I often wondered about the one from Wal-Mart. i'm not sure if it's same as the one from Wal-green. The name brand rung a bell. My wife ended up with a little cold while on it. Needless to say, we went back to the old one. I also got a little cold but was over it quickly. I'll have to go there and see which brand. It was very cheap too. hmm...

Wow, goodbye Nature Made!  Has anyone tried and had luck with the Trader Joe's brand?

Just called NatureMade Co and they told me their D3-2000 softgels are also sold under the Kirkland brand by Costco.  I have been taking those for 6 mos. and will now get my level checked. I'll be switching if it's not where it's been for the past year.

Thanks.

Jan

Dr. Davis:
This is excellent and important  information; thank you for reporting it.

Question:  has Nature Made been made aware of this?  I'm not defending them by any strtch, but is it possible that something they're not aware of has occurred?  They've always seemed to be a reputable company.
Also, I've never seen them offer a 10,000 unit single dose.

Just want to make sure you mean Nature Made and not Nature's Bounty, both of which are sold by Walgreens.

I have been taking 6,000 IU NOW Foods (brand) vitamin D3 gelcaps/day for the last three years.

My 25-hydroxy vitamin D blood level has been ~60 ng/ml after two tests in those three years.  So far, so good.

Does anyone have experience with the Country Life brand gelcaps?

By the way, Dr Davis, when you say "You might consider a 25-hydroxy vitamin D blood level", do you mean that we might consider having our 25-hydroxy vitamin D blood level measured?

can you comment the same on niacin

Thanks Dr. Davis, I have personally learned so much from reading your blog..... I wanted to know how much I appreciate you taking time from your schedule to give us such valuable advice. My father is a open heart surgery patient and the food in hospital up to his surgery was appalling and his cardiologists standard low fat recommendations is stupendous. However my parents are of the age where doctor is = GOD. I am the nutcase for advocating D3, and salmon oil, & coconut oil.... THANKS AGAIN!!!! Sharan from Ontario, Canada

Wow, that is worrying news but I am not surprised either.. there is a lot of scams out there.. but you would have thought they would be more unfamiliar brands than something we can pick up everywhere, or maybe that is just why. No one is questioning them because the brand is so known! I wonder if this goes for their other supplements too? I will for sure send this information along.

Last september 25-0H-lab 20. I started with 10000/d dried pills. March lab 140!Really surprised that the resorption of ordinary pills can be that high. Luckily no toxic "side effects". Sure I´ll pause now till next winter.

I have developed hypervitaminosis of vitamin D only taking 3000 IU daily of D3 during 5 months. I have removed all vitamin D3 of my supplements until I have levels under 50-60 ng/ml or even below.

My experience has told me that some doctors/scientists are prescribing megadoses of vitamin D to population. Probably no more than 1000 IU daily of D3 to general population is a good dose.

The comments from several people highlight the absolute need to monitor 25-hydroxy vitamin D blood levels. We have our patients' levels checked every 6 months. Only then can you truly know what your status is.

My email to Nature Made:

"I am a practicing cardiologist who monitors vitamin D blood levels in all my patients every 6 months.

The Nature Made vitamin D is yielding no increase in 25-hydroxy vitamin D blood levels, despite prior full restoration with other brands.

This suggests that there is either little or no vitamin D in the capsule.

I'd appreciate your response."

We'll see what happens. Don't expect them to say much. The chain of communication in these companies is often not open to our scrutiny, nor will they say anthing that makes them legally liable in any way.

Adolfo David,

your statement doesn't even make sense. Did you spend a lot of time outside during warm season?

1,000 IU a day is very low for most people during the winter. That being said, I'd stick with 2,000 IU a day at the most during the summer and 5,000 IU during the winter. We easily make 20,000 IU of vitamin D in the skin just being outside at midday in the summer with the body mostly exposed after 20-30 minutes so I don't see how doctors are giving megadose when they say to take only 400 IU a day. We do not routinely get tested for it unless we request for it.

If you can't get to a reputable vitamin/supplement store, head over on the Internet to Vitacost.com.
I've been buying from them for years now.
They sell hundreds of name brands at discounted prices.
I've been using Carlson's VitD3 during the winter months here in Fla.
I then get a blood test going back into the winter months.

Anyone have any experience with Sam's Club's Member's Mark brand?

http://www.samsclub.com/shopping/na

vigate.do?dest=5&item=412704&pCatg=

11017

Huhu, it would be interesting to see if they answer and what answer. It is so important to choose brands of high quality when you buy supplements like Life Extension, NOW, Nordic Naturals, New Chapter..to name only a few I think are in the top quality.

Eloise, its strange that you have not felt any side effect with 140 ng/ml of vitamin D, it is almost a toxic level!

Adolfo,

I see that you're from Spain. I wonder if the testing lab is doing it right or the dosing is way off the mark.

1,000 IU isn't very much when it comes to keeping vitamin D level in the optimal range during the winter. During the summer, we (except for elderly people) can produce as much as 20,000 IU in the skin at midday with most of the body exposed to the sun after 20-30 minutes (for light skin). Much longer for dark skin. That's why your statement doesn't make sense.

My husband and I have been using the Costco Kirkland D3 (2000 IU per gel cap) and have had wonderful results. Recently I measured in at 81 ng/mL and my husband's measured level was 53 ng/mL -- note, I am more religious about taking my vitamins everyday than he is.

Dr D.

I had been taking the NOW brand of Niacin.  I also tried the "pharma" Niaspan.  The impact on my trigs was the same (35% reduction).  recently there was a package change here in Canada. Unfortunately the contents lable indicated niacinamide.  NOW said it was a lable error and the contents were niacin.  We have not seen a new packet yet.

I have tired rexall and wallmart brands, niether produce a flush that gives me the comforting feeling there is niacin at the strength I need for trigs reduction.

If you have a resource recommendation to find quality suppliments for D3,K2 and Niacin, it would be much appreciated

One other "D" issue is that quite a high number of people do not absorb the dry form (even of D3) well if at all.  Many, like Eloise, obviously do but many can take fairly high doses of it for some time w/ no change in blood level, switch to the oil base and bring it right up.

Dr Davis:

The subject of Vitamin D supplementation is a confusing one for me. I have been following the various postings on this blog and other news articles pointing out all the benefits of Vitamin D3. However, there seems to be vast disagreement on what constitutes a deficiency across ethnic/racial groups.To quote from wikipedia's page:

"Recommendations stemming for a single standard for optimal serum 25(OH)D concentrations ignores the differing genetically mediated determinates of serum 25(OH)D and may result in ethnic minorities in Western countries having the results of studies done with subjects not representative of ethnic diversity applied to them. Vitamin D levels vary for genetically mediated reasons as well as environmental ones.[30][31][32][33]  Among descent groups with heavy sun exposure during their evolution, taking supplemental vitamin D to attain the 25(OH)D level associated with optimal health in studies done with mainly European populations may have deleterious outcomes.[11]

I'm of South Asian(Indian) descent and my 25(OH)D levels on a recent test were 31.3 ng/ml.

What level would you say is safe for someone like me ? I take a 1000 IU supplement a day now but am more than a little concerned as what is safe.

Thank you Dr. Davis for following up with Nature Made.  While they may not want to make any comments that might be self-incriminating, the evidence is in the gel caps themselves; they either contain the amount of D3 claimed, or they don't.  I think  the salient issue is the amount of D3 in the gelcap.  An argument can be made that the company is not responsible for guaranteeing patient D3 levels because of individual biology.
  If the users of the NM product have any of the original capsules remaining, they might want to hold onto them, and even purchase an unopened bottle for possible future action.

Thank You Dr Davis for your excellent blog and your easy, straight-to-the-point posts!

After discovering you back in the Fall, I joined the Grassroots program and tested for Vit D at a low level of 12.

I took 5000-10000iu of Vit D3 daily since Nov 20th and recently retested (with ZRT again).

Although the searing, scorching pain in my joints has nearly all faded (thyroid/fibro?), and I was hoping for an optimal level, my lab results were only 19 last week


Curious after reading this though - I was taking Natures Bounty from Walgreens (5000iu max strength soft gel with soybean oil).

Does anyone know if Natures Bounty is the same as Nature Made?

As always, I appreciate the time you take to relate your stories and experience with us.

Somebody asked about Country Life.  I use their 2500 IU non-fish oil gelcap and my levels are 45ng/ml, which seems about right.  Thus, I think that company is indeed selling D3.

Your advertising Glucosan? A supplement that's banned in countries like Australia? Thats stuff put me in the emergency room last year. It absorbs moisture and swells in your gut. I am very surprised to see you advertising this.

OK might have spoke too soon. I've written the company and asked them if their product contains any glucosan and if not, why they would name their product after it.

Thanks

I would expect you'll hear from them.  It's probably the most damaging publicity their brand will receive this year.

Dr. Davis

Thanks for the information.  8000iu of Walgreen's "Finest Natural" D3 gelcaps had raised my HDL's from 23 to 60.  I will test my HDL's ASAP.

William Faloon at Lef.org likes Metformin to keep appetite under control,  potential disease prevention, anti-aging benefits,  correcting "metabolic syndrome" and anti-cancer effects.
I am having problems getting under 18% body fat and am wondering if you have had good results?

This is interesting. I've been taking high dose Bio-Tech capsules which get to me 56.4ng/ml at 10,000IU, so maybe gel caps of a different brand require a smaller amount (or more)? I guess if 10,000IU of Bio-Tech works for me I'll just stick with that - just hope they don't stop selling vitamin D.
That said I think Bio-Tech's value is probably fine (and I consume it with yogurt) as my first attempt at supplementation a few years ago was 400IU D2 in gelcap which didn't do much for raising levels at all, albeit also being D2.

Here are some brands that have yielded predictable and consistent increases in vitamin D blood levels:

Vitamin Shoppe brand
NOW
Sam's Club Members Mark
Nature's Life

There are surely more, but insufficient numbers of people in my population have been repeatedly tested. Also, all of the above have been GELCAPS. Tablets are not worth it, since they are so inconsistently absorbed. Oddly, the capsules filled with powder are better absorbed, perhaps equivalent to gelcaps.

I forgot to mention Carlson.

While, in general, I've had good experiences with Carlson preparations, we've seen some inconsistent blood results with their vitamin D. This has applied to about 3 people, so it may be premature to raise a stink. However, if you are taking Carlson, it may be wise to check a blood level.

I believe the brands at Walmart also seem to work fine, though the high-dose 5000 unit capsule has not been around long enough to allow repeated testing.

Lou, I take care a lot of my skin, I use everyday all year a UVA-UVB sun protector in all my skin exposed to sun, at least SPF 15-20 in the winter and SPF 30-40 in the spring-summer. I tend to avoid sun rays directly over my skin.

Taking 3000-4000 IU everyday during 5 months has produced to me 110 ng/ml of vitamin D. It has perfect sense in people like me who are probably vitamin D3 senstive. Also I am young, so I absorb so well vitamin D3.

If you dont get a blood test I never recommend more than 2000 IU of vitamin D3 daily.

Lou, I have read a lot about Vitamin D, I am health journalist very concerned about Vitamin D deficiency and I have read many articles and papers of John Cannell and Michael Holick.

About sun and vitamin D: you produce 10.000 UI of vitamin D with sun exposure if your body needs this amount. If not, sun does not produce more vitamin D. For this reason, you cannot reach a hypervitaminosis level with sun exposure.

My diet is mainly organic, much of this also paleo, with eggs, fish and some wild fish, some organic cheese... All these have vitamin D3.

I had great results with the Bio-Tech D3 powdered capsules, 50,000 IU once per week. My D3 last month was at 79.  

For the previous year and a half I'd been taking D3 emulsion drops with my numbers in the 40s-50s at 4000 IU/day. I think the drop size was too inconsistent.

Thank you for posting this information.  I recently had my levels tested after taking 5000 IU of the Healthy Origins brand D3 gelcaps for 6 months.  Levels had only gone from 37 to 39.  I'll be switching to Vitamin Shoppe or Now brands!

Or, you can increase your pre-sunburn exposure to sunlight, which yields about 10,000 IU. With no risk of overdosing, due to down-regulatory mechanisms with the "battery is full".

Dr. Davis, I recall seeing a post in this blog about people over 40 not producing vitamin D from sunlight exposure. Do you still believe that to be the case?

I ask because empirical research with elderly patients (65 and older) suggests that people in this category (i.e., the elderly) produce only a little less (80 percent or so) than 20 and 30-year olds:

http://healthcorrelator.blogspot.com/2010/02/vitamin-d-levels-sunlight-age-and.html

Dr Davis --

Are there any simple tests for crudely estimating one's level of arterial plaque which can be performed at home?

Thank you,

-- Tom Robinson

Adolfo,
I am also a little confused about what you are saying, but this might help you since we often measure Vitamin D as micro gram (mcg) in Europe.
5000IU of Vitamin D is (from what I understand) 125 mcg. (1 mcg = 40IU)

At the moment I am taking 2 different kinds of Vitamin D, Nature's Bounty gelcaps and one in a liquid form with arginine. I am unsure of the result from each. But last time I checked I was at 76ng/ml.

I wish there was an easy way to test this at home like the sugar levels in your blood! I hate going to the doc to do this cause they always gives me the lecture that I am eating too much vitamins, and even questions why I do it - they say I should get enough from a normal diet. And when that happens I just want ask 'what the heck is a normal diet' I am pretty sure his and mine idea of a normal diet is different.

Dr Davis - you should have a test right here on your blog for different Vitamin D products!! I would do it! Tell us what brand we should eat and for how long... test our levels, and then let us switch to another - do another test, and so forth... Each person could probably test 3 different brands in a year, or?? Just a thought.

For those asking about experience with different brands, here are my results:

Niacin - Neutraceutical Brand (Vitacost online) - 1,000 mg. capsules, 1 daily:  noticable flush, even after 1 year.  Trigs went from 178 to 87.

Vit. D3 - NOW Brand, 5000 IU gelcap, 1 daily.  Measured D3 in February was 74.

I'm now going to try the Neutraceutical 10,000 iu capsule, every other day and see what happens with test results.

I am glad to hear that the capsules filled with powder are absorbed effectively.  I mistakenly ordered Vitamin Shoppe Source Naturals D-3 Bioactive Form 2000 IU capsules thinking I was ordering gelcaps.  It turned out to be capsules filled with power.

My partner and I have had our Grassrootshealth results back today, We take Country Life 5000iu softgels in MCT oil and use UVB from sunbed in winter and sun, when available, in summer.
Mine was 64ng/ml and she is 74ng/ml.
She is weighs less than me.

Eades (who led me to your blog through a tweet of this and past tweets) recommended Biotech to me. I tested at 64 taking 5,000 iu and living like a bat (if I leave the house during daylight hours I wear the finest French sunblock, Anthelios #50/60, pour la visage - for the face). Many thanks for your post. Very important, knowing this. Retweeted.

Eades (who led me to your blog through a tweet of this and past tweets) recommended Biotech to me. I tested at 64 taking 5,000 iu and living like a bat (if I leave the house during daylight hours I wear the finest French sunblock, Anthelios #50/60, pour la visage - for the face). Many thanks for your post. Very important, knowing this. Retweeted.

Several people commented on sun and vitamin D.

Despite the media's repeated claim that 10 minutes of sun will provide 10,000 units of vitamin D, this does NOT apply to the majority of us.

This tends to apply only to young people, generally younger than 30 years old. Over 40, and most (but not all) have lost much of the ability to activate vitamin D in the skin with sun exposure.

Ignore the "talking heads" who tell you that 10 minutes of sun provides sufficient vitamin D. They probably read about it in a website last evening, then speak as "authorities."

I am like Adolfo I think. When I took 4,000 IU D3 per day for just four months over the winter a couple of years ago my 25(OH)D level reached 154 ng/ml. I am not young, I am in my mid 50s but I am slim. I cut down to 2,000 IUs per day and my levels have stabilized between 60 and 80 ng/ml. I get tested every four months or so. I do not go in the sun, but I did when I was in France last year and my 25(OH)D level actually fell ! I too eat a Paleo diet with lots of oily fish which contains D and I think this helps keep my 25(OH)D level up despite only taking 2,000 IU D3. I take Carlsons.

Dr. Davis, I was not referring to anything said by "talking heads", but to research done or reviewed by Reinhold Vieth.

For the Anonymous person that asked about Niacin...I take the brand name Slo-Niacin I get at Walmart or Sam's Club...2000mg
per day to raise my HDL.  If I spread the 4 tablets out over a couple of hours I get no flushing.

HDL went from 42 to 85mg/dL in a matter of 3 months.

Other "no flush" products for me
severe flushing.

TYP uses Slo-Nicain brand.

Anyone have any experience with Sam's Club's Member's Mark brand?

That's what I take. One 5,000 units capsule every other day (plus there supposed to be 600 IU in the multi I take daily).

Definitely a good stuff. It is so ridiculously cheap, it's hard to believe it's good. How do I know? First, a test a year ago. Second, I get two weird side effects of taking vitamin D: 1) a low grade acne that I used to get once in a while disappears completely, 2) two small wart-like tumors on my wrist shrink and become very flat, barely visible.
How do I know it's vitamin D that does it? - Just for kicks, I once stopped taking it for 3 months and both effects reverted.

Here's the response from Nature Made. It's the usual corporate-speak nonsense that says nothing.

Unfortunately, because the experiences I have are from patients, not my own vitamin D, I do not have the bottles nor lot numbers to supply them. In past, when I have gone to the trouble of getting them, it never came to anything. You provide it, the information goes into the company, you never hear anything more.

So, given the difficulties, I would suggest that we all avoid Nature Made vitamin D. By the way, their fish oil is not a very good product, either. Nature Made is one of the brands we consistently see stomach upset with.



Date:     April  9,  2010
From:     Marissa Reyes, Consumer Affairs Department
Subject:  Reference #346236

Dear William Davis, MD:

We recently received your e-mail regarding Nature Made products.  We regret to hear that the quality standards of our company. [?]

Our company is called Pharmavite, and we manufacture Nature Made nutritional supplements.  We have been in business since 1971.  We are committed to quality control, and have very high quality standards.  Our Quality Control personnel sample and test all raw materials as they enter our plant, and again assay the finished product, before final packaging.  

Dietary Supplements are regulated under the FDA through DSHEA (Dietary Supplement Health & Education Act of 1994). The United States Pharmacopoeia (USP) establishes standards for the composition of drugs and nutritional supplements.  This voluntary non governmental organization was set up in 1820 and has officially been recognized by federal law since 1906.  Standards established by USP for products are legally enforceable by the FDA.  At Pharmavite we participate in the USP Dietary Supplement Verification Program (DSVP).  Many of our products have earned the DSVP seal and additional products are currently being evaluated.  Our DSVP certified products will have the DSVP seal on the product label.

Our Nature Made Vitamin D 400 IU tablets have been reviewed by the USP and bears the DSVP symbol on the label. Although the USP has not reviewed all of the Nature Made Vitamin D supplements, all of our products go through the same rigorous quality testing at Pharmavite. The products which have earned the seal help us to demonstrate the high quality of our products.

We would like to look into the product(s) your patients have been using. If you could provide the UPC and lot numbers of the product(s), we will be happy to review our records. In addition, if you would like us to test the product(s) that you currently have, we will be pleased to send a prepaid postage mailer so you may return the product(s) to us so that our Quality Control Department can
examine it. Please let us know if you would like us to send you the prepaid postage mailer.

We thank you for contacting us and hope that you will continue to use and enjoy Nature Made products with complete confidence.

Sincerely,
Marissa Reyes
Consumer Affairs Coordinator
Pharmavite, LLC
MR:346236-10

I use 5,000 iu/day from WalMart and Sam's Club and my last test result was 79 ng/ml.  I use their fish oil also.

I have taken the Biotech D3-50, 50,000 IU powder caps for about 3-4 years now.  Have not found a good source of oil caps that strong. I have not been sick in 8 years, first 4 from colloidal silver, and last 4 from D3. My 25-OH-vitaminD has been around 62-64 ng/ml.. take two 50,000 IU per week.  Now, after reading Dr Davis on powder D3 "may have erratic absorbtion", I started chewing up a gelcap with a teaspoon of coconut oil.  6 weeks later, my D3 level went from 62 to 80! on the same dose. Six weeks is probably not enough time to stabilize. I bet I may go to 90-100 when I retest next month.

Dr Cannell (www.vitamindcouncil.org) reccommends 25 IU per pound of body weight per day long term for starts and then test.  My dose works out to be 14,286 IU/day and my weight is around 300lbs.. pretty close.  No wonder skinny people build up too much D3 in their blood, no fat to store/buffer it.  Also had a couple of warts/moles, and they went away after high dose D3. I think they are caused by viruses and D3 builds up the immune system enough to fight off most viruses
--ghg

I had been taking the NOW brand of Niacin. I also tried the "pharma" Niaspan. The impact on my trigs was the same (35% reduction). recently there was a package change here in Canada. Unfortunately the contents lable indicated niacinamide. NOW said it was a lable error and the contents were niacin. We have not seen a new packet yet.

I began supplementing a total of 4,000 iu of vit d at the beginning of January. (2,000 from my multivitamin and 2,000 from Sam's Club gelcaps).  My vit d level on Feb 1 was 32.

Upon receiving these results in the middle of February, I began taking 2 drops (4000 iu) of vitacost's brand of vit d (in addition to the 2000 in my multi).  So a total of 6,000 iu per day.  

I received the results yesterday of my vit d level taken 2 weeks ago-- 94.8!

My hdl went from 38 in February to 31 two weeks ago.  
I have also been following a higher fat, lower carb (30-75g/day) diet for the past 2 months.
My triglycerides, overall cholesterol, and LDL levels have all dropped by 30-40 points.
I've cut back to 4,000 iu of vit d.

I can't seem to lose weight, however, even with the low carbs.  I am a T2 diabetic.  (AIC of 6.7 in February).

hello,i live in islamabad,pakistan.last year i ws diagnosed having osteopenia then my dr also asked me for d3 n calcium tests both came very low.since last nov i hav been taking 500IU d3 alongwith osteocare syrup.but after 7,8mnths my result was  still  the same vit d3 being 16 (here in our labs normal range is considered above 30)and calcium came 8.4,(normal range starts from 8.8)please do suggest me something really useful and effective.i want to concieve too but i think might be being so defiecient i am suffering from hormonal imbalance too.my age is 32,i have  a son 4yrs old,am quite slim 5.3height with 110pounds.thnx

Vitamin D3 2000 Iu:

NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 2000 Iu on discount at NutroVita.com.

For more details please visit:
http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

You have done a marvelous job by exploring this subject with such an honesty and depth. Thanks for sharing it with us!
termpapers99@gmail.com

Dr. Davis, I agree that consumers should be cautious of their medicine intake. I've heard of various over the counter vitamins and food supplements being sold even in stores like Wal-Mart and elsewhere. Although, they have the same content like vitamin D, there can be some problems with the percentage in each capsule. That's why they need to be guarded of the brands that they would patronize.

Aside from vitamin D, a lot of people today wanted to buy resveratrol too. They consult online resources and friends on where to buy resveratrol. Like in most drugs, experts advise to check the label, before purchasing any product to be sure of its content and effectiveness.

Thanks for sharing.

Gee, makes me want to check my medicine cabinet and the brands I have in there.
Not because it's well known means it works well.
Mavic
vitamin supplement industry

I've been taking Source Naturals 2000 IU vitamin D3.

My vitamin d is 85 ng/mL.

Is that too high? when to stop supplementing? I highly recommend this brand for increasing your vitamin D level, and it's pretty easy to get.

The costco brand was also fine - increased the level as well.

25(0H)D levels decline from Sept though to March above latitude 30N. So continuing to take 2000iu/daily will (for you as you appear to be a high responder) maintain your status above the 60~70ng/ml that provides a good reserve of D3.
Adverse events may be expected above 200ng/ml and you nowhere near that level.
Most readers require 6000iu/d to attain and maintain 60~70ng/ml through the winter.
Depending on the amount of time you spend outdoors next year it may be worth considering supplementing  alternate days or with perhaps 3 x 2000iu a week during midsummer if being above 80ng/ml bothers you. Personally I'd only reduce intake if I was repeatedly above 100ng/ml. Some test methods are slightly more variable than others and so your current level may be simply a

i'm taking 2 gms of prescription niaspan but flush very bad.  any tips on limiting this effect?

I have been taking 2000 IU daily dosage of vitamin D3 for several months with marginal improvement in level - went from 10 to 15.  Visiting this blog-post revelaed thwe reason - I have been using the NatureMade brand.

Kaiser's doctors recommended 50,000 iu weekly which initially had side effects - but I learnt it was perhaps because I was not taking it with heavy meals.

I have now been recommemded 5000 iu daily, and I thingk I will go with Carlson or Now brand. But a quick question; Isn't the 50,000 IU prescription dosage prepared by the Kaiser Lab more reliable than any leading brands? I mean - can't we trust the in-the-lab prepared prescription more than the over-the-counter branded pills?

Would appreciate if someone throes some light on this.

Dr Davis:
I enjoyed hearing your voice interviewing with Jimmie, and of course, I am quite familiar with your blog photograph. To complete the picture, would you be willing to tell us a little about your own personal experience with TYP over time?


In my opinion, yours is the most compelling health care message currently available in the USA. Particularly your observation that the excesses going on in drugs and health care bear quite startling similarities to those that have developed on Wall Street during the last thirty years.

Now, what's to be done?
The nation needs you Sir!
When has there been a more important time for you and like minded physicians to come to the fore?
There is another prominent bi-racial person who could really use someone like you to coordinate  support and guidance from the profession with his health reform planning.
I do not believe you are alone. Would you please seriously consider developing a video to articulate some of the great health business changes needed to avoid another Wall Street?
I agree it seems like an impossible task until you contemplate what Barak O'Bama is up against!
Dr D., I confess I started this thought in a rather frivolous frame of mind, but the more I think about it the better it sounds! Would you consider Surgeon General?
Best Wishes for a happy and productive 2009.

MikeV
(PS: Maybe Oprah would help with the video?)

Looking forward to reading it. I am also trying to spread your blog over at Lowcarbfriends.com...

Thanks Dr. D

any thoughts on the Quest vitamin D issue of inaccurate measurement?

I thoroughly enjoyed the interview, on my mp3 player while grocery shopping, driving, etc.  Thank you for doing the interview.  Together with the other "top 5" interviewees that Jimmy posted, it was really a blockbuster week.

What are your views on certain supplements that show promise in regard to heart health, but haven't been fully proven yet? Such as resveratrol, grape seed extract,  pomegranate, green tea, krill oil, aged garlic, cocoa, etc.

Are they safe and worthwhile to take,  or would you consider them a risk for certain patients?

Unfortunately, we can't always go to our family doctor or cardiologist (at least generally speaking), give them a list of supplements that potentially could be beneficial, and ask their opinion. 99% of the time they'll be clueless, or simply give vague suggestions, or possibly worse, give bad advice. I had one cardiologist recommend flush-free niacin to me  (the non-beneficial type), for instance.

Its very hard as a health conscious consumer, to know what supplements to use, and at what dosage. There is so much conflicting information available.
I take a small handful of vitamins, amino acids and minerals daily. I eat really well, and exercise regularly, and still have trouble controlling my hypertension.My recent heart scan showed a score of 99.  I have been looking to supplements to help, but so far the help has been minimal. Am I looking for help in all the wrong places too?

It can get frustrating even for those with a long time interest in nutrition and health. Along with my dietary and exercise regimen I take folic acid to help lower triglycerides. Then I come across a report from a newsletter that cited the Norwegian Vitamin Trial (NORVIT) and said " Folic acid supplementation was found to lower homocysteine levels by 28%., but to increase relative risks of heart attack, stroke, and death by 20%, along with a more than a 30% increase in cancer." The source recommends that NO folic acid supplements be taken outside of naturally occurring food sources.
Another newsletter by another doctor advises against  any supplementation of Vitamin D outside of natural sunshine.
Frustrating.

Please clarify your comments on Nattokinase: is this not the same food item that's high in vitamin K2, which if I understand it correctly, helps to put calcium into the bones (along with D3), so that there's less calcium going to the arteries and causing plaque.

If my understanding of K3, and that nattokinase has very high amouns of K3 in it, is correct, then are you saying that Nattokinase is not a suitable replacement for blood thinners or stroke prevention, but that it does have desirable effects for directing calcium to bones, instead of arterial plaques?

I went in for a colonoscopy recently, and did various preps for it, the most powerful one for me was the mag citrate. My photos from the colonoscopy showed pink healthy looking tissue (whew), which led me to think that expensive colon cleanses probably weren't necessary. I'd never done one, but had read about them in the past.

When I did read about them, I remember wondering if hydrogen peroxide enemas did the same thing as those oxy-cleansers. Thankfully I've never had to perform one of the more 'exotic' enemas, but I do remember our teachers warning us to use plastic gowns and stand clear if we ever had to give one.

S

I think it's desperation that often leads to the wrong places. I don't have any heart problems but it is an almost certified route to the grave in my family tree later in life, so with remaining youth I'm able to research things calmly. I visit here mainly as my own research gels with things you say.
I think the key thing is to entertain claims that are referenced and peer reviewed; even a good 'oddball' thought makes it into PubMed. And then there's no reason why an abstract couldn't be printed and discussed with an open minded doctor to look at a route that might be best for the patient.
I think in a sadistic way we like doctors to be fairly arrogant and say "this is your problem, do as I say", but we also know that at the end of the day it's you who cares about you the most. And it's simply terror that leads people into the first arms of saviour they see.

My opinion regarding "resveratrol, grape seed extract, pomegranate, green tea, krill oil, aged garlic, cocoa, etc." is... these are not supplements, these are foods.  

A whole heck of a lot of folks take a lot of ridiculously expensive "supplements" that can easily be replaced by actual food.

You know what phosphatidyl choline is?  An expensive supplement... or a dead-cheap product lecithin used in baking to assist emulsification.  In short, it makes your smoothies smoother for almost no money.

Cocoa?  Who would *supplement* cocoa? I mean... COCOA?  Is eating chocolate now some sort of chore that is easier to accomplish by taking a pill?  I eschew sugar, but don't find it difficult to get sufficient cocoa in my diet even so.  I seriously doubt there's many folks running around suffering cocoa deficiencies.  I mean, if you deeply despise chocolate, maybe take a cocoa supplement, but for the rest of us, eating cocoa is generally a lot more pleasant when it's NOT wrapped in a capsule.

I take supplements.  In fact, I take rather a lot of them.  I take a multivitamin (without iron), vitamin D3 (just started a supplement with K2 also), and fish oil, which I recommend to everyone, most especially those with metabolic syndrome.  These are cheap and sure don't hurt - one of the easiest things you can do for your health.

I also take a B complex, panthothenic acid, niacin, calcium, CoQ10 and milk thistle - each for specific reasons relative to my own health.  

But resveratol and cocoa?  Why not a glass of wine and a piece of dark chocolate?  

Why take a pomegranate supplement, eating pomegrantaes works pretty darned well for me.  Pomegrantaes are darned yummy.

Turmeric, cinnamon and garlic are all lovely foods - and were so before anyone ever did any research into them.  

CLA is the new wonder fatty acid - and you can get gobs of it by eating pasture-raised meat and dairy, which is a heck of a lot more pleasant than swallowing pills.

Food is better than pills.  

OK, we know about vitamin K2 now, but it's a fairly new discovery.  People who just went around eating cheese were getting it even before it was in pills.  

The nutrients that will be discovered next month, next year and next decade are in foods *today*.  

Just eat good food... a wide variety of organic vegetables, as much fruit as your blood glucose tolerates, lots of wholesome meat and dairy from pasture-raised or wild animals, good fats like olive and avocado oils, grains like barley and buckwheat, nuts and seeds, lots of fresh herbs and spices - you'll "cover" all the supplements they aren't even selling yet.

I meant "K2" in my comment above.

S

My opinion regarding "resveratrol, grape seed extract, pomegranate, green tea, krill oil, aged garlic, cocoa, etc." is... these are not supplements, these are foods.

------------

As the originator of the post with reference to the above 'supplements', I somewhat agree -- I just used a general term of 'supplement' to describe them. You can get some of them via food.

But I can't drink wine, so resveratrol and grape seed would have to be in capsule form. And for high doses of resveratrol, supplements are the only way, as it would take several bottles of red wine daily. Aged garlic is different than regular garlic, and is a lot easier to take as a supplement. It's also a lot kinder on your breath and digestion.  And I don't think many people will be sitting down and eating a nice bowl of krill.

My main question was in regard to them being considered worthwhile to take (in any form), and how do we go about verifying what is beneficial, without a doctor to rely on.

Decrying all supplements is similar to running down all prescription drugs. One has to be selective. Some prescription drugs are helpful for some people. So it is with supplements. If the supplement supplies something your body needs it may help. For example, 15 years ago I found that Saw Palmeto helped my prostate. It still does today, and others have found it helpful too.

The NIH study on chelation should have some results soon.

http://nccam.nih.gov/news/2002/chelation/pressrelease.htm

Rich

There seems to be a clear correlation in my ALT value between my taking the LEF Mega Silymarin product.  When I've taken it, my ALT goes down.  But I've usually stopped taking it after just a few months.

I'm now thinking that I need to give it a good 6 month to a year trial.

The "Jedi Master" I've been working with just today told me that I need to be cautious about the possibility of having NAFLD.

So, it seems to me that Mega Silymarin is a must do.

Why do you say the low-carb response  is leading to increased risk for heart disease?

Re: Both the low-carb and the low-fat responses are undesirable, both leading to increased risk for heart disease.

With due respect, I would disagree that BOTH are undesirable, but I agree that the one caused by the low fat high carb diet (only) is indeed dangerous!  

It was never proven that high triglycerides alone cause heart disease.  The available trials such as Framingham (1)  may have shown some correlation with the total cholesterol but correlation is not causuation, especially that the statistics do not distinguish between various diets. Furthermore, Framingham's correlation is restricted to men only (not women) and only for the age group 30-55.  For older men and for women of all ages the correlation becomes insignificant or reversed.

Given the above data, I think the most plausible interpretation leads me to a conclusion that the most likely direct cause of atherosclerotic cardiovascular disease is excessive blood glucose with hyperinsulinemia  (see the following papers, and Stout's papers(2) ).

Hyperglycemia and hyperinsulinemia also happen to coincide with elevated TG and LDL but those are coincidental markers of metabolic syndrome induced by the common high carb (high sugar) diets rather than causing heart disease.  That I believe has nothing to do with dietary fat.

Regards,
Stan (Heretic)

-----------
Refs:

1) JAMA. 2004 May 12;291(18):2243-52. Drug treatment of hyperlipidemia in women. Walsh JM, Pignone M.

2) INSULIN-STIMULATED LIPOGENESIS  IN ARTERIAL  TISSUE  IN RELATION  TO DIABETES AND ATHEROMA,
R.W. STOUT, Lancet Sept 28, 1968, p702.

and

INSULIN STIMULATION OF CHOLESTEROL
SYNTHESIS  BY ARTERIAL TISSUE,
R.W. STOUT, Lancet Aug 30, 1969, p467.

As serum TG's with the HF meal are lower at the end of the day than at the beginning, does this suggest that successive days of HF meals produce progressively lower & lower TG's?

I would love to hear about how to balance the risk between these extremes!  Wow, nice post.

Pythonic and Stan--

It's not that triglycerides per se are atherogenic, but the POSTPRANDIAL PARTICLES that triglycerides represent are atherogenic.

In other words, high triglycerides signals extravagant chylomicron remnants and VLDL, both of which are atherogenic.

In the ongoing debate over what constitutes a healthy or unhealthy diet, the entire issue of postprandial patterns has been ignored. Yet much of heart disease develops IN THE POSTPRANDIAL PERIOD.

i eat copious amounts of fat with positive effects. i'm a layman, but "postprandial" or not, i'm having a hard time accepting this, as the evidence i've read seems to contradict what you're saying regarding overall benefits.

why did no one pick up on the "postprandial particle" issue until now?

will this be a new controversy sweeping through the paleo/low carb blogging community now? ;)

Anyone desiring a full accounting of the hundreds of studies documenting this effect will need to refer to the Track Your Plaque Special Report, Postprandial Lipoproteins: The Storm After the Quiet.

This literature is, unfortunately, relatively difficult to understand. But just because nobody else has incorporated these findings into diet advice doesn't mean it isn't important.

Keep in mind that most dietary advice is NOT based on observation of postprandial phenomena.

so nice blog..................................................

I had a stroke last month. (Very minor, I went immediately back to work.)  As a 35 year old non-smoker/non-drinker who generally ate low carb and avoided sweets before the stroke (and had been exercising regularly for 6 weeks), I'm baffled as to why my triglycerides are between 600 and 900.  I'm now on Lovaza.  Against my doctor's advice, I decide to do a paleo type diet.  We'll see how the lipid panel does at the end of this month, but so far avoiding wheat and grains has generally made me feel better.  I've lost some weight as a bonus.

The doctor is blaming my triglycerides for the stroke, and just calling it hereditary.  It'd be nice to know just what gene I have that causes strokes!  No blood clotting disorders, no diabetes, no pancreaitis, and no hole in my heart either.

First let's take a brief overall look at heart disease because you need to combine two other major lifestyle habits with diet to truly make a difference in reversing or preventing heart disease.


But here's the good news. You can prevent or reverse heart disease by following care

Avoid tobacco
Be more active and walk 30 minutes
Choose healthier food, including more fiber, less saturated fat, and less salt.

If it were as simple as low fat leads to diabetes, the Japanese who ate the traditional low fat high rice diet would have had extremely high levels of diabetes, but they hardly had any. I would be more inclined to wonder if our diabetes epidemic is due specifically to flour and sugar rather than low fat in general.

~Dr Davis, i wonder if this finding is going to point toward advocation of "grazing", rather than two or three meals per day (in a low carb context).

Dr. Davis,
Happy new year.
here is the link to videos about FDA and drug giants. An eye opener. just in case you have not looked at it. total of 8 videos.
http://www.veoh.com/search/videos/q/generation+rx#watch%3Dv18919526gZ4fkAAk

Dr. Davis, the abstract of the study you linked read: "Ten men consumed a low-carbohydrate diet rich in monounsaturated fat (MUFA) and supplemented with n-3 fatty acids for eight weeks."

As you know, there are multiple low carbohydrate diets. This particular study did not examine a high saturated fat diet. I would love to see the result of chronic dieting featuring quality saturated fats like tallow, lard, butter, and coconut milk and avoiding hydrolyzed fats.

Dr. Davis wrote:
"The one potentially confusing aspect of all this is Gretchen's late rise in triglycerides on the low-fat diet. This phenomenon is due to something called de novo lipogenesis, or the liver's conversion of carbohydrates to triglycerides that occurs when an excessive carbohydrate load comes through diet. Because the human body cannot store anything beyond a minor quantity of carbohydrates (as glucose and glycogen), carbohydrates are converted to fats."

We don't see triglycerides being converted to glucose. It's a one way street.

Would having increased carbohydrayte storage space in the body be preferable to storing triglyceride? We have an example of that in hyperglycemia. That's storage in the bloodstream. But the body works quickly to CORRECT that.

So it's not that the body lacks glucose storage and triglyceride is the bad alternative. Not that at all. The body works hard to push glucose out of blood storage and into triglyceride in fat cells. That's a good thing.

Postprandial high triglycerides from a high fat diet is a marker of fat intake. Postprandial low triglyceride on a high carb diet is a marker of carbohydrate metabolism. The later increase in triglyceride is the corrective process.

It's hard to make the case that triglyceride is itself bad when it's one of the body's innate responses to the bad hyperglycemia. If triglyceride is bad, then the body is stuck between a rock and a hard place. It's win-lose, so the low fat diet is worse than the low carb one.

Given my experience with dieting, I would favour low carb over anything balanced in the way of fat/carb. From dietary intervention trials, I'm unconvinced that high fat is worse (or much better) than a mixed blend of carb and fat from a mortality perspective. But from experience, I favour low carb for general sense of well-being.


Stan wrote:
"Hyperglycemia and hyperinsulinemia also happen to coincide with elevated TG and LDL but those are coincidental markers of metabolic syndrome induced by the common high carb (high sugar) diets rather than causing heart disease. That I believe has nothing to do with dietary fat."

It's tough to isolate lipids as causal as opposed to effects of diet. Smoking and fructose lead to increased LDL. So in this case, high LDL is really a symptom smoking and fructose intake. The latter two likely being causal for anything related to your health. 8 egg yolks a day on a high fat diet and your LDL is a symptom of that. And some people have normal LDL on that even.

Mark.

Hi, Shel--

No, absolutely not.

Quite the opposite: Given what happens after eating, grazing is a destructive practice that likely increases risk for heart disease.

See the previous Heart Scan Blog post: http://heartscanblog.blogspot.com/2009/11/triglyceride-and-chylomicron-stacking.html

~hi Dr Davis.

i agree. and i do much better when i eat two meals within an eight hour window.

my focus has always been on keeping blood glucose low (i'm not diabetic, but use a glucose meter for my own curiosity), so was a bit floored by the thought that i have to watch every postprandial spike!

...so, what's left? huge salads and skinless chicken breasts? ;)

It is pure and simple observation of two parameters after eating a low carb and low fat meal. Nothing more that that.

After all most of us eat more than just carbs and fat: there are vitamins, enzymes, minerals, fiber and hundreds of other nutrients. I am certain that they more than compensate any damage that glucose or triglycerides can cause to your arteries.

Sorry, Vin.

You're kidding yourself if you belief that.

It reminds me of the people I meet who take a list of supplements 30 items long (though lacking the most crucial like vitamin D) prior to their bypass or heart attack. That's called magical thinking.

Both diets seem to be extremes, whereas many of us are trying to eat a balanced diet of vegetables, lean meats, nuts, and some legumes and whole grains - call it moderate fat and moderate carbohydrate - but focusing on heart-healthy foods. I'd like to see postprandial data on that.

I have been eating a primal low-carb diet for almost 2 years and feel great.  My fasting blood work is : trig = 40, HDL=88, LDL=114 (calculated), total chol=214, testosterone=606.  My heart scan score is 0.  I am physically active muscular male with 4 intense weights + some cardio workouts 2 hours each.  My bodyfat % is about 8-10% (I can see a clear 6-pack), age=43, height=5'7", weight=160 lbs.

I have made an analysis of my daily intake in a spreadsheet.  My diet on workout days is 3000 kcal, of which 50% fat (167g, out of which 60g saturated), 20% carbs (150g), and 30% protein (200g).  Half the carbs are timed post-workout (workout shake, followed by dinner of meat + sweet potato).  On a non-workout days, I do not have a shake nor sweet potatoes, so the carbs drop to 10% (70g).

Given the amount of fats I take every day, I am rather alarmed by the postprandial triglycerides.  My breakfast, in particular, has 57g of fat which will cause probably a substantial postprandial triglycerides.  Breaking up my food intake into many smaller meals doesn't seem to be a good thing.   We don't want increasing carbs or protein at expense of fats either.  Therefore, what is the solution here?

O--

I am afraid there's no quick answer. That question is answered in an exhaustive report on the Track Your Plaque website.

Alternatively, you could conduct your own do-it-yourself postprandial triglyceride test.

This doesn't detract from any of the points you're making about postprandial triglycerides--but it looks like you're reading the chart from the wrong side here for triglycerides, from the left instead of from the right.

YIKES!
I have been experimenting with a gluten-free, low carb, low sugar diet for 5 months and my LDL just shot UP from 220 to 230 and my HDL went DOWN a little from 66 to 61. (tryglicerides and CRP are excellent). This is opposite what's supposed to happen. Serum D level is good at 54.

Can someone please tell me the name of the test to request from my doctor to tell if I have the small evil-type LDL or the big fluffy okay-type LDL?

Thanks for your help,
Warmly, Catherine

These results seem completely contradictory to the way Dr. Eades described the breakdown of saturated fat in his blog "The blood samples were taken two hours after the meal.  Dietary carbohydrate is absorbed directly into the blood and makes a pass through the liver where it stimulates the production of triglycerides, the fat you see in the blood.  Fat, especially long-chain saturated fat digests very slowly, and doesn’t reach the blood until much later than the two hour mark.  While carbs go directly into the blood, fats take a different route."

Why was there a triglyceride spike after a high fat meal, but not a high carb one?  Were the fats Gretchen consumed not saturated?  It can't be both ways, which metabolic pathway is correct?

Oops, sorry i made a mistake.---My LDL went up from 120 to 130 (not 220 to 230)

Thanks for your comment Dr. Davis but for the first time you sound just like my cardiologist. He does not believe in reversal and thinks it is all down to one's genes and there is nothing one can do to change that. Well I think differently having postponed bypass surgery seven years ago. I will continue with 'magical thinking'. Its nice, you should try it sometime.

To eat one extreme one day (low fat) and then eat another extreme (low carb, high fat) the next is a sure-fire way to get whacky blood/lipid results. Also, lipid levels can fluctuate more than 10% within a given day under normal circumstances. Alternating eating radically different extremes in terms of diet is anything but normal in my view.  Stress, exercise, or even one's sex can cause also shifts.  Trying to prevent every potential/alleged problem with postprandial lipids seems like a sure-fire way to increase stress which is also damaging to the heart and body.  I doubt paleo manwoman worried about the spike in his/her triglycerides from gorging on the fat from fatty meat meals.  I think one can micromanage one's self or rather labs, lipids etc to death...

PS: Forgot to mention lab error.  Before drawing any conclusions from any lab results, have them repeated multiple times and at different labs.  My husband has to communicate with lab techs for his job and was horrified when one kept referring to "esterified" as "stir-fried"! And this was the one of the largest labs in the US...

Doctor Davis, have you seen the new PR campaign from manufactured "food" giant Unilever to "Ban butter to save thousands of lives."

Unilever is the company behind many fake foods, including fake butters Country Crock and  I Can't Believe It's Not Butter!

I've posted a little about this ban-butter campaign on my blog at blogsthatmakemethink.blogspot.com

I also have a blog about the diet we can share experiences and exchange links.
This blog http://just-slim.blogspot.com
thanks

"How to best balance the responses to reduce risk for heart disease? That's a discussion for future."

Please tackle this discussion soon.

I also keep a spreadsheet that details all the different fatty acids and such for every meal.  I've also had three lipid tests this year which were not fasting.  Two were in the afternoon, eight hours after a five-egg omelet with coconut oil, cheese and bacon; 2 hours later I had eight oz of full-fat greek strained yogurt which adds up to over 120 g of fat 6 to 8 hours before the test.  Add another 40 g of fat 2-hours pre-test and according to your theory, my triglycerides should be high.  On each occasion they were 91.  This is on a low-carb (<70g/day) diet.

There's more to postprandial triglyceride metabolism than is covered here.  My next test will be a non-fasting NMR lipoprotein analysis.  Should be interesting how that stacks up against a fasting NMR test.

Well I think differently having postponed bypass surgery seven years ago. I will continue with 'magical thinking'. Its nice, you should try it sometime.

Thanks for the information and looking forward to reading more.

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But is there any real evidence that small LDL is a *cause* of heart disease? Correlation alone isn't sufficient, of course, and Chris Masterjohn has said that even the correlation largely disappears when traditional "risk factors" such as HDL, LDL, and triglycerides are added to the model.

I ask in part because I am about to arm wrestle with my primary care doctor about my recent cholesterol panel:

Total: 382
HDL: 157
LDL: 217 (calculated)
Triglycerides: 39

He's upset about the LDL, of course, especially since it's progressively risen over time (coinciding with dietary changes pretty compatible with TYP and including quite a bit of sat fat after years as a low-fat vegetarian). Naturally, he wants me to reduce my fat consumption and retest in four months, and I'm sure a statin drug recommendation will follow just as the sunset inevitably follows the sunrise.

I am thinking of asking for a full lipoprotein panel, with the expectation that it will calm him down by showing 1) much lower real, measured LDL with my rock bottom triglycerides and 2) strong Pattern A LDL with my sky high HDL and low triglycerides.

But I'm not certain if I can really make a convincing empirical case to him that Pattern A is benign with a high LDL. (I'm also hesitating after hearing Chris Masterjohn say that LDL particle size measurements are hugely dependent on the type of assay used and that as a result it's not clear what, biologically, any given result means until these methodological discrepancies are sorted out.)

The article you cite says the number of LDL particles may be more important than the size.  Is that your experience?

@Bill : Chris Masterjohn also mentioned in a recent podcast that the current measurement technology for LDL particle size is just not sufficiently accurate to be useful.

what is your feeling on oxidized ldl?

@howard
yes, based on the hour to hour, day to day, week to week, and month to month natural fluctuations of lipids in the blood it is difficult to make any real judgements about cholesterol readings without doing multiple panels over a period of time.  the whole medical community seems to be screwed up in this respect.

I have no idea what Dr. Davis' response will be, but if you're interested in getting an NMR profile done on your own dime (and if there is a convenient location near you), check out directlabs.com for their September special.  An NMR profile will only set you back $79 (reg $127).  I've been waiting for this "sale" and am getting it done to show my own doctor.  Your health is ultimately in your hands - keep up the good fight!
Best,
Kathy

Dr D,
I totally agree small LDL is driven by excess carbohydrate intake and postprandial
triglycerides. However there is a substantial subset of people whose small LDL
is genetically driven. I believe you are aware of this phenomena.
Please let these folks know what their options are to address this important issue!
There can be a good deal of frustration when carbs and triglycerides are addressed but
with little lowering of small LDL.
Please help this substantial number of people out by outlining their options...
Gib

Thanks for that information, Kathy.

It ain't good,  just ask Wikipedia.   From the Wiki page re 'Chronic endothelial injury hypothesis':
"Once LDL accumulates in the subendothelial space, it tends to become modified or oxidized.[5] This oxidized LDL plays several key roles in furthering the course of the inflammatory process. It is chemotactic to monocytes; oxidized LDL causes endothelial cells to secrete molecules that cause monocytes to penetrate between the endothelial cells and accumulate in the intima.[6]

Oxidized LDL promotes death of endothelial cells by augmenting apoptosis. Also, through the activation of collagenases, ox-LDL contributes to a process which may lead to the rupture of the fibrous plaque[7] Oxidized LDL decreases the availability of endothelial nitric oxide (NO), which, in turn, increases the adhesion of monocytes to the endothelium.[8] Moreover, NO is involved in paracrine signalling between the endothelium and the smooth muscle that maintains vascular tone; without it, the muscle will not relax, and the blood vessel remains constricted. Thus, oxidized LDL also contributes to the hypertension often seen with atherosclerosis."

Test reply

Yes, French cardiologist Guy-Andre Pelouze MD. at the recent Ancestral Health Symposium said in his presentation "Paleodiet and atheroma: A Cardiovascular Surgeon’s Perspective" that:

1. Native (the reduced form of) LDL cholesterol is NOT atherogenic, only the oxidized form leads to atheroma, atherogenesis & arterial plaque formation.

2. Without oxidized cholesterol it's very difficult to have arterial plaque formation

3. Anti-oxidants are ineffective in preventing atheroma.

4. SDLDL easily enter the subendothelial space because SDLDL are less than 25 nm in diameter and the subendothelial space is 26 nm.

5. Subendothelial space in humans is very different in humans than other mammals due to the large amount of smooth muscle in the arterial media below the the intima layer.

And there's much more.  To see a video of Dr. Pelouze's presentation hosted on the Ancestral Health page at Vimeo just google 'vimeo, paleodiet and atheroma', then scroll to video number 33 in the right side box.

Do you REALLY believe that? We have the ability to measure the distance between the earth and the moon almost down to the millimeter, and certainly down to the centimeter. We have the ability to measure individual atoms with electron and other types of microscopy used in materials engineering and computer chip manufacturing.  Medical, biochemical & physiological textbooks are full of descriptions of the sizes of white and red blood cells, bacteria and viruses, etc. ad infinitum.  Do you REALLY think we lack the ability to measure SDLDL?  Don't be so ready to believe something just because somebody says something about it.  Use your own brain, put together everything you know and can learn on your own and connect ALL the dots before drawing a conclusion.  

Furthermore, what's the point of a statement like that?  Should we just give up measuring and trying to understand how SDLDL causes atheroma just because ONE guy says we can't measure them to his degree of satisfaction?  Should we just give up worrying about what we eat, and what we are being sold as foods that are arbitrarily declared to be safe to eat by some anonymous bureaucrat at the FDA?  Should we just ignore the ever increasing incidence rates of cancer, heart disease and atherosclerosis that by all applications of observation and simple logic are known to be entirely due to the modern industrial foods diet in every society and the peoples that subsist on them?  

I don't think so.  Homey don't play that anymore, at least this one doesn't.

@Bill,  Google and see this study: 'Detection of low density lipoprotein particle fusion by proton nuclear magnetic resonance spectroscopy'.    
"Abstract: Recent evidence suggests that fusion of low density lipoprotein (LDL) particles is a key process in the initial accumulation of lipid in the arterial intima. In order to gain a better understanding of this early event in the development of atherosclerosis, it would thus be necessary to characterize the process of LDL fusion in detail. Such studies, however, pose severe methodological difficulties, such as differentiation of particle fusion from aggregation. In this paper we describe the use of novel methodology, based on 1H NMR spectroscopy, to study lipoprotein particle fusion."

Bill,
You have no worry since your triglycerides are quite low and therefore your LDL particles are of healthy size.  Your correctly calculated LDL is only 161 using the Iranian formula (used if triglycerides low).  See LDL calculator here:
http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

And never use statins, just cut carbs.
Don

"About 80% of cholesterol is composed of fats and oils (Current Atherosclerosis Reports 2004). The
majority of an arterial clog, 55%, comes from defective cooking oils, containing mainly damaged omega 6. Most of us unknowingly purchase these oils in the cooking oil section of the supermarket. These are the oils we fry with and the oils added to most packaged foods; both fresh and frozen.

Here’s another shocker. It’s not the saturated fat —it’s the adulterated omega-6 from food processing that clogs arteries! Contrary to what we have heard for decades, it is not the saturated fat you eat that clogs your arteries! How do we know this? A 1994 Lancet article reported investigating the components of arterial plaques. In an aortic artery clog, they found that there are over ten different compounds in arterial plaque, but NO saturated fat. This means the bacon, eggs, cheese, steak, whipped cream, etc. isn’t the reason for a clogged artery. These natural saturated fats are actually good for you. You need them for body structure.

With the consumption and transport of defective processed oils, LDL cholesterol acts like a “poison delivery system,” bringing deadly transfats and other ruined oils  into the cells. It is primarily the oxidized (adulterated) omega-6 that clogs the arteries, NOT saturated fat!"  

For more just google 'Brian Peskin saturated fat' and read the day away to your heart's content.

"just because somebody says something about it. Use your own brain, put together everything you know and can learn on your own and connect ALL the dots before drawing a conclusion. "

lol. you must not know who CMast is.

Yeah, I do, and that's why I said that.

Hi, Gib--

The strategies that reduce small LDL are the same whether it's genetically-driven or acquired. However, when (presumptively) genetically-driven, it's just harder and requires a more meticulous effort.

We are now seeing more and more people achieve zero or near-zero small LDL with strict carb reduction. The big exception is apo E4 people, who can still struggle because of the peculiar physiologic effects of this pattern.

Big issue. Note that the real culprit in causing plaque may be glycated oxidized LDL.

Hi, Peter--

No, I think that is wrong. It might be correct if small LDL is regarded in a dichotomous way, i.e., pattern A vs. pattern B. But, when viewed quantitatively, I believe the real culprit is quantity of small LDL.

No question: The various lipoprotein testing companies need to talk and standardize their definitions. But this does not invalidate the concepts.

Chris Masterjohn is a very bright guy. But on this I disagree. I believe it is wrong to assume that triglycerides and HDL behave in perfect tandem with small LDL. While they do indeed correlate, they do not correlate perfectly and demonstrate independent behavior depending on postprandial phenomena and genetic factors like apo E and apo C.

This has nothing to do with LDL, but I don't know where else to ask this, so I'll dive right in.

I am reading and enjoying your book Wheat Belly, but don't understand why you lump chia seed in with other non-gluten grains to avoid or minimize. .  In my mind it is closer to flax.  Chia is truly an oil-seed and not a grain according to Dr. Coates, the "father" of chia seed research.  I have used it generously, and feel it aids in weight loss.  Chia seed is high in protein and fiber and low in carbs.  Why are you telling us to avoid or limit it?  I feel it is healthier than flax even.

Please, can you clarify your stance on chia?  I was very disappointed to read that in your book.  Other than that, I really enjoyed Wheat Belly, having avoided gluten for a few years now.

P.S.  According to calorieking.com website, 1 oz. raw chia contains 0 carbs and 1 oz. dried chia contains only 1 gram of useable carb.

Not everybody who has good HDL, good TG and eats a low carb paleo diet will have low small particle LDL numbers which is why an NMR LipoProfile is important.  People with gut issues, yeast issues,  H. Pylori or an otherwise compromised liver can have unhealthy LDL despite doing everything right on the diet front.  Getting to the root of these issues is critical to resolving it.

Thanks, Joyce. But I don't remember lumping chia with the bad stuff.

In fact, as you point out, chia belongs with flaxseed as one of the few truly healthy, low-carb foods.

Dr. Davies, on p. 212 of your book, chia is lumped in with other non gluten grains.  Maybe in future editions, the publisher can remove that?

Although I have been gluten free for years, my husband is finally going gluten free..ALL BECAUSE OF YOUR BOOK!  He has some health issues, so for that I humbly thank you.

Also, his next Toastmasters speech will be on "Wheat Belly"...how about that!

Thank you so much for a wonderful book.  Your recipes are awesome.  I look forward to a Wheat Belly cookbook!!!!

There are so many well read and brilliant posters here that I am going to jump in and ask a question totally off topic. This is not Dr. Davis' area of expertise, so I hope others may help.
I do believe I am dealing with a bone/heel spur. Too much treadmilling, trying to increase speed, etc. I have done research on the condition and I read that turmeric, taken 2-3 times a day, is helpful. I just recently began taking D3 as well, 5000 IU a day. Will the Vit D3 help as well?
Any thoughts? No, I am choosing not to visit a doctor for a cortisone shot. I am using NSAIDS for the pain and that works very well.

I've just spotted this post.  Never tried chia and wonder what you thought.  Have your patients reported similar effects?

Nina

We are now seeing more and more people achieve zero or near-zero small LDL with strict carb reduction. The big exception is apo E4 people, who can still struggle because of the peculiar physiologic effects of this pattern

Could you go in to more depth as to what strict carb reduction menas?  Is it no more than 50grams of starchy carbs such as rice or potatoes, or 100Grams?  I am guessing it is individualized, but some range of restricitons with those who have been successful would be helpful.  
I have always had a low level of Trigs- never higher tnah 75 even on a hi carb diet, and was surprised to find the NMR showing all small particles!  So Dr. Davis is right to say low Trgs not always indicative of having large LDL.  Switched to elimination of most carbs and totally changed the profile.  Only issue that is while i produced lots of particles with carb diet, i also produce lots of LDL particles with carb restriction.  Genetics i guess!  I am an ApoE 3/3, which was a surprise.  
Thanks for the good work Dr. D.  Have gotten several to buy Wheat Belly.  It will have an impact!

Nina, I am not Dr. Davis (wish I had his knowlege!), and I hope he doesn't mind me jumping in here, but I leaned about chia a few years ago when I read a book by Dr. Wayne Coates on the subject.  Chia has definitely helped me lose weight.  It is very filling.  When mixed with fluids, the chia seeds expand, and they really help to fill you up.  I've found all sorts of wonderful chia recipes on the web - from Chia "Tapioca" to beverages, etc.  I mix  it into many foods.  I think it enhances their taste.  I feel the chia seeds help with weight loss because of their appetite suppressant potential.  I hope this helped, and my apology to the good doctor for hogging the thread.

Your post doesn't provide a lot of info, but if I were to guess I would say your problem is more likely related to walking/running incorrectly than nutritional (assuming you are in reasonable physical condition).  The human foot wasn't designed to be encased in the heavily cushioned shoes we typically wear today.   As a result many of us don't know how to walk or run correctly.

Some of the better shoe stores will video tape you on a treadmill.  Just seeing the tape may be enough for you to realize what you are doing wrong.  If that doesn't help, there are professionals who should be able to figure out what might be happening.  

Also consider reading "Born to Run" if you haven't already (it's a good read even for non-runners).  It probably won't give you a direct solution, but it may give you some ideas on where to look.  Good luck.

Dr. Davis,
   I am 56 and have a strong history of heart disease in my family. I have been eating low carb for a couple of years... ( around 60 gms carb per day average..no pasta, no potato, almost no grain)  My most recent lipid panel showed LDL of 140. HDL 81, Triglycerides 43, CRP 0.2. .  I requested a test to show size of LDL. My doctor declined to order this, saying all LDL is bad.  Instead I was sent for a heart scan  ( paid out of pocket) and my calcium score was 0.  
  So now I'm trying to lower my LDL by lowering saturated fat.  Hard to do when you eat low carb. I wonder if I might be one of those Apo E 4 types that you mention, so thought I should try,.
  Here are my questions:
     Can I test my LDL size myself, through a home test? Or should I try to find out if I have Apo E 4?
      Do I really need to lower LDL if my calcium score is 0?
Louise

For the last year I have eaten zero fruit, zero grains, zero sugar. Have mostly eaten beef, occasionally eggs cooked in butter. Have done two VAP tests the last year. When I started a year ago, trigs were 115, now 142. HDL was 50, now 46. My LDL did show a change of going from pattern A/B to pattern A.
Any ideas why a diet for a year devoid of fruit, sugar, grains, would show an increase in trigs, and a slight decrease in HDL. If I have Apo E4 would my ldl go from A/B to A.
I have lost 25 lbs. in the past year. Could this be a reason my numbers seem to be off?
Thanks,
Bob

Hi, Bob--

Yes, blood drawn in the midst of weight loss can be very misleading.

Transient effects include increased triglycerides, reduced HDL, even much higher blood sugar. Thankfully, it all gets much better once weight plateaus for a couple of months.

Hi, Louise--

Sad that you have to educate your doctor.

I find it unacceptable that a nice person engaged in health is refused a simple, helpful test. Tell your doctor goodbye and find one willing to act as your partner and advocate in health, not an obstruction.

Yes, you can test it yourself through services like PrivateMDLabs.com. My view is to 1) identify how much, if any small LDL there is, then 2) reduce small LDL with diet. If you have only large LDL, you will absolutely need an LDL particle number by NMR or an apoprotein B to know what the REAL value is.

Thanks for the help, Joyce!

Thanks, Steve.

There are a number of posts on this blog that detail how to gauge individual carbohydrate sensitivity. The best way is to check 1-hour after-eating blood sugars. Second best: count carb with the cutoff being determined individually. Just go back over the past 6 months and you will find several discussions.

Hi, Joyce--

Thank you!

If chia is listed as among undesirable non-gluten grains, that was my error. Remember what Mark Twain said: "Don't read about health, else you might die of a typo."

Thanks for your response Joyce.  

The part that fascinated me was the idea that chia triggers a drop in blood sugars without a pre-spike.  I can't find anything on the net about that and wondered if other people had similar experiences.

Nina

Thanks for the reply Dr. Davis. I have a blood test scheduled six months from now, and hopefully I will see better numbers. My LDL shows pattern A so at least I did see one positive change.
Love your blog. Have learned a lot and it was the reason I gave up grains and sugar. 1 full year, no cheats.

Consider also going barefoot as much as possible - around the house, etc. You don't necessarily have to run barefoot (unless you work into it *gradually* and choose to continue it). I've recovered from heel spurs with stretching my achilles, with emphasis on stretching the soleus, and letting my feet bear my weight without any props underneath. For stretches, Anderson & Anderson have a very good book - Stretching - available on amazon.com. You didn't develop the spurs overnight, and they won't clear that quickly, either. Be patient and work with your body.

You may also wish to consider vitamin K2, very good for ensuring calcium deposition occurs in the correct locations.

Hi Doctor Davis, I talked to your about a year ago and you were kind enough then to comment on my blood results saying there was nothing to worry about - according to the Iranian formula.  I would greatly appreciate if you looked at my new results, they scared my whole family, I certainly am not going to show to the family physician, and I don't even want to think about changing from paleo style of eating to some kind of low fat cholesterol lowering diet, and taking any drugs/supplements. But may be I have to? I am 36 y.o., 5'4 and weigh 104lb.
Glucose 85
VAP TEST:
Lipids
LDL Cholesterol 149!
HDL 130
VLDL 14
CHOLESTEROL, Total 293!
Triglycerides 48
Non HDL Col (LDL+VLDL) 163!
apoB100-calc 96
IDL Cholest 4
Remnant Lipo. (IDL+VLDL3) 12
Sub-Class Information:
HDL-2  35
HDL-3  95
VLDL-3  8
LDL1 Pattern A 3.1
LDL2 Pattern A 26.0
LDL3 Pattern B  71.0
LDL 4 Pattern B  31.4

The ordinary, non-VAP Lipid panel shows:
Cholest TOTAL 279 !
Triglycerides 48
HDL Cholest 144
VLDL Cholest Cal 10
LDL Cholest Calc 125 !

Also, I can't understand how my vit. D can be so low - 29.0, when I have been sun tanning all summer here in Orange County, California, at peak hours. Is there anything that you know of that may inhibit the vit. D conversion from the sun?
Again, I greatly appreciate any insight that you can give me on this situation...

Dr Davis,
  Thank you for your reply.  For now, I found a lab I can go to and get myself tested. Two hours away.. (Oddly, I must leave NY state to get this done due to billing law.). I'm going to do this! Do you agree that my best choice is the NMR?

Hi Gib,

Option 1 will be cutting the saturated fat and cholesterol from the diet in addition to cutting the carbs. I tried eliminating eggs and cheese and my total cholesterol down from 400 to 260. By adding back "one egg a day", it went back to 320 (that's the impact of the dietary cholesterol on me, confirmed twice). I am currrently trying to replacing all saturated fat with mono unsaturated fat (olive+canola), just want to see how big the impact is. I am also going to test coconut oil separately, it is a cholesterol-free plant based medium-chain saturated fat, there is a chance I might respond to it differently.

Option 2 will be taking Statin drugs. I know it has side effects, but that's better than small dense LDL. Based on Dr Davis's previous response, for apoE, sometimes we have to go to Statin for the rescue. (My doc was pushing statin really hard on me, and I have been resisting that for the last year)

otter

Dr. Davis, you are so funny.  We'll take your book....typos and all!  Now...how about a cookbook to compliment Wheat Belly/  PLEASE????

Sorry I missed the link:

http://suzanneloomscreativity.blogspot.com/2011/09/lowering-blood-sugar.html

Nina

Hi Kira,

Just out of curiosity, could you summarize your "paleo style of eating".  I have a good friend of mine who has similar numbers (low trigs, high HDL, high LDL).  I would describe her diet as "low-carb (no sugar, no grains), low-veggie (under 15%), high meat, high sat-fat (particularly cheese, eggs and coconut)".  Is your diet somewhat similar?  I would be interested to know how the two of you compare.

NMR is my preferred method, since it yields the LDL particle number, what I believe should be the gold standard.

Thanks for asking, Joyce! I've had very preliminary conversations with my editor, but nothing firm yet.

In the meantime, in addition to the discussion on this blog, see the Wheat Belly Blog, where I will publish recipes one by one.

Hi, Kira--

You have a surprising dominance of small LDL particles, despite your slender build and lifestyle (LDL 3+4 divided by "real" LDL). This is likely genetically-determined. The means of correcting this is beyond the scope of this blog, unfortunately. You might consider joining the discussion in the Track Your Plaque website.

The vitamin D issue is common, an impaired or lost ability to activate vit D in the skin. It means doing it orally.

Thanks, Bob!

On 50 more years to go!

Dr. Davis. I'm a type 1 diabetic who is on a low carb diet (mostly primal-esque) with only meat and veg. No fruit, no grains, no legumes. I lost 14 kgs in the first three months, then stabalized at around 89 kgs. Granted my fat is going down a wee bit as muscle mass increases (doing the slow burn exercises, plus HIIT training and martial arts). That is the background.

The reason I'm posting here is confusion about cholesterol. I just got my latest results back from the lab, and they are the same. While my HbA1C is 5.3 (not bad), my cholesterol numbers don't look hot. Tryglicerides are fine (as I've stopped losing weight quickly), but HDL is low at 39, and LDL (doctor forgot to put in particle size check, but it cna't be that good as I'm a diabetic) was 150 on the spot. This was measured, not calculated.

I take ~7k miligrams (or whatever the measurement is) of fish oil a day. Well, 7k of EHA/DHA, more in total quanity including inert substances. With my exercise, low carb diet, and fish oil supplements, how is it that my HDL are still so low? Any advice?

Thanks!

Hi, Adam--

How timely! See the next post after the one you responded to in which I discuss the transient effects of weight loss, including drops in HDL that rebound over time.

Also, have you address vitamin D normalization? I aim for 60-70 ng/ml, which usually requires around 6000 units per day (gelcaps or drops only); the HDL-raising effect develops over a year or longer.

Dr Davis,

A pleasure to make your (virtual) acquaintance! My vitamin D, according to my last test (results came in yesterday, as I mentioned) levels are 59. A wee bit low, but not too bad, I think.

I've been consistently 88/89kg for three months (I've been low carb/primal for 6 months total), so haven't lost any weight in the past three months, but still my HDL levels are very low. Do you have any suggestions?

Cheers,

Adam

P.S. I'm pretty sure I've stabalized, as my triglycerides were at 29 or 39 (can't remember off hand, but pretty low). But still I had the low HDL and high LDL?

Hi, Adam--

Of course, you are wheat-free, low-carb in addition to your vitamin D? Omega-3 fatty acids?

Note that doing the diet and taking the vitamin D yield rises over 1-2 years. Patience is required.

Consider a little red wine and dark chocolate, as well.

Thanks for the response! Yes, I am completely wheat free (and was before I read your book, which was excellent). I am very low carb due to the diabetes. My HDL did go from 29 to 39 this last test (after 6 months), so I suppose, as long as maintaining this diet will continue to increase my HDL, I am ok. My concern isn't immediate gratification but more continuous improvement.

I'll come bug you again in 3 months if my HDL doesn't continue to increase

Many thanks!
---Adam

P.S. I've never been accused of not drinking enough red wine While I've been beer free for 6 or 7 months now, I do go through ~2 bottles of red a week.

I'm hoping patience pays, Adam!

Hah! Me too, because if my HDL doesn't start going up I'm gonna freak as I don't know what else to about my numbers. Diet is about as stripped down as it can be, and I'm exercising as much as is reasonable.

--Adam

HI Peter. I would say  that my diet could pretty similar, with the exception that I am still eating some low-glycmic fruit everyday (some cantaloup, grapefruits, berries) and eat lots of veggies.

Dr. Davis, thnx for your reply. I understand this is a blog and it is hard to go into details here, but would you say that it is worth for me to try change this situation by changing the die to using less saturated fat? and would NMR test clarify anything?

PS How do I further discuss this issue "by joining the discussion in the Track Your Plaque website"?

Thnx AGAIN

My numbers are like Bill's.  I was diagnosed as pre-diabetic in February, 2008 (today, I'd have been diagnosed as Type 2; my A1c was 6.5, and my FBGs were 127 and 123).  Started low-carbing shortly after that:  cut out grains, starchy veggies, almost all fruit, all milk (still use heavy cream and eat cheese).   My most recent blood lipids (accounting for some variation, but roughly consistent in pattern over the past three years):

TC:  381
LDL (direct):  279 (291 calculated)
HDL:  80 (was 40 at diagnosis)
Trigs:  52

(At diagnosis, my numbers were:
TC: 281
LDL (direct) 215
HDL: 40
Trig: 142)

I lost 65 pounds in the first 9 months after diagnosis, and, since then, have regained approximately 25 pounds (mostly muscle).  Weight has been stable for months.  My doctor is talking statins, again--which I plan to continue resisting.  I have ordered an NMR test, and will see what it has to say about my particle size.

Hi, Shottle--

Good plan. I wouldn't be surprised if NMR sheds an entirely different light on your values.

They drew the blood this morning.

Dr. Davis, I had my NMR test and the doctor who looked at it suggests that I have familial hypercholesterolemia. My LDL-P 3158
LDL-C 280 HDL-C 58, TGL 105, HDL-P 28.0 small LDL-P 1122,
LDL 21.7, LP-IR-33. I have been on no carb, no sugar, no wheat, or fruit for the last 14 months. Have been eating fatty meat twice a day and also eggs. Before I started eating beef, I was eating low carb, very little sat. fat. I was eating a lot of skinless chicken breast, and canned salmon, veggies, nuts, fruit but almost no beef. My LDL according to the basic lipid test was a little high but not crazy high. My HDL was in mid 30's. and trigs were high. I changed to a high saturated fat diet to raise HDL and lower trigs. I have been taking 1 gram of fish oil 2X daily. Is it possible that the fish oil is having an effect on my LDL? Not sure what to do about my diet. Obviously I won't go back to sugar and wheat but what about all the meat I have been eating. Would it be better to go back to skinless chicken and egg beaters even if it means my HDL going down? Just not sure what to do. Doctor believes I am at high risk since my father died at age 62 of sudden death.
Thanks,
Bob

Hi, Bob--

This is a tough situation that, unfortunately, cannot be remedied diet alone. I hate saying that.

Like people with apo E4, familial heterozygous hypercholesterolemia people are fat sensitive. First order of nutritional business remains carb-restriction to minimize small LDL particles, but you can still show large increases in large LDL with fat intake. If apo E4 is present, too, then even something as great as fish oil can increase LDL measures. However, the dose of fish oil you are using is very small and not a likely factor.

Thanks for the reply Dr. Davis. I know I won't go back to carbs and sugar, but what about beef. I have eaten almost nothing but beef the last 14 months. Would I be better off going back to skinless chicken breast? Egg Beaters, instead of eggs? Olive oil instead of butter? I know in the past when I limited saturated fat my HDL dropped to mid 30's.
Bob

Hi, Bob--

I think we could make a strong argument in favor of variety in diet and that includes meat sources. Yes, I think a broader range of meats (if you eat them; I don't want to sound like a bloodthirsty carnivore; I don't even like meat, personally) is better--fish, shellfish, fowl, pork, as well as eggs.

Results came back today:
TC:  373 mg/dL (ref <200)
LDL-C:  282 mg/dL (ref = 40)
Trigs:  47 mg/dL (ref < 150)
Large VLDL:  <0.7 (ref <=2.7)
LDL-P:  1793 nmol/L (ref = 30.5)
Large HDL-P:  14.2 umol/L (ref >=4.8)
Small LDL-P:  146 nmol/L (ref  20.5)
HDL size:  10.0 nm (ref >=9.2)
VLDL concentration was too low to determine a size
According to the interpretive information:
My HDL-P (total) of 39.1 places me in the lowest category of risk (it is beyone "high")
My small LDL-P places me well below the 25th percentile (while slightly higher than the "low" level of 117), and is indicative of lower risk for CVD
My LDL size places me well above the 75th percentile, and well into Pattern A territory (75th percentile level is 20.6), and is indicative of lower risk for CVD

Correction:  My LDL-C was 282, vs. a reference of " 40"

I give up.  I am typing things in correctly, and the comment system is dropping words (maybe it's interpreting my use of "greater than" and "less than" symbols as markup code?).  My HDL-C was 82.  The reference level is greater than 40.  My LDL-C was 282; the reference level is less than 100.

I see it dropped more information than I thought at first.  No matter, the conclusion stays the same: except for my LDL particle number and concentration, all of my lipid values indicate that I am at lower (or much lower) than average risk of CVD.  Now if only my body takes that to heart . . ..

LDL particle size was 22.1
HDL-P was 39.1 umol/L

Hi, Shottle--

Your values highlight this tremendous void we have in knowing just what to do about nearly "pure" large LDL particles.

In other words, you have lots of LDL particles, but they are nearly all the more benign large variety. What level of large LDL particles are "allowable" before they contribute to atherosclerotic plaque formation? Not known. My preference would be, given the extreme abundance of large LDL, to reduce with statin drug. I hate to say this, but this is the occasional exception in which I believe that statins might indeed be beneficial. This is not to be confused with the general and absurd overuse of the drugs, but an application for a very specific genetic variant.

At last I have had an NMR.  Thank you for the suggestion of PrivateMDlabs.com.  I can recommend this
to others who find their doctor unwilling to order tests.
I am pondering my results, trying to figure out if they are okay, or if I need to cut back on fat now, or go lower with carb reduction. What are your thoughts, Dr Davis?
   LDL Particle Number  1091  ( IS this too high??)
    Small LDL - P    129
      LDL size     21
    Large VLDL - P   < 0.7
       Large HDL - P        12.1
        HDL size           9.7
      LP - IR score    11
Triglycerides are 32  ( lower since I"ve gone completely
grain free since my last lipid panel)

These values are excellent, Louise! The only less than perfect value is the large HDL, but this tends to drift higher very slowly.

Seems particle size doesn't matter as much as particle number. According to Dr. Peter Attia, a particle is a particle.  More than 1000 is a risk factor whether they're small, medium or large and fluffy.