When MIGHT statins be helpful?

I spend a lot of my day bashing statin drugs and helping people get rid of them.

But are there instances in which statin drugs do indeed provide real advantage? If someone follows the diet I've articulated in these posts and in the Track Your Plaque program, supplements omega-3 fatty acids and vitamin D, normalizes thyroid measures, and identifies and corrects hidden genetic sources of cardiovascular risk (e.g., Lp(a)), then are there any people who obtain incremental benefit from use of a statin drug?

I believe there are some groups of people who do indeed do better with statin drugs. These include:

Apoprotein E4 homozygotes

Apoprotein E2 homozygotes

Familial combined hyperlipidemia (apoprotein B overproduction and/or defective degradation)

Cholesteryl ester transfer protein homozygotes (though occasionally manageable strictly with diet)

Familial heterozygous hypercholesterolemia, familial homozygous hypercholesterolemia

Other rare variants, e.g., apo B and C variants

The vast majority of people now taking statin drugs do NOT have the above genetic diagnoses. The majority either have increased LDL from the absurd "cut your fat, eat more healthy whole grains" diet that introduces grotesque distortions into metabolism (like skyrocketing apo B/VLDL and small LDL particles) or have misleading calculated LDL cholesterol values (since conventional LDL is calculated, not measured).

As time passes, we are witnessing more and more people slow, stop, or reverse coronary plaque using no statin drugs.

Like antibiotics and other drugs, there may be an appropriate time and situation in which they are helpful, but not for every sneeze, runny nose, or chill. Same with statin drugs: There may be an occasional person who, for genetically-determined reasons, is unable to, for example, clear postprandial (after-eating) lipoproteins from the bloodstream and thereby develops coronary atherosclerotic plaque and heart attack at age 40. But these people are the exception.

Comments (17) -

  • Might-o'chondri-AL

    4/8/2011 12:21:11 AM |

    I don't know how individuals with mis-sense SNP for gluco-kinase regulatory protein (ex: GCKR rs780094) fit into the pattern. They get more liver steatosis (fat build up) with attendant elevated LDL and triglycerides, despite less fasting glucose and less fasting insulin numbers; while their 2 hour blood glucose runs high (GCK gene is very determinate of 2 hour glucose levels), showing down-regulation of the homeostatic model for Beta cell function (HOMA-B).

    Normally GCKR regulates triglycerides and determines persons glycemic traits by governing how glucose is stored and how it is dispersed. GCKR also geneticly regulates the availablility of substrate used for de-novo lipo-genesis.

    Gene SNP of protein phosphatase 1regulatory (inhibitor) subunit 3 B (PP1R3B rs4240624) manifests increased liver steatosis  and both elevated LDL and elevated HDL; with low fasting glucose. PPP1R3B codes for controling protein and modulates the break down of glycogen (storage glucose moleccule).

    Together PPP1R3B and GCKR are integral to blood sugar dynamics and the levels of lipids in circulation.

    If Doc's regimen counter-balances individual missense genetic workings, like those above, then that is impressive corrrection achieved through intervention . I presume for people with liver steatosis missense mutations (ie:  SNPs like above) elevated LDL treatment using statins would be bad for their liver.

  • Dr. John

    4/8/2011 1:10:14 AM |

    Statins might be helpful if you have bacterial pneumonia:
    http://www.bmj.com/content/342/bmj.d1907.extract?sid=f762e55c-1a0b-4ef3-81c4-f31cc472a372

    That's because the rapidly growing pneumococcal bacteria are very susceptible to HMG-CoA reductase inhibitors (statins). The bacteria have similar cholesterol compounds (hopanoids) in their membranes, essential for their membrane function. With the statins blocking the hopanoids, they die....very quickly.

    All bacteria have a mevalonate pathway.  The HMG-CoA reductase enzyme is inhibited in bacteria and are VERY toxic to bacteria. So thus, you have a "statin-benefit" because it kills the bacteria, before it kills or injures the patient.

    Statins can essentially inhibit biological life forms.
    Dr. John

  • Dr. William Davis

    4/8/2011 1:11:01 AM |

    HI, Might--

    As usual, you've come out of left field with a totally unexpected issue!

    I'm not sure how this genetic variant fits into this argument. It is, to my knowledge, a very rare diagnosis.

  • Might-o'chondri-AL

    4/8/2011 6:40:15 PM |

    I don't envy Doc trying to sort out who needs what treatment. Genetic high cholesterol entails over 50 amino acid variations out the jumble of 692 amino acids assembled into relevant complexes.

    Pro-protein convertase subtilisin/kexin-9 (PCSK9)is involved in familiar hyper-cholestemia. Those who make too much PCSK9 (in the liver and small intestine) rapidly degrade their cholesterol receptors and can't pluck much LDL out of circulation; plasma cholesterol rises.

    Should one's genetics foster making too little PCSK9, then cholesterol receptors don't degrade. This promptly shunts cholesterol into the liver lysosome (an organelle inside a cell)for break down; thus they  measure low cholesterol in the blood.

    I speculate Doc's diet, in "normal" genetic people up-regulates cholesterol reception. Which means his program has the epigenetic effect (from diet dynamics) on "normal" liver/small intestine genes in a way that less PCSK9 is expressed

    The caucasian anglo-saxon PCSK9 D374Y mutation causes 4 times the normal cholesterol in patients. Their risk factor for pre-mature death is 10 years earlier than even more benign PCSK9 mutations; so Detective Doc Davis is willing to prescribe statins for people like them.

  • Anonymous

    4/9/2011 2:59:55 AM |

    I might be one of these poor souls.

    Eating a strict diet, one Dr Davis would be very proud of... I'm lean as can be, feel great, but my cholesterol shot through roof (while HDL dropped).    

    Frown

  • Might-o'chondri-AL

    4/9/2011 4:53:48 AM |

    Hi Annon.,
    Internet self-diagnosing shouldn't replace a good medical consultant. My comments are not qualified medical assesments; am a layman.  

    My favorite cousin has had her cholesterol testing well over 300for several decades, and is now in her late 70s. Like Doc chided me earlier, there are "genetic variant" being "very rare diagnosis."

  • Lucy

    4/9/2011 11:47:29 AM |

    What do you think about KIF6?   I was tested and found to be a non-carrier, and I was subsequently told that statins would likely not benefit me as much as diet/lifestyle changes (I'm ApoE 3/4 as well).  Does that also mean that niacin would not help?

  • Anonymous

    4/9/2011 12:52:56 PM |

    To say the least, I am very disappointed in Dr. Davis' stance regarding ApoE 4 & statins. There is abundant evidence suggesting statins are counterproductive to brain health, which is much more pronounced in Apo E4's who are already at high risk for alzheimers disease. It isn't only about lipids, there is a larger picture to consider. The brain requires cholesterol.  Also, high cholesterol levels are associated with longevity in the elderly.

  • Might-o'chondri-AL

    4/9/2011 7:44:42 PM |

    Alzheimers and the relationship of ApoE4 is different than other ApoE isoforms (like ApoE 2 & 3). In normal people ApoE is integral to clearing amyloid Beta from the brain; it forms a conjugate (ApoE/AmyloidB)that is moved out across the brain blood barrier by LRP-1 (lipo-protein related protein 1).

    ApoE4 is acted upon (cleaved) in brain neurons, yielding rump fragments with unique Carbon- terminals; and,  ApoE4 degrades easier than ApoE 2 &/or 3. These ApoE4 fragments, when in a brain cell's cytosol, influence that cell's mitochondria hydro-phobic pattern of lipid binding.

    The ApoE4 fragment properties  do 2 unwanted things to the brain cell mitochondria. It decreases the mitochondria ability to perform tasks involved in glycolysis (glucose energy). And is antagonistic to PPAR gamma; PPAR gamma is what would otherwise promote adequate mitochondria bio-genesis.

    ALzheimer lesions show higher amounts when measured in individuals with concurrent Type II diabetes and the ApoE4 isoform. The ratio of insulin in the cerebro-spinal fluid to the amount of insulin in the blood also shows a difference depending on the specific ApoE geno-type.

    Alzheimer brains are using less glucose; patients show less receptors for insulin-like growth factor and insulin, as well as less insulin degrading enzymes. It is postulated that depending on the individual's ApoE variation there is a different amyloid Beta response to brain insulin.

    Normally one goes from glucose intolerance to hyperglycemia and then elevated insulin circulating as become diabetic. Yet experiments show that giving insulin improves diabetic neuro-pathy in the brain; it seems to be a way peripheral insulin resistance causes different tissues to respond.

    In Alzheimer experiments with supplemental insulin (nasal, etc.)administration cognitive function improved. This response was more significant in those with the ApoE4 allele (compared to other ApoE types with Alzheimers, who also improved cognition ).

    So, the Alzheimer enigma seems to involve energy format dynamics for ApoE isoforms more than specific levels of cholesterol. This is not a comment on ApoE homo-zygote genes relationship to cardio-vascular risk factors, or brain lipid metabolism.

  • homertobias

    4/11/2011 3:36:34 PM |

    Mito
    You sound like Suzanne Craft.  I like her work.

  • Medicomp INC.

    4/12/2011 4:06:52 PM |

    You make an excellent point here:

    ...eat more healthy whole grains" diet that introduces grotesque distortions into metabolism

    We are encouraged by transient sources that this is almost always the best alternative for other fattening foods, yet people never really delve deep into the cons of this transition either.  It truly does take dedication to be well-informed about the dietary changes you make in your lifestyle.

  • Anne

    9/18/2011 5:58:38 PM |

    I had a body scan a few years ago, and my plaque count was 1050, when they told me that 150 was considered high, I thought  I would implode at any moment, I went to a lot of different cardiologists and had all kinds of tests and they said to exercise and not  worry about the plaque. One Dr. put me on lipitor and 3 days later I could hardly walk from the muscle pain, he told me to stop taking it and I tried niacin and red rice with the same results. I don't know how to reduce the plaque, the Dr's all said it was hereditary . I am open to any advice.

  • Dr. William Davis

    9/20/2011 12:43:37 PM |

    Hi, Anne--

    Note that this is the blog that accompanies the Track Your Plaque program that focuses on just this issue. It means 1) identify all causes of plaque, then 2) correct them, preferably using natural means.

  • JK

    10/30/2011 4:52:34 PM |

    Dr. Davis,
    I don't know if you have already addressed this topic in prior posts but allow me to suggest that in lieu of consuming statin drugs, even for the aforementioned outliers, it is possible to achieve reduced LDL cholesterol and increased HDL cholesterol by supplementing with magnesium.
    (All the ensuing statements below I humbly attribute to Mildred S. Seelig and Andrea Rosanoff, "The Magnesium Factor," pages 139-147.)
    1. Statins (Lipitor, Zocor, Baycol, Mevacor, etc.) are designed to lower cholesterol by inhibiting HMG-CoA reductase, which is the enzyme responsible for the synthesis of cholesterol.
    2. These drugs when studied, not only lower cholesterol, but also reduce total mortality, cardiac mortality, the total incidence of heart attacks, angina, and other non-fatal cardiac events. (p.140.)
    3. They also made the blood platelets less sticky, they slowed the progression of plaques and stabilized them, and they reduced inflammation in the blood vessel tissue. (ibid.)
    All these results, and more, Seelig further informs the reader, are a result of reduced mevalonate in the cells, which is the direct result of an inhibited HMG-CoA reductase, which is the enzyme that statins are designed to inhibit.
    Now stay with me for a second because here is where it gets interesting.
    4. Magnesium is a natural inhibitor of HMG-CoA reductase. Here magnesium and statins are comparable (p. 141.)
    5. Magnesium also acts on two enzymes, phosphatase reductase and phosphohydrolase which reactivate HMG-CoA reductase. By its effects on these enzymes, which contrast one another, magnesium can either stop cholesterol formation or allow it to continue depending on the body's needs.
    6. Magnesium also activates another enzyme, lecithin cholesterol acyltransferase (LCAT) which, through this action, converts LDL cholesterol to HDL cholesterol -- increasing HDL and reducing LDL.  (Statins cannot do this.)
    In the interest of brevity, I'll conclude by saying that whereas statins are known to reduce cholesterol and perhaps achieve other cardiovascular benefits, this is due in large part to their suppression of mevalonate, brought about by their inhibition of HMG-CoA reductase.
    In contrast, magnesium not only inhibits HMG-CoA reductase, meaning that it would achieve the same results as statins in "1, 2, and 3 above," but it also converts LDL cholesterol to HDL cholesterol, achieved by its activation of LCAT, which is something that statins do less consistently.
    Further, instead of poisoning HMG-CoA reductase as statins do, magnesium inhibits it in ways that can be reactivated by other (magnesium dependent) enzymes so that the body can naturally make the mevalonate and cholesterol it needs.
    This is important because vitamin D is synthesized from cholesterol (when using the sun's rays), and cholesterol is also the precursor to testosterone, estrogen, and other steroids.
    So I encourage you to consider using Magnesium for those Apo-B cases that cannot be addressed by carbohydrate restricted diets.

  • JK

    10/30/2011 4:58:10 PM |

    Sorry, meant to say Apo-E cases.

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Sun green tea

Sun green tea

Here's a great way to enjoy the health benefits of green tea during the summer: sun green tea.


I dropped two green tea bags into approximately one-half gallon of cold water in a clear glass jar. I placed the jar in the sun (with top on) for four hours, then brought it into the kitchen. I served it as iced tea with a slice of lemon and mint leaf.

The sun green tea was a smoother than standard green tea brewed with hot water. Ordinarily, if you brew hot green tea for more than 3-5 minutes, it becomes more bitter or tannic. This sun green tea, despite steeping for four hours, was not the least bit bitter or tannic.

The green tea lasted well for about 48 hours, more than enough to enjoy several glasses per day.

Comments (11) -

  • Eric

    7/21/2011 1:53:59 AM |

    Isn't there some bacteria that grows in sun tea?

  • Shreela

    7/21/2011 2:41:53 AM |

    I believe Eric is correct, although sinus problems tell me not to search for it right now LOL
    Try overnight tea in the fridge instead.
    http://www.theyummylife.com/blog/2010/08/22/How+to+Make+Refrigerator+Iced+Tea

  • Againstthegrain

    7/21/2011 6:46:21 AM |

    I have to agree with Shreela, as I have had the misfortune of drinking sun tea that had been at room temp for too long during warm weather.  Steep and store the tea cold in the fridge and discard it after two or three days if it isn't consumed, or at the first sign of anything floating in the tea.  The bacteria that grows in tea brewed at room temp (or warmer) can cause an unpleasantly strong attack of the "runs".  

    More info about this issue:
    http://www.snopes.com/food/prepare/suntea.asp

  • Joe E O

    7/21/2011 11:28:19 AM |

    Dr. Davis care to comment:

    Study: Boosting Good Cholesterol With Niacin Did Not Cut Heart Risks:
    http://www.npr.org/blogs/health/2011/05/28/136678665/study-boosting-good-cholesterol-with-niacin-did-not-cut-heart-risks?ft=1&f=1001

    Peace
    Joe E O

  • Kent

    7/21/2011 3:10:50 PM |

    Joe E O,  I would investigate the numerous other studies that have proven the effectiveness and benefits of Niacin, before dicounting it due to skewed and flawed study you reference. Keep in mind that anytime something shows benefit over the Statin Machine, it is going to have a full out assault launched against it.

  • Randy

    7/21/2011 3:18:29 PM |

    Also good with a couple of mint tea bags thrown with the green tea. Safeway Select is very good.

  • Randy

    7/21/2011 3:19:55 PM |

    Is a warm or cold extraction as effective at pulling the antioxidants out of the tea and into the water?

  • Chris B

    7/21/2011 5:58:35 PM |

    I would second the refrigerator tea suggestion over sun tea.
    Also, the reason green tea can be bitter so often is that does not like water as hot as black tea and if it is brewed with the same boiling water, that is too hot for it. If you try letting it cool just a little first or not quite get to boiling, you will get a better brew. There are sites out there that will tell you proper temperatures, but I generally don't feel like pulling out the thermometer so I usually just wing it.

  • Againstthegrain

    7/31/2011 9:41:24 PM |

    Dr. Davis,

    Most of the time, brewing tea in the sun will probably be fine, especially if the tea is consumed quickly and stored in the refrigerator.  But there definitely is *potential* for problems, especially when brewing during warmer weather or prolonged storage time out of the refrigerator.  That's what happened with one batch I made a couple summers ago -  I kept the pitcher on the counter for a few days due to lack of refrigerator space, adding ice to chill the tea when I filled my glass (or just drinking the tea at room temp).  I had at least three tea refills before I connected the tea consumption to the frequent "just-in-time" trips to the loo that day.  Upon further inspection, the tea had a slightly cloudy appearance, with a large thing floating in it.    The runs stopped after I dumped the tea and switched to drinking water.  

    Now when I "cold-brew" tea I either make it in on the counter during cooler weather or in the refrigerator during warmer weather, never in the sun where the water will become warm.  I dump leftover tea after a few days if it isn't consumed, and I thoroughly wash the container.

  • Yvonne

    8/2/2011 9:38:14 AM |

    I think I'll make the sun tea the same way Dr. Davis did, so as to get that smooth green tea flavor; but I'll add the lemon to the brewed tea after I remove it from the sun (to boost its natural acidity), and decant it in smaller jars in the refrigerator. Thanks for this recipe, Dr. Davis!

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Dreamfields pasta is wheat

Dreamfields pasta is wheat

An active question on the blogosphere and elsewhere is whether Dreamfields pasta is truly low-carb. Dr. Andreas Eenfeldt of Diet Doctor detailed his high blood glucose experience with it. Jimmy Moore of Livin' La Vida Low Carb had a similar experience, observing virtually no difference when compared to conventional pasta.

The Dreamfields people make the claim that "Dreamfields' patent-pending recipe and manufacturing process protects all but 5 grams of the carbohydrates per serving from being digested and therefore lessens post-meal blood glucose rise as compared to traditional pasta." They call the modified carbohydrates "protected" carbs.



In other words, they are making the claim that they've somehow modified the amylopectin A and amylose molecules in durum wheat flour to inhibit conversion to glucose.

I'd like to add something to the conversation: Dreamfields pasta is wheat. It is a graphic demonstration that, no matter how you cut it, press it, sauce it up, "protect" it, it's all the same thing: wheat. (It reminds me of a bad girlfriend I had in my 20s: She'd put on makeup, a pretty dress, I'd take her out someplace nice . . . She was still an annoying person who whined about everything.)

Wheat is more than a carbohydrate. It is also a collection of over 1000 proteins, including gliadins, glutens, and glutenins. Gliadins, for instance, are degraded to polypeptide exorphins that underlie the addictive potential of wheat, as well as its withdrawal phenomenon on halting consumption. Gliadin-derived exorphins are also the triggers of auditory hallucinations and paranoid delusions in schizophrenia, as well as behavioral outbursts in children with ADHD and autism.

Wheat is a source of lectins that have the curious effect of "unlocking" the proteins of the intestinal lining, the oddly-named "zonulin" proteins, that protect you from ingested foreign molecules. Ingest wheat lectins and all manner of foreign molecules gain entry into your bloodstream. Cholera works by a similar mechanism. (How about a love story: Bread in the time of cholera?)

Glutens, of course, are responsible for triggering celiac disease, the devastating small intestinal disease that now afflicts 3 million Americans, although 2.7 million don't even know it. Glutens are also responsible for neurologic conditions like cerebellar ataxia, peripheral neuropathy, and dementia ("gluten encephalopathy") and the skin condition, dermatitis herpetiformis.

Then there are the conditions for which the active wheat components have not been identified, including acid reflux, irritable bowel syndrome, asthma (excepting "bakers' asthma), rheumatoid arthritis, edema and fluid retention, and a long list of skin conditions from alopecia to gangrene.

My point: Yeah, Dreamfields pastas, from these instructive experiences, acts a lot like conventional durum wheat pasta. But, even if Dreamfields or somebody else perfects the low-carb aspect of it, it's still wheat. Modern wheat is the genetically tarted-up version of Triticum aestivum, the product of genetic shenanigans from the 1960s and 1970s.

Comments (11) -

  • Andrés

    5/28/2011 4:21:50 PM |

    Thanks for your work!

    I am not enrolled yet on track-your-plaque but I have read thoroughly your blog.

    I know you felt a different reaction to einkorn (diploid) to triticum (hexaploid), hence I wonder: have you (or any one around here, by the way) done some check yourself on durum (tetraploid)?

    I confess I am trying to cut back carbohydrates and pumping up fat, focusing specially on reducing triticum to a minimum (I favor a 60%-rye-40%-durum bread, since I "need" something to support my Gorgonsola and hard cheeses)  and am curious about the hardness about other branches of wheat (at least I found a paper about gluten seeming less aggressive on durum).

    Regards.

  • ceara sullivan

    5/29/2011 9:25:24 PM |

    Getting off wheat is very difficult for some of us. When we started a low-carb diet, we also eliminated wheat, rye, barley, and oats. And, of course, sugars in their various forms.

    My husband had no problems just quitting. I had to "step down" slowly or I became quite ill. From food.  Or rather, "food".

    We stil eat (very limitedly) legumes, rice (in the form of poha), and corn (as grits or as tacos). We don't have any of these in combination, however. IOW, on a day we have rice, we don't have the other two.

    If we cut those out entirely we'd lose weight more quickly I'm sure. However, this is working so far. Slow going but doable.

    A striking experience: after 25 years' smoking, being overweight, and a huge family history of vascular blockage in all my parents' sibs, I had the scan done a few years ago. The cardiologist who read my scan gave me a clean bill of health. My chances of a cardiac "incident" in the next five years was two percent. That was at age 65. I'm still amazed.

    So-called 'pre'-diabetes has reared its ugly head. I insisted on an (hb)A1c test last year and it came back at 5.8, much to my doc's surprise (but not mine). The next test, six months later, was 5.6 . I'll be interested to see if my weight loss has made a difference when it's time for the third one.

    It's great to be rid of wheat, but what a crime they have perpetrated on all of us. My grandson died at age 28, "heart problems". He was obese and addicted to wheat.

  • Alec

    5/31/2011 2:37:40 PM |

    This reminds me of the "Molecularly Baked" products they used to sell on the Zone Diet website. Absolute crap- lots of wheat combined with wheat protein (gluten?) and processed soy crap. Blah!

  • Dr. William Davis

    5/31/2011 4:07:29 PM |

    Hi, Andres--

    For all practical purposes, pasta made with durum wheat is still wheat. Semolina, durum, spelt, whole grain, multigrain, etc., it still remains essentially wheat. Pasta from durum, for instance, triggers sustained high blood sugars after consumption with all of the undesirable consequences that brings.

  • Abhi

    5/31/2011 5:45:57 PM |

    Dear Dr Davis,
    I love your blog!
    How do you compare this with the "Einkorn" (Jovial) pasta that you had tried and even blogged about.
    Thanks!

  • Alan D

    5/31/2011 8:42:43 PM |

    My experience with Einkorn pasta was a very small rise in blood sugar tested an hour and two hours after eating. I cooked the spaghetti and also the penne with tomato and garlic and olive oil. With regular wheat pasta my bg is 130-180. With Einkorn Jovial brand  it was barely over 100. I suspect everyone is a bit different though and some may have different results.

  • Dr. William Davis

    5/31/2011 11:17:49 PM |

    Abhi and Alan raise an important point: Einkorn is wheat, but it, I believe, far less destructive than modern Triticum aestivum, especially the dwarf variant product of genetics research.

    Einkorn is not entirely benign. After all, celiac disease was described even in the 1st century A.D. However, given a choice between modern low-carb Triticum aestivum or durum equivalents and einkorn, I would choose the einkorn, hands down.

  • Andrés

    6/2/2011 10:58:01 AM |

    Thanks for your answer!

    Well, I will try to reduce my durum intake also, then. I am now experimenting with breakfast without bread: I do an omelet with two eggs (three was a little too much a company to my white coffee), Gorgonzola and butter (I am still not convinced about the AGE issue).

    Regards.

  • Ingrown Toenail Remedies

    6/2/2011 11:08:07 AM |

    I’m a new reader and have been very impressed with your recent posts and thought to drop a friendly note. It is really a great information indeed. Waiting for more posts, is there a way to subscribe to your blog via email?

  • JT

    6/12/2011 5:12:58 PM |

    just tried a plate full of Dreamfield pasta with chicken cachitori sauce and it raised my BG to only 104 after an hour.

    I wonder it Dreamfield affects people differnetly

  • Nancy

    12/21/2011 9:27:07 PM |

    How the pasta is prepared is important to its effect on BG.  It can't be sitting around very long in a sauce, especially tomato, before the "protective coating" disintegrates.  Boil in water, drain, then put on sauce and eat.  Do not cook the pasta with sauce.  Do not store leftover pasta mixed with sauce.  Or just don't eat it at all.

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Another option for lipoprotein testing

Another option for lipoprotein testing


For those of you who have been frustrated in trying to get your lipoprotein analysis performed, here's another option.

The Life Extension Foundation at www.lef.org provides access to the VAP test, or Vertical Auto Profiler. This is the lipoprotein test run by the Atherotech company in Birmingham, Alabama. The name refers to the method used, a form of centrifugation, or high-speed spinning of your blood (plasma) to separate the various components by density.

This is a fine technique that works well. Though our preferred method is NMR (www.Lipoprofile.com, Liposcience Inc.), the Atherotech VAP is a reasonable alternative.

If you go through the Life Extension process, they will direct you to blood draw sites in your area. They charge $185 for Life Extension members, $247 for non-members. (Membership in Life Extension costs $75.) Drawback: No billing for health insurance reimbursement.

A full description of the significance of lipoproteins can also be found in my article posted on-line at the www.lef.org website at http://www.lef.org/magazine/mag2006/may2006_report_heart_01.htm
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Pill pushers

Pill pushers

Have you read the latest cover story from Forbes magazine? It's entitled "Pill Pushers: How the drug industry abandoned science for salesmanship".

It's great reading. (A condensed version is available at the www.forbes.com website: http://www.forbes.com/business/forbes/2006/0508/094a.html. They require you to provide your e-mail address though it's free.)

Drug industry advertising has raised consciousness of all the prescription therapies available for us--that's good. However, they've gone so far overboard trying to squeeze more and more revenues out of drugs that they've cost this country a huge amount in increased health care costs and even lost lives. (Forbes does a great job of summarizing some of these instances.)

Drugs like Lipitor, Crestor, Zocor; diabetes agents; anti-hypertensive agents, etc., that is, medications taken chronically, a huge financial bonanzas for drug companies. Not only do they get $100-200 per month, but they get it month after month after month. That's per drug.

Now not all medications are bad or unnecessary. There are times when they can be truly necessary and beneficial. But don't rely on drug company advertising to tell us when.

Comments (1) -

  • Anonymous

    4/30/2006 8:09:00 AM |

    I feel better then I have in Years.

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Construct your glucose curve

Construct your glucose curve

In a previous Heart Scan Blog post, I discussed how to make use of postprandial (after-meal) blood sugars to reduce triglycerides, reduce small LDL, increase HDL, reduce blood pressure and inflammatory measures, and accelerate weight loss.

In that post, I suggested checking blood glucose one hour after finishing a meal. However, this is a bit of an oversimplification. Let me explain.

A number of factors influence the magnitude of blood glucose rise after a meal:

--Quantity of carbohydrates
--Digestibility of carbohydrates--The amylopectin A of wheat, for example, is among the most digestible of all, increasing blood sugar higher and faster.
--Fat and protein, both of which blunt the glucose rise (though only modestly).
--Inclusion of foods that slow gastric emptying, such as vinegar and fibers.
--Body weight, age, recent exercise

Just to name a few. Even if 10 people are fed identical meals, each person will have a somewhat different blood glucose pattern.

So it can be helpful to not just assume that 60 minutes will be your peak, but to establish your individual peak. It will vary from meal-to-meal, day-to-day, but you can get a pretty good sense of blood glucose behavior by constructing your own postprandial glucose curve.

Say I have a breakfast of oatmeal: slow-cooked, stoneground oatmeal with skim milk, a few walnuts, blueberries. Blood glucose prior: 95 mg/dl. Blood glucose one-hour postprandial: 160 mg/dl.

Rather than taking a one-hour blood glucose, let's instead take it every 15 minutes after you finish eating your oatmeal:


In this instance, the glucose peak occurred at 90-minutes after eating. 90-minute postprandial checks may therefore better reflect postprandial glucose peaks for this theoretical individual.

I previously picked 60-minutes postprandial to approximate the peak. You have the option of going a step better by, at least one time, performing your own every-15-minute glucose check to establish your own curve.

Comments (24) -

  • Eric

    2/19/2011 5:03:57 AM |

    Have you ever used a DexCom 7, like Tim Ferriss did for the 4 Hour Body book?

  • Kurt

    2/19/2011 12:55:16 PM |

    There is evidence that alcohol decreases the blood glucose rise, which may explain in part why moderate drinkers have lower risk of heart attacks. Have you found this to be true?

  • Anonymous

    2/19/2011 3:01:47 PM |

    With all respects, Doctor Davis, but I am at a loss to understand your reasoning behind the suggestion of constructing a 2-hour curve with readings taken every 15 minutes. Invariably after eating, blood glucose level will rise and then fall over the two-hour period. I can control the severity of the "spike" by the type of food I consume. After eating however, I cannot control the shape of the curve without the intervention of medication or physical exercise. This is known. So what additional practical information is provided me from this exercise?
    My regards, StanO

  • Anonymous

    2/19/2011 3:09:36 PM |

    Hi! These are my readings using a 1-low carb meal-day approach during months.

    day   hour mg/dL
    02/15 11:17 74
    02/15 12:57 83
    02/15 13:53 79
    exercise lifting weights
    02/15 15:11 93
    end of exercise
    02/15 15:46 75
    02/15 16:22 86
    02/15 16:49 83
    meal time

    As you can see these are my pre-meal levels in a low carb diet, one meal a day approach eating nuts, yogurt, liver, meat, fish, especial atkins bread, butter, chicken, eggs etc..

    Next day I change my normal low carb meal for a high carb meal (pasta with a bit of meat) with my morning sugar in these same levels. Lets the party begin.

    02/16 13:20 finish pasta festival
    02/16 13:29 114
    02/16 13:42 103
    02/16 13:57 125
    02/16 14:06 127
    02/16 14:12 137
    02/16 14:23 119
    02/16 14:36 126
    02/16 14:48 130
    02/16 15:03 123
    02/16 15:15 106
    02/16 15:30 112
    02/16 15:46 111
    02/16 16:11 107
    02/16 16:22 105
    02/16 16:47 114
    02/16 17:21 121
    02/16 17:32 120
    02/16 18:07 113
    02/16 18:21 125
    02/16 18:50 110
    02/16 19:42 114
    02/16 20:21 130
    02/16 21:29 112
    02/16 23:37 119
    time to bed. I also feel like shit.

    Next day, do you think the party is over?

    02/17 07:20 121 (no)
    02/17 12:15  71 (finally, nearly 24 hours of high sugar levels!)
    02/17 13:00  84
    02/17 14:50  81
    02/17 15:57  71
    02/17 16:30  end meal (with a bit of wheat bread)
    02/17 16:48  99
    02/17 17:08 111
    02/17 17:27  94
    02/17 17:47  82
    02/17 18:18  87
    02/17 18:42  73
    02/17 20:09  78
    exercise (please, do not ask what type of exercise and how I can manage to check my sugar in that situationSmile
    02/17 21:31  98
    02/17 22:01  97
    end of exercise
    02/17 23:15  88
    02/17 00:38  83

    Next day

    02/18 09:18 79
    02/18 10:36 81
    02/18 11:38 85
    exercise (ski, more aerobic so my sugar levels do not increase to much. Cannot use the sticks due to low temp)
    02/18 18:00 80
    low carb meal using  whole grain special atkins bread
    02/18 18:31 85
    02/18 18:47 98
    02/18 19:08 90
    02/18 19:30 88
    02/18 19:45 93
    02/18 20:20 87
    02/18 20:40 80
    exercise
    02/18 21:12 92
    02/18 21:58 94
    02/18 22:26 91
    end of exercise
    02/18 23:39 88
    02/18 01:17 88
    exercise
    02/18 02:20 93
    end of exercise

    Next day similar to my first set of data.

  • Geoffrey Levens

    2/19/2011 5:01:08 PM |

    "I am at a loss to understand your reasoning behind the suggestion of constructing a 2-hour curve"

    Varies so much per person and meal composition.  Some people will get peak even longer than two hours w/ something like pizza that has lot of heavy grease as well as the carbs.  Or if they have any gastroparesis  issues

  • Dr. William Davis

    2/19/2011 7:05:00 PM |

    Hi, Eric--

    Sorry, but I don't know what DexCom 7 is. Can you tell me anything about it?


    Hi, Kurt--

    The effects of alcohol and alcoholic beverages are complex. The blood sugar effect is only a small part of the equation. Among the most consistent effects are reduced blood sugar with red wine, increased blood sugar with beer.

  • Dr. William Davis

    2/19/2011 7:07:12 PM |

    Hi, Anonymous--

    Impressive effort!

    Incredibly, just about any primary care doc would declare your values "normal," since you don't "need" medication.

    You've found the secret: Carbohydrates screw up health galore.

  • STG

    2/19/2011 10:54:14 PM |

    I almost had a wheat relapse today, but what I realized is that I wanted the butter. So, I ate a small bite of organic butter.

  • revelo

    2/20/2011 1:01:30 AM |

    Carbohydrates don't screw up health in most people, but they have to be managed properly. Anonymous's glucose spike occurred because he/she surprised the body with a heavier carb load than it was adapted to. It takes a week or so for the body to upregulate insulin sensitivity and glycogen storage ability. Until that upregulation occurs, high carb intake will indeed cause glucose spikes.

    Here's my own anecdote. After switching to a paleo diet for a week, I then switched back to high-carb. Upon eating 200g (dry) of cooked oats, my glucose shot up to 195 mg/dL. A week later, I was able to eat the same 200g (dry) of cooked oats and glucose remained below 120 mg/dL. What happened is that my ability to process glucose downregulated when I switched to paleo, then upregulated after I switched back to high-carb. Both the down and upregulation take a few days. It is probably inadvisable to constantly switch between paleo and high-carb. If you plan to eat high-carb, then do so consistently, so that the body is always prepared for high glucose loads.

    My recent VAP blood tests, taken after resuming my usual high-carb regimen, show HDL=66 mg/dL, LDL=61, VLDL=12, Trig=45, Lp(a)=15, HDL-2=23 (most protective HDL greater than Lp(a), thus counteracting the latter), and type A LDL pattern (mostly large buoyant LDL). CRP was .16mg/L, which is very low. Laboratory measurement of fasting glucose was 85 mg/dL, versus 84 for Reli-On Confirm home glucose testing device measured that same morning (the Reli-On device thus appears to be accurate). These results hardly suggest that a high-carb diet necessarily screws up health.

    There is also plenty of other evidence that carbs are not unhealthy for people who are lean, get daily exercise, don't have an underlying illness, and eat mostly unrefined carbs. All sorts of primitive peoples (Kitavans, Tarahumara indians, Bantus,  traditional mediterranean people's, etc) eat high-carb diets and have very low incidence of diabetes, heart disease and other chronic illnesses due to diet (they may have chronic illnesses due to parasites).

  • Might-o'chondri-AL

    2/20/2011 1:17:59 AM |

    Depression a variable: Japan 2010 journal "Anti- Aging" showed affect on blood glucose in 5 hour glucose(75 grams) tolerance test on a clinic's depressed in-patient (woman age 36). The articles authors conclude a "very low saccharide diet" is better for the brain, which runs fine on ketones.

    Fasting blood sugar = 74
    30 min post glucose = 97
    1  hour  "    "     = 78
       (coincides with insulin peak)
    2 hour post glucose = 54
       (27% below fasting blood    
        sugar)
    3 hour post glucose = 99
       (insulin less than 1/2 of
        30 min. insulin & 1/3 of
         2 hour insulin)
    4 hour post glucose = 75
    5 hour "     "       = 80

  • Anonymous

    2/20/2011 2:04:08 AM |

    I have a big question here.
    I persoanlly have my peak at 30 minutes. So my question is:
    Is it a BG of 140-160 after 30 minutes if after 60 minutes it is under 100 too bad?

  • revelo

    2/20/2011 2:49:20 AM |

    @Might-o'chondri-AL: Can't understand the logic of low-carb for depressed people. High-carb boosts serotonin. The only reason I could think of prescribing low-carb for a depressed person is because they are overweight, and the excess weight is partly responsible for the depression (inability to move about and exercise due to morbid obesity, for example).

  • Anonymous

    2/20/2011 6:27:17 AM |

    revelo, thanks for some sanity.  Reading these blog posts and most of the comments that follow is depressing.  They would have everyone believe that their inability to handle carbs is representative of normal, healthy, individuals.

    Maybe they need to get healthy, and then they can actually eat whole-food sources of carbs and stop being so scared and go and live life.

  • Might-o'chondri-AL

    2/20/2011 8:30:25 AM |

    Hi Revelo,
    I've got nothing against carbs & am still learning (I eat carbs); your blood profile seems excellent enough to trade for.My thinking on your approach is: that you may find, like me in my 20/30/40s + years, care free
    carbohydrates are fine and by
    the time hit 60 there's the unforseen to adjust to. The famous quote is: "Old age ain't for sissys."
      
    So, back to Japan ....
    Psychiatric clinic tested 2,000;
    detailed one to show how variable blood sugar/insulin expression is in depression. They claim to have got her off meds and adressed low neuro-transmitters of depression; which clinically they say (depression) is common in metabolic syndrome.

    Their flow chart for seratonin is dietary amino acid L-tryptophan as substrate with folic acid, iron, niacin and enzyme tryptophan hydroxylase; yields, 5-HTP with vitamin B6 and enzyme 5-HTP decarboxylase; yields seratonin (which in it's own right is the substrate for
    magnesium and SAMe to make into melatonin). I'll skip their GABA and dopamine flow charts.

    This was a geriatric symposium paper, so focus was on brain down the line. Their pitch was for preventing cognitive decline;
    and that ketones protect the brain from Alzheimers and Parkinsons - just as ketones diets do help in
    epilesy and other mental disorders.

    They specify that in the brain beta-hydroxy-butyrate (ketone) ups utilization of circulating oxygen more, decreases CO2 in tissues from glucose "burning", and ketones make ATP more efficiently too. As for the mitochondria, they continue to get their essential glucose molecules from gluco-neogenesis.

    My impression is they're showing that in geriatrics the potential
    accumulation of what Doc's blog
    warned about, namely  A.G.E.s
    (advanced glycation endproducts)is a risk factor for Alzheimers, etc. The authors conclusion was the central nervous system used ketones just fine;and carbohydrates were not required for old people to have good levels of circulating blood sugar.





    sowed data for 1 depressed lady

  • Anonymous

    2/20/2011 11:43:35 AM |

    Dr Davis: Two comments were made asking for your reasoning behind the suggestion for construction of a 2 hr curve. To me the comments are politely made. They are appropriate in my opinion and they deserve a response. It is obvious that you chose deliberately to ignore them.

    Your commentary is followed and I expect influences countless readers; some possibly obsessively, ie healthy individual who performed more the 75 glucose checks over a few days time.

    With your efforts to maintain this blog come added responsibilities to its readers which you currently are ignoring.

    Shame on you.

  • STG

    2/20/2011 3:47:40 PM |

    Anonymous: Your response to this blog is somewhat emotional and critical. Perhaps you could be open to the idea that some people can consume a high, unrefined carbo diet and be healthy; others will suffer adverse effects on a high carbo diet and need a more protein based or mixed diet. For those individuals that are carbo sensitive, there is good dietary advise on the blog. I do not currently test my blood sugar. I do not want to become myopic about health; however,I don't judge others on this blog who want to pursue this strategy even if they are not insulin resistant, diabetic or pre-diabetic. Moreover, I may have to resort to using a monitor in the future. The blood sugar data from another "anonymous" is very interesting and certainly provides real data for determining his or her dietary choices. Please keep an open mind and avoid insulting comments like "shame on you" which add nothing to the dicussion and are meant to insult not to educate or enlighten others.

  • Geoffrey Levens

    2/20/2011 4:38:32 PM |

    DexCom 7 is a "continuous" bg monitor for home use. http://www.dexcom.com/products

    I have been eating Dr Fuhrman's diet and lately, typical meal contains 3-4 cups chopped leafy greens, 2/3 cups cooked beans, about 2/3 oz raw seeds/nuts, 200 grams starchy root veg, one piece of fruit (most often an apple).  Peak postprandial sugars for me come very close to one hour after end of meal and are in low 120's to high hundred teens, back to fasting by 90-120 minutes Usually 90 minutes).

  • joseph

    2/20/2011 4:54:29 PM |

    why do you think that post meal levels of 120 or 140 are "normal"? Simply because are the levels that people get when eat a lot of carbs in a meal.

    You body do not like this levels, that is why it try to put them down using insulin. Why is your body doing that if they are "normal levels"?

    If you check my levels in the 4 reply you could find that when you do not eat for longs periods of time your body try keep your sugar between 70 and 90. If you are relaxed the level could be in the 70 zone and if you do some exercise it will go to 90 zone. Why your body do no increase it to "normal levels" of 120-140? Probably because this levels are not "normal".

    So you have a high carb meal. Your body react to it trying to keep your sugar down, why?. Yes... your body is stupid and doesn't have a degree in nutrition so cannot understand the science behind this "normal levels".

    When you body finally got the 85 level your dietitian says that you need to have another high carb meal. So your levels return to 120-140, and you ignorant body starts to reduce this "normal level" to 70-85. When you got that level is time to have another high carb meal, and your ignorant body returns to do the same trick.

    Years of doing that and your body cannot maintain the true normal levels your doctor says that you need to do some exercise to well... reduce sugar levels! and of course still doing 5-6 small high carb meals a day.

    So now you need to run the New York City Marathon to get rid of all that carbs in all that meals your are eating during the day.

    Of course you need increase the carbs in these meals to have energy to do all that exercises. In one of those healthy marathons you also take a high carb drink to... well... you know.

    It doesn't work, you end eating more than before because your body needs more energy to run all that healthy marathons and you are all the day hungry.

    Later your unscientific and stupid  pancreas collapse and your doctor says that you need to maintain your 34646464 high carbs meals a day, but take some insulin to help your body to reduce all the sugars YOU ARE EATING EVERY 3 HOURS.

    Probably our pancreas simply commit suicide because is not able to understand our rock solid science.

  • Anonymous

    2/20/2011 5:15:30 PM |

    Can someone explain to a non-scientist what "up-regulate" and "down-regulate" mean?  Peter

  • Anonymous

    2/21/2011 1:38:04 AM |

    A couple of people have asked why construct your own glucose curve so I thought I'd throw out my thoughts on it.  Every person's glucose will peak at different points either due to slower stomach emptying or a slower absorbed carb or whatever. I have read that many people will peak at 75 minutes.  So if you are trying to get a real idea as to how your body reacts to glucose/insulin then you need to test frequently to find YOUR personal peak.  Then you will know when to test when you try new foods.  Is that others understanding too?
    Char

  • Anonymous

    2/21/2011 3:21:29 AM |

    This blog post is so full of Fear, Uncertainty, and Doubt.  People asking questions due to being scared by Dr. Davis' suggestion of "constructing your glucose curve", so they ask him questions in the comments, like what their "glucose curve" should look like.  People thinking now they better be jabbing themselves 15 times after a meal.  Thinking about a meal for hours after a meal.  Guilt for eating that meal.

    So Dr. Davis' response?  IGNORE THEM and put up a new blog post with MORE scare-mongering:


    Now you should fear the banana!
    http://www.heartscanblog.org/2011/02/american-heart-association-diet-makes.html

    "Would you like a banana?"


    What a joke.  Show us a single person who got fat off of bananas OR potatoes, or any whole food carbs.

  • Might-o'chondri-AL

    2/21/2011 5:10:31 AM |

    Hi Peter,
    Up-regulate is an action on a gene that makes it do more of what it's capable of doing. And down-regulate is when a gene is being acted on in a way that it will do less of what it's capable of doing.

    A gene can be overactive or underactive. Depending on the dynamic, of how a specific gene ideally should be doing, regulation up or down is desired.

  • eye lift guide

    2/22/2011 9:34:34 AM |

    Here is giving nice tips. Thanks for its. I the way you explain us.

  • Dr George

    3/29/2011 7:35:53 AM |

    Hey there Dr Davis,

    Created my own glucose curve as part of my own research and actually got a bit of a scare!

    I was doing a high carb meal to try and demonstrate an early carb spike then drop.

    While I didn't get the response I was looking for I got something a bit scarier. A fasting glucose indicitive of pre-diabetes reading instead. I am amazed how one bad meal was able to send my sugar awol over night.

    Back onto low carbs for me.

    Thanks for helping open my eyes to my potential diabetes.

    Dr George

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