I depart momentarily from the primary focus of the Wheat Belly Blog and discuss something that I have been following in practice for more than 10 years. I call it Nutritional Lipidology, the study of the effects of nutrition on lipids, lipoproteins, and metabolic parameters, the stuff underlying many diseases, especially cardiovascular diseases. It is indeed relevant to the Wheat Belly conversation, as wheat elimination and, even better, grain elimination, yields dramatic effects on lipids, lipoproteins, and the factors that drive cardiovascular risk. In fact, I have found these simple strategies so powerful that most people obtain values that are better than that achieved with statin drugs and other prescription agents. No, the world does not need more statin drugs; it needs better unbiased health information that does not result in revenues for deep-pocketed drug companies.
People–including my colleagues–prefer to talk about “cholesterol.” I call cholesterol the kindergarten version of how to understand how cardiovascular disease is caused: there’s a germ of truth to it, but it vastly oversimplifies the real causes, is often misleading, and can be subverted into the service of those who are adept at bending the truth, AKA pharmaceutical companies. This discussion can get awfully hairy very quickly (I tried to tame it in the chapter called “My particles are bigger than yours” in the original Wheat Belly book), so let me try to distill it down. Follow the nutritional principles laid out in Wheat Belly, incorporate a handful of core strategies to correct common nutritional deficiencies, and cultivate and nourish healthy species of bowel flora, and you have a powerful, do-it-yourself-at-home, and marvelously effective way to correct “cholesterol” values and, more importantly, lipoproteins (lipid-carrying proteins) and metabolic factors such as blood sugar and inflammation, the real currency of cardiovascular disease.
Wheat elimination followed by these few simple strategies exert these effects on the 4 values on any cholesterol panel:
- HDL cholesterol goes up
- Triglycerides drop, often dramatically
- LDL cholesterol–remember: a crude calculated value, not a measured value, usually goes down. However, recall that this value is so unreliable that it can do anything, while real measures, such as an actual count of LDL particles (e.g., NMR lipoproteins) goes down.
- Total cholesterol–also a confusing issue, because total cholesterol = LDL cholesterol + HDL cholesterol + triglycerides/5. Thus, if HDL goes up–a good thing–total cholesterol also goes up–often interpreted as a bad thing. Total cholesterol is, in my view, an outdated and total useless value, except for occasional use in epidemiological observations within large populations, but not for application to specific individuals.
While there’s a heck of a lot more to this than my own personal experience, here was my own transformation. When I was vegetarian 25 years ago, eating on only “healthy whole grains,” fruits, and vegetables, my values were:
- HDL 27 mg/dl
- Triglycerides 350 mg/dl
- LDL cholesterol 144 mg/dl
- Total cholesterol 241 mg/dl
In addition, my fasting glucose was 161 mg/dl–I became diabetic on this low-fat, vegetarian program. And I was jogging 3-5 miles a day. (Soon after Mevacor, the first statin cholesterol drug, was approved by the FDA and released, I took it. Within 72 hours, I became acutely ill, thought I was going to die and couldn’t get out of bed for 48 hours. Likewise, simvastatin, Lipitor, and Crestor made me sore all over, made me think I had aged 30 years overnight. Needless to say, I stopped playing with them both personally and, over time, learned how to help patients control the situation with almost no reliance on this deeply flawed group of drugs.) I stopped following a vegetarian, grain-based diet over the years, eventually eliminating all grains, eating more fat, correcting my vitamin D deficiency, supplementing omega-3 fatty acids, supplementing iodine and correcting thyroid dysfunction, and supplementing magnesium, and my values–on NO drugs–are:
- HDL 97 mg/dl
- Triglycerides 43 mg/dl
- LDL cholesterol 81 mg/dl
- Total cholesterol 187 mg/dl
My fasting blood sugar: 84 mvdl. HbA1c: 4.8%. If we were to look at the changes in lipoproteins, the real values underlying the crude cholesterol values, we would observe that:
- Small LDL particles are gone or dramatically reduced–Because the amylopectin A of grains is the most flagrant trigger for this small LDL particles, eliminating wheat and grains results in marked reductions or elimination. The reduction in triglycerides and VLDL achieved with omega-3 fatty acids, coupled with enhanced insulin sensitivity achieved through weight loss, vitamin D, and magnesium add to the effect.
- VLDL particles are dramatically reduced–Because there is no amylopectin A to convert (via the liver process of de novo lipogenesis) to triglycerides that reside largely in VLDL particles, the number and composition of VLDL particles are altered and are less able to contribute to unhealthy effects, such as triggering formation of small LDL particles. Omega-3 fatty acids reduce VLDL particles substantially.
- Postprandial lipoproteins, i.e., the after-meal flood of particles into the bloodstream after digestion, is markedly reduced. While fat makes a modest contribution to postprandial lipoproteins, carbohydrates such as amylopectin A makes a larger contribution, though delayed for several hours. Eliminate amylopectin A and this effect disappears. Omega-3 fatty acids further blunt the fat-driven postprandial rise.
- The number of LDL particles (e.g., via NMR or measured as apoprotein B, the primary protein of LDL particles), the real measure of LDL and not a crude calculated value, drops substantially. This develops because of the reduction or elimination of small LDL particles within the total number of LDL particles; the cultivation of Lactobacillus and Bifidobacteria bowel flora species that express the enzyme, bile acid hydrolase, that inhibits resorption of bile acids that would otherwise have been recirculated to create more LDL particles; and correction of thyroid status.
Yes, a bit complicated. But we have to get beyond this ridiculous notion that cutting fat or saturated fat reduces “cholesterol.” You can appreciate that the situation is a bit more complex. When you start to understand what really happens with changes in diet, you quickly recognize that, not only is most of the $23 billion spent annually on statin drugs not really necessary, you recognize that astounding improvements in lipids and lipoproteins are achievable by incorporating just a few simple strategies.
Shouldn’t this be the default solution to people with “cholesterol” problems?