Nice post Bill. People really need to get this info into their heads.

Great meeting you  on the cruise!

Please could you provide links to the interventional controlled (not observational) studies that have shown a link between eating meat and cancer risk, that separate the effect from eating junk food, and the fact that vegetarians are more likely to eat healthily in general than meat eaters due to the widespread and incorrect belief that saturated fat is harmful to health.

Also, could you explain lack of cancer in traditional tribal societies with a high meat intake? You would need to do this before stating that meat intake necessarily increases cancer risk.

Hi doc,

Great blog. How do you explain the Inuit, Masaai, Komi (Siberia), Native American and similar cultural groups whose diets seemed to subsist primarily on animal products? ie. including my ancestors.

Perhaps its an emphasis on wild/grass-fed/raw dairy(or as close to) animal products as opposed to the grain-fed animal products which encompass the majority of the US that you need to be addressing?

Thanks.

Interesting point of view.  Can you please provide references to support your claims?

Great diet, and yes, it seems that we should talk about healthy eating instead of weight loss or diets. Anyway the purpose of any diet is to move your eating habits to new healthy level.

Thanks for sharing and possibility to comment! Welcome to visit Ideal Weight Blog to find some recipes and great articles! Thanks!

Just on the nitrate/nitrite subject: as far as I know nitrate is a naturally occurring compound and the human exposure to it is mostly through  consumption of vegetables, and to a lesser extent water and other foods...

http://www.efsa.europa.eu/en/scdocs/scdoc/689.htm

I would say there are 3 primary pitfalls of low-carb dieting:

1) Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet "tends to shut down the thyroid."  

2) Too much protein - this strains the thyroid as well, and encourages gluconeogenesis, which is also problematic - especially when in ketosis and insulin resistance is extreme.  

3) Extremely high in omega 6 polyunsaturated fat.  Eating a low carb diet with lots of pork fat, chicken skin, peanut butter, and nuts - the typical standbys of many low-carb dieters, provides an astronomical amount of omega 6.

By my best guesses, I was consuming 15+ grams of omega 6 while on a low-carb diet.  I've since cut that back to less than 3 grams per day and the change has been dramatic.  Of course the 400 grams of carbs per day helps too.

Dr. Davis,
Thank you for this post.  I'm certainly culpable of the "common errors" you mention.  I find that making daily decisions on what to eat difficult. I want to eat healthy and have some variety. Here's the question.  What do you eat?  What did you have for breakfast this morning?  What did you eat last night?  What do you keep in the fridge and on the counter to make following your dictates easier.
I don't want to over-think it but all this information is overwhelming.  I feel like a scientist and my body is the research subject.
Thank you for your blog.  I've learned a lot but need some direct guidance.
Sincerely,
Dana Law
San Diego, Ca

Why is "Calories in vs. calories out" a faulty concept?

Have you really read the meat leading to cancer literature carefully or do you just think it's like that? Others like Gary Taubes and Eades (who I really trust when it comes to research) have found no evidence that meat cause cancer.

On sodium nitrate, I totally agree. I get so mad when I'm walking in the grocery stores. All meat has sodium nitrate added. Grrr.

I share your thought about dairy. But do you really mean that butter triggers insulin spikes?

Most nitrite is form your own spit and originally ingested by eating vegetables.  

I believe the epidemiological studies (which also typically find fat to have bad associations...) have more to do with a lack of fruits/vegetables/polyphenols than anything that is bad about meat.  

Also, I don't think glycemic index or the insulinotropic nature of certain proteins matters one lick for people that are healthy.  I can eat a boiled potato for breakfast without my blood sugar breaking 100... I don't think diabetes is an overuse injury - more likely, it is cause by damage to the liver and then pancreas from PUFA and fructose overconsumption.  

I think Matt Stone is correct about the top three problems with Atkins.

If you're really concerned about your nitrite intake, watch your celery, arugula and spinach (and many other vegetables) consumption, too. Nitrites galore. Though it's not nitrites and nitrates in and of themselves that are linked to cancer, it's the nitrosamines that can form from them.

Sodium nitrite isn't primarily a colour fixative, it's a an anti-bacterial agent. Meats cured with sodium chloride only have to be done quite carefully to avoid botulism. Nitrite has been used since the 16th century to preserve meat. Modern cured meats also add sodium ascorbate, and ascorbates have been shown to inhibit nitrosation reactions and thus the nitroamine level in these cured meats is usually at undetecable levels.

Nitrites are produced in our mouths from bacterial reactions to the nitrates in food and water, and at least 70% of our dietary nitrite comes from this salivary nitrite (which came from our food and water). The nitrites and nitrates we then ingest are mostly either excreted fairly promptly or used to make nitric oxide. Human gastric secretions have a pH which isn't condusive to nitrosamine formation, and also include ascorbates which reduce nitrosamine formation, and keeping one's vitamin C at good levels will also have an effect. People with achlorhydria will obviously be more susceptible to nitrosamine formation. But interestingly, there are studies which now suggest that nitrite consumption is a good thing: http://www.ncbi.nlm.nih.gov/pubmed/20005970 - and branched-chain amino acids are also suggested as suppressing the effect of nitrosamines. However the amount of nitrosamines you get from smoking is definitely Not Good, and no amount of ascorbate will ameliorate it.

So, a good intake of nitrates and nitrites primarily through vegetables, some fruit, and some cured meat is good: the vegetables and fruit contain ascorbates as does your body, and most of hte meat should have it added also, minimising the formation of nitrosamines, leaving your body to get on with making use of the nitr*tes to make needed nitric oxide. (Oral nitric oxide/arginine supplements are rubbish though - the studies showing their benefit used intravenous/injected supplement.)

Personally, I'll take nitrites over botulism, thanks.

Hmmm, I've never been on a cruise, but if I did go on one, I'll bet I'd have to eat somewhat differently than I do at home, regardless of the carb count.  Between not having access to the pastured bison and wild game, raw dairy, "backyard" eggs, and organic CSA produce subscription, and so on that make up most of my family's daily diet, and no access to a kitchen, my meals on a cruise would hardly be representative of my usual diet.  

I'll bet LC cruisers are as prone to anyone when it comes to the excesses of endless supply of prepared foods on cruises, but I'm not sure we can assume that's the way they always eat.  Most people  eat somewhat differently on vacation, whether it's because they are on somewhat of a "diet vacation", or because they have to make the best of what's available.  When I was on vacation in Italy I had a gelato every day, but I certainly don't do that at home (it was a conscious decision to take a slight vacation from my diet and enjoy a local specialty for a limited time).  And I've been places where it was impossible to get eggs cooked in real butter instead of the ubiquitous "griddle grease" hydrogenated veggie oil, let alone pastured eggs and humanely produced bacon (seriously, we breakfasted at a tiny roadside diner outside Twenty-Nine Palms that had NO butter on the premises).  

And not all LC eaters are following an Atkin's diet plan, though I understand the Atkins label has become be a generic term for LC eating.  I've read an Atkins book (as well as at least a half dozen other LC diet books).  I eat LC (& GF now) but I've never followed specifically an Atkin's diet plan, nor do I describe myself as at Atkin's dieter.

I think the points you make point out that even on low carb, people can and do still rely on far too much industrial food.  It's convenient and it's everywhere (hard to avoid, esp when dining away from home).  Frankly, one of the reasons cruise vacations hold little appeal to me is the idea of having to nothing to eat all week but cr@p industrial food, no matter how talented the chefs may be at making it look and taste good.   I may be making a sweeping assumption, but somehow I don't imagine that cruise chefs are simmering their own bone broth stocks, curing charcuterie themselves, and making their own cheese (or even sourcing from small artisan vendors  very much).    I'd be extremely surprised if cruise ship food ingredients weren't offloaded from US Food tractor trailer trucks.  That's what I've seen at many land-based resorts.  When I travel,  as much as possible, I want to try the local traditional foods and specialties, prepared as authentically as possible.  That might mean eating more of something than usual (and less, too).

Isn't it also an Atkins diet error that low-carb eaters tend to be on a constant and frantic quest for processed fake food items that are pretend substitutes for the food that got them in trouble in the first place?  And many of them have made Jimmy Moore, a huge hawker of low-carb substitutes and a less-than-successful low-carber, their role model.  

I noticed on Swedish physician Dr. Andreas Eenfeldt's blog that his description of his experience on the cruise was that "[t]he big difference with Sweden is that many are fond of low-carb versions of traditional junk food, sugar, and so. Low carb cake, low carb icecream, low carb potato chips, diet sodas ... In my eyes seemed to just those participants who ate such did not have the same persuasive power of the diet. To put it nicely. Perhaps it was the roundest of them all, the man [Andrew DiMino -- Carbsmart.com?] who handed out the various "low carb" products that are advertising for his company. [Google translation]

People I know who have been totally unsuccessful on Atkins have gleefully loaded up on "substitutes" that probably have derailed them.  And the Atkins company that sells this crap will forever keep the Atkins mantra from the gaining the credibility it probably deserves.

also curious as to how butter could cause a rise in insulin. butter has even less/no carbs compared to cheese, and in previous posts you've said cheese doesnt cause blood sugar rises...

also many health food stores, grocery co-ops, and whole foods and trader joes sell either no nitrate-added or uncured deli meats and bacon. applegate and niman ranch are brands that sell these foods.

Bill you said:

"Excessive consumption of animal products--Non-restriction of fat often leads to over-reliance on animal products. Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers. It is not a fat issue; it is an animal product issue. We should consume less meat, more vegetables and other plant-sourced foods."

I don't think this is true Bill. As far as I'm aware, there is no good evidence to support protein as cancer causing. Dr. Eades has debunked this on his blog.

Andrew, scroll down and see the section on conservation of energy for why calories in vs out is faulty: http://entropyproduction.blogspot.com/2009/02/all-medical-science-is-wrong-within-95.html

Ditto what Tim said. My understanding is that it's the whey in dairy that is insulinogenic (tho it's a bit like the glycemic index ... it depends on when and what you eat it with).

Butter should not be as big a problem. One of my go-tos is ghee from grass-fed cows. The small amount of milk solids left in butter are removed when ghee is made.

If you cut out animal protein, dairy, and carbs, there's not much left to eat.

The protein sources favored by vegetarians, beans, rice, and grains, make blood sugar increase too much for people with diabetes.

One can not live on tofu and fat alone, and anyway some people say too much soy is not good.

I don't know why people have a prejudice against dairy. See this:

http://care.diabetesjournals.org/content/29/7/1579.full

If you have a diabetic tendency, it means your beta cells aren't producing enough insulin, so a food that helps them along is good.

Well said Dr. Davis!  We were certainly appreciative of your presence on the Low-Carb Cruise.  THANK YOU so much for all of your contributions...we need to get you back on the podcast later this year.

Too many calories on a high fat diet? Good luck keeping that up. I can't get 2000 most days. Too full.

Why were there traditional societies that used dairy as a staple yet were free of CVD and diabetes, including the super long lived people on the border of Eastern Europe and Central Asia?

Copy and paste the above argument for "eating too much meat."

Low carb may not be for everyone, but the biggest problem with some low carbers is probably too much n-6 from processed meat. Lots of nuts aren't that good for you either.

What is the alternative for animal protein? Soy, gluten,beans, nuts all cause other problems?

Please suggest some sample of improved Atkin diet.

Again Low carb is NOT zero carb. Many atkins folks don't really read the diet. I used atkins succesfully last year and eat more veggies then I ever did. It is not all about meqat meat meat or even high protein. And as much as I enjoy your blog- you still have a huge fear of fat. With Atkins I have improved my metabolic problems.

I've been concerned to learn, here and elsewhere, that dairy products are insulinogenic, particularly since I can't seem to manage a reasonable diet without a fair amount of them.  (Nuts don't do well with me, soy is a no-go, I can only eat so much meat, my family has egg-allergy issues, and the fish that is non-contaminated, sustainably caught, not-BPA-canned, not-fed omega-6 and dioxin-laced stuff in a disgusting fish farm, is wicked expensive and logistically impossible to get fresh for my family more than once a week....)

On the other hand, there are several dairy-reliant cultures that are quite long-lived and healthy, and dairy-consuming people in our own culture tend to be healthier than non-dairy eaters.  So maybe something mitigates the insulin question with dairy.  Just saying.

In the end, you have to eat something, and sometimes reading this blog I feel I can't eat anything.  Like Dana Law, I'd like a better picture of what an ideal, or at least acceptable, day's or week's diet would look like from your point of view.

I've followed Atkins for these last three years, losing 80lbs in the process, so am quite familiar with what's permitted and not.

Atkins did not recommend consuming any milk, nor was much yogurt or cottage cheese permitted. Hard cheese, cream cheese and heavy cream are allowed, but the Atkins diet permits less than 2-3 oz per day.

Butter is allowed liberally, but is 100% fat so can't be very insunlinotropic, if at all.

Because I raise dairy goats, until three years ago, I drank goat milk freel.  Now I never drink it, though I do have a glass of very sour kefir now and then, after the probiotics have cultured most of the lactose into lactic acid.  The kefir I drink is very tart. Most people don't like it that sour. lol

The "Atkins is High-Protein" myth is often bandied about by anti-low-carb groups. I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended; even 20% protein is not especially high protein.

My carbs come mostly from eggs, green vegetables, heavy cream for coffee, berries and other LC fruit, and certain nuts and seeds, like flax.  Peanut butter is very carby, and not freely allowed in Atkins.

I recommend reading the old Atkins book to understand what his diet really contains. Read the 1972 version, as the newer books (after 1999) were changed by Atkins Nutritionals to allow low-carb junk food that they conveniently sell.

I don't want anybody to hear "don't eat meat" here.

I think that you should eat meat. I am a former vegetarian and I don't particularly like meat. Despite this, I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat.

Dr. Davis, you sure it was "Atkins low-carbers" you were with?

"Excessive consumption of animal products"

At least with DANDR 2002, as you go up higher on the rungs, meat is replaced somewhat by veggies.  Personally, I eat around 200g of meat per day.  Of that, less than 90g is red meat (the rest is fish.)

"Consumption of cured meat"

I love bacon as much as the next guy, but in even Dr. Atkins stated in DANDR 20002 that one should "try to avoid meat and fish products cured with nitrates, which are known carcinogens."

As for dairy, it's not taboo but still has to be fitted into the carbs you are allowed per day.

This is the second blog post since the trip you have me scratching my head.  I hit your 60-60-60 markers using oat bran all the while being IGT and sporting an A1c of 4.8%.  (And before anyone asks, in DANDR 2002 Dr. Atkins mentions oat bran to bring down your cholesterol levels.)

Dr. Davis says:

"I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

Try to do that for an extended period of time. I lasted about 2 weeks. Now I have a very small meaty breakfast, and a modest size meaty dinner, and I'm STUFFED. Been like this for years. Can't eat lunch-not hungry.

You prefer plant foods which is great, but you're not in a carnivore's shoes. From our perspective, what you say is rather silly because many of us actually worry about not getting enough calories! Fat is filling. I'm a 6ft, 165 lb male and I can barely get 2000 calories I feel so full.

Amen to Zach. I'm a PUFA-phobe, and if there's no grass-fed meat or butter in my diet, where am I going to get my fat?
Nuts? (PUFAs)
Soy? (Won't eat it unless it's fermented--like miso)
SUPER-skeptical about your claim regarding insulinotropic dairy. If it is so chronic disease-inducing, wouldn't the Swiss of the Loetschental Valley been prematurely "toes up in the dirt" of the emerald green countryside before Weston Price would have arrived to find out how spectacular their health was because of the dairy they consumed?

Brilliance abounds here: http://www.paleonu.com/panu-weblog/2010/3/18/sat-fat-or-pufa-which-one-do-you-fear.html

Hey, Gretchen,

Thanks for the link!  Good to know, and I was wondering about whether producing more insulin would be good or bad for me.  I had gestational diabetes, so I do have a diabetic tendency.  I'll keep eating my yogurt, then.

Helen

Here's a good take on the conventional "wisdom" of nitrates: http://junkfoodscience.blogspot.com/2008/07/does-banning-hotdogs-and-bacon-make.html

Matt:

"Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet 'tends to shut down the thyroid.'"

I generally find your thoughts to be spot-on, so there's no need to manipulate Atkins' quote to enhance your point.  What he said was that dieting in general tends to shut down the thyroid.

"[P]rolonged dieting [including ‘this one’] tends to shut down thyroid function."

Dr Davis -
Could you please post your "typical" breakfast, lunch, and dinner? I've been reading this blog for awhile (and it's great), and have read a lot of what NOT to eat, but haven't read much on what TO eat. What should our 3 square meals/day look like?

I knew that dairy was insulinotropic, but like Emily, I was surprised to see butter on the list as butter is mostly fat, and clarified butter entirely fat.  As I understand, it is protein-rich foods like beef, chicken, and fish, that provoke unexpectedly high insulin responses, so I thought it was either the sugars or the protein in dairy, not the fat, that spiked a rise in blood sugar.  Is butter really insulinotropic like other dairy products containing lactose sugars and proteins?

Another comment about dairy and weight gain:

I have noticed that melted cheese in particular - a warm, creamy fat with some carbs and protein - is highly palatable.  Full-fat yogurt, whipped cream, and guacamole are similarly irresistible.  I could not consume more than a couple tablespoons of olive oil yet have no trouble gobbling down a few slices of cheese melted onto a piece of chicken or beef.  I'm trying to shave off 5 more pounds to reach my goal, so I've given up all dairy except for clarified butter, which I use to saute veggies.  Will see if this works.

Most of the low-carbers on the cruise seemed to be overweight.  I don't know if some of them were just starting eating low carb.  I think this is what prompted Davis' post.  If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?

Hi, Fred!

We had some great conversations. I learned a lot from your "slow-burn" discussions and I've been applying them to my workouts.

Good to see you here! I will be detailing some of the fat/animal product/cancer discussions in future.

"I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

I'm scratching my head trying to reconcile these two statements.

How about eating animal products to hunger once or twice a day?

Haggus--

Excellent point.

What Bob Atkins called "the Atkins Diet" was somewhat different from what is commonly practiced as "the Atkins Diet."

As time passes, I continue to marvel at how much he got right.

How high is "too high?" I say this not to be a smart aleck or to overlook the wisdom in "you'll know it when you see it," but this is a bit too vague to be of much use.

Clearly a largely plant-based diet supplemented with a decent amount of animal protein will trump loading up heavily on animal products to the exclusion of plant-based foods. But there's far too many vague generalizations being bandied about by so-called dietary experts these days and not a lot of concrete recommendations that can be tailored to fit a person's unique context.

-Bob Sutcliff

Wow. Echoing a few other commenters, I'd really like some guidelines on what a good diet would look like.

Jenny said: "I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended...."

Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)

I'm sure most of you can straighten me out on this once and for all. Thanks!

Dr. Davis,

it would be great after such lengthy and detailed discussions about this topic to give us a typical sample food or meal list for a day of yours.
Looking forward to it.

Renfrew

Fred Hahn: I'm mixed up about your two posts here, "People need to get this into their heads" and "Not true."

I would also like to see a typical day in the life of Dr. Davis.

Anon-  Yes, they mean a % of total calories.  You can figure it this way:

1g Protein = 4 cals
1g Carb = 4 cals
1g Fat = 9 cals

So if a person eats 2000 cals/day and 18% was from protein, then that person ate approximately 360 cals of protein.  Divide 360 by 4 and you get 90 grams of protein.

I agree that there are many low carbers who follow their eating plan less than optimally. I see them posting on the low carb forums I follow. But as one who was also on the cruise, I don't think you can really equate cruise eating with what people eat on a normal day-to-day basis!

I had resolved to eat only "real food" on the cruise, as I almost always do at home, and I had resolved not to snack. And I was pretty good about my resolve. I didn't snack, ate only three meals a day, avoided the flour, sugar, even the sugar-free cheesecake and other things provided.

But did I eat exactly the way I would eat at home? No, I didn't. I undoubtedly ate more than I would have eaten at home, and probably certainly more protein sources than I would have eaten at home. The last night of the cruise I even broke down and had one of the sugar-free margaritas, and I had a half glass of red wine at the comedy show.

And I'm sure my PUFA intake was higher than I would normally like. We had no control over how foods were prepared in the kitchen after all, or very little.

But this was 5 days out of my life, not a lifetime of eating. I didn't gain any weight on the cruise and indeed have even hit a new low this week since being back. Overall I've lost more than 100 pounds.  

I'm not convinced of the meat/cancer link either - though too much protein raises my blood sugar so I don't normal OD on protein much. I was never a vegetarian but often thought I could have gone that way as I'm not all that crazy about meat. But now I have an "It's them or me" attitude and look for meats I  enjoy better - just not too much.

Apparently Matt Stone has challenged my son to try out a super-low-calorie, essentially fat-free diet, based on 1930s research by Evans and Strang, and I'm following his progress with interest. But at the moment it's not for me. I still love my butter and coconut oil.

But we are all so different, and what works for one may not work well for another. But I wonder how many low carbers eat at home the same way they ate on the cruise?

Well said Dr. Davis!

Jimmy this is not at all what you promote.  I am confused by your comment.

Dr. Davis, are you choosing to ignore all those who have asked you to defend your claims (and the great questions asked).  This is the first post I have ever read by you that makes me shake my head.  

Sally Sue

Anon said: "Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)"

Percentages of my daily food intake. I used percentages because everyone has a different calorie ceiling where we stop losing weight. The ceiling calorie limit usually changes as you lose weight; but the percentage of Protein, Fat and Carbohydrates should remain the same.

My daily calorie limit is now around 1500 calories; when I weighed 80 lbs more, it was closer to 2000 calories; and at 2000 calories back then I was losing 3-4 lbs a week.  Either way, the grams/oz of Potein/Fat/Carbs that I eat probably won't relate well to you; but percentages can and will.

By the way, I use a food-tracking program called FitDay, that calculates your food entries into P/F/C, and into grams/oz and percentages, and also gives daily vitamin/mineral counts as well as for individual foods.  It's really quite interesting to compare the nutrition counts of different foods; that way you can see what's really worth eating.  Meat contains a lot more than just protein... it has a lot of essential vitamins and minerals, actually.

FitDay is free online, but the purchased version is much more convenient; I paid $25 three years ago and consider the money well spent.

You should track your own food intake to see for yourself what percentages your current diet contains... you might be surprised. Food tracking, whether through FitDay or some other program, is the single most useful thing that helps keep me on track.

Red meat and intestinal cancer isn't strongly linked.  In fact, it seems to be dissolving under tougher scrutiny.

http://www.medicalnewstoday.com/articles/73040.php

"Recent studies published in the journal Cancer Science have disproved the common myth that consumption of red meat increases colorectal cancer  risk."

Eat for health, not for weight loss. I agree.

However, if, perchance, you believed that you ate for health, yet the same diet kept you fat, or God forbid kept you emaciated, would you really be eating for health then?

Re Anonymous and "percentages."  This drives me crazy too.  Without a total daily calorie count, percentages are meaningless.  So what if I eat "10%" carbs, if I am noshing on 6000 calories a day?

To answer your question: yes, you do have to do some simple math.  First, figure out the number of calories in the given percentage, using a hypothetical total daily caloric intake.  40% of 2,000 calories, for example, would be 800 calories.  A carb has roughly 4-5 calories per gram, so that would equate to around 200 grams of carbs.  Protein is similar.  Fat, on the other hand, has 9 calories per gram.  So those 800 calories would be slightly less than 90 grams of fat.

Once you start doing it, it gets easier.  Practice on food labels!

Anon - most food values are given as a % of calories.  For example if you are eating 2000 calories/day of which 70% is fat, then you're eating about 155 gms of fat per day (2000 x 0.70 = 1400/9 = 155 gms). Fat has about 9 calories/gm; carbs & protein each have about 4 calories/gm.

As for "...15 to 18% of what" that would depend on what you're eating.  Three ounces of white fish (raw) has about 16 gms of protein; 3 oz of beef chuck (raw) has about 28 gms of protein.

Beth:

That doesn't prove that calories in vs. calories out is faulty.  The calories in vs. calories out concept is simply the theory that you will lose weight if you eat below BMR, regardless of what foods you eat.  The Thermodynamics argument is misapplied to this concept, IMO.

Perhaps we are simply thinking of two different concepts.

Some highlighted words from the original post: overconsumption, excessive consumption, and too many calories. The point seems to be that a little rich food goes a long way. Oh, and don't eat food that causes cancer.

Sue said,"Most of the low-carbers on the cruise seemed to be overweight. I don't know if some of them were just starting eating low carb. I think this is what prompted Davis' post. If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?"

I was on the cruise and yes, many of the cruisers were overweight.  Some are just starting a low carb lifestyle, and some are not.  I personally have lost over 150 lbs on low carb and maintained that loss for nearly 2 years now.  I consider that a success, however, I am not thin by any means and am working on about 50 more lbs.  I took the advice from many of the speakers, Dr. Davis included, and have worked it into my daily routines.  As a registered nurse, I am aware of nutrition both mainstream and low carb.  I do my research.  I try to eat cleanly most of the time.  Life interferes sometimes, much as is does for anyone who is human and as I know it has for some of the individuals who were on the cruise.  I do believe individuals who are or have been morbidly obese are vastly different from your average American with 30 lbs to lose.  Everything happens on a grander scale.  We lose weight bigger and gain weight bigger.  All I know is I've lost 100+ lbs using the Standard American Diet--twice.  Within a year I gained it back--twice.  Finding a low carb diet has saved my life.  I eat in normal portion sizes, I maintain. Is it for everyone? No.  Is it the only way? No.  But it is one way that works for many people who really need it.  

Thanks Dr. Davis, for your presentation.  I truly enjoyed it.

"Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers."

Really? Strong association? If that's true, then how do you explain this?:
http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1

Hilary said:

"Really? Strong association? If that's true, then how do you explain this?:
http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1"

Hilary, I have not formed an opinion one way or the other on this issue yet, but the study you cite was "Supported in part by the Cattlemen's Beef Board, through the National Cattlemen's Beef Association, and the National Pork Board."

Re my question as to how to translate percentages of protein, fat and carbs into grams, I should've have asked my trusted friend "google" instead of taking up someone's time here. So please forgive me.

But Thanks! to those who responded. Your explanations were very helpful.

Meanwhile, I found a site which will do all that computation for me and thought I'd pass it on.
http://www.freedieting.com/tools/nutrient_calculator.htm

Hi I was on the cruise and thoroughly enjoyed it. Sue, Yes I am overweight according to my BMI of 29, I was on the cruise the first year by the second i was 20 pound lighter by the time I got on this years cruise since last year I have lost 54 pound. Yes I am still as you say overweight but I am doing something about it. Sorry I wasn't "normal" for this year but I will be for next year. Snacks were handed out but the message was clear that these are treats and a preferable treat than something high carb and sugar loaded. There were new people there and others who have been doing it a while and of those we are all less than when we started. We had some excellent speakers i.e. Dana Carpender who spends her life educating us how to make foods using our own ingredients she even said you can put weight on eating low carb as we still can make the wrong choices. We all have the same problem with food do we not but we are prepared to be educated by the fabulous speakers who went to help us and gave their time freely to pass on their knowledge.

A big big thank you to them and you Dr Davis

Ailsa who came one the cruise all the way from the UK.

I've been reading your blog for a couple years and really enjoy doing so. I think you've got it wrong on the Atkins diet, though. I don't know where you got your information and I'm pretty sure you didn't read the books. Milk and yogurt aren't on the "diet". Atkins also told you to not eat cured meats. As far as calories are concerned, Atkins also told people to not eat too much! So... I'm having a lot of difficulty with this article in particular & wanted to pipe up. I'll go back to readin' the rest of your blog now. Thanks for all your efforts in keeping this blog up and running. -- Mike

Dr. Davis, have greatly enjoyed your insights on this blog over the year. Have had your book for a couple of years. Have noticed great benefits from your vitamin D recommendations. When is your updated Track Your Plaque book coming out? I thought it was coming out toward the end of last year? Any ETA on it? Very interested in seeing your recommendations as it relates to diet? Typical recommended breakfasts, lunchs, and dinners?

George

This seems consistent with Ray Peat's advice as far as meat meat is concerned- he recommends balancing meat intake with gelatin so as to not get too much iron (hemeprotein afterall) as well as the fact that it has a less inflammatory amino acid profile (muscle is high in tryptophan and histidine wheras gelatin has no tryptophan and lots of glycine and proline...)

Also he mentions that he always drinks coffee when he eats red meat so as to block iron overload even more!

Of course he has no problems with milk, butter and cheese consumption but prefers the latter b/c curds have a better amino profile than whey.

Over the years, I've looked closely at the studies associating red meat with colorectal cancer, and it appears to be impossible from them to separate the effects of modern meat production practices from that of the meat. In other words, it is as likely as not that what's wrong with the red meat is what we put into it, and how it is grown, versus any attribute of the meat itself.

However, whatever the cause of the problem, it pays to at least limit consumption of red meat that you buy in a supermarket.

Hi Dr Davis,

Thanks for sharing your comments. I am a big Atkins Diet follower, and we all need to remind ourselves to keep the intake of "processed" meat & foods to a minimum. Vegetables are a good way to go! Thanks for providing us <a href ="http://atkinsdietinformation.blogspot.com>Atkins Diet</a> followers with such relevant and important information

Cheers,

John

I think it's bizarre to associate ANYONE'S eating habits on a cruise with what their day-to-day life is like.

My normal food would not be available on a cruise: homemade yogurt and kefir made from fresh raw whole milk mixed with berries, pastured eggs with dark yellow yolks cooked in pastured butter, pastured meat, fresh organic fruits and vegetables, homemade chocolate made with coconut oil, cocoa, almonds and stevia... I don't see a cruise line providing food like this.

So, I'd probably do sugar-free cheesecake too, or wind up overeating fresh fruit, just cause there'd not be any of my food there.

When I travel, I do Wendy's burgers using the lettuce as a bun if hitting a drive-through or really crappy salad bars with not much beyond iceberg lettuce.

Sometimes, you do the best you can with the circumstances... cause to eat really WELL, you pretty much need a kitchen.

This article contains huge inventory of knowledge and telling about the diet and what to eat or not.

healthty diet is important..nice article about diet

Thanks for sharing this very useful tips.

Really some truth to the fact that people from Mediterranean areas are seldom obese despite eating a very high fat diet? Did science get it all wrong before? Was there a national conspiracy to force people to eat boring, healthy foods? Thanks for your good suggestion.

Welcome to visit-
weight loss accelerator.
Cheap Calorad

I haven't eaten meat or dairy in long time. Humans don't need meat or dairy. I think meat is disgusting and I'm glad I don't have to eat it. I've seen meat-eaters B-12 deficient, so this shows eating meat doesn't necessarily make someone sufficient in B-12. Methylcobalamin B-12 works great. Eating red meat apparently increases colon and breast cancer risk. I think meat was meant to be an option, just like grains or legumes. Humans were designed to survive on many different things. Plant foods are affordable and bearable for me - meat is not.

Overconsumption of dairy products--Dairy products, especially milk, yogurt, cottage cheese, and butter, are potent insulinotropic foods, i.e., foods that trigger insulin release. There can be up to a tripling of insulin (area-under-the-curve) levels. This is not good in a world populated with tired, overworked pancreases, exhausted from a lifetime of high-carbohydrate eating.

hey guys,
you out there had some great conversations that help me learn a lot from your, atkins diet, "slow-burn" discussions, meat consumption and being vegetarian.

Nice exchange of great ideas, keep going guys and thanks Dr. Davis.

What do you make of this 'physiological insulin resistance' and its role in creeping weight gain on too low carb
http://www.lowcarbconversations.com/344/22-barbara-rose-dean-dwyer-paleo-guy-weston-price-gal-discuss-body-image-more/#comment-306963040

Hi, Lance--

I've not heard this argument before. If you've got the references for the studies showing this effect, I'd be happy to take a look.

In real life, I've not seen this play out. People who restrict carbs, lose visceral fat, drop HbA1c, glucose, and insulin. Maintaining the diet does not, over the years, allow recrudescence of the phenomena of insulin resistance.

I've been using the NatureMade fish oil because it's frequently 2-for-1 at Rite Aid. My VAP cholesterol test was excellent while on the product, but I suppose that doesn't ensure that the product is doing anything. Thanks for the info.

Fresh fish does not smell like fish. Only when the fish tissue starts to decompose does it start to smell like "fish".

First of all, Doc, thanks for taking the time to do this blog. It's great to have such an expert "in the trenches" practitioner helping ordinary people like me make much better decisions on keeping my heart going!
Specifically on this post, when you write these companies, I'd suggest writing a letter and sending it by post right to the CEO.
I've found that usually gets a better, more personalized response to my concerns.

What is a person with very low Vitamin D levels, but prone to kidney stones, to do?

I wonder if that letter was generated by a worker at an overseas customer service center who, as you suggested, just opened a file and inserted text.  How many hits does your blog get?

I've wondered if the USP seal on vitamins actually means anything -- apparently, it doesn't count for much.

I have had a company actually admit to a problem with their supplements once (Jarrow), where their Ubiquinol gelcaps were leaking (found goo at the bottom of my bottle). They admitted the capsules were faulty and they planned to change the manufacturer of their gels, and even sent me a replacement bottle. So... some companies will actually admit to problems and take care of them, but that is still probably the minority.

Hi Dr. Davis,

Have your patients had any experience with CostCo's 2000 IU vitamin D3 gelcaps?

In Italy, Vit D3 drugs are available over the counter at pharmacy. They are ultra cheap. I go for an injection every 2 months as 5 vial cost less than five €.
What prevent US consumers from going to a pharmacy and buy registered drugs instead of supplements?
Quality control for drug companies is surely a bit harsher than for supplement companies.
Then, regulation can be different.

good to know, I used to buy Nature Made all the time... now I am wondering if the "gummy bear" vitamins and vitamin D I give my kids actually are vitamins.  What if they are just candy.  How can you tell for sure?

Impudent--

Great idea.

Perhaps I will send future emails and say that there are thousands of people reading this blog who will await their response!

Gary--

Because we have only one Costco (i.e., only one store), we have had too few people buying this product to say with any confidence.

It never hurts to have your blood level checked.

You might consider me 'weird' but  I actually like to chew my fish oil capsules - I like the taste of the oil and the capsule itself. This has an added important benefit: I can taste if it's fresh BEFORE I swallow. I must say I've never had a rancid one yet. Presently am using Spring Valley from Walmart. I often do the same with my liquid vit D3 caps as well.

Dr. Davis, thank you so much for all the info you put out for us.

I am a fan of your blog, but honestly this is a very low standard of "proof" that you are using. If you feel strongly about it why not get a certificate of analysis done yourself?

I'm a psych NP. My patient took 7000iu Naturemade tabs with no effect on blood level after 2 months. Have heard tabs don't absorb, so have stearing people away from them. Thanks for the info on their softgels.

If I had to get a "certifcate of analysis" performed for every supplement I questioned, we'd go bankrupt just on the testing.

I'll be interested to see what organizations like Consumer Lab, who test a broad range of supplements, come up with.

I subscribe to Consumerlabs.

When they tested vitamin D3  (1/18/10) they only tested up to 1000iu/d capsules/tablet/liquid and also some combination products.

I'm sure readers here are all aware  1000iu/daily can, at best, only raise 25(OH)D 10ng/ml = 25nmol/l.
Most readers require significantly more than that to reach >50ng/ml+ ensuring their body has an emergency stored reserve supply of Vitamin D3.

People who are overweight or suffer diabetes, Celiac or any other inflammatory condition will generally require even more than 1000iu/daily/D3 per 25lbs weight.

The LEF report Startling Findings About Vitamin D Levels in Life Extension® Members By William Faloon shows IN PRACTICE 5000iu/daily/D3 averages only just above 42ng/ml so if we are trying to achieve a level that does more that just meet our daily requirements but also enables the body to store Vitamin D for emergencies, then we require MORE THAN just 5000iu daily/vitamin D3.

At latitude 52 with a BMI just under 25 I take 5000iu/daily + regular short full body prone uvb/winter/sun/summer exposure
My 25(OH)D stays @ 64ng/ml.

I am not convinced Consumerlabs testing of tablet formulations of 400iu or even up to 1000iu has any relevance to correcting vitamin D insufficiency.

Dr. Davis

My name is Douglas Jones, I am with in Corporate Communications at Pharmavite the makers of Nature Made Vitamins.  We take your comments very seriously and need the information that Marissa asked for in her e mail.

All of our products are tested fully before they are shipped to our customers.

Please feel free to contact me directly at djones@pharmavite.net

Thank you

Thank you, Mr. Jones.

Because I identify these cases one by one over months, I don't have my patients bring in their bottles.

I have to say that I am also impressed that I got beyond the girl in the cubicle on this one.

In future, I will ask patients to bring the bottles in. If I know this leads somewhere, then it's worth the extra effort.

However, I remain confident that there is a problem.

Do you recommend multivitamins and/ or Vitamin D brands?

I am 34 years old and at an ideal body weight but had moderately low HDL when blood work was done...Just following your blog and trying to figure out ways to raise my HDL and to help prevent heart disease (My mother is in her 50s and has been on statins for bad cholesterol, a path I don't want to follow).

heatherlbrandt(at) verizon (dot) net

I had been using NatureMade fish oils for years and no belchback. I got a batch that both my wife and I had bad belching with fish taste. Called the company and they said I had been using the enteric coated. I bought some of the enteric and they don't belch back, they also are not what we had been taking. Looks like I will be switching to a different company too.

My friends have been using NatureMade fish oil for over a year now. She told me that it is very effective. I think I am guess I will giving it a try.

Hi, nice post. I have been thinking about this topic,so thanks for sharing. I will likely be coming back to your blog. Keep up the good work
termpapers99@gmail.com

In Nature Made's defense, I've been using 2,000 Vitamin D from Nature Made for the past 6 months, and my Vitamin D levels have risen about 20 points.  I've been very happy with the result, so I just started using their fish oil. I'm sitting here with a brand new bottle of their fish oil enteric coating 1200 mg pills, and smell no odor at all.  This doesn't mean other people haven't had different experiences, but it might be very dependent on your individual body chemistry, and I would suggest doing blood tests every 6 months to determine if the Vit. D you are taking is working for you.  And no, I do not work for Nature Made, and have no connections to them

I just have to say that letter show what they think of customers and how they have made made their mind to deal with any complaints. They did not even bother to get a competent person who could write a letter. Forget that. They did not even bother to prepare a template response.

There is interesting research on omega 3 bioavailability.

After mixed results with various fish oil capsules resulting in low-tide burps or flatus, i moved to Coromega.  Wonderful product.

Re Costco 2,000 iu oil capsules, i've raised my serum levels to 88 ng/ml with them.

However, given the wide range of factors that affect D uptake/utilization, titrating to standard is the only useful methodology. Blind dosing, especially at very low serum levels, might not raise serum levels at all.

Omega-3 structure may affect bioavailability: Study

By Nathan Gray, 14-Jan-2011

Related topics: Research

The type of omega-3 we take may have a distinct affect on how much is actually absorbed, according to new research.


The study, published in the European Journal of Lipid Science and Technology, suggests that omega-3 concentrates – such as triacylglycerides – have much better bioavailability than purified fish oild

The team of Spanish researchers said that the study contributes to knowledge on the intestinal lipolysis of omega-3 sources, which can be found in many commercial forms, from purified fish oil to concentrates of free fatty acids and ethyl esters.

They said that despite differences regarding their intestinal metabolism, there is lack of information about the specific composition of the absorbable fraction from omega-3-TAG or omega-3-EE concentrates.

“This comparative study showed that the in vitro bioaccesibility of omega-3-polyunsaturated fatty acid (PUFA) seems to be better as omega-3-TAG concentrates than purified fish oils,” said the researchers, led by Dr. Diana Martin from the Universidad Autónoma de Madrid, Spain.

Fish oil

Consumption of fatty acids from the omega-3 family – particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – have been advised due to their beneficial role as anti-thrombotic, anti-inflamatory, and hypolipidemic fatty acids.

The authors noted, however, that in many populations consumption of fish is quite low and does not achieve levels adequate for reaching the minimal intake level of EPA and DHA. They added that because of this, an easy way of increasing omega-3-polyunsaturated fatty acids (PUFA) intake is by the fish oils supplements oils.

They said that recent studies have produced contradictory evidence for the in vitro metabolism of fish oils and omega-3-concentrates,

The new study compared the in vitro bioaccesibility of omega-3-oils from different sources. The researchers tested salmon oil, tuna oil, enriched-omega-3 oil as triacylglycerols (omega-3-TAG), and enriched-omega-3 oil as ethyl ester (omega-3-EE).

Study details

Dr Martin and colleagues reported the rate of hydrolysis of omega-3-TAG concentrates was continuous throughout the time of reaction, whereas the digestion of salmon oil and tuna oil was initially faster but stopped after 10 min.

They added that poor hydrolysis took place for the enriched-omega-3 oil as omega-3-EE.

The breakdown of omega-3-TAG oil, salmon oil, and tuna oil mainly consisted of free fatty acids (FFAs) and monoacylglycerides, whereas the breakdown from digested omega-3-EE oil consisted of free fatty acids and undigested ethyl esters.

“This comparative study showed that the in vitro intestinal digestion of omega-3 (EPA and DHA) sources as fish oil, triacylglycerides, or ethyl ester concentrates was different,” said Martin and colleagues.

“The highest degree of hydrolysis and inclusion of lipid products … was found for the omega-3-TAG oil, but compared to fish oils long times of digestion were required,” they added.

Source: European Journal of Lipid Science and Technology
Volume 112, Issue 12, pages 1315–1322, doi: 10.1002/ejlt.201000329
“Intestinal digestion of fish oils and ω-3 concentrates under in vitro conditions”
Authors: D. Martin, J.A. Nieto-Fuentes, F.J. Señoráns, G. Reglero, C. Soler-Rivas

http://www.adajournal.org/article/S0002-8223(09)00293-4/abstract

Re vitamin D uptake & utilization, diet (taking D with a meal doubles uptake), existing D levels (see Holick re substrate starvation), D form (D2 v D3), exposure, lifestyle, age (over 50 produce less in skin), obesity (excess bf sequesters D), co-factors (affect utilization), genes, bathing (bathing strips oils off skin), etc. affect D serum levels.

http://www.scribd.com/doc/38595990/D2-D3

http://www.scribd.com/doc/37319962/Vieth-Vit-D

http://www.scribd.com/doc/36940698/D-Test-and-Treat

http://www.scribd.com/doc/45004628/D-review

http://www.scribd.com/doc/49369766/Garland-021811

"Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:
magnesium
zinc
vitamin K2
boron
a tiny amount of vitamin A
Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

Dr. I came across your site while looking for someone who was having the same problem w/ their Vitamin D levels and not finding a solution.  In fact, the brand you mentioned has done nothing for me in any of the vitamin area!  However I did come across a vitamin that has taken care of my Vit D problem and other problems.  Honestly I think the brand I am taking is the ONLY brand that is actually helping people.  Everyone I know who gets on them has had great results!  Rob Dillon - rdillon4@cox.net

Incidentally, I like the way you have structured your site, it is super and very easy to follow. I have bookmarked you and will be back regularly. Thank you

i too have suffered from kidney stones. i did a 24 hour urine test and my calcium urine level was 3 times normal. shock horror all round.
i began to take 5000iu of vitamin d3 daily and in a few weeks my calcium urine level was normal, my urologist was amazed that this had happened but i did not tell him why because english doctors do not believe in supplements and he would have had a hissy fit!!.
since then, no more stones!

arthur ashe and steve larsen (the cyclist who recently died at age 39) seem to fit the profile...

Great, I fit most of this risk profile.  (BMI is 17), although I prefer rock climbing to aerobic work.  

Maybe I should get my Lp(a) levels tested.

Dr. Davis,

Thanks for sharing this, very interesting. Are these your personal observations or do you know of any studies indicating any of the above?

Doctor Davis,

While many people are sensitive to profiling, I think you are on to something and it should be investigated. The rate of how a person ages definitely seems to be indicative of how healthy their heart. I look at pictures of John Ritter in his younger years and compare them to just before he died. Yikes, he looks like a mess! How our chins droop and stomachs grow shows something. Being pruney is one thing. Looking old is another.

-- Boris

The profile you outline for your typical lp(a) patient describes me perfectly. I'll even admit to liking Star Trek...

My lp(a) = 88 mg/dl (prior to treatment). I've lowered it significantly, in part, by following the advice on your blog.

Many thanks for all of the time you spend sharing your wisdom and experience with the world!

Hi, Bob--

Pure, unadulterated anecdote. No data whatsoever.

Nonetheless, I marvel at how often it holds true. I see several people a week who fit the description.

Hello doctor, I know this is a little off topic and for that I apologize. I ask because I am a little desperate for an answer. I hope it would not be an inconvenience to answer. I take a vitamin k supplement from the LEF brand, this one-http://www.lef.org/Vitamins-Supplements/Item01224/Super-K-with-Advanced-K2-Complex.html
It has a lot of K. I wanted to know If that high amount of k would require me to take HIGHER levels of vitamin D? Or would the regular 6000- 8000 iu would suffice, I ask that knowing that Vitamin D status is an individual thing ( I am an avid reader of your blog) But as a general rule for how they interact, I cant find any info on this. Thank you very much for your time, and keep up the good work!

Dr. Davis,

Thank you for very thought-provoking posts, but I have to say I have a slightly different slant on this:  the type of people you show have so little body fat that our (yes, I am one too) metabolism runs exclusively on what we put on our plate rather than using our body fat (intermittently) for ketogenic cycling in between meals. We lack ketone bodies.

   If we consume a high carbohydrate diet then our body has to use glucose for energy 100% of the time.   Our abnormal (on high carb) lipid profile may be (probably) a consequence of that rather than of some genetical differences.  This is the simplest explanation and may be sufficient to explain the entire plethora of observations.

That is why I used to have hypoglycemia (and beginning of angina) at the age of 42 on a  low fat vegetarian diet, 11 years ago.  That's probably why you were developing diabetes on Ornish diet.  That's why many if not most low fat vegetarians are not doing particularly well especially after a couple of years once they loose their body fat.

Regards,
Stan (Heretic)

Refs:

Carbohydrates and Diabetes

Snacking and glucose/ketogenic cycling

Very-Low-Fat Diets: What Are the Benefits?

Diabetes, liver, fructose and omega-3

It's the glucose, stupid!

Food Choices and Coronary Heart Disease

Hi, Ramon--

To my knowledge, there is no interaction. Many of my patients are on the combination and I've not noticed any shift in dose requirements. I DO believe, however, that there is an important synergy between the two in both prevention/reversal of coronary disease and bone health.

Hi, Stan--

Not so fast.

Recall that Lp(a) is "activated" by the presence of small LDL. Small LDL particles are spectacularly created by  . . . carbohydrates!

So I wouldn't be so eager to live on carbohydrates if you are a super skinny Lp(a) person.

With small LDL and Lp(a), the basic theme is fat, fat, and more fat.

Dr. Davis, thank you so much for your response! But even with such a high level of K? the dosage I am taking is over 2500% of the DV. Do you think that amount has health benefits?
thanks Dr. Davis I really appreciate you help.

Dr. Davis,

What of someone who initially fit the profile but then managed to add a fair amount of muscle tissue through hard training and enough calories and nutrients? Does this change anything?

I'm not advocating going hog wild, but do you feel that a formerly golden fit for this profile who now has more muscle mass and is quite active has a bit more of a buffer zone in terms of carbohydrate consumption?

I ask because in my work in gyms, I have known many men who would initially be carbon copies of the profile you proposed, but after 6 months to 2 years or somewhere in that range, people who just met them would never guess they had fit the profile at some point in the past.

-Steve Janzek

I am not sure of HeartHawk's BMI but he sure looks like has this problem.  From his blog:

"I have high Lp(a) with an otherwise world-class lipid panel."

"I am proactively fighting my extraordinarily high Lp(a)"

Hi, Mat--

Yes, indeed. Our beloved Track Your Plaque Heart Hawk does indeed have Lp(a). He also fits the physical/mental pattern, including the Star Trek part.

Anonymous--

Lp(a) is genetically-determined. Muscle mass has no effect, unfortunately.

Dr Davis,

I've received mixed messages concerning LP(a) and LDL. Many have said that lowering one's LDL will not lower LP(a), yet I'm a little curious as to what happened with my LP(a).

LP(a) started at 198 nmol/l, with LDL at 105 or so. I started 2000mg Niaspan, 4800mg fish oil, Pauling therapy, no wheat and a few other things you reccomended in your book for LP(a). In 3 months LP(a) was down to 109 nmol/l. In 9 months my LP(a) was down to 45 nmol/l! But my LDL was down to 26! My liver enzymes had gone from 20 to 60, my Testosterone had dropped sigmicantly and my energy was zapped.  

Therefore, I went from 2000mg Niaspan to 2000mg Niacin IR because I was told it was easier on the liver and wouldn't shoot the LDL so low while keeping HDL high. Well next test LDL was back up to 89, and felt better, but LP(a) had jumped back up to 150 nmol/l. That would lead me to believe it is tied to LDL. Would you agree?

Thanks,
Kent

It's quite funny how well I fit the criteria: 46, electrical engineer, BMI of 22, and a marathon runner. I have eliminated wheat, have 62 mg/dl 25-H levels, and enjoy extra saturated fat with my saturated fat. I may have to spring for Lp testing next time around.

I am getting mine tested shortly, once LEF puts their blood tests on sale.   I fit that profile very closely although I can gain weight if I pig out over a period of days.  I do stay away from all empty carbs but do get carbs from fruit and veggies like butternut squash & sweet potatoes.  I always eat my carbs with a protein and/or fat source to slow the assimilation into the bloodstream.

Very interesting observations!  It might explain why some healthy-looking people have heart attacks anyway.  I am curious whether the observation will hold up as you gather more info, and what other insights it might bring.

@ramon25, take a look at Chris Masterjohn's post about D, A, K1 and K2. Apparently D increases the use of and need for K, but is somewhat modulated by A. It's really interesting stuff. http://blog.cholesterol-and-health.com/2009/04/tufts-university-confirms-that-vitamin.html

Cynthia

Wow. I just realized that all of myteachers of higher math and physics were all really, really skinny guys. You're right!

@Stan

That makes a lot of sense.

Interesting stuff.  I am a 46 year old woman, runner, fit, low weight/body fat, good cholesterol levels, but have Lp(a) levels of 62mg/dl.  Huge family history of early death from sudden cardiac arrest.  I'd say add women to the profile.

I had a friend like this men he was so intelligent but when we were talking about something he said that he always was right and everybody was wrong it was a really bad problem I wouldn't like to be intelligent if I were like him.

Thanks for this great post it was very informative and helped me with my own project I am attempting to complete.
Dissertation | Thesis | book report

Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

What does one eat if they are wheat free, low carb, and low saturated fat? Can anyone give a sample day for this plan?

Have you tried T4/T3 adjustments with apo E4?

How can one find out if one has Apo E4?

Is it possible to have the same reactions to fats such as large increase in LDL, mostly large with little small LDL?  At one point i was 100% small LDL; restrcting carbs and increasing fats of all kind(good ones only) my NMR was 2098 LDL of which 200 were small were small.  HDL was 69 and TRGs 62.  Only way to get these numbers down is to be on statin and zetia.  Thought i was an ApoE 4, but test showed i am ApoE 3/3.
Perhaps i am a hyper-absorber of fats- maybe as bad as ApoE4?   With statin and zetia i can reduce the numbers to LDL total of 640 and <90 small.    So maybe the high fat diet is not so great even for those who are not ApoE4.
Thanks for your thoughts.

I'm getting my ApoE status tested soon.  I've been quite liberal with the healthy fats (olive, avocado, pastured eggs) and include saturated coconut oil and dark chocolate.  I also have high LDL particles - about 1500, but only 139 are small without statins.  I would love to find out I am 3/3 because I've already restricted grains and a variety of foods that I tested as allergic too including nuts.  I asked Dr. D on the forum if having <10% small particles was good news, but he was still worried about the total LDL.  I guess we will see how worried I should really be shortly.  BTW, I've got high Lp(a) at 26mg/dl, so I really don't need another strike against me in my plaque battle.

Lost a nice technical ApoE explanation  I spent a lot of my time on to "server error" .
I'll just lurk from now on.

Mighto:
Please stay here and enlighten us with your comments. Glitches can happen. I made it a habit a long time ago to just copy my text (Ctrl.A, Ctrl. C, on WINDOWS) before sending it. It is easy and takes no time. Text is preserved and you can try again.
I for one am enjoying your musings tremendously.
Cheers, Renfrew

What Renfrew said. I've run into this problem on blogger regularly where it decides to log me off while posting a comment. Now I always save any longish comment before posting. Better safe?

Digging into my 23andMe data, it reports back on APOE e4 status

You can find this as part of the https://www.23andme.com/you/journal/alzheimers/overview , or just check the rs7412 & rs429358 SNP's directly.

I am an APOE 3,4, and here’s what I eat on week days.
Breakfast.
Steamed raw vegetables (eggplant, zucchini, bell peppers, mushrooms, Mexican or yellow squash). Add yellow mustard and dry spices.
Natto twice a week (1 box Mito natto, throw away their soy sauce and mustard packages).
Frozen blueberries (1/8 cup), 3 tbsp flaxseed meal, 1 cup unsweetened almond milk - all microwaved for 2 min. Add ground cinnamon.
Half-ounce piece of part skim milk mozzarella cheese.
Coffee.
Lunch.
Frozen vegetables (California blend – cauliflower, broccoli, carrots) microwaved (reheat). Add a boiled egg, 1/4 avocado, yellow mustard.
Dinner.
Cooked or baked vegetables (cauliflower, bok choy, green cabbage, rapini).  
Sautéed or baked fish (tilapia, salmon, perch, trout), chicken breast, or ground turkey meat balls. Add yellow mustard, horseradish, and dry spices.
Generous amount of raw vegetables (green lettuce, pickles, tomatoes, bell peppers) with hummus.
Decaf tea with a 1/10 serving piece of 90% dark chocolate, half-ounce mozzarella cheese, and some almonds or sunflower seeds.

My daily fruit serving includes a cup of frozen dark berries (blueberries, raspberries, blackberries) from the Costco Three Berry bag.

back incollege i did a report on cancer and ottowarburg and i remember this gene being incredibly linked to cancer risk....any truth to that?

Hi, Steve--
There are indeed genetic predispositions outside of apo E4 that can provide for this response, e.g., apo B receptor variants. What is not known is when you've crossed a threshold of mostly or purely large LDL that is undesirable. Despite $2 billion spent on statin drug-related research, we still have no answer on this question.

Hi, Buck--
Similar issue as the question posed above by Steve: We just don't know what an "allowable" quantity of mostly or purely large LDL particles are. For a working value, I've been trying to keep NMR-derived LDL particle number 1500 nmol/L or less when LDL is purely large, but I have no endpoint data to justify this.

Great program, Gene, given your pattern. And I am impressed at your courage to eat natto!

Hi, Mallary--

Hardly my area, but I believe that the relationship between apo E4 and cancer in various sites is complex and modulated somewhat differently than in other apo E genotypes. Some discussion:
http://aje.oxfordjournals.org/content/170/11/1415.long

Hi, Simon--

The full diet is articulated in detail, including scientific rationale, in several reports on the Track Your Plaque website; link above. Chapter 9 of the New Track Your Plaque Guide is also devoted to this.

As you see, I will be putting out recipes here and on the Track Your Plaque website in coming months.

even 1 reconstructed paragraph just  lost to "server error"

ApoE joins with ApoB and is carried in VLDL and chylomicrons; it is ApoE that binds to tissue cell LDL receptors to start normal uptake. Inside the ApoB with lipids breaks off and heads into tissue cell lysosome.
Meanwhile ApoE and the LDL receptor head back to that cell's membrane, with ApoE carrying some cholesterol out of that cell to build into an HDL molecule for recycling.

I have the worst of both worlds, I think, as I am E2/E4.  Dr. Davis, do you have a specific program for patients with this genotype?

So, Gene, I'm curious.  It looks like you have an extremely low intake of protein.  How are your labs and what kind of activity do you do during the day?

Eggs, natto, fish, poultry, and nuts are all rich in proteins, correct? I increase my portions of fish and poultry when I go to gym. I also add canned fish on these days like tuna in water or sardines in mustard sauce. I used to consume large amounts of tofu, but stopped recently based on some negative information I learned from a TYP member forum.
Every weekday I typically walk to and from the train station, 25 min each way. I work out two or three days a week following the slow burn routine; I do cardiovascular, too. I also ride my bike for 2 hrs every weekend.
I am a software engineer, so I spend most of my business hours in front of a computer.
Before I learned about my APOE 4, I used lots of olive and canola oil and was a vegetarian, but had already reduced carbs. My labs were pretty bad and actually much worse than when I ate lots of bread and oatmeal every day. In mid-December 2010, I started eating as described above plus taking niacin (500 mg) and Crestor (10mg). I was already taking the standard TYP supplements – vitamin D3, fish oil, iodine. At the end of March 2011, my NMR was the best I had ever had: LDL-P 568, LDL-C 70, HDL-C 55, Trig 24, HDL-P 29.5, Small LDL-P 293, LDL size 20.4, HDL size 9.7, Large VLDL-P 0.7, insulin resistance 16. I don’t have genetic lp(a). I know the results can be better, so I am looking forward to my next NMR due in the fall.

I'm confused. When you say 1 in 4 have this gene are you saying it's a *problem* in 25% of everyone? As in one-quarter of us should be eating like Gene K (above)? Or is a case where the gene isn't always active or something?

I recently wrote about Alzheimer's on my blog and this question came up in the comment section.  I think about APoE4 completely differently than you do and here is why.  APoE4 confered humans the ability to migrate out of the sahara and north and south to live in climates with less solar radiation.  It allowed us to live with lower vitamin D levels.  Moreover, its presence alone means nothing unless it is accompanied with the epigenetic triggers that make it dangerous.  Dr Davis you and I both know the disease you treat (heart disease) and the one I treat (Cerebrovascular disease) are the same disease just found in different organs.  SO i think we have a lot in common in what we do but how we think about thi sissue is different.  Here is my take.  I posted this answer on another forum and I think it needs to be discussed here.

I think the ApoE4 story is an interesting one and one I briefly touched upon in my AD blog.......I will revisit it.......but ultimately I dont think it is that important if you live an optimal life from 20-60. ApoE4 means much if you make poor epigenetic choices. I think people who come here do do what the rest of America does.

The other reason I think it means little is the epidemiology of ApoE4 in those over 80 yrs old. It does not have any major impact on healthy aging once you get to old age. That tells me that the epigenetic signals need also be present for it to matter.

ApoE4 is like dynamite.......and high insulin and high PUFA consumption and lowered total brain cholesterol (due to altered lipid uptake) are the major lit matches. If they exist by themselves they are harmless......but if they are brought together you are going to get heart disease and AD early and get taken out.

Dr Kruse

So everyone who is eating or planning to eat a high fat diet should get tested for E4, or are there some things that indicate it's probably unnecessary?

Dr Kruse -

It's pretty scary for me to think that maybe I am not supposed to be eating very much saturated fat. If it's true that is unbelievably lame. This is why I'm thinking I need to check to see if I am ApoE4. (How do I test for that?) If I am, then it may explain why, even on a Paleo diet, my LDL is mostly small dense. Are you suggesting that if I keep PUFA very low, like cut out my only remaining source (almonds/pecans), that this could be a key to producing more pattern A LDL? (By the way... I have chosen to eliminate all nuts and nut butters, regardless).

-Jack Kronk

Thanks so much for the thoughts - I am an E4/E4 eating a Paleo 2.0 diet.  As I understand it, high-protein is not a healthy diet, so low-fat & low-carb is not a good idea.  Fat is the healthiest macronutrient, so I'd love your opinion on which types of fat are best for E4s.

It sounds like you have concerns about saturated fat, and of course I avoid n-6 PUFAs and get lots of n-3s from grass-fed animals & fish oil.  What about coconut oil?  Olive oil?

What sort of HDL/LDL/etc  numbers would you look for in an E4/E4 as warning signs?  As health signs?

BTW, I blog occasionally on APOE4 at primale4.wordpress.com, am going to quote your post there.

Thanks for that, Gene.  I may need to go your route with my profile.  I'm following TYP pretty religiously and am having my 6-mo labs this month, so hopefully they will be improved from last time.

Jack as I mentioned to you on my blog I think you clearly need context.  I think your epigentics are telling you something.  But here is what I cant tell you and neither can anyone else.......without testing!  You need to be tested to get that context.  I think your diet you posted gave many clues......but even I did not jump to the easy conclusion.  I think your real underlying issue is multifactorial but your VAP strongly points to a leaky gut as a source of the sdLDL.  I think the bananas and cream are problems too.  Your O6/O3 ratio maybe bad and yes......you may have a bad set of allele's for ApoE4......but guess what!  Your HS CRP was very very low.  This tells me that your match is not lit.  So you may only be carrying a stick of dynamite.  Again......carrying dynamite is not going to blow you up.  This is why you need testing to get more context.

We send our ApoE4 patients to an nearby academic lab for testing.  One is likely available in your community because cardiologist and neurologist are ordering this test quite often now.  I think your PUFA content of your diet and of your tissues is critical.  In fact for AD the PUFA content is a major factor.  I believe it is a huge factor for CAD disease as well.  Wheat, Carbs, and PUFA's all drive sdLDL production.  Its not just one part of the diet that does it.  Moreover, the more leaky the gut the more sdLDL one will have as I laid out in my VAP blog that I dedicated to yourself.  I think your case is quite representative to many thousands of people and I am glad we are talking about it here because Dr Davis is a cardiologist and is coming at this issue from a different angle than I am.  I think however when the story plays out.......we will be in the same neighborhood because human biochemistry pathways are constant.  The fuels and hormone status and the situations in our guts are the covariables that make this issue more confusing.  I think people need to know why Apoe4 is important.  It conferred an adaptive advantage to move away from the equator to lower solar radiation and lower vitamin D levels.  This adaptation is seen in many american african americans.  The other interesting finding is that the liver of these patients makes more cholesterol to try to raise the D level and pregnenolone level to offset the deficit.  It never does.  But when this set of circumstance is mixed with a high carb low fat SAD (PUFA rich) it destroys the heart, vessels and brain.  This is what we see today in many parts of the world.  Their diet is now completely mismatched for the original adaptation.  I think if you tweek the diet when you know the epigenetic variables you can easily over come an Apoe4 positive test if youre willing to change.   But you need to test!

Hi, Tim--
Very rare, as you likely know.
I believe that you simply deal with this on a practical level, i.e., deal with the small LDL and insulin resistance issues and postprandial abnormalities from apo E2 as you ordinarily would. Then deal with the LDL-accumulating aftermath from the apo E4 component.

Thanks for the insightful thoughts, Dr. Kruse.
I'm not sure how your approach folds into mine, though fascinating. I do agree that apo E4 is made much worse by the means you cite, i.e., polyunsaturates, carbohydrates that trigger small LDL. This is why, despite the LDL-accumulating effect of apo E4, I focus first on reducing the small LDL component, in effect an anti-inflammatory, glycation-reducing, oxidating-reducing approach, followed only then by dealing with any large LDL-increasing aftermath.
What is not clear to  me is how atherogenic the large LDL is at higher levels in the setting of apo E4. As you know, one of the greatest concerns in apo E4 is that its effects may not be confined to lipid effects, but may extend into non-lipid effects. But that is such poorly charted territory.

Hi, Patri--
The formal data on the various fat fractions and apo E4 are, unfortunately, very skimpy.
Saturated fat clearly increases whatever LDL dominant form there is. However, other forms of fat, even omega-3 fatty acids, also increase apo E4. This become a problem, for instance, when we try to use high-dose omega-3 fatty acids to reduce Lp(a) in the presence of apo E4.
As I commented above in response to Dr. Kruse's comments, as a practical matter I believe it is best to address the worst fraction of LDL particles first, i.e., take dietary steps to reduce small LDL particles, meaning reduce carbohydrate triggers of small LDL. Then deal with the large LDL that emerge by varying fat intake and gauging effect.
Odd thing: Even among apo E4 people, fat intake yields variable LDL-increasing effects, quite variable sometimes.
Also, recall that health extends beyond LDL. So there may be benefits to monounsaturates or omega-3 polyunsaturates, say, that extend to issues like brain and liver health.

Hi Melinda,
Please copy and post this in previous thread for ApoE4 … .
Continuation about ApoE4:
% of ApoE4 messes dynamic inside tissue cell so that ApoB turns to use Scavenger Receptors to try to start cascade which gets signal transducer (Specificity Protein 1) to up-regulate the cell membrane transporter protein ( ABCA1, ATP binding cassette transporter A1) that puts excess cholesterol out from that cell. I believe this is where Doc Davis’ stated ApoB irregularities add to the problem with ApoE4 (since normal human ApoE3 works all by itself to get that signal transducer to bind to ABCA1 to work shucking cholesterol) . When cholesterol gets to build up inside the cell the large LDL can acetylate and form excessive “droplets” in that cell’s cytoplasm; while the small LDL can oxidize from CuSO4- and load up inside that cell’s lysosome.

Meanwhile % of ApoE4 doesn’t just dock with tissue cell LDL receptors and so the macrophage scavenger receptors pick up too much cholesterol laden ApoB/ApoE lipo-protein carrier molecules. Once in the macrophage the same problem of oxidized LDL piling up in lysosome and acetylated LDL burdening cytoplasm occurs; and for that matter, in macrophages, it is down to ApoB to get the signal transducer going if any cholesterol is to be put out by cell membrane transporter protein ABCA1. This is the recipe for risky pro-atherogenic “foam cell” formation; while the individual genetics of ApoE, ApoB, assorted receptor types, signal transducer and transport protein all make it hard to predict how ApoE4 plays out.

Dr. Kruse broaches ApoE4 in alzheimers and this is in large part because ApoE4 causes the brain neurons to get less than optimal cholesterol from the brain’s astrocytes. It is ApoA1 working in HDL complex that controls the astrocyte cholesterol balance and when there is inflammation there is a risk of ApoA1 mis-folding to foster amyloid aggregations. Low intact ApoA1 and ApoE4 together increase the risk factor for cognitive problems and dementia several fold.

Diabetics with ApoE4 have that % of ApoE4 as an additional limitation; however, irregardless of the ApoE iso-form diabetic dementia risk arises from their glucose loads impairing kidney tubules, and thus fostering the uremic environment that stymies ApoA1 bio-synthesis. The normal role of ApoA1 is to bind to the transport protein which secures cholesterol into a safe bond with HDL; so low ApoA1 from any factor will challenge the brain neuron over time. I suggest there are individuals whose age impaired kidneys contribute to senile dementia from impairing ApoA1 levels being made and also possibly speeding up the normal 4-6 days kidney elimination of ApoA1 ; and so Patri’s comment on limitation of high protein intake is relevant due to it’s demand on aging kidneys.

Reply

The above comment was written by Might-o'chondri-Al.  He asked me to post it in this thread as he is having trouble posting here.

Ok I will test! But I have been asking around how to test and still don't know how? Is this something that I would just ask my doctor about? Maybe I go to the same lab that did my VAP? Since I got my results 3 weeks ago, I have made the following changes: zero bananas, reduced my cream intake by about 70% or so, lowered my overall fruit intake signigicantly, added 2 teaspoons of red palm oil daily, decreased caffeine intake (and now I am doing no coffee in August). I have also decided to eliminate all nuts and nut butters as of 2 days ago. Now my only real source of PUFA left in my diet is bacon, occassional chicken, and avocado. It's weird too, because on SAD, I was probably getting 10 times the PUFA, at least. I cooked in canola, ate loads of grain bread and corn products like tortillas. Maybe adding the saturated fats makes everything more amplified. The only thing now that I am VERY reluctant to give up is starches like potatoes and white rice. If I do, I will surely be VLC again, as I don't eat breads and very little fruit now, and rarely ever indulge in sweets. This means, by default, that most of my calories would then be sat and mono fats. Isn't that not good if I am ApoE4? What a mess! Dr Davis is right about being between a rock and a hard place. Jeez!

"high protein is not a healthy diet". you mean specifically for ApoE4 folks? I haven't been tested for it yet, but I suspect I may be ApoE4. I take whey protein daily and eat lots of eggs and beef. I do this on purpose because I do weight training 5x per week and am building muscle. Could it be true that people who are ApoE4 are not supposed to build much muscle? (logically speaking, due to the restriction on protein)

Is server cooperating now ?

ApoE4 degrades more readily than ApoE 3 or ApoE2; ApoE4 protein fragments that get into a tissue cell's cytosol can have bad effect on that cell's mitochondrial membrane lipid binding . This decreases the mitochondrial efficiency  when they try to perform glycolysis for generating energy.

ApoE4 degradation in a cell cytosol can  decrease the level at which that cell advances it's bio-genesis of  robust mitochondria; this is due to how ApoE4 fragments depresses PPAR gamma expression & PPAR gamma is what promotes making good mitochondria. (Specificly in the case of human fat tissue PPAR gamma is what regulates transcription of pre-adipocytes differentiation into true adipocytes. Hence Avandia & glitazone drugs that target the receptor of PPAR gamma do short out adipocyte differentiation;  and yet risk the side effect of increasing heart disease due to mitochondrial impairment.)

In Alzheimers the form of ApoE makes a difference; and the brain amyloids react to insulin differently with different ApoE iso-forms. The ratio of insulin in cerebro-spinal fluid as compared to insulin in plasma changes with different genotypes of ApoE.   Alzheimer patients tend to have lowered glucose utilization in their brains with  less insulin and insulin-like growth factor receptors, despite the Alzheimer brain harboring fewer insulin degrading enzymes. Which engenders a paradox whereby diabetic brain neuro-pathy experimentally improves with administration of nasal insulin; and similarly,  individuals  with ApoE4  receiving nasal insulin improved their cognitive function, with the boost being higher in ApoE4 carriers than folks with any other alleles of ApoE.

Higher amounts of Alzheimer amyloid  formed tangles are seen in Type 2 diabetics and in those with ApoE4; leading to the conclusion that "normal" ApoE3 fortuitously forms a complex with brain amyloids.
Apparently ApoE iso-forms other that ApoE4 can more readily bring an amyloid to where the molecule LRP-1 (lipo-protein related protein 1) can move that amyloid out across the brain blood barrier .

Hi Melinda,
Thanks for repost, looks like Doctor D hammered his server into shape again.

With regards to the large LDL content.  Again I am not a cardiologist, but a neurosurgeon.  The heart and brain work on the same principles of biochemistry.  And since these two organ take up much of the CO in the body they share much in common.  It is also why when we see neolithic disease affect the heart their is also a similar effect in the brain.  The Apoe4 story is one such case.  But so is the large LDL story.  Cardiology CW today believes that LDL matters.  In neurosurgery today its clear in neurodegenerative disorders we are lacking LDL and cholesterol more often than not.  This is incongruent to biochemistry.  Dr davis has said here in this thread the jury is out on large LDL in his field.  I am submitting that LDL matter little in any field.  Why?  If it did the body would have a specific detailed regulatory control method in place to deal with it and it does not.  In nature, with the consumption of organic, unprocessed parent essential fats rather than adulterated oils (PUFA's) and transfats, LDL cholesterol is supposed to be made up of significant amounts of properly functioning “parent” omega-6, linoleic acid (LA), and is not supposed to be harmful. It is the natural transporter of parent omega-6 and parent omega-3 into the cells. It is thus not critical to lower LDL cholesterol, nor is the absolute LDL number as important, if the diet contains sufficient unadulterated parent essential fats. These are unadultered PUFA's of both the omega 6 and 3 variety for clarity sake.  Also take note that the body has no natural “cholesterol sensor” in the bloodstream—it would if its levels had to be maintained within exact limits; such as, sodium, calcium, and glucose levels are monitored in many systems. For example, glucose levels are maintained to an amazingly tight 0.1% in each of us!  So Nature implemented biological mechanisms if required. There is no need for a cholesterol sensor because the absolute number is irrelevant.  That was my advice to Jack Kronk three weeks ago when he posted his VAP numbers and when I blogged about his numbers.  I understand that Dr Davis may not want to go out on a limb as I have here.  But I dont view it as a limb when the biology and biochemistry support my beliefs fully that LDL cholesterol levels are completely irrelevant to heart disease propagation.  This is why I advocate copious amounts of coconut oil to patients with heart disease and all neurodegenerative disorders including brain tumors and seizure patients.  In fact, my literature is loaded with thousands of papers supporting my belief made here.  I think its long over do that cardiologists start reading "other pathways" of data to reach conclusions that their own field muddies.  As a neurosurgeon, I read Dr Davis literature quite a lot and in comparing the two it is clear that our two fields are on a collision course from two different paths.  I got extreme clarity reading circulation over the last thirty years that cholesterol has nothing to do with heart disease.  Dr Davis has reach conclusions that are quite different from most of his fellow cardiologist as well.  I applaud him.  I just think he is still caught in the lipid hypothesis nightmare and that is the only reason he is not traveling down the road with me in unison.  Since he is a fine doc and one who clearly is ahead of his peers......i'll gladly wait for him on that road because we need him to alter what ails his branch of medicine to get to where we both need to be going for all patients.

Dr. Kruse,

What is your response to the fact that people with familial hypercholesterolemia (FH) have an exaggerated risk of CVD versus those who are not lacking ldl receptors? Why do so many of them have cardiac events in their 20's and 30's? Surely, you would not relegate this phenomenon to increased consumption of PUFA's and/or higher insulin?

There are five major classes of FH due to LDLR mutations.  FH is a collection of genetic defects.  Many believe that the end result of these defects (IE high LDL or cholesterol) cause the diseases associated with it.  I do not.  Why?  When these people live past their 6th decade they have extremely low levels of neurodegeneration.  I believe the cause of the early on set  CAD is tied to secondary effects of what the primary genetic disease does to the liver to alter its function.  If one looks at FH patients and their VAP results one sees a pattern of chronic gut inflammation that is the real source of the atherosclerosis that causes higher incidences we see in FH.   These patients all have altered gut biofilms and some of the lowest levels of Vit K2 and vit D.  They also have extremely low DHEA S and pregnenolone levels are pointing to a chronic inflammation......due not to the high cholesterol level but to an altered gut axis.  Read my blog on this here.    http://jackkruse.com/your-vap-brain-love-not-war/   My views on this topic are radically different because even with severe LDL lowering treatments the disease patterns these people face remain unchanged.  Why?  because their gut remains the source of the inflammation that damages their arteries for their entire life.  We need to focus our efforts on the gut side of the equation and not the LDL side.  Ironically Dr Davis has done this with his assault on wheat.  Wheat drives sdLDL via what mechanism?  It screws up the liver and increases gut permeability to cause issues.  His current ideas and mine are very close.......but no one is tying this together.  I think my VAP post on the gut provides you the link.

Genetic high total cholesterol is related to the over 50 amino acid variations of PCSK9 (pro-protein conertase subtilisn/kexin 9,  which comprises 692 amino acids). Individuals producing an excess of PCSK9 more extensively degrade their cholesterol receptors with surface defects; and so don't readily take up LDL out of circulation, which lets blood levels of LDL rise higher. Conversely, those making sparse PCSK9 can't degrade their LDL receptors, which pull lots of cholesterol into a tissue cell where it can pile up over time in that cell's lysosome; and blood levels of LDL seem to drop.


PCSK9's worst version is D3744; where total cholesterol trends to 4 times normal and risk of death is estimated to be even +/- 10 years sooner than even other problematic PCSK9 genetic variations that affect maybe 1 in 500 westerners and account for +/- 5% of all pre-mature coronary heart disease. As regards the "older" age survival ability of those with familial high cholesterol  this may be due to the way over time plaque holds less lipid content and acquires more collagen with calcium infiltration. In other words younger plaque is less stable and more likely to burst free and be perilous.

If fretting about plaque be aware that the average duration of carotid plaque is +/- 9.6 years; according to Carbon 14 dating from autopsies. Plaque may even form multiple times during one's life and the statistically dangerous symptoms take 5 - 15 years to manifest. Increased levels of circulating plasma insulin accelerate the rate that plaque forms; and also adds to a plaques instability (ie: potential to rupture) due to insulin's interaction with genes involved in the immune response;  like how those with insulin resistance make more pro-inflammatory cytokines. This bolsters Doc Davis' insistance to control glucose, since the down stream result is a more stable plaque.

Noteably, there is the so called "protective cytokine" TGF beta which can allay plaque rupture. This is hard to predict for individuals because we have no way to assess who has what types of TGF beta receptors around , since normal and then plaque ridden blood vessels can harbor different TGF beta receptors. TGF  is considered a vital player inside vascular smooth muscle cells because it forms part of the interactive sequence that stops the smooth muscle cells from altering; and it bears mentioning that excess cholesterol can inhibit some TGF beta pathways.

For those who asked (Jack Kronk, Peggy, et.al.) about where and how one can get tested for ApoE it's simple:   Virtually any large commercial lab in the U.S. can do the test, e.g., Labcorp, Quest, etc.   Also, Atherotech (VAP) and Berkeley Heart Labs will do the test as well.   Since it's a genetic test, it's only run once during a person's lifetime.  The test can run anywhere from around $100 on up, depending on which lab runs it for you.

In my last lipotropen test, I do not absorb chol not do I make it.  Am I a closed system?  My lp[a] is 41.  I am very puzzled.

Dee

That was from the Boston Heart lab.  I am a AP03/3.

Super interesting!

Do you know what SNP is PCSK9 ?  I'd like to look up it in my 23andme info.
Thanks,
George

Plasma PCSK9 levels correlate with cholesterol in men but not in women
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References and further reading may be available for this article. To view references and further reading you must purchase this article.


Janice Maynea, , , Angela Raymonda, Anna Chaplinb, Marion Cousinsb, Nadine Kaefera, Charles Gyamera-Acheamponga, Nabil G. Seidahc, Majambu Mbikaya, Michel Chrétiena and Teik Chye Ooia, b

aHormones, Growth and Development Program, Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ont., Canada

bClinical Research Laboratory, Division of Endocrinology and Metabolism, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ont., Canada

cLaboratory of Biochemical Neuroendocrinology, Clinical Research Institute of Montreal, Montreal, Que., Canada

Received 29 June 2007.  Available online 18 July 2007.

Abstract
Proprotein convertase subtilisin kexin-like 9 (PCSK9) is a secreted glycoprotein that negatively regulates low density lipoprotein receptor (LDLR) levels. Several single nucleotide polymorphisms (SNPs) in PCSK9 have been linked to autosomal dominant hypercholesterolemia (ADH). Conversely, hypocholesterolemia associates with both ‘loss of function’ nonsense and missense SNPs in PCSK9. We examined the association of plasma PCSK9 with lipoprotein parameters in 182 normolipidemics. For men (n = 98) plasma PCSK9 averaged 6.08 ± 1.96 μg/ml and Spearman analysis revealed significant correlation between it and total cholesterol (TC), LDLC, and TC/high density lipoprotein (HDLC) (r = 0.276, 0.282, and 0.228, respectively). For women (n = 84) plasma PCSK9 averaged 6.46 ± 1.99 μg/ml having no correlation with TC, LDLC or TC/HDLC. The ratio of plasma PCSK9/LDLC increased in men carrying ‘loss of function’ PCSK9 variations. Our results suggest a gender difference in PCSK9 regulation and function with PCSK9 correlated to TC and LDLC in men but not women.

Keywords: Plasma PCSK9; Loss of function; Hypocholesterolemia; Hypercholesterolemia; Single nucleotide polymorphisms

Article Outline
Materials and methods
dI found this on the internet, I'm not sure if this is what you need?  

Dee

All patients with FH need to have their thyroid optimized.  This issue was hashed out at the Ancestral Health Symposium on August fifth at UCLA.  Jack Kronk's VAP is helping many patients learn how to raise their HDL to increase endotoxin clearance from the portal circulation to prevent oxidation of slow moving cholesterol because of A lack of their LDL receptor.  Thyroid optimization can overcome this to a degree but it requires a physician who knows precisely how to do this and not create an unsafe situation.  Their diets has to be a strict low carb moderate protein paleo diet high in coconut oil.

This too can be assessed by looking at thyroid beta receptors......it is associated with down regulation or resistance of this specific thyroid receptor.  A company in Denmark has a clinical trial on going about this specific receptor.  Thyroid hormones bing to both thyroid alpha and beta receptors.  But disease that affect the LDL receptors seem to preferentially knock out the thyroid beta receptor.

I apologize if I sent the wrong ifo.  Didn't read it through.
Dee

Dr K. -

I am inquiring with the my Doc about getting tested for ApoE. I will let you know how that goes.

Regarding hypothyroidism, yah the issue that I'm running into is that "it requires a physician who knows precisely how to do this and not create an unsafe situation".

This is the problem with our medical system in America. I live in San Diego, one of the biggest, most advanced cities on earth, and I am having trouble finding anyone over here that can truly help me with this. My doctor situaiton is pathetic. Sorry to say that, but I'll call a spade a spade. All they want to do is put me on Lipitor and go low fat whole grain. So then I am stuck with doing my own diligent research, and appyling knowledge that I can learn from people who actually know what they are talking about, and right now, for me, that means the internet. Incredible when you think about it.

When you say low carb, do you mean no starch as well, not even potatoes? By the way... the name of this post is "The Exception to Low Carb". So... that's why this is so confusing. Some very knowledgable people think it's best to raise my intake of starches and lower my fats. If my body is creating more LDL (even small dense) because of my saturated fat intake, then it makes sense to replace sat fats with something else. I already get enough protein, so then I am left with carbs. If it has to be carbs, isn't safe starch my only real option? It can't be 'sugar'. It can't be 'fructose', or grain starch, right? Should I eat loads of salads? Or I am on the wrong track completely? Should I look at upping my mono fats in place of saturated, like using mac nut oil for cooking? Or would mono fats be just as problematic?

You see? Honestly, I know this stuff stone cold. I know what *most* people do well with, but if we don't figure out how being pre-disposed to having issues with LDL receptors really changes things, we are going to (deservedly) get hammered by the low-fat whole grain camp when a fair amount of people who thought they had it all figured out are dropping dead from eating fats because they are ApoE and had no idea.

I'm genuinely glad that my example is helping people. No doubt I am. But I'd be alright with feeling like I'm getting somewhere with all this in my personal case as well. At the moment, I can't really say that I feel that way just yet.

Patients with apoe4 have a higher rate of AD and AD is associated with a cholesterol deficiency in the brain.  So for me apoe4 is a signal to load with the MCT of coconut oil which has massive benefits to the brain metabolically.  I find it hard to believe this is bad for the heart at any level because CAD tends to mirror CVD across all measures.  I think only cardiologist have this problem with Larger particle LDL because of the faulty lipid hypothesis.  cAD is an inflammatory condition.  It ha little to do with cholesterol itself.  If the cholesterol is oxidized then there are issues but this can be followed by acute phase reactants from the liver like HS CRP.  When it's up HDL tends to be low......and it's low because the liver is being bombard by gut endotoxins and this is a direct measure of the oxidation potential of an overwhelmed portal circulation.  To further the point......thyroid hormone, testosterone, estrogen, and high vitamin D levels all raise liver HDL and this is how they protect against heart disease.  I maintain large LDL confers no risk without inflammation.......and a low HDL is a great way to know if your liver is being overwhelmed in the portal circulation.  This is why vitamin K2 confers a great cardiac benefit.......it comes from a healthy gut biome.  vAP tells you a ton about your portal circulations inflammatory burden.

M-Al, just copy your text prior to the post, or write it in the editor. I don't know which browser you use, but in Chrome if you use "back" on "server error", it will return what you typed in a reply.

Following your diet I took an NMR last summer and this summer.  The small LDL particles went down (835 to 709) but the total particles went up (1800 to 2100).  Should I stick with your diet (low carb, no wheat, D, omega3's), one Walmart glucometer) or go back to rice and beans?

I got quote at $390 for just an ApoE genetic test. Is that normal?

Have you seen any reduction in your LDL following this diet?

I've been eating paleo/primal for about a year, dropped 10 pounds, and brought my triglycerides down from a high of 325 three years ago to 130. Unfortunately, my LDL-p is over 2600 (first time it was checked), and I found out I'm APO e4/e4.

The doctor says e4/e4 should go vegan, which seems about as anti-primal as you can get.

Any suggestions for where to start looking for eating guidelines?

My goodness, how very confusing!!  I'm hypothyroid.  My HDL is 95. My total C is 285. Ny LDL is 186. But my LDL fractions are mostly big and plumb and my small total 23. So, I think I'm ok...buy my doc thinks I should go vegan. I want coconut oil, little red meat.  I evercise 5x week. My heatt stress tests were all 'well within'   So, it sounds as though I need to get the E4 tested   More?

I would be deeply grateful for your advice. I am doing my best to understand how to cope with my aPOE 3/4 status. I have Alzheimer's on both sides of my family, which has killed or is in the process of killing several relatives, including my father and maternal grandmother. Unsurprisingly, I have received much conflicting data.

I am 46. I eat a strict Paleo diet (grass-fed, wild-caught, etc.) except for some resistant starch in the form of parboiled rice and unmodified potato starch. I consume approximately 50-60% fats (majority saturated fats including daily MCT oil), 30-40% protein and 10-20% carbs. I exercise vigorously and non-vigorously -- but not every day. (Incidentally, over three years I naturally increased my testosterone by 38% using this approach, going from the low 3's to 5.3.)

My LDL is 128. My HDL is a distressingly low 33. Triglycerides are 59.

MY NEXT MOVE: Seek out an LDL particle-size test. If that reveals my LDL particles to be of an unhealthy size then I will need to consider a different approach in regard to sat fats. Also, looking  to improve my sleep, which has been my Achilles' heel (consistently get only around six hours). Finally, using super-consistent exercise and increasing oyster intake to boost the HDL.

I would appreciate any guidance.(!)

Best / Mario

I also wonder if coffee/caffeine plays a role for some people. I know that coffee tend to make me hungry, and i wonder if it is due to an effect on insulin.

Before most people begin to worry..

Major Correction:  love handles and fat that makes you look soft & flabby is subcutaneous fat, not visceral fat as stated in this post.

If you can pinch it, it's subcutaneous.

Does high fruit consumption with it's high content of fructose increase viceral fat?

Visceral fat occurs behind the abdominal wall--where the organs are.

The stuff you can grab a handful of is subcutaneous fat and it is metabolically inert.

The most concerning fat is intracellular liver fat which is deposited, as the name suggests, between the cells of the liver.  It appears to be a major cause of insulin resistance, and hence obesity.

Liver fat is made out of fructose. Dietary changes including very strict Atkins-style diets do not reduce liver fat significantly (according to biopsy studies) even after 6 months.

Most treatments for fatty liver change the liver enzyme test results which doctors interpret as meaning that the fatty liver is healing, but sadly the biopsy results don't confirm this either.

Perhaps years of eating no fructose might burn off the intracellular liver fat, but I have not seen any evidence to support this in the research.

Something that's always puzzled me is that, soft drinks typically use high fructose corn syrup, but what sugar are they using when they refer to sodas using "real" sugar?

http://www.bevreview.com/2009/02/09/pepsi-throwback-mountain-dew-throwback/

If they are using sucrose, or table sugar, then isn't that 50% fructose anways?  


Jenny, is there ANY research that suggests fructose above and beyond sucrose/glucose contributes to liver fat?

For example, if you read this headline, "High Levels of Fructose, Trans Fats Lead to Significant Liver Disease, Says Study"
( http://www.sciencedaily.com/releases/2010/06/100622112548.htm
)

you would think it's about fructose, but if you read the article it's really sugar in general they are talking about!

The glucose part of sugar is mostly benign, for people with good insulin sensitivity. We need glucose in our blood in our muscles etc. It is only a problem if you do not maintain correct levels, ie insulin resistant, or insulin deficient.

Fructose does cause problems for everybody. But there also it will cause more problems to the insulin resistant than the sensitive.

Another thing is that Liver and other tissues have a limited capacity to convert fructose to fat. If it gets overwhelmed then the fructose can escape and stay in the blood far longer than it should.

A good way to prevent this is to not drink the fructose, but eat it with food. So Fruits are OK, and eating some fructose with food is OK. Trouble with liquids is that the stomach does not store the liquid for long and releases it in the blood supply, allowing the fructose control system to be overwhelmed.

Do not think that fruit juices are healthy. Fruits are healthy but not their juice, even if it is very fresh. With food it would not be much dangerous, in limits.

Per Sandra Cabot M.D.

"The liver is able to repair itself and grow new healthy liver cells and over one to two years you will be able to reverse the fatty damage to your liver and achieve a healthy normal liver.

If you are overweight you will lose significant amounts of weight within several months, however the liver will take longer to completely repair itself..."

Recommended course of action:

Follow a low carbohydrate way of eating - eliminating all grains, sugar, fructose, etc.;
Increase the amount of raw plant food in the diet;
Eat first class protein with every meal or for a snack;
Consume healthy fats;
Do not eat very large meals;
Take a liver tonic everyday;
Drink plenty of hydrating fluids;
A regular exercise program is important.
The above is paraphrased from Dr. Cabot's book: Fatty Liver: You Can Reverse It.

Obviously more research is urgently needed.

http://en.wikipedia.org/wiki/Abdominal_obesity

Abdominal obesity=love handles = visceral fat= NASTY

Nina

The fructose in fruits and even HFCS will be burned for energy if the person is exercising.  If not, it turns into visceral fat.  Sorry, I can't give a url as proof but I know I read it from someone knowledgeable.

kevin

AGREED....ARE YOU MORE A FAN of mono-fat or saturated fat?

I've been able to dramatically reduce my abdominal and pectoral fat through a low-carb diet. I look very toned and lean. However even after strict adherence for 3 years, there is still some fat in the abs and pecs that refuse to go away. I don't eat any grains or wheat products and very little sugar and fructose, yet, this one last bit of fat refuses to perish. Perhaps it is possible that some of our bodies will genetically always store more fat than others?

paradoxically, I know 2 people who eat so many grains and wheat products and cannot get fat. They have remained lean all their life, don't have man boobs, and don't do that much exercise. What gives?

low carb with only just enough protein (atkins is high protein and gives high insulin from this), raw green veges, healthy fats (omega 3, nuts, avocados and olives) is the only way to fix it

Funny thing, I have been eating the types of food you recommend and avoiding those you don't on this post. After 4 months, I have lost 80 pounds, moved from morbidly obese to overweight and now see those love handles and tummy fat softening and starting to disappear (bye bye visceral fat). I can't wait to see what happens in the next four months! My energy is spontaneous and mental acuity has returned. I am even back in college pursuing an advanced degree in nursing. The benefits are much more than physical. Thank you for your insight. My life is better as a result.

Same Wikipedia source as mentioned before says: "Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso...". So "love handles", "polka handles" or whatever you call them, is not visceral fat!

Re: comments about "love handles" not being visceral fat.

Absolutely correct.

"Love handles" are simply an INDICATOR of visceral fat. Last I checked, I can't grab your liver or intestinal fat.

Kellygy--

80 lbs!

That's fabulous. I'd love to hear more.

I feel better though and I seem to heal better too (could be my imagination but I had a real bad scar after my hand was stabbed with glass and it has been getting so much better). Nose bleeds have significantly decreased too (only 2 minor ones in a hole year whereas I was having them everyday before I changed my diet). I have also successfully (I think) fought off a candida yeast infection as all digestive trouble and urine infections and perpetual belly button infections have ceased too!
There was no doubt I was fat deficient after following a low fat diet all my life. I just can't lose weight though. I suspect that I have fatty liver and damaged kidneys because I get back pain alot too (used to be both left and right sides almost every day after I started HFLC but now it is only the left side occasionally). But because I am in my twenties I go to see the doctor and they can do nothing for me. They don't believe in extensive liver tests and kidney tests for someone so young. They analysed my urine and found nothing wrong so that's it. Please, someone in the know tell me my next move...
Forgot to mention I take chromium every day (because Atkins says it is good for IR) and milk thistle every day because it is supposed to help fatty liver. Also to note, my blood sugars have improved and I no longer get dizzy like when I first started HFLC. So that is some progress with the symptoms. But no matter how little I eat I can't lose weight. I'm afraid to do more exercise because I don't understand why my blood sugar readings are so high afterwards. I do a bit but not much. I tried weight training but even that gives me a liver dump. Even walking around the block gives me a liver dump. Also please note, I am HFLC. I eat alot of animal fat. I don't eat too much protein, I always eat excess of fat to try and reach ketosis and I eat somewhere in the region of 20-50g of carb a day (although I think it depends where your carbs come from as to whether they matter, so the carb in an almond is locked in with all that fat. The 6% carb of 100g of almonds is better and lower carb than eating 6g of candy. I think this because of the fat burning index (heard of that?) and the fact almonds don't impact my blood sugar  hardly at all and also the fact they seem to get me into ketosis quicker than any other food).
Anyway I'm stumped.
Someone mentioned fructose. I was reading hyper lipid's post about rats who ate saturated fat with fructose/alcohol and it protected the liver. Rats who ate a low fat diet with fructose/alcohol developed "fois gras". So, believing that fructose is worse for the liver than alcohol I avoid all fruit and most veggies.
Advice/comments would be appreciated. I don't want to fall off the wagon because I believe HFLC is the way to go. I just believe myself to be damaged beyond belief. I have been overweight ALL of my life since the age of 2. But now I'm giving HFLC a bad name because I've been on it almost a year and lost only the initial 10-12pounds. :-(

My first comment said it wa posted but didn't show up. So here's part 1:

Great post - it is straight to the point. I'm not going around pinching my fat to decide whether it is visceral or not because that isn't the point. For those of you who are obsessing about what is and what isn't visceral, read this:
"Increased visceral fat can be suggested by increased waist circumference"
Another point which is a great one:
"Visceral fat, on the other hand, is metabolically active. It produces large quantities of inflammatory signals[...] Visceral fat is also itself inflamed."

I find that my waist measurement can change overnight or within 2 or 3 days up to 3 inches either way.

I am classed as morbidly obese. I have a BMI of 38. I have terrible insulin resistance (of the liver) and have pre-diabetic blood glucose readings. I have been on HFLC since October 2009 and although I seemed to deflate 10 pounds or so within the first 2 weeks of starting it, I haven't lost a pound since. I think this is because of my insulin resistance of the liver. Just like a diabetic, I get a "morning effect" of high blood sugars without eating anything. After exercise I get the highest blood sugars I've ever got since going HFLC. I know my liver is churning out too much sugar, so I've been trying to eat a tiny amount (5g) of carb every 5 hours to prevent the liver dump, yet eating HF to try and reach ketosis for as many as possible of my waking hours (I find ground nuts, butter and cream, in the form of cakes, is the fastest way to get my into ketosis, but I only ever manage a mild ketone reading although I get the breath sometimes). Every morning I feel groggy, can't wake up and have a terrible morning effect so I think I've been fat burning during the day and then just putting it on again in my sleep, once my liver dumps the sugar, which raises the insulin.
I've been researching for months and I think I need some Metformin drug, but can't have any cos I am in the UK and they only prescribe it for diabetics. I could probably fake it and pass a diabetic test because I have researched, but should I do this? Aside from increased life insurance and the pure morals of it, I would certainly be better off as a diabetic on the NHS as I'd get free BG measuring strips and free kidney and liver tests too.
I'm really struggling now and faking it may seem extreme but I don't know what else to do. I'm so overweight and because everyone knows I am HFLC they think the diet is rubbish because I am not getting any thinner. They see me eating fat and losing no weight and they turn back to their low fat diets thinking I'm a crazy woman.

So if you can grab love handles, then that's visceral fat? Then what about the type of obesity where the belly is round and tight?   You can't grab ANY of that fat, and by all definitions THAT is visceral fat...   They can't be both visceral fat.

Can't remember where I read it but one test for visceral fat is to measure your waist while standing and again while lying on your back.  It the measurements are the same, that's sq fat.  If the measurements are different, that's internal visceral fat moving away from the waist.  

kevin

Here is the most recent treatment of this subject from WebMD:

The Truth About Belly Fat

WebMD can be total garbage, just read what they had to say on the link you provided:

"Can Whole Grains Help You Lose Belly Fat?

A recent study in the American Journal of Clinical Nutrition showed that a calorie-controlled diet rich in whole grains trimmed extra fat from the waistline of obese subjects.

Study participants who ate all whole grains (in addition to five servings of fruits and vegetables, three servings of low-fat dairy, and two servings of lean meat, fish, or poultry) lost more weight from the abdominal area than another group that ate the same diet, but with all refined grains.

"Eating a diet rich in whole grains while reducing refined carbohydrates changes the glucose and insulin response and makes it easier to mobilize fat stores," says study researcher Penny Kris-Etherton, PhD, RD, a distinguished professor of nutritional sciences at Penn State University."

--these stooge researchers, never bother to compare a whole grain vs. a NO GRAIN diet, because they know what the outcome will be.

Rats that avoid  fructose also have other healthy habits, so it's hard to be sure why they got skinny.

The changes are evolutionary and ongoing. I started with Jorge Cruise's, Belly Fat Cure, and then decided to look into the underlying causes of my weight loss and came across Good Calories, Bad Calories by Gary Taubes. His book awakened my critical thinking and after stumbling across your site and TYP well, it just dominoed from there. I found resource after resource and incorporated the evidenced based research into my life health plan and it is turning into a rebirth of sorts.

Currently, I am looking into exercise techniques since my body just naturally wants to do more (I didn't do any for the weight loss.) It looks like HIIT or PACE, some cardio, resistance training, and being bare foot as much as possible are now part of the plan.

One interesting thing occurred during my low carb/sugar transition (about the time of wheat elimination), I became very dehydrated. I drank plenty of fluids but it persisted for nearly two weeks. I later learned that my food elimination was acting as a diuretic not only for water but also for sodium. I then tapered myself off my Atenolol (and onto supplements) and now have a baseline BP of 110/75. It was 145/95 on the medication. The rapid heart rates I have been experiencing for the last ten years have completely gone (not sure of the association yet).

Sleep apnea gone, hunger cravings gone, chronic fatigue gone, most back and body aches gone, wow! The dietary principles and supplements when applied properly are very powerful. Through careful evaluation, research and follow up, I am looking forward to applying these principles in my practice.

Your site is amazing.I am very impressed to see this,i want to come back for visiting your site.Keep doing Good as well as you can..

Ha, Peter!  That was funny.
Char

Bling, I have had a similar experience to yours. I've read several of the books and understand the low-carb/high-fat science, but my body refuses to lose weight after the first 10-15 pounds. No matter how low carb I go or how much exercise I do.

Worse, I also have a weird hypoglycemic response to induction. I get extreme hunger and carb cravings when I absolutely should not -- after eating plenty of protein, fat and fiber. I can eat an avocado or nuts or meat and vegetables with butter and still feel like I'm going to pass out from hunger.

It's so frustrating and I'm still looking for a way off this roller coaster.

Kali

"It's so frustrating and I'm still looking for a way off this roller coaster."

Kali, I beat my head (entire physiology really) against low carb diet for 9 long months.  Followed Bernstein's max 6 g carbs for breakfast and 12 g each for lunch and dinner.  Felt constantly more and more tired, irritable, brain fogged.  Mild exercise would leave me exhausted for 2 days...  Finally tried McDougall's diet and it helped but was having high sugar spikes.  Ended up w/ Fuhrman's Eat to Live diet, beans instead of grains. The combo of a bit higher fat that he allows from nuts/seeds and resistant starch in beans and that is working for me. Some bodies I think just do not work well in ketosis or near it for prolonged periods of time.

My local news just profiled a Diabetic who had a stroke.
In their "advice" comments from an RD, she advised that it's okay for him to have....are you ready ?...
Up to 75 grams of Fructose a day.

A Diabetic patient... 75 grams a day of Fructose ?
Do he or his doctors actually understand the grave condition of his health ?
If he listens to them, he might as well buy ownership in a Dialysis Center.

Do the schools that teach and graduate RD's have any clue at all ?
Or are they this corrupted ?

Kellgy--

Fabulous!

Please be sure to come back and update us on your progress.

Hi there,
I've been e-mailed by a friend telling me about a juice that can lower cholesterol and blood pressure if taken twice daily.
If you wanna know more go to the following links :

http://aeonlineclinic.wordpress.com/2010/09/16/lower-your-cholesterol-and-blood-pressure-naturally/

OR:

http://online-health-shop.blogspot.com/2010/09/lower-both-your-cholesterol-and-blood.html

I'm sure you'll find that information helpful. Just give me your feedback.

Thanks..
Amr.

i have read that non alcoholic fatty liver disease can be reversed by vitamin e supplementation.  

http://www.nejm.org/doi/full/10.1056/NEJMoa0907929

Geoffrey - did you eat high fat? Simply cutting out carbs results in undernourishment. Your body will shut down to save it's energy stores. You still need to feed it sufficiently. Watch Gary Taubes' latest videos http://livinlavidalowcarb.com/blog/ims-lecture-with-slides-and-qa-why-we-get-fat-by-gary-taubes/8971

Anon - Atkins is not high protein; it's high fat.

Dr. Amr - Acai Berry = Spam. Actually Spam is much healthier than that juice crap.

"Love handles" are an indicator that you have significant amounts of visceral fat???  I'm a female, with a 26 inch waist and 21% body fat.  Yet, I have love handles.

To my knowledge, the best indicator of visceral fat is a waist circumference.

@Anon - I think you missed the point deary.

Hips are always desirable on a woman but that roll of fat above them that sometimes accompanies them on overweight women may be a marker of the visceral fat problem.

But I agree with you about waist measurement seemingly being a better indicator. "Waist" measurement on a woman is different to a man. One health leaflet I saw was saying that the "waist" meaurement is around the belly button level, which for a woman is obviously wrong.

But take note, when guys have "love handles" it just ain't right.

Give the guy a break! LOL He was trying to post a semi-humorous blog title to get people's attention. If you wrote as many long, detailed and useful posts as this guy (or had half the readership he does) maybe you'd try out an almost funny title now and again.

Joker. hahaha

Thanks for the info, I really enjoy reading it!

Such a very nice post.........

@bighippedlady

Mine are definitely above the hips.  Trust me, it's not attractive.  I just don't see how this subcutaneous fat is indicative of visceral fat on someone like me.

@Anon what is "someone like me"?

Let's not forget correlation is not causality. The big deal about abdominal fat (whether it be around the true waist or around the belly button - just around that area) is that's the first palce weight goes when you have insulin problems (usually caused by blood sugars).

If you have a bit you can pinch then don't worry about it, but when it gets bigger and bigger really easily (10 month pregnant look as hyper lipid calls it on men) that's when you have a blood sugar/insulin problem.

They have found visceral fat and other problems are "indicated" by increased in waist measurement probably because it is all a marker of insulin resistance and a trip down type 2 road eventually.

So forget about pinching this fat or that fat on your body and assessing whether your flab's attractive or not. If you are overweight, mainly around the belly area, then get your blood sugar checked. And when the doctor says is "fine, nothing to worry about", don't believe him until you have seen the numbers yourself.

Better still, get a blood sugar monitor (very cheap) some pure glucose (from the chemist or the baking aisle in the supermarket) and conduct your own mini glucose tolerance test, starting from fasting and then measuring every 15mins after consuming 50g of pure glucose. Do some googling and you'll soon see if you are normal.

This is the stuff that counts. Do it and save your life. If there is anything remotely higher than normal about your glucose tolerance test then read Jenny's sites blooodsugar101 and get a good book like diabetes diet by Bernstein. Go low carb. Monitor your glucose tolerance at intervals. Watch out for your liver giving you a morning effect or a blood sugar dump which may mess up your figures.

Do note that if you are already low carb you will get a truer reading if you carb up for a few days before taking the test.

Also note that if you are severely overweight you will probably pass the test for "insulin resistance". Your doctor won't care about it and continue to call your "normal" unless your blood sugars reach the lofty heights of official diabetics. But acting sooner rather than later (i.e. by avoiding carbs) can prevent you from developing type 2 and essentially cure your insulin resistance. This is the basis of what low carb diets do and why you loose weight.

I went off on one. Praise the Lord for low carb.

Very interesting. Thanks for posting!

I absolutely had no idea that visceral fat is that dangerous! You see, after giving birth to my youngest, I have had no restrictions on my food intake hence, my weight doubled. Tomorrow, I'm definitely going to consult with my doctor about having laser liposuction. Los Angeles, where most cosmetic surgery centers are located, luckily, is only a few miles away from my house. Anyway, after all that is done, I'm probably going to need to remove the excess skin through tummy tuck. Los Angeles and other cities need to help people with obesity and weight problems.

Well Terry, I take it that after giving birth you've had many sleepless nights taking care of the baby. In my case, that was the aftermath of my last child birth. I just opted for blepharoplasty. Florida seems to be the happening place for that kind of surgery at that time, so I asked my husband to accompany me there.

But going back to the topic, what concerns me here is the fructose part. I'm an avid cola drinker, and it looks like I'm gonna have to change my lifestyle.

We can't eliminate starch amd wheat thus carbohydrates !

I think we are allowed to eat 150 grams of carbs a day . SO !!! We can eat starch and wheat after all.


I think eating more than 150 grams of carbs a day it raises insulin and then we come to the conlculsions about visceral fat.

I am having trouble with these "love handles" The rest of me looks great. I am now back on the ground chicken and veggie diet with a side of crazy cardio!

SOY milk! Surely you know all the ills of soy, probably worse than wheat

Kaayla Daniels book THE WHOLE SOY STORY is a MUST read!

They look yummy, thanks

You wrote that butter "contains the highest exogenous AGE content of any known food." Should we be eating it?

Sally,
You're right, soy (especially soy available in USA) should never be an option, and although it is listed in the recipe, I do not see that as an endorsement by Dr Davis.

Just use the almond milk. It tastes loads better anyway, and the recipe is wonderful   ;)

Do you have any substitutions to suggest for those who are allergic to nuts?  Perhaps ground flax seed in place of the almond meal, and skip the walnut?

Hi, Kurt--

I think that modest exposure is harmless. It's the "drown everything in butter" that I see some people practicing that I believe may be harmful.

Hi, Teresa--

Yes, ground flaxseed is an excellent replacement for nut meals. However, it changes the texture and need for moisture, as well as the balance of other ingredients. It may take an experiment or two to get it just right. Please let me know how your "experiments" go!

Hi,

I used to get emails whenever there was a blog post but that stopped in May.  I tried to resubscribe but am told that my email is already in the system.  Any thoughts?

Humm thats nice! thanks for the recipe. it looks delicious.