The best artificial sweeteners

13. August 2011 William Davis (23)
Our new recipes, such as New York Style Cheesecake and Chocolate Coconut Bread, are wheat-free and low- or no-carbohydrate. They fit perfectly into the New Track Your Plaque Diet for gaining control over coronary atherosclerotic plaque, not to mention diabetes, pre-diabetes, hypertension, small LDL particles, high triglycerides, high inflammation (c-reactive protein) and other distortions of metabolism.

However, there's one compromise: We include use of non-nutritive sweeteners. It's therefore important to know that artificial sweeteners are not all created equal.

One common tripping point: maltodextrin.

Maltodextrin is composed of polymers (repeating subunits) of glucose, as few as 3 or as many as 20 or more glucose subunits. So maltodextrin is glucose sugar. While it lacks the especially destructive pentose sugar, fructose, maltodextrin is metabolized to glucose and thereby increases blood sugar substantially.

Many artificial sweeteners are bulked up with maltodextrin. For instance, granulated Splenda and Stevia in the Raw, two sweeteners billed as low-calorie and sugar-free that is used on a cup-for-cup basis like sugar, are primarily maltodextrin--with only a teensy bit of Splenda or stevia.

The best artificial sweeteners, i.e., the most benign without a load of maltodextrin, are:

Liquid stevia--Just the extract from stevia leaves and water. It can be a bit pricey, e.g., $10 for a 2 oz bottle, but a little goes a long way.

Truvia--While I'm not too fond of the manufacturer (Cargill), I believe that Truvia is among the better sweeteners around. It is a mixture of the natural sugar, erythritol, that generates little to no blood sugar effects and rebiana (rebaudioside), an isolate of stevia. Some people aren't too fond of the mild menthol-like cooling effect of the erythritol nor the slight aftertaste. I find it works pretty well in most recipes.

Be aware that, no matter which artificial sweetener you use, it has the potential to stimulate appetite. I therefore like to not eat foods sweetened with liquid stevia or Truvia in isolation but as part of a meal. That way, any appetite stimulation that results is substantially quelled by the proteins and fats ingested.
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Comments (23) -

  • Princess Dieter

    8/12/2011 11:53:20 PM |

    Thank you for the link. I was just talking with hubby last night about finding a recipe for cheesecake that had no wheat/gluten and would be good for us for special treats/occasions (like an upcoming family birthday). Yay.

  • pjnoir

    8/13/2011 2:52:19 AM |

    I never use Truvia. The best stavia hands down is SweetLeaf, either the liquid or the powder. BUT Stevia acts like insulin, in fact, Asia has been using it as an insulin substitute and comes with a warning to diabetics about using it with one’s daily  insulin shots.   I stopped using it as I don’t need to rev up by insulin production.  I’m diabetic. I still go with local honey and get the benefits of having local pollen in my body.

  • Shreela

    8/13/2011 3:27:35 AM |

    Both DH and I noticed the aftertaste. I figured out how to use half stevia/half sugar for a few days, then 1/4 each, then all stevia, which solved the aftertaste problem for me. I then tried one teaspoon of sugar to a quart of stevia-sweetened tea with DH - he didn't notice any weird taste. So hopefully just adding a tiny bit of sugar for 1-2 weeks will get your taste buds used to stevia.

  • Gabriella Kadar

    8/13/2011 3:29:15 AM |

    Why do people feel the need to eat desserts?  Doesn't adherence to a consistent low carb diet eventually curb most of the craving for sweets?  One teaspoon of fruit jam should be able to quell any overweening desire.  Or is the socio-cultural programming for eating confections so deeply ingrained that people just can't live without?

  • Michia

    8/13/2011 9:06:53 AM |

    I agree.  In our house (LC for years), the same logic applies to low carb "treats" that applies to low carb Frankenfoods.  Don't eat foods that are trying to be foods that you know you can no longer have.  

    There is a real danger in continuing to eat really sweet foods, even artificially sweetened.  "Low carb" needs to be "low sweet".  If you hang in there, you do eventually lose your taste for it.  

    As for Splenda, you can find the liquid if  you try.  And the mini tablets are minimally carby.

  • cancerclasses

    8/13/2011 6:13:31 PM |

    Both cancer & systemic fungi make energy by means of glycolysis and create demands for large amounts of sugars.  People with continuing carb cravings that won't resolve may have one or the other condition.  Otherwise I'm with you, people hanging onto sweets are still living to eat rather than eating to live.

  • Might-o'chondri-AL

    8/13/2011 7:27:21 PM |

    Hi Dr. Davis,
    Server blocked me elsewhere, so writing this here.
    Amazake data when made from white rice (brown, short & long may each differ) =
    30 - 70 % complex carbohydrate saccharides
    20 - 45 % maltose (not amylose)
    3 - 5 % glucose
    5 - 9 % protein
    3 - 5% fat
    1 - 7 % fiber
    0.3 - 0.4 % mineral ash
    iron, niacin & thiamine

    Sample 1 liter (1 quart) sauce pan Amazake home kitchen batch:
    200 ml ( 7 ounce volume, +/- 200 grams) short grain brown rice rinsed and drained
    bring to boil  in 2.5 times the volume water
    reduce heat to low and, covered,  cook 50 - 60 minutes (until not wet)
    transfer cooked rice to an incubation vessel & let cool
    when cooled to  60* Celcius (140 * F) mix with 400 ml (14 ounce volume) of Koji innoculant
    cover with aluminum foil (or somehow) and put where can keep warm
    incubation ideal temperature is 57 - 60 * C  (with leeway)
    ferment for  desired time , 12 hours sweeter and I use 22 hours
    when time up pan boil the Amazake (stir) 3- 5 minutes to inactivate Koji fungi
    refrigerated covered keeps weeks

    Dosages mentioned previously (for 165 pound adult, and Amazake was eaten with protein and fat):
    (a) " low" dose with 2 hour blood glucose ending up being same as pre-prandial blood glucose was 1/8th (by volume) of the above Amazake (rough calculation would thus be ingesting 1/8th  of  +/- 600 grams  total of original dry rice and Koji rice)
    (b) "high" dose with 2 hour blood glucose rebound (suggested for athletes carbs) was 1/4 (by volume) of the above Amazake recipe (rough calculation  would in this case be ingesting 1/4 of +/- 600 grams total of original dry rice and Koji rice)

    Koji innoculant ( steamed white glutinous rice infused with Aspergillus oryzae and then dessicated) used was wholesale direct from L.A. producer Miyako Oriental Foods 626-962-9633; call for your local retailer of their Koji under the "Cold Mountain" brand. They recommend double their Koji for any volume of rice substrate. Other makers of Koji proportions may be less if the Koji is less dehydrated; family business G.E.M. Cultures in Wash. mail orders their Koji and it may (?) be suitable for using less (GEM also sells spores with instructions to make your own Koji).

  • Might-o'chondri-AL

    8/13/2011 7:43:26 PM |

    Dr. Davis,
    Orientation for those athletes interested in experimenting with Amazake:
    Innoculant of rice is Aspergillus oryzae fungal infused rice grains, called Koji; Koji has alpha-amylase, glyco-amylase, acid protease, lipase, amylo-glucosidase , acid carboxy-peptidase , chitosinase and citric acid.
    Incubation lets fungal penetrate new rice substrate and fungal hyphal tip performs hydrolytic enzyme secretion.

    Cooking the rice first gelatinizes the starch held in granules inside of organelles with lipoprotein membranes (amyloplasts) into 16 - 30% amylose and 65 - 85 % amylopectin which are ammenable to hyphal hydrolytic action. Koji's amylo-glucosidase enzyme digests the gel &  Koji's alpha amylase enzyme reduces molecular size of amylose, which makes it less viscous and more fluidly mobile. It is glyco-amylase enzyme that turns amylose and some of the amylo-pectin chains  into glucose.
    Incubation lets the fungi grow and their mycellial cell wall builds up with the amino mono-saccharide glucosamine (a.k.a. chitosan); fungi generally have 67 - 126 mg mycelial glucosamine per 1 gram dry weight mycellium. Amazake is well tolerated by most since glucosamine is useful in colitis. Glucosamine (chitosan) is a poly-cationic bio-polymer formed when chitosanase I enzyme de-acetylates chitin (in fiber); with optimal enzymatic pH being 5.5 - 6.5. Chitosan is more acid pH soluble than chitin and under chitosanase II enzyme (working from pH 3.8 -8.5) some chitin is de-acetylated to form more oligo-saccharides.

    Amazake may have biologically active high molecular weight immunological poly-anionic polysaccharide
    derivatives like the poly-acetyl carboxylic acid  COAM (chlorite oxidase oxy-amylose). COAM comes about when a saccharide chain is oxidatively cleaved between 2 carbon atoms resulting in oxy-amylose, a polymer of 2 aldehyde functions;  when these aldehydes gets further oxidized they produce functional carboxyls.  Rice has aldehydes like the volatile aldehyde hexanal we smell as stored rice &/or from rice bran.

    Rice, like most bean & grain carbohydrate polysaccharides, include the following in both the soluble and insoluble form: arabinoxylan, beta-glucan, cellulose, mannose, galactose, xylose and uronic acid. For us these non-starch  polysaccharides are not digestible;  as neither is fiber (made up of cellulose, hemicellulose, pectin and lignan ) since 90% of our dietary fiber is linked together by beta-glycosides that our digestive enzymes can't cleave. Arabinoxylan, mannan, galacto-mannan and xylan are considered anti-nutritional since can lower intestinal uptake of nutrients; while mannose reacts with amino groups in dietary protein to reduce the amount of certain aminos properly digested.

    Koji's fungal hyphal hydrolytic enzymes include mannosidase enzymes; beta mannanase catalyses the mannosidic links in insoluble mannan polysacharides where there are galactosyl residual features.  The  so-called endo-mannanase (a manno -hydrolase) cleaves mannan and galactomannan to free up molecules like manno-triose, manno-biose and manno-tetraose that human gut Bifidobacteria can then feed on. This may be part of why a substantial dose of Amazake seems to yield more delivery of  sustained energy beyond what one would get from the usual amount of short chain fatty acids put out by gut bacteria.

    Amazake incubation is a solid state fermentation, since want the minimal free fluid when culturing;  too much water and the substrate porosity is diminished and resultant depressed oxygen transport in substrate  causes fungal cell numbers to decline. A  submerged fungal ferment, when cooked rice with koji substrate is set out  too soupy can result in 3.5 times less enzymatic activity. Using  too much rice substrate mixed with too sparse koji innoculant and the fermentation won't proceed promptly due to low oxygen. Also do not stir the blend while incubating to avoid damaging mature fungal hyphae or breaking new growth.

    Mannanase enzyme development in 1st day is less than 50 units/gram and this goes to a maximum of 100 units/gram after 2 days; a peak mannanase content seems to be +/- 250 units/gram on days 3-5. I incubate short grain brown rice Amazake for 22 hours; while most commercial Amazake products and home producers probably do not incubate more than 12 hours. The longer incubation is allowed to go on for the more llikely bitter flavors develop from oxidation of the bran's oil content;  yet the bran is desired for it affords better beta- mannanase and beta-mannosidase enzymatic formation.

    Amazake has exceptional anti-oxidant properties; with longer incubation time this activity increases. Amazake also raises the bodies ability to inhibit lipid peroxidation; so concern over any of rice bran's oil oxidation is probably moot.
    END

  • Elenor

    8/14/2011 5:13:52 PM |

    You don't mention liquid surcralose (Splenda)  -- which has all the 'benefits' of sucralose without the maltodextrin.  I use it and nothing else.

  • Dr. William Davis

    8/15/2011 12:51:28 PM |

    Wow, Might. You are a walking Wikipedia!

    Thanks for the incredible insights.

  • Marlene

    8/15/2011 5:44:10 PM |

    I have never been able to find liquid Splenda in stores in the U.S.  If it's there, what brand name is it sold under?

  • ibh

    8/15/2011 8:36:23 PM |

    I use Sweet Leaf as well. It is in the powder from. the box states no chemicals,no alcohols, no erythritol, no ethanol or menthol,, no aspartame, no sucralose, no maltodextrin, no dextrose or additivees. Seems clean to me. Any thoughts as to problems with this product.

  • Anonymous

    8/15/2011 8:36:54 PM |

    Doc, also notice the removal of all of Might's comments from Guyenet's site. This speaks for itself, as to where the truth lies. Might is truly a wonder and knows what he's talking about.

  • Jack Kronk

    8/15/2011 9:57:54 PM |

    What does that mean, that the comments from Guyenet's site are removed? Stephan removed them, or Might removed them? I've traded comments with Might over there dozens of times.

  • Jack Kronk

    8/15/2011 10:00:22 PM |

    I just use pure Stevia powder, which is gauranteed to be at least 95% pure stevia crystals (like the liquid stevia, on in teh form of powder. The brand I use is Stevita. A tiny little 0.7 ounce conainer lasts FOREVER! You only need a tiny pinhc of it for coffee. It doesn't exchange well versus sugar as a substitute, but adding a little to whatever you might be baking or making can help with using less of whatever other sweetener you may need to use.

  • Janmar Delicana

    8/16/2011 12:13:10 AM |

    Dear Dr. Davis,
    It’s a great pleasure to read your blog. I find your post very informative. Thank you for sharing.
    As a reader, I consider your writing to be a great example of a quality and globally competitive output.
    As a moderator for Physician Nexus (a community for physicians) I would like to share your genuine ideas and knowledge. With this you can gain 1000 physician readers on Nexus.
    We would love for you to visit our community. It's free, takes seconds, and is designed for physicians only - completely free of industry bias and commercial interests.
    Best,
    Janmar Delicana
    On behalf of the Physician Nexus Team
    www.PhysicianNexus.com

  • Might-o'chondri-AL

    8/17/2011 12:33:07 AM |

    Stephan who hosts the WholeHealth blog is smarter than me &  the removal of my comments there came from someone using my computer. These days I do not have the time to follow Stephan's blog, which has nothing to do with validity of his approach.

  • Stefan

    8/31/2011 1:46:14 AM |

    Marlene,
    I buy it at SuperSupplements or at Whole Foods. Any nutritional supplements &vitamins stores should carry it. If you live in a place whch doesn't havenay -> use Amazon. It's simple Smile.

  • Stefan

    8/31/2011 1:50:21 AM |

    Whoops - I thought you meant Stevia. Liquid Splenda is at amazon as well

  • Serge

    9/2/2011 11:27:16 PM |

    Dr. Davis--

    I'd like to recommend ZSweet.  It's a stevia/erythritol blend but isn't a Big Ag product like Cargill/Coca-Cola's Truvia or Pepsico/Monsanto-er-Merisant's PureVia.

    It's funny how Stevia was banned by the FDA in the 80s, only to be given the GRAS label in 2008, which just happened to be the same year that Truvia was launched.  Coincidence?

  • Dr. William Davis

    9/2/2011 11:40:52 PM |

    Hi, Serge-

    I have no doubt that the clout of Cargill pushed Truvia through. I wasn't aware of ZSweet--thanks!

  • Susan

    12/18/2011 6:10:37 AM |

    I am absolutely thrilled to have found this blog.  I've been extremely cautious of sugar and sweets since my mother was diagnosed with diabetes when I was a child.  Unfortunately I did fall into the "healthy whole grains" trap for a while, but have kept my daily carbs between 50-100 for many years now.  I like Stevia products, but unfortunately they leave me with a slight headache.  I've been (sparingly) using Volcanic Agave Nectar for years, mostly in tea and for the occasional baked good.  I understand that due to the rich soil in which it's grown, and minimal processing, volcanic blue agave has a lower glycemic index-load than other traditional agave nectars, at 27.  

    Am I doing myself harm by using it?  I'd like to try the liquid Splenda, that contains no maltodextrin.  Thank you Elenor and Stefan for mentioning it, but should I be concerned about its processing?

  • jpatti

    5/27/2012 6:58:29 PM |

    I'm not big on Truvia.  

    From what I've heard from other diabetics erthyritol doesn't have the GI side effects of most sugar alcohols and has a lesser effect on bg, but even so... I prefer a plain stevia powder.

    I don't think erthyritol has been around long enough to know what it's side effects may be, that it doesn't raise bg much and doesn't cause GI distress isn't good enough. There's any number of other bad side effects that exist in the world besides those two.

    Stevia is food.  Granted, the plain white stuff is relatively refined, but I still feel better about it than erthryitol.  

    Susan, agave nectar has almost no GI effect because it is fructose, not glucose.  It has MUCH more fructose than HFCS.  Search this blog for a long list of the bad stuff that fructose causes.  I'm a diabetic, and I'd seriously rather eat sugar than agave.

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Dr. Cannell comments on vitamin D lab tests

14. July 2008 William Davis (9)
As always, Dr. John Cannell of The Vitamin D Council continues to teach us new lessons about vitamin D.

Apparently, Dr. Cannell is swamped with the attention that vitamin D is drawing, largely due to his efforts to publicize the enormous deficiency of Americans and his great talent for articulating the science. The most current newsletter, while a bit haphazard, makes some excellent new points that I reprint here.

(I did not reprint his conversation about "any form of vitamin D" being acceptable. My experience differs: In nearly 1000 patients who have taken vitamin D supplements, my experience is that most tablet forms are inconsistently absorbed, sometimes not absorbed at all. I therefore advocate only use of gelcaps or liquids. I'm told by members of Track Your Plaque, however, that they are witnessing reliable increases in blood levels of vitamin D by taking the powdered form of Bio Tech Pharmacal's product.)


Does it matter what reference lab my doctor uses?

Yes, it might make a huge difference. A number of methods exist to measure 25(OH)D in commercial labs. The two most common are mass spectrometry and a chemiluminescence method, LIAISON. The first, mass spectrometry, is highly accurate in the hands of experienced technicians given enough time to do the test properly. However, in the hands of a normally trained technician at a commercial reference lab overwhelmed with 25(OH)D tests, it may give falsely elevated readings, that is, it tells you are OK when in fact you are vitamin D deficient. The second method, chemiluminescence, LIAISON, was recently developed and is the most accurate of the screening, high throughput, methods; LabCorp uses it. Quest Diagnostics reference lab uses mass spec. Again, both Quest and LabCorp are overwhelmed by 25(OH)D requests. The problem is that the faster the technicians do the mass spec test, the more inaccurate it is likely to be. If your 25(OH)D blood test says "Quest Diagnostics" on the top, do not believe you have an adequate level (> 50 ng/ml). You may or may not; the test may be falsely elevated. Let me give you an example. A doctor at my hospital had Quest Diagnostics do a 25(OH)D. It came back as 99 ng/ml of ergocalciferol. He is not taking ergocalciferol (D2), he has never taken ergocalciferol, only cholecalciferol, and he is not taking enough to get a level of 99 ng/ml, 50 ng/ml at the most. His email to Dr. Brett Holmquist at Quest about why Quest identified a substance he was not taking went unanswered other than to say "any friend of Dr. Cannell's is a friend of ours."

Long story short: if your lab report says "LabCorp" on the top, it is probably accurate; if it says Quest Diagnostic, it may be falsely elevated. While LabCorp has also been overwhelmed with 25(OH)D requests, the LIAISON method they use is relatively easy to do and does not rely on technician skill as much as the mass spec methods do. I'm not saying this because I'm a consultant for DiaSorin, who makes LIAISON, I'm saying it because it is true. If you don't believe me, get Quest to make me an offer to be their consultant at 10 times what DiaSorin is supposed to be paying me ($10,000 per year) and see how fast I turn Quest down. If Quest fixes their test, I'd love to consult. The ironic thing: I've made both Quest and LabCorp lots of money via this newsletter, the website, and by repeatedly telling the press that people need to know their 25(OH)D level, which has contributed to the skyrocketing sales of 25(OH)D blood tests.

Demand for vitamin D tests soars as nutrient's potential benefits touted.

Here you can help. Find out which labs in your town use Quest Diagnostics and which use LabCorp. Have a 25(OH)D test at both labs the same day (you will have to pay for them yourself). Then send both results to the Vitamin D Council address below. If Quest Diagnostics does not fix their 25(OH)D test, the Vitamin D Council will fix it for them.



My doctor prescribed Drisdol, 50,000 IU per week. What is it?

Drisdol is a prescription of 50,000 IU tablets of ergocalciferol or D2. Ergocalciferol is not vitamin D but it is similar. It is made by irradiating ergosterol, which is found in many living things, such as yeast. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as human vitamin D (cholecalciferol or D3) does. However, Drisdol is a lot better than nothing. The best thing to do, if you are vitamin D deficient, and a human, is to take human vitamin D, cholecalciferol, A.K.A. vitamin D3.



What is the ideal level of 25(OH)D?

We don't know. However, thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml. In a recent study, Heaney et al enlarged on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound, cholecalciferol, and 25(OH)D levels were measured. It turn out that the body does not reliably begin storing the parent compound (cholecalciferol) in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml. The average person starts to store cholecalciferol at 40 ng/ml, but at 50 ng/ml, virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml, the body is usually using up the vitamin D as fast as you make it or take it, indicating chronic substrate starvation, not a good thing.

Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4.

Heaney RP, Armas LA, Shary JR, Bell NH, Binkley N, Hollis BW. 25-Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am J Clin Nutr. 2008 Jun;87(6):1738-42.



I have advanced renal failure and I'm on dialysis, how much vitamin D should I take?

The same as everyone else. Since I have told you about commercial labs ripping you off, let's add some drug companies. Patients with advanced renal failure need activated vitamin D or one of it's analogs, available by prescription. This is very important as their kidneys cannot make enough 1,25-dihydroxy-vitamin D (calcitriol) to maintain serum calcium. However, the rest of their tissues activate vitamin D just fine and when those tissues get enough, and when the kidneys get more vitamin D, the calcitriol spills out into the blood, lowering their need for prescription calcitriol or one of its analogs. The companies that make the analogs don't like that, it means reduced sales. So these companies do nothing, the scientists behind these companies say nothing, and renal failure patients die prematurely from one of the vitamin D deficiency diseases.

Vieth R. Vitamin D toxicity, policy, and science. J Bone Miner Res. 2007 Dec;22 Suppl 2:V64-8.



When I asked my doctor for a 25(OH)D blood test, he just laughed and said it was all idiotic. What can I do?

Help me unleash the dogs of war, the plaintiff attorneys. If you read about past nutritional epidemics caused by society, such as beriberi or pellagra, you will realize that education alone will take decades. Physicians successfully fought against the idea that thiamine deficiency caused beriberi for decades. However, things are different now. The agents of change in modern America, as obnoxious as they are, are plaintiff attorneys. Once the first malpractice lawsuits claiming undiagnosed and untreated vitamin D deficiency led to breast cancer, autism, heart disease, etc., get past summary judgment, and they will, and end up in front of a jury, and they will, things will change rapidly. One of the main reason physicians do what they do is fear of lawsuits. In a matter of months, arrogance and ignorance will give way to 25(OH)D tests and vitamin D supplementation.

Goodwin JS, Tangum MR. Battling quackery: attitudes about micronutrient supplements in American academic medicine. Arch Intern Med. 1998 Nov 9;158(20):2187-91.


And, to help support Dr. Cannell's efforts (I sent him a check for $250 a few months back; time for more), here is his contact info:

John Cannell, MD
The Vitamin D Council

Send your tax-deductible contributions to:

The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422

Privileged information

12. July 2008 William Davis (9)
In 1910, taking a person's blood pressure was considered revolutionary, a high-tech practice that was of uncertain benefit.

Dr. Harvey Cushing of Johns Hopkins Hospital in Baltimore had observed a blood pressure device while traveling in Europe, developed by Dr. Sciopione Riva-Rocci. Cushing brought this new technology back with him to the U.S. and promptly promoted its use, convinced that this insight into gauging the forcefulness of blood pressure would yield useful clinical insights.

But, in 1910, practicing physicians rejected this new technology, preferring to use their well-established and widely practiced technique of pulse palpation (feeling the pulse), skeptical that the new tool added value. Medical practice of the day was rich with descriptions of the strength and character of the pulse: pulsus parvus et tardus (the slow rising pulse of aortic valve stenosis), the dicrotic notch of aortic valve closure transmitted to the pulse, the "water-hammer" pulse of aortic valve insufficiency.

Over the next 20 years, however, the medical community finally gave way to the new technique, although only physicians were allowed to use blood pressure devices, as nurses were regarded as incapable of mastering the skills required to perform the procedure properly.

Stethoscopes were also gaining in popularity in the early 20th century, but were also the exclusive province of physicians trained in their use. Nurses were not allowed to use stethoscopes until the 1960s. Even then, nurses were not allowed to call them "stethoscopes," but "nurse-o-scopes" or "assistoscopes," and the nurses' version of the device was manufactured to look different to avoid confusion with the "real" doctor's tool.

And just half a century ago, if you wanted to look at a medical textbook, you would have to go to the library and ask for special permission. The librarian would lower her glasses and look you up and down to determine whether or not you were some kind of pervert. Only then might you be granted permission to peer into the pictures of organs and naked bodies.

Such has been the spirit of medicine for centuries: Medicine and its practices are meant to be secret, the insider knowledge of a privileged few.

Fast forward to 2008: The Information Age has overturned the rules of privileged information. Now you have access to the same information as I do, the same information available to practicing physicians. The playing field has been levelled.

Curiously, while information access has advanced at an instantaneous digital pace, attitudes in medicine continue to evolve at the traditional analog crawl. Many of my colleagues continue to be dismayed at the new public access to health information, belittle patients for excessive curiosity about their health, lament the erosion of their healthcare-directing authority. And while new concepts race ahead as we race towards a wiki-like collective growth in healthcare knowledge, physicians are still mired by their reluctance to abdicate their once-lofty positions as chief holders of secrets.

I believe that this is part of the reason why family doctors and cardiologists have been slow to adopt technologies like heart scans and self-empowering programs like Track Your Plaque: processes that take heart disease prevention away from the hands of physicians and place more control into the hands of the people.

Imagine the horror felt by physicians in 1935 of a young upstart nurse boldly trying to use a stethoscope to take a patient's blood pressure. You can imagine the internal horror now being felt as you and I dare to take control over heart disease and deny them the chance to put in four stents, three bypass grafts, then direct our future health habits.

But technology has a way of marching on. It will encounter resistance, bumps, and blind-alleys, but it will go on.

Dr. Jeffrey Dach on the Track Your Plaque program

10. July 2008 William Davis (5)
Dr. Jeffrey Dach posted a great piece on his blog, Bioidentical Hormone Blog , about his perspective on the Track Your Plaque program.

It's worth reading even for those familiar with the program, just to see a slightly different perspective. He also included many great graphics to illustrate his points.

CAT Coronary Calcium Scoring, Reversing Heart Disease












Also, see Dr. Dach's Heart Disease: Part 2, for some novel thoughts.

Vitamin D and programmed aging?

9. July 2008 William Davis (8)
As we age, we lose the capacity to activate vitamin D in the skin.

Studies suggest that, between ages 20 and 70, there is a 75% reduction in the ability to activate vitamin D. The capacity of conversion from 25 (OH) vitamin D to 1,25 di(OH) vitamin D also diminishes.

Holick M. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease.



From Holick, M. 2006

This would explain why 70-year olds come to the office, just back from the Caribbean sporting dark brown tans, are still deficient, often severely, in blood levels of vitamin D (25(OH) vitamin D). A tan does not equal vitamin D.














Courtesy Ipanemic


A practical way of looking at it is that anyone 40 years old or older has lost the majority of ability for vitamin D activation.

This often makes me wonder if the loss of vitamin D activating potential is nature's way to get rid of us. After all, after 40, we've pretty much had our opportunity to recreate and make our contribution to the species (at least in a primitive world in which humans evolved): we've exhausted our reproductive usefulness to the species.

Is the programmed decline of vitamin D skin activation a way to ensure that we develop diseases of senescence (aging)? The list of potential consequences of vitamin D deficiency includes: osteoporosis, poor balance and coordination, falls and fractures; cancer of the breast, bladder, colon, prostate, and blood; reductions in HDL, increases in triglycerides; increased inflammation (C-reactive protein, CRP); declining memory and mentation; coronary heart disease.

Isn't that also pretty much a list that describes aging?

A fascinating argument in support of this idea came from study from St Thomas’ Hospital and the London School of Medicine:

Higher serum vitamin D concentrations are associated with longer leukocyte telomere length in women

Telomeres are the "tails" of DNA that were formerly thought to be mistakes, just coding for nonsense. But more recent thinking has proposed that telomeres may provide a counting mechanism that shortens with aging and accelerates with stress and illness. This study suggests that both vitamin D and inflammation (CRP) impact telomere length: the lower the vitamin D, the shorter the telomere length, particularly when inflammation is greater.
















Data supporting vitamin D's effects on preventing or treating cancer, osteoporosis, lipid abnormalities, inflammation, cardiovascular disease, etc., is developing rapidly.

Now the big question: If declining vitamin D is nature's way of ensuring our decline and death, does maintaining higher vitamin D also maintain youthfulness?

I don't have an answer, but it's a really intriguing idea.

Synthroid, Armour Thyroid, and the battle for T3

6. July 2008 William Davis (2)
In the last Heart Scan Blog post on thyroid issues, Is normal TSH too high?, the provocative findings of the the HUNT Study were discussed. The text of the study can be found at:

The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study

Hypothyroidism, or low thyroid that is signaled by high thyroid-stimulating hormone, TSH, is proving far more prevalent an issue than previously thought. While previous estimates put hypothyroidism as affecting only about 3% of younger populations, 10-20% of older populations (women more so), data like the HUNT Study suggest that, if lower and lower TSH levels (higher thyroid) are necessary for perfect heart health, then many more people stand to benefit than we used to think.

But another crucial issue in the world of hypothyroidism: Is T4 (thyroxine) enough? Or should we be supplementing T3 (triiodothyronine) along with T4?

Your friendly neighborhood primary care doctor or endocrinologist would likely argue vehemently that T4 (as Synthroid, Levoxyl, levothyroxine, and others) is adequate and not subject to the impurities and contaminants of natural thyroid extracts. They would also argue that T4 is effectively converted to T3 at the tissue level, and exogenous supplementation is unnecessary.

Others--most of all thyroid patients themselves, along with thyroid advocates like Mary Shomon and Janie Bowthorpe, along with some physicians--argue that supplementing T3 along with T4 can be very important. They argue that people feel better, have more physical energy, lose weight more effectively, and more completely resolve many of the phenomena of hypothryoidism with T3 added. There are also some data that argue the same.

Adding T3 to the mix may address the presumed poor conversion of T4 to T3 that is peculiar to some people. It may overcome the "reverse T3" phenomenon, the production of a useless look-alike T3 that occurs in some people. It may also (anecdotally) exert greater effects on some lipid/lipoprotein parameters, such as Lp(a).

My experiences adding T3 to T4 have been mixed: Some feel better, others do not. Some show objective improvements, others do not.

Nonetheless, hypothyroidism, or incompletely corrected hypothryoidism by way of inadequate T3, is an issue to consider in your plaque-control program.

More on this somewhat complex issue, along with practical solutions to consider, can be found on the Special Report to be released this week on the Track Your Plaque website.

Letter to New York Times

3. July 2008 William Davis (9)
All right. I sent a Letter to the Editor to the New York Times. No word from them; it's no longer news.

So here is what I tried to convey.

While the authors overall did a credible job of talking to my colleagues and laying out the issues, they made the crucial and boneheaded mistake of confusing CT heart scans with CT coronary angiograms. Sadly, many people who may have been considering having a simple screening heart scan may be scared away by the confused authors, Alexn Berenson and Reed Abelson.

They do correctly point out that, while CT coronary angiograms are fascinating examples of technology and a way of visualizing coronary arteries, this test all too often is being subverted into the "let's make money from high-tech testing" medical model. It's also a test that frequently leads to the "real" test, heart catheterization, since the "time bomb" you have in your arteries might "need" a stent.

CT coronary angiograms are also virtually useless for purposes of tracking disease, since they are not longitudinally (along the length of the artery) quantitative, nor should anyone be exposed to this much radiation repeatedly.

A simple heart scan, on the hand, provides a longitudinal summation of coronary plaque volume. Radiation exposure is sufficiently low that repeated scanning can be performed for purposes of tracking . . .yes, track your plaque.

Poorly-informed reporters can do a lot of damage. As always, you and I must dig a little deeper for the truth.




Dear Editor,

Re: Weighing the Costs of a CT Scan’s Look Inside the Heart

The Times featured an article on June 29th that discussed rapidly expanding use of CT scans for the heart:
Weighing the Costs of a CT Scan’s Look Inside the Heart.

The authors, Alex Berenson and Reed Abelson, stated that CT heart scans “expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.”

I’d like to offer a clarification.

Though the authors discuss both CT heart scans and CT coronary angiograms, they confuse the two and use the terms interchangeably.

A heart scan is a simple screening test for coronary atherosclerotic plaque. It detects the presence of calcium in the heart’s arteries, provided as a “score.” (Because calcium occupies 20% of total plaque volume, knowing the amount of calcium tells you how much total coronary plaque is present by applying this simple proportion.) Just having a high score should not prompt heart procedures, since people undergoing simple screening heart scans are without symptoms. However, a stress test may yield some useful information.

On present-day CT devices, heart scans expose a patient to 0.4 mSv of radiation on an electron-beam, or EBT, device, and on up to 1.2 mSv on a 64-slice multi-detector, or MDCT, device, compared to 0.1 mSv during a standard chest x-ray. CT heart scans are therefore performed with about the same quantity of radiation as a mammogram done to screen women for breast cancer, or about the equivalent of four chest x-rays on an EBT scanner, up to 12 chest-xrays on a MDCT scanner.

CT coronary angiograms, while performed on the same devices as heart scans, require x-ray dye to fill the contours of the coronary arteries. It also requires up to several hundred times more radiation. While new engineering innovations are being introduced that promise to reduce this exposure, the current devices being used today do indeed require a radiation dose equivalent to 100 to 400 chest x-rays (usually in the range of 10-15 mSv), a value that equals or exceeds that obtained during a conventional heart catheterization.

While heart scans are most useful to detect and quantify plaque that can help determine the intensity of a heart disease prevention program, CT coronary angiograms are generally used as prelude to hospital procedures like catheterizations, stents and bypass surgery. That’s because they are performed to look for (or rule out) “severe” blockages.
CT heart scans and CT coronary angiography are therefore two different tests that yield two different kinds of information, and yield two entirely different levels of radiation exposure.

This confusion from a major and respected media outlet like the New York Times is unfortunate, because it could persuade millions of people who otherwise could benefit from simple heart scans to avoid them because of misleading information on radiation exposure of a different test.

Thank you.

William Davis, MD

Red yeast rice alert

2. July 2008 William Davis (9)
While there have been some positive reports in the media lately about the cholesterol-reducing effects of red yeast rice, Consumer Lab has issued a very concerning report.

Because Consumer Lab is a subscription website (incidentally, the $20 per year membership fee is money well spent for insightful tests on many supplements, though new reports only come out a handful of times per year), I won't discuss the results of their red yeast rice in its entirety.

However, Consumer Lab testing uncovered several disturbing findings:

--The lovastatin content varied by a factor of 100, from 0.1 mg per tablet/capsule in one brand up to 10.6 mg in another brand. By FDA regulations, lovastatin is a drug and NO red yeast rice preparation is supposed to contain ANY lovastatin. Nonetheless, despite the marketing of supplement manufacturers, it is probably the lovastatin that is largely responsible for the LDL-reducing effect. The monacolins or mevinolins in red yeast rice add little, if any, further LDL-reducing effect.

--Several preparations contain a potential kidney toxin called citrinin. The Walgreen's product, specifically, contained substantial quantities of this toxin.



Interestingly, the FDA has taken repeated action against red yeast rice manufacturers and distributors because they continue to contain lovastatin. In the FDA's most recent action in August, 2007, for instance, Swanson's product and Sunburst Biorganics' Cholestrix, were both sent letters to stop selling their product because it contained lovastatin.

The Consumer Lab findings would explain the enormous variation in LDL-reducing effect of various red yeast rice products. In my experience, some work and reduce LDL 40 mg/dl or so, some fail to reduce LDL at all, others generate a modest effect, e.g., 5-10 mg/dl LDL reduction.

In effect, red yeast rice IS a statin drug, albeit a highly variable and weak one. Although readers of The Heart Scan Blog know that I am a big fan of nutritional supplements and self-empowerment in health, I am a bigger fan of truth. I despise B--- S---- of the sort that emits from some nutritional supplement manufacturers and drug companies.

I am puzzled by much of the public's readiness to embrace a statin drug if it comes from a supplement company while avoiding it if it comes from a drug manufacturer. Personally, I do not like the drug industry, their questionable (at best) ethics, their aggressive marketing tactics, their sleazy sales people.

But, in this instance, if a statin effect is desired, I'd reach for generic lovastatin before I purchased red yeast rice. The Consumer Lab report tells us that red yeast rice IS essentially a statin drug, an inconsistent one that often contains a potential toxin.

"Average amount of heart disease for age"

2. July 2008 William Davis (4)
A 72-year old woman came to my office after a complicated hospital stay (unrelated to heart disease). She'd undergone a CT coronary angiogram and heart scan as part of a pre-operative evaluation prior to a surgery for a non-heart related condition.

The heart scan portion of the test (I was impressed they even did this) yielded a heart scan score of 212. The CT coronary angiogram portion of the test revealed a 50% blockage in one artery, a lesser blockage in one other artery.

The cardiologist consulting on the case advised her that the amount of coronary disease detected was insufficient to pose risk during her surgical procedure. He also advised her that she had "an average amount of disease for age." He thought that nothing further was necessary since she was "average."

Say what?  

What if I told you that you have an average amount of cancer for your age? After all, cancers become more common the older we get. Who would find that acceptable?

Then why should ANY amount of coronary atherosclerotic plaque be "acceptable for age"? Coronary plaque is a degenerative disease that poses risk for rupture. While it is indeed common, by no means should it be acceptable.

I would bet that this same cardiologist would be from the same school of thought that would be eager to advise heart catheterization, stent, and other procedures--revenue-generating procedures--should she have a heart attack appropriate for age.

I wish that I could tell you that this silly comment was provided by some peculiar, "everyone-knows-he's-crazy" doctor. But it was not. It was a solidly mainstream physician. He pooh-poohs nutrition, laughs when asked about nutritional supplements, thinks anyone complaining about symptoms less than a full-blown heart attack is a baby. He is respected by the primary care physicians, lectures on the advantages of prescription medications. In short, he is your typical conventional cardiologist.

This is the way they think. I know, because I was one of them. Thankfully, something banged me upside my head one day (my Mother's sudden cardiac death) and tipped me off to the painful irony of the conventional approach to heart disease.

There is NO amount of coronary disease appropriate for age. This notion is a remnant of the paternalistic, "I-know-better-than-you" attitude of the last century of medicine.

The 21st century promises a new age.

Quantum leaps

29. June 2008 William Davis (6)
A reader of The Heart Scan Blog and member of the Track Your Plaque program posted this comment on The Heart.org:

*The facts speak for themselves.*

Dr. William Davis and Dr. William Blanchet, your patients thank you for the low cost PREVENTIVE care you prescribe. The published facts speak for themselves. It is indeed a sad state of affairs, that the larger cardiology community does not take the time to research the data and results you have been reporting. Unfortunately it is the patients who are the victims of the mainstream, inappropriate, treatment protocols, as evidenced with the ongoing high rate of CV death rate.

I am dumbfounded by the lack of open-minded inquisitive curiosity to thoroughly research your claims by many/most cardiologists. Understood, we are all busy, but that is no excuse to stick with practices that do not result in major breakthrough improvements in patient outcomes.

Then again, we are all humans, and when "we" are convinced that "our" approach is correct, "we" tend to conveniently ignore any evidence to the contrary. "We" like to believe "we" have been right all along.

A very insightful book, recently published, says it all in its title: "Mistakes were made (but not by me)."

From the intensity of the comments on this topic, it is clear that we are in the middle of a battlefield. It is to be hoped that the facts will become visible before too much smoke obscures the field, and before the patients are all dead.

George Orwell said it correctly, back in 1946:

“We are all capable of believing things which we know to be untrue, and then, when we are finally proved wrong, imprudently twisting the facts so as to show that we were right. Intellectually, it is possible to carry on this process for an indefinite time: the only check on it is that sooner or later a false belief bumps up against solid reality usually on a battlefield.”

And, after several posts that preventive care with EBT would be too costly.....

*Heroic*

Prevention is what matters, but it is not very heroic. A hospital that advertises the highest volumes in heart bypasses and other heart "repair" procedures, sounds to many like a go-to place when one gets into trouble with one's heart.

Cardiologists who perform impressive surgical procedures are heroes. Not unlike fire-fighters. We celebrate them (deservedly!) for rescues and life saving heroic actions.

We tend to not pay much attention to the folks that work hard to minimize risk of calamities in the first place.

Similarly, we recently learned that it is too costly to build schools that are earthquake resistant in China. Parents had to look at their children's bodies, crushed.

Is it too graphic to imagine 20,000 American bodies, who died of heart disease, piled up on a field?

What will it take before we make prevention our first priority?

AL, Ann Arbor, Michigan


The reader also tells me that, prompted by his father's death from heart attack while following conventional advice after heart catheterization, he has lost 50 lbs and corrected his lipid patterns on the Track Your Plaque program. The reader is currently struggling with full correction of his severe small LDL pattern and is following some of the advice we discussed on our webinar recently.

Another Heart Scan Blog reader, Stan the Heretic, posted this quote from scientist, Max Planck, in his comment:


"A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." - M. Planck

(Max Planck was a German physicist who developed quantum theory, a disruptive set of ideas that supplanted other explanations of energy mechanics of the day.)


I fear that may prove to be the case for heart disease. The revenue-generating formula for heart disease management that dominates practice in cardiovascular medicine today is so deeply ingrained into the thinking and revenue expectations of practicing cardiologists that a preventive or reversal approach just won't cut it--even if it is vastly superior.

That's why it is important for you to take control yourself. You will be the one who obtains and applies the information that saves your life or the lives of those around you. It is, in all likelihood, NOT your doctor who will save your life, but YOU.

Body count

28. June 2008 William Davis (7)
Imagine the following headline:

War in Iraq a growing success: 20,000 Americans now dead!


If a newspaper ran that headline, we would all be outraged, and rightly so. Deaths in war are a tragedy. They are not something we celebrate.

Then why do we hear hospitals boasting about the number of bypass operations performed every year, number of heart catheterizations performed, number of heart attacks treated?


"_______ Hospital breaks 1000-heart bypass per year milestone"

"We treat more heart attacks than other other hospital in the state!"

"More people come to ________ Hospital than any other in the region!"



I hear this stuff on the radio, on TV, see it in newspapers and magazines, even on highway billboards every single day in Milwaukee.

Heart procedures, like deaths in war, are casualties of health.

They are not successes (though, of course, you can have a "successful" bypass). I see most procedures as a failure of prevention.

Death from heart attack is a failure of prevention. Tim Russert's death was a (unnecessary) failure of prevention. But so are bypass surgery, stents, and the like.

Such is the perverse state of affairs in hospitals and health: They celebrate illness. They glamorize it with ads displaying high-tech equipment, efficient staff in scrubs, "caring and friendly staff." But it is illness they are celebrating. Why? Because it has become a business necessity, a necessary strategy to remain competitive and profitable in the business called "healthcare" that makes money from treating people. The biggest return is from major procedures like bypass operations.

Every success in prevention denies the hospital an $80,000+ opportunity. You'll never hear that advertised.