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.
This is the blog that accompanies the 
Anybody following the discussions in these pages know that: Limiting carbohydrate intake reduces risk for coronary heart disease and heart attack.
First of all, why do conventional diets advocate restricting saturated and total fat? From the standpoint of surrogate markers of cardiovascular risk, cutting saturated and total fat reduces total cholesterol; reduces calculated LDL cholesterol; and may reduce c-reactive protein modestly (an index of inflammation). It also increases blood sugar and HbA1c (reflecting the prior 60 days blood sugars), increases glycation of the proteins of the body leading to cataracts, arthritis, and hypertension.
Problem: Total cholesterol is a combination of HDL cholesterol, an estimate of VLDL cholesterol (triglycerides), and LDL cholesterol. It is a composite of both “good” things (HDL) and “bad” things (LDL and VLDL). Cutting saturated and total fat results in reduced HDL, increased VLDL/triglycerides, and a reduction in calculated LDL. Pretty weak stuff. The last item, i.e., reduction in calculated LDL, is not even a real phenomenon. In fact, the net effect in most genotypes (genetic types) may be negative: increased heart disease risk.
In contrast, what is the effect of reducing carbohydrate without restricting fat? (In the approach I use, we start with elimination of the most destructive of carbohydrates, wheat, followed by reducing exposure to other carbohydrates, especially cornstarch and corn products, sugar, and oats.) If, say, we cut carbohydrate intake into the range of a truly low-carbohydrate diet of 10-15 grams per meal (“net” carbs, or total carbohydrates minus fiber), then we witness a number of metabolic transformations:
Reduced fasting triglycerides and VLDL
Reduced postprandial (after-eating) triglycerides, chylomicrons, and chylomicron remnants
Increased HDL and shift towards large HDL particles (presumably more protective)
Reduced small LDL particles
Reduced glycation and oxidation of small LDL particles
Reduced hemoglobin A1c
Reduced c-reactive protein and other inflammatory markers
Reduced blood pressure
By slashing carbohydrates, we also witness weight loss from visceral fat, reversal of pre-diabetes and diabetes, and reduced phenomena of glycation. And, if the wheat-free part of low-carb is maintained, you can also see marked improvement in gastrointestinal health, relief from joint pains, relief from leg edema, relief from migraine headaches, improved behavior and ability to concentrate in children with impaired learning, ADHD, and autism, better mood, deeper sleep. You will see multiple inflammatory and autoimmune diseases improve or completely relieved, such as rheumatoid arthritis and ulcerative colitis.
Having personally gone down the diabetic path and back by cutting the fat in my diet, now maintaining a HbA1c of 4.8% with fasting glucose 84 mg/d; (without medications), there should be no remaining doubt: Low-carb diets, especially if wheat-free, dramatically reduce the factors leading to heart disease; low-fat diets worsen the factors leading to heart disease.
Change your life in 60 seconds
Just had my lipid panels done after about 7 months wheat free and low carb:
Total Cholesterol: 235
Triglycerides: 71
HDL: 79
LDL: 142 (calculated)
Pretty darn good, though I’ll keep working on getting the Triglycerides down even more. I didn’t have baseline numbers, but I suspect that they were really bad as I’m severely insulin resistant, obese, and was totally inactive before starting. Insulin resistance is still not where I’d like it to be, but my HbA1C is not bad at 5.8. All these numbers are 100% due to my wheat free, low carb diet, plus fish oil and Vitamin D3 supplementation. I’m THRILLED.
Added bonus:. Skeletal pain that was 7 on a scale of 10 every moment is GONE (doctor said it was aging). Low back pain is gone, and I don’t think it really left UNTIL I cut out the wheat. GERD gone, asthma under the best control ever. I can walk 2 miles now, I couldn’t even walk across a room 6 months ago.
It works, it works, it works, it WORKS!
Excellent, Jank!
Also, note that the calculated LDL likely overestimates the true value, a common situation as you get healthier. At some point, an NMR LDL particle number or an apo B will show you the real value and I’ll bet it’s much lower than the calculated value suggests.
And that’s great on the bony pains.
Zero body fat is not ideal because healthy adipose tissue gives us adiponectin in circulation. In skeletal muscles adiponectin turns out to increase the skeletal muscle enzyme LPL (for geeks: adiponectin upregulates AMPK, which increases PGC-1alpha & also PPAR alpha leading to increased lipoprotein lipase). This essentially gives the enzymatic ability to break apart VLDL for freeing up some of the triglycerides VLDL carries to bring in it’s fatty acids to “burn” in the skeletal muscle cell’s mitochondria for ATP.
Healthy adipose sending out adiponectin can actually increase the number of mitochondria being made (mitochondrial bio-genesis response is from increased AMPK) and up the potential for “burning” fatty acid in that muscle cell; this essentially lowers the amount of lipids in muscle tissue; so having some body fat can still help keep muscles mass lean.
Doc has to oversimplify blogging about carbs and body fat, yet I like his gist. Here’s why: high blood glucose causes an intermediate molecule (succinate, & then it’s derivations ) to form that blocks +/- 25% of adiponectin from forming ideally ( in that adipose cell’s endoplasmic reticulum). This is detrimental because then target skeletal muscle cells have to make do on less than 10% of the ideal high molecular weight (HMW) adiponectin than those with healthy adipose get to work with.
To phrase it simpler, those whose carb derived blood glucose load is too much for their physiology end up living with a low level of ideal (HMW) adiponectin (ex. those with metabolic syndrome, obese, type II diabetic). And then there’s sparse skeletal muscle LPL for setting up the steps to get maximal “burning” of one’s fats in their skeletal muscle (ie: stamina suffers).
But then it turns annoying since, as Doc warns, too high a blood glucose (from dietary carb load one can’t use up) makes the liver get driven by the carbohydrate response element binding protein (ChREBP) to turn those excess carbs into triglycerides. And furthermore, that high level of ChREBP put into play also causes the person’s adipose fat cells to boost expression of their specific adipose tissue LPL (ie: body switches off skeletal muscle LPL, but turns on adipose LPL). In this situation the result is a lot of triglycerides end up getting shunted inside of the body’s adipose fat tissue cells so fat cells swell.
At the same time adipose tissue is sucking up triglycerides skeletal muscle LPL is (for the most part) not showing up to work. So most of the post-prandial made triglycerides the VLDL is trying to unload from circulation over to skeletal muscles for use can’t be plucked in by their skeletal muscles. One way to look at elevated triglyceride lab results is it (high trigs) indicates that body’s adipose tissue isn’t forming adiponectin “normally” enough to perform out & about in the other parts of the body. Doc has specified that human body fat (adipose) isn’t a victim that passively receives goops of fat, but rather an actor – like how it should send adiponectin to help skeletal muscles.
Dr. Davis,
I have experience so many benefits since I’ve been following your dietary suggestions for over a year now. My question is: What do I say to the veggie-heads and Ornish followers who claim and ask the question: If low fat diets really worsen the factors leading to heart disease, please explain why rural China was so unaffected by heart disease in the 80s?
I’m not a scientist or a researcher, and I know low-carb sure works for me, but how do I respond to this question? I’d like to be able to provide an intelligent, straight-forward answer to this never-ending argument. Thank You.
http://www.amazon.com/review/R2W7KWZKQY6BGJ/ref=cm_cd_pg_pg128?ie=UTF8&cdForum=FxZJ813G2J60B7&cdPage=128&asin=1439190275&store=books&cdThread=TxCB0L17B0KXSQ#wasThisHelpful
HI, Don–
A topic for future.
In the meantime, please be sure to read Denise Minger’s reanalysis of the China Study data that essentially debunks the entire argument.
Thx doc. I’m looking forward to understanding this better. My mind is simple… low carb is either better or it isn’t. I know it is for me… but apparently some people, for whatever reason, thrive on grains and low fat. Would love to be able to come up w an answer. Thank u. Don
Hi DonOverEasy,
Next time you want to discuss diet theories with your friends show them that 4 Jan. data of mine detailed way above.
The 1st results were for my long standing life style (ie: decades of my adult life) of eating high whole grain & low fat to theoretically prevent cardio-vascular problems my family is prone to. I was “thriving”, decent weight, did hard work and never seriously sick – so everybody said I was a model for healthy diet. I had no symptoms of any bad reaction to any grains, unlike some get.
But, according to Doc’s preventative cardiology practice I was unknowingly burdened with way too much small LDL, even though I didn’t have other metabolic issues (ex: spooky triglyceride levels). I wanted to think maybe the report print out got messed up.
Then show the 2nd lab results for evidence of how the small LDL improved as an example of when stop being fanatically low fat & unlimited whole grain (carb). If they say it was not a fluke show them the even better 3rd lab results after 1/2 year eating yet a higher fat intake.
Of course individuals will differ & so you should ask them for comparison data from their own NMR (Doc’s preferred lipo-protein test). If their small LDL is negligible on their low fat & grain (carb) based diet then that person is probably that way because of genetics; but you’ll never be able to prove that of course & good fortune for them.
Hi Might-o’chondri-AL,
Thank you for your time and your reply. I don’t doubt you or your numbers. My story is similar. My problem lies with the folks who say we are a minority.
They say we are a small percentage of pre-diabetics, who will naturally do well on low carb. My opponents maintain the vast majority of people thrive on whole grains, low fat, and high fiber, otherwise rural China would have been the “heart disease capitol of the world” in the 1980s.
I’m aware of Denise Minger and how she has shed light on Dr. Campbell’s deceptive studies. And my own story and dietary changes have proven Dr. Campbell is blowing smoke. Yet there is truth in that, China has subsisted for thousands of years on high grains and low fat. Rural China did have a low rate of heart disease. Why is that?
There’s got to be more to this story. The vegans maintain Americans are obese not because of whole grains and low fat, but because of an addiction to simple carbohydrates and sugars. Which truly is part of the problem. But only part of the problem. They believe simple carbs and saturated fats are what causes the inflammatory response that has contributed to the masses with heart disease, not whole wheat grains.
So Al (I presume) I hear you, loud and clear. I too thrive following a paleo way of life. I’ve lose 40 lbs and have great numbers. But are we the minority? I became sick on a vegan diet back in the 80s (Ornish), but I have friends (more like acquaintences) who appear to be thriving on a vegan lifestyle. Again… why is that?
I continue to search for answers. Thanks for taking the time.
Don
Hi Don,
I worked in many rural developing countries worldwide (like yesteryear’s China) and the majority of the people have (had) no food security. So even if the grain bin was full they had to feed their extended family on the realistic minimum (except for seasonal boons, like edible insect time) or risk absolute if ate all their seed grain when planting time rains hopefully came back on time .
In terms of your context this meant they did not overeat assorted types of calories in relation to how hard their daily physical exertion promptly used those available calories. We are not talking about people who are subsidized with food like the modern societies make possible – to put them into their actual context they were (are) eating by the sweat of their brow. I think there is a blogosphere disconnect with only fasting being our link to subsistence level living; & to discard any relationship to “calories in, calories out” as a sound bite just because modern food availability is pervasive..
Rural poor did (do) not eat all their livestock or fowl because it’s their only source of cash income at market and so made do with legumes (ex:beans & bushy pidgeon pea) . There is (was) no refrigeration so the vegetable & fruit crop diversification made it practical to just go with what held up reliably (ex: cabbage) or grew fast (ex: leafy greens). Cooking traditions in rural cultures was not really an art but a means to conserve things from spoiling until got used (ex: fried makes a barrier, sugar preserves, vinegar conserves, ferments drop pH dissuades bacteria).
Rural China’s low cardio-vascular disease , looked through Doc’s paradigm, is they never had enough shear over-load of inappropriately excessive blood sugar to drive the metabolic aberrations which generate the physical changes in lipids (small LDL , triglycerides) that are cardio-vascular culprits. Doc’s blogging puts protein source and fat amounts as not a factor in heart related problems, just what we are taught to worry incorrectly about.
Have your veganites take an NMR even if they are thin for show and tell.
Hi Dr. Davis,
Thank you for confirming that low carbohydrate intake can really reduce the risk of heart attack. I agree that 90% of the time drugs don’t help, natural healing is the more better road to take. I will have to read this multiple times so that I can absorb — this is really interesting.
Here is a conundrum maybe someone can help with. My husband, with CAD, follows a low-carb diet. Has lost 20-25 lbs, blood pressure is fantastic. However,weight loss has stalled over the last year. Triglycerides still too high (319), HDL still too low (38). Low-carb really has not given him the great results I have been hoping for. Any ideas?
Hi Stacie,
This is a sleepy thread by now so Iet me inform you that if you read Doc’s old posts I think you will find him repeatedly saying “…cut out wheat ” , even if you are already low carb dieting. Look above to my 5 Jan. elaboration written “For Iconnolly …” of how I suggest wheat may be a stumbling block , beyond wheat just it being a carb. It may motivate your man to give Doc’s advice a try.
Also, I refer you to the previous post titled “Mocha Walnut Brownies” where 4 Jan. I wrote “For Laura …” in response to your guy’s same slump. Please know that, despite my commenting alot, I am not an authorized spokesman for Doc, nor am I a clinician or medical expert.
Hi AL:
Thanks for the reply, We are wheat free, as well as grain free. I did not understand the post about palmitate. I think you are saying to eat less of it. Our doctor(fantastic low-carb doc)hjas recommended that my husband eat smaller portions of fat, and increase vegetable portion size. He also has begun K2, D3, and omega-3 supplementation. His Apo E genotype is also not good (E2/E4). I do not know anything about genotype, so do not know what it means.
Hi Stacie,
Doc tweaks fat intake down for ApoE4 individuals, your physician says smaller fat portions & I detailed why palmitic acid (palmitate) dietary fat comes to my mind to focus on for limiting. In conventional research high fat diets are used on mice to give them problems, like high triglycerides and insulin resistance and palmitate often comes up as indirectly culpable .
Since we are all designed to make our own palmitate those with genetic &/or food driven high triglycerides might do better just limiting dietary palmitate as much as possible. The desired amount of saturated fat can be obtained from coconut oil & adding more olive oil, due to it’s high oleate fat content, will keep the palmitate benign.
When one is ApoE2/E4 it means they make and use a type 2 & also type 4 variation of the molecule ApoE. Look at next post “DIet is Superior to Drugs” & my 10 Jan. comment about triglycerides and ApoE for now; & use Doc’s search feature for his words.
10 Jan.’s focus is on carbs & triglycerides relationship with ApoE. In your case just ignore the carb phase minutia & interject your husband’s high triglycerides into the overall dynamic laid out. People can have genetic influences on triglyceride levels & this seems to be what you must deal with.
ApoE nuances relationship with triglyceride coping suggests to me getting dietary fat without the palmitate found in meat/whole dairy. Of course that is hard to jibe with the nicer idea of eat all the meat you want; but maybe worth a trial.
Thank you Al. I read those posts. My understanding, then, is that because of the E2/E4, my husband is carb and fat sensitive. Great combo! I guess he is busted. He hates coconut oil, but olive oil is okay. We will follow our doctor’s advice, eat more vegetables and less meat. I am also hoping the D3, K2, and fish oil will help. Here is the bottom line for us: We will do the best we can diet wise, not worry or obsess about food, love each other, and above all, trust God.
I’ve always been fit and thought I was keeping myself safe from heart disease with my 10 mg Zocor prescription for the past 8 years along with exercise and trying to eat somewhat “healthy” (TC under 200 with the zocor, triglycerides and LDL’s under 100 and HDL around 70; my weight is 109, female, age 60). But my new doctor did NMR on me and I was shocked. I found out that I’m APOE 3/4, my ApoB was 100 and LDL-P 1206, HDL 72, TR 115. Since then I’ve added Slo Niacin (500 mg to start), my doctor upped my zocor to 20 mg (from what I’ve read, APOE 4′s don’t respond as well to statins except maybe for simvastatin), cut my carbs and fat intake. My next NMR will be in March. Meanwhile, I sort of feel that as an APOE 4 I’m doomed to some level of heart disease, regardless of my numbers. I’ve always been a negative person anyway….can you help allay my fears?
Ronnie,
I will let Dr Davis answer your question, but I wanted to give you some good news. I am an APOE 3/4 and my family heart disease history is terrible. I started off with an OK lipid profile (according to my PCP; I was taking Lipitor), but my NMR turned out quite bad and getting worse over time. My calcium score at that time (February 2010) was 209. Thanks to Dr Davis, with the correctly tuned diet, supplement, and exercise program, I was able to bring my NMR indicators to a very favorable range, and my calcium score in September 2011 was 191 (10% reduction). And yes, I have to take statins (Crestor 10mg). I can provide more details, but just wanted to encourage you that you are not doomed, simply because you are an APOE 4, so please do not give up!
Thank you for that, Gene. I still haven’t gotten over the inital shock of finding out my genotype. It surprised me because neither one of my parents have/had heart disease. But my fraternal twin sister has CAD which I attributed to very poor diet and sedentary lifestyle. I’m guessing she’s also APOE 4. Thanks again.
Also, Gene, whatever details you care to share would be helpful and appreciated. Ronnie
I described the diet, which took me from my worst NMR in November 2010, to a significant improvement in March 2011, and finally to an excellent NMR in September 2011 (small LDL #P less than 90 nmol/L) and a 10% reduction in my calcium score, in my comment at http://www.trackyourplaque.com/blog/2011/07/the-exception-to-low-carb.html#comment-23722. I followed this diet meticulously. I was taking 2400 mg (EPA+DPA) fish oil, 8000 iu vit D3, 675 mcg iodine in kelp tablets. Following Dr Davis’s advice, after finding out in December 2011 that I was APOE 4,3, I added Niacine 500 mg and Crestor 10 mg (all doses are daily). I also significantly reduced plant oils in my diet. Today I am experimenting with my diet trying to add fats such as 100% baking chocolate and coconut oil. (Don’t know the results yet.) I also walk for 1 hr every day (from home to train and back, and some during the lunch break) and exercise 3 days a week doing interval training (HIIT) for 20 min and following the slow burn strength resistance program.
Dr. Davis, After my doctor took me off glimeperide December 16, 2011 my blood sugars rebounded upward even though at the time I was low carb and avoiding wheat. I never lost but ten to twelve pounds on the Wheat Belly diet but followed your advice anyway because the arthritis symptoms cleared up nicely and also because of so much cardiovascular heritage on my Dad’s side of family. Just this past week I called my doctor again because my blood sugars were very unsatisfactory (FBS of 170 in the morning and 209 between meals). He allowed me to try just one half of one mg. of the glimeperide. At about the same time I began to read about Dr. John McDougall on the internet and at first dismissed him but noticed that in his most recent book, the McDougall Plan for Rapid Weight Loss, 1995, he too warns readers to avoid all flour products, breads etc. So, I have NOT returned to eating wheat but have started trying to avoid meat and fats for a while, just to see what would happen (I have never tried this before, to go without meat). Some good news: My fasting blood sugar in less than 72 hours has gone down to 114 and the chest pain and arrythmias have gone away. Maybe I am sensitive to both carbohydrates AND meats/fats. Decided to put this on this blog instead of Wheat Belly facebook or blog because of feeling like perhaps I am in a minority.
Please read other comments to that post on 7/31/2011. Especially, pay attention to Dr Jack Kruse’s comment. His blog at http://jackkruse.com/jacks-blog/ is very relevant, dense, insightful, and useful. I never miss his posts (nor do I Dr Davis’s).
Gene, thank you very much. I plan to read everything this evening. Congratulations on all your hard work and effort regarding diet, exercise and supplementation. I do have a question regarding your fish oil. In the NMR I received, the notes said that “one study demonstrated ApoE4 patients had a 15.9% increase in LDL cholesterol in response to fish oil. This needs to be confirmed in a larger study”. Do you know anything about this? I take 1000 mg fish oil daily. Also, I have another question which shows my ignorance regarding all of this. My NMR said I is am 3/4; you write you are 4,3. Does the order of the numbers make any difference? Thanks again.
Ronnie, I have no background in the medical field, so I am trying to limit the content of my posts to the links to sources from which I learned and the facts of my own experience. I would defer answers to Dr Davis or somebody else who knows.
The spelling APOE 3,4 is purely mine and I don’t know whether the order or punctuation have any meaning here. To me, it doesn’t matter.
To find out more about the fish oil, read earlier posts by Dr Davis here: http://www.trackyourplaque.com/blog/category/fish-oil. You can also find the following post by Dr Kruse (including the comments) useful: http://jackkruse.com/is-fish-oil-good-or-bad/.
No difference in the order, Ronnie.
A lot of great information on this blog. Thank you, Gene, for the links and Dr. Davis, for your response.
Dr. Clavis Eraslan product without side effects by Panax, a vessel is completely natural bronchodilator.
Plaque in blood vessels, fat layers and removes slag. Opens the way to vessel. Capillary blood circulation, prevents arteriosclerosis.
Dr. Davis,
I read about a Harvard medical study: “Low-carb diets linked to atherosclerosis and impaired blood vessel growth”.
http://news.harvard.edu/gazette/story/2009/08/low-carb-diets-linked-to-atherosclerosis-and-impaired-blood-vessel-growth/
The article said, “…mice placed on a 12-week low-carbohydrate/high-protein diet showed a significant increase in atherosclerosis, … The findings also showed that the diet led to an impaired ability to form new blood vessels in tissues deprived of blood flow, as might occur during a heart attack.”
I hope you will read this article and give your opinion about “how” they conducted their test.
Thanks
Does anyone know how to reach TYP member Gene K who posted on this thread? I would like the link to Gene’s diet that he followed for Apoe3/4 but the link that was posted earlier does not work, if you are out there Gene, or anyone, please email me diet at
dbm1st@airmail.net
Regards