The Rubbish Diet Challenge goes on tour!

I am immensely excited to announce that the Rubbish Diet Challenge, which until now has been kept to the confines of the Internet, is, for the very first time, being launched as a community based initiative in a number of locations around the UK.

Inspired by my online challenge, which took eight households through slimming their bins at the beginning of the year, two organisations are now taking the concept into their local communities and are seeking volunteers who want to reduce their waste for an 8 week challenge, set to start in the new year.

Transition Town Shrewsbury in Shropshire is launching its Rubbish Diet Challenge next week, to an audience of community leaders and interested residents, to outline how they can be involved in creating a fabulous slimming club with a difference. I am delighted to confirm that I will be attending the launch.

Elsewhere, Wiltshire Wildlife Trust launched its Waste Watchers Rubbish Diet project last week, highlighting its own exciting plan for weekly events to support all those who take part.  Emma Croft's interview with BBC Wiltshire (fast forward to 1hr 10m) calls for 8 residents from around the county to join in.


It really is an exciting time to witness the adoption of the Rubbish Diet by independent organisations and I can't wait to see the results. I also hope that these two initiatives will be the first of many that will be held around the country over the next couple of years.  So watch this space for further news.


For more information about the Wiltshire Wildlife Trust project, please contact Emma Croft on 01380 736074 or email EmmaC@wiltshirewildlife.org.

To find out more about the Transition Town Shrewsbury project or to attend its launch on Thursday 25th October (7-8.30pm at the Hobbs Room, Shrewsbury Library), contact Ali Thomas on 07972 858313 or email Alison.thomas08@gmail.com.

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The steep obesity increase in the USA in the 1980s: In a sense, it reflects a major success story

Obesity rates have increased in the USA over the years, but the steep increase starting around the 1980s is unusual. Wang and Beydoun do a good job at discussing this puzzling phenomenon (), and a blog post by Discover Magazine provides a graph (see below) that clear illustrates it ().

What is the reason for this?

You may be tempted to point at increases in calorie intake and/or changes in macronutrient composition, but neither can explain this sharp increase in obesity in the 1980s. The differences in calorie intake and macronutrient composition are simply not large enough to fully account for such a steep increase. And the data is actually full of oddities.

For example, an article by Austin and colleagues (which ironically blames calorie consumption for the obesity epidemic) suggests that obese men in a NHANES (2005–2006) sample consumed only 2.2 percent more calories per day on average than normal weight men in a NHANES I (1971–1975) sample ().

So, what could be the main reason for the steep increase in obesity prevalence since the 1980s?

The first clue comes from an interesting observation. If you age-adjust obesity trends (by controlling for age), you end up with a much less steep increase. The steep increase in the graph above is based on raw, unadjusted numbers. There is a higher prevalence of obesity among older people (no surprise here). And older people are people that have survived longer than younger people. (Don’t be too quick to say “duh” just yet.)

This age-obesity connection also reflects an interesting difference between humans living “in the wild” and those who do not, which becomes more striking when we compare hunter-gatherers with modern urbanites. Adult hunter-gatherers, unlike modern urbanites, do not gain weight as they age; they actually lose weight (, ).

Modern urbanites gain a significant amount of weight, usually as body fat, particularly after age 40. The table below, from an article by Flegal and colleagues, illustrates this pattern quite clearly (). Obesity prevalence tends to be highest between ages 40-59 in men; and this has been happening since the 1960s, with the exception of the most recent period listed (1999-2000).

In the 1999-2000 period obesity prevalence in men peaked in the 60-74 age range. Why? With progress in medicine, it is likely that more obese people in that age range survived (however miserably) in the 1999-2000 period. Obesity prevalence overall tends to be highest between ages 40-74 in women, which is a wider range than in men. Keep in mind that women tend to also live longer than men.

Because age seems to be associated with obesity prevalence among urbanites, it would be reasonable to look for a factor that significantly increased survival rates as one of the main reasons for the steep increase in the prevalence of obesity in the USA in the 1980s. If significantly more people were surviving beyond age 40 in the 1980s and beyond, this would help explain the steep increase in obesity prevalence. People don’t die immediately after they become obese; obesity is a “disease” that first and foremost impairs quality of life for many years before it kills.

Now look at the graph below, from an article by Armstrong and colleagues (). It shows a significant decrease in mortality from infectious diseases in the USA since 1900, reaching a minimum point between 1950 and 1960 (possibly 1955), and remaining low afterwards. (The spike in 1918 is due to the influenza pandemic.) At the same time, mortality from non-infectious diseases remains relatively stable over the same period, leading to a similar decrease in overall mortality.

When proper treatment options are not available, infectious diseases kill disproportionately at ages 15 and under (). Someone who was 15 years old in the USA in 1955 would have been 40 years old in 1980, if he or she survived. Had this person been obese, this would have been just in time to contribute to the steep increase in obesity trends in the USA. This increase would be cumulative; if this person were to live to the age of 70, he or she would be contributing to the obesity statistics up to 2010.

Americans are clearly eating more, particularly highly palatable industrialized foods whose calorie-to-nutrient ratio is high. Americans are also less physically active. But one of the fundamental reasons for the sharp increase in obesity rates in the USA since the early 1980s is that Americans have been surviving beyond age 40 in significantly greater numbers.

This is due to the success of modern medicine and public health initiatives in dealing with infectious diseases.

PS: It is important to point out that this post is not about the increase in American obesity in general over the years, but rather about the sharp increase in obesity since the early 1980s. A few alternative hypotheses have been proposed in the comments section, of which one seems to have been favored by various readers: a significant increase in consumption of linoleic acid (not to be confused with linolenic acid) since the early 1980s.

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Talking biogas & green heroes with Kevin McCloud at Grand Designs Live

Kevin McCloud at Grand Designs Live. (photo copyright GDL)

If there's one event that's fast becoming a highlight of my annual calendar, it's Grand Designs Live and the opportunity to a have a peek at Kevin's Green Heroes. a collection of ten designers who have been handpicked by Kevin McCloud for their commitment to both sustainability and innovative ideas.

And this year didn't disappoint. From sustainably produced wallpaper to tiles, reclaimed wood furniture to rainwater harvesting, there is something to appeal to everyone who is interested in great eco-design.

For instance I love this gorgeous wallpaper by MissPrint, an Essex based business, which uses PEFC certified materials and non-toxic inks.

And I think Hendzel and Hunt's chairs, made from reclaimed hardwood and Victorian floorboards, are just gorgeous. I'd love them for my dining room.

But when it comes to products that can have a wide impact on waste reduction, the design that stood out for me this year is the Compo food waste digester, developed by Nottingham Trent graduate Oliver Ling.

Its sleek design makes it an attractive product for any kitchen and that is crucial for opening up the marketplace to those interested in better managing their food waste.  Not everyone has a local authority food waste collection and many people are simply not interested in the idea of bokashi bins or wormeries.  However, I can see a whole host of apartment-dwellers and gadget-geeks taking a keen interest in this.

What sets the Compo apart from other systems is that as well as creating well-digested compost, its key by-product is actually biogas. Stored in small canisters, an easy collection system is central to its design, allowing its owners to earn money from the fuel generated from their domestic food waste.

Of course the message to households should always be to reduce what they can, but a solution like this helps to manage residual food waste and turn it into something useful that benefits the individual, instead of carting it off in trucks.

As I declared my particular interest in this to Kevin McCloud, he tempers my excitement with the news that the Compo is still only a prototype.

"Green Heroes usually features products that are already available for consumers to buy," he confirms. "However I thought this was such a good idea, I had to include it."

And I am glad he did because I can really see a lot of potential here.

Having caught up with the designer, Oliver Ling, it became clear that the driver behind the product was his own passion in helping to tackle the food waste problem. The prototype was created as his final year project at university, where he undertook a lot of primary research analysing the contents of domestic rubbish bins.  This is further demonstrated in that the Compo is designed to be manufactured from recycled plastic derived from food packaging.

"I wanted to design something that was sustainable," Oliver affirms.  "In fact, I believe it is so important, every product designer should get involved with sustainability".

Designer Oliver Ling, at the Green Heroes stand at Grand Designs Live

I couldn't agree more. Designers have immense power to revolutionise the future waste landscape, either through designing-out wasteful and hard-to-recycle materials from their products or in developing new processes and infrastructures that manage our wastes better.

I was interested in Kevin McCloud's view on this, especially as there is potential to develop more scaleable applications of the Compo.

And having watched his recent series of Man Made Home, which involved the construction of a cabin that enabled him to live off-grid, it was the localised production of biogas that particularly caught my attention.

Politely referring to it as "Episode 3", rather than "the one where you cooked on gas made from your own poo", the programme featured a visit to an Anaerobic Digestion plant, which incorporates the collection of dog poo and other materials to create a rich compost and biogas, capable of powering a small village.

Kevin wanted to apply this idea to his own cabin experience and in an entertaining fashion set about building an outdoor loo and biogas infrastructure to collect and process human wastes, supplemented by a good dollop of lion dung, which was retrieved from nearby Longleat.

"This isn't revolutionary," he insists. "And it's not unproven. In India, for 150 years, people have been building biogas digester systems across the country and lots of villages now have them."

Behind the obvious fun involved in building his own off-grid cabin, he was actually keen to explore what was possible, discover what could work in the UK and consider which solutions could be scaled up.

"I'd like it to go one step further and connect to the grid," he adds, "Especially as an average family can produce enough methane to cook all its food."

However, he doesn't envisage a future where households would have their own individual digesters and personally, despite my fascination for the subject, I feel a certain relief in that.

So what is the way forward?

Kevin tells me that the sensible way to do this is on a more ambitious scale, supporting several streets to divert waste from sewage systems into a local biodigester, which connects with the gas main to bring the energy source back into the home.

"Currently our infrastructure is national or regional," he says. "We could be considering all those services at a more local scale. Many sewage sites are starting to cover their tanks with methane collectors, but there is potential to create better self-sufficient communities."


"The infrastructures for collection already exist but we are very early in the process of transition and it will take philanthropists to influence and direct building self-sufficient communities."

"And where society once viewed those who once lived off-grid as green extremists, we are now considering them as true pioneers."


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Kevin McCloud is the ambassador for Grand Designs Live Birmingham and London.  For more information please visit www.granddesignslive.com

 

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Trashed! An evening in London with Jeremy Irons.

Jeremy Irons and producer Candida Brady 

introducing Trashed at London's Raindance Festival

My passion for waste reduction has taken me to many places, but Saturday was the first time it's ever landed me in a movie premiere in the heart of London.

But you can forget the red carpet on this occasion, even if the leading man was Jeremy Irons. For Saturday's movie was not some glitzy affair in Leicester Square,but an independent documentary, being screened as part of an independent film festival.

Trashed, featuring Jeremy Irons and produced by Blenheim Films, takes us on a journey around the world highlighting the issues with how our waste is managed.  It begins with the sobering sight of a rubbish dump on the coastline of Lebanon, discussing the effects of the pollutants from physical trash and leachate that spill into the Mediterranean, a serious international environmental problem.

Closer to home, the portrayal of dioxins from toxic waste sites and incinerators renders the UK's experience just as harsh viewing.  In one of the few countries in the world where waste management is so tightly controlled and where we have some of the best technology available, it is shocking to hear that even a modern incinerator in Scotland has breached emissions limits 172 times.  And that's only since 2009.

Thanks to the effects of emissions and leacheate, even if they appear to be tightly controlled, there seems to be very little escape from the consequences of burying or burning our rubbish.

And sadly, the images of villagers in a developing country throwing their rubbish into the river behind their homes, drinking water from that river, washing in it and eating the fish that they had caught from it, suddenly felt like a microcosm of the wider world within which we live.

 
It's truthful to say that Trashed, with its evidence of the amount of chemicals reaching our food chain, is very depressing viewing, not to mention the shocking images of fish and mammals that are physically injured by the debris floating in the sea.

To add a few figures to this, oceanographer Charles Moore highlights that there is now six times more plastic in the ocean than zooplankton, which form the very basis of the food chain.  And it's not the physical plastic that we can see that should only concern us, but more worryingly the material that we can't, i.e. the stuff that's so small it's easily absorbed, suppressing immune systems, hormones and reproductive systems.

With examples of whales being now so heavily contaminated that many can no longer reproduce, the documentary makers refer to the analogy of the canaries in a coal mine, a worrying prediction that what currently affects these mammals, will in the course of a few generations affect us.

I don't think any of us like to face harsh news like this, especially if we don't have the scientific background to make judgments for ourselves.  We can always believe that it is someone else's problem or that it doesn't matter to us, because we don't witness it or we won't be around to experience the sorry consequences. The problem may be seen as being too great for us to handle anyway. And the result? We just go about our everyday business, pushing it into the back of our minds, continuing life as normal.

But personally, even with the hard-to-swallow science, my own ignorance and how insignificant my own contribution is in this global picture, I welcome documentaries like Trashed.

It is better to know what we are up against, so we can mobilise human intelligence to more widely monitor, reinvent, better legislate, engineer solutions and develop new economies that reverse such trends, as well as place political pressure on those who have the power to influence international development.

Trashed gives a taster of some of the efforts that are already taking place to better manage, at the very least, Western approaches towards waste, including the San Francisco Zero Waste programme, where it is a legal requirement for every resident and visitor to participate in the recycling initiatives.  The documentary also featured a new approach to modern retail such as that promoted by Catherine Conway and her shop Unpackaged in London.  Even without such frameworks and facilities, Rachelle Strauss of MyZeroWaste.com demonstrated to Jeremy Irons, how as an individual we can take better care in choosing what we buy and vote with our wallets.

So rather than hide from this harsh tale, I would much prefer we stared it straight in the eye and committed to taking some form of action, whether it's through changing our shopping choices, recycling efforts or participating in a spot of activism.

So next time you hear that it's better to burn or bury our rubbish than fight for well managed and resourceful zero waste solutions, I'd like you to think of Trashed.  But don't take my word for it, watch the trailer.


Jeremy Irons not only makes such a powerful storyteller but having witnessed the issues first-hand, he believes that with the right support and backing from consumers, industry and governments the situation is indeed curable.

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Trashed is being screened as part of London's indie film festival Raindance,and has been nominated for the Best Documentary Award.  It is being shown again, on Tuesday 2nd October at 3pm.  Another waste related film, being screened on Saturday 6th October, is the 10 minute short, Emptys.

If you are new to the idea of Zero Waste and want to know more about action that's being taken in the UK, follow www.myzerowaste.com and the Zero Waste Alliance UK (of which I am a trustee) for further news.

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The anatomy of a VAP test report

The vertical auto profile (VAP) test is an enhanced lipid profile test. It has been proposed, chiefly by the company Atherotech (), as a more complete test that relies on direct measurement of previously calculated lipid measures. The VAP test is particularly known for providing direct measurements of LDL cholesterol, instead of calculating them through equations ().

At the time of this writing, a typical VAP test report would provide direct measures of the cholesterol content of LDL, Lp(a), IDL, HDL, and VLDL particles. It would also provide additional measures referred to as secondary risk factors, notably particle density patterns and apolipoprotein concentrations. Finally, it would provide a customized risk summary and some basic recommendations for treatment. Below is the top part of a typical VAP test report (from Atherotech), showing measures of the cholesterol content of various particles. LDL cholesterol is combined for four particle subtypes, the small-dense subtypes 4 and 3, and the large-buoyant subtypes 2 and 1. A breakdown by LDL particle subtype is provided later in the VAP report.

In the table above, HDL cholesterol is categorized in two subtypes, the small-dense subtype 2, and the large-buoyant subtype 3. Interestingly, most of the HDL cholesterol in the table is supposedly of the least protective subtype, which seems to be a common finding in the general population. VLDL cholesterol is categorized in a similar way. IDL stands for intermediate-density lipoprotein; this is essentially a VLDL particle that has given off some of its content, particularly its triglyceride (or fat) cargo, but still remains in circulation.

Lp(a) is a special subtype of the LDL particle that is purported to be associated with markedly atherogenic factors. Mainstream medicine generally considers Lp(a) particles themselves to be atherogenic, which is highly debatable. Among other things, cardiovascular disease (CVD) risk and Lp(a) concentration follow a J-curve pattern, and Lp(a)’s range of variation in humans is very large. A blog post by Peter (Hyperlipid) has a figure right at the top that illustrates the former J-curve assertion (). The latter fact, related to range of variation, generally leads to a rather wide normal distribution of Lp(a) concentrations in most populations; meaning that a large number of individuals tend to fall outside Lp(a)’s optimal range and still have a low risk of developing CVD.

Below is the middle part of a typical VAP report, showing secondary risk factors, such as particle density patterns and apolipoprotein concentrations. LDL particle pattern A is considered to be the most protective, supposedly because large-buoyant LDL particles are less likely to penetrate the endothelial gaps, which are about 25 nm in diameter. Apolipoproteins are proteins that bind to fats for their transport in lipoproteins, to be used by various tissues for energy; free fatty acids also need to bind to proteins, notably albumin, to be transported to tissues for use as energy. Redundant particles and processes are everywhere in the human body!

Below is the bottom part of a typical VAP report, providing a risk summary and some basic recommendations. One of the recommendations is “to lower” the LDL target from 130mg/dL to 100mg/dL due to the presence of the checked emerging risk factors on the right, under “Considerations”. What that usually means in practice is a recommendation to take drugs, especially statins, to reduce LDL cholesterol levels. A recent post here and the discussion under it suggest that this would be a highly questionable recommendation in the vast majority of cases ().

What do I think about VAP tests? I think that they are useful in that they provide a lot more information about one’s lipids than standard lipid profiles, and more information is better than less. On the other hand, I think that people should be very careful about what they do with that information. There are even more direct tests that I would recommend before a decision to take drugs is made (, ), if that decision is ever made at all.

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Beyond our bins: An inside peek at the UK's largest waste exhibition 'RWM with CIWM'

Having delivered a presentation last year at the country's largest waste management exhibition, I was keen to revisit RWM with CIWM and have a decent peek at what's really happening beyond our bins.

It looks like I wasn't the only one!.

The star attraction was not quite the latest wheelie bin that teleports your waste to the nearest recycling centre, but the rather marvellous Professor Brian Cox, who, thinking about it, could surely one day make that kind of magic happen.

He was, unsurprisingly, a teeny bit popular, so I tried another route in...

...but for want of a pair of stilts and an invisibility cloak, I failed, like a balloon that had popped too soon!

So very near to the particle recycling party, but yet so far.

And sadly very much out of earshot.

Thankfully, with the industry press fairy godmothers at the helm, I can still share the words of the prof, who not only teased the audience of waste professionals with the concept of space disposal, but on a serious note, reasserted that the Earth's resources are rare and must be protected.

But, I must confess I didn't trek all the way to Birmingham's NEC, just to see the professor.  I wanted to get a picture of how the waste industry is planning to helping householders and businesses waste less.  I soon got the impression that despite there still being many hurdles, those involved in the waste stream are ready to face these challenges, hurl themselves forward and keep improving targets.

Of course, the issue of targets is an interesting one and I was intrigued to discover what a panel of thought-leaders from the industry felt about the realities of Zero Waste.

Featuring senior representatives from APSRG, CIWM, WRAP and SLR Consulting, the message came over quite clearly that the view of panellists was that we will never quite reach 'zero waste to landfill'.

However, it was also discussed that great strides towards a zero waste economy are actually possible and regardless of never being able to hit zero, the benefits along the route are really worth the journey.

Maybe it is the optimist in me, but I would like to think that the members of the panel were all holding onto a secret hope that even though they said we'll never hit the magic zero, we will one day reach the rather cheeky figure of a 99.99% waste reduction rate. Okay, maybe I'm a tad extreme, perhaps for now I'll settle happily at 98%.

After all, this is the same panel which acknowledged that in 1980 the industry didn't even aspire to a 5% recycling rate and would have laughed at targets as high as 50%, a figure that in many areas is currently being met.

Another 32 years of innovation and rethinking will present a different picture, I am sure of it.

The industry already speaks of waste as now being a matter of logistics, with businesses such as Stobart  taking an interest.  It also acknowledges how it needs to be better at communicating the opportunities of designing out waste with designers and manufacturers, a process that really it shouldn't fear.  Better product design will bring better recyclate, which can be more easily streamed, fetching greater financial value in a properly managed circular economy. 

Elsewhere, we are also seeing stronger partnerships between recycling companies and manufacturers, such as Coca-Cola's joint venture with Eco Plastics.  From the retail perspective, Sainsbury's is seeking to work with local authorities to roll-out better recycling facilities at the company's stores, which will include mixed plastics recycling as well as banks for small electricals.  As for local authorities, those in charge of Household Waste Recycling Centres are increasingly seeking partners in the third sector to help push reuse, as illustrated by this recent example from Buckinghamshire

As for kerbside innovations it's great to see that developments in wheelie bin design, as well as collection vehicles, can now enable easy and smarter recycling opportunities, which offer better quality recyclables for the end markets.

However, for the industry to maximise its efficiency, it is also in the area of consumer education, where the waste sector needs to urgently innovate.

We can aspire to having the best recycling facilities in the world, yet if the materials needed to support that zero waste economy still end up in landfill or incinerators, the industry might as well pop on its slippers and smoking jacket and spend the next few decades staring into the flames of the comparatively unimaginative energy from waste.

The waste reduction and recycling messages must not just continue as they, they must be stronger and more innovative to capture the imaginations and support of a greater public, to inspire individuals and organisations to increase participation.

Independent businesses need to better understand the process of diverting their landfill waste to a recycling service, which many currently see only as a fincancial burden rather than the economic incentive that diversion offers.  And community leaders, should be encouraged to create zero waste plans that support their local areas, through recycling incentives and third-sector benefits.

Wherever EfW facilities exist, recycling messages need to be stronger still, and yes, I do recognise the irony.

There are so many fantastic innovations taking place that the waste sector has a huge story to tell.  Yet, the headlines which hit the mass media are normally those that knock the recycling process, leaving local authorities to work harder at the 'Reduce, Reuse, Recycle' message to battle the bad news stories.

It is encouraging to hear that industry journalists, such as the strong editorial team at MRW, are now forging closer links with the national media to help bring, into the public arena, news that would have once remained solely in the sector.

For it is the national media that has a key role to play in helping to change our behaviour.  As well as the "how to" advice that comes from local authorities and the Recycle Week campaigns organised by WRAP, we also need innovative features to entertain magazine & newspaper readers, TV viewers and social-media users.

Features that close in on exciting technologies, quirky recycled products, popular economics and science, or even delving into the odd celebrity bin!  It really is time for the sector to find its place in modern and popular culture.

Just imagine if someone like Clare Balding got uber-excited about waste reduction and let the cameras follow her rubbish, recycling rates would probably double by December, and if she did a double-act with Prof Brian Cox, we'd be hitting zero waste by the end of the decade.

Now there's an idea.

I rather like that.

I'll bear that in mind as I wander back to my washing-up!


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For an excellent industry overview of the highlights of the RWM with CIWM, visit Edie Waste and LetsRecycle.

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Familial hypercholesteromia: Why rely on cholesterol levels when more direct measures are available?

There are two forms of familial hypercholesteromia (FH), namely heterozygous and homozygous FH. In heterozygous FH only one copy of the gene that causes it is present, inherited either from the father or the mother. In homozygous FH, which is the most lethal form, two copies of the gene are present. FH is associated with early-onset cardiovascular disease (CVD).

Homozygous FH may happen if both the father and mother have heterozygous or homozygous FH. If both the father and mother have heterozygous FH, the likelihood that at least one in four children will have homozygous FH will be high. If both parents have homozygous FH the likelihood that all children will have homozygous FH will be high.

In fact, in the latter case, homozygous FH in the children is almost certain. One case in which it won’t occur is if the combining FH gene from the father or mother mutates into a non-FH gene before it is used in the assembly of the genome of the child. A gene mutation in a specific locus, only for the father or mother, is an unlikely event, and would lead to heterozygous FH. Two gene mutations at once in the same locus, for the father and mother, is a very unlikely event.

By the way, despite what many are led to believe based on fictional characters in movies and series like the X-Men and Hulk, mutations in functional genes usually lead to harmful traits. In our evolutionary past, those traits would have been largely removed from the gene pool by selection, making them rare or nonexistent in modern humans. Today we have modern medicine; a double-edged sword.

Mutations leading to super-human traits are very, very unlikely. The myostatin gene, for example, suppresses muscle growth. And yet the mutations that lead to little or no secretion of the related myostatin protein are very uncommon. Obviously they have not been favored by selection, even though their holders are very muscular – e.g., Germany’s “Incredible Hulky” ().

Okay, back to FH. Xanthelasmas are relatively common among those who suffer from FH (see photo below, from Globalskinatlas.com). They are skin deposits of cholesterol, have a genetic basis, and are NOT always associated with FH. This is important – several people have xanthelasmas but not FH.

FH is a fairly rare disease, even in its heterozygous form, with an overall incidence of approximately 0.2 percent. That is, about 1 in 500 people in the general population will have it. Genetically related groups will see a much higher or lower rate of incidence, as the disease is strongly influenced by a genetic mutation. This genetic mutation is apparently in the LDL receptor gene, located on the short arm of chromosome 19.

The table below, from a study by Miltiadous and colleagues (), paints a broad picture of the differences one would typically see between heterozygous FH sufferers and non-FH controls.

The main difference is in total cholesterol and in the relatively large contribution of LDL to total cholesterol. A large difference is also seen in Apolipoprotein B (indicated as "Apo B"), which acts as a LDL transporter (not to be confused with a LDL receptor). The LDL cholesterol shown on the table is calculated through the Friedewald equation, which is notoriously imprecise at low triglyceride levels ().

Looking at the total cholesterol row on the table, and assuming that the numbers after the plus/minus signs are standard deviations, we can conclude that: (a) a little more than two-thirds of the heterozygous FH sufferers had total cholesterol levels falling in between 280 and 446; and (b) a little more than two-thirds of the non-FH controls had total cholesterol levels falling in between 135 and 225.

Keep in mind that about 13.5 percent {calculated as: (95-68)/2} of the non-FH controls had total cholesterol levels between 225 and 270. This is a nontrivial percentage; i.e., these may be a minority but are not rare individuals. Heterozygous FH sufferers are rare, at 0.2 percent of the general population. Moreover, about 2 percent of the non-FH controls had non-pathological total cholesterol levels between 270 and 315. That is not so rare either, amounting to an “incidence” 10 times higher than heterozygous FH.

What would happen if people with heterozygous FH were to replace refined carbohydrates and sugars with saturated fat and cholesterol in their diets? Very likely their already high total cholesterol would go up higher, in part because their HDL cholesterol would go up (). Still, how could they be sure that CVD progression would accelerate if they did that?

According to some studies, the higher HDL cholesterol would either be generally protective or associated with protective factors, even among those with FH (). One of those protective factors may be a more nutrient-dense diet, as many foods rich in cholesterol are very nutrient-dense – e.g., eggs, organ meats, and seafood.

This brings me to my main point in this post. It is mainstream practice to diagnose people with FH based on total and/or LDL cholesterol levels. But the main problem with FH is that it leads to early onset of CVD, which can be measured more directly through simple tests, such as intima-media thickness and related ultrasound plaque tests (). These are noninvasive tests, done in 5 minutes or so, and often covered by insurance.

Even if simple direct tests are not perfect, it seems utterly nonsensical to rely on cholesterol measures to diagnose and treat FH, given the possible overlap between pathological and non-pathological high total cholesterol levels.

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