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Reader Feedback – Doctors and Cholesterol

First up, an email from Robert, who'll become a medical doctor in under a week. He must be completely thrilled, eh?

~~~

Just wanted to say hello. I’ve been a regular reader for several months now and thought I should take a moment to introduce myself. My name is Robert and I will be an MD in about six days. I’ll be starting an internal medicine residency in Reno, NV in July. I am both excited and nervous about starting, nervous largely because my patience with “modern” medicine is in rapid decline and I have three years of attending physicians to deal with. Yes, Richard, all of the doctors I have worked with personally approach health and nutrition in as mindless a manner as you think and often rant about.

~~~

I know, Robert, and isn't it the damnedest thing? Here you spend all that time, money and effort -- all the while enduring an enormous burden in terms of mental and physical stress and fatigue -- and it would certainly be an appropriate reward to be held in the sort of superman high esteem doctors have traditionally and often deservedly been held.

But I think it's safe to say that owing to the Internet, with its legions of people like me who deal in facts, logic and principles -- and not so much in titles, degrees and positions -- that we're in a situation where the gig is up. Doctors have largely squandered the goodwill they've earned over a century of hard, dedicated, lifesaving work. Thankfully, there are a growing number of docs like your very-soon-to-be self who have come to see the light. It's going to be an uphill battle for a long time.

For instance, Tim, another reader, sent me his lipid panel for comment. Though I don't expect you to comment, Robert, I have an idea that you would interpret it far differently from Tim's doctor. So, as frustrating as it is, this is a step in the right direction. There's that.

~~~

February, 2008, 225 lbs, years on the Standard American Diet:

Total 173
Trig 109
HDL 60
LDL (calc) 91
VLDL 22
Ratio 2.9

July, 2008, 160 lbs, through calorie counting, semi starvation, yet semi-low carb:

Total 145
Trig 38
HDL 69
LDL (calc) 68
VLDL 8
Ratio 2.1

Been going Paleo(!) since Sept 08, intermittent fasting, 3 days a week lifting hard efforts, sprints, eating tons of meat! Actually heading down the road for 90 days of meat only (2+ weeks in right now) so I did another panel:

May 1, 2009, 170 lbs, more muscle!

Total 226
Trig 34
HDL 82
LDL (calc) 137
VLDL 7
Ratio 2.8

Should I be concerned of the rise in Total and LDL?  From what I've read on your blog, Dr. Eades, and other sources, I don't think so.  I am more fearful of the 145 total number (cancer! etc) than the 226!  But my doctor is of the opposite opinion.

~~~

His doctor is of the opposite opinion, but why? Has the doctor been reading Eades, Davis, Sears, Briffa, or the many others out there and concluded that they are wrong? I doubt it. Tim's doctor is probably what I now refer to as a "regurgitator," i.e., as applied to the medical profession: someone who is trained to expertly diagnose and treat in accordance with conventional "wisdom," right or wrong. My non-medical opinion is that we ought to be cheering his great success in improving his health in a way that reflects every well done study and observation of this sort of thing I've seen.

For example, his C-reactive protein was .3 (a "BTW" in another part of his email), where "normal" is < 3 mg/l. This is a strong marker for inflammation -- the very thing that small, dense LDL acts upon to cause heart disease. Also, the ratios they have given Tim are of Total/HDL, which remain steady, as his HDL went from 60 to 82 (all the while you hear great cheering amongst the ignorant masses when someone goes from 45-50 and credits oatmeal or Cheerios). Normal for that ratio is 4-6, because grain and sugar eaters have such miserably low HDL. Ideal is 2-3. Mine was 2.1, so was my wife's, thereabouts, so there's three data points on that for Paleo: IDEAL.

The more important ratio by far, in my opinion, is Trigs/HDL. This is one of the biggest associations with cardiovascular disease (CVD). Again, grain and sugar eaters have abysmally low HDL (the thing that carries oxidized LDL out of your arteries and back to the liver for recycling) combined with elevated triglycerides, which is dissolved fat in the blood. Yes, ironic, isn't it? You want low levels of circulating fat in your blood? Replace grain and sugar with fat in your diet and the very first thing that will happen is that your Trigs (fat in your blood) drop precipitously. Guaranteed.

Tim went from a decent level of 109 ("normal" is considered < 150, but that's only because it's based on normal for grain and sugar eaters) to a whopping low of 34. Of course, he did it by replacing crap in his diet (grain and sugar) with real food like animals and their fat. 

Now, in case you're suspicious about the veracity of this Trig/HDL ratio being of prime importance, there's a lot out there. How about this, a 1990 (!) interview with then director of the massive, long-term Framingham Heart Study, Dr. William Castelli.

"There's a subgroup of people who have an HDL under 40 and triglycerides over 150," he explains. "These people have galloping proression of their cholesterol deposits, which will eventually lead to heart disease, and the average physician is not picking it up."

You can read the whole interview.

So, what did Tim's Trig/HDL ratio do while progressing from SAD to Paleo? It went from 1.8, which is on the very low side of ideal (< 2), to .4, which is on the screaming bleeding high side of ideal. Mine is also .4, so is my wife's, thereabouts, so three more data points for ya. Tim achieves a 4.5 magnitude improvement on his Trig/HDL ratio.

I wonder what Cheerios would have done for him.

But that's not all. His LDL is calculated, and rather than rehashing the pitfalls of calculated LDL, I'll just refer you to my 2-part series: What Do You Think You Know About LDL Cholesterol? (part 1; part 2). For another reference, here's how LDL ought to be measured: NMR LippoProfile.

But what can we glean from the information provided? Well, it turns out that the Trig/HDL ratio is a reasonable marker for LDL particle size. Remember, and you can find out more here, but small & dense LDL particles are the real danger. Guess what else? grains and sugar give you a profile where most of your LDL is small and dense, while a high fat (natural, i.e., animal) diet gives you LDL that's large and fluffy, which is inversely associated with CVD, so far as I can tell.

Ratio of Triglycerides to HDL Cholesterol Is an Indicator of LDL Particle Size in Patients With Type 2 Diabetes and Normal HDL Cholesterol Levels

RESULTS — Clinical characteristics, pharmacological therapies, lifestyle, and prevalence of diabetes-related complications were similar in both patient groups. LDL size correlated negatively with plasma triglycerides (TGs) (R2= 0.52) and positively with HDL cholesterol (R2=0.14). However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger (R2= 0.59). The ratio was >1.33 in 90% of the patients with small LDL particles (95% CI 79.3–100) and 16.5% of those with larger LDL particles. A cutoff point of 1.33 for the TG–to–HDL cholesterol ratio distinguishes between patients having small LDL values better than TG cutoff of 1.70 and 1.45 mmol/l.

Let's unpack this, and by the way, while this may look incomprehensible to many of you, do know that a couple of years ago it would have been to me too. I can only encourage you to persevere. You can develop an ability to pretty well understand this stuff. Yes, consult a doctor (hopefully one like new-doc Robert), but go in knowing and understanding what you're talking about. If a doctor is ever offended by your accumulated knowledge and insistence on questions and clear explanations, you need to find a new one.

  • LDL size correlated negatively with plasma triglycerides: higher Trigs = smaller LDL particles (bad)
  • ...and positively with HDL cholesterol: lower HDL = smaller LDL particles (bad)
  • However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger: the ratio is even more important, i.e., the higher the ratio, the smaller (badder) the LDL particles. Stunningly striking: 90% of those with small dense LDL (bad bad bad) had a Trig/HDL ratio greater than 1.33.

So, what's an average Trig/HDL ratio? I don't have time to look up averages and verify sources, but let's just assume an "on the edge" level for both Trigs (150) and HDL (40). 

That's a whopping ratio of 3.75, well above that 1.33 "cutoff"!!! So, if you present to your medical professional with better-than-"normal" triglycerides of 149 and HDLs of 41, he's going to give you a big high 5, and tell you you're on the right track. He's probably not going to even measure your C-reactive protein to determine inflammation markers, nor your Lipoprotein(a), or even homocysteine. And Tim? Before his transformation? Even with a very moderate Trig level by "normal" standards, he had a ratio of 1.8, well over that 1.33 "cutoff" between likely (with 90% confidence) small dense LDL and large fluffy. And now, at .4? Fergettaboutit. He's going to have an NMR per a subsequent email, but I can already tell you what it's going to show.

[Late edit: Note that as commenter below, GoEd, has correctly pointed out, that 1.33 ratio is based on European units for Trigs and cholesterol, i.e., mmol/l instead of mg/dl. That would all be fine and good, but Trigs and cholesterol convert differently. Dumb mistake, as I've made these conversions a number of times. So, at any rate, the ratio for Trigs and cholesterol based upon mg/dl is about 3.0, not 1.33. So, still, our example of a "normal, excellent" profile at a ratio of 3.75 is still well above the cutoff, albeit not quite as dramatically as I first implied.]

Though it is probably achievable to have a a small percentage of small LDL on a standard diet, I'm far more certain that it's going to be far easier accomplishing it on a paleo-like diet.

By the way, my lipid panels over the last year are here and here, my last with HDLs of 133. Yes: 133.

Afterthought: Tim has VLDL measurements, and the only thing I know is that lower is better. However, I've no idea how they are measured, how reliable they are as a marker, or any relevant studies. If an astute reader can educate me and the rest of us, please do so -- with my sincere gratitude.

Comments

  1. Robert (if you're reading), maybe you could consider concierge medicine if you happen to survive the next couple of years. (Or if concierge medicine survives whatever Obummer and his cronies have planned.) :)

  2. Lynn M. says:

    I'm part of the 10% with small dense LDL and a Trig/HDL < 1.33. My ratio is 1.27. What's the explanation for why people like me – the 10% group – don't have the large LDL with a Trig/HDL < 1.33?

  3. Great post Richard. Here are a few related articles:

    http://care.diabetesjournals.org/content/23/11/1679.full.pdf

  4. Richard,

    Thanks for all your good work.
    I'm not a super wiz on cholesterol calculations but I believe the ratio of 1.33 that is presented in the paper is based on European units (or mmol/l).

    As far as I understand when converting TG levels in European Units to TG levels in American Units you are supposed to multiply by 89 while when you are converting HDL from European Units you only multiply by 39.

    I suspect that this means that the TG/HDL ratio of 1.33 in the paper should be adjusted to 3.035 when applying it to the Cholesterol levels in American units (but I could be wrong).

    Cheers and Thanks again for your good work
    GoEd

  5. Robert,

    I hope not to sound too cynical but here goes. In an IM residency at a teaching center, the patients you encounter are going to be so far on the low end of the "fat tail" of the health continuum that these sort of issues will not be as big a conflict as you think. Many of your patients will be so sick, such metabolic disasters that you will be fully occupied from keeping them from dying. As an ER physician, I go entire shifts without seeing an adult less than 300 pounds. I can't tell you the last time I've done a lumbar puncture with anything less than a 6 inch needle. When I try to speak to these patients about paleo dietary principles, they look at me like I have 3 heads. Even the patients I see who have minor illnesses look so bad it is hard not to think that something much more major is going on…and sometimes there is.

    What will be frustrating is the treatment regimine you will be forced into by P4P (pay for performance) guidelines that government payors and insurers require you to "comply" with in order for treatment to be paid for. Very little P4P is based on good science, and much is driven (IMHO) by big pharma and big agra. P4P guidelines will be encountered mostly in the clinic setting where patients are less sick, but proper care is more critical. These guidelines are particularly poor WRT cholesterol management, diabetes management or anything linked to diet. If the "Commander in Thief" gets his way, this will all get MUCH worse. But in general you will be so busy pulling critically ill patients back from the brink, that you will have very little time spent on "health maintenence".

    Where you will get your chance is when you are asked to give a Grand Rounds presentation. This is your opportunity to lay out the biochemical foundations of the paleo approach. Showing this as it relates to diabetes, or management of cholesterol/coronary artery disease would be a real opportunity. If you can get someone from the biochem or cellular biology department as a co-presenter, then you will have a real opportunity to educate. Other than at this time, you won't have many opportunities to discuss dietary or exercise issues, because it mostly will never come up.

    Most importantly, during the next 3 years you need to focus on good self-care. The sleep deprivation and artificial stress that will be foisted upon you will be enormous. Keep up your good paleo habits. Coordinate your IF with your call schedule (fast when on call…the food is bad and stress will make you eat). Conserve your energy…never stand when you can sit, never sit when you can lay down.

    Regardless of the above, this will be a period of intensive learning and rapid growth, so don't forget to enjoy the process.

    Best wishes on July 1,

    Doug McGuff

  6. I have a new acronym for the Paleo principle: BPA free = Big Pharma & Agra free.

    My diet is BPA free, just as are my baby's bottles.

  7. In oh. Thanks for the heads up. Will dig into that.

  8. Ed:

    I've made an Ed in the entry. Thanks for the catch.

  9. Lynn:

    Before we look into that, make sure you've taken account of the edit I made in the post to calculate the ratio. Are you working from mmol/l or mg/dl for Trigs & HDL.

    On the other hand, 1.27 is pretty close to 1.33 and I'm sure there's lots of people on either side that close to 1.33 and much fewer exceptions the father away you get (a bell distribution).

    What's your diet like?

  10. Hello,
    I have been doing paleo since Aug 08. I read this blog daily and it is one of my favorites. I have dropped about 50 lbs and feel great. However, my blood lipids are not what I would call good. My LDL has gone way up from 116 pre paleo to 191 on a recent VAP test. My HDL has not moved at all. It stayed at 34. Trigs came down from 280 or so to 109.

    My family doctor wanted to put me on a statins a month ago. I asked for a VAP or NMR test first and got one. I am disappointed in the VAP results. As I stated, my HDL has not moved and my trigs are down but not down anywhere near the level I see others report. My particle size is classified as pattern AB a mix of both small and buoyant LDL. I was really expecting higher trigs and better size pattern.

    Here are some of the indicators: LDL 191,HDL 34,VLVD 27, Lpa 3, IDL 20 LDL R 168, LDL +VLDL3 36.

    The doctor wanted to start me on statins again. I am holding off but he recommended a carotid Ultra sound test that he says is pretty new. He said this test can predict plaque in the heart arteries. I am scheduled for this test. I am 55 year male BTW. If the test shows plaque the full court press will be on for statins from both doctors and family.
    Do you or maybe some or your readers know how long it takes for the HDL to come down? Is 9 months enough to see the HDL improvement? I am also wondering what the range is to move from pattern AB to pattern A. Are my numbers on the margin from moving up to pattern A or maybe the opposite just out of pattern B?
    Thanks for the blog I have learned a lot and really enjoy it.
    Rick

  11. Don:

    Awesome! (not a word I toss around).

  12. At least half of all heart attacks happen to people with cholesterol levels below 200. There's no strong evidence that having a low cholesterol level (below 200) improves mortality or that having a so-called high cholesterol (above 200) leads to a shorter or lower quality life. In fact, there is evidence to the contrary.

    The whole emphasis on our numbers (cholesterol, triglycerides, etc) creates a huge market for medical tests, drugs, and modified foods. But it misses the point: is the person healthy? And who determined what a healthy cholesterol level is? And by what means did they determine this? The ideal numbers are totally arbitrary and they change or have changed to make more people candidates for statin drugs. Our doctors mistake a possible symptom (so-called high cholesterol) with a disease state (which it's not).

    The modern medical approach to cholesterol makes the goal a lower cholesterol, not a healthier person. You can lower a person's cholesterol (artificially with drugs) and it will make him sicker and at greater risk for depression, cancer, liver damage, kidney failure, impotence, accidents, suicide, homicide, or violent death. Conversely, you can take someone with an unusually low cholesterol level and by feeding him/her an optimal diet, the cholesterol level might go up, along with improvements in health.

    Incidentally, many people find that eating more meat and fat, less carbs, and getting all or most of their carbs from veggies and fruits actually lowers their cholesterol if it was on the high end of the bell curve (not that this should be the goal).

    In the famous Framingham study, Dr William Castelli 1992 (Director of the Framingham study)said:
    "In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people's serum cholesterol…we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active."

  13. Let's not forget that Dr. Ravnskov has pointed out that people with higher cholesterol live the longest.

    And as Mary Enig says, a total blood lipoprotein count between 200 and 240 is normal, not a disease process.

    In any population, all measurable characteristics vary within a normal range in a Bell Curve fashion. Just as some people are shorter than average and some taller than average, some have smaller and some have larger feet, and some have lower and some have higher total lipoproteins. Thus, "high" cholesterol is not by itself indicative of a disease process any more than above average height indicates a disease process.

    I have read that taller people have, in general, a lower life expectancy than shorter people (don't have the reference). Assuming this is true, it would not give warrant for height reduction surgery for taller than average people. Similarly, even if it could be demonstrated that people with lower total lipoprotein counts did live longer, that would not give warrant to subject individuals with "above average" total lipoprotein counts to artificial cholesterol reduction.

    This gets back to the whole issue of reductionism. Tim's doctor thinks a blood cholesterol of 226 is a disease process. He completely ignores the context (patient) in which this occurs. Rather than evaluating the patient, he reduces the patient to a lab number. He wants to treat the cholesterol, not the patient.

    Don

  14. RRoscar: I believe I read on Dr. Davis's site that it takes a while for LDL levels to come down after cutting wheat and starches, and you may see an initial increase. My interpretation is that the liver is spitting out LDL and triglycerides as it detoxes itself as you lose visceral fat. While the liver is ridding itself of excess fat, your LDL levels will be elevated, but will come down once you've reduced the liver fat. This article explains the mechanism of LDL and VLDL production by the liver and the role of increased liver fat in increasing secretion of the VLDL particles (the precursor to LDL): http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2291326&blobtype=pdf . I had never realized until I read this article that VLDL is the precursor to LDL, and wonder if your physician knows it either (it doesn't help sell statins so such knowledge is not pushed by anyone).

  15. Thanks for the link Cynthia. It will take a bit to read and understand it.

  16. As the subject of the lipid panels reviewed above, I have to say "thanks" to all for the comments, links and info. I am pretty comfortable with all I have going on with my nutrition and exercise these days. The gain in total and HDL cholesterol is fab with me. The gain in LDL was a "HUH?" sorta reaction, but I need a measured NMR and particle type on the LDL to even have it be relevant. And likely I'm better off there, too. I'd be shocked if I'm not.

    I am 31 days in right now on a meat only 90 day study of sorts (me) and am loving it. I had dropped grains, legumes, sugars of all sorts some time ago now, but this next level of zero carb has no drawbacks (other than social, at family gatherings etc). My suspicion is that vegetative matter just is not vital or necessary to human life/health. I'm confirming my own bias with this little meat study.

    I'll post up with my July 1 tests and lipids after the 90 day zero carb. I think it is easy to predict, but my c-reactive protein should still be at nil, and my lipids will be ideal, can't imagine a whole lotta improvement on what I have now, but we'll see. Kidney and Liver function are all good and will stay that way.

  17. "Trigs came down from 280 or so to 109."

    I would say that cutting your trigs by more than 50% indicates you have improved your fat metabolism tremendously. Otherwise, the focus on this and that bit of lipoprotein is IMO completely misguided. Would you believe that you should go back to eating the way that gave you a lower LDL but a 50 pound greater body weight?

    If your trigs and body fat percent are both going down, you are getting healthier. You've only been paleo for 9 months, you didn't say whether you still have body fat to lose, but as you metabolize adipose it is natural that your blood lipids will not be ideal because you are releasing lipids stored in your adipose tissue.

    Plus, you have to remember you are an individual–you can't expect your numbers to look exactly like those of anyone else anymore than you can expect to have the exact same hair color, height, weight, etc. as anyone else.

    As for statins, I strongly recommend you read up on Statin Adverse Effects at this page:

    https://www.statineffects.com/info/adverse_effects.htm

    I wouldn't take a statin for any purpose. These drugs are part of the industrial environment to which our bodies have not adapted.

    For 2+ million years our ancestors lived without ever knowing anything about their lipoproteins or having statin drugs to "treat" "abnormalities." If they felt unwell, they used complex herbal medicines, not synthetic isolated "magic bullets."

    For example, you can use Red Yeast Rice:

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17302963

    Don

  18. You may also need some thyroid support, if you previously had a wheat-based diet, a deficiency of selenium can cause hypothyroidism:

    Quote……………………
    Stockdale T. Nutr Health. 1998;12(2):131-4.A discussion of the relationship between selenium, thyroxine, and indigestion.

    The manner in which wheat is grown affects its selenium content. When wheat which is low in seleno-methionine is poorly digested it is probable that a shortage of seleno-methionine will depress the activity of deiodinases and produce the symptoms of hypothyroidism.
    …………………………….. end quote

    Of course you can remedy this simply with temporary micro nutrient supplementation.

    Don

  19. Rick,

    Don brings up a good point about lipids being all out of whack when you're losing weight. It sounds like you've lost quite a bit of weight and maybe are still losing?

    As for the ultra sound, I'd recommend a CT heart scan. You should check out the track your plaque site: http://www.trackyourplaque.com A heart scan will tell you how much if any calcified plaque you have.

    Lastly, niacin, such as SloNiacin, at about 500 mg per day would probably have some positive effects on your HDL, LDL and your particle size. http://www.mayoclinic.com/health/niacin/CL00036

  20. Thanks for the info Dan Matesz. I agree being 50 lbs lighter and feeling good is much better than having low LDL? I do not intend to change from low carb to fix the LDL. Even if the carotid test shows some plaque I will try and aviod statins. I may ask for some Nicain to improve my HDL and LDL if they keep pushing the statins.

    I am not loosing much wieght right now. I have not lost anything for 90 days or so. I am 6 foot droped from 250 lbs to about 193 since Aug. The last few months I have been doing some strength training. Even though I have not lost wieght for a while I think I am changing some fat to muscle.

    I would not really be concerned about the high LDL if my HDL had gone up also or if my LDL partilce size was type A.

    Thanks again. This is a great blog.

  21. Lynn, This is actually a pretty common problem for many people over on the Track Your Plaque forum. They'll get their HDL up to 70-80, trigs down below 50 and yet still have a majority of small LDL. It's baffling… If anyone has the answer to your question, I haven't seen it yet.

  22. Paleo Newbie says:

    The reasons above is why I went into Radiology! Just finishing my 2nd year. We have a problem of reaching weight limits on our CT and MRI scanners which are around 400lbs. About once every couple of weeks we have to weigh a patient to make sure.

  23. My dad's trig/HDL ratio is 1.83. or 4.18.

    Cholesterol: 6.3 mmol/L or 245.7
    Trigs: 2.2 mmol/L or 195.8
    HDL: 1.2 mmol/L or 46.8
    LDL: 4.1 mmol/L or 159.9

    Doc wanted to put him on statins but dad refused. Now he wants to put him on Zetia (ezetimibe, ezetrol).
    I think he just needs to remove the grains.

  24. I'd echo what Don wrote, Rick.

    There's just no way I could be convinced that you are not a whole lot better off having shed 50 pounds and cutting your Trigs in half. You may not have reached optimal, yet, but once you get down to 15% BF then I would say that after a couple of months you'll be able to see what your lipids are from a healthy perspective for you.

    You feel great, you have created a situation where your body is reseting itself to be a normal and natural human being. You should pat yourself on the back, enjoy your newfound health, and stop stressing. Stressing out about this stuff might be the worse thing you could do.

  25. Lynn M. says:

    Following up on on Richard's reply to my earlier comment. I entered my Trig/HDL ratio incorrectly. It's 1.127 mg/dL, not 1.27. Considering that 3.03 is the ratio to use for mg/dL, I'm way off the bell curve for the relationship of LDL particle size to Trig/HDL ratio.

    I'm 62, female. My only NMR was 2/18/09. LDL-P 1458, Small LDL-P 1089; Total Chol 191; LDL-C 124; HDL-C 55; Triglycerides 62, Large HDL-P 9.3, Large VLDL-P 0.2. My LDL particle size is 20.5, the highest in the small range. That borderline status may be critical here.

    I have eaten a combination of WAPF and Protein Power Dilettante diet since 2001. My husband developed dementia in December 2006 and since then I've gained 25 pounds, probably from eating too much home-made raw cream ice cream, raw cheese, and pumpkin seeds as late-night comfort food. My LDL has doubled since 1/24/07; both HDL and Trigs dropped 25%. Unfortunately I'm not currently exercising. Your blog has inspired me to eliminate all grains, even sourdough foods, and try to lose that extra weight.

  26. Lynn:

    Well, grains combined with borderline on size is interesting. Dr. Davis often talks about wheat and particle size, so it would be interesting to see the effect — though I have heard from the docs and radiologists that you don't want to get radiated too often. You might end up doing something worse to yourself.

    Keep us informed.

  27. Don, you're right. By the way, do you know what is the average total colesterol (TC) level of people hospitalized with heart disease? Accordind to the guardians of the Lipid Hypothesis, it should be very high, perhaps 270 or 300 mg/dl, isn't it? Well, actually it is only 174.4 mg/dl, well below the average population TC level of about 200 mg/dl. I just wonder how will they explain his flaw now! Please see more of this in this study:

    http://www.journals.elsevierhealth.com/periodicals/jac/article/PIIS0002870308007175/