I’ve discussed this issue in past, but it bears repeating. I recently posted a quote attributed to South African doctor, Dr. Timothy Noakes, who declared that “If all diabetics adopted a low carbohydrate, high fat diet, it’s been estimated that 6 pharmaceutical companies would go out of business tomorrow.”
I’m not sure if Dr. Noakes actually said this. But I nonetheless love it because it makes the point that type 2 diabetes is a man-made disease that is reversible in the majority. I’ve done it many, many times. There are several clinical trials demonstrating this, as well, even though the everyday practicing physician continues to believe that, once you are a type 2 diabetic, you are a type 2 diabetic for life.
But it surprised me at how many commenters to this Facebook post made statements like “Yeah, well, you’ll die of high cholesterol and heart disease.”
So let’s set the record straight. But rather than repeat the arguments I’ve made here in the Wheat Belly Blog a number of times, as well as in my Wheat Belly Total Health or Undoctored books, I shall provide links to relevant conversations I’ve posted in past. A few important statements:
- Cholesterol does not cause heart disease. Cholesterol is a crude and outdated marker for the lipoprotein particles in the bloodstream that cause heart disease. We have been able to obtain detailed lipoprotein analyses for over 25 years. The results obtained via more detailed lipoprotein testing make it obvious that the factors that cause heart disease have nothing to do with fat intake or cholesterol; the results make it obvious that carbs and sugars provoke small LDL particles, VLDL particles, and other abnormalities that cause heart disease. In other words, the solution is nutritional, not drugs. But that would not serve the pharmaceutical industry well, so this insight goes essentially ignored. See this extended discussion about small LDL particles and its unique behavior that explains why it is a potent cause for coronary atherosclerosis and heart attacks. Because your doctor likely drinks the Big Pharma Kool-Aid, you may have to achieve this on your own, but you will soon appreciate that the results are dramatically superior to taking statin drugs and cutting dietary fat.
- Total fat and saturated fat do indeed increase LDL and total cholesterol values—but who cares? If you were to observe lipoproteins instead (e.g., via NMR lipoprotein analysis, as I have done for 20+ years) and tracked small LDL particles, large LDL particles, VLDL particles, HDL particles, etc., you would see that total and small LDL particles can indeed rise with fat consumption—but only if their formation is initially triggered by carb and sugar consumption. The solution is therefore not to reduce or avoid fat; the solution is to minimize exposure to carbs and sugars that initiate the process and to address insulin resistance that makes these issues worse. Once carbs and sugars are minimized, fat consumption has hardly any effect on lipoproteins, even if total and LDL cholesterol go up—you know, the numbers we ignore.
- Coronary risk requires insulin resistance, inflammation, and perhaps endotoxemia to be concurrently present. In other words, lipoprotein abnormalities in and of themselves may be insufficient to cause coronary atherosclerosis and heart attacks. It means correcting these additional processes by 1) eliminating the foods causing these processes, grains and sugars, then 2) correcting the common nutrient deficiencies that allow insulin resistance to develop (omega-3 fatty acids, vitamin D, magnesium, iodine), then 3) address dysbiosis and SIBO/SIFO (small intestinal bacterial and small intestinal fungal overgrowth that are exceptionally common) and the endotoxemia these conditions cause. In short, adhere to the strategies I advocate in my Wheat Belly and Undoctored programs—simple. On the flip side, taking a statin cholesterol drug is so limited in effect that it is laughable. Note that statins disrupt the intestinal microbiome, making it approximate the bowel flora of someone who is an obese type 2 diabetic and increases insulin resistance—it actually CAUSES insulin resistance that adds to cardiovascular risk.
- The BEST way to gauge cardiovascular risk, however, is not some indirect physiologic marker, but to measure the disease itself, i.e., coronary atherosclerosis. Because calcium occupies 20% of total atherosclerotic plaque volume, you can use a coronary calcium “score” (CCS) obtained via a CT heart scan to tell you how far along you might be. Score zero? You have essentially zero risk for heart attack over at least the next 5 years. A score of 300, 500, 1000 signifies increased risk (that we can quantify depending on age and sex). Do nothing and your CCS increases by 25% per year (on average), taking you closer and closer to heart attack and/or need for heart procedures like stent implantation or bypass surgery. Follow your doctor’s idea of “optimal medical therapy” and take a high-dose statin drug, cut your fat and saturated fat, take aspirin, exercise—how fast does your CCS increase? 25% per year—it has zero impact on the rate of increase. Follow the strategies I list above, articulated in detail in the Wheat Belly and Undoctored programs, and the majority of people stop the progression of their CCS or reduce it and thereby slash risk for heart attack and need for procedures, all while consuming plenty of fat and ignoring cholesterol values.
- When you eliminate the foods and factors like insulin resistance that eradicate small LDL particles, the gold standard measure, LDL particle number via NMR, increasingly diverges from calculated LDL cholesterol. Handy rule-of-thumb: To convert LDL particle number to an approximate equivalent in LDL cholesterol, drop the last digit. It means that a LDL particle number, for example, of 1800 nmol/L is roughly equivalent to LDL cholesterol of 180 mg/dl. Let’s say we have the following in someone: total LDL particle number 1800 mol/L, of which 1200 mol/L are small LDL particles. Simultaneously, calculated LDL cholesterol is 180 mg/dl. Follow the Wheat Belly or Undoctored program strategies and small LDL particle number drops to zero and total LDL particle number drops to 1000 nmol/L, i.e., LDL cholesterol equivalent of 100 mg/dl. But LDL cholesterol, obtained via the standard calculation, is 210 mg/dl—higher, a dramatic divergence from the real and reliable LDL particle number suggesting a LDL cholesterol equivalent of 100 mg/dl. This is because the calculation used to calculate LDL cholesterol is invalidated when we reduce carbohydrate content of the diet. Pay no mind to this absurd and outdated measure called LDL cholesterol. (The people following ketogenic diets agonize over this issue. All they need to do is obtain NMR lipoprotein analyses and they will quickly see that, although the ketogenic diet has its problems, especially disruption of the microbiome, higher cholesterol is not an issue.)
Enjoy your butter, olive oil, fatty ribeye steak, the skin and dark meat from chicken—they do not cause heart disease. In my view, the biggest cardiovascular risk factor in modern life is the ignorance of your doctor and the exploitative practices of the pharmaceutical industry.