Jimmy Moore's Cholesterol Clarity ~ Ongoing Review and Information ~ Most Recent Update 9/19/13

The original opening to this post can be read by scrolling to the end or using your browser search function to find ##### .

The intent of a single post is that for as long as this content is relevant, I will add new information to this post and "bump" it to the top of the feed.  If it grows to be unmanageable, I'll have sections with search strings for easy navigation.  For now, each update will get popped to the top of the feed reader.  New "entries" will be at the top, and will be separated from prior content with "▼▼ Content added XX/XX/XX ▼▼".    Different topics within each update will be separated by ***** and a horizontal line ... like this:

***** ▼▼ Content added 9/19/13 ▼▼ 

Interpreting Cholesterol Panels?

The final chapter of this book contains a series of 30 lipid and other marker profiles.  They are mixed up and this is presented as a means of doing some practical application of the information in the book.
Your mission (if you choose to accept it) is to interpret them based on everything you’ve learned. See if you can identify those with healthy results, those who could stand to improve their numbers, and those who have poor health risk markers.
Now, some are taking meds, there's a diabetic, some taking meds (statins or other) and a few with genetic markers, etc. so there's no way to really do any sort of fair appraisal.  I skipped this entirely when I read the book, but something prompted me to give it a second look.    So I took the liberty of summarizing the results for TC, LDL, HDL, trigs, and LDL-P for all but one example where LDL and TC were missing.  I included the ApoB on the three where it was included but left off the rest.  I wanted to summarize as much for the parameters reported for all.  Also, in the book Chris Masterjohn (and others) discussed the TC/HDL ratio being important as well as non-HDL-C.  The latter tracks well with ApoB.  In the book Chris did not put a number on this to shoot for, but one of Jimmy's experts, Dr. Davis, puts the goal at under 130 (hat tip Charles Grashow).  As for the TC/HDL, a cut-off of 3 is generally thrown around, keeping in mind that a "high end normal" TC and usual HDL would give a ratio of 4.  

So, here are the profiles.  

The top row is "healthy markers".  I kid you not.  You have five profiles there with TC around or above 300 and one exceeding 400 (which Jimmy Moore's has more recently as well).  You have one LDL exceeding 300 and one pretty close, and five that are near or over 200.  While the HDL's are high in some, most are pretty "normal" so they aren't pulling most of these folks out of the risk-fire.  Considering that one of the experts you "learn from" in the book is Dr. Dayspring, I think his guidelines (in addition to Davis') are interesting to note here.    For all the grumblings over triglycerides, Dayspring's #1 addresses them first if over 500.  The 400-500 threshold is pretty common and, while it may need to be addressed in light of LDL-P, look at the segment in the middle row-left.  Those 8 profiles are deemed "some work needed", as opposed to those above them and it is clear that Jimmy determines this with the arbitrary benchmark of triglycerides over 100.  Keep in mind that 150 is the high end of normal that is generally accepted and only one of the six skirts close to that.  If Jimmy wants to say that LDL-P matters, then he's got a tough time of it justifying himself as "healthy" - small LDL-P not being recognized as a reliable marker the context of his astronomical LDL-P.  

Now it is of interest here that you have high LDL-P in this group with normal trigs, but most have elevated LDL and TC.   I have no quarrel with the "poor" designees (middle right block) except it is interesting to note that their trigs are higher without much more elevated LDL-P compared to the middle group.   Indeed looking at all of these -- including that outlier there in the upper right, which would be Jimmy -- LDL-P and triglycerides don't seem to track with one another.  Jimmy Moore and a few doctors have arbitrarily chosen triglycerides as the marker "that matters", but as I intend to show in an upcoming post, they are probably picking the long odds marker here.  

In any case, none of these have "immediate attention required" trigs per Dayspring so we proceed to #2 on his list:
2) Look at the LDL-C, because if it is above 190 mg/dL, drug therapy is indicated no matter what else you find. At lesser levels it depends on the risk of the patient whether drug treatment is indicated.
Five of fourteen "healthy" folks meet this criterion, and a sixth comes within a couple of points.   By contrast, nobody in the "some work needed" or "poor" categories meet this.   I should have included gender, but all but one of the "poor" meet this criterion.  And then there's the TC/HDL ratio under 4.   You have two healthy and four middle group that exceed this.  Dayspring also puts non-HDL-C at 130 and ten of the healthy people fail here!  Many by quite a lot, not just a little bit.  The healthy are certainly less so compared to those that need work again by this parameter.

Did Westman read this section?  Did he offer up any Doctor's Notes?    The answer to the second question is NO.  I ask why not?

Jimmy definitively quizzes readers and concludes he is healthy because of "markers that matter" -- to him.  Nevermind ALL OF THE SCIENTIFIC RESEARCH that counters his conclusions.  This is why this book is downright dangerous if you ask me.

Here's a simple question to ask any of these LC docs and let's see if they'll answer it:  Would a ketogenic diet protect a person who is homozygous for familial hypercholesterolemia?  As in would lowering triglycerides and/or raising HDL improve their outcome or negate their very-high LDL?  I think we know the answer to that but I also doubt we'll hear it voiced by any of these folks.

What's that block in the lower left?  Well just for reference I included the two case studies in Robb Wolf's Reno first responders study paper.  On the left are the "before" profiles (Case 1 and 2), and on the right "after".  It is worth noting that both cases involved statins with no mention of "titrating off" or miniscule doses, and Case 1 involved undisclosed "more pharmaceuticals".   Do you notice anything?    First off, Case 1 is likely not LC and yet a case could be made that he bests most of the "healthy" markers in Jimmy's book.  Case 2 didn't look all that bad in the lipids department to begin with except for the HDL which came up to a respectable level -- while LDL-P went DOWN.  

I suspect that this is one reason Robb Wolf ultimately either wasn't interviewed for the book or wasn't included, though I'm not sure who did the ultimate declining there.  I also suspect this is but one reason why Robb hasn't joined the parade of 5 Star reviews over on Amazon.

***** ▼▼ Content added 9/8/13 ▼▼ 

Familial Hypercholesterolemia

Chapter 14 Nine Reasons Why Cholesterol Levels Can Go Up, Topic 4, p. 151 

Jimmy writes: 
I was surprised the first time FH was indicated on my cholesterol test results. So when I decided to write Cholesterol Clarity I figured I’d take the plunge and get tested for it. Was my high total cholesterol that has been in excess of 400 at times due to FH or something else?  In April 2013, I paid $1,200 to Ambry Genetics (Ambrygen.com/tests/familial-hypercholesterolemia) and the results would probably surprise the cardiologist whose note is reprinted above: According to my LDLR and ApoB genes, I have a “significantly decreased likelihood” of FH.
This was a wasted $1200.  As Jackie Eberstein had pointed out to him years ago, having a normal lipid panel in October 2005 pretty much took genetics out of the picture.  Jimmy Moore is 41 y.o. and this sort of thing is likely not first diagnosed at his "advanced age" (for the condition).  But here is a quote that I consider to be one of THE most irresponsible things I've read in this book that is chock full of irresponsibility:
Dr. Jeffry Gerber, who assisted me with getting this test run, confirmed that “the results are most favorable for you. May your LDL-P continue to rise and may you live a long and healthy life.”

Was this said in jest?  Maybe??  Although I cannot see why a doctor would joke about such a thing.   The graphic at right, from this analysis of Framingham study data, is pretty damning of LDL-P.

Why would anyone wish someone's LDL-P to continue to rise?  Or even stay as is?

I think this also brings Westman's co-author role into question. In his podcast interview with Diane Sanfillipo Jimmy pretty much describes Westman's input as after the fact comments. Those "Doctor's Notes". None here in this chapter. Did Westman read Gerber's comments? No alarm there?

In this section Jimmy again quotes Dr. Dayspring:
“Cholesterol in the blood might correlate with heart disease in a population, but it can never be used by individual patients because of the propensity for discordance between cholesterol and atherogenic particle measurements. It takes cholesterol getting into the artery wall to kill you. And because all lipids—including cholesterol and triglycerides—are trafficked as passengers inside the lipoprotein, it’s the type, the number, the quality of the lipoproteins that determine whether the little dump truck [lipoprotein] carrying the cholesterol molecules is going to invade your artery wall or not.”
Unlike many of Jimmy's experts, Dayspring is/was familiar with Jimmy Moore's lipid profile and diet.  He called it a "nightmare" and specifically suggested to him that he try reducing saturated fat in his diet, and if that failed that he should consider statins.   Those aware of Dayspring's views know that the bolded part is referring to apoB "tagged" LDL particles.


My Review on Amazon

I will probably be doing a separate post on the fall-out from this review.  Here is the link.  The comments on my review and one left by Dorothy Brewster are enlightening to say the least.  
Upon seeing the cover of this book, many people may get excited ... Finally a book for us patients that can help sort out some of the issues that arise when that lipid panel comes back from the lab, complete with the scary risk notations in the margin. Such a book is sorely needed. This is not that book.
Jimmy Moore has missed a golden opportunity to truly help educate people on the controversies and the current consensus on the significance (or lack thereof) of the various biomarkers and measures for assessing cardiovascular risk. This is evident in that one of the most controversial and important topics of the day in lipidology -- LDL particle number vs. LDL particle size -- is all but avoided in the one chapter devoted to the topic. This is such a disservice to those who might recognize the names of Dr. Thomas Dayspring and Dr. Ronald Krauss and purchase this book in hopes of learning more from them. Save your money.
Instead of engaging Krauss and Dayspring (and a few other true experts interviewed for the book) in a genuine dialog, Jimmy Moore has reduced this important and complex topic to a series of sound bite-style quotations (called Moments of Clarity), cobbled together with his highly biased commentary, and finished off with often banal Doctor's Notes from co-author Dr. Eric Westman. What value there is, in some of the sound bites, is diluted with quotes from "experts" with absolutely no qualifications or knowledge to be designated as such. Most are merely known within the low carb internet community and have perhaps been a guest on one of the author's podcasts.
Let's say there is a major capital improvement initiative under consideration in your town. The stakes are high and the outcome, one way or the other, will impact you personally for decades to come. Would you want to base your decision on the 30 second commercials put forth by political interest groups? Worse yet, on only those commercials a biased media outlet chose to carry? Of course not. You would attend the town hall meeting. Jimmy Moore could have brought you this town hall meeting. Instead he is the biased media outlet bringing you sound bites.
If you have troublesome cholesterol levels and want a book to convince you there's absolutely nothing to worry about, this is the book for you. If you want unbiased information to assist you to work *with* your doctor, this is not the book for you.
You will get far more information from two interviews Krauss did with meandmydiabetes: LDL Cholesterol - Ron Krauss MD and Ron Krauss - Saturated Fat? Red Meat? It Depends. Thomas Dayspring has a nice PDF on his views entitled Understanding The Entire Lipid Profile. The other experts? If you want to get the "full skinny" from Chris Masterjohn PhD, you are better off listening to his three part podcast (or read the transcripts) with Chris Kresser. Forget Gary Taubes and Mark Sisson, neither of whom has ANY special training or demonstrated knowledge of the topic. Instead, you might be interested in the free, informative, two part guest post on Sisson's Mark's Daily Apple blog by Taubes' NuSI partner, Dr. Peter Attia: The Straight Dope on Cholesterol: 10 Things You Need to Know.
Jimmy Moore has assembled an ... eclectic ... group of "experts" with a clear bias among the vast majority, and the opinions of the minority are either absent or even misrepresented by selective quotations. Most appear so blinded by their views on statins that they seem incapable of separating the issues of lipid profiles from statin treatment. Perhaps statins aren't the answer, but adopting a diet that sends your LDL through the roof may still be ill-advised.
So I purchased a copy of this book and am writing this review so that potential customers will have at least one critical pair of eyes on it. The eyes of someone who did not receive a promotional free copy or who might benefit in some ancillary way from leaving a gushing review for Jimmy Moore.
This is not the sort of book to take with you to the doctor and expect to have any sort of constructive conversation to ensue about YOUR health. Most of the MDs have no special training or experience with lipidology and are simply making up their own theories on cholesterol. Before taking any of the sound bites to heart, potential readers would do well to search on The Livin La Vida Low Carb Show and the expert's name to find where Jimmy has published the full interviews behind this book. You can listen to all of them for free.
One major theme of this book is that your doctor has outdated misinformation and is relying on your total cholesterol to put you on deadly statins to make a quick buck for their friends in Big Pharma (the unspoken accusation is that the docs themselves profit from prescribing these drugs). And yet one of these very same "experts" -- The Hamptons Diet author Dr. Pescatore -- is selling a cholesterol lowering supplement on his website! What's in it? Red rice yeast. A statin. Wikipedia has the scoop.
So while many of the MDs and others chime in on how stupid and uninformed your doctor is, they proceed to provide you with unsubstantiated wisdom like (paraphrasing) 'a low carb diet is the best to get your cholesterol where it needs to be' (Pescatore again). But "While he does test for cholesterol levels in patients who request them, 'I never do anything about it. You need to see the whole picture and not focus too much on any one marker,' Dr. Pescatore explained." Odd that he sells a statin-containing cholesterol lowering supplement then.
A second major theme is that fat and saturated fat have no impact on weight or cholesterol levels and carbohydrates do. And yet the aforementioned Pescatore says: "I don't think medical science has any idea why LDL-P would rise above 2,000 or even 3,000 in some people who eat a low-carb [aka a high fat] diet." Yet there are multiple studies showing that saturated fats in the diet DO increase LDL in many people, and "medical science" has a pretty good idea why (search on saturated fats and LDL receptors for the answer).
The author only partially discloses his history of obesity and its relevance to his cholesterol history which is also incomplete. By telling the readers that his cholesterol has always been high he is misleading, because in fact it is higher now than when he weighed 410 lbs. More importantly it was close to normal by mainstream standards after about 10 months of maintenance of his initial 180 lbs weight loss on Atkins. He has been adding a ton of fat to already fatty meals for years now while his weight fluctuated and he hit 300 lbs in 2012. Since May of 2012, Jimmy Moore has been consuming an 80% fat "nutritional ketosis" diet to lose roughly 80 lbs at the one year mark. Aside from other health issues that may be diet related, potential readers should know that he is extremely biased by his attempts to wish his worsening metabolic profile away. If you search on 6 Month Lipid Panel for Jimmy Moore you should find his latest update before this book.
In comments, Thomas Dayspring wrote... "Dr Lipid analysis: Using all the knowledge we possess today, all of the numbers that you are thrilled about have no meaning in the face of a 99th percentile LDL-P. You also should not say an LDL-C of 285 has no meaning. The cholesterol concentrations that often have no meaning are low levels (where an LDL-P is needed to evaluate risk). No one with an LDL-C of 285 with the exception of a Type III dyslipoproteinemia patient have a low apoB or LDL-P. If you have an LDL-C that high, particle testing is not needed. You need to significantly reduce the saturated fat in your diet and see what happens: repeat the NMR in 3 weeks and you will know if your nightmare LDL-P is sat fat related. I'll bet your LDL-P drops. If it does not, you need serious lipid-modulating medication. We have seen this paradoxical horrific rise in LDL-P in some people who are on ketotic diets."

Yet here is the quote Jimmy chose for Dayspring in his chapter on LDL particles (Chapter 9):

"The least accurate way of estimating your atherogenic risk on a standard cholesterol panel would be to look at total cholesterol or LDL cholesterol."
Does this seem like an accurate reflection of Dayspring's full positions on the topic? This chapter should have contained liberal quoting from Dayspring, yet Jimmy Moore claimed on his blog that "I let him make his case in my book."
Dr. Krauss has had this to say about particle number: "But most people certainly in the field of cholesterol and heart disease understand that the number of particles matter more than just how much cholesterol they carry overall. In terms of health, the first order of business is to make sure the total number of particles in a person's blood is maintained in the healthy range, because that's what dictates heart disease risk."
Instead of this information, you get quotes like "If most of your LDL particles are the large, fluffy kind, then you don't have a problem and you have nothing to worry about." This advice comes from Cassie Bjork, who is not even a medical doctor, and has no special training in lipidology. Nevermind that people with familial hypercholesterolemia (a genetic condition characterized by both very high LDL and atherosclerosis) are known for having just that fluffy sort of LDL. And nevermind that both Dayspring would take serious issue with Bjork's advice were he actually given his say ... as it appears would Krauss.
Dr. William Davis (author of Wheat Belly) writes:
"Isn't it funny that people are turning to people like Jimmy Moore for answers to their health problems rather than their own doctors because the doctors have no damn idea what's going on?"
No, it's not funny. It is utterly irresponsible.
If anyone is interested, I have a review post on my blog for this book that shall be updated regularly with new information, including links to reliable sources of information that you CAN share with your doctor: Jimmy Moore's Cholesterol Clarity ~ Ongoing Review and Information on The Carb-Sane Asylum.
Rather than getting information from so-called experts who tell you your doctor is stupid, arm yourself with credible information from credible sources. And if your doctor won't listen, find another one. Internet doctors, and others like Jimmy Moore, will be quick to point out that they bear NO liability for the not-really-medical-advice they dole out. That's just my two cents.
People reading this may have seen my comments left on other reviews. I care deeply that people get accurate information, especially when acting on that information can impact their health. Therefore, I think it is important that folks know:

1. That many of the 5-star reviews were written by people who were provided free advance copies of the book and failed to disclose this per Amazon policy.

2. That many of Jimmy Moore's "world leading experts" are not experts at all.
3. That those experts of value in the book are either under-represented or outright misrepresented in this book.
I gave this 2 stars, only because there might be a few folks who discover the names of helpful experts through this book, and might seek further information from them. Otherwise it is a 1 star.

***** ▼▼ Content added 8/28/13 ▼▼ 

Meet the Experts

These are my cream-of-the-crop experts on the subject of cholesterol.
Jimmy Moore

Philip Blair, MD ◊
Jonny Bowden, PhD  
John Briffa, BSc, MB, BS ◊■
Dominic D'Agostino, PhD ■
David Diamond, PhD ◊
Ron Ehrlich, BDS, FACNEM ◊
Jeffry N. Gerber, MD ◊
David Gillespie (Attorney) ♦
Duane Graveline, MD
Paul Jaminet, PhD ◊■
Malcolm Kendrick, MD  Essays on THINCS
Dwight C. Lundell, MD ◊■  License suspended
Robert Lustig, MD ◊■  
Chris Masterjohn, PhD  Podcasts with Kresser Part 1  Part 2  Part 3
Donald Miller, MD ◊
Rakesh "Rocky" Patel, MD ◊
Fred Pescatore, MD ◊  Sells cholesterol lowering supplements
Uffe Ravnskov, MD, PhD
Stephanie Seneff, PhD ◊■  Statins
Cate Shanahan, MD ◊■  The LDL Weight Gain Connection
Ken Sikaris, BSc, MBBS, FRCPA, FAACB, FFSc ■ Sugar and Fat Metabolism video
Patty Siri-Tarino, PhD
Mark Sisson (BA?) ◊■
Gary Taubes, (degrees not listed) ♦■

♦ = No relevant background
◊ = No particular expertise in the field of lipidology to warrant the term expert
■ = On the record making substantially erroneous claims in the field of human metabolism/physiology such as diminish their credibility as an expert on this topic.

Note:  The above key is not "all inclusive" as there are names on that list with whom I am unfamiliar or am not aware of any evidence to warrant the symbol.  Don't shoot the messenger here if you take issue with anyone for whom I haven't awarded a symbol -- State your case in comments!   If you wish to challenge a designation, I also welcome that discussion in comments.   

Also, I'll add links folks might find of interest as I have time (this will not result in popping the feed unless I do a major link dump).  I plan on fleshing out some of these as pertains to the content of this book only.


LDL-Connection vs. Statin Treatment

One overall theme that has emerged reading this book is conflating the medical establishment's position on statin treatments with the role of LDL (or other lipoproteins or components thereof) .  These two are not two sides of the same coin.   Let's look at it this way:

1.  There is a pretty good, decades old association between circulating LDL levels and atherosclerosis.  
2.  There is a connection between diet and lipids though it is generally not as simple as dietary cholesterol and/or saturated fats raising LDL levels.  (Though this is pretty simply the case for some).
3.  Lowering cholesterol levels through diet and exercise or medications ... here is where the controversy is.  What diet is best, is raising HDL necessarily good, are statins treating the symptom but not the cause.  These are all valid questions and open for debate.  But they do not alter the "facts" of #1 and 2. 

For all the focus on diet, I'll say this.  MY opinion, to be clear.  Any dietary intervention that results in a significant worsening of one's lipid profile is probably ill advised.  The first course of action should be to reverse that dietary "experiment".

***** ▼▼ Content added 8/27/13 ▼▼ 

Meet the Author

Jimmy Moore being interviewed by the Carb-Loaded documentary guys at AHS13 (Aug. 15-17 2013).


Jimmy Moore Misrepresentations

Some of the information here has been discussed before in Hacking Jimmy Moore's Latest Lipid Report.  Jimmy Moore lost his 180 lbs in 2004 and maintained the cardio he used to do through much of 2005.  He has also increased his carbs to around 100g/day.  In October 2005, Jimmy had his lipids tested ... and they were quite normal.  

TC = 201   ,    LDL = 119   ,   HDL = 71   ,   Trigs = 57   ,   VLDL = 11

By March of 2006, things started to go awry and continued through May when he wrote this blog post.  A classic quote from Jackie Eberstein (worked as a nurse in Atkins' clinic for many years):
Regarding the hereditary business about my cholesterol being high, Eberstein said my LDL would not have been 119 in October 2005 if it was genetics.
I would tend to agree but it is possible this was a hangover from taking statins as he said his TC got down into the mid 100's on them (pre-Atkins) and elsewhere he stated he stopped taking them in August of 2005 (is it possible it was already climbing?).  By May his TC was up to 304 with LDL at 230.  

click to enlarge
For some reason, Jimmy leaves this information off of the table he shared with his readers during his Nutritional Ketosis experiment, and shares with readers in his book.  His timeline begins in 2008.  The table from the book is also missing his ApoB results that were included in his 5 year summary on his blog.

But here is the full story as Jimmy has shared over the years.

It would appear that one tactic to explain away his cholesterol levels is to imply that these have always been an issue, irrespective of his diet and/or weight status.  This is not the case, however, which is why including information he has shared from late 2005 and pre-Atkins are important for context.  Still, in his podcast interview (for those who would rather not listen, there's a transcript at that link) with Practical Paleo/Balanced Bites Diane Sanfilippo Jimmy said:
I’ve always have extremely high cholesterol levels, and that’s one of the reasons I wanted to write this book. I wanted to find out what was wrong with my numbers for myself...
Not really.   And some might be interested in this Twitter exchange that landed in my Inbox:  

Before anyone accuses me of persecuting Jimmy Moore, realize that when one lies a lot that is one thing.  When one does so in a position where they are disseminating health information and it is relevant, people have a right to know.  The above is a lie -- it is only odd that he would continue to do so when he has blogged multiple times about this issue, and is seemingly bragging about negative health markers.

The one thing Jimmy hasn't yet tried is to go back to the way he was eating and exercising circa October 2005.  

Before my 180-pound weight loss success in 2004, my doctor prescribed Lipitor for my high cholesterol. At the time, I was morbidly obese and my total cholesterol levels were 230, which he described to me as dangerously high simply because they were above 200.
~ Jimmy Moore in Cholesterol Clarity (KL 938)  
Jimmy Moore's cholesterol levels on his current diet are wildly out of the norm, not just slightly high.  While 230 is a bit lower than the 275 he reported previously on his blog, if we work off of an average of around 250 -- at 410 lbs drinking over a dozen Cokes a day and eating Little Debbies by the box (his descriptions, many times) -- something very wrong is going on with his CURRENT DIET.


Experts Out of Context

Throughout the book, Jimmy sprinkles "Moments of Clarity" featuring quotes from the various experts.  There is a controversy over whether it is particle number or particle size that matters, and it is fair to say that Dr. Thomas Dayspring is a particle number guy.  The scientific evidence favors this, and there is not much evidence to support the contention that "large fluffy" cholesterol (or the metabolic milieu underlying it) is benign or, as sometimes claimed, protective.  Indeed those with familial hypercholesterolemia (genetic very high LDL) have this LDL size pattern.  Jimmy glosses over particle number in the chapter about LDL particles (focusing on size) and clearly downplays this in favor of particle size in the Advanced Health Markers chapter.   Something I'll definitely address in the future.  
From the beginning of Chapter 9 What’s This LDL Particle Thing? we get a few quotes, among them the one below:

Anyone familiar with Dr. Thomas Dayspring would probably describe him as the "particle number guy".   He is someone who works to identify those with normal LDL-C but high particle numbers (also evident in high ApoB) that are at risk.  Indeed when Jimmy announced his six month NuttyK lipid profile, Dr. Dayspring had this to say in comments:

Yet the quote above (tan box) is the ONLY contribution from Dayspring in the entire chapter on LDL particles.  Indeed much of the chapter is a collection of quotes from the various experts.    Definitely more to come on this issue, but know that no bias went into compiling this book!  

At least at first glance, Dayspring doesn't get any say on particle number.


Original Introduction to the Post, written 8/27/13

I am not going to mince words here.  I consider Victory Belt Publishing to be an utterly irresponsible publishing outfit for publishing a health book, any health book, by Jimmy Moore ... let alone one about cholesterol.  Certainly one billed as being helpful for patients to figure out what is going on with their cholesterol levels.  As I've stated multiple times, I'm not an adherent of the simplified cholesterol-heart disease hypotheses ... but at this point, neither are most doctors and certainly most scientists working in the field.  So if we really want to get to the bottom of this mystery, we need to be looking at what the current scientific evidence is saying.  What we don't need is a tome written by someone with a monumental motivation to try to justify to himself that his nightmarish lipid profile is not so nightmarish after all.   I would like to see a doctor, especially his co-author Dr. Eric Westman, unequivocally express publicly that Jimmy Moore's lipid profile is nothing to worry about, and that his current diet is not contributing to the problems along with other health issues he downplays.

So I took one for the team, and purchased a Kindle copy.

I know all of these books have the usual disclaimers.  They aren't offering medical advice and all that ... but that this one includes 28 "experts" including many that fail to qualify for that title, it is potentially harmful to many people.  Thus I will highlight whatever I find pertinent from the book, promotional podcasts, interviews and the like, here in one post.   I would add this ... There are some prominent "good names" amongst the list of experts.  I think to a one, all would be better served to write their own books on the subject rather than allowing Jimmy Moore to benefit from their reputations and credibility and risk his relaying their information through his biased filter.  The first out of context example below is what I'm talking about.

A note to my critics:   Doing a review and gathering accurate information, is not stalking or harassing.  This is a public service for those who might be inclined to purchase this book based on the 5-star reviews already accumulating on the Amazon webs, glowing reviews on blogs and social media, and a plethora of interviews and podcasts with nary a challenging question.  Many of these are by fellow Victory Belt authors and other LLVLC-affiliated (formally or otherwise) people with financial interests of sorts in the game.    Please also understand that many of the things I will be sharing are those shared by other concerned individuals who do not have a platform to do so themselves.  If anyone has a problem with what is written here (or anywhere on this blog for that matter), you can contact me with your concerns.  


Nigel Kinbrum said…
See also http://www.sciencedaily.com/releases/2013/05/130525143852.htm , which follows-on from http://www.ncbi.nlm.nih.gov/pubmed/14695923
You Tweeted the first link on 27th May.
Dan said…
@ "And some people do absorb dietary cholesterol, including the oxidised variety."

I'm one of these people.

Unless it was related to my saturated fat intake which often comes bundled in the same package as cholesterol, since sat.fat. is notably hypercholesterolemic for many individuals (witness all the people on LC forums fretting about their elevated lipids - total, LDL, apoB, LDL-P, dLDL, etc.

The problem (and dilemma for me) is that I also had metabolic syndrome, which does not respond well to a diet in which the "calories come primarily from carbohydrate".

After a lot of weight loss and sustained amount of keeping it off, I have gradually been able to add back some carbohydrates, much of which is in the form of high-fiber-dense foods. I think getting rid of obesity and keeping it off is central to keeping metabolic syndrome at bay, and it is possible to do it on a higher-carb diet. My problem is that I also find fat to be uniquely satiating and on my current vegetarian diet can easily go 7-8 hours between meals. In fact, I've been tempted to ditch the evening meal entirely, but I don't want to induce catabolism and end up with osteoporosis or sarcopenia.

It doesn't seem like there is any easy solution to the problem of obesity. I used to think that low carb high fat diets could be universally applied without any problems or even critical thinking. But there are many people who do not do well on such diets. I would recommend a few simple dietary principles, and rotating the type of diet you consume, to see what works best. I think whole foods are also a guiding principle in all this.
carbsane said…
OK ... Sunday morning and back on the usual computer. I was having trouble accessing my own comments for a few days there ... sometimes it worked ... most times not ... and there were some comments I wanted to pay more attention to. Hopefully I can do that now!
carbsane said…
It has gotten worse since this comment. The interesting thing is that I post my review and commented about disclosures with my "real" recognizable name (Evelyn aka CarbSane). For that I get shit as I expected I would, but I did it anyway. Why? Because it makes the asshats accusing others of being me look all the more foolish ... expecially those posting under pseudonyms elsewhere.

Lots of comments on my review about what a terrible, horrible, no good, very bad person I am but nothing refuting WHAT I wrote. Typical.
carbsane said…
Gerber has one of THE most irresponsible quotes in the entire book. I'll put it in the update.
carbsane said…
This is scary. Needs addressing.
carbsane said…
Who does less well with real, whole food carbs? We NEED to tease that out from "polluting" traditional populations with an excessive SAD diet. In almost all cases there, however, fat increases and carb decreases, but type plays a role too.
carbsane said…
I'm far from a lipophobe or anti-fat. But even at AHS Paul Jaminet of all people said that humans tend to drift towards around 35-40% fat. So then how do we go from there to these 50-60-on up to over 80% fat diets?

If you're Peter Attia and your lipids are good, then fine, I suppose. But Jimmy Moore is playing Russian roulette with his health and with this book encouraging others to do so too.
carbsane said…
The problem can be summed up in Chapter 9 -- Jimmy Moore does NOT provide readers with accurate information. You can't just label all current information "dogma" and good doctors don't just reach for the prescription pad when TC goes over 200.

Here's the problem you face. Statistically zero people have ever consumed a high fat diet throughout millenia. So ... do you want to look at billions of humans and how we KNOW they ate and how their cultures thrived and fared based on documentation? Or do you want to rely on anecdotes and assurances from ill-qualified "experts" that consuming primarily bovine fats is OK?

Ketones are not magic.
carbsane said…
For me my LDL always seemed to track with my weight. So if it were me, I'd try to lose the weight and see how that goes. If LC works, go for it! It doesn't sound like you're overdoing the fat but perhaps since you're gaining weight, the effect is magnified in even small surplus?

Have you ever tried a real LF diet?
charles grashow said…

The Effect of High-, Moderate-, and Low-Fat Diets on Weight Loss and Cardiovascular Disease Risk Factors

Dietary Regimens

High-Fat (HF) Diet This diet is defined as one in which patients consume 55%-65% of their daily caloric intake in the form of fat calories. Less than 100 g of carbohydrates (RCHO) were consumed daily and protein intake constituted 25%-30% of the total caloric intake. Patients ate until satiated.

Moderate-Fat (MF) Diet Patients following this dietary program consumed 20%-30% of their calories in the form of fat. Approximately 60% of their calories were from carbohydrate sources and the remaining calories were derived from protein. Patients consumed 10–12 calories per pound per day on this diet.

MF, Calorie-Controlled (Phase II) Diet Patients following this program were asked to consume 350–500 fewer kilocalories per day than required15,20 to maintain body weight. This was determined by multiplying their current weight in pounds by 10 kcal/lb to determine the required kcal intake per day; 350–500 was subtracted from this figure to determine the desired daily intake of calories. Of these calories, 15% were protein and 70% were carbohydrate, with an emphasis on complex carbohydrates vs. simple sugars. The remaining 15% of the calories could be consumed as fat in a 2:1 ratio of nonsaturated (polyunsaturated and monosaturated) to saturated fat, with no more than 5g of saturated fat intake per day.

Low-Fat (LF) (Phase I) Diet The LF diet consisted of fruits, vegetables, a limited amount of grain/cereals for breakfast and a multiple vitamin that included 100% of the US Department of Agriculture recommended daily intake of vitamins and minerals. Patients ate until satiated. Of the caloric intake, 10% was fat, 15% was protein, and 75% was carbohydrate, with an emphasis on complex vs. simple carbohydrates as shown in Table

Only patients following HF diets showed a worsening of each cardiovascular disease risk factor (LDL-C, TG, TC, HDL-C, TC/HDL ratio, Ho, Lp(a), and fibrinogen), despite achieving statistically significant weight loss.
charles grashow said…

LDL-P (or apoB) is the best predictor of adverse cardiac events, which has been documented repeatedly in every major cardiovascular risk study.

This raises the question: if indeed LDL-P is always as good and in most cases better than LDL-C at predicting cardiovascular risk, why do we continue to measure (or calculate) LDL-C at all?

SO - if this is indeed true then how can high LDL-P on a ketogenic diet be any different than high LDL-P on any other type of diet??

Isn't a particle a particle?
charles grashow said…
People like Jimmy Moore always like to use this as proof that high LDL-C does not matter

"Half the patients hospitalized with CAD had admission LDL < 100 mg/dL and three quarters had LDL <130 mg/dL."

This comes from this study


Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines.

Here's a nice poster for the study


HOWEVER - when you dig down into the study you find this

• LDL< 70 mg/dL was observed in 17.6% of patients.

• Over half the CAD patients had HDL levels < 40 mg/dL.

• HDL >60 mg/dL was observed in only 7.8% of patients.

• “Ideal” levels (LDL <70 mg/dL with HDL>60 mg/dL) were observed in only 1.4% of hospitalized CAD patients!!

SO - doesn't this seem to indicate that low LDL-C (<70 mg/dL) IS very important as well
charles grashow said…
Has Dr William "Wheat Belly Davis" changed his tune with regard to LDL-C?


This is from 2009 so if he's changed his opinion I would appreciate a link to his updated opinion

In our clinic, we disregard total cholesterol, since it is a vague and sloppy measure that can be increased or decreased in misleading ways by good factors (like increase in HDL) as well as bad (increase in LDL or triglycerides); this is discussed above. For purposes of coronary plaque reversal, we aim for (calculated) LDL cholesterol of 60 mg/dl.

This was when he was advocating his 60-60-60 target range (LDL-C <60, Trigs <60 and HDL >60)
charles grashow said…
Jimmy Moore
September 2 near Spartanburg, SCBeyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets: http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html
~ I'll be exploring these more in my next book coming in June 2014
called KETO CLARITY. Yes, weight loss is a great benefit, but high-fat,
moderate protein, low-carb diets have been shown by solid science to
produce improvements in heart health,
Type 2 diabetes, and epilepsy with emerging evidence support this way of
eating for acne, cancer, PCOS, various neurological diseases and
respiratory function. If ketogenic diets were a drug, it would be
heralded as one of the greatest medical discoveries in the history of
the world. But you can't make any money off prescribing a diet. And
whether we want to believe it or not, that does seem to be the
overriding factor beyond making patients better.

Jimmy Moore THANK YOU! We're gonna do the same format with "Moment of Clarity" quotes from 29 experts.

Craig_in_CT said…
No, I haven't tried true low fat yet. I have considered it, but I am worried about how my blood sugar would be impacted. Perhaps the Fuhrman variation of low fat, which de-emphasizes starces, would minimize those issues???

I have been looking for studies which tested the effect of very low fat (< 10%) on LDL-p and haven't seen a lot, except for a study which suggested a strong genetic component.

I do agree that losing weight should probably be my first priority.
Wuchtamsel said…
Davis has always represented a strange, undecided and scientifically unfounded view on lipids!
While he formulated this very ambitioned target range of 60-60-60 there is no proof whatsoever that increasing HDL-C at such a low level of LDL-C (or that rising HDL -C in ANY case...) has any beneficial effect. Furthermore he also favours the unfounded "benefits" of large LDL-C without any conclusive evidence.
Maybe the most damaging is his confusing (to say the least) attitude towards statins. On the one hand he is using them, on the other hand he is strengthening the strange, irrational views of his patients about them. That's probably the worst combination I could think of.
Wuchtamsel said…
Because... (DRUMROLL)... it doesn't work! Wow, who would have guessed...
Wuchtamsel said…
Yeah, especially at a TC/LDL-C ratio of almost 3. (???)
He is making that up without any reasonable doubt.
Wuchtamsel said…
It's not THAT off. The nephrologist obviously considered you having CKD and a statin IS part of a responsible and effective therapy for that.
carbsane said…
This blogger is a friend of Amber/GoKaleo's http://eatfoodasmuchasyoulikeallplants.blogspot.com/

There are quite a few studies, not to mention the Pima etc.ad infinitum, where truly LF "fixes" glucose metabolism. I know. It is difficult to fathom and I count my lucky stars I don't have to go that low fat, but .... (No I've not gone vegan either!)
charles grashow said…

You might have to register (for free) but the article is worth it - especially the images with regard to lipid composition

Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes

Too bad JImmy didn't put more of Dayspring in his book.
charles grashow said…

The aim of this series of lectures is to help clinicians better understand human cholesterol homeostasis. Lecture one the biochemistry and biology of both zoosterols and phytosterols and their stanols. The biomarkers used to assay sterol absorption and synthesis are discussed. The disease cerebrotendinous xanthomatosis is discussed
H Ford said…
Malcolm Kendrick would apparently prescribe statins if you have a family history of heart disease and a total cholesterol above 7mmol/l (270.7mg/dl

I tell patients with a cholesterol level of between 5 and 7 they’re healthy. If it’s above 7, it’s probably due to a family history of high cholesterol and if any relatives have early heart disease then it’s worth taking a statin.


(no date on page so it could be that he has changed his opinion)
Craig_in_CT said…
Thanks for the link.

I've always been intrigued by those claims. And I have seen a few personal success stories that fit that narrative, like a women who got her A1C to drop from >10, to the low 4's. But I just don't know how common that is.

When I asked on the McDougall board for studies, I got links to some early Pritkin work, and some of Neil Barnards studies. These studies show improvements in blood glucose markers, but most of the participants were still in the diabetic range at the end of the studies. Dropping fasting blood sugar from 170 to 130, or A1C from 8 to 7 isn't a cure as far as I am concerned.

But you also have to factor in the excellent blood sugar trends seen in populations that have been life long low fat eaters. My sense is that that have superb insulin sensitivity, low fasting insulin and low fasting blood sugar. Being at 80 glucose for most of the day, with spikes to 120 after a big carby meal may not be so bad relative to a low carb eater who is at 100 glucose level 24/7.

Question is: can most who have lived a lifetime on SAD, change the diet and get to the same place as someone who was never fat and insulin resistant.
charles grashow said…
charles grashow said…
It appears that Richard "Free The Animal" Nikoley is slowly abandoning low carb


Before everyone gets all antsy, I have no problem with good, natural fats. Nor cholesterol. I don't think they are to be feared in the slightest. What I'm questioning is the propriety of lots and lots of added fat as opposed to primarily getting them from whole foods like meat, fish, fowl, offal, shellfish, eggs, whole dairy, etc. We all know the stories of people—and I've enthusiastically participated in the past—literally drinking heavy cream and chowing down on coconut oil and butter by the spoonfuls.

To my mind, LCers and Paleos who pour on the added fat—often in order to avoid eating carbs, because you can't eat that much protein and vegetables—suffer from the same problem as the vegans who exclude all animal sources. They are both substituting the stuff of far higher nutrition for much lower nutrition. In the case of the vegans, they forego the most nutritionally dense by far (animals) for roughly what you see above. In the case of the fat gobblers, they are foregoing the nutrition you see right above for almost nothing.
Screennamerequired said…
Reading your review. I was wondering how long it would take for someone to accuse you of being an evil margarine, soy bean oil, statin pushing mad woman. It took about 2 posts.
Seriously there's no common sense or middle ground with these people. You're either advocating slathering your foods in butter or you're a PUFA pushing monster. Maybe a rational person could see that neither of these tactics is smart.

Another reviewer said it well. "It seems to be targeted to an audience of true believers."

If you want to hear good things and a bunch of rationalizing about your woeful markers so you can keep drinking your heavy cream and chocolate bacon, then this book's for you!
charles grashow said…
This is what drives me CRAZY with regard to Jimmy. His current diet is 80-15-5 (80% fat, 15% protein and 5% carbs).

SO - his latest guest is " biochemistry researcher, inventor and entrepreneur Binx Selby."


Binx quickly discovered the role inflammation plays on most of the chronic health issues we deal with in modern-day society and the purpose of using low-carb, high-fat diets to reduce this inflammation. He’s got a brand new book outlining many of his lifestyle principles entitled How I Grew Younger…And Why You Should Too: In just 2 weeks, you can reduce belly fat, cholesterol, inflammation, and the age of your arteries with the BalancePoint diet.

SO - I used the tool called Google and this is what I found.


To develop his theories on how a high-fat diet could fight unfavorable cholesterol counts, Selby started by investing two weeks in the library in January to pore over about 3,500 abstracts on the subject. A study from the late 1950s and early 1960s, dubbed the Mediterranean diet for itsemphasis on olive oil, informed his thinking most. Ultimately, he designed a diet based on 60 to 70 percent lipids, primarily from olive oil and other plant sources, 20 to 25 percent carbohydrates and 10 to 15 percent proteins.

"60 to 70 percent lipids, primarily from olive oil and other plant sources, 20 to 25 percent carbohydrates"

Then, for two weeks, he played the guinea pig. He drenched everything from kale salads to steamed okra with olive oil and ate only the most low-fat proteins such as fish and egg whites. Every day, he kept his dietary intake within the above percentages and cut out all grains, starchy vegetables and saturated fat — fat originating from an animal sources — to solve his cholesterol problem.

Selby’sdoctor balked at measuring his cholesterol counts after just 14 days. But the
results seemed to back the Boulder man’s health hunches.

His “bad” cholesterol LDL levels dropped from 117 mg/dl to 75 mg/dl, and the “good” cholesterol levels rose from 83 mg/dl to 106 mg/dl. The American Heart Association recommends that people at high risk for heart disease keep LDL numbers below 100 mg/dl and HDL numbers for men at 40 mg/dl and 50 mg/dl for women.

For the first two weeks, clients eliminate grains, dairy (except yogurt) and food-based sources of cholesterol, like egg yolks and meat. Clients reduce their caloric intake to 1,200 to 1,500 calories per day -- depending on age, body-mass index and weight-loss goals -- and of those calories, 65 percent or more come from unsaturated fats -- mostly olive oil -- and 10 percent from protein. The rest is in vegetables -- a lot of veggies -- and some fruits.

By eating this way, the body's metabolic pathways switch from carb-consuming to fat-burning, which decreases LDL and increases HDL ("good") cholesterol, Seltz said.


The seven principles of the diet that Binx worked out and more than 300 people have
successfully followed are these:
1. Keeping the body predominantly in fat metabolism (65 to 70 percen
2. Providing enough but not too much protein (about 10 percent of calories).
3. Allowing a few carbs, but from only low-starch and low-sugar vegetables, plus a smaller amount of fruit, for a total of about 20 percent of calories from carbohydrates.
4. Eliminating inflammatory foods, like milk, legumes, grains.
5. Including unsweetened cocoa.
6. Limiting calories to the level needed for desired weight.
7. Supplementing this with a multi-vitamin and a gram or two of Omega 3 fish oil.

Does this sound/look like ANYTHING that Jimmy uses/recommends?????
charles grashow said…
Why do people assume a LCHF diet has to be high in SATURATED FAT??

Long-term effects of a ketogenic diet in obese patients

To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1g/kg body weight protein, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients.

The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.

All 83 subjects received the ketogenic diet consisting of 20 g to 30 g of carbohydrate in the form of green vegetables and salad, and 80 g to 100 g of protein in the form of meat, fish, fowl, eggs, shellfish and cheese. Polyunsaturated and monounsaturated fats were also included in the diet. Twelve weeks later, an additional 20 g of carbohydrate were
added to the meal of the patients to total 40 g to 50 g of carbohydrate. Micronutrients (vitamins and minerals) were given to each subject in the form of one capsule per day
Rakesh Patel, MD said…
No, it demonstrates that atherogenic dyslipidemia profile seen in CAD patients have discordance b/w ldl-c and ldl-p due in most part to insulin resistance
Bris Vegas said…
When you have your "cholesterol" levels tested you are actually measuring something totally different - the lipoproteins that are used to transport lipids within the blood stream.

True cholesterol is a sterol hormone that is controlled via a negative feedback loop. So diet has little effect on true cholesterol.

Dietary fat intake has a massive influence on level and type of lipoproeteins in the blood serum.
Bris Vegas said…
The total dietary requirements of EFA are actually less than 1g per day. Even strict fruitarian diet of 2000Cal/day provides ample EFA.

It is a total myth that Okinawans ate fatty diets. Pork consumption was only about 100g. per week.

Our nearest relatives the Great Apes consume only about 3-5% of their calories as fat.
Bris Vegas said…
It takes nothing more than 4-6 weeks of a 1200Cal whole foods diet to fix a broken metabolism.
docww said…
I've been practicing medicine for over 30 years and I have saved a lot of lives. I don't just talk, I get the job done. In my opinion Jimmy Moore's book is spot on. I work in an acute care setting and just about everyone admitted to the hospital is taking a statin even though most don't benefit from taking this type of drug.

Most physicians are just too busy to talk to your about lifestyle changes that might save your life. It's much easier to write a prescription. Your criticism of Jimmy Moore seem a little bit obsessive. I suggest you read my latest blog post:

Bris Vegas said…
The vast majority of people, including most Type 2 diabetics and the morbidly obese can eventually become healthy by making suitable changes to their diet and activity levels. It takes as little as three weeks of a calorie restricted whole food diet for Type 2 diabetics to regain normal insulin sensitivity.

People don't lose weigh because they refuse to make the major dietary changes necessary for a healthy lifestyle.
carbsane said…
Agree, in most cases where permanent damage hasn't been done (e.g. longstanding frank diabetes, cirrhosis, etc.)
carbsane said…
Please do feel free to post a phone number and practice name/address Dr. William L. Wilson where you can be reached. My understanding is that it is illegal to give medical advice on the internet. I am sure that after reading your ill-informed diagnosis of my case that others will want to seek treatment for CARB Syndrome at your facility. I've been searching your hospital's website and cannot find literature on the services they provide, however. Please help me and my readers access this vital information!
carbsane said…
Publishing this comment of yours is for the sole purpose of building the public record of your activities.
charles grashow said…
Dr Wilson

What would you say if a patient came to you with blood work like Jimmy Moore has?

LDL-P 2730, Small LDL-P 478, TC 310, LDL-C 236, ApoB 238

What would you say/do??
carbsane said…
If I had compelling health reasons to try this, I would ... that's all I can say. :) I hope I dont have to because that seems quite austere to me.
Who are you and what have you done with the real Blogblog/Bris Vegas? Lol.

Yeah, yeah. . . We get it. . . http://images.tzaam.com/full/1b7.jpg
Trina said…
Not surprising to me you have an ebook and a $50 supplement to sell. I suspect you are trying to drum up traffic using the popularity of Carbsane's blog/name. I keep expecting more from folks who hold a medical license and yet ... continually disappointed.
charles grashow said…
Here he is



William L. Wilson, MD
Department of Medicine, Beverly Hospital, Beverly, MA
(Email: docww@aol.com)
docww said…
Trina--I am a working slob like most people. I support the web site with my own funds. The total amount of money I make from selling e-books and supplements doesn't cover the expenses of running the site for a month. I sell one supplement on the site because it is very difficult to find on the open market.
docww said…
You didn't include his HDL cholesterol. Based on these numbers I would say he still has some work to do. I would also need to look at his CRP and homocysteine levels. Charles--thanks for the great question!
docww said…
David--I didn't say that I have a better approach than the people you have mentioned. I do focus on brain function more than they do so I guess that sets me somewhat apart. I am not a big fan of Ornish but his approach is certainly better than the SAD.
docww said…
CarbSane: Sorry but it simply isn't true. I have a home in Greece, condos in Mazatlan and Florida and homes near Boston and in Minnesota. I could easily retire but I keep slogging away because I love helping people. I make no money off you and your friends. If you don't like my advice, please ignore it because there there seems to be a lot of people who are very hungry for this information, and I give it away for free. How stupid could I be?
charles grashow said…
Here's Jimmy's complete blood work from 12/14/12

HDL - 75
LDL - 332
TC - 429
Trigs - 60
CRP - 0.55
Plasma Homocysteine - 11.3

There were calcium oxalate crystals in the urine.

ON 10/25/12 his LDL-P was 3451, his small LDL-P was 221 (it's now 2730 and 478)

MY question is this - with low crp and homocysteine, low trigs and high HDH how much of a problem is high LDL-C and high LDL-P??

He also says his CAC is 0 but has not provided a copy of the report on his website.

His argument is that ultra high LDL and ultra high LDL-P are meaningless when there is no sign of inflammation along with low trigs and high HDL.

Some have also said that a high LDL-P on a HFVLC ketogenic diet is somehow different than the same readings on a SAD diet (assuming trigs, HDL and markers of inflammation are around the same?

Your thoughts on this as well would be appreciated.
carbsane said…
I deleted Charles' reply here because I will not entertain internet medical diagnoses on this blog.

However this is VERY enlightening both because of what prompted your diagnosis of me (my review of Jimmy's book), and because you had chosen to comment on THIS post.

Scroll up Doc. Jimmy's nightmare cholesterol profile is in this post, and some of it is in his book (also excerpted here). You did READ the book before starting your review, right?

It is also interesting how in your post about me you boast keen diagnostic skills, yet have in the past called Jimmy healthy.
carbsane said…
Greece sounds nice.
docww said…
CarbSane--It is except they do have their economic problems.
The young people don’t have jobs and are forced to move to other countries to work. As I tell my Greek wife: “You folks gave us the three best things we have—democracy, empiric science and the Mediterranean diet, and then you went on vacation!”

With your interest in nutrition, you likely know that the Mediterranean diet is one of the healthiest ways to eat. Like in most countries, they are now starting to eat more of our processed foods so they are
seeing more obesity—and brain dysfunction (CARB syndrome). Our niece is top medical student in Athens and she recently stayed with us. She clearly has early anorexia and doesn’t eat a Mediterranean diet. Her favorite food is ice cream. Like many people with anorexia she still resists any type of help.

In Mazatlan it’s very easy to eat a healthy whole foods diet. Every morning the fishermen bring in the “catch of the day” and they have a large market full of fresh fruit, vegetables and grass fed birds and animals. I found it somewhat unusual that just about everyone in Mazatlan is obese and I finally figured out why—they are the number one consumers of Coke in the world. They don’t drink water because it’s hard to find good water. They drink Coke 24/7. Their grocery stores are loaded with processed foods so they can wash
down processed food with Coke.

What’s the lesion in all this? I don’t try to promote any special restricted diet except that I recommend people reduce or eliminate
excessive fructose (mainly sugar and HFCS), high glycemic carbohydrates especially from grains and excessive omega 6 fatty acids. When people follow this plan, they slowly lose fat and their brain function improves. Certain targeted supplements can also be helpful.
docww said…
CarbSane—I did read his book, a copy I purchased myself on
Amazon. Overall I liked the book. It’s a little hard to comment on Jimmy’s overall health without having more information. He obviously has some health issues. From what I know that would include significant obesity, insulin resistance and early diabetes. One reason I wrote the post about you is because you seem so obsessed about his health.

When Jimmy blogs and uses his own health as an example,
criticizing him is certainly fair game but this book wasn’t primarily about his health. I agree with most of the material in the book concerning lipids. I think this is valuable information for many patients. Physicians hand out statins like candy and fail to give patients any nutritional advice other than “eat less and exercise more” so there is a real mess out there. He is absolutely right about the importance of triglycerides and HDL cholesterol. Total cholesterol is meaningless without more information.

I am looking at Jimmy’s lipid results as I type. Overall I think his recent numbers are quite good. I am certainly not concerned about his total cholesterol and LDL with low triglycerides and high HDL. His LDL-P is still too high so he still has some work to do. Perhaps a little more exercise and a glass of red wine is in order. To fully understand his health status I would also need to know his fasting insulin level, his CRP, his uric acid level and his homocysteine level. I certainly wouldn’t call his results “nightmarish”.

You have to remember that Jimmy was once a metabolic train
wreck so he certainly has made some progress. I think it is more valuable to focus what is actually in the book. Overall I think the advice is fairly sound. You seem to focus on the people you disagree with rather than the overall message of the book. I know you don’t think much of Gary Taubes. Gary and I do have different perspectives on some issues but we agree on others. With the
health of our nation going down the toilet I would rather focus on where I agree with people. Maybe we just have different approaches to things and that’s OK. In reading some of your posts I do agree with some of your perspectives but not all of them. I just think it makes more sense to focus on the science rather than on personalities.

As I get to know you better I may certainly change my
opinion about your tentative “diagnosis”. Unlike Jimmy to date I don’t have
access to any of your lab data or body composition so I must go by what I have
available to me—your blog posts and interactions with others. I think all of us
need to accept that fact that nobody has achieved perfect health and that we
are all a work in progress. As a clinician I try to find information that is
helpful for a given patient and because each person is different, there is no
standard approach to being healthy but I do think there is a general framework
that moves most people in a better direction.
charles grashow said…
30 Aug
@DrRonaldHoffman 40 year old, Ca score zero. What's your take on particle number? http://www.lipidjournal.com/article/S1933-2874(07)00283-8/abstract … pic.twitter.com/owIiNCmzPU

Dr. Ronald Hoffman
5 Sep

@CarbSane Ca++ score = zero proves my point: No worries!

5 Sep
@DrRonaldHoffman Also, why salmon and salad then. Why not bacon, eggs and extra creamy creamed spinach?



The salad and salmon diet

no flour products
limited whole grains
olive oil and foods rich in omega 3s
no sugar
one fruit a day
unlimited legumes
no hydrogenated fats
unlimited low starch vegetables
lean protein from fish, poultry, eggs (meat optional)

The Salad and Salmon diet is based on increasing lean protein, healthy fats such as olive oil and fish oil, and non starchy vegetables, while decreasing starches sugars, saturated fats and eliminating hydrogenated oils.

The health and therapeutic benefits of olive oil were first mentioned by Hippocrates, the father of medicine. For centuries, the nutritional, cosmetic and medicinal benefits of
olive oil have been recognized by the people of the Mediterranean. Olive oil was used to maintain skin and muscle suppleness, heal abrasions, and soothe the burning and drying effects of sun and water. Olive oil was administered both internally, and externally -
for health and beauty.

Recent research has shown that a Mediterranean diet, which includes olive oil, is not only generally healthy, but that consuming olive oil can actually help lower harmful LDL cholesterol. Olive oil contains antioxidants that discourage artery clogging and chronic diseases, including cancer (American Journal of Clinical Nutrition, Vol 61, 1338S-1345S). A recent study showed that the Mediterranean diet was helpful in reducing the
symptoms of rheumatoid arthritis (Ann Rheum Dis 2003; 62: 192-195)

The salad and salmon diet is beneficial for:

BUT - he says that Jimmy has NOTHING to worry about so why the need for the salmon and salad diet??

Like you tweeted - "Why not bacon, eggs and extra creamy creamed spinach?"
carbsane said…
There was a time when Hoffman was on WOR on a weeknight and I used to listen by default during my long late night commute. (I find talk radio keeps me more alert and I didn't like the political commentators on at that time). He seemed pretty down to earth and didn't seem to have too much woo woo on his show. Gotta say my opinion went downhill fast from his interview with Jimmy and this Twitter exchange.

It illustrates, I think, that most of the people interviewing Jimmy and promoting his book have no knowledge of Jimmy's true situation. They also didn't even bother to read the introduction to his book, let alone any of its content.

Jimmy's cholesterol levels are a direct result of his diet. It's as simple as that. It's his own business if he wants to assume the risk or convince himself he's protected by the magical ketone fairy.

The bottom line is that most of the docs even in the book talk about LC lowering cholesterol levels or mildly elevated ones not being so bad and/or requiring statins. However Jimmy's formatting has twisted that into "it's OK if your cholesterol goes haywire" and I doubt most would be on record brushing off his lipid panel.
charles grashow said…

Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl Lower Is Better and Physiologically Normal

James H. O’Keefe, JR, MD,* Loren Cordain, PHD,† William H. Harris, PHD,* Richard M. Moe, MD, PHD,* Robert Vogel, MD‡

The normal low-density lipoprotein (LDL) cholesterol range is 50 to 70 mg/dl for native hunter-gatherers, healthy human neonates, free-living primates, and other wild mammals (all of whom do not develop atherosclerosis). Randomized trial data suggest atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to70mg/dl. No major safety concerns have surfaced in studies that lowered LDL to this range of 50 to 70 mg/dl. The current guidelines setting the target LDL at 100 to 115 mg/dl may lead to substantial under treatment in high-risk individuals. (J Am Coll Cardiol 2004;43

If our genetically determined ideal LDL is indeed 50 to 70 mg/dl, perhaps lowering the currently average but elevated levels closer to the physiologically normal range may improve not just CHD but also many other diseases commonly attributed to the aging process. For all of these reasons, and given the safety record of statins, some
investigators have suggested that statins be considered for routine use in individuals over age 55 years.

SO - Loren Cordain is also co- author of a paper that not only advocates LDL-C of 50 - 70 mgs/dL BUT also suggests that statins be given to EVERYONE over the age of 55!!

Now the paleo people will tell you that he's changed his opinion on saturated fat (I've not seen any studies that prove this) but I've NEVER seen anything from him changing his
position on LDL-C!

SO - what would Jimmy's excuse be? To dismiss Cordain along with Dayspring, etc.?
charles grashow said…
5.0 out of 5 stars
Demystifies Cholesterol, Fat & Heart Disease, August 27, 2013


Aaron R. Olson "PaleoRunner" (WHITE BEAR LK, MN, United States) - See all my reviews

This review is from: Cholesterol Clarity: What The HDL Is Wrong With My Numbers? (Kindle Edition)

Jimmy Moore has a knack for taking complex health issues and making them easy to understand. In his latest book, Cholesterol Clarity: What the HDL Is Wrong With My Numbers, Jimmy obliterates the confusion surrounding your cholesterol numbers.

A typical cholesterol panel can be overwhelming to understand. Even many doctors are behind the learning curve when it comes to understanding the role of cholesterol in
the body. Cholesterol Clarity demystifies the connection between saturated fat, cholesterol and heart disease. In the book, Jimmy presents evidence that cholesterol isn't the demon we've been led to believe.

Moore does a great job dispelling some of the common myths surrounding cholesterol and heart disease. For example, he points out that over half of the patients that end up in the ER from a heart attack have perfectly "normal" cholesterol levels. He lucidly shows
evidence that the real cause of heart disease is inflammation, and guides us to foods that will help lower our heart disease risk.

If you're interested in understanding the real cause of heart disease and What The HDL is Wrong With Your Numbers, Cholesterol Clarity presents the latest evidence in an accessible and readable package.

V=Aaron OlsonJuly 25, 2013 at 9:38 PM

Glad you like the podcasts! I no longer follow the Loren Cordain, Paleo diet. I still follow a Paleo style diet, but it is along the lines of The Perfect Health Diet by Paul Jaminet. Jaminet allows for starchy tubers such as white potatoes (which he says have been around for 4 million years) and dairy.

The Perfect Health diet uses evolution as a template for eating. By looking at things like human breast milk (which is the perfect food for infants) and comparative mammalian
physiology, Jaminet points out that the human diet should be high in fat (around 55-65%), moderate in carbs (around 30%), and low in protein (around 15-20%). I still avoid grains except for white rice, which Jaminet calls a "safe starch". I try to listen to my body, but have been following PHD for several months now.

I experimented with a very low carb ketogenic diet and found that it wasn't for me. The
Perfect Health diet gives me a lot of options for delicious foods and seems to be working good for me so far. I continue to tweak my diet to see what works best for my gut and performance.

HUH - WTF - 30% carbs, white potatoes. "I experimented with a very low carb ketogenic diet and found that it wasn't for me"

charles grashow said…

5.0 out of 5 stars
Home Run!, September 19, 2013
sean j croxton - See all my reviews

This review is from: Cholesterol Clarity: What The HDL Is Wrong With My Numbers? (Hardcover)

Jimmy knocked this one out of the park.

It wasn't that long ago when I would forbid my personal training clients from consuming
saturated fat and cholesterol. I lived in fear of elevated cholesterol levels and heart disease. Eggs were white. Chicken was skinless. Beef was simply not okay.


(mentioned in the same talk as above)

- Total cholesterol/HDL ratio: preferably less than 3.0, ideally less than 2.0

SO - TC 310/HDL 66 = 4.70

Question - Do these people even read the book?? Do they JM is HEALTHY??
charles grashow said…
Remember - Jimmy's last TC/HDL ratio was 310/66 = 4.70


The Total-to-HDL Cholesterol Ratio -- What Does It Mean?by Chris Masterjohn

So what would the total-to-HDL cholesterol mean? The longer LDL stays in the blood, the more two things happen: it is exposed to oxidants, and as its limited supply of antioxidants run out, the polyunsaturated fatty acids in its membrane oxidize, leading to the further oxidation of its proteins and cholesterol; it is exposed to cholesterol ester transfer protein (CETP), which transfers cholesterol from HDL to LDL, thus boosting the total-to-HDL cholesterol ratio.

So the total-to-HDL cholesterol ratio should be a marker for the amount of time LDL particles spend in the blood. This, in turn, is dictated by the activity of the LDL receptor, which brings LDL into the liver and other tissues that need it. Since the liver only packages lipoproteins with a finite amount of antioxidants, it is critical that they reach cells, where antioxidant enzymes are regularly produced, quickly and efficiently. To whatever extent the total-to-HDL cholesterol ratio is high, this probably isn't happening.
charles grashow said…

Not all LDL cholesterol is created equal. Small, dense LDL particles are indeed the most dangerous kind and should be avoided by eliminating culprit carbohydrates and vegetable oils from your diet.

However, large,fluffy LDL particles are perfectly harmless and can be obtained by consuming your own personal carbohydrate tolerance level while consuming plenty of healthy saturated and monounsaturated fats.

This man will NEVER learn!! Large fluffy LDL particles are "perfectly harmless."???

charles grashow said…

Large, fluffy LDL particles are not only harmless, but may be protective. If they are protective, what’s wrong with having a bit more of them?
charles grashow said…

The effects of berberine on blood lipids: a systemic review and meta-analysis of randomized controlled trials.


Clinical trials have reported lipid-lowering effects of berberine intake, but the findings have been inconsistent. The aim of this meta-analysis was to assess the safety of berberine and its effects on blood lipid profiles. A systemic review was designed, undertaken and reported in accordance with the PRISMA statement. Randomized controlled trials of the effects of berberine on blood lipids in adults were included. Study population characteristics and the main results, including changes in the levels of total cholesterol, triglycerides, low-density and high-density lipoprotein cholesterol, were extracted. Weighted mean differences were calculated for net changes in blood lipid concentrations using fixed-effect or random-effects models. After filtering, eleven randomized controlled trials (including a total of 874 participants) were included in this study. The methodological quality of these studies was generally low. The final analysis showed that administration of berberine produced a significant reduction in total cholesterol (mean difference - 0.61 mmol/L; 95 % confidence interval - 0.83 to - 0.39), triglycerides (mean difference - 0.50 mmol/L; 95 % confidence interval - 0.69 to - 0.31),
and low-density lipoprotein cholesterol (mean difference - 0.65 mmol/L; 95 % confidence interval - 0.76 to - 0.54) levels,with a remarkable increase in high-density lipoprotein (mean difference 0.05 mmol/L; 95 % confidence interval 0.02 to 0.09). No serious adverse effects of berberine have been reported. In conclusion, berberine may have beneficial effects in the control of blood lipid levels. However, the efficacy of berberine in treating hyperlipidemia should be further evaluated by more randomized controlled trials in a larger population of patients.
charles grashow said…

In the Track Your Plaque program, we aim to reduce LDL cholesterol to ≤60 mg/dl (though not below 50 mg/dl, since the long-term implications of cholesterol this low remain unexplored). Even better, we aim for an apoprotein B <70 mg/dl or LDL particle number <700 nmol/l, improvements over the conventionally calculated LDL cholesterol. (Of course, always discuss these issues with your doctor.)

Track Your Plaque = Dr William "Wheat Belly" Davis
carbsane said…
So irresponsible is/was Dr. Eades.
carbsane said…
I would add that Eades is complaining over a slight rise in LDL. This is what I have been pointing out. Most studies don't impact LDL that much -- I wouldn't be alarmed by the small changes in that study. This is not what we're talking about here or in most of the lipid profiles Jimmy Moore deemed "healthy" in his book.
charles grashow said…
charles grashow said…
charles grashow said…

Lipoprotein Composition Regulates LD-P (page 6)
charles grashow said…

Lesson # 2
robertmcastillo said…
ExEffectsGuy said…
One time long ago I posted on Jimmy's blog in response to dozens of people congratulating him on some set of numbers he had posted. They looked high compared to conventional wisdom. I posted a query as to whether he was just kind of kidding himself that he was happy with these numbers. I broached the question in a most polite way and even honestly admitted that I wasn't sure if medically we knew what was OK and what wasn't and how all of these and dozens of other markers fit together in the puzzle of health. I think I hit a nerve. My post appeared, disappeared and I was blocked even from emailing him off the forum. Of course it's only my word I was being caustic or even critical, but it's so. Talk about thin skin. I do think he's desperate to live healthily and have a long life as are many. Nothing seems to work for the guy at least in his eyes and the hard stuff (lose weight without gimmicks and exercise) seem out of the question. I don't know the guy and I don't any of this as being true. Pure speculation admittedly but I base that on seeing this and yes, even living it on occasion, many times. That smile on his website appears very forced to me and that's not an aesthetic position. I guess he's making a buck at this though and that certainly takes some doing so best of luck to Jim. just wish/hope people approach this stuff he espouses with a skeptical analytical eye. Looking at his followers postings though, I don't see that happening. Time will tell I guess.
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Timar said…
"Fiber has the power to reduce LDL 20 mg or more. Many people say, “But I already eat whole wheat bread and Fiber One cereal!” upon hearing this. However, wheat-fiber based products like whole wheat bread and bran cereals have essentially no effect whatsoever on cholesterol reduction—though they’re good for bowel health."

Wow, what a gem hidden in this text! Is this really Dr. "Wheat Belly" Davis stating that whole wheat, the root of all disease, is "good for bowel" health? This text is from 2006, the gospel (Wheat Belly) has been published in 2011. Remember how he told the CBS reporter how the book is not based on a sudden revelation but a long process on finding out about the evils of wheat? This process can't have been that long, after all...
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