Ok, so I don’t know how to write short questions. This is in response to Jack Kronk’s post that was certainly of interest to me and apparently others. I wanted to follow-up with something a bit more impersonal than Jack’s specific situation, with the intention of getting to a fundamental fork in the road that I think is at the core of his post.
First, let’s level set on terminology. Please see attached the link from Chris Masterjohn, who IMO is the thought leader in this area – http://blog.cholesterol-and-health.com/2011/03/how-conflating-lipid-hypothesis-with.html
Now many of us in this community have embraced the consumption of saturated fat and dietary cholesterol. From this perspective, we are “cholesterol skeptics” along the lines of the following from Chris Kresser - http://thehealthyskeptic.org/i-have-high-cholesterol-and-i-dont-care
However, my observation is that there are skeptics, and then there are SKEPTICS. Please see the following from Kurt Harris (who continues to be my main influence, even though he is not blogging much/at all)
From Statins and the Cholesterol Hypothesis – Part I...
"I do not believe in any of the versions of the lipid hypothesis, ranging from Ancel Keys' original idea that cholesterol or dietary fat clogs the arteries, to the currently fashionable one that “small, dense” LDL particles are like microscopic rodents that are designed to burrow under the intima of your blood vessels and kill you. Neither cholesterol nor any of the lipoproteins nor LP(a) is a "cause" of CAD (coronary artery disease)...HDL, particle numbers, particle sizes, LP(a) are all parameters that are more or less associated with CAD. If they respond positively to changes in diet, then they are just covariant with decreased risk of CAD or MI due to the changes you made in your diet. They are not necessarily, and not usually the direct mediators of the decreased risk. They may track the positive changes you make in your diet, but they are not causing heart attacks any more than shoe size causes height!"
In response to a post by Chris Masterjohn - http://blog.cholesterol-and-health.com/2011/03/genes-ldl-cholesterol-levels-and.html - Kurt Harris wrote the following (March 27, 2011)
“My biggest problem with your otherwise excellent analysis here is that not a one of the studies you cite includes people eating ancestral or paleo or high fat/LC diets. The total C/HDL ratio should therefore be considered neither reassuring or necessarily alarming unless you are a SAD eater, IMO.
What do you make of the Kitavans having little heart disease but having very low HDL as reported by Lindeberg? I tend to agree with Peter that we should regard these lipoprotein numbers, including the newest fad of sdLDL, as markers for type of diet, and not as causative agents or parameters to adjust for their own sake.
And although I agree that total C can be elevated due to hypoT, I still think that the best lipid is one that you never measure, and one should diagnose thyroid issues with clinical assesment and thyroid tests. There is simply nothing to be gained -a priori -by testing for total C, HDL, LDL or even CRP. Unless you want to have to lie when you apply for health insurance (they often ask if you have high cholesterol but don't demand that you get tested - I've had that experience twice) or you want to incur the expense of following up with NMR.
There is no evidence that treating a single one of these numbers, beyond eating a whole food diet low in PUFA, etc, does anything at all to reduce your risk. Even if they actually mean something on your paleo type or WAPF diet, which I have just argued they might not...If you really want to know your personal risk of heart disease, get a calcium score or CIMT. For the same price as VAP or NMR lipoprofile, you will get information that actually means something.”
So I see the following categories implied
- You are Lipo-phobe/Cholestero-phobe - You essentially believe in the Lipid/Diet Heart Hypotheses. If you are a Paleo eater, then this is arguably aligned with the Cordain/Devany view of Paleo in that you minimize saturated fat and dietary cholesterol while adhering to the other tenets of Paleo – exclusion of Neolithic Agents of Disease (PUFA, Fructose, Gluten, etc)
- You are a Conditional Skeptic - You do not believe in the original formulation of the Lipid/Diet-Heart Hypotheses, but you do believe in certain aspects (such as the relative importance of small/dense vs light/buoyant LDL) and therefore believe that lipid numbers are something to be managed. By “managed”, I am not implying that you are going to rush out a get on a statin. “Managed” means you will modify your diet within the confines of Paleo tenets to “achieve” lipid numbers that you believe are indicative of cardiovascular health.
- You are an Unconditional Skeptic. You believe these measures are irrelevant. Regardless of the numbers, you will continue to exclude NADs and the impact to your lipid numbers does not impact your dietary choices at all within the confines of Paleo tenets
- TBD – please elaborate. Obviously there are shades of grey between 1-3 and the never ending semantic arguments that could ensue (and would rather avoid)
So finally the question - For those of you in Category #2, what keeps you from being in #3? Maybe a hedge against the possibility that there is some merit to conventional wisdom and we should not throw the baby out with the bathwater? Scientific data that convinces you that complete skepticism is wrong?
Finally, it is easy to say you are either a conditional or unconditional skeptic, but when you are faced with data that places you at the crossroads of accepting or rejecting conventional wisdom, then your true beliefs will be revealed. To be clear, I am not asking this question with any value-judgment whatsoever. I don’t care which category you place yourself in; I care why you are there so I can understand and learn from it. Maybe this will also be relevant for Jack's question.
Thanks and sorry for the length of the question (not really!)
EDIT - When push comes to shove, if I were faced with "undesirable" lipid levels, I think it would be disingenuous of me to thump my chest and state categorically that I would not fall into #2, even though intellectually I remain in #3. This is why I wrote this question because of the internal conflict that might result if/when such a situation arises. Perhaps some of you are in the same boat?