Stalking the Wily Vegans of Park Slope

This just about sums it up -- except that those vegans look suspiciously healthy...

(Click for higher resolution)

[Source]

LDL: It Ain't All Bad

When considering cholesterol numbers, most people -- doctors included -- use a simple but flawed shorthand:

• High HDL: Good!
• High LDL: Bad!
• High total cholesterol: Bad!

When you get your blood cholesterol analyzed, these numbers are often all that come back from the lab. But we know that the reality’s not quite that simple. After all:

LDL cholesterol can no longer be identified as the single source of all heart trouble. Those pamphlets adorning your doctor's waiting room may portray LDL as a kind of lone gunman taking a bead on your heart, but they hide a basic fact of science: "Bad cholesterol" is at best a poor shorthand for four major types of independently behaving LDL, each with its own implications for heart disease. We ignore the distinctions at our peril.

In fact, some types of LDL are pretty innocuous, while other forms are dangerous. The big, fluffy LDL particles are generally benign -- they don’t affect heart health. But small, dense LDL particles are bad news, triggering the inflammation that causes cardiovascular disease. People typically have a mix of large, small, and medium-sized LDL particles, but you’re obviously better off if the bigger, fluffy stuff predominates.

And here’s the thing:

A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms.

Sadly, “[t]he typical LDL test doesn't distinguish between large and small LDL particles -- it can't even spot the difference.” And as a result, even today, most doctors don’t concern themselves with this critical distinction, relying instead on total LDL numbers or total cholesterol numbers to indicate what course of medical action to take. But by lumping all the forms of LDL together, “[w]e may be medicating many people who have no clear need for medication, using drugs that don't target the right particles, and replacing foods that are benign with foods that are anything but.”

Thankfully, not too long ago, Ronald Krauss of Children’s Hospital of Oakland and his colleagues developed a device capable of distinguishing between and precisely measuring LDL and other lipoproteins to provide a much more accurate picture of cardiovascular health. Krauss and his partners have also identified the best predictors of cardiovascular disease. In order of most predictive to least, they are:

• High levels of small and medium-sized LDL particles combined with low HDL (pretty darn predictive of heart disease!)
• Low HDL levels (kinda/sorta predictive!)
• High total LDL levels (not very predictive!)

And utterly not predictive at all? Total cholesterol.

BUT: The test that Krauss developed isn't widely available. Most doctors are still going by the old standby measurements, and looking solely at total cholesterol, HDL, and LDL numbers. Ugh.

The upshot: If you’re like me -- a Paleo convert whose diet contains relatively large quantities of saturated fat and cholesterol -- you might get lab results that, on their face, look a little baffling:

• Total cholesterol: 261 mg/dL (Yikes -- that's super-high!)
• HDL: 100 mg/dL (But wait -- HDL is fantastic!)
• LDL: 97 mg/dL (Just barely within the range of “optimal,” right?)

I have no idea whether my LDL particles are large or small, but given my diet, I’m assuming the former. (Probably not a bad assumption, given that M and I eat almost exactly the same diet, and her LDL particle size was recently tested and confirmed as predominantly Type “A”: big and fluffy.) And my HDL is through the roof. I'm not at risk for cardiovascular disease.

But if you were to ask my doctor, he'd probably tell you another story based on my total cholesterol.

Science can sometimes be slow to progress, but we've got to get more sophisticated testing out there. Otherwise, the problem is that lowering your total cholesterol or LDL -- without knowing the type of LDL particles you have -- can cut both ways:

Just because you have less of the symptom (statin users take note) doesn't mean you'll have less of the disease. A drop in your total LDL cholesterol might mean nothing at all. A higher LDL cholesterol reading, for that matter, could simply mean you are a healthy person who has learned how to build an amazing sauce out of wine, garlic, shallots, butter, and heavy cream.

Or, if you’re M, a fantastic dish of sous vide pork chops seared in melted lard.

Stop With The Egg Whites

The New Yorker's food issue is out this week, and it features a lengthy piece about April Broomfield, the chef/owner of NYC's The Spotted Pig and The Breslin -- both of which are awesome for meat-lovin' Paleo eaters like me. Last month, M and I hit The Breslin for brunch, and ordered two full English breakfast plates, piled high with porky goodness, and with no beans or toast to spoil the fun.

We clearly did not do an adequate job of educating one of our brunch companions about the place, though. And as I mentioned in a previous post, he's not on the Paleo train. After scouring the menu in vain for something -- anything! -- that the USDA Food Pyramid and conventional dietary wisdom would smile upon, he asked our server whether the vegetable frittata could be made with egg whites. "No," she replied.

Of course, the server's intent wasn't to steer him towards better health. Chances are, she subscribes to the same beliefs that most people hold about the dangers of egg yolks and saturated fats and everything else on The Breslin's menu. I seriously doubt she's read Gary Taubes.

But you know who has? Director/producer/screenwriter/novelist Nora Ephron. She most certainly would not have asked for fucking egg whites.

Ephron was being interviewed by Michael Krazny on NPR's "Forum" this morning. I know next to nothing about Nora Ephron, other than that she wrote "When Harry Met Sally" or something, so I was only half-listening -- until Krazny gently chided her about her position on eggs and cholesterol. My ears perked up.

"Eating the cholesterol in eggs doesn't raise your blood cholesterol!" she countered. Krasny shot back that the Mayo Clinic says she's wrong. She stuck to her guns. And she happens to be right.

Here's what I dug up from an old HuffPo blog post of Ephron's on the subject:

[D]ietary cholesterol has nothing whatsoever to do with your cholesterol count. This is another thing I've known all my life, which is why you will not find me lying on my deathbed regretting not having eaten enough chopped liver. Let me explain this: you can eat all sorts of things that are high in dietary cholesterol (like lobster and cheese and eggs) and they have NO EFFECT WHATSOEVER on your cholesterol count. NONE. WHATSOEVER. DID YOU HEAR ME? I'm sorry to have to resort to capital letters, but what is wrong with you people?

Which brings me to the point of this piece: the egg-white omelette. I have friends who eat egg-white omelettes. Every time I'm forced to watch them eat egg-white omelettes, I feel bad for them. In the first place, egg-white omelettes are tasteless. In the second place, the people who eat them think they are doing something virtuous when they are instead merely misinformed. Sometimes I try to explain that what they're doing makes no sense, but they pay no attention to me because they have all been told to avoid dietary cholesterol by their doctors. 

According to yesterday's New York Times, the doctors are not deliberately misinforming their patients; instead, they're participants in something known as an informational cascade, which turns out to be a fabulous expression for something that everyone thinks must be true because so many reputable people say it is. In this case, of course, it's not an informational cascade but a misinformational cascade, and as a result, way too many people I know have been brainwashed into thinking that whole-egg omelettes are bad for you.

So this is my moment to say what's been in my heart for years: it's time to put a halt to the egg-white omelette.

Hear, hear.

David H. Freedman wrote in this month's Atlantic about how the health studies you hear about on the news are almost universally fraught with error and bias -- and then the information cascade takes over and we go flying off the cliff with all the other lemmings. So what happens when another study comes out and draws the opposite conclusion -- which, by the way, happens ALL THE TIME?

Too late. We're already in freefall -- and we didn't even get to enjoy the frittata with the awesomely delicious egg yolks.

I Like to Read Stuff

There are a few newly-added sites on my blogroll, and if you haven’t yet checked ‘em out, you really should. Here’s why:

Free the Animal

• I long ago bookmarked Richard Nikoley’s site and have been a regular reader for a while now, but just realized today that I’d neglected to add him to my blogroll. Nikoley is – along with Robb Wolf, John Durant, Melissa McEwen, and a few others – one of the most prominent voices on the Paleo scene. Yes, he can come across as a little cranky at times, but he’s never, ever boring. Plus, he manages to keep his man-parts clean without soap or shampoo, which is kind of badass.

Fathead

• Tom Naughton is a comedian-slash-documentary filmmaker who released a movie called “Fathead” last year. The film is a parody/response to Super Size Me, pulling back the curtains on Morgan Spurlock’s slippery claims and debunking what common wisdom has pounded into our heads about good nutrition, dietary fat, and the causes of obesity. Naughton’s mission to debunk bad food science didn’t end with his documentary; on his blog, he continues to level a critical eye on all sorts of nutrition and food-related subjects. It’s a fun read.

Cholesterol and Health

• When M got her labs back last month, she discovered that her HDL – “good cholesterol” – was way up, but so was her LDL. Was this a problem? Nope. Nutrition PhD candidate Chris Masterjohn lays it all out on his website – an easy-to-read clearinghouse of information about the true nature of cholesterol. Masterjohn is another big name on in Paleo circles, and it’s easy to understand why. (Also check out Jimmy Moore's podcast interview with Masterjohn here.)

Harder. Better. Faster. Stronger.

• Raj over at HBFS is one of my new favorites. His writing is witty and insightful, and his experience mirrors mine: Couch potato to runner to P90X grad to CrossFitter and Paleo eater. I’m intensely jealous of Raj's ability to dig into the science behind nutrition and fitness. (For example, check out his Twinkie Diet takedown, which is infinitely better written and analyzed than my weak attempt.)

This Week in Paleo

• I’ve found Angelo Coppola’s podcasts to be a great way to quickly expand my knowledge about all things Paleo. He does a thorough job of mining the blogosphere for information about ancestral eating, and frankly, it’s nice to be able to tear myself away from the computer screen and just download Angelo's podcast and listen to him chat about his week’s Paleo-related discoveries. And I’m not just saying this because my site has been featured as a "Blog of the Week" on TWIP, either. Honest.

Nom Nom Paleo

• Nepotism be damned. Nom Nom Paleo is my better half's food blog, and she regularly posts all sorts of good, meaty stuff -- from full-blown (but simple) recipes to tips on staying Paleo when dining out. Plus, she cusses like a sailor. What's not to like?

Going forward, I’ll try to continue highlighting new sites that catch my eye – and please let me know if there are others I should check out. Happy Friday, folks.

(Image: inju)

Am I About to Drop Dead of a Heart Attack?

This morning, I attended a health fair at work and got my blood work checked for the first time since going paleo. (Unfortunately, the visiting clinic didn't offer the full panoply of tests – just the basics.)

I fully expected some big changes in my cholesterol numbers. After all, over the past six months or so, I’ve increased my saturated fat consumption by approximately a bazillion percent. (Which, by the way, isn’t hard to achieve, given that I used to abstain from eating anything with saturated fat – including meat – before converting to a paleo diet. Heck, less than a year ago, I was ordering meals from a macrobiotic society every Monday night. And now, I'm subsisting on what most would consider a high-fat diet.)

But when today's results came in, my total cholesterol count still gave me a jolt: 261 mg/dL. That's almost 100 mg/dL higher than it was last year.

A health advisor at the fair frowned at the number, and then handed me this handy chart:

“Your total cholesterol level is alarming," she began. "You may want to talk to your doctor about statins. Right now, you're clearly at risk for heart disease.”

Uh, oh. That doesn't sound too good.

More after the jump...