The Hypocritic Oath

Small Dense Krauss Revisited

Posted in Uncategorized by trinkwasser on October 30, 2009

I can no longer see the name of Ronald Krauss without immediately thinking “small dense Krauss”.

Bad Peter! Hee Hee.

Actually his whole series of AGE RAGE and ALE posts starting July 2008 are well worth a read.

So is the rest of the blog if you like techy stuff.

Ronald Krauss came up in a couple of other contexts recently so I thought I’d dig up some of his material.

Much of the best stuff is subscription only, but there are several free access papers which I found on PubMed.

Have a look here to see what he’s doing. That page covers his heart healthy reputation, the next page is what he’s working on today.

This makes his dilemma somewhat clearer: if he is less diffident about some of his results he might lose his reputation, if he’s not positive enough he may lose his funding. Such is the Politics Of Diet.

There’s an interview with him which clarifies his position. IMO nutrigenomics and pharmacogenomics are the way forward: too much medicine uses the wrong kind of statistics, assuming a population is uniform and follows a bell curve when it may well be several genetically distinct sub-populations with sigificantly differing responses to food or drugs.

He co-authors this paper

Pharmacogenomics: Challenges and Opportunities (the pdf is free)

The next step after discovering your specific genes is to discover ways to adjust your environment (diet, drugs, exercise) to control their expression – but I’m getting ahead of myself.

He’s spent much time and effort in deconstructing the “lipid hypothesis” and elucidating the complexity of the systems involved, which go far beyond “eating fat makes you fat/gives you cardiovascular disease”

Lipids and Lipoproteins in Patients With Type 2 Diabetes

Smallest LDL Particles Are Most Strongly Related to Coronary Disease Progression in Men

Metabolic origins and clinical significance of LDL heterogeneity

are a selection of papers covering this subject.

Here’s an important passage from the latter

It has been demonstrated in offspring genetically predisposed to phenotype B that a very low fat, high carbohydrate diet can induce expression of this phenotype. Recently, both genetic and dietary factors have been reported to affect LDL size phenotypes in baboons. Thus, LDL subclass phenotypes may result from interaction of multiple genetic and environmental determinants, and the trait can be viewed as a marker for the mechanism underlying these effects.

AHA Scientific Statement

Managing Abnormal Blood Lipids

is a fairly typical bunch of complacency: one wonders if carbohydrates would have been mentioned at all were it not for the presence of Ronald Krauss on the team.

The L-TAP survey revealed that lipid management was suboptimal for all patients with and without CHD. Although 95% of investigators indicated that they were aware of the NCEP guidelines and believed they followed them, only a small proportion achieved the recommended LDL goals. Lack of achievement is likely caused by failure to titrate medications, inappropriate drug choices, limited effectiveness of some medications, intolerance to some drugs, and failure to address patient noncompliance.

Er, no! Lipid management was suboptimal because the diet chosen did not differ significantly from the diet it replaced. How about them apples?

Look at

TABLE 6. AHA Dietary Recommendations for Achieving Desirable Blood Lipid Profile and Especially LDL-C

isn’t this exactly what everyone is told to do, and does – but IT DON’T WORK! Listen to Uncle Ron!

Here he is in a recent paper renovating the reputation of dairy fats and covering the often observed phenomenon that while increased saturated fat intake may (or may not) increase LDL, it also increases HDL and helps reduce triglycerides, thus replacing small dense and oxidisable LDL with decently fluffy particles. I had something of a “Duh!”moment when cheese was found to be more beneficial than milk – well milk is often used as a hypostop due to its carb content, you can’t do that with cheese (or butter)!

Clinical trials in which replacement of saturated fat occurs in the context of reduced total fat and increased carbohydrate have generally not been associated with improvements in CVD is something that passed the other authors of the above AHA paper by, and they didn’t even duck.

One factor he failed to mention was Vitamin K2. Now I go along with some of the Paleo folks in limiting milk (bizarrely I prefer skimmed, but only use it in my coffee) but I have reverted to butter and cheese, partly for this reason and partly because it has rebalanced my HDL and LDL quite nicely.

OK, one last one

Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia

He is somewhat diffident about the importance of his results. he’s a bit more gung ho here and the resulting editorial was interesting, but what he really needs is a cheerleader. Step up Jeff Volek (along with Richard Feinman, natch)



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