Bad cholesterol: It’s not what you think
this was published in 2010 but very worth the read
â€˜Bad cholesterolâ€™: Itâ€™s not what you think - Health - Heart health | NBC News
The cost of that resistance had become apparent by the mid-1980s and into the 1990s as Dr. Krauss began to test whether changes in diet could change a person's LDL profile from good to bad, or from pattern A to pattern B. Using data from the Framingham Heart Study — the longest-running study of its kind — health organizations had begun to roll out the message of "good" and "bad" cholesterol, a message that in turn created the concept of good fats and bad fats. But during experiments, Dr. Krauss discovered that while a diet high in saturated fat from dairy products would indeed make your LDL levels rise, "saturated fat intake results in an increase of larger LDL rather than smaller LDL particles," as he wrote in an American Journal of Clinical Nutrition review he co-authored in 2006. A diet heavy in full-fat cheese and butter — but not overloaded in calories — triggered the relatively harmless health profile described as pattern A. (Having demonstrated the benign consequences for cholesterol from consuming dairy fat, he is currently conducting studies to find out if the same holds true for diets high in saturated fat from beef.)
Not only is dairy fat unlikely to increase heart-disease risk, Dr. Krauss and others have learned, but reducing saturated fat in a way that increases carbohydrates in a diet can shift a person's LDL profile from safe to dangerous. That's pretty much what happens whenever some well-meaning person with "high LDL" starts eating "low-fat" frozen dinners filled out with corn-derived additives, all the while engaging in the customary ravaging of a basket filled with dinner rolls.
"I like Ron Krauss and admire his work," says Dean Ornish, M.D., a fellow Bay Area heart-disease researcher and surely the most visible proponent of the idea that a diet low in saturated fat and high in carbohydrates can help reduce the risk of heart disease. But Dr. Ornish says Dr. Krauss shifted his study participants from pattern A to pattern B by having them eat more of the processed carbohydrates. "The carbohydrates they fed people were predominantly refined, like sugar and white flour," says Dr. Ornish. "That's not what I've been recommending."
Dr. Krauss concedes that it's possible that refined carbohydrates are the problem when it comes to small LDL, but adds that his study used both complex and simple carbohydrates "in a manner consistent with many people's dietary practices when they adopt a low-fat diet." Low-fat diets are old news, you say? Try telling that to the makers of, say, Baked Lays. It will take us years to shake off the damage done by broadly implicating fat in the diet. "Everybody I know in the field — everybody — recognized that a simple low-fat message was a mistake," says Dr. Krauss.
But what about statins? Dr. Krauss believes statins probably offer beneficial effects on heart-disease risk beyond those of lowering LDL (anti-inflammatory properties, for example). Interestingly, statins may help men who want to reduce their small-LDL levels. However, because they increase the removal of LDL from the blood (a process partial to larger LDL), "the benefit may be less than what you would expect from the drop in total LDL," he says.
So with small-LDL testing far from standard (your doctor can request an ion mobility analysis from Quest Diagnostics), the surest way you can reduce your numbers of the LDL that matters is to rely on time-tested advice. Eating fewer carbohydrates, losing weight, and engaging in more physical activity have all been shown to reduce small LDL. Weight loss, in fact, has been demonstrated to reverse the dreaded pattern B all by itself. In other words, worry less about eggs or butter and their effect on LDL, and focus more on eating fewer processed foods and staying in motion. "I am very much an advocate of starting with lifestyle first," Dr. Krauss says.
Would I be putting a grain-feed cow on a fad diet if I took it out of the feedlot and put it on pasture eating the grass nature intended?