The part of the study that caught my attention was "Current and former smokers had higher incident CAC rates than never smokers, but this difference was not statistically significant once other risk factors were considered. "

Dr Davis,

I recently came across your blog and it peaked my interest. I have been tracking my lipids for several years now.

Let me give you a little background. My dad had by-pass surgery when he was in his forties. He spent the rest of his life watching his diet and lipids and blood pressure. In 2005 he died from coronary failure a month after turing 71.

Because of my family history, and lipid levels (LDL 130, HDL <40), my physician wanted to start me on advicor. I resisted and tried to moderate my lipids through diet and exercise. I used the low fat diet approach and got nowhere. So I started on Advicor late in 2003. By March of 2004 my profile was right where my doctor wanted it: LDL 76, HDL 41, TriG 98. I continued on Advicor and had my lipid profile and liver enzymes checked every 6 months. I started keeping my scores in a spreadsheet and have been tracking them ever since.

After taking Advicor for a while I started reading about the side effects, about the additional predictors for heart disease, and the limitations of the physician "approved" diets.

After doing all this reading, I wanted to try once again to moderate my lipids through diet. In January 2006 I stopped taking advicor and changed my diet so as to reduce carbohydrate. I started eating cheese omlets cooked in butter for breakfast. I did not avoid red meat. I stopped eating rice, potatoes, and white flours, etc. As a result of these changed my HDL went up from 40 to 50. My TriG went down to a low of 73. Unfortunately, my LDL went up to 130-140. So after about a year I went back on Advicor but kept my diet similar (except I went back to whole grain cereal for breakfast). The other change I made last year is I started on an aggressive exercise program. I exercise 4-5 times a week for 50-60 minutes, keeping my heart rate at the 80% level. I also got a bicycle and started biking on the weekends (that has been quite fun and rewarding - I did an MS-150 ride this past October). I've only lost a few pounds 210 to 195. At 6'3" my BMI is barely in the "normal" range. I have recently switched Doctors due to other factors, but my new doctor wants to keep me on Advicor.

My questions are these. Am I just fooling myself into a false sense of security by taking Advicor and monitoring my lipids? Should I continue this plan or make some mods?

I anticipate that you will recommend a CT scan. Are they costly? Covered by insurance? Require a Dr's referral? What levels of radiation exposure do they impose?

I look forward to hearing your reply.

thats very interesting. The "conventional" risks only explain about 12% of plague increase and yet its well documented that statins reduce heart attack by somewhere between 30 and 40%.

Hi, Barry-


Thanks for your interest. However, I cannot answer direct medical questions, as good as they are.

I would invite you to look at the website that this blog accompanies, www.trackyourplaque.com.

Using conventional cholesterol as your index of risk is a fool's game. I could introduce you to hundreds of people who've had heart attacks and bypass surgery who thought they were being well served by conventional cholesterol. In my view, it is a model-T of medical testing.

I didn't find much value in this report because it doesn't look at percent changes in CAC, which seems to me to be the most important parameter to judge if plaque is growing at an unacceptable rate. Another thing about it, they didn't consider lipoprotein subclasses, but haven't most or all of the MESA subjects had NMR testing? Combining Otvos' NMR data on the MESA population with the CAC percent change data from this study could give some real insight into how and why plaque progresses. It looks like no one is going to do such a study. Is there any way a member of the public can get the raw data from the MESA studies, so we can do our own analysis? After all, MESA was funded by public funds, wasn't it?

To my knowledge, NMR lipoprotein analysis was not performed as part of this study, or at least used for this type of analysis to predict events or progression of calcium scoring.

Yes, NMR results were not used in the study, but the study was done on 5756 subjects who participated in the MESA test. Mora did a study of the NMR results 5538 MESA participants, but didn't look at CAC progression (Atherosclerosis, 2007 May;192(1):211-7) Isn't it a pretty good possibility that these studies were both done on the same basic group of MESA participants? If so, the data is out there to do a study of the effect of lipoprotein subclasses on CAC progression, it just hasn't been done yet.

Is it possible that the MESA data could be made available to us, or is the data totally  controlled by the people who collected it?

Hi, Harry--

I do believe that access is obtainable, though I am unsure how restricted. Go to http://www.mesa-nhlbi.org/default.aspx# for application information. I would like to do the same when some research time has been freed up.

Dr. Davis, from reading the MESA website, it looks like the MESA people aren't going to release the data except to qualified researchers working for established institutions or companies, and who will publish their results in a peer-reviewed journal. They aren't interested in making the data available to the general public, where it could be misinterpreted, thereby casting doubt on the overall MESA project.

That leaves people like me out, because I just want to play with the data and look for possible correlations that haven't yet been investigated, like the effect of lipoprotein subclasses on CAC progression. Unless some established research group becomes interested in doing such a study and publishing the results, it probably won't get done. It's a bit frustrating, because it looks like the data is all there to do such a study, but there is no way to get them to release the data.

It will probably take a fairly significant expenditure of time and analysis to investigate this and publish the results, so it will probably take a full time research group to do it. With all the other things you are doing, it may be difficult for you to take the time to do this kind of study. Perhaps with your contacts with clinical research people who might be interested in investigating this, (e.g., Otvos, Raggi, Budoff, Rumberger?) you could get the ball rolling.

Also, it looks like a person can't get the data unless they specify exactly what they are looking for, which sort of rules out looking for correlations that haven't been previously suspected. There is something to be said for shoveling all the data into a stepwise multiple regression program and seeing what pops up as the most significant parameters, but with the tight controls they have on releasing data, this isn't likely to happen, which is unfortunate for those of us who have a personal interested in prevention.

Hi, Harry--

All is not lost. It may take a while, but there may be some possibilities.

I've been giving it some thought. I can't give it high priority right now, given the need to get some of our own data analyzed and published. But I believe it is something we should explore in future.

--Conventional risk factors like LDL cholesterol, diabetes, and excess weight explain only a tiny fraction of why someone develops coronary atherosclerotic plaque as represented by a heart scan score.

you forgot one more benefit- effortless wieght loss! at least for many of us...

I've eliminated almost all sugar, and all refined grains, but I still  eat brown rice, oatmeal, and whole spelt bread. On my recent VAP test, my triglycerides were 78, HDL was 63, and my LDL was Pattern A (large, buoyant LDL). Also, my Cardiac C Reactive Protein was .84. I'm concluding that some whole grains are appropriate for me, and I use the blood glucose monitor to monitor postprandial glucose.

By the way, thank you for all the info.

Dr. Davis, following your advice as well as several other clarion voices in the nutritional wilderness, over the last 9 months I went from:
HbA1C 6.6, Fasting glucose 125mg/dl, BP135/85, LDL nearly 200, HDL below 30, body weight 245 (6ft tall, 40 in waist) on a mainly carb diet, to:

HbA1C 5.5, Fasting glucose 105mg/dl, BP115/70, LDL nearly in 1/2, HDL above 65, body weight 204 (still 6ft tall, but a 33 in waist) on a very low carb diet.

I've got 4 friends - all males in their 40s - who have also moved their personal numbers in these directions by greatly reducing carbs.  I'm trying to get my severely type II diabetic father to follow the same regimen, but his Medicare provided dietitian is fighting me every step of the way, with a diet based upon bread!  The struggle continues.

Thank you for being a consistent, well informed, voice of reason.  You've helped more people than you know.  (linked to you here).  Be well.

And I'm so unimpressed with the lack of any good hard endpoint data associated with the insulin sensitizers and such.  These dietary options really need to be explored further but, sadly, won't so long as physicians aren't reimbursed for it.

I agree regarding fructose.  

In people with impaired glucose tolerance, slashing starch too may indeed be beneficial.  But is there any evidence that slashing starch benefits people who have a healthy liver and pancreas?  In such people, I suspect slashing starch is just treating numbers and has nothing to do with health.  Otherwise, how do you explain Kitava, Peru, and Asia?

Sometimes I think that the results given with these studies are mostly due to the reduction of grains (lectins) and refined sugar and not carbohydrates themselves. I want to believe it is as simple as reducing carbohydrates but it doesn't explain how populations like Kuna and Kitava have good health markers even though they eat a high carb diet. Dr. WD, do you have any ideas related to this specific topic?

** I am not debating the results of low carb (I personally do paleo), and if your metabolism is already damaged low carb is the only way, but what if it is not? (you were never obese, diabetic, started healthy habits at a young age, etc).

Would these benefits also accrue to someone who does not get postprandial spikes in blood glucose on a low-carb diet - like the regular commentator "DrStrange"?

Actually, in the study reviewed in the post below, a 2-week replacement of refined carbs and sugars with dietary fat (mostly saturated) and cholesterol, led to a significant increase in HDL (14 percent increase in HDL from baseline for men).

http://healthcorrelator.blogspot.com/2010/02/want-to-improve-your-cholesterol.html

That was two weeks only.

In my own experience, higher consumption of saturated fat and dietary cholesterol has immediate effects on HDL, and those effects are especially strong with elimination of refined carbs and sugars.

Dr. Davis,

You mentioned Vitamin D.  I just got tested, level is 14.  However, I get episodes of calcium-based kidney stones (every 3-4 years or so).  How do you treat such patients?

One thing I don't understand is if all these benefits are independent or if they are all linked to glucose level.
If a particular carbohidrate causes little glucose spike will it still cause the other poblems?
Or if carbohidrate intake is followed by intense physic actvity which seems to take BG down does it still causes all the other problems?

Just letting you know, very nice post!

I totally agree.  I continued to struggle with my cholesterol the first year or so on a low carb diet.  After 3 years, my HDL has gone from 40 to 87 and my LDL has improved.  My blood pressure also improved over time.  My triglycerides were never high, but are usually in the 35 range now.  It's an awesome thing!

Welcome to Low Carb Dr. Davis!  From now on, your life will never be the the same

8-

In addition to what you have listed, which I can confirm in 100%, more beneficial effects will become apparent, such as:

- self-healing of teeth with no need for dental intervention, and roughly twice as fast healing of broken bones.

- healing of common cardiovascular diseases (arteriosclerosis, cardio myopathy and arrhythmia)

- rapid self-healing of hepatic diseases (i.e post hep-C cirrhosis healed in 6 months),

- improved kidney disease recovery (I heard of a patient  surviving on Optimal Diet without dialalysis with only 1/3 of 1 kidney left)

- normalization of one's body weight (obese loose, underweight gain),

- much stronger immune system (for instance, I never had a flu since yr 2000, before - twice a year)

- stronger more benign reaction to stress, no more paralyzing panic, no more total body vascular contraction and probably related better resistance to cold temperature.  

- no need to drink water frequently (fat metabolism releases water as an end product)

- never feel hungry again, no need to snack, eating once or twice a day becomes the norm.   For me no breakfast, no supper, only lunch and dinner, typically.  

- improved ability to hold breath longer when diving, generally we also naturally breath less frequently,

- different (improved) mood, subtle changes in the way one thinks, solves problems and react to life events, as no doubts, you will find out...  8-

Regards,
Stan (Heretic)

Daniel, I've tested my own blood glucose before and after meals and it's normal. However, I cut way back on all carbs a couple of months ago, and now eat around 47 grams of carbs per day. Results: I find that I don't need Sudafed or acid blockers at all now and I rarely take ibuprofin (an anti-inflammatory). The twinge in my shoulder and knee are gone. I've lost 10 pounds while working out *less.* I seldom get headaches, and when I do, they're mild. I also need a lot less sleep.

Should anyone care for details, I've chronicled my experience in my blog.

jandro - it is a very good question.  I wonder too but the studies I am reading (see for example Lancet. 1996 ) seem to indicate that carbohydrate reduction is beneficial in all cases, including healthy rural young populations.  

I see it now in the same light as for example alcohol consumption: if you are healthy and young, a  harm may be minimal and some wine  (in moderation) may even provide you with some calories and micronutrients (i.e. resveratrol), but why bother consuming all that starchy and sugary plant food that we are not that well adapted for, that is useful only if we have nothing else to eat and that was probably meant for us only as a temporary food to get us over some rough periods of fauna decline.

  Since there is so little modern research done specifically on this subject we are still largely in the domain of hypotheses and theories. However not all that is speculative.  For example existing archaeological research does show us that paleolithic human diet consisted typically over 2/3 of meat!  We are talking about millions of years of human adaptation.

---

Dr. Davis,  I forgot to add to my above list of benefits the following point:

- reliable improvement (in almost every case) in treating the autoimmune diseases such as rheumatoid arthritis, asthma, eczema, psoriasis etc,

- intestinal disease (Crohns, IBS , very high fat only!).  

- Multiple sclerosis (not 100% especially if nerve damage is too advanced but improvement in most cases)

There is a lot of patient cases (hundreds) of the above disease reported by Dr. Jan Kwasniewski, from his medical practice in the 1980-ties, described in his books, especially "Homo Optimus" and "Optimal Nutrition".  

I think you will find those books extremely interesting, highly recommended.  

Stan

Um Heretic.. I think Dr. Davis has been low carb for quite a while now. No need to welcome him to something he's already quite familiar with

Stan, thanks for your response:

I read the abstract of the study you link and don't see how it is related to what I mentioned. It is comparing a vegetarian population with one that eats around a pound of fish a day. Seriously, is there a question there as to which is healthier? I also don't think they are healthier primarily because they consume less carbohydrates, but rather because they consume a pound of fish a day compared to no animal fat/flesh in the other group.

If you read my original post again you will notice I am not saying a vegetarian diet (in fact, I eat over a pound of meat a day), I am just questioning whether the true problem is carbohydrates or if it is lectins, assuming you have a generous amount of animal fat and protein. I personally eat around 20% carbs, mostly coming from tubers and squashes as I find fruits too sweet (I agree that fructose should be reduced). Generally eat one piece of fruit a day.

I also don't see any evidence to your claim that humans are not adapted to plant foods. We are omnivores, and that's how we have succeeded. We are adapted to a diet similar to what equatorial hunter gatherers have, since we evolved in a similar environment. People bring many archeological references of sites located outside of Africa not realizing that the environment outside of Africa is nearly as new to us as grains are. Most HGs living in Africa have plant food present on their diet. The information you tell yourself claims 2/3 of our diet was meat, what happened to the other 1/3?

And what if someone goes really lowcarb (mostly meat) and his LDL rises up to 500? No info on the the LDL size. The remaining bloodwork results are  really good. Is this something to be worried about?

Hmm, well I eliminated wheat and all glutens from my diet in January 2009. I eliminated sugar at the same time. I also eliminated high Omega-6 vegetable oils. I basically eat low carb. I love to use coconut oil. I've lost over 100 pounds.

But my cholesterol just goes UP and UP! At least total and LDL - HDL remains in the 58-62 range and triglycerides remain in the 60-70 range. But Total cholesterol went from 229 6 months ago to 279 3 months ago, to 280 today, and LDL went from 165 6 months ago, to 190 3 months ago, to 206 today.

And I can't understand why! Of course my doctor is rabid to put me on stations and crazy with me that I refuse, and looks at me cross-eyed when I request an NMR/VAP test for LDL particle size.

But it still bothers me that it continues to go up and up and up, as I feel like I'm doing all I can to lower it. I was also diagnosed with Hashimoto's 6 months ago and put on 50 mcg of Levoxyl. Then three months ago it was upped to 75 mcg. Today it was upped to 88 mcg.

Slashing carbs eliminating the bad stuff sure is not helping my total numbers, which means a huge argument with the doctor every visit, and I hate to argue. :-(

I'm so glad I found this post!. I've had a group of clients take on paleo eating as a 6 week trial, doing so has naturally decreased their carbs. I had each person do before and after blood tests and I was concerned that 80% had a reduction in HDL. They also had reductions in Triglycerides and LDL and blood pressure and significant weight loss - but couldn't figure this one out. Thanks so much for keeping us informed of what goes on for your clients, so I know what is happening with mine is normal.

Julianne
By the way here are some of the results in people's own words
http://paleozonenutrition.wordpress.com/2010/09/01/6-week-paleo-trial-results/