Low Carb & Keto: What about Cholesterol?


Thanks to Squarespace for sponsoring this
video. Consider the ingredients in the following
low carb high fat recipe. “Two pounds of de-boned white fish, one-half
cup butter and two-thirds pint or more of cream, two tablespoon of flour, the juice
of one half lemon, salt and pepper to taste.” Excluding the fish and lemon, this recipe’s
saturated-fat-packed dairy to carbohydrate ratio is 19:1. Low carb or ketogenic cookbooks with recipes
like this may sound like a delicious way to lose weight, but what about cholesterol and
heart disease? What’s interesting about this saturated
fat heavy recipe is that it isn’t recent at all. It came from an 1895 cookbook, a time when
heart disease rates were at an all time low. Almost every single recipe in The Baptist
Ladies’ Cook Book contains butter, eggs, cream or lard. And, if you rewind to ninety nine years earlier
in 1796 when “The First American Cookbook” came out, you find plenty of recipes using
plenty of lard and fat pork, and a majority of the recipes call for butter, usually by
the pound or half pound. Before 1910, people in the United States almost
exclusively used saturated fat heavy butter and animal fats for cooking and baking. At the time, cooking with vegetable oils was
almost unheard of. But as the process of hulling and pressing
seeds and beans was mechanized, vegetable oils became cheaper than butter or animal
fat. From 1909 to 1999, consumption of soybean
oil in the United States increased by more than 1,000-fold per person, margarine consumption
increased 12-fold, but consumption of butter and lard decreased by about four-fold each. Sometime after 1910, there was concern about
the growing rates of heart disease, and president Eisenhower’s heart attack in 1955 really
got the ball rolling on figuring out what causes heart disease. There were a couple places to look: for example,
smoking rates were on the rise along with the rise of heart disease: President Eisenhower by the way, had been
a four-pack-a-day chainsmoker a couple years before his heart attack. Despite this, and the fact that the president’s
attack occurred right in the middle of the rapid decline of animal fat consumption and
rapid rise of vegetable oil consumption, saturated fat took the blame. You probably know the rest: it was found that
cholesterol is contained in the plaques that clog arteries, and saturated fat increases
your cholesterol. Thus, “artery clogging saturated fat”
became a common phrase. But before we get into whether having high
cholesterol from eating too much saturated fat causes heart disease, let’s look at
cholesterol itself. What is it for? Well, first off, it’s very important for
maintaining the integrity of cells in your body. Without it, your cells would turn to mush. A huge function of cholesterol is making and
metabolizing hormones. Hence, cholesterol levels naturally rise throughout
pregnancy, a time in which the body is producing all sorts of hormones to manufacture a fresh
human. A 1997 study of university students found
that cholesterol levels rose “proportional to the degree of examination stress.” When the body is under stress, it produces
cholesterol to make hormones that help deal with the stress. If you are awakened by a burglar trying to
break into your home at 4AM, but have a checkup later in the day, you can expect your cholesterol
levels to be sky high and for your doctor to prescribe you a statin – a cholesterol
lowering drug. Cholesterol’s importance in hormone production
also explains why men taking statins have been found to have lower testosterone. So, I hope we can agree that we need some
cholesterol. But just how good is less cholesterol? A 2001 paper documents the changes in 3572
elderly people’s serum cholesterol concentrations over 20 years, and compared them with rates
of death. They found that the group with the lowest
cholesterol had the lowest rate of survival. The author’s interpretation? “We have been unable to explain our results” You may have heard of the “French Paradox”
– a term coined in the late 1980’s that refers to the particularly low obesity and
heart disease rate in France despite people getting as much as 40% of their energy intake
from fat with 16% of it being saturated fat – this is three times the amount of Saturated
Fat the American Heart Association recommends. One theory is that red wine is what allows
French people to eat so much butter, cheese, cream, foie gras, and pate yet stay so healthy. So maybe if French people lowered their dietary
saturated fat and therefore cholesterol and drank the wine, they’d be even healthier. Well, a 1989 paper tracking the mortality
rates of 92 elderly women in a nursing home in Paris found that rate of death was 5.2
times higher in those with the lowest cholesterol. But we know total cholesterol is somewhat
outdated, and now the concern is about LDL – the so called “bad” cholesterol. As shown in a review written by multiple doctors
in departments like Cell Biology, Chemistry, Endocrinology and Nutrition science, compared
to other diets, when you go on a low carbohydrate diet, many biomarkers improve: your weight
goes down, your hemoglobin A1c goes down, glucose is down, triglycerides are way down,
but this small increase in LDL may have some people worrying. In this talk by Peter Attia, he explains:
“We were taught that LDL cholesterol is the big risk, right? If your LDL cholesterol is high, you are at
risk for heart disease. This is a study that looked at 136,000 patients
admitted to the hospital for a coronary artery event and in these patients they looked at
LDL cholesterol level and you can see that nearly 50% of them had what you would consider
a low LDL cholesterol level.” Many scientists believe oxidized cholesterol
to be the real problem as it initiates the process leading to the buildup of plaque in
the arteries. So then, how does it become oxidized? One way is, ironically, through the effects
of consuming so called “heart healthy” vegetable oils. The problem with the polyunsaturated fatty
acids in vegetable oils is that because of their structure, they are unstable. Meaning, when exposed to oxygen or heat, they
can form toxic byproducts and free radicals. Free radicals which can oxidize cholesterol
and thus lead to heart disease. So when you heat vegetable oils, free radicals
as well as small lipid fragments called aldehydes can form. Aldehydes are well known to be toxic. A hangover is suspected to be the result of
alcohol being metabolized into acetaldehyde. Research by Martin Grootveld, a professor
of bioanalytical chemistry and chemical pathology, showed that “a typical meal of fish and
chips”, fried in vegetable oil, contained as much as 100 to 200 times more toxic aldehydes
than the WHO safe daily limit. In contrast, frying butter, olive oil, coconut
oil and lardproduced far lower levels of aldehydes. Maybe McDonald’s ought to switch back to
making their fries in beef tallow, as they did before the early 90’s. “And I thought when they first started out
the french fries were very good. And then the nutritionists got at them and
it turned out to be erroneous that beef, tallow, fat was bad and…” But, vegetable oils, for example corn oil,
do an excellent job of lowering cholesterol. We’ve known this since the 1960’s. Here’s Dr. David Diamond explaining a study
on this from 1965: “They had one group that was put on a low cholesterol, low fat diet
and they had a couple tablespoons of corn oil per day. The other group as you see here, it says no
advice was given to the control patients. And the outcome was quite nice as far as the
cholesterol. So the study was a success as far as reducing
cholestero. But then, when you look at the outcome. The outcome is very straightforward. To stay in the study you have to stay alive. So now when you look at these two groups and
look at whose still in the study. And so, the people on the low fat low cholesterol
corn oil diet, only half of them were left. So twice as many people had heart attacks
and died in those that had the corn oil.” Another tragic consequence of replacing saturated
fats with polyunsaturated vegetable oils is losing out on the heart protective effects
of the fat soluble Vitamin K2 found in animal fats. The importance of vitamin K2 in heart health
is shown by research on vitamin K2-dependent reactions. For example, gamma carboxylation, requires
vitamin K as a cofactor. And, if the glutamic acid residues of gla-containing
proteins are not carboxylated, calcium cannot be properly bound. You don’t need to remember all that, but
it simply means that Vitamin K2 is necessary to take the calcium out of your heart and
put it into your bones. Calcium deposition in the vascular system
is a consistent feature of heart disease. Interestingly, as this 2004 paper shows, vitamin
K2 intake reduced mortality rates from heart disease and all causes, but vitamin K1 (found
in soybean and canola oil) did not. And, more recently we’re seeing articles
like this: Let’s take a brief moment to review how
our eating patterns have changed following dietary recommendations. Less Whole Milk, More Skim Milk, A little
less butter, Way more polyunsaturated oils, Less eggs and Beef, and More lean Chicken
and Turkey. Top it all off with a gigantic increase in
sweet syrup. You might still be wondering, “if it’s
not the cholesterol, then what causes heart disease?” Let’s take a look at a study of patients
that have a condition called “familial hypercholesterolaemia” that causes them to have abnormally high cholesterol. We’re supposed to keep our LDL below 100
to be healthy, but in these people, it was nearing 250. But, a portion of them had heart disease and
the others did not. There’s no significant difference between
total cholesterol, or the so called good or bad cholesterols. So what was different? Clotting factors. Those diagnosed with heart disease had significantly
greater baseline clotting factors. Here’s a study showing that Cardiovascular
disease clearly increases with an increase in the clotting factor fibrinogen. As Dr. David Diamond Points out: if we take
a look at the primary risk factors for heart disease: Obesity, Diabetes, High Blood Sugar,
Smoking, Aging, Inflammation, Stress and Hypertension, these are all linked to platelet activation
and clotting. The point I want to make is that at the very
least, there are much better places to look than cholesterol in trying to prevent heart
disease. For example, Dr. Mann Kummerow suspected trans-fats
to be the problem. Among other unhealthy effects, trans fats
inhibit Vitamin K2 dependent processes, promoting calcium build up in the heart. Biochemist and two time Nobel Prize Winner
Linus Pauling suspected Vitamin C deficiency to play a role as low Vitamin C stimulates
the production of the heart disease promoting Lipoprotein (a). Another big suspect is chronic inflammation There are many factors that play into this
very complex condition, and more and more data is showing that saturated fat in the
context of a low carbohydrate diet is not one of them. Despite some data like this on 1998 Europe
suggesting that more saturated fat results in less heart disease, the theory that saturated
fat causes heart disease has prevailed for quite a while and radically changed the way
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