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Cholesterol: Let’s Clear the Confusion

High cholesterol causes heart disease right?

Another case where an over simplification of science has come back and caused more harm than good.

What is cholesterol?

Cholesterol is a waxy yet essential blood lipid that has a vital role in the body’s metabolism and brain function,  it is required by almost every cell in the our bodies. It has a vital role in the body’s metabolism and brain function, therefore some cholesterol is required for optimal physical and mental functioning. It is also has a role in building hormones including oestrogen and testosterone, maintaining the integrity of cell membranes, and aiding in the absorption of vitamins.

Good vs Bad Cholesterol

We have all heard this:

  • HDL (High Density Lipoproteins) = is commonly referred to as the “good cholesterol”. HDL is considered to be beneficial as it transports cholesterol from the blood stream to the liver where it removed from the body.
  • LDL (Low Density Lipoproteins) = is commonly referred to as the ‘bad’ cholesterol. Excess LDL will increase the risk of clots due to the build-up of plaque on the inner walls of the arteries.

Recent research suggests that estimates of LDL particle number or concentration (LDL-P) is a better predictor of CV risk than LDL cholesterol (LDL-C). Basically this means that a larger number of smaller LDL particles will increase the risk of atherosclerosis (plaque in arteries narrowing and hardening them) when compared to fewer but larger LDL particles for a given total cholesterol concentration it is less the concentration of LDL in the blood but a better predictor is LDL particle size in the blood.

  • LDL-C which measures the concentration of cholesterol transported by LDL in the blood
  • LDL-P which measures the number of LDL particles in the blood

LDL-C tests have been the primary method of measuring LDL in the blood. It is cheaper Because the LDL-C measurement is a measure of the amount of cholesterol being carried in LDL, it is not a reliable measure of LDL particle concentration. For example: small, dense LDL particles have much less cholesterol than large, buoyant LDL particles. But it is these small, dense LDL that are more atherogenic. This has led to the concept that the overall number of LDL particles may be more predictive of cardiovascular risk.

Why is particle sizes and patterns Important?

LDL can be broken into two types:

Type A LDL= Large fluffy particles that “look like cotton balls and does do much damage”.

Type B LDL= Small, hard, dense particles which becomes oxidised and angry, sticking to the endothelium and creating inflammation.

So you really need to know your particle size and how many of Type A or Type B you have. Knowing your total LDL will not be as helpful, as knowing the particle size

 

The best predictor of Heart disease

There is no need for a in depth lipid panel you can get a great predictor of heart disease from a basic lipid panel. Total-to-HDL cholesterol is a ratio of total cholesterol triglycerides to HDL cholesterol. The cholesterol ratio is calculated by dividing your total cholesterol triglyceride number by your HDL number. The ratio is considered to be able to indicate the different levels of heart disease risk and has been shown to be the best predictor of cardiovascular disease risk.

Your total-to-HDL cholesterol ratio should be between 3 and 4 (according to New Zealand Health guidelines) to ensure healthy cholesterol levels and a substantially reduced risk of heart disease.

 

So how does this apply to HFLC?

The “bad science” that got us into this mess of believing that fat causes heart disease, have all been proven to be inaccurate and flawed. The main two are Ancel Keys Seven Countries Study (discussed in previous post: Food Pyramid: We Got It Wrong!), and the China Study. Low fat diets have been shown to be worse for our health in almost every way! Going low carbohydrate high fat leads to better health outcomes, disease prevention and longevity.

Consuming healthy fats raises your level of Type A fluffy particles, while eating more sugar raises the Type B angry little particles. Inflammation is what we should be concerned about as it is the leading cause  of heart/ chronic disease today. What Is causing the inflammation? You guessed it, high carbohydrate diet, high insulin level, processed foods, smoking and alcohol.

 

Improve your HDL Count

A split coconut, coconut cream and coconut oil in a bottleBoth Luric acid and (found in high quantities in coconut oil) and stearic acid (found in high quantities in animal fats) has shown to increase total-to-HDL cholesterol ratio more favorably than carbohydrates.

In other words, if you really want to impact your total HDL it is advantageous to restrict carbohydrates and get a majority of your calories from animal fats, coconut oil, and unsaturated fats like fish, nuts, avocado, and olive oil. One of the best ways to incorporate all of this into one diet plan is by following a high fat low carbohydrate or ketogenic diet.

 

Statins

Statins are a class of lipid-lowering medication, their ‘benefits’ have been grossly exaggerated while the side effects have been under-reported. There is even a class action taking place in America against statin drug companies for under-reporting side effects (muscle damage, memory loss, decreased immunity and diabetes). Statins have also been shown to decrease level of Co-enzyme Q10, a vital enzyme for energy transfer which is causing the muscle pain and damage and may be contributing to heart disease!

 

Other factors to consider:

  1. Chronic Inflammation and Stress

Both Inflammation and stress illicit similar physiological mechanisms/processes. Cholesterol levels are upregulated to bring the necessary nutrients to our tissue to assist them to heal and recover. If your stress/inflammation is not regulated and stays chronically elevated, your cholesterol level may persiantly stay high. This is typically due to a variety of lifestyle factor; diet, poor sleep etc

  2. Hypothyroid Related Issues

Thyroid hormones and cholesterol levels are intimately linked. In fact, thyroid hormone has a powerful influence on LDL receptor expression. The response is so substantial that it stimulates the LDL receptors in our liver and sex hormone-producing glands to soak up the LDL cholesterol in the blood like a sponge.

The reverse is true when our thyroid hormone levels are low. Our LDL receptors become less responsive. Resulting in excessive LDL cholesterol remaining in the blood for an extended period of time. The longer the LDL remains in the blood the more vulnerable it becomes to damage. This damage triggers plaque building process in blood vessels, increasing the probability of heart disease

 

Summary:

  • Cholesterol is required by almost every cell in the our bodies. It is essential that we are able to manufacture it
  • Over simplified method (HDL= good; LDL=Bad) creating confusion leading to poor recommendations in an attempt to minimise heart disease.  
  • Total-to-HDL ratio is more reliable predictor of heart disease than total cholesterol levels. Total-to-HDL cholesterol ratio should be between 3 and 4 to ensure healthy status.
  • High fat low carbohydrate or ketogenic diet, contrary to popular belief actually has a profound benefit on improving cholesterol levels
  • This is something that everyone should monitor at minimum once per year or if you are like me a passionate about performance get this checked along with other key biomarkers on a quarterly basis, to ensure you are functioning at a high level

 

References:

Adiels, M., Olofsson, S. O., Taskinen, M. R., & Borén, J. (2008). Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(7), 1225–1236. https://doi.org/10.1161/ATVBAHA.107.160192

Brinkworth, G. D., Noakes, M., Buckley, J. D., Keogh, J. B., & Clifton, P. M. (2009). Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. The American Journal of Clinical Nutrition, 90(1), 23–32. https://doi.org/10.3945/ajcn.2008.27326

Bueno, N. B., De Melo, I. S. V., De Oliveira, S. L., & Da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of Randomised controlled trials. British Journal of Nutrition, 110(7), 1178–1187. https://doi.org/10.1017/S0007114513000548

Cromwell, W. C., Otvos, J. D., Keyes, M. J., Pencina, M. J., Sullivan, L., Vasan, R. S., … D’Agostino, R. B. (2007). LDL particle number and risk of future cardiovascular disease in the Framiningham Offspring Study – implications for LDL Management. Journal of Clinical Lipidology, 1(6), 583–592. https://doi.org/10.1016/j.jacl.2007.10.001.LDL

Dashti, H. M., Al-Zaid, N. S., Mathew, T. C., Al-Mousawi, M., Talib, H., Asfar, S. K., & Behbahani, A. I. (2006). Long term effects of ketogenic diet in obese subjects with high cholesterol level. Molecular and Cellular Biochemistry, 286(1–2), 1–9. https://doi.org/10.1007/s11010-005-9001-x

J., T., N.D., L.-M., C.H., T., M., N., J.D., B., G.A., W., … G.D., B. (2015). Comparison of low- and high-carbohydrate diets for type 2 diabetes management: A randomized trial. American Journal of Clinical Nutrition, 102(4), 780–790. https://doi.org/10.3945/ajcn.115.112581.1

Nguyen, P. (2014). Electronic records may threaten blinding in statin trials. British Medical Journal, 5239(November), 5239. https://doi.org/10.1136/bmj.g5239

Otvos, J. D., Mora, S., Shalaurova, I., Greenland, P., Mackey, R. H., & Goff, D. C. J. (2011). Clinical Implications of Discordance Between LDL Cholesterol and LDL Particle Number. J Clin Lipidol, 5(2), 105–113. https://doi.org/10.1016/j.jacl.2011.02.001

Westman, E. C., Yancy, W. S., Olsen, M. K., Dudley, T., & Guyton, J. R. (2006). Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. International Journal of Cardiology, 110(2), 212–216. https://doi.org/10.1016/j.ijcard.2005.08.034

Wood, R. J., Volek, J. S., Liu, Y., Shachter, N. S., Contois, J. H., & Fernandez, M. L. (2006). Carbohydrate restriction alters lipoprotein metabolism by modifying VLDL, LDL, and HDL subfraction distribution and size in overweight men. The Journal of Nutrition, 136(2), 384–389. https://doi.org/10.1093/jn/136.2.384

Let’s talk Science: High Carbohydrate Vs High Fat

This article is for those that enjoy diving into topics or for someone who likes to have evidence before they make a decision.

What is Science Telling Us?
As with anything in science there are a wide range of beliefs regarding best practice for nutrition. In my last post I presented an overview of the traditional nutritional beliefs and practices (Food Pyramid: We Got It Wrong!). The goal for this post is to update you on the current literature and to pull out relevant pieces of information that will help to educate and guide you towards making a informed decision.

Common Disadvantages Associated Carbohydrate:

What happens when we consume Carbohydrate (CHO)?

As blood sugar levels rise, the pancreas produces insulin, a hormone that prompts cells to absorb and store the glucose in your system. Insulin is a vital part of our bodies normal functioning and metabolism. But when constantly bombarded with glucose through a regular uptake of high CHO the body is forced to continuously produce insulin, resulting in chronically (long term) elevated levels of hormone.

Next, similar to when your body is exposed to a drug, your body becomes resistant to the normal levels of the hormone and will require increasing amounts of this hormone to carry out the same function. With your cells not effectively responding to insulin you end up with the accumulation of glucose in your blood. This response is known as insulin resistance and is the defining symptom of type II diabetes and can be linked to a whole host of other metabolic conditions.

So can Carbohydrates can be dangerous?

When we talk about CHO we need to acknowledge that there are good and bad CHO sources. Something the oversimplified food pyramid was aware of but neglected to include for simplicity. The bad CHO such as our highly refined & rapidly-absorbed (High Glycemic Index (GI)) CHO (e.g. cereals, white bread etc) are dangerous to your health. These high GI CHO foods cause your blood sugar levels to rise rapidly after eating them and force insulin to peak rapidly and remain within your body. If you eat enough of these types of foods, and regularly eat them as part of your daily diet, then you are almost guaranteed to end up with insulin resistance.

Another downside to this way of eating and elevated levels of insulin is that it creates a pro-inflammatory state that can damage tissues and blood vessels. People who have symptoms of insulin resistance also tend to have high levels of inflammatory markers within their body and blood. Inflammation is a process by which your body’s inflammatory markers and white blood cells work to protect you from foreign substances. High inflammation is seen in people who suffer from diseases such as Cancer, Alzheimers disease, Arthritis and Cardiovascular disease.

In short your diet could be forcing your body into an inflammatory state which is similar to some major diseases today. We could argue that this state of inflammation is the leading cause of chronic health diseases today.

Interesting fact: Cornflakes have a higher glycemic response than raw sugar!! Now that is crazy! Why? Due to being highly refined, they developed the the cereal to be quickly absorbed to fire up the pleasure signals in the brain to get you hooked and wanting more. Food is being manufacture to act like a drug!

Interesting fact #2: Diet/Sugar free soft drinks will produce an insulin response even though they are ‘sugar free’. They produce a response in your body similar to when you ingest CHO drinks. If you are struggling to lose weight or control your weight, try ditching the ‘diet’ soft drink and replacing it with soda water with lime/lemon for a week or two..

So What is Good Carbohydrate?

Quite simply put you are looking for unrefined whole foods that are found in nature (fruits, vegetables, starches etc) .                                                                               

Why? Our bodies have evolved to breakdown utilise these fuels efficiently plus they have not be denatured (loss of nutrients) due processing.

Rule of thumb stay clear or packaged foods and if you do choose a packaged item then select one with minimal ingredients. My rule is no more than 3 or 4 ingredients, and I must be able to pronounce and recognise all the ingredients on the list. Another trick is when in the supermarket, shop around the outside aisles and stay clear of the aisles.  

Take home message: Stay clear of proinflammatory CHO ie refined, high glycemic index. When selecting CHO into your diet choose unrefined whole foods that are found in nature.

Should I consume Carbohydrate?

Yes, although it should be minimised where possible, CHO is important and should not necessarily be completely neglected. What is important is the type of CHO you choose to include in your diet. One of the biggest mistakes I see with people trying to make a change to their diet and health is that they try to completely remove all CHO straight away. Removing a complete food group can be dangerous as you can eliminate a number of key micronutrients essential for health. These micronutrients may be more easily accessible in certain substrates eg CHO over fat. Always aim to have a varied diet to ensure you obtain a variety of micronutrients, as some are limited to certain foods.

Carbohydrate Tolerance (Insulin Sensitivity)

Carbohydrate tolerances or insulin sensitivity (ability to produce adequate insulin when required, to ensure efficient uptake of carbohydrate) will vary from person to person. Therefore, it is important to identify your tolerance. If you possess a high carbohydrate tolerance you should still be careful of what kind of carbohydrates you choose to eat, focusing on high quality sources, not using it as a hall pass to eat whatever you please.

 

Kick Start Your Day the Right Way!

Ditch the cereals that we have been brainwashed to think epitomises a healthy start to your day. These highly refined, insulin spiking foods will quickly derail your day before you even start. Regardless of your carbohydrate tolerance, we should all aim to begin our days with a healthy fat focused breakfast.

Why? Fat does not spike hormones (Insulin) it instead produces a steady release of energy that will keep you satisfied for much longer than CHO.

Two of My Favorite High Fat Breakfasts

 

  • At home: Avocado & Eggs on Spinach

 

A great nutrient dense breakfast and normally my first meal of the day.With loads of added healthy oils such as avocado and coconut oil. Feel free to add meat source like bacon (Yes bacon!) or salmon etc

  1. On the Go: High Fat Smoothie

Mixed Berries, Coconut Cream, Cocoa, Almonds, Spinach, Chia seeds (Add some MCT for bonus fat if you have any). There is endless mixes this is just a base I normally work off.

 

 

Key Takeaway Points:

  1. Carbohydrates are not evil, there are good and bad sources of it like anything.
  2. Not everybody responds the same to carbohydrate some can handle more than others.
  3. Excessive carbohydrate leads to insulin resistance and in turn inflammation which is leading cause of chronic disease today!
  4. Regardless of your carbohydrate tolerance, we should all aim to begin our days with a healthy fat focused breakfast

 

Food Pyramid: We Got It Wrong!

For to long we have be wrong! Myself included. With the dogma that dietary fat is unhealthy causing us to get fat mass which then leads to high cholesterol, heart disease etc. However, is this truly the case??

No in fact it is continually being proven wrong! Sugar is the culprit we should be worried about, not fat.

In this post we will dive into my personal experience transitioning from traditional ‘High Carbohydrate Diet’ to a ‘High Fat Low Carbohydrate Diet (HFLC)’, finally discuss what lead our society to this point and how we got it all wrong.

My Experience in Transitioning

Before finding the High Fat, Low Carb (HFLC) diet I was bound to the pantry, unable to venture too far away from my food. I was a genuine bottomless pit constantly refueling with snacks that I felt were a necessity to get me through the day. This regular refueling involved continuous spikes in energy followed swiftly by crashes that greatly affected my focus and performance in both sport and everyday life. Mid afternoon was where I would really hit the wall, with an energy crash on most days. This was coupled with an inability to regulate my hunger, body weight (fat mass).

Transitioning from a believed high “healthy” carbohydrate diet (Classic traditional food pyramid diet) where I had minimised fat as much as possible, always selecting low fat option where possible, towards a HFLC diet had the most profound effect in both my health and performance.

It was more a mental shift than anything else, as I went against popular belief and ate what was thought to be an extremely dangerous unhealthy diet. One of the first things I noticed was the need for regular refueling and constant snacking was diminished, for the first time I was satisfied and did not feel the need to always be close to food. However, even though I was not hungry the thought of scarcity made it difficult to initially break the habit of always being close to food. I had to consciously define whether my urge was hunger or habit. Once in control of this, I was rewarded with freedom and massive amount of bonus time as I no longer needed to organise my life around food. An additional bonus was I no longer experienced energy spikes and crashes, I found I had more energy overall and this continuous stream allowed me to stay focused and be more productive day in and day out. Finally I was able to drop excess weight and had the ability to regulate my fat mass. Along with all the my physical performance in sport greatly increased. I will touch on the Fat Adapted Athlete later this month, arming you with everything you need to know so stay tuned.

 

Paradigm Shift

Flipping traditional nutritional strategies on head and taking the complete opposite approach can be scary! This is a complete paradigm shift from what I had and have been taught for so long! This was not easy, especially as this is what I was taught in my sport science degree only not that long ago, so must be right? Sadly we have been wrong and for too long and I will be the first to say I preached this traditional message for way too long. It is time to open our minds to another approach to nutrition. I am not saying this is a one fix all approach, there is no such thing in my opinion but this is absolutely a strategy you must consider!

 

Why did I change?

As for most paradigm shifts, it all begins with a personal struggle and a need for change. Chronically ill, traditional medicine said I was fit and healthy with nothing to worry about. Knowing this wasn’t the case I dived deeper past my symptoms that doctors said where normal and I identified I was dealing with severe gut and adrenal issues. Traditional medicine couldn’t even diagnose therefore no chance they could help me get over it. It was left to me to research the literature and figure it out myself. After researching and testing, I identified along with some severe food intolerances and I was fueling completely wrong! At this low point, I was willing to try anything. As I opened my mind I quickly realised that this “on the fringe” nutritional approach High Fat Low Carbohydrate had quite a lot of successes and had been well documented with a rapidly growing body of literature. Especially with in epilepsy and cancer research. After reading study after study I began to realise the true potential of this approach and the wide ranging application it had. The doubts in my mind gradually dissipated until it was time to challenge the status quo and take action and dive into the world of a high fat myself.

 

Background into the Carbohydrate Vs. Fat Debate.

You know the results, it was an amazing success! However, I still get so many that challenge my approach. Let’s take a step back and see where traditional carbohydrate focused (Food Pyramid) approach came from.

After the success of a study correlating smoking and cancer, America saw a significant decrease in both smoking and lung cancer. They decided to mimic a similar approach to combat heart disease which was a relatively new disease at this point. This study had such potential if done correctly. When establishing the new regulations there were two trains of thought, 1) High Fat and 2) High Carbohydrate. We all know what camp they picked. Sadly the research selected was biased, promoted by the big food companies driving the science to promote their products with invested interests and and today has been great scrutinised for it’s bad scientific approach. Billions were even spent trying to replicate the results of this study. Paper after paper could not prove the high carbohydrate diet to be a healthy diet! Yet we still eat this way….

As a result there has been a heavy debate ever since, as to whether sugar or fat is the culprit of the obesity epidemic. The peak of this debate was reached in 1970’s where fat was pinned as the cause of our general decline in metabolic health and massive gain in body fat.

The first dietary guidelines was designed in 1980 to combat heart disease. Landmark epidemiological studies, beginning as far back as the 1940s and ‘50s, linked heart disease to sodium, cholesterol, saturated fats and trans fats. The solution appeared clear: Cut down on the butter, whole milk and steak all the sources of saturated fats. As a result consumers zeroed in on low-fat foods, however, they didn’t necessarily adopt healthier diets overall.

In 1992 the United States Department of Agriculture (USDA) introduced the Food Pyramid, it focused on a significant increases in carbohydrate and reduction in fat. This resulted in a 15% reduction in overall fat consumption in the american diet. However, obesity and diabetes exploded at this same time.

Today, obesity rates are raising to epidemic levels and showing no signs of decline. With the incline in obesity so to has the rate of heart disease, diabetes and many other inflammatory diseases. While a key component we can not attribute this sad state of affairs to bad sciences and poor nutritional guidelines, we must also address that there are many factors at play. Technology is one of the key components, making our lives simpler in all areas, except for the fact that it leads to less work/activity and as a result makes us more sedentary. For example since entering the information age our once labour intensive jobs are continually becoming passive and sedentary by nature as technology does all the hard yards for us. This is extremely dangerous if not combated as the human bodies are designed for locomotion. Check out my Workplace wellness series of blog post for more information on this.

Before wrapping this up I would be remiss if I did take a step back to when the world was healthy, with minimal instances of heart disease, diabetes and obesity. This actually was not this long ago! Ask any of the older generation what their diet used to consist of and what you will find is their diets were based around healthy nutrient dense fats like butter, lard, meat and even lots of organ meats etc and was extremely low in carbohydrate. However, for some reason we seem to forget this.

Wrap up

Hopefully this has given you a background understanding of how we ended up in the position we are today and why a change is required. In the future post I will look into the benefits of HFLC and why you should consider it if you have not already. Finally progressing toward the athletic performance benefits of the diet and how you can apply it.