My Cholesterol is Up Again?

Christmas Sweater

Lab Results June 2018

A few days ago, I decided to get another blood test.  The results are in.  Most numbers are the same.  But two numbers stick out like an ugly Christmas sweater in June: LDL and total cholesterol.  They went up!  But why? 

Christmas Sweater

I don’t really know why.  But I have a few theories:

High-Intensity workout?

I lifted weights the morning before the test.  Doing high-intensity weightlifting in a fasted state could cause more LDL to circulate through the blood.  LDL carries, among other things, triglycerides, to the muscles.  Since my body operates mainly by burning fat, triglycerides are mobilized and sent to the muscles via LDL.  Since my blood test was only an hour or so after my workout, it’s plausible that I would still have high levels of LDL circulating in my blood.  I did not work out the mornings of my previous blood tests. 

Longer Fast?

I fasted for longer.  15 hours this time.  I only fasted for 12 hours before my previous two tests.  Perhaps my body burned through its glucose stores (lifting weights) and is in full-on fat burning mode; mobilizing a larger fleet of LDL trucks to deliver triglyceride packages to my fat-adapted muscles. 

More Meat, Fewer Carbs?

I’m eating more meat and fewer carbs.  Not just any meat, but fatty meat.  The kind that’s full of saturated fat.  Does eating more meat raise LDL?   There is solid evidence pointing to eating saturated fats as the best way to increase HDL.  However, I have yet to see strong enough evidence that increased saturated fat consumption raises LDL.  In many studies, it has the opposite effect.   

Too much meat?

It’s possible I’m over-doing it with meat.  Not because of the increased fat consumption, but the protein.  I’m not tracking what I eat.  Perhaps the amount of carbs I’ve cut is less than the amount of protein I’ve added.  Thinking back, some days it feels as though I’m eating past the point of full.

Fluke?

Fluke.  Maybe this LDL reading is a fluke.  We really don’t know for sure what causes variations in LDL readings, especially when one is on a low carb diet.  It’s entirely possible I take another test tomorrow and my readings are “normal” again. 

Is this a bad thing? 

I don’t think so.  My HDL and Triglycerides are essentially the same.  Secondarily, my HbA1C and glucose measurements are still fine. 

The correlation between high LDL and cardiovascular disease is weak.  In fact, the evidence tilts in favor of high LDL being a good thing.  Old studies have been re-examined to raise the possibility that high LDL is linked to reductions in risk for the four major killers: cancer, stroke, and Alzheimer’s disease.   

Take a look this Framingham Offspring study.  As Dave Feldman points out in a recent post, the study found if your triglycerides are less than 100 and your HDL is more than 40 (more than 50 for women), then your risk of CVD is the same whether your LDL is above 130 or below 100!

Focus on two numbers 

The important factor here is my Triglyceride to HDL ratio.  It’s under one, which means my metabolism is healthy – my carb consumption is low and my saturated fat consumption is high.  If you believe, like I do, that the big four – heart disease, stroke, cancer, and Alzheimer’s – are metabolic diseases that stem from over-eating carbs and under eating saturated fats, then I’m still cheating death.  

 

My Cholesterol Numbers After a Year of Butter

2016 - 2017 Cholesterol Comparison

In part 1, I went over where my cholesterol numbers were last year and why I wanted to improve them.  In part 2, I talked about what I ate to lower my cholesterol; things like butter, coconut oil, veggies, and meat.  What did this high-fat low-carb diet actually do to me?

The New Doctor (PA)

Flashback to a couple weeks ago when I dove into another physical and more blood work.

This time I saw a Physician Assistant.  We’ll call him PA B.  My previous doctor (Dr. H), the one that said I was fine, left general practice and became an orthopedist.  Not having any clue what background PA B had, I was a little nervous.  I decided to test him.  I had him take a look at my numbers from last year and tell me what he thought.  To my relief, he agreed with Dr. H.  In fact, he ran my numbers through an online CVD risk calculator and it said I had a 0.6% chance of experiencing a cardiovascular event (heart attack or stroke) in the next ten years.  He even spotted me two years since the calculator won’t let you enter an age less than 40!

PA B: “I wouldn’t even consider prescribing a statin to someone unless they had at least a 7% chance of a cardiovascular event.”

Awesome!  No eminent danger.  But, I still wanted to see if my year of fat worked.

Let’s get to the Numbers

A couple days later I got my new blood test results back.  The numbers were even better than I expected:

2016 - 2017 Cholesterol Comparison

Goodbye LDL

As you can see, I lost a boat load of LDL, a whopping 35% decrease!  According to the National Heart, Lung, and Blood Institute, I’ve leap-frogged from “borderline high” to “optimal.”

LDL Guidelines
LDL guidelines. Source: National Heart, Lung, and Blood Institute

Hello Desirable

With regards to total cholesterol, I’ve dropped 11%, going from “borderline high” at 215 to “desirable” at 191.

Total Cholesterol Guidelines
Total cholesterol guidelines. Source: National Heart, Lung, and Blood Institute

I Feel Awesome!

My year of fat has resulted in some pleasant, less mathematical side-effects.

My energy is smoother throughout the day.  I no longer feel like my day is a rollercoaster ride of energy peaks and valleys.

I don’t crave food, especially sugar or carbs.  When my carb intake was higher, I noticed it was difficult to go more than 2-3 hours without wanting more food.  I would even get stomach aches if I went too long.  Now, with a lower dependence on carbs, it doesn’t really bother me to go 4-6 hours, or longer, between meals.

Brandon Biking Central Park
Me biking around Central Park in NYC

My endurance is up.  In a recent trip to New York City, I walked and biked everywhere without feeling tired or terribly hungry.  Before this experiment, I probably would’ve needed a few pit-stops to resupply with fruit or a carb-based snack.

All with no meds

As I explained in my first post, my original doctor (Dr. G) was concerned about my LDL and total cholesterol numbers.  So much so, that he wanted to put me on a statin drug.  Fortunately, I said no.  And, instead of going the traditional diet-change route of cutting my fat intake and increasing my whole grain consumption, I did a 180, increasing my fat consumption and cutting my any-grain consumption.  Based on the numbers and how I feel, I’d say this experiment in taking control of my own healthcare was a success!

What I Ate This Year To Lower My Cholesterol (Besides Butter)

Food Group Breakdown

If you read part 1, you know that I was diagnosed with high cholesterol last year.  After changing doctors and doing some research, I realized despite the ugly numbers, my overall risk for cardio vascular disease was low.  But, I still wanted my numbers to look better, so I decided to start eating more fat.

What I Ate

Food Group Breakdown
Snapshot of my daily calorie ratios for different food groups with some examples.

A couple things to note:  If you stack up the top three categories – nuts/legumes, meats, and oils – you get roughly 2/3 of my calorie intake.  If you throw full-fat dairy on top of that stack, you’re looking at over 3/4 of my calories.  So yeah, I ate a lot of fat.

Is this like Paleo or Atkins?

Sort of, but not really.

Macro Percentages
Breakdown of macros for a recent day (from MyFitnessPal).

The diet I’m on now is best described as Low Carb High Fat (LCHF).

It’s similar to Paleo in that I eat whole foods, lots of veggies and meat.  The difference is I still eat dairy, some grains, and legumes (beans and peanuts) and eat very little fruit.

It’s similar to Atkins in that it’s high fat with a variety of meat.  The difference is I don’t eat eggs (slight allergy), and I don’t eat as much fat (or as little carbs) as they suggest.

I’m Not Doing this to Lose Weight

I suppose if my goal was weight loss, or better yet, body fat reduction, I’d probably shift myself closer to the higher fat/carb ratio that Atkins pushes (5-10% carbs and 70-75% fat).  But, I really just want to maintain what I have and get my cholesterol fixed.

What Most People Say I Should’ve Been Eating

USDA My Plate

The latest USDA recommended guidelines are based on a plate.  3/4 of your plate is carbs, 1/4 is protein, and as a special bonus, a glass of dairy (probably skim milk).  Now to me, this is harder to follow than the classic food pyramid because I don’t always use a plate when I eat, sometimes I use a bowl.  Often I just use my hands to grab random items out of the pantry and shove them directly into my face.

“I’m Living in a Slaughter House”

Some of you might be thinking: “Alright I know how this went down.  You woke up one morning and tore through the kitchen with vengeance in your heart, throwing every last slice of bread or animal cracker out the window.  Then you watched an instructional video and spent the rest of the day decorating you kitchen with sausages.”

Ummm…Not quite.  It was actually a MUCH slower transition process occurring over a period of a few months.

Where You At?

The first order of business was to see what I was dealing with.  So, I grabbed the MyFitnessPal app and started tracking what I ate.  After a few days, I learned quite a bit about myself:

[I like carbs]

  • I still clung to a soda habit.  A few months prior I had successfully weaned myself off a 20-year diet soda love affair and onto a 3-4 a week sugary soda routine.
  • Sugar with my tea, please.  I had fallen in love with Big Train’s sugary chai tea mix.
  • Buns are for burgers and bread is for sandwiches.  It’s the American way, right?
  • I liked rice, pasta, or bread with dinner.
  • Chips and salsa are so good, especially with a burrito.

[I don’t like saturated fat]

  • Meat fat is disgusting.  I preferred lean turkey, chicken breasts, and fish.  Beef occasionally, but only if the visible fat was painstakingly trimmed and discarded.  For some reason, hamburgers didn’t bother me as much as steak.  I guess it was a visual thing.
  • They sell whole milk dairy products?  I had grown so accustomed to fat-free or at least low-fat cheese and yogurt, I didn’t even know if full-fat versions of these products existed.

[I’m no salad eater]

I always tried to get some veggies with every meal, even if it was in the form of potato chunks dipped in oil.  Salads as meals just weren’t really on my radar.

Mmm…Liquid Donuts

Alright, time to start sprinkling in some change.  My wife gets credit for discovering what’s officially called bulletproof coffee. It involved adding butter or coconut oil or both to your coffee and blending it, but since I’m not a coffee drinker, tea it will be.  The first time I tasted BP tea, it was like I was drinking a liquid donut!  Sooo good!  Now some of that goodness was no-doubt due to the fact I was fattening up a pre-sugared chai mix, but one step at a time!

My Version of The Elvis

Breakfast was another area I could tweak.  I was already eating a fake (soy-based) sausage patty with a peanut butter and jelly sandwich.  What if I grab a full-fat sausage patty and skipped the jelly?  Full fat was great!  I was really loving the grease, but the jelly I kinda missed.  So, I moved my mid-morning banana snack to breakfast.  As time went on I made more changes, moving from sausage to a slice of bacon and eventually cutting out one slice of bread from my PB sandwich.  Here’s where it eventually evolved:

A Normal Breakfast

Tiny Bubbles Make Me Happy

Sodas were challenging to give up.  They were my office out-to-lunch-crutch.  They made Chipotle taste so good and burgers amazing.  Not to mention the caffeine boost to get through the afternoon.  I turned to a rotation of water, tea, and sparkling water (cuz I missed the bubbles) to wean my way off the sugar water.   It was hard at first, but I eventually worked my way down to two sodas a week; then one; then none.

It’s The Little Things That Kill

Sadly No More Ketchup

As time went on, other things would catch my eye.  Ketchup is one of those seemingly harmless condiments, but it does contain corn syrup and it all adds up.  I moved my yogurt snack from non-fat sugar-free to low-fat plus sugar to whole plain grass-fed.  I turned my sugar tea habit into a once a week splurge.  I brought nuts to the office with me so I wouldn’t be tempted by the free M&Ms or fruit snacks.  I still ate chips, but the higher fat kettle-cooked kind.  I ate fries, but I tried to get sweet potato fries when I could.  I added just a little more veggies when I could.

No More Rice. Please.

My wife does most of the cooking, but I will proudly point out that I make my own breakfast.  Although lately, she’s been cooking the bacon.  In any case, months before last year’s doctor visit, she had already started nudging our main meals at home toward LCHF.  Honestly, I wasn’t totally onboard with it.  In fact, for a while, she continued to cook a separate serving of carb (rice, pasta, etc) just for me.  After weeks of private arguments with myself, I finally gave in:

Me to My Wife: “Please don’t make the rice anymore.  I’m good.”

Pile on the Chicken Thighs

Curry Chicken Thigh

I think my wife had the same initial hesitations about more fat, especially meat fat.  But eventually, we both started to embrace the grease.  We traded our chicken breasts for thighs, ate more salmon, and threw in some grass-fed beef and bison.

 

Cheat Day

This is a fairly recent addition.  I stole it from Tim Ferriss after reading his book, The 4-Hour Body.  You pick a day, usually Friday or Saturday, and basically eat whatever you want.  Sadly, I’ve become so used to fat and so distant from sugar, that loading up on a bunch of donuts, cake, pie, or even some extra garlic bread tends to bring on a queasy feeling.  Sometimes my cheat just ends up being a few chunks of dark chocolate with a teaspoon of butter.

So, did all this craziness paid off?  Next time, we’ll take a look at my latest blood test results and see if I really ended up cheating death.

Why I Decided to Eat More Fat

Slacker 2016
Slacker 2016
Me at 37 after a 4-mile race in 2016.

I don’t think I’ve ever considered myself fat.  I’ve always been active.  I mean I ran track and played basketball in high school.  And since then, I’ve done some sort of walking, biking, jogging, or weight-lifting on a daily basis.  Plus where I live in Colorado, hiking and snowboarding are almost a requirement.

My diet’s always skewed towards what most would consider healthy.  Plenty of whole grains, fruit, veggies, some meat, but pretty light on the fat – predominantly chicken breasts, lean turkey, and fish.  I’d grab fast food or healthy casual (Chipotle, Qdoba, etc.) maybe 4 times a week.  But other meals were cooked from scratch at home (thanks to my wife).

Why it all began

My fondness for butter (and fat in general) started in August of 2016 with a routine visit to the doctor.  I should say routine for some people, but not for me, and probably not for most men between 20 and 50.  I was going in for my first physical since college, maybe even since high school. I really don’t remember.

So why go now? I’ve never had any serious health concerns.  I’m fairly active, I’m not overweight, I eat fairly healthy most of the time.

Well, a month prior, my dad went in for open heart surgery.  He had an aortic aneurysm – a bulge in a weak spot of his body’s main artery.  He was lucky they caught it before it burst.  Most people don’t survive the bursts.

Anyway, he got through it just fine.  But, it got me thinking about my own health.  Am I at risk for something like this?  Am I walking around with some ticking time-bomb of an issue waiting to go off at any moment?

Off to see Dr. G

Now, if you haven’t been to a doctor in a while, it’s hard pick one.  You can find a few online reviews, but most of them aren’t very helpful.  Especially if you have no idea what you’re looking for.  So, I defaulted to the same general practitioner my dad was seeing at the time – we’ll call him Dr. G.

Doctor

The visit itself was pretty uneventful.  But the lab work later that week turned out to be fun!  The morning of the test, the lab tech calls my name and she hands me a cup.

Me: “Wait…what am I supposed to do with this?”

Lab Tech: “That’s for your urine test.”

Great.  Somehow when Dr. G was mentioning blood work, the words “urine test” failed to reach my ears.  Nothing like a pop-pee quiz in the morning! I had already been fasting and I hadn’t been drinking much.  In fact, I had just peed while i was killing time in the lab waiting room.  So, the lab tech introduced me to my new best friend – the drinking fountain.

After some brief chugging-like-there’s-no-tomorrow, I got back into the lab and forked over the fluids.

I have a cholesterol fever and the prescription is…

Pills

A couple days later, I got a call from my local Walgreens that went something like this:

Pharmacist: “Mr. Eat Your Cheerios?” (most people can’t pronounce my last name right out of the gate) “Your prescription is ready to be picked up.”

Me: “Uhhh…okay. For what?”

Pharmacist: “For Lipitor” (actually, I don’t remember if it was Lipitor or some other statin)

Me: “Oookay.  Thanks.”

It turns out our friend Dr. G got my lab results back, noticed my cholesterol was high, and was nice enough to save me some time and hassle by submitting a drug order directly to Walgreens without consulting me first.  Super easy for me, right?!  All I had to do was drive a couple blocks, pick up my new drugs and carry on with the rest of my normal adult life.

But, I’m not normal.  By nature, I’m a scientist.  I question.  I dig.  I ponder.  Even if something is generally accepted as true, I still want to know why.

So instead of going to the pharmacy, I vented to my wife. I don’t remember exactly what I said, but my complaining probably included plenty of frustration over the audacity of this medical professional to assume I don’t want to discuss different treatment options and that I’ll just blindly accept whatever drug he decides to dispense my way.

Ummm…Please Explain

My next move was to call Dr. G.  Our conversation went something like this:

Dr. G: “Well your total cholesterol is high and your LDL is high.  I’ve diagnosed you with Pure Hypercholesterolemia.  Since your otherwise pretty healthy, I believe your high cholesterol is due to genetics.”

Me: “I don’t know any of my family’s cholesterol numbers, so I guess that could be the case. But, what about my HDL and Triglycerides? They seem pretty good, right?”

Dr. G: “Well, some studies are showing that too much HDL might be bad for us.”

He went on to explain how i should take the statin he prescribed and come back for follow up blood work in a couple months.

Confrontation is not my strong suit.  So, instead of responding with something like, “I don’t know what kind of Banana Republic operation you’re trying to run here!” I kindly wished him a good day and hung up the phone.

Besides, I had a lot of research ahead of me.

Here are my numbers

August 2016
* Direct measure

Nothing too crazy here.  My LDL and total cholesterol are high, my blood pressure is borderline, but still good.  The rest of the numbers are actually decent.

Reading Rainbow

I started by scouring the web for everything I could find on cholesterol and statins.  Most of what I found was pretty consistent with the American Heart Association and what we typically see in the media:

 High cholesterol leads to heart disease and stroke…HDL is good…LDL is bad…eat less fat and your numbers will improve.  

After lot’s of ho-hum data, I eventually ran across some resources that had a completely fresh take on cholesterol, cardiovascular disease, and fat:

Coincidentally, my wife had already started reading a couple other books along the same lines including Why We get Fat by Gary Taubes.

“Fat is good” and other mind blowing discoveries:

Hamburger

  • Eating fat doesn’t make us fat. But, carbs do. More specifically, it’s the insulin spikes induced by carbs that make us fat.
  • Saturated fat is good for you.  In fact, in many ways it’s better for you than carbs.
  • High Cholesterol as a whole, does not cause cardiovascular disease.  I’ve learned that fasting glucose levels, triglycerides, and especially HBA1C are better predictors of heart disease than cholesterol.
  • Most doctors (including our friend Dr. G) don’t measure cholesterol correctly.  They measure LDL count when they should be measuring the size of the LDL particles.  Big and fluffy is good, small and dense is bad.  Thankfully, you can estimate your particle size by looking at the ratio of triglycerides to HDL.
  • Cholesterol is good. As long as it’s not the small dense LDL type.  Cholesterol is responsible for transporting hormones and nutrients throughout the body.
  • Statins can have unhealthy side-effects.  Statins can disrupt our body’s natural process of dealing with inflammation, which can in some cases lead to cholesterol that is too low.

Back to the Doctor

Armed with more more info, I decided to get a second opinion.  I tried to focus on doctors that mentioned an interest in metabolic disease or diabetes in their bios, since my reading was starting to convincing me of a high correlation between heart disease and diabetes.

The new doctor I chose (we’ll call him Dr. H) looked at my prior test results and gave me some great news.  When taking into account all of my other risk factors for cardiovascular disease (age, waist size, no family history of heart disease, good HDL and triglyceride levels), I wasn’t even close to needing a statin!

So all is well, right?

Yes, but I think I can do better

Motivated by my new found counter-intuitive research, I wanted to try something crazy.  I was going to completely flip the food pyramid upside down.  For the next 12 months I would cut my carb intake (especially sugar, fruit, and bread), up my fat intake, and veggie-up a little more.  Would I see I difference in my next blood test?  I think so.

Upside Down Food PyramidTechnically, this is an upside down version of the outdated government food pyramid from 1992.  The latest guide is actually a plate and sadly, they eliminated the fats section all together.