This is an area in which I will be guilty of oversimplification. But even oversimplified, it will vastly outstrip your doctor’s focus on total cholesterol, LDL cholesterol, and statin drugs. Unfortunately, most doctors have fallen for the marketing disguised as statin drug “research” paid for by the drug industry. Statin drugs do indeed provide a very small benefit—but with substantial health (and financial) costs.
The Undoctored Wild, Naked, and Unwashed strategies address these issues quite aggressively. For example, wheat/grain elimination reduces triglycerides dramatically, often by several hundred points (in mg/dL); raises HDL cholesterol over time; and reduces or eliminates one of the most powerful causes of heart disease—small LDL particles. Omega-3 fatty acids from fish oil reduce triglycerides, removing the distorting effect of excessive triglycerides on other lipoproteins and reducing heart disease risk. Cultivation of bowel flora likewise reduces triglycerides and improves insulin response, along with reducing cholesterol values (via increased growth of bacterial species that yield bile salt hydrolase enzymes that prevent intestinal cholesterol reabsorption). In other words, the basic Undoctored strategies improve the values on the standard cholesterol panel dramatically. Some people, however, are left with higher total and LDL cholesterol values, so it is important to understand several issues surrounding these two values.
Total cholesterol is virtually worthless, as it includes HDL cholesterol. If HDL goes up (as it nearly always does on the Undoctored program) by 40 mg/dL (which is great), total cholesterol will also go up by 40 mg/dl, but many doctors try to “treat” this rise with statin drugs, which makes no sense whatsoever. There is no useful information in total cholesterol, so this outdated value should be ignored. (Personally, my HDL cholesterol used to be 27 mg/dl when I was in my thirties and following a vegetarian lifestyle while jogging five miles a day. My HDL is now 94 mg/dl—nearly four-fold higher–eating a grain-free, low-carb, high-fat diet along with the collection of Undoctored strategies such as fish oil and vitamin D. Because my HDL increased by nearly 70 mg/dl, it means my total cholesterol includes 70 mg/dl of HDL and most doctors, “educated” by marketing rather than real science, would try to treat this change.)
LDL cholesterol is usually not even measured; rather, it is calculated from the other three values (total cholesterol, HDL, triglycerides). The calculation is outdated (over 50 years old), based on crude and inaccurate assumptions, and is unreliable. It also ignores variation in LDL particles— size, duration of persistence in the bloodstream, potential for oxidation (since oxidized LDL particles are especially bad), etc. For these reasons, I call LDL cholesterol “fictitious LDL,” since it is wildly unreliable. On this lifestyle in which we sharply curtail carbohydrates (which modifies lipoprotein composition), it becomes even more unreliable, essentially invalidating the calculation.
We therefore turn to superior methods to quantify LDL particles and measure their size. (See Appendix D of the Undoctored book) Small LDL particles—by far the worst (they persist much longer, are more prone to oxidation, and are more adherent to artery walls to form atherosclerotic plaque)—are triggered by consumption of carbohydrates; large LDL particles—more benign, persisting for a much shorter period of time, less oxidation-prone, less adherent—are caused by fats. Among lipoprotein testing methods, I believe that the NMR method is the best choice for accuracy and provides the most information. A typical NMR lipoprotein test result in someone with heart disease risk would be: total LDL particles 1,800 nmol/L (the units signify number of particles per volume) and small LDL particles 900 nmol/L—meaning that 50 percent of all LDL particles are the undesirable, heart disease–causing small variety caused by grain and sugar consumption, reduced dramatically with their elimination. Other methods, though distant second choices, are to measure apoprotein B (apo B)—since each LDL particle contains one apo B molecule, which therefore serves as a virtual count of LDL particles—or direct LDL measurement. However, both apo B and measured LDL provide no indication of size and therefore do not suggest a dietary solution to correct the excess of small LDL particles, nor do they reveal the full extent of risk posed by small LDL particles.
The goal is to minimize small LDL particles (no higher than 20 percent of the total), while the goal for total LDL particles is not yet worked out, as it is not clear whether large LDL particles even contribute to heart disease risk (particularly in the absence of inflammatory phenomena) and at what level. Stay tuned to Undoctored conversations for clarification of this issue.
Dr William Davis. I dont know if you are the right person but do you previously work with Oil Search in PNG?
I just found out that my Homocysteine level is very high as well as my lipoprotein a.
My present doctor said the answer to both problems is more statins and he said he would most likely send me to a cardiologist.
Pat wrote: «I just found out that my Homocysteine level is very high as well as my lipoprotein a.»
What is the dietary context here?
What is presently being done to address these markers (or any other medical condition)?
The Undoctored program has an adjustment for elevated Lp(a), although it’s on the Undoctored Inner Circle site, and not in the book.
Elevated HCY has been a frequent topic of discussion on the UIC forum, going back a decade or more. It appears that it responds nicely to the basic program, and that shoving it around per se may not have actual outcome benefit. When it remains high, some other factors might need a look, such as MTHFR status.
re: «My present doctor said the answer to both problems is more statins…»
Ask for some data showing all-cause (not just “event”) mortality consequences for that approach.
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I had asked for a Homocysteine level because my son had a MTHFR test and was found that his body did not utilize Folate. So he was put on a high dose Folate supplement, but after about six weeks, he almost went crazy with anxiety and other symptoms. He checked it out online only to find out that it was indeed the food supplement folate causing the problem. Then in “Undoctored” Dr. Davis mentioned something about using folate but only if B12 is also at a good level. But of course, the $5500 cheek swab never included testing any of the other B vitamins. Disgusted! If only a person could be totally Undoctored! My point is that my son most likely inherited that abnormality from me.
As for lipoprotein a, I know there is no medication for that but only dietary recommendations, which I will check out again, but most likely will be unable to get a blood test again for it. Most doctors are sooooooo dumb, know nothing about any of this and refuse to even check for it.
Amen, end of rant! Thanks.
Pat wrote: «…my son had a MTHFR test and was found that his body did not utilize Folate. So he was put on a high dose Folate supplement…»
What form of folate?
re: «…it was indeed the food supplement folate causing the problem.»
Dodging folic acid (the industrial fake folate) is one of the serendipitous benefits of going grain-free, since nearly all wheat flour is fortified with that, as are other “enriched” flours in the US, recently extended to include corn masa. Avoiding grains also avoids any risk of excess iron due to that same misguided policy (a huge issue in haemochromatosis, and another that the package never warns you about).
re: «…my son had a MTHFR test…»
It’s a complex topic, and program guidance on it to date has been largely limited to advice to get tested, or (what I do) just supplement the 5-methylfolate form of B9 (not folic acid), and the methylcobalamin form of B12 (not the more common cyanocobalamin). If grain-free, exposure to the suboptimal forms then arises largely from multi-vitamins (most of which are a complete waste of money, and potentially hazardous).
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“it is not clear whether large LDL particles even contribute to heart disease risk and at what level”
I thought you just said in the article that they’re benign. So you’re recommending a high-fat diet (raises large ldl) that could contribute to heart disease risk? I’m confused now
Since you are continually revising your suggestions based on new information, I am wondering if you would be interested in using me as a guinea pig? Despite being on WB for over 5 years my LDL remains high with small particles. I have been able to lower my triglycerides to 88-104 range and my HDL has gone up. But my LDL remains stubborn. I do not cheat because if I do, I become sick and miserable. Are you interested for your research? I live 30 miles from Milwaukee.
Denise Rate wrote: «Despite being on WB for over 5 years…»
What reference information are you relying on? I ask because the program has added strategies since the original 2011 book (principally gut flora cultivation). That book also didn’t get into details on targets for Vitamin D, magnesium, fish oil and iodine (nor targets for key thyroid labs).
re: «… my LDL remains high with small particles.»
What LDL? LDL-C, DLDL, LDL-P Particles, LDL-P Small LDL?
And if LDL-C, what are the values, over time, for the actual measurements of that calculation: TC, TG, HDL?
re: «I have been able to lower my triglycerides to 88-104 range and my HDL has gone up.»
Program target for TG is 60 max (and has been for some 11 years now, by the way). Have you any readings for HbA1c? And what is fasting BG, typically? A TG above 60 usually suggests that net carb intake is higher than assumed, but it could be due to other reasons.
Program target for HDL is 60 min. That also has not changed since 2006.
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