Is shock therapy the answer to “cure” obesity?

10. August 2014 Lisa G (0)
The next obesity “fix” may be hitting the market known as "VBLOC therapy”.  This implanted device delivers intermittent electrical "blocking signals" to the intra-abdominal vagus nerve.  According to the manufacturer, the device "reduces sensations of hunger and produces satiety leading to weight loss.”

Seems to me like another classic case of conventional healthcare proposing surgery or medications to address the obesity epidemic. Pharmacologic treatment and bariatric surgery have been offered for years to win the battle of the bulge.  As a registered dietitian, who years ago begrudgingly counseled patients prior to undergoing bariatric surgery, I have seen countless people re-gaining all (if not more) of the weight lost after the first year of surgery. Same goes for pharmalogical interventions, such as Phentermine.  Sure it worked in the short-term.  But in every single case, when the medication was stopped, as it is not FDA approved for long-term use, the weight came creeping back.

My take on the releasing a significant amount of weight does not require going under the knife.  How about this instead? Address the cause of increase hunger and appetite.  This is a crucial missing link for many undergoing surgery or using medication(s) as a “solution”.  Not addressing the cause of increased hunger and ravenous eating behaviors precipitously results in rebound weight gain.  Rather than sending an electrical pulse to a nerve in the stomach, maybe the FDA should consider a Cureality-based nutrition program that is wildly successful stimulating a “side effect” of weight loss.  Wheat elimination offers a surgery-free option that reduces hunger and insistent drive to eat every few hours, thanks to freedom from gliadin driven appetite stimulation.  Weight loss is common experience due to reduced hunger and subsequent intake. Give it a try.  What else do you have to lose, but some love handles?

--Lisa Grudzielanek, MS,RDN,CD CDE
Cureality Nutrition & Health Coach

Are Your Beauty Products Toxic?

10. August 2014 Lisa G (0)
As a nutritionist and self-care advocate, I am very careful about what I put in my body.  Health benefits experienced through proper nutrition are well understood.  We avoid highly processed foods, wheat-based products, and sugary snacks because we know that are “unhealthy” for us.  But what about what we put on our skin?

An important piece of the health and wellness puzzle is not only what is on the end of our fork but on our toothbrush, slapped on our bodies and rubbed into our hair.  Skin is the largest organ and what we place on it on a daily basis penetrates the skin, enters the fat stores and contributes to the toxicity and adiposity of our bodies.  According to the Environmental Working Group, the average woman uses 12 beauty products per day, containing about 168 ingredients.  Yikes!

I’ve often held a high suspicious that endocrine disruptors such as parabens, triclosan, fragrance, and other punitive chemicals are a key suspect in the root cause of my endocrine disruption.  Interestingly, scientific evidence is now emerging to support this suspicion.

A few months back, I took a look at my hair, skin, and cosmetic products. I was shocked and horrified.  Parabens, an estrogen-mimicking preservative linked with endocrine disruption, was in dozens of products.  It reminded me of how I felt on that day years ago when I threw out all the products in my kitchen that contained wheat.  What are parabens not in?  Why was it in so many products?

In our next episode of Cureality Connections we will discuss key skin and beauty product chemicals to avoid along with other steps to take to attain beauty from within.

--Lisa Grudzielanek MS, RDN, CD, CDE

Top 3 Strength Training Exercises for Runners

28. July 2014 Amber B (0)
First and foremost, if you’re a runner and you’re not strength training you need to start.  This in and of itself could be an entire blog article.  But here I go with the synopsis. 

Strength training will indirectly help you run longer and faster.  Strength training exercises can improve your running mechanics, so that you run more efficiently.  Efficient running mechanics will lead to less wasted energy with each step and less injuries. 

Think about it.  You will take 80 to 90 steps per foot each minute you run.  If you have muscular imbalances that lead to joint mobility or stability issues you will move through an improper range of motion with each step. 

When you run for 30 minutes you take 2700 steps with each foot for a combined 5400 steps.  That could be 5400 steps of feet rolling in, rounded shoulders, wasted side to side movement or just pure pain.  Needless to say, when you are an endurance athlete it’s important that each step and every workout is adding to improved performance not to injury or fatigue.

The key to becoming a better runner is consistency.  For most runners, injuries are the biggest disrupter of consistent training.  Runners get a few good weeks or months of training, and then they are injured.   That means time off, loss of motivation, and a decrease in fitness. 

Strength training with proper form 2 to 3 times a week will reduce the onset of injuries and improve your running form.  Here are my top 3 strength training exercises for runners. 

Bulgarian Split Squat

You will need a bench, chair or stepper to perform this exercise.  Start by doing this exercise with just body weight and then progress.  The progression could include holding dumbbells, kettlebells or a barbell.  You can also make this exercise explosive. 




 
  • Place the to top of your back foot on.  If you are having a hard time with balance, flex your back toes and place them on the bench.   
  • Stand in a staggered stance about 2 to 3 feet wide.  This should allow your knee to bend while keeping your knees behind your front toes. 
  • Inhale as you begin to bend both knees. 
  • Focus on your back knee pointing straight down toward the ground and your body weight in your front heel.   
  • Keep your front kneecap inline with the 3rd toe of the front foot. 
  • Exhale as you straighten both knees to come back up to standing.  
Start with 10 repetitions on each leg and progress to 15. 

Calf Lowers

Use a stair or a stepper to perform this exercise.  Start by doing this exercise with just body weight.  The progression would include holding a dumbbell in one hand. 


 


  • Place the ball of your foot on the stair while holding on to the wall or railing.   
  • Rise up on the ball of your foot as high as your heel will go.  Make sure you have weight evenly distributed on all of your toes and that you are not rolling onto one side of your foot. 
  • Slowly, lower you heel back to the starting position.  Try counting 3 to 5 slow counts to ensure you really focus on lowering part of the movement.   
Do 10 reputations on each foot to start.  Work up to doing 20 reputations on each foot. 

Band or Cable Row

How many runners do you see hunched over logging long miles.  This exercise is for improved running posture, which can lead to improved respiration. 

To perform this exercise, use a band or a cable.  This exercise can be done with both arms or with just one arm. 





  • Stand in a staggered stance with relaxed knees.  Make sure your ribs on stacked on top of your hips to ensure good posture. 
  • Grab the handles of the band or the cable in the thumbs up position. 
  • Start the movement by protracting the shoulder blades.
  • Then bend the elbows straight back so that your biceps are close to your rib care.  Keep  your knuckles forward. 
  • To release, begin to straighten your elbows and bring your shoulders back to the starting position. 
Start with 10 repitions and work up to 20.  To increase difficulty, use a more difficult band or more weight on the cable system. 

Here’s to improving your running mechanics so that you can train more consistently.  Can’t wait to hear about the PR at your next race. 

How did Cureality get its start?

27. July 2014 William Davis (0)



In the Cureality program, we embrace information and strategies that empower you in health without drugs, without hospitals, without procedures. We convert your doctor from director of healthcare to your assistant in health. He or she is there when you need help, but you largely direct your own health future.

How did we gain the know-how, information, tools, even chutzpah to take on such an ambitious project?

It started around 10 years ago with the awkwardly named Track Your Plaque program. In fact, some of the current followers of the Cureality program are former Track Your Plaque members, having learned of the wonderful list of strategies that can be adopted to gain better control over, even reverse, coronary atherosclerotic plaque and risk for heart attack. They also learned that something special happens when you engage with other people with similar interests, all sharing ideas, insights, and resources to get the self-directed health job done. Over time, what started out as simply a source of better information for coronary health evolved into a self-directed coronary disease management program. We never set out to create something as wildly ambitious as a do-it-yourself-at-home coronary disease risk management program, but that is how it inadvertently turned out.

How we went from Information Provider to Health Empowerment Program

So we never intended to take on something so seemingly impossible as managing coronary risk on your own. But, because we armed people with such empowering, profound insights into better ways to manage their heart disease risk beyond “don’t smoke, cut saturated fat, be active, and take a statin drug”—the typical advice offered by doctors—they returned after an interaction with their doctors disappointed: doctors often declared such strategies unnecessary, or the doctor didn’t understand them—even when there were clear-cut clinical data already available to support their use. In other words, the patients—everyday people, not experts—knew more than their doctors. 

This flip-flop in the balance of knowledge made for some very interesting stories, like “Harold” (not his real name) who, having survived a heart attack and received a stent, was told by his doctor to cut his fat intake, eat more whole grains, exercise, take aspirin and a beta blocker drug, and reduce his cholesterol values with a statin drug. Upon learning all the additional information from the Track Your Plaque program, Harold returned to his doctor and asked “I’m not so ready to just go along with this idea of ‘reducing cholesterol’ to address heart disease risk. Because my goal is to gain as much control over coronary disease as possible, maybe even reverse it, I’d like to address some additional issues that I believe may be important. I’d like to have my advanced lipoproteins drawn to measure the proportion of small LDL particles I have, whether I have lipoprotein(a), an omega-3 fatty acid index and 25-hydroxy vitamin D level, and a thyroid assessment. Oh, and I believe I should also have an assessment of my inflammation status, perhaps a c-reactive protein and phospholipase A2, and my blood sugar status measured with a fasting glucose, insulin, and hemoglobin A1c.” Harold’s doctor was dumbfounded and speechless. Rather than reveal his ignorance, his doctor advised Harold that none of that was necessary, sending him on his way and telling him that he was fine.

But this left Harold with a sour taste in his mouth, having engaged in many online discussions with people who had followed conventional advice that resulted in more heart attack, more heart procedures—the conventional answers simply did not work. He also discussed his situation with people who had successfully obtained the additional information he sought, added it to their program and enjoyed dramatically improved health, including freedom from more heart attacks, heart symptoms, and heart procedures, as well as improved overall health. So Harold found an easy way to obtain the testing on his own. Within a couple of weeks, he returned to his online community and shared all his information. Within moments, he was provided useful discussion to help him understand the values, all leading to changes in nutrition, nutritional supplement choices, how and where to get the simple tools necessary, such as iodine and vitamin D supplements. He even entered his data, choosing which values he was willing to share with others, which remained private, allowing him to compare his own follow-up values several months later. Engaged in this process, self-directed but collaborative, he witnessed marked transformations in his health. Not only did he never again—over several years—ever re-develop heart symptoms nor require any more trips back to the cath lab, he lost weight, reversed a pre-diabetic sugar profile, improved his cholesterol values without drugs, got rid of the acid reflux symptoms he endured for many years, dropped his blood pressure to normal, enjoyed better mood, energy, and sleep. Slender, healthier, all accomplished without his doctor. 

Harold returned to his doctor for a routine follow-up. Slender, energetic, without complaints, on no drugs except the aspirin for his stent, the basic laboratory assessment his doctor ordered in front of him, his doctor admitted,” Well, I don’t know how you’re doing it, but these values look like a 20-year old substituted his blood for yours. They’re unbelievable. What drugs are you taking to do this?” “No drugs,” Harold replied, “I’m following a program to reverse heart disease, but it means doing some things that are different from conventional solutions.” His doctor closed their meeting with the signature response of doctors nationwide: “Well, I don’t understand what you are doing, but just keep doing it.”

Yes, Harold knew more about how to control heart disease than his doctor, more than his cardiologist. The cardiologist knew how to insert a stent or defibrillator. But deliver information that empowered Harold in all aspects of health from head to toe, while also dramatically reducing, perhaps eliminating, his coronary disease risk? As you now know, that is not what conventional healthcare does, nor is it interested in doing so, as it would relinquish control and threaten to cut off this hugely profitable revenue stream that drives “healthcare.”

Having managed to inadvertently create a self-directed coronary risk management program with such spectacular results and in probably one of the most difficult areas of all—heart disease—it became clear that a similar approach could be even more easily applied to many other areas of health, such as weight loss, bone health, cholesterol and blood pressure issues, diabetes and pre-diabetes, hormonal health, autoimmune conditions, and others. You can do it when empowered by safe, effective information, and supported by a community of sharing and collaboration. We don’t fire our doctors; they are there when we need them when, for instance, we get injured or catch pneumonia, or as an occasional resource. But doctors should no longer be able to get away with neglect, misinformation, or blindly directing you to the next revenue-generating procedure because you are empowered by the information and support you receive in Cureality.

As we get more effective in delivering this information and new tools to you, just imagine what we can accomplish in this new age of information and self-empowerment. The future for us is bright with ambitions for better interactive tools with Cureality expert staff, better ways to crowd source health answers, provide more engaging community conversation, all while the health insights that help accomplish our self-directed health goals get better and better. Each person that joins Cureality helps make this service more effective because your wisdom, insights, and experience are added to the collective knowledge. We are more powerful together than we are as individuals.

If you are already a Cureality Member, please add your comments and questions to the growing conversation. If you are not a Member, consider joining our discussions, as each new voice gets us closer and closer to better answers to take back control over health.

Sit Less and Move More.

21. July 2014 Amber B (0)


We sit way too much. Many of us have desk jobs where we sit for 8 to 9 hours a day. After we leave the office, we sit in our car to run errands. We follow that by sitting down to eat dinner. Our day ends by sitting on the couch to unwind by watching some television.

Many of us will be sitting a good 12 to 15 hours each and every day. Unfortunately the research shows that long hours of sitting can lead to obesity, heart disease, diabetes, and even early death. Don’t be fooled that your workout is enough movement. You can still be active and sedentary.

How can you add more movement to your day? First, think about all the times you find yourself sitting during the day. Then come up with a creative way that you can get out of the seat and move your feet.

Here are a couple of examples:

Instead of driving everywhere, jump on your bike. The picture above is of the bike I use to go to work or run errands. Bike riding is great exercise, greener transportation and a great stress relief.

We spend a lot of time at work sitting in front of the computer or the phone. Prop your laptop on a bookshelf to create a standing workstation. You can also purchase a sit-stand workstation you can adjust throughout the day. Get a headset and stand during phone calls.

Walk during your lunch break. Walk to the coffee shop, the mailbox, and the dry cleaners. Get your errands done on foot or just enjoy a stroll outside.

Take a movement break every hour. Do some desk push-ups, squats or walk the stairs. Need to communicate with a coworker? Don't email, walk over and talk to them.

Human beings are meant to move, not sit in chairs all day. I want to challenge you to incorporate more movement into your day. I'd love to read your comments how you move more and sit less.

Have You Had Your Prebiotics Today?

11. July 2014 Lisa G (0)


Prebiotics and resistant starch may be the missing link to your digestive health. Indigestible fibers that allow healthy bowel flora to proliferate and thrive are often called prebiotics. They are also known as resistant starches, because they are resistant to human digestion. I recently had a client call the addition of resistance starch to her diet, “the missing link my body needed”.

A starch that resists digestion and reaches the large intestine becomes food for the healthy bacteria in the large intestine. These bacteria can break down and “feed on” the resistant starch thus providing the friendly bacteria with the fuel they need to survive.

Imbalance of the quantity and type of bacteria species present in the gut contributes to gastrointestinal illness, blood sugar imbalance, obesity, mood disorders, and immune system challenges.

Green unripe bananas and plantains are one of best sources for prebiotic fiber content with 27 to 30 grams of fiber in one medium banana. Green bananas are essentially inedible. They are most easily incorporated into diet by blending into a smoothie.

One mistake frequently made incorporating prebiotic fibers from bananas is consuming bananas that are too ripe. Once the banana ripens the resistant starch is degraded and become a digestible starch. Thus, no longer a good prebiotic fiber source. In fact, the riper the banana becomes the higher the glycemic (blood sugar) response.

It can be difficult to find bananas that are very green. I made several trips to my local grocery store to find these bowel flora champions. I find it helpful to ask the produce clerk to take a look at the shipment that just arrived, noting the day the shipment arrives, for the best chance to gobble up these green beauties.

In an effort to keep green bananas green I tried a few strategies. One that sounded promising was wrapping the end of the banana to prevent the ethylene gas, which ripens the fruit, from dissipating. You can see from the image this clearly did not work. After a mere two days the green bananas were no longer green. What I found works best is placing the green bananas in the fridge. This halts the ripening process. The skin of the banana will turn brown, which is normal, but the fruit inside is still good. I’ve kept bananas in my fridge for up to 8 days and they hold up well other than the brownish black discoloring that develops on the skin. The banana will be firm and require a knife to cut the skin off the banana.

If you’d like to learn more about prebiotics and strategies to support resolution of common gastrointestinal complaints read the recently release Cureality Guide to Healthy Bowel Flora by Dr. Davis. This guide is one of the many valuable resources available exclusively to Cureality.com members.
---Lisa Grudzielanek, MS, RDN,CD,CDE
Cureality Nutrition Specialist

Something is Better Than Nothing

2. July 2014 Amber B (0)


This past weekend I attended a fitness conference with an amazing lineup of presenters. Even after 11 years in the fitness industry, I love attending these events. I’m a lifetime student always learning more and honing my craft.

I went to a presentation by Al Vermeil about joint mobility, not knowing anything about him. To my surprise, Al was the strength and conditioning coach for the Chicago Bulls and the San Francisco 49ers the years these teams won championships in their respective sports. That’s a pretty impressive resume.

Al was a great presenter, full of fun and practical advice. During his presentation, Al said the following statement:

“Every time you miss a workout, the next one is easier to miss.”

This statement really hit home because I’ve seen this time and time again working in the fitness industry and in my own life. One workout is missed, then an entire week of workouts are missed, then it’s been an entire month of never setting foot back into the gym.

It’s easy to get thrown off your workout routine when life gets busy and days get long. So what do you do? Do you just trash your workout plan?

The all or nothing attitude is common when it comes to making health changes. Either you’re following your plan 100% or you not. I’m here to tell you that doing something is better than nothing. Doing part of your workout or a mini workout is better than missing an entire workout.

The other day I had the choice to do something or nothing. I had a full day of work meetings, video, and family commitments. Here is what happened. I did shorter variation of my joint mobility routine. I followed that with a quick kettlebell circuit of 25 kettlebell swings, 12 kettlebell overhead presses, and 12 kettlebell goblet squats. I did three rounds of this circuit. That’s it! The following day, I got back to my regular exercise routine.

Be consistent with movement and you’ll always see improvements. That’s the magic of exercise. You'll get better if you just do it.

What’s the Problem with My “Healthy” Bowl of Oatmeal?

26. June 2014 Lisa G Nutrition, Oatmeal (0)


Food manufacturers have clever ways to market foods to us. Unfortunately, many foods that have a reputation for being healthy are no more than junk food disguised as a healthy food choice. I commonly see people under the influence of a “health halo” effect. This is due to strategic marketing efforts. People overestimate the nutritional value of a food that is labeled “good for you” or they underestimate the negative impact of a food because it contains a healthful ingredient, like flaxseed or fiber. In fact, a recent study from the University of Houston found that terms on food labels such as antioxidants, all-natural, and gluten-free often are used to give an otherwise standard food a "healthy" halo, and influence consumption from the well- intended consumer.

Case in point-- oatmeal. We’ve all heard about the cholesterol lower benefits from soluble fiber contained in oatmeal. It’s blasted all over packages with a paid endorsement from The American Heart Association. However, that’s not the whole story. Most people enjoy a cup of oatmeal with one to two tablespoons of added sugar and fruit such as a ripe, yellow banana. In other words, let’s enjoy a bowl of “send my blood sugar through the roof” high glycemic oatmeal. The glycemic index of oatmeal is 55, and instant oatmeal is 83. Top that with more table sugar, glycemic index 58-65 and better yet top that with a high glycemic, ripe banana with a GI of 62.

Preparing one packet of regular instant oatmeal with one tablespoon of sugar and a medium ripe banana five days per week would result in the sugar equivalent of more than 5 1/2 cups of sugar per month!

Furthermore, the story many Americans are missing is all of that sugar intake, from their so-called “healthy” bowl of oatmeal, actually raises small-dense LDL cholesterol particles, increases blood sugar and contributes to insulin resistance, faulty gut flora, and belly fat.

How do we improve upon our bowl of oatmeal? Enjoy a bowl of hot coconut flaxseed cereal, eggs any variety of ways, or last night’s leftover salmon and vegetables.

The Cureality program provides tools, guidance, and support that does not follow the party line but rather offers nutrition solutions that address the underlying causes for proliferation of many chronic diseases.

Power in Numbers

25. June 2014 William Davis (0)


In his book, The Wisdom of Crowds, author James Surowiecki begins with the story of an ox judging competition in which 800 people—not ox experts nor breeders, just ordinary people attending a county fair—were asked to guess the weight of the ox. The competition was conducted by a scientist, Francis Galton, who held a low opinion of the intelligence of the average person, remarking that “the stupidity and wrong-headedness of many men and women being so great as to be scarcely credible.” He hoped to prove, by examining the various guesses, that the average person had no idea of how to judge the real answer. After all participants casted their written votes, Galton tallied up the total and averaged the result: 1,197 pounds—just one pound off from the real weight of 1,198 pounds. Few individuals actually guessed the correct weight themselves but, when the opinions of many were combined, the result was near-perfect.

Crowds can also be a source of irrational behavior, panic, and stampede. Witness any modern football or soccer game, for instance, in which fights break out over an issue as minor as a disputed call or a heckle. Or go back through history to the countless events when mass hysteria ruled, such as the Salem Witch Trials or Orson Welles’ War of the Worlds radio broadcast.

Let’s put aside examples of mass emotional chaos of the sort that causes crowds to stampede store doors on Black Friday. Let’s focus instead on conscious, considered, thoughtful opinions. We all accept that there are as many opinions on issues as there are people, not uncommonly with widely divergent views. But can we, as Galton’s famous experiment did, combine the opinions of many and come away with some fruitful insight—the correct answer? Just as the people participating in Galton’s experiment were not experts, so Cureality participants—a crowd-sourced collection of opinions—are not experts. If we were to poll everyone to identify their area of expertise or experience, it would likely include finance, the retail industry, raising children, or teaching—but not health. Yes, we have experts curating the direction of content, but we also crowd-source collective opinion.

Right now, Cureality is based on existing science, the philosophy of self-directed health, combined with guidance and community to help the participant along in the sometimes complex world of health questions. But as our processes and procedures improve, can we—like Galton’s ox weight guessers—come away with coalescent wisdom, answers to our health questions, near-perfect solutions to health conditions that have eluded the “experts” for centuries?

I think that we can. No, I know that we can. We enter a new age in information and harness the power of the crowd-sourcing of solutions, even when no single individual has the complete answer herself.

Use This Trick to Boost Exercise Motivation

23. June 2014 Amber B (0)


Are you been struggling to get your workouts in? 

Do you belong to a gym and find that you're not going?

Do you have exercise equipment sitting in your basement collecting dust because you find that you just can’t get yourself down there?

If you answered, “yes” to any of these questions you are not alone. Many people struggle with finding the motivation to exercise.

The problem here is that you have head trash going on. Head trash is that voice inside your head coming up with a million excuses that inhibit you from carving out a bit of time to take care of yourself.

Head trash will tell you that you’re too tired, even though a workout would give you a boost of energy.

Head trash will tell you that you’re too busy, even though you just spent a half hour on Facebook.

Head trash is barking at you to take care of others, even thought you know your health is important for you well being.

Head trash is a real conflict that can get in the way of our health and fitness goals. We start an exercise program with the intentions of a long-term commitment. But after the initial excitement wears off, we find our workouts occurring less frequently. Head trash begins to take over and soon we find ourselves not exercising at all.

Here is my secret for winning the battle over the head trash that keeps getting in way of your workouts. Tell yourself that you are only going to exercise for 10 minutes and evaluate if you want to continue. If you're truly too tired you can stop after 10 minutes. If you're truly too busy you can stop and move onto a task that needs your attention.

Making this deal with your mind that you are only going to exercise for 10 minutes seems reasonable. The head trash will become quite because your mind is convinced it has an out within 10 minutes.

I've used this 10-minute trick myself. I grind through the first few minutes, but then the magic happens. Once you hit the 10-minute mark your body takes over. Exercise feels amazing and your body is energized and enjoying the movement. You have tricked your mind to get over the hurdle of starting and now you’re in the exercise groove.

Try the 10-minute trick next time your head trash is getting in the way of your workout. You'll be amazed how your workout consistency improves.

What are "normal" triglycerides?

What are "normal" triglycerides?

12. April 2011 William Davis (67)
Among the most neglected yet enormously helpful values on any standard cholesterol panel is the triglyceride value.

Triglycerides traverse the bloodstream by hitching a ride on water (serum)-soluble lipoproteins, or lipid-carrying proteins. We measure triglycerides as an indirect index of triglyceride-containing lipoproteins.

Triglycerides are a basic currency of energy. While the average American ingests around 300 mg of cholesterol per day, he or she also ingests 60,000-120,000 mg (60-120 grams) of triglycerides, i.e., 200 to 400 times greater amounts, from fat intake. Zero triglycerides in the diet or in the bloodstream is not an option.

But what represents too much triglycerides in the bloodstream? There are several observations to help us make this determination:

1) When fasting triglycerides are 133 mg/dl or greater, 80% of people will show show at least some degree of small LDL particles.

2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

3) When fasting triglycerides are 200 mg/dl or greater, small LDL particles will dominate and large LDL particles will be in the minority or be gone entirely.

4) When triglycerides are 88 mg/dl or greater after eating, then risk for heart attack is doubled. Non-fasting triglycerides in the 400+ mg/dl range are associated with 17-fold greater risk for heart attack.



From Austin et al 1990. "Phenotype A" means that large LDL particles dominate; "phenotype B" means that small LDL particles dominate.

Note that conventional "wisdom" (i.e., NCEP ATP-3 guidelines) is that triglycerides of up to 150 mg/dl are okay, a level that virtually guarantees expression of small LDL particles and increased cardiovascular risk.

Based on observations like these, in the Track Your Plaque program we aim for fasting triglycerides of no higher than 60 mg/dl and postprandial (after-meal) triglycerides of no more than 90 mg/dl.

Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role. That will be an issue for another day.
Tags :

Comments (67) -

  • Stephan Guyenet

    4/11/2011 6:58:50 PM |

    Hi Dr. Davis,

    I searched for that reference but I wasn't able to find it.  I found two papers from Austin et al. in 2000 but neither contained that graph.  Would you mind giving a more detailed reference for it?  I'd like to have that paper as a reference.  Thanks!

  • Anonymous

    4/11/2011 7:14:14 PM |

    HI Dr. Davis--

    Since I have been having my cholesterol levels checked, my triglyceride level has always been on the very low side...ave. around mid 30's.  My hdl  and ldl are generally around low to mid 80's.

    Could you say something about the people who have low triglycerides...is this healthy or a concern?

    My doctors usually think this is great , but I wonder.
    Thank you.

  • Dr. William Davis

    4/11/2011 9:40:20 PM |

    Hi, Stephan--

    Here's the URL for the abstract on Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/2372896

    I also see that I got the year wrong: It was 1990. (Now corrected.)


    Anon--

    Low triglycerides are wonderful. Your values are at the biologically perfect range.

  • Anonymous

    4/11/2011 10:07:10 PM |

    This is from Anon , who wrote you about my very low triglycerides-in the 30's.  Thank you so much for responding--I had been concerned there was something wrong with me!  
      
    I do not think my levels are due to genetics as my siblings have cholesterol issues. I think it is my diet and ex.

    Do you see many people with tri's in the 30's?  
    Thanks again!

  • Frank Hagan

    4/11/2011 10:13:07 PM |

    I must be doomed; even with vlc diet (less than 30g per day), fish oil and niacin, my triglycerides have never been under 103. They started at 440, so that's progress, but I suspect I have familial hypertriglyceridemia, as I can't get them to budge lower after two years.

    I tried going off niacin at one point, and they rose to 140 again. So I continue with the fish oil (1200mg of EPA and 900mg of DHA), niacin (1500mg 1x day) and vlc diet.

  • Might-o'chondri-AL

    4/11/2011 10:36:00 PM |

    Triglyceride (Trig.)clearing relys on the enzyme lipo-protein lipase being able to function at the capillary endothelium. If a Trig can get into a cell it is not taken out of circulation.

    Trigs move around in the circulation bound to lipo-proteins, and one natural component (among several components) of the lipo-protein molecules that carry Trigs is identified as Appoliprotein (Apo) C III. When there is an un-naturally high proportion  of Apo C III involved  this inhibits the working of the enzyme lipo-protein lipase, which is an essential enzyme for clearing Trigs from the blood stream (note: this is not discussing how Trigs get formed).

    Apo C III blocks the lipo-protein lipase enzyme from functioning at the capillary endothelium; Apo C III doesn't actually bind to the lipo-protein lipase enzyme.  It (the enzyme) can't get to work at that capillary inter-face when Apo C III over-abundant; so, there is less lypo-lysis (ie: Trig cleaving off) done to the Trig carrying lipid molecules (ie: VLDL, IDL and chylomicron lipids burdened with Trigs).

    So, what complicates the natural process when there is no underlying genetic cause obstructing Trig clearing from the blood stream ? If you said "insulin" you are correct; insulin signaling has a distinct regulatory affect on the APOC3 gene expression, which encodes for Apo C III.

    Docs interventions keep Trigs down in the obvious manner of setting up less substrate for Trig formation. What contiues to intrigue me is how insulin is involved in metabolic signalling beyond text book role of "driving" glucose into cells.

  • Might-o'chondri-AL

    4/11/2011 10:39:55 PM |

    edit last comment (mine) 1st paragraph, 2nd sentence to read:
    " If a Trig can NOT get into ...."

  • Anonymous

    4/11/2011 11:05:37 PM |

    When I had my last lipid analysis, I had been fasting for about 36 hours.  I frequently do intermittant fasting. My numbers were very contradictory and I wonder if my LDL levels were artificially increased due to the extended fast. My triglycerides were 69, VLDL were too few to be measured, but the number of small LDL particles was very high.  Thank you for addressing this issue.

  • Harry

    4/11/2011 11:21:54 PM |

    might, as I understand it, as VLDL loses trigs, it becomes IDL, and after further loss of trigs and all apolipoproteins except ApoB, it becomes LDL. I have been wondering if receptors in the LDL family are part of the process whereby VLDL and IDL and LDL lose trigs to cells throughout the body. Is this the way it works, or are receptors of the LDL family all or  mostly in the liver?

  • Adam Michael

    4/11/2011 11:35:42 PM |

    Anonymous, would you mind sharing your typical diet and lifestyle practices, including exercise?  I'm sure all curious minds could benefit!  Thank you.

  • Anonymous

    4/12/2011 1:11:53 AM |

    Adam M--In response to your question about my regimen. There really is nothing extreme about it so I have been baffled for years with my cholesterol results esp. the tri's in the 30's.

    For the past 20 yrs. I have almost totally avoided processed foods.Basically no junk food at all. Most of that time I ate no red meat. I have probably not eaten enough food...I  have always been a light eater and on the thin side. Lowish bmi but def. not anorexic or any eating disorder . I haven't eaten butter, though I do drink no-fat, or low fat milk and eat yogurt  daily as well. I use olive oil as much as I care to have, and eat walnuts and almond butter.I don't drink alcohol except on the very rare occassion--maybe a few times a yr.

    No special supplements...but fish oil over the past 8yrs. and a good level vit d. for the past few years. I was probably vit d deficient most of my life before supplementing vit d.


    For the past 10 years, I have walked briskly at least 6 days a week 4-6mi. I lift weights  (dumbbells #15-3-4 days a week. Do some tai chi.

    So you can see ...nothing too special but I do think vastly different than most Americans.

    My guess is that I am reaping the benefits of some good habits from the past 20 plus years. As I said my siblings take bp meds and statins....I don't take either. I think they have bad eating habits, don't exercise consistently and drink alcohol . Though 2 siblings have fairly decent diets, don't drink much and still need a statin and bp meds.

    I am female in my late 50's and siblings a bit older and a bit younger, male and female.

    Hope this helps. Anon.

  • Might-o'chondri-AL

    4/12/2011 1:12:10 AM |

    Hi Harry,
    The liver exports most Trigs bound to VLDL; when measuring fasting Trigs these are mostly complexed to VLDL. IDL (intermediate density lipo-protein) is really a spin off phase of a VLDL remnant, and is itself short lived (ie: IDL degrades quickly).

    When measuring fed (post-prandial) Trigs these are some appearing in VLDL (ie: liver exported) and some Trigs the chylo-microns carry (ie: from the intestine, a different source of Trigs); a relatively minor amount would be Trigs carried by IDL. When fasting (ex: overnight) there are very sparse amounts of Trigs associating with chylo-microns and IDL would be neglibible.

    HDL also has to carry Trigs; it (HDL) brings them back to the liver, which hydrolizes (cleaves) those Trigs for the liver to "play" with again. The HDL Trigs are not scavenged from the long enduring VLDL lipo-protein; but are Trigs HDL had picked up (ie: from the peripheraly circulating short lived IDL & chylo-microns).

    My understanding is that it is not the LDL receptors that are key to how & when Trigs physically get "off" of any molecule that is carrying a Trig. The Apo C III (detailed previously) is one of several proteins ( Apo C molecules exist in different iso-forms, do so simultaneously and sometimes as mutations); a lot of sub-groups get "bundled" to the Apo B complex.

    Apo C III component having excessive expression is what interfers with the enzyme  (lipoprotein lipase) involved in cleaving off Trigs. LDL receptor dynamics only add mitigating circumstances to how/where/when a circulating Trig is coming to be (or not be) presented for cleaving off.

  • Paul

    4/12/2011 3:00:41 AM |

    At least 50% of my caloric intake consists of fat, mostly saturated and monounsaturated from grass-fed tallow, ghee, butter, cheese, coconut, olive oil, almonds, avocados, and one tsp. fish oil... I get plenty from organ meats, wild salmon, free-range eggs, chicken, and beef too.  Not to mention I avoid grains, starch, and sugar as though they are poison.

    I'm a 50 y.o. male, and try to perform at least three apposing compound weight resistant exercises every day (bench-presses, pull-ups, squats, military-presses, rows, lunges, dead-lifts, power-cleans, or clean-&-jerks.)

    I've been doing this for a couple years.

    Along with very (visibly) favorable body comp muscle/fat ratios, my last 12 hr. triglyceride measurement came in at 52 mg/dl.  I think I'll stick with what I'm doing.

  • Rick

    4/12/2011 3:15:34 AM |

    Dr Davis,

    I'm a bit confused about number 4. You suggest that a postprandial value of greater than 88 is dangerous, but accept levels of up to 90 in your program. Are you sure the figures are correct?

    Also, are the 4 points in the order you intended?: you move from fasting triglycerides being too high (1), to being low (2), then to being too high again (3), then you move to non-fasting triglycerides in 4, starting with quite a very low figure (88), and suddenly jumping to 400+. How about more typical non-fasting figures in the 100+ or 200+ ranges?

  • Anonymous

    4/12/2011 5:35:26 AM |

    I must really be screwed. Even on six fish oil caps a day and a gram of niacin, I'm at 292.. my all time low was 157. I'm on even more fish oil and cut out breakfast cereal and other sources of high fructose corn syrup. What I need is a whole new genotype....

  • Alex

    4/12/2011 6:00:44 AM |

    Dr. Davis,

    While I understand that your target audience are probably Americans, as a European, I would be very grateful if you would also post values of the tests you speak of in the measurements used on the other side of the Atlantic. Here we speak of triglycerides in mmol/L, not in mg/dl, so whenever I read your posts I have to sit here with a conversion sheet and calculator, and considering that I can't make notes on other people's websites, I have to do so EVERY time I read your posts, even for the second or third time. It would be very helpful (and probably not too much work for you) if you could post values in both measurement systems, so I can put down the calculator and conversion sheet in the future and put all my attention to the contents.

    Thanks for listening.

  • LifeCoachAndy

    4/12/2011 7:38:17 AM |

    To ' I must be screwed up, VLC diet may be working for , so you  may want to try a different approach, eg. low fat plant based diet, do some fasting, also may need some attention to your liver.

  • Anonymous

    4/12/2011 8:44:10 AM |

    @Alex: +1

    Australia uses mmol/L also as it's the SI standard.

    Perhaps a converter on your site or quick reference table?

  • majkinetor

    4/12/2011 11:20:59 AM |

    "I must really be screwed. Even on six fish oil caps a day and a gram of niacin, I'm at 292.. "
    If you didn't do this, you may try exercising, sesame butter and soy lecithin.

    @Alex:
      +1
    We need M measure too. I have to convert each read, too.

  • Medicomp INC.

    4/12/2011 3:58:11 PM |

    Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role. That will be an issue for another day.

    Interesting point. Many people think that fat is the most important part of a diet to assess, other factors definitely play a role in heart complications.

  • Might-o'chondri-AL

    4/12/2011 4:43:59 PM |

    Exertion (ex: manual work, breathing harder exercising, endurance training, etc.) improves insulin resistance; the
    sedentary, overweight, obese and Type II diabetics are told to actively exercise. Less insulin lingering in circulation means less insulin signals to ratchet up the Apo C III level; Trigs can clear out of circulation (as detailed above).

    Lipo-protein lipase enzyme can then robustly cleave of circulating Trigs for then getting into cells. In the cell the Trig must be processed into a "droplet" molecule for storing inside the cell; up to 1% of our genome is suspected to be involved in the biochemistry of achieving fat "droplet", which reflects it's importance.

    Fat Storage-Inducing Transmembrane Protein (FITM) in the cell's endoplamic reticulum make this conversion of Trigs into droplets (again note: this is not how Trigs are initially assembled). FITM uses the enzyme di-acyl-glycerol O-transfer-ase
    to do the job; then the droplet is rendered into the storage form called di-acyl-glycerol.

    FITM 1 is what exists in skeletal muscle endoplasmic reticulum to make muscle stores of di-acy-glycerol. When we exert ourselves and run out of glucose to burn the muscle takes back off the acyl-CoA fractions
    from stored di-acyl-glycerol; then it cobbles back together tri-acyl-glycerol molecules (note: this is the same molecule as a tri-glyceride, the more commonly used term just skips mentioning the acyl group) to burn and meet the demand for energy.

    Quite conveniently, for those who exert themselves, sustained activity also induces more di-acyl-glycerol transferase enzyme production; it is positive feed back augmenting the rate at which muscles can access their stored "fat" to burn (ie: training increases endurance).

    With muscle fitness burning up the on site reserves of di-acyl-glyceride the muscle can then take up more Trigs from the blood stream. Thus Trigs readings are lower for most geno-type individuals who regularly exert themselves (there are a few instances, mostly disease related, where low circulating Trigs are due to the liver holding on to too many Trigs).

    Our fat (adipose) cells' endoplasmic reticulum are the other site of a lot of lipid droplet processing for storage; there the adipose cells use FITM 2. When there is no exertion (ie: muscle cells have made no room for more stored di-acyl-glycerides) the Trigs slowly  get into the adipose cells(and some other tissues); so for the sedentary individual burning off that fat "reserve" is extremely difficult.

  • Harry

    4/12/2011 5:40:24 PM |

    Might, have you seen Mendivil's paper "Metabolism of VLDL and LDL containing apolipoprotein C-III and not other small apolipoproteins" It's at

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818784/

    It seems to me that there must be some docking involved when a VLDL or LDL particle sheds trigs either in the liver or elsewhere in the body. Maybe it's not receptors of the LDL family that do the docking, but as I understand it, lipoprotein lipase isn't carried by the ApoB containing lipoprotein, but rather, is a component of the receiving cell that facilitates transporting the trigs through the receiving cell wall. The process may not involve full endocytosis, where the whole ApoB-containing particle is engulfed by the cell, but it seems to me that there must be some sort of adhesive or attractive region on the cell to trap the VLDL or LDL at least for a while so that the trig can be unloaded. Any idea how this works?

    From what I've read, it appears that the longer half-life of LDL in the circulation, vs that of VLDL and IDL, is due to ApoE being contained in VLDL and IDL, but not LDL. Since ApoE can attach to LDL receptors as well as or better than ApoB can, this results in more rapid clearance of VLDL and IDL than LDL.  

    As a result of this discussion and some references like Mendivil's paper, it appears that ApoC is involved also. Since LDL carries only ApoB, maybe that also contributes to the longer half-life of LDL.

    Might, have you considered joining Dr. Davis' Track Your Plaque (TYP) forum? I'm a member, and we have many interesting discussions of CHD issues. There is a small fee involved, but we discuss many things before they make it into the Heart Scan Blog. For example, we discussed the subject of this blog thread about a year ago, and as a result, I purchased a cardiochek meter and did a postprandial trig test. My fasting trig level was 57, and I then drank 6 oz of heavy cream. My trigs peaked 4 hours later at 69, which showed that my low-carb diet (30 g/day) had acclimated me to rapid removal of trigs. We learn a lot from each other's experiences.

    Anyway, your knowledge of cellular and molecular processes would make a great addition to the TYP forum. There are a number of ApoE3/4, E2/4, and E4/4 people there as well as E3/3's, and We sometimes discuss posts you have made in other fora. I hope you will consider joining us. And by the way, I'm not connected in any way with the TYP forum other than being a member who likes to get into the nitty gritty of CHD issues.

  • Renfrew

    4/12/2011 6:40:45 PM |

    Might o'chondria:

    I am enjoying your posts, though they are quite technical and mostly go over my head. It seems you are a very knowledgeable contributor here.
    I have one request: You'd be of service for many, if you could add some "behavioral" recommendations or at least sensible things to do/to avoid after you analyze/report/explain physiological parameters and biochemical findings.

    A simple sentence, like: Because of this, it would make sense to do this... or that.... or avoid this...would be much appreciated.
    Thanks.

    Renfrew

  • Might-o'chondri-AL

    4/12/2011 7:47:20 PM |

    Hi Renfrew,
    This is Dr. Davis' blog so it is my feeling that specific health
    recommendations be his; and he does make them (some here & apparently more specifics  elsewhere). I am not a medical doctor, and do not follow
    all his recommendations (as I know them)for that matter.

    The fancy words I use are there because contemporary science has coined them to describe the complex details researchers keep finding. A lot of the hyphens (ex: "...-...-...") in words are inserted by me; this breaks up technical words into their component parts. I chose to do this so readers might identify some of the key parts  researchers coined that word from and not just tune out because of the jargon.

  • Brent

    4/12/2011 8:26:47 PM |

    To Frank Hagan (I Must Be Doomed) and Anon (I Must Be Screwed) - It does not seem like either of you take enough fish oil.  I visited Doc a month ago and he moved me from 2,400 mg DHA & EPA per day up to 3,000 mg per day - and I my Trigs were in the upper 70's.  Have not tested since.

    My understanding of TYP dosages is that you start around 3000 mg per day (DHA & EPA) and you go up from there, as high as 6,000 mg per day until your triglycerides are under 60.

  • Renfrew

    4/12/2011 8:53:45 PM |

    Whatever happened to KRILL OIL ? Has it been forgotten?

    I have read that KRILL oil is far more bioavailable than fishoil and chemically more stable, thus less prone to go rancid. Also because we are talking about phospholipids here which are absorbed much btter than ordinary fishoil, I would assume KRILL is the better choice.
    Unfortunately there does not seem to be much science on this. Probably because big pharma cannot make a buck out of this.
    I'vew been taking Krill oil for a year now and my trigs went from 250 to 56 in about 1 month. Stable since then. Unfortunately it does not seem to reduce LDL or raise HDL.
    Any experience, comments or details on KRILL?
    Renfrew

  • Ensues

    4/12/2011 9:58:35 PM |

    Hi Frank-

    I am exactly the same way.  Mine started over 1000 then to 769.  On fish oil, VLC, and Tricor (200mg) the lowest I have been able to achieve is 229.  My HDL is very low <25.  Neither of my parents have issues.  Very frustrating.  I am hoping my body/metabolism is healing and it my tri's will come down with time.

  • Ellen

    4/12/2011 10:06:13 PM |

    Hey Anon-- you ain't the only one! my triglycerides are always around 31. I always thought they were too low as well because they flag low for the lab range.

  • Paul Mcgrath

    4/12/2011 10:14:34 PM |

    @Renfrew

    No offense, but Might-o's valuable contributions here are clear to me on what specific behavior would be a healthy one.

    It can be summed up in one word... move. Well, maybe two more words would be clearer... lift something.  You would literally have to be blind and deaf not to notice all the effective programs  to help reach your goals. I particularly love Erwin Le Corre's Movnat - http://movnat.com/

    Our distant ancestors didn't have cars, automated climate controlled houses, refrigerators, cooking stoves, grocery stores, TV's, computers, game consoles, or various other modern conveniences that relieved or distracted them from having to go do physical work... just to survive.

    Combine that with today's widely available, tasty, cheap high carb food sources, you have a perfect synergistic formula for diseases of western civilization.

  • Anonymous

    4/12/2011 10:55:41 PM |

    MCA:

    You are my bochemistry reference guide and I really appreciate your posts. Please keep posting because you have the ability to answer why.
    Moving ones body has got to be one of the best investments in physical and mental health. I would rather do that then obsess or stress-out about numbers on a lab test. Get out in the woods and mountains and cover a lot of miles. I am fortunate because I live in Montana and have the wilderness in my backyard.

  • Might-o'chondri-AL

    4/12/2011 11:33:19 PM |

    10 mg/dl  =    0.555 mmol/L
    10 mmol/L =  180.0   mg/dl

    Maybe this scale of 10s will help those who need to do quick conversions.

  • Anonymous

    4/13/2011 2:08:11 AM |

    Put me in the genetically hopeless camp.  Tri's are 150 despite vegetables being my only source of carbs and intense activity 3 x's per week (about 1.5 hrs total), body fat and natural musculature that could have me as a paleo-bod model.  I feel hopeless on the blood lipid front.

  • michael goroncy

    4/13/2011 5:43:17 AM |

    Easy to confuse....
    Chol.LDL&HDL are on a different scale than TRIGS.
    To convert mmol/l to mg/dl multiply by 39 for cholesterol.
    For TRIGS multiply by 89.

  • Anonymous

    4/13/2011 12:34:20 PM |

    @Might-o'chondri-AL said...
    " 10 mg/dl = 0.555 mmol/L
    10 mmol/L = 180.0 mg/dl"

    When you are doing molar conversions there is a different factor for every chemical. Glucose, triglycerides, ...whatever. All have VERY different figues.

  • Anonymous

    4/13/2011 12:46:46 PM |

    Since removing bread and starch from my life my values have never been so good.  I do *very* occasionally have some rice or soaked beans or lentils...but my fasting triglycerides were 33, my total cholesterol 221, my HDL was 94 and LDL 121.  Just posting in case you are collecting data Smile

  • Anonymous

    4/13/2011 1:15:52 PM |

    My fasting triglyceride level fell from 81 to 46 over a 9 month period.  During this time, I doubled my exercise from 30 mins a day to 60 mins a day (every day of the week).  I believe that this is the cause.  For those trying to cut out animal fat, I have to report that I eat chicken skin and pork fat and this does not affect my cholesterol levels.

  • Stargazey

    4/13/2011 2:07:01 PM |

    I think Might-o'chondri-AL was giving us the conversion factors for glucose.

    My triglycerides went from 118 pre-Atkins to 43 after a few years on it. No change in exercise; I just cut out the carbs.

  • Might-o'chondri-AL

    4/13/2011 3:10:33 PM |

    Thanks M. Goroncy & Stargazey,
    for correcting my mistake; I do make them, so anytime welcome errors being pointed out.

  • Geoffrey Levens

    4/13/2011 4:13:21 PM |

    "Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role."

    I exercise moderately daily, HIIT and resistance. Eat Fuhrman's ETL diet so I get about 30% calories from fat (raw nuts and seeds)and get about 250-300 grams carbs per day (zero refined carbs though).  My fasting trigs just read at 56.  High dose fish oil can elevate trigs, refined carbs also. Not so much apparently for whole foods, unrefined carbs.

  • Eric

    4/13/2011 4:38:58 PM |

    Well stated Paul Mcgrath!

  • Travis

    4/13/2011 9:43:17 PM |

    Dr. Davis,

    2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

    I have lower fasting triglycerides since going on a low carb, higher protein and fat diet similar to what you suggest (they dropped from about 100-120 to 60-90). Yet, when I've had an NMR Lipoprofile done, it shows that I have high amounts of small LDL particles (in particular 850 nmol/L of small LDL-P and 1720 nmol/L LDL-P). I'm disappointed both that my triglyercides don't seem to be consistently low and that my small LDL-P is high. I'm otherwise healthy, not obese, no signs of insulin resistance, and eat primarily meat, eggs, dairy, and leafy green vegetables (with some starchy vegetables and fruit).
    I recognize you suggest this may be partly genetic, but what does this mean for me and is there anything I can do about it? Have you written about this elsewhere that I can't find? Thanks!

  • Eric

    4/13/2011 10:25:49 PM |

    Travis- This might help ApoE.

    ApoE 4/4 have to be more selective in their fat selections and amounts than an Apo 3/3.

    This may be just 1 genetic marker that can account for your numbers.

  • Adam

    4/14/2011 1:07:53 PM |

    2 years ago, when I had a case of the flu, and it didn't go away for 3 months, my doc ordered me a blood panel. My fasting triglycerides were 240mg/dL.

    Of course, i also suffered from the typical symptoms of metabolic syndrome: high BP, high cholesterol, obesity (40" waist), diabetic level of fasting blood glucose, low HDL... He told me to eat more "healthy whole grains" and cut out all fat and eat no red meat, to which I answered "that is exactly how I have been eating for decades!"

    Google then revealed to me Marks Daily Apple, I cut out all forms of sugar, grains, legumes, partially hydrogenated oils, and most dairy. Added in more grassfed beef, wild fish, coconut. Exercise sessions are short but as intense as physically possible.

    2 years later, I'm 40kg (88lbs) lighter, my waist is now 29" (smaller than my mom and I'm a man!), no more high BP, no more high cholesterol, HDL is 90+mg/dL.

    Triglycerides? 38mg/dL.

    Good thing I didn't listen to my doctor and take a heap of pills which he said I have to take for the rest of my life.

  • Steve

    4/14/2011 1:59:16 PM |

    Fascinating NYTimes article (4/13): "Is Sugar Toxic" by Gary Taubes. LINK

  • Frank Hagan

    4/14/2011 2:00:02 PM |

    Brent, thanks for the comment re: fish oil dosage. I am at 3,900mg of EPA&DHA combined (specifically 2400mg of EPA and 1500mg of DHA).

    I have a blood test coming up in June; I may increase to 5,200 mg to see if that has more effect.

  • Frank Hagan

    4/14/2011 2:07:07 PM |

    Ensues, you might check with your doctor about using niacin (not sure if there's an issue taking it with Tricor so I would check with him; I couldn't continue on Tricor due to an allergic reaction to it).

    My lowest triglyceride reading was when I was combining VLC, fish oil at 3,900mg EPA & DHA daily and 1,500mg of niacin.

    Dr. Davis has a lot of info here on niacin, including recommendations for using SloNiacin (over the counter) instead of the prescription version (Niaspan, I think) to save money. And he has some tips to avoid the flusing most of us get (what works for me is a regular aspirin 30 minutes before taking the niacin, and drinking plenty of water.)

  • Anonymous

    4/14/2011 7:35:37 PM |

    I notice some comments about large doses of fish oil (3+ grams daily) in order to reduce triglycerides.

    Any concerns over immune suppression at these doses? Or even 1-2g doses?

    I recall one pubmed study showing close to a 50% reduction in NK activity at a rather paltry EPA dose of 720mg/daily.

    http://www.ncbi.nlm.nih.gov/pubmed/11237929

    3+gm of fish oil might scare me a bit, longterm, if that study is correct.

  • Tim Tom

    4/14/2011 8:44:56 PM |

    I agree with your last statement that carbohydrates are a much bigger culprit to high triglyceride levels than fat intake. Looking forward to that post.

  • Dash

    4/15/2011 5:32:32 AM |

    Thank you for all of this information, it was really helpful for one of my classes.

  • Might-o'chondri-AL

    4/15/2011 5:53:06 AM |

    Hi Annon,
    NK, a type of lymphocyte cell, is mostly effective against circulating and metastasizing tumors; solid tumors are much less vulnerable to NK action against them. I failed pursuing your link so couldn't read the study, yet the premise that EPA inhibits NK is sound; EPA works  partly because it does keep lymphocytes from getting into tissue cells. Other very common factors that inhibit NK are fats, alcohol and steroids.

    EPA is showing itself to be useful against cancer; I seem to recall several types of neoplastic growths are less with EPA  supplementation. The EPA incorporated into a tissue cell's lipid membrane come into play through a series of steps; benefit is not as the EPA  molecule is being carried through the circulatory system.

  • woly

    4/15/2011 8:05:52 AM |

    Might-o'chondri-AL: can you please do us all a favour and start your own blog? I have started reading the comments section of many blog posts simply to see what you have written. All your posts are incredibly interesting, please keep up the good work!

  • Ensues

    4/15/2011 3:20:29 PM |

    Thanks for the info Frank.  I had indeed read up on niacin.  I started taking 500mg a couple months ago and then bumped to 1000mg after about a month.  I have not had a blood test yet to check the results.  I am hopeful though.  As for flush.  I have tolerated extremely well with really no problems except for one night.  After 2-3 months of no issues I experienced what I would call a crazy severe flush.  My skin was burning so bad I wanted to get it off.  Head to toe, hot and painful.  Not the "mild annoyance" I have read about.  It was nuts.  Lasted maybe an hour and a half.  Drank as much water as I could and a couple of aspirin.  Resumed 1000mg the very next day and have not had an issue since.  Very strange.  Thanks again for the comment.

  • Anonymous

    4/15/2011 4:44:01 PM |

    Be very careful when taking Niacin.  I can not tolerate even the small amount in a B-complex. My blood sugar increases, but even worse I become irrationally angry at the slightest provocation.

  • Anonymous

    4/15/2011 4:57:49 PM |

    Question regarding the reduction in NK cell activity ... could it pose a problem longterm?

    Would it possibly lead to a greater chance of infections (as some rodent studies have shown)?

    If someone had a metastasizing tumor, wouldn't fish oil then be contraindicated? I seem to recall DHA having some immune suppression activity too (not via NK however), but perhaps Vit E would counteract that.

    And then there is also that fish oil/rodent/colon cancer study:
    http://www.emaxhealth.com/1275/fish-oil-increases-risk-colitis-colon-cancer-mice

    Which seems to indicate DHA may be implicated negatively with colon cancer (in mice).

    And finally... I also recall the study testing oxidation values in people, using increasing doses of DHA (which is a bit of a messy way to test, but... whatever).

    http://www.futurepundit.com/archives/006499.html

    Somewhere between the 800mg and 1600mg levels of DHA, urinary isoprostane increased, which probably isn't such a good thing.

    I'm not anti-fish oil, as I take it myself. I am just wondering if too much (2-3+ g), may have some negative consequences longterm.

  • Might-o'chondri-AL

    4/15/2011 7:47:19 PM |

    Hi Anon,
    I have no suggestion on how to dose fish oil; I'd like to hear
    Doc's limitation on use for high
    trigs. This is for orientation on what you are discussing, as I understand things.

    Rodent and human models for chronic disease (inc. cancer) involve immune systems that are dissimilar; thus no cancer treatment has (to my knowledge) come from rodent results. That Michigan Univ. (2010) study fed mice that were geneticly pre-disposed to inflammatory bowels, in addition to fish oil, corn and safflower oils; those other oils can be converted into Arachidonic Acid, which is itself pro-inflammatory in some instances.

    Isprostanes in the urine are a bio-marker of oxidative activity; their existance is not automaticly evidence of damage to healthy cells. Some isoprostanes are also carried in an esterified form by our good old HDL.

    Isoprostanes come in several forms; they are mostly (but not exclusively) by-products of our natural anti-oxidants glutathione and glutathione peroxidase activity.  In other words when see isoprostanes in the urine it shows not only that the body had/has oxidative "stress", but that the body did something about it (ie: glutathione was busy doing it's job).

    DHA apparently works to increase the apoptosis (cell suicide/programmed death) of cancer cells, including bladder cancer. One of the theories explaining this effect is that fish oil integrates into the cancer cell lipid membrane; then it becomes part of a cascade of events that along the way produces levels of endo-peroxides
    (made inside the cell hydrogen peroxide).

    A threshold (ie: high enough
    dose)of fish oil must be reached to sustain a level of hydrogen peroxide that the cancer cell will take as a signal (ROS are internal cell signal molecules)
    to go into apoptosis. While all that hydrogen peroxide is being spun off, again and again, the cancer cell's innate anti-oxidant glutathione is trying to
    keep apace and neutralize it; so an endproduct (but not the endgame of the apoptosis dynamic that can "kill"
    developing cancer) is more isprostanes showing up in urine.

  • Renfrew

    4/16/2011 1:08:20 PM |

    When talking about dosage for fishoil what are we actually talking about?
    Milligrams per pill or mg for DHA/EPA.
    I am reading here 2-3 grams of DHA/EPA. So are we talking about the pure DHA/EPA content?
    1000 mg of fishoil is surely different from 1000 mg of DHA/EPA.

    Renfrew

  • Anonymous

    4/16/2011 5:30:28 PM |

    Renfrew: amounts of EPA/DHA.

    Total content of a fish oil capsule, which is typically 1g, is meaningless without concentration numbers.

    So when 3g is mentioned, it's 3g of EPA/DHA, not simply 3, one gram capsules. 3g of EPA/DHA could be up to ten capsules.

  • Renfrew

    4/17/2011 11:35:46 AM |

    Thanks for the clarification.
    How about minimizing the number of capsules in taking KRILL oil?
    Krill oil is a lot more bioavailable (phospholipids), compared to ordinary fish oil capsules. Less capsules for the same bioavailable amount of EPA/DHA.
    It also contains Astaxanthin which is good for brain, eye and prostate health.
    The ORAC test results in much higher anti-oxidant capacity.
    Why aren't we all taking krill oil??

  • Anonymous

    4/17/2011 5:40:37 PM |

    The reasons against krill oil:

    It's not cost-effective nor is it less capsules for an equivalent amount of EPA/DHA (in fact, it's many more).

    I know of one comparison study which did show krill oil being about 50% or so more bioavailable that fish oil. But krill oil is like 5-10x the price of fish oil (based on EPA/DHA dosing). So one can do the math there.

    And there is also the fact that krill oil has been much less studied than fish oil has.

    Astaxanthin is interesting and one day I'd love to see Dr. Davis touch upon it on this blog, state if any of his patients use it, etc. But if you want astaxanthin, I'd think it'd make more sense and be a lot cheaper just to buy astaxanthin (from algae). I've seen it going for as low as $8 for 120, 4mg caps and even non-sale prices are like $10/60 caps. Much cheaper than krill oil.

  • reikime

    4/18/2011 4:27:51 AM |

    I have considered krill oil as i am very intolerant of anchovies and most fish oil caps contain it.

    Tried the Salmon oil, but ewww...nasty!

    Need the benefits of fish oil, but not the side effects.

    Thoughts? Time to take the Krill?

  • Anonymous

    4/18/2011 9:35:23 AM |

    Hey Dr Davis

    Have a look at Gary Taubes' latest post with blood lipid test results:

    http://www.garytaubes.com/2011/04/before-sugar-were-talking-about-cholesterol/

    Nina

  • Caveman

    4/30/2011 1:12:18 AM |

    Any reason to be concerned with very low trigs? Below are my latest blood test results and the trigs seem to be very low. Does this indicate anything?


    Glucose = 68.4 mg/dl
    HDL = 59 mg/dl
    LDL = 98 mg/dl
    Triglycerides = 17 mg/dl

  • James

    5/23/2011 4:24:46 PM |

    A little confused
    Before I had my latest blood test I thought having low trigs and a good TC/H ratio was the best indicators of CVD. Thanks to Dr. Davis I discovered the NMR LipoProfile and Vitamin D tests and  added them to my panel.

    The good part:
    Trigs: 50
    Total Chol: 198
    HDL-C: 70
    LDL-C: 118 (slightly elevated)

    That gives me a TC/H of 2.8, which I assume is excellent.

    But now, the surprising not so good news:
    LDL-P: 1410 (High)
    Small LDL-P: 613  (High)
    Vit D: 31.4 (Low)

    So, how can I have trigs below 60 and have a high LDL particle number and 43% of them small LDL-P?

    Can anyone help me interpret these results? BTW, I am  a 50 yo man in good shape and weight.

    Thanks in advance

  • Alfredo

    6/2/2011 3:57:56 PM |

    Hi, Dr. , please check your email system, I have not been recieving my emails since you moved to this new site.

    THanks

  • Bill

    6/10/2011 8:48:01 PM |

    The text
    "1) When fasting triglycerides are 133 mg/dl or greater, 80% of people will show show at least some degree of small LDL particles.

    2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

    3) When fasting triglycerides are 200 mg/dl or greater, small LDL particles will dominate and large LDL particles will be in the minority or be gone entirely.

    4) When triglycerides are 88 mg/dl or greater after eating, then risk for heart attack is doubled. Non-fasting triglycerides in the 400+ mg/dl range are associated with 17-fold greater risk for heart attack."
    does not appear to be sourced from the sole referenced article in this blog post. The referenced article (Austin et al, 1990) is examining a specific human genetic phenotype in regards to triglyceride, HDL and LDL levels. Is there another source of this information, or are there specific page(s) I can read of the article to derive the same information?

  • Paul Lee

    7/6/2011 12:47:01 PM |

    Just got back from the docs and have mixed feelings as she prescribed a daily statin! However reading up on the low carb sites and on this blog it might not be all bad news! Fasting Triglycerides were 1.1 (96) and TC was 7.1 (6.22) I'm in the UK and hope I hope I've converted properly. I eat low carb, avoid cereals and am reasonably active, in addition to intermittently fasting. I think I've lost weight, that was one of the reasons I went to see the doctor as I thought my weight loss had stalled, but my BMI was down to 23 from 25/6. Its slow but getting there but I did read on some of LC forums that Triglycerides might be elevated whilst actively loosing weight. Clearly there is more work to do and I'm tempted to get a second test. I won't be taken a statin even though its free (provided on the NHS).

  • Rickey

    10/20/2011 5:47:51 AM |

    I know very little about Krill Oil. There had been a bunch of posts regarding Krill oil Brand on the various forums and blogs. After doing all research on internet, i came across with Krill oil Professional, this brand product is awesome. I ordered it online from there website at very competitive pricing. And now iam feeling very much relaxed from my Arthritis joint pain/stiffness relief.

Add comment

Loading