Tuesday, August 7, 2012

My August 2012 Lipid Profile




contains this graph:


Which shows that human foragers, wild primates, and wild mammals all have mean total cholesterol levels less than 150 mg/dL.  Unfortunately, for some reason the authors of this paper failed to include easily available data collected on cholesterol levels among people from traditional plant-based, primarily grain-based agricultures.  Other populations with high immunity to cardiovascular diseases also have average serum cholesterols below 150 mg/dl, including rural Chinese (127 mg/dl, 6), Tarahumaras (125 mg/dl, 7), and Caucasian men eating macrobiotic diets (147 mg/dl, 8).

All of this data indicates that the physiologically natural level of serum cholesterol among mammals (including humans) lies below 150 mg/dL, and thus that levels above this constitute an excess of cholesterol in the blood.  Populations exhibiting these low levels of total cholesterol also have low levels of LDL.

The O’Keefe et al article presents the evidence obtained from lipid-lowering trials which indicates that “the LDL level at which the cardiovascular event rate is predicted to approach 0 is 57 mg/dL for primary prevention and 30 mg/dL for secondary prevention.  These data implicate LDL as a requisite catalyst in the atherosclerosis process whereby extremely low LDL may prevent CHD events regardless of other risk factors.” [Emphasis added]

O’Keefe et al also note that two recent studies found that reduction of LDL to physiologically natural levels (i.e. less than 70 mg/dL) halted atherosclerosis, whereas moderate lowering allowed continued progression.  Caldwell Esselstyn likewise proved that a plant-based diet that produces an LDL of less than 70 mg/dL will reverse coronary artery disease without the use of statin drugs (here).

In other words, if you get your LDL down to about 60 mg/dL (a level found in healthy wild animals and neonates) you can prevent and reverse atherosclerosis.  Since atherosclerosis occurs throughout the body, impairing oxygen and nutrient delivery to and waste removal from all tissues and organs, cardiovascular disease promotes disease of all tissues and organs, and reversal of cardiovascular disease helps to restore health to all tissues and organs. 

In fact, all of the following diseases can be outcomes of  atherosclerosis impairing blood flow to the specific tissues:

  • Macular degeneration (retina)
  • Degenerative disk disease (spinal disks)
  • Impotence (genitals)
  • Hearing loss and tinnitus (ears)
  • Strokes (brain)
  • Aneurysm (aorta)
  • Kidney failure (kidneys)
  • Intermittent claudication (legs)

Similar to this, traditional Chinese medical theory maintains that the heart rules all other organs and all disease includes impaired flow of qi and blood, and thus that effective therapy must always involve improving heart and spirit function and qi and blood circulation.

"The heart is the sovereign of all organs and represents the consciousness of one's being. It is responsible for intelligence, wisdom, and spiritual transformation...decision-making is the king's job.  If the spirit is clear, all the functions of the other organs will be normal....If the spirit is disturbed and unclear, the other organs will not function properly.  This creates damage.  The pathways and roads along which the qi flows will become blocked and health will suffer.  The citizens of the kingdom will also suffer."  The Yellow Emperor's Classic of Medicine, Chapter 8

With all of this in mind, since re-adopting a plant-based diet about 8 months ago, I have aimed  for a total cholesterol of less than 150 mg/dL and an LDL of less than 70.  

I last had my lipids checked in July of 2007.  At that time I had  eating a grain-free, paleo-style diet as described in the “practically paleo” book I published with Rachel Albert in 2004.  That diet, consisting of meat, poultry, fish, eggs, vegetables, and fruits, supplied about 25% of energy as protein (mostly animal), 40-45% as fat, and 30-35% as carbohydrate. Here’s the part of that report containing the lipid profile:




As the report shows, I had a total “cholesterol” (actually, total lipoproteins) of 231, an LDL of 138, HDL of 85, VLDL of 8, and triglyceride of 47.  The cholesterol to HDL ratio was 2.7.  Thus, my total was about 100 points above that of wild mammals, and my LDL was twice the healthy level.
I suspect that between 2007 and 2011, I had further elevation of my total and LDL, but I didn’t confirm my suspicion with lab work.  My suspicion arises from the fact that by 2009 I was eating more total fat (about 50-60% of energy from fat) and less vegetable starch (particularly fewer sweet and white potatoes) than in 2007, and I had by 2011 developed some signs associated with and thought to be caused by elevated blood lipids, particularly xanthomas . 

So, during my later paleo daze my total cholesterol was at least 231 and my HDL was at least 138.  

I had my blood drawn on the first of August, 2012, and received this report about 36 hours later:





This shows that my total cholesterol has dropped at least 50 points, and my total LDL has dropped at least 32 points since ditching my paleo daze and re-adopting a whole foods plant-based diet.  My fasting triglycerides and VLDL remain in the normal range, although higher than in 2007.    I have been eating quite a bit of fresh fruit this summer, and this may be the reason my triglycerides are higher than at the last test, although still in the healthy range.

Due largely to the substantial (at least 22%) drop in total cholesterol, my HDL level declined (by 38%) but is still well (36%) above the desired 39 mg/dL.

As noted above, in 2007 my total cholesterol to HDL ratio was 2.7, and in this latest test it was 3.4, still well below the supposedly desired 3.5.  However, recent research has shown that people who have genetic variation giving them naturally higher HDL levels do not enjoy a lower incidence of cardiovascular disease, casting very serious doubt on the hope that a high HDL level or low cholesterol to HDL level protects against cardiovascular disease. Further, we also have evidence that some fractions of HDL are harmful.  These data indicate that a high HDL does not protect against the ill effects of high total and LDL levels, so I am not concerned by the decline in my HDL level; it is still high and complements the substantial reduction in my total and LDL levels.

Finally, to reiterate, as noted by O’Keefe et al and demonstrated by Esselstyn, if you lower total cholesterol and LDL sufficiently (to less than 150 and 70 mg/dL, respectively) you will halt or reverse atherosclerosis regardless of your levels for HDL or triglycerides.

The data from wild species provides good evidence that a total blood cholesterol (lipoprotein) level above 150 mg/dL constitutes a condition of excess.  People have found many ways to rationalize this (HDL levels, LDL particle size, HDL ratio, etc), but I don't believe that these incantations will make the vascular and hemodynamic effects of excess serum LDL disappear. Simply put, mammalian cardiovascular biology is adapted to total cholesterol levels under 150 and LDL levels under 70.  Levels above these signify metabolic disorder as surely as chronically elevated fasting blood sugar.

Although my numbers have substantially moved in the right direction, they still fall short of my goals of having LDL less than 70 mg/dL and total lipoproteins less than 150 mg/dL.   To me this illustrates that it can take some time to establish a natural lipid profile after spending some years on a high cholesterol, high fat, high animal protein diet, and tells me that I can expect improvements in health as I reach physiological levels of blood lipids.  Although the National Heart, Lung, and Blood Institute recommends that adults have their blood lipids tested once every five years, I may decide to do it more frequently to monitor the effects of my whole foods plant based diet.






55 comments:

Peter said...

Nice Don,

William Clifford Roberts, American Journal of Cardiology:

“Because humans get atherosclerosis, and atherosclerosis is a disease only of herbivores, humans also must be herbivores”

http://ncp.sagepub.com/content/23/5/464.full

National cholesterol education program discloses in their third expert panel report that LDL over 100mg/dl is athrogenic per se

"Any LDL cholesterol above 100 mg/dL appears to be atherogenic. The prevalance of elevated levels in large part accounts for the near universal development of coronary atherosclerosis in the United States and the high attendant risk for developing CHD over a lifetime—49 percent for men and 32 percent for women"

“Only populations that maintain very low levels of serum cholesterol, eg. total cholesterol below 150mg/dl throughout the life do we see a near-absence of clinical CHD”.

http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

More evidence for lowering LDL to below 70

"LaRosa, who wrote an editorial [3] accompanying Lee's study, expanded on his views to heartwire: "I used to be skeptical about the idea of trying to achieve very low cholesterol levels, but now I am more accommodating. As cholesterol levels are coming down, we are seeing much lower rates of bypass surgery and elective angioplasty. I think elective angioplasty will eventually disappear altogether."

"Chimpanzees eat very little fat. They have LDL levels in the range of 40 to 70, and they don't get atherosclerosis.He noted that levels of LDL below 70 are on a par with those of nonhuman primates who don't develop atherosclerosis, adding that, like these primates, humans were designed to be vegetarians. "Our dental anatomy suggests that we are not meant to be meat eaters. Animals that eat meat have sharp tearing teeth, while we have flatter teeth more similar to vegetarian animals. I believe humans are not anatomically or metabolically designed to be meat eaters, and because we do consume animal fat that's why we get atherosclerosis. Chimpanzees don't eat meat; they eat very little fat. They have LDL levels in the range of 40 to 70, and they don't get atherosclerosis. Maybe we wouldn't get atherosclerosis either if we had levels this low."

http://www.theheart.org/article/1290061.do
---------------------------------
Having a very TC low-cholesterol is best one can do to improve chances for a long life

"Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling–perhaps due to diseases predisposing to death.”

http://www.ncbi.nlm.nih.gov/pubmed/

Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity.

“These results demonstrate a continuous, graded relationship of serum cholesterol level to long-term risk of CHD, CVD, and all-cause mortality, substantial absolute risk and absolute excess risk of CHD and CVD death for younger men with elevated serum cholesterol levels, and longer estimated life expectancy for younger men with favorable serum cholesterol levels”.

http://www.ncbi.nlm.nih.gov/pubmed/10891962

Ornish et al. demonstrated in an intervention trial that lowering LDL was associated with increased telomerase activity, which in turn is associated with longevity.

http://www.ucsf.edu/media/pdf/nobel/blackburn_and_ornish_lancet_2008.pdf

A meta-analysis of 108 randomized controlled trials of various lipid modifying interventions found that lowering LDL cholesterol significantly decreased the risk of coronary heart disease and all-cause mortality, whereas modifying HDL provided no benefit after controlling for LDL cholesterol.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645847/pdf/bmj.b92.pdf

Bog said...

Don,

your case seems to be more complex in contrast to the majority.

"Patients who participated in the 12 week Ornish program showed statistically significant improvements in their total cholesterol, LDL cholesterol, and triglycerdies. In fact, patients lowered their LDL-cholesterol levels by an average of 40%".

http://www.ornishspectrum.com/proven-program/the-research/

have you thought about supplementing your diet with low-dose statin in order to achieve your lipid profile goals? I reckon it may be a good short-term solution.

Charles Grashow said...

Here's the paper

http://www.direct-ms.org/pdf/EvolutionPaleolithic/OKeefeLDL.pdf

IS A TARGET LDL OF 50 TO 70 MG/DL PRACTICAL?
The newer and more potent statins are capable of dramatically reducing LDL cholesterol safely and tolerably in most patients. The Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial
randomized more than 3,000 patients either to rosuvastatin, atorvastatin, simvastatin, or pravastatin (28). The rosuvastatin
(10 mg/day), atorvastatin (80 mg/day), and simvastatin (80 mg/day) all achieved the NCEP ATP-III LDL goal in approximately 80% of patients. Higher doses of high efficacy statins are more effective in reaching goals especially when combined with diet and agents, such as ezitimibe, niacin, or plant sterol and stanol esters. However, today only one in three CHD patients is at or below the more liberal current LDL goal of 100 mg/dl (29).Much work remains to be done in the development of treatment strategies to achieve the LDL goal of 50 to 70 mg/dl in most CHD patients.

SO - when are you going to start taking a statin drug??

IMHO - if you do you will suffer many, many health problems. My advice - get a NMR Test - get your particle count and size and don't worry about LDL-C.

BTW - your tigs are too high - eat more fat - reconsider the vr=egan way.

Don said...

Charles,

I am not going to take any statins, except those that naturally occur in plants.

I am not going to eat animals.

Even if I would benefit from more fat, it is not necessary to eat animals to eat more fat.

My triglycerides are not too high. The NHLBI ATP III defines borderline high trigs as 150-199. Mine were only 105 on that day (and these do vary with daily diet variations). It is possible to reduce them simply by eating less fruit or doing more physical activity (mine has been curtailed by other commitments and 112 degree temperatures here in the valley). It is not necessary to eat animals to obtain health. Even if it was, I wouldn't do it.

Next, this is only one lab test, not a consistent pattern. This study http://www.ncbi.nlm.nih.gov/pubmed/8886631 found biological variability in measures of TC, 5.1%; TG, 17.0%; HDL-C 4.4% and LDL-C, 8.3% in any single individual at different times, assuming a consistent diet. More variability would arise if diet is variable, as mine is, e.g., in fruit or nut content.

This paper

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CGkQFjAD&url=http%3A%2F%2Flabmed.ascpjournals.org%2Fcontent%2F39%2F8%2F481.full.pdf&ei=QOEhUJv4I4m02gX4o4DQAw&usg=AFQjCNHEYeDX69EDgWbc5kuFvwLD5YgqOQ

states that "in analysis of TC, the performance goal for total error is 8.9%. That is, the overall error should be such that 95% of individual cholesterol measurements fall within ±8.9% of the RMP [reference measurement procedure] value." In other words, no test is 100% accurate, not even the reference measurement procedure.

Thus, unless one falls into one of the extremes for lipid levels, one needs several tests while following the same diet plan to determine what is the pattern the diet produces.

Don said...

Although the the NHLBI ATP III concluded that ANY LDL-C above 100 is atherogenic, I realize that nature almost never has such firm borders. Am I really to believe that an LDL-C of 99 is not atherogenic, but one of 101 is? No, in science we recognize borders as having ranges.

In any case, ATP III does not support the claim that particle size and count matter. As Peter quoted, “Only populations that maintain very low levels of serum cholesterol, eg. total cholesterol below 150mg/dl throughout the life do we see a near-absence of clinical CHD”.

However, what is missing from this is that the 150 mg/dl TC and 70 mg/dL LDL levels associated with immunity to cardiovascular disease are means i.e. average levels for the populations immune to heart disease, which means that some people in these populations have higher and some lower levels. Not everyone needs to have a TC below 150 and a LDL-C below 70 to be immune to atherosclerosis, they only need to be within the physiological range found within these populations that have those mean measures.

My parents are both near 80 years of age, and neither has had a cardiovascular event, despite eating far from optimal diets. My father recently had a cardiologist tell him that his coronary arteries are essentially plaque-free. I find laughable the idea that by eating a whole foods plant-based diet and achieving the lipid levels found in this test I would have a greater risk for atherosclerosis than my father who eats a better than average SAD that includes margarine, processed grains, sugar, etc.

Charles, what evidence do you have to support your advise that people do not need to concern themselves with LDL-C but only with particle count and size? Who showed that people with particular particle counts and sizes are immune to or capable of reversing atherosclerosis? On what evidence do you believe that my TGs of 106 are "too high"? You are the one making these claims so the burden of proof falls on you.

The NHLBI has done its homework, the ATP III booklet is extensively referenced, and written by a large panel of experts in the field, so to persuade any well informed individual to follow your advise instead of that of the NHLBI you will need to provide comparable evidence and expertise.

Peter said...

There's not a single real cardiovascular/lipid expert who would rage about the particle size or count, besides Thomas Dayspring. But why to rely on Dayspring when you can just listen to the bulk of researchers including Daniel Steinberg who has written and co-authored over 400 research paper's on cholesterol. Yet, the particle size & count are all the rage in the paleo/low-carb community.

Let see what Thomas Dayspring has to offer for people who are intolerant to statins

"statin intolerant: consider ezetimibe (Zetia) plus colesevelam (Welchol) plus a plantstanol (Benecol) plus aggressive low saturated fat diet. Recent data showed ezetimibe/fenofibrate was also efficacious in patients without the metabolic syndrome".

http://www.lipidcenter.com/pdf/Lipid_Treatment_Algorithm.pdf

Measuring apolipoproteins does not help risk prediction (June 19, 2012)

"The study, published in the June 20, 2012 issue of the Journal of the American Medical Association, found that measuring a combination of apolipoprotein B (apoB) and apoA1, lipoprotein (a) (Lp[a]), or lipoprotein-associated phospholipase A2 (Lp-PLA2) gave worse predictions of risk than current lipid measures—total and HDL cholesterol"

"Grundy adds that recommendations for statin use in primary prevention may need to be revisited now anyway, highlighted by the recent meta-analysis from the Oxford group that showed benefits of statins in much lower-risk individuals than those for whom treatment is currently advised. And he suggests that risk assessment may in the future move away from measuring many biomarkers and instead focus on subclinical atherosclerosis with imaging methods or simple risk projection based on age, sex, LDL levels, and perhaps another major risk factor".

http://www.theheart.org/article/1417589.do?utm_medium=email&utm_source=20120622_topStories_dreamail&utm_campaign=newsletter

Don said...

Charles,

http://circ.ahajournals.org/content/119/17/2396.full

"A report from ≈5500 asymptomatic individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) compared the per-particle associations of small and large LDL with carotid intima-media thickness, a direct and well-validated measure of subclinical atherosclerosis.28 To unmask the association of large LDL with IMT, participants were classified into categories of small LDL particle concentration (Figure 5). In these stratified analyses, higher concentrations of large LDL were significantly associated with intima-media thickness within any particular category of small LDL. This was also confirmed by regression analysis: After particle correlations were accounted for, both small and large LDL were “atherogenic” to a similar extent. "

"This was subsequently confirmed in relation to clinical CVD events in both primary prevention (Women’s Health Study; Figure 2: adjusted hazard ratios of 1.44 and 1.63 for large and small LDL, respectively, quintile 5 versus quintile 1)34 and secondary prevention (Veterans Affairs HDL Intervention Trial [VA-HIT]).51 After lipoprotein correlations were accounted for, particularly the inverse correlation between large and small LDL, both LDL subclasses showed similar associations with CVD events.34,51 LDL size was no longer associated with CVD after adjustment for LDL particle concentration and other risk factors (Figure 2: adjusted hazard ratio of 1.56 for smallest quintile of LDL size became attenuated to 1.06 after adjustment for LDL particle concentration and was no longer significant). These findings are also consistent with a prior analysis from the Quebec Cardiovascular Study in which average LDL size, measured by GGE, did not add risk information after apoB was accounted for (the latter reflecting the number of LDL particles).52"

"herefore, smaller LDL size appears to be positively associated with CVD, not necessarily because small LDL particles are inherently more atherogenic than large ones, but probably because individuals with predominantly small LDL size also have more LDL particles. But if LDL size is a surrogate for LDL particle concentration, then why not instead use non-HDL cholesterol, which is also a surrogate for LDL particle concentration and can be obtained without additional cost?"

If non-HDL cholesterol is a surrogate for LDL particle size, then it is not necessary to do NMR, and the goal is to have low levels of non-HDL cholesterol, i.e. low total cholesterol.

gunther gatherer said...

Hi Don, thanks for this. Can you possibly make the first two images clickable? Its a bit too small to read them embedded in the text.

BTW, my story is now comparable to yours: paleo for years and then VLC when that didn't work for weight loss. My fiancée did the same on my recommendation, and we both stayed overweight. Her cholesterol rocketed to 310.

After about 3 months plant-based, she and I are back below our lowest weights in high school and cholesterol is now below 150 for both. I'm 41 and she's 37 y.o.

But of course, all I hear is "where's the protein?" from family and friends.

gunther gatherer said...

And BTW, how long did it take your xanthomas to go away? Mine are still here (on my back, luckily). They developed during my VLC period.

Peter said...

Clinical utility of inflammatory markers and advanced lipoprotein testing: Advice from an expert panel of lipid specialists

"All lipoprotein particles in the LDL fraction are atherogenic, independent of size"

http://www.lipid.org/uploads/300/Expert%20Panel%20Paper.pdf

Peter said...

The same panel concluded In June 2011:

"There are no studies to formally assess the incremental risk prediction achieved by measurement of LDL subfractions
above and beyond traditional lipid measures and nonlipid risk factors".

"There are no prospective studies to show that a treatment strategy of changing LDL subfractions is superior to traditional lipid-lowering therapy in terms of atherosclerosis progression or CV morbidity and mortality".

Charles Grashow said...

Don Said - " It is not necessary to eat animals to obtain health. Even if it was, I wouldn't do it."

That says it all.

2) If the goal is to drive LDL-C to below 70 then take a look at these blood test results

Fruitarian blood work

to convert mmol/l to mg/dl
http://en.mte.cz/conversion.php?mmol=1.4&mg=&count_it=1

http://eatfruitfeelgood.com/2010/06/14/blood-test-results-in/

total cholesterol = 66.6
ldl cholesterol (calculated)= 29.88
hdl cholesterol= 25.02
cholesterol/hdl ratio= 2.66
triglycerides= 25.56

http://livingonfruit.blogspot.com/2011/02/my-personal-blood-test-results-released.html

total cholesterol= 82.8
ldl cholesterol= 46.8
hdl cholesterol= 25.2
cholesterol/hdlratio = 3.27
triglycerides = 16.2

Based on these test results why not go a raw fruitarian diet??

Charles Grashow said...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study – Implications for LDL Management

Results

At baseline, the cholesterol content per LDL particle was negatively associated with triglycerides and positively associated with LDL-C. On follow-up (median 14.8 yrs), 265 men and 266 women experienced a CVD event. In multivariable models adjusting for non-lipid CVD risk factors, LDL-P was related more strongly to future CVD in both sexes than LDL-C or non-HDL-C. Subjects with a low level of LDL-P (<25th percentile) had a lower CVD event rate (59 events per 1000 person-years) than those with an equivalently low level of LDL-C or non-HDL-C (81 and 74 events per 1000 person-years, respectively).

Conclusions

In a large community-based sample, LDL-P was a more sensitive indicator of low CVD risk than either LDL-C or non-HDL-C, suggesting a potential clinical role for LDL-P as a goal of LDL management.

Conclusions
Among alternative measures of LDL in this large, community-based study, LDL particle number was more strongly related to incident CVD events than LDL-C. Of particular relevance to the use of specific LDL treatment targets as indicators of the adequacy of LDL lowering therapy was the finding that low LDL particle number was a better index of low CVD risk than low LDL-C. Non-HDL-C provided risk prediction intermediate between LDL particle number and LDL-C, with evidence suggesting that the better prediction relative to LDL-C was due less to non-HDL-C including atherogenic triglyceride-rich particles (VLDL and remnants) and more to its strong correlation with LDL particle number. Finally, our novel finding that LDL particles are more cholesterol-depleted when LDL concentrations are lower, independent of triglycerides or LDL particle size, helps to explain why patients with low LDL-C often have disproportionately higher numbers of LDL particles (7–13). Our data show that persons with this LDL disconnect have higher CVD risk. It is therefore reasonable to anticipate that such discordant individuals would derive clinical benefit from more intensive LDL lowering than would have been indicated by their LDL-C level. Data from statin intervention trials are needed to test this hypothesis.

Peter said...

@Charles,

had you actually read about the expert panels views, you'd know damn well that they cover the Framingham study well enough. It's just that unlike amateurs, the real experts of the expert panel can properly analyze these studies, and most importantly give them the weight they deserve and have them placed in the proper context.

Clinical utility of inflammatory markers and advanced lipoprotein testing: Advice from an expert panel of lipid specialists

"To date, there is no evidence that the shift in LDL subfractions directly translates into change in disease progression or improved outcome".

http://www.lipid.org/uploads/300/Expert%20Panel%20Paper.pdf

But, as usual, since you appear to be a denialist, by citing one study you think you know better than real experts in cardiovascular disease.

Peter said...

@Charles,

I thought you were discussing the particle size. Particle count meusurement has some potential over LDL-C on people with metabolic syndrome, but not much potential for healthy people nor
very high risk people

I guess most of Don's blog readers do not fit in the category where LDL-P could make up a relevant risk predictor over traditional lipid panel.

Low risk (,5% 10-year CHD event risk)

"It is the consensus of the NLA Biomarkers Expert Panel that treatment decisions are unlikely to be altered by use of LDL-P among low risk patients. Hence, measurement of LDL-P was ‘‘not recommended’’ for this patient group".

Intermediate risk (5–20% 10-year CHD event risk)

"It is the consensus of the NLA Biomarkers Expert Panel that there are a substantial number of patients for whom LDL-C may not accurately reflect CVD risk. On the basis of the data showing that discordantly elevated LDL-P is more strongly associated with incident CVD risk than LDL-C level,167,173 measurement of LDL-P is thought to be ‘‘reasonable for many patients.’’ When LDL-P is discordantly elevated, consideration should be given to initiating or intensifying LDL lowering therapy. Conversely, a more conservative treatment approach could be considered for patients with lower LDL-P values than predicted based on their LDL-C (or non-HDL-C) concentrations. Populations known to manifest increased prevalence of discordance (elevated
LDL-P for the level of LDL-C or non-HDL-C) include patients with metabolic syndrome,171,174 as well as those with low HDL-C and/or elevated triglycerides"

CHD or CHD risk equivalent

"Because of high CV risk, patients with known CHD or a CHD risk equivalent are candidates for aggressive lipidaltering therapy. Given the clinical benefit of treating these patients with appropriate medical therapy, it is unclear whether additional LDL-P information would alter initial therapeutic decisions. Hence, it is the consensus of the NLA Biomarkers Expert Panel that use of LDL-P should be ‘‘considered
for selected patients only’’ to identify individuals
who might benefit.

http://www.lipid.org/uploads/300/Expert%20Panel%20Paper.pdf

So, Charles, please, next time more science and less pseudoscientific half-truths. Measuring LDL-P and particle size have very little benefit over traditional lipid panel for the bulk of the people.

Charles Grashow said...

@Peter

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study – Implications for LDL Management

William C. Cromwell, MD,1,2 James D. Otvos, PhD,3 Michelle J. Keyes, PhD,4,5 Michael J. Pencina, PhD,5 Lisa Sullivan, PhD,6 Ramachandran S. Vasan, MD,4,7 Peter W.F. Wilson, MD,8 and Ralph B. D’Agostino, PhD4,5
1 Division of Lipoprotein Disorders, Presbyterian Center for Preventive Cardiology, Charlotte, NC
2 Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC
3 LipoScience, Inc., Raleigh, NC
4 The Framingham Study, Boston University School of Medicine, Framingham, MA
5 Department of Mathematics and Statistics, Boston University, Boston, MA
6 Department of Biostatistics, Boston University, Boston, MA
7 Department of Preventive Medicine, Cardiology Section, Boston University, Boston, MA
8 Cardiology Division, Dept of Medicine, Emory University School of Medicine, Atlanta, GA

SO - these people have no idea what they're talking about but your "experts" do!

If this study disproves your study then maybe your study is in error.

Also - why is this study full of "pseudoscientific half-truths"??

Sandy P. said...

Hi Don,

I've been following your blog for a while and I'm quite the fan.

I did a few dietetic experiences in the last few months (vegeterian, fruitarian, etc.) and I'd like to share some of the informations I collected : it should be some interests to you.

Is there a e-mail to which I could contact you ? I'd have an easier time summarizing my thoughts.

Oh also, I'm looking for popular health forum on which I could challenge my views on dietetic.


Thank you, keep up the good job,
Samuel P.

Don said...

Charles,

"That says it all" yes, I am willing to stand for something. If the data and my panels indicated that I was at risk for heart disease because I didn't eat animals, I would admit that I was putting myself at risk of heart disease because I value my ethical health more. But no data so far has been presented to convince me that anyone has to eat animals to prevent heart disease.

I asked for evidence that altering LDL particle size or count will halt or reverse progression of atherosclerosis, and you provided one that suggests that for some people, LDL particle size might better predict their risk of a CVD event. Try again.

Also note, in the conclusion of the study you cited, this:

"Our data show that persons with this LDL disconnect have higher CVD risk. It is therefore reasonable to anticipate that such discordant individuals would derive clinical benefit from more intensive LDL lowering than would have been indicated by their LDL-C level."

They concluded that the best therapy for these individuals with "LDL disconnect" is to lower LDL more intensively, not attempt to change the particle size or stop worrying about LDL level as you advised.

You cite one study, the expert panels do what scientists do, they weigh the preponderance of evidence from multiple studies, and also consider confounders as discussed in the paper I cited in comment above. Its not that the Framingham people aren't experts, its that this is only one study which must be considered in the context of the whole body of research on LDL and LDL particle size.

Don said...

Hi Gunther,

They should be clickable now, though the resolution, at least on my screen, is not great. I added a link to the full paper available online.

Tracy's TC dropped to 106 since stopping paleo. She blogged about it: http://thefoodway.blogspot.com/2012/08/this-post-is-dedicated-to-charles.html

I really wonder if my TC got as high as that of your fiance. Between 2007 and 2010 I had greatly increased my use of saturated fats, including a lot of cream, much more than Tracy ever ate.

I still have the xanthoma also, on my back side, but it does seem to be shrinking albeit very slowly.

gunther gatherer said...

Thanks for the links Don.

Regarding TC, it was exactly between 2008 and 2012 that I was hardcore VLC á la Peter Hyperlipid and Gary Taubes (drinking heavy cream, butting butter on steak to "lower the insulin spike" and such crap) and not checking trigs because apparently "you don't need to check trigs".

Funny how LCers can't make up their minds whether we should only worry about fluffy LDL or whether we shouldn't bother checking trigs at all. Very irresponsible, and downright criminal on Taubes' part since he's making beaucoup bucks selling this dangerous line of crap.

My xanthoma is shrinking ever so slowly too, though I've only been entirely plant-based for a few months.

Is there any way you could do a post on fiber weight and estrogen levels? Estrogen is highly associated with cancers, especially breast and ovarian cancer in women. In men, high levels are correlated with prostate cancer. Contrary to Peter's beliefs, fiber DOES serve a purpose by pulling excess estrogen out of the body, thereby balancing our hormone levels. Men with stubborn belly fat could do with a bowl or two of oat bran to get rid of it:

http://www.ncbi.nlm.nih.gov/pubmed/17640158

and here are two great clips on how estrogen gets flushed by a body that's evolved on lots of dietary fiber:

http://www.youtube.com/watch?v=YiZm7dESVs0&feature=plcp

http://www.youtube.com/watch?v=7r47e-ySk48&feature=plcp

gunther gatherer said...

Some more on dietary fiber and circulating estrogen levels:

http://www.news-medical.net/news/2004/10/18/5674.aspx

And there's something being identified as "estrogen dominance syndrome" (which can occur in women and men), which is when estrogen levels are too high in relation to progesterone in the body.

Boyd Eaton claims we had anywhere from 100 to 200g of fiber per day during our evolution, so it stands to reason that our bodies are still expecting that in order to balance our metabolisms.

aspiringsteph said...

Great post and also very informative comments! Thank you!

Amy said...

When I was a high fiber low fat vegan my total cholesterol was 220 and I was a mere 25 years of age. My cholesterol reduce to 150 when I started an omnivore diet that included frying broccoli and green beans in peanut oil for most of my calories. I have lots of vegan friends that have much higher cholesterol levels than I do and they have been vegans for more than twenty years. Veganism is not a magic cure anymore than paleo or low carb.

Jimmy Gee said...

Why do supporters of this site, that love being a vegan, try so hard to prove their point. This blog has gone so far off in left field with obscure reasoning. If you are a vegan for ethical reasons, then fine - that's tantamount to practicing the religion of your choice. If you you are doing it for health reasons, then you are kidding yourself. If you look deeply and broadly enough, for every research (and I use the term lightly when it comes to nutrition research) article that purports benefits, there are as many that show deleterious effects.

There are no magic recipes for eating. Our bodies are amazingly complex and rely on a myriad of chemical reactions / interactions to function. Extracting one and extrapolating is foolish at best.

WoLong said...

Don, nice post. However, I believe that some serious studies looked at cholesterol and cancer and have found that low cholesterol, especially low LDL levels, is strongly associated with cancer. A paper in Lancet a few years ago suggested that TC should NOT be lowered below 180 in elderly people, since TC was inversely correlated with mortality. Comment?

Don said...

Amy,

"Veganism is not a magic cure anymore than paleo or low carb."

Regarding this comment and your vegan friends, "vegan" only means avoiding animal products. It does not mean eating a healthy balance of foods, as a vegan can eat processed foods (processed sugars, starches, proteins, and oils) or tropical oils (palm and coconut), or eat enough to become overfat (raises lipids), or fail to exercise (raises lipids). They can fail to consume adequate nutrients by avoiding certain whole foods or food groups (e.g. green leafy vegetables, flax, whatever), or they can avoid sunlight exposure (also increases cholesterol levels). Vegans can also use oral contraceptives (they raise cholesterol and other lipids (http://www.ncbi.nlm.nih.gov/pubmed/12277211), have hypothyroidism (raises cholesterol levels), or have familial hypercholesterolemia.

There seems to be an assumption that there is one way to eat a vegan diet, and every vegan eats that way. Of course, there are many ways to eat a vegan diet, as well as many different people eating vegan diets, each having different habits. This is why we look at the bulk of evidence and specific ways of eating a plant-based diet, rather than making blanket statements about 'veganism.'

You say you were high fiber low fat, but I don't know what you mean because the concept and practical application of "high fiber" and "low fat" varies considerably from person to person, and additionally, might mean that you excluded certain foods like flax or nuts that could have reduced your cholesterol.

You changed from what you describe as low fat veganism to omnivorism including fried broccoli and green beans. This sounds like you changed two things, namely, you added animals, and you added fat. Hence, we can't determine which, if either, change was responsible for your cholesterol reduction. Perhaps it was the increase or change in fat intake, not the addition of meat. Perhaps it was something else, like change in sun exposure, or other factors I alluded to above.

Don said...

Jimmy,

"There are no magic recipes for eating."

I wonder why you and Amy think that anyone here is talking about "magic"? We have provided scientific data, but you wave it away by suggesting that we are seeking some 'magic' way of eating. Not me, I am following the research of the best scientists, and basic facts found in numerous text books, such as the facts that humans have no dietary requirement for animal protein, saturated fats, or cholesterol.

" This blog has gone so far off in left field with obscure reasoning."

Left field is as much part of the field as the right field; and if you change your perspective, the left becomes right and right becomes left. Left and right are interdependent parts of the whole. The "left" part of reality, i.e. the part you apparently don't want to hear about or from, exists no matter how much you deny or belittle it.

"If you you are doing it for health reasons, then you are kidding yourself. If you look deeply and broadly enough, for every research (and I use the term lightly when it comes to nutrition research) article that purports benefits, there are as many that show deleterious effects."

If you are not eating a whole foods plant based diet for health reasons, you have gotten incorrect information about diet and health.

Whole foods plant based diets have been shown to prevent or reverse cardiovascular disease, diabetes, and cancer.

Numerous studies have established that people in populations eating whole foods plant based diets (e.g. rural Chinese, American vegan Seventh Day Adventists, rural Africans) have low risks of diseases of affluence, but when they make the nutrition transition to diets high in animal products and refined foods, they lose this advantage.

Based on this observation, investigators have run clinical trials to discover if whole foods plant based diets can modify disease processes.

Esselstyn and Ornish have shown that a whole foods plant based diet reverses atherosclerosis.

Ornish and Saxe have shown that a whole foods plant based diet halts or reverses prostate cancer.

Barnard has shown that a whole foods plant based diet reverses type 2 diabetes.

Other investigators have shown that whole foods plant based diets can halt or reverse autoimmune conditions.

In none of these studies have the interventions caused harm.

Besides the science, I know that a vegan diet improved my health and that of my wife. It reduced my blood lipids and improved my skin health, and my wife has lost body fat, and no longer has cystic breasts.

Every report I have seen of deleterious effects of plant based diets (including those I made in my past) have involved unnecessary energy restriction, restricted food choices, failure to insure B12 intake, refined foods, inadequate sun exposure, or other confounders.

The American Dietetic Association, a conservative organization, has reviewed all the evidence on vegan diets and concluded that if well planned and energy adequate, vegan diets can support health at all stages of human life cycle.

Lastly, like Amy, you seem to assume that there is one vegan diet eaten by all people attempting a vegan diet, and that all studies are reporting on this ONE vegan diet.

If you want to eat omnivorously, paleo, low carb, or anything else but a whole foods plant based diet, and you only want "right field" information, I wonder why you hang around this "left field" blog.

Don said...

WoLong,

I believe that has been well studied and found to be due to cancer lowering cholesterol levels. In other words, low cholesterol does not cause cancer, cancer causes low cholesterol (because a rapidly growing tumor uses a lot of cholesterol to make cell membranes).

Lower cholesterol may protect against aggressive prostate cancer:

http://www.usatoday.com/news/health/2009-11-03-prostate-cancer_N.htm

Coronary artery disease and CAD risk factors (e.g. elevated cholesterol) are also risk factors for prostate cancer: http://www.ncbi.nlm.nih.gov/pubmed/22315364

Cholesterol plays a role in breast cancer development: http://www.ncbi.nlm.nih.gov/pubmed/22867847

"distant metastasis rate was significantly higher in the breast cancer patients with an higher level of serum TC, TG, LDL-C, and LDL-C/HDL-C ratio" http://www.ncbi.nlm.nih.gov/pubmed/22780931

In an animal breast cancer study, long term simvastatin lowered cholesterol and reduced chemically induced breast tumour frequency by 80.5% and tumour incidence by 58.5% http://www.ncbi.nlm.nih.gov/pubmed/21539141

"besides lowering cholesterol level, statins exert pleiotropic effects on many essential cellular functions including cell proliferation, differentiation, and survival but also participate in the regulation of cell shape and motility. Statins have been shown to inhibit proliferation and to induce apoptosis in a variety of tumor cells. They have also been found to display antitumor effects against melanoma, mammary carcinoma, pancreatic adenocarcinoma, fibrosarcoma, glioma, neuroblastoma, and lymphoma in animal tumor models resulting in retardation of tumor growth, and/or inhibition of the metastatic process." http://www.ncbi.nlm.nih.gov/pubmed/12963986

"The levels of oxysterols, including 25 HC [hydroxycholesterol], have been found to be elevated in hypercholesterolemic serum" and "The estrogen action exerted by 25 HC [hydroxycholesterol] may be considered as an additional factor involved in the progression of breast and ovarian tumors." In other words, elevated serum cholesterol is estrogenic and promotes hormone sensitive tumor growth. http://www.ncbi.nlm.nih.gov/pubmed/21304949

This latter helps explain why lowering cholesterol with statins or diet (see the independent studies by Ornish http://www.ncbi.nlm.nih.gov/pubmed/18602144 and Saxe http://www.ncbi.nlm.nih.gov/pubmed/16880425 showing that WFPB diet inhibits prostate cancer progression) in inhibiting cancer growth.

Bog said...

@Wolong

The nobel price winners, cholesterol researchers Goldstein & Brown maintain that it's practically impossible for LDL to be too loo, our physical needs for LDL is very small. People who have genetical defect on cholesterol regulation (the opposite to those with FH), live their lives healthy with LDL just about 15mg/dl, they live about 9-12 year longer than their peers and have minimal risk for heart disease. This is why high risk people are put on statins irrespective of their LDL, the lower, the better. Human babies have LDL around 30.

Link to the paper by Brown and Goldstein

A receptor mediated pathway for cholesterol homeostatis

"Several lines of evidence suggest that plasma levels of LDL cholesterol in the range 25-60mg/dl might indeed be physiologic for human beings"

http://www.sciencemag.org/content/232/4746/34.short

The cholesterol-denialist are not aware of the J-curve (reverse causation) and troll about low cholesterol being hamrfull because it suggest higher total mortality and cancer in epidemiological studies. This is correct, but it does not follow that we should not be having low cholesterol, it just follows that the cholesterol of sick, elderly Western people plummets during the last years of the their life-span due to chronic diseases and aggressive lipid lowering agents. Cholesterol levels at the last years of life-span tells us very little.

From the Framingham

"Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling–perhaps due to diseases predisposing to death.”

http://www.ncbi.nlm.nih.gov/pubmed/3560398

Low cholesterol, mortality, and quality of life in old age during a 39-year follow-up

"More dispute has arisen regarding the association of low cholesterol and mortality in elderly persons. For example, in the Honolulu Heart Program (5) low cholesterol was associated with greater mortality risk. Obvious explanations for the association are intervening factors that both increase mortality risk and decrease the cholesterol level. In the nine-year follow-up of the Helsinki Aging Study, mortality risk was associated with both lowered cholesterol synthesis and lowered cholesterol absorption (20), which reflect terminal decline and lead to lower serum cholesterol levels. These associations are not identified, and the relationship between cholesterol and mortality becomes distorted unless the follow-up is long enough"

http://content.onlinejacc.org/cgi/reprintframed/44/5/1002

There's a great youtube serie on the cholesterol denialists and their ridiculous gimmicks.

The Futility of Cholesterol Denialism, Part 1: How Much LDL?
http://www.youtube.com/watch?v=6bSdnQ1MKGo&list=PLDBBB98ACA18EF67C&index=2&feature=plpp_video

Cholesterol, Cancer, and Depression

http://www.youtube.com/watch?list=PLDBBB98ACA18EF67C&v=2sLp_vAz9KQ&feature=player_detailpage

Bog said...

Charles likes the Framingham study

William Castelli, principle director, Framingham Study:

"You know, we know that if I can get your total cholesterol down around let's say 100 to 130 or so, and I have maybe not quite a billion people on the earth like that, and those people cannot get atherosclerosis. You know in the China Study, for example, when Chou En-lai was dying of cancer he started a study in China just like the Framingham Study. The only difference was it was in 880,000,000 people so it was a little larger than the Framingham Study. But you know they found these villages in China where you couldn't get a heart attack or you couldn't get diabetes and the women couldn't get breast cancer and you know their total cholesterol were 127, but the chances we could ever get Americans down that low with diet and exercise are not good".

"KIRK HAMILTON: But what would the diet be if you didn't have drugs and you could get everybody to do exactly what you wanted diet-wise in the United States? How would you reverse the heart disease?"

"DR. WILLIAM CASTELLI: Well you'd have them on a pure vegetarian diet and not getting fat on the vegetarian diet."

http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

People with low LDL are not the first candidates for prostate cancer

The Importance of LDL and Cholesterol Metabolism for Prostate Epithelial Cell Growth (June, 2012)

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0039445

gunther gatherer said...

Hi again, in re-reading my comment above, I meant to say "can you do a post on STOOL weight and circulating estrogen levels". Not fiber weight.

Apparently the larger the stool weight, the lower the risks of colorectal, breast, prostate, ovarian and other estrogen-related cancers.

Amy and Jimmy, why bother trying to confuse this debate with more LC propaganda? Your obvious biases will be welcomed on Gary Taubes' and Hyperlipid websites with open arms.

WoLong said...

Thanks Don for the answer. I am just a bit disturbed by a recent paper that shows that low cholesterol can predate cancers by decades, unless a cancer takes decades to develop, it would seem to suggest that there might be some cause and effect there. I should note that the authors themselves were unwilling to make such a connection.

Jimmy Gee said...

Don;

You delivered on what I expected as a response - typical "Don-ism".

As to why I look at your blog - sometimes I just need a good laugh!

Charles Grashow said...

http://www.sciencebasedmedicine.org/index.php/the-china-study-revisited/
The China Study Revisited: New Analysis of Raw Data Doesn’t Support Vegetarian Ideology

Campbell says breast cancer is associated with dietary fat (which is associated with animal protein intake). The data show a non-significant association with dietary fat, but stronger (still non-significant) associations with several other factors and a significant association with wine, alcohol, and blood glucose level. The (non-significant) association of breast cancer with legume intake is virtually identical to the (non-significant) association with dietary fat. Animal protein itself shows a weaker correlation with breast cancer than light-colored vegetables, legume intake, fruit, and a number of other purportedly healthy plant foods.)

He indicts animal protein as being correlated with cardiovascular disease, but fails to mention that plant protein is more strongly correlated and wheat protein is far, far more strongly correlated. The China Study data show the opposite of what Campbell claims: animal protein doesn’t correspond with more disease, even in the highest animal food-eating counties.

http://www.sciencebasedmedicine.org/index.php/385/
The China Study

http://www.sciencebasedmedicine.org/index.php/bill-clintons-diet/
Bill Clinton’s Diet

http://rawfoodsos.com/2010/09/02/the-china-study-wheat-and-heart-disease-oh-my/

http://healthcorrelator.blogspot.com/2010/09/china-study-ii-wheat-flour-rice-and.html

http://healthcorrelator.blogspot.com/search/label/China%20Study

http://theshmaltz.blogspot.com/2010/07/slam-dunking-of-china-study.html

Bog said...

@Charles

Campbell is scientist, Sir Richard Peto is scientist. Harriet Hall is not a scientist, in fact she is denialist buffoon who just like other infantile LCers think that high school kid can do better job in analysing the data as opposed to medical statistics professor in Oxford. Sir Richard Peto happened to also create the concept of meta-analysis.

The sources you recite are complete pseudoscientific nonsense.

Primitive Nutrition 62: China Studies, Part I
http://www.youtube.com/watch?v=b4u-5Tb8WHk&list=PLCC2CA9893F2503B5&index=62&feature=plpp_video

@WoLong

Do you think cholesterol lowering foods such as oatmeal and blueberries cause cancer? Look around you, the lowest incidences of cancer occurred in rural Asia, Central-Africa, etc, in places were cholesterol levels were very low. The Okinawa folk had very low cholesterol levels.

Bog said...

The attacks by LCers/paleo folk against Ancel Keys and Colin T Campbell are basically identical to the attacks creationist launched against Darwin. Anti-science crew has always been among us.

Bog said...

I love the China Study. It included, among others, a cohort from Guizhui county. Over 250 000 people and not a single death from cardiovascular disease during the 3-year follow up. Mean TC cholesterol were 127mg/dl. Cancer incidences were extremely low as well.

Again, nothing we would not know already from the 1920's.

Cornelius de Langen, a Dutch colonalist Doctor in Indonesia conducted the first controlled clinical experiment on diet's role to serum lipids. He noticed the ethnic Javanese had exceptionally low TC cholesterol and exceptionallty low rates of chronic disease as opposed to the Dutch society of Indonesia who had very high incidence of chronic illness. The diet of ethnic Dutch in Indonesia was that of "real food", lot of meat and butter. The diet of the native Javanese was characterized as "Spartan" it comprised mostly of rice and vegetables. Two dietary cultures sharing the same eco-niche.

Cornelis de Langen: Diet-Heart Theory, 1916

"In 1940, I confirmed De Langen’s results . . . by the observation that in North China, coronary disease, cholesterol [gall]stones and thrombosis were practically nonexistent among the poorer classes. They lived on a cereal-vegetable diet consisting of bread baked from yellow corn, millet, soybean flour and vegetables sautéed in peanut and sesame oil. Since cholesterol is present only in animal food, their serum cholesterol content was often in the range of 100 mg. per cent. These findings paralleled the observation of De Langen that coronary artery disease was frequent among Chinese who had emigrated to the Dutch East Indies and followed the high fat diet of the European colonists (Snapper 1963, 284)".

"It was not long before de Langen noted that his native Javanese patients rarely manifested the internal diseases with which he had been accustomed to dealing in Europe. Pursuing this clinical impression, he reviewed ten years of admissions charts and found only five cases of acute gall bladder disease among many thousands of patients passing through the medical wards, and only one on the surgery service out of 70,000 admissions surveyed (de Langen 1999, 130)".

"After thus documenting the rarity of gallstones, de Langen wrote about his observations of vascular phenomena: “. . . thrombosis and emboli, so serious in Europe, are most exceptional here. This is not only true of internal medicine, but also on surgery, where the surgeon needs take no thought of these dreaded possibilities among his native patients. Out of 160 major laparotomies and 5,578 deliveries in the wards, not a single case of thrombosis or embolism was seen” (de Langen and Lichtenstein 1936, 491-492)".

De Langen made similar observations on the absence of angina pectoris and the by-then-recognized syndrome of myocardial infarction. In contrast, his Dutch colonial patients had the frequency of such conditions expected among his fellow countrymen at home. The following confirmatory account is from the memoir of Isidore Snapper:

"My friend and former co-resident in Groningen, C. D. de Langen, had discovered in 1916 in Indonesia, that the obligatory vegetarian Oriental, whose intake of cholesterol was practically zero, does not develop gallstones. Soon it appeared that not only cholesterol stones of the gall bladder but also arteriosclerosis and phlebitis (also lung emboli) hardly ever occur among the Orientals (van Lieburg 2004, 171)".

http://www.epi.umn.edu/cvdepi/essay.asp?id=111

Jimmy Gee said...

@Bog

"The attacks by LCers/paleo folk against Ancel Keys and Colin T Campbell are basically identical to the attacks creationist launched against Darwin. Anti-science crew has always been among us."

What a guffaw! Anti-science crew indeed - Bog you are the proverbial pot calling the kettle black - you are more a creationist / anti-scientist than anyone - as well as a sycophant.

More

WoLong said...

@Bog,
Did I say oatmeal and blueberry cause cancer? As a matter of fact, I had oatmeal with blueberry this morning! What I said on relationship btw low cholesterol and cancer has been published in peer reviewed journals in the past decade. I also purposefully said that the authors of these papers were careful NOT to make a causal relationship, however, the suspicion is there. If we want to have an honest discussion, we need to look at all the data.
BTW, I am 90% vegetarian, so bias is not the issue.

Amy said...

Don,
I love that you have challenged the paleo and low-carb world, but even you need to admit that you're sounding a lot like Jimmy Moore. I remember when Jimmy Moore would tell people to eat more fat because they weren't doing low-fat the right way. The Low-carb diet is still not working for him. Mr. Moore has far bigger issues than carbs to deal with.

Honest to goodness the only things that I changed that lowered my cholesterol was adding fat and animal protein. I've always had a sugar and simple starch phobia and a love for bitter vegetables and running. I've always somewhat avoided the sun shine I freckle easily. My birth control had not changed.

I did lose 50 pounds when I added fat and animal protein, which is important for lowering cholesterol levels. I had gained 50 pounds when I became a vegan. I could down bowls of various fat-free bean soups and broccoli. I had completely given up starches like rice, bread and potatoes. I did eat a bit of corn, but no sugar.

Low-fat, high fiber, no meat does not make a person thin. The longer I was vegan the more food I restricted and the more weight I gained.

I don't support paleo because I can gain weight on it too. Too many restrictions. I am a bit of a diet agnostic, but I haven't completely given up on fiber, bitter greens, a fair amount of fat and some animal protein. I may at some point choose to be a diet atheist. I haven't decided. I'm open to what science will discover.

Charles Grashow said...

Jimmy Gee said...
@Bog

"The attacks by LCers/paleo folk against Ancel Keys and Colin T Campbell are basically identical to the attacks creationist launched against Darwin. Anti-science crew has always been among us."

What a guffaw! Anti-science crew indeed - Bog you are the proverbial pot calling the kettle black - you are more a creationist / anti-scientist than anyone - as well as a sycophant.

I agree totally.

Don said...

Amy,

"Honest to goodness the only things that I changed that lowered my cholesterol was adding fat and animal protein. ...I did lose 50 pounds when I added fat and animal protein, which is important for lowering cholesterol levels."

Wait, part of you missed something, and another part didn't. Since you added fat and animal protein and also lost 50 pounds, you can't conclude that "the only things that I changed that lowered my cholesterol was adding fat and animal protein."

Since your cholesterol dropped when you lost 50 pounds, and you added fat and animals before losing 50 pounds, you can't know whether it was adding some fat or adding animals or losing 50 pounds of body fat that made the difference for you.

" I had gained 50 pounds when I became a vegan. I could down bowls of various fat-free bean soups and broccoli. I had completely given up starches like rice, bread and potatoes. I did eat a bit of corn, but no sugar."

First, I am pretty sure you didn't mean that you gained 50 pounds the moment you decided to eat a vegan diet, but that you gained it over a period of time. A pound of fat represents an excess intake of 3500 kcal, so to gain 50 pounds of fat, you have to consume an excess of 175,000 kcal over some period of time. If you over ate 500 kcal per day, you could gain one pound per week and 50 pounds in a year.

A typical active 25 year old woman needs about 2400 kcal per day, and you say you have always loved running, so I will take that as your caloric requirement.

Broccoli supplies about 35 kcal per 100 g and 55 kcal per cup: http://ndb.nal.usda.gov/ndb/foods/show/2940

Lentils can represent beans and I will use cooked lentils not made as soup, one cup supplies 230 kcal: http://ndb.nal.usda.gov/ndb/foods/show/4762

I will assume you ate one cup of broccoli for every cup of beans, the two adding up to 285 kcal. Thus you would have to eat 8 portions of this combo (one cup beans plus one cup broccoli), or 16 cups total, daily to meet your caloric requirements. Assuming three meals daily, it comes to 5.3 cups of food at each of three meals, or eight cups (two quarts) at each of two meals.

Each cup of lentils weighs 198 g, each cup of broccoli 156 g, so 8 c beans plus 8 c broccoli weighs 2.8 kg, or 6 pounds. That's just to meet your basic energy needs, not enough to gain any fat. And you said bean soup, which is less energy dense due to more water than boiled lentils, so if you ate soup, it had to be more than 6 pounds of food daily.

The typical person eats only about 3-5 pounds of food daily, so you are already eating up to twice as much food as typical.

Now, to consume 500 excess kcal per day (so as to gain one pound of fat per week) as broccoli you have to eat another 14 cups (4.8 pounds, 2.2 kg) of broccoli above and beyond caloric needs. A total of 30 cups (and more than 10 pounds) of food daily.

Or another two cups of beans. A total of 18 cups of food daily.

Or 1.8 servings of the combo of 1 cup beans and 1 cup broccoli, i.e. 3.6 cups of food total.

That's a lot of food. Perhaps you gained the 50 pounds over a longer period than one year?

Don said...

@Amy again,
Now it seems you are saying that you ate beans and vegetables and had given up starches except corn. IMO, starch is the proper basis for a whole foods plant based diet, and restriction of starch intake can cause some people to overeat. The combination of beans and broccoli provides 22% of energy as protein, 63% as carbohydrate, and 16% as fat. If this constitutes most of your diet, it provides an excess of protein and could be less satisfying than a diet richer in starch.

Also, it sounds like you confirmed my guess that you weren't eating many nuts, seeds, avocadoes, or olives as whole foods sources of fat. Possibly adding some of these would have made the diet more fulfilling so that you would not consume bowls and bowls of beans and broccoli.

You seem to think that I have been advocating a low fat vegan diet.
To repeat and clarify, I am advocating a whole foods plant based diet.

Such as diet can vary in fat content depending on how much you eat of oil rich whole plant foods (e.g. olives, avocados, nuts, seeds). Although I think that the data clearly points to an animal free diet being best, and I don’t recommend eating animals, a whole foods plant based diet wouldn't necessarily even be vegan, just that more than 90% of the food energy in the diet came from plants.

Don said...

@Amy again,

"The longer I was vegan the more food I restricted and the more weight I gained."

Whoa, wait a minute. First you imply that you gained because you "could down bowls of various fat-free bean soups and broccoli," but now you claim that the gaining happened not when you ate alot but when you restricted food.

Which is it?

This last statement implies that you put calories in storage on your body as fat without eating equivalent food energy. This would be of enormous value to those who raise livestock, if they could find a way to make animals gain more weight by giving them less food.

It seems so odd that so many people claim to gain enormous amounts of weight while restricting food intake, when this never happens to other animals. Although people raising livestock would love to be able to make their animals gain weight by restricting their food intake, no one has ever reported such a thing happening. Anyone who would discover how to make this happen would be very wealthy in a very short period of time.

If we take your assertion at face value and to its logical conclusion, you would have gained weight the most rapidly if you ate nothing at all. This would completely overturn the laws of thermodynamics and indeed, all of modern science, since it would be creating body mass out of thin air.

That would qualify as magic, would it not?

Charles Grashow said...

@Don

Just curious as to how many grams of carbs you eat per day?

http://donmatesz.blogspot.com/2009/08/primal-potatoes-part-1.html

http://donmatesz.blogspot.com/2009/09/primal-potatoes-part-2.html

http://donmatesz.blogspot.com/2009/09/primal-potatoes-part-3.html

http://donmatesz.blogspot.com/2009/09/primal-potatoes-part-4.html

Do you agree that we should follow a starch based diet like John McDougall MD espouses??

http://www.youtube.com/watch?v=4XVf36nwraw

http://www.youtube.com/watch?v=yZ3hS9jpmm0

Charles Grashow said...

Don said "Although I think that the data clearly points to an animal free diet being best, and I don’t recommend eating animals, a whole foods plant based diet wouldn't necessarily even be vegan, just that more than 90% of the food energy in the diet came from plants."

So what would the non-animal non-vegan 10% consist of??

Don said...

Charles,

Just curious as to why you want to know how many grams of carbohydrate I eat per day?

I wrote: "IMO, starch is the proper basis for a whole foods plant based diet."

Is there something unclear about that?

"So what would the non-animal non-vegan 10% consist of??"

What???????


What are you fishing for?

Charles Grashow said...

@Don - you said "Although I think that the data clearly points to an animal free diet being best, and I don’t recommend eating animals, a whole foods plant based diet wouldn't necessarily even be vegan, just that more than 90% of the food energy in the diet came from plants."

Also - how many grams of carbs do you eat per day?

Don said...

Charles,

Yep, that's what I said. Are you having trouble understanding it?

Why do you want to know how many grams of 'carbs' I eat in a day?

I eat a whole foods plant based diet.

Charles Grashow said...

Don said - "Why do you want to know how many grams of 'carbs' I eat in a day?"

Just curious

Don said...

Charles,

Not worth my time. Bye.

deeplysteamupto1kgwholegrainsaday said...

I would like to leave a message for Amy, hoping that she reads it.

Amy,

Just because you lowered your calorie intake, it doesn't automatically follow that you'll lose weight in the long term, because weight changes are affected by not one but two factors: calorie intake, and calorie burning. I know it sounds paradoxical, but it's possible that, because of reduced overall food intake, in the long term your body reacts by lowering your metabolism to save calories, and consequently, you'll gain weight. You should browse the excellent site "180DegreeHealth" (not a vegan site, even though I advocate veganism), which has been explaining stuff like this for a long time. The point is that it is a mistake to severely restrict your food intake, which sounds exactly like what you were doing when you were vegan. There's no need to restrict any macronutrient on a vegan diet. You can eat as many calories as you like. And if you feel that you need fat, well, coconut oil is extremely healthy (unlike animal fats). You say that you ate a lot of beans. Bean have a lot of protein, which causes excessive satiety due to its slow digestion and prevents you from eating enough overall. It sounds counterintuitive, but it might be that on your vegan diet, you were eating too much protein, and not enough carbs or calories. Furthermore, the bulkiness of a vegan diet might cause you not to eat enough, unless you consciously counter this by eating in large bowls. I have a proposal for you: Try going back to veganism, but this time, eat large, unlimited amounts of low-protein whole starches (grains) and coconut oil if you feel like, and avoid too many beans. Eat in large bowls, not in plates - otherwise, it might be difficult to eat as many calories as you're eating right now. Abandon the idea that you need to watch your calories. Weight in the long run, is determined by factors other than your calorie intake. It completely contradicts everything you hear all the time, yet your own experience proves it, doesn'it? You gained fat on a lower calorie diet, and lost it on a higher calorie one. Browse the site 180degreehealth.com and you'll become convinced that I'm right. So just give veganism another time, and this time, eat plenty carbs and fat till get as many calories as you're getting right now, and reduce those digestion-clogging beans!

deeplysteamupto1kgwholegrainsaday said...

Oh, Amy, I forgot one thing: Cook your whole starches (and your beans too) very deeply. Another problem one might have about a vegan diet is insufficient cooking. The more you cook starches, the more they become absorbable and the less they clog your digestion. Try doubling the cooking time of whole grains, tubers, and beans (not that you need to eat many beans, make whole grains your staple and severely limit beans) and see what happens.

Jack LaBear said...

@Bog

Harriet Hall a "denialist buffoon"?

She rails against cholesterol skeptics and "denialists"
You, sir are the buffoon!

http://www.sciencebasedmedicine.org/index.php/the-international-network-of-cholesterol-skeptics/

http://www.sciencebasedmedicine.org/index.php/cholesterol-skeptics-strike-again/

Will said...

Detailed article! I went plant-based low fat on July 1, 2013. 10 months later I did blood tests and my total cholesterol is 112 mg/dL and LDL is 60 mg/dL. My fat dropped over 32 lbs and blood pressure is 106/69 pulse 50. This is all I need to know as to what is the correct diet! My previous triglycerides on vegetarian diet (including cheese, sour cream, may, oil, etc) were so high they could calculate the LDL.