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February 2002 Vol. 7 No. 2

 Far better it is to dare mightly things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows not victory or defeat.
Theodore Roosevelt

What would life be if we had no courage to attempt anything?
Vincent Van Gogh

Table of Contents:Cholesterol Lowering Drugs Need to be Used With Caution
Eating More Frequently May Lower Your Cholesterol
Beans and Peas Can Cut Heart Disease Risk
Cutting Calories Can Increase Your Lifespan
The Scientific Definition of Obesity and its Dangers
Cholesterol Lowering Drugs Need to be Used With CautionNational cholesterol guide-lines that are expected to help more Americans lower their risk of heart disease will boost the number of people eligible for cholesterol-lowering medication by 140%.

Their analysis indicates that the guide-lines could triple the number of people younger than 45 who can take medication and increase the number of older Americans eligible for the drugs by about 130%.  The costs of the drugs coupled with a lack of a national drug prescription benefit program could force some older individuals to choose between taking the drugs and buying food.

We have to look at the consequences. There is a large number of people being prescribed very expensive medication and we’ve had a limited number of years with the drugs.

The guide-lines, released last year by the National Cholesterol Education Program (NCEP), a division of the National Institutes of Health, replace those set in 1993. Now, patients with LDL (”bad”) cholesterol of 130 milligrams per deciliter (mg/dL) of blood in addition to two risk factors for heart disease are eligible for medication. The previous guide-lines set a threshold of 160 mg/dl plus two other risk factors.

People with high cholesterol are at risk of developing heart disease, the leading cause of death in the US. About 500,000 Americans die of heart disease each year. Other risk factors include smoking, excess weight, a sedentary lifestyle and type 2 diabetes.  The updated recommendations stress that diet with exercise is still the first-line of treatment for high cholesterol. But most people will fail to make the lifestyle changes necessary to lower their risk of heart disease and many will turn to the drugs for help.

The more recent recommendations qualify 36 million Americans for drug therapy, of whom nearly one-third are younger than 56, and more than one-quarter are older than 65. About 55% of those eligible are men. Under the old guidelines, 15 million people aged 20 to 79 were eligible for cholesterol-lowering drugs.

Among other changes, the guidelines now recommend an even lower intake of saturated fat, a higher blood level of HDL (”good”) cholesterol and more rigorous testing of fatty substances in the blood.
Circulation January 15, 2002;105

The big issue here is that these potent medications will be over the counter in the near future with a massive PR campaign to encourage people to swallow these potentially dangerous drugs.

The amazing thing about these new recommendations is that they completely ignore the previously published evidence that are quite clear in documenting that the actual cholesterol level itself is not the most important risk factor. It is actually the ratio between the level of total cholesterol and HDL. The ideal HDL/cholesterol ratio should be higher than 25% and generally speaking the higher the better.  The ideal triglyceride/cholesterol ratio should be below 2.0.

If you did not know any better and just listened to the “experts” you would think cholesterol is an evil substance and that most of us would benefit from lowering our cholesterol as low as possible.

Not so. Cholesterol is a vitally important substance that is responsible for building our cell membranes and many of our hormones. If the level drops to low we are actually at increased risk for depression.

There are likely to be some people who benefit from them, but it is probably far less than 5% of the people who currently take them. These are individuals with total cholesterol above 350 who have inherited liver processing problems.  If these individuals take the statin drugs however, they should also take Co-enzyme Q10, which is important for heart health and, like cholesterol, is reduced when one takes these drugs.

Eating More Frequently May Lower Your Cholesterol 

A person’s cholesterol levels may depend not only on what he or she eats, but also how often. Researchers found that middle-aged and older adults who ate frequently throughout the day had lower “bad” cholesterol levels compared with those who tended to down one or two large meals per day. This was despite the fact that the frequent eaters, on average, had a higher calorie and fat intake.

The researchers looked at data on more than 14,600 men and women aged 45 to 75 who were part of a larger cancer study. Participants were asked about their current eating habits and activity levels, and had their cholesterol levels, blood pressure and weight recorded.  The researchers found that participants’ total cholesterol counts declined as their eating frequency increased. Those who ate at least five or six times a day had the lowest total cholesterol, on average, while the highest measurements were found among those who dined only once or twice a day. The same pattern showed up for LDL (”bad”) cholesterol.

They found a decrease of approximately 5% in concentrations of total cholesterol and low density lipoprotein (LDL) cholesterol in men and women who eat six or more times a day compared with those who eat once or twice a day.  Frequent eaters did not, however, have higher levels of “good” HDL cholesterol, which is believed to help protect the heart from disease.

Yet the findings are biologically plausible. Animal research has shown that those given infrequent large meals show metabolism patterns different from animals fed more often — including a higher absorption of sugar in the intestines, higher after-meal peaks of the sugar-regulating hormone insulin, and greater activity in enzymes that synthesize cholesterol.

As for humans it could also be that frequent eaters metabolize what they eat rather differently than infrequent eaters.  Despite the higher calorie and fat intake among frequent eaters in this study, the findings do not give people license to gorge on French fries.

The authors stressed that their data do not provide evidence for advocating frequent snacking on junk food. They advised that people who wish to hold down their cholesterol levels should first and foremost eat more fruits and vegetables and cut their saturated fat intake.
British Medical Journal December 1, 2001;323:1286-1288

Beans and Peas Can Cut Heart Disease Risk 

Bulking up the diet with legumes such as beans and peas can lower the risk of heart disease. Men and women who ate legumes at least four times a week had a 22% lower risk of coronary heart disease over 19 years than those who consumed legumes once weekly.

The most enthusiastic legume eaters also had lower blood pressure and total cholesterol, and were less likely to be diagnosed with high blood pressure and diabetes. Legumes are rich in soluble fiber, which has been shown to help lower total cholesterol and LDL (”bad”) cholesterol levels and improve insulin resistance. Legumes also contain low levels of sodium and high levels of potassium, calcium and magnesium — a combination that is associated with a reduced risk of heart disease.

Folate, a mineral also found in abundance in legumes, is thought to reduce blood levels of homocysteine, a compound that can boost heart disease risk.  The results of their study are based on interviews and medical exams of more than 9,600 Americans who did not have heart disease when the study began. Over an average of 19 years, about 1,800 cases of coronary heart disease were diagnosed.

In other findings, individuals who consumed the most legumes tended to smoke more and consume more calories and saturated fat. They were also less likely to have graduated from high school. Those who ate the most legumes also tended to be younger and male.
Archives of Internal Medicine November 26, 2001;161:2573-2578

Cutting Calories Can Increase Your Lifespan 

Cutting calories has been shown to extend the life span of mammals, and now it seems a strict diet can even buy extra time for an already long-lived mutant mouse.  Scientists say their success in extending the lives of the unusually aged rodents was a surprise — one that gives more weight to the idea that restricting calories can help people lead longer lives.

Illinois researchers describe their experiments with Ames dwarf mice, a type of mouse that lives 50% longer than their normal brethren thanks to the “longevity” gene they carry. These mutant mice are similar in some respects to normal mice whose life spans have been extended by calorie restriction.

To see whether calorie restriction could confer still-longer lives to the mutants, the scientists divided 2-month-old Ames dwarf mice into two groups: one allowed to feast at will, and one on a strict diet. They did the same with normal mice. The investigators found that the dieting dwarf mice lived the longest of the four groups, while normal mice allowed to eat as they pleased had the shortest lives.

This certainly adds to the evidence that calorie restriction has a very impressive ability to prolong life. Experts suspect that the benefit of calorie restriction on life span has evolutionary roots. In times of food shortage, the body’s metabolism adjusts to aid survival. And certain hormonal regulators of metabolism have been shown to help determine the life spans of flies, worms and yeast.
Nature November 22, 2001;414:412

The Doors Of Perception: Why Americans Will Believe Almost Anything http://www.mercola.com/2001/aug/15/perception.htm
The Scientific Definition of Obesity and its Dangers By Dr. Tanner 

Prevalence

* An estimated 97 million adults in the United States, 55% of the population, are overweight or obese (body mass index [BMI] >25)1, 2

* The NHANES study of 1988-1994 indicated that 27% of females and 21% of males are obese (BMI >30)3

* The prevalence of obesity increased from 12% in 1991 to 18% in 1998. Increases were seen in both sexes and all socio-economic classes, with the greatest increase seen in 18- to 29-year-olds and in those who have achieved higher education4

* Obesity rates are underestimated because overweight people tend to underestimate their weight and over-estimate their height5

Etiology

* Obesity is a chronic condition that develops as a result of an interaction between a person’s genetic make-up and their environment. How and why obesity occurs are not well understood; however, social, behavioral, cultural, psychological, metabolic, and genetic factors are involved1

* Among possible hormones involved, leptin, discovered in 1994, has received the most attention. Leptin appears to regulate adipose proliferation and modulate eating behavior.6 A 1999 study showed that subcutaneous therapy with recombinant leptin produced weight loss in both obese and lean subjects7

* Heritability studies indicate that genetic factors may be responsible for up to 70% of the variation in people’s weight6

* Weight gain is dependent on a person’s energy intake being greater than energy expenditure. One pound (0.45 kg) is equal to 3,500 calories. Therefore, a person consuming 500 calories more than he or she expends daily will gain 1 lb a week

* A person’s body weight tends to range within 10% of a set value. Weight alterations in either direction cause changes in energy expenditure that favor a return to the set-point.8 This mechanism helps explain the terrible problem of recidivism following attempted weight loss

Complications

* Relative risk9 (p78) greater than 3,

Type 2 diabetes mellitus, gallbladder disease, hypertension, hyperlipidemia, and sleep apnea

* Relative risk 2 to 3 Coronary artery disease, knee osteoarthritis, and gout

* Relative risk 1 to 2

Breast, endometrial, or colon cancer; low back pain

The relationship between obesity and comorbidities is stronger among individuals younger than 55 years.10 After age 74, there is no longer an association between increased BMI and mortality11.
* Hypertension is the most common obesity-related disease. Hypertension and weight class are strongly associated in persons younger than 55 years (see below for definitions of weight class)12.
* About 80% of people with type 2 diabetes are obese.
* Hypercholesterolemia is prevalent in obese persons, but its incidence does not increase with increasing weight class. The incidence of diabetes, osteoarthritis, and gallbladder disease increases as weight increases.
* The prevalence of cardiovascular disease is significantly elevated for obesity class 1 in males and for all three obesity classes in females.
* Diet and exercise have been shown to be ineffective over the long term. More than 90% of people who attempt to lose weight gain it all back.
* Even in clinical trials that demonstrate substantial weight loss, the lost weight tends to be regained once supervision concludes.
* On the positive side, sustained weight loss has been shown to improve blood pressure and lipid and glucose levels.
* A reasonable goal is to lose 10% of body weight over a 6-month period.
* Patients with BMIs in the range of 27 to 35 should be encouraged to lose 0.5 to 1 lb a week at a daily calorie deficit of 300 to 500.
* Patients with BMIs above 35 should lose 1 to 2 lb a week at a daily calorie deficit of 500 to 1,000.
* A diet that is low in grains and sugar is needed to lose weight.
* A healthy diet contains about 25% fat, 20% protein, and 55% carbohydrates.
* Total caloric intake is determined by calculating basal energy expenditure and activity, then subtracting 500 calories to result in a weight loss of 1 lb a week.
* This usually means a diet of 1,000 to 1,200 kilocalories (kcal) per day for women and 1,200 to 1,500 kcal per day for men.
* Patients should be educated by a registered dietitian to eat a diet individualized to their needs.
* Physical activity is a necessary component of every weight loss plan. Exercise contributes to weight loss and maintenance, may decrease abdominal fat, and increases cardiorespiratory fitness.
* Initial exercise goal: moderate activity for 30 to 45 minutes 3 to 5 days a week
* Long-term exercise goal: at least 30 minutes of moderate to intense exercise per day1
* Behavior therapy: advice for patients
* Eat three meals a day at about the same time each day sitting at a table
* Focus on the meal. Eat slowly. Avoid distractions such as television or magazines
* Cook small amounts; use small plates
* Avoid second helpings. Clean plates directly into the garbage
Abstracted from Western Journal of Medicine January 2002;176:23-28