SFA v Carbs v MUFA's: clinical trial divided by apoe type

[RichardS]

A good one from back in 2004:
"The Effect of Dietary Fat on LDL Size Is Influenced by Apolipoprotein E Genotype in Healthy Subjects"

Full text: http://jn.nutrition.org/content/134/10/2517.long

Abstract
LDL particle size is dependent on both genetic factors and environmental factors such as dietary fat composition. The apolipoprotein E (apoE) genotype is a major genetic determinant of LDL size. Thus, the aim of this work was to study whether the apoE genotype interacts with the quantity and quality of dietary fat, modifying LDL size in young healthy subjects. Healthy subjects (n = 84; 66 apoE 3/3, 8 apoE 4/3, 10 apoE 3/2) were subjected to 3 dietary periods, each lasting 4 wk. The first was an SFA-enriched diet (38% fat, 20% SFA), which was followed by a carbohydrate (CHO)-rich diet (30% fat, < 10% SFA, 55% carbohydrate) or a monounsaturated fatty acid (MUFA) olive oil–rich diet (38% fat, 22% MUFA) following a randomized crossover design. At the end of each diet period, LDL particle size and plasma levels of total cholesterol, LDL cholesterol (LDL-C), HDL-C, apoB, apoA-I, and triacylglycerols were determined. LDL particle size was significantly higher (P < 0.04) in subjects with the apoE 4/3 genotype compared with those with apoE 3/3 and apoE 3/2 in the basal state. LDL size was smaller (P < 0.02) after the CHO diet than after the MUFA or SFA diets. After the CHO diet, a significant increase in LDL particle size (P < 0.035) was noted with respect to the MUFA diet in apoE 4/3 subjects, whereas a significant decrease was observed in the apoE 3/3 individuals (P < 0.043). In conclusion, a Mediterranean diet, high in MUFA-fat increases LDL particle size compared with a CHO diet, and this effect is dependent of apoE genotypes.

While there were only 8 APOE 3/4 subjects, the study was so well controlled that I give it good credibility. Lowest LDL-C and Apo B for the 3/4's were found with the MUFA diet vs SFA or CHO (high carb) diet.

This was one of the pivotal studies that pushed me away from a paleo-inspired high SFA diet and led to a dramatic drop in my LDL-P in 6 weeks (2200 to 1300).

[Stavia]

Very interesting Richard. What form does your diet exactly take? Eg your macronutrient percentages and main sources of fat?

[RichardS]

Very interesting Richard. What form does your diet exactly take? Eg your macronutrient percentages and main sources of fat?

Currently, for fats I focus on lean meats, some fatty salmon, pork and eggs, substantial amounts of avocado, macadamia nuts, some EVOO, cashews, almonds and 80% dark chocolate. There was also some flax bread for a while. I would estimate 50-60% fat, 15% protein, 25-35% lower to moderate GI carbs with some minor sweets and processed treats tossed in. Minimal dairy and tropical fats. No gluten for 2 years.

Before August, I was having trouble with a rising trend of LDL-P that eventually hit 2200 from a low of 1100 a few years ago. I figured that was too high to continue ignoring, so some deep diving into PubMed and hanging around here in lurking mode convinced me to give more weight to my apoe 3/4 status and cut the sat fats, increase the MUFA's and add more low glycemic carbs. That brought the LDL-P down to the 1300's in only 6 weeks. Most everything else on the NMR and Lp(a) stayed the same with solid trigs, HDL and low small LDL-P. I should add that I started some niacin in that time but have only been able to sustain 1000mg/day despite wanting to move up to 2+ grams.

[Julie G]

Impressive, Richard!

I'm waiting for a re-do of that old chestnut (from 2004) with more than eight 3/4s and at least some representation from the 4/4s- high time Think how telling THAT would be for our community.

[Stavia]

Richard, thanks for the detail, your diet is very very similar to mine percentage and detail wise. (No pork tho and no processed treats)

Julie: we have many e4/e4s here. Why don't we do our own rough cross over trial together just for our own purposes?
I started 6 months ago but got distracted.

[LanceS]

Seems like one way for 4s who need to get their LDL-p down is to follow one or both of the following hypotheses:

a) introduce low glycemic index carbs, though this may knock one out of ketosis, perhaps have a small impact in fasting insulin

b) increase the amount of MUFA

Were I a betting man I'd say a) is the answer here (with B absolutely worth trying), with uncertain implications for brain health, but the factors I can never recall were related to insulin and I guess the trick becomes how to balance insulin increase with the low carb lifestyle

If all that is true, I would guess it comes down to exposure to some sort of trigger whereby insulin triggers clearing of cholesterol likely for some time/threshold exposure, though if I recall correctly, insulin may be negated by something like cortisol (so all you sleep when I'm dead types and stress don't hurt me none types might have to coincide insulin exposure with cortisol absence). I guess exercise and insulin exposure should be the critical variables to control????

would be nice if government would start funding these types of studies... lol

is the above kinda the picture we are starting to get with our collective n=1 / pubmed inferences?

[giftsplash]

Richard I also cut my LDL-P from 2000+ to under 1300 but without much change to the diet but including Niacin and a few other over the counter supplements. It killed by testosterone and sex drive, so I stopped the supplementation. Have you seen similar negative effects with your Niacin intake?

[Hepoberman]

Seems like one way for 4s who need to get their LDL-p down is to follow one or both of the following hypotheses:

a) introduce low glycemic index carbs, though this may knock one out of ketosis, perhaps have a small impact in fasting insulin

b) increase the amount of MUFA

Actually its C. We HAVE to eliminate saturated fat. The closer we come to eliminating it, the lower LDL-P goes. This includes eggs and most food from animals...

[RichardS]

Richard I also cut my LDL-P from 2000+ to under 1300 but without much change to the diet but including Niacin and a few other over the counter supplements. It killed by testosterone and sex drive, so I stopped the supplementation. Have you seen similar negative effects with your Niacin intake?

Giftsplash,

The testosterone and sex drive angle of niacin use is new to me. I've never thought about it. At 49, my testosterone is good but was on the low side of "normal" for a year or so. I don't recall if that coincided with my earlier heavy niacin use. I have the data, but not with me right now. Sex drive ain't what it used to be - don't know what to make of that. Is there some research that suggested to you that niacin was linked or was it just personal observation?

Richard

[Ski]

Richard I also cut my LDL-P from 2000+ to under 1300 but without much change to the diet but including Niacin and a few other over the counter supplements. It killed by testosterone and sex drive, so I stopped the supplementation. Have you seen similar negative effects with your Niacin intake?

Gift, Ive been on 1000mg of Niacin for last 2 months and my testosterone is actually higher than my last test...by a lot. I know its not because of the Niacin, but I wonder if there was something else going on during the same time and the correlation isnt correct?