Janet Bond Brill, Ph.D., R.D. , nutritionist and author of Cholesterol DOWN (Three Rivers Press), has spent many years counseling patients on wellness, weight loss, and cardiovascular prevention.  Her work has been published in the International Journal of Obesity and the International Journal of Sport Nutrition.

Dr. Janet Brill--

In the New York Times (July 7, 2008), there was an article by Tara Parker-Pope regarding the American Academy of Pediatrics’ newest guidelines for cholesterol screening and treatment in our nation’s children. The revised guidelines now take a more aggressive stance regarding prescription drug treatment of high cholesterol in children, with the newest recommendation dropping the age of consideration for drug treatment from “older than 10” to as young as 8.

Is it wise to prescribe prescription medication to our children to fix what used to be considered purely an “adult” medical problem? And will statin medication taken in childhood truly lower our kids’ risk of contracting early heart disease as adults? And what about the potential for long-term side effects? Statins are "lifetime drugs" that must be taken daily to effectively keep cholesterol in check.

Pediatricians are concerned not only with the epidemic of childhood obesity that has swept our nation but also with the equally disturbing fact that high cholesterol as well as other diseases/disorders such as diabetes and high blood pressure—major risk factors for heart disease, the leading cause of death in this country—are now increasingly diagnosed in obese children. Because of this dire situation, we must take aggressive action to control these risk factors in an attempt to ward off the very real probability that these children will be predisposed to developing disease at an early age, potentially leading to premature death.

While I agree with the push to both increase detection of high cholesterol levels in children and specifically with taking aggressive action to control this major risk factor for heart disease, I am not sure about the wisdom of freely placing children as young as 8 on prescription statin medication to solve this problem. I think this action should be reserved only for those children who have been aggressively treated with lifestyle changes for a long period of time and have not responded favorably. It seems even more important for doctors to get aggressive with lifestyle changes to reduce LDL cholesterol levels in children, even more so than with adults who have a lifetime of unhealthy habits under their belts. Children are resilient and can change more easily than adults. The beauty of aggressively treating children with diet and exercise is that they will learn these habits early and hopefully continue them so that they will be predisposed to living a long and healthy life instead of premature death. Just as with adults, lifestyle changes (namely diet and exercise) are the basis for cardiovascular disease prevention and are the foundation upon which drug therapy must be applied, should lifestyle therapy fail to fully control cholesterol.

Considering that a significant reduction in LDL cholesterol can be accomplished through a few simple lifestyle changes that are no more dangerous or expensive than eating an apple or a bowl of oatmeal and taking a daily 30-minute walk, shouldn't this be our focus? Shouldn't we insist on becoming aggressive with healthful and innocuous lifestyle changes in our children before we seek to medicate them? Feeding our children pills without applying major lifestyle changes first and foremost will not fully protect them against future disease nor is it the wisest path to take to solve this dire threat to our children’s health and our nation’s future. As a parent and a professional health practitioner, I place a call to action for parents, recommending that they first resort to aggressively changing their children's lifestyle habits. If that route fails to achieve the desired goal, then and only then should medication be considered.

Book Review:  Cholesterol Down: 10 Simple Steps to Lower Your Cholesterol in 4 Weeks--Without Prescription Drugs

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Update on Jul 10, 2008 by At Basil & Spice

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