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Thread: Chris Masterjohn on Cholesterol

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    Chris Masterjohn on Cholesterol

    I just came across this interview with Jimmy Moore:

    6: All Things Lipids (Cholesterol 101) | Chris Masterjohn | Jimmy Moore Presents: Ask The Low-Carb Experts

    About 15 mins in CM says the best predictor of CVD is the ratio of TC to HDL-C. He does not believe enough work has been done to standardize LDL particle size testing and does not even mention LDL-P. I was flabbergasted to hear this after listening to pre-eminent folks like Thomas Dayspring, Lara Dall and Peter Attiia make strong and unequivocal assertions that the only number that matters is LDL-P. The TC/HDL-C ratio has been around for decades and CM says the target should be 3 which is also a very CW notion. So, after throwing so many stones at my doctor and many others I perceived to be stuck in obsolete thinking about cholesterol, CM is saying that CW is still the best, at least as far as CVD risk factors are concerned. CM goes on to say that trig numbers do not add any additional info to the TC/HDL-C ratio although they may be helpful in identifying IGT.

    This scares the crap out of me because my ratio was 5 before I started a VLC, high saturated fat diet. My primary objective is to control BG but I bet my TC is up substantially which, according to CM, means my risk of CVD is also up substantially.

    Do you think Chris Masterjohn has more cred than Attia, Dayspring and Dall?

    How can so many lipid experts be all hyped up about LDL particle size and particle count when someone like Masterjohn says the standard lipid profile and conventional TC/HDL-C ratio is the only thing that matters?

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    masterjohn is one of the brightest and best for this stuff, and is an actual scientist and researcher, unlike many of the bloviating web types. check his blog cholesterol and health, and all his writing for weston price. the interview above may be out of date, i've not listened to it, but his take on LDL particle size is absolutely correct, and i believe that mark has acknowledged as much on his blog.

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    Quote Originally Posted by Artbuc View Post
    I just came across this interview with Jimmy Moore:

    6: All Things Lipids (Cholesterol 101) | Chris Masterjohn | Jimmy Moore Presents: Ask The Low-Carb Experts

    About 15 mins in CM says the best predictor of CVD is the ratio of TC to HDL-C.
    Yep.

    Quote Originally Posted by Artbuc View Post
    He does not believe enough work has been done to standardize LDL particle size testing and does not even mention LDL-P.
    LDP-P is kinda related to LDL particle size. If all your LDL is the large puffy good kind, then your LDL-P will be low. Put another way, the at risk people are the people with the small, dense, oxidised LDL. And they have to have a correspondingly larger LDL-P.

    Quote Originally Posted by Artbuc View Post
    I was flabbergasted to hear this after listening to pre-eminent folks like Thomas Dayspring, Lara Dall and Peter Attiia make strong and unequivocal assertions that the only number that matters is LDL-P.
    The question is, what's the science behind the LDL-P stuff? As far as I know, there's only one (unreproduced) study that shows that LDL-P matters irregardless of LDL particle size.

    Quote Originally Posted by Artbuc View Post
    The TC/HDL-C ratio has been around for decades and CM says the target should be 3 which is also a very CW notion. So, after throwing so many stones at my doctor and many others I perceived to be stuck in obsolete thinking about cholesterol, CM is saying that CW is still the best, at least as far as CVD risk factors are concerned.
    Absolutely, 100% not. CW is completely wrong with it's misplaced focus on lowering total cholesterol and LDL.

    CW says that Total Cholesterol is bad, and should be as low as possible. This is rubbish. CW says that LDL should be as low as possible. This also is rubbish. CW says Trigs should be low. This is TRUE. CW says HDL should be high. This is true also.

    The concept of TC/HDL, Trig/HDL and LDL/HDL are mainstream markers (or at least they are becoming so).

    Quote Originally Posted by Artbuc View Post
    CM goes on to say that trig numbers do not add any additional info to the TC/HDL-C ratio although they may be helpful in identifying IGT.

    This scares the crap out of me because my ratio was 5 before I started a VLC, high saturated fat diet. My primary objective is to control BG but I bet my TC is up substantially which, according to CM, means my risk of CVD is also up substantially.
    No, only the ratio. Please read through the primer in my sig if you havn't seen it before.

    Quote Originally Posted by Artbuc View Post
    Do you think Chris Masterjohn has more cred than Attia, Dayspring and Dall?
    Every day of the week and twice on Sundays.

    Quote Originally Posted by Artbuc View Post
    How can so many lipid experts be all hyped up about LDL particle size and particle count when someone like Masterjohn says the standard lipid profile and conventional TC/HDL-C ratio is the only thing that matters?
    Because the LDL-P stuff is 'breaking news'. When subsequent studies are done, they might fail to reproduce the previous study, in which case LDL-P will quietly shivel up in the corner. Or they might reproduce it and show the effect is dependant on LDL particle size. Or they might confirm the effect as being independant of particle size. In which case Attia et al's viewpoint will become the consensus one.
    Last edited by magicmerl; 11-08-2012 at 04:29 PM.
    Disclaimer: I eat 'meat and vegetables' ala Primal, although I don't agree with the carb curve. I like Perfect Health Diet and WAPF Lactofermentation a lot.

    Griff's cholesterol primer
    5,000 Cal Fat <> 5,000 Cal Carbs
    Winterbike: What I eat every day is what other people eat to treat themselves.
    TQP: I find for me that nutrition is much more important than what I do in the gym.
    bloodorchid is always right

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    Quote Originally Posted by magicmerl View Post
    Yep.


    LDP-P is kinda related to LDL particle size. If all your LDL is the large puffy good kind, then your LDL-P will be low. Put another way, the at risk people are the people with the small, dense, oxidised LDL. And they have to have a correspondingly larger LDL-P.

    That's not entirely true. Jimmy moore has a large particle size yet his LDL-P is sky high. Granted he is following a very extreme diet with this "nutritional ketosis". I read Dayspring saying he may have to cut right back on his saturated fat content if things don't change.

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    Quote Originally Posted by magicmerl View Post
    Absolutely, 100% not. CW is completely wrong with it's misplaced focus on lowering total cholesterol and LDL. CW says that Total Cholesterol is bad, and should be as low as possible. This is rubbish. CW says that LDL should be as low as possible. This also is rubbish. CW says Trigs should be low. This is TRUE. CW says HDL should be high. This is true also. The concept of TC/HDL, Trig/HDL and LDL/HDL are mainstream markers (or at least they are becoming so). No, only the ratio. Please read through the primer in my sig if you havn't seen it before.
    I have read your primer but not recently. I will re-read it today. How can you say CW is wrong to drive down TC if you agree that the ratio of TC/HDL-C is the best predictor of CVD? There isn't very much you can do to increase HDL-C but you can take statins to substantially reduce TC. Also, I think it is wrong to tell people to eat as much dietary cholesterol as they want because only 15% gets absorbed (unless you are a hyper-absorber). If you already have a TC/HDL-C ratio of 5, adding more dietary cholesterol doesn't seem like a very good idea. I agree that Peter Attia is just reguritating stuff he has read on the Internet. However, lipidologists like Dayspring, Cromwell and Dall seem like very well educated people with outstanding professional credentials and positions. I don't trust Chris Kresser especially since he just starting marketing his $149 cholesterol action plan.

    Please explain why you say the desired TC/HDL-C ratio is 5 whereas CM says 3. That is a big difference! Thanks.
    Last edited by Artbuc; 11-09-2012 at 02:12 AM.

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    Quote Originally Posted by Artbuc View Post
    Please explain why you say the desired TC/HDL-C ratio is 5 whereas CM says 3. That is a big difference! Thanks.
    I found this link which may answer my question - it is a matter of risk.

    Blood Cholesterol

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    Quote Originally Posted by Artbuc View Post
    How can you say CW is wrong to drive down TC if you agree that the ratio of TC/HDL-C is the best predictor of CVD?

    It's called math.

    If; TC=180 HDL=60

    180/60 = 3

    but; TC=250 HDL=100

    250/100 = 2.5

    So if your ratios are good then TC should not matter.


    Quote Originally Posted by Artbuc View Post
    Please explain why you say the desired TC/HDL-C ratio is 5 whereas CM says 3. That is a big difference! Thanks.
    Never was mentioned 5 is better than 3. It was mentioned that ratios matter more than the perception of "high" TC (see above as to why) In other words if you have a "high" TC of 250 your doc may want you on statins even though your ratios may be better that the CW of 3. Which we think is BS since people die of CVD even with low TC. This is why ratios are used. I think that is the point CM is trying to get across.

    Looking at the role of cholesteral plays I would say having high TC but a good ratio means your body is healing or has the capacity to heal rather than a degenerative state presented by a higher ratio.
    Last edited by chima_p; 11-11-2012 at 07:42 AM.

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    "It's called math."

    Hey wise guy, I would wager I have forgotten more about math than you will ever know. If you read my post, you would understand my point that HDL-C is very difficult to change whereas TC can be changed dramatically with statins.

    "Never was mentioned 5 is better than 3."

    Griff's primer, which is what I referred to, says 5 is "ideal". Masterjohn says 3 should be the target. I am just guessing here, but if Chris Masterjohn thought 5 was better than 3 he probably would have said so. My question remains, does 3 represent a lower risk of CVD than 5? If yes, I would say 5 is NOT ideal.

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    Quote Originally Posted by Artbuc View Post
    "It's called math."

    Hey wise guy, I would wager I have forgotten more about math than you will ever know. If you read my post, you would understand my point that HDL-C is very difficult to change whereas TC can be changed dramatically with statins.

    "Never was mentioned 5 is better than 3."

    Griff's primer, which is what I referred to, says 5 is "ideal". Masterjohn says 3 should be the target. I am just guessing here, but if Chris Masterjohn thought 5 was better than 3 he probably would have said so. My question remains, does 3 represent a lower risk of CVD than 5? If yes, I would say 5 is NOT ideal.
    HDL is not difficult to increase. Increased consumption of saturated fats will drive up both HDL and TC, with a reduction in the TC/HDL ratio. (LDL will also increase and TG decrease markedly if reducing carbs but the HDL increase will more than cancel the influence of the LDL increase on the ratio). As a maths savant I'm sure you can work this out.

    Low TC is associated with increased death from cancer, increased mental illness, increased injury and death from violence, ... It is also associated with chronic infection - see Paul Jaminet's blog for more on this
    Four years Primal with influences from Jaminet & Shanahan and a focus on being anti-inflammatory. Using Primal to treat CVD and prevent stents from blocking free of drugs.

    Eat creatures nose-to-tail (animal, fowl, fish, crustacea, molluscs), a large variety of vegetables (raw, cooked and fermented, including safe starches), dairy (cheese & yoghurt), occasional fruit, cocoa, turmeric & red wine

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    Quote Originally Posted by Forgotmylastusername View Post
    That's not entirely true. Jimmy moore has a large particle size yet his LDL-P is sky high. Granted he is following a very extreme diet with this "nutritional ketosis". I read Dayspring saying he may have to cut right back on his saturated fat content if things don't change.
    Right, so for the corner cases of people on 'extreme' diets, I don't think that the science is definitive with regards to discordant LDL-C and LDL-P. Peter Attia definitely thinks that LDL-P is the cause, but I am still agnostic. Given the underlying mechanism (small particles passing through the arterial wall that would normally not be able to fit between the gaps if they are normally sized, or large and puffy) I think that it's premature to write off small LDL particle size as being a factor in CVD.

    And LDL particle size is definitely something we know we can influence, by decreasing our Trig/HDL ratio.

    Quote Originally Posted by Artbuc View Post
    I have read your primer but not recently.
    Thanks, but I didn't write the primer. Griff did.

    Quote Originally Posted by Artbuc View Post
    I will re-read it today. How can you say CW is wrong to drive down TC if you agree that the ratio of TC/HDL-C is the best predictor of CVD?
    I don't think that TC/HDL is the best predictor of CVD. I think that the RATIOS are the key metrics to look at, not the absolute values. So it's ok for you TC to go up as long as your TC/HDL ratio goes in the right direction. Basically, TC is irrelevant as an isolated variable. It's the ratio that counts. And actually, I think that Trig/HDL is really the most important ratio to focus on.

    Quote Originally Posted by Artbuc View Post
    There isn't very much you can do to increase HDL-C but you can take statins to substantially reduce TC.
    Yes there is. Eat animal fats, particularly dairy. That will increase your HDL. And since HDL is the denominator in all three ratios, increasing HDL makes ALL of your ratios better.

    Quote Originally Posted by Artbuc View Post
    Also, I think it is wrong to tell people to eat as much dietary cholesterol as they want because only 15% gets absorbed (unless you are a hyper-absorber). If you already have a TC/HDL-C ratio of 5, adding more dietary cholesterol doesn't seem like a very good idea.
    You seem to think that Cholesterol is bad. It isn't. Cholesterol is very very good and is vital to our bodily functions. Oxidised particles in our arteries are likely to cause inflammation and from there, CVD. THAT is what you should focus on if you want to prevent heart attacks.

    Quote Originally Posted by Artbuc View Post
    I agree that Peter Attia is just reguritating stuff he has read on the Internet. However, lipidologists like Dayspring, Cromwell and Dall seem like very well educated people with outstanding professional credentials and positions. I don't trust Chris Kresser especially since he just starting marketing his $149 cholesterol action plan.
    I agree with you that it's a good idea to be suspicious of people who are very earnest about selling you things. But I have a lot of respect for Chris Kresser and the freely available articles of his I've read I thought were excellent. I'd be astonished if his paywall content was junk given the high quality of his free content.

    Quote Originally Posted by Artbuc View Post
    Please explain why you say the desired TC/HDL-C ratio is 5 whereas CM says 3. That is a big difference! Thanks.
    By 'you', I presume you mean Griff's primer? I would guess that both he and CM are basing it off recent research, although the primer is probably a bit more dated than CM. But really, the takeaway is that you want the ratio to be lower rather than higher. So you eat in a way that will lower the ratio.

    Quote Originally Posted by Artbuc View Post
    I said I am guessing my TC is up because I have dramatically increased dietary saturated fat. My assumption is, based on the experiences of others, that my TC is up disproportionately compared to my HDL-C
    I'm not sure that that is a reasonable assumption to make. Because saturated fats also increases HDL as well. If you are worried about it, why not get a test done? Then you will know what your ratios are.
    Last edited by magicmerl; 11-11-2012 at 02:03 PM.
    Disclaimer: I eat 'meat and vegetables' ala Primal, although I don't agree with the carb curve. I like Perfect Health Diet and WAPF Lactofermentation a lot.

    Griff's cholesterol primer
    5,000 Cal Fat <> 5,000 Cal Carbs
    Winterbike: What I eat every day is what other people eat to treat themselves.
    TQP: I find for me that nutrition is much more important than what I do in the gym.
    bloodorchid is always right

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