Hi Dr. Davis,

What is the maximum postprandial glucose level that we can see without seeing increased risk of heart/diabetes problems? I thought I saw 120 mg/dl somewhere. Is that it? It's hard to keep track of hundreds of blogs. I just learned about Heart Scan Blog last week.

I have tested my postprandial glucose per your suggestion, and it has been very helpful, but I wanted to note that neither oatmeal (1/2 cup dry) or bananas & apples raise my blood sugar above 115.

Truly normal, non-diabetic people will rarely if ever see a postprandial glucose peak much above 125, even with Cheerios.

Postprandial hyperglycemia is widespread in populations eating an industrial diet. Those of us who have been officially diagnosed with diabetes are just the tip of the iceberg.

It is interesting that you confirm that thin slender people which  you identify as "Lp(a)" types are so much less tolerant against high refined carbohydrates!

  In my subjective observation some of the most robust people on the standard (high carb medium fat) diet are of heavy set build ( Kapha/Phlegmatic).  

They are able to easily increase their adipose tissue which probably is their main defense against high blood glucose.

This protection comes at the price of putting up weight, sometimes a lot of weight. In some  rare cases their body weight can grow above 500lb before this protection mechanism stops, their adipose tissue stops expanding, and then - and only then - they get diabetes!  Not before, not while their fatty tissue is still growing!

In my personal opinion the only difference between the heavy set type people and us ("ascetic" body types) is that our adipose tissue is for some reason (genetic?) incapable of growing beyond a minimum (in my case I was only able to put up ~10lb extra at most) therefore our fatty tissue  is not able to scoop up as much excessive glucose out of our bloodstream as their therefore we get diabetes, on a very high refined carb diet, earlier and more severe than them.  

Our ONLY defense is as you have found too - minimize consumption of high carb food such as cereals, wheat, but also fruit and starches! I personally replaced such food with animal fat, eleven years ago and all my health problems, including mild angina, disappeared as if by miracle.

Regards,
Stan (Heretic)

So, Dr. Davis, would you say that one should never have foods that raise blood sugar?  I have a 1/2 banana and rice cake post workout with protein. Do you think I should stop this practice?

I might add that the Thanksgiving post-feast lethargy, conventionally attributed to tryptophan-overload, is likely due instead to carb overload (stuffing, mashed potatoes, cranberry sauce, two helpings of pie). Since I've been low carb, I've generally filled up on turkey and salad at such meals (much more turkey than my dining companions), and also had much more post-prandial energy.

Why in the world would anyone put skim milk in oatmeal (or anything else, for that matter)? Drinking skim milk and consuming lean protein without adequate fat is an excellent way to spike your blood sugar and deplete your body's fat soluble nutrients.  I'd be curious to see how much oatmeal raises blood sugar when eaten with butter and cream. Maybe I'll do that experiment myself.

I forgot to add that I tried cheerios experiment. My BG went from fasting 86 to PPG 140. I do stay active (lifting weights and running) but lately my diet has been terrible past two years. I actually used to follow low to moderate carbohydrates but being married and having an infant to deal with knocked me off the wagon. I recently got back on the wagon but I have to admit it, it has been rough start... Just have to make it to day 14th (I always found it to be much easier after 14th day or so).

Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?

Is this a one-hour reading or a two-hour reading that we're talking about?  And is 120 the best cut off to use?

We have several 'feral' apple trees around the property here. They don't make large fruits, but I've eaten up to 3 at a time (golf ball sized) and they never made me have a +40 spike. Other varieties of large store apples do, however. I was taught that the ADA recommends a 1 hour reading of no more than 180, and a 2 hour reading of no more than 140, where the 'after' reading is also less than 40 points higher than the beginning reading. So if you began at 100, you should never break 140. My standards, however, are quite a bit lower. Bring on the bacon and eggs, and I'll wait until Nature here provides me with small apples.

Technically, if a person gets two random blood sugars over 200 mg/dl it is enough to diagnose them as diabetic. That's according to the diagnostic criteria published by the ultra conservative American Diabetes Association.

Based on the research I've seen on this topic, any blood sugar over 163 mg/dl one hour after eating a high carb meal and/or over 120 mg/dl at two hours after the meal is abnormal.

Truly normal people will be back into the mid 80s two hours after eating a high carb meal. Their highest blood sugar will be about 120, which not so incidentally, is the level at which the incretin hormones seem to kick in and stimulate insulin release.

Dr. Davis, love the blog, am learning lots. And per your suggestion, have picked up a blood glucose meter to check how I respond to various carbs.

Just a minor title quibble tho. Are there really a lot of people eating oatmeal, Cheerios, apples or bananas that think they are low-carb?

Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

Tony,

You probably still have an intact glucose regulation system, so your insulin production is robust and your insulin sensitivity is good.  You might be lucky enough to always have intact BG with grains.  

Many don't, though, and furthermore, most don't know it.  Insulin insufficiently and insulin resistance are very, very common.

I know from experience that one can seem to be quite healthy yet BG trouble is brewing below the surface for many years.  Even with a history of gestational diabetes (treated well with a LC diet), my doctors later had no idea how high my post-prandial BG goes (Cheerios can raise it to the mid-200s) because they tend to only suspect BG issues in obese patients and  they only checked FBG, which remain at the high end of normal because of my low carb intake.  

My own testing with Cheerios leads me to view it and other cold breakfast cereals as bowls of predigested sugar that creates roller coaster BG levels that don't feel good at all.  Steel-cut cooked oatmeal result in somewhat less high BG, but it still goes too high for too long.  For my own long-term health, my glucose meter tells me to ditch the cereals.

Those foods you listed Dr. Davis are not low-carb at all. I never eat them. What makes you think those are low-carb? Cheerios? Bananas? Oatmeal?

Switters--

Although I do not advocate using skim milk, most people do. So I chose that because it's so common.


Ellen--

No, I would regard that as a very high-sugar breakfast. It eventually catches up to you.


Beth--

Yes. While YOU may realize they do not belong in a low-carb diet, an incredible number of people think they do.

"Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?"  I am bumping this question up as i would also love to have a definitive answer on it.  I know two people can sit to eat identical meals and one finish in 15 minutes and the other take 45-60.  This would make a large difference in the measurements depending on where you start time "zero"

Oatmeal & banana/blueberries ups my count by only 10 or so, less if I use oat bran; but I always have high-quality whole milk yogurt as the dairy portion.

Is there an A1C level that good glucose control would correspond to, given that your recommendations for post prandial glucose are significantly lower than the usual 140/1hour and 120/2 hour?

Dr Davis: I am confused how large populations of Chinese and Japanese people who eat a high starch diet continue to have relatively low rates of heart disease. I would think that white rice would cause a high post postprandial response.
I enjoy your posts but I need a full explanation to be convinced that you are correct on this point. Very sincerely, Bobby

Ok..., I'm really lost. Recently diagnosed with type 2 on oral meds and Byetta. I don't want my children to follow my path. Thought I was being a good Mom feeding them Cheerios and Oatmeal. So now what??? WHAT DO I FEED THEM???? DR. DAVIS WHERE DO I FIND A DIET PLAN FOR THEM???

I thought oatmeal was ok for some reason, because it's oatmeal, you know like what grandpa ate?
Spiked my sugar to 190.

I haven't eaten cereals, white breads or any potato products only for the last 3 weeks and my blood sugar has responded favorably.
Morning test was usually a 100-105 (yikes) now it's 85-90. I'm not sure of the ideal low end but maybe I can see 70 in a few months.

Great blog on diabetes, Jenny.

I wonder which yields a more accurate view of what's likely to happen as you get older?

Fasting blood sugar.
Post-prandial blood sugar.
Ha1c test.

All of these issues, including when to check blood sugar, what constitutes a desirable number, etc. are all addressed in detail in the Track Your Plaque Special Report, Postprandial Responses:
Part 3 - Carbohydrates and postprandial blood sugar at http://www.trackyourplaque.com/library/fl_04-022postprandialcarbs.asp in the open content section (first 8 or so pages).

Here's a comment on oatmeal - BG before breakfast - 125. Bowl of Quaker weight control Maple and Brown Sugar oatmeal (29 carbs, 6 g fiber, 1g sugar), 1 tablespoon of chia seeds (4 carbs,4 g Fiber), 1 scoop of flax seed (5 carbs, 4 G Fiber). Handful of pecans, splash of 2 percent milk.  BG reading 2 hours later - 181. No doubt, 210+ after an hour, but I didn't check then.  Despite all the fiber and the pecans as a source of fat to slow down the sugar rush, still no go. Moral of this story (for me) - back to eggs and meats.

Dr Davis: I have read the entire report and it doesn't address the issue that was the basis of my question: Why do starch based oriental cultures have a low incidence of heart disease. They also eat a low fat diet.
I look forward to your response. Many thanks, Bobby

Add me to the ranks of the low-carb eaters. I was taking Aciphex for acid reflux and discovered that PPIs have side effects such as osteoporosis, iron deficiency anemia and hip fracture. Other side effects of low stomach acid are too numerous to list here. I stopped taking them and read that high-glycemic foods (read: starchy, sugary carbs like fruit and grains) cause reflux. (See http://heartburncured.com/) By experimenting with my diet the past few days, I've found this to be true. Goodbye, starches and sugars.

I'm making a believer out of my diabetic mom, too. The other day, she had a few bites of a bagel, some apple sauce, oatmeal--and BG of 268. She slept all day, stoned on sugar. Today, after I told her 100 times that it's the carbs, she's having bacon, cottage cheese and an egg--and a lucid state of mind.

Bobby,

It could be that they are not really consuming high amount of starch carbohydrates. Media always made it sound like they consume a lot of carbohydrates but the reality is that they may not really be consuming. However, things are changing as it's cheaper to produce processed foods so things will likely change for those people one day. It could be that they are more active as well slowing down heart disease progression. Cancers may get them first before heart disease happens. It's hard to know unless you actually travel there and observe them in person. It may not be what you think. It's really apple vs orange. Dr. Davis is specifically talking about USA population.

Do you think that postprandial glucose response to a fixed meal is a good way to evaluate the effectiveness of a diet regimen?  I'm wondering how I can compare various diet alternatives (intermittent fasting vs. paleo, for example, because I don't have the willpower to do both) with simple tests.  Blood glucose tests are very appealing to me because they are easy to do at home.

http://patrissimo.livejournal.com/1313795.html

I feel like I am whipping a dead pony here but feel I must repeat this:  Increasing dietary fat increases insulin resistance.  It takes several weeks (at bare minimum 10-14 days) of dietary fat intake of 8-10% (and no more fat than that) for the body to adjust.  Once that happens, your readings will be totally different for a high UNrefined carb meal.  And I must emphasize that only one higher fat meal may re-establish your previous level of insulin resistance for several days to weeks once again.  Eating eggs, meats, high fat diet day after day and then one high carb meal is an altogether different experiment and does not tell you in any way how you would fair on a consistently low fat, high UNrefined carb diet.

Really, once insulin resistance is reduced you will get totally different readings even for a refined carb meal as in a glucose tolerance test.

Bobby,

There's so much more to it than simply the amount of starch in the diet.  Starch is probably fine if the metabolism is functioning as it should.  But western diet and lifestyles often lead to a high amount of metabolic dysfunction, which eventually progresses to impaired glucose (& starch)  tolerance and finally diabetes.  Note that even in industrial Japan (where the diet has changed much in the past several decades), the rate of T2 diabetes incidence is quickly rising in the young.  

This is a huge topic and there isn't enough discussion about it when various "traditional" diets are compared.

Dr. Strange--

Sorry, but I don't buy it.

I've seen the opposite effect play out countless times: High fasting glucoses and high postprandial glucoses normalize with reductions in carbohydrates, increases in fats.

I saw this effect in myself over 15 years ago when I was diabetic. Now, I am no longer diabetic due to increased fats, dramatically reduced carbohydrates.

Bobby--

Perhaps a topic for a future discussion.

Being part Japanese, I can tell you that rice is typicaly eaten sprinkled with rice vinegar. That alone can modify glycemic responses.

Also, I don't believe that the Japanese diet is that high-carbohydrate. Miso, nori, mebushi, fish, natto, tofu, etc.--aside from rice, these staples are low-carb or zero-carb.

Also, check your blood sugar after rice; Nothing like wheat or sugars.

Dr. Davis: Thanks for the reply. I would love you discuss this topic in more detail in the future.
Respectfully, I do take issue with your statement that the Japanese diet is not primarily a high carb diet. I lived in Japan for a few months and even lived with a family there. Our diet was primarily rice. Seaweeds and small amounts of fish were added, but it was basically a low carb, low fat diet. I absolutely agree that wheat played not part in their diet.
I have enjoyed the topic. Bobby

Dr.Davis, yes of course your blood sugar normalized when you drastically reduced carbs and increased fat!  You stopped eating foods directly convert to blood glucose!  The body can run on primarily glucose from carbs or by converting fats via ketosis, yes?

What I am talking about takes a couple weeks at minimum to occur and that is a dramatic reduction in insulin resistance when dietary fats are consistently reduced to 8-10% total calories.

The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once.  That seems to be where the big problems arise and is the SAD, high carb/high fat diet.  Also of course, SAD is high junk, fake food which greatly exacerbates the problems.

The misunderstanding comes and is continually repeated because people try one meal of high carb after eating high fat over time so their body has fairly high IR.  You must eat very low fat, every single meal, for a couple weeks minimum to see the effect I am talking about and some people take longer than that for their bodies to loose the IR

Of topic, for which I apologise Dr. Davis, but here is an article in the mainstream media which questions the efficacy of omega-3 likening the taking of it to a "cult". - The cult of omega-3

http://news.bbc.co.uk/1/hi/magazine/8543172.stm

From the article: "There's no evidence that omega-3 reduces the risk of death or heart attack or stroke or anything like that in those of us who have not recently had a heart attack,"

Somewhat tangential, but anyone see the report on President Obama's cholesterol checkup:

138 LDL
62 HDL
  9 (calc from TC)

209 TC

It is interesting that even the President gets just the same old calculated rather than measured cholesterol test.

Dr. Strange--

Fifteen years ago, I went on the Ornish diet: no meat, no oils, just vegetables, fruits, legumes, and whole grains. I also jogged 5-8 miles per day.

I gained 30 lbs and became diabetic with blood sugars of 167 mg/dl or so.

While my personal experience does not prove or disprove the concept, I've witnessed this phenomenon many, many times.

Conversely, I have never seen anybody become a diabetic on a high-fat diet.

FWIW, I measured BG before & after a breakfast of 1/2 cup oatmeal -- 94 before, 115 (1 hour) after.  That was with 1/4 cup ground flax, a handful of frozen cranberries (whole, no sugar) and 2 T of heavy cream.

I have read that eating fat with carb lowers the effective glycemic index, which may help explain why the BG didn't rise much.

Beth

I learn so much from your blog here and at Health Central, Dr. Davis.  Thank you for the time you put into these free blogs.
I am not diabetic but had gestational diabetes with each of my three pregnancies so I am very interested in doing things to help me not become diabetic.  I have tested my blood sugar after eating old fashioned oatmeal with nuts and a dash of milk and it stays below 100, very surprising.  However if I eat a meal of tomato soup and grilled cheese sandwich it will go over 160.  In testing like I do, I am learning what I can eat and what food combinations work for now.  I'll keep checking as time goes on.
Char

Well, I bought a $10 'True" meter at Walgreens. Fasting reading after 9 hours of no food or drink,(morning) 91.  Ate two eggs cooked in butter, had a bagel ( I know, I know) with Skippy peanut butter on it. Waited 70  minutes, got a reading of 93. Hmmmm......I'm pretty sure everything is calibrated right. Does that second reading make sense?

Dr Strange:

"The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once."

That's right but how can you control how much fat or glucose your body uses? As Dr. Davis mentioned Ornish type diet + aerobic exercise does not work.

I don't say that you are complete wrong of course. Insulin resistance is usually related to increased fatty acid avaibility and that will lead to the wise comment made by Stan (Heretic). When your subcutaneous adipose tissue functions normally you do not accumulate visceral fat and get metabolic syndrome and/or T2DM.

I don't know if low carb will eventually restore health but it will certainly give more time and low blood glucose rapidly. But there may be limitations to low carb also since you have only limited access to decide what your body does with ingested foods.

Westie, actually an Ornish type diet does work IF you do NOT eat refined carbs.  You have to only eat real, whole plant foods, as close to intact as possible.  Refined carbs will alway spike bg and raise triglyerides etc.  Some people do not do well on low carb diets.  I did Bernstein's version, very strict, for about 9 months and felt worse and worse as time went on.  Low low energy, irritable, post exercise exhaustion that would last 24-48 hours, absolutely no endurance.  Yes my blood sugar was good but it is even better on McDougall (Ornish type) diet.  My lipid profile is good.  I feel much better in every respect, much more healthy.  The diet does work and well!

DrStrange, loss of energy is very bad thing and I'm glad you found a way to overcome that.

McDougall diet sounds very...hmmm...American. Avoiding fats and cholesterol seems to be a main goal. That seems to me quite stupid but I'm not a doctor so lack of knowledge could explain that.

Like most diets designed by professionals McDougall diet has very good points but McDougall +fat +cholesterol +animal protein could do better.

I don't know where these guys have come to the conclusion that if you don't eat fat you don't "have it". Every day most of the energy one uses comes from fats even on a McDougall diet.

McDougall diet does not avoid fat, only no added, extracted fat.  Whatever is present already in plants is good for you and necessary.  Some people (me)(not all) add an ounce or so of flax or chia to get some additional omega 3 to balance the predominance of omega 6 in most veg and grains.  And no, you are not getting most of your calories from fat as the starches in the complex carbs convert quickly directly to glucose which is your energy source.  If you stuff yourself and overeat and get too many calories, then yes you get conversion of glucose to fat but it will go to storage.  Eating that kind of diet, your physiology is tuned to burning glucose and you will have plenty of glucose to burn, so you will store that fat.  Also, if you eat refined carbs, added sweeteners, dried fruit, things that spike blood sugar too high, then some of that will be converted to triglycerides and fat.

Dr McDougall calls his diet "starch centered" as that is the source of fuel, starch converted to glucose.  This as opposed to a fat centered diet ie low carb, where you get your calories from burning fat.  Really not "American" but global as most traditional diets were/are starch centered with small amounts of animal products and mostly a wide variety of produce.

DrStrange- you seem to be ignoring Dr. Davis's comment- Ornish did not work well for him (or for most people that I'm aware of).  I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet.  There are people with carnitine defiencies or genetic defects that reduce fatty acid translocation across the mitochondria (such as palmitoylcarnitine transferase deficiency) who cannot use fatty acids effectively for fuel and must eat a high carb diet for energy.  But those people and types of metabolism are rare.  Perhaps you are one of them.

Cynthia

DrStrange, if you eat low fat de novo lipogenesis increases automaticly. Fatty acid formation increases both in liver and in adipose tissue. With healthy insulin  sensitivity there are no problems with that. It's totally fine and healthy.

Thinking that avoiding fat and staying on starch keeps fat out of the body is simple wrong and it is usually part of intentional marketing or unintentional black & white type thinking (stupidity?).

Avoiding fat in fact leads to "hardening" of your lipid profile in AT since glucose is metabolized to palmitic acid in the liver and then transported to storage.

McDougall diet has excellent ingredients but thinking that cholesterol or animal fat will automaticly lead to overweight and disease is truely false. You can claim it to be true and believe it but I'm sorry to say it seems to be false.

Glucose and fats both makes important fuels and I personally love them both.

Cynthia wrote:

"I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet."

If a persons health is dependent on some kind of a restricting diet can you say that person has a healthy metabolism? It can be seen as "normal" but it sure isn't healthy. For type 2 diabetics low carb will bring lot of help and quite fast but will it make carbs bad? Not in my opinion.

Things that cause metabolic syndrome, heart disease or other illnesses should be blaimed. Loss of insulin sensitivity is bad and restricting low calorie diets are bad. Most natural way to heal your metabolism is not through restriction, but through giving your body what it needs to recover and stay in good health and shape.

I use to be a vegetarian.  I went months of eating nothing but whole grain (not just "brown" but things like millet and such) and veggies and fruit along with low or no fat protein sources like beans (I soaked them myself so they weren't even canned).  The only oils came from the very small amount of olive or canola oil I used in cooking.  My total fat was right about 10%.  After about 6 months my triglicerides had skyrocketed, my cholesterol was the same as it was before I started, my weight had increased and I was diagnosed with hypothyroidism, which I believe was directly correlated with the amount of "healthy, whole, natural" carbohydrates in my very low fat "healthy" diet.  I subsequently was also diagnosed diabetic.  I am now a 2 year low-carber.  My triglicerides have plummeted, my cholesterol is lower, and my HgA1C is under 6.0.  I have also lost 70 lbs.  Some people may or may not do better with low fat, non-refined carbs, but for me it not only did not improve my health, it nearly killed me.

Here is a link from my website (www.dsolve.com) with some charts/graphs of what normal blood sugars look like compared to diabetics:
http://www.dsolve.com/news-aamp-info-othermenu-60/23-diabetes-solution/159-news

Hope this is a useful reference for what is "normal".

I've been so fatigued that will mean that I'm diabetic is because every time I ate sweet things I comes to feel a little bit bad

First of all very thanks for providing this nice tips list.one has to follow it strictly to get good health.


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Oatmeal yields high blood sugars. Even if your fasting blood sugar is 90 mg/dl, a bowl of oatmeal with skim milk, walnuts, and some berries will yield blood sugars of 150-200 mg/dl in many people.

Um. What is it with all this talk of skim milk and 2%? Are you guys serious? I don't mess around with that white poison anymore. Use raw milk or cream. Never pasteurized milk.

Also, soaking oats in an acidic base drastically changes the composition of the oats, reducing phytates and improving digestion and nutrient absorption.

Here's my oatmeal:
- soak raw oats in raw whey overnight
- dehydrate at 150 degress until crisp/dry
- one cup of prepared oatmeal in a bowl.
- one tablespoon of grass fed pasture butter
- three tablespoons of heavy cream (no additives of any kind) or raw grass fed whole milk.
- one teaspoon of raw unprocessed honey and maybe a pinch of pure stevia powder.

optionals:
- 4 or 5 soaked/dehyrdated raw almonds or pecans
- 4 or 5 blueberries

Carb heavy? maybe a bit, but it's also loaded with high quality fats and proteins.

I certainly wouldn't eat this daily because it's too many carbs and too much fiber, but 1-2 times a week of this type of oatmeal is fine and quite nutrient dense.

Wow! even better. Don't dehydrate the oats. Just drain after soaking in water (with whey) and put the soaked oats in a glass casserole dish.

Add in some coconut oil, maybe a bit of raw honey and/or stevia, cinnamon, real vanilla, and bake at 350 degrees for 35 minutes.

Cut a nice piece out and add some cream and pasture butter, maybe a few blueberries.

#1 your whole house will smell like the holiday season.

#2 you will have a nutrient filled serving of soaked oatmeal.

I'd imagine though, with the honey and the oats, that even a normal sized serving will be on the higher side in carbs, so you wouldn't want to eat this all the time and you wouldn't want to have carb heavy foods for the remainder of your day.

I know Dr Davis doesn't recommend oatmeal or butter, but if you're gonna do it you may as well do it right and I think this is leagues better than the instant garbage most people eat every single day. blucchhkk!

-Jack K.

Dr Davis,

What do you recommend for carbs for athletes?

I work out 5 days, extremely hard (crossfit/weightlifting type of stuff)

If I dip too low, I am super sluggish. Even after months of trying to be very high fat Paleo.

My Blog, low carb-high fat never worked for me.  I struggled with it and tried to "make" my body adapt for 9 months and just continually felt worse and worse.  If I worked out even moderately for an hour or so I would have to sleep after and then be wasted the rest of the day and sometimes even part of the next day.

I now eat the diet proposed by Joel Fuhrman, M.D. (Eat to Live aka ETL) with zero refined carbs but a lot of carbs some starchy vegetables and lots of beans. Raw seeds and nuts for fat and EFA.  I do supplement omega 3 (vegan DHA) and vitamins D and B-12. I do eat meat but only very small amounts occasionally.  I have plenty of energy and all my test numbers are excellent.

Of course, what a great site and informative posts, I will add backlink - bookmark this site? Regards, Reader.

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Is there an inexpensive way of finding out which form you have?

is there any truth to the idea that if your trig/HDL ratio is under 2.0 that your LDL type is predominantly large/buoyant?

Is there a way to determine whether small LDL production is carb- or genetics-caused?

Is this the same for poly/mono unsaturated fatty acids?

Dr. Davis,

Does the form of saturated fat have any impact on this in the case of genetic predisposition to small LDL formation? For example, does it matter if the fatty acids are lauric acid and stearic acid versus something like palmitic acid?

Rick Braden

Dr. Davis,
That's very interesting!!  Any chance you could provide the reference?
Thanks, Dan

This naturally leads to the question about understanding our personal genetic coding.  Without that coding information it seems difficult make an informed decision about the consequences of lowering carbohydrate and increasing fat (and saturated fat) until the consequences are upon you!

This definitely needs a follow-up post. I've not seen this distinction until now. If true, Dr. Davis, does it not present a difficult dilemma for those who have both genetic sdLDL and Lp(a)? If saturated fat needs to be restricted for genetically high sdLDL, would this not leave the Lp(a) (which responds best to saturated fat intake) unopposed? What is your proposal to address this?

Interesting post, Dr. Davis. How would one find out if they are genetically predisposed to react to saturated fat intake with an increase in small LDL?

Do you have some specific references for LDLa and saturated fat? Is it essentially congenital hypercholesterolemia that reacts with the sat fat?

this is a long overview discussion. thank you!  What would dietary recommendation be for someone if small LDL is genetic in origin?  Also, wouldn't this pattern possibly require statins to get LDL particle count as low as possible since it is unlikely that diet will do the job?  In my case, i need Lipitor and Zetia; otherwise my particle count mostly small remains high despite Vit D, normal weight,no wheat cornstarch or sugar.  Great post!

Doc -

Good post but -

Hard to understand post without the background basis on which the statement is made.

Is your statement based on clinical observations? Or is it based on opinion only?

Yes, references supporting your premise in this article would be very welcome.

This post concerns me because as a low carber I find it difficult to maintain a low carb diet without saturated fat sources. Perhaps this is driving the concern and questions from others also.

Count me in those who are waiting to see data where this is coming from.
Thanks for all your blogs posts.

Yes, I hope this isn't a hit and run post. Many learned people, such as Peter at hyperlipid would probably disagree. Do you have any references?

So what do we do if we should not eat but a few carbos and up to certain amount of protein?

The rest have to be saturated fats, isn't it?

Please, some more practical information before we all run over the cliff.

Harold, I am also interested in the familial hypercholesterolemia question.  After a quick search, I found this http://www.jlr.org/cgi/reprint/23/8/1196.pdf with a quote: "LDL has been
found to be cholesterol-enriched and triglyceride-poor
(5, 6), and in one study, the peak flotation rate of FH LDL
has been found to be higher than in normals (6),
implying decreased density, increased size, or both.
However, these results are difficult to assess, since there
is considerable heterogeneity of LDL in normal subjects,
although size, flotation rate, and composition"

So, FH people may be predisposed to large, fluffy LDL.  However, I do not know whether FHs handle saturated fats better than normals, and this is an important question.  

-Aaron

A question on triglycerides...if high TGs are a trigger for small, dense LDL and should be minimized, are there any ways to reduce area-under-the-curve TGs after a meal (other than the usual low carb, omega-3, etc. recommendations).  Are large, infrequent meals better than small, frequent meals?  Does fiber change the shape of the post-meal TG curve?

Also, does fasting TG tell the whole story?  Could one have, say, <50 mg/dL fasting TG but have elevated TG throughout the day as a result of large, high-fat meals?  

-Aaron

Thank you Dr. Davis!  Finally a voice of sanity in this whole sat fat hoopla.

I for one, although not neurotic about it, do not favor saturated fats and will eat a good non-hydrogenated margarine (like Smart Balance) over butter any day.

Please keep up this sane blog and give us the WHOLE enchilada, not just what some want to hear.

Search PubMed or Google Scholar and you will find NO data on this issue. To my knowledge, there are none that distinguish genetically -driven small LDL vs. lifestyle-induced.

This is based on having tested lipoproteins in thousands of people over the past 10+ years.

Prototypical "genetic small LDL" person: 5 ft 10 inch, 140 lb male who eats low-carb. In other words this person is at ideal weight and does not eat foods that trigger small LDL--yet has 90% small LDL by NMR (e.g., 1200 nmol/L, LDL particle number 1550 nmol/L). Should this person overindulge in saturated fat, small LDL will go up.

Dr. Davis, how do you know it is saturated fats that are the cause? For example, most low-carbers also have elevated intake of inflammatory polyunsaturated fatty acids, which I would be much more likely to blame.  But, in either case, it seems there are too many uncontrolled variables involved (as far as food intake) to pin any of them to the wall.

It's very difficult for me to believe saturated fat is the cause, while other possibilities exist.

For everyone worrying about this, just get yourself a VAP or NMR test.  If you have LP(a) or sdLDL, that will show it.  You don't need genetic testing.

What's are the trig and HDL numbers for the prototypical "genetic small LDL" person?

Thanks Dr. Davis for another insightful post from your clinical experience, giving the kind of information that helps elucidate why saturated fat works for some and not for others - and the kind of information you can't get anywhere else.  Ignore the pro saturated fat/anti-polyunsaturated fat zealots, who can't be persuaded by any evidence or logic.

"What's are the trig and HDL numbers for the prototypical "genetic small LDL" person?"

I'd like to second that - can one have high HDL and low trigs and still have a small LDL pattern?

Hello Dr. Davis

You said:

"Should this person overindulge in saturated fat, small LDL will go up."

Just to be clear, are you saying you have observed low carb subjects (how low?) that have added saturated fat to their diets and then on subsequent testing you have seen sdLDL rise in absolute and percentage terms?

If they were truly LC, were they already high sat fat at the time of the NMR or were they high PUFA (South Beach?)

May I ask how many such cases you have seen?

You should definitely publish this, or if you don't think it is publishable maybe you could give us all the data in a blog post.

Thanks, this is very interesting.

In people with presumptive genetically-determined small LDL, HDL can be 70 mg/dl or greater, triglycerides 45 mg/dl or less, yet small LDL persists, usually at 600 nmol/L (NMR).

I have approximately 100 patients like this. They tend to be very thin with BMI's of 23 or so, yet small LDL persists.

Hi Dr. Davis,

This post really intrigues me. I am a first year medical student (24 yo) with familial hypercholesterolemia. I am on a low carb paleo diet, taking omega 3, vit D and just recently added magnesium to the mix as well. I went off Lipitor two months ago just an experiment to go along with this new eating plan, and received blood work only a few days ago. Numbers about 450 on total and 285 for LDL. My CT scan already showed plaque buildup in the coronary arteries, aorta, and one valve. While I am not looking for medical advice per se (since I know you prefer not to give it over your blog) I was just curious as to how your track the plaque plan and recommendations are effected with this type of genetic disorder. My cardiologist says if I dont go on drugs immediately I'll have a cardiac event at 40 years of age. I could use some advice and direction to persue. Is it impossible to avoid genetics, and the use of drugs are unavoidable? Thanks. Really appreciate it.

How do you know how much small LDL you have?

""I'd like to second that - can one have high HDL and low trigs and still have a small LDL pattern?""

Well - just speaking for myself, I have high HDL and low trigs, and always had a mix of small/large (A/B) pattern LDL.  When I stopped eating wheat, my LDL all became large.  

I also have high Lp(a), which was uneffected by my eliminating wheat.

You can drive yourself crazy figuring out what's OK to eat and what's not.  I don't worry about it anymore.  I rarely eat wheat because I've seen results from Not eating it, try not to overdo the sugar and fruit, get plenty of veggies and protein.  

I get my VAP test once or twice a year to make sure everything is where it should be, more or less.

I'm just not going to worry about it beyond that.  

Bonnie

Dr. Harris:

Are these customers of yours lean lowcarbers eating plenty of LA or very, very much protein in their diet? If not, then what do they eat?

With regards,
LeenaS

Interesting, and concerning, since I fit that description:

Chol: 6.35mmol/L
HDL: 1.88
LDL: 4.2
Triglycerides: 0.66
Chol/HDL ratio: 3.4
American Values:  TG 58.47 LDL 162.54 HDL 72.75
Triglyceride/HDL ratio: 0.8
Hieght: 6'0
Wieght: 165lbs
BF 8%

I've had other opinions on these numbers; should I be pursuing more accurate particle numbers?  I go out of my way to consume large amounts of red meat, coconut oil, butter, and eggs.  I'm fitter and healthier (subjectively) than I ever have been at 36 than I was in my 20's.  I find it disconcerting than I could potentially be doing something detrimental.

Hi Dr. Davis

In the original post you said:

"saturated fat will increase small LDL.  In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL."

So, if I follow this correctly, you are saying that these 100 patients all had increases in their sdLDL after documented increases in saturated fat in their diets? In other words you had two data points for each subject, correct?

If the subjects did not all have documented increases in sLDL then by "persist", do you mean their sdLDL went down with LC eating (like 800 to 600, say) or do you just mean that they had a single high value and it was only measured once, but it was high?

If it is the latter, I could see how it's fair to say that some LC eaters have a higher sdLDL than we might predict (for whatever reason) but it seems like a non sequiter to conclude that the sdLDL would be made higher with more sat fat consumption.

I just want to make sure I get this straight so I understand it correctly.

Thin. Nice. I'm less concerned. lol

Does this group of people also have elevated blood sugar, as might be predicted by another of your blog postings?

http://heartscanblog.blogspot.com/2009/12/to-track-small-ldl-track-blood-sugar.html

Dr. Davis,

I concur with Dr. Harris in that more details would be nice to better understand exactly what you're saying.

Are other variables accounted for? Were many, most, or all of these patients on statin drugs, which could have prevented a shift in particle size if triglycerides were low and insulin sensitivity was high?

Again, if there is such a phenomenon going on, is the "genetic sdLDL" clearly atherogenic in the same way that "environmental sdLDL" seems to be?

If so, I ask again, what is the solution for someone who is afflicted by both Lp(a) and genetic sdLDL? The "profile" for genetic sdLDL is similar to the profile for those with Lp(a), and there is probably a lot of crossover. Saturated fat lowers Lp(a), but (presumably) raises genetic sdLDL. This is a fierce dilemma! Would not the better choice be to choose the diet that opposes the more vicious of the two, which is Lp(a)? What is the priority?

Has a high SFA diet only increased sdLDL per NMR, or has it also clearly been shown to increase CAC scores? In other words, does it clearly progress the disease itself?

David

Saturated fats not linked to heart disease: Meta-analysis - American Society for Clinical Nutrition (January 13, 2010). doi:10.3945/ajcn.2009.27725 © 2010

It would really be interesting to know what the primary sources of saturated fat are for these "100 patients".  There may be a single (widely available) common source of sat fat that these specific patients are consuming, do we even know that?  I agree, by what has been revealed, that there are too many variables to know conclusively that saturated fat is the cause of their persistently elevated small LDL.

Mark me down as someone who is not convinced that CLA, n3 rich organic, free range, and wild animal sources of fat could possibly in any way be detrimental to anyone.

When will people stop worrying about cholesterol numbers? They really don't mean anything.

Until someone explains a plausible mechanism through which lipoproteins directly kill me I will ignore it any suggestion that they do. This is what a good scientist would do.

@ Rick Braden
Re does it matter if the fatty acids are lauric acid and stearic acid versus something like palmitic acid?
Palmitate is the predominant saturated fatty acid in soybean oil. Soybean oil increases total cholesterol,LDL and LDL:HDL ratio, whilst HDL diminished.
Coconut oil (predominantly Lauric acid) does not cause dyslipidemia and promotes a reduction in abdominal obesity.

That is generally the case,  stearate does not appear to increase LDL... Laurate and stearate reduce the total cholesterol/HDL ratio

I don't know if the genetic predisposition to LDL alters response to laurate, stearate palmitate.

It may help people better understand the difference in cholesterol forms if they look at the photos of VLDL, LDL, HDL,  NED KOCK has kindly provided on his blog

If, on the other hand, your small LDL is genetically programmed, then saturated fat will increase small LDL. In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL. If your dominant genetically-determined form is small, then saturated fat increases small LDL particles.

buy jeans: I'd love to see clinical evidence supporting that claim.

Heart diseases are a major matter of concern these days therefore all that can be done to correct the diet and make it benefit good health should be taken to.

Dietary Carbohydrate Modifies the Inverse Association Between Saturated Fat Intake and Cholesterol on Very Low-Density Lipoproteins
Interesting full text free paper that may change the way saturated fat is viewed. I wonder if the source of the Saturated fat (butter/coconut oil as opposed to indoor grain fed beef/lard) and the type of carbohydrate (Wheat sweet potato)  may add a further level of complication.