Living Low Carb (17 page)

Consider also a classic study conducted in France over a four-year period from March 1988 to March 1992 and published in the journal
Circulation
in 1999.
¹⁰
The study—called the Lyon Diet Heart Study—looked at 605 patients who had already had a first heart attack. These folks were
not
in great shape—they had classic risk factors, high cholesterol, many were smokers, the whole ballgame. Half of the 600 or so subjects were given the standard advice about eating a “prudent” diet (lower fat, lower cholesterol), and the other half were given instructions on following what we call the “Mediterranean Diet”—high in olive oil, vegetables, fruits, and so on. (Neither group was given the standard treatment for high cholesterol, a statin drug.)

Are you ready for the results?

Those following the Mediterranean Diet had a 72% decrease in coronary events and a 56% decrease in overall mortality.

The results were so stunning that the study had to be stopped in the middle so everyone could go on the diet program that had produced such outstanding results.

But that’s not even the best part. Get ready for the kicker:

Though people were dying at less than half the rate expected, and were having coronary events at about one quarter the rate expected,
their cholesterol levels hardly budged
.

Did you get that? An almost 75% decrease in heart disease
without a budge in cholesterol levels
!

Now let’s fast-forward to a drug study completed in 2006, the widely publicized ENHANCE trial. If you were following the news in 2008, you couldn’t have missed this one, because it made the front pages of the newspapers and all of the television news shows. Here’s what happened.

A combination cholesterol-lowering medication called Vytorin had been the subject of a huge research project, the results of which were finally coming to light and being given enormous negative attention. One of the many reasons for this negative attention—besides the actual results, which I’m going to share with you in a moment—was the fact that the companies jointly making the drug (Merck and Schering-Plough) waited almost two years before releasing the results of the study.

No wonder. The results stunk. Which was the
other
reason this drug test made the front pages. The new “wonder” drug
lowered cholesterol just fine
. In fact, it lowered it
better
than a standard statin drug. So you’d think everyone would be jumping for joy, right? Lower cholesterol, lower heart disease—let’s have a party for the shareholders!

Not quite. Although the people taking Vytorin saw their cholesterol plummet just fine, they actually had
more
plaque growth than the people taking the standard cholesterol drug. The patients on Vytorin—low cholesterol and all—actually had almost twice as great an increase in the thickness of their arterial walls, a result you definitely don’t want to see if you’re trying to prevent heart disease.

So their cholesterol was wonderfully lowered and their risk for heart disease went up: shades of “the operation was a success, but the patient died.”

Taken together—and there are countless other examples—I think we might be able to at least
question
the widely accepted dogma that
cholesterol is what we need to be focused on when it comes to heart disease
.

But wait! If cholesterol is not the huge deal everyone thinks it is, then it’s reasonable to ask the question: so, why are we so afraid of saturated fat? After all, isn’t the big “rap” against saturated fat that it raises cholesterol? If that’s not as big a deal as we thought, why are we so afraid of saturated fat?

Now
you’re beginning to get it.

Fact is, according to a ton of research by Jeff Volek, PhD, RD, and others, saturated fat
sometimes
raises cholesterol and sometimes doesn’t. And then there’s the question of exactly what “kind” of cholesterol it does raise.

Most people are familiar with the concept of “good” cholesterol (HDL) and “bad” cholesterol (LDL). Problem is, that concept is woefully out of date, as “yesterday” as last month’s headline in
People
magazine. There are several different subtypes of HDL cholesterol and several different subtypes of LDL. The subtypes of LDL have different effects on the body and are far more interesting to us than the overall LDL number, even though that’s the number that most people focus on.

LDL cholesterol—the unfortunately named “bad” kind—actually comes in
several
“flavors”; it is
not
one homogenous substance which is “bad.” There are LDL molecules that are “large” particles, and there are LDL molecules that are “small” particles. The large particles—think of them as big fluffy cotton balls—are fairly harmless. The small ones—think of them as hard little BB gun pellets—are not.

What often happens on a high-saturated-fat diet is that LDL goes up—
but this is not the whole story
(no more so than the cost of your no-interest mortgage for the first six months is the whole story of what you owe the bank). When scientists look at the
actual particle sizes
of that LDL cholesterol, they find that higher saturated-fat intake (in the context of a low-carb diet) usually results in a significant shift to
more
of the harmless big fluffy particles and
fewer
of the much more dangerous little ones.

Let’s say, for the sake of argument, you are a person with an overall cholesterol of 200, 130 of which is “LDL” and 50 of which is “HDL” (the remainder is other stuff that we’re not going to go into right now and isn’t germane to the discussion). Furthermore, let’s hypothesize that your LDL of 130 is actually the harmless stuff (the big fat fluffy particles) and the bad stuff (the BB gun pellets).You go on a low-carb (higher-fat) diet and boom, your cholesterol is now 230 and your doctor is having a fit, furiously scribbling a prescription for statin drugs and reading you the riot act.

Not so fast. What may have happened—in fact, what
most often
has happened—is that your HDL has gone up (good) and your LDL has gone up also, but something even better has happened as well, something that flies beneath the radar unless your doctor knows to check for it: the proportion of “good” (fluffy cotton balls) and “bad” (little BB pellets) LDL has shifted
dramatically
. You might now have an HDL of 60 and an LDL of 150, but 100 of that LDL is now the big harmless fluffy particles and only 50 of it is the bad stuff. Your total number (and even your LDL) has gone up, but
the overall lipid profile has improved substantially
.

And we haven’t even begun to talk about triglycerides.

Triglycerides, which don’t get nearly as much attention as cholesterol, are a far greater risk factor for heart disease than cholesterol is.
¹¹
(They’re also a significant risk for strokes.)
¹²
And triglyceride levels always come down on a low-carb diet. Always. Not “sometimes”:
all
the time. (Which makes sense—the body takes all that excess sugar and packages it into triglycerides; so the less sugar in the diet, the fewer triglycerides in the blood.)

Furthermore, according to a Harvard study published in
Circulation
,
¹³
the ratio of triglycerides to HDL cholesterol is a much better predictor of heart disease than cholesterol is. Also, according to many experts (including the Metabolic Syndrome Institute), that ratio can serve as a good “surrogate” marker for insulin resistance. Personally, if you show me a person with a ratio of 2 (triglycerides to HDL) who doesn’t smoke, works out, isn’t overweight, and has low markers of inflammation (CRP and homocysteine, for example), I’ll bet you my life savings he’s not going to have a heart attack, and I don’t care what his cholesterol numbers are.

But hey, that’s just me.

Now let’s reexamine the effects of this mythical low-carb diet on our mythical patient whose doctor is furiously prescribing statins.

Post–low-carb diet, this guy should be taking that blood test home and jumping for joy. His lipid profile is vastly improved. By every measure, he’s doing way better than he was before the diet.

But his cholesterol went up.

To which I say:
so what
?

There are currently tens of millions of Americans on cholesterollowering medications. As of 2006, two of the five top-selling drugs in America were cholesterol-lowering medications, and they collectively rang up sales of over 18 billion dollars. Even without throwing in the annual budget of the National Cholesterol Education Program, it’s safe to say that well over 20 billion dollars a year rides on the effort to get Americans to lower their cholesterol and fat. Current guidelines are to reduce saturated fat to 7% of the diet,
¹⁴
and there’s a movement afoot to recommend lowering it even more. The American Academy of Pediatrics now recommends cholesterol screening for some children as young as 2, and treatment with statin drugs to lower cholesterol for some children as young as 8.
¹⁵

Are we likely to see a moratorium on the demonization of fat and cholesterol and a move toward eliminating the real health-robbers in our diet, like sugar and processed carbs? Not bloody likely, and probably not any time soon. As the author Upton Sinclair put it: “
It is difficult to get a man to understand something when his salary depends upon his not understanding it
.”

The bottom line is that if you’re eating a very-low-carb diet, I don’t think you have much to worry about if it contains a relatively high amount of saturated fat (see “My Big Fat Diet,”
chapter 8
), and you
certainly
don’t have anything to worry about if it contains a nice mix of fats from omega-3’s, 6’s, 9’s, and saturated.

Now, before we wrap this up, let’s be clear about one thing: I’m
not
saying you should go out and start drinking oodles of saturated fat. (I
am
saying you shouldn’t be
terrified
of it, but that’s a different statement.) The important thing to remember is this:
the metabolic effect saturated fat has on your body—its “fate,” if you will—depends entirely on what else it’s consumed with
. In the early part of the twentieth century, the American diet was much higher in saturated fat, and we had much lower rates of heart disease. Of course, we also consumed less food in general, fast food hadn’t been invented, we ate much less sugar and we moved around more. The point is that it’s not fat—not even
saturated
fat—that’s the demon here.

In 2000, Walter Willett, MD, PhD, arguably the world’s most respected nutritional epidemiologist, chairman of the Department of Nutrition at the Harvard School of Public Health and the lead researcher on the Nurses’ Health Study and the Health Professionals Follow-Up Study, was interviewed by Harvard’s
World Health News
. This is what he said:

“We have found virtually no relationship between the
percentage
of calories from fat and
any important health outcome
.”
¹⁶

Amen to that.

CHAPTER 4

So Why Isn’t
Everyone on a
Low-Carb Diet?

(OR Why Your Doctor Doesn’t
Know about This Stuff)

A
couple of years ago, I was lecturing to a large audience in the Midwest on the topic of low-carb nutrition when a woman in the audience stood up.

“I went to my doctor when I was almost 100 pounds overweight and he read me the riot act. He told me the danger I was putting myself in and how important it was for me to lose weight. He wanted to put me on some medication, but I wanted to try it on my own. I went on Atkins, and over the course of the next year I lost almost 70 pounds.”

Delighted, I asked her what happened next.

“Well,” she said, “My doctor could hardly believe how different I looked. My triglycerides had dropped to under 100, my cholesterol ratio was way improved, and my blood sugar was normal.”

“Then what happened?” I asked.

“He was just thrilled,” she replied. “He told me that what I had accomplished was amazing. And then he asked me how I had done it. I told him I had gone on Atkins.”

“And?”

“He said to me, ‘Oh, you’ve got to get off that immediately. That diet is dangerous.’”

I sighed.

The kind of thinking demonstrated by this lovely lady’s physician is closer to religious conviction than it is to a scientifically held position, and we all know how hard it is to change religious beliefs. People who will not budge from their position that low-carb eating is dangerous simply have not looked at the emerging science—and many refuse to. Fortunately, more and more health-care practitioners are beginning to open their minds and take a second look at the dietary strategy that, up until a few short years ago, was considered nutritional heresy.

In the last few years, some thirty-plus studies or papers have been published investigating various aspects of low-carb regimens. Some of these have looked at weight loss; some have looked at serum biomarkers (triglycerides, HDL, and so on). Some have looked at inflammatory markers (C Reactive Protein). Many have looked at cholesterol, and not just the total number (which is fairly meaningless; see
chapter 3
, page 68) but at the different fractions, HDL and LDL and the ratios. Some have even looked at the emerging data on LDL particle size, which tells us even more. The results are pretty clear. Low-carb diets perform as well as low-fat ones on virtually every parameter. In many cases, they perform better in terms of weight loss. In virtually all cases, low-carb eating lowers triglycerides (which in my opinion is a far more important risk factor for heart disease than cholesterol). In a very large number of cases, it improves the overall cholesterol ratio, or at least the triglyceride-to-HDL ratio (an important measure for heart-disease risk). It frequently improves glucose control in diabetics and brings down a diabetic risk factor called hemoglobin A1C.