We've seen small LDL even with HDLs in the 90's! I call small LDL the "cockroach" of lipids. If you think you have it, you probably do. Getting rid of small LDL requires a specific bug killer. (Track Your Plaque Members: Read Dr. Tara Dall's interview on small LDL.)

I've been using the NatureMade fish oil because it's frequently 2-for-1 at Rite Aid. My VAP cholesterol test was excellent while on the product, but I suppose that doesn't ensure that the product is doing anything. Thanks for the info.

Fresh fish does not smell like fish. Only when the fish tissue starts to decompose does it start to smell like "fish".

First of all, Doc, thanks for taking the time to do this blog. It's great to have such an expert "in the trenches" practitioner helping ordinary people like me make much better decisions on keeping my heart going!
Specifically on this post, when you write these companies, I'd suggest writing a letter and sending it by post right to the CEO.
I've found that usually gets a better, more personalized response to my concerns.

What is a person with very low Vitamin D levels, but prone to kidney stones, to do?

I wonder if that letter was generated by a worker at an overseas customer service center who, as you suggested, just opened a file and inserted text.  How many hits does your blog get?

I've wondered if the USP seal on vitamins actually means anything -- apparently, it doesn't count for much.

I have had a company actually admit to a problem with their supplements once (Jarrow), where their Ubiquinol gelcaps were leaking (found goo at the bottom of my bottle). They admitted the capsules were faulty and they planned to change the manufacturer of their gels, and even sent me a replacement bottle. So... some companies will actually admit to problems and take care of them, but that is still probably the minority.

Hi Dr. Davis,

Have your patients had any experience with CostCo's 2000 IU vitamin D3 gelcaps?

In Italy, Vit D3 drugs are available over the counter at pharmacy. They are ultra cheap. I go for an injection every 2 months as 5 vial cost less than five €.
What prevent US consumers from going to a pharmacy and buy registered drugs instead of supplements?
Quality control for drug companies is surely a bit harsher than for supplement companies.
Then, regulation can be different.

good to know, I used to buy Nature Made all the time... now I am wondering if the "gummy bear" vitamins and vitamin D I give my kids actually are vitamins.  What if they are just candy.  How can you tell for sure?

Impudent--

Great idea.

Perhaps I will send future emails and say that there are thousands of people reading this blog who will await their response!

Gary--

Because we have only one Costco (i.e., only one store), we have had too few people buying this product to say with any confidence.

It never hurts to have your blood level checked.

You might consider me 'weird' but  I actually like to chew my fish oil capsules - I like the taste of the oil and the capsule itself. This has an added important benefit: I can taste if it's fresh BEFORE I swallow. I must say I've never had a rancid one yet. Presently am using Spring Valley from Walmart. I often do the same with my liquid vit D3 caps as well.

Dr. Davis, thank you so much for all the info you put out for us.

I am a fan of your blog, but honestly this is a very low standard of "proof" that you are using. If you feel strongly about it why not get a certificate of analysis done yourself?

I'm a psych NP. My patient took 7000iu Naturemade tabs with no effect on blood level after 2 months. Have heard tabs don't absorb, so have stearing people away from them. Thanks for the info on their softgels.

If I had to get a "certifcate of analysis" performed for every supplement I questioned, we'd go bankrupt just on the testing.

I'll be interested to see what organizations like Consumer Lab, who test a broad range of supplements, come up with.

I subscribe to Consumerlabs.

When they tested vitamin D3  (1/18/10) they only tested up to 1000iu/d capsules/tablet/liquid and also some combination products.

I'm sure readers here are all aware  1000iu/daily can, at best, only raise 25(OH)D 10ng/ml = 25nmol/l.
Most readers require significantly more than that to reach >50ng/ml+ ensuring their body has an emergency stored reserve supply of Vitamin D3.

People who are overweight or suffer diabetes, Celiac or any other inflammatory condition will generally require even more than 1000iu/daily/D3 per 25lbs weight.

The LEF report Startling Findings About Vitamin D Levels in Life Extension® Members By William Faloon shows IN PRACTICE 5000iu/daily/D3 averages only just above 42ng/ml so if we are trying to achieve a level that does more that just meet our daily requirements but also enables the body to store Vitamin D for emergencies, then we require MORE THAN just 5000iu daily/vitamin D3.

At latitude 52 with a BMI just under 25 I take 5000iu/daily + regular short full body prone uvb/winter/sun/summer exposure
My 25(OH)D stays @ 64ng/ml.

I am not convinced Consumerlabs testing of tablet formulations of 400iu or even up to 1000iu has any relevance to correcting vitamin D insufficiency.

Dr. Davis

My name is Douglas Jones, I am with in Corporate Communications at Pharmavite the makers of Nature Made Vitamins.  We take your comments very seriously and need the information that Marissa asked for in her e mail.

All of our products are tested fully before they are shipped to our customers.

Please feel free to contact me directly at djones@pharmavite.net

Thank you

Thank you, Mr. Jones.

Because I identify these cases one by one over months, I don't have my patients bring in their bottles.

I have to say that I am also impressed that I got beyond the girl in the cubicle on this one.

In future, I will ask patients to bring the bottles in. If I know this leads somewhere, then it's worth the extra effort.

However, I remain confident that there is a problem.

Do you recommend multivitamins and/ or Vitamin D brands?

I am 34 years old and at an ideal body weight but had moderately low HDL when blood work was done...Just following your blog and trying to figure out ways to raise my HDL and to help prevent heart disease (My mother is in her 50s and has been on statins for bad cholesterol, a path I don't want to follow).

heatherlbrandt(at) verizon (dot) net

I had been using NatureMade fish oils for years and no belchback. I got a batch that both my wife and I had bad belching with fish taste. Called the company and they said I had been using the enteric coated. I bought some of the enteric and they don't belch back, they also are not what we had been taking. Looks like I will be switching to a different company too.

My friends have been using NatureMade fish oil for over a year now. She told me that it is very effective. I think I am guess I will giving it a try.

Hi, nice post. I have been thinking about this topic,so thanks for sharing. I will likely be coming back to your blog. Keep up the good work
termpapers99@gmail.com

In Nature Made's defense, I've been using 2,000 Vitamin D from Nature Made for the past 6 months, and my Vitamin D levels have risen about 20 points.  I've been very happy with the result, so I just started using their fish oil. I'm sitting here with a brand new bottle of their fish oil enteric coating 1200 mg pills, and smell no odor at all.  This doesn't mean other people haven't had different experiences, but it might be very dependent on your individual body chemistry, and I would suggest doing blood tests every 6 months to determine if the Vit. D you are taking is working for you.  And no, I do not work for Nature Made, and have no connections to them

I just have to say that letter show what they think of customers and how they have made made their mind to deal with any complaints. They did not even bother to get a competent person who could write a letter. Forget that. They did not even bother to prepare a template response.

There is interesting research on omega 3 bioavailability.

After mixed results with various fish oil capsules resulting in low-tide burps or flatus, i moved to Coromega.  Wonderful product.

Re Costco 2,000 iu oil capsules, i've raised my serum levels to 88 ng/ml with them.

However, given the wide range of factors that affect D uptake/utilization, titrating to standard is the only useful methodology. Blind dosing, especially at very low serum levels, might not raise serum levels at all.

Omega-3 structure may affect bioavailability: Study

By Nathan Gray, 14-Jan-2011

Related topics: Research

The type of omega-3 we take may have a distinct affect on how much is actually absorbed, according to new research.


The study, published in the European Journal of Lipid Science and Technology, suggests that omega-3 concentrates – such as triacylglycerides – have much better bioavailability than purified fish oild

The team of Spanish researchers said that the study contributes to knowledge on the intestinal lipolysis of omega-3 sources, which can be found in many commercial forms, from purified fish oil to concentrates of free fatty acids and ethyl esters.

They said that despite differences regarding their intestinal metabolism, there is lack of information about the specific composition of the absorbable fraction from omega-3-TAG or omega-3-EE concentrates.

“This comparative study showed that the in vitro bioaccesibility of omega-3-polyunsaturated fatty acid (PUFA) seems to be better as omega-3-TAG concentrates than purified fish oils,” said the researchers, led by Dr. Diana Martin from the Universidad Autónoma de Madrid, Spain.

Fish oil

Consumption of fatty acids from the omega-3 family – particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – have been advised due to their beneficial role as anti-thrombotic, anti-inflamatory, and hypolipidemic fatty acids.

The authors noted, however, that in many populations consumption of fish is quite low and does not achieve levels adequate for reaching the minimal intake level of EPA and DHA. They added that because of this, an easy way of increasing omega-3-polyunsaturated fatty acids (PUFA) intake is by the fish oils supplements oils.

They said that recent studies have produced contradictory evidence for the in vitro metabolism of fish oils and omega-3-concentrates,

The new study compared the in vitro bioaccesibility of omega-3-oils from different sources. The researchers tested salmon oil, tuna oil, enriched-omega-3 oil as triacylglycerols (omega-3-TAG), and enriched-omega-3 oil as ethyl ester (omega-3-EE).

Study details

Dr Martin and colleagues reported the rate of hydrolysis of omega-3-TAG concentrates was continuous throughout the time of reaction, whereas the digestion of salmon oil and tuna oil was initially faster but stopped after 10 min.

They added that poor hydrolysis took place for the enriched-omega-3 oil as omega-3-EE.

The breakdown of omega-3-TAG oil, salmon oil, and tuna oil mainly consisted of free fatty acids (FFAs) and monoacylglycerides, whereas the breakdown from digested omega-3-EE oil consisted of free fatty acids and undigested ethyl esters.

“This comparative study showed that the in vitro intestinal digestion of omega-3 (EPA and DHA) sources as fish oil, triacylglycerides, or ethyl ester concentrates was different,” said Martin and colleagues.

“The highest degree of hydrolysis and inclusion of lipid products … was found for the omega-3-TAG oil, but compared to fish oils long times of digestion were required,” they added.

Source: European Journal of Lipid Science and Technology
Volume 112, Issue 12, pages 1315–1322, doi: 10.1002/ejlt.201000329
“Intestinal digestion of fish oils and ω-3 concentrates under in vitro conditions”
Authors: D. Martin, J.A. Nieto-Fuentes, F.J. Señoráns, G. Reglero, C. Soler-Rivas

http://www.adajournal.org/article/S0002-8223(09)00293-4/abstract

Re vitamin D uptake & utilization, diet (taking D with a meal doubles uptake), existing D levels (see Holick re substrate starvation), D form (D2 v D3), exposure, lifestyle, age (over 50 produce less in skin), obesity (excess bf sequesters D), co-factors (affect utilization), genes, bathing (bathing strips oils off skin), etc. affect D serum levels.

http://www.scribd.com/doc/38595990/D2-D3

http://www.scribd.com/doc/37319962/Vieth-Vit-D

http://www.scribd.com/doc/36940698/D-Test-and-Treat

http://www.scribd.com/doc/45004628/D-review

http://www.scribd.com/doc/49369766/Garland-021811

"Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:
magnesium
zinc
vitamin K2
boron
a tiny amount of vitamin A
Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

Dr. I came across your site while looking for someone who was having the same problem w/ their Vitamin D levels and not finding a solution.  In fact, the brand you mentioned has done nothing for me in any of the vitamin area!  However I did come across a vitamin that has taken care of my Vit D problem and other problems.  Honestly I think the brand I am taking is the ONLY brand that is actually helping people.  Everyone I know who gets on them has had great results!  Rob Dillon - rdillon4@cox.net

Incidentally, I like the way you have structured your site, it is super and very easy to follow. I have bookmarked you and will be back regularly. Thank you

i too have suffered from kidney stones. i did a 24 hour urine test and my calcium urine level was 3 times normal. shock horror all round.
i began to take 5000iu of vitamin d3 daily and in a few weeks my calcium urine level was normal, my urologist was amazed that this had happened but i did not tell him why because english doctors do not believe in supplements and he would have had a hissy fit!!.
since then, no more stones!

While I certainly enjoyed your book and am extremely grateful for your generous sharing in your daily blog, I am very troubled by this blog entry. Over the last day I have been thinking quite a lot about it off and on, and that would be because I have three stents implanted; two Cypher and one Taxus.

Since my dates in the hospital cath lab in early 2004 I have been following along with TYP principles carefully with the hope of being additional plaque neutral or even a bit of regression, but I see from this entry my hopes might be dashed.

Your statement in the blog entry "I've seen this phenomenon several times now", does this mean it happens most always, or sometimes, or occasionally? What is the game plan now for these patients? Do they (or did) have any similarities that might be contributing to their plaque growth (LPa, diabetes, vit. D, BMI, gender, etc), or are their lipoproteins and assays corrected to perfection?

Thanks again for all that you do, your program and willingness to share is unique and very special to many of us. If you could follow up sometime on this situation with a future blog entry or observations, I would be most appreciative.

With concern,

Neil

Neil--
All this means is that the presence of a stent may modify the potential for reversal ONLY IN THE VICINITY OF THE STENT. Other areas, meaning the majority of your other arteries' lengths, are still subject to your control and the benefits of your prevention program.

Keep in mind that this is an experience involving just a handful of patients. To my knowledge, there are no formal published experiences like this to compare to. All patients had their patterns corrected to perfection by Track Your Plaque standards and don't seem to be distinguished by any one single lipoprotein pattern.

My "gut sense" is that the sort of plaque growth that we see around stents and tracked by heart scanning does not carry the same implications that non-stent associated plaque does.

I just found your site recently and have been reading through the posts.  I find it very educational.  Thanks!  

I'm curious.  Were the stents medicated stents (since it is my understanding that they prevent this kind of thing)?

It is unfortunate that Dr Jack Kruse had to miss the cruise due to a twitter incident, but he published his intended keynote in his blog (http://jackkruse.com/ct-12-getting-back-on-board-with-my-message/). It would be extremely interesting to see Dr Kruse's program adopted by the broad low-carb community and especially in the TYP program.
Dr Davis, would you recommend Dr Kruse's Leptin Rx and cold adaptation program to your patients? Was it in any way discussed on the cruise in the absence of Dr Kruse?

Did you give Jimmy Moore any tips on his inability to stop gaining weight no matter how low carb he goes? It is just frightening to think that this can happen to even the most staunch and informed low carber.

Hi Doc,

Just heard the tail end of a story on the BBC this morning where a researcher from Oxford Univ. was recommending that everyone in the U.K. over the age of 50 be put on a statin as a prophylactic measure - arguing that based on all relevant research, the rewards dramatically outweighed the risks.  Any thoughts?

"Good" HDL cholesterol may not protect heart after all, study suggests:
http://www.cbsnews.com/8301-504763_162-57436495-10391704/good-hdl-cholesterol-may-not-protect-heart-after-all-study-suggests/


Doubt Cast on the ‘Good’ in ‘Good Cholesterol’:
http://www.nytimes.com/2012/05/17/health/research/hdl-good-cholesterol-found-not-to-cut-heart-risk.html

This recipe is a filling and nutricious breakfast and you would never know you are eating low carb.

Pam's Veggie Skillet Breakfast for Two

1 Bunch of Asperagarus cut into 1-2 inch pieces
1 Large red, green or yellow pepper or 3-4 small peppers diced into 1 inch pieces
1 bunch green onions thinly sliced
2 cloves garlic
3 small partially cooked and diced red potatoes (or leave out if you have a very restricted carb intake or add more if you can tolerate more carbs)
1 TBL apple cider vinegar
3-6 eggs
1 TBL Grape Seed Oil
1TBL Olive Oil
Sea Salt and Pepper

Saute all the vegetales in a 12 inch skillet for three to five minutes with the Grape Seed Oil.  Add sea salt and pepper.  Do not over cook the veggies as they will continue to steam witth the eggs.  Add 3 to 6 eggs to the top of the vegetable bed being carefull not to break the yolk.  The trick is to gently lay the egg on top of the vegetables.  Cover the pan and let the veggies and eggs steam together until the eggs are done to your liking.  This is usually about three to five minutes for a softer egg that mixes well into the vegetable bed.  

Serve on plates and add more salt and pepper.  Sprinkle with the apple cider vinegar and olive oil.

Hi,

I have a quick question about your blog, do you think you could email me?

Jillian

Sounds yummy, though I'd replace the grapeseed oil with coconut oil.  

A cup of grapeseed oil has 218 mg Omega-3 fatty acids and 151708 mg Omega-6, so is a pretty bad oil to use if you value your heart health.  Most of your veggie oils are this way, WAY too much omega 6 for heart health.

I'd insist on pastured eggs (for nutrition) and freshly ground black pepper (for taste).  

Also, this sort of thing, you don't need a recipe, this much of that veggie, this much of the other.  Basically, just whatever you have leftover in your fridge is good.  I'd need an allium of some sort (onion, shallot, scallion), but otherwise... chop and throw into a skillet whatever you've got hanging about or leftover.

The big trick with fresh produce is using it up before it goes bad, and this is a great recipe to use stuff up with.

I don't know enough modern biochemistry to follow the logic of the letpin reset and haven't researched the cold stuff enough to have formed an opinion yet.

But about HIM - Google for his TED talk, where he claims to have gained 20 lbs on purpose, gone for plastic surgery to remove it, and injected himself with MRSA prior to the surgery, but it was all OK cause he soaked in a tub of ice water for hours afterwards.  

There may be something to his ideas, but... his behavior at that talk did not elicit respect for his ideas.

Thanks for posting, Pam!

On the other hand:

Low levels of HDL cholesterol lead to an increased death rate
This study was published in the Journal of Lipid Research 2012 Feb;53(2):266-72

Study title and author:
Fifty-three year follow-up of coronary heart disease versus HDL2 and other lipoproteins in Gofman's Livermore Cohort.
Williams PT.
Lawrence Berkeley Laboratory, Berkeley, CA 94720, USA. ptwilliams@lbl.gov

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/22128321

This study assessed the relationship of high density lipoprotein (HDL) cholesterol levels with total death rates and heart disease death rates. The study lasted for 53 years and included 1,905 men.

HDL cholesterol is made of HDL 2 and HDL 3. HDL 2 is larger than HDL 3.

After analysing 53 years of data the study found:
(a) Those with the lowest HDL 2 cholesterol had a 22% increase in total death rates.
(b) Those with the lowest HDL 2 cholesterol had a 63% increase in total heart disease death rates.
(c) Those with the lowest HDL 2 cholesterol had a 117% increase in premature heart disease death rates.
(d) Those with the lowest HDL 3 cholesterol had a 28% increase in total heart disease death rates.
(e) Those with the lowest HDL 3 cholesterol had a 71% increase in premature heart disease death rates.

The results of the study show that low levels of HDL cholesterol, especially HDL 2 cholesterol, are associated with higher total death rates and higher death rates from heart disease.

The best dietary way to raise HDL cholesterol levels is to eat a diet high in saturated fat. See here.

since i don't see ferritin, iron stores, or transferrin in your index, i'm going to assume you don't buy into the hypothesis that high iron stores in men can lead to CVD.  please correct me if i'm wrong.

My focus is strictly on his ideas and how they change lives of other people when they follow his example and advice. While some people may see his behavior negatively, I respect him for taking time to reply to every single comment to his blog posts, of which he receives many hundred per post.
I don't have a background to reason about Dr Kruse's conclusions and recommendations, but given that they are mostly consistent with the recommendations of other unorthodox doctors such as Dr Davis and Dr Eades who I trust, and go further extending those recommendations, and given that I have been following these recommendations with good consistent results, I don't need to worry about Dr Kruses's behavior when he has to deal with detractors.

I don't care about his detractors particularly either; I'm not a member of the Paleo community and haven't been a member of the low-carb community for some time, so have no horse in this race.

However, his behavior in that video is pretty irrational; I don't need a detractor to tell me this; my own judgment is that messing with MRSA is just flatout STUPID.

Dr. Davis and both of the Dr. Eades differ from Dr. Kruse in that they haven't behaved like stark raving lunatics.  I don't agree with everything they say, but respect them and have learned a lot from them, and from other sources as well.

I've read Dr. Kruse's ideas, and as I said, I've not researched them.  They may well be valid as I haven't spent the time on PubMed to figure it out.  Similarly, I haven't researched the ideas of the folks who hang out at the Philly Amtrak station talking to invisible people.

I can't spend my life researching, as I have to eat, sleep, exercise, talk to my husband, pet my cats, work in my garden, go to the Farmer's Market, etc.  So there must be some method of determining what to look into in depth and what to ignore; watching Dr. Kruse deliver his TED talk limited my interest in further researching his ideas.

If his ideas ARE valid, his behavior is not earning them a hearing from me.