{"id":171979,"date":"2010-01-12T19:25:06","date_gmt":"2010-01-13T00:25:06","guid":{"rendered":"http:\/\/www.diabetesforums.com\/forum\/dieting-and-nutrition-diabetes\/47567-how-reducing-hyperinsulemia-can.html"},"modified":"2010-01-12T19:25:06","modified_gmt":"2010-01-13T00:25:06","slug":"how-reducing-hyperinsulemia-can-improve-lipids","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/171979","title":{"rendered":"How reducing hyperinsulemia can improve lipids"},"content":{"rendered":"
This comes from Michael Eades’s blog for this week:<\/p>\n
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\t\t\t\tAt the time I started treating patients with the low-carb diet, cholesterol was just starting to be demonized. For the first time, people were concerned about their cholesterol levels (and at that time, the upper level for normal for total cholesterol was 220 mg\/dl, 20 units higher than it is now) It was the era Taubes discusses in his great paper The Soft Science of Dietary Fat and that Tom Naughton shows in his movie Fat Head. Low-fat diets were the rage. The 8-Week Cholesterol Cure, a book about eating giant oat bran muffins daily and taking sustained-release niacin was in the writing and destined to be a mega bestseller. The fear of fat was settling in on America.<\/p>\n

And here I was starting to put patients on low-carb, high-fat diets to help them lose weight.<\/p>\n

Back then I had bought into the lipid hypothesis and truly believed excess cholesterol did indeed lead to heart disease. As a consequence, I was a little squeamish about putting people who might actually be at risk for heart disease on the diet. I had read the biochemistry texts, and I knew that insulin stimulated HMG Co-A reductase, the rate limiting enzyme in the cholesterol synthesis pathway; and I also knew that glucagon (insulin’s counter regulatory hormone) inhibited that same enzyme. So, in theory, lowering insulin and increasing glucagon with diet should work to treat elevated cholesterol.<\/b> But, knowing those things theoretically didn’t really give me a whole lot of solace when it came to taking care of real flesh and blood patients who were entrusting their well being to me. . . .<\/p>\n

. . . The patients that I did put on the diet were typically women who were premenopausal (a group who rarely develop heart disease), so I didn’t worry about them. I checked everyone’s labwork, but no one’s was really out of whack lipid-wise at the start of the diet, so I didn’t have a lot to go on data-wise. The few who did have minimally elevated cholesterol tended to lower it over the first six weeks (I rechecked everyone at six weeks), so I figured the theoretical underpinnings of the diet were okay. But I was still uneasy.<\/p>\n

I had visions of myself in the witness box with a sneering plaintiff’s attorney saying to me: So, Dr. Eades, are you telling the members of this jury that you put the deceased – whom you knew to have high cholesterol – on a diet filled with RED MEAT! IS THAT WHAT YOU’RE TELLING THIS JURY, SIR? YOU, SIR, CAUSED THIS MAN’S FATAL HEART ATTACK, DID YOU NOT?<\/p>\n

But more than being worried about this scenario, I didn’t want to do anything harmful to anyone. I knew it would be difficult to live with myself if I thought I had killed someone or caused a heart attack out of pure negligence.<\/p>\n

You’ve got to remember that at this time there was no one in his\/her right mind recommending a low-carb diet. There was Atkins, of course, but he had been totally discredited in the eyes of the medical profession by that time. It wasn’t until over 20 years later in 2004 that he and the low-carb diet got even minimally rehabilitated. I was very uneasy to say the least.<\/p>\n

Then four patients came into my clinic, one almost right after the other, who changed my life. . . . <\/p>\n

The first of the four patients we’ll call Angie. . . . Her total cholesterol was over 300 and her triglycerides were about 1900. MD called me and said “Have I ever got the patient for you.” This was what I had been waiting for. A patient who was female and pre-menopausal with terrible lipids. I figured I could treat such a patient without any risk of her developing heart disease over the short term, and I planned to recheck lipids way sooner than the normal six weeks. Since her lipids were so out of the ordinary for one so young, I asked MD to repeat them, fasting, have the results sent to me and to send Angie to see me after her repeat labs had come back.<\/p>\n

When I got her labs, I knew the first reading wasn’t an error. In fact, they were a little worse than when MD checked them the first time.<\/p>\n

Total cholesterol: 374 mg\/dl (all values in mg\/dl)
\nLDL: ?
\nHDL: 28
\nTriglycerides (TG) 2080<\/p>\n

(There was no value for LDL because LDL is a calculated number and can’t be calculated when the triglycerides are over 400 mg\/dl.)
\n. . . <\/p>\n

I gave her a fairly rigid version of what became the Protein Power diet. I explained exactly what she should eat and what she shouldn’t and sent her on her way with my home phone number and my beeper number (this was before the days of cell phones). I told her to call me if she had even the slightest problem and to return to the office in three weeks for a recheck no matter what. And I gnawed my nails. I had the staff call her after a few days to see if she was doing okay. She reported that she was fine.<\/p>\n

I got no emergency calls from her and in three weeks she returned. Her right upper quadrant pain had vanished as had her nausea. She reported that she had never felt better. She had even lost nine pounds (which was a fair amount for her since she wasn’t that overweight to begin with). I rechecked her labs and waited anxiously for them to come back from the lab the next day. When they did, I was stunned.<\/p>\n

Total cholesterol: 292
\nLDL: 192
\nHDL 70
\nTG: 149<\/p>\n

I had hoped for a change for the better, but I hadn’t in my wildest dreams expected this kind of change. I kind of figured that her triglycerides and cholesterol would come down slowly over several months, not that they would drop like rocks in only three weeks.<\/p>\n

The second of my life-changing patients was a casual friend of mine who came to see me about a week after my experience with Angie. He was a 55 year old guy we’ll call Lynn who worked in advertising. I had gotten to know him when his company created some brochures for our clinic. He came to see me for an insurance physical.<\/p>\n

He arrived, we chatted, and then I looked him over. I poked and prodded and listened at all the appropriate places. He seemed fine. He was a thinnish white male who was just starting to develop a little (and I mean little) paunch. I would never have even noticed it had he not been sitting there with his shirt off.<\/p>\n

Talk turned to my own weight loss, and he asked me if I could put him on a diet to help him lose his little pot belly. I said ‘Sure,’ and told him about my meat, cheese, salad and green vegetable diet. I told him that I had lost my weight eating a ton of steak and had continued to do so. He was thrilled because he loved steak and had been avoiding it because of everything he had been reading about red meat and heart disease. I had our nurse draw his blood for the lab part of his physical and sent him on his way.<\/p>\n

The next day I was going through all the results from the bloodwork that had been drawn the day before when I came upon his. I nearly dropped my teeth.<\/p>\n

Total cholesterol: 312
\nLDL: ?
\nHDL: ?
\nTG: 1515<\/p>\n

(There was a note on the lab sheet that said they were unable to determine the HDL because the serum was too lipemic (cloudy with fat)?!?!)<\/p>\n

I thought, Whoa!, a 32 year old premenopausal woman is one thing, but a 55 year old male right in the middle of major-heart-disease-risk age is something else. And here I had put this guy with totally disrupted lipids on a red-meat diet, which, according to current medical thinking, would almost guarantee to make the situation worse. I put in an immediate call to his office and was told he had left that morning for vacation for two weeks. (Why he had neglected to even mention this trip when we talked for 30 minutes the day before baffled me completely.) I asked for the number wherever he was. His secretary told me that he was on a Caribbean Island and couldn’t be contacted. I told her that if he called in to have him call me immediately.<\/p>\n

My fears were somewhat assuaged because I figured, hey, the guy is on vacation, he’s not going to diet anyway. Why should I worry?<\/p>\n

He called me the day he got back and before I could get a word in told me “Hey, your diet works great. I lost five pounds while I was on vacation.” As it turned out, he was on a Caribbean Island, but it was a resort of some sort. As part of his deal, all the food was provided. He had chowed down on steak just about every day.<\/p>\n

. . . Here are his labs taken 15 days after his first ones.<\/p>\n

Total cholesterol: 195
\nLDL: 124
\nHDL: 26
\nTG: 201<\/p>\n

I was really stunned this time. How could these values change this much in just 15 days?<\/p>\n

He wanted to stay on the diet, so I told him to go for it. But I kept an eye on him.<\/p>\n

. . . [Two more, similar, histories follow.]<\/p>\n

After my experiences with these four patients, all of whom came to see me over about a three month period, I became convinced that my theorizing about the potent effects of reducing insulin was based in reality. Over the ensuing years, I saw many, many more patients with disturbed lipid metabolism whom I successfully treated with low-carb, high-fat diets, but these four, coming as close together as they did in the early days of my feeling my way along in my low-carb career, gave me the conviction to press on.<\/p>\n

I am eternally grateful to them.<\/p>\n

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This comes from Michael Eades’s blog for this week: Quote: At the time I started treating patients with the low-carb diet, cholesterol was just starting to be demonized. For the first time, people were concerned about their cholesterol levels (and at that time, the upper level for normal for total cholesterol was 220 mg\/dl, 20 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-171979","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/171979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=171979"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/171979\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=171979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=171979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=171979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}