Caution urged in reaction to cholesterol study Results no excuse for new indulgence


For those who love a fistful of french fries, loads of extra cheese and hamburgers with the works, the news seemed a gift from the gods.

Some Baltimore diners welcomed reports yesterday of recent studies that say very low cholesterol levels may be as deadly as very high levels. A few health-conscious eaters, perhaps used to bragging about their low levels, reacted with mild disbelief.

"It's one less thing to worry about," said Vickie Bonovich of Owings Mills, 33, a systems analyst with a downtown brokerage firm. She was relieved, in part, because she had just splurged on a medium-rare steak sandwich with french fries at Burke's restaurant on Light Street.

"I generally watch my cholesterol and try to keep it as low as possible because there's a history of heart disease in my family," said Ken Gross, 30, a lawyer. Despite this concern, Mr. Gross had treated himself to a cup of spuds slathered with American cheese from a Harborplace french fry stand.

After learning of the studies, Mr. Gross raised his cup in a mock toast. "I'm very happy," he said. "I'll have this more often."

Carrol Adams, 59, who works for the U.S. Department of Agriculture near his home in Belton, Texas, said he eats chicken and fish more often than red meat; fruit and vegetables more than dairy products. The result is a low cholesterol level of 172.

Would Mr. Adams, who was eating a scoop of super premium Lee's ice cream at Harborplace, indulge more often?

"I don't think I'd take a chance," he said. "And I'm probably overweight a little bit, and should lose 10 or 15 pounds." He glanced at his diminutive cup of butter pecan ice cream. "Maybe 20 pounds."

Several doctors cautioned that the public shouldn't take these new studies as a green light for dietary indulgence. Some physicians remain skeptical that low cholesterol causes health problems.

"So much has been done to educate the public on the risk of high cholesterol in the past few years, it would be terrible if we completely reversed that because of one or two suggestions like this in the literature," said Dr. Adrian S. Dobs, an endocrinologist at Johns Hopkins Hospital.

"If you're high, yes, there's no debate you need to get down," she said. "The question is if you're low, do we attempt to treat it? That's where we don't know the answer."

A report published in the Archives of Internal Medicine last month, based on data from a 12-year study of 350,000 middle-aged men, found, as expected, that the 6 percent with extremely low levels of cholesterol in their blood were far less likely than their fellow Americans to die of heart disease.

But those same 6 percent were twice as likely to die of intracranial hemorrhage, three times as likely to have liver cancer, twice as likely to die of lung disease, twice as likely to commit suicide and five times as likely to die of alcoholism.

The study is only one among several that seem to link cholesterol, particularly in levels below 160 milligrams per deciliter of blood, with a variety of ailments. The average level in the United States is about 200. Some physicians suggest that the ideal level may be 180 to 200 or 220.

Dr. Thomas Price, a stroke researcher at the University of Maryland Medical Center, said doctors have traditionally thought that some cancers and other diseases were the causes, not the effects, of low cholesterol levels.

Alcoholism often attacks the liver, he pointed out, which can limit the organ's ability to produce cholesterol. So alcoholics with liver disease would be expected to have low cholesterol.

"But that doesn't seem to be the case from stroke," Dr. Price said. In Japan, where the traditional diet is very low in cholesterol, people have very high rates of brain hemorrhage and few heart attacks. Most Japanese-Americans, meanwhile, tend to have fewer hemorrhages and more heart attacks -- just like other Americans.

Dr. Price is also intrigued by the apparent link between low cholesterol, suicide and homicide. "That remains unexplained," he said. "Clearly people who are alcoholics are more susceptible to both. But that doesn't seem to explain everything."

Dr. Michael Miller, director of preventive cardiology at UM, expressed some doubts about the studies, saying they do not demonstrate a direct cause and effect. People who don't die of heart disease eventually die of something else, he added, perhaps suggesting a false link between low cholesterol and other ailments.

He said, "For most people, 180 to 200 is certainly a desirable range."

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