QUOTE --
"Healthcare cost savings will be realized by delivering truly effective health solutions directly to people themselves"

Very true. Empowering the individual is powerful.

Congratulations to you, Dr Davis!

I just had my first heart scan done this week for $99 at a local hospital. I've been following a low-carb eating plan for several years. My score was 0 in three of my arteries and 18.38 in the left circumflex. Since this is my first scan, I don't know how it compares to before I began eating low-carb, but I'd like to think this is not a bad starting score and probably better than it would have been back when I was eating that "healthy" diet that is slowly killing so many. I will have another scan in a year, and see if I can tweak the diet a little to eliminate the small build-up I have. I am very motivated to avoid the prescription-drug, expensive procedure path that so many take as they age.

Wow Brilliant blog Dr. Davis i stumbled on it 3 days back and took time off from work and went through all your articles from april 2006 till now in 3 x 16 hour shifts. Stupendous stupendous work. By the way im a 25 year old attorney. I lost my father and grandfather to inexplicable health issues and your blog has lifted the veil on the cause - low fat high carb and high sugar diet, nutritional deficiencies especially k2 us being strict vegetarians. My mom is showing arthritic symptoms very young in her early 50s. For my parents (being high up in the government) there is no medical facility or procedure out of reach, but curative medicine is a huge drag when prevention is possible. Being bed ridden for years is hugely taxing on nuclear families whatever be the status or financial pull of a person. I Being the only child of my parents and having gone through all the trauma of attending law school caring for my father and moving houses simultaneously, your blog is endlessly empowering and valuable.

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Nice discussion very informative.

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FYI:
Radiology, November 2010
CT Scans and Cardiovascular Health

http://www.ivanhoe.com/channels/p_channelstory.cfm?&storyid=25336

Mike V

Thanks for sharing the informative post.

Super jazzed about gteting that know-how.

You know what, I'm very much inlcnied to agree.

Great Article.  As I'm sure you know by now, I've been kind of a lipidpanelaholic since having a MI 2 yrs ago.  The hardest information to find is that of how long it takes for lipids to respond to diet changes and how sensitive they can be to even the smallest amount of carbs.

Are you sure that sort of response is not due to gluten/gliadin/lectin/transfat? Four crackers doesn't sound to me like much of a carb load, but for a gluten-sensitive person like me, that could set off some inflammation.

Dr. Davis,
How does alcohol fit in to the above "equation"? Specifically wine.

Marc

I have been on a wheat-free and carb restricted diet for about 7 weeks, and being concerned that I might be Apo E4, and therefor need to also limit saturate fat as you explained in an earlier blog, I asked my doctor to order a small LDL test.  No independent lab here that I consulted knew what that was, nor obviously did my doctor, since he just ordered "small LDL".  The local hospital lab finally found the following, which is what I will have blood drawn for tomorrow:
Lipoprotein Fractionation Panel 1, Ion Mobility
Which includes:
Choesterol; HDL Cholesterol; Triglicerides; :Lipoprotein (a); Lipoprotein Fractionation Panel 2, Ion Mobility (LDL, Total; LDL, Medium and Small; LDL, VerySmall; HDL, Large; LDL Peak Diameter, LDL Phenotype)

I hope that this is what I need.  Probably it is overkill, but in this case apparently my Medicare Advantage plan will cover it since it has been more than 3 months, since I had a simple panel done.

Is there a simpler test for small LDL?  By the way the CPT codes are 80061, 83695, 83704

Sounds like cheat days may not be that good of an idea...

Yes, it does cast cheat days in a new light!

That's it, Sam.

It shouldn't be that hard. The information is actually fairly straightforward and provides crucial information.

Hi, Marc--

Alcohol does indeed slow or stop weight loss, especially if more than a serving or two are consumed. So it pays to minimize during a weight loss effort.

Probably not, Howard, since those components have not been associated with triggering of small LDL. The trans fat component can indeed trigger small LDL, but it seems to occur even with foods minus trans fats.

However, I am impressed that gluten/gliadin/lectin rolled off your tongue!

The problem is carb creep. I experienced this a few months ago when I received the results of my HbA1c test. I was still in the prediabetic range and it was higher than the HbA1c test I had a few years earlier. I didn't get it? I thought I was consuming less carbs then I was. When I actually looked at my diet there were carbs creeping in: dark chocolate and small "safe starches" (e.g, potatoes, yams). Another factor that may have impacted my blood sugar was the stress of travel/visiting family during that three month time period. My understanding is that elevated cortisol levels can raise blood sugar. In any case, my recent HbA1c is in normal range. I think this is because I eliminated even small amounts of dark chocolate and "safe starches" (see Jimmy Moore's comments about safe starches).

How low should we go in carbohydrates to avoid increasing small LDL?

I'm not sure that wheat has this acute effect on everybody. In fact, I know it doesn't happen with me. I keep a close eye on my lipids and my small LDL particles remain "relatively" low despite the fact that I consume wheat/sugar products. Then again,  my blood sugar does not significantly rise after carbohydrates, so maybe that's why. If I eat a massive plate of pasta, a glass of fruit juice, and dessert, my blood sugar may (keyword, "may") rise to 120, if that, but then it goes down to about 80 about 45 minutes after the meal. No joke. In other words, I'm thinking this effect may have to do with the degree of people's volatility to rising blood sugars. Just a guess.

Fyi, I'm the apo E/4 person who's LDL amount/particle number (226, 2,000) is extremely sensitive to saturated fats and thus I'm always lost in the conundrum of balancing fats with carbs. Difficult!

I know that if weight loss is involved, it can take a few months after weight stabilizes for lipids to normalize.  If minimal or no weight loss is involved, how long does it take?

With the example about 4 crackers would be as low as 10g carbs.  Curious of the overall effects of say 10g carbs of sweet potatoes....

Then it depends on which parameter you are talking about, Teresa.

Small LDL requires just days to respond, while triglycerides require weeks to months, while HDL requires months to years.

Hi, Davide--

No doubt: Individual tolerances to various foods, including carbohydrates, can differ. And the apo E4 person has a tougher time of it.

Unfortunately, Jethro, there's no quick and easy way to decide this, since individual sensitivity varies.

Although imperfect, you can use HbA1c, an index of glucose and not of small LDL, to gauge whether you've been triggering higher blood sugars that often parallel the triggering of small LDL particles. You could, of course, obtain lipoprotein testing 48 hours after ingesting a known amount of carbohydrates, e.g., 20 grams, but that is logistically difficult.

That all said, most people can get away with 15 grams carbohydrates per meal, while some can't tolerate more than 10, yet others do fine with 30+ grams.

Excellent point, STG! And I like the "carb creep"!

Did you see this, Dr. Davis?

http://medicalxpress.com/news/2011-10-common-link-autism-diabetes.html

And it takes years to unlearn all the inaccurate stuff learned in school, and to find and learn the good stuff that is out there.  Thanks.

How does one check to see if they are apo E4?

How does it affect lipid results?

Dr Davis:  What is the small LDL profile for native populations that consume tons of of carbs and no signs of heart disease; also, the Japanese consume lots of carbs- easily 3 cups of rice per day which is about 120 carbs from rice alone.  Low level of CAD; what are their levels of small LDL.  I know for myself ApoE 3/3 that carbs do affect the small LDL level i have and in any event in the absence of a statin i produce tons of LDL particles large or small depending upon carb levels.  I believe genetics plays a large role.
Thanks

No doubt, Steve.

However, I'm unaware of lipoprotein assessment done to answer these questions. That would be interesting, however.

Easy, Stephanie: Have an Apo E test run.

Yes, agreed, Teresa: New lessons to learn every day in this Information Age!

Thanks, Barbara. No, I hadn't seen this. But I'm not the least bit surprised!

I find it wonderfully satisfying that the puzzle pieces are falling in place, just like that 1000-piece jigsaw puzzle we struggled to put together, with the last few pieces fit just perfectly!

Dr. Davis,
Have you heard or read about Lumbrokinase helping to lower small "a" particles?
Just wondering.
Dee

Dr. Davis,

There seems to be a lot of mention of the E4 ApoE genotype.  What about those of us that are E2/E4?  Any different instructions for us?

Thanks.

With this very tough pattern, you are best following lipoproteins and glucose measures like HbA1c to gauge response to various dietary manipulations. The basic diet approach, however, is largely the same; it just may require some adjustments, e.g., fat intake.

Sorry, Dee, no info.

Where did you hear this?

Here is the quote.  Appently it just helps lower the LP[a]  and does not have any terrrble side effects.  I may try it, nothing else is working.  My little a is 43 and rising in spite of all I do.

"The one nutraceutical that has shown promising clinical results in actually lowering Lp(a) is a lumbrokinase product made by Canada RNA Biochemical called Boluoke. Like its chemical cousin nattokinase, lumbrokinase is an enzyme that helps break up fibrin—a fibrous protein that helps form blood clots—to avoid too much clotting and keep blood flowing optimally."

:

Dee

I have my results.  My PCP reported these to me "for my records" with no further comment.  Maybe he can't interpret them?
Total Cholesterol: 231 (My PCP surely would think this is high.)
I find it strange that they did not report LDL direct, though perhaps it is not done because of the breakdown below.  
Calculated LDL: 133 H MG/DL
HDL: 85 Mg/dl  This is higher than I have ever had measured.
Triglycerides: 64 Mg/Dl  Even Simvastatin only got it down to 84.  I conclude that I am not Apo E4.
The range after \ below  is the range they cite, I presume, as normal.
Lipoprotein : <10  NMOL/L \ <75  I presume this is a good result.
LDL, Total: 2268 H NMOL/L  \ 440-1600
LDL, medium and small: 651 NMOL/L \ 144-787
LDL, Very Small: 277 NMOL/L \ 75-419
HDL large: 9315 H NMOL/L  \ 469-5258
LDL Peak Diameter: 227.5 Angstrom  \216.-234.3
LDL Phenotype A  Pattern A     I believe this to be the preferred pattern, low small LD and Triglycerides.  Ref: Obesity (2009) 17 9, 1768–1775. doi:10.1038/oby.2009.146--Reversal of Small, Dense LDL Subclass Phenotype by Normalization of Adiposity
Patty W. Siri-Tarino1, Paul T. Williams2, Harriet S. Fernstrom1, Robin S. Rawlings1 and Ronald M. Krauss1

Does this calculate to large LDL = 2268-651 =1617 (Not including medium)?
When should I do this test again?
Comment?

Hi, Sam--

The "pattern A" comment is misleading. About 40% of your LDL particles are small, too much.

It means going back to the strategies to reduce small LDL, such as wheat elimination and limiting carbohydrate exposure. It is worth repeating about 2 months after weight has stabilized following a diet change.

I have been on a no-wheat, limited, very-low carb, diet now for 6 to 7 weeks already.  I cringe to think of what the numbers may have been before.  I initially lost about 12 pounds in less than 2 weeks to get to 148, I am 72-in tall, and have stabalized there by eating more high-fat non-carb stuff.  You say 40% small.  You must be using the medium and small (640) over total (2268) to get 40%.  Apparently medium and small includes the very small, which must be a fraction of small?  How long should it take for the very small to approach zero?  Isn't that the more important number?  I will be out of the country for 2 weeks.

Thanks

Yes, exactly, Sam: Combine medium and small.

Dietary and weight changes usually exert effects on small LDL within a few weeks, much faster than most other parameters.

Get a VAP test....this measures your small particle/large particle LDL.
labcorp code 804500

I am going to try to get a VAP test.  No doctors know of it....only folks on the web.  Why?  It seems like a very important test to measure your LDL properly.  Can someone elaborate on this further?

Easy, Pb: There are no drugs--read: "no financial incentive"--to treat the abnormalities generally uncovered by lipoprotein testing like VAP. Thus, no push to get it tested.