Dear DOCTOR Owen,

As I have aged, my cholesterol level has continued to climb—even though I eat less and less fat. My doctor tells me now that I need medication for my cholesterol. I have slowly gained weight, primarily in my abdomen. Why does eating less cholesterol not lower my level?

Fat Blood

Dear “Fat Blood”:

Your cholesterol level is influenced not only by your dietary fat intake, but also by your total calories and— I would imagine—your carbohydrate intake. It is very likely that, with age, you are becoming more resistant to several hormones in your body, including insulin. Insulin, thought of primarily as a sugar-stabilizing hormone, also has profound effects on fat metabolism and protein metabolism.

Excessive calories, even only a few—more than your basic caloric needs—cause you to become more resistant to your own insulin. This is regulated in a very complex manner by hormones that are secreted by the gut, which travel to the liver and the brain and balance each other. Additionally, a genetic tendency, especially, makes people less able to handle fat and carbohydrate loads as they once did. It is possible that, one day, you will develop diabetes. In fact, some studies show that elevated blood pressure is associated with weight gain in adulthood.

The disease I am describing is not diabetes, but insulin resistance. The inability of these hormones to function properly affects many organs, including the brain and the nervous system, many years prior to overt diabetes—often causing malaise, fatigue, and even nerve degeneration in the extremities (called neuropathy).

Under-eating and exercise increase insulin responsiveness, as do a number of medications that can be taken orally, such as chromium, fish oil, and hormone replacement therapy. One of the newest theories in the dietary management of insulin resistance is that under-eating may be more effective in controlling insulin resistance than constant perfect eating. Substantial under-eating is required to activate the genetic code to normalize insulin levels. Under-eating mimics the “feast or famine” situation that most of our distant ancestors faced on a daily basis. Even today, there are many cultures, such as the Pima Indians of the U.S. Southwest and Mexico, and their cousins living in the mountains—all still subsisting without electricity—who do not get diabetes. Their brothers and sisters, however, who have moved to urban areas and gained weight, have a very high incidence of diabetes.

Some popular diets, including Sugar Busters!TM and the Atkins’ New Diet Revolution, advocate protein over carbohydrates and fats; the dietary substrate, protein, may actually induce insulin responsiveness. These diets are not based on new theories. Further studies are under way to prove the Atkins’ theories at the University of Tennessee and other institutions, and the authors of Sugar Busters are just beginning their own scientific investigations to substantiate their claims. We await those results with great anticipation.

Of course, treating your cholesterol with diet intervention is important. Directly thwarting cholesterol production in the liver may be the most helpful method you can choose. The diet intervention treatment is very safe, effective, and has shown dramatic improvements in overcoming the risk of initial and subsequent heart attacks and strokes.

Probably the most important thing to know is that seven 7 out of 10 Americans will die of cholesterol; the percentage is higher for people with risk factors. Cholesterol never gets the same press that of as that of cancer, but it is much more deadly than cancer. Elevated cholesterol is now very treatable. Decreasing fat intake, increasing fat expulsion, decreasing fat production in the liver, and improving resistance to fat in the tissues are all do-able options for you at the present time. I personally attack cholesterol at every level that I can.