So, basically one can't eat carbohydrates at all, nor dairy products, nor too much animal fat. So what are you supposed to eat?

Very interesting post Dr. Davis.

And that is one more reason to replace refined carbs and sugars in one's diet with saturated fat and dietary cholesterol, which significantly contribute to a shift from Pattern B to A in LDL particles.

By the way, the usual term that I normally see is "apolipoprotein", but they may be a bias in the literature I have been reading.

This is really interesting but I only understand about 1/2 of it.  Can you break it down a little for the lay person. I am following your tweets and find them really insightful...  I would love to share more with my followers but none have the background to figure this out and how it relates to our habits. Thanks for making me reach...

Great science on the risk of small LDL particles. Now I wish our health care system made the tests easier to get. An NMR costs twice as much at my doctor's office than if I get blood drawn on my own, and my expensive insurance plan won't pay for it either way.

This is interesting;

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The nonenzymatic glycation of LDL is a naturally occurring chemical modification of apolipoprotein (apo)-B lysine residues by glucose. Once glycated, LDL is only poorly recognized by lipoprotein receptors including the LDL receptor (LDL-R), the LDL-R–related protein (LRP), and scavenger receptors. Glycated LDL (gLDL) is a preferred target for oxidative modifications. Additionally, its presence initiates different processes that can be considered “proatherogenic.” Thus, LDL glycation might contribute to the increased atherosclerotic risk of patients with diabetes and familial hypercholesterolemia. Here we investigate whether lipoprotein lipase (LPL) can mediate the cellular uptake of gLDL. The addition of exogenous LPL to the culture medium of human skin fibroblasts, porcine aortic endothelial cells, and mouse peritoneal macrophages enhanced the binding, uptake, and degradation of gLDL markedly, and the relative effect of LPL on lipoprotein uptake increased with the degree of apoB glycation. The efficient uptake of gLDL by LDL-R–deficient fibroblasts and LRP-deficient Chinese hamster ovary cells in the presence of LPL suggested a mechanism that was independent of the LDL-R and LRP. In macrophages, the uptake of gLDL was also correlated with their ability to produce LPL endogenously. Mouse peritoneal macrophages from genetically modified mice, which lacked LPL, exhibited a 75% reduction of gLDL uptake compared with normal macrophages. The LPL-mediated effect required the association of the enzyme with cell surface glycosaminoglycans but was independent of its enzymatic activity. The uptake of gLDL in different cell types by an LPL-mediated process might have important implications for the cellular response after gLDL exposure as well as the removal of gLDL from the circulation.
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http://diabetes.diabetesjournals.org/content/50/7/1643.abstract

And this;

http://diabetes.diabetesjournals.org/content/49/4/597.abstract

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Atherosclerosis is the major complication of diabetes. Accumulating evidence indicates that lipoprotein lipase (LPL) produced by macrophages in the vascular wall may favor the development of atherosclerosis by promoting lipid accumulation within the lesion.

We previously demonstrated that high glucose stimulates in vitro murine and human macrophage LPL production.
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I'm still not sure about the whole high triglycerides and chylomicrons in the absence of high glucose, though. Carbohydrate seems to make cells fat. Liver cells, muscle cells, fat cells.

Macrophages and smooth muscle cells?

Is fructose especially bad in contributing to the glycation of Apo B?  I have read in several sources that fructose creates ten times as many advanced glycation end-products (AGEs) as glucose.  I wonder if it is also similarly implicated in the Apo B glycation process.

I think it would be much more clear and less "inflammatory" to differentiate between "refined carbohydrates" like flour products, and sugars, etc. vs "unrefined, complex" carbs like those in whole, intact grains (not wheat IF you are sensitive to it and as much as 70% of population or more are fine with it)(Don't forget, doctors mostly see the ones that are ill, not the ones that are healthy), legumes, sweet potatoes, etc.  To jump from avoiding flour products to replacing those calories w/ sat. fat is a big step and leaves much out!  What happens if you replace bagels w/ whole, cooked millet for example?

The only way to control it is to have  a diet that is low on cholesterol. This is the only solution that can be followed for the results to appear.

So, I'm paleo/ primal, with good amounts of coconut oil for my fat. I just had a full lab analysis with my Dr. yesterday and turns out that my Cholesterol is high at 268. Triglycerides were ate 60, HDL at 86 & LDL 170.

Thank God he was Paleo as well, so I did not have to hear a speech about modifying my diet. What he did say, however, was that in correlation to my other readings (High Platelets and White Blood Cell counts, low RBC, Hemoglobin and Hematocrit as well as low iron saturation) shows my body is fighting a parasite/ infection of some sort, causing obvious inflammation to fend off the 'critter'.

I was immediately worried, since all naysayers to my high amounts of fat-ingesting diet always think that I will have high cholesterol.

I will watch with avid curiosity as to this correlation to my infection (most likely my dental carries) and my cholesterol. Sometimes, full homeostasis or the lack-thereof, may show us a better picture in the whole, grand scheme of things.

Dr. Davis, do you know if an increase in glycosylated LDL due to hyperlipidemia could result in altered (possibly lower) blood glucose readings?

I'm looking for cholesterol test that differentiates the LDL number into glycated- and non-glycated LDL

I wonder if people such as the Kitavans (and other pacific islanders), Hadza in Africa and many other traditional civilizations who survive on sources of carbohydrates like tubers, yams etc walk around with blood sugar  monitoring devices?

Another great and helpful post on blood sugar!
As an overweight, out of shape diabetic, I'm working on this--my blog, http://transformation-transformative.blogspot.com/, is my way of keeping myself honest and tracking my progress.
My thanks for your work!

Always great information!  So you are saying that for the normal healthy person, a target of 40-50 carbs a day is the max we should take in to avoid inflammation and they host of issues that go along with it?  I ask b/c if you eat enough veggies and fruit, even without sugar or wheat, it is easy to push over the 40-50 carbs.  Just wanted to make sure I understand so I can tune in my numbers.  Thank you for all of your work!

Hyper-glycemia is able to increase the levels of matrix metallo-proteinase 9 (MMP 9), an endo-peptidase enzyme implicated in alterations of blood vessels'   walls.  It is thought to play a role in aortic aneurisms; and, since MMP 9 is made in plaque, it is also implicated in ruptures of plaque. There is a notable increase in MMP levels in individuals with  familial hyper-cholesterol and diabetics.

Diabetics have elevated urine & blood levels of MMP 9;  but also above normal levels of  it's  inhibitor  (tissue inhibitor metallo-proteinase, or TIMP). The theory is that these conflicting markers indicate there is an ongoing paradigm, in which  vascular exterior cell matrix (ECM) remodeling is aggravated, by the influence of hyper-glycemia, and this is being opposed by a body response, which tries to keep vascular walls from getting so misshapen they lose function. (To be clear this is not necessarily a narrowing of the inside of the small blood vessels; more a case where, when measured across, it is wider. And then too this is not directly causing any worsening of systolic pressure.)

Since nothing is simple know that both too much MMP and too much of it's inhibitor TIMP are not desirable. On one hand if there is too much TIMP (ie: low MMP) then the ECM can become more fibrous from excess collagen allowed into that vessels matrix; so normal amounts of MMP is desireable. While in another context it is suggested that the way advanced glycation end products (AGE) increases oxidative stress contributes to more MMP 9; and then the high levels of vascular adhesion molecules (VAM 1),  that are notably induced by AGEs,  get to cause more monocyte adhesion to the MMP enzyme prepped vascular endothelium.

I wonder how folks who follow insane diets like Dr. Furhman's Eat to Live manage to keep their blood sugars down? According to his web site, they do manage to doso, and they keep their HDL up and their triglycerides down. There's something going on there but I'm not sure quite what it is. The diet avoids meat and fat, but it also avoids sugar and grains as well. They apparently eat a lot of beans.
Anyway, anyone could get the same results or better without avoiding meat like it's the devil, but that's another story.

The lactose content of yogurt varies a lot depending on how long it's allowed to ferment. Most people don't like sour yogurt, so most commercial yogurt producers stop the fermentation when it's still pretty sweet, even without added sweetener. The sourer the yogurt, the less milk sugar remaining. So differences in BGs after eating yogurt might stem from the level of fermentation as well as from individual differences in blood sugar control and allergies.

Not everyone goes up to 140 after meals, even very carby ones. If you look at this chart carefully, you can see that although many people go over 160 after a carby breakfast, some start below 70 and only go up to about 90 after breakfast.

http://www.diabetes-symposium.org/index.php?menu=view&source=topics&sourceid=16&chart=17&id=322

Some people on diabetes lists have tested spouses, and many say they never go above 90, although with hearsay reports like this it's not always clear when they were testing. Nondiabetics can go up to 160 after a carby meal and be back to below 100 in an hour or two.

One person who had tested diabetic and then lost about 100 pounds said that after the weight loss, he never went over 100 unless he really stuffed himself, and then I think he only went up to slightly over 100.

@ mito: my husband had a major hemorrhagic stroke 10 years ago - he was not a diabetic and his cholesterol was routinely around 150 - he was a SAD eater.

@ mcfreddy: same with the 'starch based' McDougall diet. (high carb, no added fat, no animal or dairy,  just heavy on veggies, fruits, beans, lots of sweet potatoes and potatoes - and grains as tolerated). After the initial adjustment period the majority of followers have normal stats all around.
This whole carb thing just isn't black and white - unfortunately.

Hi rhc,
Would you mind telling how old  your husband was when he had his hemorrhagic stroke ?

A fasted homeostatic blood sugar level equals around1 teaspoon of sugar out of the 1000 teaspoons of blood in your body.  When analyzing food labels & tracking your carb intake the formula to remember is the 1-5-20 rule, meaning 1 teaspoon of sugar equals 5 grams which equals 20 calories.  For optimum health an honest dietitian, nutritionist or doctor will advise keeping TOTAL carb (sugar) intake to around 10 to 12 teaspoons a day MAX, others will say 10 to 12 or 15  total ADDED sugars per day.  12 teaspoons X 5 grams per equals only 60 grams & times 20 calories per teaspoon equals just 240 calories. So yes it's not much, but considering the damage done to the body by glucose from carbs, & since ALL carbs reduce to glucose, less is better.

He was 60 - doing ok but with major right side empairment remaining and only takes one medication for blood pressure.

Hi rhc,
You realize I discussed above an  aortic aneurism; this is not in the brain. As for hemorrhagic stroke there is a risk  condition one can be born with,  relatively rare to be sure, called arterio-venous malfunction; while the common sub-arachnoid hemorrhage can be either looming likewise since birth or as a rupture associated with advancing age.
Sounds like you might be alluding to an intra-cerebral hemorrhage of some artery inside the brain. These are usually ascribed to hyper-tension's affect on brain artery.

For George Zachary ... this was blocked by Server several times when tried to send you over on Doc's 2nd post  back (ie: "The Exception to Low Carb); if anyone wants to copy and paste it there for him that would be nice.  
  
PCSK9 "non sense"mutations that lower circulating LDL cholesterol:
2% of African Americans get 40% less LDL from  these 2 in 80% of those having these:
(a) PCSK9 variant 426C G encoding Y142X (ie: tyrosine at position 142 replaced by stop codon)
(b) PCSK9 variant 2037CA encoding C679X (ie: cysteine at position 679 replaced by stop codon)

3% of Caucasian Americans get 15 to 21% less LDL from:
(a) PCSK9 sequence variant 137GT encoding R46L (ie: arginine at position 46 replaced with leucine)

PCSK9 alleles that both can give 28% less LDL:
(a) PCSK9 9142X allele in 0.8% of African Americans
(b) PCSK9 9679X allele in 1.8% of African Americans

PCSK9 9646L allele gives 15% less LDL in:
(a) 3 % of Caucasian Americans
(b) 0.7% of African Americans

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One crucial difference exists between the modern American and other populations: We have been incredibly overexposed to processed carbohydrates since birth, from teething crackers, to Lucky Charms and Scooter Pies, to pizza and beer, to "healthy whole grains."

We now arrive at later adulthood with beaten up, tired, beta cell-exhausted pancreases that make us unable to deal with the continuing flow of modern processed carbohydrates.

I am assuming you are directing your comments at sedentary unfit people.  Anyone who works  physically or trains as I do (I run and do heavy weight training), could not survive and train on those sorts of amounts of carbs.  If I go below about 200g/day for any length of time my ability to train drops off markedly.

Hi, Aileen--

Yes, indeed. This advice is definitely not intended for people who engage in high levels of endurance training. My wife, for instance, in training for an Iron Man competition, needs to supplement carbohydrates during her training sessions, such as a 112-mile bike trip.

Dr. Davis, thank you really so much. Very interesting article. I believe it is also not just a a matter of the right source of carbohydrate and carb counting but also the right food combining. But what is a person has to do a lot of intelletual work? For example,  when I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs, much more than most of my familiy members. Otherwise, it feels like the brain gets dry. On the other hand, physical  workouts never make me really hungry. IS that ok?

I do agree sandra but please explain  I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs

Hi, Sandra--

Only people who rely on carbs need them for cerebral work.

I wonder if something to boost acetylcholine might work better? There are a number of neat supplements you can use to achieve this, such as acetyl-L-carnitine.

I suggest Piracetam.

I think it is important to keep the good cholesterol foods intact in your diet.  Fruit has been getting a bad rap lately for sugar, but it is a totally different type of sugar for the body.   Apples were one of my staples when I dropped my cholesterol by 15% and weight by 45 lbs. after receiving a high cholesterol reading.    I also picked out many other good foods that contained healthy or good carbs.  Check out these other important plaque and cholesterol fighters.

www.cholesterolgoodfoods.net