Cholesterol Through a Metabolism Lens

Did you hear? The latest version of the U.S. Dietary Guidelines, released earlier this year, has removed the recommended limit on cholesterol in the diet. Cholesterol is no longer a nutrient of concern. While most of us in the nutrition world have known for a long time that cholesterol in the diet does not affect risk for heart disease, we also know that it sometimes takes a while for policy to catch up with science.

So if cholesterol in food doesn’t cause high cholesterol, what does? While some might blame saturated fat and fructose (the latest fad), I’m going to dive in and explain to you a more in-depth, big picture view of cholesterol labs and your health.

The most important thing to know is that is that cholesterol isn’t this bad-for-you-you substance that it’s made out to be. Most people think, the lower your cholesterol, the better. If you could just get it down to zero you’d be in great shape! However, cholesterol is absolutely vital to the proper function of the human body. Your body makes cholesterol, regardless of your dietary intake, for good reason. If you had no cholesterol in your body, you would be dead! It plays an important role in digestion, Vitamin D status, hormone production and balance, and many other human body processes.

You also need to know that high cholesterol isn’t a diagnosis. It’s a symptom. Just because you have high cholesterol, doesn’t mean anything bad will happen! The words ‘high cholesterol’ inspire a feeling of dread as something akin to a death sentence. The mainstream narrative on cholesterol is that arteries are like pipes and cholesterol is like gunk. The pipes get clogged up with cholesterol, and then you have a heart attack. This is a powerful image, but it’s not accurate at all. First of all, at least half of all people who suffer a heart attack have normal cholesterol levels (1, 2). Second of all, after age 65, high cholesterol is associated with health and longevity (3). Third, plaques that “clog” arteries are actually made up of calcium and oxidized LDL particles (think rancid – more on that later), and they form under the artery wall (4). So get that vision of “clogged arteries” out of your head, and if you are a health professional, quit using those test tubes full of fat to scare people at health fairs!

fa 2

Instead of looking at your high cholesterol labs with a sense of doom, let’s look at how cholesterol levels in the blood rise and when it becomes a problem.

One of the basic functions of cholesterol is to stabilize the mitochondria (the energy powerhouse of the cell), preventing their destruction by stress. Anytime you’re under a stressful situation, cholesterol rises as a protective response to the stressor. Yes, you read that right: cholesterol is a protective substance! Stress also lowers intracellular magnesium, which also causes cholesterol production to increase, since magnesium regulates the enzyme that makes cholesterol (5). Stress can be anything from psychological stress like that from jobs, family, money, etc., to physiological stress like skipping meals, not getting enough sleep, and eating poorly.

In youth and those with high metabolisms (good thyroid output AND uptake of thyroid hormone by cells), cholesterol is converted inside cells into pregnenolone, DHEA, testosterone, progesterone, and other important protective hormones. You cannot make these hormones without cholesterol!

Cells need two things to make the conversion: Vitamin A in its active form and thyroid hormone. As humans get older, their ability to convert beta carotene into active Vitamin A decreases, most Americans don’t eat much active Vitamin A in their diet, and metabolism decreases. In fact, up until about 40 years ago, high cholesterol was diagnostic of hypothyroidism, and routinely treated with supplemental thyroid hormones.


So high cholesterol is a problem because you’re not making youthful, protective hormones. But it’s also a problem because cholesterol oxidizes if it hangs around in the blood stream long enough, losing its protective functions. The cholesterol — or more accurately, the lipoproteins like LDL that are carrying cholesterol — get damaged by oxidation, and then the immune system’s response to that oxidative process is what causes the buildup of plaque and then ultimately the rupture of plaque and heart attack.

So the real question everyone should be asking when it comes to atherosclerosis and heart disease is: “what causes LDL to oxidize?”

There are three main ways oxidized cholesterol builds up in your bloodstream (6):

  • eating commercially fried foods, such as fried chicken and French fries
  • eating excess polyunsaturated fatty acids, which are found in vegetable oils, packaged food and restaurant food
  • cigarette smoking

Your doctor, and most dietitians for that matter, will tell you that polyunsaturated fats from refined vegetable oils, margarine, nuts, seeds, and other plant foods lower your cholesterol. And they’re right! But given what you just learned about cholesterol, do you really think lowering your body’s protective production of cholesterol is a good idea?! Within this framework, the effect of polyunsaturated fats is the same as the effect from statins, which come along with nasty side effects. I hope after reading this, you’ll start to understand physiologically why statins have the side effects they do, and why they’re not very helpful for most people (7).

A note about Paleo diets and fructose. Paleo bloggers and gurus have been pretty hard on fructose recently, blaming carbs and sugar for raising cholesterol. “Quit sugar and watch your cholesterol plummet!” Yup, also watch your libido and energy tank from lack of fuel for the liver and brain. Don’t fall for the low-carb trap when trying to lower your cholesterol. Fructose has pretty much been absolved of any wrongdoing in my book (8, 9).

If you have high cholesterol and your doctor is concerned, here is what I would advise:

  • Ask your doctor for a cholesterol particle size test (LDL-P). Small LDL particles are more likely to oxidize and form plaques under the artery walls (10).
  • Know your calcium status. One of my favorite things about Mineral Analysis, is the crucial information on tissue calcium it gives me. Coronary calcium scans will also give you good information about your tissue calcium buildup (4).
  • Have your thyroid status checked. This involves more than a TSH test! Blood lab work, including TSH, will tell you if your thyroid gland is producing enough thyroid hormone, but tells you nothing about your cells’ ability to use it. Broda Barnes was an American physician who was able to reduce heart disease incidence in his almost 2,000 patients by 90 percent. He used basal body temperature first thing in the morning as an indicator for thyroid uptake. Anything less than 97.8 degrees was considered functionally hypothyroid (11).

If you want to lower your cholesterol in a physiologically-sound way, that ensures proper body function for years to come:

  • Make sure your diet has plenty of sources of active Vitamin A. Eggs, liver, and grass-fed dairy are examples. Hmmm, imagine that….all potent sources of cholesterol! It’s like nature has a plan or something…
  • Make sure your diet has plenty of Vitamin K2, active Vitamin K. K2 is a calcium director and can remove calcium buildup from the arteries (12). It’s found in, again, eggs, liver, and grass-fed dairy. This is sounding more and more like a French diet. It’s not genes or the wine protecting them from heart disease (13).
  • Eat plenty of potassium-rich foods, like fruits and vegetables (14). You are likely not eating enough.
  • Eat more magnesium and supplement if needed. Cooked dark leafy greens and organic dark chocolate are good sources. Magnesium is also absorbed topically through the skin.
  • Destress!
  • Focus on all the things that improve thyroid uptake by cells: get enough calories, protein, carbohydrates, potassium and other minerals, good estrogen metabolism, and good liver function – AKA all the things I work on with clients!

Endocrine Support: a Local Workshop

  • Do you struggle with weight gain or loss?
  • Do you have trouble falling asleep or feel tired no matter how much sleep you get?
  • Are you a woman of childbearing age or a woman going through hormonal shifts?
  • Do you have a miserable menstrual cycle?
  • Do you have constant GI issues like bloating, constipation, stomach aches, or urgency?

If you answered yes to any of these questions, I welcome you to join me for an evening of education.

I’m teaching a workshop on the endocrine system. I’ll touch on how the adrenals and thyroid interact and affect body function, and also the importance of estrogen/progesterone balance. You’ll leave with new ideas on what makes a food healthy, and learn why some mainstream views on health and nutrition may be misguided.The Endocrine System

I’m planning on covering:

  1. Why does everyone think they have “Adrenal Fatigue”?
  2. Why thyroid utilization matters more than thyroid production (AKA why your doctor tells you “Your thyroid is fine.”)
  3. What is metabolic rate and why it’s the key to maintaining proper function and good health.
  4. Digestion and the menstrual cycle as key indicators of body dysfunction.
  5. What the heck do I eat? Plant-based, vegan, Paleo, Primal, WAPF, USDA Dietary Guidelines – why can’t anyone agree on what to eat?!
  6. Other Big Picture practices that are just as important as diet.
  7. Labs schmabs. How to really measure health.

Join me and Maggie Dubois from Being on Purpose – a Wellness Lifestyle for an evening workshop focused on nutrition and natural solutions for endocrine health.

Thursday March 31st, 7-9pm

Robinwood Church

12030 Warrenfeltz Lane, Hagerstown, MD 21742

Bring a friend and bring questions! The cost is $5. You can RSVP on Facebook here, or email Nicole at WholeHealthRD dot com.

Shifting the Focus from Weight to Function

It’s that time of year: everyone is making New Year’s Resolutions. And yet again, weight loss is the leading resolution for 2016.

There is a growing number of health experts who have seen the statistics and understand the physiology of weight loss who are saying, “quit focusing on weight and focus on health.” Unfortunately, there are too many other voices crowding out that message. We live in a society where overweight and obesity are seen as issues of willpower or character. The truth is, they are just symptoms. It’s true that being overweight or obese puts you at higher risk for disease. But weight is only one of many risk factors for disease, and it’s NOT the most important one. Thin people can also be malnourished and at risk for disease. A focus on weight obscures the other risk factors and equates thinness with health.

A focus on weight instead of nutrition will lead people to adopt diets, rather than eating nutritious foods. And we know with 100% certainty that current strategies to tackle overweight and obesity, which mainly focus on cutting calories and boosting physical activity, are FAILING to help the majority of people shed weight and maintain that weight loss.

Instead of focusing on weight loss in this new year, how about focusing on the health parameters that truly show your body is functioning properly?

  1. Normal body temperature (98.6 degrees) with warm hands and feet.
  2. Healthy, moist, fast-growing hair, skin, and nails.
  3. At least one bowel movement a day and little to no gas, bloating, or heartburn.
  4. The ability to sleep 8 consecutive hours with no urination or wake-ups (minus children, of course).
  5. Normal menstrual cycles with little to no PMS, bloating, or cramps; and a healthy libido in both men and women.
  6. Steady mood.
  7. Better than average resistance to colds, flu, and other infections.

There are dozens more, but these are the basic competencies of good physical function that most deserve your attention. These health parameters will tell you more about your health than your weight or any lab test. They all have to do with blood sugar regulation and metabolism. Master these and a healthy weight will likely follow.

If you are failing in one or many of these areas, the problems you are experiencing probably are, at least in part, due to your diet and lifestyle practices. Focusing on weight loss WILL NOT HELP, and can make many of these problems worse.

Take your attention away from the small details of nutrition (organic! superfoods! gluten! antioxidants! fat! fiber! carbs!). I work with clients on the “big picture practices” that help the body achieve good function: eating easy-to-digest, balanced, mineral-dense meals and snacks regularly throughout the day. If you’re sick of feeling unhealthy, and want a better solution than “eat less and move more,” I’d love to work with you!

Happy New Year!

How to Hydrate

Confession: I used to be a water-holic. I used to carry around a water bottle with me at all times to remind myself to be sipping throughout the day. I had a giant water bottle on my desk and my goal was always to drink two by the end of the work day. I collected expensive, patterned stainless steel water bottles. I only ever drank water (or alcohol…hey, I was in my 20s!).

I’m not alone. Americans are water guzzlers, taking the “8-glasses-a-day” (or more!) mantra to heart, even though there is ZERO evidence for that often-repeated recommendation.

“Stay hydrated” and “drink more water” seem to be the cure for any health issue. Health gurus promise weight loss, clear soft skin, shiny hair, reduced appetite, and more energy. <-Yes, much of this can happen when we are properly hydrated, but drinking water is not how we stay hydrated!

Confusing? Hear me out.

Around 2/3 of the water in our bodies is contained inside our cells in intracellular fluid. The remaining 1/3 of the water in our bodies is outside of our cells in our extracellular fluid (e.g. blood, interstitial fluid, cerebrospinal fluids).

The intracellular fluid is high in potassium and low in sodium. The extracellular fluid is high in sodium and low in potassium. Remember it by thinking how salty tears are – extracellular fluid is salty (hence saline in IVs!). In order to maintain a strong cell membrane and a stable environment in the cell, the fluid on the inside of the cell and the outside of the cell must maintain those opposite electrolyte qualities.

The body is always striving to maintain a balanced, homeostatic state. That’s really what hydration is, your body being in a homeostatic, balanced state where stress hormones are not activated. It’s important that the extracellular fluid is neither too concentrated nor too diluted. Either way can start a chain reaction resulting in cellular death, which means less ATP (energy) produced and a slower metabolism.

Luckily our bodies have a pretty ingenious way to signal when we need more and less water.

Thirst and urine color.

Overriding your body’s signals for more fluid (thirst) or less fluid (clear urine) is a surefire way to upset that balance and to keep the composition of the extracellular fluid dramatically different from the fluid in the cell. There is a trend I’ve noticed where people are trying to “pee clear.” I’m not sure why you would want to pee clear, as that is a stress response! Urine in the toilet bowl should be the color of lemonade, darker of course in a lab sample cup.

When I started learning more about minerals and physiology (body function), I realized all that water was basically diluting my body at a cellular level. Especially since I also eat foods that are watery, like fruits and vegetables. I have a hard time holding onto sodium and potassium (thanks for the info, mineral analysis!), and was kind of washing myself out.

Now, I drink when I’m thirsty. I drink water sometimes, but I also drink beverages that have minerals, such as mineral water, coconut water, coffee, milk, and orange juice, often with a pinch of salt. This works for my body and my metabolism.

To close, here is another perspective I found interesting, from a European with U.S. citizenship:

“It is my experience traveling with university students to Europe that many young Americans routinely over-hydrate, drinking water from Nalgene bottles, buying cold beverages any opportunity they can find and then stopping by Starbucks for a specialized coffee drink. And that is all extra to the normal meal hydration.

The biggest complaint I get from my students is the lack of free public restrooms that they are used to at home in shopping centers, stores, and fast food restaurants. When you over-hydrate, you also depend on regular rest stops. I note, for instance, that my French friends are likely to order an espresso at the same coffee shop where my students are ordering a 16-20 ounce drink.

One of the reasons for the American over-hydration is the level of propaganda they get regarding the need to drink several liters of water per day just to lose weight.”

*Note: In the elderly, the balance between sodium, potassium, and fluid is much harder to maintain. Fluid intake and nutrition in general has to be closer to ideal to keep from causing dehydration. Start monitoring NOW so you know what is optimal for you later in life.

*Note 2: Are you thirsty all the time AND peeing clear? That might actually have to do with blood sugar regulation. Come see me!

*Note 3: Has drinking copious amounts of water helped your health definitively? I’d love to hear from you! Because all I’ve seen in clients and in the general public is lots of peeing and lots of stress hormones.


Baby Knows Best

First things first – let’s get this out of the way. I don’t have a lot of experience feeding children. I have a 2-year-old and a newborn. While the toddler seems to be in great health, she sits at the dinner table, and she eats a variety of foods, I know that at age 3, 4, and 5, things could change dramatically for us! And I know my second child could be quite different!

However, I do have a lot of experience researching feeding children. I worked for three years at a non-profit where I helped research and write reports on childhood obesity and child nutrition for the Federal Government. I had access to the sharpest, brightest minds in the child nutrition world. I’ve also learned a lot since then, through both counseling clients and families, and through reading and staying up-to-date on nutrition research. At the bottom of this post are my favorite resources on feeding your children.

In this post, I wanted to highlight a study from the 1920’s I stumbled upon recently. It attempts to answer the question, “What will babies eat if they’re given free choice?” It was a research study that would never be allowed to happen today. It’s been called “the world’s longest, most detailed, most ambitious food experiment.”

Fifteen children were observed over a period of 6 years. Every day, they were offered a selection of 34 different foods, and researchers noted what they chose to eat and how much they ate. Mealtimes were set up to prevent the staff from influencing what the babies ate.

When the children’s food choices were analyzed, they were very different from each other and from the standard diet of the time. But, when the diets were examined as a whole, they showed similar macronutrient intake (calories, proteins, carbohydrate and fats).

The children were very healthy during the study and were remarkably free of the common childhood diseases of the time. Constipation was unknown among the children in the study and any colds were mild. Five of the children had rickets at the start of the experiment, which resolved without medical treatment. One child with severe rickets actually spontaneously drank cod liver oil on his own! The children’s health was monitored by physical and biochemical examinations, and by X-rays of their bones. Apparently, the radiologist at the children’s hospital was very excited at the “beautiful calcification” of the bones on the children’s X rays.

Although some of the children were undernourished when they arrived, this evened out until there were no notably overweight or thin children. Remember: this was a result of letting the children eat according to their own fullness and satiety cues.

Check out the list of 34 whole foods they used in the study. Some might surprise you!

  1. Water
  2. Sweet milk
  3. Sour milk
  4. Sea salt
  5. Apples
  6. Bananas
  7. Orange juice
  8. Fresh pineapple
  9. Peaches
  10. Tomatoes
  11. Beets
  12. Carrots
  13. Peas
  14. Turnips
  15. Cauliflower
  16. Cabbage
  17. Spinach
  18. Potatoes
  19. Lettuce
  20. Oatmeal
  21. Wheat
  22. Corn meal
  23. Barley
  24. Ry-krisp
  25. Beef
  26. Lamb
  27. Bone marrow
  28. Bone jelly
  29. Chicken
  30. Sweetbreads
  31. Brains
  32. Liver
  33. Kidneys
  34. Fish (haddock)

Oatmeal, wheat, beef, bone marrow, eggs, carrots, peas, cabbage, and apples were served both raw and cooked.

I found it interesting that the children’s tastes changed unpredictably from time to time (hello picky toddlers!), and meals were often combinations of foods that were strange to us and would have been “a dietitian’s nightmare” (from the article). For example, a breakfast of a pint of orange juice and liver, and a supper of several eggs, bananas, and milk.

Another interesting result? All infants shared a low preference for all 10 vegetables, as well as for pineapple, peaches, liver, kidney, fish, and sea salt. These foods constituted less than 10% of the total calorie intake. This goes along with many feeding experts advice today to present vegetables, but to not force feed or bribe children to eat them.

In my practice (and in general day-to-day life!), I see a lot of parents worry about their child’s weight, that their kids aren’t eating vegetables, or that their children only eat a few foods. I see food restriction, and the misguided promotion of the idea that certain foods are “better” or healthier than others.

But this study, and much of research since then, proves that children can be trusted to eat what they need for good health and growth, as long as presented with a variety of whole foods. The key is to nurture and foster that intuition as much and as long as possible, to create adults with a healthy relationship with food and who know how to listen to and respond to their body’s cues.

Trust the instincts of your children. Their bodies are much smarter than YOUR mind.


Results of the Self-Selection of Diets of Young Children, by Clara M. Davis, M.D.

Clara M. Davis and the wisdom of letting children choose their own diets, by Stephen Strauss

More resources on child feeding:

Ellyn Satter’s Division of Responsibility in Feeding

Child of Mine, by Ellyn Satter

Your Child’s Weight: Helping Without Harming, by Ellyn Satter

Ellen Satter’s website

Food Ninjas: How to Raise Kids to be Lean, Mean, Eating Machines, by Matt Stone

Don’t Make Children Eat their Greens, by Tim Lott

Estrogen in Excess

I talk a lot about “hormone balance” in my blog posts and with my clients. People nod their heads enthusiastically when I mention this concept, but I wanted to write a little bit about what I mean when I say hormone balance. There are many hormones involved in human physiology – I’m going to focus on one in this post: estrogen. Estrogen actually refers to a whole family of hormones. There are estrogens that your body produces and estrogens you get from outside the body, like the synthetic estrogen in birth control and phytoestrogens from certain plants. And don’t forget about xenoestrogens, those endocrine-disrupting chemicals like BPA we hear about so often in the news. Xenoestrogens are found all around us, especially in what I like to call the “Four P’s”: pesticides, plastics, pollution, and personal care products.

Since the Women’s Health Initiative study results were released in 2002, which showed the detrimental effects of hormone replacement therapy (HRT) for women, the public’s and experts’ opinion of estrogen has been one of confusion.

Is estrogen a ¨bad” hormone? No, but it can quickly accumulate when the body isn’t functioning properly, and that’s when the problems begin.

“Excess estrogen” is a difficult concept for many of my clients to understand. They tell me, “oh, my doctor checked my estrogen levels and they are fine.” But our bodies can become overloaded with an excess of estrogen and estrogen-like chemicals in tissues, resulting in impaired fertility, PMS, endometriosis, fibrocystic breasts, miscarriages, problems breastfeeding, and increased risk of estrogen-related cancers.

Besides the health issues listed above, other signs and symptoms of excess estrogen include:

  • Salt and fluid retention
  • Impaired thyroid function
  • Increased cortisol (belly fat!)
  • Increased permeability of the gut (food allergies/sensitivities)
  • Migraines
  • Anxiety/depression

The American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) released an opinion paper on the topic in October 2013 (1). They concluded that the evidence that links exposure to xenoestrogens and adverse reproductive and developmental health outcomes is sufficiently robust, and that reducing exposure is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals.

My doctor never brought it up when I was pregnant or in the years before – did yours?

There are two main ways to address this issue, reduce exposure, and support good estrogen metabolism and detoxification. Here are my top evidence-based tips I give to clients to address both of these.

Reduce exposure:

  1. Buy organic fruits and vegetables on the “Dirty Dozen” list, and organic meat and dairy products.
  2. Lose weight. Excess estrogen is stored in fat tissue and excess fat can actually produce estrogen on its own.
  3. Avoid canned food, or choose BPA-free cans.
  4. Limit packaged, processed foods. Certain food additives are estrogenic (2).
  5. Limit soy, the most potent estrogenic food, and a known fertility inhibitor (3). Think you don’t eat soy? Yes you do. The average American, who is definitely not a tofu-eating vegetarian, gets up to 9% of their total calories from soybean oil alone (4). What about the Japanese, you say? Some experts believe their large tea intake protects them from the detrimental effects of soy. Plus, soy is only a small part of their diet. What about meat and dairy and their hormones? Both have a small fraction of the estrogenic compounds of soy, especially when you buy organic/grass-fed/pasture-raised meat and dairy. This deserves a blog post of its own. One day, I promise!
  6. Limit vegetable and seed oils. The accumulation of these oils in the tissues promotes the action of estrogen in a variety of ways, and this effect of this tends to be cumulative and self-accelerating. Use olive oil, butter, or coconut oil.
  7. Avoid fish with high mercury levels like swordfish, shark, tilefish, and king mackerel.
  8. Use natural cleaning products or make your own.
  9. Check your personal care products for ingredients like parabens and phthalates, or check them in the EWG Skin Deep database for endocrine safety.
  10. Consider alternatives to hormonal birth control.

Support good estrogen metabolism and detoxification:

  1. Adequate protein intake. Estrogen is mainly metabolized in the liver, where it’s made more water-soluble for excretion via urine and stool. Estrogen receptors in the liver are under the control of dietary protein. Government recommendations for protein are for surviving, not thriving. I tend to recommend a moderate protein intake of 25% of your daily calories – that usually equals 80-100g for most women, depending on weight and activity level. An easy way to make sure you’re getting enough without food logging? Include a concentrated protein source (at least 15g) at all of your meals and snacks – don’t skimp out at breakfast and lunch!
  2. One serving of cooked cruciferous vegetables a day, such as cabbage, cauliflower, broccoli, kale, collards, bok choy, etc. These contain indole-3-carbinol (I3C), which promotes estrogen metabolism. Cooking makes these vegetables easier to digest and better for the thyroid. Raw carrots also have anti-estrogenic properties.
  3. Have a bowel movement at least once a day. Regular bowel movements rid the body of excess estrogen. Letting stool sit in the colon allows excess estrogen to be reabsorbed into the bloodstream. You should not require the use of laxatives, fiber supplements, magnesium, or vitamin C overdosing, or other bowel-moving crutches. See me if this is an issue for you.
  4. Get enough fat-soluble vitamins (A, D, E, K). The American diet is notoriously low in these as I’ve written about in previous posts (5, 6). That’s a shame because all 4 have direct anti-estrogen action. Vitamins A, D and K are potent inhibitors of aromatase (the enzyme converting testosterone into estrogen) – so they will directly lower synthesis of new estrogen. Vitamin E will help counteract the effects of the already existing estrogen.

For a more specific, individualized plan, make an appointment with me.

“All of the unpleasant consequences of estrogen excess happen to resemble some of the events of aging.” – Dr. Raymond Peat