Cholesterol - getting into the detail

Why choose low carb to improve your cholesterol?

In almost all situations where there is weight loss, there is generally an improvement in cholesterol profiles.

Many people have already tried multiple, low fat, calorie restricted diets over their lifetime and have struggled to lose and maintain weight loss over the years.
We find that a low carb lifestyle is a new approach for people to try and that it appears easier to maintain in the long term.

Thus, the longer a lifestyle can be maintained, the better the long-term outcome is likely to be. Protein and fat are known to keep us fuller for longer, reducing our appetites and alleviating hunger pangs, and also help to regulate blood sugar levels.

The Freshwell Low Carb Programme takes a holistic approach to improving your metabolic health. This means it goes beyond just cholesterol and aims to positively impact other interconnected factors like weight, blood sugar control, and blood pressure. By addressing these areas together, the programme provides a comprehensive strategy for overall well-being.

Reducing other markers such as blood sugar, weight and blood pressure will all contribute overall towards a reduced risk of heart disease rather than just addressing cholesterol alone.

The Freshwell Low Carb Programme allows you to personalise your approach based on your preferences and lifestyle. It aligns with the NHS Personalised Care Institute's recommendations for offering patients options that suit them best.

The Women’s Health Initiative Randomized Controlled Dietary Modification Trial followed up 28,024 women over a 21.4 year period and looked at which factors predicted the greatest risk for these women to develop heart disease over that time. The diagram below summarises the findings.

A “hazard ratio” refers to the increased (or decreased) risk associated with each factor. So, for example, in this table, having type 2 diabetes has a hazard ratio of 10.71, which, according to these numbers means that having type 2 diabetes meant that these women were more than ten times more likely to develop heart disease than those who didn’t have it. [Reference].

“Metabolic Syndrome” is calculated using waist circumference, fasting blood sugar, blood pressure, triglycerides, and HDL. These numbers almost invariably improve on a low carb lifestyle. Patients with metabolic syndrome were over six times more likely to develop heart disease.

Whilst the effect of a low carb lifestyle on LDL cholesterol is less predictable, the hazard ratio is 1.38. This means that it is much less important as a risk factor com in comparison to those of having type 2 diabetes, metabolic syndrome, hypertension (high blood pressure), obesity and triglycerides – which can all be effectively improved with a low carb lifestyle.

History of the diet-heart hypothesis

Since the 1950s, most of the medical world have focused on something called the Diet-Heart Hypothesis which essentially states that if you eat too much food containing cholesterol and saturated fat, the level of cholesterol in your blood will rise and the excess will be stored in your artery walls causing them to thicken and narrow, eventually blocking off the blood supply causing a heart attack or stroke.

The hypothesis was based on weak observational evidence [reference]. Despite numerous clinical trials attempting to confirm this theory, no causal relationship was ever established. However, some findings were largely overlooked for many years until journalists revisited the issue about a decade ago [reference]. Since then, nutrition researchers have reanalysed the data, leading to the publication of over 20 review papers. These reviews largely conclude that saturated fats do not influence cardiovascular disease, cardiovascular mortality, or overall mortality.

At medical school, we are taught about the "French Paradox". The French traditionally consume a diet high in fat, but have a low number of people dying from heart disease. This did not fit with the diet-heart hypothesis. The wine producers were quick to claim that it must have been the French wine that protected French people from heart disease! More likely though, was that the high fat intake of the French did not cause heart disease because a high fat intake does not cause heart disease.

Saturated / unsaturated fats

Saturated fat is found in higher percentages in foods such as red meat, dairy and coconut oil. But what people often don’t realise that a lot of processed foods contain saturated fats, it is just that it is more obvious in real foods and more hidden in processed foods – leading to a false image of real foods becoming ‘risky’. A real food approach, and reduction of the highly palatable processed foods, many sources of saturated fat will naturally be reduced e.g. biscuits, cakes, pastries, chocolate confectionary, ice-cream, pies, and some savoury snacks.

Over the last few decades, saturated fat has been particularly vilified in dietary guidelines as something that increases your cholesterol and therefore causes heart disease.

However mainstream, the evidence for this very controversial. More and more evidence is emerging that saturated fat is not bad for you at all. Authors of articles in prominent medical journals are arguing that guidelines on restricting saturated fats should be lifted. [reference].

Monounsaturated fat is found particularly in oily fish, avocados, and olive oil. There does at least seem to be general agreement that monounsaturated fats are fine to eat and are likely to be good for you.

Polyunsaturated fat can be found naturally, for example, in nuts. Vegetable oils also known as “seed oils” such as rapeseed, sunflower and corn oil tend to have a higher percentage of polyunsaturated fat in them. This type of vegetable oil has been promoted as "heart healthy", though the evidence for this is highly questionable. Many of these vegetable / seed oils can only be industrially extracted by grinding, pressing, adding solvent, extracting the oil, adding an alkali, centrifuging, adding water, centrifuging again, removing soapy water, deodorising and bleaching. These oils can oxidise and produce toxins when heated - a process which is often repeated several times in fast food deep fryers. We are concerned the ultra-processed nature of most of these oils though “cold pressed” minimally processed varieties of these are probably ok to eat.

Whilst everybody likes to simplify things, in reality, fat found in nature tends to be a mix of all of the above types of fat. For example, the fat in beef is about 50% saturated, 45% monounsaturated and 5% polyunsaturated. Whereas olive oil is about 14% saturated 73% monounsaturated and 11% polyunsaturated. It’s interesting to think that there is more saturated fat in two tablespoons of olive oil than there is in a standard pork chop.