I’m going to introduce some ideas about cholesterol and it’s probably going to be a regular feature to have live updates on cholesterol because it is on everyone’s mind. There was a really interesting paper, titled “Association of Lipid, Inflammatory, and Metabolic Biomarkers with Age at Onset for Incident Coronary Heart Disease in Women” that I’m going to try to explain to you.
The general approach to cholesterol needs to change
Thinking about cholesterol requires a paradigm shift, meaning a change in way of thinking. I know we’ve all been taught that cholesterol is bad, that “L” for LDL is “lousy” or “lethal” and “H” for HDL is “healthy”. The problem is that it’s not that simple. If it does matter, even the cholesterol as this paper shows, it’s nowhere near as important as the other things that we’re going to talk about. If LDL is an issue, it is one of the last things you want to deal with. This paper just came out, so it has not been discussed in the medical field much. It got no media recognition which is interesting, but I think that one of the reasons for that is that it’s written in a manner that doesn’t have headlines like “LDL doesn’t matter,” which is really what the paper says.
The old way to look at cholesterol was the total and LDL cholesterol. I was taught that’s how you do it but actually, as you look at cholesterol further, there’s the large LDL, small LDL, large HDL, small HDL, triglycerides, and different particle numbers and you can get advanced testing to actually show this in your own blood. As I’ve gone on, you remember I was introduced to this over 20 years ago and, yes, I had all the concerns that a lot of doctors have today when they look at it for the first time. I’ve lived through this and have examined, yes, you can go from the total, LDL, triglyceride, and HDL – four blood tests – to 20 blood tests (the “lipid subfractions,” it’s called). Then, you can go to other inflammatory markers, you can even go to measure the arteries now to see if you have the disease that the cholesterol measurements are trying to predict and trying to prevent.
Metabolic syndrome is the real issue
A lot has changed over the last 20 years. In the cholesterol masterclass we talk about metabolic syndrome being the new target, the new cause of atherosclerosis. Metabolic syndrome consists of not total cholesterol and LDL, it’s triglyceride and HDL. It goes from looking at two of the four factors in that four blood tests lipid to the other two. Metabolic syndrome also includes abdominal circumference, elevated blood pressure, and elevated blood glucose even if you’re not diagnosed with high blood pressure or diabetes. Pre-diabetes or pre-hypertension count in metabolic syndrome. A lot of doctors that you’re going to meet today have not been in the whole keto world for 22 years. Many of you have already shared your experiences of how doctors prejudged obesity or other health issues and that’s of course just terrible. It’s the last place where a doctor can still discriminate or be prejudiced and get away with it, not acknowledging that obesity is a disease and that everyone has their own story and that it’s worthy of treatment.
My background in research
I went into clinical research training and wrote my own clinical research studies. I was trained as what’s called an investigator-initiated researcher. Some researchers take studies that drug companies or other people write, and then they implement those studies, and they can call themselves researchers because they’re doing the study, implementing someone else’s study. I got trained to write my own studies, which means you have to understand how to not just read a paper, but how to write a grant, how to assess a certain number of people in the study to answer a question, and pose the question carefully in a way that makes sense, and even be cognizant of how much money it would cost to do a study.
That’s my background. That, I have to say, is pretty unique in the keto world. The other investigators who’ve done the work like me include Steve Phinney and Sarah Hallberg, who did the Virta Health Study – they wrote it, they implemented it – Jeff Volek, of course, at Ohio State. However, Jeff’s not a clinical researcher or MD; he’s a PhD in Exercise Physiology and Nutrition and doesn’t do studies on people with serious illnesses, for example. We all have our strengths in designing the research, and I think that gives me a particular ability to read literature that other people have written and also to critique them. When you listen to different doctors you want people who are able to read literature and who follow guidelines that a system wants. You have to know what the background of your source of information is. I’m pleased to be able to have given the Masterclass and to coach you and help you understand these things. Cholesterol is one of the big ones. I have to tell you, it’s a good thing we have cholesterol in our body because without it, we would not be alive.
Cholesterol is important
Medication is not the only way
I will repeat this and you’ll go to your doctors, the doctors will say, “No, here, do this, do that,” and each time I’ll try to respond, and I’ll give these chalk talks about that. I do think there is a role for statin medications. I’m not a statin basher like some of the keto folks out there who I think are trying to get attention by being more radical. I think there’s a role for medication, and it’s individualized. Rest assured with a keto lifestyle, you’re using lifestyle to treat the cholesterol, so it’s not like you’re not doing anything. In fact, it’s in the guidelines for medical doctors and how you treat cholesterol. The first thing you do is change your lifestyle. Most doctors with a fatalistic approach of, “my patients never change,” they’ll skip the lifestyle thing and go directly to medication, but it’s not the only way to approach things. That’s been my diplomatic way of approaching other organizations, other doctors, to just say, well, that’s one way to do it, here’s another way.
