Is it Bad for Your Health if LDL Cholesterol Goes Up With a Low Carbohydrate Diet?
Dr. Nadir Ali
Dr. Nadir Ali is an interventional cardiologist with over 25 years of experience. He is also the chairman of the Department of Cardiology at Clear Lake Regional Medical Center. Before working as a cardiologist, he served as an assistant professor of medicine for eight years at Baylor College of Medicine in Houston, where he also received his medical training.
Dr. Ali has championed many aspects of the science and practice of a low-carb lifestyle in the local Clear Lake area since 2013. He organises a monthly nutritional seminar in the Searcy Auditorium of the Clear Lake Hospital that receives more than 100 visitors every month from the local community. Dr Ali’s focus is on managing heart disease, obesity, metabolic syndrome and diabetes.
Transcript
Intro
0:15my job is to dissect out my LDL
0:19cholesterol goes up on a low-carb diet
0:21and also to find out and create a
0:24narrative if that is necessarily bad and
0:26you’d be shocked to hear that I really
0:29have no disclosures so I didn’t know
Medical knowledge is no longer a monopoly
0:33whether I should include the slide at
0:35the end or in the beginning but I
0:36thought it would have more impact in the
0:38beginning because there are people right
0:40sitting right in front of me that
0:43medical knowledge is no longer the
0:45monopoly of physicians or healthcare
0:47professionals and a lot of citizen
0:50scientists who have more insight because
0:52they can think outside the box and my
0:55transformation came because my patients
0:58grassroot effort told me that hey I
1:01needed to change and unless
1:04organizations and physicians higher up
1:07heed this warning I feel that if we
1:12don’t bring the change from top down are
1:14we gonna get buggy whipped so for the
Why LDL cholesterol goes up with low carb diet
1:19last five years I’ve been telling my
1:20patients hey eat like this animal fat
1:24fatty meat and fatty fish and in my
1:28clinical experience this is what I find
1:30when people take this to heart and
1:33practice it religiously three good
1:36things happen out here their HDL goes up
1:38the triglyceride comes down their
1:41insulin goes down and everybody agrees
1:43that this is beneficial but the dawn’
1:46LDL that everybody’s worried about goes
1:48up especially when one is being
1:51particularly good at it so before we
1:55demonize LDL or cholesterol we got to
1:57recognize that it’s an evolutionary
1:59important molecule important for life
2:02the every cell in our body the cell
2:05membrane would not have the fluidity and
2:08integrity if it were not for cholesterol
2:10on the right of the slide is the brain
2:13membrane and the structure of the brain
2:16membrane is is permitted to be the way
2:21it is and neurotransmission happens
2:24because of cholesterol rafts that give
2:26the brain membrane the structural
2:28integrity
2:28that it needs in fact the cholesterol is
2:34so important for the brain that it does
2:36not delegate that responsibility to any
2:38other organ but itself now I would not
2:41be able to stand here and give this
2:43presentation without the LDL cholesterol
2:46which is much maligned because that LDL
2:48cholesterol is supplying cholesterol to
2:51my adrenal cortex giving me the stress
2:54hormone cortisol so that I can deal with
2:55the stress the LDL molecule that
3:00cardiologists want to wipe from the face
3:02of the earth is giving cholesterol to
3:05the ovaries making all women in here
3:08look beautiful and testosterone to men
3:11making us look handsome now bile acids
3:16are absolutely essential for absorbing
3:18fat soluble vitamins for absorbing fats
3:21and they are cholesterol byproducts and
3:24cholesterol is not a metabolic fuel we
3:26cannot use it for energy so bile acids
3:29constitute the way in which we eliminate
3:33cholesterol in our gut vitamin D is a
3:37cholesterol product
3:38now both cholesterol and triglycerides
3:41are fat and they don’t dissolve in blood
3:43because blood is watery so our body has
3:47created an ingenious system to carry
3:49this cholesterol as other speakers have
3:51mentioned there’s an outer cover of
3:54phospholipids that makes the molecule
3:57dissolvable in water and the cargo is
4:00cholesterol with an identifying protein
4:02that is shown out there now on the right
4:05side of the slides have shown many
4:08beneficial functions of LDL cholesterol
4:10and I would be not be able to get into
4:12them but people watching this later can
4:14pause and peruse them so I wanted to
Why LDL cholesterol goes up
4:20find out why LDL goes up and this paper
4:23gave me a big insight now this paper is
4:26in seven people who fasted for seven
4:28days and what was found is that fasting
4:31increased their LDL cholesterol now you
4:34would think that fasting is beneficial
4:36the LDL cholesterol started at 112 ended
4:39up at 119
4:41Mondays a whopping 70% increase fasting
4:46makes us do fat metabolism so I had to
4:51go back all the way into the 1950s to
4:53the workout Josh Cahill and come up with
4:56this graph on the right and the reason I
4:58have put that up there is because we
5:01have very limited carbohydrate results
5:04when we stop eating or eating a low-carb
5:06diet what happens is that we run out of
5:09glycogen very quickly within the first
5:11four to eight hours and then you see
5:14that for certain tissues that need sugar
5:17you see that the gluconeogenesis is
5:19slowly going out and then comes down and
5:22the reason it comes down is because our
5:24body becomes adapted to burning fat as
5:28ketones so out here is shown that with
5:32prolonged fasting which is an extreme
5:34example of a low-carb diet what you’re
5:37seeing is that the ketone levels go up
5:39to five millimoles which is equal our to
5:43our blood sugar concentration so what
5:47are these amazing ketone molecules RT R
5:50is shown on the left of the screen a
5:53person who’s on a standard American diet
5:55who’s burning predominantly sugar and
5:58his brain but when you’re on low-carb
6:01diet or doing fasting the brain adapts
6:03and turns two-thirds of its used to
6:07ketones showing that it becomes fat
6:10adapted I’d like to take exception with
6:13dr. Moussa Farion yesterday because he
6:15said that we are extreme examples we are
6:17going too far we want ketosis low carb
6:20is enough I’d like to remind him that
6:23man’s entry into life and the reason
6:26that we are still alive is because we
6:28are capable of ketosis in fact I’d like
6:30your indulgence to read this word for
6:33word which says the metabolism of human
6:36II new born is essentially katatak blood
6:39glucose level Falls strikingly in the
6:41neonate and concentrations of beara
6:44hydroxy butyrate rise to about two to
6:46three milli molar newborn brain consumes
6:4960 to 70 percent of total metabolism at
6:52birth nearly half from
6:54hydroxybutyrate fitting in with this
6:57patent is maternal colostrum it contains
7:01much triglycerides proteins and very
7:03little lactose startings man entry into
7:06society on an Atkins diet so here is a
The liver
7:14liver cell and I’d like to thank all the
7:16speakers ahead of me to making it easy
7:18for me since you’re not eating carbs
7:21you’re fasting the cards are reserved
7:23for the brain the liver cell is
7:25converting fat into ketones and this is
7:30the early model as to why the
7:31cholesterol is going up and have never
7:33shared this data in front of a national
7:34audience before the enzymatic machinery
7:38that’s making ketones in US involves
7:40hmg-coa which is a branch point at which
7:44point it gets diverted to making either
7:47ketones but it can also make cholesterol
7:51this figure is a little bit more elegant
7:53for people who want to see the molecular
7:56structure of these molecules but you can
7:58see that as fatty acid is entering the
8:00liver it’s getting converted to
8:02acetyl-coa then becomes hmg-coa which is
8:07the branch point that makes either
8:09ketones or makes cholesterol so by
8:12design if you get very good at fat
8:15burning like the lean mass hyper
8:17Responder that Dave Feldman has so
8:19nicely put out by design you’re going to
8:23increase your cholesterol levels so here
8:26is a little animation the liver is
8:29synthesizing a lot of cholesterol and
8:31somebody who’s predominantly fat burning
8:33and if you follow my Twitter feed I have
8:36put in all kinds of animal as well as
8:39human studies that show this and as it
8:42is making more LDL cholesterol it’s also
8:46eliminating cholesterol in bile and
8:48through the gut the terminal terminal
8:51ileum is the one that reabsorbs the bile
8:53but less of it is reabsorbed so more of
8:55it gets out in the feces so by design
9:00since the liver is synthesizing more
9:04cholesterol it’s going to produce more
9:07LDL
9:08it’s also going to produce more bile for
9:10elimination now it was pointed out that
9:16the oxidized LDL is the culprit the
9:18oxidized LDL gets taken up by the
9:20macrophage through the scavenger
9:22receptor and there are human studies and
9:25animal studies that show that on a
9:26person on a low-carb diet the
9:29elimination of this scavenger receptor
9:33filled macrophage is much greater in the
9:37feces in a low-carb individual now this
9:41is another point that I was shocked
9:43about the liver is making a lot of
9:45cholesterol and so it is not going to
9:48take any of the LDL back into it because
9:50it doesn’t need it there are human and
9:54animal studies that show that there is
9:56LDL receptor down regulation these are
9:59the receptors that are picking up the
10:01LDL and removing it from circulation but
10:03since the liver already has the
10:04cholesterol that it needs it down
10:07regulates them now this is a little
10:10geeky slide let’s just put in for the
10:12people who really want to see it and
10:15this is a fasting study in humans and
10:18these people were not on a low-carb diet
10:21the fasting was not any prolonged but
10:24you can clearly demonstrate out here
10:26that in a fasted state the liver is
10:29making much less v LDL cholesterol which
10:32is try grow a triglyceride rich and
10:34making a lot higher LDL cholesterol
10:36which is cholesterol rich so I said that
Why do we malign LDL
10:42I wanted my patients to eat like this
10:44fatty food fatty animal fat animal
10:49protein which is fatty as well as fatty
10:52fish when they do this this is the
10:56pattern that observed if they are
10:58katatak if they are having ketones by
11:01design they’re going to have high LDL
11:02cholesterol they’re gonna have high HDL
11:04and studies show that they eliminate
11:07more fecal cholesterol and their LDL
11:10receptor goes down so now I move on to a
11:15part which says why do we malign LDL
11:18does it have any benefit so this is a
11:20rat long
11:21there are longer these bacteria and the
11:24bacteria want to cause an infection in
11:26the rat and what is happening out here
11:29is that it releases this protein which
11:32is called a gr protein which establishes
11:35a quorum and says hey there is enough
11:39milieu out here for us to cause
11:42bacterial virulence and they take
11:44foothold and cause a pneumonia now you
11:48would be surprised to know that there
11:50are animal studies that show that the
11:52lowly LDL is the one that soaks up this
11:56AGR protein so that quorum is not
11:58established and infection is abolished
12:00now here is another bit of information
12:04and that is that these bacteria also
12:07release inflammatory mediators and these
12:10inflammatory mediators cause cell death
12:13what is neutralizing these inflammatory
12:15mediators which is LPS and LTA
12:18it is same the LDL cholesterol and it
12:24reduces bacterial virulence now what
12:27about human studies I want to go to some
12:29prospective human studies this is the
12:31light in 85 study 700 patients followed
12:35for 10 years and they looked at whether
12:38cholesterol predicted their mortality
12:40their cancer death and their infection
12:42and what we found is that high
12:47cholesterol was defined as 300 or
12:49greater 250 was middle cholesterol and
12:52200 was low cholesterol the highest
12:56cholesterol group had the lowest overall
12:58mortality the highest cholesterol group
13:01had the lowest overall cancer mortality
13:04all people die of infections pneumonias
13:08the least risk of infection was in the
13:12highest cholesterol group now I told you
13:15that brain integrity is dependent on
13:19cholesterol rats for neurotransmission
13:21now this is a lothian birth cohort kids
13:25born in 1936 in the town followed in
13:282010 when there were 70 years of age and
13:31the principal reason that they were
13:33being followed is to see
13:34whether cholesterol predicted cognitive
13:37function this is what happened 300 was
13:42high cholesterol 250 was middle
13:44cholesterol and 200 was low cholesterol
13:46the highest cholesterol group had the
13:48lowest risks of hypertension the lowest
13:51risks of stroke the lowest risks of
13:53heart disease
13:54what about cognitive function the higher
13:57your cholesterol the better your
14:00cognitive function the general ability a
14:02processing speed your memory your IQ all
14:05dependent on high cholesterol about 300
14:10of these 1000 patients were on statins
14:12did statin make a difference in their
14:15cognitive skills and what we find is
14:17that the 300 people that were on statins
14:20their cognitive skills was much lower
14:22compared to their cohort that were not
14:25on statins so this is what the standard
14:30American diet is and fortunately nobody
14:32in this audience eats it it’s got the
14:34trifecta of grains added sugar and plant
14:37oils and what it does is that it causes
14:40insulin resistance and all causes all
14:42the things that we have heard about but
14:46the way I want to summarize is what is
14:48the optimal diet whether you believe the
14:51expensive tissue hypothesis or no we all
14:54recognize that we have enormous energy
14:58expensive brains and the primary focus
15:02of our digestion is a small intestine
15:04which is designed to absorb high-quality
15:06nutrients without processing them and we
15:10have rudimentary fermentation capacity
15:12as Zoe pointed out in addition we have
15:16an acid-base digestion we have a mono
15:18grass trick stomach that makes acid
15:20that’s absolutely essential for protein
15:22digestion and if we dilute that acid
15:26with fiber or fiber binds with minerals
15:30you’re not going to absorb the protein
15:32in addition our pancreas we are we are
15:36bestow’d with a pretty bad pancreas
15:39because it cannot handle the glycemic
15:41load or the glycemic index and that’s
15:44why it dies so quickly now I’m not going
15:48to go through the
15:48Graff I put it up for people to peruse
15:50it later but here are my arguments as to
15:52why animals host food predominantly
15:54low-carb animal source food is better
15:56than whole food plant-based diet because
16:00if you’re on a whole food plant-based
16:01diet by design you’re going to eat a lot
16:06of fiber in order to reduce the glycemic
16:08index and if you’re going to do that
16:11you’re going to need a large amount of
16:13time in the day to eat it to supply your
16:15brain with calories I would not be able
16:18to prepare this talk you would not be
16:21able to socialize and the practitioners
16:24of this like Zoi pointed out are going
16:26to spend a lot of time in the bathroom
Conclusion
16:32so I want you to start eating like this
16:35and when you start eating like this this
16:37is what you’re going to notice a high
16:39HDL low triglycerides low insulin and a
16:42higher LDL and this is my conclusion
16:44slide which says that should we
16:47celebrate a high LDL rather than Monat
16:50especially since most people and these
16:53will meet these three criteria they’ll
16:55have a higher LDL they’ll have a lower
16:57triglyceride they’ll have lower insulin
16:59levels because I’d like to submit to you
17:02that this is going to make you live
17:04longer have better cognitive skills
17:06lower infection rate and lower cancer
17:08risk so I really thank you for giving me
17:11the opportunity to present here
17:14[Applause]
