Wednesday, February 20, 2008

Bantu Lp(a) and Swedish Lp(a)

Lipoprotein (a) is interesting enough that I might put up some more thoughts about it, but this post is based on the Bantu cross sectional study cited, as all the best cardiac studies are, by Dr Davis of Track Your Plaque.

The initial link is to this paper which explains quite a lot about Lp(a) and its genetics.

I wanted to compare values of the Bantu with an intervention trial in some Swedes, and to think about eating fish and taking fish oil, to reduce that "risk factor" for heart disease. And yes, Lp(a) is a "risk factor" for all forms of vascular disease; ischaemic heart disease, peripheral vascular disease, cerebrovascular disease and abdominal aortic aneurism.

First the Bantu. That first paper covered the Bantu genetics, apoprotein (a) sizes and Lp(a) blood levels. Basically, if you match individual gene types, the fish eating Bantu always have lower Lp(a) than their matched apo(a) size vegetarian Bantu equivalents. You get nothing about diet in this initial paper, for that you need to go to a previous publication from the same group.

Fish eaters and vegetarians were pretty well matched for calorie intake at around 2100kcal/d. The fish eaters ate 18% of calories from protein, 12% from fat and 70% from complex carbohydrate. The values for the vegetarians were 11% from protein, 7% from fat and 82% from complex carbohydrate. Dean "Mcdonalds" Ornish would be proud of the vegetarians. BTW, both groups ate 4g/day of salt, worth remembering that.

On a fully vegetarian, completely home grown, ultra low fat, low salt, complex carbohydrate diet these Bantu natives show exactly the same rise in blood pressure with age as Westeners do. Their systolic pressure approximates quite closely to that "age plus 100" rule of thumb which used to be considered normal in the UK and diastolic pressure followed systolic as you would expect. Fish eaters stuck with a systolic around 120-130mmHg and a diastolic around 70mmHg, life long. Remember both groups only ate 4g/d of salt. Now what does that tell you about salt and hypertension? Anyway, the politically correctest Bantu had significant markers of CV deterioration with age, not so the fish eaters.

BTW, as an aside, HDL figures were abysmal with both groups at under 1.0mmol/l, exactly as you'd expect on a low fat diet. They were slightly higher in the vegetarian group, presumable because they drank more alcohol. Triglycerides were higher in the veggie group, again pretty much as you'd expect from their carb intake.

The theory was/is that it was the omega three fats which were saving the fish eaters from hypertension and Lp(a) elevation. They undoubtedly did eat more omega three fats, and less omega six fats, and we know from the Lyon Heart Study that this is probably a Good Thing.

The Bantu fishermen were getting roughly 5% of calories from fish derived fat, that's 105kcal, equivalent of about 12ml of fish oil per day, as fish. This intake of fish oil is associated with a Lp(a) concentration of 201mg/dl as opposed to 321mg/dl in the vegetarians.

So what happens if we take a group of Swedes and give them more than twice that dose of fish derived lipid, as 30ml of fish oil per day, then track their Lp(a) level? Initially the subjects were on a typical Swedish diet (no information given) and were advised not to change it throughout the study. The fish oil was added at 30ml plus some vitamin E per day for three weeks, then there were two weeks off of fish oil, then three more weeks on fish oil, but without the vitamin E (for Bruce; yes, lipid peroxides rocketed on the later protocol).

Lp(a) before fish oil plus vit E: 128mg/dl, after three weeks supplemented: 125mg/dl. Back on Swedish diet for 2 weeks: 124mg/dl, after fish oil without E for three weeks: 128mg/dl.

All of these figures are essentially identical. Fish oil at 30ml per day does nothing to Lp(a) levels on a Swedish diet. It's also worth noting that, although we don't know the Swedish geneotypes for apoprotein (a) size, these values are all much lower than either of the Bantu groups. Maybe 35% of calories from fat in Sweden?

So is it really the fish oil which is saving the carnivorous Bantu from the hypertension and elevated Lp(a) which are prevalent in their vegetarian cousins?

Somehow I doubt it, based on the Swedish data and the behaviour of Lp(a).

Intervention studies show us that low fat diets increase Lp(a) and high fat diets decrease it, I put the studies here.

The fish eating Bantu got through more than half a kilo of fish on a good day. If your average calorie in take stays unchanged, that's an awful lot of complex carbohydrate you didn't eat. If I assume causality, not eating complex carbohydrate appears to be extremely good for your cardiovascular system. And your Lp(a) levels.

You don't need any "magic" fats to drop Lp(a), unless its those magic fats are saturated fats, which seem to do the job best (just turn the DELTA study on its head).

Peter

BTW: No, I don't believe our liver manufactures Lp(a) to kill us. Again, more thoughts on Lp(a) to come. I might even talk hedgehogs if I can get my head around what they were doing with their lipids!

Another BTW, the Kitava studies showed these islanders ran at 70% calories from carbs but with Swedish levels of Lp(a). Kitava was lowish in fat at 20% of calories, but their dietary fats were almost all saturated (from coconut), with just a little omega 3s from fish. So it looks to be arguable whether you need to consume saturated fats to keep you Lp(a) levels down or keep carbs below the vegetarian Bantu levels. Ignoring genetics. Open to discussion on that one.

EDIT 28th Feb: Just been back to the Kitava papers for something else and noticed Lipoprotein(a) was around 300mg/dl, ie Bantu levels, bad Bantu levels. No heart disease. Bear in mind Lp(a) is notoriously variable from lab to lab. But still needs slotting in to Lp(a) and heart disease.

23 comments:

JohnN said...

Peter,
The simplest answer is insulin or lack thereof. Lower CHO consumption means less insulin production.
Re. Lp(a): I wonder if there are studies tracking the effects of vitamin C, omega-3 (EPA) or nitric oxide on Lp(a) levels. All three provide endothelial protection in one form or another.

Peter said...

Hi Johnn,

Yes, insulin probably controls pretty well everything. When I get home from work I'll check, but FBG and fasting insulin were comparable in the two Bantu groups. Obviously the 24h AUC for insulin must have been higher for the veggie Bantus even if they stayed normoglycaemic, possibly you could say esepcially if they stayed normoglycaemic, just due to their carb intake.

Peter

streeterville said...

Peter, I've just started reading your blog and it will take me awhile to absorb all the info. Really, I still have a hard time understanding insulin and how it works, but that's one reason why I'm here, so that's fine. Having always had a bad reaction to gluten, I've tended toward low-carb, low-grain diets, but periodically, especially during the winter, fall prey to the demon of sugar. Anyway, I just have a question, have read through What you eat posts. The cream, and fresh cream you describe, are these raw, unpasteurized cream you are talking about, and do you personally believe this makes a difference in your regime? Also, oops that's more than one question, have you ever experimented with stevia in the ice cream? And, ok, ok I'll stop after this, what kind of chocolate are using. Like, brands, please.
April

Peter said...

Hi April,

Cream is Sainsbury's normal pateurised. I think it may well matter. I ferment it to unpasteurise it. I've got no hard info on this but unfermented supermarket cream tends to flare the acne I've had for years which has almost (but not quite) gone on LC. I have stevia liquid but I get an after taste from it at high doses and am willing to accept the carbs from the glucose/honey mix I use instead. I got on fine with sucralose in my early days but am uncomfirtable with eating an organochlorine. Saccharine was my prefered artificial drug for a while but I decided a few years ago to stick to eating food!

The chocolate is a sore point. We had to give up Sainsbury's 85% cocoa as we noticed it does not claim to be suitable for coeliacs and our 11m old son had a marked skin reaction which stopped when we switched brand. We now use Green and Blacks 85%. This does not claim complete gluten freedom (made in the same factory as products which... etc) but so far so good. He gets 4 squares for his Elevenses at nursery, otherwise they try to give him fruit....... Montezuma's are all gluten free but only go up to 70% cocoa, which I now find too sweet.

Peter

Peter said...

Hi Johnn,

Glucose 4.9mmol/l in fish eaters, 4.8mmol/l in veggies. No insulin levels measured so no way of calculating HOMA scores. If trigs are a surrogate for insulin levels/resistance they are much higher in the veggies.

Peter

Bruce said...

I prefer Lindt 85% USA chocolate to other chocolates I've tried. It has no soy lecithin and no mention of a potential gluten contamination. May not use the same recipe outside the USA, however. It's 82% fat, 8% pro, 10% carbs. Almost JK ratios.

You should try sour cream, Peter. I can't even find cream except ultra- pasteurized. I get pure sour cream, nothing but cultured cream.

It's also possible to get high-fat yogurt, low in carbs. Look for Fage Total Greek Strained Yogurt. It has
69% fat, 22% protein, 9% carbs. Add sour cream and you are right around 80% fat, 15% protein ratios.

team smith said...

hi april, i thought i would comment on your comment since i am fairly new to this low-carb, high-fat, no grain diet. we get raw, unpasteurized cream from cows on a 100% grass diet. if you can get anything like this, all the better. we also get milk from the same farm and i make kefir out of it with the grains as opposed to the powder. it makes a thin yogurt like consistency, a little more sour. very good and good for your gut!

i have been doing tremendously on this diet and am so happy! i mostly consume cream, egg yolks, red meat and other meats, potatoes loaded with butter and cheese. cutting out the sugar a while ago was one of the best things for me! but now even cutting out the fruit has been so beneficial. my hypoglycemia has ended and i feel so much calmer.

i have chocolate truffle and chocolate mousse recipes if anyone is interested. lots of cream and butter! and i have been using Green and Black's 70%, too since i cannot find anything better in-store. maybe i will order some 85% from somewhere.

amanda

JohnN said...

Peter,
Thanks for the additional data.
Since fat is insulin-neutral, the amount of insulin required to process a given amount of macro-nutrient with high fat content is relatively low; an ideal fuel if one looks to circumvent the destructive effects of high circulating level of insulin. In my view, this is more important than achieving low levels of FBG and fasting insulin. The wandering trigs in the veggies' blood stream may indicate a less efficient rate of fat metabolization; the counterpart of high FBG in Low-Carbers.
One particular insight that served as my introduction to your blog sometime ago: the physiological effects of consuming fat and fasting are similar. If this is true - and I believe so - there are important implications to guide your dining habits.
If only we could feed 7 billions of the Earth's inhabitants this way.

Anna said...

Amanda,

I'd love your chocolate mousse recipe. Is your truffle recipe similar to mine (see my blog). You can email me through my blog (email on main blog page).

team smith said...

ps. i went to Whole Foods and found Vivani organic 85% dark chocolate (no soy lecithin) and Lindt 85% dark (no soy lecithin)but not organic.

yea!

amanda

Bruce said...

Amanda, my next favorite chocolate after Lindt's 85% USA is Hachez 88% and Valrhona 85%. Both of those do have soy lecithin - which I tend to avoid. (Better safe than sorry.) I don't like any organic chocolates, like Green & Black's, Dagoba, and Endangered Species.

You might like G&B's 72% Baking or Cooking Bar. I didn't care for it, or any of G&B's other bars, but it is the best G&B bar, according to Seventy Percent. But Lindt 85% USA has the #4 overall rating. Amadei, Cluizel, and Bonnat are #1-3.

Good luck finding or affording any of those. Bonnat is £2.95 ($6.95). Amadei is £4.95 ($8.75). Lindt can be found on sale 2 for $3, at drug stores, on a monthly basis.

http://seventypercent.com/chocop/

Bruce said...
This comment has been removed by the author.
Bruce said...

Also, I would suggest you go into a store with big chocolate selection, like World Market or Whole Foods. I grabbed one of everything they had, with 85% cocoa mass or higher. That narrowed the field to 3 that I like and one with no soy lecithin, which is frequently on sale. Also, try to get the latest expiration date you can find (pref 11-12 months out). I got a couple bad Lindt 85% bars one time and both had short dates.

Anna said...

Hachez 88% chocolate, yeah baby. So smooth and creamy for a dark chocolate (some are so brittle). A local store had some before Christmas. I bought up all they had at half price after Christmas. I have them hidden in a secure place...

Bruce K said...

Anna: what type of store had Hachez 88%? The only place I can find them is CostPlus/World Market. The price is just as low as online sellers. I still prefer Lindt's 85%, since the sale price is half as much and they don't have soy lecithin. But if the money were no object, I do like the creamy taste of the Hachez 88%. You can't get less bitter at 85%+. Many on Seventy Percent don't like it. I think it's amazingly smooth.

Anna said...

Bruce K:

I found Hachez 88% Premier Cru (also 77%) at Henry's marketplace the San Diego name for Wild Oats, a national chain of smallish, sort of natural food supermarkets (not as upscale as Whole Foods). They had them in the previous holiday season, too, but I have never seen them the rest of the year. Initially I bought them for stocking stuffers but quickly realized they were great stuff. The bars are long and slender, like a thick crayon or log, in a 37 gm size, selling for US$1.99 each, I think. I bought what remained when they were on 50% clearance after New Year's.

Oh no, I only have 1 remaining 88% bar, and a handful of 77%.

If you have a Wild Oats-owned store near you, check to see if they can order them.

g said...

Port (a little bit of carbs is ok!) and >70% cocoa chocolate from trader Joe's (its white from different latin countries with a yellow or orange label -- I ran out right now)...mmmmmHHHHNNNMMMMMMYYUUMM!!!

g

Bruce K said...

Anna, 37g for $1.99 is too rich for me. World Market has the 100g bars for $2.99. They have a store in San Diego. 372 Fourth Ave. Nobody else has them cheaper, not even online.

http://www.worldmarket.com/home.jsp

Anna said...

Bruce k,

A fellow San Diegan? It's been ages since I've been to a Cost Plus World Market (last time I was at one in LJ/UTC it was just Cost Plus). Thanks for the heads up on the Hachez 88% chocolate. Would never have thought to go there for chocolate, or anything edible for that matter. I'm sure there is at least one Cost Plus World Market in North County so I don't have to go, dare I say it, below the 5-805 split.

Anna said...

g,

Gotta agree with the port and super dark chocolate combination. Though the port is so sweet, I save it for rare indulgences; but what a great dessert. Currently, my favorite port is Evenus Zinfandel Port from Trader Joes (half bottle size).

Peter said...

Back in the days when I lived alone for a large chunk of the time it was Cointreau, 85% cocoa chocolate and a mug of back coffee. Used to have this while playing (OMG, it's true) Pod Racer on my son's computer, until I couldn't get through some of the harder courses.... Tended to be late at night, with the sound turned up and wired through a large stereo system.... Oh dear!

Peter

Tequila has now replaced the Cointreau and I'm not at all sure Pod Racer will run under Vista, if I ever had the time!

g said...

I'll have to try Cointreau! Anna, I'm in San Diego this week on vaca, the city with the highest concentration of triathletes per capita! LOVE IT!! it's so BALMY in the 70s degrees F and SUNSHINY! my sister and I used to swim the Cove 1/2 to 1 mile rounds everyday... But I'm a pussy now, tried the water yesterday and freaked at how cold the water has gotten *ha haa* i'm sticking with the hotel's heated triple pools (with poolside BAR service *hee he*) you're so lucky to live here!

I try to stay away from tequila... esp lovely Patrone... too many subsequent internet picts. no further comments!

-g

mtflight said...
This comment has been removed by the author.