Why I Was Somewhat Disappointed With The July 2008 New England Journal Weight Loss Study

The New England Journal Of Medicine is highly prestigious

While I was away on vacation in Florida seeing my brother recently, a well-publicized weight loss study comparing a low-carbohydrate, Mediterranean, and low-fat diet was released and published in the July 17, 2008 issue of The New England Journal Of Medicine. All the headlines were screaming how the Atkins diet is best and livin' la vida low-carb is champion of them all. It was in virtually every newspaper (including this Wall Street Journal story I was quoted in), local and national television news outlet, and all the health and weight loss blogs--A BIG STORY!

And because it put low-carb living in such a positive light as compared with the low-fat diet or the much-beloved Mediterranean diet, you would think I'd be a happy camper touting this study as the best thing to happen for low-carb in a long while. But as I stated after this other highly-publicized study out of Stanford published in Journal of the American Medical Association last March, I can't get too thrilled about yet another study that shows such insignificant weight loss on a low-carb diet after two years and doesn't really require the participants to adhere closely to anything resembling the Atkins weight loss diet. This puts me in the minority I'm sure, but I have to say this is one big reason why I was disappointed with the New England Journal study.

For those of you who missed this study, lead researcher Iris Shai, R.D., Ph.D. from the S. Daniel Abraham International Center for Health and Nutrition in Israel, put 322 "moderately obese subjects" on one of three specific diets for a two-year observation:

- LOW-CARB--Two months of 20g daily and slowly increase to 120g maximum for the duration of the study. Calorie-restriction was not required for this group.
- MEDITERRANEAN--Calorie restriction of 1500 daily for females, 1800 daily for males consuming a diet with 35 percent fat from olive oil and nuts while consuming fish and poultry in place of higher-fat cuts of meat like pork and beef.
- LOW-FAT--Calorie restriction of 1500 daily for females, 1800 daily for males consuming a diet with 30 percent of calories from fat as recommended by the American Heart Association (AHA)

Before I share the results, I have some comments. While 20g carbs is indeed the Induction phase of the Atkins diet, 120g is nowhere close to ANY phase of the Atkins diet. EVER! Why do they put people on a low-carb diet and then let 'em go to town eating carbs later? What's so freakin' hard about requiring them to stay at or under 50g a day? I just don't get that with these studies. I do like the fact there were no constraints on calories with the low-carb group and they just naturally kept their calories in check eating this way.

The Mediterranean diet group looked fine, but I was surprised to see the low-fat diet group to include so much fat. While the AHA may consider a 30 percent fat diet to be low (and it is relatively speaking), it doesn't come anywhere near the kind of low-fat diet that the infamous Dr. Dean Ornish said in my first interview with him suggesting obese and unhealthy people go on to lower their weight and improve their health. His plan is a 10 percent fat diet with upwards of 70-80 percent carbohydrates. That's not what they did with this study which is too bad since it supposedly shows the difference between low-fat and low-carb. We'll have more from Ornish is a moment.

First, let's take a look at the results of this less-than-spectacular study:

The LOW-CARB group lost the most amount of weight with 12.1 pounds followed by the MEDITERRANEAN group who lost 10.1 pounds and bringing up the tail was the LOW-FAT group who only shed 7.3 pounds (confirming the results of this long-term large study that found weight loss was insignificant on a reduced-fat diet). The researchers also observed what happened to HDL and triglycerides on these various nutritional approaches and the results were not at all shocking to those of us paying attention to our health--LOW-CARB saw a greater INCREASE in their HDL "good" cholesterol and a more significant DECREASE in their dangerous triglyceride levels making their ratio of HDL/total cholesterol much better than the other groups. Additionally, the A1C levels, an important marker in blood sugar health, as well as their C-reactive protein levels, a marker look at dangerous inflammation, both improved more with the LOW-CARB group.

Pretty good news, right? Well, it depends on who you ask. Let's see what Dr. Ornish thought about this study in this op-ed piece published in Newsweek magazine. It appears he had an issue with several things that may or may not have validity:

1. The study was funded by The Atkins Foundation, a non-profit organization led by Veronica Atkins that has donated millions of dollars to various researchers looking into low-carb diets and their effect on weight and health carrying on the legacy of the late great Dr. Robert C. Atkins.

This shouldn't disqualify the study altogether, but Ornish seems to think it does. So, are we to negate all the research conducted by you and your group on low-fat diets using the same logic, Dr. Ornish? You're better than this.

2. The LOW-FAT participants didn't eat a "low-fat" diet.

I agree, Dr. Ornish. But neither did the LOW-CARB group eat a genuinely "low-carb" diet beyond the first couple of months of the study. If we are ever gonna see a real comparison of low-fat and low-carb diets going head-to-head, then mandatory compliance is gonna have to be implemented. That's the only way to keep advocates on both sides from whining about the diet not being the actual diet every time one of these comparison studies is released.

3. The study is questionable because of calories difference.

Dr. Ornish claims the study lacks "quality" because the LOW-FAT group ate less calories but lost less weight. He says this calls into question the veracity of the data because it is "physiologically impossible" to eat less calories and lose less weight than the other groups. Ornish believes in the mistaken notion of calories in, calories out, so this is not surprising. How about that metabolic advantage at work? :D

4. The Atkins diet group ate "vegetarian sources of fat and protein" which isn't the Atkins diet with all the bacon and beef you can eat.

I'll agree that vegetarian fats and proteins are not preferred over animal fats on the Atkins diet, it's ludicrous to continue stating that the Atkins diet by the book doesn't include veggies. Anyone who has read the book and doesn't have an agenda like Dr. Ornish knows that you get two cups of green leafy veggies as well as one cup of non-starchy vegetables per day on the most restrictive Induction phase of the Atkins diet. Hello?! You make yourself look idiotic when you keep repeating the same lie over and over again, Dr. Ornish.

As for the actual sources of fat and protein in the LOW-CARB group, low-carb researcher Dr. Eric Westman from Duke University asked Dr. Shai to clarify what kind of foods were eaten by members of the low carb group. The notion that the researchers pushed a "vegetarian low-carb diet" on the participants is NOT what was done.

Here was Dr. Shai's response to Dr. Westman's inquiry:

This is kind of funny that some could think of a "vegetarian low-carb" diet. Is it a new suggested strategy? Could be interesting idea but this wasn't the case here. Our low-carb diet was based on Atkins, the participants read the book and the recipes were more or less comparable to what you know in the states.

Beef is the main red meat. What could be different? People here (in Israel) would not mix in the same meal meat and butter, a salad is considered a very rich one and not a lettuce based, and the main dressing is olive oil. As for beverages, same industry that makes money everywhere.

For example, a plate could include: fish or fried/not bread coated chicken/or red meet, broccoli and mushrooms coated with eggs, roasted eggplants, vegetable salad (peppers, cucumber, green leaves, not lettuce) with olive oil dressing. I understand that some of the low-fat people find it hard to believe that such a low-carb diet was tremendously favorable within 2 years in a well designed study, but these are the facts and the science of tomorrow, with the next long-term studies in the pipeline, may confirm or not these findings.

So, as you can see, the LOW-CARB did indeed follow more of an Atkins diet approach in terms of the specific foods they ate, not the mocking of a "vegetarian low-carb diet" as Dr. Ornish made fun of in his op-ed column.

5. HDL is only a risk factor among many to be looked at.

Oh, how convenient for you, Dr. Ornish. Yes, we know all about your "garbage trucks" analogy for HDL stating that you need more of them when you have more "junk" (LDL) to be removed. But the fact is eating a high-carb diet as Ornish suggests leads to LOWER HDL and HIGHER triglycerides, neither of which is healthy by any stretch of the imagination. And the very latest researcher is showing us that LDL and total cholesterol are not nearly as important as the HDL/triglycerides ratio that is becoming the new standard bearer for heart health. Dr. Ornish may dismiss these improvements with HDL and triglycerides by the LOW-CARB group as insignificant, but we know better.

At the end of his op-ed trying to dismiss this study as irrelevant in the grand scheme of things, Dr. Ornish states that it's time to "call a truce in the diet wars." That's something I've tried to do before noting all the areas of agreement between low-fat and low-carb, but the fact does remain we don't all agree on what is healthy, Dr. Ornish. To state so bluntly that "an optimal diet is one that is low in fat" shows just how entrenched you remain in your ideology without looking at the latest data (and I'm sure you STILL haven't read Gary Taubes' Good Calories, Bad Calories because you're afraid to have your lifelong beliefs about health challenged with evidential facts!).

Okay, enough about what Ornish thinks of this study. Let's see what some other prominent and REAL health experts think about the New England Journal study:

DR. JONNY BOWDEN

"Call me crazy, but I can't help wondering if the low-carb group would had lost even more weight if they had eaten less than the 120 grams of carbs these folks ate, all the while keeping calories at a moderate, reduced amount and incorporating other lifestyle changes like exercise and stress reduction. Can you imagine? A more reasonable level of under 100 grams a day (or even less) might have made a lot of difference--that's a level that seems to work the best for people who have problems with sugar, insulin and carbohydrates in general."

DR. JOHN BRIFFA

"This study adds to the body of evidence that suggests that lower carb and carb-controlled eating has distinct merit and generally has the capacity to out-perform low-fat diets in the weight-loss stakes (and without any conscious restriction of food intake, either). The results of this study suggest that such a diet may be superior in terms of cardiovascular disease risk too."

DR. RICHARD FEINMAN

"The major significance of the NEJM paper is that it is confirmatory of much work that has gone before. It is really not, as portrayed in the media, revolutionary. Much prior work from the laboratories of Jeff Volek, Eric Westman, Steve Phinney, Jay Wortman, Mary Gannon and Frank Nuttal and others has shown that carbohydrates, beyond simple calories, have a role in controlling how fats are used or stored. Directly or indirectly through insulin, carbohydrates encourage the storage rather than burning of fat and lead to the organization of fat into the cholesterol-containing particles that have been associated with cardiovascular disease. At the same time, the NEJM paper also confirms the evolving picture of fat as playing a passive role and emphasizes that what was once thought to be an intuitive benefit for lowering fat has consistently not panned out. The new article is a key block in a scientific structure that has been put together by many previous investigators. If the NEJM paper finally catalyzes some recognition of the scientific principles of carbohydrate restriction it will be a very important contribution."

DR. MARY C. VERNON

"For years, carbohydrate restriction and the low-carb folks, those of us who really spent our lives telling patients they could regain metabolic control and kind of being ostracized for it, we’re finally validated."

DR. JEFF VOLEK

"The findings from the recent NEJM study that showed a diet lower in carbohydrate outperformed a low fat diet confirms our previous work and that of many others. It is unique in that the intervention was 2 years and yet there was a very low subject attrition rate over such a long period of time. The low carbohydrate diet was only moderately restricted in carbohydrates (about 40% of calories). Based on our research, had the level of carbohydrate restriction been in the 10-15% range, the results would have been even more impressive. The results add to a growing body of work supporting the value of restricting carbohydrate as opposed to fat for superior weight management and metabolic health."

GARY TAUBES

"These latest trials just happen to be the best data we have on the long-term effects of saturated fat in the diet, and the best data we have says that more saturated fat is better than less. It may be true that if we lowered saturated fat further — say to 7 % of all calories as the American Heart Association is now recommending — or total fat down to 10 percent, as Dean Ornish argues, or raised saturated fat to 20 percent of calories, as Keys did, that we’d see a different result, but that’s just another hypothesis. The trials haven’t been done to test it. It’s also hard to imagine why a small decrease in saturated fat would be deleterious, but a larger decrease would be beneficial.

It’s also true that I don’t think that LDL is a particularly meaningful predictor of heart disease risk, and I think total cholesterol is meaningless (based on the evidence that I recount in the book). But the point is that the AHA and the National Cholesterol Education Program and the authorities at the National Heart, Lung and Blood Institute do think LDL is meaningful, and that’s the basis by which they have always recommended low-saturated-fat diets. They also think that total cholesterol/HDL is the single best predictor of heart disease risk, so by their assessment, more saturated fat is better than less. I think the best predictors of risk regarding cholesterol profiles are HDL and the size and density of the LDL particles themselves, and maybe measurements of a protein known as ApoB (the protein component of the LDL particle itself) — and the existing diet trials in those cases also suggest that saturated fats are at worst harmless and perhaps even beneficial.

Last point, the funding. It’s true that the study was financed by the Atkins Foundation, but to assume that the researchers went out and falsified their findings or twisted their observations to satisfy the source of funding is naive. Regrettably, the only institutions that will finance clinical trials, for the most part, are those that stand to gain from the results. That’s why the pharmaceutical industry finances drug trials. It would be nice if the government financed all these trials, but they don’t. So it’s up to the Atkins Foundation and any other organizations that might hold similar beliefs. In this case, the Atkins-funded diet trial observed the exact same results as similar NIH-funded diet trials."

Incidentally, Taubes says the National Institutes of Health (NIH) has spent $5 million for a large (300+ subjects, two-year-long) Atkins vs. AHA low-fat diet trial--the REAL THING! This is a larger and longer version of a pilot trial that observed results similar to the Israeli trial. This is the largest diet/weight loss trial the NIH has ever funded. The principal investigator is Gary Foster of Temple University, currently the president of the Obesity Society. In February 2007, Dr. Foster told Taubes the researchers had "completed the final 2 year assessments on most but not all" of their subjects. Currently the paper is "in the peer review process" and that's all we know at this point. Cross your fingers that this is the great elusive study that actually looks at low-carb vs. low-fat once and for all.

Coming as a shock to nobody, the AHA weighed in on this study expressing their concerns over the long-term weight and health impact of low-carb diets and saturated fat consumption and the lack of application to women since the majority of the study participants were men. Yadda yadda yadda...what do you expect from a group pushing two cartoon characters known as "The Bad Fat Brothers" named "Sat" and "Trans?" These people lost all dignity a long time ago.

I have long held the position that if low-carb is at least as effective as low-fat for weight loss and health, then both should be recommended alongside one another as healthy options for people to choose from. The American Diabetes Association recognized low-carb diets to diabetics for the first time beginning in January 2008 and the AHA, AMA, and other health groups should follow suit. The evidence is there if you'll simply open your eyes to it. We don't need another study, flawed or otherwise, to tell us that one way of eating that is working for so many people is livin' la vida low-carb. GIVE PEOPLE THE TRUTH and then let them choose. It's that easy.

Although I'm not particularly overjoyed by this latest study out of Israel, that doesn't mean I don't appreciate the way it helped carry on the conversation about low-carb living across mainstream America. My stepdad Frank, who only recently started on the Atkins diet to lose about 50 pounds along with my mother, was all excited when he saw the television news coverage about this study a couple of weeks back. If this excites people and gets them interested in learning more about the healthy low-carb lifestyle, then that's awesome! I can't wait to see that new NIH study Taubes was talking about, though. That one looks like the REAL DEAL.

You can e-mail Dr. Iris Shai about this study at irish@bgu.ac.il.

'Doc' Describes Me As A 'Dead Man Walking' Because Of My Elevated LDL Cholesterol

One of the risks that I willingly take blogging about health as someone who has not been trained in either medicine or nutrition is the fact that there are a whole lot of people who are much more intelligent than I am about the subjects I write about. It's just a fact of life that I've lived with since day one of my blog more than three years ago. And it doesn't bother me a bit that I don't have all the answers.

The purpose of my blog is for me to share about my experiences livin' la vida low-carb and to hopefully provide some interesting topics for discussion that will enable my readers as well as myself the chance to learn something about their own health that they probably didn't know before. One thing I've found since I started blogging in the health arena is that even the doctors and medical researchers don't always know as much as we think they do. There's a reason they call it "practicing" medicine.

With that said, I recently received a rather challenging e-mail from someone purporting to be a "Doc" according to their e-mail address who wanted to take me to task over the assertions I made in this blog post about my latest cholesterol numbers and specifically the particle size of my LDL as well as my hard-hitting column about the death of the late NBC "Meet The Press" anchorman Tim Russert. It seems the good "Doc" took great exception to my belief that the HDL/triglyceride ratio is a better indicator of heart disease risk than LDL or total cholesterol and that having large LDL particle size is protective against a cardiovascular event.

In a very condescending tone in his e-mail, "Doc" proceeded to berate my gross ignorance of some rather "basic" health concepts that I apparently haven't fully grasped yet (get a load of this guy!):

I nearly fell off my chair reading your well-meaning but very erroneous blog on Tim Russert.

If larger fluffy, buffy LDLs are protective, why is it that people with the highest risk of atherosclerosis and premature death (i.e. familial hypercholesterolemia) have 100% fluffy, buffy, LDLs?? Sure does not protect them! You with an LDL-C greater than 200 likely have large LDLs and are a dead man walking.

If low HDL-C is always bad, why are their several genetic conditions associated with very low HDL-C and longevity? Check out JAMA. 2008;299(21):2524-2532

Why have there been numerous published articles in the last few years describing many patients with myocardial infarctions who have HDL-C > 90 mg/dL?

If low LDL-C is so dangerous, why do people with hypobetalipoproteinemia who go through life with LDL-C between 5 and 40 all have longevity with no ill effects of such low cholesterol levels?

Russert's Lipids: TC = 105 LDL-C = 68 HDL-C = 37

Of course that is impossible: TC = LDL-C + HDL-C + VLDL-C
VLDL-C is derived by dividing TG by 5 thus VLDFL-C = TG/5

Thus using your numbers TG would be zero which is impossible. Of course if you knew anything about lipids, your blog would not contain so many basic errors.

Last bit of advice--Look up apolipoprotein B or LDL-P. Read the newest guidelines: A consensus statement from the ADA and ACC on Lipoprotein Management in Patients with Cardiometabolic Risk (like Russert). They were published in April in Diabetes Care and the Journal of the American College of Cardiology.

Had anyone measured LDL-P on Russert and then treated it aggressively, Russert would still be here. Of course since statins rarely normalize LDL-P, Russert needed additional medication beyond his statin to achieve apoB goal.

Hate to further blow away your statements, but if you read the new ADA/ACC statement you will see that data from three major trials (Framingham, MESA and EPIC Norfolk) have shown that LDL size is no longer considered an independent risk factor for CHD. Only thing that matters is apoB or LDL-P.

Happy reading and please correct your statements on the web site.

Well, I guess he told me, didn't he? It really depends on what research studies you are looking at and he pointed to a few that certainly made sense to him. As I stated before, I'm no expert when it comes to knowing anything and everything about the subjects I write about. I simply share what I do know and have seen applied in real life situations and let those results speak for themselves.

It's a bit presumptuous of this guy to call me a "dead man walking" because of my high "fluffy, buffy LDL" cholesterol. Further belittling my intelligence by attempting to point out my "errors" was also quite unbecoming of someone who alleges to be a professional physician whose goal is to help educate patients and make them healthy. I wouldn't want this fella being my doctor!

Although I didn't have the answers to his remarks, I knew someone who could provide an educated and reasoned response to "Doc." He's a real doctor and avid researcher on low-carb diets--Dr. Eric Westman. The following is Dr. Westman's comments back to "Doc" asking for clarification and presenting some counter-evidence rebutting the original claims made in his e-mail to me:

Thank you for forwarding this email.

1. The definition of "cardiometabolic risk" is changing, and its relationship to cardiovascular disease is imperfect. In spite of this, many medical authorities want you to do what they recommend. There are many exceptions to the recommendations, and I believe the authorities will acknowledge this readily.

2. Please teach me, "Doc." You wrote that people with "familial hypercholesterolemia have 100% fluffy, buffy, LDLs." Can you provide a reference for this statement (even case studies are fine)? Here is a recent article and it suggests otherwise...but the abstract doesn't really give enough information until I can read the full study. J Pediatr. 2008 Jun;152(6):873-8. Epub 2008 Feb 8

3. You wrote: "If low HDL-C is always bad, why are their several genetic conditions associated with very low HDL-C and longevity?"

I think that this just points out again how imperfect these markers are.

4. You wrote: "LDL size is no longer considered an independent risk factor for CHD. Only thing that matters is apoB or LDL-P."

"Doc" let me just take a moment to explain what "independent risk factor" means statistically--it is a common source of confusion. "Independent risk factor" means that, after accounting for some information, the addition of a new factor (variable) adds no more information (the association is no longer statistically significant).

My understanding is that LDL size and LDL-P are highly intercorrelated ("track together"), so that after accounting for one, the other is no longer statistically significant in its association with cardiovascular disease. It does NOT mean that LDL size is not important--it just means that you get no more additional information about the presence of cardiovascular disease from knowing LDL size when you already know LDL-P.

I look forward to learning more from you. Thanks.

Eric C. Westman, MD MHS
Associate Professor of Medicine
Director, Lifestyle Medicine Clinic

Excellent job, Dr. Westman! You took each of the points made by "Doc" and offered him the opportunity to see other data that he may not have considered otherwise. I appreciated you taking time out of your busy schedule to write back to "Doc" and give him a chance to learn something new himself. Unfortunately, that's the last we've heard of good ole "Doc." There's been nary a word out of him since Dr. Westman's reply.

Am I fallible? Yes, more than I'd like to admit. Do I know everything there is about diet, health, and nutrition? Anyone who tells you they do should be avoided because they are lying. Do I enjoy inciting an open discussion and debate of ideas? You bet your sweet bippy I do which is why I don't mind hearing from people who necessarily disagree with my viewpoints and wish to correct me. If I'm wrong and evidence is presented to me proving it, then I'm the first to make the corrections and admit the error of my ways.

But in this case, "Doc," I won't be changing a thing! By the way, where'd ya go? I'd love to hear what you have to say about what Dr. Westman said.

Tim Russert's Fatal Heart Attack Was Preventable, He Followed Antiquated Advice

In this supercharged and oftentimes volatile political election year, something tragic and sudden struck this country and has everyone buzzing in Washington and across the United States. No, it wasn't some sex scandal, drug bust, or any of the other usual news that has become almost too commonplace these days. This was something much more serious and has greater implications than even the extensive coverage the mainstream media is giving to it.

Last Friday afternoon, hard-hitting political interviewer and long-time host of NBC-TV's Sunday morning news talk show "Meet the Press" Tim Russert experienced his first heart attack and it almost instantly killed him. I cannot imagine how his family is responding to this news and my sympathies and prayers go out to them during this very difficult time. Tim was in the midst of doing what he loved--preparing for his television show--when the heart attack took his life and took him away from all of us.

So, how did a 58-year old man die from a heart attack when he was doing all of the things his doctor said he should to prevent it? Should we be concerned about what doctors are telling us about how to ward off cardiovascular disease so that we don't become the next victim of what befell Tim Russert? These are the questions people are asking in the wake of this tragedy and was the subject of what one of my readers wanted to know in an e-mail I received.

Here's what she wrote:

Hi Jimmy, I have been an avid reader of your blog for a long time. I am so scared since Tim Russert died suddenly of a heart attack at only age 58 (my husband is 57 and I'm 54) that I'd really like to get some clarification on the statin drugs and cholesterol issue. Seems like Tim Russert's doctors did all the usual things and he died anyway. I trust what Dr. Jonny Bowden has to say as he has an advanced degree in nutrition and he seems to think for himself instead of just following the status quo. Can you see if he would help reassure me with this? Thanks for your assistance, and keep up the fantastic work!

While I am no Dr. Jonny Bowden, I do have some things to say about Tim Russert's death that need to be said. I can understand your concerns and I am delighted to forward your questions to Dr. Jonny Bowden. He's one of the brightest, most articulate people on nutrition in the entire world, so you are in good hands with the information he provides to you.

But if you would allow me to comment on this subject, I have some thoughts about it. Isn't it interesting that Tim Russert did everything exactly as his doctor wanted him to and yet his very first heart attack was a fatal one? I don't think that's a coincidence either and it happens every single day without a blink of an eye from anyone.

Watch this video interview with Russert's doctor to see how dejected he is about Russert's "unexpected" death despite his best treatment strategies. It's amazing to hear his doctor basically say that Tim did everything he was "supposed" to do and yet it wasn't enough to save his life. Wanna know what the scariest part of this story is?

Check out Tim Russert's lipid profile:

LDL--68
HDL--37 (up from the lower 20's)
Total Cholesterol--105

Did you see that? Most doctors would look at those numbers and say, "See how healthy this person is because we lowered his cholesterol." And they would pound their chest with pride at putting someone like Tim Russert on a statin drug to artificially make this happen. But what good did it do him in the end? He's gone now because of that advice and there's no outrage about it. Worry, concern, perplexity, yes--but nobody is angry that this preventable death was made WORSE by the use of all the traditional means for improving heart health.

According to Russert's doctor, he didn't have Type 2 diabetes nor did he have any blood sugar issues at all. His A1c was in the normal range and as I noted previously his cholesterol was considered VERY healthy. For all intents and purposes according to the modern day medical conventional wisdom, he was the epitome of perfect health. And yet he tragically died before his time.

We now know posthumously that Russert had coronary heart disease that he was being treated for, but his doctor apparently didn't know how severe it was. But even if he did know it was extremely serious, what else would he have recommended to Tim? Higher doses of his statin drug? Even less fat in his diet? More exercise? In the end, all of these seemingly good strategies from the conventional wisdom point of view would have very likely done NOTHING to prevent this from happening.

His doctor put him on blood pressure lowering medication as well as a cholesterol-lowering statin drug to see if that would help. And Russert even rode an exercise bike to try to lose weight, although it didn't work. There's no doubt the plaque buildup around his heart was getting bigger and bigger over the years until his heart couldn't take it any longer.

We know that too low LDL can lead to depression, suicide and death. We also know that HDL "good" cholesterol (Russert's was very low--NOT good) and triglycerides (something Russert dealt with having too high over the past few years) are better indicators of heart health than LDL and total cholesterol. And it's a high-carb, low-fat diet that leads to lower HDL and higher triglycerides. No doubt this is precisely the kind of diet Russert's doctor had him on.

As you know from reading my blog, my most recent total cholesterol reading was 326 with an LDL of 246, HDL of 65, and triglycerides at 77. I am confident I don't need to go on a statin drug now or ever and I am as healthy as I have ever been in my entire life. On face value, any typical physician in America would say to me, "Oh my God, you need to be on Lipitor, Crestor, or Zetia to lower your LDL and total cholesterol."

Of course, they would be 100% wrong because my LDL particle size is the protective large, fluffy kind that your body wants and needs. Dr. Eric Westman from Duke University Medical Center in Durham, North Carolina, who is the physician who ran this test on my behalf, said almost all of my LDL is this protective kind and the percentage of small, dense LDL (which was the likely culprit in Russert's fatal heart attack) is virtually nil. And that's a GREAT thing! High LDL can be good, but low HDL is most certainly ALWAYS a bad thing to have.

When you are livin' la vida low-carb correctly, then your HDL will be well above 50 and for women well above 70. At the same time, your triglycerides will drop below 100 for an HDL/triglyceride ratio of around 1. That's what you want. Of course, you will need to get the particle size of your cholesterol subsets measured using a VAP or Berkeley test, but you can almost be guaranteed that if your HDL is up over 50 and your triglycerides are down below 100 that your LDL particle size will be the large, fluffy protective kind.

This cholesterol issue is one I am quite passionate about because the modern means for dealing with it is simply exacerbating the problem. The medical community has the blinders on and they refuse to take them off long enough to see the harm they are doing to patient after patient they put on these risky prescription drugs for a purpose that is futile and fatal in the end like it was for Tim Russert.

Here are quite a few posts I have penned about the subject of cholesterol that I think you should read when you get a chance to help you understand this issue even better:

"Doctor Claims Blood Sugar, Not Cholesterol Linked To Heart Disease"
"Low-Carb Can Raise HDL Levels Without Cholesterol Medication"
"Cholesterol Numbers Drop But At What Cost"
"Cholesterol Drugs Are About Money Not Health"
"Cholesterol Conundrum: Do I Statin Or Not?"
"Doctor Gives Me Four Months To Get LDL Down"
"Consensus On Cholesterol Is Avoid Statins"

It's time to break all those years of cholesterol indoctrination. There will be confusion and concerns in your mind at times, but that's okay. My pithy response to anyone who challenges me on cholesterol is PROVE IT'S UNHEALTHY! They can't because there isn't one iota of truth to the cholesterol con.

There's much more to this cholesterol issue and the connection to Tim Russert's
death than most people even realize. I encourage you to read a few more commentaries from people in the health community who I respect and trust about this:

JACKIE EBERSTEIN from Controlled Carbohydrate Nutrition
"What We Can Learn From Tim Russert's Death"

DR. WILLIAM DAVIS from Heart Scan Blog
"Another failure of conventional cardiac care"
"Tim Russert's heart scan score 210...in 1998"

Hopefully my answer will make you feel better about this and that consuming a diet lower in carbs, higher in fat, and with moderate protein at every meal is what is going to work best for improving your heart health over the course of your life. If only Tim Russert had been given this information instead of the antiquated traditional advice he received, then his fatal heart attack may have been averted. Perhaps this event will begin a serious discussion of heart health treatment in this country so that others can benefit from the healthy low-carb lifestyle, too. We can only hope.

Anyone interested in learning more about the alternative cholesterol hypothesis I've written about today must check out the following books:

The Great Cholesterol Con by Dr. Malcolm Kendrick
The Great Cholesterol Con by Anthony Colpo
Hidden Truth about Cholesterol-Lowering Drugs by Shane Ellison
Malignant Medical Myths by Dr. Joel Kauffman
The Cholesterol Myths by Dr. Uffe Ravnskov
Good Calories, Bad Calories by Gary Taubes

6-24-08 UPDATE: In response to an anonymous comment left about this blog post regarding the kind of diet Tim Russert ate OBVIOUSLY being a low-carb one, here's my comment:

Actually, anonymous, livin' la vida low-carb is arguably the easiest diet you can possibly go on and do for the rest of your life. I tried livin' la vida low-fat in 1999 and THAT was not sustainable in the least. No, it doesn't take some willpower to lose weight, but rather a steadfast resolve to make better choices for your health. For me and many here at my blog, that was a low-carb diet.

As for Tim Russert, he most certainly was NOT on a low-carb diet because his triglycerides were very high and his HDL was very low...these are signs of a HIGH-carb, low-fat diet that his cardiologist no doubt put him on. Here's an excerpt from the New York Times about Russert's health:

Mr. Russert had low HDL, the protective cholesterol, and high triglycerides. He was quite overweight; a waist more than 40 inches in men increases heart risk. A CT scan of his coronary arteries in 1998 gave a calcium score of 210, indicating artery disease — healthy arteries do not have calcium deposits — and a moderate to high risk of a heart attack.

None of this happens on a low-carb diet and the studies show your HDL goes above 50 and your triglycerides fall below 100 when you are low-carbing correctly. And this is PROTECTIVE against a cardiovascular event.

The studies also show that a diet low in fat and high in carbs (generally recommended as "healthy" by most of the so-called experts) is what leads to lower HDL and higher triglycerides like Tim Russert had. This is the diet that ultimately killed him, not a low-carb diet.

More Incredible Feel Good Success Stories About Healthy Low-Carb Living

Wanna be a low-carb success? Read about other successes!

Success always begets success begets success.

Just in case you haven't noticed it before, I like to encourage people. It's always been in my nature to pass on positive thoughts to those who need an uplifting word to get them through a difficult time. I'm a "can-do" kinda guy and want others to be able to experience all the best that life has to offer them. For all intents and purposes in my mind, it's the way things are meant to be.

That's why I LOVE hearing from people who have been able to accomplish incredible things with their health while livin' la vida low-carb. And that's not by accident either. This way of eating, whether the media and those so-called "experts" ever want to admit it or not, is an incredibly amazing and simple way to bring about massive improvements in not just your weight but your health, too.

I've blogged about so many ways your health is supercharged with low-carb living, but let's just take a look at a few right now, shall we?

When you start eating low-carb:

- Weight loss commences without counting calories
- Triglycerides drop below 100 very easily and quickly
- Blood sugars stabilize
- HDL "good" cholesterol rises above 50
- Sensitivity to insulin is improved
- Blood pressure decreases
- Insulin levels in the body are reduced
- Muscle mass is preserved
- Epilepsy is virtually cured
- Cancer is not allowed to spread and grow
- Concentration and clarity of thought emerges
- Energy like you haven't seen before
- More sound sleep
- A positive mood and attitude
- NO HUNGER!!!
- Beaming confidence about yourself
- Incredible fat loss

I could go on and on and on, but I've blogged about these and so many other ways your health gets better and better as a result of livin' la vida low-carb. Today, I wanted to share some more incredible feel good success stories about healthy low-carb living from some of your fellow readers who were inspired to tells their great news to me.

After sharing about my wife Christine's 55% drop in her triglycerides in just six weeks and my own incredible lipid profile numbers, the floodgates opened up and you couldn't help but express how much the low-carb lifestyle has and is STILL changing your life for the better. Be encouraged as you read these remarkable changes that have happened without the use of any prescription medications or other medicinal interventions.

Just diet, baby--a low-carb one, that is! ENJOY! :D

Hey Jimmy,

I left the American Heart Association diet to eat only meat, fish, eggs, butter and vegetables. No grains, sugar, fruit or starchy veggies of any kind. My blood pressure went down from 141/90 average to 116/65 average also was able to stop all my BP meds. Total cholesterol went from 241 down to 180 and HDL went from 43 to 62. Was able to stop taking Lipitor. Sorry but Atkins was more or less right. I no longer buy the no-fat nonsense.

YOU GO BOY! Your health improvements are indeed SPECTACULAR!!!

Jimmy,

Thank you so much for your support in my new way of eating. I read and listen to you almost every day. I read your blog about your blood sugar woes with great interest. I have been Livin' La Vida Low Carb for about 6 months only for blood sugar issues. I have had high fasting blood sugar for over 20 years. It has never progressed to anything beyond that and all other tests are normal.

I lost 30 pounds 2 years ago through sheer willpower and my fasting blood sugar did not improve. I have low trigylcerides and high HDL, and my BMI is 21. My only issue is the fasting number. My post meal numbers seem normal. I am so lost and I can't seem to get these numbers down. I am lucky my new physician has agreed that 30 carbs is a good daily max. Is there anyone out there can help me understand why nothing is helping these morning numbers!! Maybe I need to eat more fat and less protein.

I did read about a form of diabetes called mature onset diabetes of the young (MODY) where the only problem is fasting blood glucose and it never progresses to anything beyond that if carbs are controlled. I didn't start controlling my carbs at all until about a year ago and then really got serious about 6 months ago.

Can you point me to any good information about this?

It certainly sounds like you're on the right path, so don't give up hope. If you missed my podcast interview with Dr. Keith Berkowitz from last week, then you really should check it out because he may have some information that could help you. I'll be following up with him in another podcast soon, so let me know if you have any specific questions you'd like for me to ask Dr. Berkowitz. You're doing GREAT!

Hi Jimmy,

I found your podcasts today as I embark again on my low-carb "adventure." I have spent most of the evening listening, watching your YouTube videos and reading your blog and it's been a great inspiration.

I too was an Atkins follower back in 2003 and shed about 30 pounds to hit my goal weight and it was great. But things change and I left the low-carb way and I have paid for it. Still here we go again and I'm truly excited and will continue to listen and watch and read you as my body flips back (hopefully!) into the low-carb lifestyle!

Thanks very much and I hope your battle with the 30 pounds is not dragging you down too much. I am sure you will crack it!

THANK YOU so much and welcome back to livin' la vida low-carb. I urge you to make this your permanent lifestyle change and never let life get in the way again. Low-carb eating is HEALTHY eating, so there's no sense in ever eating any other way again, right? As for my recent weight woes, I'm not discouraged. Even if for some reason these 30 pounds refuse to budge, I KNOW without a shadow of a doubt that I'm healthier than I'd EVER be eating any other way. The good news is I feel better now at the age of 36 than I have in my entire life. How many people can say that? :)

Hi Jimmy:

It's your fellow low-carb buddy here. I have been following your info about Christine's triglycerides on the blog and I just had to share some related news of my own that I got last week!

I got my first ever cholesterol test done since I've been low-carbing now for about 8 months, and let me tell you it was SOOOO VALIDATING!!!

Here are my numbers:

Total Cholesterol: 197
HDL: 64
LDL: 120
Triglycerides: 61

What I find absolutely fascinating about these numbers is when you compare them to my last test in 2004 when I was in the middle of doing Weight Watchers to lose the last of my pregnancy weight. I have the food journals I kept during that 30-pound weight loss and it was soooo carb heavy (it's amazing I even lost weight). I was also exercising 1 hour a day during that time. So here's what the numbers were:

Total Cholesterol: 210
HDL: 72
LDL: 100
Triglycerides: 188!!!!

When I compared the two triglyceride numbers (61 now on low-carb, 188 then on high-carb, low-fat) I just about fainted. Totally amazing. So I wanted to add my story as more proof that consuming massive quantities of fat-laden foods does not kill you, it makes you healthier--AS LONG AS YOU KEEP YOUR CARBS LOW!!!

Oh, I had such a great time this weekend showing this to all my friends who are FREAKING out because I eat whole milk, butter and steak. It was great. I hope Christine continues to see her levels stay healthy.

The only question I have is: Can you have triglyceride levels that are too low? Any danger in that one? I hope not, cause I'm sure proud right now. Keep up the good work!!!

WOWSERS! I love the enthusiastic response you have for livin' la vida low-carb and can only tell you to keep doing what you're doing. The difference between your low-fat triglyceride numbers and your low-carb ones is astonishing. Not surprising, though, since you eat so many carbohydrates on a low-fat diet. We should pay more attention to triglycerides when we talk about heart health, but doctors usually only give it a cursory glance compared to the LDL and total cholesterol which is their be-all, end-all for determining your cardiovascular risk. Puhleez! Give me low-carb any day of the week. And I wouldn't worry about "too low" triglycerides. Mine were once as low as 43, but when they're below 100 it shows you are indeed doing low-carb the right way. YOU GO GIRL with your bad self!!! :D

Changing the world one dietician at a time!

In all seriousness though, think about what keeps people from doing low-carb in the U.S., which we know works for the vast majority of people, for weight loss and so many other levels. I've thought about this in my own efforts to help those in my own small circle that have asked for advice in achieving some of the success that I've enjoyed with low-carb. Even with the proof of a real human being standing in from of them, it's can be difficult for people to convince themselves that it's worth a try. It's not lack of knowledge, because the research has been done. It's not poverty or lack of access to the right foods. It's what I would call the "social" factors.

I stole this term from the computer world where they refer to computer hackers (sorry to have to use the "h" word) doing "social" hacking, as opposed to "technical" hacking. That is, taking the route of sweet talking or deceiving people into giving up their passwords, as opposed to using some program to guess the password, which is a lot more difficult. The white hat guys that focus their efforts on preventing the "social" hacking, by convincing users to create tough passwords and guard their information, are doing a lot more good, just in terms of sheer scale of hacking prevented, than the guys focused on the technical approach like installing better firewalls.

I make the analogy to what you are doing with helping people get past the barriers to starting low-carb. They're not technical barriers. Rather, it almost takes a rebel these days to do low-carb in the face of official opposition, in spite of the well-documented benefits and logical physiological underpinnings. Most doctors don't advocate it or they even discourage it. The USDA, ADA (OK, a glimmer of hope there), AHA, Ornish, Oz, and other high profile entities actively discourage it. If people can get past these "barriers to entry," then they will, in all likelihood, be successful.

Jimmy, you are helping to break down these barriers and in effect giving people permission to do low-carb without thinking that they will drop of a heart attack after 6 months from the fat intake. In so doing, you're doing more good to address the biggest health issue in the U.S. (and much of the world) today--the obesity and diabetes epidemics--than probably hundreds of doctors do in their lifetimes.

It's not that the technical medical advocates aren't important, but I don't think they have the potential for the scale of impact. You're doing it with ideas, and by making the ideas accessible to millions through the Internet. Let's review that again, because I really mean it, and I get the feeling you may be too humble to have digested it the first time--doing more to help more people than hundreds of doctors do in their lifetimes!

We can only imagine how many more husbands, wives, brothers, sisters, children, and grandchildren would have many more quality years with their loved ones if the professionals and professional organizations were to actually SUPPORT the low-carb approach. And I know you're working on them too! I think that day will come in our lifetimes.

OK, that turned into a long speech. But I've been thinking about these matters a lot since I got past the anger I felt initially after educating myself with information from books like Good Calories, Bad Calories. BTW, I'll be listening to more of your podcasts right after I'm finished writing this.

So, keep up the good work. Hopefully I'll get to go on one of your cruises eventually, but unfortunately I won't be able to make it this year. Phenomenal line-up you've got though, and very reasonably priced as well. Enjoy it.

What can I say to something like that? THANK YOU! I never realized when I decided to start blogging about my experiences on the low-carb lifestyle that my writings and other projects would reach so many people. All I wanted to do was have an outlet for sharing my experiences with this way of eating to show others there is an alternative to the failed low-fat diets that have been shoved down our throats for decades. It is humbling for me to think about the over three million people who have graced my blog over the past three years. I hope to keep this going for as long as the fire is inside of me to write passionately about the transforming power of low-carb living. Right now, that looks like it's gonna be FOREVER! :D THANKS for your support!

Jimmy,

I love your web site and appreciate very much what you are doing. I am just dropping a line to let you know I am a devout follower of yours and am better physically and mentally for it. Please never quit what you're doing for us low-carbers out here. Your impact is tremendous.

I have posted my story along the way on the Active Low-Carber forum. I was chronically obese, adult onset, for over 10 years. I tried dieting with Weight Watchers and on my own versions of a low-fat plan. But it never worked. I had to do something because I was definitely starting to see physical problems compiling.

My family physician--mum on diet plans--suggested I see a psychologist about my weight problem and he has been great. The first visit he had me get a copy of Protein Power. Since that January 2007 visit to him I have lost 125 pounds and counting (330/205/185). My life has improved so much.

I soak in all of your postings, all of the Drs. Eades postings, everything Gary Taubes writes, and whatever else I can find. I feel like I really understand my body now and can keep my weight stabilized without much effort. I have people all the time asking me how I've done it. I say low-carb. Most tell me they could never do it. I say I could no longer eat the way they are now because it was killing me. Anyway, thank you so much again.

Now that's interesting. Your doctor was clueless about what other diet options were out there to put you on, but he recommended a psychologist who said you should try livin' la vida low-carb. HA! That's hilarious. So a mental health doctor is better equipped to help you with your physical health than your own general practitioner?! Unbelievable! Maybe that's why people are losing faith in the medical profession and turning to alternative health sources like psychologists, chiropractors, and even online bloggers like me to give them truth that can help them truly change their lives. Your story is remarkable and probably more indicative of what is actually happening right now in our society. Physicians have let us down, so now we must take back control of our own health.

Hi Jimmy,

Thank you for the wonderful insights and speakers you provide on your blog. I just got through listening to the Berkley talk given by Gary Taubes. Actually, I found you because of him. My sister, who is a writer, is friends with him and told me about his work.

I have really enjoyed your blog and have been living low-carb for a little over a month now. Wow! What a difference! I am so happy that there is somewhere to go that provides insight, cooking tips, and general positive messages.

My husband and I are both eating this way and it has truly opened up an exciting new world. I can't shut up about it and am even chronicling my journey in a book that I am writing. I would love to send it to you when I am finished. This change has been a long time coming, but with all the information out there and my deep desire to make life better, it is a snap judgment. There is no return and that's a good thing.

I love that I have taken away my mode of coping with discomfort (food, sugar, sugar, and lots of carbs) and left myself no other option but to find real solutions. My husband and I both enjoy all the information and tips. (I tell him everything I learn.)

Thanks again and congratulations on Christine's triglycerides.

AWESOME! I look forward to reading that book when the story is completed. :)

Hi Jimmy,

The blogging world sure does take a while to get used to. I have a large number of blogging friends on MySpace and we all blog about weight loss and try and support each other. I am the only one that is living low-carb and I have a few blogging friends who don't like it when I post about low-carb.

One of them posted a blog today called "The Risks of Low Carb." It shocked me since I support all of their different lifestyles and have never posted anything bad about their diets. I was even more shocked when I read what it said. Anyway, to make a long story short I just told her that my lab work shows I am living a healthy lifestyle.

I believe it's healthier to eat a diet that allows me not to have to take my medications rather than eating carbs and have to be on medications all the time to stop the side effects carbs have on my body. It just made me feel so sad for her. She has diabetes and PCOS and I know this lifestyle is what she needs so badly.

What a witness you are for this way of eating and I admire you for standing up for the convictions of your heart about this. I've never understood the abject animosity people have for those of us who are livin' la vida low-carb. Here we are with a diet full of healthy and (GASP!) delicious whole foods like eggs, meats, butter, cream, cheese, nuts, etc. and all they can do is poo-poo it? If somebody wants to eat a low-fat diet, then knock yourself out. You won't find me criticizing you for doing so and I expect the same consideration about the way I eat, too. Remain firm in what you know is right for you and never let anyone convince you otherwise. WAY TO GO!!!

Dear Mr. Moore,

I was on the net today looking for info on Gary Taubes and his new book. I read about him in a magazine and am in absolutely in agreement with his science. The reason why I agree with him is this--I am a 60-year old woman who, when I was 22 or 23, read an article in Time magazine that dispelled the myth of eggs raising the level of cholesterol. At that time, folks were all talking about cholesterol.

A survey for cholesterol was done by some company in America, in which they took a few hundred people and put them on an egg diet. Some folks had one egg a day and the another lot had two, another three and so on up to some having 5 eggs a day. At the end of the survey which I think was done over a year, the amount of cholesterol level that the folks who had 5 eggs a day had risen minimally! There were figures and other proofs but I can't remember them, it was all so long ago.

I was particularly interested in the Time magazine article because my family had a cholesterol problem so it seems with my granddad and my father dying from heart attacks. Anyway I decided at that vain age of 23 that I would go on an egg diet in spite of the family's history and lost several pounds feeling healthier and happier.

Recently, in spite of the Atkins diet being vilified, and me being 28 pounds overweight, after having tried several diets, I reverted to the egg diet and lost those all those pounds within 3 weeks. A month has gone by and now and because of my age, I almost live on eggs and am healthy strong and still enjoying my nursing career.
If you know Gary Taubes email please send him a copy of my email to him. I'm sure he would be really happy to hear about the Time magazine survey of so long ago. Maybe he could pull it out of the archives and say, "There you are, I told you so."

LOL! That's GREAT! You sure are a fireball and I like it. I hope to have at least that much energy and vibrancy when I reach 60 in another quarter century. :) It truly is amazing that low-carb is so well-documented throughout scientific history with studies just like the egg one you noted and yet all we hear about is how Atkins low-carb is just a "fad" that is "dangerous" to your health. Oh really? If it's that bad, then why has it continued to stick around for 150 years if you go all the way back to William Banting's day? Wouldn't we be seeing massive sickness and death of Biblical proportions if low-carb was truly as bad as it has been made out to be? Me thinks these nincompoops protesteth too much! THANKS for your note and I did forward it to Gary Taubes who expressed his sincerest appreciation.

I saw the doctor today and I have GREAT NEWS. Everything went great at my check up!! I got on the scale and it said 266!!!! He looked back in my chart to see my starting weight from when he put me on his low-carb diet and was shocked to see how much weight I had lost!!! 59 pounds to his charts!!! Woohoo!! Woohoo!! Woohooo!!

He is keeping me at 500 mg of Metformin but I don't have to take any others meds!!!! He is a small town doctor here where we live and he told me that in his 30 years of practice he has never had a diabetic patient do so well and change their health around the way I have!!! Another Woohoo!!! He said he wished he could have his other patients follow me around so I could teach them how to do it!!!! LOL! He made my day! I also told him about your blog and he said he was going to look it up!

WOO HOO is right! This is the kind of story that needs to get out there to other doctors who are struggling with knowing what to do for their diabetic patients who keep getting WORSE on their recommended low-fat, low-cholesterol, high-carb diet. Put 'em on low-carb and watch how better they get almost instantaneously. This is what low-carb practitioners like Dr. Mary C. Vernon, Dr. Eric Westman, Dr. Jeffry Gerber, Dr. Keith Berkowitz, and so many more so in their practices on a daily basis. Changed lives because of livin' la vida low-carb. It's something EVERY doctor should know about and use for their patients who have not been successful on the more traditional treatment methods.

Dear Jimmy,

Last summer I was sent to a heart specialist who wanted to put me on statins for high cholesterol. I told him that I wanted to try diet and exercise. I followed a low-fat, high-carb diet dutifully for four months and lost 50 pounds. I was so excited to go in and get my cholesterol checked. I was stricken and dumbfounded when total cholesterol improved only marginally and HDL dropped and triglycerides rose.

It has taken since September 2007 for me to read and talk to enough people to finally get to the truth of the matter. I have been re-reading Atkins, Taubes, and other resources recently to figure this thing out. I have been following Atkins imperfectly for the past several months. I say imperfectly because following a non-traditional way of eating requires some very intense faith. My logic and emotions say that Atkins is great. My traditional Food Pyramid, clean your plate upbringing tells me to run to the nearest bag of carrots. With the help of the nurse today and my great HDL reading (85) and low triglycerides (78), the high-fat message has finally sunk in.

Total cholesterol 264
HDL 85
LDL 164
Triglycerides 78

All of those readings are better than my August test after two and a half months of the low-fat program, especially, the two most important indicators of heart health HDL and triglycerides. The nurse was definitely in agreement with a high-fat, low-carb diet. She told me she had been cautioned twice against this by her superiors and asked me not to mention our conversation to anyone. This is a big hospital with a huge pharmaceutical component.

Thanks so much for everything.

Now that's so scary! Here you have a nurse who "gets it" and has to engage in a covert low-carb mission to help patients like you get better. Why does a nurse who doesn't have nearly the amount of education and experience of a doctor (okay, maybe the experience, but not the book knowledge!) know more about healthy nutrition than a trained, professional doctor? What is WRONG with this picture? Frankly, I'm surprised they didn't give you a hard time about your LDL cholesterol being 164 and total cholesterol being 264. My own doctor freaked out with similar number and I haven't even shown him my recent 326 total cholesterol yet. He'd faint if he saw it! Keep fighting the good fight, my friend. You're doing super!

Do YOU have a story of low-carb success you'd like to share with me? I'd LOVE hearing from you, so don't be a stranger. Send me an e-mail with your fabulous low-carb results anytime at livinlowcarbman@charter.net. THANK YOU for being such a beacon of light in my life and giving me the motivation to keep doing what I'm doing for the sake of livin' la vida low-carb. The truth WILL prevail if we keep sharing it with a world full of people who feel so hopeless and helpless about what to do about their weight and health. God bless you guys!

My Total Cholesterol Is 326 And Why I Don't Need To Take Lipitor Or Crestor To Lower It

Of all the blatant lies we have been told about our health over the years, there is one that sticks out as the most egregious of them all because it has failed to be proven by any reputable science or through human experience. And yet millions upon millions of Americans are currently taking a prescription medication for this condition because that's what their doctor told them they needed to do to prevent the risk of heart disease. I'm of course referring to the cholesterol hypothesis.

We've all heard it throughout our lifetime that you better keep your cholesterol below 200 if you want to keep from having clogged arteries which could lead to a heart attack, stroke, or worse. These warnings have come from well-meaning physicians, dietitians, and other so-called health "experts" who are simply regurgitating what they have been taught in medical school, personal training, and from other sources.

One of those "other sources" of information are pharmaceutical companies which stand to profit greatly from a trumped-up condition that they can swoop in and come to the rescue of people with a susceptibility for atherosclerosis with a miracle pill. That's exactly what Pfizer has done marketing Lipitor, Astra-Zeneca with Crestor, and Merck/Schering-Plough with Zetia. These prescription medications are meant to treat "high cholesterol," but has anyone stopped to ask the obvious question that is that gigantic elephant in the room?

WHAT IS THE PROOF THAT HIGH CHOLESTEROL LEADS TO HEART DISEASE?

Surely you jest, Jimmy! Everyone KNOWS that you put yourself at risk when you allow your cholesterol, especially that dastardly LDL "bad" cholesterol, to rise above 200. Anyone who refuses to take a statin drug when their total cholesterol rises above this level is simply putting themselves at severe risk for some rather serious health consequences down the road. Why not just take your medicine like the rest of us are doing and put yourself out of harm's way?

You'd be surprised how many people feel EXACTLY like that. We've been so cleverly sold a bill of goods about cholesterol that it's almost sacrilegious to even suggest a contrary point of view without being looked at like you're some kind of space alien. Of course, those of us who are livin' la vida low-carb are already used to this kind of scrutiny, so what else is new? That said, what is the harm in taking a pill that supposedly will do you some good?

Well, there's PLENTY of harm that can happen. Although cholesterol numbers have come way down from where they once were, what is the cost to our health that these reductions have produced. In my podcast interview with Dr. Jim LaValle last week, he said that if you put 250 people in a room and put them all on a statin drug and just ONE of them reduced their risk of heart disease as a result of this therapy, the pharmaceutical companies believe that is good enough to put the pill on the market for the masses. But what about those other 249 people? What is the impact of a statin drug on THEIR health?!

Let's just be honest for a moment. Cholesterol drugs are about nothing more than one thing and one thing alone: MONEY! If there was no money to be had in reducing cholesterol numbers, then all this hoopla over cholesterol would never even exist. The fact is battling "high cholesterol" is big business and anything that stands in the way of that multi-BILLION dollar profit machine will be run over with a proverbial Mack truck! If word got out that livin' la vida low-carb did more to improve your risk of heart disease than statin drugs, then there would be a lot of unhappy pharmaceutical reps who have made a healthy living selling the facade that "high cholesterol" will kill you.

Let's talk about the pharmaceutical reps for a moment. Who died and made them the great purveyors of health knowledge in the United States? I understand doctors are limited on their time and ability to continue their education into the latest research that comes out about health. But why do the pharmaceutical companies get a free pass to waltz right into see my doctor--sometimes as many as six blaze in and out while I'm there--to explain about their new wonder drug for every ailment known to mankind? Can I have the same sort of privileges to go from doctor's office to doctor's office to give a presentation about the latest scientific evidence supporting a controlled-carb approach on weight and health? I think you know the answer.

So that's the system we're stuck with for now. Doctors go to medical school where they receive a grand total of maybe one week of nutritional education (two if they're lucky!) and then are forced to rely on highly-paid drug company representatives to give them "unbiased" reporting on what they need to be giving their patients for high blood pressure, obesity, and high cholesterol. It's the way we've always done it, so I guess we had better get used to it, right?

Not me. When I decided to go on the Atkins diet in 2004, I was sick and tired (literally!) of settling for the conventional wisdom for what constituted a "healthy" diet and instead chose a way of eating that would help me go on to shed 180 pounds. At the time when I still weighed over 400 pounds, I was taking Crestor after a very painful stint on Lipitor to control my "high cholesterol" which was around 250 at the time. They had me so scared of NOT taking this statin that I felt like it was my only option despite the agonizing pain these drugs have been shown to cause in more users than they even realize.

Nine months later after losing about 140 pounds, I decided to come off of statin drugs for good. And I've refused to take another one since because low-carb has worked better to make me healthier than I ever thought possible. And yet those boo birds in my head kept making a lot of noise in 2006 when I visited my doctor for a routine physical check-up. As soon as my doctor said I needed the "s" word again, I just about screamed! When I politely told him I would NOT be going back on Lipitor or Crestor again, he said he'd give me four months to lower my LDL down from 170 or else he would insist I take it.

When I presented this conundrum to my blog readers at the time, the general consensus was to avoid statins which I then began educating myself more about and learned why LDL and total cholesterol probably aren't as big a deal as they have been made out to be. I learned from people like Dr. Jeff Volek that low-carb cholesterol concerns are unnecessary because the reality is that the HDL/triglyceride ratio is a much better marker for heart health than LDL and total cholesterol. And guess what raises HDL and lowers triglycerides significantly? Yep, it's low-carb, baby! And a low-fat, high-carb diet does just the opposite according to the latest research. DUH!

Once you break through literally years of cholesterol indoctrination and instead challenge those who support the cholesterol hypothesis to prove having "high cholesterol" is unhealthy, then you are then ready to understand that there's more to it than simple terms like "good" and "bad" cholesterol. The particle size of LDL is the BETTER way to determine if that cholesterol number you see is harmful or protective. The large, fluffy LDL are protective while the small, dense LDL particle size is what you need to be wary of. You can check out the particle size of your cholesterol by having a VAP test done or something similar that would give you the breakdown of these cholesterol subsets. It's not as simple as LDL and total cholesterol anymore.

Oh, by the way, do any of these geniuses who put patients on a statin drug also recommend that they take a CoQ10 supplement since this is DEPLETED FROM YOUR BODY when you take one of these drugs? Hmmmm, I guess they just forgot to tell you that! OOPS! Or how about this study which found that having too LOW cholesterol levels leads to depression, suicide, and death? I guess that one slipped their minds, too! Double OOPS! But let's also not forget the evidence that statins can lead to some vivid and vicious nightmares as well. Better make that a triple OOPS!

One of my readers frantically wrote to me an urgent message about their recent trip to the doctor and her diagnosis of "high cholesterol." Here's what she wrote:

Hi Jimmy,

I have been doing Atkins since April 2007 and have lost 40 pounds. I just recently went to my doctor and had some blood work done. I received the results and it came back that my cholesterol is too high. My LDL is around 250, my HDL is around 54 and my total cholesterol is at 300.

I don't know what to do!! My doctor prescribed me Crestor, but I have heard awful things about it. What do you think I should do? I have been eating lean meats, fish and veggies and staying away from excessive salt intake. I don't want to stop doing low-carb. Oh and I am exercising too! I appreciate any help or advice you can give me!!

I'm so glad she wrote to me because she is EXACTLY who I wanted this blog post to be for. She has been sold that bill of goods that her cholesterol is too high and the ONLY answer she has to this grave problem they have presented to her is to take a statin drug. Gee, imagine that! Sure didn't see that one coming!

Let me just say that her HDL of 54 is great and I would be willing to bet her triglycerides are below 100. Dr. Mary C. Vernon has said that one of the surefire ways of knowing someone is low-carbing correctly is their HDL is above 50 and their triglycerides are under 100. If that's the case, then her HDL/triglyceride ratio is FABULOUS and she really has nothing to worry about.

But what about the LDL and total cholesterol? Are they really irrelevant? Well, without seeing the results of her particle size test (which I don't know if they ran or not), it's impossible to know if she's at risk with those numbers. But I do happen to know someone with similar numbers who did have a particle size test done recently--ME!

You'll recall I went to see a low-carb doctor last month about my recent mysterious 30-pound weight gain and he ran my lipid profile numbers for me. When the results came back, they would no doubt be a bit stunning to someone who looks at cholesterol in a traditional way:

Total Cholesterol - 326
Total LDL - 246
Total HDL - 65
Triglycerides - 77
Insulin - 5.8

Yes, my total cholesterol is 326 and hopefully now you know why I don't need to take a statin drug like Lipitor or Crestor to lower it. Check out my HDL/triglyceride ratio. It's virtually 1-1 and that's FANTASTIC! Note that my HDL is above 50 and my triglycerides are below 100--a sign that I'm livin' la vida low-carb 100% right despite my weight gain. So what's up with the LDL? Is the particle size where it needs to be?

The answer is YES! My doctor said that when he analyzed the LDL subset breakdown, he saw a clear majority of the LDL was the large, fluffy kind that you want to protect against cardiovascular problems and very few if any of the small, dense kind. So, despite my astronomical LDL number, it's a non-factor. And neither is the total cholesterol. Keep in mind my HDL "good" cholesterol is high like it needs to be, so that contributes to the total number, too.

So if you've been to the doctor after being on a low-carb diet and you see numbers similar to mine and my reader's cholesterol, don't panic! Get your particle size so you can be armed with the facts about what to do in response. "High cholesterol" is a gimmick to sell more dangerous statin drugs to people who could stand to benefit from the healthy low-carb lifestyle. I'd never tell you what to do for YOUR health--that's YOUR decision. But one thing is for certain. I'm NEVER gonna take a statin drug again!

And I don't have to because I'm livin' la vida low-carb!

My Wife Christine: The Perfect Example Of Why Low-Carb Isn't Just About Weight Loss

How can this beautiful face be anything but healthy?

When most people talk about the low-carb lifestyle, the subject usually centers around weight loss. And naturally so! After all, books like Dr. Atkins' New Diet Revolution, which totally changed my life forever for the better in 2004 when I lost a total of 180 pounds that year, are marketed as "diet" books. And bookstore shelves are absolutely LOADED with author after author touting this plan and that plan to help you lose the blubber.

But when we talk about "diet" in the full context of what that word really means, we're not just referring to weight loss. The simplest definition of a "diet" in my mind refers to "the way you eat." That's it! So, for people on any of the various low-carb diets like Atkins, Protein Power, South Beach, or The Zone, for example, the focus is on the mechanism that happens inside the body when you reduce your carbohydrate intake. And that is what produces the ever-elusive weight loss.

Yes, eating low-carb does indeed result in some rather spectacular weight loss. But the thing that amazed me more than anything about livin' la vida low-carb when I first started on it were the massive improvements in my health. I was taking prescription medications for high cholesterol, high blood pressure, and breathing problems. Within nine months of my low-carb way of eating, I no longer needed those prescription drugs. And I've never taken another pill from a pharmacist since.

People e-mail me all the time wanting to know why they haven't lost weight on low-carb because the scale hasn't moved as fast as they were hoping. My response back to them is usually to remind them that at least they are losing weight and that their first and foremost priority when livin' la vida low-carb is NOT weight loss, but rather it should be their health. This is perhaps the most overlooked aspect of the low-carb life that is simply ignored by people who don't think it's necessarily something they need for their life.

Take, for example, a normal weight person. Most people would look at that individual and conclude that a low-carb diet is unnecessary for them because they're not overweight or obese and, thus, are healthy, right? Welllllll, not necessarily. And the same goes for an overweight or obese person. Just because they are carrying around a few extra pounds doesn't automatically mean they are unhealthy. Of course, the extra weight can lead to health issues in the long run, but it's not a perfect indicator of current health problems.

With that said, I wanted to share with you some rather startling results from a recent physical that my dear wife Christine had at her doctor. She started on a reduced-carb dietary approach about a year ago after her triglycerides had risen to a slightly-elevated 250. Her HDL was over 50 at the time and her LDL was over 140. Of course, the doctor was very concerned about this and wanted to put her on Lipitor, but her husband (that's me!) advised against it. That's why we tried low-carb for her.

In just a few short months, Christine dropped 35 pounds and was feeling a lot better by quitting sugary sodas and eating less carbohydrates than she was. Keep in mind that she has a much higher carb tolerance than I do. I have to keep my carbs below 50g daily or I gain weight whereas Christine can eat around 150g before weight starts to creep up on her. It's the difference in our metabolism and I'm cool with it (although watching her get away with eating more carbs is a bit frustrating...but I get over it!).

Since she got her weight back down by livin' la vida low-carb, Christine has allowed a few bad habits to creep back into her diet again--eating French fries (one of her favorite foods!) when we eat out, having breaded meats, eating sandwiches with the bun, and eating her favoritest candy in the whole widey-widey world--M&M's! Yes, old habits are hard to break, but as long as her weight was in check there wasn't a reason to panic.

Or was there.

Today we got the results of her blood work and one number stuck out like a sore thumb among all the others--HER TRIGLYCERIDES!!! While Christine's HDL rose slightly to 58 and her LDL plummeted to 94 without the use of that statin drug her doctor wanted to put her on, her triglycerides actually ROSE to 293. HOLY COW!!! Needless to say, she was quite upset by this and couldn't understand why her cholesterol improved, but her triglycerides didn't. And here's the crux of why I decided to write this blog post.

Christine is the perfect example of why low-carb isn't just about weight loss. Despite all her best efforts to reduce her sugar and carbohydrate intake from the levels she used to eat and the weight loss success she experienced as a result of doing that, her health in the form of her triglycerides did not see a benefit. Sure, her lipid profile was a positive, but what happened with her triglycerides?

It's perplexing that Christine's HDL would go up, LDL would go down, but triglycerides would simultaneously rise. Dr. Mary C. Vernon has said that a rise in HDL above 50 and a reduction in triglycerides below 100 is a sure-fire way of knowing if someone is truly following a low-carb diet or not. If not, then you can tell if someone is eating something they shouldn't.

And the studies are clear: a high-carb diet lowers HDL and raises triglycerides and your HDL/triglyceride ratio is a better indicator of heart health risks than total cholesterol and LDL. University of Connecticut researcher Dr. Jeff Volek found in one of his studies that triglycerides are cut in half when following a very high-fat (85 percent), low-carb program.

Christine is looking at an anomaly of sorts. On the one hand, her cholesterol numbers are fabulous and keep her from ever having to consider the "s" word to lower them (not that she would!). But on the other hand, now her doctor wants to put her on a risky prescription drug called Lovaza to bring her triglycerides down. Christine got a big bag full of samples for her to try (HOO BOY!) and I am always curious to read the fine print about these wonder drugs.

Check out these disclaimers for Lovaza:

Before you take LOVAZA you should take these steps to control your very high triglyceride levels: modify your diet (YA THINK?!), lose weight if you are overweight, increase exercise and reduce alcohol use. Treatment with LOVAZA has not been shown to prevent heart attacks or strokes (EEEEEK! Then why would you want to take this drug in the first place?!). Burping, infection, flu-like symptoms, upset stomach, a change in your sense of taste, back pain and skin rash are LOVAZA’s most common side effects, but there are others.

Oh, is that all? Sheeez! Reading off all these potential side effects of medications designed to help improve your health is enough to make me nauseous (do they make a pill for THAT?!). As someone who has suffered with the negative side effects of statin drugs, if I can find a way to "modify" my diet to lower my triglycerides, then I will. And that's what we're gonna try with Christine instead of Lovaza.

Starting right now, she is on a strict low-carb diet. No more French fries, breaded chicken sandwiches, or M&Ms until we can get the triglycerides down (and hopefully after that, too!). It's not a weight loss thing...it's a HEALTH thing! And Christine now realizes that her lack of weight gain gave her a false sense of comfort with the way she was eating. How many others are walking around out there thinking they're okay when very clearly they are not? That's the question we should be asking about rather than what diet is good for weight loss.

Christine will go meet with a dietitian on Friday afternoon and I'll be sitting in the room with her during this conversation. We're bracing for the low-fat lecture, but I was encouraged to see on her chart that a 1600-2000 calorie diet consisting of low-glycemic foods with 35 percent fat was recommended alongside a moderate exercise routine. Considering her fasting insulin levels were also slightly elevated, this may be a plan for success. I'll be anxious to hear straight from the horse's mouth on Friday what she thinks about Christine's condition and hopefully it won't have anything to do with taking prescriptions of any kind.

We'll be meeting some of the best and brightest minds in the world of low-carb research next month in Phoenix, Arizona for a Nutrition & Metabolism symposium, so you bet we'll be asking them for their opinion about what Christine should do henceforth. But I open the floor to you my readers to share your comments about this and any personal or professional experience with what Christine is going through. I'm just surprised her cholesterol improved so much and her triglycerides did not. Any thoughts?

Cholesterol Confusion And Concerns Continue

One thing I have noticed about writing here at my blog is that previous topics I have already addressed have a peculiar way of coming back around again and again as more and more new people suddenly discover this site for the very first time. If that's YOU, then let me officially welcome you to "Livin' La Vida Low-Carb." Feel free to browse through the archives in the lower right-hand side of the page to access the more than 1,600 blog posts I have written.

I certainly don't mind covering an issue over and over again as long as people are still asking the questions that they are most concerned about. Today I received a question from a concerned e-mailer that I am sure is on the minds of many people who are either on a low-carb diet for the very first time or are thinking about it. It's about cholesterol.

With the widespread prevalance of cholesterol-lowering prescription drugs such as Lipitor, Crestor, and Zetia (with that commercial featuring the fat female television cooking show host who is utterly annoying!), people have come to fear their cholesterol numbers like never before. Oh my gosh, am I gonna die if my cholesterol goes up above 200?! As absurd as that may sound to those of us who have educated ourselves about the cholesterol lie that exists, you have to realize that a great majority of people totally freak out when they perceive they have "high" cholesterol.

Here's the frantic e-mail I received from a new low-carber about her cholesterol:

Hello! I am in my second month of a low-carb diet. I am following a modified version of South Beach. To date, I have lost 14 pounds already and was feeling great...until this week. I had a physical and got my blood work done and the results were scary. My cholesterol is sky high:

Total -- 301 (yes 301!)
HDL -- 83
LDL -- 148
Triglycerides -- 62

Now I am afraid to continue on with my low-carb diet. My doctor only states that she "Does not trust the lab results....this profile does not make sense." Boy that really scares me to hear her say she is not trusting the results. Anyways, now I fear I'm gonna have a heart attack or stroke. Do you have any insight about this? It would be greatly appreciated.

Because this e-mailer is expressing a lot of issues that I believe may be on the hearts and minds of many other brand new low-carbers or potential ones, I'd like to share with you my thorough e-mail response including pertinent links to articles I have written about this subject before. Hopefully this will shed some light on the cholesterol issue and clear up the confusion and concern that apparently continues in the minds of many.

This was my response:

THANK YOU so much for writing to me today. CONGRATULATIONS on making livin' la vida low-carb your permanent lifestyle choice and I'm happy to address your cholesterol concerns.

First, let me calm your fears and ask you to try to relax about your blood test results. We have been conditioned by the medical establishment to assume certain things as it relates to health indicators (namely cholesterol) that people get in a tizzy when the numbers fall outside of the so-called "normal" parameters.

This may surprise you, but your lipid profile isn't all that different from mine actually. And it was about this time last year that I had many of the same feelings you did regarding my supposedly "high" cholesterol numbers. Check out just a few of the posts I wrote about it at the time:

"Cholesterol Conundrum: Do I Statin Or Not?"
"Doctor Gives Me Four Months To Get LDL Down"
"Consensus On Cholesterol Is Avoid Statins"
"My Cholesterol Craziness Continues"
"Lowering Cholesterol Through Better Choices"

Since I wrote all of those posts, I have become much more educated about cholesterol numbers for people who are on a low-carb diet. They should be measured quite differently than the traditional tests administered to people eating a high-carb diet. Respected physician and low-carb expert Dr. Mary C. Vernon has said that when your triglycerides are below 100 (as yours are), then your LDL numbers are not going to be accurate.

Dr. Vernon also added that elevated HDL (which you have and that's a VERY GOOD sign you are doing the diet correctly) and total cholesterol can happen "because intermediate density lipoproteins are being measured as LDLs." In other words, some of what is being measured as LDL is actually a false positive that could be LDL or could be HDL. It distorts the entire picture.

All the latest research is pointing to low-carb benefitting cholesterol greatly, that high LDL can be good, low HDL can be bad for heart disease risk, that the triglyceride/HDL ratio is what is most important, and that HDL and triglycerides are better markers for cardiovascular risk than LDL and total cholesterol.

Those are the cold hard facts directly from the latest research!

In fact, coming up this Tuesday afternoon there will be a HUGE study that will shock the world of diet and health set to be published in a major medical journal about how low-carb diets have been found to be just as good or better on all the health indicators than high-carb, low-fat diets, including on cholesterol number. Be sure to look for my post about it then!

Also, if you haven't yet picked up a copy of Anthony Colpo's "The Great Cholesterol Con," then it is well worth the time to read all the research this Australian man has compiled about the truth regarding cholesterol. I also was able to interview him last year just before he released his book.

Are you starting to feel a little better now? I sure hope so. Like I said earlier, we have been so conditioned to worry about issues that really have no negative bearing on our health whatsoever and cholesterol is one of them. That's not to say you can't have cholesterol problems when you are on a low-carb diet, but it looks from your numbers like you are doing AWESOME with your blood test results. Your triglyceride/HDL ratio is an astonishing 0.75 (that's better than my 0.83)!

Be proud of what you are doing and confident that you are living a healthier life than you ever have before. THANKS again for writing and please feel free to contact me anytime! Take care!

Does anyone else have a thought, comment, or question to share about this issue?

3-5-07 UPDATE: One of my "lurking" readers who doesn't even have a Google or Blogger account sent me the following e-mail because she just HAD to share her appreciation for what I wrote in this post.

Hi Jimmy:

I wanted to thank you for posting this entry. I am one of those like you described who just believed everything about high cholesterol. I have to admit that while I have done the Atkins diet before, and it worked BRILLIANTLY for me, I have about 15 more pounds I wish I could lose but was a little concerned about doing it again because of the "high" cholesterol talk.

I know Atkins works and I know that those in the media who try to say it doesn't work or doctors who try to say it doesn't work and that it is bad for you for all kinds of reasons (not just cholesterol) have NO idea what they are talking about. It DOES work and I've actually never been healthier.

I get the feeling that many of these people have never read Dr. Atkins' books and just go around stating that if you eat a pound of bacon every day, you'll do your health bad. I don't quite recall ever reading that you can eat a pound of bacon in those books.

You may wonder how I could have read his books and know firsthand that those who speak poorly about the low-carb diet were wrong. Nevertheless, I fell into the trap of believing all the hype about cholesterol. Why did I do this to myself? That's a very good question.

So, let me say thank you. I appreciate that you put this issue out there and all the information you provide for us to read and educate ourselves. Not only have you done great for yourself, you DO make a difference for other people out there.

How about my feelings regarding the Atkins diet and my concerns over cholesterol now? I think I will start the Atkins diet again and lose that final 15 pounds that just will not come off any other way. I can exercise until I'm ready to pass out and I can try low-fat, low-this, low-that...but the only thing that works for me is low-carb.

Thank God for Dr. Atkins (and may he rest in peace), and thank you, Jimmy, for not being afraid to fight against the untruths while keeping us all informed.

Anyway, I'll go back to lurking now, but this entry just needed to be commented on. You've done a wonderful thing by writing it. Have a great week!

WOW, this is AWESOME! THANK YOU for writing this comment because it started off my week on the right foot. I'm always happy to share my experiences with my readers so that others can benefit from the truths I have learned. Keep up the fight and never give up! Take care! :)