When I realized that I had multiple symptoms of diabetes, I started to follow Richard K. Bernstein’s Diabetes Solution and have attempted to control my blood sugar through an ultra-low carbohydrate, high fat diet. I eat two eggs scrambled in two tablespoons of saturated fat, steak or bacon and sausage for breakfast, Korean soup with meat, kim chee and eggs for lunch, an avocado mixed with other salad and meat for supper, often with another low-carb vegetable. For snacks I’ll have sugar-free cheese cake or sugar-free crust-less pumpkin pie, topped with copious amounts of whip cream and a few berries (~tablespoon) or a few nuts, boiled eggs with mayonnaise and salt, pepperoni, or other sausage. I avoid all sugars, all grains (including rice) and all vegetables high in carbs (no potatoes, carrots or legumes). I suppose my total carb count is between 30 and 50 gm per day and I assume that I am in a consistent state of ketosis.
My low carb high fat diet has begun to heal me. I experience much less peripheral neuropathy, my arthritis has largely disappeared, my diabetic dermopathy is gone, and I have lost a lot of weight. Here are the before and after pictures.
Yet my doctor wanted to put me on statins because my cholesterol is very high, in her view, and needs to be brought down because I am at 10% risk of having a heart attack in the next ten years.
So here are the before and after numbers of my blood test: first number is ten months ago (American conversion in parentheses), and the second number (after the slash) my most recent test (two weeks ago):
- Total Cholesterol: 6.3 (243) / 9.21 (356)
- HDL Cholesterol: 1.0 (39) / 1.3 (50)
- Triglycerides: 2.34 (207) / 1.37 (121)
- LDL (calculated): 4.24 (164) / 7.29 (282)
- HBA1C: 6% / 5.5%
Here are some other markers not on the blood tests:
- Weight in pounds: 260 / 210
- Waist measurement in inches: 44″ / 36.5″
- Average blood sugar during previous three months (calculated from hbA1C): 7.7 (136) / 6.6 (118)
- Snoring has lessened both in frequency and decibels.
- No significant loss of lean mass.
- Blood pressure is now in the optimal range instead of borderline hypertension (without drugs).
My diet is healing me without the help of drugs. The only marker that has worsened, at least in the eyes of the medical community, is LDL. Yet now my physician wants to put me on statins. However, I refuse to go on statins, especially now that I’ve done a bit of research. As for the blood work, the triglycerides are down 40% and the HDL is up 30%. My HBA1C has improved, but it is still too high in my opinion, and this is likely because my liver over produces glucose (gluconeogensis), especially in the morning (dawn phenomenon), and so my metabolic disorder continues despite my strict diet. Yet my family doctor is ill-equipped to help me with this particular marker, a true sign of metabolic syndrome and diabetes, and is only concerned to lower my LDL. Having done a week’s worth of reading, several important facts have become clear to me:
- Elevated LDL is a marker only–it is not a disease.
- High Cholesterol or high LDL have no correlation with artery disease.
- High Cholesterol or high LDL are not proven causes of artery disease.
- The link between metabolic syndrome/diabetes and heart disease is far clearer and more convincing than any alleged link between cholesterol and heart disease.
- No one can answer the question of whether a person that has adopted a low carbohydrate lifestyle but has high LDL is really at risk. No such long term study has ever been done.
- A person with low triglycerides but high LDL is more likely to fall into the “Pattern A” than the “Pattern B” cholesterol. My alleged VLDL (very low density lipids) has dropped from 41.4 to 24.2, suggesting that I am shifting from Pattern B to Pattern A.
Is my doctor not guilty of straining a gnat and swallowing a camel? She had little concern about the true risk factors for heart disease (camel): high HBA1C, low HDL, high triglycerides, and visceral obesity (fat around the waist); but she was ready to kill the gnat, high LDL. While she had the results of my earlier test, she manifested not the slightest approval in my improved numbers and was anxious only about my higher LDL; and she was more worried about me than the physician who went through the numbers with me ten months earlier. The medical profession seems to have disordered priorities. This is clear from a look at heart risk calculator that she used. Risks factored into the equation are as follows:
- Male or female
- Low HDL-C
- Total Cholesterol
- Systolic blood pressure
According to her risk assessment, I have a 18.4% chance of cardiovascular disease in the next ten years. Using the same assessment criteria, my earlier self (see “before” picture) had a 15.6% risk. My loss of 50 lbs around my fat belly counts for nothing; my lower triglycerides and lower HBA1C (because I’m not “diabetic”) count for nothing. Yet which guy in the above pictures do you think has the more likely chance of a heart attack?
Now I am mostly happy with the results of the latest tests and I am very happy with the improved state of my health. Here are my three options going forward:
- Take statins to reduce my LDL.
- Reduce my consumption of saturated fat to reduce the LDL. Why? My current diet is healing me.
- Continue as before trying to fine tune my blood sugar issues and shoot for an HBA1C of 5.0%, Triglycerides of 100, and HDL of above 60. Reject my doctor’s anxiety about LDL, her dietery advice and her recommendation of statins.
I found the blog of Dr. Rakesh Patel in Arizona who himself decided to low carb using the Carbnite Solution (CNS) and was feeling much better after four months, but his LDL-P had skyrocketed. What to do? He decided to actually test himself for artery disease, because he believed that metabolic syndrome, not high cholesterol, was its likely cause. He therefore did not want to treat something that is not a disease. He himself had a Carotid Intima Media Thickness (CIMT) scan before the low carb diet and then at the four month mark his improvement was remarkable.
I had my CIMT done in 2006 on the Standard American “heart healthy diet” eating low fat, higher carb. You know those espoused by the ADA and AHA. My lipids were “normal” at this time. My thickness was 0.6 mm (about the 50th percentile). I also had two small “road bumps “ (minimal plaques) at my left carotid bulb both measuring 1.2 mm. I was not happy. I also had similar findings on a study in 1/2010.
Flash-forward to June 2012, about 4 months into CNS, my CIMT showed a thickness of 0.445 mm (13th percentile) and I had the vascular age of a 16 year old! And oh by the way, the “road bumps” were gone. All the while carrying an LDL-P of over 2500 consistently for over a year. I have also had a CT Coronary Calcium score that was zero.
Some primitive people who eat a diet rich in saturated fats and low in carbs never experienced problems with heart disease (like the Masai). Saturated fat, and the resulting high LDL that occurs in some people like myself and Dr. Patel, does not seem to cause heart disease. A diet rich in carbohydrates marked by high triglycerides, low HDL and high HBA1C causes metabolic syndrome, obesity, inflammation and artery disease. This is why diabetics have a much higher risk of death by heart attack. My maternal grandmother was diabetic and died of a third heart attack. Yet stubbornly, most doctors will not recommend high fat low carb diet because they’ve been taught to fear fat and cholesterol.
Now to answer the first question posed in the title: Which one of these guys should take statins? The guy in the before picture or the guy ten months later? In my opinion, neither. The guy in the first picture was eating too many carbs and needed to stop it. The guy in the second picture has rapidly improving health already. Why would you want to possibly destroy that with a potentially harmful treatment of a non-disease?
Offline Resources consulted:
Anthony Colpo, The Great Cholesterol Con, 2012
Jeff S. Volek, Stephen D. Phinney, The Art and Science of Low Carbohydrate Living, 2011.
Gary Taubes, Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, 2007, 2008.
Richard K. Bernstein, The Diabetes Solution, 2011.