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Weekly comment

Diet better than statins in kids' cholesterol control

15-Jul-2008

The prescribing of statins for eight years-olds is tantamount to saying that food and diet have failed, and that children are incapable of changing their eating habits and lifestyle.

Last week, the American Academy of Pediatrics (AAP) announced recommendations to prescribe cholesterol-lowering statin drugs to obese children as young as eight. But prescribing statins to children is the complete opposite of what should be happening. We cannot sensibly expect to maintain eight year-olds on statins until the end of their days. This may seem like a winning situation for pharmaceutical companies, but the financial, health and ethical implications for the public don't bear thinking about. As the old saying goes, it's better to have a fence at the top of a cliff than an ambulance at the bottom. The AAP has rightly been roundly criticised for its statement and now is the time for the food and nutrition industries to speak out and emphasise the value of dietary approaches. There can be no argument over the danger of living with high cholesterol levels, or hypercholesterolaemia to give it its scientific term. The condition has a long association with many diseases, particularly cardiovascular disease (CVD), which is the number one killer on both sides of the Atlantic. Statins have a significant role to play in the fight against hypercholesterolaemia. Indeed, children even younger than eight are currently prescribed statins but only if they suffer from conditions such as familial hypercholesterolaemia (FH). It is not wise to make widespread recommendations for a generation of eight year-olds. When I first read that AAP was taking such a stance a number of questions jumped to mind. First off, how irresponsible and potentially dangerous is it to prescribe eight year-olds statin drugs? Secondly, have any studies ever been performed to show that this course of action is not only successful but also safe? AAP panel member Dr Nicolas Stettler from the Children's Hospital of Philadelphia said: "We know that in adults, decreasing cholesterol and giving some of those drugs decreases risk of heart disease or death. So there's really no reason to think that would be any different in children." That is not a statement borne of science. One doubts that Dr Stettler will be accountable in 40 years time if something different emerges. The lifestyles of these children have got them into this state; their lifestyle must get them out of it. And that means changing their diet. There is a wealth of dietary approaches to lower cholesterol - we all know about plant sterols, clinically proven to reduce total cholesterol levels by eight to 17 per cent if consumed at a daily amount of 1.5 to 3 grams. Moreover, post-launch monitoring studies report that these do work in real populations. On top of this, there are a number of other avenues available: Oatmeal and beta-glucan from oats have numerous studies backing up their efficacy. Then there is soy, omega-3 rich oils, and even garlic. In addition, a day after the AAP released its statement, we reported on a study from the University of Pennsylvania Health System that found fish oils, red yeast rice and other lifestyle changes may reduce cholesterol levels by the same amount as a daily statin pill - a whopping 42.4 per cent drop in LDL-cholesterol levels was reported. No-one in their right mind can say that dietary avenues do not exist. And no-one can say that these will not work with eight year-olds. Blaming the food industry for the growing obesity epidemic and looking to the pharmaceutical industry to rescue us from impending doom is short-sighted. It also highlights a disturbing misunderstanding of the complexity of obesity. Even if people don't have the same reaction as me, let me explain the economics of it: It's cheaper to build fences than it is to buy ambulances. Stephen Daniells is the science editor for NutraIngredients.com and FoodNavigator.com. He has a PhD in chemistry from Queen's University Belfast and has worked in research in the Netherlands and France. If you would like to comment on this article, please email stephen.daniells'at'decisionnews.com