Hi Dr Davis, nice post

The parallels you describe so neatly become self explanatory once you realise that niacin acts on the beta hydroxybutyrate receptor. Even without full blown ketosis, LC diets raise the level of the natural ligand for the receptor that niacin, at pharmacological dose rates, stimulates. And no flush from LC.

Regarding LC diets as a means to weight loss alone misses their intrinsic health benefits.

Peter

Nicotinic acid receptor subtypes and their ligands.
Soudijn W, van Wijngaarden I, Ijzerman AP
Med Res Rev. 2007 May;27(3):417-33

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

In your experience have you seen a lipoprotein benefit to a wheat-free diet in people where there is little excess weight to lose, say 5 to 10 lbs?

Yes, though the magnitude of benefit is usually less. In this case, small LDL in particular is largely genetically driven. You can only hope to suppress it to a minimum.

as soon as I started lc, after about three months my hdl went from 40 to 68 and stays there, I don't excercise much so its not due to anything but lc I assumed.

However,my score from scan went from 183 in '04 to 390 in 07 so that alarmed me but my doc said if I didn't lc, as I lc most the time, calcium score could have been way higher.lc is not only great for weigh loss but bg and craving control
Thnx for comparison list, wish ADA would recognize this.

Chickadee North - While I am a believer in reducing/eliminating processed carbs especially for people who have metabolic syndrome, are diabetic and/or overweight, you still had an increase in calcification of 30% per year.  That outcome is consistent with the results that occur when there is no intervention in terms of diet/drugs/lifestyle.  Thus, I am somewhat skeptical that the low carb diet kept you from having an even greater increase in calcified plaque.

There are other benefits from low carb that you don't see with niacin. Lower BP, lessening (at minimum) of symptoms of many chronic diseases, lower blood sugar and insulin levels...all very important in today's world!

Can you please comment on this article:
http://in.reuters.com/article/health/idINWRI08496320071210
"In middle-aged and older women considered to be at low risk for heart disease, calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease and heart-related events like chest pain, heart attack and stroke, new research shows."
Doesn't plaque and calcium build up in the heart indicate heart disease?

Yes, excellent points!

I believe that study is yet another piece of evidence that heart scans (for coronary calcium and plaque quantification) are vastly superior to risk factor analysis, such as that in the Framingham equation. As the study points out, the Framingham risk equation mis-classified a substantial number of people as low-risk.

Incomprehensibly, the report quotes some reviewers as saying "There is not enough evidence to support coronary artery calcium screening in low-risk women and they call for further studies to better identify who would benefit from such screening."

This is another study among many that have shown similar results.  How many people have to die or have heart attacks needlessly before the deeply entrenched habits of the status quo are broken?

Re: "In middle-aged and older women considered to be at low risk for heart disease, calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease..."

I think this relates to Dr. Davis orignal post on low carb.  Since glucose metabolism involves a lot more calcium than lipid or ketone metabolism then perhaps excessive calcium build up may be a proxy for excessive glucose metabolism?

  It may explain a curious fact that anything that switches metabolism away from glucose (e.g. niacine acting towards ketone b., vitamin D3, fasting or L.C. diet) would also at the same time act protective against the coronary heart disease?  Interesting!

Stan (Heretic)

But my question is....If there are already calcifications doesn't that mean there is already Heart Disease?

So the women with calcium plaques would HAVE heart disease, not be AT RISK of developing it?

"...calcium build-up in their heart arteries, an indicator of artery-clogging plaque, predicts the development of heart disease..."

Somewhat unrelated question:  
Angiotensin II inhibitors like Benicar apparently have the additional effect of dramatically lowering Vitamin D 1,25D in the body, and some think this is useful for people with Lyme disease and chronic fatigue system ("Marshall Protocol" http://snipurl.com/1v5s6). [Adherents of this protocol believe that in these diseases, opportunistic bacteria thrive on the additional Vitamin D.]

However, for hypertensives who don't have CFS or Lyme disease, does this trait mean that drugs like Benicar, while reducing blood pressure, might be increasing coronary blockage by interfering with Vitamin D?  (I guess my questions are, Am I concerned with the right form of Vitamin D?  If  so, are angiotensin II inhibitors problematic for blocking Vitamin D?  Do they make Vitamin D supplementation pointless? If so, what's a better drug for hypertension?)

Anyway, if this question is too far afield, ignore it, and thanks for a great blog.

A few things we don't know about chickadee north;

1 her age. (did she just enter menopause or premenopause?
2 when she started her low carb diet.
3 how often her heart was scanned between 2004 and 2007.
Without knowing these, I think we have to give her doctor the benefit of the doubt.

Cindy--
Yes, you are absolutely right.

In arteries, calcium = atherosclerotic plaque, not risk for plaque. It is a risk for coronary "events" like heart attack, however.

The Benicar/ARB and vitamin D connection is interesting. I've never heard of it. Do you have any data or references?

Honestly, I'm a layperson and can't comment intelligently on it other than to suggest you look at marshallprotocol.com

Some of the things that jumped out at me were Benicar's (and to a lesser extent, other angiotensin 2 inhibitors) ability to block  at least one D3 variant, the idea that chronic fatigue/fibromyalgia/etc are the result of infection by a new form of bacteria that survives by hiding within immune system cells, the concept that because of this, D3 actually protects the bacteria in these patients, etc.

It's all wayyyy out there, but fascinating, and I thought you'd be interested.  (At the very least, it might affect your choice of hypertension med.)

I am 57 and am menopausal since 04, have lc since 03 and fell off wagon for almost a yr,was in extreme grief with death of kid sis and other significants in my life and neglected me.

Had one scan in 04 at 186 and then second scan in 07 ( 2 weeks ago) and it was 390, so yes about 30% a yr.

I assumed dropping A1C from 8 to 5.8 would have a bearing, no wheat products and eight loss of 80 lbs, way lower bp mostly about 110/68 or so would have given me less of  score.

For 5 months in yr I run a B&B and work hard enough to make a sweat and in winter I walk.

I only knew about Vit D and fish oil since coming here, few weeks back,  so take fish oil, its harsh to do as I have that HP bacteria and the fish oil makes allot of heartburn and distaste. I am waiting for the softgel Vit d 3 as can only get the dry form here, as well the l'arginine was ordered as well.
My ldl is 97, my hdl is 68 and trig are 78.Ratio is 2.5, have not got advanced lipid profile back, should all be back this week and CRP and lip protein  were all low and within norm levels.

I've been diabetic since 94 and needed insulin which I no longer need. I tried to use Actos as I read it reversed some plague so asked a doc for some, but it caused some chest pain and side effects so after 3 months I quit it.

Stress has been a factor with husbands illness, many deaths and just finished testing for lung cancer( on my recent heart scan the radiologist noticed something in my lungs???? and suggested the rule out cancer??)(never smoked a puff in my life but my mental health patients smoked in my office for a few decades until I put a stop to it in 1980 and got my wrists slapped for doing that).

Now I know I have no lung cancer am assuming my stress will decrease,husband being tested for asbestoses etc so lots of anxiety,I know thats not good for heart either,  typically I handle stress ok and use alot of humor in my life.

So now you know more and can make some impressions. This doc doesnt really know me but felt had I continued with my program from Cdn Diabetic assc which was hi grains I would have had a higher score and my A1C couldn't get under 7.8 on insulin and I needed 158 units of humalog a day to keep it there so now I am not as insulin resistant , since lc, so maybe I would have a higher score if hadn't lc.

I am only assuming and am only learning all about the TYProgram, I tried to introduce some oat bran daily but it spikes my BG way too much and I am aiming for AC under 5 so will stick with ground flax

Anyone have some insight let me know, oh yes my vit d blood level was low as was DHEA, hormone levels of progesterone and all estrogens very low too from saliva test so using bio identical progesterone cream.

I am assuming I will start on Niaspan to drop trig.

Hi, Chickadee--

I believe that you are on the right track. I encourage you to stay in contact through the Forum, where we can discuss your issues in more detail, along with feedback from other members.

Yes I plan too and once all blood work back I am hiring you to do a consultation via scanner, how new age is that!!!

I have had one diet pop a day as a treat for a sweet taste but am stopping that now too since reading about carbonation on the forum, lots of good info there for sure and dedicated membership

Lipoprotein(a) in 2004 was 0.21g/l and in 2007 June was 0.09g/l.....so there is hope for me yet
I should have new NMR results in few days.

This 04 one I had only been low carbing for one yr.So maybe prior to that it was higher, but never had it checked ??

I am exited to know that and now to try your ideas as if I could do that without supplementation and often off the statins....then who knows whats next

Thnx soooo much for all your insights

chickadee-

That's curious: a big drop in Lp(a) with low-carb diet. Although the diet clearly works, I've never seen such a a dramatic effect on Lp(a). Was there anything else you did?

Yes I went off insulin, cozzaar,lipitor, slowly lost 80lb, ate only nutrient dense foods, more meat,eggs, only low gi veg,salads, olive oil daily,I am worried what if it was an error, will know in 2 days what new results are.
Oh I ate a ton of ground flaxseed, .....my chol went up &, and HDL went from 40 to 68 and stayed there,LDl went up in that time frame and Dr Westman from Duke said its probably big fluffy good ldl stuff as typically thats what occurs with people doing low carb and getting into ketosis...could higher hdl  move out sticky lipoprotein???

Hi, Chickadee--

If you're asking whether higher HDLs are more likely to reverse plaque, the evidence would suggest that it does. HDL is probably crucial for plaque regression, since it acts as a "scavenger" of cholesterol in atherosclerotic plaque.

...so if I add excercise then my hdl should go even higher right?

Yes, and the effect can be substantial if you're starting from a sedentary lifestyle.

...was thinking what I did, I also used a full dose adult ASA daily as read in (Edtmn Protocol( the ones who do the stem cell transplant for diabetes type I) that diabetics should use a higher dose of ASA, so have used that and folic acid 1 gr OD since 03. Dont know if this accounts for it.
I am not sedentary from May to Oct as run a busy B&B and bust my butt but in winter I only curl and quilt and my Christmas gifo to myself is a gym membership, keeping in mind I have a terrible mind set about excercise so am working to change thatMaybe I will get addicted to exercise rather than carbs.

The primary function of niacin, vitamin B3, is to metabolize fats, which can then produce a usable form of energy. Niacin, also known as nicotinic acid, is one of the B- complex vitamins, the water soluble vitamins, that all work together to covert the carbohydrates in our body into sugar, for the production and metabolism of our body's energy.

just found this site. I don't have any sign of heart disease as yet but my HDL is 6.

I never met anyone with HDL that low, so that is why I'm taking niacin, 250mg split into thirds cuz the flushing and rash are awful, though brief.

Already on low carb 35 - 45g per meal and lost 22 pounds since I was newly diagnosed diabetes 3 months ago.

Question: how long to take niacin to see a rise in HDL? I don't want to take this stuff for more than 12 weeks.

Thanks a lot for this nice informative post keep posting and updating the blog on regular basis....


Smith ALan

how do you treat a very low level?non prescripton D3? how much ? I was taught to gve 50000 unts for 8 weeks.

Could you please explain why gelcaps or drops only, not tablets? I could probably guess why, but for the benefit of the audience can you tell us?

Of course, gelcap or drops only, NEVER tablets.

Could you elaborate this point?  Is this a general recommendation (e.g. ease of digestion) or are there vit. D-specific reasons?

I have a large supply of D tablets and, after reading this, am trying to make a decision regarding replacing them.

What's wrong with tablets?

I have been told that some UK Doctors correcting Vitamin D status of elderly people in care homes use ANNUAL injections of about 300,000iu/D2.

The graph in Heaney's paper from Dr Davis's blog shows roughly how long 50,000iu/D2 lasts, unfortunately because the half life of Vitamin d is only around 21days, six times Heaney's amount will not last six times as long.

If daily/weekly or even monthly supplements are not practicable then surely injections every 2 months using D3 would be a be the least worst option.

Any longer interval than 2 months for an elderly person without access to sunlight surely cannot be in the patients best interests.

Anyone.
Why the emphasis on not using tablets?
Tks.

Had a friend get all excited b/c her doctor finally ordered a 25(OH) D level on her....which came back at 16 ng/mL.

She ended her email with, "yea, so I've got to pick up the RX for the D after work today."

I immediately wrote her back and said, " did he also tell you to eat more fruits and veggies? If so, don't forget to pick up a single blueberry to eat. You need your fruits and veggies!"

Taking D2 in an effort to raise you 25OH is like eating a single blueberry in an effort to get more fruits in your diet. Its not nearly enough, it doesn't work well and it's not worth the effort, as far as I am concerned.

Then I went on to tell her about D2 being the FOREIGN source of D in humans and how it's 1/3 less effective than D3 which is the natural form of D in humans.

Why would you settle for a foreign substance when you can get the natural form and it's more effective?

In our practice, we haven't experienced any negative issues with using the bio-pharm mini-capsules of D3. In our experience, they raise blood levels consistently and adequately.

I recently had my 25hyroxy D level checked (finger stick test recommended on this site)after 2 months of 5000/day tablets and the level was 80, so perhaps some tablets are better formulated/absorbed now.

While I am not a medical professional, it is my opinion from my use and study of nutritional supplements that the most bio-available form of anything is best. D3 is a hormone and the oil/softgel form is the best way to maintain the integrity of the supplement so the body can absorb it.  A tablet is processed, dried, things are added, etc.  This changes the action of the substance in the body and you can lose the benefit.

For those asking about why one shouldn't use the tablet-based Vitamin D, but rather the oil-based Vitamin D, he has answered this before a number of times in previous blog posts. Do a quick look under his Vitamin D posts. But here is one of the relevant posts: http://heartscanblog.blogspot.com/2006/11/oil-based-vitamin-d.html

Why not tablets? Because D is fat soluble and needs to be taken with some fat for best absorption.

I keep meeting people who are put on the prescription vitamin D for 2-3 months and then they are told to stop taking it. Some of these people have told me their doctor retested and told them they now had a "normal" level. Others were told to discontinue the D after a few months with no further testing.

Two people have been off and on vitamin D 3 times. They said their doctor cannot figure out why their vitamin D test keeps dropping after they stop taking the supplement.

Not only is the wrong D being prescribed by many physicians, but it seems that many don't understand that D supplementation needs to be maintained.

It's weird how most doctors don't know how to treat vitamin D deficiencies. When I was first tested, like 2 years ago, my family doctor came out and said she had no idea what the proper treatment was. She looked it up in her little medical PDA thing, said she'd write a prescription for 50K of D2.

I declined, saying I'd use D3 instead. She didn't seem so keen on the idea, and made a point that if D3 didn't raise my levels, she wanted me to use the prescription. She also didn't seem to think they sold D3 in anything higher than RDA levels.

So... basically saying... most doctors are clueless here. But what I don't understand is, can't doctors simply look up information the same way patients can? Just because they were trained in medical school a certain way, I assume doctors would want to learn and keep up-to-date with recent treatments and such.

As for gel/drops vs tablets, it's because vitamin D is fat soluble. Take your tablets at the same time as you take your fish oil -- when you run out, get gels or drops instead.

"D3, or cholecalciferol, yields confident increases in blood levels. It is inexpensive, safe, and an exact copy of the human form of vitamin D. (Of course, gelcap or drops only, NEVER tablets.)"

I started using 5 grams of D3 because I'd read it can help syptoms of S.A.D.  I take generic D3 with dietary fat: fish oil caps and nuts mainly.  I haven't had my levels tested but having done nothing else, this has been one of the easiest winters for me to survive.  I believe D3 requires fat for absorption.  Generic D3 is cheap, dietary fat is cheap, those D3 gelcaps are not.  Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them.  

kevin

here is the best video on D3. it is an hour long and will work in IE only i guess.
http://www.uvadvantage.org/portals/0/pres/

"Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them. "

Well, there must be internet access in Wyoming.  Lots of reputable online shops sell vitamins, including host of D3 options at very competitive prices, (ordinary drug stores usually have the worst selection of D doses/options at the highest prices, too.  

Doesn't compute that sourcing Vit D would require that long of a drive.  No mail delivery?  The only other barrier I can think of is no c/c or debit card for non-cash purchases.

What about capsules, or is that covered under tablets too?

As I understand it Vitamin D is metabolised in the body from cholesterol derivatives. Since statins reduce cholesterol I take it they will also reduce Vit D as well as CoQ10, dolichols  selenoproteins and hormones and steroids that are also derived from cholesterol.

Since Vit D and other molecules (eg CoQ10) tend to be depleted in the elderly, the use of statins would increase the risk of defiencies. Statins also deplete the anti-oxidant capacity.
But when prescribed statins, no replacement for the depleted items is ever prescribed. The Canadian authorities do require a black box warning on the data sheet for statins but neither the FDA or the MHRA do so despite the known depletion. This was known in 1988 when Merck registered two patents for their statins incorporating CoQ10.
In short, the trivial gains in cardiac attacks are one thing but the adverse effects of statins are another. Given the infomercials  claiming minimal adverse reactions (having excluded all possible reactors as in the HPS study and JUPITER) doctors blieve that they do not happen and do not report patients complaints. A study has shown that only 1 to 10% of doctors actually report adverse reactions.

In the case of simvastatin, the MHRA has recorded 66 deaths in their Drug Analysis Print for this statin. This represents, then between 660 and 6600 deaths.

You're preaching to the choir here...

I am a weight loss surgery post-op.  I had a biliopancreatic diversion with duodenalswitch nearly 7 years ago.  I had already been diagnosed with osteoporosis at that time - and had never been directed to do *anything* to address it.

Fast forward nearly 7 years.  I've lost 210 pounds, a wheelchair, diabetes, hypertension, congestive heart failure, sleep apnea, high cholesterol and triglycerides - to name a few.

It wasn't until I was a post-op - who malabsorbs fats significantly, meaning fat stored vites A, D, E, and K - that I found I not only *could* do something - but should.

Today I take boatloads of calcium citrate, dry forms of A, D, E, K1, and K2 - to name a few, and have a diagnosis of osteopenia - no longer osteoporosis.  And everything is trending in the right direction.

I hope you don't mind - I enducate patients now - and I've sent a bunch of people a link to your blog to read this info about Vitamin D.  It's so important for my community to know this!

THANK YOU!

My D level was 20 when my doc prescribed 50,000 iu D2 1x per week.  After 1 month, my D levels went down to 14.  She increased me to 50,000 iu D2 3x per week.  After another month, my D level is now 7.  Why is the D2 depleting my D level?  help!!

In my view, this is the knuckleheaded thinking of the conventional practitioner: “Don’t bother me until you’re really sick.” Prevention is a practice that has become fashionable only because of the push of the drug industry. Nutrition is an afterthought, a message conceived through consensus of “experts” with suspect motivations and allegiances.