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 in to 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...
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 mall 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 evaluated 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, blue-eyed, soulful Australian Merriweather, Last Skeptik remix)
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. 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 lack of outcomes recall Cardio Controversies: Dr. Superko and his sumarai quote?). Fibrates: 5% (but they raise HDL-3 mostly). Zetia: 0-2% (again mostly HDL-3 and explains why all outcomes are negative and 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 raise the heart- and cancer-protective HDLs until I found Paleo. *overwhelmed sigh* Yes -- sure niacin 30-50%. Yeahhh -- sure fish oil 5-10%.
Low carb high fat Paleo: 200-300%.
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.
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
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
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.
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. 5132.
2. Cordain et al, Origins and Evolution of the Western Diet: Health Implications for the 21st Century, Amer J Clin Nutr; 81:341-54, 20053.
3. Science, 307:840, Feb 20054.
4. Bonjour J-P, Dietary Protein: An Essential Nutrient Factor for Bone Health, Jnl. Amer. Coll. Nutrition 24:6, 5265-5365, 20055.
5. Obarzanek et al, Dietary Protein and Blood Pressure, JAMA 275:20, 1598-1603, May 1996.
