Should You Be Concerned About Your Cholesterol Numbers?

"Cholesterol" is one of the big things people think about when evaluating their health.  It's been drummed into our consciousness.   (Largely by the drug companies who want to sell us drugs to lower our cholesterol).    This despite the fact that most people can't really tell you what exactly "cholesterol" is.   We are told things like "heart disease is the number one killer"...  We all have "ticking time bombs" inside, "heart attacks waiting to happen".

Standing around the water cooler, the subject might come up.   What's your cholesterol?   Umm... kind of high....  220.    Uh-oh.   Better do something about that!    What's yours? .... 165.    Hey!   That's great!  How do you stay so healthy?  How about you?  Umm..  265.   OMG!  We better call 9-1-1 right now!

What if I told you there is no correlation between total cholesterol and heart disease?  Hogwash, you would say.    You must be reading some "alternative" (i.e. "quack") website.   After all, anyone can put anything on the internets.  Just because you saw it does not mean it's true.

First, let me show you a couple charts.  The first shows a "risk vs. total cholesterol" for a 60 year old non-smoking male:

What???  A chart showing that total cholesterol does not matter?  What a bunch of crap!.   Which quack website did that come from?  Well, what if I told you this data came from the National Institute of Health?   Yes, the "N.I.H."...  The US Government!   Certainly that's about as far away from "quackery" as you can get, right.   (Well, that's "a whole 'nother subject", better leave that alone for now.)    The chart above came from entering numbers into this calculator.  Ok, what is the catch?   Well when I entered the numbers, I assumed a constant Total Cholesterol / HDL Cholesterol ratio of 2.5 to 1.   So, the low end point of 150 total cholesterol has an HDL of 60, while the high end point of 250 total cholesterol has an HDL of 100.  (Not out of the question... my own HDL has been as high as 99, and my ratio has been as low as 2.7.  So in other words, it's entierely possible for two people, one with a total cholesterol of 150 and the other with a total cholesterol of 250, to have the same heart disease risk, if as they have the same Total/HDL ratio.

Now let's look at another chart.  This one also shows CHD risk for the same 60 year old non-smoking male, but this one shows all points having at total cholesterol of 250:

The difference?  All of the points on this chart are for a person with a total cholesterol of 250.  However, they have differing HDL values, hence different Total/HDL ratios.   The point on the far left would be an HDL of 100 (actually same data as the far right point in graph #1) while the far right point has an HDL of only 44.   A range of 44 to 100 for HDL is not unreasonable for the general population.

So what's the message?  Should you be concerned about your "total cholesterol" number?  Probably not!   Should you be concerned about your Total/HDL ratio?  Yes!    Should you try to decrease your total cholesterol number?  Not if your HDL goes down too!

So here's what's crazy...  Look at these recommendations from the Mayo Clinic.    "Total Cholesterol" is the first thing on the list.   The recommendation is to be below 200, with 200-239 being "borderline" and 240 and over being "high".    But do you see any reference to Total/HDL ratio?   I don't either.   My own former doctor suffered from this same blind spot.  He would look at my lab results (total cholesterol is usually about 230) and immediately try to "put me on" as statin drug.   Once he even did this when my HDL result was 99!     A visit to this doctor sometimes seemed detrimental to my health, as my blood pressure would increase in anticipation of the debate we were about to have!

In my case, I find it much easier to increase my HDL thru "diet and execise" than decrease my total colesterol.   So what steps can accomplish this?   That's for another post.

"A Calorie is a Calorie"... Yes or No?

Everybody understands the concept of "calories in - calories out"...  We eat a certain amount of food, and whatever does not get "burned" gets "stored"...  as fat.   It makes intuitive sense.  We can easily understand analogies from our experience.   If I earn $1000 per week and only spend $900, my bank account will grow.  If I bring home 10 bags of groceries every week and only eat 9 bags, my home will fill up with groceries. 

Regular people like you and me, as well as "experts", professionals, and other pundits, invoke this analogy all the time.  I have been known to say it myself.  "Calories in / calories out"...  To lose calories, you must either "eat less or burn more".   End of story!  Being an engineer, I'm familiar with the laws of thermodynamics.  The first law of thermodyanmics is the law of "conservation of energy".   This means that any excess food you eat cannot vanish into thin air, therefore, it must be stored as fat.  And if you don't eat enough calories, your body cannot create them out of thin air, and you will lose fat.  But... is that really the "end of the story"?

Let's say we subscribe to the "calories in / calories out / end of story" theory.  Let's consider another analogy.  Down the road from me is Michigan Stadium, home of the Michigan Wolverines, where on Saturdays in the fall there are typically about 115,000 people shoehorned into the bleachers to watch a football game.    Down the road a few miles to the east, is Rynearson Stadium, home of the Eastern Michigan University Eagles.  This stadium is also hosting a game, but the spectators are few and there are plenty of extra seats.  You might ask, why are there so many people in Michigan Stadium?  Simple...  it's just a matter of people in / people out!   More people entered the stadium than exited.   True enough, but why did they enter and not leave?   And why didn't the same thing happen at Eastern Michigan University?  Clearly, "people in / people out" does not answer all the questions.  Just like calories in / calories out does not fully explain weight control.

One milestone in this discussion was the publication of "Good Calories, Bad Calories" by Gary Taubes in 2007.  Here is Taubes' explanation in a nutshell:  Our food-burning, energy-producing, fat-storing metabolism is complex.  Foods affect our bodies in different ways and are processed through different metabolic pathways. Not only that, but the foods we eat can directly affect the hormones that regulate when and how much we eat, as well as what our body does with those foods.  The most important of these hormones being insulin.  How the body processes its food intake is strongly dependent on insulin.

Consider another analogy - the automobile and its fuel tank.  Imagine that there is a tiny valve somewhere in the car that directs a cupful of gas of each tank to a "reserve tank"?   This reserve tank is available to be used by the car, but not easily.  The tiny valve sometimes opens to let gas into the reserve tank, but does not often open to let gas out of the reserve tank.  And this reserve tank is separate the main tank.  So when the main tank is empty, the fuel gauge says "fill me", even though there is plenty of gas on board in the reserve tank.   And so the reserve tank gets larger and larger, filling up the trunk, the roof top carrier, the u-Haul trailer, etc.  

There is such a reserve tank on the human body - the fat cells.  And, it turns out there is exactly such a "valve" on the human body... over the course of time, an abundance of insulin directs the body to store an inordinate amount of reserve energy in fat cells.  And the insulin makes it difficult for the body to access this fat, so we feel hungry.  Instead of using the fat, we do what comes naturally when hungry, we eat! 

What causes excess insulin?   Long-term consumption of carbohydrates!  So we have a vicious cycle.   Eating carbohydrates increases blood sugar, causing the body to produce insulin, which directs the body to store excess energy as fat, and makes it hard to burn the stored fat.  This makes us hungry.  What do we do?  Eat more carbohydrates.  And the cycle is repeated.  That is explained briefly in this video segment from the film "Fat Head" Tom Naughton:

By the way, Fat Head is an excellent documentary and tells the whole story.  If you have the time, I recommend you watch the whole thing!  It's free on Hulu.

So, in conclusion...  A Calorie is a Calorie... Yes?  or  No?    Actually, both yes and no.  On one hand, yes, if you eat more calories than you expend, the excess calories will be stored as fat.  There is no getting around it.   If you want to lose body fat, you must eat less than you expend.

On the other hand, they type of food you eat does affect what your body does with its calories.  If you eat a high carbohydrate diet over a long period of time, your body (thanks to lots of insulin) will develop the tendency to store lots of fat, whether it needs to or not, and lock that fat up, making it difficult to burn.

So what does this mean?   Can you eat all the bacon and steak you want and still lose body fat?  No.  On the other hand, can you eat a high carbohydrate diet, large servings of pasta and "healthy whole grains", as instructed by the USDA "Food Pyramid"...  (now superseded by "My Plate") and expect to lose body fat?  No!  And the evidence suggests that you will feel hungrier and eat more when eating a high-carbohydrate diet.

Does it work?  In my case, I would have to say yes.  In the past it seems like my weight would drift up over the years, as if there were a "set-point" it was aiming for.   If I was not watching carefully, "counting calories" my weight would constantly creep up.  I was able to reduce my weight by about 25 pounds over the course of a several years by "counting calories".  This was from 1995 to about 2003.  Then I quit paying attention, and all 25 pounds came back over the next three years.  Back up to the "set point".  So I worked at it again and lost the weight again.  For the last three years I have been able to maintain the reduced weight, about 25 pounds below the maximum, without "counting calories" or consciously eating less.   I just cut out the sugar, sweets, and the a great deal of the carbohydrates, while increasing fats and proteins.   (It is important to eat the "right" fats.  More on that in a future post.)

So if you are following the USDA's advice, and eating lots of whole wheat pasta and other "healthy whole grains" and lots of "low fat" foods, and yet the pounds keep creeping up, perhaps you need to cut back on the carbohydrates and increase your fat and protein intake. But wait! Isn't the high-carb, low-fat diet also known as the "heart-healthy" diet?   Won't we "plug up our arteries" eating "artery-clogging saturated fat"?   Shouldn't we be eating lots of "healthy whole grains"?  Surprisingly, the answer is "no"!  More on that in a future post! 

First, Eat No Sugar

The quantity of nutritional advice available is immense.    Adkins, Paleo, vegan, South Beach, low-fat,  Macrobiotic, low-carb, “healthy whole grains”, gluten-free, “fruits and vegetables”, Jenny Craig, “raw food”,  Ornish,  ….you name it!    Often, one can find two or more pundits, each recommending a “healthy diet”, yet directly contradicting each other.   One must study the evidence and choose what he or she thinks is the most helpful. 

One trap that seems easy to fall into is to change one’s nutritional plan daily depending on what one wants to eat.  Feel like a pizza or an enormous bowl of spaghetti?    Sure, let’s just say today will be a “healthy whole grain” day…  (just make sure to order “whole wheat” pizza or pasta!).    The next day, do you feel like having a king-sized cut of prime rib?   No problem, we’ll just designate this to be a “low-carb” day.    Just don’t order the baked potato with that prime rib!    Next day, how about “low fat”?   Start with a bowl of Rice Krispies, (low-fat… be sure to use skim milk!), for lunch, a giant salad with “low-fat” salad dressing, and for dinner the ubiquitous “boneless, skinless chicken breast”  and some steamed vegetables (without butter of course… we are “low-fat” today!) .   Add a stack of “low-fat” or “fat-free” cookies for dessert.  Next day, let’s go vegan.   Tons of fruits, beans, salads, tall glass of orange juice, piles of white rice, PB&J sandwich on Wonder Bread, and a big slice of apple pie for dessert…the choices are many!   So you see the point.  Pretty much everything we want to eat fits into some nutritional plan.   So in total, we end up eating pretty much anything we want.    Except….

Sugar!

While there is great conflict among the various nutritional camps, you will be hard-pressed to find anyone who says it’s OK to eat large amounts of sugar.    It’s something they all apparently can agree on!

I am reminded of one of the guiding principles for doctors, “Primum non nocere” which means “First, do no harm”.   So I suggest a good motto for us would be “First, eat no sugar”.    (As far as I can determine, the Romans did not have a word for “sugar” (good for them!) so I won’t bother trying to translate this into a cool-sounding Latin phrase.  (I’m reminded of “Semper ubi sub ubi” and “Illegitimi non carborundum”, but I digress.)

Now, some qualification is in order.  You are probably thinking, “Hey, fruits are loaded with sugar, does that mean I shouldn’t eat all those healthy fruits?”   No, I think it’s OK to eat, in moderation, fruits that contain sugar.  So let’s modify that catchphrase to “First, eat no added sugar”.   It does not sound as cool or all-encompassing, but in this form it is something that can really be done, and your diet will be much better off for it.
   
First, let’s look at a couple of foods that just should not exist.   The first one, in my opinion, is soda pop.  There is absolutely nothing good about it.  Nutritionally, it’s just sugar water.  The same is true, or nearly true, for drinks like kool-aid, lemonade, Hawaiian Punch, and other “fruit juice drinks”.   Sports drinks add “electrolytes” but they are loaded with sugar too.

Actual fruit juices, while often considered “healthful” choices, are, in fact, not much better.  Yes, they sometimes contain vitamins and other nutrients, but with the solid portion of the fruit removed, you take in much more juice (and therefore much more sugar) than you would have if you sat down and ate the actual fruit.  How many oranges did it take to make that tall glass of orange juice you had for breakfast?   My guess is way more than you’ve ever eaten in one sitting.  And you miss out on any nutrients contained in the solid portion of the fruit, and also the fiber.

In the next category are foods that have so much added sugar, that it probably would be best to avoid them completely.   In this category I am thinking of dessert type items like pies and cakes, cookies, donuts, candy, etc.   In other words, “sweets”.   Fortunately, I do not have a “sweet tooth” and it’s easy for me to “just say no” to these things.   If you do  have a "sweet tooth", I have read that it diminishes over time if you discontinue feeding it.

Now let’s look at the large number of foods that might contain added sugar, in some cases where you least expect it.  Many if not most of these contain added sugar for one reason –to entice the customer to eat large quantities of it, prefer the taste to other brands, and buy more.    This is where you can make some real changes that will help you in the long run.  Look at the ingredients, and buy “real food”.

As you probably know, “sugar” can take many forms in the ingredient list.    Some examples are as follows:

Agave Nectar, Barley Malt Syrup,  Beet Sugar, Brown Rice Syrup, Brown Sugar,  Cane Crystals, Coconut Sugar, Coconut Palm Sugar, Corn sweetener, Corn syrup, corn syrup solids, Dehydrated Cane Juice,    Dextrin,  Dextrose, Evaporated Cane Juice,  Fructose,  Fruit juice concentrate, Glucose, High-fructose corn syrup, Honey, Invert sugar, Lactose, Maltodextrin, Malt syrup, Maltose, Maple syrup, Molasses,    Palm Sugar, Raw sugar, Rice Syrup, Saccharose, Sorghum, Sorghum syrup,  Sucrose, Syrup, Treacle,    Turbinado Sugar, or  Xylose.

Foods likely to contain these substances include breakfast cereals (pre-sweetened and non pre-sweetened), canned soups, ketchup, barbeque sauce, pasta sauce, salad dressings, many brands of peanut butter (believe it or not!), snack foods, frozen dinners, and yogurt (except for “plain” yogurt), just to name a few.

Two comments:

1. You’ve probably heard the advice to “shop the outer perimeter” at the grocery store and avoid the center aisles, where the processed foods are.   Note that the list above contains foods that are, for the most part, in the center of the store.    It is quite possible to reduce greatly the amount of food you buy from the center aisles.  Just don’t go there.
2. In many cases, you can buy healthy brands of the above items that do not contain added sugar.  For example, there are healthy brands of pasta, peanut butter (the only ingredient really needed is peanuts), and soups available.  Ketchup and barbeque sauce are two items we have not found a healthy alternative for.

As an example, consider a this jar of “Jif Reduced Fat” peanut butter that is advertised as a healthy choice.  (Reducing the fat is suspect in itself, but that is for another post).    One look at the ingredient list shows this is not a healthy choice at all!

Ingredients: PEANUTS, CORN SYRUP SOLIDS, SUGAR, PEA PROTEIN, CONTAINS 2% OR LESS OF: SALT, FULLY HYDROGENATED VEGETABLE OILS (RAPESEED AND SOYBEAN), MONO AND DIGLYCERIDES, MOLASSES, MAGNESIUM OXIDE, NIACINAMIDE, FERRIC ORTHOPHOSPHATE, ZINC OXIDE, COPPER SULFATE, FOLIC ACID, PYRIDOXINE HYDROCHLORIDE.

Blecchh!   Three different added sugars!?  “Pea Protein”?  What is that and why is it needed?  Fully Hydrogenated Vegetable Oils?  (AKA Trans-Fats!).   Why are those needed?   And the rest of the items are chemicals that most of us have no clue as to what they are and what they do.  (OK, MrsWW says some of the chemicals are synthetic vitamins.  I hope they are recognized by the body as such.)

I think most people eat peanut butter along with something sweet… such as in a PB&J sandwich, peanut butter cookies, or spread on fruit, such as apples.   Yet it appears that this product is adulterated in such a way that they are trying to get people to scoop it out into a bowl and eat the whole bottle straight!

Now, compare that to this peanut butter from Krema…  Ingredients: PEANUTS.  That’s it!  We have tried this brand and it tastes great.  You can also toss a bunch of peanuts into a food processor and make your own!

So, once we have stopped eating the sugar, what to do next about the myriad of dietary choices, as mentioned at the beginning of this post?   Stay Tuned.

Another Blog??

OK, I've decided to join the blogging world.   Why?  With everything else out there in the "blogosphere", you might wonder, why another is needed.

It's going to be mostly a "Food" blog.  I certainly can't compete with (to give a few examples), The Food Babe, The Naughty Nutritionist, Empowered Sustenance, or Kelly the Kitchen Kop.    Especially since they have a photo of themselves on their blogs.

Thanks to the lovely MrsWW, we have learned an awful lot.   She puts in the hours of research, and has good "reading comprehension".   If it were not for her, I would still be eating trans-fat laden margarine, eating large quantities of pasta, making air-popped popcorn, and looking for "low-fat" foods, thinking I was making healthy choices.  The same goes for our wonderful friends who are always one step ahead of us in these things.

So I thought I would start writing things down "all in one place", kind of a "note to self".  That way, if nobody else but me reads this, it still has a purpose.   Secondly, we do from time to time get questions like "what are you doing about (insert nutrition-related topic here)?  So there is another reason to put things "all in one place".    Of course, it's going to be a long time before "all of it" gets written about.

If you do read it and find it enjoyable, interesting, or useful, so much the better!