More on this book
Community
Kindle Notes & Highlights
by
Jonny Bowden
Read between
September 20 - October 11, 2024
Understanding insulin resistance—and how to prevent, treat, and even reverse it—is one of the most important things you can do if you want to prevent heart disease.
Most doctors don’t know this. Even worse, most are still prescribing powerful drugs for a condition known as “high cholesterol” that is a lab test, not a disease, and—to add insult to injury—is being measured in an antiquated way.
doctors are prescribing powerful drugs—statins—based almost entirely on the readout from a test that should have been dumped in the dustbin of out-of-date medical ideas a long time ago.
Problematic blood measurements, such as high blood sugar, are actually markers of dysfunction that show up fairly late in the game. By the time these traditional red flags show up on your annual blood test, you could already be well on the road to pre-diabetes. And remember, pre-diabetes is diabetes; it’s just not official yet. And diabetes is pre-heart disease. You cannot ignore the early warning signs of diabetes, and unfortunately, most doctors only look for the ones that show up after the damage has already started.
Insulin resistance syndrome more than doubles the risk of diabetes, which in turn more than doubles the risk of dying of heart disease or stroke.
If this book has one single, actionable takeaway, it’s this: Get tested for insulin resistance.
Both of us—with more than eighty years of combined experience in the health field—have firmly and independently concluded that it’s not just what you eat and how you exercise that determines your health, though those things certainly matter. But it’s also how you love, how you think, how you feel, how you digest, how you manage stress, how you contribute, how you sleep, how you kick back and relax, how you meditate, how you contemplate, and how you play. They are all related.
We believe that misinformation, scientifically questionable studies, and corporate greed have created one of the most indestructible and damaging myths in medical history: that cholesterol causes heart disease and that statins are the answer.
The real tragedy is that by putting all of our attention on cholesterol, we’ve virtually ignored the real causes of heart disease: inflammation, oxidation, sugar, and stress.
guidelines warn us to limit the amount of cholesterol we eat, despite the fact that for at least 95 percent of the population, cholesterol in the diet has virtually no effect on cholesterol in the blood.
When it comes to gaining and losing weight, it’s hormones—even more than calories—that control the show. And hormones are controlled by food.
Study after study on high-protein, low-carb diets—including those rich in saturated fat—showed that the blood tests of people on these diets were similar to Al’s. Their health actually improved on these diets. Triglycerides went down. Other measures that indicated heart disease risk also improved.
Study after study has shown that lowering the risk for heart disease has very little to do with lowering cholesterol. And more and more studies reports were coming out demonstrating that the real initiators of damage in the arteries were oxidation and inflammation. These factors, along with sugar and, were clearly what aged the human body the most. These were the culprits we should be focused on.
biochemist George Mann, M.D., of Vanderbilt University, who participated in the development of the world-famous Framingham Heart Study, later described the cholesterol-as-an-indicator-of-heart-disease hypothesis as “the greatest scam ever perpetrated on the American public.”
Cholesterol plays a big role in helping fight bacteria and infections. A study that included 100,000 healthy participants in San Francisco over a fifteen-year period found that those with low cholesterol values were much more likely to be admitted to hospitals with infectious diseases.
it remains true that lowering cholesterol has a very limited benefit in populations other than middle-aged men with a history of heart disease. Yet doctors continue to prescribe statin drugs for women and the elderly, and, shockingly, many are arguing for treating children with statins as well.
Statin drugs are anti-inflammatory, and their power to reduce inflammation is much more important than their ability to lower cholesterol. But we can lower inflammation (and the risk for heart disease) with natural supplements, a better diet, and lifestyle changes such as managing stress. Best of all, none of these come with the growing laundry list of troubling symptoms and side effects associated with statin drugs and cholesterol lowering.
The inconvenient fact that lowering cholesterol has almost no effect on extending life is simply ignored by the special interests that profit enormously from keeping you in the dark. As the writer Upton Sinclair said, “It is very difficult to get a man to understand something, when his salary depends upon his not understanding it.”
when the National Cholesterol Education Program lowered the “optimal” cholesterol levels in 2004, eight out of nine people on the panel had financial ties to the pharmaceutical industry, most of them to the manufacturers of cholesterol-lowering drugs who would subsequently reap immediate benefits from these same recommendations.
There’s also a good deal of confirmation bias in research as well-people frequently find what they look for and find what they expect to find, paying close attention to any correlations that support their hypothesis and throwing out the many that don’t.
It turned out that not only was there no advantage to replacing saturated fat with vegetable oil, there was a distinct disadvantage, particularly if you were over sixty-five. Vegetable oil lowered cholesterol just fine—which was what everybody thought would happen. What vegetable oil didn’t do was save lives. In fact, in people over sixty-five, there was a distinct trend, and not at all in the direction that was expected: Those who lowered their cholesterol the most had the highest risk of dying.
“Available evidence from randomized controlled trials shows that replacement of saturated fat with linoleic acid effectively lowers serum cholesterol—but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease”
At this point in our knowledge of heart disease, inflammatory markers, cholesterol fractionization, and genetic markers, the “good” and “bad” cholesterol test is no more useful in predicting outcomes than this month’s horoscope.
The first and most important thing you need to know about cholesterol is that it cannot travel unaccompanied in the bloodstream. The second thing worth knowing is the astonishing fact that most conventional doctors do not know this.
Cholesterol always has to be contained in a protective structure—the protective container that the body uses to safely transport cholesterol is called a lipoprotein (as in “high-density lipoprotein”—HDL—and “low-density lipoprotein”—LDL.) We colloquially call these lipoproteins “cholesterol” but in fact, cholesterol is only a portion of the cargo these lipoprotein “boats” carry around the bloodstream. (For example, lipoproteins also carry triglycerides and protein.)
If you’re wondering how to lower your triglycerides, it’s the easiest thing in the world: They drop like a rock on low-carb diets.
The ratio of triglycerides to HDL is one of the best predictors of both heart disease and insulin resistance (see chapter 9). People with a high triglyceride to HDL ratio have a 16x greater risk of heart disease. That’s a 1600 percent increase!
You want your triglycerides to HDL ratio to be around 2 or less (i.e., 100 triglycerides, 50 HDL). A ratio of 5 (example: 200: 40) increases your risk for cardiovascular events significantly. A ratio of 2 (or less) is wonderful. In other words, if your triglycerides were 100 and your HDL was 50, you’d have the lowest statistical risk for a heart attack.
The state-of-the-art test for cholesterol, as of this writing, is the NMR particle test, also known as the NMR Lipo-Profile. This test doesn’t just tell you how much “HDL” and “LDL” you have, it tells you what kind of LDL you have, and, most importantly, how many boats are in the water carrying around cholesterol cargo. These boats—the lipoproteins—are technically called particles, and the NMR test tells you your total number of them. Now that’s important. The total number of particles predicts heart disease many times better than simply knowing how much LDL you have.
The point is that—given the extraordinary range of measurement tools we now have at our disposal to measure the intricacies of blood lipid levels—it is head-shakingly baffling that doctors continue to hold on to a test invented in the 1960s that’s about as accurate as a tongue depressor.
The process of atherosclerosis always—100 percent of the time—starts with a penetration of the (damaged) artery wall by a rogue lipoprotein. Many things, such as high blood pressure or cigarette smoke, may weaken and damage that artery wall, making it an easy target for penetration. But it’s the LDL particle that “does the deed” and actually moves into that “no-parking” zone. It takes up residence, and thus begins the cascade of plaque formation that can lead to a lot more serious stuff.
Now remember, lots of people have plaque, and don’t necessarily have problems. What makes plaque a problem is when it ruptures. If it ruptures, you’re in trouble. The fibrous cap comes loose and can easily cause a blockage of blood flow which, depending on location, can in turn cause a stroke or a heart attack.
If there’s a solution to the problem, it has three essential components: One, we need to reduce our exposure to toxins that create arterial wall injury. Two, we need to keep LDL particles away from where they don’t belong. And three, we need to prevent or reduce oxidation and inflammation of those LDL particles and their cholesterol content!
chronic inflammation is a significant component of virtually every single degenerative condition, including Alzheimer’s, diabetes, obesity, arthritis, cancer, neurodegenerative diseases, chronic lower respiratory disease, influenza and pneumonia, chronic liver and kidney diseases, and, most especially, heart disease.
women with rheumatoid arthritis, a highly inflammatory condition that primarily affects the joints, wind up having double the risk of a heart attack when compared to women without it.
The point is that there is, indeed, “bad” cholesterol—even “ultra-bad” cholesterol—but we’re not accomplishing anything by using a shotgun pharmaceutical approach that lowers total cholesterol. We need to get into the weeds and figure out what exactly is causing any damage, and we now have sophisticated tools to do just that. The old approach is akin to clipping a hangnail with an axe—and what’s more, the old approach has significant unwanted side effects,
As one of us (Jonny) said on the Dr. Oz Show after the first edition of this book came out, “Trying to prevent heart disease by lowering cholesterol is like trying to prevent obesity by taking the lettuce off your whoppers.”
LDL is not really a problem in the body until it becomes oxidized. Only oxidized (damaged) LDL gets under the arterial walls starting a whole inflammatory process that ultimately winds up creating plaque while causing further inflammation and injury.
It’s oxidation—and its partner in crime, inflammation—that actually initiates the process that culminates in atherosclerosis.
Cholesterol is the parent molecule for sex hormones (estrogen, progesterone, and testosterone) as well as for vitamin D and the bile acids needed for digestion. You need cholesterol for life.
Atherosclerosis begins when a rogue particle of LDL (low-density lipoprotein) gets through a weakened section of the arterial wall and parks itself there, beginning the process of inflammation.
Inflammation is initiated by damage from rogue molecules known as free radicals. This damage is also known as oxidation or oxidative stress. Antioxidants help fight this damage.
Cholesterol is only a problem when it’s damaged by oxidation and inflammation.
There are at least thirteen subtypes of LDL (“bad”) cholesterol and ten subtypes of HDL (“good”) cholesterol.2 Total particle number is far more important than “LDL.”
A total cholesterol level of 160 mg/dL or less has been linked to depression, aggression, cerebral hemorrhages, and loss of sex drive.
Want a much better way to tell whether you’re at risk? Look at these two line items on your blood test: triglycerides and HDL (the so-called “good” cholesterol). Now if you’re not too freaked out about doing a bit of math, calculate the ratio of your triglycerides to your HDL. Just divide your triglyceride number by your HDL number. If, for example, your triglycerides are 150 mg/dL and your HDL is 50 mg/dL, you have a ratio of 3 (150:50). If your triglycerides are 100 mg/dL and your HDL is 50 mg/dL, you have a ratio of 2 (100:50). (If your triglycerides are smaller than your HDL and you get a
...more
SUGAR—ESPECIALLY IN THE CONTEXT OF THE MODERN INDUSTRIALIZED DIET—is a far greater danger to your heart than fat ever was.
Insulin is at the hub of a significant number of diseases of civilization. When you control insulin, you reduce the risk for heart disease and the risk for hypertension, diabetes, polycystic ovary syndrome, inflammatory diseases, and even, possibly, cancer.
Without insulin, blood sugar would skyrocket, and the result would be coma and death: the fate of virtually every type 1 diabetic in the early part of the twentieth century before the discovery of insulin. However, without glucagon, blood sugar would plummet, and the result would be brain dysfunction, coma, and death.
You could probably lower your cholesterol—if you still care about that—by simply lowering your insulin levels. And doing so would have none of the side effects of cholesterol-lowering medication, unless you call a longer life span and better health side effects!
