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My friend sent this question to me via FB: OK, diet wonks Paul Eich, Scott Kustes or Kirez Reynolds. I have a question I hope you can help me with. I went to the doctor and my cholesterol was 267 (60 HDL). He wanted to put me on statins and I told him no, since according to my research they don’t reduce overall mortality. You just die of other stuff. Here are my questions, though; 1) does serum cholesterol matter; and 2) if so, what is the best nutritional way to reduce it? Googling, it seems both Paleo and IF not infrequently cause increases in cholesterol. I need to lose a fair amount of weight. That is a given. But what other advice might you have? Blood pressure is fine.
Dear Barry,
This is how I think about this. As you know I blogged on these topics for years and my trail of learning is recorded there (along with a mountain of links for further reading). Serum cholesterol is a poor indicator of health. 267 is high, but it doesn’t tell you what you need to know – are you inflamed, insulin resistant and therefore at risk of the “diseases of civilization”?
Doctors have to treat according to the standards – the current standards are “if cholesterol is above some number, give ’em a statin.” I’ve done a bit of reading on this topic and the best info I can gather says statins reduce all cause mortality in a very small group – folks under age 55 or so with prior cardiovascular disease. There’s no proof that reducing cholesterol levels will protect anyone from heart disease – the evidence is all over the place. There’s never been a successful intervention testing dietary modulation of cholesterol levels to reduce mortality. That’s right – after 40 years of advocacy, no trial using food to reduce cholesterol has demonstrated a benefit. Low fat diets, which also advocate substituting polyunsaturates for saturated fats, will reduce cholesterol somewhat, perhaps by 15%. Statins can also reduce cholesterol levels, but the way I read the research, that’s not helpful to most.
An interesting statistic is “number needed to treat”. I’ve seen NNT estimates for statins from 100 to over 250. That number is saying you would need to treat 100 people for five years with statins to save on life. It’s a way of assessing the cost/benefit ($3/day * 100 people * 365 * 5) to see what other treatments may be more affordable. I’ve read that baby aspirin has an NNT of 40, and no side effect to my knowledge.
The best indicators of health (the ones I care about for myself) are a decrease in abdominal circumference, low triglycerides (under 150 seems to be significant), high HDL (above 50) and normal blood pressure. High trigs with low HDL is a correlate with insulin resistance, probably a marker of it. Trigs can be lowered by most ethnicities via carbohydrate modulation, especially sugar – the body processes HFCS like alcohol; in the liver, and it turns HFCS into fat, some of which is stored in the liver. There’s a new medical condition called non-alcoholic fatty liver disease. Essentially the liver gets so full of fat it stops working well – three days of carb/sugar restriction shows measurable changes in liver fat. On a high fat, low carb and virtually no sugar diet, my trigs were 75 or lower, and my HDL was 60-75. TG to HDL of 3 or more indicates insulin resistance. Insulin resistance to metabolic syndrome to diabetes seems to be the progression – and diabetics on average die ten yearsearlier than non-diabetics.
This is why you can be over-fat and healthy – fat and insulin sensitive. Or you can be skinny and insulin resistant, which is unhealthy. Insulin sensitive, fat or thin, is healthy.
Taking all that into account, I live as though glycemic control is the most important variable – stable blood sugar around 85, and avoiding blood sugar spikes above 160, is the way to avoid the diseases of civilization. If you’ve never used a glucometer to test your blood sugar, do so. Test upon waking, before and after meals, after working out, and on days when you didn’t get enough sleep or had too much booze or had a lot more stress. You see glycemic variability on all of those instances. You can learn which foods always spike blood sugar, and avoid them. To me the first rule is – “thou shalt not sugar thyself to death.” Too much sugar, the liver gets insulin resistant, and it all goes to hell after that (as detailed comprehensively in “Good Calories, Bad Calories”). If you really want to get sick quickly, try lots of sugar, booze, lots of pain meds, low vitamin C – and anything else that keeps the liver from regulating blood sugar properly.
This is why the CF RX of “eat meat and vegetables, nuts and seeds, little fruit or starch and no sugar” is so potent.
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