One of the easiest things I do in my practice is lower triglycerides and I do this through diet and diet alone. It is only when somebody does not listen to what I tell them to do that I have to resort to the use of medication. But what exactly is a triglyceride and how do I lower this thing so easily? Well, let me tell you.
A triglyceride, as the name suggests, has three glycerides. Get it? Tri means three and the word glyceride follows, so a tri-glyceride has three glycerides. Glyceride is a fancy way of saying fat. So a triglyceride is three fats stuck together. When your doc orders a lipid profile the triglyceride number will be there as well. If your triglyceride reading is high it means the fats in your blood are high.
Now remember ‘a priori’ reasoning it goes something like this; if your triglycerides, or fats in the blood are high, it must be because you are eating too much fat. Right? Well, actually, that is incorrect and this reasoning is dead wrong, with emphasis on the dead. Because that is exactly where you will wind up if you believe that. And, yes, by the way, most docs still tell their patients to start a low fat diet if their triglycerides are elevated; AND THIS DOES NOT WORK, NEVER, EVER, EVER!!!
Are you ready for this one, the reason the triglycerides elevate in the bloodstream is because of the consumption of carbs. So when you go and start a low fat, low cholesterol diet, again, you will be eating more carbs. We learned in the last chapter this sets up the body to make more cholesterol, but it also allows the body to make more triglycerides as well, That's right, may I hear another great big Opps!!
So putting all this together, eating more whole grains and fruits and less cholesterol will help to elevate both the cholesterol and triglyceride numbers in the bloodstream, exactly the opposite of what we are trying to accomplish. But exactly how does the consumption of carbs elevate the triglyceride number? Let us take a look.
When we eat carbs they are broken down into sugars. Guess what the starting point for the making of a triglyceride is? Hmmm? Yup, you got it, it is sugar. So our bodies make triglycerides from sugar and our bodies make cholesterol from sugar. OK, let us think about this; the very things that do not contain any fat or cholesterol, are the very things our body uses to make fat and cholesterol.
By eating more whole grains (carbs) and fruits (carbs), we are providing the body with the very things it needs to make more fat and cholesterol. Yes, I am repeating myself a lot, but I cannot over emphasize how dangerous it is to follow a low fat, low cholesterol diet as well as eating more whole grains and fruits. This is exactly what the body needs to make all the bad stuff.
It is so frustrating for me to see a patient who tells me they are on a low fat, low cholesterol diet and that they have been on it for years. They come in and tell me that despite the fact they are eating healthy, they still need to take meds and are having a difficult time losing weight. OF COURSE THEY ARE! What they are essentially doing is giving the body everything it needs to make all the bad things they are trying to lower. But when I attempt to explain this to them they always go back to the old "Well, all my other doctors before told me to get on a low fat, low cholesterol diet, so I did; and now you are telling me that's wrong, when all the other docs say it's right? What makes you so much smarter."
Of course, during this exchange with my patients, I am always thinking that, no, I'm not much smarter. Actually, I feel like an idiot for not figuring this out sooner. But what does that say about the majority of physicians who are still telling their patients to start low fat, low cholesterol diets. In fact, just a few minutes ago (I am telling this story to you between seeing my patients), I received a consultative report from a cardiologist who recommended to a patient of mine to start a low fat, low cholesterol diet. Yes, very frustrating.
Another interesting side note is that when patients are told to start low fat, low cholesterol diets, most of you do. But guess what? Most docs do not believe you when you tell them you have been on a low fat, low cholesterol diet. You know why? Because when the vast majority of you go for your repeat labs in three to four months, the lipid profile has only changed marginally, if at all. And a lot of the lab reports come back worse.
So you go in to see your physician for the follow up visit to discuss your latest labs and when you tell the doc you have been on their prescribed diet, you get the look. You know, the look. From above the glasses, which I find obnoxious, and with that condescending tone you hear "Sure you have been on the diet."
But guess what, you were on the diet. I know it, you know it, but your doc thinks you are lying to them. You know why they think you are lying? Because many times the numbers are worse, not better, and since the doc believes, just absolutely believes, low fat, low cholesterol is the way to go; there is no way your numbers could have gotten worse if you were on the diet. But that is exactly why your numbers got worse in the first place: BECAUSE YOU WERE ON THEIR LOW FAT, LOW CHOLESTEROL DIET AND THEY JUST DON'T GET IT!!!!
Why? I told you why; because doctors are not trained to really think, really truly think about things in medical school. We are trained early on in medical school just to accept from the medical community that what they say is true. So that is why it took me so long to wake up and that is why, unfortunately, most docs are still ignorant of this simple truth. Especially for the newly indoctrinated graduates from medical school and even more so, for the Chiefs and Heads of Departments in medical schools and hospitals, who all need to change their way of thinking. Try to get through to those thick craniums. Unfortunately, it is not going to happen anytime soon. But these are the docs we all look up to for answers; and if they do not know, and worse, if they do not realize they do not know, we are all in trouble. Can you see the problem?
All right, I'm getting myself all worked up; let us get back to the triglyceride. So triglyceride production starts with sugar. I mentioned in chapter two something called glycolysis. This is where the production of cholesterol begins, but fat production can start here too. The sugar molecule is modified and out comes this thing called pyruvate, which is modified again and we get right back to good ole acetyl Co A.
Acetyl Co A, wait a minute, was that not the thing that cholesterol was derived from. You got it. So every time you eat sugar (carbs) the sugar will be modified to acetyl Co A and now you are well on your way to making more fat and cholesterol. Congratulations. Now your doc can put you on meds and the drug companies can pay for their Leer jets.
So now some of you may be wondering, well, hey, "What happens when I eat fat?" Great question, let’s see.
Fat digestion occurs in the small intestine. When fat is broken down it is broken down into its multiple components. Now this transformed fat will diffuse into your intestinal cells and will be reformed into substances known as chylomicrons. I know my readers who have taken biology will hear a bell ringing. These new fat things will enter a circulatory system known as the lymph.
As a side note, we have two circulatory systems, a closed one and an open one. The closed one you know as your arteries, capillaries and veins, the open circulatory system is referred to as lymph. This is the whitish watery stuff you see when you just barely scrape your hands or knees.
These chylomicrons, which are really just transformed fat, now circulate into an area called the thoracic duct and empty into veins, thus becoming part of the regular circulatory system by entering the bloodstream. These chylomicrons now diffuse into fat cells, liver cells and just about every cell of the body. Whether these are stored or used for fuel depends upon whether carbohydrates are present. In the presence of carbohydrates the chylomicrons will be stored. If there exists a low amount of carbs in the diet the fats will be used for energy.
Yes, that is correct, our bodies do use fat for fuel. But we will only use fat for fuel if there is no carbohydrate lying around. Fats are pretty tricky, not as straightforward as cholesterol. That is because sometimes fats can be used to make cholesterol, too. But this only happens when carbs are present. If one is following a diet with more fat and cholesterol (notice I did not use the term, high) and low carbs (notice I did not say no carbs), the body will use fat for fuel, cholesterol will be converted to very useful substances and there will be no extra carbs around to make any more fat or cholesterol, as described above.
There is this myth which has been propagated that the body prefers to use sugar for energy. This is not true. Guyton’s Textbook of Medical Physiology states, “Almost all the normal energy requirements of the body can be provided by oxidation of the transported free fatty acid without using any carbohydrate or protein." What this statement means is that the body can use free fatty acids, that is, a single triglyceride, for fuel. It is also widely claimed that our brain cells prefer carbs for fuel. Again, this is wrong. Our brains prefer to use molecules called ketone bodies for its energy source. Interestingly enough, the byproduct of free fatty acid breakdown is ketone bodies.
So let us put this all together. When we eat fat it is transformed, pretty quickly I might add, to another fat, which finds its way into our cells. It will be stored or used for fuel, all depending on the presence of carbs. Have a high carb presence and not only will the fat be stored, but we will make cholesterol out of it as well. Low carb presence means the fat will be used for fuel, thus leaving very little for storage or cholesterol production. So again, low fat, low cholesterol dieting is NOT the way to go. Unless, of course, you want to gain weight and make more cholesterol and get fat, have a heart attack, or develop type 2 diabetes. Yeah, I didn't think so.
A myth is a fixed way of looking at the world which cannot be destroyed because, looked at thorough the myth, all evidence supports that myth
-Edward de Bono
Stay tuned for Chapter Four
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
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