Cholesterol panels are a source of constant confusion for many people. And most doctors are no help, having been brainwashed by marketing from the drug industry, who pass off clinical trials as “science,” studies bought and paid for by the pharmaceutical industry to drive statin drug sales, with exaggerated results reported via absurd statistical manipulations (e.g., reporting “relative risk” rather than absolute risk, a misleading way to play games with numbers, a topic to discuss in future).
Sandy shared her lipid panel 2 1/2 years into her Wheat Belly experience:
“Got some blood work done, including cholesterol. I’m confused. Not sure after 2.5 years of this WOE if I’ve improved or not. Seems some has improved, but total cholesterol went up. Can someone tell me if these results are good? I don’t fully understand the numbers. Thanks for any help!”
Of course, the rise in cholesterol prompted a discussion at the doctor’s office about whether the high cholesterol should be “treated” with a statin drug. Let’s therefore take apart what has happened to Sandy’s cholesterol panel and show why any discussion about statin drugs is unnecessary and ridiculous.
Let’s take each parameter, one by one:
- HDL cholesterol–HDL cholesterol is a wonderful index of overall health and a reflection of several genetic patterns but, in general, the higher the HDL, the healthier you are, the lower the cardiovascular risk, the greater the hope for longevity. (Centenarians typically have HDL values greater than 100 mg/dl, for instance.) Sandy increased her HDL value on the Wheat Belly lifestyle from a low value of 42 mg/dl that was indeed associated with markedly increased cardiovascular risk (and I’ll bet was never once mentioned by her doctor) to an impressive 127 mg/dl—spectacular, an increase of 85 mg/dl or 300%, a level associated with incredible health, freedom from cardiovascular disease, and longevity, all achieved through the Wheat Belly strategies without drugs.
- Total cholesterol–This is the high value that many doctors try to “treat” when there is nothing to treat. Of the 279 mg/dl total cholesterol, 127 mg/dl of that value is the cholesterol contained in the HDL fraction. In other words, total cholesterol went up . . . and that’s good! Besides, total cholesterol is a miserable marker for risk because it is a composite of too many variables (total cholesterol = LDL cholesterol + HDL cholesterol + triglycerides/5—a mixture of good and bad.) The most recent analyses, such as the HUNT Study 0f 52,000 Norwegians, have debunked the notion that total cholesterol is a useful marker for cardiovascular risk. There are also subsets of people who experience reduced cardiovascular risk with higher levels of total cholesterol. So what exactly is Sandy’s doctor trying to treat with drugs?
- Triglycerides–Although I cringe at the inaccuracies and imprecision of cholesterol panels (as compared to superior advanced lipoprotein analyses that more confidently reveal sources of cardiovascular risk, such as NMR lipoprotein panels that I have used for 20 years), triglycerides are my favorite marker and, despite the uselessness of some of these values, is indeed a reliable and useful marker. Triglycerides reflect the level of very low-density lipoproteins, or VLDL, in the bloodstream. I therefore use triglycerides and VLDL as interchangeable terms. Triglycerides reflect a number of important metabolic phenomena, including blood sugar and insulin status (high triglycerides in type 2 diabetes, for instance), carbohydrate intake (via liver de novo lipogenesis, or the conversion of carbs to triglycerides), and volume of visceral fat that is made up of triglycerides that are continually released by fat cells into the bloodstream, then re-uptaken. (Although dietary fats are actually made of triglycerides, the contribution of dietary fat to fasting triglyceride levels is negligible, with some rare genetic exceptions. The relative contributions of carbs vs. fats in non-fasting, or postprandial, settings is an entirely different conversation.) High triglycerides/VLDL are also associated with having lots of small LDL particles, a potent cause for heart disease. Sandy dropped her high triglyceride level of 405 mg/dl, a level associated with high blood sugars, insulin resistance, lots of dietary carbs (e.g., grain amylopectin A), and lots of visceral tummy fat, to a wonderful 57 mg/dl. A triglyceride level of 60 mg/dl or less signals low VLDL levels, dramatic reduction or elimination of heart disease-causing small LDL particles, a drop in blood sugar and insulin resistance, and loss of visceral fat. In other words, the drop in triglycerides is a terrific marker for a dramatic reduction in cardiovascular risk and improvement in overall health. Once again: what exactly was Sandy’s doctor trying to treat?
- LDL cholesterol–Virtually all clinical trials sponsored by the drug industry focus on LDL cholesterol as the treatment target, since even they recognize that total cholesterol is a ridiculous number of no value whatsoever. But LDL cholesterol is a value that is not even measured in most cholesterol panels, but obtained via rearrangement of the Friedewald cholesterol equation from 1960: LDL cholesterol = total cholesterol — HDL cholesterol — triglycerides/5. The equation is easy to perform but only holds if you make some assumptions. You assume, for example, that everybody eats the same diet, that nobody is diabetic or pre-diabetic, and that triglycerides make no contribution to the composition of other lipoprotein particles. All of this, of course, is patently untrue, especially when you eliminate wheat, grains, and sugars from the diet, lose weight, and incorporate practices such fish oil omega-3s and cultivate healthy bowel flora. In other words, calculated LDL cholesterol is invalid—it has no value whatsoever, as it is essentially fictitious and wildly unreliable. (Unreliable to the tune of $23 billion per year to the drug industry, however.) LDL cholesterol values, even if measured, also fail to reveal that low-density lipoprotein, LDL, particles are a widely varied collection of particle types, from small, oxidation-prone particles that last up to 7 days in the bloodstream, to large, oxidation-resistant particles that last only 24 hours. (And LDL cholesterol, like total cholesterol, is a lousy marker for risk with higher levels often suggesting lower cardiovascular risk.) To truly assess what the LDL particles measure and look like, an advanced lipoprotein analysis is required—but is never performed in drug company-sponsored clinical trials. One of the reasons for this is that the real cause for heart disease—small LDL particles—is handily reduced, typically eliminated, by diet, i.e., elimination of wheat, grains, and sugars. Dietary treatment is free and yields no pharmaceutical pot of gold. So why should Pfizer, GlaxoSmithKline, or Merck pay any attention to it?
I hope that you now appreciate how absurd it is that Sandy’s doctor, in the typical superficial and cursory way of most doctors, insisted on “treating” cholesterol. There is no basis for treatment in the values on this cholesterol panel. In truth, Sandy has improved her health immeasurably in numerous ways and her cholesterol panel, if anything, suggests dramatically reduced cardiovascular risk achieved without drugs. “Treating” cholesterol in this situation would be about as helpful as conducting an exorcism to ward off the bogeyman.
You’ll find a more extended discussion about these issues in the Wheat Belly Total Health book, specifically chapter 10, “Metabolic Mastery.” Know that statin drugs can be useful for a very small percentage of the population with specific genetic disorders and for people who make no effort to correct their diet. But the vast majority of us obtain no benefit and incur only risk (e.g., 30% increased risk for type 2 diabetes) and expense by taking these terribly over-hyped drugs.