Thanks so much for this. I'm a T2 diabetic controlling my blood sugar with a low carb diet. The only thing in my recent lab work that my GP is unhappy with is an elevated vitamin D level. A few years ago, a friend gave me a copy of The China Study (along with Fuhrman's Eat to Live, because they had "changed [her] life" and she hoped they would change my life as well. Based on my experience and reading about blood sugar regulation and insulin levels, what both had to say just felt wrong to me, over and beyond the simplification one might expect in a mass-audience book. So, I was skeptical about their broader health-related claims, though I wasn't concerned enough to investigate further (and have actually considered the ethics of regifting books that I think make dangerous recommendations). Because of this, it's quite gratifying to find my initial suspicions confirmed by detailed analysis.

When I looked up The China Study on Amazon, I found this statistical analysis of the China Study dataset under the comment section.  This is simply amazing and backs up pretty much everything you've said in your blog.  I hope someone can do an analysis to confirm this analysis.

http://www.amazon.com/Analyzing-the-China-Study-Dataset/forum/Fx1YJPR95OHW08P/TxY4S5EZD8Y2XE/1/ref=cm_cd_dp_ef_tft_tp?_encoding=UTF8&s=books&asin=1932100660&store=books

Very glad to see this analysis featured here, too.  I groan every time someone recommends The China Study to me as a great authoritative book, so Minger's detailed review was most welcome.

We must keep in mind however, Minger's review and different conclusions not withstanding, that The China Study is epidemiological data and it can only show association, not causation.   It still doesn't prove in any way that consuming wheat is harmful to health.  Don't get me wrong, I'm no fan of wheat anymore and no longer consume it myself or serve it to my family.  But it *is* fuel for the argument that considerably more study is needed before the government and health agencies continue to push wheat consumption on the public as matter of policy.

Perhaps the most astonishing thing about this analysis is that is is done by an "amateur" without any axes to grind.  It is a telling comment on the dihonesty and/or stupidity of most government and industry funded research.

Campbell doesn't deny that processed refined wheat flour (which is what they eat in china) is unhealthy.  He advocates eating whole plant foods.

Whole wheat, brown rice, beans, and steel-cut oats all seem to raise my blood sugar about the same amount, which is quite a lot depending on how much I eat.  Are they equally problematic?

happy to see denise mingers study featured here.

    wheat asides, milk pasteurised or uht causes a pretty massive immune system flare up for me.

How do we explain the positive correlation between plant protein and cancer?  I'm not ready to give up my kale and chard just yet!

Denise's astute analysis gives rise to the importance "digging a little deeper". I have always thought the benefit of eggs was contrary to the "official" line of thought. Little did I know the controversial aspects of wheat until stumbling along Dr. Davis' musings.

Sorry to come off topic here but i dont have the program in my  computer to email you. Dr. what do you think of this http://www.westonaprice.org/blogs/are-some-people-pushing-their-vitamin-d-levels-too-high.html

ramon25-

Very interesting study.  I would love to hear a reply as well.

Here is the T Colin Campbell's response to Denise's debunking of the China Study:

http://tynan.net/chinastudyresponse

Some commenters have wondered whether the wheat flour assessed in the study was refined wheat.  Chinese today eat mostly refined wheat products, but in the 70s, rural Chinese on collectives might have eaten differently, so I emailed a few Chinese professors of nutrition to ask.  It's morning now in China, and I got one response from Dr. Duo Li of Zhejiang University.  He told me in a brief reply that rural Chinese ate whole wheat products and the refined wheat was rare.

Denise's analysis of The China Study is heavily flawed and therefore invalid.  Debunked by a cancer epidemiologist...

Here it is...
http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/a-cancer-epidemiologist

The proper testing procedure as stated by an expert on analysing stats...
http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/my-response-to-denises

Campbells response to Denise..
http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/campbells-response-to-denises

Campbell, in his response, thinks Minger is probably an undercover agent in a larger conspiracy.  The  debunking epidemiologist, in his, points out that correlation and association aren't the same, which will probably not come as news to Minger.  Could be Minger has kicked the hornets' nest.

What I'd like to know is how correlations > 1 and < -1 are being generated, since that's impossible.

Thanks for sharing the research point of view,yes with the obesity that is hitting America it is necessary to learn that the cause of obesity is eating more of high protein diets and fats over vegetables and fruits.

Gary Taubes says Campbell's co-worker on the original study, Oxford professor of epidemiology and statistics Richard Peto also thought the data did not support Campbell's hypotheses.

Dr. Davis

The way wheat is consumed  in the west is very different from the way it is consumed in the east(fermenting/sprouting/sourdough etc.).

This post might be helpful to 300 million americans but mislead 4 billion asians.

With due respect I'd suggest you consider the above before going all guns blazing against global wheat consumption.

But Pallav, how can the Chinese be mislead when it's the Chinese's own wheat consumption that is being looked at in The China Study?

In reality, that study can only generate ideas, it can't test them. So even if it generates the idea that wheat is bad for humans, we must test that idea before it becomes the truth. As far as I know, Dr Davis did test this idea and came with the conclusion that it was the type of wheat that made the difference. Maybe the Chinese ate the bad wheat and that's why it shows up that way?

Anonymous wrote: "What I'd like to know is how correlations > 1 and < -1 are being generated, since that's impossible."

Denise says right in the post that she gave the numbers in percentage rather than decimals to make it easier to read. I.E. +33 = 33% = .33

Martin,
The way Dr. Davis tested einkorn and wheat currently generally available in usa (http://heartscanblog.blogspot.com/2010/06/in-search-of-wheat-einkorn-and-blood.html) is probably is what brings real value to this blog.
The subhead Europe:Sourdough bread http://wholehealthsource.blogspot.com/2010/06/fermented-grain-recipes-from-around.html is very close to how wheat is consumed in India. This process very likely breaksdown a large part of the offending ingredients such as gluten and phytic acid from a cursory search i did on google scholar.
I would trust a test on this process by Dr. Davis than on statistics, which as you rightly said generate ideas but need testing.
However, when Dr Davis goes on to implicate wheat in general for all sorts of diseases like in this blogpost, that applies to americans (the specific way of consuming wheat) and not necessarily to those who process grain differently like in asia.
That is the point where things get icky and can be misleading for those consuming wheat in asia and reading such posts.
Perhaps we can all come to a better way of processing grains than cutting them out from the diet altogether?

"a diet high in animal protein, especially casein"

Quickly, briefly, because my story is only tangentially related to this post by means of Dr Davis's almost stray remark I quote above...

I am ~5 weeks into my wheat free diet -- to zero success. I do not measure myself daily in any way, but the obvious one: do I lose weight? Yes, but only ~5lbs, which represents 2% of my total body weight. I should have lost that amount easily within 1 week, if I were proceeding on this diet correctly.

And then the other stray remarks began to pile up:
1) The 20 year old girl with celiac disease who dropped wheat AND 20lbs in 2 months. (What about me?!)
2) The dinner at PF Changs. I ordered the chicken lettuce wraps and skip the rice noodle thingees. Good job, I thought. Then I lingered over the menu, saw the restaurant offers an entire page of gluten free items, and the dish I just ordered was not one of them. I called for the waiter. He explained the sauce...
3) I drink protein shakes. A lot. As fate would have it, I migrated to casein protein because it broke down more slowly thus causing satiety to last longer. Until I read this post from Dr Davis with his stray remark, did my homework, and discovered to my chagrin that on a cellular level casein protein is so similar to gluten that it might as well be the same. (In essence.)

Okay, lesson learned. This gluten free, wheat free, grain free, carb free diet is not as easy as it looks at first glance. There is way more to it than skipping bread, and pasta, etc. But now I think I have it. So Sunday is Day 1. Shame I lost those first 4 or 5 weeks, but this time...

It may be true that wheat is a major cause of heart disease, but I'm not sure the high correspondence between wheat and cvd in this study makes that case.  Richard Peto, the Oxford professor of epidemiology who was part of the original study said what the data showed was that in places where people started adopting more of a western diet their health deteriorated.  I doubt the study spells out which parts of the western diet did the harm, wheat might be a marker for western diet.

People feel threatened when facts are released that go against the standard, cultural beliefs. We are raised as children to eat animals and animal secretions and so it is understandable why so many people feel threatened when they find out that the food mama gave them is helping to promote heart disease, cancer, diabetes, obesity, autoimmune diseases, digestive disorders, etc. The China Study is the longest, most unbiased studies ever conducted and show statistically significant results, worldwide, that ingesting animal foods create chronic ill heath in humans. I have helped 400 people in the last 4 years to eat a healthy, low fat, plant based diet and they have all rid themselves of the diseases listed above. Now, I have also some Kaiser doctors who, instead of handing pills or surgery, are handing out this book and getting the same results. Thank you Dr. T. Colin Campbell for your 35 year long work. And, I know that you went into this study trying to prove the opposite results!
When people hear that their upbringing needs to be challenge, they lash out with untruths….just as yound, 23 yr old Mindy has done.

People feel threatened when facts are released that go against the standard, cultural beliefs. We are raised as children to eat animals and animal secretions and so it is understandable why so many people feel threatened when they find out that the food mama gave them is helping to promote heart disease, cancer, diabetes, obesity, autoimmune diseases, digestive disorders, etc. The China Study is the longest, most unbiased studies ever conducted and show statistically significant results, worldwide, that ingesting animal foods create chronic ill heath in humans. I have helped 400 people in the last 4 years to eat a healthy, low fat, plant based diet and they have all rid themselves of the diseases listed above. Now, I have also some Kaiser doctors who, instead of handing pills or surgery, are handing out this book and getting the same results. Thank you Dr. T. Colin Campbell for your 35 year long work. And, I know that you went into this study trying to prove the opposite results!
When people hear that their upbringing needs to be challenge, they lash out with untruths….just as yound, 23 yr old Mindy has done.

To David M Gordon - how much of the lettuce wraps did you eat. PF Changs has nutritional info on the website and says this dish has 4 servings of 5oz. Each serving is 11 carbs so if you ate the whole thing yourself, that was 44 carbs.

It is very easy to underestimate carb counts. I have found a scale can be very useful. Mine measures carbs and other stuff.

That little dish is 4 servings?  C'mon! You bet, I bet I ate the whole thing, Anne.

What is in it that weighs so much? Some iceberg lettuce leaves, chicken, the rice noodle thingees I did without, and the sauce -- which is NOT gluten free, but I changed to a gluten free sauce. I bet that swap changes the calorie count etc. (Hey, I can hope!

Sure I want to lose weight -- okay, I must lose weight -- but my issue is visceral fat and its resulting potential problems: diabetes and heart issues (inflammation).

Thank you for your comments.

Instead of driving yourself with all these numbers why not just look for visable proof in REAL people.  I decided to try plant based eating and here is what happened:  (the numbers have actually gotten better since this was published last October)  Why I'm a believer in Dr. Campbell's advice:
http://www.drmcdougall.com/stars/mike_teehan.htm

Instead of driving yourself with all these numbers why not just look for visable proof in REAL people.  I decided to try plant based eating and here is what happened:  (the numbers have actually gotten better since this was published last October)  Why I'm a believer in Dr. Campbell's advice:
http://www.drmcdougall.com/stars/mike_teehan.htm

Mike, good for you. See this:
http://www.proteinpower.com/drmike/ketones-and-ketosis/low-carb-gaining-a-foothold-with-the-mainstream/

If Campbell is right that a plant-based diet is best for most humans, why did the low carb group do better than the other two groups (Ornish and LEARN diets) in the intervention study above? Not only did the low carb group do better in weight loss, they did better in all things measured.

Denise Minger wrote:

"Here we have evidence that areas in China with the highest rates of Western-type diseases also eat the most processed starch and sugar. Maybe not in the grotesque amounts that Americans eat them, but then again, China’s “affluent disease” rates were also lower than America’s"

This could easily be the headline "Minger accuses Americans of grotesque eating habits"

Debate is good but be healthy, not paranoid
Trevor

How can anyone tell anyone else what to eat?  We all NEED plants to survive.  However, some do better with wheat in their diet and some do better with meat in their diet.  It all depends on the person.  I wouldn't go bashing The China Study until you try the whole foods plant-based diet.  Dr. Campbell also stresses that nutrition is NOT about a single nutrient or food group.  It's all about the synergy of everything working together.  I would love to see Denise's analysis of the aflatoxin rat studies.  Everyone needs to take control of their own health.  No one should rely solely on the china study as what they should do.  I personally believe in what the china study is saying, but it might not work for everyone - especially when people are raised to eat animal protein.  I know I have issues with animal protein, but others might be able to tolerate it.  Don't go bashing Dr. Campbell for trying to help people.

Dr. Bill Misner Ph.D. said:
The BMI body mass index of rural Chinese is 21.0 supported by a daily calorie intake of over 2600k/cal/day from largely plant foods.
Americans on the other hand consume largely animal sourced foods of 1989 calories per day resulting in an obese BMI of over 27.0! All one has to do is compare the source of total calories with resulting BMI.

Eating 2600 calories whole plant foods that contribute to a lean healthy BMI of 21.0 is preferred to eating 1989 calories from largely animal sources resulting in an obese 27.0 BMI.

Elevated Body Mass Index associated with food category choice are also associated with the typical disease patterns in obese persons.  The China Study shows these numerical correlations precisely.

I confirm the report that overweight exists more in cultures consuming largely animal source calories than in those whose diet is primarily whole plant foods.

Interestingly, I have observed all of the above in Americans who change their menu from animal source to whole plant source food protocols.

Warm regards,

Bill Misner Ph.D.

"I would love to see Denise's analysis of the aflatoxin rat studies."

You can read an excellent analysis HERE. In a nutshell, what those rat studies prove is that complete protein provides better nourishment than incomplete protein. Wheat is naturally deficient in lysine, and when lysine was added to the wheat protein diet, it behaved just like the casein.

Cancers are very fast growing cells, so of course they're going to grow a whole lot better if they're better nourished. I'd wager that if the rats had been fed a complete vegetable protein blend, e.g. rice and pea protein in the correct ratio, the tumor growth would have matched both the casein and wheat plus lysine.

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Friends,

  You don’t need to believe Dr. Campbell. Just read The China Study, slowly and completely, and figure out the truth for yourself. Facts speak for themselves.

  I, and a few of my acquaintances, tried a whole-foods plant-based diet (coupled with biweekly exposure to sunlight in noon and some physical activity) for a few months (strict compliance), and it is working wonders for us, so we continue to be on it. Some of my friends failed, because they were mostly eating junk (plant-based) foods.

  The China Study book is not just about Dr. Campbell’s work, but more than that it describes the work and results of numerous other research studies, independent and unbiased, that point to the undeniable benefits of a whole-foods plant-based diet.

  Denise has adopted a detailed but very narrow view that is insufficient to relate to the larger context. This approach will only add to confusion and misleading conclusions.

As a physician with the health of your patients at stake, Would you accept conclusions that were not peer reviewed?

Wonderful post... Very informational and educational as usual!

Acai Berry Optimum

Your blog entry appears to have been truncated.

How are Stan's blood sugars?

Sounds like Stan is screwed. Of course, there may be other factors mitigating his lipid pattern because he avoids the neolithic agents. Stan would be more susceptible to heart disease than ollie on the SAD, but not when they both have good diets?

Is it possible that a different diet might work for Stan? I don't know what it would be, I just wonder if it's possible.

So Ollie and Stan BOTH show substantial improvement on their LC diets.

The difference between them may well be due to genetics, but where is the evidence that Stan needs to avoid saturated fat?

Did you advise Stan to increase sat fat and then watch his sdLDL get worse?

If they accomplished this with "oils" at the expense of saturated fats (oils are liquid due to the paucity of saturated fats in them), then it looks like they both have a saturated fat deficiency, and one could speculate that Stan is even more deficient than Ollie.

Swap out the nasty oils for more butter and beef fat and coconut fat and maybe Ollie will have sdLDL of 0 (like I do on 35% of calories from sat fat) and Stan will improve even further.

Hi Dr Davis,

You describe a fascinating scenario.

Ollie has clearly lost weight. He has lost 55 lb in 6 months. That is nearly 10 pounds of "lard-equivalents" each month. This has not evaporated. It is exactly what he has been running his metabolism on. Whatever nuts and vegetables he has eaten can have been nothing in comparison to the 4 times half pound blocks of lard he has "eaten" from his own adipose tissue, every week. Result: Metabolism runs on lard and sdLDL plummet.

Stan has lost minimal weight so has run his metabolism on  his food alone. If this is low in lard he may well be running his metabolism on vegetable derived carbohydrate and nut derived omega 6 PUFA. It's possible he has NOT been eating 2lb of lard a week in his diet, because obviously this might raise his LDL. So he has NOT used lard to fuel his metabolism, he has used nuts and vegetables when Ollie has used lard from his adipose stores.

Before I would blame genetics I would get rid of the nuts and unlimited vegetables from Stan's diet and replace them with exactly the same the adipose tissue derived fuel that Ollie was using. If Stan cannot spare it from his butt (he certainly cannot at BMI 21), it's going to have to go on his plate. Two pounds of lard a week.

Then compare sdLDL values, when you have similar metabolic situations... Until then Stan just has nut and vegetable poisoning showing as sdLDL.

There do not have to be any genetics involved. There might be, but let's keep it simple for the time being... Ollie is on lard while he is losing weight. Mimic that.

Peter

Stan did improve.  Maybe he will improve further, the longer on diet?

I think it's somewhat telling that you advise your patients to eat "oils."  What kind of "oils" are they eating?  Why are your patients eating unlimited nuts?

Until you get off the Omega-6-loaded "heatlhy" polyunstaturated fats bandwagon, it's hard to take your clinical observations on "fats" very seriously.

Dr. Davis,

Help me understand the part about not eliminating meats or fats.  First, here is my blood work 15 days apart.

Total cholesterol 295 - 15 days later 156
LDL 200 - 15 days later 102
HDL   46 - 15 days later  32  (have added 1500mg of niacin since then)
Triglycerides   242 - 15 days later 109
VLDL  49 - 15 days later 22
Vitamin D was 28 – 15 days later it’s 56 (using 10,000 of Carlson’s D3)

FYI my heart scan was 899 (54 year old male)

I started on all the main nutrients you recommend here plus a few.  I dropped dairy like a hot potato including 6 or more ounces of cheese a day.  During those 15 days I ate only plant based foods (have since added some salmon and egg whites)

The only oil I use now (sparingly) is olive.  I have a couple of gallons of coconut oil I assumed would have to be tossed sooner or later.

Guess you could say I became fat paranoid and downright phobic about any saturated fat.

Am I understanding I could add back Grass-fed beef (omega-3) pastured chicken and Omega-3 whole eggs?  Coconut oil?   If so, is there some safe percentage of a person’s diet to include those proteins/fats?

By the way, my doctor wouldn’t let me out of his office without a copy of your book.  He’s one in a million as are you!

Steve

Doc, would you say family history could be a clue towards small-particle tendencies?   I have zero family members with heart issues yet I was given pause by your recent post on saturated fats having a disproportionate affect on these genetically challenged folks.  I ask because I eat a ton of rib eyes and bacon.

I have indeed had many people with presumed "genetic small LDL" load their diets with oils and fats with only minor improvement. Loaded with saturated fat, however, and there seems to be deterioration.

I know this flies in the face of the "saturated fat is great" dogma, but I don't make this stuff up. Just as I don't make up the deterioration of postprandial triglycerides and chylomicron remnant effect when saturated fats are loaded heavily in the diet.

The persistence of small LDL is also long-term, i.e., it persists for years despite continuing efforts.

Oils = olive oil, flaxseed oil, canola oil (yes, yes, I know), avocado, almond, oils from raw nuts and meats.

No polyunsaturates here. You've go the wrong guy.

On Doctor's orders, Ollie did indeed lose a massive amount of weight.
http://www.youtube.com/watch?v=IYAeYj8-G4w

@Peter, fascinating...eat lard when slim in attempt to reduce sdLDL.  Doc D thanks for 'splaining 'genetic' tendency to sdLDL & why numbers not reduced on sat fat & only reduced mildly on mono sats.  Great info guys!

"Oils = olive oil, flaxseed oil, canola oil (yes, yes, I know), avocado, almond, oils from raw nuts and meats.

No polyunsaturates here. You've got the wrong guy."

But Dr. Davis, those all chock full of PUFAs

Linseed oil (flax oil) is 71% LA and ALA

Rapeseed oil (Canola oil) is 33%  LA and ALA

Almond oil is about 25% PUFA

Even olive oil can be up to 20% PUFA

And all of these are mostly Linoleic acid.

All best left as industrial lubricants and paint additives rather than eaten.

So, you have a fat guy, who has been living on (his own) saturated animal fats, and he has improved a lot.

Then you have a skinny guy, who has been living on "healthy vegetable fats" with surprisingly much LA in them, and he has not improved that much.

So, it seems to tell that without saturated fats LDL improvement is much harder in LC, to say it kindly.

And it sounds as if butter and saturated animal fats would be advantageous for the latter guy, too. Have they ever tried this, under your coucelling?

With regards,
LeenaS

Dr. Davis,

While body composition certainly isn't a prerequisite for being part of a classic comedy team, I couldn't help but notice that Stan had the makings of a skinny-fat bean pole checking in at 5' 10" and only 148 pounds. Those stats make him sound like a diehard distance runner or a chain smoker.

While it was clearly just for illustrative purposes, I couldn't help but think that, if "Stan" exercises at all, he must not be exerting himself very much. I'm not advocating that every older gentleman suddenly attempt to impersonate Mr. Olympia, but I have to wonder seeing such a lightweight. That's not to say that I think sufficiently intense exercise would remove the problem that is genetically-based small LDL, but it is enough to make me raise an eyebrow when I see that type of weight for a male listed as 5'10".

Dr. Davis,

Would a take-home point simply be to let the numbers from proper testing be the guide versus what we "think" is right based upon generally-sound dietary advice that may apply to many, but not all, situations?

Bill Lindvall

Olive oil is monounsaturated but flaxseed oil, canola oil, avocado oil, almond oil, and oils from raw nuts are all polyunsaturated oils!  Yes, flax oil is omega 3 and canola has more omega 3 than omega 6, but both omega 3 and omega 6 are polyunsaturated.

Do you know how much saturated fat was eaten?

Maybe too much mono-unsaturates?

In another post, you said that blood sugars parallel small LDL.  Do Stan's blood sugars follow the pattern you would predict for someone with a lot of small LDL?

http://heartscanblog.blogspot.com/2009/12/to-track-small-ldl-track-blood-sugar.html

No polyunsaturates?
Because olive, flax, canola oils, nuts have no polyunsaturated fats?
I found something different.
Even avocados have 10 % PUFAs.
http://curezone.com/foods/fatspercent.asp

So what about epigenetics? Any way to modify this unknown gene or set of genes?  Pomegranate, etc?

Please guys, find so other monounsaturated (MUFA) fats with less PUFA..

I eat almonds, walnuts, extra virgin olive oil as fats and my diet is low in Omega 6, 10% or 20% of Omega 6 PUFA is nothing compared with 70 or 85% of MUFA.

My experience taking a lot of saturated fats with low carbs is bad, I prefer a diet high in MUFA and low carb.

Maybe the mental stress of having to worry about what to eat is a factor.
I do find my self stressing about that often and wonder if just enjoying the food would give me a longer nicer life quality which is in then end what matters.

Which reminds me somehting I have never read in this blog is about cortisol.
Have you ever tracked cortisol levels in your patients?

A yea ago, i went off niacin and zocor due to elevated liver enzymes.  Before I restarted niacin, an NMR lipoprotein analysis showed:
LDL particle number - 2197
Small LDL-P - 1614
LDL Particle size - 20.3
Saturated fat (% of calories) - 21%

Six months later, after radically increasing the amount of coconut oil I consumed, the results were:
LDL particle number - 896
Small LDL-P - 466
LDL Particle size - 21.6
Saturated fat (% of calories) - 45%


Five months after that:
LDL particle number - 946
Small LDL-P - 120
LDL Particle size - 21.1
Saturated fat (% of calories) - 52%

Carbohydrate consumption has held fairly steady at 10% of calories.

I agree 100% with these comments.  Not a drop of dogma in them; pure science.  Yes, omega-6 is evil; avoid foods with any of it. No nuts, no seeds. Soy -- dangerous.  Milk -- cavemen didn't drink it and it's possibly dangerous too.  Vegetables -- no, no, goodness no, they're mostly made of dreaded carbohydrates, have little fat, an fiber isn't important!  Saturated fat?  I don't know about you, but I'm too scared to go hog wild on it.

I know, I know!  Let's not eat at all.  That would drive small LDL to 0!  That would end heart disease -- and everything else -- in a flash.

Or, just maybe, we could be moderate and sensible.  Take some fish oil to balance whatever omega-6 you get in the olive & canola oils and in nuts.  Eat some, but not too much, animal protein, and mostly fish and lean meats at that, because saturated fat isn't out of the woods yet. (Just because saturated fat's risks have been over-hyped doesn't mean that we should eat all meat all the time, because the evidence is not in yet that saturated fat is a panacea.) Eat some, but not tons, of fruits, because they have antioxidants.  And for goodness sake, eat your vegatables -- lots of them, and all kinds of them -- because your mother was right to make sit at the table until you finished them.

"I couldn't help but notice that Stan had the makings of a skinny-fat bean pole checking in at 5' 10" and only 148 pounds. Those stats make him sound like a diehard distance runner or a chain smoker."

I'm 5'10" and under 145 lbs., and I'm neither.

Kurt G & Lightcan,

I think when Dr. D said no "No polyunsaturates here. You've got the wrong guy."...he probably meant to say "No (high omega 6) polyunsaturates here.".

Lastly...I have a question for Dr. Davis:

Dr. D., is this "genetic small LDL" the same as when you talked about people with ApoE4 in your November 17, 2008 post? If so, do you think it would be helpful to test ApoE before experimenting with diet??

Thanx!

John M.

Aren't most nuts full of N-6 PUFA?

Hi Dr. Davis,

and what is happend with the triclycerides of Stan. Are they high too?

This is usually when the good doctor stops answering comments.

Come on, Dr. D, prove me wrong!

You have really great taste on catch article titles, even when you are not interested in this topic you push to read it

I'm going to steal a page from T. Colin Campbell here (yechh!)

Dr Davis, you say that

"I have indeed had many people with presumed "genetic small LDL" load their diets with oils and fats with only minor improvement. Loaded with saturated fat, however, and there seems to be deterioration."

Campbell makes the contention that studies showing that low saturated fat intake is beneficial (never mind whether they actually exist or not, just for the sake of argument here) might actually have nothing to do with the type of fat in the diet, and everything to do with the protein which accompanies the fat; most animal fat in our culture comes attached to meat (protein.)

Adding plant fats and oils to the diet, including nuts, would tend to increase total percentage fat in the diet at the expense of both carbohydrate and protein. Adding animal fat, attached to meat might increase total protein percentage even as it increases total saturated fat.

Understand, I'm not saying "protein bad," I guess I'm just echoing Peter, really, Stan may be trying to live off of a protein/fat mix that's too rich in protein, entirely aside from the whole issue of saturation.

Don't tell me no one picked up on the Laurel and Hardy reference! Brilliant!

Could all you saturated fat mafia people please stop polluting the comments section?

Maybe recommend Stan use only sat fats and no poly oils and then see if there is a change.

Drs. Davis and Harris,

Googlemaps indicate you two practice your medicinal arts about 154 miles away from each other.

May I respectfully suggest a summit meeting in Manitowoc to resolve these matters?

Flax oil, canola oil, any nut oil (except macadamia nut oil), and all of those nuts -- these are all rich with polyunsaturated fats. I never eat these oils, and my Lp(a) is 2, as last measured a few months ago.

I always recommend nuts as a very moderate snack because of their high PUFA content.  Macadamia nuts are the ONE exception, with a fatty acid profile similar to olive oil.  Basically, I never recommend any food with a PUFA content greater that 12 percent.  That means canola oil is right out!

Dr. Davis, perhaps try putting a few of these presumed "genetic small LDL" people on a real low PUFA diet for a while (with more coconut oil and butter--but no nuts during this period) and see if there's improvement.

I'd bet there is.  Nothing really to lose by giving this a shot.

If it works to your satisfaction, I'll donate $1000 to your Track-the-Plaque program, or a charity of your choice.

Some other features of the presumptive "genetic small LDL" pattern:

1) It occurs in the minority of people with small LDL, likely less than 20% of people who start with substantial small LDL.

2) It is associated with insulin resistance and a tendency towards diabetes

3) It can occur independent of ApoE genotype. However, if it occurs with ApoE2, it means a very potent carb-sensitivity/diabetic tendency.

4) The "floor" of 600 nmol/L can be broken. We've had success achieving really low body weight and inconsistently with several supplements, e.g., phosphatidylcholine.

This area is fascinating, though very poorly explored. "Genetic small LDL" is truly one of the problem areas in gaining control over heart disease risk.

I currently consume coconut oil and butter  I do not use any lard or pufas  I consume a moderate amount of almonds a day ( nine) and some ground almonds as a meal replacement about 10-20gs as a meal about two or three times a week

I eat avocados maybe twice a week  about two-three

I have started to show my abdominal muscles after two months where before I looked as if I were pregnant of about a 5 month pregnancy

I have dropped half a stone  My BP is controlled by a sartan

I consume a moderate amount of frozen blueberries and raspberries May be about 1 kg of each a month

or less

I am living on saturated fat and loving it

My body works better on it but then I have blood group B

You have to eat right for your blood type perhaps?

I would like to add support to Dr. Harris' hypothesis. LDL (no NMR in our country) and TG both rise on low carb, high sat fat diet. No weight problem ever. No high protein no high PUFA for me. Pre-diabetic fasting glucose (110-120). Only complication is I had my gallbladder removed (but my brother didn't). Will increase coconut oil and olive oil on account of double cream. Feel so good on low carb it can't be wrong. Also wonder if under healthy low carb diet LDL and TG have atherogenic effect (My calcium score is low)
In summary I think Dr. Davis is onto something but I would love to know if LDL status corresponded to increased calcium score in the said patients.

Choline deficiency can lessen hyperglycemia in rodents with fatty livers. Maybe the inconsistent effects of phosphatidylcholine have something to do with that?

To the person who mentioned the saturated-fat mafia; we have limited information going in here. Trying to guess at alternate explanations isn't the same as insisting that saturated fat is good in all situations for everybody, no matter what. Proper skepticism demands that we question even the most respected sources.

Dr. Davis, this recent article seems congruent with some of your observations:

http://jn.nutrition.org/cgi/content/abstract/jn.109.115964v1

To all these nutty omega-6 fatphobes - I eat lots of nuts of all sorts, probably 40% of calories, including... peanuts, which I am aware are a legume.  I have no small LDL, undetectable CRP, and lp(a) of 4, high hdl and low homocysteine, HbA1C of 5.2.

Dr. Davis,
You said "Some other features of the presumptive "genetic small LDL" pattern:

1) It occurs in the minority of people with small LDL, likely less than 20% of people who start with substantial small LDL."


So, based on a minority of people with small LDL, you are recommending the same diet to everyone?

Please don't misunderstand: I am NOT saying that saturated fat increases small LDL in most people.

What I am suggesting is that there is a genetic minority in which saturated fat increases small LDL. These people seem to be the unusually slender, high HDL, low triglycerides, yet diabetes-prone who show apparently intractable small LDL.

I don't know for a fact why this happens, but I speculate that it is a genetically-determined trait.

This pattern responds best to a high-protein, high-fat, very low-carbohydrate diet. But saturated fat is the exception in this group.

Hello Dr Davis

I am only persisting in this as the implications might be important.

I asked, "Did you advise Stan to increase sat fat and then watch his sdLDL get worse?"

You later said, "Loaded with saturated fat, however, and there seems to be deterioration."  and ..

"What I am suggesting is that there is a genetic minority in which saturated fat increases small LDL."

and...

"This pattern responds best to a high-protein, high-fat, very low-carbohydrate diet. But saturated fat is the exception in this group."

Can I assume when you say "seems to be deterioration" and "there is a suggestion that saturated fat increases small LDL" and "saturated fat is the exception" that this is based on the observation of  serially increased sdLDL NMR values after increasing only saturated fat intake in these 100 or so patients?

If this is what you have, serial NMRs that show increased sdLDL with increased saturated fat intake, why not say so explicitly?

Or is it just a reasoned (perhaps correct, perhaps not) guess of what would happen to sdLDL in those 100 or so who have this presumed genetic pattern of persistent sdLDL?

Dr. Davis wrote:

"I know this flies in the face of the 'saturated fat is great' dogma, but I don't make this stuff up."


The way that Peter described the scenario you presented, it seems to support the health benefits of saturated fat rather than deride them

Ollie is mainlining saturated fat from his gut.  Stan is not.  Ollie's sdLDL drops like a rock.  Stan's doesn't.  

It seems like if this phenomenon of high sdLDL specifically affects low BMI people, their lack of saturated fat intake, whether through their mouths or from their love handles, could be the culprit.

Dr. Harris,

I'm a fan of your blog, but I can't help but notice that you have completely ignored Dr. Harris's questions in this entry as well as the other recent entry about saturdated fat and LDL.  I find his questions to be pertinent.

I'm actually a little surprised no one's brought up this blog, that indicates polyunsaturate consumption over 4% of calories can be detrimental:

http://wholehealthsource.blogspot.com/2009/05/eicosanoids-and-ischemic-heart-diseas.html

Eh. Took me long enough to find. At any rate, 10-20% polyunsaturates, especially if they come from omega-6, is a huge amount for a human.

Imma going to go away and let you argue now.

Hear Hear throwing cows out of windows...  It blows the polyunsaturates out  of the window

I have the printout of the Rose et al Paper..

Corn oil increased the death rate

My family has a history of high colestral and plaque build-up in the blood.  Should I stay on my Lipator and stay on a low-carb diet ?  Your article brings up some red flags for me.  Maybe I should talk to my Doctor, but my low-carb friends tell me the doctor will tell me to get off the diet !  I would like some advice.

How did that happen? Is it possible? Different diet will work to Stan? I am curious about that. I will visit this blog again. I am hoping for an update.

Obviously another great blog about eating and living right, but at some point we have to take a step back and live.  Food avoidance and constant stressing about food seems it could negate any benefits of just eating a sensible, well balanced, moderately low carb diet.  

To me, all these nutrition blogs are fun to read at work. But have you ever noticed the incredible difference in opinion from one to the next?  I take all that with a large grain of salt, pun intended.

Oh my god, I ate a walnut, surely I will be in the cath lab tomorrow getting my LAD stented;)

You might not find yourself in the cath lab from eating the random 1/2 cup of oatmeal, but you might find yourself there from stressing about it too much.

Read all the blogs, use all the information to help guide you.  But don't get in line with the zombies and wander off the deep end too far.

Just a thought.

Here's a stumper. I just had my VAP done and the results surprised me. Some background: I'm not on any medication and never have been. Never had a weight problem, body fat below 20%. I exercise regularly (CrossFit 4x/week). Never smoked. Rarely drink. I eat mostly a primal diet w/plenty of grass-fed/organic/cage-free/wild-caught meat/fish and lots of fresh veggies. Some dairy, but only hormone and antibiotic free. Hardly any grains or processed foods. Low fasting blood sugar (76 as of two weeks ago.) Here are my VAP results:

Total cholesterol: 200
HDL : 79
LDL: 106
VLDL: 14
Lp(a): 7
Triglycerides: 43

With all that I'd expect to have Pattern A LDL. Yet the VAP test says I have Pattern B! I'm not aware of any history of heart disease on either side of my family. But if it's true that my LDL is small and dense, all I can figure is that it must be genetic. I'm not really sure what to make of it! Any ideas?

Liz Stanley - while my HDL and LDL aren't as good as yours (63 and 185 respectively), I also just received VAP results that stumped me for a similar reason.  I exercise frequently, am not overweight, don't smoke or drink, eat low carb, etc., yet I have pattern B as well.  To add to the confusion, my cCRP is 0.7, which my doctor said was excellent and basically renders my test results a wash as I have zero other risk factors.  I don't know what to make of any of this when you put it all together, and I stumbled upon this post because I'm hoping to find some answers online.

While body composition certainly isn't a prerequisite for being part of a classic comedy team, I couldn't help but notice that Stan had the makings of a skinny-fat bean pole checking in at 5' 10" and only 148 pounds. Those stats make him sound like a diehard distance runner or a chain smoker.