Saturday, October 10, 2009

Low Carb Paleo: Nothing's Impossible



Low Carb Paleo

Why is low carb Paleo the way to go for not just heart disease reversal, but also for maximum vitality, lifespan and longevity?

What is Paleo?
--no grains
--no legumes
--no sugar, candy
--(if strict: no dairy, no A1 casein (goat milk is A2 and generally acceptable)

The above are the greatest sources of carbohydrates which drive insulin and thus inflammation and elevated, toxic blood glucoses and dense small LDL. Fruit -- fruit is high carb and most of us on the 'bandwagon' are low carb and minimize ALL FRUIT because Paleolithically it rarely existed.

Saturated Fat -- even Dr. Loren Cordain is getting into saturated fatty acids...! Yes really.

Robb Wolf, his Paleo protege at our Crossfit network, mentioned it indirectly a few months ago and I alluded to it on our TYP forum. It is true. Read HERE with choice quotes from Don Metasz at his wonderful blog Primal Wisdom. Neither dietary cholesterol nor saturated fat are implicated in heart disease when the authors re-examined the literature. AAAAhhh... that is right on. Recall, Dr. Mozaffarian only found heart disease regression in the highest quintile of saturated fat intake > 12.0 %? And reduced progression in the quintile of the lowest carbohydrate intake?

Consensus. I like that.

Concordance among the critical thinkers... *haa* THINCers...

Here is a quote from Cordain et al...PDF click HERE Curr Treat Options Cardiovasc Med; 2009;11:289-301.




Low Carb, Mod-High Saturated Fat Paleo establishes all the metabolic parameters that Drs. Hecht and Davis support for optimum heart health:
--Lipoproteins dominated by buoyant large LDL particles, known as Pattern 'A' (versus 'B', for BBBBBAD)
--Regression of coronary calcification EBCT score with decrease in LDL-III (dense small LDL)
--Lowest Lp(a) values


Recall that Dr. Hecht (post: Cardio Controversies) compared a variety of lipoprotein factors with percentile rank of calcium scores. Again, total LDL made no difference at all. However if we look for patterns, one can observe a concentrated portion of high coronary calcifications around 140-160s and from his analyses, we know that the great majority of these are Pattern 'B' which are dominated with dense LDL. In the CAD patients, > 40-100% are typically dense small LDL particles. Our goal at TrackYourPlaque is to achieve < 10% or lower. We do see regression though even at < 30% so this is acceptable for some individuals who can improve the buoyant HDL2b substantially (like REALLY substantially).

Heart Disease LDL example (sdLDL = ~84 mg/dl):
Let's say that someone's LDL is 140 mg/dl.
Let's say it's solidly Pattern 'B' with 60% dense and small LDL. This is not unlike some of our subclinical atherosclerosis members (no event, no revascularization, no stent, no bypass graft). These are individuals with no symptoms who made the right decision to evaluate the coronary calcification status by having an EBCT or MDCT done. Easy -- 30 seconds -- hold the breath -- don't move. Low low radiation. DONE.

OK so how much is dense LDL? 60% of 140 is about 84 mg/dl. So on the graph above -- the L-sided red line is the actually dense small LDL. The R-sided red line is the 'total LDL'. The total LDL again does not mean a thing. The proportion of small v. large LDL is what matters and the context of HOW MUCH CORONARY CALCIFICATIONS exist to determine aggressiveness of treatment strategies (or not... since it is all controllable and reversible).

What about dense LDL created by eating low carb mod-high sat fat Paleo?

From several examples among my buddies on the blogosphere and at TYP and the seminal research on high sat fat diets of Krauss RM and Volek RS, we know that dense LDL can be controlled to... ZERO on NMR

Zero...'zero' LDL-3 on NMR, as reported by several Paleo folks at TrackYourPlaque on low carb mod-high fat Paleo, some in only 4 - 6 wks of diet implementation.

Or at most 5% (but who cares? it's less then Dr. Davis' ultimate goal 10%). Jimmy Moore's is 3%. (And, zero calcium in the coronaries -- Congrats again Jimmy! *wink* of course!)

So the 'paleo' dense LDL is orange on the graph.

Do you see it? On the FAR FAR FAR left side?


Paleo LDL example (sdLDL=~0 - 5 mg/dl):
Compared with 'non-low carb Paleo' 84 mg/dl dense small LDL. That's improvement of... infinity-times.

84 to zero.

What can be achieved by low carb, high sat Paleo?



Regression perchance...?

Complete ANNIHILATION and ERADICATION of coronary plaque...?!?


Seriously... other than avoidance of all AUTOIMMUNE diseases, congestive heart failure, DIABETES, DEMENTIA, cancer...
What can be achieved by low carb, high sat Paleo?

NOTHING IS IMPOSSIBLE (the bad*ss, brown-haired, beautOfaul broad-wide dental arches, Australian Merriweather, Last Skeptik remix, and losing his v-cherries at the V-Festival again)





Low Carb Paleo Controls Trigs and Raises HDLs

Other parameters also make a difference though these metabolic measures had less statistically related coefficients compared to Pattern B (particle size), Lp(a) and regression of coronary calcifications with reduction of LDL-III (dense LDL).

(a) Low Triglyerides (TG -- a reflection of our carb intake and insulin)

(b) High Total HDLs


Again... Paleo thrashes these metabolic parameters of heart disease. Without synthetic drugs. No statins. No fibrates. No zetia. No pletal.


Yes... again it controls Lp(a) as well. All Lp(a) is DANGEROUS when the 'death band' and low HDLs are present. Do you recall... butter and coconut oil beat the cr*pola out of canola oil and olive oil for reducing and controlling Lp(a)?


See prior animal pharm post for our wonderful TYP hall of famers and Paleo examples of PERFECT lipoproteins for PERFECT regression.



Low Carb Mod-High Sat Fat Paleo Raises HDLs OUT OF THE ROOF
In addition to all of the above metabolic parameters for control of atherosclerosis, HDLs are most stunningly and astoundingly improved. No drug can reach the height of these simple diet changes. Statins: -5 to 5% (this explains the utter lack of outcomes compared with regression trials with omega-3, niacin or vitamin D recall Cardio Controversies: Dr. Superko and his sumarai quote?). Fibrates: 5% (but they raise dense HDL-3 mostly). Zetia: 0-2% (again mostly HDL-3 and explains why all outcomes are negative and even worse than statin outcomes). Pletal: 0-3% (again HDL-3).

Our goal at TYP for HDLs is 60 mg/dl but obviously higher is not harmful if it is all the buoyant HDL-2 type which is associated with reductions in Trigs (see above) and dense LDL (see first diagram).

Never in my 10+ years pharmacological career have I ever heard of diet manipulations that substantially raise the heart- and cancer-protective HDLs until I found Paleo. *overwhelmed sigh* Yes -- sure niacin 30-50% (shift to 'A'). Yeahhh -- sure liquid GOLD that I treasure...fish oil 5-10% (generous shifting to 'A' and massive immeasurable immunomodulating anti-inflammatory benefits).

Low carb high sat fat Paleo: INCREASE BY 100-200%.

My HDLs nearly doubled (60s to 105 mg/dl with TYP + high fat Paleo, and probably higher now)

Most others report doubled or tripled total HDL values from baseline. See below examples and from the post: Part II Benefits of High-Saturated Fat Diets.

Is it really that easy?
--raise HDLs
--lower dense small LDL
--shift to Pattern A from BBBBAD
--feel more energetic, vibrant, younger with maximum vitality



N-O-T-H-I-N-G is impossible.



Summary of my favorite low carb high fat Paleo stories:

Dr. Richard Bernstein MD, Type 1 DM, 70-ish years old, no diabetic complications, low carb, high saturated fat lacto-Paleo: Triglycerides–50; LDL–53; HDL–118; and LDL subparticles - Type A.

Mr. Jimmy Moore (ultimate low carb high sat fat lacto-Paleo): Pattern A, small dense LDL 3%, HDL 60s, EBCT calcium score ZERO (percentile rank, big PHAT Z-E-R-O). Family heart disease risk: HIGH.

Mr. Richard Nikoley, the low carb high sat fat Paleo King: TC 223 (6/2008: 219) TG (57) HDL 133 (106) Real LDL 66 Calc LDL (104)

Mr. Stephan Guyenet (high sat fat semi-Paleo) TC 252 TG 49 HDL 111 Calc LDL-131 (wrong, but who cares)

Mr. Scott Miller (BF 9% -- low carb high sat fat Paleo TC 223 TG 51 HDL 98 (baseline: HDL 38-ish and BF 26%) Calc-LDL 125 Lp(a) 2

Ms. Anne (Paleo and grain-free) TC 255 TG 36 HDL 93 Calc-LDL 154

Mrs. Anna (Against the Grain blog GRRRLL! ) TC 230 (2007, still transitioning to sat fat/grain-free) TG 59 HDL 72 (from 60's) Calc LDL 146
EBCT calcium score ZERO (percentile rank, big PHAT Z-E-R-O)

My Labs (on coconut oil, low carb mod-high sat fat Paleo, [25OHD]=50 ng/ml) TC 249 TG 68 (TGs 30s when no drug adverse effects) HDL 105 Real LDL 125 Calc-LDL 130 Lp(a) 2



Dr. Bernstein: Why the Low Carb Diet is Best

Dr. Bernstein is a wonderful educator, researcher, and physician. My respect for him and his brilliant work could never be overstated. His lipoproteins also R-O-C-K.

Why the Low Carb Diet is Best (click HERE link)

Part 4 of a 5 part feature

Richard Bernstein, MD, FACE, FACN, FCCWS Apr 24, 2007

Dr. Bernstein's latest book, Diabetes Solution, 3rd Edition, was published in March 2007 by Hachette Book Group, USA. His prior book, Diabetes Diet, was published in 2005 by Little Brown and Co.

When I developed diabetes in 1946, physicians thought that the high illness and death rate of diabetics was due to dietary fat and the supposedly resultant elevation of serum
cholesterol. Since the DCCT trial, the scientific literature overwhelmingly supports the role of elevated blood sugar in all long-term diabetic complications.

Yet even today, many physicians ignore the need for normal blood sugars and focus on dietary fat. The 2006 Clinical Practice Recommendations (1) of the ADA advocate large amounts of dietary
carbohydrate (45 - 65% of total calories) and small amounts of protein and fat. This recommendation is preceded by the statement that "dietary carbohydrate is the major contributor to postprandial (after meal) glucose concentration."

The high carbohydrate load is justified by the claim that "the brain and central nervous system have an absolute requirement for glucose as an energy source." This statement, while only partially correct (ketones from stored fat keep the brain alive during starvation), ignores the fact that in the absence of dietary carbohydrate, the liver, intestines, and kidneys convert dietary protein into as much glucose as the brain requires.


Virtually the entire evolution of mankind occurred when our ancestors were hunter-gatherers, well before the inventions of agriculture and animal husbandry. (2) These people had scarcely any access to dietary carbohydrate and certainly no access to animal milk, cereal grains, whole-grain and refined breads, refined sugars, and sweet fruits. They ate almost exclusively lean meat and fish, plus small amounts of leafy and other
low carbohydrate vegetables. Some humans, such as Eskimos, consumed only fat and protein. Our pre-agriculture ancestors frequently had violent deaths, but no coronary, kidney, or arterial disease, no tooth decay, and no diabetes.

By 1969, when I first began to measure my own blood sugars, I was already suffering from about 15 major and minor long-term complications of diabetes, thanks to the
low fat, high carbohydrate diet I had been following for 23 years. By about this time, scientific studies of animals had demonstrated the prevention and even reversal of many diabetic complications by blood sugar normalization.

I soon discovered that even multiple daily
insulin injections (basal/bolus dosing) would not achieve anything close to steady normal blood sugars. It was not until I lowered my carbohydrate consumption to a daily total of 30 grams (mostly from leafy and cruciferous vegetables) that things fell into place. Today my A1c is 4.5% (normal is 4.2-4.6%), and my target blood sugar is 83 mg/dl (about mid-normal for young non-diabetic adults).
Most of my long-term complications, including advanced kidney disease and severe
gastroparesis, have normalized. Those that involved irreversible muscle loss (droopy eyelids, intrinsic minus feet (diabetic foot)) have not gotten worse. My lipid profile, which had been grossly abnormal, now shows: Triglycerides–50; LDL–53; HDL–118; and LDL subparticles - Type A. I see similar results in others who follow a prehistoric diet like my own (except for some type 1's with severe gastroparesis).

Until very recently, researchers were not comparing the effects of low carbohydrate diets to the ADA low fat/low protein diet. Recent results consistently support low carbohydrate, high protein¬ diets–not only for blood sugar control, but also with regard to
weight loss and cardiac risk. Many of these studies are posted on the Web site of the Nutrition and Metabolism Society, at nutritionandmetabolism.com.

I am not alone. Thousands of type 1 and
type 2 diabetics are following very low carbohydrate diets. Many observe that both fat and protein bring about satiety, while carbohydrate leaves them hungry and craving more carbohydrate. Other studies have focused on the importance of dietary protein for prevention of bone loss (4) and for preventing blood pressure elevation (5).

Richard K. Bernstein, M.D.,F.A.C.E., F.A.C.N., F.C.C.W.S. Mamaroneck, NY 10543

References:
1. Amer Diabetes Assoc Clinical Practice Recommendations, Diabetes Care, Vol 29 Suppl 1, Jan 2006, p. 513.
2. Cordain et al, Origins and Evolution of the Western Diet: Health Implications for the 21st Century, Amer J Clin Nutr; 81:341-54, 2005.
3. Science, 307:840, Feb 2005.
4. Bonjour J-P, Dietary Protein: An Essential Nutrient Factor for Bone Health, Jnl. Amer. Coll. Nutrition 24:6, 5265-5365, 2005.
5. Obarzanek et al, Dietary Protein and Blood Pressure, JAMA 275:20, 1598-1603, May 1996.

60 comments:

O Primitivo said...

Dr. B.G., THANKS for such an amazing series of posts demistifying saturated fat intake. PALEO ROOOOCKS! Here is a small "provocative" article I wrote: "The reason the Paleodiet is NOT a Low-Carb diet" - http://forums.lowcarber.org/showpost.php?s=5106be8c0ef0f540e286eef695e6f71e&p=7723562&postcount=30

epistemocrat said...

Nice, Dr. BG.

I like Dr. Bernstein's self-experimental narrative. Fun to read his personal mythological evolution away from conventional wisdom. He cured himself.

Physician, heal thyself.

And listen to music.

Cheers,

Brent

Anonymous said...

Dr B.G. Your blog is fantastic. Everything is so detailed and well presented. Thanks

I am Paleo, But I have one weekness. I have a large fruit orchard. How much friut is too much? What limits should I place on myself so I insure I get the positive benefits in small ldl, high hdl etc...

Dr. B G said...

O Primitivo!

Thanks for you generous compliments and comments! In this modern neolithic age, there is not where to go but to regress to our paleolithic roots! Dr. Davis actually go me originally turned on to it with the TrackYourPlaque interview with DR. Loren Cordain. He has been a fan since the 1970s (I was just born *haa*).

OK -- I though fruit with the citric acid and other acids was 'acidic', no?

I don't understand the alkaline v. acidic load of foods AT ALL so your provocative article is WAY way over my head! Sorry! Also, even vinegar though acidic when consumed actually reacts and is more alkaline, is that not true? I nearly FLUNKED physical chemistry if it were not for my friend who was in the same lab session and I've known since grade school, who is now an EP cardiologist... (and eats steak frequent -- though at Cal he ate Twinkies too *yikes!*).

Then what also about omega-3 and saturated fatty acids -- are they neutral? Do they alkalinize perhaps?

Glucose is acidic. So fructose and fruit... would lead me to believe these foods are mostly highly acidic. No? High glucose levels promotes metabolic (diabetic) acidosis.

Fruits that might be exceptions are olives, coconut and guava (they are also considered 'anti-inflammatory'). Figs? Dates? Maybe too?

I would LOVE to hear more of your thoughts on this! :)

-G

Dr. B G said...

Mr. Pottenger,

You like the song??! omg it's soooo GOOD. Talent so young all around me... *wink*

Thank you for your kind comments -- hey I am a fan of BIL PIL now. Looking forward to some enticing activity and forward thinking conversations! Maybe I'll go out and support and hear your talk! You are from an extreme lineage of critical thinkers... I have WAP's book under my bed still relishing and finishing...

Exactly as you say... Dr. Bernstein did it. He failed to get good care for his Type 1 condition and he himself attended med school in order to heal himself.

With Paleo -- we are ALL healing ourselves:
--my asthma (vitamin D)
--my obesity 50 lbs overweight
--my extreme sarcopenia
--my SAD moodiness (though my husband begs to differ *haa*)
--my broken hamstrings (PT stretches, yoga, and Xfit keep them STRONG now)

Speaking of Bernstein and Type 1, Mr. Living Dangerously... is a HUGE fan of Berstein's now, carrying his book where every he goes and trying to talk to his friends and acquaintenances he meets to share how health can be optimized. He is now reporting having feeling and sensations return to his hands which were bilaterally numb for the last few decades from diabetic-related glucose toxicity. Just like Bernstein's reversal with very low low carb and high saturated fat diet.

NOTHING IS IMPOSSIBLE.

Bernstein's HDL 118.

F*Q!!! Paleo R O C K S!

I learn this everyday.

-G

Nick W said...

Dr. B.G.,

Another great post, it always feels like my head's gonna explode (in a good way!) when I read your blog. Keep it coming!! I feel far less guilty about my can-a-day coconut milk habit and the 4-dozen eggs (cooked in butter) I pack away each week after reading your sat-fat evangelising!

O Primitivo's comment above (or rather, the linked post) got me thinking about this, because I don't eat a huge amount of plant matter at the moment. But the acid-base thing is a bit of a worry I must admit.

So anyway, I thought I'd test out to see if O Primitivo's assertion is correct - that you basically cannot have a net-alkaline load and eat low carb. I looked at the acidic foods I eat in a typical day:

- 6 eggs
- 3 rashers bacon
- 200g roast chicken breast
- 200g steak
- Some almonds

This lot will come to a PRAL of approx 85.

So how much carbs would you need to eat to balance this with alkaline food? I did a bit of playing with the USDA Nutrition Database and worked out the PRAL-per-gram-carbohydrate value of foods, and found out that cooked bamboo shoots stack up pretty nicely - getting a PRAL of -85 would only require that you eat about 16g-worth of carbs from bamboo shoots. So this proves that - theoretically - the paleo diet can be a VLCD (<20g carbs) and still give acid-base balance. Woo hoo!

Unfortunately, those 16g of carbs would come from about 800g of bamboo shoots! I'm not a panda, so I had a look at other options, and found that something like a pound of leaves (spinach, chard, kale etc.) and a couple of avocados would give you about a -85 for around 35g carbs. Not mega-low-carb, but not bad really - and that sounds reasonably manageable. I certainly think that if you hammered the leaves as your main veggie at dinner, and went with a large salad for lunch, you could get somewhere near an acid-base balance without blowing the carb-piggy-bank.

Not really sure what the point of that was, other than to add yet more weight to what my mother used to tell me - "eat your greens". But I wasted 15 minutes looking it up so thought I might as well post it somewhere!

By the way Dr BG, I fired an email through to you a couple of weeks ago - you mentioned you had some articles for me about T1D. Did the mail land? Not trying to sound impatient, just wondered if it'd got there.

Cheers,
Nick.

O Primitivo said...

Hi Dr. B.G.!

My idea was just to demonstrate that a Paleolithic Diet, with 25% energy from Protein and a net zero or even alkaline PRAL (which means PRAL<0), necessarily needs more than 33% of energy from carbs (vegetables/fruits). This translates to approx. 160 gr of PALEO carbs/day for a 1920 kcal diet! So alkaline PALEO can't be LOW-CARB at the same time! According to my calculations, a neutral or slightly alkaline diet requires at least 1kg of vegetables for each 375gr of meat/fish. This is why soup is VERY important, because you can't eat 1kg of raw vegetables/day! ALKALIZING SOUP! I once made a graph ilustrating all possible diets according to PRAL. Here it is: http://www.canibaisereis.com/wp-content/uploads/tiposdedietas.gif This is in portuguese, but you get the idea. PRAL=-30 is alkaline, PRAL=+40 is acidic. PRAL=0 is neutral. X-axis stands for CARBS (alkalizing, as long as they are vegetables & fruits; NOT "healthy" whole grains or sugar!). Y-axis is PROTEIN (acidic load, being fish & meat). Lipids are neutral, they're irrelevant for PRAL. Some translations: "Cetonica" = Ketogenic; "Alcalina"=Alkaline; "Acida"=Acidic; "Hiperproteica"=High-protein; "Low-Carb"=yeah, you gessed: Low-Carb! Please also notice those lines L=100gr and L=200gr. They refer to the amount of fat, which is constant over those lines. I consider low-fat (ARGHGGG!) to be below 100gr. Hope this helps!;)

------------------------------
"Acid/Base Balance - After digestion, absorption, and metabolism, nearly all foods release either acid or bicarbonate (base) into the systemic circulation (...) Fish, meat, poultry, eggs, cheese, milk, and cereal grains are net acid producing, whereas fresh fruits, vegetables, tubers, roots, and nuts are net-base producing. Legumes yield near-zero mean acid values, reflecting an overlapping distribu-tion from slightly net acid producing to slightly net-base producing (..,) Energy-dense, nutrient-poor foods, such as separated fats and refined sugars, that contribute neither to the acid nor base load. Additionally, salt (NaCl) is net acid producing because of the chloride ion."

Some references: "Acid-Base Balance and Your Health" - http://www.thepaleodiet.com/nutritional_tools/acid.shtml

"Estimation of the net acid load of the diet of ancestral preagricultural Homosapiens and their hominid ancestors" - http://www.ajcn.org/cgi/reprint/76/6/1308.pdf

"Implications of Plio-Pleistocene Hominin Diets for Modern Humans", pages 375-376 - http://www.thepaleodiet.com/articles/2006_Oxford.pdf

Peter said...

"even Dr. Loren Cordain is getting in to saturated fatty acids"

THAT is cool.

Peter

Dr. B G said...

Yeah... sometimes the proteges influence the mentors... *haa*

I love LIFE. Like a box of full fat chocolates...

Dr. B G said...

Nick!!

I profusely apologize -- you've been on my thoughts!

Just sent off a slew of PDFs to you. Take your time digesting. I've got more 4u!

WOWOW!! Great calculations! (I have no idear what ur talkin about *haaa* Speak ENGLISH j/k that's probably what you think of all the cardiospeak).

Bamboo shoots are great -- pandas and the people in Taiwan where my parets grew up totally eat that stuff all day. I need to learn how to make them more. They soak up a lot of flavor and are like negative 'calories' like celery.

-G

Dr. B G said...

Anonymous,

Orchard!! That is difficult!

I go by the metabolic chaos represented in my common diabetic individuals. One banana on average causes blood glucoses to spike to 200-400s depending on the individual. I can't imagine their insulin levels (200s? 300s? insane).

The beginning of any good Paleo diet has an 'induction' phase which causes body fat loss and recomposition (esp when combined with some low intensity cardio and resistance training).

This is the 'ketotic' zero-carb phases typically. Then after 1-2 mos, individuals add back in 20grams per week until weight loss halts and stops. Then one needs to back off 20grams. That is the maintenance 'dose' of carbs that are enough to maintain current fat/adipose stores based on the energy demands and lean mass at that moment in time. Things shift -- so as one gains more lean mass -- actually energy requirements will go up -- but it can be done with just fat and protein as well.

We are very good at making glucose from fats and protein (via gluconeogenesis in the liver).

This ketoadaption takes 1-3 mos for most people. It sucks... working out is a little hard. For those however who have NEVER worked out, they don't notice :) *haa* But after the conversion to more efficient energy sources, energy is boundless and unlimited compared to glucose/fruit supplies (which often 'crash' right?).

Hope that helps...
-G

Dr. B G said...

O Primitivo,

That is an AWESOME graph!! In fact your whole website is kick*ss, DA BOMB.

I think you are on the right track... do you recall the Paleo diet from UCSF researchers that came out Feb this year (e pub 2008)? Overwt men reduced insulin, glucoses, weight and blood pressures on a high carb, high fruit juice, mayo Paleo diet (no grains, no dairy, no legumes).

A pronounced changes was increased potassium and higher alkalinity. I was surprised with all the carbs and fruit/juice included in the diet. Shows how acidic cereal grains are and perhaps the chelating effects of the phytic acid in grains and legumes. And how veggies can reset acidity balance.

What about exercise? Though exercise may produce more acidity, as a byproduct of exercise we also product our own antioxidants and IL-10 for rebuilding. Maybe the mitochondria become more 'efficient' with the protons on the electron chain transport units? More alkalinity over time? With more conditioning, HIIT and bursts of sprints, etc? And then ketones -- low glucose, high ketones -- isn't that alkaline (beta-OH-KB). OH is alkaline, right? (I'm sorry, my P-chem rots).

I wonder if the alkalinity is an issue for all phenotypes? I suspect the apo E4 types like Pima Indians and many northern Europeans do not 'require' vegetables or fruit. In fact, one study I reviewed showed apo E4 carriers may not even be 'equipped' to uptake beta carotene from veggies. Carotenoids from fats and protein animal sources may be the 'optimal' sources for apo E4. Low low carb is essential and life-determining for apo E4 types, the most carb-sensitive and insulin resistant folks alive. Any lick of carbs, floods and SPIKES of LDL both buoyant large and dense small LDL. Perhaps storing visceral fat was more critical for survival for these types. Maybe acidic blood is normal for these phenotypes who thrive on low carb (Paleo or not)? Perhaps some adaptation has occurred already?

I'm sorry I have more questions for you...!!

-G

O Primitivo said...

Just a note about the PRAL calculation: I considered that the average PRAL of fish/meat would be +0.08 mEq/gr and that of vegetables/fruits would be -0.03 mEq/gr. These values are in agreement with the average PRAL values of food groups in the Remer & Manz database (see page 795 - http://www.direct-ms.org/pdf/nutritionGeneral/Remer%20and%20Manz%20Acid%20Base.pdf).

So, if you consider that, on average terms, meat/fish is 20% Protein and that vegetables/fruit are 10% carbs, the PRAL of eating mostly PALEO meat/fish and vegetables/fruit will be approximately:

PRAL(mEq) = +0.08*(PROTEIN(gr)/0.20)-0.03*(CARBS(gr)/0.10) = 0.4*PROTEIN(gr)-0.3*CARBS(gr)

For a NEUTRAL diet PRAL must be 0 or negative. This equates to 4*PROTEIN(gr)<=3*CARBS(gr).

So, if you're eating 120 gr of Protein/day (600 gr of meat/fish), you'll need to eat at least 160 gr of Carbs (1600 gr of vegetables/fruit; yes, almost 2 kg/day!) to make your diet's renal load neutral/alkaline.

O Primitivo said...

Dr. B.G., thansk for the comments regarding my website. You make a lot of important questions, and very technical too. I would love to be able to answer them, but I'm afraid I can't. I don't even remember that study:(

Dr. B G said...

O hear it is! Do you need the PDF?

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.
Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A.
Eur J Clin Nutr. 2009 Aug;63(8):947-55. Epub 2009 Feb 11.

Many people have talked about but not he acid-base aspect yet! (Stephan, Mark Sisson, Dr. Eades and even Lyle) Would love to hear your thoughts!! :)

Anonymous said...

Dr B.G., Thanks for bad news! I guess I can give my fruit away(mostly figs) or workout like crazy so I can eat more carbs.

I have to do something because I am cursed with high Lp(a). I have been doing loose variants of the Paleo Diet for 10 Years. Before that I was on a low fat high carb diet.(A disaster that forced my HDL down.) I have always wondered what the correct levels of carbs and saturated fats are that can fine tune my situation. In 1999/2000 I did two Berkley heart lab studies and changed from high carb to a loose Paleo diet, added wine and walked 2-3 miles per day. HDL2b skyrocketed and Total LDL and Triglicerides declined but small LDL and LP(a) inceased slightly (I was always type A and stayed this way).
Overall I was better of. I was on a low saturated fat Paleo as advocaed by Cordain with some grains added and modest amount of fruit. Overtime I eased up on the diet and excercise and my weight increased as LDL rose and HDL fell.

Three months ago I went on a strict Paleo program.
I have lost 30 lbs and am starting to feel and look better. I hope with the help of this site and other research that I can make improvments over my original results in 2000.

thanks

Dr. B G said...

Anonymous,

WOW -- you have made so many changes already! That is incredible weight loss you've reported! FANTASTIC and many congratulations!

Fruit... yeah that is probably the continued cause of the small dense LDL on lipoprotein subfractionation.

Boy -- you are QUITE ADVANCED doing that testing so many years ago! How about a heartscan?

I was telling Robb 9mos after going gluten-free about adding saturated fats. I had been already low carb for awhile (that was how I lost 50 lbs -- at one I was running or working out daily 60-120min and NOT losing body fat; was not until cut out ALL rice, fruit and cranberry juice, then the weight really came off). Eating meat, some half n half (which I've 95% given up now), cheese, etc I had thought that I was truly getting in enough saturated fats, but I was completely wrong. Adding in just 1-2 Tbs of coconut oil daily seriously made the biggest difference for the lipoproteins.

My patients have noticed the same thing. Some won't add fats, so I make them buy NOW MCT oil (tasteless, great stuff) and take 1-3 Tbs dep on their fat-depleted diet. I've seen Lp(a) drop from 50s to 15 in 4wks with that stuff. HDLs increase 50s-60s to 70s. HDL2b increases.

Egg yolks? Do you get enough? Buy the best quality free-range, omega-3 have about 10x more lutein and other carotenoids and nutrients compared to 'organic' (which is a TOTALLY deceptive misnomer... the chickens get 'organic' corn or grains).

Drop the fruit! :) You will see UNPRECEDENTED improvements and actually lose body fat even faster!

Thank goodness for great people like Robb. Basically, for the most optimal results, one has to start counting ALL carbs -- including even ketchup. Every bite does count. Then... POUND SOME FATS. *aaaahha*. Ck the labs in 4wks -- it only takes 4 wks for results.

Looking forward to hearing your future progress!

-G

shel said...

vindication!

i've been eating a high fat paleo diet since '07.

calorie ratio carbs/fat/protein 6/20/74.

never felt better, never going back. thanks for the positive message, Dr B!

epistemocrat said...

Dr. BG,

Ironically, I speak at BIL:PIL on Halloween at 4:30 PM as the closing speaker--the day that we celebrate our collective sugar mythology. Would love to have you come; if not, we need to meet up sometime soon.

Yes, bueno song (para la salud)--good Rx of multifractals--and thanks for the *wink*. Appreciate.

Thanks for sharing your 'heal thyself' achievements--quite remarkable and warming, indeed. Nothing is impossible with the right supportive platform to unleash our potentials to thrive.

Glad to hear Mr. Living Dangerously is doing great public health work with Bernstein's book. That's the momentum we so desperately need.

Best,

Brent

Anonymous said...

Thanks for all of these good ideas. I had a calcium scan about 8years ago and was told by the cardiologist that it looked great. But I never could get a copy of the test report.

It's interesting that you mention coconut oil, because coconut is one of my favorate things. about once a month I drink the juice form a young coconut and scoop out the meat. I also love the coconut meat from older coconuts. Until I read your blog I have rationed my coconut, but now I will try eating more coconut. Speaking of coconut, I would like to hear your interpretation on what lessons can be learned from Stefan Lindburgs work in Kitava. The Kitavians ate lots of coconut, high carbs from fruit, yams and Taro root. At first glance there lipid chemistry looked unremarkable and yet they seemed to be free of heart problems. How can we explain these contradictions?

Regarding eggs, we are on the same wavelength here I have secured a local source of eggs that are raised from chickens that are pastured for at least part of there day and diet. I am thinking of raising chickens in my orchard.

Recently, I have also found a local source of grass fed beef.

Finally, In the last 2 weeks I have reached my perfect weight and have added in more fruit and nuts and my weight is stable. I am amazed at how much I am able to get away with eating.

I would like to figure all of this out but its so dificult, expensive and unpleasant to do the amount of blood testing after changing each variable that is involved. One day they will have an easy,cheap and painless way to check all of this. Then we all get it right on!

Dr. B G said...

Shel!

That is awesome!

When food is nutrient dense (e.g., no or low carbs) then the actually intake of foods is LESS overall and more efficiently metabolized. Chemical bonds are not wasted. Your 20% fat is still probably higher on the absolute gram basis than most Americans on the S.A.D. high calorie (b/c never satiated or full or content) 35% fat/12-14% sat fat diet. No confusion for the energetic pathways.

AWESOME.

-G

Dr. B G said...

Brent,

WOW -- BIP PIL is lucky to have you speaking!!! You will have such a great time in San Diego; I'm so JEALOUS. I want to get a rundown of the highlights later babe :) I'll give you a ring definitely when I see my parents in Sac-town... 29th hangin w/ da MiLFs late LATE and of course 31st is booked with the kids...

-G

Dr. B G said...

Anonymous,

The Kitavans are not the enigma everyone thinks. Coconut oil promotes ketosis despite high carbs. They moved around daily -- foraging, fishing, building houses, etc. Sweating all day in the New Guinea heat. I believe they have plaque but no one dies from it (even smoking and high HgbA1c's glucoses). They have nice WAPF-y facial structure and likely high vitamin ADEK levels.

No grains or legumes.

High omega-3, no omega-6.

Good thyroid function and OPTIMAL in utero health.

Many of the women are kinda 'chunky' in my personal opinion and who cares? Their internal metabolic c-a-l-m ROCKS THE ISLANDS.

Dancing, music... inherent to their culture :) Key to optimal living!!

-G

shel said...

sorry, typo...

carbs 6, protein 20, fat 74.

Dr. B G said...

Shel,

Then OOPS. You appear to be on similar proportions as the 'Optimal' diet as advocated by Dr. Kawsniewski! That's quite optimal imho...

-G

Treatment Shop said...

Thank you for sharing this. Looking forward for more of your update soon.

shel said...

Dr B~

yeah, you could say an Optimal diet implementing paleo principles.

my calories are very "clean" though. i eat mainly raw (incl. one cup of raw fatty meat per day, as well as cooked... gads! once you start eating raw, beautiful, unoxidized animal fat, you'll realise what you've been missing (heh)). i'm not averse to some cooking though.

Kwasniewski is ok with too much non-paleo stuff, imo. i limit eggs, really limit dairy, and don't do sausages and stuff.

i think as little oxidized fat and cholesterol as possible is very important. like i said, get the nerve, and try some raw grassfed back fat (beef, lamb etc). you'll be hooked. ;)

Dr. B G said...

Shel,

R u kidding?? I love nothing more than BLOODLY rare dripping meat... My husband can't stand it :)

We had bison very very RARE at Yellowstone... omg I died and went to heaven.

We frequently have thinly sliced lamb (New Zealand!! YUMMM) hot pot and I like to minimally 'rinse' the meat in the pot... with some raw egg of course (Taiwane style) in a Satay sauce will krill (high in n-3).

Love bacon semi-rare. Though trichinosis is rare in the U.S. I try not to take TOO many chances...

I agree about the oxidized oils -- omega-6 are the worse -- sitting on the store shelves, they are ALL oxidized already.

-G

O Primitivo said...

Dr. B.G., regarding the Frasseto Paleo Study ("Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet"), one of the very positive results was the "significant reductions in BP associated with better arterial distensibility". I made a few PRAL-Potential Renal Acil Load calculations (http://www.canibaisereis.com/download/pral.pdf) and estimated that the usual diet's PRAL in that study was +24.5 mEq (acidic) and that the Paleo PRAL was -67.0 mEq (alkaline). I'm not quite sure my sodium and cloride PRAL caculations are correct, because most PRAL calculations I've seen discard Na and Cl. I assumed Cl=1.5*Na. Anyway, there was an obvious shift from an Acid to an Alkaline diet, as well as a reduction of plasma insulin. I only know of one (very recent - published just 3 days ago) study linking an alkaline PRAL to lower BP: "Diet-dependent net acid load and risk of incident hypertension in United States women." - http://hyper.ahajournals.org/cgi/reprint/54/4/751.pdf Their conclusion was that "a higher diet-dependent net acid load is independently associated with an increased risk of incident hypertension." This association remained significant after controlling for dietary factors such as sodium, magnesium, calcium, folate, protein and potassium. Also, in the Frassetto study, the K/Na ratio improved from only 0.44 (usual diet) to 3.61 (paleo) and this was certainly very positive for the BP and arterial distensibility improvements. I like the graph in page 6, showing a positive (causal?) association between daily urinary K excretion (an index of dietary poassium intake) and improved arterial cross-sectional area. There is a discussion in Free The Animal's blog regarding BP (http://freetheanimal.com/2009/09/hows-your-blood-pressure.html) where it is said that the K/Na ratio regulates the amount of intracellular calcium, which in excess inside cells leads to blood vessel constriction and increased BP. It is also said that high insulin leads to higher BP. So both higher K/Na ratio and lower insulin levels should help achieving a lower, healthier BP. According to Dr. Loren Cordain, 3 dietary factors are primarily responsible for the modern unhealthy Na/K dietary ratio, which is greater than 1 (2.28 in the Frassetto Study): 90% of the sodium in western diets comes from manufactured salt (NaCl), it is not obtained from natural foods; vegetable oils and refined sugars make up 36% of modern energy intake and they are devoid of potassium; less vegetables/fruits and more whole grains/milk products further reduce potassium, because potassium in vegetables are 4 and 12 times higher than in milk and whole grains, respectively, whereas in fruits the potassium concentration is 2 and 5 times higher than in milk and whole grains. All this shift from our original Paleo Diet promote a net acid-load (PRAL>0) that contributes to bone demineralization, calcium kidney stones, age-related muscle wasting, hypertension, stroke, asthma, etc. Regarding these issues, please also see "Implications of Plio-Pleistocene Hominin Diets for Modern Humans", pages 375-376 - http://www.thepaleodiet.com/articles/2006_Oxford.pdf The Frasseto study was a very short term and small study, but there is no doubt PALEO WORKS! At leat it did for the last 2.4 million years, why not adopting that same POWERFUL template for today's health?

Dr. B G said...

Thanks O Primitivo! What a drop in the acidity after Paleo! Thank you very much for the clarification and your sights!!

As you mentioned the shifting in Na/K ratios affects calcium intracellularly. Calcium from dairy I think is problematic...

Calcium is a HUGE and powerful signalling molecule. Also it is what made us human... top of the food chain! Collagen, bony skeletal structure and nervous system conduction are all related to calcium...

What do you think of Cordain's article about MEAT and acid-base (only briefly brings up)?

Cordain L, Eaton SB, Brand Miller J, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: Meat based, yet non-atherogenic. Eur J Clin Nutr 2002; 56 (suppl 1):S42-S52.

http://thepaleodiet.com/articles/Meat%20Paradox%20Final.pdf

So saturated fat is just as 'neutral' as MUFA right? The trad'l H-G Inuit diet included 23% saturated fats (high HDLs, low dense LDL, low TGs).

Though n-6 PUFA may be 'neutral', I think downstream effects are probably not so neutral:
--increasing insulin
--increasing adipose storage
--increase BP
--increasing blood glucoses
--increasing arachidonic acid cascades and ruining the n-6:n-3 ratio
--increasing inflammation
--bone deossification

Cordain in the article published in 2002 cites Krauss' work and the benefits of a meat-based diet for the Greenland Inuit (diet 23% sat fat; 37% fat, 26% carb, 26% protein) and no CAD. n-3 PUFA intake: 13.7 grams daily (!!) and n-6 PUFA 5.4g/day. Cordain doesn't quite wrap his head yet around the acid-base or sat fat in the publication.

-G

David said...

Regarding the whole acid/base thing, I think you can definitely do very low carb without a problem. I'm surprised no one has linked Stephan's old post on this: http://wholehealthsource.blogspot.com/2008/10/acid-base-balance.html

i.e. If you're getting the right minerals and "activators" (vit ADK2 - from animal products!), the acid/base issue becomes a non-issue.

Being that "high-acid" diets didn't produce the diseases of civilization in traditional cultures, the acid/base theory is effectively falsified as it is usually promoted and defined. It may make sense within a certain context, but that context does not NECESSARILY include very low carb diets.

Dr. B G said...

David,

Oh YOU are WONDERFUL!

How could we forget that classic post (like my favorite Seinfield episodes)! And Miguel cited all of Frasetto's articles.

That's why I love Weston A. Price...

And Whole Health SOURCE... Dr. Stephan G!!

-G

Anonymous said...

Dr. B.G.,
I am an runner who has, I believe, made the ketoadaption you mentioned in your comments. On long runs up to 20 miles I no longer fuel up with carbs; in fact, I rarely eat before those runs, and the runs have gone very well. But what about runs longer than 20 miles? Runners are told, carbs before, during and after your run. If not carbs on really long runs, then what and why?

Dr. B G said...

Hey Runner,

Are you noticing improved speeds? Power? Better recoveries? Improved intensity even?

UCD professor Phinney has discussed using ketones for athletics but the issue of endurance events leads me to believe it is not all sorted out.

http://www.nutritionandmetabolism.com/content/1/1/2

I believe one of the Tour de France teams went Paleo but they still consumed rice (which is non-gluten).

Personally if the intensity is high for extended periods like marathons or other elite events, then it is probably more important to refuel (e.g. prevent bonking). Otherwise for low - mod intensity events (long duration), it's absolutely not necessary after adaptation I feel. With that said, it is debatable how healthy chronic, grueling, extended duration elite events are 'healthy'. The increase in inflammatory markers, CRP, IL-1, IL-6, TNF-alpha, etc imho aren't worth it...

-G

Anonymous said...

Dr. B.G.,
I would say that my runs are more comfortable and recovery is improved after keto-adaptation. I agree, that I need to refuel, especially for 50K and 50 mile events, beyond replenishing fluids. The question for me is which fuel to use. If I use carbs, doesn't that shut down, at least temporarily, my body's ability to get fuel from fat cells? If my intensity is moderate enough, maybe I don't really have to refuel since I have enough fat stores and all I have to do is prevent dehydration and loss of salts? Don't know because I haven't tried. Or should I try to consume foods high in fat?

Dr. B G said...

Hi,

That is great feedback you are seeing!

I haven't read about longer duration events at moderate v. high intensity. I believe you surmise correctly -- I think humans (like other predators) have metabolic machinery for long LONG durations of physical activity at low and moderate intensity < 50-60% max heart rate using only fat stores (both subcutaneous, visceral and intramuscular). At that intensity I suspect that we even have the abilities to replenish glycogen easily with fat and protein. (fat preferred of course but even glucose if 'snacks' are consumed as you mentioned).

Personally I feel having a little glycogen replenishment from rice or fruit after a long workout (like 2-6 hrs low to mod intensity) is good and I feel better. Is it necessary? Probably not. Maybe because I'm a girl? I don't know :) Let me know what you try and what you find works!! I'll be very curious to know!

-G

Anonymous said...

Dr. BG,
I want thank you for your blog. I check in often although some of the science goes over my head at times- I get the the idea though.

I'm a endurance runner who has made a drastic change in the last 12 months from high carb low fat to very low carb paleo diet in order to try and lower my ( as my wife would say ) super high cholesterol. I know from reading your blog that "high" isn't bad- it's the LDL's and the HDL's the make up of the LDL's.

Pre paloe my TC was 260 with HDL's in the 60's and my Dr was warning me. So I tried goingg paleo for the last 8 months. I just got my results back and my TC has gone super high. Should I be concerned? My TC is now 383. My TG's are 61, and my HDL's are 105. What the heck happened to my LDL's??? I wouldn't think they wouuld go up so high? Should I spend the money and get the extra test to see what type of LDL's I have? Or not worry about it? And does the occasional beer and red wine have anything to do with this? I am so confused. Other than the cholesterol stats I feel great. My body fat is in the <10% range and my training is going much better on the diet. Thoughts?
Thanks
Mike B

Dr. B G said...

Hi Mike B,

I take it that both the TGs and HDLs improved? HDLs went out the freaking ROOF (from 60s to 105 mg/dl)!! Took 8mos but WOW you did it!

The TGs are still hanging around 60s. That could be a little problematic because it may be associated with the presence of some residual small dense LDL particles.

The only way to know would be a $99 VAP test or similar lipoprotein fractionation lab test. If you have a positive heart scan, premature family history of events or want some reassurance, I would strongly consider advanced lipoprotein testing and then serially tracking. Clearly, the labs are in Pattern 'A' and definitely improved.

Some people make more LDL and some apparently the count reduces on Paleo/Primal. I suspect the apo E4 folks make more LDL (apo E2, less).

What does it mean? Well nothing, as long as the densest, most lethal particles don't exist.

For some individuals this may take 6-18mos to convert out of. Others, only 4wks. I think it also depends on our hormone status, energy demands, body fat recompositioning, etc.

I wish I could say don't worry. But again it depends on family history, whether plaque is present and how jacked up your body was before (high BPs? borderline blood glucoses? high inflammatory state? mental stress? frequent infections?)...

Hope that helps!
G

O Primitivo said...

(part 1/2) - Dear Dr. B.G., I love your questions because they are sooo difficult to answer;) About Dr. Cordain's article "The paradoxical nature of hunter-gatherer diets: Meat based, yet non-atherogenic", I don't know what is the paradox. Meat should be atherogenic, why? Because of saturated fat? Stearic acid has a neutral effect on blood lipids (http://www.beefnutrition.org/uDocs/stearic_acid_fs_r1.pdf). But can we trust blood lipids at all? For me, besides the sedentary lifestyle of Civilization, that promotes obesity, hypertension and vitamin D deficiency, the great poisons that promote CVD are ALL sugars, and these include simple carbs, fructose, HFCS, etc. If it makes your insulin and tryglicerides go high, then it a realy GOOD poison! Just keep eating it frequently and in a few years you're diabetic or your arteries will be intoxicated by sugar. I suppose this is also called Atherosclerosis? Diabetics are 3 or 5 times at higher risk for heart disease than most people. Is this just a mere concidence or not? High glucose, elevated HbA1C destroy your arteries! I know this may sound a bit heretic but what is so wonderful about the Mediterranean diet? Well, I'm portuguese and I know this better than anyone. "Mediterranean" is just a fancy name for HIGH FAT, HYPERLIPID, LOWER-CARB! All hyperlipid countries in the world have low cardiovascular mortality. Why? Because while they're eating those unhealthy FATS, they are not eating the “healthy” whole grains and all other forms of sugar of the Food Pyramid. France is not a paradox! Because the 2nd most hyperlipid country in the world, also has low CVD. And also the 3rd, and so on. See this graph: http://www.canibaisereis.com/download/fatintake- cardiomortality.gif Not a strong association but the trend is obvious. If you look at the data, you'll notice that the TOP 10 lower cardiovascular mortality countries in the World are also in the world TOP 16 high fat countries. Another coincide, a tremendous paradox? For me, the amount of fat comes first, and its quality in second place. A pure coincidence, a mere epidemiological association? I have an article about this, do you read some portuguese?;) - http://www.canibaisereis.com/2009/04/10/mortalidade-cardiovascular-europeia/ Let's say eating high sugar is even WORST than eating lots of corn oil. I know most people disagree with all this. A lot of this data is available from this article: http://eurheartj.oxfordjournals.org/cgi/reprint/ehm604v1.pdf I don't want to write a lot more here because this is supposed to be just a brief commentary, not a full article. But as many low-carbers know, the official low-fat diet will only make you gain fat easier, make your lipids oxidised, and this is the "paradox" for those who don't understand nutrition: MEAT or SATURATED FATS are not the poison, we allways ate these, whatever their effect on blood lipids. Low saturated fats allways failed to reduce CVD in controled studies. They’re HEALTHY! The poisons are NEW FOODS, like whole grains, high sugar/fructose intake, newly introduced, highly poliunsaturated “healthy” vegetable oils, etc.

O Primitivo said...

part 2/2 - I also would like to make clear that I believe LDL is a completelly untrustable parameter to predict heart disease. Yeah, another totally herectic idea. I’m putting myself in the fire now!;) Let me explain this with another of my epidemiological graphs. Please see this graph - http://www.canibaisereis.com/download/LDL-mortality-chart.pdf I created this one from data I used for my article about Total Cholesterol Mortality (http://www.canibaisereis.com/2009/09/19/low-cholesterol-certainly-not-healthy/) using the approximate relation LDL=0.0933*TC^1.3437, which is quite accurate and based on a large lipids database. So, total mortality is lower for LDL in range 120-150 mg/dl! What, really? Mortality is actually higher for LDL lower that 100 mg/dl? Also, the graph of cardiovascular mortality as a funcion of LDL isn't much different, it's also kind of U-shaped, with higher mortality for smaller LDL values. Yes, SMALLER! And lower cardio mortality for LDL above 120 mg/dl. I didn’t invent this data, it’s freely avaliable on-line, anyone can get it a do a simple XY graph. Another evidence is that people with CVD are CHOLESTEROL DEFICIENT, YES people hospitalized with heart disease have LOWER TC and LDL than the average person. Yeah, another paradox, an unsolved mistery? I recently wrote about this in the ImmInst - http://www.imminst.org/forum/How-to-improve-my-Cholesterol-levels-t33324.html Of course most people disagreed, but I presented my data and one argument was that high cholesterol (high LDL?) is a major cardiovascular risk factor but once you have the disease it is not anymore. What, is this real? Some people really do believe this? I've allways heard that once you have a CVD event you're at even higher risk for a second event, so high LDL should be a permanent risk marker. But it is not? And has it ever been a marker for anything? I know that saying LDL is useless as a risk marker (without studying its sub-fractions and the factors that promote it's atherogenic profile - sdLDL, oxLDL, etc.) is TOTALLY CONTRARY to what the “experts” say, its just an association, that epidemiology doesn't proves causation, bla, blah, etc., but anyway IT'S REALITY. It's one UNADJUSTED reality! Also, I know most "bad LDL cholesterol" ideas are based on statin drug studies, which do lower LDL but, as you know much better than me, at the same time also reduce inflammation and have a series of other beneficial effects that slightly result in reduced CVD. I say "slightly" because statins have quite low NNT (100 or even more - ). How do you sepparate the effects and say that lowering LDL is the way to go? Perhaps statins most unfavourable effect is (what an irony!) lowering LDL and TC, which causes higher risk for infections and parasitic diseases. One of my references on what concerns the bad science surrounding LDL is A. Colpo's article, http://www.jpands.org/vol10no3/colpo.pdf I know may people developed a lot of antibodies against this unpopular scientist, but he knows what he’s talking and I haven't seen anybody contradict his ideas with science. So, this was just to summarize that commenting on Dr. Cordain’s article on “atherogenic MEAT” is VERY difficult for me, because I became very skeptical about all these lipid markers after reading about all their incongruencies and the economical interests surrounding their use. I don’t really see how these classical lipid markers (TC and LDL) can be used to justify anything at all. Perhaps I’m being too skeptical, maybe I’ve read too many papers by Dr. Uffe Ravnskov;)).

O Primitivo said...

last part - Dr. B.G., don’t get me wrong: I think the work you're doing in this blog PHARM ANIMAL, totally dissecting the RELEVANT lipid particles and their importance in CVD, finding why and where they are atherogenic or not, is TOTALLY WONDERFUL!!! It is truly amazing and, at the same time, let me say, also very ironic, because you're doing a HUGE EFFORT just to prove one thing we already knew for the last 2.4 million years: PALEO FOODS, REAL FOODS by Mother Nature, will always be better than any other pseudo-FOOD or “miracle”-DRUG invented by Civilization! And they never caused CVD. New sugary foods certainly do! Any doubts about this?

Dr. B G said...

O Primitivo,

Put yourself in the fire?

OMG u r ON FIRE dude!!!! You're so haaaawwwtt!

I've actually mined your website for more ideas :) You mention also Michael Colgan PhD who I've recently fallen in love with his work. I will ck out the LDL curve you posted (you are VERY good with numbers and calculations). Reminds me of the J-litt and the new Marmot studies that Peter has posted on. Richard at Free the Animal just posted on a Korean study that found EXACTLY the same thing you discussed -- higher LDLs are for the long-living.

YES. We are all coming to the same concensus that it was never 'cholesterol' that killed people (cancer, heart attacks, etc).

But CARBOHYDRATES.

You have summarized everything absolutely exquisitely excellently. It is only CARBOHYDRATES that cause chronic conditions, esp the healthy-whole-MYTH-grains and fruit/fructose.

Unfortunately I don't read Portuguese :( What do you think of the Belgiums? Several studies cite their HIGH FAT, HIGH SATURATED FAT, LOW CARB diet (much like the Mediterreans) with their low cancer rates, low cardiac mortality and other longevity markers.

Thank you as always for all your insights and your amazing BLOG!

-G

David said...

G,

I like your idea in an above comment about suggesting MCT oil for those who won't add dietary fats. I don't know why I haven't thought of this for the "difficult" people (Kind of a "duh" moment right now). I promote MCT oil, sure, but never thought of suggesting it without really trying to push dietary fat intake to those who seem unwilling. I spend a lot of time trying to convince people that coconut oil, lard, butter, etc really are OKAY, but some just won't accept it. All the while, their HDLs/sdLDLs etc continue to suffer. MCT oil seems like a great alternative in these cases. Very non-threatening, and great for getting up those HDLs and such.

Speaking of HDL, I wonder if I got my vitamin D too high. Just ordered a test today to check. A couple of my fingers have been drying out and getting those little flaky/cracked spots on them. Hmm. And that makes me think of something else. I wonder if I'm getting enough vitamin A? I eat a fair amount of eggs, but hardly get any organ meats. With higher levels of vitamin D, I bet I need to be paying more attention to the vitamin A. I might start taking 10,000 IU or so to see what happens.

Sorry, just thinking out loud. :-P

David

Anonymous said...

DR. BG,

Maybe high Carb/low fat is OK for some people. On the Dr. Eadas website, he just posted a lecture with Chris Gardner of Stanford. http://www.proteinpower.com/drmike/

Gardner explains the difference beteen people who are insulin sensitive and insulin resistant and how they react to High Carb low fat vs low carb hi fat. I would like to hear your take on this. Is high carb OK for some people?

Dr. B G said...

Hey David!

Thank you also for your thoughts on fertility!

I read about the MCT oil in fact at Dr. Mike's blog when he was discussing some of the protocols by Dr. Larry McCleary. Pubmed has some great human trials with MCT oil! Yes -- it works. Obviously food and less refined food is better but MCT oil is safe, effective and studied even in children. The first application that I heard of was in the NICU in helping preemies -- reduced GI distress, diarrhea, improved body weight, etc. Again babies only survive/ thrive the first 2-4wks of life on ketones and colostrum. Premature infants -- they get neither (generally speaking).

I appreciate all your wonderful help and thoughts!!

Toxicity? Maybe?? I noticed the same when I tried to pound 100k to prevent a cold as an experiment. I suspect when we are vitamin D replete, probably chicken or beef bone stews may contain all the vitamin D that we need? Synergistically with the MK 4-9 (vitamin K2)? And the vitamin A!! And SLEEP SLEEP SLEEP!

Remember the scenes from Wanted (Angelina Jolie) when they would emerge from the 'restorative paraffin bath'? When I get sleep, good food and a handful of antioxidants... that's how I feel. BIONIC *haa*

-G

Dr. B G said...

Hey Anonymous,

I've wondered that too!!!!

Ya know Gardner kinda turned me off (like many narrow minded academians who think they know something). I recall that once Jimmy Moore wrote him and he returned the reply rather 'glibly' imho. Anyhow with the damage produced by in utero and decades of omega-6 (industrial beef, Wesso corn oil, margarine, fast food, etc), high fruit, HFCS, and healthy whole-FICTION grain damage, most Americans in my opinion lack insulin sensitivity.

And I am talking about children, adults and the elderly -- male female -- any race. I don't think anyone escapes this damage successfully. Vegetarians suffer too.

So high carb -- these individuals no doubt will have higher rates of Metabolic Syndrome and clinical diabetes sometime in the future -- studies support that.

Even elite athletes can exhibit reduced insulin sensitivity -- I have seen A1cs that are higher than Dr. Bernstein's (avg at the posted values at TYP are about 5.5% for athletes and non-atheletes -- sadly that is diabetic in my book).

I treat a lot of damaged diabetes individiuals. One disease I plan to prevent is diabetes (which makes me really P*SSED off for taking the birth control b/c I didn't KNOW about the diabetes risks associated and I am a stupid pharmacist).

So... I am sorry... no.

And we need FAT. Low fat s*cks. We cannot be beautiful, symmetrical, HAAAWWT human specimens without fat. It builds testosterone and all the other sex hormones that make us who we are to do what we are meant to do (live, survive, thrive):
http://drbganimalpharm.blogspot.com/2008/10/beautiful-things-sexyback.html

Volek, author of the high sat fat TNT diet, has testosterone (also he is a nationally ranked lifter).

-G

Anonymous said...

Mike B.

Awesome HDL Man. 105 for a male must be a record. Can you share
how much coconut oil you need to take to make that monster HDL.

When I do Endurance my TG is 51.
How high was your TG and HDL when your TC was 260?

Dr. BG.
This site is so coooooooool!

Anonymous said...

Dr,
Thank you for the speedy response on my crazy high cholesterol levels since moving to Paleo. To answer you questions, I've always been super healty and very fit. My BF levels have been in the 6-10% range for years all while eating high carb low fat. My BP is always been very low too. Probably becuase of my ultra endurance background. I will add though that I do have a family history of heart disease however I am the only one who doesn't drink in excess or smoke. And I do excercise a LOT as I mentioned. I will take your advice and have the extra tests done to see if I've got the large puffies or the bad stuff.

As a side note to you and another person that recently posted I have found no drop off in excercise performance since moving to Paleo. My recover is better and I find that I no longer get sick as much as I used to. My dental health is also better though that might be due to the fact that I'm not consuming lots of sugary sports drinks anymore. The only time that I do consume simple carbs is during my longer events and I wish that I could move away from that but they just go down easier during races.
Thanks again,
Mike B

David said...

Oh yeah, I remember when you took 100k of the D. If memory serves me, I think I might've had a part in that. Haha (Paleo peer pressure! "Come on, G. Take the D. Everybody's doin' it..."). I had taken like 150k per day for a few days when I had the flu, and it stopped it in its tracks. I'm guessing I was pretty deficient when I did that, because I didn't get any toxicity symptoms. AND, that was the last time I've been sick that I can remember. Probably wasn't the best idea for you since you already had adequate levels.

I've also read about MCT for babies (I think it was in Fife's coconut oil book?). You know, I was 3 MONTHS premature - I wonder if that's why I CRAVE ketosis now? HA.

I take K2, D, and vitamin E, but not vitamin A. I'm starting to think this has been a blind spot (no pun intended. haha) for me. I wish I could get these things from diet more easily, but I eat what I can afford, and supplement the rest. Hopefully I'm not too lopsided!

David

Anonymous said...

Anonymous,

I wish I could remember what my TG was when I was doing low fat high carb. I just remember the 260 TC and the HDL's in the 60's. I wish I could find the paperwork! I do consume a few tablespoons of Artisana Coconut butter every day along with lots of eggs, cashews, and all kinds of meats. So to answer your question I'm not sure what component helped turn my numbers around. I must admit though that I am concerned about the total number going up. As I mentioned earlier my endurance efforts have been so much better on this diet. I can go forever without bonking and I've even done some very long efforts in a fasted state with no drop off in performance.

Anonymous said...

Paleo diet is the best... Not everything Cordain have written though, but this WOE.

IT'S JUST INCREDIBLE HOW YOUR BODY REACTS!!!!

Have you notice it? your body actually tells you when to stop eating, when to start again, you feel GOOD all the time, it's just amazing how intelligent are our genes and how dumb we are trying to fool them with those 'healthy fat free wholegrain breads' YUK

I'm glad he is changing his mind about saturated fat, I still can't believe someone who is not insane would recomend canola oil over natural animal fat (i mean from a grass feed cow of course.

O Primitivo said...

Dear Dr. B.G., the Belgian diet is similar to the French! I'll quote here some data from my epidemiological database (http://www.canibaisereis.com/2009/03/21/nutrition-and-health-database/ and also from this specific table - http://www.canibaisereis.com/download/belgium-data.pdf). Most of these numbers refer to year 2003 or near this year. They Belgians are/were TOP8 in they world on what concerns calorie intake. So they eat A LOT of food, especially fats (162 gr/day, TOP3) from animal products (1120 kcal/day, TOP10). These include mainly butter (119 kcal/day, TOP4), cheese (165 kcal/day, TOP10), some eggs (45 kcal/day) and lots of milk (376 kcal/day, TOP13). Also, their fish intake is probably small, they prefer mostly meats. They consume a quite reasonable amount of vegetable products (2513 kcal/day), but not too much cereals (783 kcal/day) or even fruit (72 kcal/day). But they eat a lot of potatoes (151 kcal/day, TOP19). Which types of oils they prefer? A lot of vegetable oils (545 kcal/day, TOP8), and it is not olive oil (only 29 kcal/day). And also some coconut oil (78 kcal/day, TOP5), which has a lot of saturated fat. They also eat many nuts (47 kcal/day, TOP8). And what about sugar? A lot of refined sugar (488 kcal/day), mostly from their chocolate? Wine is appreciated (54 kcal/day, TOP11), like in France. So, these are the big numbers. Given all these animal products in their diet, their saturated fat intake must be pretty high. I don't have an estimate but it's surely high! So their TC must also be high, and it is indeed. As the experts say, it's "high risk" cholesterol (average 214 mg/dl, TOP19). And their LDLs, the bad cholesterol? I don't have data but I estimate it at 126 mg/dl, so also high risk. As we all know, these saturated fats are true killers, they progressively deposit in your artery walls and then block them, causing heart disease and thus increased mortality. Also, these high fat diets, as all experts would agree, promote obesity and diabetes, so the Belgians must also be dying from these at high rates. But instead of guessing let's have a look at those most probably horrible statistics as a result of eating lots of fats, specially saturated fats. Well, regarding heath, in 2003 they were not too hypertensive (average systolic men 127.2 mmHg/ female 118.9), not too diabetic (4.2%) and also not too obese (12%). At least they were not ranked TOP20 in any of these categories. What about age-standardized mortality rate for cardiovascular diseases, this should be a dramatic number, no? Their value was only 162 deaths/100k/year! They were ranked 143 in world on this topic in 2002. What, is this for real? This means there are another 142 countries in the world with higher cardiovascular mortality rates than in Belgium? How is this possible, if they are eating all those fats and artery-clogging saturated fats? And what about cancer? Animal products cause cancer, meat certainly causes cancer. Again, they are ranked 45 in the world, so there are another 44 countries ahead of them regarding cancer. And total mortality, the must be dying a lot, much more than healthy Chinese vegetarians? They are ranked 150 in the world, with only total mortality 504 deaths/100k/year. And by the way, total mortality in China is 842 deaths/100k/year, they are ranked 100 in the world. Ahead of Belgians, despite their pro-vegetarian lifestyle. Hum?! And the Belgians also have one of the highest Healthy Life Expectancies in the world (HALE is 71 years for both sexes, TOP13)? After all, how is this possible? I'm sorry, this is too much for me, I don't have a logical explanation. It's another paradox, let's call it the Belgium paradox! (Or perhaps is it possible that that high-fat diet, those saturated fats and that coconut oil, foods that we always ate in huge amounts in our PALEOLITHIC past, are keeping them healthier than most of us, even despite of their industrialized lifestyle? Oh NO, I must be dreaming, or in a nightmare, all the experts say those foods kill you, no chance, this is an hallucination, HELP!)

Dr. B G said...

O PRIMITIVO!

*haa* Yes, help. We need help to explain this hyperlipidemia paradoxes which completely defy the insanity of this modern world!

Belgium like France is near the coast and many rivers run through it. High minerals including magnesium, iodine, zinc and selenium are probably abundanat in the soil (relatively speaking). The grassfed cream, cheese, beef and goat are likely to receive and concentrate up the nutrients in their animal products. SFA, CLA and mega-doses of omega-3s. No industrial PUFAs?? How in the world did you find the coconut oil intake in Belgiums?! You are AMAZING!

The Belgium diet is 42% fat among the long-living elderly (I think it was the HALE study) (and they eat less carbs as they age according to the data)

In this study the women > 55 yo had HDLs of 60s. That is phenomenal. The men were lower though.

http://atvb.ahajournals.org/cgi/reprint/5/5/427

http://ije.oxfordjournals.org/cgi/content/abstract/17/3/520

Paradox!! I think you are right!

Are Belgiums completely identical to the Tokelau paradox too? High carb, even the apo B is mildly high ~100 (TYP goal < 60-70) and their apo AIs (associated good heart health) are high ~120s, the highest I've seen and likely attributed to their the wonderful saturated fat intake (not from low carb *haa*).

Saturated fats protect against NASH (fatty liver) and probably other insulin resistant related situations. Despite their high carb intake their diabetes rate is incredibly low (thank you for those numbers!!)... The diabetes rate in the U.S. is SKYROCKETING and probably more like 50% right now. 60% of all 60 yr olds are clinically diabetic or have Met Syn.

As we know saturated fats reduce NFkB and TNFa -- major triggers of cancer.

The famous Pritikin reversed coronary artery with low fat and lots of exercise, but he succumbed to leukemia (and depression/ suicide). Not enough saturated fats? Insufficient omega-3s from meat and fat sources? Not enough CLA??

I don't understand what is taking mainstream so long to comprehend the data? Do we really need to wait for generation-die-off before real progress and meaningful evolution occur?

-G

Dr. B G said...

Hi Mike B,

Those are AWESOME reports! I have not read too much about Paleo and endurance events so I really appreciate hearing your personal experiences.

I just hit the 2-yr mark for doing Paleo (it started 1-2 mos prior to getting my Crossfit nutrition cert). The more and more I get into this and hear other people's stories, the more I feel it should be advocated for everyone for optimal health, maximum vitality and H*CK better athletic performance!!

Plus it regresses plaque (if low carb high sat fat).

-G

Dr. B G said...

Hey David!

Yes -- I did my little vit D overdosing trial after succumbing to the Paleo pressure! No I'm not competitive *haaa* It was an excellent trial b/c that is the only way to know what works and what doesn't.

Interestingly some of my most healthiest patients were preemies! R U kidding? I think you are the ultimate survivor!!

Vitamin A is neat stuff. Dosing is subtle -- too much is clearly toxic and teratogenic but deficiency is even worse then K2 or D or E deficiency (blindness, no night vision, psoriasis, skin disorders, etc). Under certain situations (cancer) it appears to have high therapeutic value (if it doesn't kill off the liver -- but hey that is what chemo/rad does as well).

Diets of long-living communities are rich in animal or seafood vitamin A -- Ashkenazi Jewish, Sardinia, Okinawan, French and the Belgium. They get it from grassfed goat and beef dairy products as well as geese/duck and chicken livers. My husband bought recently a rural French cookbk (after we watched Julie and Julia for our 17th anniversary). EVERYTHING is drowned in CREAM, butter, creme fraiche, or organ meats! *haaa*

YUUUUUUMM. (*haa* No we just look at the picts -- haven't had time to try the recipes yet).

I really liked it when the fermented cod liver oil from greenpasture.org came out. Traditionally produced, fermented CLO has the bacterial fermentation products (K2 MK4s etc) as well as tons of naturally synthesized vitamin A. I feel like a Viking princess when I take it. My kids refuse though :( ...buggers. The casein-free butter oil has lots of vitamin A too. You might consider consolidating and checking these out!

-G

Dr. B G said...

Anonymous,

I know -- our genes are so SMART!!!!! Who knew!?? It is astonishing to me how progressive and SMART some people really are who figure out all this high sat fat Paleo stuff. No matter what age young or older -- this movement is just generating so much momentum.

Cordain is brilliant and courageous. He is truly an innovator. The world is not flat. And he is not afraid to say it (though he said it in the past).

Sadly I've damaged my kids' genetics (and probably their future kids as well, epigenetics) with the SAD wheat-heavy veggie oil/canola diet. Fortunately our capacity for recovery and healing is quite high I believe and will make the difference in the end.

-G

O Primitivo said...

Dr. B.G., thanks for your always insightful analysis. It's funny but even among low cholesterol countries like Japan, the people with higher longevity are those with HIGHER (yes higher!) TC levels. In the study "The Relationship between Total Blood Cholesterol Levels and All-cause Mortality in Fukui City, and Meta-analysis of This Relationship in Japan" they found lower mortality for TC in range 200-239 (RR 0.83), but also lower all-cause mortality for "hypercholesterolemic" individuals with 240 mg/dl or higher (RR 0.83). See paper here - http://www.jstage.jst.go.jp/article/jln/17/1/17_67/_article I love their conclusions: "However important the effect of cholesterol on CHD might be, the risk of all-cause mortality is lower at higher cholesterol levels. This is because of a very low incidence of CHD death in Japan (see introduction). Whether or not high cholesterol levels are a cause or effect of a high mortality, it is clinically very important to note that low cholesterol levels are associated to a sizable and significant extent with all-cause mortality (…) Switching to LDL-cholesterol from the total cholesterol in the Guidelines is good because hypercholesterolemia due to high HDL-cholesterol levels can be excluded. At the same time, this switching is very confusing. There are very few epidemiological data about the relationship between LDL-cholesterol and deaths. Considering the present meta-analysis, JAS Guidelines appear to face a serious paradox. If a doctor prescribes cholesterol lowering medicines to subjects with cholesterol levels above 240 mg/dl (6.22 mmol/l), the doctor is prescribing medicines to those who have the least chance to die. Those whose risk fo death is smallest probably have the least need for medication. Japanese subjects with cholesterol levels above 240 mg/dl (6.22 mmol/dl) should not be regarded as hypercholesterolemic or dyslipidemic because they are in the safest ranges in terms of all-cause mortality except for some genetic disorders like FH cases. Further studies are warranted." I know this seam unreal but there are other much more important variables beyond blood lipids, and beyond food! I think modern medicine focus too much on blood lipids, because they are of course related to CVD, which is the main cause of mortality. But once you focus on this single disease, and approach it on such obsessive-compulsive way as we are doing, to the IRRATIONAL point of inhibiting a VITAL substance like cholesterol, and thus increasing the risk of death from other conditions related to cholesterol deficiency, like infections and parasitic diseases (yes, we need cholesterol for immunity given by vitamin D synthesis!), there is a problem. "HUSTON, WE HAVE A PROBLEM!" If the best/main solution to our major disease of civilization, found until now, after 100 years of modern medicine, are statins, and if these DON'T even decrease total mortality on primary trials (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1663605/pdf/bmj00192-0015.pdf) and are also useless for most people who try it (because of their truly high NNT-Number Needed to Treat, usually above 60 for primary prevention and above 33 for secondary - http://archinte.ama- assn.org/cgi/reprint/166/21/2307.pdf), then we have a serious problem. It's better to have no security at all than having the false security of a dubious medicine. We can't focus exclusively on CVD this way, we should focus on OVERALL HEALTH, aiming to reduce total MORTALITY and increasing HEALTHY LIFE EXPECTANCY. And from this point of view, China is an irrelevant country, as they are ranked 63 in world mortality. Let's focus on Japan or the European Mediterranean countries (France, Spain, Italy, Greece, Portugal). Here is a list of countries ranked according to lower mortality: http://www.canibaisereis.com/download/world-mortality-data.pdf So... I would prefer to live in Japan, not in China. Or even in sunny Portugal, TOP23;) Why the Japanese live so long? I suspect it’s their high fish intake, which helps a lot with the Omega-3/6 ratios. And their healthy lifestyle, of course;)

David said...

G,

I've known about the butter oil and CLO at Green Pastures for awhile now, but haven't ever tried any of it. Kind of pricey, but you get what you pay for, right?

Later!

David

O Primitivo said...

Here are some explanations why primitive people tend to have lower/lowered cholesterol than people in industrialised societies:

Inflammation and infection do not promote arterial aging and cardiovascular disease risk factors among lean horticulturalists
http://www.anth.ucsb.edu/faculty/gurven/papers/gurvenetal2009plosone.pdf

Blood lipids, infection and inflammatory markers in the Tsimane of Bolivia. American Journal of Human Biology
http://www.anth.ucsb.edu/faculty/gurven/papers/fahetal2010.pdf

Dr. B G said...

Ricardo... Do you think we will influence Pedro ever??! *haaa!!*

Great articles and thanxxx for the forwards,
G