Cholesterol conspiracies and contortions

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A note to readers: This is the first column in a six-part series about cholesterol, health and the pharmaceutical industry, and how they can affect Salem residents. The series is called Cholesterol conspiracies and contortions.

The author of this column is not a medical professional. Readers should consult a physician before making any decisions about health and medicine.

Preventing heart disease is big business. The chief strategy is cholesterol control. Major tools are lifestyle change and pharmaceuticals.

Smoking, stress, a high-fat diet, lack of exercise and obesity are hallmarks of a sickly lifestyle. Eliminating them improves overall health, lowers cholesterol and reduces the risk of heart disease. When lifestyle changes fail to achieve cholesterol goals, physicians turn their patients to drugs.

Statins are the most widely used cholesterol-lowing drugs. Working mainly in the liver, they inhibit the body s ability to produce cholesterol.

Worldwide, 25 million people spent $27.8 billon on statins in 2006. A year later, sales rose nearly 19 percent to $33 billion. Eighteen million Americans took statins in 2007.

Salem-specific figures are not readily available. However, extrapolations from national treatment data and projections from current treatment recommendations suggest somewhere between 2,500 and 5,500 Salemites are taking statins. Estimates of high cholesterol in the population suggest as many as 8,500 residents could be eligible for therapy. In addition, according to current recommendations, 34,000 residents should be routinely tested.

Based on these estimates, annual costs in Salem are between $4 and $7 million with the potential to exceed $10 million. Costs associated with adverse events and physician visits are not factored into these approximations.

What justifies this? The easy answer, of course, is we must control cholesterol to prevent heart disease, which leads to heart attack and death. If we control cholesterol, we live longer.

Why believe this? We believe it because we believe the lipid theory which describes our traditional understanding of the relationship between LDL cholesterol and heart disease.

It begins with cholesterol, a soft, waxy, fatty-like substance found throughout the body. It is in every cell and the bloodstream. The body needs cholesterol to function properly. However, according to the lipid theory, too much cholesterol in the blood (hypercholesterolemia) can lead to heart disease and stroke.

Cholesterol does not dissolve in blood. It needs something to carry it from point A to point B. The transport vehicles are lipoproteins. They come in two varieties, low and high density.

The correct terminology is low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Common shorthand is LDL cholesterol and HDL cholesterol. In speaking or writing to the general public, medical professionals as well as food and drug manufacturers have taken to calling them bad cholesterol and good cholesterol.

LDL cholesterol is bad because it builds up in the inner wall of arteries. Combining with other substances, it forms plaque, a thick, hard sediment that narrows arteries and makes them less flexible. A person with narrow, rigid arteries has atherosclerosis and is prone to heart attack and stroke.

HDL cholesterol is good because high levels in the blood seem to protect a person from heart attack while low levels seem to increase the risk. Experts say high-density lipoproteins carry cholesterol away from the arteries. Some think they actually remove cholesterol from plaque thereby reversing buildup.

But and this is a big but is the lipid theory reality or simply an unproven hypothesis? Could it be that profit and dogma (not science) underpin an industry generating $33 billion in annual sales?

Recent science and journalistic investigations have ignited concerns and caused many to reexamine the role of cholesterol in cardiovascular disease and the use of cholesterol-lowering pharmaceuticals in preventing heart disease and prolonging life.

The Vytorin trial cracked the dam, but journalists opened the floodgates. Questions and concerns came from quarters as diverse as medical blogs, business magazines, national newspapers and medical journals. In the specific case of the Vytorin trial, even Congress got into the act as committees from both houses launched investigations. (Vytorin is a combination drug used to lower cholesterol. It and the clinical trial designed to demonstrate its effectiveness will be discussed at length in next week s column.)

It is not just the issue of cholesterol. The behavior of pharmaceutical companies, conflicts of interest in government and nongovernmental agencies and the basic trustworthiness of medical science have all come into question.

Over the next several weeks, Thinking about Salem will explore these issues. After reviewing the Vytorin trial, a column entitled The Confidence Game will look at cholesterol and statin use. In three weeks, History of a Dogma will explore how the lipid theory became bedrock science.

A Boatload of Controversy will summarize fallout issues. The final column in the Cholesterol Conspiracies and Contortions series will look at industry-sponsored research and offer thoughts for change.

Robert Moran is a freelance writer living in Salem. His columns appear regularly in the Salem Gazette.

In accordance with the following three steps to do so, not 90 days, you will find that their high-density cholesterol (good cholesterol) will be improved, while triglycerides and low-density cholesterol (bad cholesterol) fell significantly.

The first step: from start to eat

Simple diet changes can reduce 20 percent of the cholesterol. Drink plenty of water, eat more fruits and vegetables can be a lot of soluble fiber intake. Report of the American Dietetic Association pointed out that the intake of dietary fiber, the more the lower cholesterol levels significantly. Oat is to reduce serum total cholesterol best food.

Protection of fish rich in heart of high-quality fat, to eat. Stop eating margarine and hydrogenated vegetable oil, they will not only increase low-density cholesterol, but also beneficial to the human body to reduce the high-density cholesterol.

Reduce the intake of saturated fatty acids, eating an egg a day. At the same time, avoid eating oxidation of cholesterol and trans fatty acids in food, such as the sale of the stores made of food, potato chips, biscuits, coffee and cakes, and other partners.

In addition, every day to eat two medium-size carrots, within 21 days to at least allow you to reduce cholesterol 50 percent.

Step 2: add nutrients

The study, 1.5 grams daily intake of vitamin B3 can make high-density cholesterol increased 33 percent, but this does not apply to patients with liver diseases and diabetes patients. Patients with high cholesterol need in a doctor s guidance, and gradually increase the use of, but also in law of vitamin B3, every three to six months a check liver enzymes and cholesterol levels.

Plant steroids is the natural lipid-lowering star, fruits, vegetables, nuts, seeds, food and soybean products contain plant steroids. Studies have shown that in normal meals each day to add 1-2 grams of plant steroids, can reduce low-density cholesterol. Increase the intake of steroids can reduce low-density cholesterol 1/4-1/2 of the human body to absorb.

Step 3: lifestyle changes

A healthy lifestyle can make your blood flow more smoothly, beating heart more effectively. Started training plan, even if only a simple walk to stop smoking; Shaohe caffeine drinks and wine, because they will increase in triglycerides.

The most important thing is, do not eat breakfast. North America, a nutrition survey showed that domestic institutions, breakfast cereal to eat all the food people the lowest level of cholesterol, high cholesterol even eat breakfast food, their cholesterol levels than those who do not eat breakfast low.

Additional information:

From www.wickedlocal.com:
The concordance of diet with the recommended cholesterol lowering diet was moderate. Patients who used lipid lowering drugs had a lower intake.
This diet is intended for those who have concern about elevated blood cholesterol or triglyceride problems related to increased risk to coronary.
Diabetes In Control is a free weekly diabetes newsletter ezine and web site dedicated to helping medical professionals in diabetes Care better.
Take regular exercise. In addition to changing your diet, regular exercise. improves blood lipid levels and helps you achieve a health.
Current clinical guidelines recommend a lipid lowering diet as the initial treatment for raised total and low density lipoprotein cholesterol.
The most generalizable approach to lipid lowering is lifestyle change. A healthful diet and regular physical activity can improve.
Lipid Lowering by Diet Reduces Matrix Metalloproteinase Activity and Increases Collagen Content of Rabbit Atheroma. A Potential Mechanism.
Viscosity rather than quantity determines lipid lowering effects of dietary fiber in individuals consuming typical North American diet. Vladimir.

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