Why wheat makes you fat

1. October 2011 William Davis (32)
How is it that a blueberry muffin or onion bagel can trigger weight gain? Why do people who exercise, soccer Moms, and other everyday people who cut their fat and eat more "healthy whole grains" get fatter and fatter? And why weight gain specifically in the abdomen, the deep visceral fat that I call a "wheat belly"?

There are several fairly straightforward ways that wheat in all its varied forms--whole wheat bread, white bread, multigrain bread, sprouted bread, sourdough bread, pasta, noodles, bagels, ciabatta, pizza, etc. etc.--lead to substantial weight gain:

High glucose and high insulin--This effect is not unique to wheat, but shared with other high-glycemic index foods (yes: whole wheat has a very high-glycemic index) like cornstarch and rice starch (yes, the stuff used to make gluten-free foods). The high-glycemic index means high blood glucose triggers high blood insulin. This occurs in 90- to 120-minute cycles. The high insulin that inevitably accompanies high blood sugar, over time and occurring repeatedly, induces insulin resistance in the tissues of the body. Insulin resistance causes fat accumulation, specifically in abdominal visceral fat, as well as diabetes and pre-diabetes. The more visceral fat you accumulate, the worse insulin resistance becomes; thus the vicious cycle ensues.

Cycles of satiety and hunger--The 90- to 120-minute glucose/insulin cycle is concluded with a precipitous drop in blood sugar. This is the foggy, irritable, hungry hypoglycemia that occurs 2 hours after your breakfast cereal or English muffin. The hypoglyemia is remedied with another dose of carbohydrate, starting the cycle over again . . . and again, and again, and again.

Gliadin proteins--The gliadin proteins unique to wheat, now increased in quantity and altered in amino acid structure from their non-genetically-altered predecessors, act as appetite stimulants. This is because gliadins are degraded to exorphins, morphine-like polypeptides that enter the brain. Exorphins can be blocked by opiate-blocking drugs like naltrexone. A drug company has filed an application with the FDA for a weight loss indication for naltrexone based on their clinical studies demonstrating 22 pounds weight loss after 6 months treatment. Overweight people given an opiate blocker reduce calorie intake 400 calories per day. But why? There's only one food that yields substantial quantities of opiate-like compounds in the bloodstream and brain: wheat gliadin.

Leptin resistance--Though the data are preliminary, the lectin in wheat, wheat germ agglutinin, has the potential to block the leptin receptor. Leptin resistance is increasingly looking like a fundamental reason why people struggle to lose weight. This might explain why eliminating, say, 500 calories of wheat consumption per day yields 3500 calories of weight loss.

And, as in many things wheat, the whole is greater than the sum of the parts. Despite all we know about this re-engineered thing called wheat, eliminating it yields health benefits, including weight loss, that seem to be larger than what you'd predict with knowledge of all its nasty little individual pieces.
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Comments (32) -

  • Dee Miles

    10/1/2011 4:30:14 PM |

    I'm very interested in the leptin research and hope that it can help people figure out how to overcome their hurdles to weight loss. In your experience can someone correct the leptin resistance with diet? I've been grain and sugar free for 11 weeks and have even energy all day. No more cravings and eat pretty much only when I'm hungry (4-5 hours between meals). The weight loss is slow but I realize that being 43, hormones probably play a role as well.

    Thanks for doing what you do to help educate others on this topic.

  • Frank Hagan

    10/1/2011 6:04:31 PM |

    Great post, Dr. Davis.

    I blogged on leptin resistance at http://goo.gl/4lHbi, but my primary interest was the effect of high triglycerides due to a "standard American diet". There is some evidence that the high triglyceride levels block leptin from crossing the blood brain barrier and therefore prevent it from signaling that you have had enough to eat. In my own experience, going low carb eliminated the constant hunger I faced when I was 40 pounds heavier (and my trigylcerides were at 440).  Going low carb meant that I effectively eliminated wheat, as I eliminated nearly all bread, etc., and focused on animal protein and  green veggies exclusively. The effect happened very quickly, within a week, so I wonder if the wheat lectin was a factor here as well.

  • Howard Lee Harkness

    10/1/2011 9:52:54 PM |

    When I eliminated wheat from my diet in 1999 as part of my low-carb liftestyle chage, my arthritis went away (that alone provided more than enough motivation to stick with the diet for over a decade now), and I dropped 100 lbs with practically no effort. The problem is that I needed to lose *150* lbs, and that last 50 lbs refuses to budge, even on a low-carb diet. I'm beginning to wonder if I have permanently damaged my metabolism. I've noticed that I can drop about 10 lbs, and my morning body temperature goes below 80F, and eventually, I gain the 10 lbs back.

    Your advice?

  • Dr. William Davis

    10/2/2011 2:39:14 PM |

    Hi, Howard--

    This sounds an awfully lot like a thyroid issue. While I doubt that your temperature actually drops to 80 degrees F (since that is fatal), low temperatures can signal hypothyroidism. This can easily throw you off your weight plateau.

  • Dr. William Davis

    10/2/2011 2:40:55 PM |

    Hi, Frank--

    The wheat lectin-leptin connection would indeed explain many things, especially why hunger drops and weight drops so quickly when wheat is eliminated, far larger effects than can be accounted for simply by wheat's carbohydrate content.

  • Dr. William Davis

    10/2/2011 2:43:07 PM |

    Thanks for the feedback, Dee!

    Yes, you can correct leptin resistance with diet, though the effects are highly variable. In general, however, weight correlates quite cleanly with leptin serum levels.

    A tougher question is how to deal with leptin resistance that somehow causes a weight loss effort to stall. A discussion for another day!

  • Olga

    10/2/2011 4:07:23 PM |

    Hi Dr. Davis:
    Have you seen this new study?
    http://www.ncbi.nlm.nih.gov/pubmed/21943927

  • Geoffrey Levens, L.Ac.

    10/2/2011 8:02:23 PM |

    So what the heck does this mean?  Eating wild caught and pastured meats and non starchy veg as almost my only food (added coconut and olive oil), rarely a piece of fruit, I weighed 138 lbs.  As soon as I switched to an all plants, whole intact grains and potatoes and sweet potatoes based diet my weight dropped to 125 with zero change in activity level.  I have since switched most of the grains and potatoes for legumes and by more strenuous working out seem to have lost "hidden" fat and converted it to muscle.  Still at 120 but much more muscular...  This seems to be the opposite of what you espouse as  eat approximately 280 grams of carbs/day though probably 800 or so calories less than when I was eating meat, fat, and non starchy veg... Am I just an anomaly?

  • harlan

    10/3/2011 1:24:20 PM |

    Is it possible that eliminating proteins resulted in the loss of muscle?

  • Kim D

    10/3/2011 7:33:40 PM |

    A question for you Doc,

    Hoping you can give me some clarity on the genes issues of Celiac disease.  I have long suspected that I was wheat intolerant.  I suffered severe constipation since my teens, was laxitive dependant for lots of year taking handfuls a night just to be "regular".  I was able to get off the laxitives after 20 years by grinding my own wheat (and other grains).  It made all the difference in the world getting off pre-packaged foods, and dairy ( I am EXTREMELY dairy intolerant).  However, I never got "better".  I now know from your book that switching from a bad thing, to a less bad thing is not the answer, is advantagous, but still not the best .

    I have known deep down inside that something was wrong with wheat because I am like a heroin addict when I eat it... I cannnot get enough, but since it did help me get off the laxitives, I kind of argued with myself over it my having "real" systemic issue with it.  My other health issues.. skin rash (chronic) which looked and felt like DH, dermititis herpetiformus.  Dermatologist said biopsy was not going to be 100% sure to diagnose it, so I should just get the gene test to see if I had DQ2 or DQ8.  My tests came back negative to both... but I still had a terrible chronic rash for going on 15 years on my legs, lower back and occasionally my torso, like a mirror, effecting both sides of my body in the same areas.  Dermatologist just shrugged and said he couldnt tell me what it was, but he put me on dapsone, and it cleared.  I finally had relief for the first time in a long time, but couldnt stay on the dapsone, due to liver enzyme issues.

    Now, years later, and more health issues like osteoarthritis in my hands and spine and rib joints, BTW, I am only 43!!  I wind up back to questioning the wheat!!  When I found that you had written Wheat Belly, I thought, "maybe he knows something about wheat that I have been unable to find out"!?  After I read it (2 weeks ago) I immediatly changed my diet to a totally gluten free one.   ( we do not eat GMO's, and eat lots of veggies, green smoothies ect.. but I didnt realize just HOW genetically altered our wheat was.)

    I am NOT an "undiagnosed" celiac for sure, as I do NOT have the DQ genes.  The biggest change I feel from being off the wheat is less drive to eat like a maniac.  I have not had any "health" changes, but it has only been 2 weeks.  I unfortunately am noticing the constipation creeping back up though, when I am off the milled wheat.

    In your book, you seem to be speaking largely to people who have been told they do not have Celiac disease due to being misdiagnosed, or told they were NOT celiac due to false blood test results, or lack of proper biopsies...  What is y our opinion of serious immune system/ health issues happenning to folks like me, who are DQ2,DQ8 negative?  I know people WITH those genes can be reactiing (immune system) to wheat even if they are NOT actively in a Celiac disease state... but what about those of us who are not even ever going to get celiac?

    I hope my questions dont sound stupid, perhaps I need to read the book again, or I just missed this specific issue of  where we, who are without the celiac genes, fit into this picture.  Could it be that there are other genes that we dont know about?  Or, are the genes simply irrelevant, due to the fact that the gluten content, and other harmful proteins and lectins are just so out of proportion to natural unmodified wheat?
    I know for sure that my addiction is real, and has caused me much yo yo dieting in the past, never able to lose this pesky 30lbs, because once I eat a slice of toast, or a whole wheat muffin, I become like ravenous beast, who cant stop eating!!  I do know also, that to only be 43, and have such health issues already, that something has to be wrong...  Perhaps years of laxitives have injured my system... glad to have been off of them for 5 years now, but I really think your book has surely pointed me in the right direction of getting off the dwarf wheat!

  • Dr. William Davis

    10/4/2011 2:44:29 AM |

    Hi, Kim--

    There is plenty more to this thing called wheat than "just" immune phenomena. I believe it is pure folly to believe that all potential adverse effects of wheat can be identified via HLA DQ markers or celiac blood markers. There are just too many undesirable components of this thing that are not identified with currently available blood tests.

    You could be HLA DQ2 or DQ8 negative, with negative celiac markers, yet still have life-threatening disease reversed with wheat elimination.

  • Dr. William Davis

    10/4/2011 2:47:01 AM |

    Interesting, Olga.

    If we were to extrapolate this to us hairless mice, it means that an extreme low-carb restriction makes it MUCH harder to express diabetes.

  • smgj

    10/4/2011 1:49:57 PM |

    1) Only rectal temperature readings should be considered accurate. With other types of readings you have a certain heat loss - most for armpit readings, less for under tongue.
    2) You should look into euthyroid sick syndrome/reverse T3 which is a possibility if you drop the carbs all the way...? Some research suggests that we should leave about 50g carbohydrates in the daily allowance to avoid this possibility.

  • Barb

    10/4/2011 6:07:06 PM |

    Hi Dr. Davis!

    First of all, I have to say that I love your book! The information is a God-send and the way that it is presented is clear with just enough humor to be riveting (at least, for a nerd like me).

    I have a question tho’, and I hope that I am not being repetitive or redundant. All I hear and read is that by cutting wheat from the diet, a person can expect weight loss. I have read wonderful testimonials from people who have cut wheat and have lost 50 pounds in 6 months without doing anything else (exercise or caloric restriction).

    But, this does not work for me. My diet is quite strict paleo since last spring (a la Robb Wolf). I eat NO grains (including quinoa or buckwheat or other “grain-ish” items). No dairy with the exception of cream in coffee (about 3 to 4 cups per day). No peanuts, legumes or beans. No rice, potatoes, corn or peas.  No fruit (again, at Robb Wolf’s suggestion that people who need to lose should eschew fruits until their goal is reached). Of course, nothing processed, no sugar and artificial sweeteners are kept to a minimum. I drink water as needed.

    I eat nuts and seeds, eggs, all meats, fish and seafoods, green and colourful vegetables as well as coconut products (oil, milk and meat), avocados, fish oil and olive oil.

    I am 43, and feel great as long as I eat this way. I am not celiac and have not been diagnosed with any medical problems by my doctor (MD). I do however have a strong family tendency towards DMT2. So far, I seem to be OK there, but do suspect insulin resistance due to physical features. I do notice that eating grains results in stomach upsets, water retention, RAPID weight gain, mood swings and a wicked distended belly (I have been congratulated on my pregnancy... LOL!)

    I am very careful about my food intake, so I know that there are no hidden grains, sugars, etc. slipping in. This is very easy when you don’t eat anything processed. I take in, on average, about 1500 calories daily, and currently work out with weights 3 times per week. In the past, I have tried doing tremendous amounts of cardio... Again, no real results.

    I also see an ND, and he has recently requested a saliva panel to check my adrenal hormones, notably AM DHEA’s, Cortisol Curve = C1,C2, C3,C4. I am 5’6” tall and weigh 190 pounds and gain weight mostly in the mid section. I obviously need to lose weight, but everything I try results in a small weight loss (< 10 pounds), followed by a frustrated week or 2 off of my diet, which only results in a big weight gain. Seriously... I went to Mexico for 10 days a year ago. I ate and did the same as everyone else. I GAINED 15 POUNDS. Everyone else’s weight stayed the same, or showed a very small gain... only about 3 pounds.

    My regular doctor, when presented with this information shrugged his shoulders and said, “Weight loss is hard.” I am getting seriously stressed about this... This can’t possibly be normal. Close family and friends have observed and made comments like, “The way you eat and work out, you should have a near perfect body!”
    I know that you would require much more detailed information about me, but is there anything that is striking to you, or have you encountered this before? Any info that I can pass along to my MD or my ND would be so much appreciated!

    Barb

  • Roberto

    10/4/2011 6:23:32 PM |

    Dr. Davis,

    Mat Lalonde gave a speech at the ancestral health symposium called "An Organic Chemist's Perspective on Paleo" - it was mostly about bad science circulating in the Paleo community. In his speech, he mentions an interesting study that demonstrates that wheat germ agglutinin is completely destroyed in the cooking process - literally not a trace is detectable. I can't provide you a reference, because none was given, naturally, during the speech. Perhaps you could get in touch with him and get the reference. I will try myself, and get back to you if I am able to. But if that is true, I seriously doubt WGA is relevant to weight gain, because I can't think of a single wheat product that people eat raw.

    Nor do I believe that the high glycemic index of wheat is a cause of weight gain in people with healthy metabolisms. Numerous cultures have been found in great health eating high glycemic index carbohydrates such as potatos. So I find it a little hard to believe that the glycemic index of wheat initiates metabolic derangement and weight gain.

    As far as your 'cycles of satiety and hunger' and 'high glucose and high insulin' points, those too would indicate a problem with carbohydrate in general, not just wheat. So I would think 'carb belly' would be a more intellectually honest title to your book. Especially, when one considers that you improve most of your patient's health with a low-carb diet - not too mention the supplements and exercise you recommend.

    Also, Stephan Guyenet recently wrote a post outlining why insulin levels have nothing to do with fat mass.
    http://wholehealthsource.blogspot.com/2011/08/carbohydrate-hypothesis-of-obesity.html
    He presents very convincing arguments. Having read it, I personally am not swayed by your claim that wheat promotes weight gain by greatly increasing insulin levels - I dount anyone one who read that article is. He presents far more evidence that insulin levels are not relevant to weight gain than you do claiming they are. Given your claims, I think you are obligated to respond to this article.

    This post offers nothing to single wheat as a unique cause of weight gain.

  • Roberto

    10/4/2011 6:54:46 PM |

    Also...
    I recently had a debate with Tom Naughton regarding the validity of your claims. I made the following points: You claim that wheat is the greatest cause of weight gain, and removal of it from your patient's diets has yielded incredible results. But you don't treat your patients with simply a wheat-free diet. You place your patients on a low-carb, vegetable oil free, refined sugar free, processed food free diet. You also prescribe very important supplements, like omega-3 and vitamin-d, which have been shown to be beneficial independent of other changes. There are innumerable uncontrolled variables in your lifestyle recommendations - far beyond wheat removal - that could be bringing these results.

    Tom's response to me was that you have had an undisclosed (by him) number of your patients try eliminating wheat alone. Apparently, you still saw improvements. Once again, the level of improvement remained undisclosed by Tom. I would like to know how many of your patients you had advised to just eliminate wheat, and what improvements you saw. Of all the patients you've treated, if 99% have undergone your complete recommendations, it is absurd to use their improvements as a case against wheat when you have left countless uncontrolled variables.

    If you have seen improvements with strictly wheat elimination, that too cannot be effectively used as a case against wheat. Eliminating wheat creates far-reaching changes in ones diet that go beyond simply eliminating wheat. The vast majority of highly-palatable, engineered, processed junk food becomes inaccesible. No more doughnuts, no more McDonalds, no more cake. That alone is very significant. Also, when you advise your patients to eliminate wheat alone, I seriously doubt they carried on eating wheat-free junk food like deep-fried factory farm chicken wings, ice cream, and french fries in abundance. They likely embraced a healthier diet altogether that happened to disclude wheat.

  • Dr. William Davis

    10/5/2011 1:37:23 AM |

    No doubt, Roberto. The majority of real world patients in my clinic, as well as the online experience, have followed more than a wheat-free diet. Anecdotally, the people who have followed low-carb yet included wheat continued to experience issues like acid reflux, persistent small LDL, high HbA1c, etc. But anecdotal experiences cannot be used as sole proof.

    If you've read the book, you will see that there is much more to this argument than my anecdotal experience. The fact that overweight celiac patients, for instance, lose on average 26 pounds in the first six months while not restricting calories, fats, polyunsaturates, etc. is among the arguments that are consistent with this proposition, that wheat underlies many health problems, including overweight.

    No doubt: We need more data to fully document the full range of health effects of this incredibly unhealthy creation of geneticists.

  • Dr. William Davis

    10/5/2011 1:39:33 AM |

    Noted. I disagree.

    Do one thing: Eliminate wheat. Do not limit calories or portion size.

    Weight drops, usually at the rate of one pound per day. I can speculate why and I believe it is partly due to the unusually high glycemic index/insulin triggering. It might be the effects of wheat lectin on leptin receptors. But it is a very real effect.

  • Dr. William Davis

    10/5/2011 1:42:41 AM |

    Hi, Barb-

    The most common weight confounder I see is low free T3 values, i.e., low T3 thyroid hormone.

    Assess this by checking free T3, as well as reverse T3, along with TSH and free T4. I aim to keep TSH, by the way, 1.0 mIU or lower to maximize weight control, and keep free T3 and free T4 in the upper half of the quoted range, higher for T3 if reverse T3 is high.

    The cortisol curve can also uncover high cortisol levels that can counteract the effects of your otherwise excellent diet.

  • Roberto

    10/5/2011 3:49:21 AM |

    "Weight drops, usually at the rate of one pound per day."

    I'm having a very tough time envisioning that, especially if a person eliminates wheat without altering calorie intake and portion size. Let's assume the average sedentary obese person requires 2500 calories a day - a reasonable estimate I would say. If they stopped eating completely, a 2500 calorie deficit would amount to less than 3/4 of a pound weight loss per day. So how could they possibly maintain portion size and lose an entire pound per day? Perhaps if wheat was causing them sever water retention, and avoidance of wheat remedied that and led to massive amount of weight loss from water. But I doubt that is what you meant.
    Did you mean to say a pound per week?

  • Barb

    10/5/2011 6:09:05 AM |

    Thank you so much Dr. Davis!
    I will take this information in to my docs... I have a feeling that I will get further with my ND than I will with my MD.

    Thanks so much, and do not be discouraged by the naysayers. Cognitive dissonance can be a very unpleasant thing!

    Barb

  • Dr. William Davis

    10/5/2011 12:11:19 PM |

    Nope. Literally a pound per day. I know it sounds crazy.

    I don't know why. It certainly defies the "calorie in, calorie out idea." Calorie intake drops, on average, only 400 calories per day, so why would someone lose the equivalent of 3500 calories? It is definitely partly water weight, but there is a visible loss of abdominal fat for most people.

    It's not everyone, of course, but a substantial proportion of people.

  • tammy

    10/8/2011 10:14:48 PM |

    I was diagnosed with PreDiabetes in August and having a rough time Changing from eating Carbs, like that Bagel you referred to or a few cookies a day, to High Fat and High Protein. I am underweight and Still have around 7 pounds to gain  before I am at my goal. I have only My Diabetic MD who by the way is Diabetic Herself, Promoting me to Give Up the Grains and roots. All other MD's on my team have been against this saying that I am on the Cusp of Prediabetes at 5.7 and should not worry about it. I want to PREVENT being Diabetic, not come to them AFTER the fact. By the way, I have very HIGH cholesterol, so what you are saying sure seems to go right along with my Diabetic. MD. I feel torn because I know I need to gain weight and How Possibly DO I GAIN WHEN I LEAVE OFF FOODS THAT WILL HELP ME GAIN? Please respond if ANYONE has any advice. I am OPEN TO LISTEN.  I also dont feel the best after eating Sugars, but Crave them. Once I eat them, then I feel worse. CYCLE BEGINS AGAIN.

  • Dr. William Davis

    10/9/2011 11:03:38 PM |

    Hi, Tammy--

    Tough situation.

    While slashing carbs will reduce HbA1c and blood glucose, the fact that you are underweight yet still diabetic raises some unique issues. This may not be the run of the mill diabetes, but another condition such as the so-called late-onset diabetes of adulthood, a form of diabetes with features that overlap with type 1. So the comments directed at the very common overweight type 2 may not fully apply to you.

    Let us know what you learn.

  • Andrew

    11/3/2011 2:51:27 PM |

    Dr D

    I was wondering when you advise to eliminate wheat, does the same go for oats and oat bran too? Does this effect prediabetics the same way as wheat. I am very interested in your response.
    thank you

    Andrew

  • Dr. William Davis

    11/4/2011 12:49:57 PM |

    Hi, Andrew--

    The problem with oats is somewhat different: It is a blood sugar and carbohydrate issue.

    If you were to check a blood sugar 1-hour after a bowl of unsweetened whole oats, you would see sky-high blood sugars. So we do not include oat products in any form in the diet.

  • Andrew

    11/4/2011 2:29:36 PM |

    Here I was thinking that oat bran for breakfast was a good choice. Thanks Doctor D for the response

  • N

    11/7/2011 4:26:30 AM |

    Hi Doc,

    While I've significantly reduced the amount of carbs/wheat I eat, I often still find myself in situations where I can't avoid it (out with coworkers, and the run, etc).

    My resting blood glucose was a little high on my last physical (105), so I want to keep an eye on things.

    My question is this:   If you are stuck eating a meal that is going to spike your blood sugar, when would be the best time to take a 15-30min walk to try to help your muscles absorb some of the glucose?  I know insulin peaks around 90min afterwards or so.

    Would I be better off walking immediately after eating (to start the glucose absorption right away), or delaying around an hour and then walking?

  • David German

    11/16/2011 4:07:33 AM |

    Could there be a beneficial increasing metabolic rate accounting for at least some of this weight loss? I used to be able to eat untold numbers of calories when I was (much) younger, without gaining weight. Quite a typical situation.
    Now, if I could just get that quicker metabolism again  Smile

  • David

    11/16/2011 4:57:06 AM |

    Question - so, if I eliminate the modern wheat you are talkiing about, what about some of
    the other grains that are being used? For example:
    "Ancient grains", such as kamut and spelt. They taste great and if they are truly ancient grains
    they wouldn't have the integral problems.

  • Gary Mullennix

    3/8/2013 1:46:27 PM |

    I've lost 52# and maintained the loss for 16 months. My total cholesterol went from 243 to 285. My HDL went from 58 to 91. Doctor wanted to put me on a statin. I said no because I don't tolerate them (muscle pain and very poor test results) and wanted a diagnosis of CHD if I was to undergo medical treatment for that condition. A coronary calcium scan showed 0 in 2, a 100 in one and 329 in the left anterior descending. Cardiologist ordered nuclear and treadmill stress tests with neither showing any restrictions in flow or supply to the heart. So, he says to exercise vigorously 5x week/1hr daily and exercise is 70% of my treatment, diet 20% and medication would be 10% if I took the statin which I am not.  Neither my Doc or the Cardiologist knew what the VAP scores of the fractionated LDL scores meant (117 1-2, 43 3-4) but the both recommended a low fat diet and the cardiologist told me to buy and follow Dean Ornish's newest book Spectrum.
    1. Are all fractionated LDL tests of the same quality or is there one best?
    2.  Why is this called a disease and not a condition?  How am I to know if any treatment is proceeding successfully other than I'm not dead?  
    3. Years ago a physician put me on a synthetic Throid supplement to eliminate the possibility of thyroid cancer since he thought he could feel the thyroid and I had been treated with X-Ray to the head in 1946 for ringworm. My TSH scores have remained within the boundaries pretty well although my T4Free was 244.  Any comment.
    4. I was diagnosed 33 years ago as being hypoglycemic and carried sugar with me to treat low blood sugar while exercising etc.  my CRP score is just over 1, well within the test limits of the tests I take. But that is 2x your recommendation of no more tham .5. BTW, since low carb, I've not had low blood sugar event and my tested glucose runs 90.  Is it likely that this hypoglycemic condition related to inflammation and arteriosclerosis?
    5.  I'm taking antioxidant supplements, lumbrokinase, L-Carnitine, no flush Niacin, Vit D3 (6000 IU)
    6.  I'm 73, no illnesses of consequence, blood pressure of 105/65.  I live in Naples FL. There are no cardiologistts I've heard of down here willing to discuss any regimen other than low fat and statins along with exercise. Do you have a colleague within 200 miles?  

    Thank you for your work. I think my promoting your work along with Gary Taubes has caused a 500 lb weight loss for me and our friends and a nice, fat increase in HDL.

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Cureality | Real People Seeking Real Cures

An exercise in optimism

5. May 2007 William Davis (0)
Followers of the Track Your Plaque program already know that maintaining an optimistic viewpoint is important in gaining control over coronary plaque.

In fact, I believe that, in many cases, a sense of optimism may make or break your CT heart scan score-reducing efforts. Pessimists rarely drop their score, while optimists do so all the time.

This week posed a challenge to my optimism. I spent the last week on jury duty hearing the details of a murder case. For four days, I listened to blow-by-blow testimony about the totally pointless, unprovoked death of a young man by a drug-dealing thug. Much of the witness testimony was from people who shared the hopeless, violent world of the defendant.

I was, however, completely impressed by the dedication of the prosecuting attorney, a 50-some year old man who was clearly deeply dedicated to his mission and didn't once provide any indication that he was grandstanding or looking for some personal glory. He was doing his job and trying to obtain justice for the fallen victim. I was equally impressed by the judge, who seemed unfazed by the events but carefully explained why the system worked the way it did. After the trial, he provided some further insights to us jury members and I saw him as a human being who, like the prosecutor, was trying to make a small contribution to making the world better.

Though many of the witnesses who testified against the defendant shared his world, I was impressed with their courage in coming forward. They face the threat of reprisals, I'm sure, for coming forward to the law and testifying against a known career criminal. Several of them said that they were not after any reward, but simply wished to do the right thing and provide testimony that proved damning against the defendant.

I acted as the jury foreman and I was proud of how the jury members listened carefully, asked intelligent and probing questions, and then helped us render a confident and expeditious sentence: guilty.

If anything, despite the tragic circumstances, I was much heartened at how all the participants in this process played their part and justice (at least in the legal sense) was served.

Let optimism prevail, even in dire circumstances.

No need to re-invent the wheel

2. May 2007 William Davis (0)
I seem to be repeating myself lately, but I think this does bear repeating:

There's no need to re-invent the wheel when it comes to gaining control over your heart scan score.

The Track Your Plaque program is the most powerful approach known to help you gain control over your coronary atherosclerotic plaque and CT heart scan score, bar none. While 100% of people do not drop their score, more and more people every week are doing so. (One of the admitted weaknesses of the Track Your Plaque website is our failure to list more success stories; we're working on it.)

The basic program is quite simple:

--The Rule of 60 for lipids (LDL 60 mg/dl; HDL 60 mg/dl or greater; triglycerides 60 mg/dl or less)

--Identify hidden causes of plaque, esp. small LDL, Lp(a), and IDL, followed by specific corrective action

--Fish oil--minimum 1200 mg per day of EPA + DHA

--Normal vitamin D3 blood levels (We aim for 25-OH-vitamin D3 of 50-60 ng/ml)

--Normal blood sugar (<100 mg/dl)

--Normal blood pressure (<130/80)

--An optimistic attitude



Much of the other stuff--vitamin K, matrix metalloproteinase reducing strategies, flavonoid strategies, exercise-induced hypertension, etc.--are, for the majority, fluff. Their real role is in people who may have failed in stopping the rise of their heart scan score just doing the basics of the program.

If you neglect the basics, hoping to find some magic potion, I'm afraid the overwhelming likelihood is that you will fail. I've seen it happen time and again. Someone will come to my office with an extraordinary list of supplements--hawthorne, dozens of anti-oxidants, EDTA, concentrated flavonoid preparations, and on and on. Not only is it shockingly expensive to do this, it's also unnecessary and foolhardy. This kind of unfocused, hocus-pocus in the hopes of getting it right fail time after time.

The Track Your Plaque program, while not foolproof, is the best I know of. Stick to the basics and wander off when the basics fail. But there's extraordinary power in just achieving the basics.

Are we a front for drug companies?

2. May 2007 William Davis (3)
I was shocked recently when someone accused me and the Track Your Plaque website of being nothing more than a front for the drug industry, that we are promoting concepts with the hidden pharmacuetical agenda behind us.

Don't make me laugh. How in the world that kind of impression could be gotten from either the Heart Scan Blog or the Track Your Plaque website is beyond me.

But I occasionally do need to state explicity: We do not promote drugs, neither this Blog nor the Track Your Plaque website has ever sought nor been backed by pharmaceutical money. The only money that supports this website is our own and that from paying Track Your Plaque members.

In fact, I am quite proud of the unbiased content and commentary on both venues. I challenge anyone to point out how and where there is any suggested relationship to a hidden source of commercial backing. I assure you, there is none.

If I say a drug is worth you and your doctor considering, then I say so with a true belief in it, not because somebody or some company paid me to say so. If I say a drug stinks, I believe that too. If we use a specific supplement in the program, it's because we believe it truly adds value to a plaque-reversal program. We receive no money from drug, supplement, or other commercial interests to promote their products. Period.

What is "normal"?

1. May 2007 William Davis (2)
When it comes to laboratory values and medical testing, a common dilemma is knowing what is "normal." Let me explain.

First of all, when you receive a laboratory result for a test, a "reference range" or "normal range" is usually provided. Where did that range come from?

It varies from test to test. For instance, a low potassium is easy, because low potassium levels can lead to life threatening consequences, e.g., dangerous heart rhythms. High potassium likewise, because dangerous phenomena develop when potassium generally exceeds 5.5 mg/dl or so.

But what about something like HDL or LDL. Here's where confusion reigns. Often, "normal" is obtained by taking the average and saying that any value plus or minus two standard deviations (remember that painful class?) represents normal or reference range.

If that were true, what if we applied that principle to body weight. If we weighed several thousand adult women, the average would be in the neighborhood of 172 lbs (no kidding). Does that mean that 172 lbs plus or minus two standard deviations is normal? No, of course not.

There is therefore a distinction between "normal" and "desirable". For HDL cholesterol, your laboratory report might say that an HDL cholesterol of 40-60 mg/dl is normal. But is it desirable? I don't think so. The most frequent HDL level for a male with a heart attack is 42 mg/dl--hardly desirable.

Let's take triglycerides. The average triglyceride level in the U.S. is somewhere around 140 mg/dl. For those of us who do a lot of lipoprotein testing, we can tell you that triglycerides at this level, though generally regarded as being within the normal range, are associated with flagrant and obvious excesses of several abnormal lipoprotein particles that contribute to coronary plaque growth (VLDL and often IDL; small LDL; drop in HDL and shift towards small HDL).

So, always take the so-called "normal" or "reference" values on a lab report as crude guidelines that often have little or nothing to do with health or desirability. Unfortunately, many physicians are not aware of this and will declare any value within the normal or reference range as okay. An HDL of 40 mg is not okay. A triglyceride level of 140 mg is also not okay.

What is okay? What is desirable? That depends on the parameter being examined. From a basic lipid standpoint, of course, we regard desirable as 60-60-60. Desirability from a lipoprotein standpoint we will cover in a more thorough Track Your Plaque Special Report in future.

The wisdom of the masses

1. May 2007 William Davis (0)
My sister sent me these quotes:



"We don't like their sound, and guitar music is on the way out."

Decca Recording Co. rejecting the Beatles, 1962


"Stocks have reached what looks like a permanently high plateau."

Irving Fisher, Professor of Economics, Yale University, 1929


"Airplanes are interesting toys but of no military value."

Marechal Ferdinand Foch, Professor of Strategy, Ecole Superieure de Guerre, France


"Everything that can be invented has been invented."

Charles H. Duell, Commissioner, US Office of Patents, 1899



No doubt, conventional wisdom can often be laughably (tragically?) wrong. The problem is that, as absurd as all the above sentiments seem to us now and in retrospect, they represented the view of many people years ago. These views were held by many, including many people in positions of power and decision-making responsibility.

A more relevant but nonetheless laughable and widely held belief in 2007: coronary heart disease should be treated with hospital procedures.

Why is a disease that requires 30 years to develop treated only at the final moments with a procedure? Do you only change your car's oil when the engine is on its last legs? Or, do periodic, relatively effortless oil changes during the life of the car make better sense?

I witness just how brainwashed the public has become with this crazed notion when I meet someone socially at, say a fundraiser or cocktail party. When they ask what I do, I tell them I'm a cardiologist. The invariable response: "Oh, what hospital do you work out of?"

I tell them I don't, that I take care of the majority of heart disease right from the office. 99% of the time I get a puzzled look. If we had comic bubbles above our heads revealing our internal thoughts, it would read "Yeah, right. What a kook."

The notion that coronary heart disease is something that is manageable with simple tools for the majority of us in the early stages is entirely foreign to almost everybody. The hospitals and the medical industry have so succeeded in dazzling the public with images of staff in scrubs, rushing from emergency to emergency, lights flashing, scalpels flying. . . how can you possibly accomplish this at home or anywhere outside of the high-tech world of the hospital?

Well, I'm a cardiologist and I do it every day. We all need a figurative dose of electroshock therapy to shake ourselves of this crazy notion.

How important is l-arginine?

30. April 2007 William Davis (13)
Perhaps more than any other supplement, l-arginine causes frustration and confusion. It’s difficult to find, sometimes quite expensive, and some preparations cause loose stools.

Just how necessary is it?

L-arginine, you’ll recall, is a source of nitric oxide, or NO. Though it’s the same stuff as in car exhaust, NO provides a critical signaling role in your body’s cells that regulate a multitude of functions. Among the important roles of NO is to powerfully dilate, or relax, arteries. A constant flow of NO is required for health, particularly since each molecule persists only a few seconds.

L-arginine is the body’s source of nitric oxide. In addition, a peculiar but very effective blocker of l-arginine called asymmetric dimethylarginine, or ASDM, has recently been discovered to prevent the production of NO. Varied conditions like hypertension, diabetes, high cholesterol, excessive saturated fat or processed carbohydrate intake all lead to heightened levels of ASDM, often several-fold greater levels, and thereby effectively blocking NO production.

The “Arginine Paradox” is the name that some researchers in this field have given to the unusual property of l-arginine supplementation to “overpower” the blocking effects of ASDM. This is somewhat unusual in biologic systems in that an agent that blocks a receptor cannot usually be outmuscled by providing excess material for a reaction. Kind of like hoping that your car runs faster simply by topping up the gas tank.

Concrete observable benefits have been made for l-arginine in clinical trials, such as arterial relaxation that results in arterial enlargement (which can actually be seen in the cath lab); anti-inflammatory effects; reduction of blood pressure; enhancement of insulin responses, etc. All of these effects can be connected to beneficial properties that may facilitate atherosclerotic plaque regression and, indeed, there are limited data to document that this is true.

Drug companies may be greedy, but they’re not stupid. They’ve been vigorously pursuing this line of research for some years, a research path that led inadvertently to the erectile dysfunction agent, sildenafil (Viagra), and all its subsequent competitors. (Erectile dysfunction is another expression of endothelial dysfunction, since male erections are driven by the ability to dilate penile arteries.) The wonderful properties of NO enhancement continue to occupy research labs around the world.

Wow. So what’s the reluctance? In the early years of the Track Your Plaque program (meaning just a short 7-8 years ago), I was thoroughly convinced that l-arginine was a crucial, necessary part of a plaque regression program. Without it, you would rarely succeed. With it, the odds were tipped in your favor.

However, something curious has emerged recently. I’ve seen more and more people dropping their heart scan scores. Not just a little bit, but a huge amount. Witness our most recent record holder, Neal, who dropped his score 51% in 15 months. Just five years ago, this magnitude of reversal was unimaginable. Granted, Neal is our record holder, but others are obtaining 10, 18, 24, 30% drops in scores all the time. Many have done it without l-arginine.

Now, how about the people who have failed to stop a rising score? Would they do better with l-arginine as part of the mix? I believe so, but sometimes we never quite know except in retrospect. It has been a great dilemma for us trying to predict from the starting gate who will or who won’t drop their heart scan score.

My view from the trenches is that l-arginine packs its greatest atherosclerosis-fighting punch in the first year or two of use, when “endothelial dysfunction” is likely to be present (abnormal artery constriction). But as all other strategies take hold—fish oil, correction of lipid and lipoprotein abnormalities, weight loss (big effect), vitamin D (another very big effect), etc.—endothelial behavior improves over time. Perhaps l-arginine becomes a less necessary component over time.

There’s no doubt that uncertainty still surrounds the use and science surrounding l-arginine. However, if you’re interested in stacking the odds in your favor, particularly during the first year or two of your plaque-reducing efforts, I think that l-arginine is worth considering. It is cumbersome, it can be expensive, some preparations may even be foul. But in the big picture of life, with hospitals trying every possible ploy to get your body on a table for a procedure, doctors perverting their mission by signing employment contracts with hospitals and agreeing to usher you into the hospital as a paying patient whenever possible, and drug companies viewing you and me as a market for medications which may or may not be helpful, l-arginine is surely not that big a burden.

Track Your Plaque and non-commercialism

29. April 2007 William Davis (6)
If you're a Track Your Plaque Member or viewer, you may know that we have resisted outside commercial involvement. We do not run advertising on the site, we do not allow drug companies to post ads, we do not covertly sponsor supplements. We do this to main the unbiased content of the site.

We've seen too many sites be tempted by the money offered by a drug company only to see content gradually drift towards providing nothing more than cleverly concealed drug advertising. I personally find this deceptive and disgusting. Ads are ads and everyone knows it. But when you subvert content, secretly driven by a commercial agenda, that I find abhorrent.

That said, however, I do wonder if we need the participation of some outside commercial interests to help our members. In other words, many (over half) of the questions and conversations we have with people is about what supplement to take, or what medication to take. While we cannot offer direct medical advice online (nor should we) because of legal and ethical restrictions, I wonder if could facilitate access to products.

Many people struggle, for instance, with trusted sources for l-arginine, vitamin D, fish oil. Other people struggle with finding a heart scan center because of the changing landscape of the CT scanning industry. Could we somehow provide a clear-cut segment of the website that clearly demarcates what is commercial and non-Track Your Plaque-originated, yet at least provides a starting place for more info?

Ideally, we would have personally tried and investigated everything there is out there applicable to the program. But that's simply impossible at this stage.

I feel strongly that we will never run conventional ads on the site. Nor will we ever permit any outside commercial interest to dictate what and how we say something. The internet world is full of places like that. Look at WebMD. I find the site embarassing in the degree of commercial bias there. We will NEVER sell out like that, regardless of the temptation. People with heart disease are all conducting a war with the commercial forces working to profit from them--hospitals, cardiologists, drug companies, medical device companies (yes, even they advertise to the public, e.g., implantable defibrillators--no kidding). Genuine, honest, unbiased information is sorely needed and not from some kook who either knows nothing about real people with real disease, or has a hidden agenda like selling you chelation.

I'd welcome any feedback either through this Blog or through the contact@cureality.com.

The nattokinase scam

28. April 2007 William Davis (179)
A conversation about vitamin K2 commonly leads to confusion. Several people have asked about something called nattokinase.

The scientific data on the potential role of vitamin K2 deficiency in causing both osteoporosis and vascular calcification is fascinating. Along with vitamin D3, vitamin K2 may be an important factor in regulation of calcium metabolism. Supplementation may prove to be a major strategy for inhibition of vascular calcification.

Obtaining K2 in the diet is tricky, since it's present in just a handful of foods: egg yolks, liver, traditional cheeses, and natto. This is where the confusion starts.

Natto is a Japanese fermented soy product. I've had it and it's quite disgusting. Nonetheless, Japanese who eat natto experience less fracture. (A parallel study in heart disease has not been performed.) Natto is also a source of another substance called nattokinase.

Advocates (otherwise often known as supplement distributors) claim that nattokinase is a "fibrinolytic", or blood clot-dissolving, preparation that "improves blood flow, protects from blood clots, and prevents heart attacks and strokes."

Don't you believe it. This is patent nonsense. There are several problems with this rationale:

--Any oral fibrinolytic agent is promptly degraded in the highly acid environment of the stomach. That's why all medically used fibrinolytics are given intravenously. Drug companies have struggled for years to encapsulate, modify, or somehow protect protein (or polypeptide) products taken orally from degrading this way. They've never succeeded. That's why, for instance, growth hormone (a polypeptide) remains an injection, not an oral agent. An oral growth hormone, by the way, would sell like mad, so the drug companies would very much like to figure out how to bypass the degradative effects of stomach acid. One of the "researchers" behind the nattokinase claims boasts that he has single-handedly figured out how to protect the nattokinase molecule in the gastrointestinal tract. However, he won't tell anybody how he does it. Right.

--Fibrinolytic agents are extremely dangerous. In years past, we used to treat heart attacks with intravenous fibrinolytic agents like tissue plasminogen activator, urokinase, streptokinase, and others. They have fallen by the wayside, for the most part, because of limited effectiveness and the unavoidable dangers of their use. Fibrinolytics are "dumb": they dissolve blood clots in both good places and bad. While they might dissolve the blood clot causing your heart attack, they also degrade the tiny clot in your cerebral (brain) circulation that was protective. That's why fatal brain hemorrhages, bleeding stomach ulcers, and blood oozing from strange places can also occur with fibrinolytic administration. Believe me, I've seen it happen, and I've watched people die from them.

The idea that a small dose taken orally is healthy is ridiculous. Even if nattokinase worked, why the heck would you take an agent that has known dangerous and very real consequences?

Don't let this idiocy reflect poorly on the K2 conversation, which, I believe, holds real merit and is backed by legitimate science. This is symptomatic of a larger difficulty with the supplement industry: Insane and unfounded claims about one supplement erodes credibility for the entire industry. It gives regulation-crazed people like the FDA ammunition to go after supplements, something none of us need. You and I have to sift through the nonsense to uncover the real gems in this rockpile, real gems like vitamin D3, omega-3 fatty acids from fish oil, and, perhaps, vitamin K2. But not nattokinase.

Blood pressure with exercise

27. April 2007 William Davis (10)
Here's a frequently neglected cause for an increasing CT heart scan score: High blood pressure with exercise. Let me explain.

Paul's blood pressure at rest, sitting in the office or on arising in the morning, or at other relatively peaceful moments: 110/75 to 130/80--all in the conventional normal range.

We put Paul on the treadmill for a stress test. At 10 mets of effort (on the protocol used, this means 3.4 mph treadmill speed at 14 degree incline), Paul's blood pressure skyrockets to 220/105. That's really high.

Now, blood pressure is expected to increase with exercise. If it doesn't rise, that's abnormal and may, in fact, be a sign of danger. Normally, blood pressure should rise gradually in a stepwise fashion with increasing levels of exercise. But any blood pressure exceeding 170/90 is clearly too high with exercise. (Not to be confused with high blood pressures not involving exercise.) A handful of studies have suggested that a "breakpoint" of 170/90 also predicts heightened risk of heart attack over a long period.)

I see this phenomenon frequently--normal blood pressure at rest, high with exercise. This also suggests that when Paul is stressed, upset, in traffic congestion, under pressure at work, etc., his blood pressure is high during those periods, as well. I wouldn't be surprised to see other phenomena of underappreciated high blood pressure, like abnormally thick heart muscle (left ventricular hypertrophy), an enlarged thoracic aorta (visible on your heart scan), left atrium, perhaps even an abnormal EKG or abnormal kidney function (evidenced by an elevated creatinine on a standard blood panel).

Unfortunately, the treatments that reduce blood pressure are "stupid," i.e., they have no appreciation for what you are doing and they reduce blood pressure all the time, whether or not you're stressed, exercising, or sleeping.

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

The message: Watch out for the blood pressures when you have a stress test. Or, if you have a friend who is adept at getting blood pressures, get a blood pressure immediately upon ceasing exercise. It should be no higher than 170/90.

Vitamin D2 vs. vitamin D3

26. April 2007 William Davis (21)
An interesting question came up on the Track Your Plaque Member Forum about vitamin D2 vs. vitamin D3. This often comes up among our patients, as well.

Vitamin D is measured in the blood as 25-OH-vitamin D and is distinct from 1,25-diOH-vitamin D, a kidney measure, a test you do not need unless you have kidney failure.

The human form of vitamin D is cholecalciferol and is usually obtained via activation of a precursor molecule in the skin on activation by the sun. You can also take cholecalciferol and it increases blood levels of 25-hydroxy vitamin D reliably.

However, there is a cheap, plant-sourced, alternative to vitamin D3, called vitamin D2, or ergocalciferol. D2 has far less effect in the body. Taking D2 or ergocalciferol orally is an extremely inefficient way to get D. Unfortunately, it's the form often used in milk and many supplements, even the prescription form of D. About half the multivitamins and calcium supplements I've looked at contain ergocalciferol rather than cholecalciferol.

Taking vitamin D2 yields very little conversion to the effective D3. This particular issues is maddening, as the USDA requires dairy farmers to add 100 units of vitamin D to milk, and D2 is often used. In other words, the D in many dairy products barely works at all. There are many children who rely on D from dairy products who are at risk for rickets and are not getting the D they need from dairy products because of this cost-saving switch. Do not rely on milk for vitamin D for your children.

D2 or ergocalciferol is often included in the blood measures of vitamin D along with vitamin D3. The only reason it's checked with blood work is to ensure "compliance,", i.e., see whether or not you're taking a prescribed ergocalciferol. Beyond this, it has no usefulness.

25-OH-vitamin D3, or cholecalciferol, is both the blood measure and the supplement you need. This is the one that packs all the punch. Keep in mind also that it is the oil-based gelcap you want, with more consistent and efficient absorption. Tablets usually barely work at all, even if it contains cholecalciferol. Most people who take calcium tablets with D, or multivitamin with D, not only are getting a powdered form of D, but also in trivial doses. It's the pure vitamin D3, cholecalciferol, in gelcap form you want if you desire all the spectacular benefits of vitamin D.