Hi Dr Davis,

Really excellent to see this discussion of the much vilified saturated fat. If this results in a softening of the approach to saturated fat in your program I will welcome it. It seems like there have been other tweaks in this direction recently in your posts. Making a good thing better is always the way to go. Redefining that awful term "healthy fats" would be a great move.

Peter

I have the greatest respect for you, Dr. Davis. In your efforts to find the best strategies for the treatment and prevention of cardiovascular disease, you are willing to question everything and follow the evidence wherever it leads -- the mark of a true scientist. You would certainly find Gary Taubes' new book, "Good Calories, Bad Calories" to be of interest. Even if you don't necessarily accept all of his conclusions, Taubes does us all a great service by revealing the shaky underpinnings of what "everyone knows" about nutrition and health.

Jen

THANKS again for the opportunity to share with your readers, Dr. Davis!  The saturated fat issue is indeed an exciting one to watch out of the research community in the coming years.  A lot of minds will be changed if people will embrace what the evidence shows them--I am sure of it!

By the way, I also have a popular podcast show called "The Livin' La Vida Low-Carb Show with Jimmy Moore" with nearly 100 encouraging, educating, and inspiring episodes under our belt.  THANK YOU again for interviewing me for your blog!  Keep up the great work you are doing, Dr. Davis!

You should check out Gary Taubes newly released book, "Good Calories, Bad Calories".  It is a historical look at the studies that were done that vilified fat, animal protein and glorified carbohydrates.  It is a study is how really poor science led to the current recommendations.

I've been low-carbing for many years due to diabetes, but after my MI, angioplasty and bypass in May/June, I've become much, much more interested in the fat question and have been reading like crazy.  The following are my preliminary conclusions.

Fish oil is a flatout necessity to get the EPA and DHA we need.  Because of the importance of the bioactive form of vitamin D (which this blog first clued me into), I  prefer cod liver oil to regular fish oil.  

While we don't convert vegetable-based omega3 to EPA and DHA very well, there does seem to be some good reason to get a lot of ALA on it's own.  Flax and nuts are a good source of ALA. Personally, I find whole nuts and seeds or nut butters very easy to overeat, so I prefer nut meals.  A combination of almond meal and flax meal makes a great replacement for flour in making breads, muffins and cereals.  The meals can even "raise" with a bit of baking soda.  For me, it is a great dietary choice to replace starches with these good fats.

Everyone agrees monounsaturated fats are good or at worst neutral, so it's a no-brainer to use virgin olive oil on salad and avocado oil for strifry.  A friend tells me rice bran oil works well for stirfry also.  Preferring these  oils over polyunsaturated vegetable oils reduces the omega6 in your diet, thereby improving the overall omega3:omega6 ratio.

Unfortunately, canola oil as sold in supermarkets is not a virgin oil, but hydrogenated. The process produces just few enough trans fats to allow them to round down to 0 grams trans fat on the label.  If you have a source for virgin canola oil, it moves up into the olive oil and avocado oil category; otherwise, it's a trans fat and should be ditched.

We all agree, monounsaturated fats are good and trans fats are bad, the next question is whether polyunsaturated fats or saturated fats are bad.  There are bright people of goodwill with research to back them up on either side of the question.  As I've looked into this, I've come to the conclusion that it's not a simple issue.  

The primary issue with polyunsaturated fats is that they contain too much omega6 for most of our diets.  Thus the vegetable oils that were pushed as heart-healthy for so long because they were not saturated turn out to have problems in themselves.  

There's three primary issues with research showing that saturated fats are bad.  First is how often older research included trans fats in the same category as "normal" saturated fat.  We know for sure that any amount of trans fats are bad and should be avoided.

Second is that it turns out that saturated fats containing primarily mid-sized fatty acids chains are in a different category than those made of the long chains, a distinction that has only been made relatively recently.  For me, this means eggs are best fried in coconut oil, and I make my own chocolate now with coconut oil, cocoa, flavoring and sweetener.  While very caloric, it is almost all fat and therefore has almost no effect on bg, which makes it a convenient food to eat between meals.

Finally, the saturated fats from meat and dairy products produced from pasture-raised animals contain a lot of CLA (an omega6 fatty acid that turns out to be VERY good for us) and much more bioactive vitamins A and D than those raised on grain in enclosed feedlots where they don't get much sun.  For me, this means that I need to spend the money for the more expensive pasture-raised products even if that means eating less of them overall.  

I never waste the bones from pasture-raised meat or poultry, but instead make stock.  Recipes generally instruct you to skim the fat off, but I figure when I'm using pasture-raised meat, the fat is good stuff.  Besides using stock for soups and gravies, if you concentrate down until it pretty much forms a layer of gelatin under a layer of fat, it makes great stuff to saute/fry vegetables in.

I am also preferring raw milk fermented cheese for a number of additional health benefits in addition to their fat content.

I use butter from pasture-raised animals on some vegetables, e.g. artichokes.  I consider anything that makes vegetables more palatable in the diet to be a good thing as I've come to believe vegetables should be the bottom of the food pyramid.  IME, low-carbers tend to eat much more fiber than otherwise due to their high vegetable intake, so I don't see fiber as a reason to eat grains.

When pasture-raised meat and dairy is unavailable or prohibitively expensive, I would prefer low-fat dairy and the leanest meats instead.  There is definitely research that shows that monounsaturated oils are healthier than the regular saturated fats from the grocery store.  But with the pasture-raised products, I believe the saturated fat is very healthy and heart-protective.

You can located pasture-raised meats and dairy products in your area here: http://www.eatwild.com

You can locate raw dairy products in your area here: http://www.rawmilk.com

While I must low-carb for bg control, I have come to believe the macronutrient content of a healthy diet is much less important than making the *best* choices for each macronutrient.  One can do either a low-carb or low-fat diet in a healthy or unhealthy manner.  For me, the criteria in choosing foods from each macronutrient category is doing so in a manner that maximizes the micronutrients.  

Fresh vegetables, especially the nonstarchy ones, should be at the bottom of everyone's food pyramid.

Even a diabetic can handle a serving or two of the low-sugar fruits every day, though usually not for breakfast.  

Those who can tolerate a higher carb level than myself can also eat *real* whole grains, such as wheat berries, field corn, whole oats, brown rice, barley, etc.  These real cereals are much healthier than anything produced by General Mills or Post.

In practice, I buy too much fresh produce every week and then rush to try to eat it all before it goes bad.  I think this is a great shopping strategy for health.  

A great source for locating farmer's markets and community-supported agriculture (CSAs) for all your fruit and veggie needs is: http://www.localharvest.com

Those in the northeast might look to see if there is a Wegmans nearby.  One just opened up near me and I can now buy all of these products in a regular grocery trip instead of having to shop a variety of sources.

Short of quitting if you smoke, I believe controlling bg is the most important thing anyone can do to improve their heart health.  I have seen research that shows that the A1c is much more highly correlated with heart disease than lipid panels, even in nondiabetics ranges.  This is likely a large part of the explanation for low-carb being so heart-protective for most folks.

While I have been low-carbing for many years, I had lost control of my bg due to a bout with acute pancreasitis about a year prior to my MI.  I recently received my hospital records and I noticed something interesting: during my hospitalization, I was tried on several insulin regimens before they got my bg controlled.  Two days after my bg was controlled, my triglycerides and LDL (calculated) were cut in HALF.  So it seems to me that bg control is primary, which does imply a controlled-carb diet.

I think whatever the macronutrient makeup of a diet, it's a matter of choosing the best carbs, the healthiest fats and getting sufficient protein from as wide a variety of good foods as possible.

If saturated fat is not yet understood and you are trying to reduce your calcium score, do you want to risk eating it?

Jpatti--

Thank you for your exhaustive discussion!

But I'm bothered by one question: Why do you have heart disease?

With your deep appreciation of health and nutrition, how did this happen?

Hi, Rich--

At this point, I truly don't know. I thought I knew. I have to admit that the entire conversation has to, at least, raise some doubts.

It is disturbing, to say the least, that "fact" we accepted for decades seems to crumble in light of new information. There's no need, however, to dive into a diet rich in saturated fats just yet.

Hi Dr. Davis,

I'm confused about the meaning of Low-Carb labeling and an example from a recent post within the TYP member forum triggered this question.  I ask the question here because, hopefully, the great Jimmy Moore might have a thought about it too.

At the http://www.foodforlife.com/ website, I took a look at "Ezekiel 4:9® Organic Sprouted 100% Whole Grain Flourless Bread".

On the label, the Total Carbohydrates are shown to be 15 per slice.  3 grams of dietary fiber carbs and 0 sugar carbs.

So my first stupid question is "where and what are the missing 12 carbs?"

Second question is (perhaps for Jimmy):  I understand that the 3 dietary fiber carbs don't count toward the Atkins carb count right?  But would the 12 carbs of unknown type be counted toward an Atkins Diet carb count?

Thanks Dr. Davis and thanks to Jimmy Moore!!

It sounds like there's 12 g of non-sugar carbohydrates, meaning complex carbohydrates (polymers of glucose). Unless it's cellulose (which is indigestible to humans), it would indeed count towards a carbohydrate load.

Dr. Davis,
Do you recommend a particular % of calories from carbohydrate?  Or a grams-per-day?

Dr. Davis, I didn't HAVE this understanding before May.  I've been doing nothing but reading since though.

What I had was 2 decades of being a T2 diabetic, the first decade of that uncontrolled until I got a bg meter and began low-carb.

When I had pancreasitis, my bg went up to the 300s and stayed there for a year.  I was irrationally scared of going on insulin; I knew I needed insulin and kept postponing it out of fear.  I suspect that is the primary cause of my MI.  I'm on insulin now anyway AND had to have a bypass on top of it, so that was a pretty dumb move on my part.

I haven't kept up with the literature since I was first diagnosed T2 and lots more has been discovered in nutrition since then.      I was a PhD candidate in biochemistry when I was diagnosed as a diabetic, but haven't worked in the field in most of that time and discovered I knew NOTHING when I started studying.  Nutrition discussions are all about compounds that weren't even on the radar screen a couple decades ago.  This is another reason I've become convinced of the importance of whole foods as I have no idea what they'll have discovered another couple decades down the road.

Learning how the various insulins best work in my body was my first step, and it was mostly empirical as dosing information is skewed towards the ADA diet (which is pretty much as stupid as your rants against the AHA) and T1s.  

Now I'm studying heart disease itself, inflammation and endocrinology generally.  

I've also done a lot of reading about fat and nutrition along the way.  You can't study this stuff without doing so.  I'm still in recovery and not able to work, so there's little for me to do besides study this stuff day and night.  Frankly, I'm obsessed.

The fat question is a BIG question and there are intelligent arguments on both sides of the aisle.  My conclusions on this are important to me since I'm apparently betting my life on being right.  I very much want to see any evidence if I'm not right!

Or maybe not betting my life, but betting another bypass.  I've read a bypass "lasts" 15 years.  I want mine to last forever.  I know there are people who have them multiple times, but I can't understand that.  I found it to be the most horrible experience of my life and prefer to not do it again.

BTW, I'm all of 45 years old.  I am postmenopausal, but I'm still pretty young for this; I was the only one under 80 in the CCU.

The angio report said all my arteries other than the left descending (which is where the blockage was) looked good.  The bypass report said my mammary arteries looked good.  So I have a very good shot at being heart-healthy in spite of my history and diabetes if I am wise about my choices.

This is one of the reasons I'm a fan of yours.  While I'm someone unlikely to get useful information from a heart scan, I'm extremely motivated to do the bits that you've seen work in your patients.

P.S. To wccaguy: It's starch. Your body reacts to it pretty much identically to sugar because it breaks it down to sugar.  The only "complex carbs" that are not sugar in the body are fibers, we hardly break down much soluble fiber to glucose at all and don't break down any insoluble.  But starch is the same thing in your body as sugar and it's not reported separately on the label.

Hi, Bix--

For the people who need to restrict carbohydrates (e.g., low HDL, small LDL, high triglycerides, blood sugar > 100 mg/dl), we're generally recommending that carbohydrates be reduced to <30% of calories until patterns are corrected.  

However, in all practicality, I rarely actually tell patients to follow this guideline. Instead, I suggest a virtual elimination of wheat and other processed carbohydrates and this has worked well. Fibers therefore come from vegetables, low glycemic index fruits, oat bran, ground flaxseed, and raw nuts and seeds.      

If serious weight loss is needed, then <50 gram carbohydrates per day yields substantial results.

Hi DR Davis,
          Some clinical studies (Westman et al., American Journal of Medicine 2002; O’Brien et al., AHA Scientific Session 2002; Hickey et al., Metabolic Syndrome and Related Disorders, 2004; Greene et al., Obesity Research, 2003) indicate that LDL levels decrease in people following a low-carbohydrate diets. Yet despite the evidence provided by science, the majority of health professionals remain skeptical of this effect. The source of this skepticism is most likely the mistaken belief that all saturated fats cause an equivalent increase in LDL levels. Such a sweeping judgment, however, ignores a significant difference between distinct subtypes of saturated fatty acids (SFA). They include the following:

1. Lauric acid (C12:0) – this is the most atherogenic SFA, i.e. it increases LDL more than any other SFA
2. Myristic acid (C14:0) – this SFA is the second most atherogenic
3. Palmitic acid (C16:0) – this SFA is the third most atherogenic
4. Stearic acid  (C18:0) – this SFA has no effect on blood LDL, i.e. it is considered “neutral”

          Foods like red meat, butter, cheese, poultry, eggs, pork and fish are primarily composed of palmitic and stearic SFAs (typically in a 3-4:1 ratio) and contain minor amounts of lauric or myristic acids. Such a composition of SFAs would typically cause either a minor net increase or net lack of effect on total LDL levels. Yet one may ask, if a minor net increase in LDL levels is possible, then how does consuming such foods, cooked in heart healthy vegetable oils as part of a low-carbohydrate diet, lead to a reduction in LDL levels for some people?

          Firstly, it is important to note that the primary oils utilized in the ANA include olive, safflower, flaxseed, and canola oils which are rich in unsaturated fats and exert a potent reduction in LDL levels. Secondly, and more importantly, individuals who switch to a low-carb diet from a typical Western diet minimize consumption of hydrogenated oils, i.e. trans fats, found in high-carb processed food items. Since trans fats are the most atherogenic dietary fats, by increasing LDL and simultaneously decreasing HDL, it is easy to see how a low-carbohydrate diet may decrease LDL levels by this fact alone. In effect, people switching from a high-carbohydrate to a low-carbohydrate diet must, by default, consume the majority of calories from whole foods, thereby avoiding consumption of trans fats typically found in carbohydrate-rich, processed foods.

          Lastly, a reduction in LDL levels from a low-carbohydrate diet may also occur as a result of the reduction in triglyceride levels observed in the overwhelming majority of studies on low-carb diets. As triglyceride levels serve as a proxy measurement for VLDL levels, when triglycerides decrease, the VLDL size and/or particle number may decrease as well. As VLDL can be converted to LDL (following triglyceride delivery to body tissues by VLDL), it is easy to see that a reduction in triglyceride levels, and thereby VLDL, can lead to reduction in net synthesis of LDL in the blood which leads to a net reduction in total LDL levels. One further fact needs mention here. High carbohydrate consumption is known to cause an increase in triglyceride levels. Given the biochemical conversion mechanism mentioned above, this may explain why LDL levels increase on such a diet. In short, high-carb diets may be dangerous to ones cardiovascular health.

          In closing, given the enormous complexities of human metabolism, it is difficult to determine a priori who will experience a reduction in LDL levels as this effect is dependent on numerous factors that are not easily measured (previous dietary habits, genetic factors, overall lifestyle, etc). Nonetheless, known and demonstrated scientific facts reveal that it is not counterintuitive nor misleading to expect that in some individuals LDL levels may decrease in a low-carbohydrate dietary regimen.

Great converstaion, thank you for this opportunity.
Colette Heimowitz

Hey wccaguy,

THANKS for your very kind comments!  When it comes to marketing labels on so-called "low-carb" products, my advice would be to be smart about what's right for YOU!

The Ezekiel bread question is a good one and I've heard it regarding the Atkins Nutritionals bars and Dreamfields pasta most often.  It really will depend on the individual and how it impacts YOU!

Personally, Atkins bars don't bother my weight and Dreamfields does not raise my blood sugars.  But there are "missing" carbs in both of those products just like there are in the Ezekiel bread.

One good thing I like about the Ezekiel breads is the fact that they are all-natural, sprouted sources.  But I agree with Dr. Davis that the carb counts in these breads are MUCH too high.

I prefer the low-carb breads from the Francis Simun Bakery in Dallas, TX.  They are the best low-carb breads I've ever tasted and only have a couple of net carbs per slice after you subtract the dietary fiber.

Excellent question!  Feel free to contact me anytime at livinlowcarbman@charter.net.

Hi, Colette--

Wow! Well said! Very helpful discussion of the differing saturated fatty acid effects on LDL.

Yes, I agree. I've seen many people reduce LDL particle number and small LDL, as well as triglycerides and VLDL, by reducing carbohydrates.

Fascinating discussion!

I have a message for jpatti:

If you change your proportions of macronutrients closer towards the following (in g per kg of ideal body weight per day):

Protein 1 g/kg,

Fat 1.5-3.5 g/kg, (mostly animal fat including whatever beef or pork fat comes handy including corn or wheat-fed cattle as well; please be not afraid of saturated fat, if such fat hurt I would be dead long ago!)

Carbohydrates 0.5-0.8g/kg,

- your glucose control will further improve and you may be able to minimize your insulin injections, or even discontinue it if your pancreas is still producing even a little bit.

Stan B.

Colette,

Can you provide a cite for your ranking of the SFAs by atherogenicity?  I have been looking for this very thing.

Thanks

Hi there, I'm a regular reader and occaisional commenter at Jimmy Moore's blog, and since someone asked about saturated fats affects on your calcium score, just thought I'd add my experience with that very subject.

In a word, for me at least, none. Not at all. Zero.

I've been low carbing for five years, eating saturated fats in a very liberal fashion. Lots of beef, butter, cheese, etc. etc.

Went to get a cholesterol test, my doc is alarmed at my LDL and total score (201 and close to 300,) I tried to explain to her that on a low carb diet, triglycerides are low, LDL will be large safe fluffy kind (btw, go see Dr. Eades blog at www.proteinpower.com for lots of excellent info on this-hey why not interview him as well?), but it went in one ear and out the other. She tried, really tried to get me to go on statins, but I refused. She then asked if I would consider a CT scan.

Sure, why not.

Long story short, scan results come back, ZERO calcium. Doc never mentioned statins again.

mrfreddy,

Good for you, but keep in mind that you're a sample of one and that a negative CAC scan doesn't prove that you're not doing serious damage to your arteries.  Especially if you're young, five years could be way too short a timeframe to see calcified coronary plaque emerge, although you may be full of soft plaque.  (Do you know your LDL is big and fluffy because you've had your lipid subfractions checked, or are you just assuming because of what you've read on the Internet?  You should also consider a carotid IMT.)  The foods you eat have been proven to cause transient endothelial dysfunction, the very sort of abnormal changes in vasodilatory capacity seen in diseased coronary arteries.  These changes are measurable and reproducible.  (See Esselstyn's Prevent and Reverse Heart Disease.)

Atherosclerosis aside, you're also skyrocketing your risk of certain cancers (esp. prostate), cardiomyopathies and arrhythmias, liver and kidney diseases, etc.  Again, no doubt your creatinine and other kidney function tests would look fine right now, but you don't see abnormal changes in these tests until the vast majority of your kidney tissue is destroyed, and at that point it doesn't come back.  I'd urge you to recognize that you're making yourself a guinea pig  and not to get too confident on the basis of a single test result.  Documentation on the dangers of high animal product consumption goes back for many decades, but we have perhaps 5-10 years' experience with Atkins and related diets, and already the results aren't good.  Atkins himself was overweight and suffered from hypertension, CAD, cardiomyopathy and CHF at the time he supposedly slipped and hit his head.

I really wish Dr. Davis wouldn't dress down you low-carbers on his blog.  Atkins did us a favor by pointing out the dangers of refined carbs, but the fact that HFCS and white flour are toxic junk foods does not imply that butter, bacon, and cheese aren't also toxic junk foods.

bad,

I'm not so young, I'm 51 in fact.

It's actually amazing to me I didn't have any calcium, since I had an atrocious diet before I found low carb.

As to the LDL, it is widely known that if your triglycerides are low, your LDL will always (well, almost always, there might be weird cases...) be the large fluffy kind. That said, yes, I did have an LDL subtype test done, and yes, it's mostly the large fluffy kind, type A pattern I think they call it. Btw, my HDL is pretty high too.

As to the supposed dangers of a animal based diet, I'll point you towards Gary Taube's book, Good Calories Bad Calories, where he examines the sloppy science that leads to these sorts of nonsense conclusions. There's an article about it in today's NY Times Science section, you should check it out.

As for the 5 -10 years of low carb diets, I'm not worried. We humans evolved over the past 2 million years on a diet that surely was high fat and had to have been low carb. I am hardly a guinea pig, in fact, those of you following a low fat/low sat. fat diet are the ones taking on a new, experimental, and unproven diet, when you look at it from the long view- two millon plus years versus the past 30 or 40 or so. Early results indicate your fat phobic diet - skyrocketing obesity, diabetes, heart disease, cancer-aren't too good.

As to Atkins, didn't you mention something about a case of one? Anyway, I'll just say you are badly misinformed about his condition at the time of his death, and about the cause of his death.

I'm off to enjoy some nice non-toxic grass fed beef, and some low starch vegetables smothered in non-toxic grass-fed butter.  but first I have some non-toxic grass-fed cheese as a snack...

enjoy your tofu dude....

mrfreddy,

Cool calcium score. I visit here because I feel Dr Davis is a pragmatist and will do whatever is needed to drops scores. It is just possible that this could be the watershed after which saturated fat is finally recognised as the perfectly healthy human food that it is. Scores like your's will push TYP in that direction. In 20 years time, what will we think about the saturated fat phobia so prevalent today?

Peter

mrfreddy,

Thanks for the book recommendation.  I hadn't heard of it (looks like it's very new), but I'll check it out.  I have read sat fat apologia in the form of Enig's Know Your Fats.

Appeals to "man's natural diet" are pseudoscience at its worst, and I refuse to address them or base my own diet on them.  No question humans evolved as omnivores; our dentition, digestive enzymes, etc. prove it.  (Those few claiming otherwise tend to be animal rights whackos.)  Furthermore, we can be certain that grains (but also dairy, don't forget) appeared only in the last 10,000 years, refined flours, oils, and sugars in the last couple thousand, and HFCS and hydrogenated oils in the last <100.  But it's still a quantum leap to Atkins.  Nobody knows the ratio of meat to plants eaten by paleolithic man, and it's a moot point anyway because we don't know the impact on his health or longevity (although it's a safe bet he usually didn't live long enough to suffer heart attacks or prostate cancer).  So all nutritional camps are stuck working with basically post-WWII research.

I'd recommend to you Eat To Live by Joel Fuhrman.  Among many other misconceptions, it addresses the low-carb mantra, "We tried low-fat and got obese from it."  But we didn't!  The stats show a slight reduction in fat as a % of calories over the last 30 years, along with a shift to more vegetable oils and a simultaneous large increase in total calories.  We are still eating almost as much of the animal fat and adding the trans-fat and white flour on top.

Finally, wherein did I err about Atkins?  This was all over the press after the coroner's report was leaked to PCRM.  But if I'm wrong, please correct me.

You can research Atkins health and cause of death on your own, just don't rely on PCRM. That is just a propaganda wing of PETA, one of the most unethical and dishonest organization as I've ever heard of. Even their name is a lie. It leads you to believe their members are all doctors, but only a small fraction actually are.

I'm familiar with Eat to Live... the only good thing I can say about it is that it is as low carb as a diet that avoids animal protein and fat can be. Which is a good thing, if you insist on being a vegetarian. But why avoid animal protein? To get the protein you need in a meal, you can eat a 12 ounce steak, or 35 cups of brocoli, hahaa. I know what I prefer. Anyway, none of the so called science the ETL crowd likes to quote stands up to any serious scrutiny.


Low carb diets, including Atkins, are about as close as we can get, or need to get IMHO, to a true paleo diet. The important thing is to keep sugar and starch out of the diet. as this wasn't present during most of our evolution. It makes sense-our bodies evolved to deal with fats and proteins, we thrive on it. But we don't react very well to sugar. Of course, it's a good idea to supplement with Omega 3, and to eat grass fed as much as you can.

It all boils down to the question of whether or not saturated fats are bad for you. When you look at the origins of that idea, and take an objective look at the science behind that idea, it falls apart. That, and given the likelihood that our ancestors probably ate as much of the rich fatty animal parts they could get their hands on, should tell you something.

Here's a couple of other facts for you to ponder. If you don't eat enough saturated fats, and you aat a lot of carbs, guess what your body turns those carbs into? Yup, good old saturated fats. If it's so harmful, why does the body make it?

Also, I've read that mothers milk can contain a lot of saturated fats.

I realize I'll never convince you, but give the Taubes book a go, and try to be objective about it. You may find yourself tucking into a juicy ribeye someday soon without a shred of guilt.

Hi badCRC,

You wrote: "But if I'm wrong, please correct me.". Where do you want me to start? Much of what you said is as "bad" as the Cyclic Redundancy Check (CRC) on your computer, I am afraid.

I read what you wrote in response to mr.Freddy. For starters, Mary Enig, PhD is one of the premier lipid specialists. I hardly would call her writings and experience "sat fat apologia". She is the one that can be credited for our current (after decades of fighting for it) understanding of the many dangers of the man-made, engineered fats called trans-fats. Not exactly the work of a delusional person or apologist.

Second, your assessment of the statistics regarding total fat consumption is seriously flawed. First, you base it on epidemiological "evidence" which is nothing but number crunching games that can, basically, be used to prove that the moon is made out of green cheese. The fact is that there is not a single piece of scientific evidence proving beyond reasonable doubt that (saturated) fat consumption in itself is detrimental to health. What IS there, is again epidemiological number games. But association doesn't prove causation. There are simply no tightly controlled, randomized clinical studies proving this.

Third, you point to the solution in your answer. White flour, sugar, starch, and overconsumption of Omega-6 vegetable oils are the culprit. Not saturated fat which has shown to be, at worst, health-neutral. Not to mention the vast amount of clinical, tightly controlled studies that show an abundance of evidence for the many health benefits of, for example, tropical virgin coconut oils - a "super-saturated" fat.

Fourth, you are definitely wrong to dismiss the brilliant work of the many (especially early) anthropologists, researchers and scientists that studied (and still study) real populations under real-life circumstances. Without exception they all reported that these "primitive" peoples were in excellent, vibrant health and showed none of the many ailments and illnesses we "modern" idiots suffer from. Only when "civilized" CRAP (Cereals Refined And Processed) was introduced, including, of course, sugars in it's many (also hidden) forms, health would decline and suffer.

Finally, you are completely off the mark on Dr. Atkins death. That despicable group called PCRM you are referring to is nothing else than a bunch of wild-eyed ultra-low-fat anti-meat (vegetarian) fanatics that will do anything, say anything, and distort any truth or half-truth to get their dietary delusions exposed by the media - that same media that is always willing and ready to do anything to sell more newspapers. This PCRM and associated violent terror groups(!) like PETA have been earmarked by the FBI as a terrorist organization and many of it members (including the director) have been prosecuted and convicted. The fact is that AFTER his untimely death dr. Atkins showed a higher weight - which is completely normal as a result of fluid retention as organs shut down, one by one. Do some research (and find out the real facts!) before you believe PCRM propaganda and other nonsense. Trust me, you could not be more wrong on this one.

Peter said he visits here because Dr Davis is a pragmatist and will do whatever is needed to drops scores.  Me too.  A heart scan is unlikely to give me useful info because of the bypass, but it is AWESOME to know what has actually been shown to work in live patients wrt actual measurements of coronary disease.  I've not seen anything like it anywhere.

I mentioned previously I've been low-carbing for a very long time before my pancreas was damaged.  I know about low-carb.  Unfortunately, I know about piles of mozzarella and pepperoni melted on a low-carb tortilla as a "pizza" and lots of other low-carb junk food.  Low-carb is a good start, but it's not the whole thing.

You can do any diet unhealthily.  Living on low-carb "bars" and sugar-free candy isn't much healthier than doing low-fat by eating Snackwells; reminds me of vegetarians that live on chips and french fries.  

Macronutrients are only part of the picture.  IME, we have ignored the importance of micronutrients.  This is why I like the fat from pasture-raised meat and dairy.  And this is why I *now* eat up to 10 servings of veggies per day, and a couple servings of fruit as well, which I did not do prior to the heart attack.

I reread the diet chapter in TYP last night.  I agree with more than 90% of it.  In fact, I suspect the disagreement on the topic of saturated fat is much less important to overall health than the huge emphasis on vegetables.  We need this stuff - and we don't yet know half of why we need it.  The emphasis on unprocessed food is also very, very important.  

There's minor points I disagree with Dr. Davis on wrt to diet - most having to do with fats.  And I don't see why anyone should eat nasty soy protein powder when there's lovely milk and whey protein powders!  But I agree MUCH further than I disagree.  Nearly everyone, whether eating low-carb, low-fat, or just the typical American diet, would be doing better to follow Dr. D's diet.  

I am of the opinion that if more than half the food on your plate at each meal is vegetables, it's much less important whether it's lowfat cheese or pasture-raised fullfat cheese melted over it.

It's a *good* choice to use 2 eggs in an omelet instead of 3, to cut the cream cheese in the middle in half, and to make up the difference with an artichoke or quarter head of butterhead.  But it's not because it cuts fat, rather because it adds veggies.  

There's a certain amount of focus on macronutrients which implies that's the primary difference in our diets.  But my diet has more in common with a low-fat veggie eater than it does with many low-carb folks.  The type of dressing that tops a salad is much less significant than eating salads daily.

I'm a long-time reader of this blog but seldom contribute.  This thread must be a record for Dr Davis.  The last few commenters reminded me that extremists exist in both sides of the lowfat discussion. And I tend to disbelieve extremists for no other reason than they're extremists.  

Another lowcarb site recently published a study of what wild monkeys eat.  This is worthwhile because early man would have evolved eating the same way.  It showed wild monkeys eat a lot of fruit during the summer months, turning excess sugar into fat.  During the winter months they burned that fat.  Overall monkeys eat a varied diet of fruits, nuts and bugs.  No saturated fat, I assume.  Meaning no butter, no steak...  It suggests that although we can live on saturated fats, that just means we can adapt to digest just about anything, not that it's the best longterm diet.  

I eat a lot of lean meats, vegetables, nuts and fruits.  Very little wheat, as Dr Davis recommends.  I'm 51, my resting pulse is 50, my BP is 105/55.  It may be healthy but a "juicy steak" is something I find repugnant.

Annonymous,

you should understand something about human evolution. We came from pre-human creatures that yes, ate a mostly vegetarian, monkey like diet. Over a very long stretch of time, we ate more and more meat, making it possible for us to develop bigger brains and smaller stomachs. We needed an energy dense food to do that. Meat is that energy dense food. Fats in particular.

I'm no expert, but my understanding is that because monkeys still have the big stomachs and small brains, they need to eat all day long to get enough nutrition out of what they eat. Mostly vegetation, but they do eat some meat (even other monkeys!) and bugs.

I'll remain civil here and just point out that a sneering tone and ad hominems won't save your life or mine.

I don't trust PCRM either, so here's the coroner's report on Atkins, indicating a history of MI, CHF, etc.:

http://www.thesmokinggun.com/archive/atkinsmed4.html

(Surely you're not arguing that the coroner had an animal rights agenda?)  I realize Atkins swelled with fluid; I'm referring to his weight at admission to the hospital: just shy of 200 lbs.  At his height, 6'0", that's a BMI of 27 -- significantly overweight.  If you had read Fuhrman, you would know that (although there are better measures than BMI) the true ideal weight for longevity is much lower than the CDC/WHO arbitrary cutoff of 25.

It's interesting that you Weston Price people dismiss all epidemiological studies out of hand, yet gush over the "brilliant work" of the early anthropologists -- Price himself, presumably -- which was just an informal version of the same thing, without statistical controls.  Stopping on a tropical island for a few days to snap pictures of the natives' teeth is good science, but peer-reviewed multiple regression analysis on thousands of subjects in different countries is junk science, moon made of cheese, etc.  Could it be special pleading because those studies aren't finding the results you like?  Anyway, there's a small sample at the bottom of this blurb from Fuhrman:

http://drfuhrman.com/library/article2.aspx

... and for the rest, I'll just refer you to the many hundreds of citations in his book (which also addresses your misconception about protein requirements).

Still not good enough, you say.  You want "objective science" proving the danger of sat fat.  Did you miss the reference to Esselstyn in my original post?  You can measure the damage inflicted on your arteries by animal fat using brachial artery flow-mediated dilation (FMD).

If you're not familiar with this test, they take an ultrasonic measurement of the diameter of the subject's brachial artery at a spot on the forearm, then wrap a BP cuff around the upper arm and inflate it to crazy pressures, like 300 mmHg, for five minutes (ouch).  Then they release the cuff and repeat the measurement over time.  At first the artery is much narrower.  In subjects with normal endothelial function, the artery soon gets much bigger in diameter than when it started.  This is called "compensatory dilation" and is caused by the inner layer of arterial tissue, the endothelium, secreting nitric oxide, your natural vasodilator.  It's the same mechanism your body uses e.g. to swell the coronaries in response to increased oxygen demand by the heart.  In subjects with dysfunctional endothelium (e.g., because of atherosclerosis), the artery doesn't dilate like it should.

Interestingly, you can induce that same dysfunction by feeding the subject a high-fat meal.  They fed a test group a 900-cal breakfast rich in animal fat (Sausage McMuffin meal, IIRC) and a control group a 900-cal low/no-fat breakfast (mostly shredded wheat, again IIRC) and found normal dilation in the controls but severely inhibited dilation in the high-fat group for several hours after eating.

I won't repeat this again; read the book.

Finally, as big an issue as sat fat is, you're wrong to think that it boils down to that.  The larger issue is nutrient density -- the fact that animal products (along with refined grains and oils) are rich in energy (calories) and deficient in carotenoids, flavonoids, organosulfides, etc., and hundreds of other protective micronutrients still undiscovered in fruits and vegetables.

howdy again MR. Bad,

sorry if I was sneering, just get carried away sometimes!

about that coroner's report-do you know how coroner's reports get filled out? Some guy in a coroner's office, who isn't familiar at all with a patient's history, scribbles something on a piece of paper. Yes Dr. Atkins did have heart issues, but his claim was that it wasn't related to his diet. I personally don't know, and you don't either.

And yes, he was slightly overweight, as are a lot of folks who follow his advice to not worry about calories, just cut the carbs. That only gets you so far. That's why I stopped "doing Atkins" a long time ago. I still low carb-he got that part right.

Do you know how that coroner's report got  into the public's eye? Your nasty and unethical PCRM folks obtained it illegally and distributed it, that's how. Because, in their view,it's a usefull piece of propaganda.

I believe you said something earlier about a study of 1 doesn't mean much. I agree. So enough about Dr. Atkins.

About Dr. Furhman, he's gotta do more than list a load of references. You need to make an objective, scientific analysis of those studies, and of ALL the relevant studies. You can't start with a conclusion already in mind-animal fats are bad-and find all the studies that support that notion, or seem to. That is sloppy science. That's what Taube's book is about.And I guarantee you that is what Furhman has done. He is ignoring all the evidence - and it is growing bigger all the time - that animal protein and fats are not the problem, but it's excessive carbs/starch/sugar.

Speaking of sloppy science, the study you mentioned is a fine example. A McDonald's sausage McMuffin? Oh puh-leaze. Do you know how many carbs are in that thing? Not to mention trans-fats?

And yes, I always eat lots of vegetables and fruit. Right next to my steak and with butter (on the vegetables, not the fruit! Although, buttered blueberries? hmm, might be better than it sounds...)

bad_cr

You've missed out in your reading somewhat, check this link

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12064344&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSuml

before you bet your life on those mysterious undiscovered

"hundreds of other protective micronutrients still undiscovered in fruits and vegetables"

which you believe in.

Here is the last line of the abstract from the above citation:

The overall effect of the 10-week period without dietary fruits and vegetables was a decrease in oxidative damage to DNA, blood proteins, and plasma lipids, concomitantly with marked changes in antioxidative defence.

Please note the word decreased.

I do have the full text, which is interesting but irrelevant to anyone fully committed to herbivory.

Personally I'm more impressed by a EBCT score of zero than the advice to read Fuhrman's book.

Peter

PS here are the comments from one of the main funders of this vegetable wash out study:

"The study has been carried out with financial support in part from a Danish Food Technology grant (FØTEK2, ‘Antioxidants from plants’) and in part from the Commission of the European Communities, Agriculture and Fisheries (FAIR) specific RTD programme, CT 95-0158 ‘Natural Antioxidants from Foods’. It does not necessarily reflect its views and in no way anticipates the Commission’s future policy in this area"

I doubt it will affect your future policy either.  However, I genuinely wish you luck. You may need it.

Sorry the link got chopped, the paper is

Green tea extract only affects markers of oxidative status postprandially: lasting antioxidant effect of flavonoid-free diet.

Young et al Br J Nutr. 2002 Apr;87(4):343-55

Enjoy

Peter

bad,

If you and Dr. F. and the PCRM are right about saturated fats, how do you explain EACH of the following:

1) Native populations who ate animal protein/fat almost exclusively (Inuit, Masai, etc.)did not have heart disease. No cancer either. No diabetes. If saturated fat alone was the boogey man you think it is, this simply could not be possible. Clearly other factors are involved.

2) Your own body makes saturated fat when you don't eat enough of it.

3) Mothers milk contains saturated fat. A lot of it.

4) Human evolution. How could we have gotten to the point we're at now, if animal protein/fat was really so dangerous?

5) Our bodies have numerous mechanisms/hormones, etc. to RAISE blood sugar. Only one, insulin, to lower it.

6) Test after test of a true low carb diet have shown that the diet improves cholesterol, particularly in regards to reducing the only really meaningful part of cholesterol numbers, low density, small LDL particles. These are dangerous because they are small enough to penetrate cell walls and form plaque. Low carb diets have been proven, again and again, to reduce their presence. High carb diets do the opposite.

Given all that, I think I'll continue to eat the diet that my body seems to be designed (exquistly so I might add) to eat.

Baddie my pal,

About that sausage mcmuffin study, take a look at what Dr. Eades has to say about that one:

http://www.proteinpower.com/drmike/?p=144

Here's my condensed version:

The "researchers" only reported on a SUBGROUP,ie a MINORITY, of the subjects of the study-they IGNORED the majority of subjects who didn't give them the response they were looking for.

In reality, most of the subjects involved in the test actually had improved "arterial compliance" on the ridiculous high fat high carb" meal.

This is a classic example of truly sloppy science.

Here's a little quote from Dr. Eades.

So, actually, a majority of the subjects had improvement in arterial compliance with the high-fat diet as compared to the high-carbohydrate diet. But our researchers remained undeterred by these facts as they went on throughout the rest of the paper describing all the negative findings in the minority of subjects who responded negatively to what could only be described as a horrendous meal by anyone’s standards (except executives of McDonald’s, I suppose).

Thanks for the amicable responses.

mrfreddy,
I don't remember for sure if it was a McD's breakfast.  It wasn't the carbs, because the control group meal was loaded with what you and I would agree are junk carbs (shredded wheat).  Could have been the trans fats, but there were several experiments, and the same results were demonstrated with other high-fat meals -- including the beloved extra-virgin olive oil.  Again, this was Esselstyn, not Fuhrman.

I should make that distinction clear:

Esselstyn:
- afraid of all fats, plant or animal; strictly vegan, <10% fat by calories; allows unlimited whole grains
- cured advanced CAD in a small group of subjects using this diet
- member of PCRM

Fuhrman:
- not affiliated with PCRM (AFAIK)
- allows animal products for up to 10% of calories; nutrient density, not avoidance of specific foods, is the point; most "vegan" diets are horrible
- much harder on refined carbs than animal foods; whole grains allowed in moderation, but totally unnecessary and harmful for certain individuals
- fats from whole plants are beneficial; optimal diet varies somewhat by individual, and may be anywhere from 10% to 40%+ fat

Now to your points:
1. Inuit, at least, still have worse longevity than even fat Americans.  (See http://www.itk.ca/media/backgrounder-health.php)  Almost any traditional diet seems to be better than McMuffins, soda, and Twinkies (surprise).  But what's optimal?  The populations with the highest proportion of centenarians (Okinawans, Abkhazians, Vilcabambans, etc.) all eat diets almost entirely of whole plants.  None are strictly vegan.

2. Irrelevant.  How much glucose do you eat?

3. I thought human milk fat was mostly medium-chain triglycerides, not the atherogenic long-chain SFAs; I'll have to read Mary Enig again.  Human milk is also 42% sugar (lactose) and only 7% protein by calories!  (http://www.disknet.com/indiana_biolab/b120a.htm)  Nobody disputes that babies' dietary needs are different from adults'.  What's your point?

4. Evolution only needs you to live to about 30, so I don't see how this is relevant.  Natural selection wouldn't have selected out smokers, either.

5. I don't get what you're saying here.  Clearly, for most of our evolutionary history our overriding concern was getting enough calories from any source.  All these appeals to "evolution" are conjectural BS.  What do comparative and epidemiological studies show to be optimal for health and longevity?  That's the question.

6. Fuhrman addresses this.  Yes, starting from the toxic American diet, low-carbing causes (rarely maintained) weight loss and, consequently, improved lipid profile, insulin response, etc.

The absence of clinically apparent disease (right now) isn't the same thing as good health.

Peter,
Your PubMed link got truncated.  Please try again or post the title and abstract.  I am very interested in reading this very counterintuitive-sounding study.  (Even the most diehard low-carber usually doesn't argue that veggies are bad for you?)

Interesting comments.  (I got a lot of ideas for my reading list!)

Dr. D, thank you for your response.

Curious - If we remove the argument of whether saturated fat is good or bad ... is there an opinion of whether meat protein is good or bad?  I'm wondering about the hormones, the iron, the amines, the bacteria, etc.

Bad bad,

responding to your responses..

Now to your points:
1. Inuit, at least, still have worse longevity than even fat Americans. (See http://www.itk.ca/media/backgrounder-health.php) Almost any traditional diet seems to be better than McMuffins, soda, and Twinkies (surprise). But what's optimal? The populations with the highest proportion of centenarians (Okinawans, Abkhazians, Vilcabambans, etc.) all eat diets almost entirely of whole plants. None are strictly vegan.

Noone knows what caueses these populations to live longer. This is data chery picking at it's best.

2. Irrelevant. How much glucose do you eat?

haha, got a chuckle here. you actually have a good point... the body makes sugar from protein, to provide the glucosse the body needs. However, sugar, or glucose, is only used in very very small amounts, for just a few places in your body. My understanding is that sat. fats are a critical building block for all cells throughout the body.

3. I thought human milk fat was mostly medium-chain triglycerides, not the atherogenic long-chain SFAs; I'll have to read Mary Enig again. Human milk is also 42% sugar (lactose) and only 7% protein by calories! (http://www.disknet.com/indiana_biolab/b120a.htm) Nobody disputes that babies' dietary needs are different from adults'. What's your point?

Point is, if nature provides it, how can it be dangerous? It supports the notion that saturated fats are beneficial, even needed, by our bodies.  as for human breast milk, I think it's content varies a lot, even on the same day. I've seen all sorts of descriptions of what's in it, none of which agree with the other. But it does include lots of protein, and saturated fats.

4. Evolution only needs you to live to about 30, so I don't see how this is relevant. Natural selection wouldn't have selected out smokers, either.

If you want to disregard the fact that your body evolved over millions of years to thrive on a diet of meat and fat, because early humans tended to die early (no doctors, medicine, plumbing, not to mention nearby tribes and beasties that want to kill you....), well, I don't know what to tell you.

5. I don't get what you're saying here. Clearly, for most of our evolutionary history our overriding concern was getting enough calories from any source. All these appeals to "evolution" are conjectural BS. What do comparative and epidemiological studies show to be optimal for health and longevity? That's the question.

comparative epidemicologial studies are the height of BS. Read Taubes.

6. Fuhrman addresses this. Yes, starting from the toxic American diet, low-carbing causes (rarely maintained) weight loss and, consequently, improved lipid profile, insulin response, etc.

I would say that a low carb diet is helluva lot easier to stick to and maintain that Dr. Furhman's diet. I've been on it five years plus. I stick to it because it satisfies, really satisfies, to the core. In a way that Dr. F's rabbit food could never satisfy.

There are thousands on the low carb forums that have maintained quite easily.

I would also say that any given low carber's lipid profile is better than it would be on Furhman's diet. It' the triglycerides number that really counts. While his diet is a low sugar as it can be for a mostly vegetarian diet, it still delivers a lot of sugar to the body.

what's your triglyceride count, btw? I think mine was 60 or so, but I'd have to look it up to be sure. If your's is under 100, I'd be suprised.

The absence of clinically apparent disease (right now) isn't the same thing as good health.

Only if we accept your definition of "good health". I'll take very low small LDL, zero calcium, and the fact that I rarely get sick (I've only had two or three colds in the past five years, in spite of the fact that I work in close proximity with folks who are coughing and hacking away, not to mention my carb loving gf who gets two or three colds a year...)

I'm waiting patiently for your response to Dr. Eades on your silly Sausage McMuffin study. Particulary the point that the researchers only found the adverse reaction in a small minority of subjects, that most of them reacted better to the horrendous high fat/high carb meal. This is pure junk science.

The reference for the intervention trial is here. NB this was NOT a low carb study.

Youmg et al  Br J Nutr. 2002 Apr;87(4):343-55 Green tea extract only affects markers of oxidative status postprandially: lasting antioxidant effect of flavonoid-free diet.

Some idea of how plant consumption produces sustained antioxidant effects is given here, thank goodness for uric acid:

Lotito SB and Frei B (2006) Consumption of flavonoid-rich foods and increased plasma antioxidant capacity in humans: cause, consequence, or epiphenomenon? Free Radic Biol Med. 2006 Dec 15;41(12):1727-46

A very much weaker observational study "associating" antioxidants with DNA damage (but it's as valid/invalid as those associating red meat with cancer) is this one:

Watters JL et al (2007)  Associations of antioxidant nutrients and oxidative DNA damage in healthy African-American and White adults. Cancer Epidemiol Biomarkers Prev. 2007 Jul;16(7):1428-36

I have only the abstract for that study but here's the punchline:

"African-Americans had statistically significantly lower plasma concentrations of vitamin E, alpha-carotene, beta-carotene, and lutein + zeaxanthin than Whites, as well as lower self-reported intake of most antioxidants. Levels of oxidative DNA damage, measured using the alkaline comet assay, were lower in African-Americans than Whites."

I make no specific suggestion that eating plants is bad for you, other than the vast array of poisons they have evolved to combat herbivores, more that there are publications you should consider. In the words of Eeyore "Think of all the options... before you settle down to enjoy yourselves"  A.A. Milne (1928) The House at Pooh Corner. Methuen & Co. Great Britain p96.

Peter

mrfreddy,
Forgot to respond to the Eades rebuttal...  Actually, the paper Eades attacks isn't one of the ones Esselstyn cites, which are:

Robert A. Vogel, Clinical Cardiology, June 1999: "Brachial Artery Ultrasound: A Noninvasive Tool in the Assessment of Triglyceride-Rich Lipoproteins."
http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=407824

Note: In the book he doesn't mention McDonald's; I think it was in the video talk on his website: http://www.heartattackproof.com/media.htm

... and the olive oil one:
R. Vogel, M. Corretti, and G. Plotnick, Journal of the American College of Cardiology, 2000: "The Postprandial Effect of Components of the Mediterranean Diet on Endothelial Dysfunction."
http://content.onlinejacc.org/cgi/content/abstract/36/5/1455

Anyway, I read the abstract and I say Eades is attacking a straw man.  They didn't just slice off the bottom tail of the curve and conclude circularly that some people react badly to McMuffins.  They showed that, in that subgroup of "fat reactors" (and only in that group), the endothelial dysfunction correlated with markers of insulin resistance, including baseline TG, glucose, and insulin, and peak postprandial TG.  I think the article was badly titled; their real conclusion seems to be this sentence: Normal weight young subjects with an insulin resistance phenotype show significantly decreased vascular compliance, increased postprandial TG peaks, and markedly reduced plasma nitric oxide metabolites after a high-fat meal.

Given what we know about the importance of NO-mediated vasodilation, these studies are hardly junk science.  Still, Esselstyn definitely implies that everybody will exhibit that same set of responses.  In reading the two Vogel abstracts, nothing jumps out at me that contradicts that, but the Blendea article certainly suggests that it's not that simple.  Geez, this is complicated enough even assuming everybody is intellectually honest.  Thanks for that link.

Peter,
I'll have to look over these.  I am aware that a lot of the nifty antioxidant effects seen in vitro turned out not to work in vivo.  I will say that Fuhrman doesn't overemphasize "antioxidants" in touting the many benefits of veggies.  Anyway, I picked up Taubes' book today and am plowing through it.

Dr Davis said:

"At this point, I truly don't know. I thought I knew. I have to admit that the entire conversation has to, at least, raise some doubts."

It's statements like this that set Dr. Davis and this blog apart.  He is willing to look at the data and follow it wherever it leads, even if it might mean letting go of a long standing belief.

Thank you, Dr. Davis, providing such valuable information.

I asked my doc for advanced lipid profiling and she says the jury is still out on this, I asked for a repeat calcium score test, I have to pay for it myself $400 as she says they don't know how accurate it is.or whats the info useful for??

I take Lipitor 10mg a day and would love to get off it as reviews for women and lipitor are not good, I eat low carb, am off insulin, down 80 lbs and have good labs results. My last calcium score was 183 in 2004 and would like to see if it is down is it worth me pushing her to order these tests??

Actually thats a dumb question to ask here, I read your book Dr D, great, but I don't eat grains as need a shot of insulin to do so, and I do use some sat fats, not allot but some cream in a coffee once a day and some butter on vegs,  try to keep under 20 gr a day.

I think you already know what I think: I have no hesitation whatsoever in suggesting that repeat CT heart scans, especially after a 3 year interval provide INVALUABLE feedback on your program. Also, have you addressed vitamin D?

Hi, yes I am going next week to ask again for the calcium score as just switched Dr. I use Vit D 1000 u a day.

For the last 5 years I've focused on raising my HDL, both with diet and immediate-release niacin. By eating a moderate fat (38%) diet rich in polyunsaturates and low in saturated fats and taking 4g niacin daily I was able to raise my HDL from 32 to 44.  After reading Gary Taube's book, I decided to transition to a high fat (60%), low carb (7%), approach and also increased by saturated fat intake (31% of calories) that contained significant amounts of coconut oil.  My LDL increased by 4 points while my HDL skyrocketed up to 71!  Polyunsaturated fats now account for only 6% of calories.  BTW, my triglycerides also dropped significantly.

Meta-analysis of prospective cohort studies evaluating the association
of saturated fat with cardiovascular disease
Full text of this paper is online thanks to http://metabolismsociety.org

For those who aren't aware Frank Hu and Ronald M. Krauss, M.D are significant figures in lipid research and the American Journal of Clinical Nutrition is probably the world's most prestigious nutrition journal.

Very funny this appears the same week the UK's Food Standards Agency starts it Ban the Butter campaign.

The government advice to "eat more healthy whole grains" is not off-base.  But that's not what Americans did.  Instead they ate more fructose and replaced saturated fats with more polyunsaturated fats.  This is totally fundamentally different than eating a low-fat, high-carbohydrate diet like that of the rural Zulu tribe studied by T.L. Cleave or the Africans studied by Denis Burkitt and Hugh Trowell that were diabetes and obesity-free.  

Americans are still not even coming close to the grain consumption of a century ago, when such diseases were exceedingly rare.

This video is very good:

"Vitamin D and Diabetes-Can We Prevent it?"

http://www.youtube.com/watch?v=wTtmvMvgfl0

At this link you'll find the slides of a short presentation on
The Influence of high vs. low sugar cereal on children's breakfast consumption.
There are some surprising findings.

I found it at Cerealfacts.org website

The situation in the UK is much the same. The breakfast cereals most likely to find at discounted prices are those with the most sugar.

It's  often the case the choice of cereal going into the trolley is made by the child rather than the parent. There should be more restrictions on the promotion of pre-sweetened cereals to kids.

In my early 60s I notice that I don't get much "kick" out of sugary foods as I might have earlier.  I've gotten to the point where I can't believe the amount of sugar in say cookies or ice cream...which I no longer buy.  

I do now take several phyto-extracts...pomegranate...blueberry...cocoa...resveratrol...green tea...grape seed...etc.

Pomegranate at least has been shown to moderate insulin response and maybe reverse atherosclerosis.

http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114814

Great post!
I've just blogged about my eating history too...  years of low-fat, high starch, high fruit eating led me to the brink of diabetes. I'm amazed I survived childhood!

Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? [Unless progenitor cells are also damaged...]

Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)?  It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it.

"Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? "

That explains why my obese elderly mom has normal blood sugars even though she has always eaten diet high in simple carbs.

Dr. A, your previous diet was indeed low fat and starch based but there was not much actual, real food in it!  I am missing the connection both here on this thread and in your blog, between people eating manufactured, food like substances that don't have much fat in them and are loaded w/ refined/highly processed starch carbs w/ almost zero fiber or nutrients in them, and the eating of actual whole grains, either fully intact or minimally processed.

"Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)? It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it."

If you haven't already, check out Jenny Ruhr's blog, Diabetes Update, and her related website, Diabetes 101.  Type II is being subdivided according to short and long-term beta cell function and insulin resistance.  Different genes cause different impairments.  Emerging is MODY (mature onset diabetes of the young), or type 1.5.  A defining characteristic is that the ability of the pancreas to secrete insulin declines slowly over time, rather than suddenly as in type I, but it declines no matter what the treatment.

I am a Ketosis Prone Type 2 diabetic and it isn't necessarily true that glucose toxicity leads to permanent loss of pancreas functioning.

Typically, we will lose all pancreas secretion and will go DKA, at that point we are essentially type 1's. We need insulin to survive but after 2 to twelve weeks of normal blood sugars we can be taken off insulin and we will have near normal blood sugars.

Weird, yes, but there are thousands of us out there so this isn't uncommon.

Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus
http://www.annals.org/content/144/5/350.abstract

My blog has more information, if you are interested.

We seem to be severely intolerant of carbs so I too wonder what would have been the case, if years ago the carbs were taken out of my diet.

Michael Barker - your blog is fascinating. Thanks for the pointer. Will you be allowing comments?

What a great resource!

Matt Stone said...
"The government advice to "eat more healthy whole grains" is not off-base. But that's not what Americans did." The public were conned. Manufacturers turned whole grains into dust and formed the dust into junk. Because everything that was in the grain was in the junk, they called the junk "whole grain".

Sadly, this is what happened to me. I had glucose problems by age 15, but they told me for years I was fine. There was less information available in those days. I stopped all soda and junk, but it was too late, my fate was sealed. My pancreas and teeth were damaged. Somehow I managed to eat fruit without getting headaches years later, so I thought fruit in moderation was healthy. I though my fatigue was from my mercury fillings, but now I realize some of my fatigue was from fruit sugar. I blame society and my parents, although I forgive my parents. I was fed tons of soda and every type of high glycemic junk food you can imagine.

You are so right, i cannot beleive that anyone would think that

It comes with the territory - chalk it up and keep writing!

What bothers me is that, with so much health information in the world, it's becoming tougher and tougher to tell what's genuine and what's marketing, lies, or other just plain nonsense. But thanks for the encouragement.

And here's another "I agree wholeheartedly". It can be hard to find a doctor on the same page though. Anyone have suggestions?

Amen brother!    One of the big problems with self directed care is the lack of true knowledge for the public to help them make choices.  For example  The dietary advice given from our government and other health agencies (ADA,  AHA, food pyramid etc) to cut the fat and red meat, eat whole grains and lots of fruit.

Agreed. I've thought something like this would be very nice. In my mind, I've been calling it 'distributed medicine', but 'self-directed health' sounds more empowering.

Hi StephenB,

This is the future of medicine!!

I suggest Dr. Kenneth Tourgeman. He is definitely on the same page as Dr. Davis.  He is a nephrologist who preaches a hunter gatherer lifestyle and practices scientific nutritional medicine with high dose vitamin D3 and high dose omega 3 fish oil. His blog is nephropal.blogspot.com

This is one of the wisest suggestions I have heard in a long time. If other medical practitioners would accept this advice, it could revolutionize our healthcare system.

Not that I disagree, but just how realistic is this.  Most people cannot even manage to keep their own computer running properly, how can they be expected to manage their health to the extent I suggest.

Not that I approve of paternalistic "do as I say" doctors, but I don't see a system such as yours work for the majority of people.  I'd like to see a system that encourages patients to take charge of their health care, instead of considering them trouble maker when when they do.  But that will always be a minority.  Most people want to be told what to do.

This is amazing. I was just thinking the same thing about one hour ago after doing some reading on my own health issues.

Thank you for putting this forward, this idea will indeed revolutionize the health care "industry" for the better, when people start taking it upon themselves to manage their own tests, results, medications, supplements, etc. outcomes will improve dramatically.

Mark my words.

I know a handful of doctors who are like this, and they seem to make a psychological difference as well as a physical one.
However, most might be worried that you'll think for yourself - in the wrong or right direction. They can't be having that.

Dr. David Grimes (who once proposed that statins work by somehow activating the vitamin D receptor) published a book on the vitamin D/cholesterol connection this April.
http://www.vitamin-d-deficiency.co.uk/
A very nice man as well. I've had an email conversation with him.

I agree that healthcare should be largely self-directed, and I absolutely agree that the public should be allowed to make more informed decisions about their own health. However, I think that to assume that all Americans have the discipline and intelligence to truly take charge of their own care is very misguided.  Our health problems go far beyond the misinformation from the ADA and AHA.

This change can't come too soon. I recently went to the VA hospital to get bloodwork done. I wanted any sort of test to give me a baseline on which I could monitor improvements from changes in my diet.

The nurse refused several tests because they cost money, said with mild scorn, "You apparently don't want anything from the VA other than testing" and later chastised me for refusing a mammogram and pap smear. (Aren't those costly, too?)

This is my body. I call the shots. Please, just answer my questions and help me help myself.

StephenB

>It can be hard to find a doctor on the same page though.

Absolutely. And in the UK, with its large General Practice centres, it is hard to see the same doctor twice. 'First consult you doctor' is written everywhere these days, but one doesn't have *a* doctor, so there can't be a relationship established on trust. It is also getting harder to buy simple non-prescription drugs like aspirin over here, due to nannying by pharmacists.

Hello Dr Davis,

I just found this article about Type-1 Diabetes and wheat; thought you would like it, unless you already red it.

http://diabetes.diabetesjournals.org/content/58/8/1789.abstract

Let me post a hypothetical question: What if your health were tracked, if online interactions were truly interactive, and you could be prompted/reminded/coached to consider various strategies for health using your individual health data?

That is what we are working on here using Track Your Plaque as the prototype.

Congratulations! Our selection committee compiled an exclusive list of the Top 100 heart disease Blogs, and yours was included! Check it out at http://thedailyreviewer.com/top/heart-disease

You can claim your Top 100 Blogs Award Badge at http://thedailyreviewer.com/blog/9076

Cheers!

Angelina...

billye

Sorry to be off topic -- I love the nephropal blog but wonder if anyone else is having problems with it?  Everytime I log on it knocks out my wireless connection.

Dont know where else to put this but I voted on your thyroid question. I answered "questioned why but ordered the tests"

But the rest of the story is he said the results were fine although my TSH was High "normal" and my T4 was OUT of range low.

Went to see a new doc this week.

Nick,

I have not heard anything about connection problems from anyone.  Leave a comment for Dr T at nephropal.blogspot.com and I am sure that he will look into it.

Dr. Davis, i agree with you what you just said. but, there is even bigger issue to deal with here. the FDA. for example: FDA is going after natural thyroid hormons. which have been selling safely in the market for 100 years now. talk about pure money muscle power. FDA have no problem approving dangrous drugs for cholstrol. it confuses the issue further for the people who are trying to learn about their own health.
http://thyroid.about.com/b/2009/08/26/end-natural-thyroid.htm?nl=1#commentform

Dr. Davis said: Let me post a hypothetical question: What if your health were tracked, if online interactions were truly interactive, and you could be prompted/reminded/coached to consider various strategies for health using your individual health data?

Well that would be just great, IF one didn't have to worry some about an insurance company accessing such data and using it against one to deny coverage or prevent one from obtaining future coverage. Such info would have to be COMPLETELY private.

Until there are no "pre-existing condition" exclusions in health insurance, and it doesn't matter if such information could possibly be accessed by insurance, I will just "do it myself".

Technology can be a two-edged sword.  I had a heart scan and my insurance wouldn't pay for it... but they apparently were interested enough in the results to make it damn near impossible to obtain life insurance, health insurance, and long term care insurance on the open market, due to my "pre-existing condition".

Luckily we will have "lifetime medical insurance" through an employer's generous retirement plan and eventually Medicare.  Not so lucky about the long tern care coverage, though.

Until technology can guarantee complete privacy, and no possible controverted use of information, I have great reservations, no matter how well intentioned and valuable the information.

madcook

Hi, Mad--

Yes, indeed.

I believe that, while imperfect, online security is the solution. Only you (or those you designate) can access your info. This is how Google Health, Microsoft Health Vault, and Revolution Health's health archiving services work.

It's happening. And it will change healthcare for the better by putting more information and control into the hands of the consumer. This is a GOOD thing.


Kris--

Yes, this is very worrisome.

The FDA is threatening to "clamp down" on thyroid preparations and "bioidentical hormones," two areas in which most of us agree no action is required and in fact will be destructive.

I've written my letters to the FDA expressing my objection to their policies. Everyone else should, too.

Just saw my doc for annual physical (I'm 49).  Mentioned the heart scan blog and he said calcium score tests are "bogus".  "insurance companies don't pay for them so they must not mean much, plus if the plaque doesn't reduce flow, it's not a problem".  And he's young (early 40's).  Kept quiet after that; no use trying to convince him to open his mind.

Hi Dr. Davis (and readers),

I have conceptualized this movement to the 'Patient of One' healthcare system in a few essays:

http://epistemocrat.blogspot.com/2008/12/health-care-sans-primary-care.html

and then, more recently, through many of my recent blog postings:

http://epistemocrat.blogspot.com/

(feedback welcomed)

Cheers to fostering an inviting and respectable community of self-directed self-experimenters.

Thanks,

Brent

To a degree I've had something like that for a while now. Our local surgery uses nurses, prescribing nurses etc. for routine stuff, which frees up the doctors' time for serious stuff. For example when mother is ill I can always get a doctor to call (or paramedics/ambulance) or take her to the surgery where she is seen by a triage nurse and a GP is called immediately if required.

My GP (In fact all the GPs) are comparatively clueful BUT limited by accountants as to what they are and are not permitted to do - and here's the problem, when the doctor is cut out of the loop then even the receptionist is permitted to refuse tests or refuse to give out the results and otherwise hinder my looking after myself. The not-doctors are even more limited as to what they are and are not permitted to do and it still needs a real doctor to override these restrictions, for example to get a full lipid panel rather than TChol, and then be given the actual numbers.

If these relatively recent financial restrictions were lifted again (some hope!) it'd be an ideal system, I get the tests I need and the prescriptions I need and as much or as little support as I require to work on the results. Reversing this back to a patronising  "eat up your carbs yum yum and we'll weigh you again in six months and check for statin deficiency once a year" may "save" money but only in the short term.

The doctors themselves aren't happy about Big Brother - but they realise that opposing it will lead to loss of their employment

Thanks for posting this.  My husband has allowed himself to be carried along with my strict low-carbing for a few months now, and has lost 25 pounds +  or so so far. He had labs a couple of months ago, and his Triglycerides were up and his HDL somewhat low.  So of course his physician wants him to repeat the labs in Oct., and will want to put him on meds , I'm sure, if he still exhibits that profile.  But I will advise him to wait, to continue with what he's doing until his weight loss stabilizes, and this post will give me the concise authoritative ammo I'll need to encourage him both to continue with carb restriction and to resist medication, which he almost certainly is not a proper candidate for.  Perfect timing for us, and thanks so much! jennytoo.

on another subject, but I'm curious about your thoughts on krill oil.

Here's a post by Michael Eades on the subject:
http://www.fourhourworkweek.com/blog/2008/07/23/krill-oil-48x-better-than-fish-oil/

Hi Dr Davis,

While fat is stored as triglycerides, it is released from adipose stores as non esterified fatty acids, and these will be predominantly palmitic acid in humans. Non esterified palmitic acid appears to be an excellent inducer of insulin resistance, and insulin resistance has been hypothesised by several authors to be a completely normal physiological adaption to fasting or seasonal carbohydrate absence. While weight loss is on going, the circulation is flooded with NEFA and "physiological" insulin resistance should predominate. If the person continues to consume "good" carbohydrate at above acute metabolic needs, the excess will get shipped out of the liver as VLDLs. Under insulin resistance lipoprotein lipase, routinely under the control of insulin, won't be doing much lipolysis and so VLDLs can hang around in the circulation... Muscle can happily accept NEFA as a prime source of energy without lipoprotein lipase having to split the lipids from VLDLs, so leave the VLDLs there to show up as fasting trigs....

Once weight is stable the NEFA release from adipose tissue will be much better matched to metabolic needs. With the improved insulin sensitivity due to loss of visceral fat, control of both adipose hormone sensitive lipase and endothelial lipoprotein lipase activity should normalise and allow VLDLs and HDL to settle in to  more cardiologically acceptable numbers.

Just an idea. The prediction it makes is for a reduced HbA1c due to the reduction in bulk carbohydrate (this must happen to allow lipolysis for weight loss), coupled with no drop or an increase in fasting blood glucose due to the NEFA induced insulin resistance. Very curious as to whether this happened...

Idea is open for kicking.

Peter

Thanks for the article.  In the midst or losing a good deal of weight I had a finger prick test here at work.  My HDL had indeed dropped into the low 20's but my Triglycerides had also dropped (maybe a good does of fish oil and cod-liver oil help those?).  Anyway my weight has pretty much stabilized at a good level and I'm looking to do a good blood test in a few weeks.  Hopefully the HDL numbers are coming up.

The post about Brad is from August of 2008.  So how is he doing now?  Did the triglycerides drop and HDL rise?

I wonder what happened to Brad now? How did it go? By the way, I wanna share this video I came across with: http://www.youtube.com/watch?v=lj-ZnG3NoZY You'll surely learn a lot of information here.

I'm glad I found this blog after finding out that I may have a 1.7 spleen aneurysm (need ultrasound to confirm). Will study this and the other blog you have for ideas. Also it is first year my cholesterol was over 200 (218) in years and I think diet can be related. I asked this on other comment but am wondering about spelt flour and breads made with it claiming to be wheat-free.