I wrote to Dr. Leonardi, my "vitality and longevity" doctor to get his reply. He wrote back:
I’ve read all this before. If this information overshadowed the dozens of studies connecting LDL-C with heart disease and its reduction to reduced heart disease, the medical profession at large would embrace it. The truth is the overwhelming data clearly demonstrates the association of LDL (and more particularly, LDL particle number) to coronary risk.So today I finally decided to write to Dr. Douglass:
Dr. Douglass and Staff:I look forward to receiving some kind of reply, hopefully.
I am particularly concerned about the scientific grounds for your attacks on the entire anti-cholesterol movement. . . .
My doctor gave me the marketing sheet for the NMR LipoProfile test which includes the following claims:
- "The number of LDL particles interacting with the artery wall is what drives the disease, not the cholesterol within them." --Contemporary Diagnosis and Management in Preventive Cardiology, March 2006
- "In seven diagnostic outcome trials . . . The number of LDL particles (LDL-P) was proven to be a better predictor of CHD risk than LDL cholesterol (LDL-C)." --Specific studies cited:
- Kuller at al. NMR spectroscopy of lipoproteins and risk of CHD in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 2002;22:1175-80.
- Blake et al. LDL particle concentration and size as determined by NMR spectroscopy as predictors of cardiovascular disease in women. Circulation 2002;106:1930-37.
- Otvos et al. LDL and HDL particle subclasses predict coronary events and are changed favorably by gemfibrozil therapy in the Veterans Affairs HDL Intervention Trial (VA-HIT). Circulation. 2006;113:1556-63.
- Rosenson et al. Relations of lipoprotein subclass levels and LDL size to progression of coronary artery disease in the PLAC I trial. Amer J Cardiol 2002;90:89-94.
- Mackey et al. Lipoprotein subclasses and coronary artery calcification in postmenopausal women from the Healthy Women Study. Amer J Cardiol 2002;90(8A):71i-76i.
- Mora et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2007; 192:211-7.
- Cromwell et al. LDL particle number and risk for future cardiovascular disease in the Framingham Offspring Study – implications for LDL management. J Clin Lipidol 2007;1(6):583-92.
Book cover via AmazonMeanwhile, my daughter handed me the book that appears to provide the full basis for all of your claims about cholesterol (at least all the claims you and/or your copywriter make in your The Biggest Medical Lie of the Last 50 Years booklet--many of which you seemed to repeat in your latest [October 2008] newsletter). I am referring, of course, to the Introduction to Sally Fallon's Nourishing Traditions.
I am distressed to find that all of Fallon's references pre-date every one of the studies cited by my doctor and/or NMR LipoProfile--most of them by decades. Is the "old science" of the '60s, '70s and '80s really better than the "new science" of the 2000s?
Thanks so much!
Cholesterol is an oil, and blood is water-based. Oil and water don't mix, so in order for cholesterol to be transported in the bloodstream it must be carried inside lipoprotein particles. There are a variety of different lipoprotein particles, but for the sake of brevity I will just discuss low density lipoprotein (LDL) particles.
ReplyDeleteHistorically, we have not had the technology to directly quantify lipoproteins, so we have relied upon measurements of the cholesterol carried inside lipoproteins as a surrogate marker. Accordingly, we have come to regard the cholesterol carried inside LDL particles as "bad" cholesterol.
Terminology:
LDL-C = the cholesterol inside low density lipoprotein particles.
LDL-P = the NUMBER of low density lipoprotein particles.
Using the amount of cholesterol inside LDL particles as a surrogate marker for the number of LDL particles is very much like counting the number of passengers traveling up and down a road in order to estimate the number of vehicles traveling up and down the road. There are significant variations in vehicle size, and also in the number of passengers in each vehicle (a 5-passenger car might not always carry 5 passengers). We can transport 100 passengers in 20 vehicles holding 5 people each, or 50 vehicles with 2 people each, or 100 vehicles with 1 person each. The number of passengers is identical in each scenario, but the risk of a traffic jam is not.
Similarly, LDL-C does NOT always do a good job of reflecting LDL-P, and this is a problem because it is the NUMBER of LDL particles interacting with the artery wall that causes atherosclerosis (it's a gradient-driven process - when there are a lot of LDL particles there is a strong gradient, and therefore a high risk of diffusion of particles through gaps in the artery wall).
We now have tons of science showing us that quantifying lipoprotein particles works better than measuring the cholesterol inside lipoproteins for the purposes of predicting cardiovascular endpoints. In fact, guidelines are beginning to recognize the superiority of particle number measurements over cholesterol measurements, and to recommend that particle number be measured.
HOWEVER, although cholesterol often fails to predict risk at the individual level, there are nonetheless strong population-level correlations between cholesterol and cardiovascular endpoints. Correlation does not equal causation, but when we dissect an atherosclerotic plaque, it is full of cholesterol. The only way for that cholesterol to get there is for an LDL particle to carry it from the bloodstream, through the endothelial lining of the artery wall, and into the sub-endothelial space (where it is oxidized into a foam cell, fatty streak, and ultimately becomes a plaque).
The fact that LDL-P works better than LDL-C does NOT invalidate the "cholesterol hypothesis." The primary culprit in atherosclerosis is low density lipoproteins, and advancing from LDL-C to LDL-P does NOT change this fact -- it simply means that we now have BETTER ways of predicting LDL-related risk than using the cholesterol content of the LDL particles.
The NMR LipoProfile test does indeed work better than cholesterol tests, but the availability of a better test doesn't invalidate the old test any more than buying a widescreen HDTV invalidates the 19-inch TV you used to watch with rabbit ears.
This is a very simple, high level overview. I am happy to address questions.
Best Regards,
Marc
marcwgarber@comcast.net
Wow, Marc! Thank you for your "comment"!
ReplyDeleteYou have made quite a powerful set of statements, and you used excellent illustrations to make your points intuitively easy to understand.
And now I'm curious.
Not to pry into your personal business, but . . . how do you know so much? And how have you gained the ability to express your knowledge so well?
Again, thank you for sharing your understanding. It makes a lot of sense.