Search Results for: cholesterol

Don’t Worry About Cholesterol

A comment by Dr. Charlie, biochemist.

~~~

Sorry for delay in getting back to you re TC/ apoB and Gabriella’s concern over a patient who had a blip in her LDL readings. In a way I’m glad that I did because just by chance I watched again the Wisdom of Clouds speech by Tom Naughton and the lecture by Prof Tim Noakes on YouTube, entitled “The Great Diet Controversy: UCT taught me to Challenge Beliefs”.

Although we could discuss the size and shape of the cholesterol bearing particles and whether it’s the number or total quantity that should be considered, I think that it is more important to consider whether the whole concept of the cholesterol hypothesis is correct. In the early days of the hypothesis many trials attempted but failed to establish a clear link between cholesterol and CHD – yet the medical profession were eventually persuaded that there was a very positive relationship.

I would agree with Noakes’ response to a question concerning cholesterol levels and say that women should not pay any attention to them – no work has shown any link for them and for men over 50, high cholesterol levels have been shown to be protective. For example, many studies, including the famous Framingham study begun in 1948, have shown that in people over 50/60, higher levels of cholesterol are protective (ie the death rate comes down with higher cholesterol). I just happen to have to hand the results of a recent Scandinavian study. This study published in the Scandinavian Journal of Health Care [I think that's the one - Ed] looked at the levels of cholesterol and risk of death in almost 120,000 adults living in Denmark.

The researchers found that having higher than recommended levels of total cholesterol was associated with a reduced risk of death. So they looked at the death rates amongst men who had a total cholesterol level of less than 5 mmol/l and compared that figure with the death rates of men who had total cholesterol levels between 5 and 5.99, and those between 6 and 7.99, and those with levels of 8 and above.

  • They found that in men aged 60-70 when compared to those who had a total cholesterol level of less than 5...
  • those with levels of 5.00-5.99 had a 32% reduced risk of death; and
  • those with levels 6.0-7.99 had a 33% reduced risk of death.

Even in individuals with levels of 8.00 mmol/l and above, the risk of death was no higher than it was for those with levels less than 5.0 mmol/l.

The results were similar for women too. In women aged 60-70, levels of 5.0-5.99 and 6.0-7.99 were associated with a 43 and 41 per cent reduced risk of death respectively.

In individuals aged 70 and over, the results were similar, except here, levels of total cholesterol of 8.00 mmol/l or more were associated with a reduced risk of death too (in both men and women).

Together, these findings suggest that the current total cholesterol recommended by medics and other health professionals are way off beam. And the authors of this study suggested –rather meekly that - these associations indicate that high lipoprotein levels do not seem to be harmful to the general population.

So I hope you appreciate that for me the minutiae of particles may be of academic interest but not of medical interest – apart from the fact that higher levels are protective!

~~~

It has been 2007 since I have blogged on this topic, saying essentially the same thing, and nothing seems to change.

Thanks, Dr. Charlie!

Cholesterol Con

For those following along with me on this exercise, diet, fasting journey, it should be quite apparent that my diet has shifted considerably since I began this in May '07, to where now I am quite comfortable eating a diet very high in saturated fat mainly from animal sources (coconut oil would be an exception). But how did that happen? Did I do a lot of research on it and decide it was the best approach, or what?

Nope. I just followed my nose, or, more specifically, my appetite. None of any of this was remotely apparent prior to having undertaken a number of fasts, normally of 30-hour duration, culminating in a workout for most of them. At first (prior to beginning the fasting), I gradually adopted a "Paleo" approach because it made logical sense. In evolutionary time scaled to one year, humanity has been exposed to grains for about a day, and concentrated vegetable oils for ten minutes (that's a short YouTube; check it out). But then something odd happened with the fasts. My appetite changed dramatically. Now, why would that be? Why does it persist? Long story short: it originally changed to wanting just lots of meat, but over time, even my appetite for huge cuts of meat has subsided. Now, I seem to desire mostly very high fat content (animal, including unsalted butter), modest meat, and just very small bits of carbs in the form of some vegetables, nuts, and a little fruit (had some pineapple with breakfast, yesterday). Incidentally, these cravings, tastes, and hungers are unmistakable. Fasting seems to heighten the senses in this regard. For example, I have become very sensitive to salt and add little to none on most things, anymore. Normal salted butter tastes very salty to me now.

So in order to accept the hypothesis that dietary saturated fat I hunger for is damaging, in the context of mostly non-agricultural diet -- i.e., little to no grain-based products -- it would be necessary to conclude that either (1), human hunger adversely motivates the human organism to harm itself (which is prima facie absurd), or (2), that I suffer from some ailment most other people don't have that's causing me to hunger for things that are harmful to me, which seems unlikely as no other symptoms present (quite the contrary: I feel better than I have in 20 years). A third possibility, equally unlikely in my view, is that just as my hunger changed from lots of meat to more modest portions with higher fat, I'm on the cusp of yet more appetite changes that'll have me eating from fruit baskets and standing in line at Fresh Choice in no time.

So there I was, in somewhat of a quandary. Virtually the whole nutritional world stands against me, while friends jokingly propose that they take out life insurance policies on me. Yet, I know what I hunger for, and I'm pretty sure that some reasonable semblance of the path I tread has been traveled before me, before "nutrition" was even approached as a science, and with nothing but apparently excellent human results. So mostly just to satisfy my curiosity, along with the perverse pleasure in pointing out to the horrified that they actually know nothing of what they talk about, only that they "know" "artery-clogging-saturated-fats" from everything they see, hear, and read in the major media outlets. So what do I know, now? Well, after lots and lots of poking around, reading the abstracts and texts of many studies, I know at least some of the actual data upon which much of what's reported is based. I also know that many studies are not reported at all in the mainstream. I know there is nothing like a scientific consensus; say, like the consensus that a certain strain of viruses cause the common cold. I know that there is tons and tons and reams and reams of studies and data, going back decades, that not only doesn't support the saturated fat, cholesterol hypothesis, but actually contradicts it, and I know that from these data emanate hyper-complex sub-hypotheses in attempts to explain it away.

There has never, ever been a single study even remotely linking high saturated fat intake to either elevated total cholesterol, or heart disease (there is to the contrary, though). Not to mortality either (though there is to the contrary). Neither are there any studies conclusively linking high cholesterol to heart disease or mortality, though there are studies linking low cholesterol to higher mortality. It just goes on and on.

Via Carbophobe, I came across this book review of Dr. Malcolm Kendrick's The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It. From there, I found this great article by the doctor, which I understand to pretty much summarize much of what's in the book. Read it, though here are a few short excerpts to wet your appetite.

The cholesterol hypothesis can be likened to a cathedral built on a bog. Rather than admit they made a horrible mistake and let it sink, the builders decided to try and keep the cathedral afloat at all costs. Each time a crack appeared, a new buttress was built. Then further buttresses were built to support the original buttresses.

Although direct contradictions to the cholesterol hypothesis repeatedly appear, nobody dares to say 'okay, this isn't working, time to build again from scratch'. That decision has become just too painful, especially now that massive industries, Nobel prizes, and glittering scientific careers, have grown on the back of the cholesterol hypothesis. The statin market alone is worth more than £20billion each year. [...]

The MR-FIT trial in the USA was the most determined effort to prove the case. This was a massive study in which over 350,000 men at high risk of heart disease were recruited. In one set of participants, cholesterol consumption was cut by 42 percent, saturated fat consumption by 28 percent and total calories by 21 percent. This should have made a noticeable dent in heart disease rates.

But nothing happened. The originators of the MR-FIT trials refer to the results as 'disappointing', and say in their conclusions: 'The overall results do not show a beneficial effect on Coronary Heart Disease or total mortality from this multifactor intervention.'

In fact, no clinical trial on reducing saturated fat intake has ever shown a reduction in heart disease. Some have shown the exact opposite: 'As multiple interventions against risk factors for coronary heart disease in middle aged men at only moderate risk seem to have failed to reduce both morbidity and mortality such interventions become increasingly difficult to justify. [...]

This quote followed a disturbing trial involving Finnish businessmen. In a 10-year follow-up to the original five-year trial, it was found that those men who continued to follow a low saturated fat diet were twice as likely to die of heart disease as those who didn't. [...]

Variations on a theme emerged. It is not saturated fat per se that causes heart disease. It's the ratio of polyunsaturated to saturated fat that is critical. Or is it the consumption of monounsaturated fats, or a lack of omega-3 fatty acids, or an excess of omega-6? Take your pick. These, and a host of other add-on hypotheses, have their proponents.

As of today nobody can - or will - tell you which type of fat, in what proportions, added to what type of anti-oxidant, vegetable, monounsaturated fat or omega-3 is the true culprit. Hugely complicated explanations are formulated, but they all fall apart under scrutiny. [...]

Before looking at the connection between blood cholesterol levels and heart disease, it is worth highlighting a critically important - remarkably unheralded - fact: After the age of 50, the lower your cholesterol level is, the lower your life expectancy.

Perhaps even more important than this is the fact that a falling cholesterol level sharply increases the risk of dying of anything, including heart disease.

There's lots and lots more, so read the whole thing if this is of interest to you.

And so back to my own personal experience, I took this just an hour ago. Less than a year ago I pretty much filled these out. And by the photos, you know what I've been eating.

Baggy_pants

Saturated Fat & Cholesterol Worries are so 2009

I love evolution, but particularly in thinking. It's not an issue of right vs. wrong but a process hallmarked by honesty. Evolution happens in large swaths of time, such that discrete changes at any point in time are hard to identify short of outright re-evolution. Then one day, you realize that everything has changed. To my mind, the job of historical scholarship is to relate those seeming gulfs, such that people laf at the way they think today, realizing it's likely fleeting.

Going back to 2007/8 when I first jumped on this bandwagon, perhaps the most helpful thing was to dismiss the dogma of limiting saturated fat and its cholesterol, or cholesterol changing properties. I still remember being part of the whole gig, as blogging about saturated fat and cholesterol in those first few years was an everyday staple. I touted HDL test results as high as 133 mg/DL. Even the Wife Unit got up to 93. No idea what either of us test, today. I'm not interested in such tests anymore.

Around 2010 I developed a nagging nag that I'd gone from unnatural in one direction to unnatural in the other. Saturated fat from animals and some plant oils (coconut & palm) may not be deleterious in the slightest, but why process, concentrate and chow down so much? Moreover, while fats in general are a bunch of lipids, that's about all they are. Check it out.

I got too sick of—and especially low carbers—postings and Tweetings about eating spoonfuls of [processed and concentrated] "nutritious" fats as though it's a superfood (no such thing except offal). Why? That's just going too far in a benign dietary direction to prove IT'S THE RIGHT DIRECTION!

Alas, that's the one thing I've learned from this path: Everyone has to be right, such that everyone else is wrong.

Meat. Fish. Fowl. Vegetables. Fruits. Nuts, perhaps. Get 'em yourself. Cook 'em yourself. And you don't need to essentially deep fry everything—where it's OK, 'cause you're using a skillet! I still have a few ounces left of a 1-lb tub of leaf lard I got almost 3 months ago.

All that said, it does serve to review from time to time. Dr. Greg Venning, always looking out for me, shot me a video the other day. It's an Aussie production, and has as its mainstay authorities Dr. Michael Eades, Dr. Jonny Bowden and Gary Taubes, amongst a couple of others I'm not as familiar with.

It's pretty remarkable how the Doktors in the interview, those from the Australian Heart Whores for the Statin Drug Industry (AHWSDI), appear as dear in headlights.

The video is about a half hour and I enjoyed it a lot. (Good job, Gentleman Mike!)

Heart of the Matter Part 1 Dietary Villains from Michael Eades on Vimeo.

This is a good time to pimp for Tom Naughton, again. Fat Head Director's Cut is to me the go-to in this realm, and it's all done in a sometimes serious, sometimes comedic presentation that begins by debunking The Queen of Fear Porn, Morgan Spurlock, who still won't release his actual food journals from Super Size Me (because he lied his ass off).

So go get Fat Head and watch for a screen clip of this blog in the Director's Cut....

What You’re Up Against, Again

Everybody knows that "good cholesterol" is good, right? Well, actually, none of you probably know that. You've heard it reported, your doctor has told you so, and so you believe that "good cholesterol" is actually good. Pay attention, because that's not a trivial distinction and it has broad implications in all manner of knowledge.

So, on the heals of my summary of the Cholesterol Con, there's this:

High Levels of "Good" Cholesterol May Be a Bad Thing

A Dutch research study suggests that high levels of "good" HDL cholesterol are not so good - in fact, they may actually increase the risk of a cardiovascular event.

Peter, the UK veterinarian of Hyperlipid runs down the details (thought: could veterinarians in general be smarter than doctors for humans, having to deal with the biology and metabolism of multiple species, thus having a more generalized -- indeed principled -- approach to medicine?). I think he gets to the bottom line.

Are you seeing a pattern here? It all comes down to particle numbers, sizes, contents. What controls all of these? Not statin deficiencies, as in IDEAL.

Forget your cholesterol. What marker predicts heart attacks and total mortality without all of the paradoxes?

Follow EPIC and HbA1c (yes, same that same EPIC study as this one) to get some sort of clue. Control what you are doing wrong diet/lifestyle-wise to glycosylate your haemoglobin and your liver will sort out whatever cholesterol particles sizes/numbers it needs for health.

Be sure and follow that link in his quote, above. And here's another word of advice. It's a good idea to educate yourself on how to read these studies and understand them, or at least get a general idea. It takes a little time and effort, but it builds on itself, just like the more you learn of a language, the more you are equipped to learn even more, faster. The information is out there, and much of what I've been posting about is how this stuff gets misreported -- or not reported at all -- when it conflicts with the received public catechism. Ultimately, nobody is really going to care about your health. But you can, and the information is out there.

The ABC Australia Pulls Catalyst Show On Cholesterol & Statins. So See It While You Still Can.

When I was alerted to this last week my reaction was "it's a good thing." It's always a good thing when the government (no typo) censors something they don't want you to see.

I make no meaningless distinctions between the State, Media, and Mega Business—particularly when it comes to the food and drug multinationals. One in the same, pretending to be different. Hell, there's isn't even investigative journalism, anymore. Whether right or wrong, deep investigative journalism into the affairs of State serves a good purpose. Witness that there are still some who see this. I give you Sheryl Attkisson and Michael Isikoff.

Here was the ABC's press release concerning their own shame.

Today, the ABC’s independent Audience and Consumer Affairs Unit has released its findings regarding a controversial Catalyst program on statins and heart disease.

The detailed investigation was prompted by a number of complaints into two Catalyst programs, collectively titled Heart Of The Matter, aired in October last year. The report of the investigation is available here.

While acknowledging the importance of public health issues relating to the efficacy of heart disease treatment and the contrasting opinions of highly-qualified scientists, the A&CA has concluded that the second episode breaches ABC standards on impartiality.

Because of the interlocked nature of the two programs, both will be removed from the ABC website. Information will be added to the program website and the ABC Corrections page to advise of the steps that have been taken.

Ah, isn't that sweet. Don't let people decide for themselves. Protect your advertising revenue coming from big drug and food companies under the guise of "protecting the public from reporting that 'breaches ABC standards on impartiality.'"

What an hlarious laf at pipsqueaks and clown whores for ad revenue. I'm talking to you, Mark Scott, whore.

But, in the end this is a good thing, because information can't be contained. These programs and transcripts probably exist in a number of places, but are actually still on The Way Back Machine.

So here's what I need you to do for planet earth today.

  1. Put on your hats of objectivity. Whether or not you agree with the message, realize that the shenanigans that gets a message banned that you disagree with is the same shenanigans that will get the message banned you agree with.
  2. Everyone gets to decide for themselves, and everyone has an opportunity to persuade or dissuade others. This is the nature of the Internet, of unfettered access to information anyone in the world who cares enough can upload or publish for everyone's consideration.
  3. Watch the programs and/or read the transcripts while you still can.
  4. Get this message out, that I've just written, to as many folks as you can.
  5. Admonish anyone you have contact with, who has the tech and tools, to preserve these programs and transcripts, forever. The Way Back Machine is pretty cooperative in removing stuff at the request of originators, so get on it.

With any luck, far more people will end up seeing these programs now, as a result of the ABC's shameful actions, than otherwise ever would have.

Update: I would be remiss to not shout out for Dr. Maryanne Demasi, the lovely peach who put this together. I can only imagine her disappointment at having it pulled. She'll win in the end.

Politisizing Science

Here we go, again. Listen: I may have a blog up tomorrow about gene expression, featuring the mightiest mouse you've ever seen, but the point is that we can overcome our genetic evolution: only about 999 out of a thousand ways are going to be bad. We do it everyday.

Lipid Panel

Following up from this, I don't see how you could have a better lipid panel than this, which is a clip right off my Med record on Kaiser's website, results obtained yesterday:

Lipid panel

Total Cholesterol is really a bullshit number, because observe that I could get to an "ideal" <200 by making my HDL worse, like say 50. Triglycerides way low, just like you want, and HDLs stratospheric, also, just like you want. LDL is only 4 points off "above optimal" figure of <100.

The ratios are as follows:

  • Total/HDL = 2.1 (average is 4-6 and ideal is 2-3; I'm on the extreme end of ideal)
  • HDL/LDL = 1 (average is .3-.4 and ideal is above .4; again extreme end of ideal)
  • Triglyceride/HDL = .4 (optimal is <2, so again, extreme end of ideal)

While my fasting glucose seems high at 109, free insulin was only 6 (standard being 4-29, lower the better) and Glycohemoglobin (HGBA1C %) comes in at 4.8 (standard range 4.6 -  6 with the lower range being optimal). Glycohemoglobin is the percent of hemoglobin with sugar bound to it and doesn't change very rapidly over time, while a blood glucose test is sugar levels at that moment, so the HGBA1C % is a far more reliable method of checking whether you're borderline Type II.

All in all, not bad for being on such an unhealthy diet and eating things like this and this and this.

So, any of you low-fat-grain-eaters want to go up against those numbers?

Update 3/19/2009: Here's my latest lipid panel.

Quick Links

Just a couple of tidbits.

From Chris at Conditioning Research, eat lots of eggs. They're really good for you and it's probably because of the cholesterol. I know (heresy).

And from Peter the veterinarian at Hyperlipid, higher fat, primarily of the saturated variety (animals baby!) does lots of good things. Here was a funny recent quote from Peter.

"Are all these experts wrong, as well as the expert advisory panels on cardiovascular disease?"

Yes!

A much better question:

Which hormone converts a vascular smooth muscle cell to an osteogenic cell (calcium phosphate secreting) in the vascular media?

Answer: Insulin

The NCEP answer: It's a statin deficiency! (what was the question? Oh never mind)

In case you don't follow, the working hypothesis is that cardio-vascular disease is caused by high cholesterol, statins reduce cholesterol, so the fundamental problem is that we're born with a statin deficiency. Funny.

As a side note, unless you read medical journals (probably even if you do), the best sources for keeping up on ALL the studies are some of the blogs I link to. You won't get it in the standard media. They are uninterested in the dozens and dozens of studies that pound away at the myth that high (saturated) fat: bad / high (grian) carbs: good.

Jesus. Had a look around you lately? Never have carbs been so high and saturated fat so low in the American diet.

How To Raise Your Cholesterol

Huh? Why would you want to do that?

Well, the short answer is that it very well might lengthen your life. Let's have a go at Dr. Malcolm Kendrick, MD.

When I went to medical school I was told that the very high rate of heart disease in Scotland was caused by a diet containing far too much saturated fat. This raised our Scottish cholesterol levels. The excess cholesterol was, in turn, deposited in the artery walls, thus narrowing them to the point where they blocked up - causing angina, heart attacks and death.

The answer, therefore, to preventing heart disease was to eat less saturated fat, thus lowering cholesterol levels. Or, if you couldn't get people to eat less fat, then simply lower cholesterol level with drugs. It all seemed very simple and exceedingly straightfoward. Why look anywhere else, when the answer was clear.

Uh, OK, so why raise cholesterol? He continues.

For years I did not question this orthodoxy. Then, one day, I was on holiday in France. Whilst chewing on a fatty steak, dripping in butter, it suddenly struck me that the French ate rather a lot of saturated fat. As I peered through the smoke filled restaurant I also recognised that they smoked quite a bit too. However, their rate of heart disease was one tenth that of Scotland (age and sex-matched).

I then looked at the other classic ‘risk factors' for heart disease in France e.g. blood pressure, HDL ‘good cholesterol' levels, body mass index (BMI), amount of exercise taken. I found that, in comparison to the Scots, the French ate significantly more saturated fat, had the same cholesterol levels, the same blood pressure and the same HDL ‘good cholesterol' levels. They also had the same average BMI and took slightly less exercise (on average). They smoked considerably more. In short, much worse classical ‘risk factors,' one tenth the rate of heart disease.

This became the basis of the "French Paradox." I lived, worked, and ate in France for two years in the early 90s and can surely attest to the good eats, by which I mean: fat, fat, and more fat. People tend to think the French are famous for their bread and wine, which they are, but they consume much less of it than most people think. As I showed here, the proportion of bread to cheese is the reverse of what it is here and elsewhere. Rather than spreading a little cheese on a lot of bread, you place a huge gob of cheese (and butter too) on a small piece of crust. About the only time I saw the French eat quite a bit of bread was petit dejeuner (breakfast). Back to Kendrick.

So, the soon to be Professor, Hugh Tunstall-Pedoe looked at the French, and their diet, and came to the conclusion that the French were protected against heart disease by their high consumption of garlic, red-wine and lightly cooked vegetables (full of anti-oxidants, don't you know). Very soon after this, it became a ‘fact' that these three factors were protective against heart disease.

One slight problem is that there never was, and still is not, the slightest evidence that any of these three factors provides any protection. I write this in the certain knowledge that many of you are absolutely convinced that garlic, red-wine and anti-oxidants truly are protective, and that many studies have proved it. To which I would say..... ‘show me the studies'.

And now comes the punch line. What do the studies actually show?

To give another example of facts that aren't true. Namely, that saturated fat intake raises cholesterol levels. The Framingham study, the longest lasting, most respected study into the causes of heart disease (started in 1948) reported that ‘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.' Dr William Castelli - director of the Framingham study at the time - 1992.

That's bad, you see. You don't want your cholestrol levels decreasing (as they typically do with age). You want to keep them "elevated." Here's why.

For example, here is another quote from the Framingham study on the impact of cholesterol levels themselves. There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years. 11% overall and 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels.

In short, once your cholesterol level starts to fall, you are much more likely to die from heart disease. A 150% increase in relative risk for every 10 % fall, approximately. Add this to another very big study of the elderly, published in the Lancet: Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol levels, and show that long term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations the greater the risk of death.

It's only a matter of time.

It is a slight comfort to know that in fifty years (hopefully many fewer than this), people will look back at cholesterol lowering and say ‘You did WHAT?' Were you MAD? Don't you know that cholesterol is absolutely vital for human health? Didn't you realise that blocking cholesterol synthesis would directly lead to nerve cell damage, muscle destruction, liver obliteration and cancer?

So, how do you raise your cholesterol to adequate, healthful levels, for which I believe -- as shown in these graphs based on data from four governmental databases worldwide -- is 200-220?

Eat healthful fats, and lots of them: butter, ghee, coconut oil, coconut milk, cream (preferably from pastured cows), quality real cheeses, and of course all the animal fat you can get your hands on, along with the meat. Yep, especially the chicken skin.

For more information on Dr. Malcolm Kendrick's views on cholesterol, see The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It. Here is a great primer by the doctor that's a must read: The Great Cholesterol Myth.

I blogged about that article more than a year ago.

Low Cholesterol to “Die For”

I was having an email exchange with my aunt the other day who was lamenting how her husband's doctor told him that his total cholesterol of 117 (!) is one that most people would "die for." Maybe he's right, as we'll see in a minute; but first, I should point out that George is in his late 80's. So, always be careful about assigning causes to correlations. Correlations are great things, but the best way to regard them is as falsification (disproof) of hypothesized causation.

Reader and commenter on this blog, Ricardo, and blogger in his own right at Canibais e Reis has done something truly amazing (and has surely put Ancel Keys in short pants). Lots of this is going to go over the heads of most people, including myself, but I'm quite confident a number of math and health whizzes will be on this project in short order.

Ricardo has essentially combined data from the following sources into a single database anyone can access:

  • UN Food and Agriculture Organization Statistical Yearbook
  • FAOSTAT food consumption database
  • British Heart Foundation Health Statistics database
  • World Health Organization Global Health Atlas

In the end, he had data on 170 countries, which he eventually narrowed to 86 countries in order to get a complete data set for all available parameters. You can read about the whole thing right here. This just scratches the surface of what can be done, but here's a couple of examples. How about death in men from heart disease against total cholesterol? (click here for full size).

Picture 1

While the correlation isn't great, it is interesting to note that the lowest heart disease mortality is associated with total cholesterol of 200-220 for quite a group of countries. And do note the saturated fat junkie French right down there at the bottom, edged out only slightly by the Japanese.

Now let's look at life expectancy for women from birth against total cholesterol (click here for full size).

Picture 2

Here, the correlation is much stronger and shows unmistakably an association between higher total cholesterol levels and longevity for women. Interestingly, it looks again like total cholesterol of 200-220 seems to be the sweet spot.

So, guys & gals, how much do you want to "die for" low cholesterol?

Let me stress and reiterate, however. This does not prove or suggest that higher cholesterol causes longevity or reduced mortality from heart disease. Nor does it prove that low cholesterol causes decreased longevity or increased mortality from heart disease. What it does do is prove that "high cholesterol" does not cause more death from heart attack or decreased longevity and it proves that "low cholesterol" does not cause less death from heart attack or increased longevity.

Finally, it proves that every single person, worldwide, out there touting "low cholesterol" is an abject ignoramus. That means we're probably talking about more than 95% of physicians, including your own.

Here's a good primer on the cholesterol con from Dr. Malcolm Kendrick, which I blogged a bit over a year ago.

LDL Cholesterol Nonsense

Cholesterolcon-1 Well, I was all prepped for a link and quick hits roundup, but first up was a bit about LDL cholesterol, as in the calculated one...as in the one most of you get when you have your blood work done. After a bt of poking around, the link roundup can wait.

But back up a bit, all the way to here, where I posted my first lipid panel about a year ago. At a calculated LDL of 104, I got a warning of "elevated" from the doc. Then, as some of you may recall from last February, those lipid numbers caused one naturopath to email me with some concerns. The solution? Well, in a nutshel, the solution would be to dramatically increase my triglycerides (fat in your blood) from a low of 47 to somewhere perhaps in the 150ish range, thus letting the Friedewald equation do its thing. How's that, you ask? Well, I laid it all out in this post: What Do You Think You Know About LDL Cholesterol? This post has been picked up in links a couple of times in the last few days. The first was by Tom Naughton, maker of Fat Head, a film I highly recommend as a way to introduce people to the fraud of conventional "wisdom" in nutrition.

In brief, the Friedewald equation for calculating LDL (direct measurement is expensive) is that you take total cholesterol, subtract HDL, and then subtract further your triglycerides divided by 5:

LDL (calculated) = Total Cholesterol - HDL - Triglycerides/5

A cursory glance at that equation should help explain what I meant above, where I wrote that the way to have low(er) LDL would be to dramatically increase my triglycerides. How does one do that? It's quite simple: eat lots of hearthealthywholegrains. You can even get the job done quicker by tossing in sugar, sodas, and any manner of processed food in abundance. I think the average Trig level in America is in the area of 200 and increasing. All else remaining equal, had my Trigs been 200 instead of 47, then I would have been able to subtract 40 (200/5) instead of 9.4 (47/5). Thus: 219 - 106 - 40 = 73. That would earn me a hand shake from my physician, all for replacing a good deal of the meat, eggs, veggies, and fruit I eat with bread, pasta, sweets and other crap. (Of course, if I were to do that, all things would not remain equal, because my HDL would also take a huge nosedive.)

Next, Sephan at Whole Health Source picked up that link and also came up with something of help for those of you out there who may not want to go to the expense of paying for your own NMR Lipoprofile or a Vertical Auto Profile (VAP). What has been known for a long time is the Friedewald becomes very unreliable at Trig levels over 400. It has also been suspected that it's equally unreliable for Trig levels below 100, a level of triglycerides achieved by almost al low-carb / paleo practitioners. Dr. Eades explains it in this post.

So, what Stephan came up with is an equation that purportedly does a better job at calculating your LDL when your Trigs are below 100.

LDL (calculated) = Total Cholesterol/1.19 + Triglycerides/1.9 - HDL/1.1 - 38

Now, if I run my same 219 total, 47 Trig, 106 HDL through this new equation, I get a calculated LDL of 75 and not the 104 that motivated my doctor to caution me (and to probably make a note that I'll soon be a candidate for a statin prescription).

Well, guess what else? Turns out I had another lipid panel done a while back and I convinced them to do a direct measure of LDL: 66. That's not too far off the 75 rendered by the equation above, and so, while an NMR, VAP, or direct measure is the best way to go, you can at least perhaps get some immediate peace of mind by doing your own calculation per the above formula.

Would be very interested to see your comments comparing your latest numbers, Friedewald verses the new equation, particularly if you have Trigs significantly below 100.

Finally, my friend Jimmy Moore recently interviewed Dr. Malcolm Kendrick, author of The Great Cholesterol Con. I recommend both.

Cholesterol Con: Call for Help

I frequently get emails from fairly new paleo / primal / low-carb practitioners worried about their newly obtained lipid panel that supposedly shows a degradation, particularly in the form of elevated total C, and/or elevated LDL.

Often, these emails read something like this:

"I've eliminated grains, legumes, processed sugars, vegetable oils, processed food of all kinds, and starchy vegetables like potatoes while adding more vegetables of varied kinds, more berries and less sweet fruits, more eggs, some nuts & seeds, free range eggs, grassfed beef and other meats, lots of fish & seafood, more butter and other natural fats.

I've lost 25 pounds, I feel great, I sleep wonderfully, my blood pressure is way down and I have been able to drop meds for seasonal allergies..."

Now, given the above, realize that there are tons of doctors who will berate, caution, cajole their patients for these behavioral changes, simply on the basis of a lab number -- and in particular -- totally disregarding the patient's own feelings of enhanced health and well being.

So, I need to put together a single static page that can be frequently updated as more and more resources come out about the great cholesterol con. Of course, I'll be listing all my past posts on the topic, and I am aware of a number of posts from other bloggers -- and some of you have already sent me lots of stuff (Thanks, Ricardo C.).

However, I know there's a lot out there so can I ask fr a bit of help? Please drop in the comments or email me your favorites: books, websites, blogs, specific articles or posts, studies, anecdotes, or whatever you think might be of value. I'll compile.

Thanks, y'all.

I’m Deleting More and More Comments on a Whim. Why? Success, That’s Why.

I don't give a fuck about a lot of commenters on this blog. Those I care a lot about? Lots. Why? They understand their place, as I understand mine. They know who they are. ...And Sean called me butthurt, once, so my love is still begrudged.

I don't have it nearly as bad as so many who are not much more than troll bait, because everyone knows I'm happy to tell you to go fuck yourself in comments; here; just as anywhere else. Face-to-face, too...as I recently relayed in a comment. You want to meet face to face over a dispute? Ask. I'll be there: Los Gatos / San Jose. I recently gave out my home address and cell number to a bunch of morons on r/paleo on Reddit (ask them). I put up. Proven. ...I actually got a call within minutes and it ended very cool. I mean no one real harm, at all, or ever—quite the contrary—and it's uproariously funny how that plays out in an actual face-face or phone call. I'm just not a little man pussy, like so many clamor to be.

...All the anonymous sock puppets, showing up here and there in increasing frequency? I just adore clicking "Delete." Not banning them. In fact, I hope they post again, because then I get to sit there in my liesure and click (or, really, just touch on the iPad) "Delete."

Laf.

I mine minds. Yes. I'm a sometimes Paleo blogger, food blogger, health blogger, social commentarial and everything I ever want to be doing in any moment, without fear or trepidation about what some fucking moron—or their collective of morons—is going to think about it. As I say: been at this for a long time. "Suck on it" (1st time I think I said that; overrated).

There are only a few million, maybe a few tens of millions of truly smart people in the entire world of billions. There are only a few thousand who have done the basic science and engineering—and overcome the billions of morons working against them—to give all the morons lots of shiny toys to be placated with, and to shut the fuck up so the smart people can go onto the next thing. Moron is the norm, perpetually relatively.

It's what I'm all about. It's all—and only—what I'm all about.

Then, there's this: Someone willing to show his stuff, and who has never even been in comments, here.

Hi Richard,

Ive been lurking on your site since the beginning of the year (2012) after finding it linked from Martin Berkhan's site after I found his Lean Gains site.  I switched to real food and cut out all the processed crap and figured out the gas, bloating and explosive movements Ive had my entire life ceased.  Then I had some of those damn rolls at a steak house and before we left I made a visit and spackled their porcelain for them.  I guess at that point we had it figured out pretty well that I have a wheat allergy. Anyway I wound up on your site due to cholesterol research since my parents are both on drugs for high cholesterol.  I finally went to a doctor at my mother in-law's urging to get checked out a few months after changing my eating habits and all my numbers and my wife's numbers came back great. The stories on your site have helped me feel better, and implementing eating real food has given a side effect of losing ~78 lbs over 10 months.

My wife and I escape to New Hampshire over the hot Florida summers, and it's the best place I have ever been to eat natural whole food in my life. Every intersection of the state seems to have a farm stand, and there is local made sausage, vegetables and raw dairy within 20 minutes of our camp. We found the raw dairy just a couple of weeks ago, and holy shit if its not the best fucking milk I've ever had.  We drive by the cow barn on the way to the house to pick the milk and yogurt up, and the only thing we have seen going in is hay.  The rest of the farm is grass. They milk their 22 cows twice a day. Now I have to try and find this stuff down in florida, where raw milk will kill you and is for pet consumption only.

Attached is a shot of me in New Hampshire last year, and another shot from the same place a couple days ago.  I was ~285 last year in that shot, 220 in the shot from this year.

Thanks for the site and getting information out there for me to find. Without your site, Dr. Davis' site and Berkhan's site I'd probably still be 310 lbs like at the end of last year, feeling like shit and getting yelled at for noxious fumes emitted from my rear by my wife.

yearLater
One lesser year later

But this is impossible. I don't have abs. Who in the world could possibly identify with my way of doing things?

OMG: Paleolithic Diet is Associated With Unfavorable Changes to Blood Lipids in Healthy Subjects

Yep. Read it and weep, you idjit Paleos; you, so erroneously self-assured as to dismiss the dietary diktats of your superior masters and their grain and drug peddling bedfellow financiers.

The abstract of the "study," courtesy of all-around fuckwit, Eric Trexler.

Background: The Paleolithic (Paleo) diet is one modeled after the perceived food consumption of early human ancestors of the Paleolithic Era, consisting of mainly meat, fish, fruit, vegetables, eggs, and nuts. The purpose of this study was to examine the effects of a Paleo diet on blood lipids, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-HDL cholesterol, triglycerides (TG), total cholesterol (TC), and the ratio between TC and HDL (TC/HDL) in a healthy population. [emphasis added]

There's your premise: 'we're going to evaluate your results according to our standards—not yours.' Of course, their "standards" are based on a chronically unhealthy grains, sugar, and machinery lubricant (processed food makeup) munching, highly overweight and obese society that subsists primarily on some manner or other of processed crap in boxes and fast food cheaply produced and engineered by global food conglomerates, combined with increasingly uniform and tight "standards" in terms of biomarkers—such that the global drug conglomerates and their distribution network of pushers (i.e., doctors and grant whore researchers) can sell you pills to ameliorate the problems caused by the former.

It all has zero bearing on a healthy diet, Paleoish or, The Old Grandma Diet.

Methods: Subjects of both genders (23 males, 20 females) with no history of diabetes, heart disease, dyslipidemia, or other metabolic disease were asked to eat an ad libitum Paleo diet for 10 weeks. Throughout the intervention, subjects participated in a CrossFit-based, high-intensity circuit training exercise program. Prior to the intervention, body weight, body fat percentage (BF%), maximal oxygen consumption (VO2max), TC, TG, HDL, and LDL were measured. These measurements were repeated following 10 weeks of a Paleo diet.

Wowzers! 10 whole weeks? Well, can't allow those people to go without all those "cholesterol lowering" crap-in-a-box cereals for very long (in favor of meat, fish, fowl, vegetables, fruits and nuts) now, can you? You might run into problems with the "ethics" committee. Or, hell, perhaps The Ohio State University might put in jeopardy some of that nice research funding. Here's the Fed portion of their total $934 million (about 50% of all).

OSU Federal Funding
OSU Federal Research Funding

Notice how the National Institues of Health (cholesterol is BAD) and Department of Agriculture (grains are hearthealthywholegrains = GOOD) make up about half of the Fed portion, so 25% of the whole. Then there's Industry Funding, 11% of the total, $101 million.

Don't suppose that has any bearing on things. It's all just about Teh Data.

Results: As a whole, there was a significant increase in non-HDL (107.1 ± 6.0 mg/dL to 120.2 ± 6.5 mg/dL; P < 0.01), LDL (93.1 ± 5.4 mg/dL to 105.6 ± 6.1 mg/dL; P < 0.01), TC/HDL (3.0 ± 0.2 to 3.3 ± 0.2; P < 0.05), and TC (168.8 ± 5.4 mg/dL to 178.9 ± 6.6 mg/dL; P < 0.05) in healthy subjects following a Paleo diet. When stratified into groups based on initial blood lipid levels, deleterious changes were found in those with optimal HDL (82.1 ± 3.2 mg/dL to 68.6 ± 4.8 mg/dL; P < 0.05), non-HDL (86.6 ± 3.9 mg/dL to 101.4 ± 4.8 mg/dL; P < 0.01), TC (157.2 ± 0.7 to 168.2 ± 0.9 mg/dL; P < 0.05), TC/HDL (2.5 ± 0.1 to 2.7 ± 0.1; P < 0.05), and LDL (69.1 ± 3.1 mg/dL to 83.5 ± 4.1 mg/dL; P < 0.01), whereas those within sub-optimal stratifications showed no significant changes.

"[D]eleterious changes were found." OMG! Change your whole diet and workout regime and over 10 weeks (!!!) your lipids wiggle around a bit +/-. "Deleterious" simply refers to the completely unestablished premise that cholesterol levels mean much of anything for individuals one way or the other. It couldn't possibly be anything like, dropping sugar water and sugar laden crap in a box for 10 weeks begins to clear up subclinical fatty livers with a concomitant rise in LDL, Trigs & such, ya think?

Nope.

Subjects also decreased body weight (177.6 ± 5.8 lbs to 170.6 ± 5.3 lbs; P < 0.001) and BF% (24.3 ± 1.2% to 20.7 ± 1.2%; P < 0.05), while increasing VO2max (3.18 ± 0.14 L/min to 3.46 ± 0.15 L/min; P < 0.001).

Say WHAAAT? Oh, cool: seven pounds average weight loss (2/3 pound per week), 3.5% loss in body fat (so the "weight loss" was fat loss), and athletic performance increased. Then let's take a look at the conclusions.

Conclusions: Our results demonstrate that an ad libitum Paleo diet intervention is associated with deleterious changes to blood lipids in healthy subjects, despite concurrent improvements in body composition and cardiorespiratory fitness. Future research should focus on determining recommendations that embrace the positive aspects of the Paleo diet, while minimizing any deleterious impact on blood lipids in a healthy population.

Turns out that Dr. Adel Andro of SuppVersity mentioned this study a few days back and did up a nice chart (click for full size).

a
 

He also wrote:

If you take a closer look at the abstract and the actual "side effects" (figure 2), the 10-weeks of paleo dieting + CrossFit-based, high-intensity circuit training exercise program had on the body composition and fitness levels, I personally cannot but ask the following question:

"What is the significance of the elevations in LDL and minor reductions in HDL in a scenario that produces exactly what has just been shown to be at the heart of the 'Obesity Paradox' and lipid values that are still within the ever-narrowing 'normal' or 'optimal' range?"

I'll leave it up to you to answer this question and decide whether it can really be so bad to rid yourself of all modern, processed foods including any form of processed sugar, soft drinks, and coffees, while fueling your life and workout related energy by increasing your consumption of lean meat, fish, eggs, nuts, fruit, and vegetables.

Now, let's take a look at the title of the study, again:

Paleolithic Diet is Associated With Unfavorable Changes to Blood Lipids in Healthy Subjects

That's manipulative dishonesty, folks, and plain as day. By smuggling in an unsubstantiated premise (that cholesterol really means much of anything causal for individuals) and using it to imply that "Healthy Subjects" were transformed into less healthy, as a direct result of a Paleo diet of whole foods and intense exercise Eric Trexler renders himself unfit for employment in any trusted position anywhere.

Personally, I wouldn't trust that dishonest, lying fuckwit to fetch my mail or take out the trash.

Now then, I have just rendered richly deserved justice.

Exposing the Cholesterol Myth

I probably get more questions about cholesterol than anything else. But cholesterol is not a problem to be managed. Your diet is to be managed, it should be a natural diet of meats, fowl, seafood, good fats (animal, coconut, olive), vegetables, berries & nuts.

Take nine minutes for Dr. Ron Rosedale to expose the cholesterol scam.

Tomorrow I'll post a couple of advanced lipid panels from readers for discussion.

Ouch! More Low LDL Cholesterol to “Die For”

Here's one you probably won't find reported far & wide:

Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction.

After 3 years, patients with admission LDL <= 105 mg/dL had higher all-cause mortality rate compared to patients with LDL > 105 mg/dL (14.8% vs. 7.1%, p = 0.005). The higher all-cause mortality persisted (OR 1.8, 95% CI 1.0-3.5, p = 0.05) even after adjustment for confounding variables. CONCLUSIONS: In our cohort, lower LDL-cholesterol at admission was associated with decreased 3-year survival in patients with NSTEMI. Whether this was a result of current therapy or a marker for worse baseline characteristics needs to be studied further.

The bottom line? The body count for 517 patients with heart problems over three years was twice for the low LDL cholesterol as the for "high" LDL cholesterol people.

Peter the UK veterinarian has observations.

My take home message is that having a low LDL cholesterol, as guesstimated by your cardiologist using the Friedwald equation, is very bad news if you have just had a heart attack.

This is really just a quick hit to call attention to Peter's analysis, so go have a close look.

More reading:

Low Cholesterol to "Die For"

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

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

“High Cholesterol,” Statins & Diabetes

My mom went to the doc yesterday. As a Type 2 diabetic who controls it pretty well, she nonetheless still does regular visits. She's very low-carb Paleo-ish, and while she was able to be off insulin for a time completely, still finds she needs very small doses now and then.

To the endocrinologist's credit (a new doc), she did acknowledge being impressed with my mom's diet and supplement regime. But there was one little problem: mom's total cholesterol is 217. The doc asked her if she wanted cholesterol lowering meds. But my mom reads this blog and was thus prepared, indicating that for women, higher cholesterol is associated with increased longevity (lowest all-cause mortality and not just an overly reductionist tunnel vision, zeroed in on cardiovascular mortality).

But the doc retorted with something I can't recall reading or hearing about, specifically. She asked my mom if the studies and information she's relying on concerned women with diabetes and not just a general cross-section, as diabetes is associated with twice the heart disease and stroke as for non-diabetics (according to the doc).

Hmm.... So I did some initial digging around. I ended up writing this in a reply email.

The problem is: what level of diabetes? You control yours pretty well, so there is no comparison between you and someone who doesn't.

There is ZERO benefit to lowering cholesterol, especially in women (indeed, the greater chance is it's harmful). Cholesterol doesn't cause heart disease; inflammation does and this is how statins, when they work, work. But keeping grains, legumes, sugar, and vegetable/seed oils out of your diet has an even more anti-inflammatory influence I suspect. Actually, it simply allows your body to go back to its natural, non-inflammatory state.

I added links to an article by Dr. Duane Graveline at Spacedoc, as well as Chris Kresser's 2-part video series on statins at The Healthy Skeptic. The problem is, neither of those seemed to address the issue specifically, and moreover, there's this quote from the first link.

The fact that there is no statistically proven cardiovascular benefit from the use of statins for cholesterol reduction in women was first publicly disclosed by Uffe Ravnskov in his book, Cholesterol Myths and has been corroborated repeatedly by numerous longitudinal clinical studies.

The ASCOT study, the largest randomized clinical study of statin effectiveness in women, found that the women who took Lipitor, developed more heart attacks than women in the group given placebo.

While not statistically significant this finding hardly supports cardiovascular benefit. In this ASCOT study, 2,000 women were included among 10,000 patients having elevated blood pressure and at least three other cardiovascular risk factors.

Again and again, clinical studies have failed to show that the use of statins lowers cardiovascular risk in women who do not already have coronary heart disease or diabetes.

So just when you think it's all settled, there's that D word, right at the end. This is off the top of my head but as I recall, statins have only been shown statistically beneficial to men who have had a previous coronary event (statins reduce the rate of subsequent events). But is there another category of benefit out there I don't know about?

So I did more digging and came up with this:

Is diabetes a coronary risk equivalent? Systematic review and meta-analysis

Abstract

Aims To determine whether patients with diabetes without prior myocardial infarction (MI) have the same risk of total coronary heart disease (CHD) events as non-diabetic patients with previous myocardial infarction.

Methods Using MEDLINE, EMBASE, Cochrane and MeSH in this systematic review and meta-analysis, extensive searching was carried out by cross-referencing from original articles and reviews. The study consisted of cohort or observational studies with hard clinical endpoints, including total CHD events (fatal or non-fatal myocardial infarction), stratified for patients with diabetes but no previous myocardial infarction, and patients without diabetes but with previous myocardial infarction. Studies with less than 100 subjects, follow-up of less than 4 years and/or without provisions for calculating CHD event rates were excluded. The review of articles and data extraction was performed by two independent authors, with any disagreements resolved by consensus.

Results Thirteen studies were included involving 45 108 patients. The duration of follow-up was 5–25 years (mean 13.4 years) and the age range was 25–84 years. Patients with diabetes without prior myocardial infarction have a 43% lower risk of developing total CHD events compared with patients without diabetes with previous myocardial infarction (summary odds ratio 0.56, 95% confidence interval 0.53–0.60).

Conclusion This meta-analysis did not support the hypothesis that diabetes is a ‘coronary heart disease equivalent’. Public health decisions to initiate cardio-protective drugs in patients with diabetes for primary CHD prevention should therefore be based on appropriate patients’ CHD risk estimates rather than a ‘blanket’ approach of treatment.

So on the one hand, statins are of no benefit to women, even those who have had a previous coronary event (unlike for men), and on the other, even men & women with diabetes who have never had a coronary event are far less likely to have one than non-diabetics who've had one.

While that's not a direct study of the question (do statins lower coronary events in women with diabetes?), putting 2 and 2 together seems to imply to me that given the rate of serious side-effects experienced by those on stains, combined with what seems like a very dubious benefit to a woman with well controlled diabetes, equals not much reason to take them and lots of reasons not to.

Anyone have anything contrary, or better. Either way.

Exposing the Cholesterol Con

[Just a quick off-topic aside. Darya Pino at Summer Tomato did a mildly critical but fair & balanced post on paleo dieting. Go take a look and drop a comment about your own experience if it suits you. From my perspective, we out to be able to take fair criticism to refine & strengthen our message.]

This is just a rather quick hit & run with some excerpts and commentary that I wanted to post because it's nice to finally see something in the mainstream news that echos what I and my fellow bloggers have been saying all along, for nearly three years in my case. From MSNBC:

Bad cholesterol: It’s not what you think

Yea, no shit. And it never was. And there was little justification to ever create the "tidy narrative" in the first place.

For decades, a tidy narrative about the relationship between LDL cholesterol and heart disease has affected everything from the food we eat to the drugs we take to the test results we track and the worries we harbor. This oversimplified view of cholesterol — that all LDL is the same and that all LDL is bad — has enabled the adoption of an accompanying oversimplified dietary belief, that all saturated-fat consumption raises your risk of heart disease.

Oversimplified view of cholesterol --> oversimplified view of diet --> complex and dangerous drugs --> obesity --> diabetes --> more complex and dangerous drugs --> lots of drug company profits --> lots of assholes still out needlessly scaring people to death.

The LDL hypothesis has also encouraged many of us to swallow the most-prescribed class of drugs in recent history. Americans spent more than $14 billion on LDL-lowering medications in 2008. Whether that money came out of their own pockets — straight up, or through ever-escalating co-pays — or out of the hemorrhaging U.S. health-insurance system known as Medicare, it's a huge expenditure. Twenty-four million Americans take statins, and the latest health directives suggest that those numbers should be higher. And why stop at grown-ups? Some pediatricians want to start feeding Lipitor (and the like) to kids.

$14 billion for something with tons of side-effects and of dubious, nonexistent value for all but a small subset: men under 65 who've already had a coronary event. Sure, if you've had a heart attack already, go right ahead and "trust your heart to Lipitor."

LDL comes in four basic forms: a big, fluffy form known as large LDL, and three increasingly dense forms known as medium, small, and very small LDL. A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms. The big, fluffy particles are largely benign, while the small, dense versions keep lipid-science researchers awake at night.

But here's the problem: The typical LDL test doesn't distinguish between large and small LDL particles — it can't even spot the difference. And people can have mostly large LDL or mostly small LDL in their overall LDL, depending upon a host of genetic, lifestyle, and environmental factors. Your own personal mix may make all the difference between living to a heart-healthy old age and becoming a Monday-morning casualty at your desk.

Right. And Americans are spending $14 billion per year on statins and it's based on irrational, uncorrelated, unproven associations with a measurement technology that "can't even spot the difference." I'll bet the drug companies are all over getting this new measurement technology into wide usage. Yea, right.

Now, to heap even more outrage on the deal, how long back has it been since it was known that the small-dense sub-particles associated and reasonably predicted heart disease risk? 1976, almost 35 years ago. Dr Krauss recounts:

The heart-disease community was not impressed. "It took me 4 years to publish that paper," he says, recalling his early work on sub-particles in the late 1970s. "That's beginning to tell you some of the obstacles I was going to face."

Big surprise, eh? There's more.

But during experiments, Dr. Krauss discovered that while a diet high in saturated fat from dairy products would indeed make your LDL levels rise, "saturated fat intake results in an increase of larger LDL rather than smaller LDL particles," as he wrote in an American Journal of Clinical Nutrition review he co-authored in 2006. A diet heavy in full-fat cheese and butter — but not overloaded in calories — triggered the relatively harmless health profile described as pattern A. [...]

Not only is dairy fat unlikely to increase heart-disease risk, Dr. Krauss and others have learned, but reducing saturated fat in a way that increases carbohydrates in a diet can shift a person's LDL profile from safe to dangerous. That's pretty much what happens whenever some well-meaning person with "high LDL" starts eating "low-fat" frozen dinners filled out with corn-derived additives, all the while engaging in the customary ravaging of a basket filled with dinner rolls.

Well that should do it. You might want to check out the inane comment from Dean "Chubby Faced Diet" Ornish.

Is Cholesterol a Problem to Be Managed?

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.

First up is Tim, who we first saw right here. Then we saw his transformation photos. He decided to do a 90-day experiment with eating meat only. He sent his latest numbers.

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?

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.