dr. davis whats your take on brown rice? is it a good replacement for wheat? a cup full at mealtimes?

Dr Davis:  As you well know, not all of us can lower small LDL through carb restriction and wheat elimination to a level where small LDL is only say 30% of total LDL, a number low enough to perhaps get plaque regression. I have elimated all wheat, and eat low carb,have achieved HDL of 59, LDL of 45, NMR particle of 609, 57% of which remain small. Take Crestor and Zetia. Vitamin d measures at 60 and no thyroid issues.   My TRG's are only 28.  So, i think i am one that may have a CETP issue not responsive wholly to diet; if this drug works, it would most likely be of help to me and many others. The only way my particle count comes down is with drugs.  Not sure how i can go lower on the carb front given my only carbs now are veggies; no fruit or starch except teaspoon of Metamcuceil.  Any other natural ways to lower small LDL?

OK, I'm confused.  It sounds like this drug will increase the number of small LDL:

"This yields a several nanometer smaller LDL particle, now the number one most common cause of heart disease in the U.S."

But then, maybe not:

"CETP inhibition is really a strategy to reduce small LDL particles"

Dear Dr Davis,
what is your commentary about this new investigation which represents decreasing properties of whole grain food to ldl levels
http://jn.nutrition.org/content/140/12/2153.short?rss=1
Thank you in advance for your opinion
George

Dr. D.

I love your Blog. Keep up the good work.

A few years ago I would have been very excited about this new class of drugs. I am however not so sure this drug will be the super star people think it will be (despite being able to raise HDL so much).

According to Chris Masterjohn @ The Daily Lipid Blog, he believes that much of the benefit of HDL is because HDL transfers vitamin E to the endothelial cells and that CETP inhibitors actually decrease the transfer of vitamin E from other lipoproteins to HDL by about half.  

http://blog.cholesterol-and-health.com/2009/03/wherefore-art-thy-protection-o-hdl.html

Another recent statin study, with null results: http://www.ncbi.nlm.nih.gov/pubmed/21067805

My experience on the Paleo diet plus psyllium plus guar gum equals this drug.  My HDLs went from 35 to 91.

@ JCarey:

Paleo diet + psyllium + guar gum raises HDL?
Glad you hdl's are up..got any references or links for this?

This is my take Chris.

Paleo diet = increases HDL as a result of an increase of dietary fats.

Psyllium husk = lowers LDL by stimulating the conversion of cholesterol into bile acid.  It may also lower small LDL by controlling glucose levels by slowing digestion.

Guar gum = lowers small LDL by controlling glucose levels by slowing digestion.

It amazes me to no end that people have forgotten what the longest long term study has shown us about LDL.  1998 final Framingham data.  Those with the lowest LDL levels died the soonest and those with the highest levels lived the longest and yet we are still trying to lower LDL small large or medium sized.  Its the oxLDL that matter. Dr. Davis keep fighting the battle.  

Dr. K

I notice from the Merck statement that this drug did not reduce CRP like most statins.

A few responses:

Anonymous--It depends on individual carb sensitivity. Most people can tolerate small quantities, e.g., 1/2 per serving. Others (like me) cannot even tolerate this much without triggering a surge in blood glucose and small LDL.

Steve--You likely have what I call "genetic" small LDL, meaning a CETP variant. Niacin can help. Beyond this, we struggle. I've seen variable effects with more fats, phosphatidylcholine, medium-chain triglycerides, and milk thistle. We also lack endpoint data to tell us what a desirable level is. I believe, however, it is somewhere around 300 nmol/L.

Jim--In the first paragraph, I was referring to the small LDL-yielding effects of CETP and triglyceride exchange. Blocking CETP prevents this exchange from occurring.

thanks for the response dr. davis.

What I saw from the study was no real difference after 76 weeks in mortality or cardiovascular events. In fact there were 11 deaths in the anacetrapib group and 8 deaths in the control group.

I don't find that encouraging, but maybe it was too short term.

thank you Dr Davis for your recommendations.  I have tried Slo-Niacin and had great difficulty tolerating it at 1500/1000 mg doses. Felt much better when not on it.  Have tightened up my diet even more, eliminating fruit and cheese and Greek Yogurt.  Will see what next NMR brings.  Might add Niacin at low dose to existing regime.  My small LDL particle size at 20.6 is type A and small particles not to far off from the 300 you suggest despite the proportion of small LDL to total LDL being larger than optimal

Dr. Davis - can you comment on an article that Shane Ellison has written entitled "Hidden Truth About Cholesterol-Lowering Drugs"?

Within the article, Mr. Ellison provides the statement that low cholesterol is a bad thing, not a good thing and people with higher cholesterol are living longer.

Can you place this in context with regard to small LDL particles?

Steve,
I'm not Dr. Davis, but I also have difficulty with Niacin.  I also have high homocysteine.  These 2 things can go hand in hand.  For me, it's a methylation problem.  I'm an undermethylator, which means I have to supplement with TMG and a few other things.  You should get your Homocysteine checked, and if it is elevated, be very careful with Niacin, since Niacin can make it worse unless you supplement with TMG etc...

thanks Tyson:  Homocysteine level is in normal range,but near the high end, ie 10 vs. 12 being top of the range.  My understanding is that it elevates with age and i am pushing 60.  I also hear that a B complex vitamin might make sense.

Perhaps Dr. Davis may weigh in on the homocysteine issue with regards to treatment and Niacin use.

Don't get your hopes up for anacetrapib. Despite the researchers best attempts to hide it, the anacetrapib group had higher cardiac mortality, and higher overall mortality. So, do you care that some numbers changed, or that the drug increases the risk of death? I wrote an article on the subject on my blog: http://clintoncpr.blogspot.com/2010/11/anacetrapib-scam-improve-your.html

Considering alledged 400% increase in cardiovascular mortality rate....

http://high-fat-nutrition.blogspot.com/2010/11/anacetrapib-giggle.html

...I think I'll pass on this new wonder drug.

You no longer crave these foods.

It's true!  We've done it.  My husband and I stopped eating all grains and sugar in February.  At this point, we really don't miss them any more.  It was a huge change, but it's worth the effort.  I've lost over 20 pounds (10 to go)and my husband has lost 45 pounds (20 to go).  On top of it, our body shapes have changed drastically. It is really amazing.   I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.

I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.

With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones.  To our surprise, it wasn't  that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.

Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion.  We're really enjoying this.  It's like feeling younger.  

It's not a diet for us.  This will be the way we eat from now on.  Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.  

Eating out (or at other peoples' places) has probably been the hardest part of this adjustment.  But now we're getting pretty comfortable saying what we won't eat.  I'm starting to enjoy the reactions it produces.

Just wanted to share our experience with your readers.

BTW, Dr. Davis, we got the Carlson Vitamin D3 softgel caps and are each taking 4000 units a day.

That's fabulous!

Your post was so interesting that I read it to my two teenagers, who are both encountering great skepticism from their friends and grandparents and other relatives when they bring up this topic.

I hope it helps give them some perspective!  

One of my husband's favorite comments to people is "Grains are for birds". That slows them down a bit.  

I also just remembered a conversation I had a few months ago  with a neighbor who had invited us to dinner.  She asked if we had any food allergies or things we couldn't eat. She knew we were on some kind of diet.  I told her no food allergies to worry about and the diet is really simple: no grains, no potatoes and no sugars.  She was quiet for a minute and then replied "My goodness, that's just about our whole diet!"  It was hilarious.

It really is interesting that tobacco companies Phillip Morris & RJ Reynolds also sell processed foods that are responsible for so many life style disease problems effecting western society. My grandfather passed away undoubtedly by his life time of smoking.  Even after he had a heart attack he couldn't stop smoking for any length of time.  As soon as a stressful situation occurred, he was back using his pacifier, as we called his pipe.  I'm guessing the same reaction occurs with high glycemic, processed food.  

Another addiction that is worth mentioning is convenience.  In sales there is a saying that simply says "people are lazy."  It means, the more work a salesman does for a customer the less likely he/she will say no.  Fast, processed, food sellers are master salesmen at promoting their products such that it is hard to say no.  

I'm doing my part to promote healthy eating when outside the house.  A relative owns an award winning restaurant in St. Louis.  Talking to him about my new heart healthy diet, he mentioned that next time I'm in town he would like me to meet the chef.  The two of us will then create a couple heart healthy, TYP inspired, meals to be placed onto the menu.  I’m looking forward to this.  It will not only be fun to work in the kitchen with an accomplished chef but to also  have an easy place to visit for a healthy meal.

I agree.

Howeever, I do believe that we can maintain the convenience factor to some degree without too much sacrifice of health.

My kids and I were in a hurry recently to make a movie time. There wasn't enough time to squeeze in a healthy lunch, so we ended up at Trader Joe's and bought a bag of unsalted, dry roasted pistachios and mixed nuts (not roasted in oils). Not a perfectly well rounded meal, but lacking many of the negative effects of the overly processed, addictive foods.

Keep us posted on how your St. Louis menu turns out!

BarbaraW,

Keep it up, it's worth it and you won't look back!  I and my wife   went low carb high animal fat  (the "Optimal Diet") 8 years ago and we never felt better!

  Many things will improve, not just weight reduction:  you will think clearer, your reflexes will improve, your breathing rate will go down, your blood pressure will normalize.  You will never or rarely have a fever or viral infections like cold or flu.  You will become more resistant to cold temperature and you will rarely feel tired, ever!

Great results, Stan.

But let me make clear that I do NOT advocate high animal fat.

In my view, despite the results you've enjoyed, there are adverse health--and social--consequences of high intake of animal fat, including dramatic escalation of cancer risk.

There is no doubt that carbohydrate reduction alone achieves dramatic improvement in health and weight reduction. We've witnessed that on the Atkins' diet, for instance, a diet that is eminently effective for weight loss but is without question an unhealthy approach if followed for any more than a few weeks. (Bladder infections, constipation, higher colon cancer and other cancer risk, etc.)

So, in my view, please do not follow an unlimited animal fat approach.

Hi Stan and Dr. Davis,

We've been following the Eades' Protein Power plan for the most part and I don't think they advocate high fat. But we're not trying to go low fat, either. In any case, we've gravitated lately to eating more poultry and fish instead of red meats.  I think that has helped our weight loss a bit, along with cutting down on nuts and cheese.  We love red meat and do have it a couple of times a week, since we're fortunate to be in an area where we can easily get locally raised (grass-fed) beef and lamb, as well as free-range chickens and wonderful eggs. Quite different from what's typically sold in the grocery stores. Tastes much better.

On another note, over the last 6 months, we've noticed our meal portions have become somewhat smaller.  We're not consciously trying to cut them down, it's just happened.  I think because we're eating more satisfying food we don't need quite as much. We find a less frequent urge to snack in between meals, too.

We've already experienced a number of changes you mention, Stan, like blood pressure magically settling into perfect range and no colds/flu this past winter.

It's all quite amazing, isn't it!

Barbara