Archive for July, 2008

Statins for Kids?

Monday, July 21st, 2008

Can you believe it? Cholesterol-lowering drugs for 8-year olds? Thanks go to the American Academy of Pediatrics (A.A.P.) who included in this pronouncement July 7, on lipid screening for infants and children “…For children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered.The idea is to give statin drugs early in life to children with elevated lipids-screening begins as early as “age 2, but no later than age 10,”-presumably to prevent heart attacks 30-60 years later. This assumes there is evidence these drugs when taken for decades actually helps prevent coronary disease.

Yet we have no idea even today what happens when people take statins for more than the 15-20 years, (since the onset of the statin “revolution.”) We do know some patients on these drugs-numbers continue to be hotly disputed-can suffer one or more of the following serious side effects, including, but not limited to: liver function abnormalities, memory loss and cognitive impairment, serious, even fatal muscle disease, an increase in cancer incidence, and a host of other problems, many of which are related to length of therapy.

A few doctors have applauded this stunning idea of the A.A.P., many others are shocked. “To be frank, I’m embarrassed for the A.A.P. today” said one academic authority, Dr. Lawrence Rosen. “Treatment with medications in the absence of any clear data? I hope they’re ready for the public backlash.” Dr. Darshak Sanghavi, a pediatric cardiologist and Professor at the University of Massachusetts Medical School, quoted in the New York Times, remarked, “How many heart attacks do we hope to prevent this way?”

Physicians who sat on the Academy’s committee on nutrition which issued the guidelines, admit there are no long-term data on statin use, but claim without citing evidence, there are adequate safety data to justify their recommendations. Safety data for 10, 30, or 50 years? Incidentally, the report’s lead author, Dr. Stephen Daniels, told The Associated Press that he had worked as a consultant to Abbott Laboratories, and Merck, but not on their cholesterol drugs. He was not available for comment when the study was released.

In the meantime, the Food and Drug Administration has already approved the use of the statin, Prevachol, for use in children as young as 8. One of the most serious problems may be opening the door for pharmaceutical advertising. I can see it now on Sesame Street, Nickelodeon, and the Disney channel, if not Desperate Housewives: “Tell your mom to have your cholesterol checked.”

Trans Fats Terror

Thursday, July 3rd, 2008

Everything is so dangerous that nothing is really very frightening.

Gertrude Stein

Most trans fats consumed today* are created industrially through adding varying amounts of hydrogen to plant oils (“unsaturated”), tending to solidify them into fats, called “saturated.” This process was developed in the early 1900’s and was first commercialized as Crisco in 1911. These more saturated fats have a higher melting point, which makes them attractive for baking and extends their shelf life. The consumption of trans fats is supposed to increase one’s risk of coronary disease by raising levels of “bad” LDL cholesterol and lowering levels of “good” HDL cholesterol. Various self-appointed, as well as official health authorities, including the Government, the FDA, the American Heart Association, and others, recommend that consumption of trans fat be reduced to trace amounts.

Trans fats from partially hydrogenated oils are described as dangerous, even life-threatening. Coronary-provoking, life-threatening foods once included red meat, eggs, butter, and other dairy products though once upon a time, Crisco® and margarine were the mainstay of deep frying.) But now dangers range from Big Mac’s and Whoppers, to egg rolls and French fries soaked in trans fats and other deep fried delectables, tuna salad with the wrong mayonnaise, even girl scout cookies (sic!).

Trans fat alarmists would have you believe that transient changes in blood fats or lipids are a direct assault on survival by increasing your chances of a heart attack. But the available scientific data fails to back up that assertion. A number of studies of human populations have attempted to associate consumptions of trans fats with increased heart attack risks, but the only conclusion that can be fairly drawn is that, if indeed there is a risk, it is statistically unprovable. As I have pointed out in my recent blog of June 26, there are are over 260 “risk factors”, i.e. stress, smoking, heredity, diabetes, high blood pressure or being just alive, all associated with the risk of developing coronary disease, heart attacks, or sudden death.

Yes, blood lipids, serum cholesterol, etc. are included prominently among these risks, but to jump from diet to serum blood lipids to heart attacks is more than a leap of faith, it is a magisterial mockery of scientific logic. This was amply illustrated a few years ago when the National Academy of Sciences’ Institute of Medicine (IOM) jumped on the trans fat bandwagon. “While touting studies showing that trans fats temporarily altered blood chemistry, the IOM glaringly did not cite any studies showing that trans fats posed any real risk to real people.” See Steve Milloy’s interesting site. As he also pointed out in one of his newsletters written for Easydiagnosis, “Thirty years ago, the diet police scared us away from animal fat-based butter and began singing the praises of what they said was a healthier alternative, trans fat-based margarine. Now, the diet police have done an about-face and want to scare us away from those same trans fats – all the while omitting mention that their butter scare was bogus from the (start).”

Now, according to last week’s New York Times, restaurants are preparing for the “Big Switch.” No longer is it merely unhealthy to eat trans fats, it is probably illegal to sell them: In New York City as of July 1, if restaurants and other commercial food purveyors serve baked goods, fried foods-to virtually anything on the menu not free of trans fat, they risk fines up to $2,000. Many foods your mother warned you about, including butter, palm oil, and lard are back in style and completely legal.

Since the New York ban on trans fat, a dozen other cities, including Boston, Philadelphia, and Seattle have called the Trans Fat Help center in NYC for advice in implementing their own bans. Watch the menus everywhere for warnings, and don’t forget to check your supermarket and food labels on everything from corn flakes to canned peas. -Uh-oh, I forgot, natural trans fats found in meat from animals and dairy products are acceptable and declared safer than the manufactured variety. They are still legal. the question is, for how long?

*If you want to learn some interesting things about the chemistry of cis or trans, stereochemistry, enantiomers, etc. I suggest this excellent Wikipedia site. The simplest way to describe the geometrical forms of some compounds is in the context of chirality (chiral, derived from the Greek, meaning hand) in which two mirror images of a molecule cannot be superimposed onto each other, much like the concept of the spacial difference between the left and right hand. The left glove can never be worn on the right hand. In chemistry these differences are referred to as enantiomers , and occur in two forms, cis and trans or “optical isomers,” because they rotate a beam of polarized light in counter-or clockwise directions. The property was first described in 1815!.