As Dave Feldman says, “We don’t know.”
But today I’ve started participation in the process he set up that will help us get the answer.
The standard blood lipid panel includes several measures and calculations that doctors (and particularly cardiologists) use to estimate health and future risk of a heart attack, stroke or some other cardiovascular event.
- LDL-C (calculated)
You’ll also see a Total Cholesterol figure, but almost everyone would agree that it’s practically meaningless.
High Triglycerides (> 150 mg/dL) and low HDL-C (< 40 mg/dL for men and < 50 mg/dL for women) are two of the five elements that go into a diagnosis of metabolic syndrome. Others include:
- High blood pressure (Systolic > 130 mmHG, Diastolic > 80 mmHg)
- High Blood Glucose
- Abdominal Obesity (waist > 40 inches for men or > 35 inches for women. Note that this is the measurement at the belly button, or the natural waist, not the jeans waist size.)
Metabolic syndrome is diagnosed when you meet any three of those five criteria, and the medical community clearly recognizes that metabolic syndrome massively increases your risk of cardiovascular disease, diabetes, many cancers and even Alzheimer’s and other forms of dementia.
What isn’t included in the diagnosis of metabolic syndrome?
It’s not even a factor that’s considered.
And yet it’s the one number which, if elevated, will get you a referral to a cardiologist, even if all of your other factors are optimized.
I know. It happened to me.
In January of this year I had a physical with a new primary care physician, complete with the standard lipid panel.
My Triglycerides? 45 mg/dL. Outstanding.
HDL-C (the “good” cholesterol)? 74 mg/dL. Also excellent.
Blood pressure. In the normal range. So was blood sugar.
I had lost 60 lbs. from my peak and had gotten rid of my abdominal obesity.
Every marker looked great.
Except LDL-C. That was 224 mg/dL.
Most cardiologists want that below 100, and they consider anything above 189 very high.
That’s why I got the call from my new primary care physician and a referral to cardiology, with a suggestion that I might want to consider taking a statin.
As part of that evaluation I got a coronary artery calcium scan, and my score was 0, which indicates low risk. I didn’t take the statin.
But the CAC score only measures the plaques that have calcified, not the newly formed ones. So like Dave, I’m cautiously optimistic that a high LDL level on its own doesn’t increase my heart disease risk. But we really don’t know.
That’s why I’m thrilled to be part of the Lean Mass Hyper-responder study, which will follow 100 people like me for a year. We all have high HDL, low triglycerides and LDL of more than 100.
This morning I’m in Los Angeles, where I had my first coronary CT angiogram with contrast, to measure the current extent of any atherosclerosis.
I’ll be taking blood ketone measurements every day for the next year to demonstrate that I’m staying on a ketogenic diet, and then a year from now will repeat the coronary CT angiogram.
My results, along with the others, will help the researchers understand whether LDL on its own is something to be concerned about, in the absence of other risk factors.
We all owe Dave and the Citizen Science Foundation huge thanks for their perseverance in making this study happen, and in raising the funds for it.
This is information that’s important to know, but Pharma would never pay for it.
And while many of us have been involved in individual n=1 experiments with our own diet and health, pulling together a large cohort like this will hopefully help us get statistically significant data that can help others make informed decisions.
I hope I’m right, and that having elevated LDL-C without other risk factors will be show to not increase atherosclerosis progression.
But if that turns out to not be the case, that’s important information to have as well, and could lead to treatment modifications.
I’m confident that I’m in much better health than I was five years ago.
Whatever the outcome of this study, within the next couple of years I’ll have better data to guide future decisions.