Jane Brody and her elevated cholesterol

I just read Jane Brody’s article in today’s New York Times.

Yeesh.

It reminds me of a joke I once heard about a redneck who went to see Hamlet for the first time. When he emerged from the theater a friend asked him what he thought of the play. The redneck replied: It wasn’t nothin’ but a whole bunch of quotes strung together. That’s the way I feel about Ms. Brody’s article. It ain’t nothin’ but a bunch of false, undocumented, never proven, non-verified statements all strung together.

Here’s what happened to Jane to set her off writing this twaddle.

She has been bopping along for most of her 65 years slowly following her own idiotic nutritional advice. And, I’m sure, feeling very full of herself for being so very, very good. She goes in for a routine check up and discovers – GASP! – her cholesterol is slightly elevated. It was 222 mg/dL with a high normal being 200 mg/dL. Never mind that her HDL is nicely positioned at 69 mg/dL or that her triglycerides are pretty low at 99 mg/dL, she freaks out over her total cholesterol (a meaningless reading) and her minimally elevated LDL levels (134 mg/dL). Now, if she were a reader of this blog – or even of the pertinent medical literature – she would know that a low triglyceride level and a high HDL level means that her LDL is of the large particle variety that is not only not dangerous, but actually beneficial.

Her doctor tells her not to worry about it because it isn’t all that high. But poor Jane has been swimming far too long in the fear-of-cholesterol sea to fall for that. Her cholesterol is high, by God, and she’s going to do something about it.

And what do you reckon she’s gonna do?

You’re right. She’s gonna go whole hog on a low-fat diet. She’s going to cut out the cheese; she’s going to take some over-the-counter plant stanol cholesterol-lowering supplements; she’s going to lose some weight.

And she does it all.

But when she returns for a recheck in three months her cholesterol has gone up even more. It is 236 mg/dL and her LDL is 159.

Whoa! Now she’s in big time gotta-get-serious-about-this mode. Gotta get the fat down, gotta cut the red meat, gotta go for the low-fat ice cream, gotta ratchet up the fiber, gotta, gotta, gotta…

She goes back in three months later for another blood test and AAAAAARRRRRRGGGGGGHHHHHHHH. Her total cholesterol is at 248 and her LDL is 171.

Now she is in blind panic mode.

What can she do?

She’s helpless, helpless, helpless.

She’s done everything she knows how to do to lower her cholesterol, but it just keeps going up.

Her angst becomes overwhelming when her doctor tells her

Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.

Oh – My – God!

She can hardly breathe.

But wait, she tells herself, there is something that can save me from this horrible disease of a high lab value.

The super drugs of the century. STATINS!!!!! She proceeds with her doctor’s enabling help to statinate. Now she can rest easy – at least until it’s time for the next blood test. If her disease isn’t cured by then, she’ll go on a higher dose.

She is obviously relieved she’s fallen into the bosom of the ever-effective statins despite the fact that the preponderance of properly done studies have shown statins confer no health benefits to women of any age and that women over the age of 65 (she is 65) who have high cholesterol live longer than those who have normal to low cholesterol. And she missed the studies showing both men and women over the age of 65 who take statins have an increased incidence of cancer.

So, she’s volitionally taking a drug that has a) been shown to be worthless for her, b) been shown to cause cancer, and c) a long list of its own side effects, some of them fatal. An interesting choice for a supposedly smart woman to make.

Let’s look a just a few of the falsehoods strung together in this article.

A heart-healthy [total cholesterol] reading should be under 200.

…the LDLs, the bad guys that deposit plaque on artery walls, were 134 — “high” since they should be under 100 if I want to maintain a healthy cardiovascular system.

Were my days going to be numbered by a surprise coronary or stroke? [Implies that cholesterol causes surprise coronaries and/or stroke. Elevated cholesterol is actually protective against stroke.]

Now it was time to further limit red meat… [implies that red meat increases cholesterol and causes heart disease.]

She goes on and on, but you get the point. None of these statements have been validated by the medical literature.

But my favorite is the following:

By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. [my italics]

Researchers, especially those employed at the drug companies, have tried and tried to prove that lowering cholesterol makes a rat’s rear end’s worth of difference, and they’ve been spectacularly unsuccessful. Occasionally a study shows a tiny benefit in a small subset of subjects (not, however, the subset Ms. Brody falls into) giving the idea that “researchers finally proved” that lowering cholesterol helps. The fact that she states it as she does, that “researchers finally proved” indicates the truth, which is that for years none of the studies (the Queen Mother of them all, Framingham, as a case in point) has proved squat. So, are we going to ignore all the negative results because that doesn’t ‘prove’ that statins work. Give me a break.

What I find distressing about this article, aside from the fact that it spreads misinformation, is that Ms. Brody’s experience is all too common.

I’m sure that today (or any day you want to pick) thousands of people across the country have gone to their doctors for a routine physical and have learned their cholesterol levels are a little high. With all the cholesterol-is-evil hype (or meme) everyone has been relentlessly bombarded with for the past couple of decades, anyone who finds he/she has an elevated cholesterol level has to varying degrees the same reaction Ms. Brody had.

When an elevated cholesterol level is brought to light for the first time, most people regard it as a wake up call. They say to themselves: Okay, I’m middle-aged, I’m overweight, I don’t eat right; it’s time for me to get my act together. I’ll whip this in no time.

What do they do? You guessed it. They head for the low-fat diet.

And what happens?

The same thing that happened to Jane Brody.

For the first time in their adult lives they try to diet and exercise, and they work hard at it, and their cholesterol levels continue to go up. Then they become even more diligent and work even harder and cut even more fat. I see them all the time in restaurants. They’re the ones eating a bowl of granola with skim milk and a banana. And toast without butter, but with jelly (there’s no fat in jelly). Or like Jane, they’re the ones eating the low-fat ice cream.

And they’re doomed to failure. And they end up going on statins for the rest of their lives. Just like Jane Brody will.

What should they do instead? My recommendation is to first find a doctor who understands the whole cholesterol situation. Second, lose some weight on a low-carb diet, which will improve insulin sensitivity and decrease glucose levels, all of which make much more impact on the cardiovascular system than fiddling with controlling cholesterol level. But, a nice side effect of such a diet is that cholesterol levels typically normalize fairly quickly.

Remember, if the lipid hypothesis is valid (and it still is only an hypothesis), the only measurements that really matter are triglyceride levels, HDL levels and LDL particle size. You want your triglycerides to go down; you want your HDL to go up; and you want to get your LDL particle size bigger.

Restricting carbohydrates makes triglyceride levels fall like a rock. Fat, especially saturated fat, makes HDL levels go up. And at least a dozen studies have shown that shifting from a low-fat diet to a low-carb, higher-fat diet shifts LDL particle size from small to large.

You get all these benefits from a low-carb diet. Too bad Ms. Brody hasn’t figured this out. Or maybe she has, but she just doesn’t want to give up her low-fat ice cream.

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46 thoughts on “Jane Brody and her elevated cholesterol

  1. I wonder why Jane doesnt go get a CT heart scan if she is so worried about heart disease. I did one to humor my doctor, who was pressuring me big time to get on statins, came back I have zero plaque. In spite of my “high” cholesterol, just over 300 (high LDL, but also very high HDL, and very low trig.). Results come back, hold your breath…zero plaque! Doc. shut up about the statins…

    It’s what I recommend to anyone who’s worried. Did your doctor still try to get you on statins? Take a look at this post from way back. Read the bottom portion.

    http://www.proteinpower.com/drmike/?p=62

    Cheers–

    MRE

  2. Thanks for that! In my low fat days I followed Miss Brody’s advice religiously, even have one of her cookbooks (which hasn’t been opened in 10 years). after 4 1/2 years of following a low carb approach to eating, my Triglycerides are 45 (as of may 2007) my total cholesterol is 200 even (down from 218 in 2003, ldl is 116, vldl of 9. but what i find most remarkable is my hdl is 75. It was 40 before I started in 2003.

    Rob

    As Dave Barry says: I AM NOT MAKING THIS UP. A low-carb diet really does work for most people just as it has worked for you. Thanks for the nutritional/lab hisotry.

    Cheers–

    MRE

  3. Reminds me of one of my favorite things to tell people:

    Patient: Doctor, it hurts when I do this.
    Doctor: Then don’t do that.

    I guess Brody’s doctor missed that day in medical school.

    Had she taken that last plunge and actually become a vegetarian, I wonder what her blood work would look like? Funny that she draws the line against prevailing dogma when it comes to giving up meat.

    Dave

    I, too, am surprised she didn’t make the final plunge.

  4. What a maroon!

    My favorite line was . . . “I will continue to follow a heart-healthy diet”. . .

    She has excoriated saturated fat for YEARS because ‘it raises bad cholesterol’.

    She is now following a diet that ‘raises bad cholesterol’ and christens it heart-healthy.

    Logic isn’t her strong point.

    Hi Walt–

    No, logic is not her strong point. Perhaps her diet has impaired her critical thinking skills. Or perhaps she’s just fatally infected with the low-fat meme. She followed such a ‘heart-healthy diet’ and watched her lipids situation deteriorate, so now she’s committing to it even more. Makes a lot of sense to me.

    Cheers–

    MRE

  5. I wonder how she was eating before to give her the high HDL and low triglycerides? Sounds vaguely like results from a low carb diet.

    A lot of people have crummy diets and have good lipid values. Another way to have these values is to follow a low-calorie diet and exercise a lot – both of which she does. One of the reasons there has been so much confusion about the negative effects of carbohydrates in the diet is that low-calorie diets bring about the same changes as do low-carb diets. The rural Asians, for example, consumed of necessity (they were poor and on the verge of malnutrition most of the time) a low-cal diet that was pretty high-carb and showed few ill effects from it. Their diets were high in carb as a percentage of overall calories, but actually fairly low in carbs overall because their caloric intake was so low.

    Best–

    MRE

  6. I was struck by her assertion that “a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.” A traveling salesman? What decade is she stuck in?

    I used to have *two* of Brody’s cookbooks and the recipes were gawdawful. Still, I used them religiously (bit by that meme for a few years to my chagrin). Everything lacked salt, tasted like cardboard, and if I served them to company, no one had seconds. Only copious amounts of cream, butter, salt, or olive oil could save these abominations.

    I finally got rid of her books during a huge cookbook purge back in 2004 after I realized the error of my ways and could plainly see that low carb and I were bound together for life. No point in having the wrong guidelines around taking up space. Most of my cookbooks were donated, but I wouldn’t wish Ms. Brody’s books on anyone, even at thrift store prices, so they went into the recycling bin.

    Nina Planck also has a good commentary on the Brody cholesterol hand wringing, too. She makes a very good point (that the masses don’t often think about) about how science doesn’t progress in a smooth linear fashion, but rather in major, wrenching paradigm shifts) (I had plate tectonics in my mind as I read it, must be a California thing). We are in the middle of one of these scientific paradigm shifts and Brody is like a “flat earther” clinging to desperately to her outdated theory. Sad, really. And she is so public about it all.

    Anna

    Hi Anna–

    You’ve hit the nail on the head: she is definitely a ‘flat earther.’

    Cheers–

    MRE

  7. Firstly I just want to thank you for this post. The article you discuss described my experience with high cholesterol and the snow ball effect there after. And, I was only 18 years old at the time. The strong family history was the reason for the early jump towards statins. Due to my own stubborness, I was on and off statins only for short periods of time over the next 20 years. I experienced cognitive and emotional side effects each time I went on them. After my second pregnancy I discovered the Atkins diet, and through my own research, uncovered the truth. Cholesterol is an innocent bystander and that inflammation is the true cause of heart disease. I am now my ideal weight, have always had low normal blood pressure. In short I feel great. I volunteered for a trial comparing family history with incidence of CAD, and genetics. As a result I was given a fast CT. It showed minimal blockage to my right coronary artery (I am 41 years of age now). The cardiologist said he would have expected it to be much worst given the high total and LDL cholesterol numbers (10 and 5.5 respectively), and yet statins were prescribed. I went on crestor and felt awful, and after 3 months went off them for good. I just got the results from my blood test after a 3 month course of ezetrol and krill oil and no statins, and the numbers are impressive. My HDL on a low carb diet climbed from 1.2 to 1.5 and then stayed at 1.7. After Krill oil it is a whopping 2.0. That is a record high for me. The cholesterol blocking drug (ezetrol) has dropped total cholesterol by the predicted 20% (and I have experienced no side effects what so ever), and for the first time in my life my total cholesterol/HDL ratio is within the excepted range of

    Hi Maria–

    Looks like not all of your comment made it through. Thanks for the cholesterol history. I’ve seen the same thing in many, many patients. I’m glad the diet and krill oil are working so well for you.

    Keep me posted.

    Cheers–

    MRE

  8. Great post!

    I love the thought process of the lipid hypothesis: “Saturated fat raises cholesterol, which causes heart disease. We know this because statins lower cholesterol and have no effect on heart disease anywhere besides a pharmaceutical lab. Oh, and you get cancer.” Huh?!

    One thing, though: I’m a bit surprised to see her triglyceride level of 90 something be considered low, with HDLs of 69. That gives her an HDL/Tri ratio of .75 or so. I was under the impression that this was not so good.

    My triglycerides are 35 (with HDL of 52) and I was thinking that was more or less normal for a “good” number. Did I miss something or is the range of “good” just quite large?

    Hi Keenan–

    The number you are talking about is the triglyceride to HDL ratio, which, in Jane Brody’s case was good to start with. A good triglyceride/HDL ratio is anything below 5, with the more below 5 the better. In her case, she started with 95/69 about 1.4, which is great. She didn’t list her triglyceride and HDL values in subsequent labwork, but based on my experience with many, many patients, I’m sure the ratio got worse as she progressively reduced the fat in her diet. I find it remarkable that she focuses on total cholesterol and LDL when even devout believers in the lipid hypothesis (at least the scientifically astute ones) pay more attention to triglycerides and HDL.

    In your case, the ratio is 35/52 or less than 1, which is very good indeed.

    Cheers–

    MRE

  9. Great post. I sent it to my parents. We all have “high” cholesterol in the family and I don’t want any of us to go on statins.

    I hope your parents aren’t too infected with the low-fat meme.

    Cheers–

    MRE

  10. Ms Brody’s experience follow’s mine so closely, that I get confused when I read about her experience. No butter, no salad dressings, low HDL. She even had her knee pain relieved when she underwent knee surgery. I simply cut the carbs and was stunned to find all my joint pain gone.

    It’s too bad she doesn’t read the studies

    Too bad, indeed. But if she had, I wouldn’t have had anything to post about yesterday.

    Cheers–

    MRE

  11. Dr. Mike, you’ve outdone yourself with this one. An excellent tour de force on this tremendously important and timely topic; and the comments I’ve seen so far from your other fans here have also been great. That’s another reason I come here often. (How does it feel to be a superstar?)

    Ok, I know some of the above is a bit over the top. So, one thing: You mention that we should all make the effort to find a doctor who understands the whole cholesterol situation. I couldn’t agree more; but I think there’s a problem. And the problem, at least in my experience, is that a doc with this knowledge and approach is nearly impossible to find; the info seems to just not be readily available, if at all. The docs in my region run a rather closed society and of course are very risk averse. And I suppose we can all guess why. A practicing doc who makes it widely known, for example, that he/she is a diet/cholesterol skeptic will perhaps be vilified or shunned by his/her peers and he/she sure as hell won’t advertise it. Part of the blame of course has to fall on our legal system and particularly on our scandalous “health” care system which in my view includes a very corrupt pharma business model. Maybe what we need on an interim basis is some kind of underground network or informal database for finding the right docs. We could maybe employ that until such time as the paradigm shift happens and this can all come out into the wider world. I don’t think it’s so over the top to believe that society will have made a great leap forward once the shift happens and this particular meme can finally be discredited and buried. (Maybe even Brody will shape up, especially if she comes to realize that statin use could quickly turn her into a zombie; but I’m not holding my breath on that one.) I’m sad to say this may take a long time. On the other hand, with a blog like yours and Gary Taubes’ book about to be published, and more people becoming aware (as evidenced by the comments generated by your blog) maybe it will happen sooner. God, I hope so.
    BTW, I’m still planning to submit your name for Surgeon General. 🙂
    W

    Hi Wil–

    Whose to say that Jane isn’t already a zombie. She thinks like one.

    Thanks for the kind words once again.

    Cheers–

    MRE

  12. I wonder why Jane doesnt go get a CT heart scan if she is so worried about heart disease. I did one to humor my doctor, who was pressuring me big time to get on statins, came back I have zero plaque. In spite of my “high” cholesterol, just over 300 (high LDL, but also very high HDL, and very low trig.). Results come back, hold your breath…zero plaque! Doc. shut up about the statins…

    It’s what I recommend to anyone who’s worried. Did your doctor still try to get you on statins? Take a look at this post from way back. Read the bottom portion.

    great post, that guy could almost be me, same age – 51, similar numbers-total cholesterol around 300… except I never tried statins. I had read too much already.

    So the doctor shut up about the statins after that, tho I got the impression she just thinks I’m some sort of genetic freak. I tried to explain about low carb nutrition, triglycerides, LDL subtypes, etc. etc., but it just seemed to go in one ear and out the other…

    Hi mrfreddy–

    It usually does with these folks…go in one ear and out the other. They’ve got meme-itis.

    Cheers–

    MRE

  13. This is why I love low carb.Not only do I get an outstanding diet that has improved my health by leaps and bounds. i have received real information on what cholesterol is.I no longer fear cholesterol and I am in control when it comes to my cholesterol health. Primarily, this is thanks to you Dr. Mike and your cool wife, Mary Dan.

    Thanks,
    Mary T.

    Hi Mary–

    Thanks for the nice words. We both appreciate them.

    Best–

    MRE

  14. We laugh at her ignorance but forgot the real tragedy: Thousands of people just like Ms. Brody will follow her advice!

    How true, how true.

  15. Dr. Eades,
    You continue to impress. I don’t know if the whole “cholesterol issue” could ever be summed up more thoroughly and succinctly than you just did in this post. I will be encouraging all of my patients and newsletter subscribers to read this post.

    PLEASE, PLEASE, PLEASE keep up the good work!

    Hi Daniel–

    Good to discover that you’re still a reader. I haven’t heard from you in a while.

    Thanks for the kind words. Pass the post around to all.

    Cheers–

    MRE

  16. Isn’t there one more big negative in the things Ms. Brody is doing, that we haven’t mentioned yet? The obvious emotional stress she is causing herself by her (over) concern at her “numbers”.

    Wonder how much THAT is adding to her problems?

    Good point. I’m sure her cortisol is soaring along with her cholesterol.

    Cheers–

    MRE

  17. forgive me dr. mike, i’m a little slow with this. i know i’m fine, but i had to fend off statins at my last doctor visit and will again at my follow up next week. i would appreciate it so much if you could go through how to evaluate the numbers once more for me! i want to give an intelligence rebuttal to my doctor.

    total chol. 311
    HDL 98
    LDL 202
    VLDL 11
    trigylderides 53
    C-reactive protein 1.09

    THANKS, susan

    Total cholesterol is the combined total of all the cholesterol subfractions, i.e., LDL, HDL, and VLDL. If your cholesterol is high, but it’s high because it’s made up of good cholesterol, then even the doctors who are afraid of cholesterol should be happy. But they’re often not because they are focused only on total cholesterol because they don’t understand the big picture. Probably the most important of the lipid numbers – if any are important at all – are the levels of triglycerides and of HDL. You want triglycerides low and HDL high. The ratio of the two, that is triglycerides divided by HDL (triglycerides/HDL) should be below 5. In your case this ratio is great. 53/98 = 0.54. Less than one is terrific. Also, depending on the lab, your C-reactive protein shows that you don’t have a chronic inflammatory problem.

    Hope this helps.

    MRE

  18. There’s this study: http://www.biomedcentral.com/1741-7015/3/6 which shows diabetics and/or heart patients on statins had 13% less mortality over a 5 year period.

    I’ve been a T2 for almost 2 decades. Almost 2 years ago, I became insulin-dependent subsequent to a pancreatitis attack. Three months ago, I had a MI, emergency angioplasty (unsuccessful at clearing the blockage), a week of IV heparin and then CABG. So… if statins reduce mortality in both diabetics and heart patients, I seem a perfect candidate.

    It seems to me that statins make a terrific amount of sense for someone in my position (I’m also on a beta-blocker, ACE-inhibitor and aspirin daily as well as my insulins).

    There seems to be nearly religious fervor on the statin issue – people who think statins should be mass-prescribed to almost everyone vs. people who think they should never be prescribed no matter what – I have actually seen arguments that death is preferable to taking a statin!

    I thought that 13% decrease in mortality over 5 years was pretty persuasive… even if it turns out that statins do nothing whatsoever for LDL or the mechanism involved is completely unrelated to cholesterol.

    What is your opinion on when a statin should be prescribed?

    A second question… I’ve heard a lot of anecdotal evidence from people that low-carb lowers total cholesterol and triglycerides and raises HDL. But I’ve also heard a few people for whom low-carb raised LDL… sometimes to the degree that the HDL:LDL ratio was significantly worsened. What do you think is the best solution for these people… or do you think it just doesn’t matter?

    Hi Jackie–

    Your specific statin situation is something you need to work out with your doctor.

    You’ve got to remember that all drugs come with side effects up to and including death – even aspirin. Each time you take a drug (or a physician gives a drug) the decision needs to be made that the risk of taking the medicine is more than compensated for by the benefit that the medicine may bring. If it’s not worth the risk, then it’s not worth taking.

    The study you cited shows a slight advantage to the group taking the statins verses the group on placebo, but this difference is in relative risk. You can read here my post on relative risk to see what that means. In this case it means that out of about 10,000 subjects about 150 more died over the 5 years of the study (or let’s say 30 per year out of 10,000) as compared to 10,000 subjects taking the drug. On a best case basis, let’s assume that those 30 patients per year would have lived had they taken a statin, then statins would have provided a value to them. But for the other 9,970 patients (and remember, these were all high risk patients), the statins would provide no benefit whatsoever. In the case of this particular paper the stated risk is even suspect because the researchers used an intent-to-treat kind of analysis, which many people – me included – feel overstates the value of the drug being tested. Here is not the place to get into the whole intention-to-treat debacle – I’ll leave that for a post all its own. But you and your physician need to decide if the reward of taking a statin is worth the risk.

    Even if this paper were totally valid, it wouldn’t really change my mind because any medical paper has got to be evaluated along with the volume of other studies looking at the same issues, which, in the case of statins, have shown them to come up short.

    Best–

    MRE

  19. I was just reading about James Lind, the English physician from the 18th century and was reminded of this when reading about Ms. Brody’s plight.

    “He continued his work on scurvy and, in 1753, published one of the classics of medical literature, A Treatise of the Scurvy. What as clear to Lind, and is commonplace to us, was not so readily accepted by the naval bureaucracy of his day. It took over forty years for the British Admiralty to adopt Lind’s simple prophylactic daily dose of one ounce of lemon juice per man. The official order cam through in 1795, just a year after Lind’s death. It has been estimated that this 42-year delay cost the Royal Navy 100,000 casualties to scurvy.”

    It seems the fact that the establishment doesn’t like to change goes way back.

    Wonder what some of her other lab findings like insulin, CRP , Homocysteine, etc. were/are?

    That’s why they’re, well, the establishment. Because they don’t want to change.

    Cheers–

    MRE

  20. I’d like to thank you for the time and effort that you put into your blog. It’s the first thing that I look at every morning after logging on. I have read all of your books (including “Thin So Fast”) and recommend them to anyone who says “I can’t lose weight.” Although I’m not at my ideal weight yet (about 15 pounds to go), I continue to lose slowly and painlessly using your guidance.

    I’m “prediabetic” and so would like your take on this article on the front page of the Wall Street Journal:

    http://online.wsj.com/article/SB118774113343604709.html?mod=hps_us_pageone

    Thank you once again.

    Hi Isabella–

    I plan on doing a post about that article soon, that way more people can read about it than just the few who go through the comments.

    Cheers–

    MRE

  21. Dr. Mike,

    If your readers would like some good info on cholesterol & especially the dangerous of statins, a good website to visit would be the one by Chris Masterjohn.
    Go to http://www.cholesterol-and-health.com/

    Porter

    Hi Porter–

    Thanks for the link. For the other readers caveat emptor. I haven’t had time to go through this site, so I can’t vouch for it’s accuracy.

    Cheers–

    MRE

  22. Thank you so much for this post Dr. Mike! I’m printing and mailing it to my 77-year old mother who has been on statins for the last year. She won’t listen to me ’cause I’m not a Dr. but at least I got her to take coq10. I’m gonna highlight the part that says statins does nothing for women over 65 and may cause cancer part!

    Hi Crystal–

    I hope it works. Congratulations on at least getting her to take the CoQ10.

    Cheers–

    MRE

  23. Dr Eades,

    Greetings from Australia. I’m staggered by Ms Brody’s stubbornness here in persisting with something that’s not working, and then eventually reaching the triumphant end point of diabetes 2.

    But something struck me even more while reading Herodotus last night while waiting for friends in the foyer of the Sydney Opera House, the following passage (in Rawlinson’s translation):

    http://www.herodotuswebsite.co.uk/Text/Book3.htm

    …..[3.22] …… [W]hereupon he asked what the Persian king was wont to eat, and to what age the longest-lived of the Persians had been known to attain. They told him that the king ate bread, and described the nature of wheat – adding that eighty years was the longest term of man’s life among the Persians. Hereat he remarked, “It did not surprise him, if they fed on dirt, that they died so soon; indeed he was sure they never would have lived so long as eighty years, except for the refreshment they got from that drink (meaning the wine), wherein he confessed the Persians surpassed the Ethiopians.”

    [3.23] The Icthyophagi then in their turn questioned the king concerning the term of life, and diet of his people, and were told that most of them lived to be a hundred and twenty years old, while some even went beyond that age – they ate boiled flesh, and had for their drink nothing but milk………

    As usual, none of this is new, as the above describes events c. 490 BC.

    And Ms Brody is quite fortunate in a way to have these problems on the eve of the publication of Taubes’ new book. Perhaps, if she had any sense, she will view that book in a different light (yes, I’m ever the optimist) and act to save her health.

    Thanks again for your wonderful blog, (including the non-nutritional stuff),

    Michael Richards

    Hi Michael–

    Thanks for the nice words about the blog, and thanks very much for the Herodotus quote. It hits the mark.

    I doubt that Jane will have much truck with Gary Taubes’ new book because he makes her look the fool throughout it. Actually she makes herself look like a fool; he simply reports on her reporting.

    BTW, what opera did you see?

    Cheers–

    MRE

  24. This post was very informative and timely for me……my doctor nearly had a coronary after she saw my latest results a couple of weeks ago (I was a little concerned by the high LDL but after reading through the PP forum I now understand that they’re likely to be the big fluffy type).

    Total cholesterol 302
    HDL 117
    Trig 53
    LDL 175

    She ordered the test after learning of my intake of full-fat (the look on her face was priceless) cream, cheese and butter as part of my calcium intake. When I said that my trig and HDL levels looked great she said “well those aren’t the numbers we’re interested in” and pointed to the total cholesterol and LDL numbers. When I said that I didn’t believe that sat fat was bad in the context of a low carb diet she said “well I respectfully beg to differ” and pointed to the results as proof. What to do? I don’t see that changing doctors will make any difference really. My last doctor freaked when he discovered I was in ketosis after taking in a urine sample – his comment? “you’re not on one of those crazy diets are you?”.

    Wow! I guess I just haven’t realized how many doctors there are out there who are out of touch. All I can say is that more and more doctors are coming around to the low-carb way – at least based on the groups I speak to. You might try calling the ASBP (American Society of Bariatric Physicians. The president of the group is an avid low-carber) to find a physician near you, then ask when you call that doctor’s office if he/she takes care of people on a low-carb diet. If so, then give that one a whirl.

    Cheers–

    MRE

  25. another dimension opened doc,challanging the convention. I’d be reading more about this in coming days. what do you have to say about my 132/159 levels? & a very unhealthy eating habits?

    I need a little more info than what you’ve provided to give an intelligent answer.

  26. Remember, insanity is doing the same thing over again and expecting different results. Maybe we should name her Insane Jane. 🙂

    I’m begining to think that the less choesterol you eat, the more your body makes. I doubt Jane will ever get it. Now that I eat more fat & cholesterol along with fewer carbs, my cholesterol went down.

    Hi Dan–

    You’ve got it right. The less cholesterol you eat, the more your body makes. I know it’s true because I read it in a great book called Protein Power.

    Cheers–

    MRE

  27. Interesting, I had not heard of the triglyceride to HDL ratio before. I got a cholesterol test about a year and a half ago after they found I had a fatty liver on ultrasound (I’m currently a 27 year old woman) and my numbers were total: 217 HDL: 45 LDL: 105 trig: 344. In response to the astoundingly high triglyceride levels, I went on a low-carb diet (ketosis inducing) for about a month, but stopped because it was making my other health problems worse. Subsequently, I did not go back to my regular diet, but was certainly eating higher fat (and higher saturated fat) and lower carb.

    After about a year and a half, my numbers were total: 249 HDL: 50 LDL: 167 trig: 158. My doctor, of course, totally freaked out. I was thinking, maybe this isn’t so bad… Yeah, my LDL went up, but so did my HDL and my triglycerides went way down, from very high to nearly normal…and this trig/HDL ratio went from 7.64 to 3.16. Wow! So does that mean that even though my LDL numbers went up, their mean particle size likely also increased?

    Incidentally, I’ll be going back on a really low-carb diet. I recently discovered I am allergic to gluten and it causes my joint pain and fatigue. It took me about a month on a gluten-free diet for my symptoms to get better, and during much of that time they were actually worse. So now I know it wasn’t the low-carb diet that was making me feel worse when I first tried it, it was withdrawal from the gluten, which is obviously naturally low on low-carb. Horray for low-carb!

    Hi Raina–

    It means that your LDL particle size probably went up. But the only way to tell for sure is for your doctor to have the lab actually measure your LDL particle size or get a lab test called an ApoB100, which basically measures the number of LDL particles you have in a given amount. If the amount of LDL goes up or stays the same and the number of particles go down, then each particle has to be bigger.

    Hope this helps.

    MRE

  28. Dr. Mike:

    I pray I don’t get trapped in your trash this time, but just got blood work back yesterday. Triglycerides from 87 to 62, Total Cholesterol from 155 to 273, HDL from 28 to 43, LDL from 110 to 218, Ratio 5.5 to 6.3 on Atkins — Blood pressure 106/62, Glucose 101 to 92, 30-inch waist, lost 46 pounds since last visit, weight lifting 3x per week and running 6 days, I eat fat and protein with each meal. Should I worry? (My Doc wondered if I work out…very concerned)
    Oh, AST=41. What is AST?

    Charles (the runner from Raleigh)

    Hi Charles–

    Your doctor knows more about you than I do, so you need to work with him/her. All else being equal it looks like both your triglycerides and your HDL went in the right directions. The ratio looks good. A low ratio such as you have typically indicates that the LDL particles are large and fluffy.

    An AST test is a measure of liver damage. Yours is slightly elevated (based on the lab I used to use – your doc’s lab may have different normals), but the important thing is whether it has changed. If it was higher at the last test but is going down, that’s good. You need to discuss your concerns with your doctor.

    Cheers–

    MRE

  29. Dear Dr. Eades,

    Your blog has become an indispensable part of my online reading. Thanks for all you do and thanks for the recommendations. Here is the nearly impossible bit:

    “… first find a doctor who understands the whole cholesterol situation…”

    Too bad there isn’t an online database of doctors who understand these things. Then maybe we could find a doctor without the incredible awkwardness of phoning up strange medical offices, speaking to a receptionist or a nurse, and trying to extract answers from them. Quite impossible to get the doctor on the phone, and the others there wouldn’t know how to reply or would fob you off with guesses just to get you off the line.

    Any suggestions?

    Thanks for the great blog!

    LL

    Hi Laurel–

    I’m glad you enjoy the blog.

    As for physicians in the know on cholesterol…you could try looking through the list of members on the Cholesterol Sceptics site – most of these folks would, I’m sure, be knowledgeable. Maybe you could find someone near you who could recommend someone even closer. Also you could check the Weston Price Foundation website for any info they might have on such physicians. I wish I had a list myself that I could disseminate.

    Cheers–

    MRE

  30. One thing bugging me. Most of us believe that the lipid hypothesis is wrong. IE – Saturated fat is not evil and elevated cholesterol does not cause haert disease as commonly believed. Yet when singing the praises of a lo-carb diet and defending sat fat you all point to the better (presumably) lipid profile acheived by a lo carb diet. To me that still using a surrogate marker to prove a point and gets into the same problem I have with the fat-o-phobes. I don’t care what surrogate markers one achieves – what I want to see is evidence of true health. (On both side of the argument). What we need is a clinical trial that matches diets against actual morbidity and mortality – regardless of surrogate measures. I don’t want to know if a diet achieves a certain BMI, lipid profile, blood pressure, etc. I want to know what kind of diet produces a long healthy, life free from real diseases with real symptoms and real reduction in quality of life. Don’t tell me what lifestyle produces ideal BMI, lipid profile, BP etc.
    Tell me which one makes me feel good when I wake up every day, wards off susceptibility to infectious disease, GI distress, depression, cancer, aches and pains. That’s what I want to achieve – not a pretty chart with acceptable numbers.

    Why can’t doctors/researchers get this?

    Hi labrat–

    I understand your frustration but science is going to have to figure these things without a lot of the ideal data that can be had from animal studies.

    You wrote:

    What we need is a clinical trial that matches diets against actual morbidity and mortality…

    That would be wonderful, but to get a truly accurate study one would have to randomize humans into two groups, give one group one diet and the other group the other diet, keep these humans on nothing but these diets for the rest of their lives, then sit around and wait for them to die.

    Since it’s pretty obvious that we can’t manipulate humans like we can lab animals, we’re never going to have the absolute answers, and will have to rely on surrogates.

    Cheers–

    MRE

  31. Dear Dr. Mike

    I so enjoy and appreciate reading your blog, I learn so much, and today’s was one of your best yet!

    A short while back, you reviewed Malcolm Kendrick’s “The Great Cholesterol Con”, which I bought and read at your recommendation.

    In it, he says all of the lipid theory is hogwash, even the high HDL-good, high LDL-bad part, and we should all just stop worrying about cholesterol period. There’s zolch, zero, nada, no link between cholesterol and mortality from heart disease.

    In your blog above, you say “Remember, if the lipid hypothesis is valid (and it still is only an hypothesis), the only measurements that really matter are triglyceride levels, HDL levels and LDL particle size. You want your triglycerides to go down; you want your HDL to go up; and you want to get your LDL particle size bigger.”

    Do you believe in any part of the lipid hypothesis?

    Hi Karen–

    That’s a good question. Let’s say I’m an agnostic at this point.

    There is some evidence that a high HDL is helpful and that high triglycerides are associated with increased rates of cardiovascular disease. But I don’t know if these things themselves are driving forces or if they are simply markers for something else. The strongest evidence seems to implicate the low-particle-sized LDL. But again, is this a cause or a marker for something else that’s happening that is the real cause.

    Having said all that, I don’t really worry about it because whether those lab parameters are causal or simply markers makes little difference to me because the low-carb diet fixes them all.

    Cheers–

    MRE

  32. Dr. Eades,

    Thanks so much for your article. You’ve successfully proven that I’m smarter than Jane. 🙂

    When I was in my 30s, I had my first cholesterol check. It was something like 260, so of course my doctor said I needed to go on a low fat diet. I tried it and gained three pounds in a week. Distraught, I stumbled upon Jonny Bowden’s ‘Shape Up’ diet group on iVillage, and started on a low carb diet instead.

    A few weeks later, I went back to my doctor and had my cholesterol retested. It had dropped to around 230. They asked me what I had been doing, and when I told them I just stopped eating sugar and junk carbs, they didn’t believe me! And as you may have guessed, they told me I still needed to lower my cholesterol. So I e-mailed all my numbers – HDL, LDL, and triglyceries – to Jonny and asked his opinion. I don’t remember the exact numbers, except that my triglycerides were 50. Jonny told me that my numbers looked great to him, so I started reading more and more about cholesterol and its effect (or lack thereof) on heart disease. I finally just stopped getting it checked.

    My father-in-law takes statins, and I worry about him. His cholesterol is really low and his triglycerides are really high, but he trusts his doctor completely on this. The whole family – except my husband and me – are low fat freaks. They eat all kinds of nasty fake food because it’s low fat. It’s all crazy.

    I know the low-carb folks are going to be proven right one day soon (if not already), but will it be in time to save the poor souls who are gulping down the statin drugs? I hope so.

    Hi Pam–

    It’s really a sad state of affairs. Elderly people need more protein and fat than they did when they were middle aged. But because of the cholesterol scare, they don’t eat any of the good sources of these macronutrients. And the thing that is particularly pitiful about it is that study after study has shown that elderly people with higher cholesterols are healthier and live longer than those with low cholesterol. Sad, sad, sad.

    Best–

    MRE

  33. Actually, not an opera but a concert in the Concert Hall (which is actually larger than the Opera Theatre):

    http://www.sydneysymphony.com/event_detail.asp?s=459

    Tugan Sokhiev conductor
    Boris Berezovsky piano

    PROKOFIEV Piano Concerto No.3 in C major
    BERLIOZ Symphonie fantastique

    The Prokofiev was great. But I’ve heard better live performances of the Berlioz (e.g. Colin Davis and Charles du Toit with the SSO).

    All the Best,

    Michael Richard

    Thanks. I’m envious. One of my goals is to someday see an opera in the Sydney Opera House. Maybe you can host.

    Cheers–

    MRE

  34. I appreciate the link on relative risk, but am not sure it applies to the study in question as the absolute numbers didn’t seem THAT tiny.

    Could you provide a cite or two regarding statins generally, pros and cons? I feel like I need a tad more ammo before meeting with my cardiologist as “everyone on the internet knows they’re bad” is not exactly a persuasive argument, ya know?

    Hi Jackie–

    A couple of things…

    First, with all due respect, it’s not my job to prep you for your visit to your cardiologist.

    Second, you can take a look at this post and read about a number of studies showing the lack of efficacy of statins.

    Third, you have leave to do your own PubMed search and decide for yourself based on ALL the available literature whether statins are for you or not. Go to the PubMed site, type in statins, and have at it.

    Cheers–

    MRE

  35. Dear Dr Eades,

    Thanks for this posting. Could not believe my eyes. This is the sad state of medical ‘journalism’. It would be a blessing for NYT-readers if Mrs Brody, being such an influential (but hopelessly misguided) health writer, happens to be one of the many people in whom even low dose statin therapy rapidly causes debilitating pathology.

    Melchior Meijer
    The Netherlands

    I see your point, but I try not to wish bad things on anyone, not even on Jane Brody.

    Cheers–

    MRE

  36. Dr. Eades, Thank you for your continuing efforts!

    My husband and I have each lost 40 pounds (so far) and improved our skin, our sleep, our attitude (random outbursts of rage – totally gone), lowered our stress, etc – since April.

    My husband’s doctor was thrilled with his continually lowering blood sugar numbers, his lower weight, and took him off glucophage.

    But now he’s “a little worried” about his slightly elevated total cholesterol. The note he sent said, “we need to talk about putting you on statins”. Arghhhh. How can I put an eyeroll in here?

    And I’ve just finished 5 days at Canyon Ranch, where I had to specially request a yolk in the morning, or some chicken with the veggie stirfry. And endless lectures about how I’ve been on some crazy diet.

    I read your blog regularly, and participate in a low carb forum with many that have adapted to intermittent fasting, and to the low carb way.

    I forgot what “freaks” we are! When even the acupuncturist started to lecture me about how I should be eating grains, and I tried to explain how frustrated I was that the ADA was trying to kill the diabetics with their suggestions about grains. She lectured me some more until I finally burst into tears.

    Thank God for your continuing efforts! The comments on the news articles. The spotlights on new medical studies.

    Thank you thank you thank you.

    Sarah

    Hi Sarah–

    I’m glad you enjoy all the writings. I do have a question, though. How could a die hard low-carber go to Canyon Ranch? That’s as low-fat as you get. It’s the enemy of good nutrition (and good sense, for that matter).

    Cheers–

    MRE

  37. I feel fortunate that I don’t know who Jane Brody is. Apparently I saved money ona nasty cookbook or two.

    I can testify that LC doesn’t always lower one’s cholesterol. MY wife is a case in point, she’s been on LC for three years and has about the same total cholesterol as before. Her ratio is good at 4.2, and her triglycerides are in double digits so I think she is OK. In any case, we don’t subscribe to the simplistic and idiotic “clogged pipe” model, we both think she is safe because without the carbs there to cause general inflammation, there is nowhere for the cholesterol to adhere.

    My own cholesterol went down dramatically when I went to LC. While it gave me some comfort at the time (I started LC after my dad died of a heart attack at 56), in retrospect I don’t think it was a big deal.

    The low-carb diet usually lowers elevated total cholesterol levels, but not always. What it does do is lower elevated triglycerides and raise HDL and increase LDL particle size.

    Best–

    MRE

  38. I realize your job is not to get me educated, but I needed somewhere to start. Thanks for providing that!

    My pleasure. I hope you find what you’re looking for.

    Best–

    MRE

  39. I am 57…I have had basically the same experience as Jane Brody…and the same results…my doctor put me on a low fat diet and my lipid values rose…and rose and rose…after resisiting taking statins for 5 years, about one year ago I gave in. On 10 mg of Lipitor, within 60 days my total chol went from 299 to 159 and my LDL went from 200 to 99…BUT….after hearing about statin induced cardiomyopathy and doing a little more personal research, and especially after reading Dr. Arthur Agastins’ book the South Beach Heart Program, and now reading some of your posts, I have decided to tell my doctor when I see him next month that I will no longer take Lipitor. Since I have a month left on my prescription I am going to finish it out to see what my lipid profile will be after one full year on the lowest dose of Lipitor. Knowing that 50% of the people who have adverse cardiac events have normal chol levels, why should I risk heart failure when having low chol levels may not make a difference?

    Hi Cathy–

    Good luck. I’ll be interested to hear what your doc has to say about it all.

    Cheers–

    MRE

  40. I am 40 and was diagnosed with adrenal fatigue last year (too many stressors all at once: move, new job, major family illness, sandwich generation, etc). I have always had a healthy diet and get a reasonable amount of exercise. Since my diagnosis, I take a daily regimen of fish oil ( 1200 mg), vitamin c (1000 mg), pantothenic acid (B5 – 500 mg), a multi-vitamin, licorice root, and adrenal support (various herbs).

    Four years ago, my cholesterol was 162 with HDL of 73, LDL of 82, and triglycerides of 34. My most recent test shows cholesterol of 166 with HDL of 90, LDL of 70 and triglycerides of 32. Is there a point where HDL is too high or triglycerides are too low? If so, are there any symptoms I should be aware of?

    Thank you!

    As far as I’m concerned there isn’t a point at which HDL is too high or triglycerides too low. Your numbers look fine.

    Cheers–

    MRE

  41. Check your site meter or traffic tracker and you will see that I have been on this site for a long time, reading through all of the above.

    I just came from the doctor’s office. My numbers CHOL 301, HDL 60, TRI – 137, LDL 214.

    I maintain a high protein diet though probably not a super strict one. Rice is a staple at our home, otherwise, it is pretty strict.

    The doc said I needed drugs to bring the numbers down. I pointed out that the HDL was high, the TRI low (somewhat) and he said, “We are not concerned about those numbers.” Sounds like a couple of posts above.

    I immediately made a list of things to cut out, add or substitute – egg substitute (- yolks), no milk, no cheese, less meat, add fish oil and oat bran…

    And then for the heck of it I started looking around and came upon your site.

    Lo and behold, it seems I might have been doing something right in the first place.

    The Tri:HDL ration is 2.28, <5, good by your standards, meaning my high LDL is made up of larger bubbles(?) I forget what you called them.

    I am a hard exerciser at the gym, 45-90 minutes at least five times a week….lifting weights and cardio. I am also 53. I am sure that helps.

    Whew, that might be more info than you care to read, but I have a couple of questions.

    1. Do I need to substantially change the way I eat just to meet my Doc’s expectations? high-protein, lo-carb (and when I do, it’s complex carbs), no processed foods, no trans fats and rice cause it’s there. Or can I go on business as usual?

    2. What can I do to increase metabolism, because my weight continues to creep up?

    I watch the calorie intake pretty closely…and as I pointed out, I work hard at the gym. My particular exercise menu involves weights so I know I might/could have gained some muscle mass, but I am just 6’1″ and now weigh 235 (my heaviest ever!), despite my best efforts to eat right and exercise hard.

    I don’t like being heavy and the lo-carb style doesn’t seem to be lending itself to losing weight. BTW, BP at today’s check up – 106/64…always around 105-115.

    So, the extra weight doesn’t seem to be hard on my body other than I just don’t like the way I look.

    Any suggestions on how to increase the fire inside, to burn more calories would be much appreciated. Oh, and I don’t do coffee, caffeine and such.

    Thanks for the good read above. I appreciate finding some reassurance after feeling pretty down on my way home today from the doc’s office.

    Hi Bill–

    I can’t really give specific dietary advice to individual readers without having them as actual patients. But it has been my experience that when people go on a good-quality, whole-food low-carb diet, they lose weight and improve their lipid profiles. If as you say rice is a staple in your home (your triglycerides levels look like you’re getting some extra carb), then you’re probably eating way too many carbs. For some reason people tend to think that if they add a bunch of meat or other protein sources to a bunch of carbs, they’re still doing a low-carb diet. But they’re not. I would carefully restrict carbs to below 30 gm per day ( a single cup of cooked rice contains 45 gm of carb) while consuming plenty of good quality protein and see what happens. But work under the care of your physician.

    Cheers–

    MRE