Ok, so I don???t know how to write short questions. This is in response to Jack Kronk???s post that was certainly of interest to me and apparently others. I wanted to follow-up with something a bit more impersonal than Jack???s specific situation, with the intention of getting to a fundamental fork in the road that I think is at the core of his post.
First, let???s level set on terminology. Please see attached the link from Chris Masterjohn, who IMO is the thought leader in this area ??? http://blog.cholesterol-and-health.com/2011/03/how-conflating-lipid-hypothesis-with.html
Now many of us in this community have embraced the consumption of saturated fat and dietary cholesterol. From this perspective, we are ???cholesterol skeptics??? along the lines of the following from Chris Kresser - http://thehealthyskeptic.org/i-have-high-cholesterol-and-i-dont-care
However, my observation is that there are skeptics, and then there are SKEPTICS. Please see the following from Kurt Harris (who continues to be my main influence, even though he is not blogging much/at all)
From Statins and the Cholesterol Hypothesis ??? Part I...
"I do not believe in any of the versions of the lipid hypothesis, ranging from Ancel Keys' original idea that cholesterol or dietary fat clogs the arteries, to the currently fashionable one that ???small, dense??? LDL particles are like microscopic rodents that are designed to burrow under the intima of your blood vessels and kill you. Neither cholesterol nor any of the lipoproteins nor LP(a) is a "cause" of CAD (coronary artery disease)...HDL, particle numbers, particle sizes, LP(a) are all parameters that are more or less associated with CAD. If they respond positively to changes in diet, then they are just covariant with decreased risk of CAD or MI due to the changes you made in your diet. They are not necessarily, and not usually the direct mediators of the decreased risk. They may track the positive changes you make in your diet, but they are not causing heart attacks any more than shoe size causes height!"
In response to a post by Chris Masterjohn - http://blog.cholesterol-and-health.com/2011/03/genes-ldl-cholesterol-levels-and.html - Kurt Harris wrote the following (March 27, 2011)
???My biggest problem with your otherwise excellent analysis here is that not a one of the studies you cite includes people eating ancestral or paleo or high fat/LC diets. The total C/HDL ratio should therefore be considered neither reassuring or necessarily alarming unless you are a SAD eater, IMO.
What do you make of the Kitavans having little heart disease but having very low HDL as reported by Lindeberg? I tend to agree with Peter that we should regard these lipoprotein numbers, including the newest fad of sdLDL, as markers for type of diet, and not as causative agents or parameters to adjust for their own sake.
And although I agree that total C can be elevated due to hypoT, I still think that the best lipid is one that you never measure, and one should diagnose thyroid issues with clinical assesment and thyroid tests. There is simply nothing to be gained -a priori -by testing for total C, HDL, LDL or even CRP. Unless you want to have to lie when you apply for health insurance (they often ask if you have high cholesterol but don't demand that you get tested - I've had that experience twice) or you want to incur the expense of following up with NMR.
There is no evidence that treating a single one of these numbers, beyond eating a whole food diet low in PUFA, etc, does anything at all to reduce your risk. Even if they actually mean something on your paleo type or WAPF diet, which I have just argued they might not...If you really want to know your personal risk of heart disease, get a calcium score or CIMT. For the same price as VAP or NMR lipoprofile, you will get information that actually means something.???
So I see the following categories implied
- You are Lipo-phobe/Cholestero-phobe - You essentially believe in the Lipid/Diet Heart Hypotheses. If you are a Paleo eater, then this is arguably aligned with the Cordain/Devany view of Paleo in that you minimize saturated fat and dietary cholesterol while adhering to the other tenets of Paleo ??? exclusion of Neolithic Agents of Disease (PUFA, Fructose, Gluten, etc)
- You are a Conditional Skeptic - You do not believe in the original formulation of the Lipid/Diet-Heart Hypotheses, but you do believe in certain aspects (such as the relative importance of small/dense vs light/buoyant LDL) and therefore believe that lipid numbers are something to be managed. By ???managed???, I am not implying that you are going to rush out a get on a statin. ???Managed??? means you will modify your diet within the confines of Paleo tenets to ???achieve??? lipid numbers that you believe are indicative of cardiovascular health.
- You are an Unconditional Skeptic. You believe these measures are irrelevant. Regardless of the numbers, you will continue to exclude NADs and the impact to your lipid numbers does not impact your dietary choices at all within the confines of Paleo tenets
- TBD ??? please elaborate. Obviously there are shades of grey between 1-3 and the never ending semantic arguments that could ensue (and would rather avoid)
So finally the question - For those of you in Category #2, what keeps you from being in #3? Maybe a hedge against the possibility that there is some merit to conventional wisdom and we should not throw the baby out with the bathwater? Scientific data that convinces you that complete skepticism is wrong?
Finally, it is easy to say you are either a conditional or unconditional skeptic, but when you are faced with data that places you at the crossroads of accepting or rejecting conventional wisdom, then your true beliefs will be revealed. To be clear, I am not asking this question with any value-judgment whatsoever. I don???t care which category you place yourself in; I care why you are there so I can understand and learn from it. Maybe this will also be relevant for Jack's question.
Thanks and sorry for the length of the question (not really!)
EDIT - When push comes to shove, if I were faced with "undesirable" lipid levels, I think it would be disingenuous of me to thump my chest and state categorically that I would not fall into #2, even though intellectually I remain in #3. This is why I wrote this question because of the internal conflict that might result if/when such a situation arises. Perhaps some of you are in the same boat?
asked byAravindan_Balasubramanian (13682)
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on July 11, 2011
at 06:42 PM
I would consider myself to be #3 You are an Unconditional Skeptic. I eat as per ancestral ways, not re-enactment, but avoiding NADs, frankien-foods, wheat, sugar, seed oils, etc. Perhaps I am lucky that I have strong ties to a part of my family (Native Americans) who still live very closely to how our ancestors did, they still hunt & fish, eat self grown veggies, a little fruit and largely avoid sugar, flour & oils, basically living off the land as much as possible. In their communities the elders are very healthy, rarely is diabetes, CVD, seen or overweight people. No one is plagued by Cholesterol issues. For me that is all the proof I need that this way of living is what is best for me & mine.
on July 12, 2011
at 03:01 AM
I am a conditonal skeptic. If there is a single indicator that I would indeed jump around and get excited about, it is triglycerides.
This statement sums it up well:
HDL, particle numbers, particle sizes, LP(a) are all parameters that are more or less associated with CAD. If they respond positively to changes in diet, then they are just covariant with decreased risk of CAD or MI due to the changes you made in your diet. They are not necessarily, and not usually the direct mediators of the decreased risk. They may track the positive changes you make in your diet, but they are not causing heart attacks any more than shoe size causes height!" - Kurt Harris
I agree that cholesterol numbers are imprecise measurements of something we don't fully understand, and that they do indicate something, as in dietary effects.(And I don't think that "dietary effects" are unimportant.) I think they are "related indicators" but are not in and of themselves, directly causal re: cardiac events. I find Paul Jaminet's discussions about LDL and HDL particularly interesting in this regard. The roles of HDL and LDL may be far more complex and important to overall health, far outside of "clogged or unclogged artery status" and more involved in infectious clearance and thus, indirectly in inflmammation status. This is very interesting to me.
Discussion of different cultural eating patterns which involve peoples living in radically different climates makes me crazy. It makes absolute intuitive sense that what could even be described as absolutely polar nutrition patterns would occur in areas with vastly different flora/fauna and climate. And that these radically different diets could seemingly both be healthful isn't surprising to me at all. When I lived in the arctic, I ate alot of raw caribou , raw whale skin and fat, semi and raw fish, fermented whale blood, lots of dried seal and seal oil and lots of cooked of all the above as well. I have since childhood, run very "hot" and thrive in colder climates.(Nordic ancestry at least in recent generations) My ideal sleeping room would be maybe 45 -50 degrees. All the above foods are very heating, as even the the raw carbou was typically eaten dipped in seal oil. I married into the deep south about 6 years ago. There is NO WAY I could eat that diet here and my diet here is typically very salad/veg weighted, grounded with a substantial amount of fish, foul or meat.Though I love fat, and have lifelong, I am sometimes very uncomfortable eating too much of it here as it is HOT and I get HOTTER! When Don M. writes of his diet changes, what I am tuned into is the fact that he lives in the low desert in Arizona, which in my book was well described by a friend as: like living in a giant kitty litter box in hell.
I cannot imagine eating a very heavy fat/meat based diet there. No, I wouldn't be eating grains, but my diet would have to lighten up considerably, as it did when I moved to the HOT south (but not nearly as hot with as long a hot season as Don's area.) Anyhow, I am getting far afield. This is all to say that I am often frustrated with comparisons of African continent diets in the same breath with Inuit diets. These people are very much rooted in a place/climate in ways that are very poorly understood by by distant, modern cultures.
And I would certainly expect my lipid panel to look quite different living and eating a traditional high arctic diet than it would living in a tropical island clime or in a traditional African culture. How could it not? And why couldn't it, as a dietary indicator, look quite different, but reflect the fact that I 'd be consuming no frankenfoods, much simpler food, and food that is indigenous to my immediate area, only when it is available. Different indicator patterns for very different climates/bodies/energy demands/diets.
on July 11, 2011
at 08:23 PM
For as long as I've been interested in nutrition (~20 years) I've suspected that the whole cholesterol "thing" (e.g. lipid hypothesis) was somewhere between misguided, selectively correct but widely wrong, or fundamentally flawed. This was based on anecdotes, the study of traditional diets, the health of my family and friends, and just personal experience for how I feel after I eat certain foods.
I just never thought that eating wholesome fatty foods was bad for me, and have always felt that processing foods to remove their fat was just wrong. In contrast, I'm absolutely certain that eating a "food pyramid" diet is bad for me. At the same time, I never heard a good explanation for what does cause arteriosclerosis and heart disease, though I thought the explanation was out there somewhere.
Relatively recently, I have read things from doctors, nutritionists, trainers and athletes in the Paleo orbit that answer these questions with scientific backing and lots of testimonials, and this has pushed me to the 100% skeptic camp. Except for perhaps certain cases (i.e. unhealthy people who have already had a heart attack), I think the lipid hypothesis is complete bunk.
There are however some more unanswered questions in my opinion. It is just as clear to me that different people need different diets, and it stands to reason that different people react differently to high or low levels of saturated fats or grains. IOW, some people become less healthy by eating more saturated fat. I don't know exactly how this would show up -- if it is cholesterol figures, higher rates of disease, etc. Perhaps these are the people that get "high bad LDL" scores when they eat a lot of fat, maybe they are just well-adapted to grains, or who knows what.
I think a lot of medical and nutritional ideas from the past 50-60 years are going to turn out to be dead wrong.
on July 11, 2011
at 06:50 PM
I'm firmly in category #3. I think that the only reason anybody cares about cholesterol is because it was easy to measure with 1930's technology and that people went fishing for correlations (and then cherry picked the data when they didn't find it). It's a virtually meaningless number that's quick and easy to measure so meaning is attached to it.
on July 11, 2011
at 06:41 PM
I don't believe cholesterol causes any disease period. Nothing I have supports unless the data or diets were gamed. Eat paleo and I think you're doing well
on July 11, 2011
at 06:31 PM
I am a Conditional Skeptic and if my numbers were bad I might just fall back into being a Lipo-phobe/Cholestero-phobe.
The science of what I read pertaining to whether or not cholesterol matters often times goes over my head. It sounds good to me and makes sense, but then so does the science about why cholesterol is bad. I am not adept at reading studies and taking them apart, so I count on other people to do that for me most of the time.
eta: I was thinking about this last night and wanted to clarify that if I did come back with terrible numbers I WOULD STILL NEVER, EVER TAKE A STATIN. NEVER. I would however probably try to tweak my diet to get the numbers back down.
on July 12, 2011
at 03:45 PM
Trying to tinker around with altering these numbers is a guessing game at best because all of the tests done to determine correlations and possible connections to what lipid numbers mean all have their faults. I have said for a long time that the best way to figure it out once and for all would be to do a large, controlled study with a wide swath of people from many backgrounds and family conditions that eat some version of Paleo, but specifically people who eat like most of us do on Paleohacks, not SAD! The only problem is, this study will take a really long time, and perhaps even decades to see a significant number of heart incidents in a group like this. So we are stuck analyzing numbers taken from groups of people that do not eat well, and this messes up the whole operation in my opinion.
I've read/seen/heard enough to know for sure that I am nowhere near #1, and at times, I have felt closer to #3 than anything. I don't think any form or type of cholesterol actually causes heart disease or prevents it either. And even finding surefire correlation is tricky indeed.
But like Aravind eludes to, when my numbers came back with multiple red flags according to what is currently perceived as bad lipid combinations, it made me really think about everything a lot deeper. You can all have an air of confidence about this and say you are firmly in camp #3 forever and ever, but I think no matter any of you say, if your numbers came back with low HDL, small dense pattern B LDL, high VLDL with higher trigs than optimal, you might take a step back too. When it becomes personal, it just might be enough to slice a thin edge off of that cavalier attitude and drag you back closer to #2.
Chris Masterjohn brought some interesting perspective to it, especially with the bit about how not fasting may have seriosuly influenced the trigs in my blood for the test and that my numbers now may not actually be that much different than my lipid panel from Oct 2010. What I expected was a significant increase in HDL, from 42, to maybe around 60 or so. I would have liked to see that very much. If I ate the same amount of soybean oil as I do coconut oil, I would be drowning in O6. Also, regardless of how many bananas I've been eating, I surely expected my LDL to be a strong pattern A.
At any rate, I am not going to drive myself bonkers, but I can't help ask myself, what if I am really in trouble? What if this trend in my blood catches up to me in several years? It's too important for me to snuff it off and camp out at #3 after seeing what my report just came back with. So for now... I will be watching this closely, and continuing to learn and gain a deeper understanding of its importance or perhaps lack of real importance. And I'm quite grateful to be connected to so many amazing resources of people who understand how all this works and care enough to help others out so we can all learn from it.
As of July 8, 2011, Jack Kronk is posted up in camp #2.
on July 12, 2011
at 01:47 AM
The minute I start to suck wind when I'm running, I'll wonder...
But right now, I'm 36 and all I eat is fat fat fat. I ran 5 miles today in the blazing sun and barely broke a sweat. I went to a pool here at school and seeing all the 20 year old guys there made me realize that I look better than I did when I was 20. When I play basketball against them I can run circles around them. I honestly have my 20 year old body and athleticism - ON (so-called lethal) FATS.
Besides, I have a hard time believing the human body exhibits any kind of counter-evolutionary mechanism/function. Why would one of our very own organs produce a molecule (cholesterol) that threatens the very existence of our species, and manufacture it over and over, daily throughout the human life span? That just doesn't compute IMHO.
I believe if you have small dense LDL particles, that just reflects a high amount of oxidative stress in your body which is the result of low antioxidant levels (antioxidants that must be obtained by eating more plant foods) and excess metabolic waste/free radicals/advanced glycation end products.
It is mainly this systemic inflammation that wreaks havoc on the blood vessels of the cardiovascular system and creates conditions that accelerate heart disease.
I would think you could correct your lipid profile best, not by cutting back on saturated fat and cholesterol, but by adding more biodiversity to your diet. Be MORE Paleo, not LESS Paleo.
Eat more plants.
Drink more herbal teas.
I don't think I'll ever understand the segment of the Paleo community that rails against plants like we haven't shared the planet with them for over one million years pretty much breathing their oxygen while they use our carbon dioxide to make glucose (which is the only usable source of energy for our brain cells).
I'm on a tangent, sorry.
To sum it up, I highly doubt there is a destructive force lurking in the human body.
Cholesterol all the way.
6:30 AM jog with Melky my BTF (Boston Terrier Forever).
I won't be sucking wind.
on July 12, 2011
at 12:57 AM
I'm drifting into camp 3 on this one, if only because every fiber in my being screams, "NOOOOO!" whenever a doctor starts talking about controlling cholesterol. I feel that I've been blessed with a good BS detector, and whenever I run into the current incarnation of the lipid hypothesis it sets if off all sorts of alarms in my head. The numbers may very well mean something, but the common wisdom about how to apply the info just feels wrong to me.
on July 11, 2011
at 08:11 PM
I do think that there is a most desirable lipid profile. There seems to be a benefit to having more pattern A LDL to a point and having more of the good kind of HDL. The HDL is anti-inflammatory and supports the immune system, and the LDL seems to be inversely associated with many disease, conducive to better hormonal status, and exhibits antioxidant activity in the blood. There seems to be negatives to serum triglycerides like damage to the arteries. blocking leptin signaling and such. However if I looked at Jack's CRP, fasting glucose and insulin, oxidative markers and other stuff and I found that they were all good, and if he said he felt good, I wouldn't say that his triglycerides are a problem, they aren't high enough to be a marker of metabolic syndrome, or to be particularly pathological in themselves.
on July 12, 2011
at 04:37 PM
At this point I have read too much, and studied too much nutrition and biochemistry to ever subscribe to an anti-cholesterol/anti-saturated fat lifestyle. There is far to much fallacy in the belief that by focusing on a cholesterol-free/low sat fat diet that it will lead to a healthier/disease-free life. However, I don't think that it makes me a conditional skeptic to see that there is validity to things like LDL particle size, C reactive protein, or AA/omega-6 ratios. When a person becomes metabolically deranged, there are specific physiological adaptations that happen. There are some consistencies like elevated blood pressure, higher cholesterol, inflammatory biomarkers etc. that occur. They differ in every individual, that is why they are relative. Blood TC or TG levels by themselves are almost meaningless, but if you put them together with other bio-markers it can help paint a picture. Far to often we become reductionistic in our thinking that the body is so simple and that by manipulating specific bio-markers either with drugs or supplements we will become healthier. On the same token, we have become far too confident in deciding how healthy someone is by simply looking at their lipid panel or BP reading. This is the exact same allopathic thinking that got us where we are today. The paradigm needs to shift to a vitalistic or wellness approach, and understand that it isn't just food that will keep you healthy, but adequate physical movement and mental/emotional well-being also. Stress-physiology, whether from crap food, mental stress, or inactivity, will all produce similar physiology. Crappy insulin sensitivity, elevated inflammation, poor lipid bio-markers etc.... The more we get back to what nature intended for the human species (palo-type eating, primal moving, and community/relationship oriented communities) the healthier we become. Everytime.
on July 12, 2011
at 02:28 AM
To the unconditional skeptics: What of the well-understood process of atherosclerotic plaques forming from macrophages that become foam cells after consuming far too many oxLDL particles (a phenomenon that does not occur with normal LDL particles)? Yes, the systemic inflammation aggravating the endothelium plays a large and even pivotal role, but to ignore oxLDL seems a bit head-in-the-sand. And, all things being equal (a big caveat!), more LDL/small LDL would seem to imply more oxLDL.
Of course, eating paleo/primal/ancestral tends to help all these things, so I think the discussion is immaterial for most people who eat right. But just because cholesterol lipoproteins aren't the Big Baddie doesn't mean they are completely insignificant.
See Chris Masterjohn's article on the atherosclerotic process here: http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html
See the Jaminet's article on high LDL possibly being indicative of deficiency or other issues here: http://perfecthealthdiet.com/?p=2547
on July 12, 2011
at 01:16 AM
Unconditional = faith = crap, if you're trying to figure out how something works. Things seem to be dose dependent. I'm almost certain that literally everything we're being told about it by the boob tube is utter nonsense. Cholesterol is innocent until proven otherwise. But not unconditionally.
on July 11, 2011
at 06:46 PM
i'm in the #3 category. i eat paleo, feel great and basically don't worry about too much beyond that. funny thing is that when i was weighing well over 300 lbs my bp and lipids were pretty damn awesome. i haven't had them tested since i went paleo and to probably won't.
on July 11, 2011
at 08:02 PM
I'm unconditionally FOR controlling my LDL, using whatever means available. There's too much history in my family of arteriosclerosis and stroke to take a chance on being wrong. Whether it was from the high starchy carbs or high sat fat they ate, I'm not taking a chance on something that's easily controlled. And I'm also talking about end-of-life events. They lived to late 70's - maybe I could make to healthy mid 80's before something else wears out.
on July 11, 2011
at 10:21 PM
Low HDL and High TGs matter and they're both usually the result of eating too much fructose for too long. I think the 3 paths (which obviously often overlap) to a heart attack are 1) tobacco 2) synthetic trans fats and 3) fructose.
High LDL-C and TC seem to basically be indicators of an individual's dairy fat consumption. Whether or not that has some attached morbidity is anyone's guess.
on July 12, 2011
at 06:40 AM
I completely missed Kurt Harris's comment on Chris's blog. I raised this very same objection a few years ago in a yahoo group and we got into a big argument about the whole thing. "We" being myself, Chris, and a guy who used to call himself Bruce but now goes by the name Ian.
I just checked out Chris's post. Nice post and discussion though he didn't answer Kurt Harris. Thanks for asking the question.