12.10 Cholesterol

The start of my jour­ney to get my choles­terol un­der con­trol was the ini­tial blood test I had in Septem­ber 1998. My prepa­ra­tion for the test was atro­cious. You can read about it in the “The Choles­terol Diet” sec­tion above.

Here are the re­sults of the test.

Cholesterol <200 261
Triglycerides 10–150 215
HDL 40–60 60
LDL <130 158
Chol/HDL ratio <5.0 4.4

The re­sults came back with a to­tal choles­terol of 261. At that time a val­ue less than 200 was thought to be healthy. At 261 my to­tal blood choles­terol was dan­ger­ous­ly high. Sim­i­lar­ly my triglyc­erides and LDL were far above their nor­mal ranges.

The only bright spot was my HDL, which was 60. HDL stands for high den­si­ty lipids and is the good choles­terol. LDL stands for low den­si­ty lipids, or the bad choles­terol.

An im­por­tant ra­tio is to­tal choles­terol to HDL. The low­er this is the bet­ter. In my case it was 4.4, well in the healthy range.

My doc­tor want­ed to put me on drugs. I didn’t want to do this un­less it was ab­so­lute­ly nec­es­sary be­cause drugs have side ef­fects, and I had read that there were oth­er ways to solve the prob­lem. So I start­ed to do the re­search. I read some books and I searched all over the In­ter­net.

The book I found the most use­ful was Fat Free, Fla­vor Full by Dr. Gabe Mirkin. His the­sis was that most peo­ple could get their choles­terol un­der con­trol by go­ing on a diet that had 10% fat, 10% pro­tein, and 80% com­plex car­bo­hy­drates. “Fruits, veg­eta­bles, whole grains, and beans” he said over and over. This was con­sis­tent with oth­er ma­te­ri­al I read.

I stuck to this reg­i­men for a year, then I went back for the retest in Septem­ber, 1999. The re­sults were hand­ed to me in an en­ve­lope. I wait­ed un­til I got to my car to read them. It was a good job that I did. When I saw the re­sults I whooped and hollered (for­tu­nate­ly all the win­dows were shut). Here are the re­sults:

Cholesterol <200 199
Triglycerides 10–150 208
HDL 40–60 48
LDL <130 109
Chol/HDL ratio <5.0 4.1

My to­tal choles­terol had fall­en to 199, just in­side the nor­mal range. I had gone from 261 to 199, achiev­ing a 24% re­duc­tion in my choles­terol with­out tak­ing any drugs!

My LDL was in the nor­mal range also. I had gone from 158 to 109, a 31% re­duc­tion.

That there wasn’t much change in the triglyc­erides was a dis­ap­point­ment.

The oth­er dis­ap­point­ment was that my HDL had fall­en. Still, that had to be ex­pect­ed. If I went on a diet that re­duced blood fats, then I should ex­pect that all blood fats would be re­duced, even the healthy ones. How­ev­er, the news on HDL was not all neg­a­tive. The to­tal choles­terol to HDL ra­tio was now 4.1, an im­prove­ment over the pre­vi­ous year’s val­ue of 4.4


After 1999 I didn’t have a fast­ing blood test un­til March 2003. Here are the re­sults.

Cholesterol <200 228
Triglycerides 10–150 267
HDL 40–60 53
LDL <130 122
Chol/HDL ratio <5.0 4.3
Liver enzymes
sgot/ast 0–37 45
spgt/alt 6–37 61

The re­sults were dis­cour­ag­ing. My to­tal choles­terol was 228, up from 199. My LDL was 122, up from 109. But the bad news was that my triglyc­erides were as high as they’d ever been—267, up from 208.

As of 2003 I had been hav­ing a par­ty for 46 years. I start­ed drink­ing beer se­ri­ous­ly when I was 18 (the le­gal drink­ing age in Eng­land) and added wine a cou­ple of decades lat­er. I knew that as I got old­er I would have to cut down. In­deed, I had been mea­sur­ing what I drank for some time. In the ear­ly 1990s I drank two light beers and 21 oz. of 11.5% wine each night. A few years lat­er I changed to one light beer and 17 oz. of 13% wine.

One of the ef­fects of al­co­hol is to raise the triglyc­erides. Another is to raise the liv­er en­zymes. In pre­vi­ous tests only the triglyc­erides were a prob­lem. But in the March 2003 blood test, the liv­er en­zymes were no longer in the nor­mal range.

I knew it was time to bite the bul­let and cut back on the al­co­hol. As of March 29, 2003, I start­ed drink­ing two 5 oz. glass­es of wine each night and I switched to non-al­co­holic beer.

The Portfolio Diet

After my 1999 test I con­tin­ued re­search­ing choles­terol. Ear­ly in 2003 I read an ar­ti­cle on re­search into the “port­fo­lio” diet. PMID 16522904, also ap­pendix 4.

Para­phras­ing the re­searchers, they said, “OK, there have been stud­ies show­ing that bran flakes low­er choles­terol and soy low­ers choles­terol and beans low­er choles­terol and so on. Sup­pose we put all of these in­gre­di­ents into one diet and see what hap­pens.” The re­sults were startling and spec­tac­u­lar. They achieved a 35% re­duc­tion in choles­terol.

So for a month pri­or to my June 2003 test I went on the Port­fo­lio Diet. This wasn’t too far from my nor­mal diet. I em­pha­sized okra and egg­plant a lit­tle more. I added a tea­spoon of psyl­li­um (Me­ta­mu­cil) in wa­ter to my lunch and my late night snack. I also added an ounce of al­monds to my late night snack.

In a three month pe­ri­od, I re­duced my al­co­hol in­take and adopt­ed the Port­fo­lio Diet. The re­sults were spec­tac­u­lar:

Cholesterol <200 174
Triglycerides 10–150 129
HDL 40–60 52
LDL <130 96
Chol/HDL ratio <5.0 3.3
spgt/alt 6–37 43

My to­tal choles­terol dropped to 174, the low­est since I have been keep­ing records. My triglyc­erides were 129, the first time they were ever in the nor­mal range. My LDL was a low 96. My spgt/alt liv­er en­zyme was much im­proved, hav­ing gone from 61 to 43, but it was still above the nor­mal range.

An in­ter­est­ing re­sult from this test was my HDL lev­el. I had re­duced my to­tal choles­terol to a low lev­el, but my HDL had not gone down. It was rea­son­ably high at 52. My to­tal choles­terol to HDL ra­tio was a healthy 3.3.

The ques­tion here is this: my to­tal choles­terol dropped to its low­est lev­el since I have been keep­ing records, so why didn’t the HDL drop pro­por­tion­ate­ly? My sus­pi­cion is that the mech­a­nism of the Port­fo­lio Diet is to sop up LDL choles­terol while not chang­ing the rest of the fat pro­duc­ing mech­a­nism very much. How­ev­er, this is just the mus­ings of a lay­man and needs to be proved or dis­proved by qual­i­fied re­searchers.

To quan­ti­fy the mag­ni­tude of the change in my HDL lev­els, it’s use­ful to com­pare the ra­tio of my HDL to to­tal choles­terol in each of my blood tests:

Date HDL Total Ratio
9/98 60 261 .23
9/99 48 199 .24
3/03 53 228 .23
6/03 52 174 .30

Pri­or to go­ing on the Port­fo­lio Diet the ra­tio was sta­ble. In the last test it was much im­proved.

When I start­ed on my quest to bring my choles­terol un­der con­trol, the med­i­cal com­mu­ni­ty fo­cused on LDL, the bad choles­terol. Since then, LDL has been shown to be a poor pre­dic­tor of fu­ture car­diac dis­ease. About half the peo­ple who have car­diac events have nor­mal LDL. Nowa­days, the fo­cus is on HDL and triglyc­erides.

Niacin and some oth­er drugs raise HDL. How­ev­er, stud­ies have shown that this does not im­prove mor­tal­i­ty. The oth­er way to raise HDL mod­est­ly is by en­durance ex­er­cise.

Mt. Wash­ing­ton is one of my fa­vorite places. Mary Ann and I hiked up it ev­ery year. When I found out that peo­ple over 70 en­tered the Mt. Wash­ing­ton Road Race (MWRR) and walked up the moun­tain, I de­cid­ed to en­ter.

More peo­ple want to par­tic­i­pate than can be ac­com­mo­dat­ed so there is a lot­tery. Just be­fore the lot­tery re­sults were an­nounced in March 2009, I found I had can­cer. I had won a place in the race and I was able to use it to se­cure a place in 2010. I spent six months train­ing on a tread­mill and it was gru­el­ing.

In April 2010, two months be­fore the MWRR, I had a fol­low-up vis­it with my on­col­o­gist. I asked him to add a lipid pro­file to the blood test. Here are the re­sults:

Cholesterol <200 199
Triglycerides 10–150 80
HDL 40–60 60
LDL <130 123
Chol/HDL ratio <5.0 3.32

Triglycerides/HDL Ratio

In 1998 doc­tors fo­cused on to­tal choles­terol and LDL. Since then it has been found that triglyc­erides (TG) and HDL are bet­ter pre­dic­tors of car­dio­vas­cu­lar dis­ease. An es­pe­cial­ly im­por­tant num­ber is the TG to HDL ra­tio. A val­ue un­der 2 is con­sid­ered healthy, 4 is high risk, and 6 is very high risk. Here is a re­view of my TG/HDL ra­tio over the years.

9/1998 261 158 215 60 3.58 Initial test, before SWLL
9/1999 199 109 208 48 4.33 After one year on new diet
3/2003 228 122 267 53 5.04 Cut alcohol after this test
6/2003 174 96 129 52 2.48 Added Portfolio Diet
4/2006 179 98 147 52 2.83
4/2007 180 99 117 58 2.02 Living the Portfolio Diet
4/2008 187 108 108 57 1.89
4/2010 199 123 80 60 1.33 Train for the MWRR
9/2011 200 124 117 53 2.21 No race training in 2011
8/2012 185 109 102 56 1.82 Two months after 2012 race
4/2015 186 100 114 63 1.81 Most recent lipid profile

Here are the con­clu­sions I draw from this table.

At the start I was in a pre­car­i­ous sit­u­a­tion. Both my to­tal choles­terol and my TG/HDL ra­tio were dan­ger­ous­ly high.

After be­ing on Dr. Gabe Mirkins high com­plex car­bo­hy­drate, low fat diet for a year, my to­tal choles­terol dra­mat­i­cal­ly im­proved. The down­side was that my TG/HDL ra­tio, which was al­ready dan­ger­ous­ly high, got worse. It was dur­ing this year that I lost 11 lb. even though I wasn’t di­et­ing.

The March 2003 test showed that my triglyc­erides were at an all time high. After do­ing the re­search I con­clud­ed that I need­ed to re­duce my al­co­hol con­sump­tion.

For the June 2003 test I was al­ready on the low al­co­hol reg­i­men and I changed my diet to in­clude com­po­nents of the Por­fo­lio Diet. The re­sults were an all time low for to­tal choles­terol and a much im­proved TG/HDL ra­tio.

In 2010 I was train­ing for the MWRR. Once a week I would spend more than two hours on a tread­mill. Two thirds of the time was at an el­e­va­tion of 12%, speed 2.7 mph and the rest of the time at 15% el­e­va­tion, speed 2.4 mph. I did not hold onto the tread­mill. The blood test done while I was on this train­ing reg­i­men showed that in­tense ex­er­cise can low­er triglyc­erides and raise HDL.

Fi­nal­ly, the table shows the con­tri­bu­tions to the metabol­ic syn­drome score.

My HDL lev­el has al­ways been above 40, so 0 metabol­ic syn­drome points for HDL.

Since 2006 my triglyc­erides lev­el has been be­low 150, so 0 metabol­ic syn­drome points for triglyc­erides.

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