08 December 2011

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]


Nightingale said...

Too bad medicine is going the way of global warming: more religion than science.

Glad my cholesterol is "high."

Hope government doesn't ban butter, or I'll have to buy a cow...or goat.

l arginine said...
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Anonymous said...

It's only a paradox when the expected outcome differs from the actual outcome and the validity of the 'expected outcome ' can't be challenged. Why on earth do they bother with these experiments if they completely ignore the evidence and just shout PARADOX!!! Like the fatty Mediterranean diet ...PARADOX!!

Barry Groves said...

Couldn't agree more with all of you!

Actually, Nightingale, it would have to be a cow; you won't make much butter from goat's milk.

Nightingale said...

Guess that's why goat butter is so expensive!

johnfused said...

Now here's a real paradox: under the blog there's an advert proclaiming 'Lower your Cholesterol' with Flora ProActiv -- yikes, what will people think?! And presumably you can't put up any warning signs about that, but have to rely on people's good sense... Good sen... oooh...

HS4 said...

This is bit off topic I suppose but any advice, Barry, for someone who's tried many times to adopt a low carb, moderate protein, high fat regimen but with no success?

I find it very difficult to eat more than small amounts of fat or animal protein at one meal. If I force myself to eat a high protein meal I feel ill all day - queasy, overly full, sometimes nauseous. The only thing that quietens these symptoms is eating a carb, even in small quantities.

I have read a great deal of literature, both popular and technical, on low carb regimens and am absolutely convinced this is the best way to eat but cannot manage to get there myself. Any suggestions or insight would be very much appreciated.


Barry Groves said...

Yes, HS4, it is off topic. If you send me your email address (to barry@second-opinions.co.uk), I'll reply further to that if necessary.

In the meantime, don't force yourself to eat any more fat or protein than your body tells you it needs. When you have eaten enough, stop. If you eat until you feel sick, you've eaten too much. That's how this way of eating works.

If you have been used to filling a large plate with all those veges, you'll find that, with this way of eating, your intake volume will be a lot less than you are used to.


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lesley said...

I'm so enjoying reading Trick and Treat, there's similarities with the Dukan diet. My daughter has never looked back since she went on this approach to healthy eating. She has been about 2 stone over weight for many years and has stayed at a stady 9.5 stones now for several months. She ate pasta last week and felt ill the next day. I've been researching diet for my husband who has Rheumatoid Arthritis. The drugs he takes have side-effects that are unpleasant, plus the amount of painkillers he takes have more undesirable affects on the body. So, its steaks on the menu today.

Anonymous said...

Hi Barry! Love the blog and your website. what is your opinion on types of dairy? I mean is there really such a difference between raw unpasteurised milk, or the shop bought stuff?

Dairy has also shown to be insulin promoting, especially milk. Should milk be avoided in favour of cream? And what about grass fed?

I know you are an advocate of low carb eating but what about the quality of the dairy? surely feedlot grain fed cattle will produce a different kind of milk to their grass fed counterparts?

Barry Groves said...

Hi Bob

I am a fan of raw milk. And there really is a huge difference between that and the shop bought stuff: If nothing else, raw is cleaner. No farmer selling raw milk could allow his milk to be contaminated with anything - he would soon go out of business; however, farmers producing milk which will go through the factory processing that shop bought milk does, need not be so careful. It's no secret that milk for pasteurisation contains vastly more blood, pus and other nasties. The processing also robs it of pretty much all of its nutritional value. And removing the cream makes it positively dangerous. See my article on low-fat dairy for more detail.

Yes, grain feeding cattle does change the proportions of various fatty acids - in favour of omega-6 polyunsturates, which we don't want! Grain feeding also ruins the health of the cattle!!

I think milk could be a valuable food resource if farmers were left to do what they do best. But they aren't. So, I do not drink milk at all, as I cannot get it raw. But I can get (from a friendly farmer) and do drink about half a gallon of double cream (48% fat) a week.


Sharon said...

Hi Barry,
I have been following your advice in the Trick and Treat book and lost weight - didn't have a lot to lose but am finding I have not lost the reflux I have had for a few years. My carbs are well down and fat content well raised. Can you advise please?
Much appreciated