Gretchen's postprandial diet experiment

Gretchen sent me the results of a little experiment she ran on herself. She measured blood glucose and triglycerides after 1) a low-fat diet and 2) a low-carb diet.









Gretchen describes her experience:

Several years ago I received a windfall of triglyceride strips that would expire in a week or so. I hated to waste them, so I decided to use them to test my triglyceride and BG responses to two different diets: low carb and low fat.

The first day I followed a low-fat diet. For breakfast I ate a lot of carbohydrate, including 1 oz of spaghetti cooked al dente and ¾ cup of white rice. For the rest of the day I ate less carbohydrate but continued to eat low fat.

The second day I followed a low-carb diet. For breakfast I ate a lot of fat, including a sausage, mushrooms fried in butter, 2 slices of bacon, and ¼ cup of the creamy topping of whole-milk yogurt. For the rest of the day I ate less fat, especially less saturated fat, but continued to eat low carb.

Both days I measured both BG and triglyceride levels every hour until I went to bed. On the low-carb day I had 3 meals. On the low-fat day, I was constantly hungry, had 4 meals, and kept snacking.

You can see the results in Figure 1. On the low-fat diet, after a “healthy” low-fat breakfast of low-glycemic pasta with low-fat sauce, my BG levels shot up to over 200 mg/dL and took more than 6 hours to come down. My triglycerides, however, remained low, and at first I thought perhaps the low-fat diet might be better overall. However, after about 6 hours, the triglyceride levels started to increase steadily, and by the next morning, they were higher than they had been the day before.
On the low-carb diet, my BG levels stayed low all day. However, after meals, the triglyceride levels skyrocketed. After meals they came down, and by the next morning they were lower than they had been the day before.

As I interpret these results, the high triglyceride levels after eating the high-fat meals represent chylomicrons, the lipoproteins that transport fat from your meals to the cells of your body. The high triglyceride levels the morning after eating the low-fat meals represent very low density lipoprotein, which takes the cholesterol your liver synthesizes when your intake of dietary cholesterol is low and distributes it to cells that need it, or again, to the fat for storage.

There are several interesting factors to consider here. First, when you have a lipid test done at the lab, it’s usually done fasting, which means first thing in the morning after not eating for 8 to 12 hours. It tells you nothing about what your triglyceride levels were all day.

Second, the low-carb diet resulted in lower fasting triglyceride levels, but much higher postprandial triglyceride levels. Which are more dangerous? I’m afraid I don’t know. You should also note that the high-fat, low-carb breakfast was extremely high in fat, including saturated fat. I don’t normally eat that much fat but wanted to test extremes.

Third, although the low-fat diet didn’t produce the very high postprandial triglyceride levels that the high-fat diet did, it produced extremely high BG levels that persisted for 6 hours. Some people think that it’s oxidized and glycated lipids that are the dangerous ones, so high BG levels and normal triglyceride levels might be more dangerous than very high triglyceride levels and normal BG levels. Note that high BG levels also contribute to oxidation rates.

Fourth, this shows the results of an experiment with a sample size of one. My physiology might not be typical. If you want to know how your own body’s lipids respond to different types of diets, you should get a lipid meter and test yourself. Unfortunately, your insurance is unlikely to want to pay for this, so it will be an expensive experiment.

The main point of this is that the results of different diets are complex. We have to eat. And what we eat can affect many different systems in our bodies. Finding the ideal diet that matches our own physiology and results in the best lipid levels as well as BG levels is a real challenge.



This was a lot of effort for one person. Thanks to Gretchen for sharing her interesting experience.

Gretchen makes a crucial point: Some of the effects of diet changes evolve over time, much as triglyceride levels changed substantially for her on the day following her experiment. Wouldn't it be interesting to see how postprandial patterns develop over time if levels were observed sequentially, day after day?

The stark contrast in blood sugars is impressive--Low-carb clearly has the advantage here. Are there manipulations in diet composition in low-carb meals that we can make to blunt the early (3-6 hour) postprandial lipoprotein (triglyceride) peak? That's a topic we will consider in future.

More of Gretchen's thoughts can be found at:

http://wildlyfluctuating.blogspot.com
http://www.healthcentral.com/diabetes/c/5068

Comments (11) -

  • ET

    11/27/2009 5:10:43 PM |

    Interesting results.  I follow a low-carbohydrate (<60 g/day) eating plan and I recently had blood drawn and sent to a lab for glucose and cholesterol testing.  It was supposed to be fasting, but the sample was drawn 4.5 hours after I had gotten up for the day.  By then, I'd already eaten breakfast several hours earlier and my coffee with coconut creamer and  half-and-half which represents around 60 grams of fat and 9 grams of carbs.  Both my  glucose and triglycerides were 91.  My total cholsterol was unchanged.  My fasting triglycerides are usually around 45.  I did exercise prior to having the sample taken which could influence my triglycerides.

    On an earlier occassion, I also had a non-fasting cholesterol test performed by a lab and the sample was taken mid-afternoon.  I'd consumed around 150g of fat total that day, starting nine hours earlier and my triglycerides were 79.

  • DrStrange

    11/27/2009 6:07:28 PM |

    Having done similar myself though only testing blood sugar, I can say for certain that if you ate a truly low fat diet (<10% calories from fat) for 2 weeks prior to the test and then ate a truly low fat meal, your blood glucose curve would have been similar to that for the low carb meal.  The spike comes from insulin resistance, largely caused by dietary fat.  It takes about 2 weeks on a low fat diet for that component of IR to be reversed.  I have repeated this same experiment several times with identical results.

    There are two ways to keep a fairly flat sugar curve.  One is a very low carb diet, the other a very low fat diet.  For the low fat diet to work however it must be constant without cheating.  In my experiments I found that only one meal of "normal" fat content, increased IR and caused sugar spikes for many days after.  Over about 10-14 days, my post postprandial sugar curve returned to normal.

  • Nigel Kinbrum BSc(Hons)Eng

    11/27/2009 8:09:00 PM |

    Any chance of persuading someone (Oxford Group, say) to do a randomised crossover intervention trial with a suitable washout period and using different Carb/Fat percentages e.g.
    15P, 55C, 30F (Standard American/English Diet) alternating with:-
    15P, 5C, 80F
    15P, 15C, 70F
    15P, 25C, 60F
    15P, 35C, 50F
    15P, 45C, 40F
    15P, 65C, 20F
    15P, 75C, 10F but without adding extra sugar? The trial previously mentioned has received criticism on a board I post on for adding extra sugar to exaggerate results.

  • Gretchen

    11/28/2009 2:12:20 PM |

    DrStrange, perhaps it was not clear from the quoted material, but I am diabetic. My BG would go up on a low-fat diet. That's what I was on for about 6 months after diagnosis, and I certainly did not have normal blood glucose levels. My A1c was much higher than it was on low-carb, high-fat.

    However, it would be very interesting if nondiabetic people repeated my experiment. I think exaggerated TG responses may be caused by whatever it is that causes the diabetes.

  • Anonymous

    11/28/2009 3:01:50 PM |

    I think DrStrange illustrates that there must be momentum to physiological responses to what is a typical diet for any one person. A low carber's insulin levels may not be ready to handle an untypical (for them)carbohydrate load while a person with a low fat diet maintains higher insulin at all times.

  • Gretchen

    11/28/2009 3:32:59 PM |

    My experiment was flawed in several ways. I was not planning on publicizing the results, so I didn't weigh food or make sure the protein amounts were the same.

    And I didn't do the usual 3-day high-carb eating to make sure I was producing carb-producing enzymes. Not eating carbs can produce diabetes blood glucose (BG) levels in a nondiabetic: called "starvation diabetes" because starvation is the ultimate LC diet.

    However, I already knew I was diabetic. And people with diabetes have different lipid responses, so someone without diabetes would probably not see such a dramatic difference.

    A good experiment for a nondiabetic who has been on a LC diet would be the following:

    1. Measure BG and TGs for a day on your usual LC diet. Weigh the food so you can get exact nutrient levels. This would tell you what happens when you're adapted to the LC diet. Probably measuring every 2 hours would be enough.

    2. Eat a low-fat diet without preparation and follow BG and TGs for a day.

    3. Continue to eat the low-fat diet for a minimum of 3 days, maybe a week or 2 as suggested by DrStrange. Then repeat the experiment in No. 2, eating exactly the same thing.

    4. If you wish, repeat the experiment in No. 1, to see if your lipids went high when you weren't adapted to the LC diet.

    I do know someone else who was concerned that she might be diabetic, and while on a LC diet, her BG levels in a home "glucose tolerance test" approached diabetic levels. She then went on some kind of vegan diet, and on this diet, her BG levels stayed low on the GTT.

    So yes, not eating carbs and eating more fat (two different inputs) can produce a result that looks like diabetes. Which of these two factors is more important is not clear because when you reduce one nutrient you have to increase another to keep the calorie content constant.

  • DrStrange

    11/28/2009 3:45:39 PM |

    Gretchen, were you consistently at about 10% total calories from fat on your "low fat diet"?  Fat intake for most needs to always be not more than about 10% of total calories  for insulin resistance to be dramatically reduced. If someone is insulin dependent, the insulin they take will be maximally effective in that case but the fat intake must be at that low level for every meal ongoing.  One meal with excess fat and IR can shoot up and take many days to come back down.  This is what I found in my body.  Also, this is presupposing that all carbs are coming from very few fruits, vegetables, whole/intact grains (not flour, not sugar, etc)

    I really do not know which is healthier in the long run for someone who is insulin dependent, low fat/high carb or high fat/low carb.  There are studies showing increases, long term, of a number of health problems w/ high fat intake.  On the other hand, w/ the low fat diet you would need to use more insulin which is inflammatory.

  • DrStrange

    11/28/2009 3:59:33 PM |

    Anonymous, I do not have high insulin levels, in fact the opposite!  My A1c was creeping up a couple years ago (peaked at 6.4) so i tried low carb for 9 months and felt worse and worse the entire time.  More research and switched to low fat/high carb.  I have been on a very low fat, vegan (McDougall) diet for about 20 months now.  My A1c last tested 5.1 fasting insulin is <2.00 uIU/ml.  Recent glucose tolerance test with insulin values showed this after fasting ingestion of 75 gm glucose (I am only 5'3" 110 pounds:

    BG (mg/ml) fasting=82, 1/2 hour=114 1 hour=103, 2 hour=86, 3 hour=100

    insulin (uIU/ml) fasting<2, 1/2 hour 8.5, 1 hour=11.0, 1 1/2 hour=13.4, 2 hour=18.1

  • Gretchen

    11/28/2009 9:56:57 PM |

    DRStrange

    Maybe we should discuss this privately, as the best way to treat diabetes is really not the topic of this blog. There are so many variables. You can get my e-mail on my blogsite, which is at the end of the stuff that Dr. Davis cited. Use Wildly Fluctuating.

  • buy jeans

    11/2/2010 8:21:09 PM |

    Gretchen makes a crucial point: Some of the effects of diet changes evolve over time, much as triglyceride levels changed substantially for her on the day following her experiment. Wouldn't it be interesting to see how postprandial patterns develop over time if levels were observed sequentially, day after day?

  • Dharini

    11/13/2011 11:56:52 PM |

    De novo lipogenesis is almost non-existant in humans. Trigs being high the day following a high carb meal probably reflect the regular trigs levels for a particular person. This would be true for any macronutrient composition that is not low in carbs.

    Naturally after a low carb meal there is an increased turnover of lipids because the brain does not have any glucose or glycogen sources for fuel. Thus, triglyceride levels fall ad fasting triglyceride levels are low.

    More importantly, fasting triglycerides DO NOT independently predict risk of heart disease once you adjust for post-prandial triglycerides. (Bansal et al_JAMA 2007_Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women)

    The effects of a low carb diet on postprandial triglycerides has been measured over 4 weeks in a study by Natalie et al_Diabetes Care 2009. They also found a worsening of triglycerides post prandially.

Loading
Letter from the insurance company

Letter from the insurance company

Claudia got this letter from her health insurance company:

Dear Ms. ------,

Based on a recent review of your cholesterol panel of January 12, 2011, we feel that you should strongly consider speaking to your doctor about cholesterol treatment.

Reducing cholesterol values to healthy levels has been shown to reduce heart attack risk . . .


Okay. So the health insurer wants Claudia to take a cholesterol drug in the hopes that it will reduce their exposure to the costs for her future heart catheterization, angioplasty and stent, or bypass surgery. This is understandable, given the extraordinary costs of such hospital services, typically running from $40,000 for a several hour-long outpatient catheterization procedure, to as much as $200,000 for a several day long stay for coronary bypass surgery.

So what's the problem?

Here are Claudia's most recent lipid values:

LDL cholesterol 196 mg/dl
HDL 88 mg/dl
Triglycerides 37 mg/dl
Total cholesterol 291 mg/dl

By the criteria followed by her health insurer, both total and LDL cholesterol are much too high. Note, of course, that LDL cholesterol was a calculated value, not measured.

Here are Claudia's lipoproteins, drawn simultaneously with her lipids:

LDL particle number 898 nmol/L
Small LDL particle number less than 90 nmol/L (Values less than 90 are not reported by Liposcience)

LDL particle number is, by far and away, the best measure of LDL particles, an actual count of particles, rather than a guesstimate of LDL particles gauged by measuring cholesterol in the low-density fraction of lipoproteins (i.e., LDL cholesterol). It is also measured and is highly reproducible.

To convert LDL particle number in nmol/L to an LDL cholesterol-like value in mg/dl, divide by ten (or just drop the last digit).

Claudia's measured LDL is therefore 89 mg/dl--54% lower than the crude calculated LDL suggests.

This is because virtually all of Claudia's LDL particles are large, with little or no small. This situation throws off the crude assumptions built into the LDL calculation, making it appear that she has very high LDL cholesterol.

Do you think that Big Pharma advertises this phenomenon?

Comments (24) -

  • Anonymous

    3/18/2011 1:49:34 AM |

    Dr. Davis,

    I think total cholesterol should be 290, perhaps, and not 29?

    I have started using the lipoprofile in my practice.  Patients with relatively normal lipid profiles are startled with the results.  Getting them to make any changes is another thing, but I will keep trying.

    Teresa

  • Anne

    3/18/2011 7:42:37 AM |

    I live in the UK under the National Health Service but I also  have private medical insurance. I know that neither my private medical insurance company, nor the NHS itself, know my cholesterol numbers - they are known only to the lab, my doctors and me. How is it that patient information, which should be confidential, is given to insurance companies ? I find that a very worrisome aspect of this.

  • Kris @ Health Blog

    3/18/2011 8:08:05 AM |

    I find it kind of strange how obsessed american doctors are with cholesterol levels, in my country (Iceland) this is not such a big deal.

    It's almost as if the doctors in America are going out of their way to find something wrong with their patient so that they can treat it.

    For example high cholesterol, thyroid disorders. I pretty much never hear people talk about those things here.

  • Anonymous

    3/18/2011 11:55:23 AM |

    and when she refuses to do as ordered, her insurance company will find out about that, and will then terminate her coverage. Anybody want to make a bet? So much for privilege and confidentiality in the ole US of A.

  • Peter

    3/18/2011 1:29:41 PM |

    Seems very odd, I've had health insurance fornforty years, and they've never given me any advice or indication that they read my lab results.

  • Marg

    3/18/2011 2:22:16 PM |

    Some insurance companies routinely require physical examinations before they will write life insurance and are happy to find any reason not to write the insurance. Could this have been a life insurance company?

  • Galina L.

    3/18/2011 2:33:23 PM |

    What do you think is the best line of defense for the patient? My husband has similar calculated LDL - 181, the rest of numbers are excellent and he is in a very good health at 50 years old. Blood pressure is excellent(115/65), pulse is 45 at rest, fasting BS is 76. Our doctor admits it, but recommends Lipitor anyway. Our health insurance is about to be changed and it makes me worry about perspective pressure from insurance people on my husband to take that Lipitor.

  • Anonymous

    3/18/2011 2:37:48 PM |

    How does an individual give honest answers on health questionaires when applying for new or additional life or health insurance?  If they ask my PCP they would be told that I am low risk for heart attack.   If they look at my CT scan score they would see that I am in the 90th percentile - high risk.
    These are hypothetical questions at this point but my inclination would be to base my answer on my PCP's opinion rather than my calcium score, in part because medical insurance does not cover CT scans (apparently because they don't consider them to be a reliable predictor of risk) and in part because I have taken steps to significantly reduce my risk.

  • Anonymous

    3/18/2011 2:41:21 PM |

    Let's name names!  I have coverage by United Health Care through an employer.  I have gotten several letters in the past couple of years telling me I NEED this test, or that that test, to maintain my good health!  [However, never anything about the value of lipoprofile testing!]

    I consider this an abhorrent practice, an invasion of my privacy, and totally reject their "advice".  Advice should be coming from my doctor, and in fact it is.  I don't need their nurse "case manager" nor this advocacy for excessive testing.

    There's nothing like a letter from an insurance company to raise blood pressure!

    madcook

  • Barbara

    3/18/2011 4:35:25 PM |

    It is very disturbing to me that 1) her health insurance has access to her medical records and 2) that a for-profit organization is getting involved in her healthcare. Having moved from Australia about five years ago, everything about American health care disturbs me. I trust no one; they all seem to be desiring a profit and therefore paperwork is their main concern, not patient care, health, or longevity.

  • Jonathan

    3/18/2011 6:31:50 PM |

    My last test showed calculate LDL at 208, however the one from three months ago was "directly measured lipid" and showed 263 LDL direct, so might the calculated version be wrong in either direction?  I have pattern A and am FH.

  • susan

    3/18/2011 6:53:21 PM |

    I'm for naming names too!  I have Aetna health insurance through my employer. I don't get letters from them, but I get emails. Just today, I told my email program to automatically delete any further emails from the "Simple Steps to a Healthier Life" program. Plus whenever I sign into the online portal, I get nagged to have all kinds of tests, fill out questionnaires, and join health improvement programs.  I got so tired of the demand that I "fill out a health assessment questionnaire" I finally gave in, hoping it would be removed from the page. It just opened a new can of worms: now I have a half dozen new "suggestions" on my "to do list". Bah humbug!

    I'm of the "live and let live" school.  Why go looking for trouble?  As long as I'm not having symptoms, I feel no need to undergo all of these tests.

    Thank God my doctor is beginning to understand that I'm not going to be taking any of those Pharma-pushed poisons just because my lab results don't meet someone's criteria. Once again, I say Bah humbug!

  • Dr. William Davis

    3/18/2011 7:15:53 PM |

    Thanks for catching that, Teresa.

    It is indeed an eye-opener, isn't it?

  • Dr. William Davis

    3/18/2011 7:17:42 PM |

    Anne and Kris--

    Fascinating non-American perspectives.

    Insurance companies have incredible info on us. I'm always surprised more is not made of this issue.

    Remember: The more they know, the better they are at denying coverage.

  • Anonymous

    3/18/2011 8:19:22 PM |

    Dr. Davis,

    I didn't want to put this here (not sure if I could post it elsewhere) , but I thought you would find this interesting if you haven't seen it yet.

    http://www.psychologytoday.com/blog/p-nu/201103/cardio-may-cause-heart-disease-part-i

    RyanH

  • Anonymous

    3/18/2011 8:25:47 PM |

    Anonymous1 said:
    "I have coverage by United Health Care through an employer"
    Ah, United. I have Oxford/United. '
    Several years ago, when everyone at Oxford (and patients) worked toward a noble goal of "salary" for their CEO of 1.6 Billion a year, they sent me several letters suggesting that I have basic check up. I followed their suggestion. Then, I started to receive letters ... refusing to pay - 100% refusal. Each time, I had to call and ask nicely and politely: "Are you nuts?" They paid.

  • Dr. William Davis

    3/18/2011 10:52:16 PM |

    Though I am not in the habit of defending health insurers, I have found that they tend to provide a benign "you should speak to your doctor about . . ." kind of approach.

    I often wonder, however, if at some point they start to be more coercive. Something like: "You should strongly consider a cholesterol-reducing drug. We anticipate that your premiums may be higher if you do not."

    That would be scary.

  • Anonymous

    3/19/2011 12:50:53 AM |

    Ah, I should have continued.
    In a way, Oxford achieved their goal. What they paid was minimal, but they avoided bigger cost at that time.
    They scared me to death - if they don't pay for what they send to ( with letters firmly printed) which is basic, stated officially in some book as my right, they probably won't pay for anything else. I neglected all symptoms and asked for medical attention when I really didn't have any choice (and in a slightly new climate)
    I was diagnosed with two quite serious conditions - neither curable, but one was preventable and the other was at this time preventable to a degree. I mean the condition would be one only (the result of "bad" accumulation +genes?), less serious and correctable.

  • Contemplationist

    3/19/2011 3:16:40 AM |

    An insurance company has a tremendous incentive to reduce its costs and hence a great incentive to find out the truth. If they are not, it means that something is fishy. Why are insurers not commissioning their own studies? Are they not allowed to? Is it the regulators who are holding them back? Or are they actually stupid?

  • Anonymous

    3/19/2011 3:59:39 AM |

    I have not had any insurers say they know what a patient's lipid numbers are, but they can pretty well tell from claims data what tests have been done, and what medications are prescribed.

    We get faxes all the time recommending that meds be changed or weaned or made as needed rather than routine.  Yes, I know Mrs. Jones has been on an ulcer medicine for 6 months, and we should try to wean it.  What they don't know is that she won't change her diet and lose some weight, so maybe her symptoms would stop, and her symptoms get horribly worse without her ulcer medication.

    Teresa

  • jkim

    3/19/2011 2:57:41 PM |

    Dr. Davis,

    Based on Claudia's numbers, I guess I should expect a letter from my insurance company and a prescription from my doc for a statin. I won't fill the scrip.

    I'm 65, slim, eat VLC, and haven't been afraid of  saturated fat. But I just got my labs and TC was 476, HDL 146, Triglycerides 79 (I'd had wine with dinner--they're usually in the 30s), and LDL 314!!!

    How worried should I be about these numbers?

  • susan

    3/21/2011 1:57:39 AM |

    Hey Dr. Davis,

    At my last visit, my doctor mentioned my lipid numbers; but even he had to admit that my LDL (157) and TC (234) had improved (from 177 and 255), and the rest of my labs were all WNL. I generally eat low carb -- other than my recent indulgence in mini PB cups -- so I suspect that, as you indicated, the actual numbers are better than the official calculated numbers.

    My doc didn’t try to prescribe any meds this time. But at other visits he’s tried to guilt me into following the accepted guidelines by telling me his “performance score” is determined by how well he adheres to those guidelines, including prescribing all the meds and tests recommended by the so-called experts for a patient of my age with my lab results.

    I also fear that things are changing in this regard – and not for the better. Our government has now decided that we all must have insurance or pay a fine. If I refuse to follow the recommended guidelines, either my insurance company or my doctor, or both, may “fire” me. The truth is, I really don’t give a fig which entity it is (doctor, insurance company, or government panel) that tries to hector me into following guidelines promulgated by “experts” who believe in the lipid hypothesis. I simply choose to believe that I’m in charge of my body and that I get to determine whether to take a recommended med or have a recommended test.

    As for insurance companies getting lab results, I don’t know whether the doctor’s office or Quest Labs has been feeding my results to my insurance company, but when I look at my online health info on the insurance company’s web site, all my lab results are listed. And I’m sure the company is basing at least some of its many recommendations on those results.

    I must admit, having the results online makes it easy for me to keep track of them; but given the ease with which records can be hacked, I fear for my health privacy. And I resent the big brother attitude of the insurance company. I'm a well-informed, healthy adult. Treat me like one.

  • ShottleBop

    3/21/2011 4:50:53 AM |

    Just this past week, my insurance company (Aetna), which has paying for my test strips for the past year and a half, sent me a letter suggesting that I might have diabetes, and should talk to my doctor.

  • jkim

    3/21/2011 1:39:31 PM |

    Hi Dr. Davis,

    I spent the weekend reading your older posts about LDL. I guess I need to get a test done to determine my LDL particle number before my doc and I have a discussion. Thanks for posting that info in such detail on your blog.

Loading