Cholesterol Paradox In Survival After Stroke Thrombolysis

Supports Chapter 22: The dangers of low cholesterol

There are many paradoxes in cardiovascular medicine. These are where real life doesn't follow what 'everyone knows' is true. Indeed there are so many paradoxes that I would have thought that by now, the 'establishment' would have caught on to the fact (as I see it) that these paradoxes are not paradoxes, but examples of evidence that the accepted paradigm about raised cholesterol being the cause of a wide range of cardiovascular diseases is wrong, wrong, wrong!

But they don't, so to add to the many, already published 'paradoxes' another has just been published in the European Journal of Neurology. It is from research conducted at the Hospital del Mar, Barcelona. Paradoxically, it finds that patients with ischaemic stroke who have low cholesterol levels are more likely to die after a stroke than similar patients with higher cholesterol levels.

The research team measured cholesterol levels in 220 patients with ischemic stroke who underwent intravenous thrombolysis (clot-busting treatment) within 4.5 hours of symptom onset.

As expected, stroke severity, as measured on the National Institutes of Health Stroke Scale (NIHSS), was the most significant determinant of patient survival at 3 months in all models. However, the NIHSS score correlated inversely with patients' levels of total cholesterol, triglycerides, and LDL cholesterol (it did not correlate with HDL cholesterol).

Put another way, it means that higher total cholesterol levels were significantly associated with higher survival, and remained so after accounting for stroke severity.

Three-month mortality, when total cholesterol was divided into tertiles (thirds) were as follows:

25.7% in the lowest tertile (<155 mg/dL; 4.0 mmol/L)
13.7% in the middle tertile (155-192 mg/dL; 4.0-4.9 mmol/L)
5.5% in the highest tertile (>192 mg/dL; 4.9 mmol/L).

"Our study does not allow us to identify the reason why low cholesterol is associated with increased mortality after [ischemic stroke], although we could hypothesize that this is an epiphenomenon or a surrogate marker of poor prognosis rather than an effect related to cholesterol levels," they say. But they do note that cholesterol is essential for cell membrane function, and has many other important roles, making it "plausible" that high blood cholesterol levels could be neuroprotective.

The authors say that: "The mechanism of this apparent paradox, common to both ischaemic and haemorrhagic strokes, remains unexplained, and merits further research."

But they always say that - it keeps them in a job. What I would like to see researchers like these to say, just once, is "this increases the evidence base that having a low cholesterol levels is not healthy."

Roquer J, et al. Serum cholesterol levels and survival after rtPA treatment in acute stroke. Eur J Neurol. 2011 Dec 5. doi: 10.1111/j.1468-1331.2011.03607.x. [Epub ahead of print]

Something Rotten in the State of Denmark

What I wrote Trick & Treat for
I imagine there can be few readers of this blog who are not aware that ther Danish government has begun to tax 'saturated fat' If you haven't seen it in the news, here is an example from the Daily Telegraph

This move to price healthy foods beyond the reach of the poorer members of Danish society will undoubtedly make the manufacturers of junk foods very happy because, of course, their products contain very little saturated fat - just hydrogenated polyunsaturated fat! And, of course, as we know, it will have an effect that is exactly the opposite of what they hope to achieve. But when you have ignorant politicians who are influenced by Big-Food and let down by incompetent nutritionists, this is exactly the sort of lunacy that results.

I can understand their motives but, surely, someone must have spoken out against this move before it happened.

But there could be a wider problem: The domino effect. Now that one country has gone mad, it could prove to be contagious, with other countries caught up in the lunacy.

One can't help but wonder how this hydra that saturated fats are in abny way harmful has kept sprouting heads for many decades after it was shown to be based on deception. And, as the Danes have made this move "to counter the growing trend of obesity", how does taxing the only fat which has been shown not to cause obesity and which actually has the lowest calorific value of any fat - only about half as many calories as polyunsaturated fats - going to help.

Our politicians are probably no better informed than the ones who have let the Danes down so abysmally, so I'm not holding my breath that ours are not equally gullible and we won't see such stupidity here.

For my part, my MP, David Cameron, the Prime Minister, together with his Health Secretary, Andrew Lansley, both have a copy of my Trick & Treat. One can only hope one or other of them has read it.

Barry

Feeling down? Then eat some fat!

Supports Chapter 26: Diet and the brain

When you are feeling down what is the most likely comfort food you would choose? Something carbohydrate-based and sweet? In fact, according to researchers from University of Leuven, Belgium, in a study in the Journal of Clinical Investigation, the best mood-enhancer is fat.

Using functional magnetic resonance imaging (MRI) scans, the team led by Lukas Van Oudenhove, MD., PhD charted specific areas of the brain which are known to light up when a person is sad. For the study, they recruited 12 healthy individuals, none of whom was obese. They were then given an infusion of a fatty acid emulsion or saline solution via a feeding tube straight into their stomachs. This meant that taste was not involved and the participants did not know whether they were receiving saline or fat.

The fat was used because most comfort foods, such as chocolate, have a high fat content.

The researchers found that the levels of sadness among those fed the fat was approximately 50% lower compared to those fed saline solution, and say:

"These findings increase our understanding of the interplays among emotions, hunger, food intake and meal-induced sensations in general which may have important implications for a wide range of disorders including obesity, eating disorders, and depression."

In interview, a co-author, Giovanni Cizza, MD., said that he believes that the gut must be talking to the brain in some way:

"We did not know if you put fat in the stomach without pleasant stimulus, it could modulate our emotions ... There must be a way in which the gut talks to the brain."

The areas of the brain that get activated or suppressed as a result of emotion and mood were impacted by fatty acid emulsion. These fats reduced some of the emotion or neural changes, and this is a phenomenon that many patients have described.

"Many things in obesity have been said to be psychological and this adds to the body of evidence that something physical is going on."

Unfortunately, the recommendation to come from this study wasn’t that, perhaps, people who are sad or depressed might benefit from eating more fat, as you might have supposed, but that if scientists can identify what is going on, there might be a potential for new drug developments!

Oh, well, you can't win them all!

Reference
Van Oudenhove L, McKie S, Lassman D, et al. Fatty acid-induced gut-brain signaling attenuates neural and behavioral effects of sad emotion in humans. J Clin Invest. 2011. doi:10.1172/JCI46380.

Now, What Are We Going to Eat For Breakfast?

Reinforces Chapter 6: The Seeds of Ill-health

You may have read recently that, because of the use of recycled newspapers being used in the manufacture of cardboard used to make breakfast cereal boxes the boxes pose a serious cancer risk.

How times have changed.

I remember, many years ago, reading a study conducted on rats, which tested the relative nutritional merits of different breakfast cereals. In this study, the rats were divided into groups and each group was given a different breakfast cereal to live on. Then the last group was fed on the chopped-up cardboard breakfast cereal boxes.

Guess which group lived longest.

I expect you chose correctly: Yes, it was the group that ate the chopped up cereal boxes.

I regret that I can't find the reference for this study now, but the American consumer advocate, Robert Choate, quoted the study to a U.S. Senate subcommittee in Washington in 1970 as an example of the woeful nutritional inadequacy of breakfast cereals.

So this latest news must have come as something of a bombshell to the masses. Now, it seems, the only healthy thing about breakfast cereals you could rely on - the cardboard boxes they come in - can no longer be trusted either.

Oh dear! What on earth are we going to eat now? some will cry.

Me? I'll stick to my scrambled eggs for breakfast.