Saturday, February 9, 2013

The Nutrition Debate #87: Optimal Blood Lipid Levels

Be warned! This is a very hot topic, particularly if you are as intemperate as I can be (am?). I recently refused the recommendation of an endocrinologist given to me over the phone by his nurse, saying to her “the doctor really should be ashamed of himself” for suggesting I “try” a certain statin drug. The next morning the doctor called me at 7:30 AM, saying I had hung up on his nurse. Not true, she hung up on me after I made that comment.

Apparently she hadn’t told him what I’d said, leaving it to me to tell him directly. It definitely added fuel to the fire. He then calmly told me that the LDL value in my Lipid Panel was high and that both the ADA and the AHA guided that my LDL should be below 100mg/dl. I told him that I didn’t care what the ADA and the AHA guidelines said. I then went into a bit of a harangue about Ancel Keys, and suggested the doctor really should “go back to school.” That did it. He declared, “You need to find a new doctor. I’m not going to treat you.” And then he hung up. Two hang-ups in a row! But I don’t blame him. I was rude – really rude. Maybe even hostile? Perhaps a “little” angry? But I think mostly just disappointed.

But I don’t apologize for what I said. I had high hopes that I would find an endo who was enlightened. I haven’t seen any endo in over 20 years, seeing only an internist/cardiologist 3 or 4 times yearly, and I wanted to establish a relationship with an endo in the community near our winter home. I failed, and it was my fault. Of course, I could have accepted the prescription he offered and then refused to fill it. Then the doctor could simply have written in my chart that, like all the other old people (his PA told me) who “don’t care about their health,” I was just “non-compliant.” She told me that when I asked her why other patients didn’t follow her recommendation to eat Low Carb. She eats about 60 carbohydrate grams a day. I eat about 15, for glucose control. I am a 26-year-long Type 2 diabetic who is carb intolerant.

Anyway, in reaching my latest level of self-assurance (expressed as arrogance or ignorance or both, depending on your perspective) about the optimal blood lipid levels, I had a fresh recollection of Chapter 41, “Blood Lipids,” in “Perfect Health Diet” (Scribner, 2012), the new book by Paul and Shou-Ching Jaminet (both PHDs). It’s a very good book, even if I recommend it only for “background” for most Type 2s. They do get “into the weeds” a bit, but explain everything very well, and I really like their approach to healing – finding the root causes rather than treating the symptoms.

Chapter 41 has the following sub-sections: “Optimal HDL Levels,” “How to Raise HDL Levels,” “The Immune Functions of LDL,” “Optimal Blood Lipid Levels,” and “Troubleshooting Blood Lipids.” I will discuss only the section “Optimal Blood Lipid Levels” in this missive and then relate it to my own test results from the lipid panel performed by my “new” (and now former) endo. For the other sections of this chapter and the rest of the book, you should buy the book. I regard it as an essential reference and a must for any nutrition “library.”

“The ideal serum lipid profile – the one that produces the best health and minimizes mortality – looks like this:” (pg 366)

·         Total Cholesterol level between 200 and 260 milligrams per deciliter

·         LDL Cholesterol level above 100 milligrams per deciliter

·         HDL Cholesterol level above 60 milligrams per deciliter

·         Triglyceride level around50 to 60 milligrams per deciliter

How did my profile compare to the Jaminet’s ideal? Here is the endo’s lab report for my serum lipid profile:

·         Total Cholesterol level = 245

·         LDL Cholesterol level = 176

·         HDL Cholesterol level = 58

·         Triglyceride level = 54

Okay, I missed the HDL target by 2. But, this was the lowest HDL I have had in over 4 years (12/08 = 57) and the average of my last 15 HDLs going back to July 2007 is 75. But, in all other respects my scores appear to fit the Jaminet’s ideal.

My LDL (176) was high – the highest it has ever been (since 1992, when my lab reports first starting calculating LDLs). And my Total Cholesterol, at 245, was the highest ever, and my Total Cholesterols go back almost 40 years to 1974. So, I am intrigued and will look forward with some anticipation to my next “home” doctor’s appointment on 4/22/13.

I am comforted somewhat, however, by the knowledge that my TG/HDL ratio = 0.93, which is <1.0 and therefore “ideal.” In my column #27, a 2008 paper published in Clinics and available though PubMed (2008 August 63(4) 427-432) here, the conclusion is that this ratio is “…the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined.” I would like to have known, though, what my hs C-Reactive Protein score was. Oh, well.

© Dan Brown 2/9/13

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