Saturday, October 27, 2012

The Nutrition Debate #72: How to “Fix” Your Cholesterol

Physicians all over the world want to “fix” your “cholesterol.” They’re well meaning, and they know there is a small benefit, probably due to a reduction in inflammation, associated with a reduction in the LDL lipoprotein component of your Total Cholesterol, all other components being equal. They know that by lowering your LDL, your Total Cholesterol will be lowered by the same amount. And they know they can do that with a pill. They can get it to within the range recommended by the “standard of practice” by prescribing a statin drug: Crestor or Lipitor or Zocor or another brand, or one of the generics, commonly simvastatin. So, what’s wrong with that? The answer: it’s not enough!

In the first place, lowering LDL Cholesterol is by far the most common intervention for which your doctor can write a “script” (prescription).That’s why they do it. It must be frustrating for them though since “high cholesterol” (meaning both Total Cholesterol and LDL) is almost always associated with low HDL and high triglycerides. They are all so common in the population, and they are seen in the same patient. The result, however, is that sales of statins in the U.S. alone passed $20 billion a few years ago, but since HDL and triglycerides are more difficult to “treat,” they remain unchanged.

It must be doubly frustrating that “high cholesterol” is commonly associated with hypertension (high blood pressure) and obesity. Collectively these indications are called Metabolic Syndrome. See The Nutrition Debate #9 here for the indications and ranges. The particular cholesterol markers associated with Metabolic Syndrome are, interestingly, low HDL lipoproteins and high serum triglycerides. This is why in medical terms this cholesterol condition is called “dyslipidemia,” which means dysfunctional blood lipids (fats).

Although progress is being made in treating high triglycerides, unfortunately there is no pill to beneficially raise HDL. But dietary intervention works for both of these. See The Nutrition Debate #67 “HDL Cholesterol and the Very Low Carb Diet” here, #68, “Triglycerides, Fish Oil and Sardines” here, and then #27, “…the strongest predictor of a heart attack” (the Trig./HDL ratio) here for evidence of the CVD benefits of dietary intervention from both HDL and triglycerides.

Of course, hypertension can be treated with medications, usually a “cocktail” of two or three, but obesity stubbornly resists medical interventions. It is up to the patient, the doctors say, and the doctors usually report the patient is “non-compliant.” That is to say, the patient either cannot lose weight on the recommended restricted calorie balanced diet, or the patient who does lose weight soon gains it all back and often “then some.” Hunger wins out. The body doesn’t want to be starved even with fat reserves. It tells you to eat lots of glucose (carbs) for quick energy, even between meals.

So “high cholesterol” and hypertension, seen together, are still the targets most doctors treat together. The problem is: Total Cholesterol is an antiquated and almost useless term. It is only used because it can be easily measured and the calculated component lowered to the standard-of-practice range by statins. HDL and triglycerides remain unchanged. But, a Total Cholesterol that would be “too high,” because of its LDL component, would be perfectly okay with your doctor if the LDL were the same but the HDL was much higher and the triglycerides much lower. See The Nutrition Debate #25, “Understanding Your Lipid Panel” here, for two identical Total Cholesterols with different components.

The reason for this is evident from the formula used for the lab test of your cholesterol. It is called the Friedewald formula. In it, Total Cholesterol and HDL and triglycerides are assayed (actually measured), but the LDL value is calculated, thusly: LDL = T.Chol – HDL – TG/5 (where triglycerides/5 are a surrogate for VLDL within a wide range).

So, the best way to truly “fix” your cholesterol is to significantly raise your HDL and lower your triglycerides. And if you follow my “prescription” for doing that, by following a restricted-calorie Very Low Carbohydrate diet, you will also lose weight without hunger, because your body will be free to burn your body fat. And as a result, you will get control of your blood sugar (if you need to), and lower your blood pressure. Your Type2 diabetes (if you have it, or you are pre-diabetic) will go into remission and you will have no clinical signs of dysglycemia. Your Metabolic Syndrome will go undetected because the indications will have abated. Your doctor can’t do that. You can. But first you have to know your cholesterol – not just your Total Cholesterol and LDL, but also your HDL and triglycerides. Take charge of your health and find out!
© Dan Brown 10/27/12


  1. This comment has been removed by the author.

  2. "...LDL = T.Chol – HDL – TG/5 So, the best way to truly “fix” your cholesterol is to significantly raise your HDL and lower your triglycerides...."

    Dan, If you use your equation, your LDL will be less if you increase your TG, not lower it as you state, altho I concur you want to lower TG.

    1. Hi Huskurtle,
      I don't follow your comment. What I am saying is when you eat VLC, it is likely that you will significantly lower your triglycerides and raise your HDL. If total cholesterol remained the same, the effect on LDL would be to lower it somewhat. But that is not likely. It is more likely that your LDL would be flat or slightly higher, and as a result so would your total cholesterol, but your doctor would be happy because of the high HDL and low triglycerides. See The Nutrition Debate #25 for a detailed example. I will try to do it here also with values for two formulas (Plug the values into the formula LDL = TC – HDL – TG/5).
      Where HDL = 40 & TG = 150 and TC = 200, LDL would be 130. Note all values are borderline “bad,” but
      Where HDL = 80 & TG = 50 and TC = 200, LDL would be 110. Here you have very good HDL and TG with the same TC, but a slightly lower LDL. However, a more likely scenario would be an LDL that is unchanged at 130 and a slightly higher TC = 220. My doctor is very happy with this set of numbers.
      Dan Brown