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High Cholesterol & Diet

Posted by Lynda on May 19th, 2012 (Diet, Nutrition)

A dietitian’s perspective on high cholesterol and the news about two conflicting medical studies that were published this week.

As a dietitian, I was deeply concerned about two articles on high cholesterol that were  in the news this week on the very same day, reporting contradictory medical research. One was on the BBC News website, the other in the New York Times.

Before I begin, the current medical thinking about cholesterol is that it is made up of two components – LDL cholesterol – which is usually touted as the bad boy in heart health; and HDL cholesterol – the good guy and- more of which is thought to protect the heart against cardiovascular disease.

The BBC story, titled Should NHS consider giving statins to healthy people, was reporting on the results of a study by researchers at Oxford University that was published in the medical journal The Lancet. The researchers concluded that healthy people over the age of 50 should be given statins on the NHS if they had a mere 10% risk of cardiovascular disease. The study was being reviewed by NICE, the regulatory drug body of the NHS in the UK.

As a dietitian, this article made me mad because it barely mentioned the role a healthy diet and good nutrition play in heart health. Instead it was encouraging the taking of prescribed pills on a wide-spread national scale, even for healthy people.

Only at the end did it mention that another doctor, Professor Shah had questioned the conclusion that statins should be prescribed to healthy people instead of recommending diet and lifestyle choices to improve cardiovascular health. Also the article did not really explain the emerging side-effects of statins – effects we are only just beginning to see because the drug has only been in circulation since the late 80s and widely prescribed since the 1990s.

The article in the New York Times was titled, Doubt Cast on the ‘Good’ in ‘Good Cholesterol.  It reported on the results of an entirely different medical study which had looked at the role of genetics in HDL cholesterol levels. It found that raising HDL levels may not make any difference to heart disease risk because people who inherit genes that give them naturally higher HDL levels throughout life have no less heart disease than those who inherit genes that give them slightly lower levels. If HDL were protective, those with genes causing higher levels of HDL should have had less heart disease. I quote from the New York Times:

“I’d say the HDL hypothesis is on the ropes right now,” said Dr. James A. de Lemos, a professor at the University of Texas Southwestern Medical Center, who was not involved in the study. Dr. Michael Lauer, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, agreed.

“The current study tells us that when it comes to HDL we should seriously consider going back to the drawing board, in this case meaning back to the laboratory,” said Dr. Lauer, who also was not connected to the research. “We need to encourage basic laboratory scientists to figure out where HDL fits in the puzzle — just what exactly is it a marker for.”

The other interesting thing, is that in both April and March 2012, two entirely different and separate medical studies found that LDL cholesterol – the so-called bad cholesterol – seemed to play a role in protecting the body against cancer. The New York Times article proved just how little we actually know about cholesterol and the complex role it plays in overall health and longevity.

Statins are a very lucrative drug for the pharmaceutical companies that make them. And I would be very interested to know which company, if any, sponsored the study that was published in The Lancet.

Statins began life when a Japanese biochemist named Akira Endo started looking for a cholesterol lowering drug in 1971 by looking for a micro-organism that could inhibit the enzyme in the liver that produces cholesterol. The substance he identified was named mevastatin, but it was never marketed because of its adverse effect on tumours, muscle deterioration and death in laboratory dogs.

Nevertheless, his research sparked the interest of an American scientist named P. Roy Vagelos who later became the CEO of Merck & Co, which outside the USA and Canada is one of the largest pharmaceutical companies in the world. He made several trips to Japan and by 1978 had isolated a micro-organism he called Iovastatin which was first marketed as a drug in 1987 called Mevacor.

You have to remember that in the early 1980s, research on the link between cholesterol and cardiovascular disease was in its infancy. We are so used to the low v. high cholesterol message that we read everywhere in newspapers, websites and health magazines that it is common parlance. But in 1984, many doctor were sceptical about the ‘healthy’ effects of Mevacor.

To market the drug successfully, Merck had to convince doctors and the public about the dangers of high cholesterol, and that statins were safe and good for longevity. So he sponsored a study, the Scandinavian Simvastatin Survival Study or “4S” – the results of which were announced in 1994. In this study researchers tested simvastatin (later sold by Merck as Zocor) on 4,444 patients with high cholesterol and heart disease. After five years, the study concluded that patients saw a 35% reduction in their cholesterol, and their chances of dying of a heart attack were reduced by 42%.

In 1995, Zocor and Mevacor both made Merck over US$1 billion and Endo was awarded the 2006 Japan Prize, and the Lasker-DeBakey Clinical Medical Research Award in 2008.

The long-term effects of statins are still unknown because the drug has only been widely prescribed since the 1990s. So the adverse effects that it may have on the body are still being discovered as the people who were over 50 in the 1990s and prescribed it twenty years ago, start showing the effects. Not only has it been linked to kidney failure as the BBC article said, but also an increase in diabetes, neuropathy and even memory blanks similar to Alzheimer symptoms, among other things. The fact that LDL cholesterol – usually the bad guy – may be a cancer protector also highlights the fact that popping pills which effect the body in variety of ways, is not the answer to good health. Scientists and doctors still do not fully understand the complexities of the human body. Pharmaceutical companies have profits at the forefront of their minds, not health.

So, what should we do about heart health? It is simple – improve your diet and add some exercise to your life. As a dietitian, often the people I see about lowering cholesterol have poor diets and are over weight. They do not eat whole grains or enough fruit and vegetables which contain all sorts of vitamins and minerals that are beneficial to heart health.  They do little or no exercise – and some drink and smoke too much too.

If you are worried about high cholesterol, concentrate on your diet and exercise regime before resorting to statins. Here are my top 5 tips for improving cardiovascular health.

1. Achieve and maintain a healthy weight so the heart does not have to work harder than necessary.

2. Stop smoking because it causes a fatty build up in the arteries that forces the heart to work harder to pump blood around the body.

3. Choose polyunsaturated or monounsaturated oils and spreads – oils that are good for the body – and avoid trans fats like the plague.

4. Choose foods such as whole grain breads and cereals, whole wheat pasta, brown rice, fruits, vegetables, legumes, lean meat, poultry and oily fish. Drink no more than 1-2 servings of alcohol a day.

5. Get 30-40 minutes of exercise on most days of the week – even if its just going for a brisk walk.

If you would like to see a dietitian in Sydney, get in touch.  We have clinics in Mona Vale, Kogarah and Ryde,  plus Saturday home consultations for those who can’t get away from work during the week.

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