Hey everybody.
First off, if this is a redundant thread forgive me, and then kindly direct me to the preexisting discussion!
When I was in my late teens my dad had his first major heart attack and then bypass. My mom has had hers now,too. When I reached my early 20s I realized that if I didn't take proactive steps then to change my lifestyle and get as fit as possible, I'd likely be having my chest split open too when I got older. It was quite a reality check but I like to think that it saved my life.
I rediscovered a love for cycling, made smarter nutritional choices, and lost 70 pounds. My blood pressure is under control without any need of meds. In fact, the only thing I do need is an occasional ibuprofen or Tylenol. I am in better physical shape now at 36 than I was in high school.
But you can't fight your genes.
I saw a quote somewhere that says we are "50% genetics and 50% cheesburger"
Well, Igot the results back from my last blood work up and my numbers are all very low--super low.
Trouble is, my HDL-or "good" cholesterol, is 34 and my doc wants it at 36 or better. The first thing he said was "exercise" and then he remembered who he was talking to and just kinda left it at that. I play competitive volleyball three nights a week and cycle 10-25 miles DAILY regardless of season. I've been reading nutritional value labels on the back of food boxes for YEARS and make my choices accordingly. I already gobble down the olive oil, the omegas, the nuts, avoid the hydrogenated stuff etc etc etc. LOVE dark chocolate. don't smoke. Do enjoy a margarita a couple times a week but now they are saying that might even be a good thing too although I wonder......
So I am at a loss....the need to get your HDLs up is just as critical as dropping your LDLs but I don't know of anything else I'm not already doing. I know there are statins and things available to help lower your LDL but not much yet in the way of raising the HDL.
Any tips or ideas?
ModoVincere
02-07-07, 01:15 PM
I think the ratios of LDL/TC and Tri/HDL are considered better predictors than just the raw numbers. Also I would imagine that the difference between 34 and 36 is within the range of lab error and not of any importance. In fact, if you had your Cholesterol retested today, I would wager that the numbers would all be different than they were on the other test.
That said, exercise is considered the best way to raise HDL. I know you said you do a lot of exercise, but I don't see any weight lifting. You might want to try adding in a little weightlifting to your current regimen along with a little added protein to the diet to help support the weightlifting routine.
aikigreg
02-07-07, 02:32 PM
You need to:
1. Consume LOTS of fish oil. LOTS.
2. Eliminate processed carbs such as bread and cereal.
3. Oatmeal is your new friend. It's now going to replace that bread and cereal you just lost.
4. Get a half to 1 cup veggies at each meal
5. Eat 5-6 small meals a day.
6. Send me money for curing you.
SSP
02-07-07, 02:40 PM
Niacin...it's cheap, and one of the few products that will raise HDL.
I have a very similar family history, and have been using niacin for 10 years now to control my cholesterol. Using it, I've managed to raise my HDL into the 60-80+ range (it used to be below 40).
There's a book available on Amazon (http://www.amazon.com/Cholesterol-Control-Without-Diet-Solution/dp/0966256875/sr=1-1/qid=1170883512/ref=pd_bbs_sr_1/102-9852949-2303350?ie=UTF8&s=books) that is all about using niacin for cholesterol control. The author's kind of "out there", but the basic advice is good.
I buy cheap, non-time release niacin at CostCo and take 2500 mg/day (1000 in the morning, and 2500 in the evening...less than 7 cents per day!). But, don't try taking this much to start, or you'll really regret it!
Niacin can cause a "flushing" skin reaction (you'll get red, and kind of itchy). Your body builds up a tolerance to it over time, however, allowing you to take larger doses without any effect. But, you have to take it religiously, because you can lose your tolerance quickly (within a few days). The best way to start is by taking a single 500 mg (or less) in the evening just before bed - that way the flush will happen after you're asleep (hopefully).
It may take a few months before you can build up to higher levels, and you might not want to go as high as I have (I'm at the upper end).
You'll also need to consult with your doc, and get liver function tests after you've been on it for a month or two to make sure you're not having any liver problems.
Enthalpic
02-07-07, 03:11 PM
Ask your doctor about garlic, it can help, but is not completely risk free so ask first. If you give it a try, ensure you tell future health care providers you are on it just like you would any other medication.
Lowers LDL, raises HDL in those with high total values.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17105707&query_hl=1&itool=pubmed_docsum
Niacin is the way to go. I don't take any since my HDL is 87 but the research is solid. You might also
consider resveratrol. I have brought my HDL from 43 about 9 years ago to 87 this September and the only major change in my lifestyle/supp intake was resveratrol, alpha lipoic acid and acetyl L-carnitine. I believe it was the resveratrol that did the most. Resveratrol also makes you go faster (more on that later). Here is some good info from the New York Times a few weeks ago:
THE CONSUMER; An Old Cholesterol Remedy Is New Again
By MICHAEL MASON
Perhaps you heard it? The wail last month from the labs of heart researchers and the offices of Wall Street analysts?
Pfizer Inc., the pharmaceutical giant, halted late-stage trials of a cholesterol drug called torcetrapib after investigators discovered that it increased heart problems -- and death rates -- in the test population.
Torcetrapib wasn't just another scientific misfire; the drug was to have been a blockbuster heralding the transformation of cardiovascular care. Statin drugs like simvastatin (sold as Zocor) and atorvastatin (Lipitor) lower blood levels of LDL, the so-called bad cholesterol, thereby slowing the buildup of plaque in the arteries.
But torcetrapib worked primarily by increasing HDL, or good cholesterol. Among other functions, HDL carries dangerous forms of cholesterol from artery walls to the liver for excretion. The process, called reverse cholesterol transport, is thought to be crucial to preventing clogged arteries.
Many scientists still believe that a statin combined with a drug that raises HDL would mark a significant advance in the treatment of heart disease. But for patients now at high risk of heart attack or stroke, the news is better than it sounds. An effective HDL booster already exists.
It is niacin, the ordinary B vitamin.
In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent. Its principal side effect is an irritating flush caused by the vitamin's dilation of blood vessels.
Despite its effectiveness, niacin has been the ugly duckling of heart medications, an old remedy that few scientists cared to examine. But that seems likely to change.
''There's a great unfilled need for something that raises HDL,'' said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic and president of the American College of Cardiology. ''Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective.''
In 1975, long before statins, a landmark study of 8,341 men who had suffered heart attacks found that niacin was the only treatment among five tested that prevented second heart attacks. Compared with men on placebos, those on niacin had a 26 percent reduction in heart attacks and a 27 percent reduction in strokes. Fifteen years later, the mortality rate among the men on niacin was 11 percent lower than among those who had received placebos.
''Here you have a drug that was about as effective as the early statins, and it just never caught on,'' said Dr. B. Greg Brown, professor of medicine at the University of Washington in Seattle. ''It's a mystery to me. But if you're a drug company, I guess you can't make money on a vitamin.''
By and large, research was focused on lowering LDL, and the statins proved to be remarkably effective. The drugs can slow the progress of cardiovascular disease, reducing the risk of heart attack or other adverse outcomes by 25 percent to 35 percent.
But recent studies suggest that the addition of an HDL booster like niacin may afford still greater protection.
After analyzing data from more than 83,000 heart patients who participated in 23 different clinical trials, researchers at the University of Washington calculated this month that a regimen that increased HDL by 30 percent and lowered LDL by 40 percent in the average patient would reduce the risk of heart attack or stroke by 70 percent. That is far more than can be achieved by reducing LDL alone.
Other small studies have produced similarly encouraging results, but some experts caution that the data on increased HDL and heart disease are preliminary.
Researchers at 72 sites in the United States and Canada are recruiting 3,300 heart patients for a study, led by Dr. Brown and financed by the National Institutes of Health, comparing those who take niacin and a statin with those who take only a statin. This large head-on comparison should answer many questions about the benefits of combination therapy.
Many cardiologists see no reason to wait for the results. But niacin can be a bitter pill; in rare instances, the vitamin can cause liver damage and can impair the body's use of glucose. High doses should be taken only under a doctor's supervision.
A more frequent side effect is flushing. It becomes less pronounced with time, and often it can be avoided by taking the pills before bed with a bit of food. Doctors also recommend starting with small doses and working up to larger ones.
Extended-release formulations of the vitamin, taken once daily, are now available by prescription, and in many patients they produce fewer side effects. And a new Merck drug to counteract niacin-induced flushing is being tested in Britain. If it works, the company plans to bundle the drug with its own extended-release niacin and with Zocor, its popular statin.
Until then, consider this: If it means preventing a heart attack, maybe it is better to put up with flushing than to wait for the next blockbuster.
''If you can just get patients to take niacin, HDL goes up substantially,'' said Dr. Nissen of the Cleveland Clinic. ''Most of the evidence suggests they'll get a benefit from that.''
ericgu
02-07-07, 09:14 PM
You need to:
1. Consume LOTS of fish oil. LOTS.
2. Eliminate processed carbs such as bread and cereal.
3. Oatmeal is your new friend. It's now going to replace that bread and cereal you just lost.
4. Get a half to 1 cup veggies at each meal
5. Eat 5-6 small meals a day.
6. Send me money for curing you.
I also noticed that the poster didn't mention what kind of carbs he was eating. #2-#4 are important (as you note).
psycholist
02-08-07, 11:00 AM
THe last three or four times I had the lipid panel done, my HDL has hovered right about the mid-low 30 mark-not much change despite my best efforts. My LDL has slowly decreased. My doc says HE would be happy to see a 36 but I would like to think I could go higher. Funny how for years and years people simply focused on the overall total and now we finally realize that the different lipids and their ratio to each other are critical .
No way will I cut out my carbs. Processed stuff, yes, already doing that as much as possible , but I could go vegan before I could drop my beloved breads and cereals. Again, labels have a lot of trickery going on--"stone ground" doesn't mean squat in relation to the type of grains used.
About the fish oil...I tried eating cold-water fish three times a week and it just got monotonous and I have dropped off a bit there. Do the caplets have any side effects...I mean, do you take one in the morning and walk around smelling like a hot day at the fishing pier? My mom has a big jar of the gelcaps and it reminds me of cod liver oil when you open the lid....but someone was telling me recently that there are newer more refined types available. I think the same holds true for the garlic, right? The main drawback was horrible breath.
The niacin sounds promising, tho I wish there was a way to get a higher level of these nutrients through the food I eat. I don't put much faith in many supplements simply because a lot of them are still unregulated and scientifically untested. There are also a lot on that shelf that are totally reliable and safe to use but the trouble is knowing the difference.
Sounds like I should ask my doc about getting on a niacin supplement, and maybe try out the fish oil caps.
Al.canoe
02-08-07, 07:11 PM
Hey everybody.
But you can't fight your genes.
I saw a quote somewhere that says we are "50% genetics and 50% cheesburger"
Well, Igot the results back from my last blood work up and my numbers are all very low--super low.
Trouble is, my HDL-or "good" cholesterol, is 34 and my doc wants it at 36 or better. The first thing he said was "exercise" and then he remembered who he was talking to and just kinda left it at that. I play competitive volleyball three nights a week and cycle 10-25 miles DAILY regardless of season. I've been reading nutritional value labels on the back of food boxes for YEARS and make my choices accordingly. I already gobble down the olive oil, the omegas, the nuts, avoid the hydrogenated stuff etc etc etc. LOVE dark chocolate. don't smoke. Do enjoy a margarita a couple times a week but now they are saying that might even be a good thing too although I wonder......
So I am at a loss....the need to get your HDLs up is just as critical as dropping your LDLs but I don't know of anything else I'm not already doing. I know there are statins and things available to help lower your LDL but not much yet in the way of raising the HDL.
Any tips or ideas?
Suggest you get a copy of the China Study by Campbell (published in 2005). It's about $11.00 from Amazon. It's not risking much money even if you don't care for the book. You have made a tremendous amount of progress and the book will help you continue it by becoming well informed on the latest libratory experiments, human trails and population studies on the role of nutrition on heart (and cancer) problems. The scientific data is presented so you can decide how to proceed with foods suitable for your needs.
About the only way to increase HDL for a male is strenuous exercise. The longer and more strenuous the more your HDL will rise. You seem to be exercising a lot already. You could have a high level of testosterone which tends to suppress HDL. Mine went really high (above the 45 to 50 I keep mine) when I had to take a testosterone blocking drug as part of a prostate cancer treatment. The total Cholesterol is more important than HDL/LDL . However true that statement might be, stick with your doctor's advice.
By the way, a major topic of the China Study is the control of cholesterol. You'll see curves showing Cholesterol levels vs. heart attack rates.
You can drive your total Cholesterol way down by dramatically reducing your intake of meat, fish, eggs and milk products and eat more like those people in the third world that don't get heart problems or at least they don't until they start eating like we do.
Genetics plays a minor role compared to nutrition and exercise. With proper nutrition and exercise, the genetics impact is actually minimized.
Al
Al.canoe
02-08-07, 07:26 PM
No way will I cut out my carbs. Processed stuff, yes, already doing that as much as possible , but I could go vegan before I could drop my beloved breads and cereals. Again, labels have a lot of trickery going on--"stone ground" doesn't mean squat in relation to the type of grains used.
About the fish oil...I tried eating cold-water fish three times a week and it just got monotonous and I have dropped off a bit there. Do the caplets have any side effects...I mean, do you take one in the morning and walk around smelling like a hot day at the fishing pier? Sounds like I should ask my doc about getting on a niacin supplement, and maybe try out the fish oil caps.
There is a lot of confusion concerning carbs. What they really should be say is to reduce the refined carbs like white flour and the sugars, especially the High fructose corn syrup.
Vegans eat bread, but it's whole grain. I'm not Vegan (but I only eat a little of non-plant food), and eat a lot of bread. But I won't touch a bread unless the first ingredient listed isn't whole wheat or whole oats, or whole some other grain.
I also eat a lot of whole grain cereal. I have to buy it in the organic section to avoid high fructose corn syrup and the partially hydrogenated fats. I mix several types together for taste and buy the lower sugar varieties and avoid the high fiber ones. You don't need fiber loading if you eat fruits, vegetables and whole grains.
Eating fish is more folklore than fact. Even the sacred Omega-3 thing is getting confusing due to recent studies showing no benefit from them. I do like anchovies and sardines once in a while. They are low on the food chain so they don't accumulate the murcury.
Al
umd
02-08-07, 09:57 PM
I've never really understood the cholesterol numbers. The last time I had my blood tested, my HDL was 90 and my LDL was 109, for a chol/hdlc ratio of 2.4. The references ranges were >= 40 for HDL, < 130 for LDL, and < 5.0 for the ratio, so it looks like I'm good despite a high TOTAL cholesterol of 214. The triglycerides were 73...
Al.canoe
02-09-07, 05:44 AM
I've never really understood the cholesterol numbers. The last time I had my blood tested, my HDL was 90 and my LDL was 109, for a chol/hdlc ratio of 2.4. The references ranges were >= 40 for HDL, < 130 for LDL, and < 5.0 for the ratio, so it looks like I'm good despite a high TOTAL cholesterol of 214. The triglycerides were 73...
With a 214 total Cholesterol, you need to be on a Statin. Provachol, one of the first and the most tested, is the safest and is as effective as those hyped on the media.
Cholesterol comes from two sources: what the body makes and what you eat. What the body makes is more than sufficient. All animal products (including fish, fowl and milk products) have major amounts of Cholesterol. Plant products have none. By severally reducing the intake of animal products you can make big reductions in Cholesterol. My son in-law dropped his by nearly 40 points in just two months just last year.
If you want the scientific basis for this, get the China Study by Campbell ($11.00 at Amazon). The book is not a self-help book, it just presents the scientific results of lab tests, human trials and population studies (which all agree) that indicate why the rich western world get an order of magnitude more heart attacks and cancers than the rural developing world; at least until those folks migrate to the US or Europe.
By the way, the rate of heart attacks in this country are as high as they ever were. What has dropped and is reported in the media is the death rate from heart attacks. The medical system is better at treating them, but we have made zero progress in preventing them.
I decided 40 years ago when I developed high blood pressure to not have a heart attack in the first place and to do it with out drugs. So far so good.
Al
aikigreg
02-09-07, 06:35 AM
No way will I cut out my carbs. Processed stuff, yes, already doing that as much as possible , but I could go vegan before I could drop my beloved breads and cereals. Again, labels have a lot of trickery going on--"stone ground" doesn't mean squat in relation to the type of grains used.
About the fish oil...I tried eating cold-water fish three times a week and it just got monotonous and I have dropped off a bit there. Do the caplets have any side effects...I mean, do you take one in the morning and walk around smelling like a hot day at the fishing pier? My mom has a big jar of the gelcaps and it reminds me of cod liver oil when you open the lid....but someone was telling me recently that there are newer more refined types available. I think the same holds true for the garlic, right? The main drawback was horrible breath.
.
Well, until you're really and truly ready to make some dietary changes, don't expect much to change in your health.
Fish oil caps are fine, but you will get fishy tasting burps. I prefer Carlson's Fish oil with Lemon Flavoring. It's straight oil - not caps. The lemon extract makes it very flavorful. Fish oil should never smell fishy - that means it's substandard. I take the fish oil and make salad dressing with it, put it in protein shakes, or just spoon it down. It's quite tasty.
umd
02-09-07, 07:09 AM
With a 214 total Cholesterol, you need to be on a Statin. Provachol, one of the first and the most tested, is the safest and is as effective as those hyped on the media.
See, that's what I don't understand; my doctor was unconcerned since my triglycerides and LDL were fairly low and my total was only high because my HDL was through the roof. I also don't have any other risk factors except being male...
!!Comatoa$ted
02-09-07, 07:38 AM
See, that's what I don't understand; my doctor was unconcerned since my triglycerides and LDL were fairly low and my total was only high because my HDL was through the roof. I also don't have any other risk factors except being male...
Your Dr. probably knows that since your HDL is high there is no need to put you on drugs. As well, the ratio is more telling than the actual numbers. OF course, if you are really concerned you should ask doc for an explanation.
According to Fishbach (2004) "Another method for assessing CAD/CHF risk is by calculation the LDL/HDL ratio"
They go on to say:
A low risk is a ratio of 1, and an average risk is a ratio of 3.55.
Yours is 1.21. Maybe this is what your Doc looked at and this is why he feels it is not a big deal.
Fishbach (2004) goes on to say that an HDL of >75 indicates no risk of CHD and this is also associated with longevity.
If you think about it, if the only factor for determining CAD risk was total cholesterol why would there be a need to look at both HDL and LDL?
Fishbach, F. (2004) A Manual of Labratory and Diagnostic Tests. (7th ed.) Philadelphia: Lippincot, Williams, and Wilkins.
Al.canoe
02-09-07, 07:56 AM
See, that's what I don't understand; my doctor was unconcerned since my triglycerides and LDL were fairly low and my total was only high because my HDL was through the roof. I also don't have any other risk factors except being male...
Yup, I understand the problem. But the evidence is that your cholesterol is way too high. The average Cholesterol among those populations that are relatively immune to heart attacks is in the 120's. In controlled human trials, folks with badly clogged arteries have had them unblock when their Cholesterols were reduced to that level. When those folks in the 120's adopt the US/Euro diet, their Cholesterols shoot up and they get heart attacks at about the same rate as we do.
I learned 40 years ago at age 26 that doctors are not trained in prevention, but only in repair. My doctor back then wrote me a prescription for my high blood pressure. I said, if I take a drug now, what are you gong to do for me when I'm 40 and it's worse? He said not to worry about it.
I tore up the prescription and put into his coat pocket. I later got a new doctor that had worked with Kenneth Cooper who later became the aerobics Guru. Went home and did some reading and started Jogging. Cured my high blood pressure in two months. That drug he wanted to give me was determined 10 years later to be a carcinogen. I know as a friend of mine was on it.
Another friend of mine on high blood pressure medication started cycling a lot. In three months he started getting faint. They had to take him off his blood pressure medication. His blood pressure was too low. This was about 6-months ago. Not much has changed in 40 years. Doctors are not trained in physical fitness, nutrition (they get their literature in medical school from the dairy and meat industries) and lifestyle issues.
Get the China Study, you'll completely understand as I finally did. You'll also understand why what you read in the media is so confusing and contradictory.
Al
Turboem1
02-09-07, 08:21 AM
You need to:
2. Eliminate processed carbs such as bread and cereal.
3. Oatmeal is your new friend. It's now going to replace that bread and cereal you just lost.
I am confused on this. Is oatmeal not a processed carb? Also for the people saying they eat bread but it is whole wheat or whole grain or whole oat. What is the difference and why is one good and one not? I have pretty much cut bread out of my diet (and i dont really miss it to much) but a slice or 2 every now and then would be nice.
aikigreg
02-09-07, 08:39 AM
I am confused on this. Is oatmeal not a processed carb? Also for the people saying they eat bread but it is whole wheat or whole grain or whole oat. What is the difference and why is one good and one not? I have pretty much cut bread out of my diet (and i dont really miss it to much) but a slice or 2 every now and then would be nice.
Depends on what kind you buy. Steel cut oats are the whole oat. other oats like Quaker Quick cook have some of the outer hull removed but are mostly intact. They are then rolled flat and cooked a bit so that they be quickly cooked by you. This isn't much processing overall. The sugary packet stuff OTOH, is even more processed and has chemicals added.
White bread on the other hand has all the healthy stuff removed, then the grain is ground to dust and bleached. Then coloring and vitamins are artificially added. Adding brown coloring makes it "wheat bread." Sometimes a small amount of "whole grain" is added to get an aproved label, but it's still processed to hell. You want the label to read "Only 100% whole wheat or whole grain" if you're going to eat it.
White bread has the same insulin effect as table sugar. Others vary on that scale based on the amount of whole grain.
Label laws come from the FDA and USDA. I no longer believe these agencies are exactly concerned for my health.
Nearly 100% of my carbs now come from whole food - veggies and fruits. I have had no digestion issues or severe allergy reactions since then, and I haven't been sick once. I used to get 4 bouts of bronchitis a year and other things besides. I'm a big believer now.
psycholist
02-09-07, 10:48 AM
I need to add one detail to my personal profile....I'm female, and I understand that gender plays a big role in how your lipid mechanism works. Even down to the symptoms we have when experiencing a cardiac attack.
"Vegans eat bread, but it's whole grain. I'm not Vegan (but I only eat a little of non-plant food), and eat a lot of bread. But I won't touch a bread unless the first ingredient listed isn't whole wheat or whole oats, or whole some other grain."
sorry-what I meant here is that it would be easier for me to totally give up all meat (which would be tough enough) than to forgo the breads. I don't go nuts in the bread section but it's just a much-loved food group.
I got to thinking about the actual numbers yesterday and decided to call the doc and write them down, along with their preferred ranges. When we initially went over them in the office we really just focused on the HDL and I realized I didn't have the info down for my own personal consideration.
Here's what I got:
HDL =46 (I swear I heard a different number in his office but this is the official number on the sheet)
and the range is 35-65. I am guessing the reason he wants my HDLs up, up UP is because he knows both of my parents and sees any potential for improvement there as life insurance....
LDL=91 <100 optimal
Triglyc=42 32-200 acceptable
total chol=145 range <200
I am 5'11 and my weight hovers about the 166 lb mark. I have areas that I'd love to see tone up, like anybody else, but weight isn't an issue here. It's like the rail thin guy walking around only he's quietly harboring a total cholesterol of 325. Outward appearances can be deceptive.
My doc said he has issues with the niacin debate given the potential for liver damage...but the fish oil notion was ok if I wanted to give it a try.
What is the best dosing rate......I will have to reread some of the posts because I think we already covered that.
ModoVincere
02-09-07, 11:16 AM
Unless you have another risk factor which you have not shared with us, I see nothing in those numbers to be worried about. Would it be nice to have higher HDL? sure. Is it necessary? I would not say that it is.
I would resuggest that you consider some weight lifting and adding protein to your diet. Cholesterol is carried through body by lipo-proteins. You most likely have no shortage of lipids in your body or in your diet, but based on the description you gave of your diet I would suggest more protein.
SSP
02-09-07, 11:28 AM
My doc said he has issues with the niacin debate given the potential for liver damage.
FWIW, I've been taking niacin for 10 years, with my doc's knowledge and support. It's made a big difference in my lipid profile (especially, by boosting the HDL - one of the few substances that does that).
I get yearly blood work done, that includes a liver function test...but this precaution is recommended for anyone taking statins too (or, any drug that works on the liver).
As for family history...my dad died at age 47 :( . I'm currently 54, and my goal is to double his lifespan, to bring up the family average. :D
!!Comatoa$ted
02-09-07, 12:04 PM
Sounds like I should ask my doc about getting on a niacin supplement, and maybe try out the fish oil caps.
I was just reading something interesting about fish oil and niacin, in particular the role of omega 3 and 6 in combination with niacin.
Omega 3 reduces swelling in the inflammatory response, and Omega 6 enhances swelling. Initially they both compete for the same enzyme Delta-5-desaturase, but then the pathways diverge from that point on. In the inflammation reduction pathway that omega 3 oils follow, and in combination with zinc, niacin and vit. C, the pathway eventually produces leukotrienes and prostaglandin types that will reduce inflammation.
When omega 6 fats are metabolised their metabolites will eventually produce leukotrienes and prostaglandin types that enhance inflammation, and in some cases will also reduce inflammation.
If the diet is high in omega 3 they will out compete omega 6 for the D5d, and there will be less enzyme for the inflammation pathway. In effect, this will prevent cells from sticking to arteries, increase nitric oxide production, which causes vasoconstriction that lowers blood pressure, stabilise plaques, as well as other responses that lead to more compliant arteries thus halting or lessening atherosclerosis.
It appears that there are a lot of things that can be done, like eating a diet that is varied in foods that are minimally processed. Someone here has said before, that when you do groceries you should shop the perimeter.
velopismo
02-09-07, 12:04 PM
With a 214 total Cholesterol, you need to be on a Statin. Provachol, one of the first and the most tested, is the safest and is as effective as those hyped on the media.
I don't think so. Your risk of CHD is very low. My Total cholesterol is 221 but with my HDL at 87 and low trig at 65 my risk of CHD is very low. Another test you can get is a LDL Phenotype test. If you have a type A phenotype as I do (LDL particle diameter >268 Angstoms) your risk of CHD is even lower. Large LDL particle size means it won't penetrate the blood vessel walls. From Wikipedia:
There has also been noted a correspondence between higher triglyceride levels and higher levels of smaller, denser LDL particles and alternately lower triglyceride levels and higher levels of the larger, less dense LDL
http://en.wikipedia.org/wiki/Low_density_lipoprotein
My guess is you have type A LDL and you have nothing to worry about. High HDL levels are very desirable and correlate nicely with extended lifespans.
"It has been recognized for many years that high HDL is associated
with lower risk of heart disease, and the National Cholesterol
Education Program has recommended that an HDL level of less than *35
mg/dl should be regarded as a risk factor. In people lucky enough to
have a very high HDL (85 or more) the risk of heart disease remains
less than half the average level even when the LDL is quite high
(220)."
"In the United States, men's average HDL is about 45 and women's is
55. HDL under 40 is an especially bad sign, while anything over 60 is
considered good. Studies suggest that each single point of increase in
HDL is matched by a 2 percent to 3 percent reduction in heart
disease."
http://answers.google.com/answers/threadview?id=388222
Al.canoe
02-09-07, 12:09 PM
I need to add one detail to my personal profile....I'm female, and I understand that gender plays a big role in how your lipid mechanism works. Even down to the symptoms we have when experiencing a cardiac attack.
it would be easier for me to totally give up all meat (which would be tough enough) than to forgo the breads. I don't go nuts in the bread section but it's just a much-loved food group.
HDL =46 (I swear I heard a different number in his office but this is the official number on the sheet)
and the range is 35-65. I am guessing the reason he wants my HDLs up, up UP is because he knows both of my parents and sees any potential for improvement there as life insurance....
LDL=91 <100 optimal
Triglyc=42 32-200 acceptable
total chol=145 range <200
I am 5'11 and my weight hovers about the 166 lb mark. I have areas that I'd love to see tone up, like anybody else, but weight isn't an issue here. It's like the rail thin guy walking around only he's quietly harboring a total cholesterol of 325. Outward appearances can be deceptive.
My doc said he has issues with the niacin debate given the potential for liver damage...but the fish oil notion was ok if I wanted to give it a try.
What is the best dosing rate......I will have to reread some of the posts because I think we already covered that.
You maybe somewhat overweight unless you have a large muscle mass. Everything else looks outstanding. It appears that the overweight thing's impact on health is not well understood. Some research says it's really bad, other indicates not so bad.
One good thing about the China Study is it gives you curves so you can assess risk. So if you don't want to go "cold turkey" or "cold ham" on meat, you can choose how much you are willing to eat and see what that does to the risk of a heart attack or cancer. Of course these are population averages, so it's not your personal, individual risk.
Even the USDA's 2005 nutrition guidline which replaced the so-called food pyrimid reccomends 8 or 9 servings of fruits and vegitables a day and meats in 3 oz portions, not the huge quantities ( Conehead "mass quantities") that folks eat today. Try tapering off. I did so for a few decades before I went to nearly zero.
I personnally wouldn't do Niacin. It's dealing with the symptoms and not the cause and I'm very carefull in what non-natural stuff I injest. There are very few supplements that are tested for negative consequences for near-term much less for long-term consequences.
By the way, I ask for copies of all lab tests and keep them in my records.
Al
ModoVincere
02-09-07, 12:33 PM
I was just reading something interesting about fish oil and niacin, in particular the role of omega 3 and 6 in combination with niacin.
Omega 3 reduces swelling in the inflammatory response, and Omega 6 enhances swelling. Initially they both compete for the same enzyme Delta-5-desaturase, but then the pathways diverge from that point on. In the inflammation reduction pathway that omega 3 oils follow, and in combination with zinc, niacin and vit. C, the pathway eventually produces leukotrienes and prostaglandin types that will reduce inflammation.
When omega 6 fats are metabolised their metabolites will eventually produce leukotrienes and prostaglandin types that enhance inflammation, and in some cases will also reduce inflammation.
If the diet is high in omega 3 they will out compete omega 6 for the D5d, and there will be less enzyme for the inflammation pathway. In effect, this will prevent cells from sticking to arteries, increase nitric oxide production, which causes vasoconstriction that lowers blood pressure, stabilise plaques, as well as other responses that lead to more compliant arteries thus halting or lessening atherosclerosis.
It appears that there are a lot of things that can be done, like eating a diet that is varied in foods that are minimally processed. Someone here has said before, that when you do groceries you should shop the perimeter.
I see someone has been reading up on eicosanoid production.
A quick summation is this: Arachidonic acid and EPA compete for the D5D pathway. Arachdonic acid can be found in substantial quantities in red meats and egg yolks. EPA can be found in substantial quantities in cold water fish such as Salmon. In addition, Arachadonic acid can be created in the body from Omega 6 oils (vegetable oils). Arachadonic acid produces pro-inflamatory eicosanoids while EPA produces eicosanoids that are anti inflammatory in some cases, but in most cases are simply far less biologiacally active than their Arachadonic acid counterparts.
!!Comatoa$ted
02-09-07, 01:30 PM
I see someone has been reading up on eicosanoid production.
A quick summation is this: Arachidonic acid and EPA compete for the D5D pathway. Arachdonic acid can be found in substantial quantities in red meats and egg yolks. EPA can be found in substantial quantities in cold water fish such as Salmon. In addition, Arachadonic acid can be created in the body from Omega 6 oils (vegetable oils). Arachadonic acid produces pro-inflamatory eicosanoids while EPA produces eicosanoids that are anti inflammatory in some cases, but in most cases are simply far less biologiacally active than their Arachadonic acid counterparts.
Actually I was reading about innate defences and the role of inflammation and infection as a general defence mechanism. I wish I were able to display the chart
What you have said is what I have read, but you explained it much better than I could. Can I bring you to the exam on Monday?
I was also trying to simplify how the omega FA's affect atherosclerosis in combination with the niacin treatment that was mentioned earlier. Some had mentioned fish oils as a way to promote a good lipid profile, while others mentioned niacin as a good way to do it.
Then I just happen to be reading about how the interaction of niacin and omega 3's, more specifically ALA's being converted to stearidonic acid, then with the help of D5d, niacin, vit. C and zinc can promote anti-inflammation properties. These wonderful chemicals can be found in many different foods in their natural state, and combined with exercise can promote good health.
Drugs may work great, but there is more than one way.
psycholist
02-09-07, 03:32 PM
As for family history...my dad died at age 47 . I'm currently 54, and my goal is to double his lifespan, to bring up the family average.
That's exactly what I mean. Dad has one living brother. The other 6 died before they reached their mid-50s of cardiac disease. Dad was diagnosed with cardiomyopathy over 10 years ago and has been limping along with a defibrilator and heavy meds ever since. I can only hope that I got a super whopping big dose of mom's mother's genes because those people are longevity freaks. Every one in their 80s...grandma is 84 and until this past month still put in a 40 hour workweek.
When somebody warns me I'll get killed by a passing car while riding I just nod and tell them that the odds are much higher that my genes will kill me if I played it safe and stayed home in the recliner.
You maybe somewhat overweight unless you have a large muscle mass. Everything else looks outstanding. It appears that the overweight thing's impact on health is not well understood. Some research says it's really bad, other indicates not so bad.
I was in the ER some time back for my very first experience with a kidney stone. The doc on call was giving my basic symptoms and stats to another physician and I overheard him estimate my weight to be about 135-140. Had I not been ready to chew my own fingers off from the pain, I would have liked to corrected him just to see the disbelief on his face. But I get that a lot.
I got my skeletal frame from my dad...my shoulders are nearly as wide as most men's and I have long fingers and wear a men's 9 court shoe. I am very developed in the leg, especially the quads, and it took a little time to adjust to the notion of "losing inches and gaining weight" when I first rediscovered cycling. I look tall and lean but the weight is there in muscle mass. We get it beat into our heads early on that the scales are the ultimate litmus test, when in reality that number doesn't reveal all that much information about a person's actual fitness.
In the United States, men's average HDL is about 45 and women's is
55. HDL under 40 is an especially bad sign, while anything over 60 is
considered good. Studies suggest that each single point of increase in
HDL is matched by a 2 percent to 3 percent reduction in heart
disease."
Then I am guessing a sane and attainable goal to set would be what...bring my HDL up from 46 to 55?
The higher the better but there could also be genetic limitations....
more questions. sigh.
Al.canoe
02-09-07, 04:04 PM
I was in the ER some time back for my very first experience with a kidney stone. The doc on call was giving my basic symptoms and stats to another physician and I overheard him estimate my weight to be about 135-140. Had I not been ready to chew my own fingers off from the pain, I would have liked to corrected him just to see the disbelief on his face. But I get that a lot.
I got my skeletal frame from my dad...my shoulders are nearly as wide as most men's and I have long fingers and wear a men's 9 court shoe. I am very developed in the leg, especially the quads, and it took a little time to adjust to the notion of "losing inches and gaining weight" when I first rediscovered cycling. I look tall and lean but the weight is there in muscle mass. We get it beat into our heads early on that the scales are the ultimate litmus test, when in reality that number doesn't reveal all that much information about a person's actual fitness.
Then I am guessing a sane and attainable goal to set would be what...bring my HDL up from 46 to 55?
The higher the better but there could also be genetic limitations....
more questions. sigh.
This HDL/LDL stuff, like BMI, is just the present infatuation with trying to reduce things to some equation. It will pass as we get a better understanding of the physiology. Even, if it the LDL/HDL infatuation is relevant to heart attacks, the population from which the data was derived was a population of poorly nourished couch potatoes. That's because that's the vast majority of American population. There are very few studies that deal with the physically fit.
And don't forget, with all this HDL/LDL focus, the heart attack rate is as high as it ever was. So much for progress.
Don't be too focused on a few numbers. A change from 46 to 55 is probably trivial. Besides, with your total Cholesterol is so low, the HDL/LDL thing is probably irrelevant for you.
By the way, the reason I thought you might be overweight to some degree is because I didn't read your post carefully enough.
Al
SSP
02-09-07, 04:11 PM
This HDL/LDL stuff, like BMI, is just the present infatuation with trying to reduce things to some equation. It will pass as we get a better understanding of the physiology. Even, if it the LDL/HDL infatuation is relevant to heart attacks, the population from which the data was derived was a population of poorly nourished couch potatoes. That's because that's the vast majority of American population. There are very few studies that deal with the physically fit.
And don't forget, with all this HDL/LDL focus, the heart attack rate is as high as it ever was. So much for progress.
Don't be too focused on a few numbers. A change from 46 to 55 is probably trivial. Besides, with your total Cholesterol is so low, the HDL/LDL thing is probably irrelevant for you.
Are you a doctor, or do you just play one on TV? :rolleyes:
With the OP's significant family history of cardiovascular disease, I would strongly urge her to pay attention to real doctors and real science, rather than some anonymous internet poster.
Even if the science changes over time, with her family history she needs to be aggressively proactive, based on the best current understanding of the science involved.
psycholist
02-09-07, 04:20 PM
Yeah, I was going to mention the BMI debate as well. You nailed it---the need for some handy all-encompassing formula.
I laugh when I come across one of those old height-weight ratio charts like the ones we had in every health class--and every Dr's office for that matter. Those figures were arrived at by some skewed formula as well, which was probably considered sound medicine in its day. I think I was supposed to weigh 130 or something according to that chart. Funny thing is, using the BMI formula and plugging in those values,, I'd be like a 18 or 16 and then lose my job on the Italian catwalk circuit. Wah.
psycholist
02-09-07, 04:25 PM
I only wish there were a way to go back somehow and see what the numbers were like for the rest of my dad's family...compare patterns.
Al.canoe
02-09-07, 06:21 PM
Are you a doctor, or do you just play one on TV? :rolleyes:
With the OP's significant family history of cardiovascular disease, I would strongly urge her to pay attention to real doctors and real science, rather than some anonymous internet poster.
Even if the science changes over time, with her family history she needs to be aggressively proactive, based on the best current understanding of the science involved.
I see, she should pay attention to you because your not anonymous right. Did you read my previous post where I said to pay attention to the doctor? Are you the post troll who decides what folks should say here?
As far as science is concerned, I am an expert there. I have a Bachelors in Engineering and an MS in Engineering Science. I have worked for 35 years in both Engineering and Science doing R & D. I am well versed in the scientific method and can spot a phony or unsubstantiated claim and poorly done research.
Believe me, the doctors are not up on the science, and if they are, they have to pick and choose because of so much poor research and the conflict of interests of many researchers. You are on your own whether you realize it or not.
A doctor should be considered as an advisor only. That's why they recommend getting second opinion. Why would they (like my insurance company) do that if there was anything like a consensus? Why are we the sickest country concerning heart disease, diabetes (type 2) and cancer, yet we spend more per capita than any other country? Why is medical treatment the third leading cause of death in the US?
My rule for forty years has been to not trust the medical profession, but to rely on myself. It has served me well.
Al
Al.canoe
02-09-07, 06:44 PM
Yeah, I was going to mention the BMI debate as well. You nailed it---the need for some handy all-encompassing formula.
I laugh when I come across one of those old height-weight ratio charts like the ones we had in every health class--and every Dr's office for that matter. Those figures were arrived at by some skewed formula as well, which was probably considered sound medicine in its day. I think I was supposed to weigh 130 or something according to that chart. Funny thing is, using the BMI formula and plugging in those values,, I'd be like a 18 or 16 and then lose my job on the Italian catwalk circuit. Wah.
I have read that BMI was developed for population studies and never intended to be applied to individuals. I and I'm sure many others, wondered for years why we scored so poorly on BMI. Then after years of BMI hype, they come out and say that you can't apply it too people who weight train. At the time I was lifting 60,000 pounds a week to keep in shape for wilderness canoe tripping in Canada (I had to carry about 110 pounds on the portages) I had a lot of muscle mass, far above our couch potatoe population so I didn't score well.
I remember those old H/W tables. I never fit those either. I also remember when they said that if you got below a certain weight for a given height you had a higher death rate. That "story" lasted for years. Then it turned out that they forgot to correlate for smoking. Smokers back then at least, tended to be thinner than the general population. Once they did the analysis correctly, thinner was always better as far as death rate.
One needs to be very skeptical of medical and nutrition research results, especially after it's interpreted and hyped in the media. One has to also be skeptical of a doctors advice and question, question, question and study as much as you can.
Al
SSP
02-09-07, 07:08 PM
I have read that BMI was developed for population studies and never intended to be applied to individuals. I and I'm sure many others, wondered for years why we scored so poorly on BMI.
Perhaps you're a statistical outlier, but the vast majority of people characterized by BMI as "overweight" (BMI>25), or "obese" (BMI>30), are, in fact, "overly fat".
Average BMI's have been increasing in this country for decades, and it's not because we're a nation of hunky weight lifters. :rolleyes:
AnthonyG
02-09-07, 07:13 PM
I've never really understood the cholesterol numbers. The last time I had my blood tested, my HDL was 90 and my LDL was 109, for a chol/hdlc ratio of 2.4. The references ranges were >= 40 for HDL, < 130 for LDL, and < 5.0 for the ratio, so it looks like I'm good despite a high TOTAL cholesterol of 214. The triglycerides were 73...
This thread NEEDS a reality check.
A total cholesterol level of 214 is LOW! Any lower and I would be worried that its TOO low.
There is NO SCIENTIFIC evidence whatsoever that high cholesterol levels are harmful and 214 is by NO means high anyway. This time around your doctor is making more sense that some of the advice here.
Advising you that you NEED to go on statins for a cholesterol level of 214 is just incompetence of the highest order.
Regards, Anthony
Al.canoe
02-09-07, 07:27 PM
Perhaps you're a statistical outlier, but the vast majority of people characterized by BMI as "overweight" (BMI>25), or "obese" (BMI>30), are, in fact, "overly fat".
Average BMI's have been increasing in this country for decades, and it's not because we're a nation of hunky weight lifters. :rolleyes:
I agree with you.
Al
Al.canoe
02-09-07, 07:36 PM
This thread NEEDS a reality check.
A total cholesterol level of 214 is LOW! Any lower and I would be worried that its TOO low.
There is NO SCIENTIFIC evidence whatsoever that high cholesterol levels are harmful and 214 is by NO means high anyway. This time around your doctor is making more sense that some of the advice here.
Advising you that you NEED to go on statins for a cholesterol level of 214 is just incompetence of the highest order.
Regards, Anthony
Read the China Study. You will have reems of scientific evidence. Of course, I expect you to say that Campbell and the numerous researchers whose works are covered in the book are examples of "incompetance of the highest order". Easy for you to say I'm sure.
By the way, a few years ago my doctor with my concurrance put me on Pravachol (a statin) at a Cholesterol level that varied between 200 and 220. That has been seconded by my new doctor (the first one left town) and a Nurologist.
High order incompetance is rampant.
I xpect that since I now have given up most animal products, I'll probably get off of it soon.
Al
AnthonyG
02-09-07, 08:09 PM
Read the China Study. You will have reems of scientific evidence. Of course, I expect you to say that Campbell and the numerous researchers whose works are covered in the book are examples of "incompetance of the highest order". Easy for you to say I'm sure.
By the way, a few years ago my doctor with my concurrance put me on Pravachol (a statin) at a Cholesterol level that varied between 200 and 220. That has been seconded by my new doctor (the first one left town) and a Nurologist.
High order incompetance is rampant.
I xpect that since I now have given up most animal products, I'll probably get off of it soon.
Here's one of the best critiques of the cholesterol myth I've read, http://www.thincs.org/Malcolm.choltheory.htm
One of his realy strong points is this. If high levels of blood cholesterol were bad and was the CAUSAL factor for CHD then why don't people with high blood cholesterol actualy have MORE CHD. Why aren't their blood vessels just falling apart?
The thing is that their blood vessels aren't just falling apart and the plauqes are rather distinct on otherwise strong blood vessels. The real evidence is that something caused a local injury to the vessel and in the course of trying to heal itself a plaque has formed which leads to CHD. The point is that high cholesterol wasn't the cause of that plauqe, something else was.
EDIT: OK and I shouldn't have just gone off at you but claiming that someone with a total cholesterol of only 214 NEEDED to go on statins was just pushing my buttons. Leave nonsense like that to someone who is liscensed to make such nonsense claims.
Here's one of the best critiques of the cholesterol myth I've read, http://www.thincs.org/Malcolm.choltheory.htm
One of his realy strong points is this. If high levels of blood cholesterol were bad and was the CAUSAL factor for CHD then why don't people with high blood cholesterol actualy have MORE CHD. Why aren't their blood vessels just falling apart?
The thing is that their blood vessels aren't just falling apart and the plauqes are rather distinct on otherwise strong blood vessels. The real evidence is that something caused a local injury to the vessel and in the course of trying to heal itself a plaque has formed which leads to CHD. The point is that high cholesterol wasn't the cause of that plauqe, something else was.
EDIT: OK and I shouldn't have just gone off at you but claiming that someone with a total cholesterol of only 214 NEEDED to go on statins was just pushing my buttons. Leave nonsense like that to someone who is liscensed to make such nonsense claims.
Regards, Anthony
Are you telling me to get off my statin because my doctor put me on it at a Cholesterol range off 200 to 220 and with the concurrence of two other doctors? You are doing what you accuse me of doing. Pretty arrogant aren't you?
I can say what I please, especially since there is a large body of science on which I base it and I have provided a reference and where it can be obtained. Some of you folks can get pretty hostile when you are faced with ideas that challenge your preconceptions. Words like nonsense are just damn arrogant and indicate a lack of civility.
Amazing, there are critics of the China study. I've read the book and many others on the subject over the past 40 years and the China study is about the only credible one out there. I have read all the negatives on the China study I could find and they are definitely NOT credible; at least not yet. Matter of fact, some are so off base, one has to wonder if they actually read the book or like you, heard about it and are hostile (threatened?) towards new ideas.
Al
!!Comatoa$ted
02-10-07, 06:33 AM
Hey Al.
If doctors and the medical establishment are wrong and know nothing about science how come you listen to them when they say you need to lower your cholesterol levels, but when they say something else that goes against what you think you know they are automatically wrong.
You claim that you are well versed in science as well, but then you say that it is amazing that anyone could even question the China study. Would not criticism lend credence to the China study? Or is criticism and more than one way of trying to see things, a bad thing.
How about feeling threatened by new ideas as you say. You seem to get quite defensive when someone says something that is contrary to your way of thinking, and then all you can say is read the book by so and so. It seems this book has contributed to blunting you thought processes. Indeed if you were so well versed in medicine you would not need the China study, or the doctors to tell you how to be healthy you should know it on your own. After all you are an engineer and should know more about health than anyone else, ohh yeah you read a book as well.
Al.canoe
02-10-07, 07:01 AM
Hey Al.
If doctors and the medical establishment are wrong and know nothing about science how come you listen to them when they say you need to lower your cholesterol levels, but when they say something else that goes against what you think you know they are automatically wrong.
You claim that you are well versed in science as well, but then you say that it is amazing that anyone could even question the China study. Would not criticism lend credence to the China study? Or is criticism and more than one way of trying to see things, a bad thing.
How about feeling threatened by new ideas as you say. You seem to get quite defensive when someone says something that is contrary to your way of thinking, and then all you can say is read the book by so and so. It seems this book has contributed to blunting you thought processes. Indeed if you were so well versed in medicine you would not need the China study, or the doctors to tell you how to be healthy you should know it on your own. After all you are an engineer and should know more about health than anyone else, ohh yeah you read a book as well.
Sounds like the Global warming "debate". The medical nutrition community are not any more in agreement than the global weather scientists. It's just politically incorrect to disagree with what is the convention of the times.
Read the China study. Then critique it if you can. I'll debate the data, but not the political correctness of the group of scientists that provided the data through research that spans about three decades.
As I've stared before, you are on your own concerning health issues. So if you want to go with what you perceive as the establishment, that's fine as long as it works for you. But given that the heart attack rate is as high as it ever was, you better be well informed.
Al
AnthonyG
02-10-07, 07:43 AM
Are you telling me to get off my statin because my doctor put me on it at a Cholesterol range off 200 to 220 and with the concurrence of two other doctors? You are doing what you accuse me of doing. Pretty arrogant aren't you?
I can say what I please, especially since there is a large body of science on which I base it and I have provided a reference and where it can be obtained. Some of you folks can get pretty hostile when you are faced with ideas that challenge your preconceptions. Words like nonsense are just damn arrogant and indicate a lack of civility.
Amazing, there are critics of the China study. I've read the book and many others on the subject over the past 40 years and the China study is about the only credible one out there. I have read all the negatives on the China study I could find and they are definitely NOT credible; at least not yet. Matter of fact, some are so off base, one has to wonder if they actually read the book or like you, heard about it and are hostile (threatened?) towards new ideas.
Al
See some of the references I posted. One important criticism of how the China Study has been used is that the supposed link between consumption of animal foods and cancer/disease is really rather weak. It could be mistaken for statistical noise yet it was jumped on. There were MUCH stronger links to come from the China Study, namely tobacco. There are many other criticisms of the China Study that I have linked to.
See some of my other links regarding cholesterol. One of the things that really gets my goat on the subject of cholesterol is the little issue of bracket creep. 250 used to be considered a healthy cholesterol level. Then 220 used to be a good level and funny thing is that in Australia it STILL IS. No doctor in Australia is going to prescribe statins for anyone with a cholesterol level of 220 or less. The idea of doing this is ludicrous.
So why have the recommended levels come down? Why is Australia's level and most of the rest of the world to higher than that for the USA? Where's the science to support the change?
The information just isn't there. The whole show is being run by well meaning health bureaucrats who believe what they are doing is the right thing but they just can't wait for the scientific evidence to come in or they believe that many people would die. Their intentions are good but what if the lipid hypothesis was wrong. How many people are being harmed by well meaning advice? When the evidence starts coming in that something is wrong can we admit our mistakes or is it easier to think that the advice was right but we just need to try a little harder so recommended levels are lowered instead.
Regards, Anthony
!!Comatoa$ted
02-10-07, 08:30 AM
Sounds like the Global warming "debate". The medical nutrition community are not any more in agreement than the global weather scientists. It's just politically incorrect to disagree with what is the convention of the times.
Read the China study. Then critique it if you can. I'll debate the data, but not the political correctness of the group of scientists that provided the data through research that spans about three decades.
As I've stared before, you are on your own concerning health issues. So if you want to go with what you perceive as the establishment, that's fine as long as it works for you. But given that the heart attack rate is as high as it ever was, you better be well informed.
Al
I am not saying that anyone is wrong, and political correctness is not a concern here. You indicated that it is amazing that anybody is critiquing the study. Critique of the study means that people have read it and have opposing viewpoints. Now I see that the study is actually a book and did not appear in a journal. Does this mean that it could not get past the review process because it is not credible, or that there is so much bias in the community that sheer ignorance would not let it pass through review process? Or that it is not aimed at the medical establishment but more of a marketing ploy to sell it to the masses? If no one were to critique it that may mean that it is probalby not worth the paper that it is written on.
You also claim that you know more than people who have devoted their lives to science because you yourself have a degree in the sciences. Do you get your hair cut at the dentist?
In working with people there is a need to work with the individual and find what works best for them, and apply the evidence on how it applies to the individual. Did your doctors not work with you to find the best solution for you, or did they say this is the road that will work with everybody so we will disregard the individual?
As for increasing cases of MI, CHF, and CMP, look at more than just the food that people eat, as well as the food they eat. What do many of the people who suffer from heart disease have in common, not in just their habits but in their physical makeup? Many are in poor physical shape, and have been for many years, even before they had the Dx of heart disease. Of course this all may go together, people eat poorly, they have less energy, they exercise less, and the circle continues. Of course if one were to take a drug the threat to their lives would be ameliorated.
There is more to consider than one study, and the criticism of it. Some of the criticism states the obvious, that the study does not cover all the bases, but how could it, it would be impossible to have a study that can claim it all. It seems that the critique makes the study more relevant in saying that the information is good but there is more than one way to health, and there are factors that should be considered that the study does not address.
I wish you everlasting health.
velopismo
02-10-07, 09:29 AM
Let's try to end this argument by finding some middle ground. I think both sides have valid points. I do believe that someone with a cholesterol of 214 with a high HDL and low blood pressure has little risk of a heart attack. On the other hand statins are considered a very safe drug and may bring your risk factor for CHD even lower. Statins work as a anti-inflammatory and reducing inflammation is a good thing for overall health. Statins also appear to protect the body from the flu. If you live in Australia and watch what's going in Indonesia you know why you should be concerned. See: http://effectmeasure.blogspot.com/2005/09/bird-flu-and-statins.html If I could get a hold of statins I would have some in the house for this reason alone. Here is a article from New Scientist that lays out the middle ground.
Statins: Wonder drugs for the masses?
07 October 2006
NewScientist.com news service
James Kingsland
Enlarge image
Should you consider statins? (Source: European Society of Cardiology)So you think you're healthy? You are in your 40s, feel right as rain, normal blood pressure, normal cholesterol, pretty good diet, occasional exercise. How would you react if your doctor suggested you take a powerful drug every day for the rest of your life?
The drug, known as a statin, will lower your cholesterol even further and reduce your risk of a heart attack or stroke. According to one recent estimate, most men and many women over 40 could benefit from the drugs. If you are worried about side effects, your doctor will reassure you that a meta-analysis that pooled data from 14 trials involving more than 90,000 people shows the treatment is very safe. The same study suggests that even if your cholesterol level is normal, taking a statin can still reduce your cardiovascular risk. And the greater your risk - if you smoke, suffer from high blood pressure or diabetes, or have a family history of heart disease, for example - the greater the potential benefits.
"Lowering cholesterol is beneficial in pretty much everyone who has been studied," says Colin Baigent, who coordinated the meta-analysis by the Clinical Trial Service Unit (CTSU) at the University of Oxford. "It doesn't really matter what the cholesterol level is. It could be average or even low, but if you reduce it even further in a person who is at high risk you get benefits." Statins also have anti-inflammatory properties, and have shown promising results when used to treat diseases like rheumatoid arthritis, multiple sclerosis and Alzheimer's. Some research even suggests they can help tackle viral infections such as hepatitis C and HIV.
Can any drug really be that good? As enthusiastic doctors put ever more people on statins, sceptics are warning that we don't know enough about the possible adverse effects of taking them over a lifetime. Others claim that statins' potency against heart disease has little to do with lowering cholesterol and instead results from their anti-inflammatory properties, leading some to dismiss them as "expensive aspirin". So could the rush to put millions more people on statins be a costly mistake?
The association between cholesterol, its transport in the bloodstream by a protein called low-density lipoprotein and heart disease is fairly well established. Cholesterol in the form of LDL, so-called "bad cholesterol", can infiltrate the walls of coronary arteries, contributing to the formation of a fibrous plug of immune cells called a plaque. If this ruptures it can trigger the formation of a blood clot that blocks the artery and starves the heart of oxygen - a heart attack, in other words. Equally disastrously, the clot can break free and block arteries in the brain, triggering a stroke.
Statins were originally isolated from fungi in the 1970s by Japanese biochemist Akira Endo. The first statin on the market, lovastatin, was approved by the US Food and Drug Administration in 1987, and currently there are seven statins sold worldwide, some purified from fungi, others synthetic, which vary slightly in their effects (see right).
Statins are thought to prevent heart attacks and strokes by reducing the level of the "bad" LDL cholesterol in the blood. They bind to an enzyme called HMG-CoA reductase and block the first step in the liver's cholesterol-synthesis pathway, causing the amount of cholesterol in the membranes of liver cells to plummet. The cells respond by producing more surface receptors for LDL cholesterol, which pull it out of the blood.
It now seems that the further you reduce your LDL cholesterol levels, the better. This was borne out last year by the CTSU meta-analysis (The Lancet, vol 366, p 1267). It found that over a five-year period, statin therapy reduced the risk of major cardiovascular events such as a heart attack or stroke by about a fifth for every millimole reduction in LDL cholesterol per litre of blood, regardless of how high or low people's levels were to start with (an LDL cholesterol level below 3.5 mmol/l is usually regarded as healthy).
However, it is also becoming clear that statins have a wide range of other effects on the body, perhaps because blocking HMG-CoA reductase inhibits the production of many other molecules besides cholesterol. There is growing evidence, for instance, that their efficacy in preventing cardiovascular disease could be at least partly due to reducing inflammation. Two studies published last year in The New England Journal of Medicine (vol 352, p 20 and p 29) found that statins' beneficial effects correlated with falls in levels of C-reactive protein, an indicator of general inflammation, independently of any effect from cholesterol reduction.
This makes sense because for some time now doctors have suspected that the build-up of plaques in blood vessels is an auto-immune disease triggered by a bacterial infection (New Scientist, 11 January 2003, p 36). Statins also seem to help people with autoimmune diseases such as rheumatoid arthritis and multiple sclerosis, and they are known to counteract the effects of gamma-interferon, an important immune signalling molecule associated with these diseases.
Expensive aspirin
Aspirin is another drug that reduces inflammation as well as preventing blood clotting. Low daily doses reduce the risk of heart attack in men by around a third. "People have used the term 'expensive aspirin' to describe the statins, because the benefit is about the same," says Morley Sutter, a pharmacologist at the University of British Columbia in Vancouver, Canada. Of course, aspirin is not free of side effects: most notably, it increases the risk of stomach bleeding.
The inflammation findings are highlighted by the minority of researchers who think lowering cholesterol is the wrong way to prevent cardiovascular disease. Yet Richard Peto, an epidemiologist at the University of Oxford, insists that cholesterol must take the lion's share of the blame. As evidence, he cites familial hypercholesterolaemia, an inherited condition caused by a defect in the receptor for LDL cholesterol: people with the condition are unable to clear LDL from their blood and have a much higher risk of heart disease. Peto has little time for speculation about statins' anti-inflammatory effects. "Some people want to make things too complicated. We know that LDL particles are causative and that these drugs reduce them."
Even so, there are anomalies that have yet to be explained. These include the so-called French paradox: southern European countries like France where the rate of heart disease is much lower than in the UK, despite the risk factors, including cholesterol levels, being similar. One of the many proposed explanations for this is that more exposure to bright sunlight in these countries protects against heart disease by stimulating synthesis of vitamin D in the skin (New Scientist, 9 August 2003, p 30). This idea is supported by studies in the US showing a correlation between living at higher altitudes - where exposure to ultraviolet light is greater - and lower risk of heart disease.
David Grimes, a doctor at the Royal Blackburn Hospital in Lancashire, UK, goes so far as to suggest that statins bind to the same receptors as vitamin D (The Lancet, vol 368, p 83). He notes that there is a close match between the conditions that statins treat or prevent and those in which vitamin D may play a preventive role, including coronary heart disease, multiple sclerosis, transplant rejection and rheumatoid arthritis. "The immense benefits of statins may have nothing to do with cholesterol," he says. "It might turn out to be an expensive way of giving vitamin D." Michael Holick, a vitamin D specialist at Boston University, says it would be easy to test whether statins bind to vitamin D receptors, and his lab is considering doing just this. "It could either give a major new insight about statins and vitamin D, or put the idea to rest."
Whatever the mechanisms, though, no one doubts that statins do work. The CTSU meta-analysis showed that the greater the cardiovascular risk a patient faces - whether related to age, smoking, hypertension, diabetes or a previous stroke or heart attack - the more they benefit. Recent studies suggest that statins not only help prevent heart attacks, but also reduce the damage a heart attack causes. Such findings have made statins the biggest-selling prescription drugs ever, with global sales of $26 billion in 2004, a figure that looks set to rise even higher. "Studies indicate that the drugs are very safe, so the question then really just becomes a social and economic one," says Baigent. "You essentially go down the risk levels until you run out of money."
So who should get statins? Guidelines vary greatly. The European Society of Cardiology defines a person to be at high risk if they have a 5 per cent chance or greater of suffering a fatal cardiovascular event in the next decade or by age 60 (see Table). One study estimates that in Norway - one of the healthiest nations in the world - this would include a staggering 85 per cent of men and 20 per cent of women over 40. The ESC recommends such people should be given lifestyle advice, followed by drug treatment if they fail to reduce their cholesterol levels.
There is no doubt that stopping smoking, improving your diet and getting more exercise can make a big difference. The trouble is that most of us do not change our lifestyle. "Most people in industrialised countries probably do need to be on statins if they have risk factors because it's so hard to achieve the same cholesterol-lowering using diet alone," says Michael White of the University of Connecticut, Storrs.
Balancing act
Some doctors, however, are alarmed by the trend towards dishing out statins to millions more people and giving higher dosages to lower cholesterol even further. They say the benefits for those who do not already have heart disease are small, while the potential risks are largely unknown. "What price should you pay for a modest effect?" Sutter asks. "The price shouldn't be very high because the effect is weak at best." A 20 per cent reduction in cardiovascular risk may sound impressive, but it doesn't look quite as good when you realise what it means for each individual: if your risk of having a heart attack over the next five years is 5 per cent, say, then taking statins will reduce it only to 4 per cent.
The CTSU meta-analysis found the chances of dying from any cause fell by just 1.2 per cent for those on statins, while the benefit for people who have not already suffered a heart attack or stroke works out at 25 fewer "major vascular events" over five years for every 1000 people on the drugs. That means 975 out of 1000 people risk side effects without any clear benefit during the first five years. The meta-analysis, however, also confirms that it takes time for statins to have an effect and that the longer you take them the more difference they make, but it has yet to be shown that this is still true after 20 or 30 years.
Sutter and others say that statin researchers have failed to report adverse effects in enough detail to allow doctors and patients to weigh the potential costs against the benefits. "There's no good reporting of adverse effects at high doses and very modest reporting even at moderate doses," Sutter says. "If you are prescribed a statin, the doctor expects you to take it for the rest of your life," says Uffe Ravnskov, an independent researcher and former hospital doctor based in Lund, Sweden, who runs The International Network of Cholesterol Skeptics. He claims almost half of patients have adverse effects.
Alleged side effects include memory loss, extreme irritability, aggression, suicidal impulses and impotence. Evidence for these remains sketchy, however, coming from small trials and case studies. Statins do cause liver damage in around 1 per cent of patients, but this should be picked up by routine liver function tests and can be reversed by coming off the drugs. It is also clear that statins can damage muscles. As many as a fifth of people taking the drugs in trials say they experience some muscle weakness or pain, and exercise seems to make things worse. These symptoms are commonplace anyway in middle-aged and elderly people, however, and a similar number of patients taking a placebo also report them. So it is difficult to determine the exact extent of the problem.
In very rare cases statins cause rhabdomyolysis, a severe form of muscle damage in which the breakdown products cause kidney failure. The rate was especially high with cerivastatin (Baycol), which caused 50 deaths and was withdrawn in 2001.
Confusingly, some small studies have hinted that statins increase the risk of cancer while others suggest they may guard against it. The CTSU meta-analysis found no association between cancer and statins, and a similarly large study from the US, which looked at 26 trials involving 87,000 patients, also found no link (Journal of the American Medical Association, vol 295, p 74).
Most trials, though, have lasted only five years or less. For some this leaves lingering doubts. "You don't get lung cancer after smoking for 10 years; it takes much longer to show up," Ravnskov points out. "Heavy smokers get lung cancer in their 50s and 60s and they have smoked for decades before that." Nevertheless, White, who led the US study, is confident that even after five years some signs of increased cancer risk would show up in trials. "Within the period we were looking at you should at least have started to see some trends," he says.
The crucial issue now facing policy-makers is how and where to draw the line that defines who should be offered statins. In the US and Canada, prescribing guidelines focus on lowering cholesterol below certain thresholds, depending on the individual's overall risk of a heart attack or stroke. The lowering of the US target levels in 2004, which is leading to millions more people being put on statins, sparked controversy when it was revealed that eight out of the nine experts involved had ties to statin manufacturers.
In Australia, New Zealand and the UK, the emphasis is on treating those with the highest overall risk rather than on cholesterol targets. This year, a Canadian study that modelled the effects of applying the various guidelines concluded that the high-risk approach is more effective in terms of number of lives saved per number treated (BMJ, vol 329, p 529). It found, for instance, that applying the US guidelines would result in twice as many people taking statins as the New Zealand guidelines without preventing any more deaths.
Yet even the more conservative guidelines will lead to millions more people taking statins for the rest of their lives, often starting younger or being given higher doses. You could be one of them. If the advocates of statins are right, this policy will come to be seen as a triumph for preventative medicine, saving tens of thousands of lives. If the critics are right, for those with a low risk of heart disease statins could do more harm than good. Which will you bet your life on when your doctor mentions the s-word?Oh yes, take Vitamin D supplements in the winter.
psycholist
02-10-07, 12:27 PM
An interesting exchange, with many valid points.
The bottom line for me, however, is this: despite doing it all "by the book " (enter your preferred title of choice), you are still bound by your genetics. And in that case I simply have to approach things the best way I know, which is to stay active and make educated choices where my health is concerned. And not go nuts thinking about the other possibilities.
I have an uncle who was always the gym rat of the family, even before exercise as we know it became mainstream. He ate right, worked out, did it all. Lived in Alaska, climbed McKinley twice. Always the gonzo athelete. But he didn't believe in health insurance and seldom went to the Dr's. Last year his family moved back to the midwest and got on a standard health plan. His sis (my mom) had just had her first triple by-pass and this got him to wondering about his own situation. He grudgingly had a physical and a treadmill stress test and the doc stopped the test mid stream and guess what--he was on his back having a four way by-pass three days later. I am not kidding, two major vessels were 80% occluded , two others slightly less. ANd I don't even know if he had been having the usual symptoms.
All the time beforehand I was all smug thinking, ha, I got this family cardio thingy beat. I learned early enough -my 50s and 60s will be different. So when my uncle went through all this I seriously got nervous, thinking I had it all wrong and it didn't matter, you play the hand you get dealt, genetically. But that is way too defeatist so I chose to buckle down even harder. If my doc tells me to get my HDLs up , I'm going to try it.
Al.canoe
02-10-07, 03:37 PM
Let's try to end this argument by finding some middle ground. I think both sides have valid points. I do believe that someone with a cholesterol of 214 with a high HDL and low blood pressure has little risk of a heart attack. On the other hand statins are considered a very safe drug and may bring your risk factor for CHD even lower. Statins work as a anti-inflammatory and reducing inflammation is a good thing for overall health. Statins also appear to protect the body from the flu. If you live in Australia and watch what's going in Indonesia you know why you should be concerned. See: http://effectmeasure.blogspot.com/2005/09/bird-flu-and-statins.html If I could get a hold of statins I would have some in the house for this reason alone. Here is a article from New Scientist that lays out the middle ground.
There may not be a middle ground per say as the understanding of what is going on is too open to interpretation even by the experts. The science is too immature. The post is an excellent summary of the state of understanding for those who study folks nourished with the western diet.
The last I heard anything on the C-reactive protein, they didn't know if the protein itself was the culprit, or if it was in fact an indication of inflammation. The thinking was (and could still be) that you had to have both higher cholesterol and higher protein levels to be at risk. But this was and possibly still is very preliminary
Statins can have serious side affects and I believe two had to be pulled from the market as they were seriously hurting people. Pravachol has apparently few real negatives according to both the trial and to the team of doctors I mentioned before. Also, I take a small dosage. It's been out there longer than the others so there's the most experience with it. I have had zero side affects. The N E Journal of Medicine article reporting the trial results indicated that deaths from all causes dropped some thing like 5% during the trail. Reasons unknown.
The China Study community draws far different conclusions as to the cause and the prevention of heart attacks. The major reason is that they studied a much broader population sample. In addition to the western countries, they studied folks from that part of the earth's population that does not consume a high animal-product diet of the affluent countries of the west. They would argue that the science discussed in the post does not lead to the proper conclusions because the true results are masked by investigating only a population that has too high an intake of animal products. They argue and I agree at least for now, that their results get to the actual cause of the problem.
You don't do statins or any other drug with the China Study concept, you just cut you animal product consumption. If you want to reduce your risks by the maximum, you would reduce animal based protein consumption to about 5% of your total calorie intake. Actually less than 5% for heart issues, the 5% is good enough for cancer, which is the more important issue for me personally. They document several human trials where folks with badly clogged arteries unclogged with this regime. Something that's never happened with statins, except for minimal amounts at very high and very dangerous doses.
At such a low animal product consumption, you need to supplement with B12 and that's it, except for D as mentioned if you don't get much sun. I've read that if you live north of Atlanta, you might want to do the D thing in the winter at least. I stay suntanned all year, so I don't worry about it.
At this point, I'm convinced that the China Study folks have got the superior concept. However, as I've said the science is still immature, so I track both camps. The implications of the China Study are far more profound for prevention than the "western country only" group. For example, for those populations that keep the animal protein consumption below 3%, They have a heart disease rate of about 150/100,000. For an 8.5% consumption, typical of the US back around 1955, it's 600 to 700 per 100,000. A huge difference. The differences are of the same magnitude for several cancers (like Prostate, my issue and breast cancer), Diabetes, bone breakage or bone-loss and autoimmune diseases.
However, the China study folks have nothing for bird flue. Statins got that one hands down.
On the aspirin thing. I started taking a daily low dose about 10 years ago. That's when I found out I was allergic to aspirin (it caused my Asthma medication to be ineffective). So I quit. About 7 years later I was visiting my neurologist for check-up (had years before a fracture in the inner layer of my carotid artery like one can get in a car crash, but I suffered no severe impact). He was pleased that I was on Provachol, but displeased that I was not taking aspirin. This had nothing to do with my carotid artery, it was more the heart issue. So he writes me a prescription for Plavix (sp?). I got home and checked it on the web. It's a powerful blood thinner. One side affect is if I crash my mountain bike, I could bleed to death internally. That was another prescription I tore up.
Well, today we cleared about a half mile of new mountain bike trail: an addition to our 18 miles. Had two hamburgers with my fellow trail workers at the post-work BB-Q. That could kill me for sure since I'm into the China Study, but tomorrow I ride!
Al
Al.canoe
02-10-07, 03:54 PM
An interesting exchange, with many valid points.
The bottom line for me, however, is this: despite doing it all "by the book " (enter your preferred title of choice), you are still bound by your genetics. .
That is not the current thinking, at least for now. Even for cancer. My daughter sent me some stuff that the American Cancer Society believes that genetics plays only a 3% role. Many researchers/doctors say that proper nutrition and with exercise, you minimize the affect of genetics.
But, since you can't do anything about genetics, it might not determine your best course of action anyhow, but be a good motivator to continue your healthy life style. My motivator was getting high blood pressure at 26. Now at 67 it's typically 110-120/ 70-75 with no drugs.
Al
velopismo
02-10-07, 04:52 PM
An interesting exchange, with many valid points.
The bottom line for me, however, is this: despite doing it all "by the book " (enter your preferred title of choice), you are still bound by your genetics. .
Al is on the money with this one. I would never had believed it until I read about this last summer but genes appear to have a only a small effect on your lifespan. So do your homework and find out what you can do to live longer. Do consider resveratrol. See this from last weeks Fortune Magazine cover story: http://money.cnn.com/2007/01/18/magazines/fortune/Live_forever.fortune/?postversion=2007011906
http://money.cnn.com/2007/01/30/magazines/fortune/anti-aging_drugs.fortune/
http://www.imminst.org/forum/index.php?act=ST&f=6&t=14124&s=
http://www.imminst.org/forum/index.php?act=ST&f=6&t=13062&s=
This is from the NYT:
August 31, 2006
The New Age
Live Long? Die Young? Answer Isn’t Just in Genes
By GINA KOLATA
Josephine Tesauro never thought she would live so long. At 92, she is straight backed, firm jawed and vibrantly healthy, living alone in an immaculate brick ranch house high on a hill near McKeesport, a Pittsburgh suburb. She works part time in a hospital gift shop and drives her 1995 white Oldsmobile Cutlass Ciera to meetings of her four bridge groups, to church and to the grocery store. She has outlived her husband, who died nine years ago, when he was 84. She has outlived her friends, and she has outlived three of her six brothers.
Mrs. Tesauro does, however, have a living sister, an identical twin. But she and her twin are not so identical anymore. Her sister is incontinent, she has had a hip replacement, and she has a degenerative disorder that destroyed most of her vision. She also has dementia. “She just does not comprehend,” Mrs. Tesauro says.
Even researchers who study aging are fascinated by such stories. How could it be that two people with the same genes, growing up in the same family, living all their lives in the same place, could age so differently?
The scientific view of what determines a life span or how a person ages has swung back and forth. First, a couple of decades ago, the emphasis was on environment, eating right, exercising, getting good medical care. Then the view switched to genes, the idea that you either inherit the right combination of genes that will let you eat fatty steaks and smoke cigars and live to be 100 or you do not. And the notion has stuck, so that these days, many people point to an ancestor or two who lived a long life and assume they have a genetic gift for longevity.
But recent studies find that genes may not be so important in determining how long someone will live and whether a person will get some diseases — except, perhaps, in some exceptionally long-lived families. That means it is generally impossible to predict how long a person will live based on how long the person’s relatives lived.
Life spans, says James W. Vaupel, who directs the Laboratory of Survival and Longevity at the Max Planck Institute for Demographic Research in Rostock, Germany, are nothing like a trait like height, which is strongly inherited.
“How tall your parents are compared to the average height explains 80 to 90 percent of how tall you are compared to the average person,” Dr. Vaupel said. But “only 3 percent of how long you live compared to the average person can be explained by how long your parents lived.”
“You really learn very little about your own life span from your parents’ life spans,” Dr. Vaupel said. “That’s what the evidence shows. Even twins, identical twins, die at different times.” On average, he said, more than 10 years apart.
The likely reason is that life span is determined by such a complex mix of events that there is no accurate predicting for individuals. The factors include genetic predispositions, disease, nutrition, a woman’s health during pregnancy, subtle injuries and accidents and simply chance events, like a randomly occurring mutation in a gene of a cell that ultimately leads to cancer.
The result is that old people can appear to be struck down for many reasons, or for what looks like almost no reason at all, just chance. Some may be more vulnerable than others, and over all, it is clear that the most fragile are likely to die first. But there are still those among the fragile who somehow live on and on. And there are seemingly healthy people who die suddenly.
Some diseases, like early onset Alzheimer’s and early onset heart disease, are more linked to family histories than others, like most cancers and Parkinson’s disease. But predisposition is not a guarantee that an individual will develop the disease. Most, in fact, do not get the disease they are predisposed to. And even getting the disease does not mean a person will die of it.
There are, of course, some valid generalizations. On average, for example, obese men who smoke will die sooner than women who are thin and active and never get near a cigarette. But for individuals, there is no telling who will get what when or who will succumb quickly and who will linger.
“We are pretty good at predicting on a group level,” said Dr. Kaare Christensen, a professor of epidemiology at the University of Southern Denmark. “But we are really bad on the individual level.”
Looking to Twins
James Lyons used to think his life would be short. Mr. Lyons, a retired executive with the Boy Scouts of America, thought of his father, who died at 55. “He had one heart attack. It was six hours from onset to death, and that was it.”
Then there were his first cousins on his father’s side. One died at 57 and another at 50. “He was in a barber chair and had a heart attack,” Mr. Lyons said of the 50-year-old. “He died on the spot.”
“He was a big strapping guy, 6-4, healthy and energetic. Then, boom. One day he was there, and the next day he was gone.”
“I approached my 50’s with trepidation,” said Mr. Lyons, who lives in Lansing, Mich.
But his 50’s came and went, and now he is 75. He is still healthy, and he has lived longer than most of his ancestors. He is baffled as to why.
It seems like common sense. Family members tend to look alike. And many characteristics are strongly inherited — height, weight, a tendency to develop early onset heart disease or to get diabetes. Even personalities run in families. Life span would seem to fit with the rest.
But scientists have been trying for decades to find out if there really is a strong genetic link to life spans and, if so, to what extent.
They turned to studies of families and of parents and children, but data analysis has been difficult and any definitive answer elusive. If a family’s members tend to live to ripe old ages, is that because they share some genes or because they share an environment?
“Is it good socioeconomic status, good health or good genes?” Dr. Christensen asked. “How can you disentangle it?”
His solution, a classic one in science, was to study twins. The idea was to compare identical twins, who share all their genes, with fraternal twins, who share some of them. To do this, Dr. Christensen and his colleagues took advantage of detailed registries that included all the twins in Denmark, Finland and Switzerland born from 1870 to 1910. That study followed the twins until 2004 to 2005, when nearly all had died.
Now, Dr. Christensen and his colleagues have analyzed the data. They restricted themselves to twins of the same sex, which obviated the problem that women tend to live longer than men. That left them with 10,251 pairs of same-sex twins, identical or fraternal. And that was enough for meaningful analyses even at the highest ages. “We were able to disentangle the genetic component,” Dr. Christensen said.
But the genetic influence was much smaller than most people, even most scientists, had assumed. The researchers reported their findings in a recent paper published in Human Genetics. Identical twins were slightly closer in age when they died than were fraternal twins.
But, Dr. Christensen said, even with identical twins, “the vast majority die years apart.”
The investigators also asked when the genetic factor kicked in. One hypothesis, favored by Dr. Christensen, was that the strongest genetic effect was on deaths early in life. He thought that deaths at young ages would reflect things like inherited predispositions to premature heart disease or to fatal cancers.
But there was almost no genetic influence on age of death before 60, suggesting that early death has a large random component — an auto accident, a fall. In fact, the studies of twins found almost no genetic influence on age of death even at older ages, except among people who live to be very old, the late 80’s, the 90’s or even 100. The average age at which people are dying today in the United States is 68.5 for men, and 76.1 for women, according to Arialdi M. Minio of the National Center for Health Statistics. This statistic differs from life expectancy, which estimates how long people born today are expected to live.
Finding Randomness
Even though there may be a tendency in some rare families to live extraordinarily long, the genetic influence that emerged from the studies of twins was significantly less than much of the public and many scientists think it is.
A woman whose sister lived to be 100 has a 4 percent chance of living that long, Dr. Christensen says. That is better than the 1 percent chance for women in general, but still not very great because the absolute numbers, 1 out of 100 or 4 out of 100, are still so small. For men, the odds are much lower. A man whose sister lived to be 100 has just a 0.4 percent chance of living that long. In comparison, men in general have a 0.1 percent chance of reaching 100.
Those data fit well with animal studies, says Caleb Finch, a researcher on aging at the University of Southern California. Genetically identical animals — from worms to flies to mice — living in the same environments die at different times.
The reason is not known, Dr. Finch said.
“It’s random,” he said. “Since we can’t find any regular pattern, that’s the hand wave explanation — randomness.”
And random can mean more than one thing.
“There are two phases of randomness,” Dr. Finch said. “There’s the randomness of life experiences. The unlucky ones, who get an infection, get hit on the head or get mutations that turn a cell into cancer. And there are random events in development.”
Random cell growth and division and random differences in which genes get turned on and how active they are during development can cause identical twins to have different numbers of cells in their kidneys and even different patterns of folds in their brains, Dr. Finch pointed out. And random differences in development early in life can set the stage for deterioration decades later.
But seemingly random events can still come as a shock. That’s how Annmarie Bald felt when her identical twin, Catherine Polk, died in her sleep of a heart attack. It happened seven years ago, when Ms. Polk was 43. To this day, Ms. Bald, of Forked River, N.J., lives in fear that the same thing will happen to her. She nervously sees her doctor every year for a checkup, and every year her doctor tells her the same thing: her heart is fine.
“The question in my mind every day is, ‘How did I end up still here and she’s gone?’ ” Ms. Bald said. “It’s not something you ever get over.”
Yet even diseases commonly thought to be strongly inherited, like many cancers, are not, researchers found. In a paper in The New England Journal of Medicine in 2000, Dr. Paul Lichtenstein of the Karolinska Institute in Stockholm and his colleagues analyzed cancer rates in 44,788 pairs of Nordic twins. They found that only a few cancers — breast, prostate and colorectal — had a noticeable genetic component. And it was not much. If one identical twin got one of those cancers, the chance that the other twin would get it was generally less than 15 percent, about five times the risk for the average person but not a very big risk over all.
Looked at one way, the data say that genes can determine cancer risk. But viewed another way, the data say that the risk for an identical twin of a cancer patient is not even close to 100 percent, as it would be if genes completely determined who would get the disease.
Dr. Robert Hoover of the National Cancer Institute wrote in an accompanying editorial: “There is a low absolute probability that a cancer will develop in a person whose identical twin — a person with an identical genome and many similar exposures — has the same type of cancer. This should also be instructive to some scientists and others interested in individual risk assessment who believe that with enough information, it will be possible to predict accurately who will contract a disease and who will not.”
Alzheimer’s disease also has a genetic component, but genes are far from the only factor in determining who gets the disease, said Margaret Gatz of the University of Southern California and Nancy Pedersen of the Karolinska Institute.
Dr. Gatz and Dr. Pedersen analyzed data from a study of identical and fraternal Swedish twins 65 and older. If one of a pair of identical twins developed Alzheimer’s disease, the other had a 60 percent chance of getting it. If one of a pair of fraternal twins, who are related like other brothers and sisters, got Alzheimer’s, the other had a 30 percent chance of getting it.
But, Dr. Pedersen noted, Alzheimer’s is so common in the elderly that it occurs in 35 percent of people age 80 and older. If genes determine who gets Alzheimer’s at older ages, Dr. Pedersen says, “those genes must be very common, have small effects and probably interact with the environment.”
As for other chronic diseases of the elderly, Parkinson’s has no detectable heritable component, studies repeatedly find. Heart disease appears to be indiscriminate, striking almost everyone eventually, says Dr. Anne Newman of the University of Pittsburgh, who has studied it systematically in a large group of elderly people.
But the general picture is consistent in study after study. A strong family history of even a genetically linked disease does not guarantee a person will get it, and having no family history does not mean a person is protected. Instead, chronic diseases strike almost at random among the elderly, making it perhaps not so surprising that life spans themselves have such a weak genetic link.
Matt McGue, a psychology professor at the University of Minnesota who studies twins, contrasts life spans with personality, which, he says, is about 50 percent heritable, or attention-deficit hyperactivity disorder, which is 70 to 80 percent heritable, or body weight, which is 70 percent heritable.
“I’ve been in this business for a long while, and life span is probably one of the most weakly heritable traits I’ve ever studied,” Dr. McGue said.
Seeking Rare Families
At the National Institute on Aging, the question still hovers: Is it possible to find genetic determinants of exceptional health and longevity?
“If you could identify factors for exceptionally good health, that might allow people to avoid disease,” said Evan Hadley, director of the institute’s geriatrics and clinical gerontology program.
There are two methods to do this, Dr. Hadley said. One is to look at how the genes of centenarians differ from those of the rest of the population. But, he said, that requires that if longevity genes exist, they are common among centenarians. And, so far, such studies have not yielded much that has held up — with one well accepted exception: a gene for a cholesterol-carrying protein that affects risk for heart disease as well as Alzheimer’s disease. Those who have that gene have double the chances of living to 100. But that chance is not much anyway. Only about 2 percent of people born in 1910 could expect to reach 100. The second approach is to look for rare genes in unusually long-lived families. “If there is something in a family, it may be in only one or a few families,” Dr. Hadley said. But it may have a big effect.
So the National Institute on Aging is starting a research project with investigators at three United States medical centers and at Dr. Christensen’s center in Denmark. The plan is to find exceptional families, those in which there is a cluster of very old, closely related members — two sisters in their 90’s, for example — whose children, who would typically be in their 70’s, and grandchildren, can be studied too.
Today, many families have a few members living to advanced ages, but very few families have many of them. And in large families, just by chance, someone may live past 90, but it is unlikely that most of the brothers and sisters will get there. For these families, there does not appear to be a genetic component to life spans.
For now, the study is in a pilot phase, testing a scoring system to define the families who seem to fit the criteria.
“If you are really, really old in a family, that gets you more points,” Dr. Hadley said. “You get more points for being 97 than for being 92. But we also are looking at the whole family structure. If there are just two siblings in a family and both live to 98, that’s very exceptional. But suppose there are eight kids and they all made it to 87. That’s pretty unusual, too.’’
If the researchers find genes in the oldest family members that seem to be associated with protection from a disease like heart disease and with a long life, they will follow the younger members of the family, children in their 60’s and 70’s, asking if the same genes seem to protect them as they age.
Some wonder if the project can succeed, said Dr. Newman, who is directing one study center, at the University of Pittsburgh. “The big debate is, is it possible for there to be a few genes that are protective or is it going to be so complicated that we won’t be able to figure out the genetic factors? Is it going to be that some people are just lucky?”
She is optimistic, reasoning that since some families tend to have early onset of certain diseases, others probably have a genetic predisposition to get diseases like heart disease, cancer and Alzheimer’s so late that most members do not get them at all and live very long and healthy lives.
“This would be the flip side of early onset,” she says.
Mrs. Tesauro is in the pilot study. She had always been healthy and active, a self-described tomboy growing up who played tennis until she was 85. “I just can’t sit still,” she said.
She was a woman who knew her mind, so eager to go to college that she defied her father, who thought it was a waste of money, and worked her way through. She ended up with a master’s degree in education and a career as a high school teacher.
Her twin was different. She was the frilly type, Mrs. Tesauro said, and was not much of a student. She failed a grade in high school and barely graduated. Both Mrs. Tesauro and her sister married and had children.
Mrs. Tesauro was born first, and it is a common belief even among scientists that the twin born first is stronger and lives longer. But when he looked at the Scandinavian data, Dr. Christensen said, he found that birth order made no difference in health or longevity.
The day before visiting Mrs. Tesauro for the first time, the Pittsburgh investigators tried to call her, just to be sure she was still alive and still healthy enough to be interviewed. When they could not reach her, they began to worry.
But all was well. Mrs. Tesauro answered the phone the next morning and explained why they had had such trouble. She was out running errands.
Al.canoe
02-10-07, 04:59 PM
You indicated that it is amazing that anybody is critiquing the study. Critique of the study means that people have read it and have opposing viewpoints. Now I see that the study is actually a book and did not appear in a journal. Does this mean that it could not get past the review process because it is not credible, or that there is so much bias in the community that sheer ignorance would not let it pass through review process? Or that it is not aimed at the medical establishment but more of a marketing ploy to sell it to the masses? If no one were to critique it that may mean that it is probalby not worth the paper that it is written on.
You also claim that you know more than people who have devoted their lives to science because you yourself have a degree in the sciences. Do you get your hair cut at the dentist?
I wish you everlasting health.
I make no claims to know more than anybody. If you could point out where I wrote such a thing, or just implied it, I'll retract (erase) it immediately.