Thursday, October 13, 2016

A note about diabetes, LDL cholesterol and the Bulletproof Diet

I was perusing the Bulletproof forums the other day and came across two types of complaints about the diet. The first dealt with acid reflux and the other dealt with high cholesterol readings (specifically LDL, which is the "bad" type).  I'll deal with the latter first.

The official Bulletproof response to the cholesterol question is here.  BP says "The government of Sweden ... is recommending a diet high in saturated fat. "  What he is referring to, but does not cite, is the Swedish Council on Health Technology Assessment's report on Dietary Guidelines for Obesity (English translation). To be sure, you can indeed extrapolate from this report, but I would be careful since the report states rather clearly that "(w)e have not reviewed the scientific literature for the connection between food and health in the general population."

The affirming quote from the SBU, which I believe BP refers to is:
…a greater increase in HDL cholesterol (“the good cholesterol”) without having any adverse affects on LDL cholesterol (“the bad cholesterol”). This applies to both the moderate low-carbohydrate intake of less than 40 percent of the total energy intake, as well as to the stricter low-carbohydrate diet, where carbohydrate intake is less than 20 percent of the total energy intake. In addition, the stricter low-carbohydrate diet will lead to improved glucose levels for individuals with obesity and diabetes, and to marginally decreased levels of triglycerides.”   (Source)
Unmistakably this quote, which you will find cited by numerous blogs, is the basis for the BP claim. I am not here to debunk the claim. In fact, it may well be true. The fact remains that if the convention wisdom were right, it would never change, but it does (remembers, doctors used to endorse cigarettes).  However, evaluating the effects of low-carb diets on non-diabetics is beyond the scope of my inquiries and reports.
As a diabetic, I find that when my diet is comprised of significant amounts of carbs that controlling my blood glucose levels is more difficult.  Additionally, I find it tough to maintain a stable weight, lose weight and feel good on the conventional diet.  To say nothing of the inflammation problems that I deal with eating grains and food from grain sources.
My position on the Bulletproof diet remains that it definitely works for people like myself who are 1) diabetics 2) very active (i.e. run marathons) and 3) have difficulty eating a "normal" diet.  I am sure it also works for people with other challenges and/or lifestyles. But I would not recommend this diet to anyone who functions well on a conventional diet.

The specific complaint that arose on the Bulletproof forum was that some people were posting that their LDL (aka "bad") cholesterol blood numbers were rising after being on the diet.  There is nothing magical or mystical happening here. If you consume more cholesterol than you did before, you will have this result. The solution is rather simple: eat less cholesterol.  In fact, ironically, it's rather easy to stay under 300mg of dietary cholesterol per day while on the Bulletproof diet. I do it most days (though I sometimes will have eggs).
In the Bulletproof response, BP contends that LDL gets a bad rap because it is found in arterial plaque. The argument is that the presence of LDL in plaque does not prove causality, and indeed on the surface it does not. The problem is that LDL cholesterol is a necessary component of arterial plaque. You can infer, quite strongly, that if your LDL levels are low, then there's less LDL to be used for plaque. This is logic.  In other words, less LDL means less opportunity for plaque, whereas BP holds that more LDL does not mean more opportunity for plaque; and I hold that we simply do not yet know for certain if the presence of LDL is a catalyst for arterial plaque or not, even though it sure as heck plays a significant role. BP further argues that polyunsaturated fats are to blame for plaque. Even if true, this argument fails to take into account that LDL remains a necessary component for arterial plaque as well.  It's like saying that the necessary components of a fire are heat, fuel, and an oxidizing agent, but that increasing your fuel source component doesn't increase your risk of fire.

Think of how a fire works.  You need heat, fuel and an oxidizing agent (i.e. oxygen).  With atherosclerosis you need cholesterol, fatty substances, cellular waste products, calcium and fibrin (as per AHA).  Take away enough heat/fuel or oxygen and you don't have a fire. Take away enough LDL cholesterol/fatty substances etc and you don't have atherosclerosis. Period. There is no logical basis for disputation on this matter.  So I say, why take the risk?  It's easy to keep your intake of cholesterol under control on the Bulletproof diet.

The other complaint I saw come up a few times was about acid reflux. Yikes. As of now I don't know enough to respond to that one, but I have noticed it myself. Until the diet I had never experienced acid reflux.

As someone who is very active I am forced to carefully monitor and measure my carbohydrate intake to ensure that my glycogen stores are in good shape, and that I don't ingest more carbs than are absolutely necessary to run as needed.

My last note would be about the Glutathione Force supplement. I have ordered a quantity of the Bulletproof supplement, along with a bottle of the NOW FOODS version.

Again, I love the Bulletproof diet and truly appreciate the results I am seeing. But I differ with BP on the matter of cholesterol.

Here are some other interesting quotes from the Swedish study:
Those who drink a lot of coffee also have lower mortality from any cause.

In the short term advice on moderate and strict low carbohydrate diet slightly more effective, but in the longer term there is no difference.






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