Hi Dr. Davis.
I’m actually both pleased and troubled with the link to Dr. Diamond’s presentation that you’ve provided.

On the “pleased” side, Dr. Diamond’s analysis is:
•  An excellent/very well done presentation
•  Fact based (e.g. cites numerous studies, documented references, named experts, etc.)
•  Spans the test of time (e.g. references from the 1800’s thru the present day)
•  Ferrets out the major drivers of our present-day obesity epidemic & debunks other commonly held beliefs
•  Synchs with some of the Track Your Plaque (TYP) tenants (e.g. TYP guidance on triglycerides, diet, sugars, etc.)
•  â€œFlags” potential issues like conflict of interest which might have a tendency to creep into the science on occasion (e.g. the Keys report, the errant conclusions resulting from the NCEP report and supporting studies, etc.)

On the “troubled” side, Dr. Diamond’s analysis seems to:
•  Fly in the face of some of the foundational tenants of TYP
•  His analysis/conclusions, and that of other experts he cites, is that cholesterol of any kind is NOT correlated with Coronary Heart Disease (CHD) – at least as a root cause of heart disease (see Myth #2 and Dr. Diamond’s related analysis)
•  That LDL cholesterol – and although not stated by Dr. Diamond I’m inferring – the “sticky kind”, i.e. the small particles that actually adhere to artery walls (not the fluffy LDL particles that bounce away), are actually good!! On his “Final Issues 2” slide, and later in his related pictorial slides (entitled “What Causes Coronary Heart Disease?”), he makes reference to [LDL] cholesterol as a “Misunderstood Hero”?
•  That small, sticky LDL particles actually help the body recover from the damage created by the real culprits… sugars that work in concert with certain bacterias to create micro-tears in our artery walls
•  That small, sticky LDL actually results in the belt-and-suspenders, Rube-Goldberg “spackle” [which again I infer from Dr. Diamond’s presentation ultimately becomes plaque], that fixes (admittedly in a suboptimal and too-late manner) the damage already done by the artery-tearing, sugar/bacteria combo.  Plaque caused by LDL is actually the ‘finger in the dike’, last ditch effort, to fix the artery tears!  Kind of the last line of defense. [see slides on page 53 and Dr. Diamond’s related YouTube discussion.]

As a result, just curious about your thoughts on Dr. Diamond’s hypotheses.  
1.  Am I getting Dr. Diamond’s message(s) right?
2.  If yes, do you concur with – or tend toward – the theory(-ies) supported by Dr. Diamond and other cited experts about the role of cholesterol in CHD?  I gather from your blog post that you sympathize with his glycation theory(-ies), but how about the rest?
3.  If yes again, does that change some of the TYP direction?  For example, a significant part of the TYP approach is to reduce, as much as possible, small LDL particles. If LDL – and thus the resulting plaque – is indeed a suboptimal last line of defense, does reduction of LDL particles lead to a sub-optimization of the body’s last-ditch defense/“back-up plan” to deal with arterial microtears?
4.  Also, knowing that plaque/“spackle” is admittedly a suboptimal last ditch effort, what consequence does reversing plaque ultimately have given that the real damage – the tears in the artery walls (the seemingly real CHD culprits) – has already occurred. Are we pulling the finger out of the dike… without addressing the real root cause of the problem?  â€¦and if yes, what’s the back-up plan to the body’s back-up plan? If we reduce LDL and plaque, and the arterial damage is already done due to years and years of sugar abuse, what plugs the dike then?  I’m not talking about the preventive approaches of avoiding glycation in the first place… obviously that seems to be the real, preventive answer. I’m referring to those of us – for whom preventative measures are too late because the microtears are already there – who might be already living with the consequences of years of potentially errant diet/health guidance (by Keys, NCEP, etc.) and thus “spackle” in our arteries?  If the "spackle" is removed, does the dike start leaking again?

Although I thought I was “on the path to CHD righteousness”, I’m now confused again as a result of Dr. Diamond’s insights. Thanks for any clarifications Dr. Davis!

Dr. Davis,
I'm also anxious to hear what you think of the "hero" role of LDL in plaque.  I'm hoping he didn't go too far off the reservation on this point because the entire hour long presentation was so well done (comprehensive, well-explained, and credentialed) that it will be a powerful aid in spreading the word on both carbohydrates and how messed up the typical GP is with cholesterol treatment (not their fault - but the ATP-III as you say).  It was the tipping point for me.  I'm going off Lipitor now, which I"ve been on for years and will look into your TYP program to ensure I'm doing the right thing.

HI, Joe--

This "hero" thing, to my knowledge, is extrapolation and supposition. It is an interesting notion. I, too, was impressed with his presentation, but I think that the "hero" thing paints LDL as an entirely innocent player and I don't believe it is. We have only to look at people with heterozygous familial hypercholesterolemia who can have heart attacks in their 30s with pure large LDL to know that there is more to LDL's behavior than a protective function.

Hi, G--

By providing the link to Dr. Diamond's wonderful talk, I didn't mean to suggest that everything he says should be taken as gospel.

Virtually everything he said up until the "spackle" I do agree with. The spackle argument is pure supposition. It makes sense, but only to a degree and ignores the quantitative (e.g., heterozygous familial hypercholesterolemia) and qualitative (small, oxidation- and glycation-prone LDL particles with unique conformations that differ from larger LDL) differences in LDL particles.

Nonetheless, Dr. Diamond's recounting of how this mess was created was enlightening and well-presented and I still enjoyed it.

Dr. Davis,

I watched Dr. Diamond's presentation in its entirety.  I agree that he's done some great investigative medicine, especially looking into long-established research on carbohydrate intake, and, more recently, digging into questions of research funding and conflicts of interest.

His presentation leaves me with a major question about the role of cholesterol.  Diamond claims that high cholesterol levels are not harmful, so long as they are below 300 mg/dL, and that cholesterol has a helpful role.  It is used by arteries to repair themselves after the arterial lining is torn, infected by bacteria, or otherwise damaged.  This is why, he says, we find cholesterol in atherosclerotic plaques, together with white blood cells and dead bacteria.  Yet, we know from your reports and others that an elevated LDL particle number *is* correlated with coronary events.

What's going on here?  Is cholesterol itself harmful, or is high particle number just another symptom of high carbohydrate intake, which causes glycation and loss of elasticity in the arterial walls, leading to damage?

I just read the other comments, so the above question has been answered.  Thanks for all the info!

Hi Brian--
While I truly enjoyed Dr. Diamond's presentation, I think this particular path leads us down a dead end.

I don't think cholesterol per se is harmful; I believe that the particles that contain, among many other things, cholesterol can be harmful, especially small, oxidation-prone, glycation-prone LDL particles. I believe it would be an incredible stretch to say that small LDL particles are somehow protective.

I have inherited cholesterol and just learned from my health store guy that all the grains I have been eating are likely responsible for the high numbers of my small LDL(527) particles.  I thought oatmeal and other whole grains would squeege-mop the bad guys out of my system.  This news is also likely why I haven't  lost any weight (I eat lots of veggies and apples, fibrous fruits and protein.)  I do not use processed foods at all.  I walk a mile to work each day and I am still 10-20 # overweight (and yes it is right in my middle.)  My health guy is the one who directed me to this blog.  Any other information is most welcome.  I am trying to figure out what to fix everyday (supper/dinner) is the hardest.
Joan phillips

Eliminate wheat and cornstarch, check.

What about other grains?

Is it necessary to eliminate ALL grains to get control of small LDL, etc., etc.?

What about oats, as oat bran is a mainstay fiber of the TYP program?

Are cooked oat groats (whole oats) an acceptable grain on TYP?

So many questions... perhaps better to post these on the TYP members forum.  

Thanks for this informative blog!

Terri
madcook

Well somebody should invite a "Wheat Patch" -
The withdrawals are very very strong for me and have taken some time to subside.

Hi Dr Davis,

Here's an intro

the peptides

more on the peptides

male breast enhancement?

behavioural effects

Insulin effects

I like that last one as it provides a link through exaggerated pancreatic response to carbohydrate, subsequent hyperinsulinaemia leading to reactive hypoglycaemia. Then hunger triggers another bagel, more hyperinsulinaemia and then an anticipatory bagel becomes habitual as hunger is unpleasant and can be avoided. This sets up for chronic hyperinsulinaemia with pathological insulin resistance as a survival tactic for muscles to avoid sugar poisoning. Chronic hyperinsulinaemia equals metabolic syndrome, small dense LDL etc etc...

Both spinach and haemoglobin contain similar sequences, but wheat is verging on indestructable in its structure, plus it opens the tight junctions between eneterocytes to gain access to the systemic circulation, not a feature of many other foods...

Peter

The schizophrenia links would be off topic on a CVD blog...

What implications are there for someone to eliminate wheat if they are not overweight and their triglycerides and LDL particle size are both in a good range?

I was lucky not to have the brain fog on quitting wheat, but I had it when I was abusing wheat!  

Truly, it feels like I got my old brain back, the youthful, smart one, when I quit eating wheat and all gluten.  Such brain fog that stuff gave me.

Not only did I have withdrawal symptoms when I eliminated wheat (and barley and rye), but I become fatigued, irritable, foggy brained and red eyed if I get even the tiniest bit of these grains. I have non-celiac gluten sensitivity. Tests by Enterolab revealed my body makes antibodies against gluten(the carrier proteins in these grains).

The heart connection? For me, I think wheat contributed to or caused the inflammation that blocked my heart vessel. I cannot prove this other than to say my health has improved dramatically since giving up wheat and other related grains. I have also found I need a diet low in carbs to keep my blood glucose low. That eliminated all the other grains.

How common is gluten sensitivity? There is a growing number of doctors who believe this affects 10-30% of the population. Add to that, the people who have a wheat allergy(wheat is among the top 8 allergens), and you have a lot of people who should not be eating even a smidgen of wheat.

Peter, thanks for the links.

I haven't eliminated wheat, but after eliminating corn and its derivatives from my diet, my already painful and increasingly serious sinus infection cleared up.  I also went from needing 11-12 hours of sleep to 9-10.

I think allergies to corn are very common but almost never recognized.  Corn is in almost every processed food.  I was sick for a decade before a friend suggested avoiding corn and it took only two days to see a dramatic improvement in my health.

I can only speak from my own experience, but after eating wheat (all grains) for 50 years, my immune system is shot. Now if I consume even a couple of items (pasta or muffin or bread), within a day my feet swell up and my left knee is so painful I can barely walk nevermind the pain in my back. Those are just the first warning signs. If I dare continue, I know that within a short time I could possibly die. After a week of no grain and sugar, I'm practically jumping out of bed with no pain whatsoever anywhere. I have tested this several times (stupid me) and no longer experiment.

i have been off wheat and soya for two weeks, for the first week i felt fine, but now i feel half asleep, like i haven't got enough energy for anything and could just fall asleep at any given moment.  i though i was alone! I have also dropeed two dress sizes in the past two weeks and am becoming concerned about how quickly i am losing weight? should this slow down soon? I am a little over weight, but not massively so i don't want to lose too much.

i eliminated wheat from my diet and had the  fogginess and headaches.

very informative blog, thank you

I'm on day 4 of wheat removal and it's very tough.

I know from experimentation that potatoes, rice, fruit, corn (corn flakes), and even artificial sugars like a chocolate bar don't affect these withdrawal symptoms.  

I haven't tried oatmeal or barley out of a fear of gluten, but just to add to the discussion that I'm finding wheat uniquely bad for withdrawal even though I'm getting plenty of carbs from white rice and fruit, also getting plenty of meat and fat and veggies.  Adding in wheat makes the withdrawal symptoms go away, although I feel much worse physically.  Thus, I'm having heavy fatigue and headache constantly despite having a moderate amount of carbs with each meal.  Also, from experience, the rice I eat with each meal gives me very mild negative effects physically, so I'm positive all of this headache and fatigue is from wheat withdrawal.  It's become very consistent by now.  I hope this goes away soon...