Nutritional Lipidology

The statin drug industry and their willing and eager servants, i.e., doctors, have managed to prop up a drug franchise that has reaped hundreds of billion of dollars over the years while providing little benefit but plenty of harm. Although I’ve discussed these issues many times here in the Wheat Belly Blog, the Wheat Belly books, and more recently in the Undoctored book and Blog, it bears exploring further. I keep on hoping that clarity, logic, evidence, truth and repetition overcome our lack of billions of dollars in marketing that Big Pharma controls, a genuine David-vs-Goliath situation.

I call all the varied causes of coronary heart disease and heart attack that are wonderfully correctable using nutrition “Nutritional Lipidology,” the study of the effects of nutrition on lipids, lipoproteins, and metabolic parameters that, if uncorrected, can lead to cardiovascular disease. It is indeed relevant to the Wheat Belly conversation, as wheat elimination and, even better, grain elimination, yields dramatic effects on lipids, lipoproteins, and the factors that drive cardiovascular risk. And there are other natural strategies that further and dramatically improve factors that could have led to heart diseases. In fact, I have found these simple strategies so powerful that most people obtain values that are superior to that achieved with statin drugs and other prescription agents. No, the world does not need more statin drugs; it needs better unbiased health information that does not result in revenues for deep-pocketed drug companies while genuinely reducing cardiovascular risk.

Big Pharma and my colleagues prefer to talk about “cholesterol.” I call cholesterol the kindergarten version of how to understand how cardiovascular disease is caused: there’s a germ of truth to it, but it vastly oversimplifies real causes, is misleading, and can be subverted into the service of those who are adept at bending the truth, AKA pharmaceutical companies and those who fall for their clever marketing, i.e., practicing physicians. This discussion can get awfully hairy very quickly (I tried to tame it in the chapter called “My particles are bigger than yours” in the original Wheat Belly book), so let me try to distill it down. Follow the nutritional principles laid out in Wheat Belly and Undoctored, incorporate a handful of core strategies to correct common nutritional deficiencies, and cultivate and nourish healthy species of bowel flora, and you have a powerful, do-it-yourself-at-home, and marvelously effective way to correct “cholesterol” values and, more importantly, lipoproteins (lipid-carrying proteins) and metabolic factors such as blood sugar and inflammation, the real currency of cardiovascular disease.

Let’s begin with the overly-simplistic changes that develop on a standard 4-item cholesterol panel. Wheat elimination followed by a handful of simple strategies exert these effects on any cholesterol panel:

• HDL cholesterol goes up
   
• Triglycerides drop, often dramatically
   
• LDL cholesterol–remember: a crude calculated value, not a measured value, usually goes down. However, recall that this value is so unreliable that it can do anything, while real measures, such as an actual count of LDL particles (e.g., NMR lipoproteins) goes down.
   
• Total cholesterol–also a confusing issue, because total cholesterol = LDL cholesterol + HDL cholesterol + triglycerides/5. Thus, if HDL goes up–a good thing–total cholesterol also goes up–often interpreted as a bad thing that many doctors mistakenly try to “treat” with statins. Total cholesterol is, in my view, an outdated and totally useless value, useless for application to specific individuals.

While there’s a heck of a lot more to this than my own personal experience, here was my own transformation. When I was vegetarian 25 years ago, eating only “healthy whole grains,” fruits, and vegetables, my values were:

• HDL 27 mg/dl
• Triglycerides 350 mg/dl
• LDL cholesterol 144 mg/dl
• Total cholesterol 241 mg/dl

My fasting glucose was 161 mg/dl–I became diabetic on this low-fat, vegetarian program–a metabolic disaster. And I was jogging 3-5 miles a day. (Soon after Mevacor, the first statin cholesterol drug, was approved by the FDA and released, I took it. Within 72 hours, I became acutely ill, thought I was going to die and couldn’t get out of bed for 48 hours. Likewise, Zocor, Lipitor, and Crestor made me sore all over, made me think I had aged 30 years overnight. Needless to say, I stopped playing with them both personally and, over time, learned how to help patients control the situation with almost no reliance on this deeply flawed group of drugs.) I stopped following a vegetarian, grain-based diet over the years, eventually eliminating all grains, eating more fat, correcting my vitamin D deficiency, supplementing omega-3 fatty acids, supplementing iodine and correcting thyroid dysfunction, supplementing magnesium, making efforts to cultivate bowel flora, and my values–on NO drugs–are:

• HDL 97 mg/dl
• Triglycerides 43 mg/dl
• LDL cholesterol 81 mg/dl
• Total cholesterol 187 mg/dl

My fasting blood sugar: 84 mg/dl. HbA1c: 4.8%–no more type 2 diabetes, no drugs. If we were to look at the changes in lipoproteins, the real values underlying the crude cholesterol values, we would observe that:

• Small LDL particles are gone or dramatically reduced–Because the amylopectin A of grains is the most flagrant trigger for small LDL particles, eliminating wheat and grains results in marked reductions or elimination. The reduction in triglycerides and VLDL achieved with omega-3 fatty acids, coupled with enhanced insulin sensitivity achieved through weight loss, vitamin D, and magnesium add to the effect.
   
• VLDL particles are dramatically reduced–Because there is no amylopectin A to convert (via the liver process of de novo lipogenesis) to triglycerides that fill VLDL particles, the number and composition of VLDL particles are altered and are less able to contribute to unhealthy effects, such as triggering formation of small LDL particles. Omega-3 fatty acids further reduce VLDL particles substantially.
   
• Postprandial lipoproteins, i.e., the after-meal flood of particles into the bloodstream after digestion, are markedly reduced. While fat makes a modest contribution to postprandial lipoproteins, carbohydrates such as amylopectin A make a larger contribution, though delayed for several hours. Eliminate amylopectin A and this effect disappears. Omega-3 fatty acids further blunt the postprandial rise.
   
• The number of LDL particles (e.g., via NMR lipoproteins or apoprotein B, the primary protein of LDL particles), the real measure of LDL particles and not a crude calculated LDL cholesterol value, drops substantially. This develops because of the reduction or elimination of small LDL particles within the total number of LDL particles; the cultivation of Lactobacillus and Bifidobacteria bowel flora species that express the enzyme, bile acid hydrolase, that inhibits resorption of bile acids that would otherwise have been recirculated to create more LDL particles; and correction of thyroid status.

Yes, a bit complicated. But we have to get beyond this ridiculous notion that cutting fat or saturated fat and taking statins reduce “cholesterol.” When you start to understand what really happens with changes in diet, you quickly recognize that, not only is most of the billions of dollars spent annually on statin drugs not necessary, you recognize that astounding improvements in lipids and lipoproteins are achievable by incorporating just a few simple strategies with results dramatically SUPERIOR to that achievable with statins.

The real tragedy of focusing on cholesterol and statin drugs, as you can see, is that it diverts attention away from the factors that really underlie cardiovascular risk , But this is why I say that YOU can do a better job at reducing or eliminating cardiovascular risk than your doctor.