I'm going to begin by saying that via this blog I've likely contributed to the notion that it should. I've posted my own cholesterol numbers a few times, have written many posts on it, argued how the paleo-like diet improves the numbers, and so on.
For decades, likely since Ancel Keys, there has been a focus on reducing cholesterol, under the presumption that high cholesterol causes heart disease. And, so, there's all sorts of dietary advice, and now prescription medications to lower cholesterol. In fact, no such causal link has ever been even close to being proved. And, in fact, even the associations once thought to be solid, aren't there.
Want proof of that? Got 77 seconds?
Let's just sum it up beyond what's given in the video: about half the people who die of heat disease have low cholesterol, half high. For women, higher cholesterol seems to be associated with higher longevity. For older people too.
In spite of this, many of us on paleo like to tout our great lipid numbers. Why? If none of these "associations" are even very sound, and a causal link has never been established, then what's "good" or "bad" in these numbers?
The thing about a paleo like diet is that we operate from a principle that has tons of basis in fact: we know what we evolved to eat. We know the archeological record of excellent health for pre-agricultural humans. We know that dozens, even hundreds of primitive hunter-gatherers, pastoralists, and other non-industrial peoples have been observed by physicians and other scientists going back 200 years, and virtually none of the diseases of civilization show up. We know all this, yet then go get our lipids tested to confirm that we're eating right.
Shouldn't we just know that we're eating right? How do you feel? Very nearly everyone raves about how great they feel; that is, until they get their cholesterol numbers and they aren't in the club with the rest of us who have "good" numbers.
I've come to believe that there's a lot of silliness going on and I'm sorry to have been a part in promoting it.
Cholesterol is not a problem to be managed, a diet of real foods is what is to be managed and the cholesterol numbers are the numbers.
Let's dive into a couple of examples. I had three, but I have misplaced one and can't find it. If the reader who wanted his numbers looked at by other readers for comment would still like that, please email it again and I'll append it to this post. I previously did a post on a reader Patrik's MNR LipoProfile.
You have my earlier cholesterol numbers from that previous post you did. I did a 90 day Zero Carb test with a sample of one (me, 41 year old, white male) from May 1 to August. Primarily ate beef from a free range, hormone free local ranch.
Got some numbers back. You have my previous from that post. In a nutshell:
c-Reactive Protein unchanged at .3 mg/L
HbA1C unchanged 5.2%
mean plasma glucose unchanged 119 mg/dl
So no changes, and liver and kidney function all remained unchanged/fine
My Lipid Panel this time is an NMR Lipoprofile, so the proper thing, I suppose. I can rattle off the numbers:
Total Cholesterol 288 mg/dl
Triglycerides 50 mg/dl
HDL 93 mg/dl
So, I had a Total increase, a slight Triglyceride increase and a pretty good HDL increase.
More NMR Nitty Gritty I'll need help sorting out as the units of measure are odd to me, but here it is:
Total LDL Particle Concentration 1348 nmol/L (considered borderline high)
Small LDL Particle Concentration sub 300 nmol/L (with sub 600 optimal)
Total HDL Particle Concentration 34 umol/L (considered intermediate)
Large HDL Particle Concentration 17.9 umol/L (with above 9 optimal, so banger)
And they threw in my calculated LDL at 185 mg/dL which is a guess using the Friedewald equation?
SO, I don't understand how to convert units, nmol/L and umol/L, but I gather that my LDL is indeed up, but it is pretty much all the non-threatening A type larger. And my HDL is also about as big and protective as it gets. Couple all that with the low low low inflammation markers, the low glucose levels, and I'm sitting pretty happy. Would like help converting and interpreting the NMR nmol/l and umol/L numbers..... got any experts at hand?
I think my LDL is classified "borderline high" but conventional wisdom still does not take particle size (mine are large and fluffy) into consideration. My lab results even have this little pro- "statin-ator" comment:
"...studies have shown that elevated LDL particle concentration is associated with increased risk for coronary heart disease. Statins effectively reduce the number of LDL particles, but DO NOT GENERALLY INFLUENCE THE SIZE DISTRIBUTION OF THE LDL PARTICLES...."
So, I could spend a ton of money to get likely smaller LDL particles, AND less protective HDL, and muscle cramps, cancer, and neurological disorders, but I think I'll stay statin free, and keep on pouring in the animal fats.
My one comment would be that the LDL particle number of 1348 nmol/L corresponds to an actual LDL of 134. Notice that his Friedewald measured LDL (the kind 99% of people get) is 185, an error of 40%. I recently blogged about this and a new formula some Iranian researchers came up with for when triglycerides are under 100. There's a calculator too. Well, under that formula, Tim's calculated LDL comes out to 145, a very reasonable calculated approximation of his actual of 134.
OK, great, right? paleo diet -- even a near zero carb one -- confirmed. Tim has the cholesterol numbers to prove it. No slight to Tim at all, and yea, anyone is going to be pleased to get these results. But what if you don't?
The next reader is "John." Rather than an MNR, he has pre and post paleo VAP tests. I've uploaded the files for reference.
Now, for those who don't want to dig deep, here's the summary from John:
I just got a blood lipid panel from my first 3 months of Paleo. Very, very few cheats in that 3 months.
LDL direct went to 396 from about 150
Triglycerides went from 114 to 150
HDL didn't budge, mid 60s
Total Cholesterol went from 240 to 485
After a few questions, he ads further:
1. I am 5'11", started the diet at about 162, am about 150 now, stronger than ever in recent memory (22 pullups this morning). I tend to be lean, my weight until my mid-20s was 130 lbs, I was a fanatic distance runner.
2. Pretty normal diet, not too much crap compared to average. I was not a dessert freak or anything. Lots of chips (doritos, etc.) was my main weakness.
3. I'm trying to eat mostly meat. We usually have a vegetable or salad with the meal, my wife likes that. Especially early on, I'd marinade the steak in soy/teriaki blends or something like that, but how much is going to soak in? At least the last month or so, I've been using dry rubs instead.
I have been eating much less fruit than she has. I'm trying to hold that to one or two servings a week. I'm totally mystified by the triglycerides as well. I can't see where they'd be coming from. I thought lower triglycerides would be the slam-dunk effect of this diet right off the bat.
So, what do you make of that? Should John immediately stop paleo and go back to lots of Doritos? Anyone have any ideas? Anyone seen this huge of a jump in a paleo or low-carb dieter?
I have no idea, myself. But I do think that tremendous of a jump merits some attention, as it could be signaling something else going on. In the meantime, I'd still eat real foods. John should probably look into getting some sort of consultation with a reputable low-carb doc.
To close it up, I'm going to quote what my Hyperlipid UK veterinarian friend Peter told Tim about his cholesterol, as it's insightful and what really got me to thinking about this. See, John's was by far the most dramatic increase, but I've received many disappointed emails from new paleo dieters who didn't get into the "good cholesterol club" with myself and others.
I think you are pretty well in charge of understanding your lipids. The comment about statins reducing LDL count but not size is simply wrong, but this is about what you would expect in our statin culture.
Bear in mind it is perfectly acceptable to view your lipid panel as evidence you are eating an appropriate diet made of real food, which promotes health. The lipids reflect that diet and are secondary markers of the diet... It is not necessary to believe in good or bad cholesterol. Eat Food and never mind the lipids. The Kitavans have "awful" lipids because they eat a carb based real food diet. The real food results in health, the lipids are bad. But the lipids cause no badness because it's not the lipids which are the problem. It's the food that matters! Most real junk is carb based, which is why "carb" lipids are "associated" with ill health. Blame the food not the lipids...
That's just my cantankerous way of looking at things!
Exactly. It's not that it's an awful thing to view your lipids as some confirmation of eating a good diet. But it's probably just confirmation bias, because, what happens when you're John?