Sunday, August 16, 2009


Cholesterol management is a continuing topic of interest amongst nutritionists, medical practitioners, policy makers and consumers, ever since this biochemical has been implicated in arterial diseases. The belief that cholesterol and its metabolic companions lipoproteins are involved in forming dangerous plaques on the walls of arteries has spawned an entirely new industry that manufactures and markets drugs called statins to reduce cholesterol levels in the blood. The statin manufacturers, numbering about a dozen are estimated to be raking in a mammoth turnover of about $ 26 billion in USA alone and this 'magic' drug is routinely being prescribed to people with cholesterol levels, even marginally higher than recommended optimum concentration in the blood.

The family of cholesterol containing lipoproteins like VLDL, LDL and HDL is present in human body at varying levels depending on the genetic make up, food intake, living style and some other factors. Cholesterol by itself is a soft waxy lipid that is not soluble in water or blood and it is in the form of lipoproteins that cholesterol performs its assigned metabolic functions. Cholesterol is critical for cell wall synthesis besides being a precursor to all of the steroid hormones like estrogen, testosterone, cortisone and others. Many believe that HDL cholesterol is good while LDL and VLDL cholesterol types are responsible for heart diseases. While body synthesizes cholesterol routinely through the mediation of HMG CoA Reductase enzyme, many of the foods we consume also contribute to cholesterol in the body. Optimum concentration of LDLs in blood is less than 100 mg/dL while high risk levels begin at 160 mg/dL. HDL concentration is generally around 40-60 mg/dL and a ratio of 5:1 for total cholesterol to HDL cholesterol is considered beneficial. Arcus juvenilis, a pale ring around the iris in the eyes and yellowish fatty deposits under the skin around the eyes called xanthelasmata usually are indicators of high cholesterol levels in the body.

There does not seem to be any unanimity regarding the role of cholesterol in causing heart attacks. Many believe that high levels of LDL and VLDL cholesterol are responsible for forming arterial plaques which block blood circulation through the heart causing myocardial infraction. A few reputed experts, however, contest this thesis and assert that cholesterol numbers are not important but small dense LDL particles formed in the blood probably due to development of insulin and leptin resistance, cause plaque formation. According to them these small LDL particles can squeeze between cells lining the inside of the arteries (gap junction) of the endothelium where they get stuck and are potentially oxidized causing inflammation of the lining and plaque formation. In support, hundreds of studies have been cited where majority of patients hospitalized for heart attack have cholesterol numbers, well within the recommended levels and reduction in cholesterol is not well correlated to reduction in mortality rate. While the ability of statin drugs to lower the circulating cholesterol is undisputed, whether such intervention helps to reduce the chances of heart attack is a debatable point and jury is till out on this issue. Many believe that high fibrinogen levels play more important role by its tendency to form blood clots and consequent effect on the heart.

Adding another dimension to this burning issue is the reported side effects of statins implicating it in muscle pain, nerve damage and memory impairment. Further the enzyme that is inhibited by statins to achieve low cholesterol numbers is also vital for synthesizing the co-enzyme Q10 involved in metabolic reactions converting food into usable energy for transport to the cells in the body. It is also well argued that current recommended levels of cholesterol are not easily achievable with diets and exercise regimes, except through intervention drug therapy using statins. No wonder that more than 12 million Americans are hooked on to statins because of the scare posed by such perceived dangers of cholesterol.

Consumption of whole cereals and pulses, soybean, garlic, onion, hot pepper, cloves, green tea, fruits like strawberry, grapefruit, orange and apple, almost all vegetables, fish, red wine, olive oil, many spices, nuts like almond and walnuts and most of the every day natural foods provide plenty of antioxidants which can ensure that cholesterol will never pose a problem vis-à-vis the heart. Naturally occurring phytochemicals present in plant foods work in different ways to protect the heart by preventing formation of blood clots and lowering of cholesterol. Probably food industry can seize the opportunity to win the 'hearts' of the consumers through the food route and break the stranglehold the statin industry has on them at present!


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