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.

Sometimes I get confused when people say "wheat". Do you think this also applies to other grains? What about rice and oats?

Thanks,
David

Received so much valuable advice from Dr Davis blog(Vit D,Fish Oil, Thyroid,Niacin) that even though I love wheat(the thicker the crust on anything the better)That I decided to trust him on this one too. I had 10 days of misery ie:no energy,grumpy,and hungry. My wife said bad words about Dr D.... threatened to force feed me donuts because I was so nasty tempered. Now 2 months later I dropped the 15 lbs I needed to, feel better and have found it easy to stay off the stuff. Thanks Dr Davis (my wife says she is sorry!)

Or rye, perhaps?

I was listening to a CD version of the book "1491". It talked about the uniquely Native American ("Indian") invention of agriculture combining maze (corn) and squash and other beans. This provides all the essential amino acids.

It somewhat paralleled the Western invention of agriculture based on wheat and other grains(barley, oats,...).

The comment of significance was that the Native Americans were considerably taller than the newcoming European settlers.

I wonder if that is a "wheat thing" as well.

I read not long ago that when Lafayette and the French soldiers joined forces with the new Americans during the Revolutionary war, it was noted that the new Americans were also taller than the French soldiers.

I wonder.

Although i have reduced my wheat intake by 90% now, but it is not always easy to follow this diet. specially when you also have to avoid few other grains because of the hypothyroid issue. even though it has been said that iodine sufficiency shouldn't let goiter foods do any harm but, i can still feel the effects of these foods with in minutes after consuming, cooked or uncooked.
Few years ago i had bloody stomach every time i went to the bathroom. tired of doctors wait game and suggested operation date 3.5 months away, that's when i decided to become my own doctor and basically started studying my self. i was lucky that with in 3 days i was able to stop the bleeding with simple usage of Aloe (not the regular aloe it is high dose of Aloe Mucilaginous Polysaccharides) and manuka honey. but i learned later on that, all of this started with hypothyroid. while studying this stomach issue i went through this made sense notes from this alternative mental health site.
http://www.alternativementalhealth.com/articles/walshMP.htm
where the author talked about oxidative stress and said,
"factor to consider is the high incidence of oxidative stress in the G.I. tract. This environment can destroy key digestive enzymes such as DPP-IV (needed to break down casein & gluten)..... This condition is especially common in autism-spectrum disorders. Failure to correct the oxidative stress would doom supplemented enzymes to an early death. The result can be similar to Pickett's Charge at the battle of Gettysburg.... The digestive enzymes are mowed down as soon as they enter the G.I. tract. The casein-free, gluten-free diet often results in rapid striking improvements. However, nutritional supplements which overcome G.I. tract oxidative stress can make the CF/GF diet unnecessary.
Normalization of zinc, metallothionein, and glutathione in the G.I. tract isn't difficult to accomplish. It's a lot easier to take a couple of capsules daily than this difficult diet. It takes about 6-8 weeks for the G.I. tract to get "fixed" using this therapy.
We've had many patients who were extremely sensitive to dairy and wheat.... and did marvelously after the CF/GF diet. Many of these same patients completely lost their sensitivity to casein and gluten after the antioxidant supplementation..... and now can eat a normal diet without a problem".
the reason that i am bringing this discussion that i have seen people in certain communities where wheat is their at least 40% of the total diet. yet some individuals in that same community are still got no wheat belly and no major health issues what so ever.

"Mental fog" seems very ambiguous.  Is there any kind of scientific data or quantifiable means by which one can measure the effect of wheat on "brain fog?"

Any studies, or is it all anecdotal evidence?

Please read about the Specific Carbohydrate Diet and the book "Gut and Psychology Syndrome" by Natasha Campbell McBride. Very interesting and nothing we learned in medical school.

There are some who propose that we shouldn't eat any grains at all, because all grains have some particular proteins (particularly defence peptides) which provide protection to the grain plant, but which are harmful to the human immune system. This includes rice, corn, maize, etc.

Check out this article: "Cereal Grains - Humanity's double-edges sword" http://www.thepaleodiet.com/articles/Cereal%20article.pdf

Although I don't doubt the health benefits of eliminating wheat, I am interested in how the Mediterranean diet is considered healthy, yet includes pasta.

Fruits/veggies/grapes mitigate the damage wheat does, or is there some other mechanism? Perhaps genetics play a role, where certain individuals have a much bigger problem with wheat (as to heart disease) than others?

Wheat is the enemy. Ah well....that explains the Italians; and for that matter, the French.  But wait, they are, on average, more healthy than Americans,...... So what about those Japanese and other Asian cultures who consume vast amounts of Omega 6 from soy....maybe their delta-6 desaturase is higher than the average American, and maybe, just maybe they have more exercise in their daily routine.

Dear anonymous, it is a myth that Asians eat vast amounts of soy. They actually eat very little each day. Our food manufacturers have sold us that bill of goods so that we will buy products (franken-foods) with "healthy soy" which is actually the waste product of the soy oil industry--yet another bad for you food.

No disrespect to the French and the Italians - I love to visit both countries and know many natives - but the French and Italians are just "less sick" than we are, they aren't necessarily good examples of abundant health, esp the Italians.  They don't eat as much pasta as we are led to think, but wow, they do eat a lot of bread and sugar.  I saw lots of signs of diabetes among the locals when I was in Italy last summer.  

Overall, my impression from my visits to friends and family of my husband's (for nearly 15 years) is that Europe seems to be heading down a similar  sorry path we've already trodden; they are just a few years behind behind us.  Some European countries are following at a slower pace or a slightly different route, but the signs are there that the industrial food culture is permeating and doing damage, esp in the younger generations.  I think it's happening in industrial parts of Asia, too.

Celiac disease research is very active in Italy because  of the high rate of celiac incidence there.  Check Pub Med, you'll see a high number of Italian papers.

Anna,
You have more personal experience than I do from visits and I respect you observations.  I have not been to either country for over 10 years.

Take a look at the stats on Nationmaster:-

http://www.nationmaster.com/graph/hea_hea_dis_dea-health-heart-disease-deaths

Italy and France are low on the list for heart disease deaths.

Also on Nationmaster you can find stats for a whole host of other things EG wine consumption..... France and Italy top this list. On soft drink consumption, they are at the bottom. Obesity stats also show them at the bottom and USA is #1 but USA is not #1 for heart disease deaths, it is in the mid tier.

In my copy of Lao-Tzu's Te Tao Ching, which was found in a Chinese Han era tomb dated 168BC, it states that one of the other documents found in the tomb was a treatise on "the health benefits of grain avoidance".

Pasta is made from Durhum wheat which has a slightly different genetic profile from baker's wheat.
Even a single amino acid difference in a gluten or casien sequence can change the way it breaks under pepsin digestion, altering or blocking the production of any given exorphin. In my experience the Durhum gluten exorphin is not as vicious as the baker's wheat gluten exorphin, but it is still nasty.
This is paralleled in milk chemistry - beta-casien from A2 milk has a proline residue where beta-casien from A1 milk has a histidine residue; this means that A1 milk forms the potent exorphin beta-casomorphin 7 in amounts approximately 100x that of A2 milk. A1 and A2 are genotypes of common milk bearing cows. Many people who cannot tolerate A1 milk (normal cows milk) can tolerate A2 cow's milk, or goat's milk, which has A2 properties. (Milk can create other exorphins, but BCM-7 is especially potent and well-researched)
This is all linked to the use of low-dose naltrexone to stimulate and harmonise immunity by elevating endorphin levels. LDN can be seen as a drug that undoes the harmful effects of exorphins.
Also, large amounts of digestive protease enzymes are heavily relied on by many alternative canmcer therapists (as is LDN); these will tend to digest exorphins before they enter the bloodstream. This is not the actual rationale for enzyme-based cancer therapy, but to my mind it makes far more sense than the out-dated traditional explanation (the Beard hypothesis). Use of morphine after cancer surgery is associated with a significantly lower rate of remission - morphine is the classical exorphin.
The exorphins only enter the blood if two conditions are met - inadequate pancreatic digestive enzymes (proteases), and/or excessive intestinal permeability (or stomach ulcer) - "leaky gut" (because exorphins, like classic opiates, act directly on the gut, a lack of pancreatic enzymes can eventually lead to leaky gut. Aspirin abuse (even 1 a day, which has increased the rate of Crohn's disease five-fold in a population study - I use ginkgo or reishi instead), antibiotics, and many other drugs can contribute to leaky gut. Probiotics and good nutrition (adequate protein annd fats) are protective against it.

Andrew, there are scientific studies online done on rats in mazes that show orally administered gluten exorphins affect standard tests of learning, memory, etc (mazes and the like) without affecting "swim time" or other more physical parameters. That equates to "brain fog" (cognitive impairment) in humans, I reckon. This is one of the 15 references on PubMed:

[Delayed effect of exorphins on learning of albino rat pups]
[Article in Russian]

Dubynin VA, Malinovskaia IV, Beliaeva IuA, Stovolosov IS, Bespalova ZhD, Andreeva LA, KamenskiÄ­ AA, Miasoedov NF.

Abstract
The delayed effect of food-derived opioid peptides (exorphins) after chronic administration on postnatal days 1-14 on the learning of albino rat pups has been studied. Heptapeptide YPFPGPI (beta-casomorphin-7), pentapeptide YPLDL (rubiscolin-5) and pentapeptide YPISL (exorphin C) improved the development of the conditioned foraging reflex in a complex maze. Hexapeptide PFPGPI lacking the N-terminal tyrosine proved inefficient. Only beta-casomorphin-7 had an effect (negative) on passive avoidance conditioning. The obtained data confirm that exorphins (particularly, milk-derived beta-casomorphins) can have significant and long-term effects on the environmental adaptation of young mammals.

Among the many devastating effects of celiac disease , the immune disease that develops from wheat gluten exposure, are mental and emotional effects, such as anxiety, fatigue, mental "fog," depression, bipolar illness, and schizophrenia, that disappear with removal of gluten. Many parents of autistic children also advocate wheat-free diets for similar reasons.

Good post! I respect you observations. Pasta is made from Durhum wheat which has a slightly different genetic profile from baker's wheat. I am interested in how the Mediterranean diet is considered healthy, yet includes pasta.
Boxing/MMA Supplies

While the term "mental fog" is really vague and unscientific, thinking in more specific terms one can see that , yes it is well documented.  The protein in wheat gluten is very difficult to digest, and in the case of certain autistics, schizophrenics, celiacs, people with wheat gluten enteropathy etc. it is not completely broken down, forming long chains of peptides that have a chemical composition similar to opiates.  These people are all known for their resistance to dietary change and extreme addiction to wheat gluten and often dairy, the protein of which has a chemical composition similar to that of wheat gluten and therefore, is also may form similar peptides.  The symptoms such individuals display might be described in similar terms, dazed, spaced out, the appearance of opium addicts, or "mental fog."  There is research on this phenomenon.