Association of Apolipoprotein B and NMR Spectroscopy–Derived LDL Particle Number with Outcomes

Association of Apolipoprotein B and Nuclear Magnetic Resonance Spectroscopy–Derived LDL Particle Number with Outcomes in 25 Clinical Studies              

1. Thomas G. Cole¹,*,                      
2. John H. Contois²,
3. Gyorgy Csako³,
4. Joseph P. McConnell⁴,
5. Alan T. Remaley³,
6. Sridevi Devaraj⁵,
7. Daniel M. Hoefner⁴,
8. Tonya Mallory⁴,
9. Amar A. Sethi⁶ and
10. G. Russell Warnick⁴

                    

Abstract

 

BACKGROUND: The number of circulating LDL particles is a strong indicator of future cardiovascular disease (CVD) events, even superior to the concentration of LDL cholesterol. Atherogenic (primarily LDL) particle number is typically determined either directly by the serum concentration of apolipoprotein B (apo B) or indirectly by nuclear magnetic resonance (NMR) spectroscopy of serum to obtain NMR-derived LDL particle number (LDL-P).

                    

CONTENT: To assess the comparability of apo B and LDL-P, we reviewed 25 clinical studies containing 85 outcomes for which both biomarkers were determined. In 21 of 25 (84.0%) studies, both apo B and LDL-P were significant for at least 1 outcome. Neither was significant for any outcome in only 1 study (4.0%). In 50 of 85 comparisons (58.8%), both apo B and LDL-P had statistically significant associations with the clinical outcome, whereas in 17 comparisons (20.0%) neither was significantly associated with the outcome. In 18 comparisons (21.1%) there was discordance between apo B and LDL-P.

                    

CONCLUSIONS: In most studies, both apo B and LDL-P were comparable in association with clinical outcomes. The biomarkers were nearly equivalent in their ability to assess risk for CVD and both have consistently been shown to be stronger risk factors than LDL-C. We support the adoption of apo B and/or LDL-P as indicators of atherogenic particle numbers into CVD risk screening and treatment guidelines. Currently, in the opinion of this Working Group on Best Practices, apo B appears to be the preferable biomarker for guideline adoption because of its availability, scalability, standardization, and relatively low cost.

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Whatever the nutrition authorities have to say… the exact opposite is likely to be the truth!- Kristjan Gunnarsson

How to Win an Argument With a Nutritionist or Registered Dietitian

By: Kris

For reasons I have disclosed before, I prefer not to get in to online arguments with nutritionists.
I used to enjoy it, but ended up becoming frustrated so I gave it up.

But… I often observe these arguments online.

It’s fun. Usually.

There’s an annoying pattern I’ve noticed though.

The people who are arguing with the nutritionists, who seem to have all the facts straight and are trying to make their point, don’t cite any studies.

This is a problem!
I get it…
Not everyone has a ton of studies bookmarked on their computer and it can be quite a hazzle to start looking them up at the time of need.

But citing studies is critical in an argument about science. Nutrition = science!
So, with this article I decided to collect studies for the main arguments against some of the more foolish claims made by nutritionists, vegans and know-it-all low-fat zealots.

All of them are in a copy-paste friendly format. Just highlight the URLs to the studies and Click Ctrl+C (Cmd+C on mac) or right click and select “Copy.”

If you tend to get in to these online arguments a lot, I suggest you bookmark this page!
Remember Kris’s Law:

“Whatever the nutrition authorities have to say… the exact opposite is likely to be the truth!”

(Disclaimer: Many nutritionist are good people and seem to know what they are talking about, but the ones that seem to be the most active in the mainstream media seem to do little other than spreading potentially dangerous misinformation.)

Nutritionist Says: Protein is Bad For Your Bones

Put on: this face.
There are some short-term studies showing that the increased acid load from a high protein intake can lead to increased calcium excretion. That is true, but this is only a short-term phenomenon.

The long-term epidemiological studies on protein intake and bone health shows the exact opposite. Increased protein intake correlates with improved bone health and a lowered risk of fractures.

http://www.ncbi.nlm.nih.gov/pubmed/21102327
http://onlinelibrary.wiley.com/doi/10.1359/jbmr.2000.15.12.2504/full
http://www.ajcn.org/content/69/1/147.short
http://onlinelibrary.wiley.com/doi/10.1359/JBMR.040204/full
http://www.springerlink.com/content/0595572652p658w7/
http://www.jacn.org/content/24/suppl_6/526S.short

Nutritionist Says: Protein is Bad For Your Kidneys

Put on: this face.
There is NO evidence that increased protein is harmful for people with healthy kidneys.
In fact, the studies show that increased protein can lower blood pressure:

http://jama.jamanetwork.com/article.aspx?articleid=201882
http://hyper.ahajournals.org/content/38/4/821.short
http://www.ncbi.nlm.nih.gov/pubmed/20711407
…and improve blood sugar control in type II diabetics:

http://www.ajcn.org/content/78/4/734.short
http://care.diabetesjournals.org/content/25/3/425.short
http://diabetes.diabetesjournals.org/content/53/9/2375.short
High blood pressure and diabetes are the key risk factors for kidney failure. Consequently, eating more protein, not less, should be good for the kidneys.

The advice to restrict protein intake for the bones and kidneys is likely to have the exact opposite effect.

Here are two review articles that show no harmful effect of protein consumption on kidney health:

http://www.jissn.com/content/1/1/45
http://www.nutritionandmetabolism.com/content/2/1/25

Nutritionist Says: Whole Wheat is Good For You

Put on: this face.

Whole wheat raises the blood sugar faster than most other foods and its glycemic index isn’t much lower than refined wheat..

Additionally, gluten is likely to be harmful for people who don’t have celiac disease.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1954879/
http://www.ncbi.nlm.nih.gov/pubmed/21224837
http://www.ncbi.nlm.nih.gov/pubmed/6111631
Whole wheat raises small, dense LDL, which is extremely atherogenic and can lead to heart disease:

http://www.ajcn.org/content/76/2/351.short

Nutritionist Says: Low-Carb Diets Are Dangerous

Put on: this face.

This is simply not true. There are no documented severe reactions to low-carb diets and they tend to improve all the main biomarkers of disease, including HDL cholesterol, triglycerides, blood sugar, LDL particle size, blood pressure and body fat levels.

Low-carb diets have an outstanding safety profile and appear to be healthier, more effective and easier to follow than low-fat diets:

http://www.ncbi.nlm.nih.gov/pubmed/12679447
http://www.ncbi.nlm.nih.gov/pubmed/17341711
http://www.ncbi.nlm.nih.gov/pubmed/19099589
http://www.ncbi.nlm.nih.gov/pubmed/19439458
A lot more studies on this here.

Nutritionist Says: Eating Fat Makes You Fat

Put on: this face.

This seems logical enough, but doesn’t hold up in practice.

Diets that are high in fat, but low in carbs, and eaten without restricting calories are usually a lot more effective than low-fat, high-carb diets that are calorie restricted.

http://www.ncbi.nlm.nih.gov/pubmed/12761365
http://www.ncbi.nlm.nih.gov/pubmed/12761364
http://www.ncbi.nlm.nih.gov/pubmed/12679447
http://www.ncbi.nlm.nih.gov/pubmed/15148063
Again, more studies here.

Nutritionist Says: Saturated Fat is Unhealthy

Put on: this face.

Not true. Saturated fat raises HDL cholesterol and changes the LDL pattern from small, dense (bad) to large, fluffy (good).

This has been studied extensively and an association of saturated fat with heart disease has never been proven.

http://www.ajcn.org/content/77/5/1146.short
http://www.ncbi.nlm.nih.gov/pubmed/1386252
http://www.ajcn.org/content/67/5/828.short
http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract
http://www.sciencedirect.com/science/article/pii/S0899900711003145

Nutritionist Says: Eggs Are Bad For You

Put on: this face.

Not true at all. Eggs, especially the yolks, are incredibly nutritious and highly satiating. There has never been any proven association between egg consumption and cardiovascular disease.

http://www.ncbi.nlm.nih.gov/pubmed/16340654
http://onlinelibrary.wiley.com/doi/10.1111/j.1467-3010.2006.00543.x/full
http://digitalcommons.uconn.edu/dissertations/AAI3138385/

Nutritionist Says: Diet Soda Can Help You Lose Weight

Put on: this face.

This is true in the context of a controlled diet. However, most people don’t count calories and do not eat a controlled diet.

In the context of a western, ad libidum diet, epidemiological studies show that diet soda consumption is associated with severe weight gain, diabetes and the metabolic syndrome.

http://circ.ahajournals.org/content/117/6/754.full.pdf+html
http://care.diabetesjournals.org/content/32/4/688.short
http://www.nature.com/oby/journal/v16/n8/abs/oby2008284a.html

Nutritionist Says: Sugar is Just Empty Calories

Put on: this face.

It’s true that sugar is empty calories, but that’s just the tip of the iceberg. Sugar can also lead to fatty liver, insulin resistance and may be a significant contributor to the metabolic syndrome.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673878/
http://www.sciencedirect.com/science/article/pii/S0168827808001645
http://www.nature.com/nrgastro/journal/v7/n5/full/nrgastro.2010.41.html

Conclusion

Kris’s law still holds.

It doesn’t seem like it is about to change in the next few decades. Modern nutrition keeps on clinging to the old ideas that brought us the obesity epidemic and for some reason they seem completely unwilling to change their minds.

Are there any other myths (lies?) you would like me to cover? Shoot me a comment below and I’ll see if I can add them to the list.

I’d love for this post to become a “weapon” for all of us to change the world, one nutritionist at a time.
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Read the complete article here.

The UCLA Study: Elevated LDL Not Associated With Heart Attack Risk

The UCLA Study: Elevated LDL Not Associated With Heart Attack Risk Sent Wednesday, November 23, 2011

Diet Heart News, volume 1, number 8

The UCLA Study: Elevated LDL Not Associated With Heart Attack Risk Since the early 1950s, mainstream researchers have been seeking the cause of atherosclerosis and heart disease spearheaded early on by University of Minnesota professor and American Heart Association board member Ancel Keys. The result - the 50 year old Diet Heart or Cholesterol Hypothesis: If you eat too much food containing cholesterol and/or saturated fat, the level of cholesterol in your blood will rise. The excess cholesterol will be deposited in artery walls, causing them to thicken and narrow. In time, this will block blood supply to the heart or brain causing a heart attack or stroke. According to this still unproven but enduring hypothesis, high blood cholesterol is caused by an atherogenic diet high in cholesterol and saturated fat - found mainly in animal products such as red meat, whole milk, eggs, butter - and the tropical saturates coconut and palm. In this scenario, high blood cholesterol is the main cause of atherosclerosis and heart disease. The medical and nutrition communities and various government agencies have been behind Diet Heart ever since. If animal fat and high blood cholesterol are the chief villains, then cholesterol-lowering diets and cholesterol-lowering drugs would appear to be wise choices. But 50 years later - after a lengthy test of time - the incidence of heart disease has not gone down as promised, and researchers like science writer Gary Taubes have uncovered a great deal of their evidence that is unsupportable, contradictory, and hopelessly wrong. A look at the recent five year UCLA/AHA Study The UCLA research team used an American Heart Association database that included 541 hospitals across the country. The database provided detailed information on 136,905 patients hospitalized for cardiovascular disease whose lipid levels upon hospital admission were documented. The results after five years: 75 percent of patients hospitalized for a heart attack had LDL cholesterol below 130 mg/dl - in the so called safe range. Even more astounding, 50 percent of patients had LDL below 100 mg/dL - considered optimal. (21 percent of the patients were taking a statin cholesterol-lowering drug.) Now don't you think that the UCLA researchers would have concluded that there was no association between elevated LDL and risk of heart attacks? After all, this was a five year study of heart attacks suffered by 136,905 patients in an American Heart Association database that included records from 541 hospitals. Yes - this should have been the nail in the coffin for the Diet Heart or Cholesterol Hypothesis, but not according to study director Dr. Gregg C. Fanarow, Professor of Cardiovascular Medicine and Science, David Geffen School of Medicine, UCLA, who concluded: "Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk... " May not be low enough! Low cholesterol is already associated with depression and death by accidents, cancer and violence. According to the American Heart Association's journal Circulation, 1992; 86:3, the all cause death rate increases when total cholesterol drops below 180. Isn't there sufficient evidence now to conclude that elevated LDL and total cholesterol are not the cause of heart attacks and that the cholesterol hypothesis should be discarded along with official low fat diets and cholesterol-lowering drugs? Don't hold your breath! UK cardiologist Dr. Malcolm Kendrick: "I have come to realize that there is, literally, no evidence that can dent the cholesterol hypothesis... The effect of this study on the cardiovascular research community was....as you would expect...nothing at all, a deafening silence..." Dr. Fonarow disclosed that he has conducted research for GlaxoSmithKline and Pfizer and serves as a consultant and has received honorarium from the following drug companies: Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer and Schering Plough. Dr. H. Bryan Brewer, a physician-scientist at the National Heart, Lung and Blood Institute, failed to disclose his ties to AstraZeneca. Brewer had previously written a glowing report in a medical journal about Crestorwithout disclosing that he is a paid consultant and had presided over a company-sponsored symposium." He and the others forgot! Earlier in 2004, the doctors in the National Cholesterol Education Program (NCEP) who wrote the current cholesterol guidelines and, in effect, control cardiology, failed to disclose that six of the nine authors had direct financial ties to the makers of statin drugs, including: Pfizer's Lipitor, Bristol-Myers Squibb's Pravachol, Merck's Lovastatin, and AstraZeneca's Crestor. The new more stringent cholesterol-lowering guidelines boosted statinsales from $15 billion in 2004 to over $23 billion in 2005. And now the UCLA study provides more proof that lowering cholesterol with drugs or diet will not reduce cardiovascular disease or the risk of heart attack. But as Winston Churchill said: "Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened." [especially if there is money to be made]. ================================================================= Read the complete article here.

I Wish I Had Lipoprotein(a)!

Posted on August 8, 2012 by Dr. Davis

 

Why would I say such a thing? Well, a number of reasons. People with lipoprotein(a), or Lp(a), are, with only occasional exceptions:

–Very intelligent. I know many people with this genetic pattern with IQs of 130, 140, even 160+.

–Good at math–This is true more for the male expression of the pattern, only occasionally female. It means that men with Lp(a) gravitate towards careers in math, accounting, financial analysis, physics, and engineering.

–Athletic–Many are marathon runners, triathletes, long-distance bicyclists, and other endurance athletes. I tell my patients that, if they want to meet other people with Lp(a), go to a triathlon.

–Poor at hydrating. People with Lp(a) have a defective thirst mechanism and often go for many hours without drinking water. This is why many Lp(a) people experience the pain of kidney stones: Prolonged and repeated dehydration causes crystals to form in the kidneys, leading to stone formation over time.

–Tolerant to dehydration–Related to the previous item, people with Lp(a) can go for extended periods without even thinking about water.

–Tolerant to periods of food deprivation or starvation–More so than other people, those with Lp(a) are uncommonly tolerant to days without food, as would occur in a wild setting.

In short, people with Lp(a) are intelligent, athletic, with many other favorable characteristics that provide a survival advantage . . . in a primitive world.

So when did Lp(a) become a problem? When an individual with Lp(a) is exposed to carbohydrates, especially those from grains. When an evolutionarily-advantaged Lp(a) individual is exposed to carbohydrates, more than other people they develop:

–Excess quantities of small LDL particles–Recall that Lp(a) is a two-part molecule. One part: an apo(a) made by the liver. 2nd part: an LDL particle. When the LDL particle within the Lp(a) molecule is small, its overall behavior is worse or more atherogenic (plaque-causing).

–Hyperglycemia/hyperinsulinemia–which then leads to diabetes. Unlike non-Lp(a) people, these phenomena can develop with far less visceral fat. A Lp(a) male, for instance, standing 5 ft 10 inches tall and weighing 150 pounds, can have as much insulin resistance/hyperglycemia as a non-Lp(a) male of similar height weighing 50+ pounds more.

Key to gaining control over Lp(a) is strict carbohydrate limitation. Another way to look at this is to say that Lp(a) people do best with unlimited fat and protein intake.
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Read the complete article here.