Help! My Cholesterol Is Too High (or Is It?)

Since I started my Keto diet, my Cholesterol has been steadily going up. This was the opposite of what I expected. The accepted wisdom is that a ketogenic diet lowers your cholesterol numbers. My excellent physician who always writes little hand written notes on my test results wrote Yuk on my last lipid test.

My Doctor was not happy with my going on this diet. The fact that I had been on cholesterol and triglyceride medication for years and still had high triglycerides that weren't controlled concerned her. This diet was in her opinion overly top heavy in cholesterol and saturated fats and she was very concerned about heart disease. And here are my recent Yucky numbers.

05/06/2014 Units Ref Range

Cholesterol i 291 H mg/dL (< = 299)

LDL 156 H mg/dL (< = 100)

HDL 117 H mg/dL (40 - 60)

Non-HDL Cholesterol i 2.49

Triglycerides 90 mg/dL (< = 150)

In looking into this, doctors have found that twenty to thirty percent of the people on Ketogenic diets or restricted Atkins start seeing higher cholesterol numbers. I haven't been able to find much of an explanation for this, other than the fact that we are "hyper-responders"(see Notes). That eating foods high in cholesterol raises the cholesterol in our blood. It was time for me to really look into what these numbers represent.

What I have found out about cholesterol was quite surprising. Here's the story:

"Since the 1950’s, it has been assumed that cholesterol is the main culprit behind atherosclerosis, the thickening plaque lining the arteries that might presage a heart attack. It was therefore recommended that blood levels of cholesterol be lowered, and the recommended numbers themselves kept going down, According to Lynn Payer, in her book Medicine and Culture, the median total cholesterol range for initiating drug therapy was 340 to 359 mg/dl in 1983, 300 to 319 in 1986, 240 to 259 in 1990, and that same year dietary therapy was instituted at levels of 200 to 219 mg/dl total serum cholesterol." (Cholesterol –Is it really so bad? by Annemarie Colbin, Ph.D)

They have just recently revised the numbers again. Downwards.

How did the connection between cholesterol and heart disease begin?

The Seven Countries Study

In 1958, an American scientist called Ancel Keys started a study called the Seven Countries Study, which examined the association between diet and cardiovascular disease in different countries.

The study revealed that the countries where fat consumption was the highest the rate of heart disease was also high, supporting the idea that dietary fat caused heart disease.

The problem is that he intentionally left out:

Countries where people eat a lot of fat but have little heart disease, such as Holland and Norway.

Countries where fat consumption is low but the rate of heart disease is high, such as Chile.

Basically, he only used data from the countries that supported his theory, a process known as "cherry picking".

This highly flawed observational study gained massive media attention and had a major influence on the dietary guidelines of the next few decades.

The McGovern Committee

George McGovern

In 1977, an American committee of the U.S. senate led by George McGovern published the first Dietary Goals For The United States in order to reverse the epidemic of heart disease in the country.

These guidelines received massive criticism at the time from many respected scientists like John Yudkin (who insisted that sugar was to blame) and the American Medical Association.

Basically, the dietary goals were:

Eat less fat and cholesterol. Less refined and processed sugars. More complex carbohydrates from vegetables, fruits and grains.

These guidelines were picked up by the USDA (United States Department of Agriculture) – and turned into the food pyramid (very convenient for them since their job is to sell grains).

Basically, a low-fat, high-carb diet… for everyone. (by Kris Gunnars. Authority Nutrition)

Since that time there have been many studies trying to link high cholesterol and heart disease. The only problem is that they haven't been able to. Take for example the "Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease". Looking at 23 studies and 347,747 subjects from 5-23 years it found that:

"there is no significant evidence for concluding that dietary saturated fat is associated with increase risk of CHD(Coronary Heart Disease) or CVD(Cardiovascular Disease)."(The American Journal of Nutrition, January 13, 2010)

This mistaken idea has created a multi-billion dollar industry which as it turns out, has some nasty repercussions.

The problem is that when cholesterol is restricted through medication and diet it has some unintended consequences. Fifty percent of the membrane in every cell of our body is made up of cholesterol. The brain needs, craves and makes its own cholesterol. As a matter of fact your brain is made up of 12-13% of cholesterol. Your Liver produces 75% of your body's cholesterol regardless of what you're ingesting and recycles what's not used. That's how important it is. So what are some of the things that scientists have found happens when you use statins to inhibit the body's ability to create cholesterol?

Research by an Iowa State University scientist suggests that cholesterol-reducing drugs known as statins may lessen brain function. Yeon-Kyun Shin, a biophysics professor in the department of biochemistry, biophysics and molecular biology, says the results of his study show that drugs that inhibit the liver from making cholesterol may also keep the brain from making cholesterol, which is vital to efficient brain function. "If you deprive cholesterol from the brain, then you directly affect the machinery that triggers the release of neurotransmitters," said Shin. "Neurotransmitters affect the data-processing and memory functions. In other words -- how smart you are and how well you remember things." Shin's findings will be published in this month's edition of the journal Proceedings of the National Academy of Sciences. (February 26, 2009)

Dr. Duane Graveline, MD, Former NASA scientist and astronaut, suffered from such memory loss, while taking his anti-cholesterol medication. He managed to to save his memory by stopping the pills and eating lots of cholesterol-rich foods. Since then he has described his experience in his book, Lipitor: Thief of Memory, Statin Drugs and the Misguided War on Cholesterol. Anyone hear of the word Alzheimer's?

But to be fair, doctors are trying to save lives and prevent heart attacks, aren't they? They will tell you that when it comes to medications, you need to weigh the pros and cons of every medical therapy. (What's the loss of a few neuron here or there if it can save your life?). Let's see what the latest information from the American Heart Association states:

The percentage of American adults (over age 20) with LDL Cholesterol at or above 130 mg/dl is (only):32.6%.

add that to the Mega Data study out of UCLA which states:

People with “high” LDL make up 32.6% of the population, but account for just 27.9% of the heart attacks.

They found that 75% of patients hospitalized for heart attacks had LDL numbers in the "safe range" (below 130 mg/DL of which 21% were taking a statin). What was even more amazing was that 50% of those had LDL of less then 100 mg/dL.

So unless I'm misunderstanding these conclusions, low cholesterol doesn't seem to do much to prevent heart disease or heart attacks, but more and more people are being put on statin drugs every day to prevent heart disease and heart attacks. Let me just reiterate that while I think that most doctors really want to do the best for their patients, it seems to me that they just haven't caught up with these latest findings and stopped prescribing them.

The truth is cholesterol is like a paramedic. The body sends a message to the liver when it can't clear an infection, remove toxic elements or heal a wound. The liver then sends cholesterol because all healing involves the birth, growth and functioning of thousands of cells: immune cells, endothelial cells and many others. These cells are in large part made of cholesterol and fats and they can't form, grow and repair themselves without a good supply. When the heart and its valves are inflamed, the liver sends cholesterol to the site to help fix the damage. If the inflammatory damage is great you will have cholesterol hanging around there to help in the repair. When a heart attack happens, and doctors autopsy the patient they find streaks of cholesterol filled plaque and jump the the conclusion that it's the fault of too much LDL cholesterol. This whole scenario seems to be a case where the innocent bystander (Cholesterol), is being blamed for the crime (heart disease). That is why most doctors will regularly check your cholesterol and not routinely do a CRP (a blood test which shows your level of inflammation). Swelling of the arteries has been linked to an increased risk of heart disease and a C-reactive protein test appears to be correlated to heart disease risk. On the bright side, cardiologists today are looking at the real culprit of heart disease and its causes. This culprit has also shown its hand in type 2 diabetes, dementia and cancer to name just a few. What is this underling condition? It's INFLAMMATION. John Yudkin was right all those years ago. It is the sugar which causes inflammation and by association heart disease.

So lets take a look at my lipid numbers in light of these findings. New research has shown that it's not enough to look at HDL and LDL in isolation. We need to look at the Ratio of one to another.

1. You should aim for an HDL/Total cholesterol ratio of 0.24 and above. (In my case you divide 117 by 291. Mine is .39)

2. Your triglycerides should be no more than twice your level of HDL. (117 x 2 = 234. Mine is 90, no triglyceride problem here.)

3. An HDL/LDL ratio of 0.3 is desirable while 0.4 and above is ideal. (117 divided by 156. Mine is .75)

Based on this criteria even though at first my numbers appear to be scarey high, in actuality they're pretty good.

Looking into this has taught me that there's no real demarcation between large ("Good") and small ("Bad") Cholesterol. LDL is what your liver sends to the site where it's needed for it's repair jobs and HDL is the cholesterol that's being sent back to the liver to be recycled. There are two kinds of LDLs. One is light and buoyant and occurs when someone starts ingesting a lot of saturated fats. It's neutral and doesn't get trapped in inflamed tissue. And the other is small particle sized LDLs that come from carbohydrates, those are the ones that can can get trapped in the arteries' cell lining when there's inflammation. You do have to worry about the "inflammation". Anything that doesn't circulate gets oxidized or becomes rancid which creates a vicious circle further amplifying the inflammatory response and increasing the size of the plaque (where these small particle sized LDLs can get trapped). You also have to worry about high triglycerides (that's when a "Fat" and a "Carbohydrate"(sugar) marry; their offspring is a triglyceride. It causes thickened blood and again, inflammatory response. That leads to, (you guessed it), heart disease. Cholesterol doesn't seem to be a problem on a Ketogenic diet even when the overall numbers are high because restricting carbohydrates prevents small LDLs and tends to produce mostly the light buoyant kind.

Notes:

1. Carbs affect thyroid function so directly because insulin is needed for the conversion of the inactive T4 into active T3 and insulin is very low on a Ketogenic Diet.

2. Hypothyroidism can cause adrenal fatigue through over activity (HPA axis dysregulation). Also your LDL-C levels can increase in patients with overt hypothyroidism.

2.Cortisol has also been shown to increase on low carb diets.

3.If you are on Synthroid you should know that it can be a saboteur of your diet. It is made with 1 gram of pressed sugar as a filler (it needs to be counted as part of your daily carb intake for your diet total). I now get my T4 and T3 mixed with olive oil in a capsule from a pharmacy in Madison WI. (Women's International Pharmacy) They've been around for decades, have a good reputation in Wisconsin and they will deliver internationally.

Note: Good Dietary sources of Cholesterol

Cold liver oil provides 570mg of cholesterol per 100g.

Fresh egg yolk has 424mg of cholesterol per 100 g. (Eat the Yolk)

Butter provides 218mg of cholesterol per 100g.

Cold-water fish such as salmon, sardines, and mackerel provide form 173mg to 81mg per 100g.