Cholesterol Clarity or More Disparity

For decades cholesterol has been a major player when it comes to preventing heart disease. Measuring blood cholesterol and knowing your numbers is of key importance. If your numbers spell danger, you need to know what to do. Otherwise, you may be in big trouble.

Cholesterol Clarity or More Disparity

In their book published last year, Heart 411: The Only Guide to Heart Health You’ll Ever Need, Marc Gillinov MD and Steve Nissen MD write: “High cholesterol has no symptoms; every day, we see patients who learn about their high cholesterol only after they arrive in the coronary care unit with a heart attack. Avoid this scenario. Have your cholesterol tested. If the results suggest you are at risk, review the information in the next few pages. It might just save your life.”

Gillinov, a heart surgeon, and Nissen, a cardiologist, are both highly respected doctors and scientists at the Cleveland Clinic in Ohio. Both of them have delivered hundreds of invited lectures at hospitals, academic meetings, and seminars in the United States and many other countries. I highly recommend their book for those who want to increase their understanding of how to prevent heart disease. Of course, the book deals with many other issues than cholesterol.

In their book, Gillinov and Nissen briefly go through the role of cholesterol in our body. They point out that “every cell in your body contains cholesterol, and you can’t live without it.” They highlight the importance of cholesterol for our cell membranes and the role it plays as a building block for many important hormones. They describe the “two types of blood-borne cholesterol, which are distinguished by their attached lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL).” They point out that “high levels of LDL or “bad” cholesterol are associated with the development of plaques in the arteries. Oxidation of LDL cholesterol in the blood enables it to enter the walls of arteries, leading to a build-up of plaques. HDL or “good” cholesterol works in opposite fashion, removing cholesterol from the arteries and returning it to the liver, where it is removed from the body.

They point out that “high levels of LDL or “bad” cholesterol are associated with the development of plaques in the arteries. Oxidation of LDL cholesterol in the blood enables it to enter the walls of arteries, leading to a build-up of plaques. HDL or “good” cholesterol works in opposite fashion, removing cholesterol from the arteries and returning it to the liver, where it is removed from the body.

Gillinov and Nissen also tell us that “Eighty percent of the body’s cholesterol is made by the liver. While most people think that diet is the most important factor in determining cholesterol levels, this is a myth. Only 20 percent of your cholesterol levels comes from your diet, which explains why it is so difficult to reduce blood cholesterol levels via dietary interventions alone”. They say: “Understanding the limitations of dietary interventions often helps people accept the fact that they need to take cholesterol-lowering drugs.” However, they underscore the importance of a good diet to influence blood cholesterol. In their opinion a good diet is “low in saturated fats, high in fiber and whole grains”.

They say: “Understanding the limitations of dietary interventions often helps people accept the fact that they need to take cholesterol-lowering drugs.” However, they underscore the importance of a good diet to influence blood cholesterol. In their opinion a good diet is “low in saturated fats, high in fiber and whole grains”.

They underscore the important role of LDL cholesterol in predicting the risk of heart disease: “Study after study has confirmed the strong relationship between high levels of LDL and heart disease.” Because HDL cholesterol appears protective, they believe that total cholesterol has major limitations as a predictor of heart disease. “The LDL level is the best predictor of the risk of heart attack and stroke, and the basic concept is simple: the lower, the better.

The message from the experts is clear and simple: Know your numbers. LDL cholesterol is the most important subtype when it comes the risk of heart disease. Lowering cholesterol by diet is often not effective, but eating diets low in saturated fats and high in fiber and whole grains may be helpful. If you don’t succeed in lowering your LDL cholesterol, don’t be afraid to take drugs.

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Cholesterol Clarity – Jimmy’s Army

Jimmy Moore doesn’t believe the experts. I just finished reading his recently published book Cholesterol Clarity – What the HDL is wrong with my numbers? Moore’s co-author is Eric Westman MD, an internist in Durham, North Carolina.

Jimmy Moore is well known in the United States for his iTunes podcasts and his popular blog, Livin’La Vida Low-Carb. He has effectively dealt with obesity himself, and for years his cholesterol numbers have been really bad. He is motivated by his own experience and eager to help other people who are struggling to improve their health.

In the Introduction to his book, Moore says: The title of this book is Cholesterol Clarity for a reason: The intention is to make the truth about cholesterol absolutely clear. This book is not for medical geeks. It’s not filled with complex terminology and jargon that makes the layperson’s eyes glaze over. “

Jimmy Moore
Jimmy Moore, author of the book Cholesterol Clarity – What the HDL is wrong with my numbers?

Although I’m probably a medical geek according to Moore’s definition, I must say I enjoyed reading his book. More importantly, I also learned a lot from it. It is so well written, and it has this ultimate freshness about it. I never expected that I would agree with everything Moore writes in his book, and I don’t. Of course, that doesn’t mean I’m right, and he’s wrong. However, I like the way he approaches the subject, and I admire his talent when it comes to explaining complex and highly debated issues.

I never expected that I would agree with everything Moore writes in his book, and I don’t. Of course, that doesn’t mean I’m right, and he’s wrong. However, I like the way he approaches the subject, and I admire his talent when it comes to explaining complex and highly debated issues.

Moore says: “I have no doubt that this book will be controversial. It challenges conventional wisdom about how we eat and live – rules that we have grown up with and followed for most of our lives”.

I agree with Jimmy Moore. I’m afraid many of my colleagues won’t like his book. They may even believe it to be dangerous because it contradicts many of the current recommendations from medical experts and public health authorities. However, I believe that everyone who is trying to take control of his/her own health will learn a lot from reading Moore’s book.

Jimmy Moore has no formal medical or nutritional health education. He does not refer to many scientific studies in his book. Instead, he has chosen to select an army of what he calls “trusted advisers who know the answers to the most pressing questions about health”. Moore constantly quotes these individuals throughout his book.

Jimmy´s army
Moore’s army consists of twenty-nine individuals. Some are nutritionists, some are physicians, and some are neither. Some are respected scientists and leaders in their field. He has chosen many trustworthy and knowledgeable individuals, although some appear more trustworthy than others.

Moore’s army consists of twenty-nine individuals. Some are nutritionists, some are physicians, and some are neither. Some are respected scientists and leaders in their field. He has chosen many trustworthy and knowledgeable individuals, although some appear more trustworthy than others. Obviously, Moore has handpicked a team of specialists who support his own theories. But I have to assume that all these individuals don’t agree with Jimmy Moore on everything he writes, but I could be wrong. What Moore fails to do is to also choose experts who don’t support his opinion. I assume doctors Gillinov and Nissen would not have been fit enough for his army.

Obviously, Moore has handpicked a team of specialists who support his own theories. But I have to assume that all these individuals don’t agree with Jimmy Moore on everything he writes, but I could be wrong. What Moore fails to do is to also choose experts who don’t support his opinion. I assume doctors Gillinov and Nissen would not have been fit enough for his army.

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What’s the Clarity All About?

After introducing his army, Moore goes on to describe the important role cholesterol plays in our body and he describes how little effect the cholesterol in our diet seems to have on blood levels of cholesterol. He discusses the evidence, or rather the lack of evidence linking saturated fat with heart disease. He touches on the evidence behind the lipid hypothesis, the fear of dietary fats, and the rising incidence of obesity and

He discusses the evidence, or rather the lack of evidence linking saturated fat with heart disease. He touches on the evidence behind the lipid hypothesis, the fear of dietary fats, and the rising incidence of obesity and type-2 diabetes, which has occurred despite Americans dutifully cutting their fat intake.

He criticizes the overwhelming emphasis on dietary fat and cholesterol consumption as the true culprits in heart disease. “Emerging evidence proves that these supposed health experts have been dead wrong and yet they continue to cling to this outdated and outright harmful information.” I assume Gillinov and Nissen belong to this group of “supposed health experts”.

Quite predictably, Moore discusses the role of inflammation in heart disease. Most specialists who doubt that cholesterol plays a direct causative role in atherosclerosis believe that inflammation is a key factor. However, although research indicates that inflammation plays a huge role, it doesn’t imply that cholesterol doesn’t matter. Indeed, atherosclerosis and heart disease may be caused by a complex interplay between different components of lipoproteins, including cholesterol, as well as oxidation, inflammation and other known or unknown mechanisms. Cholesterol and inflammation are not mutually exclusive.

Moore writes: “Without inflammation, cholesterol can’t harm you”, and he’s probably right. But he might as well have written: “Without cholesterol, arterial inflammation as we know it won’t harm you”.

Moore recapitulates what major health groups have said about cholesterol through the years. He manages very well to reflect the stringent, monotone, and scientifically unsupported view repeated for so many years, that the only thing that matters when it comes to diet and heart disease is too much cholesterol in the blood and the importance of avoiding saturated fat and cholesterol in our diet. I’m afraid this approach has produced more harm than good when it comes to public health.

Moore criticizes the widespread use of cholesterol-lowering drugs (statins). He believes there are alternatives to drug treatment when it comes to improving our health and “that lifestyle should be the first step to improving health and cholesterol numbers.

He cites Dr. Thomas Dayspring when saying: “The real problem with most people is that they just don’t do what’s required to see improvements happen. If you want to go totally drug-free, then you have to get serious about lifestyle and diet changes”. Many people could learn a lot from Jimmy Moore when it comes to improving health with serious lifestyle changes.

Cholesterol Clarity or More DisparityMoore attempts to redefine what we normally see as a heart healthy diet. This is not an easy task because the cholesterol issue has become such a big part of conventional thinking. An example of that is fearing that a highly nutritious food such as eggs is dangerous for your health because it’s rich in cholesterol.

In Jimmy Moore’s mind “heart healthy” does not imply eating less fat and more carbohydrates. He is very skeptical about sugar, grains and starchy carbohydrates as well as omega-6-rich vegetable oils.

Moore discusses the question why “so many doctors are clueless about cholesterol”. He is “troubled by how little most traditionally trained medical doctors are taught about the nutritional component of health”. Sadly, I think he has a point here. The influence of nutrition and lifestyle on health definitively played a minor role in my own medical training. This is an area where doctors have to improve.

However, Jimmy Moore could be overestimating his own and his army’s greatness when saying: “Apart from the experts quoted in this book, the mainstream medical community seems determined to stick with outdated and potentially dangerous ideas.”

Moore does a very good job in explaining the meaning of different laboratory numbers, total cholesterol, LDL cholesterol, triglycerides, as well as the role of newer tests like ApoB, LDL-P, Lipoprotein (a), particle size assessments (patterns A and B) and C-reactive Protein (CRP).

Cholesterol Clarity or More Disparity

It’s quite interesting to compare the approach by Gillinov/Nissen and Moore/Westman to the role of cholesterol in heart disease and cardiovascular prevention. Gillinov and Nissen consider a heart healthy diet to be low in saturated fats, high in fiber and whole grains. Jimmy Moore and his army, on the other hand, believe that eating less carbohydrates and more fat is beneficial.

Gillinov and Nissen consider it positive that 25-30 million Americans are taking statin drugs to lower the risk of heart disease and stroke. Jimmy Moore and a part of his army, however, see statin drugs as a marketed poison. How can we explain such a huge difference of opinion? Who’s right and who’s wrong?

I think Jimmy Moore handles the question elegantly at the beginning of his book when he writes: “For years, popular wisdom has held that having elevated levels of cholesterol in your blood is extremely dangerous, leading to heart attack, stroke, even death. Therefore, it must be lowered by any means necessary. Those means include cutting saturated fat and cholesterol from your diet and taking cholesterol-lowering prescription drugs. Sound familiar? Well, some of us took the time to stop and ask a few simple questions: Isn’t the human body a lot more complex than this simplistic solution implies? Isn’t our health dependent on more than one single marker like total cholesterol?”  I suspect Gillinov and Nissen agree with these words. So maybe there is no disagreement after all.

Although I don’t believe Jimmy Moore has managed to resolve all the fog around the cholesterol issue he certainly has given it an honest and fresh try. I know I will read many chapters of his book again and again. Although I may not necessarily always find the truth, I will enjoy it, and I’m quite sure it will help me become a better doctor.

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Steinar
6 years ago

Honestly written, ignited desire to read Jimmy Moore.

Mie
Mie
6 years ago
Reply to  Steinar

Might be a good idea. One could always use a decent laugh. 🙂

Although, in terms of Moore’s health, his yo-yo -dieting and strange ideas e.g. about LDL not being important whatsoever are nothing to laugh about.

charles grashow
charles grashow
6 years ago

It’s interesting he leaves out this from Dr Dayspring

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Doc´s opinion
Admin
Doc´s opinion
6 years ago

Actually Jimmy Moore quotes Gary Taubes saying that “LDL-P tend to increase in a small segment of those people who eat a low carb-high fat diet”. However, he doesn´t consider it a big issue. It doesn´t surprise me that Doctor Dayspring is not ready to ignore a severely elevated LDL-cholesterol. Very few doctors would.

charles grashow
charles grashow
6 years ago

https://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-v Thomas Dayspring aka “Dr Lipid”  May 26, 2012 But no way is CIMT as imformative as total LDL-P or apoB A positive IMT implies subclinical atherosclerosis – likely the apoB and LDL-P were elevated for years before the vessel wall became abnormal enough to cause a positive IMT Thomas Dayspring aka “Dr Lipid”  May 23, 2012 Peter is right on: If you have too many small LDLs or too many big LDLs you are at risk for CHD. If you have all small LDLs but total LDL-P is normal, there is no risk. If you have normal numbers of very large… Read more »

Doc´s opinion
Admin
Doc´s opinion
6 years ago

Charles. No, I don’t think LDL-C and LDL-P will become irrelevant although HDL is high and TG and CRP low. Of course they may become less relevant when other markers are good. I don’t think anybody really knows whether the relevance of high LDL – particle count (LDL-P or ApoB) is different on a ketogenic diet than on a non-ketogenic diet.

Superchunk
Superchunk
6 years ago

Doc,

I have to question your statement “Without Cholesterol, Inflammation can’t harm you…” Ignoring all the other problems with inflammation in general, won’t there always be enough cholesterol in the body that significant inflammation will become a problem? In other words, a low-carb/no-bad-fat diet is practical and should minimize inflammation in most people, however high inflammation such as produced by a high-carb diet would almost never be accompanied by sufficiently low Cholesterol to avoid danger..Thoughts?

And many thanks for your great blog…

Doc´s opinion
Admin
Doc´s opinion
6 years ago
Reply to  Superchunk

Thanks for commenting Superchunk. My statement was merely hypothetical. I was trying to support my view that cholesterol and inflammation are both involved in atherosclerosis and heart disease. Without one or the other, heart disease as we know it would probably not exist.

bill
bill
6 years ago

Dr. Sigurdsson:

So, are you also advocating consuming more “heart healthy
whole grains”?

Doc´s opinion
Admin
Doc´s opinion
6 years ago
Reply to  bill

Bill. In general terms my answer to your question is no. However, we are all different when it comes body weight and metabolism in general. Healthy whole grains may be a good choice for many individuals, while in other situations I believe it is better to avoid them.

Richard Mjödstånka
Richard Mjödstånka
6 years ago

Doc, I emphasize that the overwhelming consensus of lipid researchers is that the inflammation associated with CHD is a causal product of elevated LDL cholesterol (See Steinberg 2008). When cholesterol is reduced, the inflammation dissappears. We’ve known about 100 years that CHD is accompanied with inflammation, however, the inflammation story became the new fad of the early 2000s, kind a like the vitamin E craze in the 1970s. Elevated Remnant Cholesterol Causes Both Low-Grade Inflammation and Ischemic Heart Disease, While Elevated Low-Density Lipoprotein Cholesterol Causes Ischemic Heart Disease without Inflammation (2013). https://www.ncbi.nlm.nih.gov/pubmed/23926208 Moreover, oxidation of LDL is just one modification… Read more »

Mie
Mie
6 years ago

Amusing. There’s nothing “politically incorrect” about a vegetarian diet, and the thought of someone actually uttering such words strikes me as … Well, nevermind. The reason why Ornish – or any other low-fat vegetarian diet, for that matter – needn’t be praised unduly is that its effectiveness isn’t that much better from the point of view of clinical studies. You know, those that COMPARE diets to other diets? “The above stressed above is clearly nonsense. It’s clear that Nissen and Gillinov would need broader palette to operate.” That does indeed sound odd, but instead of the usual, old epidemiological data,… Read more »

Richard Mjödstånka
Richard Mjödstånka
6 years ago

Continues… in regards to Nissen’s and Gillinovs statement: “Eighty percent of the body´s cholesterol is made by the liver. While most people think that diet is the most important factor in determining cholesterol levels, this is a myth. Only 20 percent of your cholesterol levels comes from your diet, which explains why it is so difficult to reduce blood cholesterol levels via dietary interventions alone”. The above stressed above is clearly nonsense. It’s clear that Nissen and Gillinov would need broader palette to operate. In the 7CS the lowest mean serum cholesterol of 3.7mmol/l was observed in one the Japanese… Read more »

charles grashow
charles grashow
6 years ago

@Richard Can one separate dietary saturated fat intake from dietary cholesterol intake? https://ajcn.nutrition.org/content/19/3/175.full.pdf DIET AND SERUM CHOLESTEEOL IN MAN: LACK OF EFFECT OF DIETARY CHOLESTEROL ANCEL KEYS, J. T. ANDERSON, OLAF MICKELSEN, SADYE F. ADELSON AND FLAMINIO FIDANZA Outcome: Cross-sectional surveys in Minnesota on young men – no relationship between dietary cholesterol and the total serum cholesterol concentration Two surveys on Island of Sardinia – failed to show any difference in the serum cholesterol concentrations of men of the same age, physical activity, relative body weight, and dietary pattern, but differing markedly in cholesterol intake Carefulstudy during 4 years with… Read more »

bhrdoc
6 years ago

Thanks Axel for another informative look at the cholesterol controversy. I take issue with Nissen when he and his colleague write that: . “The LDL level is the best predictor of the risk of heart attack and stroke, and the basic concept is simple: the lower the better.” Multiple studies have shown that elevations in non-HDL-cholesterol and low HDL-cholesterol are far better lipid predictors of risk. In addition, if LDL level were so predictive of risk how can they account for the fact that in the 7CS, at the very same level of LDL (no matter whether it is high… Read more »

charles grashow
charles grashow
6 years ago
Reply to  bhrdoc

You said “LDL particle number is probably what we should be measuring, since LDL-cholesterol represents a broad range of densities with greater or lesser degrees of atherogenicity.”

My question remains – high LDL-P, high ApoB, low CRP, low homocysteine – is this a bad profile?

Mie
Mie
6 years ago
Reply to  bhrdoc

I don’t think there’s a conflict in advocating for lower LDL levels AND stating that other risk factors need to be accounted for, too. If you exercise, don’t smoke at all nor drink excessively and eat a healthy diet (plenty of veggies, fruit and berries; mostly unsaturated fat; protein from vegetable sources, fish and nuts etc.), you’ll get lower LDL, higher HDL, better blood pressure etc. etc. That is, you’ll be able to lower a whole bunch a of risk factors. Now, unfortunately, as simple as the abovementioned seems, in real life it seems to be nearly impossible to those… Read more »

charles grashow
charles grashow
6 years ago

Stains can also reverse plaque https://content.onlinejacc.org/article.aspx?articleid=1136395 Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging Our study demonstrated one-year lipid-lowering therapy with 20-mg atorvastatin (the maximal approved dose in Japan) to induce a marked LDL cholesterol reduction and a significant plaque regression in the thoracic aorta. In the abdominal aorta, even the 20-mg dose resulted in only a retardation of plaque progression, and a significant progression was observed in the 5-mg dose treatment. These findings suggest that atorvastatin has a greater effect on plaques in the thoracic aorta than in the abdominal aorta.… Read more »

Richard Mjödstånka
Richard Mjödstånka
6 years ago

@Barbara, did the 7CS provide data on LDL cholesterol? I am under an impression the study only looked at TC cholesterol. Once again, cholesterol damage is about cumulative exposure. We do not know what were the cholesterol levels of the Crete people during their adolescence or during the war years, do we? Certainly TC cholesterol was higher among Americans than among the Cretan people. They were not on par as you suggest. The Americans had their mean serum cholesterol around 240s during the 1960s. These were not comparable to Cretans. And we know for a fact that Americans at the… Read more »

bhrdoc
6 years ago

You are correct Richard about the 7CS – those data related TC not LDL-C to CVD mortality. But at any level of TC, high or low, CVD mortality in Cretan men was a quarter of that in US men. As for HDL-C, nothing raises HDL-C more than saturated fat, with monounsaturated fat intake coming in second. The only fat that lowers HDL-C levels is trans fat. I don’t know how you can prove that no one with heterozygous PCSKY-9 ever had atherosclerosis. I have certainly seen any number of people with low LDL-C who still develop ASCVD, and my oldest… Read more »

Doc´s opinion
Admin
Doc´s opinion
6 years ago

In the study by Cohen and coworkers published 2006, PCSK9 mutation was associated with lower levels of LDL cholesterol and lower risk of coronary heart disease. However, coronary artery disease was found among individuals with the mutation. Despite a very low plasma level of LDL cholesterol (53 mg per deciliter [1.4 mmol per liter]), one patient died at the age of 68 years, within 24 hours after his first myocardial infarction. Thus, patients with very low LDL cholesterol can have a heart attack. Cohen and coworkers concluded that the reduced risk of coronary artery disease among those with the PCSK9… Read more »

Richard Mjödstånka
Richard Mjödstånka
6 years ago

Doc, some people of European origin may have partially degraded PCSKY-9 function and thus lower levels of blood cholesterol because of this. However, I referring to people with heterozygot mutation. The ones who have been identified are all black. In addition, there are few individuals with full-blown homozygot form of the mutation, these people have their lifelong LDLs around 7-14 mg/dl. All so far identified have been the epitomes of good health. I suspect the one who died with CHD was one pf with partial degration of PCSKY9 function and with life long LDL only slightly lower than average LDL… Read more »

Richard Mjödstånka
Richard Mjödstånka
6 years ago

Anyways Doc, I admit that the person you referred to should not have died in CHD. Very unlucky individual. But then again, unless we have information of his/her cholesterol at midlife, it’s hard to consider this case as a true exception. If there was atherosclerosis in people with heterozygot PCSK9 mutation, then obviously I’d have to rethink my ideas and it would mean that you had been right about cholesterol all the way. Time will tell 🙂 Also, I do not know the details of the study you referred to, but thanks to these Swedish experts I do know that… Read more »

Mie
Mie
6 years ago

“But then again, unless we have information of his/her cholesterol at midlife, it’s hard to consider this case as a true exception.” Since this patient still had an LDL-level of 1.4 mmol/L at the age of 68, I’d argue that its likely that he had significantly lower LDL levels during most of his life. And in any case, his LDL-level was well below the upper end of the sc. physiological level (1.5 mmol/L). Now, the guy was severely obese, suffered from hypertension and smoked. All “classical” risk factors. What this case hints is that you simply CANNOT and SHOULDN’T rely… Read more »

Charles Grashow
Charles Grashow
6 years ago

https://atvb.ahajournals.org/content/15/8/1043.long Predominance of Large LDL and Reduced HDL2 Cholesterol in Normolipidemic Men With Coronary Artery Disease The association between large LDL size and CAD was significant (P26.8 nm) was more prevalent among subjects with CAD (43%) than among control subjects (25%) (P<.002). Among subjects with this LDL size profile, subjects with CAD had significantly higher (P<.05) VLDL triglyceride, VLDL cholesterol, and VLDL apo B levels and significantly lower (P<.0001) HDL2 cholesterol levels than controls. Thus, in this normolipidemic population with CAD, a predominance of very large rather than small LDL particles was associated with increased VLDL and reduced HDL2 cholesterol… Read more »

Doc´s opinion
Admin
Doc´s opinion
6 years ago

Charles. I agree with you. Large particles can be atherogenic. Patients with familial hypercholesterolemia often have large LDL particles. Nonetheless, their risk of atherosclerosis and heart disease is high. Their LDL cholesterol is high and so is their LDL particle number (LDL-P). Large particles don´t prevent them from developing atherosclerosis. This may support the theory that the number of LDL particles is more important than particle size when it comes to estimate risk.

Laurence Chalem
6 years ago
Reply to  Doc´s opinion

I realize that this blog is nearly six months old, however, I could not keep my comments to myself. The problem with FH does not revolve around cholesterol or its carriers. No, the body raises those levels as a solution to the real problem, which is disheartening to me that it is not part of the knowledge base of a doctor writing on the subject. Moreover, although some people hetero- or homo-zygous for FH perish as a result of atherosclerosis, most do not. Rather, they die of valve issues and other non-atherosclerotic CVD.

Axel F Sigurdsson
Admin
Axel F Sigurdsson
6 years ago
Reply to  Doc´s opinion

Thanks for the comment Laurence. I’m quite impressed that you believe you know what is and what is not a part of my knowledge base. That shows a wonderful insight on your behalf. Then you probably know, as well as I do, that prior to the widespread use of statin therapy for patients with heterozygous FH, the risk of premature coronary heart disease (CHD) was very high https://aje.oxfordjournals.org/content/160/5/421.long In a 1974 study of over 1.000 first and second degree relatives of 116 index patients, the risk of fatal or nonfatal CHD by age 62 was 52 percent for male and… Read more »

Laurence Chalem
6 years ago

Please note that I didn’t say they didn’t get atherosclerosis, I said it wasn’t the cause of death of most people with FH. Even so, the main question is what is the real problem with FH? You must know that it isn’t the cholesterol. It’s the…

Laurence Chalem
6 years ago

Following up, as I see no one has responded, the problem with FH–a misnomer–isn’t the cholesterol, it’s deficient cholesterol receptors. Much like in insulin resistance the body compensates by producing too much insulin, when cholesterol receptors are insufficient, the body produces too much cholesterol and its carriers, because cholesterol is such a vital molecule.

See for example:

https://drmalcolmkendrick.org/2013/07/16/you-are-a-very-black-swan-indeed/

Axel F Sigurdsson
Admin
Axel F Sigurdsson
6 years ago

The role of LDL receptors and their availability is certainly an important issue. The PCSK-9 inhibitors that are now being tested in clinical trials increase the availability of LDL-receptors which probably is the main reason why they lower blood cholesterol. Of course we still don’t know about the clinical efficacy of these drugs. You’re absolutely right that the underlying problem with FH is lack of or dysfunctional LDL-receptors. This commonly leads to high levels of circulating LDL-cholesterol in blood. The numbers of LDL-particles (LDL-P) is also high due to the lack of clearance of these particles from the blood stream.… Read more »

Laurence Chalem
6 years ago

Lower the risk of coronary events on patients that have already had a coronary event? By how much and at what cost?All statin trials utilize relative risk instead of absolute risk obfuscating the real benefit, which is negligible in absolute terms, at the cost of diabetes, pain, memory loss, et al. Many researchers today think that inflammation is the cause of atherosclerosis. The problem is that all anti-inflammatory trials have resulted in a significant increase of CHD mortality. A better interpretation of these findings taken together is that inflammation is beneficial; it is not the cause. I think that atherosclerosis… Read more »

Charles Grashow
Charles Grashow
6 years ago

https://www.lecturepad.org/pdf/tomdayspring/human_lipid_transportation_system.pdf Lipid and Lipoprotein Basics Thomas Dayspring MD, FACP, FNLA, NCMP It is crucial to have a clear understanding of how particle size contributes to atherogenesis (it does not). All LDL particles, large or small are atherogenic (will enter the arterial wall) if present in increased numbers (elevated LDL-P). If LDL-P is low (physiologic), there is little risk whether one has large or small LDL particles. Indeed, once LD-P is known, LDL size is no longer an independent risk factor for CHD. If LDL-P is high, CHD risk is high no matter whether the high LDL-P is driven by toomany… Read more »

Evelyn aka CarbSane
6 years ago

Hello, I haven’t read through all of the comments so please forgive me if I’m repeating anything. You wrote: Jimmy Moore has no formal medical or nutritional health education. He does not refer to many scientific studies in his book. Instead, he has chosen to select an army of what he calls “trusted advisers who know the answers to the most pressing questions about health”. Moore constantly quotes these individuals throughout his book. Moore´s army consists of twenty-nine individuals. Some are nutritionists, some are physicians, and some are neither. Some are respected scientists and leaders in their field. He has… Read more »

Doc´s opinion
Admin
Doc´s opinion
6 years ago

Thanks Evelyn for your important comments.
As I wrote in my article I don´t agree with Jimmy Moore on everything he writes in his book and the interpretation of some of the lipid profiles is an example of that. I also agree that handpicking “specialists” and quoting them as Jimmy does is a problem because he has obviously selected individuals and quotes that support his own opinion. Of course this may be interpreted as one type of “cherry picking”.
Again, thanks for sharing your thoughts.

Brian
Brian
6 years ago

Jimmy said to email him and he’ll get on it 🙂 [email protected]. Email jimmy and he will have you on his show to chat more.

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