Kelsey Marksteiner: Great question. First I just want to make sure that you’ve taken a look at Chris’s High Cholesterol Action Plan. That goes a bit more into detail about the Mediterranean Paleo approach. This is really most often recommended for someone with a history of heart disease or at high heart disease risk. Regarding the foods that I would recommend, the biggest change here is the fat. Instead of using mostly saturated fat as your fat source, these people want to really focus on monounsaturated fat, things like olives, olive oil, macadamia nuts. Nuts, in general, are going to have more of the good kind of polyunsaturated fats, too. Avocados, things like that. That’s the biggest change that they’re going to make, especially if they’re coming already from a Paleo diet, where they’re very used to using saturated fats. They would also focus on leaner cuts of meat, meats that don’t have as much saturated fat included.
Then in terms of percentage of carb and fat, you want to definitely make the carbs go up a bit, especially if they were on a lower-carb diet before, mostly just because it’s going to be very, very difficult to get all of your fat from those kinds of fat sources if you’re trying to avoid saturated fat as well, if you’re doing a low-carb diet. A very good percentage of your calories is going to be coming from fat at that point, and it’s just really tough to get it all from those sources. Typically it’s going to be a higher-carb approach, coming from good sources of carbs, of course, so those Paleo carbs that we’re always talking about. I don’t tend to really focus too much on the actual percentage, but I would say at least probably 30 percent of calories as carbohydrates, but some people may need to go above that, again, really so that they can just get that fat under control. There’s no maximum of saturated fat grams that I tend to focus on. If someone has a history of a heart attack or something like that, where they’re very high risk, I will try to keep it as low as they can, just to be on the safe side. We’ll just really focus on their fat intake from olives, olive oil, avocados, nuts, that sort of thing, and just really try to cut that saturated fat as much as possible.
For someone who just has a higher risk, you could maybe have them eat a little bit of saturated fat. I would just play it to their lab results. If their lipoprotein particle number is really, really high and then you cut slightly on the saturated fat, but maybe not even a ton, and it goes down a lot and eventually gets to at least a somewhat normal level, you could potentially keep it there or you could cut it further to get it into an actual normal level if that’s possible.
I’d really play it to the lab values if you can. Just kind of track those with all of the interventions that you’re doing, and just use that, really, because a lot of these clients … I’ve had clients with high risk or who have had history of heart disease, where they’re coming from something like a ketogenic diet and this is a total change for them. They’re often kind of upset, not only at themselves sometimes because they were doing something that was potentially harmful to them by doing a ketogenic diet with a very high saturated fat intake, not knowing that they were someone who is very, very sensitive to saturated fat intake, and that was pushing their risk level up exponentially at that point, but they’re also kind of angry because they’ve probably put a lot of effort into doing a ketogenic diet or a very-low-carb diet. Then having to switch all your fat intakes again, having to switch your macronutrient intakes pretty significantly again, they’re kind of tough to work with. I’ll tell you that.
Again, take it slow, use the lab values to not only prove to yourself that what you’re doing is lowering their risk, but also make sure that you’re educating the patient that what they’re doing is actually lowering their numbers. If they can see that proof, they’re going to be a lot more on board with you. Oftentimes when they come to you, they’ll be kind of confused because they don’t know what they’re doing wrong necessarily because they think they’re doing something very, very healthy, and it’s just that they are very sensitive to the effects of saturated fat. So you’re going to have to do a lot of education, and you’re going to have to back that educating up with the lab results based on the interventions and proving to the patient that what you’re doing and what you’re recommending is actually working to lower their risk.