21 Comments

I want to hear about it, don’t stop.

I’d hope people understand that it’s your first-person experience and not a decree going out to the entire population.

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Julia,

I'm a keto-friendly cardiologist and a skeptical cardiologist (www.theskepticalcardiologist.com)

As such, I know that for many people a keto-diet is there pathway to success at weight management and all the cardiovascular benefits that accrue when one achieves sustained weight loss. However, perhaps 15% of those going full Atkins type keto have a marked rise in apo B/LDL. It's possible that the marked weight loss from a keto diet by eliminating diabetes, improving HDL/trigs, lower inflammation could outweigh such increases and not increase the risk of atherosclerotic disease. We need more data to know that.

You wrote "I had a CAC test done in Chicago, about 10 years ago, when I declined to go on statins. My score was 3. It’s true that the only good score is 0. But 3 is not terrible. I will be interested if it is higher than 3. If it is, I may have to modify my KLC lifestyle to have less saturated fat in it. This will be hard for me. I like my saturated fat. It keeps me feeling full."

A couple of comments, if I may:

1. CAC score always goes up. Yours will be significantly higher. A score of for a 55 year old white female is at the 77th percentile (I'm not sure what your age was 10 years ago but took a stab) 77th% means you were higher than 3/4 of women your age and at higher risk for ASCVD. A score of 3 for a 65 year old white female is at 54th%, close to the average and doesn't alter risk. I predict your current CAC will be at the same percentile rank of your prior one.so unlikely to change the calculus.

You can plug all your numbers into the online MESA calcium calculator to see your 10 year risk with and without the CAC score.

2. The evidence that switching from saturated fat to unsaturated fat reduces ASCVD risk is very weak. The evidence for statin or other lipid-lowering therapy reducing ASCVD risk is very very strong. You mentioned you really wanted to avoid taking a statin. I suspect this is because there is a strong anti-statin bias in the keto community which propagates misinformation on statins. These are arguably the safest and most life-saving medications that modern science has invented.

If you start one your apo B and LDL will drop like a rock and you can continue eating the diet that you feel most comfortable with.

Here's the page on my blog that summarizes all I've written on statins.It addresses statin denialists, safety, and how to start if you are hesitant (https://theskepticalcardiologist.com/category/statin-drug-therapy/)

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I understand why you changed your mind about how you approach writing about health and diet. I do find what you write enlightening because I relate to it so much. I’m older than you, late 70s, but I just slipped over into the diabetic range after being pre-diabetic for probably 15 years. I managed it all with diet and exercise, not well, but well enough, I suppose. Most recently, since 2019, I was fairly successful with intermittent fasting, but the weight was stubborn and wouldn’t let go, and my A1C climbed to 6.6. Not terrible. Not good. I don’t want to be on insulin. I also know the effects of diabetes as my father died from its effects and struggle the last 20 years of his life with it. I hope you will continue to update us with your experiences and insights on the topic. You are probably wise to not be the sage on the stage in this matter, but your story is valuable to those of us who share the same concerns. I love reading what you write and listening to you speak.

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May 26, 2023Liked by Julia Sweeney

Hi Julia, please go down the rabbit hole of the carnivore way of eating. It is absolutely life-changing. As a menopausal woman, I look and feel better now than I have at any other time in my adult life. High LDL cholesterol is nothing to be worried about. In fact, cholesterol is extremely protective and we need it for our bodies to function optimally, especially as we get older. And before you think this is some radical, insane thing, let me just give you a list of American doctors who all have a large following and that fully espouse the carnivore way of eating: Dr. Ken Berry, Dr. Anthony Chaffee, Dr. Lisa Wiedeman, Dr. Sean O'Mara, Dr. Robert Kiltz, Dr. Jaime Seeman, Dr. Tro, and Dr. Shawn Baker, to name a few. They all have YouTube channels that discuss in great detail the benefits of the carnivore lifestyle. These doctors will tell you that the lowest carb diet is the best, red meat is king, and saturated fat is the only fat we should be eating. They don't believe in statins, and they don't believe high cholesterol is something to be worried about. As a 52 year old woman, I am on ZERO medications, and I have a CAC score of 0, and my LDL is scary high, but I am not concerned at all. I have been carnivore for two years. Do a deep dive and you won't be disappointed. All the best to you and big hugs.

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May 25, 2023Liked by Julia Sweeney

Julia you may not be THE expert but you have pointed me in the direction of experts such as Dr Lustig and Dr Fung! If you saw how traditional medicine is being practiced on a daily basis like I see, you might adjust your percentages! (And I work at a “world class institution”) Fatty livers ALL DAY LONG and zero good advice on how to reverse it from their doctors, however we HAVE come up with tests that we can charge $$$ for them to see just how fatty their liver might be! Uncontrolled diabetes in patients that still think orange juice is healthy for them. I totally get your point though about giving advice and it’s a true mark of intelligence to know that you might be wrong! Keep us informed!

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May 26, 2023Liked by Julia Sweeney

I remember when my mother in law's new husband had a stroke. She immediately researched like a maniac and put into practice some of the things she'd learned and then decided she'd better write a book on the topic. Because he was getting better, which, of course, made her an expert. So she wrote this book, full of all the things she'd found down various rabbit holes. Meanwhile, her husband never recovered past those initial weeks and within a year, he had died. We never talked about that book again. Not saying that you wouldn't have written something extremely worthwhile (and you may still!). But you know--those rabbit holes and obsessions get us all going. And then you come up for air and suddenly realize there are about a million more holes you didn't go down yet. And who has that much time? (Glad your diet worked for you.)

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May 25, 2023Liked by Julia Sweeney

hello. Just wanted to say that i refused statins for years and years and years despite every doctor being freaked out by my cholesterol numbers. Finally, after a very intense doctor visit (and a CAC scan of 1), I got very scared and started taking a statin. Oh my god! Normal cholesterol numbers! Can basically eat what I want! No side effects (for me--I know this isn't true for everyone). And--best of all--I no longer worry! I didn't realize how much my cholesterol numbers were stressing me out. I don't know your reasons for not taking a statin. May be very good reasons. But....well, I had good reasons, too. And now, I feel a zillion times better. Just very grateful for my tiny statin!

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hi julia, i've been a primary care NP working with patients with metabolic syndrome, diabetes, & pretty much everything else under the sun for going on 30 years now. what struck me in your report above was that you've gone from 2 glasses of wine a day to 2 glasses of wine a week. no wonder you've lost weight! that was a great move. as for keto vs carbs, meh. at this point i've seen it all. people can lose weight on any food restriction diet, whether they're restricting keto or restricting carbs. eating well always comes back to exercising common sense: limit processed food, desserts, sweetened drinks, & alcohol; eat veggies/fruits with fiber every day; don't fall for the ozempic craze that will make you look haggard & the minute you stop (maybe due to supply chain issues) you'll rebound to your original weight & beyond. some docs i work with keep pressuring me, fruitlessly, to start certain patients on ozempic; it's annoying because i think GLP-1s (as they're called) are appropriate only in a very specific group of patients.

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That description of the body as a poorly organized city is hilarious.

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This made me happy because it seemed a little off-brand for you, even though your brand is constantly learning and wanting to share everything you have learned and help everybody! I think losing weight will forever be something some people are doing well and something some people are not doing even though they know they could or should be doing it and something other people are saying why the hell do we even have to do this, love thyself! And it's always shifting, so at one moment someone will tell me they are wearing that little WHITE dress for the first time in decades and I will think -- "please shut up." And other times it's me saying that to someone who is probably thinking "please shut up." So I like where you landed even though I am currently following your program as if you do know what are talking about and I get it, it feels good, and I'm glad you shared it, and now because I also know nothing and it's only been two days, I will also shut up. xo

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I appreciate deeply that you acknowledge that your take on eating healthy and being healthy is just that - it's *your* take. Of course, you are more knowledgeable than the average bear, so I appreciate your take.

My body is extremely efficient at hanging onto every last damn calorie I eat, and so, found myself in the miserable position of gaining every last pound I had painfully lost while meticulously following a program, during my late in life pregnancy. And after I delivered my beautiful boy I continued to gain weight. My body was in a terrible way - I think not only did every fat cell rebounded happily, but they invited along friends! Sigh. So - I don't know if this is common but, after I had the baby, my body kept gaining weight! It was on a roll! I gained more than my high fat weight, and I did not seem to slow down. The previous program I'd been on was too arduous for me, a new mother. I became morbidly obese. Obesity runs in my family. When my child was a teenager, I decided to bite the bullet, and received bariatric surgery. Not any easy lifestyle to adapt to, but I was highly motivated. I followed all my surgeon's rules for living (take your vitamins, don't stretch out your pouch, eat your proteins first. It was quite an adjustment. But after 1 month, I threw away my diabetes meds per my doctor. In five months I lost half my weight. After 15 years I have maintained the weight loss. I am grateful for my surgery. My feet don't hurt. I have lots of energy. Yes, this surgery is only for a small subset of people. But I am so grateful for my current health, and my new ability not to obsess over what I eat. (And I don't mind my saggy skin - I'm old now. 😊) And everyone's journey is their own. Grateful for your knowledge and point of view. 😊❤️

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KLC gave me kidney stones!!! Maybe I didn't drink enough water? I was losing weight, but those kidney stones did me in. I am trying a whole new system of eating. Focusing on anti-inflammatory foods, and eating every 3 to 4 hrs, and avoiding sugar and grains. I am 67, and value your opinions from your experience and everyone else's here! But food aside, you are the absolute highlight of my week! Thank you for sharing your wonderful self with us. ❤️

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This is such a great post. It really shines. It should be required reading for medical students and patients alike! I think your 85/15% percentages are just about right, and your commentary on the power of human care and good intentions shows that a really good system would ideally combine these with the hard science and evidence-based approaches. It's about having more time, less burnout, and more genuinely compassionate practitioners. And nice patients are always highly appreciated.

Any time I get a "simple question" in the office, it is really hard to give a "simple answer." The rabbit holes expand like pyramids downwards into the cellular, molecular, atomic, and freaking quark level complexity! Ok, so I don't know much about quarks except that they have flavors - up, charm, down, bottom, top, and strange. Those adjectives also describe how it feels to be a patient sometimes. It is a necessary conceit to answer anyone's question with a zoomed out authority, because hopefully the broad outlines of truth we offer as scientists and physicians are enough to make some sense of the chaos.

I've been planning a series of posts on what the medical/scientific community concludes about diet, based on the best evidence and consensus. I'll base it not on my own opinions or cherry-picked studies, but rather on a pretty rigorously written and referenced chapter in UpToDate. This reference costs me like $1000/ year so I might as well use and translate it!

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Please say more about your resistance going on statins. I too am seeing my doctor in July and hopefully my numbers will be low enough to avoid them.

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I also understand that your writings on this are your personal experiences and you're not attempting a diagnosis of anyone. I appreciate you sharing them and hope you will continue. Your writings on this subject got me re-thinking things and I am doing my own research for my own body regarding klc-thanks. BTW-I think my husband is a cat, also. He's an engineer, so...That was a great piece!

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Julia, thank you for your honesty, enthusiasm, and pure heart. You wanted to help others. I get that you want to pull back. There's an overwhelming amount of information to decipher you need to get right.

All we can do is focus on ourselves and our loved-ones. People may see your results and that could make get people think.

A bit of my own background: In 2012, I reversed my health by dropping processed carbs and sugar. My family (husband, adult daughter, mom, stepdad, now sister and her husband) saw my results and followed. We all had radical health success--no more migraines, lowered blood pressure, reversed pre-diabetes, progress mentally and physically from lyme disease, lowered weight, and more energy.

All of our doctors were in shock. None of these medical pros believed it was just diet.

Move ahead to 2020: My husband and I f*cked up our health due to quarantine insanity and boredom: we went back crap food and lots of booze. In December 2020, my husband almost died from a hemorrhagic stroke (not a clot, but a brain bleed). There were other factors. We didn't realize his kidney issues affected his blood pressure. The stroke happened from a collision of horrible decisions and ignorance (the kidneys).

The last two years, he's learned to walk again. We're back to our low carb, low sugar way of eating with lots of organic vegetables and grass-fed meat and free range eggs, I get from a farm box. We're now back on track.

But until July of 2022, my husband was on prescribed medications that nearly killed him (antidepressants and sleeping pills). He was put on those when in the hospital for the stroke (he was bummed out from the stroke and couldn't sleep because hospitals are noisy. I asked his doctor if he could taper off and was told they'd help with his neuroplasticity (the brain's ability to recreate neuron and nerve pathways).

But my once witty and mellow musician husband had a moodswings, and my five-foot-eleven husband was 130 lbs and kept losing weight. He had no appetite. He had horrific intestinal pain.

In July of 2022, we tapered him off the drugs. He began enjoying food again. Gained twenty pounds in three months. No more intestinal issues. His old personality came back. We began to enjoy life again. He's back to playing music again.

In December of 2022, we went to his doctor about some post-stroke pain. The doctor wanted to put him on a drug I read has all the side effects he recovered from. I began getting emotional, telling the doctor about how the other drugs almost killed him and the doctor began screaming at me. He rolled his chair over to my seat and stood over me. "Don't ask questions. Just listen to your doctor!" He lost it. I got up to leave. He yelled, "And don't come back!"

I got physically sick hearing what you shared about those doctors mocking women and the internet, while the American Medical Association doctors seem to work more for the pharmaceutical industry than for us.

Not once did our doctors warn us about my husband's kidney issues affecting his blood pressure. When we got healthy with our low carb diet, they scoffed or shrugged.

I say now that doctor who screamed at me (he was once my doctor, too) is good for shrugs or drugs.

There are good doctors out there. But, having worked in a hospital, I also know many doctors feel superior to us.

I understand your caution, but please don't let these white suits make you feel inferior for looking further.

Hey, what's now called "alternative" in health and medicine has existed for millenia, i.e. herbs, natural remedies, etc. Yes, present society had benefited from modern medicine (antibiotics and procedures, etc.), but the fact that none of my family doctors recommended dropping sugar and processed food... well, food truly is medicine. Diet SHOULD be addressed. Also, good fats (MCT oil, avocado, grass-fed meat) are said to be important for brain function. I do think not all fats are bad. I eat eggs and meat, I have clear arteries and low blood pressure.

I wrote to you earlier about my Uber driver recommending Jason Fung to me. The driver told me, years ago he had plaque in his arteries (he said). He began following Jason Fung's diet recommendations. Went back for a scan of his arteries and was told they're wide open.

P.S. I have a family member in Canada with dementia, so I often read about dementia. More than once I've heard people say family members seemed to think clearer when off of statins. So please look into that.

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