Sunday, December 27, 2009

Here's My Answer to a Question Posed to Me on My Website About Cholesterol Profiles

Dr. Carlson,
I have listened to your thoughts on low carb from your interview with Jimmy Moore and wanted to get your advice. I had my cholesterol checked 2 days ago and here are the comparisons from my previous results.
From August of 2009 before starting low carb:

LDL = 153 HDL= 54 Trigs= 50

Yesterday's Results:

LDL= 158 HDL= 65 Trigs=37

The nurse told my wife that she was gonna talk to the doc and that something had to be done (I'm assuming statins). Tell me your thoughts...... Also, what are those equations Total/HDL or Trig/Total or something? I would think my risks would be lower now with the better HDL and lower Trigs.


My response:

Hi There!

First off, your numbers are obviously better. I noticed you didn't mention what the Total Cholesterol was; that is good because it means nothing anyway. I ignore the LDL because it is usually calculated and I can guarantee by the way you reported it to me it was.

So the only 2 numbers you need to worry about are the HDL and the Trigs.Notice your HDL went higher and your Trigs went lower. Once the HDL becomes greater than 59, you have a negative risk for heart disease (and many other disease processes).

Now the ratio I use is the Trig/HDL ratio and I want this at 2 or less. Yours is obviously less than 1. Great job!

My only argument for the use of statins is for plaque stabilization. That is, if there is plaque already on an artery, the statins make it less likely for the plaque to rupture as it is the rupturing of plaque that causes the heart attacks and strokes.

How do you know if you have plaque on the coronary arteries? Well, if you've been eating low fat/cholesterol and you're in your forties, you probably have plaque within your coronary arteries.

Important point: the plaque that builds up on our arterial walls comes from the modification of sugar molecules in the diet NOT from the fat/cholesterol in the foods we eat.Most doctors think the opposite to be true.

So if you're in your forties, been eating low fat/cholesterol, you probably have plaque. I generally start a statin while I'm waiting for the HDL to raise, once I get my patient on the right way to eat. But your HDL is 65, so I could easily argue against the use of a statin.

BTW, if your doc tries to start you on anything other than a statin...just say no. The agents such as Zetia, Tricor and Trilipex are a waste of a drug, and the only docs who use them are the one's who are ignorant of the correct way to eat. Oh wait, that means just about every doctor...

One last thing. An indirect way to assess if you might have coronary artery plaque is by having a carotid Doppler done. If you have mild thickening on the carotids, studies have shown you most likely have thickening on the smaller diameter coronary arteries. In this case I start my patients on a baby aspirin (so long they are not pregnant or nursing).

If no plaque is present, and I start you on the correct way to eat, no matter what your lipid panel is to start---YOU GET NO CHOLESTEROL LOWERING MEDS FROM ME!

And I'll leave with the statement "Lowering total cholesterol has never been shown to lower one's risk for heart disease.never,ever,ever..."Hope that helps!

Dr Jim


  1. Another ways to determine the presence of coronary plaque is with a coronary artery calcium scan. Calcium makes up about 20% of the content of arterial plaque and these fast EBT scans (very little radiation compared to slow scanning machines) can measure the total amount and location of calcium deposits, thereby disclosing the amount and location of plaque. Scores are assigned based on the age and gender of the person as well the amount/location of the plaques. A baseline scan in early middle age can be used as comparison for later scans. A 0 score is no detectable plaque. Even if the number is higher and plaque is present, the scans are most useful for monitoring progression of plaque. If after a scan a year or two later, the score is nearly the same, the plaque is stable, but it if is higher is it growing and disease is progressing. If it is lower, the plaque is regressing (which is possible with the right diet and lifestyle - which is often contrary to the Conventional Wisdom on CAD).

  2. That is all true! Thanks Anna!