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Misleading Research Reports
Cholesterol Revisited
Why Not Statins?
Naturally Healthy Cholesterol
Ask Dr. J: Prostatitis
References
In The Health News
Diet and Disease
Recipe of the Month: Mixed Bean Cumin Soup
Dear Friends,
Two recent reports have renewed my concern about how the
public is fed supposedly scientific health information that
does not present the full picture, especially when it comes
to natural therapies. It is difficult enough for professionals
to tease out the truth in medical articles, perhaps more difficult
for health journalists, but it must be totally confusing for
the layperson.
An article in the New England Journal of Medicine purportedly
showed that the herb echinacea was not useful for treatment
or prevention of viral infections. Another article, this time
in the British Medical Journal, suggested that multivitamin-mineral
supplements were useless for the elderly in terms of preventing
infections, use of health services, or quality of life. Both
of these articles and the headlines that they generated were
misleading. The authors of the multivitamin study at least
admitted that the supplements might be valuable in other ways
not evaluated in their study, and they cited some studies
on higher doses.
The doses of most multivitamin preparations (usually a one-per-day
type multi) are very low, and usually not in therapeutic ranges.
For example, the multi in this research contained only 2666
IU of vitamin A, 60 mg vitamin C, 5 µg vitamin D3, 10
mg of synthetic vitamin E, 1.4 mg of B1 (thiamine), 1.6 mg
of B2 (riboflavin), 18 mg of B3 (nicotinamide), 6 mg of B5
(pantothenic acid), 2 mg of B6 (pyridoxine), 1 mcg of vitamin
B12, 200 mcg of folic acid, 15 mg zinc, and a few other nutrients.
While possibly helpful for deficiency diseases, such low doses
are not adequate to see the full benefits of potent vitamins
on the health of elderly people, but these headlines might
deter them from taking valuable supplements.
In the echinacea article, the researchers used several preparations
that are not commonly found in health food stores, and they
used only the root of one species of herb, E. angustifolia,
rather than the whole plant or root and rhizome mixtures of
species. In treating these young healthy students, they used
just 900 mg, a low dose compared to the 3000 mg recommendation
of the World Health Organization and Health Canada. and they
did not use standardized extracts. Their preparations were
notably low in some of the active compounds, specifically
echinacoside, which was absent from all three extracts. I
typically recommend 500-1000 mg of a standardized extract
containing both E. purpurea and E. angustifolia, and this
is much more potent than powdered root extract.
These articles just emphasize the confusion in the media
regarding the benefits of supplements, and how to interpret
studies. Antagonists to dietary supplements have jumped on
these two reports to steer people away from valuable products
that might otherwise help them avoid illnesses and unnecessary
drugs. It is worth the effort to find the truth behind the
headlines.
Cholesterol is a vital physiological compound that is manufactured
in the body for a variety of purposes. It is the foundation
molecule for building steroid hormones, it is part of cell
membranes and nerve fiber insulation, a component of bile
to help digestion, and a precursor to vitamin D (produced
by the action of sunlight on skin cholesterol). Your body
makes all that you need, but it is also a component of some
foods. The amount that you make is usually higher than the
amount in food, but both may contribute to elevated levels
in the blood.
Cholesterol is attached to protein in the blood stream in
a variety of forms called lipoproteins. The so-called “good
cholesterol” is the “HDL” or high density
lipoprotein (smaller particles that pack down more densely),
and the “bad cholesterol” or “LDL”
is the low density form, larger particles that do not pack
so densely. It is quite clear that high levels of total serum
cholesterol (TC) and low levels of HDL cholesterol increase
the risk for arterial disease, or hardening of the arteries,
including heart disease, cerebral vascular disease (strokes
and dementia), and leg blood vessel disease (pain on exercise).
Numerous studies over many years show that high TC increases
the risk of death and disease, and low levels of HDL is a
risk factor in itself. In 1986, evaluation of 361,662 men
between 35 and 57 years old showed that those with TC levels
above 181 mg/dl had a progressively increasing risk of coronary
mortality as cholesterol levels increased. Those in the top
15 percent of cholesterol levels (above 253 mg/dl) had four
times the risk of those with the lowest levels. Higher levels
of TC were also associated with the greatest overall mortality
(including non-cardiac causes).
Cholesterol is not bad, but too much LDL in the blood is
undesirable. On the other hand, HDL-cholesterol has many positive
effects, and is associated with lower risk. HDL helps to clear
cholesterol from the blood, carrying it to the liver for excretion.
It also acts as an antioxidant, in most instances is anti-inflammatory,
and inhibits the stickiness of platelets, all of which reduce
the risk of vascular disease.
A low level of HDL, independent of TC levels, is a risk factor
in itself. In a study of 8000 men older than 42, 1300 of whom
had cholesterol lower than 200 mg/dl, researchers found that
low HDL (below 40 mg/dl) was more important than total cholesterol,
especially for men with diabetes. HDL below 40 mg/dl with
TC below 200 was associated with 36 percent higher heart mortality
compared to higher HDL with the same TC.
Because of all its benefits, you want to keep your HDL well
above 40 mg/dl, preferably more than one-third of the total
cholesterol. It can be difficult to raise HDL levels, but
it is possible through lifestyle changes and dietary supplements.
With all of the vascular disease risks associated with high
cholesterol, you might think that the extensive prescribing
of statin drugs (Lipitor, Mevacor, Zocor, Crestor, and others)
would be justified, but this is not the full picture. Statins
work by blocking the action of an enzyme called HMG CoA reductase,
which is essential for the production of cholesterol. This
same enzyme is essential for the production of coenzyme Q10
(coQ10), an antioxidant that is essential for mitochondrial
energy production.
CoQ10 is critical for healthy muscle, among its other benefits.
It is particularly important for heart muscle function, because
the heart muscle is always active and requires a lot coQ10
to meet its energy needs. CoQ10 also appears to protect the
brain from age-related deterioration, inluding Alzheimer’s
and Parkinson’s diseases. It is likely that blocking
of coQ10 production can lead to an increased risk of heart
failure.
In addition to blocking coQ10 production, the statins have
a number of side effects, including nausea, diarrhea, constipation,
liver disorders, muscle aches and tenderness, fatigue, and
the more serious muscle disease called “rhabdomyolysis,”
with destruction of muscle tissue. This side effect can be
serious, and lead to kidney failure. One statin drug was pulled
from the market because of this side effect.
While drug companies deny it, numerous reports associate
statins with a variety of neurological disorders. These include
simple memory loss to serious amnesia, confusion, disorientation,
and difficulty producing common words or familiar names. Side
effects are much more common than with many other drugs.
Doctors have been convinced by drug companies that even low
levels of TC are not low enough, so they give statins too
frequently and at too high a dose, especially considering
that healthy alternatives are available, much less expensive,
and free of side effects. While statins might have other benefits
(protection of arterial endothelium and reduction of inflammation),
these come at too great a cost—physiological and financial.
I have often written about the benefits of diet and exercise,
both of which can be as effective at maintaining a healthy
cholesterol as any statin drugs. In one study, a diet rich
in soy protein and high in fiber, including almonds, oats,
barley, eggplant, and okra, lowered cholesterol (and CRP)
as much as statins. Decreasing meat and saturated fat also
favorably affects risk factors.
Supplements that help cholesterol include 1000 mg of niacin
(which can raise HDL levels by 30 percent and is one of the
most effective heart protectors), 20 mg of policosanol (which
lowers cholesterol, protects endothelium, is anti-inflammatory,
and can increase HDL by 15 percent). I have previously reported
on cholesterol lowering with red yeast rice, garlic, and guggulipid.
These lifestyle changes make statins unnecessary.
Q. Is it wise to take antibiotics for possible
prostatitis if no infection is found in the urine?
—KL, via Email
Acute infections of the prostate with bacteria can produce
symptoms of burning and pain on urination, pelvic discomfort,
urinary frequency and urgency, urethral discharge, and even
fever, chills and general aching and fatigue. This may start
as a bladder infection that spreads to the prostate. Usually
it is safest to treat this kind of infection with antibiotics,
as an infection that travels up to the kidneys can be quite
dangerous.
Chronic bacterial infections often lead to similar but less
intense symptoms, and it is common for no bacteria to show
up in the urine. These infections may be caused by chlamydia
or mycoplasma, which also respond to antibiotics.
It is also possible to have the same symptoms without any
bacteria evident, called non-bacterial prostatitis (also referred
to as prostadynia, which simply means pain in the prostate).
Non-bacterial prostatitis is more common than bacterial prostatitis.
Depending on what the problem is, it may well be appropriate
to take antibiotics, but they are not effective against viruses.
Non-drug treatments can enhance medications or replace them
if antibiotics are not indicated.
Benign prostatic hyperplasia (BPH) can lead to some of these
symptoms by blocking ducts and obstructing the flow of prostatic
secretions. In addition to antibiotics (if warranted), sitz
baths, regular ejaculation, and a number of some dietary supplements
can help.
Saw palmetto (320-480 mg, standardized) and pygeum (100-200
mg, standardized) relieve prostatitis and BPH symptoms. Quercetin
(1000 mg), an antioxidant and anti-inflammatory flavonoid
also helps. I recommend zinc, a component of prostatic secretions
(30-50 mg), high doses of vitamin C (4000-10,000 mg) for its
antibiotic and anti-inflammatory effects, and deodorized garlic
(1000-2000 mg) as a natural antibiotic.
Avenell A, et al., Effect of multivitamin
and multimineral supplements on morbidity from infections
in older people... BMJ. 2005 Aug 6;331(7512):324-9.
Turner RB, et al., An evaluation of Echinacea
angustifolia in experimental rhinovirus infections. N Engl
J Med. 2005 Jul 28;353(4):341-8.
American Botanical Council, Herbal Science
Group Says Dosage Too Low in New Echinacea Trial, www.herbalgram.org;
July 27, 2005.
Martin MJ, et al., Serum cholesterol, blood
pressure, and mortality... [in]...361,662 men. Lancet. 1986
Oct 25;2(8513):933-6.
Navab M, et al., The role of high-density
lipoprotein in inflammation. Trends Cardiovasc Med. 2005 May;15(4):158-161.
Fujimoto Y, et al., High density lipoprotein
inhibits platelet 12-lipoxygenase activity. Res Commun Mol
Pathol Pharmacol. 1994 Sep;85(3):355-8.
Goldbourt U, et al., Isolated low HDL cholesterol
as a risk factor for coronary heart disease mortality. A 21-year
follow-up of 8000 men. Arterioscler Thromb Vasc Biol. 1997
Jan;17(1):107-13.
Richter V, Rassoul F, Ageing, cardiovascular
risk profile and vegetarian nutrition. Asia Pac J Clin Nutr.
2004;13(Suppl):S107.
Jenkins DJ, et al., Direct comparison of...cholesterol-lowering
foods with a statin... Am J Clin Nutr. 2005 Feb;81(2):380-7.
Jenkins DJ, et al., Direct comparison of
diet...vs statin on C-reactive protein. Eur J Clin Nutr. 2005
May 18; [Epub ahead of print]
Mahn K, et al., Dietary soy isoflavone...antioxidant...endothelial
function...blood pressure ... FASEB J. 2005 Aug 17; [Epub...]
Castano G, et al., Effects of policosanol
on... hypertension and type II hypercholesterolaemia. Drugs
R D. 2002;3(3):159-72.
Menendez R, et al., Effects of policosanol
treatment on...oxidative modification in vitro. Br J Clin
Pharmacol. 2000 Sep;50(3):255-62.
Carlson LA, Nicotinic acid: the broad-spectrum
lipid drug. A 50th anniversary review. J Intern Med. 2005
Aug;258(2):94-114.
Garg R, et al., Effective and safe modification
of multiple atherosclerotic risk factors in... Am Heart J.
2000 Nov;140(5):792-803.
Obesity in the United States has jumped again to 25 percent
of the population (15 percent of kids), and higher in 10 states.
About 2/3 of Americans are overweight or obese, leading to
a health crisis that is becoming more dangerous than smoking.
Trust for America’s Health documents this trend and
makes recommendations (F as in Fat... http://://healthyamericans.org/reports).
One reason: fast food (read junk) restaurants are clustered
around schools—school neighborhoods have 3-4 times as
many as other areas. (Austin SB, et al., Clustering of fast-food
restaurants around schools...Am J Public Health, 2005 September;
95(9):1575-1581.)
Anti-inflammatory drugs (NSAIDS) and low-dose aspirin can
cause serious gastrointestinal bleeding and death (Lanas A,
et al., A nationwide study of mortality...associated with
[NSAID] use. Am J Gastroenterol. 2005 Aug;100(8):1685-93.).
Mortality in this study was 15 per 100,000 users, with one-third
of all deaths attributed to low-dose aspirin use. This is
commonly recommended for heart disease prevention, but safer
alternatives exist.
Quitting smoking and improving diets are credited with the
reduction in heart deaths seen in England and Wales from 1981
to 2000. While smoking played the largest role, a significant
part was from reduction of saturated fat and salt and an increase
of fruits, fiber, and unsaturated oils. (Unal B, et al., Modelling
the decline in coronary heart disease deaths in England and
Wales, 1981-2000: comparing contributions from primary prevention
and secondary prevention. BMJ. 2005 Aug 17; [Epub ahead of
print]) Primary prevention (preventing disease from occurring
in the first place) was four times more effective than secondary
prevention (stopping recurrence and complications in people
who already have vascular disease).
After soaking a mixture of black beans and white navy beans
for 4 hours and discarding the soaking water, pressure cook
them in fresh water (12-15 minutes). Sauté chopped
onions, garlic, and diced carrots, in olive oil with lots
of cumin, a pinch of cayenne or minced fresh hot pepper (to
taste), and a small amount of thyme. When the onions are glassy,
add the cooked beans, fresh water, diced potatoes, and a small
amount of sea salt or tamari soy sauce. When the potatoes
are soft, add large amounts of fresh chopped greens (I use
fresh chard as it grows so well in my garden and it is very
tender, but you can also use spinach or other greens). When
the greens are just wilted, add a bunch of chopped fresh cilantro
and turn off the heat. Mix this all together and add lemon
juice or cider vinegar to taste. This is a stew or soup, depending
on how much water you use. You may want to puree it in a food
processor. Serve this by itself or with any whole grain bread
or brown rice.
drjanson@drjanson.com
Practice phone: 603-878-2256
180 Massachusetts Ave., Suite 303
Arlington, MA 02474
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