Nutrition...do we know anything???

[shakeybrainsurgeon]

The present dogma about cholesterol is that there are two kinds: good (HDL) and bad (LDL). The optimum ration is 50/50, with HDL being partially regulated by execise (tribal peoples like the Inuit, who eat mostly animal fat, have high HDL, presumably because of their high level of fitness).

A billion dollar industry has arisen for statin drugs, which lower total cholesterol levels, in the belief that lower cholesterol levels = less heart disease, even if the levels are lowered pharmacologically (as opposed to using diet and exercise). For a few statins, like Lipitor, there is some evidence that this is true, although for others, like Crestor, there is NO evidence that the drug lowers the risk of stroke or heart attack.

But, before we assume that this must be true (drug-induced lower cholesterol is a good thing), consider the outcome of a very recent pharmaceutical trial of a new drug that raises HDL (it was reviewed in Nature, but curiously ignored by the media). This must be good too, right? In fact, the study was halted because it seemed to kill people FASTER... oops! Their HDLs went up, and they got vascular disease faster...either we don't undertsnad HDls at all, or manipulating them therapeutically is harmful in some other way. Either way, it suggests that playing with our lipid levels in unnatural ways can have unpredictable outcomes...

The researchers scratched their heads --- higher HDL should be good! A whole slew of drugs to raise HDL, by a number of companies, has hit a brick wall. As Firesign Theater used to say "everything we know is wrong!"

Take home message: we still don't understand the relative role of fat levels, real or pharmacoloigically controlled, versus genetics, smoking, obesity, hypertension, age and lack of exercise in the genesis of vacular disease. This study shows, once again, that we know little about the role of nutrition in health except in extreme cases (vitamin deficiency, severe hypercholesterolemia, ect). HOWEVER, this hasn't stopped the billion dollar industries like statin drugs, nor has it stopped politicians from legislating our freedoms (no trans fat, no lard, no red meat...).

I say, eat that steak and go run a few miles...it's cheaper than Crestor, believe me.

 

[Wildcard]

Always said, a little of everything. I just hope Im not missing out on bacon and eating oatmeal for no reason.....

 

[Cacia]

50:50? really? that's not what I thought....

HDL/LDL levels have been pretty accurate at predicting your CV future, I thought. I agree that the pharmecueticals raise a lot of questions. Rebound and +/- feedback loops for one thing, make me uneasy. Not sure if that is the proper pharmacological term, but I know you know what I am trying to say.

C-reactive protein is another value that might tell us a lot. The whole inflammatory response some individuals seem to have is mysterious. My brother in law had a major ischemic event and underwent a CABG at 40. His brother thinks maybe it was a vacularitis, as in an acute vs a chronic condition.

 

[shakeybrainsurgeon]

50:50? really? that's not what I thought....

HDL/LDL levels have been pretty accurate at predicting your CV future, I thought. I agree that the pharmecueticals raise a lot of questions. Rebound and +/- feedback loops for one thing, make me uneasy. Not sure if that is the proper pharmacological term, but I know you know what I am trying to say.

C-reactive protein is another value that might tell us a lot. The whole inflammatory response some individuals seem to have is mysterious. My brother in law had a major ischemic event and underwent a CABG at 40. His brother thinks maybe it was a vacularitis, as in an acute vs a chronic condition.

The usual value in labs is the total cholesterol to HDL ratio. The average American is about 4 or 5 to 1, i.e., a total cholesterol of 200 and an HDL of 50. The optimal ratio is 2:1, or 100 total cholesterol/50 HDL, or 50 LDL/50 HDL. This is difficult to achieve, except in the very fit and genetically gifted.

The HDL and CRP are very good predictors, that's true...the issues are 1) how much our diet is really responsible for these values (some, but not as much as we have been lead to believe) and 2) whether artificially changing the numbers with drugs will mimic the clinical outcome of reducing them naturally (again, some effect, but not as much as we think --- and, as shown above, the outcome of drug therapy may be paradoxically bad).

There's no doubt that in people who already have bad coronary disease, or who have pathologically elevated cholesterol levels (say, 500+), statins are a godsend. But I see 90 year old women with normal hearts and a cholesterol of 210 paying for Lipitor...crazy.

As to feedback loops...the body has a cholesterol thermostat (it is, after all, an essential component of cell membranes and a precursor to steroid hormones)...messing with it with drugs can have bad secondary effects.

I think the solution to the cholesterol problem lies first in exercise, second (and a distant second) diet and third, drugs. We do a lot of dietary contortions and take a ton of chemicals to compenstate for the fact that we as Americans don't do squat. We can't even walk around to get our own groceries... supermarkets have become like NASCAR tracks. Not everyone riding those electric carts has a true disability. If so, being non-ambulatory has become epidemic.

 

[Cacia]

oh, thanks for that. I thought you meant HDL and HDL equal.
Yes, the statins will affect millions of people.
Trans fats are a huge villian in the cholesterol picture too, since hydrogenated fats are another manipulation that we really have limited understanding of. I will eat butter but I really avoid trans fats.

Personally, I think getting your HR up even four times a week for 20 minutes would be so managable and painless for most people.

I gave my brother in law the Polar HR monitor for Christmas and I don't think it went over too well. His family members have been dropping like flies. I love mine, JB gave it to me and I use it a lot. We just got the Garmin computers that have cool training programs for cycling and GPS on them. I don't work out that much, but the little I do is made more entertaining with gadgets I guess.

I am really tired of the handicapped parking situation. It's such a joke. And when is the last time you saw a war vet amputee use one? I never have.

 

[shakeybrainsurgeon]

One of our lab techs in my old lab was a war amputee... he told me, I don't know this for a fact, that the handicapped spaces were originally intended to be wider than normal spaces to allow those with walkers or wheelchairs more room to get out of their vehicle. They were not intended just to be closer. Now, he says, they are the usually the same size as other spaces, which defeats the purpose to some degree.

I agree that the handicapped plates are given out indiscriminately these days. Ironically, I suspect most war amputees are motivated and adapted to the degree that they don't need the spaces at all.

As an aside, it's funny to see people spend half an hour looking for a space close to the mall, then spend three hours walking aimlessly about in it. It's like the people who take the elevator at work, then spend two hours on the stairmaster at the gym.

 

[RonDawg]

One of our lab techs in my old lab was a war amputee... he told me, I don't know this for a fact, that the handicapped spaces were originally intended to be wider than normal spaces to allow those with walkers or wheelchairs more room to get out of their vehicle. They were not intended just to be closer. Now, he says, they are the usually the same size as other spaces, which defeats the purpose to some degree.

I can't speak for other states, but in CA handicap spaces are required to be a certain size; simply taking a normal size space, painting the edges blue, and putting the required stick figure person in a wheelchair symbols isn't going to cut it, even if it's in front of the door.

In older parking lots that were designed before the Americans with Disabilities Act, to comply with the law they sometimes take two standard spaces and convert them into one handicap space, or more often they take three standard spaces and make them into two handicapped ones.

Next to the spaces is a blue-painted cross hatch area. THAT is supposed to allow space for a wheelchair-lift equipped vehicle to operate. However, some people think it's OK to park in those cross hatch areas. I let them know otherwise to the tune of $325.

As an aside, it's funny to see people spend half an hour looking for a space close to the mall, then spend three hours walking aimlessly about in it. It's like the people who take the elevator at work, then spend two hours on the stairmaster at the gym.

Sometimes, it's not that simple.

At my department, the building was designed in such a way that its first floor stairwells have the doors on the OUTSIDE of the building. Meaning, if you want to go from the first floor up to the second floor, you have to first step outside to do so. The other floors have the stairwell entrances within the building, but not the first floor. Even if you are willing to go outside, you can't as the first floor stairwell entrances are locked and very few have the key. The stairwells were primarily designed as emergency exits, so getting back into the building that way was not a design priority :shakehead

Also, my knees have no problem with me going UP stairs, it's going DOWN them that they don't like. I much prefer low-impact exercise such as a stairmaster or an elliptical trainer.

Other than that, I do try to get as much exercise as possible during my daily routine, such as parking a good distance away from any building. It also reduces the likelihood of my car getting those annoying door dings too.

 

[DeputyDan]

I think the solution to the cholesterol problem lies first in exercise, second (and a distant second) diet and third, drugs. We do a lot of dietary contortions and take a ton of chemicals to compenstate for the fact that we as Americans don't do squat. We can't even walk around to get our own groceries... supermarkets have become like NASCAR tracks. Not everyone riding those electric carts has a true disability. If so, being non-ambulatory has become epidemic.

I agree. And would add to cut the trans-fats as much as possible.

 

[Warthaug]

While the cholesterol thing is complex, how statins protect against heart disease is commonly misunderstood. Although statins do reduce cholesterol levels, it looks like that's not their major mechanism of action. As you correctly point out, its not clear what effect lowering cholesterol (or raising "good" cholesterol) has. But one thing is for certain - although statins may not prevent heart attacks, they do reduce the severity of heart attacks & strokes...

Statins funciton by inhibiting the synthesis of cholesterol, and do not directly impact on the HDL/LDL balance (HDL and LDL are basically two different ways cholesterol gets packaged, but the cholesterol in those "packages" is the same). Generally speaking, when you lower cholesterol you will see a shift towards more "good" and less "bad" cholesterol, but that is a consequence of HDL/LDL regulation, rather then a direct effect of the statin.

Any way's, as it turns out cholesterol is pretty important for our bodies - you need it to make some hormones, and more importantly, it is a component of cell walls. For years it was though that the beneficial effects of statins was to reduce cholesterol levels, but as it turns out, it looks like the major effect of statins is to inhibit the inflammatory "arm" of the immune system, possibly through altering the structure of the walls of those cells.

Heart attacks and strokes fit into a more general class of injury called "ischemia/reprofusion injuries". Basically, these injuries occur when blood flow to a tissue is stopped (say, by a clot during a heart attack, the step called "ischemia"), and then the blood flow is restored (called "reprofusion"). As odd as it may seem, the major source of damage during these injuries is not the ischemia, but rather is the reprofusion stage - when blood starts flowing again. For reasons we don't yet understand, during the reprofusion stage our immune system invades and damages/kills the oxygen-starved tissues. Statins inhibit this influx of immune cells, and as a consequence, appear to reduce the damage during a ischemia/reprofusion injury.

There was a clinical trial looking at this a while ago - basically, doctors gave suspected heart attack patients massive doses of statins when they were admitted. It was found that this greatly reduced the morbidity and mortality in these patients. I believe that patients who were on long-term statins also saw a similar benefit.

In terms of the media not picking up the report - I'm not surprised. Amazing advances are made in science every month, and yet only a small handful ever come to the attention of the public. Not to mention the media has a tendency to get things mixed up. Last year our lab was featured in the local news about some advances we made in understanding the mechanisms of liver injury during hepatitis. Before we started the interview, we handed the reporter a piece of paper which outlines, in point form, our research. First point read:

1) Hepatitis has 2 major causes:
a) Autoimmune hepatitis, where our immune system attacks our liver, &
b) Viral hepatitis, caused by infection of the liver by viruses such as the hep A, B, and C viruses.

Somehow this translated into "There are three major types of hepatitis; Hepatitis A which is autoimmune, and Hepatitis B&C, which are caused by viruses".

AND, of the two or so hours of video they shot of our lab, they chose to use the worst video - did they use the video of the cool laser-shooting microscope - no. Did they use the video of the funky machine pumping blood, while scanning the blood with lasers - no. Did they use any video even remotely interesting (even one without lasers) - no. What did they use - a video of me nearly knocking over a rack of test tubes :light:

In terms of preventing heart disease and stroke, no bottle of pills beats a balanced diet combined with 30+ minutes of cardio exercise 3+ times a week.

Bryan

 

[Cacia]

HEY! Great post---thanks for taking the time to write it up. I really enjoy getting your perspective. Often the people that know the most don't take the time to lay it out. The reprofusion aspect I had not heard...Collateral circulation physiology is intriguing too.

The inflammation component is very interesting. I notice more and more people are tracking thier C-reactive protein.

elliptical trainer.

From what I hear, those things will do your knees in. I am no expert, but ask some sports medicine gurus about it. Not a natural movement for the knee, even though it is low impact.

30+ minutes of cardio exercise 3+ times a week.

so easy, people just need to realize how little makes a difference.