Why not just get "perfect" lipids and call it a day?

5. September 2006 William Davis (0)
What if you achieved the Track Your Plaque lipid targets: LDL cholesterol 60 mg/dl, HDL 60 mg/dl, and triglycerides 60 mg/dl?

After all, these are pretty stringent standards. Compared to national guidelines (the ATP-III Guidelines of the National Cholesterol Educational Panel), the Track Your Plaque 60-60-60 goals are laughably ambitious. There's a lot of wisdom hidden in those numbers. The triglyceride level of 60, for instance, is a level at which triglycerides become essentially unavailable for formation of triglyceride-containing lipoprotein particles such as small LDL and VLDL.

If you get to the 60-60-60 target, isn't that good enough? What if you just held your values there and went about your business? Will coronary plaque stop growing and will your CT heart scan score stop increasing?

Sometimes it will. But, unfortunately, many times it will not. The experience generated through clinical trials bear this out. Studies like the St. Francis Heart Study and the BELLES Trial both showed that just reducing LDL cholesterol is insufficient to stop plaque growth. Beyond the Track Your Plaque experience, there's no clinical trial experience that shows whether the 60-60-60 approach does any better.

In our experience, achieving 60-60-60 is indeed better than just reducing LDL. That makes sense. Just raising HDL from the average of 42 mg/dl for a male, 52 mg/dl for a woman adds advantage. Compound this with triglyceride reduction from the plaque-creating equation, and you've doubled success.

But there's even more. What if you had hidden patterns not revealed by conventional lipids? How about lipoprotein(a)? Small LDL? Postprandial (after-eating) abnormalities? Hypertensive effects (more common than you think)!

In 2006, stopping the increase in your heart scan score is, for most of us, not just a matter of taking Lipitor or its equivalent and sitting back. For nearly all of us, stopping the progression of your score is a multi-faceted effort.
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What to Eat: The diet is defined by small LDL

What to Eat: The diet is defined by small LDL

9. April 2010 William Davis (15)
I approach diet from the perspective of small LDL particles.

Small LDL particles have exploded in frequency and severity in Americans. It is not at all uncommon to see 70% or more small LDL particles (i.e., 70% of total LDL particle number or Apo B) on lipoprotein testing. (I saw two people today who began with over 95% small LDL.)

Small LDL particles are:
--More likely to persist in the bloodstream longer than large LDL particles.
--More likely to adhere to components of atherosclerotic plaque.
--More likely to gain entry to plaque.
--More likely to be taken up by inflammatory white blood cells which, in turn, become the mast cells that fill coronary plaque.
--More likely to be oxidized.
--More likely to be glycated (8-fold more likely than large)

To add insult to injury, foods that trigger small LDL formation--i.e., carbohydrates--also cause high postprandial blood sugars. High postprandial blood sugars, in turn, glycate small LDL. That combination of events accelerates 1) plaque growth, 2) plaque instability, and 3) aging.

So carbohydrates trigger this sequence, carbohydrates of all stripes and colors. Not just "white" carbohydrates, but ALL carbohydrates. It's all a matter of degree and quantity. So, yes, even quinoa, bulghur, and sorghum trigger this process. I've only recently appreciated just how bad oats and oatmeal are in this regard--really bad.

Foods that trigger small LDL also trigger higher blood sugars; foods that trigger higher blood sugars also trigger small LDL. Small LDL and blood sugar are two different things, but they track each other very closely.

So, in the Track Your Plaque approach to diet, we craft diet based on these simple principles:

1) Eliminate wheat, cornstarch, and sugars--These are the most flagrant triggers of small LDL, blood sugar, and, therefore, LDL glycation.
2) The inclusion of other carbohydrates, such as oatmeal, quinoa, rye, etc. depends on individual sensitivity. Individual sensitivity is best gauged by assessing one-hour postprandial glucose.

Stay tuned for more in this series. Also, Track Your Plaque Members: We will be having an in-depth webinar detailing more on thees principles in the next couple of weeks.
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Comments (15) -

  • Anonymous

    4/9/2010 8:44:03 PM |

    How ia ApoB test used to know small LDL? Particle count exams aren't available in my area but ApoB is. So I'd like to know how to read this test.

    thankyou

  • Dana Law

    4/10/2010 12:45:03 AM |

    Dr. Davis,
    Please give us an eating plan.  You rant about people making lousy decisions with food.  We need some direction.  What are you eating?  Please tell us.  I find this part the most difficult.  I know I've improved in my quality of food.  Three times a day I need to make the best choices.  It's like being married to a nymphomaniac. You have to have to satisfy the healthy needs of your body, everyday!
    I believe you know what you are talking about.  You've improved our lives but tell us, please, what you are doing personally, day by day, to make those LDL particles small.  
    Sincerely,
    Dana Law
    San Diego, Ca
    P.S. This is a rant.  We need your help.

  • Taylor

    4/10/2010 5:48:55 AM |

    Love your blog, sir. I've been reading up over the last couple weeks--one question I couldn't find answered, though, was which glucose monitor you'd personally recommend? There are a lot of them out there on the market and I'm completely at a loss for how to tell them apart!

    Thanks for all the important work you do.

    --T.

  • ET

    4/10/2010 11:04:36 AM |

    For me, reducing carbs to <90g/day did little to improve my small, dense LDL.  My LDL particle number was over 2,000 and my small, dense LDL >1,600.  Increasing my saturated fat intake and niacin dropped my small, dense LDL to <120 in less than a year.

  • JC

    4/10/2010 11:26:38 AM |

    Many of those who live in the "green zones" have a high carb diet and yet live long healthy lives.Maybe the type of carb really is important.

  • Peter

    4/10/2010 11:47:32 AM |

    Re: the cultures that eat high carb but have low rates of diabetes (Japan) do they have low post-prandial scores and low small LDL particles despite lots of rice or corn and beans?

    I'm wondering why some very high carb cultures have so little obesity, heart disease, and diabetes.

  • Lou

    4/10/2010 2:09:54 PM |

    For people who are confused of what to eat, etc - check out Whole Health Source website. Very helpful.  Check out diabetes and diet under LABELS on the right side that Stephan explains in more details why, how, what, etc works.

    If there's a diet book that you can buy from a bookstore, Paleo Diet would probably be the best but it's not perfect. It says to avoid but it's perfectly fine and even the author changed his mind and it's fine to consume them.

    Free The Animal website has helpful information on how to make dinners.

    Dana Law, there's not need to eat 3 times a day. It's not really required. You can have two very nutritional meal with high amount of fat and feel satisfied for a long time, preferably break fast and dinner with maybe handful of snack like pecan, almond, walnut. That's pretty much how I eat. We're not programmed to eat that often anyway. That's how blood sugar stays low.

    JC and Peter, you need to be more specific... are we talking about percentage of meal high in carbs or total amount of carbs? Two entirely different things. We eat way more carbs than those people, I bet. I'd have to travel to those places to see that myself because I don't believe anything media tells us.

  • Paula

    4/11/2010 12:25:10 AM |

    Dana,
    Dr. Davis's "eating plan" is available to Track Your Plaque members.  I've been a member for over a year, and I can't tell you how much I've learned.  Check out the website at trackyourplaque.com and sign up!

  • Anonymous

    4/11/2010 7:35:20 AM |

    Dana, stop your ranting.  Your air of entitlement is annoying.  The fact that Dr. Davis graciously gives of his time to post some of his insights and advice does not make him a servant at your beck and call.

  • Anonymous

    4/11/2010 1:30:51 PM |

    ET, thanks for your post.  Some folks get carried away with Paleolithic diet or nothing. For those of us who prefer to limit our meat consumption, 2-3grms/day Niacin is a must.

    Dr D is always solid about whether his information is anecdotal or based on clinical trials.  If you would like additional supporting evidence for Niacin and its effects on LDL particle size, check out lipdsonline.org and search "niacin"

    " As in previous studies, niacin therapy had no significant effect on LDL cholesterol concentrations; however, after 3 months of treatment the number of small and medium sized LDL cholesterol particles was significantly decreased in those given niacin compared with those given placebo"

    Trevor

  • Tom

    4/11/2010 2:35:58 PM |

    I agree that I find it pathetic that someone would rant on a free website and some of the very best information available anywhere.  Please stop it now.

    Other posters who are asking about meters, etc:  please review the prior blogs that are listed alphabetically on the left.  Jeez folks, make some effort will you?

    Tom C.

  • Gina

    4/12/2010 4:28:27 AM |

    Yeah! So good to hear you speak out re the quinoa, oats and other carbs. Seems I can get clients to consider letting go of wheat (surprising) but  they now think quinoa is the nectar of the gods. 15 years ago I had a hard time selling even a handful of quinoa and now it is the sweetheart of grains. go figure...oh yet  again it is about who is pushing the stuff. You suppose Ornish is involved ;)
    Great post yet again Doc!

  • Anonymous

    4/12/2010 6:45:36 PM |

    I don't see what is wrong with Dana's post..... maybe we are just a tad more relaxed, those of us who don't eat too much meat Smile
    Trevor

  • April

    4/13/2010 4:42:17 AM |

    yes,I agree that a diet high on carbohydrates and sugar makes people obese and increases the risk for them to be diabetic.

  • Anonymous

    6/26/2010 6:36:17 PM |

    Do any of the home cholesterol meters (Cholesetch , Cardiochek, etc.) measure LDL particle number (i.e. small dense vs. the large not-so-dangerous kind)?

    Would be nice to conveniently measure real ldl once a day!

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What is "normal"?

What is "normal"?

1. May 2007 William Davis (2)
When it comes to laboratory values and medical testing, a common dilemma is knowing what is "normal." Let me explain.

First of all, when you receive a laboratory result for a test, a "reference range" or "normal range" is usually provided. Where did that range come from?

It varies from test to test. For instance, a low potassium is easy, because low potassium levels can lead to life threatening consequences, e.g., dangerous heart rhythms. High potassium likewise, because dangerous phenomena develop when potassium generally exceeds 5.5 mg/dl or so.

But what about something like HDL or LDL. Here's where confusion reigns. Often, "normal" is obtained by taking the average and saying that any value plus or minus two standard deviations (remember that painful class?) represents normal or reference range.

If that were true, what if we applied that principle to body weight. If we weighed several thousand adult women, the average would be in the neighborhood of 172 lbs (no kidding). Does that mean that 172 lbs plus or minus two standard deviations is normal? No, of course not.

There is therefore a distinction between "normal" and "desirable". For HDL cholesterol, your laboratory report might say that an HDL cholesterol of 40-60 mg/dl is normal. But is it desirable? I don't think so. The most frequent HDL level for a male with a heart attack is 42 mg/dl--hardly desirable.

Let's take triglycerides. The average triglyceride level in the U.S. is somewhere around 140 mg/dl. For those of us who do a lot of lipoprotein testing, we can tell you that triglycerides at this level, though generally regarded as being within the normal range, are associated with flagrant and obvious excesses of several abnormal lipoprotein particles that contribute to coronary plaque growth (VLDL and often IDL; small LDL; drop in HDL and shift towards small HDL).

So, always take the so-called "normal" or "reference" values on a lab report as crude guidelines that often have little or nothing to do with health or desirability. Unfortunately, many physicians are not aware of this and will declare any value within the normal or reference range as okay. An HDL of 40 mg is not okay. A triglyceride level of 140 mg is also not okay.

What is okay? What is desirable? That depends on the parameter being examined. From a basic lipid standpoint, of course, we regard desirable as 60-60-60. Desirability from a lipoprotein standpoint we will cover in a more thorough Track Your Plaque Special Report in future.
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Comments (2) -

  • Anonymous

    5/12/2007 10:15:00 PM |

    A brief aside, if I may. You speak about the dangers of serum potassium of over 5.5; I was diagnosed as a Type 2 diabetic in December, and my serum potassium is 6.0. What can I do? I know you can't diagnose someone online, but any suggestions would be hugely appreciated.

  • Dr. Davis

    5/13/2007 3:30:00 AM |

    A potassium of 6.0 is potentially life-threatening within a relatively short time. Medical attention is needed ASAP. Unfortunately, this is entirely unrelated to the issues we discuss here.

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