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Why Do Most Doctors Seem Clueless When It Comes To Understanding Cholesterol?

Being a member of the highly-respected medical profession has got to be one of the most rewarding experiences for those who choose to invest and educate themselves for many years to serve the general public with the knowledge they’ve obtained through all of this intense training. It’s not an easy road to obtain those letters after you name signifying you have the credentials to practice medicine on patients who have a medical need. Let me just say up front that I have nothing but great respect for those people who decide to become a nurse, doctor, naturopath, chiropractor, and any number of other healthcare-related careers. It’s a very noble profession in my eyes and I for one am glad they do what they do for those times when I or a family member have needed or will need medical assistance.

But there’s one thing that really bothers me about the practice of medicine as it exists in the year 2010 and it’s this: I can’t help but notice there seems to be an obvious disconnect between a doctor’s complex understanding of the way the human body functions and the impossible-to-miss nutritional component of it all. Sadly, much of this way of thinking is based on some rather shifty “science” that was pushed on our culture primarily by Ancel Keys and George McGovern decades ago (read Gary Taubes’ brilliant Good Calories Bad Calories book for the full scoop on this story!), but all the latest 21st Century research is showing some truly remarkable signs that maybe saturated fat isn’t so bad for heart health after all and that perhaps it’s not the total or LDL cholesterol that’s most important but the particle size that matters the most. You’re just not hearing a lot about these kind of ideas from the mainstream medical world right now and that’s truly baffling to me if the goal is to make people as healthy as possible while educating them on how to prevent cardiovascular health problems down the road.

In light of all we know about the irrelevance of LDL when your HDL is above 50 and your triglycerides are below 100, receiving cholesterol test results from people who are “concerned” about their heart health is rather disturbing to me–especially when their numbers come in and look simply spectacular. There’s a real worry out there that people have when they think they’ve crossed some kind of threshold where they begin fearing having a heart attack or stroke. It’s what Dr. Marshall Deutsch referred to in my July 2009 podcast interview as the “fat nocebo effect.” Here’s one recent example of a woman who shared the results of her NMR LipoProfile test with me and she wanted to know if she was okay or not:

Hi Jimmy,

Would you mind looking at my NMR Lipoprofile results? I’m meeting with the doctor on Monday and was wondering what you thought.

LDL-P: 1354
Small LDL-P: 151
Total cholesterol: 249
LDL-C: 159
HDL-C: 85
Particle size: 21.1
Triglycerides: 27
Large HDL P: 19.1
Large VLDL P: below 0.7

Most doctors would look at these results and zoom in immediately on just two numbers: Total and LDL cholesterol. They think total cholesterol should be below 200 and that LDL cholesterol needs to be under 100. But why? What is the purpose of lowering these numbers to those levels? Ask any physician that question and you’ll probably get an answer like, “Well, that’s the standard we’ve always used.” But WHY?! Is there any measurable improvement in heart health by bringing those cholesterol numbers down to those levels? Nope.

And how do most primary care doctors intend to treat this “high” cholesterol? Well, they say you need to lower your fat intake, exercise more, and take a statin drug like Lipitor or Crestor, of course. But we already know statins lead to some disturbing health side effects that are much worse than any supposed “danger” you could ever have from your “high” cholesterol (see the “Statin Effects Study” out of The University of California at San Diego for more information). I’ve always challenged people who say you NEED to lower your cholesterol to prove it’s unhealthy. Nobody can ever sufficiently answer that question. Cholesterol numbers are indeed dropping, but at what negative cost to our health in the process? We know having low cholesterol levels could lead to depression, suicide, and even death, so why do we continue to pursue artificially pushing the numbers down?

To my reader who sent me her NMR LipoProfile test results, let me just say that you have INCREDIBLE numbers that indicate you are low-carbing well–VERY well. How, you may ask? Well, I generally look at three specific things on this test: HDL, triglycerides, and small LDL-P.

HDL–A reading of 85 is indicative that you don’t skimp on your fat intake (especially saturated fat) and that you understand the purpose of consuming a large quantity of fat as a percentage of your total caloric intake. Fat becomes the fuel for your body in the absence of carbohydrate and the result of this added fat that your body craves in a corresponding rise in HDL “good” cholesterol. Consuming fatty foods like butter, coconut oil, animal fat, lard, and other sources is a great way to boost your HDL well above the 50 that is the target for people who are livin’ la vida low-carb. You are well above that mark!

Triglycerides–A bottoming out of this at 27 clearly tells me that you have a solid control of your carbohydrate intake most likely at a ketogenic level (below 50g daily). This is an essential element of lipid health that is often overlooked in the weeping and gnashing of teeth over LDL and total cholesterol. But anyone who’s been low-carbing for at least a few months will tell you one of the most noticeable impacts on their lipid health that happens when you cut the carbs is your triglycerides drop like a rock! Keeping your triglycerides under 100 is much more important than worrying over what you LDL cholesterol is and you’re doing a bang-up job of it!

Small LDL-P–This number gets to the crux of the best news with your overall test results. In all, you have 1354 LDL particles floating around in your blood. Of those, there are only about 12 percent that are comprised of the small, dense, and dangerous kind of LDL cholesterol. The other 88 percent of your LDL particles are the large, fluffy, and protective kind that will not penetrate the arterial wall and lead to cardiovascular issues. Have you heard from any doctor or other medical professional that there is such a thing as “good” LDL cholesterol? It’s not widely communicated to the public because this would totally destroy the diet-heart hypothesis and multi-billion dollar statin drug industry that much of our treatment of heart health has been based on for much of the past three decades. Your numbers are fantastic and nobody should ever tell you otherwise.

Your total cholesterol of 249 is completely meaningless and I’m sure your conventional wisdom doctor will try to put you on some kind of a statin drug to “lower” your LDL of 159–but don’t do it! There’s no scientific reason to ever take a prescription pill like that especially for women. Read Lesson #2 of 21 Life Lessons From Livin’ La Vida Low-Carb where I explain more on this subject. Arm yourself with all the facts before going to see your doctor. You are doing VERY well, my friend and should be quite proud of your progress. Keep it up!

Following her doctor visit, this reader wrote me back to let me know what happened:

I just wanted to tell you that my doctor actually did not recommend a statin–so that was good. She said the large, fluffy LDL made my lab results “somewhat more favorable,” but that the total cholesterol of 249 still mattered to her. She recommended a change in my diet and something she called “Omega 3-6-9″ for reducing the total cholesterol. She also suggested a low-fat diet and I didn’t think quickly enough to counter that a low-fat diet would drive up my triglycerides and thus drive the LDL upwards. The way we left it, I said I would try the “Omega 3-6-9.” Wish me well!

You are already doing extremely well and I’m so proud of you for realizing lipid health is much more than about LDL and total cholesterol. The omega blend will certainly help improve your numbers even more as long as it is in conjunction with a high-fat, adequate protein, low-carb nutritional approach. Keep me abreast of your progress and I can’t wait for you to see your numbers continue to improve. While your doctor may continue to think total cholesterol numbers above 200 “matter,” the fact is they don’t and are actually estimated. Keep learning about lipids and be proud of your HDL above 50, triglycerides below 100, and small LDL-P mostly nonexistent in your body. It’s a sure-fire sign you are livin’ la vida low-carb and reaping the amazing benefits this way of eating has to offer you! CONGRATULATIONS!

  • JD

    1) Most physicians IMO are under the spell of the drug reps. Not sure how many of them are taking money from the drug reps but there have been plenty of stories in the news that SOME have.
    2) To treat high LDL is THE standard medical practice and makes them legally safe from malpractice suits.
    3) Most doctors do what they have been taught and they have been taught that high LDL is an issue.

    All three of those statements are absolutely true, JD. But the heavy influence of pharmaceutical reps is something that should have been changed as part of the healthcare reform because it’s a HUGE problem. I think the American Medical Association should revisit the LDL issue and based their judgment on the latest research that looks at HDL and triglycerides as bigger factors. And medical schools need to stop peddling this nonsense that LDL is the one and only issue related to heart disease. We’ve got a lot of work to do!

    –Jimmy

  • Rene

    Jimmy, you are so right! I am an RN and see the reps plying the docs with samples, freebies, and the results of studies sponsored by the pharmaceutical companies.

    My HDL is 62, up from 24 (statin/ADA diet,) and my triglycerides are 42, down from 200’s (statin/ADA diet,) as a result of LLVLC. Blood sugars are in the absolutely normal range recommended by Dr Bernstein. 70lb weight loss. What does my doc recommend? Get back on statin to get my total numbers and LDL down, and make sure I eat enough carbs!!!!! Even though my labs show no risk for cardiovascular disease based on the research. Whaaaaaaaaaat??????

    I went to a doc not on my insurance plan and paid out of pocket in order to get the labs I thought were indicated, and my primary care doc refused to order. NMR results pending. He put me on Vit D 10,000iu/day (results were 24!) and thyroid medications. He had also previously RX’d the insulin I needed to fine tune my blood sugars. I’m hoping I can lose the last few pounds with his help.

    MY primary doc is going to flip out. Walked out on me when I told him about the insulin. He refused to give me a referral to the other doc so my insurance would cover my visits/labs. He is a type 1 diabetic and told me A1c of 7 is perfect!!!!!! Whaaaaaaaaaaaaat????????

    The problems are so HUGE.

    WOW, Rene! It’s even worse than I realized. Good for you taking control of your health despite the ignorance of your doctor.

    –Jimmy

  • Dan (aka Renegadediabetic)

    WHY? Because they have drugs to lower LDL and those drugs are making $$$$$$ for big pharma. Why would they give up all that revenue? Just keep propagandizing the doctors and hide the truth from them.

    Then there is the $$$$$$ to processed food companies for foods that supposedly lower your cholesterol…….

    Loved Rene’s comment. She’s on the right track.

    Well if that’s true (and I believe it is), then we need to get the medical profession focused back on HEALTH rather than PROFIT. The truth is out there for doctors to see…now it’s time they stand up and be heard.

    –Jimmy

  • helen

    a quote from Uffe Ravnskov, M.D., Ph.D.
    “Cholesterol is a peculiar molecule. It is often called a lipid or a fat. However, the chemical term for a molecule such as cholesterol is alcohol, although it doesn’t behave like alcohol. Its numerous carbon and hydrogen atoms are put together in an intricate three dimensional network, impossible to dissolve in water. All living creatures use this indissolvability cleverly, incorporating cholesterol into their cell walls to make cells waterproof. This means that cells of living creatures can regulate their internal environment undisturbed by changes in their surroundings, a mechanism vital for proper function. The fact that cells are waterproof is especially critical for the normal functioning of nerves and nerve cells. Thus, the highest concentration of cholesterol in the body is found in the brain and other parts of the nervous system.”

    so cholesterol is not a fat and it is not a lipoprotein and without cholesterol we would certainly die, maybe that is why so many cancers are starting to appear with the medical world saying get rid of cholesterol and substances like vitamin C not being uptaken at high enough levels to help with collegen production to protect our cells the nasties get in and the body is compromised.

    THANKS for sharing, Helen! I love that Dr. Ravnskov who was a fantastic guest recently on my podcast show.

    –Jimmy

  • Rafik

    As a physician, I can speak from experience and let the world know that there is VERY LIMITED instruction in the field of nutrition while in medical school. It is so unfortunate as you all know how important nutrition is. Besides standing behind the USDA food pyramid there is no real intense instruction in this field. It was mind blowing to read all these books i.e. Bowden’s “Living Low Carb” Taube’s “Good Calories Bad Calories” Atkins “New Diet Revolution” and realizing as a physician I was completely misled as a medical student.
    Just my 2 cents…

    • http://www.livinlavidalowcarb.com Jimmy Moore

      THANKS for your comments, Dr. Hodeib! And I’ve heard this same thing from many of the physicians I have interviewed on my podcast. However, it seems most doctors these days get most of their updated information on treating patients from the pharmaceutical reps who swarm in and out every single day peddling the next great pill with all of their dubious side effects while virtually ignoring the natural component involved–healthy, whole foods nutrition. Would I be granted the same privilege to waltz into doctor’s offices sharing about the health benefits of consuming a high-fat, moderate protein, low-carb diet? Not likely…not ever. We have a messed up system and I’m trying my darndest to arm people with quality, factual information they can use as they pursue optimal health and weight. Thank you again for sharing your perspective.

  • Katie C

    Jimmy, thank you so much for this post. I have been dealing with the same issues with my doctor. I follow a paleo-type diet plus butter and heavy cream, and my cholesterol levels were measured two months ago as follows: Total 239, HDL 75, Triglycerides 55, LDL (calculated) 153. I have not gotten a VAP test because my doctor won’t order it, but I’m guessing with the low tri’s and high HDL that it’s the Type A big fluffy kind.

    My doctor freaked out and told me to cut out all butter, eggs, cream, bacon, red meat, liver, and processed carbs (doesn’t seem to get that I don’t eat those). I know he wants to put me on a statin, and when I asked him about whether high LDL is bad, he said that “the biggest study found that for every 1 percent reduction in LDL there was a 2 percent reduction in heart disease risk.” He didn’t say it, but I know he was referring to the great misread of the Framingham heart study (Tom Naughton over at the Fathead blog has written about this, as have some others in the community). I believe that the study actually found that for older subjects, a reduction in cholesterol was associated with a significant increase in overall mortality, but as a lay person, I don’t have access to the original study to show my doctor. What do you do when your doctor believes misinformation like that? Do you have access to the actual study results?

    Thank you so much for all that you do, and good luck on your continuing journey of good health.

    • http://www.livinlavidalowcarb.com Jimmy Moore

      THANKS Katie! Your numbers look fantastic because your HDL is significantly above 50 and your triglycerides are well below 100–these are the standard bearers for health with all that I know about lipid health. It it HIGHLY likely your LDL is mostly the large, fluffy kind you want and not the small, dense and dangerous kind. I provide ample scientific evidence supporting this in Lesson #2 of my latest book 21 Life Lessons From Livin’ La Vida Low-Carb if you need references. :) Keep living healthy, my friend!

  • Rebecca

    Hello! Your information is so helpful. I have been on a statin medication that has caused me all kinds of problems. Due to finances I was put in a position where I had to cut back on the amount of pills I took. Rather then take one every day I was taking one every other day. When I went back for a check my levels were still good and my Doctor was pleased. She still thinks I’m taking them daily. What I want to know is why any specific person should take them daily if every other day works in keeping the levels in check? Thank you.

    • http://www.livinlavidalowcarb.com Jimmy Moore

      Rebecca, I would argue you don’t need to take statins EVER, especially women who have never been studied with this therapy on heart health. Eat a high-fat, moderate protein, low-carb diet and your HDL will be above 50, your triglycerides below 100, and the LDL particle size will be mostly the large, fluffy kind you want. I used to take statins myself and came off of them permanently within nine months of livin’ la vida low-carb.