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.