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.

HFCS Name Sanitized to Boost Flagging Sales

A rose by any other name?

The Corn Refiners Association (CRA) has been trying for years to make high fructose corn syrup (HFCS), which I prefer to call the ‘Corn Refiners Association Product’ (CRAP), as acceptable as all other forms of sugar. As more and more studies show that CRAP (HFCS) is a major cause of the recent dramatic increases in obesity, diabetes and other ‘metabolic diseases’ in the US, UK and other westernised countries, consumers are getting the message and are abandoning CRAP laden foodstuffs in their droves.

Does the CRA give up? No sirree! The CRA think that if they change its name, the gullible public won’t notice. According to the Associated Press, CRA is now petitioning the U.S. Food and Drug Administration (FDA) to allow it to change the name of the highly-processed, controversial sweetener to ‘Corn Sugar’, which they fervently believe will make it more acceptable.

No matter how you look at it, CRAP (HFCS) is a highly-processed, unnatural form of refined sugar that inflicts a heavy burden on the liver. Besides being derived from corn, most of which is genetically-modified (GM), HFCS is linked to metabolic syndrome, heart disease and type-2 diabetes. If that weren’t bad enough, a study last year also found that much of the HFCS contains high levels of toxic mercury caused by the chemical refining process necessary to produce the HFCS. Nearly a third of the HFCS-containing breads, cereals, sodas and other consumer foods tested as part of the study showed up positive for mercury.

Despite the overwhelming evidence showing that HFCS is harmful to health, the CRA is determined to change its image. With millions of acre of corn to get rid of somehow, they can’t afford not to. Consumption of HFCS has reached a 20-year low, and shows no sign of picking up. So the CRA have a new marketing slogan which claims that ‘whether it's corn sugar or cane sugar, your body can't tell the difference. Sugar is sugar’.

Oh yes it can – otherwise our bodies wouldn’t get sick from eating it!

The best forms of sugar are those which occur naturally, and in their whole form. That said, the main cause of sugar’s adverse effects on health lie in the fructose content, not the glucose. So it is better to cut down on even very sweet fruits and honey which are fructose (levulose) rich. If you must sweeten anything, use stevia leaf extract. Better still learn to like the naturalness of foods without adding sweetener.

So whether it’s called High Fructose corn Syrup or Corn Sugar, it’s the same thing, with the same results. As Shakespeare wrote: ‘A rose by any other name would smell as sweet’. Similarly, HFCS by any other name will still be CRAP.

Another Huge Study Finds Little Benefit From '5-a-day'

Supports Chapter 8: Why 'Five Portions'?

You may have heard on the news today about this latest study, which didn't find much benefit from forcing five portions of fruit and veges down. I was not surprised as all the ones before it are detailed in Chapter 8 of Trick and Treat. But it was good of the media to report it. 'Bad news' like this is generally missed.

There have been several studies since the '5-a-day' message was first trumpeted. None so far has found much, if any benefit from eating so much vegetation. This latest one is by far the biggest - but its findings are much in line with the earlier studies.

Wouldn't it have been better if the diet dictocrats had thought to do a study before they told us all to eat so much!

The abstract to the latest study is below.

I have written a full article explaining why it's NOT a good idea to eat 5-a-day.

* * * * * *

Paolo Boffetta, et al. Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC) JNCI 2010 [e-pub ahead of print]



ABSTRACT
Background: It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk.

Methods: We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992–2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking.

Results: Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person-years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol.

Conclusions: A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.


CONTEXT AND CAVEATS

Prior knowledge

The association between high intake of fruits and vegetables and reduction in overall cancer risk is not conclusively established.

Study design

European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study was conducted between 1992 and 2000. Diet and lifestyle data were self-reported by the participants. Cancer incidence and mortality data were obtained from country-specific national and regional registries. Association between overall cancer risk and high intake of total fruits, total vegetables, and total fruits and vegetables combined was assessed. Estimated cancer risks were adjusted for smoking, alcohol consumption, and many other variables.

Contribution

High intake of vegetables, and fruits and vegetables combined, was associated with a small reduction in overall cancer risk. The association was stronger in heavy alcohol drinkers but was restricted to cancers caused by smoking and drinking.

Implications

This study reveals a very modest association between high intake of fruits and vegetables and reduced risk of cancer.

Limitations

The inverse association between overall cancer risk and high intake of fruits and vegetables was weak. Errors inherent to self-reported dietary habits may have resulted in bias.

But weren't we told that statins didn't have side effects?

Supports Chapter 1: Trick to Treat

This short article was published in the Daily Mail today. It's a long time since I blogged, so I thought I'd include it for your enjoyment.

The statin manufacturers have always denied that their products have side effects. They have been so convincing that many doctors have simply refused to hear their patient's complaints.

Now there is a new cholesterol-lowering drug in the offing. I don't propose to discuss the merits or otherwise of lowering cholesterol; I'm sure you kmnow my feelings on that. I just want to show you how this new drug is being promoted: "free of the side-effects associated with statins."

So after denying that statins had side effects, the fact that they have is going to be used to launch this new drug.

I wonder what side effects this new drug will have. There are always some.

Here' the article:

11/03/2010
Daily Mail
By: Presswatch
New 'statin' without the side effects
Cholesterol levels declined by a third in patients taking eprotirome tablets, according to a study published in the New England Journal of Medicine. The drug was free of the side-effects associated with statins, including muscle and liver problems, depression, loss of libido and difficulty sleeping. Eprotirome, which is still several years away from the market, is unlikely to replace statins. But it could be given to the hundreds of thousands who cannot tolerate the drugs. It also lowers levels of other harmful blood fats that are not combated by statins, but are known to raise the risk of heart disease.