Dr. Davis Primer

Whenever I implicate carbs instead of fat as a major risk factor for obesity and heart disease, I am met with rolling eyes and eventually that look that says “you’re insane.”

In an ongoing effort to convince my audience that I am NOT nuts, I encourage them to read the advice of someone with better qualifications on the subject: a cardiologist.

Not just any cardiologist mind you, but a rare breed actually concerned with prevention:
Dr. William Davis

Dr. Davis’ Heart Scan Blog is full of great info but there is a LOT to wade through.

To make your first encounter with Dr. D easier, let me start you off with a few recommendations:

1. Know your risk factors for heart disease

2. Understanding cholesterol Values
The LDL/HDL/Total cholesterol numbers are NOT a good indication of your risk of heart disease. These number can mislead by underestimating or overestimating risk. Learn what Lipoprotein analysis (NMR) is and understand what small LDL particles are.

3. Reducing your risks and reversing heart disease
There is no one post that pulls this all together* but his advice is consistent:

  • Eliminate sugars, wheat and cornstarch
    Eliminate–not reduce, but eliminate wheat products from your diet, whether or not the fancy label on the package says it’s healthy, high in fiber, a "healthy low-fat snack", etc. This means no bread, pasta, crackers, cookies, breads, chips, pancakes, waffles, breading on chicken, rolls, bagels, cakes, breakfast cereal. This includes
  • Eliminate junk foods
    such as candies, cookies, pretzels, rice cakes, potato chips, etc.
  • Take Omega 3
    It must be from fish oil There is no need for expensive brands like Lovaza (aka Omacor). Dosing frequently (eg 2-3 times per day) seems to enhance the effect. Take a minimum EPA + DHA of 1200 mg per day (ie 4000mg standard fish oil) or more.
  • Take Vitamin D3
    This should be oil based (ie gel not tablet). Dr. D has on occasion recommended Carlson’s and Vitamin Shoppe brands.
    "Though needs vary widely, the majority of men require 6000 units per day, women 5000 units per day. Only then do most men and women achieve what I’d define as desirable: 60-70 ng/ml 25-hydroxy vitamin D blood level." ref
  • Dr. D has also mentioned that exercise may enhance the benefits of these changes but he does not discuss exercise much.

    Likewise he has stated that one should not allow saturated fats to dominate but again his blog does spend a lot of time on this recommendation. In this respect he is more conservative than much of the low-carb community particularly given that he remains anti-egg yolk: "One yolk per day is clearly too much."

    More info:

* Note that this list is my own compilation from various posts and may not accurately reflect Dr. Davis’ protocol due to errors of omission or emphasis.

Ideology trumps evidence

Fantastic opinion piece in the NYT:
Believing in Treatments That Don’t Work

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face of data. Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?

And when we insist on evidenced based healthcare, will our doctors accept it?

High Cholesterol – Low Triglycerides

I recently got my lipids tested. Unfortunately I do not have access to detailed subfraction tests so I was only able to get the high level numbers.

I’ve been low-carbing for quite a while now. I’ve generally had good cholesterol figures so this would be telling for the increased consumption of fat in my diet.

The results, however, were a bit confusing:

Total cholesterol
  229 – high
54 – low


My total cholesterol number has climbed significantly over the past 2 years (it was ~170 before) which is a concern. However the low triglycerides with the high cholesterol figure gives contradictory risk indications for heart disease.

Now I’m aware that not all LDL are created equal but I wanted some definitive advice on this point (it wasn’t coming from my doctor who didn’t even remark on the triglyceride number).

In my searching, I found this interesting and succinct comment on the subject here which I am reprinting as it addresses my question directly:

LDL cholesterol can be broken down into two kinds, pattern A and pattern B. LDL pattern A is large fluffy particles that are less dense than pattern B and not easily oxidized. LDL pattern A is essentially benign with respect to heart disease. LDL pattern B on the other hand is small dense particles that are easily oxidized and more closely associated with heart disease. It has been theorized that the harm to the arteries is associated with oxidized cholesterol. Ok, enough about that. To summarize, LDL pattern B (think small dense BBs) is bad, LDL pattern A (light and fluffy) is not a problem.

Now you would think that the lab actually measured your LDL, but they likely didn’t. Most labs just calculate LDL from the following equation:

LDL = Total Cholesterol – HDL – triglycerides/5

So from this, you don’t know if you are predominately LDL pattern A (no big deal) or predominately LDL pattern B (much more risk). Some labs do have the capability to measure the LDL gradient and can determine your predominate LDL pattern type. However, there is another way. Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (the non risky kind), and conversely, a high triglyceride/low HDL level is strongly associated with LDL pattern B (the harmful kind). This is one reason that high triglycerides alone are an independent risk factor for heart diease.

Ok, where am I going with this with respect to your situation. Other studies have shown that a high triglyceride/HDL ratio is the best indicator for heart disease risk (approximately 8x better at predicting heart disease risk than high total cholesterol alone). A triglyeride/HDL ratio of 5.0 is moderate risk and the higher the number, the higher the risk, while a ratio of <2.0 is very low risk.

From what I have just described, you can see that with your very low triglyceride level (<100) and moderately high HDL level (>50) you are at very low risk of heart disease. Also, your very low triglyceride level indicates that your LDL is predominately pattern A, the harmless kind. If you are still concerned, you can have your LDL gradient measured to determine your LDL pattern type.

I wouldn’t even remotely consider cholesterol lowering medications without knowing your LDL pattern type to see if there is any risk associated with your lipid levels because there are potential significant side effects (muscle damage, neurological damage, liver damage, even death – i.e. the Baycol recall) associated with many cholesterol lowering medications (statins in particular).

Oh, and I think that your low sugar, lower carbohydrate diet is the way to go to lower your risk of heart disease because of the positive effects it has on triglycerides and HDL.


Unfortunately the mystery man Alan does not provide any references however this is broadly in line with what I have read elsewhere. My triglyerides/HDL = 1.18 which suggests, according to Alan, that I am very low risk for heart disease.

I will, however, get my LDL gradient tested at the first opportunity.



Follow Up Here: How Gluten Free Impaired my Cholesterol Numbers