Cholesterol & lipids

Optimize your lifestyle

Meaty Facts about Cholesterol

Let’s look at cholesterol, which has enjoyed the status of being the number-one dietary supervillain for at least the past 50 years. Our interpretation of its role has gone through a dramatic change over the last several decades. The fact that we’re still unsure what cholesterol’s functions are and what significance low and high levels may mean should indicate that we still have a very long way to go to full understanding.

 

Common wisdom regarding cholesterol, whether total or LDL cholesterol, has been that if it’s high, you’re at increased risk for cardiovascular disease. Certainly, there is a great deal of scientific theory to back that up. Much of the research comes from associational studies that look at populations and compare rates of heart disease with corresponding cholesterol levels. The evidence includes a number of animal studies, and drug trials have demonstrated that lowering cholesterol can decrease the incidence of disease.

Many of these studies have been repeated multiple times with similar results; therefore, perhaps the theory should stand. Indeed, often when someone’s blood test comes back with an elevated cholesterol level, the doctor almost automatically offers a drug to lower cholesterol. Heck, I remember when I was a medical student many years ago, I often overheard the attending physicians joking about how popular cholesterol-lowering statin drug Lipitor should be placed in the water supply because all the lazy, fat patients needed to be on it. That’s how commonplace treating high cholesterol with drugs had become.

 

So, let me make a simple observation about conclusions that come from an associational study. Let’s assume you have a study that says people with elevated levels of cholesterol have a higher risk of heart disease. Fair enough—certainly there’s data to support that. But what if you ask, “Does that association hold up in all people in all situations?” That’s a simple question, but it drives a lot of thought and gets at the heart of some of the problems with this type of science. Suppose I could gather a subset of people who have elevated cholesterol but who also are profoundly insulin sensitive; they’re also very lean and have low levels of systemic and vascular inflammation. Does the association still hold? Or if it does, is it so small, in light of those other factors, that it’s rendered insignificant?

 

Let’s use some arbitrary numbers and say that risk of heart disease goes up 20 percent if you have an LDL higher than 130, but it goes down 150 percent if your insulin is lower than 3. Heart disease goes down another 85 percent if your waist is smaller than your height, and it goes down a further 120 percent if you have a C-reactive protein (a marker of inflammation) level lower than 1.0. In this theoretical situation, your risk for heart disease would be very favorable in the big picture. Now, many would be tempted to suggest that we should lower the risk even more by getting the cholesterol down by using drugs or perhaps a low-fat diet. Certainly, that strategy might be beneficial if all the other factors also remain favorable. But what happens if they don’t? What happens if going on the low-fat diet causes your insulin to rise or your C-reactive protein to go up? What happens if you take a drug and the side effects cause you to gain weight, and your waist expands? Those are questions we need to ask.

 

Also, we have a mounting pile of evidence that shows that heart disease risk is more influenced by other factors, including things like hyperinsulinemia, inflammatory status, and triglyceride levels, than it is by cholesterol levels. One interesting group of people that have been studied are those who have a genetic variant that leads to something called familial hypercholesterolemia. Basically, many of these people walk around with sky-high cholesterol levels, but they don’t die of heart disease any more frequently than anyone else; people with this condition have normal life expectancies. If they have unfavorable insulin levels, the story is different: heart attack city. This implies that high cholesterol by itself is insufficient to cause cardiovascular disease, which should be no surprise because we are complex systems that are affected by myriad interrelated variables.

 

Dave Feldman, a wonderful citizen scientist, has been demonstrating that our cholesterol levels can change by up to 100 points in a matter of a few days based on nothing more than what that person has eaten in the preceding few days. An interesting study shows that cholesterol rises by about 36 percent when a person fasts for one week. Now, under the assumption that meat is bad for us because it can cause cholesterol to rise (which it can) then does that also mean that eating nothing is equally bad for us?

 

The assumption is that low cholesterol is always a good thing when it comes to preventing heart disease; because heart disease is our number-one killer, that’s where our focus should be. Plus, we have some pretty cool drugs that lower cholesterol and are worth billions of dollars. (But I’m sure no one was concerned about the money to be made from those drugs, right?) However, what about the role of cholesterol outside the discussion of heart disease? What part does it play in our bodies? What effect does it have on things like all-cause mortality? What about diseases like cancer and certain neurodegenerative diseases? Entire books are dedicated to this stuff, but I’ll touch on it briefly here. (Believe me, I really want to get back to talking about steaks, but I need to at least mention this stuff.)

 

Your entire body—every single cell you have—contains cholesterol. That’s the major difference between defining a plant cell and an animal cell. (I used to laugh when I’d see advertisements on plant products pointing out the fact that they were “cholesterol free.” Well, duh; of course—because they’re plants.) Your brain uses something like 25 percent of your body’s cholesterol, and many of your hormones are made from it. Cholesterol is integral to the structure of every cell in your body. You can easily find studies that link low cholesterol to depression, violence, suicide, and neurodegenerative diseases. Some studies report that people tend to die younger if they have low cholesterol. Some cancers have been linked to low cholesterol. Infectious disease can be more difficult to fight when cholesterol levels are low.

 

If you list some of the major associative factors that are believed to be a contributor to heart disease, you will find the relative effect of cholesterol level to be relatively lower on that list. If you then stratified those factors by things that can be most efficiently adjusted with drugs rather than through lifestyle changes, you would see cholesterol at the top of that list. Not surprisingly, billions of dollars have been focused on the factor that’s drug-modifiable, whereas the lifestyle factors largely receive lip service.

 

Suffice it to say that I don’t think that low cholesterol is necessarily a good thing. High cholesterol may be problematic in certain cases, but that doesn’t necessarily mean it always is. Some people will continue to be concerned about this particular particle or that particular subfraction of this or that lipid, and perhaps that concern and the knowledge it spawns will lead to the answer to immortality. Or perhaps we’ll just replace heart disease with cancer, dementia, or some other equally awful way to die.

 

The bottom line is this: You and I will likely die of heart disease or cancer regardless of the diet we choose. For example, data on vegan and vegetarian mortality indicates the number-one and number-two killers for that group are cancer and heart disease. Heart disease kills a lot of people, and most people die with so-called normal cholesterol.

 

It saddens me to see almost daily that so many people are examined with a simple annual blood lipid test and then offered a drug to lower their cholesterol based only on that test and no further investigation. The overprescribing of cholesterol medications largely comes down to a lack of time and education on the part of physicians. You can literally walk into your doctor’s office after having lost every ounce of fat on your body, feeling the best you have in decades, sporting excellent blood pressure and otherwise perfect metabolic markers, but if your annual blood test reveals high cholesterol, you’ll still leave the office with a prescription for some medication without any further discussion. In my view, that’s unacceptable, and it’s a sign of systemic laziness. We have to remember that our physiology is an incredibly complex system with far more going on than we can hope to find out with a snapshot of what’s traveling in our blood at one particular instant.

 

Today, it’s encouraging to see more and more patients challenging some of the knee-jerk reaction of their doctors, and the patients are asking for more information. Remember that no one has more at stake regarding your health than you do. Be a pain in the ass; ask for more details and more testing. Challenge your physician to up his game. I’ve learned more from patients than I ever learned from any textbook.

 

 

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.

Learn more HERE

 

Getting Hung Up on Health Markers

Often when people follow some form of a low-carb diet, they focus on monitoring certain things through blood testing to get some insight into the effects of diet. Blood testing provides some data and often can help to troubleshoot problematic health issues. Before I get into some of the common observations that I’ve made about carnivore dieters, let me put some things into perspective.

When you have your blood drawn, its contents are representative of what is being transported via your blood during that exact moment in time. Many, if not most, of the things that can be measured in the blood can change on a weekly, daily, hourly, and even momentary basis. For instance, blood cholesterol can change dramatically over a few days, hormones can change by the hour, and liver enzymes or inflammatory markers can go up or down based on recent activity or exercise levels. Lab values can be significantly affected by many things, including stress, sleep, illness, activity, exercise, weather, temperature, time of day, and time of year. So, trying to attribute any one particular laboratory reading exclusively to diet can be problematic.

Just as the nutrition science–based food recommended daily allowances were based on a population that was arguably sick from eating a high-carbohydrate, grain-based diet, many of the common laboratory reference ranges were based on that same population. We truly do not have a good set of reference ranges for the populations who follow the low-carbohydrate and carnivore diets. With this in mind, I want to share some of the areas where labs for carnivore dieters can diverge from the general population.

Blood Lipids

Blood lipids probably cause the most concern for both patients and their physicians. First of all, blood lipid levels are dynamic; they can vary fairly significantly over a matter of even a few days. Your total cholesterol on Wednesday may be remarkably different the following Tuesday. Let’s assume that the numbers you get represent a daily average. (However, this assumption is likely false.) When we look at the lipid number for a carnivore dieter, we often see elevated total and LDL cholesterol; this is not always the case, and often LDL/total cholesterol will be largely unchanged or even lower.

Another common finding among carnivore dieters is a general trend toward elevated HDL, the so-called good cholesterol, and generally lower triglycerides. In general, higher HDL and lower triglycerides are thought to represent an improvement in cardiovascular risk, but this is not absolute, particularly regarding the HDL. As I’ve already mentioned, it’s important that you realize that large energy shifts and weight loss can be responsible for unexpected numbers, such as higher than expected triglycerides, particularly at the beginning of a transition to the carnivore diet. I often suggest that people wait six months or more before getting routine labs after starting the diet, unless there’s a compelling reason to do it earlier, such as to address an illness.

Glucose

Glucose control is important, and generally speaking, a carnivore diet tends to lead to very well-controlled glucose numbers. If you’re going to talk about glucose, then you definitely need to be aware of your insulin status. When you look at a blood glucose reading in isolation, you leave out a major part of the story of blood sugar control, potential diabetes, and other chronic disease risks. If you’re going to worry about heart disease, insulin sensitivity is one of the most important modifiable risk factors you can be concerned with. It’s right up there with smoking, and it’s far more important than relative cholesterol levels. You can use a fasting insulin level with a fasting glucose level to calculate something called a HOMA-IR score, which is one of several reasonable measures of insulin sensitivity.

In general, a carnivore diet tends to lead to improved insulin sensitivity over the long term. Glucose tends to remain stable for people on the carnivore diet because the glucose the body is using is not being ingested; it’s being produced mostly from protein, a small amount of fat, and a few other sources, such as lactate, via a process generally described as gluconeogenesis. Gluconeogenesis is probably the most precise way to control glucose regulation, and in the long term, it leads to well-controlled and stable blood glucose numbers. People with both type 1 and type 2 diabetes also note that in the long term they tend to see excellent blood glucose control, although it may take a few months for the level to normalize.

Liver Function

Liver function studies tend to be normal for people on the carnivore diet, and the assumption that increased protein is damaging to the liver is based upon a fallacy. NAFLD (non-alcoholic fatty liver disease) is an increasingly common diagnosis. Fortunately, we know from observations of carnivore populations and by extrapolating data from low-carbohydrate studies that a carnivore diet tends to improve this problem. Liver function tests can be slightly elevated for several reasons, and if you’re having them evaluated, you should be aware of benign reasons for their elevation. One of the more common reasons is recent intense exercise, which can result in slight elevations of these enzymes for up to a week.

Inflammation

In a similar vein, markers of inflammation, such as C-reactive protein, can show a transient elevation after exercise or other acute stresses on the body. This marker and other inflammation labs can be used as risk factors for predicting cardiovascular or other disease potentials. Once again, it appears that a carnivore diet tends to lead to low levels of inflammatory markers.

Kidney Function

Kidney function is often a concern with higher protein diets, but the concern stems from data from animal studies that haven’t been replicated with humans. In general, the consensus is that high-protein diets do not damage kidneys. Some people still are concerned that an already damaged kidney will fail more quickly in the presence of higher levels of protein, but that data is tenuous at best. We have some reports of improved renal function in people who’ve followed a carnivore diet. If you have compromised renal function and are concerned that consuming too much protein while on a carnivore diet might be problematic, it’s worth your effort to track the function over time.

Hormone Levels

Thyroid function is generally improved on a carnivore diet, and we have observed improvements in autoimmune-related issues such as Hashimoto’s thyroiditis. One interesting thing to note is that thyroid hormone, particularly T3 levels, may seem to be low, but the clinical function is noted to be good. This likely represents a decreased requirement for circulation of the hormone or an increase in receptor sensitivity. Therefore, you should not need a supplement in the absence of a clinical need.

Similarly, when people follow a carnivore diet, reproductive hormones tend to normalize and function optimally. It becomes very important to consider clinical function as we assess particular hormone levels. Both men and women note improvements in libido and clinical testosterone function when they follow a carnivore diet, particularly after they’ve moved beyond the adaptation phase.

Iron Levels

Iron deficiency is one of the most common deficiency problems in the world, and a carnivore diet is undoubtedly the most efficacious way to prevent that problem because it’s tremendously high in bioavailable heme iron. On the other hand, too much iron, particularly when stored in excess quantities in the tissue, has been associated with some health problems, such as diabetes, cardiac disease, or liver disease.

Fortunately, excess iron levels don’t seem to occur to any significant degree on a carnivore diet. It’s likely that underlying metabolic disease and inflammatory states contribute to excess iron storage. In general, a carnivore diet tends to improve those conditions, and that may be the reason why high storage levels as assessed by serum ferritin don’t seem to be a problem, even though carnivore dieters have a relatively high iron intake.

Miscellaneous Health Markers

In general, you can expect both red and white blood cell counts to fall within the normal ranges. However, you may see slightly lower white blood cell counts, which may be associated with a generally lower inflammatory state. Levels of serum electrolytes, such as sodium, potassium, chloride, calcium, and magnesium, tend to be normal. Our bodies do a pretty good job of maintaining these in fairly narrow physiologic ranges.

Some people express concern that a carnivore diet can lead to an acidic environment, but our blood pH is aggressively controlled and very tightly regulated. As long as we have functioning lungs and kidneys, we can keep our blood pH right where it needs to be regardless of dietary input.

The concerns about acids leaching minerals from our bones for buffering purposes are unfounded. Higher protein diets ultimately lead to better long-term bone health, especially because our bones are approximately 40 percent protein.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
Learn more HERE

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