What increases blood sugar more than wheat?

Take a look at these glycemic indexes (GI):


White bread 69
Whole wheat bread 72
Sucrose 59
Mars bar 68
White rice 72
Brown rice 66


I've made issue in past of whole wheat's high GI--higher than white bread. Roughly in the same glycemic league as bread are shredded wheat cereal, brown rice, and a Mars candy bar.

With few exceptions, wheat products have among the highest GIs compared to the majority of other foods. For instance:


Kidney beans 29
Chick peas 36
Apple 39
Ice cream 36
Snickers Bar 40


Yes, by the crazy logic of glycemic index, Snickers is a low-glycemic index food.

While I do not believe that low GI makes a food good or desirable, since low GI foods still provoke high blood sugars, small LDL particles, trigger glycation, and other abnormal phenomena, they are clearly less obnoxious than the items in the first list.

Take a look at this list:

Cornflakes 80
Rice cakes 80
Rice Krispies 82
Rice pasta, 92
Instant potatoes 83
Tapioca 81



Starches that are dried and/or pulverized, such as cornstarch, potato starch, rice starch, and tapioca starch (cassava root) will increase blood sugar even more than wheat. Foods with these starches have GI's of 80-100.

Cornstarch, potato starch, rice starch, and tapioca starch: Sound familiar? These are the main starches used in "gluten-free" foods. A hint of the high GI behavior of these dried starches is seen in the GI for cornflakes of 80.

So remember: Wheat-free is not the same as gluten-free. Gluten-free identifies junk carbohydrates masquerading as healthy because they don't contain one unhealthy ingredient, i.e. wheat.

Comments (38) -

  • Anonymous

    7/15/2010 3:20:49 PM |

    These are the reasons to go grain-free, except for flaxseed.

  • Suzan

    7/15/2010 3:46:32 PM |

    As a gluten intolerant person, I can say that those gluten-free foods make me ill. I favor a grain-free Primal diet.

  • Anonymous

    7/15/2010 3:48:19 PM |

    Is it also accurate to say that high glycemic index only applies to wheat, and not unrefined WHOLE wheat, or wheat KERNELS?

    Aaccording to this, wheat kernels's GI is less than 50:
    http://www.southbeach-diet-plan.com/glycemicfoodchart.htm

    Also, eating whole wheat makes you feel fuller longer, which is a benefit, no?

  • Peter

    7/15/2010 3:48:30 PM |

    I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease.  I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes.  anyone have a theory?

  • DrStrange

    7/15/2010 4:01:44 PM |

    "I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease. I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes. anyone have a theory?"

    There seems a stubborn tendency on this site to confound refined carbs ie flour products w/ intact, whole grain carbs.  They do behave differently in the body. Also, significant differences in some people's physiologies, individual, personal, differences that must be accounted for.  And probably most importantly, for the Africa etc question, total calorie intake is a huge factor.  If you eat more than your body needs, calories become excess blood sugar; spikes, triglycerides, etc.  US and western Europe, esp US, people just eat way to many calories because they are eating nutrient poor, manufactured, refined, imitation foods that do not satisfy the body's needs for nutrition in terms of micronutrients and oversupply calories.  If you only eat starches/carbs in the form of whole intact grains and starchy veg IN THE CONTEXT of a diet emphasizing micronutrient rich, nonstarchy veg, then you just will not have all the problems.

  • Jenny

    7/15/2010 5:47:17 PM |

    The glycemic index is a poor guide to carbohydrate impact because it is based on the fallacy that carbs that don't raise blood sugar at 1 hour after eating don't matter.

    They do.

    The carbs in many supposedly low glycemic foods WILL metabolise into glucose over a period of anywhere from 1.5 to 5 hours (Pasta) and when they do, they require insulin secretion to be dispersed.

    Also, "Glycemic Index" values for identical foods vary from study to study because the reading depends on the blood sugar status of the subjects used to test the foods. It is a junk measurement created by the food companies to fight the success of the low carb movement.

    Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health.

  • Pallav

    7/15/2010 6:19:28 PM |

    Dr Davis

    Dont be so stubborn. Get a hold of cooking practises as practised outside of your country too. If america is consuming wheat the wrong way, or you are consuming wheat in a wrong way don't implicate wheat in its entirety.

  • Pallav

    7/15/2010 6:21:32 PM |

    Imagine if i consume fish day and night cooked in hydrogenated vegetable oils and then implicate fish for my health problems. How stupid would that be?

  • John

    7/15/2010 6:51:53 PM |

    Hello, what happens if you consume bread with a fat or protein e.g. butter or cottage cheese.

    Will the bread contribute too much to insulin pike or will it be buffered by the fat/protein in the same serving?

    Thanks.

  • Carl

    7/15/2010 9:58:41 PM |

    Glycemic index if flawed in that it counts fructose as a carb for the denominator but uses glucose as the numerator -- at least as I understand it.

    Fructose follows a different metabolic path, but it is more destructive when in the blood than glucose -- which is probably why the liver does all the fructose metabolism.


    I revised glycemic index which used glucose and glucose based starches only in the denominator would be a better index to determine which foods slowly feed glucose into the body.

    Or, you can use glycemic index and just not look at fructose and sucrose containing foods.

  • Matt Stone

    7/15/2010 10:05:33 PM |

    Peter-

    Starches do not raise blood sugar or cause hyperinsulinemia in people on traditional diets because they are not insulin resistant like modern man on low-nutrient, refined-carbohydrate, vegetable and trans fat laden fare with a vast array of other complications.  

    Kitavans for example ate 69% of their food as unrefined carbohydrate, most of it as starch, yet the average fasting glucose is less than 70 mg/dl with zero documented cases of hyperglycemia or type 2 diabetes...

    http://180degreehealth.blogspot.com/2010/06/staffan-lindeberg.html

  • Dr. William Davis

    7/15/2010 10:10:58 PM |

    I have yet to meet a wheat product I liked.

    In my experience, they ALL increase blood sugar to one extravagant degree or another.

    Wheat also triggers inflammatory phenomenon more than any other food known. Celiac disease just one manifestation of wheat-triggered diseases.

  • Dr. William Davis

    7/15/2010 10:13:55 PM |

    Hi, Jenny--

    I agree wholeheartedly.

    We do the exact same thing as you: Count carbohydrate grams or check 1-hour postprandial glucoses. Works far better than the misleading glycemic index or glycemic load.

  • Anne

    7/15/2010 10:54:28 PM |

    After going gluten free I quickly discovered I felt better if I avoided all grains. I became very serious about eliminating grains after I found they all raised my blood glucose even if I ate them with fat and protein. I am now on a fairly simple primal-like diet.

    I run a support group for gluten intolerance and I tell people that the gluten free diet can be a healthy or as unhealthy as they want to make it. Sadly, many people who go gluten free don't want to change their diet other than to substitute gluten free products for their favorite wheat products. The market for gluten free foods has exploded and still growing. The most recent addition is Gluten Free Bisquick.

  • Lori Miller

    7/16/2010 12:42:56 AM |

    When I cut out wheat in January, my appetite ratcheted down and my bloating went away. That's reason enough for me to leave wheat alone.

    Since I cut way down on carbs in late February (probably less than 50g per day), a lot of aches and pains suddenly disappeared. The one in my left shoulder returns if I eat quite a bit of carb. For me, at least, it's carbs in general that seem to be inflammatory.

  • Lori Miller

    7/16/2010 12:51:06 AM |

    Jenny said, "Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health."

    This is what my mother and I have been doing for the past few months since we went low-carb. It's worked for us. (She's diabetic and I'm prone to acid reflux, so non-fiber carbs give us a smackdown very quickly if we eat too many of them.) It's easy, too, since it just involves looking at a label and doing a bit of subtraction. I never quite understood how the index worked--maybe because it doesn't?

  • Lori Miller

    7/16/2010 1:41:39 AM |

    For a thickener, I use xanthan gum. All the carbs in it are fiber. It's expensive, but a little goes a long way. I use half a teaspoon to thicken my protein/peanut butter shake, which is around 12 ounces.

  • julianne

    7/16/2010 3:20:33 AM |

    I have followed a low Glycemic load diet (always with protein and moderate carbs at each meal, plus a little good fat) in two different ways, for 12 years I used small amounts of grains including wheat (Zone Diet). 14 months ago I removed grains and legumes (but kept to Zone ratio as it works well for me) after reading this outstanding paper by Loren Cordain.
    "Cereal Grains: Humanities double edged sword"
    http://www.thepaleodiet.com/articles/Cereal%20article.pdf

    The difference was amazing - no more PMS breast pain, no more menstrual cramps, no more joint swelling, some fat loss, ganglion cyst that I'd had for 10 years shrank, no more constipation, all I can say is: try it - grain free is a cut above managing glycemic load with grains.
    Even fruit and it's fructose content is fine in moderate amounts (2 -3 serves day)

  • Anonymous

    7/16/2010 3:58:51 AM |

    I have celiac and type II diabetes, the fastest way to get my blood sugar in the danger zone is to eat "gluten-free" foods.  1/2 of a gluten free 6 inch pizza on a recent camping trip when we stopped in town for lunch sent me over 200. The only answer is to stick with real food, and skip anything with tapioca starch!

  • Bilal Shanti

    7/16/2010 10:18:01 AM |

    For people who respond well to low-carb diets, it’s important to sort out the nutritional value of a food from its affect on blood sugar. For someone who is (take your pick as they mean similar things): sensitive to sugar, prediabetic, Type 2 diabetic, insulin resistant, or has metabolic syndrome, keeping blood glucose stable is an important priority for health. In that way, it’s not much different from any condition that is treated by diet tradeoffs must be made. Someone who is allergic to wheat, for example, can still eat a balanced, healthy diet without harming their body. So can someone who strives for stable, normal levels of blood sugar.

    My Social Bookmarks: Bilal Shanti Facebook, Dr. Bilal Shanti Wordpress, Bilal Shanti MD Vitals, Dr. Bilal Shanti MD SiliconIndia, Bilal Shanti 123people, Bilal Shanti MD LinkedIn

  • Food, flora and felines

    7/16/2010 1:36:51 PM |

    @ Peter: Maybe it's the letcins? I came across a bit on how lectins may promote obesity (and so metabolic syndrome) in the whole food health source recently;

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins.html

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins-part-ii.html

  • DrStrange

    7/16/2010 3:50:39 PM |

    anonymous: "The only answer is to stick with real food...!"

    ALWAYS!!!

  • help to stop smoking

    7/16/2010 6:22:54 PM |

    For most people, this is just interesting, albeit, a little confusing. It is for me anyway. I don't pay attention to anything I eat, except I try to avoid desserts (when possible).

    I'm curious, are there simple guidelines for those who are gluten intolerant or have similar food "issues". Also, don't most people who "feel" they are gluten allergic, not?

    I read somewhere that it takes an endoscopic biopsy to officially diagnosis someone as gluten intolerant? For instance, a family member thinks she is because she thinks bread gives her gas. Weird, huh? Last time I checked, EVERYTHING gave her gas! Smile

    But apparently the internet has many sites just waiting to fill her head with crazy ideas.

  • Dr. William Davis

    7/16/2010 6:42:37 PM |

    Hi, Help to stop--

    My personal view is that all humans should stop consuming wheat. There is more to wheat intolerance than celiac disease, the conventionally accepted health problem provoked by wheat gluten.

    But there are so many other expressions of wheat intolerance that are rarely diagnosed, from childhood behavioral disorders to unexplained ataxias (imbalances due to neurologic deterioration) to peripheral neuropathies to diabetes to heart disease . . . and the list goes on and on.

    The difficult thing is that the majority of these people with non-celiac wheat intolerances test negative for celiac markers like anti-endomysial antibodies and anti-gliadin IgG.

  • Anonymous

    7/16/2010 10:24:18 PM |

    As I understand it the glycemic index was set using only slender healthy college age men, hardly a model for me!

  • Lori Miller

    7/17/2010 12:22:13 AM |

    @Help to Stop, according to Norm Robillard, a microbiologist, carbohydrates produce gas in the digestive tract. Fat and protein, not so much. In my case, wheat--especially whole wheat--made me so bloated I looked like I was pregnant. (Look up "wheat belly" on this site.) Since cutting out almost all the starchy, sugary carbs, I no longer have this problem. I recommend your family member with the gas problem try a low carb diet and avoid dairy products.

  • Pallav

    7/17/2010 4:50:20 PM |

    Dr. Davis.

    "wheat is not for human consumption"
    .
    knock knock! anyone home?
    cooking styles? perhaps?
    .
    Hydrolysis and depolymerization of gluten proteins during sourdough fermentation
    http://pubs.acs.org/doi/abs/10.1021/jf034470z
    .
    Sourdough Bread Made from Wheat and Nontoxic Flours and Started with Selected Lactobacilli Is Tolerated in Celiac Sprue Patients http://aem.asm.org/cgi/content/abstract/70/2/1088
    .
    Potential of sourdough for healthier cereal products http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHY-4F6CRDT-2&_user=10&_coverDate=03%2F31%2F2005&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383360&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c744a61e5abbed1ed60c4a079ff39fb5.
    .
    Prolonged Fermentation of Whole Wheat Sourdough Reduces Phytate Level and Increases Soluble Magnesium http://pubs.acs.org/doi/abs/10.1021/jf001255z
    .
    Phytase activity in sourdough lactic acid bacteria: purification and characterization of a phytase from Lactobacillus sanfranciscensis  CB1
    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4846KTT-11&_user=10&_coverDate=11%2F01%2F2003&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383734&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b30d3245227db0269ca748da5d73c62f
    .
    Article
    Moderate Decrease of pH by Sourdough Fermentation Is Sufficient To Reduce Phytate Content of Whole Wheat Flour through Endogenous Phytase Activity http://pubs.acs.org/doi/abs/10.1021/jf049193q

    i'm curious why wheat is still unsuitable after neutralizing gluten and phytic acid?

    kindly explain the science dr. davis!

  • TomF

    7/17/2010 9:23:30 PM |

    Can you successfully build muscle mass on a grain free/low-carb diet?  I am eating to gain weight, but I'm concerned my diet is not optimal (i.e. heavy in carbs).  However, I'm afraid that if I drop the carbs down I could end up doing myself a disservice in terms of building muscle mass.

  • Lori Miller

    7/18/2010 1:41:41 PM |

    Tom F, I was a Body-for-Lifer for six years. For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go.

    Recently, I started the Slow Burn program by Fred Hahn. It's a strength training program. Having done weightlifting for six years, I was fairly strong, but I've found these exercises very challenging--especially the one-legged squats. With the BFL exercises, I was at the limit of what my joints, not muscles, would take. With Slow Burn, the exercises are easier on your joints, so my muscles are getting more of a workout.

    A few people have written about the Slow Burn program: Dr. Michael Eades (he's a co-author of the book: http://www.proteinpower.com/drmike/uncategorized/slow-burn-fitness-for-boomers/

    Tom Naughton: http://www.fathead-movie.com/index.php/2009/10/01/taking-the-6-week-cure-almost/

    and me (see comments too, Fred Hahn was kind enough to make some suggestions).
    http://relievemypain.blogspot.com/2010/07/exercise-without-joint-pain.html

  • DrStrange

    7/18/2010 3:16:59 PM |

    "For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go. "

    It's all about individual physiology and uniqueness.  I basically had the opposite reaction when I did this, going from moderate fat fairly high carb "health food "diet. After about 9 months on low carb (approx 30 grams/day total) high fat diet, I felt like I was dragging an anchor all day every day. Gradually worse as time passed. If I did even mild exercise ie Nordic Walking for a couple miles, I would be totally wasted to the point I would almost have to sleep for a couple hours then continue to feel exhausted for another 24 hours or so.  Finally got smart and went the other way first McDougall and got my energy back then "upgraded" to Fuhrman and finally stabilized blood sugar etc.

  • Dr. William Davis

    7/18/2010 4:47:52 PM |

    Pallav-

    Please read the past posts in this blog.

    Wheat is not just about gluten, though gluten proteins are indeed a major part of the adverse reaction to wheat.

    We also have neurologic phenomena attributable to wheat, only some of which may be gluten-mediated. We have amylopectin A, among the most highly digestible starches known, accounting for wheat ability to increase blood sugar more than just about all other carbohydrates.

  • rmarie

    7/19/2010 3:50:35 AM |

    @ Dr. Strange
    We know each other from the McDougall forum. I left, because I couldn't take the constant hunger any more, even though I ate practically all day long. I lost so much weight that my BMI was down to 17.5. I did McD for almost 1 1/2 years. At the end I weighed 3 pounds less than when I was 17 - which was 50 years ago!

    (note to others, I'm 4'11" started McDougall weighing 93 lbs and within 3 months was down to 88 and then actually went down to 85lbs. That's when I said 'no more' and went over to the low(er) carb community (60-80g).

    Unlike most people I have never had any aches or pains, joint problems or digestive problems in my life.
    And I've always been very active with lots of energy both with low-fat/high carb or low-carb/high fat. I see no difference except that I can now often go 3-4 hours between meals before I get hungry.

    But I did not adopt the american way of eating (junkfood and sodas) after coming here from Europe. I started McDougall starch based diet because of its promise to lower blood sugar (he does have many success stories, helped change people's lives in more than 30 years and offers many well researched science based articles to support his position). It is so confusing when each side is certain they have the answer WITH STUDIES TO PROVE IT.

    I have been pre-diabetic for at least 10 years that I know of. Doc never said much because the cut off number was 126 and I was well below that.

    Low-fat, high carb surprisingly did not change my BS much either way. I certainly did NOT have the reaction Dr. Davis talks about.

    Everyone reacts differently (maybe there is something to the metabolic typing after all?

  • Pallav

    7/19/2010 9:05:31 AM |

    Dr davis

    Thanks for your reply. what wheat contains is probably not entirely known, ill give it to you because of the clinical results coming through but wheats culpibility in the crime is quite interesting and certainly whether some component of wheat is responsible for the results you are observing or whether it is just a matter of preparation would certainly call for further investigation.

  • JTownsend

    7/21/2010 10:07:28 PM |

    Inspired by the good doctor I have essentially eliminated all grains from my diet, particularily wheat, with positive results. But I must admit that I do still enjoy a cold beer and am loath to
    forsake this one precious pleasure. Where does beer fit in I wonder? It is a grain product I guess just like bread or cereal. So is it on the banned list for cardiac health?

  • Anonymous

    7/23/2010 3:41:22 PM |

    Is there a safe sandwich bread out there in most local stores?  I eat sandwiches most every day and I'm trying to figure out how to follow your advice re wheat.

  • Anonymous

    8/26/2010 4:23:10 PM |

    Try Glucose Level by Sprunk-Jansen.

    GLUCOSE LEVEL helps to support glucose metabolism and to maintain insulin levels already within the normal range. GLUCOSE LEVEL uses four plant extracts - nettle, salt bush, walnut and olive - which work together to help bring your blood sugar levels into alignment.

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Dr. Cannell comments on vitamin D lab tests

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

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

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?

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

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

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

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"

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

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

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.