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 that set her off on 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! – that 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 for 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.
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.
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.
She is now 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 that she’s fallen into the bosom of the ever-effective statins despite the fact that the preponderance of properly done studies have shown that 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 that show that 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 a) has been shown to be worthless for her, b) has been shown to cause cancer, and c) has its own list of 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 rats 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 that their cholesterol levels are a little high. With all the cholesterol-is-evil hype (or meme) that everyone has been relentlessly bombarded with for the past couple of decades, anyone who finds he/she has an elevated cholesterol levels has to varying degrees the same reaction that 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 cholesterol. 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 levels 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.
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
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
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
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
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
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