Hooray for high cholesterol!

That's right, bruthas and sistahs. Let me start by testifying that I have been eating what your average cardiologist would consider insanely massive amounts of saturated fat. Lots and lots of heavy cream. Whole milk. Gobs and gobs of coconut oil. Mountains of butter. In short, I've been gorging on all the things mainstream medicine and the government have been saying will kill me.


But last month I read Gary Taubes's Good Calories, Bad Calories, so now I have a clue about how to read a lipid profile, which is a good thing because otherwise I would be distinctly confused by what this one says. Total cholesterol at 265 is flagged as too high, as is LDL at 176. But triglycerides are 93, well within range, and HDL is 70, with an asterisk which says HDL >59 is considered a negative risk for coronary heart disease. So which is it, risk or no risk?


In 1977,  the National Institutes of Health funded five studies to look at how well LDL cholesterol and VLDL triglyceride numbers predicted heart disease. This was the first time any money had been put into looking at anything other than total cholesterol. The result? Writes Taubes:

In men and women fifty and older, Gordon and his collaborators wrote in the Framingham paper, "total cholesterol per se is not a risk factor for coronary heart disease at all." LDL cholesterol was a "marginal" risk factor.


HDL was the "striking" revelation. Both analyses confirmed that the higher the HDL cholesterol the lower the triglycerides and the risk of heart disease.....For those fifty and older, which is the age at which heart disease ceases to be a rare condition, HDL was the only reliable predictor of risk.


Later Taubes describes work done by Ronald Krauss in the 1980s -- Krauss has worked at NIH and Berkeley, and chaired the nutrition committee of the American Heart Association, so he's as establishment as they come even though he's not singing the mainstream song. Krauss studied LDL cholesterol, which can be subdivided into large, fluffy LDL and small, dense LDL. Fluffy is good. Dense is bad. 


Pattern A is dominated by large, fluffy LDL and implies a low risk of heart disease; pattern B is the dangerous one, with predominantly small, dense LDL. Pattern B is invariably accompanied by high triglycerides and low HDL. Pattern A is not. Krauss and his collaborators reported in JAMA that heart disease patients were three times more likely to have pattern B than pattern A. Krauss called B the atherogenic profile.


Well, if that's the case, why do we bother with total cholesterol numbers at all? Shouldn't we be looking at HDL and which pattern of LDL we have?


The answer to that is a labyrinthine tale involving stodgy bureaucracy, scientific ego, and agencies not willing to reverse course when a mistake, especially a large mistake involving very large amounts of money, has been made. I can't cover it in a blog post (and I'm only giving the Cliff Notes on cholesterol here as well). You'll just have to read GCBC (a seminal healthgeek work in any case) for the fascinating full story. But consider this. HDL is raised by eating saturated fat. In 1977, when the HDL news broke, new dietary guidelines had just been published by McGovern's Senate committee, guidelines that stressed avoiding saturated fat and eating more carbohydrates. The NIH had committed over $250 million to various studies attempting to prove that lowering total cholesterol, in part by eating little saturated fat, would lower risk of heart disease. The sudden revelation that high HDL could actually be protective, and you can accomplish that by eating steak and eggs? Very inconvenient indeed.


So we heard no screech of the brakes as the health bureaucracies realized the error of their ways and reversed direction. Nope. Instead we got more vilification of butter and cream, 26.6 million American adults with heart disease, and lipid profiles with contradictory messages. It takes decades for real science to become widely known, and longer if it has to swim upstream against a tide of money headed in the opposite direction. Don't even get me started on statins.


More on interpreting cholesterol numbers here.


We're going to have to keep an eye on this, LD said solemnly, pointing to my total cholesterol number. But I was reading the part where it said I have a negative risk, and smirking a little to myself, thinking about the Hollandaise sauce I was going to have on my eggs when I got home.