VAP Dietary Advice

      64 Comments on VAP Dietary Advice

A friend of mine recently had a VAP test done, and a reader happened to pick up a brochure on the VAP test around the same time.  Both sent me scans of one page that explains what a VAP test measures, and a separate Diagnosis/Lifestyle Therapy page offering advice on how to improve less-than-stellar lab scores.  (If you don’t already know, a VAP test is much more detailed than a standard lipid panel, measuring specific particle counts and sizes.)

Below, I’ve matched up some of the explanations with the advice.

VLDL Cholesterol
VLDL is the main carrier for triglycerides and, if elevated, can be an independent risk factor for heart disease.
Diagnosis: Elevated triglycerides and VLDL
Lifestyle Therapy: Low carbohydrate diet, exercise.

IDL Cholesterol
IDL cholesterol is a strongly inherited independent risk factor for heart disease and is elevated in patients with a family history of diabetes.
Diagnosis: Elevated IDL
Lifestyle Therapy: Low carbohydrate diet, exercise.

LDL Cholesterol Pattern
LDL exists in a range of sizes from small, dense “Pattern B” to large, buoyant “Pattern A.”  The smaller LDL cholesterol sizes are associated with an increased risk for heart disease.  Small, dense LDL is prevalent in patients with insulin resistance or diabetes.
Diagnosis: Small, dense LDL Pattern B
Lifestyle Therapy: Low carbohydrate diet, exercise.

Metabolic Syndrome
Metabolic Syndrome is characterized by the combination of several metabolic risk factors, including elevated triglycerides, low HDL, and small, dense “Pattern B” LDL that increase the overall risk for heart disease.
Diagnosis: Metabolic Syndrome
Lifestyle Therapy: Low carbohydrate diet, increased good fats in diet, exercise.

Lp(a)
The “heart attack” cholesterol, Lp(a) is a strongly inherited risk factor for heart disease.  This does not respond to traditional LPL-lowering drugs.
Diagnosis: Elevated Lp(a)
Lifestyle Therapy: No direct effect.  Control other coronary risk factors.

So here’s the picture so far:  We have all these bad subfractions of cholesterol that may cause heart disease.  The advice for reducing them includes a low-carb diet.  Lp(a), the “heart attack” cholesterol, doesn’t respond to diet or LDL-lowering drugs, so the advice is to focus on lowering the other bad subfractions – again, with a low-carb diet.  We also want more good fats in the diet to raise HDL.

Now look at this explanation and advice:

Real LDL Cholesterol
The real LDL Cholesterol that circulates in your body.  Total LDL = Lp(a) + IDL + Real LDL.
Diagnosis: Elevated Real LDL
Lifestyle Therapy: Low fat diet, exercise.

So there you have it.  You can reduce the most damaging LDL subfractions with a low-carb diet (except for Lp(a), which doesn’t respond to diet), you can raise your HDL by eating more fat, but to reduce your total LDL and thus save yourself from a heart attack, you need a low-fat diet.

Right.  And here’s my advice for getting clean:  To clean your arms and legs, use soap and water.  To clean your chest and back, use soap and water.  To clean your face, use soap and water. But to clean your entire body, use dirt.

Head.  Bang.  On.  Desk.

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64 thoughts on “VAP Dietary Advice

  1. r2d2

    I have a question about being on the paleo/primal/whatever while only occasionally eating cakes/pizzas/etc.

    So, let’s say I eat lots of eggs and meats all the time as a part of my main diet.

    But then I go out with friends, and eat some cakes and later pizzas. Maybe once a month or so.

    Isn’t this dangerous? My simple logic goes like this: The cakes and pizzas will raise my blood sugar, inflaming my blood vessels, and then all the cholestrol/fat/etc. that I got into my blood from eating eggs/meats/etc. will get stuck in the inflammation, causing atherosclerosis.

    In other words: Is occasional junk food eating more dangerous for paleo people than others? What do you think?

    I think our bodies can handle the occasional indulgence. It’s frequent and on-going indulgences that overwhelm our ability to heal.

    That assumes, however that you’re not 1) dealing with a lot of existing metabolic damage, and 2) not prone to go on a binge after giving in “just this once.”

    Reply
  2. Caitlin

    The research in Philip’s comment above scares me. I’ve been low carbing for a few years. Both I and my boyfriend decided to get an NMR test. His small particle count was very low (GOOD) but mine was sky-high, very high. But at the same time particle size came back “Pattern A”. HDL, Trigs, etc. the usual LC pattern. I don’t know what to think, but I’ve kept up the lifestyle.

    If by small particles they mean Lp(a), that’s largely genetic. According to Dr. “Wheat Belly” Davis, people with that gene especially need to avoid sugar, wheat, etc. He uses Niacin to bring down Lp(a).

    Reply
  3. Jesrad

    I’m a bit confused about the “pattern A” and “pattern B” LDL… Which one really is a problem and a true risk-factor for cardiovascular disease ? What I got from various websites points to either being a “worse” culprit than the other…

    The confusion is understandable. We have a particle called Lp(a) that’s considered bad, a pattern called “A” that’s good, and a pattern called “B” that’s bad. It’s easy to mix up those A’s and B’s.

    Reply
  4. Brian

    That reminds me, are you going to repost your statin Christmas poem this year Tom?

    I forgot about that one. Sure, I’ll post it.

    Reply
  5. Philip

    Current research shows that lipoprotein particles, not cholesterol levels, are most closely associated with artery health as accepted in a consensus statement by Cardiology and ADA (J Am Coll Cardiol. 2008;51(15):1512-1524). And, a scientific statement in 2011 by the Am Heart Assoc pointed out that particle counts, using ApoB measurements, to be more highly correlated with CVD (circulation 2011). In addition, the later article stated that the “lowest risk of incident and recurrent CVD in association with the lowest fasting triglyceride levels”. But, few medical providers or cardiologist are familiar with these facts. Ask you doc for an ApoB or use the TG/HDL ratio to see your real CVD risk.
    Of course what lowers TG and particle number? Low carb

    Unfortunately, you’re correct: many doctors haven’t kept up with the research. I had a doctor recommend I go on a low-fat diet because my total cholesterol was “elevated” at 203. My triglycerides were 70 and HDL was 64. It was right there in front on the lab results. He should have been congratulating me.

    Reply
  6. Caitlin

    The research in Philip’s comment above scares me. I’ve been low carbing for a few years. Both I and my boyfriend decided to get an NMR test. His small particle count was very low (GOOD) but mine was sky-high, very high. But at the same time particle size came back “Pattern A”. HDL, Trigs, etc. the usual LC pattern. I don’t know what to think, but I’ve kept up the lifestyle.

    If by small particles they mean Lp(a), that’s largely genetic. According to Dr. “Wheat Belly” Davis, people with that gene especially need to avoid sugar, wheat, etc. He uses Niacin to bring down Lp(a).

    Reply
  7. Pierce

    re: TriHealth-

    How is a private corporation doing what it pleases within the law (and I am not agreeing with that action) either “fascism” or contrary to libertarian thought?

    It isn’t. It’s merely astoundingly stupid.

    Reply
  8. Pierce

    re: TriHealth-

    How is a private corporation doing what it pleases within the law (and I am not agreeing with that action) either “fascism” or contrary to libertarian thought?

    It isn’t. It’s merely astoundingly stupid.

    Reply
  9. A Country Farmer

    Philip’s comment (and Tom’s response) were interesting. I found the two studies Philip mentioned [1,2], but I didn’t see any talk about Triglyceride/HDL ratio.

    I’m on a hunter-gatherer diet and recently got some numbers: Triglyceride=62, HDL=57 and non-HDL=329, which worried the doctor (although [1] doesn’t emphasize that diet elevates non-HDL, whereas [2] clearly shows that Triglycerides are impacted by diet). I think my next step is to get the apoB and LDL particle measurement through nuclear magnetic resonance.

    [1] http://content.onlinejacc.org/article.aspx?articleid=1138812
    [2] http://circ.ahajournals.org/content/123/20/2292.full

    The NMR would be a good idea. In the meantime, here’s a study on TG/HGL ratio:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

    Reply
  10. A Country Farmer

    Philip’s comment (and Tom’s response) were interesting. I found the two studies Philip mentioned [1,2], but I didn’t see any talk about Triglyceride/HDL ratio.

    I’m on a hunter-gatherer diet and recently got some numbers: Triglyceride=62, HDL=57 and non-HDL=329, which worried the doctor (although [1] doesn’t emphasize that diet elevates non-HDL, whereas [2] clearly shows that Triglycerides are impacted by diet). I think my next step is to get the apoB and LDL particle measurement through nuclear magnetic resonance.

    [1] http://content.onlinejacc.org/article.aspx?articleid=1138812
    [2] http://circ.ahajournals.org/content/123/20/2292.full

    The NMR would be a good idea. In the meantime, here’s a study on TG/HGL ratio:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

    Reply
  11. Bill Lee

    The heart health dietary advice equivalent to 1+1+1=37. As a wise man once said, “something here just doesn’t add up.”

    That wise man (Tom Monahan) is a pretty good musician too.

    Reply
  12. Lori

    I’d say it was probably a typo or copyediting error, but most doctors don’t see anything wrong with the idea that humans are composed of parts that have nothing to do with each other.

    Reply

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