From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Normal Cholesterol Level???
Date: Wed, 20 Aug 1997
Newsgroups: sci.med.nutrition

In <5tdjlc$o7d@mtinsc04.worldnet.att.net> northjack@worldnet.att.net
(Jack North) writes:

>When having a blood test for Cholesterol and Triclycerates (sp?), what are
>acceptable levels for men at 50?




That depends.  If you're healthy and have few risk factors for heart
disease (don't smoke, don't have high blood pressure, diabetes, a bad
family history, etc), the AHA says you can get by with LDL cholesterol
less than 160.  That generally corresponds to a total cholesterol of
about 210-220 for the average man.  For people with risk factors, they
need to stay below LDL 130.  People with proven heart disease had
better keep LDL below 100.

Probably all the above are really not stringent enough if you really
want to play it safe.  Epidemiologically, heart disease mortality rises
starting at about cholesterol 160 (total) or LDL about 100 in men.  HDL
levels also factor in, and you'd like your ratio of total to HDL
cholesterol to be less than 5, and preferably less than 3.
Triglycerides are generally a much less important factor, having only a
mild impact on heart disease risk, unless quite high.

                                          Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Normal Cholesterol Level???
Date: Thu, 21 Aug 1997
Newsgroups: sci.med.nutrition

In <19970821023500.WAA25563@ladder01.news.aol.com> runnswim@aol.com
(RunnSwim) writes:

>Total Cholesterol to HDL ratio is relevant to the vast majority of people
>who are NOT on an ultra low fat diet. It is probably not important to
>people who are on an ultra low fat diet and who have total cholesterols
>less than 150. For example, Tarahumara Indians have total cholesterols
>averaging 135 and TC/HDL ratios averaging about 5.5. Yet they have
>virtually no heart disease.



    Agreed.  People on very low fat, often very low calorie diets often
have ratios which are not very impressive.  For instance, in rural
China.  But, as you point out, if your cholesterol is 150 due to your
diet, you're not going to get heart disease.

    I coathored the first study of nutrition and cholesterol changes in
Biosphere II, where we saw changes very much like primitive and
Pritikin type diets.  Average cholesterol in Biospherians fell from
about 180 to 125 (so you KNOW they weren't sneaking in pizza), but as
in most low cal vegetarian diets, HDL fell almost as much as total
cholesterols.

   I know there's a big fight among the Pritikins as to whether or not
it's essentially okay to add monounsaturates to the Pritikin diet (the
heresy of Sears, etc).  I can only suggest: try it and see.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Help, need to raise my HDL!
Date: Sun, 09 Nov 1997
Newsgroups: sci.med.nutrition

In <3464FDDB.17E9@pacbell.net> Bill Ellis Fleenor
<efleenor@pacbell.net> writes:

>Tino & Maggie Sanchez wrote:
>
>> My recent HDL level was only 26, how can I increase this? I eat a low
>> fat diet and exercise 4 1/2 hours a week(cardio) plus do some weight
>> training, I have lost 52lbs, but still am overweight.
>>
>> thanks,
>> Pilar
>
>A low-fat diet will lower your HDL. I found this out when I was part of a
>study group for the Nat'l Inst. of Health investigating the effects of
>diet and exercise on cholesterol. My LDL went down about 10% on a 20% of
>calories from fat diet, but so did my HDL, so the ratio stayed the same
>and my LDL dropped into the danger zone (<35) giving me another heart
>attack risk factor. Working with the dietician on the study, I tried to
>improve the HDL by increasing consumption of monounsaturated fat (olive
>oil) but this was inconclusive (gaining weight is counter productive.)
>
>You may want to talk to your doctor about taking niacin. I take 250 mg
>with each meal; it raised my HDL from 31 to 39. However you have to start
>with a small dose, like 50 mg/day and build up; it causes
>gastrointestinal problems in many people. Liver function needs to be
>monitored if taking over 1000 mg/day. Niacin is usually not used in those
>with diabetes. I use the crystalline form from Endurance Prod.
>
>Here is a link
>http://www.heartinfo.org/qalib/qanda/zhinqa20565.htm  Excerpt:




The poster above is correct, and his advice is good.  Other tricks to
try to get HDL up are aerobic exercise (the best idea), a bit of
alcohol (one glass of wine a day, no more), and curcumin from the spice
turmeric (any health food store will be able to help-- dose is 200-600
mg curcumin per day with meals).  Aged (deodorized) garlic (even more
than fresh) also raises HDL.  And the drug cimetidine raises HDL for
many, though I'm not sure if it's a good idea to take it for that
reason alone (maybe it is if the effect is large-- try it!)

   In postmenopausal women, estrogen gets HDL up.  For women with a
uterus, addition of a progestin (like progesterone) is necessary, but
this erases some of the estrogen effect.  Micronized progesterone
rather than the artificial medroxyprogesterone/Provera (which is the
products PremPro and Premphase-- avoid these) will have the least
effect in this retrograde direction.

                                     Steve Harris, M.D.

From: runnswim@aol.com (RunnSwim)
Newsgroups: sci.med.nutrition
Subject: Re: HDL questions!
Date: 4 Mar 1998 00:44:03 GMT

>>From: JeffJ318@aol.com
>>Date: Tue, Mar 3, 1998 18:47 EST

>>Hi

>>My HDL level is 23
>>My LDL level is 87
>>Tryglc level is 185
>>Total choles is 148

>>What is my ratio of risk and how do the numbers add up to anyone with
experience looking at them?

>>One doc told me due to the HDL alone that I am at high risk for coronary
artery disease. This doc wants to do cardio-cath.

>>Another doc said not to worry about the HDL as the other numbers minimize my
risk.<<

>>Any more thoughts on my numbers? Could it be in the genes?
>>White male, non-smoker all my life,
>>48 years of age, weight 160 and 5"10. Also exercise and eat healthy.<<

While I can't give you specific medical advice, here are some general
comments about your HDLs and triglycerides.  If you are really
"eating healthy" (meaning mainly low fat/high veggie/high fiber, etc.)
then you have every reason to be happy with your "numbers" and
little reason to be fearful.  You certainly do not need a cardiac cath,
based on what you have written above.

HDLs are important for people with high LDLs.  Your LDLs are pretty good
(though I must ask if there is some mis-print above, as HDLs + LDLs
add up to only 110 and you say that your total cholesterol is 148).
Your triglycerides are kind of high.  You can probably bring them down
by exercising some more or by eating more veggies/high fiber foods and
less sugar.  But your triglycerides are probably not as high as they
appear for the following reasons (addressed in an earlier communication
posted on this newsgroup):

Subject:	Triglycerides/HDLs: Consistently Misunderstood
From:	runnswim@aol.com (RunnSwim)
Date:	18 Dec 1997 19:34:17 GMT

In article <01bd0a4d$4d934aa0$4eab85cd@compaq>, "Linda C." <Lindac@wcnet.org>
writes:


>"When health-conscious individuals try to lower their total fat intake,
>they may be forgoing some benefit of the polyunsaturated and
>monounsaturated fats, the argument runs.  A diet low in fat and high in
>carbohydrates lowers not only LDL but also HDL.  It also raises the level
>of triglycerides, fatty molecules that raise the risk of heart disease when
>blood levels are excessive".

For the umpty-eleventh time:

Never in nutritional history have so many ostensibly bright people
totally misunderstood something so consistently.

When you examine blood lipid levels as risk factors for something,
this applies only to the population being studied.  It cannot be
extrapolated to another population not representative of the population
under study.

Take, for example, HDLs.  This is a lipid fraction involved in lipid
transport.  High HDLs are said to be good.  Low HDLs are said
to be bad.  HDLs are said to be perhaps the most important
risk factor for coronary artery disease in some studies.

But this applies only to people on a "standard American diet."
Such a diet is associated with a moderately large daily lipid load.

But HDL levels have no predictive value for coronary risk in
people in Finland, who eat a higher fat diet than Americans.  In
this population, the only thing which predicts and correlates
is LDL cholesterol (the bad cholesterol).

Likewise, in people on low fat diets (for which having HDLs to
tote around a lot of blood lipids is much less important, because
there are many fewer lipids to tote around), HDLs are also
unimportant as a coronary risk factor.  People on very low fat
diets often have very low HDL levels and high total cholesterol
over HDL levels, but also have virtually no risk at all of coronary
artery disease.  When people are put on very low fat diets,
their HDLs commonly fall, but this is just a physiologic marker
that the low fat dieter is accomplishing something worthwhile, in
that his/her body recognizes that there is no longer a need for
all of that HDL, just as someone who isn't taking in a lot of
carbohydrate or protein also produces less insulin, because it
is not needed as much.

So, at a certain point in fat restriction, HDLs start to fall disprop-
ortionately to total cholesterol, because the total lipid load is
no longer rate limiting to lipid transport, and a lower amount of
HDL can keep up with the job of clearing the blood lipids.  There
is good research to show that this is precisely what happens.

Now, with regard to triglycerides, this can also be very misleading.
Triglycerides are just free fatty acids packaged on a glycerol skeleton
for transport and storage.  They are the form in which free fatty
acids get transported through the blood to go into fat cells or muscle
cells for storage.

You get circulating triglycerides in your blood in one of two
ways.  First, eat fat in a meal and the fat gets broken down
into free fatty acids by lipase (fat digesting) enzymes, where
they then get packaged into triglycerides for transport and
storage.  So your triglycerides go way, way up after a fatty
meal.  Then the triglycerides eventually find their way into
fat cells, where they get stored.  When you measure a
"fasting" level of triglycerides (the way it is usually done),
the level tends to be at the low point of the day, because
you've had all night to clear the post-eating triglycerides
out of your blood.

Now, let's say that you eat no fat in your diet.  Instead you
eat a lot of carbohydrates.  And let's say that you don't
exercise very much, meaning that the sugar from the absorbed
carbohydrates has no place to go.  What happens to the
extra sugar?

Well, the sugar gets converted into free fatty acid molecules,
which get converted to triglycerides, and transported to your
blood for storage.  But what happens to the blood triglyceride
levels is very interesting.  Someone on a higher fat diet has
a huge increase in triglycerides right after eating, which slowly
goes down as the triglycerides enter fat cells for storage.  So
if you measure triglycerides at several times during the day,
triglyceride levels tend to be quite high and go down low
only by morning, when the person has been fasting for a long
time.

But someone on a high carb/low fat diet does NOT have a
big jump in triglycerides right after a meal.  You measure
afternoon triglycerides in someone on a low fat diet, and they
will be much lower than in someone on a higher fat diet.
But the process of converting excess sugar to fat and then
packaging this into triglycerides and then releasing this
back into the blood for transport and storage into fat cells
takes a long time.  So the "fasting" levels of triglycerides
for someone on a low fat diet will not be all that much lower
than the post eating levels.  And the fasting levels may
even go up in someone who was previously on a higher
fat diet, EVEN THOUGH THE TOTAL AMOUNT OF
CIRCULATING TRIGLYCERIDES PER 24 HOURS IS
ACTUALLY GOING DOWN.

Intervention studies are interesting.  Remember that
the Pritikin studies combine low fat with low glycemic,
high fiber carbohydrate, and enough exercise to deplete
muscle glycogen to ensure that when dietary
carbohydrate gets absorbed as sugar that it has someplace
to go.  Well, Pritikin patients have significantly reduced
fasting triglycerides, even though they are eating a diet
which is 75% carbohydrate.  In contrast, Ornish's patients
restrict fat, don't necessarily control the glycemic quality
of the carbs, and get much less exercise.  Their LDL
cholesterol falls brilliantly, but their fasting triglycerides
are not reduced (they even go up, albeit not statistically
significantly).  But I'll wager that even Ornish's patients
had a fall in their total circulating triglycerides per 24 hours,
if not in their fasting levels, while the Pritikin patients
certainly had a major fall in the 24 hour triglycerides, to
go along with the fall in fasting triglycerides.

Another important caveat is the type of circulating triglycerides.
When triglycerides are assembled from free fatty acids
converted from sugar, they are physically of the "fluffly"
type, which are less injurious to blood vessel walls than
the "small, dense" type.

Remember also that absorbed fat gets stored as fat at 98%
efficiency, meaning that there is only a 2% energy "tax"
in the storage process.  But dietary carbohydrate gets
converted to fat and stored as fat at ony 76% efficiency,
meaning that you lose 24% of the excess calories in the
work it takes to do the conversion and storage.

In the October JAMA study, you had people who were
put on diets which ranged between 22% fat and 27% fat.
All groups improved their LDL cholesterol, lost weight, did
not increase insulin, etc.  But people fretted that the 22%
group showed an increase in HDLs and fasting triglycerides.
Remember, that the "quality" of carbohydrates was not
controlled, and the 22% group may well have just substituted
sugar for fat.  And there was no exercise program.  But,
for all we know, the total triglcerides per 24 hours may actually
have gone down in the 22% group (for all of the reasons
discussed above).  And the reduced HDLs was most likely
just a physiological marker for the body getting to the
point where it didn't need as much HDL to handle the reduced
load of dietary fat.

The ideal is to replace fat with veggies,
high fiber grains, and fruits.  And to "graze, not gorge."
And to exercise regularly.  And to try and make sure
that the bulk of the dietary fat is in the form of
endogenous fat (e.g. lettuce is 10% calories as fat),
monounsaturated fat, and fish oils.  The vast majority
of people who do this will see big improvements in
many things which are important to long term well being.

But the "disadvantages" associated with even imperfect
fat restriction diets (such as in the JAMA study) are way
overstated.  The net benefits to all of the groups in that
study of even a highly-flawed low fat diet plan were
convincing and significant.

- Larry Weisenthal