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How Fat Makes You Skinny . . . (Eating Fat Lowers Your Cholesterol?!)

Diseases seem to arrive in three’s each day in my office.  Today I had three different patients with cholesterol concerns who were notably confused about what actually makes the cholesterol worse, and what causes weight gain.  Each of them, like many patients that I see, were stuck in a state of confusion between low fat and low carbohydrate lifestyle change.   My hope is to give my patients and anyone reading this blog a little more clarity regarding what cholesterol is, how it is influenced and how it affect our individual health.

First, the standard cholesterol profile does not give us a true picture of what is occurring at a cellular level.  The standard cholesterol panel includes: total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the “bad” stuff) and triglycerides.  It is important to recognize that the “-C” in these measurements stands for “a calculation” usually completed by the lab, and not an actual measurement.  Total cholesterol, HDL-C and triglycerides are usually measured and LDL-C is calculated using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)].  (No, there won’t be a quiz on this at the end  . . . so relax.)

However, an ever increasing body evidence reveals that the concentration and size of the LDL particles correlates much more powerfully to the degree of atherosclerosis progression (arterial blockage) than the calculated LDL concentration or weight (1, 2, 3).

There are three sub-types of LDL that we each need to be aware of: Large “fluffy” LDL particles (type I), medium LDL particles (type II & III), and small dense LDL particles (type IV).

Lipid Planet Image
Weight & Size of VLDL, LDL & HDL

 

Misleading LDL-C
Why LDL-C is misleading: Identical LDL-C of 130 mg/dL can have a low risk (Pattern A) with a few “big fluffy LDL particles or high risk (Pattern B) with many small dense LDL particles.

Second, it is important to realize that HDL and LDL types are actually transport molecules for triglyceride – they are essentially buses for the triglycerides (the passengers).  HDL can be simplistically thought of as taking triglycerides to the fat cells and LDL can be thought of as taking triglycerides from the fat cells to the muscles and other organs for use as fuel.

Third, it is the small dense LDL particles that are more easily oxidized and because of their size, are more likely to cause damage to the lining of the blood vessel leading to damage and blockage.  The large boyant LDL (“big fluffy LDL particles”) contain more Vitamin E and are much less susceptible to oxidation and vascular wall damage.

Lipid Danger Slide

Eating more fat or cholesterol DOES NOT raise small dense LDL particle number.  Eating eggs, bacon and cheese does not raise your cholesterol!  What increases small dense LDL particles then?  It is the presence of higher levels of insulin.  Insulin is increased because of carbohydrate (sugars, starches or fruits) ingestion. It is the bread or the oatmeal you eat with the bacon that is the culprit.  The bread or starch stimulates and insulin response.  Insulin stimulates the production of triglycerides and “calls out more small buses” to transport the increased triglyceride to the fat cells (4, 5, 6, 7).

Fourth, following a very low carbohydrate diet or ketogenic diet has been demonstrated to decreased small dense LDL particle number and correlates with a regression in vascular blockage (8, 9).  So, what does this really mean to you and me?  It means that the low-fat diet dogma that that has been touted from the rooftops and plastered across the cover of every magazine and health journal for the last 50 years is wrong. . . absolutely wrong.

I talk about this and answers questions on today’s Periscope.  You can see the recording on Katch.me with the comments in real time here:

https://www.katch.me/docmuscles/v/2f0b6d07-d56a-368b-b4f6-34a5ab3da916

 

Or, you can watch the video below:

References:

  1. Superko HR, Gadesam RR. Is it LDL particle size or number that correlates with risk for cardiovascular disease? Curr Atheroscler Rep. 2008 Oct;10(5):377-85. PMID: 18706278
  2. Rizzo M, Berneis K. Low-density lipoprotein size and cardiovascular risk assessment. QJM. 2006 Jan;99(1):1-14. PMID: 16371404
  3. Rizzo M, Berneis K, Corrado E, Novo S. The significance of low-density-lipoproteins size in vascular diseases. Int Angiol. 2006 Mar;25(1):4-9. PMID:16520717
  4. Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002 Jul 23;106(4):523-7. PMID: 12135957
  5. Elkeles RS. Blood glucose and coronary heart disease. European Heart Journal (2000) 21, 1735–1737 doi:10.1053/euhj.2000.2331
  6. Stanhope KL, Bremer AA, Medici V, et al. Consumption of Fructose and High Fructose Corn Syrup Increase Postprandial Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Young Men and Women. The Journal of Clinical Endocrinology and Metabolism. 2011;96(10):E1596-E1605.
  7. Shai I et al. Cirulation. 2010; 121:1200-1208
  8. Krauss RM, et al. Prevalence of LDL subclass pattern B as a function of dietary carbohydrate content for each experimental diet before and after weight loss and stabilization with the diets.  American Journal of Clinical Nutrition. 2006; 83:1025-1031
  9. Gentile M, Panico S, et al., Clinica Chimica Acta, 2013, Association between small dense LDL and early atherosclerosis in a sample of menopausal women, Department of Clinical Medicine and Surgery, University “Federico II” Medical School, Naples, Italy Division of Cardiology, Moscati Hospital, Aversa, Italy A. Cardarelli Hospital, Naples, Italy

Nutritional Values of Commonly Used Ketogenic Foods

I’ve had a number of emails and requests from patient’s to locate a source for fat percentages and protein contents of various foods as they prepare and follow a ketogenic lifestyle.  I’ve looked all over, however, nothing easy and concise has made itself readily available, and there hasn’t been a simple one page tool at your fingertips . . .

Hopefully, this list will start to fill that gap.  Use the list to calculate protein and fat levels as needed.  Let me know if I can add to the list or if there are foods you commonly use that I’ve missed.  Keep the ketones up and your waistline down!

Nutritional Values of Common Ketogenic Foods:

Food:                                                                       Protein Contents:                                Fat Contents:

Steak (Ribeye) –                                                      65 grams per 8 oz.                                 49%

Steak (Top or Bottom Round) –                             23 grams per 3 oz.                                  33%

Ground Beef (75% Lean) –                                      22 grams per 3 oz.                                 55%

Pork Chop (boneless) –                                            26 grams per 3 oz.                                15%

Ham –                                                                      17 grams per 3.5 oz.                              12%

Bacon (grilled) –                                                      22 grams per 3.5 oz.                               75%

Sausage (beef) –                                                     14 grams per 3.5 oz.                              79%

Sausage (pork) –                                                     17 grams per 3.5 oz.                              75%

Chicken Breast (boneless, skinless) –                     24 grams per 3 oz.                                  18%

Turkey Breast –                                                       24 grams per 3 oz.                                  15%

Yellowfin Tuna –                                                     25 grams per 3 oz.                                  10%

Light Tuna –                                                             22 grams per 3 oz.                                 8%

Halibut –                                                                  23 grams per 3 oz.                                  19%

Sockeye Salmon –                                                   23 grams per 3 oz.                                  22%

Tilapia –                                                                   21 grams per 3 oz.                                  13%

Deli Meats:

Roast Beef –                                                            18 grams per 3 oz.                                  16%

Canadian bacon –                                                    15 grams per 3 oz.                                  33%

Pepperoni –                                                             18 grams per 3 oz.                                  83%

Roast Turkey Breast –                                             18 grams per 3 oz.                                  15%

Snacks:

Beef Jerky (Jack Links) –                                          13 grams per 1 oz.                                9%

Peanut Butter (Peter Pan Crunchy) –                      8 grams per 2 tbsp.                                76%

Mixed Nuts –                                                           6 grams per 2 oz.                                    79%

Almonds, raw –                                                       6 grams per 1 oz.                                    66%

Walnuts, raw –                                                        4 grams per 1 oz.                                    85%

Sunflower seeds, raw –                                          6 grams per 1 oz.                                    76%

Tofu –                                                                      12 grams per 3 oz.                                  30%

Greek Yogurt –                                                        23 grams per 8 oz.                                  0%

Cheeses:

Swiss Cheese –                                                        24 grams per 3 oz.                                  66%

Cream Cheese –                                                      11 grams per 3.5 oz.                               79%

Ricotta cheese –                                                      10 grams per 3.5 oz.                               63%

Cheddar cheese –                                                    24.6 grams per 3.5 oz.                            74%

Eggs –                                                                      6 grams per 1 large egg                         60%

(Adapted from http://www.caloriecount.com)

A printable PDF copy of this information is available here:

Nutritional Value of Common Foods.

To live in the presence of great truths and eternal laws, to be led by permanent ideals –  that is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him.  Hopefully, these posts are adding to your stable ideals.

Why Your Oatmeal is Killing Your Libido

Have you noticed that there are a large number of advertisements in the media about checking your testosterone or “Low T” Syndrome?  It seems like this is the new advertising trend on the radio and late night TV.

Suddenly, everyone’s testosterone is low and men are complaining about their libido,  . . . or are they?

Low testosterone
Benefits of Testosterone Optimization. (Image Credit: ArtOfManliness.com)

If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded.  About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels.  But this shouldn’t be a surprise.  Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women.  In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.

Image Credit: http://www.townsendletter.com/July2012/metsyndrome0712.html
Image Credit: www.townsendletter.com/July2012/metsyndrome0712.html

In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women).  Interestingly, Leptin resistance has a similar effect.  I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.

How to you improve your testosterone?  Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer.  The most natural way to improve your testosterone is to change your diet.

A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss.  A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.

KetoOS
KetoOS – Drinkable Exogenous Ketones

What is a ketogenic diet?  It is a diet that restricts carbohydrates to less than 50 grams per day, thereby causing the body to use ketones as the primary fuel source.  So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs.  And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.

How To Start Your Weight Loss Journey

Weight loss, better put as “fat loss,” is a journey.  A journey brought you to where you stand today, and it will be an even more exciting journey getting back to that size you’ve been daydreaming about.  So, how do you most effectively start down the path of this journey?
That is the great question.  It is the most important question I get asked every day.  In the words of Napoleon Hill, “Desire is the starting point of all achievement, not a hope, not a wish, but a keen pulsating desire which transcends everything.”

First, Know Where You Are Coming From.
A journey requires knowing where you were, were you are today and where you want to go.  Get a journal and weight yourself.  Write it down and then check your weight every 3-5 days.  DO NOT weigh yourself every day.  I repeat DO NOT weight yourself every day. This can be discouraging because is is normal to fluctuate 2-5 lbs every day based on meals and water intake.   Many people see this fluctuation and thing they are failing, then give up.  The journal helps this.  Recording your weight helps you see the progress.

The journal is also to help you record what you eat.  Plan and record your meals IN YOUR JOURNAL.  If you are being followed by a weight loss specialist, they will want to see your journal.  If you are seeing me in my office, bring the journal with you to EVERY visit.  Record every thing you eat.  PlanAnd, record your water intake.  I am amazed at how many of my patient’s are dehydrated and just putting water back into their systems help them loose weight.

Second, Plan Your Day.
Planning is the key to weight loss on any program.  
You should plan your exercise and plan your meals the night before.  Failing to plan is really just planning to fail.  Your plan should include 1) keeping carbohydrate intake less than 20 grams per day and 2) getting adequate proteins to match your goals. 

Third, What’s the Underlying Cause of Your Weight Struggles?

You can’t effectively lose weight unless you understand why you are gaining weight.  Two thirds of my patients are hyperinslinemic – they produce too much insulin in response to any sugar, starch or carbohydrate.  This is also called “insulin resistance.”  This is the primary cause of weight gain in 85% of the population.  People produce between two to thirty times the normal amount of insulin in response to a piece of bread or a bowl of cereal.   When they eat a single piece of bread, their bodies respond as if they ate the whole loaf.  If they eat a bowl of cereal, their bodies respond as if they ate the whole box of Captain Crunch.

This variable over production of insulin is why some patient’s gain more weight than others eating and exercising the same way.  Your doctor can easily identify this through blood work.  For starters, if your waist circumference is larger than 40 inches as a male or larger than 35 inches as a female, you’re probably insulin resistant.  Most men complain they don’t have a tape measure to measure their belly, so I tell them if they walk toward the wall and the first thing that touches the wall is their belly, “you’re insulin resistant.”

Skin Tags
Skin Tags

Skin tags or the presence of thickened browning skin at areas of skin folds (acanthosis nigricans) are classic signs of insulin resistant.

Acanthosis Nigricans
Acanthosis Nigricans of the Neck-line

Hypoglycemia or low blood sugar is another sign of hyperinsulinemia or insulin resistance.  This is where a person gets light headed or dizzy 2-5 hours after eating a meal that contains mainly starch or sugar.

Insulin resistance requires a dramatically different dietary approach than the standard diets we’ve been taught all our lives. The “heart healthy” diet, DASH diet, vegetarian/vegan diet, low fat diet or calorie restricted diet just don’t work with hyperinsulinemia or insulin resistance.  If you are insulin resistant, a low fat/calorie restricted diet will not be very effective, and you may even gain weight with this approach as many of my patients have experienced.

If you have any of these symptoms, you need to follow up with your doctor or weight management specialist.  Find out where your insulin levels are in relationship to your diet.  Losing weight is possible.  You can get started here with my ketogenic dietary program.

As this is a journey, it will probably have a number of twists and turns that are often made easier with a road map.  Getting checked out with your doctor, and evaluating your metabolic status is your road map.  Check out the health programs I offer to my patients to get this road map. I’ve also produced hundreds of videos on YouTube and DocMuscles.Locals.com to help you down the road.   Either way, enjoy the journey!!