The Low Carb Luxury Newsletter: 
Volume III / Number 20: October 25, 2002: Page 7
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      Answering Mail
The Cholesterol Question
                                                                         "Never face facts
                                                                    If you do you'll never get up in the morning"

                                                                         Marlo Thomas

Dear Lora,

I have been low-carbing since January of 2002 and have lost 50 pounds. I have about 40 to go to be at my ideal weight. I love the diet and have more energy than I've had in a long time. I have osteo-arthritis and had a hip replacement almost two years ago at the age of 54. Low-carbing has let me lose weight (great for my arthritis) without hunger and without having to increase my exercise rate (I do water aerobics three times a week).

However, I do have a problem which I do not recall being addressed in any of the low-carb literature I have read. In September I went to the doctor for my yearly exam. I now have high cholesterol for the first time, which I can only attribute to this diet. Thankfully, my blood pressure has improved. It was borderline last year, and this year the nurse commented that I have the blood pressure of a 20-year-old.

Here are my stats:
  2001 2002
Cholesterol  217  295
Triglyceride   70   66
HDL   72   79
LDL  131  203
My HMO doctor suggested that I go back to the way I was eating last year and come back for another blood test in three months. I don't want to give up this way of eating. Any suggestions?


Hello Karen,

Thank you for taking the time to write and share your concerns, rather than just assuming your cholesterol levels should run you from this way of eating.

Let's look at this situation.

First, while your total cholesterol number has increased, two of your marker numbers have improved. Your Triglyceride levels have gone down, and triglyceride level is by far the strongest risk factor for heart disease. Recently, 17 studies involving over 46,000 men followed over 8 years and nearly 11,000 women followed over 11 years indicated that a small elevation of triglycerides led to a 32 percent increase in cardiovascular risk in men and 76 percent increased risk in women. These results clearly challenge the emphasis that has been placed on total cholesterol and LDL cholesterol.

And your HDL (high-density lipoprotein, also known as "good" cholesterol) has gone UP. Both very good signs of progress that should continue to improve.

Your concern here is your level of LDL (low-density lipoprotein). LDL is a carrier molecule that transports Cholesterol and Triglycerides in the blood from the liver to the body's cells. An elevated LDL can be a worry because it can indicate there is too much cholesterol in the blood. Although long considered the "bad" cholesterol, recent research indicates that some sub-fractions of LDL are actually heart protective.

All that said, the really important numbers are your ratios, not your total cholesterol. The ratio is obtained by dividing the HDL cholesterol level into the total cholesterol. The goal (according to the American Heart Association) is to keep the ratio below 5:1; the optimum ratio is 3.5:1.

Your ration is currently 3.7:1.

Now, to get your LDL further in line, let me suggest that if you ARE taking in transfats on a daily basis (known to raise LDL and often triglycerides as well), that you try to cut them out completely. That means using butter, lard, and cold pressed or expeller pressed oils and no shortening, margarines, or products whose labels claim "partially hydrogenated" oils.

Increasing your fiber can also help to bring cholesterol levels back in line.

However, going back to your old ways of eating can do more harm than good. Carbohydrates — especially sugars — raise LDL and triglycerides, and lower HDL levels. Eating dietary cholesterol has little if any effect on serum cholesterol levels.

A team of researchers at Duke University Medical Center has conducted an ongoing weight-loss study that entailed monitoring 50 subjects who were following the Atkins plan. The results, published in the peer-review American Journal of Medicine, suggest that the Atkins plan is not only effective in weight loss and management, but manifests significant improvement in a number of cardiovascular disease risk factors.

The study compared the controlled carbohydrate Atkins plan to the American Heart Association diet advocated by many health professionals for cardiovascular health. Each were on their plan for a 6-month period.

In each part of the study, 60 subjects were monitored for clinical values, side effects, body composition and bone-mineral density. Food records provided measures of caloric intake as well as carbohydrate, protein and fat intake. This comparative study demonstrated that subjects on a controlled carbohydrate eating program lost both more weight and more body fat than subjects following a low-fat diet. In addition, those subjects controlling their carbohydrate intake showed a decrease in triglycerides and total cholesterol as well as an increase in HDL ("good") cholesterol levels.

To be specific, the Atkins followers showed the following results regarding cholesterol levels:

Total cholesterol level decreased by 11mg/dL; low-density lipoprotein cholesterol level decreased significantly by 10 mg/dL; triglyceride level decreased with a high level of significance by 56 mg/dL; high-density lipoprotein (HDL) cholesterol level increased significantly by 10 mg/dL; and the cholesterol/HDL cholesterol ratio was also significantly decreased by 0.9 units.

The long-term Harvard Nurses' Health Study further backs this up. More than 75,000 women aged 38 to 63 with no cardiovascular diseases were monitored for a decade. Using food-frequency questionnaires, researchers found that the higher a woman's intake of foods with a higher glycemic index, the higher the risk of coronary heart disease.

I hope this helps put things into perspective a bit more. And congratulations on the outstanding weight loss success, renewed energy levels, and normalized blood pressure. I know just how wonderful it feels to have all those benefits!

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