On Wed, 13 May 1998, Scott Maxwell wrote:

> Also, a great deal of evidence now is pointing toward elevated homocystene
> and triglyceride levels as much more dangerous than cholesterol.  Without
> simple carbs, triglyceride levels plummet dramatically.  I don't know much
> about homocystene vis-a-vis Neanderthin but I know that B vitamins
basically
> eliminate the threat.  Anyone else know anything about this?

Recent research by Gaziano and others indicates that the ratio of
triglycerides to HDL is important.  TGL levels are usually quite
responsive to lowcarb diet, but HDL is harder to affect.

Homocysteine is the new "rising star" of CHD risk factors.  This
substance appears to be responsible for making the artery walls
"sticky" to the oxidized LDL cholesterol, so that keeping
homocysteine low tends to reduce (or even reverse?) the buildup.
There is some interesting information about homocysteine at the
Solgar web site (www.solgar.com), including an interview with
McCully, the man whose research first identified it as a risk
factor.  It is true that in the vast majority of people, adequate
levels of certain B vitamins, especially folate, B-12 and B-6,
will reduce homocysteine levels dramatically.  There is an
article on this in the current American Journal of Clinical
Nutrition, showing that it is the B vitamins and not antioxidants
that does the trick.

But here's the question that needs to be considered in connection
with Neanderthin: Given that B vitamins are quite vulnerable to
degradation as a result of storage and cooking of foods, is
supplementation advisable?  I have read that it is hard to get
adequate folate even from "fresh" foods because they are not
usually all that fresh, and cooking them reduces the content even
further.  This is why it is recommended that pregnant women take
folate supplements now, no matter what they are eating.

I don't know the answer to the question, but since B vitamins are
pretty cheap it seems reasonable to be cautious.

> Anyway, it is quite possible that 10 years from now, cholesterol will be
> forgotten as a villain.  I am lucky in that simple-carb-free diets seem to
> be great for my cholesterol levels.  If you find this not to be the case
for
> yourself, you will just have to weigh the existing evidence and make your
> own decision.

Part of the problem is the easily misunderstood nature of the
word "risk factor".  Generally, A is a risk factor for B if A
raises the probability of B over what it would otherwise be.
That doesn't mean, however, that it makes B likely in absolute
terms.  Thus, if you are told that having a total cholesterol of
250 makes a heart attack "twice as likely" as it would be if you
had a total cholesterol of 180, it could still be true that your
chances of having a heart attack went from 1% to 2%.  McCully
(the homocysteine researcher) discovered that about 2/3 of his
patients with CHD did not have elevated cholesterol levels.
Furthermore, there are *lots* of people with high cholesterol who
never develop CHD.  Although it is clear that cholesterol plays
some part in the CHD process, it is also becoming clear that it
is not a simple cause-and-effect relationship.  If McCully is
right, LDL cholesterol is dangerous only in the presence of
elevated homocysteine.  And other research indicates that it is
only *oxidized* LDL that is dangerous.  If this is correct, then
Neanderthin's avoidance of readily oxidized vegetable oils is a
very good thing.

If this reasoning is correct -- and it's still pretty speculative
-- then if oxidation and homocysteine are controlled, LDL
cholesterol need not be worried about.

Todd Moody
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