TWIN NOAKES 1
How it started
My identical twin sister and I have a family history of high cholesterol (or is it? See the section on cholesterol). Having had it tested a few days apart from each other earlier this year it became a topic of discussion at our grandmother’s birthday dinner. We were debating the big C with our brother when we hit on the differing theories surrounding the dietary causes of cholesterol and how to deal with it.
I innocently remarked that it would be interesting for Jeanne and I to each follow one of the contrasting eating plans to see what happens. I then added that it would be great to get the input from Professor Timothy Noakes and a few months later that is exactly where we are.
What’s the Aim?
Let me start by saying that this is not a professional scientific research project. The results won’t be conclusive and may wobble a bit as we get under way. For a watertight experiment you’d need everything we do to be 100% regulated, many many months of following the diets and many more sets of twins doing exactly the same thing.
What this is, is a public interest project. Why? Because high carb vs high fat/protein diets are what the public is interested in right now. Jeanne and I and almost everyone we know is asking the question:
“Which eating plan should I do? If only I could do both at the same time and see what happens.”
Well, being genetically identical twins we can do exactly that.
We’re medically healthy and relatively fit individuals who share a genetic footprint and can be literal guinea pigs for Jo and Jo-anne public. We’re not taking on the medical academia, we’re the ‘you’ out there taking on these two eating plans to see what happens.
How it will work
Professor Timothy Noakes graciously agreed to assist me in the project, as were Jamie Smith as Project Manager and Rael Koping as Dietician.
Rael has devised eating plans for Jeanne and I and will touch base with us throughout the two-month period to see how we’re doing. Jeanne will follow the high fat/protein diet and I’ll be going the high carb route. Our food intake will be hunger driven and therefore the amount we consume will be uncapped.
Jamie has set up the following tests and manages the project in general:
- Blood pressure
- Hip and waist circumference
- Resting metabolic rate
- Body fat percentage
We will also be doing fortnightly blood tests at Pathcare to track our changes in the following:
- HDL Cholesterol
- LDL Cholesterol
- Total Cholesterol
- Fasting insulin
- Fasting blood glucose
Once the two months is up I will publish an article detailing our journey and the results, and then go on to do a few months of the high fat/protein diet to double check our findings. This leg of the project won’t involve the same level of testing but I’ll track my weight, body fat percentage and a few of the more basic elements for healthy living.
As mentioned above, I will be doing the high carb diet and Jeanne will be taking on the high fat/protein diet. It’s important to note that the eating plans are both very balanced – the point is that we’re two normal people eating what everyday people would eat according to these two dietary philosophies – they’re not ‘diets’ as the word is classically understood.
Our guidelines in terms of the macronutrient composition of our diets are:
High Carb: Fat% 20, Carb% 65, Protein 15%
High Fat/Protein: Fat 65%, Carb 16.3%, Protein 18.3%
Here is a list of some of the foods we’ve been assigned:
HIGH CARB PLAN – Low GI Bread, Oats, Wheetbix, Provitas, Rice, Couscous, Pasta, Cottage Cheese, Low Fat Yoghurt, Cucumber, Banana, Tomato, Apple, Guava, Squash, Marrows, Mushroom, French Salad, Lean Meat
HIGH FAT/PROTEIN PLAN – Eggs, Kippers, Beef Biltong, Chicken, Beef, Cheddar Cheese, Greek Yoghurt, Sweet Pepper, Celery, Asparagus, Mushroom, Tomato, Onion, Spinach, Sprouts, Cauliflower, Broccoli, Avocado, Guava, Orange, Apple, Rye Vita,
A large portion of my energy comes from carbohydrates and most of Jeanne’s energy comes from proteins and fats, but be assured that the rest is made up mostly of of fruit and veg.
Finally, we’ve been asked to eat breakfast, lunch and supper with snacks in between.
Our Exercise Regimes
I was wondering how I would be able to create a relatively equal exercise playing field for Jeanne and I given our very different life-styles. The fact is that although I’m a full-time Mom and don’t have time to go to gym like Jeanne does, we are almost identical in terms of fat percentage, weight and muscle tone. This is because I run around after two small children, lifting and carrying them and their paraphernalia and being up and about from morning till night.
The solution came just before we started the project when I came across BodyTec at the Steenberg Shopping Center just up the road from where I live. With this new way of training, Jeanne and I get the equivalent of 3 x 90 min weight/toning sessions in just 20 mins a week. Although this isn’t something prescribed to us by Prof Noakes or Jamie (Project Manager), I believe it will tick the exercise box for our purposes. Jeanne will add a bit of cardio on top of that and that should get us to about the same level. (Please click on their logo to get more information).
TWIN NOAKES 2
Wow, what a ride so far. Jeanne and I have had a blast (with some lows in between) and are super excited about the road ahead.
Here’s a quick heads up on how Twin Noakes will work moving forward…
The project will now be used to double check the results we got in phase 1 as I swap from a High Carb onto the LCHF diet. I’m excited to announce that Jeanne is still doing very well after the LCHF diet she was on and is thriving as she progresses through her first pregnancy! Due to her glorious state, she won’t be actively taking part in Twin Noakes 2 but she’ll be keeping in touch and letting you know how it’s all going.
My three major areas of struggle on the High Carb diet in phase 1 were the following:
My Health: my blood work at Pathcare showed a very negative impact on my risk factors
My Body: I put on weight and fat
It makes sense therefor to focus on these three facets of my life as I swap from a High Carb diet to a LCHF eating plan. Here’s some more detail on how I’ll be proceeding:
Going forward, I will be eating the LCHF in a sustainable way which means that there will be a GnT on the weekends and some Lindt 70% choc on occasion. The point of doing it this way is that I represent most of you out there who want to eat like this for the rest of your lives and not get into the battle of ‘dieting’. For a better idea on what I’m eating, click on the Diet Doctor icon and refer to the list on his site.
Bodytec will continue sponsoring my weekly toning sessions which has added such an interesting dimension to the project. I will also be working with a personal trainer to see what I can do about my ‘soft bits’ through combining a LCHF diet with focused exercise.
I’ll be monitoring my cholesterol and other risk factors with monthly blood tests with Pathcare:
- HDL Cholesterol
- LDL Cholesterol
- Total Cholesterol
- Fasting insulin
- Fasting blood glucose
Tying this all together will be my continued weekly check-ins.
I’m proud to announce that Piz Buin have come on board in terms of sponsorship. As we head into the South African Summer and I work on getting back into shape, I’ll be applying their fantastic sun protection products as well as cheating here and there with their divine sun-tan lotion.
Here’s a look at the final test results from the original Twin Noakes (1) project …
Here is the report written by our wonderful Project Manager, Jamie Smith…
The twins’ cholesterol story
James Smith, 20 November 2012
Cholesterol is seen as the ultimate rival in the war against coronary artery and heart disease but it is often a poorly understood enemy, even by many physicians. If you take a closer look at the complex role that cholesterol plays in the body, you’ll see that it is not quite as simple as finding ways to lower your ‘bad’ cholesterol and raise your ‘good’ cholesterol. It should also become clear that measuring total cholesterol is virtually useless to assess ones risk for disease.
Cholesterol plays many crucial roles in the body. These include regulating what can pass into and out of cells and the production of hormones. In other words cholesterol is critical for life. The problem arises when cholesterol lands up in the wrong place, the most dangerous of these places being the cells that line the major artery walls.
So how does cholesterol land up in the wrong place? To understand this, one needs to know a little more about how cholesterol gets transported around the body. Cholesterol is hydrophobic which means that it cannot dissolve in water or more importantly, in blood. To be transported in the blood stream it therefore needs to be packaged in something that doesn’t mind floating around in water. For cholesterol, this comes in the form of a protein wrapped vehicle called a lipoprotein. You may have heard of LDL and HDL cholesterol. This refers to two different types of cholesterol containing lipoproteins. There are also others, for example IDL, VLDL, Lp(a) and chylomicrons, which are closely related to LDL particles, but lets ignore them for now and try to keep things relatively simple.
LDL has been dubbed the ‘bad’ cholesterol but in fact it plays a crucial role transporting triglycerides (fats) to muscles for energy and returning cholesterol to the liver so that it can be processed for other functions. The problem is that under certain conditions LDL-C (LDL-cholesterol) will penetrate and deliver its cholesterol to the cells in artery walls. This is bad news. The body will immediately mount an immune response and hopefully rid the cells of their unwanted guests. If these cells are continuously bombarded with LDL-C particles the immune response will battle to cope and inflammation will occur. This may lead to narrowing of the artery and the formation of a plaque, which can rupture and block the artery resulting in the tissues being starved of oxygen. If that tissue is the heart the consequences can be deadly. This is why considerable emphasis has been placed on measuring the amount of cholesterol found in LDL and in reducing this number. The real threat however is not the total amount of cholesterol packaged into the LDL particles but in the number of LDL particles present in the blood. It is a concentration game so the more particles present in the blood, the more particles will violate the barrier to the artery cells and the more cholesterol will be delivered to these cells and cause havoc. Measuring LDL particle number is key to determining true risk for atherosclerosis but this is only done commercially by a handful of companies worldwide. An alternative is to measure LDL particle size under the assumption that the smaller the particles the more there are likely to be. However, this test is not offered commercially in South Africa either. The standard LDL-C concentration test which is offered by most pathology labs, only estimates the amount of cholesterol carried by LDL particles. This is only useful if LDL-C correlates well with LDL particle number, however this is not reliably the case. In fact, in about a third of the population, LDL-C and LDL particle number do not predict the same thing. LDL-C is therefore not always particularly useful for estimating risk of cardiovascular disease.
HDL-C and has been dubbed the ‘good cholesterol’. It gained this reputation because it mops up excess cholesterol, for example from the cells in artery walls, and returns it to the liver or gut where it can be processed or excreted. It also delivers cholesterol to hormone producing tissues or fat cells where it is used or stored. Many studies have shown that people with high levels of HDL-C in their blood have a lower incidence of coronary artery disease. Hence it is seen as desirable to have high levels of HDL-C in the blood. However, drugs designed to raise HDL-C do not necessarily reduce cardiovascular events. The reason for this appears to be that it is actually the higher number of HDL particles and in particular the larger, more mature particles that are important to decrease the risk of cardiovascular disease and not simply HDL-C concentration.
Clinical trials have shown that a low carbohydrate diet tends to favorably increase blood HDL-C and reduce triglycerides whereas a low fat, high carbohydrate diet tends to do the opposite. Jax’s HDL-C seemed to drop ever so slightly on the high carb diet which was a bit worrying since it meant that she dipped below level of 1.2 mmol/L which places her at increased risk. Jeanne’s HDL-C was in the healthy range to start off with and didn’t really change much during her high fat diet. Neither Jax nor Jeanne’s triglycerides changed significantly over the 8 weeks and both were well within the healthy range.
Jax and Jeanne’s blood samples were also analysed for LDL particle size because small dense particles are more dangerous than the large fluffy ones. This was done by the lipid expert, Prof. Marais, at the University of Cape Town. He used a method that can place their LDL particle size into one of 5 categories (A, AI, I, IB, B). ‘A’ is the largest particle size category with ‘A’, ‘AI’ and ‘I’ being desirable, whereas ‘B’ is the smallest category and places the individual at a 3 fold greater risk for cardiovascular disease. ‘IB’ is also regarded as undesirable. Jeanne’s LDL particles were in the ‘AI’ category, which places her safely at the larger end of the spectrum. Her particle size did not change much during the 8 weeks. Jax’s LDL was in the ‘I’ category and was therefore less favorable than Jeanne’s but still considered ‘desirable’. Interestingly, Jax’s particle size decreased ever so slightly over the 8 weeks on the high carb diet but this change is probably not clinically significant as it was minor and did not shift to a smaller category. Another interesting finding from the particle size test is that Lp(a) was present in both Jax and Jeanne’s blood sample. Lp(a) is a lipoprotein in the same class as LDL but is absent in most people. Its presence at high levels in the blood increases ones risk for atherosclerosis (artery disease) but unfortunately the quantity of Lp(a) could not be determined by this test. Blood Lp(a) is genetic, hence the reason that both twins had it and according to Prof Marais, it is not influenced by external factors such as diet.
In clinical trials, blood LDL-C (ie cholesterol in LDL particles measured by the lab) seems to respond differently to a low carbohydrate diet depending on the person and on how much saturated fat is eaten. More often than not it goes up a little while in some cases it comes down. Either way LDL-C is not as important as it was once thought to be because LDL particle size tends to increase and the particle number decreases with a low carbohydrate diet (i.e. becoming less dangerous). Conversely, a diet high in carbohydrate and particularly poor quality carbohydrates such as sugars and refined starches results in a significant shift towards the more dangerous, small-dense-LDL particles. For these reasons a moderate increase in LDL-C is considered safe when other risk factors (e.g. HDL-C, triglycerides, LDL particle size etc.) are favorable.
Having said that both Jax and Jeanne had high LDL-C levels to start with, which in itself is not much cause for concern. However Jeanne’s LDL-C increased dramatically over the 8 weeks on a high fat diet. Since both twins have Lp(a) present in their blood, Jeanne’s sharp rise in LDL-C is worth keeping a close eye on. However, the fact that she has favorably high HDL-C, low triglycerides, low fasting glucose, low HbA1c and large LDL particles is reassuring. Their elevated LDL-C may indicate an underlying familial genetic predisposition to high LDL-cholesterol and is certainly worth investigating further. It may be a good idea for Jeanne to cut down on the saturated fat content of her diet until we fully understand the implications of a very high LDL-C level in her case.
If you would like to read more about cholesterol and other health issues related to diet, I would highly recommend Peter Atilla’s website (www.eatingacademy.com) for which I am grateful for much of the information present in this article.
BIA fat%, WEIGHT and DEXA SCAN
Here are the first of our final test results.
Weight: The trend here showed quite early on and so there are no surprises here.
BIA Fat%: Also no surprises here. Both our weight and BIA fat% are confirmed by the body measurement results which come out on Monday.