The most common question I get asked via comments on this blog and email is how to lower cholesterol levels and/or LDL levels. People asking this question have usually just gotten a high cholesterol reading of one kind or another and have heard the pronouncement from their doctor: You need to go on a statin.
The funny thing is, most of the people asking me this question probably have read more than their own doctors have about statins. They don’t want to start taking an expensive drug with a lot of side effects and even the potential for causing death.
But, they also don’t want to confront their doctor.
They figure the best way to deal with the situation is to seek out some other way to lower their cholesterol, so their doctor will leave them alone about statins. Usually they begin by cutting the fat in their diet or more rigidly adhering to whatever diet they happen to be on. They go back to their doc a couple of months later, expecting significantly improved labs, but typically discover their cholesterol levels even higher.
There is a solution.
In case you’re not one of the people in this situation, let me give you an example of what these emails look like. Here is a message I got a few days ago from one of the few high school classmates I keep up with.
Hope all is well with you. I received not great blood tests back today and my doc says has to be genetic and wants me on statin drug. Can you steer me to information about possibly a diet route? Or should I just go on statin drug – she also gave me a lab slip to check liver functions after 30 days of taking drug?! I’m looking for some alternate information. Thank you.
She attached her labwork:
- Total cholesterol 303 mg/dL
- LDL cholesterol 213 mg/dL
- HDL cholesterol 75 mg/dL
- Triglycerides 76 mg/dL
Obviously her doc was not up on the latest cholesterol news. Else she would have
- known that statins have never shown any decrease in all-cause mortality in women of any age.
- known that a higher cholesterol in a woman my friend’s age correlates with greater longevity.
- realized that a good part of my friend’s total cholesterol was made up of HDL cholesterol, which is the so-called good cholesterol.
But she was blinded by seeing the 303 total cholesterol and the 213 LDL cholesterol levels.
So, she knee jerked, said it was genetic (because my friend is a semi-vegetarian, and I’m sure her doc couldn’t fathom any other reason for her elevated cholesterol other than a genetic one, since she eats very little meat), and prescribed a statin.
There is a different solution to this problem, and it probably isn’t what you think.
I want you to take about 30 minutes to watch a video by an engineer named Dave Feldman who, using an engineering approach, has probably figured out the way for you to drop your cholesterol like a rock.
Without drugs. With dietary changes alone.
And the changes are not what you’re likely expecting.
Like Dave, I was an engineer for several years before I went to medical school, so I’m annoyed at myself for not figuring this out. But, in my defense, I came of medical age before the big cholesterol scare, and by the time it really got going, I was deep into treating patients with low-carb diets. And most of my patients saw their elevated cholesterols normalize. Not all, but most.
I always wondered about the ones who didn’t have their cholesterol levels fall (or in a few cases had them actually increase), and I watched them like a hawk. But the more people I treated and the more I studied cholesterol, the less concerned I became with elevated lab readings.
Dave Feldman came to it from a different perspective: his own extremely high cholesterol levels.
Consequently, he was highly motivated to do some self experimentation and recruit a few willing subjects (at first friends and family members) into his own study. He’s had incredible results. As have the other people who have tried his formula.
Take a look at the video, then let’s get back together below after you’ve watched it. Don’t be alarmed when the video timer says it’s 43 or so minutes long; there’s a lot of Q&A. You’ll get the meat of it in about 30 minutes. Usually I make video notes when I put up videos like this one, but I believe this one is so good, and Dave does such a great job of presenting his work, that you really need to watch to make sense of what I’ll be discussing after.
The info presented in this video is some of the most exciting work I’ve seen in a long time.
Wasn’t what you were expecting, right?
But it makes sense. Especially in view of the mechanism he lays out starting at 14 mins into the video.
A typical cholesterol experience
Let’s take a look at a well-known journalist who, despite following what she considered a perfect diet, had her cholesterol go up. This is a piece I wrote about the cholesterol trials and tribulations of Jane Brody, the health columnist (and avid high-carb, low-fatter) for the New York Times. She wrote about her experience herself, and you can find that in the link in my blog post.
You need to read this if for no other reason than that I had such fun writing it. She’s gotten her digs in on me, so I enjoyed getting a few licks back.
In a nutshell, she did what almost everyone does in this situation. She tried to be good (by which in her view meant eating low fat) and then doubled down to try to be even better. And all that happened was that her cholesterol levels went even higher.
Now you know why.
Low-carb diets and elevated cholesterol levels
After watching Dave’s video, it’s pretty easy to see why Jane Brody’s cholesterol continued to climb as she cut more and more fat from her diet. But what about people on low-carb diets? Why does their cholesterol sometimes go up. They’re eating more fat, not less.
I’ve got a news flash for you.
Despite being hash tagged as #LCHF (which if you don’t know, means Low-Carb, High-Fat), low-carb diets are, for the most part, low-fat diets.
There are two ways of looking at fat. One way of measuring the fat in the diet – and this is the way most people look at it – is as a percentage of calories. In this way of calculating, if half your calories are fat, then you’re on a 50 percent fat diet.
Another way is to measure the actual amount of fat you eat irrespective of how it compares to the total number of calories you eat. This is the way your body does it. Your body doesn’t care what the percentage of fat is – your body wants to know how much fat you’re eating. How many grams. Is it enough? Is it too much?
The whole percent calories deal is a nutritionist construct for who knows what reason. It’s immaterial other than to those who want to flog you for eating too much fat.
Let me show you what I mean.
I don’t want to go through all the calculations for an entire day’s worth of food on a Standard American Diet (SAD) and a low-carb diet (or #LCHF, if you prefer), so I’m going to use a typical lunch as the proxy for an entire day.
If you’re on the SAD and you waltz into a McDonald’s for a quick lunch, you may end up with a Big Mac, an order of fries, and (I’m giving the SAD a break here because odds are it would be a supersized sugar-sweetened soda) an unsweetened ice tea. If you go to to the USDA National Nutritional Database, search for these items, and figure out the calories, fats and carbs, you’ll come up with the following numbers:
- Total calories = 941
- Fat calories = 459
- Carb calories =376
Fat calories = 49% of calories.
Which is much higher than the 30% to 35% fat most nutritionists recommend. To them, 49% of calories is a lot of fat.
(Worth noting that the meal would be lower in percent fat if we’d added in the sugar/corn syrup calories of a supersized soda, which by itself could top 400 calories! That would have dropped the meal to 34% fat and all the nutritionists would have doubtlessly applauded.)
Now, let’s go through our low-carb dieter’s selection. Our LCHF hero orders the Big Mac without the fries. And has the unsweetened iced tea. He — or she — then gets rid of the Big Mac bun and scrapes off as much of the Big Mac sauce as possible, because it’s filled with added carbs and nasty vegetable oils. This #LCHF meal ends up sporting the numbers below:
- Total calories = 350
- Fat calories = 234
- Carb calories = 60
Fat calories = 67% of calories.
Call an ambulance! Immediately! Heart attack waiting to happen. Fat at 67% of calories is more than double the amount most nutritional experts would recommend.
There’s more to the story.
I didn’t show the actual amount of fat in the first ‘regular’ Big Mac lunch, nor did I show it in the #LCHF version.
So let’s take a look.
The regular Big Mac lunch with all the sauce and the fries contains 51 grams of fat.
The #LCHF version (emphasis on the High Fat) contains a mere 26 grams of fat, just about half the fat of the regular Big Mac meal.
Most low-carb diets are like this. They are really lower-fat diets when compared to the SAD.
And they are lower-calorie diets as well. Compare the calories in the full Big Mac meal to the #LCHF version. Way less than half.
So, if, as Dave Feldman’s data show, eating fat is what makes your cholesterol levels go down, you can see how going on a low-carb diet could end up making your cholesterol go up. And it’s easy to see the fix, oui?
Since I’ve used the example above, I’ve got to digress for a bit to tell you something that always slays me.
Have you ever noticed that if you go out to lunch with friends and have the Big Mac meal with fries and everything, no one really says anything to you? But if you don’t order the fries, and you throw away the bun, and eat only the patties and the little lettuce, tomato, and whatever comes with it, people say: “Oh, you’re on one of those crazy low-carb diets. Don’t you know those will wreck your kidneys, and all that fat will clog your arteries?”
I can’t tell you how many times I’ve heard it. It’s fewer actual grams of fat, but now suddenly because it doesn’t contain the added starch of the bun and the sugar of the sauce, it’s a dangerous high fat diet.
Okay, digression over.
LDL particle number
The LDL particle number (LDL-P), as contrasted with the LDL cholesterol level (LDL-C), is maybe a term some of you aren’t familiar with.
Since the medical mainstream, especially that part of it that makes statin drugs, but also the part that promotes them, is so convinced that cholesterol is the driving force behind heart disease, they keep looking for more and more ways to slice and dice cholesterol.
I’m not sure, but it’s probably all in an effort to find the Holy Grail of cholesterol measurements, the one that absolutely correlates with heart disease, and is finally found to be causal. They haven’t found it yet, but they keep trying.
One of these numbers is simply the number of LDL particles in a given volume of blood.
If you divide the LDL-C level by the number of particles in the sample, you can determine the size of the particle. Generally, the larger the LDL particles, the better. So, if you don’t have a lot of LDL particles and you have an average amount of LDL-C, then dividing them as described results in your having large LDL particle size.
The proponents of the low-fat diet crow that they lower LDL-C. And that’s generally true. However, one of the problems with the high-carb, low-fat diet is that they also tend shrink LDL-particle size, which is not a good thing.
Their LDL-C goes down (but not always – see Jane Brody’s case above), while their particle number stays the same, resulting in smaller, denser LDL particles. A bad thing.
Some lipidologists now consider LDL particle number to be the most important measurement, so it’s another nail in the low fat diet coffin. And it’s reassuring to know that Dave Feldman’s data show that consuming extra fat decreases not only the total cholesterol and LDL-C but the LDL particle number as well.
Does the Feldman approach work with the Standard American Diet as well as it does with the ketogenic diet?
We don’t know. He’s tested it only with the baseline being the ketogenic diet. And, there is no data that I know of showing what would happen were you just to go face down in the extra fat while eating the SAD.
There are some old studies out there kicking around showing that people who fast actually drive their cholesterol levels up, which goes along with Dave’s theory as to mechanism.
During a fast, the liver is sensing no fat coming in, so it jumps into action to package some and send it to the tissues.
But no real studies I’ve seen examine what happens when you add the extra fat to the SAD. (As of this writing, I can say there may be such studies, but I’m in a plane somewhere over the Atlantic as I write this and can’t search for them right now.)
Dave keeps up with all this on his site cholesterolcode.com, so I would encourage you to go there and look at the data. He posts new data there all the time.
If you do try this on your own and do the Feldman protocol, be sure to send your results along to Dave to add to his rapidly growing database.
And keep me posted as well. I would love to hear your experience.
In case you’re interested, I had my own cholesterol checked a couple of years ago, and here are my numbers. I suspect they reflect the low-fat, low-calorie nature of my regular #LCHF diet. I’m going to load up on fat before my next labs to see what happens. But I already have a pretty good idea.
Based on Dave’s work, if you add more good saturated fat (on a low carb diet) even in just the few days before a blood test, the lipid numbers will likely look ‘better’, whatever that means.
The take home message I want to leave you with is how rapidly changeable cholesterol values can be.
Dave Feldman’s data has shown that eating fat three days before can markedly alter your total and LDL cholesterol numbers. Eating fat five days before can bring about huge changes in your LDL particle number.
Given that cholesterol levels and particle numbers can change dramatically in just a matter of a few days, why in God’s name would anyone want to go on a statin because of a single ‘snapshot in time’ cholesterol reading that is a little high?
Depending upon what you eat, it may drop like a rock in a couple of days.
Statins are not benign drugs. They come with a host of side effects, occasionally fatal ones.
You end up having to have your liver monitored closely, which requires extra trips to the doctor’s office, which are expensive, and extra sticks, which are painful.
And that doesn’t include the expense of the drugs.
Additionally, you risk developing diabetes (females in particular), muscle aches and pains, and memory loss. Plus, at this stage, no one knows what the long-term overall effects are on cholesterol-dependent tissues, such as the brain.
And it horrifies me to think how many people are taking them right now based on just one single cholesterol reading that was a little high.
The statin decision is a choice you’ll have to make along with your physician. I just think you need to have all the facts at hand before you even consider taking the statin plunge.