Wednesday, February 8, 2012

My Third Cholesterol Podcast with Chris Kresser Is Now Up: What to Do, If Anything, About High Cholesterol

by Chris Masterjohn

My latest podcast interview with Chris Kresser is now up.  We discuss therein what I consider the most likely reasons why someone switching to an ancestral diet would develop cholesterol levels outside the range of non-industrialized populations eating traditional diets rich in saturated fat and low in polyunsaturated fat, the upper range of which I consider to be about 220-250 for total cholesterol, with increases being of concern primarily when they are either greatly elevated above this range or when they are more moderate but constituted primarily by an increase of non-HDL-cholesterol so that the total-to-HDL-cholesterol ratio increases substantially.  

We discuss these not as causes of heart disease, but as metabolic markers.  For that reason, we discuss "good" reasons why this might happen transiently (such as correcting obesity or fatty liver) and "bad" reasons why it might happen more permanently, the latter of which require corrective action.  These "bad" reasons mainly include hypothyroidism secondary either to an elevated ratio of plant goitrogens to iodine (which I discussed in great detail in my Thyroid Toxins Special Report) or to excessive carbohydrate restriction.

This is new material, so I recommend listening to the whole show, but if you follow the link you will find a useful table of contents that will help you navigate to the part of the podcast that most interests you if you so choose.  There's even a full transcript for those inclined to read rather than listen.  I had a little cold when we recorded, so please excuse my voice if it sounds just a little bit nasal.  Here it is:


Enjoy!

Read more about the author, Chris Masterjohn, PhD, here.

28 comments:

  1. I'm a little confused about the non-alcoholic fatty liver disease/CVD connection. Did you see this recent prospective cohort study published in BMJ that concluded:

    "Non-alcoholic fatty liver disease was not associated with an increased risk of death from all causes, cardiovascular disease, cancer, or liver disease."

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220620/

    responses to it here: http://www.bmj.com/content/343/bmj.d6891?tab=responses

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    1. Hi thaneverbefore,

      Thanks for the link. I hadn't seen that study. It conflicts with the one done in diabetics and the one done in healthy Japanese. The Japanese study was prospective and showed a very impressive correlation. The difference between the two cannot be the result of random error, I do not think, because it is so large. I will look at this paper in more detail and try to determine whether the difference results from different methodology or the use of different populations. If I don't get back to you by the weekend, please remind me.

      Chris

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  2. I also have a question after listening to the podcast. I recently asked my doctor for an NMR LIPOPROFILE test from Health Diagnostic Lab, Inc. Total CHL= 260, LDL-C Direct= 158, Trigs=63, HDL-C=73,
    non-HDL-C=187. There is also information on the lipoprotein particles and apolipoproteins on here (I can provide if necessary)

    All I know that there are RED marks indicating "high risk" all over this thing. As far as I know there is no history of heart disease in my family. With these numbers in mind should I be concerned? Of course my doctor wants me to take statins, she didn't indicate how many mg's. Your thoughts...also cam you suggest anything I can take if I should be concerned. I pretty much eat a WAP way of eating 90% of th time. Thx!

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  3. Hi Hutchman,

    Based on current guidelines, this is moderate risk. Based on traditional peoples eating a diet rich in saturated fat and low in polyunsaturated fat, the elevation is only modest. It is less concerning because the HDL-C is fairly high and the ratio isn't out of range. This does not seem worrisome to me, but I would back that up by other signs and symptoms, and if you get a chance you may want to verify with calcium score or carotid ultrasound that you do not have atherosclerosis developing. This should put you and if you're lucky your doctor at ease.

    Chris
    Chris

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  4. And I support what Chris K said in the comments at the podcast site. I would do several tests over several months, making sure your weight is stable, to assess the long-term average and variation before making any conclusions.

    Chris

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  5. Excellent as always Chrissyguns.

    Regarding the fermented cod liver oil, why do you prefer that to the regular stuff? And how is it fermented anyway? I always thought only carbs could be fermented. I assume it is bacteria breaking down some of the fats in it?? Are you not worried that this could damage the delicate omega 3 PUFAs in it?

    Also, is fish a good source of iodine? I eat it sometimes, but not other seafood so much.

    Thanks!

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    1. Hi Big Marty,

      The fermented stuff is closer to the original that was preferred by physicians because of its supposed greater efficacy, and which was done away with when the chemists -- who hadn't even discovered vitamins yet -- said they could find nothing in it that should account for its greater value over the refined CLO. It's raw, less processed, and according to some anecdotes more easily digested. Dave Wetzel says he has tested it and found no lipid peroxidation even kept at room temperature. But I don't prefer it with certainty; it's just what I'm using right now.

      Fish has some iodine and will contribute to the requirement, but it may not be enough for everyone.

      Chris

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    2. Cheers Chris.

      So is there no other choice except fermented or refined? Does no one sell it raw but unfermented? Like freshly squeezed out of the cod's liver and into a bottle?

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    3. Hi Big Marty,

      If you search for high-vitamin cod liver oil you will probably find some unfermented options but good quality.

      Chris

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  6. Apart from really enjoying the discussion, I did appreciate the written version. Being dyslexic, I find speech, without seeing the face, much more difficult to comprehend. I'd love to see this done for as much as possible.

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    1. Great Jenny! Unfortunately I can't do that for podcasts I do, but Chris K has a volunteer who's doing it for all the podcasts he conducts. That volunteer is doing some great work!

      Chris

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  7. I listened to this last night. All I can say is Im more confused than ever about how to eat for best control of diabetes and all it entails. And the thyroid thing!?! I have eaten 50-75NC for 5 yrs now. Good glucose numbers but am I messing up everything else? UGH

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    1. Hi Karen,

      Well we weren't addressing diabetes so I can see how that would be confusing. I don't know what 50-75NC means. Do you have signs of hypothyroidism?

      Chris

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    2. I think she is saying 50-75 net carb grams / day

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  8. Hello Chris, I've listened to all 3 parts of the podcast (brilliant!) but I am still confused about what to do if I have FH (which I do). You mentioned FH a few times but the discussion always stopped before becoming really helpful.

    So should I avoid SAFA and emphasize PUFA that are otherwise seen critically because of being prone to oxidation? What kinds of PUFA? What about MUFA in this condition? I have side effects when trying statins (muscle pains) so this no option for me, with TC in the range of 400 and LDL about 290 mg/dl, type 2 diabetes and being a bit hopeless but very frightened.

    Thank you, Helga

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    1. Hi Helga,

      My opinions on treating FH are still under formation. I think whatever is done, you need to cooperate with a knowledgeable practitioner. Heterozygous FH is not a death sentence, but it's dangerous not to treat it. I think you should periodically monitor atherosclerosis directly though, say, carotid ultrasound or calcium score, to verify that it is under control. I think since you are much more able to affect things not directly related to your lipid clearance, you should put the most effort into targeting them. For example, focus on minimizing oxidative stress and inflammation, and providing nutritional support for collagen synthesis (e.g. adequate vitamin C and copper). Thoroughly investigate all aspects of thyroid metabolism and optimize if warranted, as thyroid hormone stimulates LDL clearance even in heterozygous FH. I do think that, if it effectively brings blood lipids into a more normal range, a diet that is restricted in fat and cholesterol may be called for. But I would not use PUFAs, because these would likely promote oxidative stress. I would consider a Kitavan-style diet, where the total fat content is low (~20%) but most of it is saturated because virtually all of it comes from coconut. Naturally you have to consider how you feel on this diet and your other indicators of health, and all of this should be done under the guidance of a health care practitioner.

      Hope that helps,
      Chris

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    2. Hi Chris,

      thank you so much for your helpful advice!

      I am a bit sad, that after having digged through the thicket of confusing nutritional advice for years and finally quite happily having found sound concepts like Sisson's or the "Perfect Health Diet", my special FH case will likely force me into other directions and might renew my "cognitive dissonance"...

      I might add that I am 78 years old now (perhaps not that bad for a FH patient...) but suffering from distinct signs of sclerosis with the need for an aortic valve transplant in 2010 and isolated systolic hypertension since then.

      My biggest problem - I fear - will be to find that "knowledgeable practitioner" in my area, because I live in "Old Europe" (you recognised my bumpy English) - in Hamburg, northern Germany, important harbour, traditionally somewhat british-style calm/reserved mentality, not krachledern at all... ;-) - where the physicians I met to date hardly knew anything about FH and possible strategies for its treatment. Except perhaps to some minor degree my son, a former physician, but never more than an ophthalmologist and therefore fairly overchallenged with the FH-topic as well (but in the same FH boat, though approx. usually 100 mg/dl lower in TC and LDL).

      Two questions are left for me at the moment, please: Avoiding PUFAs includes Omega-3s, particularly no fishoil-supplements? My beloved Kerrygold butter is no good idea too? And the Kitavan-style diet is OK for diabetics? (Three questions - sorry...)

      Once again thank you so much for sharing your insights and greetings from old Europe,

      Helga

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  9. I'm interested in doing a fatty liver test.. I'm a skinny fat guy ( 5'8, 155lb) and from the chest up and legs down, I look slightly underweight, but I have this embarrassing protruding belly! Would a full body CT Scan also find a fatty liver, or is it only mri, ultrasound, FibroSURE, biopsy, etc?

    BTW, anyone try iodine-rich kelp noodles or cochayuyo? I'd like to minimize the goitrogen effects of crucifers since I juice a bunch of kale & brocolli sprouts everyday! I don't eat millet, but perhaps I'll give up the amaranth grains too just to be on the safe side as well!

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    1. Hi Ben,

      I think CT scan can play a role in diagnosing fatty liver (hepatic steatosis), but you should check with your diagnosing physician which route is best. You may want to get checked for celiac (fairly uncommon) and small intestinal bacterial overgrowth (very common). Broccoli sprouts are about ten times higher than broccoli in goitrogens, so you may want to monitor your thyroid closely and definitely supplement with iodine.

      Chris

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    2. Thanks, that hits home actually... I've been meaning to see if I have a bacteria overgrowth. I regularly consume kefir/yogurt and was concerned about all those 'live' cultures getting in me. I had read that you can kill off some of these bugs by mixing in some honey (manuka mgo 550 ) with the yogrut but that may not be working for me.

      Also, for a couple years now, I eat only 1 'meal' a day typcially. The thought of breakfast makes me nauseous, and I keep myself satiated during the day with fortified water. Dinners are usually big, but perhaps this low insulin activity during the day might be another reason to check to make sure the thyroid isn't low! Thanks!

      BTW, here's an interesting study mentioned on NPR's science friday on the mechanism of yogurt probiotics:
      http://stm.sciencemag.org/content/3/106/106ps41

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  10. I have read all your (very helpful) posts/reports/interviews on cholesterol and essential fatty acids, but am still unclear on how much fermented CLO to take. I live in New England, so need the D; have lousy night vision (perhaps because of astigmatism), so likely need A, but don't want to overdo the Omega 3. My dry skin could be from too much or too little? I have been taking 2 tsp CLO in winter, 1 in summer, and my D level is now consistently @40. If I cut back on CLO, can I expect to maintain that? There is breast cancer in my family, and the Grass Roots Health studies recommend at least that preventively. My cholesterol escalated steadily every year since menopause (now in my sixties) and has now stabilized quite high (@300), ratios good (HDL 89, Trig 57). I am very active and fit, so fortunately no one's recommending statins. I otherwise eat a whole food diet, including grass fed meat (occasionally liver), raw milk dairy (kefir, yogurt & butter), eggs, lots of vegetables, very little grain. But no fish (only shrimp). I take a Sea Vegetable supplement and High Vitamin Butter Oil with the CLO. Can EFA profiles be tested, or should I just keep winging it? Do you recommend taking an antioxidant such as astaxanthan to prevent oxidation? thanks, G

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  11. I am 21-year old who was diagnosed with heterozygous Familial Hypercholesterolemia (FH) more than 10 years ago. I have been monitoring my lipid levels fairly consistently over the last 4/5 years.

    Since the advent of 2012 I have switched to a Paleo/WAP lifestyle. Before that I had been vegan on and off for more than a year.. ;)

    To see the effect of my new diet on my lipid profile, I just got back my results:

    CHL=507 , HDL=102 , LDL=353 , TRI=136

    Also had a Lp-PLA2 test simultaneously: 225 ng/ml

    Oxidative LDL test result reads: 28,2 ng/ml


    My LDL has gone up quite sharply to 353. Before the high fat+low-carb diet, my LDL would usually hover around 200.

    I have been on a low dose of statins for almost a year when I was 19 but ditched them altogether despite getting my LDL down to 160.

    I suppose one lipid panel reflecting the effects of my new diet is definitely not representative of a longer-term development but I am a bit puzzled as to how to proceed.

    I will have my lipids tested over the next few months to detect a trend. I was also thinking of getting an ultrasound. Calcium level when last tested in late 2011 was at 9,7 mg/dl. Would that be worth checking again?

    Anyhow, Chris I would greatly appreciate your thoughts on my situation as the incompetence of the majority of doctors here in Germany is rather astounding...

    Thanks so much for any information provided on this blog.

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    1. By the way, it may help to know that my father suffered a light heart attack at age 47 but is still living. My grandfather (paternal site) died in his 60s.

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  12. Chris
    Listened to your podcast with Chris K and I have read a lot of his and stuff. I have some basic question about thyroid. If one has had their thyroid removed and has been taking levoxl for the past 15 years, how does that affect t3/t4 conversion. The only number from the doctor is the TSH which is 1.38.
    This leads to a second question about the interaction between thyroid and cholesterol. Actually it is not the total cholesterol 203.
    Hld 58 trig 43 ldl 136
    The problem is small ldl_p 935 which as near as I can tell is the 95th percentile. I am told the numbers are discordant.
    The numbers have been going up for the past five years and I have gradually been getting worse. During those five years I have been going more toward a Paleo diet. I didn't know what that was five years ago.
    My father who is 88 has had three bypass surgeries since he was 58 (every fifteen years.) Trying to understand what to do.

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  13. Hey Chris & Chris-

    I'm interested in your interpretation of some resent VAP results after eating paleo/low carb (around 30 net carbs/day) for 3 months. I am in the processing of losing weight and have already lost 23 lbs and only have 6 more to go. My VAP results were TC 307, LDL 239, HDL 48, TG 95, pattern B-large particles. T4 1.2 and TSH 2.96. Even though my thyroid tests were normal do you think it would be safe to take a iodine supplement? (I eat no seafood.) Maybe increase healthy starches a little? I'm anxious to get this under control without a statin. Any input I would greatly appreciate!

    Thanks,
    Trista

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  14. To tell the truth I am shocked a bit to learn that. Thank you for sharing this useful information I will definitely show this post to my father as he must think about cholesterol and his health. By the way your website is as cool as resume services review online and I appreciate your work.

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