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Avoid Getting Mired In Minutia

August 24, 2009

Recently, I was in a discussion with a gentleman who was concerned about espresso. Not about how tasty espresso is compared to other coffee preperations, but he was concerned about a compound found in unfiltered coffee that can raise cholesterol in men. This is a case of missing the forest because you can’t see past the trees.

First, the espresso: the gentleman in question was concerned because of this headline: How Coffee Raises Cholesterol. With a headline like that, your average bear won’t think twice to drop the coffee. Really, the mass of gray flesh between the ears should be used to explore. Fortunately I’ve done this for you and pulled up a couple points:

  1. The rise is minor, 6 to 8%. If you already have a good lipid profile, you shouldn’t worry; this guy doesn’t.
  2. It’s a mice study. I note this because lab mice are bred specifically for their purpose. The melting pot called a human being doesn’t always express the same effect.
  3. As evidenced by this study, which shows inconsistent effects with trying to raise cholesterol through the same means. When the cholesterol rose, it was the HDL (“good” “cholesterol”), not the LDL.

So here’s a person with already elevated cholesterol worried that it might be his coffee. It’s not. It’s a multi-factor issue. Let’s take a look at a few things; first saturated fat intake and heart disease:

So the country that consumes the most saturated fat, associated with heart disease and increased cholesterol, actually had the lowest rate of the former. If you run a confidence interval, you get this:

From the physicist who ran the curve:

All statistics done in MATLAB. I found that if I define

SF = % saturated fat intake

CHD = # heart deaths per year per 100,000 men


CHD = (-4.734 +/- 2.003)*SF + (144.5 +/- 21.4)

+/- errors are standard deviations (i.e. one sigma) with an R^2 = 0.13 (terrible) between the fit data and experimental data.

The plot I provided shows the baseline along with a top and bottom curve which are the 95 % confidence interval lines (~1.96 sigmas).

Although the statistics appear fairly poor, we can make one statement of interest. A positive slope is equivalent to a positive correlation between CHD and saturated fat (i.e. saturated fat bad!) and a negative slope is a negative correlation (i.e. saturated fat good!). Evaluating that statement using confidence intervals we have a 0.9 % chance of a positive slope and a 99.1 % chance that the slope is negative.

In other words, increased saturated fat intake is 99 % likely to be correlated with decreased incidence of death from heart disease.

As its understood now inflammation, specifically high levels of C reactive protein, is a better indicator of heart disease risk. The work of Dr. Paul Ridker (and others) can be thanked for bringing this to the forefront:

These data suggest that the C-reactive protein level is a stronger predictor of cardiovascular events than the LDL cholesterol level and that it adds prognostic information to that conveyed by the Framingham risk score.

Which isn’t to say LDL shouldn’t be watched, but the tiny oxidized LDL is the “bad” lipoprotein while the big fluffy LDL are just doing their job: taking cholesterol to the cells that need it. Unfortunately a simple blood panel doesn’t show us which is which. So as long as both CRP and LDL are in a “safe” range you’re OK, right? Right?

Well, not exactly. The Tsimane tribe, of Amazonian Bolivia, have a very high level of CRP and yet low rates of heart disease. More to the point, there are groups with extremely high sat fat intake, normal cholesterol, and low heart disease (Masai, Tokelau). There are also groups with low sat fat intake, normal cholesterol, and low heart disease rates (Okinawan, Kitava). So different diets, different diet composition, nearly non-existent western diseases. Why is that?

A western diet, specifically our diet, isn’t high in sat fats. It’s high in junk: Omega 6 fatty acids and high GI carbs in abundance. Both have been demonstrated to dramatically increase systemic inflammation, which ties to CRP numbers. Couple that with chronic stress than many westerners have and you have a recipe for a high chronic inflammation soup…the perfect environment for heart disease. We’re also the nation of the magic bullet, so asking a person to change their diet and reduce their stress and get more exercise…doc, just give me a pill! Of course, there is no such thing.

What the native diets have in common, what we fail at so miserably as Americans, is this: they eat real food, we don’t. They get their carbs from roots, fruits, and veggies; we get ours from boxes and plastic bags. They get their meat grilled from fresh game; we get ours chicken fried. They eat to live; we have become a nation of orthorexics. If one was to shop the border of the supermarket only, you’d be on a fast track to great health.

So What’s The Take Home?

  1. My original point is that getting mired in minutia, namely worrying about a compound that can raise cholesterol levels in humans though is poorly reproduceable in studies, will only raise your stress, increase your inflammation and give you a heart attack!
  2. Its more complicated than blood markers, though they have to be taken into consideration.
  3. Instead, focus on what you can control and keep it simple: Eat Real Food. Eat Real Food. Eat Real Food!

4 Comments leave one →
  1. August 25, 2009 2:03 am

    Great post! Unfortunately, it’s about as easy to convince most people to change their diet as their religion or political party.

  2. David Sears permalink
    August 25, 2009 5:33 pm

    Excellent post, I’ll send this one to some friends of mine.


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