Just how do higher VLDL and higher triglycerides promote insulin resistance?

Dr. Davis, I've just recently stumbled upon this blog and I love it.  Thank you for so generously sharing your insights.

I was wondering if would suggest any different dietary guidelines for people with familial hypercholesterolemia.  In particular, I have heterozygous FH for which I am taking 40mg Crestor, but I am an otherwise healthy, lean 25 year old male with lipid numbers of 47 Trig / 169 LDL (calculated)/ 73 HDL.  I closely follow a paleo/primal diet and fitness routine so I am hoping the LDL is the large and in little danger of oxidation.

To any other FHers out there, I would be happy to hear about your experiences.

Thanks!

46% carbs is still high in my opinion. I tend to agree with Dr. Eades in the book Protein Power where your carb requirements should not exceed 1.3 times your protein requirements and that should be based on lean body mass and activity level. The rest fat, mostly saturated animal fat. Tropical oils are great too.

Does this chart, which shows that HI people have much higher DNL on a low-carb diet, explain Gretchen's result in your previous article?  She is HI (hyperinsulinemic), right?

So people on a low-carb/high-fat diet who have normal levels of insulin will not experience the post-prandial spike in triglycerides that Gretchen did.

DNL really gets turned on many-fold if the triglycerides are "simple," rather than "complex."

Could you please explain the difference between 'simple' and 'complex' triglycerides.

Thanks!

Anonymous re familial Hz hypercholesterolemia.  I, too, am Hz and started with the Track your Plaque (Dr Davis') program about 4 months ago. I think that you have stumbled upon the best diet for this condition. (paleo/ low-carb) I am trying to find that balance of the least amount of Crestor that I can take vs how much sat fat I can add to my diet while keeping my LDL in line.
I was on a weekly total of 80 mg Crestor, and my LDL-c was 170 as of 2 weeks ago. My LDL particle count is still too high, so I have just started to add another 20mg dose per week.  I take it every other day, so my new weekly total of Crestor will be 100mg.

You should consider joing the Track your Plaque program that is run by Dr Davis.  There many great discussions there and some very sharp minds that contribute to the discussion forum.

At the very least, get an NMR lipid profile done; this will let you know the most important aspect of your LDL, which is the number of particles that comprise it.

A point of clarification: Fat intake leads to high postprandial triglycerides--there is absolutely no doubt about this. This occurs regardless of insulin sensitivity, body weight, carbohydrate content of the meal, etc.

Fat = triglycerides. When you eat fat, triglycerides go up postprandially.

Anon--

Simple carbohydrates = simple sugars like candy, soft drinks, juices: immediately absorbed, no fiber

Complex carbohydrates = carbohydrates that occur in polymers or bound up in fibers, less rapidly absorbed.

In my mind, both are undesirable, though complex are less undesirable.

Dr. Davis, surely you don't mean *all* complex carbohydrates are undesirable, do you?  Carbohydrates from, say, sweet potatoes and oat bran must be (more than) just fine, on balance.  And as to fat, might the solution be to increase good fat (mono and omega-3) but avoid saturated and trans fat?

Great post! I have just completed a university nutrition course... knowing that carbs turn to fat easily I was stunned to find the following in my course text:
The amount of glycogen that can be stored is quite limited(no more than a few hundred grams in total), so the stores are filled quite quickly and if more glucose is available, then the excess could be converted into fat for storage. Fat stores in the body are effectively unlimited. However, it appears that excess carbohydrate is normally used for energy rather than being converted to fat.

Dr. Davis,

Aren't the results of the study questionable due to the fact that the participants' diet was prepared in a laboratory and may have consisted of health-altering foods (i.e. gluten, artificial fructose, trans fats, veggie oils)?  Do they list the diet composition in the study?  I may have missed it.

Also, regarding runners and their fuel sources: I've read that Ethiopian runners don't hit "the wall" like runners in more modern cultures do.  This means they have an efficient fat-burning metabolism, correct?  Their diet composition is mostly starchy non-gluten carbs:

"Diet was high in carbohydrate (76.5%, 0.4 g/kg BM per day) and low in fat (13.4 %)."
Food and macronutrient intake of elite kenyan distance runners

Interesting?

"However, it appears that excess carbohydrate is normally used for energy rather than being converted to fat."

That's true. The biggest impact of carbs is that they are used for energy first, which means more of the fat consumed can be stored. This has been proven with radioactive studies that show that most of the fat in your body comes from fat in food, not from carbs. Of course, if you consume enough carbs, then those too will be converted to fat. Also, whether carbs directly become fat or not, the outcome is the same: more fat is stored in presence of more carbs.

Much of the confusion here seems to be the unawareness that different saturated fat subtypes have different post-prandial effects.  This was demonstrated by Hegsted eons ago and formulated into an equation.  Google it.

Clearly, the predominant subtype of saturated fat in fatty meats is HARMFUL.  A HEALTHY high fat, low carbohydrate diet is EQUALLY BALANCED among the three fat macrotypes, not EXTREME to saturated fat.  Typically, studies just use the Atkins version of extreme high satirated fat, low carb.  A recent study showed that eating 1-2 slices of processed lunchmeat or 1 hot dog a day increases heart disease risk by 40% and diabetes by 20%, and that's on top of the increased risk of cancer from the nitrates.

As far the high carb, low fat diet (S.A.D.), the culprit is the lack of soluble fiber which slows down post-prandial absorption.  The best at ameliorating this role is glucomannan.

But people, don't kid yourself.  There are SEVENTEEN independent risk factors for heart disease.  You have to circumvent ALL of them to completely eliminate the risk.  A low, unrefined carb diet (<25% calories) with the remaining calories from balanced, unrefined fats and lean protein is a big part, but the rest involves influencing biochemistry and genetic expression via supplementation.

A diet weighed towards carbohydrates, especially if 50% or greater calories are carbohydrate, is sufficient to provoke plenty of DNL, even in slender people. DNL is a big part of the reason why low-fat (and, thereby, high-carbohydrate) diets result in higher triglycerides. DNL really gets turned on many-fold if the triglycerides are "simple," rather than "complex.

Eat your complex carbs, and take a vegan algae-derived DHA/EPA supplement. Your triglycerides, if they're high, will drop like a stone. The healthiest, longest-lived, large populations on the planet eat starch-based diets.

If the problem with carbs is DNL, this implies that an amount up to where DNL is triggered is safe.  So I see why you recommend no more than 15 net carbs per meal.  Would this amount change for a (natural) body builder?  For example, i do 30 min strength training with weights at double my body weight.  I would like to replenish my muscles to prevent glycogen depletion.  Do you think it would be safe to increase the amount of carbs consumed in the post work out meal to 30 or 50g of complex carbs?

Dr. Davis, would like your thoughts on the Trader Joe's brand Omega-3 Fatty Acids:
1200 mg Fish Oil
400mg EPA
200 DHA
Thanks,
Chris O

I use Pharmax Finest Pure Fish Oil with Essential Oil of Orange from the TYP Marketplace.  I take 1 tablespoon per day to help reduce Lp(a).  Is it better to take this dose at one time or divide it through the day?

In Iceland where I come from we have a really high quality fish oil called Lysi.

In my opinion liquid form is the only real way to take it, with caps you have to take a ridiculous amount to reach the same amount as in a tablespoon.

Plus you have no way of knowing if the fish oil caps are spoiled except to chew them, often they're not even refridgerated in the supermarket.

I remember from an earlier thread that spacing the dose out over the day works better than a big dose once daily. That makes sense, given that you are trying to alter some liver metabolism that goes on around the clock. I've been using the Life Extension capsules, six a day, for several years with pretty good results. It gets my TG from 400+ to about 170. I'm hoping the gram a day of regular niacin I've been taking for a few months helps further and gets my HDL out of the sewer (27). I'll know that in a few days...

Nice tasting Liquid fish oil brand, 1 teaspoon=
1,500 mg EPA
+ 750 mg DHA
----
= 2,250 mg EPA + DHA
+   380 mg other Omega 3
-------
= 2,630 mg. Omega 3/teaspoon
(out of a total fish oil content of 4,400 mg./tsp.)

Canada made "Natural Factors",
"Dr. Michael Murray recommended pharmaceutical grade" says label; extracted
from anchovy/sardine/mackerel;
1 teaspoon stateside cost works out to less than US$1 a teaspoon; each teaspoon has 40 calories, 15 mg cholesterol, total fat 4.5 gr. (being 3.5 gr. polyunsaturated), natural vitamin E and natural orange flavor, no heavy metals/environmental toxins ... I've no financial interest in the product.

What about Carlson's?



http://www.amazon.com/Carlson-Finest-Liquid-Omega-3-Orange/dp/B001LF39S8/ref=wl_it_dp_o?ie=UTF8&coliid=I27QWKFK5P760T&colid=1J0P20X13IM7F

What are your thoughts on Chris Masterjohn's research regarding very low requirements of polyunsaturated fats in the human diet?  High amounts of fish oil would certainly contravene this hypothesis.  I am referring to his position paper, How Essential Are The Essential Fatty Acids?

The best fish oils should be, as expected, in fish. Eat more fish!!!;))

"1 teaspoon Pharmax fish oil, for example, provides an equivalent quantity of omega-3 fatty acids as 6 standard fish oil capsules on a milligram for milligram basis, but more like 8 to 9 capsules when absorption efficiency is factored in."

Color me confused, Dr D. At the moment, I ingest 6 (3, 2x/day) Sam's Club Omega 3 capsules (the ones you recommended in a long-ago post) to obtain the 6 Grams of total DHA and EPA/day. Does your comment I quote above mean that, with the liquid form, I can take less than the equivalent of 6G/day  because of its absorption efficiency? And how much, if yes?

Really, I am sufficiently befuddled that I think even my question is not clear...

Help!

Where can I check if the fish oil is trigyleride form?

uh.. off topic.. when I clicked on my bookmark, to the Heart Scan Blog all of the website except these comments are in what looks like Russian!!  nothing else on my computer is corrupted...anyone else?.. and how do I fix this?  I am on an IMac.

Thanks,
Jeanne

Fixed it!  funny that it was only this website.

on topic- I am very intolerant to anchovies, will Krill oil help me?  can't take ANY fish oil with anchovy.

Thanks

Seeing some confusion here: the ideal active ingredients in fish oil are the EPA mg. & DHA mg. omega 3's. Lables indicate there are other omega 3 oils, plus other non-omega 3 oils in all products and together these are the mg of "fish oil" (product may specify yet another blending oil). Companies make their EPA mg. & DHA mg. concentrations different, incur production costs to make it higher doseage and our purchase price reflects that.

If you have a theraputic goal for intake: it is not so much how much fish oil, but how much you need to take of any one specific product a day to meet your target for total EPA mg. & DHA mg. Omega 3 fatty acids. For a name brand product Doc recommended and gave his daily dose (whether capsule or liquid)he apparently did the math.

Unfortunately I am illergic to fish oils and react badly to them. Not a good way for me to get my omegas so I need an alternative.

Udo' Oil does do a 369 oil that has no fish oils. So far that is the only one I have been able to find I can handle.

best fish oil is no fish oil. Certainly if anyone knew how fish oils were made , they would not take them. It's interesting how dr. Davis says fish oil with no odor are best but those are simply sterilized and deodorized and for a reason so that the taste of smell would not be repulsed. Trust your own gut instead of anyone else I guess. Ray Peat has chronicled data and science behind the dangers and lipid peroxidation of fish oils. Brian Peskin makes a case that these derivative oils are a huge burden for the cells and should never be taken. Naturally such oils are protected by vitamin E and saturated fat but not in these fish oils. Most other literature documents effects of omega 3 on cancer metastasis, just google it.

Now Foods Omega-3 Fish Oil 16.9 fl. oz.
Serving Size: 1 tsp (5 ml)
Servings Per Container: 100
EPA: 740 mg
DHA: 475 mg
Other Omega-3 Fatty Acids: 185 mg
Total Omega-3 Fatty Acids: 1,400 mg

Cost: $19

100% triglyceride form **

** Now Foods 16.9 fl. oz. is the brand I use and I can confirm this is the TG form after a polystyrene test.  (Take a styrofoam cup, place a small amount of fish oil at the bottom of the cup, wait ten minutes, and if it eats through the bottom it's the EE form.)  

I can also attest that I do not suffer from "fish burps" that the EE form is known to cause.

Anonymous about Lp(a)--

We have no formal data on dosing regimens, but I have been advising dividing dose in two, a.m. and p.m. This appears to be working well.

David--

You may be confusing fish oil dose with dose of EPA+ DHA.

Check your label to see EPA + DHA content. This is what you use to dose your fish oil.

Readers

Is Carlsons fish oil the Triglyceride form one?

SVinay:  Carlsons Super Omega-3 Fish Oil is the ethy ester form.

I am currently taking Heart Health Omega-3 1000mg by Swiss Natural Sources.EPA 300 and DHA 200.  I take three capsules daily.  I have also purchased Jamieson's Omega-3 Select with the same EPA DHA content as the Swiss.  The Jamieson's is less fishy smelling and I will switch back to it when I finish the Swiss.  
Canned boneless herring fillets are usually a part of my lunch.  Omega-3 2g.  I also found some canned cod liver.  I'll try it in an egg bake.

For the poster who had a question about Carlson's... the liquid and low-dose caps are natural triglyceride. Their higher concentrate capsules are ethyl ester.

I currently like Barlean's, as it's triglyceride and relatively inexpensive. Their higher concentrates are ethyl ester though, so go for the lower conc. ones if you want the trig form.

I do disagree with Dr. Davis as far as preferring liquid however, due to oxidation issues. I'd recommend the caps instead, and simply chew them, if swallowing capsules bothers you. The caps do offer some extra oxidation protection.

Hi Vlado,
I think so-called
"pharmaceutical" grade fish oil is distilled to seperate out concentrated gradients of "x"% DHA & "x" % EPA in a product. Yes, fish scraps that the oil is extracted from first gets heated, but so is cooked fish. Solvent residues concievably might be in some products; you can inform me of other compounds resistant to purifying out.

1 teaspoon oil = 5 mL. = 200 pharmaceutical size droplets = 4.54 grams .... I, for example, weigh 79,379 grams (175 pounds/79.4 Kg.) and assume a daily teaspoon dose of 4.5 grams fish oil can be metabolized safely. If you've details on how the omega 3's are noxious when added into the diet please explain.

Is my fish oil already peroxidized and/or are ingested omega 3 lipids peroxidized to my detriment at this level? My math shows that one teaspoon for me is 5.7 hundred-thousandths of my body weight; multiplying 0.000057 x 79379 grams that I weigh = 4.5 grams in teaspoon of oil.

Is there any data guiding recommendations on the ratio of EPAHA? I've never come across any primary data on the subject. To the best of my knowledge, the ideal intake and ratio of EPA and DHA remain unknown and a point of contention. I've noticed many fish oils have a 3:2 ratio of EPAHA, but I don't know where that is coming from. I'd love to know your thoughts, Dr. Davis.

I love the brand from www.strongerfasterhealthier.com
They make 5 flavors with zero fish oil taste. My kids ask for it, so it's a big win in our house. The concentration of EPA and DHA towered over even barleans.

Carlson's Super DHA Gems and EPA Gems concentrate capsules are TG form.

Dear Dr Davis

I am looking for a Kosher liquid omega 3 fis oils
I find nutri supreme research
Calories   40

Calories from Fat   40

Total Fat   4.5g    7%**

Cholesterol   18mg   6%**

EPA   950 mg   *

DHA   475 mg   *

Other Omega 3   325 mg   *

Total Omega 3 Fatty Acids   1750 mg

is this ok? or there is something Kosher better?---------------------------------------------

Check out Ascenta! All their fish oil is in triglyceride form.

ascentahealth.com

What is your opinion of Krill Oil?

Dr. Williams, I am wondering what you think of only taking high doses of EPA? See the following article:
http://igennus-hn.com/omega-3-epa-treatment-for-a-heart-condition-news-release/

As I have M.E. (post viral fatigue syndrome) as well as astronomical total cholesterol (great tryglycerides), I''m interested in trying this protocol. Would love your input.