I know your physician has your best interests at heart when he or she notices a slight increase in your LDL (“bad”) cholesterol and suggests that you further eliminate fats from your diet, or consider starting a statin medication. Your physician may recommend Mayo Clinic’s Heart Healthy diet, with controlled portion size, abundant vegetables, fruits, and whole grains as the basis of your new eating plan, a diet which also encourages reduction of saturated fat and cholesterol (including coconut oil and eggs), opting for low fat proteins, including legumes, and less red meat. Unfortunately for patients who follow that advice, it is based on outdated scientific information and is likely to increase the incidence, in sensitive people, of metabolic syndrome and type 2 diabetes. With that double whammy, you are at increased risk of cardiovascular disease (heart attacks, strokes and high blood pressure), no matter how attractively tiny your LDL number now appears.
What more current research has shown, but will not be shared by the pharmaceutical representatives peddling statins in the doctor’s office, is that the more worrisome and proximate cause of heart disease is inflammation resulting in disruption of the blood vessels’ lining, particularly when found in association with visceral (abdominal) fat, elevated fasting blood sugar, elevated triglycerides – all parts of metabolic syndrome and type 2 diabetes.
In the old paradigm, a total cholesterol over 200 mg/dL or an LDL over 100 mg/dL were thought to be worrisome. Reducing dietary fats or taking statins reduced both those numbers and along with them reduced HDL cholesterol, a number everyone would like to see go up rather than down. In the newer paradigm, two ratios are more important than either of those individual values mentioned above. First, the ratio of total cholesterol to HDL should be a number like 3 or ideally even lower. That is achieved with total/HDL cholesterol numbers of 240/80 just as easily as it is with values of 180/60. A low fat diet, and/or statin medications are likely to give you numbers more like total cholesterol of 180 and…sorry: and HDL of 30-40, yielding a ratio dangerously higher than 3. The second ratio with predictive ability is the ratio of triglycerides to HDL, a number I would like to see under 2. That low-fat, high-fruit and grain diet will give you numbers like 180/30 which is… egads! 6 is way more than 2!
In the new paradigm, from current science, we have learned that:
- Dietary cholesterol has little influence over serum cholesterol: the body increases cholesterol production when dietary cholesterol falls, and vise versa.
- There is no correlation between cardiovascular disease and any of the following: dietary saturated fat, total LDL, total or dietary cholesterol.
- LDL cholesterol values represent a heterogeneous population of hazardous LDL particles (small, beady and likely to get caught in an inflamed blood vessel) and big fluffy LDL particles that bounce right over any bump in the vascular road. Two ways to determine your LDL particle profile are the LDL particle number (high numbers are hazardous, representing more small particles) and the LDL typing, A (big) vs. B (small) particles.
- The potential side effects of statins include increased risk of muscle pain, dementia and cognitive deficits, breast cancer, and more.
- The potential side effects of a high carbohydrate diet in sensitive people include elevated triglycerides, fasting glucose, visceral fat accumulation and type 2 diabetes.
- Saturated fats, cholesterol, and nutrients in avocados, coconut oil, and eggs are well loved by your brain, heart and metabolism.
Most importantly we have learned in the new paradigm that a low carbohydrate, high fat, moderate protein diet outperforms both the Mediterranean Diet and the ultra-low-fat Ornish diet when it comes to weight loss and preventing or reversing the main plagues of modern civilization, which I would count as six: cardiovascular disease (heart disease and strokes), type 2 diabetes, cancer, arthritis, dementia and depression. I use the word “plague” quite intentionally: as a nation we suffer significant morbidity, mortality, and expense attributed to all of these conditions.
I will agree with your physician that wild-caught salmon and non-starchy vegetables are great for you and encourage you to eat them freely! I must respectfully disagree with the rest, however, and encourage you to eat pasture-raised meat and eggs (at least two a day), plenty of vegetables, with healthy fats like avocado, coconut, olive oil and others. I would suggest that you limit your fruit intake and consider the near or total elimination of grains – particularly gluten – and most legumes. For the good of your heart, liver, pancreas, joints and for the balancing of our federal health care budget.