Post 18 of 365
This is part 10 of my review in Layman's terms of the book 'The Art and Science of Low carbohydrate Living' By Jeff S. Volek, PhD, RD & Stephen D. Phinney, MD, PhD
note: This again is a very long and informative chapter, so I have split the review of this chapter into two parts as with the Insulin Resistance chapter.
A doctor will give a prescription as soon as your Cholesterol rises by the smallest amount, even though in the last decade the lesson has been, total cholesterol is not the only thing to look at with health. This chapter is about dietary intervention and helping to reduce heart disease. Statin drugs may reduce LDL;s (Low density lipoproteins) but the proof is not there that it reduces the risk of cardiovascular disease, is the wrong target being aimed at?
Lipoproteins are particles traveling through the blood stream delivering lipids to the cells. In the center of teach particle are the lipids, fat substances like cholesterol, triglycerides, phospholipids and proteins that are surrounded by a water-soluble substance so it can travel easily through to watery blood.
LDL-C (low-density lipoproteins)- carries these particles from the liver to organs throughout the body
HDL-C - (high-density lipoproteins) - does the opposite, the particles travel back to the liver to be disposed of.
Between 1950 and 1970 it was assumed saturated fats caused high cholesterol which caused heart disease, this hypothesis still stands after over 40 years, is it correct?
LDL Response to a Low Carbohydrate Diet
In studies LDL's can rise , fall or stay the same on a low carb diet, but the question is, is this a problem! Quite often the LDL will rise and this is why many doctors will recommend a low fat diet which without Statin use the LDL's will do the same , rise , fall or stay the same. Now I have completely confused you!
Factors to consider;
1/ A study in 1994,' the Lyon Diet Heart Study', revealed after 27 months (at which time the study was abruptly cancelled) showed a dramatic decrease in mortality in the group on a high fat diet as opposed with the participants on the "American Heart Association' diet (low fat). Even though there was the massive benefit for reduced heart disease (on high fat-low carb) there was no advantage to lowering the LDL in either group. So even though the evidence showed the benefits for reducing heart disease , on a high fat-low carb diet, the study was cancelled because there was no reduction in LDL, on either side. The question is asked again is the cause of heart disease really LDL's?
2/ There can be a high degree of error in the serum levels testing of LDL-C, a compilation of the lipids into all of the lipoproteins.
3/LDL-C is a compilation of a variety of sizes. testing should divide the sizes and the smaller the LDL's are the more dangerous they are associated with the increased risk of heart disease.
In reducing carbohydrates, the other lipid and inflammatory readings improve so are the slight increase in LDL-C truly a problem. If Triglycerides have decreased this would mean the more dangerous Very small LDL would reduce (this is what you want to happen and almost always does on a low carb diet).
LDL-C; Quality Over Quantity
Is there more to the story than LDL-C are the bad cholesterol and HDL-C are the good cholesterol! As we have just gone through the LDL-C has different sizes, the larger puffier ones are safe, but the very small LDL-C are extremely dangerous for atherosclerosis as the smaller the lipoprotein, the more likely it can penetrate the arterial walls. The smaller they are also leaves them wide open to oxidative stress , hence inflammation. this is why full testing on lipoproteins is so important before being put on statins or even thinking you are at risk of heart disease.
Statins and Low Carbohydrate Diets
Yes statins, lipid lowering drugs, do reduce LDL-C but their impact on lowering coronary events is much less clear. More studies have linked lowering the risk of coronary damage ,or events, to reduction in inflammation than reduction in LDL-C. Therefore if a diet can reduce this rather than pharmaceuticals, isn't this the better way. So do the risks and side effects of taking statin drugs needs to be weighed up against the potential benefits. Side effects to statins include and not limiting to, muscle pain, fatigue, increased risk of diabetes and cognitive impairment. A statin will reduce LDL-C without a doubt but a low carb diet will reduce LDL-C, reduce inflammation, reduce triglycerides, reduce risk of diabetes , as well as reducing weight, which obesity is most likely the catalyst to start with.
This is a very individual decision, and the advise of a health care professional is necessary. There are certain cases where it is imperative to take statins or other cholesterol lowering medications, the point they are making here is look at all options and make sure all testing is done to work out your actual cholesterol levels in all particle sizes (a good practitioner can do this and not just go on basic testing) this is important. Work with health and diet first , look at all options and consider all out comes. In part two of chapter 8 we will be going more into triglycerides (triglycerides are storage of fat in the body) and how important it is to look at these in your blood tests.
Triglyceride as a Target
Carbohydrate is the Major Driver of Plasma Triglycerides
Carbohydrate is the Major Driver of LDL Particle Size
The Triglyceride Saturated Fat Connection
Importance of Raising HDL-C
The Triglyceride/HDL Ratio as a Correlate to Insulin Resistance
Post-Script: Triglyceride Metabolism Primer