Tag Archives: HDL

Dieting for Risk Factors

With the usual caveat that I am not a medical professional, I want to propose an idea for your consideration. I would encourage you to discuss this idea with your doctor before embarking on any diet plan.

I think it makes sense to first identify your individual risk factors for the things that kill us. The Centers for Disease Control (CDC) publishes charts showing the leading causes of death for men and for women. Looking at the charts you see that heart disease is the leading cause of death at about 27% of all deaths. We tend to focus on those stats and work to minimize our chances of dying from heart disease. That’s certainly the approach taken on a society-wide level with the low-fat diet recommendations (the low fat diet is thought to reduce serum cholesterol levels leading to less heart disease, although many of us find that it increases cholesterol instead.) What I think we are ignoring is that our individual risk factors may be for something entirely different. Remember, that heart disease is not the cause of death for a majority of the people … 73% of them, in fact. Are we increasing our risk of dying early by trying to reduce our risk for heart disease?

The American Heart Association (AHA) identifies the risk factors for heart disease in two categories, those you can change and those you cannot. The categories are a mistake, in my view. It is the risk factors you cannot change that may be the most susceptible to changes in diet: age, sex and heredity. 83% of the deaths due to heart disease happen after age 65, so time is on your side if you are younger than that. Males are more susceptible to heart disease, and have a higher incidence of dying younger than that age 65 statistic. And family history, including race, plays a factor.

The factors you “can change”, according to the AHA, are things like tobacco use, obesity, high blood pressure, serum cholesterol levels, activity levels, and diabetes.

The standard treatment to reduce risk factors for heart disease is a low fat, relatively high carbohydrate diet and prescription drugs to lower cholesterol. The prescription drugs are necessary because many people find a low fat, high carbohydrate diet raises cholesterol (especially triglycerides). Low carb diet advocates challenge this view, and note that many people find a low carb diet improves their lipid profile without the use of prescription drugs (as well as improving weight, high blood pressure and other factors).

The problem is that there is no easy way to score these factors. Do you check off each factor, and if you have more than three, start to worry? Or is family history such an important factor that it, by itself, compels you to work to reduce your risk? Certainly, if your parents and all your siblings died of heart attacks, you probably realize it “runs in your family.” But for most of us, even getting the full list of risk factors isn’t enough to tell us if we, personally, are at risk.

The place to start is a doctor who knows your medical history. Ask him point blank: what do you think I’m going to die from? The answer will be about risk factors for the diseases on those CDC charts, and which one your history indicates the greatest risk for you. Heart disease and cancer are at the top, by a large margin. But as you read down the list, you see stroke, respiratory disease, and diabetes.

Its interesting that diabetes is a risk factor for heart disease, and diabetes itself is the 6th leading cause of death.

My largest risk factor, given my family history and age, sex and physical condition is diabetes. Several people in my family, a brother and my mother, have adult-onset diabetes. I’m male, over 50, and have more than two of the markers for “metabolic syndrome” (pdf file from CDC on metabolic syndrome). In contrast to that, I have very little heart disease in my immediate family.

My doctor recommended a low carb diet to reduce my high triglyceride level; success is shown by lowering triglycerides from 462 to 113 on my last blood test. I’m staying on it to lower my weight and blood glucose level, as well as meet the other cholesterol goals (HDL, LDL, etc., as shown on the About Page).

The term “diet” is often associated with a reduced calorie, temporary eating regimen that you abandon after reaching a weight goal. The problem with this approach is that it ignores the very real impact your diet has on your health. The real goal should be to live longer, not simply to lose weight and “look good”. A pretty corpse is still dead.

Your diet should reflect the best bet to protect against your individual risk factors, and not to fulfill a broad societal goal.


Since March 11, 2009, I have not had a single meal knowingly “off plan” … even while visiting Disneyland, notorious for its horrible choices. Its not that I’m a paragon of virtue and possess great willpower; the low carb diet suits me. And I’m never hungry.

The main reason for trying a low carb diet was to reduce my triglycerides from 462 and try to hold off the onset of diabetes. Having been given the word that I have more than three of the markers for “metabolic syndrome”, and have a great chance of becoming diabetic, I realized it was time to get serious. Past attempts at reforming my cholesterol included a low fat diet and exercise I adhered to for several years, but I was miserable. And my cholesterol numbers got worse, not better. Most “low fat” foods are also “high carb”, and I was employing the wrong tactics.

At my last blood test, my triglycerides were down to a respectable 113. I have some work to do to raise HDL, the “good cholesterol”, but increases in good fats, rich in omega 3’s, should help in that regard (my HDL has risen from 20 to 31, but should be above 40).

Weight loss isn’t my primary goal, but from a high of 248 pounds sometime before starting on low carb to my current 215 pounds is a plus. I’m on the verge of leaving an “obese” BMI and entering the range of merely “overweight”. In two years, I should be closer to my goal, 195 pounds (calculating at the average of 1 to 2 pounds lost per month).

So its all good. I talk about the immediate benefits I saw on the About page, and none of those problems that fell away so quickly have returned. No GERD, blood pressure remains normal without medication, even the more personal issues have resolved nicely. Its hard not to trumpet the benefits of the diet to everyone, but perspective demands that I realize what has worked so well for me might not work for everyone.