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The C word
Why are Iranians obsessed with cholesterol

By Mahyar Etminan, Pharm.D
July 26, 2001
The Iranian

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 cholesterol."

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 cholesterol levels.

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.

Comment for The Iranian letters section Comment to the writer Mahyar Etminan, Pharm.D