What percentage of a cholesterol decrease can be attributed to statins ?



Matti Narkia wrote:

> 15 Oct 2003 10:01:31 -0700 in article
> <[email protected]> [email protected] (Dr.
> Andrew B. Chung, MD/PhD) wrote:
>
> >Matti Narkia <[email protected]> wrote in message news:<[email protected]>...
> >> Tue, 14 Oct 2003 14:27:20 -0400 in article <[email protected]>
> >> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
> >> >
> >> >Ketones remain a physiologically bad thing.
> >> >
> >> Please elaborate. References?

> >
> >Drink a bottle of acetone (a ketone) and get back with us about your experience.

>
> Is that your medical advice?
>


If you want medical advice, you'll have to call my office for an appointment.


--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
[email protected]lid wrote:

> On Tue, 14 Oct 2003 14:13:32 -0400, "Dr. Andrew B. Chung, MD/PhD"
> <[email protected]> wrote:
>
> >> >Ime, you still run the risk of rapid regain as described above.
> >>
> >> But what would be the mechanism for this regain?

> >
> >See above.

>
> Much too vague. No useful information. Seems like a low probability.
> I'm not worried.
>
> >
> >> I have NO desire to
> >> eat other foods.

> >
> >Perhaps at this point in time. Can you really say you never will have?

>
> I am stating the probability, which is, of course, never 100%, but
> still quite high.
>
> >> I have, for many years, had more than 2 pounds of vegetables each day.
> >> As part of my lunch, I had a pound of vegetables, and the total
> >> calories, as given on the package, were about 170. Add another 20-30
> >> calories for the delicious sauce and we're at about 200. Some protein
> >> and a few carbs brought it to about 600. I was QUITE full and TOTALLY
> >> satisfied, largely because of the vegis and spices. It also has a LOT
> >> of nutrition built in. Tell me what's wrong with this approach?
> >>

> >
> >The quantity is a problem.

>
> Why is it a problem? Too many calories (not true)? Too much fat (not
> true)? Wrong kind of fat (not true)? Why, EXACTLY, is quantity the
> problem, assuming I eat as described and do NOT gain weight?
>
> >> I have been free for years to change to another diet, but I have no
> >> desire to do so. Why would I change?

> >
> >Only you and God would know.

>
> The half that I know says there will not be a change.
>
> >> Are you suggesting that I have
> >> some deep, hidden "preference" that has not come out despite years of
> >> opportunity to do so?
> >>

> >
> >It remains possible.

>
> Probabilities are more important than possibilities. It is POSSIBLE
> that both of us could be killed simultaneously, each by a 10.45 pound
> meteorite. Who cares? The probability is too low to worry about.
>
> Would you agree that the probability of "rapid regain" is low, based
> on what has been happening for years? If not, please tell me what
> mechanism would reverse the probability so drastically? It is POSSIBLE
> that I could get some malady to cause me to gorge myself, as you
> suggest. Is that PROBABLE, given what you know?
>
> vic


If you had a handle on the amount of food you are eating, rapid weight regain
would be impossible.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Tue, 14 Oct 2003 19:17:13 GMT in article
<[email protected]> Matti Narkia <[email protected]>
wrote:

>Tue, 14 Oct 2003 14:43:41 -0400 in article <[email protected]>
>"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
>
>>Matti Narkia wrote:
>>
>>> Tue, 14 Oct 2003 14:25:22 -0400 in article <[email protected]>
>>> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
>>>
>>> >> It's true that type 2 diabetes
>>> >> is much more common with overweight people, but normal bodyweight does not give
>>> >> 100% protection against it.
>>> >>
>>> >
>>> >Ime, it does seem to do exactly that.
>>>
>>> Not true.
>>>
>>>

>>
>>Sorry, it is the truth.

>
>Tell that to my in-law and have a look at the
>
>Type 2 Diabetes in Children and
>A d o l e s c e n t s
>C O N S E N S U S S T A T E M E N T
>AMERICAN DIABETES ASSOCIATION
>http://care.diabetesjournals.org/cgi/reprint/23/3/381.pdf
>
>From page 2:
>
> "... As noted above, obesity is a hallmark of type 2 diabetes, with
> up to 85% of affected children either overweight or obese at
> diagnosis. ..."
>
>IMHO 85% is less than 100%.


Here some additional evidence for those, who still may not convinced that even
normal weight people can get type 2 diabetes (although risk is very small):

Goodpaster BH, Krishnaswami S, Resnick H, Kelley DE, Haggerty C, Harris TB,
Schwartz AV, Kritchevsky S, Newman AB. Related Articles, Links
Association between regional adipose tissue distribution and both type 2
diabetes and impaired glucose tolerance in elderly men and women.
Diabetes Care. 2003 Feb;26(2):372-9.
PMID: 12547865 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12547865&dopt=Abstract

"CONCLUSIONS: Elderly men and women with normal body weight may be at
risk for metabolic abnormalities, including type 2 diabetes, if they
possess an inordinate amount of muscle fat or visceral abdominal
fat."


NORMAL WEIGHT ELDERLY STILL MAY BE AT RISK FOR DEVELOPING DIABETES, ACCORDING
TO UNIVERSITY OF PITTSBURGH STUDY
PITTSBURGH, Feb. 13, 2003
http://newsbureau.upmc.com/medsurg1/goodpasterdiabetescarestudy.htm

"“Our study found that, even though an elderly person may not be
overweight, he or she might still be at risk for developing
diabetes,” said Bret H. Goodpaster, Ph.D., of the University of
Pittsburgh division of endocrinology and metabolism and principal
investigator of the study.

[...]

The study found that among those with type 2 diabetes, 22 percent
were normal-weight men and 12 percent were normal-weight women.
Another 14 percent of men and 22 percent of women had impaired
glucose tolerance. Taken from another perspective, this means that
two thirds of men with type 2 diabetes were not obese. A similar
pattern emerged for women."


eMJA: 1: Epidemiology and prevention of type 2 diabetes and the metabolic
syndrome
http://www.mja.com.au/public/issues/179_07_061003/sha10375_fm.html

"Type 2 diabetes is a complex metabolic disorder characterised by
hyperglycaemia and associated with a relative deficiency of insulin
secretion, along with a reduced response of target tissues to insulin
(insulin resistance). Its metabolic and clinical features are
heterogeneous; people with type 2 diabetes range from those of normal
weight or underweight with a predominant deficiency of insulin
secretion (in whom slowly evolving type 1 diabetes should be
considered) to the more common obese person with substantial insulin
resistance."


Is Hyperglycemia the Major Culprit in Diabetes or Simply a Marker of
Endothelial Dysfunction?
Eric S. Freedland, MD
http://www.diabetesincontrol.com/friedman/Counter4.shtml

"At least 90 percent of patients with type 2 diabetes are overweight.
While simply being overweight is a risk for type 2 diabetes, one must
also bear in mind that a subset of non-obese adults without apparent
glucose abnormalities can rapidly develop type 2 diabetes, which may
be attributable to an autoimmune and inflammatory process."


Pharmacological therapy for Type 2 diabetes
http://www.medforum.nl/idm/pharmacological_therapy_for____.htm

"The author recommends sulfonylurea treatment as monotherapy in
normal weight Type 2 diabetics and metformin in those who are
overweight."


--
Matti Narkia
 
Wed, 15 Oct 2003 16:12:42 -0400 in article <[email protected]>
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
>
>If you want medical advice, you'll have to call my office for an appointment.


With all due respect, I'm afraid that you won't qualify for my purposes.



--
Matti Narkia
 
Matti Narkia wrote:

> <snip>Is Hyperglycemia the Major Culprit in Diabetes or Simply a Marker of
> Endothelial Dysfunction?
> Eric S. Freedland, MD
> http://www.diabetesincontrol.com/friedman/Counter4.shtml
>
> "At least 90 percent of patients with type 2 diabetes are overweight.
> While simply being overweight is a risk for type 2 diabetes, one must
> also bear in mind that a subset of non-obese adults without apparent
> glucose abnormalities can rapidly develop type 2 diabetes, which may
> be attributable to an autoimmune and inflammatory process."
>


The latter would not be true type 2 diabetes but rather more akin to type 1 since there would be islet
cell failure.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Matti Narkia wrote:

> Wed, 15 Oct 2003 16:12:42 -0400 in article <[email protected]>
> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
> >
> >If you want medical advice, you'll have to call my office for an appointment.

>
> With all due respect, I'm afraid that you won't qualify for my purposes.
>
>


Then why are you here hanging out in a cardiology newsgroup?

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:

>> "At least 90 percent of patients with type 2 diabetes are overweight.
>> While simply being overweight is a risk for type 2 diabetes, one must
>> also bear in mind that a subset of non-obese adults without apparent
>> glucose abnormalities can rapidly develop type 2 diabetes, which may
>> be attributable to an autoimmune and inflammatory process."
>>

>
>The latter would not be true type 2 diabetes but rather more akin to type 1 since there would be islet
>cell failure.


Sure sounds like it, unless he's speculating about an attack outside the
islets that mimics/causes type 2. Some sort of systemic autoimmune activity is
possible, but this looks like no more than speculation to me.
--
Jim Chinnis Warrenton, Virginia, USA
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:

>Matti Narkia wrote:


>> With all due respect, I'm afraid that you won't qualify for my purposes.
>>
>>

>
>Then why are you here hanging out in a cardiology newsgroup?


Providing us with great, detailed information and a willingness to put the
science first?

I greatly appreciate Matti Narkia's contributions. They fit well in this
science newsgroup.
--
Jim Chinnis Warrenton, Virginia, USA
 
On Wed, 15 Oct 2003 16:31:00 -0400, "Dr. Andrew B. Chung, MD/PhD"
<[email protected]> wrote:

>> Probabilities are more important than possibilities. It is POSSIBLE
>> that both of us could be killed simultaneously, each by a 10.45 pound
>> meteorite. Who cares? The probability is too low to worry about.
>>
>> Would you agree that the probability of "rapid regain" is low, based
>> on what has been happening for years? If not, please tell me what
>> mechanism would reverse the probability so drastically? It is POSSIBLE
>> that I could get some malady to cause me to gorge myself, as you
>> suggest. Is that PROBABLE, given what you know?
>>
>> vic

>
>If you had a handle on the amount of food you are eating, rapid weight regain
>would be impossible.


I don't want to get in a debate about your 2 pound diet. You seem to
be getting enough debate as it is, and I don't want to add to it.
Given the somewhat extreme nature of the debate, perhaps it is too
hard for you to admit, on this list, that another approach might be
good.

I would say that if you had a handle on the TYPE of food you are
eating, rapid weight regain would be impossible. The basis for this is
that if I wish, I can STUFF myself, 3 times a day, with well over 2
pounds of food total. I feel perfectly satisfied, get excellent
nutrition, and never gain weight. It seems to work at least as well as
any diet I have seen, and much better than most in the long run.

I will end with this, though, so as not to open another front in the
assault. <g>

vic
 
[email protected]lid wrote:

> On Wed, 15 Oct 2003 16:31:00 -0400, "Dr. Andrew B. Chung, MD/PhD"
> <[email protected]> wrote:
>
> >> Probabilities are more important than possibilities. It is POSSIBLE
> >> that both of us could be killed simultaneously, each by a 10.45 pound
> >> meteorite. Who cares? The probability is too low to worry about.
> >>
> >> Would you agree that the probability of "rapid regain" is low, based
> >> on what has been happening for years? If not, please tell me what
> >> mechanism would reverse the probability so drastically? It is POSSIBLE
> >> that I could get some malady to cause me to gorge myself, as you
> >> suggest. Is that PROBABLE, given what you know?
> >>
> >> vic

> >
> >If you had a handle on the amount of food you are eating, rapid weight regain
> >would be impossible.

>
> I don't want to get in a debate about your 2 pound diet. You seem to
> be getting enough debate as it is, and I don't want to add to it.
> Given the somewhat extreme nature of the debate, perhaps it is too
> hard for you to admit, on this list, that another approach might be
> good.
>


Closely supervised feedings might be good :)

>
> I would say that if you had a handle on the TYPE of food you are
> eating, rapid weight regain would be impossible.


Actually, all-you-can-eat of any TYPE of food makes rapid weight regain possible.

> The basis for this is
> that if I wish, I can STUFF myself, 3 times a day, with well over 2
> pounds of food total. I feel perfectly satisfied, get excellent
> nutrition, and never gain weight.


That would be a logically flawed basis.

> It seems to work at least as well as
> any diet I have seen, and much better than most in the long run.
>


In other words, it would not work.

>
> I will end with this, though, so as not to open another front in the
> assault. <g>
>
> vic


See:

http://www.heartmdphd.com/wtloss.asp

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Jim Chinnis wrote:

> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:
>
> >Matti Narkia wrote:

>
> >> With all due respect, I'm afraid that you won't qualify for my purposes.
> >>
> >>

> >
> >Then why are you here hanging out in a cardiology newsgroup?

>
> Providing us with great, detailed information and a willingness to put the
> science first?
>
> I greatly appreciate Matti Narkia's contributions. They fit well in this
> science newsgroup.


Then you'd better advise Matti to believe that ketones are bad rather than find
out from drinking a bottle of it.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
On Wed, 15 Oct 2003 22:50:49 -0400, "Dr. Andrew B. Chung, MD/PhD"
<[email protected]> wrote:

>> >If you had a handle on the amount of food you are eating, rapid weight regain
>> >would be impossible.

>>
>> I don't want to get in a debate about your 2 pound diet. You seem to
>> be getting enough debate as it is, and I don't want to add to it.
>> Given the somewhat extreme nature of the debate, perhaps it is too
>> hard for you to admit, on this list, that another approach might be
>> good.
>>

>
>Closely supervised feedings might be good :)


Your range of alternatives leaves out a lot of rather good
possibilities.

>> I would say that if you had a handle on the TYPE of food you are
>> eating, rapid weight regain would be impossible.

>
>Actually, all-you-can-eat of any TYPE of food makes rapid weight regain possible.


That's NOT what I said. You are twisting my words, and I do not
appreciate it. Read MY statement again. I was assuming my "had a
handle" means the same as your "had a handle". You conveniently left
that out of your answer, which distorted the meaning of what I said.

Since I seem to have to spell it out for you, what I mean is that you
can eat enough to stuff yourself IF you "had a handle" on it, meaning
you CONTROL the TYPE of food. In the specific case I am discussing the
food you can stuff yourself with has about 200 cal/pound. I normally
can't eat more than about 1.5 pounds at a meal, because I am stuffed.
So, if I stuffed myself for all 3 meals, I would have about 900 cal.
I'm NOT going to get fat on 900 cal/day. Do you think I will get fat
on 900 cal/day?

I can't wait to see how you twist this one so you won't have to admit
that someone can eat more than 2 pounds a day, for an extended period,
and not gain weight. <g>

>> The basis for this is
>> that if I wish, I can STUFF myself, 3 times a day, with well over 2
>> pounds of food total. I feel perfectly satisfied, get excellent
>> nutrition, and never gain weight.

>
>That would be a logically flawed basis.


See the above. (One of your favorites. <g>)

>> It seems to work at least as well as
>> any diet I have seen, and much better than most in the long run.
>>

>
>In other words, it would not work.


Why not? Are you saying I, or anyone else, will get fat on 900
cal/day? If they will not get fat, then the diet will work.

We already know, from my experience, that I can maintain it for an
extended period. I have tried others, even those prescribed by
doctors, and they are MUCH harder to stay on than my present one.

>> I will end with this, though, so as not to open another front in the
>> assault. <g>


Actually, I won't just yet because I don't like people twisting my
words just so they won't have to admit something. I'm beginning to
understand why you generate so much animosity here.

I guess it IS too hard to admit. You are really doing a disservice to
others by presenting such a biased discussion, especially under the
guise of a doctor. Too bad. I was hoping for something better.

vic
 
[email protected]lid wrote:

> On Wed, 15 Oct 2003 22:50:49 -0400, "Dr. Andrew B. Chung, MD/PhD"
> <[email protected]> wrote:
>
> >> >If you had a handle on the amount of food you are eating, rapid weight regain
> >> >would be impossible.
> >>
> >> I don't want to get in a debate about your 2 pound diet. You seem to
> >> be getting enough debate as it is, and I don't want to add to it.
> >> Given the somewhat extreme nature of the debate, perhaps it is too
> >> hard for you to admit, on this list, that another approach might be
> >> good.
> >>

> >
> >Closely supervised feedings might be good :)

>
> Your range of alternatives leaves out a lot of rather good
> possibilities.
>


Did someone ask for a range?

>
> >> I would say that if you had a handle on the TYPE of food you are
> >> eating, rapid weight regain would be impossible.

> >
> >Actually, all-you-can-eat of any TYPE of food makes rapid weight regain possible.

>
> That's NOT what I said.


If you don't have a handle on quantity, that is what you mean.

> You are twisting my words,


Hardly.

> and I do not
> appreciate it.


Some folks can't handle the truth.

> Read MY statement again.


Have already.

> I was assuming my "had a
> handle" means the same as your "had a handle".


Doesn't it?

> You conveniently left
> that out of your answer, which distorted the meaning of what I said.
>


Hardly.

>
> Since I seem to have to spell it out for you, what I mean is that you
> can eat enough to stuff yourself IF you "had a handle" on it, meaning
> you CONTROL the TYPE of food.


You just contradicted yourself.

> In the specific case I am discussing the
> food you can stuff yourself with has about 200 cal/pound. I normally
> can't eat more than about 1.5 pounds at a meal,


Glad to hear that you have come around to weighing your food.

Congratulations, you now have a handle on what you are eating and drinking.

> because I am stuffed.
> So, if I stuffed myself for all 3 meals, I would have about 900 cal.
> I'm NOT going to get fat on 900 cal/day. Do you think I will get fat
> on 900 cal/day?
>


Not if you have a handle on the quantity of food & drink you are taking in.

>
> I can't wait to see how you twist this one so you won't have to admit
> that someone can eat more than 2 pounds a day, for an extended period,
> and not gain weight. <g>
>


A person who is stuffing himself or herself runs the risk of rapid regain of any
weight that may have been lost on any diet.

>
> >> The basis for this is
> >> that if I wish, I can STUFF myself, 3 times a day, with well over 2
> >> pounds of food total. I feel perfectly satisfied, get excellent
> >> nutrition, and never gain weight.

> >
> >That would be a logically flawed basis.

>
> See the above. (One of your favorites. <g>)
>


Yes, please do.

>
> >> It seems to work at least as well as
> >> any diet I have seen, and much better than most in the long run.
> >>

> >
> >In other words, it would not work.

>
> Why not? Are you saying I, or anyone else, will get fat on 900
> cal/day? If they will not get fat, then the diet will work.
>


See above.

>
> We already know, from my experience, that I can maintain it for an
> extended period. I have tried others, even those prescribed by
> doctors, and they are MUCH harder to stay on than my present one.
>


Ask your doctor about trying the 2PD approach as described at:

http://www.heartmdphd.com/wtloss.asp

>
> >> I will end with this, though, so as not to open another front in the
> >> assault. <g>

>
> Actually, I won't just yet because I don't like people twisting my
> words just so they won't have to admit something. I'm beginning to
> understand why you generate so much animosity here.
>


Simply writing truthfully.

>
> I guess it IS too hard to admit. You are really doing a disservice to
> others by presenting such a biased discussion, especially under the
> guise of a doctor.


Not a guise. Sorry.

> Too bad. I was hoping for something better.
>


Here is my better:

http://www.heartmdphd.com/healer.asp


God's humble servant,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Wed, 15 Oct 2003 22:51:50 -0400 in article <[email protected]>
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:

>Jim Chinnis wrote:
>
>> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:
>>
>> >Matti Narkia wrote:

>>
>> >> With all due respect, I'm afraid that you won't qualify for my purposes.
>> >>
>> >>
>> >
>> >Then why are you here hanging out in a cardiology newsgroup?

>>
>> Providing us with great, detailed information and a willingness to put the
>> science first?
>>
>> I greatly appreciate Matti Narkia's contributions. They fit well in this
>> science newsgroup.

>
>Then you'd better advise Matti to believe that ketones are bad rather than find
>out from drinking a bottle of it.


Hmmm ... Let's find out how bad a ketogenic diet really is by reading a couple
of citations from the study:

Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, Volek JS.
A ketogenic diet favorably affects serum biomarkers for cardiovascular disease
in normal-weight men.
J Nutr. 2002 Jul;132(7):1879-85.
PMID: 12097663 [PubMed - indexed for MEDLINE]
http://www.nutrition.org/cgi/content/full/132/7/1879 (full text)
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12097663&dopt=Abstract

"... There were significant decreases in fasting serum TAG (-33%),
postprandial lipemia after a fat-rich meal (-29%), and fasting serum
insulin concentrations (-34%) after men consumed the ketogenic diet.
Fasting serum total and LDL cholesterol and oxidized LDL were
unaffected and HDL cholesterol tended to increase with the ketogenic
diet (+11.5%; P = 0.066). In subjects with a predominance of small
LDL particles pattern B, there were significant increases in mean and
peak LDL particle diameter and the percentage of LDL-1 after the
ketogenic diet. There were no significant changes in blood lipids in
the control group. To our knowledge this is the first study to
document the effects of a ketogenic diet on fasting and postprandial
CVD biomarkers independent of weight loss. The results suggest that a
short-term ketogenic diet does not have a deleterious effect on CVD
risk profile and may improve the lipid disorders characteristic of
atherogenic dyslipidemia.

[...]

There were changes in the distribution of the LDL subfractions that
would be considered favorable in terms of CVD. We observed general
increases in the mean and peak LDL particle sizes during the
ketogenic diet, which were more pronounced in subjects that exhibited
a pattern B distribution at the start of the study. Individuals with
pattern B exhibit a predominance of small dense lipoproteins and this
distribution is associated with increased risk of CVD (13 ,14 ) and
was recently shown to be the best discriminate factor for the
presence of CVD even when adjusting for other risk factors (21 ).
Although the characterization of pattern B is likely to have a
genetic origin (22 ), changes in diet are known to influence the
distribution of LDL subclasses. For example, switching to a fat-rich
diet (46% vs. 24% of total energy) was shown to increase mean
particle diameter and large LDL-1 mass and decrease small dense LDL-
III cholesterol (28 ), while reductions in dietary fat have the
opposite effect (6 ,7 ). Despite the changes in LDL size, we did not
observe any significant changes in oxidized LDL concentrations.
Collectively these studies indicate that when dietary fat is reduced,
the distribution of LDL moves toward a smaller more dense particle
and when dietary fat is increased the distribution of LDL moves
toward a larger less dense particle. The reason some individuals are
more stable in their LDL subclass distribution in response to changes
in diet is unknown but is likely to reflect complex interactions
between metabolic and genetic traits that are influenced to varying
extents depending on the level of dietary fat (1 ,7 ).

We observed a significant decrease in fasting and postprandial
insulin responses after the ketogenic diet. Decreases in resting
insulin concentrations have been reported in response to 3–4 d of a
low-carbohydrate diet high in fat (34 –38 ). The mechanism for such a
response probably resides in the greater reliance on fat oxidation
induced by dietary carbohydrate restriction (39 ) and subsequent
reduced requirement for insulin to assist in glucose uptake. To our
knowledge, the reduced postprandial insulin response to a fat-rich
meal observed after a ketogenic diet has not been reported in the
literature. According to our estimate of insulin resistance using
fasting levels of glucose and insulin, subjects in this study were
not insulin resistant and there was no adverse effect of the
ketogenic diet on insulin sensitivity. This is in agreement with
other studies showing no adverse effects on glucose metabolism or
insulin resistance after ketogenic diets using the insulin clamp
technique (40 ,41 ).

Numerous studies now suggest that high-carbohydrate diets can raise
TAG levels, create small, dense LDL particles, and reduce HDL
cholesterol (i.e., atherogenic dyslipidemia)—a combination along with
insulin resistance, that has been termed syndrome X (42 ,43 ).
Syndrome X is postulated to be resistance to insulin-mediated glucose
disposal by muscle (44 ), 30% of adult males and 10% to 15% of
postmenopausal women have this particular syndrome X profile, which
is associated with several-fold increase in heart disease risk.
Replacing saturated fat with carbohydrate appears to accentuate
insulin concentrations and the atherogenic dyslipidemia associated
with syndrome X (44 ,45 ). The ketogenic diet in this study resulted
in favorable responses in fasting TAG, postprandial lipemia, HDL-C,
LDL particle size, and insulin levels in healthy normolipidemic men.
Although the duration of the diet was short (6 wk), these data
suggest that a ketogenic diet does not have an adverse effect on
accepted biochemical risk factors for CVD and improves those
associated with syndrome X."


As for high-carbohydrate diets I repeat the following quote from above:

"Numerous studies now suggest that high-carbohydrate diets can raise
TAG levels, create small, dense LDL particles, and reduce HDL
cholesterol (i.e., atherogenic dyslipidemia)—a combination along with
insulin resistance, that has been termed syndrome X (42 ,43 )"

Doesn't sound too good?


See also

Ketogenic Diet Reduces Seizures In Many Children, Hopkins Researchers Find
http://www.sciencedaily.com/releases/2001/10/011001071818.htm

Hemingway C, Freeman JM, Pillas DJ, Pyzik PL.
The ketogenic diet: a 3- to 6-year follow-up of 150 children enrolled
prospectively.
Pediatrics. 2001 Oct;108(4):898-905.
PMID: 11581442 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11581442&dopt=Abstract

"... CONCLUSION: Three to 6 years after initiation, the ketogenic
diet had proven to be effective in the control of difficult-to-
control seizures in children. The diet often allows decrease or
discontinuation of medication. It is more effective than many of the
newer anticonvulsants and is well-tolerated when it is effective."

--
Matti Narkia
 
Mon, 06 Oct 2003 21:30:34 -0400 in article <[email protected]>
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:

>Thorsten Schier wrote:
>
>> However, a very-low-carbohydrate
>> diet improves all aspects of
>> atherogenic dyslipidemia, decreasing fasting
>> and postprandial triglyceride levels, increasing
>> HDL, increasing LDL size, and decreasing
>> insulin, independent of weight loss.14,23"
>>

>
>Ime, this effect has not been independent of weight loss. Without weight loss, LC dieters rarely improve their lipid
>profile.
>

Sharman et al. found that this is not true. See below:

Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, Volek JS.
A ketogenic diet favorably affects serum biomarkers for cardiovascular disease
in normal-weight men.
J Nutr. 2002 Jul;132(7):1879-85.
PMID: 12097663 [PubMed - indexed for MEDLINE]
http://www.nutrition.org/cgi/content/full/132/7/1879 (full text)
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12097663&dopt=Abstract

"ABSTRACT
Very low-carbohydrate (ketogenic) diets are popular yet little is
known regarding the effects on serum biomarkers for cardiovascular
disease (CVD). This study examined the effects of a 6-wk ketogenic
diet on fasting and postprandial serum biomarkers in 20 normal-
weight, normolipidemic men. Twelve men switched from their habitual
diet (17% protein, 47% carbohydrate and 32% fat) to a ketogenic diet
(30% protein, 8% carbohydrate and 61% fat) and eight control
subjects consumed their habitual diet for 6 wk. Fasting blood
lipids, insulin, LDL particle size, oxidized LDL and postprandial
triacylglycerol (TAG) and insulin responses to a fat- rich meal were
determined before and after treatment. There were significant
decreases in fasting serum TAG (-33%), postprandial lipemia after a
fat-rich meal (-29%), and fasting serum insulin concentrations
(-34%) after men consumed the ketogenic diet. Fasting serum total
and LDL cholesterol and oxidized LDL were unaffected and HDL
cholesterol tended to increase with the ketogenic diet (+11.5%; P =
0.066). In subjects with a predominance of small LDL particles
pattern B, there were significant increases in mean and peak LDL
particle diameter and the percentage of LDL-1 after the ketogenic
diet. There were no significant changes in blood lipids in the
control group. To our knowledge this is the first study to document
the effects of a ketogenic diet on fasting and postprandial CVD
biomarkers independent of weight loss. The results suggest that a
short-term ketogenic diet does not have a deleterious effect on CVD
risk profile and may improve the lipid disorders characteristic of
atherogenic dyslipidemia."

--
Matti Narkia
 
Tue, 14 Oct 2003 08:40:27 GMT in article
<[email protected]> Matti Narkia <[email protected]>
wrote:

>Mon, 13 Oct 2003 14:04:47 -0400 in article <[email protected]>
>"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote:
>>> comes to the merits of low-carb diets.
>>>

>>Pray tell why are you a big proponent of low-carb diets when there is obviously minimal data to support it despite its 30
>>year history?

>
>That seems to be changing. There have been recently some good quality studies,
>which were mentioned here, and the following yesterday's news article tells
>about yet another study:
>
>Low-Carb Diets Are Working, Study Says
>http://story.news.yahoo.com/news?tmpl=story&cid=534&e=4&u=/ap/20031013/ap_on_he_me/low_carb_mystery
>http://www.boston.com/yourlife/heal.../10/13/low_carb_diets_are_working_study_says/
>

Actually, there seems to be also quite old low carb studies in the medline, if
one bothers look for them. Here some:

1: Rabast U, Vornberger KH, Ehl M.
Loss of weight, sodium and water in obese persons consuming a high- or
low-carbohydrate diet.
Ann Nutr Metab. 1981;25(6):341-9.
PMID: 7332312 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7332312&dopt=Abstract

Abstract:

"Isocaloric 5.61 mJ (1,340 kcal) formula diets involving the
isocaloric exchange of fat and carbohydrate were fed to 21 obese
persons selected for sex, height, and weight before the start of the
treatment and distributed over three groups. The weight loss observed
during the carbohydrate-restricted diets was significantly greater
than during the high-carbohydrate diet. After 28 days of treatment
the weight loss recorded on the high-carbohydrate diet was 9.5 +/-
0.7 kg, as compared to 11.4 +/- 0.7 kg (p less than 0.05) on the corn
oil-containing diet and 12.5 +/- 0.9 kg (p less than 0.01) on the
butter-fat-containing diet. The weight loss achieved was not
dependent on the type of fat administered (saturated vs.
polyunsaturated). When calculated cumulatively, sodium excretion
during the first 7 days was significantly greater on the low-
carbohydrate diet, whereas after 28 days the total amount of sodium
excreted was highest on the high-carbohydrate diet. Potassium
excretion during the low-carbohydrate diets was significantly greater
for as long as 14 days, but at the end of the experimental period the
observed differences no longer attained statistical significance. At
no time did the intake and loss of fluid and the balances calculated
therefrom show significant differences. From the findings obtained it
appears that the alterations in the water and electrolyte balance
observed during the low-carbohydrate diets are reversible phenomena
and should thus not be regarded as causal agents of the different
weight reduction."

2: Rabast U, Schonborn J, Kasper H.
Dietetic treatment of obesity with low and high-carbohydrate diets: comparative
studies and clinical results.
Int J Obes. 1979;3(3):201-11. Review.
PMID: 395115 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=395115&dopt=Abstract

Abstract:

"In spite of numerous studies in the literature, it is still
questionable as to whether the isocaloric exchange of carbohydrate
and fat, in the form of a diet, leads to different degrees of weight
loss. In comparative studies, obese patients given a low-carbohydrate
(4.14 MJ [1000 kcal]) formula diet (diet Ia) lost 14.0 +/- 1.4 kg and
those given an iso-energetic high-carbohydrate diet (diet Ib) 9.8 +/-
0.9 kg. The degree of weight loss was significantly different. Daily
weight losses were 362 g and 298 g respectively. Comparative studies
of high and low-carbohydrate (7.83 MJ [1900 kcal]) formula diets
(diets IIa and b) with a greater number of calories did not show any
significant difference. However, there was a greater mean weight loss
with the low-carbohydrate diet (351 g/day) compared with that under
the high-carbohydrate diet (296 g/day). Evaluation of 117 patients
treated with formula diets resulted in a weight loss of over 9 kg in
102 obese patients and over 18 kg in 52 patients. The good response
to the low-carbohydrate diet was partly responsible for the
successful therapy."

3: Rabast U, Kasper H, Schonborn J.
Comparative studies in obese subjects fed carbohydrate-restricted and high
carbohydrate 1,000-calorie formula diets.
Nutr Metab. 1978;22(5):269-77.
PMID: 662209 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=662209&dopt=Abstract

Abstract:

"45 obese subjects were fed a high-carbohydrate, relatively low-fat,
or a low-carbohydrate, relatively high-fat 1,000-calorie (4.14MJ)
formula diet. The diet provided for an isoenergetic substitution of
170 g of carbohydrates for 75 g of fat. Weight reduction up to day 30
was significantly higher in the subjects on the carbohydrate-
restricted diet. There were no significant differences between the
water and electrolyte balances. The mean total weight reduction
achieved on the high-carbohydrate diet was 9.8 +/- 4.5kg with a mean
daily weight loss of 298 +/- 80g, while the corresponding values on
the carbohydrate-restricted diet were 14 +/- 7.2 kg and 362 +/- 91
g/day, respectively."

4: Rabast U, Kasper H, Schonborn J.
[Treatment of obesity with low-carbohydrate diets (author's transl)]
Med Klin. 1975 Apr 11;70(15):653-7. German.
PMID: 1143166 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1143166&dopt=Abstract

Abstract:

"Therapeutic problems with low-carbohydrate diets in the weight
reduction of the obese are summarized presenting results of the
literature and results of the own group. The small number of patients
and the short periods of treatment do account to the controverse
results observed by other authors with low-carbohydrate diets. Also
studies performed under ambulant conditions should be interpreted
carefully. The therapeutic effect of the low-carbohydrate formula
diet tested, satisfied even in comparison with a diet discribed in
other studies. Concentrations of plasma triglycerides and cholesterol
elevated in part turned to normal during therapy. There were no side
effects of the gastro-intestinal tract. Hypocaloric diets with
reduction of carbohydrates are discussed to have a good therapeutic
effect for the following reasons: High value of satiety and increase
of the metabolic rate."


--
Matti Narkia
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:

>Jim Chinnis wrote:
>
>> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:
>>
>> >Matti Narkia wrote:

>>
>> >> With all due respect, I'm afraid that you won't qualify for my purposes.
>> >>
>> >>
>> >
>> >Then why are you here hanging out in a cardiology newsgroup?

>>
>> Providing us with great, detailed information and a willingness to put the
>> science first?
>>
>> I greatly appreciate Matti Narkia's contributions. They fit well in this
>> science newsgroup.

>
>Then you'd better advise Matti to believe that ketones are bad rather than find
>out from drinking a bottle of it.


Again, it's a *science* newsgroup. No one can tell someone else what to
believe. It's a place to discuss the science and the evidence.
--
Jim Chinnis Warrenton, Virginia, USA
 
Thu, 16 Oct 2003 20:47:54 GMT in article
<[email protected]> Jim Chinnis
<[email protected]> wrote:

>"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:
>
>>Jim Chinnis wrote:
>>
>>> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in part:
>>>
>>> >Matti Narkia wrote:
>>>
>>> >> With all due respect, I'm afraid that you won't qualify for my purposes.
>>> >>
>>> >>
>>> >
>>> >Then why are you here hanging out in a cardiology newsgroup?
>>>
>>> Providing us with great, detailed information and a willingness to put the
>>> science first?
>>>
>>> I greatly appreciate Matti Narkia's contributions. They fit well in this
>>> science newsgroup.

>>
>>Then you'd better advise Matti to believe that ketones are bad rather than find
>>out from drinking a bottle of it.

>
>Again, it's a *science* newsgroup. No one can tell someone else what to
>believe. It's a place to discuss the science and the evidence.


Unfortunately it starts looking like many of Chung's opinions are based on
belief system rather than evidence. In these circumstances discussing evidence
has turned out to be next to impossible.




--
Matti Narkia