I'm very excited to read what sounds like a possible change in your position on saturated fat (agreed: it's only one of a list of many other beneficial dietary practices, and I shouldn't focus too much on that one).  

My own substantial weight loss, achieved by substituting fat (and saturated fat) for carbs while keeping protein intake moderate, has been such a revelation to me.  It's been quite difficult to believe that what we've been told by dietary authorities is not only incorrect, but is most likely exactly backwards.  Fat has not made me fat.  Fat has and continues to make me full.  Being full got me to a BMI of 23.  Becoming slender again has restored my athletic performance as well as improving the blood markers that most of your readers track.

Taken as a whole, this list of dietary advice might possibly be summed up as, "Enjoy good eating in moderation."  IMHO, at the end of the day, a balanced approach is an essential part of any sustainable lifestyle.

I have had what I consider great results with raising my HDL from 312 a few years ago following my physician's AHA recommendations to 51 now by doing most of the things you suggest in this blog (I am male).  My question is,  how good is this as a heart health indicator?  Even though your book suggests that only a scan will tell, I am nervous about X-rays and the cost of a scan.  Can I take some solace in my dramatically increased HDL?

I almost totally agree.

The only minor disagreement is that I would extend "wheat products" to include the other grains and starchy carbs. I am very cautious about all of that group.

My major disagreement is the omission of Australia from your list of excellent dry red wine producers

Cheers, Alan, T2 Diabetic, Australia

Anonymous re: HDL--

No, sorry, absolutely not. It is an indicator, not the real thing, meaning plaque.

If you advise eating saturated fats, then why specify "lean meats"?.

What percentage of your patients don't respond to the HDL boosting therapy you advise?

I raised my vit D level to 56, dropped wheat, increased exercise, took niaspan (albeit at only 500mg), took 3 grams omega-3/daily, took a wine extract supplement, ate  a small amount dark chocolate daily....

And my HDL went down 1 point. My weight isn't an  issue, I think, as I'm 6'1"", about 175 lbs. My body fat is approx. 15% (not sure if that's good or not). I eventually had to drop the niaspan, as I was getting heart palpitations, but it didn't seem to be doing much for my HDL anyway.

What is recommended for patients when their HDL won't seem to budge? And a better question... why isn't it raising on the therapies you recommend, when it does work for most patients? Are there any rare causes for low HDL, outside of genetically low HDL?

I can echo the last post. I have tried all of Dr. Davis' strategies, plus others, and it's resulted in slight reductions in my already low ldl and triglycerides but no change in my low hdl. I'm in great shape, eat well, exercise regularly, no heart issues or risk factors besides the low hdl, which I assume in my case is genetic.

I didn't know where else to post this question.  Is this true?

"Another way to know if abundant HDL is valuable is to look at its particle size -- smaller is better. A large study has found that people with high HDL (above 70 mg/dL) but very large particles had more risk of heart disease than people with low HDL (under 40), probably because larger particles aren't as active. But again, there's no easy commercial test for that."  This quote appeared today at http://www.oregonlive.com/health/index.ssf/2009/09/you_docs_answering_questions_a_2.html.  Mehmet Oz is usually suspect to me, anyway, but I am still curious about this statement.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

Cool Post !!!!!


smith ALan

Unfortunately you don't sound like a conspiracy theorist.  I even know of an example of a fortune 500 company receiving air time for one of their products by "respected" news agencies.  

Back in the summer of 1999 or 00 one would have thought the supplement SAMe was the cure all for depression and arthritis.  Magazines Time, & Newsweek ran articles on it.  My memory isn't so good anymore but I believe one of them even placed SAMe on the front cover.  The nightly news NBC, CBS, and ABC all ran gushing reports on SAMe and its natural curing abilities.    

I'd like to say that the news reporting was done because SAMe is truly a wonder supplement.  That is not the case.  It is a fine product I suppose but not the kind of product that deserves the enormous press coverage that it did.  The reason it received so much press is because the large multi national company asked them to do so.

Dr. Davis, these comments are a huge inspiration.

As a b-school prof, I know that pharma and hospitals are not intentionally exploitative, but the profit motive inexorably works its effects in all aspects of the decision process, and ethical standards are gradually stretched to the minimum limits of acceptability.

I recently did a casual analysis of the ads in Reader's Digest. About 80% of the ads are for prescription drugs to treat lifestyle-inflicted illnesses, such as high BP, type 2 diabetes, and inability to sleep, as wells other highly questionable illnesses such as "restless leg syndrome, or RLS." Daytime TV is about the same. You may notice that the ads now say "talk to your prescriber" instead of "talk to your doctor" -- in other words, they don't care who prescribes it, only that it gets prescribed.

THESE ADS ARE THE REVENUE SOURCES FOR THE MEDIA, WHICH MUST CATER TO THE ADVERTISERS IN ORDER TO STAY IN BUSINESS. PHARMA PAYS FOR THE RESEARCH IN UNIVERSITIES, AS WELL.

People don't bite the hand that feeds them!

Wow! I wasn't aware of that.

Would you know who the company was?

Rich--

I had no idea that the proportion of pharmaceutical ads had grown to such an extraordinary number. The drug industry is not stupid--their direct-to-consumer advertising must be working in a big way.

Yeah, maybe I'm too cautious, but giving the companies name shouldn't be a problem in this case.  The SAMe pills were made by an Italian firm that had/has a contract with BASF.  (They could be a division of BASF.)  

I was told by a BASF employee that their press department is very good and persuasive.  They wanted to create a buzz for the product.  70% of sales for health foods are generated on new products.  People like to rush out and try the new thing.

Don't forget to include the "non-profits". Back in the 1950's my father, a physician, told me that the American Cancer Society did not really want to find a cure for cancer. From some of the things the American Heart Associaton promotes, I don't think they really want to stop heart disease.
Anne

I couldn't agree more.

Thank goodness we have someone like you, Dr. Davis, who can help us sort through all these industries who are looking for "suckers".

There is a very interesting 6 part documentary on youtube about marketing and the pharmaceutical industry. "Big Bucks, Big Pharma"
Here is the link to part 6.

http://www.youtube.com/watch?v=IVDTo8Rm1rE&feature=related

Without in any way wishing to contradict the idea that fructose is even worse than glucose readers here may enjoy reading this article on the perils of a diet high in
fermentable carbohydrates.
Dietary Carbohydrates and Dental-Systemic Diseases"
The paper was written by a dentist after reading Taubes Good Calories Bad Calories. Readers who find GCBC hard work may like to start with this Medical News Today article based on the above paper.
If A Diet Is Bad For The Teeth It Is Also Bad For The Body

Don't forget agave syrup/nectar.  That is the latest "low glycemic" sweetener temping sugar addicts, particularly to those interested in health.  Agave sweeteners are VERY high in refined fructose, with some brands much more fructose than HFCS (I've seen figures as high as 92% fructose).

Even more worrying, agave sugar products  are labeled as safe for diabetics, who are particularly prone to damage from frequent consumption of concentrated fructose.

The people I see using or recommending agave sweetner products seem to think that because they can't detect an immediate post-prandial BG rise, that agave syrup is somehow better (therefore healthier) than sugar and safe for liberal and/or frequent use.  Not so.  All refined/concentrated sugars need to be limited in both quantity and in frequency, including concentrated fructose.

I see "moderation" used a lot in reference to sugars and agave products whenever criticism of sugars is made.  But what is "moderation"?  Do we even have a reference point anymore in our sugar-drenched culture?  "Moderation" in the 21st century is still at least a hundred pounds per capita more sugars than most humans consumed just a few hundred years ago, and much more than our paleolithic ancestors consumed. Even "moderation" needs to be considered in moderation.

Wow, that's really interesting.

In the past I've wondered if something real simple (like removal of soda/sugary drinks) from society would have a major impact on both heart and general health.  Apparently it would.

It's also weird how cardiologists (in general) overlook sugar intake almost completely. When I last saw my cardiologist, I was sort of baffled that they were offering the patients waiting for infusion therapy snacks while they wait. The nurse commented how  the patients go  first for the peanut butter/jelly sandwiches and they run out fast. And I'm there thinking... are they crazy, giving  sugary food to heart patients?  Then I remembered most cardiologists tend to be fat intake oriented only.

Question for Dr. Davis -- what amount of fructose, daily would you consider safe? Is any amount  safe? As certain fruits do provide health benefits even if they do contain fructose. Berries are still acceptable? What gycated hemoglobin level do you aim for with your patients and have you noticed any differences in plaque progression based solely on this value?

Hi Dr Davis,
Could you tell us more about beer? Do you mean that beer has fructose added to it? Or that it contains a lot of fructose naturally? In general, how high up is beer on your list of things that we shouldn't eat? I ask because I'm having some success cutting down on sweet things and on wheat, and beer is one of my chief culinary pleasures. I don't mean that I drink a lot or that I drink everyday, just that I thoroughly enjoy the 3 or 4 beers a week I do have. (I generally drink brews made with 100% barley malt.)

So low glycemic fruits (which are high in fructose) like apples, apricots, berries, cherries, grapefruit, plums, and prunes can be hazardous to our health...

I'm starting to run out of things I can eat.

Hi,
Thank you for the link to the JCI
study. I can hardly wait to see how the CRA will militantly respond. As a former research technician I am driven crazy when the CRA claims that sucrose and HFCS are essesntially similar. Take the variant HFCS-55. To the casual observer the 55% fructose: 45% glucose composition looks 5% different than the 50:50 ratio found in sucrose. That is, until you do the math.
55%:45% = 55/45 = 1.22.
This means in every can of Coke
(bottled in the USA) there is, compared to glucose, 22% extra fructose. The CRA can't deny the math; they designed the ratio. To your health.

Did anyone notice that one of the authors of the article is RM Krauss? I love chasing his articles on pubmed.  His saturated fat articles from a few years back are particularily interesting.  I think of him as "small dense krauss" in the age,rage and ldl series on Peter's blog.

Dr. Davis - there's so much great information here, but when we ask questions to try to understand the information, you don't answer them!

Thank you, Curious.

But most of my time is spent in my more-than-full-time cardiology practice, consulting to the nutritional supplement industry, research, and the practically full-time website, Track Your Plaque, in which I engage in discussions with your wonderfully savvy Members. So I have to triage my time accordingly.

Also, I read the comments and I try to cover as many of the points as possible in future posts or in the content we post on Track Your Plaque.

Remember: As I post prominently on the blog: The Heart Scan Blog accompanies Track Your Plaque; it is not meant to be a standalone source of information.

Dr, D.  Those of use who TYP ( "track your posts") on this Blog may not be as "bought in" as the members of your track your Plaque members.

If fructose is added to beer, it will be converted to alcohol so none left in the final product.  If wheat is used in the beer grist, the starches that are extracted are converted (mostly) to alcohol so no residual "toxins" to cause swelling.

It isn't high fructose corn syrup consumption or prepared meals that makes Americans one of the most overweight nations in the world, its eating more calories that you need; it comes down to pure physics

I'd like to see a post about the lie of Calories. Fat is calculated at 10 kcal/gram because if burns (bomb calorimeter) better than sugar (calculated at 4kcal/g, the same as fiber).

But of course sugar is much more available to our bodies as energy than fat or fiber.

This makes the Calorie a big lie and emphasizes even more the low-fat diet (because fat would obviously be easier to cut by calorie than carbs).

When people try to talk about the "physics of losing weight", they need to address the underlying assumptions that make the whole system a lie.

Jammer, Please, it is a fundamental law: you can not create or destroy energy.  Mechanistically the body may deal with fats, sugars and proteins differently but unless you live in an alternate dimension, calories absorbed by the gut are either expended as energy or stored in the body in one form or another.  Belief in some magical effect of being able to "eat all the xyz without putting on weight" is a matter of faith and faith is neither fact nor science.

Anonymous, on the contrary, you are expressing faith in but one interpretation of the Laws of Thermodynamics (LoT).  When tested, results often show that one can eat more calories on a restricted carb diet and be less hungry and lose more weight.  The reasons are many and I refer you to Good Calories Bad Calories should you wish to learn more.  The body is not a closed system, and your interpretation of the LoT imply that it is.  What do I mean?  â€œCalories in = energy expended + fat accumulated/depleted” is correct, but only if one realizes that some calories drive hormonal responses which have an effect on the equation.  Eat more protein, feel less hunger, be more active, thus expend more energy.  Eat more carbohydrate (measured by glycemic load in particular), feel more hunger and behave like hungry people do - rest more, thus expending less calories.

Do teenagers grow because they eat too much or because their bodies are responding to the complex interaction of hormones?

Do pregnant ladies gain weight because they eat too much or because their bodies are responding to the complex interaction of hormones?

Do post-menopausal ladies gain weight more easily because they suddenly begin to eat too much, or because their bodies are responding to the complex interaction of hormones?

Do tall thin people (ectomorphs) just magically match their consumption and expenditure (thus remaining slender despite what appears to be high food intake)?  Or are they genetically programmed to a different hormonal response than endomorphs?  

If you met two people, one tall and thin and the other shorter, wider, with a large pelvis and heavy bones – don’t you already know that one will struggle more with their weight than the other?  You do, and you know it long before you know which one is the least disciplined in the non-food arenas in their lives.  

Are you aware of the research that shows, repeatedly, that the obese consistently eat less than many or most of those who are not obese?

Do those who are heavier than we think they should be eat too much, or are they responding to the hormonal mileu they have created by eating foods which we are not designed to eat?  I think the later.  Obesity is not the result of a character flaw, it is a result of widespread consumption of foods (primarily cereal gains, sugar and agricultural products which have exceptionally high carb content) we are not genetically adapted to.  These foods drive a hormonal response the results in energy accumulation as fat.

Aplloswabbie,notwithstanding the impact on what drives people to consume or expend energy at different rates, all excellent info., the equation is still balanced in the end.

Anon, agreed, but the significance of our agreement on that fact is low, as it provides little utility in assisting ourselves or others with their health.  For me, the realization that "low fat" diets are unnatural and drive metabolic derangement gave me a chance to eat good food to satiety, but avoid the high body fat that plaques my family.  Best regards.

How much fructose does beer have then? From what I could find, the fructose content of barley malt is significantly lower than other sugars.

how about mal;tose from tapioca syrup?

Now if you could get Congress to drop the high tariffs on sugar so it becomes less expensive than HFCS, we all could live longer.

Not much longer, we predominantly have sugar from local beet rather than HFCS in the UK, yet our stats aren't much better. IMO there's little difference in the relative toxicity between sugar and HFCS within the context of a high wheat diet

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So fruit, in moderate portions, is bad for me?
*snort*
I understand targeting HFCS just as you would large amounts of sucrose.  It's the AMOUNT of these substances that can be a problem.  The other nutrients I get from a piece fruit can far outweigh any possible negative of small amount of fructose in the piece of fruit.  Decisions are all about risk vs. benefit. I imagine there are no risk-free food choices.

No risk-free food choices, Anon?  Whole fruits and vege have little risks!

Very good post that busts everything that http://betterworldcookies.blogspot.com/2010/06/why-i-use-agave-nectar-examination-of.html says!

Wow, I had no idea of this. I should start being careful with my eating, I am really worried about my health now due to several conditions and this is a real eye opener

Fructose is concentrated, of course, in high-fructose corn syrup, comprising anywhere from 42-90% of total weight. Fructose also composes 50% of sucrose (table sugar). Fructose also figures prominently in many fruits; among the worst culprits are raisins (30% fructose) and honey (41% fructose).

A point that Robert Luskin makes in his video "Sugar, the Bitter Truth" is that biochemically fructose does not produce Leptin in the body, the "stop eating" hormone.

A great ingredient for corporate food products - the more fructose, the more you eat/drink before feeling "full". Given that the calorie surplus that makes the US one of the fattest countries in the world is only 20 calories per day, high fructose corn syrup could account for that all by itself.

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