Plaque is the stuff of coronary heart disease. It is CONTROLLABLE, it is STOPPABLE, it is REVERSIBLE.
But you must be equipped with the right information on diet, nutritional supplements, and hopefully the avoidance of medication.
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Here’s an interesting example of what you might call “extreme carbohydrate intolerance.”
May is a 44-year woman who has now had her 7th stent placed in her coronary arteries. She lives on a diet dominated by breads, breakfast cereals, muffins, rice, corn products, along with some real foods.
Her conventional lipid panel and other lab values:
Total cholesterol 346 mg/dl
Triglycerides: 877 mg/dl
HDL cholesterol: 22 mg/dl
LDL cholesterol: incalculable
(Recall that LDL cholesterol is usually a calculated, not a measured value. The excessively high triglycerides make the standard calculation invalid–more invalid than usual.)
Fasting blood glucose: 210 mg/dl
HbA1c (a reflection of previous 60-90 days average glucose): 7.2% (desirable 4.5% or less)
ALT (a “liver enzyme”): 438 (about five-fold normal)
At 5 ft even and 138 lbs (BMI 27.0), May appears small. But the modest excess weight is all concentrated in her abdomen, i.e., in visceral fat.
By lipoprotein analysis via NMR (Liposcience), May’s LDL particle number was 2912 nmol/L, or what I would call a “true” LDL of 291 mg/dl. (Drop the last digit.) Of the 2912 nmol/L LDL particles, 2678 nmol/L, or 92%, were small.
The bad news: This pattern of extremely high triglycerides, extremely high LDL particle number, low HDL, predominant small LDL, and diabetes poses high-risk for heart disease–no surprise. It earned her 7 stents so far. (Unfortunately, she has made no effort whatsoever to correct these patterns, despite repeated advice to do so.)
The good news: This collection is wonderfully responsive to diet. LDL particle number, small LDL, triglycerides, blood glucose, and HbA1c drop dramatically, while HDL increases. Heart disease will at least slow, if not stop.
It’s amazing how far off human metabolism can go while indulging in carbohydrates, particularly a genetically carbohydrate-intolerance person. (Actually, I wouldn’t be surprised if May’s diet, as bad as it seems to you and me, still fits within the dictates of the USDA food pyramid.) The crucial step in diet to correct this smorgasbord of disaster is elimination of carbohydrates, especially that from wheat, cornstarch, and sugars.
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Hi Dr. Davis.
These numbers are awful, but I think a point must be stressed regarding natural vs. industrial carbohydrate-rich foods. These numbers are not typical for normoglycemic folks who eat natural carbohydrate-rich foods.
Avoiding natural carbohydrate-rich foods in the absence of compromised glucose metabolism is unnecessary. Those foods do not “tire” the pancreas significantly more than protein-rich foods do.
Protein elicits an insulin response that is comparable to that of natural carbohydrate-rich foods, on a gram-adjusted basis (but significantly lower than that of refined carbohydrate-rich foods, like doughnuts and bagels).
http://healthcorrelator.blogspot.com/2010/04/insulin-responses-to-foods-rich-in.html
And nobody can live without protein. It is an essential nutrient. Usually protein does not lead to a measurable glucose response because glucagon is secreted together with insulin in response to ingestion of protein, preventing hypoglycemia.
I definitely get the whole low-carb thing, but I think you always use the extreme cases to make your point. Even dietitians would not recommend that much starch. In fact, many of the "top" dietitians limit starch quite drastically in their meal plans. They are not as ignorant as you think. However, because they have clinical experience (which I know you have too), they know that draconian, restrictive diets do not work. Therefore, they work starches in the diet a bit, so people don't feel "deprived." Still they choose "better" starch options like beans (OMG LECTINS!!!).
I do not believe for one second that the majority of people claiming to be eating according to the USDA guidelines are doing so within the correct caloric guidelines. They are eating far too much and making terrible choices for starches to boot. Portion control is tough obviously. I think people who cannot master it may find low-carb useful because they eliminate starches/sugars outright and don't have to worry about serving sizes. Plus, ketosis gives them a metabolic advantage allowing them to consume more calories and still lose weight. It definitely is not an end all solution though.
Also, they don't bad mouth carbs in the press because people being people would start avoiding things like vegetables.
There is nothing inherently wrong with carbs. We just have to eat them within reason. Just like calcium for example. Too much calcium is linked to heart attacks and prostate cancer. But in moderate amounts, it is helpful.
Okay, I went my two weeks without wheat carbs. My results are purely non-scientific, but here goes. I lost 4 pounds, down to 156. I wasn't hungry at all. I didn't have any bread cravings like I thought I would. But I did have a hard time sleeping, for whatever reason.
After my two weeks I had angel hair pasta and a hamburger on a wheat roll. My stomach was slightly upset for a couple of days once I started eating wheat carbs again – probably just a coincidence though.
So I proved I could do it and I proved to myself that I wouldn't starve or go crazy without my bread. So, I think I'll be more careful about the wheat I put into my system. On the other hand, it looks like May needs to correct things and do it sooner than later.
Just goes to show ya. I'd *love* to weigh what Mary weighs – but it seems there is more involved that that. I just had an NMR test recently myself. Total LDL particle count was 2018. My doctor is freaked and says it's a horrible number. Every website I consult says it's a horrible number -though my small LDL is 212, only 10.6% of the total. But all the websites I consult say the total number is far more a risk factor than paticle size.
But what were the HDL and triglycerides of the people with high particle counts. High like Mary's? My own HDL (measured just last week) is 66 and my triglycerides 49.
But how do you get the particle number down? I've already been low-carb for four years, gluten-free for 18 months, avoid all sugars, take D3, magenesium, K2, 1500 mg niacin.
Might it go down if I can get my thyroid normalized? That's one issue I'm still trying to work through with my doctor. Sheesh, the older I get the harder it gets. So many things to consider I sometimes wonder how anyone manages to stay alive for a few weeks – let alone many years for most of us.
So for people with existing coronary artery issues and Small particle LDL is it true that increasing fat (especially saturated fat) only makes this worse? If you go low carb you need to also be low fat?
I read that "low fat" is bad for Pattern A but beneficial to pattern B.
Dr. Davis?