THE SUNDAY TELEGRAPH – 28 March 1993
Back to the eggs and bacon, Mr C
Medical trials, says Dr James Le Fanu, put the cholesterol bogey in its place.
MR C. G. from Middlesex is a man of habit. For five decades he started the day by treating himself to a proper breakfast – eggs and bacon, thickly buttered toast, marmalade and fresh coffee. Then he had his cholesterol measured: it was 7.6, and life has never been the same since.
The morning egg is boiled and the smell of sizzling bacon is just a memory: indeed, I gather he has cut out virtually all animal fats, and soya margarine now covers his toast. The result? He has lost 7lb, his cholesterol is down to six, and ‘I’ve lost my former sense of wellbeing’.
Mr C. G. had read that low cholesterol levels are associated with depression, and wondered whether this might be the explanation. He writes asking my opinion and, as I am sure many readers have had similar experiences, I hope he will accept a public rather than a personal reply.
For more than a decade the medical profession has persuaded itself that the cholesterol question was all sorted out. Cholesterol whooshes around the circulation, furring up the arteries, and as a result far too many people keel over from coronaries before their time. A rigorous low-fat diet can certainly lower cholesterol, and if it were widely adopted the nation’s arteries would remain squeaky clean. For those with very high cholesterol, this is insufficient and they have to take cholesterol-lowering drugs.
The implication of all this is that cholesterol consciousness will prevent thousands of premature deaths, make a lot of money for the drug companies, and everyone will live happily ever after.
Well, not that happily. Take, for example, the 1,906 men who took part in a trial with the cholesterol-lowering drug, Cholestyramine. This is actually rather an unpleasant drug to take, not dissimilar to swallowing a mouthful of sand before each meal. Unsurprisingly, it does not do great things for the appetite, while also causing heartburn, flatulence and dyspepsia. As all the participants were healthy middle-aged men, who presumably enjoyed their food, this must have been a bit of a downer. In addition, compared with a control group, they had an increased incidence of gallstones, cataracts and cancer of the colon. Was it worth it? After five years there were eight fewer deaths from heart disease (30 in all, compared with 38 among the controls), but as Cholestyramine is an expensive drug, each life saved cost a million pounds.
In overall terms, this scarcely seems worth the candle.
Serious doubts set in two years ago, when Professor Matthew Muldoon of Pittsburgh University reviewed all the cholesterol-lowering trials, including this one, and found they did no good at all. Certainly there was a beneficial, if modest, reduction in heart disease, but the side-effects of the drug had led to an equivalent increase in deaths from ‘accidents, violence, trauma and suicide’.
One could speculate that having to take an unpleasant drug for years might make anyone suicidal, but Prof Muldoon argued that cholesterol-lowering in general might have adverse psychological consequences, increasing suicides, suggesting that accidents are the tip of the proverbial iceberg and hinting at a much wider and more generalised problem of unhappiness and personality change.
The cholesterol-lowering brigade cried ‘Foul’ and dismissed Prof Muldoon’s observations as a chance finding of no significance.
There is, however, quite a lot of evidence, none of it reassuring, linking cholesterol and personality. It has been noticed that anti-social criminals -youths with ‘aggressive conduct disorders’ and murderers who are ‘habitually violent when intoxicated by alcohol’ – all have lower than average cholesterol levels. Why should this be? Cholesterol is an integral part of the walls of cells, including those of the brain. Lower the cholesterol, argues Dr Hyman Engelberg of the California Arteriosclerosis Research Foundation, and you reduce the number of receptors for the neuro-transmitter, Serotonin, which we know is involved in ‘behaviour control’.
The simple answer to Mr C. G’s query, then, is that it is not possible to say for certain whether lowering cholesterol causes depression. But the evidence is highly suggestive. Further, and this is a crucial point, the ‘normal’ cholesterol level rises with age. For those over 60, like Mr C. G, the optimum is actually around 7.00. A lot higher than this and there is a small increased risk of heart attacks: lower than this there is an increased risk of strokes and cancer.
Mr C. G’s boiled eggs and soya margarine are, therefore, likely to be doing him both physical and psychological damage, and I urge him to revert to his proper breakfast without delay.
Copyright: Telegraph Group Ltd