13 Nov 2017 03:11am IST
Lately, I have been receiving queries from various quarters asking whether “it is true what they hear about the “latest” research” on cholesterol”. Appended they remit a lengthy article doing the rounds via WhatsApp groups. The enquirers want to know what the credibility of the news is.
The article on WhatsApp avers that “Cholesterol” has been finally removed from the “Naughty List” and is no longer a “nutrient of concern.” It alleges that doctors are seen doing a U-turn on their warnings to stay away from high-cholesterol foods to avoid clogged arteries. This means that eggs, butter, full-fat dairy products, coconut oil and meat could be classified as “safe”. The piece of writing further claims there’s no such thing as “good” and “bad” cholesterol.
First of all, it must be noted that the above exposé, which is giving rise to so much speculation, was published in the Washington Post two years ago. It has not been accepted by any peer-reviewed Medical Journal. While it is true that much confusion prevails among doctors themselves vis-à-vis the cholesterol saga, we know that the 2017 American Heart Association (AHA) guidelines continue to recognise the role of the ill- effects of an unwholesome diet and cholesterol, just as before. The guidelines are also extensive, providing 87 total recommendations on a broad range of clinical scenarios encountered in clinical practice. What is more, there is little doubt that “statins” (cholesterol-reducing drugs) lower cardiovascular risk significantly. Further, extremely low LDL-C (bad cholesterol) levels of less than 20 mg/dL (attained with powerful statins) are beneficial and safe, at least in the short term.
One thing we must concede though: There has been a lot of churning in this field, yet the latest guidelines stick to the same advice the AHA has given for decades—to eat less fat and fewer animal products and eat more plant foods for good health. This decision to keep with the status quo reflects much of the current, relevant science. But, as expected, criticism abounds about scientific studies, especially the accusation that “the scientific committee advising the US government does not always use standard methods for most of its analyses and instead relies heavily on systematic reviews from professional bodies, such as the American Heart Association and the American College of Cardiology, which are heavily supported by food and drug companies!”
Meanwhile, we have two praiseworthy scientific studies with regard to plaque in “atherosclerosis” (process that hardens our arteries and causes heart attacks and stroke). The first study, far from reversing warnings about bad effects of high levels of “ “bad” cholesterol puts greater emphasis on the deleterious effect of “high sugar intake”. The new view tells us emphatically that it is “net carbs and processed fructose” that must be consumed judiciously. Doctors feel that it is the high intake of sugars coupled with “excess insulin/insulin resistance” that promotes inflammation, causing our visceral fat to release toxins that lead to a cascade of events that trigger “atherogenic dyslipidemia”, (the clumping of the now familiar culprits: high oxidized LDL (bad cholesterol), triglycerides and low HDL (good cholesterol). An important point is further being made: doctors may plan to ask us henceforth to measure our “fasting insulin levels” on a regular basis to know whether we are inching towards “insulin resistance”.
In the second landmark study, Dr Catherine Paddock PhD, insists that the problem of clogged arteries may boil down to “bacteria”, and not the diet. The fat molecules in the plaques that clog up our arteries and raise the risk of heart attacks and strokes may come from bacteria that live in our mouths and guts, not just from what we eat. This was the main result of a study led by the University of Connecticut that was published recently in the Journal of Lipid Research. Apparently, bacteria living in our mouth deliver a “double whammy.” They produce an enzyme that breaks down the bacterial lipids into starting materials for making molecules that promote inflammation and plaque formation.
If the “cholesterol story” already has you perplexed, remember, that “Life is similar to a bus ride. The journey begins when we board the bus and ends when we exit. We meet people along our way, of which some are strangers, some friends and some strangers yet to be friends, and all that leaves us confused. It is the fun of being confused that makes us rejoice; without that, the journey altogether would neither be worthwhile nor smooth.” But, admittedly, the cholesterol controversy revolves around something far more important: -- our very health and well-being. It is hoped that the 2018 guidelines will be more explicit although it may never be possible to give a “one size fits all” type of advice.
Meanwhile, instead of being carried away by social media fads, let’s ban transfats, fill up on fiber, go for fish, opt for olive oil, go nuts, stay away from excess crabs, pay more attention to dental and gut hygiene and, last but not the least, exercise to remain physically fit and shed off the excess kilos to ward off “insulin resistance”.
(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa, column writer, singer/songwriter/music aficionado, Mando exponent, past president of the state IMA, social activist, popular orator and toastmaster, family man, with deep faith in God.)