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1. Welcome, Jimmy Moore! [3:23] 2. The Sally Fallon issue and keeping an open mind [5:38] 3. Jimmy's new book, Cholesterol Clarity [12:44] 4. Busting myths: Does fat or cholesterol in our diet raise the level of cholesterol in our blood? [20:13] 5. Worthwhile markers: What and when to get tested [24:43] 6. How low is too low? [43:50] 7. How to talk to your doctor and what to ask for [56:15] 8. Familial hypercholesterolemia [1:07:14]
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Diane Sanfilippo: Hey, everyone. Welcome to Episode 101 of the Balanced Bites Podcast! This is Diane Sanfilippo. I am here without my cohost Liz Wolfe today, but I am not alone. I'm here with a fantastic guest, and I'm really, really excited to talk to him today. He's a good friend of mine from around the whole paleo, low-carb community. But before I introduce my guest, let me just quickly mention our show sponsors. We have two amazing show sponsors. Chameleon Cold-Brew is a delicious cold-brewed coffee. It's organic. It's fair trade. You can keep it in your fridge, pop it open, mix it with some delicious coconut milk and a little bit of water because it is a concentrated coffee, so don't drink, like, 16 ounces of Chameleon Cold-Brew and think that you didn't get that much caffeine because you did! But it's delicious, and what I love about it is just being able to make a fresh glass of iced coffee for myself without having to go out to the store, and I know it's really high quality, like I said, organic and fair trade. Coffee beans are some of the most heavily sprayed with pesticides. If you're not getting organic coffee, you definitely want to look into that as a switch. You can get 25% off of your order if you use the code BALANCEDBITES at checkout. Hop over to the blog post for this episode, and you will find a link to their website as well as the information on that code if you missed it.
Our other amazing sponsor is Pete's Paleo, and they are a meal delivery service and nationwide shipping of delicious paleo meals that are premade, precooked, and ready to go. They're frozen, so they'll arrive at your door. You can pop them in the freezer, and then you can just defrost them in some warm water, heat them in a skillet, give them a little cook-through there just so they're warmed all the way up, and enjoy those anytime. I know a lot of people have tried them already. They're coming onto the Facebook page and letting me know that it's been really helpful and helping them along their way with their paleo journey. You can also get some really amazing bacon from them. It's very well sourced, clean. Pete is curing all of that himself, so it's not coming from anywhere else. I just got about 10 pounds of Pete's Paleo bacon, so I'll be posting up some pictures so you guys can see what that looks like. It's amazing stuff. You can also get two free meals with your order at checkout. The code is BALANCEDBITESROCKS. So again, hop over to the blog post, you can find that code, and they'll hook you up.
1. Welcome, Jimmy Moore! [3:23]
So that's all for our sponsors, and I'm ready to introduce my guest, Jimmy Moore. Jimmy, are you there?
Jimmy Moore: I am here!
Diane Sanfilippo: Woohoo!
Jimmy Moore: Woohoo!
Diane Sanfilippo: Where are you today? Are you home?
Jimmy Moore: I'm at home.
Diane Sanfilippo: OK.
Jimmy Moore: It's my home office in South Carolina.
Diane Sanfilippo: South Carolina, OK. It's a New Jersey-to-South Carolina connection today. We have a fantastic interview set up for Jimmy. I have a ton of questions from Facebook. Jimmy has a brand-new book. It's called Cholesterol Clarity. It's coming out very, very soon, and I wanted to get him on the show because we actually have never had a full episode just talking about cholesterol, and this is one of my favorite topics. I love talking about it in the seminars. I love having people's heads explode when I start to talk about all of this stuff!
Jimmy Moore: Kaboom!
Diane Sanfilippo: So let me give you guys a little bit of a background on Jimmy if you're not familiar with him. Jimmy Moore catapulted onto the health scene in 2004 after a phenomenal 180-pound weight loss success enabled him to come off of prescription drugs for high cholesterol, high blood pressure, and respiratory problems. He is the energetic personality behind the über-popular Livin’ La Vida Low- Carb blog and host of one of the top-ranked iTunes health podcasts, The Livin’ La Vida Low- Carb Show. He has interviewed well over 700 of the world’s top health experts and dedicated his life to helping people get the best information possible so they can make the right decisions about their health. It's that passion for helping others that drives him to continue educating, encouraging, and inspiring on a daily basis.
I can attest to that, Jimmy!
Jimmy Moore: Thank you!
Diane Sanfilippo: You and I have been friends for a couple of years now, and you interviewed me first about my 21-Day Sugar Detox before it was even a glimmer in a real publisher's eye, right? So we go back a few years here. Thank you for coming on the show!
Jimmy Moore: I can always say I knew you when.
Diane Sanfilippo: Yes.
Jimmy Moore: I knew you before you were a New York Times Best-Selling Author!
Diane Sanfilippo: Indeed, you did! And for those of you who want to quickly jot down any notes about where to find Jimmy before we get into the interview, LivinLaVidaLowCarb.com, and the new book website is called CholesterolClarity.com. Why don't you tell people just a little bit about…
2. The Sally Fallon issue and keeping an open mind [5:38]
Actually, you know what? I think you and I wanted to briefly discuss the Sally Fallon issue.
Jimmy Moore: Dun dun duunnn!
Diane Sanfilippo: Yeah. Did you have Sally on your show recently?
Jimmy Moore: I did.
Diane Sanfilippo: Tell me what happened.
Jimmy Moore: It aired last week, and she basically was willing to come on. We've been good friends for many years as well, and I wanted to have her on because I did not like when I heard you on your rant – which I loved your rant, by the way, don't get me wrong – but I didn't like that there's kind of this rift now between the Weston A. Price Foundation and the paleo people because of the comments that she was making about paleo. Definitely go back and listen to Diane's rant if you missed it because it was really, really good. I was listening to it actually on the way back from a trip I was recently on. I was like: You go, Diane! So anyway, I had Sally on, and it really boiled down to this, Diane: She doesn't like the terminology “paleo” because it has now become so associated with lean meats, and that's kind of the crux of her issue with paleo, is Loren Cordain and even Robb Wolf, she said, have so, I guess, identified the paleo diet as a lean, low-fat type of diet, which is absurd to you and me, but that's what people look for. When they search for “paleo diet,” they're finding Dr. Cordain and Robb Wolf's sites, and she says that in their books they put the emphasis on lean meats and that that does not jive with the Weston A. Price Foundation.
Diane Sanfilippo: OK. I think it's pretty funny that she assumes that that's what people are finding because I think we know some of the kind of prominent voices out there, who they are beyond that.
Jimmy Moore: Right.
Diane Sanfilippo: I actually think a lot of people might stumble across that information to start out, but one of the things I love about the paleo community and people who go paleo is that we've been taught the opposite of what we're now doing, which is obviously the same with this whole cholesterol thing, for so long that most people don't just accept it at face value. They might take the information right away and say: OK, I'm going to do so this. And then within days, weeks, months, they're researching for more information.
Jimmy Moore: Right.
Diane Sanfilippo: These people don't just say: OK, I'm going to put all this fat on my plate now or even “all of this protein” or whatever and not ask more questions. That's one of the things that I love, is that people do ask the questions. I can't come up with a really great analogy for this because I don't know of one. Maybe it's like how the Atkins Diet – I know you've talked about this a lot, where people just assume that Atkins just means bacon and cheese and meat, right?
Jimmy Moore: Right.
Diane Sanfilippo: And that's a very undereducated point of view on the Atkins Diet as Dr. Atkins created it. There are plenty of vegetables in the Atkins Diet. Perhaps the introductory phase is not as heavy in some plant foods, but I think there's just a misunderstanding there, and it's the popularization of what the concept means that then becomes pervasive, and then if somebody just stumbles across paleo and they're like: Well, this is the same as Atkins and Atkins is just cheese, bacon, and meat, it's like all of a sudden people have no idea what they're talking about. I just feel like it was a huge mistake to make a broad generalization based on old information.
Jimmy Moore: Well, I can tell you I told her about how the number-one paleo book on Amazon right now is not by Robb Wolf or Loren Cordain. It's by this lady… what's her name? Oh, yeah, Diane Sanfilippo!
Diane Sanfilippo: Oh, yeah!
Jimmy Moore: And I told her about your work, and obviously she had heard your podcast.
Diane Sanfilippo: She had heard the podcast or she had heard about it?
Jimmy Moore: Heard about it, and she read a lot of the blog posts. But anyway, I think it's just kind of a semantics thing at this point because most of the paleo community is on board with healthy fats, and we've been heavily influenced by the Weston A. Price Foundation and the work of people like Chris Masterjohn who have been out there talking about a lot of those principles for so many years. It broke my heart to hear there's such a rift… when there's really not.
Diane Sanfilippo: Yeah.
Jimmy Moore: I mean, we're more on the same page than not. Definitely listen to that podcast if you missed it.
Diane Sanfilippo: I think the thing just about the mindset on it, just the way that it comes off. I think in general, and this is what I've heard as well, like I said on the episode, her interactions with some people is that she's heard X, Y, Z. This is what she will say paleo means because of X, Y, Z, and has been closed minded to hear anything else. That's the part I don't like. I don't like when people are closed minded to, like what you said, actually saying: Hey, do you know what the number-one paleo book is right now? Do you know that it does talk about soaking, sprouting, and fermenting? It talks about the Weston Price Foundation. It talks about fats. It's a totally different thing, and I think that's one of the things that you bring to this community, is an open mind. You have your foundation in a low-carb approach, obviously. Your website is Livin' La Vida Low Carb. We're going to talk all about cholesterol and probably some about fat and all that in just a second, but I think one of things that's really great about your shows is that you don't just talk to people who agree with you, and I think that's really important for all of us. I mean, I'm not about to bring someone who promotes an exclusively plant-based diet onto my show. I don't need to have arguments with people and all of that, but I think when it comes to nutrition and health, we're pretty sure we know what we're doing. We're pretty sure we have something right here, but there's always a chance that there's something that we're doing that's not perfect, right? And so I think having that piece of an open mind to: Oh, there's this other approach, too, that might also work?!
Jimmy Moore: You don't want John McDougall or Dean Ornish on your podcast?!
Diane Sanfilippo: Ugh. Or 30 Bananas a Day or whoever that guy is.
Jimmy Moore: Durianrider was actually pretty sane! I was surprised.
Diane Sanfilippo: I'm just waiting for a video to come out with a still from one of my videos where my face looks, like, totally crazy and he just… yeah, I feel like he'll pause it on something where I look like twice the size of what I am and all of a sudden I've gained 50 pounds on my paleo diet.
Jimmy Moore: Well, he lost credibility when he said Robb Wolf is fat.
Diane Sanfilippo: Oh, yeah, with, like, a six-pack.
Jimmy Moore: I was like: Robb Wolf? Of all the people in the world, Robb Wolf? Really?!
Diane Sanfilippo: That's really funny.
Jimmy Moore: [sigh]
Diane Sanfilippo: Oh, boy.
Jimmy Moore: He never touches Mark Sisson, though.
3. Jimmy's new book, Cholesterol Clarity [12:44]
Diane Sanfilippo: Oh, man. Yeah. All right, well, let's get into talking about your book. Cholesterol Clarity is what it's called. I love that name. Obviously I'm a fan of alliteration!
Jimmy Moore: Thank you.
Diane Sanfilippo: Balanced Bites, Practical Paleo…
Jimmy Moore: There you go.
Diane Sanfilippo: Yeah, I can't stay away.
Jimmy Moore: Actually, you know, my original title was going to be Lipid Logic –
Diane Sanfilippo: Ooo, tongue twister.
Jimmy Moore: – but a buddy of mine said nobody knows what “lipids” mean.
Diane Sanfilippo: No, they don't.
Jimmy Moore: So then I said: Well, I want it to be about cholesterol so it has to be cholesterol something.
Diane Sanfilippo: Mm-hmm.
Jimmy Moore: And we just kind of bounced some ideas, and suddenly it just came to both of us, Cholesterol Clarity, and that was just, like, a goldmine.
Diane Sanfilippo: Yeah, it works really well. I got a chance to preview the book, and I love how throughout the book you have those little moments of clarity. I think that's perfect. So why don't you just tell people a little bit about the book. We're going to get into a ton of questions because I think that's what we really want to do with this show, but yeah, just give us a little bit of background, why you wanted to write the book and who it's for and kind of what the goal is of the book.
Jimmy Moore: Yeah. Diane, there have been a lot of books that have been put out there about cholesterol, and most of those books by a lot of the people who are featured in my book, they just say: Well, don't worry about cholesterol. Cholesterol is not the enemy. You need to stop testing it. You need to stop worrying about it. OK, that's all well and good, but out here in the real world, people do worry about their cholesterol. So why not give them not just the information that says maybe you don't need to be focusing so much on cholesterol, but if you are going to focus on cholesterol, here's the numbers you should probably be shooting for, here are the markers that are probably much more important than what we've been told, and kind of point people in the right direction. And we tried very hard to make the language in it so simple, so easy to understand. That's kind of been the trademark of my blog for many years, is I try to take some complex science and then whittle it down so that the common person can understand it. And then, of course, I tapped into a lot of the people I've interviewed on The Livin' La Vida Low Carb Show to be my guest experts. I have 29 of them throughout the book in those moment-of-clarity quotes you were talking about that go a little more advanced. So my goal, Diane, would be people would read the book, basically read most of the words that I wrote, and then go and learn some more, then come back and read those moment-of-clarity quotes, and then know exactly what those people are talking about.
Diane Sanfilippo: I loved those little interjections because I think it's a really hard thing to do to be a doctor or a scientist who talks about this stuff at an academic level and then also be able to communicate to the masses.
Jimmy Moore: Right.
Diane Sanfilippo: And I think that's really where the important job is for people like us, to do that translation and distilling the information to what's practical and usable and easy to understand, as you mentioned. And I think having those experts in your back pocket to really get into a little bit more detail and science has been really helpful.
Jimmy Moore: Yeah.
Diane Sanfilippo: I love this because this is exactly what I've tried to do in a lot of the seminars I'm teaching, is go through podcasts that you've done, interviews with some of the people you mention in the book, and also some interviews between Chris Kresser and Chris Masterjohn, who's also in your book as a resource. I think it's fantastic that you have all of those folks coming together with you so that you can do the job that needs to be done and kind of making it easy to understand but also making sure that people know: Hey, this is not just me saying this.
Jimmy Moore: Right, and I also implored one of my low-carb research practitioner friends, Dr. Eric Westman, to be my coauthor because I'm just Jimmy Moore, the Joe Schmo who lost some weight. I mean, I don't have any credentials after my name in terms of nutrition, so I may not be taken as seriously as somebody who would. So I asked Dr. Westman to come on and be a coauthor, and he actually throughout the book did these little doctor's notes. He would read what I'd written, and then he'd add in his two cents' worth based on his experience with patients and research. I was really happy because when I turned in my manuscript and I gave it to Dr. Westman to take a look at before I turned it in to Victory Belt, he read it all the way through and he said: I don't need to change anything about this. I was like: OK, that's pretty cool!
Diane Sanfilippo: Mm-hmm. I think what's actually funny too – and then we'll get into some of these questions because I have a ton of questions – but I think it's kind of funny. I've heard that perspective about like: Well, I'm just kind of a regular person, from a lot of people, and there's a little bit of concern about writing a book, even for someone like myself as a nutritionist, will people trust me? Will people listen to me? But you know what? People have gone to their doctors for the past however many years, and it's obvious that the doctors either don't have all the answers or don't have the right answers or are just flat out not helping people.
Jimmy Moore: Right.
Diane Sanfilippo: And what I think is really cool about what we've done with the Internet is that we can create content, we can create a sense of trust and loyalty in our readers because we're moving along, we're learning, we're teaching them. And at some point… so this doctor went to med school and learned a whole bunch of stuff that has nothing to do with what you're teaching, you know what I mean? And now you know a lot more about cholesterol and how it works in the body than a doctor does because that's not what they're learning or they learned it for a few days and then forgot all about it because the curriculum then leads to what are your symptoms, what diagnosis do I give you, and what pill do I give you for that? Or what surgery do I perform. So I think the cool thing is that people today… and I know my generation, too, and it's not everyone, but we're becoming more and more self-sufficient and doing our own research and realizing that we can't rely on people we once thought to be experts on how the human body works and how nutrition plays into that. I think we're recognizing that it doesn't have to just come from an MD, and in fact, most of the time when it does, we don't even agree with them anyway.
Jimmy Moore: And that's the theme song of this book, Diane, is you are the one, you're the final arbiter about what happens in your health. Stop abdicating your responsibility to take control of your health to your doctor, and take back the reins of control. That's kind of one of the long-term goals I'd love to see happen with this book, is people are like: Well, I had no idea I was in control and I could do something about my health. It sounds funny to people like you and me, yet people sometimes need permission to do things, and this is one of those things that they really need to be doing.
Diane Sanfilippo: Yeah. So let's get into some of the questions, and I'll try and do these in some kind of order that makes sense, but hey, organization on podcast questions is not my strong suit.
Jimmy Moore: Noooo…
Diane Sanfilippo: My assistant Charissa usually gets that stuff together for us –
Jimmy Moore: We love Charissa!
Diane Sanfilippo: – But we're doing this podcast on our own. We're going rogue!
Jimmy Moore: Booyah! Well, between the two of us we have a little experience doing this.
4. Busting myths: Does fat or cholesterol in our diet raise the level of cholesterol in our blood? [20:13]
Diane Sanfilippo: We'll be OK. So why don't we just start with some of the basics. Let's have you talk a little bit about whether or not fat and cholesterol that we eat affects cholesterol in our blood. Yes or no? How much, how little? And how important is it?
Jimmy Moore: You know, it's interesting. I was at a conference. I go to a lot of conferences, more than just the paleo conferences. I do an obesity conference every year, the American Society of Bariatric Physicians, and earlier this year in April I went to the one out in San Diego, and Dr. Peter Attia was one of the speakers, a really well-known guy out there in the health realm. And he gave a talk about this very subject, and in there he talked about how much of cholesterol that you consume actually gets into the bloodstream and people must think: Well, if you're eating cholesterol, that's what raises your cholesterol. We've been told that. Did you know only about 15% of that cholesterol actually gets absorbed by the body? The rest is excreted. Now, that's a shock to a lot of people because they have long eaten cholesterol-free foods, whatever is labeled “cholesterol free,” and cutting out the egg yolks from eggs because they think it's that cholesterol in the food they're eating that's raising their blood levels of cholesterol, but it's just not true.
Diane Sanfilippo: So what in our diet actually can affect cholesterol, either positively or negatively?
Jimmy Moore: Well, it's certainly a myriad of things, and we go into great detail about this, but just put simply, carbohydrate is going to always, always raise triglycerides. When you go above your level of carbohydrate tolerance, triglycerides are kind of the first marker that says: Hey, dude, you gotta back off on the carbs just a bit. So what you're looking for is to keep that number below 100 and optimally under 70. Now, the conventional wisdom says 150 is the cutoff, but once you hit 150, you're eating a whole lot of carbs if you're still that high. So try to get that number below 100, and if you still have high triglycerides, maybe you haven't gone low enough. So that's one.
Another one that can really do a good job of raising HDL cholesterol, which is the so-called “good cholesterol,” is fat. So when you eat real food saturated fats, monounsaturated fats, really any fat that's not a vegetable oil and it's a real-food source, it's going to do good things to your HDL cholesterol. That's another thing.
And then the symbiosis between making triglycerides go below 100 and HDL – By the way, HDL should be above 50 or ideally, optimally above 70. Once it's below 50, you're not eating enough fat to be able to bring that number into line. And it's that ratio between the triglycerides and the HDL, which you ideally want to have pretty close to 1:1 ratio, when that is happening, something else that's happening to the LDL cholesterol – and this is going to get a little bit geeky, but we explain all this in the book – there are two types of LDL. You're looking at different particle sizes, so you have pattern A, which is the large, fluffy kind of LDL particles, and then pattern B, which are the small, dense, and pretty dangerous atherosclerotic LDL. If you keep the HDL-to-triglyceride ratio around 1:1, you're going to have mostly pattern A, the large and fluffy. You want to try to avoid the pattern B because those small ones tend to go behind the arterial wall and cause inflammation, which we talk about in the book as well, which is the real cause of heart disease. The only reason cholesterol shows up is because inflammation is present. If there was no inflammation, cholesterol levels would not elevate. So if you have an elevated cholesterol, that's just a sign that says: Hey, you have some inflammation going on somewhere in your body that probably needs to be taken care of. Deal with the inflammation. Don't artificially lower the cholesterol.
5. Worthwhile markers: What and when to get tested [24:43]
Diane Sanfilippo: Good question here as a follow-up that I want to ask you because this is something that I've learned about and just want to clarify… Well, that's why Cholesterol Clarity is the name of the book! Two things: The first one, you had mentioned the different types of LDL, and what I've heard from Chris Masterjohn is that the current thinking on how to measure that, we'd had some different testing. I think there were two different tests out there, and what Chris Masterjohn had said most recently was that the tests were not really the most accurate and your results were really more correlated with which lab did the test than the actual measure.
Jimmy Moore: Right.
Diane Sanfilippo: So what's the best way for people to find out which pattern they have more of? Or is there a different measure that you'd like them to be looking for? Maybe it's the particle count or something else.
Jimmy Moore: Yeah. There's a really good test that we talk about. There are actually about six tests besides your basic cholesterol test that we mention in the book that people can have run. I tend to prefer the NMR LipoProfile test. It's run out of the Raleigh, North Carolina, and it will give you the total number of LDL particles. When you get your standard cholesterol test back, LDL-C, that's pretty much an estimated number, which kind of makes the whole idea of making it less than 100 kind of ludicrous. If it's just an estimated number, why are we so precise on what number it should be? But that's neither here nor there. The NMR LipoProfile will give you that total number of LDL particles. It also will show you the total number of small LDL particles, that pattern B. So if you have a preponderance of your LDL particles being the small, you have issues you have to deal with. And again, you deal with it by increasing the amount of fat in your diet, which will raise your HDL; decreasing the amount of carbohydrates in your diet so that your triglycerides will go below 100; and when that happens, you will shift from pattern B to pattern A. So the NMR is the one that I really like. I'm not sure which one Chris has issues with, but I know he's a big believer in the ratio between the HDL and total cholesterol. There's equal evidence that that's good, but also the triglyceride-to-HDL ratio being a good proxy for knowing whether you have the pattern A or pattern B.
Diane Sanfilippo: Yeah. I love that. It's funny, I think in terms of measures that we can get from our blood that we actually can tell something worthwhile from, it seems like triglycerides is one of the basic measures that people are getting in their lipid profiles that most of us can agree that's a legitimate number to look at. We know when we look at total cholesterol, it may or may not be super indicative of anything. It may just tell us some kind of story, but then we always have to dig deeper.
Jimmy Moore: Yeah, I put in the book an analogy with total cholesterol. It's like knowing the end of a baseball game is 25. You don't know if one team won 24-1 in an absolute blowout or if it was a nail-biter at 13-12. You just don't know what the makeup is of that total.
Diane Sanfilippo: That's a good one.
Jimmy Moore: Basing treatment solely on the total cholesterol is just ludicrous.
Diane Sanfilippo: Yeah. I think the analogy I've used in my seminars is I have a CrossFit coach who weighs 230 pounds. Now, what is that 230 tell you about him? I could just say I have a friend who weighs 230 pounds. You have no idea what that means. You have no idea if that's a tall, lean person or not.
Jimmy Moore: Right. He could be 7'4″.
Diane Sanfilippo: Yeah. Or 6'5″ and 4% body fat.
Jimmy Moore: There you go.
Diane Sanfilippo: So yeah, the absolute number is not as telling. What can we tell people? I have my few points that I normally would teach people, but I'm going to ask you. What can we tell people about some of those absolute numbers in terms of, you know, when are they actually at least telling us something to the point where, OK, let's do some more digging, let's work out some of these ratios, let's really find out what the story is? For example, we have a question from a woman who's 30 years old. Her cholesterol total was 230, and she's a little concerned about. I'll tell you, for example, my cholesterol measure, I would say, was about a year and a half ago when I felt like I was dying working on Practical Paleo because I was so stressed out, was 240, and I wasn't concerned about that. I knew I was under a lot of stress and I was like: OK, it is what it is. My triglycerides were, like, 42 at the time.
Jimmy Moore: Wow.
Diane Sanfilippo: So I was like: OK, I'm fine. But that being said, what are some numbers that at least tell us something that, OK, now we need to dig a little more because we need to find out why?
Jimmy Moore: Yeah, your listener who has the 240 or 230, or whatever it was, total cholesterol, guess what? You're completely normal. I remember talking to Chris Masterjohn about this and kind of what traditional cultures that had zero heart disease and what their average cholesterol level was. Do you want to know what the average cholesterol level was of traditional cultures for females that eat a high-fat diet? It was 250. Now, that's quite a ways up from the 200 that most doctors nowadays view as the be-all, end-all, where if you're at 201, you're at great risk for heart disease, but if you're at 199, suddenly you're at no risk. That just never makes sense. So 230 is actually not too bad. But really total cholesterol doesn't become an issue and it really isn't an issue, per se, but it might be an indicator, like you were talking about writing your book, that stress is going on or any number of things. We have a whole chapter in the book where we talk about nine reasons why your cholesterol levels can go up, and it's all kinds of things from hypothyroidism to weight loss to stress to having some kind of a gut health issue. I personally recently had some mouth surgery, and periodontal disease can actually raise cholesterol. Again, that's that inflammation thing happening and the cholesterol responding to that. So there are all kinds of things that are involved here, and simply looking at one marker when it comes back supposedly elevated and thinking that that means something, it really doesn't mean anything.
Now, you did ask, what numbers do mean things? We've already talked about a couple of them. LDL cholesterol, pretty much looking at LDL-C is irrelevant. It's looking at the LDL size, and so that's where that particle size test, the NMR LipoProfile, you have that run, you find out how much of your LDL particles are the small, dense kind. Ideally you want that absolute number to be as low as it can possibly be. I've heard some people say under 200. I know one of my experts, Dr. William Davis, says he's getting that number to zero in a lot of his patients. But if you get it below 20% of your total LDL particles, you're pretty much doing a good job of keeping your heart health in order. Triglycerides is another one. As you mentioned, your triglycerides were stellar despite having the 240 total cholesterol, and keeping that triglyceride number under 70, that's a really good sign that you're eating properly for your body and you're nourishing it well. And then the last marker, I would say, is HDL cholesterol, and it's kind of a parallel marker. As triglycerides go down, HDL tends to go up. So you want that HDL cholesterol to get above 70, and again, that ratio between the triglycerides and the HDL, that is so key. If you get that number below 2 but definitely, ideally below 1, you're in good shape.
Diane Sanfilippo: You mentioned weight loss as one reason why these numbers can kind of get a little wonky, and I know Chris Masterjohn has said before that really your weight should be stable for at least a couple of months before you can get a measurement that's going to be sort of normalized.
Jimmy Moore: Right.
Diane Sanfilippo: And we have this standard deviation of… I think he had said 17 points one way or the other. So that means that your measurement today to tomorrow… Sorry about that ambient noise. There's a lawnmower.
Jimmy Moore: Wrrrrr.
Diane Sanfilippo: Of course, it must be lawn-mowing day. But that measurement today to tomorrow could vary. That actually gives you 34 points total that it could vary up or down.
Jimmy Moore: Yeah. Can I tell you a story?
Diane Sanfilippo: Yeah.
Jimmy Moore: I've always have extremely high cholesterol levels, and that's one of the reasons I wanted to write this book. I wanted to find out what was wrong with my numbers for myself, and so I had my cholesterol run back in December. As you know, I was in the midst of nutritional ketosis and pretty heavy weight loss at that time, and I was just curious what my total cholesterol would be. It came in at 419 total cholesterol in December. Well, once I became weight stable at the end of my nutritional ketosis experiment and was weight stable, like you said, for at least that couple of months, I had it tested again, Diane, and you want to know what the total cholesterol was then? 306.
Diane Sanfilippo: Yeah, wow.
Jimmy Moore: So it dropped well over 100 points in about six months, and all I did was stabilize my weight, and those numbers kind of came back in line. I mean, 300 is about where it usually is when I'm not dealing with weight loss. So there you go.
Diane Sanfilippo: It's a really common issue and a really common question because so many of the people who come to my blog and listen to the podcast, they're going through pretty significant weight loss. And we're not talking about a couple of pounds that have just moved because you've tweaked your diet.
Jimmy Moore: Right.
Diane Sanfilippo: We're talking about significant weight loss, I'd say a minimum of 10 pounds or even 20. Your body's actually changing, and your liver has to deal with processing everything that's happening when it comes to fat and cholesterol metabolism. So that's what really has to kind of catch up and let things kind of chill out before you get that measurement done. I know a lot of people try and do, like, a 30-day challenge. They do measurements before and measurements after, and I'm not just talking a waistband measurement, I'm saying they get blood work done. And sometimes it can be revolutionary for them. From day 1 to day 31, it's crazy different in a good way. And for some people it's not, and I just want to make sure people who maybe don't see things move in the “right direction” or maybe they see these numbers increase and they freak out. I think one person commented on my Balanced Bites page and said: My cholesterol has gone up on this diet – which I don't like to promote a “diet” – but it's gone up and I'm done. And I was like: Hey, can we talk about this? I need to hear what's going on with you. And I don't know if she stayed or left, but there's so much more to the story than that one snapshot measurement. And if people are really concerned about what's happening day to day, like you said: Hey, let me see what's happening when I'm in the middle of this experiment and I'm losing weight. It's that kind of thing. Measure it regularly.
Jimmy Moore: Yep.
Diane Sanfilippo: Measure it every month because the pattern is more important than a snapshot. Is that what you would say?
Jimmy Moore: Exactly.
Diane Sanfilippo: OK.
Jimmy Moore: Yeah, that's one of the issues I have with the whole way we treat high cholesterol. We see one number, and in fact, I got an email just today from a lady whose number came back 225 or something like that, and the doctor was just going: Statin, statin, statin. And she was like: For one time that it came back?! And she convinced the doctor: All right, give me 60 days. She was about to start a pretty serious low-carb, high-fat type of diet. She got it run again, and the results were she dropped her LDL by 45 points –
Diane Sanfilippo: Yeah.
Jimmy Moore: – and kept her HDL and triglycerides pretty much stable where they were, and they were in really good spots. But a lot of her total cholesterol was HDL. Because it was 105, it kind of artificially made the total look like it was higher when in actuality she was extremely healthy, and yet here he was wanting to put her on a drug that was going to artificially lower her cholesterol. And yes, it would have lowered the HDL as well.
Diane Sanfilippo: Right.
Jimmy Moore: It's sad, Diane, that it's come down to a numbers game and not treating actual health.
Diane Sanfilippo: Yeah, and I think there's two sides to this story. One is I feel like a lot of times when it comes to – and we'll kind of address this in a little more detail at the end of the show because I think it's a good topic to close out on, you know, a little bit more about talking to your doctor about this stuff when they are obviously not in the know – but I think one of the disconnects is that if I showed up at a regular doctor, which I don't have a primary care physician. I don't go to the doctor. I mean, it's not something I do. But if I did and I got my cholesterol measured, they would look at me, look at my numbers, and probably say the same thing.
Jimmy Moore: Yep.
Diane Sanfilippo: And I would probably look back at them and want to have a very aggressive conversation about looking at me as a person. Like, look me in the eye and tell me that I'm not a healthy person, when I'm telling you here's what I eat every day – because they don't necessarily know or agree with my way of eating, I'm sure. Here's how I exercise. Here's my back squat. No, I'm just kidding!
Jimmy Moore: [laughter]
Diane Sanfilippo: But really talking about what's going on with the person and their overall appearance. Is their complexion good? Are their eyes bright? – all these things that doctors used to do years and years and years ago – and actually take that person into account. And I think that's one side. You may have a very healthy person whose numbers for what that doctor “knows” to be healthy are a disconnect. It's like: Well, this person seems to be healthy. They're lean and fit and strong. But these numbers tell me you're not healthy, so you should probably take this drug. And that's just a huge disconnect. But the other side is, and this is something when I talk about carbohydrate metabolism and people who are the unlucky ones who don't get the metabolic signs on the outside of their body, right? They don't get the body fat. They get the high triglycerides, and they actually do get these blood markers that show us you're not healthy despite the fact that to modern society, because they're not overweight, they look healthy from the outside. So there are two sides to that. You know what I mean? There are the numbers that are telling you one thing because the doctor just has a different picture of what those numbers should be, and then there are also those people who think that they're healthy because their waistline's not expanding, but their triglycerides are over 200.
Jimmy Moore: Right.
Diane Sanfilippo: And their cholesterol is coming back really high and it's not healthy. Is there anything else, any other kind of notes you have, or any other thoughts you have on that, because I know we also have a question, what about if cholesterol is too low? What number would be too low, and why would that happen, and what do we do about it?
Jimmy Moore: Yeah, I definitely do have one more thing before we get to the too low one. In the introduction I tell a story about how I went to Sam's Club because they always offer this free total cholesterol screening. I do it just to have fun, and I went up there, and this was the time when it came back 306. I was in line. The lady in front of me was pretty morbidly obese. Her blood pressure, I overheard, was about 180/110. It was very high. And the lady's numbers came back. She got her blood sugar and her total cholesterol. Her blood sugar came back 85 or something like that. It was really good. And then her total cholesterol was something like 180-something. And the phlebotomist said: Hey, you're the sign of health! You're really healthy! And the lady responded: Yeah, my cholesterol and my blood sugar have always been naturally low. And then the phlebotomist said back to her: Yeah, the less of that stuff – talking about cholesterol – that you have in your body, the better off you are. And I was behind her going: Oh, please, Jimmy, don't say anything. Don't say anything.
So then it was my turn, and the phlebotomist looked at me and said: Wow, you look like you're a healthy young guy. Your numbers are going to be great, I just know it! And I knew what my numbers were kind of going to be, and she was just all happy and cheerful and everything until [gasp!] the number popped up on the screen, and you would have thought –
Diane Sanfilippo: She saw a ghost, right?!
Jimmy Moore: Oh, my gosh. She thought I was going to keel over in the parking lot with 306. And I told her: You do know in December it was 419. And she just went: [gasp!] Are you taking a drug to bring that down?! Nope, no drugs. Aren't you going to do something about that 306 number? Nope, not worried about it.
It's just this whole idea that health is predicated on what a number on a machine is telling us. Now, that number on the machine might tell you something is going on, but it's not a disease in and of itself to have high cholesterol.
Diane Sanfilippo: Exactly. You can't blame the firefighters for the fire, right?
Jimmy Moore: Yeah, we put that in there, too, as an analogy.
Diane Sanfilippo: It's a good one!
Jimmy Moore: Quite frankly, yeah. I mean, it would be absurd to people to say: Well, the reason there are fires is there are firefighters because every time there's a fire there are firefighters there, so they must be the problem. Well, no, that doesn't make sense to us. So why would we blame cholesterol for putting out the fire of inflammation? It equally does not make sense.
6. How low is too low? [43:50]
Diane Sanfilippo: Why don't we talk about, what is too low? Why would it be too low, and what do people need to know about having cholesterol that's too low?
Jimmy Moore: A lot of people, they think because of all the propaganda we've seen on television from the statin drug commercials, go lower! And so it's kind of this notion that the lower your cholesterol levels are, the healthier you are, and there's one example we put in the book, a very famous example, Tim Russert, who was the host of Meet the Press back in the 2000s, and he died of his very first heart attack in his 50s, and his total cholesterol – get ready for this – 105. So if low cholesterol is supposed to be heart healthy, why the blankety-blank did Tim Russert die? Well, he died because he had inflammation in his arteries. He had a very high heart calcium score, which we also talk about in the book, getting that run to know if actual disease is taking place. He was following all the advice that his doctors were telling him to do: Eat a low fat diet, eat lots of healthy whole grains, exercise every day – and probably take a statin drug to get that low of a cholesterol. And yet what did that get him in the end? It took away the very life-saving measure that could have prevented that heart attack from killing him. The cholesterol is there as a healing agent. It's going to make you better if you have inflammation. And yet if you rob your body of that cholesterol, you're taking away the firefighters, and your whole house is going to burn down.
Diane Sanfilippo: That's a good one. Tell me what you think about this: I don't like to give specific numbers because it is different for everyone, right?
Jimmy Moore: Yep.
Diane Sanfilippo: But we do know there are numbers that tell us something more than others.
Jimmy Moore: Yeah.
Diane Sanfilippo: When people ask me and say: Give me a number. And actually the interview you did with Dr. Dayspring, I basically drew pictures after listening to that because that's how I learn, in sound and pictures.
Jimmy Moore: That's what I did during the interview!
Diane Sanfilippo: It's really one of these funny things, as a total side note, I've realized that the reason writing is so hard for me is that I don't learn by reading.
Jimmy Moore: You do Venn diagrams everywhere.
Diane Sanfilippo: Right! But you know, at 35, I can own the fact that reading is not how I learn best. I learn best by listening, and I learn best from pictures, and I'm like: So what?! Some people can't learn from listening or from pictures.
Jimmy Moore: So Practical Paleo: The Picture Version is coming soon!
Diane Sanfilippo: Well, I would say it's mostly in pictures anyway.
Jimmy Moore: That's true.
Diane Sanfilippo: I don't think there will be a recorded audiobook version because I don't think I could read meal plans!
Jimmy Moore: [laughter]
Diane Sanfilippo: But if I have a client come to me, and especially a female, because we know that women's cholesterol levels should generally be what?
Jimmy Moore: 250.
Diane Sanfilippo: OK, I was going to say at least 20 to 30 points higher than what men's should be.
Jimmy Moore: Right. That's right. And men are 220.
Diane Sanfilippo: So if a woman came to me and her cholesterol was around 150, I would be very concerned that that's too low.
Jimmy Moore: Right.
Diane Sanfilippo: And something that's anywhere from, like, 170 to 250, to me, would be OK. And maybe it's just my bias because I think healthy cholesterol levels are good and to me, healthy means more, like, around that 200, especially for women because we have more hormones to make from that cholesterol substrate. That's why our cholesterol levels tend to be higher. We need more of it. It's doing a job. And I actually had somebody just on the Facebook page asking about her husband's low testosterone, and he had been on a statin for 10 years, and I'm not surprised because you can't make testosterone without cholesterol.
Jimmy Moore: Right.
Diane Sanfilippo: I had a client like that years ago who had been on a statin 20 years, and his testosterone was in the tank. He was getting shots, testosterone injections. And I was like: Hold on. [laughter] You're stealing out the front door and putting it in the back door. You're trying to make something out of nothing here without this cholesterol in your body. That is one of the things that people, they feel like if it's low that they're doing fine and they're healthy, and that's a huge misconception. And what you had just mentioned about the heart attack with the low cholesterol, I don't remember where Liz was reading this, but she was talking about this in one of our seminars, where just as many people are having heart attacks with low cholesterol as they are with high. It's just not something that gets talked about.
Jimmy Moore: Yeah, there's a statistic we put in the book. They actually did a study, Diane, of people that were admitted to a hospital –
Diane Sanfilippo: Yep, I think that's the one.
Jimmy Moore: – for a heart attack or for some heart-related event, and they checked their cholesterol. Want to know what percentage of them had “healthy” levels of cholesterol? Seventy-five percent, so 3 out of every 4 had cholesterol levels below 200, whether it was naturally below 200 or with a statin drug, and yet they were still admitted to the hospital with a heart-related event.[silence]
Diane Sanfilippo: [laughter]
Jimmy Moore: Oh, you forgot to turn on your microphone. I'm going to play Liz this time: You forgot to turn on your microphone!
Diane Sanfilippo: I'm back. I'm back. My printer actually is possessed, and so it started doing its whole rigmarole over there with the sound and all that.
Jimmy Moore: Mwrrrrr.
Diane Sanfilippo: This was another thing. The question comes up a lot, why is it that the number keeps getting lower where doctors are recommending a statin? And why are the doctors so insistent? What I've told people – and again, tell me if this is accurate – you can actually sue your doctor if you were to have an incident, a heart attack, and they did not recommend a statin drug to you.
Jimmy Moore: That's right.
Diane Sanfilippo: It's a standard of care. This is written in their… You're going to be a doctor, and you're going to be measuring cholesterol, and this is what you're going to do. If it comes back at this number, you have to recommend this drug. We know you don't have to take it just because they recommend it, but if they don't recommend it and something happens, they could be sued.
Jimmy Moore: That's right.
Diane Sanfilippo: OK, so that's why they're doing it.
Jimmy Moore: Yeah, the ATP Guidelines is what they're looking at, the ATP Cholesterol Guidelines. Currently we're under the ATP 3 Guidelines, which were out about a decade ago, where they supposedly looked at all of this science that supported whatever the science was saying about cholesterol. The unfortunate thing is they're debating ATP 4, and the reason it's taking so long is because they need what they call that first level of evidentiary science to support it. Well, unfortunately nobody's buying into all the research that's being done on LDL particles. Nobody's doing studies on triglycerides and HDL. The only thing that has that level-one evidence is LDL because back in the '90s, that's what everybody was obsessed on. That's what all these statin drug companied poured their money into because guess what? Statin drugs do a darn good job of lowering LDL cholesterol. So they didn't care about anything else. The only thing we have is level-one evidence for LDL, but even that evidence is shoddy at best. They really need to be looking at practical, who is actually using triglycerides, HDL, the particles – all of these things – in practice, what are the results they're seeing, and they need to be publishing those results, but unfortunately they don't have the money to get the properly funded and properly formulated research to do it. So yeah, they're going to keep lowering that level. I think what I heard from one of my experts is they're going to lower the total cholesterol levels to be 180 or less, and then LDL they're wanting to lower –
Diane Sanfilippo: [laughter]
Jimmy Moore: I know. It's absurd, isn't it? And then the LDL they want to lower from 100 to 70 now. They'd be shocked at my 200-something LDLs!
Diane Sanfilippo: And mine! Well, not my 200 LDL. So just to kind of reiterate for people, the reason why your doctor still has the information that he or she has is that these guidelines can't change when the research isn't there to support it. Part of the reason the research isn't there, quite frankly, is that drug companies don't want to spend money to prove any of what they're currently doing wrong or inaccurate.
Jimmy Moore: Right.
Diane Sanfilippo: A $30 billion-a-year industry, statin drugs? Probably more now at this point?
Jimmy Moore: Yep. $29 billion annually as of the last one, but I would not be surprised if it's more.
Diane Sanfilippo: Huge industry.
Jimmy Moore: Yeah. It's gone generic now, so they may make a little bit less, but wah on them!
Diane Sanfilippo: So that's the thing: When it comes to research, there are a couple of different big reasons why it's easier or harder to get research done when it comes to nutrition and health and all this stuff in humans. It's sometimes really hard to do research on diet and things like that because you can't do things that might cause harm.
Jimmy Moore: Right.
Diane Sanfilippo: So it's really hard to just get that information. And the second part is just that funding unless the drug companies are going to fund it, which they're not because the answer has nothing to do with the prescription. So that's one real issue. The other that I think Dr. Dayspring was talking about is, can you imagine the thousands, tens of thousands, hundreds of thousands of doctors, MDs, who've been saying one thing for the past 20 years… I remember as a child having my cholesterol tested and my parents worrying about it as a child.
Jimmy Moore: Yeah.
Diane Sanfilippo: We didn't really do anything about it. I remember I went to summer camp, and when I came back it was better. I don't know what that really meant. But can you imagine that you've been going to your doctor for however long and they have been bullheaded on the fact that they are right and this is what's true, and now all of a sudden they're wrong? Then what?
Jimmy Moore: Yeah. And that's kind of where we are. They're stuck.
Diane Sanfilippo: And reeducating that entire system… This is another one of those things where we can't wait for the medical system to do what's right. We have to be self-motivated. We can't wait for the US Department of Agriculture to tell us the right thing about what to eat. You just can't rely on the government to do this kind of stuff.
Jimmy Moore: Preach it, girl.
Diane Sanfilippo: I mean, this is why I don't have a doctor. I don't have a health condition that needs to be monitored, and – knock on wood – that's why I do what I do with my diet and lifestyle because I know that those things are in the cards for me if I didn't live the way I live. But it's very rare that I think that person will know and do something for me that's helpful. And that's unfortunate.
Jimmy Moore: And the good news is you can find a lot of great information – yeah, there's some crappy information, too – but a lot of great information online. You can run your own cholesterol tests and other health tests. We talk about that in the book, where you can go and do that on your own without a doctor. A lot of people think they have to go to a doctor.
Diane Sanfilippo: Right.
Jimmy Moore: Now, I have great respect for the medical profession, but you're right. You have to be very discerning about who you go see, which is why I'm glad to see Primal Docs and Paleo Physicians Network and my Low-Carb Doctors Blog. All of those doctors on all of those lists are doing really great work, trying to help patients, and looking at the patients and not at whatever their numbers say.
7. How to talk to your doctor and what to ask for [56:15]
Diane Sanfilippo: OK, so last couple of questions here. You mentioned briefly before about what people should really get tested, and I'm sure this is all covered in great detail in the book. I definitely think anybody who's interested in this topic – you know, I've referred to a few different podcasts before. I love your interview with Dr. Dayspring, but it's definitely very scientific and sometimes hard to understand. The same thing with Chris Kresser and Chris Masterjohn who did a three-part series that I loved. Again, you and I kind of need to end up distilling this stuff, but it's just because this is what we do, not because other people shouldn't be able to understand it, but hey, they've got other jobs and things that they're experts at!
Jimmy Moore: Yeah.
Diane Sanfilippo: So what are the LDL markers, what are those couple of markers that people really do need to get measured? What do they need to tell their doctor because I have a couple people saying: You know, I asked for this, and they didn't do it. What is it that I really need to be hard and fast on asking for? And then I want to close out just talking about how we can have conversations with doctors about this stuff.
Jimmy Moore: Yeah, the problem is when you go to your doctor and you ask for a specific test and they say: Oh, well, only if you have a history of heart disease in your family should you have that run. You are the one in control of your health. You're actually hiring that doctor as a consultant in your health. He or she is not the final arbiter about what happens to your health. You are! So if you want and you ask for specifically by name that particle size test – And there are several of them. I tend to like the NMR LipoProfile test. – If you ask specifically for that test and then they give you push-back, you say: But I want the NMR LipoProfile test. Just be persistent and say: That's what I want to have run. And even if insurance doesn't cover it, you can get that one run online for $125. I don't have health insurance. I do it all the time just to kind of see where my numbers are. That's the one you want to get because it is going to tell you the story. It will give you all the standard lipid panel results – LDL, HDL, triglycerides, all that stuff – but it also gives you the particle breakdown so you get the particle number, the particle size, and then you can see exactly where you stand.
There's also another number on there that tells you about insulin resistance on that NMR LipoProfile test. It's an LP-IR score, and that's a really big one, too. I've seen some people have really good triglycerides and HDL, but then the LP-IR score tends to be elevated somewhere around 40 or 50. Well, optimally it needs to be below 15. If it's above 15, you're starting to show signs of insulin resistance. Mine's 10, by the way. And so you bring that number down the same way that you raise HDL and lower triglycerides. Find your carbohydrate tolerance to that level that allows your triglycerides to drop below 100, find the fat intake that allows your HDL to go above 50, and when you do that, your LP-IR score is going to come down and you're not going to show signs of insulin resistance. And I can tell you, Diane, one simple test that people can do if you don't want to run cholesterol all the time. A lot of my experts in the book, and we have 29 of them, a bunch of them said stop measuring your cholesterol. Measure your blood sugar instead. See where your fasting blood glucose levels are and even postprandial. Let's see what's happening during meals. That's going to really tell you a lot of the story about your true heart health issues.
Diane Sanfilippo: A couple quick follow-ups there: The way I would probably frame this for people is when they get their basic numbers back, the total, the HDL, the LDL, the triglycerides, normally I would only tell people: You know what? Go get those additional tests if something comes back where your doctor is worried or you're worried or that LDL number is over 200.
Jimmy Moore: Right.
Diane Sanfilippo: At that point or close to it, maybe there's something else going on and it's worthwhile, because for some people they're like: Well, I don't have $100 to spend, so do I need to do this additional testing? Perhaps for them, unless they're reaching these points where we know there can be some other metabolic issues going on, I mean, is that something that you would say? Obviously there are people who want to get all of it tested just to know, but are there those people where it's like: OK, for you, you really should find out deeper information?
Jimmy Moore: Yeah, and for the purposes of helping people figure out what some of those things are, we have a whole chapter in there of if you have this levels that are a little bit higher than what your doctor would prefer, let's try to take a look at what's causing that LDL and total cholesterol to be so high to begin with. Artificially lowering it with a statin drug is not going to solve whatever that issue is. If you have some kind of a gut infection going on, you need to take care of that. This is not going to be cured by taking a drug to lower your cholesterol. So definitely listen to your body, let those numbers tell you the story, and if your numbers are elevated, something else is going on. Now, for me personally I can tell you my 306 total cholesterol, that is a sign something's going on, so I've been actively dealing with that. I have long presumed it was my teeth health issue, so I got all the mercury amalgams taken out of my mouth, and I had some infections fixed and teeth pulled. It gave me a lot of pain, by the way! I had all of those things done. I'm anxious to see, Diane, if six months down the road I retest and suddenly my cholesterol levels are “normal” because I fixed the underlying issue, not because my doctor insisted I take a statin drug and I never dealt with that underlying issue.
Diane Sanfilippo: Bring the firefighters home!
Jimmy Moore: Yep.
Diane Sanfilippo: Before they actually get a chance to do what they're supposed to do.
Jimmy Moore: Exactly.
Diane Sanfilippo: I just had another really quick curiosity question.
Jimmy Moore: Sure.
Diane Sanfilippo: That insulin resistance number, I'm curious if people who see improvements in their cholesterol and their LDL particles and all of that, if any of them are coming back showing signs of insulin resistance but it's not pathological. I know Robb Wolf has talked about this before, where if you're on a low-carb diet, a ketogenic diet for a really long time, you can become insulin resistant. But when I say “not pathological” if you're listening, it just means it's not dangerous or unhealthy or something that will lead to metabolic derangement. It's just that you haven't been using sugar for so long as a primary fuel source that your cells actually are not as receptive to some of the signals from insulin because you haven't needed it for a long time. You've sort of shut down that processing a little bit, so if you were to actually carb binge one day, your blood sugar might be extremely high because the insulin's just been kind of chilling out when you haven't really used it. So have you seen that at all? I'm just curious or not sure.
Jimmy Moore: In myself personally or in the people that read my blog?
Diane Sanfilippo: Yeah, have you seen it in anyone where they are coming back showing that a little bit of an elevated level but you know that that's really not a pathological thing, it's not an issue? Have you ever seen that? Or does that measure take that into account somehow?
Jimmy Moore: Peter at Hyperlipid has also talked about this quite a bit. Definitely check out his work. But yeah, that's what we're going to talk about in my next book, Keto Clarity. We're going to kind of get into some of those things, the unintended consequences that may be happening. And maybe they're good, maybe they're bad. We'll definitely vet all of that out. But I haven't personally seen that, Diane, and I've been pretty ketogenic for about 10 years now.
Diane Sanfilippo: Cool. Well, that's good to know. And we get a teaser of what the next book will be! OK, so just to wrap things up, I think we covered a lot of great information. What I'll try and do is put links to everything, obviously links to your book and to previous shows. If you have a couple of other previous shows that you think you want me to send people to besides the one, I think it was on Ask the Low-Carb Experts with Dr. Dayspring, which is my… For some reason, my iPod…
Jimmy Moore: Plays that one?
Diane Sanfilippo: Well, it plays this weird random one, one of Sean Croxton's shows whenever I plug it in.
Jimmy Moore: Sean's on mine, too! It'll just start playing in my pocket.
Diane Sanfilippo: His, like, adrenal webinar keeps coming up whenever I plug my phone in, and I'm like: Oh, what's up, Sean? It's every time I turn my phone on.
Jimmy Moore: Yo! What's up, y'all?!
Diane Sanfilippo: Yeah! It's just this on interview, my phone that won't sync everything, that interview is always there, and I love re-listening because inevitably you hear something new each time or you understand things differently so they make more sense the more you hear them… well, for me. But yeah, send me any links you have to more shows that you think people should listen to. And then let's just have a little quick conversation about what people can do if they're having trouble having this conversation with their doctor, if they're dealing with a doctor who either just doesn't believe in what they're doing nutritionally. I think a lot of people have the experience where their numbers improve dramatically, and so most of the time the doctor doesn't argue with that, right? Most of the time the doctor's like: OK, whatever you're doing. They throw their hands up like: Whatever, I don't know. They don't even understand why things got better!
Jimmy Moore: But you know what? Before it even gets to that level where they throw their hands up and they see the results, they probably already have been pushing a statin really hard.
Diane Sanfilippo: Right.
Jimmy Moore: So like we talked about earlier, let them do the things they have to do to CYA themselves –
Diane Sanfilippo: Yeah.
Jimmy Moore: – Because they have to do that. That doesn't mean you have to fill it. Now, obviously I'm not giving medical advice or anything like that, but if you want to try these nutritional approaches we talk about for improving your numbers without using medications, you can take that prescription obediently from your doctor. He has legally fulfilled his obligation to give you the prescription. You can proceed to rip it up and throw it in the garbage can if you want to and give this a try and then go back in and get markers done. That lady I was telling you about earlier who dropped her cholesterol from 225 down to the 180s, that happened because her doctor said: Statin, and she said: I want to do it nutritionally, and she did do it nutritionally. So it is possible. It is happening. That's how you approach it with your doctor. Play their games because unfortunately that's kind of the system we live in. You have to allow them to CYA. And if you allow them to do that and then you see results, we explain everything in the book. There is a one-pager in the back of the book that you could literally rip out and give to your doctor if you wanted to, to say: This is kind of what I'm shooting for with my numbers. And it may be different from what they learned, so who knows? Maybe they'll learn something in the process of checking out Cholesterol Clarity.
8. Familial hypercholesterolemia [1:07:14]
Diane Sanfilippo: And just so I know, because I did have a couple of questions on this, do you guys cover some issues around familial hypercholesterolemia in the book?
Jimmy Moore: Oh, yeah.
Diane Sanfilippo: OK. So there is a genetic disorder.
Jimmy Moore: There is. And a lot of people think it's automatic if your levels are at certain levels. On your cholesterol test results, and it's always been on mine since it's been over something like 275. Every single time, Diane, I get my cholesterol test results back, it says: Candidate is very likely to have familial hypercholesterolemia. I kept seeing that over and over again, so when I started writing this book, I said: You know what? I'm going to get tested. Guess what? Those tests aren't cheap to run. I ran the two major tests measuring for whether you have FH or not. There's homozygous, which is where you have it from both parents. That's the really, really bad one because those are the people who get heart disease in their 20s and die very early. And then there's heterozygous where you get it from one parent and it's not as bad. You can certainly control it a little better, but it's still bad enough and you have a propensity to have higher cholesterol. So I had it run because when I had the 419, I was thinking: OK, here we go. Maybe I have FH. Well, I ran it, and $1200 later I have a very small chance of having FH. So in other words, it's not FH why mine is high, which kind of begs the question, if it's not FH, what else could it be? And so we kind of go through all those things. But yeah, familial hypercholesterolemia is definitely one that people should be at least aware of. If you've tried everything else, you've eliminated every other possibility that it could be why your cholesterol is high, then maybe FH comes into play, and we go into pretty good detail in the book about what you can do about it.
Diane Sanfilippo: And those are the people who need to find out a little bit more whether or not a medication is helpful for them. I wonder, too, if these medications were developed and they were helping people with FH and then it just became this explosion of like: Oh! We can lower everyone's cholesterol, and that's going to be healthy for everyone!
Jimmy Moore: Yeah.
Diane Sanfilippo: Well, this was really fantastic. Everyone can check out your work, as we said, at… Do you want to give them your website address again?
Jimmy Moore: Sure! It's LivinLaVidaLowCarb.com, or if you just Google “Jimmy Moore,” I'm very lucky. The first whole page of my name is my stuff. And then CholesterolClarity.com is the book website.
Diane Sanfilippo: I'll link them up. Thank you so much!
Jimmy Moore: Thank you!
Diane Sanfilippo: I really enjoyed this conversation. Have fun at AHS!
Jimmy Moore: Well, it would have already been done, actually!
Diane Sanfilippo: Well, that's OK. I'm going to say: Have fun. And you'll say: Oh, I had fun!
Jimmy Moore: Yes, I had great fun!
Diane Sanfilippo: Awesome. All right, we'll catch you soon.
Jimmy Moore: Thank you.
Diane Sanfilippo: So you can find myself at BalancedBites.com, and tune in next week for more of your questions. We'll catch you then!
Diane & Liz