A/Prof. Ken Sikaris - 'Does LCHF Improve Your Blood Tests?'

the better bit of science and this is why I got involved because I like the science I'm a pathologist we study disease and whilst that might be a whole lot of facts those facts can be turned into information and knowledge and that knowledge is of real value when it's applied so that's what getting the facts in place and teaching people how to use them about so we're talking about low carb high fat diets and I'm going to concentrate on the blood test for carbs and fats and if you want to know more certainly read Jimmy's book so this is how blood fats float around in our blood in these spheres inside the sphere are fat or triglyceride and cholesterol stuck to triglyceride and cholesterol ester first Rostock to fatty acid and outside is this surface of other fats phospholipids and cholesterol as well as some protein some big chunky bits to try to hold it together but this is one of the spheres that we have in our blood there are a whole lot of different lipoproteins and they vary in size we talked about small dense LDL but you know there's something even smaller which is high density of LDL the high density lipoprotein which is the so-called good form and then these gigantic pack of spheres which you make in the blood after a meal to transport all that fat that you've eaten to deliver into the until other organs so to us cholesterol is somewhere in there and fats are somewhere in there we're more interested in what each one of those things do so as I said from the intestine you eat fat and you make this big pile of micron particle and then the tissues keep taking out they're the bits they want and the bits that's left the chylomicron remnant goes to the liver and then the liver itself can make its own fat from sugar as we all know or but it can export fat and the the cholesterol that it makes they can export them and the export particle the expert sphere is called the LDL cholesterol this one here the LDL cholesterol now veiled AirPlus drawers full of triglyceride it's being packaged out so that the people who use triglyceride for fat can use it and as the fats being taken out of it it gets smaller and smaller so VLDL becomes LDL and once it's given up all of its triglyceride and distribute a bit of cholesterol it's finished and should go back to the liver and be recycled like a truck that's empty go back to home base and fill up again so this is all now HDL is a bit of a mystery this particle so it just seems to form whenever there's lots of cholesterol around that needs to be taken back to the liver but this is all natural there's no blood vessels involved here this is what nature intended for triglycerides and for cholesterol so the livers making VLDL it's gradually being transformed the intermediate density lipoprotein can go back to the liver the LDL but the normal LDL can go back to the liver that's all health and without it there's people that can't do this they're incredibly sick so what is this particle that's full of cholesterol that ends up in blood vessels and block it's got nothing to do with nature what can happen to LDL is rather than going back to the liver it can stay in the blood and change its character change it to be smaller and harder or be glycated or oxidized and once LDL changes the liver wants nothing to do with it it's like a broken track I don't want those tracks back here tell them the rubbish pits of the body to get rid of it and if those rubbish pits happen to be anywhere near your blood vessels that's a disaster so let's think about a bit more detail about how these particles interact with each other because that's important so fructose can be converted to triglycerides in the liver and as I said normally you export that as the VLDL particles it's packet of fat that goes out to the tissue but if you make too much of that VLDL like there's so many trucks on the road and nobody wants to use the fat they just hang around in the blood that's where you have high triglycerides in your blood because the body doesn't want to use them it's too busy using carbs so if this VLDL particle accumulates it starts crashing into the other particles first of all fatty liver so what predicts fatty liver high levels of triglyceride and there's these other things anybody probably have to listen to my other youtubes there VLDL correlates with triglyceride so when I just talk about this VLDL particle it means triglyceride you can tell whether you've got a lot of VLDL being made and not used if you've got high triglyceride and and just an issue people often ask me how we're how do these the numbers add up if the total cholesterol 6 and the bad cholesterol 4 and the Tate's deals 1 well two point two and five does not make six how do they add up to six we work out how much VLDL cholesterol there is from the triglycerides divided by 2.2 and as Jimmy said that's a faith that's a sort of a formula we use even when we don't have evidence for it because there's no other way of trying to work out how much of the LDL cholesterol there is and we're not supposed to use that calculation when the triglycerides are too high because as we're going to tell you because when the triglycerides are high the particles start crashing into each other and the whole formula starts breaking down so here's this VLDL that people on high carb diets make a lot of and not only can it crash into HDL but there's a protein that helps it swap bits and pieces with HDL HDL is actually trying to help out this big particle that nobody loves and say well give me some of your triglycerides and I hope you distribute it but you know HDL is giving up its cholesterol ester taking up fat helping get rid of the fat giving up its cholesterol ester getting rid you know what happens to HDL and then it disappears it gets worn out and disappears in its effort to help the LDL do its job and so anybody who's got high triglycerides or high V LDL will have a low HDL it goes hand-in-hand if your triglycerides go up your HDL will go down so triglycerides go down your HDL will go up and there's this inverse relationship the high your triglycerides the lower your HDL now that's pretty bad that you're messing up the whole job of HDL but there's something even worse because the VLDL the fact triglyceride rich particle can crash into LDL it's it's child and the child wants to help its parent says will you give me some of your triglyceride market I'll help to distribute it you know and eventually now LDL doesn't disappear and we're out with that it just becomes small and hard and that small subtle change in LDL that's been trying to help out via Dell it means that it's abnormal it changes so much that the liver says no no you've worked too hard helping LDL I don't want anything to do with you either this track has just worn out you shouldn't have done that and so we can predict who has small dense LDL from the triglyceride levels so as your triglycerides increase if they're above 1.5 this is the percentage of your LDL that's in the small dense form and see patients that have triglycerides of two and a half or 3 virtually all of their LDL is in the small dense form that the liver wants nothing to do if it has to hang around in the blood to find another home and that home is probably going to end up being your blood vessels there's just some other data saying when triglycerides increase this is some of our own Australian data and triglycerides increase the percentage of small dense LDL just increases so the problem with LDL is that we change it we might change it by making it smaller we might change it by oxidizing it in and those inflammatory turns or smoking and oxidizing it and it has to be taken up by something and is taken up by the immune system like macrophages and the microbe the immune system sort of lines that blood vessels of the body keeping keeping security like there's rubbish in that blood vessel let's gobble it up yeah but if there's too much rubbish you're going to end up with all the rubbish in the blood vessel these are just some pictures of actual you know LDL particles that are supposed to go back to the liver they're going into the pits of the liver if it's a small dense LDL particle it won't go into that pit just come straight out and when we're talking about small don't imagine that it's a big and fluffy and small and dense there were words that we used to exaggerate the situation the difference is if you can tell the difference between those two spheres there that's the difference there difference in size by the same amount it's a very subtle change in that size of a sphere that means the liver wants nothing to do with it it's 26 nanometers compared to 24 nanometers so if now the language we use is a bit exaggerated as a small and dense and bigoted fluffy there's a very subtle difference that makes a big difference to the body and when you have small dense LDL as Jared grievin and Ron craftsman that presence of the small dense LDL correlates with all of the cardiovascular risk market your blood pressure your weight your your insulin levels your glucose levels so it's right at the core of the problem this disturbance now as Jimmy said you can get it done measured in some places in America by NMR cost 167 dollars probably cost you more to transport the sample to America and for the last 10 years there's been a lab in Melbourne the Sydney Adventist Hospital that's been doing these tests and I just want to show you a little bit about the tests it's fairly simple it's got a put a drop of blood on top of a gel depending on how small the particle is it'll go deeper into the gel it's as simple as that it gives a beautiful colored explanation and here we have all of the particles in this patients blood so here is the smallest particle got right into the gel that is H the HDL particle here's the next smallest particle which is LDL and there's a particular that's the bad LDL the small and dense this patient for she hasn't got any and and the normal LDL in the yellow up this end is that the LDL particle the triglyceride rich particle and in here is something called the intermediate density particle remember the Vale deal has to become LDL it goes through this intermediate density form now when we use the freed world equation we assume that nobody has any ideal but everyone has IDL so this is sort of bringing to clear lie the fact that we've been making the story too simple not only in terms of good and bad but all the different forms of LDL and the presence of this other particle called IDL now this patient he is not so good this patient here has got this LDL form which is smaller it's got deeper into the gel that's small dense LDL making quantitating the report that red part is what you don't want to see and normally the small dense LDL ship now sorry this is the idea so you remove the IDL that's normally where we assume there's none there well up to one and a half of that six remember the six millimole quality of your total cholesterol up to one and a half of it is normally ideal but it'll never be seen on your lipid Pratt your standard lipid profile we just ignore that fraction and it accounts for a significant part of your triglycerides you can tell from the triglyceride level whether got ideal present as well so this whole issue of you know you can calculate all of this is just a game that we've played and the game has been causing a lot of damage and a stock trying to stop playing this game okay so here's some results of some patients who've been on low-carb high-fat diets and they've changed their lipid profile so cholesterol six-and-a-half triglyceride one point six in Australia we say that should be under one and a half rather than under one point eight as Jimi said so it's borderline at best and the HDL is one point for the LDL which is what the doctors really worried about it's four point two and this patient has 11% of that LDL in a small dense form and we could have predicted that because the outlet release roads are a bit high anyone with high triglycerides has small dense LDL so they go onto the low-carb high-fat diet and their triglycerides fall their HDL improves because the trees aren't consuming those particles and the small dense LDL was virtually disappeared now even I do not know how to interpret that there IDL hasn't changed because nobody's interested in I do so triglycerides over 1.5 that's 35 percent of men in Australia in the last survey and 22% of women 35 percent of men in Australia have small dense LDL in their blood and it's ending up in blood vessels and courting atheroma it's that's what the problem is here's another patient cholesterol 5.2 LDL 1.5 the doctor said that's fantastic you don't need a statin you're perfectly okay the triglycerides were 2.1 even though they've got a low level of LDL 17 percent of it is in the small dense form so they go onto a low-carb high-fat diet and the cholesterol increases and the LDL increases and really freaks or the doctors out in everyone but they're small dense LDL has disappeared and that is the literal bottom line in terms of this patient's cardiovascular risk a similar example of patient now this patient here even though they got the benefit with the trick falling and that else small dense LDL falling they didn't have a cholesterol rise on the diet the LDL didn't really increase too much and the total cholesterol didn't hardly change at all and look at the ideal it was low and fell even lower now I'm just showing you that there's a lot more information that we don't understand why does one person go up and the other one not go down why does one have a higher ideal Niang doesn't have a higher ideal as soon as we start measuring cholesterol in a proper way we'll be able to understand each person as an individual now there's been lots of studies of the low-carb high-fat diet is this profile in low-carb high-fat diets and and what they did is studied some people that they truly put onto a low-carb three gram per day and you know 71 percent fat and their cholesterol increased their LDL increased that's what most people do on the low-carb high-fat diet their cholesterol and their LDL cholesterol will increase but their HDL increases and these patients actually started off with a really healthy triglyceride didn't change so most people sort of look at that and say well the cholesterol is increase the LDLs increase that's bad don't go on this diet because they haven't gone to the next step to say but how has the LDL changed I've tried to have some direct this is what normally happens remember LDLs being made vldls being made it's being transformed to IDL is that body should take the fat out of it and then eventually to LDL and both the fragments the the bits that are left the ideal new LDL go back to the liver that's the healthy way that the body should work in a high carb diet we're making lots of LDL the tissues don't want any of the triglyceride so we're not making the ideal or the LDL and the veiled Elle's hanging around crashing into LDL and making small dense LDL so what happens in a high-fat diet in a high-fat diet whenever we make the LDL the body's using fat and it will convert it quickly to IDL and quickly to LDL and in a way there's more traffic going through this fat cycle and making more LDL and that's why LDL should increase and a high-fat diet you're generating more LDL more happy natural LDL and it should increase because of the traffic so every survey we have shows in general most people on a low-carb high-fat diet will have a higher total cholesterol a higher LDL but their triglycerides will be lower and their HDL will be higher another randomized trial so triglycerides for cholesterol if anything Rises LDL anything rises and HDL Rises which is good now the study I'm just saying there's lots of studies with truly low carb diets which generally show that low-carb tends to result in greater weight loss more of a triglyceride fall and more of an LDL rise than any low-fat diet now this studies here they've gone that extra step yes cholesterol in this study the cholesterol didn't really change very much but it actually fell statistically the triglycerides fell a lot and the small dense LDL disappeared that was the bottom line that we wanted to hear that's the big benefit of the low-carb high-fat diet that the small dense LDL at rubbishy form which can get into blood vessels disappears high-fat diet another study from 2012 now the carbs in this diet read that great but they still saw a decrease in small dense LDL so the recent studies whether looking at the important thing rather than the cholesterol in the LDL they're looking at the important stiff which is the HDL triglycerides and the small dense LDL they're showing this important benefit so the more your triglycerides fall the bigger that will that bigger your LDL becomes if you like it's not small and dense anymore relatively recent study so in my results these are my cholesterol results for the last 30 years so before I live in the laboratory it's easy for me to get tests done I've been testing myself for thirty years and yes most of my colleagues have been saying I can do cholesterol of six you know I'm being sued on look nobody in my family's ever died of a heart attack I could live with it so I did get on to a statin at one stage but I hated it so it stopped it anyway so then I went up to low carb high fat and apart from one value it seemed to be smaller than I would I think that was about one or two months into the diet it fell but then it came back up to six so my total cholesterol didn't change on the hike I've got I was expecting it to rise like most people but it didn't change my LDL which was four you know above three point five that's why they want to put me on a statin you know this is bad can it should have increased on the like half that diet and it fell temporarily but it's still around three and a half for my HDL level which has always been one is our cutoff in Australia for men which is always been just hovering around one you know really want to be above one-and-a-half once I went onto the low-carb high-fat diet when to one point four one point six there's actually one point eight now there is no drug known in the world that will increase somebody's HDL from one point zero to one point eight but that's what a high-fat diet can do and my triglycerides which have been way over one and a half for most of my life and under one point eights the lowest I've got and I had mentioned my small dense LDL is not doesn't matter so you know the now a couple of papers just to say that I haven't got diabetes but this tights been tested in diabetics and it has the same benefits not only improvements in triglycerides and HDL and small dense LDL but also a fall in the hemoglobin a1c and the low-carb high-fat diet has a greater benefit in the hemoglobin a1c which might explain the moment then does a calorie match high carb low fat diet so hemoglobin a1c is the red color in your blood is hemoglobin and when sugar sticky it sticks to everything and it sticks to the red color in your blood that's hemoglobin a1c means more or less glucose stuck to it here it is here and the handy thing about hemoglobin is that it hangs around in your blood for three months so the amount of glucose that's stuck on to your hemoglobin reflects what your glucose levels have been for the last three months so it's a very handy way to judge now if you go on to a low carb high fat diet and improve everything within weeks the hemoglobin is not going to check a 1c is not going to change because it remembers all the glucose levels that you've had over the last three months so the hemoglobin a1c takes at least three months to change after a low-carb high-fat diet I'm got my results in a graph in my O&C wasn't too bad was five point four which is upper limits of normal it fell to five point two after the first three months and I thought that's not very impressive well it's now four point eight because it's a year later so you just have to have a bit of patience with the glucose levels and the improvement so hemoglobin a1c such an important figure at least as important as triglyceride because the amount of sugar stuck to hemoglobin I am average man of glucose in your blood as the hemoglobin a1c level rises so does your risk of coronary disease of dying of heart attacks of strokes it rises exponentially now we say that when your hemoglobin a1c is above 6.5 percent you have diabetes you not only got a really high risk of cardiovascular disease and so on but you've got the risk of eye disease and kidney diseases and we want to get that a1c down out of that danger zone but the cardiovascular risk didn't start to rise when you were diabetic it started to rise way back here that represents years and years before you develop the diabetes so most people that have heart disease or heart attacks in Australia and not diabetic they're pre-diabetic they're on the pathway to diabetes but the heart attack Optum first so the way to interpret the hemoglobin a1c in general terms because labs are slightly different four and a half to five and a half percent is what your a1c should be if you want to be away from cardiovascular risk a rave away from that progression to diabetes if you're in the five point six to six point four range you're on the road to diabetes you have to do something if you're above 6.5 percent you've got diabetes but there is hope there if you're a young diabetic and you get everything right you can cure yourself of diabetes if you're older it's a bit hard to do because the islet cells are gone out and certainly this is the only thing we used to concentrate on 10 years ago if your a1c is above 8 and you're diabetic you'll need to do something so a1c not only correlates with outcome but it correlates with higher triglycerides low HDL and if we had a small dense LDL there I'm sure that it would be rise as UAH hba1c rose so a non calorie restricted low carb diet is effective at treatment for type 2 diabetes so if you put diabetics onto a normal diet they might get a bit of an improvement in triglycerides probably not a 1c probably not low carb diet massive improvements in triglyceride therefore small dense LDL and major improvements in hemoglobin a1c just some other things to mention this is a low low carb study or a dietary study with diet and exercise three weeks in those three weeks they could change it doesn't take much to drop triglycerides to decrease small dense LDL you can do it in three weeks but as soon as you leave that place where they need the resolve trial and you go home and reserve to your own diet it will come back not necessarily with a vengeance but it'll come back so as we've said all day today this dye is magical but you have to stick to it it's not a two-week cure this is a lifetime decision now just some last things and these are important issues a lot of people have contacted me regarding lipid levels so here's somebody on low carb high fat cholesterol 7.9 Triggs are great HDL is great the HDL is quite high this cholesterol is a bit high and normally when a doctor sees that he does that thinking you've got a genetic these with your cholesterol level once it gets to a Don 9 I think we've definitely got a genetic disease so now I don't know why I didn't know why the why some people on low carb high fat can have these massive rises in cholesterol here's another one for point seven four point six low carb high fat nine and nine usually means familial hypercholesterolemia you're going to have a heart attack by age 40 and die so doctors are entitled to worry about a cholesterol of nine it is reassuring that that triglyceride is low HDL is high so we can sort of say yes the LDL must be in a small dense in not in a small dense form in the large buoyant healthy form the natural form but I wish we understood it another patient low carb high fat six point four to nine point three and here we didn't measure something called lipoprotein little a and that is a genetic form of LDL this patient did have a genetic form of LDL which they find hard to get rid of out of the blood and when you go low carb high fat more of it appears and it doesn't clear and that just to I was thinking well that makes sense patients with high low protein little a may get this exaggerated response to height low carb high fat and then I got another patient with this just another patient with the same sort of rise so what is I thought I did have another patient with a heart I'm not there it is there's the lipoprotein little a so it should be under point three it's four times normal anything it's increasing as well so this is lipoprotein little a it's an LDL particle remember LDLs good it's just a good LDL particle but for some reason Nature Genetics have said attach this thing which is the appo a protein it's got this tail on them it's like a literally a tail on the LDL particle and when the liver sees this particle it says I want nothing to do with you we don't like tails here and for some people we don't know it might end up in your blood vessels now this is a small proportion of the population it's only a few percent but if I see a patient on a low-carb high-fat diet have this big rise in cholesterol LDL I think you need to measure the LP a little a and then we can decide what to do so the concept here is that is the normal pathway so VLDL IDL eventually everything gets back to the liver but what happens if there's a problem with that final step of get the LDL gating back to the liver like lipoprotein little a it's going to accumulate so we need to measure the LP little a there are the other sort of genetic abnormalities of our poby that might occur here's a patient most impressive all 5.7 to 16 a cholesterol of 16 he usually means what we call homozygote familial hypercholesterolemia these children die of heart attacks this lady was not a child she was postmenopausal she didn't have familial hypercholesterolemia she didn't have a high cholesterol the low-carb high-fat diet brought this out and she didn't have library protein delay I don't know why is her LDL accumulating on this on the under the impact of the low-carb high-fat diet and there may be other reasons for LDL to create clear thyroid disease does effect the LDL particle goes through the body we've known that patients with hypothyroidism have high cholesterol and higher LDL maybe the mixture of thyroid disease and low carb high fat may be having a relationship and there are the things too because this this ideal particle Cassie would we have to test her ideal maybe this is all ideal because the ideal particle relies on a different receptor to the app to the LDL receptor it relies on the appo II receptor and many of you'll know that we can genotype patients for the type of a pony there is there's a whole lot of is six different types of a pony genotypes and it could be that that is also a determinant of who gets these massive Rises of LDL on the low-carb high-fat diet it's only a few percent of people obviously is less than truly less than five percent but it is as far as most doctors concerned one of the risks of the low-carb high-fat diet so I would recommend particularly with anybody with a family history of high disease that go onto this diet once you go on to it in a month or two check your lipid levels to make sure you're not one of these it may be harmless but it's best to know about it rather than two years down the track somebody sees your cholesterol level of 16 I think what the hell are you doing okay and so getting back to you know this patient here who had the cholesterol rise I think I showed them to you before but I didn't highlight the idea out this patients idea went from zero point three to one point nine on the low-carb high-fat diet so presumably they've got some sort of a power issue which means that the high fat diets are resulting in a high level of idea nevertheless it still encourages patients stay on their diet because look at a small dense LDL it's disappeared so in summary low-carb high-fat diet decreases small dense LDL that's what its benefit is it does that at the same because it decreases triglycerides same time it increases HDL and for both healthy people and for diabetics it will decrease hemoglobin a1c they are the fantastic benefits of the low-carb high-fat diet but it does increase cholesterol and LDL and perhaps ideal in in most people and some people to an exaggerated extent and remember I said on pathologists I need to understand why so that I can reassure you that it's not harmful Thanks

Channel: Low Carb Down Under

Views: 71,823

Rating: 4.9324894 out of 5

Keywords: Low Carb Down Under, www.lowcarbdownunder.com.au, LCDU, LCHF, Low Carb High Fat, Professor Ken Sikaris, Blood Test (Diagnostic Test), Glycated Hemoglobin (Chemical Compound), Pathology (Medical Specialty), Cholesterol (Chemical Compound), Carbohydrate (Nutrient), fat metabolism

Id: MXkE8_NdAyQ

Length: 37min 58sec (2278 seconds)

Published: Fri Jan 23 2015