Some thoughts on cholesterol

Here are a few notes from Monday's show. Sorry for the delay, it's been a busy week!

Good overview about cholesterol http://www.netdoctor.co.uk/diseases/facts/hypercholesterolemia.htm

Remember not all cholesterol is “bad”, in fact without it we would be dead! It stops our cells from leaking, makes bile to help us digest and is essential in the production of hormones, amongst other things. A lower than normal blood cholesterol level has a negative effect on longevity.

The primary medical treatment is to prescribe cholesterol lowering drugs (the most common are known as ‘statins’). A metaanalysis suggests that the only real overall benefit is for middle-aged men with a history of cardiovascular disease. There is little or no evidence that overall this treatment benefits women.

One controversy concerns the ratio of beneficial cholesterol (HDL) to 'bad' (LDL) or total cholesterol. If your ratios are within normal range, it is debatable how adverse your blood cholesterol levels will be on your cardiovascular health.

Mercola (may need to enter email address to access articles) is a medical professional who leads the charge against drug treatment for high cholesterol. I don’t agree with everything Dr Mercola says, but this is a good summary of literature to illustrate the problems with chiolesterol lowering driugs.

A précis of some relevant studies

European Heart Journal
Published 3 year study 11,500 patients and found that low cholesterol
caused:
-Increase in lung cancer
-Increase in other cancers
-Higher risk of cardiac death
-Erectile dysfunction and infertility
-Loss of memory and mental focus
European Heart Journal 1997, 18, 52-59


Swedish Researcher found:
-Individuals with low cholesterol suffer from frequent and severe infections
-Individuals with high cholesterol had a lower mortality than the average
population
Uffe Ravnskov, MD, PhD, independent researcher Magle Stora Kyrkogata 9,
S-223250 Lund, Sweden


University San Diego School of Medicine
Study showed
-High cholesterol can be protective against environmental toxins rather than
harmful
-Low cholesterol is a risk factor for heart arrhythmias
-High cholesterol readings are associated with protection from neurotoxins
and cancer protection


Journal of American Medical Association
30 years of follow-up from the Framingham Study
-No correlation between high cholesterol and mortality, but correlation
between low cholesterol and mortality
-CVD death rates increased 14% for every 1 mg/dl drop in total cholesterol
per year
Anderson KM. Cholesterol and Mortality, 30 years of Follow-up from the
Framingham study. JAMA 1987 Apr 24;257(16):2176-80


Journal of Cardiac Failure
Paper on Low Cholesterol
-Analysis of 1,134 patients with heart disease
-Low cholesterol was associated with worse outcomes in heart failure
patients and impaired survival rates
-Elevated cholesterol was not associated with hypertension, diabetes or
coronary heart disease.
Horwich TB. Et.al. Low Serum Total Choesterol is Associated with Marked
Increase in Mortality in Advanced Heart Failure. J Card. Fail. 2002
Aug;8(4):216-214


Japanese Study
-Found as cholesterol levels went up death rates from CHD went down
Okayama A., Marmot MG Int. J Epidemiol Dec 1993

Despite successful attempts to lower cholesterol with statin drugs, the
death rate from heart disease has not changed in 75 years and mortality from
heart disease is more than double what is was in 1996.
Uri Goldbourt. Arteriosclerosis Vol 10. No 4. July/August 1990

Oxidative Stress and Inflammation are the root cause of elevated LDL:
-A group consuming American diet had lower antioxidant levels versus the
Mediterranean diet which had increased antioxidant levels.
-Mediterranean's had one-third the rate of heart attacks that Americans did
Leon Study, Circulation, 1999, 99. Pg 779.

-Study with 11,500 patients showed that the risk of death in the low
cholesterol group (160mg/dl and below) was 2.27 times higher than those with
high cholesterol.
-Most common cause of death in low cholesterol patients was cancer.
European Heart Journal (1997) 18,52-59.


Recent rethinks on some foods containing cholesterol
Cholesterol and eggs: There’s been a big rethink about the effect of cholesterol in eggs. They’ve been officially anointed as ok in moderate amounts in a low cholesterol diet. This article covers some of the background.

Cholesterol and seafood: While fish has consistently played a role in a healthy lipid balance, for years many types of seafood including prawns, squid and lobster – have been considered high in cholesterol. The latest rethink is that they are not all that bad. In fact the cholesterol in this type of food may be slightly different (less harmful/possibly beneficial) and there is no negative correlation between a diet high in this type of seafood and coronary heart disesase. The take home message is that omega 3 rich fish is better but other seafood as long as its not fried, is no longer the bad guy.

Tips to lower your cholesterol

A vegan (animal product free) diet is a clinically proven way to lower or normalise your cholesterol levels. However this won’t appeal to all people. I’d suggest a “vegan plus fish” approach, limiting all meat and dairy to 1-2 serves a week is a good compromise.

Fibre – think vegetables, fruit, nuts, seeds, beans, lentils and wholegrains like brown rice, oats, quinoa, amaranth, millet (grains still containing their bran/outer layer in particular) – in large amounts, daily.

Not surprisingly alcohol and smoking are not recommended.

Take a B vitamin supplement with about 50 mg of B3. Many studies use a very high dose Niacin (B3) supplement often 10 x this dose but note it is in an extended release form that is not easily available over the counter. High doses of niacin cause an uncomfortable type of flushing but more of a concern is the negative effect is has on the levels of other b vitamins. I’d suggest you start with the strong, mega-B and concentrate on your diet for best results.

If you can’t have fish at least 4 times a week add a fish oil or Omega-3 supplement.

Note: If you are taking statin drugs consider taking a Co-Q10 supplement.