Saturday, February 21, 2015

Dr. Nancy Snyderman Confuses Today Show Viewers About Heart Health, Cholesterol and Paleo Diet

Does NBC have a truthiness problem?

Like it wasn't bad enough she sneaked out of her house to get restaurant take-out while under quarantine for Ebola exposure.

This month NBC's medical "expert" Dr. Nancy Snyderman lost her remaining shred of credibility after misleading viewers on The Today Show about HDL and LDL cholesterol and the Paleo diet.

The so-called "Women of Today" -- Savannah Guthrie, Natalie Morales, Hoda Kotb, Tamron Hall, Dylan Dreyer, Sheinelle Jones and Erica Hill -- all had their blood tested for cholesterol levels.

Here's a clip of what happened:

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And here's why it was wrong on so many levels.

First of all, Snyderman mixed up optimal HDL and LDL cholesterol levels during the segment. After first stating that HDL should ideally be over 60 and LDL should be under 100, she later told Erica Hill:
"Your HDL was 108. But your LDL, which you want 60 or lower is 112. So that might easily be related to animal fat. So if I were you I would get off that paleolithic whatever it is, that caveman diet, and just go back to being a girl."
Hello? Looks like you mixed up your Hs and Ls there, Nance, making it sound like Hill's numbers were far worse then actually they were.

Some visitors to The Today Show website, which featured a video clip of the segment, were appalled by Snyderman's number confusion. One commenter wrote, "As a woman who works in cardiology, I am very disappointed that she got this so wrong.  It is so important to get this message out to women, and today she confused so many. Even if this isn't her personal speciality, it is common knowledge in medicine." 

But that wasn't the only mistake Snyderman made.
Dr. Nancy Snyderman
After first lauding a few of the newswomen for their lab results, Snyderman told Hill, "Erica, you came in with the all-time worst numbers. You came in at 228 which on the surface sounds like, uh, high. But interestingly, because you're fit and you exercise, your HDL -- your protective number -- is high. So it skews you high a little bit."

Ah, but it's not just about exercise. Even Big Pharma loving WebMD admits that increased HDL happens when you eat a diet far lower in carbs than the American Heart Association recommends. Thus, people who follow Paleo diets may be more likely to enjoy better heart health than those who follow the carb-loving USDA dietary guidelines bought and paid for by the wheat, corn and sugar industries.

Erica Hill
The shamed Hill was left as red-faced as her dress, "confessing" she has been eating more, gasp, red meat and bacon. "I'm on this weird 30 day diet where I've given up grains, dairy, sugar, legumes and alcohol."

Please don't apologize for not eating sugar, Erica. You weren't the one giving out lollipops after the blood draws.

What's unfortunate is that Snyderman dumbed down the cholesterol story to elementary school level by making it sound like there are universally agreed upon "good" and "bad" numbers and unless you fit into a prescribed range you should be signing up for a lifetime supply of Lipitor.

For one thing, HDL and LDL are not even cholesterol per se, they are lipoproteins, which are like boats that carry cholesterol as their cargo. Not the same thing at all.

Nor did Snyderman mention the role of triglycerides in assessing the risk of cardiovascular disease (CVD) and the preference among many lipid experts of using the ratio of triglycerides to HDL to tease out whether one's LDL carries large buoyant particles or smaller dense particles. It's the small dense ones that lodge in the arteries, and if your triglyceride levels are low, you likely have more of the large buoyant ones that don't cause problems.

Dr. Barry Sears of The Zone Diet fame provides a great layperson explanation of good and bad LDL here:
In more recent years, scientists discovered two types of LDL cholesterol. One type consists of large, fluffy LDL particles that appear to have no potential to cause atherosclerosis or the development of plaques on the large or medium-sized arteries. The other type consists of small, dense LDL particles that are strongly associated with arterial plaques and this can increase the risk of heart disease.

So now you have good “bad” cholesterol (large, fluffy LD particles) and bad “bad” cholesterol (small, dense LDL). Getting confused?

Well, so is everyone else who is fighting the cholesterol wars, because we now know that the more bad “bad” cholesterol you have, the more likely you are to have a heart attack, whereas having a high level of the good “bad” cholesterol isn’t likely to have any adverse health effects.

How can you tell which type of LDL you have? All you have to do is determine your ratio of triglycerides to HDL cholesterol, which would be found as part of the results of your last cholesterol screening.

If your ratio is less than 2, you have predominantly large, fluffy LDL particles that are not going to do you much harm. If your ratio is greater than 4, you have a lot of small, dense LDL particles that can accelerate the development of atherosclerotic plaques – regardless of your total cholesterol levels.
Understanding the relationship of cholesterol to CVD risk is incredibly complex and I am still wrapping my brain around it. My favorite source of information right now is an eight-part series that breaks down the science behind cholesterol by Dr. Peter Attia on his blog, The Eating Academy. Unless you are a biochemist, you may have to read it several times before it sinks in.

Meanwhile, here's what the Twitterverese had to say about Snyderman's cholesterol segment on Feb.5:

The bottom line is we are still learning about the link between cholesterol, diet and heart health every day. Let's not just be all smug and pretend we know it all when we don't.

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