Blood glucose 160

What happens when blood glucose hits 160 mg/dl?

A blood glucose at this level is typical after, say, a bowl of slow-cooked oatmeal with no added sugar, a small serving of Cheerios, or even an apple in the ultra carb-sensitive. Normal blood sugar with an empty stomach, i.e., fasting; high blood sugars after eating.

Conventional wisdom is that a blood sugar of 160 mg/dl is okay, since your friendly primary care doctor says that any postprandial glucose of 200 mg/dl or less is fine because you don't "need" medication.

But what sort of phenomena occur when blood sugars are in this range? Here's a list:

--Glycation (i.e., glucose modification of proteins) of various tissues, including the lens of your eyes (cataracts), kidney tissue leading to kidney disease, skin leading to wrinkles, cartilage leading to stiffness, degeneration, and arthritis.
--Glycation of LDL particles. Glycated LDL particles are more prone to oxidation.
--VLDL and triglyceride production by the liver, i.e., de novo lipogenesis.
--Small LDL particle formation--The increased VLDL/triglyceride production leads to the CETP-mediated reaction that creates small LDL particles which are, in turn, more glycation- and oxidation-prone.
--Glucotoxicity--i.e., a direct toxic effect of high blood glucose. This is especially an issue for the vulnerable beta cells of the pancreas that produce insulin. Repeated glucotoxic poundings by high glucose levels lead to fewer functional beta cells.

A blood glucose of 160 mg/dl is definitely not okay. While it is not an immediate threat to your health, repeated exposures will lead you down the same path that diabetics tread with all of its health problems.

Comments (28) -

  • Pater_Fortunatos

    2/25/2011 8:20:12 PM |

    There are lot of unusual and interesting formulations you are using, but I really can't understand the meaning of this one:

    "Glycation and of LDL particles."

    Maybe my english is not the best (I am no native english speaker).Maybe you could enlighten me?

    About the article. Now I realize that during 35 years of life, I had lots of such glycemic  values and not having any idea about effects.
    Do you have any ideea about glycemic index if I eat quite a lot of fruits? (can't control it lately).

    Thank you!

  • Might-o'chondri-AL

    2/25/2011 8:50:30 PM |

    Hi Pater_F.,
    I just read this post too, so see your quote shows a word to edit out. Remove the word "and", then it reads correctly "Glycation of LDL ...."

  • Flavia

    2/25/2011 9:05:59 PM |

    Hi Dr. Davis,

    What do you think is a safe amount of carbs to eat in one sitting? No more than 50 maybe? What really gets me is the aging!! I do not want wrinkles!

    For a 5'4, 125lb woman, what would you recommend is the top limit of carbs to have per meal to avoid this?

  • susan

    2/25/2011 10:54:14 PM |

    Thanks for the info about how the body handles high glucose levels. Funny you should mention a glucose of 160…

    I generally stay with the low carb lifestyle. I’ve been checking my glucose on a fairly regular basis and it generally runs in the high 80s to high 90s. Exercise can bring it down to mid 70s. Fasting levels are creeping up into the low 100s.

    Late yesterday afternoon, however -- after a good low carb day -- I succumbed to my baser urges and consumed several handfuls of mini Reese’s PB cups. Pretty dumb, I know.  

    2 hours later, BG = 161  -- whoa, I guess that was even dumber than I thought
    After a good low carb dinner, BG = 99  -- respectable, considering  
    This morning’s AM Fasting BG = 150 – what the heck??  (it’s been running a little high, but not that high
    Large coffee w/ cream on the way to work, BG = 118  -- getting there, slowly  
    Low carb breakfast and lunch, BG = 113  -- wow! Never dreamed it would take this long  

    Well, I knew it was a stupid thing to do. Now I know how stupid it really was. I’m sure my BG will continue to come back down to a reasonable level. I’ve been toying with the idea of rejoining the gym and starting the Slow Burn program. Guess it’s time.

  • Dr. William Davis

    2/26/2011 12:41:00 AM |

    Thanks for catching the typo, Pater and Might.

    HI, Flavia--

    It is truly an individual thing. For some, it's 20, 30, or 50 grams. For others, it's zero.

    Body size, age, genetics, recent exercise, et. all enter into the equation. This is why I am a fan of checking postprandial blood glucoses.


    Hi, Susan--

    It can really be a sobering experience. When this happens to me, I feel awful for several hours, sometimes all day. I've learned that it's not worth the momentary indulgence.

  • belly fat exercises

    2/26/2011 7:22:01 AM |

    Yes insulin lowers blood sugar levels by converting glucose to glycogen which is stored in the liver and by increasing cell permeability to glucose.

  • Might-o'chondri-AL

    2/26/2011 8:41:02 AM |

    Individual liver condition may influence how dangerous the blood sugar reaction actually is.

    "Fasting, overnight, trigs (triglycerides) are mostly bound to VLDL. But once eat there are trigs complexed to chylomicrons (from the intestine), IDL (intermediate density  lipo-protein, a VLDL spin off), in standard VLDL and even HDL.

    HDL, "good" lipo-protein, is the returner of cholesterol from the peripheral regions of the body back to the liver; it too carries trigs. In the liver hepatic trig lipase enzymes hydrolize (cleave) off the HDL's trig load; and those trigs can then get complexed to both IDL and chylomicrons.

    The re-circulated trigs add to the new trigs certain foods generate. When we look specificly at LDL bound trigs those trigs were passed on over from VLDL trigs, whether if were freshly tagged onto VLDL or from overnight fasting VLDL trigs.

    In the case of chylomicron trigs and IDL trigs the lipase enzymes in the adipose (fat) tissue and
    intestine, as well as triglyceride lipase enzymes in the liver, cleave those trigs into component free fatty acids and glycerol. In practical terms that's when we get fat in a form we can "get fat" from.

    Fat in the liver tissue also causes extra fatty acids to go out into the blood stream and, among other tissue, into skeletal muscles. The muscles of course do have the potential to use fat as fuel.

    Only problem is when insulin resistance starts to develop progressively in the liver, when fat in there messes with our trig balancing act. The back log concentration of intra-hepatic trigs is one of the conditions
    when post meal hyper-insulinism is dangerous.

    Then there is a further complication. When insulin resistance starts to go on outside the liver those peripheral tissues keep performing lypolysis. They are
    trying to burn fat while waiting on blood glucose stuck outside their cells. So even more freed up fatty acids go back in the blood to burden the liver.

    At this stage the liver
    can't re-esterfy (break back down) the burden of free fatty acids into trigs. So more gets built into fat inside the liver and eventually can lead to blockages (steatosis). It is a vicious cycle looping trigs and free fatty acids in a double "whammy" on the liver.

    To recap the immediately preceeding. A new/young/healthy liver takes in a meal, produces some extra trigs and sends it out tagged to VLDL. Once liver damaged/old/fat there are high levels of free fatty acids in circulation, the liver response to insulin drops (liver insulin resistance), the liver passes along meals glucose but the skeletal muscles are full of trig derivatives (di-acyl-glycerides, to be precise), so the muscles don't pick up the glucose either.

    Once an individual's liver fat is interfering with things to an even worse degree there are further complications. Namely the trigs complexed to VLDL get out of the liver less and it is mostly chylomicron trig and IDL trig complexes circulating in the blood.

    In fact, a measurement where total trigs keeps dropping can
    indicate chronic liver disease. And in hepatitis the physical synthesis of VLDL is
    progressively reduced; the virus inhibits protein movement in the liver microsome needed for VLDL production.

    Remember there is a liver triglyceride lipase enzyme. It has several functions and can act as a binder for many other lipoproteins, including LDL.

    Individuals who geneticly, or due to pathology (like in hepatitis), produce too little of this enzyme have another problem. This enzyme insufficiency makes the blood
    level of HDL complexed trigs keep rising (trig can't be cleaved off HDL who brought it back to liver)so HDL can't do it's "good" cholesterol job.

    The same enzyme insufficiency also lets trigs complexed to LDL, IDL and chylomircrons become elevated in the blood stream.

  • Might-o'chondri-AL

    2/26/2011 9:04:46 AM |

    Cut off my post's theory, too long.

    If individual has no fat in the liver (or minimal liver fat that is not enough to mess up trig metabolism), then blood sugar spike generated trigs not a problem. This can be genetic propensity, liver circadian rhythm co-incidence &/or life style.

    Those laying down liver fat, geneticly impinged &/or life style disadvantaged seem to be getting good advice from Doc.

  • Anne

    2/26/2011 1:14:56 PM |

    Watch out if you are in intensive care. The American College of Physicians now recommends that blood sugar be maintained between 140-200mg/dL. Their main concern is blood sugar going too low. In Hospital Blood Sugar Levels Should be Higher

    They will also feed you an ADA approved high carbohydrate diet to guarantee those highs.

  • Nigel Kinbrum

    2/26/2011 3:05:29 PM |

    @Dr. Davis: Are those your own BG readings after eating oatmeal? If low-carb/keto adapted, eating a pile of carbs is a bad idea as glycolytic pathways are down-regulated.

    @Anne: How about wearing a bracelet with important medical information on it in the event of becoming unconscious?

  • Anonymous

    2/26/2011 3:09:43 PM |

    These recent blog entries regarding blood sugar are extremely simple even to the point of being vague.

    I have found a site that goes into great detail regarding blood sugar, its control, and the problems associated with both high and low blood sugar levels. The blogs entries are so successful that they were edited and published as a book.

    The author continues to blog weekly and includes practical detail, as well as references to current medical science. Don't let the label "diabetes" throw you. There is a tremendous amount of information regarding how to avoid T2DM with improved blood sugar control. How and when to check your blood sugar, using your meter to determine the impact of what you eat on blood sugar, the deleterious effects of higher than normal blood sugars, even what is normal sugar are all addressed and in useful detail...there are even discussions regarding low carb and paleolithic diets. If you want 5-10 quickly and poorly written sentences on a topic, read the HeartScan blog. If you are interested in reading entire well written intelligent essays visit these sites below. I think that the "MD" label misleads many readers. Don't let the fact that the writer of the Blood Sugar 101 sites is not an "MD" throw you. She is a diabetic and has lived with it for several years. Her approach to medical treatment is that it should be "evidence-based" which seems often missing from other sites.

    Take a few minutes to review,

    Blood sugar 101 (general information site)
    http://www.phlaunt.com/diabetes/

    Associated blog site
    http://diabetesupdate.blogspot.com/

  • Anonymous

    2/26/2011 4:59:13 PM |

    What happened to the post about the Blood Sugar site? It seems to have been deleted. I am sute that I saw it here earlier. Does anyone know the url for the site. it looked interesting.

  • Anonymous

    2/26/2011 6:45:18 PM |

    yeah i saw it too. seems poster was a bit critical of Dr. Davis last several postings. sorry don't have the web sites mentioned. didn't know that you could delete a post that you don't like.

  • Anonymous

    2/27/2011 2:30:17 AM |

    @ Anne,

    In the ICU, there is risk with both too high and too low a blood sugar.  Perhaps 140-200 is an unhappy medium where risks are balanced.

    'Recent research, including a study in the Feb. 15 issue of the Annals of Internal Medicine, has found that the use of intensive insulin therapy comes with an increased risk of low blood sugar (hypoglycemia) which can be deadly. The study also concluded that using intensive insulin therapy to significantly lower blood sugar levels isn't associated with greater improvements in health outcomes.'

    Many ICU patients aren't eating anything anyway.  It isn't until after they are on the general medical floor that the ADA diet is given, and their sugars chased down to a lower range with insulin and/or drugs!

    Teresa

  • Might-o'chondri-AL

    2/27/2011 2:32:27 AM |

    11,000 Koreans studied by Stamford's Sun Kim, M.D. published in Journal Clinical Endocrinology (2011):

    27% had fatty liver (ultrasound diagnosis); 47% of those with fatty liver had high fasting insulin vs. only 17% of those without fatty liver having high fasting insulin. All subjects with fatty liver also had high blood sugar, high trigs and low HDL.

    Participants followed for 5 years; and data correlated on those with, and those without fatty liver who became clinically diabetic. Study conclusion is that fatty liver in participants preceeds Type 2 Diabetes by +/- 5 years in a statistically significant number (ie: no fatty liver = less risk of developing adult onset diabetes).

    Doc undoubtably has new patients and blog readers who have mildly fatty livers that don't think he's right. He should make them hire Revelo to put them through their paces instead.(Joke attempt there Revelo, not a personal digg.)

  • Anonymous

    2/27/2011 5:07:52 PM |

    I am familiar with the web sites that were mentioned in the deleted post. I did not think the post was very critical at all. It only said that these sites provided more detailed information regarding the recent blood-sugar related topics being discussed here. By the way, these sites contain a good deal information that you will only see around here at the Doctor’s pay-to-join blog.

  • revelo

    2/27/2011 7:59:44 PM |

    The martinet in me would be happy to whip anyone into shape who needs it. Seriously though, even the most extreme exercise program is child's play compared to what happens when you get sick. Imagine someone saying to you: "First I'm going to saw through your ribcage, and then I'm going to slice through your arteries..." It's like something out of a horror movie. And yet that is what happens during open heart surgery. And then there are those ailments for which there is no medical relief, surgical or otherwise. Be afraid of getting sick, be very afraid. Be willing to endure any sort of diet and exercise regime to avoid getting sick.

  • Dr. William Davis

    2/27/2011 8:08:44 PM |

    Ni, Nigel--

    No, not my personal blood sugars, but typical responses I've seen in many patients.


    Re: deleted comments
    I have no problem with criticisms. I do have problems with people saying things like "you're an asshole" or similar comments that add nothing to the conversation.

    I now have a zero-tolerance policy for rudeness, but NOT criticism.

  • Anne

    2/27/2011 9:16:04 PM |

    @ Nigel - I like MediAlert bracelets.

    @ Teresa - IMHO, the ADA meal plan is much too high in carbohydrates. It does not make sense to me to cause an elevated blood sugar and then use a medication to bring it down. How about lower the carbohydrate load and use minimal medication? You can find this program in Dr. Richard K Bernstein's book "Diabetes Solution".

    I am T2 and am able to keep my blood sugars in a good range by diet alone by greatly limiting my carbohydrates.  

    I understand those in the ICU present with many challenges to obtaining optimal blood sugar control.

  • Anonymous

    2/28/2011 1:50:55 AM |

    @ Anne,

    I was concerned that anyone without medical training who didn't look at the article linked to in your post wouldn't realize that there are risks to both too low and too high blood sugars in the intensive care unit.

    The comment about the ADA diet and using insulin and drugs to control blood sugars, was meant to poke fun at the ADA.  I apologize.  

    Teresa

  • Helen

    2/28/2011 11:54:36 PM |

    I don't doubt that high blood sugars are harmful, but I do wonder if when they are very transient if the effect is so terrible.  I have always had poor glycemic control.  In terms of going to 200 on a glucose tolerance test, I have diabetes.  But my blood sugars have been lower on a low-fat diet than they were on a low-carb one.  It also now takes me three times as many carbs to get to 175 or so than when I was on a low-carb diet and they are disposed of very quickly - I get down to 75-90 within an hour and a half.  I do think I have a MODY-like form of diabetes - that I'm not particularly insulin resistant.  I'm still not sure what all is going on, but I've been checking my blood sugar rather compulsively for 10 months, and this is what I've found.  

    I'm nearly 45 years old, have great blood pressure, triglycerides of 44 (this may be part of my particular MODY diabetes profile - a few types have genetically low triglycerides), high HDL and low LDL.  I look young for my age.  I don't have any microvascular complications.  I'm still very concerned about my glucose levels, but whatever diet I'm on my BG goes up above 160 with nearly every meal (I can catch it if I test at just the right time), but transiently.  A high-carb diet makes my fasting glucose and between-meal readings much lower, so the overall average is lower.

    Perhaps M-Al is right, if you are  storing fat in your liver, or if you are insulin resistant, it's a different story.  Perhaps anti-oxidant status, overall diet quality, and other lifestyle factors have an impact that large-scale studies don't pick up, since the numbers and outcomes of those with a Dunkin Donuts diet are averaged in with those with a whole foods diet, one along the lines of what Stephan Guyenet suggests.  

    I do think I'm not normal, and a "normal" person with the blood sugars Dr. Davis cites is courting trouble.  But I'm worried about getting too obsessive about my normal, since there's only so much I can do to control it.  It might be that I can be healthy even given the givens.  

    I also think it's worth considering that someone on a low-carb diet often is going to have more trouble disposing of a sudden influx of carbs.  It takes about three days of consistently higher carbs before the body adjusts.  Some people clearly develop higher triglyerides and other trouble on a high-carb diet.  My point is just that the context of one's particular phenotype is important - and sometimes tough to figure out.

  • Might-o'chondri-AL

    3/1/2011 5:56:01 AM |

    Hi Helen,
    I don't want to over step blog protocol, so this is just feedback. The blood test for glycated hemoglobin shows how the blood glucose dynamic is playing out the last couple of months.

    HbA1c is that test and, I believe, Doc set a result over 5.5% is undesireable. Maybe it would give you some insight to how your ranges of blood sugar are playing out.

    Someone here (thank you sir) recommended summitcountymedicalsociety.prepaidlab.com ; I recently used them. Credit card payment gets you an email prescription (to print out) for blood tests, they've cooperating independent
    blood drawing clinics nationwide and lab results are emailed to you. (I needed their 800 phone # help some and they resolved every issue promptly.)

    Charge = US$13 for HbA1c test plus +/- $16 for processing fee(one fee for unlimited tests, it seemed). Their prices were so much cheaper than other online options.

  • Helen

    3/1/2011 11:51:40 AM |

    Thanks, M-Al -

    At initial Dx, my A1C was 6.4.  After seven months on a strict low-carb diet (like 60 g carbs/day) and a 20 lb weight loss (I'd only been 10 lbs overweight at Dx, for the first time in my life, but I lost 20 during that time.  I've now lost nearly 30, not all for good reasons.) it was down to 6.0.  I'm monitored quarterly and am due for another A1c.  We'll see if my lower readings are borne out by the test.  I don't expect miracles, but I'm doing the best I can.  Some people's blood sugars only come down so much.  Metformin was ineffective for me and insulin would probably be dangerous, since my BG dips so far on its own post-prandially after peaking.

  • Anonymous

    4/16/2011 9:58:46 AM |

    DISCLAIMER, MY ENGLISH IS NOT VERY GOOD and this is loong SO BARE WITH ME ON THIS,I HAVE READ @ printed all this BLOG AND DROVE MY FAMILY(DOCTORS) and FRIENDS @  CARZY 1 ! THANKS!

    So i finally got my  glucometer:  OneTouch Ultra (ahh) + brand new strips (ouch) not cheap here where i live...  my old man  (doctor, lives on a diet of coffee, diet soda, bread pasta, cookies, candy etc, etc, etc + a few drugs... and is tall and "lean") thinks im completely crazy. ( im 33, 78kgr, also lean and muscular)

    so my pattern: OMP-day  fasting
    ( 23h, 24h, 27h, 30 hrs regular fasts) + 3 day wrkts
    (home, chin ups, push ups, squats) rest of the tm im mostly sedentary

    my readings so far...

    D1: 13-4

    10:00 >  71mg/dL >  FS@BS (prior that  day ate a bit of candies... pascuas)

    11:00 >  ERROR (didnt put the right code, got pissed @ didn't test)

    D2: 14-4  (no carb)

    3:07 > 70mg/dL >  FS@BS

    EAT: meat (+)yolks(+) cheese (+) butter (-) water

    4:05  > 81 mg/dL > AE@BS

    5:05  > 77 mg/dL > AE@BS

    D3 15-4 "workout" day (chin ups)  + carb
    ERROR, 2 little blood, !"·$%didn't test  (assumed 70mg/dL  FS@BS)



    11:00 >EAT: (pWRKOUT)

    meat(-) yolks (+) cheese(-) butter (-) tomato juice (+) 350CC Whole MILK+ 100G " 60% CHOCOLATE"  ( 37g carbs. aprox 20@30g sucrose + milk sugars )
    this baby

    http://www.chocolatesaguila.com.ar/uploads/info_nutricional/tabletas_rellenas_3344.pdf

    ( copy paste if u care)

    11:00 >EAT

    12:05 >  75 mg/dL > AE@BS

    12:20 > 72 mg/dL  > AE@BS

    1:06 >  82 mg/dL > AE@BS  
    ( waited 2 long there?)

    2:09  > 70 mg/dL > AE@BS

    6:12 > 67 mg/dL > AE@BS

    D3 16-4  
    ("rest day" upped the carbs anyway)

    "FS@BS"  (didn't bother to test. low as usual, i guess)

    1:00 > ??? mg/dL
    EAT: salted peanuts... roasted in vegetable oil... 100gr (could not find my chocolate...)

    2:00 > ??? mg/dL
    EAT:
    one lean, small cut of meat+ ham+ 6 yolks omelet fried in butter,  the usual 100g cheeses- Roquefort, sardo, pategras,cuartirolo,feta, 6tbs tomato juice, salt, peeper, (napolitanta)

    Dessert: -2-  ice cold glasses of 300CC WHOLE MILK + 2 TBS of Cheap sugary cocoa powder  (approx 20@30g sucrose total + milk sugars)

    3:05 > 107 mg/dL (!)

    - moved my arse a bit and did 2  slow sets of dumbbell squats, (40 reps with16k w total, super slow and easy)

    3:36 > 83 mg/dL

    4:37 > 66 mg/dL

    ok, any comments ? are my number ok?  what makes more sense , eating chocolate ( fiber, slower absrs possible less sucrose, or drinking  milk?  (talking desert here) i do not  eat vegetables, ( just, pepers, tomato juice and mushrooms) do not  eat fruit, and of course do not even touch gluten nor refined crap, and always try to limit my PUFA, and fructose load.

    also im thinking i should test my BS levels differently?  maybe  eating one (large) H fat, H 2 moderate protein, meal per day changes things a bit?  so maybe waiting 1 hrs is not enough ( thats why i used milk x 2 today, and did not wrkout to speed things a bit)

  • Anonymous

    4/16/2011 10:19:41 AM |

    edit, im 68 kgr ( not 78) ... always do the same mistake, maybe i need to gain weight!

  • Anonymous

    4/16/2011 11:01:28 AM |

    OneTouch Ultra Meter
    Eating pattern: OMP-day  
    ( 23h, 24h, 27h, 30 hrs  fasts)


    D1 REST DAY

    3:07 > 70mg/dL >  FS@BS

    EAT: meat (+)  yolks (+) cheese (+) butter ( -)  water

    4:05  > 81 mg/dL > AE@BS

    5:05  > 77 mg/dL > AE@BS


    D2 WRK DAY

    11:00 >  71mg/dL  FS@BS

    EAT: meat (-) yolks (+) cheese(-) butter (-) tomato juice (+)  +  350CC Wf MILK + 100G " 60% dark chocolate"

    12:05 >  75 mg/dL > AE@BS

    12:20 > 72 mg/dL  > AE@BS

    1:06 >  82 mg/dL > AE@BS

    2:09  > 70 mg/dL > AE@BS

    6:12 > 67 mg/dL > AE@BS


    D3  REST DAY (upped the carbs, + added liquid sugar, wrst  case)


    1:00 > ??? mg/dL
    EAT: salted peanuts... roasted in vegetable oil... 100gr

    2:00 > ??? mg/dL
    EAT:one lean, small cut of meat+ ham+ 6 yolks omelet fried in butter, 140g cheese, 6tbs tomato juice,  (napolitanta) 2  ice cold glasses of 300CC W MILK WITH 2 TBS of Cheap sugary cocoa powder  (aprox 20@30g sucrose + milk sugars)

    3:05 > 107 mg/dL (!)

    -did 2   slow sets of dumbbell squats, (40 reps with16k w total, no effort)

    3:36 > 83 mg/dL

    4:37 >  66 mg/dL

    Hypoglycemia?
    any opinions about my numbers, (imm33) should i ditch the milk @dark chocolate and eat "healthy vegetables" and "fruit" (no)


    should i wait longer 2 test my BS? (slower digestion time, one meal and all)

  • Anonymous

    4/17/2011 8:50:49 AM |

    today


    17-4 > WRKT

    9:00 > 69 mg/dL

    10:58 > EAT (6 YOLKS, CHEESE, BUTTER, 1TBS TOMATO JUICE - OMELET + 400GR MINCED MEAT, 6 STRIPS BACON, 5TBS TOMATO JUICE, BUTTER)

    2:07 > END

    DISHWASHING

    2:16 > 350cc WHOLE MILK

    2:21 > 100G 60% chocolate

    2:34 > END

    2:40 > 300cc WHOLE MILK + 1 TBS SUGAR (nesquik)

    3:01 > 71mg/dL

    3:36 > 74mg/dL

    4:39 > 83mg/dL

    5:42 > 74mg/dL

    650cc milk + lots of  sucrose... where is the zomg 160 blood glucose doctor? (btw i had been eating sucrose @ and grains like crazy 90% of my life, now im eating waay less sugar and 0 grains)

  • Anonymous

    4/17/2011 11:57:29 AM |

    edit,

    1:58 > EAT  (not 10:58...)

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Low HDL makes Dr. Friedewald a liar

Low HDL makes Dr. Friedewald a liar

There's a $22 billion industry based on treating LDL cholesterol, a fictitious number.

LDL cholesterol is calculated from the following equation:

LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5

So when your doctor tells you that your LDL cholesterol is X, 99% of the time it has been calculated. This is based on the empiric calculation developed by Dr. Friedwald in the 1960s. Back then, it was a reasonable solution, just like bacon and eggs was a reasonable breakfast and a '62 Rambler was a reasonable automobile.

One of the problems with Dr. Friedewald's calculation is that the lower HDL cholesterol, the less accurate LDL cholesterol becomes. If it were just a few points, so what? But what if it were commonly 50 to 100 mg/dl inaccurate? In other words, your doctor tells you that your LDL is 120 mg/dl, but the real number is somewhere between 170 and 220 mg/dl. Does this happen?

You bet it does. In my experience, it is an everyday event. In fact, I'm actually surprised when the Friedewald calculated LDL closely approximates true LDL--it's the exception.

Dr. Friedewald would likely have explained that, when applied to a large population of, say, 10,000 people, calculated LDL is a good representation of true LDL. However, just like saying that the average weight for an American woman is 176 lbs (that's true, by the way), does that mean if you weigh 125 lbs that you are "off" by 41 lbs? No, but it shows how you cannot apply the statistical observations made in large populations to a single individual.

The lower HDL goes, the more inaccurate LDL becomes. This would be acceptable if most HDLs still permitted reasonable estimation of LDL--but it does not. LDL begins to become significantly inaccurate with HDL below 60 mg/dl.

How to get around this antiquated formula? In order of most accurate to least accurate:

--LDL particle number (NMR)--the most accurate by far.

--Apoprotein B--available in most laboratories.

--"Direct" LDL

--Non-HDL--i.e., the calculation of total cholesterol minus HDL. But it's still a calculated with built-in flaws.

--LDL by Friedewald calculation.

My personal view: you need to get an NMR if you want to know what your LDL truly is. A month of Lipitor costs around $80-120. A basic NMR costs less than $90. It's a relative bargain.

Comments (5) -

  • Mike

    3/18/2007 1:52:00 AM |

    What is shocking is that enormous prescriptions for statins are written based on the calculated LDL.

  • Dr. Davis

    3/18/2007 1:16:00 PM |

    Yes, $22 billion last year, in fact. All prescribed for a number that is a crude estimate, sometimes a complete fiction. Imagine your state trooper ticketed you because his radar device said you were doing 60 mph when you were really doing 35 mph.

  • Anonymous

    2/6/2008 1:37:00 AM |

    Why NMR over the other tests Berkeley Heart Lab or VAP?

  • Anonymous

    7/2/2008 7:02:00 PM |

    I don't understand.  If in this example, the doctor (wrongly) thinks the LDL number is 120mg/dl, how does that cause the prescription of Lipitor? Unless I'm reading it backwards, and the doctor is actually telling the patient their LDL is 170mg-220mg, but unwittingly, it's actually 120mg/dl.

    And, if a low HDL causes the LDL number to be inaccurate, does that also cause the total cholesterol number to be inaccurate too?

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