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Dr. Davis, I agree Tom has hit on something HUGE with his film FAT HEAD which is why I asked him to join us on the cruise to show his film.  THANK YOU for your incredible contributions during the conference and I am grateful to you for your generous donation of time to join us.

The low-carb manifesto tries to convince you that fat doesn't matter and therefore calories don't matter.  LC books pander to the people who can't or won't control their appetites, telling them, 'It's not your fault, have some brie instead of a cookie'.

But ingested fat being twice the calorie density of carb or protein does eventually add to the fat stores.  Those LC dieters who lose weight and maintain have CCK's effect on satiety to thank.  

kevin

Tom Naughton's diet related blog is also worth keeping an eye on.
Always interesting, sometimes extremely funny, he believes in straight talking so doesn't mince his words.
Tom's other blog is also interesting

This is great! Check out my blog post on blood sugar and metabolic syndrome...http://tinyurl.com/y9tr8va

It is a good film and the animation of how fats get into cells made it easier to understand. Tom's blog is always an entertaining and educational read. http://www.fathead-movie.com/

I so wish I could have been on the cruise - maybe next time.

Hi Dr. Davis,
this is a comment for your fish oil article.  I have a curious case: one has very high triglycerides (above 1000 mg/dL) and recurrent acute pancreatitis since 20s, have been taking 9grams of omega-3 in combination with 145mg tricor, 40mg simvastatin and niacin (1g) per day for 1 year and haven't successfully lowered the triglycerides.  His LDL and cholesterol are both normal with very low HDL (<20). No liver, kidney, pancreas or thyroid disease.  Underweight, not drinking, follow a strict low fat, complex carb, good protein, high veggie diet.  What do you recommend?

freyal, just wondering what your goals are with your patient?  If you are trying to kill him, you are doing a good job.  

A low-fat, high "complex" carb diet will keep the triglycerides high and the HDL low, as you have proven.  It doesn't matter how much fish oil, statins, or niacin you add, until you re-align your thinking with regard to diet, you are never going to help this guy.

Have you actually read this blog?  Because your question is ridiculous if you have.

Thanks for your response!  I actually just started reading this blog more extensively after posting my comment above.  I see Dr. Davis's point on limiting carb.  So do you recommend low-fat low carb diet?  He actually tried low-carb high protein diet sometime ago but without much success.  Because it is hard to just eat protein (will be very high protein here for 2000-cal daily intake) without fat and carbs.  Maybe the failure was because he couldn't limit fat as strictly as in the low-fat, carb+protein diet.  His TG is very sensitive to dietary fat too.  But now we will try low fat, low carb and high protein diet and see if there is a reduction.


Another problem is, what do you recommend for the "gas" problem associated with high protein diet?  Thanks for your help!!

Freyal, so you are saying his chylomicrons don't get cleared from the blood within reasonable time?

freyal, no, high-protein/low-fat is not good either (look up "rabbit starvation").  Use a very low-carb/ moderate-protein/high-fat diet.  The best fats to raise HDL and lower triglycerides are saturated fats like butter, tallow and coconut oil.  Stay away from vegetable and most nut oils, especially because they are high in inflammatory omega 6 oils.

Gas (usually caused by fermentable carbohydrates, including lactose if he is eating dairy) may not be much of a problem when you correct the diet but if it is, try digestive enzymes and betaine HCL.  

Check out some other blogs on Primal or Paleo diets.  http://www.paleonu.com/ is one of the best, click on "Get Started" to see the diet then check out the rest of the blog!

Hi Anna,
yes.  His TG remains above 1000 with healthy diet and TG lowering medications.  His TG would only come down to normal level after several days of fasting during hospitalization due to acute pancreatitis.

Hi Anonymous,
thanks for the rabbit starvation info.  I thought high protein-low fat-low carb would be lacking a lot of essential nutrients.  

But about your point that "The best fats to raise HDL and lower triglycerides are saturated fats like butter, tallow and coconut oil.", I have never heard about this and could not find any source.  Could you please point me to some studies that support this claim?  Thanks!

freyal - is the patient gluten free instead of just wheat free?

Hi,
he is not gluten free or wheat free.  He tried moderate-fat, low carb, high protein diet, and also low-fat, moderate complex carb + moderate protein diet.  Both did not work to lower his TG.  He is not allergic to gluten I believe.

Someone above mentioned high saturated fat (butter palm oil etc) works better to lower TG.  I'm not sure about this approach.  Even if there are studies supporting this (I only found one so far),they were all done with normal people.  He is not normal in terms of TG, he has genetically very high TG and is very sensitive to dietary fat (be it saturated or unsaturated) and would get acute pancreatitis every time following a large heavy greasy meal.  
I appreciate all your comments, please leave more if you have thoughts about this patient, thank you!

freyal - start with the PaNu blog and then look at the following blogs http://high-fat-nutrition.blogspot.com/, http://drbganimalpharm.blogspot.com/. http://www.nephropal.blogspot.com/ - you will see hundreds of studies analyzed.

the niacin is too low.  it should be 3gms/day.  ensure it is niacinic acid.

http://www.lipidsonline.org/slides/slide01.cfm?q=niacin

and

McKenney JM, McCormick LS, Schaefer EJ, et al. Effects of niacin and atorvastatin on lipoprotein subclasses in patients with atherogenic dyslipidemia. Am J Cardiol 2001;88:270-274.