20 replies to this topic

[OEXCHAOS]

I have read that fiber is the easiest, safest, and fastest way to lower LDL...plus an added benefit of lowering prostate risk and perhaps dropping a few pounds, too. M

[maineman]

"Fiber" is great stuff. The question is will it reduce the LDL to a level that has been shown to prevent coronary and related disease. Tested and researched. Answer? No. Until statins were developed we used Fiber, (dietary or supplement, like Metamucil) and for some, cholestyramine powder. This is back in the 70s and 80s. We also used high doses of Niacin supplements ( a "natural" vitamin). By the time the 1988 NCEP (National Cholesterol Education Program) guidelines were published we realized that we could NOT reach patient goals with these methods alone. Our current advice is this: get your LDL below 130 and KEEP it there, however you can. If you cannot do it by diet, (either unwilling, unable or cursed with genetically high LDL as some are) then please take a pill. Your life is at stake. Or if diet alone (along with fiber, etc) just doesn't quite get you to 130 or less, please take a pill. When I prescribe a Pill, which is always as a last resort, I weigh all risks and benefits. The balance is massively tilted to the benefit side for this number one cause of mortality and morbitity. As for prostate..... risk..... do you mean BPH or prostate cancer? THere is a big difference. There is currently no known way to PREVENT prostate cancer, only excellent early detection and rapidly improving treatment protocols. (another smile-on-my-face improvement since I"ve been in practice). As for BPH we all get it as we age. Saw Palmetto, either in tea or capsule has been shown to be moderately effective for those who may be getting up a few times a night to tinkle.. mm

[calmcookie]

Good heavens, my friend, there certainly ARE ways to prevent prostate cancer. And I am not alone in this opinion. It is shared by some prominent scientists, including Dr. Walter Willett (MD PhD from Harvard School of public health) and 72 year old, Dr. Bob Bruce (MD PhD) from the University of Toronto ... to name just TWO). Will explain more in the morning.

Edited by calmcookie, 15 February 2006 - 04:13 PM.

[OEXCHAOS]

As for prostate..... risk..... do you mean BPH or prostate cancer? THere is a big difference. There is currently no known way to PREVENT prostate cancer, only excellent early detection and rapidly improving treatment protocols. (another smile-on-my-face improvement since I"ve been in practice). As for BPH we all get it as we age. Saw Palmetto, either in tea or capsule has been shown to be moderately effective for those who may be getting up a few times a night to tinkle..

mm

Actually, I thought I read that those with diets high in fiber had a lower incidence (or parhaps later onset?) of prostate cancer. I used to be hipper on some of this stuff as I was playing squash with the head of the UC Barrett Cancer Center and a few other movers in Cincinnati medicine. There was all sorts of talk in the 80's and 90's about this stuff.

BTW, the medical field has certainly improved it's approach to prostate cancer...not that long ago, it was a pretty nasty affair with some pretty unplesant long term effects. My father just recently had a bout and it was essentially a 6 month inconvenience (thanks to both new treatments and early detection). I was and am impressed.

M

[calmcookie]

MM, Please give me just ONE scientific reference that proves high cholesterol foods, such as eggs and liver, increase cholesterol levels. Just ONE, well designed study. C.C.

[maineman]

MM,

Please give me just ONE scientific reference that proves high cholesterol foods, such as eggs and liver, increase cholesterol levels. Just ONE, well designed study.

C.C.

CC, Here's 44 studies. These are the references sited in the groundbreaking study
by Hunninghake, et.al in 1993. They were the first to really challenge the 1988 NCEP guidelines to see if it was feasible for the general population to follow the cholesterol lowering guidelines. It was their conclusion that diet alone wasn't going to cut it. I hope these help.

maineman

• <LI value=1>Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988;148:36-69.[Abstract] <LI value=2>Bradford RH, Shear CL, Chremos AN, et al. Expanded Clinical Evaluation of Lovastatin (EXCEL) study results. I. Efficacy in modifying plasma lipoproteins and adverse event profile in 8245 patients with moderate hypercholesterolemia. Arch Intern Med 1991;151:43-49.[Abstract] <LI value=3>The Lovastatin Study Group II. Therapeutic response to lovastatin (mevinolin) in nonfamilial hypercholesterolemia: a multicenter study. JAMA 1986;256:2829-2834.[Abstract] <LI value=4>Havel RJ, Hunninghake DB, Illingworth DR, et al. Lovastatin (mevinolin) in the treatment of heterozygous familial hypercholesterolemia: a multicenter study. Ann Intern Med 1987;107:609-615.[Medline] <LI value=5>Lovastatin Study Groups I-IV. Lovastatin five-year safety and efficacy study. Arch Intern Med (in press). [url="http://"""]<LI value=6>Market research data. Phoenix, Ariz.: PDS/Walsh America, 1991. [/url]<LI value=7>Fats and other lipids. In: National Research Council. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press, 1989:159-258. [url="http://"""]<LI value=8>Harris WS, Held JD, Dujovne CA. The dietary R.I.S.C. rating: a novel method to assess the hyperlipidemic potential of a diet. Arteriosclerosis 1988;8:633a-634a.abstract [/url]<LI value=9>Connor SL, Gustafson JR, Artaud-Wild SM, et al. The cholesterol/saturated-fat index: an indication of the hypercholesterolaemic and atherogenic potential of food. Lancet 1986;1:1229-1232.[Medline] <LI value=10>Steiner PM, Freidel J, Bremner WF, Stein EA. Standardization of micro-methods for plasma cholesterol, triglyceride and HDL-cholesterol with the Lipid Clinics' methodology. J Clin Chem Clin Biochem 1981;19:850-850.abstract <LI value=11>Myers GL, Cooper GR, Winn CL, Smith SJ. The Centers for Disease Control-National Heart, Lung, and Blood Institute Lipid Standardization Program: an approach to accurate and precise lipid measurements. Clin Lab Med 1989;9:105-135.[Medline] <LI value=12>Warnick GR, Albers JJ. A comprehensive evaluation of the heparin-manganese precipitation procedure for estimating high density lipoprotein cholesterol. J Lipid Res 1978;19:65-76.[Abstract/Full Text] <LI value=13>Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.[Abstract/Full Text] <LI value=14>Manual of laboratory operations: Lipid Research Clinics Program. Vol. 1. Lipid and lipoprotein analysis. Washington, D.C.: Government Printing Office, 1974. (DHEW publication no. (NIH) 75-628). <LI value=15>Cloey TA, Bachorik PS. Use of a dual-precipitation procedure for measuring high-density lipoprotein 3 (HDL3) in normolipidemic serum. Clin Chem 1989;35:1390-1393.[Abstract/Full Text] <LI value=16>Stein EA, DiPersio L, Pesce AJ, et al. Enzyme-linked immunoabsorbant assay of apolipoprotein AII in plasma, with use of a monoclonal antibody. Clin Chem 1986;32:967-971.[Abstract/Full Text] <LI value=17>Stein EA, Kreisberg R, Miller V, Mantell G, Washington L, Shapiro DR. Effects of simvastatin and cholestyramine in familial and nonfamilial hypercholesterolemia. Arch Intern Med 1990;150:341-345.[Abstract] <LI value=18>Miller JA, Stein EA, Kaplan LA. Development of a competitive binding enzyme-linked immunoabsorbant assay (ELISA) for plasma apolipoprotein E using a monoclonal antibody (MAb). Clin Chem 1990;36:964-964.abstract [url="http://"""]<LI value=19>Stein EA, Kumbla L, Miller J, Srivastiva L, Kashyap M. Development and evaluation of a competitive ELISA for Lp(a). Clin Chem 1992;38:1067-1067.abstract [/url]<LI value=20>Smith SJ, Cooper GR, Henderson LO, Hannon WH. An international collaborative study on standardization of apolipoproteins A-I and B. Clin Chem 1987;33:2240-2249.[Abstract/Full Text] <LI value=21>Labeur C, Rosseneu M, Henderson LO. Results of the first survey on Lp(a) measurements in lyophilized serum pools. Presented at the 55th European Atherosclerosis Society Meeting, Brugge, Belgium, May 17-19, 1990. abstract. <LI value=22>Warnick GR, Mayfield C, Albers JJ, Hazzard WR. Gel isoelectric focusing method for specific diagnosis of familial hyperlipoproteinemia type 3. Clin Chem 1979;25:279-284.[Abstract/Full Text] <LI value=23>Sprecher DL, Taam L, Brewer HB Jr. Two-dimensional electrophoresis of human plasma apolipoproteins. Clin Chem 1984;30:2084-2092.[Abstract/Full Text] <LI value=24>McDowell IFW, Wisdom GB, Trimble ER. Apolipoprotein E phenotype determined by agarose gel electrofocusing and immunoblotting. Clin Chem 1989;35:2070-2073.[Abstract/Full Text] <LI value=25>Searle SR. Linear models. New York: John Wiley, 1971. <LI value=26>Laska E, Meisner M, Kushner HB. Optimal crossover designs in the presence of carryover effects. Biometrics 1983;39:1087-1091.[Medline] <LI value=27>Bishop YMM, Fienberg SE, Holland PW. Discrete multivariate analysis: theory and practice. Cambridge, Mass.: MIT Press, 1975. <LI value=28>Ramsay LE, Yeo WW, Jackson PR. Dietary reduction of serum cholesterol: time to think again. BMJ 1991;303:953-957.[Medline] <LI value=29>Lewis B, Hammett F, Katan M, et al. Towards an improved lipid-lowering diet: additive effects of changes in nutrient intake. Lancet 1981;2:1310-1313.[Medline] <LI value=30>Mattson FH, Grundy SM. Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man. J Lipid Res 1985;26:194-202.[Abstract] <LI value=31>Cobb MM, Teitelbaum HS, Breslow JL. Lovastatin efficacy in reducing low-density lipoprotein cholesterol levels on high- vs low-fat diets. JAMA 1991;265:997-1001.[Abstract] <LI value=32>Schoeller DA. How accurate is self-reported dietary energy intake? Nutr Rev 1990;48:373-379.[Medline] <LI value=33>Mertz W, Tsui JC, Judd JT, et al. What are people really eating? The relation between energy intake derived from estimated diet records and intake determined to maintain body weight. Am J Clin Nutr 1991;54:291-295.[Abstract] <LI value=34>Duncan KH, Bacon JA, Weinsier RL. The effects of high and low energy density diets on satiety, energy intake, and eating time of obese and nonobese subjects. Am J Clin Nutr 1983;37:763-767.[Abstract] <LI value=35>Sheppard L, Kristal AR, Kushi LH. Weight loss in women participating in a randomized trial of low-fat diets. Am J Clin Nutr 1991;54:821-828.[Abstract] <LI value=36>Bray GA. Obesity. In: Schneider HA, Anderson CE, Coursin DB, eds. Nutritional support of medical practice. 2nd ed. Philadelphia: Harper & Row, 1983:466-90. <LI value=37>Watts GF, Lewis B, Brunt JHN, et al. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS). Lancet 1992;339:563-569.[Medline] <LI value=38>Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992;56:320-328.[Abstract] <LI value=39>Clifton PM, Wight MB, Nestel PJ. Is fat restriction needed with HMGCoA reductase inhibitor treatment? Atherosclerosis 1992;93:59-70.[Medline] <LI value=40>Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials. Arterioscler Thromb 1992;12:911-919.[Abstract] <LI value=41>Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med 1991;325:461-466.[Abstract] <LI value=42>Gordon DJ, Probstfield JL, Garrison RJ, et al. High-density lipoprotein cholesterol and cardiovascular disease: four prospective American studies. Circulation 1989;79:8-15.[Abstract] <LI value=43>Sacks FM, Willett WC. More on chewing the fat: the good fat and the good cholesterol. N Engl J Med 1991;325:1740-1742.<A onclick="ISIwin('ISI')" href="http://content.nejm....&link_type=MED" target=ISI>[Medline]
• Keys A. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge, Mass.: Harvard University Press, 1980.

[Echo]

Not only is MM right, but he doesn't take it far enough. If you analyze results from studies such as PROVE IT (http://www.brightsur...ArticleID=21344) and more recent trials, very intensive, aggressive lowering of LDL cholesterol with high dose statins can safely further reduce cardiovascular death, heart attacks, strokes, etc in patients who are at high risk and have already had a cardiovascular event.

I'm talking about LDL levels less than 70, even down to 50 or less.

CC, you of all people should know that diabetics have the most aggressive form of diffuse vascular disease and are the prime candidates for Lipitor or other powerful statins, targeting LDL less than 100 in all diabetics and maybe even less that 70, and definitely less than 70 in any diabetic with vascular disease.

I sincerely hope that you wouldn't argue against using Lipitor in your diabetic patients. That would be a huge disservice to them. You could take all the lives lost in an entire year due to Lipitor and save more than that in less than a day, probably less than a few hours. Please.

Echo

[calmcookie]

MM and Echo,

You are NOT reading what I wrote. You are not paying attention to details. I asked for ONE study that proved that eating high cholesterol foods, like eggs and liver, RAISES your cholesterol. YOU GAVE ME NOTHING THAT PROVED THAT.

YES Echo and MM ... if you eat the typical American diet YOU will need Lipitor or other statin drugs ...... to stay alive ... I never disputed that. But, if you only attempt to understand what I'm saying ... instead of jumping to defend yourself ... you would realize that there is a dietary approach that, if understood, completely eliminates the NEED for any cholesterol lowering drugs. The head of Harvard School of Public Health, Dr. Walter Willett (MD PhD) would back me up on this, so would 72 year old University of Toronto Nutrition professor, Dr. Barry Bruce, so would 53 year Diabetes survivor / and diabetes specialist, Dr. Richard K. Bernstein ... along with several other people who know far more about this topic than you.

Read my post under "consider the possibility that there IS a cure for cancer ... just open your mind to the POSSIBILITY that there are dietary principles that you know nothing about. Because, I AM absolutely certain you know nothing about what I'm referring to.

That's it for me. Good luck.

[Echo]

MM and Echo,

You are NOT reading what I wrote. You are not paying attention to details. I asked for ONE study that proved that eating high cholesterol foods, like eggs and liver, RAISES your cholesterol. YOU GAVE ME NOTHING THAT PROVED THAT.

YES Echo and MM ... if you eat the typical American diet YOU will need Lipitor or other statin drugs ...... to stay alive ... I never disputed that. But, if you only attempt to understand what I'm saying ... instead of jumping to defend yourself ... you would realize that there is a dietary approach that, if understood, completely eliminates the NEED for any cholesterol lowering drugs. The head of Harvard School of Public Health, Dr. Walter Willett (MD PhD) would back me up on this, so would 72 year old University of Toronto Nutrition professor, Dr. Barry Bruce, so would 53 year Diabetes survivor / and diabetes specialist, Dr. Richard K. Bernstein ... along with several other people who know far more about this topic than you.

Read my post under "consider the possibility that there IS a cure for cancer ... just open your mind to the POSSIBILITY that there are dietary principles that you know nothing about. Because, I AM absolutely certain you know nothing about what I'm referring to.

That's it for me. Good luck.

CC, I'll be the first to admit I don't know as much about dietary advice as I should and that you seem to have a lot of knowledge, though you seem very polarized in your opinions. Let me make a few points.

1. I can't quote you the study you want. Who would want to sponser such a study--what could they possibly gain? Who would want to volunteer for this high fat diet study?

2. Much of the evidence comes from the counter study comparing groups that adopt a low fat diet and compare to those who stay with the status quo. Those studies generally show a modest reduction in LDL cholesterol, modest because much of it does depend on genetics and LDL receptor densities as I explained before. some of these studies may show no effect due to the lack of motivation/success in the study group or unanticipated/unconscious good habits in the control group. The largest effect of diet intervention can, of course, be seen in the groups with the highest starting LDL level to begin with--countries like Scotland, Norway. To see the benefit of low fat diet in people with minimally elevated LDL, you have to get even more aggressive in the low fat prescription as Dean Ornish has clearly shown. Of course, such strict diets are beyond the long term motivation of most people, who end up needing statins to get to goal.

3. Migration studies suggest the same and try to control for the genetic component. Japanese tend to have very low fat consumption and historically low rates of heart attacks. When they migrated to Hawaii, their dietary fat intake increased and the heart attack rates became intermediate to the US. When they migrated to the west coast of the US, their fat consumption went up even further as did their heart attack rates.

4. Not to say that low carb diets can't improve LDL chol, esp sticking to complex carbs rather than simple sugars. Remember that as a people, we have varied genetics and may respond differently to similar interventions. Some folks on a low carb diet end up with much higher LDL and some with lower. There is genetic variability.

5. There is some sense in moderation, balancing a reasonably low fat diet along with a reasonably low carb diet. What are your thoughts on Mediterranean diets.

Finally, in my expert opinion dealing with atherosclerosis in the heart, carotids, and leg arteries, it is better to shoot first, ask questions later. Anyone who already has had an event like a heart attack, as well as high risk individuals (diabetics, multiple other risk factors, documented early disease) needs to be started on statin first, with an emphasis on dietary intervention second. Why? The vast majority of patients don't achieve goal with diet alone IN THE REAL WORLD.

Then, I dangle the carrot in front of the patient that if they can institute excellent lifestyle interventions, eat right, exercise lots and bring their LDL down to ridicuously low levels, that we will be able to cut their dose of statin and perhaps even stop it. But the burden of proof is on them. I think it is irresponsible to maintain a wait and see attitude on diet control for 6 months in HIGH risk individuals. Research shows that patients will die that could have been saved.

Echo

[dougie]

"in HIGH risk individuals" needs to be repeated. And for those medically not inclined, you shouold elaborate on who you mean.