The C word
Why are Iranians obsessed with cholesterol
By Mahyar Etminan, Pharm.D
July 26, 2001
As a young boy I remember going to Persian parties and sometime during
the party, specially around dinner time, the conversation usually shifted
from politics to food, health and yes, the C word, Cholesterol. I have even
seen elderly Iranian men in a party secretly munching on a noon-khamei (cream
puff) for fearing their wives would say, "Drop it! It has too much
What prompted me to write this is that the other day I had to argue with
my grandma to try a special dish. She refused saying it's "rich in
cholesterol." I said "Grandma do you even know what cholesterol
is?" She said "No but the doctor says it is very bad." Of
course my grandma is correct but how bad is it?
Now that I am wiser and more educated on this topic, I still don't know
why Iranians are so obsessed with it. When I tell any Iranian that I am
in the health care profession and have a good knowledge in research methodology
and medicine, people start asking me about cholesterol. The questions are
diverse but usually revolve around what types of food to avoid, what drugs
to take to reduce this damn cholesterol. Well, I intend to get rid of some
myths by actually talking about some of the main issues.
Cholesterol plays a big role in our body. It shapes our cells and makes
up many hormones and chemical messengers. Of course the bad cholesterol
or what we call LDLs have shown to be detrimental to our health because
they can clog up arteries and potentially cause a heart attack or stroke.
Studies have shown that people who have high levels of bad cholesterol are
more likely to have a heart attack or stroke. Thus, what we are really worried
about are these heart attacks and strokes and would care less about the
actual cholesterol itself.
So how strong is the scientific evidence behind these claims? Well, this
is the difficult part. It is not exactly simple. Because of the limitations
on the length of this article, I cannot discuss in detail all the scientific
evidence and the controversies around them. However, I will say that studies
have shown that cholesterol is one risk factor for having a heart attack
or stroke. I emphasize the word one because there are other important
risk factors including family history, age, other medical conditions, lack
of exercise etc.The point is that it seems we are obsessed with one risk
factor but don't know much or aren't doing enough about the other eight
or nine others that have also been linked to causing heart attacks.
Science has defined causes of a disease (say heart disease) as a collaboration
of smaller causes. For example, for someone to have a heart attack, many
circumstances and biochemical processes have to occur at the right time
and circumstances in order to cause a heart attack in that person. Having
a high cholesterol may be one of these causes or events but it sure isn't
the whole story. That is why 50% of people with heart attacks have normal
The other issue revolves around the drugs that have shown to reduce cholesterol.
Do we want to just take costly pills that may have side effects, or are
we more interested in having less heart attacks and strokes? Of course it
is the latter. In fact the new generation of these cholesterol drugs have
shown impressive results. They have shown to reduce death in patients with
high or relatively low levels of cholesterol.
But the question is if we give 100 people these pills and ask them to
take them every day, tolerate the potential side effects as well as the
high costs for a duration of three to five years, would all 100 people benefit?
The answer is no. Some patients may and some may not. Unfortunately, there
is no way of predicting who would benefit. A similar analogy is giving aspirin
to ten people with a headache and expect all ten to have their headaches
relieved. It simply won't happen; three or four may have their headache
completely gone, three may ache less and the rest may still have headache.
No drug will ever guarantee therapy in 100% of the population.
So why are Iranians obsessed with the C word. I think there are several
reasons. It probably has something to do with the fact that we listen too
much to friends and family and the media, probably none of which are experts
in this field.
Having a high cholesterol level should not be thought of as a death sentence.
Believe me, if this was the case we would have anti-cholesterol medications
in our water supply or even sprinkle some on our ghorme sabzi. Next time
you see an elderly Iranian going for that noon-khamei with fear, please
give reassurance that it will be just fine. We should enjoy all foods in
moderation because life is too short to think about cholesterol.