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From The September 2001 Issue of Nutrition Science News
A Prescription for Alarm
by Jack Challem
The headlines were practically surreal: A new federal report urged that 23 million more Americans be given prescription drugs to lower their cholesterol levels.
What's wrong with this picture?
Aside from the proclamation that huge numbers of people be medicated, it was as if we all had been transported back to 1970, when elevated blood cholesterol was assumed to be the prima facie cause of heart disease. We were, apparently, expected to forget that homocysteine and C-reactive protein are far more accurate predictors, and perhaps more likely causes, of heart disease.
The report, published in the Journal of the American Medical Association and written by a panel of physicians and researchers under the auspices of the National Institutes of Health, recommended that 36 million Americans be prescribed cholesterol-
lowering drugs, up from the 13 million now taking these medications. Dietary changes were given little more than lip service.1
The study ignored the many contradictions in the theory that elevated cholesterol causes heart disease. Cholesterol is essential for health and is the key building block of steroid hormones and endogenous vitamin D. Many people with normal cholesterol levels still develop heart disease and have heart attacks.
The report encouraged physicians to nearly triple the number of patients receiving statins, a popular—and highly profitable—class of cholesterol-lowering drugs, including Lipitor, Pravachol and Zocor. The prescription increase would be a boon to the makers of statin drugs, whose sales have increased by about 20 percent annually and reached $14 billion in 2000.2
"This approach to prevention is entirely misguided and based on an outmoded hypothesis of causation [of heart disease]," says Kilmer McCully, M.D., of the Veterans Administration Hospital, Providence, R.I. "Treatment of cholesterol elevation and dyslipidemia is merely addressing a symptom and not the cause of the disease."3 McCully, a leading expert on heart disease, was the first to claim that elevated levels of homocysteine, a toxic by-product of methionine metabolism, are a prime risk factor for heart disease and stroke.
Statins work by reducing the body's production of HMG-CoA reductase, an enzyme needed for cholesterol synthesis. But inhibiting HMG-CoA reductase also interferes with production of coenzyme Q10, a vitamin-like substance that energizes heart cells and enhances immune function. Although statins are promoted as relatively safe drugs, they may increase the risk of heart failure and cancer.4
Three alternative steps could reduce the risk of heart disease at less cost and with greater safety:
- Increasing consumption of folic acid and vitamins B6 and B12, which lower homocysteine levels.5,6 Homocysteine damages blood vessel walls and, says McCully, sets the stage for subsequent cholesterol deposits.7
- Taking natural vitamin E supplements to reduce levels of C-reactive protein, an inflammatory compound that increases the risk of heart disease by 4.5 times.
8-10 Heart disease is increasingly viewed as a disease of blood-vessel inflammation.
- Eating a healthy diet, which can lower cholesterol and have other health benefits as well. Low-fat diets often translate into diets high in refined carbohydrates from pasta and bread. Such excess calories contribute to obesity and insulin resistance. Indeed, insulin resistance (and excess insulin production) raises levels of cholesterol, triglycerides, and blood pressure—all risks for heart disease. A more sensible diet would limit calories from refined carbohydrates and increase consumption of lean meats, fish and vegetables.
It is time to adopt what we have learned during the past 30 years, not return to the inchoate recommendations of the past.
Jack Challem, known as the The Nutrition Reporter, has been writing about vitamin research for 25 years and is the author of Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance (Wiley, 2000).
References
1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001;285:2486-97.
2. Aoki N. Cholesterol drug makers' influence is pondered. Boston Globe/New York Times Health Syndicate, June 1, 2001.
3. Personal communication, May 18, 2001.
4. Bliznakov EG, Wilkins DJ. Biochemical and clinical consequences of inhibiting coenzyme Q10 biosynthesis by lipid-lowering HMG-CoA reductase inhibitors (statins): a critical overview. Advances in Therapy 1998;15:218-28.
5. Selhub J, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993 Dec 8;270:2693-8.
6. Ubbink JB. Vitamin B-12, vitamin B-6, and folate nutritional status in men with hyperhomocysteinemia. Am J Clin Nutr 1993 Jan;57:47-53.
7. McCully KS, Wilson RB. Homocysteine theory of arteriosclerosis. Atherosclerosis 1975;22:215-27.
8. Ridker PM, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. New Eng J Med 2000;342:836-43.
9. Devaraj S, Jialal I. Alpha tocopherol supplementation decreases serum C-reactive protein and monocyte interleukin-6 levels in normal volunteers and type 2 diabetic patients. Free Rad Biol Med 2000;29:790-2.
10. Upritchard JE, et al. Effect of supplementation with tomato juice, vitamin E, and vitamin C on LDL oxidation and products of inflammatory activity in type 2 diabetes. Diabetes Care 2000;23:733-8.
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