Cholesterol effects of carbohydrates

24. March 2009 William Davis (31)
Let's take a hypothetical person, say, a 50-year old male. 5 ft 10 inches, 160 lbs, BMI 23.0. He's slender and in good health.

Our hypothetical man eats a simple diet of vegetables, some fruit, nuts, and meats but avoids processed industrial foods. By macronutrient composition, his diet is approximately 30% protein, 40-50% fat, 20-30% carbohydrate. His starting lipid panel:

Total cholesterol 149 mg/dl
LDL cholesterol 80 mg/dl
HDL 60 mg/dl
Triglycerides 45 mg/dl

His starting lipids are quite favorable (though I don't often see this kind of starting panel nowadays except in athletes). We begin here because this hypothetical man is going to serve as our test subject.

We ask our hypothetical man to load his diet up on "healthy whole grains." He complies by eating whole grain cereals for breakfast, whole wheat toast; sandwiches made with whole grain bread; dinners of whole wheat pasta; snacks of granola bars, whole wheat pretzels and crackers.

Three months later, his lipids show:

Total cholesterol 175 mg/dl
LDL cholesterol 130 mg/dl
HDL 45 mg/dl
Triglycerides 150 mg/dl


You can see that LDL cholesterol has increased, HDL has dropped, and triglycerides have increased. This wave of change is the hallmark of carbohydrate excess, but more specifically of overreliance on wheat products. Beyond his lipid panel, the man has gained 10 lbs, all concentrated in a soft roll around his abdomen, his blood sugar is now in the "borderline range" of between 110 and 126 mg/dl, i.e., pre-diabetic.

If we were to examine this man's advanced lipoproteins (e.g., NMR from Liposcience, or VAP from Atherotech), we would see that there has been an explosive increase in small LDL particles, along with a shift of large HDL to small, and the appearance of multiple abnormal classes of particles called VLDL and IDL (signalling abnormally slowed clearance of dietary by-products from the blood).

Familiar scenario? The "after-carbohydrate" situation is the rule among the people who I first meet who claim to be eating a "healthy" diet, though their patterns are usually much worse, with higher LDL, lower HDL, and much higher triglycerides, an exaggeration of our hypothetical man's abnormalities.

What if our hypothetical man now goes to his conventionally thinking (read "taught medicine by the pharmaceutical industry") physician? What will likely be the advice he receives? Reduce his saturated fat intake, eat plenty of healthy whole grains, take a statin drug.

Although my illustrative man is hypothetical, I've seen this scenario play out many thousands of times. It happens in real life all the time. It is predictable, it is highly manipulable. Sadly, it is rarely recognized for what it is: the result of excess carbohydrates, or what I call "Carbohydrate Intolerance Syndrome."

The misinterpretation of this condition has created 1) an epidemic of diabetes and pre-diabetes, 2) a nation of frustrated obese Americans, 3) a $27 billion per year statin industry, 4) another growth opportunity for the drug industry in diabetes drugs.

Wheat Belly Revisited

23. March 2009 William Davis (24)
Do you have a wheat belly?

When I first coined this phrase back in July, 2007, I had witnessed the phenomenal health effects of wheat elimination in several hundred patients.

In the nearly two years that have passed since my original post, I have witnessed hundreds more people who have done the same: eliminate pretzels, crackers, breads of all sorts, bagels, pasta, muffins, waffles, pancakes, etc.

If anything, I am convinced now more than ever that wheat is among the most destructive foods in the human diet. At least 70% of people who eliminate wheat from their diet obtain at least one, if not several, substantial health benefits.

Now, if I were trying to sell you something, say, an alternative to wheat, then you should be skeptical. If I tell you that drug or nutritional supplement X is great and you should take it, only to follow it with a sales pitch, you should be skeptical.

What am I selling? Nothing. I gain nothing by telling everyone to avoid wheat. In fact, I wish it wasn't true. Wheat foods taste good. Wheat flour makes great comfort foods. In years past, I spent many hours sitting at the bagel shop reviewing papers over a cup of coffee and a bagel. No longer.

So here, back by popular demand, the original Wheat Belly post:



Wheat Belly

You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer.

How about "wheat belly"?

That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta.



(By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.)

It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc.

How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere.

Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner.

"But that's what they told us to eat after Dan left the hospital after his last stent!"

Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc.

I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world.

As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.

Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.

You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.

Thank you, Crestor

20. March 2009 William Davis (9)
I'm sure everyone by now has seen the Crestor ads run by drugmaker, AstraZeneca. TV ads, magazine ads, and the Crestor website all echoing the same message:

"While I was busy building my life, something else was busy building in my arteries: dangerous plaque."

While previous drug trials with Mevacor, Pravachol, Zocor, and Lipitor have focused mostly on examining whether the drugs reduced incidence of cardiovascular events, Crestor studies have also focused on effects on atherosclerotic plaque volume. The best example is the ASTEROID trial that demonstrated approximately 7% reduction in plaque volume by intracoronary ultrasound.

So the AstraZeneca decision makers took the leap from cholesterol reduction to plaque reduction.

I'm sure this switch wasn't taken lightly, but was the topic of discussion at many meetings before the decision to make plaque reduction the focus of hundreds of millions of dollars of advertising. After all, billions of dollars are at stake in this bloated statin market.

Ordinarily, I couldn't care less about how the drug manufacturers conduct their advertising campaigns. But this one I paid attention to because the Crestor ads are helping fuel a new way of thinking about coronary heart disease: It's not about the cholesterol; it's about the atherosclerotic plaque that accumulates in arteries.

It's not cholesterol that grows, limits coronary blood flow, and causes angina. It's not cholesterol that "ruptures" its internal contents to the surface within the interior of the blood vessel and causes blood clot and heart attack. It's not cholesterol that fragments from the carotid arteries and showers debris to the brain, causing stroke. It's all plaque.

I took the same leap years ago, though not backed by hundreds of millions of dollars of marketing money. When I first called my book Track Your Plaque, some of the feedback I got from editors included comments like "I thought this was a book about teeth!" Even now, the word "plaque" in the book title and website is responsible for confusion.

But AstraZeneca is helping me clear up the confusion. As the word plaque gains hold in public consciousness, it will become increasingly clear that cholesterol reduction is not what we're after. We are looking for reduction of plaque.

If you are trying to develop an effective means to reduce or reverse coronary heart disease, then there are two simple equations to keep in mind:


Plaque = coronary heart disease

Cholesterol ? coronary heart disease


Plaque is the disease, cholesterol is not. Cholesterol is simply a crude risk for plaque.

While I'm no friend to the drug industry nor to AstraZeneca, some good will come of their efforts.

Supermarkets and buggy whips

17. March 2009 William Davis (17)
Will supermarkets eventually phase out, joining the history books as a phenomenon of the past? Or are supermarkets here to stay, an emblem of the industrialization of our food--easy access to foods that are convenient, suit the undiscriminating masses, stripped of nutritional value despite the prominent health claim on the package front?

Anna left an insightful comment on the last Heart Scan Blog post, Sterols should be outlawed, along with some useful advice on how to avoid this trap for poor health called a supermarket:


I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.). What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.

When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).

It's almost like being on another planet! There's always so many new products (most of them I hesitate to even call food). It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste. I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold Irish cheese, because I know their cows have pasture access and it's real food).

What's really shocking to me is how large some sections of the markets have become in recent years. While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas). Meat and seafood counters have shrunk, though. Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

But the chilled juice section is h-u-g-e! And no, I don't think there is a Florida orange grove behind the cases. Come on, how much juice do people need? Juice glasses used to be teeny tiny, for a good reason. To me it looks like a long wall stocked full of sugar water. Avoiding that section will put a nice dent in the grocery expenses.

The yogurt case is also e-n-o-r-m-o-u-s! Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"! Chock full of every possible variety, but very little fit to eat. The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home). I can flavor them at home if needed. The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

I found the same "cooler spread" in the butter & "spread" section. The spread options were just grotesque sounding. Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc. A few plain butters were enhanced with "butter flavor" - say what? And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.


Well said, Anna.

There's a huge supermarket about 1 mile away from my house similar to the one Anna describes with aisle after aisle of eye-catching cellophane-wrapped foods. I go there about every 3 or 4 months, and then I only go to get something I need in a pinch. Every time I go, I too am reminded just how many products there are that look more like junk food than real food.

But there's no real money in real food. Who gets rich off of selling green peppers, tomatoes, and eggs?

Supermarkets sell these modern industrial foods because people buy it: Look around you. You don't get to be a 250 lb 5 ft 2 inch-woman by eating too many cucumbers.

Like Anna, I drive an additional several miles to Trader Joes', buy at farmers' markets whenever possible, buy some odds and ends like wine and cheese and raw nuts at specialty stores. I grow my own basil in a big pot I keep in the kitchen and we are just about to start turning over the soil in the back yard for our vegetable garden. I don't need nor do I miss having the choice among 40 different chips, 25 brands of ready-made microwavable dinners, an entire aisle of breakfast cereasl (all of which are virtually the same with different names and labels), or 75 varieties of salad dressing.

The supermarket for me--and I hope for many of you--has become a place rarely frequented, and only for the odd forgotten item. Oh, I forgot the dog chewies the grocery does have--my dogs love them. So perhaps they are good for something after all.

Sterols should be outlawed

14. March 2009 William Davis (10)
While sterols occur naturally in small quantities in food (nuts, vegetables, oils), food manufacturers are adding them to processed foods in order to earn a "heart healthy" claim.

The FDA approved a cholesterol-reducing indication for sterols , the American Heart Association recommends 200 mg per day as part of its Therapeutic Lifestyle Change diet, and WebMD gushes about the LDL-reducing benefits of sterols added to foods.


Sterols--the same substance that, when absorbed to high levels into the blood in a genetic disorder called "sitosterolemia"--causes extravagant atherosclerosis in young people.

The case against sterols, studies documenting its coronary disease- and valve disease-promoting effects, is building:

Higher blood levels of sterols increase cardiovascular events:
Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study.

Sterols can be recovered from diseased aortic valves:
Accumulation of cholesterol precursors and plant sterols in human stenotic aortic valves.

Sterols are incorporated into carotid atherosclerotic plaque:
Plant sterols in serum and in atherosclerotic plaques of patients undergoing carotid endarterectomy.




Though the data are mixed:

Moderately elevated plant sterol levels are associated with reduced cardiovascular risk--the LASA study.

No association between plasma levels of plant sterols and atherosclerosis in mice and men.




The food industry has vigorously pursued the sterol-as-heart-healthy strategy, based on studies conclusively demonstrating LDL-reducing effects. But do sterols that gain entry into the blood increase atherosclerosis regardless of LDL reduction? That's the huge unanswered question.

Despite the uncertainties, the list of sterol-supplemented foods is expanding rapidly:




Each Nature Valley Healthy Heart Bar contains 400 mg sterols.












HeartWise orange juice contains 1000 mg sterols per 8 oz serving.













Promise SuperShots contains 400 mg sterols per container.














Corozonas has an entire line of chips that contain added sterols, 400 mg per 1 oz serving.














MonaVie Acai juice, "Pulse," contains 400 mg sterols per 2 oz serving.














Kardea olive oil has 500 mg sterols per 14 gram serving.










WebMD has a table that they say can help you choose "foods" that are sterol-rich.

In my view, sterols should not have been approved without more extensive safety data. Just as Vioxx's potential for increasing heart attack did not become apparent until after FDA approval and widespread use, I fear the same may be ahead for sterols: dissemination throughout the processed food supply, people using large, unnatural quantities from multiple products, eventually . . . increased heart attacks, strokes, aortic valve disease.

Until there is clarification on this issue, I would urge everyone to avoid sterol-added "heart healthy" products.


Some more info on sterols in a previous Heart Scan Blog post: Are sterols the new trans fat? .

Texas today, tomorrow . . . the world?

10. March 2009 William Davis (0)
Texas state representative, Rene Oliveira, has introduced legislation that mandates heart scans for adults in the state of Texas.

Rep. Oliveira

A press release from the SHAPE Society ( Society for Heart Attack Prevention and Eradication) reads:

Assessment of heart attack risk on the basis of traditional risk factors alone such as high cholesterol and high blood pressure and so forth, while useful, misses many who are at high risk and also incorrectly flags some for high risk who are in fact at very low risk of near term heart attack; on the other hand detection of atherosclerosis by non-invasive imaging, as suggested by the SHAPE group, accurately identifies plaque and improves the ability to identify at-risk individuals who could benefit from aggressive preventive intervention while sparing low-risk subjects from unnecessary aggressive medical therapy," said Dr. P.K. Shah, Director of Cardiology at Cedars Sinai Heart Institute in Los Angeles, a leading member of the SHAPE Task Force who is also an active member of the American Heart Association. "Sadly, these vulnerable patients go undetected until struck by a heart attack, because insurance companies don't cover the newer heart attack screening imaging tests."


Rep. Oliveira, whose coronary disease was first uncovered by a heart scan and prompted a bypass operation, states:

"It is about time that we cover preventive screening for the number one killer in Texas, and take action to reduce healthcare costs through preventive healthcare. Right now, we are extending the lives of those who can afford the procedure while hundreds of thousands of Texans with hidden heart disease go undetected because of antiquated thinking. The time has come for this change."


Is this what we've come to? Since practicing physicians are either so entranced by the drug and procedural solutions to heart disease, do we need to resort to heart scan by legislation?

It does indeed appear that we've come to this point. Should this trend catch on, it will surely mean an upfront increase in healthcare costs to cover the expense of heart scans. But in the long run, it will mean reduction in healthcare costs--dramatic reduction--if heart scans prompt effective preventive action.

What your doctor doesn't know about heart disease

9. March 2009 William Davis (12)
What causes coronary heart disease or coronary atherosclerotic plaque, this thing that we track with heart scans?

Well, here are a few little-publicized facts about heart disease that you are unlikely to hear from your When's-the-next-stent? cardiologist or the What is there besides statins? primary care doctor.

(Since everybody knows that smoking is a modifiable risk for heart disease that can be readily identified, let's focus on the blood tests that reveal heart disease causes.)


What's the number one most common cause for heart disease?

Small LDL particles. The proliferation and popularity of the snack food/processed food culture, compounded with the "eat more healthy whole grain " propaganda has launched small LDL solidly to first place as the most common reason to have heart attacks, stents, and bypass. All that advice to increase your "healthy whole grain" intake? It increases heart attack risk.


What's the number one most aggressive cause for heart disease?

That's lipoprotein(a), or Lp(a). It's certainly not high cholesterol, though the drug industry loves that you think that. We could argue over whether smoking is more aggressive, but the two are pretty darned close. Combine the two--Lp(a) in a smoker--and the combination is an explosively powerful trigger for heart disease and stroke.


What's the number two cause for heart disease?

After small LDL comes low HDL cholesterol. Ask anyone who has had a heart attack: What was your cholesterol panel like? 9 out of 10 will say "My LDL cholesterol was 135 mg/dl" while knowing little or nothing about HDL, which is commonly in the 30-42 mg/dl range--sufficient to contribute to heart disease risk considerably.


Can "normal" thyroid hormone tests still contribute to heart disease?

Yes. Hypothyroidism is an exceptionally powerful risk factor for heart disease. Many people have been told that their thyroid tests are "normal," when in reality risk for heart disease may be as much as tripled from low thyroid with thyroid blood tests in the "normal" range.


Does a "balanced, healthy diet" prevent heart disease?

No, it does not. In fact, the modern notion of a "balanced, healthy diet" increases risk for heart disease. Of course, the dangers of such diets vary, depending on how you define it. If it's the diet advocated by the USDA Food Pyramid, then it is an enormously destructive diet that causes your health to careen towards both diabetes and heart disease. The American Heart Association TLC diet is little better.


Does eating fish twice a month reduce heart attack risk?

Yes, it does--but just barely. Unfortunately, large studies that show that eating fish as infrequently as twice per month reduce risk for dying from heart attack have led some authorities to suggest that's all you need to do. What they fail to understand is that the benefit is dose-dependent--the greater the intake of omega-3 fatty acids, the greater the benefit (within reason, of course). So, while the effect can be detected by eating fish twice per month, it doesn't mean that full benefits are achieved with this "dose." Full benefits are obtained by mimicking the omega-3 intake of the Japanese.


Do nutritional supplements reduce risk for heart attack?

If you are referring to vitamin D, then, yes, nutritional supplements reduce risk for heart attack . . . enormously. We need more data to validate this phenomenon, though epidemiologic observations strongly bear this out, including the Health Professionals Follow-up Study, the Framingham Heart Study and NHANES, all of which demonstrate a graded effect: the lower the vitamin D blood level, the greater the risk for heart attack.

Over the years, we've experienced more than our share of disappointments in nutritional supplements for heart disease, including vitamin E and B vitamins to reduce homocysteine. But I believe that nothing approaches the solid feel of vitamin D--no other nutritional supplement raises HDL, reduces triglycerides, reduces blood sugar, enhances insulin responses, reduces the inflammatory C-reactive protein, reduces blood pressure like vitamin D. Vitamin D is here to stay--and I'm very grateful.

And don't forget omega-3 fatty acids from fish oil, yet another supplement with unquestioned benefits for reduction of heart attack and death from heart attack.


Why didn't your doctor counsel you on the importance of these issues?

The primary reasons your doctor didn't tell you any of the above:

1) He/she has been persuaded that only drugs are of any real use in health. Nutritional supplements? Hah!

2) Neither the number one cause of heart disease in the U.S.--small LDL particles--nor the most aggressive cause for heart disease--Lp(a)--are corrected by patent-protectable, high profit pharmaceutical agents promoted to your doctor. Instead, these abnormalities can be corrected inexpensively, without prescription. That means no expensive commercials, no media spots, no write-ups in magazines.

3) Your doctor's business is to treat crisis: sore throat, broken ankle, lung tumor, heart attack. Prevent heart disease 10 or 20 years before it shows itself? Heck, no (unless the marketing pull of the drug industry is involved, of course).


It's best that you bear in mind: What your doctor doesn't know can kill you.

Thank you, Dr. Eades

6. March 2009 William Davis (7)

Thanks to some readers of The Heart Scan Blog, I've become acquainted with Dr. Michael Eades' wonderful blog, Health and Nutrition by Dr. Michael R. Eades, MD.

Dr. Eades is co-author (with his wife, Mary Dan Eades, MD) of Protein Power

In one of his conversations, I stumbled on this exchange between Dr. Eades and one of his readers:



Reader: Regarding EBT scans, I looked up the topic on Google and read an informative 5-page article: EBT (Ultrafast CT) Scans - Godsend, or Scam? Dr. Fogoros says that false positives (where the EBT shows the presence of calcium, but the patient has little coronary artery blockage) occur about 50 percent of the time. The next step, if the EBT is positive, is to do a heart catherterization to find out whether there actually is coronary artery blockage. So the odds are that I’d have to worry!

Dr. Michael Eades: The info you got from Google is one of the reasons one shouldn’t get medical information online. As far as I’m concerned the EBT is the BEST way to determine the presence of plaque. If you have a positive calcium score, you have plaque, and there’s an end on’t (as Samuel Johnson would say). Now you may have a low calcium score for your age or you may have a calcium score that doesn’t change, which means you have stable plaque, but if you have a positive calcium score, you have some amount of plaque in your coronary arteries.

And whoever says that the next step to take if you receive a positive calcium score is a coronary artery cath is a real moron. That’s probably the last thing you would want to do if you are asymptomatic. All the cath procedure does is shows whether or not you have a blockage - you can have huge amounts of plaque (which are a disaster waiting to happen) and have a normal cardiac cath.

If you want to get a little more information on the validity of EBT than what you find on Google, take a look at Dr. Davis’ blog or get a copy of his book: Track Your Plaque. I’m not crazy about all of Dr. Davis’ dietary recommendations because he comes to diet from a different perspective than I, but the EBT info in his book is terrific.

Cheers–

Dr. Eades "gets" it. He understands that quantification of coronary plaque is a tool for prevention, not something to be subverted into the service of procedures for the financial benefit of my colleagues.

And I think that he is absolutely correct on the diet discussed in Track Your Plaque--it's due for a revision. I wrote the book in 2003, while we were still locked into the low-fat mindset. Much has changed.

Since then, our enormous experience in metabolic manipulation and lipoprotein analysis has shown that there is a far better way to correct the causes of coronary plaque and seizing hold of heart scan scores. In particular, the explosion of small LDL has prompted major changes in the diet, specifically removal of wheat and cornstarch, the foods that trigger small LDL particles.

(I am still in the midst of negotiations for release of a bigger and better Track Your Plaque II. In the meantime, Track Your Plaque Members can refer to the New Track Your Plaque Diet, Parts I, II, and III.)

Can millet make you diabetic?

5. March 2009 William Davis (10)















If wheat is so bad, what about all the other grains?

First of all, I demonize wheat because of its top-of-the-list role in triggering:

--Appetite--Wheat increases hunger dramatically
--Insulin
--Blood sugar--Wheat is worse than table sugar in triggering a rapid, large rise in blood sugar
--Triglycerides
--Small LDL particles--the number one cause for heart disease in the U.S.
--Reduced HDL
--Diabetes
--Autoimmune diseases--Most notably celiac disease and thyroiditis.

Most other "healthy, whole grains" aren't quite as bad. It's a matter of degree.

Millet, quinoa, oats, sorghum, bulghur, spelt, barley, cornmeal--While they don't trigger appetite nor autoimmune diseases like wheat does (oat can in some people), they still pose a significant carbohydrate load sufficient to generate the other phenomena like excessive insulin and blood sugar responses. The grams of carbohydrate of these grains are virtually identical to wheat: 43.5 grams per 1/2 cup (uncooked). The exceptions are barley, which is especially loaded with carbohydrates: 104 grams per 1/2 cup, while oats are lower: 33 g per 1/2 cup.

It's all a matter of degree. Some people who are exceptionally carbohydrate-sensitive (like me) can have diabetic blood sugars with just slow-cooked oatmeal or quinoa. Others aren't quite so sensitive and can get away with eating them.

People with high blood sugars (100 mg/dl or greater) can be very sensitive to the blood sugar effects of these grain carbohydrates. The best marker of all are small LDL particles measured on a lipoprotein panel, such as NMR. Small LDL particles are exquisitely sensitive to your carbohydrate intake: small LDL gets worse with excessive sensitivity to grain carbohydrates, gets better with reduction or elimination.

Flagrant small LDL, in combination with low HDL, high triglycerides, and pre-diabetic or diabetic patterns all develop from carbohydrate indulgence, along with "wheat belly."

Don't believe it? The prove it to yourself: Go to Walmart and buy an inexpensive glucose meter and check your blood sugar one hour after eating. You can gauge the health of these foods by observing the blood sugar increases. (Small LDL closely parallels blood sugar rises.)

The grain that fails to trigger any of these abnormal patterns? Flaxseed. Flaxseed is entirely protein, fiber, and healthy oils, with virtually no digestible starches. In fact, flaxseed is one of the few foods that reduces the quantity of small LDL particles.

Are you a tree?

5. March 2009 William Davis (6)
I assume you answered no. Then why would you consider taking the plant form of vitamin D (ergocalciferol)? That's the prescription form of vitamin D, often dispensed as 50,000 unit tablets.

There's nothing wrong with plants. Some of my favorite foods are plants, full of nutritional value.

Then why shouldn't vitamin D2 from plants be every bit as good as the human form of vitamin D?

I believe the issue boils down to taking hormones from non-human sources. (Remember: Vitamin D is a hormone, a very powerful one at that.) Plants can be wonderful sources of flavonoids, fibers, protein, fats, vitamins, minerals, and other healthy components. But hormones?

There are other examples of non-human hormones being given to humans with undesirable or unpredictable effects:

--Xenoestrogens, phytoestrogens, and non-human mammalian estrogens--While non-human estrogens may partially mimic human estrogens, they can also block estrogen effects, or exert altogether novel effects. Non-human mammalian estrogens like Premarin can exert very peculiar (side-)effects, despite their role as prescription estrogen supplementation in humans.

--Progestins--The synthetic versions of human progesterone, like their non-human estrogen counterparts, exert weird effects that are a world apart from real progesterone.

--Sterols--Similar in structure to human cholesterol (while not a hormone, a building block for hormones), sterols have been used to reduce intestinal cholesterol absorption. However, if sterols are absorbed into the blood, they can enormously accelerate growth of atherosclerotic plaque.

--Anabolic steroids--These modifications of the testosterone molecule build muscle, but also cause liver cancer, kidney failure, violent behavior, suicide and homicidal behavior. That's not normal.

Outside of a pharmacologic effect (e.g., prednisone in place of human cortisol), there is no reason to take a non-human hormone in place of a human hormone. For that same reason, there is NO reason to take plant vitamin D2 (prescription or over-the-counter) in place of human vitamin D3.

If the non-human hormone is identical to the human form, then there is no difficulty. The best example of this are thyroid hormones from pigs. That's what Armour Thyroid is, a thyroid hormone replacement that works wonderfully well.

You will notice that virtually all of the examples of non-human hormones substituted for human hormones share one common motivation: profit. Synthetic or modified versions are more readily patent-protectable, unlike their natural counterparts which are not.

Vitamin D2 is an anemic facsimile of the real human hormone, vitamin D3 (cholecalciferol). Stay away from it.
Wheat Belly #5 on New York Times Bestseller list!

Wheat Belly #5 on New York Times Bestseller list!

9. September 2011 William Davis (66)
The New York Times just released its bestseller list due for release September 18th, 2011 . . . .

Wheat Belly is #5!! (That darned Jane Fonda woman elbowed me out for the #4 spot!

[caption id="attachment_4452" align="alignright" width="574" caption="Wheat Belly hits #5 on New York Times Bestseller List--in 1st week!"][/caption]
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Comments (66) -

  • Sean

    9/9/2011 3:54:19 AM |

    Hey, congratulations Dr D.
    I hope you aren't going to go all Hollywood on us now that you are a best-selling author.

  • Princess Dieter

    9/9/2011 7:03:22 AM |

    GREAT! I know I got several folks to buy by blogging/reviewing/facebooking, and some are doing the no-gluten now (including my sis!)

    Now, onto the next one on cholesterol/heart health, yes? ; )

    Oh, and I just started using a glucose monitor to test...interesting (but I hate pricking my finger, wuss that I am.)

    Again, congrats. Go take on Big Grain!

  • miki

    9/9/2011 8:01:02 AM |

    Congratulations! There is hope! I couldn't not notice Tim Ferriss right behind you. He is also "Plaeoish".

  • Michia

    9/9/2011 8:45:39 AM |

    Awesome!  And, oh yeah, you just turned into a much bigger target Wink

  • Alexandra

    9/9/2011 10:03:21 AM |

    I just shared this story over at Fat Head but I thought you might enjoy it as well.
    My copy of Wheat Belly arrived yesterday and is next on the reading list.

    Related story...a very happy turn of events.

    Back in June of this year, a musician friend of mine came to my area for a concert.  I hadn’t seen him in several years and was distressed to see him using a cane (he is only about 57 years old) and clearly appeared to be in pain.  This sweet guy came up to me and said I looked healthy and full of life (what a lovely compliment!) He told me that he had been suffering from severe joint pain throughout his body and was now living on pain medication and was having difficulty performing. He asked me what I was doing to be healthy (I am 120 lbs lighter since the last time he saw me.)  Rather than tell all on a busy concert night, I told him I would send him an e-mail with links, etc. the next day. The e-mail included Fat Head as well as numerous blogs and web sites that I thought would be of help to him.  Long story short, I saw my friend again this past weekend... no cane and walking comfortably.  He told me that, so far, all he had done was stop eating cereal and bread and within three months was able to stop all his pain medications and can again walk without pain, or a cane!  To have played a role in helping this wonderful person feel well again made my heart swell!

  • Debbie B in MD

    9/9/2011 11:04:49 AM |

    My copy just came yesterday!!! I am really enjoying it and making a list of who needs a copy for Christmas presents. Maybe they will be early presents because I wouldn't want to keep this from those I love any longer than necessary. Congratulations!!!

  • Dr. William Davis

    9/9/2011 12:07:35 PM |

    Thanks, Debbie!

    Your mention of Christmas reminds me that I should put some holiday recipes up on the blogs. Holidays tend to be incredible wheat-fests, so it's best to be armed with tasty wheat-free, low-carb recipes.

  • Dr. William Davis

    9/9/2011 12:12:02 PM |

    Wow, Alexandra! Great story.

    Now, more than likely your friend would have tested negative for celiac markers and his doctor would say it was all in his head or a coincidence. This is precisely what I've been seeing.

    Imagine we live in a village where 9 out of 10 people who drink from the water well in the center of town get sick; they stop drinking water from the well, they all get better. They drink from the well again, they get sick, etc. With a consistent and reproducible effect like this, how long do we wait for the clinical trial to prove to us that we are sick from drinking the water?

  • Dr. William Davis

    9/9/2011 12:24:52 PM |

    Yes, Miki, it appears to me the top sellers on the list are all diet books. That tells us something!

  • Dr. William Davis

    9/9/2011 12:27:48 PM |

    Thanks, Princess.

    Because the Wheat Belly 100% wheat-free approach is so critical to the heart health message, this alone will occupy me and my team for some time. Corollary to the Wheat Belly message is that, follow this idea and the need for drugs for cholesterol, hypertension, diabetes, arthritis, and other conditions is dramatically reduced or eliminated in many, if not most, people. I think this message bears repeating . . . and repeating and repeating.

  • Dr. William Davis

    9/9/2011 12:29:21 PM |

    Believe me, Sean, I'm not going anywhere! I grew up very poor, had to work for everything, so I believe that I've learned humility and to appreciate the small things in life. This has always been about the message, not about notoriety. And the message is much too big for any one person to manage singlehandedly.

  • otterotter

    9/9/2011 1:40:09 PM |

    Dr. Davis,

    This is a great news, congratulations !  and now I cannot even wait for my copy to arrive.

    One more question: I know wheat is bad, but is "pure wheat bran" good for me ? I am using a lot of wheat bran in my diet to promote the fibre in take.


    cheers!

    zuo

  • Dee

    9/9/2011 2:17:21 PM |

    Congadulations on Wheat Belly.  I hope a lot of Doctors read or hear about it.  Glutin intorance is rampant throught out the world.
    Dee

  • Lori

    9/9/2011 3:44:03 PM |

    Congratulations! As I posted on the Fathead blog, my mother found out for herself how far wheat can push up blood sugar. An hour after she ate a piece of toast, her BG was 245, up from 101. (Yes, that's two hundred forty-five.)

  • Bill Davis

    9/9/2011 4:47:57 PM |

    Dr Davis

    Good book!

    However, I think the message of the book is bigger than what the cover would lead one to believe. Mis- representation? I was wondering at first knowing somewhat of the origins of the book. In fact I was somewhat disappointed that the cover only addressed a side effect of this 'medication'. And I try to avoid side effects.

    That being said, what do I think is the real message of the book? (and I should know - check my name. Actually I'm the other BD.) It is definitely IMO chapter 10. I'm beginning the third time through 10.

    Then, I saw your post above and it made me think (yes I do that at times since I am sentient) - This is such an important book EVERYONE should read chapter 10. Is this just another diet/food book?  Whether you or the publisher chose the title (they do sometimes you know) it got my chapter 10 right up there where many more will read it. There are 6 out of 10 on that NYT list about what, one would be led to believe, this book is about.

    Diet books are a dime a dozen but heart disease is here to stay (unless the message of ch10 gets out!).

    Again - Good book. Congratulations!

    My new doctor in Boulder needs this in his waiting room. He has your other ones there.

  • cancerclasses

    9/9/2011 5:20:34 PM |

    The fiber myth is just another anti health lie designed to keep you sick and in surgery, forget the conventional wisdom on this one too and do the opposite, you'll be healthier.  Everyone needs to learn the long established and well known scientific truth about fiber, not the conventional wisdom and opinions constantly parroted by the media.  Just google 'brian peskin fiber' and read the post titled "Fiber Fiction" where you'll see the rest of this short cut & paste:  
    "In 2004, the cancer journal, Cancer Epidemiology Biomarkers & Prevention, stated that colon cancer is not helped by eating fiber Dr. Gilbert Omenn stated in a 2000 New York Times article on this subject: “There’s not a shred of [cancer fighting] evidence from these trials. ...the surprising results [no cancer protection] showed the need to rigorously put belief systems to the test, especially when you are making recommendations to literally hundreds of millions of people.” He concluded with, “...it is time to abandon the idea that fiber can help prevent colon cancer.” (Emphasis added)

    As referenced in my landmark book, “The Hidden Story of Cancer,” fiber actually worsens
    colon cancer rather than helping it. Even the Cancer Institute finally agrees with this conclusion. The
    true tragedy lies in the fact that those following this advice and eating the most fiber get the most colon cancer! This fact was reported in 2000 in the Lancet, the world’s premier medical journal.
    There is a general misconception that plant foods are loaded with vitamins that we benefit from; unfortunately, these nutrients are locked away in the plant fiber, or cellulose, which cannot be digested by humans. Herbivores are able to break down the cellulose and get to the nutrients, but due to our digestive tract design, humans cannot."

    And there's more to learn there, be sure to google that and read up, for your health's sake.

  • Joe

    9/9/2011 5:21:42 PM |

    Come up with a tasty, healthy, low-carb (wheat free, of course!) substitute for cannoli and I can guarantee that there will be a national holiday named after you, Doc.

    "Dr. Davis Day," which will fall somewhere between Thanksgiving and Christmas, and celebrated by BILLIONS!

    Joe

  • Hans Keer

    9/9/2011 5:44:52 PM |

    Congratulations doc D. How can this message be brought to an even broader public?

  • otterotter

    9/9/2011 5:54:50 PM |

    Thanks cancerclasses, I will read the bok.

    I am taking fibre mainly to increase the bowl movements to once a day intead of once every two days, and it works for that purpose. Not sure whether it is good or bad through.

  • Linda

    9/9/2011 8:51:05 PM |

    Not to get TOO personal, but, what difference does it make if the bowels move every day or every other day? Why not let your body just do it's thing when it is ready?

    Add some flax to your daily diet, that should do the trick! That stuff really moves things along. LOL

    I can remember my mother taking laxatives every day when I was a kid, and she insisted that we had to move those bowels! When I told her, as an adult, that I sometimes go two or more days, she had a fit!

    It just isn't necessary..............................

  • Galina L.

    9/10/2011 12:27:28 AM |

    Why not increase a dose of a magnesium supplement? I am taking some and have to be careful with the dose because it can make bowl movements more frequent. For some people it should be a desirable side-effect.

  • otterotter

    9/10/2011 1:08:30 AM |

    Linda,

    I have grounded flax seeds in my diet as well, but the problem is I cannot have too much of it. Overdosing flax seeds made my blood too thin and ended up in emergency room last year, with bloody stool ...

    To go 100% wheat free, I might have to try corn bran ...

  • otterotter

    9/10/2011 1:11:00 AM |

    Yes, I am having magnesium as well, it make the stool softer, but not more frequent... well unless you take too much of it.

  • Michia

    9/10/2011 1:24:33 AM |

    Hi otterotter
    This informative site helped me a lot while I was coming back after surgery for a bowel resection several years ago.  
    http://www.gutsense.org/
    I echo the recommendation of magnesium and would add vitamin C.  Make it magnesium citrate, best absorption.  Start in easy since too much at once of either will put you on the, um "fast track" Wink
    I eat VLC, and have to stay 100% wheat-free or risk the wrath of an RA flare.

  • Dr. William Davis

    9/10/2011 2:00:01 AM |

    I am no expert in bowel health, but I do know that some GI--minded people hold the opinion that stool held for prolonged periods in the intestinal tract changes in character and leads to the cascade of changes leading to cancer.

  • Dr. William Davis

    9/10/2011 2:02:08 AM |

    Hi, Hans--

    I believe that is currently underway!

    Just today, I've gotten dozens of phone calls and emails from major national media, all wanting to understand what the heck is going on with this crazy Wheat Belly thing.

  • Dr. William Davis

    9/10/2011 2:03:18 AM |

    Wow, Joe. Thank you.

    But you give me too much credit. I am simply the delivery boy on this information.

    But thank goodness you picked a day after Halloween!

  • Dr. William Davis

    9/10/2011 2:10:28 AM |

    Thank you, Uncle Bill!

    While I chose the main title, Wheat Belly, I had pushed for a much more edgy (obnoxious?) subtitle: Muffins tops and man boobs in a whole grain world.

    They would not budge on the "man boob" thing.

  • Dr. William Davis

    9/10/2011 2:16:58 AM |

    Aaagghhh! One piece of toast, blood sugar goes up 144 mg/dl!

    I feel like we should conduct an exorcism.

  • Dr. William Davis

    9/10/2011 2:17:44 AM |

    Yes, I agree, Dee. It is rampant.

    It is, in my experience, the rule and not the exception. It certainly does NOT end at celiac disease, but ranges far and wide into virtually every facet of health.

  • Dr. William Davis

    9/10/2011 2:19:38 AM |

    Hi, Zuo--

    Because wheat fiber is essentially cellulose (AKA wood), it is inert. There is only danger for the most exquisitely wheat- and gluten- sensitive.

    However, there are plenty of non-wheat fibers to take advantage of, such as nuts, vegetables, seeds, flaxseed, and chia.

  • Diane

    9/10/2011 11:42:14 AM |

    Hi Princess,
    Check out this example of "painless blood sugar testing" on the Blood Sugar 101 website.  I can vouch for its effectiveness!
    http://www.phlaunt.com/diabetes/19774432.php

  • Teresa

    9/10/2011 4:31:49 PM |

    Enhorabuena, dr, Davis, me gustaría saber si algún día podré leer su libro en español.

  • Patricia

    9/11/2011 3:13:55 PM |

    Plants contain both indigestible fibers like cellulose and digestible fibers like pectin.  Both impart health benefits.  Digestible fibers absorb and carry out bile acids that promote the production of carcinogens by intestinal bacteria.  Indigestible fibers builk up stools, speeding up transit time and thereby dilluting carcinogens produced by anaerobic bacteria in the gut.  Plant fiber is good, and we can get enough of both kinds from non-starch vegetables and fruits.

  • greensleeves

    9/11/2011 5:16:56 PM |

    Dear Dr. Davis:

    Just finished Wheat Belly. Congrats - what an excellent book! I wish you every success.

    I was intrigued by your comments on einkorn, and very interested to read your experiments with it here. I've been baking all kinds of bread for more than 25 years now. I began after living in France in the early 80s and wishing to eat the delicious French-style breads at home, such as pain de campagne, which at that time were very difficult to find in the USA. I couldn't get the same results, so I began to study a lot of dough chemistry to discover the differences between traditional French grains and the American grains I was using.

    They are quite different, as you so accurately note! The French have largely resisted engineered foods, and now we know they were apparently right to do so.

    As others have noted, your einkorn bread would have had even fewer blood sugar effects had you followed a traditional 3-day soourdough process. Traditional European breads take 3-5 days to make, and the sourdough process substantially changes the dough chemistry. Also, very fresh flour is almost never used in traditional baking - it should always be allowed to sit in a cool place (the underground cellar or "cave" of the baker's mill, traditionally) for about 3 weeks before using. Part of the "astringent" taste you note in the einkorn is due to the very fresh flour.

    This also leads me to ask you more about rye. Rye traditionally grew as a "weed" in European fields during wet years, when the wheat didn't fare so well. Until the late 19th century, almost all French bread would have contained some rye, as they were commonly harvested together and ground together. Only the very rich could afford to have their grains sorted to pure wheat. During a very wet, cold year, the field would have been more rye than wheat, actually. In Germany and Scandinavia, where it's quite cold in the winter, too cold for normal wheats, people ate more rye, even exclusively so.

    We've all seen traditional German-style or Danish-style rye - 100% whole dark rye bread with coriander, made the traditional sourdough way. It takes more than 3 days to make, and after baking the bread has to sit for 24-48 hours before it can be sliced. The bread is nearly black, like pumpernickel, very dense, almost a brick, and you have to eat it in super-thin tiny slices. Everyone in Denmark will tell you rye is much healthier than wheat.

    Your book mentions rye a few times in passing, which deeply intrigued me. Rye has low levels of gliadin - the protein you persuasively argue as being very problematic for many people - but in rye, these are covered by another structure called pentosans.

    These pentosans are what prevent rye from rising and make the dough as sticky as glue and completely wet, so difficult to work with. 100% rye can't be kneaded and doesn't form a dough that can be shaped into loaves - you have to pour it into the pan. Rye also has another protein called secalin, which may bother celiacs, but may not effect the wheat-gluten intolerant.

    I wonder if people with mild wheat intolerances - not full celiac - could tolerate small amounts of traditional-style German/Scandinavian rye breads, just as they may be able to tolerate small amounts of einkorn? That is, could everyone's Danish grandmother be correct? Smile

    Do you have any insight into rye, Dr. Davis? Sorry for the long comment, and thank you so much for your inspiring and wonderful book!

  • Dr. William Davis

    9/12/2011 2:30:59 AM |

    Hi, Green--

    Excellent! Thank you for your valuable insights into the unique French wheat and bread experience.

    As you have likely gathered, despite the differences in rye, its genetics, the quantitative and qualitative differences in the gliadin, there are few data to tell us how much better or worse it can be except in celiac sufferers who, of course, have their reactions triggered by rye.

    Of course, we still have lectins to contend with in rye. My suspicion is, given the phenomenon that I believe applies, that the whole is greater than the sum of the parts, i.e., each undesirable component of wheat (gliadin, lectins, amylopectin A) adds up to tell only part of the story. I suspect that there are other, yet unidentified, components of wheat, and thereby perhaps rye, that account for its extravagant unhealthy effects that are greater than the sum of the parts.

  • Dr. William Davis

    9/12/2011 2:31:35 AM |

    Thank you, Patricia, for a wonderful discussion!

  • greensleeves

    9/12/2011 6:37:21 AM |

    Thanks so much for your quick response, Dr. Davis! Of course those opposed to your work will quickly bring up the French experience, which is why I mention it. Smile

    If you have time, please let me point you to a seminal 1990 book on bread, "The Taste of Bread," by the French bread "guru," baker Raymond Calvel. You will be very interested in Chapter 15, where he - the ultimate authority - discusses the health concerns around bread, as known already in 1990. He discusses the problems of conventional agriculture, that fill flour with fungicides and pesticides. And he notes that modern industrial methods of bread-making oxidize the dough to ill effect.

    He also discusses what he calls "toxic factors" in bread, particularly phytic acid, and he quotes a French study describing how it interferes with calcium, iron, and magnesium absorption. He does mention celiac disease and wheat allergy - very prescient for 1990.

    Finally, he quotes from various French medical experts who argue that bread should equal around 20% (about 400 calories) of a woman's daily calorie intake. Calvel closes arguing that people need to eat a higher quality, traditionally made, organic bread from traditional-style flours without additives. And this is from a French baker in bread-loving France! (Note that the actual French level of consumption he documents is a mere 5 oz of baguette per person a day - about 360 calories.)

    Compare this to our recent Food Pyramid guidelines, which suggested Americans eat "up to" 11 servings of grain products a day - for bread which is served in 1 oz Wonder slices, that's more than twice what even the French ate in the same time period.

    Here the USDA pyramid was telling Americans to eat "up to" 770 calories, or nearly 50% of a woman's daily recommended 1,600 calories! In the added sugars section of those guidelines, the chart explicitly called out bread as a good food with no added sugars! Doughnuts, Danish, muffins, cookies and poundcake are also noted for having 2 or less added sugars. You had to read pretty deep in the smaller print to find out the guidelines suggested that women eat "only" 6 slices of bread a day.

    So when your critics point to the fact that French women eat bread and yet "don't get fat," please note the massive differences in French and American consumption levels. Smile

  • Ryan

    9/12/2011 1:24:59 PM |

    Bought my copy at Barnes and Noble yesterday.  Going to read it this week and share with my in-laws who have all sorts of issues that going Wheat Free could possibly help.  
    I have been Wheat free for 3 years now.  It has been great Smile  A lot of things have improved -- mostly my tummy aches are finally gone and I can eat dinner without having to go to the bathroom within 20 minutes of eating.

  • Dr. William Davis

    9/12/2011 11:47:49 PM |

    Hi, Ryan--

    You're not alone.

    I'd crudely estimate that, oh, 50 million people share the same gastrointestinal issues that you've suffered from consumption of this thing called "wheat."

  • Dr. William Davis

    9/12/2011 11:54:57 PM |

    Hi, Green--

    Thank you for your incredibly insightful perspectives!

    Interestingly, I had a casual conversation with a cameraman from Paris just today. While no expert in bread or wheat, he reiterated much of what you told me about the very different taste, texture, and baking habits of French bread. What is not clear to me is that, while the French preparation of bread may impair weight gain, does it spare you from all the other adverse effects of wheat? An interesting topic for though and investigation.

  • Rodger Morrow

    9/13/2011 1:16:14 AM |

    As you may have seen, Novak Djokovic just won the U.S. Open men's singles title, becoming the sixth man to win three Grand Slam titles in the same year. His record for the year: 64-2.

    But did his gluten-free diet have something to do with it? Some people think so:

    http://www.independent.co.uk/sport/tennis/is-a-glutenfree-diet-behind-djokovics-smash-success-2285004.html

    Dr. Davis, we welcome your thoughts …

  • Peggy Cihocki

    9/13/2011 1:29:17 AM |

    This is beyond awesome! But I hope it climbs even higher on the list and gets to #1! I already have it in my Kindle App 4 iPhone, but will be buying a copy for my daughter--unless she buys it herself for her Kindle! This is a message that needs to be spread like wildfire!
    @Greensleeves, your comment about French bread is very interesting and enlightening. Those are important points to bring up when someone tries to counter Dr. davis' message with tales of The French. Ah, the French, always the "paradox!"

  • pam

    9/13/2011 6:42:13 AM |

    congrat.
    my book just arrived today.
    will bring it to office cause my colleagues just don't believe me about wheat gives "belly" & "moobs" (man boobs).
    i was hoping that the title photo is a real wheat belly. (just for the shock value) but perhaps that's too gross & sensational. XD
    regards,

  • Dr. William Davis

    9/13/2011 12:43:54 PM |

    Hi, Pam--

    I actually pushed for a big wheat belly on the cover, but the publisher wouldn't hear of it. They thought it would paint the book as simply another weight loss book.

  • Dr. William Davis

    9/13/2011 12:44:51 PM |

    Thanks, Peggy!

    (Maybe I should get myself one of these Kindle things. My daughter says she loves hers, too.)

  • Dr. William Davis

    9/13/2011 12:46:48 PM |

    Hi, Rodger--

    Of course, it's impossible to prove in an individual instance, but it sure sounds like something happened to really supercharge his performance. I predict that we will be hearing plenty more about enhanced performance of athletes who say goodbye to wheat, mostly due to increased power of concentration and greater capacity to generate sustained energy.

  • Sue

    9/13/2011 4:56:41 PM |

    My Dad died of cerebellar ataxia, twenty years ago.  Your book is the first explanation for this terrible condition that I have seen.  Of course, consumption of the 'new' wheat would not have been a factor at that time, but then we have always had celiacs.  The question is, has there been an increase in cerebellar ataxia in recent years?  Or has enough time elapsed for it to have become apparent?  
    I have been mostly grain free for some years now, so am part of the Choir reading your book.  My issue is mostly with minor joint pain, diagnosed as the beginnings of arthritis.  I also have Dupuytren's disease, and really am hoping that it will not progress.  I have a question that was not answered in the book.  Just how dedicated need a person be?  Am I losing ground and doing myself harm if I indulge in a wheat laden treat now and again?  Should I really be paying attention to the hidden wheat in sauces and condiments?  Or can I continue with a more lackadaisical approach, avoiding the obvious baked goods, cereals etc, but not sweating the small stuff?
    Congratulations on the success of the book, and thank you for writing it.

  • Might-o'chondri-AL

    9/13/2011 6:24:28 PM |

    To Greensleeves  (Server  was blocking this days ago & then "Moderator" too),
    You will enjoy all sourdough rye study "Structural diff. btwn. Rye & wheat ...lower post-prandial insulin ..." in 2003 Am J Clin Nutri; 78(5):957-964 full text http://www.ajcn.org/content/78/5/957.full
    And 2009 "Endosperm & whole grain rye breads ... beneficial blood glucose profile" in Nutrition Journal 2009, 8:42 full text http://www.biomedcentral.com/content/pdf/1475-2891-8-42.pdf

  • Dr. William Davis

    9/14/2011 2:45:23 AM |

    Thank you, Sue.

    Modern wheat was phased into diet starting about the late 1970s, so it may indeed have played a part in your Dad's illness.

    If your Dad potentially had a wheat-induced disease, I would err on the side of safety and be meticulously wheat-free.

  • Dale

    9/15/2011 12:58:44 AM |

    Dr. Davis, Congratulations! May "Wheat Belly" be on the NY Times Best Seller for a long, long time - so your work can improve many more lives as it has so spectacularly improved mine! I'll be happy to share my story.

  • Dr. William Davis

    9/15/2011 11:43:28 AM |

    Thanks, Dale!

    If you'd like to share a story, just post the details here and I will repost.

  • Darleen Michael-Baker

    9/15/2011 4:48:17 PM |

    Congrats Dr. D!!

    I just heard about your book over on Dana Carpendar's "hold the toast" blog last week and promptly zipped over to Amazon and bought it for my Kindle.  I cannot stop reading! Fascinating information, thank you so much for writing this.

    I haven't read through all the comments nor have I read any other of your posts yet so please forgive me if this is old news to you but I wanted to know if you had read either of Gary Taubes's books.  "Good Calories, Bad Calories" or "Why we get fat and what to do about it?"  Your book compliments the info in those very well.

    Now if I could just get hubby to read them!

  • Dr. William Davis

    9/16/2011 2:41:39 AM |

    Hi, Darleen-

    Thank you!

    Yes, I've read both of Gary Taubes' very excellent books. He has done a great service by bringing the light of day to many subjects that we previously just accepted as "conventional wisdom."

  • Mark. Gooley

    9/17/2011 2:10:11 AM |

    Saw it in a Barnes and Noble while on a trip, so I... ordered a Kindle version and read that on my phone (didn't want to lug books around).  I'm so glad it's doing well.  I've been eating low-carb for a year now and it's helped my type 1 diabetes a lot, but I've lost little weight.  I hadn't stopped eating wheat entirely but now I have, and we'll see if that's any help.  Seems a lot of type 1 diabetics have trouble losing weight once they've piled it on from trying to keep blood sugar levels reasonable while eating carbohydrates...

  • Dr. William Davis

    9/17/2011 1:22:41 PM |

    Yes, Mark, a tough balancing act.

    But I have indeed seen marked improvements in blood sugar with wheat elimination in type 1 diabetes. Also, note that type 1 diabetes is, to an incredible and underappreciated degree, a disease of wheat exposure. You may recall from the book that type 1 diabetics are 20-fold more likely to develop celiac disease and vice versa. They are, in many ways, one and the same. It means that the benefits of wheat elimination may be especially dramatic in many with type 1 diabetes.

  • LaurieLM

    9/19/2011 9:22:43 PM |

    Very Good Dr Davis, I have purchased 8 copies of 'Wheat Belly' so far. I put my low-carb, no-wheat money where my mouth is. Like I did with purchasing copies of Gary Taubes' 'Good Calories, Bad Calories' and handing it out like no-sugar candy, I'm doing with 'Wheat Belly'. 4 of the 8 copies have been given to physicians- one to my internist, one to my doctor-sister and two to two doctor friends( one an internist and one an ob-gyn). I am trying to reach as many doctors as I can and I have lots of pre-med students in my orbit and whose attention I command for several hours each week. Each one teach one......or two or ten PLEASE.

  • Dr. William Davis

    9/20/2011 12:36:03 PM |

    Wow! Thank you, Laurie.

    We could all use more friends like you!

  • Averyclaire

    9/22/2011 11:32:25 PM |

    Just heard about your book, downloaded it to my Nook and I wondered ...Have you ever heard of this ailment?   I am a 62 year old woman with something that seems to have mystified the three doctors I have seen, including two gastroenterologists (one from NW Hospital in Chicago).  I suddenly began having “attacks” after eating.    Within a few bites of food, I became “sick” with four hours worth of excruciating pain in the upper abdomen, terrible abdominal distension and often vomiting (no diarrhea).  At first I thought I had food poisoning.    This had happened beginning two years prior maybe once every three or four months.   I thought my stomach had become sensitized to tainted food.  (I made this up....but this is what I began to think.)   Until last April when it happened over and over and over and didn’t quit.   At least four times per week I was in severe pain hanging over the commode.    I discovered by visiting the drug store that I could take Ultra Strength Gas-X at the first symptom of an oncoming attack and reduce the pain and bloating down to one or two hours rather than four.    I tried Beano, but that didn’t seem to work.   Thinking I perhaps couldn’t digest something I was eating, I began to take over-the-counter health food store enzyme tablets when I had a big meal.  I still was sick.    I tried first being fat free, then I tried being lactose free, and then I tried being gluten free.    NOTHING.   The two doctors I had seen at this point did not know what was wrong.   I had LOTS of blood work done, a colonoscopy, an endoscopy, an MRI (which compared previous CT scans) to check for blocked ducts, stones, tumors, etc.   NOTHING.    I even went to the hospital in the middle of a severe attack to have blood drawn to check for pancreatitis.   NOTHING.   So while I was waiting several weeks to see a third doctor at Northwestern Hospital in Chicago, I began to chart my food.    Much to my surprise it seemed that carbohydrates were the culprit.   So I began a regimen of no pasta, no bread, no cereal, no rice, no potatoes.   I soon discovered that I could not eat beets, carrots or spinach either.    So now I began to suspect complex carbohydrates to be the culprit.    

    When I told this to the doctor at Northwestern he looked at me like I was crazy.   He said he never heard of this, talked about a surgery where they cut some sphincter muscle, and said he did not think my condition warranted it, but it was possibility.   He sent me for Celiac/gluten/sprue testing and NOTHING showed up.    When I told him I stayed away from these complex carbs for three weeks and was not sick....he simply said “keep on doing what you are doing.”   Let me know if you get sick again.   I did NOT go back.

    I do get sick occasionally when I try to add “old” favorites back into my diet.   I have a small list of complex carbs from the internet and try to stay away from these things.   I am worried because I ate a lot of whole grains and now I have NONE.    I am worried about my nutrition.   I eat yogurt or oatmeal (I don’t understand why oatmeal does not make me sick) for breakfast.   I eat salad, simple soup, or yogurt for lunch....sometimes eggs.   For dinner I eat chicken or fish and mostly green beans.    My husband and I have not eaten red meat for a long time because he had bladder cancer two years ago (he’s OK now).   However, I cannot seem to get filled up.   I am always hungry.   Now I have added some red meat back into my diet because I need more than just chicken and fish to fill me up.   I used to make meatless meals with pastas and rice, but no more.  I discovered I could eat an Atkins Bar once a day, or perhaps take an Atkins drink for nutrition.  And of all things I can eat as a treat....I eat soft serve yogurt or fudgsicles.   These do not seem to bother me.

    I have lost 40 pounds (not a bad thing for me) since May 1st.

    I do not think I am crazy.   I retired from my job last December and have a wonderful husband who is also retired and we truly enjoy one another’s company.   I have several very fun, and fulfilling hobbies.   And I belong to several women’s groups that fill my days.

    Have you ever heard of an ailment like this?    Can you offer any solutions, ideas, cures?   I would appreciate anything you could tell me or suggestions you could make.

  • Dr. William Davis

    9/23/2011 12:34:53 AM |

    Hi, Avery--

    I'm afraid you're asking a cardiologist with an interest in wheat and its effects on overall health about a complex gastroenterological issue. So I'm afraid I'm unlikely to shed much light on your difficult struggle.

    One thought: Did anybody assess you for bacterial/yeast overgrowth? Various foods, especially wheat, can modify the bacteria of the intestinal tract, such that they are different, more harmful species, and can also ascend higher towards the stomach where they don't belong.

  • Averyclaire

    9/23/2011 8:37:59 PM |

    Thank you Dr. Davis.   I find your book fascinating.   Learning so much about wheat in general puts things in perspective for me.   You seem so knowledgeable about the wheat and other illnesses, I thought you might have heard of my problem.  I have seen two gastroenterologist specialists and an endocrinologist and had lots of tests, but not the bacteria thing.   I will inquire about this.  I appreciate your taking the time to mention this.   I have been taking probiotics, but no cure yet.   I simply stay away from complex carbs.   I did have a lot of heart testing done a couple of years ago and that is super good.  Thanks again.

  • Penny

    9/24/2011 2:46:29 PM |

    Congratulations on the success of your new book!
    How do you feel about products like Garden of Life, Perfect Food, re: wheat grass? Is this something to avoid?

    Thanks, Penny

  • Penny

    9/24/2011 9:12:08 PM |

    opps, it's Garden of Eden. I am interested in adding green products like this to my smoothies. Do you think these will cause any wheat issues? And just from your knowledge do you feel these products are a good source of nutrients for people?


    Thanks, Penny

  • Dr. William Davis

    9/25/2011 12:06:41 AM |

    Hi, Penny--

    The many green products out there, thankfully, are free of wheat contamination. Just be sure to examine the label.

    They are, in general, a wonderful source of nutrients. Modern agricultural techniques have caused nutrients to be depleted and block absorption into the plant. Such supplements may therefore make up for such food-sourced deficiencies.

  • Dr. William Davis

    9/25/2011 12:11:08 AM |

    Let us know what becomes of your situation, Avery.

  • Dacid

    10/4/2011 9:33:04 PM |

    Google the website "the fiber menace" and read the blog and buy the book.  The author nails the coffin lid shut on fiber same as the good doctor does with wheat.

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Vitamin D--A coronary risk factor

27. May 2006 William Davis (1)
Look up "coronary risk factors" in any text and you'll find high cholesterol, smoking, diabetes, and high blood pressure listed. You won't find deficiency of vitamin D listed.

Ask 99% of physicians if a deficiency of vitamin D is a coronary risk factor and you'll get rolling eyes and a sigh.

Yet, in the Track Your Plaque experience, vitamin D is emerging as a very important factor in coronary plaque development. We have observed that there are a substantial number of people whose lipids and lipoproteins are not abnormal enough to fully explain their heart scan score. In other words, there seems to be something else necessary to satisfactorily explain the magnitude of coronary plaque.

I believe that severe vitamin D deficiency is at least one of the most important factors. We've seen many people with blood levels of vitamin in the range of severe deficiency (<20 ng/ml of 25-OH-Vitamin D3) yet bland lipids and lipoproteins.

Correcting vitamin D blood levels to 50 ng/ml also seems to be among the required factors in stopping coronary plaque growth, or stopping your heart scan score from increasing.

Keep your eye on this extremely important and exciting issue. Sadly, it won't be propelled into the media like the conversation about cholesterol or high-tech procedures, since no company stands to profit from it. But you and I don't have to play that game.

Cholesterol is dead!

26. May 2006 William Davis (0)
I saw a patient in the office yesterday. He came to me for an opinion regarding his high heart scan score of 525, putting him in the 90th percentile (5% annual risk of heart attack).

His doctor had been puzzled because his LDL cholesterols had ranged from 110 to 131 mg--actually below average. (The average LDL for the U.S. is 132 mg.) Likewise, HDL was a favorable 63 mg.

Lipoprotein analysis told the story loud and clear. His LDL particle number, a far more precise measure of LDL, was 2448 nmol/l. This means that his true LDL was more like 240-250 mg! (You can get a sense for what the true LDL is from LDL particle number by dropping the last digit: 2448 becomes 244.) Conventional LDL was therefore inaccurate by over 100 mg.

He also had a severe small LDL particle pattern. The cause of his coronary plaque was a large excess of small LDL particles. LDL cholesterol (and total cholesterol, likewise) didn't even hint at this pattern. Nor did his favorable HDL.

Think of LDL particle number as an actual count of LDL particles per volume, e.g., number of particles per cc of blood. This makes it easier to conceptualize. LDL particle number is the measure you get when you have an NMR lipoprotein profile, our preferred method of lipoprotein testing. If this is unavailable to you, apoprotein B is a reasonable second choice, though not as accurate in my view. More info on NMR is available at their website, www.lipoprofile.com.

How to make a $1 million in cardiology

26. May 2006 William Davis (0)
Want to make a $1,000,000 as a cardiologist in the next year? It's easy. All you have to do is:

1) Perform heart catheterizations or other procedures on anybody you can, even if it's not necessary. Perform them even if the patient has no symptoms and the stress test is normal.

2) Perform heart catheterizations if the patient is too timid or ill-informed to object.

3) Insert coronary stents in blockages, even when they're minor and it's not necessary.

4) Turn every heart procedure into a revenue-producing stream by looking for other profit opportunties, such as minor kidney artery blockages.

5) Heart disease is frightening. Scare the heck out of patients by exagerrating the dangers so they'll go through testing and procedures gratefully.


Sound absurd? Well, it would be if these weren't all true.

These are real examples, as awful as it sounds. I've witnessed all these behaviors. Not just occasionally, but with regularity.

Just today, I encountered a colleague who performs heart catheterizations routinely (up to several per day) when any symptom is present and the stress test is entirely normal. This is grossly inappropriate.

Your protection is being better-informed and avoid being sucked into the vast and frightening cardiovascular machine of revenue-yielding procedures. Part of your protection is to get a CT heart scan, then engage in a program of heart disease prevention.

Doctor, do I have lipoprotein (a)?

25. May 2006 William Davis (0)
I met Joyce today for a 2nd opinion. She told me about this conversation she'd had with her cardiologist:

"Doctor, do you think I could have lipoprotein (a)? I read about how it can cause heart attacks even when cholesterol is controlled."

"What does it matter? Even if you have it, there's nothing we can do about it. There's no treatment for it."

Joyce was understandably groping for some means to prevent her coronary disease from causing more danger. At 56, she'd already survived a heart attack that resulted in two stents to her left anterior descending. Around 9 months later, she received a 3rd stent to another artery.

Her doctor had put her on Pravachol and said that was enough. "We know that cholesterol causes heart disease and the Pravachol reduces it. Why do we need to know anything more?"

So Joyce came to me for another view. I explained to her that there are, in fact, several ways to deal with lipoprotein(a). It is, without a doubt, among the more difficult patterns to manage--but not impossible. In fact, we have a growing list of participants in the Track Your Plaque program who have stopped or reduced their heart scan scores.

I continue to be horrified at the level of ignorance that prevails among my colleagues, the cardiologists, and the primary care community. If your doctor gives you advice like this, get a new doctor.

Is it mainstream or alternative?

24. May 2006 William Davis (0)
A question I get about once a week: "Is your program a kind of alternative medicine?"

Our program for control and reversal of coronary plaque using CT heart scans applies an eclectic panel of tools to achieve its goals. We use high-tech methods like lipoprotein analysis and CT heart scans; nutritional supplements like fish oil, vitamin D, and l-arginine; diet strategies and "functional foods" (using foods as a therapeutic tool); and conventional medication.

I don't consider this approach "alternative" in the sense that it uses unmeasurable or spiritual strategies. But I don't consider it mainstream, either, since current mainstream practice of heart disease prevention is far less rigorous with far less satisfactory results.

I think I can sum up the Track Your Plaque approach by saying that we use tools that work. Our measure of success is whether or not your heart scan score is stopped or reduced--that's hard to fudge. You can call it what you will, but I call it the best program for heart disease prevention I know of, alternative or mainstream.

Want to see someone turn diabetic?

24. May 2006 William Davis (0)
If you want to witness the transformation of someone into a pre-diabetic or diabetic, put them on a low fat diet.

Dr. Dean Ornish's program, detailed in his books, Dr. Dean Ornish's Program for Reversal of Heart Disease and Eat More, Weigh Less , are woefully outdated in 2006. Yet the low fat notion continues to show up in the consciousness of people I talk to about heart disease reversal.

"I'm already on a low fat diet. Do you think my heart scan score has reversed?"

Highly unlikely. What Dr. Ornish (as a non-cardiologist, by the way) failed to recognize is that what he did manage to reverse in a small number of people is something called "endothelial dysfunction", but he did not reverse or shrink coronary plaque.

Given the limitations of technology when the Ornish concept got its start, it appeared as if reversal was obtained. In reality, all his approach accomplished was a relaxation in tone of abnormally constricted arteries, thus giving the appearance of reversal. Increased artery tone, or endothelial dysfunction, is extremely common when atherosclerotic plaque is present.

Any cardiologist will tell you that there are many ways to reverse endothelial dysfunction: exercise, weight loss, cholesterol drugs, drugs for high blood pressure, fish oil, hormonal therapy, vitamin C, l-arginine, etc. There is nothing special about a low fat diet.

In fact, Track Your Plaque followers will recognize that a low fat diet is, in fact, potentially harmful, particularly when low HDL or small LDL is part of your pattern.

Let's bury the outdated ideas of the Ornish low fat diet once and for all. It doesn't work. All it may do is confuse you and set you back from your real coronary plaque reversal program.

Inulin: A fiber for weight loss

23. May 2006 William Davis (10)
Here's an interesting product that seems to be gaining some popularity for weight loss: Inulin.

Not to be confused with "insulin", with which it is completely unrelated, inulin is a naturally-occurring plant fiber. It's found in broccoli, asparagus, celery, etc. Like beta-glucan from oats or pectin, inulin is a so-called soluble fiber, a fiber that assumes a gel-like consistency when exposed to water.

Inulin has the effect of increasing satiety, or the sensation of fullness. This cuts your craving for foods. I've tried it recently and I prefer it over glucomannan, another soluble fiber for satiety.

The people at Stonyfield Farms have been adding inulin to their yogurts from some time. The nutritionist at the company tells me that there's 2-3 grams of inulin per 6 ounce container of their yogurt.

You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies. I came across a neat product called Fiber Choice that's now being distributed widely throughout the U.S. I tried their Weight Management version. It was a delicous strawberry taste. The label says take two chewable tablets twice a day, but I found that two tablets three times a day somewhat better. It's best taken around 30-60 minutes prior to each meal and it causes you to be fuller with less food. One caution: It'll cause loads of gas, especially in the beginning. For that reason, you might try starting with a smaller dose, or start on the weekends when you have the option of some privacy!

More info on the Fiber Choice product can be found at their website, http://www.fiberchoice.com.

Disclaimer: I have no relationship with the manufacturer of this product. I'm simply passing on some thoughts on my experience with this interesting possibility for weight loss.

Will you recognize the truth when you see it?

23. May 2006 William Davis (0)
Do you ever wonder that, if the truth were given to you, that you'd recognize it as such? Or would you dismiss it as just another bunch of nonsense?

After all, you and I live in the Information Age. It means that we have access to mountains of information like never before in human history. But it also means that the truth is often drowned out by an avalanche of mis-truths, sales pitches and marketing, and just plain nonsense.

This struck me the other day when I was talking to a patient.

64 years old with a high heart scan score placing her at significant risk, she looked confused. I'd just described the multitude of causes of coronary plaque that we'd uncovered. The heart scan alone had been a shocker.

"I don't understand. My doctor told me that I had nothing to worry about. I've known him for years and he knows me really well. He did a stress test. That was fine. I don't get all this other stuff you're telling me--lipoprotein whatever..."

Despite my efforts to help her gain an understanding of our intensive approach, she just became increasingly more frustrated. "I just don't think I can do this."

That's the last I've heard from her. As far as I know, she's returned to the comfort of her family doctor who has reassured her over the years. And perhaps there's some good in that. But I do fear for the day when, unexpectedly, she suffers some catastrophe that we told her was coming sooner or later unless real preventive efforts were started.

You could say that she failed to recognize the truth when it was given to her-- boldly, unadorned, and with far greater scientific certainty than the casual reassurances she was accustomed to. But, unfortunately, that's all that some people want.

Don't neglect the basics in your heart disease reversal program

23. May 2006 William Davis (0)
Carl loved new ideas and novel approaches. You could tell by the sheer number of nutritional supplements he took. His list had grown to 18 different supplements over the past two years.

Carl came to me for coronary plaque regression. Lipoprotein analysis did uncover several previously unsuspected abnormalties, most notably small LDL particles and lipoprotein(a). In addition, Carl's LDL cholesterol ranged between 111 mg-156 mg and he was clearly hypertensive, with systolic blood pressures consistently around 150-160. (Recall that people with Lp(a) are more prone to hypertension.)

Carl was more than willing to have his lipoprotein(a) reduced. We did so with niacin and testosterone and the level dropped to near zero. Likewise, we corrected his small LDL pattern with niacin, fish oil, and a reduction in processed carbohydrates.

But Carl really resisted doing much about his LDL cholesterol and high blood pressure. I got the sense that these "boring" issues simply didn't interest him. After all, LDL cholesterol and blood pressure were the stuff of TV commercials and the popular conversation propagated by drug companies.

Carl's follow-up heart scan, however, finally persuaded him: a 24% increase in one year, likely due to the neglect of the basic issues.

I liken Carl's case to being like the teenager with a new car who polishes the paint to a bright finish, puts new wheels and tires on it, spruces up the interior with various doodads--but then fails to change the oil. Sometimes it's the most basic issues that can diminish your success.

Issues like LDL cholesterol and high blood pressure aren't the most glamorous, but they do count in your coronary plaque control program.

Is your doctor a hospital employee?

21. May 2006 William Davis (0)
There's a disturbing trend that's growing--silently but rapidly.

In Milwaukee, three hospital systems compete for the local health care dollar. To gain more control over revenues and the routing of patients, the hospitals are aggressively hiring physicians to work for them. I've witnessed many of my cardiology colleagues, primary care doctors, and a substantial number of procedural specialists enticed by the offers made by hospital employers.

This phenomenon is not unique to Milwaukee but is being used in many, perhaps most, major cities in the U.S.

This means that physicians are employees of the hospital. That way, employee-physicians are obliged to use only the hospital system that employs them. In the old days, your doctor could use any hospital he/she desired, depending on the quality, location, facilities, etc. Now, many physician-employees are given no choice but to use the hospital that pays their salary.

That by itself is not necessarily bad. But combine salary with incentives for bringing in patients for hospitalization and procedures--that the rub. In other words, physician-employees are incentivized to generate more revenue for the system, just as employees in many other industries.

If you're a salesman for an insurance company, your job is to bring in more business. If you're a worker on an auto production line, you're expected to meet certain quotas. These same principles are now being applied to many physicians.

How does this affect you? Well, if your physician--especially procedure-driven specialists like cardiologists, general surgeons, orthopedists, etc.--is a hospital employee, BEWARE! Do you really need that procedure, or is your doctor suggesting you have a procedure because it will add to his track record?

Prevention? In this model of health care, why bother? It certainly doesn't pay for a hospital to keep you well. Then why should your physician-employee?

Be careful who you're dealing with. If your physician is a hospital-employee, don't bet on getting preventive care. It's more likely you're that just a future source of revenue when it's time for your bypass operation, hip replacement, carotid endarterectomy, etc.

What more powerful argument is there for increased self-empowerment and information for health care consumers?