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I am listening to the first podcast by Ivor
No one in USA uses ratios. I mean no one in the National Lipid Association uses them or talks about them.
Lipidologists don't use "bad" or "good" for LDLc or HDLc.
He ignores the preponderance of multiple trials that confirm the lower the LDLc the better.
Ivor cherry picks his trials.
I wrote a blog on Ivor- Irish Nihilism link
The size of particle is another red herring.
If you have low LDLc or low LDLp if doesn't matter how large they are.
No good way to measure oxidized LDLp
Health of endothelial wall is huge.
The best way to keep the wall healthy is to not expose the wall to LDLp greater than 1,000
The healthy HDL vs bad HDL is a real thing but again the best way to deal with this is to lower LDLp and triglycerides.
Ivor says a person with a high LDLp can be healthy if all the endothelial measures are good.
He has no evidence of any trials with this.
In theory it maybe true but in clinical practice no lipidologist would go alone with it.
He has no evidence of any trials with this.
In theory it maybe true but in clinical practice no lipidologist would go alone with it.
PCSK9 trails get patients LDLc down to 20 with great results.
I think these podcasts of Ivor might be before the several PCSK9 trials
If Ivor were honest he would not ignore the new data and the old data showing the lower the LDLc the better.
Ivor says treating the high LDLp in a "healthy" patient would be a bad engineering mistake.
I have shown Ivor my list of 200 patients with ASHD that got their LDLc down.
They did very well. No heart attacks.
They did very well. No heart attacks.
My 200 patient list link
Ivor has never treated any patient.
Clinical medicine is very far from engineering.
Totally different discipline.
Ivor came up with the idea of "root cause" being insulin resistance.
Diabetes is definitely a high risk factor but hypertension is also.
More importantly than both DM and HTN,
lowering LDLp or LDLc have been consistently shown by the best scientific trials over decade that
the lower the LDLc the better.
lowering LDLp or LDLc have been consistently shown by the best scientific trials over decade that
the lower the LDLc the better.
It is irrefutable!
Ivor's references are refutable.
I dove deep into analysis of Ivor's references in Eat Rich Live Long.
He had no answer to this blog
He had no answer to this blog
My review of Eat Rich Live Long by Ivor
Review of Eat Rich Live long
March 31,2018
I would give Eat Rich Live Long five stars based on it's wake up call on insulin resistance.
If I only considered it's Lipoprotein particle or ApoB and weight maintenance sections I would give it one star.
Thus I settled on a 3 star rating.
This is an excellent text.
A great guide for people interested in LCHF(Low Carbohydrate High Fat) or Atkins type diet.
I have been on LCHF since reading Gary Taubes book, Why We Get Fat: And What To Do About It in Jan 2012.
I decreased my exercise, and eat ad libitum and did not gain weight even while I traveled around the world.
I probably didn’t lose weight because I ate a lot of protein.
The authors explain this phenomenon on p 309.
Very high amounts of protein are okay if you are trying build muscle with a weight lifting program.
I was satisfied because I was not hungry and I was not gaining weight with less exercise.
Subsequently I obtained ketone blood test strips and could closely monitor my nutritional ketosis.
However I did not lose weight on this diet.
I had been 280 pounds and lost 80 pounds on traditional 1500 low calorie diet.
The restrictive discipline after 1.5 years was too much.
I decided to eat more low glycemic fruit as I increased my exercise to 2.5 hours a day.
I gained 1.5 lbs. a month till I gained back 50 lbs.
This is when I learned you cannot outrun your fork and I lost faith in low glycemic fruits.
I turned to diet medications not just for weight loss but also for weight loss maintenance.
I believe this book has a wonderful message.
This must be incorporated in new guidelines to get Doctors to order it.
The fasting glucose is not enough.
If insulin resistant then LCHF is the essential diet as outlined brilliantly in Eat Rich Live Long.
The second wonderful message is the importance of a CAC (Coronary Calcium CT) to determine risk for cardiovascular event along with scoring the usual risk factors.
I am Board Certified in the American Board of Obesity Medicine. I think any diet can lose weight.
The challenge is maintaining that weight loss by finding a diet that is ad libitum and can be maintained for life.
Eat Rich Live Long fails to address the problem of weight loss maintenance in the reduced obese adequately.
The authors neglect the science that the excess fat cells the obese have never disappear even with Bariatric surgery.
The large number of shrunken fat cells in the
Low Leptin tells your brain you are starving.
Several mechanisms including decreased thermogenesis and
increased Ghrelin (increased hunger) are 2 ways Leptin causes slow weight regain even on a reduced calorie diet over the long term.
It is not all about insulin.
It is much more complicated than that.
Dr Gerber sites several of his patients losing weight and maintaining it for 1-2 years.
All diets can do that.
LOOK AHEAD showed that over 10 years diet and exercise fail to maintain weight loss.
As per the National Weight Control Registry(NWCR) only 5% have the willpower to maintain diet of 1500 calories and one hour walk/d to maintain their weight loss.
Using the science of a calorie is a calorie they(NWCR) should continue to lose weight.
No, low leptin breaks that rule and this sub-starvation diet (1500 calories) will only maintain weight, not break through the plateau.
Eat Rich Live Long suggests several strategies to maintain weight loss or break through the plateau.
p333:
1- Internalize the books principles.
2- Follow the 10 action steps on p 72
3-Make these action steps a habit
This is all about WILL POWER which can't be sustained over 5-10 years with terrible hunger caused by a low calorie diet and low leptin.
Very lame, it is the same message as the lifestyle message of the guidelines.
The false hope of diet and exercise that failed in the 10 year LOOK AHEAD trial.
p334:
“Love your Ghrelin”.
The author is telling us to use hunger positively.
This does not work. You cannot stay on a diet for life if you are always hungry unless you are the 5% in the NWCR (National weight control registry)
Nutritional ketosis and high protein does provided satiety over the short term. There nothing to show it works more that 5-10 years.
The number of fat cells has the last word.
No way to increase the low leptin in the shrunken fat cells other than to regain weight.
p337
1-Meal spacing. Eat only 3 meals a day and try to cut it down to two meals a day.
2-Fasting
3-Decrease the fat in your diet from 160 g/d to 100 g/d.
This reduces your diet to 1,100 calories.
The authors write "This is not the cliched "eat less, move more" .
Sorry, cutting out 100g of fat equals 900 calories.
2200 cal minus 900 cal = 1100 cal a day.
This is a sub-starvation diet link
For IR patients (insulin resistant) meal spacing will increase hunger unless you are on diet medications.
For muscle building it is very difficult to get to 130 to 150 grams of protein a day on two meals a day.
Need high protein snacks in between meals to reach protein goal and for satiety.
Fasting is a draconian measure over the long term.
Talk about the amount of willpower needed for that.
Finally,
The authors fail to recognize the necessity of statins, niacin and Zetia to treat high CAC score or secondary cardiovascular disease or the very high ApoB of Familial Hypercholesterolemia
On twitter the Authors told me they are not statin "denialists" Eat Rich Live Long does not reflect this position.
p271 "you can't lower your CAC score with the orthodox approach of a low fat diet and medication"
p261 "If there are no insulin resistance or inflammatory issues present, then a high ApoB is very likely not an issue."
P247 William Peter Castelli is a giant in the field of lipidology.
I have heard him speak.
He is now 86 yo and his last paper was 1999.
He is not a current lipid investigator.
Castelli's comments in 1996 are made without benefit of AIM-HIGH 2011, HPS2-THRIVE 2013, ODYSSEY 2018, WESCOPS 2004, IMPROVE-IT 2004, 4S 1994. Old references have historical valve but must not be used against the preponderance of recent evidence.
I am a Fellow and Board Certified in the National Lipid association.
The preponderance of excellent random controlled trials, double blinded with large number of people in study for significances validates the rule:
the lower the ApoB (lipoprotein particles not cholesterol) the better outcomes in mortality.
P262" EAT RICH LIVE LONG
APOB/APO1: The Master Ratio."
There are many problems with ratios.
Suffice to say non-HDL cholesterol is much better.
Get it under 80.
You don’t need to get advanced lipid testing for this.
Total Cholesterol minus HDLc = nonHDLc.
The authors never mention this simple calculation that can be done with a standard lipid panel.
It is much better than LDLc which Ivor uses cherry picking to show how bad LDLc is a bad marker.
Yes it LDLc can have disocordance which is why we use nonHDLc.
LDLp or ApoB particles done on advanced lipid testing should also be done at some point to determine if there is discordance.
p354 "people with verified FH (familial hypercholesterolemia) should discuss PREVENTATIVE treatment options with a specialist in the field"
To not mention the PCSK9 treatment option reflects a very biased approach to the medical treatment of high ApoB (lipoprotein particles)
In summary I applaud Eat Rich Live Long program of LCHF as soon as early insulin resistance is detected with 2 hour post prandial glucose and insulin level.
However their immense blindspot to the benefit of getting LDLc,non-HDLC, LDLp or ApoB as low as possible in people with high CAC by giving statins, niacin or Zetia is a great detriment to Eat Rich Live Long.
The authors lose credibility for their important message about Insulin Resistance when they cherry pick data to build up the supreme importance of insulin.
I think they are reacting to the Ancel Keys disastrous seaqueway to high carbohydrate low fat diets as the only healthy diet.
Some people are hyper-absorbers of cholesterol.
These people benefit greatly from Zetia.
Most elevated ApoB or LDLp is genetic rather than diet related.
Thus if someone has 5% cardiovascular risk and a positive CAC (higher than zero) they need to lower their ApoB or LDLp
NonHDLc should be less than 80
Non-HDL cholesterol and remnants are not discussed in the book.
These numbers only need the routine lipid panel not advanced testing.
For my approach which is similar with Eat Rich Live Long buy kindle edition for $3 on Amazon.com by looking up my book The Chronic Disease of Obesity Published Feb 2, 2018 published iUniverse
Boom Ivor!
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