The Reporter Probably Knows Less About Cholesterol Than ....

"Studies showed us that high cholesterol levels were one of the most important risk factors for the development of heart attack and stroke, and we had evidence that lowering cholesterol lowers the risk of heart attack and stroke," Ridker says. "You can't say that about most everything else."

But looking at just one number doesn't provide a detailed-enough picture to precisely assess risk, because it doesn't account for the interplay among LDL, HDL and triglycerides, or the fact that each of these affects risk in a different way, Mozaffarian says.

http://www.washingtonpost.com/national/health-science/you-probably-know-less-about-cholesterol-than-you-think-you-do-heres-some-help/2014/06/16/d9fa9350-e4fa-11e3-8f90-73e071f3d637_story.html

The headline was "you probably know less about cholesterol than you think you do."

The irony is killing me!  The scientific and medical community went a non-scientific lark for 30 years and they think "we" don't know much about cholesterol?  Expletive deleted here.

The first line of the article refers to a cardiologist who has to re-teach everyone what they should know about cholesterol - because his profession has been butchering this stuff for years.  Shame on them.  A money quote:

"There's a lot of confusion and controversy around cholesterol," says Mozaffarian, an associate professor of medicine and epidemiology at Harvard Medical School. "There is even confusion among the scientists who study it."

Of course there is.  That is why the scientific method is needed.  The problem was, folks used their power and positions of authority to spread conjectures about the science of cholesterol as if it were scientifically proven truth.  Why?

 "Studies showed us that high cholesterol levels were one of the most important risk factors for the development of heart attack and stroke, and we had evidence that lowering cholesterol lowers the risk of heart attack and stroke," Ridker says. "You can't say that about most everything else."

Translation: There's a weak correlation between high total cholesterol and CVD, and there's limited evidence, very little, that shows lowering cholesterol can reduce the incidence of CVD.  But there was never strong evidence that lowering blood cholesterol - either total or LDL - could be used for primary prevention of CVD.  

The author goes on to describe various results of epidemiological studies, all of which have been "shown by studies" to be junk.

To make sure the irony levels in your blood are high enough, the author dives right into unproven speculation about how to "reduce your risk" (aka how folks who do epidemiology assess risk via mathematics, which has nothing to do with actually determining how these behaviors affect live people via intervention study), by doing this, that or the other to change the numbers reflected on your lipid panel.  Which is to say - the author just continues the cycle of confusing speculation based on expert opinion, immature science and ..... bovine excrement.

Example:  Should you try to raise your HDL by medications or some magic pill (niacin, for example)?  No, that has been proved not to work, and may be harmful.  In other words, folks with high HDL generally are healthier, but if you take a sick person and manipulate their HDL it does not help.

A lovely understatement, for those who appreciate understatement:
"But there is some disagreement over which dietary changes are best for heart health, says Roger Blumenthal, director of the Ciccarone Center."
Translation:  "We don't have a freaking clue."

""For most people, cholesterol from food isn't a contributor to their cholesterol levels," Blumenthal says."
And for those whose blood cholesterol levels are affected by their dietary cholesterol intake, they have no idea whether that matters at all in the cause of CVD.

"High-fat foods, such as cheese and chocolate, have also been regarded as verboten, yet "the evidence for this may not be as strong as we once thought," he says."
Translation:  "We didn't have a freaking clue, but were unable to keep our mouths shut."

 So, in the face of all of the mis-information in just this one article, much less the rest of the web, what a guy or gal to do?

Eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar/wheat.

Make your belly smaller, increase your muscle mass, learn more each day about how to eat for health and performance.

Things About Cholesterol That Make You Go "Hmmm?"

"The way the body transports fats and cholesterol into the body is really interesting because it doesn't go directly into the blood stream from the gut.  Instead, it gets shipped through the lymph nodes and it arrives right at the big vein that goes into the heart  ... the body has to make sure the heart gets plenty of this first because it knows the heart needs fat and cholesterol."  Stephanie Seneff in "Cholesterol Clarity" by Jimmy Moore

The case against the lipid hypothesis is:
1.  There never was a case FOR the lipid hypothesis
2.  Most of the cholesterol you eat doesn't get to your blood, so eating a low cholesterol diet is pointless and takes away some of the most nutritious foods
3.  Dietary restriction of saturated fat has a very small effect on blood cholesterol; if consumption of saturated fat kills us by raising cholesterol, the effect would have to be manifested by blood cholesterol increases of a very small amount
4.  Restricting saturated fat or any fat has never been proved by intervention study to reduce mortality.  Epidemiological studies, as they tend to be, show "everything" with regards to high/low cholesterol, and high/low fat intake.
5.  The government spent over a billion dollars on studies designed to confirm the lipid hypothesis, and these efforts have spanned the better part of forty years.  They have still not confirmed the lipid hypothesis (which should be termed the lipid conjecture)
6.  Statins reduce mortality in a small group of very sick people (young but with existing heart disease).  They do not reduce mortality in those who have "high" cholesterol but are otherwise healthy.  Statins were the best evidence that lowering cholesterol reduces the incidence of CVD, but they are still not proof that lowering cholesterol is a treatment for CVD.  While statins do in fact reduce blood levels of cholesterol, you have to treat 100 folks for five years to be able to save one from death.  A baby aspirin, on the other hand, will save that same person if you treat 40 people for five years.  The cost difference for these two is exponential, as are the risks (for baby aspirin, there are almost none).  In other words, statins appear to be a high cost, high risk, low effect alternative for baby aspirin.
7.  A powerful LDL cholesterol reducing statin, combined with an agent that decreased absorption of cholesterol and thus reduced LDL over and above statin treatment, was found to give increased mortality compared to the control group, and the test was stopped early (vytorin)
8.  A recent study found that of those admitted to the hospital for acute heart disease, as many had high cholesterol as had low cholesterol, which is congruent with the fact that those who die of CVD have high and low cholesterol, relatively speaking.  In other words, "high cholesterol" is a weak correlate with cardiovascular disease, and is at most only one cause of CVD, and a small one.

The story of how the whole world became flummoxed by the bad science of fat and cholesterol one is a sordid tale of woe and indicts centralized control of drugs, medicine, science and the USDA to boot (every wonder what in the frock the USDA is doing messing about dietary recommendations?).

"We have this issue of cholesterol being the number-one cause of heart disease in the eyes of most of my cardiologist colleagues.  That would have some merit if it as 1963."  Dr. William Davis, from "Cholesterol Clarity" by Jimmy Moore

I've just started digesting Jimmy's book, but hope to learn more.
(Minor edits January 26, 2014)

JAMA - Higher Cholesterol Please

Cholesterol and Mortality:

30 Years of Follow-up From the Framingham Study
Keaven M. Anderson, PhD; William P. Castelli, MD; Daniel Levy, MD
JAMA. 1987;257(16):2176-2180. doi:10.1001/jama.1987.03390160062027.
ABSTRACT | REFERENCES
From 1951 to 1955 serum cholesterol levels were measured in 1959 men and 2415 women aged between 31 and 65 years who were free of cardiovascular disease (CVD) and cancer. Under age 50 years, cholesterol levels are directly related with 30-year overall and CVD mortality; overall death increases 5% and CVD death 9% for each 10 mg/dL. After age 50 years there is no increased overall mortality with either high or low serum cholesterol levels. There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels). Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling-perhaps due to diseases predisposing to death.

(JAMA 1987;257:2176-2180)

.
http://jama.jamanetwork.com/article.aspx?articleid=365739

The most widely respected medical journal, The Journal of the American Medical Association, published a study entitled:

"Cholesterol and Mortality. 30 Years of Follow-up from the Framingham Study." Shocking to most, this in- depth study showed that after the age of 50, there is no increased overall death rate associated with high cholesterol! There was, however, a direct association between low levels (or dropping levels) of cholesterol and increased death.

Specifically, medical researchers reported that CVD death rates increased by 14% for every 1 mg/dL drop in total cholesterol levels per year.141 For example, an individual whose total cholesterol levels dropped 14 mg/dL during 14 years would be expected to have and 11% higher death rate than persons whose cholesterol levels remained constant or rose during the same period.
http://thepeopleschemist.com/does-the-family-really-need-lipitor-and-aspirin/

In other words, cholesterol is a marker, a correlate, of health going wrong, not a cause of health going wrong, which is why efforts to manipulate cholesterol do not make people less sick.

Cholesterol Eaten, Cholesterol Made, Cholesterol in Arteries

On any given day, we have between 1,100 and 1,700 milligrams of cholesterol in our body. 25% of that comes from our diet, and 75% is produced inside of our bodies by the liver. Much of the cholesterol that’s found in food can’t be absorbed by our bodies, and most of the cholesterol in our gut was first synthesized in body cells and ended up in the gut via the liver and gall bladder. The body tightly regulates the amount of cholesterol in the blood by controlling internal production; when cholesterol intake in the diet goes down, the body makes more. When cholesterol intake in the diet goes up, the body makes less.

This explains why well-designed cholesterol feeding studies (where they feed volunteers 2-4 eggs a day and measure their cholesterol) show that dietary cholesterol has very little impact on blood cholesterol levels in about 75% of the population. The remaining 25% of the population are referred to as “hyper-responders”. In this group, dietary cholesterol does modestly increase both LDL (“bad cholesterol” and HDL (“good cholesterol”), but it does not affect the ratio of LDL to HDL or increase the risk of heart disease. (2)

In other words, eating cholesterol isn’t going to give you a heart attack. You can ditch the egg-white omelettes and start eating yolks again. That’s a good thing, since all of the 13 essential nutrients eggs contain are found in the yolk. Egg yolks are an especially good source of choline, a B-vitamin that plays important roles in everything from neurotransmitter production to detoxification to maintenance of healthy cells. (3) Studies show that up to 90% of Americans don’t get enough choline, which can lead to fatigue, insomnia, poor kidney function, memory problems and nerve-muscle imbalances. (4)

http://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy

Grab the eggs, bon appetite!

However, eggs every day may not be great if you have any egg sensitivity.  Paleo man probably ate all the eggs he/she could find, but he/she could only find them seasonally, and there's some evidence that every day consumption may create issues.

For men: Tim Ferriss recommends an egg or two every night before bed, as cholesterol is the raw material for testosterone production, and you make T at night when sleeping. 

"Lowering" Cholesterol and "Wishing on the Moon" - Which Is More Effective?

The answer to that question is - we don't know.  Perhaps neither!
After over 40 years of telling you that lowering cholesterol is good for you, your government - NIH, surgeon general or USDA - has yet to prove it. Folks die every day with "low" cholesterol, and many with "high" cholesterol live for a long time and with good health.  If you are counting on this very poor health correlate, you should probably rethink your strategy.

However, the foods in this article are good choices - beef, pistachios, almonds, and small amounts of tomato juice - aside from their so called cholesterol lowering properties.  They are blood sugar neutral and nutrient dense.  Hunt and gather yourself some of this soon!
http://www.menshealth.com/nutrition/cholesterol-fighting-foods

Head Scratcher

It's a head scratcher that an organization like this - the health newsletter of Harvard - is lazily recommending actions that are ten years out of date.  Even the institution's own scientists have moved past the "lowfat to lower cholesterol" fad and back towards science.

The emailed newsletter starts:
"People can reduce cholesterol levels simply by changing what they eat. For example, if you are a fan of cheeseburgers, eating less meat (and leaner cuts) and more vegetables, fruits, and whole grains can lower your total cholesterol by 25% or more. Cutting back on saturated fat (found in meat and dairy products) and trans fat (partially hydrogenated oils) can reduce cholesterol by 5% to 10%."

They recommend these four things to "lower your cholesterol":
"Stick with unsaturated fats and avoid saturated and trans fats.  
"Get more soluble fiber. 
"Include plant sterols and stanols in your diet."

Head scratcher part 1: There's no evidence - after forty years or more of examination - to show that "lower cholesterol" is a benefit for mortality reduction.  Your government, in its infinite wisdom, spent nearly a billion dollars to prove that its advice to reduce cholesterol and fat intake was in fact good for mortality reduction.  Said government failed to show any such thing.  

Second, eating plant sterols and stanols to lower cholesterol is equivalent scratching your private parts to make the sun come up sooner - I guess is might work, but the evidence is sketchy.  Sure, if you believe the conjecture that cholesterol is a cause of early mortality by causing damage to blood vessels, then it might be considered a common sense thing to use a "natural" plant based "food" to lower cholesterol.  But after forty years, and still no direct evidence that cholesterol manipulation via diet (or statin) is helpful for reduced all cause mortality - REALLY?!  A dearly beloved family member would dutifully down benecol every night on a piece of bread and announce proudly that it was "reducing" her cholesterol - how I managed to keep my pie hole shut about that I'll never know.  The kicker?  For females her age, "low cholesterol" correlates with increased mortality.  
The idea that fiber helps mortality is all the rage, but suffers, like the idea of diet to reduce cholesterol, from a lack of evidence.  Why people remain so in love with the idea is a little confusing when there are so many reasons not to down magnum doses of fiber and so little in the way of evidence that fiber is a big benefit - or any benefit.
The topic of cholesterol and causation of disease is very, very complex.  Seems like folks with "high LDL" (which can mean a lot of cholesterol packaged in LDL particles, or a large number of LDL particles, or some combination of both) have a higher correlation with heart disease; but some folks with "normal" LDL die young (Tim Russert being a prime example, his was reportedly 70, which is "low").  HDL has a correlation with reduced mortality, but efforts to raise HDL do not decrease mortality.  Insurance companies - who have a lot more at stake in your health than do your doctors - bet on your ratio of total cholesterol to LDL cholesterol.  
I read this newsletter to gauge changes in the perception of the common view.  At least this perspective - of doing what is best for you based on changes you can verify for yourself without relying upon "expert opinion" - has become obvious for the old guard.  They advise:
"Find the diet that work for you. When a friend or relative tells you how much his or her cholesterol level dropped after trying a particular diet, you may be tempted to try it yourself. If you do and after a few months you discover that you’re not getting the same benefits, you may need to chalk it up to genetic and physiological differences. There is no one-size-fits-all diet for cholesterol control. You may need to try several approaches to find one that works for you.  Although diet can be a simple and powerful way to improve cholesterol levels, it plays a bigger role for some people than for others. If your doctor suggests a lower-fat, lower-cholesterol diet, and despite your best efforts it isn’t working, you may need a different kind of diet, or medication, or both to bring cholesterol down."
It is curious to consider how this will all play out over time.  I don't see a day when all of the "experts" who have advocated low fat and statins to save the world will just have a conference and announce "what we've been telling you was bogus."  At some point, however, the truth will be too obvious for any rational denial.  The "It's the Sugar, Stupid" paper (from Monday and Wednesday's post) will be another nail in the "low fat for health" coffin, making the causality chain something like:
1. Too much sugar causes metabolic derangement (metabolic syndrome)
2. Unchecked, metabolic syndrome progresses to diabetes (full blown loss of glycemic control), and excess carbohydrate in general exacerbates the issue once one is over the metabolic syndrome threshold
3.  Diabetes predicts about a ten year shorter lifespan, and a much shorter period of active life.
The role of fat and cholesterol in this chain is minimal, and if eating high fat and high cholesterol helps you retain glycemic control and avoid metabolic syndrome, we've been in reverso-world the last 30+ years.

Low Cholesterol Will Kill You

"Heart attack survivors live longer if they have high cholesterol"

"Low cholesterol levels increase the risk of death from stroke, cancer
and all causes"

"Low cholesterol levels predict death in patients with bacteria in the
blood"

"Colon cancer deaths increase in men with low cholesterol"

http://www.fathead-movie.com/index.php/2012/10/08/book-review-low-choles
terol-leads-to-an-early-death/

Are these joke headlines? Yes - and no. These headlines come from a
book entitled: Low Cholesterol Leads to an Early Death - Evidence From
101 Scientific Papers.

The death of the cholesterol myths is long overdue but still not close -
we're a nation of statinators. So it's nice when someone takes the time
to read scientific studies and report those findings which DON'T make
the abstract.

Thanks, Tom Naughton, for the review - and if you have not seen Tom's
work, Fat Head The Movie, in which he eats high fat fast food for 30
days and loses weight while improving his fasting lipid profile - do it!
The movie is funny and informative.

Testimonial: Moi

I received my final free health check up this month (not really free, you the taxpayer paid for it) in prep for my retirement from a 23 year military career.  In this post, I lamented the fact that so many folks my age are taking drugs for some malady or another - usually hyper tension, lipids or gout.

My BP this year was 120/80, better than when I was a college student 26 years ago.  My fasting lipid profile:
Triglycerides were 37, LDL 108, HDL 77.   Total cholesterol, 192.
Fasting glucose was 88.

Interestingly, when triglycerides are below 75, the formula they use to estimate LDL overestimates LDL - thus it is likely less than 100.  Not that I care.

What's the point?  Am I just crowing about myself, chest thumping?  No, no, no.

A bit.

Yes.  Still ....

How many times have you heard that you should eat less cholesterol to "lower your cholesterol"?  How many times have you heard you should eat less saturated fat to lower your cholesterol?  How many times have you been advised to eat "heart healthy whole grains" to lower your cholesterol?

How many times after those commercials, by the way, have you seen a commercial for either glucose monitors or viagra/cialis?  Man, those marketing folks know how to get you coming and going.  Pardon the pun.

What if I told you I eat over 60% of calories as fat, and that's what gives numbers like the ones above, (drugs not required).  What if I told you there's no reason to limit cholesterol intake?  What if I said I eat more fat than ever but my numbers are "better" than they've been in five years (and they've always been "good")?

The point is the entire field of medicine has run off on a lark with cholesterol, fat and health.  They kicked science to the curb, bit off on bizarre government recommendations and started to peddle meds like candy.  They may not even tell you, since they seem not to know, that if you don't want to use meds you can cure what ails you, for 80 plus percent of the population, via carbohydrate restriction.  If you ask to see the intervention study that shows low fat diets are good for longevity - or even cholesterol management - you'll get a blank stare.  The best studies I have seen show that what you have been told is opposite of the truth - when you eat saturated fat, your cholesterol numbers improve.  When you eat "heart healthy" whole grains, your glucose numbers will be crap.  And if you think trading nasty fasting glucose numbers for a ten point reduction in total cholesterol is a good deal - you should be reading this blog more often.

Of course, I don't expect that you take the numbers from my case and then become a believer - I obviously have good genes as far as fasting lipids go because my numbers didn't look too bad even when I ate nothing but low fat, "heart healthy" junk.  My numbers didn't look bad even when I reached weights over 215 pounds for the first time in my life.  My numbers, except for blood pressure, have never looked bad, no matter how much crap I slammed down my pie hole.  But they look better now that I eat fat first and foremost, with adequate protein, and veggies as convenient.

Whole fat dairy? Yes.  Real butter?  Yes, every day.  Red meat?  Not often enough.  Coconut oil, a nearly 100% saturated fat?  Yup, usually with macadamia nuts or sunflower seeds (or dark chocolate!). Do I eat 5000 servings every 15 minutes of spinach and broccoli?  Only once.  A long time ago.  Not recommended.

The point is - forget the diet wars. Forget the USDA.  Forget the pamphlets that advocate whole grains, fruits until you are broke and veggies until your back yard is completely overrun with tomato plants.  Try carbohydrate restriction.  Shoot for 100g/day or less.  See if it works for you.  Get some help to do it right.  Read a few genius books like the Protein Power Life Plan or The Art and Science of Low Carbohydrate Living.  If desperate and broke, just read this blog, each of the thousand posts for the last three years - desperate and broke after all deserves boredom (which I provide for free).  Find some friends - preferably at a CrossFit gym - who also pursue Paleo or Primal or just plain old "not eating too many friggin carbs."

In the process, I bet you will lose weight, lose the drugs, and feel a heck ova lot better.  The side effect of eating too few carbs?  You might get low carb flu for a few days or a couple weeks even - after that, the side effects are low appetite, smaller waist, more muscle, better sleep and better mood.  I think you can buck up for that.  If you can't, there are always statins, beta blockers, Uloric, and the last resort for those that wreck themselves - viagra and cialis.  And don't kid yourself folks, if you don't get a handle on your metabolic problems, that's the road you will walk.

Eat meat, vegetables, eggs, nuts and seeds, little fruit or starch, no sugar/wheat.

Lies, Damned Lies, and Health Science

This is one is the mother lode of the cholesterol myths.  First, the obsession with lipoprotein numbers based on the correlation between cholesterol and CVD, and the resulting misinterpretation of cholesterol as causative in the relationship.  Then there's the guess that eating in a certain way to change cholesterol numbers will be effective in undoing the causative relationship.  Then there's the supposition, still not proved (and in fact, disproved) after nearly forty years to trying, that eating less saturated fat will lower one's risk of CVD, and/or positively influence one's lipoprotein (LDL, HDL) numbers.  


These mistaken suppositions lead to advice that will help precisely no one, and from the perspective of the paleolithic model, they seem downright foolish:
-eat margarine instead of butter (manmade goop instead of a natural food)
-eat vegetable oils (invented about fifty years ago, mostly produced from industrial waste)
-use skim milk instead of full fat milk
-eat lean meat instead of full fat cuts


For a bucket full of reasons why these suppositions and supposed solutions are balderdash, check this list of posts: http://fireofthegodsfitness.blogspot.com/search/label/Cholesterol


Here's an example of what happened when one real world low fat/low cholesterol priest tried out her own prescription:  Mike Eades Summary of Brody's Story.  The scary part of this narrative is that low cholesterol correlates with higher mortality rates in older ladies - she is effortfully putting herself into a higher "risk" condition.


Here is a set of facts that turns the cholesterol myths totally on their heads:  
What Works Best - Statins or a Porterhouse?   The BLUF:  a porterhouse steak, fifty percent animal fat and fifty percent protein, will provide you with a better fasting lipids profile.


Here's a cut from the Harvard article linked above.  How long until the true believers at Harvard give up their faith and return to facts?
Harmful LDL creeps upward and protective HDL drifts downward largely because of diet and other lifestyle choices. Genes play a role, too — some people are genetically programmed to respond more readily to what they eat — but genes aren't something you can change. 


So far, so good, now get ready for the faith based proclamations:
Here are four things you can:
Saturated fats. The saturated fats found in red meat, milk and other dairy foods, and coconut and palm oils directly boost LDL. So one way to lower your LDL is to cut back on saturated fat. Try substituting extra-lean ground beef for regular; low-fat or skim milk for whole milk; olive oil or a vegetable-oil margarine for butter; baked fish or chicken for fried.


At least The H and I can agree on this topic:
Trans fats. Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. Trans fats boost LDL as much as saturated fats do. They also lower protective HDL, rev up inflammation, and increase the tendency for blood clots to form inside blood vessels. The Institute of Medicine recommends getting no more than two grams of trans fats a day; less is even better. Although trans fats were once ubiquitous in prepared foods, many companies now use trans-free alternatives. Some restaurants and fast-food chains have yet to make the switch.


Many of what would be considered the most authoritative voices will pass along mis-information that will damage your health.  Don't trust any of us.  Learn a little bit more every day.  Use your own intellect, conduct your own experiments, find the solution that works for you.

Lowers Cholesterol. So What.

There's a new diet in town, it's referred to as "The Portfolio Diet."  Here's the introduction:

Low-fat diets, move over. When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods such as oatmeal, nuts, and soy products is better.

http://www.health.harvard.edu/blog/portfolio-beats-low-fat-diet-for-lowering-cholesterol-201108263248

What are the specific foods to lower cholesterol?

Margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.

Here's why it is such “good news”:

In a head-to-head test against the low-fat diet traditionally recommended by the American Heart Association, the portfolio approach was the clear winner. (You can see the makeup of the test diet here.) After 24 weeks, it lowered harmful LDL cholesterol by 13%, while the low-fat diet lowered LDL by only 3%. As an added benefit, the portfolio approach also lowered triglycerides and blood pressure, and did not depress the level of beneficial HDL cholesterol. The results were published in the Journal of the American Medical Association.

Well, that's the good news for the author.  What he points out next may actually make it good news for some of the un-knowing; now a doctor could do something instead of recommending a low fat diet, which was always a poor choice for a person with a "cholesterol problem", after which no result would likely be obtained and for which the patient would then be prescribed a statin.  IOW, this beats the heck out of the low-fat-high-carb-statin crazy train. 

Here’s what they say about the virtue of this diet and its mechanisms:

None of these foods is a magic bullet against high LDL. In fact, the combination is probably important, since they lower cholesterol in different ways.

Here are some suggestions for adding these foods to your diet:

Plant sterols. The best sources of these are margarines enriched with plant sterols and stanols, such as Benecol and Take Control, and other foods to which they have been added, including orange juice, granola bars, and cooking oil. You don’t need more than 2 grams a day.

Of course, one of these articles would be complete unless it mentioned the darling of the non-meat crowd, fiber.  I'm still waiting for any evidence that fiber is good for you, but since everyone in these circles is convinced that it is good for you, no one ever is embarrassed not provide proof of fiber's virtue.  Hey, I'll grant it may be good for silly things like lowering cholesterol.

Soluble fiber. Two servings per day should be sufficient. Good sources of soluble fiber include oats and oat bran, barley, almost any kind of bean, eggplant, and okra. Aim for 10 grams of soluble fiber per day.

I will not comment on soy too much, but if you want to know why you don’t want to eat soy, I recommend Lierre Keith's “The vegetarian Myth.”

Not long ago, the only ways to get soy protein was by eating soybeans or tofu (also called bean curd). Today you can buy soy milk, soy bars, soy burgers, dried soy protein, and more. Soy protein and fish are two of the healthiest ways to get your daily protein. Twenty-five grams of soy protein a day is a good target.

Nor would any one of these articles be complete unless they cited the mythical “heart healthy” diet “rich” in some random feel good food item like beans, fiber, whole grains, or perhaps statins dissolved in the drinking water.

All participants in the study followed a heart-healthy diet that was low in saturated fat (minimal butter and other dairy fats, beef fat) and rich in fruits and vegetables, beans and whole grains.

So, why is this article a complete joke?

Mainly because the entire premise – lower cholesterol is good – is junk science.  There is, quite simply, no proof that lower cholesterol predicts a better mortality rate.  The government spent big piles of money over several years trying to prove the “cholesterol conjecture” and failed.  Totally.

The gory details may be found here: http://garytaubes.com/wp-content/uploads/2011/08/Science-The-soft-science-of-dietary-fat.pdf

Above and beyond that, efforts to manipulate cholesterol numbers do not have a great track record.  Vytorin was a statin with another agent which also lowered LDL cholesterol, and it worked like a champ for lowering cholesterol – however, the product test was halted when it became clear that those with the Vytorin lowered cholesterol numbers were dying off faster than the control group.  The same thing happened when they paired a statin with a powerful form of niacin (to raise the HDL cholesterol) – lower LDL, higher HDL and a higher mortality rate.  I’m thinking all that might be quantified as “not good” for the idea of treating cholesterol numbers.  How about just eating good food instead? 

Note:  I’m in year five of “eating good food” and will have my fifth round of blood work results soon, and I’ll post.  Generally, my numbers show triglycerides under 75, LDL over 115, HDL over 60, glucose around 85, and something like a 200 total cholesterol.  The doctor says things like “I don’t know what you are doing but keep doing it.”

The plus side of the article is how it lays waste to the concept that low fat intake helps to improve cholesterol.  It does not, and the fact that so many believed that it did was a pure shame.  If you want health, start by avoiding foods that skyrocket your blood sugars - for most of us, that means skipping the heart healthy grains and taking it easy on the fruit.

As Dr. Mary C. Vernon is reported to ask at medical conferences:  "I'll give you this $100 bill if you produce an intervention study that shows a better outcome from a low fat diet than from a carb restriction diet."

If someone can lose weight and feel good eating beans and whole grains and soy products, great.  It probably works for some, but hopefully, only if they like that kind of food.  For me, low fat was misery and poor sleep and many allergies and a big belly and moderate physical performance and worst of all – it necessitated that I keep food handy all the time to stave of the reactive hypoglycemia (which is not to say that I did low fat “right” – I could have done better with less sugar; but why?  I like meat!).   The list of meds and maladies I’ve eliminated from my life by eating good food is long. 

Eating low meat or low fat based on one’s belief in the junk science that is propagated by articles like this one from this Harvard-disaster-factory-of-nutritional-hoohah is another pure shame.

Eat meat and vegetables, nuts and seeds, little fruit or starch, no sugar no wheat, and live well.

Eat Fat To Lower Fat Levels

This guy is a potent analyst, and I enjoyed this reminder of what would be considered a paradox for those steeped in the low fat, high carb diet of the last 30 years:  fat content in your blood increases as you increase the carbohydrate intake in your diet.
http://rdfeinman.wordpress.com/2012/02/22/saturated-fat-on-your-plate-or-in-your-blood/

Why this happens:
1.  Those eating chronically high levels of carbs lose the ability to process fat as fuel (stores of the requisite enzymes fall within the cells that should be able to burn fat).
2.  Excessive carb intake requires that the liver convert blood glucose into triglycerides (three fatty acids bound together with a type of sugar); these are delivered to VLDL and are shunted around the body in the blood stream.
3.  The liver also turns some of the excess glucose into palmitic acid, a saturated fatty acid which some say is a factor in leptin resistance.
4.  In conditions of excess blood glucose, most cells preferentially burn glucose for fuel as a defensive measure - as this glucose is burned off, more can be taken in by the cells, helping to prevent glucose toxicity.

In short, in a person taking in excess sugars, whether that be from bread, sugar, high fructose corn syrup, or fruit juice, there's an entire chain of downstream effects that generates fatty acids in the blood and then prevents the body from using those fatty acids for fuel. 

This is why a predictable result of carb restriction, starting at 150g/day and increasing as carbs are restricted further, is decreased levels of fatty acids and triglycerides in the blood.  The lipid profile of high triglycerides, low HDL, and high LDL, is being called the atherogenic profile.  You should expect, following carb restriction, to see triglycerides under 100, HDL greater than 50, and LDL should increase or stay the same (beware - LDL numbers for folks on very low carb diets are not accurate - the cheap way to measure cholesterol involves a formula which does not require measurement of the actual number of LDL particles and their cholesterol.  This formula is inaccurate for those eating low carb).   

This is also why it's neither the cholesterol, nor the lipoproteins carrying them around, that are killing you, per se, and why we can't just manipulate these numbers to improve health.  You can use pharmaceuticals to raise HDL and lower LDL, but that does not make you healthy if you are sick from eating too many carbs.  What makes you healthy is to stop eating too many carbs.  Eat meat, vegetables, nuts and seeds, little fruit/starch, no sugar/wheat.

Not the Cholesterol?!?

Thanks to Credible Evidence for the bird dog to this post From Heart Scan Blog

Cholesterol doesn’t harm, maim, or kill. It is simply used as a crude–very crude–marker. It is, in reality, a component of the body, of the cell wall, of lipoproteins (lipid-carrying proteins) in the bloodstream. It is used a an indirect gauge, a “dipstick,” for lipoproteins in the blood to those who don’t understand how to identify, characterize, and quantify actual lipoproteins in the blood.

Cholesterol itself never killed anybody, any more than a bad paint job on your car could cause a fatal car accident.

OK, then why has there been so much focus on it for the last 40+ years?!?!

Here's the short version - cholesterol is under the light post; as in, you must surely have heard about the folks who find a drunk on his hands and knees looking for his car key.  When asked, he replies that his car is a couple hundred yards away, but it's too dark there to find a key.  With cholesterol, there's a correlation with higher levels and mortality, AND the atherosclerotic plaques associated with heard disease and stroke - cardiovascular disease - are composed of a large amount of cholesterol.  So it would have been crazy not to suspect that high cholesterol causes cardiovascular disease (CVD).  So the government ran a bunch of tests trying to prove the conjecture that either high cholesterol intake (which has a minor impact on blood cholesterol levels) or high cholesterol in the blood CAUSES CVD.  But it has never been proved, and with so many dollars expended trying to prove the causative relationship, and none being found, I think you'd have be pretty faithful in the conjecture not to believe it has been disproved.

If that story seems crazy, and you'd like to read more, there's a powerful version of it here:
The Soft Science of Dietary Fat

Why do you care?  Mainly so you can make informed choices about your relationship with your doctor.  If you read the Taubes article, you will know more about cholesterol than most doctors seem to, and you can therefore make a decision about your potential treatment options that is not dependent on the degree to which your doctor has kept up with emerging knowledge.  I still find myself stunned when I meet a doc who thinks cholesterol will kill someone.

Eat eggs, eat steak, eat bacon if you like those foods, or don't, but hopefully whatever you choose won't be the result of a never proved conjecture about diet, cholesterol and CVD.

Variation Is Evidence Of Weak Science

Mercola:
When I eliminated all my grains and starchy vegetables, I actually experienced some negative effects. My energy levels declined considerably, and my cholesterol, which is normally about 150, rose to over 200. 
*Fascinating!  Dr. Mercola thinks a cholesterol of 150 is good, and a cholesterol of 200 is bad, as expressed above - but what is that information based on?  He never clarifies, but he should.  One could just as easily say a 150 is worse than a 200 based on the correlations with mortality - but neither number is significant in my view.  They are but correlates.

It appears I was suffering a glucose deficiency and this can trigger lipoprotein abnormalities. It also seemed to worsen my kidney function. So, while carbohydrate restriction is a miracle move for most people, like most good things in life, you can overdo it.
*The questions is - how long did he try the low carb?  Some people of course take a longer time than others to adapt to running on low carb.  On the other hand, he was never obese, so it may have been the case that he simply doesn't need to go very low in carb intake.
This information really underscores how important glucose is as a nutrient, and some people can't manufacture glucose from protein as well as others, so they need SOME starches in their diet or else they will suffer from metabolic stress.
*There has to be some truth in this - ectomorphs, those who tend towards length and leanness, are clearly not "fat loving" in physiology.  It would be easy to believe that the "skinny" like Dr. M just don't run as well on fat as those of other somatotypes.
About half of your proteins have glucose attached to them, and if they don't have glucose, they simply don't work well, if at all. Your body needs glucose both as a substrate and as a fuel in order for these proteins to work well. If you drop below 200 calories of glucose per day, you might notice some negative consequences in the way you feel and even in some of your blood work, as I did.
*200kcal/day obviously is about 50g/day.  I would count that as very low carb.  50-100g/day works well for me.
My experience now shows me that I need to have some source of non-vegetable carbs. I still seek to avoid nearly all grains, except for rice and potatoes. I typically limit my total carbohydrate calories to about 25 percent of total daily intake, and my protein to about 15 percent, with the additional 60 percent coming from healthful fats like butter, egg yolks, avocados, coconut oil, nuts and animal fat.
*Impressive!  Most people will do well on this type of diet.  But you have to try it and see how you look feel and perform - after allowing time for fat adaptation - to see what level of carb consumption allows you to maintain glycemic control (as evidenced by body composition, especially abdominal circumference, and how you feel).
http://articles.mercola.com/sites/articles/archive/2012/01/23/wheat-or-rice-as-safe-starch.aspx?e_cid=20120123_DNL_art_1

The more I learn about cholesterol, the more convinced I am that it is the proverbial key under the lightpost - folks are looking at it because it can be seen, but there's not much reason to think it matters.  It is at best a correlate with heart disease and stroke (aka vascular disease), but not a cause.

But, you might say, if high cholesterol is a correlate of vascular disease, and cholesterol makes up a significant component of atherosclerotic plaques, isn't is rational to think there's a causal relationship?  Yes, it is a rational thing to think, but after years and years of trying, no one has yet proved the causal relationship.  I was a low brow solution to think that cholesterol, like grease, was killing folks by sticking to arteries like grease in a pipe.  "Really?"  Yes, they really wanted to think of human arteries as if they were static like a grease filled pipe.   "Pull the other one."

Women, Statins

http://www.time.com/time/magazine/article/0,9171,1973295,00.html

Interesting article, complex topic.

First, there's very little info that supports the efficacy of statin use for females, so I hope those who are getting that recommendation will take the time to research the matter carefully.  My opinion based on experience is that doctors have as difficult a time keeping up with medical developments as any other profession does - there's absolutely not a guarantee that the doctor knows more than you do or could - especially since it's not the doctor's life that's at stake.

You needn't take my word for that - have a listen to this episode of Jimmy Moore's excellent podcast, for a decryption of how cardiologist Lowell Gerber found his way out of the low fat woods using carb restriction, and along the found out "that my patients had not been lying to me".  IOW, the patients kept saying "Doc, I am doing what you say" but their conditions were worsening; it was only when the doc took his own advice that he realized he'd had them barking up the medically correct but wrong tree.

When looking at statin results, the confusing language is hard to get around.  They talk about reduction of mortality from cardiac events.  They talk about "reduction of risk."  They talk about better cardiac results for this group or that group.  But often, what is found in statin trials is the cardiac disease is interrupted, apparently, but other disease risks increase.  Many statin trials show a wash for all cause mortality; thus the Cochrane Collection's ambivalent report on their efficacy in a 2011 meta analysis.

Further, statin trials are short, meaning there is probably time to evaluate the benefit but not to evaluate the side effects.  With many medications, the benefits make themselves know before the costs - for example, alcohol and cocaine (and stimulants in general).

One thing I think HAS been proved about statins, and that is that they work, if they do, due to a reduction in inflammation.  They are supposed to work by lowering levels of lipoproteins (the vessels that transport cholesterol), but that causality has never been proved.  I would say it was convincingly disproved by vytorin, a med which combined statins with another cholesterol lowering drug, and was effective at lowering cholesterol - but increased mortality of those taking the drug (as I've reported on before).

Notice in the two year old article linked above, however, the entire intro is build around the "cholesterol gunks up your arteries like grease in a pipe" model.  How quaint!

If you want to dig deep into the science of lipoproteins, cholesterol and disease - I recommend this podcast/transcript from Chris Kresser with Chris Masterjohn, and this link from chriskresser.com: Cholesterol

Here's the BLUF:  think of heart disease as the result of broken glass floating around in your blood vessels, and the atherosclerotic plaques are your body's response to the cuts.  What do I mean by "broken glass"?  Masterjohn equates easily oxidized particles in the blood to glass - useful when whole, but dangerous when broken.  The particles in your blood that oxidize most easily are LDL particles with a high content of polyunsaturated fatty acids (PUFAs), and the small, dense LDL particles left over after your body responds to high carb intake via conversion of glucose to triglycerides.  Under the "what to do" category, think of inflammation reduction via carb restriction and low intake of PUFAs, ingesting enough of the essential vitamins and minerals, maintaining a healthy gut, and cultivating a good set of gut bacteria.  Easier said than done, sure, but the first step is - carb restriction.  No sugar/no wheat is part two.  These two are probably 80% of the formula.

Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Cholesterol Disinformation

So, you think people are to ignorant to know and process the truth, the whole truth, nothing but the truth.  You decide you need to tell them something simple enough to follow, and so what if it is unproved - YOU MUST ACT!!  So you tell everyone to stop eating cholesterol in your foods (no more eggs), and to stop eating foods with saturated fat.  Easy, simple, a prescription anyone can both understand and act on.  

Just one problem - it doesn't help anyone to be healthier!  This Rx does not result in much "improvement" in your cholesterol numbers, and an even smaller improvement in mortality reduction. 

Why, then, would I still see such a poster on the wall of a medical professional's office?!

It's simple enough, in that once enough people said "saturated fat and cholesterol is bad", folks believed it, science be damned.  The old model, which seems so banal now that it is hard to believe anyone truly believed it, was that cholesterol was floating around in the blood in excess, and stuck to the arteries like grease clogs a drain.  In hindsight, this seems almost impossibly simplistic.  

The best understanding at present is that, unlike the poster above's clear message, LDL isn't "bad" per se.  Further, reducing cholesterol via statins, oatmeal, or any other "number manipulation" does not improve mortality (as has been addressed in this blog often).

What you can do to measure your health, the best measure known now, is to reduce triglycerides while raising HDL.  While you do this, control your glucose levels.  To do this, eat meat, vegetable, nuts and seeds, little fruit or starch, and no sugar or wheat.  Adjust your intake after measuring glucose levels and re-evaluating TG/HDL levels.  With TG under 100, and HDL over 50, and with fasting glucose under 100 and falling, you can be confident you are eating well.

Cholesterol isn't the villain, and never was.  This has been known for a long time.  It's a shame that an otherwise proud profession cannot catch on.

The Cholesterol Con "Man"

From the guy who wrote the book on the cholesterol con, and his case is still valid.
Total cholesterol levels didn’t make a whit of difference to coronary heart disease risk, and were in fact associated with a lower risk of stroke[1].
Oops. Bet this study won’t be getting the extravagant media coverage given to all those shonky Big Pharma-sponsored statin studies that are prematurely ended whilst the “miracle” drug is still showing a piddling but “statistically significant” advantage…
So what factors were associated with increased stroke and heart attack risk?
Only age, smoking, systolic BP, diabetes and physical activity were predictive of stroke, while age, male gender (get those iron levels checked fellas…), smoking, systolic blood pressure, HDL cholesterol, diabetes, BMI, physical activity, CRP, and fibrinogen were predictive of coronary heart disease.

http://anthonycolpo.com/?p=2188

This study was a relatively large epidemiological study.  These studies can't show causality, only correlation, however - when there's no correlation, there's also likely to be no causation, whereas, the opposite is not true.  But this study isn't the only nail in the cholesterol hypothesis of disease, it's just the latest.

More to follow on Mr. Colpo, who is one very interesting blogger, perhaps most famouse for his fiesty exchanges with practically anyone of note in the diet blogger world.

Gupta on Cholesterol Myths

http://www.cnn.com/2011/HEALTH/08/17/cholesterol.myths/index.html?iref=obnetwork

"The cholesterol number is essentially worthless," says Dr. Arthur Agatston. The Miami cardiologist and South Beach diet books author says the cholesterol of people who have heart attacks and those who don't are almost identical.

"The overlap is troubling," Dr. Kwame Akosah at the University of Virginia agrees. "As an isolated predictor, it falls short."
As a sign of the weakness in cholesterol numbers alone, one large study found the average LDL cholesterol of people hospitalized for heart disease was 105, which is considered "near optimal."
The study, published in the American Heart Journal in 2009, found almost half of the hospital admissions had LDL cholesterol levels below 100, traditionally considered "low risk."

 

Another study found that only half of heart attacks occurred in people with high cholesterol (at or above 240), while a fifth of the heart attacks struck people whose cholesterol levels (below 200) deemed them safe based on long-held guidelines.

Most heart attacks are not caused by the slow narrowing of blood vessels but by a rupture of a blister or bubble of plaque in an artery that is less than 50 percent blocked. Half of all heart attacks come with no warning at all, making diagnostic tests all the more important.

Dr. Gupta's advice:

A class of drugs called statins lowers LDL cholesterol. Exercise and a low-fat diet rich in fruits, vegetables, whole grains and legumes can also lower LDL and raise HDL. Smokers who quit also improve their cholesterol numbers.

But the numbers themselves may be only the first step in learning your heart health.

From my perspective, very few people who need to lose weight and improve their blood lipid profiles will benefit from the ADA/AHA/USDA style diet described above.  Whole grains, legumes, and fruits in particular are often trouble for folks struggling to emerge from metabolic syndrome or type II diabetes.  That said, if that works for you, fantastic!  But since that advice has been flouted for the last thirty or so years to little positive effect, I'm not optimistic that it will help a lot of people. 

Lucky for you, you live in an age when don't have to rely on a doctor's advice to determine what type of diet is more healthy for you.  You can use a blood glucose meter, and frequent tests of your fasting lipic profile, to get feedback from your body's reaction to any diet you want to test.  Forget the bad science and the politically motivated advice from so called non-profit organizations.

When you get ready to try meat and vegetables, some nuts and seeds, little fruit and starch, and no sugar or wheat, I predict your triglycerides will decrease, your HDL will increase, your LDL will increase marginally but it will be the large, fluffy type of LDL which are regarded as benign, and your weight and blood pressure will also decrease, as will your appetite.  With a few refinements from there, you can stare down the diseases of civilization while eating and living well.

I Know It's Only High Cholesterol But I Like It ...

If you can hear the Rolling Stones tune in that title ... you are really good.

Take a look at Chris' videos, they tell a good tale.

http://chriskresser.com/i-have-high-cholesterol-and-i-dont-care

Big Fat Wolf Post

Interesting guest post at Robb's site. 
http://robbwolf.com/2011/08/03/big-fat-blog-post-part-1/

Here's the BLUF:
-Saturated fat has never been proved to make you sick.  However, in combination with a high carb, high inflammation diet, it may exacerbate a bad thing.  The key - with the atherogenic profile (high triglycerides, high LDL, low HDL) you are likely suffering from excessive systemic inflammation and too much of what are called "small dense" LDL.  These LDL particles are easily oxidized, and are a likely element of lethal atherosclerosis.
-The ratio of omega 3 fats to omega 6 fats is significant, and while supplementation of long, branched chain omega 3s is important (fish oil is best) for those who consume too much omega 6 and too little grass fed animals/dairy, but eating better quality food is the best option.
-MCTs (medium chain triglycerides) are good!  Read the post for their relatively short description of why.
(Edited 8 Sep 11)

Magic Pills? Not Really

Niacin Doesn't Improve Mortality
This study examined the effect of taking a dose of niacin, to raise HDL, with a statin, which lowers LDL.  It proved to be more dangerous than not taking the niacin, even though the two drugs had the expected effects of raising/lowering HDL/LDL respectively.  The doctors and scientists reportedly said about this - "We don't know why." 

Consider this perspective.  If you have LDL levels outside of the so called norms, and take a statin to lower the LDL, you get largely a tradeoff between risk of cardiovascular death and other deaths - but mortality is about the same, unless you've already had a heart attack and you are under the age of 65.  In the later case, your all cause mortality is improved by taking the statin. 

If you take a statin with another compound that lowers LDL by an independent mechanism (the combined drug was called Vytorin), you get a massively reduced LDL number but no improvement in mortality.

If you reduce triglycerides by taking a spoonful of oil after each meal, you change the triglycerides but don't appear to get a better mortality rate.

If you eat a low fat diet, you can reduce your cholesterol numbers - but you can't improve your mortality.

In short, you can manipulate the biomarker, but doing so does not interrupt the disease process.

In other words, there does not seem to be a causal connection between the discrete levels of these markers in the blood and the damage that is recognized as heart disease, CVD, etc.  Having high triglycerides, low HDL and high LDL is recognizable as a pattern of markers that indicates a greater liklihood of future illness and reduced longevity.  However, ttreatments aimed at manipulating these easy and cheap to measure bio markers do not restore health, or interrupt disease processes.

So if you are thinking, "If high levels of these biomarkers do not cause disease, what does?!?"  you are onto the million dollar question.  The short answer is, if you eat the neolithic agents of disease - excessive carbohydrate/fructose intake and imbalanced intake of omega 3 and omega 6 fatty acids, resulting in metabolic derrangement (excess blood glucose) and imbalanced inflammatory response - you create the underlying disease states that result in all of the manifestations of the "Diseases of the West": cancer, heart disease, gout, diabetes (type II, and probably type I), hypertension, obesity, osteoporosis, tooth and gum disease, Parkinson's, Alzheimer's, ALS, etc (some of which are caused by others on the list).  The underlying disease processes are well understood in the case of gout, for example, but not as well for others.

If you are eating a paleo diet, most or all of your bio markers will improve.  It's a reasonable assumption that you are dodging the bullets we know as "Diseases of the West."  There's no doubt in my mind eating some version of the Paleo diet is your best bet on wellness.  But the frustrating truth is - it is still just a well informed risk/reward curve we're living on, we don't know for sure what the outcomes for longevity will be.  Therefore, seems like we should chase a version of the Paleo diet that makes our lives better here and now, that aligns with living a life of activity and enjoyment and accomplishment.  The OCD perfect Paleo diet with no joy and no fun and no love misses the point.