You just THINK you're low-carb

Systematically checking postprandial (after-eating) blood sugars is providing some great insights into crafting a better diet for many people.

I last discussed the concept of postprandial glucose checks in To get low-carb right, you need to check blood sugars.

Here are some important lessons that many people--NON-diabetic people, most with normal blood glucoses or just mildly increased--are learning:

Oatmeal yields high blood sugars. Even if your fasting blood sugar is 90 mg/dl, a bowl of oatmeal with skim milk, walnuts, and some berries will yield blood sugars of 150-200 mg/dl in many people.

Cheerios yields shocking blood sugars. 200+ mg/dl is not uncommon in non-diabetics. (Diabetics have 250-350 mg/dl.)

Fruits like apples and bananas increase blood sugar to 130 mg/dl or higher.

Odd symptoms, such as mental "fog," fatigue, and a fullness in the head, are often attributable to high blood sugars.

A subset of people with lipoprotein(a) can have wildly increased blood sugars despite their slender build and high aerobic exercise habits.


Once you identify the high blood sugar problem, you can do something about it. The best place to start is to reduce or eliminate the sugar-provoking food.

Comments (72) -

  • Lou

    2/27/2010 2:18:18 PM |

    Hi Dr. Davis,

    What is the maximum postprandial glucose level that we can see without seeing increased risk of heart/diabetes problems? I thought I saw 120 mg/dl somewhere. Is that it? It's hard to keep track of hundreds of blogs. I just learned about Heart Scan Blog last week.

  • Tony

    2/27/2010 2:37:06 PM |

    I have tested my postprandial glucose per your suggestion, and it has been very helpful, but I wanted to note that neither oatmeal (1/2 cup dry) or bananas & apples raise my blood sugar above 115.

  • Anonymous

    2/27/2010 2:57:36 PM |

    Truly normal, non-diabetic people will rarely if ever see a postprandial glucose peak much above 125, even with Cheerios.

    Postprandial hyperglycemia is widespread in populations eating an industrial diet. Those of us who have been officially diagnosed with diabetes are just the tip of the iceberg.

  • Stan (Heretic)

    2/27/2010 3:16:38 PM |

    It is interesting that you confirm that thin slender people which  you identify as "Lp(a)" types are so much less tolerant against high refined carbohydrates!

      In my subjective observation some of the most robust people on the standard (high carb medium fat) diet are of heavy set build ( Kapha/Phlegmatic).  

    They are able to easily increase their adipose tissue which probably is their main defense against high blood glucose.

    This protection comes at the price of putting up weight, sometimes a lot of weight. In some  rare cases their body weight can grow above 500lb before this protection mechanism stops, their adipose tissue stops expanding, and then - and only then - they get diabetes!  Not before, not while their fatty tissue is still growing!

    In my personal opinion the only difference between the heavy set type people and us ("ascetic" body types) is that our adipose tissue is for some reason (genetic?) incapable of growing beyond a minimum (in my case I was only able to put up ~10lb extra at most) therefore our fatty tissue  is not able to scoop up as much excessive glucose out of our bloodstream as their therefore we get diabetes, on a very high refined carb diet, earlier and more severe than them.  

    Our ONLY defense is as you have found too - minimize consumption of high carb food such as cereals, wheat, but also fruit and starches! I personally replaced such food with animal fat, eleven years ago and all my health problems, including mild angina, disappeared as if by miracle.

    Regards,
    Stan (Heretic)

  • Ellen

    2/27/2010 3:37:17 PM |

    So, Dr. Davis, would you say that one should never have foods that raise blood sugar?  I have a 1/2 banana and rice cake post workout with protein. Do you think I should stop this practice?

  • Aliceq

    2/27/2010 4:04:02 PM |

    I might add that the Thanksgiving post-feast lethargy, conventionally attributed to tryptophan-overload, is likely due instead to carb overload (stuffing, mashed potatoes, cranberry sauce, two helpings of pie). Since I've been low carb, I've generally filled up on turkey and salad at such meals (much more turkey than my dining companions), and also had much more post-prandial energy.

  • switters

    2/27/2010 4:29:41 PM |

    Why in the world would anyone put skim milk in oatmeal (or anything else, for that matter)? Drinking skim milk and consuming lean protein without adequate fat is an excellent way to spike your blood sugar and deplete your body's fat soluble nutrients.  I'd be curious to see how much oatmeal raises blood sugar when eaten with butter and cream. Maybe I'll do that experiment myself.

  • Lou

    2/27/2010 4:50:15 PM |

    I forgot to add that I tried cheerios experiment. My BG went from fasting 86 to PPG 140. I do stay active (lifting weights and running) but lately my diet has been terrible past two years. I actually used to follow low to moderate carbohydrates but being married and having an infant to deal with knocked me off the wagon. I recently got back on the wagon but I have to admit it, it has been rough start... Just have to make it to day 14th (I always found it to be much easier after 14th day or so).

  • Jolly

    2/27/2010 5:33:14 PM |

    Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?

  • Anonymous

    2/27/2010 6:02:41 PM |

    Is this a one-hour reading or a two-hour reading that we're talking about?  And is 120 the best cut off to use?

  • B.K.

    2/27/2010 6:07:06 PM |

    We have several 'feral' apple trees around the property here. They don't make large fruits, but I've eaten up to 3 at a time (golf ball sized) and they never made me have a +40 spike. Other varieties of large store apples do, however. I was taught that the ADA recommends a 1 hour reading of no more than 180, and a 2 hour reading of no more than 140, where the 'after' reading is also less than 40 points higher than the beginning reading. So if you began at 100, you should never break 140. My standards, however, are quite a bit lower. Bring on the bacon and eggs, and I'll wait until Nature here provides me with small apples.

  • Jenny

    2/27/2010 6:32:44 PM |

    Technically, if a person gets two random blood sugars over 200 mg/dl it is enough to diagnose them as diabetic. That's according to the diagnostic criteria published by the ultra conservative American Diabetes Association.

    Based on the research I've seen on this topic, any blood sugar over 163 mg/dl one hour after eating a high carb meal and/or over 120 mg/dl at two hours after the meal is abnormal.

    Truly normal people will be back into the mid 80s two hours after eating a high carb meal. Their highest blood sugar will be about 120, which not so incidentally, is the level at which the incretin hormones seem to kick in and stimulate insulin release.

  • Beth@WeightMaven

    2/27/2010 7:45:44 PM |

    Dr. Davis, love the blog, am learning lots. And per your suggestion, have picked up a blood glucose meter to check how I respond to various carbs.

    Just a minor title quibble tho. Are there really a lot of people eating oatmeal, Cheerios, apples or bananas that think they are low-carb?

  • craig&jan

    2/27/2010 8:03:10 PM |

    Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

    Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

    I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

  • craig&jan

    2/27/2010 8:03:10 PM |

    Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

    Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

    I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

  • Anna

    2/27/2010 8:54:10 PM |

    Tony,

    You probably still have an intact glucose regulation system, so your insulin production is robust and your insulin sensitivity is good.  You might be lucky enough to always have intact BG with grains.  

    Many don't, though, and furthermore, most don't know it.  Insulin insufficiently and insulin resistance are very, very common.

    I know from experience that one can seem to be quite healthy yet BG trouble is brewing below the surface for many years.  Even with a history of gestational diabetes (treated well with a LC diet), my doctors later had no idea how high my post-prandial BG goes (Cheerios can raise it to the mid-200s) because they tend to only suspect BG issues in obese patients and  they only checked FBG, which remain at the high end of normal because of my low carb intake.  

    My own testing with Cheerios leads me to view it and other cold breakfast cereals as bowls of predigested sugar that creates roller coaster BG levels that don't feel good at all.  Steel-cut cooked oatmeal result in somewhat less high BG, but it still goes too high for too long.  For my own long-term health, my glucose meter tells me to ditch the cereals.

  • Jazwaza

    2/27/2010 9:10:44 PM |

    Those foods you listed Dr. Davis are not low-carb at all. I never eat them. What makes you think those are low-carb? Cheerios? Bananas? Oatmeal?

  • Dr. William Davis

    2/27/2010 10:06:22 PM |

    Switters--

    Although I do not advocate using skim milk, most people do. So I chose that because it's so common.


    Ellen--

    No, I would regard that as a very high-sugar breakfast. It eventually catches up to you.


    Beth--

    Yes. While YOU may realize they do not belong in a low-carb diet, an incredible number of people think they do.

  • DrStrange

    2/27/2010 10:26:34 PM |

    "Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?"  I am bumping this question up as i would also love to have a definitive answer on it.  I know two people can sit to eat identical meals and one finish in 15 minutes and the other take 45-60.  This would make a large difference in the measurements depending on where you start time "zero"

  • mikeak

    2/27/2010 11:45:35 PM |

    Oatmeal & banana/blueberries ups my count by only 10 or so, less if I use oat bran; but I always have high-quality whole milk yogurt as the dairy portion.

  • Anonymous

    2/28/2010 1:25:16 AM |

    Is there an A1C level that good glucose control would correspond to, given that your recommendations for post prandial glucose are significantly lower than the usual 140/1hour and 120/2 hour?

  • Bobby

    2/28/2010 1:27:39 AM |

    Dr Davis: I am confused how large populations of Chinese and Japanese people who eat a high starch diet continue to have relatively low rates of heart disease. I would think that white rice would cause a high post postprandial response.
    I enjoy your posts but I need a full explanation to be convinced that you are correct on this point. Very sincerely, Bobby

  • stelladwn

    2/28/2010 3:29:46 AM |

    Ok..., I'm really lost. Recently diagnosed with type 2 on oral meds and Byetta. I don't want my children to follow my path. Thought I was being a good Mom feeding them Cheerios and Oatmeal. So now what??? WHAT DO I FEED THEM???? DR. DAVIS WHERE DO I FIND A DIET PLAN FOR THEM???

  • Ateronon

    2/28/2010 4:42:30 AM |

    I thought oatmeal was ok for some reason, because it's oatmeal, you know like what grandpa ate?
    Spiked my sugar to 190.

    I haven't eaten cereals, white breads or any potato products only for the last 3 weeks and my blood sugar has responded favorably.
    Morning test was usually a 100-105 (yikes) now it's 85-90. I'm not sure of the ideal low end but maybe I can see 70 in a few months.

    Great blog on diabetes, Jenny.

  • Peter

    2/28/2010 12:58:05 PM |

    I wonder which yields a more accurate view of what's likely to happen as you get older?

    Fasting blood sugar.
    Post-prandial blood sugar.
    Ha1c test.

  • Dr. William Davis

    2/28/2010 2:42:55 PM |

    All of these issues, including when to check blood sugar, what constitutes a desirable number, etc. are all addressed in detail in the Track Your Plaque Special Report, Postprandial Responses:
    Part 3 - Carbohydrates and postprandial blood sugar at http://www.trackyourplaque.com/library/fl_04-022postprandialcarbs.asp in the open content section (first 8 or so pages).

  • ATHiker95

    2/28/2010 5:17:39 PM |

    Here's a comment on oatmeal - BG before breakfast - 125. Bowl of Quaker weight control Maple and Brown Sugar oatmeal (29 carbs, 6 g fiber, 1g sugar), 1 tablespoon of chia seeds (4 carbs,4 g Fiber), 1 scoop of flax seed (5 carbs, 4 G Fiber). Handful of pecans, splash of 2 percent milk.  BG reading 2 hours later - 181. No doubt, 210+ after an hour, but I didn't check then.  Despite all the fiber and the pecans as a source of fat to slow down the sugar rush, still no go. Moral of this story (for me) - back to eggs and meats. Smile

  • Bobby

    2/28/2010 5:57:38 PM |

    Dr Davis: I have read the entire report and it doesn't address the issue that was the basis of my question: Why do starch based oriental cultures have a low incidence of heart disease. They also eat a low fat diet.
    I look forward to your response. Many thanks, Bobby

  • Lori Miller

    2/28/2010 6:24:23 PM |

    Add me to the ranks of the low-carb eaters. I was taking Aciphex for acid reflux and discovered that PPIs have side effects such as osteoporosis, iron deficiency anemia and hip fracture. Other side effects of low stomach acid are too numerous to list here. I stopped taking them and read that high-glycemic foods (read: starchy, sugary carbs like fruit and grains) cause reflux. (See http://heartburncured.com/) By experimenting with my diet the past few days, I've found this to be true. Goodbye, starches and sugars.

    I'm making a believer out of my diabetic mom, too. The other day, she had a few bites of a bagel, some apple sauce, oatmeal--and BG of 268. She slept all day, stoned on sugar. Today, after I told her 100 times that it's the carbs, she's having bacon, cottage cheese and an egg--and a lucid state of mind.

  • Lou

    2/28/2010 10:40:50 PM |

    Bobby,

    It could be that they are not really consuming high amount of starch carbohydrates. Media always made it sound like they consume a lot of carbohydrates but the reality is that they may not really be consuming. However, things are changing as it's cheaper to produce processed foods so things will likely change for those people one day. It could be that they are more active as well slowing down heart disease progression. Cancers may get them first before heart disease happens. It's hard to know unless you actually travel there and observe them in person. It may not be what you think. It's really apple vs orange. Dr. Davis is specifically talking about USA population.

  • Patri Friedman

    2/28/2010 11:06:25 PM |

    Do you think that postprandial glucose response to a fixed meal is a good way to evaluate the effectiveness of a diet regimen?  I'm wondering how I can compare various diet alternatives (intermittent fasting vs. paleo, for example, because I don't have the willpower to do both) with simple tests.  Blood glucose tests are very appealing to me because they are easy to do at home.

    http://patrissimo.livejournal.com/1313795.html

  • DrStrange

    2/28/2010 11:14:58 PM |

    I feel like I am whipping a dead pony here but feel I must repeat this:  Increasing dietary fat increases insulin resistance.  It takes several weeks (at bare minimum 10-14 days) of dietary fat intake of 8-10% (and no more fat than that) for the body to adjust.  Once that happens, your readings will be totally different for a high UNrefined carb meal.  And I must emphasize that only one higher fat meal may re-establish your previous level of insulin resistance for several days to weeks once again.  Eating eggs, meats, high fat diet day after day and then one high carb meal is an altogether different experiment and does not tell you in any way how you would fair on a consistently low fat, high UNrefined carb diet.

    Really, once insulin resistance is reduced you will get totally different readings even for a refined carb meal as in a glucose tolerance test.

  • Anna

    2/28/2010 11:46:14 PM |

    Bobby,

    There's so much more to it than simply the amount of starch in the diet.  Starch is probably fine if the metabolism is functioning as it should.  But western diet and lifestyles often lead to a high amount of metabolic dysfunction, which eventually progresses to impaired glucose (& starch)  tolerance and finally diabetes.  Note that even in industrial Japan (where the diet has changed much in the past several decades), the rate of T2 diabetes incidence is quickly rising in the young.  

    This is a huge topic and there isn't enough discussion about it when various "traditional" diets are compared.

  • Dr. William Davis

    3/1/2010 1:28:15 PM |

    Dr. Strange--

    Sorry, but I don't buy it.

    I've seen the opposite effect play out countless times: High fasting glucoses and high postprandial glucoses normalize with reductions in carbohydrates, increases in fats.

    I saw this effect in myself over 15 years ago when I was diabetic. Now, I am no longer diabetic due to increased fats, dramatically reduced carbohydrates.

  • Dr. William Davis

    3/1/2010 1:31:16 PM |

    Bobby--

    Perhaps a topic for a future discussion.

    Being part Japanese, I can tell you that rice is typicaly eaten sprinkled with rice vinegar. That alone can modify glycemic responses.

    Also, I don't believe that the Japanese diet is that high-carbohydrate. Miso, nori, mebushi, fish, natto, tofu, etc.--aside from rice, these staples are low-carb or zero-carb.

    Also, check your blood sugar after rice; Nothing like wheat or sugars.

  • Bobby

    3/1/2010 1:55:03 PM |

    Dr. Davis: Thanks for the reply. I would love you discuss this topic in more detail in the future.
    Respectfully, I do take issue with your statement that the Japanese diet is not primarily a high carb diet. I lived in Japan for a few months and even lived with a family there. Our diet was primarily rice. Seaweeds and small amounts of fish were added, but it was basically a low carb, low fat diet. I absolutely agree that wheat played not part in their diet.
    I have enjoyed the topic. Bobby

  • DrStrange

    3/1/2010 3:33:23 PM |

    Dr.Davis, yes of course your blood sugar normalized when you drastically reduced carbs and increased fat!  You stopped eating foods directly convert to blood glucose!  The body can run on primarily glucose from carbs or by converting fats via ketosis, yes?

    What I am talking about takes a couple weeks at minimum to occur and that is a dramatic reduction in insulin resistance when dietary fats are consistently reduced to 8-10% total calories.

    The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once.  That seems to be where the big problems arise and is the SAD, high carb/high fat diet.  Also of course, SAD is high junk, fake food which greatly exacerbates the problems.

    The misunderstanding comes and is continually repeated because people try one meal of high carb after eating high fat over time so their body has fairly high IR.  You must eat very low fat, every single meal, for a couple weeks minimum to see the effect I am talking about and some people take longer than that for their bodies to loose the IR

  • Kamila

    3/1/2010 3:59:00 PM |

    Of topic, for which I apologise Dr. Davis, but here is an article in the mainstream media which questions the efficacy of omega-3 likening the taking of it to a "cult". - The cult of omega-3

    http://news.bbc.co.uk/1/hi/magazine/8543172.stm

    From the article: "There's no evidence that omega-3 reduces the risk of death or heart attack or stroke or anything like that in those of us who have not recently had a heart attack,"

  • Anonymous

    3/1/2010 4:13:35 PM |

    Somewhat tangential, but anyone see the report on President Obama's cholesterol checkup:

    138 LDL
    62 HDL
      9 (calc from TC)

    209 TC

    It is interesting that even the President gets just the same old calculated rather than measured cholesterol test.

  • Dr. William Davis

    3/1/2010 6:21:10 PM |

    Dr. Strange--

    Fifteen years ago, I went on the Ornish diet: no meat, no oils, just vegetables, fruits, legumes, and whole grains. I also jogged 5-8 miles per day.

    I gained 30 lbs and became diabetic with blood sugars of 167 mg/dl or so.

    While my personal experience does not prove or disprove the concept, I've witnessed this phenomenon many, many times.

    Conversely, I have never seen anybody become a diabetic on a high-fat diet.

  • Beth

    3/1/2010 7:42:38 PM |

    FWIW, I measured BG before & after a breakfast of 1/2 cup oatmeal -- 94 before, 115 (1 hour) after.  That was with 1/4 cup ground flax, a handful of frozen cranberries (whole, no sugar) and 2 T of heavy cream.

    I have read that eating fat with carb lowers the effective glycemic index, which may help explain why the BG didn't rise much.

    Beth

  • Anonymous

    3/1/2010 11:20:00 PM |

    I learn so much from your blog here and at Health Central, Dr. Davis.  Thank you for the time you put into these free blogs.
    I am not diabetic but had gestational diabetes with each of my three pregnancies so I am very interested in doing things to help me not become diabetic.  I have tested my blood sugar after eating old fashioned oatmeal with nuts and a dash of milk and it stays below 100, very surprising.  However if I eat a meal of tomato soup and grilled cheese sandwich it will go over 160.  In testing like I do, I am learning what I can eat and what food combinations work for now.  I'll keep checking as time goes on.
    Char

  • Sifter

    3/2/2010 3:36:18 AM |

    Well, I bought a $10 'True" meter at Walgreens. Fasting reading after 9 hours of no food or drink,(morning) 91.  Ate two eggs cooked in butter, had a bagel ( I know, I know) with Skippy peanut butter on it. Waited 70  minutes, got a reading of 93. Hmmmm......I'm pretty sure everything is calibrated right. Does that second reading make sense?

  • westie

    3/3/2010 8:41:33 AM |

    Dr Strange:

    "The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once."

    That's right but how can you control how much fat or glucose your body uses? As Dr. Davis mentioned Ornish type diet + aerobic exercise does not work.

    I don't say that you are complete wrong of course. Insulin resistance is usually related to increased fatty acid avaibility and that will lead to the wise comment made by Stan (Heretic). When your subcutaneous adipose tissue functions normally you do not accumulate visceral fat and get metabolic syndrome and/or T2DM.

    I don't know if low carb will eventually restore health but it will certainly give more time and low blood glucose rapidly. But there may be limitations to low carb also since you have only limited access to decide what your body does with ingested foods.

  • DrStrange

    3/3/2010 9:17:04 PM |

    Westie, actually an Ornish type diet does work IF you do NOT eat refined carbs.  You have to only eat real, whole plant foods, as close to intact as possible.  Refined carbs will alway spike bg and raise triglyerides etc.  Some people do not do well on low carb diets.  I did Bernstein's version, very strict, for about 9 months and felt worse and worse as time went on.  Low low energy, irritable, post exercise exhaustion that would last 24-48 hours, absolutely no endurance.  Yes my blood sugar was good but it is even better on McDougall (Ornish type) diet.  My lipid profile is good.  I feel much better in every respect, much more healthy.  The diet does work and well!

  • westie

    3/4/2010 8:29:37 AM |

    DrStrange, loss of energy is very bad thing and I'm glad you found a way to overcome that.

    McDougall diet sounds very...hmmm...American. Avoiding fats and cholesterol seems to be a main goal. That seems to me quite stupid but I'm not a doctor so lack of knowledge could explain that.

    Like most diets designed by professionals McDougall diet has very good points but McDougall +fat +cholesterol +animal protein could do better.

    I don't know where these guys have come to the conclusion that if you don't eat fat you don't "have it". Every day most of the energy one uses comes from fats even on a McDougall diet.

  • DrStrange

    3/4/2010 3:06:13 PM |

    McDougall diet does not avoid fat, only no added, extracted fat.  Whatever is present already in plants is good for you and necessary.  Some people (me)(not all) add an ounce or so of flax or chia to get some additional omega 3 to balance the predominance of omega 6 in most veg and grains.  And no, you are not getting most of your calories from fat as the starches in the complex carbs convert quickly directly to glucose which is your energy source.  If you stuff yourself and overeat and get too many calories, then yes you get conversion of glucose to fat but it will go to storage.  Eating that kind of diet, your physiology is tuned to burning glucose and you will have plenty of glucose to burn, so you will store that fat.  Also, if you eat refined carbs, added sweeteners, dried fruit, things that spike blood sugar too high, then some of that will be converted to triglycerides and fat.

    Dr McDougall calls his diet "starch centered" as that is the source of fuel, starch converted to glucose.  This as opposed to a fat centered diet ie low carb, where you get your calories from burning fat.  Really not "American" but global as most traditional diets were/are starch centered with small amounts of animal products and mostly a wide variety of produce.

  • Drs. Cynthia and David

    3/4/2010 8:42:22 PM |

    DrStrange- you seem to be ignoring Dr. Davis's comment- Ornish did not work well for him (or for most people that I'm aware of).  I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet.  There are people with carnitine defiencies or genetic defects that reduce fatty acid translocation across the mitochondria (such as palmitoylcarnitine transferase deficiency) who cannot use fatty acids effectively for fuel and must eat a high carb diet for energy.  But those people and types of metabolism are rare.  Perhaps you are one of them.

    Cynthia

  • westie

    3/5/2010 8:27:16 AM |

    DrStrange, if you eat low fat de novo lipogenesis increases automaticly. Fatty acid formation increases both in liver and in adipose tissue. With healthy insulin  sensitivity there are no problems with that. It's totally fine and healthy.

    Thinking that avoiding fat and staying on starch keeps fat out of the body is simple wrong and it is usually part of intentional marketing or unintentional black & white type thinking (stupidity?).

    Avoiding fat in fact leads to "hardening" of your lipid profile in AT since glucose is metabolized to palmitic acid in the liver and then transported to storage.

    McDougall diet has excellent ingredients but thinking that cholesterol or animal fat will automaticly lead to overweight and disease is truely false. You can claim it to be true and believe it but I'm sorry to say it seems to be false.

    Glucose and fats both makes important fuels and I personally love them both.

    Cynthia wrote:

    "I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet."

    If a persons health is dependent on some kind of a restricting diet can you say that person has a healthy metabolism? It can be seen as "normal" but it sure isn't healthy. For type 2 diabetics low carb will bring lot of help and quite fast but will it make carbs bad? Not in my opinion.

    Things that cause metabolic syndrome, heart disease or other illnesses should be blaimed. Loss of insulin sensitivity is bad and restricting low calorie diets are bad. Most natural way to heal your metabolism is not through restriction, but through giving your body what it needs to recover and stay in good health and shape.

  • darloudasha

    3/6/2010 10:25:53 PM |

    I use to be a vegetarian.  I went months of eating nothing but whole grain (not just "brown" but things like millet and such) and veggies and fruit along with low or no fat protein sources like beans (I soaked them myself so they weren't even canned).  The only oils came from the very small amount of olive or canola oil I used in cooking.  My total fat was right about 10%.  After about 6 months my triglicerides had skyrocketed, my cholesterol was the same as it was before I started, my weight had increased and I was diagnosed with hypothyroidism, which I believe was directly correlated with the amount of "healthy, whole, natural" carbohydrates in my very low fat "healthy" diet.  I subsequently was also diagnosed diabetic.  I am now a 2 year low-carber.  My triglicerides have plummeted, my cholesterol is lower, and my HgA1C is under 6.0.  I have also lost 70 lbs.  Some people may or may not do better with low fat, non-refined carbs, but for me it not only did not improve my health, it nearly killed me.

  • phishery

    7/9/2010 3:12:34 PM |

    Here is a link from my website (www.dsolve.com) with some charts/graphs of what normal blood sugars look like compared to diabetics:
    http://www.dsolve.com/news-aamp-info-othermenu-60/23-diabetes-solution/159-news

    Hope this is a useful reference for what is "normal".

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  • Jack

    11/24/2010 4:00:02 PM |

    Um. What is it with all this talk of skim milk and 2%? Are you guys serious? I don't mess around with that white poison anymore. Use raw milk or cream. Never pasteurized milk.

    Also, soaking oats in an acidic base drastically changes the composition of the oats, reducing phytates and improving digestion and nutrient absorption.

    Here's my oatmeal:
    - soak raw oats in raw whey overnight
    - dehydrate at 150 degress until crisp/dry
    - one cup of prepared oatmeal in a bowl.
    - one tablespoon of grass fed pasture butter
    - three tablespoons of heavy cream (no additives of any kind) or raw grass fed whole milk.
    - one teaspoon of raw unprocessed honey and maybe a pinch of pure stevia powder.

    optionals:
    - 4 or 5 soaked/dehyrdated raw almonds or pecans
    - 4 or 5 blueberries

    Carb heavy? maybe a bit, but it's also loaded with high quality fats and proteins.

    I certainly wouldn't eat this daily because it's too many carbs and too much fiber, but 1-2 times a week of this type of oatmeal is fine and quite nutrient dense.

    Smile

  • Jack

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    Wow! even better. Don't dehydrate the oats. Just drain after soaking in water (with whey) and put the soaked oats in a glass casserole dish.

    Add in some coconut oil, maybe a bit of raw honey and/or stevia, cinnamon, real vanilla, and bake at 350 degrees for 35 minutes.

    Cut a nice piece out and add some cream and pasture butter, maybe a few blueberries.

    #1 your whole house will smell like the holiday season.

    #2 you will have a nutrient filled serving of soaked oatmeal.

    I'd imagine though, with the honey and the oats, that even a normal sized serving will be on the higher side in carbs, so you wouldn't want to eat this all the time and you wouldn't want to have carb heavy foods for the remainder of your day.

    I know Dr Davis doesn't recommend oatmeal or butter, but if you're gonna do it you may as well do it right and I think this is leagues better than the instant garbage most people eat every single day. blucchhkk!

    -Jack K.

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Restaurant eating: A fructose landmine

There is no remaining question that fructose is among the worst possible things humans can consume.

Followers of the Heart Scan Blog already know this, from conversations like The LDL-Fructose Disconnect, Where do you find fructose?, and Goodbye, fructose.

But fructose, usually as either high-fructose corn syrup (44%, 55%, occasionally higher percentage fructose) or sucrose (50% fructose), is ubiquitous. I've seen it in the most improbable places, including cole slaw, mustard, and dill pickles.

It's reasonably straightforward to avoid or minimize fructose exposure while eating at home, provided you check labels and focus on foods that don't require labels (like green peppers, salmon, and olive oil, i.e., unprocessed foods). But when you choose to eat at a restaurant, then all hell can break loose and fructose exposure can explode.

So what are some common and unsuspected fructose sources when eating at a restaurant?

Salad dressings--Dressings in all stripes and flavors are now made with high-fructose corn syrup and/or sucrose. This is especially true of low-fat, non-fat, or "lite" dressings, meaning oils have been replaced by high-fructose corn syrup. It can also be true of traditional non-low-fat dressings, too, since high-fructose corn syrup is just plain cheap.

Olive oil and vinegar are still your safest bets. I will often use salsa as a dressing, which works well.

Sauces and gravies--Not only can sauces be thickened with cornstarch, many pre-mixed sauces are also made with high-fructose corn syrup or sweetened with sucrose. Barbecue sauce is a particular landmine, since it is now a rare barbecue sauce not made with high-fructose corn syrup as the first or second ingredient. Sauces for dipping are nearly always high-fructose corn syrup-based.

Ketchup--Yup. Good old ketchup even is now made with high-fructose corn syrup. In fact, you should be suspicious of any condiment.

Highball, Bloody Mary, Margarita, Daiquiri, beer--Even the before-dinner or dinner drink can have plenty of fructose, particularly if a mix is used to make it. While Blood Marys seem the most benign of all, adorned with celery, pickle, and olive, just take a look at the ingredient label on the mix used: high-fructose corn syrup.

Fructose is a stealth poison: It doesn't immediately increase blood sugar; it doesn't trigger any perceptible effect like increased energy or sleepiness. But it is responsible for an incredible amount of the health struggles in the U.S., from obesity, to diabetes, to hyperlipidemias and heart disease, to arthritis, to cataracts.

A glycation rock and a hard place

Advanced Glycation End-products, or AGEs, the stuff of aging that mucks up brains, kidneys, and arteries, develop via two different routes: endogenous (from within the body) and exogenous (from outside the body).

Endogenous AGEs develop via glycation. Glycation of proteins in the body occurs when there are glucose excursions above normal. For instance, a blood glucose of 150 mg/dl after your bowl of stone-ground oatmeal causes glycation of proteins left and right, from the proteins in the lens of your eyes (cataracts), to the proteins in your kidneys (proteinuria and kidney dysfunction), to skin cells (wrinkles), to cartilage (brittle cartilage followed by arthritis), to LDL particles, especially small LDL particles (atherosclerosis).

At what blood sugar level does glycation occur? It occurs even at "normal" glucose levels below 100 mg/dl (with measurable long-term cardiovascular effects as low as 83 mg/dl). In other words, some level of glycation proceeds even at blood glucose levels regarded as normal.

There's nothing we can do about the low-level of glycation that occurs at low blood sugar levels of, say, 90 mg/dl or less. However, we can indeed do a lot to not allow glycation to proceed more rapidly, as it inevitably will at blood sugar levels higher than 90 mg/dl.

How do you keep blood sugars below 90 mg/dl to prevent excessive glycation? Avoid or minimize the foods that cause such rises in blood sugar: carbohydrates.

What food increases blood sugar higher than nearly all other known foods? Wheat.

Is einkorn the answer?

People ask: "What if I would like a piece of bread or other baked product just once in a while? What is safe?"

Eli Rogosa, Director of The Heritage Wheat Conservancy, believes that a return to the wheat of our ancestors in the Fertile Crescent, circa 10,000 years ago, is the answer.

Former science teacher, now organic farmer, farm researcher, and advocate of sustainable agriculture, Eli has been reviving "heritage" crops farmed under organic conditions, some of her research USDA-funded.

In particular, Eli has been cultivating original 14-chromosome ("diploid") einkorn wheat. Although einkorn contains gluten (in lesser quantities despite the higher total protein content), the group of proteins that trigger the immune abnormalities of celiac disease and other immune phenomena, Eli tells me that she has witnessed many people with a variety of wheat intolerances, including celiac disease, tolerate foods made with einkorn wheat. (The variety of glutens in einkorn differ from the glutens of the dwarf mutant that now dominate supermarket shelves.)

Eli travels to Israel every year, returning with "heritage" seeds for wheat and other crops. She formerly worked in the Israel GenBank as Director of the Ancient Wheat Program. She has written a brochure that describes her einkorn wheat.

Eli sent me 2 lb of her einkorn grain that nutritionist, Margaret Pfeiffer, and I ground into bread. Our experience is detailed here. My subsequent blood sugar misadventure, comparing einkorn bread to conventional organic whole wheat bread is detailed here, followed by the odd neurologic effects I experienced here.

Anyone else wishing to try this little ancient wheat experiment with einkorn can also obtain either the unground grain or ground flour through Eli's website, www.growseed.org. Most recently, einkorn pasta is being retailed under the Jovial brand at Whole Foods Market.

If anyone else makes bread or any other food with Eli's einkorn wheat, please let me know:

1) Your blood sugar response (before and 1 hour after consumption)
2) Whether you experienced any evidence of wheat intolerance similar to what you experienced with conventional wheat, e.g., rash, acid reflux, gas and cramping, moodiness, asthma, etc.

But remember: Wheat effects or no, einkorn is still a grain. My belief is that humans do best with little or no grain. The einkorn experience is an effort to identify reasonable compromises so that you and I can have a piece of birthday cake once a year without getting sick.

Genetic incompatibility

Peter has lipoprotein(a), or Lp(a), a genetic pattern shared by 11% of Americans.

It means that Peter inherited a gene that codes for a protein, called apoprotein(a), that attaches to LDL particles, forming the combined particle Lp(a). It also means that his overall pattern responds well to a high-fat, high-protein, low-carbohydrate diet: The small LDL particles that accompany Lp(a) over 90% of the time are reduced, Lp(a) itself is modestly reduced, other abnormalities like high triglycerides (that facilitate Lp(a)'s adverse effects) are corrected. Small LDL particles are, by the way, part of the genetic "package" of Lp(a) in most carriers.

Peter also has another gene for Apo E4, another genetically-determined pattern shared by 19% of Americans. (Another 2% of Americans have two "doses" of Apo E4, i.e., they are homozygotes for E4.) This means that the Apo E protein, normally responsible for liver uptake and disposal of lipoproteins (especially VLDL), is defective. In people with Apo E4, the higher the fat intake, the more LDL particles accumulate. (The explanation for this effect is not entirely clear, but it may represent excessive defective Apo E-enriched VLDL that competes with LDL for liver uptake.) People with Apo E4 therefore drop LDL (and LDL particle number and apoprotein B) with reductions in fat intake.

This is a genetic rock-and-a-hard-place, or what I call a genetic incompatibility. If Peter increases fat and reduces carbohydrates to reduce Lp(a)/small LDL, then LDL measures like LDL particle number, apoprotein B, and LDL cholesterol will increase. Paradoxically, sometimes small LDL particles will even increase in some genetically predisposed people.

If Peter decreases fat and increases carbohydrates, LDL particle number, apoprotein B, and LDL cholesterol will decrease, but the proportion of small LDL will increase and Lp(a) may increase.

Thankfully, such "genetic incompatibilities" are uncommon. In my large practice, for instance, I have about 5 such people.

The message: If you witness paradoxic responses that don't make sense or follow the usual pattern, e.g., reductions in LDL particle number, apoprotein B, and small LDL with reductions in their dietary triggers (i.e., carbohydrates, especially wheat), then consider a competing genetic trait such as Apo E4.

The folly of an RDA for vitamin D

Tom is a 50-year old, 198-lb white male. At the start, his 25-hydroxy vitamin D level was 28.8 ng/ml in July. Tom supplements vitamin D, 2000 units per day, in gelcap form. Six months later in January (winter), Tom's 25-hydroxy vitamin D level: 67.4 ng/ml.

Jerry is another 50-year old white male with similar build and weight. Jerry's starting summer 25-hydroxy vitamin D level: 26.4 ng/ml. Jerry takes 12,000 units vitamin D per day, also in gelcap form. In winter, six months later, Jerry's 25-hydroxy vitamin D level: 63.2 ng/ml.

Two men, similar builds, similar body weight, both Caucasian, similar starting levels of 25-hydroxy vitamin D. Yet they have markedly different needs for vitamin D dose to achieve a similar level of 25-hydroxy vitamin D. Why?

It's unlikely to be due to variation in vitamin D supplement preparations, since I monitor vitamin D levels at least every 6 months and, even with changes in preparations, dose needs remain fairly constant.

The differences in this situation are likely genetically-determined. To my knowledge, however, the precise means by which genetic variation accounts for it has not been worked out.

This highlights the folly of specifying a one-size-fits-all Recommended Daily Allowance (RDA) for vitamin D. The variation in need can be incredible. While needs are partly determined by body size and proportion body fat (the bigger you are, the more you need), I've also seen 105 lb women require 14,000 units and 320-lb men require 1000 units to achieve the same level of 25-hydroxy vitamin D.

An RDA for everyone? Ridiculous. Vitamin D is an individual issue that must be addressed on a person-by-person basis.

Heart scan: Standard of care?

If coronary disease is easy to detect by measuring coronary calcium, shouldn't this represent the standard of care?

In other words, if you've been seeing your doctor and he/she has been monitoring cholesterol levels and, inevitably, talks about statin drugs, then you have a heart attack, unstable angina, or die--yet never knew you had heart disease--isn't this negligence?

Coronary calcium, and thereby coronary atherosclerotic plaque, are markers for the disease itself. Unlike cholesterol, high blood pressure, etc., that represent risk factors for coronary atherosclerotic plaque, coronary calcium is a measure of total plaque: "soft" elements like lipid collections, necrotic tissue, fibrous tissue, as well as "hard" elements like calcium. Because calcium occupies 20% of total atherosclerotic plaque volume, it can be used as an indirect "dipstick" for total plaque.

So why isn't an unexpected heart attack, hospitalization for unstable heart symptions, emergency bypass, etc., not regarded as potential malpractice? These are not benign events, but potentially life-threatening.

The costs of doing drug business?

Here's a telling situation.

Liz had been on prescription niacin, Niaspan, 1500 mg per day (3 x 500 mg tablets) for several years to treat her severe small LDL pattern and familial hypertriglyceridemia (triglycerides 500-1000 mg/dl). Because her health insurance had been paying for the "drug," she insisted on taking the prescription form.

A change in insurance, however, meant that the Niaspan was no longer covered. Her pharmacy wanted to charge $227 per month.

Liz came to the office in tears, worried that she was going to have to choke up $227 per month. I reminded her that, as I had told her several years ago, she could easily replace the Niaspan with over-the-counter Sloniacin or Enduracin. Both release niacin over approximately 6 hours, just like Niaspan.

Here are the prices I've seen with Sloniacin, 100 tablets of 500 mg:

Walgreens: $15.99
Walmart: $12.99
Costco: $8.99

So the most expensive source, Walgreens, would cost Liz just under $15.99 per month to take 1500 mg per day.

$15.99 versus $227.00 per month for preparations that are highly similar. Hmmmmmm.

I wonder what the $211.01 extra per month goes towards? Admittedly, Abbott Labs, the current company selling Niaspan (after Abbott acquired Kos), has invested in a few clinical trials, such as ARBITER-HALTS6. But does supporting research justify this much difference, a difference that amounts to $2532 over a year? If just 100,000 patients are prescribed Niaspan at this dose (a typical dose), this generates $253 million.

Is the cost of developing and marketing a supplement-turned-drug that great? Is this justifiable? Is it any wonder that our health insurance premiums continue to balloon?

I use Sloniacin and Enduracin almost exclusively.

Measurement

A crucial component of self-empowerment in healthcare is to be able to measure various health parameters. More and more measurement tools are entering the direct-to-consumer arena.

Quantification of various phenomena is important in managing many aspects of health. Imagine a carpenter trying to build a house without the use of a tape measure, level, or other measuring tools. In health, as in building a house, measurement, adjustment, and correction are critical.

Among the most helpful health measurement tools:

Blood glucose meters--Blood glucose meters aren't just for diabetics. They are among the most powerful weight loss tools available.

Blood pressure cuffs--There's no better way to assess blood pressure than to assess it under all the varied conditions of life: When you're tired, when you're excited, when you're upset, when you're happy, hungry, stomach full, morning, night. This is a lot better than the one isolated measure in the doctor's office.

Digital thermometers--Your first a.m. oral temperature is a great way to assess thyroid status. We aim to maintain first a.m. oral temperature around 97.3 degrees F, the normal human temperature upon arising that reflects normal thyroid function. (No, Dr. Broda Barnes fans, axillary temperatures should NOT be used due to flagrant variation from right armpit to left armpit, modifying effects of clothing and ambient temperature, etc. Oral temperature tracks internal, "core," temperature fluctuations reliably, including circadian variation, far better than axillary temperatures.)

Fingerstick blood tests--An incredible number of blood tests are now available just by performing a simple fingerstick in your kitchen or bathroom. You can get 25-hydroxy vitamin D, lipids, thyroid measures (TSH, free T3, free T4), hormones (DHEA, testosterone, estrogens). And the list is growing rapidly. Salivary tests are also growing in number for many of the same measures.

A variation on fingerstick blood tests are devices like CardioChek that allow you to do a fingerstick, but also run the test on your own device at home. (The CardioChek device tests total cholesterol, triglycerides, and HDL.)

Urine pH--You can dipstick your own urine to assess the relative acidity or alkalinity of your lifestyle. Acid pH (7 or below) suggests that diet is weighed too heavily in favor of animal products and grains. An alkaline pH (above 7) suggests plentiful vegetables and fruits, not counteracted by animal products and grains.

There are many more, including the ZEO device to monitor sleep quality, RESPeRATE for reduction of blood pressure, HeartMath to manage stress and augment the parasympathatic (relaxation) response. We've come a long way compared to the health monitoring devices of just 25-30 years ago.

Anyway, that's a partial list. Given the rapid advances in technology that allow such home tests, I anticipate a much longer list in the coming few years.

For some perspective on how far these devices have come, here's a great graphic of an early sphygmomanometer, or blood pressure gauge.


Courtesy Wellcome Library, London

I lost 37 lbs with a fingerstick

Jack needed to lose weight.

At 5 ft 7 inches, he weighed in at 273 lbs, putting his BMI at a sobering 42.8. (A BMI of 30 or above is classified as "obese.") In addition to lipoprotein(a), Jack had an extravagant quantity of small LDL (the evil "partner" of lipoprotein(a)), high triglycerides, and blood sugars in the diabetic range. With a heart scan score of 1670, Jack had little room for compromises.

Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order.

So I taught Jack how to check his blood sugars using a fingerstick device, what I call the most important weight loss tool available. I asked Jack to check his pre-meal blood glucose and his one-hour after-meal blood glucose and not allow the after-meal blood glucose to rise any higher than the pre-meal. For example, if blood glucose pre-meal was 115 mg/dl, after-meal blood glucose should be no higher than 115 mg/dl.

If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.

Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.

What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise.

Six months later, Jack came back 37 lbs lighter. And he got there without calorie-counting, without regulating portion sizes, without hunger.

The two kinds of small LDL

You won't find this in any publication nor description (at least ones that I've come across) about the ubiquitous small LDL particles. It's an observation I've made having obtained thousands of advanced lipoprotein panels of the sort that break lipoproteins down by size. I've discussed this issue previously here. But small LDL is so ubiquitous, not addressed by conventional strategies like statin drugs or fat restriction (it is made worse, in fact, by reducing fat in the diet), that it is worth keeping at the top of everyone's consciousness.

(Because most of the lipoprotein analyses performed in my office are done via NMR, I will discuss in terms relevant to NMR. This does not necessarily mean that similar observations cannot be made with centrifugation, i.e, VAP from Atherotech, or gel electropheresis from Berkeley, Boston Heart Lab, Spectracell, and others).

There are two basic varieties of small LDL particles:

1) Genetically-programmed--e.g., via cholesteryl-ester transfer protein (CETP) activity
2) Acquired--via carbohydrate consumption


It means that people with acquired small LDL from carbohydrate consumption can reduce small LDL to zero with reduction of carbohydrates, especially the most small LDL-provoking foods of all: wheat, cornstarch, and sucrose.

It also means that people who have small LDL for genetically-determined reasons can only minimize, not eliminate, small LDL. By NMR, we struggle to keep small LDL in the 300-600 nmol/L range when genetically-determined. (People typically start with 1400-3000 nmol/L small LDL particles prior to diet changes and other efforts.) We can only presumptively identify genetically-determined small LDL when all the appropriate efforts have been made, including reduction in weight to ideal, yet small LDL persists.

Here is where we need better tools: when you've done everything possible, yet small LDL persists.

While we break LDL particles (NOT LDL cholesterol, the crude and misleading way of viewing atherosclerosis causation) down by size, it's really about all the undesirable characteristics that accompany small size:

--Distortion of Apo B conformation--i.e., the primary protein that directs LDL particle fate is distorted, making it less likely to be cleared by the liver but more likely to be taken up by inflammatory (macrophages) in the artery wall, creating plaque. It means that small LDL particles linger for a longer time than larger particles.

--Small LDLs are more oxidation-prone. Oxidized LDL are more avidly taken up by inflammatory macrophages.

--Small LDLs are more glycation-prone.

--Small LDLs are more adherent to structural tissues, e.g., glycosaminoglycans, that reside in the artery wall.

You and I cannot measure such phenomena, so we resort to distinguishing LDL particles by size.

The drug industry believes it may have a solution to small LDL in the form of CETP-inhibiting drugs, like anacetrapib. In the way of nutritional solutions beyond carbohydrate reduction, weight loss/exercise, niacin, vitamin D normalization, and omega-3 fatty acid supplementation, there are exciting but very preliminary data surrounding the possibility that anthocyanins may inhibit CETP activity. Having toyed with this concept for the past 6 months, I remain uncertain how meaningful the effect truly is, but it is harmless, since we obtain anthocyanins from foods colored purple or purplish, such as blackberries, blueberries, cherries, red leaf lettuce, red cabbage, etc.

I welcome any unique observations on this issue.