If I reduce my carb intake I’d feel shit on the bike
That can't be right surely, unless you are quite a few hours into an endurance ride?
I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.
But perhaps I have more fat reserves than you!
I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.
A lot of people are proud of that ability but I think it's pretty much genetic and the habitual component is itself most likely derived from your genetics. If you can't do it, it's not necessarily because you're weak/a fattie/a rubbish cyclist etc etc.
I hadn't realised that having carbs before a bike ride was a necessity for some people, obviously it eventually becomes one. But if I couldn't ride a bike without significant carb loading I would assume that something wasn't quite right.
And btw I was suggesting that it might be me who is the fatty with plenty of reserve fuel! I am probably about half a stone overweight.
Being a carb monster lowers your insulin sensitivity and messes up your profile of ldl/hdl.
Hence why cake MID RIDE is neither here nor there as it doesn’t spike your insulin.
This comes back to my point about diet. You can’t see the relevance as you’re determined not to understand the true nature of the problem 😉
🚨 It’s not about Cholesterol in your diet. 🚨
It’s about maintaining a healthy metabolism. Which starts with the mitochondria and good old Z2 training 🤣🤣🤣
It’s not tied to weight either. If anyone used to watch ‘supersize V superskinny’ it was always picked up on how many of the skinny folk had shocking metabolisms because they ate junk.
They were skinny and unhealthy.
This study found the link between insulin sensitivity and cholesterol disfunction (they made more and absorbed less) to be greater than with BMI.
https://www.sciencedirect.com/science/article/pii/S0022227520318782
if I couldn’t ride a bike without significant carb loading I would assume that something wasn’t quite right.
Having a bowl of porridge oats and a coffee before a ride is hardly carbo loading, it's just breakfast and I seriously doubt that cutting out my oats, fruit and low fat yoghurt in the morning is going to have any impact on my cholesterol
I can easily get up in the morning, not have any carbs, and cycle 25 miles without any problem, and probably a lot further than that.
So could I, but I would be only able to pootle, maybe you just pootle.
If anyone used to watch ‘supersize V superskinny
Never watched it, but one day at school many years I had to cover a pshe lessons and the just had to watch an episode of super size v super skinny kids...turns out I used to know the dietician really quite well for a short time years before!!
Crosshair, my understanding is that in people with a genetic predisposition to high cholesterol there is a stronger link between dietary cholesterol and blood cholesterol.
I seriously doubt that cutting out my oats, fruit and low fat yoghurt in the morning is going to have any impact on my cholesterol
It can potentially have an effect, but a negative effect.
https://joinzoe.com/learn/can-eating-oats-reduce-cholesterol.amp
Having a bowl of porridge oats and a coffee before a ride is hardly carbo loading
Apologies there is obviously a bit of a misunderstanding, you talked about just reducing your carbs would make you "feel shit".
I took feeling shit as "feeling unwell". And that you would therefore feel unwell if you had half a bowl of porridge.
Yeah if you can’t do up to a 90 min smashfest on the bike with no carbs then I’d say there’s work to do.
The only thing I can find about hyperresponders to dietary cholesterol suggests that you would have as much extra HDL as you do LDL. Ie you’d have higher total cholesterol for zero extra risk of heart disease.
But if both HDL and LDL go up you still have higher ldl? I doubt the "science" on this is as definitive as you, or that doctor blokey you linked to hope. Let's not forget I am a doctor too and know my multivariate stats and the limitations.
PS Chelsea bun, flat white and a banana on my ride today is that too much or not enough carbs over my 75km ride for the carb police? Don't forget I had a bowl of oats for breakfast with a coffee too ( that had skimmed milk). Just for reference it was a steady flat ride but I did sit on the front for most of it!!
Most GP’s went to med school 20-30 or so years ago where nutritional training was close to zero.
Cholesterol now seen as lagging indicator and Apob more important. Listening to a few podcasts from Attia and reading the journals it seems like the last 30 years have fell to correlation = causation. Some now believe cholesterol is actually a response to damage and is used by the body to repair so while high cholesterol is bad, it is not the cause.
Being the armchair scientist myself from the school of YouTube I’d put 50% down to genetics, 25% to calorie excess / quality and 25% to being sedentary for most of the day.
Blaming sugar is way too easy IMO. People look for magic cure / reason but if your dog gets fat / I'll you simply feed less and walk more...
Need to add lack of sleep / stress somewhere in the mix too. Cortisol is not good but carbs actually help reduce it.
My take as a GP:
Total Cholesterol = HDL Cholesterol (technically HDL-C but we will use HDL for simplicity) + Non HDL Cholesterol (technically Non HDL-C but we will use Non HDL). Non HDL Cholesterol includes LDL, VLDL plus others. We generally use Non HDL as a marker (rather than eg LDL) as it is easier to accurately measure. Cholesterol is Cholesterol. When we discuss Non HDL or HDL we are discussing the transporter which is carrying Cholesterol in the bloodstream. They can be "big/good" transporters (like buses) = HDL, or "small/bad" transporters (like mopeds) = Non HDL. We are generally better off with more buses and less mopeds as it seems to be the mopeds that sneak into blood vessel walls which have been temporarily damaged (by eg chronic high blood pressure/ chronic inflammation in Diabetes etc). They then deposit their Cholesterol which then leads to inflammation and hence poor repair. Ultimately this leads to thickened, unstable blood vessel walls and hence heart attacks/strokes etc.
Raised Non HDL Cholesterol is an independent risk factor for cardiovascular disease. Once you normalize for Non HDL it seems that HDL, Triglycerides (TG) etc have little bearing on that specific risk. HDL and TG are important for helping to determine your metabolic health overall so a low HDL, high fasting TG pattern would typically be seen in someone who is more at risk of metabolic issues like Type 2 Diabetes, Non Alcoholic Fatty Liver Disease (NAFLD), Hypertension, Obesity and High Non HDL. Another way of looking at it would be that as someone gets more metabolically unfit, they will likely see their HDL drop and their Non HDL and TG rise. There are a range of conditions called Familial Hypercholesterolemia which are genetic, relatively common and fall outwith what we might expect above, so can confuse the picture. Your own genetics will certainly play a part in your Cholesterol profile, but that is true for everything from hair color to height etc.
Apolipoprotein B (ApoB) measurement gives an exact number of the harmful transporters in the bloodstream (Non HDL Cholesterol tells you the molar concentration or mass of the harmful particles, not the number) and it is likely that knowing the number of them is more useful than the mass, but it is not widely available in the UK. It is probably more useful than Non HDL, and it would make all our lives easier as we would be dealing with one number only - it is also often conceptually challenging to have this discussion around a number defined as a Non-number (Non HDL).
Obesity is associated with a higher risk of metabolic illness as above but not in a 1 to 1 ratio. So say around 60-70% of obese people have evidence of metabolic illness, compared to 20% of normal weight people (I'm not certain on the exact numbers). Therefore it seems it is possible to be obese and healthy (well, normal life expectancy etc) and it is certainly possible to be slim and unhealthy (any/all of the metabolic issues above).
Any lifestyle intervention will have the biggest health impact on the most unhealthy people. So for example if you are in the bottom 25% for diet (very difficult to define that group as so many variables but hey ho - this is just conceptual) then dietary changes may have a significant impact on your Non HDL as well as your metabolic parameters generally. But if you are already top 25% for diet then further fine tuning, eg further reducing saturated fats, is unlikely to have much impact.
If someone is obese and metabolically unhealthy then a healthier lifestyle will improve metabolic markers (Abnormal Cholesterol profile, Hypertension, NAFLD etc) and outcomes long term but may or may not effect significant weight loss. In my opinion it is important to separate weight (which isn't a great health metric to track) from the metabolic markers above (which are). In general when doctors advise weight loss, I suspect we mean improve metabolic health/fitness though we aren't at the stage as a scientific community to be certain about that yet.
Yeah the carb thing is not an easy answer. I guess the simplest way is to think of it as rocket fuel- so when you're being a rocket, there's no harm to it 😉
Fuelling for performance is very different than fuelling for health...
https://megaphone.link/FL9154070915
This is a pretty interesting episode where they discuss the balance between the two.
Sports drinks, gels, and race food are focused on one thing—getting simple sugars from our mouths to our muscles. Research unequivocally supports their use for maximizing performance, but there’s also a mounting body of evidence that associates simple sugars with diabetes, heart disease, dementia, cancer, and other conditions. Because we care about both our performance and our health, we have to ask an important question: Where’s the balance?
Fuelling your ride today won't have done any harm, but being able to jump on the bike and do a couple of hours (of any intensity) after an overnight fast should be achievable if you have good metabolic flexibility.
Skipping breakfast and eating on the bike once your aerobic system is firing is a good starting point.
After listening to the original Attia/San Milan stuff, I built up to doing 6hr fasted rides in 2021 at low intensity to try and kick start my own metabolism after I got fat during my broken leg recovery in 2020. Who's to say if it worked but I definitely felt like a different person afterwards. Even silly stuff like my Hayfever and asthma is better. And then building on that in 2022, I've really noticed the difference on the way home from group rides etc. My bottom end endurance is almost limitless regardless of whether I've ridden hard. Back in 17/18/19 that wasn't the case. I'd normally limp home from a Banjo or Chainy.
So for example if you are in the bottom 25% for diet (very difficult to define that group as so many variables but hey ho – this is just conceptual) then dietary changes may have a significant impact on your Non HDL as well as your metabolic parameters generally. But if you are already top 25% for diet then further fine tuning, eg further reducing saturated fats, is unlikely to have much impact.
Thanks Ioneonic, explained like that it is very obvious and makes perfect sense, I just didn't think of it!
I couldn't understand why someone had said earlier that a change of diet had caused a huge change in their cholesterol levels when my GP is absolutely adamant that I cannot reduce my cholesterol levels significantly through diet.
My GP who I have known for decades knows my lifestyle very well and will be aware that I have a heavily Mediterranean diet. He keeps telling that my "good" cholesterol is exceptionally high which why my total cholesterol is slightly high.
He tells not to worry about my cholesterol levels but then says that I might as well take statins as they won't do me any harm! I am currently sitting on a statin prescription which he has given me whilst "I think about it"!
Fat Fiction - Full Movie - Free - YouTube
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They’ve even thought about adding statins to the water supply in the USA 🤣
https://bigthink.com/health/statins-drinking-water-wonder-drugs/
Statins in our drinking water? Do you realize that 70 percent of you is water?
And as human beings, you and I need fresh, pure water to replenish our precious bodily fluids.
@ernielynch you raise a slightly different but much more useful point. The question we should ask isn't "What is my cholesterol?". It is "What is my cardiovascular risk and how do I best reduce it?".
Once you reach around 40 to 50 we can say the biggest threats to your health and longevity will be Cardiovascular Disease (CVD), Alzheimer's Dementia, Cancer (Lung most commonly), Frailty and Type 2 Diabetes (T2DM).
The same healthy lifestyle will reduce the risk of all of these:
1. Sleep - 7h per night
2. Activity - 2 hours or 10k steps equivalent daily (not bankable)
3. Exercise - 150 minutes of moderate or above per week plus resistance
4. Nutrition - whole food diet (Mediterranean Diet probably has the most evidence)
5. Smoking - zero
6. Alcohol - increasingly looks like zero
That covers risk reduction for them all.
In addition your CVD risk can be reduced by the following:
7. Treating blood pressure to 120/80 if above this
8. Lowering Non HDL Cholesterol
And that is it. Everything else is fine tuning or debatable as far as I can see. So the choice of doing 1-8 depends on an individualised risk benefit analysis for each. If your risk is high enough then the pendulum swings to doing more of them. If you are already following as healthy a lifestyle as you want/can but your risk remains unacceptably high for you, then you might decide to lower your BP if it is above 120/80, or to take medication to lower your Non HDL Cholesterol. Note I've not mentioned a number for the latter - it is a sliding scale, the lower the Non HDL, the lower the risk.
We have population level targets for diagnosing Hypertension, or when to consider statins but on an individual basis we can discuss them at any stage. Generally the risk of treating a BP of 121/80 will outweigh the benefit so we don't do it (in general we don’t treat BP unless it is >135/85 as a home average) but that doesn't change the underlying science.
So I would tend to go through 1-6 and catch the low hanging fruit… I try and see in which of these you are in the lower 25% and encourage improvement eg If you are already a heavy exerciser but sleep is terrible then exercising more isn't your best option - sleep optimisation is.
If the risk is high enough anyway, or there is not much you can or will change in 1-6 then we would discuss the risk/benefit of doing 7 and/or 8. You can already see that if your BP is normal then the only other lever available is lowering your Non HDL (first line drug treatment is with statins - this is a common scenario) - there isn’t really a lower limit.
We use Risk calculators for CVD risk - you can use them yourself online. I think most UK GP systems use QRisk 2 though the updated QRisk 3 is available online. If the 10 year risk > 10% then your GP would generally initiate a risk reduction discussion but you can initiate at a lower risk if you wish. (* A significant concern is that a 10 year risk assessment is not forward looking enough, but it is the best we have. It should act as a basis for discussion, not be definitive). Age and sex are factored into risk (CVD unusual in 20s, very common on 70s) so at some point your age alone will take you across the 10% risk threshold. Irrespective of why your risk is raised, lowering your non HDL will reduce it - it might not be the best way of doing so (you might be better off stopping smoking, or reversing your T2DM) but it will.
It looks likely that intervening early (ie lowering your risk/Non HDL/BP) before you reach higher (eg >10%) risk later in life is beneficial but I'm not aware of firm evidence backing this up. My risk in my mid 50s is 4.9% (relatively low) but we have a strong family history of CVD from 45 onwards, and a genetic high non HDL. I am also pretty good on 1-7 so 8 is my "low hanging fruit". Hence I take a statin though many/most wouldn't, and I respect that (as long as they have had a full explanation).
Hope that makes sense. Your 3.8% risk is low if you are in your 50s, maybe a concern if much younger.
And I'd agree with @crosshair that performance and health are not the same thing. The best time to have a cake is mid ride or straight after a ride (GLUT4 stuff above, much reduced insulin response so you have limited the "harm") but it is still cake with saturated fat or whatever - it doesn't magically make it not cake. I'd enjoy eating it, lick the plate and move on.
More interesting would be the use of energy bars/gels/recovery drinks during or after a ride to aid performance (most people are not having these for pleasure) - eating wholefood carbs here are probably a better option for health - this might be unacceptable for convenience or performance reasons but the gels etc are not likely to be in any way healthy. I use energy bars for convenience during rides but wholefood carbs after.
Thanks for your input Ioneonic, a few things to think about! 👍
Incidentally I saw my Chinese acupuncturist this afternoon and I mentioned that I had slightly raised cholesterol, she responded by saying that I should drink clove water every morning and that after six weeks I would see a drop in my cholesterol level.
I have checked and there is indeed apparently fairly strong evidence that clove reduces HDL. I thought great, unlike statins something natural like cloves can't possibly have side effects.
But then I checked......
Side effects include rare allergic reactions, local irritation, contact dermatitis, haemorrhagic pulmonary oedema, bronchitis, pneumonia, occupational allergic contact dermatitis, and central nervous system depression.
I guess anything that actually works is also likely to do stuff that you don't want it to do.
Probably quoting a QRisk score or similar. You can have a play with the inputs here:
Given risk increases with age, I'd be more interested in the relative position I had to someone with optimally controlled metrics. It may be that you close to normal population risk.
On the topic of Attia's 'Cetenarian Decathlon' philosophy and what that looks like:
Not watched it yet but seems like a nice précis some of his book takeaways.
