Is Lower Blood Cholesterol Really Better?

Dr. John Briffa
Special to The Epoch Times
Oct 17, 2007
Is it in their best interests to lower their cholesterol? Very few of us will not have noticed that the last couple of decades have seen a concerted effort from health agencies and health professionals to persuade us that we should be driving our cholesterol levels down to lower and lower levels. When I was at medical school the upper limit of cholesterol was 6.5 mmol/l (255 mg/l). But it's come down steadily since then and now stands at 5.0 mmol/l (195 mg/l). My suspicion is that it will fall even lower over the years. Who knows, it may get so low that practically everyone will be classified as having raised cholesterol, and be recommended to lower this with specialized food products and/or drugs.
However, since cholesterol is a constituent in the walls of cells in the body as well as steroid hormones, there is an issue for questioning whether lower really is better.
Some have suggested that low levels of cholesterol may predispose to health problems, including those that relate to brain function.
Last month saw the publication of a study in the journal, Neurobiology of Aging, in which Dutch researchers assessed the relationship between cholesterol levels and mental function in about 1,200 individuals aged 65 or over. The participants in the study were assessed over a six-year period. Lower blood cholesterol levels in this group were associated with a reduction in both general cognition and information processing speed. The authors of this study concluded: " … lower total cholesterol may be considered as a frailty marker, predictive of lower cognitive functioning in elderly." [1]
Of course with studies of this nature, it is impossible to know whether the low cholesterol itself is responsible for the associated poorer brain function. One way to assess this might be to attempt to lower cholesterol levels and see what it does to brain function. In one study, individuals treated with lovastatin (a cholesterol-reducing drug), compared to those taking a placebo, saw significant reductions in measures such as vigilance and general cognitive function [2]. This study, though, also tested the effect of another statin drug (pravastatin), which did not appear to have this same adverse effect on brain function.
Even if we take the apparent association between lovastatin and impaired brain function at face value, we do not know whether this was due to cholesterol lowering per se or some side effect of the medication.
Another study, though, adds further evidence to support the notion that lower cholesterol levels may impair brain function. In it, a low-fat diet was pitted against a standard diet over a 12-week period [3]. Over the course of the trial, the performance of a task that required sustained attention was significantly worse in individuals who had reduced their cholesterol. And the lower the cholesterol fell, the worse the performance in this test was.
Even if it turns out that cholesterol reduction is bad for the brain, I have no doubt that proponents of the lower cholesterol concept will point to other benefits of this endeavor. Yet I think it is worth bearing in mind that the evidence shows that in essentially healthy individuals, cholesterol reduction through drugs has not been shown to save lives. And dietary approaches do not appear to reduce funeral rates either, even in those with a history of cardiovascular disease.
Furthermore, there is at least some evidence showing that in later life, higher levels of cholesterol are actually associated with enhanced longevity [4–7]. In short, there is mounting evidence, I think, which suggests that as far as cholesterol is concerned, lower is not always necessarily better.

References:
1. Van den Kommer TN, et al. Total cholesterol and oxysterols: Early markers for cognitive decline in elderly? Neurobiology of Aging. 2007 Sep 19; [Epub ahead of print]
2. Roth T, et al. Comparative effects of pravastatin and lovastatin on nighttime sleep and daytime performance. Clinical Cardiology. 1992; 15:42–432
3. Wardle J, et al. Randomized trial of the effects of cholesterol-lowering dietary treatment on psychological function. American Journal of Medicine 2000; 108(7): 547–553
4. Brescianini S, et al. Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging. Journal of the American Geriatrics Society 2003; 51(7): 991–996
5. Forette B, et al. Cholesterol as risk factor for mortality in elderly women. Lancet, 1989; 1:868–870
6. Jonsson A, et al. Total cholesterol and mortality after age 80 years. Lancet, 1997; 350:1778–1779
7. Weverling-Rijnsburger AW, et al. Total cholesterol and risk of mortality in the oldest old. Lancet, 1997; 350:1119–1123

Twist and Ouch

Important information for all of us, not just athletes.

October 28, 2007
Most athletes will have back trouble sooner or later -- if they’re not suffering already. Here’s what to do about it.

http://www.nytimes.com/2007/10/28/sports/playmagazine/28physed.html?ex=1351310400&en=d74dcfa901ad4b9e&ei=5124&partner=permalink&exprod=permalink

Edible, Sure. But Just How Incredible?

The much maligned egg is one of the most healthful foods around. Egg albumin or egg white is considered to be the reference protein to which all other foods are compared to for protein quality. Egg yolk is loaded with nutrients such as lutein (a carotenoid important for eye health), and vitamins A and D. For more info on the cholesterol controversy, see October 10th blog on
Diet and Fat: A Severe Case of Mistaken Consensus

October 1, 2007, 12:18 pm
(Alan Zale for The New York Times)
At breakfast recently a friend of mine passed on the scrambled eggs. “I’m watching my cholesterol,'’ he said. Another woman I know only orders Egg Beaters, which are essentially cholesterol-free orange-colored egg whites.
Of all the commonly consumed foods, eggs contain the highest amounts of cholesterol, and that’s why many people shun them. Now, the American Egg Board is bringing back its “Incredible Edible Egg” campaign to reiterate the health benefits.
So are eggs good for you or bad for you? I asked Dr. Walter Willett, Harvard University’s famed nutritionist, for his take.
“Dietary cholesterol has been greatly oversold as a health concern, in part because it has a small effect on blood cholesterol levels,'’ said Dr. Willett, who has never received funding from the egg industry. Eggs, in particular, have gotten a bad rap. “Some of the foods that contain high cholesterol, such as eggs, have many other healthy components,'’ he said.
Egg yolks, organ meat, shellfish, whole-fat dairy products and red meat are rich sources of dietary cholesterol. But the biggest influence on blood cholesterol level is the mix of fats in the diet, not how much cholesterol you eat in food.
The average person makes about 75 percent of blood cholesterol in his or her liver, while the rest is absorbed from food. One of the biggest problems with giving up eggs is that people turn to other breakfast foods like bagels with cream cheese, pastries and muffins. These are loaded with unhealthy saturated fat, which increases blood cholesterol levels far more than the dietary cholesterol found in eggs. The downside of eggs is that many people only eat them cooked in butter or oil, or with sausage, also loaded with saturated fat.
There are a few caveats. Egg consumption has been linked to a higher risk of heart trouble in people with diabetes. And a small number of people are unusually sensitive to dietary cholesterol — in them, foods like eggs can disproportionately increase blood cholesterol.
Still, said Dr. Willett, “the large majority can consume eggs in reasonable amounts.” For a more lengthy explanation of the impact of dietary cholesterol and fats on your health, check out The Nutrition Source from the Harvard School of Public Health. And Northwestern University has a useful fact sheet comparing dietary cholesterol and saturated fat in various foods.

Industry Money Fans Debate on Fish

Much confusion about amount of fish a pregnant woman should consume. The latest recommendation from the National Healthy Mothers, Healthy Babies Coalition actually contradicted the goverment warnings about fish consumption, encouraging pregnant women to consume higher amounts of mercury tainted fish. Now there is evidence that this organization received funds from the National Fishery Institute. What else is new?

By MARIAN BURROS
October 17, 2007
The government and a private group are at odds on tuna’s safety.
http://www.nytimes.com/2007/10/17/dining/17fish.html?ex=1350360000&en=6aed88dd50be347c&ei=5124&partner=permalink&exprod=permalink

Diet and Fat: A Severe Case of Mistaken Consensus

This is brilliant and timely since we discussed the cholesterol controversy in class last night.

http://www.nytimes.com/2007/10/09/science/09tier.html?ex=1349668800&en=67642ef2330f51af&ei=5124&partner=permalink&exprod=permalink

Kids' Use of Heartburn Drugs Surges

This is really frightening. Acid blockers are among the most commonly used drug in the US by adults, so what now? Shall we begin poisoning our children? Do people realize that by suppressing stomach acid (HCl), we reduce the absorption of minerals, some vitamins and amino acids? This can lead to anemia, brittle bones, and what about reduced zinc absorption? Will we begin seeing cases of hypogonadal dwarfism and macular degeneration? What about the overgrowth of bacteria and increased risk of infections? Maybe parents should take an interest in what their kids are eating and modify their diets before looking for some easy fix. By the way, I don't know any kids or adults for that matter who have a deficiency of Prilosec, Prevacid, Tagamet or Zantac, do you?

October 4, 2007
By THE ASSOCIATED PRESS
CHICAGO (AP) -- The number of young children on prescription drugs for heartburn and other digestive problems jumped about 56 percent in recent years and researchers say obesity and overuse might be contributing to the surprising increase.
The surge was found in a Medco Health Solutions Inc. analysis released Thursday of U.S. prescription data for 2002-2006. It suggests that more than 2 million U.S. children 18 and under used drugs for digestive or gastrointestinal complaints last year.
''It's a signal that something's going on that we need to keep an eye on,'' said Dr. Robert Epstein, Medco's chief medical officer. ''Whether it's parents getting their children diagnosed more frequently, or obesity,'' or other factors, ''it bears further study,'' he said.
Researchers at Medco, a pharmacy benefits management company based in Franklin Lakes, N.J., analyzed prescription drug claims of more than 575,000 U.S. children.
They calculated that 557,259 infants and children up to age 4, or about 3 percent of youngsters in that age range, were taking these drugs last year. That's about a 56 percent increase from 2002.
There was a 31 percent increase among children aged 5 to 11, climbing to an estimated 551,653 children, or 2 percent in that age group in 2006, the analysis found.
Almost 1 million children aged 12 to 18 had prescriptions for the drugs last year, but that was up only 6 percent over 2002.
Acid-reducing drugs called proton pump inhibitors are the most common medicines prescribed for GI problems, the analysis said. They are used for acid reflux associated with heartburn, and a related condition called gastroesophageal reflux disease or GERD.
Some of these, including Prevacid, were approved for use in children during the study period, which likely also contributed to the prescription surge, said Dr. Benjamin Gold, an Emory University specialist in children's digestive diseases.
Heartburn is a common complication of being overweight and the surge happened during the nation's rising obesity epidemic, said Dr. Renee Jenkins, president-elect of the American Academy of Pediatrics. She noted that more than 10 percent of U.S. preschoolers and 30 percent of older children are considered overweight.
Gold said there's no hard data on how many children have acid reflux or GERD. But there's some evidence that the numbers are rising, and obesity could be playing a role, he said.
Heartburn and acid reflux are also extremely common in infants and young children. Many of them outgrow it and drug treatment often isn't needed, so the increase raises concerns about whether these drugs are sometimes being used unnecessarily, said Jenkins, a Howard University pediatrics professor.
While some children do require treatment including prescription drugs, many get better with no treatment or lifestyle changes such as smaller, more frequent meals or cutting down on fatty foods, she said.
Still, parents increasingly are demanding that doctors prescribe medicine for reflux, in part because of direct-to-consumer marketing, Gold said. But also, symptoms including frequent spitting up, irritability and stomach aches are troublesome and many parents prefer a quick fix, he said.
Gold said reflux drugs are generally safe but there is some evidence linking long-term use with an increased risk of infections including pneumonia and bowel inflammation.
To avoid overuse, Jenkins said parents should be willing to try non-drug approaches for treating reflux and other digestive problems in young children.

Mmm, Phytonutrients: New Respect for a Humble Juice

Wall Street Journal

Katy McLaughlin

September 25, 2007

For years, many pediatricians, child-rearing books and parenting Web sites have warned parents against apple juice, casting it as "sugar water" with fewer nutrients than other fruit juices. Parents have found this advice hard to swallow, because kids tend to love apple juice.
Now it appears that parents have been vindicated by new research showing that apples contain more beneficial nutrients than previously thought. The new thinking builds on scientists' growing understanding of the importance of phytochemicals (plant chemicals) in fighting chronic disease and promoting health. While much of the research underscores the importance of eating whole fruit, the findings also rehabilitate apple juice -- particularly the unfiltered kind -- as a source of valuable antioxidant compounds.
The new research shows that apples contain many of the same benefits of exotic fruits like pomegranates, Noni fruit and açai that are being marketed as antioxidant powerhouses. Studies at Cornell University's Department of Food Science have found that the unique combination of thousands of phytochemicals in apples -- mainly concentrated in the peel -- retard tumor growth in cell cultures and in animals. In particular, apples are high in triterpenoids, which have "very potent activity in tumor cell growth," says lead researcher Rui Hai Liu.
Dr. Liu believes that apples pack a powerful health benefit because the many phytochemicals work together, and he is currently studying how this potential synergy works. He says each phytochemical is metabolized differently, suggesting that a package can be effective on many different levels in the body.
Another series of studies, conducted over the past five years by researchers at the Center for Cellular Neurobiology and Neurodegeneration Research at the University of Massachusetts Lowell, found that apple juice improved cognitive function in mice. The center is currently studying the juice's effect on Alzheimer's patients, says Tom Shea, the lead researcher.
Both sets of studies received some funding from the U.S. Apple Association and the Apple Products Research and Education Council, trade groups for the industry; the Cornell research also got funds from the American Institute for Cancer Research. Study results were published in peer-reviewed journals.
Doctors and nutrition experts warn that apple juice can still be overdone. For children, it is important to serve pure juice, with no sugar added, and limit total fruit-juice consumption to amounts recommended by the American Academy of Pediatrics: four to six ounces per day for children ages 1 through 6, and eight to 12 ounces for 7- to 18-year-olds. The limits are key because the sugars in juice can be hard for some children to digest and can cause gastrointestinal problems.
Nutritionists recommend eating whole fruit, which provides not only the entire peel but about 3.3 grams of fiber per medium-size apple. But apple juice can provide some of the benefits of whole fruit, says Suzanne Farrell, a spokeswoman for the American Dietetic Association.
Consumers can get more of a health benefit from juice by drinking unfiltered varieties, sometimes called apple cider. A study published this year by Polish scientists in the Journal of the Science of Food and Agriculture showed that unfiltered, or cloudy, apple juice is 50% to 80% more effective as an antioxidant than clear juice. Cloudy apple juice is made by shredding apples, straining the resulting juice and bottling it. Filtered juice goes through extra-fine sieves that remove more solids, which means it often contains less peel.
Most apple juice, filtered or unfiltered, is pasteurized. (The Food and Drug Administration requires that all fruit juice be pasteurized, or carry a label outlining the risks of unpasteurized juice, which has been linked to illness and a death in the past.) While pasteurization has been shown to reduce the level of some phytonutrients in apple juice, Dr. Liu says it could be possible that others actually become more potent through processing -- much as cooking tomatoes increases their lycopene content. More research is needed to determine pasteurization's exact effect.