On Thu, 7 Sep 2000, Harper, Laura wrote:

> Now to my question.  I recently had a blood test with the following results:
> LDL - 202, HDL - 98, triglycerides - 29, blood pressure 89/53.  I'm a 47
> year old female, 5'11 tall and weight 128 pounds (I'm very small boned).  I
> discontinued the birth control pill in March after 20 years. My doctor is
> having a fit over the LDL and thinks it's dangerously high.  I think,
> overall that it's pretty good.  He wants to take another test in about three
> months to see if there's any change.

The cholesterol issue is one of the more vexing questions that
arise with this kind of diet.  The fact is that many people will
see a substantial increase in LDL when they start consuming
liberal amounts of animal fat.  This is because saturated fats
downregulate the LDL receptors in the liver.  While it is true
that *some* people will see a decrease in LDL, there is no
evidence that this is generalizable.  The lowcarb propaganda
according to which you can lower your cholesterol while eating
all the animal fat you want, as long as you control your insulin
by strict carb restriction, is simply false.  It works for some,
and not for others.  Your LDL probably won't be much different in
3 months, unless you cut calories considerably.  This does have
an effect (You will hear, for example, about the Masai, who eat
mostly meat, blood, and milk, but who have very low cholesterol
levels.  Their caloric intake, however, is generally low.
Likewise, Dr. James Hays did a study of the effects of an
Atkins-like diet, in which 90% of the fat was saturated.  He got
substantial cholesterol reductions, but it was an 1800-calorie
diet, and the subjects were diabetic men, so this was also a
low-calorie study).

So the first thing is to accept that elevated LDL is, for some of
us, what you get when you eat this way.  My LDL went up to 242
after 3 months on Neanderthin and, 3 years later, it has drifted
down somewhat but is still high (currently about the same as
yours).  The second thing is to figure out how to interpret this
fact.  Your doctor is alarmed, and most people would be
horrified.

First, you should study the material at
http://home2.swipnet.se/~w-25775/index.htm
... and print it out for your doctor as well.  Dr. Ravnskov is a
respected and published researcher in this field, not an Internet
crackpot like me.  Also read the somewhat technical paper at
http://www.cabi.org/catalog/JOURNALS/samples/pns/html/pns58163.htm.
The bottom line of this one is that recent research suggests that
it is not the total amount of LDL that matters, but the amount of
"small, dense" LDL in it.  This is not measured by routine lab
tests, but we know that the amount of dense LDL corresponds to
triglycerides (TG -- called TAG in Britain), and your TG is
spectacularly low.  This indicates that your LDL is not very
atherogenic at all.  There is some discussion as to whether the
"light" LDL is actually beneficial, but I haven't found much on
that.

In 1997, Michael Gaziano of the Harvard Medical School did a
study from which he concluded that the single most predictivly
important blood lipid ratio is TG:HDL, the lower the better.  A
ratio less than 2 would be considered good; less than 1 is
excellent.  Yours, at .3, is the lowest I have ever heard of.
Incidentally, Gaziano's research makes perfect sense in light of
the Griffin article on LDL atherogenicity.

So, in my view your "numbers" are really excellent, and I think
your doctor is mistaken to be concerned about the LDL reading.
That concern is simply out of date.  I've had this conversation
with my own doctor, and he has been honest enough to admit that
he doesn't have time to keep up with this stuff, but relies on
whatever the "received" view is; and the received view changes
only slowly.  And it is also true that the makers of Pravachol,
etc., are making plenty of money by people continuing to be
worried about LDL numbers.

Todd Moody
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