This is great!  I'm eager to hear of a commercially-available ground Einkorn wheat flour.  I don't have the means or know-how to mill my own flour but I'd really like to try baking with Einkorn.

Pasta is one non-Primal carb I do not miss at all.

-why try to simulate neolithic foods with paleolithic-type ingredients?

-why try to eat pasta at all?

-is it really that hard to give up?

Pasta dates back 4,000 years and has a lower glycemic index than bread, so I don't think it is such a bad thing.

Here is  Einkorn flour:
http://www.growseed.org/einkorn.html

Expensive, but may be worth it.  I'd love to know if anyone gets it and has success baking with it.

-4000 yrs is nothing for human evolution and nutrition

-a snickers bar has a lower GI than pasta
-but I wouldn't eat a snickers bar either
-if something is bad, relative to something else that's "not so bad"....why eat it at all???

Interesting recent discovery:


Bread was around 30,000 years ago -study

LONDON (Reuters Life!) – Starch grains found on 30,000-year-old grinding stones suggest that prehistoric man may have dined on an early form of flat bread, contrary to his popular image as primarily a meat-eater.

The findings, published in the Proceedings of the National Academy of Sciences (PNAS) journal on Monday, indicate that Palaeolithic Europeans ground down plant roots similar to potatoes to make flour, which was later whisked into dough

[edited]

The researchers said their findings throw mankind's first known use of flour back some 10,000 years, the previously oldest evidence having been found in Israel on 20,000 year-old grinding stones.

The findings may also upset fans of the Paleolithic diet, which follows earlier research that assumes early humans ate a meat-centered diet.

http://news.yahoo.com/s/nm/20101018/india_nm/india522760

Einkorn is becoming popular all across the US.  Jovial Pasta is a great product and an easy way to try einkorn.

I have been able to secure a supply of whole organic einkorn wheat berries and make them available for sale on the einkorn blog.  

This einkorn really is fun to cook with too.

Regarding 300,000years ago eating grains.

You need to read the following article, which shows that startling papers are easier to publish. Also Medical establishment is not very good at catching analytical errors.
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

Evidence of grains on seeds doesn't imply that humans were eating grains. It does mean that they were using some grains. It could be for colors for painting. It could also be that sometimes they were starving and ate it.

Just getting some thing published in a journal doesn't automatically mean that the abstract says what the paper says or the paper reports things factually, or the paper uses the evidence correctly, or the paper does the analysis correctly. There are so many ways of getting the desired results, and the peer review only works to throw out unpopular ideas. Eating wheat is not unpopular.

I came across Jovial in WF a few weeks ago. I am not wheat sensitive, so I can't comment on the that difference, but I will say it is the best whole wheat past I have ever tried- hands down not even close.

Thanks Anand for pointing out the lies-damned-lies-and-medical-science Atlantic article!

Hmmm....sounds interesting. But I worry - just because we don't feel outward symptoms doesn't mean harm us not being done.

Now, I sound like a hypocrite since I like my tequila and wine, but Einkorn won't give you a buzz. ;)

I agree - stone age man probably had a very hard time collecting seeds and "grain". Add to that the grinding and the rest of the preparation and I very much doubt that is was anything like a staple. Grains may be a means of survival when nothing better can be obtained.

To "Anonymous" who said: "...[Jovial] is the best whole wheat pasta I have ever tried - hands down..." I wonder how you'd say this compares to Dreamfields pasta.  I realize we're not exactly comparing apples to apples, but still some sort of practical comparison would be useful.

@Anand Srivastava  

So basically, we shouldn't believe anything we read on this board?

Hi, Bonnie--

Judging from my single einkorn baking experience and from what GrowSeed.org's Eli Rogosa tells me, you can bake perfectly fine bread with einkorn. It will not rise like conventional wheat flour, rising only a little.

However, I am not trying to paint einkorn as a problem-free grain. It is just an interesting indulgence and part of a fascinating broader conversation about this thing called "wheat.
"

My girlfriend and I tried Jovial pasta last week, and the taste and texture were similar to regular whole wheat pasta, so we plan to substitute it in our recipes.

Awesome post and Nice Information. I really enjoy This Information. thanks sharing this information and also comments Great... Now Foods

Since no one has yet posted their baking-with-Einkorn results in detail, I will! Complete with step-by-step photos of my bread-baking experience. I think it's delicious!
http://www.illinoislori.blogspot.com/2012/12/honest-food-trying-ancient-wheat.html

You forgot agave syrup, which a lot of people are using as an "all natural" low-glycemic replacement for HFCS. In fact, it contains more fructose than HFCS.

One manufacturer's products include “low glycemic monosacharide.” Gosh, I wonder what that is.

It would be a service, if you (or someone) posted a "fructose" content list which includes all the common fruits and berries. I eat a lot of berries and have wondered if that is such a good idea. A list would help us define "good calories" regarding these possible fructose bombs.

Thanks for the visuals and labels on fructose...I am very aware of fructose contents and fruit -- especially since I have experience with fruit and gout attacks that may or may not be supported in literature.  I will only add that every time you purchase a product DO NOT ASSUME CONTENTS ARE THE SAME as when you last purchased.  For example, Classico pasta sauces which I used as base for soups and stews (all LC) has started adding sugar.  CostCo Kirkland brand marinated artichoke hearts (again LC) started out using olive oil, now uses cannola oil. My experience as label-reading shopper is food producers are now adding sugars including fructose to just about everything because the buying public perceives sugar to be tastier...even the rotisserie chickens most grocery delis have now...be careful if you very LC to whether the spice rub has sugar in it.

What don't you find it in?

Finding it hard to believe that an apple wouldn't have some other redeeming value that counteracts or balances the fructose content: soluble fiber, fiber, vitamins, minerals, etc.  Hopefully this is not an indictment of all fresh fruits?

It's all very well to measure fructose content, but it is meaningless unless we know what intake levels have to be before they become problematic.

In my own case, when I went "paleo" a couple of years ago, I swore off sugar, grain, and processed foods.  I lost 15 lbs over six months without trying.  Now this was before I heard about the fructose issue, and I was eating fruit like I never had before in my life, 3 to 4 pieces a day, and the sweet ones, too:  apples, bananas, grapes, dates, etc.  Surely I was ingesting more fructose than I had been before with a blob of ketchup here, steak sauce there...

Not to put too fine a point on it, but what you show as A.1. Steak Sauce is actually their marinade. Real A.1. Steak Sauce (at least my bottle) contains no HFCS, but does have 2g sugar per serving. Thank you for spending the time you do on this blog; you, along with some others, have given me the intellectual and scientific basis I needed to change my diet. The improvements, physical and mental, have been astounding.

The fructose info is interesting, but I agree with GK. We really need to know what is considered a safe level before condemning all fructose sources.

Fruits do have certain health benefits, some more than others, especially berries. There is also the possibility that by becoming super fructose-phobic and avoiding all fruits/berries,  that one could decrease their chances of heart disease, just to succumb to cancer instead.

Perkdoug, I have found that the web site "nutrition data" has a breakdown of sugars for things. Go to nutritiondata.com and type in the food you are interested in. Choose the right food and quantity and then go down to the section on carbohydrate and click the see more details. When I did that for dates, 1 medjool has about 7.6 grams of fructose (eek!). Like many folks I am cutting down on my fructose consumption so use this table a lot.

How about the king of HFCS--Soft drinks and candy.

As someone else asked, "what don't you find it in?"

Fructose can be found in many vegetables too.  One sweet onion has 6.69 grams, a half head of cabbage has 6.58 grams, a head of lettuce has 5 grams, a cup of chopped red peppers has 3.37 grams, a medium sized cucumber has 2.62 grams.  In fact nutritiondata.com lists 138 vegetables which have some amount of fructose in them (albeit many having very small amounts.)

So, if one's goal is to avoid all sources of fructose and still maintain any semblance of good health, well good luck.

@Nameless: Well put!

I think tossing fruit is a bit of the baby out with the bathwater.Fruit has the most wonderful spectrum of bright tastes and flavors of any food we have on the planet. "Healthy" vegetables encompassed the bitter, the flat, and the algae like part of the flavor spectrum. Me, is meet and nice in small to medium quantities but when eaten in low-carb volumes, it just becomes something you shovel in to make hunger go way.

Fruit is a wonderful gift. Adding a little sugar and heating some berries produces this wonderful sauce you can pour over pancakes or creps (if my diabetes let me have crepes). Some fat, flour, and salt makes a wonderful crust that you wrap around sliced and spiced fruit. Cold cherries crunch between your teeth dribble juice around your tongue while you roll the stone around your mouth cleaning off the last of the fruit meat. Peaches with ginger, peach blackberry, blueberry pie. Sliced and cored apples cooked in red-hot cinnamon sauce on the stove and then chilled before serving on Christmas Eve. On a hot August day, wandering through an orchard and dodging Yellowjackets when picking a beautifully ripe peach off the tree.  Pulling a crisp apple out of winter store in November and tasting what will become cider.

On a more practical level, I also need to make the decision on how much fruit versus how much bulk  laxative? If I eat one piece every days, I'm looking 8+ tablespoons of Metamucil.  bleck.  I'd rather starve myself in  other areas to make room for the delightful sweetness of fruit.

Who said throw fruit out?

I believe you are reading things that aren't there.

I disagree.  without giving a threshold of "bad", your presentation implies that all fructose at any level is bad.  I read some comments as expressing fear or doubt that they were eating too much fruit.  others like me what to know the threshold of bad.

just between you and me, I'd give up living before I gave up fruit.  no joke.  the flavours of fruit are that important to me.  I've already lost enough food ground with diabetes, I'm not giving up any more.

According to Dr. Richard Bernstein, fruit does not have to be a part of a healthy diet. Here is what he says in his book, Diabetes Solution:

"Although eliminating fruit and fruit juices from the diet can initially be a big sacrifice for many of my patients, they usually get use to this rapidly, and they appreciate the effect upon blood sugar control. I haven't eaten fruit in almost forty years and I haven't suffered in any respect. Some people fear that they will lose important nutrients by eliminating fruit, but that shouldn't be a worry. Nutrients found in fruits are also present in the vegetables you can safely eat."

Dr. Bernstein has had T1DM for about 50 years and advocates a very low carb diet to help normalize blood sugars. http://www.diabetes-book.com/

Because of blood sugar problems I have eliminated all sources of HFCS and have greatly limited my fruits. I find I can eat a few berries or a bite or two of other fruits without raising my blood glucose, but I mostly stick with colorful low carb veges.

Dr: Davis -- "Who said throw fruit out? I believe you are reading things that aren't there."

Yet you start this post with a photo of an apple. Although perhaps it wasn't  your intention, it certainly implies that fruit is bad.

National estimates of dietary fructose intake increased from 1977 to 2004 in the United States.
high-fructose corn syrup percentage of sweeteners increased from 16% in 1978 to 42% in 1998
Since 1978, mean daily intakes of added and total fructose increased in all gender and age groups, whereas naturally occurring fructose intake decreased or remained constant.
If you can't get the full text at least read the abstract. The full text has some interesting charts presenting the data more clearly.
It isn't eating naturally sourced fructose from whole fruit driving increased obesity. Increases in fruit consumption are dwarfed by greater increases in total daily energy and carbohydrate intakes.

RE: Comment by Nameless (“Yet you start this post with a photo of an apple. Although perhaps it wasn't your intention, it certainly implies that fruit is bad”)
-------------------------------------------------------------------------------------------

The good doctor is merely demonstrating in effective graphic terms that
too much of a good thing is not good. The numbers (ie gms of fructose)
are important guidelines. There’s no point in getting your nuts in wringer over it!

Bernstein developed Diabetes at age 12. He was born in 1934, so at age 75, he has been diabetic for 63 years. No diabetic complications. Normal blood sugar for all!!

I think its more helpful to express sugar content (and fructose if known) as a percentage rather than an amount per (varying) serve.  It makes it easier to compare apples to apples (scuse pun).  I've prepared a few listings of various food groups (several hundred items in each) on this basis at www.howmuchsugar.com if you are interested.

Some people suffer from fructose malabsorption. One source states that it is found in approximately 30-40% of the population of Central Europe. If one has that condition, then it would be prudent to avoid all fructose, even the fructose found in fruit. I love the taste of fruit, but it is destroying my health due to malabsorption issues. Fortunately, we know that some cultures lived very healthy lives without eating fruit (e.g. Eskimos).

I don't get it. What am I not seeing?

How much high fructose corn syrup is in a serving of the BBQ sauce? How much in a serving of the steak marinade?

You state such figures for a serving of apple (1 medium), and for a serving of honey (2 Tablespoons).

I had to give up fruit to prevent further beta cell damage (above 140 apparently for pre-diabetics, and maybe everyone, I don't know). Fruit and many veggies are toxic to people with glucose intolerance. I had to give up veggies for now, until I can find one that I can tolerate. Cabbage was too hard on my blood sugar. I am slowly trying to figure out what I can eat and how to minimize the glycemic impact. Unfortunately, I might have to damage my beta cells to find out what works. The system told me I was fine, even though I told them I had sugar problems. I gave up on doctors 10 years ago, since they were useless. I finally bought a meter and started testing, and the truth is painful.

In addition, since I have been involved with cardiac CT for now nearly 24 years, the PLC also affords me an opportunity to develop a CT coronary angiography training program for cardiologists and radiologists (www.cardiaccta.us). Together, these new efforts are merely an extension of my interests in prevention, patient care, and teaching.

I dunno, just take the orange wedge out completely and shift the diary rec's to full fat instead of low fat and it would be a pretty good plan!  I notice that they recommend both eggs and beef in the protein section!!!

Hard to justify all those subsidies if you don't recommend eating the product you subsidize.

Pharmacology depends on an unhealthy diet as well.

Now excuse me while I polish my tin foil hat some more.

Saw this and thought of you:
http://www.youtube.com/watch?v=qDYKHduoQ00  Woman 'can't stop eating' cornstarch [NBC: 6-03-2011]

The idea that we should get nutritional advice from the Department of Agriculture should tell everyone the purpose behind the advice is nothing but promoting the increased sell of agricultural products. Now there was a time when that might have been acceptable - say around the 1700's or so - but with the devolution of farming in the US and the bastardization of foods and farmin and farm animals alike - it is akin to buying in big on the eve of the Market Collapse of 1929.

The clue to perpetuating sickness is to oversimplify, never provide details, supply conflicting information incessantly and encourage people to trust the "experts" - most of which haven't a nickels worth of common sense left in their brain account or haven't done a nickels worth of research on a topic.

"The USDA should stay out of the business of offering nutritional advice. They are very bad at it. "

I love it!  I wrote about this today too.  I do think the plate is an improvement over the pyramid.  But I did some tweaking and made my own plate that I like a lot better: http://knitfitter.blogspot.com/2011/06/new-usda-nutrition-plate-and-my.html

"It looks to me like the USDA has not only failed to keep up with the evolution of nutritional thought, but has regressed to something close to advising Americans to go out and buy stocks on the eve of the 1929 depression. "

I agree, this is like the fox guarding the hen house.  There's no way the government should be allowed to advise us on what to eat since the agricultural business segment has such a powerful lobby.   I actually liked this plate, only because it was far better than the food pyramid, which mistakenly emphasized more carbs and less fat.  At least now they have shifted the direction to fewer carbs and more fat.  I think of it as the lesser of evils - so the MyPlate isn't right but it's better than the food pyramid.  I wrote a post on it at http://cravingsugar.net/the-new-food-pyramid-myplate-usda-says-eat-less-carbs-more-fat.php.

I agree that the USDA is bad at it, and that there are powerful interests influencing the message.  For instance, when the last food "pyramid" was unveiled,  advice to avoid sugar that was originally included had been taken out, thanks to the sugar lobby.

On the other hand, there are some well-meaning people involved, trying to get a message out.  They may be misguided in some ways, but not everyone promoting this is corrupt.  With the current obesity epidemic, there's a lot of genuine public health interest in getting a good "message" out about nutrition.  Having worked somewhat in that field, I know the impulse in an earnest one.  

Here's what Pee Wee Herman would call the "Big But": your readers, who can converse intelligently about AGEs and sdLDL are a world apart from *most Americans,* who first must get their hand out of the potato chip bag and their lips off the 64oz value-sized Dr. Pepper.  The USDA, whatever its faults, is trying convey a message that can be understood, and a goal that can be achieved.  

I think messages like "eat a rainbow," "eat your colors," or "fill half your plate with vegetables" are better slogans - partly because I don't think grains and dairy are necessary*, and that improperly prepared grains and all gluten grains are problematic (I take a more nuanced position than Dr. Davis).  But I do think part of the reason the USDA's "plate" is so dumbed-down is that complex messages just don't work in public health.  

(*Though I do feel dairy's necessary for me!)

P.S.  I love how butter and fortified margarine used to be their own food group!

Was wondering if anyone had looked at the effect on farming if everyone switched from wheat and grains? Obviously the effect on the processors, Nabisco, Kellogg's would be disastrous which is why it probably won't happen, but would there be enough, beef, pork, chicken, egg, diary, production to go round?  Could wheat fields be switched over to cattle or rearing or should they produce bio-fuel instead? Arguably we all eat too much so we could just dump the grains portion and maintain existing meat/fish/dairy. But our diet has been somewhat determined by being able to produce enough food for a booming population on a small planet. "Food for thought" anyway.

Hi Paul Lee,
Maybe  global protein needs could be met 100% by converting the grain fields over to growing substrate feed stocks for poultry or iguana meat.  A diet of always only  protein  would  not be  great,  so you need to figure out what  you intend to complete human  nutritional needs with.  Cereal grains are just so convenient  for energy calories that most nations rely on them; they don't need refrigeration,  transport easily and have long storage.

Agribusiness has undoubtedly increased yield and thereby enhanced accessibility and reduced price. But I fear they have also created a house of cards that, in many ways, many be unsustainable or will yield unintended effects.

The painfully familiar food recalls from E. coli or Salmonella contamination that result from factory farming and other mass production practices will inevitably catalyze a return to organic, old-fashioned farming methods with higher prices, a concentration on necessary foods and not "luxury" junk foods.

That sounds like a good thing to me.

Paul raises a crucial point: How do we make the switch to a world without modern high-yield wheat without a cataclysmic shift in economics? I don't know. But it will be much like the gradual shift from mass produced eggs to free-range, organic eggs, just on a much larger scale. It will be a process that won't occur next Tuesday, but hopefully over the next 50+ years. In the meantime, tens of millions of people will unknowingly suffer from consumption of this thing being sold to use called "wheat."

Interesting stuff, and Might-o'chondri-AL, I try and get at least 50% of total calories from fat. Without wanting to drift OT,  I don't know whether you have seen this news in the States there has been major problems with German grown (organic) vegatables (cucumbers, tomato's etc) with E.coli (Spanish veg was blamed at first). Literally thousands of tons of veg are being dumped. Salad is certainly off the menu in Europe this week!

"The painfully familiar food recalls from E. coli or Salmonella contamination that result from factory farming and other mass production practices will inevitably catalyze a return to organic, old-fashioned farming methods with higher prices, a concentration on necessary foods and not “luxury” junk foods."

I am loving this! I hope this becomes the reality-- sooner the better.

It's bad that the government is wrong, but the media multiplies it many times over by parroting these guidelines to public. For example, the US News Diet Rankings:

http://health.usnews.com/best-diet/best-overall-diets

Some of my comments on my blog:

http://health.usnews.com/best-diet/best-overall-diets

My advice: The USDA should stay out of the business of offering nutritional advice. They are very bad at it. They also have too many hidden motives to be a reliable source of unbiased information.

I don't think they will stop offering advice since so many people seek guidance.
Your advice should be:  Ignore the nutritional advace offered by the USDA.  It is very bad advice because they have too many hidden motives to be a reliable source of unbiased information.  Seek nutritional advice from more reliable sources.

Unfortunately, how do we know which sources are reliable?  Vegetarianism makes sense.  What do they have to say?

I think the grain section should be dumped entirely and fruit section should a sliver at best or there should be some mention that those with blood sugar issues may want to greatly reduce ALL fruit.  I find that the tolerance to fruit is highly individual.  Since I lowcarb and my fasting sugars are usually mid 80s unless I've had an unusually large late night meal in which case it can be mid 90s -- I was shocked to see what the allegedly lower sugar fruits such as raspberries and blackberries (both high fiber too) are really doing to my sugar since I started self testing.  I am beginning to think that with my genetics and age, even the so-called healthy berries can be the devil.

I am 5'2.5" and weighed 107.5 this morning.  I'm in my late 40s and only medication is armour/cytomel for hypothyroid.  Both parents and only sibling are type 2s -- dad was a slender type 2.  Ex: This morning fasting sugar was 86.  I had a black coffee and skipped breakfast and went on a long brisk walk (1.25 hour) in the heat.  At brunch at 1:00PM consisting of 3 soft boiled pastured eggs; a few ounces (2 or so) of leftover grassfed ribeye; 6 olives (I sweated a lot outside and needed more salt despite salting eggs and steak-- I eat no processed food except canned sardines and find I need extra salt sweating in hot sun or I get extremely weak, very low blood pressure etc); and now for the grand mistake -- 1 cup of mixed blackberries/raspberries.  I took my sugar 15 minutes later and it was 128; 15 minutes later; 138; 15 minutes later 123; 15 minutes later 118 etc

I have eaten similar to the above meal minus fruit but adding large amounts of raw freshly shelled hazelnuts and my blood sugar will not spike anywhere near 138 despite adding several hundred more calories.  I've even checked numerous hours later to see if there is a late spike and while the highest point does take longer with large meal containing big amounts of nuts (slow digestion) and no spike -- a slow steady rise generally never going over 115 and coming back down over the next few hours.  

So fruit sugars can be the devil for some of us and given the diabetes epidemic -- I think the fruit wedge should be much much smaller or come with a caveat.  Or better yet, given the disasterous history of government dietary recommendations, perhaps the government should stay out of our kitchens entirely.

"But small LDL is so ubiquitous, not addressed by conventional strategies like statin drugs or fat restriction (it is made worse, in fact, but reducing fat in the diet)"

Just to be clear about the above quote. You say "it is made worse, in fact, but reducing fat." Did you mean "by" reducing fat?

Also, if that is the case, is that because of the fat itself or because less fat means replacing it with carbs?

In addition to CETP inhibition, some other benefits of red/blue/purple foods (that also include polyphenols other than the anthocyanins - elligitanins, etc) include:

1) inhibition of amylase - less of a blood sugar spike after eating starchy foods, less aberrant glycation and AGEs.
http://www.ncbi.nlm.nih.gov/pubmed/15796622

2) Estrogenic activity - anthocyanin stimulates the beta-estrogen receptors in blood vessels and bone, not much activity in the alpha receptors in breast, uterus.
http://www.ncbi.nlm.nih.gov/pubmed/20049322

3) Phosphodiesterase inhibition!
http://www.ncbi.nlm.nih.gov/pubmed/15769121

I was surprised that Ron Krauss, who did a lot of research on small particle LDL and recently published a mega-study supposedly showing saturated fat is unrelated to heart disease, made these comments in a recent interview:

People should limit saturated fat to 10% of their diet, though some can get away with more.

Optimal carbs intake: 35 to 40%.

People used to get heart disease from high cholesterol, but now its mainly high carbs.

The interview is here, and those ideas are toward the end:

http://www.meandmydiabetes.com/2010/03/26/ldl-cholesterol-ron-krauss-md/

I would love to know if you have any comment.

This is worth knowing about! Low cost (relatively) lab tests without needing a doc visit/prescription

https://summitcountymedicalsociety.prepaidlab.com/

All tests performed by LabCorp

sometimes it comes down to our health being all about our genetics. As a result of the recomendations of this blog with regard to wheat and sugar elimination, normalizing vitamin D i have taken down my LDL from 1810, all small to 609 of which 346 are small; i can only lower my particles with statins- diet alone will not do it.  My understanding of the research is that at low levels, size does not matter. I will note that when my particles were sky high i thought i was follwoing a very healthy low fat, grain oriented diet.  Now, i eat now grains and have a fair amount of mono fats from avocado and olive oil, some sat fat from lean meats, poultry and eggs, and hope i have minimized the progression of artery plaque that shocked me when i found out i had it when i followed healthy heart diet, exercise and maintained a very lean body weight.  Gentics are tough to overcome, but the risks can be minimzed via diet and meds.

Different segments of the same carotid artery can apparently be affected by a different gene. Each segment is itself susceptable to different pathological processes, like shear rate of the near inner arterial wall. Artherosclerosis at different arterial segments seem to predict if pathological event will be ischemic stroke or myocardial infarction.

The North Manhattan Study tried to tweak 145 genes modulated by 702 single nucleotide polymorphisms. That study and the San Antonio, Erasmo Rucphen and Framingham have led to opinions that 30% to 60% of the thickness of the carotid artery's intima-media is geneticly inherited. Then for carotid plaque +/- 28% is passed on geneticly.

Sex of the individual and racial ethnicity are other genetic variables. Doc Davis' clinical observation is telling us something equally important about small LDL's genetic variation.

Is small LDL the "VLDL" on blood results?

Hi, Tommy--

Yes, indeed. Just a typo.

Probably both.

Hi, Jonathan--

Excellent! Yes, the conversation surrounding anthocyanins is becoming increasingly interesting.



Hi, Peter--

I don't personally know Ron Krauss, but I too have been puzzled by the fact that his public comments don't seem to reflect his research findings. If he were to echo the important findings of his research, he would indeed be a low-carb, high-fat advocate.

Steve--

Wonderful results! The diet approach works, no doubt about it.


Hi, Ryan--

No, two different things.

Hello Dr.Davis,
Your comments sound very similar to Dr Ray Strand...do you read his work? If not, I think you would enjoy his thoughts. His website is www.drraystrand.com
Cheers,
Sue in BC Canada

Question for all you Small Particle techies out there.  Always had "Good" lipid panels, even though overweight and borderline type 2 under control with a low carb diet.

Numbers usually average:
Total Cholesterol 125
LDL  65
HDL  45
Tri  90  

Just got first particle size test done, results in VAP format:  

LDL-1 3
LDL-2 0
LDL-3(B) 36
LDL-4(B) 34

I know particle size goes down as the LDL- number goes up, but how do these numbers translate to the NMR numbers Dr. Davis listed as a target for those of us genetically pre-disposed to pattern B LDL?

^I'm interested in the same thing

Brent,

Your small LDL makes up 96% of your total LDL particles. This is a severe pattern.

Also, your HDL is too low and your triglycerides are a tad too high. Dr. Davis' Track Your Plaque goal of 60-60-60 is a good rule of thumb. LDL down to 60, HDL up to 60, trigs down to 60.

If you're currently following a low-carb diet and still have all of this small LDL, your small LDL pattern is probably the genetic type that Dr. Davis talks about here.

David

ThatÂ’s not just logic. ThatÂ’s ralley sensible.

IJWTS wow! Why can't I think of thnigs like that?

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While I certainly enjoyed your book and am extremely grateful for your generous sharing in your daily blog, I am very troubled by this blog entry. Over the last day I have been thinking quite a lot about it off and on, and that would be because I have three stents implanted; two Cypher and one Taxus.

Since my dates in the hospital cath lab in early 2004 I have been following along with TYP principles carefully with the hope of being additional plaque neutral or even a bit of regression, but I see from this entry my hopes might be dashed.

Your statement in the blog entry "I've seen this phenomenon several times now", does this mean it happens most always, or sometimes, or occasionally? What is the game plan now for these patients? Do they (or did) have any similarities that might be contributing to their plaque growth (LPa, diabetes, vit. D, BMI, gender, etc), or are their lipoproteins and assays corrected to perfection?

Thanks again for all that you do, your program and willingness to share is unique and very special to many of us. If you could follow up sometime on this situation with a future blog entry or observations, I would be most appreciative.

With concern,

Neil

Neil--
All this means is that the presence of a stent may modify the potential for reversal ONLY IN THE VICINITY OF THE STENT. Other areas, meaning the majority of your other arteries' lengths, are still subject to your control and the benefits of your prevention program.

Keep in mind that this is an experience involving just a handful of patients. To my knowledge, there are no formal published experiences like this to compare to. All patients had their patterns corrected to perfection by Track Your Plaque standards and don't seem to be distinguished by any one single lipoprotein pattern.

My "gut sense" is that the sort of plaque growth that we see around stents and tracked by heart scanning does not carry the same implications that non-stent associated plaque does.

I just found your site recently and have been reading through the posts.  I find it very educational.  Thanks!  

I'm curious.  Were the stents medicated stents (since it is my understanding that they prevent this kind of thing)?

Actually one can eat Ezekial Bread, which is a brand name for an excellent form of sprouted grain bread. The grain is sprouted, then milled; unlike regular flour breads which mill the seed.

This method of making bread is mentioned in the Bible. Also mentioned in the Bible is Olive Leaf which is an excellent anti-oxidant and anti-pathogenic herb. I used it recently to treat an eye sty. I took the Olive Leaf capsules internally.

Well, I've heard of some, diabetics all I think, who have had a cath done and ended up with stents simply because they are diabetic.  No symptoms, just high cholesterol and diabetic.  

I know one woman who has 2 50% blockages and has been told she needs a bypass ASAP....and completely asymptomatic. (her's was diagnosed by ultrasound, external ultrasound too, does that sound right? can they see that degree of detail?)

Hi, Cindy--

No, ultrasound cannot visualize coronary arteries. But they can visualize the left ventricle. Perhaps she had an abnormal left ventricle that provided presumptive evidence of poor flow. But that's just my guess.

This post reminds me of how trusting people can be with hospitals and magazine articles, even when they suspect something might be wrong.  

When it comes to investments it always amazes me how people can trust strangers to invest their hard earned money.  A person might read a magazine article about a "hot investment", or maybe a stock broker mentions the companies latest recommendations from their company "research experts".  And without much thought and no research of their own people will happily hand over cash with out really knowing what investment they are buying into.    

It is a different reaction if a stranger off the street came to you and said he/she knows of a fantastic investment you should buy into.  If that happened, you would naturally be cautious.  If you did not dismiss the stranger outright, you would ask questions, want to know what kind of success the stranger had in the past, details about the investment, and what was their definition of success?  

I've been talking with a lady who's husband has heart disease.  She learned of my heart healthy diet and felt a need to give me her negative unsolicited thoughts.  She reads magazines and tells me of the latest procedures or drug possibilities being developed.  She does not think highly of her husbands doctors. Up until the other day I had not heard her say a kind word about any doctor.  "They don't know what they are doing!" she would tell me.  I told her about TYP and the great information she could learn from the web sight,and the success many are having with reversing heart disease, but TYP did not interest her.  Her doctor had not told her of CT scans, lipoprotien testing.  Even learning from me about heart healthy supplements and diet held little to no interest for her.          

The other morning she told me her husband had a check-up and the doctor told him he was doing "fantastic".  I nodded and said that was great, I hope he has continued success.  I walked away thinking what I really wanted to say - why do you still trust so much?  Did you ask for your husbands doctors definition of fantastic?  Is it fantastic because he has enriched the hospital with procedure after procedure?

Yes. Well said.

As you point out, most people regard the absence of symptoms the same as health. Of course, that's not even close to the truth.

The emerging phenomenon of self-empowerment in health will make for great confusion as well as great opportunity.

Dr. Davis,

A little bit off the main thread, but what do you think are the chances of having completely clear coronary vessels if you have a heart scan score of zero?

Thomas--

The chances are excellent. The likelihood of uncalcified plaque and the risk of coronary events like heart attack is exceptionally low.

There are exceptions when symptoms are present or certain forms of lipid (cholesterol) abnormalities are present, but they are indeed exceptional. Please read the Track Your Plaque Special Report, What if my heart scan score is zero?

Sad but its all about the money now. After my 3rd visit to er room last dec 04 I had them unplug me and walked slowly out of the cath lab...Dr. said I needed bypasses etc., but I refused...plus the 10,000 for all the drugs was a bit much...3 bags of morphine was the cheapest........read your book after scan and have been doing good so far so guess 2 of the 4 stents from 03/1999 are not blocking anymore plus nitro use is way down now going into the 4th yr.

Was going to make appt. but with the weather so bad I'm just staying put and reading all this stuff. Would like to say my BP is lower now that am low carbing and no atenolol or altace needed so what you eat does make a big difference.

Hope you keep this site going as its really helping me a lot. I'm so far keeping the right neck flowing at 50% after operation, the left still no flow and not operatable now. Good luck and keep the info coming....Roaming

You'd say with all these claims it should be doable to prove or disprove scientifically. Why is there so much controversy around food?

Hi Dr. Davis,
      I want to thank you for educating me about lipid profiles and think the following data might show readers  how some of your ideas play out (all varied experimentation coincided with a daily high protein intake).

  Jan. 2011 1st ever NMR lipo-protein analysis was done after  4 months of  consistent home food prep of pretty low fat (only olive oil  and 1 tablespoon coconut oil daily) but plenty of whole wheat and  half  potatoes:
* LDL # of particles (P) = 1,676 in nmol/L------------being a LDL cholesterol (C) reading of 139 mg/dL
* small LDL  # P           = 1,021 nmol/L   ---------------yikes! you advise smLDL be less than 117 nmol/L
* HDL # of particles      =      28.8 umol/L --------------being a HDL C reading of 45 mg/dL
* Triglycerides               =      90 mg/dL     -------------- true,  I never struggled with my weight

(B) May 2011 2nd NMR after another 4 months but added in more fat (1 teaspoon highly concentrated fish oil daily, 90% chocolate, handfulls of nuts, more olive oil and kept coconut oil at 1 tablespoon daily for a controlled experiment), added 500 mg Niacin 3 times a day (in stages up to1,500 mg. total daily), 6000 IU daily vitamin D, deliberately cut out all grains except for social politeness  and substituted in daily Koji fermented brown rice (rustic Amazake):
** LDL # P...............=   976 nmol/L -------------------------------- being LDL C of 100 mg/dL
** small LDL # P .... =     96 nmol/L -------------------------------- nice surprise
** HDL # P ............ =     27.3 umol/L ------------------------------being an increase to  HDL C of 64 mg/dL
** Triglycerides ......  =    42 mg/dL -------------------------------- despite daily carbs over 150 gr. daily

(C) Dec. 2011 3rd NMR after another 7 more months thinking Doc's advice is worthwhile I added in yet more fat (mainly daily 2 tablespoons of coconut oil, more 90% chocolate), bumped Niacin up to 1,000 mg twice a day (2,000 mg. total daily), cut out the Amazake, kept up the vitamin D adding daily vitamin K & daily ate main mid-day meal out as lunch on spicy Thai & Chinese fish/shrimp/soup/rice meals (my next control):
*** LDL # P .......... = 764 nmol/L ---------------       being LDL C of 107 mg/dL  ( 2x coconut's  saturated fat)
***small LDL # P... = less than 90 nmol/L --------surprised me NMR can't count lower
***HDL # P .........   =   41.4 umol/L -------------------- being an increase to HDL C of 88 mg/dL
*** Triglycerides ....=  43 mg/dL -------------------     daily carbs below ~ 120 gr.  &  lost  too much weight

Dr John McDougall is coming out with a new book called "the Starch Solution" which advocates  NO fat and Little protein and eating a minimum of 900 grams of starch each day.  In the 80's he had a local call in talk radio program and I remember callers saying they followed the diet religiously but their triglycerides were sky high. He would tell these callers to stop eating fruit. Not much left when you can't have fat, much protein, or fruit.  He'd also tell callers that giving your child cow's milk guaranteed them to have diabetes and advocated sweetened rice milk instead.

I'd love to see a well-designed study comparing your approaches.  Just don't ask me to be a test subject for his approach.

I find that I garner all the benefits you list from following this dietary approach with the exception of one -- better sleep.  When I reduce my carbohydrate count, my energy soars and I suffer from terrible insomnia.  I have read that your body adjusts in, but I have not found this to be the case personally.  After 10 days of little sleep, I do notice that my fasting blood sugars are up 10-15 points and concentration starts to suffer (as well as patience).

Do you have any suggestions for battling low-carb induced insomnia?  If I raise my carbs above 100, my sleep improves, but weight loss ceases (I still have more weight to lose) and blood sugar creeps a little.  I have tried herb teas and melatonin without success.

Thanks for all you do!

Dr. Davis, I'm curious what you make of the research showing big inconsistencies in reported LDL particle size between the various advanced lipoprotein analysis techniques. VAP, for example, apparently reports far fewer people as Pattern A than NMR, GGE, or TGE. Even measured LDL-C seems to vary quite a lot between the techniques.

This seems to call into question the usefulness of such testing, since the results seem to depend mostly on which methodology happens to be chosen. Here's one example that has full text publicly available:

http://www.clinchem.org/content/52/9/1722.full#_jmp0_

Can you comment on "Forks Over Knives"?

Dr. Davis,

My husband, a patient of yours, has been following the no wheat diet for around 2 months. He also has been limiting his  carbohydrates to around 15 grams per meal.  He runs around 20 miles a week plus bikes around 30 miles a week. He has lost around 20 pounds in the last 2 months. He started at around 160 pounds..... I think he has lost way too much weight for his 6 foot frame. He says, he's just following your guidelines.

Shouldn't athletes take in more carbohydrates than 15 grams per meal?

Jackie

JC, Dr. Davis can speak for himself; however, if you are looking for a good critique/review of Forks Over Knives, I would recommend this one by Denise Minger:
http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/

Jackie, that gives your husband a BMI of 21.9, well within the "normal" range of 18.5 - 24.9.
Your husband has transformed into a fat burner, and if he's able to continue working out at his current pace, I wouldn't worry about it.  But if he's lost muscle mass, or feels lethargic, he should probably up the carbs a bit, and the protein (perhaps a protein shake, post workouts?).

A lot of people would love to have your husband's "problem."

Mitochondrial
Congratulations!
There are alot of us at Track Your Plaque who are great fans of yours. Wish you would join us.

Having taken the same low-carb route and seen all the benefits Dr Davis lists here, I too had good sleep as my remaining frontier. I found the blog of Dr Kruse (http://jackkruse.com) a great addition to Dr Davis's program and a terrific education resource. Please read his sleep-related posts (http://jackkruse.com/category/sleep/) and all the rest for that matter, as all are related. I find it amazing how well these two view points (Dr Davis's and Dr Kruse's) agree. I made these steps to see my sleep improve dramatically: do not eat or exercise after 7:30pm, take a hot shower before bed, go to bed early enough to allow 7.5 hrs to sleep, wear an eye mask during sleep to ensure total darkness, take a capsule of lemon balm herb (Melissa) before bedtime.

I get a BMI of 19. On the website that I put in the calculations  it says he is "underweight".

And at the same time, the general public can read this: http://www.webmd.com/diet/news/20120104/report-looks-at-best-diets-easiest-to-follow. No comments...

Jackie, I think I misread your message. I thought he was currently 160 pounds, and apparently he's lost 20 of those pounds, right? If so, this BMI calculator still has him within the "normal" range.

http://www.cdc.gov/healthyweight/assessing/bmi/

    Underweight = <18.5
    Normal weight = 18.5–24.9
    Overweight = 25–29.9
    Obesity = BMI of 30 or greater

Anyway, I'd say he's just fine, with the same caveats.  That is, if he's lost muscle mass, eat more protein (especially protein shakes after each workout), and maybe up the carbs a bit if he's feeling weak in any way. I ran the numbers on several other web sites (Mayo Clinic and NIH) and they all say the same. He's within the "normal" range, but just barely.

Stephanie,  I found that low carb gave me better sleep except when I took some supplements, etc, at bed time.  Don't know what you are taking, but I found that D3 at night kept me up and recently a new formulation of glucosamine (sp?) did the same (can't figure out what is causing that).  Soo, if you are taking anything in the late afternoon or evening, you might want to experiment and see if taking them earlier helps... Check Seth Roberts for info on D3 scheduling.

Hi Jackie,
I'm with you on 160 lbs. for 6 footer is too scrawny if the person is healthy . That is also my situation (being  6 feet tall)  if I go  low carb of  (say) fewer than 100 grams carbs daily .There is no current science that  adults being real thin is better than being heavier - just the opposite.
When I get scrawny there's muscle, but my capacity for day in and day out sustained life style physical exertion is (in my 60 year old body) less than when I weigh more. And a day or two of  missing a good meal & exceptional stress
or exertion can cause notable dip in weight when I'm eating very low carb.
Doc has your husband as his  patient,  so there may be other considerations they are considering. I don't wish to confuse BMI with crucial medical goals they are working on. So am speaking of my own monitoring and my lab results (detailed above) are not necessarily what other slim individuals would see.
I have not tried a months long protracted experiment of  gorging on more dietary fat as an alternative to my eating moderate daily carbs (say,  over 100 grams). Handfuls and handfuls of nuts don't seem to promptly boost me back towards 165 lbs. like augmenting with moderate carbs does.

Stephanie, have you tried Magnesium citrate about an hour before going to bed?  It tends to relax you and help you sleep and it doesn't hurt--Magnesium is one of the one of the things we tend to lose on low carb. I take it to prevent leg cramps and it also helps me get to sleep.

JC, Here is an excellent commentary on Forks over Knives: http://rawfoodsos.com/2011/09/22/forks-over-knives-is-the-science-legit-a-review-and-critique/ I'm sure Dr. Davis will concur with her analysis, though I will let him speak for himself on that.  However, in the mean time, if you haven't checked it out, Denise Minger does a great job of dissecting it.

All I can do is sputter, sputter, sputter.  Talk about ridiculous!  The "diabetes diet" will ensure that a person stays diabetic and dependent on medication.  The "most heart healthy diets" will more than likely cause heart disease rather than prevent it.   The DASH diet also ensures that a person maintains high blood pressure and dependent on medication.  Awful.  But you're right--that's what the general public sees and believes.  Makes me wonder if there is hope.

For Iconnolly & others,
Doc  has everyone confused why he clinically finds wheat elimination more dramatic on gut fat than just restricting carbs. He decries modern dwarf wheat, yet not all genetic confabulations will have the same lectin protein structure, so this is details how some may play roles in adipose tissue changes. When a lectin has a molecular structure where their folded protein's usual strands coil like a loop, instead of just being strands, then what occupies the loop's center becomes important.

If the peptide (protein building block) variation has an arginine amino acid leading that lectin's loop it can be a problem. That arginine torques the loop, makes it more flexible overall and gets where it is not supposed to be. It, this type of lectin variation, can itself be used in a pro-inflammatory way. It should be understood this lectin doesn't so much evilly abuse what it touched on the adipose cell as be acting more like a thing (substrate) involved in co-activation.

Vascular adhesion protein 1 (VAP1) has a lesser known function as an enzyme (VAP1 = semi-carbazide sensitive amine oxidase) and it comes to the surface of adipocytes when there are immunological molecular action. Doc talks about belly fat being prone to inflammatory modulation and obese adipose cells can have macrophages crusting them. (The role of  vascular endothelium VAP1 is not discussed here.)

On the adipocyte it's VAP1 (a folded glyco-protein molecule) is configured in a way that it's enzymatic function part is down a channel like groove with a leucine amino poking in that pathway sort of  like a goalie. This goalie leucine (Leu469 position) keeps random triggers from getting past it to tag upto where the actual VAP1 activation spot is and provoke stray responses.

Franken-wheat, as per Doc's opinion,  with an arginine looped lectin can torque/slip past that VAP1 leucine goalie &  get to dock. If the genetic wheat leads with another amino at a lectin loop then it usually (can't say never, since maybe there is a rare amino lectin loop able to dock) basicly won't be able to navigate past the VAP1's  leu469 and engage catalytic action. And, looking at the other end,  there are likely individuals whose VAP1 engender a variation other than leu469 in the goalie placement that actually is less selective and lets some lectins without an arginine led loop slip down the alley to dock  and engage.Thus different world wide batchs of wheat and individual adipose tissue surface responses to lectins in general can vary, as we see.

Once the franken-lectin with arginine docks into the adipose VAP1's activation center the enzyme  uses that lectin to perform a function. The vulnerable NH2 group of that lectin's arginine amino binds to that VAP1's  molecule called topa-quinone. Then a transitional enzymatic driven state (Schiff base) occurs and, as the Schiff base is not permanent, it segues into a kind of half way oxidation phase (for geeks the VAP1 amine oxidase oxidized the arginine's amine into an aldehyde with a byproduct of hydrogen peroxide, & some ammonium).

Here, as a consequence of that modified oxidative change over, hydrogen peroxide (H2O2) is put out on the apidocyte cell in a generally speaking small amount. H2O2 is reactive but, it should be remembered,  also a signaling molecule in it's own right. Individual adipocyte conditions will dictate how some react and being gaseous H2O2 can penetrate cells and diffuse to play out it's roles . In general, H2O2  produced by enzymes outside/on the cell (as opposed to H2O2 generated inside cell cytosols or cell mitochondria) alters conditions setting things up for even more local immunological activity (most understand VAP1's classical adhesion function is to snag immune cell's rolling by in the circulation so they can get into a cell that is imperiled and use H2O2 to innately kill infectious agents).

If one eats franken-wheat  with a lectin arginine loop and one's VAP1 leu469 gate-keeper is in place (to let it by) you still aren't absolutely doomed to an auto-immune like assault with  reactive H2O2 plaguing your adipose tissue. An unusual genetic quirk down in the  VAP1's enzyme activation site can have a variation of  the usual tyrosine amino in the 471 position (tyrosine471). Without tyrosine471 in the enzymatic well then no topa-quinone is made from  tyrosine and then instead the franken-lectin loop's arginine will just meet up with a phenylalanine molecule instead. And,  conveniently nice for those without topa-quinone down there in that VAP1 enzymatic site no Schiff reaction even starts to go forward &  so no H2O2 on the outside of  that adipose cell instigates the pro-inflammatory circumstances Doc traces back to wheat .

Might-O-Al:
You said you take no meds, but Niacin at the doses you take would be viewed as a  med, and sexert powerful influence on lipids  in lowering them, and affecting the size of LDL particles.  It also increases the HDL.  I think you experienced all of this, so how much is from carb restriction vs

Dr Davis:  From my reading it seems unclear that when you lower LDL particle count to say 800 or below, how important the mix is between large and small particles.  I believe this is even stated on the NMR report: "Small LDL-P and LDL size are associated with CVD risk, but not after LDL-P is taken into account".  I believe the writings of many lipidologists seems to say that at low levels of LDL Particles in line with your recommendations, the mix of small and large is not important.
Might you elaborate on this?

Thanks,

Hi Steve,
I don't think I am eating "low" carb - just not a naturally thin person eating unlimited carbs. In fact Doc, a fan of "very" low carb, seems to have been very tolerant of me here when elaborate any  contrarian comments.  I probably simply don't over-eat for my activity level.
I did try Doc's suggestion to use the finger stick  home blood glucose meter to test how different carb amounts I was including in some of my experimental meals played out. And , putting  credence to his admonition about post prandial glucose "excursions" (spike), reduced some of my core meals' total carbs .
In those examined daily staple meals (or thin me specifically)  I generally found I felt fine with the reduced carbs and the post prandial blood glucose tests examined at 15 minute intervals showed a more modulated excursion. But when I tried to go with very low carb (15 gr./meal) or even low carb (maybe barely 100 gr. daily) I became gaunt  (so apparently my  hold steady weight/strength is closer to  120 gr. carbs daily).
I wanted last trial months to be less about precise control in home eating and more to see if modest dining out in the world (I usually work overseas & NMR test not available)  would adversely affect my lipo-protein fractions that Doc's other protocols (fish oil, niacin, vit. D, skip wheat) had started improving. I settled on cheap daily oriental restaurant lunch since cup of rice & fish/veggie cooked in vegetable oil  (with some sugared spice) is pretty much the best I have available to eat in developing countries.
Agreed, that daily niacin of 2,000 mg is a self-dosing amount & yet is in Doc's upper range for unsupervised use (another practice I thank him for showing me here). To orientate any readers I'd like to be clear that  this is not to say I am blindly recommending such a high dosage.
After 4 months on 1,500 mg. daily niacin I deliberately had some liver enzyme tests, SGOT (a.k.a. AST) & SGPT (a.k.a ALT), to make sure  I was not provoking unknown damage. When  taking 1,500 mg. daily niacin my  SGOT = 20 Iu/L (ideal = less than 40) & SGPT = 17 (ideal less than 55) makes me feel confident that the last 7 months of  taking 2,000 mg. daily niacin has also been safe, for me.

@ Might: "There is no current science that adults being real thin is better than being heavier – just the opposite."

Please define "real thin" and "heavier" and "gaunt" in clinically relevant terms.

The BMI, while not perfect, provides a pretty good baseline.  In fact, the original studies included smokers (and artificially thin), which biased the results (of course smokers will have a higher mortality rate!) against the low side of "normal."

"I’m with you on 160 lbs. for 6 footer is too scrawny if the person is healthy"

I just don't understand a comment like that., Might.  If a person is, by definition, healthy, how or why can he be "too scrawny"?  By what measure?

Hi Might-o'chondri-AL,
You must have a great job, I cannot afford the NMR so frequently. If you found a cheaper way to get that done, let us know ;)

Might O Al:
Thanks for your detailed response.  Sounds like you have things under control.  How large are your LDL particles?  For me, mine seem to run on the low side- at 20.6 per NMR and without  very large carb restriction i generate lots of small LDL whether on low or high carb.  Not sure what is going on with the liver or the metabolic issue i might have.  Normal weight at 144 at 5'6", normal thyroid, D, so with a family history of CAD I take a statin and Zetia to control the level of my LDL particles which at last count were 560, but small of 400 with TRGS of only 52.   HDL of 55.  and HDL particles of 35.  Maybe a bit more fat will help the profile.

From some of what i have read, as LDL particles get to a low level, size does not seem to matter. That is at least to Dr. Dayspring and others.
Regards,

I originally posted this question in the wrong place.  I know that low carb diets benefit all genotypes, but I've read that APOE 3/4's also need to consume LOW fat diets to lower their heart disease risk (as opposed to moderate fat diets for other genotypes).  Do you agree?

Hi Steve,
I am not a clinician & since seem endowed with good health  my concerns are different than Doc's patients. People here should remember this is Dr. Davis' blog & he has the cachet to give advice about real medical problems.
As I've aged there are  physical changes I can detect and some research tells me are silently common. As a  6 foot 136 lb. high school wrestler I hit the mats as  "wiry". At 60, if  my 32 inch waist pants slip, I know  poolside that I look  like a "scrawny" old grey head instead of robustly fit.  
My work in developing countries show(ed) me I was naturally like the under-privileged locals -  real thin on adequate food intake while working hard.  With age comes vulnerability, so without any body mass reserve (to draw down on) a whip thin "healthy" older person who develops an alarming health problem may (without competent intervention) have to catabolize their muscles for converting into survival energy ; the only thing is, that the aged (unlike the young) are also prone to sarcopenia (muscle loss) .
I think all can see modern longevity is excellent,  and yet many are even overweight. A 2011 Cordoba Argentina study suggests their older overweight  women had better cognitive function than matched ones with normal BMI . Another  fairly recent report says that older overweight African-american women are more satisfied with their quality of life than matched American females of all  races.
Doc told us he knows  tri-athalon  competitors who can't train to their satisfaction eating low carb. They would be good models for "health", but apparently they want some reserve -  for at least the upper body strength (all muscle isn't identical) .
Sorry no precise numbers/definitions were given. If my shaving mirror shows a a tight face hinting at the underlying bones  then I'll eventually weigh myself.  When I get a couple of lbs. back over 160 lbs. I  see some softness in my face, stop looking like am  malnourished & seem to get less easily tapped out using my upper body muscles when life demands it.

Hi Jim,
$70 NMR online script, your local ( most states legal) blood draw service via iNeedLabs dot com -  not financialy associated. Doc's theories intrigued me .... Since usually am somewhat out in the bush, with rustic medical care, I decided to repeatedly cough up the test money when 1st NMR showed I was way off Doc's mark. I've an abysmal familial cardio-vascular  history that I'd already beat & now feel have a demonstrably (NMR tested) better protocol.

Hi Steve,
1st NMR (low fat, unmonitored carbs) LDL size = 20.6 (size)
2nd NMR (up fat, mostly rice, less carbs) LDL "  = 21.1
3rd NMR (more fat, more niacin, + carbs ) LDL" =   21.3
(lab calls LDL size of  20.6 to 23 as "large" - so mine got  bigger).

I don't know if what the doctor you mention is valid. Some investigators contend when LDL gets down to around 60 mg/dL (in that traditional measurement scheme) the conditions are such that LDL can (will?)  be drawn back out  from within the vascular wall intima; and so there is a  mitigation of the amount of cholesterol in that plaque. Maybe this is what Dr. Dayspring is alluding to & presumably the logic would follow that this reduces risk factor ; making LDL cholesterol particle size  irrelevant because even if it is smLDL & prone to cause problems it won't get to accumulate where it shouldn't to the degree it can cause real damage.
I am not declaring the preceding to be a relevant fact, and have additional issues in light of the following nuance. A  Cochran Group (2009?) independent meta-analysis of years of statin research indcates  that although statins are demonstrably useful helping those who already have had a cardio-vascular event (and survived) the same statins are not statistically proving to prevent someone from having their first cardio-vascular crisis.
Ideally Doc will address whether LDL particle size can be irrelevant & when.
  .

It is the ketosis that gives me insomnia.  My supplements have been steady for a couple of years and my regimine includes magnesium citrate and citramate.  Does anyone else experience insomnia when in ketosis?  If so, have you found a way to combat it?

I really wish this would be addressed in more blog posts.  I will be getting my ApoE results in a few weeks and am highly confident I am not 3/3.   Possibly even 2/4.  Yikes!

You can find previous posts on this topic here: http://www.trackyourplaque.com/blog/category/apoprotein-e.

Stephanie, my personal experience is you do not have to be in ketosis to lose weight. Sure, it happens more slowly than while in ketosis, but it does happen. That is, if you keep your carbs between 50 and 100 grams a day (fiber included). What exactly do you mean by "weight loss ceases" - how many pounds do you have to lose and for how long have you plateaued? If it has been less than a month or two since you last saw any weight loss, I don't think you have any reasons to worry just yet. Give your body time to adjust. And maybe start exercising too - try high-intensity interval training and body weight exercises or weight lifting.

"As a 6 foot 136 lb. high school wrestler I hit the mats as “wiry”. At 60, if my 32 inch waist pants slip, I know poolside that I look like a “scrawny” old grey head instead of robustly fit."

Again, Might, you seem more concerned with appearance than with health or fitness. Which, of course, you're entitled to do. And so is Jackie. She thinks her husband looks better with 20 more pounds on his frame. Even though he is within the "normal" or "ideal" BMI range, a useful measure of overall health and mortality. That's a good place to be, in my opinion. So I don't see any reason for being concerned about it, which she seems to be (I could be wrong about that, too).

And if you feel that you look better at the pool with a few more pounds on your own frame, by all means, go for it!

PS: Just putting a few more pounds (especially if they're just pounds of fat) on your frame won't necessarily keep you from getting "tapped out" when using your upper body muscles, but lifting more weights, more frequently, will.

PPS: I'd really like to see that study that says African American women are more satisfied with their quality of life than others. It just doesn't compute. Neither does the Cordoba Study, which is refuted by dozens of similar studies.

I'm sorry, you say that if you up your carbs to 100/day, the sleeping problem resolves, but weight loss stops. I think you can try to stick with 100, perhaps up to 120, give yourself time and see if things improve. Many people can lose weight while eating between 100 and 150 g/day.

Hi Joe,
J. Zilberman, MD, Instituto Cardiovascular de Buenos Aires, Argentina studied 300 post-menopausal Córdoba women, with 52.6 % having obese BMI,  administered Boston Abbreviated Test & Mini-Mental Statement Examination" to  put forth findings "Association Between Menopause, Obesity, and Cognitive Impairment" at Oct. 2011 U. Mississippi conference "Physiology of Cardiovascular Disease: Gender Disparities"  hosted by University of Mississippi  relating that, in +/- 60 year old females those having more BMI correlated with more cognition - including the stipulation that waist width due to obesity (in other words adjusting for limitations of using BMI) postitively, meaning yes in a good way, correlated  with over all cognition. The researchers only speculate the cause of  this female cognitive benefit is because fat holds estrogen ,and so the more fat the more post-menopausal estrogen availability to allay impairment.

To be clear I am definitely not trying to imply overweight African-american women will have ideal physiological health, yet mental ease has it's benefits for quality of life. If you look at Japan health research you will also find categories beyond raw number measurements. Consider  2011 U. Alabama  report by team of  Dr. T. Cox "Examining the association between body mass index and weight related quality of life in black and white women";  DOI 10.1007/s11482-011-9160-8

Politely, can I ask you your age?

Hi Dr. Davis,
you recommend 40-50 grams of carbohydrates per day, 13-16 per meal, assuming 3 meals per day.
If I only had 2 meals per day (i.e. intermittent fasting) would I still have only 13-16 C per meal or 20-25?
If I only had 1 meal per day (i.e. intermittent fasting) would I still have only 13-16 C per meal or 50?
In other words, does the fasting period compensate for the impact of higher carbs per meal?

Thanks!

Greetings, Dr. Davis and Track Your Plaque readers,

I’m a 57-year-old lady who just stopped eating wheat in pursuit of a 40-pound weight loss and more energy. My husband and I like many foods on a low-carb diet.  I don’t miss wheat at the moment, and my husband is coping okay wheatless; but he wonders, in the absence of bread, what he can use to sop up sauces, olive oil, etc. at dinnertime. Surely he’s not the only person who became accustomed to using bread this way.

I can’t think of a grain-free low-carb substitute. Can anyone else suggest one?

Dr Davis:
Can you clarify and give us your view as to how important LDL particle size is when total LDL particles are 600 or less?  Thanks.

I miss bread for that particular reason too!   It's about the only time I really, really miss bread.  
.  I use this recipe http://247lowcarbdiner.blogspot.com/2011/11/bacon-avocado-grilled-cheese-sliders-on.html?m=0 for the coconut "bread" and it's savory and does a good job sopping up all those delicious sauces.

Just had my lipid panels done after about 7 months wheat free and low carb:

Total Cholesterol:  235
Triglycerides: 71
HDL: 79
LDL: 142 (calculated)
Pretty darn good, though I'll keep working on getting the Triglycerides down even more.  I didn't have baseline numbers, but I suspect that they were really bad as I'm severely insulin resistant, obese, and was totally inactive before starting.  Insulin resistance is still not where I'd like it to be, but my HbA1C is not bad at 5.8.  All these numbers are 100% due to my wheat free, low carb diet, plus fish oil and Vitamin D3 supplementation.  I'm THRILLED.  

Added bonus:.  Skeletal pain that was 7 on a scale of 10 every moment is GONE (doctor said it was aging).  Low back pain is gone, and I don't think it really left UNTIL I cut out the wheat.  GERD gone, asthma under the best control ever.  I can walk 2 miles now, I couldn't even walk across a room 6 months ago.  

It works, it works, it works, it WORKS!

This works for me:

http://www.youtube.com/watch?v=DX7wrTX8ybQ

Especially for soaking up egg yokes.

It also tastes great when toasted, buried in butter and carb-free pancake syrup, with a little cinnamon sprinkled on top.

Yes, Might, I found the study, and question the results, in light of so many studies that suggest just the opposite is true.  Additionally, it doesn't say anything about men.

Regarding Alabama study? It concluded pretty much what I expected it to conclude, that "  obesity not only increases risk for morbidity/mortality, but also impacts the quality of life of obese individuals." Yes, I think African American women are more comfortable with obesity and being overweight (a cultural artifact?) than white women (which is probably why they are less healthy and suffer higher rates of mortality than white women), but you suggested this translated to a better "quality of life," and I don't think that's necessarily the case. Too much of a leap, I think.

About my age?  Sure. Do you want my biological age? That would be 70. So I'm entering my eighth decade on this planet, and feel like I'm still in my 30s. That's mostly because I now look a lot like I did in my early 30s (less most of the hair!), while I was still smoking and still led an active, physical life. I'd rather not talk about my late 30s, 40s, 50s and early 60s, when the wheels came off, and before "I saw the light."

Kudos Joe,
So you'll like this: in the pool the other day I met a fellow in his early 90's who eventually asks me my age. I tell him 60 & he deadpan's: "I got shoes older than you!"

Thanks for sharing that link. I'll try it. I'll also post back any other solutions I may find.

Many thanks for that, Joe, and also for the other serving suggestions. I'll gladly try it.

Zero body fat is not ideal because healthy adipose tissue gives us adiponectin in circulation. In skeletal muscles adiponectin turns out to increase the skeletal muscle enzyme LPL (for geeks: adiponectin upregulates AMPK, which increases PGC-1alpha & also PPAR alpha leading to increased lipoprotein lipase). This essentially gives the enzymatic ability to break apart VLDL for freeing up some of the triglycerides VLDL carries to bring in it's fatty acids to "burn" in the skeletal muscle cell's  mitochondria for ATP.

Healthy adipose sending out adiponectin can actually increase the number of mitochondria being made (mitochondrial bio-genesis response is from increased AMPK) and up the potential for "burning" fatty acid  in that muscle cell; this essentially lowers the amount of lipids in muscle tissue; so having some body fat can still help keep muscles mass lean.

Doc has to oversimplify blogging about carbs and body fat, yet I like his gist. Here's why: high blood glucose causes an intermediate molecule (succinate,  & then it's derivations ) to form that blocks  +/- 25% of  adiponectin from forming  ideally ( in that adipose cell's endoplasmic reticulum). This is detrimental because then target skeletal muscle cells have to make do on less than 10% of  the ideal high molecular weight (HMW) adiponectin than those with healthy adipose get to work with.

To phrase it simpler,  those whose carb derived blood glucose load is too much for their physiology end up living with a low level of   ideal (HMW) adiponectin (ex. those with metabolic syndrome, obese, type II diabetic). And then there's sparse skeletal muscle LPL  for setting up the steps to get maximal "burning" of one's fats in their skeletal muscle (ie: stamina suffers).

But then it turns annoying since, as Doc warns, too high a blood glucose (from dietary carb load one can't use up) makes the liver get driven by the carbohydrate response element binding protein (ChREBP) to turn  those excess carbs into triglycerides. And furthermore,  that high level of ChREBP  put into play also causes the person's adipose fat cells to boost expression of  their specific adipose tissue LPL (ie: body switches off skeletal muscle LPL, but turns on adipose LPL). In this situation the result is a lot of  triglycerides end up getting shunted inside of the body's adipose fat tissue cells so fat cells swell.

At the same time adipose tissue is sucking up triglycerides skeletal muscle LPL is (for the most part) not showing up to work. So most of the post-prandial made triglycerides the VLDL is trying to unload from circulation over to skeletal muscles for use can't be plucked in by their skeletal muscles. One way to look at elevated triglyceride lab results is it (high trigs) indicates that body's adipose tissue isn't forming adiponectin "normally" enough to perform out & about in the other parts of the body. Doc has specified that human body fat (adipose) isn't a victim that passively receives goops of fat, but rather an actor  - like how it should send adiponectin to help skeletal muscles.

Nicely done, Might!

Your experience is a perfect example of what can be achieved with diet and some supplements--no drugs!

The world has been persuaded that statin drugs are the only answer. Your experience shows that you can achieve values that are SUPERIOR to those achievable with drugs.

I'm going to post your comment as blog post. Thank you!

Perhaps we should call it the "Don't eat anything diet," or the "Eat only vegetables diet."

Dr. Jeff Volek and Dr. Ron Krauss are among the investigators who have already provided validation of these issues using lipoprotein analysis.

I make the 2 min bread recipe using almond flour.  Basically, its
1/4 c. almond flour, 1/4 tsp baking soda, 1/4 tsp baking powder, pinch of salt, 1 T oil, 2T heavy cream, and 1 egg.  I mix it in a small square pyrex and bake in the microwave for 2 min.  Then I slice it in half to make it thinner and toast it.  Voila!  It passes for bread and makes a great LC sandwich.  Something like this does make being LC and grain free, a whole lot easier!

I wonder if the circadian variation in cortisol is thrown off as you lose weight, e.g. evening surge rather than morning surge.

Some people in this situation have had success with higher doses of melatonin, e.g., 10-20 mg and/or the Seriphos form of phosphatidylserine.

Yes, Denise Minger does a great job, citing issues that I would have cited, also.

As always, nutritional thinking falls into this trap: If something or some practice that is bad is replaced with something less bad, then more of the less bad thing must be good. If the standard American diet is replaced with a plant-based, low-fat diet and there are apparent benefits, then this diet must be the ideal.

False logic. And the notion that the diet advocated by Esselstyn et al reverses coronary disease is a fiction. This is a whole conversation in itself. Perhaps a topic for future!

Dr. Davis,
I have experience so many benefits since I've been following your dietary suggestions for over a year now.  My question is:  What do I say to the veggie-heads and Ornish followers who claim and ask the question:  If low fat diets really worsen the factors leading to heart disease, please explain why  rural China was so unaffected by heart disease in the 80s?  

I'm not a scientist or a researcher, and I know low-carb sure works for me, but  how do I respond to this question?  I'd like to be able to provide an intelligent, straight-forward answer to this never-ending argument.   Thank You.

www.amazon.com/review/R2W7KWZKQY6BGJ/ref=cm_cd_pg_pg128?ie=UTF8&cdForum=FxZJ813G2J60B7&cdPage=128&asin=1439190275&store=books&cdThread=TxCB0L17B0KXSQ#wasThisHelpful

Excellent points, Joe. Thank you.

Also, note that this diet is not calorie-restricted. If you'd like a 3-egg omelet with mozzarella cheese, covered lavishly with olive oil, spinach, mushrooms, and green peppers, have it and go back for seconds.

Some people who exercise for prolonged periods, however, may require additional carbohydrates, such as a banana or cooked sweet potato or glucose preparation (Goo) in the midst of exercise.

I pay no mind to what Liposcience says, as the data they use and the concepts followed for crafting "reference ranges" is flawed. I like their service (for the most part; they are quite dysfunctional when it comes to customer service), but I do not agree with some of their information.

There's too much here to cover in a comment, so suffice it to say that we cannot craft "normal" or "desirable" ranges for endpoints based on cardiovascular events, since events will lag or underestimate what the disease itself is doing, i.e, a measure of atherosclerosis. Also, Liposcience often bases their observations, as do many lipidologists, on values within a population, e.g., calling "normal" the median +/- 2 standard deviations. This is a deeply flawed notion of "normal."

No, I do not.

I believe the cut the fat notion for apo E4 is an oversimplification.

Perhaps this is worth covering in future.

No, it does not.

Hyperglycemia and glycation develops after a specific carbohydrate ingestion and has no "memory" for what was or was not consumed earlier.

I post recipes on both www.trackyourplaque.com and the Wheat Belly Blog that accompanies the Wheat Belly book: www.wheatbellyblog.com.

There are also around 35 such recipes in the Wheat Belly book. The next Wheat Belly book, slated for release in early 2013, will contain 150-200 recipes.

Still important, Steve.

Note that persistent small LDLs do not occur in isolation, but are often accompanied by postprandial lipoprotein distortions and higher levels of glycation. So persistent small LDL, regardless of the proportion to total LDL, serves as a marker for several metabolic distortions.

Note that I do not track LDL particle size; I track number of small LDL particles, what I believe is a superior marker.

Excellent, Jank!

Also, note that the calculated LDL likely overestimates the true value, a common situation as you get healthier. At some point, an NMR LDL particle number or an apo B will show you the real value and I'll bet it's much lower than the calculated value suggests.

And that's great on the bony pains.

HI, Don--

A topic for future.

In the meantime, please be sure to read Denise Minger's reanalysis of the China Study data that essentially debunks the entire argument.

Yes, this is a big problem, Bill.

None of the lipoprotein testing companies talk to each other, leaving us with variable cutoffs for defining 'pattern A" and "pattern B." And there are next to no data with cross-technology comparisons.

Until that happens, I ignore the semi-arbitrary and often misleading "pattern A" and "pattern B." Instead, use the total small LDL particle value and divide by total LDL and this gives you proportion or percentage small LDL. On VAP, add LDL3 + LDL 4, then divide by "Real" LDL.

Thx doc.  I'm looking forward to understanding this better.  My mind is simple...  low carb is either better or it isn't. I know it is for me...  but apparently some people, for whatever reason, thrive on grains and low fat.  Would love to be able to come up w an answer.  Thank u.   Don

Hi DonOverEasy,
    Next time you want to discuss diet theories with your friends show them  that 4 Jan. data  of mine detailed way above.
The 1st results were for my long  standing life style  (ie: decades of my adult life) of eating high whole grain & low fat to theoretically prevent cardio-vascular problems my family is prone to. I was  "thriving", decent weight, did hard work and never seriously sick  - so everybody said I was a model for healthy diet. I had no symptoms of any bad reaction to any grains, unlike some get.
    But, according to Doc's preventative cardiology practice I was unknowingly burdened with way too much small LDL, even though I didn't have other metabolic issues (ex: spooky triglyceride levels).  I wanted to think maybe the report print out got messed up.  
   Then show  the 2nd lab results for evidence of how the small LDL improved as an  example of when stop being fanatically low fat &  unlimited whole grain (carb). If they say it was not a fluke show them the even better 3rd lab results after 1/2 year eating yet a higher fat intake.
   Of course individuals will differ & so you should ask them for comparison data from their own  NMR  (Doc's preferred lipo-protein test).  If their small LDL is negligible on their low fat  & grain (carb) based diet then that person is probably that way because of genetics; but you'll never be able to prove that of course & good fortune for them.

Hi Might-o'chondri-AL,
Thank you for your time and your reply.  I don't doubt you or your numbers.  My story is similar.  My problem lies with the folks who say we are a minority.  

They say we are a small percentage of pre-diabetics, who will naturally do well on low carb.  My opponents maintain the vast majority of people thrive on whole grains,  low fat, and high fiber, otherwise  rural China  would have been the "heart disease capitol of the world" in the 1980s.

I'm aware of Denise Minger and how she has shed light on Dr. Campbell's deceptive studies.  And my own story and dietary changes have proven Dr. Campbell is blowing smoke.  Yet there is truth in that, China has subsisted for thousands of years on high grains and low fat.  Rural China did have a low rate of heart disease.  Why is that?

There's got to be more to this story.  The vegans maintain Americans are obese not because of whole grains and low fat, but because of an addiction to simple carbohydrates and sugars.  Which truly is part of the problem.  But only part of the problem.  They believe simple carbs and saturated fats are what causes the inflammatory response that has contributed to the masses with heart disease, not whole wheat grains.

So Al (I presume) I hear you, loud and clear.   I too thrive following a paleo way of life.  I've lose 40 lbs and have great numbers.  But are we the minority?  I became sick on a vegan diet back in the 80s (Ornish), but I have friends (more like acquaintences) who appear to be thriving on a vegan lifestyle.  Again... why is that?

I continue to search for answers.  Thanks for taking the time.
Don

Hi Don,
I worked in many rural developing countries worldwide (like yesteryear's China)  and the majority of the people have (had) no food security. So even if the grain bin was full they had to feed their extended family on the realistic minimum (except for seasonal boons, like edible insect time)  or risk absolute if ate all their seed grain when planting time rains hopefully came back on time .  
In terms of your context this meant they did not overeat assorted types of calories in relation to how hard their daily physical exertion promptly used those available calories. We are not talking about people who are subsidized with food like the  modern societies make possible -   to put them into their actual context  they were (are) eating by the sweat of their brow. I think there is a blogosphere disconnect with only fasting being our link to subsistence level living;  &  to discard any relationship to "calories in, calories out"  as a sound bite just because modern food availability is pervasive..  
Rural poor did (do) not eat all their livestock or fowl because it's their only source of  cash income at market and so made do with legumes (ex:beans & bushy pidgeon pea) . There is (was) no refrigeration so the vegetable & fruit crop diversification made it practical to just go with what held up reliably  (ex: cabbage) or grew fast (ex: leafy greens). Cooking traditions in rural cultures was not really an art but a means to conserve things from spoiling until got used (ex: fried makes a barrier, sugar preserves, vinegar  conserves, ferments drop pH dissuades bacteria).
Rural China's low cardio-vascular disease , looked through Doc's paradigm,  is they never had enough shear over-load  of  inappropriately excessive blood sugar to drive the metabolic aberrations which generate the physical changes in lipids (small LDL , triglycerides) that are cardio-vascular culprits. Doc's blogging puts protein source and fat amounts as not a factor in heart related problems, just what we are taught to worry incorrectly about.
Have your veganites take an NMR even if they are thin for show and tell.

Hi Doc,

I'm an APOE2/4 and would love to have you cover this subject in more detail.

Thanks,
Tim

Hi Dr. Davis,

Thank you for confirming that low carbohydrate intake can really reduce the risk of heart attack. I agree that 90% of the time drugs don't help, natural healing is the more better road to take. I will have to read this multiple times so that I can absorb --- this is really interesting.

Here is a conundrum maybe someone can help with.  My husband, with CAD, follows a low-carb diet.  Has lost 20-25 lbs, blood pressure is fantastic.  However,weight loss has stalled over the last year.  Triglycerides still too high (319), HDL still too low (38).  Low-carb really has not given him the great results I have been hoping for.  Any ideas?

Hi Stacie,
This is a sleepy thread by now so Iet me inform you that if you read Doc's  old posts I think you will find him repeatedly saying "...cut out wheat " , even if you are already low carb dieting. Look above to my  5 Jan. elaboration  written "For Iconnolly  ..." of how I suggest wheat may be a stumbling block ,  beyond  wheat just it being a carb.  It may motivate your man to give Doc's advice a try.
Also,  I refer you to the previous post titled "Mocha Walnut Brownies" where 4 Jan. I wrote "For Laura ..."  in response to your guy's same slump. Please know that, despite my commenting alot,  I am not an authorized spokesman for Doc, nor am I a clinician or medical expert.

Hi AL:  

   Thanks for the reply,  We are wheat free, as well as grain free.  I did not understand the post about palmitate.  I think you are saying  to eat less of it.  Our doctor(fantastic low-carb doc)hjas recommended that my husband eat smaller portions of fat, and increase vegetable portion size.  He also has begun  K2, D3, and omega-3 supplementation.  His Apo E genotype is also not good (E2/E4).  I do not know anything about genotype, so do not know what it means.

Hi Stacie,
Doc tweaks fat intake down for ApoE4 individuals, your physician says smaller fat portions & I detailed why palmitic acid (palmitate) dietary fat comes to my mind to focus on for limiting. In conventional research high fat diets are used on mice to give them problems, like high triglycerides and insulin resistance and palmitate  often comes up as indirectly culpable .
Since we are all designed to make our own palmitate those with genetic &/or food driven high triglycerides might do better just limiting dietary palmitate as much as possible. The desired amount of saturated fat can be obtained from coconut oil & adding more olive oil, due to it's high oleate fat content, will keep the palmitate benign.
When one is ApoE2/E4 it means they make and use a type 2 & also type 4 variation of the molecule ApoE. Look at next post  "DIet is Superior to Drugs" & my 10 Jan. comment about triglycerides and ApoE  for  now; & use Doc's  search feature for his words.
10 Jan.'s focus is on carbs & triglycerides relationship with ApoE. In your case just ignore the carb phase minutia & interject  your husband's high triglycerides into the overall dynamic laid out. People can have genetic influences on triglyceride levels & this seems to be what you must deal with.
ApoE nuances  relationship with triglyceride coping suggests to me getting dietary fat without the palmitate found in meat/whole dairy. Of course that is hard to jibe with the nicer idea of eat all the meat you want; but maybe worth a trial.

Thank you Al.  I read those posts.  My understanding, then, is that  because  of the E2/E4, my husband is carb and fat sensitive.  Great combo!  I guess he is busted.  He hates coconut oil,  but olive oil is okay.  We will follow our doctor's advice, eat more vegetables and less meat.  I am also hoping the D3, K2, and fish oil will help.  Here is the bottom line for us:  We will do the best we can diet wise,  not worry or obsess about food, love each other, and above all, trust God.

I've always been fit and thought I was keeping myself safe from heart disease with my 10 mg Zocor prescription for the past 8 years along with exercise and trying to eat somewhat "healthy"  (TC under 200 with the zocor, triglycerides and LDL's under 100 and HDL around 70; my weight is 109, female, age 60).  But my new doctor did NMR on me and I was shocked.  I found out that I'm APOE 3/4, my ApoB was 100 and LDL-P 1206, HDL 72, TR 115.  Since then I've added Slo Niacin (500 mg to start), my doctor upped my zocor to 20 mg (from what I've read, APOE 4's don't respond as well to statins except maybe for simvastatin), cut my carbs and fat intake.  My next NMR will be in March.  Meanwhile, I sort of feel that as an APOE 4 I'm doomed to some level of heart disease, regardless of my numbers.  I've always been a negative person anyway....can you help allay my fears?

Dr. Davis, After my doctor took me off glimeperide December 16, 2011 my blood sugars rebounded upward even though at the time I was low carb and avoiding wheat.  I never lost but ten to twelve pounds on the Wheat Belly diet but followed your advice anyway because the arthritis symptoms cleared up nicely and also because of so much cardiovascular heritage on my Dad's side of family.  Just this past week I called my doctor again because my blood sugars were very unsatisfactory (FBS of 170 in the morning and 209 between meals).  He allowed me to try just one half of one mg. of the glimeperide.  At about the same time I began to read about Dr. John McDougall on the internet and at first dismissed him but noticed that in his most recent book, the McDougall Plan for Rapid Weight Loss, 1995, he too warns readers to avoid all flour products, breads etc.  So, I have NOT returned to eating wheat but have started trying to avoid meat and fats for a while, just to see what would happen (I have never tried this before, to go without meat).  Some good news:  My fasting blood sugar in less than 72 hours has gone down to 114 and the chest pain and arrythmias have gone away.  Maybe I am sensitive to both carbohydrates AND meats/fats.  Decided to put this on this blog instead of Wheat Belly facebook or blog because of feeling like perhaps I am in a minority.

Ronnie,
I will let Dr Davis answer your question, but I wanted to give you some good news. I am an APOE 3/4 and my family heart disease history is terrible. I started off with an OK lipid profile (according to my PCP; I was taking Lipitor), but my NMR turned out quite bad and getting worse over time. My calcium score at that time (February 2010) was 209. Thanks to Dr Davis, with the correctly tuned diet, supplement, and exercise program, I was able to bring my NMR indicators to a very favorable range, and my calcium score in September 2011 was 191 (10% reduction). And yes, I have to take statins (Crestor 10mg). I can provide more details, but just wanted to encourage you that you are not doomed, simply because you are an APOE 4, so please do not give up!

False logic. And the notion that the diet advocated by Esselstyn et al reverses coronary disease is a fiction. This is a whole conversation in itself. Perhaps a topic for future!

I can't wait for that conversation.Very soon I hope.

Thank you for that, Gene.  I still haven't gotten over the inital shock of finding out my genotype.  It surprised me because neither one of my parents have/had heart disease.  But my fraternal twin sister has CAD which I attributed to very poor diet and sedentary lifestyle.  I'm guessing she's also APOE 4. Thanks again.

Also, Gene, whatever details you care to share would be helpful and appreciated. Ronnie

I described the diet, which took me from my worst NMR in November 2010, to a significant improvement in March 2011, and finally to an excellent NMR in September 2011 (small LDL #P less than 90 nmol/L) and a 10% reduction in my calcium score, in my comment at http://www.trackyourplaque.com/blog/2011/07/the-exception-to-low-carb.html#comment-23722. I followed this diet meticulously. I was taking 2400 mg (EPA+DPA) fish oil, 8000 iu vit D3, 675 mcg iodine in kelp tablets. Following Dr Davis's advice, after finding out in December 2011 that I was APOE 4,3, I added Niacine 500 mg and Crestor 10 mg (all doses are daily). I also significantly reduced plant oils in my diet. Today I am experimenting with my diet trying to add fats such as 100% baking chocolate and coconut oil. (Don't know the results yet.) I also walk for 1 hr every day (from home to train and back, and some during the lunch break) and exercise 3 days a week doing interval training (HIIT) for 20 min and following the slow burn strength resistance program.

Please read other comments to that post on 7/31/2011. Especially, pay attention to Dr Jack Kruse's comment. His blog at http://jackkruse.com/jacks-blog/ is very relevant, dense, insightful, and useful. I never miss his posts (nor do I Dr Davis's).

Gene, thank you very much.  I plan to read everything this evening.  Congratulations on all your hard work and effort regarding diet, exercise and supplementation.  I do have a question regarding your fish oil.  In the NMR I received, the notes said that "one study demonstrated ApoE4 patients had a 15.9% increase in LDL cholesterol in response to fish oil.  This needs to be confirmed in a larger study".  Do you know anything about this?  I take 1000 mg fish oil daily.  Also, I have another question which shows my ignorance regarding all of this.  My NMR said I is am 3/4; you write you are 4,3.  Does the order of the numbers make any difference?  Thanks again.

Ronnie, I have no background in the medical field, so I am trying to limit the content of my posts to the links to sources from which I learned and the facts of my own experience. I would defer answers to Dr Davis or somebody else who knows.
The spelling APOE 3,4 is purely mine and I don't know whether the order or punctuation have any meaning here. To me, it doesn't matter.
To find out more about the fish oil, read earlier posts by Dr Davis here: http://www.trackyourplaque.com/blog/category/fish-oil. You can also find the following post by Dr Kruse (including the comments) useful: http://jackkruse.com/is-fish-oil-good-or-bad/.

No difference in the order, Ronnie.

A lot of great information on this blog.  Thank you, Gene, for the links and Dr. Davis, for your response.

Dr. Clavis Eraslan product without side effects by Panax, a vessel is completely natural bronchodilator.
Plaque in blood vessels, fat layers and removes slag. Opens the way to vessel. Capillary blood circulation, prevents arteriosclerosis.

Dr. Davis,
I read about a Harvard medical study: "Low-carb diets linked to atherosclerosis and impaired blood vessel growth".
http://news.harvard.edu/gazette/story/2009/08/low-carb-diets-linked-to-atherosclerosis-and-impaired-blood-vessel-growth/
The article said, "...mice placed on a 12-week low-carbohydrate/high-protein diet showed a significant increase in atherosclerosis, ... The findings also showed that the diet led to an impaired ability to form new blood vessels in tissues deprived of blood flow, as might occur during a heart attack."
I hope you will read this article and give your opinion about "how" they conducted their test.  
Thanks

Does anyone know how to reach TYP member Gene K who posted on this thread?   I would like the  link to Gene's diet that he followed for Apoe3/4  but the link that was posted earlier does not work, if you are out there Gene, or anyone, please email me diet at

dbm1st@airmail.net

Regards

May I ask, what is the optimal serum range for Vit D.  What do you consider too high and what are the undesirable consequences of too much vitamin D?
Thank you kindly -- fantastic blog !

I wonder- do you have a general rule of thumb for a starting dose based on how much the person weighs? I've found that 1,000 IU per 25 lbs of bodyweight seems to generally get it in the ballpark.

The "1000 units per 25 lbs body weight" that Dr. John Cannell suggests does indeed work well, though there is still great variation among individuals.

For that reason, we aim to maintain blood levels of 25-hydroxy vitamin D of 60-70 ng/ml.

can supplementing with D3 negatively impact TSH thyroid levels, causing TSH to increase? I have seen this stated on another blog.  Suggested remedy was to lower intake of D3.  Thanks.

With daily effort your endurance will continue to increase. In no time at all you will be able to sustain 30 minutes of continued activity. Now as you begin to get into better shape you will be on your way to experiencing fast weight loss.

Great article, I'd never known how vitamin D was related to weight loss until now.

But, with all supplements for weight loss it would need to be combined with exercise for best results

I have the same question as Steve: Can increased D3 affect TSH or thyroid in general. I have hashimotos thyroid autoimmune, and have increased my D3 for osteoporosis reasons, but it seems to be affecting my TSH---need less medication to have same levels of normal TSH.  I read that D is good for autoimmune disease.
Thanks for your response!
Kate

Awesome! really very nice article.

I wanted to take more than 4,000iu because I'm obese (11-17-08 level was 64, 8-3-09 level is 55), but my PCP said not to for fear of kidney problems?  I just upped it to 8,000iu.  We'll see - I sure could use help in the weight loss arena.

Though the levels of vitamin d and weight loss seem to be correlated, is it always true.

Dr. Davis
(Probably not the right forum to post this comment but I just had to send this to you)

Not many weeks ago a colleague of mine (let’s call him Eric) asked me if I knew the difference between D2 and D3 and I told Eric that D2 comes from irradiated mushrooms and D3 comes from the wool. In other words D3 is the same kind of vitamin as humans get from the sun. Humans just don’t get enough and we can’t produce it on our own, like the sheep can. (D3 is natural for humans, D2 is not just like you have said)

After telling Eric this, he asked me how he would know what he is taking and I gave him the medical definitions of them both (D2 = Ergocalciferol; D3 = Cholecaliciferol). Since I was aware of that he had gotten his Vitamin D by prescription I told him “I am 99.9% sure that you are taking D2, but I would be thrilled to find out I am wrong”.

Eric called his pharmacy right away and got the answer I was expecting: Ergocalciferol. When confronting the person Eric was talking to the answer he got back was that Ergocalciferol is the only Vitamin D they are giving out.

A week later, Eric had a new appointment with his doctor and decided to ask him about the D2/D3 issue. The doctor said he knew that there was a difference in them both, but could not say what, not even the basic facts I mentioned above. But the doctor stamped a post-it with what he had sent to the pharmacy just to show Eric… “Vitamin D3; 50,000IU tab” is what the stamp said.

Eric, off course, got confused and was starting to believe that the Pharmacy had made a mistake by giving him Ergocalciferol (D2) since the doctor had given him D3, or at least that is what was stamped on the little note he had.

Today, after getting a refill of his Vitamin D he also got and kept all his paperwork that came along with it. Still in believe about that stamp the doctor had given Eric earlier he asked me to double and triple check that my definition of D2 and D3 was correct. I did, just for my own sanity, and I was still right.

One of the sheets Eric brought me today was the “Patient Education Monograph” sheet stating the drugs and how to use it and so on… The thing the jumped out the most to me was this:

Generic Name: Vitamin D – Oral
Common Brand name(s): Drisdol, Maximum D3
Identification: PA140 Green Oval Capsule

This is the Drug Eric was given: Vitamin D 1.25 MG softgel; Generic name: Ergocalciferol

My researching mind went into high concentration mood and I started to dig. And this is what I found:

The brand name Drisdol is Ergocalciferol (D2), not D3. The Brand name Maximum D3 seems to be hard to find out there in cyber space as a brand name. But the ones I found that was called Maximum D3 seems to be the real stuff, however none of them required a prescription.

When trying to find out through the identification number on the pills (PA140) I now know for sure that Eric is taking Vitamin D2 and not the preferably Vitamin D3. The Brand Name Drisdol had the identification W on one side and D92 on the other, but it is still Ergocalciferol.

The only conclusion I can draw from all this is that the medical industry does not know or care about the difference in D2 and D3 – it is all same to them. And as long as the pharmacies only give out D2 it does not matter what the doctor prescribe anyway.

I knew that people are most likely to be prescribed a D2 pill than to be told to buy over the counter D3. But it was almost heart breaking to see the letter D and number 3 right next to the drug Drisdol as we know is a D2 vitamin. It just didn’t make sense to me that they can be labeled as the same type of medication, when we know it is not!

I love your blog, and I just wanted you to know that I am passing on your information to as many as I can. If you are interesten in seeing any of the documents that I have from this story you can just email me at helena.mathis@hotmail.com

moderator

shouldn't you take helena mathis' email off the blog post ?

This looks interesting.

Good point! I suppose this is true of anything fat-soluble, if you reduce the fat deposit then the concentration will increase?

wow..excelent post, thanks for sharing

thanks for this - with all sorts of info available on the net - this one gives me a greater understanding on vitamin D in relation to my weight loss level. More posts like this

I take calcium with my vitmain D3.  The vitmain D3 I take has olive oil with it.  It is highly advised to take calcium when taking more than 1000 UI daily.  You should get tested for vitamin D3 levels in your blood.  You can get a private lab or do it through a doctor.  I take 1000 UI for every 25 lbs.  I tried taking it a few days that way and I lost 4 lbs in a few days.
You shouldn't take more the recommend amount on the bottle more than a few months.

Thanks Every body for sharing information ....

You really need to consult a doctor if you have any plans to lose weight. Ask for a prescription of the right dosage of Vitamin D and eat nutritious foods as well. Don't forget to exercise too, its helpful.

In my case, I created my own – FatBlasters. It’s essential that you not feel alone, and reaching out to friends (new or old) is typically a smart move. I just heard about PeetTrainer, but didn’t know about it when I began down the road to weight loss. You have to know that others are out there for moral support – they know things that you couldn’t possibly know, and they’ve probably been “in your shoes” at some point in the past (or present). Share stories, laughter, tears, successes, and failures – share them. There are thousands of communities out there, so keep looking until you find the one that fits you.

Nice post on the Vitamin D and weight loss. Overweight is one of the major problem in the world. People do lot of things for losing the weight.

What is suggested here is that if you start out with an inadequate vitamin D level, it’s possible that this might inhibit or impede your ability to lose weight on a reduced caloric diet?

yes my dear friend ,definitely you lose weight on a reduced caloric diet, HCG diet , thanks

There is many more information on this post about how to reduce our weight loss and also there is plenty of information about the functions of vitamin D in weight loss.Office plugin Its really a helpful information to all of us.

This is a common phenomenon with substantial weight loss: lose weight and the need for vitamin D is reduced. The reduction in dose is roughly proportion to the weight lost. Vitamin D should therefore be reassessed with any substantial change in weight of, say, 10 lbs or more, either up or down, because of the influence of fat on vitamin D blood levels.

Vitamin D is good for weight loss.

I am now on a weight loss program and I can say that I am getting a very good result. I never thought that vitamin D can really affect my weight loss program.

Thanks for sharing the importance of vitamin D in loosing the weight. keep posting such a nice post....



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