As has been pointed out with each column, I am not a doctor or a health care professional, and I do not offer dietary or health-related advice. You must draw your own conclusions from my ramblings, and of course you do so at your own risk. Here comes the “however”: I can do simple math and read a lab report, especially one that gives an “IN range,” “OUT range,” and “Reference Range,” plus other guidance, for each test ordered.
At each office visit, my doctor always orders a complete blood count and a comprehensive metabolic panel, including a lipid panel and an Hb A1c, plus, from time to time, other specialty tests (Cardio High Sensitivity CRP, etc.). This column is going to be about understanding the lipid panel. That includes Total Cholesterol, HDL Cholesterol, LDL Cholesterol (calculated), Triglycerides, and the (total) Cholesterol/HDL Ratio. Some panels also include VLDL.
Most people know the drill: “high” total cholesterol is not a good thing, that there is “good” cholesterol (HDL) and “bad” cholesterol (LDL), and that we should try to get our circulating triglyceride levels down. If we aren’t successful at doing this through dietary restriction of saturated fat and cholesterol containing foods (per our doctor’s advice), he is going to prescribe a pharmacological solution to lower our LDL, and thereby our Total Cholesterol as well. We are going to be asked to support the $20 billion dollar annual statin market by taking Crestor, Lipitor, or Zocor (or Simvastatin, its generic equivalent). These are listed with the most recent and most effective first. But, is it that simple?
We shall ignore the efficacy of the dietary advice for purposes of this example, but I want it to be clear that I totally and completely disagree with that advice, based on all the science I am reading and on my own personal (n = 1) experience. Nevertheless, let us suppose that two people (or the same person, in two “snapshots” of lipid panels taken a few years apart) have identical Total Cholesterol, to wit: 200mg/dl (milligrams per deciliter). One has an HDL of 40mg/dl, an LDL of 130mg/dl (calculated), a Triglyceride count of 150mg/dl, and a Total Cholesterol/HDL ratio of 5.0. ALL FIVE OF THESE VALUES ARE BORDERLINE OUT OF RANGE. They would appear in bold in the “OUT range” column on your lab report. Your doctor would tell you, according to my understanding of the “Standards of Practice,” to cut down on all those saturated fat and dietary cholesterol containing foods, and probably to exercise more as well. BAD ADVICE, IMHO.
Now let’s look at another lipid panel: Total Cholesterol also 200mg/dl, HDL = 80mg/dl, LDL = 110mg/dl (calculated), Triglycerides = 50mg/dl, and a Total Cholesterol/HDL ratio of 2.5. The only value that is borderline high in this panel is Total Cholesterol at 200mg/dl. Everything else is textbook WUNDERBAR! It’s true, the LDL is above optimal (<100mg/dl), but remember LDL is a derived (calculated), not a measured value. The formula for LDL in the simple lipid panel is LDL = Total Cholesterol – HDL – Triglycerides/5. And, if your doctor was worried about your less than optimal LDL’s (because of existing heart disease, other cardiac risk factors such as hypertension, obesity, metabolic syndrome or higher than “normal” fasting plasma glucose or Hb A1c scores) he could order the VLDL test, or an even more sophisticated VAP test of LDL particle size (“A”= “large and buoyant” or “B” =“small and dense.”) Regardless, this lipid panel would NOT lead your doctor to prescribe statins or require dietary change. He would tell you to “continue with whatever you are doing.”
Bottom line: a Total Cholesterol test score of 200mg/dl on your lipid panel, with the first subset of values, can put you in the “dog house,” on dietary restrictions, and soon thereafter when dietary changes don’t work, on a diet of statins.
Or, you could have a lipid panel similar to the second example* and become your doctor’s poster boy, as I did after I’d been on a very low carb, high fat and moderate protein way of eating for a year or so. My doctor (a cardiologist) just tells me to keep on doing what I’m doing. Even though he started me on this program, he doesn’t want to know what I eat. For him, it’s no more lectures, just smiles, and when the test results come in, a congratulatory phone call.
For my doctor, my office visit is one of the “high points” of his day, he says. I can believe it. No stress (for him). No more arguments (from me). No latent suspicions or overt charges of “non-compliance” (cheating) with the dietary restrictions he imposed. And, above all, no hypocrisy for having to preach the baloney -- excuse me -- the bad medical advice that the public health, big pharma, media and the medical establishment continue to dish out to the lemmings who put their trust, and their lives, in the hands of “big brother,” the dietary Dictocrats, our nanny state. Sorry – I just had to vent, (and crow, of course)
* My most recent (8/15/11) lipid panel: TC = 209, HDL = 92, LDL (calc.) = 111, TC/HDL = 2.3, Triglycerides = 32
© Dan Brown 8/28/11
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Wednesday, August 31, 2011
Thursday, August 18, 2011
The Nutrition Debate #24: What About Cholesterol?
And what about dietary cholesterol? Again, quoting from Mary Enig, PhD, and Sally Fallon, authors of “The Skinny on Fats, “Here, too, the public has been misinformed. Our blood vessels can become damaged in a number of ways—through irritations caused by free radicals or viruses, or because they are structurally weak—and when this happens, the body's natural healing substance steps in to repair the damage. That substance is cholesterol. Cholesterol is a high-molecular-weight alcohol that is manufactured in the liver and in most human cells. Like saturated fats, the cholesterol we make and consume plays many vital roles:
• Along with saturated fats, cholesterol in the cell membrane gives our cells necessary stiffness and stability. When the diet contains an excess of polyunsaturated fatty acids, these replace saturated fatty acids in the cell membrane, so that the cell walls actually become flabby. When this happens, cholesterol from the blood is "driven" into the tissues to give them structural integrity. This is why serum cholesterol levels may go down temporarily when we replace saturated fats with polyunsaturated oils in the diet.46
• Cholesterol acts as a precursor to vital corticosteroids, hormones that help us deal with stress and protect the body against heart disease and cancer; and to the sex hormones like androgen, testosterone, estrogen and progesterone.
• Cholesterol is a precursor to vitamin D, a very important fat-soluble vitamin needed for healthy bones and nervous system, proper growth, mineral metabolism, muscle tone, insulin production, reproduction and immune system function.
• The bile salts are made from cholesterol. Bile is vital for digestion and assimilation of fats in the diet.
• Recent research shows that cholesterol acts as an antioxidant.47 This is the likely explanation for the fact that cholesterol levels go up with age. As an antioxidant, cholesterol protects us against free radical damage that leads to heart disease and cancer.
• Cholesterol is needed for proper function of serotonin receptors in the brain.48 Serotonin is the body's natural "feel-good" chemical. Low cholesterol levels have been linked to aggressive and violent behavior, depression and suicidal tendencies.
• Mother's milk is especially rich in cholesterol and contains a special enzyme that helps the baby utilize this nutrient. Babies and children need cholesterol-rich foods throughout their growing years to ensure proper development of the brain and nervous system.
• Dietary cholesterol plays an important role in maintaining the health of the intestinal wall.49 This is why low-cholesterol vegetarian diets can lead to leaky gut syndrome and other intestinal disorders.
Cholesterol is not the cause of heart disease but rather a potent antioxidant weapon against free radicals in the blood, and a repair substance that helps heal arterial damage (although the arterial plaques themselves contain very little cholesterol.) However, like fats, cholesterol may be damaged by exposure to heat and oxygen. This damaged or oxidized cholesterol seems to promote both injury to the arterial cells as well as a pathological buildup of plaque in the arteries.50
Damaged cholesterol is found in powdered eggs, in powdered milk (added to reduced-fat milks to give them body) and in meats and fats that have been heated to high temperatures in frying and other high-temperature processes. High serum cholesterol levels often indicate that the body needs cholesterol to protect itself from high levels of altered, free-radical-containing fats. Just as a large police force is needed in a locality where crime occurs frequently, so cholesterol is needed in a poorly nourished body to protect the individual from a tendency to heart disease and cancer. Blaming coronary heart disease on cholesterol is like blaming the police for murder and theft in a high crime area.” End of long quote. Note all the footnotes are in the Weston A. Price website article, “The Skinny on Fats.”
To add insult to injury, remember that we make, i.e. our liver and cells make, cholesterol to “make up” for all those good foods (eggs, butter, cream, marbled beef, shrimp, liver, etc.) that we avoid eating to follow doctor’s orders. It has too. It needs cholesterol to do all the things described above, and it works holistically to get what it needs. It’s a good thing too. Just imagine if the human race were dependent for survival on the vagaries of current government public health policy. I’ll take autonomic homeostatic regulation over Obamacare and Congressional regulation any day. It doesn’t shut down.
© Dan Brown 8/14/11
• Along with saturated fats, cholesterol in the cell membrane gives our cells necessary stiffness and stability. When the diet contains an excess of polyunsaturated fatty acids, these replace saturated fatty acids in the cell membrane, so that the cell walls actually become flabby. When this happens, cholesterol from the blood is "driven" into the tissues to give them structural integrity. This is why serum cholesterol levels may go down temporarily when we replace saturated fats with polyunsaturated oils in the diet.46
• Cholesterol acts as a precursor to vital corticosteroids, hormones that help us deal with stress and protect the body against heart disease and cancer; and to the sex hormones like androgen, testosterone, estrogen and progesterone.
• Cholesterol is a precursor to vitamin D, a very important fat-soluble vitamin needed for healthy bones and nervous system, proper growth, mineral metabolism, muscle tone, insulin production, reproduction and immune system function.
• The bile salts are made from cholesterol. Bile is vital for digestion and assimilation of fats in the diet.
• Recent research shows that cholesterol acts as an antioxidant.47 This is the likely explanation for the fact that cholesterol levels go up with age. As an antioxidant, cholesterol protects us against free radical damage that leads to heart disease and cancer.
• Cholesterol is needed for proper function of serotonin receptors in the brain.48 Serotonin is the body's natural "feel-good" chemical. Low cholesterol levels have been linked to aggressive and violent behavior, depression and suicidal tendencies.
• Mother's milk is especially rich in cholesterol and contains a special enzyme that helps the baby utilize this nutrient. Babies and children need cholesterol-rich foods throughout their growing years to ensure proper development of the brain and nervous system.
• Dietary cholesterol plays an important role in maintaining the health of the intestinal wall.49 This is why low-cholesterol vegetarian diets can lead to leaky gut syndrome and other intestinal disorders.
Cholesterol is not the cause of heart disease but rather a potent antioxidant weapon against free radicals in the blood, and a repair substance that helps heal arterial damage (although the arterial plaques themselves contain very little cholesterol.) However, like fats, cholesterol may be damaged by exposure to heat and oxygen. This damaged or oxidized cholesterol seems to promote both injury to the arterial cells as well as a pathological buildup of plaque in the arteries.50
Damaged cholesterol is found in powdered eggs, in powdered milk (added to reduced-fat milks to give them body) and in meats and fats that have been heated to high temperatures in frying and other high-temperature processes. High serum cholesterol levels often indicate that the body needs cholesterol to protect itself from high levels of altered, free-radical-containing fats. Just as a large police force is needed in a locality where crime occurs frequently, so cholesterol is needed in a poorly nourished body to protect the individual from a tendency to heart disease and cancer. Blaming coronary heart disease on cholesterol is like blaming the police for murder and theft in a high crime area.” End of long quote. Note all the footnotes are in the Weston A. Price website article, “The Skinny on Fats.”
To add insult to injury, remember that we make, i.e. our liver and cells make, cholesterol to “make up” for all those good foods (eggs, butter, cream, marbled beef, shrimp, liver, etc.) that we avoid eating to follow doctor’s orders. It has too. It needs cholesterol to do all the things described above, and it works holistically to get what it needs. It’s a good thing too. Just imagine if the human race were dependent for survival on the vagaries of current government public health policy. I’ll take autonomic homeostatic regulation over Obamacare and Congressional regulation any day. It doesn’t shut down.
© Dan Brown 8/14/11
Sunday, August 7, 2011
The Nutrition Debate #23: The Benefits of Saturated Fats
The benefits of saturated fat? To admit to such a belief is surely heretical, so I do not expect my reader(s) to commit such apostasy “on faith.” But, purely as an observer of another’s fall from grace, you may want to read further to see how this idea develops and is supported by science. If this sounds like a classic battle of orthodoxy vs. the enlightened, you’re right. You certainly won’t hear it spoken of by any of the usual sources of information in our modern society: Government, Agri-Business, and the Mass Media. Who but the small grass-fed beef or pastured chicken egg purveyor would benefit, besides you?
As you already know, one of the apostles of human nutrition that I follow is Mary Enig, PhD, a Director Emeritus of the Weston A. Price Foundation, who with Sally Fallon, President of the Foundation, wrote “The Skinny on Fats.” This really is a “must read” for anyone interested in eating in a healthy way and living a long life. Do yourself a favor and google it.
Because it is more technical than I am qualified to write about, and cites many sources as references, I quote from it directly again here: Note that each of the 8 references are provided at the Foundation “hit” on “The Skinny on Fats.”
“The much-maligned saturated fats—which Americans are trying to avoid—are not the cause of our modern diseases. In fact, they play many important roles in the body chemistry:
• Saturated fatty acids constitute at least 50% of the cell membranes. They are what give our cells necessary stiffness and integrity.
• They play a vital role in the health of our bones. For calcium to be effectively incorporated into the skeletal structure, at least 50% of the dietary fats should be saturated.38
• They lower Lp(a), a substance in the blood that indicates proneness to heart disease.39 They protect the liver from alcohol and other toxins, such as Tylenol.40
• They enhance the immune system.41
• They are needed for the proper utilization of essential fatty acids.
Elongated omega-3 fatty acids are better retained in the tissues when the diet is rich in saturated fats. 42
• Saturated 18-carbon stearic acid and 16-carbon palmitic acid are the preferred foods for the heart, which is why the fat around the heart muscle is highly saturated.43 The heart draws on this reserve of fat in times of stress.
• Short- and medium-chain saturated fatty acids have important antimicrobial properties. They protect us against harmful microorganisms in the digestive tract.
The scientific evidence, honestly evaluated, does not support the assertion that "artery-clogging" saturated fats cause heart disease.44 Actually, evaluation of the fat in artery clogs reveals that only about 26% is saturated. The rest is unsaturated, of which more than half is polyunsaturated.45 “(end of quote)
Among the most vilified of animal foods high in saturated fats has been butter. As noted previously it is now enjoying a comeback, while margarine, made from partially hydrogenated vegetable oil (trans fat), has suffered a sharp decline.
In 2000, before her more than 20 year campaign to bring trans fats to the public’s attention had reached full fruition (she had testified on it at the 1977 McGovern Commission), Dr. Enig wrote (again, in “The Skinny on Fats”), “The Diet Dictocrats have succeeded in convincing Americans that butter is dangerous, when in fact it is a valued component of many traditional diets and a source of…fat-soluble vitamins. These include true vitamin A or retinol, vitamin D, vitamin K and vitamin E as well as all their naturally occurring cofactors needed to obtain maximum effect. Butter is America's best source of these important nutrients. In fact, vitamin A is more easily absorbed and utilized from butter than from other sources.61 Fortunately, these fat-soluble vitamins are relatively stable and survive the pasteurization process.”
But what about cholesterol and heart disease? Well, if you’re still asking these questions, I recommend you go back and read this series from the beginning. All of the articles are archived at http://danbrown-thenutritiondebate.blogspot.com. Or, if you’re just a little skeptical, stay tuned; the next article will be “What About Dietary Cholesterol?” and then the next, “Understanding Your Lipid Panel.” The apostasy goes on unabated, for your reading pleasure.
© Dan Brown 8/7/11
As you already know, one of the apostles of human nutrition that I follow is Mary Enig, PhD, a Director Emeritus of the Weston A. Price Foundation, who with Sally Fallon, President of the Foundation, wrote “The Skinny on Fats.” This really is a “must read” for anyone interested in eating in a healthy way and living a long life. Do yourself a favor and google it.
Because it is more technical than I am qualified to write about, and cites many sources as references, I quote from it directly again here: Note that each of the 8 references are provided at the Foundation “hit” on “The Skinny on Fats.”
“The much-maligned saturated fats—which Americans are trying to avoid—are not the cause of our modern diseases. In fact, they play many important roles in the body chemistry:
• Saturated fatty acids constitute at least 50% of the cell membranes. They are what give our cells necessary stiffness and integrity.
• They play a vital role in the health of our bones. For calcium to be effectively incorporated into the skeletal structure, at least 50% of the dietary fats should be saturated.38
• They lower Lp(a), a substance in the blood that indicates proneness to heart disease.39 They protect the liver from alcohol and other toxins, such as Tylenol.40
• They enhance the immune system.41
• They are needed for the proper utilization of essential fatty acids.
Elongated omega-3 fatty acids are better retained in the tissues when the diet is rich in saturated fats. 42
• Saturated 18-carbon stearic acid and 16-carbon palmitic acid are the preferred foods for the heart, which is why the fat around the heart muscle is highly saturated.43 The heart draws on this reserve of fat in times of stress.
• Short- and medium-chain saturated fatty acids have important antimicrobial properties. They protect us against harmful microorganisms in the digestive tract.
The scientific evidence, honestly evaluated, does not support the assertion that "artery-clogging" saturated fats cause heart disease.44 Actually, evaluation of the fat in artery clogs reveals that only about 26% is saturated. The rest is unsaturated, of which more than half is polyunsaturated.45 “(end of quote)
Among the most vilified of animal foods high in saturated fats has been butter. As noted previously it is now enjoying a comeback, while margarine, made from partially hydrogenated vegetable oil (trans fat), has suffered a sharp decline.
In 2000, before her more than 20 year campaign to bring trans fats to the public’s attention had reached full fruition (she had testified on it at the 1977 McGovern Commission), Dr. Enig wrote (again, in “The Skinny on Fats”), “The Diet Dictocrats have succeeded in convincing Americans that butter is dangerous, when in fact it is a valued component of many traditional diets and a source of…fat-soluble vitamins. These include true vitamin A or retinol, vitamin D, vitamin K and vitamin E as well as all their naturally occurring cofactors needed to obtain maximum effect. Butter is America's best source of these important nutrients. In fact, vitamin A is more easily absorbed and utilized from butter than from other sources.61 Fortunately, these fat-soluble vitamins are relatively stable and survive the pasteurization process.”
But what about cholesterol and heart disease? Well, if you’re still asking these questions, I recommend you go back and read this series from the beginning. All of the articles are archived at http://danbrown-thenutritiondebate.blogspot.com. Or, if you’re just a little skeptical, stay tuned; the next article will be “What About Dietary Cholesterol?” and then the next, “Understanding Your Lipid Panel.” The apostasy goes on unabated, for your reading pleasure.
© Dan Brown 8/7/11
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