T Nation

US Guidelines on Cholesterol


For anyone who doesn't keep up with the actual research and various literature, it seems the official stance is finally acknowledging that they've been wrong all along.

I can't tell you how many times I'ver explained to people that how much they eat has little to no impact on their levels.




Stu, I'm a cardiovascular epidemiologist. Among my friends that are generally "more aware" of fitness/diet, I have seen an explosion of Facebook shares, likes, etc since this became public news.

We're still not ALL the way towards mainstream dietitian acceptance that the U.S. guidelines have been way, way off for the last few decades, but we're getting there.


My wife is a cardiologist. She could have been sanctioned or possibly sued for malpractice if she told patients to eat whole eggs or go over 30% cals from fat so she focused more on telling her patients to cut down on sugar intake.

Triglycerides and LDL goes up primarily from sugar intake. The liver MUST convert excess fructose into triglycerides (after liver glycogen needs are met).

Also blood cholesterol going up is the body's action to heal microvascular damage. As a result it may be a sign of an underlying problem, but in the absence of runaway microvascular inflammation, artificially lowering blood cholesterol blocks the natural healing process. See the statin companies thought that within the next few years, EVERY AMERICAN would just start taking statins by age 35 or 40 and they'd have a cash-crop, but blocking blood cholesterol may instigate heart disease.

Replacing animal foods/fats with plant fats has clearly been shown to cause diabetes by producing severe choline deficiency. http://perfecthealthdiet.com/2010/11/dangers-of-a-zero-carb-diet-ii-micronutrient-deficiencies/ Not to mention causing chronic inflammation and oxidative damage from oxidized PUFA's.

In general, calling blood cholesterol the cause of future heart disease is like telling someone that if they have a band-aid on, they may end up with a cut underneath.


im now testing the effect of cholestrol & saturated fat consumption on ldl levels.
i will have another test on March 9th and let you know.
my ldl is 182 according to the test i had last week by the way.
im very curious to see the result.


The problem is that LDL doesn't predict heart disease very well.


yes but i also want to see the effect of reducing cholestrol & saturated fat intake on hdl and triglyceride levels as well.

im literally running a scientific experiment here, thats very cool :))


One of the difficulties in treating chronic disease is that it's like playing Whack-A-Mole. Drug companies find out that Risk Factor X is associated with Disease Y, and we make a drug to reduce Risk Factor X. And it usually works at reducing Risk Factor X, but that doesn't always translate to long-term benefits because, as you've noted, sometimes we "fix" one problem and create two more.


Ok, but remember your description isn't exactly true. You have to change other parts of your diet in the test. If you just stop eating saturated fat, you either have to replace that intake with another nutrient or reduce overall calories. This is one of the things that makes dietary studies so hard.

I'm assuming you'll be replacing those calories which means you are studying the effect of what you are adding as much as what you are removing.

Really what you are studying is conglomerate changes of what happens when a person tries to avoid saturated fat (which is really more important than studying dietary components in isolation because, as I mentioned, it is impossible to replicate with a living person).

You may find this interesting:

Basically people told to eat as much as they want whenever they want but to not eat carbs do better in every category the study measured for health. Atkins stomped every other diet tested EVEN for heart health markers.


Atkins nets bodyweight loss largely because it leaves people chronically "un-loaded" on glycogen which of course holds water in the muscles and liver.

Atkins has one problem. At under 20-30% cals from carbs, insulin sensitivity drops to preserve glucose for the brain. Also is can raise triglycerides a little versus 20-30% carbs, and RAISE fasting glucose a little due to the decreased insulin sensitivity.


First, I don't do Atkins FTR.

The study was pretty long term. The people in the Atkins group lost far more than glycogen. And insulin resistive people lost like 2 or 3 times the weight of other diets so even with glycogen loss, they lost substantially more.

Also, what does insulin sensitivity matter in the absence of carbs? Especially if eating some carbs improves that sensitivity (when it would matter what your sensitivity is). If I remember the Atkins group increased sensitivity anyway.

The triglyceride thing didn't pan out in that study. All blood markers in the Atkins group improved and every single improvement was better than any other diet in every measurement.

And also remember the atkins one was the only diet that was not semi-starvation which IMO makes every single other diet impossible to sustain over time (there are plenty of studies showing this). Which is important to note because exactly following the diet was not studied, what people actually did when "following" the diet was measured.


Perhaps, just perhaps some of the neo-paleo pundits have pushed 25% carbs with circa 150 grams of potatoes or rice because they know that it sounds a lot more appetizing than a zero carb approach. I think that more carbs are called for for vigorous exercise though. Another possibility is that those who claim to follow Atkins actually end up getting 100+ grams of carbs a day. I only got 30 minutes into the video though. Did they have a "low but not VERY low carb approach below the "zone" diet level?" Zone is 40%, Isocaloric is 33%, PHD is 25%. Obviously anyone with bad glucose tolerance who reduces carbs is going to improve, but what I have read suggests that over 20% produces better tolerance than Atkins which used to recommend 20 GRAMS of carbs a day.

But just reducing bodyfat is going to improve glucose tolerance. Reduced glucose tolerance will raise fasting blood sugar by upramping gluconeogenesis, so what I have seen is very low carb diets producing fasting glucose levels just over 100, instead of under 100. Not sure if a fasting blood sugar of 105 is really a bad thing or just a sign of problems that don't exist on low carbs anyway.

Also, they lost more than water, but most Atkins dieters will lose 5-10 pounds of hydration in the first 2-3 weeks. That is a big chunk of a 20 pound loss, and enough to make the fat loss comparable to other diets.


Absolutely good points. The Atkins people were probably eating some carbs even though it's essentially a 0 carb approach. And it may have been that the weight loss more than made up for nutrient effects on blood profile. The study is more about what's the best diet to teach people than what is the absolute best diet to actually follow (which is true of most dietary studies).

But no, in this study weight loss was not comparable though people really fell into 2 categories. First, insulin sensitive People. For them it really didn't matter they lost about the same on all the diets. However, for more insulin resistive people (as measured by fasting glucose) the results weren't even close, Atkins was far far far better. But again, and this is important for both types, Atkins was the only non-semi-starvation diet. All others had people counting macros and calories and not eating even if hungry. Atkins has no macro or calorie counting and no intake restriction (no semi-starvation). It is literally a "eat as much as you want whenever you want diet". Even though it is interesting to note that the Atkins dieters did reduce caloric intake to almost exactly the same levels as the caloric restriction diets. The caloric reduction in Atkins was just the result rather than the means.


And regarding the Atkins people reducing cals, some nutritional theorists have speculated that the hunger issues may be from varying degrees of grain based food allergies. I for one will absolutely have sinus congestion at night if I eat a sandwich with wheat bread, and it wakes my up feeling hungry, but I just don't get it with potatoes or rice in moderation.

Atkins certainly all but eliminates wheat. People can disagree about wheat, but I believe it harms intestinal flora, and causes at least mild allergic symptoms in most people.

Also you mentioned insulin insensitive people. That makes sense too. Clearly if a blood sugar spike from a meal is going to pour insulin into the blood (because you have low sensitivity so you get continued secretion until blood sugar comes down) then you are going to stimulate massive lipogenesis from eating even 30 grams of carbs 3 times a day. You will also get periods of higher blood sugar spikes (150-180 or more) which cause all of the associated problems.

Gaining muscle though can be very helpful for insulin insensitive people because muscle will basically act as a sugar sponge all the time keeping levels from getting too high. And it give your body a place to put carbs other than Liver-fat and Adipose.


this thread is giving me a major brain boner. Interesting stuff, guys.


the level of english is too advanced in this thread, im just a turkish guy that learned english in high school :slight_smile:

long story short, do you believe my ldl will drop down after stopping dietary cholesterol and saturated fat intake for a month or is it completely irrelevant?


no, don't drop the saturated fats.


Long story short: it might drop down, but we have learned that "high LDL" alone isn't a serious marker of CVD risk, although the field as a whole has been slow to embrace this.

The rest of your markers, triglyceride/HDL ratio and glucose, are fine.

People with "high LDL" but a normal triglyceride/HDL ratio are not really at high risk.

So basically, you're trying to reduce LDL for no reason. It might come down if you go ahead with the dietary changes outlined, but you're unlikely to BENEFIT from that.


1) Do you eat a high carb diet or a lower carb diet?

2) Do you have any real reason to believe that you have the beginning of heart disease (family history, smoking, lots of aerobic exercise?)

3) Do you have any reason to believe that you have thyroid problems?

4) Do you eat food fried in vegetable oils? What kinds?

5) Do you eat much sugar, sweets, sodas, drinks with sugar?


Excepting this: 1) high LDL may show thyroid disfunction or low T3 specifically and 2) It may be a sign of early heart disease (not a cause), and 3) I would probably want to reduce LDL if I already had early stage ischemic heart disease.


My wife had a 160 LDL and 40 HDL a year ago. She limited sugar, replaced soybean/corn oil with butter, coconut and olive oil and 2 whole eggs, and also added some garlic and a little cocoa and is at 120 and 60.