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.
