Amen!  I took Lovaza for a year when my physician gave me a coupon for a monthly supply at $5/month for 12 months.  I obviously stopped when it ran out because of the "real" price.  I've started using CardioTabs (http://www.cardiotabs.com/Omega-3-Fish-Oil/productinfo/OMEGA-EC/) instead on the advice of my physician.  Any feedback on this brand?

What is your opinion about Nordic Naturals DHA?  It contains 450 MG DHA and 90 MG EPA, along with 15 IUs of Vitamin E (alpha tocopherol) in two soft gels.  I've read in many places that fish oil containing more DHA than EPA is superior.

Even though Obama and his socialists would vehemently disagree, you make a logical point.

I use Spring Valley brand and it costs me about $11 for a two for one deal (two bottles). 200 capsules per bottle 1000 mg each. EPA + DHA is only 300 per capsule but for the price taking 6 per day isn't a problem. Under $12 every 2 months isn't bad.

Hello everybody!

Well, I see this article refer to a matter of price and less about quality.

Dr Davis, please, what do you think about NOW Foods suplements?
Sorry for being offtopic!
Thanks for your blog, your work changed my life.
All the best from Romania!

For maximum absorbability, use liquid not capsules or gels, and eat with a high fat meal.

New research also shows the probiotics in yogurt also help to minimize the oxidation:
http://www.nutraingredients.com/Research/Yogurt-proteins-could-stabilize-omega-3-enrichment

as does pollen spore shells (exines)
http://www.nutraingredients.com/Research/Pollen-spores-could-enhance-omega-3-bioavailability

A good value for omega-3s is Twin Labs:
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

Take a look at Trader Joe's odorless omega 3. 90 capsules for less than $9. 1200 mg fish oil 400 mg EPA and 200 mg DHA in each capsule. The only brand I have been able to find with a 2 to 1 ratio of EPA to DHA. And there is no after taste.

I eat omnly grassfed beef and wildcaught salmon. Chicken is pastured. I don't eat grains or vegitable oils. I use coconut oil and tallow for cooking.
That being said, can one get too much Omega 3?

Great point about the cost effecting others. Studies ghave shown that fish oil that is too pure is not as good as fish oil with a little bit of "mother" in it. Clean not sterile.

Huge props to you, Dr. Davis, for admitting regret and posting future accountability by NOT filling scrips for Lovaza.

Hopefully, the husband of that patient reads your blog.  But I doubt it.

Hi Dr. Davis,
Thank you for living your principles, and, as always, for your candid and unvarnished thoughts.
Sincerely,
Tom C

I take 4 of Sam's Club triple-strength fish oil plus a 1 gram Krill Oil from Puritan's Pride.  The omega 3s, ground flax seed, curcumin, and Jean Carper's Super Osteo Gold have allowed me to jog at age 71 without any joint injury.

Assuming no problems with Lp(a) you can reduce the need for so much fish oil by changing your diet to low omega-6 intact.  There is competition between the two essential fats so try to limit foods high in omega-6 first.  Once you've done that you can cut back on all those fish oil capsules. It's probably helpful to take some vitamin E too to prevent potential fatty acid oxidation.

Thanks for not being part of the problem, Dr. Davis.

The thing is, some prescription plans have a copay. If the plan of the couple is like mine, they'd have had a $30 copay. It's possible they were only saving $20 a month. For our friends outside the U.S., that'll buy a movie ticket and popcorn for one person. Nine hundred dollars is more than my mortgage payment.

The real problem is the pharmaceutical industry and not patients who wish for prescriptions or insurance companies. Here in the UK, the last I heard,  Lovaza (marketed under the name Omacor) costs the National Heath Service £50 ($78) per 100 capsules, that is considerably less than what it costs in the US and roughly the same as comparable fish oil omega-3 supplements from health food shops in the UK. This is the pharmaceutical company charging this and it is they who should be brought to account when it comes to over profiteering from patients and insurance companies, imho.

I've started using CardioTabs instead on the advice of my physician. Any feedback on this brand?

Not a very good deal, Anonymous.

Each bottle includes 180 capsules, but a serving size is 3 capsules (to equal 975mg of DHA and EPA). Multiply that serving size by 6 to attain Dr Davis's objective of 6000mg of DHA and EPA per day. This means:
1) You must ingest 18 (!) capsules/day;
2) Each bottle of 180 capsules is a mere 10 days supply; which means
3) 3 bottles/month at a cost of ~$100/month.

Several commenters have asked about specific brands.

Consumer Lab (www.consumerlab.com) is a great place to start to see what brands have been tested.

While it is clear that no mercury, PCBs, dioxin, or furans have been measured in any brand of OTC fish oil (slight contamination of cod liver oil, not fish body oils, with PCBs), there are differences in oxidative breakdown products.

A quick test of oxidation: Smell your fish oil. It should only be faintly fish, not overwhelmingly fishy.

Can you give us some references on why 6,000 epa/dha for lp(a) carriers?

Finding a suitable plaques for our home is little hard to do. Your special taste of art and rare places provide it in best quality sometimes become the challenges to do it. But, because of the importance of the plaques you have to find it whatever it takes.

What about Weston A. Price suggesting that there is a potential for Omega 3 overdosing as well as the concern from contaminants  in fish oil compared to Cod liver oil due to fish oil being mostly from farmed fish? Also the benefits of Vitamin A and D from taking Cod liver oil rather than fish oil.  Personally I don't use cod liver oil, but should I be concerned about too much fish oil? Have there been long term studies?
Thanks

Tommy

This is one of the many reasons for our skyrocketing insurance costs. People need to take more responsibility for their own health. Unfortunatley, this concept is in direct conflict with the prevailing trend in our society.

With the direction our health care industry is going, future costs will become quite prohibitive. In an effort to fight class warfare this new health care system will create a class of those who will be able to afford effective health care while the rest of us who are dependent on the government's version will be left waiting . . . It really is our fault.

What's pathetic about the situation is, if the insurance company would shoulder some of the cost of basic fish oil instead of the prescription Lovaza, everyone in the system would benefit.  The way it is, everyone in the system loses.

I have always used scott emulsion. A couple tbs per day.
is that one good?

Anonymous about insurance paying for supplement fish oil--

Yes, a brilliant idea!

I've had the same idea and wondered why an insurance company didn't just shell out the money to prove for themselves that OTC is every bit as good as the prescription, then encourage their insured to use this instead. It would provide HUGE savings with no downside.

Dr Davis

with the us treasury printing currency by the boatload if everyone operated with cost savings in mind there would be hyperinflation due to excess money floating in the economy. So government channels try to mop up and circulate as much currency as possible and keep the bottlenecks to a minimum.

No wonder usa is looking at a consistent high inflation future or maybe hyperinflationary future.

I wonder about oxidation and possible immune system suppression at the 6 gram dose level. Although I suppose in patients with high Lp(a), it's the lesser of two evils. Emulsified fish oil may be worth trying, to see if it decreases Lp(a) even further.

Eventually Lovaza will go generic, which will be sort of odd, when prescription fish oil potentially could be in the same ballpark as OTC. Not sure how the FDA will make sense of it, unless the dosages are exactly the same... not sure how prescription fish oil ever really made sense really.

Also, don't eat with fiber as this hurts absorption.  

The following are listed in the ConsumerLab.com report, but I'm not a member so don't know how it rates:

Twin Labs Mega EPA ( 1 capsule = Epa 550 Mg, Dha 215 Mg )
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TL-1403

Nordic Natural Ultimate Omega + CoQ10  ( 2 capsules = Epa 650 Mg, Dha 450mg)
http://www.nordicnaturals.com/en/Products/Product_Details/98/?ProdID=1446

Green Pastures Fermented Cod Liver Oil and Butter Oil Blend (~139 mg EPA, ~83mg DHA),
http://www.greenpasture.org/retail/?t=products&a=line&i=fermented-cod-liver-oil

Vital Choice Wild Salmon Oil (240 mg EPA, 220 mg DHA)
http://www.vitalchoice.com/product/omega-3-salmon-oil/1000-mg-sockeye-salmon-oil-softgels-180-count

The nordic product also has 60mg of CoQ10, and 30IU of vitamin E!

Dr Davis as a practicing neurosurgeon and age management doc I write for Lovaza all the time.  At least 75 Rx a month.  Does it bother me?  Yes it does.  But I feel better knowing those who are taking it are being proactive and healthy instead of a dog chasing its tail with his or her PCP.  Everything is relative my friend.  I suggest you focus in on the good because their is bad in everything but if you focus in on the good it magnifies itself.  Keep fighting the battle.  I do. I get more patients off Statins and on Fish Oil and resveratrol than you can imagine.  Love your work and the book.  I have saved lives because of you.  you passed it forward and now I do too everyday.  Dr. K

Presumably, the guy has been paying his health care insurance premiums.  Based on the facts you describ, his insurance covers prescriptions for Lovaza.  Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?

@anonymous who wrote:

"Why should he have to pay additional money out of pocket to receive a benefit to which he is entitled under his insurance program?"

If we focus only on an insured and his contractual rights under his insurance policy, he should not "have to pay additional money out of pocket..."

However, that focus is arguably too narrow as it fails to consider the effect on insurance premiums for the rest of an insurance company's policy holders/payers. This is one of the evils of a system that requires citizens to obtain health insurance - it forces other people to subsidize, to use Dr. Davis's example, an expensive prescription when cheaper and equally effective alternatives exist. This is not an isolated example; consider prescription Vitamin D2 vs. D3 supplementation, etc...

I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
  I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
I can see both sides of the situation. The situation is a grey area.
I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

I can appreciate your feelings about writing such a costly perscription.  For years... when my GP would write a perscription for a cheap oc medication I just bought it without submitting the script and having my insurance incur the pharmacists dispensing fee as well as the basic cost of the OC medication. It seemed so ridiculous and costly!
Over the years I realized that my extended benefits cost me about $3,000 out of pocket whether I use them or not.
  I figure I did not create this mess and even though it is silly I don't worry much about the costs to my insurer.
I can see both sides of the situation. The situation is a grey area.
I know that my insurer is in buisness to make a profit and doesn't hesitate to refuse and question claims. I figure that I am in the buisness of making the best of my  personal finances.

As a liberal, I say thank you. We can only provide health care for all, if it is affordable. Abusing the system only ensures less and less people will have access to quality health care.

I love this article.  It makes me gag when I see commercials on TV for Lovaza or Niaspan.  This is one example of what's broken in our healthcare system.

+! on the Trader Joe's omega-3 capsules. They are cheap and they have 50% concentration of combined EPA/DHA. TJ's sells two models of their omega-3 and the other has a lower concentration.

I'll take Lovaza when it's a free sample. It has a 90% concentration but I think the overall total in Lovaza is not much higher than what is available from the local drug store.

The only advantage Lovaza could have is that is monitored very carefully for purity and the like. I'm not sure that's much of a concern.

-- Boris

Are such high doses necessary? 7-8 grams per day of EPA/DHA seems like it would get you well past the desirable 8-10% on the HS-Omega-3 Index (usually only requiting 1-3 grams daily). Is there any need to go beyond 10%?

I take 5-6 TJ omega-3 capsules during the day. Maybe that's a bit much but maybe there is a saturation point? I don't know. I know that omega-3 has cleared my mind, reduced my eye pain, and lowered my blood pressure.

-- Boris

So glad to hear it. When the ads came on TV, it was just another Big Pharma scam. Take a natural product and package it for mega profits.

I finally knuckled under and let my doctor write a prescrption for Niaspan for me - as we were fighting terribly as she was *ADAMANT* that I HAD to take STATINS as my cholesterol was too high (though my HDL was 62 and my triglycerides were 65) and I was flat out refusing. So she then suggested I had to take Niacin.

I was willing to give Niacin a try as I have seen Dr. Davis talk about it here - and she just sent in the prescription via her computer to the mail-order pharmacy I'm required to use to get my prescription insurance coverage.

So imagine my SHOCK when I got the online notice that the prescrption had been filled, and I was able to look it up. A 90-day prescription of Niaspan was about $400! I almost fainted, though my patient share was $75 - or $25/month.

But I still thought it was highway robbery and will never fill the prescription again. If I continue t take Niacin I think it will be Slo-Niacin for me. I'd heard Niaspan was expensive, but had no clue it was that much!

Dear friends,

On Omega-3 highdoses EPA/DHA ; Minami Nutrition is providing Supecrital extraction (low temperature, and not molecular distillation!!) Omega-3 as well guaranties on purity below the detection limit next provinding a 93% Omega-3 per one softgel or 820 mg EPA/DHA per one softgel. look into www.minami-nutrition.co.uk availabel in the US at Wholefoods.

Some people are worry on too much intake of fish oils. Indeed if you swallow standard fishoils with low levels of EPA/DHA as most US products you may swallow also a lot of saturated fats. Go for 1 softgel a day a softgel tahts provide you almost 1 g Omega-3 or a minimum as 820 mg EPA+DHA per softgel. a lot of brands having high levels of pcb's.(see http://www.cbsnews.com/stories/2010/03/02/health/main6259938.shtml ) be also a ware when mention "per serving" could be 2 to 4 or more softels a day.  Avoid liquid oils as they oxidize fast, as well I'm not in favor of codliver oils as too low on EPA and DHA and to high on vitamin A when taking 500 mg EPA/DHA.

THANK YOU!! For taking a stand where many in your profession will not. We need more of this!

Even the traditional medical community is finally realizing that the omega 3s in fish oil provide some of the best natural health benefits on the planet. Worldwide, the omega 3 supplement market is in the billions of dollars. The drug companies want a piece of the action.

Great insights about how we can have a healthy lifestyle.Omega 3 is good for the heart that's why many people are eating foods rich in Lycopene.

Vitacost.com has their own brand of fish oil, NSI Mega EFA® Omega-3 EPA & DHA.  At 6000mg EPA/DHA a day (10 capsules) in a 240 cap container for $22, that comes out to be $27.50 per month.  And they often have 10% off sales, like right now till 10/31/10.  My personal experience with them has been good, their NSI brand has been high quality, and I rarely find a better price elsewhere.  I'm currently taking 6000mg EPA/DHA daily.

Very interesting post. My mother has been taking a Thyroid supplement for years, and I'm always interested to find out more facts about the medicine she takes. I'll make sure to tell her to shop around before committing to one pharmacy. Wal-Mart is the price leader? How unusual! Thanks for sharing.

You guys in the US are lucky.  In Sweden, you have to beg to even get T3 (synthetic form, of course), and the main treatment is levothyroxine.

To get Armour Thyroid, you have to apply for a *license* with the Swedish equivalent to the FDA, and even then, you have to have been on medication for a year w/ stable values, but residual symptoms for a sub-functioning thyroid.

The common argument against is that the T4-to-T3 ratio is too high (which is why you take one in the morning, and one in the afternoon, duh...), as well as non-standardised doses.  The latter claim was recently changed to "potency issues in different batches". Well, it is my understanding that levothyroxin also suffers from this, at laest judging from the past problems with Synthroid in the US.

But perhaps the main problem is that Nycomed, the company producing the most common medication (Levaxin), seem to be unhealthily tight with the endocrinologists. Plus, of course,  hypothyroidism being listed in the MDs guidebooks as being something easy to treat with synthetic T4 replacement...

I showed this to my brother, who is a pathologist specializing in blood transfusions, and he pointed out that since Armour is distilled from thousands of cows, it is possible to get Mad Cow disease from Armour thyroid medication.

What is your take on this?  I myself would rather not take Synthroid.

Jenny

"since Armour is distilled from thousands of cows, it is possible to get Mad Cow disease from Armour thyroid medication"

Armour is made from the thyroid glands of *pigs*, not cows (porcine, not bovine).  Furthermore, the current  leading theory is that MCD is transferred from consuming brain & spine tissue, not muscle meat or glandular tissue.

Now if pigs are fed rendered cow parts that include MCD prions, that might be a cause for concern.  But one would need to know that is the case, and that pigs could get MCD, which as far as I know, isn't the case.

I only found out about the whole T3 thing this week. I've been wondering for the past three years why I still feel like crap.

Unfortunately from what I have read it appears T3 therapy is almost frowned upon in Australia (even the National Thyroid Foundation warns against it's use).

I just don't know what to do, I'm so sick of feeling the way I do.

I have been unable to obtain my Armour thyroid for three days and no "end in sight" I am already feeling horrible. This is so disturbing to me it calls for a class action suit.  I cant help but wonder what is REALLY behind all this.  Not even the docs and pharmacists are being told, let along the sufferers.  I feel angry and helpless-I have had to resort back to my Levoxyl and I dread this.

Dr. Davis, the national shortage of desiccated thyroid meds would be a valuable and timely subject for a post.

There are a number of reasons for the current and projected continued shortage of natural thyroid preparations and patients are pretty much in the dark about what/why happened, and how to manage in the interim.

Both Mary Shomon at thyroid.about.com and Janie Bowthorpe at www.stopthethyroid madness.com (thyroid patient advocates) have posted updates about their communications with suppliers/FDA insiders etc., in an effort to learn more and spread useful information about what is happening with the natural desiccated thyroid shortage and ways to cope if it's impossible to get via your normal avenues.   Some people are finding they can get natural thyroid preparations from Canada, where there is no shortage.  

Chain drugstores are purported to be sold out of nearly all natural thyroid meds.  

Compounding pharmacies are generally the best US option currently, though who knows how long that will last.  I know the one I use is already limiting Nature-throid refills to 30 days and substituting various tablet sizes for splitting and doubling in order to provide people with their Rx.  I had only switched from synthetic Levoxyl and Cytomel less than two months before all this came to a head.

And I'm finding the Nature-throid (natural desiccated sooooo much better than the synthetic T4/T3 duo that I'll try my mightiest to stay with it or another natural thyroid preparation before considering going back to synthetic thyroid hormone.

Belinda,

I understand the same situation with T3 exists in the UK, and that is often the case in the US.  I've been lucky enough to have eventually had doctors who at the very minimum agreed to prescribe T3, too and I found it to be a big improvement over T4 along.  But now that I have been on natural desiccated thyroid (Nature-throid, similar to Armour) I would never willingly go back to the synthetics.  I'd change doctors if necessary.

Even though T3 is frowned upon doesn't mean it is totally off limits, right?  Many, many people feel better with some T3 along with their T4, though the ratio of the two is subject to debate.  But it is quite reasonable to assert yourself and insist on at least a trial of T3 added to your T4.  I know this isn't always easy, but unfortunately it seems we need to be our own advocates with thyroid conditions.  The squeaky wheel gets the grease.  The quiet wheels just roll along...

I am thoroughly convinced that, for at least 70% of people requiring thyroid replacement, the added T3 component makes a world of difference compared to isolated T4: More energy, greater alertness, better mental clarity, better weight loss, larger effects on lipoprotein(a).

When taking armour thyroid supplements, we must also consider a few factors.  One is if you have a history of diabetes, an overactive thyroid, a long-term underactive thyroid, infertility, swelling of the skin (particularly around the eyes and cheeks), or pituitary gland problems. And if you are going to have surgery, consult the doctor first.

Gee thanks for ruining my dinner! Lol.

Anyway, I came across this article from Fox News website -

"Low-Carb Diet Could Raise Bad Cholesterol Levels"

http://www.foxnews.com/story/0,2933,587393,00.html

I don't know where to begin to point out why it's misleading...

Frustrating when media does that and only to cause more confusion over low carb diet, high carb diet and such.

Lou.

That Fox News article has already been covered HERE.

Nige.

It says:
"Both groups lost around 6 kilograms (13 pounds). But the individuals on the low-carb diet actually had an average increase of 12 milligrams per deciliter increase in their LDL levels, up from 109 milligrams per deciliter (less than 100 is considered optimal); the high-carb diet group showed a 7 milligram per deciliter decrease, down from 102."

"The low-carb group also showed greater increases in their levels of free fatty acids, which are released into the blood when the body breaks down stored fat. High levels of free fatty acids make it more difficult for the liver to store glucose, which in turn ups sugar levels in the blood. Consistently high sugar levels define diabetes."

So I guess the low carbers started burning fat from their guts as if that is bad and also would not be able to store glucose if they were eating any.

Well duh...

Dr. Davis...that picture should be placed on every bag of bread...

Agreed Lou.

Hey, what's the problem? The rat is by far the most nutritious part of that loaf!

Good one.

Uh, wouldn't that raise the protein level and make it less bad?

At our farm, we have a rule: eat our food, and we can eat you. We draw the line at rats and mice though.

The bread was definitely bad for the dead mouse!

I need to get my glasses checked.  I thought I was looking at a chunk of black mold til reading these comments.  When I took a closer look...yuck.  

It almost looks like a contrived photo.

kevin

So I guess the low carbers started burning fat from their guts as if that is bad and also would not be able to store glucose if they were eating any.

I've already been an angioplasty victim ... excuse me, I mean angioplasty patient ... and doctors want me to go through a second angiomutilation ... I mean angioplasty.

Ain't no way they're gonna do that to me again. Even though they would get big bucks from my insurance.

Angioplasty is being promoted as a cure for Multiple Sclerosis Based on Paolo Zamboni's work.
Free download here
Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes
Candian TV program on the subject.
The Liberation Treatment: A whole new approach to MS

I'd be very interested to know if any Track Your Plaque users have MS and whether they have seen improvements in venous blood flow and reduction of MS progression as a result of the program.

Higher levels of vitamin D may well have an impact on the damaging consequences of iron.
By raising adiponectin levels would vitamin D improve bloods anti coagulating properties?
High omega 3 intake should improve blood flow.
Would Niacin also act as a vasodilator and improve blood flow?

"get that feeling of doing something"

says it all...

Angioplasty is not completely useless. As the poster points out "proven useless unless you are in the middle of a heart attack...". It can save lives in such cases.

Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?

There are  thousands of websites which provides information  about  
how is angioplasty done.
But dilseindia is one  of the websites where one can get good info about the  angioplasty.

Sometimes I get confused when people say "wheat". Do you think this also applies to other grains? What about rice and oats?

Thanks,
David

Received so much valuable advice from Dr Davis blog(Vit D,Fish Oil, Thyroid,Niacin) that even though I love wheat(the thicker the crust on anything the better)That I decided to trust him on this one too. I had 10 days of misery ie:no energy,grumpy,and hungry. My wife said bad words about Dr D.... threatened to force feed me donuts because I was so nasty tempered. Now 2 months later I dropped the 15 lbs I needed to, feel better and have found it easy to stay off the stuff. Thanks Dr Davis (my wife says she is sorry!)

Or rye, perhaps?

I was listening to a CD version of the book "1491". It talked about the uniquely Native American ("Indian") invention of agriculture combining maze (corn) and squash and other beans. This provides all the essential amino acids.

It somewhat paralleled the Western invention of agriculture based on wheat and other grains(barley, oats,...).

The comment of significance was that the Native Americans were considerably taller than the newcoming European settlers.

I wonder if that is a "wheat thing" as well.

I read not long ago that when Lafayette and the French soldiers joined forces with the new Americans during the Revolutionary war, it was noted that the new Americans were also taller than the French soldiers.

I wonder.

Although i have reduced my wheat intake by 90% now, but it is not always easy to follow this diet. specially when you also have to avoid few other grains because of the hypothyroid issue. even though it has been said that iodine sufficiency shouldn't let goiter foods do any harm but, i can still feel the effects of these foods with in minutes after consuming, cooked or uncooked.
Few years ago i had bloody stomach every time i went to the bathroom. tired of doctors wait game and suggested operation date 3.5 months away, that's when i decided to become my own doctor and basically started studying my self. i was lucky that with in 3 days i was able to stop the bleeding with simple usage of Aloe (not the regular aloe it is high dose of Aloe Mucilaginous Polysaccharides) and manuka honey. but i learned later on that, all of this started with hypothyroid. while studying this stomach issue i went through this made sense notes from this alternative mental health site.
http://www.alternativementalhealth.com/articles/walshMP.htm
where the author talked about oxidative stress and said,
"factor to consider is the high incidence of oxidative stress in the G.I. tract. This environment can destroy key digestive enzymes such as DPP-IV (needed to break down casein & gluten)..... This condition is especially common in autism-spectrum disorders. Failure to correct the oxidative stress would doom supplemented enzymes to an early death. The result can be similar to Pickett's Charge at the battle of Gettysburg.... The digestive enzymes are mowed down as soon as they enter the G.I. tract. The casein-free, gluten-free diet often results in rapid striking improvements. However, nutritional supplements which overcome G.I. tract oxidative stress can make the CF/GF diet unnecessary.
Normalization of zinc, metallothionein, and glutathione in the G.I. tract isn't difficult to accomplish. It's a lot easier to take a couple of capsules daily than this difficult diet. It takes about 6-8 weeks for the G.I. tract to get "fixed" using this therapy.
We've had many patients who were extremely sensitive to dairy and wheat.... and did marvelously after the CF/GF diet. Many of these same patients completely lost their sensitivity to casein and gluten after the antioxidant supplementation..... and now can eat a normal diet without a problem".
the reason that i am bringing this discussion that i have seen people in certain communities where wheat is their at least 40% of the total diet. yet some individuals in that same community are still got no wheat belly and no major health issues what so ever.

"Mental fog" seems very ambiguous.  Is there any kind of scientific data or quantifiable means by which one can measure the effect of wheat on "brain fog?"

Any studies, or is it all anecdotal evidence?

Please read about the Specific Carbohydrate Diet and the book "Gut and Psychology Syndrome" by Natasha Campbell McBride. Very interesting and nothing we learned in medical school.

There are some who propose that we shouldn't eat any grains at all, because all grains have some particular proteins (particularly defence peptides) which provide protection to the grain plant, but which are harmful to the human immune system. This includes rice, corn, maize, etc.

Check out this article: "Cereal Grains - Humanity's double-edges sword" http://www.thepaleodiet.com/articles/Cereal%20article.pdf

Although I don't doubt the health benefits of eliminating wheat, I am interested in how the Mediterranean diet is considered healthy, yet includes pasta.

Fruits/veggies/grapes mitigate the damage wheat does, or is there some other mechanism? Perhaps genetics play a role, where certain individuals have a much bigger problem with wheat (as to heart disease) than others?

Wheat is the enemy. Ah well....that explains the Italians; and for that matter, the French.  But wait, they are, on average, more healthy than Americans,...... So what about those Japanese and other Asian cultures who consume vast amounts of Omega 6 from soy....maybe their delta-6 desaturase is higher than the average American, and maybe, just maybe they have more exercise in their daily routine.

Dear anonymous, it is a myth that Asians eat vast amounts of soy. They actually eat very little each day. Our food manufacturers have sold us that bill of goods so that we will buy products (franken-foods) with "healthy soy" which is actually the waste product of the soy oil industry--yet another bad for you food.

No disrespect to the French and the Italians - I love to visit both countries and know many natives - but the French and Italians are just "less sick" than we are, they aren't necessarily good examples of abundant health, esp the Italians.  They don't eat as much pasta as we are led to think, but wow, they do eat a lot of bread and sugar.  I saw lots of signs of diabetes among the locals when I was in Italy last summer.  

Overall, my impression from my visits to friends and family of my husband's (for nearly 15 years) is that Europe seems to be heading down a similar  sorry path we've already trodden; they are just a few years behind behind us.  Some European countries are following at a slower pace or a slightly different route, but the signs are there that the industrial food culture is permeating and doing damage, esp in the younger generations.  I think it's happening in industrial parts of Asia, too.

Celiac disease research is very active in Italy because  of the high rate of celiac incidence there.  Check Pub Med, you'll see a high number of Italian papers.

Anna,
You have more personal experience than I do from visits and I respect you observations.  I have not been to either country for over 10 years.

Take a look at the stats on Nationmaster:-

http://www.nationmaster.com/graph/hea_hea_dis_dea-health-heart-disease-deaths

Italy and France are low on the list for heart disease deaths.

Also on Nationmaster you can find stats for a whole host of other things EG wine consumption..... France and Italy top this list. On soft drink consumption, they are at the bottom. Obesity stats also show them at the bottom and USA is #1 but USA is not #1 for heart disease deaths, it is in the mid tier.

In my copy of Lao-Tzu's Te Tao Ching, which was found in a Chinese Han era tomb dated 168BC, it states that one of the other documents found in the tomb was a treatise on "the health benefits of grain avoidance".

Pasta is made from Durhum wheat which has a slightly different genetic profile from baker's wheat.
Even a single amino acid difference in a gluten or casien sequence can change the way it breaks under pepsin digestion, altering or blocking the production of any given exorphin. In my experience the Durhum gluten exorphin is not as vicious as the baker's wheat gluten exorphin, but it is still nasty.
This is paralleled in milk chemistry - beta-casien from A2 milk has a proline residue where beta-casien from A1 milk has a histidine residue; this means that A1 milk forms the potent exorphin beta-casomorphin 7 in amounts approximately 100x that of A2 milk. A1 and A2 are genotypes of common milk bearing cows. Many people who cannot tolerate A1 milk (normal cows milk) can tolerate A2 cow's milk, or goat's milk, which has A2 properties. (Milk can create other exorphins, but BCM-7 is especially potent and well-researched)
This is all linked to the use of low-dose naltrexone to stimulate and harmonise immunity by elevating endorphin levels. LDN can be seen as a drug that undoes the harmful effects of exorphins.
Also, large amounts of digestive protease enzymes are heavily relied on by many alternative canmcer therapists (as is LDN); these will tend to digest exorphins before they enter the bloodstream. This is not the actual rationale for enzyme-based cancer therapy, but to my mind it makes far more sense than the out-dated traditional explanation (the Beard hypothesis). Use of morphine after cancer surgery is associated with a significantly lower rate of remission - morphine is the classical exorphin.
The exorphins only enter the blood if two conditions are met - inadequate pancreatic digestive enzymes (proteases), and/or excessive intestinal permeability (or stomach ulcer) - "leaky gut" (because exorphins, like classic opiates, act directly on the gut, a lack of pancreatic enzymes can eventually lead to leaky gut. Aspirin abuse (even 1 a day, which has increased the rate of Crohn's disease five-fold in a population study - I use ginkgo or reishi instead), antibiotics, and many other drugs can contribute to leaky gut. Probiotics and good nutrition (adequate protein annd fats) are protective against it.

Andrew, there are scientific studies online done on rats in mazes that show orally administered gluten exorphins affect standard tests of learning, memory, etc (mazes and the like) without affecting "swim time" or other more physical parameters. That equates to "brain fog" (cognitive impairment) in humans, I reckon. This is one of the 15 references on PubMed:

[Delayed effect of exorphins on learning of albino rat pups]
[Article in Russian]

Dubynin VA, Malinovskaia IV, Beliaeva IuA, Stovolosov IS, Bespalova ZhD, Andreeva LA, KamenskiÄ­ AA, Miasoedov NF.

Abstract
The delayed effect of food-derived opioid peptides (exorphins) after chronic administration on postnatal days 1-14 on the learning of albino rat pups has been studied. Heptapeptide YPFPGPI (beta-casomorphin-7), pentapeptide YPLDL (rubiscolin-5) and pentapeptide YPISL (exorphin C) improved the development of the conditioned foraging reflex in a complex maze. Hexapeptide PFPGPI lacking the N-terminal tyrosine proved inefficient. Only beta-casomorphin-7 had an effect (negative) on passive avoidance conditioning. The obtained data confirm that exorphins (particularly, milk-derived beta-casomorphins) can have significant and long-term effects on the environmental adaptation of young mammals.

Among the many devastating effects of celiac disease , the immune disease that develops from wheat gluten exposure, are mental and emotional effects, such as anxiety, fatigue, mental "fog," depression, bipolar illness, and schizophrenia, that disappear with removal of gluten. Many parents of autistic children also advocate wheat-free diets for similar reasons.

Good post! I respect you observations. Pasta is made from Durhum wheat which has a slightly different genetic profile from baker's wheat. I am interested in how the Mediterranean diet is considered healthy, yet includes pasta.
Boxing/MMA Supplies

While the term "mental fog" is really vague and unscientific, thinking in more specific terms one can see that , yes it is well documented.  The protein in wheat gluten is very difficult to digest, and in the case of certain autistics, schizophrenics, celiacs, people with wheat gluten enteropathy etc. it is not completely broken down, forming long chains of peptides that have a chemical composition similar to opiates.  These people are all known for their resistance to dietary change and extreme addiction to wheat gluten and often dairy, the protein of which has a chemical composition similar to that of wheat gluten and therefore, is also may form similar peptides.  The symptoms such individuals display might be described in similar terms, dazed, spaced out, the appearance of opium addicts, or "mental fog."  There is research on this phenomenon.

Actually one can eat Ezekial Bread, which is a brand name for an excellent form of sprouted grain bread. The grain is sprouted, then milled; unlike regular flour breads which mill the seed.

This method of making bread is mentioned in the Bible. Also mentioned in the Bible is Olive Leaf which is an excellent anti-oxidant and anti-pathogenic herb. I used it recently to treat an eye sty. I took the Olive Leaf capsules internally.

Hi Dr Davis,

Really excellent to see this discussion of the much vilified saturated fat. If this results in a softening of the approach to saturated fat in your program I will welcome it. It seems like there have been other tweaks in this direction recently in your posts. Making a good thing better is always the way to go. Redefining that awful term "healthy fats" would be a great move.

Peter

I have the greatest respect for you, Dr. Davis. In your efforts to find the best strategies for the treatment and prevention of cardiovascular disease, you are willing to question everything and follow the evidence wherever it leads -- the mark of a true scientist. You would certainly find Gary Taubes' new book, "Good Calories, Bad Calories" to be of interest. Even if you don't necessarily accept all of his conclusions, Taubes does us all a great service by revealing the shaky underpinnings of what "everyone knows" about nutrition and health.

Jen

THANKS again for the opportunity to share with your readers, Dr. Davis!  The saturated fat issue is indeed an exciting one to watch out of the research community in the coming years.  A lot of minds will be changed if people will embrace what the evidence shows them--I am sure of it!

By the way, I also have a popular podcast show called "The Livin' La Vida Low-Carb Show with Jimmy Moore" with nearly 100 encouraging, educating, and inspiring episodes under our belt.  THANK YOU again for interviewing me for your blog!  Keep up the great work you are doing, Dr. Davis!

You should check out Gary Taubes newly released book, "Good Calories, Bad Calories".  It is a historical look at the studies that were done that vilified fat, animal protein and glorified carbohydrates.  It is a study is how really poor science led to the current recommendations.

I've been low-carbing for many years due to diabetes, but after my MI, angioplasty and bypass in May/June, I've become much, much more interested in the fat question and have been reading like crazy.  The following are my preliminary conclusions.

Fish oil is a flatout necessity to get the EPA and DHA we need.  Because of the importance of the bioactive form of vitamin D (which this blog first clued me into), I  prefer cod liver oil to regular fish oil.  

While we don't convert vegetable-based omega3 to EPA and DHA very well, there does seem to be some good reason to get a lot of ALA on it's own.  Flax and nuts are a good source of ALA. Personally, I find whole nuts and seeds or nut butters very easy to overeat, so I prefer nut meals.  A combination of almond meal and flax meal makes a great replacement for flour in making breads, muffins and cereals.  The meals can even "raise" with a bit of baking soda.  For me, it is a great dietary choice to replace starches with these good fats.

Everyone agrees monounsaturated fats are good or at worst neutral, so it's a no-brainer to use virgin olive oil on salad and avocado oil for strifry.  A friend tells me rice bran oil works well for stirfry also.  Preferring these  oils over polyunsaturated vegetable oils reduces the omega6 in your diet, thereby improving the overall omega3:omega6 ratio.

Unfortunately, canola oil as sold in supermarkets is not a virgin oil, but hydrogenated. The process produces just few enough trans fats to allow them to round down to 0 grams trans fat on the label.  If you have a source for virgin canola oil, it moves up into the olive oil and avocado oil category; otherwise, it's a trans fat and should be ditched.

We all agree, monounsaturated fats are good and trans fats are bad, the next question is whether polyunsaturated fats or saturated fats are bad.  There are bright people of goodwill with research to back them up on either side of the question.  As I've looked into this, I've come to the conclusion that it's not a simple issue.  

The primary issue with polyunsaturated fats is that they contain too much omega6 for most of our diets.  Thus the vegetable oils that were pushed as heart-healthy for so long because they were not saturated turn out to have problems in themselves.  

There's three primary issues with research showing that saturated fats are bad.  First is how often older research included trans fats in the same category as "normal" saturated fat.  We know for sure that any amount of trans fats are bad and should be avoided.

Second is that it turns out that saturated fats containing primarily mid-sized fatty acids chains are in a different category than those made of the long chains, a distinction that has only been made relatively recently.  For me, this means eggs are best fried in coconut oil, and I make my own chocolate now with coconut oil, cocoa, flavoring and sweetener.  While very caloric, it is almost all fat and therefore has almost no effect on bg, which makes it a convenient food to eat between meals.

Finally, the saturated fats from meat and dairy products produced from pasture-raised animals contain a lot of CLA (an omega6 fatty acid that turns out to be VERY good for us) and much more bioactive vitamins A and D than those raised on grain in enclosed feedlots where they don't get much sun.  For me, this means that I need to spend the money for the more expensive pasture-raised products even if that means eating less of them overall.  

I never waste the bones from pasture-raised meat or poultry, but instead make stock.  Recipes generally instruct you to skim the fat off, but I figure when I'm using pasture-raised meat, the fat is good stuff.  Besides using stock for soups and gravies, if you concentrate down until it pretty much forms a layer of gelatin under a layer of fat, it makes great stuff to saute/fry vegetables in.

I am also preferring raw milk fermented cheese for a number of additional health benefits in addition to their fat content.

I use butter from pasture-raised animals on some vegetables, e.g. artichokes.  I consider anything that makes vegetables more palatable in the diet to be a good thing as I've come to believe vegetables should be the bottom of the food pyramid.  IME, low-carbers tend to eat much more fiber than otherwise due to their high vegetable intake, so I don't see fiber as a reason to eat grains.

When pasture-raised meat and dairy is unavailable or prohibitively expensive, I would prefer low-fat dairy and the leanest meats instead.  There is definitely research that shows that monounsaturated oils are healthier than the regular saturated fats from the grocery store.  But with the pasture-raised products, I believe the saturated fat is very healthy and heart-protective.

You can located pasture-raised meats and dairy products in your area here: http://www.eatwild.com

You can locate raw dairy products in your area here: http://www.rawmilk.com

While I must low-carb for bg control, I have come to believe the macronutrient content of a healthy diet is much less important than making the *best* choices for each macronutrient.  One can do either a low-carb or low-fat diet in a healthy or unhealthy manner.  For me, the criteria in choosing foods from each macronutrient category is doing so in a manner that maximizes the micronutrients.  

Fresh vegetables, especially the nonstarchy ones, should be at the bottom of everyone's food pyramid.

Even a diabetic can handle a serving or two of the low-sugar fruits every day, though usually not for breakfast.  

Those who can tolerate a higher carb level than myself can also eat *real* whole grains, such as wheat berries, field corn, whole oats, brown rice, barley, etc.  These real cereals are much healthier than anything produced by General Mills or Post.

In practice, I buy too much fresh produce every week and then rush to try to eat it all before it goes bad.  I think this is a great shopping strategy for health.  

A great source for locating farmer's markets and community-supported agriculture (CSAs) for all your fruit and veggie needs is: http://www.localharvest.com

Those in the northeast might look to see if there is a Wegmans nearby.  One just opened up near me and I can now buy all of these products in a regular grocery trip instead of having to shop a variety of sources.

Short of quitting if you smoke, I believe controlling bg is the most important thing anyone can do to improve their heart health.  I have seen research that shows that the A1c is much more highly correlated with heart disease than lipid panels, even in nondiabetics ranges.  This is likely a large part of the explanation for low-carb being so heart-protective for most folks.

While I have been low-carbing for many years, I had lost control of my bg due to a bout with acute pancreasitis about a year prior to my MI.  I recently received my hospital records and I noticed something interesting: during my hospitalization, I was tried on several insulin regimens before they got my bg controlled.  Two days after my bg was controlled, my triglycerides and LDL (calculated) were cut in HALF.  So it seems to me that bg control is primary, which does imply a controlled-carb diet.

I think whatever the macronutrient makeup of a diet, it's a matter of choosing the best carbs, the healthiest fats and getting sufficient protein from as wide a variety of good foods as possible.

If saturated fat is not yet understood and you are trying to reduce your calcium score, do you want to risk eating it?

Jpatti--

Thank you for your exhaustive discussion!

But I'm bothered by one question: Why do you have heart disease?

With your deep appreciation of health and nutrition, how did this happen?

Hi, Rich--

At this point, I truly don't know. I thought I knew. I have to admit that the entire conversation has to, at least, raise some doubts.

It is disturbing, to say the least, that "fact" we accepted for decades seems to crumble in light of new information. There's no need, however, to dive into a diet rich in saturated fats just yet.

Hi Dr. Davis,

I'm confused about the meaning of Low-Carb labeling and an example from a recent post within the TYP member forum triggered this question.  I ask the question here because, hopefully, the great Jimmy Moore might have a thought about it too.

At the http://www.foodforlife.com/ website, I took a look at "Ezekiel 4:9® Organic Sprouted 100% Whole Grain Flourless Bread".

On the label, the Total Carbohydrates are shown to be 15 per slice.  3 grams of dietary fiber carbs and 0 sugar carbs.

So my first stupid question is "where and what are the missing 12 carbs?"

Second question is (perhaps for Jimmy):  I understand that the 3 dietary fiber carbs don't count toward the Atkins carb count right?  But would the 12 carbs of unknown type be counted toward an Atkins Diet carb count?

Thanks Dr. Davis and thanks to Jimmy Moore!!

It sounds like there's 12 g of non-sugar carbohydrates, meaning complex carbohydrates (polymers of glucose). Unless it's cellulose (which is indigestible to humans), it would indeed count towards a carbohydrate load.

Dr. Davis,
Do you recommend a particular % of calories from carbohydrate?  Or a grams-per-day?

Dr. Davis, I didn't HAVE this understanding before May.  I've been doing nothing but reading since though.

What I had was 2 decades of being a T2 diabetic, the first decade of that uncontrolled until I got a bg meter and began low-carb.

When I had pancreasitis, my bg went up to the 300s and stayed there for a year.  I was irrationally scared of going on insulin; I knew I needed insulin and kept postponing it out of fear.  I suspect that is the primary cause of my MI.  I'm on insulin now anyway AND had to have a bypass on top of it, so that was a pretty dumb move on my part.

I haven't kept up with the literature since I was first diagnosed T2 and lots more has been discovered in nutrition since then.      I was a PhD candidate in biochemistry when I was diagnosed as a diabetic, but haven't worked in the field in most of that time and discovered I knew NOTHING when I started studying.  Nutrition discussions are all about compounds that weren't even on the radar screen a couple decades ago.  This is another reason I've become convinced of the importance of whole foods as I have no idea what they'll have discovered another couple decades down the road.

Learning how the various insulins best work in my body was my first step, and it was mostly empirical as dosing information is skewed towards the ADA diet (which is pretty much as stupid as your rants against the AHA) and T1s.  

Now I'm studying heart disease itself, inflammation and endocrinology generally.  

I've also done a lot of reading about fat and nutrition along the way.  You can't study this stuff without doing so.  I'm still in recovery and not able to work, so there's little for me to do besides study this stuff day and night.  Frankly, I'm obsessed.

The fat question is a BIG question and there are intelligent arguments on both sides of the aisle.  My conclusions on this are important to me since I'm apparently betting my life on being right.  I very much want to see any evidence if I'm not right!

Or maybe not betting my life, but betting another bypass.  I've read a bypass "lasts" 15 years.  I want mine to last forever.  I know there are people who have them multiple times, but I can't understand that.  I found it to be the most horrible experience of my life and prefer to not do it again.

BTW, I'm all of 45 years old.  I am postmenopausal, but I'm still pretty young for this; I was the only one under 80 in the CCU.

The angio report said all my arteries other than the left descending (which is where the blockage was) looked good.  The bypass report said my mammary arteries looked good.  So I have a very good shot at being heart-healthy in spite of my history and diabetes if I am wise about my choices.

This is one of the reasons I'm a fan of yours.  While I'm someone unlikely to get useful information from a heart scan, I'm extremely motivated to do the bits that you've seen work in your patients.

P.S. To wccaguy: It's starch. Your body reacts to it pretty much identically to sugar because it breaks it down to sugar.  The only "complex carbs" that are not sugar in the body are fibers, we hardly break down much soluble fiber to glucose at all and don't break down any insoluble.  But starch is the same thing in your body as sugar and it's not reported separately on the label.

Hi, Bix--

For the people who need to restrict carbohydrates (e.g., low HDL, small LDL, high triglycerides, blood sugar > 100 mg/dl), we're generally recommending that carbohydrates be reduced to <30% of calories until patterns are corrected.  

However, in all practicality, I rarely actually tell patients to follow this guideline. Instead, I suggest a virtual elimination of wheat and other processed carbohydrates and this has worked well. Fibers therefore come from vegetables, low glycemic index fruits, oat bran, ground flaxseed, and raw nuts and seeds.      

If serious weight loss is needed, then <50 gram carbohydrates per day yields substantial results.

Hi DR Davis,
          Some clinical studies (Westman et al., American Journal of Medicine 2002; O’Brien et al., AHA Scientific Session 2002; Hickey et al., Metabolic Syndrome and Related Disorders, 2004; Greene et al., Obesity Research, 2003) indicate that LDL levels decrease in people following a low-carbohydrate diets. Yet despite the evidence provided by science, the majority of health professionals remain skeptical of this effect. The source of this skepticism is most likely the mistaken belief that all saturated fats cause an equivalent increase in LDL levels. Such a sweeping judgment, however, ignores a significant difference between distinct subtypes of saturated fatty acids (SFA). They include the following:

1. Lauric acid (C12:0) – this is the most atherogenic SFA, i.e. it increases LDL more than any other SFA
2. Myristic acid (C14:0) – this SFA is the second most atherogenic
3. Palmitic acid (C16:0) – this SFA is the third most atherogenic
4. Stearic acid  (C18:0) – this SFA has no effect on blood LDL, i.e. it is considered “neutral”

          Foods like red meat, butter, cheese, poultry, eggs, pork and fish are primarily composed of palmitic and stearic SFAs (typically in a 3-4:1 ratio) and contain minor amounts of lauric or myristic acids. Such a composition of SFAs would typically cause either a minor net increase or net lack of effect on total LDL levels. Yet one may ask, if a minor net increase in LDL levels is possible, then how does consuming such foods, cooked in heart healthy vegetable oils as part of a low-carbohydrate diet, lead to a reduction in LDL levels for some people?

          Firstly, it is important to note that the primary oils utilized in the ANA include olive, safflower, flaxseed, and canola oils which are rich in unsaturated fats and exert a potent reduction in LDL levels. Secondly, and more importantly, individuals who switch to a low-carb diet from a typical Western diet minimize consumption of hydrogenated oils, i.e. trans fats, found in high-carb processed food items. Since trans fats are the most atherogenic dietary fats, by increasing LDL and simultaneously decreasing HDL, it is easy to see how a low-carbohydrate diet may decrease LDL levels by this fact alone. In effect, people switching from a high-carbohydrate to a low-carbohydrate diet must, by default, consume the majority of calories from whole foods, thereby avoiding consumption of trans fats typically found in carbohydrate-rich, processed foods.

          Lastly, a reduction in LDL levels from a low-carbohydrate diet may also occur as a result of the reduction in triglyceride levels observed in the overwhelming majority of studies on low-carb diets. As triglyceride levels serve as a proxy measurement for VLDL levels, when triglycerides decrease, the VLDL size and/or particle number may decrease as well. As VLDL can be converted to LDL (following triglyceride delivery to body tissues by VLDL), it is easy to see that a reduction in triglyceride levels, and thereby VLDL, can lead to reduction in net synthesis of LDL in the blood which leads to a net reduction in total LDL levels. One further fact needs mention here. High carbohydrate consumption is known to cause an increase in triglyceride levels. Given the biochemical conversion mechanism mentioned above, this may explain why LDL levels increase on such a diet. In short, high-carb diets may be dangerous to ones cardiovascular health.

          In closing, given the enormous complexities of human metabolism, it is difficult to determine a priori who will experience a reduction in LDL levels as this effect is dependent on numerous factors that are not easily measured (previous dietary habits, genetic factors, overall lifestyle, etc). Nonetheless, known and demonstrated scientific facts reveal that it is not counterintuitive nor misleading to expect that in some individuals LDL levels may decrease in a low-carbohydrate dietary regimen.

Great converstaion, thank you for this opportunity.
Colette Heimowitz

Hey wccaguy,

THANKS for your very kind comments!  When it comes to marketing labels on so-called "low-carb" products, my advice would be to be smart about what's right for YOU!

The Ezekiel bread question is a good one and I've heard it regarding the Atkins Nutritionals bars and Dreamfields pasta most often.  It really will depend on the individual and how it impacts YOU!

Personally, Atkins bars don't bother my weight and Dreamfields does not raise my blood sugars.  But there are "missing" carbs in both of those products just like there are in the Ezekiel bread.

One good thing I like about the Ezekiel breads is the fact that they are all-natural, sprouted sources.  But I agree with Dr. Davis that the carb counts in these breads are MUCH too high.

I prefer the low-carb breads from the Francis Simun Bakery in Dallas, TX.  They are the best low-carb breads I've ever tasted and only have a couple of net carbs per slice after you subtract the dietary fiber.

Excellent question!  Feel free to contact me anytime at livinlowcarbman@charter.net.

Hi, Colette--

Wow! Well said! Very helpful discussion of the differing saturated fatty acid effects on LDL.

Yes, I agree. I've seen many people reduce LDL particle number and small LDL, as well as triglycerides and VLDL, by reducing carbohydrates.

Fascinating discussion!

I have a message for jpatti:

If you change your proportions of macronutrients closer towards the following (in g per kg of ideal body weight per day):

Protein 1 g/kg,

Fat 1.5-3.5 g/kg, (mostly animal fat including whatever beef or pork fat comes handy including corn or wheat-fed cattle as well; please be not afraid of saturated fat, if such fat hurt I would be dead long ago!)

Carbohydrates 0.5-0.8g/kg,

- your glucose control will further improve and you may be able to minimize your insulin injections, or even discontinue it if your pancreas is still producing even a little bit.

Stan B.

Colette,

Can you provide a cite for your ranking of the SFAs by atherogenicity?  I have been looking for this very thing.

Thanks

Hi there, I'm a regular reader and occaisional commenter at Jimmy Moore's blog, and since someone asked about saturated fats affects on your calcium score, just thought I'd add my experience with that very subject.

In a word, for me at least, none. Not at all. Zero.

I've been low carbing for five years, eating saturated fats in a very liberal fashion. Lots of beef, butter, cheese, etc. etc.

Went to get a cholesterol test, my doc is alarmed at my LDL and total score (201 and close to 300,) I tried to explain to her that on a low carb diet, triglycerides are low, LDL will be large safe fluffy kind (btw, go see Dr. Eades blog at www.proteinpower.com for lots of excellent info on this-hey why not interview him as well?), but it went in one ear and out the other. She tried, really tried to get me to go on statins, but I refused. She then asked if I would consider a CT scan.

Sure, why not.

Long story short, scan results come back, ZERO calcium. Doc never mentioned statins again.

mrfreddy,

Good for you, but keep in mind that you're a sample of one and that a negative CAC scan doesn't prove that you're not doing serious damage to your arteries.  Especially if you're young, five years could be way too short a timeframe to see calcified coronary plaque emerge, although you may be full of soft plaque.  (Do you know your LDL is big and fluffy because you've had your lipid subfractions checked, or are you just assuming because of what you've read on the Internet?  You should also consider a carotid IMT.)  The foods you eat have been proven to cause transient endothelial dysfunction, the very sort of abnormal changes in vasodilatory capacity seen in diseased coronary arteries.  These changes are measurable and reproducible.  (See Esselstyn's Prevent and Reverse Heart Disease.)

Atherosclerosis aside, you're also skyrocketing your risk of certain cancers (esp. prostate), cardiomyopathies and arrhythmias, liver and kidney diseases, etc.  Again, no doubt your creatinine and other kidney function tests would look fine right now, but you don't see abnormal changes in these tests until the vast majority of your kidney tissue is destroyed, and at that point it doesn't come back.  I'd urge you to recognize that you're making yourself a guinea pig  and not to get too confident on the basis of a single test result.  Documentation on the dangers of high animal product consumption goes back for many decades, but we have perhaps 5-10 years' experience with Atkins and related diets, and already the results aren't good.  Atkins himself was overweight and suffered from hypertension, CAD, cardiomyopathy and CHF at the time he supposedly slipped and hit his head.

I really wish Dr. Davis wouldn't dress down you low-carbers on his blog.  Atkins did us a favor by pointing out the dangers of refined carbs, but the fact that HFCS and white flour are toxic junk foods does not imply that butter, bacon, and cheese aren't also toxic junk foods.

bad,

I'm not so young, I'm 51 in fact.

It's actually amazing to me I didn't have any calcium, since I had an atrocious diet before I found low carb.

As to the LDL, it is widely known that if your triglycerides are low, your LDL will always (well, almost always, there might be weird cases...) be the large fluffy kind. That said, yes, I did have an LDL subtype test done, and yes, it's mostly the large fluffy kind, type A pattern I think they call it. Btw, my HDL is pretty high too.

As to the supposed dangers of a animal based diet, I'll point you towards Gary Taube's book, Good Calories Bad Calories, where he examines the sloppy science that leads to these sorts of nonsense conclusions. There's an article about it in today's NY Times Science section, you should check it out.

As for the 5 -10 years of low carb diets, I'm not worried. We humans evolved over the past 2 million years on a diet that surely was high fat and had to have been low carb. I am hardly a guinea pig, in fact, those of you following a low fat/low sat. fat diet are the ones taking on a new, experimental, and unproven diet, when you look at it from the long view- two millon plus years versus the past 30 or 40 or so. Early results indicate your fat phobic diet - skyrocketing obesity, diabetes, heart disease, cancer-aren't too good.

As to Atkins, didn't you mention something about a case of one? Anyway, I'll just say you are badly misinformed about his condition at the time of his death, and about the cause of his death.

I'm off to enjoy some nice non-toxic grass fed beef, and some low starch vegetables smothered in non-toxic grass-fed butter.  but first I have some non-toxic grass-fed cheese as a snack...

enjoy your tofu dude....

mrfreddy,

Cool calcium score. I visit here because I feel Dr Davis is a pragmatist and will do whatever is needed to drops scores. It is just possible that this could be the watershed after which saturated fat is finally recognised as the perfectly healthy human food that it is. Scores like your's will push TYP in that direction. In 20 years time, what will we think about the saturated fat phobia so prevalent today?

Peter

mrfreddy,

Thanks for the book recommendation.  I hadn't heard of it (looks like it's very new), but I'll check it out.  I have read sat fat apologia in the form of Enig's Know Your Fats.

Appeals to "man's natural diet" are pseudoscience at its worst, and I refuse to address them or base my own diet on them.  No question humans evolved as omnivores; our dentition, digestive enzymes, etc. prove it.  (Those few claiming otherwise tend to be animal rights whackos.)  Furthermore, we can be certain that grains (but also dairy, don't forget) appeared only in the last 10,000 years, refined flours, oils, and sugars in the last couple thousand, and HFCS and hydrogenated oils in the last <100.  But it's still a quantum leap to Atkins.  Nobody knows the ratio of meat to plants eaten by paleolithic man, and it's a moot point anyway because we don't know the impact on his health or longevity (although it's a safe bet he usually didn't live long enough to suffer heart attacks or prostate cancer).  So all nutritional camps are stuck working with basically post-WWII research.

I'd recommend to you Eat To Live by Joel Fuhrman.  Among many other misconceptions, it addresses the low-carb mantra, "We tried low-fat and got obese from it."  But we didn't!  The stats show a slight reduction in fat as a % of calories over the last 30 years, along with a shift to more vegetable oils and a simultaneous large increase in total calories.  We are still eating almost as much of the animal fat and adding the trans-fat and white flour on top.

Finally, wherein did I err about Atkins?  This was all over the press after the coroner's report was leaked to PCRM.  But if I'm wrong, please correct me.

You can research Atkins health and cause of death on your own, just don't rely on PCRM. That is just a propaganda wing of PETA, one of the most unethical and dishonest organization as I've ever heard of. Even their name is a lie. It leads you to believe their members are all doctors, but only a small fraction actually are.

I'm familiar with Eat to Live... the only good thing I can say about it is that it is as low carb as a diet that avoids animal protein and fat can be. Which is a good thing, if you insist on being a vegetarian. But why avoid animal protein? To get the protein you need in a meal, you can eat a 12 ounce steak, or 35 cups of brocoli, hahaa. I know what I prefer. Anyway, none of the so called science the ETL crowd likes to quote stands up to any serious scrutiny.


Low carb diets, including Atkins, are about as close as we can get, or need to get IMHO, to a true paleo diet. The important thing is to keep sugar and starch out of the diet. as this wasn't present during most of our evolution. It makes sense-our bodies evolved to deal with fats and proteins, we thrive on it. But we don't react very well to sugar. Of course, it's a good idea to supplement with Omega 3, and to eat grass fed as much as you can.

It all boils down to the question of whether or not saturated fats are bad for you. When you look at the origins of that idea, and take an objective look at the science behind that idea, it falls apart. That, and given the likelihood that our ancestors probably ate as much of the rich fatty animal parts they could get their hands on, should tell you something.

Here's a couple of other facts for you to ponder. If you don't eat enough saturated fats, and you aat a lot of carbs, guess what your body turns those carbs into? Yup, good old saturated fats. If it's so harmful, why does the body make it?

Also, I've read that mothers milk can contain a lot of saturated fats.

I realize I'll never convince you, but give the Taubes book a go, and try to be objective about it. You may find yourself tucking into a juicy ribeye someday soon without a shred of guilt.

Hi badCRC,

You wrote: "But if I'm wrong, please correct me.". Where do you want me to start? Much of what you said is as "bad" as the Cyclic Redundancy Check (CRC) on your computer, I am afraid.

I read what you wrote in response to mr.Freddy. For starters, Mary Enig, PhD is one of the premier lipid specialists. I hardly would call her writings and experience "sat fat apologia". She is the one that can be credited for our current (after decades of fighting for it) understanding of the many dangers of the man-made, engineered fats called trans-fats. Not exactly the work of a delusional person or apologist.

Second, your assessment of the statistics regarding total fat consumption is seriously flawed. First, you base it on epidemiological "evidence" which is nothing but number crunching games that can, basically, be used to prove that the moon is made out of green cheese. The fact is that there is not a single piece of scientific evidence proving beyond reasonable doubt that (saturated) fat consumption in itself is detrimental to health. What IS there, is again epidemiological number games. But association doesn't prove causation. There are simply no tightly controlled, randomized clinical studies proving this.

Third, you point to the solution in your answer. White flour, sugar, starch, and overconsumption of Omega-6 vegetable oils are the culprit. Not saturated fat which has shown to be, at worst, health-neutral. Not to mention the vast amount of clinical, tightly controlled studies that show an abundance of evidence for the many health benefits of, for example, tropical virgin coconut oils - a "super-saturated" fat.

Fourth, you are definitely wrong to dismiss the brilliant work of the many (especially early) anthropologists, researchers and scientists that studied (and still study) real populations under real-life circumstances. Without exception they all reported that these "primitive" peoples were in excellent, vibrant health and showed none of the many ailments and illnesses we "modern" idiots suffer from. Only when "civilized" CRAP (Cereals Refined And Processed) was introduced, including, of course, sugars in it's many (also hidden) forms, health would decline and suffer.

Finally, you are completely off the mark on Dr. Atkins death. That despicable group called PCRM you are referring to is nothing else than a bunch of wild-eyed ultra-low-fat anti-meat (vegetarian) fanatics that will do anything, say anything, and distort any truth or half-truth to get their dietary delusions exposed by the media - that same media that is always willing and ready to do anything to sell more newspapers. This PCRM and associated violent terror groups(!) like PETA have been earmarked by the FBI as a terrorist organization and many of it members (including the director) have been prosecuted and convicted. The fact is that AFTER his untimely death dr. Atkins showed a higher weight - which is completely normal as a result of fluid retention as organs shut down, one by one. Do some research (and find out the real facts!) before you believe PCRM propaganda and other nonsense. Trust me, you could not be more wrong on this one.

Peter said he visits here because Dr Davis is a pragmatist and will do whatever is needed to drops scores.  Me too.  A heart scan is unlikely to give me useful info because of the bypass, but it is AWESOME to know what has actually been shown to work in live patients wrt actual measurements of coronary disease.  I've not seen anything like it anywhere.

I mentioned previously I've been low-carbing for a very long time before my pancreas was damaged.  I know about low-carb.  Unfortunately, I know about piles of mozzarella and pepperoni melted on a low-carb tortilla as a "pizza" and lots of other low-carb junk food.  Low-carb is a good start, but it's not the whole thing.

You can do any diet unhealthily.  Living on low-carb "bars" and sugar-free candy isn't much healthier than doing low-fat by eating Snackwells; reminds me of vegetarians that live on chips and french fries.  

Macronutrients are only part of the picture.  IME, we have ignored the importance of micronutrients.  This is why I like the fat from pasture-raised meat and dairy.  And this is why I *now* eat up to 10 servings of veggies per day, and a couple servings of fruit as well, which I did not do prior to the heart attack.

I reread the diet chapter in TYP last night.  I agree with more than 90% of it.  In fact, I suspect the disagreement on the topic of saturated fat is much less important to overall health than the huge emphasis on vegetables.  We need this stuff - and we don't yet know half of why we need it.  The emphasis on unprocessed food is also very, very important.  

There's minor points I disagree with Dr. Davis on wrt to diet - most having to do with fats.  And I don't see why anyone should eat nasty soy protein powder when there's lovely milk and whey protein powders!  But I agree MUCH further than I disagree.  Nearly everyone, whether eating low-carb, low-fat, or just the typical American diet, would be doing better to follow Dr. D's diet.  

I am of the opinion that if more than half the food on your plate at each meal is vegetables, it's much less important whether it's lowfat cheese or pasture-raised fullfat cheese melted over it.

It's a *good* choice to use 2 eggs in an omelet instead of 3, to cut the cream cheese in the middle in half, and to make up the difference with an artichoke or quarter head of butterhead.  But it's not because it cuts fat, rather because it adds veggies.  

There's a certain amount of focus on macronutrients which implies that's the primary difference in our diets.  But my diet has more in common with a low-fat veggie eater than it does with many low-carb folks.  The type of dressing that tops a salad is much less significant than eating salads daily.

I'm a long-time reader of this blog but seldom contribute.  This thread must be a record for Dr Davis.  The last few commenters reminded me that extremists exist in both sides of the lowfat discussion. And I tend to disbelieve extremists for no other reason than they're extremists.  

Another lowcarb site recently published a study of what wild monkeys eat.  This is worthwhile because early man would have evolved eating the same way.  It showed wild monkeys eat a lot of fruit during the summer months, turning excess sugar into fat.  During the winter months they burned that fat.  Overall monkeys eat a varied diet of fruits, nuts and bugs.  No saturated fat, I assume.  Meaning no butter, no steak...  It suggests that although we can live on saturated fats, that just means we can adapt to digest just about anything, not that it's the best longterm diet.  

I eat a lot of lean meats, vegetables, nuts and fruits.  Very little wheat, as Dr Davis recommends.  I'm 51, my resting pulse is 50, my BP is 105/55.  It may be healthy but a "juicy steak" is something I find repugnant.

Annonymous,

you should understand something about human evolution. We came from pre-human creatures that yes, ate a mostly vegetarian, monkey like diet. Over a very long stretch of time, we ate more and more meat, making it possible for us to develop bigger brains and smaller stomachs. We needed an energy dense food to do that. Meat is that energy dense food. Fats in particular.

I'm no expert, but my understanding is that because monkeys still have the big stomachs and small brains, they need to eat all day long to get enough nutrition out of what they eat. Mostly vegetation, but they do eat some meat (even other monkeys!) and bugs.

I'll remain civil here and just point out that a sneering tone and ad hominems won't save your life or mine.

I don't trust PCRM either, so here's the coroner's report on Atkins, indicating a history of MI, CHF, etc.:

http://www.thesmokinggun.com/archive/atkinsmed4.html

(Surely you're not arguing that the coroner had an animal rights agenda?)  I realize Atkins swelled with fluid; I'm referring to his weight at admission to the hospital: just shy of 200 lbs.  At his height, 6'0", that's a BMI of 27 -- significantly overweight.  If you had read Fuhrman, you would know that (although there are better measures than BMI) the true ideal weight for longevity is much lower than the CDC/WHO arbitrary cutoff of 25.

It's interesting that you Weston Price people dismiss all epidemiological studies out of hand, yet gush over the "brilliant work" of the early anthropologists -- Price himself, presumably -- which was just an informal version of the same thing, without statistical controls.  Stopping on a tropical island for a few days to snap pictures of the natives' teeth is good science, but peer-reviewed multiple regression analysis on thousands of subjects in different countries is junk science, moon made of cheese, etc.  Could it be special pleading because those studies aren't finding the results you like?  Anyway, there's a small sample at the bottom of this blurb from Fuhrman:

http://drfuhrman.com/library/article2.aspx

... and for the rest, I'll just refer you to the many hundreds of citations in his book (which also addresses your misconception about protein requirements).

Still not good enough, you say.  You want "objective science" proving the danger of sat fat.  Did you miss the reference to Esselstyn in my original post?  You can measure the damage inflicted on your arteries by animal fat using brachial artery flow-mediated dilation (FMD).

If you're not familiar with this test, they take an ultrasonic measurement of the diameter of the subject's brachial artery at a spot on the forearm, then wrap a BP cuff around the upper arm and inflate it to crazy pressures, like 300 mmHg, for five minutes (ouch).  Then they release the cuff and repeat the measurement over time.  At first the artery is much narrower.  In subjects with normal endothelial function, the artery soon gets much bigger in diameter than when it started.  This is called "compensatory dilation" and is caused by the inner layer of arterial tissue, the endothelium, secreting nitric oxide, your natural vasodilator.  It's the same mechanism your body uses e.g. to swell the coronaries in response to increased oxygen demand by the heart.  In subjects with dysfunctional endothelium (e.g., because of atherosclerosis), the artery doesn't dilate like it should.

Interestingly, you can induce that same dysfunction by feeding the subject a high-fat meal.  They fed a test group a 900-cal breakfast rich in animal fat (Sausage McMuffin meal, IIRC) and a control group a 900-cal low/no-fat breakfast (mostly shredded wheat, again IIRC) and found normal dilation in the controls but severely inhibited dilation in the high-fat group for several hours after eating.

I won't repeat this again; read the book.

Finally, as big an issue as sat fat is, you're wrong to think that it boils down to that.  The larger issue is nutrient density -- the fact that animal products (along with refined grains and oils) are rich in energy (calories) and deficient in carotenoids, flavonoids, organosulfides, etc., and hundreds of other protective micronutrients still undiscovered in fruits and vegetables.

howdy again MR. Bad,

sorry if I was sneering, just get carried away sometimes!

about that coroner's report-do you know how coroner's reports get filled out? Some guy in a coroner's office, who isn't familiar at all with a patient's history, scribbles something on a piece of paper. Yes Dr. Atkins did have heart issues, but his claim was that it wasn't related to his diet. I personally don't know, and you don't either.

And yes, he was slightly overweight, as are a lot of folks who follow his advice to not worry about calories, just cut the carbs. That only gets you so far. That's why I stopped "doing Atkins" a long time ago. I still low carb-he got that part right.

Do you know how that coroner's report got  into the public's eye? Your nasty and unethical PCRM folks obtained it illegally and distributed it, that's how. Because, in their view,it's a usefull piece of propaganda.

I believe you said something earlier about a study of 1 doesn't mean much. I agree. So enough about Dr. Atkins.

About Dr. Furhman, he's gotta do more than list a load of references. You need to make an objective, scientific analysis of those studies, and of ALL the relevant studies. You can't start with a conclusion already in mind-animal fats are bad-and find all the studies that support that notion, or seem to. That is sloppy science. That's what Taube's book is about.And I guarantee you that is what Furhman has done. He is ignoring all the evidence - and it is growing bigger all the time - that animal protein and fats are not the problem, but it's excessive carbs/starch/sugar.

Speaking of sloppy science, the study you mentioned is a fine example. A McDonald's sausage McMuffin? Oh puh-leaze. Do you know how many carbs are in that thing? Not to mention trans-fats?

And yes, I always eat lots of vegetables and fruit. Right next to my steak and with butter (on the vegetables, not the fruit! Although, buttered blueberries? hmm, might be better than it sounds...)

bad_cr

You've missed out in your reading somewhat, check this link

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12064344&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSuml

before you bet your life on those mysterious undiscovered

"hundreds of other protective micronutrients still undiscovered in fruits and vegetables"

which you believe in.

Here is the last line of the abstract from the above citation:

The overall effect of the 10-week period without dietary fruits and vegetables was a decrease in oxidative damage to DNA, blood proteins, and plasma lipids, concomitantly with marked changes in antioxidative defence.

Please note the word decreased.

I do have the full text, which is interesting but irrelevant to anyone fully committed to herbivory.

Personally I'm more impressed by a EBCT score of zero than the advice to read Fuhrman's book.

Peter

PS here are the comments from one of the main funders of this vegetable wash out study:

"The study has been carried out with financial support in part from a Danish Food Technology grant (FØTEK2, ‘Antioxidants from plants’) and in part from the Commission of the European Communities, Agriculture and Fisheries (FAIR) specific RTD programme, CT 95-0158 ‘Natural Antioxidants from Foods’. It does not necessarily reflect its views and in no way anticipates the Commission’s future policy in this area"

I doubt it will affect your future policy either.  However, I genuinely wish you luck. You may need it.

Sorry the link got chopped, the paper is

Green tea extract only affects markers of oxidative status postprandially: lasting antioxidant effect of flavonoid-free diet.

Young et al Br J Nutr. 2002 Apr;87(4):343-55

Enjoy

Peter

bad,

If you and Dr. F. and the PCRM are right about saturated fats, how do you explain EACH of the following:

1) Native populations who ate animal protein/fat almost exclusively (Inuit, Masai, etc.)did not have heart disease. No cancer either. No diabetes. If saturated fat alone was the boogey man you think it is, this simply could not be possible. Clearly other factors are involved.

2) Your own body makes saturated fat when you don't eat enough of it.

3) Mothers milk contains saturated fat. A lot of it.

4) Human evolution. How could we have gotten to the point we're at now, if animal protein/fat was really so dangerous?

5) Our bodies have numerous mechanisms/hormones, etc. to RAISE blood sugar. Only one, insulin, to lower it.

6) Test after test of a true low carb diet have shown that the diet improves cholesterol, particularly in regards to reducing the only really meaningful part of cholesterol numbers, low density, small LDL particles. These are dangerous because they are small enough to penetrate cell walls and form plaque. Low carb diets have been proven, again and again, to reduce their presence. High carb diets do the opposite.

Given all that, I think I'll continue to eat the diet that my body seems to be designed (exquistly so I might add) to eat.

Baddie my pal,

About that sausage mcmuffin study, take a look at what Dr. Eades has to say about that one:

http://www.proteinpower.com/drmike/?p=144

Here's my condensed version:

The "researchers" only reported on a SUBGROUP,ie a MINORITY, of the subjects of the study-they IGNORED the majority of subjects who didn't give them the response they were looking for.

In reality, most of the subjects involved in the test actually had improved "arterial compliance" on the ridiculous high fat high carb" meal.

This is a classic example of truly sloppy science.

Here's a little quote from Dr. Eades.

So, actually, a majority of the subjects had improvement in arterial compliance with the high-fat diet as compared to the high-carbohydrate diet. But our researchers remained undeterred by these facts as they went on throughout the rest of the paper describing all the negative findings in the minority of subjects who responded negatively to what could only be described as a horrendous meal by anyone’s standards (except executives of McDonald’s, I suppose).

Thanks for the amicable responses.

mrfreddy,
I don't remember for sure if it was a McD's breakfast.  It wasn't the carbs, because the control group meal was loaded with what you and I would agree are junk carbs (shredded wheat).  Could have been the trans fats, but there were several experiments, and the same results were demonstrated with other high-fat meals -- including the beloved extra-virgin olive oil.  Again, this was Esselstyn, not Fuhrman.

I should make that distinction clear:

Esselstyn:
- afraid of all fats, plant or animal; strictly vegan, <10% fat by calories; allows unlimited whole grains
- cured advanced CAD in a small group of subjects using this diet
- member of PCRM

Fuhrman:
- not affiliated with PCRM (AFAIK)
- allows animal products for up to 10% of calories; nutrient density, not avoidance of specific foods, is the point; most "vegan" diets are horrible
- much harder on refined carbs than animal foods; whole grains allowed in moderation, but totally unnecessary and harmful for certain individuals
- fats from whole plants are beneficial; optimal diet varies somewhat by individual, and may be anywhere from 10% to 40%+ fat

Now to your points:
1. Inuit, at least, still have worse longevity than even fat Americans.  (See http://www.itk.ca/media/backgrounder-health.php)  Almost any traditional diet seems to be better than McMuffins, soda, and Twinkies (surprise).  But what's optimal?  The populations with the highest proportion of centenarians (Okinawans, Abkhazians, Vilcabambans, etc.) all eat diets almost entirely of whole plants.  None are strictly vegan.

2. Irrelevant.  How much glucose do you eat?

3. I thought human milk fat was mostly medium-chain triglycerides, not the atherogenic long-chain SFAs; I'll have to read Mary Enig again.  Human milk is also 42% sugar (lactose) and only 7% protein by calories!  (http://www.disknet.com/indiana_biolab/b120a.htm)  Nobody disputes that babies' dietary needs are different from adults'.  What's your point?

4. Evolution only needs you to live to about 30, so I don't see how this is relevant.  Natural selection wouldn't have selected out smokers, either.

5. I don't get what you're saying here.  Clearly, for most of our evolutionary history our overriding concern was getting enough calories from any source.  All these appeals to "evolution" are conjectural BS.  What do comparative and epidemiological studies show to be optimal for health and longevity?  That's the question.

6. Fuhrman addresses this.  Yes, starting from the toxic American diet, low-carbing causes (rarely maintained) weight loss and, consequently, improved lipid profile, insulin response, etc.

The absence of clinically apparent disease (right now) isn't the same thing as good health.

Peter,
Your PubMed link got truncated.  Please try again or post the title and abstract.  I am very interested in reading this very counterintuitive-sounding study.  (Even the most diehard low-carber usually doesn't argue that veggies are bad for you?)

Interesting comments.  (I got a lot of ideas for my reading list!)

Dr. D, thank you for your response.

Curious - If we remove the argument of whether saturated fat is good or bad ... is there an opinion of whether meat protein is good or bad?  I'm wondering about the hormones, the iron, the amines, the bacteria, etc.

Bad bad,

responding to your responses..

Now to your points:
1. Inuit, at least, still have worse longevity than even fat Americans. (See http://www.itk.ca/media/backgrounder-health.php) Almost any traditional diet seems to be better than McMuffins, soda, and Twinkies (surprise). But what's optimal? The populations with the highest proportion of centenarians (Okinawans, Abkhazians, Vilcabambans, etc.) all eat diets almost entirely of whole plants. None are strictly vegan.

Noone knows what caueses these populations to live longer. This is data chery picking at it's best.

2. Irrelevant. How much glucose do you eat?

haha, got a chuckle here. you actually have a good point... the body makes sugar from protein, to provide the glucosse the body needs. However, sugar, or glucose, is only used in very very small amounts, for just a few places in your body. My understanding is that sat. fats are a critical building block for all cells throughout the body.

3. I thought human milk fat was mostly medium-chain triglycerides, not the atherogenic long-chain SFAs; I'll have to read Mary Enig again. Human milk is also 42% sugar (lactose) and only 7% protein by calories! (http://www.disknet.com/indiana_biolab/b120a.htm) Nobody disputes that babies' dietary needs are different from adults'. What's your point?

Point is, if nature provides it, how can it be dangerous? It supports the notion that saturated fats are beneficial, even needed, by our bodies.  as for human breast milk, I think it's content varies a lot, even on the same day. I've seen all sorts of descriptions of what's in it, none of which agree with the other. But it does include lots of protein, and saturated fats.

4. Evolution only needs you to live to about 30, so I don't see how this is relevant. Natural selection wouldn't have selected out smokers, either.

If you want to disregard the fact that your body evolved over millions of years to thrive on a diet of meat and fat, because early humans tended to die early (no doctors, medicine, plumbing, not to mention nearby tribes and beasties that want to kill you....), well, I don't know what to tell you.

5. I don't get what you're saying here. Clearly, for most of our evolutionary history our overriding concern was getting enough calories from any source. All these appeals to "evolution" are conjectural BS. What do comparative and epidemiological studies show to be optimal for health and longevity? That's the question.

comparative epidemicologial studies are the height of BS. Read Taubes.

6. Fuhrman addresses this. Yes, starting from the toxic American diet, low-carbing causes (rarely maintained) weight loss and, consequently, improved lipid profile, insulin response, etc.

I would say that a low carb diet is helluva lot easier to stick to and maintain that Dr. Furhman's diet. I've been on it five years plus. I stick to it because it satisfies, really satisfies, to the core. In a way that Dr. F's rabbit food could never satisfy.

There are thousands on the low carb forums that have maintained quite easily.

I would also say that any given low carber's lipid profile is better than it would be on Furhman's diet. It' the triglycerides number that really counts. While his diet is a low sugar as it can be for a mostly vegetarian diet, it still delivers a lot of sugar to the body.

what's your triglyceride count, btw? I think mine was 60 or so, but I'd have to look it up to be sure. If your's is under 100, I'd be suprised.

The absence of clinically apparent disease (right now) isn't the same thing as good health.

Only if we accept your definition of "good health". I'll take very low small LDL, zero calcium, and the fact that I rarely get sick (I've only had two or three colds in the past five years, in spite of the fact that I work in close proximity with folks who are coughing and hacking away, not to mention my carb loving gf who gets two or three colds a year...)

I'm waiting patiently for your response to Dr. Eades on your silly Sausage McMuffin study. Particulary the point that the researchers only found the adverse reaction in a small minority of subjects, that most of them reacted better to the horrendous high fat/high carb meal. This is pure junk science.

The reference for the intervention trial is here. NB this was NOT a low carb study.

Youmg et al  Br J Nutr. 2002 Apr;87(4):343-55 Green tea extract only affects markers of oxidative status postprandially: lasting antioxidant effect of flavonoid-free diet.

Some idea of how plant consumption produces sustained antioxidant effects is given here, thank goodness for uric acid:

Lotito SB and Frei B (2006) Consumption of flavonoid-rich foods and increased plasma antioxidant capacity in humans: cause, consequence, or epiphenomenon? Free Radic Biol Med. 2006 Dec 15;41(12):1727-46

A very much weaker observational study "associating" antioxidants with DNA damage (but it's as valid/invalid as those associating red meat with cancer) is this one:

Watters JL et al (2007)  Associations of antioxidant nutrients and oxidative DNA damage in healthy African-American and White adults. Cancer Epidemiol Biomarkers Prev. 2007 Jul;16(7):1428-36

I have only the abstract for that study but here's the punchline:

"African-Americans had statistically significantly lower plasma concentrations of vitamin E, alpha-carotene, beta-carotene, and lutein + zeaxanthin than Whites, as well as lower self-reported intake of most antioxidants. Levels of oxidative DNA damage, measured using the alkaline comet assay, were lower in African-Americans than Whites."

I make no specific suggestion that eating plants is bad for you, other than the vast array of poisons they have evolved to combat herbivores, more that there are publications you should consider. In the words of Eeyore "Think of all the options... before you settle down to enjoy yourselves"  A.A. Milne (1928) The House at Pooh Corner. Methuen & Co. Great Britain p96.

Peter

mrfreddy,
Forgot to respond to the Eades rebuttal...  Actually, the paper Eades attacks isn't one of the ones Esselstyn cites, which are:

Robert A. Vogel, Clinical Cardiology, June 1999: "Brachial Artery Ultrasound: A Noninvasive Tool in the Assessment of Triglyceride-Rich Lipoproteins."
http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=407824

Note: In the book he doesn't mention McDonald's; I think it was in the video talk on his website: http://www.heartattackproof.com/media.htm

... and the olive oil one:
R. Vogel, M. Corretti, and G. Plotnick, Journal of the American College of Cardiology, 2000: "The Postprandial Effect of Components of the Mediterranean Diet on Endothelial Dysfunction."
http://content.onlinejacc.org/cgi/content/abstract/36/5/1455

Anyway, I read the abstract and I say Eades is attacking a straw man.  They didn't just slice off the bottom tail of the curve and conclude circularly that some people react badly to McMuffins.  They showed that, in that subgroup of "fat reactors" (and only in that group), the endothelial dysfunction correlated with markers of insulin resistance, including baseline TG, glucose, and insulin, and peak postprandial TG.  I think the article was badly titled; their real conclusion seems to be this sentence: Normal weight young subjects with an insulin resistance phenotype show significantly decreased vascular compliance, increased postprandial TG peaks, and markedly reduced plasma nitric oxide metabolites after a high-fat meal.

Given what we know about the importance of NO-mediated vasodilation, these studies are hardly junk science.  Still, Esselstyn definitely implies that everybody will exhibit that same set of responses.  In reading the two Vogel abstracts, nothing jumps out at me that contradicts that, but the Blendea article certainly suggests that it's not that simple.  Geez, this is complicated enough even assuming everybody is intellectually honest.  Thanks for that link.

Peter,
I'll have to look over these.  I am aware that a lot of the nifty antioxidant effects seen in vitro turned out not to work in vivo.  I will say that Fuhrman doesn't overemphasize "antioxidants" in touting the many benefits of veggies.  Anyway, I picked up Taubes' book today and am plowing through it.

Dr Davis said:

"At this point, I truly don't know. I thought I knew. I have to admit that the entire conversation has to, at least, raise some doubts."

It's statements like this that set Dr. Davis and this blog apart.  He is willing to look at the data and follow it wherever it leads, even if it might mean letting go of a long standing belief.

Thank you, Dr. Davis, providing such valuable information.

I asked my doc for advanced lipid profiling and she says the jury is still out on this, I asked for a repeat calcium score test, I have to pay for it myself $400 as she says they don't know how accurate it is.or whats the info useful for??

I take Lipitor 10mg a day and would love to get off it as reviews for women and lipitor are not good, I eat low carb, am off insulin, down 80 lbs and have good labs results. My last calcium score was 183 in 2004 and would like to see if it is down is it worth me pushing her to order these tests??

Actually thats a dumb question to ask here, I read your book Dr D, great, but I don't eat grains as need a shot of insulin to do so, and I do use some sat fats, not allot but some cream in a coffee once a day and some butter on vegs,  try to keep under 20 gr a day.

I think you already know what I think: I have no hesitation whatsoever in suggesting that repeat CT heart scans, especially after a 3 year interval provide INVALUABLE feedback on your program. Also, have you addressed vitamin D?

Hi, yes I am going next week to ask again for the calcium score as just switched Dr. I use Vit D 1000 u a day.

For the last 5 years I've focused on raising my HDL, both with diet and immediate-release niacin. By eating a moderate fat (38%) diet rich in polyunsaturates and low in saturated fats and taking 4g niacin daily I was able to raise my HDL from 32 to 44.  After reading Gary Taube's book, I decided to transition to a high fat (60%), low carb (7%), approach and also increased by saturated fat intake (31% of calories) that contained significant amounts of coconut oil.  My LDL increased by 4 points while my HDL skyrocketed up to 71!  Polyunsaturated fats now account for only 6% of calories.  BTW, my triglycerides also dropped significantly.

Meta-analysis of prospective cohort studies evaluating the association
of saturated fat with cardiovascular disease
Full text of this paper is online thanks to http://metabolismsociety.org

For those who aren't aware Frank Hu and Ronald M. Krauss, M.D are significant figures in lipid research and the American Journal of Clinical Nutrition is probably the world's most prestigious nutrition journal.

Very funny this appears the same week the UK's Food Standards Agency starts it Ban the Butter campaign.