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We’re moving to www.getfitinchbyinch.com, my new website. Please bookmark the new site and see you there!
I am so proud of my colleagues. After an impromptu conversation one afternoon about a colleague’s frustration with his weight gain, I tentatively brought up the diet and lifestyle changes my family and I made almost 2 years ago and how it improved our physical and mental health, not to mention how we achieved (or almost achieved) our weight loss goals. I say tentatively because evangalizing does turn a lot of people off, and I prefer a more pull-strategy rather than a push-one.
What followed was an intense 4 way conversation (others gathered around), with rapid fire questions questioning me intently about evolutionary theory, the specifics of the diet, what one can actually eat and disbelief that certain kinds of fat can be good for you.
Despite the skepticism, the seed was planted and over the next couple of weeks, the topic would be raised multiple times, with great interest and some disbelief.
Because of what I was saying was such a paradigm-shifting idea, my two colleagues still had resistance. N would give me his patented raised eyebrows disbelieving look, especially on the topic of fat. D would repeatedly say “but what can you eat on such a diet?!” (a common intial refrain – my mother had the same reaction).
The skepticism completely disappeared when I decided to show them before and after pictures of my transformation as well as that of my sister (with her permission of course).
After more chats and more proof via success stories from Mark Sisson’s site, both of them jumped on board.
In order to help them with dishes, I created a one week plan to get them started and give them an idea of what to prep at home. This menu was based on what I created for my mother in early 2011. It was more to give them an idea of what to cook rather than a hard and fast menu plan.
I took further initiative and recommended Sarah Faragoso’ book EveryDay Paleo full of easy recipes, with ingredient lists that are not intimidating. N bought a copy and has had resounding success applying the recipes, including the meatloaf recipe which I have not yet attempted.
D, who was a sandwich and bagel eating vegetarian, started to eat chicken when she jumped on board paleo. She is still a little resistant towards red meat but I am sure she’ll come around in good time.
Her dishes are simply mouth watering and I drool looking at them. She noted she’s saving a lot of money by making her food at home. She’s also commented that she does not miss the sandwiches nor the bagels.
N, due to his self-proclaimed carb addiction, had a harder time initially due to being hit with a strong version of the carb flu. He reported dizziness, tiredness and headaches for a week. I had prepared him for it but the flu still took him by surprise.
Thankfully, he gritted his teeth and survived it.
Displayed in the pic above is a dish he personally prepared and brought to work. The pecan encrusted chicken is from Faragos’s cookbook while the cauliflower side dish is N’s own creation.
This video from TEDX featuring Dr. Terry Wahls made the rounds several months ago and is fascinating to watch. The good doctor suffered from multiple sclerosis, an auto-immune disorder that attacks the brain and spinal cord. The form Dr Wahls had was so virulent that it made her completely wheelchair bound.
In desperation, she re-hauled her diet after stumbling across paleo on the Internet. She started to fix her body at the cellular level using nutrient dense foods like grass-fed meats, vegetables, seaweed, fruits and organ meats (so nutritious yet so hated by Westerners).
NOT eating certain types of foods likely helped just as much as increasing her intake of nutrient dense food. She does not eat grains, sugars or dairy.
I really like this passage from her talk. It deserves to be quoted in full:
I am the canary in the coal mine, here as a warning to all of you. We have a choice. We can continue to eat that delicious, convenient, tasty processed food and watch ourselves and our children grow steadily more depressed, overweight and diabetic.
Or, we can continue to watch health care costs balloon out of control, bankrupting us individually and collectively as a country.
Or, we can eat for our mitochondria, eating vegetables and berries, organic grass fed meat, and seaweed, and have more vitality.
One person I know who was not moved by my entreaties, nor by the examples of people I helped, nor by the articles I sent him about achieving health via nutrient dense foods, nor by the books that influenced me, actually got convinced to jump on board and adopt this way of eating after watching this video.
It is that powerful.
Read Part I here
We had a two-pronged strategy
1.) Stop further deterioration of her mental faculties by not taking the statins anymore.
2.) Reverse and restore her memory and mental acuity through diet and supplementation.
It was still early days for me as well and I was debating whether I was sentencing my mother to cardiac arrest city if I recommended she stop the statins but because she hated that particular medication with a passion, she already took the initiative to flush the pills down the toilet before I was even said a word.
Of course, I kept her doctor in the loop and he was not happy but keep in mind that a doctor can only recommend. He can’t force anyone to take pills. We imbue doctors with a lot of authority and part of my own paradigm shift was to realize and act on the fact that we inidividually should take an active role in maintaining our health, and not give up so much control to institutional authorities, including doctors and the medical and pharmaceutical systems.
Next step was to start her on a paleo-ish diet, with lots of:
1.) Protein: Red meat (beef, lamb), chicken, eggs, fish.
3.) Natural Carbohydrates: Lots of vegetables and some fruits (later I realized she was overfond of fruits and tried to ban it but it is still a struggle for her).
4.) Fats: High fat dairy like butter and cream. Tropical oils like coconut oil.
What did I eliminate?
1.) Anything made from grains, sugar and vegetable oils.
2.) Anything processed.
3.) Anything that came in a box or a package.
4.) Anything low-fat including skim milk and fat-free yofurts (if it’s low fat then it’s high in sugar – the taste has to come from SOMEWHERE).
Essentially, I put her on a diet where her carbohydrate intake was under 50 grams a day. I was aiming for under 30 grams of carbs a day, making it a ketogenic diet, but knowing my mother, under 50 grams was a bit more reasonable as that would increase her rate of adherence. In contrast, the Canadian Food Agency recommends a daily intake of approximately 240-275 grams of carbs per day for a woman of my mother’s age.
Speaking of ketogenic diets, which have been found to be very effective for reducing epileptic fits in children, a pilot study revealed that these diets were found to be therapuetic for Alzheimers. Keto diets are an extremely high fat diet, and they supplying plenty of fat for the brain. The result is the brain is then able to use alternative energy sources (ketones) that skip pathways that synthesize glucose (main energy source when eating carb heavy Standard American Diet).
Back to my mother’s treatment.
I kept a food diary for her, for monitoring and tracking purposes, and below is an example of what she would eat in a day.
Breakfast: 2 eggs scrambled, cooked in butter, with cucumber and sausage. 3 beef sausages.
Lunch: Zucchini and eggplant lasagna with bechamel sauce (almond flour, parmesan cheese, 3.5% milk and 1 egg) and meat tomato sauce.
Dinner: 2 buttered oven-baked chicken breasts, marinated in mustard sauce. Spinach salad with tomatoes and cucumbers, with olive oil and lemon dressing.
Her and my father ate like royalty.
Hello my readers…sorry for the delay in writing…summer beckoned and I took a little hiatus. I am back though and I’ll start off with a post that I promised to write in this entry.
As I had mentioned before, one of the major catalysts that kicked off my interest in the link between health and diet was experiencing the shocking effect of my sharp-as-a-tack mother’s memory loss.
I found that there was a link between the statins she was prescribed and memory loss.
Complaints from patients who take statins, as per Dr Beatrice Golomb in this NYtimes article, include:
Being unable to remember the name of a grandchild, walking into a room and forgetting why you are there, or starting a sentence and being unable to finish. Some complain of personality changes or irritability.
My mother experienced some of these symptoms, including forgetting entire conversations and not knowing why she entered a room.
Our brains loves cholsterol (25% of our body’s cholesterol is found in the brain), and since statins inhibit cholesterol production there is a very strong link between Alzheimer’s and low cholesterol.
Who are the people at high risk for developing Alzheimer’s?
Dr Emily Deans wrote a passage that encapsulates the reason perfectly.
(Diabetics) are at higher risk for heart disease, and in the US at least they are very
aggressively statinized, especially in the last 10 years. It would be
considered malpractice for a primary care doc or cardiologist not to
encourage statin use in a diabetic with a whiff of high cholesterol. But it
seems quite plausible that drastically reducing cholesterol in combination with
the hyperglycemia of diabetes is the perfect storm for developing
This scenario fit my mother to a tee. She is diabetic and was strongly encouraged to take statins, which she did. At her lowest cholesterol levels (and highest A1C1 readings) she started to deteriorated cognitively, i.e. she started to forget things.
So in order to prevent further deterioration of her cognitive functions, she stopped taking the hated statins.
As she can be somewhat acrebic sometimes, she said: “I’d rather die of a heart-attack than lose my mind…at least the heart-attack will be quick”.
At that point, although she was willing to do what I recommended, she wasn’t quite fully convinced that I knew what I was talking about regarding diet. It was too much of a paradigm shift for her that meat and fats were good for you and things like bland “oatmeal”, which her doctor recommended as part of a “heart healthy breakfast”, was bad – that same oatmeal which would drive up her blood sugar sky high every day by the way.
It is a testament to her love and faith in me that, despite her skepticism, she put her life in my hands and we got to work.
P.S. Earlier this year, the FDA fnally put warnings on statins, advising that they could raise blood sugar levels and cause memory loss. About time.
The past couple of cholesterol posts were re-posts from Griff, a remarkable poster from Mark’s Daily Apple forums, who delved deep into existing research by reputable sources (check the end of this post for a references list) in order to give a thorough and comprehensive explanation of what cholesterol numbers mean.
Armed with this info last year, I got to work on my mother’s cholesterol panel history, mainly to check for trends and progression.
Below are my mother’s numbers from March 2011 (pre-paleo) and Dec 2011 (after several months of paleo).
March 2011 Dec 2011
TC 208 mg/dl (5.37 mmol/L) 257 mg/dl (6.69 mmol/L)
Trig 87 mg/dl (0.98 mmol/L) 65 mg/dl (0.74 mmol/L)
HDL 77 mg/dl (1.99 mmol/L) 85 mg/dl (2.21 mmol/L)
LDL Friedwald 113 mg/dl (2.93 mmol/L) 160 mg/dl (4.41 mmol/L)
LDL Iranian 112 mg/dl (2.93 mmol/L) 136 mg/dl (3.55 mmol/L)
Trig/HDL 1.13 0.76
Any person looking at this will immediately freak out at the increase in TC from March (before my mother adopted the diet) to December.
I didn’t feel like plugging in her numbers from all the way back from 2002 but rest assured that in March of 2011 she had her lowest TC numbers ever, mainly with the help of statins. According to conventional wisdom, that is the goal, to have very low cholesterol levels in order to reduce the risk of heart disease. However, this was also the time of her severest muscle pain and the start of her memory loss. Her body, due to the statins, reduced its production of the much needed cholesterol thus affecting the part of her body, her brain, that utilized it the most, as well as reducing the production of co-enzyme q10 which led to musko-skeletal pain all over her body.
After March, she cut out grains and sugar and all sorts of refined carbs, increased her intake of vegetables, proteins and saturated fat and attempted to reduce/moderate her dairy and fruit intake (her major weakness) and took supplements like cod liver oil, ubiquinol and coconut oil.
By December, after months on the diet, her fatigue and muscle pain were completely gone. For the first time in years she was able to sleep through the night because her legs no longer ached. She walked for hours, which she couldn’t do in the past due to pain. And best of all…she got back her memory, 100%.
In addition to the great body of evidence that is illustrating the lack of link between high cholesterol and cardio vascular disease, there is also a body of work that is finding that low cholesterol increases the chances of dying from a variety of causes. A study of old women showed that cholesterol levels of 270 was best associated with longevity (Forette, et al., 1989).
Here is a study from UCLA in 2009 that showed over 73% of people admitted to hospitals for heart attack had “normal” cholesterol and around 50% had “optimal” cholesterol levels.
Let’s go back to my mother’s numbers.
Her March Trigs (bad cholesterol) are high at 87 mg/dl. Notice how they dropped more than 20 points to 65 mg/dl by December, after months of doing paleo and reducing her refined carb intake. That’s great news.
Her HDL (good cholesterol) was 77 before she adopted the diet and then increased to 85, another big gain, mainly due to increasing her intake of saturated fats. Again, great news.
My mother’s doctor took one look at the increase in LDL and freaked out. Not so fast though. Recall that unlike HDL and Triglycerides, LDL is not a measured value but rather a calculated one, mainly because LDL particles are so small.
Most labs use the Friedwald equation to measure LDL, and the equation uses Trigs and HDL as factors in the equations.
Total – (HDL + [Trigs/5]) = LDL
But the Friedwald equation assumes that Triglycerides values are between 100 and 400. Anything less or greater skews the LDL result.
My mother’s Trig of 87 in March didn’t skew the LDL too terribly cause that isn’t far from a 100. However, her result of 65 in Dec does skew the LDL results dramatically. Using the Iranian equation for calculating LDL, which doesn’t make assumptions about Trig levels like in the Friedwald equation, my mother’s LDL value is reduced to 136 from 160. Not shabby.
Another option for people who want to get a more accurate reading of their LDL levels is to demand a VAP test which actually measures LDL vs having it calculated.
The most important indicator for propensity for cardiac arrest however, are ratios. Specifically the Trig/HDL ratio which indicates the level of risk for heart disease.
The Trig/HDL ratio will also indicate whether your LDL is small and dense (bad – Pattern B) or large and fluffy (neutral – Pattern A). A larger number indicates smaller LDL particles and a smaller number indicates larger LDL particles.
The ideal ratio of Trig/HDL is 2 or below. 4 is high. 6 is bad.
My mother’s Trig/HDL ratio went from 1.13 in March 2011 to 0.76 in Dec 2011. Excellent. Her risk of developing heart disease went even lower and the ratio indicates that her LDL is of the large and fluffy neutral kind, not the small dense plaque-building kind.
In conclusion, even if her cholesterol numbers increase, nobody will care because she isn’t going to change the way she eats and we know there isn’t much of a link between heart diseases and high cholesterol. We also do know that high cholesterol in women correlates positively with longevity and that low cholesterol in everyone correlated with developing a host of diseases and illnesses.
Continuing with Griff’s excellent post
CHOLESTEROL RATIOS, AND WHY THEY’RE MORE IMPORTANT THAN TOTAL CHOLESTEROL
There are three ratios that scientists have found which measure the impact of cholesterol in the body. These are the ratios between the total amount of cholesterol measured and the HDL (Total/HDL), between triglycerides and HDL (Trig/HDL), and between LDL and HDL (LDL/HDL). Each one is an indicator of something different. Many doctors don’t pay attention to these ratios, and that’s a shame, because they’re a far better indicator of cardiovascular health than the total cholesterol number. You’ll see why in a minute.
The ideal ratio of Total/HDL is 4.4 for women and 5 for men. Also, according to http://www.yourmedicaldetective.com/public/523.cfm and several other sites, the ratio of your trigs to your HDL will indicate whether your LDL is small and dense (bad – Pattern B) or large and fluffy (neutral – Pattern A). A larger number indicates smaller LDL particles and a smaller number indicates larger LDL particles. It’s an inverse relationship.
The ideal ratio of Trig/HDL is 2 or below. 4 is high. 6 is “danger!!” This ratio indicates the level of risk for heart disease. Additionally, a low ratio of Trig/HDL is great because it’s a semi-reliable indicator of lower free insulin levels. Lower free insulin is good. (However, this doesn’t appear to work for those of African descent, so take that with a grain of salt.)
The ideal ratio of LDL to HDL is 4.3 or lower. 4.4 to 7.1 is average. 7.1 to 11 is moderate. 11 or more means you’re at high risk for developing heart disease. The ratio of LDL to HDL is considered to be a marker of carotid plaque, or how much plaque you have built up in your arteries.
THE BOTTOM LINE
So if we look at Joe’s results (using the Iranian equation), his ratios are:
Total/HDL: 250/70 or 3.57 (ideal = 5 or below)
Trig/HDL: 40/70 or 0.57 (ideal = 2 or below)
LDL/HDL: 129/70 or 1.84 (ideal = 4.3 or below)
Even if we use the Friedewald equation (with its misleading, overestimated LDL), Joe still does pretty well:
Total/HDL: 250/70 or 3.57 (ideal = 5 or below)
Trig/HDL: 40/70 or 0.57 (ideal = 2 or below)
LDL/HDL: 172/70 or 2.45 (ideal = 4.3 or below)
In all cases, Joe’s ratios are well below the “ideal” – and being below the ideal is awesome. And look at that ratio of trigs to HDL! It’s a great indicator of lower free insulin levels for Joe, and the ratio of Total/HDL also says that his LDL is probably (mostly) Pattern A.
Let’s compare that to Pat, who’s been on a low-fat, high-carb diet and exercising with chronic cardio, and whose doctor thinks he’s doing really well because his cholesterol tests came back with these numbers:
LDL (calculated with the basic Friedewald equation): 131, or (calculated with the Iranian equation): 153
Pat’s ratios are:
Total/HDL: 180/25 or 7.2 (ideal = 5 or below)
Trig/HDL: 120/25 or 4.8 (ideal = 2 or below)
LDL/HDL: 131/25 or 5.24 (Friedewald LDL); 153/25 or 6.12 (Iranian LDL) (ideal = 4.3 or below)
Compared to Joe, Pat’s got one foot in a heart disease grave! His Total/HDL is way above the ideal, his trig/HDL is in the “nearly danger” zone, and his LDL/HDL says “Look, you’re at average risk for heart disease and heading higher.” But if the doctor only focuses on total cholesterol, Joe’s the one who’ll be put on a statin, while Pat might be advised to find ways to bring up that HDL number a little bit, if his doctor does anything other than congratulate him on his “good” cholesterol numbers. And way too many doctors focus only on total cholesterol.
One of the most valuable pieces of research I came across, on the journey to improve my mother’s and family’s health, was a comprehensive and thoroughly researched post by poster Griff on Mark’s Daily Apple on how to read your cholesterol panels and what the numbers really mean.
I’m quoting the entire thing below. This man, an academic by training, has performed a huge public service synthesizing his research into understandable English. My mother’s doctor didn’t know what hit him when I came to our meetings fully armed with a list of questions to ask based on Griff’s research below (in turn sourced from medical and scientific sources – click on his name link above to get list of sources).
Btw, the cholesterol numbers used in Griff’s post use milligrams per deciliter blood (mg/DL) which is used in the US. Canada and the rest of the world uses unit millimol per litre (mmol/L). I’ll insert the Canadian values in brackets next to the US ones.
DEFINITIONS OF TERMS
Total cholesterol: This is the total of all three kinds of cholesterol: HDL + LDL + Triglycerides. Each of them has a different function inside the body.
The recommended level of total cholesterol these days is 200 mg/DL or less (under 5.20 mmol/L).
Cholesterol: A waxy substance that is actually an alcohol (hence the -ol suffix). It’s carried by lipoproteins (fats and proteins) through the water-based environment of the bloodstream (remember that water and oil don’t mix). It’s necessary to sustain cell wall integrity and to repair damaged cell walls within (among other places) the arterial system of the body. Many things can damage the cell walls in the arteries and veins, including (but not limited to) stress, high blood sugar, high insulin levels, and lack of physical activity. When damage happens to these cell walls, the body has to do something about it. Normally, it will repair them with saturated fat and protein, which is what cell walls are made of, but if we’re not eating those things, the body can’t produce them out of thin air, so it sends cholesterol in as a stopgap measure. Your body uses cholesterol to make a “patch” over cell walls that need to be repaired, but if we don’t give it the proper amount of raw materials (saturated fat and protein) to repair them with, the patch will stay there, and like any old bandage, eventually start to peel off. In the absence of the proper raw materials, the body slaps another layer of cholesterol over them to make sure that the patch doesn’t break. This is where cholesterol buildup, or plaque, in the arteries comes from. The longer the body has to go without the right raw materials, the worse the problem gets, and these plaques can eventually break off, just like a scab on the outside of your body does, and block up the arteries, causing a heart attack or a stroke. The technical term used for “increases risk of heart disease” is “atherosclerotic,” which, translated out of its non-English roots, means “athero” (artery) “sclerotic” (hardening).
One of the problems with the way that current medical science treats cholesterol is that it doesn’t recognize the function of cholesterol. It just sees higher cholesterol readings and naively assumes that since high cholesterol and heart disease “seem” to go together, that cholesterol must be the cause of heart disease. The real cause of heart disease is what causes both the damage to the cell walls and the (ideally) temporary patches of cholesterol: not enough of the right raw materials being given to the body, and too much of the stuff that damages the cell walls being given to the body – to wit, too many carbs and not enough saturated fat or protein. It’s like blaming firemen for a fire, or blaming a bandage for the wound, and saying “if we take away some firemen, the fire will die out,” or “if we take the bandage off the wound, the wound will heal without help” (even though it’s usually a wound that needs stitches in order to close up and heal). It’s overly simplistic, it’s a junior-high-school-level mistake, and it makes no sense.
LDL (Low-Density Lipoprotein): This has been blamed as the “bad” cholesterol because its job is to go around inside your body, bringing cholesterol from the liver to spots that need repair, and placing cholesterol “patches” on them. There are two types: Pattern A and Pattern B. Sometimes you’ll have a mixed bag: Pattern A/B, some of each. When you have a VAP test, this is part of what gets reported. Pattern A is “large and fluffy” and non-atherosclerotic, like a cotton ball. Pattern B is “small and dense” and atherosclerotic, like a BB pellet. You want to have Pattern A. Pattern B is sometimes called “oxidized” cholesterol, and because it’s so small and dense, it can penetrate the endothelium (the thin layer of cells that line the inside of the blood vessels), just like a BB pellet penetrates skin. So Pattern B LDL is worrisome, because it can also cause damage to the cell walls inside the arteries. LDL becomes Pattern B due to a number of reasons, but one of the main ones is insulin resistance. If you lower your insulin resistance (which low-carbers almost always manage to do), then your LDL Pattern B goes down, which is good.
The recommended level of LDL these days is no more than 150 mg/DL (under 3.4 mmol/L), and most doctors now want it below 100.
HDL (High-Density Lipoprotein): This is considered the “good” cholesterol because its job is to go around inside your body and clean up used cholesterol. HDL goes around after the patched area has been repaired, and cleans up the old cholesterol patches, taking them back to the liver for processing and breakdown. You can see why HDL is high-density: it carries old cholesterols with it to the liver, so it’s got lots of tightly-packed stuff on it, hence high-density. Low-density LDL is just the opposite – it’s dropping cholesterol here and there, so it’s no longer as dense.
The recommended level of HDL these days is at least 40 mg/DL (1.3 mmol/L) for women and 50 mg/DL (1.0 mmol/L) for men. Some recommendations are “get it above 60.”
Triglycerides: The “cholesterols” made in the liver from the carbs you eat. They are technically not cholesterol at all, but fat. They’re used by cells for energy. A third kind of cholesterol called VLDL (very low-density lipoprotein) carries triglycerides around in the body, delivering them to cells for energy. When VLDLs lose most of their triglycerides, they become smaller and denser, and now they’re LDLs instead of VLDLs. Triglycerides can shoot the level of VLDL way, way up – the more triglycerides you have, the more VLDL is needed to move it around the body. So if you’re eating lots of carbs, your triglycerides are going to be higher, and since VLDL becomes LDL when it deposits its triglycerides into the cells, your LDL will also be higher.
The recommended level of triglycerides these days is under 150 mg/DL (1.7 mmol/L).
EQUATIONS USED FOR CHOLESTEROL MEASUREMENT
There are two equations used today for cholesterol measurement. The first one, and the one most commonly used, is called the Friedewald equation. It works fine as long as your triglycerides are at least 100 and below 400, but outside of that range things get wonky. And the main problem is, when your triglycerides are below 100, it overestimates LDL levels. A quick rundown:
The Friedewald formula used to calculate total cholesterol is:
LDL + HDL + [Trigs/5] = total.
But because LDL are so small in comparison to the other particles, what they usually do is calculate your LDL. They measure your HDL, your Trigs and your Total – so the equation becomes:
Total – (HDL + [Trigs/5]) = LDL.
Because this equation miscalculates LDL if you drop below 100 trigs, I’d recommend that you always, always demand a VAP test, which is a direct measurement of the LDL. People who restrict carbs usually have very low triglycerides, which means that we’re going to have problems if the lab uses the Friedewald equation to calculate our LDL levels. According to Dr. Mary Vernon, “These labs in which the LDL is calculated are not accurate if your triglycerides are below 100… The equation used to calculate these numbers makes assumptions which are not accurate when triglycerides are low.” (from http://www.livinlavidalowcarb.blogsp…t-results.html).
To give an example of how it doesn’nt calculate LDL correctly, let’s look at a hypothetical cholesterol result. Let’s say that Joe the Primal Dude goes in for a lipid profile after six months on the Primal diet. Here’s his results (before they do the LDL calculation):
Total: 250 (ideal <200)
HDL: 70 (ideal >60)
LDL: ? (must be calculated) (ideal <100)
Trig: 40 (ideal <150)
This is a common profile for someone who’s been low-carbing/eating Primally for a while. Now, when we put that into the Friedewald equation, here’s what we get:
250 – (70 + (40/5)) = LDL
250 – (70 + 8) = LDL
250 – 78 = LDL
250 – 78 = 172
This may give Joe’s doctor a heart attack if he doesn’t know what he’s looking at, as many doctors don’t. To him, Joe’s LDL and total cholesterol levels are way above the “ideal” numbers, and that must mean that Joe is headed for a heart attack or a stroke if he doesn’t take a statin drug immediately and get those numbers down.
For many doctors, this level of analysis is as far as they go. The nuanced information about the two types of LDL is something they either don’t have or aren’t aware of. And recognizing that if Joe’s HDL were lower, his total cholesterol would be lower too – they don’t often see that, either.
However, there is a newer equation, called the Iranian Equation, that does a better job of calculating LDL when trigs are below 100. That equation is:
(Total/1.19) + (Trig/1.9) – (HDL/1.1) -38 = LDL
Let’s plug Joe’s numbers into this equation and see what we get.
(250/1.19) + (40/1.9) – (70/1.1) – 38 = LDL
210 + 21 – 64 – 38 = LDL
231 – 102 = 129
Look at that. It’s a difference of almost 50 points in Joe’s favor. With the Iranian equation, his numbers come out to:
Part of the reason the Friedewald equation doesn’t work so well is that Trig/5 issue. The Friedewald equation assumes that anything that isn’t HDL or triglycerides is LDL. LDL is the “leftover” number. Well, when your trigs are 200/5, the number it will subtract from the overall total is 40, but when your trigs are 40/5, the number it will subtract from the overall total is 8. That’s a big difference, because the smaller your trigs are, the more of the “leftover” number in the equation gets attributed to LDL, and that’s really misleading.
For Canadian and other non-US readers, go to these cholesterol conversion calculator to figure out your numbers.
Part II coming up.