THE KETO ZONE AND YOUR CHOLESTEROL
“IF YOU WERE MY PATIENT, I would put you on a statin drug right away,” said the doctor. “You need to lower your cholesterol.”
Then the doctor went on to explain how her own father had almost died from a heart attack at age fifty. “He ignored his cholesterol numbers,” she warned. “You need to do something right away.”
At age forty-six, Ryan had moderately high cholesterol that had not changed much in years. His triglycerides were also a little high, while his HDL cholesterol or good cholesterol was a little low, but not alarmingly so.
People with high LDL numbers and high triglyceride numbers usually have a degree of insulin resistance, may be pre-diabetes, or may have metabolic syndrome. But Ryan did not have metabolic syndrome or pre-diabetes yet, but yes, he needed to do something. The answer, however, was not taking a statin drug.
I told Ryan, “In three months, we should have your LDL cholesterol and triglycerides lowered and your HDL raised. What you need to do is cut down dramatically your intake of both sugars and carbs and balance your fats.”
Three months later, it was a completely different ball game. All his tests had improved and normalized.
CHOLESTEROL-TREATING OPTIONS
When it comes to cholesterol, people can get into trouble if they do not understand what the numbers actually mean. Typically, there are four ways to deal with cholesterol numbers:
• Ignore them completely
• Try an herb or supplement or “miracle cure”
• Take doctor-prescribed drugs
• Change the diet
We all would agree that ignoring something, especially our cholesterol numbers, will never fix anything. We cannot get the results we want by ignoring the problem, but you would be surprised by how many patients I have seen over the years who have tried this method. Ignorance is not bliss. Trust me, this never ends well.
There are a lot of “testimonials and quack science” floating around, much of which probably ends up in your e-mail spam folder, that promise a certain drink or powder or herb or seed or supplement or nutrient or exercise will magically lower your cholesterol. Yes, there are some supplements or herbs that may help, such as citrus bergamot, soluble fiber, and plant sterols, but many do not help at all.
The option that is seen by many to be the most solid and scientific answer is to take a doctor-prescribed statin drug to lower cholesterol. Statins are one of the most-prescribed drugs in America. The negative side effects are worth it, so discussion closed.
But are statin drugs the only solution?
There is another option, one that has been scientifically proven to be effective. It requires more effort and self-control than any of the other choices, which is one of the reasons why it is seldom chosen, but it usually works incredibly well. In addition, there are usually no bad side effects and some positive side effects.
This option is to change your diet. It is exactly what the Keto Zone diet is all about, and it is incredibly effective at lowering the bad LDL pattern B cholesterol (see “What Are Your Real Cholesterol Numbers” later in this chapter), lowering triglyceride levels, raising good cholesterol, treating high blood pressure, and reducing the risk for heart disease.
TALKING CHOLESTEROL NUMBERS
When it comes to achieving ideal cholesterol numbers, most doctors, as I used to do for many years, will say something like:
• LDL levels should be below 100 (mg/dL)
• Triglyceride levels should be below 150 (mg/dL)
• HDL cholesterol should be above 40 (mg/dL)
• Total cholesterol should be below 200 (mg/dL)
For those who ask what the acronyms mean, we tell them:
• LDL (the bad cholesterol) is low-density lipoprotein that carries fat through the bloodstream. Cholesterol by itself is unable to be dissolved in the blood and must be transported by carriers called lipoproteins, which are made up of fat and protein.
• HDL (the good cholesterol) is high-density lipoprotein. It carries LDL cholesterol away from the arteries and back to the liver where it is disassembled and excreted from the body.
• Triglycerides are fatty acids. Their key role is for long-term fat storage for the purpose of generating energy. However, high amounts of triglycerides in the blood are associated with plaque formation in the arteries.
But what are you to do with that information? Doctors, dieticians, and nutritionists will usually tell you to:
• Take statin drugs to lower your LDL numbers
• Lower your intake of saturated fats
• Cut out all foods with cholesterol
• Get more fiber (which is usually a good thing)
• Make sure your carbs are 45 to 65 percent of your calories
• Manage your weight
• Get more physical exercise
There we have it. And that is about as deep as most people, as well as most doctors, ever go on the subject of cholesterol. That is usually all they know.
But when it comes to cholesterol, your cholesterol, it pays to know more.
Did you know that cholesterol in your body does not mean you have plaque buildup? Not at all!
Maybe you thought, Cholesterol is bad for my health. In truth, your liver makes cholesterol all the time. Your body needs it. The one organ that needs cholesterol the most is your brain.
Or maybe you have been taught: Cholesterol causes plaque buildup in my arteries.
This is one of the biggest errors in our thinking. It is at this point that people assume cholesterol, all cholesterol, is bad and must be minimized in an effort to avoid plaque buildup and heart disease.
That was the same logic Keys, the “father of cholesterol,” followed with his low-fat revolution. Remember how he tried to prove that higher saturated fat intake caused heart disease, but decades later it was shown that sugar is the main villain and not saturated fat?
IT’S A FACT
Your liver makes most of the cholesterol that you have in your bloodstream.
But the belief that a low-fat, high-carb diet is good and healthy continues to move forward, especially when it comes to lowering cholesterol. At first glance, it is “easy” to connect fats with cholesterol, plugging arteries, plaque buildup, and all sorts of plumbing analogies.
But the answer is not blaming or banning cholesterol. High cholesterol is not the main cause of plaque. The real culprit is inflammation and oxidized cholesterol.
WHAT IS OXIDIZED CHOLESTEROL?
Oxidation is like rust that forms on a piece of iron left outside in the rain. The oxidation process inside your body is like rust damage to your cells. It is this oxidized cholesterol and inflammation that is mainly responsible for plaque buildup in your arteries. This naturally leads to the question: What causes cholesterol to oxidize?
Understand that your LDL cholesterol is most damaging to your arteries and most likely to cause plaque if it is oxidized by free radicals. Excessive dietary intake of unhealthy polyunsaturated fats (PUFAs), such as soybean oil (the most consumed oil in America), corn oil, sunflower oil, safflower oil, and canola oil, causes increased oxidation of LDL cholesterol, a process in which the LDL rancidifies or is damaged to the extent that it is very prone to form plaque in the arteries. When any polyunsaturated oil, including grape-seed oil, is exposed to heat, the LDL cholesterol becomes damaged by free radicals or is oxidized. For this reason, never cook with PUFA oils. Most restaurants, especially fast food restaurants, use these cheap inflammatory oils in most of their food.
There are healthy polyunsaturated fats (PUFAs) with a healthy ratio of omega-6 to omega-3, which include walnuts, flaxseeds, and chia seeds and their oils. However, an excessive intake of PUFAs, even healthy PUFA oils, can cause inflammation in the body, especially if they are heated. Omega-3 fats, such as DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) found in fish and shellfish, are anti-inflammatory and quench inflammation in the body. A good ratio of omega-6 to omega-3 is 1:1 to as much as 4:1.
The main fear of patients and their physicians for decades has been saturated fats and the belief that saturated fats are the main cause of heart disease. But the truth is saturated fats only cause inflammation if they are eaten with excessive amounts of sugars or carbohydrates or if you do not consume adequate amounts of omega-3 fats, and most of us do not get adequate amounts of omega-3 fats in in our diet.
One fat that everyone should avoid is trans fat or hydrogenated fat, which promotes inflammation in the body and causes plaque to form in the arteries. I have discussed this extremely dangerous fat at length in prior books, including The Seven Pillars of Health and Let Food Be Your Medicine.
There is now a lab test that measures oxidized LDL levels. This is a much better predictor of heart disease than any other blood test. However, most physicians never order this test, maybe because there is no drug available to lower it. The Keto Zone diet will lower oxidized LDL levels as long as you lower your consumption of polyunsaturated fats and increase your omega-3 fats.
Oxidation is technically the work of free radicals, and those free radicals are set loose to wreak havoc in our bodies by the excessive consumption of polyunsaturated fats. These free radicals cause inflammation, and as I have told my patients for many years, inflammation is the root cause of most chronic diseases, including heart disease, high blood pressure, dementia, and autoimmune disease.
Jimmy Moore and Dr. Eric Westman, in Cholesterol Clarity, make the same call: “[Inflammation] is the real culprit in heart disease, not cholesterol. Without inflammation in the body, cholesterol would move freely through the body and never accumulate on the walls of blood vessels. Inflammation is caused when we expose our bodies to toxins or foods the human body wasn’t designed to process.”31
Eating antioxidants (such as blueberries and other berries) as well as taking antioxidant supplements such as CoQ10 and vitamin E to help combat oxidation is not a bad idea, but the way to really treat the oxidation, to wipe it out of your system, is to increase your omega-3 fats such as EPA or DHA to a healthy ratio of omega-6 to omega-3 of 4:1 or less. Choose only modest or small amounts of healthy polyunsaturated fats, such as walnuts, flaxseeds, and chia seeds, and avoid foods that contain soybean oil, corn oil, canola oil, and other inflammatory oils, especially if they are heated. Finally, by lowering your intake of sugars and starches by being in the Keto Zone, you are quenching both inflammation and oxidation.
Many foods contain soybean oil, including most margarines, shortenings, mayonnaises, salad dressings, imitation dairy, frozen foods, and commercially baked goods. Most French fries in US restaurants are cooked in corn oil, another inflammatory polyunsaturated fat that sets us up for heart disease.32
The Keto Zone diet plays a big role in helping treat both oxidation and inflammation.
WHAT ARE YOUR REAL CHOLESTEROL NUMBERS?
If you have taken a typical blood test, a lipid panel, you know what your LDL, HDL, and triglyceride numbers are. That is a good place to start, but there is another piece of information that may change everything for you.
On a standard lipid panel, your LDL number is technically a calculated number (the Friedewald equation). There are two types of LDL:
• Big puffy LDL pattern A (neutral)
• Small dense LDL pattern B (plaque forming)
Ratio wise, you want approximately 80 percent to be the big LDL pattern A and 20 percent or preferably less to be the small LDL pattern B. (Ideally, LDL pattern B should be less than 600 nanomoles per liter [nmol/L], but less than 200 nanomoles per liter is much better.) That is because the big pattern A LDL is not dangerous to your health. It is covered with a layer of fat, which protects it from oxidation, which in turn protects you.
It is the LDL pattern B that is dangerous. Because the small LDL pattern B is so quick to oxidize, you know that also means:
• Oxidative stress or free radicals damaging the blood vessels
• Inflammation
• Eventual plaque buildup since it can easily penetrate the wall of the artery
• Glycation or cross linking of collagen in the blood vessels, causing stiff blood vessels, more inflammation, and more plaque formation
Consider this description by Barbara V. Howard and her co-researchers: “Small LDL particles reside in the circulation longer, have greater susceptibility to oxidative damage by free radicals, and more easily penetrate the arterial wall, contributing to atherosclerosis. No matter what your total LDL-C concentration, if you have relatively more small particles (referred to as Pattern B) it puts you at a several-fold higher risk for heart disease compared to people with larger LDL particles (Pattern A).”33
IT’S A FACT
High triglycerides are a sign that your LDL pattern B cholesterol is also high.
It is sugar and carbohydrates that trigger the production of LDL pattern B cholesterol. That is because eating sugar and excessive amounts of carbohydrates (especially processed carbs) spike the blood sugar, programing the body to produce LDL pattern B cholesterol. Consider the following:
• Sugar increases free radicals in your blood.34 And when you have free radicals, you have cell damage and organ damage, not to mention inflammation and eventually plaque accumulation in the arteries.
• “Anything that provokes an increase in blood sugar will also, in parallel, provoke small LDL particles,” wrote William Davis in Wheat Belly. “Anything that keeps blood sugar from increasing, such as proteins, fats, and reduction in carbohydrates such as wheat, reduces small LDL particles.”35
But when you get your cholesterol measured, most doctors will order a lipid panel test for you. This measures your combined LDL number of both pattern A and pattern B. That is like arguing that the swimming pool is completely safe for little children because it is on average only two and a half feet deep—five feet at one end and one inch at the other.
IT’S A FACT
People who eat potatoes on a regular basis are at greater risk of heart disease. A study of 42 European countries found potatoes consumption to be a predictor of coronary heart disease.36
That is indeed a problem! If your LDL numbers are high, you really ought to know both of your LDL numbers, the pattern A number as well as your pattern B number. One test that gives you an accurate measurement of both your LDL numbers is the NMR (nuclear magnetic resonance) Lipoprofile. It is like an MRI profile of your cholesterol.
Most labs offer the NMR Lipoprofile test, which means it is readily available. It is helpful to have clarity on your LDL numbers. Some patients will take a lipid panel three months after starting the Keto Zone diet to see what progress they have had with their LDL. But it is a good idea, much like a second opinion, to know both LDL numbers, pattern A and pattern B. The NMR Lipoprofile, unlike a standard lipid panel, gives you both LDL numbers.
Your insurance may not cover the NMR Lipoprofile, but I would recommend it if you can afford it. If you cannot, have the standard lipid panel test done before you start the Keto Zone diet and then about three to six months later. Your HDL will usually go up. Your triglycerides will definitely drop, and that is good. If your overall cholesterol goes up, you really should have the NMR to see if it was the neutral LDL pattern A or the dangerous LDL pattern B that went up, then adjust the Keto Zone diet accordingly. Most commonly, the LDL pattern B goes down after three to six months on the Keto Zone diet. If your pattern B is elevated, it will usually take at least three to six months on the Keto Zone diet to lower it. (See appendix D for more information.)
STATIN DRUGS LOWER CHOLESTEROL
While many debate the side effects of statin drugs, I have seen far too many negative effects in my patients to recommend them as an effective way to lower cholesterol.
Some of the side effects of statin medication include muscle pain and damage, liver damage, increased blood sugar or type 2 diabetes, and neurological side effects including memory loss and confusion.37
I have personally witnessed mental deterioration in the form of memory impairment, dementia, and Alzheimer’s as the direct results of cholesterol being lowered in the brain. You know how the brain needs cholesterol to function. Lowering cholesterol levels in the brain is never good, but that is one result of statin drugs.
Though the side effects are a big reason why statin drugs should rarely be used to lower cholesterol, there is also another reason.
As we have just discussed, the susceptibility of LDL pattern B to oxidize and eventually form plaque clearly puts this type at the top of the list of cholesterol you want to lower.
Everybody would agree with that, and since statin drugs lower cholesterol by as much as 40 percent, then it seems logical to get on statin drugs right away.
But based on what you now know about LDL and there being two different types, LDL pattern A and LDL pattern B, you should be asking one very important question: Will statin drugs lower my LDL pattern B?
Here is the problem: statin drugs do not lower LDL pattern B significantly. In fact, there is no drug to lower LDL pattern B cholesterol significantly. In one study, statin therapy did not decrease the proportion of LDL pattern B, but in fact increased it.39
Yes, statins lower LDL, but they are actually lowering your overall LDL number, which you know includes mainly the neutral pattern A and less of the time-bomb-ticking pattern B.
IT’S A FACT
Statin meds reduce levels of CoQ10 (Coenzyme Q10) in the body. CoQ10 is a powerful antioxidant that is found in almost every cell in the body and helps convert food into energy. Studies have shown that CoQ10 may decrease the muscle pain from statin meds.38 Patients on statin meds should take 100 milligrams of CoQ10 once or twice a day.
If statin drugs cannot lower your LDL pattern B significantly, why take the drug in the first place? That is a valid question, one that you will have to answer for yourself, but I do not fault the pharmaceutical companies for trying to find a medicine to reduce our cholesterol problems. What they did not know when they started, as we have only discovered in the past twenty years or so, is that LDL is composed of two very different numbers and that it is the LDL pattern B that causes us untold troubles. Statin drugs do decrease inflammation, which is one of the root causes of heart disease.
The low-fat, high-carb mind-set from the 1950s was also based on insufficient evidence. Saturated fats, almost a swear word in some circles, do indeed raise cholesterol—LDL pattern A, the neutral kind. But it is the excessive sugars and carbs that mainly raise the dangerous LDL pattern B cholesterol.
All the fear about fats clogging arteries and causing heart attacks turns out to be unfounded. That revelation is a game changer for many.
The fact that statin drugs cannot lower LDL pattern B significantly explains a few things, such as: why heart disease has only continued to climb despite the high number of prescriptions for statins, why many heart attack victims had healthy levels of LDL, and why lower LDL numbers do not equal a lower risk for heart attacks.
That also explains why countries like France, which consumes far more fat (especially olive oil) than the United States, and Switzerland, which has significantly higher cholesterol rates than the United States, both have much lower rates of heart disease and heart attacks than the United States.40
With all that said, it is clearly no longer a question about lowering cholesterol in general. Instead, there is only one question that we all (doctors included) should be concerned with: How can I lower my LDL pattern B?
The good news is that your LDL pattern B can be lowered by reducing your intake of carbs and sugars. And that reality brings us right back to the Keto Zone diet.
The Keto Zone diet effectively lowers your triglycerides, raises your HDL, lowers your LDL pattern B, and usually either lowers, maintains, or raises the neutral LDL pattern A. More specifically, it helps convert your LDL pattern B into pattern A. (See appendix D for more information.)
It is pretty amazing that it is possible to change the dangerous small LDL pattern B into neutral large LDL pattern A, but that is exactly what happens on a low-carb diet.41
As for lowering the triglyceride levels, those are specifically impacted by the low-carb diet. As Jeff Volek and Stephen Phinney explain, “When our metabolism adapts to a low carbohydrate diet, saturated fats become a preferred fuel for the body, and their levels in blood and tissue triglyceride pools actually drop.”42
IT’S A FACT
It’s not dietary fat that causes high triglycerides—it’s carbs and sugars.
Clearly, a low-carb diet is the best plan of attack for better heart health. The healthy high-fat and moderate-protein elements of the Keto Zone diet also help significantly, specifically with fish oil (omega-3), olive oil, almonds, pecans, macadamia nuts, avocados, grass-fed butter, and grass-fed meats, but we will talk more about those specific foods soon.
Many people have high triglycerides, low HDL, and high LDL. It is extremely common. That is also a sign they have elevated amounts of LDL pattern B hard at work forming plaque. They need to take action, and the Keto Zone diet is the answer.
The Keto Zone diet will help your body convert the small LDL pattern B particles into the big neutral LDL pattern A. At the same time, your HDL numbers usually go up, and your triglyceride levels almost always go down (as does your blood pressure).
And you will lose unwanted weight along the way—all the better!