Let’s not worry about the total cholesterol or total LDL. Those figures are close to meaningless. The best indicators of possible heart disease we can find in a standard lipid panel are the triglycerides and HDL. Triglycerides are a type of blood fat, but fasting triglycerides are mostly a reflection of how many refined carbohydrates you eat. His are pretty good for a diabetic. The HDL looks pretty decent too, but it could be higher. Eating more natural fats will do that. Let’s look at the ratio of triglycerides divided by HDL. That’s a better predictor of heart disease than total cholesterol or LDL, because it will give us an idea if his LDL is the large, fluffy variety or the small, dense variety …
Afterwards, she said it would be helpful if I could write up some kind of guidelines to help her interpret those numbers in the future. I never got around to writing those guidelines, but now I don’t have to. I’ll just send her a copy of Jimmy Moore’s latest book, Cholesterol Clarity: What the HDL Is Wrong With My Numbers?
The Clarity part of the title is appropriate because (let’s face it) there’s a lot of confusion out there about cholesterol. Most people have a vague (and incorrect) notion that too much fat and cholesterol in the diet will cause heart disease by raising cholesterol levels in our bloodstreams. Some have heard that LDL is the “bad” cholesterol and HDL is the “good” cholesterol, but that’s where their knowledge stops. Pretty much everyone believes the lower your cholesterol, the healthier you are. I even once read an online comment from a vegan who was upset that her cholesterol was “normal” because she believed that by avoiding animal products completely, her cholesterol level ought to be close to zero.
It’s that kind of confusion about cholesterol and health that Cholesterol Clarity (which Jimmy wrote with Dr. Eric Westman) aims to dispel in language the non-medical crowd can easily understand. As the introduction explains:
If you like straight talk that cuts through the muckity muck, you’ve come to the right place. The title of this book is Cholesterol Clarity for a reason: The intention is to make the truth about cholesterol absolutely clear. This book is not for medical geeks. It’s not filled with complex terminology and jargon that makes the layperson’s eyes glaze over. There are, for sure, a few technical terms you need to know, but we’ve provided a convenient glossary of terms in the back of the book that will explain everything for you in a language you can understand. In addition to examining the current recommendations for cholesterol levels and why they may not be valid, we will provide a practical guide to all the major cholesterol numbers, their ideal ranges (which are likely much different from what you have been told), and what specific actions in your diet and lifestyle you can take to address any troubling areas in your cholesterol profile.
After the introduction, Jimmy anticipates a question readers who don’t know him may have – why should I listen to a guy who isn’t a doctor? – and answers it by introducing the panel of experts he consulted when writing the book. You’re no doubt familiar with many of the names: Dr. Malcolm Kendrick, Dr. William Davis, Dr. Duave Graveline, Dr. John Briffa, Dr. Uffe Ravnskov and Dr. Chris Masterjohn, to name just a handful of the 29 people listed – people who actually understand what cholesterol does and doesn’t do to us. They are all quoted liberally throughout the book. (And as usual, some of Dr. Kendrick’s comments will make you chuckle.)
Jimmy, of course, has a vested interesting in understanding cholesterol and heart disease. His brother Kevin died of heart disease at age 41. Jimmy’s doctors have pestered him for years about his high cholesterol, and yet he scored a zero on a calcium test, which measures the plaque in coronary arteries. Back before he knew better, he even took statins and suffered through the side effects.
The easiest way to describe what the book covers is to list the chapters, so here they are:
What Is Cholesterol and Why Do You Need It?
Forget Cholesterol—It’s the Inflammation
What Do Major Health Groups Say about Cholesterol?
Doctors Are Questioning the Anticholesterol Message
Statin Drugs: Magic Pill or Marketed Poison?
What Does Heart Healthy Really Mean?
Why Low Fat Ain’t All That
Carbs and Vegetable Oils: The Twin Villains
What’s This LDL Particle Thing?
Forgotten and Ignored: Triglycerides and HDL
The Experts Weigh In on Key Heart-Health Markers
Why Are So Many Doctors Clueless about Cholesterol?
What Do You Mean My Cholesterol Is Too Low?
Nine Reasons Why Cholesterol Levels Can Go Up
I’m Still Worried about My High Cholesterol!
But Aren’t the Cholesterol Guidelines Based on Solid Science?
The Low-Fat, Vegetarian Myth
How Your Doctor (Mis)Interprets Your Cholesterol Test Results
What Your Basic Cholesterol Test Results Mean
Eight Advanced Health Markers You Should Consider
Test Your Ability to Read Cholesterol Test Results
Now That You’ve Been Enlightened, What Happens Next?
At the end of each chapter, there’s a bullet-point summary.
The chapter titled What Is Cholesterol and Why Do You Need It? would be comforting to the vegan who was upset that her cholesterol level wasn’t near zero. Here are a couple of quotes:
Cholesterol is a waxy, fatlike substance produced primarily in the liver. It is absolutely essential to the life of humans and animals; without it, our cells could not repair themselves, we could not maintain proper hormone levels, we could not properly absorb vitamin D from the sun, we could not regulate our salt and water balance, and we could not digest fats.
Did you know that cholesterol has some amazing antioxidant properties that can actually help guard you against heart disease? Ironic, isn’t it? There are many reasons why your cholesterol levels might go up: It could be your body’s response to inflammation (a critical concept we’ll discuss in chapter 2), or it could be a sign that part of your body is malfunctioning—maybe, for example, your thyroid function is low. We’ll get into these and the other possible reasons for elevated cholesterol levels later on in the book. For now, all you need to know is that cholesterol is a major line of defense when your immune system comes under attack. So lowering cholesterol levels artificially with drugs could make you more susceptible to germs or bacteria wreaking havoc on your health.
That chapter also includes an explanation of where the Lipid Hypothesis came from and why it was never based on solid science. The next several chapters cover the standard-issue “expert” beliefs about heart disease, the likely true causes of heart disease (inflammation being chief among them), and why artificially beating down our cholesterol levels with statins is usually a bad idea.
After exonerating cholesterol and pointing the finger at inflammation, the book explains why diets that restrict saturated fat and cholesterol aren’t the key to avoiding heart disease. As we Fat Heads know, those diets can, if anything, make the situation worse. Swap fats for processed carbs, and you spike your blood-sugar levels. Swap saturated fats for processed vegetable oils, and you increase your intake of inflammation-producing omega 6 fats.
Yes, vegetable oils can lower LDL, but as clinical research quoted in the book demonstrates, that doesn’t translate to a lower risk of heart disease. In at least one major study, men who lowered their LDL levels by sucking down polyunsaturated vegetable oil ended up with a higher rate of heart attacks. Why? Because what matters most is the type of LDL your body is producing, as the book explains in chapter 9:
There are two major classifications of LDL particles that can be measured: Pattern A is the large, fluffy, and generally harmless kind that is described as “good” LDL (yes, there is such a thing); Pattern B is the small, dense, potentially dangerous kind that is described as “bad.” Pattern B LDL can easily penetrate the arterial wall, compromising your heart health. This is what you are trying to avoid at all costs, so knowing the breakdown of your LDL particles is critical to determining overall heart health.
A standard lipid panel doesn’t distinguish between Pattern A and Pattern B. In fact, on a standard lipid panel, the LDL is calculated, not measured. If your doctor isn’t interested in knowing what type of LDL you’re producing, you can find out for yourself. The book lists some web sites where you can order tests that measure LDL directly and determine the particle size, not just the count.
The next several chapters explain the markers that actually matter (triglycerides, HDL, etc.) and how to interpret them if you’re looking over the results of a cholesterol test. These are the chapters that answer the questions my mother-in-law was asking me when we were going over my father-in-law’s lipid panel: Which numbers should I be looking at? What do they mean? Is this number too high, too low, or about right?
Some cholesterol skeptics insist that lipid panels are completely useless and nobody should bother even looking at them. I don’t agree, and I’m happy to say Jimmy doesn’t either. If your triglycerides are through the roof, if your HDL is in the cellar, those are indications that something could be very, very wrong with your diet or your metabolism. As the book explains in one of the later chapters, a dramatic change in your lipids can also signal an underlying health problem that’s affecting your cholesterol, such as hypothyroidism, infection, stress or hormonal imbalances.
The point of the book isn’t that lipid numbers don’t matter – they do. But as Dr. Dwight Lundell is quoted as saying, it’s important for people to educate themselves about what those numbers mean. If your HDL is 75 and your triglycerides are 62 (excellent numbers) but your total cholesterol is 220, all you’re likely to get from the average doctor is a lecture about your cholesterol being too high and a recommendation for a low-fat diet or a statin. If you don’t know any better, you’ll end up following advice that will make your lipid panel (and your health) worse, not better. That’s why educating yourself matters.
Cholesterol Clarity is an excellent, easy-to-read resource for those who want to educate themselves.
And yes, I’m going to send a copy to my mother-in-law.