Eat Better Episode 8 - Doc's Opinion

04/02/15 • 61 min

Eat Better with Paleo Britain and Dr. Ragnar

In Episode 8 of the Eat Better podcast, Chloe and I talk with Dr. Axel Sigurðsson of Doc’s Opinion (www.docsopinion.com) about cholesterol, diet, statins, and heart disease. We cover: -What useful information you can get from a basic cholesterol test -Why focusing on “good” and “bad” cholesterol doesn’t really predict heart disease -What dietary and lifestyle modifications you should make if you have heart disease -The pros and cons of taking statins Notes Early on we discuss the triglyceride:HDL ratio, which you can get by diving your triglyceride level by your HDL level. Both of these can be found on the basic cholesterol test from your GP. Using UK units (mmol/L), a ratio below 0.87 is considered ideal. Click HERE (http://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/) for an article where Axel discusses those numbers. We also discuss the pitfalls of using LDL (aka “bad”) cholesterol as a marker of heart disease, even though this is what doctors often use to decide if somebody should be on a statin. Axel has written an article about this HERE (http://www.docsopinion.com/2013/12/15/10-pitfalls-of-using-ldl-cholesterol-to-assess-risk/). Later on we discuss ways to reduce heart disease risk through diet and lifestyle. Because of the need to regulate insulin to minimise heart disease risk, Axel recommends: -A diet rich in fresh vegetables and fish -A diet low in (processed) carbohydrates -Focusing on stress modification We also discuss some of the pitfalls of statins. The evidence behind using them to prevent heart attacks (primary prevention) is pretty thin, and the downsides probably outweigh any potential benefits. HERE (http://www.ncbi.nlm.nih.gov/pubmed/25655639) is a fascinating recent paper which details why statins may (this is largely still theoretical) actually increase the risk of heart disease by interfering with mitochondrial function and vitamin K2 metabolism. There is also increasing evidence to suggest that, particularly as age increases, higher cholesterol levels reduce overall mortality, and are particularly important for things like brain function and reducing dementia risk. The Norwegian HUNT 2 study that I mention can be found HERE (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/). Though this is just an observational study, they found no increase in risk of death or heart disease with increasing cholesterol levels, and in women especially, those with the highest cholesterol had the lowest risk of death. Head to www.drragnar.com for more information. Disclaimer: Podcasts do not replace medical advice from your own doctor, and any lifestyle or medication changes should be discussed with them.

Previous Episode

Eat Better Episode 7 - Fish

In episode 7 of the Eat Better Podcast, Chloe and I discuss fish: • Why is fish an important part of the diet? • Where should you get your fish from? • How much should you worry about dioxins and mercury? • What about fish oil supplements? Notes One part of the discussion got lost in the edit: Many trials have shown that adding DHA (and EPA) to the diet (as krill oil, cod liver oil, or fish oil) can both increase HDL and reduce triglycerides. This lowers the Triglyceride/HDL ratio, which is an important potential marker of future heart disease. Fish oil supplements At the end we touch upon fish oil supplements. As with everything, it is best to get your DHA and EPA from whole foods. The benefits of real seafood have consistently been shown to be better than supplementing. Two or three portions of fatty fish per week should be plenty for most people, as we mention in the podcast. If you’re not a regular fish eater or want to boost your DHA intake for various reasons, I personally think that minimally-processed cod liver oil is best. Get the best you can afford, and shop around, as analyses have shown that fish oil supplements are often oxidised (damaged), and don’t get the DHA/EPA you pay for (http://www.ncbi.nlm.nih.gov/pubmed/25604397). Fermented cod liver oil is very popular at the moment, but that process potentially increases the likelihood that the DHA will no longer be in the ideal sn-2 position I mention. It may also make the fats more likely to be rancid and oxidised. However, the Weston A. Price foundation have released an analysis of Green Pasture fermented cod liver oil, which shows no evidence of rancid fats (http://www.westonaprice.org/uncategorized/concerns-about-cod-liver-oil/). On the other side of the argument, here is a release from Nordic Naturals describing their take on fermented fish oils (http://www.bolderbrokers.com/uploads/4/1/3/0/41303351/nn_fermentedclo-2.15.pdf). I won’t weigh in on the debate, but I like my DHA as minimally processed as possible. Therefore I take something like Icelandic Lysi, from a bottle in the fridge (http://www.lysi.com/consumer-products/cod-liver-oil/liquid-cod-liver-oil). No pills or extra manufacturing steps. Finally, there is also some debate about vitamin D to A ratios in cod liver oils, with a risk of relatively large doses of vitamin A, which can inhibit the proper function of vitamin D. Norwegian and Icelandic bottled cod liver oils usually contain 1,000-1,200IU of vitamin D (400-600% of recommended daily allowance) and 2,000-2,500IU of vitamin A (around 100% of recommended daily allowance) per tablespoon, in a 1:2 ratio. This is well within appropriate intakes for most people. However, it is worth checking your own brand. If you are supplementing with any product that includes vitamin D or A (like cod liver oil), it is important to make sure you are getting enough vitamin K2, as the three play important roles together. Get more K2 from: • Grass-fed full-fat dairy (http://drragnar.weebly.com/podcast/eat-better-podcast-episode-1) • Eggs, particularly free-range eggs (and probably fish eggs) • Goose or duck liver • Natto (http://en.wikipedia.org/wiki/Natt%C5%8D)

Next Episode

Eat Better Episode 10 - Karl Seddon

In this episode we talk to Karl Seddon of Elixa probiotic, who has developed a new way of delivering large doses of bacteria to the gut. We talk about: - Why we’re just scratching the surface of what can be achieved with probiotics - Karl’s own experiments with diet, microbiome and cognitive performance - Why the evidence for manipulation of the microbiome isn’t as good as we might think Elixa probiotics: www.elixa-probiotic.com Karl’s work on Free the Animal: http://freetheanimal.com/2015/05/prebiotic-probiotic-mercenaries.html In the episode, I also mention the work of Grace Liu, who runs The Gut Institute: www.thegutinstitute.com Disclaimer: Podcasts do not replace advice from your own qualified medical practitioner who will be familiar with your own individual health concerns.