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Cholesterol conundrum thickens: Low-carb versus low-fat diets debated

Which is worse: the meat or the bread?
Which is worse: the meat or the bread?
Photo by Neilson Barnard

In recent years, doctors increasingly have treated high cholesterol with statins and advice to go on low-fat diets in an assumption that the drugs and avoidance of saturated fat can "fix" the problem. But despite increasing research, even the American Academy of Family Physicians (AAFP) can muster up only "qualified" endorsements of potential solutions, reported the AAFP News on Wednesday.

Key among the concerns that make cholesterol such a conundrum: How LDL cholesterol and cardiovascular risk relate and when and how statins should be used to lower cardiovascular risk. And both issues remain highly controversial as both physicians and patients become vocal about the side-effects and questionable benefits of statins for treatment.

Now a new study is pointing to the use of a natural remedy for the problem: Rapeseed oil, reported the UK Telegraph on Wednesday. Researchers discovered that in addition to helping with diabetes, the oil "significantly reduced" bad cholesterol in almost all patients.

Known as canola oil in the United States, the benefits highlight the potential to use food as medicine to treat cholesterol rather than prescriptions. The problem: Even some physicians don't understand how to interpret cholesterol levels or the truth about low-carb versus low-fat diets.

Patients typically are advised to go on low-fat diets based on the model of the American Heart Association (AHA), which advises those seeking to protect themselves from heart disease with healthy cholesterol levels to steer clear of fats and go for grains. Its diet includes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts "while limiting red meat and sugary foods and beverages."

But "this idea that you eat something, it gets into your bloodstream and it clogs your arteries is just false. Nothing remotely like that is happening," says cardiologist Dariush Mozaffarian, who notes that a recent survey showed less than half of people understand cholesterol.

And the advice to avoid red meat and use low-fat dairy rather than full-fat dairy while eating more whole grains may lead to its own set of problems, warned Jonny Bowden, author of "The Great Cholesterol Myth: Why Lowering Your Cholesterol Won't Prevent Heart Disease-and the Statin-Free Plan That Will." In an exclusive interview on Wednesday, Jonny told me why he feels the AHA advice is problematic.

Urging consumers to avoid red meat and full-fat dairy raises the question of "whether it matters at all," says Jonny. "Saturated fat in the diet as a direct cause of increased risk for heart disease has been completely debunked by a number of recent studies, most recently in the March Annals of Internal Medicine."

And even when saturated fat raises cholesterol, "it raises HDL and the big bouyant LDL molecules." As a result, it improves rather than worsens the blood lipid profile," explained Jonny, who also authored "Living Low Carb: Controlled-Carbohydrate Eating for Long-Term Weight Loss."

Describing the AHA advice as "way past its expiration date," Jonny advises focusing on "whole, unprocessed foods, with the fat intact, plenty of vegetables, nuts, berries, grass-fed meat and wild salmon, and stop worrying about cholesterol." It's a low-carb Paleo-style approach that is echoed by Jimmy Moore, who experienced his own cholesterol crisis prior to losing 180 pounds on a Paleo ketogenic diet.

For those who are told that their cholesterol is too high, Jimmy told me in an exclusive interview that there's an "inherent problem with looking at total cholesterol. It is comprised of one number you want to be high (HDL-C), one number that is calculated based on a mathematical formula called The Friedewald Equation (LDL-C), and completely misses one of the most important blood fats that is a major sign of cardiovascular risk (triglycerides)."

Co-author of "Cholesterol Clarity: What The HDL Is Wrong With My Numbers," Jimmy feels that physicians "should be looking at are the true culprits in heart disease--inflammation and oxidative stress." The foods that consumers are advised to eat in the Standard American Diet (SAD) such as whole grains and omega-6 vegetable oils such as rapeseed or canola oil are the ones that result in inflammation and oxidative stress.

"Interestingly, these foods will drop your LDL-C number on your cholesterol panel, but what they do is shift your LDL particles to more of the small, dense, and dangerous kind you don't want. This isn't healthy and yet the health authorities couldn't care less," sums up Jimmy.

He agrees with Jonny that the AHA advice to cut saturated fats and consume more whole grains makes no sense, terming it "one of the dumbest, most ill-advised pieces of nutritional advice for you." Instead, he recommends "reducing the intake of foods that are most inflammatory--carbohydrates and vegetable oils--and consuming more of the anti-inflammatory foods such as butter, coconut oil, fatty meats, and full-fat dairy."

Jimmy, who has co-authored an upcoming book on low carb high fat (LCHF) ketogenic diets ("Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet") with Dr. Eric Westman, also notes that our national fear of fat is causing part of our problems. "Saturated fat is arguably the healthiest part of the human diet that people are quite literally scared to death to eat. Some people actually believe they will have a heart attack within moments of consuming a food like butter or meat, but this is not based on any solid scientific evidence."

Moreover, for those seeking to lose weight and improve their health, fat is "the missing key to optimizing health because it controls hunger, cravings, and provides so many health benefits by improving the production of ketone bodies that is the preferred fuel source for the body." And multiple studies have demonstrated the benefits of this approach, says Dr. William Lagakos, author of "The poor, misunderstood calorie: calories proper."

In a trio of studies, "reducing carbohydrate intake led to a substantial, spontaneous reduction in appetite," noted Dr. Lagakos. Moreover, "weight loss was significantly greater" for those on high fat low carb ketogenic diets.

As for the cholesterol conundrum, Dr. Lagakos cites research showing that "there is not a strong causal relationship between dietary fats with blood cholesterol levels, and blood cholesterol levels with disease outcomes." In addition, studies have shown that sacrificing that steak and biting into biscuits topped with "I Can't Believe It's Not Butter" instead sends you in the wrong direction with regard to reducing your risk of heart disease and improving your cholesterol levels.

In a study published in the Annals of Internal Medicine, researchers compared low-carbohydrate ketogenic diets to low-fat diets to treat obesity and hyperlipidemia. Co-led by Dr. Westman, the study concluded that high-fat low carb diets had significantly more favorable outcomes.

"Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet," they wrote.