I have a Chinese friend that asked if Lp(a)is an inherited trait that Asians are known to have.  Are there races more likely to have Lp(a) than others?

Hi Dr D,

Thanks for the study, another very interesting one!

You also have to consider that the fish must be displacing something from the diet of the vegetarian Bantu. By definition that means that there MUST be a reduction in vegetable intake. We know from hard intervention studies that a low fat diet automatically increases Lp(a) by 7% and adding copious fruits, vegetables and nuts makes the situation slightly worse (9% increase). Conversely a high fat diet reduces Lp(a) by 11%. The high fat diet was only 60% calories from fat and allowed 13% of calories as carbohydrate, so there is ample scope for less vegetables as a really radical intervention to drop Lp(a).

Although not looking at Lp(a) the other hard intervention study looking at oxidative damage to lipids (and DNA and protein) found that near total elimination of all vegetables, without carbohydrate reduction, markedly reduced oxidative damage.

When replacing veggies with fish it shouldn't surprise anyone that Lp(a) drops.

Peter

I'd finger grains as the culprit before before vegetables any day.

Peter,
  The second study quoted has this logic:
"Since no long-term effects of GTE were observed, the study essentially served as a fruit and vegetables depletion study.The overall effect of the 10-week period without dietary fruits and vegetables was a decrease in oxidative damage to DNA, blood proteins, and plasma lipids, concomitantly with marked changes in antioxidative defence."
    But the study did not have a group of people who were on a proper(TYP style?) fruit & veg diet to compare. So it sounds like "there were no long-term effects of GTE, but the diet was meat, so it must be the fruits and veggies that is the culprit". Or am I missing something?
-neelesh

RE: racial differences in Lp(a). Yes, there are distinct differences in Lp(a) levels and apo(a) size. Africans have the highest level. There are also pockets of incrased Lp(a) in the British/Irish/Scottish, some of  Jewish descent, among others. I do not know about Asian.

zute, I'd blame grains for a host of problem but the low fat diet study doesn't give you menus, so who's to say. Except concluding that fruit, veg and nuts don't protect you from grains any more than they protect you from a reduced fat diet. Whichever. But the second study, which only looked at oxidative damage, was high in bread and cake. It's a pity they didn't look at Lp(a) in this one. I know which way I'd bet it went.

Neelesh, I'm not quite sure I understand you comment. Are you suggesting meat inclusion alters the finding that fruit and vegetable elimination reduces oxidative damage? On a basic low carbohydrate, HIGH meat diet blood antioxidant status improves within three days. Again, this is far off of the topic of Lp(a), but meat got the credit for improving antioxidant status. You could equally well argue it was the lack of vegetables.

I feel there is a massive difference between eating a steak on its own and eating that same steak with chips, peas, tomatoes, a bowl of green salad plus two bread rolls on the side. Intervention studies suggest one oxidises your lipids, the other doesn't. Epidemiological and observational studies are usually performed by people without this concept. In intervention studies veggies don't do so well. The authors are usually amazed. Very off topic (sorry) but there are very few intervention studies which measure Lp(a).

Peter

Hi Peter,

Interesting study.  Do you have any reason to attribute the increase in antioxidant defenses to increased meat consumption, rather than decreased carb?

Hmmmmm...    I take high doses (5-6 grams) of High Potency EPA/DHA Fish Oil daily.

I haven't seen any effect on my high Lp(a).

Maybe it has to be directly from the fish (and while I do eat fish - it's only once or twice a week).

Fruits and veggies - I eat a lot of those, too.

Sheesh - this is confusing.  I can't imagine eating less fruits and veggies.

Bonnie

Peter,
  What I mean is this. Without a group of people being subjected to a fruit+veg+GTE diet and another group to meat+GTE group, one cannot conclude that "meat+GTE= less oxidation damage" implies  "lack of veg/fruit = less oxidation damage" .
    Again, this does not mean that there is no credit to the observation that meat+GTE reduced oxidation damage. However, we cannot logically deduce from that observation  "hence it is because of lack of fruits and veggies".

High Lp(a) is one of the factors cited for the very high incidence of CVD in the South Asian population (India, Pakistan, Bangaldesh....).  Search Pubmed for work done by Dr. Enas Enas

Hi sasquatch,

I originally thought it was the lack of carbs rather than the high meat intake in the cyclist study, but the high carb vegetable washout study convinced me it was the lack of vegetables rather than carbs per se.

The persistent antioxidant effect of fruit and veggies appears to be largely an effect of uric acid produced by ourselves in response to fructose. I've got a paper on this somewhere. Certainly the body eliminates most plant based antioxidants as fast as it can, ref the green tea extract paper.

The Bantu on the lake eat roughly half a kilo of fish a day (300-600g/d). That's about 100g of animal protein and 550 kcal animal calories. Assuming a 2000 kcal food intake that's an awful lot of displaced vegetables. Results speak for themselves. As far as you can talk about results in an observational study.

The paper linked to by Dr Davis provides this reference, which goes some way to explaining Bonnie's finding of no change in Lp(a) with fish oils. Unfortunately none of the fish (fish oil?) supportive refs have even abstracts on pubmed, so it's hard to see what's happening. BTW, I've got nothing against fish oils, 5g/d sounds like a very physiological intake. But it doesn't displace much in the way of vegetables.

Peter

Hi Neelesh,

I think that the study concluded that the GTE  had no lasting effect beyond its excretion in the urine, with an elimination 1/2 life of 2 hours.

There is no suggestion that meat plus GTE did any better than meat without GTE. It was a cross over study, so both groups got 3 weeks on GTE and 3 weeks off GTE.

Their conclusion was that GTE supplementation made no difference to any measured parameter.

As the GTE made no difference to antioxidant status (except transiently in the immediately post consumption period), the only hypothesis ultimately tested was whether fruit and veg elimination reduces oxidative stress.

So comparing a meat plus GTE diet with a veg plus GTE diet is a little pointless.

I would agree that you could argue that GTE does much more in the absence of meat, but I would want some logic as to how that might happen. I don't see why this should be the case.

In this study we had a group of people acting as their own controls, drop the veggies, oxidation reduces, reintroduce the veggies, oxidation increases. Forget the GTE. It looks very simple to me, but then I'm a simple person.

I as far as I can see the full text downloads for free. It does deserve careful reading. The EU was a major funder of the study and this funder was VERY unhappy with the results. From the EU's comments, linked to the asterisk at the end of the title, it looks to me as though the authors fought their funders tooth and nail to publish. It's a good study.

Peter

I am a 34 year old male South Asian, who recently had a mild MI (troponin returned a negative, but my doctors confirmed an MI). Subsequently, I had an angiography which revealed an occlusion in the right coronary artery (RCA). All other fields (leftmain, LAD) etc were normal. I underwent a PTCA (coronary angioplasty) which opened up the block. I was not administered any stents, as the doctor felt that the thrombus would clear on its own.

This was exactly 3 months ago. About 2 weeks ago, I went through a lipid profile test, along with some other tests the doctor prescribed (liver function test, Lp(a)). It was here that it was revealed that my Lp(a) was at 115 mg/dl. All along, all my risk factors were negative (blood pressure, blood sugar, lipids, and the only high figure was a marginally high cholesterol of 222). Finally, the doctor was able to put his finger on why this happened to me.

He has now put me on Niacin, alongwith my statin (Tonact 20) and Clopivas tablets. I understand that Lp(a) is largely genetic, and not really fixable through lifestyle changes. I must mention that my cholestrol has come down to 94 from a value of 222 after I have been on medication, a healthy diet, and exercise, all of which I am maintaining with some rigor.

I would like to know:

1. Where do I stand on the Lp(a) thing? Is there anything I can do to help my cause? Just how bad is it? Am I unlikely to live very long, or develop further complications?

2. Is it safe for me to have children? Will I be passing on this condition? What are the chances that my child will be unhealthy?

3. I like to have a drink of beer occasionally. I have got a green signal from my doc a month or so ago to have the odd drink. Is it ok if its beer, and not wine, as he has recommended? Is it ok if I have  2 pints (each pint 330 ml) about 2-3 times a week?

4. My Triglyceride levels are quite low (90). Also, my HDLC is currently at 30, and LDLC is 46, while VLDLC is 18. The LDLC/HDLC ratio is 1.53. Also CPK is 124 u/L. All other tests have returned normal values. F.B Sugar is 77 mg/dl. Fasting Urine Sugar is Nil. Blood Pressure is normal, I am not obese. There is no history of heart disease in the family known prior to this. I have quit smoking (I was a heavy smoker, about 20-30 cigerettes daily).

promit,
hope you've been reading this blog carefully! good luck

My mother had a serious problem of coronary plaque reversal, she now enjoys of great health but doctors lasted too much to diagnose the disease she was going through.

The Lugalawa Study opens the question of whether similar results can be obtained not by moving to Tanzania and fishing Nyasa Lake, but by mimicking their experience by supplementing high doses of omega-3 fatty acids.

I'm not very familiar with the AHA, but they sound just like the American Diabetes Association (ADA).

And yet if you read a typical article on "gynecomastia" you'll rarely see anything suggesting a problem with feeding plant estrogens (like processed soy foods) and insulin-spiking foods (like wheat and grain products) to growing male babies, children, and adolescents.  Usually the focus on on the remedy.

"Moobs" seem to  a growing phenomenon that rapidly increased with the rise in soy and processed grain consumption during the past 3 decades, though it may also be due to everyone's increased awareness of appearances or the Seinfeld episode with Kramer's invention of a "mansierre" and similar media references.  I was never really aware specifically of the existence of "man-boobs" until the late 1980s and even then, I noticed it mostly on overweight middle-aged and older men  and thought the condition on slim men to be extremely rare (turns out it isn't).  I never heard any slang terms  until just a few years ago and now I regularly hear quite a few names for it.  It seems like the condition is everywhere at every age and weight level now - I don't think I was less observant 25 or 30 years ago.   Even grade school kids are aware of the condition and slang names, though if they eat the school lunches, they'll likely end up with their own set.

Nicely said.

The world we live in is a strange one. Man boobs - moobs - are now so common that they seem to elicit little or no attention. I was at a pool recently with the wife and kids, and moobs were present in abundance. Perhaps we've come to think of them as inevitable, as we seem to think that tooth decay, myopia, diabetes, heart disease, dementia all the other diseases of civilization are inevitable concomitants of being human.

As John Durant recently said over at Hunter-Gatherer, we need a new concept of normal. Disease isn't normal. Health is normal. And we must come to recognize that only when we aren't lean, fit and ready for whatever the world thows us  - when, for instance, moobs begin to sprout on our boys- something has gone very wrong.

So funny but true.  I like to run quite regularly and have some friends into running also.  They love to 'carb up' before a race!!  Yet, they can't figure out how to loose that bit of belly hanging over their belt w/o extreme excercise or calorie restriction.  I've been doing VLC (very low carb) for about 2 years now.  I've got no 'wheat belly' to be found .  Maybe I'll let'em in on my little secret!  Age of these guys are a couple in 40's and one is 60.  So funny, I see them eat their bannana and grape nuts/shredded wheat every morning.  It seems an impossible task to lift the veil that 'FAT is bad for you' montra that's been lied to us the last 30 years.  Keep doing what your doing Dr. Davis.

I eat bananas every day. I eat a lot of fruit. I have 1/2 cup of rolled oats (which I soak overnight with an acid medium) every morning, with ground flax and cottage cheese...been doing it for years. I also have quinoa daily and most weeks brown rice also at dinner which I also soak. Lots of veggies. No bread, no wheat no sugar or anything containing sugar. No processed foods. I don't have a belly and as a matter of fact I have a hard time keeping any weight on. I'm 53 years old 5'10" and currently 169.5 lbs. I don't eat till I'm full and I eat pretty big portions...any more would be ridiculous.  I prefer being around 173 or at least 170 but weight just falls off of me. I'd say I eat moderate carbs.  Every one is different.  I think I eat sensibly and pretty traditional. Eggs, chicken, meat in small portions (3-5 oz) soaked grains in moderation, lots of veggies and fruit, water and raw milk, walnuts and almonds, ground flax, extra vitamin D and fish oil capsules. I exercise a lot and have for the last 30 years or more.

I think the problem is a bit more complicated than just too much wheat.  With age men's testosterone levels decline while estrogen levels go up.  Men in their 50's can have hormone patterns similar to a woman.  And if a man develops BPH, the medications that allow him to get a full night's sleep suppress his testosterone levels while leaving estrogen unchecked.  Being 54 with BPH I worry about gynecomastia.  I used beta-sitosterol as an alternative to alpha reductase inhibitors but recently found articles that say sterols like beta-sitosterol cause the same side effects as Proscar.  My weight now is less than when I was in high school in 1973.   I follow the Sears antiinflammation diet.  

kevin

Is it wheat or the carbs in the wheat that's the villain?  

If it's the wheat, should both soluble and insoluble fiber be avoided?

Also, the poppyseed reference seems kinda random... is there something particular about poppy seeds?

Thanks for the laugh with the post title!

At 260 lbs on my 5'7" frame as of May 13, I had "wheat belly," and lots of it, along with dangerously high LDL, low HDL and high triglycerides, and, ironically, borderline hyperthyroidism at .34 TSH.  That was also around the time I discovered this blog.

Since June 11, I've  been grain-free except for flaxseed; have not had any processed foods; cut down on added salt; have had nothing to drink except water and unsweetended almond milk; have had only lean meats to eat; greatly increased my intake of vegetables (mostly leafy green, i.e., kale, Swiss chard, spinach, red/grean leaf lettuce with some occasional asparagus and broccoli); have had  minimal dairy (maybe 4-8 ounces of cheese per week, at most); and some avocado, and a little fruit.

As of July 21, I'd lost only 18lbs even though my hyperthyroidism is all but confirmed (TSH dropped to .19 as of 7/8 and lots of symptoms have hit).  Since then, I don't feel as if I have dropped an ounce, my clothes feel the same in terms of fit, and of course, I still have plenty of "wheat belly."

Next weigh-in is on Friday, 8/13, when I see my endocrinologist for the 1st time.  How bad is my luck that I can't lose weight quickly on a very low carb diet AND with hyperthyroidism?!

My wife tells me that Playtex is no longer in the bra business.

Oh well. It was the only bra manufacturer that I popped off the tip of my tongue.

Franklin--

Yes, well said. I, too, worry more about our children and the strange dietary legacy we leave.

I constantly have to remind patients, family, and friends that what we hear on TV, radio, read in magazines, etc. is largely driven by industry, easily drowning out the message that we are trying to disseminate.

I have heard of "beer belly" and clearly its occurrence is ubiquitous, but "wheat belly" is something new. Are they the same thing or are we talking about a different condition?

Moobs are *not* a new phenomenon, lol!  Take a look at very old Buddha figurines. . . .
But, *more* for sure.  

But anyone interested needs to look at pollution (air, water, food) and see how much of it is pseudoestrogens.  We are feminizing a whole generation of baby boys.

I appreciate the low carb/preventing insulin release science, but how the heck do people maintain muscle mass on a low carb diet?  Short sets can only be fueled by muscle glycogen, so how does one support their weight training on such a low carb diet?

Dr Davis,
Have you looked into the Primal Blueprint at www.Marksdailyapple,com ?

That lifestyle is pretty much what you're trying to tell us about.

Hi dr davis

Im drinking protein supplements and i dont know that glutamine peptides is from wheat protein.

What can you say about artifial sweetener acesulfame potassium in the ingredients of most whey supplements??

Trey,

go to bodybyscience.net for answers about conserving muscle mass

Jeanne

Hi, Puddle--

Excellent point.

I do believe, however, that high-carbohydrate eating and obesity are typically accompanied by the man boob phenomenon. I rarely see them in slender men who might "just" have exposure to pseudoestrogens.

Dr. Davis, this must be the funniest post you have ever written. My husband thankfully didn't have moobs, but he had wheat belly and "Cheerio" face. One day I gathered up all the "heart healthy" whole wheat bread, Cheerios, Kashi bars and crackers and put them in a big garbage bag for the trashman.

He was not especially pleased, but with the exception of ferreting out a couple of stale Girl Scout cookies late one night (I call this "carbdar") he was good about it. Then one morning about 6 weeks later, he came flying out of the bedroom with his shirt up pointing to his belly, which was significantly reduced. He is quite pleased with himself now.

Thanks for taking the time to write this blog. We had diner last evening with a good friend who is a head of cardiology at a large suburban hospital. In short, he hasn't a clue when it comes to nutrition. Do you see any progress with cardiologists in this area? Or are they all just Statinators?

Okay, okay, I give. I don't want any man boobs! I'll try going wheat free for two weeks and see if I notice a difference in all this stuff that I read about on this blog.

So no wheat products and watch my carbs, right? Fruits/veggie carbs good, wheat/sugar carbs bad.

I'm also going to start cooking with coconut oil. George Dejohn in Dallas has talked it up on his radio program, so I'm going to finally give that a try as well.

Wish me luck. I think I'll be going through withdrawal cravings, big time.

Dr Davis

with regard to the comment on Budhas moobs it is very funny. My take is him being located in a wheat eating country - India could have contributed to his moobs (nice catch puddle) and perhaps the neurotoxins in the wheat gave him the nirvana experience *snicker snicker*

to add to the above

its the Laughing buddha with moobs and wheat belly not the Nirvana Buddha!

Hi,

I tried to help out many people but it seems hopeless at this point. Most don't believe me. I even tried to provide studies, etc but they refuse to do so. I hope that we eventually break through but as long as drug companies, etc continue to control things, it's going to be tough no matter what. It appears to be all about profits and federal gov't is for that. What a shame...

stopsmoking: You are not serious, are you? You intend to eat no wheat for two weeks and I suppose you expect results at the end of two weeks? That means you are looking for a QuickFix - but your body is not a machine with a reset button. You will have to invest a little more time and patience.

I wonder what makes sense for poor countries.  I see that Sonia Ghandi wants to wipe out malnutrition by giving every poor family a 77 pund bag of grain, sugar, and kerosene each month.

Anonymous - Fortunately, I'm pretty healthy and don't have anything to get a quick fix for, except a little belly fat. I just want to see if I can stop eating this for two weeks, then I'll see how I feel. When I stopped drinking sodas, I did feel better after two weeks. Nothing I could put into words, just better. That's what I meant by see how I feel.

What will probably happen is I will have proved to myself that I can go at least 2 weeks without, so I'll start another 2 week goal. That's what I did with sodas and it worked out pretty well - 4 years without a coke!

Hi Anon,

260 lbs and 5' 7" sounds typical.  Don't be so hard on your self.  The version of a low carb program you describe sounds lacking.  I have lost 55 pounds over about 18 months and holding.  I get it that you are frustrated.  You do not lose weight on a straight line on a low carb program.  You are not taking homeostasis in to account.  That is the body fighting you to keep your system in balance, therefor, you will hit plateaus, and because we are all different,  the duration between a weight drop could take weeks or even months.  But, rest assured the weight loss will start again.  It didn't take a few weeks to put on most of your weight and your body will fight to keep it on, because, it thinks famine is upon you.  If you think that just giving up wheat is going to solve all of your health problems, get over it.  Our idea of a health supporting evolutionary lifestyle that works is high saturated fat and unlimited flesh with a few very low starch veggies and a few not very sweet berries (1 cup daily mostly blue berries).  Don't worry about quantity, let your hunger drive limit you.  Eating as an evolutionary lifestyle dictates will automatically stop hunger and give you satiety.  After 18 months on our program my diabetes type 2is cured along with obesity.  I can't tell you every thing in this short comment, but, talk it over with your doctor and see what he thinks before you proceed.

Billy E
Editor, evmedforum.com

I am so the poster child of this syndrome.  Therefore, I've started my own blog on how to combat it.  I stubbled on you while trying to research other blogs that are somewhat like mine.  I love this.  You are brilliant.  Please visit mine, while rudimentary, I do believe we share the same concepts of health.  www.appleandpears.com

Hi, Anonymous--

Sadly, my colleagues are still trapped somewhere in "low-fat, take your Lipitor" land.

Anyone who has tested small LDL as many times as I have eventually comes to realize that the carbohydrates are the culprit, not the fat.

Although not directly related to this post, have you ever read this published study?

http://jn.nutrition.org/cgi/content/full/134/10/2517

The reason why I ask, is because I have never heard you mention the relevant association between genotype and LDL size.

Hello Doctor Davis

It seems to me you are describing a "hypos", just like those my newly diagnosed T1 step-son suffered from, until he learned to over-eat for his insulin dose. This in otherwise normal people would seem to be a failure of the glucagon response, whose function is to release glucose to the blood via glycogenolysis.

Recent food tests seem to show that many proteins induce as much insulin to the bloodstream as some carbohydrates do, which naturally enough reduces BG - as well as storing protein - and the glucagon response then steps in if BG goes too low.

You know this middle aged visceral fat used also to be called "beer belly", and according to some might even be re-labeled "fructose belly".
My point is, wheat may be cause in some, but there are other foods which manage to produce the same effects.

your article is very nice, i have found good information from this. Even i have found good information about Chet Holmes

Umm ... Playtex still makes bras!
http://www.google.com/search?aq=f&sourceid=chrome&ie=UTF-8&q=playtex+bras

Also, the "bloop" over the belt is not visceral fat, it is subcutaneous fat.  It's the hard bellies that look like a pregnant woman that are mostly visceral fat under the abs around the organs that is pushing outward.  Two good tests to distinguish the two are whether you can squeeze a roll (sub-Q) or how much disappears when you try to hold in your tummy really hard (sub-Q fat cannot be held in).  

I'm curious about the estrogen link.  In women, menopausal reductions in estrogen production are associated with increased VAT -- not weight gain per se but a shift of SCAT to VAT.  If VAT produces estrogen, is this nature's version of HRT? -- stimulating our secondary estrogen producing "organ" when the first one shuts down?  That seems odd given the negative metabolic consequences of VAT accumulation.

So Dr. Davis do you mean wheat or all grains?  I eat very little wheat (no breads or cereals here as we have kids that are gluten/casein free) but I do enjoy the rye bread that is popular here in Europe with my lunches.

LOL The USDA Playtex line was hilarious. But who knows anymore? Ours is a crazy world where the elites are completely wrong and unwilling to acknowledge it, while attacking others as idiots.

William Davis has written a very information to and knowledge about heart disease in men