Dr. Davis:

Wondering if you could clarify your thoughts a bit. You promote elimination of wheat and corn starch (which I fully believe in) but then also comment on the elimination of carbohydrate (in the aggregate) as being a key factor for health. I'm not convinced that all carb is problematic for a person with a normal metabolism. Of course, it doesn't hurt anything; just wondering at your experience with those who don't go low carb but do drop the wheat.

Thanks.

Scott

So why have so many doctors bought into this whole statin thing?  If you question the need for a statin, you are first bullied to take them and second shown the door if you continue to resist!

Dear Dr. Davis, the improvement you describe for Mr. Lew is mainly because of wheat elimination, fish oil supplements or 25-hydroxy vitamin D increased levels? Or is just because of the significant weight loss and hypocaloric diet? In other words, from your experience, would you expect similar results in other people, for example, with the same approach but with no weight loss at all?

Dr. Davis,

Are you still recommending Niacin?  I haven't seen it mentioned for low HDL in a while.

It would be interesting to know how long Lew's dietary/supplemental changes were in effect before his hsCRP impressively dropped from 4.1 mg/dl to .4 mg/dl?

Two months into a LC diet and two weeks without grains my hsCRP was 2.43 mg/dl, HDL-75, TGs-82, calculated LDL-105, VLDL-16. Yes, my doctor advised me to go on a statin and a low-fat, high fiber diet to lower my LDL number to <75 (not going to happen). In my case, I do not need to lose weight, just manage blood sugar.

Still, it would be interesting to know when to expect a lowering of CRP and what other factors beside coronary plaque determine the measured hsCRP when one is mimicking Lew's strategy?

I have had a dramatic improvement in my hs-CRP, but it occurred slowly. Nine years ago my hs-CRP was over 13 and I was having one stent after another and ultimately bypass. As I made lifestyle changes, my hs-CRP started to fall a little. In 2003 I stopped eating gluten(wheat, barley and rye) and by 2005 my hs-CRP dropped to 4.98.

Now I have given up all grains because of blood sugar issues and my hs-CRP is 2.19 - not perfect but heading in the right direction. My vitamin D is now 54ng/ml instead of 24. I do take fish oil.

I doubt a statin could lower hs-CRP from 13 to 2.19

i have been looking to join the track your plaque website,but the site that asks for a credit card does not appear to be secure/encrypted; it is not an https site for example.  Therefore any data you put in for a credit card is out there in cyber space.  any suggestions?

Great results, Anne!

In general, CRP reductions occur over several months. The phenomenon that both exerts profound effects but can slow the process down is WEIGHT LOSS.

Scott--It depends on whether there are metabolic measures that reflect intolerance to wheat and other carbohydrates, such as small LDL or increased CRP.

Dr. Davis,

when you say eliminate wheat and other food that cause small LDL : which other foods are you referring to? Is it all simple carbs such as sugars, processed foods etc. or something else?

Thanks.

Vin--

Eliminating wheat means just that: anything made with wheat. Otherwise, the effect does not kick in.

The ml/dl units for CRP levels are likely a typo, one that is widely found in the medical literature and confusing for the novice attempting to determine normal serum CRP levels.  Levels above 2 or 3 mg/L are often cited as indicative of increased cardiac risk and levels at or above 2 mg/L (0.2 mg/dl) were required for eligibility in the Jupiter study.

Dr Davis,

I've been on a Low carb diet for the last six months.  My triglycerides is 60, HDL 61 but my direct LDL is 174, APOPROTEIN B is 119. My CRP was .6.  Should I be worried about the APOPROTEIN B score of 119?  My doctor recommended that I take a Statin drug....with the high LDL score and APO_B score.  I don't eat any grains and currently taking fish oil, niacin and vitamin D gel based pills.  I would like to stay away from statins....but I'm getting frustrated in not being able to lower my LDLs through diet.

To those of you who have eliminated grains; reduced your fear of naturally saturated fat (be wary of trans fats and most vegetable oils, though); have seen your HDL go up; etc., but are still worried about what seems like an elevated LDL (remember, it's probably just a calculated number, not a direct measurement), then consider that few primary care docs even see people who eat like that, so  they don't know what to do with the unusual profile that comes up.  They rec a statin as a knee-jerk reaction to any "elevated" LDL number, despite all the other "risk factors" that look fine - it's to cover their you know whats (one doc even said that to me).

I ran into this with my endo who noted in my file the high calculated LDL and total cholesterol numbers (but the ratios and triglyc are great and far better than they were 5 ya before I got my BG under control by restricting carbs, then eliminating wheat).  

In response to the suggestion I consider a statin, despite no other reason besides the high "calculated" (estimated) LDL number, I said, "then let's take a closer look at that LDL.  Please order a detailed cholesterol lipoprotein panel [same as TYP recommends] to directly count and measure the LDL particles, because I think it's highly likely the LDL will be few in number plus will be the large fluffy kind not associated with CVD."  At that point I did know that my atypical high fat, low carb diet that I followed to manage my BG tended to promote the right LDL and minimize the small dense LDL particle formation.  So I wasn't worried at all about the LDL number, but probably most people are conditioned to worry about LDL these days.

That was before I knew about heart scans.  Now that I've had a heart scan with an unsurprising 0 score.  So if I get another statin recommendation (prob less likely now),  I'll say that "there is no measurable plaque in my coronary arteries,  so no thanks" (not to mention the questionable benefit of statins for women, anyway).  

These days, before I consider taking *any* treatment that wasn't needed on an emergency basis, I look into it thoroughly
from ALL angles and make sure no stone is unturned - to be sure I truly will benefit from it and not be harmed (and that means a direct look at the so-called risk factors and side effects or undesireable outcomes, not just an estimate or calculation.  We've been programmed to fear any high LDL number, but we need LDL; that's why we make it -  it serves a physiological function.  We just have to get past the oversimplification of "good and bad" cholesterol and make sure we make the the healthier forms.

Good going Anna!

The cluefulness factor varies a lot between doctors. One of mine noted "weird" lipids without relating them to what was obvious "diabetic dyslipidemia". Many in the UK will only look at TChol.

My current one is more competent than many, she agrees that my slightly high LDL is not dangerous since my trigs and HDL have become so good. But she is adamant that I cannot have CRP or homocysteine tested and lipoprotein panel is totally unavailable. Not entirely her fault, it's those accountants.

I'm trying to educate her into the benefits of carb lowering. She's coming round to understanding my point of view but is restricted by protocols from recommending it to others. I'm getting through better with the nurses who seem more able to suggest useful techniques without fear of being disciplined or losing their jobs.

Hello Dr. Davis,

I'm on a ketogenic diet and in the process of weight loss. Went to the doc and got my blood test to find out that my cholesterol numbers were good, however, I had high CRP (5.5). The doctor immediately suggested statins. No additional tests to rule out an infection or other strategies to determine the cause of the inflammation.

I'm aware that during weight loss the blood test results can be skewed. (You talk about this here: http://www.trackyourplaque.com/blog/2011/09/what-is-this-wacky-thing-called-weight-loss.html) However, given that my cholesterol results are good, I'm wondering why the CRP would be high.

You can get a more detailed background about my case here (which includes blood test results): http://www.reddit.com/r/keto/comments/o4lk8/bloodwork_after_3_months_of_keto/

Sincerely,

A.E.

Thanks for posting this.  My husband has allowed himself to be carried along with my strict low-carbing for a few months now, and has lost 25 pounds +  or so so far. He had labs a couple of months ago, and his Triglycerides were up and his HDL somewhat low.  So of course his physician wants him to repeat the labs in Oct., and will want to put him on meds , I'm sure, if he still exhibits that profile.  But I will advise him to wait, to continue with what he's doing until his weight loss stabilizes, and this post will give me the concise authoritative ammo I'll need to encourage him both to continue with carb restriction and to resist medication, which he almost certainly is not a proper candidate for.  Perfect timing for us, and thanks so much! jennytoo.

on another subject, but I'm curious about your thoughts on krill oil.

Here's a post by Michael Eades on the subject:
http://www.fourhourworkweek.com/blog/2008/07/23/krill-oil-48x-better-than-fish-oil/

Hi Dr Davis,

While fat is stored as triglycerides, it is released from adipose stores as non esterified fatty acids, and these will be predominantly palmitic acid in humans. Non esterified palmitic acid appears to be an excellent inducer of insulin resistance, and insulin resistance has been hypothesised by several authors to be a completely normal physiological adaption to fasting or seasonal carbohydrate absence. While weight loss is on going, the circulation is flooded with NEFA and "physiological" insulin resistance should predominate. If the person continues to consume "good" carbohydrate at above acute metabolic needs, the excess will get shipped out of the liver as VLDLs. Under insulin resistance lipoprotein lipase, routinely under the control of insulin, won't be doing much lipolysis and so VLDLs can hang around in the circulation... Muscle can happily accept NEFA as a prime source of energy without lipoprotein lipase having to split the lipids from VLDLs, so leave the VLDLs there to show up as fasting trigs....

Once weight is stable the NEFA release from adipose tissue will be much better matched to metabolic needs. With the improved insulin sensitivity due to loss of visceral fat, control of both adipose hormone sensitive lipase and endothelial lipoprotein lipase activity should normalise and allow VLDLs and HDL to settle in to  more cardiologically acceptable numbers.

Just an idea. The prediction it makes is for a reduced HbA1c due to the reduction in bulk carbohydrate (this must happen to allow lipolysis for weight loss), coupled with no drop or an increase in fasting blood glucose due to the NEFA induced insulin resistance. Very curious as to whether this happened...

Idea is open for kicking.

Peter

Thanks for the article.  In the midst or losing a good deal of weight I had a finger prick test here at work.  My HDL had indeed dropped into the low 20's but my Triglycerides had also dropped (maybe a good does of fish oil and cod-liver oil help those?).  Anyway my weight has pretty much stabilized at a good level and I'm looking to do a good blood test in a few weeks.  Hopefully the HDL numbers are coming up.

The post about Brad is from August of 2008.  So how is he doing now?  Did the triglycerides drop and HDL rise?

I wonder what happened to Brad now? How did it go? By the way, I wanna share this video I came across with: http://www.youtube.com/watch?v=lj-ZnG3NoZY You'll surely learn a lot of information here.