TIME: Almanac 1993/TIME Almanac 1993.iso/time/100989/10098900.017

Text File | 1992-09-23 | 6.0 KB | 116 lines

                                                                                HEALTH, Page 108

Don't Go Back to Butter


The less-cholesterol campaign is under fire, but not discredited

By Andrew Purvis


    Nothing is more appealing than a simple solution to a
complex problem. That is why so many people have eagerly
embraced the notion that eating right can prevent heart disease.
Following the advice of the U.S. Government's National
Cholesterol Education Program (NCEP), millions of Americans have
lined up to get their cholesterol checked and have purged their
refrigerators of fatty foods. Food manufacturers are pumping up
sales simply by touting their products as "cholesterol free."
Rarely has a health campaign so quickly become a national
obsession.

    But now a backlash may be in the offing. In the provocative
new book Heart Failure, excerpted in the September issue of the
Atlantic magazine, Thomas Moore, a Washington-based writer,
contends that overzealous crusaders against cholesterol have
exaggerated the benefits of low-fat diets. Moore, who spent
four years reviewing the scientific literature on the subject,
acknowledges that researchers have established a link between
high cholesterol and increased risk of heart disease. He
argues, however, that diet modification cannot do much to lower
cholesterol, that reducing blood levels of the suspect
substance has not been proved to prolong life and that
cholesterol-lowering drugs may carry more risks than benefits.
Moore's readers are likely to come away totally bewildered about
what to believe and whose advice to follow.

    Is he right? Up to a point, yes. Many of his criticisms of
the anticholesterol campaign have been voiced by respected
researchers in the New England Journal of Medicine and the
Journal of the American Medical Association. Certainly, many
people have an overly simplistic view of the relationship
between diet and heart disease. Observes Dr. Allan Brett, an
assistant professor at the Harvard Medical School: "Some
patients have been led to believe that lowering cholesterol is
like magic: eat a bowl of oat bran, and you're cured. For most,
that's not true."

    None of Moore's arguments, however, disprove the basic
contention that high-cholesterol diets are potentially
hazardous. The evidence against cholesterol is stronger than he
implies. If his readers go back to pouring on the gravy and
spreading the butter, then the book will have done them a
disservice.

    Unfortunately, heart disease is a hideously complex
phenomenon. Diet is just one of a panoply of risk factors, which
also include heredity, smoking, high blood pressure and obesity.
Even the idea that cholesterol is "bad" is seriously flawed,
since the chemical is produced naturally in the body and is
vital to the functioning of human cells. It is carried in the
bloodstream by two types of molecules: low-density lipoproteins
(LDL) and high-density lipoproteins (HDL). Too much LDL is
harmful because it contributes to the accumulation of fatty
deposits that block arteries, but large amounts of HDL are
thought to be beneficial because they seem to help clean the
blood vessels. Moore correctly points out that many routine
cholesterol checks may be misleading, since the tests often do
not distinguish between LDL and HDL levels, and those that do
may be inaccurate.

    Moore's contention that diet has little impact on
cholesterol levels is an oversimplification. Some patients
respond dramatically to diet therapy, others hardly at all. The
author cites studies showing that people who change their eating
habits generally lower their cholesterol levels by 5% to 10%.
But Dr. James Cleeman, coordinator of the NCEP, maintains that
the typical reduction range is more like 10% to 15%.

    Even more controversial is Moore's suspicion that lowering
cholesterol does not increase one's odds for a longer life. In
the major studies that have probed this issue, people with low
cholesterol got heart disease less often than those with high
levels. But, as Moore points out, the low-cholesterol people
did not live longer on average, because some of them died from
other ailments. Whether this was by chance or the result of low
cholesterol remains an open question. That puzzling outcome
does not overly impress most researchers. They feel that as
additional, longer studies are completed, it will be proved that
lowering cholesterol can prolong life. In the meantime, it makes
sense for people to try to reduce their risk of heart disease
and take their chances with other illnesses.

    Moore is on firmer ground in sounding an alarm about drug
therapy. While the NCEP says cholesterol-lowering drugs should
be used only after diet modification fails, many doctors are too
quick to reach for the prescription pad. Reason: patients find
it easier to take pills than to give up steak and eggs. Yet
taking drugs for a lifetime can have unintended and perhaps
dangerous side effects. The well-established anticholesterol
drugs, including cholestyramine and nicotinic acid, seem to be
relatively safe, but they can produce such discomforts as nausea
and intestinal pain. Newer drugs, like the heavily promoted
lovastatin, may be better tolerated, but their long-term safety
and effectiveness have not been established. Moreover, reducing
cholesterol too far may carry some risk. Some studies, not yet
confirmed, have shown a link between abnormally low cholesterol
levels and increased danger of cancer and stroke.

    So what is the bottom line? Like it or not, there is no
simple way to guarantee a life free of heart disease. Someone
may swear off French fries for decades and still be struck down.
Someone else may eat eggs every day and live to be 100. But in
the game of life, smart players look at the odds. And most
health professionals remain convinced that a sensible diet, with
only moderate amounts of saturated fats and cholesterol, raises
the odds of avoiding a heart attack.