Thursday, September 3, 2009

Cardio Controversies: Dr. Superko, MD

“It is not good to settle into a set of opinions. At first
putting forth great effort to be sure that you have
grasped the basics, then practicing so that they may
come to fruition is something that will never stop for
your whole lifetime. Do not rely on following the
degree of understanding that you have discovered,
but simply think. . . This is not enough.”

Hagakure, Yamamoto Tsunetomo (a Samurai)
September 10, 1716
Quoted by Dr. Superko, MD

Often at TrackYourPlaque I've been curious as to why regression on CT isn't admittedly easy as pie... like one-two-three... ?? A-B-C...??

Routinely now I would say all the lipoproteins I've been coaching or those that refer to us from Paleo/ Primal/ Protein Power sites are being reported at goal and optimal within months of starting TYP or after only 4-5 weeks of tweaking the diet. These wonderous and spectacular results are reported by members, both new and old, with HORRIFIC family histories of premature CAD events. Lp(a) is a risk factor for 90-100% of these individuals, the toxic vascular plaque accelerant.

Yes, all are Paleo or lacto-Paleo.
Yes, all are moderate to HIGH dietary saturated fat.
Yes, all are lower carb or VLC (very low carb).

No, they do not necessarily lose weight.
No, no changes in the $200+ supplements per month. (or...even better taking virtually none)
No, it was not hard. (OK, maybe... !debatable, but hey members pay $80/yr to learn how to live the 'spartan' *ironic laugh* tasty, high fat life where you feel younger, more vital, enjoy better skin/hair and at the same time beat subclinical CAD and stroke risks!??)

Yes, some LOWERED THE DOSE OF THE STATIN by extreme measures (sometimes against the advice of their LDL-centric-fool-cardiologist... SSSSSHhhhh)
because of the, remember, low-trig-statin- i-n-t-e-r-a-c-t-i-o-n.
Yes, repeat, they lowered the stupid-statin-red-pill and obtained BETTER RESULTS.

Or... unequivocally better no statins at all.

Yes, they are not unlike the previous Paleo/semi-Paleo (statin-free) peeps I profiled earlier HERE including Doug/dcarrns regression story.

No Statins

Why do statins ruin results often? Maybe because they are actually ineffective in this world of 'whole grain happiness' and veggie oil madness? Maybe because Lp(a) is not responsive to statins and, in fact, statins raise Lp(a)? Maybe because IDL, another frequent and overlooked cause of premature and subclinical atherosclerosis, is not responsive to statins? Maybe because statins completely fail to shift lipoproteins to the desirable Pattern 'A'? Maybe because statins do not lower coronary calcifications on EBCT or MDCT in over a dozen of trials that I've reviewed? Maybe because statins block wound-healing which may not exclude plaque lesions? Maybe because statins cause muscle tissue breakdown, mitochondrial defects and coenzme Q10 depletion? Maybe because statins inhibits nerve ending re-myelination of our nervous system?

Maybe because statins prevent the formation of Large LDL which are the primary/only transport units in our circulatory system for cancer- and heart-protective antioxidants like Vitamin K2 (MK-4 through MK-9), Carotenoids (Astaxanthin, Lutein and the 200+ others), Vitamin E tocopherols tocotrienols, and cholesterol which comprises 20+% of our nervous system, integral to every cell membrane and the provides the backbone structure to ALL our vital hormones necessary for life, survival and reproduction?? (Vitamin A, another fat-soluble 'hormone-like' nutrient, on the other hand is so important it has its own transporter known as retinol binding proteins.) For regression and hard clinical event reduction, Dr. B.G. Brown showed in the landmark 3-yr HATS trial in post-CAD men and women (see below graph), the treatment group achieved a high rate of large buoyant LDL (~70% of participants) and HDL2 increased by 61% (total HDL increased 30% from baseline low-30's mg/dl). About 25-30% of participants had Lp(a).

Many cardiologists are starting to speak out about statins' frank lack of outcomes and even their dangerous side effects. Stanford doctor Dr. Mark Hlatky, MD is no exception in an NEJM editorial HERE. How scary is it that the statin industry is trying to peddle these teratogenic Category 'X' drugs to S.A.D. obese teenagers (who might have s*x and might get pregnant)? Obese children are their targets too, children who have rapidly growing brains and nervous systems which require cholesterol?

How about... Lack of regression? Marginal regression? 'Sucky' lack of clinical reduction in coronary events when comprehensively compared to niacin trials and omega-3 trials? Do cardiologists even know regression if it smacked them in the knee? Like those that sit on committees? In the AHA?

Question: Which drug/vitamin, which mimics ketosis, trumps statins in comparisons of CAD outcomes, all-cause mortality, AND angiographic-regression studies, by raising Large HDL2, lowering small dense LDL and controlling toxic Lp(a)? (Figure 1, from the below reference)

Lipid management to reduce cardiovascular risk: a new strategy is required.
Superko HR, King S 3rd.
Circulation. 2008 Jan 29;117(4):560-8; discussion 568.
Free PDF

"Myopic Focus on LDL"

Soon I'll be meeting a patient of Dr. Superko's from 10yrs ago; this gentleman was on niacin and doing NMR subfractionation of cholesterol lipoproteins before it became en vogue at places like TrackYourPlaque. I find it be a quite a coincidence because I've been reading much of Dr. Superko's work the last few weeks. Dr. Superko was no longer his physician after he became busy on the lecture circuit and with Berkeley Heart Lab. It appears this eminent cardiologist, prolific researcher, and author is still pretty busy and now earnestly trying to prevent more Americans from dying from the coronary artery disease epidemic. Will it be enough?
"Although this level of success in the fight against heart disease is laudable, a great danger for our patients’ future health lies in the assumption that cholesterol reduction alone will stem the tide of coronary heart disease (CHD). It is wise and prudent to remember the words of Yamamoto Tsunetomo that “this is not enough.” The purpose of this article is to challenge healthcare workers to consider the possibility that the cholesterol-lowering program has in large part failed to stem the epidemic of CHD and that the well-meaning focus on LDL-C reduction has deflected interest in other therapeutic aspects of lipoprotein treatment that provide equal or greater benefit. This myopic focus on LDL alone is not surprising because, so far, guidelines have not adequately addressed other evidence."

"Statistical Significance Does Not Necessarily Mean Clinical Relevance"

Which strategies appear to lower CAD risk the most? It appears from Superko's provocative assertions that raising Large HDL2-cholesterol is the most critical according to current secondary prevention studies (niacin: HATS HATS-MetSyn FATS FATS-10yr CDP CDP-15yr CLAS-I CLAS-II ARBITER). With trials like the well-designed secondary trial in post-MI men and women, the Lyon Diet Heart, it was observed how mildly re-balancing the n-6:3 ratio resulted in 73% reduction in CAD events as well nearly an equally impressive 70% reduction in all-cause mortality (cancer, accidents, suicides, etc). In fact, in the Lyon Diet trial, LDL increased 1.7% and HDL decreased (yikes) 3%. Could the improvements in death rates be from increases in the Large HDL2? Subfractionation of the lipids were not done (or at least I can't find them) but that is necessary to see below the surface how omega-3 fatty acids work. Omega-3 PUFAs, like saturated fatty acids, bind PPAR and effectively lower small LDL (which are toxic) and raise Large HDL (which are regressive). Quite literally, in clinical trials, fish oil does not change total HDL-Cholesterol hardly at all but instead invokes dramatic, TECTONIC shifts in HDL2, sometimes even increasing by 150-300%. Niacin has a similar shifting effect on subfractions enlarging and enriching small particles into larger, buoyant, fluffier particles. Like omega-3 PUFAs and saturated fatty acids, niacin improves both HDL and LDL particle content and functionality.
"Statistical, or mathematical, significance is a tool useful in calculating how likely it is that the results of an experiment are due to chance alone and not really due to the intervention. Achieving statistical significance generally means that the results observed probably were not due to chance alone and probably were the result of the intervention used in the clinical trial. A value of P=0.05 indicates that there is still a 1 in 20 chance that the results were due to chance alone and not the intervention. Thus, statistical significance is a mathematical tool to test the hypothesis that the results observed were probably due to the intervention, but it does not necessarily mean the results are clinically significant or even meaningful..."

"The potential harm in the assumption that mathematical significance is equivalent to clinical significance is that many public and professional individuals have the misleading impression that if they just get their LDL-C low enough, they will be free of CHD risk. The results of 5 large statin trials show that this is a dangerous misconception in that it leaves large numbers of patients still at risk for cardiovascular events."

Statins and LDL reduction... 'This is not enough.'

Niacin . . . m a y b e .

Diet is definitely the best. Trumps them all.

At TrackYourPlaque we agree with Superko and have taken it further.

Grasp the 'Basics' for Regression (TYP Goals):
1. No statins
2. Vitamin D > 60
3. Trig < 60
4. HDL > 60
5. Small LDL less than 10% or none (LDL-IVb as low as possible and diet works well, again, very VERY well)
6. Large LDL > 60%
7. Large HDL (2b) > 50%

Regression is associated with Large HDL (Krauss RM et al, ATVB 1996).
Progression is associated with Small LDL, notably LDL-IVb (Superko HR, Krauss RM et al, ATVB 2003).

Answer: Niacin (which mimics ketotic diets, coming up in Benefits of High-Saturated Fat Diets, Parts VI and VII)


Adam Wilk said...

Great, great stuff!!! Now if I could only 'man up' and deal with the monster niacin flush that comes my way @500mgs., (& I want to do this twice a day? What am I, nuts????!!!) I'd definitely sleep better at night knowing I've got a powerful ally!!! Thanks for putting everything in such clear & entertaining terms!!!

Dr. B G said...

Hey Adam,
Your welcome! The warmth does signal that it is working doesn't it?

Anonymous said...

Come the winter I take the niacin before I go to bed, the flush means no need for the electric blanket or the heating on. Spend on the supplement and save on fuel...LOL


Anonymous said...

Just a quick question, Dr BG, : can meaningful amounts of niacin be obtained from dietary sources. My insticts tell me that it shouldn't really be necessary to require to supplement with niacin if the overall diet is healthy. Maybe something in the modern diet increases the need for niacin orl aleternatively, something is missing which would have provided the benefits niacin appears to provide.

Going off topic, but something which just popped in to my mind: is there to your knowlewdge any association between skin tags and thyroid function. I kow they are associated with insulin resistance - but given their prominance in the neck area I wondered if they may in particular be linked to TSH levels or some more direct measure of thryoid function - in the same way maybe that viscreal fat is associated with insulimn levels.

Its been my experience that more medicine often dismisses something as harmless simply because its not understood or no method of treatment is available.

Another example being campbell de morgan spots which as I understand it are a marker for liver damage.

Geopgraphic tongue is yet a another.

Sorry for the digression. Intersting post as always.

Paul Anderson.

Dr. B G said...


Gives that nice 'sexy' glow too!



I definitely think you are on to something. Skin tags do appear where there is friction -- necklines etc -- but I see what you mean. Hypothyroidism is so rampant and so is insulin resistance and hyperinsulinemia. All of these also are associated with fatty liver, NASH, and congestion of the liver (caused by dietary CARBs, not fat). Fatty liver is like the visceral fat that you mentioned. When I see the ALT (liver test) greater than 12, one can presume pretty accurately they have some calcified liver going. A calcified gall bladder can be typically expected too.

Geographic tongue is a B-vitamin deficiency. Sometimes related to poor absorption via 'leaky gut' syndrome or just a S.A.D. diet. Are you still consuming wheat and other glutens (barley rye)?


Adam Wilk said...

Dr. B G,

I was also thinking of taking a baby aspirin each time I attempt the niacin, but I just read that aspirin could actually block the production of the so-called prostaglandins responsible for the flush (this thing called Prostaglandin D2--PGD2) so I wouldn't be doing myself any favors, right? Here's the interesting thing I read--apparently, the human heart has a huge capacity for producing this PGD2--so here I'm thinking, G@d forbid one has chest pain or doesn't feel well, perhaps a good old niacin flush could do the trick of flooding the heart with blood? And in my crazy head, why not add a little nattokinase for good measure? My doctor would look at me like I have two heads if I uttered this in her presence!!
Okay. Let me go flush now...wish me hot luck.

Dr. B G said...

Hey Adam,

Well aspirin is great for a lot of things, esp thick blood and fevers. It is interesting that you noted the PG responses! Our heart sure has a capacity for so many things, doesn't it?


Anonymous said...


I take 2 baby aspirins at night with my extended release Niacin (2 x 500mg of Enduracin) and my lipid profiles have improved a great deal. Here are some articles that talk about Niacin and Prostaglandin D2:

I would recommend you start off with a 250mg extended release dose and then work your way up to 500mg, 750mg, etc. Both Endur and Slo-Niacin come in 250mg & 500mg sizes:

I would recommend against taking niacin twice daily. Dr. Davis talks about how your liver needs a daily break from it:

If you still cannot tolerate niacin then try taking some with Quercetin (which might be heart healthy in and of itself*). Quercetin might block the flushing effect:

If that doesn't work and you still want to take Niacin, then you can wait and see if Merck's new ER Niacin will be released. It has a 2nd ingredient which is said to block the flushing effect. My guess is that this stuff will be close to $3.75 or more for a tablet (as opposed to less than 25 cents for Enduracin or Slo-Niacin).

Another supplement which is said to raise HDL is Neptune Krill Oil. I myself haven't tried it but this study looks impressive:

As for Nattokinase, Doctor Davis feels that it is snake oil. If you search his blog, you will see his comments against it.

Hope this helps.

John M.


Dr. B G said...

John M.,

I appreciate all your links and resources!

In fact if the HDL is really low (like ditches low < 30 mg/dl) and Lp(a) present, skipping niacin works better according to some anecdotal evidence from Castelli WP (one of the Framingham researchers who never believed the low-fat/low-sat fat myths).

Crystalline niacin actually works the best (sounds like meth doesn't it??) but it is not tolerated well at all. The trough (low blood level) that occurs is what improves niacin's efficacy.


Adam Wilk said...

Thanks for taking the time to address my niacin woes!
I'm a big fan of William Davis myself (he's the one who got me to begrudgingly [did I spell that right?] dump my 'no flush' niacin, that inositol hexa-stuff...grrr...of course, I had no problems taking that--I'm flushing miserably at 100mgs regular niacin--why me, G@d? Why?
Anyhoo, I'm fine with the backing down to one dose a day, but funny enough (if my slowly fading memory serves me right..) I've always thought that Dr. Davis railed against the slow-niacin stuff...I have to go back now...
Now if only niacin was as easy to take as fish oil...hmmph...
And Dr. B G, you're 100% right about the weight loss aspect of eating lower/low/zero carb, whatever forms one may take on--the weight thing must be kept separate from the lipid improvement category, because true, I don't gain weight when I'm faithful, but I sure as heck don't drop pounds left and right--you're one of the first of 'the professionals' to address this, too, and I sincerely appreciate that as well.

The natto, the serrapeptase, and the bromelain I'm going to stick with, I'm hoping and praying they all act like Pac-Man in my arteries!!

Dr. B G said...


Flushing frequently occurs with the immediate release but Slo-niacin usually does not as much. That is my personal experience as well when I tested them.

OTC Slo-niacin comes in 250 mg tabs or cut in half the 500mg tabs. I have my patients take it initially every other day to help develop tolerance, for 1 mon then gradually increase monthly if no intolerable flushing (and labs for gout/uric acid and liver tests/ALT are all in order and fine).

Hope that helps!


David said...

Another spectacular post, G!

@Adam -- I've found that if the niacin flush is hard to handle, it does help to take it twice per day. Now, I know that there's some concern about it being hard on the liver, but as far as I know, these negative effects are usually only from the extended release preparations that stay in the body for like 12+ hours. If you use the crystalline (immediate release) niacin, it's not going to stick around in the body for nearly that long. I wouldn't take it any more than twice per day, but I've never seen a problem when people take it in a morning/evening dose. The flush usually stops happening in a matter of a couple days using this method.

The reason it works is because it keeps your histamine all used up. Your mast cells contain histamine-- kind of like balloons filled with ping-pong balls, and niacin comes along, pops those balloons, and all the ping-pong balls come pouring out (yeah, this really isn't very scientifically precise at all, but you get the point!). Over time, the histamine refills, and the process starts over. But if you can keep the histamine tanks empty, you won't flush, and your body adjusts anyway.

If there's any doubt about taking the niacin 2x per day, you can always keep your liver enzymes monitored for changes. You can also take a small dose in the morning (enough to provoke a flush-- 100 mg or whatever it takes) and then take whatever the larger dose is at night.

I've seen limited success with quercetin (quercetin has a stabilizing effect on the mast cells -- it is good for seasonal allergies), and even experimented on myself to see if it helped the flush (I stopped taking niacin for awhile so that I'd flush again). Might've helped a little, but it's hard to say. Makes sense in theory, but doesn't play out in real life as well as I wished it did. I found that it does help to take it with vitamin C, as this has a direct antihistamine action.

Good luck with it!


Dr. B G said...

Awesome TYPs David!!

Anonymous said...

Sept. 5, 2009

G, terrific blog.
In the article by Dr. Superko, page 565, under HDL-C-Raising Therapy, it says,This attribute of nicotinic acid helps drive cholesterol out of fatty plaque and into HDL3 for eventual removal.
I thought HDL2 is the better HDL, than HDL3. Is this a typo?. Please clarify.

Adam Wilk said...

Thanks for your informative and thoughtful suggestions--they are indeed appreciated!
Lots to think about!

dr j said...

have you guys got an angle on how we might find an opportunity to exploit the flush?

Specifically for dry diabetic skin.

When i look at some of the background papers on the little known effect of diabetes on skin, ie dry skin, prone to yeast growth on moist areas, its primarily due to poor circulation especially near the skin layers ie poor capillary health.

Plus the sweat on the skin leaves glucose on the skin, a subsequent food source for yeasts to thrive.

So if we could find, or develop, a protocol (maybe based on anecodotal reports, eg we know that niacin improves gum health)we might be able to improve skin health using niacin to generate a flush and assist skin component building through better blood supply, plus alos need to supply essential nutrients.

As collagen is about 25% of proteins in the body, we would need to maintain Vit C status, and other amino acid levels. We know that copper is involved in angiogenesis so addition of such micronutrients might be needed too.

Any thoughts on finding that one angle that might work?

dr john
and yes I want to get rid of my dry skin!

steve said...

i eat no grains,sugar, etc, and yet have failed to generate large LDL. Recent NMR had particle count of 598 of which 549 small. Am taking 1000 Niacin which is barely tolerable: intense itching unless aspirin taken everyday,and Niacin virtually same time everyday. Other problem is excessive dryness caused by Niacin which for an eczema sufferer is a problem. I think the small particle issue for many(and me) is probably genetic. Weight is fine, and D3 is 62. Large HDL-P was 17.1 and TRgs 29. I do not think the literature with regard to shifting particle size is as black and white as you do. There is evidence, but it is not unequivocal. Any thoughts? Thank you. Steve.

Dr. B G said...


Thank you for kind compliments!

See Box 1 in this article, a CME about HDL-raising 'prospects'. Its kinda funny all the drugs coming out when the simplest strategies can be eating (insulin-sensitizing) and some movement (insulin-sensitizing). I haven't seen drugs working better. Fenofibrate has NO clinical improvements in trials because it RAISES HDL3 and nearly nothing for HDL2 (it can raise SCr too).

The Superko article you read is correct... from peripheral cells (eg lipid cores of plaque, fatty calcified livers, etc) cholesterol is effluxed out via ABC-G1 dependent pathways and deposited into HDL2. HDL2 has to predominate or at least 'exist' for regression for this reason. Our TYP goal, HDL 60 mg/dl, is the optimum for full HDL functionality which may take 1-4 yrs (or less if one is Paleo). To me, it is heartening to see nearly all hard clinical events cease in 3yrs of the HATS trial with only a 60% increase in HDL2 and achieving Pattern A.

Interconversion of HDL3 to large HDL2 also occurs from TG-rich lipoproteins (from carbs from the diet) in the liver and intestines via LCAT. When you read the CME, you'll see CETP converts large HDL2 to small HDL3. You and I know that is why saturated fats work well. CETP activity is reduced with dietary saturated fats. This is one of the mechanisms how saturated fats potently raise HDL2 and lower HDL3 (and small LDL).

We do need some HDL3, but HDL3 just cannot be the predominating subparticle. Dr. Wm Castelli (Framingham researcher) has said that HDL3 do not protect. However, I believe it is like Lp(a) -- depending on the context -- in fact some Lp(a) can be protective. All the HDLs and other lipoproteins have unique roles and functionality in our immune system. Certain human characteristics evolved to take 'advantage' of unique environmental niches (eg, microbe and infectious, vitamin C- and/or B3 deficient scenarios).


Dr. B G said...


Are you taking anything that inteferes with the production of large LDL?

How much fruit to you indulge in daily? All carbs generate small LDL.
Are your hormones f*cked up?

You should consider joining TYP for more strategies. If you are already a member, then consider reading the stories of bka123, sergrad, dcarrns, Jake or any of the Paleo folks. Focus on the stories of regression and good lipoproteins that you'd like to emulate.

Niacin research shows regression -- but one must take 3000 to 4000 mg daily. Research with Niacin alone or in combo (colestid, fibrate, low LOW dose statin) all show angiographic regression and GINORMOUS reductions in HARD clinical events. You don't like the particle shifting that is evident in the niacin trials? Do you know how to read the medical literature?

For good black/white stories on particle shifting, you must also read the ketosis research by Vokek JS, Hayes JH, etc.

Good luck -- stay optimistic and curious!


Dr. B G said...

Oops -- I meant VOLEK. He has great book, the TNT diet. I'd avoid the dairy though that triggers and causes eczema for many folks.

steve said...

thanks for your response. eat little fruit(berries in days when i take Whey protein in am). Little to no cheese; perhaps some real parmigian some days. Eat grass fed beef,wild seafoot, eggs. I keep the carbs low except for veggies(no potatoes, have some carrots and tomato).
I was not referencing Niacin; was speaking of diet only where i believe the data is equivocal on particle size shifting. As the only male in my family who has not experienced a coronary event i am betting there is a large genetic component to the story of having all small dense particles. Weight fine, Testosterone is 640(scale250-1000); D3 of 60. Large HDL-P of 17.1 with HDL of 62 per NMR. TSH was 1.5, but jumped recently to 2.9. I think it was the Niacin or D3. Blood Pressure of 110/75. See Nephropal blog for same experience.
I know Volek work. Niacin will have to go: it just casuses me to many issues. Am very allergic and think perhaps there may be a histamine relationship.

Dr. B G said...

dr j!

Dry skin can be ameliorated! Skin is a good indicator of overall health status. Most people reports after hormone balancing and optimization, skin improves. Eczema and dry skin is very responsive to diet -- elimination of all possible allergens (gluten, wheat, dairy/casein, etc). Vitamin A, high dose fish oil, flaxseed oil (omega-3 ALA) and other essential fatty acids are also vital.

Essential fatty acids, SFAs, vit A and other agents like CLA and phytosterols that benefit skin (and vasculature) are found in butter oil ( Recently my sister and I found some ghee at Whole Foods and the health food store made from pastured cow butter (no casein).

I agree -- vitamin C and all things that support collagen are good things as well as avoiding excessive UV rays, AGEs from carby foods, fruit, etc.

Have you tried any coconut oil topically after a bath? NOW brand sells a great topical vitamin E that is a great topical antioxidant.

Hope that helps. I'd love to hear about your results later and the experiments!


Dr. B G said...


Even with a TSH of 1.5 -- body temsp and the FT4 and FT3 (and other parts of the panel) will determine if you are low thyroid.

You didn't answer my question. Are you on a statin that is preventing the formation of Large LDL?

My guess is that you have statinosis. Overstatination, high insulin and/or low thyroid are most likely inherent to small LDL. Low thyroid raises insulin. Did you know that insulin turns on HMG CoA Reductase? You mentioned allergies. These are just one component of the myriad of the problems you likely have. Food allergies trigger autoimmune disease -- plaque is autoimmune. Did you know that?

Ck out Dr. Mark Hyman MD UltraMIND. Give me a book report here in 1wk!


steve said...

My oversight on the statin. I take 10mg of Lipitor. While on it i have seen my HDL increase from 41 to 54 to 62, and my particle count come down. Had been 100% small, now 90%. I respect your view, but hard to imagine the 10mg of Lipitor is keeping me from having mostly large LDL. Oh, before going on the 10mg of Lipitor, i went 3 months no statins and low carb, no grains, starches, wheat. Also, doubt improvement of Thyroid will get it to mostly large LDL, but will investigate. I know Hymans work. Isn't he low fat and grain ok for diet. Dr. Superko is anti sat fat; at least that is so from his book of 2003. I am not anti sat fat as i eat meat fish(, eggs,use whey protein min hard cheese. Thank you for your thoughts.

steve said...

i do not know insulin, but blood glucose was 78 before Niacin and 85 after it.

Dr. T (Nephrologist) said...

Thank you for the great post!!!!

Dr. B G said...


You are asking me questions because you have heart disese correct?

If you have heart disease, then you must have insulin resistance or some form of hyperinsulinemia. That is just a fact. One glucose reading is often misleading and irrelevant. Postprandial 15 30 60 90 120 min is more meaningful for metabolic individuals. Your HDLs sound EXCELLENT now! It is not the Lipitor b/c that drug dose not raise HDLs significantly. It only raises 2-5% at the dose you reported 10mg/day; at higher doses it LOWERS (yikes) HDLs 5-10%.

Other mechanisms are more highly associated with the degree of HDL increase that you reported -- did you lose weight? How low carb did you go? How much more exercise do you do? Resistance training? What change in body fat? Insulin-sensitizing supplements?

Also, Niacin + low carb raises HDLs pretty nicely like yours.

TSH varies hour-by-hour and you are lucky you caught it at 2.9 (both 1.5 and 2.9 indicate Hashimoto's, an autoimmune destructive calcification process).

Any dose of Lipitor can prevent Large LDL formation when Trigs are less than 180. What are your Trigs?

You are absolutely correct -- those providers are still 'low' saturated fat unfortunately -- but they do offer other solutions for your health which override their blindspots. Everyone has blindspots (even me). TrackYourPlaque's blindspot was pro-statination up until only recently. Hyman is Paleo exercise and Paleo eating including BEEF, grassfed beef. However you can tell from his skin, Hyman is still low saturated fat. To me, he does not appear as 'virile' or sexy as Volek or other true Paleo people. Volek on the otherhand has nearly got the whole picture, but is lacto-Paleo. Good luck.


Dr. B G said...

Thank you Dr. T! I think you are perfect and super!

steve said...

yes, got some plaque. am going to check out the thyroid. it is a recent increase and i think due to Niacin which severly drys out my skin. Trgs are only 29, and i take fish oil of 2tbs per day(carlson brand). HDL was 54 before Niacin. Carbs:i do not count them. No grains(except some ground flax) and absolutely no sugar, flour. Weight: 145-148 and no weight loss. Meat i eat if red is grass fed, chickens organic. Carbs only leafy greens, veggies, avocado and only oil if olive. No store bought salad. Four readings of Blood glucose over time has never been more than 87 and only this high since Niacin; pre-Niacin under 80. Supplements: D3(measured at 62), magnesium, CoQ10, and Centrum over 50 multi. Am on TYP by the way. Will check out books you suggest. Just read one by Stephen Sinatra and Dr. Grundy. Familiar with those? Am told i look no where near my age of nearly 59, so go figure! Thanks; you provide very interesting insights and I like your edgy challenging way! Spunk is attractive!

David said...

How much saturated fat do you eat, Steve? I think G is on to something with the statin preventing the large lipoproteins in your case, but also, I've noticed with my own clients that even if certain correct paleo principles are followed, the lipoproteins don't really start shifting dramatically until larger amounts of SFAs are eaten.

Also (and this is a small matter), your testosterone isn't really great. It's at 52% of the range ((640 - 250)/(1000 - 250)*100), which might be okay, but in my book it's not optimal until it's in the upper third of the range.

steve said...

I neglected to say that the eczema i have is atopic kind. Have it since birth, but only gotten bad recently.

i exercise and lift weights. thanks again

Anonymous said...


Dr. Davis has not railed against Slo-Niacin. If you read his blog, it is the type of niacin he actually recommends the most. He has railed against the older "slow release" formulations (12 or more hours to release) which shouldn't be confused with Slo-Niacin which releases over 6-8 hours..which makes it an "extended release" formulation. Niaspan and Enduracin also are considered extended release formulations. As for G's suggestion of cutting the tablets in half, I would be concerned that depending on the formulation, this might cause it to be released faster then the 6-8 hours which would mean more flushing.. :(

Dr. J, I haven't tried it yet, but I was told that getting a water filter on your shower head can help with dry skin. I believe excess chlorine can make the skin dry.

Dr G., I know you aren't a statin fan and nor am I, but what is your opinion on statin use for people with FHC like myself? Pre-statin, pre-niacin, pre-D3, not overweight and better than average American diet (but not Paleo or even Mediterranean) but taking 2,400mg of EPA/DHA (LEF brand) here were my NMR results from 3 years ago (age 37):

LDL-P: 3,645
Small LDL-P: 2,492
Large LDL-P: 1,154
LDL-C (calculated): 318
HDL-C: 26
Triglycerides: 133 (prior to fish oil, Tris were as high as 432 in the past)
Total Cholesterol: 371
LDL particle size: 20.6
Large HDL-P: 4.7
Large VLDL-P: 0.2
Medium VLDL-P: 0.0
Small VLDL-P: 128.7
IDL-P: 0
Large HDL-P: 4.7
Medium HDL-P: 0.0
Small HDL-P: 14.4
lp(a): 6 (from 3.5 years ago actually)

Surprisingly, a heart scan at that time was: 0,0,0. I was expecting to have a high score.. I did have one small pixel of calcium near that aorta, but I am hoping that with my much better lipids plus taking D3 & K2 that bit of calcium will be gone or at least not gotten any worse.

After those results, my physician who specializes in treating people with lipid disorders kept my n3s the same put me on 1g of Niaspan (but I take Enduracin instead..he he), 2,000IU of D3 (which has since been increased), 10mg of Zetia & 10mg of Crestor (I know...I warned me about proteinuria before but my Dr. swears up and down that is not class specific to Crestor).

Any thought you could offer would be most appreciated.

John M.

Dr. B G said...

Hey Steve,

Thanks for the compliments!

Honestly, I don't read many 'reveral' books because they are all bunk. Even Superko... though I respect all the NMR research and promotion of using this technology. If anyone actually got heart disease reversal correct (in addition to Dr. Davis), then wouldn't we hear about it? Wouldn't it be on the news? Oprah? No, all we have is Oz pimping resveratrol for everything. On cardiologist sites like, Dr. Blanchet in Colorado and some of us from TYP are apparently the only ones that 'kinda get it'. IMHO the cardiologists at Pharma-funded sites like that are are not unlike Sinatra, Ornish, Pritikin and Superko... conventional low fat drug pushers. The U.S. death rate for CAD is 200% more than 20 yrs ago. Are these cardiologists correct? Is it working? I don't think so.

I believe you'll find Hyman more applicable than the whole stack of books you currently have! David likes Dr. McCleary's Brain Trust as well. I need to read it too! The Brain Trust would help anyone with autoimmune, low HDL, small LDL predominance and/or Lp(a) issues.

'Cholesterol buffering' -- the more dietary cholesterol you get, the more downregulation of LDL esp the small stuff. Same with dietary saturated fats.

Consider reading this:

Are you sure you consume enough (as David mentioned)?

Fruit? Even a lick of fruit will screw the metabolic machinery and raise insulin. Fructose may not raise the blood glucoses sometimes, but it increases insulin. When you read the above article, then it will be realized why fruit raises small LDL.

Why is the eczema worsening? niacin? Are you getting enough vitamin A and E from meat, eggs, which again only come from fatty sources of food?

Again the HDL increase is phenomenol 50%! Way better than the HATS trial participants! The LDLs should have correspondingly improved and shifted to Pattern 'A'. A couple things you might want to consider:
--unhappy immune system (eczema, allergies) do what Hyman advises including fixing the hormones
--no carbs, ketosis
--higher dietary saturated fats
--no statin
--more omega-3 flaxseed oil and EPA DHA 7-8 g/day for inflammation (read also OmegaRx Zone by Sears)

Another book I really like is Broda Barnes MD who treated Hypothyroidism for half of a century without even advanced lab testing. He advised a 'Paleo like' high saturated fat diet that was near-ketotic for hypothyroidism. I find that fascinating. Saturated fats 'reset' membrane potentials and cell-to-cell signalling. This improves thyroid function. (omega-6 fats on the other hand are toxic and reduce thyroid hormone activity; these obviously should be minimized in the diet).


Dr. B G said...


Have you read this link that Chris from Conditioning Research put up?
Precious Testicles

What kind of interventions do you advise to get the T up? The article is so funny -- they talk about the 'stress' and pregnenolone steal that occurs. Of course, this is presuming people have not completely calcified their adrenals and/or eat low cholesterol.

I've been referring men and women to a practitioner for hormone balancing. She prescribes a customized blend for topical application. I can't overstate how immensely helpful it has been for people.

You are probably already aware that hormones control Lp(a) -- all of them.


Dr. B G said...


Do you have premature CAD events in your family? That extremely low HDL is ominous. Some FHC have no events. I dunno why -- better genetics for HDL or antioxidant capacity that neutralize the potentially higher small LDL?

About 5% of heartscans of zero can turn out for hard clinical events due to soft (unmeasurable) uncalcified plaque. It is good you are adhering to an anti-inflammatory diet and supplements.

Crestor + zetia -- no studies showing reducing in events yet, esp in FHC that I am aware of.

Elevated Trigs -- though you are young like me, you probably have a jacked up pancreas and insulin resistance to boot.

Consider the high HIGH benefits of a lower carb diet to control insulin, apo B and small LDL. Ketosis, intermittent fasting and long low-intensive cardio would be a great benefit for you. Getting body fat down and lean muscle mass up has HUGE benefits as well for the lipoprotein pattern (high Trig, high small LDL) you report.

Zetia has no clinical trials showing improvement (only cancer, SEAS and ENHANCE) because it increases the population of small particles. Zetia very effectively blocks absorption of dietary cholesterol -- wtf -- we need cholesterol. Cholesterol is not the 'problem' in FHC. FHC is overproduction and overexpression of apo B (content of Trigs and LDL) due to EXQUISITE sensitivity to dietary carbohydrates, exercise, etc. A deficiency of dietary saturated fats makes it worse. It is not unlike Lp(a). When low fat or low sat fat diets are sub'd for habitual diets, Lp(a) increases/worsens and HDLs go down.

The Trigs are now < 150-180. Crestor can actually start preventing the large LDL formation according to several trials. On the other hand, very LOW low carb, mod-high saturated fat diets lower small LDL in only 4-6wks and invokes shifts to Pattern A.

Let me know how it goes!


David said...


lol-- funny article. I hadn't seen it yet.

I think the topical creams are fantastic for correcting hormones. I very much recommend it.

I do some hormone consultations in a supportive role, and have seen some great results. I'll tell you one of the most interesting ones here, lately. A woman came to see me who had highly elevated testosterone levels (oddly, her insulin levels were excellent). I told her she might try drinking a couple cups of spearmint tea every day. Three weeks later she retested and the number had dropped 40%. All with some really tasty tea (iced, with a little stevia). She's also starting on some saw palmetto, which is one of the best things ever to reduce T levels in women.

For low testosterone, I think topical bio-identical replacement is great, and I of course suggest this. But there are other suggestions from a few other angles, as well.

Exercise-- especially high intensity exercise, working large muscle groups. Squats are fantastic. Multi-joint exercise is a must. This maximizes the hormone response.

Zinc-- This seems to help, as zinc is required for T synthesis. Where do we find a lot of zinc? Oysters, pork, beef, chicken. Yeah, all the foods we should be eating anyway.

Nettle-- If you have too much SHBG, then free T is going to be low. Nettle binds up SHBG, allowing free T to increase.

Chyrsin-- It's helpful to have estrogens checked as well. Oftentimes, if there's too much aromatase activity, an excess of testosterone gets converted to estrogen. This results in low T and high estrogen (and usually decreased insulin sensitivity, as well). Chrysin seems to be a pretty effective aromatase inhibitor, or at least I've seen pretty decent results with it.


steve said...

Dr Bg: Thanks again. I take two tablespoons of Carlson per day: Trigs are 29. Also take 2-5 tablespoons of ground flax. Add flax oil? Have been taking them in a Jay Robb shake with some strawberries several times per week for brkfst; otherwise brkfst is eggs with leftover green veggies. Lunch is salad with turkey avocado,egg on days i don't have them in am(sometimes not at all). Dinner: green veggies or cauliflower, with some salad and only use olive oil; red meat(grass fed) 2x per week and fish or organic chicken rest of week. If have to go out: fish snack: 99% dark chocolate or undutched cocoa with xylitol. sometimes red wine(may cut it out due to histamine).
Crp: .4 to.6 so i can't believe there is much inflamation. Yes, i think the Niacin is a real issue for the skin and affect Thyroid. I have stopped it. When taking it(since June '09) always have to take bably aspirin. What do you think of the diet? Not sure i can do much more, but appreciate your feedback. Note: I am only male in my family(brother,father, paternal grandfather) all had coronary events. I work to avoid that. I know you are against statins,but it may have to be the way to go to get small particles down. I know you are a fan of Krauss, but even in his studies, 100% do not shift from small LDL to large LDL. Just as you say about regression i think applies to small dense moving to large fluffy. I have to believe there is a genetic component in which case need to get LDL as low as possible. I have tried pre-statin and was unable to do so. I have the diet(except for berries sometimes in am) tight as i can get it. Oh, take metamuceil.

lightcan said...

Dear G,
I just received my blood results and I need to ask a question related to hypothyroidism and LDL. It seems I have low T3 measured for the first time (I can't compare with baseline) but my LDL has doubled in a year from 148 to 319. I'm doing low carb/paleo with a bit of dairy for a year now and I was hoping that my lipids had improved. HDL, TG, vit D, hba1c are ok. TSH 2.1 T4 15 (bad conversion obviously) Do you think with supplementation LDL is going to go down? It's a bit scary to see such a change.

Dr. B G said...


CRP is not indicative of chronic inflammation (unless you have sinusitis or other severe allergy) eg related to 'leaky gut' or arterial calcifications. Where did you get that idea?

You diet sounds devoid of saturated fats. You probably don't even get in the AHA stupid 10%! That would be the bare minimum. David is correct. You will not shift lipoproteins unless dietary saturated fats hits 12-20% (or even higher). When you stop the niacin, you may see the small LDL and HDLs worsen. Consider the strategies I discussed upstream and hitting some coconut oil.

Have you tried logging in to to analyze your diet? Or try to get the grams sat fat and carbs breakdown? Unfortunately that sight offers no reliable info on grassfed beef or goat -- so the sat fat and n-3 n-6 pufas will be incorrect.


Dr. B G said...


Chrysin is funny stuff isn't it? Can you tell who will be the good responders? Hard to tell how screwed up people's desaturases and P450 steroid pathways are. I'm getting better at predicting biomarkers, but I think it is an art that will take a lifetime to master!

Nettle! HOW COOL! Never thought of that one. Spearmint tea! Very interesting -- spearmint relaxes smooth muscle as well, including the esphogeal sphincter which can trigger GERD/heartburn for susceptible people. Your clients are very lucky!!!


Dr. B G said...


What happened?

Are you mentally stressed?

Did you get the cortisol assessed as well? Low or high cortisol can affect hypothyroidism. Do you see a good anti-aging practitioner who can do salivary testing and hormone balancing (including thyroid replacement)?

In the mean time, you may want to consider going lower carb and strategies to support good stress reduction (sleep? R&R?, vacation?), thyroid support and insulin-sensitizing supplements.


lightcan said...

Dr. B.G.
thanks for responding. I got really worried. Yes, I'm stressed but not more than before, this year I've been even less so because I didn't work and from a feeling of everything is bad I went to whopee I'm losing weight. I lost 30 kg and I got back to my weight of 7 years ago before I conceived my first child. And I'm going to bed earlier. But the Ph.D. that I have to finish is always there at the back of my mind (the guilt, feeling a failure surely kills you slowly). Yes cortisol would be high, I'm always irritable, get angry/upset easily.
Well, I only went to the GP. I don't know where to find an anti-ageing hormone expert in Dublin.
Lower carb I can do. That means more animal fat, doesn't it, and cut the veg and fruit even lower? Related to stress reduction I'll try to control myself, go for a walk on my own, do relaxation for 20 min, go to bed before 11. Could you be more precise regarding the thyroid support and insulin-sensitizing supplements? Is there a website that you can recommend?
Thanks again. I was hoping you can put me on your list of people with great lipids, but it seems not.:|

Anonymous said...


Thanks for the response. And yes, my Father had untreated FHC and passed away of sudden MI at the age of 43. My older brother had a MI at age 42 as well.

I am familiar with soft plaque and it does concern me. That is why I seek to further improve my lipoproteins. I think one thing that has helped me is that I don't seem to have lp(a).

Yes, I know my HDLs were low and that has always concerned me. Here are my best test results (from 1 year ago) since I began the Crestor, Zetia & ER Niacin regimen almost 3 years ago:

LDL-P: 1,200
Small LDL-P: 369
Large LDL-P: 831
LDL-C (calc.): 103
HDL-C: 48
Trig.: 103
Total Chol.: 222
LDL particle size: 22.0
Large HDL-P: 9.0
Large VLDL-P: 0.8
Medium VLDL-P: 29.7
Small VLDL-P: 34.2
IDL-P: 0
Large HDL-P: 9.0
Medium HDL-P: 0.6
Small HDL-P: 23.2
lp(a): ?

Surprisingly, my diet hadn't changed much and I actually had put on some weight, so I was surprised in the big drop in small LDLs. Go figure..

As for Zetia preventing the absorption of cholesterol, I figure since I do have FHC, perhaps it isn't a bad thing to prevent absorption of dietary cholesterol which might be oxidized from cooking and instead let my body make most of it internally (which is where most of us get our cholesterol from anyways..). Here is an article that talks about oxidized cholesterol from cooked foods:

Speaking of Zetia, do you know if it interferes with the absorption of vitamin D3? I know D3 is made from cholesterol and as such has a similar structure.

Anonymous said...


As for exercise, I have a sedentary desk job, but I currently go to the gym 2-3 times a week and do heavy resistance training (compound exercises mostly). My Doctor wants to me to go on the treadmill 6 times a week for 30 minutes a session @ 3.5 miles per hour. I have done that in the past, but I prefer the weight lifting instead.

I think I might fit into the "skinny fat" category of people that Dr. Davis talks about. I am 5'-10-1/2" and I currently weigh about 180 lbs. You can see my upper ribs and even my back ribs when I stretch, but I do have this stubborn abdominal fat. My pants size is 33" (up from 28" in high school). I know I would probably benefit from increasing my SFAs and going paleo or lacto-paleo but I've been a wussy about implementing those changes. It also doesn't help matters that I'm a picky eater and I don't like to cook unless it's boiling water or nuking something. Do you know of any websites that have Paleo diet tips/recipes for lazy men on the run?

I went out and bought a digital thermometer that is supposedly accurate within 1/10th of a degree. I did some morning oral temp readings recently and here's what I came up with:

96.83, 96.51, 96.23, 96.38, 96.52, 96.39 and 96.79

These readings are less then the 97.3-97.8 degrees Dr. Davis mentions and also what I've read about elsewhere. I also have a cold intolerance compared to my friends it seems. I've been taking a multivitamin that has 150mcg of iodine for years, but now I am considering higher doses of Iodine (daily doses of 500mcg to perhaps as high as 12.5mg temporarily). If things don't improve, I would then consider some thyroid testing. I never had a complete thyroid panel done but I have had my TSH tested in the past and it was 2.711 one time and 2.075 another time.

My serum testosterone was low (322ng/dl) when I had it tested 3.5 years ago, but I am hoping that with the heavy resistance training it has since improved. As for going to a T Doctor, I really don't want to do that and start having to apply creams/patches, get injections or have T pellets shot in my butt. Plus, male pattern baldness runs in my family and because I still have most of my hair (some very minor thinning), I don't want to risk losing any more.

Any ways, I will end this here but I do appreciate you letting myself and other readers of your blog pick your brain. Keep up your great work!


John M.

Peter said...

Dr BG-
I noticed you mentioned high doses of Niacin, 3 to 4 grams. I am taking 2 grams daily in a single dose, immediate release. Would there be a benefit in doubling this up? I switched from slo niacin because my HDL was only at 39 after a year of use. After doing the fast release for a while, I barely get a rash, even when I don't take an aspirin the same time. One seems to build up a tolerance.

You might try oral dose coconut oil for your skin problems. My son had this and we tried a bunch of stuff. nothing worked. He took a shot of coconut oil (probably about 10-15 grams). Skin problems gone the next day. takes it for a while then quits. The problem then comes back. He does the coconut oil again, next day the skin problems are gone. This has now happened at least 5-6 times, so I am sure it is the coconut oil.

steve said...

Dr.BG: Read the Sears book. He is low fat, and thinks sat fat is inflammatory. Interesting how so many who you like for some of their other recommendations persist with a cautionary view if not avoidance of saturated fat. Now on to Hyman book.
Peter: Thanks for the recommendation on coconut oil. How old is your son? He swallows straight coconut oil? Am i getting that right? Is a shot= to 1 or 2 tablespoons?
Is his eczema of the atopic kind?

Dr. B G said...


Hang in there GRRLL! Things will get brighter soon and you will feel your old self again! Congratulations with the weight loss (I hope it was intentional).

Have you considered reading Hyman's Ultramind -- all the info is in there including resources for practitioners. I don't know if he includes international providers? He is not particularly low carb -- therefore consider modification of his 'plan' by finding a low carb book to supplement like Protein Power or TNT Diet. These are excellent health resources as well.

Insulin sensitizing supplements that I like are (which of course work better with exercise and yoga, relaxation techniques):
--alpha lipoic acid
--flavanoids like green tea extract and pycnogenol
--high high dose fish oil
--MCT oil

Fruit is overrated. We get the same fiber, nutrients and minerals from non-starchy veggies without an insulin spike. Insulin worsens thyroid function, cholesterol and our abilities to cope with stess.

Good luck!


Dr. B G said...

Hey John,

Did we last talk about Enduracin, MMPs and Crestor at Heart Ciphers? Like... a million years ago?? That is funny.

Slo-niacin is a scored tablet -- the matrix is a polygel release and fine to tablet-split.

You are not a wuss -- you will beat the odds stacked against your family history in this day and age of toxic food choices at every turn and step and a world full of pollution and pesticides that ruin little thyroid glands. No easy survival task for you. Of course I have totally faith you are successfully working toward that.

All do-able. You sound like you already work out quite a bit -- the last few pounds of body fat won't be hard.

However, being hypothyroid does make everything an uphill battle (both ways *haa*). Low T is hard to resolve without sufficient stimulus -- I do believe that chronic low-intensity cardio does have a role. This kind of physical activity retrains sedentary and atrophic muscles and switches off the hormones leading to excessive estrogen (MOOBy side effects) and improves insulin resistance. Consider listening to your doc!

On the other hand, is he/she aware that Zetia has had TERRIBLE results in clinical human studies, eg in the ENHANCE trial which was conducted in a participants with FHC? It was observed advancement in CIMT increased in only the Zetia arm -- not statistically significant but the amount was quite a big deal. The SEAS was also particularly sad news (not).

Like all low HDL situations, saturated fat raises HDL, HDL2, or HDL2b in every study I read, no matter what apo E form or type of cholesterolemia. How can that be explained? In fact, the higher the dietary content, the higher the HDL or HDL2 increase.

I'm not aware of zetia blocking vitamin D... however D3 is a cholesterol structure. Who knows?

Those improvements are fantastic:
--doubling in Large HDL2
--reduced sdLDL
--reduced %-sdLDL from 50% to only about 30%

Keep up the strong work! I'd love to hear your progress later and what works out for you!


Dr. B G said...


My goodness you are a fast reader! Which Sears book did you tackle first?

I like the OMEGA Rx ZONE the best.

Sears is now apparently converted to 'Paleo' -- Robb heard him talk recently.

Sears' older books still discussed a BUNCH of grains and carbo's. His ratio of 40% carbs is WAY WAY too much for insulin resistant and hyperinsulinemia folks. That would give me diabetes.

Thanks for the report back.


David said...

"Read the Sears book. He is low fat, and thinks sat fat is inflammatory."

Sears has always kind of harped on the whole Arachidonic Acid thing as a basis for the saturated fat/inflammation connection (if I remember right-- it's been a long time since I read his stuff), but I think that whole idea - at least in the context of a low-carb diet - has proven to be a bust. Check out this abstract of a study by Volek et al.:

In the context of low-carb, those with the highest AA had the least amount of inflammation. It takes oxygen for AA to degrade, and since low-carb creates less oxidative stress, the AA doesn't break down and get all wicked.

Cool beans.

lightcan said...

Thank you. You're the best. Not only did you listen but you tried to help too. I'm here worrying about huge LDL levels that nobody has ever seen before, my doctor wants me on high dose statin and nobody cares about my thyroid. I even read that low thyroid in pregnancy causes low IQ in their babies and now I worry for my son who is 4.
Anyway, I'm grateful for your suggestions. I hope I can come back in a while with great news across the board.

steve said...

i read only the one you recommended, Omega Rx. His website says fill your plate with 1/3 protein, rest veggies and fruit or veggies only. He is still with lean protein, sat fat minimization. Hyman book UltraMind is on wait at library; it obviously is in demand, probably due to his having been on PBS.

Anonymous said...

Hi G,

Yes we did have a discussion about Crestor at Heart Ciphers blog about a year or so ago. You warned about proteinuria back then. Good memory! I don't recall discussing MMPs in that instance however..

And actually my small LDLs went from 68% to 30%. I eat too many carbs but my goal is to reduce the carbs and incorporate more SFAs & MUFAs and less n6s in my diet.

I think you are correct that low T is hard to resolve without sufficient stimulus. I haven't had a girlfriend in longer then I care to admit, so I am sure the lack of "stimulus" has lowered the T! lol

Are MOOBys man boobs? lol My chest is muscular (can do 325lbs+. on the seated dip machine) so luckily no man boobies.

My Doctor is aware of the ENHANCE trial but he thinks the difference is not statistically significant like you mentioned. I think he'd rather have me on zetia and a lower dose statin then no zetia and a higher dose statin. I will however bust his chops about SEAS trial (after I read it myself) the next time I see him.

I enjoy your blog and keep up the good work!

~John M.

steve said...

David: Your memory is correct. Sears hits Arachodonic acid/inflammation hard. Sat fat creates more of it he says.

Dr.G: Everyone i know, including me has bowel issues when go to low(20/30grams) on the carbs. Any suggestions? Milk of Magnesia capsules, Psyllium(metamuceil). And if going so low carb causes these bowel issues, going to low carb over a long term period may not be so wise.

David said...


AA seems to only be "bad" when it excessively breaks down (degrades) into things like prostaglandin E2 or leukotriene b4. This doesn't happen to the same degree in a low-carb setting, but it can happen under other dietary conditions. I wonder if Sears is simply extrapolating the observations of the inflammatory cascade with higher carb diets to a low-carb diet simply because it has the common theme of saturated fat? The study by Volek seems to clearly contradict the idea that high AA necessarily leads to inflammation.

I was at the book store tonight, and sat down for awhile with Sears' recent book, "Toxic Fat." For all the disagreements I might have with him, I found that he really had a lot of very good things to say, and it was hard to put down. Very engaging read.

Also, Steve, I know your question about bowel problems was addressed to G, but I'll throw in my two cents as well. When you say you're having trouble, I'm guessing that you're constipated. Certainly this is not a problem everyone has, and I know several people whose bowel issues are improved on a low-carb diet. But many, like yourself, don't do well -- at least at first. Dr. Wolfgang Lutz noticed that it sometimes took adults a couple months to adjust to a lower carb intake before the bowels would function normally again. In the meantime, he recommended enemas to get them through the tough times.

I frequently recommend magnesium for this problem. Specifically, I recommend magnesium oxide, as this is a poorly absorbed form that will stay mostly in the gut, drawing water in by osmosis (it's nice and cheap, too). I'd take 500 mg twice a day -- morning and evening -- giving it a couple days to work before adjusting the dose from there. If you get diarrhea, of course back off the dose. If you're still not going after two or three days or so, hike up the dose a bit. Maybe 500 mg in the morning and 1,000 mg at night. Adjust the dose accordingly after that. I've found magnesium to be super effective for this problem, even with some people who had tried "everything else." It works through physics (osmosis), not so much through chemistry, so at some point something's gotta give!

David said...

BTW, I don't really recommend magnesium oxide indefinitely, but just as a temporary assistance until the bowels can do their own thing.

lightcan said...


so, taking Magnesium citrate 200 mg every evening long term is not recommended? On low carb I too have those 'problems'. I was wondering why the water seems to be absorbed in the colon more than it should. I try to keep well hydrated. (just trying to figure it out, I'm not convinced by the fibre+water formula)
Would magnesium oxide not increase the free radicals when it breaks down? This would make it a poorer form of magnesium, wouldn't it?
Too much citric acid is not good either, is it? (The majority of cheaper multivitamins have magnesium oxide in them, but not a lot of it)
Thank you.

David said...

I don't have a problem with taking magnesium long-term - in fact I think a good case can be made for robust magnesium supplementation. Magnesium citrate should be fine for this purpose, along with other chelated forms like magnesium chloride.

Magnesium oxide isn't really a great form to be taking as a long term nutritional supplement because it's so poorly absorbed (4% absorption by some estimates, though some say as high as 30%). Also, there are some digestive side effects reported with long-term (high-dose) use, and there's also some concern about enteroliths in the colon (though these are really rare). I've observed a lot of people taking reasonable amounts of magnesium oxide and have never seen any significant side effects (other than temporary diarrhea or some stomach upset), but I still think it's wise to recommend it with caution.

I'm not convinced that fiber is the answer, either. Fiber damages the intestinal epithelial cells, causing them to form mucus as a defense mechanism, which of course helps things along in getting carried out. That's why fiber "works," and I'm not sure that overloading your guts with the stuff is a great idea day after day.

Another idea that people frequently miss-- Eat. More. Fat. This often resolves constipation on a low-carb diet. People sometimes end up eating a bunch of protein and then forget about getting enough fat.

lightcan said...

Thank you, I was thinking about that, maybe I should eat more fat. My body seems to want it too. I was thinking all day about mascarpone.;)

Dr. B G said...


RE: AA -- our bodies make it when the steroid pathways are 'off', omega-6 excess in cell membranes, insufficient omega-3, excessive carbs, excessive endogenous insulin production, insulin resistance, hypothyroidism, etc.

Yes AA is found in some foods (like corn fed beef and milk/cheese products) but usually these are foods that are low in omega-3 and high in omega-6 as well, which I personally would avoid.


You ROCK -- great explanations!


Boy we've been around the blogosphere awhile. We should all do a potluck. *haaa* Paleo style. Glad to hear no MOOBies... *wink*


I have laid awake in my bed worrying the EXACT SAME THINGS -- how much I've toxified my kids and their DNA with what I ate, transfats, omega-6, and HUGE vitamin ADEK1K2 and omega-3 deficiencies.... And hypothyroidism during pregnancy!

What can we do? Just do our best honey!!