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Medical Forum / General / Nutrition / March 2005The Great "Mediterranean Diet" Fraud.
I've posted scientific papers here before about "Mediterranean Diet" claims, but this is worth pointing out: New York's Newsday newspaper, page A34, 3/17/05: "...in Cyprus... Greece, Malta and Slovakia a higher percentage of men are obese or overweight than the 67 percent of U.S. men." In addition, you can go to the World Health Organization's web site and take a look at some of the cancer rates for Mediterranean nations. Italy's is really bad, even when compared to the USA. Some are slightly better, but if you want a real difference, you need to look at the countries where highly saturated fatty acids comprise a big part of the diet (coconut and palm kernel oil), such as Sri Lanka (which also has a very low heart disease rate). People in Mediterranean nations, in general, eat diets higher in antioxidants that Americans, and that is the likely explanation for lower heart disease rates in some of the nations (since heart disease is largely due to oxdizied cholesterol, also known as oxysterols, and not normal cholesterol). :: I've posted scientific papers here before about "Mediterranean Diet" :: claims, but this is worth pointing out: [quoted text clipped - 16 lines] :: due to oxdizied cholesterol, also known as oxysterols, and not :: normal cholesterol). The present day Mediterranean diet differs greatly from the _traditional_ Mediterranean diet once eaten. In Crete, which was praised for its diet, the grains where mostly used in unrefined form around 1960 and before. Also the use of red meat was very rare compared to the present day consumption.  SignatureJuhana Where is the basis, then, of this claim. Is it Ancel Keys' book, Seven Countries? If so, according to him, your cholesterol should be between 200 and 220 for optimal life expectancy, but he didn't know about oxidized cholesterol. In any case, there was a study of rural Italy in the 60s, and they concluded that the grains eaters had a much higher cancer rate. That might be because they ate less fruit and vegetables than others. I would say the biggest difference, though, is the use of the extremely unhealthy unsaturated oils: sunflower, canola, safflower, flax, corn, vegetable, etc. The evidence demonstrating how dangerous these oils can be is so overwhelming it's almost funny. Do a www.pubmed.com search for lipid peroxidation or oxidative stress and you'll see what I mean. >than others. I would say the biggest difference, though, is the use of >the extremely unhealthy unsaturated oils: sunflower, canola, >safflower, flax, corn, vegetable, etc. The evidence demonstrating how Sorry, but the population that did eat canola or olive oil had the highest life expectancy. But I tend to agree about your statement about soy oil use which is a pure omega-6 oil with a proportion of more than 100:1 of omega-6:omega-3 letting the peroxidation enzymes running wild, by lack of the strong substrate inhibitor class omega-3 acids. (Omega-3 has a Km on COX about 10 times less combined with a Vm of about 10 times less. Low Km means much less is needed to have the enzyme running at 50% Vm. That means, if both is present, omega-3 is preferred substrate, but form products very slowly compared to arachidonic acid, and do NOT produce any thromboxane, while PGI-3 is a fully active substance. And most lipoxygenase products from EPA are counteractive towards the products from arachidonic acid, like leukotriene formations etc.(and also for these enzymes, omega-3 in general bind better than omega-6. > Sorry, but the population that did eat canola or olive oil had the > highest life expectancy. Hm, I wonder where you got data for canola, as it is relatively recent "invention". There was no canola before 1980. I am not sure that 25 years are enough to make any study of "life expectancy". BTW, FYI, canola is kind of rapeseed oil with reduced euric acid content. It is little known, but euric acid is probably one of the most atherogenic substances known... Mirek >BTW, FYI, canola is kind of rapeseed oil with reduced euric acid >content. It is little known, but euric acid is probably one of the most >atherogenic substances known... In carnivores, yes. Are you one?? > I've posted scientific papers here before about "Mediterranean Diet" > claims, but this is worth pointing out: I rather doubt it, as if you had actually read any of Keys research papers you would not be making such dumb statements. Keys recently died at the age of 100. I have written two web pages that talks about Keys' actual research data. Seven Countries Study http://food.naturalhealthperspective.com/sevencountriesstudy.html This web page covers the only Mediterranean diet worth eating. Diet of Southern Italy http://food.naturalhealthperspective.com/southitaly.html This web page covers the diet most people assume is the recommended Mediterranean diet. But, it is not. -- john gohde I read the entire book, Seven Countries, and he couldn't be clearer. Cholesterol between 200 and 220 is optimum. The studies since then that have been well conducted all say the same. Go get your cholesterol down to 120 and see what happens to you. You will deserve it for closing your mind. On my super high saturated fatty acid diet, my cholesterol is 209, HDL is 63, and LDL is 123. TGs are low and glucose is 75. As to people eating a great deal of canola oil and living long, healthy lives, I want to see that study. I've searched pubmed for "mediterranean diet" and there are foolish abstracts that just make claims and there are the ones that point out how there is little evidence for such claims. Don't be lazy. Do some research or stop misleading people. :: I read the entire book, Seven Countries, and he couldn't be clearer. :: Cholesterol between 200 and 220 is optimum. The studies since then [quoted text clipped - 6 lines] :: As to people eating a great deal of canola oil and living long, :: healthy lives, I want to see that study. Okinawan elders have an average total cholesterol of 170 and a good total cholesterol:HDL ratio with a diet containing canola oil as the major source of fat. In addition they have a high intake of polyunsaturated omega-3 fats. They are a population with one of the longest life-expectancies in the world. SignatureJuhana :: montygram wrote: :::: I read the entire book, Seven Countries, and he couldn't be [quoted text clipped - 13 lines] :: polyunsaturated omega-3 fats. They are a population with one of the :: longest life-expectancies in the world. Here is a study. Suzuki M, Wilcox BJ, Wilcox CD. Implications from and for food cultures for cardiovascular disease: longevity. Asia Pac J Clin Nutr. 2001;10(2):165-71. Okinawa Research Center for Longevity Science, Naha. A healthy cardiovascular system, with minimal arteriosclerosis, good endothelial function and well-compensated ventricular function has been observed at advanced ages, and linked to a healthy lifestyle. This has consisted of a plant-based diet, low in salt and fat, with monounsaturates as the principal fat. Other healthy lifestyle factors include regular physical activity (farming and traditional dance) and minimal tobacco use. The associated negative risk factors are low homocysteine, healthy cholesterol profile (Total:HDL ratio less than 3.5) and reasonable blood pressures throughout the life cycle. Hormone-dependent cancers including breast, ovary, prostate and colon and osteoporotic complications, such as hip fracture rates, are also less frequent compared to the west. Protective factors may include high anti-oxidant consumption, mainly flavonoids and carotenoids, through a high vegetable (e.g., onions) and soy intake. Related biological observations include low lipid peroxide, high superoxide dismutase activity and high serum hydroxyproline, a marker of bone formation. Dehydroepiandrosterone (DHEA) and its hormonal byproducts testosterone and oestrogen appear to be high in Okinawan serum compared with age-matched Americans, possibly reflecting a slower age-associated decline in the sex hormone axis in Okinawans. This may be linked to better cardiovascular and overall health. Further study is needed to delineate the reasons behind the impressive cardiovascular and overall health of the Okinawans. PMID: 11710359 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=11710359 When the Okinawans emigrate to other countries and adopt a western diet with high in saturated fat, their risk of getting degenerative diseases increase. http://www.ingentaconnect.com/content/bsc/cep/2004/00000031/A00201s2/art00003 SignatureJuhana > Okinawan elders have an average total cholesterol of 170 and a good > total cholesterol:HDL ratio with a diet containing canola oil as the > major source of fat. Umm, you sure about the canola? I suspect you mean soy oil. Adam Becker ::: Okinawan elders have an average total cholesterol of 170 and a good ::: total cholesterol:HDL ratio with a diet containing canola oil as the ::: major source of fat. :: :: Umm, you sure about the canola? I suspect you mean soy oil. The Okinawan researchers write: "We found that the most common fat in the Okinawan diet is also monounsaturated fat, mostly from the canola oil that they use for stir-fry cooking." "The Okinawan's main method of cooking is low-temperature stir-fry (not deep-frying). Canola oil os the main cooking oil, and is one of the healthiest oils on the market." (Willcox, Willcox & Suzuki, The Okinawa Program, Clarkson Potter Publishers, NY 2001, p. 30, 72) SignatureJuhana "The Okinawan's main method of cooking is low-temperature stir-fry > (not deep-frying). What are the temperatures involved? Laurie :: "The Okinawan's main method of cooking is low-temperature stir-fry ::: (not deep-frying). :: What are the temperatures involved? :: :: Laurie No mention about that. Personally I don't think that canola oil is ideal for frying. I would rather use extra virgin olive oil and fry only in low temperatures and very lightly. Extra virgin olive oil reduces lipid peroxidation slightly better than canola oil because of the phenolic compounds of olive oil contains. Canola oil would be better for salad dressings than frying because of the higher content of polyunsaturated oils. But the fact that Okinawan centenarians use canola oil (or a combination of rapeseed oil and soy oil) even in frying is an indication that it is a reasonably safe and healthy choice. SignatureJuhana >dressings than frying because of the higher content of polyunsaturated >oils. But the fact that Okinawan centenarians use canola oil (or a Seems like PUFA content in rape seeds may vary a lot. The brand I normally use have less PUFA and saturated fats than olive oils (Eldorado or EuroShopper rape seed oil) and more oleic acid (and free of C20:1) :: Umm, you sure about the canola? I suspect you mean soy oil > The Okinawan researchers write: "We found that the most common fat in > the Okinawan diet is also monounsaturated fat, mostly from the canola > oil that they use for stir-fry cooking." OK, I stand corrected. But that must be a relatively new development. Canola's only been on the market for about 25 years. Certainly the Okinawin elders weren't using it in their formative years. > But the fact that Okinawan centenarians use canola oil (or a > combination of rapeseed oil and soy oil) even in frying is an indication > that it is a reasonably safe and healthy choice. Oh, canola's healthy, all right. Rapeseed oil? From http://www.wholefoods.com/healthinfo/canola.html How was Canola Oil developed? In the late 1970s, canola was bred from rapeseed to contain low amounts of erucic acid, a long chain fatty acid that had been associated with detrimental health effects in animal studies [It's thought to be atherogenic - Adam.] The new oil was referred to as LEAR oil (Low Erucic Acid Rapeseed) or Canola oil (from Canadian oil low acid, since most canola oil was grown in Canada). What is Erucic Acid? Erucic acid is a 22-carbon fatty acid that is present in all members of the Brassica family in trace amounts. Erucic acid constitutes 40%-50% of the fatty acid content in rapeseed, however canola has been bred to typically contain less than 2% erucic acid. Because of this, canola oil is thought to have a more neutral taste and to be healthier for human consumption. Note that erucic acid is not all bad: for individuals with the wasting disease adrenoleukodystrophy, erucic acid is actually helpful with treatment and was the lifesaving ingredient of Lorenzo's oil. Adam Becker > :: Umm, you sure about the canola? I suspect you mean soy oil > [quoted text clipped - 5 lines] >Canola's only been on the market for about 25 years. Certainly the >Okinawin elders weren't using it in their formative years. I think in the actual case they mean rape seed oil (pre-Canola) >::: Okinawan elders have an average total cholesterol of 170 and a good >::: total cholesterol:HDL ratio with a diet containing canola oil as the [quoted text clipped - 9 lines] >(Willcox, Willcox & Suzuki, The Okinawa Program, Clarkson Potter >Publishers, NY 2001, p. 30, 72) Canola oil is rape seed oil and was developed in Canada. It has only been around for 20-30 years. I sincerely doubt the Okinawans can point to this as their "secret" to longevity. ;o) rr :: On Wed, 23 Mar 2005 18:50:01 +0200, "Juhana Harju" :: <shantigiri@despammed.com> wrote: [quoted text clipped - 17 lines] :: been around for 20-30 years. I sincerely doubt the Okinawans can :: point to this as their "secret" to longevity. ;o) Nor do I think so. It was a question of its safety. SignatureJuhana >Canola oil is rape seed oil and was developed in Canada. It has only >been around for 20-30 years. I sincerely doubt the Okinawans can point >to this as their "secret" to longevity. ;o) Other brands of rape seed oils has in some civilisations been around for longer time than that. But I agree it is wrong to call it Canola oil Because I seek to educate, not admonish, here is the citation from Keys' Seven Countries (the 1979 book, page 135): "At levels below 200 mg/dl, decreasing cholesterol concentrations tend to be associated with increasing rates of non-coronary death." This finding is consistent. Read the books, Heart Failure or The Cholesterol Myths, for example, for references and analysis of the pertinent evidence. But the key is preventing the oxidation of cholesterol. On page B17 of New York's Newsday newspaper (March 1, 2005), AHA spokesperson Dr. Richard Stein states: "What we've learned in the last 15 years is that LDL has to be oxidized in the vessel wall... [in order for plaque to accumulate and become dangerous]." You can find more than a few scientific papers that make this point at www.pubmed.com, which is used for research by scientists. The more saturated fatty acids you eat, the healthier you will be, just as long as you don't eat things with saturated fatty acids that also contain dangerous substances (a good example of this would be a fried hamburger). Coconut oil is best fat source: "Cholesterol, coconut, and diets on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau Island Studies." Ian A. Prior, M.D., et. al. (The American Journal of Clinical Nutrition 34: August 1981, pp. 1552-1561). Quotation from the abstract: "Vascular disease is uncommon in both populations and there is no evidence of the high saturated fat intake have a harmful effect in these populations." Quotation from the text: "The migration of Tokelau Islanders from their atolls to the very different environment of New Zealand is associated with changes in lipids that indicate increased risk of atherogenesis. This is associated with an actual fall in saturated fat intake... and an increase in carbohydrate and sugar." For more on this a other interesting studies, see Bruce Fife's book, Saturated fat may save your life. My book, which will cover this, and other diet/health subjects, should be available in less than a year. And I intend for it to be a profit-free book, meaning that you can get it at actual cost, probably around $4 or so. I'll post at least one free chapter here when I finish it. I scanned your website, and unfortunately, you seem to be conflating two separate studies by Dr Keys: the Six Countries Study (1953) and the Seven Countries Study (1970). The former attempted to demonstrate a positive correlation between total fat consumption and death from heart disease. It did so, but only after throwing out the other 16 data points(countries) originally part of the study. The latter attempted to demonstrate a similar correlation between total serum cholesterol and death from heart disease. Plotted out, the 15 data points from this study ALSO showed no meaningful correlation, but DID reveal a wide range of cardiac death over a wide range of cholesterol, an inconvenient fact that Dr. Keys et al never mentioned or explained in their much ballyhooed book. I respectfully submit that your "actual research data" is, to say the least, incomplete. Rob Capps I scanned your website, and unfortunately, you seem to be conflating two separate studies by Dr Keys: the Six Countries Study (1953) and the Seven Countries Study (1970). With the results of the former, the authors attempted to demonstrate a positive correlation between total fat consumption and death from heart disease. It did so, but only after throwing out the other 16 data points(countries) originally part of the study. In the latter, they attempted to demonstrate a similar correlation between total serum cholesterol and death from heart disease. Plotted out, the 15 data points from this study ALSO showed no meaningful correlation, but DID reveal a wide range of cardiac death over a wide range of cholesterol, an inconvenient fact that Dr. Keys et al never mentioned or explained in their much ballyhooed book. I respectfully submit that your "actual research data" is, to say the least, incomplete. Rob Capps :: I scanned your website, and unfortunately, you seem to be conflating :: two separate studies by Dr Keys: the Six Countries Study (1953) and [quoted text clipped - 10 lines] :: ballyhooed book. I respectfully submit that your "actual research :: data" is, to say the least, incomplete. Verschuren WM et al, Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995 Jul 12;274(2):131-6. "[...] a 0.50-mmol/L (20-mg/dL) increase in total cholesterol corresponded to an increase in CHD mortality risk of 12%, which became an increase in mortality risk of 17% [...] CONCLUSION--Across cultures, cholesterol is linearly related to CHD mortality, and the relative increase in CHD mortality rates with a given cholesterol increase is the same." http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7 596000&dopt=Citation SignatureJuhana Only oxidized cholesterol is dangerous. Go to pubmed, put in the relevant search words, and see for yourself. The okinawa thing is a complete fraud. Those who did live to very old ages ate pork, raw sugar cane, and guess what - there was no canola oil available in those days. Now, as they are dying much younger, they are using canola oil. You people are really out of touch with reality. :: Only oxidized cholesterol is dangerous. Go to pubmed, put in the :: relevant search words, and see for yourself. The okinawa thing is a :: complete fraud. Those who did live to very old ages ate pork, raw :: sugar cane, and guess what - there was no canola oil available in :: those days. Now, as they are dying much younger, they are using :: canola oil. You people are really out of touch with reality. You don't know a thing about the diet of Okinawan centenarians. I have read the entire book and also other material about the subject. When the results don't please you it is very easy to say that the study is a complete fraud. If the Okinawan studies don't please you can also look at the China study which contradicts clearly your claims about pork and saturated fat. SignatureJuhana >Only oxidized cholesterol is dangerous. Go to pubmed, put in the >relevant search words, and see for yourself. The okinawa thing is a >complete fraud. Those who did live to very old ages ate pork, raw >sugar cane, and guess what - there was no canola oil available in those Agree about Canola oil. They used rape seed oil. :: On 23 Mar 2005 14:47:18 -0800, "montygram" <nazztrader@lycos.com> :: wrote: [quoted text clipped - 6 lines] :: :: Agree about Canola oil. They used rape seed oil. Canola oil is a market name for rape seed oil. So it is same stuff. Montygram's claims about pork eating are not valid. Main protein sources of Okinawan centenarians are tofu and fish. Pork is eaten very little. SignatureJuhana >Canola oil is a market name for rape seed oil. So it is same stuff. >Montygram's claims about pork eating are not valid. Main protein sources >of Okinawan centenarians are tofu and fish. Pork is eaten very little. No. Canola oil is just one brand of many types of LEAR oils. Made in Canada. The oils produced eg. in Sweden is another brand of LEAR. In China and probably Okinawa LEAR is not used at all. In China, C22:1 can be as high as 25% or more in food oils used for many years. With no side effects. Why? In humans, after a lag period, peroxisomes are induced to take care of C22:1. This don't happen in rats and alike and the fat is building up, confusing researchers in the 70'ies to believe intake of it was the main reason of heart attacks. The problem was the first project in biochemistry/nutrition I was presented, but chose to work on enzymology instead (but could have used this problem as one of the models for substrate concurrency/inhibition studies) :: On Thu, 24 Mar 2005 21:00:20 +0200, "Juhana Harju" :: <shantigiri@despammed.com> wrote: [quoted text clipped - 6 lines] :: No. Canola oil is just one brand of many types of LEAR oils. Made in :: Canada. Canola oil has become a generic name meaning rape seed oil. Just as hoovering has become a generic name for vacuum cleaning. SignatureJuhana >Canola oil has become a generic name meaning rape seed oil. Just as >hoovering has become a generic name for vacuum cleaning. Canola seeds are one kind of LEAR, Low Erucic Acid Rape. You have also rape seeds and rape seed oils that are high in erucic acid,mostly grown for industrial use since erucic acid has scared a lot people. Such oils are still in use for humans in China. > Verschuren WM et al, Serum total cholesterol and long-term coronary > heart disease mortality in different cultures. Twenty-five-year [quoted text clipped - 6 lines] > increase in CHD mortality rates with a given cholesterol increase is the > same." http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7 596000&dopt=Citation > -- > Juhana This is an ABSTRACT. Of a selective RE-ANALYSIS. Read the ORIGINAL data, plot the points, and a different pattern emerges: different populations within the same countries show VASTLY different mortalities. Specifically, Finland(interior vs coastal) and Greece(Crete vs Corfu) demonstrate similar serum cholesterol levels with very different rates of death from heart disease. As I mentioned, 15 data points did NOT plot out a good correlation. Notice that even the ABSTRACT says: "To increase statistical power six cohorts were formed, based on similarities in culture and cholesterol changes during the first 10 years of follow-up." SIX? What about the other NINE? Similarities in culture? BS. If the original study design yielded negative results, good scientists don't pick and choose data points to revive the hypothesis. This article is junk, clearly following the poor example originally set by Dr Keys picking the 6 countries out of 22 that suited his idea, they have picked the 6 out of 15 that suited theirs. Thank you for pointing out this abstract. Instructive to know that as recently as 1995, Dr Keys' dishonesty was still being emulated. Rob Addendum: Upon further reflection (another 3 minutes or so), it occurs to me that the 6 cohorts may not have been simply PICKED from the original 15 cohorts, but FORMED from the 15. Which STILL probably involved excluding the ones that didn't "fit". A minor difference, but statistical sleight-of-hand takes many forms. Here's another form: the relative risks (RR) that they list do NOT include the 95% confidence interval, but a 1.2 could very well be 0.7 to 1.8. Which (for the statistically impaired) means that the 1.2 is not significant, could very well be due to random chance. Not having a copy of the original article, I can't say this for sure. However, having read abstract after abstract on pubmed, more often than not the CI is included, unless it demonstrates a non-significant result - very common, and misleading, practice. Rob :: Juhana Harju wrote: :: [quoted text clipped - 6 lines] :: populations within the same countries show VASTLY different :: mortalities. [...] I have never said that total cholesterol is a good and watertight predictor of heart disease. But I would like to ask you: do you also deny the predictive value of total cholesterol:HDL ratio? SignatureJuhana No need to be defensive. I wasn't attacking YOUR beliefs, merely the historical foundations of current theory. Whether or not any subfraction of serum cholesterol is predictive of anything is a separate issue. But as I have recently engaged in a review of the literature, I felt compelled to set the historical record straight. Now, as to tot chol:HDL, I'd like to reframe your question before answering it. Here goes: Is the ratio of total cholesterol to HDL the BEST predictor of CHD? To THIS question, I can answer an unequivocal "No." You see, the structure of your original question made it impossible to issue a denial, but also made it impossible to give a meaningful answer. You could just as easily have asked if I deny the predictive value of homocysteine, male pattern baldness, or even creased earlobes. I cannot deny that all of these are nominally predictive, but that doesn't mean I'm going to endorse their routine clinical use. So, back to my preferred question and answer. The practice of evidence-based medicine requires the selection of tests with the strongest predictive value AND the lowest cost. If something worked better than cholesterol but was horrendously expensive, I couldn't conscientously support its use. But if that something worked better AND was relatively cheap...is there such a beast? Yup. In the past few years, the chronic inflammatory theory of CAD etiology has been gaining support. And the utility of acute phase reactant assays - especially C-reactive protein - in predicting the onset of disease has been repeatedly demonstrated. More importantly, serum hsCRP has beaten ANY subfractional combination of cholesterol you care to name, in recent studies of considerable statistical power. As to cost, both run less than $50 (US). hsCRP is currently more expensive, but labs typically lower their prices when the volume goes up, and hsCRP isn't ordered NEARLY as often as FLP. Researchers whose careers have been built on the cholesterol issue (especially those on the payroll of Big Pharma), are amusing in their attempts to equivocate, but I'm betting that by the time I finish my residency or shortly thereafter - say 5 years - hsCRP will be within the acceptable standard of care. Maybe within 20 the NCEP will be nothing more than an historical footnote. Otherwise, I'll have to explain myself over and over and over... Have I explained myself to YOUR satisfaction? :) :: Now, as to tot chol:HDL, I'd like to reframe your question before :: answering it. Here goes: [quoted text clipped - 39 lines] :: :: Have I explained myself to YOUR satisfaction? :) I do agree with the inflammation theory in the ethiology of CAD and I agree that hsCRP has good predictive value. However, I would like to see references that would show that hsCRP is unequivocally better predictor of CAD than TC:HDL ratio. So, references to back your claim, please. :-) Based on the studies and abstracts I have read I would say that TC:HDL ratio and hsCRP are equal in predicting CAD and combining them would give the best results. Measuring homocysteine also would further add the predictive power. I think that CAD is a multifacetial disease and can not be explained or predicted by one factor only. SignatureJuhana References? Happy to. To date, here are the best-powered, relevant studies: Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002 Nov 14;347(20):1557-65. Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, Pfeffer MA, Braunwald E; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005 Jan 6;352(1):20-8. Just for fun, here's one from the same group favoring tot chol to HDL...but for predicting PAD, not heart disease: Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001 May 16;285(19):2481-5. :: References? Happy to. To date, here are the best-powered, relevant :: studies: [quoted text clipped - 18 lines] :: predictors of peripheral arterial disease. JAMA. 2001 May :: 16;285(19):2481-5. I am still not quite convinced. The studies by Ridker et al. compare LDL and CRP, not TC:HDL ratio and CRP. This is important because the ratio has better predictive value than LDL. Actually studies are saying just what I said in my previous post: TC:HDL ratio + hsCRP taken together give the best predictive results. Below are couple of studies that you might find interesting. Paul M. Ridker et al, C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infarction. Circulation. 1998;97:2007-2011. http://circ.ahajournals.org/cgi/content/abstract/97/20/2007?ijkey=2794b6e0c8f708 4ae3b028fffd4f1460d0a528a2&keytype2=tf_ipsecsha Please notice the combined effect: http://circ.ahajournals.org/cgi/content/full/97/20/2007/F3 This might especially interest you as it supports strongly the view of the importance of hsCRP: Willcox BJ et al, C-Reactive Protein as a Novel Risk Factor for Cardiovascular Disease: Is It Ready for Prime Time? http://www.arabmedmag.com/issue-15-11-2004/cardiology/main01.htm SignatureJuhana Oops. Forgot to include this one, in which all standard cholesterol subfractions were compared to CRP(still on top): Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000 Mar 23;342(12):836-43. However, an interesting point here. Dr Ridker & company originally studied men (male physicians, specifically) in whom total cholesterol to HDL outperformed CRP, and later studied women, in whom the reverse was true. A split ticket, using only case-control evidence. Unfortunately, the RCT (my 2nd cited reference, the PROVE IT-TIMI 22 trial) only reported the LDL subfraction results. I suspect they HAVE the data for the standard FLP (who orders JUST an LDL?). I hope we get to see it someday. Either way, if the case-control evidence is applied to clinical practice, and if you are forced by the bean-counters to chose only ONE test for screening (not at all far-fetched), the FLP is not the best choice for over half the population (women), hsCRP is. Based on the recommendation track record of bodies such as AHA, NHLBI, and NCEP, this will likely be swept aside in the interests of (over)simplicity, and the standard of care(in the US, at least) for the near-future will still be "one-size-fits-all": FLP for everyone. Thanks for the info and the skepticism; if there better ingredients for rational discourse than these, I don't know of them. Rob :: Oops. Forgot to include this one, in which all standard cholesterol :: subfractions were compared to CRP(still on top): [quoted text clipped - 23 lines] :: Thanks for the info and the skepticism; if there better ingredients :: for rational discourse than these, I don't know of them. Thanks. I agree with you that hs-CRP is still heavily neglected. If TC:HDL and hs-CRP are about equal risk factors I wonder why people are given no dietary advice for lowering inflammation? In the public health care there is a lot of talk about dietary means to lower cholesterol but absolutely no advice about lowering inflammation by diet. Isn't that interesting? SignatureJuhana > In the public health care there is a lot of talk about > dietary means to lower cholesterol but > absolutely no advice about lowering inflammation by > diet. Isn't that interesting? Remember the quality of the advice the US government historically has given about cholesterol and nutrition in general (eat no eggs, use margarine instead of butter, eat high carbs and low fat, omega-6 fats are PUFA and therefor 'good fat', starch is 'complex carbohydrate' and much better for you than sucrose...) It's probably just as well they're keeping their collective mouth shut about inflammation. Adam Becker ::: In the public health care there is a lot of talk about ::: dietary means to lower cholesterol but [quoted text clipped - 9 lines] :: It's probably just as well they're keeping their collective mouth :: shut about inflammation. Yes and I guess the same applies to other countries as well. My opinion is that the safest policy would be to adopt a diet which would give you a good total chol:HDL ratio /and/ keep inflammation minimum at the same time. The Mediterrean diet and especially the Portfolio diet developed by the Toronto University are pretty good in this respect. They are both efffective in lowering cholesterol and CRP. SignatureJuhana >Researchers whose careers have been built on the cholesterol issue >(especially those on the payroll of Big Pharma), are amusing in their What about those founded by a chocolate producer? (Throne-Holst foundation, the former producers of Freia and Marabou chocolates in Scandinavia) Not sure I take your meaning. By "those", are you referring to researchers' careers "founded by a chocolate producer" or studies FUNDED by said producer? Assuming you were referring to the latter, are there studies funded solely, or even chiefly, by this foundation? And if so, how often are they cited in the literature? How often are they trotted out by drug reps in doctors' offices? Or profiled in the mass media? And incidentally, what do these studies actually SHOW? Another question I almost feel dirty asking: does the Foundation's money come SOLELY from candy? Here in the States, many of the big food conglomerates have Big Tobacco as well as Big Pharma investors. Nestle in Switzerland DEFINITELY has competing interests beyond candy. Same may be true, in some form, of Throne-Holst/Freia&Marabou, and you might not know it unless you dig a little. OTOH, maybe you meant something else entirely. Easy to get me started, though! Rob >I rather doubt it, as if you had actually read any of Keys research >papers you would not be making such dumb statements. Still plugging that old flawed Seven Countries Study? >Keys recently died at the age of 100. George Burns died at age 100. What's your point? >I have written two web pages that talks about Keys' actual research >data. rr Rob Capps wrote: "I'm betting that by the time I finish my residency or shortly thereafter - say 5 years - hsCRP will be within the acceptable standard of care." It is now, in Canada at least. My doctor (who isn't that long out of residency) first did total cholesterol (the cheapest test) as part of a general screening at 65, promptly asked for the more expensive ratio tests, then went through over a dozen detailed questions about personal/family medical factors before deciding that she didn't need any other tests to advise me. Our bodies are indeed a tad too complex to put just one number on! |
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