Another important consideration somewhat related to diabetes is Arteriosclerosis or hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis that involves a restriction in the flow area of the arteries resulting from a build-up of plaque (fatty deposits) on the arterial walls. This flow restriction can result in circulatory issues and severe cases can result in bypass surgery. While arteriosclerosis has a variety of causes, some of which are genetic and some are lifestyle-related. Lifestyle-related causes include:
- Various forms of tobacco (and possibly similar non-tobacco) consumption.
- Obesity, diabetes/insulin resistance.
- High triglycerides & low HDL Cholesterol (as a result of insulin resistance)
The prevention of Arteriosclerosis is similar to the control of Type 2 Diabetes: not smoking and maintaining healthy weight. Maintaining a healthy weight requires a healthy diet and staying physically active.
I mention Arteriosclerosis because there has been some controversy about eating a low fat (and especially low cholesterol) diet in order to control [blood] serum cholesterol and triglycerides. There are 2 kinds of serum cholesterol: HDL (High-Density Lipoprotein: “good” cholesterol) and LDL (Low-Density Lipoprotein: “bad” cholesterol). While the American Heart Association maintains that LDL Cholesterol (LDL-C) causes plaque to form on arterial walls, this has been shown to false and people actually live longer with high LDL cholesterol levels. HDL Cholesterol (HDL-C) helps to scavenge some of the LDL from the bloodstream and carry it to the liver for excretion. Excess glucose (primarily from carbohydrates) in the body are converted into triglycerides and stored in fat cells throughout the body. The combination of low levels of HDL Cholesterol and high levels of Triglycerides have been linked to heart disease and the simplest way to control both is to maintain a low and steady baseline level of insulin.
While there are many kinds of dietary fat, they can simply categorized as either being saturated or unsaturated. Saturated meaning that the available molecular positions are occupied by hydrogen atoms and saturated fats are typically solids (as opposed to liquids) at room temperatures. Mono-unsaturated fats contain a single carbon double bond whereas poly-unsaturated fats contain two or more carbon double bonds. The length of the carbon chain in a fat affects how it is absorbed and metabolized. See Saturated Fat.
Fats (and oils) are composed of three fatty acid molecules combined with a glycerol (aka glycerin) molecule . Fatty acids are long, straight chain carboxylic acids and glycerol is an organic compound containing multiple hydroxyl groups. Omega-3 fatty acids are a particular kind of polyunsaturated (fat molecules that have more than one unsaturated carbon bond in the molecule) fatty acid that is important for normal metabolism and that the body is not able to manufacture. While Omega-3 fatty acids can be obtained from plant-based sources (such as seeds and nuts), fish (such as salmon, mackerel, tuna, herring, and sardines) are an especially rich source. The best forms of vegetable cooking oils are the ones that have a lower levels of Omega-6 fatty acids such as olive oil, avocado oil, coconut oil, and red palm oil. Good refined vegetable oil alternatives are canola oil and palm kernel oil. Although demonized by the Diet-Heart Hypothesis, animal fats (butter, lard, tallow, etc) are more stable at high temperature (because they're saturated) and are actually the healthier and tastier alternative. See Revision History: McDonald’s Broke My Heart.
The liver manufactures the majority (about 80%) of the cholesterol in your body with the remaining 20% coming from the food you eat. As a result, it is difficult to control LDL cholesterol levels purely by controlling saturated fat intake. A low-carb diet tends to increase LDL-C levels but research has shown that people with higher LDL-C levels tend to live longer and those with lower LDL-C levels tend to have more Cardiovascular Disease (CVD - including heart attack, angina (chest pain), and stroke). LDL-C is part of the immune system and works with macrophages (white blood cells) to kill infection. A Mayo Clinic Study (published in 2019-11) found that LDL-C was protective against death when people were diseased and, following a heart attack, people were 24% LESS likely to die with HIGH cholesterol.
Russian scientists in 1908 developed the Lipid/Cholesterol Hypothesis based on research involving feeding saturated fats to herbivores. Ancel Keys used the Lipid Hypothesis to develop the Diet-Heart Hypothesis (ultra low fat diet with avoidance of saturated fats) and cherry-picked data in his Seven Countries Study to support his hypothesis. The Diet-Heart Hypothesis is a key part of Canada's Food Guide and the US Food Pyramid, which also promote the Mediterranean Diet, which was first publicized by Ancel Keys. The 1968-73 Minnesota Coronary Experiment confirmed that a low saturated fat diet did in fact reduce serum cholesterol and showed a direct correlation between lower cholesterol and increased mortality. See also Revisionist History: The Basement Tapes.
Statins (eg, atorvastatin [Lipitor], fluvastatin [Lescol XL], lovastatin [Altoprev], pitavastatin [Livalo], pravastatin [Pravachol], rosuvastatin [Crestor, Ezallor] and simvastatin [Zocor, FloLipid], etc) are regularly prescribed to lower LDL cholesterol levels but are minimally effective in improving lifespan (statistically only a few days). The side-effects of Statins are significant and can include insulin resistance (diabetes), Coenzyme Q10 deficiency, cancer, low testosterone/erectile dysfunction, liver disease, kidney disease, muscle atrophy, cataracts, mitochondrial dysfunction, dementia, etc. For those on a low-carb diet, statins also appear to reduce ketone body production. The adverse effects of taking statins appear to outweigh the trivial extension in lifespan and appear to be most beneficial those who maintain an unhealthy diet and lifestyle.
Coronary Artery Calcium score (CAC) is a much better indicator of arteriosclerosis than traditional risk factors. The lower the score, the better and it is possible to have a CAC score of zero. Statins do not appear to have any effect on CAC progression. The prevention of CAC is not well understood but there has been research linking gut bacteria to plaques.
There are 7 types of LDL cholesterol (LDL-1, LD-2, LDL-3, ... LDL-7). Pattern A LDL cholesterol consists of Types 1 & 2 (LDL-1, LDL-2), which are benign and the good forms of LDL cholesterol while Pattern B consists of the remaining Types 3-7, which are the bad forms. The main risk from high levels of LDL cholesterol is that glycation of the Pattern A LDL from high levels of blood sugar which converts cholesterol to the Pattern B LDL. High levels of Pattern B cholesterol are the ones that form the plaques in Atherosclerosis. Increasing blood glucose levels tends to increase LDL glycation so this is another excellent reason to keep blood glucose in control. Glycated LDL molecules (Pattern B) become more damaged when they are oxidized and they are more prone to oxidation in the presence of oxidized (rancid) Omega-6 fatty acids.
While Lipids are frequently tested in Laboratory Blood Work, doctors generally do not request the advanced lipid particle size test (Lipid Electrophoresis: a lipid subfraction test) that identifies the LDL type proportions (ie, Pattern A & B). A good way to estimate whether you have Pattern A or Pattern B is through the Triglyceride and HDL tests. LifeLabs indicates a target range of <1.71 mmol/L of Triglycerides and >1.29 mmol/L of HDL Cholesterol in their Lipid Tests.
| Lipid Test | High Likelihood of Primarily Pattern A LDL-C |
High Likelihood of Primarily Pattern B LDL-C |
| Triglycerides Target: <1.71 mmol/L |
<0.5 mmol/L <9.0 mg/dL |
>2.0 mmol/L >36 mg/dL |
| HDL Cholesterol Target: >1.29 mmol/L |
>1.5 mmol/L >27 mg/dL |
<0.4 mmol/L <7.2 mg/dL |
| Triglyceride/ HDL-C Ratio Calculation |
<0.8 mmol/mmol <1.8 mg/mg |
>1.8 mmol/mmol >4 mg/mg |
Eggs can be good source of Omega-3 fatty acids if the chickens are fed an enriched diet. While eggs contain both unsaturated and saturated fats, the saturated fats in eggs tend to have a high HDL to LDL ratio. Even so, for many years the American Heart Association recommended the consumption of egg per day (or a total of 7/week) as a safe limit for healthy people, while a somewhat lower consumption (up to a total of 4/week) has been recommended for diabetics, but they have now dropped these recommendations. Since eggs have a glycemic index of zero, egg consumption (without the customary accompanying toast/potatoes) reduce blood sugar levels, which would in turn reduce the risk of cardiovascular disease. If you're already on a low-glycemic-index-carb/high-fat diet and your blood sugar is under control, it would appear that egg consumption would actually be beneficial part of your diet.
Trans Fats are generally vegetable oils that have been partially hydrogenated but some animal fats (eg, beef fat & dairy fat) also contain small amounts of trans fats. Saturated fats are fully hydrogenated. Hydrogenation make vegetable oils more stable and rancid-resistant. Trans Fats have adverse effects on human health and their consumption should be avoided or at least minimized. Trans Fats are bad because they simultaneously raise LDL and lower HDL cholesterol and they contribute to insulin resistance and create inflammation.
- The Nutrition Source: Types of Fat
- The truth about fats: the good, the bad, and the in-between.
- Healthy Canadians: Fats
- Dietary Fat and Cholesterol | Colorado State University
- Rabbit models for the study of human atherosclerosis: from pathophysiological mechanisms to translational medicine
- The Nature of Things: The Cholesterol Question
- Dr. Paul Mason - 'Saturated fat is not dangerous'
- Dr. Paul Mason - 'Blood tests on a ketogenic diet - what your cholesterol results mean'
- Dr. Paul Mason - 'High cholesterol on a ketogenic diet (plus do statins work?) - 2019 update'
- Dr. Paul Mason - 'Treating Metabolic Syndrome'
- Eggs might help your heart, not harm it
- Dr. Nadir Ali - 'Why LDL cholesterol goes up with low carb diet and is it bad for health?'
- Nina Teicholz - 'Vegetable Oils: The Unknown Story'
- Dr. Chris A. Knobbe - Omega-6 Apocalypse: From Heart Disease to Cancer and Macular Degeneration - AHS19
- Omega-3 Fatty Acids - Fact Sheet for Health Professionals
- Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism
- [Statins and mitochondria].
- Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: a 6 year follow-up study of the METSIM cohort
- Dr. David Diamond on Deception in Cholesterol Research: Separating Truth From Profitable Fiction
- The Science of Healthy Fats
- Heart Disease 101 by Nick Andre @ Low Carb Houston 2019
- Effect of pravastatin on plasma ketone bodies in diabetics with hypercholesterolemia.
- Coronary calcium is all we need for risk assessment, yet we do not use it often enough
- New link between gut microbiome and artery hardening discovered
- Biofilms, Lipoprotein Aggregates, Homocysteine, and Arterial Plaque Rupture