Setting cholesterol level

October 30, 2005 11:59 AM

Someone tells me if this is real!

The enclosed three paragraphs, which I wrote last week for the Weston A Price Foundation website to add to the "Oiling of America" article tells how the 200 mg/dl cutoff for serum cholesterol was decided back in 1984.

posted by zouhair to health (10 comments total)

The American Heart Association recommends less than 200mg, but allowing for age, ill-health, and individual exercise limits, 200-239 runs the “borderline high risk” for stroke and circulatory trouble. For HDL levels, anything under 130 is preferable.
posted by Smart Dalek at 12:43 PM on October 30, 2005

I'm not sure what you are asking. The blurb you link to basically describes an overheard conversation that the author believes was critical to allowing the National Heart Lung and Blood Institute (NHLBI) to run trials with people who had cholesterol in the 200-240mg/dl range to be included in the trials, paving the way for them to not to see improvements in their cholesterol levels through dietary restriction and thus strongly suggesting that medicine would be necessary for them (i.e. a real gimme to pharmaceutical companies.)

This is the Oiling of America article (originally published in Nexus Magazine)
This is Taubes' The Soft Science of Dietary Fat article (originally published in Science)

from the Science article: "When investigators tracked all deaths, instead of just heart disease deaths, the cholesterol curves were U-shaped for men and flat for women. In other words, men with cholesterol levels above 240 mg/dl tended to die prematurely from heart disease. But below 160 mg/dl, the men tended to die prematurely from cancer, respiratory and digestive diseases, and trauma. As for women, if anything, the higher their cholesterol, the longer they lived"

What part of the article are you wondering about?
posted by jessamyn at 12:43 PM on October 30, 2005

Whoops. For LDL levels, anything under 130 is preferable.
posted by Smart Dalek at 12:45 PM on October 30, 2005

Well, it certainly is a real article--which was followed by several rebuttal articles. However, in a later article in Science by Scott Grundy he makes the follow rebuttals:

"Although Taubes acknowledges the difference between saturated and unsaturated fatty acids, he does not draw a clear enough distinction in his discussion of dietary fats in general. Consequently, the article obscures the potential for public health benefits of substituting unsaturated for saturated fatty acids in the American diet."

Another rebuttal from Arne Astrup:
"In his discussion about the importance of dietary fat and CHD, Taubes focuses on the effect of fat on fasting blood lipids, but low-fat diets with plenty of fruit, vegetables, and fish predominantly exert their cardioprotective effect through other mediators such as blood pressure, thrombotic, fibrinolytic, and arrhythmic factors. Accordingly, an increase in dietary fat of 1% of energy intake is associated with an 8% increase in CHD (2). A Mediterranean, fat-reduced diet includes plenty of fruits, vegetables, and fish, and such a diet has been shown to reduce mortality by 45 to 60% in individuals with CHD (3).

The message in the article is misleading and counterproductive for public health policy to reduce dietary fat content and increase the consumption of fruit, vegetables, and fish, and to increase physical activity, advice based on robust scientific evidence."

Taubes still stands by his statement in that same article of Science, however. Taubes: "The article doesn't obscure the benefits; it simply questions whether they are sufficiently large for healthy individuals who eat reasonable diets (that is, sufficient fruits and vegetables) to be concerned. It also questions whether all Americans will benefit from a low-fat diet, or whether for some, at least, there are risks involved as well, which is still an unanswered question."

This is all in the Aug. 3 2001 issue, if you have access to the archives.
posted by divka at 12:50 PM on October 30, 2005

Is there a strong correlation between cholesterol and morbidity? Yes.

Are many medical cutoffs somewhat arbitrary? Yes. It's a constant struggle in epidemiology and statistics, and it alters sensitivity and specificity.

I too am not sure what you're asking about.
posted by gramcracker at 1:02 PM on October 30, 2005

I consider Mary Enig and Sally Fallon (from the Weston A. Price Foundation (more on Weston A. Price) quacks. They do not seem to read scientific data the way practically all other scientists do, and they are very proud of not being politically correct (they promote a diet with lots of cheese and other animal fats). The problem, as with most quacks, is that they do have some good points (e.g.: phytic acid can be a problem with grains, if unleavened breads are the staple of a diet), but their general conclusions (you should make sure you consume close to no phytic acid at all) are way off.

I would take anything they say with a huge grain of salt.
posted by davar at 3:56 PM on October 30, 2005

The Weston A Price Foundation is full of nuts and quacks and they have no credibility on any subject. They may be right or they may be wrong on this one, but they've been wrong so often I just wouldn't bother listening to them at all.
posted by Optimus Chyme at 5:43 AM on October 31, 2005

Here is another article that supports Taubes's contention.

As far as how arbitrary medical cutoffs are, the usual method for determining a "normal" lab value is to measure a large number of healthy individuals, and then make "normal" any value within 2 standard deviations of the mean (95% of the people measured) This was done with cholesterol when the normal value was 240; that is why the newer values are more properly reported as "recommended" rather than "normal". As Dr. Abramson (quoted in the linked article and a vocal critic of drug companies) points out, the overall mortality does not improve siginificantly when cholesterol is lowered even if there is a slight gain in cardiovascular mortality.
posted by TedW at 6:19 AM on October 31, 2005

I just got back from the MD to discuss my latest results. My total was 214 which the MD said would be borderline except for the fact that my HDL was 83 which made my "ratio" 2.6. He goes on to say that so long as this ration is under 5 it's all good.

This isn't an answer more like adding a question of my own. So is it the total level or the ration that really matters?
posted by Carbolic at 9:38 AM on October 31, 2005

Thanks to you all, my real concern was about the 2 last paragraphs :

But what Gary Taubes didn't know was that there was a political decision being made on the floor of the NIH (Building 10) Mazur Auditorium that day in December 1984. The decision would allow the National Heart Lung and Blood Institute (NHLBI) to have yet another even more extensive long-term "trial" to work on. The NHLBI could not get more money from Congress for more large trials such as the MRFIT or LRC and they were developing the National Cholesterol Education Program. With the cutoff number at the lower end of the normal range (200 mg/dl), they could include all of the healthy normal citizens in the range that would need treatment with diet, and since the diet would never work to permanently lower those normal levels (eg, 200 mg/dl to 240 or 260 mg/dl) to below 200 mg/dl, they could recommend that all these people should go onto cholesterol-lowering medications.

The three men who were heading the NHLBI (Cleeman, Lenfant, and Rifkin) were standing together in the Mazur Auditorium just before the Cholesterol Consensus Conference began. They were discussing the cutoff level of serum cholesterol to put into the consensus report. One said to the other two, "but we can't have the cutoff at 240 [mg/dl]; it has to be at 200 [mg/dl] or we won't have enough people to test." Several of us from the University of Maryland Department of Chemistry Lipids Research Group were standing directly behind them and within clear earshot. We looked at each other and of course were not surprised when the final numbers came out. This small chat did not get onto the tapes that Taubes reviewed.

Do they really set the normal level just to get enough people to begin the study ?
posted by zouhair at 1:23 PM on October 31, 2005