The Perfect Carnivore

People who carry the gene for lipoprotein(a), Lp(a), tend to be:

--Intelligent--The bell curve of IQ is shifted rightward by a substantial margin.
--Athletic--With unusual capacity for long-endurance effort, thus the many marathoners, triathletes, and long-distance bikers with Lp(a).
--Tolerant to dehydration
--Tolerant to starvation
--Resistant to tropical infections

In other words, people with Lp(a) have an evolutionary survival advantage. More than other people, they make clever, capable hunters who can run for hours to chase down prey, not requiring food or water, and less likely to succumb to the infections of the wild. In a primitive setting, people with Lp(a) are survivors. Evolution has likely served to select Lp(a) people for their superior survival characteristics.

But wait a minute: Isn't Lp(a) a risk for heart attack and stroke? Don't we call Lp(a) "the most aggressive known cause for heart disease and stroke that nobody gives a damn about"?

Yes. So what allows this evolutionary advantage for survival to become a survival disadvantage?

Carbohydrates, especially those from grains and sugars. Let me explain.

More so than other people, Lp(a) people express the small LDL pattern readily when they consume carbohydrates such as those from "healthy whole grains." Recall that the gene for Lp(a) is really the gene for apoprotein(a), the protein that, once produced by the liver and released into the bloodstream, binds to an available LDL particle to create the combination Lp(a) molecule. If the LDL particle component of Lp(a) is small, it confers greater atherogenicity (greater plaque-causing potential). Thus, carbohydrate consumption makes Lp(a) a more aggressive cause for atherosclerotic plaque. The situation can be made worse by exposure to vegetable oils, such as those from sunflower or corn, which increases production of apo(a).

Also, more than other people, Lp(a) people tend to show diabetic tendencies with consumption of carbohydrates. Eat "healthy whole grains," for instance, or if a marathoner carb-loads, he/she will show diabetic-range blood sugars. I have seen long-distance runners or triathletes, for instance, have a 6 ounce container of sugary yogurt and have blood sugars of 200 mg/dl or higher. The extreme exercise provides no protection from the diabetic potential.

Because carbohydrates are so destructive to the Lp(a) type, it means that people with this pattern do best by 1) absolutely minimizing exposure to carbohydrates and vegetable oils, ideally grain-free and sugar-free, and 2) rely on a diet rich in fats and proteins.

The perfect diet for the Lp(a) type? It would be a diet of feasting on the spoils of the hunt, devouring the wild boar captured and slaughtered and eating the snout, hindquarters, spleen, kidneys, heart, and bone marrow, then eating mushrooms, leaves, nuts, coconut, berries, small rodents, reptiles, fish, birds, and insects when the hunt is unproductive.

Capable hunter, survivor, consumer of muscle and organ meats: I call people with Lp(a) "The Perfect Carnivores."

Comments (19) -

  • BuckarooBanzai

    10/2/2012 7:07:35 PM |

    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?

  • Dr. Davis

    10/3/2012 1:40:11 AM |

    Not necessarily, Buckaroo.

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

    Perhaps this is something worth discussing in future.

  • Ulrik

    10/3/2012 3:20:49 PM |

    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.

  • Anand Natrajan

    10/3/2012 6:54:13 PM |

    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

  • Bob

    10/3/2012 7:16:40 PM |

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

  • BuckarooBanzai

    10/3/2012 9:43:10 PM |

    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.

  • Susan

    10/4/2012 1:30:46 AM |

    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?

  • Yet Another Kim

    10/4/2012 6:38:19 PM |

    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.

  • Gene K

    10/6/2012 1:21:32 PM |

    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/.

  • Haley Joel

    10/9/2012 10:14:20 AM |

    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

  • Celeste

    10/12/2012 7:51:31 PM |

    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

  • Rick

    10/16/2012 10:46:29 AM |

    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

  • Gene K

    10/21/2012 2:47:14 AM |

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

  • Stephanie

    10/26/2012 2:36:07 PM |

    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!

  • RFM

    1/4/2013 4:15:47 PM |

    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.

  • Richard

    2/3/2013 8:33:08 PM |

    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.

  • Mar

    8/19/2013 7:58:22 PM |

    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

  • R Shaffner

    11/20/2013 10:20:28 PM |

    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).

  • R Shaffner

    11/20/2013 10:27:45 PM |

    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!

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Heart scan curiosities 3

Heart scan curiosities 3


Note the shape of the chest in this 64-year old man. The front of his chest (upper portion of scan) is concave. In other words, if you were looking at this man (shirtless, of course) face to face, his chest would bow inward, rather than the usual outward configuration. The official name for this is "pectus excavatum".





Compare this to the normal chest in the second image, in which the chest is convex. Face to face, the chest would bow slightly outward.















What does it matter? The pectus excavatum in and of itself has no importance, just a curiousity. (I personally find this surprising, given the fact that the heart actually appears squashed by the sternum, or chest wall.) However, it is commonly associated with a "floppy" mitral valve (also called mitral valve prolapse), a common congenital disorder of the mitral valve often accompanied by a slender build, loose joints, and even a nervous disposition. Occasionally, in its more severe forms, the aorta is also enlarged. (This man's aorta is not enlarged.)

So, while we can't actually visualize the mitral valve by a CT heart scan, we can surmise that he likely has a floppy mitral valve, is slender, is probably a nervous sort, and has long limbs with loose joints. He probably required braces as a child, since many people have a phenemenon of "crowded teeth". The roof of his mouth, or hard palate, probably unusually high up in the mouth. He probably has a "weak chin", meaning a less prominent protuberance of his chin. His fingers and toes are likely unusually long and slender.

It could mean that some attention and exploration of how floppy his mitral valve might be could be useful, e.g., an ultrasound or echocardiogram. He might even require oral antibiotics at the time of any oral or some gastrointestinal procedures, since floppy valve are more susceptible to blood infections when potentially "dirty" orifices are instrumented.

All that from a heart scan!
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