Wednesday, August 22, 2007

Jane Brody's Cholesterol Goes Up

Melinda sent this article from yesterday's New York Times:

Cutting Cholesterol, an Uphill Battle, by Jane E. Brody

Jane Brody is the author of Jane Brody's Good Food Book: Living the High-Carbohydrate Way, among others. She's an award winning columnist for the New York Times, Personal Health section. Here's a short bio.

In the article, Ms. Brody described her battle with cholesterol:

Baseline readings (Includes exercise of 60-90 minutes/day):
total cholesterol 190 - 205 mg/dl.

December 2006 readings:
total cholesterol 222
LDL 134
HDL 69
triglycerides 95

... LDL was high so she cut out cheese, lost 3 pounds, took plant stanols, continued exercising 60-90 min/day ...

March 2007 readings:
total cholesterol 236
LDL 159

.... She further limited red meat, stuck to low-fat ice cream, ate more fish, increased fiber, took fish oil, exercised 60-90 min/day...

June 2007 readings:
Total cholesterol 248
LDL 171

Her doctor’s conclusion: "Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it."

Ms. Brody is concerned that her lipid-based risk factors may predispose her to a heart attack or stroke. She decided to take a statin.

Keep in mind that as the percentage of calories contributed by fat in Ms. Brody's diet declined, the percentage contributed by carbohydrates likely rose.

Do you agree with Ms. Brody's doctor's conclusion?

The following is an oft-cited study that sought to evaluate the relationship between the amount and type of carbohydrate consumed, and risk for coronary heart disease (CHD). It appeared in the American Journal of Clinical Nutrition in 2000.

A Prospective Study Of Dietary Glycemic Load, Carbohydrate Intake, And Risk Of Coronary Heart Disease In US Women

Over 75,000 women (part of the Nurses Health Study) with no previous diagnosis of diabetes, heart attack, angina, stroke, or other cardiovascular diseases were followed for 10 years. Their diets were analyzed periodically during that time.

"Dietary glycemic load1 was directly associated with risk of CHD after adjustment for age, smoking status, total energy intake, and other coronary disease risk factors."
Those who consumed the most daily carbohydrate (around 226 grams/day) fell into the highest quintile for GL, and had almost double the risk for CHD than those who consumed the least carbohydrate (around 144 grams/day).

The following piece of data stood out for me, in light of the theme of my recent posts:
"Dietary glycemic load did not appear to be determined by any particular food; the 2 most important contributors to dietary glycemic load in this population were mashed or baked potatoes (8%) and cold breakfast cereals (4%)."

The Lipid Profile Doesn't Tell The Whole Story

It's unfortunate that glucose and insulin markers weren't presented, if they were evaluated at all, since the authors of the above study state:
"Insulin resistance, hyperglycemia, and related metabolic disorders have long been recognized as important risk factors for CHD."
And that:
"High dietary glycemic load apparently induces [those states of] hyperglycemia and hyperinsulinemia, which can lead, in turn, to hypertension, dyslipidemia [high cholesterol, LDL, etc.], and possibly impaired fibrinolysis and thrombosis, all of which can increase the risk of CHD."
Do you agree with Ms. Brody's doctor's conclusion? That nothing she could do to her diet could improve her risk factors for CHD?
1 In this study, glycemic load was the product of the glycemic index of a food and its carbohydrate content.

1 comment:

Anonymous said...

Ms. Brody is a shill for the American Dietetic Association which is a shill for the food industry. Her motto, and the motto of the ADA, is everything in moderation. Too bad this motto makes no sense. For example, no one would recommend smoking in moderation and no one would recommend eating trans fats in moderation. The truth is, cholesterol goes up with a high glycemic diet. That means it is not recommended to eat quickly absorbed carbs such as sugar (and remember, potatoes are converted rather rapidly to glucose making potatoes the highest glycemic food of all). So, it is not carbs, it is how fast they are absorbed. That means to lower cholesterol you need to eat lots of fiber and lots of complex carbs, i.e., vegetables. Also, cut out the saturated fats. Bottom line, the doctor is wrong.