The Migraine Miracle - your pill free path to headache freedom
04
NOV
2017

5 Common Myths About Cholesterol (Migraine Miracle Moment)

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In this episode of The Miracle Moment, I discuss the crucial connection between carbohydrates and migraines.

The Miracle Moment: 5 Myths About Cholesterol

The Miracle Moment: “5 Myths About Cholesterol”Few things are more misunderstood than the relationship between fat and cholesterol in the diet and our risk of cardiovascular disease, and the interpretation of cholesterol blood tests. In this episode of the Miracle Moment, Dr. T reviews 5 common myths about cholesterol. Please share with anyone you think would benefit from this discussion.Links mentioned:MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom (including the new Beastslayer Training Academy): mymigrainemiracle.com/endofmigraineDOWNLOAD THE GUIDE TO GETTING STARTED at beastslayers.com PRIMAL PROVISIONS, our Migraine Miracle meal planning service: mymigrainemiracle.com/primalprovisions PRIMAL PROVISIONS Pick of the Week – Sloppy Joe's: mymigrainemiracle.com/sloppyjoeMigraine Miracle Facebook group: https://www.facebook.com/groups/899131986822364The book that started it all – The Migraine Miracle: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751ARTICLES AND STUDIES Mentioned:TG:HDL as most useful number in standard lipid panel:Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? American Journal of Cardiology. https://www.ncbi.nlm.nih.gov/pubmed/16054467 Study of the use of lipid panels as a marker of insulin resistance to determine cardiovascular risk. The Permanente Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625988/Negligible effect of dietary cholesterol on blood cholesterol:Cholesterol intake and plasma cholesterol: an update. Journal of the American College of Nutrition. https://www.ncbi.nlm.nih.gov/pubmed/9430080Low cholesterol associated with higher mortality:Low cholesterol is associated with mortality from stroke, heart disease, and cancer: The Jichi Medical School Cohort Study. Journal of Epidemiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899519/US Population eating less fat, more carbs since dietary guidelines came out: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htmFull archive of Miracle Moment episodes can be found at mymigrainemiracle.com/moment

Posted by The Migraine Miracle on Thursday, October 26, 2017

EPISODE TRANSCRIPT

[00:00:01] Howdy everyone. Welcome to the Migraine Miracle Moment. [3.1]

[00:00:05] I’m your host Dr. Josh Turknett. I’m a neurologist, migraine specialist, and author of the book The Migraine Miracle and a migraine sufferer myself, and the mission of this show, The Miracle Moment is to help you find your path to migraine freedom without pills. [16.4]

[00:00:21] So in this episode I’m going to be covering 5 MYTHS ABOUT CHOLESTEROL. [4.7]

[00:00:27] This is a subject with an incredible amount of confusion and misinformation, largely because the prevailing story of cholesterol that was around for many many years is one that we now know to be wrong. And that confusion includes misunderstanding about the cholesterol blood tests and what numbers are actually worth caring about, and what they mean. [24.9]

[00:00:52] And so one of the things I’ll be doing in this episode is sharing with you what those tests actually mean, along with the one test on the standard cholesterol panel that’s actually worth paying attention to. [12.0]

[00:01:05] Now some of you may be wondering why I’m covering cholesterol on a show about migraines, and in particular when we’re still kind of covering the foundations of the Migraine Miracle plan. [12.8]

[00:01:19] And one reason for that is because I get a lot of questions on this topic, and so I thought this would be a good way to address a number of them in one fell swoop. [9.4]

[00:01:29] And the other is because this is one of those areas where folks who are putting the Migraine Miracle plan into action might get derailed by well-meaning friends and family and even health care providers moving from the traditional Western diet to one that’s fit for a human usually means a significant reduction in carbohydrate intake, and a rise in dietary fat intake. [25.5]

[00:01:55] And thanks to all the confusion about fat and cholesterol including what blood cholesterol testing actually means this may lead others to worry about your fat intake or your cholesterol levels, or you yourself may still worry about it as well in the back of your mind. [16.5]

[00:02:12] After all, a lifetime of indoctrination doesn’t just vanish overnight. [3.8]

[00:02:16] In fact, if you have friends and family who could benefit from a better understanding of what actually matters when it comes to fat and cholesterol and cholesterol testing. this will be a great episode to share with them. [12.5]

[00:02:29] So feel free to share away. What I’m going to cover here is really important stuff, and much of it is still not common knowledge. [8.1]

[00:02:38] But before we dig into the nitty gritty of cholesterol, let’s first celebrate our BEAST SLAYER of the WEEK. [5.5]

[00:02:44] So in each episode of The Miracle Moment we highlight somebody in our migraine miracle community who recently dealt a mighty blow to the beast. And this week our Beast Slayer is Kip. [12.0]

[00:02:57] So I’m going to read a comment that Kip posted a little while back on our Facebook page inside of our group that we have for our Migrai-Neverland members. [14.1]

[00:03:11] And he writes: “Some awesome news to report. I started this diet a year ago and saw incredible improvements in going from two to three migraines a week to one a week which was usually caused by going off to mimic the migraine miracle plan. [12.8]

[00:03:25] “The last few months I have been at one or two a month and again usually I can point my going off plan to the migraine return. My biggest concern in changing my diet to a low grade ketogenic diet was my long term health when I began this a year ago. [14.4]

[00:03:39] “I was 42 and about 10 to 15 pounds above my ideal weight. About 25 percent body fat. I was in pretty good shape but my cholesterol numbers numbers were really bad being on the standard American diet. [12.2]

[00:03:52] “My doctor was giving me one more year before I had to start a statin drug. [3.9]

[00:03:57] “Well, just got my physical done at the Mayo Clinic and all my bloodwork and stats are PERFECT. I am down about T 15 POUNDS and my body fat dropped to almost 17 percent. [9.7]

[00:04:07] “Here is the most amazing part – my cholesterol dropped ALMOST 100 POINTS to an acceptable range. This is the first time in my adult life I have had acceptable cholesterol. [9.7]

[00:04:17] “My Mayo Clinic said whatever you are doing keep doing it. What I do is simply this follow Dr T’s plan. I keep my macros in the 60 to 70 percent fat range 20 percent protein and the rest carbs, which I try to get only from plants and nuts. [15.4]

[00:04:33] “No sugar and no gluten. I was so pumped when I walked out of that doctor’s appointment. If I can do this anyone can trust me on that.” So I chose Kip as our Beast Slayer in part because his comments clearly relate to our topic of discussion today, and in those comments he gives voice to what many people may worry about, which is what will happen to their cholesterol levels. [21.8]

[00:04:55] And more importantly their risk of cardiovascular disease if they increase the fat in their diet. The answer to that, which we review today, may surprise you, as it did Kip. [10.0]

[00:05:06] So thank you for sharing your story with us. I can talk all I want about the science behind diet and cholesterol, and why so much of what we’ve been told is wrong, but there’s really no substitute for hearing the story of someone who’s gone down the same path and is having great results, not just with their migraines but with other markers of health. [17.9]

[00:05:24] As I’ve said before, the MIGRAINE MIRACLE PLAN isn’t just how I eat to keep the beast away. I also eat this way, and I actually started eating this wayM because it affords me the best chance of a life well lived, free of the chronic diseases that are so common now. [13.8]

[00:05:39] And that includes minimizing my risk of cardiovascular disease, which is why we started caring about cholesterol in the first place. [7.7]

[00:05:47] So to read other success stories and to download the guide to getting started with the Migraine Miracle plan you can head over to beastslayers.com. [8.1]

[00:05:56] And to learn more about Migrai-Neverland, our premier resource for migraine sufferers, which now includes the recently completed Beast Slayer Training Academy, head over to mymigrainemiracle.com/endofmigraine. [12.7]

[00:06:09] All right so now let’s bust some cholesterol myths. [6.0]

[00:06:15] So if we were to look back at any point in history to determine the moment that things started going south with respect to the health of the western population, it would be around the mid-twentieth century, which was when a dietary fat and cholesterol were hypothesized to be the cause of heart disease. [16.7]

[00:06:33] And I won’t go into too many of the historical details, but basically what happened was that scientists who was studying cardiovascular disease had a hypothesis based on some animal studies that high cholesterol caused the plaques that lead to cardiovascular disease, which we also sometimes referred to as hardening of the arteries. [18.4]

[00:06:52] And furthermore, the hypothesis was that high cholesterol in the blood was due to fat and cholesterol in the diet. [7.1]

[00:06:59] So the basic idea was that you eat more fat and more cholesterol, you end up having higher cholesterol in the blood. And that ends up clogging your arteries with plaque, which ultimately is what causes things like heart attacks and strokes. [13.1]

[00:07:13] And this is a very important point to remember as we talk about cholesterol, which is that the whole reason we started reducing fat in the diet and caring about cholesterol in the first place was to reduce the chances of plaque build up in our arteries. [14.3]

[00:07:28] And this hypothesis was never proven, and was actually quite controversial even when it was first introduced, and we now know that it’s wrong. But unfortunately it ended up making its way into dietary guidelines prematurely and has profoundly impacted how people have eaten and how people think about what foods are healthy. [20.9]

[00:07:50] Incidentally, if you want a really great overview of the story of how this all happened the book Good Calories Bad Calories by Gary Taubes covers it really well. [9.9]

[00:08:00] So ultimately this cholesterol hypothesis and the guidelines that sprang from it led to people cutting out fat from their diets and animal fat in particular, and then increasing their consumption of carbohydrates and the proliferation of an entire industry of low fat Frankenfoods that were laden with sugar. [19.5]

[00:08:21] And it also led to the rise in the consumption of vegetable and seed oils which were branded as heart healthy, and which studies have now shown up actually make us more likely to have heart disease. [11.5]

[00:08:33] And it also led to the dangerous and destructive notion that sugar was nothing more than a harmless empty calorie. [6.5]

[00:08:40] So in other words it led people to do more of the very behaviors that we now know to be the things that actually DO lead to heart disease and obesity and diabetes and not to mention migraines. So altogether it led to the decades long epidemic of diabetes, obesity, and metabolic syndrome, and the growing health care crisis that we now find ourselves in as we try to care for a population that’s sicker than ever from preventable illnesses. [26.6]

[00:09:07] And now if the fat and cholesterol causes heart disease hypothesis were correct, then all these changes should have led to us all becoming healthier. That of course is not at all what happened. [10.8]

[00:09:18] And it wasn’t because people didn’t listen to those recommendations. They did. All in all, over the past half century or so in the U.S. we’ve reduced our total fat intake. We’ve increased the proportion of fat that comes from vegetables and have increased carbohydrate intake, all the things that the guidelines said we were supposed to do to make us healthier. [20.2]

[00:09:39] Yet we’re UN-healthier than ever. [1.6]

[00:09:41] And wrapped up in all of this misinformation is the issue of cholesterol. Fat was said to be bad because it increased cholesterol in the blood and that high cholesterol is what clogged arteries. [11.3]

[00:09:53] Now this is entirely untrue. [1.4]

[00:09:55] In fact, nobody who does research in this field believes this to be true anymore. Yet, most people, even many doctors, are still operating as if this high cholesterol in the blood clogged arteries is true. [11.7]

[00:10:07] Unfortunately, all of this is kind of like someone once hypothesizing that eating cardboard would protect us from heart attacks. And so everyone started recommending people eat cardboard before anyone actually proved that was true. [11.6]

[00:10:19] And then an entire industry grew around eating cardboard, and then parents began telling their children that cardboard was health food, and so it became to a point where everyone just saw it as an inherent truth about the world. [11.1]

[00:10:30] And then one day a few people started questioning this conventional wisdom saying it made no sense, cardboard isn’t really human food. And they noticed that eating cardboard was actually making people sicker, but they were in a strange position of having to prove to the rest of the population that cardboard wasn’t actually good for you, despite the fact that it was an absurd thing to believe in the first place. [19.9]

[00:10:51] And so this idea that fat and cholesterol in the diet clogs the arteries has been one of the most enduring and intractable myths, probably for a number of reasons. And not surprisingly, even though on some level many people now realize that a diet that’s high in carbohydrates, especially refined carbs, is unhealthy, people still worry about clogged arteries if they start eating more fat and cholesterol. [24.9]

[00:11:17] And the reason this is relevant to the migraineur is that reverting to a diet that’s appropriate for a human means ditching the typical inflammatory high carbohydrate, low fat diet that was recommended for so long, and adding unhealthy fats from things like butter, olive oil, coconut oil, lard, tallow – things which have been long demonized in this catastrophic great fat scare that we’ve been in. [22.8]

[00:11:40] So it’s critically important to understand these things, not just so you can win the battle against the beast, but so you can protect yourself from misinformation that would lead you to do things that would increase your risk of chronic disease. [11.7]

[00:11:53] In my opinion, the greatest tragedy of the Great Fat Scare has been that people made sacrifices to do things they thought were healthy, like eating tasteless low fat foods, which ended up making them sicker. [11.7]

[00:12:05] And if we’re going to make decisions in the name of better health, it’s critical that we have quality information to base those decisions on. [6.7]

[00:12:12] So with all that in mind to help us frame how we got to this strange place, I’m going to now cover 5 myths about cholesterol in hopes of providing a more accurate understanding of what really matters in this area hen it comes to the food we eat, and in the interpretation of cholesterol testing. [18.6]

[00:12:32] And honestly this could be a 40 hour long episode, but I’ll try to keep it to the highlights here. [4.9]

[00:12:37] So let’s get to our first myth. So myth number one is that cholesterol is bad because it clogs the arteries. [7.8]

[00:12:46] And the truth is that cholesterol is vital to health. [3.9]

[00:12:50] So cholesterol is one of the most important molecules in the human body, and cholesterol and fat are absolutely vital to brain function and for brain development, meaning it’s especially important for kids to have enough of it. [12.7]

[00:13:03] The brain itself is 60 percent fat, and a quarter of that is cholesterol. [5.4]

[00:13:09] Breast milk, the only source of nutrition that a developing baby needs, is chock full of fat and cholesterol in order to support the needs of a developing brain. [9.8]

[00:13:20] And then cholesterol is also necessary for the production of several hormones. [3.6]

[00:13:24] So in the end, without cholesterol you die, which means that if you’re going to give a patient medications that block the production of cholesterol, a vital molecule and disrupts the finely tuned systems for regulating this vital substance, then you must be absolutely certain it’s the right thing to do, and you should have complete knowledge of the impact of that intervention. [21.0]

[00:13:46] Now remember the only reason any of us now thinks of cholesterol is anything but a vital, life giving molecule, is because it was once thought that cholesterol in the blood caused the buildup of plaque in the arteries. [12.4]

[00:13:59] We now know a heck of a lot more about how plaques actually form in the arteries than we did when this hypothesis was first made, and we know that it’s not high cholesterol in the blood that drives plaque formation. [12.0]

[00:14:11] It’s not cholesterol but the particles that carry cholesterol in the blood, and a particular kind of particle at that that are the instigators of the process that leads to plaque build up in the arteries. I’ll cover this a bit more in a minute. [13.4]

[00:14:25] Our second myth is that high total cholesterol in the blood is bad. [4.2]

[00:14:30] And the truth is that high total cholesterol is not a useful marker of cardiovascular disease risk. [6.0]

[00:14:36] Now I just mentioned that cholesterol in the blood is not the cause of plaque buildup, but rather cholesterol carrying particles. So that alone means blood cholesterol is not really the test we should care about if we’re trying to assess cardiovascular disease risk. [14.0]

[00:14:51] But what’s also really important to know is that the risk curve when it comes to blood cholesterol is U-shaped, and here’s what I mean by that. [10.3]

[00:15:01] So here’s some data from one of the biggest studies on cholesterol, where it tracked 12000 patients in Japan over the course of 12 years. So the graph on the left is the one for men which has four different bars. [15.9]

[00:15:18] And the one on the right is the one for women. And so on the x axis you have cholesterol levels, and on the y axis you have the all cause mortality risk. [11.7]

[00:15:30] And you’ll note here, which is noted with the orange arrow, that for men, those with the highest mortality were the ones with the lowest cholesterol, and the ones with the highest cholesterol which was that skinny little bar on the end. [13.8]

[00:15:45] So people with less than 160 millimoles per liter of total cholesterol had the highest mortality risk and then second to that was people over 240 at the very highest range. [12.2]

[00:15:58] And so if you were to plot this graph as a line it would resemble the letter U, with your highest risk being on the edges of the ends of the lowest and the highest. [9.7]

[00:16:08] Which is why we would call it a “U-shaped” risk curve. [3.1]

[00:16:11] But also note here that for women, by far the highest mortality rates were in women who had the LOWEST cholesterol levels of less than 160. And as cholesterol levels in the blood went up, mortality rates went DOWN. [14.5]

[00:16:26] So there is evidence of an association at least between the highest blood cholesterol levels and mortality risk, at least in men. But whether or not those higher readings actually reflect an increase in cardiovascular risk has everything to do with why that cholesterol is up, because it could be high for any number of reasons. [20.1]

[00:16:47] And some of those reasons are actually things you want. [2.3]

[00:16:50] So in other words nobody should ever be basing treatment decisions on total cholesterol because, number one, it’s not what actually matters when it comes to the the physiology of plaque build up. [10.6]

[00:17:01] And, number two, because low cholesterol is just as, if not more risky, than high cholesterol, especially if you’re a woman. [7.7]

[00:17:09] And if your total cholesterol is very high or very low, it should then lead to an investigation as to why that’s the case. [7.6]

[00:17:18] So as an analogy here, say you were monitoring someone’s heart rate remotely, and you saw that at 10 o’clock in the morning every day their heart rate went up from 70 beats per minute to 120 beats per minute. [12.1]

[00:17:30] Now that increase could be because their heartbeat is going out of rhythm, which could be a sign of a dangerous condition, in which case treatment might be warranted, or it could just be because every morning they’re going out for a jog in which case that heart rate of 120 is making them healthier. [16.1]

[00:17:47] And if you prescribe medication to keep the heart rate from going up in that situation it would have negative consequences. [6.6]

[00:17:55] And it’s exactly the same situation with high total cholesterol in the blood – knowing what to do about it requires that you know what’s causing it to be high. [8.8]

[00:18:04] And unfortunately for years people have been prescribed cholesterol lowering medications, mainly statins, simply for high cholesterol levels, without ever exploring the reasons behind it, which is like prescribing heart rate lowering medication in our analogy above without first figuring out why the heart rate was going up every morning. [19.4]

[00:18:24] Now let’s move to our third myth, which is that cholesterol in our diet increases cholesterol in our blood. [7.2]

[00:18:32] The truth is that the cholesterol we eat has virtually NO EFFECT on our blood cholesterol. [5.8]

[00:18:39] So almost all the cholesterol in the blood is produced by our body and most of it by the liver. [5.8]

[00:18:45] So in other words most of the cholesterol in your blood doesn’t come from the cholesterol you eat, but from the cholesterol your body makes. [8.3]

[00:18:54] So our body regulates the amount of cholesterol in the bloodstream because it’s such a critical molecule for our health, which is why the amount of cholesterol that we eat has hardly any influence on the amount of cholesterol in our blood. [12.8]

[00:19:08] Yet for years we were told to limit how much cholesterol was in our diet, and we were told to do this long after the science behind this was well-established. [10.3]

[00:19:19] And perhaps the absolute worst consequence of this is that it led to the demonization of eggs, and in particular egg yolks, and the tragedy that is the egg white omelet. [10.6]

[00:19:30] We took what is arguably the most nutritious thing a human being can eat – an egg yolk – something that contains every nutrient needed to make a vertebrate animal from scratch, and arguably the single most nutritious food we have, and told people to avoid it. [14.0]

[00:19:45] And then even worse we told them to eat the part of the egg that contains comparatively few nutrients, and on top of that contain substances that block the absorption of those nutrients which the egg whites. Now that’s not to say that egg whites are bad for you but just that they’re nowhere near nutritious as the yolks. [16.0]

[00:20:02] And fortunately, even the nutritional authorities have reversed their position on this issue. [5.4]

[00:20:07] So here is an article from the Cleveland Clinic recently titled “Why you should no longer worry about cholesterol in food. [7.0]

[00:20:15] Here’s another one from the Harvard Medical School blog announcing “Panel suggests that dietary guidelines stop warning about cholesterol and food. [7.9]

[00:20:24] Now this is in 2015. But here’s the really sad thing. [4.3]

[00:20:29] We’ve known this to be true for a very long time. Not only was there never any evidence that cholesterol in the diet affected cholesterol in the blood, but we’ve actually known that dietary cholesterol has no significant effect on blood cholesterol for decades. [15.1]

[00:20:44] So here is a study from 1997 in the Journal of the American College of Nutrition that says the “misperception that dietary cholesterol determines blood cholesterol is held by many consumers in spite of evidence to the contrary. Many studies reported over the past two years have shown that dietary cholesterol is not a significant factor in an individual’s plasma cholesterol level or cardiovascular disease risk. Reports from the lipid research clinic’s research prevalence study and the Framingham Heart Study have shown that dietary cholesterol is not related to either blood cholesterol or heart disease deaths. In a similar manner 10 clinical trials of the effects of dietary cholesterol on blood lipids and lipoproteins indicate that addition of an egg or two a day to the diet has little effect if any on blood cholesterol levels. [52.0]

[00:21:37] So thankfully everyone has come to the realization of the harm that’s been caused by telling people to avoid cholesterol in food. [8.0]

[00:21:45] However there are still lots of people still operating under the idea that cholesterol in food is bad for them. [5.9]

[00:21:53] Now let’s move to myth number four, which is that there is bad cholesterol and good cholesterol. [6.3]

[00:22:00] And the truth here is that there is a bad cholesterol carrying particle. [4.1]

[00:22:05] So many of you have probably heard the terms bad cholesterol and good cholesterol, and here bad cholesterol typically refers to LDL cholesterol and good cholesterol is referring to HDL cholesterol. [12.9]

[00:22:19] HDL and LDL are actually not cholesterol at all, but particles that transport cholesterol around the blood. [7.4]

[00:22:27] So you can think of HDL and LDL as boats that transport cholesterol in the bloodstream. And both of these particles HDL and LDL are absolutely necessary for cholesterol metabolism, so you couldn’t live without them. [14.2]

[00:22:41] However we do now know that LDL particles are the ones that lodge themselves in the walls of arteries and kick off the process that leads to plaque buildup. [9.8]

[00:22:52] However not all LDL particles are created equal, and it’s a particular kind of LDL particle that is prone to lodging itself inside of the arteries. [9.6]

[00:23:02] So some LDL particles are large and buoyant or fluffy, meaning they’re not very dense, while others are small and dense. And the particles that are the ones that damage the arterial walls are the small and dense ones. [14.3]

[00:23:17] And the more of these particles there are floating around, the more likely they are to lodge themselves in the walls of the arteries. [6.3]

[00:23:24] So there are two important things here. One is that cholesterol itself has nothing to do with the process of plaque build up but rather the particles that carry cholesterol around in the blood. [11.1]

[00:23:36] They are the boats and cholesterol is just the passenger. [2.9]

[00:23:39] So when we get a number in the standard cholesterol testing for our LDL or HDL cholesterol we’re only getting a count of how many passengers there are. [9.9]

[00:23:49] But what we really care about is how many boats we have and how big or small those boats are. So what we really want to know is if we have a lot of small LDL particles floating around, and unfortunately the standard lipid test that’s usually done doesn’t measure the size of particles – that’s only done through what’s known as advanced lipid testing, which will give you that kind of information. [23.5]

[00:24:13] So if we do have high LDL cholesterol on the standard test, we don’t know if it’s because we have a high number of small LDL boats or because we have a lower number of large LDL boats, which are not of the same concern. [14.2]

[00:24:29] However there is something that the typical cholesterol testing does give you that can give you a good estimation of the type and number of particles of LDL particles that you have, which I’ll discuss next. [11.8]

[00:24:41] So myth number five is that LDL cholesterol is the most important marker. [5.5]

[00:24:47] This is the one that gets the most attention. The truth is that the triglyceride to HDL ratio is the most useful number. [9.6]

[00:24:57] So as I’ve said, total cholesterol in the blood isn’t a measurement we should ever use to base treatment on because it doesn’t give us the information we actually need to assess cardiovascular risk. [10.9]

[00:25:09] Likewise, LDL cholesterol doesn’t give us enough information either. [3.9]

[00:25:13] If it’s high we don’t know if it’s because you have a lot of small dense LDL particles carrying that LDL around or because you have very large and fluffy particles that can carry around a lot of cholesterol. [14.3]

[00:25:28] So one option to find out that information would be to do the advanced lipid testing that I discussed earlier. [5.8]

[00:25:34] But it turns out there is something on the standard lipid panel that can be used to give you a pretty good idea about the type of LDL particles you have. And it’s actually been shown not surprisingly to be the most predictive number in standard lipid testing. [14.2]

[00:25:49] And that number is the ratio of triglycerides to HDL. [4.0]

[00:25:54] So this ratio, not total cholesterol, and not LDL cholesterol, has been shown to be the most accurate predictor of heart disease risk or plaque build up in the arteries. [10.7]

[00:26:05] So here’s a study published in 2005 in the American Journal of Cardiology that was looking to figure out if you could actually use something in the standard lipid panel to try to determine both whether or not someone was insulin resistant, and to determine if you could figure out the type of LDL particles they had, since these were the two two of the best predictors of cardiovascular risk. [21.7]

[00:26:27] Again, not total cholesterol, and not LDL cholesterol, which are still the things most people end up focusing on. [5.7]

[00:26:33] And the answer here was yes, and it was the ratio of triglycerides to HDL, which correlated very well with advanced testing for insulin resistance, and with the advance testing for LDL particle size and number. [13.5]

[00:26:47] So as they conclude here, “the optimal triglyceride to high density lipoprotein cholesterol ratio for predicting insulin resistance and LDL phenotype – meaning whether you have small or big LDL particles – was 3.5 milligrams per deciliter, a value that identified insulin resistant patients with the sensitivity and specificity comparable to the criteria currently proposed to diagnose the metabolic syndrome. The sensitivity and specificity were even greater for identification of patients with small dense LDL particles. In conclusion a plasma triglyceride to HDL cholesterol concentration ratio greater than or equal to 3.5 provides a simple means of identifying insulin resistant dyslipidemic patients who are likely to be at increased risk of cardiovascular disease. [49.5]

[00:27:38] So this is what we should care about when we test our blood liquids. [4.8]

[00:27:43] Here’s another study on the same topic where they followed 103,000 patients over a period of eight years and reached the conclusion that “insulin resistance, as manifested by a high triglyceride to HDL ratio, was associated with adverse cardiovascular outcomes more than other lipid metrics, including LDL cholesterol which had little concordance for physicians and patients should not overlook the triglyceride to HDL ratio. [28.8]

[00:28:12] So there are two important things to take away here. [2.4]

[00:28:16] First is that this ratio is what we should care about, not LDL cholesterol, which in the old story is the bad cholesterol, and certainly not total cholesterol. [9.2]

[00:28:25] And second is that the reason that this ratio is so predictive appears to be because it correlates very well with insulin resistance, because insulin resistance is really the root cause of plaque buildup. [11.7]

[00:28:38] And remember this is why we ever started caring about cholesterol testing in the first place, because we’re trying to understand our risk of plaque build up in our arteries. [8.3]

[00:28:47] So anything in the diet that increases our triglyceride levels and decreases our HDL levels are going to increase this ratio, which we don’t want. [8.7]

[00:28:57] And what sort of things do that? [1.7]

[00:28:59] Carbohydrates. [0.6]

[00:29:00] Especially refined and simple carbs will both raise triglyceride levels and lower HDL levels. And of course these are the same things that also lead to insulin resistance and type 2 diabetes, not coincidence. [12.0]

[00:29:12] So all of this provides a clear explanation of how the dietary changes we’ve made as a population over the past half century in response to the unfounded fears over fat and cholesterol have resulted in an increase in the very diseases those changes were to help us avoid. [15.5]

[00:29:29] I should also add that the accepted ratio that’s considered to be healthy for triglycerides to HDL is 2 or less. [8.4]

[00:29:38] So to sum all this up, cholesterol is vital for life. [3.9]

[00:29:43] Low cholesterol levels are associated with higher rates of death especially in women. [4.6]

[00:29:48] Cholesterol in the diet doesn’t impact cholesterol in the blood. [3.1]

[00:29:52] And the best predictor of cardiovascular disease risk in the standard cholesterol panel is the triglyceride to HDL ratio with under two considered to be the target. [10.6]

[00:30:04] So hopefully that clarifies some of the confusion around this issue and perhaps more importantly will give you confidence in the face of well-meaning friends and family who may worry about your fat and cholesterol intake, and maybe you’ll even be able to turn the discussion around and plant a seed that could lead to them making some changes for the better. [20.4]

[00:30:25] Or you could just also direct them to this episode of The Miracle Moment. [3.3]

[00:30:29] I’m also going to be coming out with a follow up episode on what actually happens to the cholesterol numbers when people move from a standard high carbohydrate diet to a diet that’s low to moderate in carbohydrate and higher in healthy fats. [14.7]

[00:30:44] And if you have any questions about what I’ve covered here, please feel free to ask in the comments, and I can address those in the follow up episode as well. [8.9]

[00:30:54] Also the show notes will include all of the links to the references that I mentioned in this episode. [7.0]

[00:31:02] All right so now it’s time for our Primal Provisions Pick of the Week. [3.5]

[00:31:06] So for those of you who don’t know Primal Provisions is our weekly meal planning service where every Saturday we send out a Migraine Miracle meal plan along with recipes for all the meals, grocery lists, and prep day instructions for people who want to prepare their meals in advance for the week. [17.4]

[00:31:24] So it’s a really easy way of getting started with the Migraine Miracle plan, especially the food part, as it takes all the planning and decision making off the table and saves you time and anxiety and ensures that you have delicious meals to eat throughout the week. [14.1]

[00:31:39] So every week inside of our Facebook group we take a poll to see which recipe from Primal Provisions people want us to post. [7.6]

[00:31:47] And the winner this week was our Migraine Miracle Sloppy Joes. [5.6]

[00:31:53] So this one is definitely a crowd pleaser because who doesn’t love Sloppy Joes, right? [5.3]

[00:31:58] I know most people are used to eating Sloppy Joes on a bun, otherwise they’re not so sloppy. And in fact in our house we eat it without a bun. [9.0]

[00:32:08] So maybe that should be called a not-so-sloppy-joe, or perhaps just a joe, but taking the bread off of typically bread-ridden things is one of the best moves you can make in terms of better health, and it will certainly contribute to improving that triglyceride to HDL ratio that I just talked about. [16.8]

[00:32:25] I personally don’t miss bread at all anymore, especially because I know how much better I now feel without bread in my life. [7.4]

[00:32:33] But if you do find yourself in need of a bread like foodstuff to serve with your Sloppy Joe, maybe to appease some other Sloppy Joe enthusiasts in your family, we’ve also included the recipe for our cream cheese crepes, which work really well as a bread substitute in a number of situations, including this one. [18.9]

[00:32:53] So that wraps up this episode of The Miracle Moment.[2.8]

[00:32:56] Thank you so much for joining me here today. [2.1]

[00:32:58] Like I said, feel free to leave comments or questions in the comment section on Facebook, and please feel free to share this with anyone you know who might benefit from a better understanding of the fat and cholesterol issue. You might just change somebody’s life. [17.1]

[00:33:16] And if you’re listening to the podcast version of this episode and find yourself enjoying it, it’d be great if you leave a rating or review in iTunes. It really helps other people to discover it and it’d be very much appreciated. [13.3]

[00:33:30] So I’ll see you next week for another full length episode. Until then, go SLAY THE BEAST! [6.0]

[33:34.7]

ARTICLES AND STUDIES Mentioned:

TG:HDL as most useful number in standard lipid panel:

Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? American Journal of Cardiology. https://www.ncbi.nlm.nih.gov/pubmed/16054467

Study of the use of lipid panels as a marker of insulin resistance to determine cardiovascular risk:

The Permanente Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625988/

Negligible effect of dietary cholesterol on blood cholesterol:

Cholesterol intake and plasma cholesterol: an update. Journal of the American College of Nutrition. https://www.ncbi.nlm.nih.gov/pubmed/9430080

Low cholesterol associated with higher mortality:

Low cholesterol is associated with mortality from stroke, heart disease, and cancer: The Jichi Medical School Cohort Study. Journal of Epidemiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899519/

US Population eating less fat, more carbs since dietary guidelines came out: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm