New
Cholesterol Guidelines Issued
New federal guidelines
for managing cholesterol issued in the US will increase the number
of Americans who are treated for high cholesterol -- either by
diet or drugs -- by roughly 36 million.
Among other changes,
the guidelines now recommend an
even lower intake of saturated fat a higher blood level of HDL,
or "good" cholesterol more rigorous testing of fatty
substances in the blood (triglycerides).
People with high cholesterol
are said to be at risk for heart disease, the leading cause of
death in the US.
About 500,000 Americans
die of heart disease each year. Other risk factors include:
- smoking
- excess weight
- a sedentary lifestyle
- type 2 diabetes
The guidelines update
the previous recommendations made in 1993. The new recommendations
still focus on lowering LDL, or "bad" cholesterol, with
a level below 100 milligrams per deciliter of blood (mg/dL) still
considered ideal.
However, the guidelines include a change in the recommended level
of HDL or "good" cholesterol. Now an HDL level of less
than 40 mg/dl is considered to be a risk factor for heart disease,
as opposed to 35 mg/dl.
The guidelines also
place greater emphasis on triglycerides, another fatty substance
in the blood. The guidelines recommend that doctors urge patients
whose triglyceride level is borderline to lose weight and exercise.
Healthy adults should
also have a lipoprotein analysis, which measures triglycerides,
total cholesterol, LDL and HDL cholesterol once every 5 years.
Previously, a screening test that looked only at total and LDL
cholesterol was advised.
Recommendations include:
- Patients should
consume no more than 7% of calories from saturated fat rather
than the previous recommendation of 10%.
- Adults are advised
to consume no more than 35% of calories from total fat, up from
the previous recommendation of 30%, provided that the main source
is unsaturated fat, which does not raise cholesterol levels.
- The
new target for cholesterol is less than 200 mg a day versus the
previous target of under 300 mg.
The soluble fiber found in cereal grains, beans, peas, legumes,
and fruits and vegetables may help to lower cholesterol level,
and exercising and maintaining a healthy body weight have been
shown reduce LDL cholesterol and boost HDL cholesterol levels.
Women are advised
against choosing hormone replacement therapy (HRT) as a replacement
for cholesterol-lowering drugs. According to the NHLBI, HRT does
not appear to lower the risk for a major heart attack among postmenopausal
women with heart disease and may increase the risk of stroke.
Overall, the guidelines
mean that 65 million Americans should make dietary changes to
lower cholesterol, up from 52 million who are now candidates,
and 36 million should be taking cholesterol-lowering drugs, compared
with 13 million who are prescribed the drugs.
The Journal of the American Medical Association May 16 2001;285:2486-2497
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Dr. Mercola's Comment:
OK, here we go again.
Now the "experts" have raised the ante. They changed
the "normal" range so even more people will be put on
cholesterol lowering drugs.
Prior to the new recommendations
13 million Americans "qualified" to be placed on these
drugs. With these new recommendations 36 million Americans now
qualify -- nearly triple the amount.
After all, that is
the answer, isn't it? If people can't lower their cholesterol
by following the low-fat nonsense then they need to take these
drugs to prevent them from falling prey to the number one killer
in the US, heart disease.
Hogwash. Nothing could
be further from the truth.
If you have been receiving
the newsletter for some time you will be familiar with my position
on this issue.
About one year ago
the experts predicted that HALF the population will be taking
these types of drugs.
The big issue here
is that these potent medications will be over the counter in the
near future with a massive PR campaign to encourage people to
swallow these potentially dangerous drugs.
The amazing thing
about these new recommendations is that they completely ignore
the previously published evidence that are quite clear in documenting
that the actual cholesterol level itself is not the most important
risk factor. It is actually the ratio between the level of total
cholesterol and HDL.
The ideal HDL/cholesterol
ratio should be higher than 25% and generally speaking the higher
the better.
The ideal triglyceride/cholesterol
ratio should be below 2.0.
If you did not know
any better and just listened to the "experts" you would
think cholesterol is an evil substance and that most of us would
benefit from lowering our cholesterol as low as possible.
Not so. Cholesterol
is a vitally important substance that is responsible for building
our cell membranes and many of our hormones. If the level drops
to low we are actually at increased risk for depression.
There are likely to
be some people who benefit from them, but it is probably far less
than 5% of the people who currently take them. These are individuals
with total cholesterol above 350 who have inherited liver processing
problems.
If these individuals
take the statin drugs however, they should also take Coenzyme
Q10, which is important for heart health and, like cholesterol,
is reduced when one takes these drugs. The proper way for nearly
everyone else to control their cholesterol levels is by reducing
their grain intake by following the food choice program I recommend.
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