You are not what you eat; you are what you do with what you eat. The same can be applied to the different molecules and compounds inside and outside of cells.
How does this pertain to diet and biology?
It is not about “calories in versus calories out” as we so often hear.
It’s about the effect of specific nutrients on the hormonal regulation of metabolism.
There’s always an “excess” of nutrients sitting outside cells (something Craig Thompson at Sloan-Kettering pointed out in a paper in Science), but cells won’t take them up unless they are told to (like insulin “telling” the cell receptors to take up glucose). The mere presence of “too much” of a substance in the blood stream isn’t really the issue. There is almost always an “excess” of fat, cholesterol, and nutrients in the body.
Cholesterol is a great example, and has been one of the most misrepresented organic chemical substances in our bodies.
Most of you have heard that "cholesterol is bad."
This can't be further from the truth.
Peter Attia, a friend and extremely knowledgeable MD who shares the same passion for reversing the obesity and diabetes epidemics, recently put it somewhat succinctly:
Cholesterol is very good! In fact, there are (fortunately rare) genetic disorders in which people cannot properly synthesize cholesterol. Once such disease is Smith-Lemli-Opitz syndrome (also called “SLOS,” or 7-dehydrocholesterol reductase deficiency) which is a metabolic and congenital disorder leading to a number of problems including autism, mental retardation, lack of muscle, and many others.
Cholesterol is absolutely vital for our existence. Let me repeat: Cholesterol is absolutely vital for our existence. Every cell in our body is surrounded by a membrane. These membranes are largely responsible for fluidity and permeability, which essentially control how a cell moves, how it interacts with other cells, and how it transports “important” things in and out. Cholesterol is one of the main building blocks used to make cell membranes (in particular, the ever-important “lipid bilayer” of the cell membrane).
Beyond cholesterol’s role in allowing cells to even exist, it also serves an important role in the synthesis of vitamins and steroid hormones, including sex hormones and bile acids. Make sure you take a look at the picture of steroid hormones synthesis and compare it to that of cholesterol (above). If this comparison doesn’t convince you of the vital importance of cholesterol, nothing I say will.
One of the unfortunate results of the eternal need to simplify everything is that we (i.e., the medical establishment) have done the public a disservice by failing to communicate that there is no such thing as “bad” cholesterol or “good” cholesterol. All cholesterol is good!
The only “bad” outcome is when cholesterol ends up inside of the wall of an artery, most famously the inside of a coronary artery or a carotid artery, AND leads to an inflammatory cascade which results in the obstruction of that artery (make sure you check out the pictures in the links, above). When one measures cholesterol in the blood – we really do not know the final destination of those cholesterol molecules!
What can I measure that predicts risk of heart disease?
Writes Peter Attia:
The (very) short answer is this:
Doctors typically measure the following in a standard cholesterol test:
- LDL-C – the concentration of LDL (“bad”) cholesterol in your blood
- HDL-C – the concentration of HDL (“good”) cholesterol in your blood
- TG – the level of triglycerides (“bad”) in your blood
Combining HDL-C and TG into a ratio (i.e., TG/HDL-C) is probably the single best predictor of cardiac risk you can derive from a standard cholesterol test. The lower the ratio, the lower your chances of having an “adverse cardiac event,” as the medical community describes it (e.g., a heart attack). Despite what doctors tell you, LDL-C is pretty much useless for predicting your risk of heart disease. In fact, it’s not even part of the risk assessment for metabolic syndrome, which everyone agrees is the central link to heart disease (and virtually all other chronic diseases we’re afflicted with).
INTERVIEW WITH GARY TAUBES
In 2005, my wife and I interviewed Gary Taubes, an award-winning scientific investigative journalist, at his apartment in New York City. We were planning on doing a documentary on diet and health, and during this time (January 2005-May 2005) I went on a fast food diet. I was basically doing a documentary similar to Fat Head before (I think) Fat Head. (Tom Naughton did an incredible job.)
Whether the documentary will eventually see the light of day is unclear, but I wanted to share some clips on the blog that we produced along the way.
"In the case of diet and heart disease, Ancel Keys's hypothesis that cholesterol is the agent of atherosclerosis was considered the simplest possible hypothesis, because cholesterol is found in atherosclerotic plaques and because cholesterol was relatively easy to measure," writes Gary Taubes in Good Calories, Bad Calories (GCBC). "But as the measurement technology became increasingly more sophisticated, every one of the complications that arose has implicated carbohydrates rather than fat as the dietary agent of heart disease." In this 2005 interview, before the publication of GCBC, Taubes discusses the cholesterol story. A more comprehensive account can be found in Chapter 9 of GCBC: Triglycerides and the Complications of Cholesterol.
Below is a clip of the interview we conducted.
YOUTUBE: Gary Taubes | The Complications of Cholesterol
FURTHER READING ON CHOLESTEROL
In Peter Attia’s series on Cholesterol (provided below), you may be surprised to learn the following conclusions:
If you remember only one factoid from the previous three posts on this topic, remember this: If you were only “allowed” to know one metric to understand your risk of heart disease it would be the number of apoB particles (90-95% of which are LDLs) in your plasma. In practicality, there are two ways to do this:
- Directly measure (i.e., not estimate) the concentration of apoB in your plasma (several technologies and companies offer such an assay). Recall, there is one apoB molecule per particle;
- Directly measure the number of LDL particles in your plasma using NMR technology.
If this number is high, you are at risk of atherosclerosis. Everything else is secondary.
Attia concludes: "If you want to stop atherosclerosis, you must lower the LDL particle number. Period."
What is most surprising, or unfortunate, is that most assays your doctor prescribes cannot elucidate your LDL particle number.
The Straight Dope on Cholesterol: Part I | Peter Attia, MD
The Straight Dope on Cholesterol: Part II | Peter Attia, MD
The Straight Dope on Cholesterol: Part III | Peter Attia, MD
The Straight Dope on Cholesterol: Part IV | Peter Attia, MD
The Definitive Guide to Cholesterol | Mark Sisson
The Most Important Thing You Don’t Know About Cholesterol | Chris Kresser
RECIPE | ROASTED BRUSSELS SPROUTS & BACON
Here’s what to gather to feed 4-6 people as a side dish:
- 1.5 lbs of Brussels sprouts
- 2-3 tablespoons of avocado oil, melted lard, or macadamia nut oil
- 4 slices of bacon, diced
- salt and pepper
- aged balsamic vinegar
Here’s what to do:
Preheat your oven to 400° F. Trim the ends and any old outer leaves from the Brussels sprouts.
Cut the sprouts in half and toss them with extra virgin olive oil, salt, and pepper. Dump them on a foil lined baking sheet, making sure to keep everything in one layer. Sprinkle the diced bacon over everything and pop the tray in the oven.
The sprouts take about 30-35 minutes to roast, so set your timer for 10 minute intervals x3 to regularly rotate and flip the sprouts ‘n swine. Check for seasoning and drizzle some of your favorite vinegar on the finished dish.
Courtesy of Nom Nom Paleo
Bob Kaplan holds advance degrees in exercise physiology and business, an undergraduate degree in nutrition, is a nationally certified personal trainer, and owns and manages Get In Shape For Women in Wayland.
For more information about Kaplan's services at Get in Shape For Women in Wellesley, please call 781-237-7752 or visit at 259 Washington Street, Wellesley, MA, 02481, or online at www.getinshapeforwomen.com for a free health assessment.