Free the Animal

Triglycerides: 93.5% Reduction in Three Weeks - 3,100 to 202

So there you have it: the punchline, right there in the title.

But who did it, and how? That would be none other than Dr. William Davis, cardiologist. So then, what sort of medical procedure did he perform? What sorts of pharmaceuticals did he prescribe? To what level did he admonish his patient, Daniel, to cut the arterycloggingsaturatedfat and to eat lots more servings of hearthealthywholegrians?

Of course, anyone who actually reads and thinks for themselves -- rather than swallowing the cloistered expert-&-authority-protectionism of conventional "wisdom" -- should know, he did none of those things; which, given the other successes he's blogged about -- some of which I've highlighted here -- exposes most if not all of the "lipid establishment" (i.e., cloistered expert-&-authority-protection racket) as con men: most physicians in that role, all the drug companies, and our beloved (not!) FDA.

Got it? Good, so let's move on.

Since most of you who should know, know, what then, dear supplicant to cloistered expert-&-authority-protection rackets, did Dr. Davis do? I'm glad you asked! It's actually simple: step one is that he "prescribed" 3,600 mg of over-the-counter omega-3 fatty acids per day, i.e., plain ol' fish oil caps. Depending on concentration, that could be anywhere from 5 to 10 1g caps per day, guesstimating. After 10 days, Trigs had dropped from 3,100 to 1,100. Step two was to continue on the OTC fish oil and eliminate wheat, corn starch, and sugar from the diet (in other words: less hearthealthywholegrains, more arterycloggingsaturatedfat). This took him from 1,100 to 202 in another 10 days.

Daniel, a sufferer of what's known as familial hypertriglyceridemia, now has lower Trigs than whole bunches of people walking about without such a genetic disorder. For those who don't know, triglycerides are fat circulating in your blood. The more hearthealthwholegrains and sugar you eat, the higher will be your triglyceride levels. The more arterycloggingsaturatedfat you eat, the less will be your levels. Almost all paleo and low-carb eaters have levels less than 100, and most of us hang out in a range of 40-60. I believe the average in the US is around 150 or so, and climbing (all while the cloistered expert-&-authority-protection racket claps and cheers over irrelevant, non-associated lower LDL levels). Lots of people are walking around at 400 and higher. But, hey, they lowered their LDL by eating lots of hearthealthywholegrains, and thus helping out Big Agra, who, in gracious turn, helps the cloistered expert-&-authority-protection racket. It's all quite cozy, incestuous...and insanely profitable.

High triglycerides are bad, very bad, and in my opinion, far worse than "elevated" serum cholesterol (lipoproteins). High triglycerides are well associated with death from heart disease, while half of those who die from heart disease have low cholesterol and half have high cholesterol.

Well, that about sums up the story (but not the rant), so the rest is devoted to Dr. Davis himself, who tells the brief story here and here.

I am continually surprised at the number of people with high triglycerides who are still treated with a fibrate drug, like Tricor, or a statin drug, when fish oil -- widely available, essentially free of side-effects, with a proven cardiovascular risk-reducing track record --should clearly be the first choice by a long stretch.

Could Dr. Davis be referring to his own colleagues in the medical profession -- most, probably?

Uh, yep:

Unfortunately, most of my colleagues, if they even think to use omega-3s, choose to use the prescription form, Lovaza. Indeed, several representatives from AstraZeneca, the pharmaceutical outfit now distributing this miserably overpriced product, frequently barge their way into my office poking fun at our use of nutritional supplements instead of the prescription Lovaza. "But insurance covers it in most cases!" they plead. "And your patients will know that they're getting the real product, not some fake. And they'll have to take fewer capsules!"

Dr. Davis has previously blogged about the Lovaza rip off; punchline: $3,600 per year vs. $150 per year (all while so many in America clamor to have everyone pay for everyone else's "health" care...).

He says further:

I never use Lovaza to reduce triglycerides, even in familial hypertriglyceridemia -- the FDA-approved indication for Lovaza -- and have not yet seen any failures, only successes.

Good for Daniel, and good for the heroic Dr. Davis, who gives a great prognosis.

He's got just a little further to go to achieve the biologically ideal level of less than 60 mg/dl. You can see that it is not really that difficult--provided someone didn't load you down with nonsense about "cutting your fat," or statin or fibrate drugs.

And guess what, on a related topic? I just heard from a very well respected health blogger in email that a guy who'd contacted him about fatty liver disease got his enzymes back to normal in a single month. This, after 9 whole years of a fatty liver. What advice did this health blogger give him? Drop the sugar, vegetable oils, and take fish oil.

Let's be clear who the enemies are in all this: many of Dr. Davis' colleagues, all pharmaceutical companies, the FDA, and the whores in the mainstream media who can't wait to bend over for each and every one of the foregoing as often as they possibly can.

You didn't hear that here first, but you'll hear it often.

Reader Feedback - Doctors and Cholesterol

First up, an email from Robert, who'll become a medical doctor in under a week. He must be completely thrilled, eh?

~~~

Just wanted to say hello. I’ve been a regular reader for several months now and thought I should take a moment to introduce myself. My name is Robert and I will be an MD in about six days. I’ll be starting an internal medicine residency in Reno, NV in July. I am both excited and nervous about starting, nervous largely because my patience with “modern” medicine is in rapid decline and I have three years of attending physicians to deal with. Yes, Richard, all of the doctors I have worked with personally approach health and nutrition in as mindless a manner as you think and often rant about.

~~~

I know, Robert, and isn't it the damnedest thing? Here you spend all that time, money and effort -- all the while enduring an enormous burden in terms of mental and physical stress and fatigue -- and it would certainly be an appropriate reward to be held in the sort of superman high esteem doctors have traditionally and often deservedly been held.

But I think it's safe to say that owing to the Internet, with its legions of people like me who deal in facts, logic and principles -- and not so much in titles, degrees and positions -- that we're in a situation where the gig is up. Doctors have largely squandered the goodwill they've earned over a century of hard, dedicated, lifesaving work. Thankfully, there are a growing number of docs like your very-soon-to-be self who have come to see the light. It's going to be an uphill battle for a long time.

For instance, Tim, another reader, sent me his lipid panel for comment. Though I don't expect you to comment, Robert, I have an idea that you would interpret it far differently from Tim's doctor. So, as frustrating as it is, this is a step in the right direction. There's that.

~~~

February, 2008, 225 lbs, years on the Standard American Diet:

Total 173
Trig 109
HDL 60
LDL (calc) 91
VLDL 22
Ratio 2.9

July, 2008, 160 lbs, through calorie counting, semi starvation, yet semi-low carb:

Total 145
Trig 38
HDL 69
LDL (calc) 68
VLDL 8
Ratio 2.1

Been going Paleo(!) since Sept 08, intermittent fasting, 3 days a week lifting hard efforts, sprints, eating tons of meat! Actually heading down the road for 90 days of meat only (2+ weeks in right now) so I did another panel:

May 1, 2009, 170 lbs, more muscle!

Total 226
Trig 34
HDL 82
LDL (calc) 137
VLDL 7
Ratio 2.8

Should I be concerned of the rise in Total and LDL?  From what I've read on your blog, Dr. Eades, and other sources, I don't think so.  I am more fearful of the 145 total number (cancer! etc) than the 226!  But my doctor is of the opposite opinion.

~~~

His doctor is of the opposite opinion, but why? Has the doctor been reading Eades, Davis, Sears, Briffa, or the many others out there and concluded that they are wrong? I doubt it. Tim's doctor is probably what I now refer to as a "regurgitator," i.e., as applied to the medical profession: someone who is trained to expertly diagnose and treat in accordance with conventional "wisdom," right or wrong. My non-medical opinion is that we ought to be cheering his great success in improving his health in a way that reflects every well done study and observation of this sort of thing I've seen.

For example, his C-reactive protein was .3 (a "BTW" in another part of his email), where "normal" is < 3 mg/l. This is a strong marker for inflammation -- the very thing that small, dense LDL acts upon to cause heart disease. Also, the ratios they have given Tim are of Total/HDL, which remain steady, as his HDL went from 60 to 82 (all the while you hear great cheering amongst the ignorant masses when someone goes from 45-50 and credits oatmeal or Cheerios). Normal for that ratio is 4-6, because grain and sugar eaters have such miserably low HDL. Ideal is 2-3. Mine was 2.1, so was my wife's, thereabouts, so there's three data points on that for Paleo: IDEAL.

The more important ratio by far, in my opinion, is Trigs/HDL. This is one of the biggest associations with cardiovascular disease (CVD). Again, grain and sugar eaters have abysmally low HDL (the thing that carries oxidized LDL out of your arteries and back to the liver for recycling) combined with elevated triglycerides, which is dissolved fat in the blood. Yes, ironic, isn't it? You want low levels of circulating fat in your blood? Replace grain and sugar with fat in your diet and the very first thing that will happen is that your Trigs (fat in your blood) drop precipitously. Guaranteed.

Tim went from a decent level of 109 ("normal" is considered < 150, but that's only because it's based on normal for grain and sugar eaters) to a whopping low of 34. Of course, he did it by replacing crap in his diet (grain and sugar) with real food like animals and their fat. 

Now, in case you're suspicious about the veracity of this Trig/HDL ratio being of prime importance, there's a lot out there. How about this, a 1990 (!) interview with then director of the massive, long-term Framingham Heart Study, Dr. William Castelli.

"There's a subgroup of people who have an HDL under 40 and triglycerides over 150," he explains. "These people have galloping proression of their cholesterol deposits, which will eventually lead to heart disease, and the average physician is not picking it up."

You can read the whole interview.

So, what did Tim's Trig/HDL ratio do while progressing from SAD to Paleo? It went from 1.8, which is on the very low side of ideal (< 2), to .4, which is on the screaming bleeding high side of ideal. Mine is also .4, so is my wife's, thereabouts, so three more data points for ya. Tim achieves a 4.5 magnitude improvement on his Trig/HDL ratio.

I wonder what Cheerios would have done for him.

But that's not all. His LDL is calculated, and rather than rehashing the pitfalls of calculated LDL, I'll just refer you to my 2-part series: What Do You Think You Know About LDL Cholesterol? (part 1; part 2). For another reference, here's how LDL ought to be measured: NMR LippoProfile.

But what can we glean from the information provided? Well, it turns out that the Trig/HDL ratio is a reasonable marker for LDL particle size. Remember, and you can find out more here, but small & dense LDL particles are the real danger. Guess what else? grains and sugar give you a profile where most of your LDL is small and dense, while a high fat (natural, i.e., animal) diet gives you LDL that's large and fluffy, which is inversely associated with CVD, so far as I can tell.

Ratio of Triglycerides to HDL Cholesterol Is an Indicator of LDL Particle Size in Patients With Type 2 Diabetes and Normal HDL Cholesterol Levels

RESULTS — Clinical characteristics, pharmacological therapies, lifestyle, and prevalence of diabetes-related complications were similar in both patient groups. LDL size correlated negatively with plasma triglycerides (TGs) (R2= 0.52) and positively with HDL cholesterol (R2=0.14). However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger (R2= 0.59). The ratio was >1.33 in 90% of the patients with small LDL particles (95% CI 79.3–100) and 16.5% of those with larger LDL particles. A cutoff point of 1.33 for the TG–to–HDL cholesterol ratio distinguishes between patients having small LDL values better than TG cutoff of 1.70 and 1.45 mmol/l.

Let's unpack this, and by the way, while this may look incomprehensible to many of you, do know that a couple of years ago it would have been to me too. I can only encourage you to persevere. You can develop an ability to pretty well understand this stuff. Yes, consult a doctor (hopefully one like new-doc Robert), but go in knowing and understanding what you're talking about. If a doctor is ever offended by your accumulated knowledge and insistence on questions and clear explanations, you need to find a new one.

• LDL size correlated negatively with plasma triglycerides: higher Trigs = smaller LDL particles (bad)
• ...and positively with HDL cholesterol: lower HDL = smaller LDL particles (bad)
• However, an inverse correlation between the TG–to–HDL cholesterol molar ratio and LDL size was even stronger: the ratio is even more important, i.e., the higher the ratio, the smaller (badder) the LDL particles. Stunningly striking: 90% of those with small dense LDL (bad bad bad) had a Trig/HDL ratio greater than 1.33.

So, what's an average Trig/HDL ratio? I don't have time to look up averages and verify sources, but let's just assume an "on the edge" level for both Trigs (150) and HDL (40). 

That's a whopping ratio of 3.75, well above that 1.33 "cutoff"!!! So, if you present to your medical professional with better-than-"normal" triglycerides of 149 and HDLs of 41, he's going to give you a big high 5, and tell you you're on the right track. He's probably not going to even measure your C-reactive protein to determine inflammation markers, nor your Lipoprotein(a), or even homocysteine. And Tim? Before his transformation? Even with a very moderate Trig level by "normal" standards, he had a ratio of 1.8, well over that 1.33 "cutoff" between likely (with 90% confidence) small dense LDL and large fluffy. And now, at .4? Fergettaboutit. He's going to have an NMR per a subsequent email, but I can already tell you what it's going to show.

[Late edit: Note that as commenter below, GoEd, has correctly pointed out, that 1.33 ratio is based on European units for Trigs and cholesterol, i.e., mmol/l instead of mg/dl. That would all be fine and good, but Trigs and cholesterol convert differently. Dumb mistake, as I've made these conversions a number of times. So, at any rate, the ratio for Trigs and cholesterol based upon mg/dl is about 3.0, not 1.33. So, still, our example of a "normal, excellent" profile at a ratio of 3.75 is still well above the cutoff, albeit not quite as dramatically as I first implied.]

Though it is probably achievable to have a a small percentage of small LDL on a standard diet, I'm far more certain that it's going to be far easier accomplishing it on a paleo-like diet.

By the way, my lipid panels over the last year are here and here, my last with HDLs of 133. Yes: 133.

Afterthought: Tim has VLDL measurements, and the only thing I know is that lower is better. However, I've no idea how they are measured, how reliable they are as a marker, or any relevant studies. If an astute reader can educate me and the rest of us, please do so -- with my sincere gratitude.

"WTF": Read the Label

I've become a real label reader lately, and I almost never like what I find. There are exceptions, such as when I got to Whole Foods and get a few tubs of Alexander Valley Fresh Sauerkraut, where the ingredients are: cabbage, filtered water, sea salt, and... there is no "and." That's it. That's what the label of a Real Food product reads like. It even works for dogs, where I regularly get the dried chicken breasts, duck breasts, venison and buffalo livers, and even lamb's lung. In each case, the ingredient label has only one word: chicken; duck...you get the idea.

The biggest shocker is the way HFCS or High Fructose Corn Syrup has made its way into virtually everything. I recall looking at a bottle of BBQ sauce a while back, and, you guessed it: HFCS was ingredient number one. Same with catsup. Virtually all of them have HFCS as the first, second or third ingredient.

OK, so now what? We'll, how about a "healthy alternative" sweetened with, let's say, "agave nectar?" Sounds exotic; healthy even. But at 80-90% fructose, it's not only a health fraud but is actually far worse than corn syrup.

Here's why: Not All Sugars are Equal. Stephan blogged that study too, and here's what he said:

...In one group, the drinks were sweetened with glucose, while in the other group they were sweetened with fructose.

After ten weeks, both groups had gained about three pounds. But they didn't gain it in the same place. The fructose group gained a disproportionate amount of visceral fat, which increased by 14%! Visceral fat is the most dangerous type; it's associated with and contributes to chronic disease, particularly metabolic syndrome, the quintessential modern metabolic disorder (see the end of the post for more information and references). You can bet their livers were fattening up too.

The good news doesn't end there. The fructose group saw a worsening of blood glucose control and insulin sensitivity. They also saw an increase in small, dense LDL particles and oxidized LDL, both factors that associate strongly with the risk of heart attack and may in fact contribute to it. Liver synthesis of fat after meals increased by 75%. If you look at table 4, it's clear that the fructose group experienced a major metabolic shift, and the glucose group didn't. Practically every parameter they measured in the fructose group changed significantly over the course of the 9 weeks. It's incredible.

And now I come to the inspiration for today's post, which is Mark Sisson's post for today: WTF?... Where's The Fat?! where he takes you on a label reading roller coaster that ought to make you sick to your stomach. And, for those who want to see Mark at his sarcastic best, this is the post for you.

...What manner of culinary wizardry can make a delicious, creamy version of ranch dressing without all that artery-clogging fat? They must be doing something right, because they almost outnumber their full-fat counterparts on the shelves. And the people I see frequenting the aisles are always trim, slim, and full of vitality. Plus, what with the nationwide rates of diabetes, obesity, and heart disease plummeting to all-time lows just as the fat-free movement finally seems to be picking up steam, I think we can thank the good folks of Kraft, Best Foods, and Lean Cuisine for their commitment to public health.

And so I set out to peruse the aisles of the local supermarket for evidence of these shining beacons of health and chemical ingenuity. I hoped to discover the secrets so that I might recreate the delectable food products at home and avoid messing up my kitchen with “recipes” and “raw meat” and “food.”

Mark takes you on quote a photo tour through supermarket isles, and in the end, comes away as most of us would and do, now.

My trip to the inner aisles of the grocery store left me in a state of disbelief. I knew what I was in for, but I still came out amazed. I’m amazed that people can continue to deceive themselves into thinking what they’re eating is actually food, let alone healthy food, and I’m amazed at the cunning of food marketing that plays off this deceit...

"...we eat too much because we're too dammed hungry."

We don’t eat too much because we’re more gluttonous than our grandparents. We eat too much because in the 1970s because the McGovern committee convinced us we need to live primarily on low-fat grains and other starches. We eat too much because our insulin levels are too high. We eat too much because we’re storing too many calories as fat.

Tom Naughton.

Yep, as I have said, it's all about hunger. It's been a different world for me for a long time, now, and it's the primary reason I know it's for life. If you eat lots of "whole grains," even fair amounts of sugar, and load up even moderately on other forms of carbohydrate, it's very likely that you and I don't mean the same thing when we talk of hunger.

But I think I know what you might mean. For, I remember a day when hunger was nauseating. It was debilitating. It was: eat something now, and all attention turned to that. It's one reason I talk less about fasting to beginners at this. One day I realized that I had been eating pretty decent Paleo for 3-4 months before I did my first fast, I had been eating somewhat "clean" for months before that.

So, now, I recommend that people go until they realize hunger isn't the same anymore ("I could eat, or, I could wait -- even a long time... and hey, I kinda enjoy this feeling.") and then try their hand at a fast. Fasting gives you, as I have said, high resolution into your own hunger.

That resolution is the key to making this a style for the rest of your life, and you'll never look back.

Back to Tom's good post linked above.

...emphasis should be shifted toward encouraging people to drastically reduce their consumption of carbohydrates; do that, and the “eating less” will take care of itself.

Poison Sugar - In Shocking Pictures

I do a fair amount of harping about processed foods, focussing a lot on grains and frankenoils and such. I should talk more about what I consider to be the number one killer in all the world: sugar, especially refined sugar and concentrated forms.

Now, let me show you why. But first, how much sugar is circulating in your entire body at any one time? Let's say you have ideal fasting blood glucose (80 milligrams per deciliter -- mg/dl). For an average sized person with a blood volume of 5 liters, that comes out to...ready for this?...ONE 4 gram SUGAR CUBE. Skeptical? Well, let Dr. Michael Eades convince you.

Now, at an average consumption of 156 pounds per American per year, "only" 29 pounds of that is from the sugar bowl. The rest is added sugar in the products most Americans are eating. How much is that? Well, here's what 4,373 of them look like.

At 4 grams each (remember, that's the total volume of sugar in a fasted, healthy person), that block is 17,492 grams, or only 38 pounds (it's actually hollow). That's only 10 pounds more than what the average person gets from the sugar bowl. So, how many sugar cubes does the average American consume, per year? How about 17,690 sugar cubes, meaning that the Average American consumes over seventeen thousand times their normal fasted blood sugar in the space of the year. That means they consume 49 times their blood sugar every day and if they're awake for 16 hours, that's 3 times per waking hour. If we look at it in terms of three meals and two snacks, that's 10 times normal blood sugar per meal or snack.

And it's a mystery to everyone why health is so messed up, consuming that quantity of something that was never in our diets in any quantity before 100 years ago? Instead, we hear endless calls from expert-morons that we need to cut the fat, something that has been part of our diet in significant quantity for eons. Frankly, I'm amazed the problems aren't far worse. What a resilient organ, that pancreas.

So, how do we get so much sugar? Here's how, right here: Sugar Stacks. Keep in mind as you browse through the many illustrations, that each sugar cube represents total blood glucose volume (4 grams) in a healthy fasted individual.

So, one can of cola, 9 times normal blood sugar.

Be sure to get LOW- FAT ice cream. Don't worry that a scoop is five times normal blood sugar.

Uh oh! I think Mrs. Fields uses REAL BUTTER in her cookies. Run away!

Tell me you've never downed a whole bag of these. And how about the movie theater king sized ones?

The HEALTHY LOW-FAT alternative!

Stick with the berries, paleo people!

And veggies!

At nearly 14 times normal blood sugar. Caution: don't get it with the arterycloggingstaturatedfat butter melted on top. That's unhealthy!

At nearly 28 times normal blood sugar, I sure hope they don't use real FULL-FAT CREAM in these. That would really be a lot of FAT!

So, be sure to look at all the pictures over at Sugar Stack, bookmark it and pass it along to family and friends, and pass around this entry as well. Most people have no clue about the massive amounts of sugar they are eating.

And keep another thing in mind: this is based upon average consumption of 155 pounds of sugar per person per year. There are plenty of individuals consuming over 250 pounds per year.

Losing Weight is Pretty Much Like Eating Lard

I'm going to revisit a post from a few months ago; but first, I'm going to highlight a post by Tom Naughton, creator of the documentary film Fat Head, which I mini-reviewed here. Let me just mention that this is probably the best tool available for introducing friends and family to the notion of an evolutionary basis for diet. I have screened it with a number of both and the enthusiasm has been uniformly resounding. It's a Big Fat Deal.

Alright, so here's Tom's clever post on his blog (notice that this blog is featured on his short blogroll amongst very good company; thanks, Tom).

Can Your Own Bologna Kill You?

See, Tom figured something out, and I'll give you a clue:

It’s easy to find the breakdown of lard on the internet. It’s mostly oleic acid, palmitic acid and stearic acid, with several others making up the balance. Add them up, and it turns out that lard is about 38 percent saturated, 11 percent polyunsaturated, and 45 percent monosaturated. (The numbers don’t add up to 100 because some of the trace fats were unclassified.)

[...]

...I finally found a paper in which the researchers stated that they extracted human body fat from the subjects’ buttocks. Since research subjects are often college sophomores, I’m guessing this took place at a fraternity initiation. In any case, I saw pretty much the same list of fatty acids. Add them up, and it turns out that human body fat is about 35 percent saturated, 51 percent monosaturated, and the rest polyunsaturated. In other words, it’s similar to lard.

This reminded me of the post of mine I'll now revisit.

All Diets Are High-Fat Diets

Just as Tom did, I showed how if losing fat is part of your weight loss goal, which unless you're crazy it is, then you're going to be burning through your own fat, making your diet, if successful, a high fat diet.

Let's say you have 50 pounds of excess fat you'd like to lose in order to get down to around 15% body fat or thereabouts. Assuming you'll be successful, what does that imply? It means, necessarily, that you're going to metabolize 50 pounds of your own fat in order to accomplish your objective. So, even if you do this by means of a "low-fat" diet, it's still high-fat, as you've got 50 pounds or 175,000 calories worth of fat to burn through. If you do it in six months, that's almost 1,000 calories of fat per day. Presuming a basal metabolism of 2,500 calories, and what you do eat is 20% fat (a "low-fat diet"), then you'd be eating 300 calories of fat and 1,200 calories of protein and carbs combined, for a total consumption of 1,500 calories. The remaining 1,000 would be coming from your own fat, released into your bloodstream and metabolized. Out of the total 2,500, 1,300, or about 50%, are calories from fat.

But Tom actually went a step further and got the breakdown of fat composition, as shown above. It makes the irony of the whole thing only that much sweeter, or ought I to say: fattier.

So let's tie it together: if one is attempting to lose weight, presumably mostly from fat and not lean tissue, then they will of necessity be on a high fat diet, 35% of which, minimum, will be saturated fat from their own body (plus whatever saturated fat they eat). At 1 pound of weight loss per week, that's 3,500 fat calories, 1,225 from saturated fat, which is 135 grams of "artery clogging saturated fat" (so called).

As I concluded in the former post: "When finally you've explained, and they've understood, you can then ask them how come they're not afraid of clogging their own arteries with all the fat they intend to be releasing into their own bloodstream."

Saturated Fat Epidemiology for Math Geeks

A week or so ago, I posted a bit of epidemiology concerning saturated fat intake associated with heart-disease deaths by country. As you saw, it was all over the map. I did speculate, however, that if you were going to try to fit a curve, it would slope downward, meaning: more saturated fat, less heart disease deaths.

Well, owing to my vast network of resources [grin], physicist Robert McLeod offered to fit a curve if I could get him the tabular data, which, thanks to Ricardo, I did. So, here's the graph (see here for the one with the country labels).

Here's what Robert had to say.

All statistics done in MATLAB. I found that if I define

SF = % saturated fat intake

CHD = # heart deaths per year per 100,000 men

then

CHD = (-4.734 +/- 2.003)*SF + (144.5 +/- 21.4)

+/- errors are standard deviations (i.e. one sigma) with an R^2 = 0.13 (terrible) between the fit data and experimental data.

The plot I provided shows the baseline along with a top and bottom curve which are the 95 % confidence interval lines (~1.96 sigmas).

Although the statistics appear fairly poor, we can make one statement of interest. A positive slope is equivalent to a positive correlation between CHD and saturated fat (i.e. saturated fat bad!) and a negative slope is a negative correlation (i.e. saturated fat good!). Evaluating that statement using confidence intervals we have a 0.9 % chance of a positive slope and a 99.1 % chance that the slope is negative.

In other words, increased saturated fat intake is 99 % likely to be correlated with decreased incidence of death from heart disease.

Saturated Fat and Heart Disease Deaths

Ricardo Carvalho, whose great database work I highlighted yesterday, just emailed me another graph. The latest saturated fat data he could find was from 1998, but see if you can find any correlation.

It's all over the map. If you had to draw a trend, however, how would it look? I'd probably start it from the left at the 120 and finish off to the right at about 80, i.e., more saturated fat associated with less CHD mortality.

Update 3/30/2009: Physicist Robert McLeod took the tabular data I provided and did a fit in MATLAB. The punchline is that there's only a 1% chance of the slope being positive (more saturated fat correlated with more CHD deaths) and a 99% chance the slope is negative (more saturated fat correlated with fewer CHD deaths).

Interesting how, once again, the French thumb their noses at the rest of the world. Red wine? Gimmeabreak. I lived there, and most people have no idea how much animal fat most of them eat. From their fat-heavy sauses to their fatty charcuterie and pâté, to their sweet butter and many fine cheeses. I've remarked before about the difference between how Americans eat cheese and how the French do it. In America, I see people taking a whole slice of bread (or a cracker) and thinly spreading cheese on it. In France, you take a small bit of crust and pile a huge mound of cheese on it. And that's often not all. Many French first put a big pat of sweet butted on, and then the cheese. Like this; tiny piece of cracker, big butter, and big cheese:

Yea, I ate it. It was in the interest of science. Frankly, I think the "French Paradox" has a lot more to do with getting a healthy dose of K2 in their diets from all the organ meats they frequently eat (tripe, kidney, liver), as well as the butter and cheese.

Low Cholesterol to "Die For"

I was having an email exchange with my aunt the other day who was lamenting how her husband's doctor told him that his total cholesterol of 117 (!) is one that most people would "die for." Maybe he's right, as we'll see in a minute; but first, I should point out that George is in his late 80's. So, always be careful about assigning causes to correlations. Correlations are great things, but the best way to regard them is as falsification (disproof) of hypothesized causation.

Reader and commenter on this blog, Ricardo, and blogger in his own right at Canibais e Reis has done something truly amazing (and has surely put Ancel Keys in short pants). Lots of this is going to go over the heads of most people, including myself, but I'm quite confident a number of math and health whizzes will be on this project in short order.

Ricardo has essentially combined data from the following sources into a single database anyone can access:

• UN Food and Agriculture Organization Statistical Yearbook
• FAOSTAT food consumption database
• British Heart Foundation Health Statistics database
• World Health Organization Global Health Atlas

In the end, he had data on 170 countries, which he eventually narrowed to 86 countries in order to get a complete data set for all available parameters. You can read about the whole thing right here. This just scratches the surface of what can be done, but here's a couple of examples. How about death in men from heart disease against total cholesterol? (click here for full size).

While the correlation isn't great, it is interesting to note that the lowest heart disease mortality is associated with total cholesterol of 200-220 for quite a group of countries. And do note the saturated fat junkie French right down there at the bottom, edged out only slightly by the Japanese.

Now let's look at life expectancy for women from birth against total cholesterol (click here for full size).

Here, the correlation is much stronger and shows unmistakably an association between higher total cholesterol levels and longevity for women. Interestingly, it looks again like total cholesterol of 200-220 seems to be the sweet spot.

So, guys & gals, how much do you want to "die for" low cholesterol?

Let me stress and reiterate, however. This does not prove or suggest that higher cholesterol causes longevity or reduced mortality from heart disease. Nor does it prove that low cholesterol causes decreased longevity or increased mortality from heart disease. What it does do is prove that "high cholesterol" does not cause more death from heart attack or decreased longevity and it proves that "low cholesterol" does not cause less death from heart attack or increased longevity.

Finally, it proves that every single person, worldwide, out there touting "low cholesterol" is an abject ignoramus. That means we're probably talking about more than 95% of physicians, including your own.

Here's a good primer on the cholesterol con from Dr. Malcolm Kendrick, which I blogged a bit over a year ago.

My High HDL "Secret"

For reference, see the last post about my 133 (mg/dL) HDL.

Fat is King. More particularly: saturated fat. Now, how do you get that? Well, you can eat a lot of fatty beef, chicken skin, and so on, but only about 30-40% or so is saturated (15% saturated from olive oil). Or, you can get it very efficiently by eating all that, but by also dipping, slathering and generally enjoying the hell out of your life with sauces. I'm an absolute fiend for sauces. Even, now, with grilled meats.

Gotta have a sauce. Mine are all home made, and they are almost all based on: coconut milk. It's more efficient in saturated fat delivery -- far more so -- than even heavy cream. Let's take a look; the average can of full-fat coconut milk being 14 ounces. Here's nutfacts for 8 ounces, a little more than half, which is an average amount I'd use to thicken or base a sauce for 2-4 people (unless it's a Thai curry, in which case I might use two full cans, four times the amount below -- so go ahead and have your heart attack now):

Holy shit, Batman! 88% of the damn thing is fat, and of those 57 grams in a cup, 51 grams, or 90%, is "ARTERY-CLOGGING SATURATED FAT!!!" Yep, God is trying to kill you, seeing as how coconut is a staple food for a number of (heart healthy) populations.

Modern ignorance (and moronity).

Here's a characteristic dish from a couple of mights ago which I'll call Indian / Thai / Polish.

In all my time in Asia, it never escaped my attention -- even in the 80s -- that Thais generally have wonderful body composition and Indians generally have lousy body composition. Well, they both eat lots of hot curries. The difference? Indian curries are water based. Thai? Coconut milk based, not only making them way easier to prepare, as they require very little reduction for a nice thick sauce, but wonderfully creamy on the palette (though HOT!).

On the other hand, I generally like the complexity and variety of Indian curries over Thai curries. The solution? Use coconut milk in your Indian curries, and use whatever the hell meat you want. (The coconut milk) Doesn't change the flavor a lick, so far as I can tell, though I'm sure some would disagree. Fine. I'm fine and know what I'm doing. In fact: it's a wonderful discovery.

The other part is that I don't do nan, the Indian bread (amongst many others you can have) that goes along with most curries, in addition to the rice. I don't think Thais do that, at least not that I've seen. Don't get me wrong: love nan; I can eat a whole lot (prior to the nuclear heartburn I used to get every time -- now none -- regardless of how spicy).

I do often cook up a bit of Basmati or Jasmine rice. Two to three heaping tablespoons will do it. Eat it with a tablespoon (as the Thais do). This introduces sauce and a spot of rice (if you're adding a starch) to each bite.

I do this a lot, and more and more. By the way, that's an Indian lamb curry paste (they have a dozen different curries for everything) with some water (it called for 2 cups, but that was to simmer and braise the lamb -- the polish is already cooked). To that I added probably half a can of coconut milk and a good teaspoon of cayenne to boost the heat several notches. There's uncured Polish and an Onion.

Save your leftovers and toss a couple of eggs on them in the morning. Seriously.

News Flash: Above 40% Dietary Calories From Fat Virtually Eliminates Heart Disease

The data is in:

Now quick, quick, and go see the shocking rest.

(Note: Ancel Keys was an utter fraud.)

And later: I hope everyone gets the tongue-in-cheek about this post...

Sugar Feeds Cancer

I've previously posted on this, one post you should definitely read. Via a comment on Art's private blog, I see even more evidence that that ingesting sugar (including too much grain and/or fruit / juice) in the presence of cancer kills people a lot faster. Read what Patrick Quillin, PHD, RD, CNS has to say.

A mouse model of human breast cancer demonstrated that tumors are sensitive to blood-glucose levels. Sixty-eight mice were injected with an aggressive strain of breast cancer, then fed diets to induce either high blood-sugar (hyperglycemia), normoglycemia or low blood-sugar (hypoglycemia). There was a dose-dependent response in which the lower the blood glucose, the greater the survival rate. After 70 days, 8 of 24 hyperglycemic mice survived compared to 16 of 24 normoglycemic and 19 of 20 hypoglycemic. This suggests that regulating sugar intake is key to slowing breast tumor growth.

In a human study, 10 healthy people were assessed for fasting blood-glucose levels and the phagocytic index of neutrophils, which measures immune-cell ability to envelop and destroy invaders such as cancer. Eating 100 g carbohydrates from glucose, sucrose, honey and orange juice all significantly decreased the capacity of neutrophils to engulf bacteria. Starch did not have this effect.

A four-year study at the National Institute of Public Health and Environmental Protection in the Netherlands compared 111 biliary tract cancer patients with 480 controls. Cancer risk associated with the intake of sugars, independent of other energy sources, more than doubled for the cancer patients. Furthermore, an epidemiological study in 21 modern countries that keep track of morbidity and mortality (Europe, North America, Japan and others) revealed that sugar intake is a strong risk factor that contributes to higher breast cancer rates, particularly in older women.

If I had to speculate, it would be that cancer is brought about by unnatural foods in our diets (grains & vegetable oils, primarily) that generate and promote chronic inflammation and this inflammation, in-turn, causes cancer. And, once that job is complete, sugar takes right over to feed that cancer.

Wanna read something really dumb, then, continuing with Quillin?

In 1990, I called the major cancer hospitals in the country looking for some information on the crucial role of total parenteral nutrition (TPN) in cancer patients. Some 40 percent of cancer patients die from cachexia.5 Yet many starving cancer patients are offered either no nutritional support or the standard TPN solution developed for intensive care units. The solution provides 70 percent of the calories going into the bloodstream in the form of glucose. All too often, I believe, these high-glucose solutions for cachectic cancer patients do not help as much as would TPN solutions with lower levels of glucose and higher levels of amino acids and lipids. These solutions would allow the patient to build strength and would not feed the tumor.

Good job, folks. Give them intravenous nutrition, 70% of which is the primary fuel for cancer cells, a medical fact know since 1931 -- a discovery by Otto Warburg that earned him a Nobel prize in medicine.

Oh, well, even though high fat-eating gunter-gatherers don't get cancer, we certainly couldn't feed cancer patients high fat.

Finally, if you read that previous post of mine that I highlighted at the beginning of this post, then you are aware of the anecdote of a man putting his metasticized lung cancer into remission via a high-fat diet a-la Jan Kwasniewski (see here, too). Well, Dr. Quillan has another similar one.

A female patient in her 50s, with lung cancer, came to our clinic, having been given a death sentence by her Florida oncologist. She was cooperative and understood the connection between nutrition and cancer. She changed her diet considerably, leaving out 90 percent of the sugar she used to eat. She found that wheat bread and oat cereal now had their own wild sweetness, even without added sugar. With appropriately restrained medical therapy -- including high-dose radiation targeted to tumor sites and fractionated chemotherapy, a technique that distributes the normal one large weekly chemo dose into a 60-hour infusion lasting days -- a good attitude and an optimal nutrition program, she beat her terminal lung cancer. I saw her the other day, five years later and still disease-free, probably looking better than the doctor who told her there was no hope.

Now, if all this is true, and we know what other bad things sugar does -- like making you fat & diabetic -- then why in the world would you want to touch it in any significant way?

Oh, and by the way, can you guess the other thing we talk about here a lot that actually protects you should you get cancer and require chemotherepy? (hint: it starts with an 'f')

Don't Listen To Me! (Part 2)

I'm going to break with standard practice and go ahead and quote the whole thing, here, because there's no single part of that can be excerpted and it's just too important. Here's some resources to check out:

• My original post: Don't Listen To Me!
• Dr. Dwight Lundell's part 1 article: Heart Surgeon Admits Huge Mistake
• Dr. Lundell's book websites: The Great Cholesterol Lie; The Cure for Heart Disease
• Dr. Lundell's interview with Dr. William Davis of the Track Your Plaque program

And now, here's part 2 of Dr. Lundell's heroic article.

Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. Let’s say you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.

Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation.

While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.

How does eating a simple sweet roll create a cascade of inflammation to make you sick?

Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.

When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.

What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator — inflammation in their arteries.

Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6’s are essential –they are part of every cell membrane controlling what goes in and out of the cell — they must be in the correct balance with omega-3’s.

If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation. Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.

There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation-causing omega-6 fats like corn and soybean oil and the processed foods that are made from them. One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labeled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.

A Tale of Two Mayo Clinic Dietician Morons

You've really got to love the Internet.

Another thing I love is watching establishment, authoritarian "experts" -- who fake a livelihood and self-esteem regurgitating the party line -- get it right in the teeth.

That's what happened to these two dumbshits, Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D. in this post ("For those with diabetes — there's more to it than carbs"). I'm not even going to quote any of it because it's just so dumb. 1+1=3 dumb; that's how dumb.

But luckily, as of right now, 31 out of 33 commenters -- most of whom are T2 diabetics or successfully treat T2 diabetics -- have given the two morons a rash of real nice kicks in the teeth. Here was one of my favorite comments, by Debbie (of the two comments that were not kicks in the teeth, one was a question and another was a comment by the author of the post):

This is the sort of article which helps reinforce the truth of the comment my son frequently makes: "If you want to understand human nutrition *never* ask a dietician or a nutritionist, ask a biochemist". I'm a T2 diabetic and thank God I'm pretty internet-savvy. Thus I know full well that a diet that is 45% carbs is a true "killer" diet for diabetics. Any diabetic who researches the issue knows that a real low carb diet is the best hope for longevity. I try to keep carbs at about 5% of my total caloric intake, sometimes up to 10% but *never* higher than that! Higher would send my blood sugars spiraling out of control. But my numbers are all good. I eat plenty of saturated fats too, since I feel quite sure it is not a demon. Not that I eat fat indiscriminately. I avoid trans fats, and polyunsaturated vegetable fats. But I eat my share of dairy fat, animal fat, coconut oil, and monos like olive oil. My typical diet is 70% fat, 5% carb, 25% protein. It's easy to maintain, makes me feel incredible. So far I've lost 70 pounds, and all my numbers are much better. But I pity the poor diabetic who does not have access to the internet. They are the ones likely to lose their limbs, their eyesight, etc. I used to respect the Mayo Clinic as a dispenser of medical information, but after reading this I realize I can't trust a word written here either!

It gets better. A few days later (Feb 3), they published a follow-up moronic post that essentially said the same stupid things. So far, about 12 of 14 comments are good teeth kicks, while a couple of diabetics are recommending going on a pea brain-diet (vegetarian). I particularly liked this comment by Mary Kolk, who literally saved her husband's life from the dietitians and medical doctors doing their level best to kill him -- and those dietitians and medical doctors very nearly succeeded in killing him, by Mary's account.

You have got to be kidding me! You need to read Dr. Richard Bernstein's book, "Diabetes Solutions Third Edition" It is amazing how the medical community refuses to acknowledge tremendus benefits of eating a low carbohydrate diet. My husband is a type 2 diabetic for over 25 years. He had severe neuropathy in both feet and could not walk over 75 to 100 feet at any one time. He was eventually put on insulin after the doctor felt there was nothing more he could do for him. Beginning at 5 units a night, a year later he was on 43 units a night. His weight ballooned to 280 pounds. He was depressed and I told my kids that in 6 months I would be pushing dad around in a wheelchair. About 7 years ago I read Dr. Bernstein's book. I read that book and realized it was all about my husband. Six years ago, my husband accepted responsibility for the diabetes, went on a program of low carb and exercise this was the result: he lost 80 pounds in 9 months, his HA1c fell to 6.5 from 11, he goes to the gym 3 times a week and walks 2 miles each time. He came off of insulin about 3 months after beginning this program and his doctor takes him OFF of meds each time he sees him. He has not had insulin in 6 years! He feels wonderful, he looks wonderful and he is wonderful. He was literally dying in front of my eyes - seeing his doctor faithfully and following what his doctors told him to do. And he was dying slowly. He is now fully alive and well. His HDL is great.

(HT: Doc Eades)

What Do You Think You Know About LDL Cholesterol? (Pt 2 of 2)

Part One

The purpose of part one was to demonstrate the meaninglessness of calculated LDL cholesterol in relation to the equation used to calculated it, and how triglycerides, while being a very important risk factor for heart disease in its own right, have been steadily increasing on average and potentially giving a false sense of security as increases in triglycerides cause a mathematical (not necessarily biochemical) lowering of calculated LDL serum cholesterol.

I promised that in this second and final part, I will demolish the notion that you have any real idea of what your actual LDL cholesterol is, based on standard bloodwork involving calculated values. And I shall deliver.

Let me frame what I'm going to say this way: there are millions of people with low calculated LDL (say, <50-60) who are at infinitely more risk for atherosclerosis, rupture, and fatal heart attack than are many people with calculated LDLs in the high 200s and higher. If you eat significant amounts of carbohydrate, especially as processed food, have low HDL (<60), high triglycerides (>200), then it's essential to know exactly what your LDL really is. The standard blood panel is essentially worthless for this.

But I'm here to help. But first, let me show you what I mean by turning to Dr. William Davis, the cardiologist who originated Track Your Plaque and who blogs at The Heart Scan Blog. Dr. Davis, who used to practice by performing various coronary procedures such as installing stents, now spends his time detecting, preventing, and reversing heart disease.

He has lots of stories to tell. Let's get started.

Don't believe your LDL cholesterol!
"Harry's case is typical. For years, his doctor told him his LDL cholesterol of 123 mg was okay. But a heart scan score of 490 (90th percentile at age 52) made him question just where his coronary plaque came from.

"Lipoprotein analysis told a very different story: His LDL particle number was 2400 nmol, meaning his true LDL was more like 240 mg, nearly double the value of LDL obtained through his doctor. Harry had other sources of risk, too, but the LDL particle number was a clear stand-out. [...]

"...When LDL's are actually meaured, you find that LDL is rarely accurate. In fact, in our experience, inaccuracy of 30-50% is the rule, sometimes 100%. The one telltale hint that calculated LDL is wrong is when HDL is <50 mg -- that's nearly everybody. "

How accurate is LDL cholesterol?
"If there's so much attention paid to LDL, how accurate is it? 100%? 90%? 80%?

"Well, it varies widely. Occasionally, it's truly accurate, but most of the time it's miserably inaccurate. Every single day, I see people with LDL cholesterols that underestimates true (measured) LDL by 40%, 50%, and even over 100%. In other words, LDL cholesterol might be 120 mg/dl by the conventional method, but the genuine measured value might be 160 mg/dl, or even 240 mg/dl. It can be that far off -- and it's not rare.

"The converse can occasionally be true, though rarely in my experience: that conventional LDL overestimates true LDL. I saw someone in the office today like this, with a conventional LDL of 142 mg/dl but a true measured LDL of 115 mg/dl. I may see one or two more people like this the rest of this year."

When LDL is more than meets the eye
"I pointed out to Jerry that, given the low HDL and high triglycerides, his calculated LDL of 112 was likely inaccurate. In fact, if measured, LDL was probably more like 140-180 mg/dl. LDL particles were also virtually guaranteed to be small, since low HDL and small LDL usually go hand-in-hand (though small LDL can still occur with a good HDL).

"So Jerry's LDL is really much higher than it appears. To prove it, Jerry will require an additional test, preferably one in which LDL is measured, such as LDL particle number (NMR), apoprotein B, or "direct" LDL.

"It's really quite simple. Jerry likely has a high number of LDL particles that are too small. This pattern confers a three- to six-fold increased risk for heart disease."

The many faces of LDL
"Ginnie came in for an opinion about her heart scan score of 393. At age 57, this put her in the 99th percentile, a high score.

"LDL cholesterol: 96 mg/dl - This value puts Ginnie's LDL in the most favorable 25% in the country.

"LDL particle number: 2140 nmol/l - This value is in the worst 25% of the country and is the equivalent of an LDL cholesterol of 214 mg/dl (take off the zero).

"In addition, over 90% of Ginnie's LDL particles fell into the small class."

Making Dr. Friedewald an honest man
"Colleen started with the usual discrepancy between conventional calculated LDL cholesterol of 121 mg/dl and the far more accurate LDL particle number (NMR) of 1927 nmol/L. [...]

"In other words, by this simple manipulation, Colleen's Friedewald calculated LDL is off by 58%. This is very common, a phenomenon I witness several times every day.

"By LDL particle size, 75% of all Colleen's LDL particle were abnormally small (small LDL particle number 1440 nmol/L). This is a moderately severe small LDL tendency."

A Tale of Two LDL's
"Kurt, a 50-year old businessman with a heart scan score of 323, had a:

"--Conventional (calculated) LDL of 128 mg/dl - Real measured LDL 241 mg/dl.

"Laurie, a 53-year old woman who underwent a coronary bypass operation last year (before I met her), had a:

"--Conventional LDL of 142 mg/dl - Real measured LDL was 85 mg/dl.

"(By "real, measured" LDL, I'm referring to LDL particle number in units of nmol/L obtained through NMR lipoprotein testing and dividing by 10, or just dropping the last digit to convert the value to mg/dl. This technique was arrived at by comparing the population distributions of these two parameters, LDL particle number and calculated LDL. This is the gold standard in my view. Similar numbers can be obtained by measuring apoprotein B, direct LDL, or calculated non-HDL, with diminishing reliability from first to last.)

"In other words, Kurt's conventional LDL underestimated real LDL by 88%. Laurie's conventional LDL overestimated real LDL by 40%."

~~~

Had enough? Now do you see what I mean? I'll finish by quoting the heroic Dr. Davis once more from the last of those series of links.

Interestingly, Laurie's doctor had insisted she take Lipitor for a high LDL cholesterol. Her real LDL was, in fact, low to begin with and benefits of a statin drug would be little to none. (Remember, in our Track Your Plaque approach, multiple other treatments are included, such as omega-3 fatty acids from fish oil, vitamin D normalization, and wheat elimination, strategies that yield benefits that others expect to obtain with statins.) Laurie's real cause of her heart disease proved to have nothing to do with LDL cholesterol, but involved lipoprotein(a) and thyroid issues.

Kurt proved to have a severe preponderance of small LDL particles--the worst kind of LDL, while Laurie had none--a benign pattern.

Then how can anyone make sense of the conventional, calculated LDL cholesterol that is generally (95% of the time) provided? If accuracy can stretch to plus or minus 80% . . . you can't. Conventional LDL is a miserably inaccurate number. The problem is that obtaining a superior number requires a step or two more testing and insight, something most busy primary care doc's simply don't have in the midst of a day filled with arthritis, bronchitis, diarrhea, belly aches, and seborrhea.

Yet conventional--I call it "fictitious"--LDL serves as the basis for this $27 billion (annual revenues) industry selling statin drugs.

This is meant to be neither an argument in favor of nor against statin drugs. However, it is plain as day that any study designed to reduce LDL cholesterol will be hopelessly clouded by calculated LDL imprecision. A calculated LDL of, say, 143 mg/dl might really be 187 mg/dl, or it might be 74 mg/dl--you can't tell by looking just at LDL. Yet billions of dollars of research and billions of dollars of healthcare costs are based on the treatment of this number.

So, what's your LDL? Unless you've actually had it measured, you do not know. Neither does your doctor. Are you on medications or dietary prescriptions as a result of the fiction that you believe is your LDL? And how about particle size? Large & fluffy are actually good, while small and dense are very bad. You might have a low LDL, but with a high percentage of small and dense particles, and you could be at 6 or 10 times the risk as someone with an LDL of 250, but 99% large & fluffy. Don't be fooled by your doctor, HMO, hospital, or the drug companies.

And guess what will reduce your small and dense LDL every time? You guessed it: get off the grains, (particularly wheat), sugar, processed foods, processed vegetable oils; and take omega 3s and vitamin d to get your levels above 60.

How do you find out what your LDL actually is? Dr Davis says, "Our preferred method is NMR (LipoScience) LDL particle number, probably the most accurate of all. Second best: apoprotein B, direct measured LDL, and non-HDL."