'Doc' Describes Me As A 'Dead Man Walking' Because Of My Elevated LDL Cholesterol

One of the risks that I willingly take blogging about health as someone who has not been trained in either medicine or nutrition is the fact that there are a whole lot of people who are much more intelligent than I am about the subjects I write about. It's just a fact of life that I've lived with since day one of my blog more than three years ago. And it doesn't bother me a bit that I don't have all the answers.

The purpose of my blog is for me to share about my experiences livin' la vida low-carb and to hopefully provide some interesting topics for discussion that will enable my readers as well as myself the chance to learn something about their own health that they probably didn't know before. One thing I've found since I started blogging in the health arena is that even the doctors and medical researchers don't always know as much as we think they do. There's a reason they call it "practicing" medicine.

With that said, I recently received a rather challenging e-mail from someone purporting to be a "Doc" according to their e-mail address who wanted to take me to task over the assertions I made in this blog post about my latest cholesterol numbers and specifically the particle size of my LDL as well as my hard-hitting column about the death of the late NBC "Meet The Press" anchorman Tim Russert. It seems the good "Doc" took great exception to my belief that the HDL/triglyceride ratio is a better indicator of heart disease risk than LDL or total cholesterol and that having large LDL particle size is protective against a cardiovascular event.

In a very condescending tone in his e-mail, "Doc" proceeded to berate my gross ignorance of some rather "basic" health concepts that I apparently haven't fully grasped yet (get a load of this guy!):

I nearly fell off my chair reading your well-meaning but very erroneous blog on Tim Russert.

If larger fluffy, buffy LDLs are protective, why is it that people with the highest risk of atherosclerosis and premature death (i.e. familial hypercholesterolemia) have 100% fluffy, buffy, LDLs?? Sure does not protect them! You with an LDL-C greater than 200 likely have large LDLs and are a dead man walking.

If low HDL-C is always bad, why are their several genetic conditions associated with very low HDL-C and longevity? Check out JAMA. 2008;299(21):2524-2532

Why have there been numerous published articles in the last few years describing many patients with myocardial infarctions who have HDL-C > 90 mg/dL?

If low LDL-C is so dangerous, why do people with hypobetalipoproteinemia who go through life with LDL-C between 5 and 40 all have longevity with no ill effects of such low cholesterol levels?

Russert's Lipids: TC = 105 LDL-C = 68 HDL-C = 37

Of course that is impossible: TC = LDL-C + HDL-C + VLDL-C
VLDL-C is derived by dividing TG by 5 thus VLDFL-C = TG/5

Thus using your numbers TG would be zero which is impossible. Of course if you knew anything about lipids, your blog would not contain so many basic errors.

Last bit of advice--Look up apolipoprotein B or LDL-P. Read the newest guidelines: A consensus statement from the ADA and ACC on Lipoprotein Management in Patients with Cardiometabolic Risk (like Russert). They were published in April in Diabetes Care and the Journal of the American College of Cardiology.

Had anyone measured LDL-P on Russert and then treated it aggressively, Russert would still be here. Of course since statins rarely normalize LDL-P, Russert needed additional medication beyond his statin to achieve apoB goal.

Hate to further blow away your statements, but if you read the new ADA/ACC statement you will see that data from three major trials (Framingham, MESA and EPIC Norfolk) have shown that LDL size is no longer considered an independent risk factor for CHD. Only thing that matters is apoB or LDL-P.

Happy reading and please correct your statements on the web site.

Well, I guess he told me, didn't he? It really depends on what research studies you are looking at and he pointed to a few that certainly made sense to him. As I stated before, I'm no expert when it comes to knowing anything and everything about the subjects I write about. I simply share what I do know and have seen applied in real life situations and let those results speak for themselves.

It's a bit presumptuous of this guy to call me a "dead man walking" because of my high "fluffy, buffy LDL" cholesterol. Further belittling my intelligence by attempting to point out my "errors" was also quite unbecoming of someone who alleges to be a professional physician whose goal is to help educate patients and make them healthy. I wouldn't want this fella being my doctor!

Although I didn't have the answers to his remarks, I knew someone who could provide an educated and reasoned response to "Doc." He's a real doctor and avid researcher on low-carb diets--Dr. Eric Westman. The following is Dr. Westman's comments back to "Doc" asking for clarification and presenting some counter-evidence rebutting the original claims made in his e-mail to me:

Thank you for forwarding this email.

1. The definition of "cardiometabolic risk" is changing, and its relationship to cardiovascular disease is imperfect. In spite of this, many medical authorities want you to do what they recommend. There are many exceptions to the recommendations, and I believe the authorities will acknowledge this readily.

2. Please teach me, "Doc." You wrote that people with "familial hypercholesterolemia have 100% fluffy, buffy, LDLs." Can you provide a reference for this statement (even case studies are fine)? Here is a recent article and it suggests otherwise...but the abstract doesn't really give enough information until I can read the full study. J Pediatr. 2008 Jun;152(6):873-8. Epub 2008 Feb 8

3. You wrote: "If low HDL-C is always bad, why are their several genetic conditions associated with very low HDL-C and longevity?"

I think that this just points out again how imperfect these markers are.

4. You wrote: "LDL size is no longer considered an independent risk factor for CHD. Only thing that matters is apoB or LDL-P."

"Doc" let me just take a moment to explain what "independent risk factor" means statistically--it is a common source of confusion. "Independent risk factor" means that, after accounting for some information, the addition of a new factor (variable) adds no more information (the association is no longer statistically significant).

My understanding is that LDL size and LDL-P are highly intercorrelated ("track together"), so that after accounting for one, the other is no longer statistically significant in its association with cardiovascular disease. It does NOT mean that LDL size is not important--it just means that you get no more additional information about the presence of cardiovascular disease from knowing LDL size when you already know LDL-P.

I look forward to learning more from you. Thanks.

Eric C. Westman, MD MHS
Associate Professor of Medicine
Director, Lifestyle Medicine Clinic

Excellent job, Dr. Westman! You took each of the points made by "Doc" and offered him the opportunity to see other data that he may not have considered otherwise. I appreciated you taking time out of your busy schedule to write back to "Doc" and give him a chance to learn something new himself. Unfortunately, that's the last we've heard of good ole "Doc." There's been nary a word out of him since Dr. Westman's reply.

Am I fallible? Yes, more than I'd like to admit. Do I know everything there is about diet, health, and nutrition? Anyone who tells you they do should be avoided because they are lying. Do I enjoy inciting an open discussion and debate of ideas? You bet your sweet bippy I do which is why I don't mind hearing from people who necessarily disagree with my viewpoints and wish to correct me. If I'm wrong and evidence is presented to me proving it, then I'm the first to make the corrections and admit the error of my ways.

But in this case, "Doc," I won't be changing a thing! By the way, where'd ya go? I'd love to hear what you have to say about what Dr. Westman said.

Tim Russert's Fatal Heart Attack Was Preventable, He Followed Antiquated Advice

In this supercharged and oftentimes volatile political election year, something tragic and sudden struck this country and has everyone buzzing in Washington and across the United States. No, it wasn't some sex scandal, drug bust, or any of the other usual news that has become almost too commonplace these days. This was something much more serious and has greater implications than even the extensive coverage the mainstream media is giving to it.

Last Friday afternoon, hard-hitting political interviewer and long-time host of NBC-TV's Sunday morning news talk show "Meet the Press" Tim Russert experienced his first heart attack and it almost instantly killed him. I cannot imagine how his family is responding to this news and my sympathies and prayers go out to them during this very difficult time. Tim was in the midst of doing what he loved--preparing for his television show--when the heart attack took his life and took him away from all of us.

So, how did a 58-year old man die from a heart attack when he was doing all of the things his doctor said he should to prevent it? Should we be concerned about what doctors are telling us about how to ward off cardiovascular disease so that we don't become the next victim of what befell Tim Russert? These are the questions people are asking in the wake of this tragedy and was the subject of what one of my readers wanted to know in an e-mail I received.

Here's what she wrote:

Hi Jimmy, I have been an avid reader of your blog for a long time. I am so scared since Tim Russert died suddenly of a heart attack at only age 58 (my husband is 57 and I'm 54) that I'd really like to get some clarification on the statin drugs and cholesterol issue. Seems like Tim Russert's doctors did all the usual things and he died anyway. I trust what Dr. Jonny Bowden has to say as he has an advanced degree in nutrition and he seems to think for himself instead of just following the status quo. Can you see if he would help reassure me with this? Thanks for your assistance, and keep up the fantastic work!

While I am no Dr. Jonny Bowden, I do have some things to say about Tim Russert's death that need to be said. I can understand your concerns and I am delighted to forward your questions to Dr. Jonny Bowden. He's one of the brightest, most articulate people on nutrition in the entire world, so you are in good hands with the information he provides to you.

But if you would allow me to comment on this subject, I have some thoughts about it. Isn't it interesting that Tim Russert did everything exactly as his doctor wanted him to and yet his very first heart attack was a fatal one? I don't think that's a coincidence either and it happens every single day without a blink of an eye from anyone.

Watch this video interview with Russert's doctor to see how dejected he is about Russert's "unexpected" death despite his best treatment strategies. It's amazing to hear his doctor basically say that Tim did everything he was "supposed" to do and yet it wasn't enough to save his life. Wanna know what the scariest part of this story is?

Check out Tim Russert's lipid profile:

LDL--68
HDL--37 (up from the lower 20's)
Total Cholesterol--105

Did you see that? Most doctors would look at those numbers and say, "See how healthy this person is because we lowered his cholesterol." And they would pound their chest with pride at putting someone like Tim Russert on a statin drug to artificially make this happen. But what good did it do him in the end? He's gone now because of that advice and there's no outrage about it. Worry, concern, perplexity, yes--but nobody is angry that this preventable death was made WORSE by the use of all the traditional means for improving heart health.

According to Russert's doctor, he didn't have Type 2 diabetes nor did he have any blood sugar issues at all. His A1c was in the normal range and as I noted previously his cholesterol was considered VERY healthy. For all intents and purposes according to the modern day medical conventional wisdom, he was the epitome of perfect health. And yet he tragically died before his time.

We now know posthumously that Russert had coronary heart disease that he was being treated for, but his doctor apparently didn't know how severe it was. But even if he did know it was extremely serious, what else would he have recommended to Tim? Higher doses of his statin drug? Even less fat in his diet? More exercise? In the end, all of these seemingly good strategies from the conventional wisdom point of view would have very likely done NOTHING to prevent this from happening.

His doctor put him on blood pressure lowering medication as well as a cholesterol-lowering statin drug to see if that would help. And Russert even rode an exercise bike to try to lose weight, although it didn't work. There's no doubt the plaque buildup around his heart was getting bigger and bigger over the years until his heart couldn't take it any longer.

We know that too low LDL can lead to depression, suicide and death. We also know that HDL "good" cholesterol (Russert's was very low--NOT good) and triglycerides (something Russert dealt with having too high over the past few years) are better indicators of heart health than LDL and total cholesterol. And it's a high-carb, low-fat diet that leads to lower HDL and higher triglycerides. No doubt this is precisely the kind of diet Russert's doctor had him on.

As you know from reading my blog, my most recent total cholesterol reading was 326 with an LDL of 246, HDL of 65, and triglycerides at 77. I am confident I don't need to go on a statin drug now or ever and I am as healthy as I have ever been in my entire life. On face value, any typical physician in America would say to me, "Oh my God, you need to be on Lipitor, Crestor, or Zetia to lower your LDL and total cholesterol."

Of course, they would be 100% wrong because my LDL particle size is the protective large, fluffy kind that your body wants and needs. Dr. Eric Westman from Duke University Medical Center in Durham, North Carolina, who is the physician who ran this test on my behalf, said almost all of my LDL is this protective kind and the percentage of small, dense LDL (which was the likely culprit in Russert's fatal heart attack) is virtually nil. And that's a GREAT thing! High LDL can be good, but low HDL is most certainly ALWAYS a bad thing to have.

When you are livin' la vida low-carb correctly, then your HDL will be well above 50 and for women well above 70. At the same time, your triglycerides will drop below 100 for an HDL/triglyceride ratio of around 1. That's what you want. Of course, you will need to get the particle size of your cholesterol subsets measured using a VAP or Berkeley test, but you can almost be guaranteed that if your HDL is up over 50 and your triglycerides are down below 100 that your LDL particle size will be the large, fluffy protective kind.

This cholesterol issue is one I am quite passionate about because the modern means for dealing with it is simply exacerbating the problem. The medical community has the blinders on and they refuse to take them off long enough to see the harm they are doing to patient after patient they put on these risky prescription drugs for a purpose that is futile and fatal in the end like it was for Tim Russert.

Here are quite a few posts I have penned about the subject of cholesterol that I think you should read when you get a chance to help you understand this issue even better:

"Doctor Claims Blood Sugar, Not Cholesterol Linked To Heart Disease"
"Low-Carb Can Raise HDL Levels Without Cholesterol Medication"
"Cholesterol Numbers Drop But At What Cost"
"Cholesterol Drugs Are About Money Not Health"
"Cholesterol Conundrum: Do I Statin Or Not?"
"Doctor Gives Me Four Months To Get LDL Down"
"Consensus On Cholesterol Is Avoid Statins"

It's time to break all those years of cholesterol indoctrination. There will be confusion and concerns in your mind at times, but that's okay. My pithy response to anyone who challenges me on cholesterol is PROVE IT'S UNHEALTHY! They can't because there isn't one iota of truth to the cholesterol con.

There's much more to this cholesterol issue and the connection to Tim Russert's
death than most people even realize. I encourage you to read a few more commentaries from people in the health community who I respect and trust about this:

JACKIE EBERSTEIN from Controlled Carbohydrate Nutrition
"What We Can Learn From Tim Russert's Death"

DR. WILLIAM DAVIS from Heart Scan Blog
"Another failure of conventional cardiac care"
"Tim Russert's heart scan score 210...in 1998"

Hopefully my answer will make you feel better about this and that consuming a diet lower in carbs, higher in fat, and with moderate protein at every meal is what is going to work best for improving your heart health over the course of your life. If only Tim Russert had been given this information instead of the antiquated traditional advice he received, then his fatal heart attack may have been averted. Perhaps this event will begin a serious discussion of heart health treatment in this country so that others can benefit from the healthy low-carb lifestyle, too. We can only hope.

Anyone interested in learning more about the alternative cholesterol hypothesis I've written about today must check out the following books:

The Great Cholesterol Con by Dr. Malcolm Kendrick
The Great Cholesterol Con by Anthony Colpo
Hidden Truth about Cholesterol-Lowering Drugs by Shane Ellison
Malignant Medical Myths by Dr. Joel Kauffman
The Cholesterol Myths by Dr. Uffe Ravnskov
Good Calories, Bad Calories by Gary Taubes

6-24-08 UPDATE: In response to an anonymous comment left about this blog post regarding the kind of diet Tim Russert ate OBVIOUSLY being a low-carb one, here's my comment:

Actually, anonymous, livin' la vida low-carb is arguably the easiest diet you can possibly go on and do for the rest of your life. I tried livin' la vida low-fat in 1999 and THAT was not sustainable in the least. No, it doesn't take some willpower to lose weight, but rather a steadfast resolve to make better choices for your health. For me and many here at my blog, that was a low-carb diet.

As for Tim Russert, he most certainly was NOT on a low-carb diet because his triglycerides were very high and his HDL was very low...these are signs of a HIGH-carb, low-fat diet that his cardiologist no doubt put him on. Here's an excerpt from the New York Times about Russert's health:

Mr. Russert had low HDL, the protective cholesterol, and high triglycerides. He was quite overweight; a waist more than 40 inches in men increases heart risk. A CT scan of his coronary arteries in 1998 gave a calcium score of 210, indicating artery disease — healthy arteries do not have calcium deposits — and a moderate to high risk of a heart attack.

None of this happens on a low-carb diet and the studies show your HDL goes above 50 and your triglycerides fall below 100 when you are low-carbing correctly. And this is PROTECTIVE against a cardiovascular event.

The studies also show that a diet low in fat and high in carbs (generally recommended as "healthy" by most of the so-called experts) is what leads to lower HDL and higher triglycerides like Tim Russert had. This is the diet that ultimately killed him, not a low-carb diet.