#263 – How do macronutrients affect your blood sugar and metabolic health? | Dr. Robert Lustig & Ben Grynol

Macronutrients include fat, protein, and carbohydrates. Fiber is a type of carbohydrate. All four nutrients have different effects on glucose and metabolic health. Dr. Robert Lustig and Ben Grynol discuss the metabolic health effects of each macronutrient, how to prevent age-related muscle loss, how to improve gut health, and more.

(03:36) — Protein helps prevent age-related muscle loss

Protein is a macronutrient that in conjunction with exercise (i.e., resistance training) helps build and preserve muscle to prevent sarcopenia.

Protein is the macronutrient of the moment. Everybody is really excited about protein. And the reason they’re excited about protein is because of new data that shows that muscle loss leads to metabolic syndrome, declining health, and early death. No question, sarcopenia is a bad guy in this story. As we said, aging is a driver of sarcopenia. Without question, protein is essential to mitigate that risk. But it’s not just protein; it’s protein plus exercise. You cannot turn protein into muscle unless you exercise as well.

(04:25) — What if you just consume protein and do not exercise?

Protein also helps blunts glucose spikes.

The answer is protein will lower the glucose rise. One reason it will lower the glucose rise is because protein is mixed in all the other food, so it presents a competitor to glucose absorption. So it keeps the glucose in the lumen longer because of the various nutrients within the digestive food, as opposed to a soft drink where it gets absorbed super easily and super rapidly.

(05:21) — Leucine is a stimulator of insulin release

Leucine is one of the nine essential amino acids.

Twenty amino acids compose the different proteins we consume. Nine of those amino acids are called essential amino acids. You have to consume them; your body can’t make them. And you have to get those nine essential amino acids. One of those amino acids that’s essential is called leucine. Leucine is very high in milk, and it’s very high in corn. And leucine, of all the other amino acids, is the one that goes to the beta cell and stimulates insulin by itself without glucose. So we always talk about glucose being a stimulator of insulin release, but leucine is a stimulator of insulin release as well. When you consume high doses of leucine, in the form of corn-fed beef, chicken, and fish, or in the form of milk, you will generate a greater insulin response, which will keep your glucose spike lower—because, after all, insulin’s clearing glucose from the circulation. So that sounds like a good thing. But, as we’ve talked about, that insulin rise is part of the problem because it’s driving growth when you want burning. So in a sense, it’s making your cell be dyssynchronous with the food load that it is dealing with. So, while keeping the glucose down is essential and the whole reason for wearing a CGM, the goal is to keep the insulin down. And leucine makes the insulin go up.

(08:55) — Which fats are good and bad for you?

Dr. Lustig explains the seven different types of fats and their pros and cons.

And then finally there’s fat. Dietary fat. And that’s really complicated. And the reason is that there are seven different fats and they all do different things. And three of them are good for you. And three of them are a little less good for you. And one of them is downright poison. We have to discuss each one because people want to know. What are the good-for-you ones.

(13:22) — How dietary fat affects your glucose response

Dietary fat when consumed alone will not cause a blood sugar spike. When consumed with carbohydrates, fat will prime the beta cells to release more insulin.

What does dietary fat do to your CGM reading? Well, it depends. It depends on what exactly you are eating. If you are eating straight fat, like a ketogenic diet, your serum glucose should vary almost not at all. And the reason is that fat does not stimulate glucose. It does not stimulate insulin. However, what fat does is it primes the beta cell to release more insulin in response to glucose. So if you eat fat and glucose together (i.e. Cinnabon), the fat is going to prime the beta cell to release more insulin in response to that glucose rise than it would have otherwise. So even though it didn’t change the glucose response, it changes the insulin response. And you will get a bigger insulin response because the fat was paired with sugar. And that’s pretty much true for fat and virtually any carbohydrate. So in and of itself, fat is not a stimulator of glucose rise or insulin rise. But because it primes the beta cell, it generates an increased insulin response, which is not good from a metabolic standpoint.

(14:59) — The importance of fiber

Many people in the United States are not getting enough fiber.

Fiber is the stealth nutrient. Fiber is your friend. Fiber is probably the most important nutrient you don’t absorb. For years, fiber wasn’t even a nutrient because you didn’t absorb it. The FDA finally made a change and said, “Yes, we do need fiber in our diet.” And they set a minimum amount of 25 grams per day. The median for America right now is 12 grams per day. We all probably should be getting about 50 grams per day. That gives you some idea about where we are. We’re getting about one-quarter of what we need and about one-half of what is at least rational. Now, why is fiber so important?

(15:52) —What does fiber do?

Dr. Lustig explains the six functions of fiber.

Fiber does six things that all improve metabolic health. The first thing it does is it gives some bulk. It gives a mechanical stretching for the stomach, which gives you a feeling of fullness, reducing total food intake. Number two: The insoluble fiber, the cellulose, forms a latticework, like a fishnet, on the inside of your intestine. The soluble fiber—the pectin, the inulin, like what holds jelly together—they plug the holes in the fishnet, and together they form a gel, a whitish gel, and you can see it on electro-microscopy, coating the inside of your small intestine and generating a secondary barrier. And that secondary barrier prevents the transport of glucose and fructose and sucrose and starches from the intestine into the bloodstream, this keeping your blood glucose down, which you measure on your CGM. Well, that keeps your insulin down. And so that’s good for your metabolic health because it’s all about getting that insulin down . . .

[00:00:00] Fiber is the stealth nutrient. Fiber is your friend. Fiber is probably the most important nutrient you don’t absorb. Okay. For years, fiber wasn’t even a nutrient because you didn’t absorb it. The FDA finally made a change and said, yes, we do need fiber in our diet. And they set a minimum amount of 25 grams per day.

[00:00:29] Okay. The median for America right now is 12 grams per day. We all probably should be getting about 50 grams per day. Alright, that gives you some idea about where we are. We’re getting about one quarter of what we need and about one half of what is at least rational. INTRO

[00:00:49] Ben: So in February of 2024, Dr. Robert Lustig and I found ourselves sitting across from each other in Los Angeles. We had planned to sit down and have a little chat about metabolic health and some of the implications around lifestyle, sleep, exercise, all these pillars of metabolic health. When we ended up sitting for six hours, we had a really deep conversation and we covered a number of topics.

[00:01:16] Ben: The idea was that we were filming some videos, some short form videos, which would be helpful for Levels members and anyone interested in metabolic health generally to get more insight into some snippets, some takeaways of what they could think about certain categories of metabolic health. Well, we decided to cut these into a podcast as well.

[00:01:36] Ben: So we’ve got a number of topics and we thought, why don’t we categorize them and people can pick and choose what they want to listen to. So lots of good information, lots of soundbites here, but we stitched them together into these different categories. So, there’s some transitions, but it might be something that is of interest.

[00:01:53] Ben: So the idea is always, I hope it helps people to learn more, to take metabolic health into their own hands

[00:01:59] Ben: In this episode, Rob covers macronutrients and nutrition. Specifically Things like protein, fat, fat and glucose regulation, fiber, sources of fiber, and then sugar. What’s the difference between fructose, sucrose, and glucose? What happens when you have excess fructose? How does that lead to increases in uric acid and overall metabolic dysfunction?

[00:02:23] Ben: What are some of the implications around low carbohydrate diets and cholesterol? and how can people think about low carbohydrate diets as it relates to glucose? Lastly, it provides an outlook on cholesterol.

[00:02:35] Now there’s protein. So protein is the macronutrient of the moment. Everybody’s really excited about protein. And the reason that they’re excited about protein is because of new data that shows that muscle loss leads to metabolic syndrome, declining health, and early death. No question sarcopenia is a bad guy in the story.

[00:03:03] And as we said, aging is a driver of sarcopenia. And without question, protein is necessary to mitigate that risk. But it’s not just protein, it’s protein plus exercise. You cannot turn protein into muscle unless you exercise as well. What if you just consume protein? That’s all. The answer is, protein will lower the glucose rise.

[00:03:36] One reason it will lower the glucose rise is because protein is mixed in all the other food and so it presents a competitor to glucose absorption. So it keeps the glucose from rising. in the lumen longer because of the gamish of the, uh, various nutrients within the, uh, within the chyme, within the, the, the digested food, as opposed to, say, a soft drink where it gets, uh, absorbed super easy and super rapidly.

[00:04:08] So, it will keep the glucose rise down for that reason. But it’ll also keep the glucose rise down for a different reason, which is maybe not so good. So protein, as you may know, have 20 amino acids that compose the different proteins that we consume. Nine of those amino acids are called essential amino acids.

[00:04:34] You have to consume them, your body can’t make them. And you have to get those nine essential amino acids. One of those amino acids that’s essential is called leucine. And leucine is very high in milk, and it’s very high in corn. And leucine, of all the other amino acids, is the one that goes to the beta cell and stimulates insulin by itself, without glucose.

[00:05:06] So we always talk about glucose being the stimulus to insulin release. Yes, but leucine is a stimulator of insulin release as well. When you consume high doses of leucine in the form of corn fed beef, chicken, and fish, or in the form of milk, you will generate a greater insulin response, which will keep your glucose spike lower, because after all, insulin’s clearing glucose from the circulation.

[00:05:37] So that sounds like a good thing, but as we’ve talked about That insulin rise is part of the problem, because it’s driving growth when you want burning. And so, in a sense, it’s making your cell be dis synchronous with the food load that it is, uh, uh, dealing with. So, while keeping the glucose down is essential, and the whole reason for wearing a CGM, the goal is to keep the insulin down, and leucine makes the insulin go up.

[00:06:14] And then finally there’s fat, dietary fat, and that’s really complicated. And the reason is because there are seven different fats, and they all do different things. And three of them are good for you, and three of them are a little less good for you, and one of them is downright poison. So we have to discuss each one because people want to know.

[00:06:43] All right, what are the good for your ones? Omega 3s. Omega 3s are the single best thing you can put in your body. Omega 3s, as we’ve talked about, you can find in certain vegetables and in marine life. Omega 3s are heart healthy, anti inflammatory, anti Alzheimer’s, and our current Omega 3 consumption is way low.

[00:07:07] Number two. Monounsaturated fatty acids. Oleic acid. This is what’s in olive oil. Olive oil is a winner, and the reason is because olive oil stimulates the liver to produce a transcription factor which helps total body metabolism. And that’s a good thing. The only bad thing about olive oil is if you heat it too high.

[00:07:31] Because the double bond in olive oil that makes it a monounsaturated fatty acid can flip when you put heat across it. And if it flips, now you have a trans fat, which is the worst. Number three, polyunsaturated fatty acids. You know, walnut oils and various other nut oils are polyunsaturated. They are also good.

[00:07:54] They also will keep your LDL down. They will keep your membranes intact in good ways. But like olive oil, if you put enough heat across those double bonds, they will flip and you will get trans fats. And because there are more double bonds, more risk for it. Number four, saturated fat. Now everybody thinks saturated fat is bad because they’ve been told for 50 years as saturated fat is the bad guy.

[00:08:25] No, saturated fat is cardiovascularly neutral. It’s neither good nor bad. It doesn’t have any double bonds. So you can heat it to any level you want and it won’t change its structure Because there’s no double bond to break or to flip. Um, it is not necessarily good for you But dairy saturated fats have a phospholipid signature, which actually is associated with metabolic health prevention of cardiovascular disease and diabetes So dairy saturated fat and red meat saturated fat aren’t even the same.

[00:09:03] Number five, medium chain triglycerides. Now they’re also very, uh, hot, because number one, the vegans love it, because they’re not animal fat, things like coconut oil, and the paleo, uh, people love it, because it, you know, fits within the paleo diet. And for the most part, they tend to be reasonably good too, unless you mix them with a whole lot of saturated fat, in which case you end up with a whole lot of triglyceride being, uh, manufactured in the liver, which is not so good.

[00:09:38] Number six, omega 6 fatty acids. These are the seed oils, the, um, soybean oil, the, uh, cottonseed oil, the, uh, corn oil, et cetera. And those are the precursors of arachidonic acid. And Uh, therefore, uh, the precursors to inflammation. And so they drive inflammation, and you want to try to keep those down. And they are in virtually every ultra processed food.

[00:10:04] And then finally, number seven, trans fats, which are the devil incarnate. And the reason is because we don’t have the, uh, enzyme to break that trans double bond. Well, the reason they were put into the food in the first place was because the bacteria don’t have that enzyme either. They can’t chew them up.

[00:10:25] They can’t make trans fat laden food rancid, vis a vis the 10 year old Twinkie. And so virtually every baked good prior to 2000 had a multitude of trans fats. Well, they were lining our arteries and our livers and causing metabolic syndrome and early demise.

[00:10:45] So what does dietary fat do to your CGM reading? Well, it depends. Depends on what exactly you’re eating. If you are eating straight fat, like a ketogenic diet, your serum glucose should vary almost not at all. And the reason is because fat does not stimulate glucose. It does not stimulate insulin. However, what fat does is it primes the beta cell to release more insulin in response to glucose.

[00:11:21] So, if you eat fat and glucose together, i. e., uh, Cinnabon, The fat’s going to prime the beta cell to release more insulin in response to that glucose rise than it would have otherwise. So even though it didn’t change the glucose response, it sure as hell changed the insulin response and you will get a bigger insulin response because the fat was paired with sugar.

[00:11:55] And that’s pretty much true for fat and virtually any carbohydrate. So in and of itself, fat is not a stimulator of glucose rise or insulin rise, but because it primes the beta cell, it generates an increased insulin response, which is not good from a metabolic standpoint.

[00:12:20] Fiber is the stealth nutrient. Fiber is your friend. Fiber is probably the most important nutrient you don’t absorb. Okay. For years, fiber wasn’t even a nutrient because you didn’t absorb it. The FDA finally made a change and said, yes, we do need fiber in our diet. And they set a minimum amount of 25 grams per day.

[00:12:49] Okay. The median for America right now is 12 grams per day. We all probably should be getting about 50 grams per day. Alright, that gives you some idea about where we are. We’re getting about one quarter of what we need and about one half of what is at least rational. Now, why is fiber so important? Fiber does six things that all improve metabolic health.

[00:13:17] The first thing it does, It gives some bulk, it gives a mechanical stretching to the stomach, which gives you a feeling of fullness, reducing total food intake. Number two. Insoluble fiber, the cellulose, forms a latticework, like a fishnet. on the inside of your intestine. The soluble fiber, pectins, the inulin, like what holds jelly together, are globular.

[00:13:48] They plug the holes in the fishnet and together they form a gel, a whitish gel, and you can see it on electron microscopy, coating the inside of your small intestine and generating a secondary barrier. And that secondary barrier prevents The transport of glucose and fructose and sucrose and starches from the intestine into the bloodstream.

[00:14:14] Thus, keeping your blood glucose down, which you measure in your CGM. Well, that keeps your insulin down. And so that’s good for your metabolic health, because it’s all about getting that insulin down. Third thing. The food doesn’t get absorbed early, so it moves through the intestine. where the microbiome lives and it will chew it up for its own purposes.

[00:14:38] So you are feeding the gut. And when you feed the gut, then you’re Intestine bacteria don’t have to chew on the, uh, mucin layer that’s protecting it. Number four, it greases the skids and moves the food through the intestine faster. This is why fiber laxatives exist, is to prevent constipation, because it carries water with it and moves the food through the intestine faster.

[00:15:03] Well, that generates the satiety signal at the end of the intestine sooner, faster. So you won’t eat that second portion. Number five, the soluble fiber in what you eat. serves as food for the colonic bacteria, which will turn that into short chain fatty acids, acetate propionate butyrate, which are anti inflammatory, help prevent irritable bowel syndrome and prevent Alzheimer’s disease.

[00:15:32] And finally, The insoluble fiber acts like little scrubbies on the inside of the colon. Basically sloughing off can colon cancer cells so that you don’t get colon cancer. So the amount of fiber you consume is inversely correlated with your risk for colon cancer. So every single thing fiber does improves your metabolic health and the way it shows up is in the reduction in the glucose response on CGM.

[00:16:02] In fact. A high fiber diet will give you the glucose response of a ketogenic diet. And a ketogenic diet is the one that suppresses insulin the most.

[00:16:17] Any food that came out of the ground has fiber, because that’s what allows the food to get out of the ground. So, fiber is in fruits, yes, fructose is in fruits too, but the fiber reduces the absorption. And so it makes that fructose less of a burden and safe. Fiber is in vegetables. stringy vegetables, not as much for starchy vegetables, uh, green vegetables.

[00:16:52] And of course, if you eat green vegetables, you’re going to get all those antioxidants also, which are good for you as well, because they’re going to take care of the reactive oxygen species we spoke about earlier. Animal products do not have fiber, contrary to popular opinion. So you have to basically restrict yourself to produce.

[00:17:16] Now, does bread have fiber? And the answer is, very few. Some breads do, because they’re made from grain, and wheat has fiber, until the mill takes it away. So if you take a wheat berry, And you measure the weight of the husk, which is the fiber, against the weight of the endosperm, which is the starch in the center.

[00:17:45] Turns out the fiber is 25 percent of the kernel. 25%. So in order to find a high fiber bread, you have to look at the total carbohydrate to dietary fiber ratio on the side of the package. And you have to do the calculation yourself, because they’re not going to do it for you. If the total carbohydrate to fiber ratio is 3 to 1 to 5 to 1, then that is a high fiber bread.

[00:18:15] And that is a bread worth eating for its metabolic benefits. Anything above that means that the fiber has been stripped out. And even if they call it a high fiber bread, it’s not. Even if they call it a whole grain bread, it’s not. Because they can call it whole grain if they started with whole grain before they did the pulverization and got rid of the husk.

[00:18:43] So just because it’s brown doesn’t make it good. You actually have to look at the fiber content of the bread. So, what breads are high fiber breads? You can go to Whole Foods or to specialty grocery stores and look for German fitness bread, as an example. So this is bread that is a pound, but it is like a brick.

[00:19:08] It’s thin, and it’s small, and it is dense. It has very high fiber. It’s cut very thin. And it makes a really lousy sandwich. And the reason is because there’s not that much gluten in it to hold it together. If you go to the grocery store, the breads are twice or to four times the size. They’re all puffed up.

[00:19:33] Those are high gluten breads. They make a terrific sandwich. But they have all had their fiber stripped out. And they all have carbohydrate to fiber ratios of 8 to 1 to 10 to 1. Those are the breads that are not metabolically worth eating.

[00:19:51] There are 262 names for sugar. 262. And the reason is because the food industry likes it that way. Because they can use a different name for sugar on the side of the package. And a different sugar can be number 5, number 6, number 7, number 8, number 9, and when you add it up it’s number 1. They hide it in plain sight.

[00:20:18] Virtually every one of those 262, it’s because of the fructose. That’s the problem. So what is glucose and what is fructose? And while we’re at it, what is sucrose? And high fructose corn syrup? Glucose is what plants make in starch. Fructose is what plants make in sugar. Starch, not sweet. Sugar, sweet.

[00:20:54] Glucose, not very sweet. Fructose, very sweet. Fructose is addictive, because fructose stimulates the reward center of the brain. And tells you, this feels good, I want more. In the same way cocaine, heroin, nicotine, and alcohol do. And it makes sense because fructose and alcohol are metabolized the same way, do the same things metabolically in the body, and also centrally in the brain.

[00:21:26] Fructose and alcohol both lead to Alzheimer’s disease. Fructose is half. of sucrose, half of dietary sugar, half of high fructose corn syrup, half of maple syrup, honey, agave. If it’s sweet and it’s, quote, natural, it’s fructose. That’s the way it works. Fructose. Fructose has metabolic detriments that glucose does not.

[00:21:59] Glucose stimulates mitochondria to work better. Fructose inhibits mitochondria from working better. Fructose inhibits three enzymes. involved in mitochondrial function. I’ll name them real quick. AMP kinase, ACAT L, and CPT 1. Bottom line, fructose inhibits mitochondrial function. Fructose inhibits ATP generation.

[00:22:26] Fructose inhibits energy metabolism. Fructose makes you sick. The goal is keep the fructose down. How do you do that? Well, get rid of the dietary sugar. The problem is there are 262 names for them! And the food industry uses them all. So, until we have policies that address this issue in Washington and London and throughout the world, you have to be on your guard.

[00:23:01] Another problem with fructose is, It’s not measured by the CGM. Glucose is monitored by the CGM, fructose is not. So when you consume something with a lot of sugar, your CGM will rise because of the glucose. But you won’t even see the contribution of the fructose because it’s not being picked up by the CGM.

[00:23:26] But because the fructose does all of these things that glucose doesn’t, it’s seven times worse and you don’t even measure it on the CGM. So absolutely essential to try to keep your dietary sugar consumption low. Low. How low? Well, how about zero? No one needs it. There is no biochemical reaction in any vertebrate organism that requires dietary fructose.

[00:24:00] How’s that? Now, we can tolerate a certain amount. Up to about 25 grams of sugar, therefore 12 grams of fructose per day.

[00:24:15] That would be six teaspoons of added sugar per day. An orange juice is 11 teaspoons. A Milky Way bar is seven teaspoons. A bowl of Froot Loops is four teaspoons. So you can see it adds up pretty fast. Bottom line is if you want dessert, have dessert. Just don’t eat dessert for breakfast, lunch, dinner, and snacks.

[00:24:49] Fructose is a metabolic toxin in the same way alcohol is a metabolic toxin. And it makes sense that it should be because after all, where do we get alcohol from fermentation of fructose? It’s called wine. We do it in Napa and Sonoma every day. The big difference between the two is that for alcohol, the yeast does the first step of metabolism, which is called glycolysis.

[00:25:12] For fructose, we do our own first step after that. They’re virtually identical. In the same way that alcohol, uh, causes metabolic damage, fructose causes metabolic damage. One of those ways is through a compound made in the liver called uric acid. Now uric acid is a bad guy in the story. Uric acid is one cause, not the only, but one cause of hypertension, high blood pressure.

[00:25:42] Uric acid blocks an enzyme in your blood vessels that relax your blood vessels called nitric oxide. Uric acid reduces nitric oxide. Well, fructose metabolism leads to uric acid. And uric acid is a bad guy in this story. So, uric acid also inhibits mitochondrial function. It also generates increased fat in the liver.

[00:26:13] And it increases blood sugar. blood pressure. Fructose is a driver of metabolic syndrome, in part, through uric acid. Keep the uric acid down, keep the fructose down. By the way, while you’re at it, keep the purines down. That’s red meat, because that also raises uric acid, too.

[00:26:36] If you eat a low carb diet, whether it’s a ketogenic diet, or a paleo diet, or just an Atkins diet, okay, what it means is you’re reducing your total carbohydrate, and hopefully sugar, and you are raising your dietary fat. So you will generate a higher LDL, but it’s going to be that large, buoyant LDL, which again is cardiovascularly neutral.

[00:27:01] That’s not the bad guy on the lab slip. It looks like the bad guy because of these reference ranges that make no sense. Ultimately the goal is get the small dense LDL down and statins don’t touch those. The other issue about statins is that 20 percent of people who go on statins either end up with, uh, inflammation of their muscles called rhabdomyolysis.

[00:27:32] Or, because statins are actually a mitochondrial toxin by themselves, end up with hyperglycemia, actually frank diabetes. So the question is, to lower the LDL, that’s not important, but to put yourself at risk for hyperglycemia, which is important, is that a good trade?

[00:27:52] Low carb diets are in vogue. Ketogenic diets are commonplace now, okay? Keto friendly stuff in the grocery store. First of all, is it really keto friendly? How do you know? You think it’s been tested? Don’t be so sure. Just because it says it’s keto friendly doesn’t mean it is. But let’s say you’re doing your own ketogenic diet at home.

[00:28:18] You’re actually making the food yourself and you know what you’re eating. What’s going on is that that fat is priming that insulin response, but because there’s no carbohydrate, you don’t release it. It’s there, but it’s saved up for a rainy day. And then you have that slice of pizza and you break your diet.

[00:28:42] What’s going to happen? Well, you’re going to get this big glucose response because your liver is not going to basically absorb any of the glucose because it, the transporters have gone down. So it’s all going to flood your bloodstream. Your beta cell is going to see a higher glucose response because the rest of your body has learned to run on ketones instead of glucose.

[00:29:09] So you’re not even going to be shoveling glucose into cells. And so, you’re going to get a bigger glucose response, therefore you’re going to get a bigger insulin response because your beta cells have all of this insulin stored up, waiting to go because it hasn’t been called on in weeks and weeks. And so you’re going to get this glucose insulin explosion just because you broke the diet.

[00:29:35] And that is going to drive virtually all that glucose into fat and it’s going to undo that ketogenic diet in one meal. And people who fall out of the ketogenic diet now are not getting the benefits of low carbohydrate anymore. And the reason is because their insulin’s gone up. Now they’re on a high fat, medium carbohydrate diet with insulin, which is about the worst diet you can be on.

[00:30:02] So if you’re going to do a ketogenic diet, you have to actually be pretty fastidious about it. I’m for it. I’m not against it. You can’t just play ketogenic. You have to do it.

[00:30:18] Cholesterol is a funny thing. Cholesterol is necessary. Everybody thinks cholesterol is bad because they’ve heard it causes heart disease. Cholesterol is absolutely necessary. If you need cholesterol, you need cholesterol for membranes. You need cholesterol for steroids. Cholesterol is so essential that our body has a method for manufacturing it out of nothing.

[00:30:42] Out of glucose for that matter. So cholesterol gets a bad rap. And the reason is because there are actually multiple cholesterols. There’s LDL, there’s HDL, and then there’s this other one that’s not really, uh, an LDL at all. It’s called triglyceride, but it goes along with it because it’s VLDL. It’s got some cholesterol in it.

[00:31:18] It’s not the one that matters. It’s the pattern of all of them together that matter. And this is where doctors need to basically go back to med school because all this stuff has changed really in the last ten years. And your doctor may not know it. LDL has always been thought of as the bad guy. High LDL, oh, you need a statin.

[00:31:45] Well, there are two LDLs, there’s not one, there’s two. One’s called large buoyant and one’s called small dense. They are not the same. Except the LDL. So, assay measures both at the same time. So the lab test says they’re the same, but they’re not the same. Large buoyant LDL is cardiovascularly neutral, and it’s the one that dietary fat raises.

[00:32:09] So dietary fat turns out to not be very important in terms of cardiovascular disease. Small dense, on the other hand, is very important. Small dense turns out to be the atherogenic particle. Or at least an evolution of the atherogenic particle called remnant cholesterol. And small dents can get under the surface of the endothelial cell in the arteries.

[00:32:40] And start the foam cell formation process that leads to the plaque that leads to the heart disease. And it’s more easily oxidized because it’s smaller. And so, it’s the bad guy in the story. And what raises your small dense LDL? Well the same thing that raises your triglyceride because that’s the thing that gets turned into the small dense LDL.

[00:33:03] That’s sugar. So sugar is the driver of the LDL fraction that generates the heart disease. Dietary fat. And then we have HDL. HDL, for the most part, is good. The higher the HDL, the better off it is. And the reason is because that’s also an evolutionary output of LDL, once the cholesterol’s offloaded. And then that comes back to the liver to be reloaded.

[00:33:34] So basically, the HDL’s a shuttle mechanism. And so the higher the HDL, the better the shuttle mechanism’s working.