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5 Health Markers That Matter More Than Total Cholesterol And LDL-C

Published on September 3, 2013,

Jimmy Moore’s  book Cholesterol Clarity challenges the approach of most physicians who, when analysing a patient’s cholesterol results, zero in their focus on two specific numbers to determine the state of heart health risk and treatment—total cholesterol and LDL-C. Instead, he says, there are 5 other numbers that matter more. This is from CarbSmart…

Cholesterol Clarity1. Triglycerides

This is one of two numbers that I describe in my book as the “forgotten and ignored” part of your cholesterol panel. This is critically important to not just your cardiovascular health, but your overall health as well. Although my own doctor quickly dismissed my low triglycerides as a positive sign of my state of health, virtually every single one of the 29 experts I interviewed and featured inCholesterol Clarity agreed that lower triglycerides are a much more relevant marker than total cholesterol and LDL-C. The goal to shoot for with your triglycerides is under 100 (mainstream medicine says it should be 150 or below, but you can show signs of metabolic health issues at this level), and optimally under 70. The best way to do that is to reduce the amount of carbohydrates you are consuming to suit your own personal tolerance level. I have to personally stay around 30g total carbohydrates in my diet or I’ll see my triglycerides go back up again. You’ll need to tinker and tweak your intake to see what level is best for you. Your triglyceride number will precipitously rise above 100 if you’re consuming too many carbs, so use this marker to your advantage.

2. HDL-C: High-Density Lipoprotein

The second leg in that “forgotten and ignored” part of your standard cholesterol panel is your HDL-C. Sometimes referred to as the “good” cholesterol, it’s definitely a healthy thing to have this number above 50 at the very least, and optimally above 70. There are many ways to get your HDL cholesterol higher, but the best way is to eat more fat in your diet, especially saturated fat. While things like butter, coconut oil, full-fat meats and cheeses, and other delicious fat-rich foods have been vilified as being “artery-clogging” in our culture for decades, the reality is these are the very foods that can help you become heart-healthy by raising your HDL-C. When you reduce your triglycerides by cutting the carbohydrates in your diet, while consuming more fat to increase your HDL, it’s a fantastic one-two punch that gives you a distinct advantage in your pursuit of optimal health. Higher HDL and lower triglycerides are much more indicative of robust heart health than whatever your total and LDL cholesterol numbers are.

3. LDL-P: LDL Particle number

You might be wondering what in the world this is since you won’t find it on a standard cholesterol panel. That’s true, you won’t. But it is important to know your LDL-P number. This can be obtained by asking your doctor to run what’s called an NMR Lipoprofile test. Many people erroneously believe LDL is just one number because all they’ve ever seen on their cholesterol test results is LDL-C. But the reality is there are many subfractions of LDL particles that can be measured directly through the use of some pretty sophisticated technology, like the nuclear magnetic resonance (NMR) testing. Getting this run by your doctor (who may push back at you when you request it claiming it is unnecessary) will begin to give you a much clearer picture about what is actually going on inside your body. The more LDL particles you have floating around in your blood, the greater the risk of those particles penetrating the arterial wall. There’s still some debate amongst the cholesterol experts about whether it is the total number of particles or the size of the particles that matters most. Since the science isn’t settled on this, we present both sides of that argument in Cholesterol Clarity and let the reader decide for themselves which side they choose to believe.

4. Small LDL-P: Small LDL Particle number

As I just shared, when you get an NMR Lipoprofile test run by your doctor, it will let you see exactly how many LDL particles there are in your blood (this comprises your LDL-P number). But it also will show you the size difference between those LDL particle subfractions. This is an important marker that you really need to know about, especially if you have a high LDL-C number that your doctor wants to lower by use of stains. When you have mostly the small, dense, and dangerous LDL particles in your blood, that’s what is known as Pattern B. Conversely, when the majority of your LDL particles are the large, fluffy, and buoyant kind, that’s referred to as Pattern A. The Small LDL-P begins to become much more problematic when this number comprises more than 20 percent of your total LDL particles. For example, if your LDL-P is 1000, then your Small LDL-P needs to be 200 or less. Not to sound like a broken record, but if you consume less carbohydrates to your own personal tolerance level, and eat more healthy saturated and monounsaturated fats in your diet, then your Small LDL-P will go down. Incidentally, that statin drug your doctor is trying to push on you will indeed lower your LDL cholesterol, but it will do so by eliminating the large, fluffy kind first, leaving you with a higher percentage of small LDL particles that put you at a greater risk for having a heart attack. It’s something to consider the next time your physician pulls out his prescription pad because of your “high cholesterol.”

5. hsCRP: high sensitivity C-Reactive Protein

Technically, this blood test is not a part of your “cholesterol panel.” But it is perhaps the most indicative test you could have run to see if actual heart disease is beginning to manifest itself in your body. The high sensitivity C-Reactive Protein (hsCRP) is the marker that shows you the level of systemic chronic inflammation in your body. Without inflammation, there is no risk for heart disease. Period, end of story. So wouldn’t you want to test to see what your level of inflammation actually is? Absolutely. That’s why everyone needs to know what their hsCRP is, sometimes referred to simply as CRP. I’ve seen ranges of CRP between 0-10 being touted as healthy, but the ideal number should be below 1.0. Mine is currently at .55 which means I have minimal inflammation in my body and a very low risk for heart disease despite having a total cholesterol level of 306. Eliminating stress, cutting carbohydrates, and ditching those so-called “healthy” vegetable oils are all pro-active ways to greatly reduce your inflammation and make yourself healthier than you ever thought possible.

More at: 5 Health Markers That Matter More Than Total Cholesterol And LDL-C

The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number

Published on May 9, 2013,

We recently featured an article by Chris Kresser which set out to bust a common diet and heart myth that suggests eating cholesterol and saturated fat raises cholesterol levels in the blood. Chris has now produced a second article in the series busting the follow-up myth – that high cholesterol is the cause of heart disease. This is from…

English: Love heart

(Photo credit: Wikipedia)

Part of the confusion about cholesterol and its role in heart disease is caused by imprecise terminology. So, before I explain why high cholesterol is not the underlying cause of heart disease, we have to cover some basics.

Cholesterol is not technically a fat; rather, it’s classified as a sterol, which is a combination of a steroid and alcohol. It’s crucial to understand that you don’t have a cholesterol level in your blood. Cholesterol is fat-soluble, and blood is mostly water. In order for cholesterol to be transported around the body in the blood, it has to be carried by special proteins called lipoproteins. These lipoproteins are classified according to their density; two of the most important in cardiovascular disease are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

I know this can get confusing quickly, so let me use an analogy to make this more clear. Imagine your bloodstream is like a highway. The lipoproteins are like cars that carry the cholesterol and fats around your body, and the cholesterol and fats are like passengers in the cars. Scientists used to believe that the number of passengers in the car (i.e. concentration of cholesterol in the LDL particle) is the driving factor in the development of heart disease. More recent studies, however, suggest that it’s the number of cars on the road (i.e. LDL particles) that matters most.

Coronary arteries are essentially hollow tubes, and the endothelium (lining) of the artery is very thin—only one cell deep. The blood, which carries lipoproteins like LDL, is in constant contact with the endothelial lining. So why does the LDL particle leave the blood, penetrate the endothelium and enter the artery wall? The answer is that it’s a gradient-driven process. Going back to our analogy, the more cars there are on the road at one time, the more likely it is that some of them will “crash” into the fragile lining of the artery. It’s not the number of passengers (cholesterol) the cars are carrying that is the determining factor, but the number of cars on the highway.

The significance of this in terms of determining your risk of heart disease is profound. When you go to the doctor to get your cholesterol tested, chances are he or she will measure your total, LDL and HDL cholesterol. This tells you the concentration of cholesterol (passengers) inside of the lipoproteins (cars), which is not the driving factor behind plaque formation and heart disease. Instead, what should be measured is the number of LDL particles in your blood.

LDL cholesterol levels and LDL particle number are often concordant (i.e. when one is high, the other is high, and vice versa), and this is probably why there is an association between LDL cholesterol and heart disease in observational studies. The elevated LDL cholesterol was more of a proxy marker for elevated LDL particle number in these cases. But here’s the kicker: they can also be discordant. In layperson’s terms, it’s possible to have normal or even lowcholesterol, but a high number of LDL particles. If this person only has their cholesterol measured, and not their particle number, they will be falsely led to believe they’re at low risk for heart disease. Even worse, the patients that are the most likely to present with this pattern are among the highest risk patients: those with metabolic syndrome or full-fledged type 2 diabetes. The more components of the metabolic syndrome that are present—such as abdominal obesity, hypertension, insulin resistance, high triglycerides and low HDL—the more likely it is that LDL particle number will be elevated.

On the other hand, patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease. In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P. Yet they will often be treated with statin drugs or other cholesterol lowering medications, because the clinician only looked at LDL-C and failed to measure LDL particle number. This is a concern for two reasons. First, statin drugs aren’t harmless. (I’ll go into more detail on this in the third post of the series.) Second, studies suggest that lowcholesterol can increase the risk of death, especially in women and the elderly…

The article concludes…

Heart disease is a complex, multifactorial process. The likelihood that we’ll have a heart attack depends on numerous factors, including genetics, diet, lifestyle and living environment. The purpose of this article is not to suggest that LDL-P is the only risk factor that matters, or that other risk factors shouldn’t be taken into consideration. It is simply to point out that existing evidence suggests that LDL-P is a much better predictor of heart disease risk than LDL or total cholesterol, and that it appears to be one of the better markers available to us now.

More (including references) at:  The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number

Chris Kessler has a special follow up article here: What Causes Elevated LDL Particle Number?

Success Story: “Down 57 lbs and Health Improved With No Portion Control and No Calorie Counting”

Published on March 11, 2013,

 Jim picked up a copy of the book “Wheat Belly” as a way to lose a few extra inches he had put on since retiring from full-time work but he had no idea how much impact going ‘wheat-free’ would make. In seven months he has lost 57 lbs in weight, seen improvements across his health markers and suggests it has turned the clock back 25 years. This is from the Wheat Belly Blog…

Jim before and after from

Jim before and after from

I am a 61-year old male, retired (but still working part time) early childhood educator. I am 5′ 7″ and medium-framed. Picked up your book in August via Amazon after a Google search for “diet to lose abdominal fat.” My wife, an RN, had been concerned that the 25 lbs I had gained since my retirement in 2007 had gone straight to my gut.

For years I had been a recreational runner and had held a weight of about 185 lbs. Slowed down a bit in the 1990′s due to a diagnosis of fibromyalgia. Weight began to climb and, by retirement, I was about 210 and had quit running. BP started to climb and cholesterol did, as well. Portion control, workouts at the gym, following my wife’s Weight Watchers’ regimen couldn’t seem to do any better than a 10-15 lb loss, with rebounds always following. My PCP [primary care physician] finally put me on Diovan and simvastatin, but my BP and lipid profile merely leveled off, didn’t really improve. This past summer, my weight ballooned to 234 lbs with a BP of 136/92. I had to do something.

Your book caught me with the comparison of the GI [glycemic index] of whole grain bread vs. the Snickers bar. I was on the wheatless way before I finished the first chapter. Began cold turkey on August 13 and had no problems finding satisfaction without wheat. The weight began to drop immediately and I have had continuous small, but steady, weekly losses for 30 weeks. I have no problems asking for substitutions at restaurants (hold the potato, double veggies please) or politely declining the ice cream and cake at family parties. I look upon it as a chance to educate others about my choices and your findings….I’m not a zealot but realize it’s a way of life.

The numbers speak for themselves. I lost 57 pounds. Triglycerides (355 to 60) and HDL (45 to 72) improvements amaze me. My blood pressure wasn’t this good when I was running. Not sure I understand the whole LDL profile (last March it was 145, in Sept it dipped to 57, now it’s back up to 158…but it’s calculated, not measured). I have had glaucoma for many years and my quarterly eye pressure checks average about 18-20. My last two checks were 16. The opthamologist asked what I was doing differently. This winter, my fibromyalgia symptoms have pretty much vanished.

No portion control, no calorie counting, minimum exercise (although my part time job working with preschoolers keeps me hopping), and I’m never hungry. When I’m not working, I usually grab a handful of almonds for lunch or a snack…just don’t seem to need as much. Great breakfasts and diinners–just no wheat, no sugar, no problem.

The Wheat Belly Cookbook is already dog-eared as my wife begins to move in the WB direction also. Many friends and associates are noticing the change and I’ve had many inquiries at work about my appearance. I have never used a real photo of myself on my Facebook profile before, but can’t believe the transformation. Dr. Davis, you’ve helped me turn back the clock 25 years. All I can say is thank you, thank you, thank you.

More at:  A “No portion control, no calorie counting” success!

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