid such testing problems and help you get on an inexpensive, regular testing schedule, I highly recommend joining the GrassrootsHealth D*Action Project6; a worldwide public health campaign aiming to solve the vitamin D deficiency epidemic through focus on testing, education, and grassroots word of mouth. When you join D*action, you agree to test your vitamin D levels twice a year during a 5 year program, and to share your health status to demonstrate the public health impact of this nutrient.

There is a $60 fee each 6 months for your sponsorship of the project, which includes a complete new test kit to be used at home (except in the state of New York), and electronic reports on your ongoing progress. When you finish the questionnaire, you can choose your subscription option. You will get a follow up email every 6 months reminding you “it’s time for your next test and health survey.”

This is probably one of the least expensive and most convenient ways to take control of your health. To join now, please follow this link to the D*Action sign-up.

Source: Dr. Mercola


Burnout burden high among US physicians.

Burnout appears to be more common among physicians than among other adults working in the United States, with nearly half of those who participated in a national survey reporting at least one symptom of burnout, data published in the Archives of Internal Medicine suggest.

Previous studies have examined the link between burnout and quality of care, increased risk for error and its role in physicians’ relationships, alcohol abuse and suicidal ideation. However, according to the study researchers, the June 2011 national survey is the first to evaluate the rates of burnout among a large, diverse sample of US physicians.

Study results

Tait D. Shanafelt, MD, of the department of internal medicine at Mayo Clinic in Rochester, Minn., and colleagues obtained a sample of physicians from all specialties from the American Medical Association Physician Masterfile. Of the 27,276 physicians who received an initial invitation to participate, 7,288 physicians completed the surveys. To develop a comparison with the general US population, researchers also surveyed a probability-based sample of 3,442 working US adults aged 22 to 65 years.


Researchers measured three domains of burnout — emotional exhaustion, depersonalization and low personal accomplishment — using the Maslach Burnout Inventory. The Primary Care Evaluation of Mental Disorders assessment was used to measure symptoms of depression, and other questions were asked to assess work–life balance concerns.

According to data, 45.8% of physicians reported at least one symptom of burnout; 37.9%, high emotional exhaustion; 29.4%, high depersonalization; and 12.4% expressed a low level of personal accomplishment.

Study researcher Liselotte N. Dyrbye, MD, MHPE, associate director of research applications in the department of medicine program on physician well-being at Mayo Clinic in Rochester, Minn., told Endocrine Today that characteristics of the job may account for the high prevalence of burnout among physicians.

“Given that nearly 50% of physicians have burnout, the problem stems from environment/work-related factors rather than character flaws/personal characteristics of a few susceptible physicians,” Dyrbye said.

Physicians in emergency medicine (P<.001), general internal medicine (P<.001), neurology (P<.01), radiology (P=.02) and family medicine (P=.001) had the highest rates of burnout. Those in pathology, dermatology, general pediatrics and preventive medicine, including occupational health and environmental medicine, had the lowest rates, researchers wrote.

Moreover, compared with the general population control group, physicians were more likely to have symptoms of burnout (37.9% vs. 27.8%) and be dissatisfied with work–life balance (40.2% vs. 23.2%).

“The study confirms that there is an alarmingly high prevalence of burnout among physicians, with the highest among physicians who are in the front line of care (family medicine, general internal medicine, ER) and among those who work longer hours. Burnout and struggles with work–life balance are greater for physicians than other US workers,” Dyrbye said.

A pooled multivariate analysis adjusted for age, sex, relationship status and hours worked per week also revealed an association between level of education and burnout. When compared with workers with high school degrees, physicians with DO or MD degrees had a higher risk for burnout (OR=1.36; P<.001) than those with bachelor’s degrees (OR=0.8; P=.048), master’s degrees (OR=0.71; P=.01) or professional or doctoral degrees other than DO or MD (OR=0.64; P=.04).


Drybye said the researchers hope the study results will generate discussion on how to address the problem of burnout.

“We hope that this study will fuel a national dialogue about how to minimize burnout. Efforts are needed to identify and address the work-related factors that are contributing to burnout among physicians. To date, the issue of physician burnout has not surfaced in any meaningful way during discussions of how to reform health care delivery,” Dyrbye said.

Besides this study, Dyrbye said she and Shanafelt have also written an article on how burnout threatens the success of health care reform regarding the Affordable Care Act.

“It isn’t so much preventive medicine subspecialists, but rather general internal medicine, general pediatrics and family medicine physicians who are most likely to be seeing more patients. This will place an additional strain on physicians in the front lines — many of whom are already struggling with burnout,” Dyrbye said.

The researchers wrote that it is up to policymakers and health care organizations to address this problem “for the sake of physicians and their patients.” – by Samantha Costa

For more information:

Shanafelt TD. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.3199.

Andrew F. Stewart

  • This is an interesting and important paper documenting that burnout and adverse work–life balance issues affect physicians disproportionately as compared to other US workers; and to explore the reasons for this. The results suggest, with appropriate cautions regarding limitations and confounders, that certain specialties within medicine are more severely affected than others.

With regard to the field of endocrinology, no specific information is available, since the many disparate general internal medicine subspecialties are combined into a single group. Thus, high-earning proceduralists (eg, cardiology, pulmonary, GI physicians with better personnel support systems) are lumped together with lower earning RVU/E&M coding non-proceduralists (eg, rheumatology, endocrinology, infectious disease physicians with little personnel or other ancillary support). One might reasonably infer that endocrinologists are most akin to family practitioners and general internal medicine physicians who are disproportionately affected by burnout and work–life balance issues. The authors may want to share their database with subspecialties for subset analysis, or analyze it more deeply themselves to see whether trends exist in specific subspecialties. This information would be of value to the Department of Health and Human Services, the AMA and other agencies interested in managing and financing health care reform.

As the authors point out, most studies in this area offer little in the way as to guidance regarding burnout- and life balance-prevention measures, other than counseling and support measures, and fail to address the organizational, procedural and support issues that lead to the occurrence of what is an obvious problem.

As they also point out, work–life balance issues and burnout predict both work force dropout and lower levels of quality of patient care.  There is no attempt to quantify these in the current study. This would be an attractive area for further study.

Overall, this is a timely and important study, although much more remains to be done analytically, and also with regard to interventions.

Source: Endocrine Today.


New Novartis Phase II data show LCZ696 may provide clinical benefits in patients with a difficult-to-treat form of heart failure.

  • PARAMOUNT study shows LCZ696 reduced a key predictor of morbidity and mortality in patients with a common form of heart failure called HF-PEF[1],[2]  
  • Up to half of the 20 million Europeans and Americans diagnosed with heart failure have HF-PEF[3]-[5], leading to reduced life expectancy and frequent hospitalization[4]-[6]  
  • No therapies are currently approved to reduce morbidity and mortality in patients with HF-PEF, or heart failure with preserved ejection fraction[5]-[7]
  • Phase III PARADIGM-HF study currently investigating LCZ696 in heart failure with reduced ejection fraction (HF-REF), the other common form of heart failure 


Novartis today announced results from the Phase II PARAMOUNT study showing that the investigational compound LCZ696 is the first therapy to significantly reduce a key predictor of morbidity and mortality in patients with a condition called heart failure with preserved ejection fraction (HF-PEF)[1],[2]. This difficult-to-treat disease affects up to half of the 20 million people with heart failure in Europe and the US [3]-[5]. The data were presented at the ESC Congress 2012 (European Society of Cardiology) in Munich, Germany[1], and published simultaneously in The Lancet[2].


The results show that after 12 weeks, LCZ696 met its primary endpoint by reducing NT-proBNP[*] – a marker of stress on the heart and a predictor of patient outcomes – significantly more than valsartan[1],[2]. The data also suggest that LCZ696 may reverse some structural changes to the heart[1],[2] that occur in patients with heart failure[8].


[*]N-terminal pro-B-type natriuretic peptide


“These Phase II results show that this novel treatment approach has the potential to reduce stress to the heart and to reduce enlargement of the left atrium of the heart, which occurs in patients with heart failure,” said Dr Scott Solomon, Professor of Medicine at Harvard University and Director of Noninvasive Cardiology at Brigham and Women’s Hospital in Boston, USA. “So far no treatment has been shown to reduce morbidity and mortality in patients with HF-PEF. The favorable effects seen in this study are encouraging, and further testing of LCZ696 is warranted in this patient population.”


Heart failure (HF) is a disease in which the heart is unable to supply enough blood to meet the body’s needs[7],[8]. There are two common types: heart failure with preserved ejection fraction (HF-PEF) and heart failure with reduced ejection fraction (HF-REF) [7],[8]. In patients with HF-PEF, the percentage of blood pumped out of the heart (also called the ejection fraction) remains within the normal range, but the heart does not relax enough to pump effectively[5],[7],[9]. This results in structural changes that progressively weaken the heart leading to a range of debilitating symptoms. Patients with HF-PEF also commonly have other conditions such as hypertension, diabetes and atrial fibrillation[7],[8].


“The results of the PARAMOUNT study are promising for patients with HF-PEF as there is no effective treatment currently available,” said Tim Wright, Global Head of Development, Novartis Pharma. “We believe that thanks to its novel mode of action and these positive study results, LCZ696 could significantly benefit people living with chronic heart failure. These results support our commitment to heart failure patients at every stage of their disease through our ongoing program of clinical trials.”


Heart failure affects an estimated 20 million people in Europe and the US[3], and kills around half of all patients within five years of diagnosis[10],[11] as they suffer acute episodes in which their symptoms suddenly become worse and urgent hospital treatment is needed[5],[7]. Patients suffer fatigue, shortness of breath and swollen limbs[5],[7],[8], limiting their ability to complete everyday tasks and placing an ever greater burden on caregivers. Not only does heart failure have a severe impact on patients, but it also represents a major economic burden for healthcare providers[12].


LCZ696 is the first in a new class of medicines called angiotensin receptor neprilysin inhibitors (ARNIs)[13]. It works in a different way to existing heart failure treatments by inhibiting an enzyme (neprilysin, or NEP) in order to promote the body’s protective mechanisms, and blocking receptors involved in the narrowing of blood vessels (angiotensin receptors)[13]. LCZ696 therefore acts simultaneously on two important pathways in the development of the disease[13].


The PARAMOUNT study showed that after 12 weeks of treatment, reduction in NT-proBNP was 23% greater with LCZ696 than valsartan (p=0.005)[1],[2]. In addition, there was a greater reduction (p=0.003) in left atrial size (cardiac remodeling) in LCZ696-treated patients at the end of the 36-week study[1],[2]. This suggests that LCZ696 could provide an effective treatment for patients with HF-PEF. The study also showed that LCZ696 had an acceptable safety profile and was well tolerated in patients with HF-PEF[1],[2].


LCZ696 is one of several compounds being developed by Novartis across the spectrum of heart failure. In addition to HF-PEF, LCZ696 is also being investigated for the treatment of heart failure with reduced ejection fraction (HF-REF) in the Phase III PARADIGM-HF study[14]. A recent Phase II study also showed that LCZ696 is more effective than valsartan in reducing blood pressure[15], and a Phase III program has been launched for the first-line treatment of hypertension in Asia.


PARAMOUNT was an international 36-week, randomized, double-blind, multicenter, parallel group, active-controlled study to compare the efficacy, safety, and tolerability profile of LCZ696 with valsartan in patients with HF-PEF[1],[2]. The study consisted of a 12-week core study and a 24-week extension phase[1],[2]. The study included 301 patients (mean age 71 years) with HF-PEF (left ventricular ejection fraction >45%)[1],[2]. They all had elevated NT-proBNP (>400 pg/ml) and at least one of the following symptoms of HF-PEF: shortness of breath on exertion, shortness of breath when lying flat, episodes of shortness of breath at night, and swollen ankles[1],[2]. After stopping any treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), they were randomized to LCZ696 (50 mg twice-daily) or valsartan (40 mg twice-daily), an ARB indicated for heart failure[1],[2]. Doses of both drugs were doubled after one week and doubled again after a further week to a maximum dose of 200 mg and 160 mg twice-daily, respectively[1],[2].

Source: Novartis Newsletter.


Calcium, vitamin D supplements failed to prevent BMD loss.

Calcium and vitamin D supplementation during androgen deprivation therapy did not prevent loss of bone mineral density among men with prostate cancer, according to study results.

Bone mineral density (BMD) loss is an adverse effect of ADT for men with prostate cancer. Doctors routinely recommend 500 mg to 1,000 mg calcium and 200 IU to 500 IU vitamin D per day as a supplement, according to background information in the study.

“Calcium and/or vitamin D supplementation to prevent loss of bone mineral density in these men seems so logical that no one had questioned whether it works,” Mridul Datta, PhD, a postdoctoral fellow at Wake Forest Baptist Medical Center, said in a press release.

Datta and colleagues reviewed guidelines for calcium and vitamin D supplementation.

They also analyzed the results of 12 clinical trials that evaluated a combined 2,399 men with prostate cancer who were undergoing ADT. Those trials compared the effects of calcium supplements, vitamin D supplements and other drugs on BMD.

Only one of the 12 trials showed an increase in BMD in the lumbar spine (0.99% in 12 months). The largest decrease in BMD in the lumbar spine was –4.9% in 12 months.

The trial results indicated that calcium supplementation of about 500 mg to 1,000 mg and vitamin D supplementation of 200 IU to 500 IU did not prevent BMD loss.

“It wouldn’t be so bad if there were simply no obvious benefit,” researcher Gary G. Schwartz, PhD, MPH, associate professor in the departments of cancer biology, urology, and epidemiology and prevention at Wake Forest Baptist Medical Center, said in the release. “The problem is that there is evidence that calcium supplements increase the risk of cardiovascular disease and aggressive prostate cancer, the very disease that we are trying to treat.”

Further studies are needed to evaluate the safety and efficacy of calcium and vitamin D supplementation in this patient population, the researchers wrote.

Clinical trials to determine the risk-benefit ratio of calcium and vitamin D supplementation in men undergoing ADT for prostate cancer are urgently needed,” they concluded.

Source: Endocrine Today.

Bone is a plastic tissue .

Decades ago, medical school final exams took the form of essays rather than the current multiple choice questions. For the histology finals, I selected the topic “Bone is a plastic tissue.” I knew absolutely nothing about the skeleton other than it was brittle and broken. It turns out that not only was I wrong but I knew as little about it as the professors: for the one and only time in medical school, I topped the class.

Bone is clearly a plastic tissue subject to modeling during growth and development and remodeling shortly after epiphyseal closure. The most common skeletal disease resulting from altered remodeling is osteoporosis in which resorption outstrips formation. Monitoring resorption and formation — measures of total skeletal metabolism — is overlooked in favor of monitoring bone mineral density — measures of regional, not total, skeletal status.

Why bring this up now?

A PubMed search for the last 10 years returned 35,121 citations (275 meta-analyses) for “bone density” and 13,162 citations (28 meta-analyses) for “bone turnover markers”. There is clearly no shortage of peer-reviewed literature regarding bone turnover markers, but there is so much variability in those 13,162 citations that meaningful consensus data is lacking.

You don’t need reminding that adherence to oral medications for osteoporosis is low, and not that great for injectable (subcutaneous or IV) therapies. Several studies have examined the use of markers to improve medication adherence but, to my knowledge, none of them have found markers to be useful in maintaining compliance with therapy.

Bone turnover markers have no role in determining which patient is a candidate for osteoporosis therapy and have not had much effect on patient adherence to therapy. My own practice is to measure markers as I recommend the patient start therapy and re-check markers after 6 months of therapy to both monitor that the therapy is effective and that the patient is adherent to therapy. My success rate in the latter is no better than reported in the literature.

I repeat measurement of markers when serial measurement of BMD indicates that BMD is no longer increasing. Ongoing use of osteoporosis therapies is safe for the vast majority of patients in whom BMD has plateaued, but there is increasing awareness of atypical femoral shaft fractures in a small minority of patients on long-term antiresorptive therapy. With that in mind, I interrupt therapy in patients with stable BMD, where bone turnover markers are in the bottom quartile of the reference interval. I re-check them at 6 monthly intervals until the values get to the top half of the reference interval, at which time therapy is re-started. That happens infrequently. When allowed by insurance coverage, I repeat BMD measurement after 1 year off therapy but have yet to see a patient in whom BMD has declined during that year. I cannot recall a patient in whom an uptick in remodeling has not occurred within 2 years without antiresorptive therapy and use that as an indication to re-start treatment.

Which markers to use? My preference is or serum CTX (resorption) and P1NP (formation) because patients are never in a hurry to provide a 24-hour urine collection or even a fasting urine sample.

Much has been written about the diurnal variation of biochemical markers of bone remodeling and the intra- and interassay variability. These are specious arguments against serial measurements of bone turnover markers. Firstly, when remodeling is suppressed as a result of therapy, even 50% variability in markers (it is not that variable) does not move many patients from one quartile to another. Secondly, there are many laboratory tests in which the variability is the same or even worse than for bone turnover markers. That has not stopped any clinician I know from continuing to order and rely on those results.

The bottom line — patient adherence to therapy tests our skills as clinicians every day. Asking a patient to wait 2 years to see if the therapy we prescribe is effective or not makes little sense to me.

Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for Endocrine Today, Endocrine Practice, Journal of Clinical Densitometry, Journal of Women’s Health, Osteoporosis International and Calcified Tissue International. Dr. Kleerekoper is also a founding board member of the newly formed Academy of Women’s Health.

Source: Endocrine Today.


Patients with diabetes likely to benefit most from everolimus-eluting stents.

New data showed that all available drug-eluting stents were safe and effective in reducing the risk for target vessel revascularization and target lesion revascularization in patients with diabetes. However, results also suggested that everolimus-eluting stents may be the best option for this patient population.

To compare the efficacy and safety of drug-eluting stents with both bare metal stents and each other, Sripal Bangalore, MD, assistant professor at New York University School of Medicine, and colleagues conducted a mixed treatment comparison meta-analysis of 42 randomized controlled trials involving 10,714 patients with 22,844 patient-years of follow-up.

“When compared with bare metal stents, all drug eluting-stents were associated with a 37% to 69% reduction in the rate of target vessel revascularization, but the magnitude of this reduction varied with the type of stent,” researchers wrote.

In terms of efficacy, researchers found a 62% probability that everolimus-eluting stents (Xience V, Abbott Vascular) have the lowest rate of any stent thrombosis and an 87% probability that everolimus-eluting stents have the lowest rate of target vessel revascularization when compared with sirolimus- (Cypher, Cordis), paclitaxel- (Taxus Express, Boston Scientific) and zotarolimus-eluting stents (Resolute, Medtronic). Sirolimus-eluting stents were also found to be similar to paclitaxel- and everolimus-eluting stents but significantly more effective than zotarolimus-eluting stents. Data also indicated that everolimus-eluting stents were more efficacious than paclitaxel- or zotarolimus-eluting stents.

In terms of safety, everolimus-eluting stents were associated with a 57% probability of having the lowest death rate and an 81% probability of having the lowest rate of myocardial infarction. Researchers also found a median death rate of 17.51 per 1,000 patient-years of follow-up among patients with bare metal stents. For drug-eluting stents, median death rate varied between 14.51 and 20.27 per 1,000 patient-years, according to data.

The researchers said there was limited usable data on the use of zotarolimus-eluting stents in patients with diabetes, which may have affected

Source: Endocrine Today.



NIH trial to examine use of methotrexate for prevention of CVD.

Researchers have launched an international, multisite trial to determine whether methotrexate can reduce cardiovascular disease that results in myocardial infarctions, strokes and deaths in patients at the highest risk, according to an NIH press release.

The NIH-funded Cardiovascular Inflammation Reduction Trial (CIRT) will be led by Paul Ridker, MD, MPH, the Eugene Braunwald professor of medicine at Harvard Medical School and director of the Center for Cardiovascular Disease Prevention, a translational research unit at the Brigham and Women’s Hospital, and colleagues.

“If this generic drug, which is already on the market at low cost, proves effective for reducing risk of heart attacks, stroke or death, it has the potential for broad public health impact in saving lives and reducing disease,” Ridker said.

In November, the CIRT researchers will begin site selection of 350 to 400 sites within the United States and Canada. Patient recruitment will begin in March, with an eventual patient enrollment of 7,000 adults aged 18 years and older; they will be followed for 2 to 4 years. The estimated primary completion date is December 2016, and the estimated study completion date is December 2017.

Patients who experience no adverse effects during a 5-week testing period will be randomly assigned to standard care plus placebo or standard card plus low-dose methotrexate, according to the press release. Additionally, patients will take folic acid to prevent vitamin deficiencies.

The primary outcome measures will determine the rate of recurrent major CV events. The secondary outcomes measures will determine whether low-dose methotrexate will reduce all-cause mortality and certain heart- and blood vessel-related conditions and events (ie, incident deep vein thrombosis, pulmonary embolism, atrial fibrillation, hospitalization for chest pain or congestive heart failure, nonsurgical procedures or coronary artery bypass surgery, and newly diagnosed type 2 diabetes).

“This trial could have global impact by potentially changing treatment recommendations for millions of individuals with heart disease,” Gary H. Gibbons, MD, director of the National Heart, Lung, and Blood Institute, said in the release.

Disclosure: CIRT is funded by the NHLBI grants 1 U01 HL101422-01A1 (Clinical Coordinating Center) and 1 U01 HL101389-01A1 (Data Coordinating Center). Dr. Ridker has served as a consultant for various entities, receives additional research grant support from Novartis, and holds patents held by the Brigham and Women’s Hospital, which have been licensed to Siemens and AstraZeneca.

Source: Endocrine Today.


Stronger statins associated with muscle problems.

Among patients taking statins, those who reported experiencing muscle problems were prescribed a stronger or more potent statin, according to study results recently published in PLoS One.

Researchers analyzed 147,789 case reports from the FDA Adverse Event Reporting System (AERS) database linking muscle-related adverse events to statin use from July 2005 to March 2011. Statins selected for analysis included: atorvastatin (Lipitor, Pfizer), simvastatin (Zocor, Merck), lovastatin (Mevacor, Merck), pravastatin (Pravachol, Bristol-Myers Squibb), rosuvastatin (Crestor, AstraZeneca), fluvastatin (Lescol, Novartis) and generic equivalents and foreign designations. Death, disability and hospitalization were collected as outcome measures for the main adverse event categories, which included joints and tendons, muscle atrophy and injury, and muscle coordination and weakness.

Overall, researchers found that relative risk rates were consistently higher for rosuvastatin and fluvastatin, intermediate for atorvastatin and simvastatin and low for pravastatin and lovastatin. When all muscle categories were incorporated, study results showed that rosuvastatin had the highest ranked risk, followed by atorvastatin (55%), simvastatin (26%), pravastatin (17%) and lovastatin (7.5%).

“These findings underscore that stronger statins bear higher risk — and should be used with greater caution and circumspection,” Beatrice Golomb, MD, PhD, professor in the departments of medicine and family and preventative medicine at the University of California, San Diego, said in a press release. “These rankings closely match the individual potencies of each statin. Thus, the strength of the statin drug appears to be a dominant factor in determining how likely muscle problems are to occur.”

Source: Endocrine Today.