6: ‘All Things Lipids (Cholesterol 101)’ | Chris Masterjohn

AIR DATE: February 16, 2012 at 7PM ETFEATURED EXPERT: FEATURED TOPIC: “All Things Lipids (Cholesterol 101)”

Episode 6 of “Ask The Low-Carb Experts” features the topic “All Things Lipids (Cholesterol 101)” with blogger and doctoral candidate in Nutritional Sciences at the University of Connecticut  where he will be graduating this Spring. He is the creator and maintainer of Cholesterol-and-Health.Com and is the author of two blogs, The Daily Lipid at Cholesterol-and-Health.Com and Mother Nature Obeyed at WestonAPrice.org. He is also a frequent contributor to Wise Traditions, the quarterly journal of the Weston A. Price Foundation. Chris is the author of five publications in peer-reviewed journals, including a letter to the editor of the Journal of the American College of Cardiology criticizing the conclusions of a widely publicized study about the effect of saturated fat on blood vessel function, and letter to the editor of the American Heart Journal arguing that the effect of cholesterol ester transfer protein inhibitors on vitamin E metabolism should be studied before these drugs are deemed safe for preventing heart disease, a hypothesis published in Medical Hypotheses about the molecular mechanism of vitamin D toxicity and the involvement of vitamins A and K in this mechanism, a pilot study in humans suggesting that vitamin E protects against some of the negative effects of sugar consumption published in the Journal of Nutritional Biochemistry, and a review published in Nutrition Reviews about the potential for green tea to prevent or treat nonalcoholic fatty liver diseases. Chris Masterjohn has thoroughly studied the impact of cholesterol on your health and the answers he has discovered might just surprise you. If you have questions about cholesterol, HDL, LDL, triglycerides and more then this is the podcast for you.

Here are some of the questions Chris addressed in this podcast:

DARREL ASKS:My cholesterol has been high for quite a while. I was previously on Lipitor which made me feel pretty bad (old and feeble even though I’m neither) so I quit. This week my doctor got back my blood work and noticed my number was high (295) and insisted I go back on Lipitor. He said I was a ‘heart attack brewing’. I don’t want to and need some ammunition. Point me in the right direction.

MARK ASKS:I have a senior lady that her doctor has recommended her to take statins for a while. She doesn’t want to go on them, and her doctor just ran an Lp(a) test and hers was at 80. I seem to recall that statins don’t really affect Lp(a) and it’s mostly genetic. I’m not sure of her triglyceride/HDL ratio at this time, but should she be worried? Seems that Lp(a) is only an issue if you have heart disease or a lot of inflammation.

JOHN ASKS:

http://diabetes.diabetesjournals.org/content/early/2011/05/18/db11-0085

Question: Is MGmin LDL the silver bullet of atherosclerosis?

I’ve read suggestions that small, dense LDL is the killer, but I see studies suggesting that large, fluffy LDL can also be atherogenic.

JAMIE ASKS:In some countries (like Australia) you cannot get your cholesterol measured down to “small dense” and “large fluffy”. They only measure the basics, Triglycerides, HDL, LDL and Total cholesterol. From these numbers, is there a good ratio to indicate good health versus poor health?

SHARON ASKS:My husband has high cholesterol which is made worse by another necessary medication he takes. Triglycerides were over 700; he is taking very high doses of statins, bring it to 600; We started Paleo (no sugars; no grains; full-fat dairy and meats) and blood results after two weeks showed them at 199. Is this possible to have such a dramatic change so quickly from this diet? If followup blood work shows continued improvement, what is the number that would get his doctor to take him off of the statins?

SAM ASKS:I’m a 42-year-old male with little to no family history of heart disease. My latest VAP results include:

Tot LDL-Chol Direct 167 H mg/dLTot. HDL-Cholesterol Dir. 52 mg/dLTot. VLDL-Cholesterol Dir. 23 mg/dLSum Total Cholesterol 241 H mg/dLTriglycerides-Direct 75 mg/dLTot. NonHDL Chol(LDL+VLDL) 189 H mg/dLTotal apoB100 – calc. 118 H mg/dLLP(a) Cholesterol 4.0 mg/dLIDL Cholesterol 23 H mg/dLReal LDL-Cholesterol 140 H mg/dLSum Total LDL-C 167 H mg/dLREAL-LDL Size Pattern A ARemnant Lipoprot(IDL+VLDL3) 37 H mg/dL

My doctor insists I take a statin such as Lipitor. I say I may not need it. Which one of us is right? Also, is it possible that statins inhibit the formation of arterial plaque over time?

PAUL ASKS:What are your thoughts on all the alarmism surrounding glycation and fructation?

KAREN ASKS:I’m about to have blood work done to be underwritten for term life insurance. I’m concerned that my cholesterol levels may have elevated because I’ve only been LC’ing for about 9 months. If it comes back bad, do you have any advice for how to explain what’s going on to help mitigate the consequences?

LEO ASKS:It’s been almost 2 years since going low carb. Before that time I was taking fenofibrate for almost 8 years because of very high trig (700 -380) and low HDL (37) because of eating SAD. Now my trig is 100 – 75, HDL is 57 and still improving without taking meds. I read that eating saturated fat and red wine will help increase HDL. At my last doctor visit he suggested in begin statins because my total cholesterol was 250 and my LDL was 148 and to see a cardiologist. I asked that he do the test for determining large and small LDL particles to which he replayed he was not qualified to request that test! I also mentioned to him that the LDL level is really a fictitious number gathered by the Friedewald equation. Would you suggest I see a cardiologist and check further? Would it be a good idea to request a CAC score, Lp(a) and test for density particles of LDL?

WILLY ASKS:How are you? My question is what is Lp(a)’s role in heart disease and should we really even track it. As I recall Dr. Kurt Harris from the panu blog has what is considered a high level yet has a very low calcium score. While some on Dr. Davis heart scan blog have levels lower than his and suffer from high calcium scores or other cardiovascular issues. If we should be concerned with this lipid what is the best way to lower it? Niacin? Saturated Fats? Low Carb? I wonder if Lp(a) is just the new kid on the block for Big Pharma trying to keep the lipid hypothesis alive.

VALERIE ASKS:Chris, In your most recent interview with Chris Kresser you indicate that a TC:HDL ratio of 4 might be cause for concern and should be evaluated. My husband and I just got our results back, our ratios are 4.3 and 4.6. We can rule out recovering from obesity and fatty liver disease. What do you advise we do if anything? Get retested to establish our averages? Without going into too much detail, we have been following a WAPF/Paleo diet for 4 years, we are healthy and fit, I am 47, my husband is 40. Next, I have in my notes a TC range of 180-250 as found in traditional cultures. Can you also provide a range for HDL and LDL? And last, what foods, herbs, supplements, and food preparation techniques would you advise to support a healthy LDL receptor uptake process?

KYLE ASKS:There seems to be a growing interest in the blogosphere with the work of Dr. Ray Peat. A major tenet of Peat’s philosophy revolves around the toxicity of virtually any dose of polyunsaturated fats (PUFA)–both n3 and n6. Given your past work on EFAs and PUFAs in general, I’d love to hear your thoughts on Dr. Peat’s stance.

LUKE ASKS:What is the relation of lipid volume in the blood and speed of blood flow in the arteries and the body in general? (e.g, the documentary “Supersize Me” made a big deal about animal fat causing slower measured blood flow)

ELLEN ASKS:I believe higher cholesterol levels are healthier and protective against many illnesses. If my normal total cholesterol is around 205, and I make a diet change that has the effect of dropping my total cholesterol to 165, am I compromising the protective aspect of cholesterol? LDL is also lower at 92 and HDL has stayed about the same (55). Trigs are at 92. CRP is .75 and HbA1c is 5.5.

MACKAY ASKS:Patient just came back with very high cholesterol, but sub markers were phenomenal.

HDL 99Triglycerides 66HSCRP .4

Positive for celiac, although eats very little wheat. Total cholesterol 450. What could cause this?

EDWARD ASKS:Regarding lab measurements…lipid panels: Cholesterol measurement – what is actually being measured in standard lipid profiles, and what is being estimated? Is LDL calculated based on your TG measurement?

DEANNA ASKS:My stepdad has high cholesterol (mostly high Triglycerides) and has for many years—I have attached his lab report from last May—his numbers were better.

Total cholesterol 252Triglycerides 534HDL 33Testosterone 235Free testosterone 8.9

He takes: 160mg Fenofibrate, Benicar, Lovaza, DHEA, Niacin, and just started taking Red Yeast Rice. My mother thought he was on a statin—but Fenofibrate and Lovaza aren’t statins are they? Are they just as bad? Haven’t heard much discussion on these meds.

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