Mike wrote a blog piece a while back called “The Low Fat Hammer” about how entrenched the belief in the health benefits of the low fat diet remains in the minds of the media, the public, and (Heaven help us) in the minds of many doctors, despite the mountain of scientific evidence amassed to the contrary. In virtually every head to head contest that has pitted low fat against low carb, low fat has failed miserably across the board.
Study after study has shown the low fat diet to be a failure in treating obesity, in solving diabetes, in reducing blood pressure or in decreasing heart disease risk. Granted the low fat diet does offer some mild reduction in total cholesterol and LDL, but with the offsetting side-effect that it also lowers HDL and changes the type of LDL particle made from the healthier large, fluffy ones to the small, dense ones that promote atherosclerosis. So even that minor benefit–i.e., lowering total cholesterol and LDL, if those really were benefits, which looks more and more suspect by the day–would be a wash. And yet, still, many of my well-intentioned, fellow physicians across the country continue to prescribe the low fat diet for their patients with elevated cholesterol. And, as per drug company marching orders, when the low fat diet fails (which it surely will) they turn to their favorite cholesterol lowering drug. No matter what, they just gotta get those cholesterol numbers down. Never mind that it appears that those particular numbers don’t really mean much. As Mike pointed out in a recent blog, if a cholesterol number is important, it’s HDL, not LDL and not Total.
I am constantly amazed when I hear stories of healthy people–even women–who are counselled to take cholesterol lowering drugs to treat these numbers even when they’re accompanied by offsetting positives. For instance, a woman I recently learned about was wrestling with her doc’s recommendation of taking a statin drug because her LDL was 149. The kicker, however, was that her HDL (the good stuff, the one you want as high as possible) was a whopping 135!! As the study Mike wrote about in his blog pointed out, LDL and total cholesterol didn’t matter a whit in determining heart disease risk, but every 1 point increase in HDL correlated with a 1% reduction in risk.
For crying out loud, with a normal HDL reading for a woman being in the neighborhood of 50 or 60, how low is this woman’s risk? Seventy-five or 85% lower than average? If her triglycerides were also below 100 (and I’ll bet the farm they were) she’s really in good shape.
Would she benefit from taking a statin? I doubt it.
Would it harm her? Maybe not, but maybe so, since side effects (even very serious ones) are not uncommon for these drugs.
But shouldn’t she get that evil cholesterol down? Bear in mind that most of the cholesterol in the blood comes, not from the food we eat, but from production in the liver. Its manufacture is under the control of a particular enzyme that goes by the unwieldy name HMG Coenzyme A Reductase. Statin drugs work by inhibiting (or slowing down the activity of) this enzyme, with the end result being that the liver makes less cholesterol.
All fine and well, but could there be a better, less potentially toxic method to achieve the same end?
Yep. Since insulin stimulates the activity of this enzyme, and since a low carb diet reduces insulin levels, eating a low carb diet reduces the activity of this enzyme and reduces cholesterol production. And if the total number is still up higher than you like and this worries you (probably needlessly), why not try a dose of inositol hexanicotinate (a B vitamin marketed under the name No-Flush Niacin) instead? It’s been proven clinically to work well, is cheaper, and has fewer potential side effects.