Author Topic: What's the skinny on cholesterol  (Read 521 times)

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Offline God Bomb

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What's the skinny on cholesterol
« on: April 10, 2017, 03:46:28 AM »
and fringe theories about cholesterol.

I hear some people saying that foods rich in animal products aren't bad and dietary cholesterol wont lead to bad blood cholesterol, heart disease, etc.  Are they wrong and why are they wrong?  They seem to present their case with evidence, although it's hard to summarize from memory.

My basic understanding of controlling cholesterol boils down to these things, please tell me if I'm wrong or missing anything

get checked by a doctor
don't be overweight
exercise regularly
limit saturated fats and trans fats.
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Offline Noisy Rhysling

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Re: What's the skinny on cholesterol
« Reply #1 on: April 10, 2017, 06:22:40 AM »
Never did any of the "recommended" things. At 64 my piping was pristine. The Y-donor had undergone several heart procedures by age 60, badly gummed up. Mom, the lady who cooked most of what he ate, no problems. Jury's out as far as I'm concerned.
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Offline daniel1948

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Re: What's the skinny on cholesterol
« Reply #2 on: April 10, 2017, 09:22:35 AM »
My understanding is that dietary cholesterol is not an issue because it gets broken down in the stomach, but that saturated fats encourage the body to make cholesterol. And too much total fat has too many calories, leading to obesity, which is a problem in itself. But that extremely-low-fat diets, once encouraged, are now out of favor.

Of course some, including some regular posters here, disagree with this view, and will probably chime in.

I think most agree that exercise is good, but even that view is not unanimous. And some people even dispute the notion that serum cholesterol is bad at all. But I think the vast majority of science-based health professionals agree that a high level of serum cholesterol is bad.

It is clear that genes play a big role as well.
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Offline Mr. Beagle

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Re: What's the skinny on cholesterol
« Reply #3 on: April 10, 2017, 10:02:42 AM »
Sample size of one: For years I was marginally over the line, and so the doctor had me on Zocor. About two years ago, I started a moderate program of weight loss simply via (1) incrementally more exercise (one extra half-hour session a day), (2) pacing my calories during the day to stabilize sugar highs and lows, and to better count calories, and (3) more veggies and using meat more as a condiment than a meal.

The result was to put me marginally under the line, and I have been off Zocor for over a year. Which strategy worked? I have no idea. But again, I was marginal. My brother is not, and nothing seems to work except statins.
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Online CarbShark

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What's the skinny on cholesterol
« Reply #4 on: April 10, 2017, 10:30:12 AM »
There is no evidence that dietary cholesterol is an issue for all but a few people with specific medical conditions.

Same with saturated fat.

Transfats are bad.

Sugar and fast/simple carbs raise ldl ("bad cholesterol") lower HDL ("good cholesterol") and elevate serum triglycerides  Also the particle size of ldl becomes small and dense and that's bad too


Your mileage may vary.
« Last Edit: April 10, 2017, 11:52:36 AM by estockly »
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Offline jt512

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Re: What's the skinny on cholesterol
« Reply #5 on: April 10, 2017, 03:17:53 PM »
My understanding is that dietary cholesterol is not an issue because it gets broken down in the stomach, but that saturated fats encourage the body to make cholesterol. And too much total fat has too many calories, leading to obesity, which is a problem in itself. But that extremely-low-fat diets, once encouraged, are now out of favor.

That's more correct than not.  But dietary cholesterol does not get broken down at all; it is excreted more-or-less as cholesterol.  Within the range of usual consumption in the West, there is little observable relationship between dietary cholesterol consumption and blood cholesterol levels.  However, no one ASFAIK has recently compared usual levels of cholesterol consumption with extremely low levels.  There were a handful of older studies that did this and found that when cholesterol consumption is lowered to extremely low levels, blood cholesterol levels were improved, and the effect was independent of dietary fat consumption.   So if you were to reduce your consumption to, I would guess, a few servings per week, the reduction in dietary cholesterol would have a beneficial effect.

Offline God Bomb

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Re: What's the skinny on cholesterol
« Reply #6 on: April 11, 2017, 01:54:48 AM »

Sugar and fast/simple carbs raise ldl ("bad cholesterol") lower HDL ("good cholesterol") and elevate serum triglycerides  Also the particle size of ldl becomes small and dense and that's bad too


Even when total calories and fibre are controlled?
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Offline jt512

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Re: What's the skinny on cholesterol
« Reply #7 on: April 11, 2017, 02:10:11 AM »
Sugar and fast/simple carbs raise ldl ("bad cholesterol") lower HDL ("good cholesterol") and elevate serum triglycerides  Also the particle size of ldl becomes small and dense ...

That statement is meaningless.  Macronutrients do not have absolute effects, only relative effects compared isocalorically to other macronutrients.

Online CarbShark

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Re: What's the skinny on cholesterol
« Reply #8 on: April 11, 2017, 11:21:24 AM »
Sugar and fast/simple carbs raise ldl ("bad cholesterol") lower HDL ("good cholesterol") and elevate serum triglycerides  Also the particle size of ldl becomes small and dense ...

That statement is meaningless.  Macronutrients do not have absolute effects, only relative effects compared isocalorically to other macronutrients.

Well that's progress. The Lipid Hypothesis, upon which the Dietary Guidelines were based, suggested that consumption of fats and cholesterol is what caused CVD via changes in the lipid profile (LDL; HDL; TG) and BP.

Then the claim was that it only Saturated fat and dietary cholesterol.

Then the claim was Saturated fat, and while they still recommend reducing Saturated fat there is no strong clinical evidence to support that, and even the ADA is admitting that.

So now the "thinking" is that we should forget about macronutrient proportions and focus on Eating Patterns.

I'm not sure how you're making the distinction between absolute and relative effects and coming to the conclusion that all those studies found no absolute effect. Do you have evidence to support that?

Here's a couple of links that suggest otherwise.

(In both cases the reduction in carbs was moderate, still far to high to meet the threshold for nutritional ketosis.)


Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects


Quote
The HFLC group had greater mean decreases in serum triglyceride (P=0.07), and hs-CRP (P=0.03), and greater mean increases in HDL cholesterol (P=0.004), and total adiponectin (P=0.045) relative to the LFHC. Secreted adipose tissue adiponectin or TNF-α did not differ after weight loss for either diet.


Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. - PubMed - NCBI

Both groups achieved similar

completion rates
   LC diet: 71%
   HC diet: 65%

mean (95% CI) reductions in weight
   LC diet: -9.8 kg (-11.7, -7.9 kg)
   HC diet: -10.1 kg (-12.0, -8.2 kg)
 
blood pressure
   LC diet: -7.1 (-10.6, -3.7)/-6.2 (-8.2, -4.1) mm Hg
   HC diet: -5.8 (-9.4, -2.2)/-6.4 (-8.4, -4.3) mm Hg

HbA1c
   LC diet: -1.0% (-1.2%, -0.7%)
   HC diet: -1.0% (-1.3%, -0.8%)

fasting glucose
   LC diet: -0.7 mmol/L (-1.3, -0.1 mmol/L)
   HC diet: -1.5 mmol/L (-2.1, -0.8 mmol/L)
LDL cholesterol
   LC diet: -0.1 mmol/L (-0.3, 0.1 mmol/L)
   HC diet: -0.2 mmol/L (-0.4, 0.03 mmol/L)


Compared with the HC-diet group, the LC-diet group achieved:

greater mean (95% CI) reductions in the diabetes medication score
   LC diet: -0.5 arbitrary units (-0.7, -0.4 arbitrary units)
   HC diet: -0.2 arbitrary units (-0.4, -0.06 arbitrary units); P = 0.02

glycemic variability assessed by measuring the continuous overall net glycemic action-1
   LC diet: -0.5 mmol/L (-0.6, -0.3 mmol/L)
   HC diet: -0.05 mmol/L (-0.2, -0.1 mmol/L); P = 0.003

triglycerides
   LC diet: -0.4 mmol/L (-0.5, -0.2 mmol/L)
   HC diet: -0.01 mmol/L (-0.2, 0.2 mmol/L); P = 0.001

greater mean (95% CI) increases in HDL cholesterol
   LC diet: 0.1 mmol/L (0.1, 0.2 mmol/L)
   HC diet: 0.06 mmol/L (-0.01, 0.1 mmol/L); P = 0.002
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Offline jt512

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Re: What's the skinny on cholesterol
« Reply #9 on: April 11, 2017, 03:52:13 PM »

I'm not sure how you're making the distinction between absolute and relative effects and coming to the conclusion that all those studies found no absolute effect. Do you have evidence to support that?

Macronutrients, by definition contain dietary energy.  If you are investigating effects of macronutrients in a dietary trial, you have to hold total energy consumption constant; otherwise, the effect you observe will be confounded with the effect of increasing total energy.  In order to hold total energy constant, you have to decrease energy intake from other macronutrients.  Thus it is impossible to define an absolute effect of a macronutrient.  Any such definition will fail, because the effect will either be confounded with total energy or confounded with the effect of decreasing intake of other macronutrients.  So the concept of "absolute effect" for a macronutrient is meaningless.

What you can do in a controlled trial, however, is isocalorically substitute the macronutrient of interest with a single other macronutrient.  Thus, you can observe the effect of substituting SF for either MUF, PUF, or carbohydrate; that is, you can observe the effect of one macronutrient relative to another. 

Thus it is meaningless to say, for example, that SF increases LDL-cholesterol, because the effect it has on LDL-cholesterol can only be defined relative to the effect of the other macronutrient(s) it replaces.  But what we can say is that compared to consuming an equal amount of PUF, SF increases LDL-cholesterol.

Online CarbShark

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Re: What's the skinny on cholesterol
« Reply #10 on: April 11, 2017, 06:33:36 PM »

I'm not sure how you're making the distinction between absolute and relative effects and coming to the conclusion that all those studies found no absolute effect. Do you have evidence to support that?

Macronutrients, by definition contain dietary energy.  If you are investigating effects of macronutrients in a dietary trial, you have to hold total energy consumption constant; otherwise, the effect you observe will be confounded with the effect of increasing total energy.  In order to hold total energy constant, you have to decrease energy intake from other macronutrients.  Thus it is impossible to define an absolute effect of a macronutrient.  Any such definition will fail, because the effect will either be confounded with total energy or confounded with the effect of decreasing intake of other macronutrients.  So the concept of "absolute effect" for a macronutrient is meaningless.

What you can do in a controlled trial, however, is isocalorically substitute the macronutrient of interest with a single other macronutrient.  Thus, you can observe the effect of substituting SF for either MUF, PUF, or carbohydrate; that is, you can observe the effect of one macronutrient relative to another. 

Thus it is meaningless to say, for example, that SF increases LDL-cholesterol, because the effect it has on LDL-cholesterol can only be defined relative to the effect of the other macronutrient(s) it replaces.  But what we can say is that compared to consuming an equal amount of PUF, SF increases LDL-cholesterol.

So in multiple studies with at least two arms  (often isocaloric, but not always, but calories can be controlled for) the lipid profile for each subject had changed by the end. In many cases some factors improved on LCHF and those same factors got worse on HCLF.

So I don't see the distinction between relative and absolute in those cases.


See points 8 and 10 of this article.


Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base - Nutrition

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Offline jt512

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Re: What's the skinny on cholesterol
« Reply #11 on: April 11, 2017, 07:50:06 PM »

I'm not sure how you're making the distinction between absolute and relative effects and coming to the conclusion that all those studies found no absolute effect. Do you have evidence to support that?

Macronutrients, by definition contain dietary energy.  If you are investigating effects of macronutrients in a dietary trial, you have to hold total energy consumption constant; otherwise, the effect you observe will be confounded with the effect of increasing total energy.  In order to hold total energy constant, you have to decrease energy intake from other macronutrients.  Thus it is impossible to define an absolute effect of a macronutrient.  Any such definition will fail, because the effect will either be confounded with total energy or confounded with the effect of decreasing intake of other macronutrients.  So the concept of "absolute effect" for a macronutrient is meaningless.

What you can do in a controlled trial, however, is isocalorically substitute the macronutrient of interest with a single other macronutrient.  Thus, you can observe the effect of substituting SF for either MUF, PUF, or carbohydrate; that is, you can observe the effect of one macronutrient relative to another. 

Thus it is meaningless to say, for example, that SF increases LDL-cholesterol, because the effect it has on LDL-cholesterol can only be defined relative to the effect of the other macronutrient(s) it replaces.  But what we can say is that compared to consuming an equal amount of PUF, SF increases LDL-cholesterol.

So in multiple studies with at least two arms  (often isocaloric, but not always, but calories can be controlled for) the lipid profile for each subject had changed by the end. In many cases some factors improved on LCHF and those same factors got worse on HCLF.

So I don't see the distinction between relative and absolute in those cases.

That's unfortunate, because it is an important concept.

Offline lonely moa

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Re: What's the skinny on cholesterol
« Reply #12 on: April 11, 2017, 08:53:24 PM »
"The man", (Ronald Krauss) would say not to worry about eating saturated fat, poor lipid profiles are due to easily metabolised processed carbohydrates.

As ES mentions, we aren't speaking of metabolic outliers.
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