Dear Ms. MacLeod:

http://www.cbc.ca/healthmatters/recentstories/CBC.ca-Healthmatters-Transfat.html

I understand that there are standards that journalism adheres to in
publishing outrageous claims about causes of disease. The evidence about
transfats is far short of identfying it as a "major cause of premature
heart disease."

Please see below.

Dennis Raphael, Ph.D.
Associate Professor & Undergraduate Programme Director
School of Health Policy & Management
Atkinson Faculty of Liberal & Professional Studies
York University
4700 Keele St.
Toronto ON M3J 1P3
Ph: 416-736-2100 ext. 22134
Fax: 416-736-5227
E-mail: [log in to unmask]
--------------------------------------------------------------------------------------------------------------
Toronto Star
LIFE, Friday, December 12, 2003, p. F05
On matters of the heart, cholesterol and Oreos

Judy Gerstel
Toronto Star

Last week I wrote about spouses cheating on-line and a Toronto agency that
facilitates adultery. Enough people e-mailed me with personal experiences
that I began to feel like a voyeur.

I also heard from "attached" men, including one who said his best asset is
honesty, wanting to interact in ways ranging from sublime to ridiculous
with my middle-aged body.

I confess to being tempted by a 21-year old eager to give me a foot massage
(my new boots are killing me); he's experienced at this kind of thing, he
says, because he regularly massages the feet of his 55-year old mother.

But life is not all fun and games.

So let's turn to heart and body matters of a different nature: cholesterol,
Oreo cookies, trans fats. Also, poverty, childhood deprivation and what it
takes to have a healthy society.

More and more, trans fats are regarded as public enemy number one. What
people don't realize is that the real front in the war against heart
disease is not the food we eat, says York University professor Dennis
Raphael.

It's the food people don't get to eat.

"The excessive concern with trans fats is a joke," says Raphael. "For the
average, healthy person going to Loblaws, the health effects, if any, are
going to be negligible.

"But having close to 800,000 Canadians using food banks on a monthly basis,
with not enough money to spend on basic needs, experiencing stress and
insecurity, that's really sowing the seeds for poor cardiovascular health."

Raphael is a tireless proselytizer for acting on the proven link between
health and socioeconomic status.

And he thinks it's too bad we're getting sidetracked by the likes of Oreo
cookies: "Cholesterol by itself is not really that much of a risk factor."

Take that ubiquitous advertisement showing a body on a gurney, accompanied
by the query, "Would you rather have a cholesterol test or a final exam?"

Yes, cholesterol-busting statins do help reduce heart attacks, but the
impact is not all that dramatic, notes Raphael.

"Of people who take statins, 95 per cent don't have heart attacks over a
five-year period. Of people who don't take statins, 92 per cent don't have
heart attacks." And possible adverse long-term effects of these drugs are
largely unknown.

While cholesterol may be a good predictor of heart disease as a selective
variable, if you put it in context with other variables, such as childhood
infections and deprivation, it seems that cholesterol may be a byproduct of
other processes.

In other words, levels of cholesterol associated with heart disease may
occur simultaneously with heart disease, but may not be the causal agent.

Causation is a tricky concept. We're tempted to attribute cause to
adjacency.

For example, the best minds used to believe that noxious odours and foul
air called miasma caused disease.

As it turns out, the bad smells were associated with the true cause of
disease: infection agents in the unsanitary water and environment.

Some researchers now caution that cholesterol may fit into the "miasma
theory" of disease.

In a letter published in the British Medical Journal last year about the
link between dietary fat, cholesterol concentration and coronary heart
disease (CHD), Swedish physician and scientist Uffe Ravnskov wrote,
"accumulated epidemiology actually strongly contradicts such a link."

He cited a study of Japanese migrants in the U.S. showing that cultural
upbringing was the strongest predictor of CHD.

"Those who were brought up in a non-Japanese fashion but preferred lean
Japanese food had a heart attack almost twice as often as those brought up
in the Japanese way but preferred fatty American food."

Also, Masai people probably have the highest intake of animal fat in the
world, notes Ravnskov. And yet, abnormalities on electrocardiography were
far less frequent than in Americans. In southern India, mortality was seven
times higher than in the north (and age at death was 44 years compared with
52), even though people in the north ate 19 times more fat, mostly animal
fat, and smoked more.

Canada's Fraser Mustard, in a book titled Why Are Some People Healthy And
Others Not? states, "since the main cause of heart attacks is a
thromboembolic event, it is difficult to see how changes in cholesterol
levels in adult males will dramatically change outcomes since there is no
evidence cholesterol has a major effect on the thromboembolic process.

"This may be one of the reasons why ... trying to lower cholesterol levels
has not had a dramatic effect on the incidence of heart attacks."

Referring to Mustard's observations that two processes are at work in
cardiovascular disease- those that cause thickening of blood vessels and
those that cause narrowing and blood clotting- York University's Raphael
argues that the presence of environmental stressors may be related to the
second process, the main cause of heart disease.

"Whether the second process occurs appears to be related to whether the
person experiences stress," Raphael says.

He makes the point to emphasize his findings that low income and social
exclusion are major causes of heart disease in Canada.

But in questioning the focus on cholesterol- a focus which serves the
pharmaceutical industry by making statins the best-selling drugs- Raphael
is challenging us to think critically about it. You can find out more about
how cholesterol may be more of a red herring than a cause of cardiovascular
disease on-line at www.ravnskov.nu/cholesterol and at www.thincs. org.
Thincs stands for The International Network of Cholesterol Skeptics.

Of course, this doesn't mean you should run right out to buy Oreos. But it
doesn't hurt to question received wisdom, especially when it results in a
handsome profit.

And it doesn't hurt to be reminded that the people around us who are living
in poverty and finding sustenance at food banks aren't just hungry and
stressed, they're the ones who are most at risk for heart disease and heart
attacks.

jgerstel @ thestar.ca


Category: Society and Trends
Uniform subject(s): Diseases, therapy and prevention
Edition: Ontario
Length: Long, 793 words

Copyright © 2003 Toronto Star, All Rights Reserved.

Doc. : news·20031212·TS·0031212254576


This material is copyrighted. All rights reserved. © 2001 CEDROM-SNi
--------------------------------------------------------------------------------

POOR CHOICE OR NO CHOICE? Evidence links disease with poverty, so why keep
blaming fries?
By Dennis Raphael
Get off the couch and exercise. Stop smoking. Don't touch those fries.
Do these things, we're told, and we can fight off obesity, heart disease,
and diabetes.

But a recent study published in the British Medical Journal provides
further evidence that adverse life conditions--not lifestyle choices--are
the main contributors to obesity, heart disease, and diabetes.

Even more significant, this study relates the risk factors for these
diseases in adults to the socioeconomic status they experienced as
children.

Researchers at the University of Bristol assessed the degree of insulin
resistance, blood cholesterol levels, and obesity among 4,286 women.
Insulin resistance is the body's inability to utilize insulin to process
blood sugars. It's a major contributor to heart disease and to Type II
diabetes, the most common kind, which appears in adulthood.

Most disturbing is the news that childhood socioeconomic circumstances were
even better predictors of insulin resistance than adult situations. Women
from lower-income conditions as children and as adults were 58% more likely
to show high insulin resistance than those who lived in higher income
conditions. But women living in better social and economic circumstances as
adults still had a 29% greater chance of being insulin resistant if they
grew up in low-income families.

Women who grew up poor were more likely to show increased insulin
resistance and have higher levels of bad cholesterol and obesity than those
who lived under better conditions as children. These relationships remained
after taking into account adult social and economic conditions.

The study came out shortly after the latest release of the Report Card on
Children showing that childhood poverty is on the rise in Toronto. The
number of children in low-income families rose 9% in the city from 1995 to
1999, and the city's poorest neighbourhoods have experienced a 35% increase
in the number of children since 1996.

Because they're growing up poor, these children are at greater risk for
obesity, heart disease, and diabetes as adults. But if disease prevention
and awareness campaigns continue on their present course, these kids may
grow up to be adults who are blamed for putting themselves at risk for
these diseases by smoking, not exercising, and eating unhealthy food. And
yet, research since the mid-1970s has found that lifestyle factors account
for only a small proportion of whether someone develops heart disease or
diabetes. In fact, Health Canada and Canadian Public Health Association
policy statements of the past 25 years make it clear that socioeconomic
circumstances are the best predictor of both the risk and the actual
incidence of heart disease and diabetes.

Many researchers have noted that trying to prevent lifestyle illnesses by
changing adult lifestyle behaviour is unlikely to alter the incidence of
heart disease and diabetes if no improvement is made in people's economic
conditions. Poverty influences health by determining the level of material
resources available such as income, shelter, food, etc., stress that
threatens bodily functioning, and the adoption of unhealthy coping habits
such as poor diet, smoking, and alcohol use.

These factors--the social determinants of health--are clearly not under
individual personal control. They're not choices people make. Is it a
lifestyle choice to have poor parents or be homeless or hungry because of
inadequate social assistance or minimum wages?

These social determinants of health are sensitive to social and economic
policies that result from government decisions.

Knowing all this, knowing that children living in poverty grow up at
greater risk of diabetes, heart disease, and obesity--all very costly to
our public health care system--would we not expect that governments at all
levels would promote the health of Canadians by assuring the quality of
these social determinants of health? Wouldn't we also expect that public
health, health care, and heart and diabetes associations would consider how
social and economic conditions affect health? And yet we hear little from
these sources except to be preached to about the importance of making
"healthy lifestyle choices," even though these choices are relatively
unimportant to the health of Canadians.

Why is this the case?

One question to ask is: Who benefits from such neglect?

Governments that weaken the social safety net, transfer wealth from the
poor to the wealthy through tax cuts, and privatize public services create
the risk conditions that lead to heart disease and diabetes. Yet these
governments can point to their lifestyle-oriented heart disease and
diabetes programs as "evidence" of their commitment to health care. Public
health units can appear to be working to improve health without raising
sensitive economic and social issues that would embarrass their political
paymasters.

Why disease associations also neglect the social determinants of health is
less clear. We can only hope that research findings--especially the recent
one about the impact of childhood poverty on adult risk of heart disease
and diabetes--will guide the Heart and Stroke Foundation and the Canadian
Diabetes Association to feature the following tips in their pamphlets:

Reduce poverty.
Improve economic and social conditions to reduce insecurity and stress.
Restore the social safety net.
Such tips--consistent with the latest research--would serve to focus public
attention on the real risk factors for heart disease and diabetes--and in
the process improve the health of all of us.
(Dennis Raphael is an associate professor in the School of Health Policy
and Management at York University and the author of Social Justice is Good
for Our Hearts.)
Taken from The CCPA Monitor, September 2003
Canadian Centre for Policy Alternatives
http://www.policyalternatives.ca

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