Health for life

Its been too long since Ive spoken about cholesterol, too long I tell you. For those of you who dont know, I would sum up my view on cholesterol like this: its the most overhyped risk factor for heart disease there is. All you hear in the media is "Watch your cholesterol!" or "Cheerios lower cholesterol!" or "This food is cholesterol-free, so its good for you!". Bollocks. Bollocks I say.

First of all, the cholesterol in the food you eat barely has any effect on the cholesterol in your blood, if it has any effect at all. And second, lets set the record straight on "high cholesterol"... please for the love of God, quit worrying about it. Your total cholesterol is just about meaningless unless its taken in context with your triglycerides, HDL, and LDL... even better, your LDL particle number. Despite having no real, accurate clinical implications though, "high cholesterol" has taken on this sort-of boogey man role, scaring every health-conscious person into Lipitor land.

Anyway, I came across something today that was just too good not to write about; this stuff needs to be shared. This study was designed to analyze lipid-lowering therapy, but thats not the part I want to talk about here; its the cholesterol levels of the patients that piqued my interest. The researchers examined 65,396 patients hospitalized for heart disease (heart attack or angina) across the United States. Below youll find a screenshot of the baseline blood lipid data, taken within the first 24 hours of admission. You would expect, based on what you think you know, that heart disease patients must have had high cholesterol, right?

Average blood lipid values upon admission among all study participants.

Nope. On average, their cholesterol was 170.1 mg/dl, well below the high limit of 200. If any of these people had visited the doctor for a check-up a week before their hospitalization, the doc would have looked at these numbers and said "Steve, your cholesterol is great! Keep up the great work!" Assuming his name is Steve.

But things werent great. Each of these people experienced an acute coronary event that required hospitalization and very well could have ended their lives. Its irresponsible that were putting so much stock into cholesterol values when they clearly are NOT a good indicator of heart disease risk.

Sometimes it only takes one little piece of data, like this one, to completely change your beliefs on cholesterol and heart disease. I hope this provided the baseball to your brand new home window.

But what does this mean??
Now, theres an excellent chance that many of these people were already taking a cholesterol-lowering drug. Theres no data in the study to show whether this is true, but since so many people are on them, its very likely. So lets say for a moment that they were on statins. Say their normal cholesterol levels are around 220 mg/dl, and the statins bring it down to a more friendly-looking 170. Well, this only destroys the cholesterol and heart disease connection even more doesnt it? First off, it doesnt say much about the efficacy of the drugs. But also, it shows that reducing cholesterol from "high" back into "normal", at least via these mechanisms, is useless.

Okay, let me say it another way... if high cholesterol is the cause of our problems, lowering it should reduce our risk, regardless of the manner by which we do so. If it is not the cause, and it is just an indicator of a problem, then pharmacologically lowering it will NOT reduce our risk. It will, in fact, just make things appear to be fine when they are not.

Its sort of like when we get sick and we get a fever. We may take over-the-counter meds to reduce the fever; it makes us feel better and it takes away one of the symptoms of our illness. But we forget that the fever is an important part of our bodys defense mechanism to fight a bacterial infection... bacteria dont like the heat. We may feel a little better, but we remain just as sick as we were before, and weve now likely prolonged our sickness by messing with our bodys natural defense mechanisms.

The fever is like cholesterol, the symptom. The bacterial infection is the root cause. Got it? Okay its not a perfect analogy, but you get the point.


What is the root cause of heart disease then? If not total cholesterol, what should we focus on? Well thats a big can of worms... there are many factors that go into it. Stay tuned next week for a comprehensive guide on how to prevent heart disease!

Below is another presentation from the American Association for Cancer Researchs annual conference last week. (I posted another one from their conference about diabetes link to colon cancer here.)

Dr. Irwin and her colleagues found that high levels of fasting C-peptide (a marker for insulin*) was associated with a higher incidence of death from breast cancer in women in their 40s whose cancer was at an early stage. That association decreased as women entered their 50s and 60s. The women did not have diabetes.

They analyzed data from 689 women with breast cancer who were enrolled in the Health, Eating, Activity, and Lifestyle (HEAL) Study. The women were followed for up to 9 years, until 2004.

Insulin has been shown in clinical studies to stimulate the growth of breast cancer cells. This epidemiological study supported that association.

When Do Insulin Levels Rise?

Often, before a diagnosis of diabetes, the bodys cells become increasingly resistant to insulin. That sends a signal to the pancreas to secrete more. It isnt until the beta cells of the pancreas lose their ability to respond that insulin levels drop off. By that time, blood sugar levels are high and type 2 diabetes is well established.

The authors of this study recommended that younger women with breast cancer adopt lifestyle changes, such as exercise, that can moderate insulin levels.


* C-peptide is a protein fragment that splits from proinsulin after proinsulin is released from the pancreas. C-peptide levels lect insulin levels.

________ You can find this abstract by visiting the AACR abstract page, selecting "Poster Session B", and paging down to Abstract B99: Fasting C-peptide levels and breast cancer death in women with breast cancer: The Health, Eating, Activity and Lifestyle (HEAL) Study.

Older men who have low levels of vitamin B12 have a higher risk of having fractures. These are the findings of researchers at the Sahlgrenska Academy as a part of an international study of a total of 1000 older men.

Osteoporosis is one of the worlds most widespread diseases, and intensive research is under way worldwide to identify its causes and to be able to prevent fractures.

In an extensive study, researchers at the Sahlgrenska Academy at the University of Gothenburg can now show that low levels of vitamin B12 in the blood increases the risk of fractures in older men.

International research project
This study is a part of an international research project initiated by the National Institutes of Health (NIH) in the US and comprises 11,000 men in total. In their part of the study, the Gothenburg researchers studied 1,000 Swedish men, MrOS Sweden, with an average age of 75, and used various methods to analyze the blood concentrations of the B vitamins B12 and folate, which are found in our food naturally.

Higher fracture risk
The results show that the risk of suffering a fracture six years later was higher among men who had low B12 levels at the beginning of the study than men with normal B12 levels. In the quartile with the lowest B12 content, the risk was elevated by approximately 70 percent compared with the others. The risk increase pertained primarily to fractures in the lumbar region, where the risk increase was up to 120 percent.

"The higher risk also remains when we take other risk factors for fractures into consideration, such as age, smoking, BMI, BMD (bone mineral density), previous fractures, physical activity, the D-vitamin content in the blood and calcium intake," says Catharina Lewerin, researcher at the Sahlgrenska Academy.

Does this mean that older men can prevent fractures by eating more vitamin B12?

"It has not been scientifically established, but such studies are under way, including one large Dutch study where older individuals over the age of 65 are treated with both vitamin B12, folic acid and vitamin D to investigate the occurrence of fractures.

"Right now, there is no reason to eat more vitamin B12, but rather treatment shall only be applied in confirmed cases of deficiencies and in some cases to prevent deficiencies. For anyone who wants to strengthen their bones and prevent fractures, physical activity 30 minutes a day and quitting smoking is good self care," says Catharina Lewerin.

New method

In this study, the researchers used a relatively new method called holotranscobalamin, which measures the amount of vitamin that is taken up in the cells, which is considered to be a more sensitive test for B12 deficiency.

The article was published online in Osteoporosis International.