Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine! hosted by veteran type 1, diabetes author and educatoAsk-DMine_buttonr Wil Dubois.

This week, Wil takes a bite out of a couple food-related questions about cholesterol and the widely-popular Paleo diet that's all the craze these days. Go on, wet your appetite and read on!

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Marty, type 2 from Florida, asks: Is there anything to the myth of cholesterol levels being connected to how many eggs you eat? And statins seem so confusing, what do they do for us? I hate taking meds, and just want to know what's best for me!

Wil@Ask D'Mine answers: Luckily for us, your question comes at the perfect time, as September is National Cholesterol Education Month. So, here's the scoop on cholesterol and, you know, that good ole' friend we like to call diabetes.

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You may remember a 411 info post on cholesterol that we published here at the 'Mine back in September 2011... well, I'm going to add to that today.

First and foremost, like sugar, cholesterol is not inherently evil. Too much or too little of it is evil. Cholesterol, in the right amount, serves an important biological function. As we all know, in excess it's a big driver of heart disease. But too little cholesterol has been linked to cancer, depression, hemorrhagic stroke, respiratory problems and the ominous-sounding (and frequently fatal) aortic dissection—a tear in the inner wall of the aorta that quickly expands like a collapsing flood dyke.

The American Heart Association has established target cholesterol levels to keep you between the heart disease and the aortic dissection, but getting to those levels is not as easy as it sounds. One-third of the cholesterol in your blood comes from your diet. Two thirds comes from your liver—more on that lion's share of your body's cholesterol in a moment.

The diet third of your cholesterol is something you can control. The FDA thinks you should be conHeart and Eggs Cholesterolsuming a maximum 300 mg of cholesterol daily, although not everyone agrees. You can look at any food label and see how much of that 300 mg any one food is contributing to your daily budget.

So, to eggs. Like diabetes, opinions can vary on eggs, too. Some say eggs get an unfortunate bad rep based on old science that's since been debunked to show that eggs don't have the cholesterol impact everyone once thought. But the conventional wisdom remains: eggs are the bad egg when it comes to dietary cholesterol. A single egg, well, the yellow part anyway, is the number one high cholesterol food in the universe pound for pound. One egg buys you 70% of what the feds think you need for the entire day. So your two-egg omelet puts you over the top, at 140% of the recommend daily intake, and the three-egg truck stop special... well, just drive yourself from the truck stop straight to the ER if you plan to eat that every day.

Hey, you ask, so what's the number two bad egg, after eggs? The number two high-cholesterol food is James Bond's favorite: Caviar. Foie Gras comes in third, and then butter. Followed, oddly, by prawns next, and then the Colonel's secret recipe.

So eating fewer eggs can reduce your dietary cholesterol. Should you cut eggs out? I don't think so; it can lower your cholesterol some, but what about that other two thirds? The part of your cholesterol that your liver makes? The part you can't control on your own? What if your liver, all on its own, makes so much cholesterol that it puts you waaaaay over the top of the American Heart Association guidelines? In that case, even if you consumed NO cholesterol by eating only beans, cereals, corn, fruits, grains, and potatoes (sorry, my Paleo brothers and sisters) you'd still be at risk for heart disease. What to do?

This is where taking a statin comes in. Statins are prescription meds that hold back the liver's production of cholesterol by inhibiting an enzyme called HMG-CoA, which in turn causes a change in low-density lipoprotein receptors in liver cell membranes, which then causes... Oh never mind. It's magic.

But it's magic that works so well, it's actually the standard of care for all persons with diabetes to take one—or at least be prescribed one—so if your diabetes doc hasn't talked to you about this, he or she is not doing the job right. How big a pill you should take depends on how big a problem there is. A lot of folks have mindless rage against prophylactic medications in standards of care, but you should check out the mortality data comparing people who took statins and people who didn't, before you shoot the messenger.

And food-wise, like everything else, I personally think we should do our best to stay in the middle of the road. We should not live on the five foods highest in cholesterol, nor should be become a radical corps of anti-cholesterol troops. We should eat moderately across a wiCholesterolde range of foods, enjoy what the universe has to offer, and medicate any imbalances that we end up inheriting from our non-Paleo genes, our non-Paleo environment, and our non-Paleo lifestyles.

Of course, the whole issue of cholesterol is all way more complicated than I made it out to be, as we have three major types of cholesterol and many more subtypes. Not all are created equal and there are complex interplays between them. Paraphrasing Dr. McCoy, "Damn it Jim, I'm a diabetes advice columnist, not a lipidologist!"

To try and sort out all of this lipid stuff, the Feds created a website called "Live Healthier, Live Longer" to teach us all about how to reduce our cholesterol. Ironically, the Live Healthier Live Longer website has been discontinued.

I'm not sure what to make of that.

Maybe the website should have taken its statin.

 

Tim, type 1 in Oregon, asks: What do you think about this Paleo diet for people with diabetes?

Wil@Ask D'Mine answers: The Paleo diet, for anyone living under a rock (Get it? Paleo? Rock? Oh, never mind. I won't quit my day job for a career in comedy) is the slang for the Paleolithic Diet, now all the rage. It's basic principle is that we should only eat the foods we evolved to eat, and that if we did so, all of our modern illnesses—like diabetes and heart disease—would become extinct.

The Dr. Atkins of Paleo is Dr. Loren Cordain, who, although he didn't "invent" the notion, certainly popularized it with his books, website, and media appearances on the subject. He's not a medical doctor or a physical anthropologist, but a professor of Health and Exercise at Colorado State U.

For all practical purposes, the modern Paleo diet means not eating foods that are "modern," with modern being defined as anything from after the advent of agriculture around 4,000 years ago. A "proper" Paleo diet would consist of grass-fed meat, fish, fruit, nuts, eggs, and veggies. You are to throw cereal grains, sugars, dairy, potatoes, and processed foods out of your cave. Of course, people who are actually practicing Paleo range from those who just cut out processed foods and call it a day, to those who decide they should have multiple wives like they claim our Paleo forefathers did. (BTW, evidence for this being a common practice amongst real Paleo peoples is a tad shaky, to say the least.)

In the sciences, the diet is controversial, and there are more holes in the theory than in Swiss Cheese, which you aren't supposed to eat if you are going Paleo. Many folks argue, correctly, I think, that there is no frickin' way to really know what our ancient cave-dwelling Paleo kinsmen and women ate; that even if we did, those foods aren't really available anyPaleo more (they have evolved, too); that our genes change more rapidly than most people realize; and that there is no solid evidence that the Paleo diet even works at all when it comes to the claimed long-term health benefits.

But let's just set all that aside and think about diet for a moment. Humans evolved as opportunistic omnivores. Both our teeth and our guts are built for variety. So are our taste buds. The range of foods we can get nutrition from is mind-boggling. I'd bet if we could fire up the time machine and go back, we'd find our Paleo ancestors were surviving on everything from nuts, to berries, to bugs, to slow rabbits, to saber tooth tiger road kill. If it was lying on the ground, our ancient ancestors probably picked it up and ate it. Not exactly Paleolithic Camelot, is it? It was probably rather disgusting compared to our modern romanticized and idealized Paleo diet.

But I went off the rails here and didn't really answer your question. Like any low-carb diet, maintaining Paleo will make it easier to maintain your blood sugar. So that could be a good thing. Will it reverse your diabetes? I very much doubt it, as you are a type 1. Could it reverse type 2? Maybe, if we are talking about a very obese type 2 who still has endogenous insulin production intact, and if that person got to a normal weight on a Paleo diet. But even then, I'd hesitate to call the person cured. Still, it would be a hell of a good treatment. His or her insulin resistance would plummet as the weight fell off, and the low glycemic nature of the diet would require less insulin to maintain normal blood sugars. So a "Paleo diet" could very well be good medicine for some people with diabetes, but we shouldn't kid ourselves that it's a magic solution for all the world's health ills.

Note that one of our 'Mine team members living with type 1 experimented with this diet, with mixed results; you can read about that here.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.