Deleterious Effects of Elevated NEFA - Background

I though I would summarize the events/research leading up to my decision to group certain posts under a summary title.

Without a doubt, the most disturbing aspect of my research into the effects of LC (VLC) diets has been the discovery of further elevated NEFA/FFA.  Most in the low carb community -- particularly diabetics -- focus almost singularly on blood glucose levels and insulin action for the maintenance of BG's.  

To the extent that lipids are considered, there is a big focus on lower fasting triglyceride levels and increased HDL.  While not all LC'ers see an increase in LDL, many will see an increase -- sometimes dramatic -- in LDL.  Usually these are dismissed because VLC will result in more of the "fluffy" large particles that are considered less atherosclerotic.  One of my worries is that we don't have a huge (or even much of any) pool of data for modern day low carb eaters.  So while these trends seem promising, I think it is premature to get too excited -- especially to the point of considering large LDL as "protective".  The alternative is to look at primitive cultures and/or their isolated modern day counterparts.  The VLC/VHF "poster cultures" are the Inuit and Masai.  The former, apparently do not exhibit atherosclerosis/CVD, but I would be extremely wary of extrapolating this to modern zero-carbers.  The Inuit diet is uber-heavy on marine omega 3's, the likes of which would require extreme supplementation to duplicate.  Atherosclerosis IS seen in the Masai, however something in their lifestyle renders this inconsequential due to a compensatory increase in vessel diameter.

Regardless, another circulating lipid goes all but ignored:  Non-esterified (aka Free) Fatty Acids (essentially long chain).  Any Google search on elevated NEFA will produce a scary lot of hits describing all sorts of deleterious outcomes.   And yet nobody, conventional medical establishment included, seems to focus on these levels.  But obesity and/or Metabolic Syndrome are associated with elevated NEFA's as well as diabetes (both types).  There's increasing evidence that NEFA are both directly and indirectly responsible for pathogenesis of diabetes and atherosclerosis/CVD.   

Low Carb diets (especially VLC) can produce marked improvements in regulating blood glucose levels.  But NEFA have been shown to be elevated by high fat meals, with or without concurrent carb ingestion, and due in significant part to release from adipose tissue, not just dietary intake.