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This page contains a single entry from the blog posted on October 6, 2009 12:46 AM. The previous post in this blog was Die, my pretties. The next post in this blog is Recall 2.0: Who are you, and where have you been?. Many more can be found on the main index page or by looking through the archives.

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Tuesday, October 6, 2009

New numbers to watch

I like my doctor, Lou. The guy knows what he's doing, cares about his patients and shows it, and keeps up with the latest stuff. Today I had a routine physical exam, part of which is going through the results of recent lab tests, and I got an earful from the good doctor about a new way of looking at blood chemistry. I hadn't seen Lou this animated about something in a while, and so I knew I should listen up.

From time immemorial we've all heard that we need to keep an eye on our cholesterol, and a couple of decades ago we refined that down to LDL, the "bad" one, and HDL, the "good" one. If I've got this right, the numbers we've always gotten in our blood tests have measured the volumes of those substances in the blood.

But now it appears that within the realm of LDL, they're figuring out that the number and size of the particles that carry the cholesterol are what's important. As I understand it, size matters, in that big LDL particles aren't as damaging as small ones. The big ones can't get through to start messing up your arteries, whereas the little ones can. And the more LDL particles of any size there are, the worse off the patient is. Apparently, the greater the number of vehicles careening around in there, the greater the risk that one or more are going to hit something. Therefore, in addition to watching LDL and HDL in the bloodstream, it's also smart to keep an eye on one's "LDL particle number" and "small LDL particle number." You want both those numbers -- the numbers of "bad" particles floating around -- to be low. You may have a low volume of LDL, but if there are too many particles, you could still be a candidate for trouble. And on the size of the LDL particles, the bigger the better.

I hope I got that right. I probably shouldn't prattle on so much about something I don't really understand, but maybe this will get somebody who's due for a physical in to see his or her physician soon. Who knows? Maybe your "bad" cholesterol situation isn't as bad as you thought -- or maybe where you thought you were in the clear, it ain't necessarily so. Meanwhile, on my end, it's nice to watch something new while I'm watching myself get older.

Comments (6)

The next time you talk with Lou the Dr, ask him how much he knows about inflammation in the vascular system, how it affects coronary artery disease, and why lots of people are much more concerned about inflammation issues than cholesterol. In countries that consume significantly more seafood, especially of the fatty kind, coronary disease is way lower than in the US. Japan is about one of the lowest with Inuit populations that survive on large doses of salmon and other fatty fish (or mammals). The cholesterol debate is bizarre but seeing statistics that compare increased seafood consumption with lower mortality rates speaks for itself.
The weird part of this is that FDA suggests that we consume 2-6oz portions of fish or seafood per week. Our average consumption in the US is about 16 lbs per year. Calculating the 2-6 oz portions over the course of a year would yield about 42 pounds AVERAGE. The issue is that there isn't enough fish to harvest to make up that amount. So I guess only the ones who get the message will survive.

homosystines...ask about that!
And all this drivel from big pharma about all the meds for high cholesterol could be just totally bogus.

Your Doctor was right on!
I was fortunate to attend a standing-room only talk by Dr. John McDougall a few weeks ago. He is a leading proponent of a plant-based, no fat diet. The dangers of the tiny plaques inside arteries are the real dangers - not the large "old" LDL particles. Where do these plaques come from? Our western diet - animal-based high fat diets.
Here is a link to a "conversation" that Dr. McDougall had with Tim Russert after his death. It was controversial, but contained some great information about LDL and heart disease.
http://www.drmcdougall.com/misc/2008nl/jun/russert.htm

I have been a vegan on a no fat (that's right - no olive oil!) for a few months. I've been a vegetarian for a number of years, but feel so much better on my new way of eating. I've lost weight and have much more energy.
There are several physicians and researchers out there who are taking on big pharma, the meat and dairy industries and the processed food companies to try to get out real information on health and nutrition. Among them are Dr. John McDougall, Dr. Caldwell B. Esselstyn (author of " Prevent and Reverse Heart Disease" and T. Colin Campbell, PhD., author of The China Study".
I hope everyone reads the article in the Sunday NY Times (on the website) about the tainted hamburgers - disgusting!!

It's nice to think that your doctor is on top of the health news that affects you. But there are other possibilities for explaining what he is going on.

If you are not a health professional, it is comforting to believe that your medical practitioner always acts on a sound scientific basis. But unfortunately, there are fads among health practitioners just as with every other kind of human endeavor.

Consider cholesterol. First we were told that total cholesterol was the important number to look at. Then different schools argued that either hdl, ldl, or triglycerides were individually most important. Then there are whole schools that talk about the ratio of one or more of these elements to the others as the most important consideration. Now the latest hype is that you should look at the size of your ldl particles. You can be sure that within the next few years there will be still another "breakthrough" explanation of how some aspect of cholesterol affects heart disease.

Are we seeing real progress here or just the occurrence of fads in the health and medical professions? Is there any noticeable downward effect of the incidence of heart disease?

There's a great book called "The Last Well Person: How to stay healthy despite the health care system" by a Harvard doc who teaches at a med school in North Carolina, Nortin Hadler. It's a really, really powerful book, with a big chapter on statins and heart disease in general, and other chapters on evaluating health claims, benefits, etc.

Couple that with Shannon Brownlee's book "Overtreated: How too much health care is making us sicker and poorer" and you really get a different perspective on things. Where we need a lot more health care is in the low-profit end of things (primary care, preventive care); what we get are fabulously expensive things like systems to measure LDL particle size for white guys with lots of insurance.

I have to second Mary's post about Dr. McDougall. His program will absolutely prevent heart disease.

Dr. Neal Barnard and Dr. Dean Ornish are two other doctors who push a similar diet to Dr. McDougall's.


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