Cholesterol: journal of a campaign

20 March 2004
Clearly I have to do something about cholesterol levels and the related questions of blood glucose and weight. The statin model for control is basically unappealing to me, on several grounds (not least being a desire to not be in thrall to pharmaceutical companies, and to not be on lifetime medication), and I'd prefer "lifestyle changes" to what I think of as chemical dependency.

Ron sent me a number of pointers to Web resources that seem to me to make a lot of sense, and further said that he'd used niacin successfully himself. The most complete and coherent material I've found so far has been the pages of Joseph Mercola --an osteopathic physician. His "nutrition plan" emphasizes control of insulin levels, reduction of grains, exercise, more vegetables [notably as juice], 1/3 uncooked food, fish oil, high protein (he advises eggs, not dairy, limited soy [though he exempts fermented soy, specifically tempeh and miso], bison, limited beans ["If you have high insulin levels, you will want to avoid beans until you have normal insulin levels. If you have achieved your ideal weight, you can introduce beans."], reducing sweeteners). There are bits of his advice that I'm somewhat dubious about: he advocates NOT cooking eggs ["Scrambled eggs or omelets are one of the worst ways to prepare eggs "], and warns against the heavy metal toxins and other contaminants in fish, and avoids non-fermented soy ["avoid tofu, soy protein products, soymilk"] and dairy. Chlorine and fluoride in water also come in for warnings. And "Coffee has been shown to raise cholesterol, worsen your insulin control...", and fruit juices...

In fact, the more I read of the Mercola scheme, the more dubious I am... though a goodly fraction of that is due to my own established food prejudices, which have (truth be known...) no particular theoretical or factual bases.

Mercola is chary about niacin (see comments)

Niacin: one version... and NIH on Niacin For High Cholesterol. Also (which has a Lipitor ad on the right frame). Several sites mention "no-flush" niacin (inositol hexanicotinate) --available in various packagings, e.g., Says Columbia's Go Ask Alice:

niacin... is helpful in reducing cholesterol under certain conditions. One such condition is when the high cholesterol is due to a particular hyperlipidemia type. This means your body produces too much cholesterol. You should be monitored by your physician while taking niacin supplements because the amount you may need to take will very likely cause side effects. At high amounts, niacin is no longer acting as a typical "daily vitamin" but instead as a drug. Discuss this thoroughly with your physician before starting any type of regimen of supplementation.
Among the warnings: Nutrition Action --(which says "Large doses of niacin are not supplements, but drugs," says Louis Lasagna, dean of the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston. "Niacin is capable of damaging the liver, activating peptic ulcers, impairing glucose tolerance, and precipitating gouty attacks," he adds. And many niacin-takers suffer from flushing, headaches, nausea, heartburn, and diarrhea), and also includes this counter-Mercola statement: "A diet rich in beans, whole grains, fruit, and other foods high in soluble fiber can help lower cholesterol levels. There's no question about that."

see also Center for Medical Consumers ...and their page on statins on Nicotinic acid for high cholesterol

Supplement Watch on niacin

So here's what I come down to today after an hour of walking and thinking:

...but various sources disagree on some specific foods, saying that they are either "good" or "bad". In this regard, I am quite confused about the "true" status ofMy own downfalls are clear enough: And I'd like to have better perspective on what animal proteins aren't "toxic", either from their production technology [industrial agriculture], or feeding behavior [fish at top of food chain], or saturated fat/cholesterol content?

I believe that I have genetic predisposition toward elevated cholesterol, so "lifestyle" has to compensate. Can it?

Could 3 months of niacin PLUS exercise PLUS dietary adjustment put my HDL/LDL into better balance? And if in better balance, could exercise and diet maintain?

22 March
On the coffee question: Mochajen's Compilation of Caffeine Research is one of many that seem to suggest NO particular coffee/cholesterol connection.

It seems that the coffee diterpenes cafestol and kahweol are the culprits, though they are pronounced only in Scandinavian boiled and Turkish methods of brewing. More than anybody could EVER want to know about their toxicology can be found here ...and Annual Review of Nutrition (vol 17 [1997]) seems to have an article on THE CHOLESTEROL-RAISING FACTOR FROM COFFEE BEANS

Some coffee brewing techniques raise the serum concentration of total and low-density-lipoprotein cholesterol in humans, whereas others do not. The responsible factors are the diterpene lipids cafestol and kahweol, which make up about 1% (wt:wt) of coffee beans. Diterpenes are extracted by hot water but are retained by a paper filter. This explains why filtered coffee does not affect cholesterol, whereas Scandinavian "boiled," cafetiere, and Turkish coffees do. We describe the identification of the cholesterol-raising factors, their effects on blood levels of lipids and liver function enzymes, and their impact on public health, based on papers published up to December 1996.
Further, a Journal of Internal Medicine article avers that French Press coffee is also guilty: Consumption of French-press coffee raises cholesteryl ester transfer protein activity levels before LDL cholesterol in normolipidaemic subjects
Unfiltered coffee brews like French-press coffee, Scandinavian boiled coffee and Turkish coffee contain 3-6 mg of each diterpene per cup [ 2]. These diterpenes are the most potent cholesterol-raising substances from the diet that are known. Therefore, the action of cafestol and kahweol offers an interesting model to study the effect of dietary substances on cholesterol metabolism in humans.
...sooooo the conclusion seems to be that filtering is the magic solution. So I see myself continuing to use the espresso pot, but pouring the result through filters... oh, what we'll do to keep our addictions...

23 March

A study of 9,600 Americans found that those who ate plenty of legumes had lower total cholesterol. Legumes are rich in soluble fiber, which has been shown to help lower total cholesterol and LDL (''bad'') cholesterol levels, the study authors note. [Archives of Internal Medicine 2001;161: pp.2573-8].
Legume Consumption and Risk of Coronary Heart Disease in US Men and Women
NHANES I Epidemiologic Follow-up Study
Lydia A. Bazzano, PhD; Jiang He, MD, PhD; Lorraine G. Ogden, MS; Catherine Loria, PhD, MS; Suma Vupputuri, PhD, MPH; Leann Myers, PhD; Paul K. Whelton, MD, MSc
Arch Intern Med. 2001;161:2573-2578.
Background Soybean protein and dietary fiber supplementation reduce serum cholesterol in randomized controlled trials. Consumption of legumes, which are high in bean protein and water-soluble fiber, may be associated with a reduced risk of coronary heart disease (CHD).
Methods A total of 9632 men and women who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) and were free of cardiovascular disease (CVD) at their baseline examination were included in this prospective cohort study. Frequency of legume intake was estimated using a 3-month food frequency questionnaire, and incidence of CHD and CVD was obtained from medical records and death certificates.
Results Over an average of 19 years of follow-up, 1802 incident cases of CHD and 3680 incident cases of CVD were documented. Legume consumption was significantly and inversely associated with risk of CHD (P = .002 for trend) and CVD (P = .02 for trend) after adjustment for established CVD risk factors. Legume consumption 4 times or more per week compared with less than once a week was associated with a 22% lower risk of CHD (relative risk, 0.78; 95% confidence interval, 0.68-0.90) and an 11% lower risk of CVD (relative risk, 0.89; 95% confidence interval, 0.80-0.98).
Conclusions Our study indicates a significant inverse relationship between legume intake and risk of CHD and suggests that increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD in the general population.

25 March
Cleaned-up Exercise and Food acts are presently producing a pound a day of negative avoirdupois... and in general my frame of mind is much improved.

30 June
I notice that I didn't do much keeping track of... but I did have a recheck of the little numbers at the end of May, after a couple of months of diet and exercise, and was very pleased to have them in much better conformation --triglycerides especially had declined, and 20ish pounds lost has made quite a difference in overall feeling of fitness.

24 April 2005
Just to close the loop... 10 months later, I gained back that 20 (New Yorker cartoon: caption "your lost weight", picture of several quanta of weight, one consulting wristwatch, sez 'time to head back'). In January I started taking Vytorin, and since then have had no side effects. Levels are now in 'normal' territory, and I'm eating cheese and eggs ad lib. Avoirdupois will eventually succumb to diet/exercise reform.