Interesting. I'm looking through my screening results (I'm in Europe) and there is no mention of LDL, but I have two other values, P-Apo A1 (1.77 g/L) and P-Apo B (1.09 g/L). Is there a relation between these and LDL/HDL?

It is good to have positive feedback via blood testing to show changes one is making to their body. I wonder what is a good interval between tests to show cholesterol changes?

On a similar note, I have been eating low carb for 4 months using my blood meter to reduce both blood sugars and insulin resistance for pre-diabetes. I am still thinking about your slo-niacin suggestions and how the bad increase in blood sugar and insulin resistance vs the good cholesterol effects would affect me. I am waiting to get results from my first NMR lipoprofile to make a decision.

Indeed, restricting carbohydrates is more similar to taking statins than many people think. With the advantage that it does not have the side effects of statins, and is not costly at all.

Many people do not know that carbohydrates stimulate the production of VLDL, suppressing the production of free fatty acids and ketones. Our liver then pumps out small VLDL particles at a high rate, and these end up as small-dense LDL particles. The potentially atherogenic type, in the presence of other factors (e.g., chronic inflammation).

Low carbohydrate dieting stimulates the production and release of free fatty acids and ketones, suppressing the production of VLDL. Our liver then pumps fewer VLDL particles into the bloodstream (since FFAs and ketones are already doing a good job at feeding muscle and brain tissue), and when it does it lets out big VLDL particles, which end up as large-fluffy LDL particles prior to re-absorption by the liver.

If anyone wants to see what these particles look like, the figure in the post below may be useful:

http://healthcorrelator.blogspot.com/2010/02/large-ldl-and-small-hdl-particles-best.html

Ketones are not shown because they are water soluble:

http://healthcorrelator.blogspot.com/2010/04/ketones-and-ketosis-physiological-and.html

Do you have any comments on oatmeal? I've noticed that for me personally, it doesn't significantly spike my blood sugar, and I've heard a lot about how oatmeal can improve cholesterol -- but of course this is often just focused on total cholesterol or general LDL amount.

Hi Dr. Davis
I'm really hoping to hear your opinion on this study:
http://www.pnas.org/content/early/2009/08/21/0907995106.abstract?sid=

Hear, hear, Ned!

I agree: Carbohydrate restriction is the unsung hero of VLDL and LDL reduction, though actual measurements are required to appreciate this effect.

Oatmeal anonymous--

It's all about individualizing your food choices.

Checking postprandial blood sugars is an excellent way to know if these issues apply to you or not, or to what degree.

What are your thoughts on Amlamax for the reduction of LDL?

OK, so here's my question... I am young (late twenties), thin (BMI: <20.2), and active (run, bike).  However, I still have almost all small, dense LDL.   I'm an ApoE 3/4, which I understand means I need to limit the amount of fat in my diet.  However, if grains also contribute to small LDL, what am I supposed to eat?   I don't eat much wheat as it is (my husband is celiac), but I do enjoy oats, rice, and the occassional piece of bread when we eat out, etc.  Would cutting all grains from my diet and living on only vegetables, some fruits, and lean meats be acceptable? Sounds like a boring and sad diet...

Oatmeal reducing Cholestral is a joke. If I eat Oatmeal for breakfast( even a 1/2 cup) my BG numbers stay HIGH all day. Oatmeal is not a food I have on my breakfast table ever.

Over what time period were these
panels taken or in other words, how many weeks or months in-between test?
Love the blog!
CB

Who knows where to get an (NMR) lipoprotein panel in Toronto/Mississauga?

You say, "LDL particle number 2620 nmol/L (which I would equate to 262 mg/dl LDL cholesterol)"

Why would you equate 2620 nmol/L to 262 mg/dl? The conversion factor given at http://jama.ama-assn.org/content/vol295/issue1/images/data/103/DC6/JAMA_auinst_si.dtl is roughly 1mmol/l = 39mg/dl.

Holym--

I believe you are confusing Friedewald calculated LDL in nmol/L and LDL particle number--two entirely different things.

My simple conversion is meant to yield a "Friedewald-like" LDL cholesterol from LDL particle number.

I do agree!!

Where can I find the peer reviewed research upon which you base your advice? Thanks

My lab results are in, and they are,  on balance, not much improved. I think.

The changes I effected since my prior panel panel 3 months ago:
1) Lost 20 lbs
2) Ingest 6,000mg of fish oil for a total of 1200mg (total) of DHA and EPA/day
3) Ingest 500mg of Slo-Niacin/day (with 125oz of water/day)
4) Ingest 6,000mg of Vitamin D/day (Changed to the proper Vitamin D soy capsule from the powdered tablet)
5) Eat a large handful of almonds/day
6) Exercise hard (weight training and cardio intervals for a minimum of 90 minutes/day).

The (worsened) numbers:
1) Total Cholesterol: 269 (from 267)
2) LDL Cholesterol: 186 (from 175)

The (improved) numbers:
3) Triglycerides: 201 (from 280)
4) HDL Cholesterol: 43 (from 36)

Unfair to ask you, I know, but I am frustrated. What do I do wrong? What can I do more? I am VERY reluctant to take a statin, as I have tried many, all with terrible side-effects. And, fwiw, I started today on my wheat-free diet.

Thank you for your guidance,
David

Man-boobs: Another reason to lay off the Doritos.

I'm usually the first to say, "Hoooray for boobies!" Maybe not this time though.

I've known about man-boobs for a while and I have noticed many thinner guys having them too. It makes me wonder how much fat is inside that that slimmer body.

What does a man do with their own boobs though?  Hmm... a new potential market!

--

not just grains.. also too much fruits and fruit juices.

off topic Q: 47y male, very busy, but otherwise fit and lean, on paleo since a few months, has CRP=0, A1c=5.5, homocysteine=11, TSH=3.4, cholesterin 4.1mmol. low vitamin D (about to be remedied). his father has some bypasses. do you think to stay low-carb'ish paleo is sufficient here, or should he do something about his TSH and homocysteine (it's my brother). can this be caused by drinking 8-10 coffees a day lol? thanks!

Soy also contains a lot of phytoestrogens. Another thing to get rid of.

Ditch flax, too.  

Hmmm, is the rate of male breast cancer rising, too I wonder?

not just for men
heaps of my female patients want breast reduction surgery
I tell them to start eating green veges and more fish, and kill the carbs, but most would prefer the surgery because the healthy option is too hard!  go figure

the sad thing is for some of us even when we lose the weight, or the vast majority of the weight, the male breasts still don't go away. I have my gynecomastia surgery schedule for november....it's been a dream of mine for several years and i've been saving for it for a long time.

I read that drinking milk can cause a substantial insulin response even greater than that of a snickers bar?  There are a whole lot of people out there addicted to milk.  Telling them they shouldn't eat bread and pasta mortifies but adding dairy to the equation puts them right over the top

Not to split hairs, but glycemic load, which is what raises blood insulin,  is an entirely dose-dependent variable.

According  to Nutritiondata. com, a Snickers bar comes in three sizes.

"Fun size" (15g) GL of 5
I bar (2 oz)  GL of  57
I king size bar (4 oz) GL of 113

Whole wheat bread, commercially prepared
1 slice: GL of 5

So, yes if you had two slices of WW bread, you've doubled the amount of a fun-size Snicker.  But eat the big Snickers and you are way, way over that.

The devil is in the details.

Great post.  I'm sorry it wasn't there 2 years ago when I was working with a male client who was in despair about the man boobs.

Nina

Could low Testosterone blood levels in the male population be the cause of this ?
There's a detailed article on this matter in the June 2010 LEF magazine.
The article shows that this deficiency is in epidemic numbers.

Hi, Me--

Absolutely correct.

However, you will find that, of the foods listed, ALL increase blood glucose not a little, but a lot. Drawing distinctions among them and declaring one is better is like telling people that Marlboros are bad for you and Salems are better. Therefore, smoke more Salems.

It's that bad.

I'm curious about your statement that visceral fat converts testosterone to estrogen --> the man boobies.

There's the implication then that visceral fat leads to low testosterone.

This study would indicate that the direction of causation may be the other way around.  Visceral and total fat were measured in 110 Japanese-American men and measured again 7.5 years later.  Those with low testosterone levels at the beginning of the study had increased visceral fat.  

Visceral fat produces estrogen and that can lead to man boobies.

So lowT --> belly --> boobs seems a more likely scenario.  

I'm not sure we can look to a booming plastic surgery business for male breast reduction as being indicative of some sort of dietary induced increase in the incidence of man boobs.  Undergoing the knife has become increasingly popular for all sorts of procedures for men.

I would also add anecdotal evidence that many of the overweight men I know with this problem also happen to carry more weight in their butts, legs and subQ belly rather than sporting the "pot-belly".

After being diagnosed with BPH I specifically looked for a remedy other than 5-alpha reductase inhibitors.  I found and used beta-sitosterol for nearly a year.  Eventually I noticed nipple sensitivity.  I read it's an early symtom of gynecomastia.  Then I found that beta-sitosterol acts as a 5-alpha reductase inhibitor.  I quit using the medication about six weeks ago and now have significantly less sensitivity.  But the tradeoff is now I'm back to nocturia.  

kevin

It really looks awful for a man to have boobies and that's one that turns me off. I don't want to be with a man be with bigger boobs than I am. Is soya included in the list of food to be avoided?

And soy, soy, soy.  It is being promoted as a "health food" but most of it is genetically modified (unless organic) & all of it is high in plant estrogens.  NOT good for anyone:  women, men, developing children. (Unless it is fermented, not typical.) What is the formula most commonly used for babies?  Soy & lots of sugar.  

Bad, bad stuff.

Very interesting Blog.



Smith Alancli

I too would add soy to the list.  All these "healthy" foods aren't so healthy.  They are being promoted as "healthy" because they make $$$$ for big processed food.

I once saw an ad from PCRM telling men to go veg to reduce man boobs.  However, going veg would just mean more soy and insulin-dirupting foods, which would make the problem worse.

Thank you so much for this info. My family has been gluten free for several years, but I still react to GF breads. Most of our dietary decisions have come about through observing how we react to particular foods, even when we don't understand *why*. I've been avoiding "GF" breads because I react so badly to them . . . and now I know why. Thanks for the verification.

Men who are taking the BP med sprionolactone (trade name Aldactone) can sometimes experience gynecomastia. It's an uncommon, but well-known side effect of some drugs, and not always just a function of food intake or exercise (or lack thereof).

You forgot one VERY important thing on your list:

ALCOHOL!

Ethanol promotes aromatase converting testosterone to estrogen. Also, lupulin in hops is a potent phytoestrogen making beer a double whammy.

I would also like to add that brassica vegetables (broccoli, cauliflower, kale, cabbage, Brussels sprouts, etc) are rich in indole-3-carbinol and diindoylemethane which are wonderfully potent anti-estrogenic molecules.

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