Dagood:
This actually is really similar to an earlier question except that it's not about my patient,
it's about me. So I do have FH, Familial... I can't ever say the long thing.
Chris: That's fine. FH is good.
Dagood: So familial hypercholesterolemia
and I also have multiple food sensitivities. So my diet is already pretty limited. I can't eat wheat
or gluten, and I can't eat any dairy, and corn is not great. So there are a lot of different
limitations that I already have. I'm trying to do everything that I can to address my vascular
inflammation. My cholesterol is obviously pretty high. You and I talked about this some time ago.
I am seeing a cardiologist who has me on statins. I am already experiencing exercise intolerance
when I go out and play a game, I'm wiped out for that night and the following day like I got run
over by a truck and that's at a very low dose. So I'm trying to figure out all the things that
I can do on my own to try and address this. And specifically, I think I need to get after the
inflammation because I have always struggled with inflammation and I have a couple of
autoimmunities. So the question really is the cardiologist is saying that saturated fats will
raise my vascular inflammation and from what you were saying, saturated fats, cholesterol
will get into my bloodstream and not get cleared, which I guess is maybe the same thing. I'm trying
to figure out where to go with my diet when now fats are an issue as well and I'm trying
to address auto-immunity and keep my glucose level low too, because I'm just borderline pre-diabetic.
Chris: Okay. So I think there's
a number of separable issues here. So I guess the first one would be you believe that you
are experiencing exercise intolerance from the statins that you're on, and so it might
be possible to try to brainstorm things around that, but it would be ideal if you could manage
your blood lipids with your diet sufficiently to at least reduce the dose of the statin
if that's causing the exercise intolerance through mechanisms that we're not quite sure about.
So I do think that doing what we talked about before around the lines of a low-fat,
low-saturated fat, low-cholesterol diet is going to be the best way to do that. Now you mentioned
being pre-diabetic and so it is important to take the low-fat part of that, which implies a low-fat,
high-carbohydrate diet in the full manifestation. So first of all, it's a separable component of the
diet so you need a low-saturated fat, low-cholesterol diet
without necessarily eating a low-fat diet. Then second of all, as I talked about before,
the effect of that on blood lipids is dependent on
the healthfulness of your insulin pathway. And so over time, that's something where you
can play the balance between those two things and as you improve your blood glucose handling,
you can fit in more carbohydrates to have a fuller dietary effect.
So I think that in the more immediate situation, I don't think there's any
problem with going on a low-cholesterol, low-saturated fat diet and emphasizing...
I don't think you mentioned any protein foods that you can't tolerate, but emphasizing lean proteins
and whole food lean proteins are things like white fish, low-fat dairy, and poultry products and,
well, most poultry products like chicken breasts. I'm really not a fan in the big scheme of things
of boneless, skinless chicken breasts, but for someone who's specifically trying to get
lean proteins in, chicken breast is great, and if it comes down to being able to lower
the dose of a drug that appears to be causing exercise intolerance,
then I think it does make sense to go down that direction. So just emphasizing... And, of course,
there are also other things, whey protein or something, where if you're trying to get
something more convenient in as a way of getting the protein then that can also be an option.
Dagood: Yeah. I do use pea protein. I can't use
anything dairy, but pea protein. Chris:
Yeah. Okay, fair enough. So nix the whey protein and low-fat dairy concept, but otherwise intact.
And then the high-cholesterol foods... Saturated fat's obvious. That can be plant oils such as
coconut oil, but it can also be... dairy fat is especially high, ruminant meat fat is fairly high
and then most traditional oils aren't super low. So there is saturated fat in olive oil and salmon.
So those are things that are not... You wouldn't want to consume them in
excess or in an unlimited fashion, but having those fattier foods can be used in moderation
mainly under the circumstances of being pre-diabetic and wanting to manage blood glucose.
So then the second component of that would be managing blood glucose, and I don't think it's a
good idea to condemn all carbohydrates as a means of managing that. I think the best thing would be
to get a continuous glucose monitor or a regular glucose monitor. If you're using a regular glucose
monitor, use 30 minute, one hour, two hour, three hour, four hour time intervals after a meal and
collect a baseline before a meal and look at how do different starches that you don't have
an immunological response to... so you don't have to test grains because you don't tolerate them,
but other foods that are rich in starches, whether it's carrots, or potatoes, or sweet potatoes, or
whatever it is. Whatever's in your list of tolerated foods, how do those different foods
affect your blood sugar differently when you control for the carbohydrate intake?
Then also what is the carbohydrate intake that you can tolerate in the context of a
standard mixed meal with the lean proteins you are normally consuming that doesn't cause your blood
sugar to go over 140 at any of those time points? So with a little bit of experimentation, you can
develop starch blocks. Like 30 grams of carrot equals 45 grams of carbohydrate from potatoes
equals whatever. All defined as the maximum amount of starch from the whole food that you
can tolerate without your blood sugar going above 140 at any time point, and then you can develop a
system where you can substitute those blocks of carbohydrate knowing that they fit within
what you've tested. And you can periodically retest just randomly to make sure that it's
still working, but you've gotten a data-driven individualized plan of amounts of specific types
of carbohydrates that you tolerate from both a blood sugar and an immunological standpoint,
and then you have your means of balancing the protein and the fat in a way that is moderated.
Then as you get your blood sugar more under control,
you can eventually increase the carbohydrate and decrease the fat, and those things together
should help you manage your blood lipids in a way that might help you lower the dose of the
medication, which you'd have to work with your doctor on, the prescribing doctor.
So if you can do that, that might help the exercise intolerance.
So that's one super-component of what you asked about. Second super-component of what
you asked about would be, can you get around the statin effect on the exercise intolerance?
So I'm of mixed mind on what might be causing that. I do think that it's possible
that inhibited MK4 and CoQ10 synthesis could both be at work there. Both of them are important
in the mitochondria for energy metabolism. Vitamin K2 goes beyond that by playing a role
in the mobilization of fuel from adipose and liver to muscles during exercise through an effect on
osteocalcin and interleukin-6 signaling. I believe I covered it in The Ultimate Vitamin K2 Resource
at chrismasterjohnphd.com/k2. But anyway, there's multiple ways that MK4 and CoQ10...
...both of which are decreased in synthesis by statins that they would play into exercise
intolerance, so that's one component. Another component of that would be that,
I think, just generally feeding lipid-soluble things to the muscles is going to be an issue,
and so if you are increasing LDL receptor activity or you're biasing lipids towards the liver and
away from the muscles... The only way I can think of to get around that is really to
just ramp up the supply of fat-soluble nutrients, and that's going to be especially important
if you're eating a lower-fat diet because your absorption of fat-soluble nutrients in general
is going to be lower, but just supplementing with a mixed cocktail of fat-soluble vitamins might be
a way to get around that, I'm speculating, but it seems like it's probably important.
That's, I guess, how I would see that second super-component of what you said, and then I
believe the third big super-component was addressing vascular inflammation.
I'm not sure what you are thinking of there. What measurements have you gotten of vascular
inflammation? Dagood:
Honestly, I've got just the most basic stuff. I think, in general, they're not seeing really high
markers, they're just telling me that saturated fats will increase vascular inflammation. I have
high oxidized LDL. That's one of the markers. Chris:
Got it. So everything that I talked about in the first super-component for getting
the blood lipids under control will directly impact the vascular inflammation in your case-
Dagood: Okay.
Chris: ... LDL oxidation probably is
the main thing contributing to that. Dagood:
Okay. All right. That's very helpful. Thanks a lot. Especially about the exercise intolerance.
I had sort of dropped off some of my supplements and I can ramp those back up and see what happens
because I'm on a minimum statin. It's 10 milligrams, three times a week so if I can't
handle it here, I can't handle it. Chris:
Sounds great. Dagood:
Thanks a lot. Chris :
You're welcome, take care.