I've been looking for local people with similar points of view around my area and stumbled on your blog a few months ago. I had no idea you were in the San Jose area. I'm an Emergency Physician who works in San Jose. I've been a paleo convert for 4 months and my entire family is eating that way. I plan on living disease-free and this, to my best knowledge is the only way to do it. Life is quite different now that I know better than to trust conventional medical theories to treat patients. When I see patients now I run down their medication lists and quickly stop statins and antacids (proton pump inhibitors, Zantac etc.) and any other useless medication that they've been on for years and never questioned. You'd be amazed how many women are on statins (never been shown to help them) and people over 65 (again, useless). Those medications that they really can't stop (type I DM on insulin) I counsel them about dietary changes. The look on their faces when I tell them to eat saturated fat and more meat is priceless.

The nice thing about the hospital where I work is that we do not accept honorarium from pharmaceutical companies and even more importantly: They aren't allowed on our property to solicit MD's. I get the greatest reward when I call many of these patients on follow up and find out that they're doing better - especially when they lose the grains from their diet. That still doesn't stop stupidity at our institution though. I recently had a 35 year-old male admitted with angina (90% involvement of LAD and ended up with 2 stents... sigh). I told him to increase saturated fat and protein afterwards. The note afterwards was from his angry primary doctor who wrote ("ER MD told him to eat more fat and protein. Consulted nutritionist on advising patient to go on low-fat ADA cardiac diet"). I almost punched the computer screen.

Anyways. If you're ever in need of emergency care in the area, there is a Paleo-friendly Emergency Physician around!

I'm going to put him in touch with some of the other paleo-friendly docs via email. Maybe they can get some sort of network going. Things are looking up.

Related posts:

1. Mom Rings In: “Amazing Results”
2. The San Pedro Square Farmer’s Market
3. Paleo Trumps — the Science
4. The Hidden Benefit of the SAD: Iodine?
5. How’s This For Stupid?

@rnikoley is my guru! I've been eating (and showering) #paleo all week and my appetite has crashed, energy level soared.

Well I really do blush when people haul out the guru thing, but I get it, I guess. I have some knowledge and experience, I pass it along, it works for almost everybody -- because it's based on principles and patterned after our natures as evolved wild animals -- and makes me look like a "guru." But nothing could be further from the truth. The way of the guru, such as a Dr. Mehmet Oz, is to make you increasingly dependent on his advice. My aim, rather, is to make people independent. Animals don't need gurus. As I wrote in that post:

"But then there's that Guru factor, and I just hate that. I loath Gurus, and you should too. You know what I think a Guru is? It's someone who sells you tantalizing, feel good, sound good lies or incomplete information that rarely if ever works for anyone as advertised. When it doesn't work for most (i.e., it works for some, just like stopped clocks are right twice per day) there's always the subtle implication that you're just not applying the info right. But don't worry. The next product speaks exactly to those problems. Repeat. Over and over."

Next up is a comment posted yesterday by William on my post some time ago on hunger.

Since I've gone on the paleo diet (1 week), I'm ALWAYS incredibly hungry. What can I do about that? Even though I ate carbs before, I wasn't into junk food or bingeing, so I'm a little confused by these hunger pangs.

Also want to ask your opinion on a few things:

1. Mediterranean diet (French/Italians) with cheeses, wines, pastas, breads.

2. Is dairy as bad as grains or sugars?

3. Are fruits bad? (pineapples, mangoes, etc).

4. How strict are you on artificial preservatives?

5. How do you add variety to your diet? One big fear I have is that I'll get sick of chewing leafs.

6. Can one drink anything other than water, and are there any primal/paleo deserts?

And what I'd like to do this time is to ask my readers to answer these questions; which, of course, fits right in with the introduction. If everyone's a guru, then there must not be much too it, is there? So join right in folks and give William a helping hand, like you always do with the questions. Pick a number, or all six. And it would be really great to have as many who can field the hunger question. The more personal experience on that one, the best.

Related posts:

1. Animals Don’t Need Gurus
2. World Paleo Domination – Part 2
3. PaleoHacks
4. The “Experts”
5. January in Review

Let me preface this by saying I'm just starting out on my Paleo/Primal journey. I am also terrible at wading my way through scientific studies, and have the kind of luck where I think I've got something covered, and then some other group of studies pops up and I'm on my ass again. In short: as a layman I tend to steer clear of grand scientific statements, like "fat is good/bad" for fear of sounding like an ass. [...]

However, I come across things like this. [A discussion on Mark Sisson's forum as to whether too much fat can be bad. -Ed]

And I'm more than a little lost. This guy seems to have a rather solid case that one group, who I thought were a prime example of what a good diet could be like, actually have serious health problems. Things like this always leave me worrying that I don't have my ass covered on the data here and, well, I just worry that I might have made a mistake and end up paying for it 20-30 years down the line. [...]

I am serious about committing myself to a diet, even it means a major overhaul, but only if it's right. I just think it's obvious, given what we know about diabetes as well as what man's body is designed to handle, that anything which is basically sugar must be avoided, so it didn't take much to convince me to give these up... but going the other way, determining what I ought to eat has been a lot harder to figure out. [...]

Do you recommend any method for really going about learning to integrate all this data about and learning what is right? I fear that, because I only come across scientific articles from what you and people like Mark recommend, that I'm getting a biased perspective, and not getting a really good, overall view of the data.

Have you read Good Calories, Bad Calories by Taubes? In that book and others (like The Great Cholesterol Con by Colpo) much in the way of studies that supposedly support the "lipid hypothesis" are cited. It should not be difficult to find studies that support conventional wisdom. Just look at the news outlets regularly.

Well I read that whole thread and was quickly reminded why I don't generally partake in such discussions any longer. Yep, I think both the Kitavan diet of 70% natural carbs and the Inuit diet of 80% natural fats are extremes on both ends of the spectrum, are likely both healthful, but, as extremes, are probably not optimal.

I think a person does well to just eat real food better than 90% of the time and don't worry and obsess about it. And, I think that what one likes to eat is something that changes -- ebbs & flows -- over time. Initially, I was big on lots of protein (big steaks). However, since getting better and better at the tasty, fatty sauces I make, I'm eating less protein and I feel fine. Sometimes I like veggies, and then I'll go periods where by the time my fat & meat are eaten (often I end up leaving food) I have no appetite for veggies -- and besides, I often skip the veggies altogether in preference for a couple of enormous teaspoons of full fate Fage yogurt with a few berries, cherries and/or nuts.

I have absolutely no idea -- I have never had an idea -- what my macronutrient ratios are beyond knowing my carbs are relatively low, my fat relatively high, and I'm getting enough protein. I have no interest in knowing specifics beyond that. The more variety and randomness in my diet, the better. I never count anything, never measure anything, and I never will. I tried FitDay for about 2-3 days once and promptly concluded that it was an enormous waste of time, and boring to boot.

Seriously, it absolutely drives me nuts, sometimes, the BLATANT OBSESSION going on out there, and it's certainly not helpful for you and other newbies to the paleo / primal / evfit scene.

For a great book on diet that I'm currently reading, check out Nora Gedgaudas' Primal Body Primal Mind. While Mark's Primal Blueprint is indeed excellent and everyone should read it, it's more of a total lifestyle work, whereas the former is a body and mind integration focused on nutrient intake.

I hope that helps. Don't let people freak you out. This all makes sense and it would be extremely odd if it didn't (make sure to read Part II of my Saturated Fat series that should go up later today or tomorrow). Eat Real Food -- as much or as little as you desire, when you desire, and sometimes eat nothing and sometimes pig out, even on natural carbs.

Related posts:

1. Ask Mark Sisson
2. The “Groan” Diet
3. The Ultimate List of Primal and Paleo Resources in One Place
4. 200
5. What A “Sterling” Transformation!

You've asked to be kept up to date, so I thought I'd touch base. As of this morning's weigh-in, I'm down 94 pounds in just under 6 months. Now, that's from a high of 374, so at 280 I'm not exactly svelte (yet), but needless to say I'm thrilled with the progress. I've lost 10 inches from my waistline. It's actually been quite easy - it's amazing what we can do when we just make up our minds.

[...]

Thanks again for all the great information, you (along with some of the other paleo bloggers) have helped me find a lifestyle that works very well for me.

Well you're welcome, Chris, and thank you for making the commitment to change your life, for sticking with it, and for making your results known to me so that others can be inspired and motivated by your phenomenal and rapid success on a path to health and vitality.

The best to you, and please continue to keep us informed.

Related posts:

1. Way More Important Than… (106 Pounds Lost in 7 Months)
2. World Paleo Domination – Part 2
3. Paleo Trumps — the Science
4. Criticisms of Free the Animal. Want to Chime In?
5. And Chris Gabel Rings In

...30 years old, MD in anesthesia and critical care in Italy, fed up with being 40 pounds overweight. I've always been the big girl, since I was little, and now that I'm a grown up i would really LOVE to shed the pounds at last. Tried it all: low-cal-low-fat; doesn't seem to work. Went vegetarian and literally BALLOONED UP...

So now I've been on evolutionary for 6 days and it looks good. I've just subscribed to your freetheanimal site. A few questions; maybe you can help me out a bit:

• Do calories count when on pure EF?

• How often should I fast, if at all?

• Should I work out according to the power law workout max twice a week?

Very nice of this reader to donate a subscription, even having been reading the blog for only a few days. I really appreciate that. Here was my email response.

I actually don't know if calories count or not if one keeps the carbs low. I tend to think there's some "metabolic" advantage, but who really knows how it works (more heartbeats, higher respiration, more poop...?) and what the limits are. I have heard anecdotes of people eating upwards of 10,000 kcals per day of 80-90% fat, a little protein, and not gaining weight over weeks of the experiment.

But what's the point?

The real power of EF is that you don't need to count anything. Don't be afraid of natural fats (animal, coconut, olive oil), eat plenty of then (60-70% of energy), moderate protein, low carb and everything seems to take care of itself. Just eat real food. When you do, you should find appetite begin to change. So, you never need to count anything because you're shedding weight, your hunger is far different than before, and you should feel really good and energetic most of the time.

I'm a big proponent of intermittent fasting and have blogged a lot about it. See the category on the blog. I think that at first it should be regimented and formal, twice a week for losing and once per week for maintenance. Now that I'm about where I want to be, I just fast randomly, sometimes skipping a meal, and sometimes two or three: 18 hour fasts, 24, and sometimes 30 or 36. I usually try to do them in advance of my workouts. However, fasting isn't essential -- though I think skipping a meal or two here and there is important (look up autophagy) -- but you can easily progress without it.

I have never worked out more than 1 hr per week, 2 x 30 minutes. The power law aspect is that in such brief time you can get far more intense. Nobody believes I only do 1 hr a week, when many overweight people I know trudge along at low-intensity for hours per week and never make any progress.

There was a follow-up email today with an important question and I thought I'd provide an answer here, along with the opportunity for anyone else to share experiences of insight.

So far I've been on EF for 7 days and lost 3 pounds. I do hope it will keep up... the last four days have seen a scale that will not move either way. plus, this might sound like psychological blabber but trust me I'm so scared that this, too, might fail like countless other methods, that I'm afraid of the scale... any suggestion about how to SANELY relate to a scale is greatly appreciated.

Well, first, you should understand that a lot of that initial 3 pounds is water that your body no longer needs to bind glycogen (since you're depleting it). The goal is to convert your metabolism to that of a fat burner. You've got a few hours of glycogen stores if you're eating a lot of carbs, and your body screams bloody murder when you're not keeping those levels up with regular sugar intake. Conversely, you've got 3-4 months or more of fat stores (and you can make the needed glucose for brain and red blood cells with protein). When you become a fat burner your appetite should change radically.

But it's a process. For some, it's rapid, and for others, it just takes a while. But -- and it's a BIG BUT -- you don't need to be hungry all the time and you get to eat luxuriously. Check out the Food Porn category. I eat better than virtually every person on earth eating grains and sugar -- and not just in terms of nutrition -- but in terms of taste and satisfaction. Last night after eating the curry I blogged, I recall sitting there in such an amazing state of contentment for the longest time, and with none of the bloated or tired feeling one gets in the hours to come -- and I ate a lot.

So, you know what? Even if I didn't lose much weight, express my genes, and reset my body to the way evolution intended, I'd still eat this way for the way I simply feel. Give this at least a few months and don't ever discount the way you feel. It's critical.

It's a feature of the modern, agriculture-backed church and state bedfellows that you are always called upon to sacrifice and to feel guilt when you feel pleasure and contentment by means of your own individual efforts. Conventional, fake "contentment" -- the "contentment" of a slave -- in a world where parasites run things demands that everyone produce to keep them in blood to suck, and their only viable long-term strategy for that is to instill unearned guilt. They do that by promoting fantasies as real, crating problems where no problems exist, and then provide a "solution" that of course requires allegiance, worship, obedience, sacrifice.

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary. --H. L. Mencken

And it's that guilt, alarm, and clamoring for safety and salvation that causes you to torture yourself with low-fat diets of industrially processed garbage -- and then try a burn it off in hours of toil on a treadmill or some other penance for your sins.

There's the theory. For the practical, I would recommend that you don't look at the scale very often. In an evolutionary context, we are simply not very good at gaining valid knowledge from observations of very complex systems (like metabolism). There was a book written a few years back that I highly recommend: Fooled by Randomness, by Nassim Nicholas Taleb. If you've read any of Art de Vany's blog, you may have seen reference.

You don't want to get yourself stressed, worried -- or overly exuberant -- by obsessing on the scale. Personally, I look at it twice per week, after each workout on the way to the sauna. In over two years at this, I can tell you that there have been a multitude of inexplicable swings up to 5 pounds in either direction. So, what you want to do is pay attention only to the highs & lows.

You are trying to shed fat and to keep and strengthen lean tissue. So, what you want over time is to observe lower highs and lower lows on the scale, and between those two established trends, never mind what happens, so long as you're keeping your eating practices at 80-90% good.

Anyone else have anything to add?

Related posts:

1. I Guess It’s Gonna Be a Fast
2. Quick Reader Question
3. Jay’s Rapid Progress
4. Part of Why I Do This
5. Same Shirt: Three Years & 60 Pounds Later

~~~

Q1. From Joe:

I have been reading the blog for about 6 months and had tremendous success eating Paelo style. I had a quick question - Sometimes when I eat refined foods (grains, bread, pretzels, hoagies etc...) my mood becomes nasty. I get angry for little or no reason. When I go back to strictly paleo, I am more patient and I am more pleasant overall. Do you know of or have you ever heard of anything about how food effect a persons mood?

~~~

Q2. From Marc:

Perhaps you can help me, I started eating paleo and following a plan very similar to yours about 3-4 months ago since then I have gained 12 pounds. Not muscle. Pants getting tighter. 220lbs to 232. Basically at a loss on what to do next. Any advice would be appreciated. Blood work good, thyroid ok.

[Ed: He goes on to detail some exercise & eating habits that seem completely appropriate to me.]

~~~

Q3. From Tom.

Richard, I'm a follower of Free The Animal. I happened to come across a blog site called Heart Scan and noticed a comment you'd sent about your thyroid and tsh levels. This caught my attention because I 'suffer' from thyroid problems. When I was 13, I had surgery for Graves Disease and a portion of my thyroid was removed. My levels appeared to be fine after until I started gaining weight in my late 30's. I went and had my tsh levels checked. All out of whack. I was placed on synthroid and my levels went down; however, I felt terrible and my heart would randomly palpitate making me think I was having a heart attack. I told my primary care physician about this and she said my blood test results were within 'recommended standards' and I needed to continue the regimen even though it didn't make me feel any better. I had her send me to the local endocrinologist. That turned out to be a waste of time! She had diabetes posters all over her office and that appeared to be her 'bread & butter'. She told me I just had to get used to being over weight and not feeling good. In fact, she said I might not even have any thyroid tissue left. Sounded like a life sentence to me from an 'expert'. When I got home, I chucked the synthroid down the toilet and went to a naturopath. I started taking a non-prescription thyroid supplement and also a daily kelp tablet. The heart palpitations went away. I started feeling better. About this same time, I stumbled across Art Devany's Evolutionary Fitness website and later Free The Animal. I also went and had an ultra sound scan and found out I still had thyroid tissue. I've lost weight and my eyebrows are growing back (another telltale sign of thyroid problems). I know I need to eventually have my tsh levels checked; but, I feel good and my cholesterol levels are lower now than when I was on synthroid. I'm hesitant to have the western medicine gurus get me in their clutches again.  Any words of wisdom?

~~~

OK readers; anyone want to weigh in? I'll be happy to engage in comments as well. Thanks, as always, to the many of you willing to lend a hand to your fellow travelers.

Related posts:

1. The Hidden Benefit of the SAD: Iodine?
2. Reader Questions and Results
3. Reader Real Results
4. Reader Questions (Part 1)
5. Do You Need to Gain Weight? Try Paleo

~~~

I don't know if it is removing grains, sugars, vegetable oils, etc. from my diet, or the supplements I am now taking, or a combination, but I am getting amazing results that I didn't even think about at the time I started.  Even though I take medication for rheumatoid arthritis I still had some pain.  I tried and succeeded in keeping the Methotrexate at a low dosage because of the damage it can cause to the liver.  I was willing to live with some pain and did not allow it to alter my lifestyle.  I always had some pain in my lower legs and feet, my knees, my hips, my shoulders and neck, and my hands, especially my thumbs.  I had additional pain in my feet caused from nerve damage from diabetes.  Several of my toes were actually frozen. I couldn't move them except with my hand.  They always hurt.

Well, I still have nerve damage in my feet but there is little pain, just kind of a feeling like some of the toes are tingly.  I do not have complete movement back yet, but a measurable improvement, especially on my left foot.  I can actually separate all the toes without using my hand, just by wanting to.  My right foot is improving but at a slower rate.  It was the worst of the two so that is understandable.  I don't have pain  in the rest of my body.

I should be able to get off the oral diabetic meds within the next couple of months.  After that I will try to get rid of the meds for arthritis.  It is scary, because if it doesn't work it is 3 months of total and complete hell.  But I am going to try it.  I want to be on the supplements and the paleo program for a while longer before I do.

Thank you, thank you, thank you.

~~~

Well, what can I say? 

Related posts:

1. Birthday Shoes Interview
2. Thinking Through It
3. Learning to Walk
4. Barefoot
5. “Orcas in the ER”

~~~

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.

Related posts:

1. LDL Cholesterol Nonsense
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I just wanted to let you know that you are certainly changing (saving?) lives with your blog.  I forget how I found Free The Animal, but it was shortly after I started my New Year's resolution to drop the 20 lbs I'd gained in the past 18 months.  I had the idea that I was going to Zone because it had helped me lose weight in the past, although I remember quitting because it was a hassle to weigh and measure every bite of food (and quite frankly, I was starving on 12 blocks/day).  Anyway, finding your blog coincided nicely with my Zone procrastination so I decided to follow your recommendations instead.  January 1st, I weighed 145 lbs and a week ago, 125 lbs.  The best part of that is that much of the weight lost was this big spare tire of fat around my waist and no starving.

Also thanks to you/your blog, I began to supplement Vit D heavily. I should mention here that I'm an RN, and since it was cold & flu season the topic came up with some of my coworkers regarding Vitamin D supplementation.  One of the older nurses was telling the younger girls how important it was to take "the recommended 400 IU per day".  If I didn't read your blog, I wouldn't have known that 400 IU isn't likely to do much for people with D deficiency.  I kept taking 6000 IU (and kept my mouth shut - can't argue with some of those old battleaxes and win).  D Action sent my test results in April and my level is 76.

My annual "physical" is coming up in a few weeks, and I am curious to see if my physician will check my cholesterol.  Last year my HDL was a pathetic 38. I'm hoping that after 5 months of healthy eating, there is an improvement.

So thank you, Richard.  Because of your drive to educate the rest of us, you have helped me make truly positive changes in my life and health.  Keep up the great work!

~~~

Pretty amazing, eh? The Zone, a working life amongst medical professionals, and all it really takes is some decent common sense to eat real food, plenty of natural fat, and the rest takes care of itself.

Hearty congratulations to Eileen.

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The community really responded. There are many great comments there, and I encourage you to read them all, but I also want to re-post a couple as recognition for some really good help.

~~~

First, from David:

Obviously you got into your current condition through a combination of what you eat, how much you eat and what you do (or don't) for exercise. Here's the obvious. Keep doing the same and you'll continue down the same path, at least as fast. if you figure you're 60-80 lbs overweight now, you'll be another 60-80 lbs heavier in 10 years. So here's something obvious ... change what you eat, change how much you eat, change your exercise. Now, we all know that is easier said than done. After all we eat the amount that we do because we're hungry. Overweight people have a hard time exercising, because they're overweight. I think the place to start is with WHAT you eat.

Start with the easy changes. Dump all fructose that is not in fruit. That means dump soda. Dump almost every breakfast cereal. READ the ingredients of stuff you buy. If it includes sugar, high fructose corn syrop, corn solids et cetera ... DO NOT buy it. Google on how the body metabolizes fructose, how it goes straight to abdominal fat, how it does not give you any sense of fullness, and what abdominal fat does to your body and your liver in particular. That should motivate you.

Dump anything made with any kind of fat or oil identified as hydrogenated or modified.

If you do that it will make a huge difference.

Next consider dumping grains. It took me about 5 years to admit that it was worth trying. I have never looked back. It was hard to do, but like quitting smoking, it is fantastic afterwards.

Learn about how to reset your hormones, such as insulin and leptin. They are way out of balance now. I know this because you are overweight.

Once the weight is coming off and once you purge the crap out of your diet, you will feel more energy and will be able to exercise.

Cut fructose and work on your hormones and you'll start feeling full after eating.

These are all simple things but they are up to you. YOU have to make a change. Right now just about any change would be better than carrying on with your current path. Good luck and keep writing here for support. Richard has collected some good people here.

~~~

Patrik:

Who's right? Is the AHA, Cleveland Clinic, Cholesterol Fascists, etc? Or is it the people such as Weston Price, Sally Fallon, Mary Enig, Udo Erasmus, and Ussi Rasnikov and their beliefs on what is the determining factor(s) in heart-disease?

It is easy for anyone to say: I am right. Here is why. Also, humans have a tendency to try and split the difference as in "I don't know who is right, let's just agree that both parties are 50% right".

This, I think, in evaluating fitness/health/life philosophy is incorrect.

Here is what I use to evaluate Paleo versus Conventional Medicine/Fitness. Use at your own risk.

1) What is the underlying framework that any specific advice rests on?

Modern medicine/fitness almost completely ignores evolution. I think this is wrong as "Nothing in Biology Makes Sense Except in the Light of Evolution."

2) Cui bono?

Modern medicine and pharma. Don't get me wrong, I am for Free Markets and I do think that pharma has done a lot -- but in some cases, the incentives are not aligned correctly.

3) So-called studies and "science"

Again, don't get the wrong impression. I use reason and logic to arrive at my conclusions about Paleo BUT I'd advise reading this post when it comes to evaluating "studies"

There is increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims. However, this should not be surprising. It can be proven that most claimed research findings are false.

BTW cui bono is also relevant when it comes to "science". Do you think that "scientists" aren't subject to confirmation bias?

4) Very important. A healthy amount of both empiricism and skepticism. Is Paleo working for you?

My experience: it has changed my life. I wish I been raised this way.

Aside from the empirical aspects of Paleo -- there is much conjecture. We don't know what the Paleolithic was like.

For example, the debate over sat fat in the Paleo community. (Personally, I don't think it is harmful and suspect it is healthful. But Loren Cordain could certainly be right and I could be dead wrong.)

Are we, right at this very point, getting some things 100% wrong? We sure as hell are.

But so is Western Medicine. Again, don't get me wrong. If I am in a car accident, get me to a emergency room, use all of western medicine, pharma incuded, and fix me up stat!

I don't know if that helps -- but this is how I view epistemological questions of who is right and why they are.

My recommendation: Get off your ass, suck it up and try it. Stop pussyfooting.

If it doesn't work after an honest effort, 3 months or so, nothing is stopping you from going back to the ostensible healthy Standard Government Recommended Diet.

~~~

Erik:

You got it right with "unwilling," but not "unable." It's up to you, man. And you've been keeping up with paleo/Weston Price literature since age 18? Man. What's stopping you?

I first happened upon paleo when I rescued a flat-coat retriever puppy from a trailer park in Escondido. The guy was undernourished and I, of course, rushed to the nearest Petco for a bag of Nutro-Max. Lamb flavor, I believe. "Flavor" shoulda tipped me off. Anyway, he didn't react well. Loose stool, runny nose, sluggish temperament. Something was wrong, and I figured it just might be diet. I was just an English major in school, but I knew the basics of evolution - and I just kinda figured "Hey, this dog is, for all intents and purposes, a wolf. Wolves don't cook and process their meals. Why the hell is he eating all these polysyllabic ingredients?"

I did a bit of digging around online and found that entire communities had sprung up around raw, ancestral feeding. Raw meat, bones, organs. It made perfect sense, and Charlie (my pup) agreed. Shiny coat, boundless energy, white teeth - it worked to perfection.

I got to thinking that maybe the same sorta dietary concept could be applied to all animals. Maybe even, or especially, humans. I'd been putting on a fair amount of weight, having ballooned up to 235 lbs at age 25 (with a fair amount of muscle underneath, but still...), and I figured something new (or ancient) might work.

It did. I dropped the grains, the legumes, and most of the starches, upped the fats and protein, and started paying attention to everything I ate. I also dropped the body fat. Thanks to blogs like Richard's and Mark Sisson's and Stephan's, I got into Weston Price and all the fat soluble vitamin stuff. Cod liver oil, activator X, raw dairy. This way of eating / living / behaving / works so flawlessly it feels like magic. The way vitamins D, A, and K2 work in concert to heal cavities and regulate calcification? Absolutely insane. Such elegant simplicity. Such beauty. Nature wins again.

How can you see the evidence, read the testimonials, acknowledge the millennia of real world case studies that support it - and still reject the paleo way? I can understand if you were ignorant of this stuff, but you've been reading about it for decades! C'mon! I'll echo a previous commenter and say, "Give it three months."

Three months of fatty steaks, coconut milk curries, and handfuls of macadamia nuts. Heaping salads with feta and olive oil dressing. Roasted chicken, crispy skin, organs, and all. The odd fast. A few days of intense workouts every week, no more than forty five minutes per session. Dust the cobwebs off those old football muscles! Go for a hike every once in awhile. Play with your kid (once she's walking). Hell, I sometimes use my (now full-grown) retriever as a mobile, asymmetrical weight. You could do the same with your kid if cautious (I'm no parent, so perhaps I suggest heresy). No weights or gym membership? Check craigslist for a cheap set or buy sandbags from the hardware store. Bodyweight is good enough, too; when I was heavy, one of the advantages was built in resistance training.

While I don't appreciate the clunky foot cocoons they peddle, Nike had it right with "Just do it." So, yeah: do it, man. Good luck (though you won't really need it... it's all just so easy).

~~~

And those were just three out of a dozen of helpful comments. Feel welcome to read 'em all.

Oh, by the way, this is really the norm here, now. Just last week another reader in need of help got an outpouring.

Thanks you commenters, for such willingness to share and help.

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