Unexpected effects of a wheat-free diet

17. September 2009 William Davis (59)
Wheat elimination continues to yield explosive and unexpected health benefits.

I initially asked patients in the office to eliminate wheat because I wanted to help them reduce blood sugar and pre-diabetic tendencies.

A patient would come to the office, for example, with a blood sugar of 118 mg/dl (in the pre-diabetic range) and the other phenomena of pre-diabetes or metabolic syndrome (high blood pressure, high inflammation/c-reactive protein, low HDL, high triglycerides, small LDL), and the characteristic wheat belly. Eliminate wheat and, within three months, they lose 30 lbs, blood sugar drops to normal, blood pressure drops, triglycerides drop by several hundred milligrams, HDL goes up, small LDL plummets, c-reactive protein drops.

People also felt better, with flat tummies and more energy. But they also developed benefits I did not anticipate:

--Improved rheumatoid arthritis--I have seen this time and time again. Eliminate wheat and the painful thumbs, fingers, and other joints clear up dramatically. Many former rheumatoid sufferers people tell me that one cracker or pretzel will trigger a painful throbbing reminder that lasts a couple of hours.

--Improved ulcerative colitis--People incapacitated with pain, cramping, and diarrhea of ulcerative colitis (who are negative for the antibodies for celiac disease) can experience marked improvement. I've seen people be able to stop all their nasty colitis medications just by eliminating wheat.

--Reduction or elimination of irritable bowel syndrome

--Reduction or elimination of gastroesophageal reflux

--Better mood--Eliminating wheat makes you happier and experience more stable moods. Just as wheat is responsible for a subset of schizophrenia and bipolar illness (this is fact), and wheat elimination generates dramatic improvement, when you or I eliminate wheat, we also experience a "smoothing" of mood swings.

--Better libido--I'm not sure whether this is a consequence of losing a belly the size of a watermelon or improvement in sex hormones (esp. testosterone) or endothelial responses, but more interest in sex typically develops.

--Better complexion--I'm not entirely sure why, but various rashes will often dissipate, bags under the eyes are reduced, itching in funny places stops.


It's also peculiar how, after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people.

Obviously, people with celiac disease, who can even die of exposure to wheat, are even worse. What other common food do you know of that makes us sick so often, even occasionally with fatal outcome?
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Comments (59) -

  • Olga

    9/17/2009 1:08:20 PM |

    Hi Dr. Davis:

    Are you familiar with Dr. Wolfgang Lutz from Austria.  He has a book entitled "Life Without Bread."  He has been treating patients with a low carbohydrates diet for over 40 years and he has seen improvements in the same conditions in his patients.  In his book he presents data from his patients over the last 40 years and it's very impressive.  Here is the amazon.com link to the book:
    http://www.amazon.com/Life-Without-Bread-Low-Carbohydrate-Diet/dp/0658001701/ref=sr_1_1?ie=UTF8&s=books&qid=1253192708&sr=8-1

    Thanks so much for writing this blog.

  • Adam Wilk

    9/17/2009 1:23:39 PM |

    I absolutely agree with what you're saying here--for the most part, I do not eat wheat, but I must tell you, the desire for any wheat product never leaves (in my case, anyway) and is frequently craved--but what a punishment for indulging, even once in a great while:
    A few days ago, whilst enjoying a delicious mostly protein and fat dinner at Outback, my wheat devil got the best of me, and I took a mere slice of that delicious bread they put on the table, with a generous pat of butter.  Within 5-10 minutes, I literally felt my nose and sinuses swelling up on me.  Not fair, but reality.
    Hmmph.

  • Helena

    9/17/2009 1:43:44 PM |

    Oh this is so true! I love myself when I stop eating wheat and a lot of sugars - can't get enough sex och have much more energy!

    But from time to time I fall back and just crave that pasta... and every time I do, I regret it; Stomach cramps is always what will be served for dessert!

  • Anonymous

    9/17/2009 2:35:30 PM |

    Dairy and lots of sugar.
    But wheat might be the worst.

  • Susan

    9/17/2009 2:48:41 PM |

    Two years ago, my knees hurt so badly that I avoided sitting in low chairs (I couldn't get out of them) and I was "one-footing" stairs. Then I went on a low-carb diet and the pain cleared up. I failed to put two and two together until a trip to France where I "allowed" myself small amounts of bread and suddenly it became important to know if a metro stop had an escalator. Now I know that eating wheat will result in knee pain 48 hours later.

    Fast forward to this summer when my 24-year-old daughter was having stomach pain--it was after meals, but sometimes the pain woke her in the night. "Heartburn," said her physician, maybe related to stress, and put her on Nexium for a month to see if it cleared up. It did, but returned when her prescription was over. Having read about the side effects of PPI use, I suggested to my daughter that she consider eliminating gluten and/or milk products for a while to see if that helped. She did (although she whimpered a bit about giving up beer). The pain disappeared almost immediately, and a bit of experimentation showed that it was wheat and only wheat that caused the pain (cheers).

    When my daughter described the pain, I realized that I had the same symptom when I was her age, but I didn't have it looked into because it never lasted long enough to bother with (I'm one of those doctors' kids who avoid doctors).

    So my question is, in light of all of the signs that point to wheat intolerance as a cause of gastrointestinal distress and joint pain and a whole lot of other things, why is eliminating wheat not the first course of action?

    By the way, I found the recent article in Scientific American on celiac disease, leaky gut and automimmune disease to be very interesting.

  • Chris

    9/17/2009 3:37:49 PM |

    Does wheat elimination include eliminating beer, particularly, wheat beer?

    It's the only wheat--or grain for that matter--in my regular diet.

  • Gretchen

    9/17/2009 6:25:00 PM |

    "after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people."

    I gave up wheat a long time ago when I found it triggered acid reflux. And I found just the opposite.

    As long as I didn't eat wheat regularly, I could have the occasional wheat with no problems.

  • Anonymous

    9/17/2009 8:01:42 PM |

    Does anyone know if Ezekial 100% sprouted whole grain bread (yes contains some sprouted wheat + many other grains) is still considered "wheat" as I want to have a zero wheat diet.  Hmmm  think I just answered by own question.  thanks!

    All posts by william-davis

    Coenzyme Q10 and statin drugs

    23. July 2006 William Davis (0)
    Although drug manufacturers claim that muscle side effects from statin drugs occurs in only around 2% or people or less, my experience is very different.

    I see muscle weakness and achiness develop in the majority of people taking Lipitor, Crestor, Zocor, Vytorin, etc. I'd estimate that nearly 90% of people get these feelings sooner or later.

    Thankfully, the majority of the time these feelings are annoyances and do not lead to any impairment. Full-blown muscle destruction is truly rare--I've seen it once in over 10 years and thousands of patients.

    The higher the dose of statin drug and the longer you take it, the more likely you're going to have muscle aches.

    I experienced a strange phemomenon myself today. I worked outdoors for about 4 hours, pulling weeds, digging in the dirt, spreading topsoil. (I have an area of overgrowth in the front yard.) Admittedly, I worked pretty hard and it was a warm, humid day.

    I was sore, as you'd expect at age 49. But, much more than that, I was exhausted--my muscles ached and I had barely enough strength to get up the stairs.

    Hoping for some relief, I took an extra dose of coenzyme Q10. I usually take 50-100 mg per day. Today, when I felt this overwhelming muscle fatigue, I took an additional 200 mg. Within 10 minutes, I felt a surge of energy. It was, in fact, a perceptible, quite dramatic feeling.

    I am thoroughly convinced, through my own experiences on Lipitor (I have a high LDL particle number despite a healthy lifestyle, among other abnormalities), and the experiences of many other people, that coenzyme Q10 can be an extremely useful tool to minimize the muscle aches and weakness of the statin drugs.

    If you do indeed need to take one of these agents, coenzyme Q10 is worth knowing about. Supplementing coenzyme Q10 has, for me, been a real lifesaver. For many people, LDL reduction is a crucial part of their heart scan score control program. In my experience, many of them would not be able to take the drug without eozyme Q10.

  • donny

    9/18/2009 1:33:52 PM |

    Before the phrase "wheat-belly" was phrased, there was the phrase "beer-belly." Personally, I don't care if it's made from barley or wheat, beer poses a clear danger either way.

  • pooklaroux

    9/18/2009 4:50:34 PM |

    I suffered from IBS for years, and discovered the "cure" when I went on Atkins in 1999.  I'm afraid, though that in my case, eliminating wheat alone isn't sufficient, I seem to have problems with any grain that is high in fiber. One or two amaranth based cookies was enough to trigger IBS symptoms for a whole weekend.

  • DropYourAllergies

    9/18/2009 5:34:49 PM |

    Gluten >> Allergy ? > InTolerance ? > Celiac ?

    Did YOU Know / Have you been told ?

    That > If YOU suspect that You have a Gluten InTolerance / Celiac Disease > Do NOT begin a Gluten Free DIET > Until You have been Medically Diagnosed ( See Below ).

    IF ..
    You would like information regarding a >  Personal Use >  Self Test / Finger Stick Kit > That will test You for presence of Celiac AntiBody ..
    Contact / CALL >  DropYourAllergies.com

    > FDA Approval Status ? > In the Works > But already used extensively WorldWide by Medical Communities to Screen their populations for Celiac Disease ...
    And this Test > CAN be obtained for YOUR Personal Use... NOW !

    Why Wait ? > Certainly > Your Celiac Disease and HEALTH Will Not.

    Research indicates that > Children will visit 6 Pediatricians BEFORE their Celiac Disease is Diagnosed... WHY ?

    ALSO > Allergy Mothers of Allergy Children > Who wish to > Take the FEAR Out of FOOD > i.e. Eat a Peanut = Trouble for their Child > Need only visit their Primary Care Dr. for an Insurance covered, FOOD Allergy Blood Test.

    Test to Determine if InTolerance of ALLERGY.

    Once Test ID’ed > You receive a Custom FOOD allergy DIET Plan > Suggesting FOODs to Eat, Not Eat, Restrict & ReIntroduce > All based on EACH Patient’s unique Test Result.

    And..
    The SAME Blood Test CAN be used to Identify YOUR Child's Offending Seasonal & Year-round Enviro Allergens .. with Neutralization via Child Friendly, Drug FREE > NaturesAllergyDrops.com > Immuno-DROPs ( Think SHOTs But No OUCH !) > Which Neutralize the SOURCE of Your Child's Test Identified Offending Enviro Allergens / Allergy Disease.

    STOP ! > A Lifetime of Medicating Your allergy SYMPTOMs > While your Enviro Allergy Disease > Continues / Exacerbates UnAbated ..

    Leading EACH Sufferer on a LifeTime, Slippery Slope of “Allergy Driven” diseases ( allergic ASTHMA to Name One ), recalcitrant Health Issues & compromised Quality of Life / Poor Self Image. > Achoo & OUCH !  

    YES > You CAN take ALLERGIES > Out of Your Child's Future ...

    Best Health = Wealth Regards

    Stephen
    DropYourAllergies.com

    Celiac Information:

    > Serology ( Blood testing ) as well as Biopsy requires the presence of antibodies to gluten.

    > A gluten-free diet reduces circulating antibodies thus compromising a proper diagnosis.  There are no clear guidelines for a proper gluten challenge to ensure sufficient circulating antibodies for a positive result; some individuals requires 1 month, other years.  

    > Key Take HOME Message !

    With 1 in 100 being affected,
    Rule out Celiac Disease > Before going Gluten-Free
    Regardless of Rationale.

  • kris

    9/18/2009 7:55:11 PM |

    Susan,
    couple weeks ago, I had to take a trip and drove for 8 hours right after my hard work out at gym. didnt have time to eat at my regular time. that night i had stomich spasm, so bad that it almost made me cry. (now i am completely wheat free for more than 10 months now). only thing that helped me immediate,was powdered Magnesium. the pain would start around 2am and stay on until I take liquid magnesium. the pain wouldnt go away for week or so. funny thing is that in the morning i would go to gym and workout hard with no pain at all. 4 days ago I had to see my doctor and he put me on on Nexium. That was the first night that there was no pain how ever the side effects of Nexium were sharp headache and stomach spasm for 5 minutes. I think that when body is firing on all cylinders, it is important to eat regularly, small meals, more often.

  • Suresh

    9/18/2009 8:38:46 PM |

    Dr. Davis,

    I have seen the mention of eliminating wheat from the diet in many of your articles. Does that mean something like rice is not as bad as wheat namely is wheat is the worst among the grains rice, barley, corn etc ?

    Thanks!

    -Suresh

  • water

    9/18/2009 9:04:16 PM |

    Sara,

    I found your comments extremely interesting and would like to know more about your research, especially relative to this:
    "those in the sexual organs are among the most sensitive"  Do you have reference I can follow?

    I've been reading about periperhal neuropathy and autonomic neuropathy and this article was particularly interesting:

    Unlike PN, AN is often asymptomatic. Among symptomatic patients (55%), erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.  

    pns.ucsd.edu/JPNS/Ravaglia.accepted.06.16.04.pdf

    An improvement in his ED was definitely an unexpected results of a gluten free diet (wheat free was not enough), but my spouse saw further improvements without dairy and soy.

  • Anonymous

    9/19/2009 3:23:47 AM |

    William,
    Your comment on the fermentation of soy in Asian cultures appears to imply that this is important to render "safe" food from Soy.  So do you make the same generalization about cow's milk.....? IE it should be cheese and yoghurt before consumption?

    Donny,
    what is the scientific relation between "wheat belly" and "beer belly" ? none, I would argue. Other than both are not desirable and result from over indulgence.

    There are a surprising number of people who are sensitive to specific foods.  I love sushi.  My wife is allergic to raw seafood yet she can down a piece of wheat gluten (seitan) with no affects. I have friends who can't go near gluten without severe cramps. My wife can also eat beef yet it gives me terrible gas. On the other hand, beans have absolutely no impact to my gas productivity.  I write this to highlight that many many people have issues with certain foods while other remain unaffected. YMMV as the saying goes, so lets celebrate those who find relief in changing their diets but lets not claim panacea
    Trevor

  • Dr. William Davis

    9/19/2009 1:59:09 PM |

    Suresh--

    Yes, wheat stands out as a uniquely destructive grain. While other grains can also increase blood sugar and trigger adverse patterns, wheat is undoubtedly the worst. I know of no other grain than wheat that is accompanied by addictive behavior, also.

  • Anonymous

    9/19/2009 3:24:20 PM |

    Re: beer and barley

    Barley also contains gluten, so if you're avoiding wheat because of the gluten, you'll need to avoid barley (and rye) as well.

    Re: rice

    The data that the idiotic "China Study" book is allegedly based on suggest that rice is the best grain to eat if you're going to eat grain. The highest rate of heart disease in China is found in the province where wheat is a dietary staple and little meat is consumed.

  • Anne

    9/19/2009 4:27:57 PM |

    1:100 may have celiac disease, but estimates of those with non-celiac gluten sensitivity range from 10-40% of the population.

    It is true, if you want to be tested for celiac disease(villous atrophy), then you do need to keep eating gluten until the testing is completed. If the tests come out negative it does not mean that you have no problem with gluten. You may still have latent celiac disease, non-celiac gluten sensitivity, wheat allergy or wheat intolerance. I am beginning to see more journal articles about gluten sensitivity. Dr. Green recently wrote in the JAMA that more attention needs to be given to gluten sensitivity.

    I did not go through blood a biopsy testing as my doctors refused to run these tests. I used Enterolab to confirm I have antibodies to gluten. This was enough proof for me. Enterolab cannot diagnose celiac disease, but it can tell you if you are reacting to gluten and you can be wheat/gluten free for up to 2 years for this test.

    There is nothing dangerous about a gluten free or wheat free diet and, luckily, we don't need a doctor's prescription to change our diet. A gluten free diet can be as healthy or as unhealthy as one wants to make it. Along with gluten free, I follow Dr. Davis' recommendation of a low sugar diet to keep my blood glucose in check.

  • taemo

    9/21/2009 1:23:30 PM |

    Ouch! much sugar? Damn! diabetes is you will get.

  • Anonymous

    9/21/2009 5:20:19 PM |

    Dr. Davis,

    Okay... wheat is BAD.  But... does this include wheat bran, often used as a source of fiber in the diet?  I mean the bran only, NOT wheat germ, or whole wheat, or wheat flours.

    Thanks for all you do!

    madcook

  • Dr. William Davis

    9/21/2009 9:43:47 PM |

    Hi, Mad--

    No, wheat bran is essentially inert. It does not interact with anything and so does not exert any adverse effects. It's like eating wood.

  • Anonymous

    9/22/2009 9:25:21 PM |

    I disagree with wheat bran being inert.  It is a source of phytic acid which has mineral binding properties.  Also, reading sites like FiberMenace.com, bran fiber is certainly not benign.

  • denparser

    9/22/2009 11:40:04 PM |

    @Anonymous (before me)

    I agree with your statement. Its a fact, try read health book.

  • Stan (Heretic)

    9/23/2009 11:48:20 AM |

    I have to mention one more benefit to your list, that I noticed:

    - hugely improved dental health and self-healing (sealing) of damaged teeth.

    We know that wheat's agglutins (WGA) affect and reduce D3 transport, I have a suspicion that wheat may be also interfering with K2 (thus teeth) but haven't seen much esearch on this yet.

    Stan (Heretic)

  • Anonymous

    9/24/2009 7:41:01 PM |

    TedHutchinson, there are many other sources that agree that fiber is not beneficial and is indeed harmful if you don't care for the one referenced.

    Nevertheless, Dr. Davis is incorrect about bran being inert.  It does contain phytic acid which interferes with mineral absorption.  Another reason wheat avoidance helps teeth and bones.

  • dves

    9/27/2009 12:53:06 PM |

    @taemo

    haha. you're right.. control use of sugar to avoid diabetes.

  • denparser

    9/27/2009 12:54:22 PM |

    @Thomas

    it has different nutrition level and most of all, its taste.

  • Anonymous

    9/28/2009 5:34:44 PM |

    I have a question: after spending a year in France, I realized that yes, French people are typically lean and thin, however, they eat so much wheat! Pastries, white pastas, cereals...
    Do French people display the same numbers when it comes to celiacs disease and wheat intolerance? I am curious to know. Or might it have more to do with volume or the fact that their breads are more often homemade? Thoughts?

    I went gluten free for nearly two years and then have been dabbling back into spelt and wheat. My primary reasons for trying the elimination were skin-related (itch, chronic eczema). Sad to say, it don't help much, though I did feel pretty healthy. I just ate a croissant the other day from an organic bakery that stone mills. It was heavan. I didn't feel foggy or anything, so perhaps the key is moderation?
    Anyway, great site, very informative. Looking forward to hearing your thoughts on those skinny french people.
    PS-I don't have a weight problem and ironically I didn't lose weight when I went gluten free. Ended up eating more meat (allergic to nuts)...

  • trinkwasser

    10/2/2009 4:03:33 PM |

    Interesting that inflammation would appear to be a component of nearly all these symptoms which wheat elimination "cures".

    My depression and mood swings appear to be closely correlated with blood glucose swings, which may be why that also improves.

    I'm another one for whom wheat bran is not inert: it generates BG spikes, although not to the degree of whole wheat. Lectins, phytic acid or wheat germ agglutinin?

    http://high-fat-nutrition.blogspot.com/2007/11/how-toxic-is-wheat-well-first-point-is.html

  • Anonymous

    10/3/2009 2:40:52 AM |

    Ted,
    Thanks for the link to the livin lavida low carb site interview with Dr. Davis.  Your links are always informative.
    In my opinion, all newbies visiting this web site should be directed to this reference for a great summary of what is important in taking care of your heart via diet changes. v.cool, thanks
    Trevor

  • Sew Bee It

    10/6/2009 10:28:46 PM |

    I've just found your blog via Feed the Animal, and I'm so happy I did!  Thank you so much for you posts, I'll be reading often.  

    You have a few comments here, but I figured I'd add to your collection of anecdotal evidence:  I'd gone paleo for about a month when I took one 24 hour period off (dinner to dinner).  3/4 of a medium pizza, a snickers bar, 1/2 can pringles, and a dozen chocolate coated gingerbread cookies ended up on the menu.  Within 30 minutes of eating the pizza my heartburn had returned, withing hours of eating bits of the rest I was in PAIN.  Why I kept eating this junk for the next day, I have no idea.  The more of it I ate the worse my stomache got.  Severe upset stomache, badly sufuric burps, bowel discomfort, you name it!  And after that 24 hours I finally reached a level of toxicity where my body literally rejected the food.  So toxic was this junk that use to be "normal" food, that my body threw it up in self defense.  

    Needless to say I'm totally commited to the paleo eating now!

  • Jenny

    10/10/2009 12:59:02 AM |

    What element in wheat are you referring to? everyone needs fiber which is a major component of wheat, people can't be allergic to fiber as their digestive system would pack up if you didn't have any.

  • Anonymous

    10/12/2009 11:24:02 PM |

    Does abstaining from wheat include staying away from spelt and kammut and Emmer wheat as well..or is it the GMO wheat that is the problem?
    Some doctors believe spelt is more digestable than regular wheat.

  • Jamie

    11/2/2009 1:06:55 AM |

    Jenny,

    Not true at all. I eat very little fiber and am more regular and have less digestive issues than I ever have. As long as one eats enough fat, there is no need for fiber.

  • Beverly

    3/28/2010 6:24:41 PM |

    You can get Gluten-Free beer.  One brand is called Red Bridge.  There's another, but I forget the name.  I drink the Red Bridge.  Not bad.

  • Beverly

    3/28/2010 6:48:23 PM |

    Besides, you can get your "roughage" from raw veggies and salad.  I've been low-carb for about 6 wks. now; haven't had any bread, rice, pasta, wheat, etc.  I've never felt better and have more energy.  My brain is functioning better, too.  Also, have lost 4 lbs.

    Beverly

  • Julianne

    6/25/2010 11:17:42 PM |

    Hi Dr Davis,
    Thanks for a great blog.
    I just wanted to share my experience of wheat free (I actually went paleo so fully grain and legume free)
    No more swelling knees. Probably mild auto-immune, mother has it also.
    Large - I mean large and multiple bumps - ganglion cyst that I had for 10 years shrank and disappeared.
    PMS with horrid breast pain - gone.
    Menstrual pain - less with fish oil, gone with paleo.
    Constipation - gone
    Pre-menopausal spotting the week prior to menstruation, had this for 10 years - gone.
    Lost weight - that last 3 pounds that make me look my best.

    I wrote about it here, I for one want to spread the news as a nutritionist.
    http://paleozonenutrition.wordpress.com/2010/05/24/my-nutrition-journey/

  • Alina M

    9/7/2010 1:51:47 PM |

    Is whole grain wheat also harmful?

    Thank your very much for all your information.

  • legend_018

    9/10/2010 1:16:13 AM |

    So people just give up having

    1. bread and butter with meals or crusty bread with pasta
    2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
    3. pancakes

    That seems hard to give up.

  • Anonymous

    9/12/2010 10:03:37 AM |

    As an experiment and in an attempt to lose weight, I put my whole family on a low-carb diet. Cutting out wheat was part of it.
    My husband has suffered from a mild type of colitis for the last 15 years. One year ago an awful smell developed with the colitis. Whenever he went to the toilet or passed wind an obnoxious, sour smell like old cheese/rotten eggs lingered a long time after. It caused me to move out of our bedroom, as the smell would cause me to wake up repeatedly. 3 weeks on the wheat-free diet the smell was suddenly gone. It was nothing short of a miracle. It was not something I had expected from the diet, but a very welcome side-effect indeed, as I hate bad smells. By the way - can anyone tell me what generates that particular sour, rotten smell?

  • Rusa

    9/28/2010 11:51:02 PM |

    legend 018 said:
    So people just give up having

    1. bread and butter with meals or crusty bread with pasta
    2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
    3. pancakes

    That seems hard to give up.



    Yes. They are addictive, aren't they? Isn't that the point? Wheat is addictive.

  • KMebust

    11/9/2010 4:16:59 PM |

    A criticism, then a question:
    Any food you give up for months will cause diarrhea and cramping when you come back to it, because you've lost the bacteria that help you digest it.  I've experienced this with dairy, meat, and potatoes.  I am skeptical that wheat is any different than other foods in that regard.
    I have family members who have experienced benefits from gluten free diets, but don't want to give it up altogether, for various reasons.  Does cutting back-- say, not eating bread but not actively eliminating gluten from all your food choices-- have lesser but similar effects?

  • Anonymous

    12/17/2010 7:55:34 PM |

    Thank you so much Dr. Davis.  You have confirmed our worst fears that seemingly "healthy" wheat is actually a form of subtle malnutrition.  Please mention that it is the gluten that causes the problems.  Not in the allergic sense, but by blocking the important nutrients from fruits and veggies to vitamins and minerals.  Gluten forms a mucoid plaque which covers the small intestine thus causing subtle malnutrition and is therefore responsible for dozens of illnesses.

  • James

    1/18/2011 8:13:42 PM |

    I have given up wheat because of its effects on myself including acid reflux, rapid heart beat, irritated hemmoroids.  

    All of the effects you have mentioned have been documented as far back as 1995.  This is especially true of RA. I remember articles in the nutrition press stating that wheat was one of the triggers for RA. Thanks for all the information.

  • Ravi

    2/9/2011 5:28:47 PM |

    Hello Dr. Davis,

    We would like to invite you to summit your exceptional posts to our new ParadigmShift BlogShare at DaiaSolGaia.  
    Please check it out! Thank you. http://daiasolgaia.com/?p=2212

  • Ravi

    2/9/2011 5:30:25 PM |

    ... fingers: type "submit"... thank you. Wink

  • Pixie

    3/11/2011 10:59:55 PM |

    I wish this was the case for me.  I have suffered with IBS for 27 years.  I have gone on gluten elimination diets for up to 30 days twice in the past 15 years with no change.  Incorporating it back in, the only thing I noticed was a little bit of heartburn if I had wheat in the morning. I've tested negative for Celiac's and wheat allergies.
    I'm not saying your are wrong. But for me a wheat free diet was no cure for IBS.  Frown  (I WISH!)
    -Karen

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All posts by william-davis

Diet by LDL

7. March 2012 William Davis (0)
Conventional notions of heart healthy diets, such as that advocated by the American Heart Association, are largely based on observations of total and LDL cholesterol.

So, cut the saturated fat in the diet, cut the overall fat content, and replace them with polyunsaturated oils like safflower, corn, and vegetable oils and increase consumption of whole grains and total and LDL cholesterol show a modest downturn. Thus, diets like the American Heart Association Total Lifestyle Change approach advocate limiting total fat to no more 25 to 35% of calories and saturated fat to no more than 7% of calories.

Orange Cream Cookies

5. March 2012 William Davis (5)
If you loved Creamsicles as a kid, you'll love these Orange Cream Cookies. (Sorry, no photo: We ate them up before I realized we hadn't taken the photo. And, worse, we did it twice!)

Ingredients:
2 cups almond meal
2 tablespoons coconut flour
1 teaspoon baking soda
½ teaspoon sea salt
¼ cup golden raisins
½ cup chopped pecans
Sweetener equivalent to 1 cup sugar
2 tablespoons finely-grated orange rind
1 large egg
2 tablespoons coconut oil, melted
½ cup whipping cream (or coconut milk)
1 tablespoon vanilla extract

Preheat oven to 350º F.

Combine almond meal, coconut flour, baking soda, salt, raisins, pecans, sweetener and orange zest in bowl and mix.

In separate bowl, whisk egg, then add coconut oil, whipping cream, vanilla extract and mix together. Pour wet mix into dry and blend by hand thoroughly.

Spoon onto parchment paper-lined baking pan (or oiled pan) and flatten with spoon to ½-¾ inch thickness. Bake for 20-25 minutes or until toothpick withdraws dry.

Why are heart attacks still happening?

4. March 2012 William Davis (10)
I'm a cardiologist. I see patients with heart disease in the form of coronary artery disease every day.

These are people who have undergone bypass surgery, received one or more stents or undergone other forms of angioplasty, have survived heart attacks or sudden cardiac death, or have high heart scan scores. In short, I see patients every day who are at high-risk for heart attack and death from heart disease.

But I see virtually no heart attacks. And nobody is dying from heart disease. (I'm referring to the people who follow the strategies I advocate, not the guy who thinks that smoking a pack of cigarettes a day is still okay, or the woman who thinks the diet is unnecessary because she's slender.)

Two high-profile deaths from heart attacks occurred this week:

Davy Jones--The iconic singer from the 1960s pop group, the Monkees, suffered sudden cardiac death after a large heart attack, just hours after experiencing chest pain.

Andrew Breitbart--The conservative blogger and controversy-generating media personality suffered what was believed to be sudden cardiac death while walking.

It's a darn shame and it shouldn't happen. The tools to identify the potential for heart attack are available, inexpensive, and simple. The strategies to reduce, even eliminate, risk are likewise available, inexpensive, and cultivate overall health.

The followers of the Track Your Plaque program who

1) get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
2) identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
3) correct the causes

enjoy virtual elimination of risk.

My letter to the Wall Street Journal: It's NOT just about gluten

8. February 2012 William Davis (7)
The Wall Street Journal carried this report of a new proposed classification of the various forms of gluten sensitivity: New Guide to Who Really Shouldn't Eat Gluten

This represents progress. Progress in understanding of wheat-related illnesses, as well as progress in spreading the word that there is a lot more to wheat-intolerance than celiac disease. But, as I mention in the letter, it falls desperately short on several crucial issues.

Ms. Beck--

Thank you for writing the wonderful article on gluten sensitivity.

I'd like to bring several issues to your attention, as they are often neglected
in discussions of "gluten sensitivity":

1) The gliadin protein of wheat has been modified by geneticists through their
work to increase yield. This work, performed mostly in the 1970s, yielded a form
of gliadin that is several amino acids different, but increased the
appetite-stimulating properties of wheat. Modern wheat, a high-yield, semi-dwarf
strain (not the 4 1/2-foot tall "amber waves of grain" everyone thinks of) is
now, in effect, an appetite-stimulant that increases calorie intake 400 calories
per day. This form of gliadin is also the likely explanation for the surge in
behavioral struggles in children with autism and ADHD.
2) The amylopectin A of wheat is the underlying explanation for why two slices
of whole wheat bread raise blood sugar higher than 6 teaspoons of table sugar or
many candy bars. It is unique and highly digestible by the enzyme amylase.
Incredibly, the high glycemic index of whole wheat is simply ignored, despite
being listed at the top of all tables of glycemic index.
3) The lectins of wheat may underlie the increase in multiple autoimmune and
inflammatory diseases in Americans, especially rheumatoid arthritis and
inflammatory bowel diseases (ulcerative colitis, Crohn's).

In other words, if someone is not gluten-sensitive, they may still remain
sensitive to the many non-gluten aspects of modern high-yield semi-dwarf wheat,
such as appetite-stimulation and mental "fog," joint pains in the hands, leg
edema, or the many rashes and skin disorders. This represents one of the most
important examples of the widespread unintended effects of modern agricultural
genetics and agribusiness.

William Davis, MD
Author: Wheat Belly: Lose the wheat, lose the weight and find your path back to health

60-year old man dies of high cholesterol

1. February 2012 William Davis (12)
Never saw a headline like this? Neither have I. That's because it doesn't happen.

Cholesterol doesn't harm, maim, or kill. It is simply used as a crude--very crude--marker. It is, in reality, a component of the body, of the cell wall, of lipoproteins (lipid-carrying proteins) in the bloodstream. It is used a an indirect gauge, a "dipstick," for lipoproteins in the blood to those who don't understand how to identify, characterize, and quantify actual lipoproteins in the blood.

Cholesterol itself never killed anybody, any more than a bad paint job on your car could cause a fatal car accident.

What kills people is rupture of atherosclerotic plaque in the coronary arteries. For all practical purposes, you must have atherosclerotic plaque in order for it to rupture (much like a volcano erupts and spews lava). It's not about cholesterol; it's about atherosclerotic plaque. Plaque might contain cholesterol, but cholesterol is not the thing itself that causes heart attack and death.

So why do most people obsess about cholesterol? Good question. It is, at best, a statistical marker for the possibility of having atherosclerotic plaque that ruptures. High cholesterol = higher risk for heart attack, low cholesterol = lower risk for heart attack. But the association is weak and flawed, such that people with high cholesterol can live a lifetime without heart attack, people with low cholesterol can die at age 43.The same holds true for LDL cholesterol, you know, the calculated value based on flawed assumptions about LDL's relationship to total cholesterol, HDL cholesterol, and VLDL cholesterol.

A crucial oversight in the world of cholesterol: There are many other factors that cause atherosclerotic plaque and its rupture, such as inflammatory phenomena, calcium deposition, artery spasm, hemorrhage within the plaque itself, degradative enzymes, etc., none of which are suggested by cholesterol measures.

But one observation has held up, time and again, over the past 40 years of observations on coronary disease: The greater the quantity of coronary atherosclerotic plaque, the greater the risk of atherosclerotic plaque rupture. An increasing burden of atherosclerotic plaque along the limited confines of coronary arteries, just a few millimeters in diameter and a few centimeters in length, is like a house of cards: It's bound to topple sooner or later, and the bigger it gets, the less stable it becomes.

If you are concerned about future potential for heart disease and heart attack, don't get a cholesterol panel. Get a measure of coronary atherosclerotic plaque.

Back to basics: Coronary calcium

30. January 2012 William Davis (42)
After having my attentions pulled a thousand different directions these past 6 months, with the release of Wheat Belly and all the wonderful media attention it has attracted, I've decided to pick up here with a series of discussions about the fundamental issues important to the Track Your Plaque program and prevention and reversal of coronary atherosclerotic plaque.

I fear the discussions at times have drifted off into the exotic. This is great because this is how we learn new lessons, but we can never lose sight of the basics, else we risk losing control over this disease.

Imagine you've got a beautiful new car. You wax it, gap the spark plugs, rotate the tires, etc. and it looks brand-new, just like it came off the dealer's lot. 50,000 miles pass, however, and you realize you've forgotten to change the oil. Ooops! In other words, no matter how meticulous the attention to transmission, tires, and paint job, neglect of the most basic responsibility can ruin the whole thing. We can't let that happen with heart health.

If we propose to reverse coronary atherosclerotic plaque, we've got to have something to measure. First, it tells us whether we have atherosclerotic plaque in the first place, the stuff that accumulates and blocks flow and causes anginal chest pains, and ruptures like a little volcano and causes heart attacks. Second, it gives us something to track over the years to know whether plaque has grown, stopped growing, or been reduced. Without such a measure, you will be driving without a speedometer or odometer, just guessing whether or not you've gotten to your destination.

Of course, the conventional approach to heart disease and heart attack is not to track atherosclerotic plaque in your coronary arteries, but to track some distant "risk factor" for atherosclerotic plaque, especially LDL cholesterol. But LDL cholesterol is flawed at several levels. First, it is calculated, not measured. The nearly 50-year old Friedewald equation used to calculate LDL cholesterol is based on several flawed assumptions, yielding a value that can be 20, 30, or 50% inaccurate as a rule, only occasionally generating a value close to the real value. (No point in publicizing this problem, of course: Why compromise a $27 billion annual cash cow?) It also ignores the effect of diet. (No, cutting fat does not reduce LDL for real, only the calculated value. Cutting carbohydrates, especially wheat--"healthy whole grains"--slashes measured LDL values like NMR LDL particle number and apoprotein B.)

But all risk factors are, at best, snapshots of the situation at that moment in time. They change from day to day, week to week, month to month, year to year. If you do something dramatic in health, like lose 50 pounds, you can substantially change your risk factors values, like LDL cholesterol and HDL cholesterol. But you may not modify the amount of atherosclerotic plaque in your heart's arteries.

Measuring the amount of atherosclerotic plaque in your heart's arteries is, in effect, a cumulative expression of the effects of risk factors up until the moment of measurement.

There are several stumbling blocks, however, in the concept of measuring coronary atherosclerotic plaque. We cannot measure all the unique components of plaque, such as fibrous tissue like collagen, or degradative enzymes like collagenases, or inflammatory proteins like matrix metalloproteinase, or the debris of hemorrhage and inflammation. We struggle to contemporaneously mix in measures of bloodborne inflammation, coagulation and viscosity, and physiological phenomena of the artery itself, like endothelial dysfunction, medial (muscle) tone, and adventitial fat.

So we are left with semi-static measures of total coronary atherosclerotic plaque like coronary calcium, obtainable via CT heart scans as a calcium "score." No, it is not perfect. It does not reflect that moment's blood viscosity, it does not reflect the inflammatory status of the one nasty plaque in the mid-left anterior descending, nor does it reflect the irritating sheer effects of a blood pressure of 150/95.

But it's the best we've got.

If anyone has something better, I invite you to speak up. Carotid ultrasound, c-reactive protein, ankle-brachial index, stress nuclear studies, myoglobin, skin cholesterol, KIF6 genotype . . . none of them approach the value, the insight, the trackability of actually measuring coronary atherosclerotic plaque. And the only method we've got to gauge coronary atherosclerotic plaque that is non-invasive and available in 2012? Yup, a good old CT heart scan calcium score.

Myocardial infraction

15. January 2012 William Davis (45)
I've seen a few heart attacks this past year . . . but none in the people who follow this program.

I saw a heart attack in a priest, a wonderful man who was unable to say "no" to his parishioners who insisted on bringing pies, cakes, and cookies every day.

I saw an impending heart attack in a 74-year old man, a football coach who thought the whole wheat-free, low-carb thing was some wacko trend. Four stents later, he's changed his mind.

A 69-year old woman had to be hospitalized for heart failure due to partial closure of an artery. She repeatedly told me that she simply could not follow the diet because it was "too restrictive."

There were a few others. Interestingly, all felt they were eating healthy, minimizing junk foods and avoiding fatty foods. None were wheat-free nor restricted carbohydrates.

In other words, in the people who follow the basic advice of the Track Your Plaque program to do such simple things as eliminate wheat, don't indulge in junk carbohydrates, normalize vitamin D status, supplement omega-3 fatty acids, supplement iodine and correct any thyroid dysfunction . . . well, they have no heart attacks.

Diet is superior to drugs

7. January 2012 William Davis (27)
Might-o’chondri-AL left this wonderful record of his lipoprotein experience in the comments to the last Heart Scan Blog post. It is a great example of what is achievable with diet and a few supplements . . . without drugs.


(A) Jan. 2011 1st ever NMR lipo-protein analysis was done after 4 months of consistent home food prep of pretty low fat (only olive oil and 1 tablespoon coconut oil daily) but plenty of whole wheat and half potatoes:
* LDL # of particles (P) = 1,676 in nmol/L————being a LDL cholesterol (C) reading of 139 mg/dL
* small LDL # P = 1,021 nmol/L —————yikes! you advise smLDL be less than 117 nmol/L
* HDL # of particles = 28.8 umol/L ————–being a HDL C reading of 45 mg/dL
* Triglycerides = 90 mg/dL ————– true, I never struggled with my weight

(B) May 2011 2nd NMR after another 4 months but added in more fat (1 teaspoon highly concentrated fish oil daily, 90% chocolate, handfulls of nuts, more olive oil and kept coconut oil at 1 tablespoon daily for a controlled experiment), added 500 mg Niacin 3 times a day (in stages up to1,500 mg. total daily), 6000 IU daily vitamin D, deliberately cut out all grains except for social politeness and substituted in daily Koji fermented brown rice (rustic Amazake):
** LDL # P……………= 976 nmol/L ——————————– being LDL C of 100 mg/dL
** small LDL # P …. = 96 nmol/L ——————————– nice surprise
** HDL # P ………… = 27.3 umol/L ——————————being an increase to HDL C of 64 mg/dL
** Triglycerides …… = 42 mg/dL ——————————– despite daily carbs over 150 gr. daily

(C) Dec. 2011 3rd NMR after another 7 more months thinking Doc’s advice is worthwhile I added in yet more fat (mainly daily 2 tablespoons of coconut oil, more 90% chocolate), bumped Niacin up to 1,000 mg twice a day (2,000 mg. total daily), cut out the Amazake, kept up the vitamin D adding daily vitamin K & daily ate main mid-day meal out as lunch on spicy Thai & Chinese fish/shrimp/soup/rice meals (my next control):
*** LDL # P ………. = 764 nmol/L ————— being LDL C of 107 mg/dL ( 2x coconut’s saturated fat)
***small LDL # P… = less than 90 nmol/L ——–surprised me NMR can’t count lower
***HDL # P ……… = 41.4 umol/L ——————– being an increase to HDL C of 88 mg/dL
*** Triglycerides ….= 43 mg/dL ——————- daily carbs below ~ 120 gr. & lost too much weight

Isn't that great? Spectacular job, Might!

MIght achieved values that are superior to that achievable with, say, a high-dose statin strategy. Statins only reduce total LDL particles, reducing small LDL in a non-selective way. And, of course, this diet does not cause muscle aches, memory loss, nor liver problems.

Something to consider: As the diet has become so effective, we can reduce our reliance on niacin. In fact, the benefits of niacin diminish substantially, as small LDL is reduced, HDL increased, triglycerides decreased, and postprandial lipoproteins subdued with the diet only.

Low-carb is heart healthy

4. January 2012 William Davis (88)
Anybody following the discussions in these pages know that: Limiting carbohydrate intake reduces risk for coronary heart disease and heart attack.

First of all, why do conventional diets advocate restricting saturated and total fat? From the standpoint of surrogate markers of cardiovascular risk, cutting saturated and total fat reduces total cholesterol; reduces calculated LDL cholesterol; and may reduce c-reactive protein modestly (an index of inflammation). It also increases blood sugar and HbA1c (reflecting the prior 60 days blood sugars), increases glycation of the proteins of the body leading to cataracts, arthritis, and hypertension.

Problem: Total cholesterol is a combination of HDL cholesterol, an estimate of VLDL cholesterol (triglycerides), and LDL cholesterol. It is a composite of both "good" things (HDL) and "bad" things (LDL and VLDL). Cutting saturated and total fat results in reduced HDL, increased VLDL/triglycerides, and a reduction in calculated LDL. Pretty weak stuff. The last item, i.e., reduction in calculated LDL, is not even a real phenomenon. In fact, the net effect in most genotypes (genetic types) may be negative: increased heart disease risk.

In contrast, what is the effect of reducing carbohydrate without restricting fat? (In the approach I use, we start with elimination of the most destructive of carbohydrates, wheat, followed by reducing exposure to other carbohydrates, especially cornstarch and corn products, sugar, and oats.) If, say, we cut carbohydrate intake into the range of a truly low-carbohydrate diet of 10-15 grams per meal ("net" carbs, or total carbohydrates minus fiber), then we witness a number of metabolic transformations:

Reduced fasting triglycerides and VLDL
Reduced postprandial (after-eating) triglycerides, chylomicrons, and chylomicron remnants
Increased HDL and shift towards large HDL particles (presumably more protective)
Reduced small LDL particles
Reduced glycation and oxidation of small LDL particles
Reduced hemoglobin A1c
Reduced c-reactive protein and other inflammatory markers
Reduced blood pressure

By slashing carbohydrates, we also witness weight loss from visceral fat, reversal of pre-diabetes and diabetes, and reduced phenomena of glycation. And, if the wheat-free part of low-carb is maintained, you can also see marked improvement in gastrointestinal health, relief from joint pains, relief from leg edema, relief from migraine headaches, improved behavior and ability to concentrate in children with impaired learning, ADHD, and autism, better mood, deeper sleep. You will see multiple inflammatory and autoimmune diseases improve or completely relieved, such as rheumatoid arthritis and ulcerative colitis.

Having personally gone down the diabetic path and back by cutting the fat in my diet, now maintaining a HbA1c of 4.8% with fasting glucose 84 mg/d; (without medications), there should be no remaining doubt: Low-carb diets, especially if wheat-free, dramatically reduce the factors leading to heart disease; low-fat diets worsen the factors leading to heart disease.

Mocha Walnut Brownies

1. January 2012 William Davis (11)
Richer than a cookie, heavier than a muffin, brownies are ordinarily an indulgence that leaves you ashamed of your lack of restraint. Have one . .  . or two or three, and you will surely pack on a pound of belly fat.

But these mocha walnut brownies, as with other recipes I provide, will not pack on the pounds. With no wheat to trigger appetite, nor any readily-digestible carbohydrate to generate blood sugar highs and lows, you can have a nice brownie or two or three and nothing bad happens: You don’t send blood sugar sky-high, don’t trigger formation of small LDL particles and triglycerides, you don’t trigger appetite, you don’t gain a pound of belly fat. You simply have your brownie(s) and enjoy them.

Serve these brownies plain or topped with cream cheese, natural peanut or almond butter, or dipped in coffee.


Ingredients:
8 ounces unsweetened baking chocolate (100% chocolate)
4 tablespoons coconut oil or butter, melted
2 large eggs, separated
½ cup coconut milk (or sour cream)
2 teaspoons vanilla extract
2 cups ground almonds
2 tablespoons coconut flour
1 cup chopped walnuts
¼ cup unsweetened cocoa powder
2 teaspoons instant espresso
Sweetener equivalent to 1 cup sugar or to taste (e.g., liquid stevia, Truvía, erythritol)


Preheat oven to 350º F.

Melt chocolate using double boiler method or in 15-second increments in microwave. Stir in melted coconut oil or butter.

In small bowl, beat egg whites until frothy. Add egg whites, egg yolks, coconut milk, and vanilla extract to chocolate mixture and mix thoroughly by hand.

In separate bowl, combine ground almonds, coconut flour, walnuts, cocoa powder, espresso, and sweetener. Mix thoroughly.

Add dry mix to chocolate mix and mix together thoroughly. If dough is too stiff, add additional coconut milk, one tablespoon at a time.

Place mixture in 9-inch baking pan and bake for 25 -30 minutes or until toothpick withdraws dry.

What's the best lipoprotein test?

29. May 2007 William Davis (5)
This is a frequent question from Track Your Plaque Members and others interested in improving their heart disease prevention program beyond that of simple-minded cholesterol testing.

I obtain lipoprotein testing every day on patients. I can tell you with the confidence of having done thousands of these tests that plain, old-fashioned cholesterol testing is like relying on riding a scooter to work compared to an 8-cylinder modern automobile. The scooter might get you there, but any rain, snow, or long distance to travel and you can just forget it.

All too often, lipoprotein testing uncovers abnormalities that standard cholesterol testing simply fails to uncover.

So, among the various lipoprotein tests available, which is best?


There are three commercial tests available today:

1) Gel electropheresis (GGE)--often known by its "brand" name as the Berkeley lipoprotein profile, after Berkeley HeartLabs. GGE uses a gel with an electric field applied to cause lipoproteins to migrate, based on particle size and charge.

2) Vertical auto-profile (VAP)--a form of centrifugation, or high-speed spinning of blood plasma to separate lipoprotein particles.

3) Nuclear magnetic resonance (NMR)--the idea of putting plasma in an NMR (also known as MRI) device to characterize blood proteins.

All three tests do an excellent job. All are competitively priced. All have validating data--lots of it--to justify their broad use (though health insurers, in their vast wisdom, would still have you believe that the tests are "experimental").

But is one better?

Having done many of all three (though least of VAP), I am partial to Liposcience's NMR. (By the way, I receive no fees from Liposcience to use their test, nor to promote it in any way.)

I believe NMR is superior in a few ways:

1) I believe that the LDL particle number is the best way to truly quantify LDL, better than apoprotein B and "direct" LDL.

2) It provides what I believe to be more accurate small LDL measures.

3) It provides intermediate-density lipoprotein (IDL), a post-prandial, or after-eating, measure not available on the other two.

Perhaps I'm biased because I use the NMR most frequently. But I've used it because I felt it yielded superior, more clinically believable, data.

In truth, all three laboratories do an excellent job and you'd be served fine by obtaining any of the three. But my heart goes to NMR.

Vitamin K2, aspirin, fish oil and blood thinning

27. May 2007 William Davis (12)
An interesting question came up from one of our Track Your Plaque Members on the Forum.

"I am now taking 9 mg of vitamin K1 and 1000 mcg of K2.

Does taking this supplement with this much K1 have a counteracting effect on the thinning/anticlotting properties of aspirin and fish oil that I also take?"


Great question (along with lots of other greater discussions we have on the Forum.)

The answer: Vitamin K should have no effect on the platelet-blocking effects of aspirin or fish oil. The majority of blood clot inhibiting effects of aspirin and fish oil arise from their ability to keep blood platelets from "clumping" (just like the TV commercials for Plavix).

Vitamin K, on the other hand, participates in the liver production of blood clotting factors (like II, VII, IX, and X, among others for you curious ones).

Thus, vitamin K-dependent clotting factors and platelet-blocking are two separate pathways to forming blood clots. Some of us refer to the difference as "red clots" from the vitamin K pathway and "white clots" from the platelet pathway, since they really do have this different physical appearance.

The vitamin K2 conversation, like that about vitamin D, is fascinating for its potential to provide the missing link between the tightly-tied fortunes of bone health and atherosclerosis. Why is someone with a high CT heart scan score far more likely to have osteoporosis? Vitamin D and K2 deficiency may provide the missing link for many people.

"Drug no cure for gluttony"

24. May 2007 William Davis (0)
That's the headline I'd like to see associated with rosiglitazone, brand name Avandia.

The recent negative press, whether deserved or not, surrounding the prescription drug rosiglitazone for pre-diabetes and diabetes highlights the fact that drugs never--never--substitute for what we can achieve with lifestyle changes.

Typically, rosiglitazone reduces blood sugar a few milligrams, reduces C-reactive protein, and very modestly reduces triglycerides and its associated evil lipoprotein friends. It also causes an average weight gain of 8 lb in the first year of use.

What will weight loss achieve, especially if accomplished through dramatic reduction or elimination of processed carbohydrates and wheat products, along with fish oil supplementation, vitamin D normalization, and exercise? Extraordinary benefits, far superior to what is achievable with this drug. In fact, while rosiglitazone is a Band-Aid for this process, the lifestyle changes can represent a cure in many or most instances.

It should come as no surprise that a drug that does nothing more than increase sensitivity to insulin cannot erase the devastating effects of an unhealthy life. Take rosiglitazone but neglect exercise, don't bother with vitamin D, indulge in pretzels and breakfast cereals, gain more weight . . . It serves the drug company's agenda better than it serves health.

Rosiglitazone not so rosy?

23. May 2007 William Davis (3)
Dr. Steve Nissen of the Cleveland Clinic published a study that suggests that the pre-diabetes and diabetes drug, rosiglitazone, may increase likelihood of heart attack by 43%.

I say "suggests" because the analysis was something called a "meta-analysis", a re-examination of data obtained by pooling unrelated studies and reanalyzing the data. Strengths of this sort of analysis: Sometimes trends that are not evident in smaller studies finally become evident in the larger numbers of participants obtained through pooling of data. Downside: Any statistician will tell you that a meta-analysis can only suggest an association, it cannot prove it.

Nonetheless, we are talking about people's lives. As they say, if you are taking this drug, also known by the brand name, Avandia, then talk to your doctor. I think that this is sound advice, as there are a number of factors to weigh in decision making. For instance, how far along the diabetic path are you? Have you had negative experiences with other agents?

It will, unfortunately, be months to years before confirmatory evidence on this question become available. In the meantime, Nissen will accuse the drug industry of pushing drugs through the FDA approval process without full safety data. GlaxoSmithKline, the manufacturer of Avandia, will counter with claims of weak data, the existing trials not confirming Nissen's findings, etc. We've seen it before.

My take on this is to step back and look at the broad picture. Do we need yet another reason to say that it's far better to maintain normal body weight, dramatically reduce reliance on processed carbohydrates and wheat, exercise, and following other insulin-sensitizing strategies, rather than rely on insulin-sensitizing drugs? (That's what rosiglitazone is supposed to do.) Metabolic syndrome, also known as pre-diabetes, or diabetes is present to various degrees in two thirds of all adults I meet. Nearly all of it is self-inflicted. Nearly all of it is curable with the above lifestyle strategies if undertaken early enough in the process.

A 190 lb, 5 foot 2 inch woman, or a 220 lb, 5 foot 10 inch man, both of whom are surprised that they have pre-diabetes really need to get a grip on reality and health. To me, it's no surprise that drugs do not reverse all the nasty manifestations of lifestyle gone berserk. It should also come as no surprise that the complex, chaotic physiologic mess created by metabolic syndrome and pre-diabetes is not perfectly managed by adding one drug.

The lipid distorting effects of weight loss

22. May 2007 William Davis (0)
Roger experienced a near-fatal heart attack 6 years ago. He survived thanks to the quick action of bystanders who initiated CPR and called 911. An emergency catheterization was performed and a stent implanted into the closed right coronary artery. But that's not why I tell Roger's story.

Since then, Roger has become comfortable with the idea that he has heart disease. His initial commitment to good nutrition and exercise has waned, as it often does in us distractable humans. So Roger gained about 30 lbs through a long winter, inactivity, eating frozen dinners, and the cookies and baked goodies his daughters made him.

As a result of the weight gain and inactivity, Roger's HDL dropped to 32 mg/dl, triglycerides rose to 211 mg/dl, blood sugar crept up into the pre-diabetic range of 116 mg/dl. Undoubtedly, small LDL was out of control beneath the surface. His tummy reflected the weight gain, flaccid and overhanging his belt.

I read Roger the riot act. I reminded him of what he had experienced and nearly didn't survive. Weight loss and a re-invigoration of his nutrition and exercise efforts was going to be crucial.

Roger listened and took it to heart. Over three months, he lost 24 lbs, a phenomenal result. However, his repeat lipid panel showed an HDL of 28 mg/dl, triglycerides 234 mg/dl, blood sugar unchanged.

"I don't get it! I lose all this weight and the number get worse?!" Roger was understandably upset after his enormous effort.

I told Roger that after a profound weight loss, lipids can go berserk for up to two months after weight has stabilized. Typically, HDL drops and triglycerides rise--the opposite of what we want. But wait another two or so months after weight has stabilized and the numbers begin to look beautiful.

Why does this crazy effect happen? I really don't know and I've never heard a satisfactory explanation for it. But it is very real and quite predictable.

The lesson: after a substantial weight loss, be patient. Check your lipid numbers too soon and you might be confused or disappointed. If you do check them, bear in mind that additional time may need to pass before you see the weight loss fully reflected.

Cholesterol reduction and wheat

22. May 2007 William Davis (0)
In my previous post, Identical twins and the explosive influence of weight , we witnessed an excellent example of the profound influence of food choices and weight control on lipoproteins. The heavier twin among these 35-year old male twins (Steve) had an LDL particle number over two-fold higher than his more slender counterpart (Alfred).

The heavier twin, Steve, got here through numerous and longstanding dietary excesses: fast foods, saturated fats, sweets, processed foods. The conventional answer to Steve's lipid dilemma would be to modestly reduce his reliance on saturated fat, exercise, and limit snacks.

How far would that get Steve? Not very far at all. With regards to his high LDL particle number of 2256 nmol/l (representing an "effective" LDL cholesterol of around 225 mg/dl), it would be reduced a little, perhaps 10%.

Notice, however, that 72% of all Steve's LDL particles are small (1639/2256). This is the pattern that responds dramatically to a sharp reduction in processed carbohydrates, especially wheat-containing products.

If Steve were to eliminate all wheat products--all breads, breakfast cereals, pretzels, cookies, cakes, pasta, crackers--LDL particle number will drop dramatically, perhaps 50%, often more depending on the magnitude of weight loss. Small LDL will respond most obviously and will be sharply reduced, perhaps disappear. Incidentally, these changes might not be well reflected by the conventional calculated LDL cholesterol, since small LDL particles are well-concealed by standard measures.

Reducing corn products, white and brown rice, and potatoes would also add to the effect. But, in 2007, wheat products represent 90% of the problem for the majority of people. Reducing or eliminating wheat therefore yields the biggest effect by a long shot.

Steve therefore represents an excellent example of how reducing processed carbohydrates, esp. wheat-containing products, can yield an unexpected and paradoxical reduction in LDL cholesterol as evidenced by the highly accurate LDL particle number (or apoprotein B). Reducing saturated fat sources also helps, but it certainly will not yield the kind of results most people need. You've got to be smarter than the simple-minded conventional advice.

Identical twins and the explosive influence of weight

21. May 2007 William Davis (1)
A Track Your Plaque member, Eugene, brought this fascinating story to my attention.

Eugene has two nephews, identical twins aged 35 years. Despite their similar personalities and appearances, somehow these two drifted apart in weight with Steve outweighing Alfred by 30 lbs.

Eugene explains:

These guy's are big not, but overly fat. Just big. One is about 30 lbs heaver than the other. They live 2 blocks apart, they ate the same (together) meal the night before the blood work. Their mother is a type 2 diabetic with a heart condition. Steve does not eat as well as his twin, junk food and a lot of processed starches.


Their results:



LDL-Particle number
Alfred 900
Steve 2256

Small LDL-P
Alfred 400
Steve 1639

HDL-C
Alfred 44
Steve 36

Triglycerides
Alfred 85
Steve 355

Metabolic Syn.
Alfred no
Steve yes


Glucose

Fasting
Alfred 93
Steve 112

1hour
Alfred 134
Steve 206

2 hour
Alfred 105
Steve 172


Identical twins begin with the very same genetic background. As these two graphically illustrate, weight can have a profound influence in the genetically susceptible.

LDL particle number alone is 250% greater in the heavier twin. The dreaded small LDL particle is over 400% worse! Look also at the dramatic differences in blood sugar.

If you ever had any doubts about the importance of excess weight and nutrition, just remind yourself of this fascinating illustration.

Thanks, Eugene.

Low-fat diets raise triglycerides

19. May 2007 William Davis (4)
Martin, a hospital employee, knowing that I fuss a great deal with lipids and lipoproteins, showed me his lipid panel because the result triggered a "panic value" for triglycerides at 267 mg/dl. He asked if he should go on a serious low-fat diet.

I asked Martin what he had for breakfast: a whole wheat bagel with no-added-sugar jam. Lunch: a turkey sub on whole grain bread, no mayonnaise. Snacks: baked chips, pretzels ("a low-fat snack!").

In years past, if person developed high triglycerides levels, a very low-fat diet was prescribed. Someone would come to the hospital, for instance, with abdominal pain from pancreatitis (an inflamed pancreas)due to the damaging effects of triglyceride levels >1000 mg/dl. For this reason, many people still believe that all instances of elevated triglycerides should be treated with a reduction in fat intake.

This is absolutely wrong. While a fat restriction may reduce triglycerides in genetically-programmed responses when triglycerides are >1000 mg/dl, lesser levels of high triglycerides of, say 250 or 300 mg/dl, do not respond to dietary fat restrictions as a sole strategy.

Yes, a reduction in unhealthy fats (saturated, trans, polyunsaturated) helps. But a reduction in fats of all sorts is not necessary and can, in fact, worsen the problem. We learned this lesson years ago with the Ornish diet and similar ultra low-fat approaches. When you reduce fat intake significantly to <10% of calories, triglycerides go way up. In those days, it wasn't uncommon to see triglycerides skyrocket past 200 or 300 mg/dl on these diets.

Why are triglycerides important? Triglycerides are an ingredient in creating the lipoproteins VLDL, IDL, small LDL. Elevated triglycerides trigger a drop in HDL, a shift towards small, ineffective HDL, and contribute to heightened inflammation. Higher triglycerides also tend to go hand in hand with lipoproteins that persist for extended periods (12-24 hours or longer) in the blood after a meal.

Triglycerides respond very nicely to a dramatic reduction in processed carbohydrates, especially wheat and corn. Of course, wheat is the bulk of the problem, since it has grown to occupy an enormous role in many people's diet, not uncommonly eaten 3,4, or 5 times per day in various forms, as it has in Martin's diet. Eliminating all sources of high-fructose corn syrup is also helpful, since high-fructose corn syrup shoots triglycerides way up. (Recall that high-fructose corn syrup is everywhere: ketchup, beer, low-fat or non-fat salad dressings, breads, fruit drinks, sports drinks, breakfast cereals, etc.)

Curiously, it is a fat that also powerfully reduces triglycerides in the form of fish oil. In the Track Your Plaque program, fish oil, taken at truly effective doses of 4000 mg per day or more (to provide at least 1200 mg EPA+DHA), is our number one choice after reduction of processed carbohydrates for reduction of high triglycerides.

The dreaded niacin "flush"

18. May 2007 William Davis (55)
As most anybody who takes niacin knows, it can cause a hot flushed feeling over the chest and face that is generally harmless, though quite annoying.

Many doctors are frightened by this response and will warn patients off from niacin. Some people who take niacin are so annoyed that they find it intolerable.

However, a very simple maneuver can relieve the hot flush in over 90% of instances: Drink water. Let me explain.

I usually instruct patients to take niacin at dinnertime. That way, food slows absorption modestly. I also ask them to drink water with dinner. If the flush occurs after dinner (usually 30-60 minutes later), then drinking two 8-12 oz glasses of water immediately breaks the flush within 3 minutes in the great majority of people. It's quite dramatic.

Doing this around dinner (lunch works just as well) allows sufficient time to clear the excess water from your body before bedtime and spare you the aggravation of disrupted sleep to urinate. Drinking plenty of water works most of the time. Only an occasional person will need to take a 325 mg uncoated aspirin to more fully break the flush. I generally suggest that patients keep the uncoated aspirin in reserve if the water doesn't provide relief within a few minutes.

Thankfully, the intensity of the niacin flush lessens, often disappears, with chronic use.

Why do some people develop the flush and other don't? It is believed that some people metabolize niacin more rapidly to a compound called nicotinuric acid, a niacin metabolite that causes dilation (relaxation) of skin capillaries--thus the flush. The rapidity of converting niacin to nicotinuric acid is determined genetically.

An occasional person really struggles with niacin to the point of intolerance. However, on the positive side, these people may also be "hyper-responders" to niacin, i.e., they show exagerated benefits in raising HDL, reducing small LDL, etc., from small doses such as 250 mg per day.

If you experience the hot flush of niacin, think water to put out the fire.

A cure for pessimism?

16. May 2007 William Davis (3)
Followers of the Track Your Plaque program know that we place great value on having an optimistic outlook. Not only are you more likely to be happy and successful in life, you are also far more likely to drop your CT heart scan score. Virtually everyone who has succeeded in dropping their heart scan score dramatically has been an optimist, including our most recent record holder who dropped his score an astounding 51%.

But what if you are a pessimist, someone who gripes and complains about everything, sees the bad in other people, blames others for anything and everything that goes wrong--yet you still desire to drop your heart scan score? Are you a lost cause? Should you just give up?

I don't think so. I will admit that, of all the hurdles we encounter in trying to purposefully stop or reduce heart scan scores, overcoming a pessimistic attitude is probably the toughest. Tougher than being overweight, maybe tougher than even Lp(a).

Perhaps there's a solution in two years of psychotherapy sessions with a counselor, or exploring unresolved childhood conflicts with a psychologist, or an antidepressant drug. Pessimism is, after all, a deeply-ingrained pattern of behavior, something that can't be changed just by suggesting it or simple self-realization.

The closest thing I know of to a quick and relatively easy solution for converting a pessimist to an optimist is very simple:

Do good things for other people.

Something peculiar happens to the pessimist when he/she starts to help others. They are less threatened by other people (since much griping is really fear in disguise), begin to see others as vulnerable creatures who could use their help rather than sources of annoyance, and a kinship with others is acquired.

Doing good things can mean giving blood, donating money to the Sierra Club or other charity, volunteering with the Boy Scouts, tipping the hard working waitress trying to pay for college more generously, paying compliments to people around you, helping a neighbor carry the groceries when you see him struggling, showing a child how to make a paper airplane . . .

Good deeds can take a million different forms. But it must involve you personally. It can't mean delegating a helpful activity to your spouse. You must also do it frequently, not just once a year. It doesn't have to cost money, it doesn't have to involve a lot of time (though your personal bodily involvement does yield the greatest return in optimism). These are things anyone can do and help make the world around you a little better.

If taking these small steps towards an optimistic attitude are too much for you, then I would worry that you are destined to fail in dropping your heart scan score.