I realize that no one (besides me, and my doctor) is interested in my latest cholesterol test, but…I think they can be used to impart a wider message – a lesson really – on the effect that diet can have on the health markers the medical establishment considers important. Doctors don’t really know much about nutrition, and if they follow the Standards of Practice and the “Dietary Guidelines”, well…you’d be well advised not to follow that dietary advice. Doctors do like a good lipid panel though, so what dietary advice produces that?
My doctor scribbled “good” next to my latest lipid panel. From my perspective, it was better than good; it was stellar! Total Cholesterol: 184, HDL Cholesterol: 91; Cholesterol/HDL ratio: 2.0; LDL Cholesterol (calculated): 84; and Triglycerides: 46. To these, I always add the TG/HDL ratio, considered by some clinicians today to be "...the strongest predictor of a heart attack." Mine is 46/91 or 0.5, nothing less than outstanding!
In response, some (like my wife) will say, “Well, it’s genetic, and you’ve always had a ‘low cholesterol’” (i.e. Total Cholesterol). That is the value that most people (and their doctors) remember. It’s not true, in my case (as I’ll point out later), but, apart from that, why is it that most doctors only treat a high Total Cholesterol?
The answer is because most people who eat a Standard American Diet will have a borderline HDL (40mg/dl for men and 50mg/dl for women). They will also probably have borderline Triglycerides (near 150mg/dl). That leaves only LDL (and Total Cholesterol), and guess what? While doctors don’t have a handy drug to treat borderline HDL and triglycerides, they sure do have drugs to lower LDL, and thus Total Cholesterol: STATINS.
So, if your “cholesterol” isn’t so good, your doctor will likely prescribe a statin for you. If you take it, and tolerate it without harsh side effects, be assured: statins WILL lower your LDL cholesterol and your Total Cholesterol. The Friedewald equation explains it: TC = LDL + HDL + TG/5. Lower your LDL and you will lower your TC! You are now in good standing with your doctor, ‘cause there’s not much more they can do for you.
But what about ...the strongest predictor of a heart attack, the TG/HDL ratio? Only diet can transform TG and HDL, and fix them good! I eat a Very Low Carb diet and practice Intermittent Fasting. I do it to keep my blood sugar low and stable, to keep my serum insulin low as well, and thus burn body fat to lose weight.
I originally went on a Very Low Carb diet (20g/day) just to lose weight. We – both my doctor and I – were surprised to see that it had an immediate and very dramatic effect on my long-standing Type 2 Diabetes. To avoid hypoglycemic events (“hypos”), I had to immediately (the very 1st day and throughout the 1st week) stop taking the oral diabetes medications I had been prescribed over many years. I had been maxed out on 2 classes of oral meds and was starting a 3rd. Afterwards, I was left with only a small dose of Metformin which I continued for 14 years.
But the other effect that neither my doctor nor I expected was that, over time, my HDL Cholesterol more than doubled (from 39 to 81mg/dl average) and my triglycerides dropped by 2/3s from 137 to 49mg/dl average. And this remarkable change continues to this day (15 years later), as my most recent lipid panel (HDL = 91 and TG = 46) demonstrates. Of course, as I lost weight my blood pressure improved (on the same meds) from 140/90 to 110/70. The most recent was 120/75 (I regained 35 of the 170 pounds initially lost.) And my inflammation marker, the hsCRP, a reliable “risk factor” for a constellation of morbid outcomes, is now almost always <1.0.So, what difference does diet make? I attribute all of these changes to diet, a Very Low Carb diet. My Type 2 diabetes is in remission, my lipids (cholesterol) are “good” or “stellar,” depending on whose interpretation, my blood pressure is well controlled, and my chronic systemic inflammation is indiscernible. Even my LDL is excellent (84mg/dl vs. <130mg/dl reference range, or “<100mg/dl for patients with CHD or diabetes.” And I did it all without a statin. You can too, but you have to be willing to treat yourself, and change your diet.