Lethal Lipids II

22. May 2009 William Davis (7)
I call the combination of low HDL, small LDL, and lipoprotein(a) "lethal lipids," since the trio is an exceptionally potent predictor for heart disease. Uncorrected, the combination is a virtual guarantee of heart disease.

Ed is a perfect example of someone who came to my office recently with this pattern. His starting values:

HDL: 34 mg/dl

Small LDL: 78% of total LDL
NMR: Small LDL 1655 nmol/L; total LDL particle number 2122 nmol/L)

Lipoprotein(a): 205 nmol/L


The atherogenicity, or plaque-causing potential, of this pattern was reflected in Ed's heart scan score of 2133.

You can readily see that, of this combination, only HDL cholesterol would be adequately identified through conventional lipid testing. Small LDL and lipoprotein(a) need to be specifically measured via lipoprotein testing.

And, contrary to the drug industry's "statin drugs for everybody" motto, this pattern, while improved with statin therapy, is not shut off.

Specific correction of each abnormality is required. For instance, niacin addresses all three: increases HDL, reduces small LDL, and (usually) reduces lipoprotein(a). A standard low-fat diet makes this pattern worse by reducing HDL, increasing small LDL, and (usually) increasing lipoprotein(a).
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Comments (7) -

  • Anonymous

    5/23/2009 4:12:16 PM |

    so what kind of diet should this person adopt?

  • karl

    5/23/2009 6:06:51 PM |

    He should eat low carb and take niacin and fishoil to start..

  • Anna

    5/24/2009 6:25:38 PM |

    Eating more natural fats including natural fats, like coconut oil and nutrient-dense fats ( pastured egg yolks and grass-fed butter especially), will raise his HDL, too.

  • Fran

    5/29/2009 2:23:50 AM |

    My husband's HDL was always in the 20's, a direct result of the low (to no) fat, low cholesterol diet recommended by most physicians. After much research and a NEW physician (ND) who recommended a low carbohydrate, high protein and adding good saturated fats, triglycerides dropped from 150 to 61 and HDL rose from 29 to 60. Small dense particles are moving in the right direction to large buoyant. We are what we eat and AHA has it all wrong.

  • Jessica

    5/29/2009 9:52:58 PM |

    There's an interesting post over at Musings of a Dinosaur regarding his likely decision to INCREASE use of statins...

    http://dinosaurmusings.blogspot.com/2009/05/ahead-of-curve.html

  • Davide

    6/3/2009 1:04:05 AM |

    Dr. Davis,

    You're a busy guy--I know. But can you please do me the honor just answer this one question that bugs me to no end?

    If its the particle number and size of LDL that really matters, and (not the amount) then that means that dietary saturated fat has ABSOLUTELY NOTHING to do with heart disease; there is absolutely no connection between saturated fat intake and CHD. Is this correct?

  • Trinkwasser

    6/17/2009 12:45:49 PM |

    Well I'm not Dr Davis and nor are these guys but they say no

    http://www.natap.org/2009/HIV/042209_01.htm

    Commentary here

    http://www.drbriffa.com/blog/2009/04/17/no-evidence-that-saturated-fat-causes-heart-disease-its-official/

    and here

    http://blog.nutritiondata.com/heart_health_blog/2009/04/surprising-new.html?cid=152483327#comments

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Winning Through Intimidation

Winning Through Intimidation

31. August 2006 William Davis (0)
Do you remember the book, Winning Through Intimidation by author Robert J. Ringer?



In his 1984 bestseller, author Ringer details how to succeed in business by overwhelming clients and competition by appearing hugely successful and powerful. Rather than a business card, he'd hand out an elegant book to represent himself. He'd show up in a limousine to a meeting, even when he could barely afford it. He used these tactics, even when he was a small-fry, in commercial real estate and built a successful business following such techniques.

This reminds me a lot of what happens in conventional medical practice: The large and successful hospitals, filled with trained staff and technology, exude legitimacy and success. How can they possibly be wrong? Such overwhelming know-how and multiple levels of expertise mustbe right!

Let's be grateful that we do have access to such high-tech, capable care. Unfortunately, just as Mr. Ringer used deceptive practices to appear something he wasn't, this is also true in hospitals. Not all physicians have your best interests in mind. Their principal concern is how profitable your care can be for them--can you be persuaded to have your stent, bypass, etc.. After all, look around you: Aren't all this equipment and personnel impressive? Aren't you intimidated?

The patient that most recently drove home this issue for me recently was a smart and capable executive who came in for consultation. He had been told by his internist that a surgery (to replace his aorta, a HUGE procedure) was probably necessary. In my view, it was not--his process was simply not that far progressed. The risks for danger over the next several years was virtually nil. Unfortunately, this man, now confused and worried, sought an opinion from the chief of thoracic surgery (in the usual white coat and with professorial demeanor, I'm sure) in a major metropolitan hospital (in Chicago), who promptly rushed him off to the operating room.

The pathology report, cleverly not mentioned in any other of the hospital documentation, showed what I had suspected: this man had mild disease that wasn't even close to requiring surgery. But, with all that technology, $100,000 or so of costs, chief of surgery who looked the part, etc.--they must be right!

Robert Ringer's concepts only ring too true for hospitals and some of the unscrupulous physicians in practice. Don't allow yourself to be intimidated.
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