I thought that chylomicrons produced by the gut became bouyant fluffy LDL and that IDL produced by the gut became small dense LDL.  No?

Also, it occurs to me that this "gut-produced particle clearing" phenomena could be all/part of the cholesterol benefit of intermittent fasting.  By allowing the body time to fully convert/reduce the gut produced lp particles, the body has more time to restore a homeostatic balance of blood lipid particles.

Both meals were high-carb and high-fat. Can you be more specific in placing the blame on either the high-fat or high-carb component? I am inclined to believe that a high-fat (but low-carb) diet would not show the same stacking effect.

Hi Dr. Davis,

So I guess that we could either not eat for approximately 7 hours after each meal (which I just kinda eyeballed from the chart where I thought that it would end up back at baseline) or eat something that does not contribute to either plasma TG or chylo concentrations. In the "Grazing" post you had replied that veggies probably wouldn't have much of a negative post-prandial effect. Would anything else be safe to eat without affecting these numbers? Probably not, LOL! Just trying to look for a practical application of this information, because If I had to go 6 or 7 hours without eating, I would have to struggle with compliance. Thanks!

Nice summary, Dr. Davis.

I eat two low carb meals per day. A small breakfast in the morning and a large dinner at the end of the day. I also fast 1-2 days per week. I am definitely in favor of spacing out meals far apart. This also helps with insulin sensitivity and weight management. Even on a low carb diet, insulin spikes when we eat. This is countered by glucagon, of course, but palmitic acid still creates a temporary (and reversible) insulin resistance for awhile after this, and it just doesn't make sense to keep feeding this cycle with frequent meals - low carb or not. It is very freeing to eat less often. You can devote your time to other things. Hunger takes care of itself once gluconeogenesis kicks in and blood sugar is under control, and you stop obsessing over food. It's great.

Posts like this make me glad I've changed my eating habits to eliminate all snacks and often have just two meals a day.

This only probes that when one eats a glycemic meal.

Hi Dr. Davis,

Seems like these meals had high levels of both carbohydrate and fat.  Don't postprandial chylomicrons and triglycerides reflect dietary fat rather than dietary carbohydrate?

Dan

I tend to graze, and I once tested the effect of grazing vs 3 meals on my blood sugar levels.

On Day 1, I ate as I normally do (grazing), but every time I ate something, I put an equal amount of the food aside.

On Day 2, I divided the set-aside food into three groups and ate 3 meals, with no snacks.

Results were what you might expect. With the 3 meals, the peaks were higher, but because there was more time between meals, the blood sugar dropped lower before the next meal.

The overall average blood sugar was almost exactly the same.

I suspect lipids are similar.

I once tested my triglyceride levels every hour all day on a low-carb and a low-fat diet.

You can see the results graphed in the second edition of my book "The First Year: Type 2 Diabetes."

On the low-fat diet, at first the TGs went down, but then they started to climb and by the end of the day they were higher than they had been when I started.

Of course with a home meter I couldn't differentiate different types of TG.

I had been eating LC, so I was adapted to that way of eating. I didn't eat low-fat for a week before doing the low-fat trial, so those results might be questionable.

How much of an impact does/do you suspect that the quality of food choice have/has on this "stacking effect"?

Is this much of an issue for someone eating every 3-4 hours or so and consuming lean meats, fresh fruits and vegetables, moderate amounts of fat from avocados, coconut, olives, nuts/seeds, and so on?

The offerings in the study, while possibly common fair for many folks, is hardly indicative of what a lot of health-conscious fitness types are doing these days, which is why I ask.

I'm curious if the same issue would still exist with more health-promoting choices, even if to a smaller degree, or if it is not an issue in that case.

A clarification: The meal used in this study was not intended to represent some sort of "ideal" meal, but a meal of exaggerated composition that yields useful observations during the testing period. I would not interpret the data to suggest that the diet was good nor bad. (Though, obviously, thes were junk food meals.)

Both fats and carbohydrates affect postprandial patterns in complex ways. Recall, for instance, that fructose causes extravagant distortions of postprandial responses.

perhaps this makes the case for eating (a) high fat, moderate protein meal(s) during the day.

my breakfast consists of fat/meat and lunch is olive oil/bison sashimi or olive oil/lamb sashimi, both with fresh herbs. not much in the way of carbs. i don't know yet, but i have doubts about the negative effects of chylomicrons in the absence of carbs.

But would the 9-hr pattern really be
better if they had the same total intake all in one meal? This is not shown.
Presumably it'd have only one peak, but that peak would be significantly higher.

This contrarian study of low carb linked with atherosclerosis in mice...does raise some questions on high protein/low carb effect on endothelium (edited to fit space)

A new study reported Online in the Proceedings of the National Academy of Science (August 24, 2009) provides information about the effect of the low-carb, high-protein diet on the health of blood vessels.

Conducted by a team of scientists at Beth Israel Deaconess Medical Center (BIDMC), the study found that mice placed on a 12-week low-carb, high-protein diet showed a significant increase in atherosclerosis—and an impaired ability to restore blood vessels.  

Senior author Anthony Rosenzweig, MD, Director of Cardiovascular Research at BIDMC and Professor of Medicine at Harvard Medical School, and lead author Shi Yin Foo, MD, a clinical cardiologist in the Rosenzweig laboratory at BIDMC, conceived the mouse study in a very human manner.

Dr. Foo began thinking about the possible dangers of low-carb, high-fat diets after seeing heart-attack patients who were on the diet—and after Rosenzweig himself went on the diet.

“I asked Shi Yin to do a mouse experiment—so we could know what happens in the blood vessels and so I could eat in peace.”

The doctors fed mice known to develop atherosclerosis in the same manner as humans one of three diets: a standard mouse diet (65% carbs, 15% fat, 20% protein), a “Western diet” in line with the average human diet (43% carbs, 42% fat, 15% protein), and low-carb, high-protein diet (12% carbs, 43% fat, 45% protein). All three diets contained the same amount of calories. The last two diets contained the same amount of fat and cholesterol.

As in most such diets, carbs were replaced with protein.

Significantly, the low-carb mice exhibited a greater degree of atherosclerosis, as measured by plaque accumulation: 15.3% compared to 8.8% for the Western diet group. “Our question was, ‘Why do the low-carb mice have such an increase in atherosclerosis,’” Foo said.

Importantly, traditional markers slightly favored the low-carb group. “None of these results explained why the animals’ blood had more atherosclerotic blockages and looked so bad,” Foo said.  

The researchers looked at the animals’ endothelial or vascular progenitor cell (EPC) counts. “Examination of the animals’ bone marrow and peripheral blood showed that the measures of EPC cells dropped fully 40% among the mice on the low-carb diet—after only two weeks,” Rosenzweig said.

This finding suggests that the low-carb, high-protein led to an impaired ability to form new blood vessels in tissues deprived of blood flow, as occurs with atherosclerosis. The researchers hypothesized that the Western diet and the low-carb/high-protein diet caused “comparable injury and inflammation.” The low-carb group, however, suffered an impaired ability to repair and restore blood vessel function.

Rosenzweig  continued: “Although the precise nature and roll of [EPC] cells is still being worked out, these results succeeded in getting me off the low-carb diet.”

Rosenzweig stressed the apparent disconnect between weight loss and standard blood markers—where the low-carb diet worked—and vascular health. It appears that blood vessel health can be affected by more than fat and cholesterol—in this case, carbs and protein.  

Protein—the bodybuilder’s favorite macronutrient—may actually be an offender. Too much protein (and too little carbohydrate) may damage blood vessels and/or prevent restoration.

“For now,” says Rosenzweig, “it appears that a moderate and balanced diet, coupled with exercise, is probably best for most people.”

Sifter, that study was kind of ridiculous. They used ApoE-/- mice. Read Peter's enlightening take on it here:

http://high-fat-nutrition.blogspot.com/2009/08/low-carbohydrate-high-protein-and-apoe.html

And Part II: http://high-fat-nutrition.blogspot.com/2009/08/low-carbohydrate-high-protein-and-apoe_28.html

Hi,
I tend to eat every three hours, five meals a day. My triglycerides were recently meausred, they're at 33. I guess that does not support your bet, right? Or maybe I am getting this all wrong...
Kind regards,
Felix

Ornish advocates grazing and scored zero on the heart scan, so maybe what you eat is more critical than when, for plaque building.  He, like you, wouldn't go near the refined carbs in the experiment you cite.

When you see the patterns in hundreds or thousands of people, you realize that not everybody is the same. In fact, the range of differing responses is dramatic.

So, no, you cannot draw any conclusions about the experience of one.

I must be missing something, but wouldn't eating smaller meals result in smaller peaks and possibly quicker decline? So yes, stacking may occur, but isn't it conceivable that overall blood levels would be no higher than they would be with the larger meals?

I agree with Beth.

Beth, Jim,

That's the question I alluded to above
(see above, between Shel's & Sifter's
comments).

We would really need to see the corresponding curve for the same subjects, instructed to eat both meals
at one go.

So it doesn't look like this study by itself allows us to draw definite conclusions (on the question of grazing vs. gorging).

What you think about news - GOPers Hold 'Prayercast' to Ask God to Stop Health Reform ?
Wanna hear your opinion

This just reinforces the notion that fasting triglyceride levels are fairly useless for predicting disease.  It's the postprandial that matters since most people spend most of their lives in a postprandial state.

Rosenzweig stressed the apparent disconnect between weight loss and standard blood markers—where the low-carb diet worked—and vascular health. It appears that blood vessel health can be affected by more than fat and cholesterol—in this case, carbs and protein.

Thanks a lot for this unique informative post I like this post.



Smith ALan

I've been following most elements of the program and my historically elevated triglycerides have come down from 308 in Nov. '07 to 213 in mid Jan. '08. Also, previous physical in Dec'06 they were 383.
Cut back on the carbs and my daily coca-colas the last couple of weeks and am curious to see how big an effect that will have on them.

Hi,
My HFCS google alert picked up your blog. The problem with HFCS is that it has invaded our food supply. Courtesy of the Corn Refiners Assoc., go to
www.corn.org/NSFC2006.pdf p29-30 list all the food and products that contain HFCS. Some surprises:
bagels, soups, cough syrups.
StopHFCS.com lists foods that are
HFCS-free. They welcome additions
and suggestions. Our home is HFCS-free. My soft drink of choice is
Goose Island Root Beer!
Take care,

Dr Davis,

One huge question I have not seen answered is this. Drs measure FASTING tgs which are low on a lower carb diet. But a friend who had access to a cholesterol meter for a while found that after meals on a wheat free low carb diet tgs were extremely high for many hours a day.

So should cholesterol be measured without the usual 12 hour fast? Few  of us ever fasts that long except for the test.

Since the fasting glucose test is so poor at detecting diabetes, I wonder if the fasting cholesterol test is similarly flawed.

Dear Dr Davis,

My copy of 'Track Your Plaque' arrived this morning ! I had to cancel from the first company I ordered it from and found another who had a copy in stock. Thankgoodness, just in time ! I'm seeing my cardiologist on Monday for my echocardiogram and will feel more prepared to discuss referral for an EBCT scan now.

I'm reading TYP straight away and finding it an easy read full of lots of good advice. I just read the bit about using natural progesterone cream - how interesting. I've been using that for about ten years, using it first for PMS, then for osteoporosis (which it didn't prevent but it might have been worse without it), and now I see it may be helping my heart health

I am finding that I already follow the principles of the diet except I don't eat any dairy, grains or legumes, I follow a low carb Paleo diet and have lots of vegetables, though only low carb ones as I'm diabetic too (type 2 but not typical as I'm thin and not insulin resistant)...I loved that bit on page 130 "Eat vegetables, vegetables, and more vegetables. Occasionally add more vegetables". And I do exercise and take fish oils and eat tons of fish, and vitamin D3. I still hope this will help my valve problem.

bw's
Anne

I've been on a near-zero carb diet for 1.5 years and at my last blood screening my triglycerides were 43, HDL 53 and LDL 124. Would this indicate I have a high level of the good LDL? I eat zero wheat, sugar and HFCS.

I've noticed something interesting at my local "natural" food store (sort of a smaller local clone of Whole Foods) ... and that is the infiltration of agave syrup, both as a product and as an ingredient in processed organic food products.  This store proudly states that it doesn't carry foods with HFCS (nor will it sell lard, but that is another rant) yet agave syrup is far worse in terms of high fructose content and all the health problems that concentrated fructose causes (high triglycerides, AGEs, uncontrolled hunger, insulin resistance, obesity, etc.  

As I will get roller coaster blood glucose levels if I don't carefully watch my sugar and starch intake, I looked into agave syrup, because in the last year it was often recommended to me for its "low glycemic" index.  It is often labeled "safe for diabetics".

Well, raw or not, agave syrup (nectar) is an extremely concentrated source of fructose, because the agave juice is hydrolyzed with enzymes to break apart the sugar molecules, allowing the glucose sugar molecules to be removed (I don't care if heat isn't used or if minerals remain, if that isn't "processing", what is?).  According to Wikipedia, the fructose content can be as high as 92% in some brands of agave syrup.  Compare that to 50% fructose in table sugar and 55% in HFCS.  

No one I have talked to who uses or recommends agave syrup is aware of this (especially at the store level), yet agave syrup is halled as a superior, "healthy" sugar to use (perhaps with abandon?), especially for diabetics and anyone who is health conscious.  Enough to make your toes curl, isn't it?

I have kept my triglycerides low (last lab 52) and that is pretty typical for me) since 2004 by reducing all sugars and starches (especially wheat) to a minimum, except for some non-starchy veggies and some very dark chocolate (70-88% cocoa solids).  I can achieve normal blood glucose levels without medication this way.  Prior to 2004 my triglycerides were well nearly 200 all the time.  With my gestational diabetes history and current impaired glucose intolerance (despite normal weight) the last thing I need is worsen things by using HF agave syrup because it is labeled a "low-glycemic" or "healthy", safer sugar.

Thanks, Anna. I wasn't aware of that.

Are all triglycerides the same?  Or is there a subtype analysis for them, too?

Yes, there are, though the breakdown depends on the laboratory and analysis used.

Jenny--

This is among the reasons that I bash conventional cholesterol testing--among many other reasons.

Postprandial (after-eating) patterns, however, are not well explored. One measure we use that is obtained from fasting blood but serves as a useful surrogate measure of postprandial patterns is intermediate-density lipoprotein.

Small vs. large LDL can be genetically determined, as well as influenced by food and lifestyle. So you cannot tell just by looking at the conventional lipid panel.

I have seen a few postings by you in which you mention that beer often contains high fructose corn syrup.  I brew as a hobby and I am unaware of any brewer that uses HFCS in beer making.  True, commercial brewers use adjuncts like rice, but most beer is made primarily from malted barley.  The typical sugar profile from malted barley is 50% maltose, 18% maltotriose, 10% glucose, 8% sucrose, and 2% fructose.  Most residual sweetness in beer comes from complex carbs like dextrins that yeast can't break down easily.

Just thought you'd want to be accurate on this point.  Not saying that beer is a good thing, or that the types of calories in beer don't contribute to the problems you hve identified, but I think the mechanism is something other than HFCS.

My father suffers from triglycerides and all of your advices have been taken a long time ago, this really helps to control them and keep a healthy happy life.

Good advice, I have heard most of this before but have never actually take them to practice, I am getting concerned about my weight lately so I better follow tis directions.

Reduction of high-glycemic index foods--Most notably wheat. Everybody knows that we shouldn't eat Snickers bars or bags of licorice. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they are causing triglycerides to skyrocket, dropping HDL, forming small LDL, increaaing blood sugar and blood pressure, and increasing obesity.

Well ain't this funny. I once had a random blood fat test (20th October) and as I was unaware they would do that test in my blood test. I had just eaten a lunch consisting of red meat and fruit juice (with tons of fructose) about an hour before. My serum triclyceride number was 0.4mmol/l or 35mg/dl. I guess it pays to be naturally skinny.

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