Wheat, cornstarch, and sugars ... all have been out of my diet for a while now.

I really appreciate the information and advice in your blog.

Dr. Davis,

There's a belief in the low carb community that if triglycerides are low that LDL tends to be the large, buoyant sort that isn't problematic.  But this fellow's triglycerides are fairly low and clearly he has an issue.  What do you think?  Can one depend on having the harmless sort of LDL if you've cut out the grains and sugars?

When can we expect an update on his numbers?

A low fat high carb diet reduced my HDL big time and didn't effect my total LDL much. This seems quite different from these results. I thought low fat usually reduces HDL. Am I wrong?

What are the sources of cornstarch? I can't think of anything that has cornstarch in it except, well, cornstarch.

Hi, Nancy--

No, you cannot.

Humans are a hodgepodge of varying genetic tendencies. While elimination of these small LDL triggering foods reduces small LDL, it doesn't always eliminate them, especially in the genetically predisposed.

I don't want to waste your time, but in case you don't know: I (and maybe others) received this email today. It was marked as "SPAM" but I opened it anyway since it had your name on it. If you didn't authorize it maybe you should mention it in your blog. Thanks. Joe.

From: Dr. Davis - PharmaNutrients (email addressed followed) hilary at pharmanutrients.com
Subject: Dr. Davis recommends Cardio for optimal heart health
Date: November 4, 2009 8:02:02 AM MST

http://www.pharmanutrients.com/cardio-landing-a

Supplements can be of great help in getting rid of free radicals  to our body.  A good source of vitamins and antioxidants to suffice what we lack from food intake.

Hello Dr.,

So if after eliminating wheat, cornstarch and sugars the lipoprotein test still show a high percentage of small LDL particles (probably due to genetics) - What could be done next?

In my view, once wheat has been eliminated, it should stay that way. I've seen too many people explode in weight and lipid abnormalities with resumption of wheat. I liken it to stopping alcohol in an alcoholic--once "dry," I would not recommend a drink or two.

Hi, Dave--

The reduction of small LDL after dietary changes are made is among the most difficult patterns of all the address. This is discussed in great detail in several reports and forums on www.trackyourplaque.com.

I've been reading your blog for about a year.  I am fitness professional at a healthy weight, but have had issues with genetic moderately high cholesterol (including Lp(a)). High HDL, low Triglycerides, high end of normal LDL (mixed A/B size) AND several high liver enzymes for some unexplained reason (possibly NAFLD?).

I finally eliminated wheat from my diet (95% of the time) about 8 months ago.  My recent blood work came back and the most profound change was that ALL of my LDL particles are now in the Large range, AND nearly all of my liver enzymes are within normal range for the first time!  An unexpected surprise!

Could it be that my liver doesn't like wheat??  Go figure!  

I am now a believer

Thanks for your educational blog!

Bonnie

According to A very-low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins, about 1 in 3 men switch from pattern A (large) LDL to pattern B (small) LDL on reducing their dietary fat intake & replacing it with carbohydrate.

Any idea whether this figure also applies to women?

Hi, Bonnie--

That's great!


Nigel--

Yes, it applies to females, as well.

How do we know that these results aren't more about the "dangerous" foods than the times they were eaten? If this experiment had been done with a few slices of turkey and a big salad and a glass of milk, would the results have been the same?

Well, I don't believe that high carbohydrate diets are causing ADD, but I do feel that some ADDers may be especially sensitive to high insulin levels generated by the modern low fat diet.

That's why the European tradition of walking after a meal is best. On weekends I always walk to and from the restaurants I frequent, which results in a 30 minute walk each way (or more).

If we had a pill for that folks would definitely abuse it.

If memory serves...doesn't taking a shot of apple cider vinegar after a high carb/sugar meal do just that?

Diluted with some water, of course, to spare the esophagus.

Steve, you are so right!  we would be starting rehab services for such a pill!

interesting strategy.  bet the fitness purists would have other ideas about your exercise choice.  it got the job done though.

honestly, i have not been as physically active as i should be and i wonder if that is why my fasting glucose is not low.  it can be over 90 some mornings.  not outrageous but not low for someone habitually eating low carb.

That post makes me wonder what food choices should be for athletes?  Should they stick to a higher carb diet with the knowledge that they're going to burn it off with a few hours of intense exercise?

(I'm not an athlete, but I'm curious as to your answer).

Thank you, Dr Davis, I can now ask my wife to buy an Xbox and a stationary bike for my, ehrm, our, health.

L-carnosine, l-arginine, l-lysine don't have anti-glycation properties?. They might help after lunches.

I like to have, dare I say Pizza 2-3 times a year. It has been shown to have the biggest spike in my blood sugars, so I time it before a work out.

I eat my Pizza usually at lunch not dinner, then do something like pushups and running up and down the stairs.

The first time I tested after pizza, I was shocked. I started the pushups, then the stairs. Within 20 minutes of working those muscles blood sugar dropped more than 80 points.

My name is Maureen and I have been reading your blog since last fall and I have found it very interesting and informative.  I have not fully incorporated paleo diet but understand its merits.  I try to follow the Mediterranean diet with some "cheating" for the past year and a half.

I have had a weight isssue most of my life with a few times of successful dieting. I am happy to say that I have never regained all the weight  back and then some like you hear most people do. I currently want to lose 15lbs and for me the best way to do that is with structure, ie a specific diet plan that tells you what to eat and how much such as so many carbs, proteins and fats.

My question to you is if I were to follow this way of eating and I gain the weight  back would it be better than if I were to follow the Mediterranean  diet?

I would appreciate your feedback.

Is there such a thing as an emergency glucose lowering pill?

As background, I'm not diabetic, but I am glucose-impaired, as they say, and follow my blood sugars fairly often.  I don't know why I don't see this more often, but I've found that drinking wine (I drink red) can help keep blood sugars down on a questionable meal.  For instance, if I eat potatoes without wine, my sugars will go high.  If I drink wine with a meal with potatoes, my sugars behave themselves.  If I remember correctly from my reading, apparently alcohol prevents the liver from pushing out sugars into the bloodstream.

fyi, this is no magic pill but dietary fat is known to blunt blood glucose spikes.

Such a thing exists. It is called insulin. Just kidding of course. By the way, I used to love Indian food, great way to get a good low-carb meal, but now I worry that most indian places use lots of vegetable oil and I don't need the omega 6.

Berny3, my understanding is that alcohol simply gets in front of carbs, and is digested first.  But eventually your potato will get its turn to raise your sugar levels. So could it be just a matter of timing your glucose measurements to catch that delayed spike?

Anti-glucose pill = Pycnogenol.

http://findarticles.com/p/articles/mi_pwwi/is_200702/ai_n17168252/

You mentioned "a 'morning-after' pill, or actually a 'meal-after' pill, a supplement pill or liquid that blunts or eliminates the blood glucose rise after a meal".

Doesn't Alpha Lipoic Acid already do just that?

There isn't likely to be much (or any) cornstarch in Indian restaurant food. Do you tend to have problems with lentils, chickpeas, and/or dairy?

(Kenneth - I'm not anonymous for the sake of it, but because I can't remember the 500 passwords I need for all these sites)

There IS a pill for this. Acarbose. It's an alpha glucosidase inhibitor which prevents, or at least slows the hydrolysis of small to mid size sugars into glucose. It would be entirely possible to design even more potent inhibitors or ones that target multiple pathways on the route to carb absorption. However, there is no free ride. That undigested sugar isn't going to go away. It's going to ferment in the gut and cause gas and may act as an osmotic laxative.

GI complaints are quite common with acarbose, and anyone who is lactose intolerant knows firsthand the downside of carbohydrate malabsoption. Remember that lactose is half glucose. They can gorge themselves on dairy and not get a blood sugar spike, at least from the lactose - if they don't mind spending the rest of the day in the toilet.

@ Steve "If we had a pill for that folks would definitely abuse it" and @ anonymous "Is there such a thing as an emergency glucose lowering pill?"

Yes, it's called Repaglinide or Prandin - you take it just before your high carb meal and it makes your pancreas produce a bit more insulin to cover the carbs in that meal and that meal only. It works just for the meal so it's not like other oral hypoglycaemic meds. Not that that is a good thing - it could stress the pancreas and some would say it could lead to beta cell burnout, but if you only took it occasionally when you wanted an Indian buffet ?

Doesn't cinnamon taken with a meal lessen the spike?

LifeExtension's CinSulin may provide modest lowering of blood glucose:
http://www.lef.org/magazine/mag2010/ss2010_Protect-Your-Body-from-a-Silent-Killer_01.htm

40 minutes on a stationary bike ?

Just place 4 - 5 all out sprints for 10 seconds each, spaced 2 minutes apart.
Done in less then 10 minutes, same result.

But this is the caveat, the sprints must be all out/as fast as you possibly can sprint.

Your muscles are like a giant glucose sink when they are empty.
The most efficient way to get them to  empty quickly is by explosive complete all body movements.

Kenneth again. The more I think about it, I suspect that none of the pharmacological strategies proposed would do much good in terms of truly offsetting a high-carb lifestyle or heavy binge. I already mentioned the problems inherent to blocking absorption.

Raising insulin directly or indirectly will drive down the glucose spike, but to what end? For non-diabetics, the glucose bump is temporary and likely doesn't do much direct damage - maybe some extra glycation. The real problem for the purposes of this blog is atherogenic problems - fat storage and triglyceride formation and all of the bad things that happen with lipoproteins as a result. Using insulin will lower the glucose spike by ramming it into those processes faster. Lots of diabetics who have decent control still have awful lipid panels, especially those following the standard diet.

Maybe supplements which enhance insulin sensitivity might help. Or metformin, which lowers liver production of glucose and helps sensitivity somewhat. But at the end of the day, the only solution is probably not to abuse carbs in the first place and to stay active.

In response to several commenters:

Apple cider vinegar, cinnamon, acarbose, fats/proteins can indeed blunt postprandial glucose rises, as can a number of other strategies.

However, I believe that lipoic acid and l-carnosine are better blockers of glycation than of glucose excursions, a bit different.

Also, I did not mean to suggest that riding a stationary bike while playing Xbox was somehow superior to, say, jogging or dancing. It just happened to be what I felt like doing that day.

Anya is right on the money!

Flavia--

Excellent point.

Don't you love when traditional or intuitive practices seem to provide real benefit?

Hi, Ari--

I am not a believer in "carb loading." I believe that most athletes overdo carbs and pay the health price for it down the road.

Most people who engage in serious exercise may need to ingest carbs during exercise, particularly during extreme efforts. But I believe the notion of carb loading is overblown, particularly if you are already on a low-carbohydrate restriction.

The closest thing I can think of to a magic pill would be Ortho Glucose from AOR..

http://www.aorhealth.com/html/products.php?id=204

and Mito Charger

http://www.aorhealth.com/html/products.php?id=194

I don't trust any restaurants anymore. A lot of "ethnic" restaurants think Americans want food sweet and salty and amend traditional recipes appropriately.

I ate in an Indian restaurant that adds potatoes to their raita, which is supposed to be just yogurt and cucumbers and spices.

So I always ask about ingredients.

Question: How long would it have taken you to come down from 170 or so *without* the bike? Sometimes a spike from carbs comes down quickly if you don't eat a lot of fat.

GUAR GUM CAPS BEFORE, pectin would probably work also.  I've taken 6 guar gum caps before and lowered the measured peak glucose after e.g. oatmeal.

Dr Mirkin says that you will improve your athletic performance by eating high carb/high sugar at the beginning or during an intense endurance race....but he adds, not to eat that way when not exercising.

Here's an compromise between Anya's all out effort sprints and 40 minutes on the stationary bicycle. Try some deep knee bends. Once you get the rhythm down (squat down, rising on your toes and placing your hands behind your heels to stabilize you, then stand up, lowering your heels back to the ground and raising your arms straight out in front of your chest), these comfortable, but very effective at getting your heart rate up and opening the muscles to take up glucose. Also, you can perform deep knee bends anywhere and while wearing any sort of clothing.

The real problem, I suspect, is not being lean (body fat over 15% for a man). All it takes is being a few pounds overweight and metabolism changes dramatically for the worse.

Wow!  After YEARS of studying the effects of carbohydrates on the body in an effort to prevent diabetes, I never knew that simply exercising after a meal would lower your blood sugar.  This is news to me!  I have NEVER heard this, not even from my doctor.  I have heard exercise is good of course, and I have heard that walking can lower your blood sugar overall, but not so directly as you say.  I will definitely not be getting diabetes now.  My mom got it at age 30, but I'm 43 and still have kept blood sugar low.  I guess its now about to get lower.  Thanks.

Also, laptop on treadmill is fun too, and has a way of keeping me walking for up to 4 miles.

The danger is in fructose which is converted directly to fat, because the body has no mechanism with which to use fructose.

Fructose comes from starch, bread, pasta - anything made from grains and leads to increased fatty acids in the blood.

A healthy diet means you don't need to worry about eating too much!

I always eat a high carb/sugar meal before I run, and since I've been training for a half marathon, I can use the extra energy from glucose spikes.

My main criticism of this article is: why are you not playing Black Ops!!!!!1

C'mon, Dr. Davis! When was the last time the pharmaceutical industry invented a new drug then chose NOT to sell it? But if they did come up with a pill to reverse the blood sugar spike from eating hi-carb foods, would it be able to reverse glycation, inflammation & all the other damage that sugar does to to our bodies?

Too many Americans would definitely abuse a pill like that unless it was prohibitively expensive. But the side effects from the pill would prolly be worse than the damage from the sugar.

My suggestion: Do what the French & the Italians have always done: Have a glass or 2 of wine with your high-carb meals. I've been a low-carber for more than a decade now & it's a lifestyle (not a 'diet') that I swear by. But I have yet to find a medical professional who can explain how the French can eat baguettes & croissants every day, how the Italians can have pasta at practically every meal, yet they remain thin & gorgeous & Syndrome X is practically unknown in those countries.

Maybe there's some truth to that Blood Type Diet business, but I say it's gotta be the wine.

If memory serves, there are test strips you can dip in sauces or soups ahead of time to detest the presence of sugars (presumably starches as well?)

In the January 2011 issue of LEF magazine they address this matter.
They talk about Glucose...the Silent Killer.
They also recommend/sell two supplements for this very subject.
One is for Glucose Absorption Control.
The other is a Calorie Control Weight Management Formula.

@RC:  Wine won't necessarily correct a starch centered diet in the long-run.  Obesity is not unheard of in Italy -- quite the opposite -- about half the men and over a third of the women. Huge amounts of obesity in Southern Italy and even in places where my father's relatives hail from -- Rome -- kids start out slender but decades of  pasta result in the common pot belly (pregnant looking men) and plump women by middle age and beyond.  Sicily -- another pasta and wine loving country has plenty of obese adults as well as children.  Even if pasta doesn't result in fat -- it does its damage in other ways such as the type 2 diabetes my thin father had. The benefits to the diet there is that pasta is merely a course of many courses and can be skipped.  Also, this is changing now but families used to cook meals at home -- no junk food meals.  Fresh veggies and meats, cheeses, plus of course the pasta and bread etc.  Modern times have made junk/convenience foods invade Italy -- McDonalds, fast-foods, packaged frankenfoods...ugh.

Yes, I wish that there was such a pill. Better yet, I wish that there was a pill that one could take that would provide for world peace and tranquility ...

It is disappointing to watch this once informative blog descend to its current level of mediocrity.

Count me as another reader that is finished with this blog.

Going back to my item about using red wine at dinner to keep blood sugars down, one of the Anonymous people said that the "alcohol simply gets in front of carbs, and is digested first. But eventually your potato will get its turn to raise your sugar levels."  Well, last night I didn't have potatoes, but I did have quite a bit more carbs than I normally would think wise, and had approximately 2 glasses of wine.  I then took my blood sugars three times at one hour intervals (I had to go to sleep, you see).  The first reading was 97, an hour later it was 92, an hour later it was 90.  I got up out of bed 2 hours later and it was down to 86.  Now, I'm the type where when I eat something that has too many carbs, my sugars go way up in the first 45 minutes to an hour.  By the second hour, the sugars come down into a decent range.  So I'm wondering – does the alcohol really go first, with the carbs waiting in the wings, or does the wine work to slow things down — allowing some carbs to be processed and delaying others?  If I had taken my blood sugar again 2 or 3 hours later, would I see the spike then?

Hey "Anonymous" know exactly how you feel about the blog. Its sad.

Red wine does indeed reduce blood sugar, though the effect I've seen tends to be no more than 5-10 mg/dl.

I was thinking more along the lines of, say, American ginseng. Several gram doses have the potential to reduce postprandial blood sugar by 20-40 mg/dl. However, I am uncertain of the long-term safety of such a practice due to effects on the pancreas.

A mediocre thought to keep this
on life support without the irreplaceable infusion from the blogosphere tribe of Annonymous. If they'd gone back just one entry of Doc's they'd have been able to read 2 comments of mine related to some of the science behind Doc's obsession with blood sugar.

As a disclaimer, I personally don't just say no to carbs - even though my old knees won't cooperate on wind sprints or deep bends to bail me out.

Circadian rhythm is widely known, and erroneously construed merely relate to wakefulness. There are also distinct circadian cycles involved in the liver, heart and lungs.

Not having the time now to detail the relevant liver circadian dynamic I'll just highlight some. In short,
blood glucose and insulin, et. al. is not always a linear reaction; a spike is not always just another bad spike for everyone everytime of day.

O.K., for you researchers, in circadian involvement of liver up/down regulation phases
here are some leads(in no particular order): impact on glucose and lipid balance; transcription of insulin metabolism phases; mitochondrial fat burning; gluconeogenesis; gluco-corticoid receptors; triglycerides; glucose phosphate isomerase and 6-phosphofructokinase-2; HmGCoA lysase and reductase; S-transferase theta-2 and more.

Sounds like chronic cardio to me.

I take 500 mg metfomin each night
I am not diabetic
It's my "glucose lower pill"

I think that cinnamon capsules, GTF chormium or CLA / omega-3's would do the same thing.  It all depends on if these nutrients would cause a hypoglycemic response in some people.

Serious question: what would a shot of vodka do in a scenario like this? (i.e., after carbs have been accidentally consumed, and after blood sugar has consequently risen).

Oops I see the same question about alcohol was already raised vis a vis red wine. Though I'm still not 100% clear on the answer!

Supposedly, pine bark extract taken with a meal supposedly keeps blood sugar from spiking. Then again, the conclusive evidence was only found in animal studies:

http://www.ncbi.nlm.nih.gov/pubmed/15925302

As a glucose intolerant, I have tried all kinds of things to keep my blood sugar under control. My biggest disappointment was vinegar before meal. It did nothing for me. I am of Indian origin and used to be a vegetarian. Tried Basmati rice which some claim has a more favorable glucose response. Again no effect on me. Tried fermented Indian dishes (dosa and idly) which also didn't help. I have now given up eating rice/wheat entirely and eat a lot of eggs and fish. It may just be that I am not meant to consume carbs.

BTW, potato in Raita is quite common in India. To me, Indian cooking in the US is characterized by a very limited set of dishes with blunted flavors. But, I do wonder what was in Dr Davis' soups and vegetables. Some Indian dishes use sugar or jaggery (cane juice boiled into unrefined sugar) but the dish would be detectably sweet. Another possibility is indiscrimate use of tomato sauce or ketchup added as shortcut to flavor sauces which of course contains HFCS!

Playing Modern Warfare while pedaling away on the bike?  Your stock just went way up in my book good sir.

You people are right about the vegetable oil. Its really deplorable - our ancestors in India all used Ghee (clarified butter) heavily. Then the cholestrol propaganda from the West started a few decades ago and now everyone cooks with one or other vegetable oil.
Original Indian dishes made with ghee are much more delicious, especially non-vegetarian ones.

-Fructose comes from starch, bread, pasta - anything made from grains and leads to increased fatty acids in the blood.-

I pity those who are in care of this ignorant british MD. Starch breaks down to a glucose in the body - never a fructose. Also fructose increases liver fat more than fatty acids in the blood.

Then I suppose I am the imperfect carnivore-tendency towards high Lp(a) which is recently under control but also apoE3/4 which suggests limiting fat (or is it just saturated fat?).  Limit carbs...no, limit saturated fat.  OK, so that leaves lean meat, avocadoes, nuts and non-starchy veggies, right?

Not necessarily, Buckaroo.

The apo E4 introduces a trait of highly variable fat-sensitivity.

Perhaps this is something worth discussing in future.

I'll second a request for your opinions on what to do when you're ApoE ε3/ε4 or ε4/ε4! This is very interesting, but just the beginnings of personalized medicine.

Dr. Davis,
I have extremely elevated Lp(a) (190 mg/dL) that hasn't budged despite 2 g niacin  and  4 g  fish oil daily.  I am seem to fit several of your descriptors, i.e. thin, premature CHD at. 47, LDL that is resistant to lowering beyond 85 mg/dL despite statin and niacin therapy, borderline fasting glucose etc. Always been very physically active and that hasn't changed despite one stent.

However, I am not and don't want be to be a carnivore. Any other options?
Thank you.

Anand

What level of Lp(a) do we need to be concerned about?

I would welcome a more in-depth discussion of the role of fat sensitivity in apoE4.  I've not been able to find anything remotely like a consensus on PubMed, and The Perfect Gene Diet which addresses was a big disappointment.

Well, I just got my Lab Results back and I am the lucky carrier of Lp(a) as well as Apo E3/4 and probable FH or FDB. LDL-C Direct 205, HDL-C 95, Triglycerides 52, LDL-P1969, LP(a) Mass 64, LP(a) Cholesterol 13. I have been wheat free, sugar-free, low carb, high fat for about 3 years. Looks like I will have to make some changes, but feel uncertain because high fat is what has really helped me lose weight. Without the fat, I have cravings. Higher carbs are no good for me. Would coconut oil perhaps lead to better results?

Hmm, I've recently learned I have lipoprotein(a). I am definitely not an endurance athlete (I adore sports where I can go hard for a minute and then recover), but the rest of the sketched profile fits.

I'm not sure how I feel about your assertions wrt carb tolerance as it applies to me, though. If I eat by preference with no effort to restrict, I get on average 100g carb/day (a bit less if there are no social demands), but higher or lower levels of carbohydrate don't seem to make too much difference in my blood glucose readings (or mood or ability to lose weight). I have had some wild effects from medication, though: the Mirena IUD (levonorgestrel) in particular caused a crazy post-prandial rollercoaster and elevated fasting glucose for a couple of months until I pulled the plug.

I am ApoE 3/4, and I have followed this issue closely. You may find some useful advice on Dr. Kruse's Optimal Living site, especially in his EpiPaleo diet - http://jackkruse.com/brain-gut-6-epi-paleo-rx/.

Hi Susan,

Instead of coconut oil i would rather suggest to have some high calorie food, because oil makes you increase of cholesterol not fat , having high calorie food like cereals will also help in have some energy in the body

Dr. Davis,

I am working on bringing my husband's Lp(a) 14 and apoB 109 down.  His current pattern is A/B smack in the middle.  What confuses me is saturated fat. How is this good for bringing down your numbers (assuming your not apoe4) when it is also highly inflammatory.  Perhaps this is in the book but it hasn't arrived yet.
Thanks.

Celeste

Look at this article on kidney failure in sugar cane workers...horribly fascinating.

http://openchannel.nbcnews.com/_news/2012/10/16/13866856-mystery-kidney-disease-decimates-central-america-sugarcane-workers?lite

It is hard to believe that regular readers of this blog will consider cereal in their diets.

I just got my first VAP test results back and my Lp(a) is 12 mg/dL.  I probably fit your description pretty well, except I have no idea if I get diabetic if I eat lots of grains.  I used to be semi-vegan but I was a marathoner at the time.  I do know that back then I would get very hungry every 2 hours and I would gain weight pretty easily if I stopped doing so much cardio.  My LDL has gone up (116 now, pattern A, was 94 a year ago) since going paleo 1.5 years ago, but my HDL is also up (95, was 85) and my trigs are down (55 now, was 65).

Thanks for the info!  I'll keep my carbs low as I can while keeping my energy up.  I know if I don't eat some starches I start to feel pretty awful, especially during certain times of the month.  I guess I should start using a glucometer!

Dr. Davis,

My VAP test showed that I have an Lp(a) of 12 on a normal scale of 1-10.  A specific Lp(a) blood test showed that I have an Lp(a) of 250 mg/dL.  Do you see such discrepancies often?  How can both tests possibly be right?

Thanks.

Kinda disliked that the text encourages confirmation bias, but had a private test for lp(a) anyway ($50, pretty cheap info).  It was predictably, very high, which matched up to the NMRLipo derived suspicions I had, big numbers were all awesome, with a bajillion ldl-p and very near diabetic a1c & insulin resistant! lol.

Needless to say, sugar and refined grains are now mostly deleted.    Keeping a <10% cap on carbs for now; not sure I can manage a smaller cap, but we'll know if that change was sufficient in a couple more months.

If someone needs a reason why lp(a) and associates would be evolutionarily advantageous?   On a distance hunt, away from village support, quick repair is better than good repair; and a downed hunter may not have much meat, but will have some body fat, and will have dried fruit.   Sugar+injury+gobs of sticky things in the blood, good nuff to be back in the game quickly (if painfully).    No one cares if their hunters die at 55 instead of 75.

nb... objectively measured, I fit your stated tendency characteristics exactly.   I'd kinda like to live past 55 though.

Hi Dr. Davis,
My husband has very high Lp(a) at 30 years old. We are trying to get on the right diet to help him so he can live a long life and not die of a heart attack at a young age like his mother, uncle and both grandfathers. You seem to be very knowledgeable in regards to Lp(a) levels in cardiac patients. His doctor is not and we are currently doing the Caldwell Esselstyn diet (plant-based, low-fat) to reverse plaque build-up. Reading your blog suggests to me that we are on the wrong track. Can you please point me to the research papers from which you derive your specific conclusion that high Lp(a) carriers should be carnivorous?
I would greatly appreciate any help!
Thank you so much,
Mar

How about eggs, dairy and fish?

And be sure to take low-dose aspirin, which has been shown to "abolish" the incremental risk of having Lp(a).

Dr. Davis,

I've had high Lp(a) readings in the past.  I've lost 35 pounds and dropped 4 meds, by eating low-carb, high-fat.  It's a now a lifestyle for me, not a temporary diet.  And I get plenty of fish oil, so I'll see what your recommendations do for my Lp(a).

I'm curious what you think of this study:  http://www.atherosclerosis-journal.com/article/S0021-9150(08)00522-4/abstract .  For the women in this study, the incremental Lp(a) risk was from having a minor allele in the LPA genotype, and for those women in this large study, low-dose aspirin eliminated that incremental risk.

I've been taking daily aspirin too, but now I think I know how it helps.

Thanks for all you do!