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Respiratory System and Health

Cholesterol, prevention, remaining healthy

Should your cholesterol level be tested?

By Dr. W. Gifford Jones

March 14, 1988

Thank God there are still researchers like Dr. John Frank on this planet who challenge popular medical practices. Doctors who prove it's wise to take a look at the total picture rather than jump on bandwagons. Who remind physicians that before patients are routinely screened for cholesterol they should be aware of the implications of being told,"Your cholesterol is high and you need medication for this problem."

The research community doesn't always applaud when Dr.John Frank, an assistant professor in preventive medicine and biostatistics at the University of Toronto rejects routine screening for cholesterol. There are several traps for both unwary physicians and patients when this test is done.

The mania for cholesterol screening has been imported from the U.S. Americans conducted a 150 million lipid study using a drug called cholestyramine. Their conclusion ? Patients with increased blood cholesterols who took this drug suffered 30 per cent fewer heart attacks and coronary deaths. A study in Finland using another drug to lower blood cholesterol gave similar results.

But that's where the good news ended. Both studies revealed that these drugs did not decrease the overall mortality. Rather, the same number of people were still dying but from other problems. The main cause was an increase in accidental deaths. Others patients developed gastrointestinal cancers, liver problems and stones in the gallbladder. It appeared that patients with a high cholesterol were exchanging one devil for another one.

Another disadvantage is rarely mentioned by either doctors or the laboratories that test for cholesterol. Dr. Frank says that the measurement of total cholesterol can be off as much as 30 to 40 milligrams and that the values for high density lipoproteins can't be believed unless they're done by an extremely high-powered laboratory. Moreover, one cholesterol determination isn't enough to label someone as being in either the high or the low risk category. He says four or five blood tests are required to obtain an accurate assessment of cholesterol.

The implications are obvious. Some patients will be incorrectly told they are at high risk. Others will be erroneously reassured that all is well.

There's another hazard. In England doctors prescribe anti-cholesterol drugs for patients who have a blood cholesterol of 300 mg. But in North America patients may be started on this medication when the blood cholesterol is much lower. This would include 40 per cent of the population. And it means that more people become potential candidates for cholestyramine.

An unanswered question remains. Why was there an increase in the number of accidental deaths? Dr. Frank offers this explanation. Patients who are started on cholestyramine must take it for the rest of their lives. He says the medication causes flatulence and gastrointestinal discomfort.That people on drugs start thinking they're sick people. That possibly the medication causes subtle changes in the central nervous system . The end result may be unconscious inattention and an ensuing accident. And that there's even a chance the mortality rate may be larger than believed because the study hasn't been conducted long enough.

J.B.Moliere, the French playwright and actor, remarked in 1673 that," Nearly all men die of their medicines, not of their diseases." This may also be true in 1988 if we start to treat 40 per cent of the population with drugs that many do not need. The harsh fact is that nature never gives anything away and always exacts a price. It cannot be stressed too strongly that when patients are told to take a drug for the rest of their lives doctors must be damn sure they will be better off following this advice.

I would consider taking cholestyramine only if both my parents had died of heart disease at 40 years of age. And if older siblings had also succumbed to this malady at an early age. But I'd run for the woods if a doctor suggested this therapy for a moderately elevated blood cholesterol. For one thing there's more to coronary attacks than a high cholesterol level. Recent studies reveal that high fibrinogen levels may be a better prognosticator of heart attack than cholesterol.

The best preventative for patients with borderline levels of cholesterol is to stay thin, get plenty of exercise, eat a balanced diet ,stop smoking, maybe increase the intake of vitamin C and relax with a drink before dinner .


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod