On Sun, 13 Sep 1998, Ilya wrote:

> I keep wondering if total cholesterol figures are nearly meaningless as far as
> good health is concerned. Various ratios, yes, blood triglycerides, yes, but
> total cholesterol?  Whouldn't it be more reflective of the need to transport
> fat around the body? If you eat a lot of fat (or burn a lot of it) then your
> total cholesterol goes up, but if that's the case, who cares? Most of the studies,
> if carefully scrutinized, do not show much correlation between total cholesterol
> and cardiovascular desease, cancer, etc. So why do we keep brining it up?
>
> just wondering, Ilya

One reason is that *some* studies show a stronger correlation
between total cholesterol and cardiovascular disease than do any
ratios.  Other studies show different things.  The picture is so
muddled that it is as hard to dismiss any given theory as it is
to accept it.

Another reason is the fact that even those contemporary HGs who
eat a lot of fat tend to have very low total cholesterol,
according to Eaton.  This refutes the theory that total
cholesterol is just a function of how much fat you eat.  Ravnskov
points out that the correlation between dietary fat and
cholesterol seems to appear only in laboratory studies but not in
studies of free-living humans.  Others dispute this, pointing to
studies of populations where fat intake and cholesterol levels
have risen at the same time.

The fact is that nobody yet fully understands the link, if any,
between cholesterol and health.  It is therefore premature to
dismiss it.  Even the various ratios, such as TC/HDL, are not
always improved on a high-fat Neanderthin kind of diet.  In my
case, that ratio got much worse.  For some people, ratios are
improved by substantial increases in HDL.  For others, the HDL is
very resistant to change, no matter how much fat is eaten.  A
possibility is that the ability of HDL to change in response to
diet is a marker for tolerance of a high-fat diet.  Another
possibility is that many of the problematic effects of dietary
fats on blood lipids depend on total calories.  Again, I have
collected interesting anecdotes from the lowcarb support list
from people who went on ketogenic diets, lost a lot of weight and
saw their total cholesterol go down.  Then they stopped losing
weight and, at the same time, cholesterol started to go back up.
It is certainly tempting to theorize that the fat caused the
elevated cholesterol only at the point where the diet became
hypercaloric.  Recently on the lowcarb technical list a study was
mentioned that shows significant decrease in cholesterol after as
little as four days of substantial caloric reduction.

Here's something to think about.  As everyone around here knows,
Karsten Andersen's cholesterol averaged around 400 during the
1928 Bellevue experiment; Stefansson's returned to the low 200s,
after an initial rise.  Both men averaged around 2,500 calories
per day.  Andersen, however, was quite thin, weighing only about
130 pounds.  Stefansson weighed about 154 pounds.  For a man of
Andersen's weight, caloric maintenance would be about 1,950
calories, or even less, given the largely sedentary nature of his
life during the experiment.  For Stefansson, maintenance would be
about 2,300.  (This uses the 15 cal./lb. rule of thumb for
estimation).  This suggests that Andersen's diet was more
hypercaloric than Stefansson's.  Perhaps it is this, in the
presence of large amounts of dietary fat, that explains the
difference in serum cholesterol.  Perhaps it also explains the
low cholesterol of HGs and primates.

As the saying goes, inquiring minds want to know.

Todd Moody
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