Response from Nature Made

Here's the response from Nature Made when I emailed them about my concern that there appears to be no vitamin D in their vitamin D gelcaps.

It is the usually CYA corporate-speak that says nothing. The grammatical errors make it clear that this was a "canned" response.



Date: April 9, 2010
From: Marissa Reyes, Consumer Affairs Department
Subject: Reference #346236

Dear William Davis, MD:

We recently received your e-mail regarding Nature Made products. We regret to
hear that the quality standards of our company. [?]

Our company is called Pharmavite, and we manufacture Nature Made nutritional
supplements. We have been in business since 1971. We are committed to quality
control, and have very high quality standards. Our Quality Control personnel
sample and test all raw materials as they enter our plant, and again assay the
finished product, before final packaging.

Dietary Supplements are regulated under the FDA through DSHEA (Dietary
Supplement Health & Education Act of 1994). The United States Pharmacopoeia
(USP) establishes standards for the composition of drugs and nutritional
supplements. This voluntary non governmental organization was set up in 1820
and has officially been recognized by federal law since 1906. Standards
established by USP for products are legally enforceable by the FDA. At
Pharmavite we participate in the USP Dietary Supplement Verification Program
(DSVP). Many of our products have earned the DSVP seal and additional products
are currently being evaluated. Our DSVP certified products will have the DSVP
seal on the product label.

Our Nature Made Vitamin D 400 IU tablets have been reviewed by the USP and bears
the DSVP symbol on the label. Although the USP has not reviewed all of the
Nature Made Vitamin D supplements, all of our products go through the same
rigorous quality testing at Pharmavite. The products which have earned the seal
help us to demonstrate the high quality of our products.

We would like to look into the product(s) your patients have been using. If you
could provide the UPC and lot numbers of the product(s), we will be happy to
review our records. In addition, if you would like us to test the product(s)
that you currently have, we will be pleased to send a prepaid postage mailer so
you may return the product(s) to us so that our Quality Control Department can
examine it. Please let us know if you would like us to send you the prepaid
postage mailer.

We thank you for contacting us and hope that you will continue to use and enjoy
Nature Made products with complete confidence.

Sincerely,
Marissa Reyes
Consumer Affairs Coordinator
Pharmavite, LLC
MR:346236-10



Patients who come to the office do not provide me with the bottles nor lot numbers. In past, when I've gone to the trouble of doing this (with other companies, not Nature Made), it has come to nothing helpful. The information gets passed on to the company and we hear nothing and never learn if there was a problem, or receive some more corporate-speak letter saying everything was fine. This is obviously a liability-avoidance tactic: Admitting that something was wrong would open them up to legal risk. So, frankly, I can't be bothered.

So we are left with the unsatisfying experience of relying on street-level experiences.

For now, my advice: Avoid Nature Made vitamin D. Too many people have had blood tests demonstrating that they are not obtaining any vitamin D.

By the way, the Nature Made brand of fish oil is among the very few problem brands of fish oil we've encountered. Fish oil should be only mildly fish in smell and generally should not cause stomach upset and excessive belching if properly purified. Nature Made is excessively fishy when you smell it, suggesting oxidation. We've had repeated (dozens) of patients who have experienced difficulties with this brand. Rather than dealing with the frustrating gobbledy-gook of this company, just avoid their products.

Comments (31) -

  • Tony

    4/10/2010 1:40:39 PM |

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

  • Anonymous

    4/10/2010 3:06:53 PM |

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

  • Impudent_Observer

    4/10/2010 3:31:05 PM |

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

  • gindie

    4/10/2010 3:44:38 PM |

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

  • whatsonthemenu

    4/10/2010 4:34:04 PM |

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

  • Anonymous

    4/10/2010 5:36:51 PM |

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

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

  • Gary Wu

    4/10/2010 5:45:05 PM |

    Hi Dr. Davis,

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

  • Painlord2k

    4/10/2010 5:55:53 PM |

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

  • Nancy

    4/10/2010 8:11:24 PM |

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

  • Dr. William Davis

    4/11/2010 1:04:57 AM |

    Impudent--

    Great idea.

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

  • Dr. William Davis

    4/11/2010 1:05:51 AM |

    Gary--

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

    It never hurts to have your blood level checked.

  • rhc

    4/11/2010 1:40:53 AM |

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

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

  • Anonymous

    4/11/2010 1:54:25 AM |

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

  • Daniel Schroeder

    4/11/2010 4:00:08 AM |

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

  • Dr. William Davis

    4/11/2010 1:05:50 PM |

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

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

  • TedHutchinson

    4/11/2010 7:41:25 PM |

    I subscribe to Consumerlabs.

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

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

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

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

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

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

  • Douglas Jones

    4/11/2010 11:10:00 PM |

    Dr. Davis

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

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

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

    Thank you

  • Dr. William Davis

    4/12/2010 11:34:16 AM |

    Thank you, Mr. Jones.

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

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

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

    However, I remain confident that there is a problem.

  • Heather Brandt

    4/13/2010 10:10:58 PM |

    Do you recommend multivitamins and/ or Vitamin D brands?

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

    heatherlbrandt(at) verizon (dot) net

  • Anonymous

    5/18/2010 10:34:01 AM |

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

  • dining tables

    7/6/2010 3:44:11 AM |

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

  • Trem papers

    8/16/2010 10:25:23 AM |

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

  • dlrose123

    10/19/2010 2:03:49 AM |

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

  • auto insurance quotes

    3/9/2011 1:13:12 AM |

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

  • Anonymous

    3/17/2011 5:35:13 PM |

    There is interesting research on omega 3 bioavailability.

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

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

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

  • Anonymous

    3/17/2011 7:03:36 PM |

    Omega-3 structure may affect bioavailability: Study

    By Nathan Gray, 14-Jan-2011

    Related topics: Research

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


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

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

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

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

    Fish oil

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

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

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

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

    Study details

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

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

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

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

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

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

  • Anonymous

    3/17/2011 7:04:21 PM |

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

  • Anonymous

    3/17/2011 7:15:55 PM |

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

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

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

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

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

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

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

  • K.N.O.W. (Kids Need Our Wisdom)

    3/27/2011 9:30:17 AM |

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

  • Study in UK

    4/14/2011 7:54:42 AM |

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

  • gareth

    9/7/2011 10:13:45 PM |

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

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Triglyceride and chylomicron "stacking"

Triglyceride and chylomicron "stacking"

Continuing the comments started in Grazing is for cattle, here's an interesting study from the Oxford Center for Diabetes, Endocrinology and Metabolism.

Volunteers were fed a test meal breakfast of Rice Krispies, a banana, and a chocolate milkshake (76.4 grams carbohydrates, 51.9 grams fat, 12.2 grams protein). Lunch was served 5 hours later and consisted of a cheese sandwich and a second chocolate milkshake 43.4 grams carbohydrates, 49.6 grams fat, 24.0 grams protein). Frequent blood samples were then assessed over the day. (Don't try this at home: These are obviously very dangerous foods!)

Here's the pattern of triglycerides that was observed (1st dotted vertical line = breakfast, 2nd dotted vertical line = lunch):



Note that triglycerides only begin to decline 3-4 hours after breakfast, only to peak higher after lunch.


Here's the pattern observed for chylomicrons, the "granddaddy" of lipoproteins that derives from intestinal absorption of fatty acids:



Both graphs from Heath RB et al Am J Phyiol Endocrinol Metab 2006.


With chylomicrons, note a similar pattern to triglycerides: Chylomicrons begin to decline at 3-4 hours, only to peak higher after lunch.

This is the first study to examine the effect of sequential meals on such postprandial (after-eating) patterns. But it makes the graphic point that, if insufficient time is permitted between meals, both triglycerides and chylomicrons will "stack" themselves higher and higher. (Chylomicrons are subjected to processing by the enzyme, lipoprotein lipase, to form highly atherogenic, or plaque-causing, chylomicron remnants.)

While not examined in this study, my bet is that "grazing," i.e., eating small meals or snacks frequently, is an extreme instance of triglyceride, chylomicron, and chylomicron remnant stacking. That can only lead to one thing: accelerated heart and vascular plaque.

Comments (24) -

  • Ross

    11/10/2009 6:02:20 PM |

    I thought that chylomicrons produced by the gut became bouyant fluffy LDL and that IDL produced by the gut became small dense LDL.  No?

    Also, it occurs to me that this "gut-produced particle clearing" phenomena could be all/part of the cholesterol benefit of intermittent fasting.  By allowing the body time to fully convert/reduce the gut produced lp particles, the body has more time to restore a homeostatic balance of blood lipid particles.

  • Jim Purdy

    11/10/2009 6:34:06 PM |

    Both meals were high-carb and high-fat. Can you be more specific in placing the blame on either the high-fat or high-carb component? I am inclined to believe that a high-fat (but low-carb) diet would not show the same stacking effect.

  • Will

    11/10/2009 7:14:27 PM |

    Hi Dr. Davis,

    So I guess that we could either not eat for approximately 7 hours after each meal (which I just kinda eyeballed from the chart where I thought that it would end up back at baseline) or eat something that does not contribute to either plasma TG or chylo concentrations. In the "Grazing" post you had replied that veggies probably wouldn't have much of a negative post-prandial effect. Would anything else be safe to eat without affecting these numbers? Probably not, LOL! Just trying to look for a practical application of this information, because If I had to go 6 or 7 hours without eating, I would have to struggle with compliance. Thanks!

  • David

    11/10/2009 7:19:09 PM |

    Nice summary, Dr. Davis.

    I eat two low carb meals per day. A small breakfast in the morning and a large dinner at the end of the day. I also fast 1-2 days per week. I am definitely in favor of spacing out meals far apart. This also helps with insulin sensitivity and weight management. Even on a low carb diet, insulin spikes when we eat. This is countered by glucagon, of course, but palmitic acid still creates a temporary (and reversible) insulin resistance for awhile after this, and it just doesn't make sense to keep feeding this cycle with frequent meals - low carb or not. It is very freeing to eat less often. You can devote your time to other things. Hunger takes care of itself once gluconeogenesis kicks in and blood sugar is under control, and you stop obsessing over food. It's great.

  • scall0way

    11/10/2009 8:04:57 PM |

    Posts like this make me glad I've changed my eating habits to eliminate all snacks and often have just two meals a day. Smile

  • Adolfo David

    11/10/2009 10:48:57 PM |

    This only probes that when one eats a glycemic meal.

  • Anonymous

    11/10/2009 11:34:03 PM |

    Hi Dr. Davis,

    Seems like these meals had high levels of both carbohydrate and fat.  Don't postprandial chylomicrons and triglycerides reflect dietary fat rather than dietary carbohydrate?

    Dan

  • Gretchen

    11/10/2009 11:48:27 PM |

    I tend to graze, and I once tested the effect of grazing vs 3 meals on my blood sugar levels.

    On Day 1, I ate as I normally do (grazing), but every time I ate something, I put an equal amount of the food aside.

    On Day 2, I divided the set-aside food into three groups and ate 3 meals, with no snacks.

    Results were what you might expect. With the 3 meals, the peaks were higher, but because there was more time between meals, the blood sugar dropped lower before the next meal.

    The overall average blood sugar was almost exactly the same.

    I suspect lipids are similar.

    I once tested my triglyceride levels every hour all day on a low-carb and a low-fat diet.

    You can see the results graphed in the second edition of my book "The First Year: Type 2 Diabetes."

    On the low-fat diet, at first the TGs went down, but then they started to climb and by the end of the day they were higher than they had been when I started.

    Of course with a home meter I couldn't differentiate different types of TG.

    I had been eating LC, so I was adapted to that way of eating. I didn't eat low-fat for a week before doing the low-fat trial, so those results might be questionable.

  • UofMWolverine81

    11/11/2009 1:34:37 AM |

    How much of an impact does/do you suspect that the quality of food choice have/has on this "stacking effect"?

    Is this much of an issue for someone eating every 3-4 hours or so and consuming lean meats, fresh fruits and vegetables, moderate amounts of fat from avocados, coconut, olives, nuts/seeds, and so on?

    The offerings in the study, while possibly common fair for many folks, is hardly indicative of what a lot of health-conscious fitness types are doing these days, which is why I ask.

    I'm curious if the same issue would still exist with more health-promoting choices, even if to a smaller degree, or if it is not an issue in that case.

  • Dr. William Davis

    11/11/2009 2:00:01 AM |

    A clarification: The meal used in this study was not intended to represent some sort of "ideal" meal, but a meal of exaggerated composition that yields useful observations during the testing period. I would not interpret the data to suggest that the diet was good nor bad. (Though, obviously, thes were junk food meals.)

    Both fats and carbohydrates affect postprandial patterns in complex ways. Recall, for instance, that fructose causes extravagant distortions of postprandial responses.

  • shel

    11/11/2009 2:16:43 AM |

    perhaps this makes the case for eating (a) high fat, moderate protein meal(s) during the day.

    my breakfast consists of fat/meat and lunch is olive oil/bison sashimi or olive oil/lamb sashimi, both with fresh herbs. not much in the way of carbs. i don't know yet, but i have doubts about the negative effects of chylomicrons in the absence of carbs.

  • Anonymous

    11/11/2009 2:34:43 AM |

    But would the 9-hr pattern really be
    better if they had the same total intake all in one meal? This is not shown.
    Presumably it'd have only one peak, but that peak would be significantly higher.

  • Sifter

    11/11/2009 3:55:32 AM |

    This contrarian study of low carb linked with atherosclerosis in mice...does raise some questions on high protein/low carb effect on endothelium (edited to fit space)

    A new study reported Online in the Proceedings of the National Academy of Science (August 24, 2009) provides information about the effect of the low-carb, high-protein diet on the health of blood vessels.

    Conducted by a team of scientists at Beth Israel Deaconess Medical Center (BIDMC), the study found that mice placed on a 12-week low-carb, high-protein diet showed a significant increase in atherosclerosis—and an impaired ability to restore blood vessels.  

    Senior author Anthony Rosenzweig, MD, Director of Cardiovascular Research at BIDMC and Professor of Medicine at Harvard Medical School, and lead author Shi Yin Foo, MD, a clinical cardiologist in the Rosenzweig laboratory at BIDMC, conceived the mouse study in a very human manner.

    Dr. Foo began thinking about the possible dangers of low-carb, high-fat diets after seeing heart-attack patients who were on the diet—and after Rosenzweig himself went on the diet.

    “I asked Shi Yin to do a mouse experiment—so we could know what happens in the blood vessels and so I could eat in peace.”

    The doctors fed mice known to develop atherosclerosis in the same manner as humans one of three diets: a standard mouse diet (65% carbs, 15% fat, 20% protein), a “Western diet” in line with the average human diet (43% carbs, 42% fat, 15% protein), and low-carb, high-protein diet (12% carbs, 43% fat, 45% protein). All three diets contained the same amount of calories. The last two diets contained the same amount of fat and cholesterol.

    As in most such diets, carbs were replaced with protein.

    Significantly, the low-carb mice exhibited a greater degree of atherosclerosis, as measured by plaque accumulation: 15.3% compared to 8.8% for the Western diet group. “Our question was, ‘Why do the low-carb mice have such an increase in atherosclerosis,’” Foo said.

    Importantly, traditional markers slightly favored the low-carb group. “None of these results explained why the animals’ blood had more atherosclerotic blockages and looked so bad,” Foo said.  

    The researchers looked at the animals’ endothelial or vascular progenitor cell (EPC) counts. “Examination of the animals’ bone marrow and peripheral blood showed that the measures of EPC cells dropped fully 40% among the mice on the low-carb diet—after only two weeks,” Rosenzweig said.

    This finding suggests that the low-carb, high-protein led to an impaired ability to form new blood vessels in tissues deprived of blood flow, as occurs with atherosclerosis. The researchers hypothesized that the Western diet and the low-carb/high-protein diet caused “comparable injury and inflammation.” The low-carb group, however, suffered an impaired ability to repair and restore blood vessel function.

    Rosenzweig  continued: “Although the precise nature and roll of [EPC] cells is still being worked out, these results succeeded in getting me off the low-carb diet.”

    Rosenzweig stressed the apparent disconnect between weight loss and standard blood markers—where the low-carb diet worked—and vascular health. It appears that blood vessel health can be affected by more than fat and cholesterol—in this case, carbs and protein.  

    Protein—the bodybuilder’s favorite macronutrient—may actually be an offender. Too much protein (and too little carbohydrate) may damage blood vessels and/or prevent restoration.

    “For now,” says Rosenzweig, “it appears that a moderate and balanced diet, coupled with exercise, is probably best for most people.”

  • David

    11/11/2009 5:12:36 AM |

    Sifter, that study was kind of ridiculous. They used ApoE-/- mice. Read Peter's enlightening take on it here:

    http://high-fat-nutrition.blogspot.com/2009/08/low-carbohydrate-high-protein-and-apoe.html

    And Part II: http://high-fat-nutrition.blogspot.com/2009/08/low-carbohydrate-high-protein-and-apoe_28.html

  • Felix

    11/11/2009 9:03:14 AM |

    Hi,
    I tend to eat every three hours, five meals a day. My triglycerides were recently meausred, they're at 33. I guess that does not support your bet, right? Or maybe I am getting this all wrong...
    Kind regards,
    Felix

  • Peter

    11/11/2009 12:43:13 PM |

    Ornish advocates grazing and scored zero on the heart scan, so maybe what you eat is more critical than when, for plaque building.  He, like you, wouldn't go near the refined carbs in the experiment you cite.

  • Dr. William Davis

    11/11/2009 1:05:15 PM |

    When you see the patterns in hundreds or thousands of people, you realize that not everybody is the same. In fact, the range of differing responses is dramatic.

    So, no, you cannot draw any conclusions about the experience of one.

  • Beth

    11/12/2009 6:28:40 PM |

    I must be missing something, but wouldn't eating smaller meals result in smaller peaks and possibly quicker decline? So yes, stacking may occur, but isn't it conceivable that overall blood levels would be no higher than they would be with the larger meals?

  • Jim Purdy

    11/12/2009 11:45:31 PM |

    I agree with Beth.

  • Anonymous

    11/13/2009 2:23:16 AM |

    Beth, Jim,

    That's the question I alluded to above
    (see above, between Shel's & Sifter's
    comments).

    We would really need to see the corresponding curve for the same subjects, instructed to eat both meals
    at one go.

    So it doesn't look like this study by itself allows us to draw definite conclusions (on the question of grazing vs. gorging).

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  • Isaac

    3/25/2010 2:04:30 PM |

    This just reinforces the notion that fasting triglyceride levels are fairly useless for predicting disease.  It's the postprandial that matters since most people spend most of their lives in a postprandial state.

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    Rosenzweig stressed the apparent disconnect between weight loss and standard blood markers—where the low-carb diet worked—and vascular health. It appears that blood vessel health can be affected by more than fat and cholesterol—in this case, carbs and protein.

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