Addictive Foods

25. June 2007 William Davis (3)
Kraft Foods, Inc. is manufacturer of Kool Aid, Oscar Mayer, Kraft Macaroni and Cheese, Velveeta, Honey Maid Grahams, and hundreds of other processed food products. Post cereals also falls under the umbrella of Kraft with products like Raisin Bran, Post Toasties, and Fruity Pebbles. Annual revenues in 2006 for Kraft: $34.4 billion. A big operation with enormous influence over our eating habits.

Nabisco is manufacturer of Oreos, Ritz Crackers, Chips Ahoy and many others. Like Kraft/Post, it is also a big player.

While Nabisco was owned for several years by tobacco giant RJ Reynolds, in 2000 it was acquired by Philip Morris, another big tobacco manufacturer.

More recently in Spring, 2007, Philip Morris (now called Altria--you'd change your name, too, if it was synonymous with dirt) spun off its Kraft subsidiary for a big profit. However, the management structures remain intertwined.

In other words, despite the shuffling of shares, the two industries, big tobacco and big food, are in many respects one and the same.

Is it any surprise that the same industry that made billions of dollars pushing addictive nicotine products responsible for the deaths of hundreds of thousands of people is now intimately involved with addictive products produced and marketed by the processed food industry?

If you believe that food manufacturers are innocently and honestly conducting their businesses, simply think back to the testimony provided in front of Congress during the tobacco industry hearings. Broad deception, concealed truths, and outright lies were commonplace. There was no conscience involved. This was about money--and lots of it.

Why should the processed food industry, intimate with the tobacco industry, be any different?

If you want control over heart disease and your heart scan score, buy produce and buy local. Spend your time in the produce aisle, not the cereal or chip aisle. Unprocessed food, unadorned by bright labels, cartoon animals, American Heart Association endorsements, that's what we should seek.

Heart Scan Curiosities #7

25. June 2007 William Davis (1)



Here's a situation that crops up once in a while, occurring in perhaps 2% of heart scans.

The white within the circled area represents calcium, and thereby atherosclerotic plaque, situated immediately at the "mouth", or opening, of the the right coronary artery. What is somewhat unusual is that this plaque is not principally coronary, but aortic. That is, the plaque is mostly situated in the large vessel called the aorta. The three coronary arteries arise from the aorta.

In this instance, the aortic plaque involves the mouth of the right coronary artery. (In views not shown, the plaque also extends into the artery as well.) I call this a "double whammy" because the same plaque can post risk for heart attack and stroke.

Generally, aortic plaques pose risk for stroke. When aortic plaque fragments, little bits and pieces can travel upward to the brain and block an artery, thus a stroke.

In the coronaries, disrupted ("ruptured") plaques don't generally shower debris, but permit blood clot formation, resulting in heart attack.

This plaque, however, poses the theoretical risk of both heart attack and stroke because of its strategic location.

Should a plaque like this be handled any differently? I don't think so. But it does provide another reason to take atherosclerotic plaque in any artery seriously.

The nutrition counterculture

23. June 2007 William Davis (2)
When we look back over our American nutritional history over the last 50 years, it's hard not to come to the conclusion that much of the innovation in nutrition did not come from official agencies like the Food and Nutrition Board of the Institute of Medicine, the National Academy of Sciences, the FDA, the USDA, or the AMA.

Instead, it came from the popular culture. It came from bold, extravagant claims made by maverick figures like Ancel Keys, Nathan Pritikin, Dean Ornish, and Robert Atkins. Of course, some ideas have now fallen by the wayside, dismissed in a broad American "experiment" as ineffective, impractical, or kooky. But it permitted experimentation on an extraordinary scale with millions of people following a particular strategy at a time.

The advice of the official agencies tended to be reactionary. When nutritional deficiencies (remember those?) of the early 1900s were prevalent, they issued advice on food choices to help alleviate deficiencies. When deficiency transformed into excess after World War II, "smart" food choices from food groups and "sensible eating" became the theme.

Unfortunately, the advice was always adulterated by the enormous influence of various special interests, anxious to protect their national franchise. Powerful groups like the meat industry, wheat producers, and the dairy industry all made sure they had a big hand in crafting and influencing what was told to the American people.

The result: the advice offered by official groups has always represented the compromise of what some agency wished to convey to the people and the very powerful input of industry. What if the government decided to advise us what automobile to buy? Imagine the uproar in the auto industry when Washington tells us to buy Toyota for fuel economy and reliability. How long would that advice last?

That's why almost no knowledgeable adult follows the advice of the USDA, the National Academy of Sciences, or the Food Pyramid. I believe that we all intuitively recognize that the advice is watered-down, sometimes silly, sometimes downright unhealthy.

Nonetheless, the national experiment in diet that has taken place since 1950 has led to a collective wisdom of what is good and what is bad. The most productive conversations on nutrition therefore take place outside of the USDA and Washington. It occurs, instead, in places like bookstores, websites, and the media. Of course, there's lots of misinformation and profiteering in these sectors, as well. But like the enormous force unleashed by the collective wisdom of those contributing to the Wikipedia phemonenon, we've zig-zagged to something closer to the truth than ever uttered by an official agency.

Prescription vitamin D

23. June 2007 William Davis (32)
Niacin:

Over-the-counter: $2-5 per month
Prescription: $120 per month


Fish oil:

Over-the-counter: $3-6 per month
Prescription: $120 per month


Vitamin D:

Over-the-counter: $2 per month
Prescription: $70 per month



With vitamin D in particular, the prescription form is vastly inferior to the over-the-counter preparation. This is because the prescription form is ergocalciferol, or vitamin D2, not the effective human form, vitamin D3 or cholecalciferol.

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively.

Moreover, D2 is the plant-based form. It is a form not found naturally in humans. D3 is the mammalian form, the same found in humans that exerts all its biologic benefits.

Then why is the prescription form of vitamin D2 (brand names Driscol and Calciferol) more expensive?

It's the same old pharmaceutical industry scam: Look for something patent protectable, regardless of whether it's superior to the non-patent protectable product, then sell it for exagerated profits. Though it is inferior and the science and clinical experience prove that it's inferior, you can still fool lots of people, including prescribing physicians. So what if you only make $50 or $100 million?

Don't fall for it. Prescription doesn't necessarily mean superior. In fact, the prescription form may be significantly inferior, as with vitamin D2. But the pharmaceutical industry carries such power and persuasion, who's going to know?

Nutrition activist Mike Adams

20. June 2007 William Davis (1)












I borrowed the above comic from the website of nutritionist, more properly nutrition activist and author, Mike Adams. His website, www.newstarget.com, was a pleasant surprise.

I was actually looking for some thoughts on pharmaceutical advertising and its pervasive and destructive effects and came across one of Adam's reports, Pharmaceutical television advertising is a grand hoax at http://www.newstarget.com/021526.html. The piece is a rant against the pharmaceutical industry's constant bombardment of the media, who have also been co-opted into their service, enticed by the enormous advertising revenues the drug industry brings.

But I was surprised to find an insightful, informative website on health issues, particularly healthy eating that rejects the manufactured food industry's intensive effort to persuade us to eat their products. While I don't agree with everything Adams has to say, his website provides some great food for thought. He also provides lots of downloadable information.

There's also some great laughs at his poke at the pharmaceutical industry with his Disease Mongering Engine at http://www.newstarget.com/disease-mongering-engine.asp, in which you get to create your own diseases. I got a real kick out of this.

CT scans and radiation exposure

19. June 2007 William Davis (8)


The NY Times ran an article called

With Rise in Radiation Exposure, Experts Urge Caution on Tests at

http://www.nytimes.com/2007/06/19/health/19cons.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1182254102-vQpytpx6W/Z9gvAaNPDZvA



“This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”


Where do CT heart scans fall?

Let's first take a look at exposure measured for different sorts of tests:



Typical effective radiation dose values

Computed tomography Milliseverts (mSv)

Head CT 1 – 2 mSv
Pelvis CT 3 – 4 mSv
Chest CT 5 – 7 mSv
Abdomen CT 5 – 7 mSv
Abdomen/pelvis CT 8 – 11 mSv
Coronary CT angiography 5 – 12 mSv

Non-CT Milliseverts (mSv)

Hand radiograph Less than 0.1 mSv
Chest radiograph Less than 0.1 mSv
Mammogram 0.3 – 0.6 mSv
Barium enema exam 3 – 6 mSv
Coronary angiogram 5 – 10 mSv
Sestamibi myocardial perfusion (per injection) 6 – 9 mSv
Thallium myocardial perfusion (per injection) 26 – 35 mSv

Source: Cynthia H. McCullough, Ph.D., Mayo Clinic, Rochester, MN


If you have a heart scan on an EBT device, then your exposure is 0.5-0.6 mSv, roughly the same as a mammogram or several standard chest x-rays.

A heart scan on a 16- or 64-slice multidetector device, your exposure is around 1.0-2.0 mSv, about the same as 2-3 mammograms, though dose can vary with this technology depending on how it is performed (gated to the EKG, device settings, etc.)

CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 chest x-rays or 20 mammograms. Now that's a problem.

The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legimate medical questions. They are not screening tests to be applied broadly and used year after year.

Always be mindful of your radiation exposure, as the NY Times article rightly advises. However, don't be so frightened that you are kept from obtaining truly useful information from, for instance, a CT heart scan (not angiography) at a modest radiation cost.



Detail on radiation exposure with CT coronary angiograms on multidetector devices can be found at Hausleiter J, Meyer T, Hadamitzyky M et al. Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates. Circulation 2006;113:1305-1310, one of several studies on this issue.

Mediterranean diet vs. American Heart Association Diet

18. June 2007 William Davis (4)
In 1994, the Lyon Heart Study demonstrated a 50-70% reduction in coronary events in participants who followed a diet rich in vegetables, olive oil, fish, nuts, red wine, and enjoyed meals as a family activity. Various other studies have documented similar phenomena with less metabolic syndrome, better lipid patterns, less obesity with the Mediterranean lifestyle.

There are two fundamental differences between the Mediterranean diet and the diet advocated by the American Heart Association (AHA) for people with heart disease: the Mediterranean diet uses olive oil more liberally, such that fat calories can reach 40% of total; and, unlike the AHA diet, processed foods are not a part of the Mediterranean diet. Greeks, for instance, are far less likely to eat Count Chocula cereal for breakfast, or snack on Healthy Choice Premium Caramel Swirl Sandwich (ice cream sandwiches) or Malt-O-Meal Honey Nut Scooters. All three of these foods on listed on the AHA Heart-Check Mark heart-healthy program.

In other words, remove all the processed foods, and the AHA diet pretty closely resembles the Mediterranean diet. There are differences but they tend to be relatively small. If the only major difference is the presence of processed foods, wouldn't you therefore expect the AHA to embrace the Mediterranean diet?

Here's what their official stand on the Mediterranean diet states:

Does a Mediterranean-style diet follow American Heart Association dietary recommendations?

Mediterranean-style diets are often close to our dietary recommendations, but they don’t follow them exactly. In general, the diets of Mediterranean peoples contain a relatively high percentage of calories from fat. This is thought to contribute to the increasing obesity in these countries, which is becoming a concern.



The AHA is actually lukewarm towards the diet that was the first to show a dramatic decrease in heart attack and death. Why?

The answer is obvious, once cast in this light. To wholeheartedly endorse the Mediterranean diet might be seen as an indirect rejection of American processed foods. You know, the foods that have caused an extraordinary and unprecedented epidemic of obesity in the U.S., the foods that are manufactured by ConAgra, General Mills, Kelloggs--all also major financial contributors to the AHA, according to the AHA Annual Report.

I tell my patients: If you want heart disease, follow the American Heart Association diet. In my view, it is a diet founded on politics and money, not on health. How else could Cocoa Puffs be regarded as heart healthy?

Track Your Plaque in 50,000 BC

16. June 2007 William Davis (3)
Imagine we could send you back in a time machine to 50,000 BC.

However, our agreement: no modern tools or equipment. Just your brain, hands, and legs. And your landing spot will be tropical or semi-tropical, the same climate that humans spent much of their evolutionary time in.

Not only might you rub elbows with contemporaries like homo erectus and neanderthalensis, you'd also have to fend for your life and survival.

To eat, you will have to chase and kill wild game, all with your bare hands or crude tools crafted from sticks and stones. You will have to learn what wild berries, roots, and plants are edible and distingusih them from those that make you retch, make your bowels run, or kill you. You won't be able to cultivate grain, at least for a good long time, since you don't have a community that makes such an undertaking easier.

Instead, you are constantly on the run, from the moment you awake until you finally settle back as the sun sets, hopefully with a full stomach, but often empty and growling, anticipating the hunt and forage of tomorrow.

You are outdoors all day, except for the period when you hide in your cave or self-made shelter. You wear what little clothing you can make yourself from your kills, a skin or two. Your skin becomes a dark brown, a 5 foot 10 inch male will weigh 140 lbs, a 5 foot 5 inch woman 95 lbs. There are obvious downsides: your teeth will rot, you will be prone to infections, and predators view you as fair game.

But the result will be that many chronic diseases of modern life will no longer be worries for you. Heart disease? Highly unlikely. Do you need vitamin D? No, because you are outdoors virtually all day with most of your body surface area exposed to sun. Omega-3 fatty acids? You get those from the wild game you eat, since they have higher omega-3 content feeding in the wild, not eating corn like modern livestock. Since your body fat is minimal, just enough for survival, you don't need niacin.

In other words, many of the strategies of the Track Your Plaque program are modern necessities, responses to the "deficiencies" of modern life. Of course, I don't really have a time machine. I also doubt that you wish to hunt wild game every day, forage for plants and roots, run nearly-naked in the sun. You probably also have become accustomed to brushing your teeth and not viewing every animal as a potential threat to your life.

Nonetheless, I find this an interesting exercise for understanding the role of all the tools we use in the Track Your Plaque program for plaque control.

When pessimism wins

15. June 2007 William Davis (3)
When I first met Hank, I immediately sensed it: anger, hostility, fear. His heart scan score of 685 just made it worse.


He didn't want to be there talking to me. His wife was giving him a hard time. Work was a constant source of irritation. The receptionist at the front desk screwed up his paperwork. Our office charges were too much.


In short, Hank was a pessimist. A bad one.


All the nutrition information out there is bunk. Only he knew how he should eat right. It's stupid to take a lot of fish oil. "You want me to grow gills?"


Among the parameters we use in the Track Your Plaque program is blood pressure during exercise, which provides a surrogate measure of blood pressure during emotional stress, anxiety, etc. "No, I don't need that. I already exercise." No amount of justification could change his mind. "A guy at work had a stress test. They said everything was fine, then Bang! He drops dead. What good is that?"


Hank did go along with a few pieces of advice.


A repeat heart scan 12 months after the first: 870, a 27% per year rate of increase. That's about what would happen if Hank had done nothing, had taken no action to try and stop or reduce his heart scan score.


I don't know if Hank will ever succeed in dropping his score. In fact, I suspect that he will fail, meaning that plaque will grow and he will eventually, perhaps in a year, two or three, require several stents, heart bypass, or have a heart attack. In other words, Hank's pessimism is a self-fulfilling phenomenon: If he believes he will fail, he will. If he believes the world is a rotten place, it is.


Is it possible to "cure" someone like Hank of his deeply-rooted pessimistic attitudes? I don't know of any easy solutions for someone with attitudes as deeply-ingrained as Hank's. (See my prior post, "Cure for pessimism?" at http://heartscanblog.blogspot.com/2007_05_01_archive.html.)

I believe it does help to make someone aware of their attitudes and that it does indeed exert ill health-effects--if they will believe it. But this is a very tough nut to crack.

Bad news on CoQ10?

13. June 2007 William Davis (8)
A review of the effects of Coenzyme Q10 (CoQ10) on the muscle aches and weakness (myopathy) of statin drug therapy was just published in the Journal of the American College of Cardiology.

(Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy. J Amer Coll Cardiol 2007;49(23):2231-2237.)

This is not a study, but a review of the existing scientific and clinical data available on this topic. The study authors conclude with a lukewarm statement:

". . .there is insufficient evidence to prove the etiologic [causal] role of CoQ10 deficiency in statin-associated myopathy and that large, well-designed clinical trials are required to address this issue. The routine use of CoQ10 cannot be recommended in statin-treated patients. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot besatisfactorily treated with other agents. Some patients may respond, if only via placebo effect."

Should the media get hold of this report, be prepared for the usual "Nutritional supplement no help for drug toxicity" headlines, or "Yet another nutritional supplement shows no benefit" with parallels drawn to vitamin C or E.

There are several issue that need to be factored into the discussion:

1) This is not a study, just a review. Thus, any biases of the authors are more likely to exert themselves.

2) The understanding of CoQ10 absorption among different preparations may be an issue. I just received a mailing from Life Extension that made extravagant claims about the superior absorption of ubiquinol, to be distinguished from ubiquinone, the more common form. They claim that eight-fold increased absorption and blood levels of CoQ10 are achievable with ubiquinol. Unfortunately, virtually all the supportive data are unpublished, proprietary observations, i.e., generated by companies who make or sell it. This is as reliable as drug manufacturers who publish glowing reports on their own drugs--perhaps it's true, but it requires unbiased corroboration.

3) Despite the lack of a large, well-funded clinical trial (all are small), the issue continues to live and breathe because of the powerful anecdotal experience.

In our experience, CoQ10 does work. It doesn't work all of the time, perhaps just 80-90% of the time. It does generally require higher doses (100 mg per day, occasionally more). It very clearly must be an oil-based gelcap (just like vitamin D) to work; capsules containing powder do not work.

It's difficult to doubt when someone starts a statin drug, develops the muscle aches and weakness, begins CoQ10 and obtains distinct relief, stops CoQ10 and aches and weakness return, then only to go away again with resumption of CoQ10 . I've seen this countless times.

We do need better information on CoQ10. There's no doubt about it. For people who obtain benefit from statin therapy, I think CoQ10 remains a useful solution. A better solution would be to get rid of the offending drug. But that's not always possible--e.g., LDL cholesterol 190 mg/dl despite the best diet and "adjunctive" food effort. Then CoQ10 can be very useful.
Why wheat makes you fat

Why wheat makes you fat

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

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

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

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

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

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

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

Comments (32) -

  • Dee Miles

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

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

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

  • Frank Hagan

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

    Great post, Dr. Davis.

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

  • Howard Lee Harkness

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

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

    Your advice?

  • Dr. William Davis

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

    Hi, Howard--

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

  • Dr. William Davis

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

    Hi, Frank--

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

  • Dr. William Davis

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

    Thanks for the feedback, Dee!

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

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

  • Olga

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

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

  • Geoffrey Levens, L.Ac.

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

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

  • harlan

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

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

  • Kim D

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

    A question for you Doc,

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

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

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

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

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

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

  • Dr. William Davis

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

    Hi, Kim--

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

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

  • Dr. William Davis

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

    Interesting, Olga.

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

  • smgj

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

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

  • Barb

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

    Hi Dr. Davis!

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

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

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

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

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

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

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

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

    Barb

  • Roberto

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

    Dr. Davis,

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

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

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

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

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

  • Roberto

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

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

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

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

  • Dr. William Davis

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

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

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

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

  • Dr. William Davis

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

    Noted. I disagree.

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

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

  • Dr. William Davis

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

    Hi, Barb-

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

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

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

  • Roberto

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

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

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

  • Barb

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

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

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

    Barb

  • Dr. William Davis

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

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

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

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

  • tammy

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

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

  • Dr. William Davis

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

    Hi, Tammy--

    Tough situation.

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

    Let us know what you learn.

  • Andrew

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

    Dr D

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

    Andrew

  • Dr. William Davis

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

    Hi, Andrew--

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

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

  • Andrew

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

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

  • N

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

    Hi Doc,

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

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

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

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

  • David German

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

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

  • David

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

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

  • Gary Mullennix

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

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

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

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Is there something fishy about fish oil?

27. January 2010 William Davis (0)
To be sure, there's plenty of misinformation out there about fish oil. Take a look at the swill that passes for health information on Woman's Day: On Call with Dr. Sandy: Fish Oil and Mercury:



Reader Question: My doctor recommended that I take a fish oil supplement, but I'm concerned about mercury. Is there any way to tell which brands are lowest in mercury content?



On Call Response: When it comes to OTC supplements, the answer is no. Though most fish oil supplements sold by major brands are probably safe, there's really no way to tell what's in the bottle or how much mercury it might contain.



Perhaps Dr. Sandy should read the many independent analyses performed on nutritional supplement fish oil, including those at Consumer Lab and Consumer Report before she offers her blind criticisms.

Lovaza vs fish oil supplements?

27. January 2010 William Davis (55)
Lovaza is the FDA-approved form of fish oil that is available only by prescription. It contains 842 mg of the omega-3 fatty acids, EPA and DHA, per capsule.

The FDA application for Lovaza is viewable here on the FDA website. Interestingly, while there is plenty of the usual regulatory gobbledy-gook about toxicology, dose escalation, and efficacy in the extensive documentation, there is little said about the issue of contamination.

In other words, critics of nutritional supplement fish oil harp on the possibility of contamination with mercury and pesticide residues, like dioxin and PCBs (polychlorinated biphenyls). Yet there is virtually nothing about these same issues in the FDA application for Lovaza.

Let's take a look at a sample over-the-counter fish oil product. Our friends at PharmaNutrients (a new Track Your Plaque partner for nutritional supplements) have a fish oil product called PharmaNutrients" Cardio. Here's an independent analysis of the Cardio product (per 1000 mg fish oil capsule):

EPA content: 566.1 mg
DHA content: 216.6 mg
(Total EPA + DHA 782.7 mg)

Cardio passed all tests for peroxides, PCBs, dioxin, furans, dioxin-like PCBs, and heavy metals (arsenic, cadmium, lead, mercury) using criteria at least 60% more stringent than European Commission (EC) standards (EC standard <2 picograms/gm for dioxins and furans, PharmaNutrients <1 picograms/gm; EC standard <10 picograms/gm for dioxin-like PCBs, PharmaNutrients <3 picograms/gm). PCBs levels in particular are less than 0.009 ppm, 90% below the industry-wide purity standard of 0.09 ppm. Likewise, mercury is >90% lower than European Commission standards.

In other words, this over-the-counter "pharmaceutical grade" fish oil has virtually nothing but omega-3 fatty acids.

Interestingly, the PharmaNutrients fish oil capsule also contains the third omega-3 fatty acid, docosapentaenoic acid (DPA), a neglected form that some authorities have proposed has superior cardiovascular protective properties over eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). If DPA is included in the analysis, PharmaNutrient's Cardio contains a total of 900 mg omega-3 fatty acids per capsule.

At some point, I'd like to see a head-to-head comparison not just on purity grounds, since I am convinced that high-quality products like Cardio can match or exceed the purity of prescription fish oil, but on efficacy in raising omega-3 blood levels, the omega-3 index. (The omega-3 index is a predictor of heart attack and sudden cardiac death--the higher, the better.) My prediction: High-quality fish oil supplements will match or exceed prescription fish oil.

More on blood sugar

25. January 2010 William Davis (36)
Take any of the following foods:

One chicken breast
Quarter-pound ground beef
6 oz salmon steak
½ cup raw almonds
3 eggs scrambled in olive oil

How much is blood sugar increased by any item in the above list?

If you said virtually zero, you’re correct. Eat any of these foods, regardless of portion size, and blood sugar won’t change substantially. If you started with a blood sugar of, say, 90 mg/dl, 1-2 hours later it would be 90 mg/dl. It might go up or even down a few milligrams, but for all practical purposes it remains substantially unchanged.

How much is blood sugar increased by the foods in this list:

2 slices multigrain bread
1 whole wheat bagel
4 oz high-fiber breakfast cereal
2 whole grain pancakes, 2 oz maple syrup

The foods in this list are a different story from the first. Depending on your body weight, exercise habits, and other factors, a typical blood sugar response in an otherwise healthy non-diabetic person would be 120 mg/dl to 160 mg/dl. In someone with diabetes, it could easily exceed 200 mg/dl.

That isn’t good. Large blood sugar excursions to 140 mg/dl have been clearly associated with greater risk for heart attack, progression to diabetes, inflammatory responses, and other adverse health effects. In fact, blood sugars as low as 100 mg/dl after eating have been associated with increased cardiovascular risk.

Then why are the USDA, American Heart Association, the American Dietetic Association, and the American Diabetes Association telling us to eat more of the foods that shoot blood sugar up to such high levels? “Eat more healthy whole grains”?

To see how much the issue of exaggerated blood sugars after eating applies to you, a simple blood sugar check 1-2 hours after eating can show you. Either your doctor can have the test drawn or you can purchase your own inexpensive glucose meter (e.g., Walmart, Wagreens).

My prediction: You will be very surprised at blood sugar responses after common foods, including “healthy whole grains.” And, by the way, keeping blood sugar excursions to a minimum will facilitate weight loss.

Postprandial blood sugar: Almonds vs. whole wheat bread

22. January 2010 William Davis (0)
Here's my postprandial (after-eating) blood glucose demonstration.



I tested raw almonds vs. 100% whole wheat bread, matched for calories. (Full nutritional composition below.)



Blood sugars:

Raw almonds

Start:

One-hour after eating:





2 slices 100% whole wheat bread

Start:

One-hour after eating:





100% whole wheat bread, 2 large slices

Water (g) 24.69

Energy (kcal) 158

Protein (g) 8.29

Fat, total (g) 2.14

Carbohydrate (g) 26.43

Sugars, total (g) 3.56

Fiber, total dietary (g) 4.4

Cholesterol (mg) 0

Saturated fatty acids, total (g) 0.478

Monounsaturated fatty acids, total (g) 1.022

Polyunsaturated fatty acids, total (g) 0.384





23 almonds, raw



Energy (kcal) 159

Protein (g) 5.86

Fat, total (g) 13.64

Carbohydrate (g) 5.98

Sugars, total (g) 1.07

Fiber, total dietary (g) 3.4

Cholesterol (mg) 0

Saturated fatty acids, total (g) 1.03

Monounsaturated fatty acids, total (g) 8.525

Polyunsaturated fatty acids, total (g) 3.331



To get low-carb right, you need to check blood sugars

19. January 2010 William Davis (60)
Reducing your carbohydrate exposure, particularly to wheat, cornstarch, and sucrose (table sugar), helps with weight loss; reduction of triglycerides, small LDL, and c-reactive protein; increases HDL; reduces blood pressure. There should be no remaining doubt on these effects.

However, I am going to propose that you cannot truly get your low-carb diet right without checking blood sugars. Let me explain.

Carbohydrates are the dominant driver of blood sugar (glucose) after eating. But it's clear that we also obtain some wonderfully healthy nutrients from carbohydrate sources: Think anthocyanins from blueberries and pomegranates, vitamin C from citrus, and soluble fiber from beans. There are many good things in carbohydrate foods.

How do we weigh the need to reduce carbohydrates with their benefits?

Blood sugar after eating ("postprandial") is the best index of carbohydrate metabolism we have (not fasting blood sugar). It also provides an indirect gauge of small LDL. Checking your blood sugar (glucose) has become an easy and relatively inexpensive tool that just about anybody can incorporate into health habits. More often than not, it can also provide you with some unexpected insights about your response to diet.

If you’re not a diabetic, why bother checking blood sugar? New studies have documented the increased likelihood of cardiovascular events with increased postprandial blood sugars well below the ranges regarded as diabetic. A blood sugar level of 140 mg/dl after a meal carries 30-60% increased (relative) risk for heart attack and other events. The increase in risk begins at even lower levels, perhaps 110 mg/dl or lower after-eating.

We use a one-hour after eating blood sugar to gauge the effects of a meal. If, for instance, your dinner of baked chicken, asparagus brushed with olive oil, sauteed mushrooms, mashed potatoes, and a piece of Italian bread yields a one-hour blood sugar of 155 mg/dl, you know that something is wrong. (This is far more common than most people think.)

Doing this myself, I have been shocked at the times I've had an unexpectedly high blood sugar from seemingly "safe' foods, or when a store- or restaurant-bought meal had some concealed source of sugar or carbohydrate. (I recently had a restaurant meal of a turkey burger with cheese, mixed salad with balsamic vinegar dressing, along with a few bites of my wife's veggie omelet. Blood sugar one hour later: 127 mg/dl. I believe sugar added to the salad dressing was the culprit.)

You can now purchase your own blood glucose monitor at stores like Walmart and Walgreens for $10-20. You will also need to purchase the fingerstick lancets and test strips; the test strips are the most costly part of the picture, usually running $0.50 to $1.00 per test strip. But since people without diabetes check their blood sugar only occasionally, the cost of the test strips is, over time, modest. I've had several devices over the years, but my current favorite for ease-of-use is the LifeScan OneTouch UltraMini that cost me $18.99 at Walgreens.

Checking after-meal blood sugars is, in my view, a powerful means of managing diet when reducing carbohydrate exposure is your goal. It provides immediate feedback on the carbohydrate aspect of your diet, allowing you to adjust and tweak carbohydrate intake to your individual metabolism.

Food sources of vitamin K2: Reprint

19. January 2010 William Davis (59)
For some reason, my December, 2007, Heart Scan Blog post, Food sources of vitamin K2, has been receiving a lot of traffic.

I therefore reprint the vitamin K2 post below.




Vitamin K2 is emerging as an exciting player in the control and possible regression of coronary atherosclerotic plaque. Only about 10% of dietary vitamin K intake is in the K2 form, the other 90% being the more common K1.

The ideal source of K2 is natto, the unpalatable, gooey, slimy mass of fermented soybeans that Japanese eat and has been held responsible for substantial decreases in osteoporosis and bone fractures of aging. Natto has an ammonia-like bouquet, in addition to its phlegmy consistency that makes it virtually inedible to anyone but native Japanese.

I say that the conversation on vitamin K2 is emerging because of a number of uncertainties: What form of vitamin K2 is best (so-called MK-4 vs. MK7 vs. MK-9, all of which vary in structure and duration of action in human blood)? What dose is required for bone benefits vs. other benefits outside of bone health? Why would humans have developed a need for a nutrient that is created through fermentation with only small quantities in meats and other non-fermented foods?

Much of the developing research on vit K2 is coming from the laboratories of Drs. Vermeer, Geleijnse, and Schurgers at the University of Maastricht in the Netherlands, along with several laboratories in Japan, the champions of K2.

MK-7 and MK-8,9,10 come from bacterial fermentation, whether in natto, cheese, or in your intestinal tract; MK-4 is naturally synthesized by animals from vitamin K1. While natto is the richest source of the MK-7 form, egg yolks and fermented cheeses are the richest sources of the MK-4 form.

Chicken contains about 8 mcg MK-4 per 3 1/2 oz serving; beef contains about 1 mcg. Egg yolks contain 31 mcg MK-4 per 3 1/2 oz serving (app. 6 raw yolks). Hard cheeses contain about 5 mcg MK-4 per 3 1/2 oz serving, about 70 mcg of MK-8,9; soft cheeses contain about 30% less. Natto contains about 1000 mcg of MK-7, 84 mcg MK-8, and no MK-4 per 3 1/2 oz serving.















Feta cheese

Thanks to the research efforts of the Dutch and Japanese groups, several phenomena surrounding vitamin K2 are clear, even well-established fact:

--Vitamin K2 supplementation (via frequent natto consumption or pharmaceutical doses of K2) substantially improves bone health. While K2 by itself exerts significant bone density/strength increasing properties in dozens of studies, when combined with other bone health-promoting agents (e.g., vitamin D3, prescription drugs like Fosamax and calcitonin), an exaggerated synergy of bone health-promoting effects develop.



--The MK-4 form of vitamin K2 is short-lived, lasting only 3-4 hours in the body. The MK-7 form, in contrast, the form in natto, lasts several days. MK-7 and MK-8-10 are extremely well absorbed, virtually complete.

--Bone health benefits have been shown for both the MK-7 and MK-4 forms.

--Coumadin (warfarin) blocks all forms of vitamin K.





Interestingly, farm-raised meats and eggs do not differ from factory farm-raised foods in K2 content. (But please do not regard this as an endorsement of factory farm foods.)

Another interesting fact: Since mammals synthesize a small quantity of Vit K2 forms from vitamin K1, then eating lots of green vegetables should provide substrate for some quantity of K2 conversion. However, work by Schurgers et al have shown that K1 absorption is poor, no more than 10%, but increases significantly when vegetables are eaten in the presence of oils. (Thus arguing that oils are meant to be part of the human diet. Does your olive oil or oil-based salad dressing represent fulfillment of some subconscious biologic imperative?)

If we believe the data of the Rotterdam Heart Study, then a threshold of 32.7 micrograms of K2 from cheese yields the reduction in cardiovascular events and aortic calcification.

It's all very, very interesting. My prediction is that abnormal (pathologic) calcium deposition will prove to be a basic process that parallels atherosclerotic plaque growth, and that manipulation of phenomena that impact on calcium depostion also impact on atherosclerotic plaque growth. Vitamins D3 and K2 provide potential potent means of at least partially normalizing these processes.

As the data matures, I am going to enjoy my gouda, Emmenthaler, Gruyere, and feta cheeses, along with a few egg yolks. I'm going to be certain to include healthy oils like olive and canola with my vegetables.


All images courtesy Wikipedia.

Copyright 2007 William Davis, MD

Family lessons

17. January 2010 William Davis (4)
Lou was recovering from his 3rd bypass operation. This third go-round left him weaker, slower, less quick on the rebound. In fact, he was lucky to have survived.

At 71 years old, Lou went a good 15 years since his second bypass, another 10 years prior to his first bypass at age 46.

In the days immediately following Lou's bypass, I had a chance to talk to his son, who stayed at his Dad's bedside while Lou struggled through post-op recovery.

"Did your Dad tell you about why this has happened, what caused his heart disease?" I asked.

"Sort of. He just said I should get checked," Lou's son, Aaron, replied.

"Did he mention the lipoprotein(a) pattern he has?"

"No. He never mentioned anything like that. He just said to get checked."

That's how it gets played out more often than not: Mom or Dad has a heart attack, stents, or (3rd) bypass, the children are told to get checked. Getting "checked" assumes that the doctor knows what to check for.

In Lou's case, the reason why he was in the hospital getting his 3rd (and final) bypass was lipoprotein(a), along with genetically-determined small LDL particles, low HDL, a postprandial (after-eating) disorder, hypertension, and borderline diabetes, not to mention vitamin D deficiency, omega-3 fatty acid deficiency, and marginal thyroid function. (Lou, a retired city employee, had showed only marginal interest in correcting these patterns. While he accepted medications, he proved unwilling to engage in the diet and nutritional supplement strategies required to correct his patterns.)

So Lou's 3rd bypass operation provided a moment of reflection for Aaron to ask: "Could I share the fate of my Dad?" With Lou's combination of genetic patterns, there was at least a 75% likelihood that he did. Sadly, going to his doctor would likely yield little more than a cholesterol panel, a question about smoking, and a prescription for Lipitor.

Just getting "checked" would be, more than likely, a recipe for disaster for Aaron: heart disease in his 40s or 50s. That's why you need to take control over this sad state of affairs and ask--no, insist--that an effort be made to determine whether you might share your parents' fate.

Look like Jimmy Stewart

15. January 2010 William Davis (23)

"This diet works great," Don declared. "But I think I've lost too much weight."

At 67 years old and 5 ft. 11 inches, Don began the program weighing 228 lbs (BMI 31.9). Because of high triglycerides, high blood sugar, high c-reactive protein, and excessive small LDL, I instructed Don to eliminate all wheat products from his diet, along with cornstarch and sweets. His intake of lean meats, eggs, vegetables, oils, raw nuts, etc. was unlimited.

Don now weighed 194 lbs, down 34 lbs over 6 months (BMI 27.1). Triglycerides, blood sugar, blood pressure, and well-being had improved dramatically; small LDL, however, had dropped only 30%--still room for improvement.

"My friends say I'm too skinny. They ask if I have cancer!"

I've heard this many times: Someone loses weight in a relatively short period of time and friends and family tell you you're too skinny. "It must be cancer. Nobody loses weight like that."

Unfortunately, many Americans have forgotten what normal looks like. Normal is certainly not a 190-lb, 5 ft 4 in woman, nor is it a 228 lb, 5 ft 11 inch man. But Americans have put on so much weight that the prevailing view of what constitutes "normal" weight has been revised upward. Normal is closer to what we see in old movies from the 1940s and '50s with people like Jimmy Stewart and Donna Reed. That's what we are supposed to look like.

So Don actually remains mildly overweight but is judged as "too skinny," or even cancer-ridden, by friends and family.

Ignore such comments. As you lose pounds and approach a truly desirable weight, realize that you are returning to the normal state, not the vision of "normal" now held by most Americans.

Getting vitamin D right

11. January 2010 William Davis (90)
Vitamin D is, without a doubt, the most incredible "vitamin"/prohormone/neurosteroid I have ever encountered. Frankly, I don't know how we got anything accomplished in health pre-D.

Unfortunately, people I meet rarely take their vitamin D in a way that accomplishes full restoration of vitamin D blood levels. It really isn't that tough.

Here's a list of common tripping points with vitamin D:

"I take vitamin D: 1000 units a day."
This is probably the most common mistake I see: Taking a dose that is unlikely to yield a desirable blood level. (We use 60-70 ng/ml of 25-hydroxy vitamin D as our target.) Most men and women require 6000 units per day to achieve this level. There is substantial individual variation, however, with an occasional person needing much more, a rare person requiring as little as 1000 units.


"I bought some vitamin D on sale. They were white tablets."
Time and again, patients in my office who initially have had successful vitamin D replacement, despite being reminded that only oil-based forms should be taken, switch to tablets. While they initially showed a 25-hydroxy vitamin D blood level, for instance, of 67 ng/ml on 8000 units per day with an oil-based capsule, they switch to a tablet form and the next blood level is 25 ng/ml. In other words, tablets are very poorly or erratically absorbed.

I have had people use tablets successfully, however, by taking their vitamin D tablets with a teaspoon of oil, e.g., olive oil. Oil is necessary for full absorption.


"I'm going to Florida. I'll stop my vitamin D because I'm going to lay in the sun."
Wrong. 90% of adults over 40 years old have lost the majority of their ability to activate vitamin D in the skin. A typical response might be an increase in blood level from 25 to 35 ng/ml--a 10 ng increase with a dark brown tan.

There is an occasional person who, with sun exposure, increases blood levels substantially. This can occur in both fair-skinned and dark-skinned people, though I've never seen it happen in an African-American person. The occasional person who maintains the ability to convert vitamin D with sun exposure, or young people, should seasonally adjust their vitamin D dose, e.g., 6000 units winter, 3000 units summer, or some other regimen that maintains desirable blood levels. You can see that monitoring blood levels (we check levels every 6 months for the first 2 years) is crucial: You cannot know what your vitamin D needs are unless you assess 25-hydroxy vitamin D levels.


"I drink plenty of milk. I don't think I need to take vitamin D."
Oh, boy. This is so wrong on so many levels.

First of all, no adult should be drinking plenty of cow's milk. (A discussion for another day.) Second of all, cow's milk averages 70 units of vitamin D, often the D2 form (ergocalciferol), per 8 oz. Even if the FDA-mandated 100 units per day were present, an average adult dose of 6000 units would require 60 glasses of milk per day. Can you say "diarrhea"?

Likewise, other food sources of vitamin D, such as fish (300-400 units per serving) and egg yolks (20 units per yolk), are inadequate. This makes sense: Humans are not meant to obtain vitamin D from food, but from sun exposure over a large body surface area. And this is a phenomenon that is meant to occur only in the youthful, ensuring that nature takes its course and us older folks get old and make way for the young (i.e., unless we intervene by taking vitamin D supplements).


"My doctor said that my vitamin D blood level was fine. It was 32 ng/ml."
Let's face it: By necessity, your overworked primary care physician, who manages gout, hip arthritis, migraine headaches, stomach aches, prostate enlargement, H1N1, depression, etc., is an amateur at nearly everything, expert in nothing. Nobody can do it all and get it right. Likewise vitamin D. The uncertain primary care physician will simply follow the dictates of the laboratory form that specifies "30-100 ng/ml" as the "normal" or "reference range." Unfortunately, the laboratory often quotes population distributions of a lab measure, not an ideal or desirable level.

To illustrate the folly of population distributions of a measure, imagine you and I want to know what women weigh. We go to a local mall and weigh several thousand women. We tally up the results and find that women weigh 172 lbs +/- 25 lbs (the mean +/- 2 standard deviations). (That's true, by the way.) Is that desirable? Of course it isn't. Population average or population distribution does not necessarily mean ideal or desirable.


"My husband's doctor said he should take 4000 units per day. So I just take the same dose."
That would be fine if all adults required the same dose. However, individual needs can vary enormously. A dose that is grossly insufficient for one person may be excessive for another. Once again, vitamin D dose needs can be individualized by assessing 25-hydroxy vitamin levels in the blood.


"I don't need to take vitamin D. I already take fish oil."
I suspect this mistaken belief occurs either because people confuse fish oil with cod liver oil, which does contain some vitamin D. (Cod liver oil is not the best source of vitamin D, mostly because of the vitamin A content; also a discussion for another time), or because they've heard that eating fish provides vitamin D. However, fish oil capsules do not contain vitamin D unless it is added, in which case it should be prominently and explicitly stated on the label.


"I don't have to take vitamin D. It's summer."
For most people I know, if it's a bright, sunny July day, where are they likely to be? In an office, store, or home--NOT lying in the sun with a large body surface area exposed. Also, most people expose no more than 5-10% of surface area in public. I doubt you cut the grass in a bathing suit. Because of modern indoor lifestyles and fashion, the majority of adults need vitamin D supplementation year-round.


I advise everyone that gelcap vitamin D is preferable. Some, though not all, liquid drop forms have also worked. Take a dose that yields desirable blood levels. And blood levels of 25-hydroxy vitamin D are ideally checked every 6 months: in summer and in winter to provide feedback on how much sun activation of D you obtain.

If your doctor is unwilling or unable to perform vitamin D testing, fingerstick vitamin D test kits can be obtained from Track Your Plaque.

Jimmy Moore's thyroid adventure

10. January 2010 William Davis (17)
My friend, Jimmy Moore of Living La Vida Low Carb, describes his thyroid experience here.

As Jimmy points out, he was looking for a way to jump-start a 50-lb weight loss. In my experience, low thyroid hormone levels ("hypothyroidism") are an exceptionally common cause for weight gain. Correcting even marginal hypothyroidism can facilitate weight loss, often resulting in 10 or more pounds of weight loss within the first month.

Unfortunately, Jimmy's thyroid hormone panel proved normal: TSH 1.3, thyroid hormones free T3 and free T4 in the mid- to upper-half of the reference range.

I say "unfortunately" because it is really an easy, inexpensive, and benign solution for losing weight. (I don't, of course, wish that Jimmy or anyone else develops a thyroid condition. But it really can provide gratifying weight loss results when thyroid function is low.) Jimmy might consider taking his oral temperature first thing in the morning as another means of assessing the adequacy of thyroid function.

Perhaps you will be luckier than Jimmy and have thyroid dysfunction that can be corrected and jump-start your weight loss program. Fingerstick thyroid test kits like the one Jimmy used are available here from Track Your Plaque.