Sunday, August 12, 2012

AHS 2012 Part 1: Safe Starches and LDL-C vs. LDL-P

So this past weekend, I was able to attend AHS 2012 in Cambridge, MA.  For those of you who don't know, the Ancestral Health Symposium is an annual event that began last year, and it brings together all of the most well-known people in the paleo community for a weekend full of lectures, debates, paleo food, and apparently, large amounts of free chocolate and coffee.  Or maybe it was only me who spent half the conference eating free dark chocolate samples and drinking americanos.  Oh well, coffee is life.

Caveman chocolate.

It was a great weekend, and I got to meet some great people who I've learned so much from over the past couple of years.  Stephan Guyenet, Chris Kresser, Mark Sisson, just to name a few.  Also got to meet Laura from Ancestralize Me, which was great because she's also on the RD track and I love bitching about My Plate.  I did NOT get to meet Robb Wolf, which I was really disappointed in since he's sort of the ring leader of this whole paleo movement.  Maybe next time.  I was so pleasantly surprised to learn how down to earth and approachable these people were.  Despite their status in the community, they were willing to socialize with everyone and blend in.  I really appreciated their everydayness.

Anyway, over the next few days I'll be discussing my thoughts on some of the main topics from AHS this year, and also talk about the event as a whole and what it means for the future of the paleo community. So without further ado...

Safe Starch Debate
One of the best presentations of the weekend was the safe starch debate involving Paul Jaminet, Chris Kresser, Cate Shanahan, and Ron Rosedale.  Let me first just say how ridiculous it is that we're even asking the question "Is there such a thing as a safe starch?"  I'm sorry but it's stupid.  Especially when it followed Chris Masterjohn's great presentation, which explained very clearly how humans, as compared to apes, have evolved the ability to digest greater amounts of starch through salivary amylase.  This is not debatable.  Of course starch is safe.  The question is, how much starch is safe for a given person?  Well, according to Chris Masterjohn's data, humans have varying abilities to produce salivary amylase.  So there is a spectrum in terms of the ease at which humans digest starch.  Some can handle it very easily and perhaps in large quantities, while others may have a hard time digesting a lot of starch.

Chris Kresser (middle) dominating the safe starch debate

The obvious answer to safe starch debate is... it depends.  One person may be just fine on a diet high in starch from potatoes and sweet potatoes, while another person may be better off limiting their potato consumption.  There is no one diet for everybody, which is why I think Chris Kresser clearly came out on top in this debate, because he understands this concept.  Ron Rosedale came off as a complete idiot, in my opinion, although he did make some interesting points.  He advocates a low-carb, ketogenic diet for everyone, which I completely disagree with.  Cate Shanahan was on the low-carb side as well, although she was not as militant about it, and I was happy to hear her conclude with the idea that eating real food is what matters most.  Not to forget about Paul Jaminet, I thought he was great in this debate as well, but having read his book, I know he is of the opinion that the optimal human carbohydrate intake is fixed at between 100-150g per day.  Any more, according to him, is toxic.  I just can't agree with that.  So Kresser for the win.

Oh, and there's also that pesky fact that nearly all 7 billion people on earth eat a starch-based diet.  I know that doesn't mean it's optimal, I'm just saying.  They're not killing us.

The concept of LDL-P seemed to be a theme this past weekend.  LDL-P stands for LDL particle number.  In a typical lipid panel from your doctor, they are measuring LDL-C, or LDL concentration.  According to Peter Attia, and Robb Wolf mentioned it in his talk as well, LDL-P is a much better predictor of heart disease than LDL-C. 

From Dr. Attia's presentation.  This graph compares LDL-C levels with incidence of heart attack.  Most heart attacks occurred in people with what is considered a "normal" level of LDL-C.  What would conventional medicine do?  Lower the reference range and prescribe more statins.  What should we do?  Get a new fucking risk factor.

Let's make up an example.  Say you have a healthy LDL-C, as measured by your doctor, at 120 mg/dl.  That's a good thing, as far as he's concerned.  But LDL can vary in size.  If all those particles are small LDL particles, then there must be a lot of them to make up that concentration of 120 mg/dl.  If you have a lot of LDL particles, you're at high risk of heart disease, regardless of what your LDL-C says.  On the other side of the coin, you may have large LDL particles.  In this case, you have fewer total particles that make up that 120 mg/dl.  Here, you would be at low risk.  Of course, you could also look at someone with high LDL-C, say 200 mg/dl, and you could make the case that he or she may or may not be at risk, depending on the size and total number of LDL particles.

I  have been familiar with the LDL particle size idea for a while now.  But according to Dr. Attia, particle size is largely irrelevant in its own rite.  Small, dense LDL particles are very much associated with a higher risk for heart disease, but it is not the small LDL that are causing disease.  It is because small LDL often indicates a large particle number that explains the association with heart disease.  It is not the small, dense LDL itself.  In a situation where someone might have low LDL-C, low LDL-P, and small particles, the risk of disease remains low.  Or if someone has high LDL-C, high LDL-P and large particles, their risk of heart disease is high.

I realize this may be confusing.  But here's the take home message:  It looks like the LDL-C measurement, the one doctors are currently using, is largely useless.  While higher LDL-C may increase the chances that you've got a high LDL-P (only makes sense, right?), the two are not necessarily connected.  We need to start measuring LDL-P if we're ever going to get an accurate measurement of heart disease risk.

That's it for part 1 of my AHS review.  I've got much more to talk about, so stay tuned for the next part!

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