I'm very excited to read what sounds like a possible change in your position on saturated fat (agreed: it's only one of a list of many other beneficial dietary practices, and I shouldn't focus too much on that one).  

My own substantial weight loss, achieved by substituting fat (and saturated fat) for carbs while keeping protein intake moderate, has been such a revelation to me.  It's been quite difficult to believe that what we've been told by dietary authorities is not only incorrect, but is most likely exactly backwards.  Fat has not made me fat.  Fat has and continues to make me full.  Being full got me to a BMI of 23.  Becoming slender again has restored my athletic performance as well as improving the blood markers that most of your readers track.

Taken as a whole, this list of dietary advice might possibly be summed up as, "Enjoy good eating in moderation."  IMHO, at the end of the day, a balanced approach is an essential part of any sustainable lifestyle.

I have had what I consider great results with raising my HDL from 312 a few years ago following my physician's AHA recommendations to 51 now by doing most of the things you suggest in this blog (I am male).  My question is,  how good is this as a heart health indicator?  Even though your book suggests that only a scan will tell, I am nervous about X-rays and the cost of a scan.  Can I take some solace in my dramatically increased HDL?

I almost totally agree.

The only minor disagreement is that I would extend "wheat products" to include the other grains and starchy carbs. I am very cautious about all of that group.

My major disagreement is the omission of Australia from your list of excellent dry red wine producers

Cheers, Alan, T2 Diabetic, Australia

Anonymous re: HDL--

No, sorry, absolutely not. It is an indicator, not the real thing, meaning plaque.

If you advise eating saturated fats, then why specify "lean meats"?.

What percentage of your patients don't respond to the HDL boosting therapy you advise?

I raised my vit D level to 56, dropped wheat, increased exercise, took niaspan (albeit at only 500mg), took 3 grams omega-3/daily, took a wine extract supplement, ate  a small amount dark chocolate daily....

And my HDL went down 1 point. My weight isn't an  issue, I think, as I'm 6'1"", about 175 lbs. My body fat is approx. 15% (not sure if that's good or not). I eventually had to drop the niaspan, as I was getting heart palpitations, but it didn't seem to be doing much for my HDL anyway.

What is recommended for patients when their HDL won't seem to budge? And a better question... why isn't it raising on the therapies you recommend, when it does work for most patients? Are there any rare causes for low HDL, outside of genetically low HDL?

I can echo the last post. I have tried all of Dr. Davis' strategies, plus others, and it's resulted in slight reductions in my already low ldl and triglycerides but no change in my low hdl. I'm in great shape, eat well, exercise regularly, no heart issues or risk factors besides the low hdl, which I assume in my case is genetic.

I didn't know where else to post this question.  Is this true?

"Another way to know if abundant HDL is valuable is to look at its particle size -- smaller is better. A large study has found that people with high HDL (above 70 mg/dL) but very large particles had more risk of heart disease than people with low HDL (under 40), probably because larger particles aren't as active. But again, there's no easy commercial test for that."  This quote appeared today at http://www.oregonlive.com/health/index.ssf/2009/09/you_docs_answering_questions_a_2.html.  Mehmet Oz is usually suspect to me, anyway, but I am still curious about this statement.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

Cool Post !!!!!


smith ALan

Unfortunately you don't sound like a conspiracy theorist.  I even know of an example of a fortune 500 company receiving air time for one of their products by "respected" news agencies.  

Back in the summer of 1999 or 00 one would have thought the supplement SAMe was the cure all for depression and arthritis.  Magazines Time, & Newsweek ran articles on it.  My memory isn't so good anymore but I believe one of them even placed SAMe on the front cover.  The nightly news NBC, CBS, and ABC all ran gushing reports on SAMe and its natural curing abilities.    

I'd like to say that the news reporting was done because SAMe is truly a wonder supplement.  That is not the case.  It is a fine product I suppose but not the kind of product that deserves the enormous press coverage that it did.  The reason it received so much press is because the large multi national company asked them to do so.

Dr. Davis, these comments are a huge inspiration.

As a b-school prof, I know that pharma and hospitals are not intentionally exploitative, but the profit motive inexorably works its effects in all aspects of the decision process, and ethical standards are gradually stretched to the minimum limits of acceptability.

I recently did a casual analysis of the ads in Reader's Digest. About 80% of the ads are for prescription drugs to treat lifestyle-inflicted illnesses, such as high BP, type 2 diabetes, and inability to sleep, as wells other highly questionable illnesses such as "restless leg syndrome, or RLS." Daytime TV is about the same. You may notice that the ads now say "talk to your prescriber" instead of "talk to your doctor" -- in other words, they don't care who prescribes it, only that it gets prescribed.

THESE ADS ARE THE REVENUE SOURCES FOR THE MEDIA, WHICH MUST CATER TO THE ADVERTISERS IN ORDER TO STAY IN BUSINESS. PHARMA PAYS FOR THE RESEARCH IN UNIVERSITIES, AS WELL.

People don't bite the hand that feeds them!

Wow! I wasn't aware of that.

Would you know who the company was?

Rich--

I had no idea that the proportion of pharmaceutical ads had grown to such an extraordinary number. The drug industry is not stupid--their direct-to-consumer advertising must be working in a big way.

Yeah, maybe I'm too cautious, but giving the companies name shouldn't be a problem in this case.  The SAMe pills were made by an Italian firm that had/has a contract with BASF.  (They could be a division of BASF.)  

I was told by a BASF employee that their press department is very good and persuasive.  They wanted to create a buzz for the product.  70% of sales for health foods are generated on new products.  People like to rush out and try the new thing.

Don't forget to include the "non-profits". Back in the 1950's my father, a physician, told me that the American Cancer Society did not really want to find a cure for cancer. From some of the things the American Heart Associaton promotes, I don't think they really want to stop heart disease.
Anne

I couldn't agree more.

Thank goodness we have someone like you, Dr. Davis, who can help us sort through all these industries who are looking for "suckers".

There is a very interesting 6 part documentary on youtube about marketing and the pharmaceutical industry. "Big Bucks, Big Pharma"
Here is the link to part 6.

http://www.youtube.com/watch?v=IVDTo8Rm1rE&feature=related

Without in any way wishing to contradict the idea that fructose is even worse than glucose readers here may enjoy reading this article on the perils of a diet high in
fermentable carbohydrates.
Dietary Carbohydrates and Dental-Systemic Diseases"
The paper was written by a dentist after reading Taubes Good Calories Bad Calories. Readers who find GCBC hard work may like to start with this Medical News Today article based on the above paper.
If A Diet Is Bad For The Teeth It Is Also Bad For The Body

Don't forget agave syrup/nectar.  That is the latest "low glycemic" sweetener temping sugar addicts, particularly to those interested in health.  Agave sweeteners are VERY high in refined fructose, with some brands much more fructose than HFCS (I've seen figures as high as 92% fructose).

Even more worrying, agave sugar products  are labeled as safe for diabetics, who are particularly prone to damage from frequent consumption of concentrated fructose.

The people I see using or recommending agave sweetner products seem to think that because they can't detect an immediate post-prandial BG rise, that agave syrup is somehow better (therefore healthier) than sugar and safe for liberal and/or frequent use.  Not so.  All refined/concentrated sugars need to be limited in both quantity and in frequency, including concentrated fructose.

I see "moderation" used a lot in reference to sugars and agave products whenever criticism of sugars is made.  But what is "moderation"?  Do we even have a reference point anymore in our sugar-drenched culture?  "Moderation" in the 21st century is still at least a hundred pounds per capita more sugars than most humans consumed just a few hundred years ago, and much more than our paleolithic ancestors consumed. Even "moderation" needs to be considered in moderation.

Wow, that's really interesting.

In the past I've wondered if something real simple (like removal of soda/sugary drinks) from society would have a major impact on both heart and general health.  Apparently it would.

It's also weird how cardiologists (in general) overlook sugar intake almost completely. When I last saw my cardiologist, I was sort of baffled that they were offering the patients waiting for infusion therapy snacks while they wait. The nurse commented how  the patients go  first for the peanut butter/jelly sandwiches and they run out fast. And I'm there thinking... are they crazy, giving  sugary food to heart patients?  Then I remembered most cardiologists tend to be fat intake oriented only.

Question for Dr. Davis -- what amount of fructose, daily would you consider safe? Is any amount  safe? As certain fruits do provide health benefits even if they do contain fructose. Berries are still acceptable? What gycated hemoglobin level do you aim for with your patients and have you noticed any differences in plaque progression based solely on this value?

Hi Dr Davis,
Could you tell us more about beer? Do you mean that beer has fructose added to it? Or that it contains a lot of fructose naturally? In general, how high up is beer on your list of things that we shouldn't eat? I ask because I'm having some success cutting down on sweet things and on wheat, and beer is one of my chief culinary pleasures. I don't mean that I drink a lot or that I drink everyday, just that I thoroughly enjoy the 3 or 4 beers a week I do have. (I generally drink brews made with 100% barley malt.)

So low glycemic fruits (which are high in fructose) like apples, apricots, berries, cherries, grapefruit, plums, and prunes can be hazardous to our health...

I'm starting to run out of things I can eat.

Hi,
Thank you for the link to the JCI
study. I can hardly wait to see how the CRA will militantly respond. As a former research technician I am driven crazy when the CRA claims that sucrose and HFCS are essesntially similar. Take the variant HFCS-55. To the casual observer the 55% fructose: 45% glucose composition looks 5% different than the 50:50 ratio found in sucrose. That is, until you do the math.
55%:45% = 55/45 = 1.22.
This means in every can of Coke
(bottled in the USA) there is, compared to glucose, 22% extra fructose. The CRA can't deny the math; they designed the ratio. To your health.

Did anyone notice that one of the authors of the article is RM Krauss? I love chasing his articles on pubmed.  His saturated fat articles from a few years back are particularily interesting.  I think of him as "small dense krauss" in the age,rage and ldl series on Peter's blog.

Dr. Davis - there's so much great information here, but when we ask questions to try to understand the information, you don't answer them!

Thank you, Curious.

But most of my time is spent in my more-than-full-time cardiology practice, consulting to the nutritional supplement industry, research, and the practically full-time website, Track Your Plaque, in which I engage in discussions with your wonderfully savvy Members. So I have to triage my time accordingly.

Also, I read the comments and I try to cover as many of the points as possible in future posts or in the content we post on Track Your Plaque.

Remember: As I post prominently on the blog: The Heart Scan Blog accompanies Track Your Plaque; it is not meant to be a standalone source of information.

Dr, D.  Those of use who TYP ( "track your posts") on this Blog may not be as "bought in" as the members of your track your Plaque members.

If fructose is added to beer, it will be converted to alcohol so none left in the final product.  If wheat is used in the beer grist, the starches that are extracted are converted (mostly) to alcohol so no residual "toxins" to cause swelling.

It isn't high fructose corn syrup consumption or prepared meals that makes Americans one of the most overweight nations in the world, its eating more calories that you need; it comes down to pure physics

I'd like to see a post about the lie of Calories. Fat is calculated at 10 kcal/gram because if burns (bomb calorimeter) better than sugar (calculated at 4kcal/g, the same as fiber).

But of course sugar is much more available to our bodies as energy than fat or fiber.

This makes the Calorie a big lie and emphasizes even more the low-fat diet (because fat would obviously be easier to cut by calorie than carbs).

When people try to talk about the "physics of losing weight", they need to address the underlying assumptions that make the whole system a lie.

Jammer, Please, it is a fundamental law: you can not create or destroy energy.  Mechanistically the body may deal with fats, sugars and proteins differently but unless you live in an alternate dimension, calories absorbed by the gut are either expended as energy or stored in the body in one form or another.  Belief in some magical effect of being able to "eat all the xyz without putting on weight" is a matter of faith and faith is neither fact nor science.

Anonymous, on the contrary, you are expressing faith in but one interpretation of the Laws of Thermodynamics (LoT).  When tested, results often show that one can eat more calories on a restricted carb diet and be less hungry and lose more weight.  The reasons are many and I refer you to Good Calories Bad Calories should you wish to learn more.  The body is not a closed system, and your interpretation of the LoT imply that it is.  What do I mean?  â€œCalories in = energy expended + fat accumulated/depleted” is correct, but only if one realizes that some calories drive hormonal responses which have an effect on the equation.  Eat more protein, feel less hunger, be more active, thus expend more energy.  Eat more carbohydrate (measured by glycemic load in particular), feel more hunger and behave like hungry people do - rest more, thus expending less calories.

Do teenagers grow because they eat too much or because their bodies are responding to the complex interaction of hormones?

Do pregnant ladies gain weight because they eat too much or because their bodies are responding to the complex interaction of hormones?

Do post-menopausal ladies gain weight more easily because they suddenly begin to eat too much, or because their bodies are responding to the complex interaction of hormones?

Do tall thin people (ectomorphs) just magically match their consumption and expenditure (thus remaining slender despite what appears to be high food intake)?  Or are they genetically programmed to a different hormonal response than endomorphs?  

If you met two people, one tall and thin and the other shorter, wider, with a large pelvis and heavy bones – don’t you already know that one will struggle more with their weight than the other?  You do, and you know it long before you know which one is the least disciplined in the non-food arenas in their lives.  

Are you aware of the research that shows, repeatedly, that the obese consistently eat less than many or most of those who are not obese?

Do those who are heavier than we think they should be eat too much, or are they responding to the hormonal mileu they have created by eating foods which we are not designed to eat?  I think the later.  Obesity is not the result of a character flaw, it is a result of widespread consumption of foods (primarily cereal gains, sugar and agricultural products which have exceptionally high carb content) we are not genetically adapted to.  These foods drive a hormonal response the results in energy accumulation as fat.

Aplloswabbie,notwithstanding the impact on what drives people to consume or expend energy at different rates, all excellent info., the equation is still balanced in the end.

Anon, agreed, but the significance of our agreement on that fact is low, as it provides little utility in assisting ourselves or others with their health.  For me, the realization that "low fat" diets are unnatural and drive metabolic derangement gave me a chance to eat good food to satiety, but avoid the high body fat that plaques my family.  Best regards.

How much fructose does beer have then? From what I could find, the fructose content of barley malt is significantly lower than other sugars.

how about mal;tose from tapioca syrup?

Now if you could get Congress to drop the high tariffs on sugar so it becomes less expensive than HFCS, we all could live longer.

Not much longer, we predominantly have sugar from local beet rather than HFCS in the UK, yet our stats aren't much better. IMO there's little difference in the relative toxicity between sugar and HFCS within the context of a high wheat diet

性欲のピークを迎えたセレブ熟女たちは、お金で男性を買うことが多いようです。当、熟女サークルでは全国各地からお金持ちのセレブたちが集まっています。女性から男性への報酬は、 最低15万円からとなっております。興味のある方は一度当サイト案内をご覧ください

プロフ見た感想を携帯アドの方に送ってください。悪口は気が病むので止めておいて欲しいですjewely.jmtjd@docomo.ne.jp

So fruit, in moderate portions, is bad for me?
*snort*
I understand targeting HFCS just as you would large amounts of sucrose.  It's the AMOUNT of these substances that can be a problem.  The other nutrients I get from a piece fruit can far outweigh any possible negative of small amount of fructose in the piece of fruit.  Decisions are all about risk vs. benefit. I imagine there are no risk-free food choices.

No risk-free food choices, Anon?  Whole fruits and vege have little risks!

Very good post that busts everything that http://betterworldcookies.blogspot.com/2010/06/why-i-use-agave-nectar-examination-of.html says!

Wow, I had no idea of this. I should start being careful with my eating, I am really worried about my health now due to several conditions and this is a real eye opener

Fructose is concentrated, of course, in high-fructose corn syrup, comprising anywhere from 42-90% of total weight. Fructose also composes 50% of sucrose (table sugar). Fructose also figures prominently in many fruits; among the worst culprits are raisins (30% fructose) and honey (41% fructose).

A point that Robert Luskin makes in his video "Sugar, the Bitter Truth" is that biochemically fructose does not produce Leptin in the body, the "stop eating" hormone.

A great ingredient for corporate food products - the more fructose, the more you eat/drink before feeling "full". Given that the calorie surplus that makes the US one of the fattest countries in the world is only 20 calories per day, high fructose corn syrup could account for that all by itself.

Hey there,
Really nice job, There are many people searching about that now they will find enough sources by your tips.
Also looking forward for more tips about that

Thanks very much for this nice submit;that is the type of factor that retains me going by way of these day. I¡¯ve been trying round for this web site after being referred to them from a buddy and was happy when I found it after looking for some time. Being a avid blogger, I¡¯m glad to see others taking initivative and contributing to the community. Just needed to comment to show my appreciation on your article as it¡¯s very appleaing, and lots of writers do not get authorization they deserve. I'm sure I¡¯ll drop by again and will suggest to my friends.

Wow, nice post,there are many person searching about that now they will find enough resources by your post.Thank you for sharing to us.Please one more post about that..aftstr

Nice work, I would like to read your blog every day Thanks

Great tips, I would like to join your blog anyway,

HI
"Goodbye, fructose"
nice post
With Best Regards
interior design ideas
home furniture
interior design

Great information, you have a wonderful blog and an excellent article!!

Thanks for the posting. Loads of good writing here. I Wish I Had found this site Sooner

If high GI foods are bad and low GI foods are just less bad, then what does that leave that is good?  Protein and fat?  Sounds good to me!

I absolutely love this post!

So many people don't understand this basic concept.

I have had to expose several 'health conscious' individuals at various health food stores as to WHY that Agave Nectar is just nature's 'High Fructose Corn Syrup'. Along with the Ethanol poisoning from the Fructose, their insulin is spike through the roof for longer than if they just ate table sugar!

Thank you for continuing to educate the masses on the truth, instead of these horrific 'wives tales' that just don't seem to die!

I was diagnosed a type 2 diabetic 30 years ago.  Now at age 70, I've lost 60 pounds through exercise and avoiding processed foods.  My breakfast every morning is boiled oats-groats and whole barley.  My vision is 20/20 and my A1C is always under 6%.  My diet is mostly vegetarian except for salmon or mackerel in my salad.  I usually avoid wheat products except when travelling or on social occasions.

Health Test: I love the "agave nectar is just nature's 'high-fructose corn syrup.'" Well said!

What about Stevia? is stevia ok as a sugar substitute? please advise.

I don't disagree with your comments on GI in general, although as an Aussie I believe  it should be noted that Jennie Brand-Miller had a great deal to do with the develpment of the GI/GL concept.

As a type 2 diabetic I used the concept in a slightly different way. I used peak post-prandial testing to develop my own personal database of the effect of various foods on my own blood glucose levwels. In effect, a personal GL list.

My main reason for commenting was this: "Check your blood sugar after a low-glycemic index food like oatmeal. Most non-diabetic adults will show blood sugars in the 140 to 200 mg/dl range." Although I agree that oatmeal would do that to me - probably worse than 11mmol/L(200mg/dL) I have doubts that it would do that to a non-diabetic. In my experience testing friends and relatives I have never tested anyone who had levels that high after a meal who was not subsequently diagnosed as a type 2. The non-diabetics I have tested, regardless of the carb load of the meal (usually a feast like Christmas) have never reached 8(144), let alone higher numbers.

I would be interested to know if you have seen numbers like that personally in your clinical experience in non-diabetics, apart from those affected by medications like Prednisone. Or was the statement based on the experience of others?

This is one of the few published examples that I am aware of showing post-prandial blood glucose levels in non-diabetics:
http://www.diabetes-symposium.org/index.php?menu=view&chart=4&id=322

Note particularly slides 17 and 27.

Cheers, Alan
http://loraldiabetes.blogspot.com/

Why do you think the traditional extremely high carb Japanese diet
left its population almost free of obesity and diabetes?

Good post.
In the last few years there has been a better parameter, called "Glycemic load" (GL).
While GI is always the same, independent of HOW MUCH you eat, GL takes into account "portion size".
This is important because if you are eating half an apple or 2 apples it will have the same GI regardless, but not the same GL.  

Renfrew

Asians eat lots of rice, and they're skinny. Therefore starch is good for you and should be consumed in large quantities. Buy my ebook, "The Edgy Contrarian Hipster Diet"!

The Mercola mixed diet recommends eating occasional higher glycemic foods AFTER the rest of a meal...since this apparently blunts the insulin response.

I've been indulging in oatmeal...eaten dry as a snack.  Also fruit.  Shame on me.

Also beans as part of meals...not recommended (like wheat as far the effect on the gut?).  Not to mention the salted nuts roasted in hydrogenated oils.

Still have some work to do.....

I buy food only every 3 weeks or so...and I find that when I run out of "favorites" near the end of this period and am eating only lean meats...assorted veggies...olive oil...spices...I feel better.  Though I do seem to get a major itch to go buy some "junk food"...plus a kind of panic as far as running out of food.  

Wondering WHY this is...since I do feel better...do I have addictions?  Need to go to a clinic to recover?

I may be addicted to the sugar rush???  The oatmeal rush? The bean rush?  The hydrogenated oil/nut rush?  

Dependent on my food reactions?

Hi Dr. Davis,

If I remember correctly, in your book you recommend oat bran to decrease cholesterol.  Is that still the case?  (Many thanks for all the great work.)

Thank you so much for this -- the proof is always in the testing and I abandoned many "low-GI" foods early on.  

It sounds good, but ... I never had any success with it.  I thought it must be ME, and ended up feeling (more) sorry for myself.

"A slice of whole grain bread is really not that different from a icing-covered cupcake," except for the fiber, micronutrients, antioxidants, etc.

Alan--

Yes, I've seen many, many people with either "normal" (<100 mg/dl or 5.5 mmol/L) or slightly increased blood glucose (100-110 mg/dl or 5.5-6.0 mmol/L) with high postprandial glucoses.


Peter--

I believe there are a number of reasons, including the use of rice in place of wheat. Being part Japanese, I am well aware of their eating habits which are not as high-carb as often made out. There are confounding factors, as well, including iodine content of the diet.

Also, there are indeed fat, diabetic Japanese people, also. Diabetes is, in fact, a growing problem in Japan.

Dr. Davis is right about the Japanese diet.  Northeast Asians eat a bowl of rice or noodles at every meal, but that is the only high GI food at the table.  A typical Japanese, Korean, or Chinese meal includes fish or meat and non-starch vegetables.

Moreover, type II diabetes is common among middle-aged Asians, who get the disease at lower BMIs than non-Asians.  

I am wondering about the accuracy of identifying whole grain products as low GI.  The Easy GL Diet Handbook lists a GI of 37 for whole wheat pasta compared to 43 for regular pasta.  Likewise, brown rice and long-grain white rice have nearly identical GIs of 55 and 56, respectively.  Low GI is defined at around 55 or less, so pasta qualifies as low GI, but the difference between whole grain and refined varieties is not significant, especially when GI is converted to GL.  As the good doctor notes, it's best to avoid grains altogether.

I did the test today
And this are the results I had.

After wake up: 86

A bit over an hour after breakfast (rise with some vegetables, one egg, broccoli, and one cup of lapsang tea): 93

30 Minutes after lunch (Portion of papaya, bowl of 'auyama' soup, half chicken breast with tomatoes and green peas, one boiled potato and salad with olive oil, one cup of lapsang tea): 111

60 Minutes after lunch: 101

Afternoon before eating some oats: 94

30 Minutes after oats (quaker classics, soaked in water for 10 minutes with some almonds): 110

60 Minutes after oats: 121

30 Minutes after dinner (3/4 chicken breast same sauce as lunch, broccoli, salad, couple glasses of red wine): 109

60 Minutes after dinner: 116

90 Minutes after dinner: 92

This opens many questions to me, like how much the time at which I had the oats affects. Or the fat I just had them with some almonds instead than as part of a whole meal

Also as dinner seems to have more effect on my glucose than lunch even when lunch had  fruit and a potato I wonder if this is due to the black tea at lunch or to the time of the day.

Also I wonder how much effect had the wine at dinner.

I'll do some more tests when my fingers recover

I would add to this post the fact that fructose has low GI, yet is more toxic and screws up the metabolism more than most other carbohydrates.  (E.g. causing fatty liver disease and insulin/leptin resistance; increasing hunger rather than satiating it.)  Food companies are motivated to add fructose to their products so they can claim a lower GI (hence the agave craze), but the fructose does more harm than most higher-GI carbs.

I soon discovered that "low GI" foods, like oatmeal and other whole grains, still cause an unacceptable rise in my blood sugar.  Low GI may be a little better than high GI, but filtered cigarettes are a little better than non-filtered cigarettes.  Both are still bad.

Glycemic load, which also takes into accout the number of carb grams, is much more relevant.  Non starchy veg, meat, & fat are about as low GI/GL as you can get.

As for agave nectar, they still have to process it to extract it.  I'm not sure it's all that "natural."

Low-glycemic index foods trigger the very same responses as high-glycemic index foods—they’re just less bad. But less bad does not equate to good. Low-glycemic index foods cause weight gain, trigger appetite, increase blood pressure, and lead to the patterns that cause heart disease.

I eat oats with milk and 2 tbsp of ground flax seeds every morning, and since I'm doing that every morning I lost 10 pounds, and I feel great. I don't crave for sweet anymore. So, I don't understand how low glycemic foods like oats can increase your weight?
Few of my friends who implemented oats and flax seed in their diet had similar results.
No one mentioned very valuable fiber that oats contain.

Ivan
Male, 37 y.o.

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.