The Wab Diet

[wabmester]

This is a follow-up to an earlier thread on nutrition and the low-carb craze.

For background, your lipid profile is considered the single best predictor for your risk of coronary heart disease.   Other important factors are smoking and being overweight, but serum lipid levels are universally a better predictor than either.

My total cholesterol has always been under 200, which for a long time was considered "OK".   But these days, there's a lot more emphasis on the lipid components, specifically the ratio of good to bad cholesterol, and more recently studies have narrowed the definition of "bad" to low-density lipids with small partical size.

At my most recent checkup in June, my new doc was younger and more up-to-date on CHD/diet research than my previous doc, and he recommended a low-carb diet to address my wacky lipid profile.

Here are the results:

June (before diet)
LDL 93 (target < 130, < 100 is good)
HDL 29 (target > 40, > 60 is good)
TriG 362 (target < 150)
Total 194 (target < 200)
Ratio 6.69 (target < 5, < 3 is good)

My diet up to this point had been pretty low-fat.  Notice that my total cholesterol  is OK, and my LDL is fine, but my HDL is low, my TriG is high, and my ratio is rediculously high.   This possibly indicates an early stage of insulin resistence.

Normally, the liver balances the production of HDL and triglycerides in response to spikes in carb intake, but my carb intake is just one *long* spike, so I'm cranking out triglycerides day and night and making very little HDL.

At this point, I switched to a low-carb, high-protein, high-fat diet.  Here's my next lipid profile:

July
LDL 130
HDL 32
TriG 125
Total 192
Ratio 6.0

My LDL is up, but anything under 130 is considered OK.  HDL is up, TriG are way down (normal for the first time I can recall), and my ratio is coming down.

Phase II is to maintain the same low-carb diet and supplement with Niacin.   The doc wants me to get up to 1000 mg/day, which is on the low-end of what studies have shown can raise HDL.   Since I don't really understand how high doses of niacin act, I whimp out and eat only about 400-600 mg/day.

Got the results today:
LDL 131
HDL 38
TriG 127
Total 195
Ratio 5.13

So, the bottom line is that my lipid profile has improved quite a bit.   I'm almost normal now.   And I have taken the easiest approach I can think of: no exercise, no drugs, eat like crazy, and pop a couple of niacin tabs ocassionally.

For the next phase, I plan to reintroduce exercise and reduce my fat intake a bit.   There's still plenty of room for improvement, but I'm trying to vary the parameters individually to see what works best for me.

 

[Zipper]

Have a beer or 2 a day, preferrably dark, oatmeal and ground flax for breakfast, lots of nuts, and run for half an hour or walk for an hour each day.

 

[wabmester]

Zipper, I know that's not bad advice, but what I haven't yet figured out is how good that sort of advice is and what the mechanisms are.

I like the idea that research has found that flavonoids are good for you, and even if the effect is marginal, that purges any guilt I have when I drink red wine and eat high-cocoa chocolate (both of which I do fairly often).

As far as a high-fiber diet, I haven't seen anything to suggest that the effect is anything but marginal, so it's not high on my list.

I do eat lots of nuts on the low-carb diet because they're a good-tasting low-carb snack, and it's wonderful that they also have good fats and fiber, but I'm not sure how powerful those latter effects are.

Endurance exercise appears to have a beneficial impact on HDL levels, and I love the outdoors, so that's my next experiment.   Frankly, I have no idea by what mechanism exercise works its magic.   I would love to understand that mechanism so I could ensure that the type of exercise I do is maximally beneficial.

So, here's my working theory until I learn something that tells me otherwise:

-- The behavioral change with the most leverage is carb reduction, and I think I understand how that works.

-- Exercise and niacin both have a big impact on HDL levels, so those are next on my list.

-- There's pretty good evidence that moderate fat intake and generally low-calorie consumption helps too, so I'm willing to experiment.

-- Some of the other mainstream advice concerning fiber, fruits and veggies, antioxidants, etc appears to have a pretty marginal impact on CHD risk, so I'm not going overboard with this stuff, but I'll continue to chomp on the ocassional apple and banana.

 

[wabmester]

run for half an hour or walk for an hour each day.

Zipper, I found this metastudy that attempts to answer the exercise question in terms of duration, intensity, and frequency to best raise HDL:

http://www.unm.edu/~lkravitz/Article folder/cholesterolNEW.html

Summary: Run, don't walk.  The longer, the better (shoot for an hour).  And at least 3 days/week, but preferably 7 days/week.

 

[John Galt]

I can't run for exercise (maybe more sex?)

Here are my numbers from last May:

LDL 207
HDL 68
TRIG 128
TOT 301
RATIO 4.4

Comments?

John Galt

 

[Zipper]

Thanks for the study Wab. I started running back in 1968 when Cooper came out with his first Aerobics book. I've always watched my diet, treated hydrogenated oils as poison, and enjoy a beer or 2 a day . Having a happy marriage and great kids has been a bonus.

 

[wabmester]

LDL      207
HDL       68
TRIG    128
TOT     301
RATIO   4.4

Comments?

John Galt, I'm not a doctor, so my advice can be dangerous to your health.    Your LDL is the only factor that's out of wack.   Your HDL is so high that it's considered a *negative* risk factor (i.e., it will offset another risk factor you might have).   Assuming you don't smoke, there's no family history of CHD, and you don't have hypertension, you'll probably live forever.

You might ask to have a better discriminating test done.   There are something like seven different kinds of LDL, and only the small partical types are suspected of causing plaque formation.

The better tests will look at your apoprotein ratio or breakout the LDL components via gel electrophoresis.  I might ask for them myself once my simple lipid profile is in better shape.

Edited to add that the standard medical advice is to keep your LDL below 160, and to try a low-fat diet to get there.

 

[John Galt]

Hey Wab. I just found (by accident) my lab work from
a physical in Dec, 2002. The LDL was a bit lower, but the ratio was the same. They assessed my risk as
"average". I don't smoke, no family history of CHD, and
my blood pressure is good. Guess I better go celebrate.

John Galt

 

[BUM]

Hey, we could be on to something here. How about a specific topic like "Up your HDL" or "Hey, guy howze ur trigly?"

My recent stats stack up closer to John Galts than others. One doc wants to put me on statins. Another doc says forget about it! Because of the ratio.

LDL 181
HDL 81
Tot 286
Trig 118
Rat 3.5

I'm taking the advice (so far) from doc#2 since I dont want to enter ER with an expensive pharm habit

BUM

 

[John Galt]

I have heard horror stories about cholesterol lowering
meds. I don't want the expense and I don't want to
add to the "witches brew" I'm already injesting.
Plus, my liver function has been funky for at least
20 years and I'm still here, but don't want to screw that
up any more. Sooooooooooooo, although the Dr.
who did my last blood work said I would need more
than diet, exxercise and natural (herbal) help
(read prescription meds), I am holding off. My ratio is good and if I can just get the LDL headed down I
will be satisfied. BTW, I was thinking some more
about my family tree and can't recall anyone on either
side with CHD. I'm sure there was someone but if so,
I didn't know about it.

The wab diet continues with only a little cheating.
Results will be in around month end.

John Galt

 

[trailblazer]

If you're looking for a medicine that works on cholesterol but doesn't affect the liver, try WelChol. My doc put me on this about six months ago and it works on chol. levels, but has left my liver enzymes at the normal level.

 

[John Galt]

WelChol? Have not heard of it. Thanks trailblazer.
I'll check it out.

John Galt

 

[grumpy]

Hope I'm not too late to join this discussion. A few years ago my total cholesterol was 247. This was with a low fat, high carb diet and daily vigorous exercise (swimming or walking). My doctor put me on Lipitor. I am on a lot of other Rx's for several different chronic problems. Lipitor is the only Rx I have ever taken that does exactly what it is supposed to do with virtually no side effects (for me, anyway). After a few months my blood work showed:

Tot cholesterol = 185
HDL = 55
LDL = 116
Tri = 68
Ratio = 3.4

After about a year on the Lipitor I was gaining weight so I switched to the Adkins diet and have stayed on it pretty strictly since then. My most recent blood work was virtually unchanged and I have taken off, and kept off about 15 pounds.

My father had heart disease so I am pretty motivated to avoid those problems.

Grumpy

 

[wabmester]

Hey, Grumpy. That's a good looking lipid profile -- congrats!

I don't have a reference handy, but I believe studies have shown that statins are no more effective than diet and exercise, so I'm determined to avoid drugs as I whip my lipids into shape.

In addition to the low-carb diet, I'm now running and biking about 5 days/week. I'll do some more bloodwork after a couple of months to measure the effect.

One rather depressing thing I need to keep in mind is that those nasty lipids have been doing their dirty work for the past 40 years, so I need to do more than simply get them to a normal level. I need to try to reverse the damage.

 

[cute fuzzy bunny]

A couple of other things you can do that might help a little:

Buy enteric coated fish oil capsules in bulk at the warehouse stores. I forgot what I paid for mine but it was about 1/3 the cost of buying at the drug store. Omegas are proven to help.

I usually buy margarines with the plant stearol additives (the one I get even adds some omegas). They're slightly more expensive but at least you can offset the fat consumed with some natural cholesterol reducers. Taste is ok. Truth in lending statement: I still use butter sometimes when I cook. There is no substitute.

 

[wabmester]

Buy enteric coated fish oil capsules in bulk at the warehouse stores.

Yummy

That would go against my working theory, which is that a lot of things are known to be good or bad, but most people don't know the magnitude of goodness and badness. I'm just starting to get a feel for the magnitudes myself, but my preliminary findings are:

carbs: BIG magnitude
exercise: pretty big magnitude
fish oil capsules: lost in the noise

 

[haha]

Exercise Notes

I played high school and college sports. Unlike some here, I am not a gifted athlete, but just kept at it because I liked it and liked what it did for me. Except for short downtimes due to illness or extreme busyness, I have always kept up my exercise routines.

One thing I have noticed- most elite or dedicated athletes are very lean. But lots of the others exercise year after year and stay fat. I think that eating is a big part of it. On this score, the low carb diet referenced by Wab above seems unbeatable. I've been on it since 1997, and I never gain weight, and have good athletic endurance, and I really enjoy my meals.

Intensity of exercise seems to matter. I look at other athletes, and it seems there are lots of fat racket ball players, fewer fat squash players. Lots of fat joggers, but if you will really get out and go, not too many fat runners. I think that any fitness program should have at least some all out or near all out intervals. Subject of course to your Doc certifying you as not likely to keel over.

A swimming pool is always full of fat lap swimmers, but again if you have the skill to put the coal to it, swimming leads to lean bodies.

One sport that seems to really slim people down is biking. Maybe it is just too uncomfortable for fat people to continue, but most serious biking enthusiasts are really thin. I used to ride a lot of centuries, but lately I am more sensitive to the saddle pressure, and don't enjoy it as much. Also, the damn cars scare me.

Today my main aerobic base is swimming. Every day, I will either swim a mile or so freestyle, or walk five miles or so. I don't jog. For dry land intensity, I jump rope or row on a Concept2- one of the truly great exercise implements. I would use it more, but again, for long rows my butt gets sore. Sometimes I drive to a park and do windsprints, usually 40s with a three count between intervals. This is seriously aversive, so I have to force myself to do it.

I hope these things are helping my health, but I know they are helping my life. My hobbies are salsa and swing dancing, and I never have to sit down, even when the music is quite fast. At age 63, this is enough reward for me. Plus, in ER one can become bored, and swimming at least is an unending skill improvement challange.

In most things of life I feel pretty much clueless, but this is one that has worked out well for me. If I weren't concerned that some idiot would sue me if he pulled a muscle, I would do personal training. But once you have substantial assets, the income needs to be balanced against the risk, IMO.

Well, hasta luego, time to hit the pool

Mikey

 

[haha]

fish oil capsules: lost in the noise

Not necessarily. My wife was starting to develop osteoarthritis in her fingers, a big problem for a professional organist and pianist. With fish oil supplements and nothing else, she stopped the arthritis in it's tracks. It's been over a year now, with continued good results.

Mikey

 

[cute fuzzy bunny]

Try a little research. Regular intake of fish oil in modest amounts (like a capsule) results in 12-40% reductions in LDL and triglycerides. In the enteric coated caps you dont taste or 'burp' it. Flax is good, but fish oil is better.

Substituting a stearol based margarine for your regular butter or margarine can give you an extra 5%. You can also get it in orange juice.

Pretty good amount of noise for eating a 3c pill and changing from one product to another.

 

[wabmester]

Try a little research.  Regular intake of fish oil in modest amounts (like a capsule) results in 12-40% reductions in LDL and triglycerides.

That would be interesting.   Do you have a reference?   I only found a Danish study that indicated that 4g/day might lower your cholesterol ratio by 1%.   And that was a fairly small study, so it seems like noise to me.

There are a couple of good studies out there that looked at multiple factors over a long period with many participants (in the 1000s).   My goal is to work with those factors that have been proven to pack a real wallop.

 

[cute fuzzy bunny]

Google "fish oil cholesterol".

There are roughly 9000 studies. I've read the contents and summaries of about 60. The AHA web site also links some of their studies and recommendations to take it.

So far I havent seen *any* that didnt show a positive effect.

Lots of good individual stories as well. For what those are worth.

There are also a lot of studies and medical opinions with very strong negative feelings about low total carb/high fat diets, but as is the norm theres enough contrary data to let you pick and choose your proof sources.

 

[wabmester]

FWIW, I have nothing vested in being right or wrong. I would enjoy being proven wrong since it would mean learning something new.

In any case, here's an abstract to the Danish fish oil study that concludes "... the team observed no significant effects of fish oil on LDL cholesterol, HDL cholesterol, or the concentration of small dense LDL particles, linked to symptoms of heart disease."

http://www.defeatdiabetes.org/Articles/fishoil021017.htm

 

[John Galt]

Man, this is confusing. Fish oil, Wab diet, Atkins diet,
red rice yeast? What's a fellow to think? My grand parents had bacon and eggs every day, cooked in lard
and lived into their late 80s. What to cut out?
Frappacinos? Slimfast? Burgers? Chips? Dip?
T bones? Booze? I'm tempted to just ignore the whole thing. After all, my ancestors knew nothing about this
and thus never worried about it.

John Galt

 

[johnblake]

but my preliminary findings are:

carbs: BIG magnitude
exercise: pretty big magnitude
fish oil capsules: lost in the noise

Hey Wap,
Where does genetics fall on this scale?

 

[wabmester]

Where does genetics fall on this scale?

It's probably a huge factor, but not one most of us have any control over.

Change what you can, don't sweat what you can't, and argue about the minutia