What Mr. Clinton did NOT do

12. February 2010 William Davis (36)
You've likely already heard that former President Bill Clinton underwent a heart catheterization today during which one of the bypass grafts to his coronary arteries was found to be occluded. The original coronary artery was therefore stented.

Dr. Alan Schwartz, Mr. Clinton's cardiologist, announced to the gathered press that Mr. Clinton had followed a good diet, had adopted a regular exercise program, but that his condition is a "chronic disease" like hypertension that is not cured by these efforts.



Needing a stent just 6 years after four bypass grafts are inserted is awfully soon. I would propose that it has less to do with having a "chronic disease" and more to do with all the things that Mr. Clinton likely is NOT doing. (In addition to all the other things that Mr. Clinton did not do.) In other words, in the Track Your Plaque world, procedures are a rarity, heart attacks virtually unheard of. I would wager that Mr. Clinton has been doing none of the following:

--Taking fish oil. Or, if his doctor was "advanced" enough to have advised him to take fish oil, not taking enough.
--Vitamin D--Followers of the Heart Scan Blog already know that vitamin D is the most incredible health find of the last 50 years, including its effects on reducing heart disease risk. Unless Mr. Clinton runs naked in a tropical sun, he is vitamin D deficient. A typical dose for a man his size is 8000 units per day (gelcap only!).
--Eating a true heart healthy diet. I'll bet Mr. Clinton's doctor, trying to do the "right" thing, follows the prudent course of advising a "balanced diet" that is low in fat--you know, the diet that causes heart disease. Judging by Mr. Clinton's body shape (central body fat), it is a virtual certainty that he conceals a severe small LDL pattern, the sort that is worsened by grains, improved with their elimination.
--Making sure that hidden causes are addressed--In addition to the "hidden" small LDL, lipoprotein(a) is another biggie. Lp(a) tends to be the province of people with greater than average intelligence. I believe Mr. Clinton qualifies in this regard. I would not be at all surprised if Mr. Clinton conceals a substantial lipoprotein(a) pattern, worsened in the presence of small LDL.
--Controlling after-meal blood sugars--Postprandial (after-eating) blood sugars are a major trigger for atherosclerotic plaque growth. There are easy-to-follow methods to blunt the after-meal rise of blood sugar. (This will be the subject of an in-depth upcoming Track Your Plaque Special Report.)
--Thyroid normalization--It might be as simple as taking iodine; it might involve a little more effort, such as supplemental T3. Regardless, thyroid normalization is an easy means to substantially reduce coronary risk and slow or stop coronary plaque growth.


It's not that tough to take a few steps to avoid bypass surgery in the first place. Or, if you've already had a procedure, a few additional steps (of the sort your doctor will likely not tell you about) and you can make your first bypass your only bypass.

Magnesium and arrhythmia

11. February 2010 William Davis (35)
Because magnesium is removed during municipal water treatment and is absent from most bottled water, deficiency of this crucial mineral is a growing problem.

Magnesium deficiency can manifest itself in a wide variety of ways, from muscle cramps (usually calves, toes, and fingers), erratic blood sugars, higher blood pressure, to heart rhythm problems. The abnormal heart rhythms that can arise due to magnesium deficiency include premature atrial contractions, premature ventricular contractions, multifocal atrial tachycardia, atrial fibrillation, and even ventricular tachycardia, fibrillation, and Torsade de Pointes (all potentially fatal). Magnesium is important!

Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

Here is a Heart Scan Blog reader's dramatic rhythm-correcting response to magnesium supplementation:



Dr. Davis,

A few months ago, I contacted you inquiring if you had written any articles on arrhythmia. You were generous enough to answer and guide me to an LEF article you'd written in which you stressed fish oil and magnesium. I had been suffering with bad PVCs [premature ventricular contractions] for over 20 years, and they had gotten so bad recently that I was told my next options were ablation or pacemaker!

I was already on fish oil and had not seen any difference, and so I researched the magnesium you suggested more thoroughly and found a huge body of studies supportng its effect on arrhythmia. I also read many posts on heart forums with people having success with it. After getting advice from various bloggers, I tried magnesium taurate in the morning and Natural Calm (an ionized form of mag citrate) in the afternoon and evening. Within three days the PVCs were quite diminished and by 2 weeks totally gone! As long as I keep taking it, they never return---not even one irregular blip---even when I drink strong coffee! The magnesium also cleared up my restless leg syndrome, my eye twitching, and insomnia. (Apparently, I was the poster-girl for magnesium deficiency.)

I am so angry that after all these years of suffering, trying various medications, and seeing at least 4 different cardiologists that NOT ONE ever even mentioned trying magnesium. The generosity of the few minutes you took to answer my email and steer me in a helpful direction brought me total relief.

Thank you SO MUCH!

Warmly,
Catherine C.

Video teleconference with Dr. Davis

10. February 2010 William Davis (4)

Dr. Davis is available for personal
one-on-one video teleconferencing

to discuss your heart health issues.


You can obtain Dr. Davis' expertise on issues important to your health, including:

Lipoprotein assessment

Heart scans and coronary calcium scores

Diet and nutrition

Weight loss

Vitamin D supplementation for optimal health

Proper use of omega-3 fatty acids/fish oil


Each personalized session is 30 minutes long and by appointment only. To arrange for a Video Teleconference, go to our Contact Page and specify Video Teleconference in your e-mail. We will contact you as soon as possible on how to arrange the teleconference.


The cost for each 30-minute session is $375, payable in advance. 30-minute follow-up sessions are $275.

(Track Your Plaque Members: Our Member cost is $300 for a 30-minute session; 30-minute follow-up sessions are $200.)

After the completion of your Video Teleconference session, a summary of the important issues discussed will be sent to you.

The Video Teleconference is not meant to replace the opinion of your doctor, nor diagnose or treat any condition. It is simply meant to provide additional discussion about your health issues that should be discussed further with your healthcare provider. Prescriptions cannot be provided.

Note: For an optimal experience, you will need a computer equipped with a microphone and video camera. (Video camera is optional; you will be able to see Dr. Davis, but he will not be able to see you if you lack a camera.)

We use Skype for video teleconferencing. If you do not have Skype or are unfamiliar with this service, our staff will walk you through the few steps required.

Thinner by Thursday

10. February 2010 William Davis (0)
You want to lose a few pounds . . . Okay, maybe 50 or 75.

Should you exercise? Lengthen you workout? Push the plate away, deny yourself seconds, use a smaller plate?

Of all the weight loss strategies I've tried in patients, there's only one that stands out as a means of obtaining immediate--meaning within 3 days--weight reduction.

Wheat elimination.

Omega-3 Index: 10% or greater?

9. February 2010 William Davis (19)
We've previously considered the question:

What is an ideal level of omega-3 fatty acids in the blood?

Recall that omega-3 levels in red blood cells (RBCs), a measure called the "omega-3 index," have been associated with risk for sudden cardiac death:





In a recent analysis, 265 people experiencing sudden death during a heart attack (ventricular fibrillation, successfully resuscitated) showed an omega-3 index of 4.88%, while 185 people not experiencing sudden death during a heart attack showed an omega-3 index of 6.08%.

We have more ambitious goals than just avoiding sudden death, of course! How about the omega-3 index associated with reduced risk for heart attack? A recent analysis of females from the Harvard School of Public Health suggested that RBC omega-3 levels as high as 8.99% were still associated with non-fatal heart attack (myocardial infarction), compared to 9.36% in those without heart attacks, suggesting that even higher levels are necessary to prevent non-fatal events.

Most recently, another study comparing 50 people after heart attack with 50 controls showed that people with heart attack had an omega-3 index of 9.57% vs 11.81% in controls--even higher. (This study was in a Korean population with higher fish consumption. There was also a powerful contribution to risk from trans fat RBC levels.) The investigators concluded: "The area under the receiver operating characteristic curve of fatty acid profiles was larger than that for traditional risk factors, suggesting that fatty acid profiles make a higher contribution to the discrimination of MI cases from controls compared with modified Framingham risk factors."

The data suggest that, while an omega-3 index of 7.3% is associated with reduced risk for sudden cardiac death, a higher level of 10% or greater is associated with less risk for heart attack. Surprisingly, fish consumption and fish oil intake account for only 47% of the variation in omega-3 index.

I believe the emerging data are becoming increasingly clear: If you desire maximal control over heart health, know your omega-3 index and keep it 10% or higher.

Let's soak 'em with fish oil

8. February 2010 William Davis (12)
If you don't think that charging drug prices for fish oil is wrong, take a look at a letter from an angry Heart Scan Blog reader:


Hello Dr. Davis,

My 44 year old brother had an MI [myocardial infarction, or heart attack] in June. He got pushed around due to "bad government insurance," a state-run program for the "uninsured": government pays 1/3, job pays 1/3, and individual pays 1/3.

What they didn't tell him is that there is no major medical coverage and little to no prescription coverage. We fought for 4 months to get him open heart surgery that the insurance was not going to pay for.

Now, with no assistance, terrible insurance, and no disability he has little to no income. He is a heavy equipment mechanic and is trying to be the "good American"-- take care of his bills, not file bankruptcy, etc.

Anyway, the doctors never seem to pay attention to what they prescribe. Lipitor was not working for him, due to side effects. Now they want to give him Zetia and Lovaza....Zetia at $114, and Lovoza is $169.85! Wow! For dead fish???? I think this is a little fishy! I looked up Lovaza, gee how nice, they will give you a $20 coupon....

Forget it, he can't afford this stuff. So I am enrolling in the Zetia program for him. And trying to get him OTC [over-the-counter] fish oil. The most prevalent fish oil around here (that I take myself is) Omega 3 Fish Oil that has EPA 410mg, DHA 274.

Thanks for your blog. It made me feel better that I wasn't the only one outraged by this stuff. I 've been a nurse for 20 years and it just never seems to get better. Thank you for your wisdom.

Sincerely JP, Tennessee


Had this reader not been aware that her brother could take fish oil as a nutritional supplement, he likely would have been denied the benefit of omega-3 fatty acids in slashing the risk for recurrent cardiovascular events. You and I can buy wonderfully safe and effective fish oil as a nutritional supplement, but there won't be a sexy drug representative to sell it, nor an expensive dinner and payment for a trip to Orlando to hear about it.

Heart scan gone wrong

6. February 2010 William Davis (9)
Those of you reading the Heart Scan Blog, I hope, have come to appreciate the power in measuring atherosclerotic plaque, the stuff of coronary artery disease, and not relying on indirect potential "risk factors," especially the fictitious LDL cholesterol.

However, like all things, even a great thing like heart scans can be misused. Here's a story of how a heart scan should NOT be used, submitted by a reader.


Dr. Davis,

First of all, let me start out by commending you on all of the work you are doing with your website, blogs, etc. You are truly a breath of fresh air at a time when conventional medicine is no longer making any sense. In the last 3 years or so, I have spent a lot of time using the internet to try and find answers . . . and just about every time, when I find things that make "sense," it coincides which the recommendations you provide. Thank You!!

I am 56 years old, and roughly 5 years ago I bought your book, Track Your Plaque, primarily because I had asked my then Internal Medicine physician about why we weren't more "proactive" about determining the state of our cardiovascular health...since the means to do so existed (scans). He was trying to get me to go on a statin because my cholesterol #'s were a little high and at the time I smoked. Other than that, I was in perfectly good health with no side effects or issues. The following year at my annual physical, we again discussed this and he gave me a few options and I ended up having a calcium score done, which showed some blockage, but again, I never had any pains, sweats, or any other symptoms whatsoever, and I am a very active former athlete. This is when I bought your book to try and set a course of plan that wouldn't just include pharmaceuticals.

At the same time, my father was in his last months of life dealing with prostate cancer and the multiple radiation and chemo treatments, so I was making many trips from my home to be with him . . . a 4 hour drive, and very disruptive to family, as I still have 3 kids at home. At what I thought was going to be my last visit with him, I stopped at the cemetery he had planned on being buried to confirm details and such and then started home.

As I was driving, a symptom hit me which I was unfamiliar with (pretty sure it was an anxiety attack now) and I stopped at a friend's house in Chicago, as I didn't want this to be a heart attack while I was driving. This is when I began thinking about the heart scan and the blockage, and ended up driving back later that night and went right to the ER....not because I had any chest pains, but thought it best to be checked out because I did not want to go before my dad did. I ended up staying the night. In the morning the cardiologist PA [physician's assistant] came in with a copy of my calcium scoring and said it was best to have a heart cath...which I was in total agreement with since it would definitively tell me the current condition of my coronary vessels. As I was getting ready to be wheeled into the cath lab, they approached me with a form that would allow them to treat (stent). This is where I became very uncomfortable, in that I had never even met the cardiologist . . . and I didn't like this. No one ever had asked if I was experiencing pains or anything else . . . but I buckled and signed the form.

Before you knew it, I was awake watching my heart being cathed and the cardiologist angry because they did not have all the right sizes of stents, so he had to use a couple extra and I ended up w/5 total . . . and my life changed forever! In looking back, I can't necessarily argue the need for intervention, but in hindsight, it would have been nice to have tried an alternative method of reversing my plaque, especially since I had never experienced any symptoms and didn't appear to be in any imminent danger.

Upon release from the hospital I was put on a cocktail of drugs that typically follow and I then began to search and research. No one talked to me about lifestyle changes other that smoking....but nothing on diet or other means of cholesterol control, etc....in fact, when I had to pick out my meals in the hospital, they wouldn't let me have cheese....but the rice crispy treat was fine....how stupid! They originally told me the Plavix had to last 6 months....and then 12....and then 2 years....I stayed on it for 1-1/2 years and it was the only thing other than a baby aspirin. I went to another cardiologist out of town and he wanted me back on 5 or 6 medications and said that now I had the stents....I would have to be on these for life.....and he was the expert that talked at several main conferences.....my last trip to him.

Now, fast forward to about 6 months ago: I was participating in a father-son soccer scrimmage and was playing goalie. It was wet out and I couldn't catch very well. So being the competitive person I am, I resorted to using my chest on several of the saves and also took a direct blow to my eye ( I wear glasses) and the eye started swelling up pretty good. We then finished and went inside to have pizza and everyone was concerned about my eye. About 30 minutes later I excused myself as i felt some pretty significant sweats and subsequently a pretty severe pain directly in the middle of my chest....I was having a heart attack! Called 911 and went to hospital (2-1/2 years since original stents) and my local cardiologist removed the blockage that was at the anterior portion of my 1st stent causing the blockage. The huge disappointment to me is that I had taken many steps to improve my overall health. But now that I have foreign bodies in my vessels, the chance of further clotting is something that i will most likely always have to live with.

BU, Michigan



This is an example of how heart scans should NOT be used. They should NEVER be used to justify a procedure, no matter how high the score or where the plaque is located. The "need" for procedures is determined by symptoms (BU's symptoms were hardly representative of heart disease), blood findings, EKG, stress testing, and perhaps CT coronary angiography. "Need" for procedures can never be justified simply on the basis of the presence of plaque by a heart scan calcium score.

Unnecessary procedures like the one BU underwent are not entirely benign, as his experience at the soccer game demonstrated.

Heart scans are truly helpful things. But, like many good things, they are subject to misuse in the hands of the uncaring or greedy.

Blood sugar: Fasting vs. postprandial

5. February 2010 William Davis (23)
Peter's fasting blood glucose: 89 mg/dl--perfect.

After one whole wheat bagel, apple, black coffee: 157 mg/dl--diabetic-range.

How common is this: Normal fasting blood sugar with diabetic range postprandial (after-eating) blood sugar?

It is shockingly common.

The endocrinologists have known this for some years, since a number of studies using oral glucose tolerance testing (OGTT) have demonstrated that fasting glucose is not a good method of screening people for diabetes or pre-diabetes, nor does it predict the magnitude of postprandial glucose. (In an OGTT, you usually drink 75 grams of glucose as a cola drink, followed by blood sugar checks. The conventional cut off for "impaired glucose tolerance" is 140-200 mg/dl; diabetes is 200 mg/dl or greater.) People with glucose levels during OGTT as high as 200 mg/dl may have normal fasting values below 100 mg/dl.

High postprandial glucose values are a coronary risk factor. While conventional guidelines say that a postprandial glucose (i.e., during OGTT) of 140 mg/dl or greater is a concern, coronary risk starts well below this. Risk is increased approximately 50% at 126 mg/dl. Risk may begin with postprandial glucoses as low as 100 mg/dl.

For this reason, postprandial (not OGTT) glucose checks are becoming an integral part of the Track Your Plaque program. We encourage postprandial blood glucose checks, followed by efforts to reduce postprandial glucose if they are high. More on this in future.

Diabetes from fruit

2. February 2010 William Davis (38)
Mitch sat in my office, looking much the same as he had on prior visits.

At 5 ft 7 inches, he weighed a comfortable 159 lb, though he did have a small visible "paunch" above his beltline.

I had been seeing Mitch for his heart scan score of 1157 caused by low HDL of 38 mg/dl, severe small LDL (87% of total LDL), and lipoprotein (a).

Part of Mitch's therapeutic program was elimination of wheat, cornstarch, and sugars, the three most flagrant triggers of small LDL particles, and weighing his diet in favor of oils and fats to reduce Lp(a). However, Mitch somehow failed to follow our restriction on fruit, which we limit to no more than two 4 oz servings per day, preferably berries. He thought we said "Eat all the fruit you want." And so he did.

Mitch had a banana, orange, and blueberries for breakfast. For lunch, along with some tuna or soup, he'd typically have half a melon, a pear, and red grapes. For snacks, he'd have an apple or nectarine. After dinner, it wasn't unusual for Mitch to have another piece of fruit for dessert.

Up until Mitch's last visit, he'd had blood glucose levels of 100-112 mg/dl, above normal and reflecting mild insulin resistance and pre-diabetes. Today, on his unlimited fruit diet, his blood sugar: 166 mg/dl--well into diabetes territory.

I helped Mitch understand the principles of our diet better and advised him to reduce his fruit intake to no more than the 2 small servings per day, as well as sticking to our "no wheat, no cornstarch, no sugar" principles.

While fruit is certainly better than, say, a half-cup of gummy bears (84.06 g carbohydrates, 50.12 g sugars), fruit is unavoidably high in carbohydrates and sugars.

Take a look at the carbohydrate content of some common fruits:

Apple, 1 medium (2-3/4" dia)
19.06 g carbohydrate (14.34 g sugar)

Banana, 1 medium (7" to 7-7/8" long)
26.95 g carbohydrate (14.43 g sugar)

Grapes, 1 cup
27.33 g carbohydrate (23.37 g sugar)

Pear, 1 medium
25.66 g carbohydrate (16.27 g sugar)

Source: USDA Food and Nutrient Database

Fruit has many healthy components, of course, such as fiber, flavonoids, and vitamin C. But it also comes with plenty of sugar. This is especially true of modern fruit, the sort that has been cultivated, hybridized, fertilized, gassed, etc. for size and sugar content.

When you hear such conventional advice like "eat plenty of fruits and vegetables," you should hear instead: "eat plenty of vegetables. Eat a small quantity of fruit."

The sniff test

31. January 2010 William Davis (0)
It is well established that omega-3 fatty acids from fish oil are free of mercury, PCBs, furans, and other pesticide residues. Several independent analyses have all agreed: little to none are contained in fish oil. In the Consumer Lab series of assessments, for example, no fish oil supplement failed because of any heavy metal or pesticide residue.

However, oxidative byproducts are a problem. Just as fish that sits on the store shelf or your refrigerator too long starts to smell "fishy," so will fish oil. When fish or fish oil becomes rancid, smelling like rotten fish at its worst, it means that
Eat triglycerides

Eat triglycerides

8. June 2011 William Davis (31)
Dietary fats, from olive oil to cocoa butter to beef tallow, are made of triglycerides.

Triglycerides are simply three ("tri-") fatty acids attached to a glycerol backbone. Glycerol is a simple 3-carbon molecule that readily binds fatty acids. Fatty acids, of course, can be saturated, polyunsaturated, and monounsaturated.

Once ingested, the action of the pancreatic enzyme, pancreatic lipase, along with bile acids secreted by the gallbladder, remove triglycerides from glycerol. Triglycerides pass through the intestinal wall and are "repackaged" into large complex triglyceride-rich (about 90% triglycerides) molecules called chylomicrons, which then pass into the lymphatic system, then to the bloodstream. The liver takes up chylomicrons, removes triglycerides which are then repackaged into triglyceride-rich very low-density lipoproteins (VLDL).

So eating triglycerides increases blood levels of triglycerides, repackaged as chylomicrons and VLDL.

Many physicians are frightened of dietary triglycerides, i.e, fats, for fear it will increase blood levels of triglycerides. It's true: Consuming triglycerides does indeed increase blood levels of triglycerides--but only a little bit. Following a fat-rich meal of, say, a 3-egg omelet with 2 tablespoons of olive oil and 2 oz whole milk mozzarella cheese (total 55 grams triglycerides), blood triglycerides will increase modestly. A typical response would be an increase from 60 mg/dl to 80 mg/dl--an increase, but quite small.

Counterintuitively, it's the foods that convert to triglycerides in the liver that send triglycerides up, not 20 mg/dl, but 200, 400, or 1000 mg/dl or more. What foods convert to triglycerides in the liver? Carbohydrates.

After swallowing a piece of multigrain bread, for instance, carbohydrates are released by salivary and gastric amylase, yielding glucose molecules. Glucose is rapidly absorbed through the intestinal tract and into the liver. The liver is magnificently efficient at storing carbohydrate calories by converting them to the body's principal currency of energy, triglycerides, via the process of de novo lipogenesis, the alchemy of converting glucose into triglycerides for storage. The effect is not immediate; it may require many hours for the liver to do its thing, increasing blood triglycerides many hours after the carbohydrate meal.

This explains why people who follow low-fat diets typically have high triglyceride levels--despite limited ingestion of triglycerides. When I cut my calories from fat to 10% or less--a very strict low-fat diet--my triglycerides are 350 mg/dl. When I slash my carbohydrates to 40-50 grams per day but ingest unlimited triglycerides like olive oil, raw nuts, whole milk cheese, fish oil and fish, etc., my triglycerides are 50 mg/dl.

Don't be afraid of triglycerides. But be very careful with the foods that convert to triglycerides: carbohydrates.

 

 

 

 

 

 

 
Tags :

Comments (31) -

  • Kurt

    6/8/2011 2:51:47 AM |

    There must be genetic variations, though, as my triglycerides have measured between 78 and 90 on every test since 1993. For the past two years, I've been eating a 20% fat diet (with about 50% carbs), and on my latest VAP test, my triglycerides were 78. The diet, by the way, lowered my LDL 30%.

  • Ian Goldsmid

    6/8/2011 2:55:47 AM |

    Dr. Davis

    Could you please clarify:

    If I have one slice of gluten free mixed grain /seed toast - and very liberally heap Organic Coconut Oil & Almond Butter on it - am I still going to get the exaggerated carbohydrate to triglyceride conversion effect from the toast?

    Thanks, IJG

  • Gene K

    6/8/2011 3:28:45 AM |

    Dr Davis,

    How much TG-rich foods is it safe for APOE 4 people to consume? Will this amount depend on their fasting TG? Will it be per meal or a day's total?

    Thank you.

  • Markus Damian

    6/8/2011 7:16:16 AM |

    I think this article is excatly on target- I ate a low-fat, high-carb vegetarian diet for years, and at one point my measured triglyceride levels were > 300. After I started omitting most refined carbs from my diet (and upping my fat/protein intake correspondingly), my last reading has been 88. So, for me at least, dietary intake of triglycerides is not substantially related to blood levels.

  • Markus D

    6/8/2011 7:32:02 AM |

    ... having said that, there is something which I don't quite understand. Given that virtually the entire human population is on a high-carb feast, it must be that some of us react differently to high-carb diet than others, otherwise everyone would have elevated triglyc levels, right? My mother, who is certainly genetically quite close to me, eats a high-carb, low-fat diet, and her triglyceride levels are normal ...  Many thanks, M.

  • Might-o'chondri-AL

    6/9/2011 12:18:07 AM |

    EPA (eicosa-pentaenoic fatty acid)  an omega-3  poly-unsaturated fatty acid reduces the amount of glucose that is made into tri-glycerides ("trigs") , thus decreasing de-novo lipo-genesis put out by the liver.  When I added daily concentrated fish oil  with 1,500 mg EPA & 750 mg DHA to my moderate carb diet my NMR  tested measurement of trigs went from 90 mg/dL down to 42 mg trigs/dL (tests  were 4 months apart).  

    EPA also increases the amount of insulin related glucose transporters inside skeletal muscle cells, which allays insulin resistance;  it (EPA) induces the skeletal muscles to "burn" more glucose for ATP energy  in oxidative phosphorylation , which decreases irritating lactate output that contributes to body "aches".  Insulin in circulation can then also work as a co-fact0r with EPA,  together they go on to increase functional  leptin  levels  (leptin = anti-appetite);  thus  we get less impulse to "graze"   between meals on  carbs that make  trigs.

  • carb sane

    6/9/2011 11:57:11 AM |

    Actually, it has been established that DNL is NOT a major source of fatty acids in VLDL.

    http://carbsanity.blogspot.com/2011/05/where-do-triglycerides-come-from-part-i.html

  • majkinetor

    6/9/2011 1:49:40 PM |

    Actually, its around 20%

    http://ajpendo.physiology.org/content/286/4/E577.full

  • majkinetor

    6/9/2011 1:49:59 PM |

    Nice. I didn't know that. Thats pretty big amount of EPA/DHA, it is therapeutic amount often used for COX-2 inhibition.

    Can you tell more about the dosage ? Did you try smaller dose ? Is it fish oil or fish capsule or simply fish ? What are you thoughts about potential problems with PUFA and oxidation in regard to fish oil ?

  • carb sane

    6/9/2011 5:05:24 PM |

    Firstly, that's not about VLDL.  Secondly, that means around 80% comes from dietary fat.    Did you read my link?

  • Might-0'chondri-AL

    6/9/2011 6:15:27 PM |

    Hi majkinetor,
    I only went from no fish oil supplementation as an experiment to taking 1 tsp of Natural Factor's "pharmaceutical grade"  (  concentrated Canadian product's total fish oil=4,400 mg.  with 2,630 Omega 3 fatty acids of which 1,500 = EPA & 750 = DHA)  taken, as free  poured liquid along with morning food and evening food in 1/2 tsp measuring spoon slurps. Intake  of liquid oil was at the same time ate carbs , and carb intake was similar for when had 1st measured trigs when wasn't supplementing with fish oil  .  

    I personally don't think PUFA oxidation is an issue in diets that have lots of substrate for gut bacteria to make short chain 4 carbon fatty acid butyrate. It (butyrate) up-regulates many distinct  GST (glutathione S-transferase) genes;  these go on to tackle multiple lipid peroxidation by-products  (ex:  activity neutralizes 4-hydroxy- nonenal &  trans-alk-enals/dienals ),  while  micro-somal GST promotes the glutathione conjugation to electro-philes  which then can act to decrease lipid hydro-peroxide activity.

  • majkinetor

    6/10/2011 7:25:50 AM |

    Ah, sorry, I missread your post.

  • majkinetor

    6/10/2011 7:30:08 AM |

    Secondly, that means around 80% comes from dietary fat
    Not at all.
    80% from dietary fat AND cho.

  • Jimmy

    6/10/2011 11:11:24 AM |

    Might: Do you live in Canada?
    Jim

  • Helen

    6/10/2011 11:25:24 AM |

    M-Al,

    I used to take fish oil, but now that I'm measuring my glucose daily, I find that even a small dose immediately raises my fasting glucose 10-15mg, and somewhat worsens my post-prandial readings.  My own observation is in keeping a study that showed that prediabetic women's glucose control was worsened by a fish oil supplement.  (I don't have the link handy.)  Can you explain?

    I have the same troubles with modest supplements of vitamin C and niacin, though I'm sure for different reasons.  I find it interesting, and I don't mean that in any coded way, that two of Dr. Davis' recommended supplements  (fish oil and niacin) impair glucose control in me and in some studies.  I am wondering if this might explain in part his advice to shun carbs.  In the context of those supplements, carbs are not well tolerated.

  • Dr. William Davis

    6/10/2011 12:12:00 PM |

    Several commenters make the point that there is genetic variation in susceptibility to triglyceride intake and carbohydrate intake.

    Absolutely. Two people on the same diet can have wildly different results. Part of this is attributable to apo E genotype, apo C genotype, lipoprotein lipase and hepatic lipase genotypes, among others. Body weight and previous eating habits will also enter the equation. However, in most people increased triglyceride intake does not result in substantial increase in serum triglycerides.

  • Might-o'chondri-AL

    6/10/2011 9:59:19 PM |

    Hi Helen,
    I've heard some respond as you mention;  I wonder if they were all overweight during the data collection period, as pre-diabetic could imply.  In your circumstances (ie: blood glucose goes up with supplements)  it would be instructive to know if  you've a tendency for excess weight.

    My own niacin use went from none to 3x per day of 500 mg.  niacin taken with meals;   my own 2011 NMR lipid tests done 4 months apart were as follows.  Without any niacin fasting NMR cholesterol test results:  LDL = 139,  HDL=45,  total number of LDL particles  = 1,676,  with the number of small LDL particles  = 1,021 nmol/dL .  As for NMR cholesterol test with 1,500 mg daily total  niacin :  LDL = 100, HDL = 64,  total number of LDL particles = 976 , with the number of small LDL particles = nmol/dL.

    The nice plunge in small LDL doesn't seem to be due to a massive restriction of carbs;  in fact,  both my  HbA1c  and fasting serum glucose test result ciphers  went up slightly after I had  instituted niacin &  EPA/DHA fish oil  (started both at same time).   Incidentally,  I've never had  weight gain problems  and unintentionally lost 10 pounds I didn't intend to  since started taking the fish oil;  losing so much small LDL was more than thought possible and maybe wasn't 100% due to the niacin  (also daily  added  6,000 IU vitamin D3 from none, taken as 2,000 IU  with each meal).

    So,  before you decide that niacin & EPA/DHA supplements driving up your post-prandial glucose is positively detrimental it might be good to have your own baseline data (ie:  NMR for cholesterol & HbA1c for accretion of  blood sugar) .  If you are in the USA you can get a valid blood draw order in ANY state at all and the emailed results by using  cheapest online arrangement from summitcountymedicalsociety.prepaidlab.com ;  their doctor orders the blood test for you and,  of course, I have no financial interest in this .

  • Might-o'chondri-AL

    6/10/2011 10:04:42 PM |

    edit,
    see 2nd paragraph's last sentence to Helen above, missing number in last set of data is for number of small LDL nmol/dL and should be 96 (ninety-six) ... in other words  that data shows that with niacin the  small LDL  "plunged" to 96 from being 1,021 nmol/dL without niacin supplementation.

  • Helen

    6/11/2011 5:27:07 AM |

    Hi M-Al,

    I'm different from a lot of visitors to this blog in that I have never had cholesterol problems.  I don't remember my exact numbers but my HDL and LDL split has been deemed "ideal," and my triglycerides range from 44-48, with total cholesterol being about 157.  

    My current BMI is 20 or less (haven't checked the charts lately) and my highest ever was 25, about a year ago.  Generally, I've been in the 23 range.  So, no, I don't have a propensity to weight gain.  On the other hand, I'm borderline diabetic.  Last year, at my highest BMI, my A1C was 6.4.  On low-carb, it slowly got down to 6.0, and my last test, on low-fat, was also 6.0, although according to my meter readings, taken at least three times a day, it should be 5.3.  I'm definitely right on the border with the diabetes, though have pushed it back some over the past year.  My blood sugar *sometimes* shoots to 200 or over within the first hour of eating (a "diabetic" number, though my endocrinologist says it has to be 200 at two hours to be considered clinical diabetes), but it quickly goes down again.  My liver seems to pump out a lot of glucose.  I tend to have a fasting glucose between 109 and 125.  Sometimes it gets as low as 99.  On low-carb, it ranged from 125 to 145, and was 160 a few times.  

    Needless to say, my biggest concern is my glucose level.  Metformin didn't help, low-carb didn't help much (and definitely made my tolerance for any amount of carbs next to zero - I once went to 198 on a carrot and half an orange, but I don't anymore.  It also gave me heart palpitations, worsened my insomnia, and greatly impaired my exercise tolerance), and I wonder if I'm just stuck with what I've got at this point.  Not that I'm throwing in the towel.  Fortunately, my cholesterol profile has  been ideal, my resting heart rate and blood pressure are low-normal, and my weight is okay without a struggle.  But I'm getting aches and pains in my joints and think the fish oil could help there.

  • Peter

    6/11/2011 1:32:44 PM |

    Dr. Davis, at one point you were concerned that you were eating too many nuts
    because your ratio of omega 3 and 6 was off.  What is your current thinking about the trade-offs?

  • Might-o'chondri-AL

    6/11/2011 10:02:26 PM |

    Hi Helen,
    lost 2 replies, says server error ... sorry

  • Might-o'chondri-AL

    6/11/2011 10:14:46 PM |

    Hmm Helen,
    Sounds like epigenetic or good old genetic polymorphism ... appears that Hexokinase II (HK II) is NOT staying inside skeletal muscle mitochondria and glucose-6-phosphate (G-6-P) is working to keep HK II in cell cytosol in a loop,  whereby HK II engenders glycogen output and instigates lots of G-6-P ... that cell has own glucose from glycogen so GLUT 4 (glucose transporters) move too far away to pick up blood glucose  ... liver glycogen  for it's part involves HK IV (glucokinase) and G-6-P too, but may not be root of  your syndrome ... too slow a rate of G-6-P degradation and /or too many carbon or nitrogen terminals on HK II would allow G-6-P to yank HK II  into metabolism cranking out glycogen ...  hey - twice wrote this already.

  • Might-o'chondri-AL

    6/12/2011 12:49:42 AM |

    Helen, Hi-
    Metaformin probably did not work for you because it functions to increase glucose uptake by provoking anaerobic glycolysis to create additional glucose demand;   you may already be doing plenty  of anaerobic glycolysis  as a consequence of your extra ordinary local glycogen synthesis.  The carbon from glucose with anaerobic glycolysis engenders a lot of lactate being produced; your aching joints and body pain syndrome fit the profile of excessive lactate in circulation.

    There is no easy way to determine what phase of the G-6-P dynamic with Hexokinase forms is not working normally, if even involved.  When we wean to real food our skeletal muscles start to run glucose metabolism with HK II and GLUT 4,  rather than the HK I and GLUT 1  we started with;  this change over occurs when we  starts to relatively "burn" both carbs and fats  and skeletal muscles develop  their insulin sensitivity.

    I am not  a clinician, and you have your personal physician to guide you; if I had a distorted  HK II  and G-6-P pattern ( that was unresponsive to low carbs)  I would try to end run it,  and not have skeletal muscle cells utilizing glucose to stop ratcheting up G-6-P and short out the negative feedback loop . I'd  significantly increase my consumption of  dietary fat in the explicit form of unheated virgin coconut oil  and fatty fish (for the EPA/DHA);  if taking EPA causes  blood sugar to rise it is probably because the EPA is driving skeletal muscles to "burn" fat , and thus skeletal muscles are using less of the HK II glycogen  which itself then used even less blood glucose as substrate  (ie: EPA  reduces blood glucose commonly used so glucose level in blood measures higher if cell metabolism aberrant  in the manner like I surmise).

  • Might-o'chondri-AL

    6/12/2011 4:28:39 AM |

    Hi Jim,
    Am not  residing in Canada.

  • majkinetor

    6/12/2011 7:04:12 AM |

    Vitamin C can give falsely higher values when measuring bunch of markers, most notably glucose. Its because it is so similar with glucose (very similar net formula, the same transporters in the body - GLUT, its made from glucose in animals etc...)

    About oil, it can only slow down carb absorption and let the body tolerate better. Did you experiment with other fish oil manufacturers ? Perhaps something in the product apart from fish oil makes you feel that way. For instance, ascorbyl palmitate is typical antioxidant used (along with Vitamin E) so this can be responsible for false higher reading.

  • majkinetor

    6/12/2011 7:22:27 AM |

    Helen, did you try megadosing with Vitamin C (~10g per day as frequent as you can). Vitamin C influences beta cells in the pancreas and deficiency is common in diabetes. Scorbutic guinea pigs show defects in insulin metabolism in vitro. Higher glucose levels compete with C for transporter. Add chromium if you didn't. Daily exercise will surely help. Since low carb made your glucose problem worst (most probable is higher hepatic insulin resistance that is consequence of low carb diet) you might try to return some safe starches back (for instance potato or rice) and keep CHO between 50 and 75 g per day.  Ashes and pains in the joint might be consequence of your too low carb diet since carbs are used for joint functions. Carbs are also used for intestinal mucus which so on very low carb you might have some micronutrient deficiencies.

  • Dee

    6/13/2011 7:47:05 PM |

    Have you tried adding D-ribose to your mix of supplements?  It has helped with my muscle aches from exercise.

  • Kris - Health Blog

    6/14/2011 7:52:50 AM |

    It seems that a lot of doctors would do well by going back a few years in time and re-reading Biochem 101.

  • Jim Anderson

    6/14/2011 7:05:22 PM |

    My wife and I have both been following a low-carb eating plan.  For me, that has meant increased fat consumption from the start.  I have felt full and satisfied after meals, and can go longer without feeling hungry.  I have also lost weight steadily.  My wife, however, has had a harder time of it.   She claims that is because women just have a harder time losing weight than men do.  That's true, I guess, in general, but I have also noticed that she seems to be avoiding fat a lot more than I do.  (Well, I don't avoid it at all!)  So she gets hungrier more often.  It is very difficult to overcome years and years of anti-dietary fat propaganda!

  • Joe Lindley

    6/30/2011 2:04:03 PM |

    Yes!  Thanks for the complete explanation of the fats vs. carbs impact.  I'm successfully on a low carb diet now after quitting Atkins years ago because my wife was worried I'd keep over from a heart attack.  With the right information out there now that dietary fat won't hurt you, people can stick to a low carb diet and get enough satiety (food satisfaction) with fats in the diet to stay on a diet.  It's truly been a disaster that the nutrition authorities shooed us away from dietary fats starting in the 1970s.  It's taken decades to get the word out that dietary fats are OK.  I published a nostalgic post on this about how Barney Fife got it right back in 1963:  http://bit.ly/m5eAhE

  • James Roberts

    7/30/2011 12:59:43 AM |

    Great post, great site.  I made my way to focusing on triglycerides by starting with Lipitor.  I had some bad though serious side effects (mostly insomnia),  so I dropped it and worked really hard on reducing fat intake.  That pretty much worked, but surprise (to me)... triglycerides went way up.  Now that I've also worked on cutting empty calories my levels are down to borderline.  Once you make it to a genuinely healthy diet everything seems to work out Wink
    cheers,
    James

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