I witness spectacular results restricting carbohydrates, both in the office as well as in my online experiences, such as those in Track Your Plaque. Of course, the diet I advocate is not just low-carb; it starts with elimination of wheat (for a long list of reasons). So the diet is wheat-free in the setting of low-carbohydrate.
What does this accomplish? Here’s a partial list:
–Weight loss-Specifically, loss of visceral fat, the kind hinted at on the surface as “love handles” or what I call “wheat belly.”
–Reduced blood sugar and HbA1c (reflecting prior 60-90 days glucose)
–Marked reduction in small LDL and triglycerides, increased HDL
–Reduced inflammatory measures like c-reactive protein
–Reduced leptin and leptin resistance, increased adiponectin
–Reduced estrogen and prolactin in men, accompanied by shrinkage or loss of enlarged breasts (“man boobs”); reduced estrogen in females accompanied by reduced risk for breast cancer
Pretty impressive. But there’s one group of people who can experience unexpected effects with this diet: The 25% of people with apoprotein E4.
Everybody has two genes for apo E; the most common type is apo E 3/3. Around 1 in 4 people have 1, less commonly 2, genes for apo E4.
I hate apo E4. I hate apo E4 because it means I’ve got to dust off the nonsense I used to tell patients about cutting their fat, cutting their saturated fat. But that’s what apo E4 people have to do. But it doesn’t end there.
Apo E4 people also typically have plenty of small LDL particles triggered by carbohydrates. Put fats and carbohydrates together and you get an explosion of small LDL particles. Remove fats, small LDL goes down a little bit, if at all. Remove carbohydrates, small LDL goes down but total LDL (mostly large) goes up. The large LDL in apo E4 does seem to be atherogenic (plaque-causing), though the data are fairly skimpy.
So apo E4 creates a nutritional rock and a hard place: To extract full advantage from diet, people with apo E4 have to 1) go wheat-free, low-carb, then 2) not overdo fats, especially saturated fat.
It still gives me the creeps to tell an apo E4 person that they’ve got to watch their fats, worse than watching Starsky and Hutch reruns.
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