Friday, November 29, 2013

New Paleo, Low-Carb & Health Blogs

I always love finding new resources. Thanks to Jimmy Moore for his great work compiling new blogs in health, low-carb and Paleo.

Here's his list of "46 New Paleo, Low-Carb & Health Blogs for November 2013" -- stoked to be included as #6 on this list!

So, as you take a few days off from work, kick your feet up on the couch and eat Thanksgiving left-overs, take a look at some of these resources.

Tuesday, November 26, 2013

I didn't win a turkey...but my face went numb: Vienna Turkey Trot Race Report

My face was numb. As I tried to talk to my wife, Stephanie, after I cross the finished line she said "it was like you had a stroke." I was talking, but my facial muscles sure weren't moving much. We quickly went inside the Vienna Fire Department, a partner of that day's race, to warm up.


Just 19 minutes before that I toed the start line in what was probably the coldest race I've ever participated in. Wind chills were in the mid-teens - I think around the start time it was 15 degrees. Nonetheless, a fairly sizable crowd of runners came out to run either the 5k loop or 10k double loop of the 11th annual Vienna Turkey Trot. I ran the 5k.

But, as much as the cold was front and center on my mind as I went through my warm-ups, my thoughts also zeroed in on my left calf, the site of some nagging on-and-off soreness/tightness over the past month or so. 

After about a month off in October, the month of November was suppose to be a slow re-entry into training and starting to set the foundation for my training build for Boston. But, this whole calf thing has really thrown a wrench into my running plans. My workout on Tuesday this past week was my first after about two weeks off from running.

Nonetheless, my calf was feeling pretty good after about 20 minutes of warm up and a little light stretching to complement the foam rolling I've been doing on an almost daily basis.

After a best attempt at the Star-Spangled Banner by a kid I didn't envy playing a brass horn, I took my place at the front of the pack. Judging by the race results from last year I knew I had a decent shot at another podium but it would be tough having been out of training for a bit. This was also at the very beginning of my training block for Boston (and next year's triathlon season), so I went into the race hoping to take a baseline of where I was. I won't lie though, the Whole Foods turkey awarded to the first overall male and female sounded pretty awesome.

I couldn't have been more happy when the start gun went off and to finally start moving. My hands were really the only cold thing at this point (despite wearing gloves), though I felt my legs start to stiffen a little at the start.

I didn't go out with the lead runners, who seemingly sprinted off the start line. I settled into a small disperse second wave not too far behind. Judging by how fast the lead runner ran the first 400 meters, I knew I couldn't keep pace. Oh well, so much for the turkey. He ended up running a 5:15 pace.

The first mile I felt pretty good. Not sure if it was the slight downhill grade or the fact that my legs were warming up (I may have been one of three wearing shorts), but it went by pretty quickly. I was somewhere in the 5 to 9th place range at this point. I focused more on simply keeping pace with some of the runners around me.

The course was a fairly standard out and back, but knowing I was running slightly downhill the first half meant only one thing, an uphill second half. Coming up on the turn around, I ran in a small group with two other runners. One of them, obviously in a bit better shape, would pull in front on a a few of the uphills, while I acceleratd on the downhill to draw even.

The turn around was at the worst spot. It was right after about a 75 yard downhill, meaning, of course, that right when you rounded the cones, you faced the challenge of a hill straight away.

I steadily climbed that hill and tried to push as hard as I could on the second half. I definitely felt some fatigue in my quads from being a bit out of shape.

The order of runners was pretty much set after the first quarter mile and remained that way most of the race. With about a half mile left, the women's overall winner passed me. I was able to pull ahead of the guy I had been jockeying with earlier in the race, though. 

The last quarter mile was a downhill. I was so happy. I let gravity help me a bit and gave it whatever I had left. I crossed the finish line, and tried to catch my breath. My wife came up to me to see how I was doing. I tried talking, but my facial muscles didn't move much. They were pretty numb. We quickly hurried inside to warm up and congratulate some of the other runners.

I finished exactly at 19 minutes - good for 8th overall and 1st in my age group of 20-29.

It wasn't close to a PR, but I was happy considering where I am in training. Time to start building.

Sunday, November 17, 2013

Forget talent or intelligence - It's all about GRIT

This weekend I watched a short TEDtalk by Angela Lee Duckworth, and had to share. In my opinion, she captures the one thing that's needed to excel in all facets of life, but seemingly overlooked - grit.

In her words:
"Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future, day-in and day-out, not just for the week, not just for the month, but for years. And working really hard at making that future a reality."

So, dream big. Aim high. Set goals. Don't settle. And work as hard as you possible can to get there. Life's a journey and an adventure. Decide how you'd like to spend those precious days and go for it. Search for and embrace the things that truly make you happy - the things that make you feel alive.

For me, and in the words of Rudyard Kipling, I'll be "fill[ing] the unforgiving minute with sixty seconds' worth of distance run."

Friday, November 15, 2013

Less statins, not more

Earlier this week I wrote about Jimmy Moore's new book Cholesterol Clarity, which really dives into many of the misconceptions around the issue and tries to cut through the noise, so to speak.

You can read the full post here.

One of the main take-aways for me from that book was around the prescription and use of statin drugs, particularly how much of a "well oiled machine" this system has become. Most importantly, there are a variety of documented side effects and negative impacts on long-term health, which often get swept under the rug because they do one thing (which doctor's have been taught is really the only important thing about cholesterol) really well - lower LDL cholesterol.

As it turns out, however, we're likely to see the prescription of statin medication dramatically INCREASE in the coming years. Here's why.

On Tuesday of this week, the American Heart Association and the American College of Cardiology released new guidelines on obesity, cholesterol, risk assessment and lifestyle. In addition to stating that obesity "should be managed and treated like a disease" (that's the topic for an entirely different posting, and one that's stirred up quite a bit of controversy) the guidelines also suggest that "more Americans could benefit from statins."

Here are the groups who they recommend should take statin drugs:
  • People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
  • People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
  • People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.
 So, if you find yourself in one of these categories and weren't taking a statin drug previously (and this (and this particularly applies to women where there is a great deal of evidence showing the significant drawbacks of taking statins), chances are your likely to hear the recommendation from your doctor the next time a cholesterol test shows high LDL-c levels.

I think a recent New York Times opinion article by Harvard Medical School lecturer John D. Abramson sums it up quite nicely:
"We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them."

Friday, November 8, 2013

What's wrong with the conventional wisdom on cholesterol and how it could actually be harming us

I just finished reading health blogger and podcaster, Jimmy Moore's, new book called Cholesterol Clarity: What the HDL is Wrong with My Numbers. For those interested in diving deeper into one of nutrition's most misconstrued and contentious issues, or simply want the "straight dope on cholesterol" (borrowing from the name of Peter Attia's unparalleled blog series on the issue, which I HIGHLY recommend), this is a must read book. Not only does it provide some of the latest research and thinking on the topic through a series of interviews with 28 leading experts in the field, but Moore packages the information in an accessible way for the widest possible audience, whether you're a lipid researcher or someone who just wants to stay healthy.

So, let's dive into some the main issues in the book and some of my key takeaways. 

Cholesterol is actually a good thing that plays an irreplaceable role in the body. Bottom line: if you don't have cholesterol, you die. Morbid, but true. Here are a few essential things it does or supports in the body:
  • Hormone production, including estrogen, progesterone, testosterone, pregnenolone, adrenaline, cortisol, and DHEA
  • The health and efficiency of cell membranes
  • Nervous tissue, including the white matter in your brain
  • Optimal adrenal gland function, which modulate a number of different vital hormones like adrenaline as well as kidney function
  • Water and electrolyte balance
  • Formation of Vitamin D
  • Immune function
By far, one of the most important things influenced by cholesterol is something called coenzyme Q10, or CoQ10. Some, like Nora Gedgaudas, the author of Primal Body, Primal Mind, have called CoQ10 the "single most important nutrient for the functioning of the heart."

When cholesterol is too low, bad things can happen. Based on the important functions listed above, you can probably guess some of the negative things that can happen in the body when cholesterol is too low. For example, cholesterol actually plays a very important role in tissue repair, specifically with stem cell production. As a result, blood vessels can become stiffer - not a good combination with small, dense LDL particles. Research has also shown a close link between low cholesterol and a higher risk of infection, cancer, and a variety of mental side effects, such as depression and a higher likelihood of suicidal behavior.

In fact, research has documented that people with the lowest cholesterol levels actually had the highest rate of death from coronary heart disease and demonstrate a greater risk for some cancers. In addition, this study actually found that almost half of patients hospitalized for heart disease (80% experiencing acute symptoms), had LDL cholesterol levels less than 100 mg/dL, which is the current recommended level by the American Heart Association. As Moore argues, LDL cholesterol (and total cholesterol) are bad predictors of heart disease risk.

Dietary cholesterol doesn't really impact your numbers. The amount of cholesterol from food makes up only about 15-30 percent of your body's total cholesterol. In fact, the overwhelming majority of cholesterol our bodies use - up to 2 grams every day - is actually produced within the body itself, mostly in the liver. Cholesterol is tightly regulated by the body and as Dr. Chris Masterjohn explains in Cholesterol Clarity, "if we eat a lot of cholesterol, our bodies make less of it; if we eat less cholesterol, our bodies make more of it. In most people, the majority of cholesterol that is circulating in the blood is made by their own bodies."

All LDL isn't "bad cholesterol." There are actually two kinds, or patterns, of LDL cholesterol. Pattern A is large and fluffy, regarded by experts as generally harmless. Pattern B, on the other hand, are potentially more dangerous since they are small and dense. Many will say that this measure of particle size and number, or LDL-P, is a much better way of determining risk, than the traditional LDL-C measure that shows up on a standard lipid panel (which is actually a calculated number, not one that's directly measured - more in the next section on this).

Thankfully, there are more and more options available to test for this. One such test is called the NMR LipoProfile test made by the relatively new diagnostic testing company in North Carolina, LipoScience. The test uses NMR technology (which stands for nuclear magnetic resonance and is regarded as one of the best technologies on the market) to actually measure the number of LDL particles in a blood sample.

Of course, certain dietary choices can influence the ratio of Pattern A and Pattern B LDL in the blood, which Moore also flags as quite concerning. He particularly focuses in on the relatively recent trends towards promoting polyunsaturated fats, mostly in the form of vegetable oils (things like canola oil, soybean oil, etc). It is true that there is a fair bit of research showing the effectiveness of polyunsaturated fats (PUFAs) at lowering LDL in the blood. The problem is that PUFAs help achieve this reduction in LDL primarily through decreasing the number of good Pattern A LDL particles, leaving mostly Pattern B. You can see how this can be extremely concerning for heart disease and atherosclerosis risk. One of the best ways to increase the number of good Pattern A particles and decrease the number of Pattern B particles is by eating quality saturated fats from things like coconut, and grass-fed beef and butter.

LDL is actually a calculated number on your standard lipid panel. If there is one number from the standard lipid panel that doctors focus on, along with total cholesterol, it's LDL. The entire statin-prescribing system, argues Moore, has been built upon artificially defining a certain threshold for LDL and total cholesterol (which isn't really rooted in any solid evidence as mentioned above) and teaching physicians (very well) to automatically prescribe the drug once your numbers exceed these thresholds. Usually any conversation about diet is secondary or nonexistent. This is essentially how Lipitor and other statin drugs have become some of the most commonly prescribed medication on Earth.

Among some alternatives, like testing for LDL particle size and number, there is also pretty strong consensus that your ratio of HDL cholesterol to triglycerides is a better gauge of current heart health. Both numbers are on the standard lipid panel, which makes them a bit more accessible. The easiest prescription to maximize HDL while minimizing triglycerides is by avoiding carbohydrates and eating more fats.

Keeping total cholesterol low, as guidelines recommend, is 100% counter-intuitive. The prevailing guidelines by a variety of public health authorities focus exclusively on total cholesterol and LDL, and specifically keeping these two numbers low. In the case of total cholesterol, guidelines suggest this number should be kept under 200. But the irony of all of this is that if you're trying to keep total cholesterol low, you're assuming all components that make up the total should be kept to a minimum.

Most people know this is hardly the case. As I mentioned, having a lot of large, fluffy Pattern A LDL particles is not nearly as harmful as having a lot of Pattern B. Also, when it comes to HDL cholesterol, or the so-called "good" kind, every leading health authority suggests we need to keep this number as high as possible. This seems like a big contradiction to say keep some cholesterol particles, like HDL, high, while applying an arbitrary cap to total cholesterol.

Statins do a lot more harm than good. Though statins do lower LDL cholesterol (which I hope I've already convinced you is not necessarily a good thing), here are a few examples of the documented negative consequences of taking statins:
  • This 2013 article found a 21% increased risk of death among women with breast cancer who took statins compared to those who didn't. Other studies have documented the link between statin use and musculoskeletal diseases and joint pain.
  • Compared to people who did not use statins, statin users had had a 50% increased risk for any musculoskeletal pain, a 59% increased risk for lower back pain, and a 50% increased risk for lower extremity pain.
  • This review article documents the ample evidence showing increased risk of cardiovascular disease in women among statin users, including a three-fold increase in risk of coronary artery and aortic artery calcification.
  • Statin use has been shown to hinder the positive effects of exercise among overweight and obese individuals. 
It's all about inflammation. If there is one thing to worry about instead of cholesterol, Moore argues, we should be much more concerned about inflammation in the body and the things that cause it. This is the true cause of atherosclerosis. In his words, "without inflammation, cholesterol can't harm you." It's really all about cholesterol oxidation, which is nearly a two-fold better predictor of heart disease risk than simply looking at cholesterol alone. So, we should be focusing more on things that cause chronic inflammation in the body, which results from poor diet, smoking, lack of sleep, infrequent exercise, elevated stress, and a compromised gut, just to name a few that Moore references. One of the best blood markers for determining the amount of chronic inflammation in the body is something called high-sensitivity C-reactive protein, or hs-CRP. Many experts have argued that hs-CRP is a much better biomarker to track because it's a much better predictor of heart disease and health complications than total cholesterol or LDL.  


This book is definitely for everyone. I thoroughly enjoyed the balance struck between offering practical guidance while underpinning it all with sound science. If you're trying to cut through all the noise out there on cholesterol or you're interested in tracking your own health and wellness, this is definitely worth the read. My only critique - but this is coming from a researcher who loves evidence - is the lack of citations in the book. Moore does provide some suggested references for additional reading, but I personally could've really benefited from the book to a greater degree with citations, particularly for many of the chapters discussing the science.

Nonetheless, I highly recommend taking a look at this book. It'll definitely challenge (and maybe even change) the way you think about cholesterol.

Note: I was not compensated in anyway for writing this posting. Views are my own.