Amen, brother! This is the dirty little secret that proponents of the lipid-hypothesis of CAD continually try to sweep under the rug. Looks like the cat's out of the bag, though, thanks to the internet.

But what can be done about post-meal elevated triglycerides?  Would it be best to avoid fats too, and just eat fruits and vegetables, if one had the will power to do it?

Perhaps we should just give up eating altogether.

I think that worrying about post-meal elevated triglycerides is probably shortening your life more than post-meal elevated triglycerides.

so what does this mean?

"It also remains true if you chronically consume fats."

my understanding is that it is actually in support of normal metabolic functioning for us to "chronically" eat fat. low carb eating, in my lay-person's opinion, means therefore eating good fats (and i am of the un-pc standpoint that saturated animalfats are a-ok) , not just green veggies alone. low-car and low-fat would be no fun! but that's just my 2 cents.

I've had two non-fasting cholesterol tests performed in the last year.  My fasting triglycerides are around 40.  My triglycerides three hours after eating a meal with 10g carbs and 59g of fat were 91.  The time prior to that, they were 79 eight hours after breakfast and three hours after lunch (both were high-fat meals).

Yeah, they go up, but not that much.

So what about the other side of the equation? Decreasing the absorption rate of fat (or spreading it out over more meals) might not help any. But if you can optimize the deposition of fat where it really belongs, in subcutaneous fat tissue-- that is, if fat is deposited in fat tissue where it belongs until needed, at a rate close to the rate at which new dietary fat is absorbed into the bloodstream-- then there shouldn't be a problem.
Interventions that raise HDL generally increase adiponectin. Eating less wheat, beer, fructose, or adding in fish oil, niacin, vitamin d, even being born a woman. And they also associate with less wheat belly.

http://www.springerlink.com/content/dpy09vbc0r8jxnm9/

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Conclusion/interpretation. These data suggest that adiponectin concentrations are determined by intra-abdominal fat mass, with additional independent effects of age and sex. Adiponectin could link intra-abdominal fat with insulin resistance and an atherogenic lipoprotein profile.
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Maybe they've got cause and effect reversed here? I read a study in mice that were leptin-deficient. Adding extra adiponectin made the mice fatter. So adiponectin is probably not so much a reaction to deposited fat as it is a promoter, maybe a facilitator of proper fat storage.

?

Thanks, interesting post. Just wondering: what about proteins?

So if I eat cheese slices with butter as snacks all day, my triglys will be chronically high and I can get heart problems?

Does this mean that intermittent fasting is very important if you eat low carb/paleo style?

Where Oh Where can I find a Doctor like Doctor Davis in the New Jersey area?

My doc who is a cardiologist referred to by local medicenter when it was found out my Trigs were 235 and Total Cholesterol were 295, LDL 195, HDL 57, promptly put me on 5 mg Crestor to lower trigs and LDL, never discussed diet or anything with me. His office plastered with Pfizer Lipitor posters and Crestor bags given by pharma reps.

Heres the kicker, this was all done with blood work that was NON-FASTING. I had blood drawn an hour after I had eaten eggs and bacon. This was also around halloween time too when I was over indulging on ALOT of Sub sandwiches and bread and lots and lots of candy. I love peanut butter cups. But I know 5 a day is excessive, which was my intake.  Was I getting a DOUBLE Whammy increasing my Trigs?

Since I found this blog, I've been taking my Crestor which I don't want too. But have taken up the no wheat diet and HFC out of my diet that Dr Davis suggests. Dropped 18 pounds in a matter of weeks.

Took my own cholesterol with one of those home machines after 4 weeks of Crestor. Doctor wants to test after 3 months. But my Total Cholesterol was 151, calculated LDL 87, HDL 50 and Trigs 69. I wonder how much was the Crestor doing the change or the change in my diet and 18 pound weight loss?

Sorry for the rambling, but Dr. Davis your blog does give great info and brings peace of mind to me.

Anonymous,

Absolutely not. Having elevated triglycerides immediately after a meal is not a dangerous thing. It's only when they are chronically elevated that you are in danger. Same thing with insulin. Chronically elevated levels are the problem.

Both of these are caused by excessive sugar/carb consumption.

-Bryce Lee

Bookmarked this. Sometimes non-standard due to you after sharing. Positively value my time.

Dr. Davis: a friend of mine recently had triglycerides trending up to 700 and more. I pointed him to your blog, recommended low carbs and fish oil, and after *one month* his TGs are around 200.

Kudos to you.

Interesting series of posts. But keep one thing in mind: Excess blood glucose is converted to palmitic acid by the liver...a saturated fat.

(This fact alone should give the anti-saturated-fat crowd pause...if the body could have evolved to convert glucose to any type of fat, why did it evolve to produce a saturated fat? Can't be too bad for you...)

Anyway, if the body through DNL produces a saturated/healthy fat after only a very brief (and normal) spike in blood glucose - after which the glucose returns to a normal fasting level - then high starch (not fructose) diet appears to be quite healthy. This would answer the question of why a rice-base culture can maintain good health while consuming a diet high in starches...in effect, they are eating a high saturated fat diet.

If they don't eat continuously, allowing their bodies time to eliminate the excess blood glucose and the attendant insulin spike before the DNL triglycerides (palmitic acid) hits their blood stream, then there is no insulin-driven storage of the fats. Instead, they have elevated blood-borne fats that remain available for a consistent energy source of over time, of a type that their body prefers and has evolved to produce.

Can you get the same effect from eating saturated fat in the first place? Yes. But to assume that this is better than the starch-driven approach you have to accept that higher levels of ANY saturated fat in the bloodstream is unhealthy. Which runs counter to the viewpoint of paleo and low-carb eaters.

As Stephen has pointed out, there is no evidence that post-prandial glucose spikes are dangerous to someone with a healthy metabolism (i.e. not a type I or II diabetic). So, if there is no evidence of danger from a post-starch-meal spike, why would your body care where it got its saturated fat? Either dietary or liver-produced, it’s all the same once it is in your blood.

Following the chain of reasoning further, a high-starch diet that leads to DNL production of palmitic acid would be healthier than a high fat diet composed of vegetable oil or other undesirable fats.

We have to be very careful about quickly latching onto bits of "evidence" that confirm our biases. Remain scientific, think it through. The human body is an amazingly complex organism; when we begin to isolate its responses to prove our points, we can start down a path that leads to conclusions that may satisfy our dietary worldview, but are not entirely accurate.

Scott W

Note: If we are being carefully scientific in our approach, we should be careful to distinguish our descriptive terms for non-fat and non-protein calorie sources. "Carbohydrates" is too general. It encompasses fructose, which as a much different effect on the liver than glucose. My discussion above focuses on starches for a reason; they break down to glucose, which the body has evolved to handle efficiently, even in large quantities. It can handle fructose, too, but did not experience it in large quantities prior to modern times. Even using the term "sugar" is inaccurate, since it is half fructose and half glucose. By extension of my discussion above, eating pure glucose powder (dextrose) would be as healthy for a rice-based culture as eating white rice itself. You are simply giving the body the end product of rice digestion (glucose), from which it can produce palmitic acid.

There's no question that postprandial triglyceride-rich lipoproteins are causally related to atherosclerosis, regardless of whether they were fat-driven or carbohydrate-driven.

However, these brief posts are NOT meant to endorse low-fat diets. They are meant to show that a simple low-fat vs. low-carb approach is too simple-minded. There are other aspects of diet that count for substantial effects. Postprandial phenomena are one important class of effects that cannot be fully controlled by just controlling carbohydrate or fat content of the diet.

You still haven't explained why the chart in your previous post (Di Novo Lipo-what?), where normoinsulinemic people have lower DNL on a high-fat diet, is in marked contrast to the chart of Gretchen in the post before that (Gretchen's postprandial diet experiment II) when she was eating high-fat.  From those two posts, it seems that peoples' postprandial triglyceride level is dependent on the amount of insulin they produce (and obviously how sensitive they are to that insulin).  Therefore a high-fat diet is not problematic unless one is also hyperinsulinemic.

Wow, these numbers are wild.  It'd be great to see where they are in six months, assuming a change in diet.

Did you see the WSJ article today?

"Giving Up Gluten to Lose Weight? Not So Fast"

The last sentence is priceless:

“Also, for dieters, going back to gluten after avoiding it can lead to stomach cramps, bloating, diarrhea and other symptoms, at least temporarily.”

If an egg had that effect on you, they'd do a recall.

http://online.wsj.com/article/SB10001424052748703846604575447413874799110.html

great post! would be cool if you could pipe the links to your posts into your twitter account as well (there are online services), so that it can easier be forwarded by followers of you.

The WSJ should give up the diet reporting and stick to what they (supposedly) know - financial news.  

There's giving up gluten and then there's giving up gluten but maintaining a high starch alternative grain  GF diet.   Of course replacing one starch with another won't result in weight loss if one is overweight.  It's even possible to gain weight on such a GF diet.    

Are people really silly enough to take diet advice from "creaky bones" Gwenyth Paltrow?

I watched the WSJ video.  It wasn't bad.  It was mainly ridiculing "gluten-free" imitation products.  The lady recommended eating natural foods that are gluten free.

I am completely baffled by some of the lipid panel numbers I see. She had 7 stents put in but there are many out there seemingly with no problems, with high numbers like that. Meanwhile I have eaten right and exercised seriously for the last 30 years, have never been overweight, always been in shape, had good lipid panel results but suffered a heart attack last year anyway. I just had bloodwork shortly before the attack and once again (as had been the case for years) I was told I was in perfect health. My triglycerides were good as was my CRP and my complete lipid panel. Actually any test I took ever, always produced good results. Even after my heart attack they couldn't get my heart rate up high enough in my stress test unless I ran longer and at the steepest incline. I'm still in great shape.....but I had a heart attack.  I never had a belly or bulge and still don't. 5'10" 169 lbs.  Go  figure.

My results after eight months: http://paleohacks.com/questions/9124/first-post-paleo-blood-work-results

After 8 months and -50lbs  I can safely say that the std American flour/sugar diet is complete bullshit.

I bet that poor woman has forgotten what it's like to feel good. She'll surely feel better with an improved diet. I wish her the best.

Re: WSJ article, I got a stomach ache that lasted two days the last time I ate a chocolate chip cookie made of wheat flour. That's some kind of "temporarily"!

Lipids after two years of high-fat, moderate-protein, very low-carb eating:
Total Cholesterol: 220, Triglycerides: 69,
HDL: 98,
LDL: 108.
I think I'll carry on that way.

After 7 stents and she still refuses to change her eating habits? I think that got my attention more than anything else in your report of this patient. I guess I am baffled on why people do not take charge of their health especially when expert advice is offered on a "silver platter".

Tommy,

Sorry to hear that.  I guess it goes to show nothing is a guarantee.  No matter what we do, the chance is always there.

Tommy, your case only goes to prove that cholesterol doesn't cause heart attacks.  
There is something else causing CVD.
Inflammation from Poly fat and grains seem the most plausible to me.

"Tommy, your case only goes to prove that cholesterol doesn't cause heart attacks.
There is something else causing CVD.
Inflammation from Poly fat and grains seem the most plausible to me."

I had my CRP checked and it was below 4 just before my HA. After taking care of myself for the last 30 years and always doing well in every aspect I really felt backed against the wall afterward. My numbers are very low now (pretty close to 60's across the board) but all of this is more complexed than just numbers.

Hi, Tuck--

That's great!

It reminds me of the USDA's request for public commentary on the food pyramid revision, prefaced by "We don't understand why, after we tell people to increase consumption of whole grains, they keep on gaining weight and becoming diabetic."

42--

Well said!

"eating right" and "taking care of myself" only tells me you were healthy by your standards or by the governments standards.  Most of the people I hear say "I eat healthy" means they eat lower fat but mostly trans fat when they do.

There has to be something causing your problem.  I would suspect what ever makes you extra hungry would be a possible cause.  Maybe it's too low cholesterol.  Agreed; very complicated.  Maybe it's just genetics.  Maybe there's something in the past 30 years that was not right but what?  A lot of maybes there.  Have you had a calcium score?

Tommy-

Do you have Lipoprotein(a)? You sound to me like a textbook Lp(a) case. Better get it checked and address it.

Trans fat? nooooooooo...lol.
No refined crap, no processed anything. Damn...I don't even eat ketchup(sugar)!! I consider AMA snobish about food intake. I had a conversation with a "heart healthy" dietitian from the hospital after my heart attack and she wanted me to have less than 50 g of fat per day (impossible). I told her I go by percentages of total calories consumed and explained it to her. She had no clue and didn't understand it in simplest terms. "Ok what if I wanted to consume more fat and just added non fat calories to my total intake....that would lower my percentage right? Uhhh....what? lol

@ David
I am thinking I may be LP(a) and I have been taking extra Vitamin D as well as a high dose of fish oil. Next cardiologist visit I will discuss Niacin as well as pattern B possibilities.

Tommy, what about stress and sleep?  Stress is a killer...

David, that is my suspicion. It's complicated because a lot of things happened at once at that time. Through July and August I was under stress from problems at work combined with personal family issues. In September i went on a cruise an ate up a storm as well as drank more than normal gaining 14 lbs. (my prior good blood labs gave me confidence ..ha ha ha.) Then I came home, worked out hard and lost all the weight in a week. Then my grand daughter got sick and I was very stressed out about it while my work issues were still mounting. In October I had an argument in the morning before leaving work (I had been switched to an overnight shift)and was stewing when I went to sleep. I woke up a few hours later having a heart attack. The rest is history.

Hi Dr. Davis.

These numbers are awful, but I think a point must be stressed regarding natural vs. industrial carbohydrate-rich foods. These numbers are not typical for normoglycemic folks who eat natural carbohydrate-rich foods.

Avoiding natural carbohydrate-rich foods in the absence of compromised glucose metabolism is unnecessary. Those foods do not “tire” the pancreas significantly more than protein-rich foods do.

Protein elicits an insulin response that is comparable to that of natural carbohydrate-rich foods, on a gram-adjusted basis (but significantly lower than that of refined carbohydrate-rich foods, like doughnuts and bagels).

http://healthcorrelator.blogspot.com/2010/04/insulin-responses-to-foods-rich-in.html

And nobody can live without protein. It is an essential nutrient. Usually protein does not lead to a measurable glucose response because glucagon is secreted together with insulin in response to ingestion of protein, preventing hypoglycemia.

I definitely get the whole low-carb thing, but I think you always use the extreme cases to make your point.  Even dietitians would not recommend that much starch.  In fact, many of the "top" dietitians limit starch quite drastically in their meal plans.  They are not as ignorant as you think.  However, because they have clinical experience (which I know you have too), they know that draconian, restrictive diets do not work.  Therefore, they work starches in the diet a bit, so people don't feel "deprived."  Still they choose "better" starch options like beans (OMG LECTINS!!!).

I do not believe for one second that the majority of people claiming to be eating according to the USDA guidelines are doing so within the correct caloric guidelines.  They are eating far too much and making terrible choices for starches to boot.  Portion control is tough obviously.  I think people who cannot master it may find low-carb useful because they eliminate starches/sugars outright and don't have to worry about serving sizes.  Plus, ketosis gives them a metabolic advantage allowing them to consume more calories and still lose weight.  It definitely is not an end all solution though.

Also, they don't bad mouth carbs in the press because people being people would start avoiding things like vegetables.

There is nothing inherently wrong with carbs.  We just have to eat them within reason.  Just like calcium for example.  Too much calcium is linked to heart attacks and prostate cancer.  But in moderate amounts, it is helpful.

Okay, I went my two weeks without wheat carbs. My results are purely non-scientific, but here goes. I lost 4 pounds, down to 156. I wasn't hungry at all. I didn't have any bread cravings like I thought I would. But I did have a hard time sleeping, for whatever reason.

After my two weeks I had angel hair pasta and a hamburger on a wheat roll. My stomach was slightly upset for a couple of days once I started eating wheat carbs again - probably just a coincidence though.

So I proved I could do it and I proved to myself that I wouldn't starve or go crazy without my bread. So, I think I'll be more careful about the wheat I put into my system. On the other hand, it looks like May needs to correct things and do it sooner than later.

Just goes to show ya. I'd *love* to weigh what Mary weighs - but it seems there is more involved that that. I just had an NMR test recently myself. Total LDL particle count was 2018. My doctor is freaked and says it's a horrible number. Every website I consult says it's a horrible number -though my small LDL is 212, only 10.6% of the total. But all the websites I consult say the total number is far more a risk factor than paticle size.

But what were the HDL and triglycerides of the people with high particle counts. High like Mary's? My own HDL (measured just last week) is 66 and my triglycerides 49.

But how do you get the particle number down? I've already been low-carb for four years, gluten-free for 18 months, avoid all sugars, take D3, magenesium, K2, 1500 mg niacin.

Might it go down if I can get my thyroid normalized? That's one issue I'm still trying to work through with my doctor. Sheesh, the older I get the harder it gets. So many things to consider I sometimes wonder how anyone manages to stay alive for a few weeks - let alone many years for most of us.

So for people with existing coronary artery issues and Small particle LDL is it true that increasing fat (especially saturated fat) only makes this worse? If you go low carb you need to also be low fat?
I read that "low fat" is bad for Pattern A but beneficial to pattern B.

Dr. Davis?