HDL 80 mg/dl

14. November 2011 William Davis (73)
More and more people in my clinic are showing HDL cholesterol values of 80 mg/dl or higher, males included.

Think about it: Nationwide, average HDL for males is 42 mg/dl and for females 52 mg/dl. Even though these average values are generally regarded as favorable, HDL cholesterol values at these levels are nearly always associated with higher levels of triglycerides, postprandial (after-eating) lipoprotein abnormalities, and excessive quantities of small LDL particles.

HDL particles are, of course, protective and are powerfully anti-oxidative. Higher levels of HDL have been associated with reduced potential for cancer, as well as reduced risk for heart disease.

Following the simple regimen that we follow to gain control over coronary plaque has therefore increased levels of HDL to heights that are uncommon in the rest of the population, levels that readily top 80, 90, or 100 mg/dl. That regimen includes:

1) Elimination of all wheat--Yes, consumption of "healthy whole grains" sets you up to have lower HDL levels; elimination of wheat increases HDL.
2) Limited carbohydrate consumption--While eliminating wheat is a powerful nutritional strategy to increase HDL, non-wheat carbohydrates like quinoa, millet, beans, rice, and fruit can still cause high triglycerides that lead to reduced levels of HDL. Limited exposure helps keep HDL at higher levels.
3) Omega-3 fatty acid supplementation--Because omega-3 fatty acids reduce both triglycerides and blunt the postprandial rise in lipoproteins that can cause HDL degradation, HDL rises with omega-3s from fish oil.
4) Vitamin D supplementation--The effect is slow, but it is BIG. HDL just goes up and up and up over about 2 years of supplementation. Before vitamin D, HDL levels of 60 mg/dl were the best I could hope for in most people. Now 80 mg/dl is an everyday occurrence.

Other factors can also be used to increase HDL levels, such as weight loss, red wine and alcohol, exercise, cocoa flavonoids, green tea, and niacin. But following the regimen above sends HDL through the roof in the majority.
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Comments (73) -

  • Kurt

    11/14/2011 1:46:29 PM |

    I have had a similar result. I eliminated most grains except brown rice, I take one Fisol fish oil capsule with each meal and 1,000 iu of Vitamin D each day. My most recent HDL reading was 79 mg/dl, up from 63 mg/dl about 18 months ago, and 15% higher than my highest reading ever. I was pretty pleased.

  • majkinetor

    11/14/2011 2:49:33 PM |

    What is your opinion on high HDL + high [hs]CRP. Some doctors understand this as marker of inflammation or auto-immune disease.

  • Melissa

    11/14/2011 2:50:04 PM |

    I'll share some (half) of my HDLs with the highest bidder. I worry about mine being too high (they've always been ridiculously high). Is there ever a tipping point where high HDLs are an indication of inflammation? BTW, for the most part, I've been on the regimen you mention above for ages. I've never taken niacin and I don't drink alcohol other than occasional red wine, but I get lots of exercise in the form of yoga, hiking, skiing, etc. I never step foot in a gym. =) I've been GF for a decade.
    Melissa
    Hope all is well with you!

  • Fat Guy Weight Loss

    11/14/2011 3:01:30 PM |

    Sounds like I am doing everything right.  Looking forward to my next cholesterol test to see how high my HDLs are.  So what is your recommendation for Vitamin D supplementation?

  • Linda

    11/14/2011 3:25:04 PM |

    Yup, I am doing all these things recommended by our "esteemed leader" and I am proud to say that my most recent blood work indicated Triglycerides at 49 and HDL's at 90!!!
    Have to see a cardiologist this week due to some weird chest pressure a week ago, no "cardiac event", just weird pressure,  which brought about an angiogram and a stent insertion. I am braced for the inevitable "statin lecture" which I have already endured while still in the hospital. If he persists in pushing this drug, I am going to walk out of his office and look for another doctor.
    With a Tri/HDL ratio of .54, there is no way I am going to swallow statins everyday, destroy my liver and/or muscles, and end up buying more #%*$%  drugs!

  • Kenneth

    11/14/2011 3:41:53 PM |

    Is this fabled HDL effect of Vitamin D somewhat linear over the initial two years or is it some sort of tipping point effect where your HDL jumps up sharply after some sort of saturation point?  Over 8 months or so this year I got my D levels up from about 30 to 60. During that time, my HDL actually dropped from mid to low 30s!  My TG levels are rotten at about 300 even with lots of fish oil and a gram of Niacin.  I've also cut back considerably on carbs, though going wheat free is a real struggle for me.  Is a D-25 level of 60 high enough to see a potential HDL boost? Does one have to wait a full two years to know if you're going to be a responder or not? I've resisted the idea of statins or tricor for years, but I'm not getting a lot of traction with the alternatives. At what point is it reasonable to "throw in the towel"?

  • James Winningham

    11/14/2011 6:42:00 PM |

    Dr. Davis,

    Good information on Omega 3s. I remember reading a lot about the ratio of Omega 3s to 6s, and that Flax oil had that correct ratio. Is there anything to this?

  • Jonathan Carey

    11/14/2011 7:23:06 PM |

    Even with familial hypercholesterolemia, I tripled mine from 34 to 91.  My non-commercial website tells how I did it.

  • Might-o'chondri-AL

    11/14/2011 7:53:41 PM |

    Hi Kenneth,
    If Doc's protocol , & not just recommended supplements but his insistence on carb control, is not producing the anticipated adult trig results then autophagy is likely problematic. Triglyceride (trig) breakdown is less when one's capacity for auto-phagy (cellular self cleaning) is less. The Korean Healthy Twin 2008 study sets trig heritability as +/- 46% but did not parse the genetics.

    Genetics of the autophagy related gene 7 (Atg) means that an individual with low Atg 7 will have less autophagy in the liver and more trigs hanging around in the liver since their liver trigs are not being broken down quickly. And yet, in the young especially,  contrary to linear logic less autophagy "normally" fortuitously trends toward less trigs in the adipose (fat) tissue. So, even a non-obese adult with relatively less adipose mass there can be a genetic quirk inciting high trigs coming out from the liver into circulation that doesn't readily seem related to diet.

    Inside each cell is an auto-phagosome component that is designed with it's own dual membrane to hold lipid "droplets". It is from hydrolysis of trigs in lipid droplets that the liver gets the trigs it sends out from the liver with VLD - this is the trig rich VLDL shuttling which Doc warns us  fosters smLDL.

    The auto-phagosome (cell's self scavenger) is the cellular component that 1st has to be able to pick up the lipid droplet and then move on over to the lyso-some organelle inside that same cell to conjoin. Only then can the un-needed trig, that is now inside the lyso-some, be degraded by the cell's natural lyso-some action. For most aging/old individuals their liver autophagy capability declines and so their livers risk the burden of piling up lipids; &  that can contribute to the age associated progression of the metabolic syndrome's high trigs.

    Doc would know better than me the clinical worth of O'Keefe's  2009 Mayo Clinic symposium contention that  EPA/DHA of 3-4 grams daily is useful to lower trigs, whereas  common 1g/d dose is beneficial against human endothelial/arterial dysfunction. The omega-3 EPA lowers the trigs more than the DHA molecule.

  • Ensues

    11/14/2011 8:32:52 PM |

    I wish I could experience the HDL rise I consistently read about.  I am convinced I have familial hypertriglyeridemia.  I do not eat wheat, supplement aggressively with Vitamin D, and take a significant amount of Pharmx liquid fish oil daily and I cannot achieve an HDL marker above 24.  It ran 23-24 before all of the other actions.  It just does not move despite the interventions.   Starting to titrate up on Niacin now.  Will try everything before I capitulate to a fibrate.  If I lived in WI I would be making an appt with Dr Davis!

  • Bill

    11/14/2011 10:03:33 PM |

    My HDL is off the chart at 159. It's so unusually high that my doc has no idea whether it's good or bad, or what it means.

    He says it's 50% higher than the next highest he's ever seen. He had a hard time thinking of *any* lab result he's seen from any patient that was 50% higher or lower than the max or min he's ever seen in others in his many years of practice. He thinks it definitely means something big, but what?

    He suspects either a genetic oddity (my mother's HDL has always run quite high, too, though not nearly that high), a chronic, latent infection, or ominous autoimmune problems beyond my known Hashimoto's.

    He does not know if my HDL of 159 means my (calculated) LDL of 217 and impressive total cholesterol of 382 are safe or not. My triglycerides are an impeccable 39.

    I plan to do full lipoprotein panel at some point to clarify these strange numbers. I really don't know whether to celebrate or worry. I'm not sure anyone has the answer.

  • Kenneth

    11/14/2011 11:49:40 PM |

    If someone can figure out how to separate out some of your sky-high HDL with plasmaphoresis and preserve it as a blood product for re-infusion, some of us could take some of it off your hands! Smile

  • steve

    11/15/2011 12:14:00 AM |

    Nice to hear about the HDL improvements, but what about particle count? No doubt small LDL particles may decrease, but how high is everyone seeing there Large LDL particles increase to?  It also may be unclear that higher HDL is in and of itself beneficial; many with high HDL have ever increasing calcium scores.

  • Might-o'chondri-AL

    11/15/2011 2:30:30 AM |

    Hi Majknetor,
    CRP (C reative protein) level is more significant regarding the stabiity of plaque (ie: risk of rupture) and less indicative of  the degree of coronary artery calcification.  CRP  can be a marker for other physiological doings in non-cardio vascular pathological processes an individual is undergoing. When adjusted for age and race relying of  CRP as a predictor of heart problems is not precise.

  • Might-o'chondri-AL

    11/15/2011 2:54:23 AM |

    Hi Ensues,
    Lancet's U.K. 2010 meta-analysis ("Effect of fibrate on cardiovascular outcomes: a systemic review & meta-analysis") indicates that fibrates for those with low HDL & high trigs are preventative in the context of  suffering less coronary disease and less re-vascularization surgery  being needed. But,  that  fibrates have no  beneficial effect on strokes  (since strokes, whether hemorhagic or embolism is not "driven" by cholesterol in plaque). And,  in terms of  amount of cardio-vascular fatal events fibrates offer no statistical benefit  vs. not taking fibrates when look at  how many actually die from cardiovascular events.

  • Might-o'chondri-AL

    11/15/2011 4:39:11 AM |

    Unsolicited low HDL primer:
    HDL has protein (ApoA1 & ApoA2) & lipids (cholesterol esters, triglycerides, sphingomyelins & glycerophospholids). "Normally" +/- 70% of  HDL protein is ApoA1 & +/-20% is ApoA2. If your genetics stick you with reduced ApoA1 then that contributes to low HDL levels &  generally ApoA2 is less affected by genetics.

    When % of trig burden in HDL goes up & it  gets to the kidneys that  trig rich HDL's ApoA1 protein undergoes endo-cytosis (engulfing) and the ApoA1 is cleared away by the kidney (whereas ApoA2 is not excreted by the kidney). Then, in this trig dynamic,  HDL levels stay low - since person is repeatedly shy of ApoA1 to build with. If there is genetic low ApoA1 to begin with then this further limits the elaboration of HDL; especially considering ApoA1 is broken down (& eliminated) faster than ApoA2 anyway.

    Mass spectrometry analysis shows high HDL is most notably associated with  high sphignomyelin levels - since a feature of  high HDL is less trigs  and usually cholesterol esters are only 13 - 27% of the lipid particles on HDL  the it's sphingomyelin carrying capacity goes up . The ApoA2 protein has more affinity for trigs (& cholesterol esters) since ApoA2 limits the other lipids ability to get on the HDL surface; so it is easier to have higher sphignomyelin when there is less Apo2 in one's HDL .  The more ApoA2 , at the expense of ApoA1, the more trigs and more VLDL (fibrates work, in part,  by acting on Apo2's gene regulatory element).

    There are gender differences in HDL levels.  The Dutch Erasmus  Rucphen study puts HDL heritability at 54%  & Caucasians seem more prone to low HDL than some other stock..

  • Might-o'chondri-AL

    11/15/2011 8:52:15 AM |

    cont. (in case some didn't know relevance):
    Having high amounts of HDL means there is lots of sphingomyelin tied up by HDL's ApoA  & thus less freely circulating sphingomyelin to get picked by LDL's ApoB . Blood plasma levels of sphingomyelin are associated with coronary artery disease all by themselves, as a stand alone marker without being referenced to one's cholesterol level.

    This relates to HDL's potential to limit the progression of atherosclerosis &  not HDL's well touted role in reverse cholesterol transport .  When small LDL's ApoB  lipoprotein with a burden of sphingomyelin gets into an artery wall the enzyme sphingomyelinase can hydrolizes  it in a way that leads  to that ApoB's aggregation. Then that lipoprotein can't readily get back out &  it stays there in a form that  adds to the polymerization which occurs when the macrophage foam cell it is in dies and incorporates into plaque.

  • Alexandra

    11/15/2011 11:09:31 AM |

    I haven't ever had complete bloodwork done...well, 18 years ago when I was pregnant with my final child, they took what seemed like a quart of blood from me but those results were never mentioned to me, so I don't know what was done.  If I find a doctor and ask to have bloodwork / a lipid panel, etc. done, what should I ask for? Is there a specific wording required on the prescription so that the lab will check for small vs fluffy?  Vit. D levels, etc.  What else should be checked?  I am 50, have never been ill beyond a cough or cold.. I check my own BP, avg about 118/78. I test my own BS...fasting is in the 80's.  I've been low carb for 4 years (lost 120+lbs) and LC paleo for over 1 year. I feel better than ever so maybe its time for bloodwork to see if things are going as well as I feel they are.
    I appreciate any suggestions.

  • Dr. William Davis

    11/15/2011 1:08:21 PM |

    Hi, Alexandra--

    Ask for lipoprotein analysis. I prefer NMR lipoprotein analysis. However, if your doctor gives you a blank stare, it's not time for asking for labs, but time for a new doctor.

  • Dr. William Davis

    11/15/2011 1:11:42 PM |

    HI, Bill--

    The whole notion of HDL functionality, i.e., separating good from bad effects, is still in its infancy. And, yes, the HDL without doubt increases total cholesterol. Yet another reason why we should completely discard lipid values and only use lipoproteins. My bet is that your measured LDL (e.g., NMR LDL particle number or apo B) are far lower than the calculated value would suggest.

  • Dr. William Davis

    11/15/2011 1:13:47 PM |

    Hi, James-

    Imagine seeing you here!

    Flaxseed is a great source of linolenic acid as an omega-3; it may have modest independent benefits outside of conversion to DHA/EPA. Chia likewise.

  • Dr. William Davis

    11/15/2011 1:14:51 PM |

    Yes, it's likely something close to linear.

    Also, note that, if your diet results in weight loss, there will be a transient DROP in HDL, only to be followed by a long, slow rebound.

  • Dr. William Davis

    11/15/2011 1:15:47 PM |

    Also, Linda, look for other factors, such as Lipoprotein(a), vitamin D deficiency, thyroid dysfunction.

  • Dr. William Davis

    11/15/2011 1:16:16 PM |

    Sufficient to achieve a 25-hydroxy vitamin D level of 60-70 ng/ml. Please see the 3 million posts on this blog about this.

  • Dr. William Davis

    11/15/2011 1:18:01 PM |

    Hi, Melissa--

    The data on the potential inflammation and other counterproductive functions on HDL are still too early for prime time. So right now we have measures like total HDL, apo A1, HDL particle number and large vs small HDL. Boston HeartLabs has some additional measures, but I still do not know now valid these measures are. I'd also like to see better corroboration of the French groups indictment of inflammatory HDL before we start to pursue this avenue.

  • Dr. William Davis

    11/15/2011 1:18:49 PM |

    Never heard that.

    I see CRP as a marker of wheat and carbohydrate consumption, along with vitamin D deficiency. Correct those two and CRP almost always drops to zero or close to it.

  • Linda

    11/15/2011 2:35:05 PM |

    Vitamin D3 supplementation?  Check
    Thyroid dysfunction?   Blood test done. TSH was 2.70. Early AM temps are always below 97.8 but my doctor does not see a problem.

    Lipoproteins?  They don't bother to check for that, guess they don't see the importance, at least among the doctors I've seen.

    Oh well..........................

  • berger6696

    11/15/2011 5:05:14 PM |

    I've been wheat free vlc paleo for 6 months.  I've also been supping with 3 1000 mg fish oil and 4000 iu vit D daily for the past 3 months.  My HDL has fluctuated but basically stayed in the mid/low 30's, while my total, LDL and TGs have gone up significantly.  What do you make of this?

  • Alexandra

    11/16/2011 1:20:00 AM |

    Thanks... I don't have a doctor so that will help me weed them out a little.

  • Ensues

    11/16/2011 5:53:30 PM |

    Thanks for the comments Al!  There lies the dilemma I have struggled with.  Do I medicate just to chase a marker?  Looks like some benefit in terms of disease reduction but is that worth any negative consequences from the medication?  I really wish the data was more definitive.

  • Ensues

    11/16/2011 5:54:45 PM |

    No.  BMI hovers around 32-33 after a year of paleo template eating.  (Lost 25ish lbs)

  • Might-o'chondri-AL

    11/16/2011 6:11:56 PM |

    Hi Alexandra ,
    Like you I have no USA doctor , so for NMR twice used (what is now called) iNeedLabs.com : an online service - no prescription required; pay for  tests prior to visiting your local blood draw lab... their doctor authorizes blood draw (not available in N.Y./N.J../Mass./R.I.)

  • Linda

    11/17/2011 12:39:03 AM |

    Dr, some questions for you?
    1. Are statins ever helpful?
    2. Once you take them, are you on them forever?
    3. I now have one stent after an angiogram detected blockage. I also have blockage in two other areas. Is it necessary for me to take a statin even with an excellent HDL/triglyceride ratio, etc?
    4. Dr. tells me if I refuse statins, I WILL have a heart attack!
    5. I am female, over 60, following LC diet, taking D3 5000 IU, etc.

    I have not had a cardiac event, simply chest pressure.

  • Dr. William Davis

    11/17/2011 1:05:10 AM |

    Linda--

    I invite you to read the 1100 posts preceding this one. Note that this blog will not replace your doctor, just help you be better informed.

  • Dr. William Davis

    11/17/2011 1:06:18 AM |

    Insufficient information, Berger.
    If weight loss has occurred, for instance, triglycerides will go up, HDL will go down, LDL can do anything. This all improves when weight plateaus.

  • majkinetor

    11/17/2011 9:54:34 AM |

    There is some info about it here:
    http://perfecthealthdiet.com/?p=3122#comment-21029

  • majkinetor

    11/17/2011 9:58:24 AM |

    Do you think that IF style eating trains autophagy pathways ?

  • berger6696

    11/17/2011 12:58:26 PM |

    Thanks for the reply Doc!  I'm 5'9.5 135lbs.  Vary low body fat and pretty athletic build.  I crossfit.  When I started paleo I was 145 with much more fat around the waist (I swim in my old pants, lost about 2-3" around waist).  I feel really good but my labs are just not working with me (I sent you a copy of my VAP test on Fbook).  I'm just really confused on why my labs are not doing what they should and what to try next?

  • Might-o'chondri-AL

    11/17/2011 9:16:53 PM |

    Hi Majkinetor,
    You're concerned about high HDL & linked to it's relationship with inflammation. Virus (& some bacteria), whether symptomatic or not,  want to use sphingomyelin (HDL carries some) because a series of enzymes converts it into sphingosine-1-phosphate (S1P;  HDL carries some S1P). In some cases super high HDL may be attempt to short out a virus (ie: remove circulating sphingomyelin substrate & clear S1P away)  while the more ancient  viral adaptability tries to take advantage of the situation.  Pathology  worsens when viral proteins "lay" on lipids blocking the micro-somal tri-glyceride transfer protein from promoting key lipoprotein events (beneficial ApoB/VLDL /trig dynamics) in the liver cells' endoplasmic reticulum; & also viral proteins "goop" on to ApoA1 (HDL's main protein) in the golgi apparatus.

    The S1P works both inside and outside cells in "normal" health as a signaling molecule. Viruses (& cancer cells) contrive to hijack this dynamic for those signal effects on cell motility (scoot over), cell's ability to survive challenges, proliferation of cells and in some inflammatory processes. S1P can alter the Calcium 2+ level inside a cell  to put into play enzymes that foster th inflammatory cascades (ex: inside cell cytolsolic phospholipase A2 enzyme being set off makes Arachidonic acid get free to make inflammatory leukotrienes, prostaglandins & thromboxanes - which, many recognize are also unwanted agitators of cardio-vascular inflammation). When the S1P lipase enzyme is around then it breaks down S1P (cancer  blocks S1P lipase enzyme, because without S1P cancer goes apoptotic/dead).

  • Ryan

    11/17/2011 9:35:47 PM |

    US News ranks diets.  Here is what they said about Paelo and no Grains...
    http://health.usnews.com/best-diet/paleo-diet

    "Possibly. By shunning dairy and grains, you’re at risk of missing out on a lot of nutrients. Also, if you’re not careful about making lean meat choices, you’ll quickly ratchet up your risk for heart problems." -- So you are missing out on a lot of nutrients... then they don't name any nutrients you would be missing.  So they are really trying to say if you eat a lot of different veggies and fruit and lean meats and nuts, etc... I would be missing out on something grain offered?  
    Laughable.

    Grains vs other food groups: http://robbwolf.com/book-resources/

  • Kenneth

    11/17/2011 11:50:08 PM |

    Much has been written here about statins and their relative benefits and limitations. Does anyone have any thought/experiences to share about fibrates, specifically fenofibrate? After years of inadequate progress on my triglycerides by other means, I'm going to give generic tricor a shot. My doc doesn't seem to think statins would be of much help with TG, with the possible exception of lipitor, which would be an insurance nightmare.  I can't seem to find a lot of "street wisdom" about Tricor or that class of drugs. It seems to have sort of a nasty reputation for side effects - GI upset and a relatively high incidence of liver trouble.  On the other hand, the potent statins and doses required to really dent TGs would have their own issues too?

      Are there any dosing strategies or nutrients which might mitigate side effects of fibrates  the way Q-10 can with statins?  I'm a bit nervous about taking this plunge into such pharms, but I'm not getting where I need to be with diet, fish oil, niacin and Vitamin D.  I've tried other things touted for this like Sytrinol to no effect. I just don't see a lot of "low-hanging fruit" solutions left. I'm not diabetic, not more than maybe 7 pounds overweight. I'm going to get evaluated for thyroid in a few weeks and that could turn out to be part of it, but in the meantime I've got a script for fenofibrate with my name on it....

  • Linda

    11/18/2011 12:34:00 AM |

    Dr. Davis this information was given on the "Morning Joe" program on MSNBC  11/17/11 what can we get out of it?By Linda Carroll
    msnbc.com contributor
    updated 11/16/2011 3:50:04 PM ET 2011-11-16T20:50:04
    Print Font: +-When it comes to the heart, vitamin D can be a double-edged sword.

    Scientists have long known that low levels of the nutrient can hurt the heart, but new research shows that higher than normal levels can make it beat too fast and out of rhythm, a condition called atrial fibrillation, according to a report presented at the annual meeting of the American Heart Association.

    The study, which followed 132,000 patients at a Utah based medical center, found that the risk of newly developed atrial fibrillation jumped almost three-fold when blood levels of vitamin D were high.

    Most people get at least some of their daily needs of vitamin D from sunlight. But in cold northern climates where everyone bundles up for the winter -- inadvertently blocking rays that raise the body’s vitamin D levels  -- people are often encouraged to take supplements to boost levels of the nutrient to protect the bones and heart, said the study’s lead author, Dr. Jared Bunch, director of electrophysiology research at the Intermountain Medical Center in Murray, Utah.

    However, because everyone absorbs these supplements differently, blood levels need to be tested to make sure they’re in the safe range, Bunch explained.

    High levels of vitamin D only occur when people take supplements, Bunch said. Because consumers assume supplements sold over the counter are safe, they may not realize the danger of taking too much vitamin D, he added.

    “People are looking toward therapies considered to be natural to treat a broad variety of disease states and as a means of prevention,” Bunch said. “We see patients who take a tremendous amount of vitamin supplements.”

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    .Bunch said the normal range for vitamin D was 41 to 80 nanograms per deciliter (ng/dl). Patients in the study were designated as having excessive vitamin D had had readings above 100 ng/dl.

    The recommended daily intake of vitamin D for people from 1 year to age 70 is 600 IUs, or international units a day, based on what is sufficient for bone health, according to the National Institutes of Health. There are few natural food sources of vitamin D, although oily fish such as tuna or salmon are among the best. For example, 3 ounces of cooked salmon contains 447 IUs of vitamin D per serving. Small amounts are also found in cheese and egg yolks. The Department of Agriculture provides a comprehensive list of foods containing vitamin D.

    Bunch advised people who have recently been diagnosed with atrial fibrillation and are taking vitamin D supplements to make sure their doctors check blood levels of the nutrient.

    He suspects that the effects of high vitamin D on heart rhythms are reversible.

    “If the levels are excessive, I would hope that when they’re cut back the arrhythmias would improve as well,” Bunch said.

  • Alexandra

    11/18/2011 1:52:49 AM |

    Thanks,  I happen to be in rural NY...

  • Might-o'chondri-AL

    11/18/2011 2:49:36 AM |

    Again Majkinetor,
    Cell's internal proteo-some takes misread/misfolded/worn out proteins (including nitrated MnSOD) apart  via proteo-lysis for recycling the amino acids, since aminos too "costly" to just ditch & cell wants to control it's  protein concentration in real time. Cell's lyso-some in the old person have less portals to get the damaged mitochondria & lipid droplets in for recycling so usually the aged have 10- 20 %  "cluttered up" cells (ex: neurofibril tangles in Alzheimers uses junked mitochondria membrane segments that collapsed). TFEB is the master protein that switches on our lysosome building gene & thus helps improve autophagy play out.

    A low calorie dieter performs pretty robust  autophagy so is potentially less disease prone & that liver is not burdened with so many defective molecules. However, full-on calorie restriction sees reduced autophagy - probably (?) because most everything molecular is crucially needed right where it is ("if it ain't broke don't fix it" paradigm). Intermittent fasting is like periodic starvation and is a type of full-on calorie restriction; so extended fasting inhibits autophagy.  This it should be pointed out is different (nothings simply linear) than when we normally overnight "fast" (ex: don't eat between dinner & breakfast); which upregulates PPAR & downstream inhibits mTORC1 so that our mTORC1 doesn't dampen down normal nighttime autophagy & cell recuperation .

    If  a fasting thin person's tissue protein gets used to run their metabolism it first has to be de-aminated (amino acids cleaved) so that protein molecule's carbon backbone can be oxidized. If the starvation wasn't too prolonged (like we do overnight) most of that protein molecules carbon will be used to make glucose via gluco-neo-genesis &/or glycogen (via glyco-neo-genesis for back up fuel). Some who lose weight fueling via their protein do so because it takes 7 ATP to turn protein into 1 ATP of useable  energy & then will pee out lots of water to get rid of the ammonia nitrogen byproduct.

      

    If one still has body fat (unlike the emaciated) then the fasting level of  FGF21 (fibroblast growth factor) is what upregulates liver keto-genesis in  period of "starvation".  Since  TypeII diabetics (& many obese) have lots of  FGF21  some diabetics measure ketones in their urine to monitor if their condition is getting potentially perilous. Autophagy goes down when the amount of beta-oxidation being performed goes up;  when there is sparse gene Atg7 activity this down-regulates autophagy  and then there are less trigs building up (ie: autophagy  activity up from more Atg7 activity means more lipid droplets shunted to lyso-some for kicking out of cell to be cobbled into trigs to move around - if not excessive trigs are useful).

    Does intermittent fasting train autophagy to be better? I think in the sense that the yo-yo effect of driving the body to scavenge itself for energy substrate (ideally fatty acids & not protein) means intermittent fasting is an form of conditioning. For most the rising ketogenesis  means there was a drop in circulating insulin. It could be said that fasting/starvation forces the liver to behave insulin intolerant ( when liver autophagy is suppressed there is insulin resistance) & that when resume eating the net affect is beneficial due to hormesis. This hormesis inclines the starved faster person to re-bound with a stronger insulin signaling response. Partly that rebound is due to the exagerated degree insulin signal surges through it's intended cascades when the re-fed person's  liver & skeletal muscle cells' Akt gets phosphorylation anew (sort of a pivotal  "oh yeah/that's it/way to go/do me" phosphorylation event on the waiting serine residue of Akt).

  • Might-o'chondri-AL

    11/18/2011 9:35:59 AM |

    Hi Majkinetor,
    I see Doc's has told you above that IF & autophagy are  " likely something close to linear."  Maybe I am misinterpreting the practice of  intermittent fasting & how it plays into our liver's rhythmic genetic expression. I assume it meant close to 24 hours without food.

    +/-6 hours after finishing last meal of the day  there is a rise in lipid droplets shunted for  recycling (a kind of autophagy)  & in the liver these are designed  to be going for ketone making.  Usually our ketone body output lasts +/- 8 hours, but if one is very low carb this might differ . We also should have a  +/- 6 hours cortico-sterone peak that usually  parallels the later part of  a standard overnight ketone cycle . Circadian cortico-sterol levels being up foster the gluco-neogenesis processes we use to build a reserve for when the ketones usually decline. So to hold onto that  reserve (normally for our coming day's get up & go) those cortico-sterols inhibit glucose being taken up into non-liver tissues ( or  used up in the liver). Since insulin signal for glucose to be used is not being acted on I have likened it to being a mimicry of insulin resistance (most people will have insulin in circulation all the time)..

    What do consistently insulin resistant people like Type II diabetics manifest? Lots of muscle protein breakdown (catabolism), protein & ketones  in urine , even before breakfast  lots of trigs (from lipid droplets)  &  plenty of glucose not  being taken up into  tissues. Unfortunately this isn't the way recuperative autophagy is supposed to work, because pathological insulin resistance runs it's program even during the daytime. We are designed to recycle/restore & recuperate while we sleep at night.  Autophagy of our old mitochondria power organelles also ideally happens at night, since you don't want to lose power during an challenge.

    Anyway, so if you had your 8 hours of ketones  +  6 hours of glucose +  2 hours of glycogen filling in  that means after +/- 16 hours of not eating you are into starvation (as opposed to overnight fasting). At this stage your body nutrient sensing is registering the caloric limitation & is trying to hold off doing any cellular house cleaning because that  type of autophagy requires a lot of energy expenditure. If you have some body fat it will go into ketogenesis - but in this instance I don't consider it systemic autophagy, more like catabolism because at that stage you have to bust those fatty acids out to get at them. Calorie restriction is considered to inhibit autophagy, this does not mean no autophagy occurs just minimal autophagy .

  • Roger

    11/19/2011 11:38:14 PM |

    All above is correct, except the 600 IU recommendation, exactly because absorption varies from person to person.  
    The only way to find out if you should be taking more, less, or none st all is with regular blood tests.

  • donna

    11/20/2011 5:23:28 AM |

    Just had mine tested and it is 77.

  • majkinetor

    11/20/2011 11:12:34 AM |

    Thx M-al, for providing me new research points
    I appreciate your detailed response.

  • Dr. William Davis

    11/20/2011 4:02:06 PM |

    Unfortunately, Linda, this will be used as fuel for the "nutritional supplements are dangerous" argument.

    I think the only lesson to learn from this study is that, as we already knew, toxic levels of vitamin D are toxic.

    I advocate testing vitamin D twice per year and I aim for 60-70 ng/ml.

  • Dr. William Davis

    11/20/2011 4:04:52 PM |

    Fenofibrate works to reduce triglycerides, Kenneth, but I have seen almost nobody not respond to the mix you quoted.

    In other words, even if you start with triglycerides of 2000 mg/dl--extremely high--it virtually always drops with wheat elimination and dramatic reduction of carbohydrate and omega-3 fatty acids. While fibrates work to reduce triglycerides, they are almost never necessary.

    So I fear there is something wrong in what you are doing, e.g., insufficient diet change.

  • Dr. William Davis

    11/20/2011 4:05:28 PM |

    Yup, this is the stuff that the dietitians are reading and following.

  • kenneth

    11/20/2011 6:28:36 PM |

    I'll be the first to admit my diet change or at least consistency, is not all that it might be.  Going wheat free/very low carb is a tough deal, especially in light of what you say as far as even one cheat day a week effectively undoing your blood chemistry for a week afterward.  

    I should clarify that fish oil DID help, considerably. My TG was never insane high like 2000, but upper 400s with very low - upper 20s HDL, and God knows what sort of other particle problems, as I haven't done a VAP or NMR.  Just by taking fish oil and eliminating egregious things like lots of pizza and booze, my levels dropped by about a third. Niacin at a gram a day did nothing for TG for me, but did give me a few points on HDL. I have been unable to tolerate a higher dose despite careful titration, and for reasons beyond flushing.  When I was really on top of everything with diet and exercise, it dropped further, but never below 160 and HDL was still unimpressive. I suppose the tricor could work one of two ways, either pharmacologically or  the side effects might turn out to be so intolerable that wheat free discipline doesn't look so bad anymore!

  • fred hoy

    11/20/2011 7:59:46 PM |

    TTHE HEALTHY HEART SONG
    My doctor told me I was plugged, my arteries lined with plaque.
    I need to change my ways today or have a heart attack,
    eat more fish and drink more wine and do more exercise,
    for then you will extend your life, to tell more truths than lies.

    The doctor ordered me some drugs to take each day for sure.
    There is no guarantee of cure, except to make me poor.
    For everywhere both far and near, the rich and poor will die.
    Of heart attack and stroke and in their graves they’ll lie.

    Along came Linus Pauling with his saving protocol.
    He said to drink more orange juice, with a little alcohol.
    The truth that you must know to keep your arteries clear.
    Is not as simple as his words, you must not harbor fear.

    The cure to keep you healthy, is more than vitamin C,
    Amino acids, niacin, and anti-oxidant teas.
    Along with fearsome exercise and cleansing of your gut.
    Remove your mind from prejudice, think thoughts not from your butt.

    It’s been 2 years, since my doctor said my heart is full of fat.
    With Linus Pauling’s protocol, each day I firmly sat.
    My cardio said I should know my calcium score, so he scanned my heart.
    If its under 10 he won’t see me no more.


    The pain is gone, mchest is clear, my pressure’s nice and low.
    When I climb a hill I chug along, my legs just seem to flow.
    My doctor checked my score, he dropped his jaw in awe.
    A zero faced him squarely, thats exactly what he saw.
    yipee yiyay yipee yipee yiyoo learn linus paulings protocol.he song is based on my true experience. for complete story visit "healthyheartfredhoy.com"

  • LindaS

    11/20/2011 8:24:06 PM |

    Thanks for clearifying this Doctor Davis. It seems like everything the  media tells us Re: supplements,  is done in a frightening, alarmist fashion. Except when speaking of pharmaceuticals such  statins or anti-depressants, etc etc. then "all' is good and safe. You can see who holds the money bags!!!!

  • Dr. William Davis

    11/21/2011 1:34:30 PM |

    Yup. Sad, but true.

    Billions of dollars buys plenty of clout and attention. This is why conversations like this count: It is part of our effort to be better armed against it.

  • Dr. William Davis

    11/21/2011 1:35:49 PM |

    Wow, Fred, that's great!

    Now, could you do it in haiku?

  • Dr. William Davis

    11/21/2011 1:37:18 PM |

    Hi, Kenneth--

    HDL will not show its full potential until triglycerides are 60 mg/dl or less. Wheat-free, by the way, is no sacrifice in my mind; it is the most liberating health strategy I know of.

  • Ensues

    11/22/2011 9:24:55 PM |

    Hi Kenneth-

    I am just exactly like you.  Nothing I do budges my tri's or my HDL.  I did Tricor the largest dose possible and together with fish oil, low carb, vitamin d etc I got down to 220.  That's the lowest I have ever seen it.  I personally had no side effects with Tricor.  I quit after a couple of months because I loathed being on a daily medication.  Last reading was 600 and I eat very low carb.  Very frustrating.  Good luck!

  • alfredoe

    11/22/2011 11:22:03 PM |

    Omega 3 from flaxseeds is in a chemical form (ALA) that makes it ineffective for triglycerides control. You need omega 3 in the EPA and DHA chemical form (this kind of omega 3 is ALWAYS from animal origin, never from vegetable origin).

    You should get your omega 3 from fish, cod liver or krill oil. That is the way to lower your triglycerides and raise your HDL cholesterol.

    Please read http://www.omega-3-fish-oil-wonders.com/fish-oil-and-heart-disease.html

  • alfredoe

    11/22/2011 11:35:27 PM |

    I am sorry to contradict no wheat, or low carb, is a BIG sacrifice for many.  I see real carbohydrate addicts every day. I am addict to corn in all its forms, it is a big pain.

  • Kenneth

    11/23/2011 3:41:20 AM |

    Maybe what we need is a strict diet of nothing but iceberg lettuce and a brisk walking program from one end of Australia to the other! Smile I'm going to give the Tricor a shot and see how it does.  In theory it could chop my TG in half from 329 where it last was. Maybe a third is more realistic. IF I get no nasty side effects, the daily drug thing doesn't bother me. I take a handful of supplements twice a day. I suppose I'll keep cracking on the diet and exercise bit too.  I too had hope to do it all without meds but at 41, I figure I don't have a lot of "watch and wait" time left. I got buddies not very much older than me going down with strokes, another who just got home from a five-way bypass. I want no part of that scene!

  • Justin

    11/28/2011 10:25:12 PM |

    Hi Doc,

    Excellent blog. Seriously. You are changing people's lives.

    I'm a firefighter and VERY active, and it's pretty obvious a "low" carbohydrate diet isn't going to work well for me. I've tried it, and the performance hit is significant.

    How would one find a balance between enough "safe" carbohydrates to support activity levels (potatoes, limited rice if no GI issues are evident, tons of vegetables), and keeping those HDL, triglyceride, and particle size distribution numbers looking ideal?

    Thanks a ton,

    Justin Arnold

  • chessguy

    11/30/2011 11:24:34 PM |

    Hi folks,
    I am an unmedicated diabetic and my fasting blood sugar is now around USA 85, uk reading is 4.7,

    my previous hb1ac has always been 5.8 but this time I expect it will be close to 5.0 much better.

    My plan is very lowcarb , and fairly high fat,circa 20 carbs per day in total.

    I am only about 10 pounds 4 kilo overweight max.

    In the last 4 weeks I have lost 11 pounds circa 5 kilo on the very low carb high fat diet/ with ligh exercise too.

    My aim is to lower my cholesterol without statins if possible, and to loose a few kilos, And reduce my Hb1ac.

    My energy levels are fantastic , my vit D was around 40 a year ago it is 70 now as I have been on a few sunny holidays and supplements of circa 2000iu vit d daily.And fish high in omega  3 times a week.

    The question is the big rise in LDL normal, or any ideas I can reflect on.????

    Did I take the test too early ?? ##
    Has any one else experienced this.??

    Has any one taken crestor or some statin for a while til this levels out hopefully,

    Any one taking a statin while on a low carb high fat diet and why , did the low carb high fat not work ??

    MY total cholesterol and HDL have gone "beserk" , but triglycerides have lowered.

    Total Cholesterol: << this was taken two weeks ago it was only the third week into my very low carb high fat diet,#
    9.8 mmol/L = 382.2 mg/dL

    LDL Cholesterol:
    7.6 mmol/L = 296.4 mg/dL ~ My ldl has basically doubled here ###

    HDL Cholesterol:
    1.46 mmol/L = 56.94 mg/dL slight improvement here

    triglycerides:
    1.54 mmol/L = 137.06 mg/dL big improvement here THEY HAVE NEVER BEEN SO LOW

    Test taken on 29/07/2011 <<<< Before the very low carb high fat diet.

    " THE UK & USA MEASUREMENTS ARE SHOWN side by side ".

    Total Cholesterol:
    5.8 mmol/L = 226.2 mg/dL

    LDL Cholesterol:
    3.4 mmol/L = 132.6 mg/dL

    HDL Cholesterol:
    1.37 mmol/L = 53.43 mg/dL

    triglycerides:
    2.25 mmol/L = 200.25 mg/dL
    Goodluck
    chessguy

  • Dr. William Davis

    12/1/2011 4:18:21 AM |

    Hi, Chess--

    Recall that LDL is a calculated value and thereby an incredibly unreliable value. The fact that triglycerides have dropped so precipitously suggests that LDL has converted to large and will overestimate true LDL.

    What you need is a genuine lipoprotein panel, e.g., NMR, once weight has plateaued for about 2 months.

  • Dr. William Davis

    12/1/2011 4:24:10 AM |

    Thanks, Justin.

    The "performance hit" is likely temporary and tends to diminish or disappear within a few days to weeks, as your body converts to a fat burning metabolism.

    The only time you need to actually supplement carbohydrates is during an exceptional long-distance or long-duration effort.

  • Kenneth

    12/2/2011 10:28:54 PM |

    What's your sense of the prospects of the CETP inhibitors now in the pipleline? It seems like they managed to engineer out the blood pressure problems caused by aldosterone or whatever it was, and they show phenomenal increases in HDL. IF any of these pan out and the HDL produces is actually functional, I'd be all over that.....

  • JLMK

    12/6/2011 4:31:53 AM |

    Linda,
    For more info on statins, please see Stephanie Seneff's take. She recently presented at the Weston A Price conference in Dallas.

    http://people.csail.mit.edu/seneff/statins_think_twice.html

    Best wishes,

  • Dr. William Davis

    12/6/2011 5:25:39 PM |

    Stilll much to learn about those agents.

    However, in the meantime, I am witnessing HDL values of 80 mg/dl and near-complete or complete elimination of small LDL with the diet. By the time the CETP inhibitors come out on the market, I don't think we will need them.

  • Bob

    5/2/2012 7:42:59 PM |

    Hi Dr Davis,

    I am striving to approach the 80 marker, although my HDL has not been that high. In 2008 it was 53 with a total cholesterol level of 194. Trigylcerides were 46. Glucose was 93. I am a 6 foot tall, 55 year old guy and 178 lbs.

    With the help from a Naturopath, I have added 750mg of Nicotinic Acid (Slo niacin) per day to lower a slightly elevated level of LPa of 16mg. and I have large buoyant LDL. The results of a few months on the slo Niacin is that my Total Cholesterol is 175, Trigylcerides are 22, HDL is 75, and LDL is 96. My glucose tested at 96.Liver tested normal, slightly elevated kidney function.

    My question is on the Niacin and glucose levels- I understand that Niacin will increase glucose, but how do I go about lowering it? I try to eat low gylcemic, try to eat low carb- certainly no refined carbs, (about 100 grams a day)and I excercise regularly.

    What else can I do to get my glucose down and move the HDL up? Thank you, Sir.

  • Charles

    7/7/2014 1:14:51 PM |

    500 mg of otc niacin gives me trigs of about 49, HDL of about 69 and Iranian LDL of about 62. 750 mg gave me trigs of 34, Iranian LDL of 34 and HDL of 57.

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