Gary Taubes, in "Good Calories, Bad Calories", would argue that what is causing the small LDL is in fact the same thing causing the obesity.  Over consumption of starchy carbohydrates and sugars basically.  

I think you'd find that book amazing. It is a comprehensive history in the mis-information cascade about diet and heart disease (and cancer).

Previous month oats (oatmeal/oatbran) were advised for correcting LDL numbers.
No grains is the advise this month.
Oats are also grains, are they not?
So is it okay to eat oats or not?

Hi, Nancy--

Yes, I agree. I am presently reading Taubes' book and am impressed with his grasp of the issues, a refreshing re-examination of issues most of us accepted as "fact."

I'm using the word "grains" too loosely. I really mean processed wheat. I've had positive experiences with oats and flaxseed. I think some of the coarse grains like quinoa and barley are good to neutral.

Dr Dave - why do you think the American Heart Association, and other similar influential organizations, are failing to advise the public about wheat products, if they are contributing to the raise in small LDL particles, as you state?

I can't speak for them, but I suspect that, as always, it has to become common knowledge among physicians before the policy makers in the AHA decide to make a change. They usually wait until data become overwhelming before allowing it to become their position. Also, there is a lot of money in the low-fat concept. See my posts about the AHA Heart CheckMark program, a very profitable program.

Yes the unfortunately it's the 'Big Business' monopoly again. Quite sickening actually!

I am very interested but also concerned about this, and as a dietitian I do recommend wheat based products - can you suggest any journals/books on this matter?

Yes, several sources:

1) See my Blog post Oat vs. Wheat at  http://heartscanblog.blogspot.com/search/label/Oat%20vs.%20wheat in which I discuss Dr. Brenda Davy's study.

2) Dr. Ronald Krauss has published rather extensively on this. Enter "Krauss" and "small LDL" into your PubMed search.

3) Look at Dr. Loren Cordain's website, www.paleodiet.com, that contains reprints of his many reviews of the effects of grains on health.

The most recent addition to the lay literature on this topic is Gary Taubes excellent book, "Good Calorie, Baad Calorie".

Dr Davis - many thanks for that, I will look into it.

Excellent clip: leftover pizza = healthy breakfast. I love it. I can hear my friends now, "I order pizza because the leftovers make such a good breakfast."

Next we'll hear that chocolate muffins made with vegetable oil are good for b'fast because "they're better than nothing, have no cholesterol and chocolate enhances serotonin function."

Healthy breakfast choice = bad food + one slightly positive attribute grossly exaggerated.

Well said!

I would love to hear your thoughts (review) on Taubes' book, "Good Calories, Bad Calories", after you have finished reading it.

Thank you. I will.

We are also going to add a Book Review section on the www.trackyourplaque.com website near future.

I'm only a few hundred pages into Taubes book, but one of the things I'm liking a great deal thus far is his explanation of many of the factors measured in the TYP program.

I was already familiar with the carb/insulin stuff (which is greatly simplified, leaving out the effects of glucagon, amylin, cortisol, the thyroid and sex hormones - all of which also effect blood glucose).  

I'm much newer learning about heart disease.  A lot of what was empirical in the TYP book is explained much more thoroughly by Taubes.

I like the Fanaticcook blog entry also - it's refreshing to see someone discuss whole grains who actually knows what a whole grain *is*.

I watched the online video debate between Taubes, Ornish, and Dr. Barbara Howard of the AHA.  Taubes appeared to be unaware of the TYP program and the kind of incredible results being frequently reported at the TYP forum by forum members.

Here's the YouTube link:

http://www.youtube.com/watch?v=JPyme62niYM
For what it's worth, IMO, you and Mr. Taubes need to have a chat so he's better armed with evidence of what a low-carb diet can do with heart disease.  (As if you needed more to do, huh?)

Jimmy Moore must have his contact information given that he did an interview with Mr. Taubes.

You da' man doc!

I watched the online video debate between Taubes, Ornish, and Dr. Barbara Howard of the AHA.

wccaguy,

FYI: I am pretty sure that this show is from 2001, after Taubes published his "What if it's all been a big fat lie" article on saturated fats and the lipid hypothesis.

You comment "whole grains create small LDL!". Would beer (which is grain-based) be a culprit in your opinion, even in moderation? tia

John

Hi, John--

Great question. However, I am uncertain. There is very little data on this specific issue, nor have I seen enough lipoprotein patterns pre- and post- beer inclusion.

My gut sense: one or two beers a day is okay, provided weight is not impacted

Not meaning to belabor the subject, you single out wheat versus "grains" in general as particularly detrimental, while oats for example are not, and can be even beneficial. Where does corn sit in this whole "grains" scheme? In a typical TYP program, are corn-based tortillas for example preferred to wheat-based ones, or are both to be avoided?

Hi, John--

From a glycemic index/small LDL/weight standpoint, corn products are every bit as detrimental as wheat.

I single out wheat, however, since Americans are over-dependent on wheat products by such a huge margin. It isn't at all unusual, for instance, for someone to eat wheat products 5 times a day. That would be very unusual with corn products, however.

Interesting article, never thought that grains may do such things. I was also wondering the same that John about beer.

It sure sounds healthy, but it's same worn advice that has resulted in a nation drowning in obesity. The food choices advocated by this dietitian keep us fat. It also perpetuates this epidemic of small LDL particles.

In response to Johns comment about beer:

I'm no expert on the subject but from my experience with home brewing, it is my understanding that all, or at least most, of the carbohydrates are converted to simple sugars which are then fermented by yeast into alcohol and CO2.

And so, rather than the sugar ending up in the persons blood stream, it is transformed into alcohol which enters the blood stream.

So the real question is:

"How does alcohol affect the ammount of small-LDL in the blood stream?"

What I do know is that alcohol tends to lower the blood glucose levels, which I would think would be beneficial since it's blood glucose that the body uses to produce small-LDL.

After further research i've descovered this:

http://jcem.endojournals.org/cgi/content/full/92/7/2559

Results: Alcohol intake was associated with total low-density lipoprotein (LDL) particles in a U-shaped manner. Consumers of one or more drinks per week had the highest number of large LDL particles, whereas consumers of 7–13 drinks per week had the lowest number of small LDL particles. Alcohol intake was strongly positively associated with large- and medium-sized high-density lipoprotein (HDL) particles but had an inverse relationship with concentrations of small HDL particles and small- and medium-sized very-low-density lipoprotein particles. Average particle sizes of all three lipoproteins were positively associated with alcohol intake. Associations were generally stronger among women than men but in similar directions. Beverage type did not consistently modify these findings.


Long story short:

DRINK MORE BEER!

Transform all those nasty carb ridden grains into beer!

Grain industy's happy, people are happy and we'll all be alot healthier.

CRISES AVERTED!

Hi Dr. Davis,

Adipose tissue also stores a lot of LA (proportional to long-term diet) and that will influence blood lipids.  The half-life of adipose LA is about 2 years, so changing that contribution is a long-term process.

I used the omega profile thru YFH.com.  My AA/EPA ratio was 1.39 on 7.5gm EPA+DHA (1 TBS EicoRx)daily  This dose also cured my asthma and almost eliminated my seasonal allergies.  EicoRx has GLA added, which pushes eicosanoid synthesis more toward the "Good Side".  One of the best basic fish oils is available thru the life extension foundation.  It is 60% pure (600mg EPA+DHA per 1000mg capsule) and contains sesame lignans and olive extract.  It is certified thru IFOS.  I got it on sale for under $10 for a bottle of 120!

I wonder if taking 6G of EPA+DHA/day - split as three separate dosages has any advantage over a single dose?

Dr. Davis!

I like your n=1 experiment!

Thank you for sharing your results. In all honesty, I think your Japanese blood demands more omega-3's.  That might in fact be genetic!!
  
-G

Dr. Davis!

I like your n=1 experiment!

Thank you for sharing your results. In all honesty, I think your Japanese blood demands more omega-3's.  That might in fact be genetic!!
  
-G

What about the studies that Harvard's nutrition webpage cites that omega-3 and omega-6 were both beneficial and that they are not competition with each other?

http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/omega-3-fats/index.html

The studies have citation numbers of 4 and 5 but i'll link them here anyway

http://www.ncbi.nlm.nih.gov/pubmed/17876199?dopt=Citation

"Adequate intakes of both n-6 and n-3 fatty acids are essential for good health and low rates of cardiovascular disease and type 2 diabetes, but the ratio of these fatty acids is not useful. Reductions of linoleic acid to "improve" this ratio would likely increase rates of cardiovascular disease and diabetes."

http://www.ncbi.nlm.nih.gov/pubmed/15630029?dopt=Citation

"n-3 PUFAs from both seafood and plant sources may reduce CHD risk, with little apparent influence from background n-6 PUFA intake."

I wonder if there are any other commercial labs doing Omega3/6 testing? Ideally, I'd like to get it a regular lab, through insurance, as I see enough doctors that I can get one to write a script.

Any concerns about GeneSmart also selling Omega 3 supplements? It seems like a conflict of interest to me somehow. I would look at a VAP test differently if the same company sold statins direct to the consumer, for instance.

Aw, shucks! Since dark chocolate is supposed to have good antioxidants, and nuts are supposed to have good fats, I thought that peanut or almond M&Ms would be the perfect health food.

I'm currently taking 3600 mg EPA-DHA in 5 gels of PurPride fish oil at $.04 per gel...while equiv LEF fish oil would be 3 at $.17 per.

I'm sure the LEF quality is better.

Was wondering if 5 gels (3600 mg) was too much...looks like it might not be.

Omega6s are one of the reasons I cut back on most nuts. Walnuts are the worst. The lowest amounts of omega6s are in macadamia nuts, so I still eat few of those. For this same reason I rarely eat avocados any more - they were throwing off my omega6/omega3 balance way too much, despite all the fish and supplements. Compared to most nuts and avocadoes even grain-fed beef is pretty benign from omega6 point of view.

I wonder if any progress is being made in evaluating each person as a unique system. The same levels for everyone may not be appropriate.

I don't know how many nuts you're eating a week Doc, but 8 oz. of mixed nuts has about 25 g. 18:2 n-6 (LA).  Most nuts are high in LA, except for macadamia nuts.  Walnuts are the highest, with 38 g. LA per 100 g. of nuts.  Pecans are next at 20, peanuts at 15, almonds and pistachios at about 13.5, and cashews at 8.5. Macadamias have only 1.3 g. LA per 100 g. of nuts.

Hello,

I just purchased the omega 3/omega 3/6 ration test -

what does the omega ratio test cover? The ratio in tissue? Blood? My understanding is that the ratio in tissue is what is the best identifier, but I believe it says that blood is tested?

*confused*

All the evidence suggests that dietary linoleic acid (plant-based omega 6) is perfectly healthy - it's the dietary arachidinoic acid (animal-based omega 6) that's problematic.

Omega-6 intake seems to be a tripping point. We'll discuss that in a future post.

Dr Davis,
If we order test kits from overseas, even if the kit arrives OK I'm worried about customs problems when sending back my own blood in order to get the results. Any idea how likely this is to be a problem?

Hi, Rick--

To my knowledge, there should be no problem with international orders.

I remember one of the marketing points made by krill sellers is that krill EPA/ DHA is absorbed better into the cell membrane verses regular fish oil.  It would be interesting to see if that is true.

Interesting comment about the krill, although to do a fair comparison the Omega 3 intakes would need to be equal (or in the same ballpark) for both fish and krill.

To get to 1-2 grams of Omega 3s/daily from krill, it'd probably bankrupt you.

I think krill may do a better job than fish oil as to  reducing c-reactive protein and probably does absorb better. But it's not so cost effective at large doses.

Are you a vegetarian?  I think I read somewhere you don't like meat.  Perhaps this is contributing to your omega 3 index.

Hi.  I just recently saw something on WebMD that said Fish Oil has been shown to worsen your risk of heart disease.  What do you think about that?

I previously posted that I was taking 3600 mg O3s...when it is actually 1500 mgs...
will be increasing to around 2900 mgs.

Do have a question as far as the interaction of a pomegranate extract which I take...where this is also supposed to help clear plaque...any such thing as too much arterial clearing?

These companies that sell supplements and omega 3 index tests dont do the analysis.  
The lab that created the Index, OmegaQuant, does the lab work and is blinded to patient information.