“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
“Overtraining is wasted training.”
T.V. Interviewer: “So, which opponent poses the biggest threat to you…?”
Ernie McCracken: “Me. If I get drunk and fall down and hurt myself…”
Bill Murray (Kingpin)
I was fit, but I wasn’t healthy.
One of the most important lessons I’ve learned is that there is a difference between fitness and healthiness. Even if everything seems great externally (i.e. you look good, you can lift heavy things, you can fit into your skinny jeans, you can run really far), your internal physiology may be a different story. Usually the two go hand in hand, but it is important to realize that this is not always the case. Of course most people understand this principle, which is why we get annual physicals that include turning and coughing and drawing blood for basic lab tests. But what happens when the numbers don’t come back perfect?
During the summer of my fourth year in Graduate school I decided to get my cholesterol measured for the first time. I’m not sure what triggered the decision but I just couldn’t wait to see how much fat I had coursing through my blood. Most of the medical community recommends that you start getting your blood lipids analyzed in your 30’s. I have always been fascinated with collecting data related to my personal health so I jumped the gun and had my blood drawn for a lipid profile soon after my 28th Birthday.
I wasn’t concerned about anything, I was just curious. After all, I’ve always kept up a rigorous workout routine and maintained a healthy diet — minus the occasional Natty Ice and Sonic chilidog fueled weekend when I was an undergrad. Really though, since I started wrestling in the 8th grade, I maintained a fairly constant state of overtraining that lasted through my senior year of college. Even after my wrestling career ended, I continued to workout fanatically. Retired wrestlers come in two flavors: those that stay a little bit obsessed with training and eating right for the rest of their lives, and those that stay a little bit obsessed with training but give the weight maintenance part of the sport the middle finger by eating crap and gaining 20-40 pounds. At least those are the two scenarios I’ve seen play out over and over again with my wrestling friends. But the point is, I was the former, so why worry about my cholesterol?
The day of my appointment, I walked into University of Iowa’s Student Health clinic, hopped up on the doctor’s toilet-seat-paper-covered office chair, flexed my arm, and watched as the nurse draw a couple vials of blood. The specific test I had ordered was a standard fasting blood lipid profile, meaning I didn’t eat or drink anything other than water for 12 hours prior to my appointment. I was told that the results would come in the mail in a couple of weeks so I went on enjoying life as usual. A week later, I received a letter containing a brief robot-like paragraph from my doctor, followed by the results of my blood test:
Total Cholesterol: 118 milligrams/deciliter of blood (mg/dL)
LDL Cholesterol: 95 mg/dL
Triglycerides: 40 mg/dL
HDL Cholesterol: 24 mg/dL
The blip from my doctor at the start of the letter informed me that everything was “normal” but my HDL levels were “low”. His recommendation was to do another lipid analysis in a year. Umm…okay, but what exactly did these numbers mean? And what do these fats, or lipids, or cholesterol particles do?
It turns out that when clinicians talk about cholesterol, they are usually referring to cholesterol molecules AND their protein carriers. Let me explain: cholesterol is not very soluble in water so it doesn’t’ travel well in our water-based bloodstreams. Instead, small protein taxi-drivers called lipoproteins transport cholesterol and triglycerides throughout our bodies. Chylomicrons, the largest of these lipoproteins, carry fats in the form of triglycerides from the intestinal mucosa to the liver. The liver converts unburned food metabolites into low-density lipoprotein (LDL) particles that eventually get secreted into plasma. There are two different categories of LDL particles, but we will get to that later. Finally, high-density lipoprotein (HDL) particles act like miniature bulldozers and dump trucks in your body, collecting cholesterol in the blood and transporting it back to the liver for excretion.
Stay with me, this stuff could save your life: when you eat, your body converts calories it doesn’t need into triglycerides, which are stored in your fat cells. Between meals, certain hormones will cause these triglycerides to be released for energy. The problem is that most people eat more calories than they need for energy (usually this caloric excess is the result of eating too many carbohydrates). As a result, these people have high levels of triglycerides in their blood, which increases their risk of cardiovascular disease.
LDL is traditionally called bad cholesterol because some scientific studies have shown a correlation between cardiovascular disease and high levels of total LDL. I say “total” LDL because now we know that there are two different patterns of LDL particles, pattern-A and pattern-B. Pattern-A LDL particles are large and fluffy, similar to HDL particles, while pattern-B particles are small and dense. Pattern-B LDLs are dangerous because they can easily lodge between the endothelial cells that line your blood vessels (endothelium). Moreover, when oxidized, these particles can cause inflammation. On the other hand, pattern-A LDLs are good for you. These particles do NOT lodge between endothelial cells and are strongly associated with low triglyceride levels. Additionally, pattern-A LDLs have been shown to promote muscle growth – cool.
HDL, or good cholesterol, is a well-behaved, friendly scavenger that cruises our bloodstreams and removes harmful pattern-B LDL particles from where they do not belong (e.g. the endothelium). HDLs then reuse and recycle these LDL particles by transporting them to the liver for reprocessing. Think of it this way; HDL particles are a maintenance crew that chemically scrubs your endothelium clean and keeps it healthy. Low HDLs have been associated with high levels of pattern-B LDL particles and increased risk of cardiovascular disease.
To sum up:
High triglycerides; high levels of pattern-B LDLs; low levels of HDLs = increased risk of cardiovascular disease = BAD
Low triglycerides; low levels of pattern-B LDLs; high levels of HDLs = decreased risk of cardiovascular disease = GOOD
Pattern-A LDLs (probably beneficial but for now classified as benign) = neither increases or decreases your risk of cardiovascular disease = NEUTRAL
Now you have a meat and potatoes view of how these blood lipids function, as well as which ones are helpful, and which ones are harmful. The biggest take away from all of this is that your total cholesterol levels don’t mean much…that is, unless you know the pattern of your LDLs. Unfortunately, the only way to determine this is to get a highly specialized blood test involving polyacrylamide gradient gel electrophoresis. Personally, I would rather run my eyes into bicycle spokes than run another gel (any scientists reading this?). The good news is that low triglyceride levels are strongly correlated with high levels of pattern-A LDLs, so all you need to do is lower your triglycerides and a pattern-A profile will likely follow suit.
For your records, here are the not-so-hard numbers that the medical community currently recommends (i.e. you are healthy if the values in your lipid profile fall within the following ranges):
Total Cholesterol: Under 200 mg/dL
LDL Cholesterol: Under 130 mg/dL
Triglycerides: Under 150 mg/dL
HDL Cholesterol: Over 40 mg/dL (Men), Over 50 mg/dL (Women)
Again, 99% of the time, your measured total cholesterol and total LDL cholesterol values will not give you any useful information. So what information are we left with? Your triglyceride and HDL levels. Recall that low triglycerides and high HDLs = GOOD. In fact, the ratio of your triglycerides to HDLs is currently the best indicator of your cardiovascular health. The clinical community purports that an ideal ratio (tridglycerides divided by HDLs) is 2 or less.
For example, 110 mg/dL : 60 mg/dL (Triglycerides : HDL) = 110/60 = 1.83 < 2. A ratio of 4 is considered “high” and a ratio of 6 is considered “much too high”. In reality, you should aim to get your ratio as close to 1 as possible.
Recall that my HDL levels were a dismal 24 mg/dL:
Armed with the above information, you now know that my HDL levels were much too low (almost 50% lower than the minimum ideal value). But how could this be? I was fit, my blood pressure was low, and I felt great. What was I doing wrong? After talking with my doctor directly, he told me that a person’s HDL levels are genetically predetermined and there wasn’t much I could do. Seriously, that’s exactly what he said. I did some initial research and found a couple of clinical studies showing that a person’s HDL levels could be raised by eating massive quantities of specific fruits and vegetables. For example, consuming one large white onion a day was shown to raise patients’ HDL levels, despite having what I’m sure was a deleterious effect on their dating lives. I mentioned these studies to my doctor, but he assured me that changing my diet would have very little influence on my HDL levels.
Please write down the following advice: assume any clinician you go to for medical advice is not an expert. Whenever you are faced with a health problem, get a 2nd, 3rd, and 4th opinion, and do your own research. If you keep hearing the same thing from every clinician you see and your own research agrees, slowly move your doctor from the ‘not an expert’ category to the ‘trusted expert’ category. Anyone instructing you on your personal health shouldn’t be considered an expert until proven to be one by you. Be respectful to your doctors, but make sure you double and triple-check any “facts” he or she tells you. I had to learn this lesson the hard way.
So what did I do to increase my HDL levels? For over a year, I accepted my genetically deprived fate and went on enjoying life as usual. I continued working out and following my FDA-approved diet. I even got another lipid profile done in the spring of 2010 with similar results. But I just couldn’t accept the fact that there was nothing I could do to influence an aspect of my own health. I continued researching the issue in my spare time, then, in the summer of 2010, I came upon a bunch of scientific articles that cited the benefits of eating a diet based on fats rather than carbohydrates. This lead to a reckoning in my personal nutrition and fitness regimens, one that helped me double my HDL levels while losing 10 pounds of stubborn body fat. Ironically, the 3 biggest changes I made are all considered “bad decisions” by most clinicians.
Here are the 3 bad decisions I made:
1. I ate lots of animals.
Like billions of people around the world, I had fallen victim to the fat-free = healthy mentality that started around the 1970’s and is still being pushed on everyone today. Check out the FDA’s Food Pyramid, which is now MyPlate, and you’ll see what I mean. The government still thinks that “fat in” equals “fat on” your body. And despite the mountains of scientific evidence against them, most health-care professionals still want you to believe that fats are bad, saturated fat is evil, carbohydrates are good, and grains are messianic.
Think about it. From grade school onward, we were all taught to rarely eat meat, to take the yolks out of our eggs, and to buy fat-free versions of our favorite foods. But as the fat, and thus the flavor, was removed, sugar was added to compensate. Fast-forward to 2012 and diabetes, heart disease and cancer rates are through the roof. Obesity has become an epidemic. I’ve written several articles about this in the past so I’ll just sum up the scientific truth for you in two sentences. Eating too many carbohydrates will make your insides and outsides gross. Following a diet based on protein and healthy fats will make you feel great and look great naked.
The first thing I did to raise my HDL levels was drastically change my diet. Here was my average daily diet from about 1995 to 2010:
|Breakfast||5-6 egg whites, large bowel of oatmeal with honey, 1 handful of blueberries or 1 piece of fruit|
|Lunch||2-3 servings of whole wheat pasta with 1-2 chicken breasts cut up (all fat removed), 1 serving of vegetables|
|Snack||1 large sandwich (lean turkey or other deli meat with fat-free cheese slices), OR a fat-free meal-replacement shake|
|Dinner||1 large salad with fat-free ranch dressing (or similar), 2-3 servings of chicken or meatball pasta OR 1-2 burritos with fat-free refried beans, fat-free cheese, and chicken|
In the above diet, only 10-20% of my calories were coming from fat, with the clear majority coming from carbohydrates of all kinds. Additionally, I was starting each day off with a ton of carbohydrates (bad for you); I was eating a lot of wheat and other grains (very bad for you); I was drinking meal-replacement shakes that contained sucralose or aspartame (very, very bad for you); and I was consuming foods and dressings stored in cans and plastic bottles (mmm…BPA and rancid fats)
Here is what I changed my diet to in August, 2010:
|Breakfast||4-6 whole eggs, 6 thick slices of bacon (5-8 oz), 1 avacado|
|Lunch||1 pound of grass-fed ground beef (yes, an entire pound), 1 serving of sweet potatoes or yams, and 2-3 servings of asparagus or broccoli cooked in 1-2 tablespoons of extra-virgin coconut oil|
|Snack||1 cup of almonds and dark chocolate (70-80% cocoa)|
|Dinner||1 large salad with walnuts, dried cranberries, vinegar and extra-virgin olive oil, 3-4 servings of fatty meat (ribeye, pork or lamb chops, beef or pork roast, salmon, mackerel, or chicken with bacon)|
With these dietary changes, most of my calories started coming from very healthy sources of fat while only ~20% of my calories were coming from carbohydrates. Here’s the kicker: I lost 10 pounds in just two weeks. Keep reading to see how this “bad decision” (i.e. eating a high-fat diet) changed my lipid profile.
2. I stopped running.
The training regimens I followed prior to 2010 were asinine. And even though my wrestling career ended in 2005, I continued working out 8-10 times a week for the next 5 years. But “working out” can mean a lot of things; for some it means running 10 miles, for others it means clenching their butt muscles at the office. For me, a workout used to equal running 5-10 miles at ~70% of my maximum heart rate or spending 1-2 hours in the gym doing various strength exercises (usually 10-12 exercises, 3-5 sets per exercise, 8-12 reps per set). Trust me, this is not bragging. This is me explaining how foolish, wasteful and unhealthy I used to be.
Why did I worship extensity over intensity for so long? The truth is it was easier to jog 5 miles than it was to run 5 explosive, 100-meter, all-out sprints. And somewhere deep in my subconscious I was infected with the mentality that aerobic exercise was my golden ticket to elite health. The more time you sacrifice on the road or in the gym, the greater the health benefits, right? Wrong.
Many clinicians love to cite cherry-picked studies that correlate aerobic exercise with a decreased risk of cardiovascular disease, but they fail to mention two things:
1) Excessive aerobic exercise (i.e. chronic cardio) can impair immune system activity, reduce organ function, and warp the structure of muscle fibers.
2) High-intensity, interval training increases HDL levels and prevents heart disease more efficiently and more effectively than classical, cardiovascular training.
The proof was in the pudding; despite my love affair with long bouts of aerobic exercise, my HDL levels remained low. Why? The likely explanation is that my incessant overtraining diminished the overall constitution of my body. In other words, my system was overloaded and my HDLs suffered as a result. This makes sense considering that high levels of stress have been shown to decrease patients’ HDL levels.
The following table displays my average weekly training regimen before and after August, 2010. These changes not only affected my HDLs (keep reading), but they also increased my strength gains, lowered my body fat percentage, and helped me sleep better.
|Before August, 2010||After August, 2010|
|Monday||Morning: Strength TrainingEvening: 5 Mile Run||Rest|
|Tuesday||Strength Training||High-Intensity Circuit|
|Wednesday||7.5 Mile Run||Rest|
|Thursday||Morning: Strength TrainingEvening: 5 Mile Run||Rest|
|Friday||Strength Training||High-Intensity Circuit|
|Saturday||5 Mile Run||Rest|
|Sunday||10 Mile Run||Rest|
Changing my training regimen changed my life. After August, 2010, I performed 2-3 high-intensity circuits (i.e. Crossfit-type workouts) a week. Importantly, my rest days included at least an hour of relaxing activity, such as taking a long walk or playing some sort of pick-up game.
3. I boozed it up daily.
If you have low HDL levels, start drinking alcohol moderately and consistently. That being said, do some research and some experimentation to find out how much you need to drink to maximize the associated health benefits while minimizing the potential risks. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), men should limit themselves to 1-3 drinks per day and women should limit themselves to 1-2 drinks per day.
The fear of being sued has rendered the majority of medical doctors speechless concerning the overwhelming benefits of drinking alcohol in moderation. Yet, there is a pile of data showing that consuming 7-14 drinks evenly over the course of a week will dramatically increase your HDL levels, while also lowering your blood pressure and extending your life. You can read more about the benefits of alcohol and how many drinks you should have per week here.
Before I found out about my low HDL levels, I would drink an average of 3-4 servings of booze, 1-2 nights per week (sophomore and junior years of college excluded). Sometimes I would go a couple of weeks without drinking and sometimes I would bring it a little harder. The biggest problem with this lifestyle was that my drinking wasn’t consistent; I would surprise my body with a session of binge drinking and then cut off my alcohol intake cold turkey. This is a great way to wreck your health and make your face look like you just finished watching the little girl crawl out of the television set in The Ring movies.
The change I made was simple. I started having 1-2 glasses of red wine or bourbon per night with dinner. If you are into bourbon, I recommend Maker’s Mark, it is incredibly smooth and 100% gluten free. Occasionally I would have 3 drinks, and just as occasionally I would have none. The key is that my alcohol consumption was consistent and moderate.
Okay…I made some changes to my diet and workout routine, but were these changes effective? In other words, did the above three “bad” decisions increase my HDL levels?
Yes. My HDL levels increased from 24 to 48 mg/dL.
In less than 5 months, I was able to double my HDLs while keeping my triglycerides below 50 mg/dL. In fact, my triglycerides were less than my HDLs, giving me a triglyceride to HDL ratio of 0.9. Recall that my doctor said there was very little I could do to raise my HDL levels more than a few points. You tell me, which category does he belong in?
One important note is that I was on a fish oil supplement both before and after I made any of the above changes (i.e. the “bad” decisions). The omega-3 fatty acids in fish oil have been shown to help maintain very low triglyceride levels. Mine were consistently around ~40 from 2009 through 2011. Taking a fish oil supplement will change your lipid profile, and your life, for the better. I recommend 2-3 grams per day, with a 1:1 ratio of EPA to DHA.
The overall message to take away from this article, and from this lifestyle blog in general, is that there is always something you can do fight back. You can impose your will on your health and your wellbeing under almost any circumstance. Sure, there will be times when your influence will only go so far, but that doesn’t mean you should stop trying. Listen to your doctor, but never take no, as in there is nothing you can do, for an answer.