We've been talking a lot of about increasing dietary saturated fatty acids (SFAs) at TYP. The Part 3 Track Your Plaque Diet was published approximately half a year ago and I've been remiss in not promoting it more sooner.
The NEW Track Your Plaque Diet:
Part 3 Special Issues
-- Apo E
-- Metabolic Syndrome (MetSyn)
Key Summary from Dr. Davis:
--Liberal fat intake of some saturated fats from eggs, meats (non-cured and processed), dairy; monounsaturated; fish oil
--Completely avoid hydrogenated, “trans,” fats
--Wheat and cornstarch reduction or elimination
[Edit: I don't agree with Davis' remaining 'edicts' because they do not appear to work and raise inflammation per clinical trials... =< 200mg cholesterol per day, =< 20 grams saturated fat per day and 15+% omega-6 vegetable PUFAs daily and LDL =< 60 mg/dl]
The Track Your Plaque Basic Diet Principles
Diet Principle #1: Eliminate wheat and cornstarch, limited dairy
Diet Principle #2: Don’t limit fats, but choose the right fats
Diet Principle #3: Unlimited vegetables, some fruits
Diet Principle #4: Unlimited raw nuts and seeds
Diet Principle #5: Unlimited healthy oils
Diet Principle #6: Foods should be unprocessed
Regression or Stabilization
Pioneering the field of cardiovascular research, regression and plaque tracking, Dr. Davis has been promoting (the below) seven TYP goals for Y E A R S . . . light years ahead of the common conventionalist/ interventionalist. New recent observations made by both researchers investigating atherogenic dyslipidemias and by those conducting long-lived healthy centenarian research are, in fact, aligned with several of these seven TYP goals. Maximixation of plaque control and regression have been observed when these seven goals are optimized (TYP 2.0).
For carotid arteries, achievement of any of the below factors will likely induce entire resolution of atherosclerotic plaque. However for the coronary arteries, regression is slightly tougher for a variety of reasons and achievement of all or nearly all seven will support dramatic coronary calcification regression.
Coronary arteries are thinner and more affected by systemic inflammation and the shearing forces secondary to high blood pressure (whether during physical exertion or at rest).
On the other hand, for stabilization and complete elimination of coronary events (angioplasty, stent, MI, bypass or death), gaining control of only three out seven is right on the money... imo.
We define stabilization as EBT CAC score progression of less than 10-20% annual increase.
The average American increase is 30-60% annually (of course faster in Lp(a), apo E4, diabetes and MetSyn).
Wouldn't you like your investment portfolio to grow as fast as American plaque?
So...Easy. To gain control.
Choose any 3.
1) Small-Dense-LDL =< 10% of total LDL particles (imo irregardless of total LDL on NMR or VAP) (Dr. Davis' TYP Goal)
2) HDL > 60 mg/dl (Dr. Davis' TYP Goal)
3) HDL2 (Large-HDL) > 50% of total HDL particles (Dr. Davis' TYP Goal)
4) Large-LDL > 60% total LDL particles (soft goal)
5) vitamin D = 60-80 ng/ml (Dr. Davis' TYP Goal)
6) Sufficient omega-3 ALA and EPA DHA (fatty acid profile, AA:EPA ratio of 1.5-2.0:1; if we flip the ratio around to EPA:AA, in other words omega-3 to omega-6 ratio of 1:1.5, then we're talking 60% of our RBC/cellular membranes being enriched with omega-3 PUFAs content versus omega-6 PUFAs. We really like 60% for some reason at TYP...go figure.)
7) control of inflammation (unfortunately few 'markers' to TRACK):
- dietary (avoidance of gluten, food allergens, casein, etc; adequate ADE K1 K2 MK4-9 vit C B-vits the right ones and minerals Iodine Mg Zn Se, fiber (if tolerated), saturated fatty acids, CLA, GLA, cholesterol, CoQ10/quinones, plant sterols (esp stigmasterol), etc)
- environmental (stay away from plastics/bisphenols/ heavy metal exposure/ pollution/ pesticides, etc)
- mental /psychosocial (stress, excessive physical training, etc)
- hormonal (optimization of thyroid, vit ADEK1K2, omega-3, SFAs, E T P DHEA preg, insulin, cortisol, melatonin, etc)
- pharmaceutical/xenobiotic (adequate intake of antioxidants/ omega-3/ phytochemicals/ FOOD to thwart toxins; avoidance of synthetic hormones, certain drugs (excessive statins), synthetic vitamins (eg, Lurotin, D2/Ergocalciferol, etc), omega-6-PUFA seed/legume oils, etc))
Original TYP Goals for Regression: 60-60-60
HDL = 60 mg/dl or higher
TG = 60 mg/dl or lower (#9)
Vitamin D [25OHD] = 60 ng/ml or higher
Am I a *haa* h e r e t i c . . . ?
(LDL = 60 mg/dl is #8 and IMO optional -- this is the easiest with synthetic drugs but unfortunately it prevents #1-4 for some low chol/low fat folks)
VLCD + Cholesterol + SFAs Support 'Super-TYP' Goals #1 through 4
Dr.Volek has published numerous articles on nutrition and metabolism in regards to the benefits of VLCD (very low carb diets) and ketogenic diets in controlling insulin and other hormones. He has shown in various studies how very low carb diets shift small dense LDL particles (atherogenic) to large, fluffy, buoyant LDL particles (regressive). Cholesterol and SFAs (saturated fatty acids) from eggs were demonstrated by Volek to be particularly effective at promoting larger HDL particles, the 'good' cholesterol associated with plaque regression, longevity and cancer protection.
Below is a diagram illustrating the proposal how low carb diets reduce insulin and how high fat/cholesterol diets increase Large-HDL (HDL-2) particles and increase LDL-receptors on adipose cells (and presumably the 'cholesterol core' of atherosclerotic plaque in diseased coronary, carotid, renal and peripheral arteries).
Again, obtaining the lowest proportion of small dense LDL is the holy grail of plaque victims (eg, anyone with a positive (+) EBT coronary calcification score).
Modification of lipoproteins by very low-carbohydrate diets.
Volek JS, Sharman MJ, Forsythe CE.
J Nutr. 2005 Jun;135(6):1339-42. PDF here.
Eggs distinctly modulate plasma carotenoid and lipoprotein subclasses in adult men following a carbohydrate-restricted diet. Mutungi G, Volek JS, et al. J Nutr Biochem. 2009 Apr 13.
Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. Mutungi G, Volek JS, et al. J Nutr. 2008 Feb;138(2):272-6.
Healthy Centenarians Attain ~4 of 7 TYP Goals
Long-lived centenarians, also known as probands, had lipoprotein analyses performed via NMR. Of the markers tracked, four out of seven TYP goals were achieved. Interestingly, centenarian data shows that they still display vitamin D deficiency like the rest of us.
See picture (top)
Figure 2 displaying the Percentage of Large and Small HDL and LDL Particle Sizes in Long-Lived Probands, Offspring, and Ashkenazi and Framingham Controls HDL indicates high-density lipoprotein; LDL, low-density lipoprotein. *P less than .001 for probands vs Ashkenazi and Framingham controls and P less than .001 for offspring vs Ashkenazi and Framingham controls for both large and small HDL and LDL particle sizes.
1) Small-Dense-LDL =< 10% of total LDL particles (irregardless of total LDL on NMR or VAP) (TYP Goal)
2) HDL ~ 60 mg/dl (Table 1: women HDL=56 (SD 15); men HDL=50 (SD 17)) (TYP Goal)
3) HDL2 (Large-HDL) > 50% of total HDL particles (TYP Goal)
4) Large-LDL > 60% total LDL particles (soft goal)
Barzilai N et al. JAMA 2003. Oct 15;290(15):2030-40. Unique lipoprotein phenotype and genotype associated with exceptional longevity.
Apparently this sub-population of Ashkenazi Jewish have a genotype variation on the CETP gene which regulates and controls HDL-particle sizes. HDL-cholesterol is an antioxidant and they have the genetic ability to upregulate Large-HDL particles more than the rest of us. Their offspring may have version as well. The offspring (and controls, who were the spouse of the offspring) who were free of any chronic conditions (no hypertension, no metabolic syndrome, no cardiovascular disease) incidentally displayed similar high HDL particle counts, large HDL and LDL particle sizing and buoyancy, and reached the TYP goals of greater 60% Large-LDL and greater than 50% Large-HDL. Their counterparts with chronic conditions failed to meet these goals.
Polymorphism in CETP Gene and Phenotype of Exceptional Longevity
Can we exert control on our gene expression? We already know by altering omega-3 and vitamin D blood levels, we can alter gene expression of the various components of our immunity and cardiovascular health (Weaver KL J. Biol. Chem 284: 15400-15407; Biocarta; DeLuca HF PNAS 1993 90(20):9257-9260).
Volek et al have demonstrated how one can achieve control of small dense LDL via inhibition of CETP activity by a very low carb diet/HIGH-FAT DIET with additions of dietary eggs/cholesterol/SFAs.
Can we obtain similar sd-LDL less than of 10% lipoprotein profiles as long-lived heart-disease-free, cancer-free centenarians? We may not have the genetic programming/genotype but I certainly believe with our current understanding and technology, achievement of the centenarian phenotype is a definable undertaking.
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