We get the statins even though they can be extremely toxic and can even cause death. We don’t have any data showing that they will make us live longer. We believe that they can reduce the cholesterol levels of practically everyone, even though the evidence shows that few people besides middle-aged men who have already had a heart attack will benefit.
In spite of all the misinformation out there about cholesterol, diet, and the statins, we have actually come a long way. As recently as 1961 we didn’t have the technology to distinguish between “good” HDL and “bad” LDL cholesterol much less the newer technology that allows us to differentiate between different cholesterol subtypes and particle sizes. These alternative lipid tests include the Vertical Auto Profile test or VAP, Nuclear Magnetic Resonance or NMR, Lipoprotein Particle Profile or LPP, and the cholesterol test from Berkeley HeartLab.
For years I have been interested in and have written about these alternative lipid tests. Most doctors, however, don’t know anything about them. Even respected nutritionist Mark Sisson, who writes Mark’s Daily Apple, has concerns about them. A year ago he wrote that he didn’t think they were accurate enough. Since Dr. Bowden recommends that we use one or another of these alternative lipid tests, I asked him how he would respond to Mark’s evaluation.
“Mark’s probably right that the earlier versions of these tests were not perfect,” Dr. Bowden told me. “But some of the problems he mentions-- like getting different results from two different labs-- are well known to happen with all kinds of blood measures, certainly not just this one.
“In any case, the tests these days are pretty darn good and, more importantly, even if they were 10% off they're still providing the only information that means a thing in cholesterol testing, which is particle size and number. That makes them, in my book, a zillion times more valuable than the old-fashioned cholesterol test. I’d rather have a 95% accurate test that tests the right thing than a 100% accurate test that tests something that’s irrelevant.”
Knowing that you have a “high” LDL level is pretty much a useless piece of information, Dr. Bowden says, unless you know how much of your LDL is the small, dense kind (which is harmful) and how much is the big, fluffy kind (which isn’t). And a much better way to predict heart disease is to calculate your ratio of triglycerides to HDL.
In one study published in Circulation, the journal of the American Heart Association, people with the highest triglyceride-to-HDL ratios had 16 times the risk of developing heart disease than those with the lowest ratios. “If you have a ratio of around 2, you should be happy, indeed, regardless of your cholesterol levels,” while a ratio of 5, “is problematic.”
One of the most pervasive myths we have is that a low-carb diet will lead to dangerously high lipid levels. Since I have been following a very low-carb diet since 2007, I looked up my ratio of triglycerides to HDL in my most recent lipid profile. I’m not very good at numbers, but I could see that this number was okay: my triglyceride level was 79 and my HDL was 73, so my ratio seems to be a quite acceptable 1.08. In June 2004, before I started a very low-carb diet, my triglyceride level had been 160 and my HDL was 27 -- for a dangerously high ratio of 5.93.