Maggie had been doing well on her prevention program, enjoying enviable cholesterol levels. In fact, Maggie had nearly been within the intensive targets we use to tip the odds in favor of completely shutting off, even reversing, coronary plaque. I call this set of targets The Rule of 60: HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less. (By the way, this can be achieved in many people with little or no prescription drugs.)
Last fall, her last set of cholesterol values were:
Total cholesterol: 149 mg/dlLDL cholesterol:** 67 mg/dlHDL cholesterol: 73 mg/dlTriglycerides: 43 mg/dl**
Maggie had a wonderful series of holidays, starting with Thanksgiving and ending with a New Years' celebration. Not surprisingly, Maggie's holidays involved a frenzy of indulgent eating: cookies, cakes, pies, stuffing, potatoes, candies, etc.
Maggie returned to the office in January 6 pounds heavier with the following cholesterol values:
Total cholesterol: 210 mg/dlLDL cholesterol:** 124 mg/dlHDL cholesterol: 57 mg/dlTriglycerides: 144 mg/dl**
In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol.
At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy.
Having done thousands of lipoprotein panels (testing that reveals the underlying changes), I can tell you that, beneath the surface, the following has occurred:
- Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood.
- Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via the enzyme, cholesteryl-ester transfer protein (CETP) activity. Smal LDL is much more likely to cause heart disease, by the way.
- Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL.
The critical factor in Maggie's holiday overindulgences was carbohydrate intake, i.e., foods made with sugar, wheat flour, and cornstarch. This triggered a domino effect in cholesterol and lipoprotein patterns that can be misinterpreted as excessive fat intake or a genetic predisposition. It is nothing of the kind. In fact, while overdoing the goodies, had avoided the butter, fried foods, and other oil-containing foods. Her excesses had all been the sweets and baked goods.
I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future, opting instead for more raw nuts, oils, non-starchy foods, and minimizing goodies. She will revert promptly back to her 60-60-60 values.