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Why Do Most Doctors Seem Clueless When It Comes To Understanding Cholesterol?

Posted Apr 26 2010 9:09am

Being a member of the highly-respected medical profession has got to be one of the most rewarding experiences for those who choose to invest and educate themselves for many years to serve the general public with the knowledge they’ve obtained through all of this intense training. It’s not an easy road to obtain those letters after you name signifying you have the credentials to practice medicine on patients who have a medical need. Let me just say up front that I have nothing but great respect for those people who decide to become a nurse, doctor, naturopath, chiropractor, and any number of other healthcare-related careers. It’s a very noble profession in my eyes and I for one am glad they do what they do for those times when I or a family member have needed or will need medical assistance.

But there’s one thing that really bothers me about the practice of medicine as it exists in the year 2010 and it’s this: I can’t help but notice there seems to be an obvious disconnect between a doctor’s complex understanding of the way the human body functions and the impossible-to-miss nutritional component of it all. Sadly, much of this way of thinking is based on some rather shifty “science” that was pushed on our culture primarily by Ancel Keys and George McGovern decades ago (read Gary Taubes’ brilliant Good Calories Bad Calories book for the full scoop on this story!), but all the latest 21st Century research is showing some truly remarkable signs that maybe saturated fat isn’t so bad for heart health after all and that perhaps it’s not the total or LDL cholesterol that’s most important but the particle size that matters the most . You’re just not hearing a lot about these kind of ideas from the mainstream medical world right now and that’s truly baffling to me if the goal is to make people as healthy as possible while educating them on how to prevent cardiovascular health problems down the road.

In light of all we know about the irrelevance of LDL when your HDL is above 50 and your triglycerides are below 100 , receiving cholesterol test results from people who are “concerned” about their heart health is rather disturbing to me–especially when their numbers come in and look simply spectacular. There’s a real worry out there that people have when they think they’ve crossed some kind of threshold where they begin fearing having a heart attack or stroke. It’s what Dr. Marshall Deutsch referred to in my July 2009 podcast interview as the “fat nocebo effect.” Here’s one recent example of a woman who shared the results of her NMR LipoProfile test with me and she wanted to know if she was okay or not:

Hi Jimmy,

Would you mind looking at my NMR Lipoprofile results? I’m meeting with the doctor on Monday and was wondering what you thought.

LDL-P: 1354
Small LDL-P: 151
Total cholesterol: 249
LDL-C: 159
HDL-C: 85
Particle size: 21.1
Triglycerides: 27
Large HDL P: 19.1
Large VLDL P: below 0.7

Most doctors would look at these results and zoom in immediately on just two numbers: Total and LDL cholesterol. They think total cholesterol should be below 200 and that LDL cholesterol needs to be under 100. But why? What is the purpose of lowering these numbers to those levels? Ask any physician that question and you’ll probably get an answer like, “Well, that’s the standard we’ve always used.” But WHY?! Is there any measurable improvement in heart health by bringing those cholesterol numbers down to those levels? Nope.

And how do most primary care doctors intend to treat this “high” cholesterol? Well, they say you need to lower your fat intake, exercise more, and take a statin drug like Lipitor or Crestor, of course. But we already know statins lead to some disturbing health side effects that are much worse than any supposed “danger” you could ever have from your “high” cholesterol (see the “Statin Effects Study” out of The University of California at San Diego for more information). I’ve always challenged people who say you NEED to lower your cholesterol to prove it’s unhealthy . Nobody can ever sufficiently answer that question. Cholesterol numbers are indeed dropping , but at what negative cost to our health in the process? We know having low cholesterol levels could lead to depression, suicide, and even death , so why do we continue to pursue artificially pushing the numbers down?

To my reader who sent me her NMR LipoProfile test results, let me just say that you have INCREDIBLE numbers that indicate you are low-carbing well–VERY well. How, you may ask? Well, I generally look at three specific things on this test: HDL, triglycerides, and small LDL-P.

HDL–A reading of 85 is indicative that you don’t skimp on your fat intake (especially saturated fat) and that you understand the purpose of consuming a large quantity of fat as a percentage of your total caloric intake. Fat becomes the fuel for your body in the absence of carbohydrate and the result of this added fat that your body craves in a corresponding rise in HDL “good” cholesterol. Consuming fatty foods like butter, coconut oil, animal fat, lard, and other sources is a great way to boost your HDL well above the 50 that is the target for people who are livin’ la vida low-carb. You are well above that mark!

Triglycerides–A bottoming out of this at 27 clearly tells me that you have a solid control of your carbohydrate intake most likely at a ketogenic level (below 50g daily). This is an essential element of lipid health that is often overlooked in the weeping and gnashing of teeth over LDL and total cholesterol. But anyone who’s been low-carbing for at least a few months will tell you one of the most noticeable impacts on their lipid health that happens when you cut the carbs is your triglycerides drop like a rock! Keeping your triglycerides under 100 is much more important than worrying over what you LDL cholesterol is and you’re doing a bang-up job of it!

Small LDL-P–This number gets to the crux of the best news with your overall test results. In all, you have 1354 LDL particles floating around in your blood. Of those, there are only about 12 percent that are comprised of the small, dense, and dangerous kind of LDL cholesterol. The other 88 percent of your LDL particles are the large, fluffy, and protective kind that will not penetrate the arterial wall and lead to cardiovascular issues. Have you heard from any doctor or other medical professional that there is such a thing as “good” LDL cholesterol? It’s not widely communicated to the public because this would totally destroy the diet-heart hypothesis and multi-billion dollar statin drug industry that much of our treatment of heart health has been based on for much of the past three decades. Your numbers are fantastic and nobody should ever tell you otherwise.

Your total cholesterol of 249 is completely meaningless and I’m sure your conventional wisdom doctor will try to put you on some kind of a statin drug to “lower” your LDL of 159–but don’t do it! There’s no scientific reason to ever take a prescription pill like that especially for women. Read Lesson #2 of 21 Life Lessons From Livin’ La Vida Low-Carb where I explain more on this subject. Arm yourself with all the facts before going to see your doctor. You are doing VERY well, my friend and should be quite proud of your progress. Keep it up!

Following her doctor visit, this reader wrote me back to let me know what happened:

I just wanted to tell you that my doctor actually did not recommend a statin–so that was good. She said the large, fluffy LDL made my lab results “somewhat more favorable,” but that the total cholesterol of 249 still mattered to her. She recommended a change in my diet and something she called “Omega 3-6-9″ for reducing the total cholesterol. She also suggested a low-fat diet and I didn’t think quickly enough to counter that a low-fat diet would drive up my triglycerides and thus drive the LDL upwards. The way we left it, I said I would try the “Omega 3-6-9.” Wish me well!

You are already doing extremely well and I’m so proud of you for realizing lipid health is much more than about LDL and total cholesterol. The omega blend will certainly help improve your numbers even more as long as it is in conjunction with a high-fat, adequate protein, low-carb nutritional approach. Keep me abreast of your progress and I can’t wait for you to see your numbers continue to improve. While your doctor may continue to think total cholesterol numbers above 200 “matter,” the fact is they don’t and are actually estimated. Keep learning about lipids and be proud of your HDL above 50, triglycerides below 100, and small LDL-P mostly nonexistent in your body. It’s a sure-fire sign you are livin’ la vida low-carb and reaping the amazing benefits this way of eating has to offer you! CONGRATULATIONS!

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