Jane Brody and her elevated cholesterol
I just read Jane Brody’s article in today’s New York Times.
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.