Re: Lipids, Carbs, Statins and all that.
- From: Quentin Grady <quentin@xxxxxxxxxxxxxxx>
- Date: Tue, 04 Nov 2008 12:25:31 +1300
Thanks Randy,
There is a lot to follow up. It is interesting that what is
significant for men and women differs where LDL particle size is
concerned.
Best wishes,
Quentin.
On Sun, 2 Nov 2008 21:00:30 -0800 (PST), "randy@xxxxxxx"
<randy@xxxxxxx> wrote:
Interesting thread and I?ve been meaning to weigh in for about a week--
now.
On Exercise:
It?s been commented that only ?really intense? exercise, the kind that
most folks here wouldn?t do, raises HDL. Although there is intensity
thresh hold for exercise to increase HDL, it?s not that great and I
suspect within the limits of many here.
About 75% of max heart rate is all it takes at about 7 miles/week.
That?s about a heart rate of 125 for a 55 year old male. For someone
in shape that works out to a slow grandpa jog of about 10- 20 mph. If
you?re out of shape a brisk walk should do it. [1]
On fat type, ldl levels and ldl type:
Wes Wrote:
Has it ever been empirically shown that if you increase fats
while keeping carbs, protein, and exercise the same, that
TG goes up, LDL goes up or HDL goes down?
Reply:
It has definitely been shown that increasing saturated fat intake will
consistently raise LDL levels. This is not a matter of debate. In
fact, the 1985 Nobel Prize in medicine was awarded for elucidating the
biochemical machinery involved.
Some here seem to believe that even though LDL levels will increase
under this scenaro, only the low density light/fluffy LDLs will
increase when carbs are kept low. It's felt that only the
smaller.heavier particles are harmful and therefore so long as a low
carb diet is in place there is nothing to worry about.
In fact the most current thinking and data indicate that both both
types of LDL are bad and the important indicator is the number of LDL
particles present, irrespective of particle size. A great backgrounder
on this topic can be found here. [3]. (Please read this first if you
plan to comment)
On Dr. William Davis
I too am very impressed with Dr. Davis?s work (http://
heartscanblog.blogspot.com) (http://www.trackyourplaque.com). He?s my
main source of life style suggestion for preventing and treating CAD.
I was surprised that no one here has seems to be aware (they haven?t
posted it anyway) of his central theme. Namely that the only way to
know the condition of your coronary arteries is to see how much plaque
is gunking up the works. The easiest way to do this is with a calcium
scan (EBCT test). This quick, painless and not overly expensive test
will provide a direct indicator of the condition of your coronary
arteries. Where I live you don?t even need a prescription to get this.
There are facilities where you can walk in an get one.
Dr Davis has got a great free informative pdf at his web site on the
technical justification of this test and lots of case histories of
folks with great lipid numbers and a lot of plaque on their arteries
and visa versa.
I?m really waiting for a published study looking at low carb diets
with high saturated fat intake using this test. Jeff Volek and his
group at Univ of Conn don?t seem to think that saturated fats (I think
Taubes is of this mindset also) are harmful in the context of very low
carb diets. This test could resolve the matter pretty quickly.
Regards
Randy
1. HDL & Exercise
Sports Med. 1999 Nov ;28 (5):307-14 10593643 (P,S,G,E,B) Physical
activity and high density lipoprotein cholesterol levels: what is the
relationship?
[My paper] P F Kokkinos, B Fernhall
Cardiology Division, Veterans Affairs Medical Center, Georgetown
University Medical Center, Washington, DC 20422, USA.
High density lipoprotein cholesterol (HDL-C) levels are strongly,
inversely and independently associated with coronary heart disease
(CHD). Increased physical activity is associated with reduced CHD
mortality. This protection against CHD
may partially be explained by the increase in HDL-C levels observed
following aerobic exercise training. Many also agree that an exercise
threshold needs to be met before such favourable changes in HDL-C
metabolism can occur. Most likely, the exercise-induced changes in HDL-
C are the result of the interaction amongst exercise intensity,
frequency,
duration of each exercise session and length of the exercise training
period. Although a relative contribution of each exercise component
(intensity, duration and frequency) is also likely, it has not been
established. There is also substantial support for a dose-response
relationship. Favourable changes in HDL-C appear to occur
incrementally and reach statistical significance at approximately 7-10
miles per week or 1200 to 1600kcal. Exercise-induced changes in HDL-C
may also be gender dependent.
The volume of exercise required to increase HDL-C levels appears to be
substantially more for women than men. This perhaps is due to higher
HDL-C levels in women at
baseline compared with men. However, the many other health benefits
derived from increased physical activity should encourage women to
participate in regular exercise regardless of the exercise effects on
HDL-C levels. A practical
approach in prescribing exercise for patients is to use moderate
intensity exercises (70 to 80% of predicted maximal heart rate), 3 to
5 times per week, for a total of 7 to 14 miles per week. This is
equivalent to approximately 1200 to 1600kcal per week.
2. Miles run per week and high-density lipoprotein cholesterol levels
in healthy, middle-aged men. A dose-response
relationship.Kokkinos PF, Holland JC, Narayan P, Colleran JA, Dotson
CO, Papademetriou V.
Cardiology Division, Veterans Affairs Medical Center, Washington, DC.
OBJECTIVE: To examine the association between miles run per week and
high-density lipoprotein cholesterol levels in healthy middle-aged
men. BACKGROUND: Regular exercise increases levels of high-density
lipoprotein cholesterol.
However, the exercise requirements for such increases are not well
defined. METHODS: Healthy, nonsmoking men (n = 2906; age, 43 +/- 4
years) completed a questionnaire on health habits and physical
activities and a symptom-limited
exercise test. They were then stratified on the basis of the number of
miles run per week. Six groups, with mileages of 0, 5, 9, 12, 17, and
31 per week, were established.
RESULTS: A gradual increase in high-density lipoprotein cholesterol
level was
observed with increased miles (0.008-mmol/L [0.308-mg/dL] increase in
high-density lipoprotein cholesterol level per mile).
Most of the changes were associated with distances of 7 to 14 miles
per week. Levels of low-density lipoprotein cholesterol,
triglycerides, and the ratio of total cholesterol to high-density
lipoprotein cholesterol also improved with weekly mileage.
The high-density lipoprotein cholesterol level correlated
significantly with all exercise components, anthropometric measures,
and alcohol consumption. Group comparisons disclosed significant
differences (P < .05) in exercise time to exhaustion, miles run per
week, body fat, body weight, and body mass index. Age and alcohol
consumption were similar across groups.
CONCLUSIONS: These results indicate a dose-response relationship
between miles run per week, high-density lipoprotein cholesterol
level, and other
lipoprotein-lipid levels. Most changes were noted in those who ran 7
to 14 miles per week at mild to moderate intensities. A mile-age
threshold for changes in high-density lipoprotein cholesterol level
was not observed. However, when compared
with those of the nonexercising group, high-density lipoprotein
cholesterol levels attained statistical significance at 7 or more
miles per week.
PMID: 7848025 [PubMed - indexed for MEDLINE]
3. http://jcem.endojournals.org/cgi/reprint/88/10/4525.pdf
5. LDL Particle Number, Not Size, a Significant Predictor of CVD Risk
Nov. 11, 2004 (New Orleans) ? The number, not the size, of low-density
lipoprotein (LDL) cholesterol particles predicts heart disease risk,
according to an analysis of blood samples from more than 3,200
participants in the Framingham Heart
Offspring Study.
"It's the total particle number rather than size or anything else that
is important," lead investigator Ernst J.
Schaefer, MD, a professor at the Freidman School of Nutrition Science
and Policy, chief of the Lipid Metabolism
Laboratory, and senior scientist at the Jean Mayer USDA Human
Nutrition Research Center on Aging at Tufts University in
Boston, Massachusetts, told Medscape
Dr. Schaefer presented the results of the analysis here at the
American Heart Association (AHA) 2004 Scientific Sessions.
The study analyzed frozen blood samples from 1,529 men and 1,708 women
who were followed for an average of eight years to monitor the
development of fatal or nonfatal myocardial infarction, stroke,
claudication, and angina. During the follow-up period, 220 men and 116
women developed one or more of those conditions.
The LDL particle numbers and size were analyzed using nuclear magnetic
resonance spectroscopy, Dr. Schaefer explained
at a press conference.
Considering just LDL factors, univariate analysis indicated that LDL
particle size and number were significantly (P < .001) associated with
cardiovascular event risk in both men and women, but on multivariate
analysis, particle size becomes
nonsignificant, Dr. Schaefer said, and only particle number was a
significant predictor.
Other known risk factors such as age, smoking history, diabetes, blood
pressure, and high-density lipoprotein cholesterol level were
significant for both men and women in the univariate model. But in the
multivariate analysis, the best risk predictor model for men was age,
systolic blood pressure, diabetes, smoking, and LDL particle number.
For women, multivariate analysis identified age, systolic blood
pressure, smoking, and LDL particle size, but not diabetes.
Asked about the availability of tests to measure LDL particle number,
Dr. Schaefer said the tests were readily available. He suggested that
LDL particle testing be done in "high-risk patients to optimize
cholesterol profile." He added that "standard testing leaves something
to be desired."
Sidney Smith, MD, director of the Center for Cardiovascular Science
and Medicine at the University of North Carolina in Chapel Hill, and a
spokesperson for the AHA, told Medscape that Dr. Schaefer's study is a
significant example of recent
advances in cardiovascular disease prevention and treatment.
"Think about where we have come in the past five years [in the
management of cardiovascular disease]," Dr. Smith said.
"We're now treating the risk factors rather than the disease." Dr.
Smith was not involved in the study.
Quentin Grady ^ ^ /
New Zealand, >#,#< [
/ \ /\
"... and the blind dog was leading."
http://homepages.paradise.net.nz/quentin
.
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