TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/100989/10098900.017

Text File | 1990-09-18 | 6KB | 105 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.