 What's the best way to stay healthy in the face of so much conflicting nutrition information? Well, ideally you would go to the source, the gold standard, the peer-reviewed medical literature, and read through the stacks of the latest medical journals. But who's got time for that? I do! Welcome to the Nutrition Facts podcast. I'm your host, Dr. Michael Greger. Today I answer common questions like what's the ideal LDL cholesterol level and What's going on when someone who eats healthily, but their blood sugars are still out of control? Ideal LDL depends on whether or not you have been diagnosed with heart disease. If you have not a lifetime LDL, well, actually a lifetime LDL under 100 should protect you from heart disease. However, if you didn't figure this out until middle age and your LDL is too high, and you're trying to get it down to prevent heart disease, then 70 would be the target. If you already have heart disease, then the target draw in terms of secondary prevention, prevent the second heart attack, drops down to like 30 to 50, or basically as low as possible. So we're saying, could there be a harm of having cholesterol too low? We didn't know until PCSK9 inhibitors came out. We have these new biologic injectable drugs, which can drop people's LDL cholesterol into these single digits. Still not seeing any problems with hormone manufacture like testosterone, estrogen, or any other issues that have piled on. So only benefit as you go lower and lower, but most people should not need drugs to get their LDL down. They just need to cut out or cut down on the three things that increase one's cholesterol. And that is saturated fat found mostly in animal fats and junk trans fats, found almost exclusively now in animal fat. Now that's been removed from the food supply from partially addressing the oils and third is dietary cholesterol found predominantly in eggs, but throughout the animal kingdom. Just do all that. Your cholesterol should drop right down. Add in a whole bunch of high fiber plant foods, which is say whole plant foods and you can push cholesterol down even further. Yes, in addition to eating healthy, there are a few foods, particularly that may lower LP little A further. And I think those are black cumin seed and flax seeds. OK, Jesse has natural low HDL with a whole plant based diet. LDL and triglycerides plummeted fantastic. But the talks about a triglyceride HDL ratio was important. A number to track LDL is an important number to track. We used to think HDL, so-called good cholesterol, was good and actually had benefits in terms of reducing disease risk. It turns out that is not the case based on a whole range of evidence, including drugs that raise HDL, which actually had to be stopped early because it was killing people. And probably most importantly, these so-called Mendelian randomization studies were people who just genetically at birth, born with genes that give them kind of unnaturally elevated HDL throughout their entire lives, regardless of what they eat or how they live, do not actually have lower cardiovascular disease. However, those born with high LDL die early from cardiovascular disease. And with those born with low LDL are protected from heart disease, regardless of what they eat, proving that effectively proven, of course, there's actually real proving, proving in terms of randomized controlled trials. But it's the best in terms you get for observational data, which shows that LDL is actually a risk factor, not just a correlate. So don't worry about your HDL, worry about your LDL, and it's wonderful that they're down. And that's fantastic. Congratulations. Okay, Francis says, when is the main reason why one's A1C fluctuates from high to low and high to low? For those of you who are like, what is an A1C? It is a measure of kind of long-term blood sugar control over the last few months or so, but really biased towards kind of more recent events. And so the main reason is people are eating different foods. And although women can get hormonal changes throughout the month that even if they're eating the same thing, they can have different blood sugar responses. So that could be one reason. And, you know, if you're sick, you know, you have really high blood pressures, even if you're kind of eating healthy. But typically, we tend to think of A1C as in terms of diabetic control and how well medications are working. And for pre-diabetes or in general, it's typically what's happening with a diet, primarily the glycemic load of different foods. And so I encourage people to cut out refined grains and things that cause too high of a blood sugar spike. Okay, Santanu says, with Fumpa's diet, reduce sugar substantially. I want to know, how do I reduce insulin resistance? Great. But if you want to reduce your insulin resistance, you decrease the cause of insulin resistance, which is excess saturated fat intake in the context of a hyperchloric diet, or excess visceral adiposity, if your waist measure your belly button is more than half your height, you need to lose weight to reduce that visceral fat and decrease insulin resistance, regardless of what you eat. Okay, BLK says, type 2 diabetic, oh, but eating healthy, wonderful, not on meds, fantastic. Oh, but can't get glucose under control. And so one of the reasons maybe you're still, you're suffering insulin resistance from excess visceral fat. So if you have excess abdominal fat, it can spill fat in your bloodstream, and so you don't have it going into your mouths, you still have these high levels of fat in your blood and that interferes with insulin responsiveness in your muscles and liver. And that's what causes type 2 diabetes, especially when it offloads fat to your poor pancreas and can destroy some of your insulin producing cells. And so weight loss would be the next step. And if your glucose is under control, you should indeed. Talk to your doctors about being on meds until something like metformin, until you can get it under control with diet, though it may take weight loss to drop your visceral fat to levels where your insulin resistance drops enough that you can reverse your diabetes. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org slash testimonials. We may be able to share it on our social media to help inspire others. To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page. There you'll find all the detailed information you need plus links to all the sources we cite for each of these topics. For a vital, timely text on the pathogens that cause pandemics, you can order the e-book, audio book, or hard copy of my latest book, How to Survive a Pandemic. For recipes, check out my new How Not to Diet cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And of course, all the proceeds I received from the sales of all my books go to charity. NutritionFacts.org is a non-profit, science-based public service where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There's no ads, no corporate sponsorship, no kickbacks. It's strictly non-commercial, not selling anything. I just put it up as a public service as a labor of love as a tribute to my grandmother whose own life was saved with evidence-based nutrition.