What Do You Think You Know About LDL Cholesterol? (Part One)

Are you aware that the LDL cholesterol results you get in your routine blood workup is likely a complete fiction? That's right, and it's because LDL isn't measured, but calculated. Here's the formula, called the Friedewald equation:

LDL = Total Cholesterol - HDL - Triglycerides/5

So, for example, if one goes on a grain based, high carb, low fat diet which is well known to make triglycerides skyrocket, what would be the effect on your (calculated) LDL, all else remaining about equal? Your LDL would go down, your doctor would be pleased, you'd be ecstatic, and you may have actually increased your risk of, um, death (but maybe not of a heart attack, so yippee!). In fact, both very high and very low LDL associate with all-cause mortality (death from all cause, not just cherry picking heart disease). Where does risk appear to be lowest? I'm not sure, but for cancer risk, it's an LDL of around 130, i.e., lower or higher equals greater risk, and remember, I'm talking about LDL alone.

So, you want to reduce your LDL like a good soldier? Then increase your triglycerides dramatically. All else remaining equal, each 5-point increase in Trigs gets you a point off your LDL. Increase Trigs by 100 (easy to do with grains, sugar, and other refined carbs) and you can lower your LDL by 20.

So what are triglycerides? Most simply, fat circulating in your blood. Government recommendations are for a level of 150 and below. Mine are 47, and what you might not know about high-fat (and consequently low-carb) dieters is that they all have pretty low triglycerides (in the 50-80 area). Those who eat lots of grains and sugars in the form of bread, pasta, rice, processed foods, sweetened sodas, and, yes, fruit juices: you'll see triglyceride (fat circulating in blood) levels of 200 and on up, sometimes way up. 300-400 and above are not uncommon. Alright, so, eat lots of natural fat (from animals, coconut, and olives) in order to reduce your sugar intake (carbohydrate) and you'll dramatically reduce your triglycerides; eat low fat with lots of sugar (carbohydrate -- yes; bread and pasta is, essentially: sugar), raise the fat levels in your blood, and potentially lower your LDL.

Conclusion: a six-pack of Coca Cola per day ought to do the trick. Trigs will skyrocket and your LDLs will probably go down. Your doctor will tell you you're doing a great job, and you can live in ignorant bliss.

Or, you can get wise about triglycerides. Jonny Bowden was out with an informative post a few days ago, Triglycerides: What You Need to Know. Now, with the foregoing Friedewald equation in mind, and my rather pedestrian analysis and examples, get a load of this.

New Analysis Shows Troubling Trend in Triglyceride Levels May Be Linked to Rising Rates of Obesity (that does not look to be a permalink, so you may end up having to search the NLA site)

A new 30-year analysis of the National Health and Nutrition Examination Survey (NHANES) database conducted by the National Lipid Association (NLA) indicates that while Americans are doing a better job of managing LDL or "bad" cholesterol, the percentage of adults with high triglycerides, a blood fat linked to heart disease, has doubled, leaving many people at risk for potentially life-threatening events such as heart attack or stroke. Results of the analysis were presented today at the American Heart Association's Annual Scientific Sessions in New Orleans.

So, now, watch how they can't see the forest through the trees.

Between 1976 and 2006 the number of Americans with unhealthy isolated LDL levels dropped from 43 percent to 40 percent, an improvement that researchers attribute to more aggressive educational initiatives and treatment. However, far less emphasis has been placed on controlling triglycerides. The rising rates of isolated high triglycerides seen over the last three decades underscore the need for physicians and patients to understand and treat all three key lipids, which include LDL, HDL or "good" cholesterol and triglycerides.

Get it? They attribute lower LDLs with better education and treatment, when the Occam's Razor explanation is that by virtue of the equation they use, the majority of the lowering of LDL is likely a simple mathematical relationship having to do with elevated triglycerides. In other words, their "educational initiatives" have been to prescribe low fat, high sugar (carbohydrate) diets, resulting in grossly elevated triglycerides and moderately lower LDLs.

This is the outright FRAUD that's being perpetrated against you by "authorities" and "experts," many in the pay of the drug companies who want you popping statins.

And just in case you don't know, there's really no meaningful association between LDL and heart disease. Time and time again, if hundreds of thousands of heart attack patients are analyzed, half have low LDL and half have high LDL. It's irrelevant. However, the association with high triglycerides is very well established. See here and here and here, and that's just a 5-second Googling. I could get you a dozen more in five minutes.

Even the National Lipid Association, from which this study and statement originate, acknowledges an independent association with triglycerides.

...triglycerides are the third component of the lipid profile and are an independent and compounding risk factor for heart disease, the leading cause of death in the U.S. Studies have shown that the risk of developing heart disease doubles when triglyceride levels are above 200 mg/dL. When triglycerides are above 200 mg/dL and HDL cholesterol is below 40 mg/dL, a person is at four times the risk of developing heart disease.

Tomorrow, in Part Two, I shall demolish the notion that you have any clue as to what your LDL really is. If you are getting standard blood tests, you have no idea what your LDL is, and I can prove it. That number on your printout is completely worthless and meaningless. And, if you take any real stock in it, and you have triglycerides over 150, or even 100, you are probably living under a false sense of security, courtesy of the "experts."

What Do You Think You Know About LDL Cholesterol? (Pt 2 of 2)

Comments

  1. I had no idea that when a doctor measured your LDL that he or she is actually using a formula! Thanks for the information.

    - Dave

  2. I just double checked my blood work (on my fridge with a gold star) numbers. Baseline Triglycerides was 109. Six months getting primal with it (ditched carbs, upped fat and protein intake, from proper sources) and hit 38. I go in for another 6 month check here directly. What tests should I be asking for?!

  3. Really insightful post.

    I have been low-carb/paleo'ing for the last 2 and a half years. A year ago when I went to get my bloodwork done, the lab was not able to come up with an LDL, they said it was because my triglycerides were too low. I always wondered what triglycerides had to to with LDL, I guess this explains the relationship.

  4. I assume that the difference between small and large LDL will be discussed tomorrow?

  5. Richard,

    Great post as usual. The "calculated" LDL is annoying. My dad, my brother and I all fell into this trap. We went paleo(your style paleo, not the fat phobic kind) and our LDL went up while the trigs went way down. Duh! That formula explains it all.

    Do you have a recommended test that will do a measurement so we can put this behind us? I want to know the real deal here, not the BS.

  6. Yep.

  7. Great stuff as usual

  8. Thanks, Keith. Just as you, just trying to hold everything together and keep 'em coming for more.

  9. Richard — you're KING!

    'Pedestrian…analysis'??!

    wtf — you just explained simply what 99.9% of Cardiologists… and 99.9% of all physicians do NOT comprehend. At all.

    TG and HDLs are everything and a fat deprived diet are the fastest way to degrade them.

    Your labs, again, I'm DROOLING, are amazing. They represent how the Paleo diet and lifestyle are the only way to go for longevity, optimal vitality and disease protection. Diana Hsieh's (your protege?) and Stephan's ROCK too (mine are good too — when I'm not hormonally f*cked up).

    Lookin forward to the next post! :)

    -G

  10. Thanks, Doc.

  11. Tim, I'll address the name of the test in part 2 that I should get up later.

  12. Jeff, yes, that info will be in part 2, likely later today or this evening.

  13. As usual, a class act post, Richard. Highly informative.

  14. Great post

  15. As another data point, a few years ago (pre Paleo eating) I had a blood lipid screen. It put HD at 54, LD at 106. I didn't realize the significant of triglycerides at the time, and don't remember the number.

    It's worth noting that I'm a pretty lose dieter. I eat paleo(ish) but I cheat a bit, and still eat dairy. The big changes for me were grass fed meat (and a lot of it) much more fruits and vegetables and much less grains.

    After a year or so of this I decided it was time to get another blood test.
    HD is now 70, LD is 90 and triglycerides are 40.

    I am curious if you have any sources for the idea that lower LD is associated with higher all cause mortality, or that 130 is idea with regard to cancer risk. I agree with the rest of your post very strongly, but those two claims are completely new to me.

  16. Chris:

    Sorry, with so many comments this one slipped by me yesterday.

    I got the 130 number from Briffa:

    http://www.drbriffa.com/blog/2008/08/27/new-evidence-links-low-cholesterol-with-increased-risk-of-cancer-and-death-and-what-are-we-to-make-of-conventional-cholesterol-guidelines/

    I've read the low LDL association many times — too many times and places to remember where — but here's some stuff I Googled:

    As I recall, the association is most pronounced in older people.

  17. Adipex_Phentermine_Pill says:

    Great! Thank for information, I'm looking for it for a long time,