No more cookies

15. January 2011 William Davis (13)
Jeanne enjoyed her Christmas holidays. She especially liked sharing the cookies she made for her grandchildren, sneaking 2 or 3 every day over a couple of weeks. On top of this, she enjoyed the Christmas candy, egg nog, leftover stuffing and cranberry sauce, topped off with a night of nutritional debauchery on New Year's Eve.

Lipid panel in October:

Total cholesterol 146 mg/dl
LDL cholesterol 72 mg/dl
HDL cholesterol 64 mg/dl
Triglycerides 49 mg/dl

Lipid panel in early January:

Total cholesterol 229 mg/dl
LDL cholesterol 141 mg/dl
HDL cholesterol 59 mg/dl
Triglycerides 147 mg/dl


I call the holidays The Annual Wheat and Sugar Frenzy. It's the carbohydrates, especially those from products made of wheat and sucrose, that caused the marked shifts in Jeanne's lipid patterns. Let's take each parameter apart:

--Triglycerides go up due to de novo lipogenesis, liver conversion of carbohydrates into triglycerides. Triglycerides enter the bloodstream as VLDL particles which, in turn, interact with LDL and HDL.

--LDL goes up because carbohydrate exposure increases VLDL, followed by conversion to LDL. The triglyceride-rich LDL created is converted to small LDL particles. Had we measured small LDL changes in Jeanne, we likely would have measured something like an increase (by NMR) from 800 nmol/L to 1600 nmol/L, a carbohydrate effect.

--The increased VLDL also makes HDL triglyceride-rich, cause more rapid degradation of HDL particles. (It also makes them smaller, like LDL.) Given sufficient time (a few more months), HDL would drop into the 40's.

--Total cholesterol changes reflect the composite of the above numbers. (Total cholesterol = LDL cholesterol + HDL cholesterol + Trig/5) (Note that, as HDL drops, so will total cholesterol; that's why this value is worthless and should be ignored.)

So don't be surprised by the above distortions after a period of carbohydrate indulgence. Although your unwitting primary care doc will see such changes as opportunity for Lipitor, it is nothing more than the cascade of effects from a carbohydrate-driven distortion of lipoproteins.
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Comments (13) -

  • Michaelf

    1/15/2011 2:59:27 PM |

    Why so many lipid panels?

    Doesn't cholesterol naturally ebb and flow?  Or does it only ebb and flow when we feed it?

    For my taste the second panel is better, other than the HDL.  I'd say she did a good job getting her Cholesterol up over the holidays....

    One of the highlighted lines in my Taubes book is the piece about the lower the cholesterol the higher the incidence of cancer.  Correlation I know but wasnt all the science about cholesterol a well choreographed dance around correlation.

    My father was a cancer patient and a heart patient.  He "naturally" had cholesterol in the 150-160 range and was sick his whole life.  

    IMHO that womans cholesterol is doing what it does to save her life.  Rising to wrangle up the garbage she's dumping down her throat.  

    My fathers never rose to combat the garbage he was dumping down his throat.  What are your thoughts on that?

    If this stuff happens as you say, a fairly simple pattern, then why the differences?

  • Brent

    1/15/2011 3:22:09 PM |

    Dr. Davis - This is off topic for this particular post, but I want to suggest the next blog post for you.  

    First, cudos for keeping this blog informational only, without a hint of commercialism in in.  However, I and perhaps others who read it have seriously considered contacting your office for an appointment to become patients, even though we live in other parts of the country.

    Would you consider posting a topic on the blog of how this could work?  My thoughts are to have necessary tests done in advance of a visit, so that things which normally take 2-3 visits could be accomplished in one. Is a list of these things something that could be determined by a phone interview with your office staff when the appointment is being made?  Can your office arrange for heart scans to be done in Milwaukee in the AM for a PM appointment with you?

    Important question: Is a heart scan at a closer facility (Still 3 hours away) & track your plaque membership (not yet done because I've not had a scan yet) just as good as a visit to your office once a year or would I get additional benefits becoming a patient? i.e., can you rely on scan scoring done by others if I wanted your opinion on the results?

  • Lori Miller

    1/15/2011 4:38:56 PM |

    Two other things all those carbs will do to susceptible people is give them bloating and acid reflux. The posts on that subject have been my two most popular over the past month.

    Re: cholesterol, mine is 140. The total didn't change much when I cut way back on the carbs, but the ratio of HDL:LDL improved. If I'm sick or riddled with cancer, I'm afraid it's escaped my notice. My liver must be making all I need.

  • Anna

    1/15/2011 5:16:45 PM |

    I don't miss the cookies, overly sweet eggnog, and Christmas candy at all, since I revised my diet in early 2004.  I don't gain holiday weight anymore; in fact, some years I lose a couple pounds between Thanksgiving and New Years.

    When I celebrate during the holidays with food, I do indulge (if you can call it, that because my indulgences tend to be nutrient-dense and very satisfying, too) with rich paté, lovely artisan cheeses, fish roe (caviar) and deviled eggs, fresh veggie slices, and bacon-wrapped scallops and shrimp, etc.  I make egg nog that isn't nearly so sweet as well as super easy homemade truffles with very dark chocolate, which has just a small amount of sugar.

  • revelo

    1/15/2011 5:21:24 PM |

    I eat a high carb diet (60% typically, lots of oats, beans, potatoes) and just got back my first test result:

    Cholesterol, Total   152
    Triglycerides         39
    HDL Cholesterol       70
    VLDL Cholesterol calc  8
    LDL Cholesterol calc  74

    I'm lean (16% body fat according to my electronic scale, 12% according to a formula I found on the internet) and get plenty of moderate exercise (yoga and walking). So it appears all those carbs are NOT turning to Triglycerides in me.

    Rather, when I eat carbs, the glucose goes into the muscles. After I finish my last meal for for the day, the body gradually burns off this stored glucose so that the muscles are mostly depleted by the next morning, when I break my nightly fast. Isn't this how the body is supposed to work? I have to disagree with this notion that the muscles can only store a couple of hundred grams of glucose. I think that amount of glucose that can be stored increases in lean people who exercise and routinely eat large amounts of carbs.

  • Michaelfgu

    1/15/2011 5:33:52 PM |

    Brent, You have been reading my mind! Yes, Dr Davis please tell us how best this could best be accomplished as per Brent's comment!

  • Might-o'chondri-AL

    1/15/2011 7:05:52 PM |

    Bit over simplified; unless holiday indulgences (prior to patient's Jan. lab test) were made rich tasting without using any fat &/or cholesterol content
    (and wasn't over eating, nor lazing around).

    Clinic patients are presumably often already suffering with metabolic syndrome. An absolute admonishment is going to become rote patient visit after patient visit.

    Is a prevention strategy for everyone, or just the sedentary and geneticly pre-disposed? One's adult health may be doing well with a contrary diet. By middle age Doc's restrictions might be a pre-emptive strategy for countering metabolic changes to come.

  • shutchings

    1/15/2011 8:26:23 PM |

    So if Jeanne returns to restricting sugar and flour from her diet in January, her profile improves.  Did she leave lasting damage?  Is the risk only that disease will develop during her holiday relapse?

  • Dr. William Davis

    1/15/2011 10:26:20 PM |

    Anna--

    I love the gourmet-bent you've taken with your diet. That's a great direction to go.


    Brent and Michael--

    You can call my office at 414-456-1123 to arrange an out-of-town visit. Alternatively, call the same number to arrange a video teleconference to review lipoproteins or your coronary prevention program. (Video teleconference is not covered by insurance, however.)

  • Anonymous

    1/15/2011 10:54:00 PM |

    I treat so much cholesterol in my patients with bio-identical hormone therapy in addition to nutritional biochemistry / blood test to help rebuild the adrenals and help the body convert the excess cholesterol into the LDL and then into the next hormone called pregnenolone. Most people who have high cholesterol have silent adrenal dysfunctions/ burn out / PTSD whereby the cholesterol does'nt convert into the next hormone.
    Most MD's won't look to check the adrenal and sex hormones in conjunction with and cholesterol test.
    What an oversight eh !

  • Marc

    1/16/2011 7:57:03 PM |

    I used to have very lows trigs (35-45 range), I start eating high fat low carb & 6 month later my trig went up to 79.

    Carbs = elevated trigs??
    Not for me.

      My lowest trigs were in my vegetarian days eating whole wheat, oats, beans etc...when I started upping the fats & meat my trigs went up (even when cutting down wheat, which I dont eat it anymore)

    Could you provide an answer to this mr Davis?

  • Sophie

    1/24/2011 10:49:24 AM |

    I agree that holidays is a season to increase weight gain. Uncontrollable eating can risk our health. There is no any guarantee how long can our body take the cholesterol we're feeding. So proper self-discipline is needed. Low carbohydrate diet is the best diet for those who want to lose weight especially for diabetic people.

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How much omega-3s are enough?

How much omega-3s are enough?

8. May 2007 William Davis (7)
The basic dose we advocate for the Track Your Plaque program is 1200 mg per day of EPA + DHA, the essential omega-3 fatty acids.

1200 mg EPA+DHA is generally obtainable by taking 4 capsules of 1000 mg of fish oil, since the majority of preparations contain 180 mg EPA and 120 mg DHA per capsule.

But how will you know if a higher dose wouldn't be even better?

The principal parameter to look at is triglycerides. If triglycerides remain above 60 mg/dl, we usually consider increasing fish oil.

Another measure that's very important is intermediate-density lipoprotein, or IDL, also called "remnant lipoproteins" on a VAP panel. Persistence of any IDL or remnant lipoproteins is reason to consider more fish oil. Most commonly, if there is some persistence of either, we increase fish oil to 6000 mg per day of a standard preparation, or 1800 mg/day of EPA+DHA.

The only time we see persistence of IDL or remnant lipoproteins with this higher dose is when triglycerides are really high. If starting triglycerides are, for instance, 500 mg/dl, then even this higher dose may be insufficient. This is when more highly concentrated preparations of fish oil may be necessary, occasionally even the prescription form, Omacor. (We currently use Omacor only when high doses of EPA+DHA are required, most because of its outrageous cost. Two capsules per day costs around $120 per month; three capsules per day to provide 1800 mg/day of EPA+DHA costs $180 per month. I think this is outrageous and so we use it only when absolutely necessary.)

You might even argue that a higher dose of 1800 mg EPA+DHA, or 6000 mg of a standard capsule, might be preferable for more assured reduction of heart attack risk--even when triglycerides and IDL are perfectly under control. I wouldn't argue with you. But you won't observe any measurable feedback that tells you that a heightened effect is being obtained. I take that dose myself, in fact, despite the fact that elimination of wheat products and weight loss was sufficient to drop my triglycerides to the target level. I figure it's a small additional effort for added peace of mind.
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Comments (7) -

  • Anonymous

    5/8/2007 7:46:00 PM |

    I have just joined the Track Your Placque Site.  I take fish oil daily, 3200 EPA/1600 DHA.  At this dose my AA/EPA score is 2.14.  When I had LDL electrophoesis done, my pattern was A pattern and I was not on the fish oil at that time.  I am wondering whether it would be better to have an NMR test or a VAP test, or both?

  • Dr. Davis

    5/9/2007 1:57:00 AM |

    Hi,
    In general, I prefer the NMR. However, the electrophoretic test you already had should provide more information than just breaking your LDL pattern down into types "A" or "B". The real numbers to pay attention to are the LDL subclasses III and IV. Add up those numbers to determine how much small LDL you really have (in percent). Anything more than 10% we regard as sigificant.

  • Mike

    5/9/2007 8:00:00 PM |

    Is there any reduction in triglycerides from taking flax seed or other non-EPA/DHA sources of omega-3s?

  • Anonymous

    5/10/2007 12:18:00 AM |

    Thank you.  The report is broken down into the various LDL subclasses.  This information is helpful.

  • Dr. Davis

    5/10/2007 12:28:00 AM |

    Mike-
    No, unfortunately not. Only fish oil exerts the sort of triglyceride and lipoprotein correcting effects that we need.

  • Anonymous

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

    Dr., what do you think of Krill oil? Is it better than "regular" fish oil?

  • Dr. Davis

    5/13/2007 3:25:00 AM |

    We've actually had a fairly extensive conversation on this question on the Track Your Plaque Forum. Fish oil is tried and true, and the advantages of krill oil--purportedly containing less pesticide residues (no less mercury since fish oil does not contain mercury) and virtually pure DHA--are not fully worked out. However, if you choose to give it a try, let us know what kind of results you get.

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