"Get regressive"

6. May 2009 William Davis (0)
This caught my eye:



Niaspan, prescription niacin, now sold by Abbott Laboratories, is now promoting its advantages in regressing coronary plaque:



In patients with a history of coronary artery disease (CAD) and hypercholesetgerolemia, Niaspan (niacin), in combination with a bile acid-binding resin, is indicated to slow progression or promote regression of atherosclerotic disease.



And the new slogan: "Get regressive."



Interestingly, the new marketing campaign is based on relatively old data. They base this new claim on 3 studies:



1) Cholesterol-Lowering Atherosclerosis Study (CLAS)--a 1987

CRP House of Cards

4. May 2009 William Davis (15)
Lew has coronary plaque with a heart scan score of 393. At age 53, that's in the 90th percentile (higher score than 90% of men in his age group).

On our search for causes of his coronary plaque, we identify low HDL of 41 mg/dl, high triglycerides of 202 mg/dl, small LDL (83% of total), calculated LDL of 133 mg/dl, and severe vitamin D deficiency with a starting blood level of 25-hydroxy vitamin D of 19 ng/ml.

His c-reactive protein: 4.1 mg/dl--above the cut-off of 2.0 mg/dl that the pharmaceutical industry is targeting as a mandate for statin therapy, particularly given the JUPITER data.

Lew instead eliminates wheat and other small LDL-provoking foods and, as a result, loses 28 lbs in 3 months; adds omega-3 fatty acids from fish oil; supplements vitamin D sufficient to increase his blood level to 70 ng/ml.

Along with dramatic correction of his starting abnormalities, his c-reactive protein: 0.4 mg/dl--no statin drug.

In my view, increased CRP is nothing more than a surrogate for the inflammatory phenomena that arise from high-carbohydrate diets, overweight, and small LDL. Correct those and CRP drops off a cliff. In fact, it is exceptionally rare for CRP to not drop to very low levels following this formula.

I believe that CRP is one more item on the list of reasons--the house of cards--the pharmaceutical industry is building to persuade us to take more and more statin drugs. LDL not low enough? Take more statin. Diabetic with low cholesterol? Take a statin. Inflammation? Take a statin.

Enough already.

At-home blood tests

2. May 2009 William Davis (6)
Our at-home blood tests are proving a hit.

So far, vitamin D is the number one most popular test, no surprise.

Second--to my surprise--is DHEA. I would have predicted it would have been thyroid testing.

Our male and female hormone panels are also proving popular.

I've personally been using the thyroid and vitamin D testing to monitor my levels. I increased my Armour thyroid based on a low free T3 value, while my vitamin D was perfect at 77 ng/ml on 8000 units vitamin D3 (cholecalciferol) per day.

The process of performing the blood spots is straightforward. The finger pricks are virtually painless using the automatic spring-loaded finger stick devices:





The number of blots to make depends on how many tests you'd like. Just a vitamin D test requires 2 blots. If 6 or more tests are ordered at a time, then all 12 blots should be made. (Two spring-loaded lancets are provided in each kit.)





If you are interested in any of our at-home blood tests, go here.

Our own Heart Hawk has posted an editorial on about blood spot testing on Health Central:

Simple, affordable home blood testing is a real game-changer in the arena of informed, self-directed healthcare. For the first time broad access to home blood testing, on a scale similar to that enjoyed by persons who routinely test their blood sugar, is available to virtually everyone and it removes doctors as the gatekeepers of these tests. Even private insurance companies and Medicare are beginning to understand the potential for improving healthcare and decreasing costs and are slowly beginning to expand coverage of home blood testing much as they do for diabetics or persons taking anti-coagulants.

"Help keep your family goiter free"

1. May 2009 William Davis (10)
People ask, "If I need iodine, should I go back to iodized salt?"

First of all, how did this notion of iodized salt originate?

In 1924, J. Edgar Hoover was appointed head of the FBI, Marlon Brando and Doris Day were born, and Calvin Coolidge was elected President of the United States. Half of American households had a car, while 1 in 4 Americans were illiterate.



In the 1920s, cities were a fraction of their current size and a third of the U.S. population, or 36 million people, lived in small rural communities.

Goiters were also wildly prevalent in 1924. Up to a third of the population in some areas of the country, particularly the Midwest, suffered from goiters, thyroid glands that enlarged due to lack of iodine.

Goiters were not only unsightly, but sometimes grotesque, causing a visible bulge in the front of the neck. Occasionally, they would grow so big that it compressed adjacent structures, like the trachea, and would have to be surgically removed. Goiters were commonly associated with thyroid dysfunction, especially low thyoid or hypothyroidism, that resulted in low IQ's in schoolchildren, debilitation in adults. Women of childbearing age delivered retarded children.

So iodine deficiency in early 20th century America was a big problem. How to solve this enormous public health problem in a large nation without television, few radios, no internet, with a largely rural and often illiterate population?

Thus was iodized salt born, a simple, technologically available solution that could be implemented on a large scale nationwide at low cost. The FDA chose this route in 1924, figuring that it was the best way to ensure that most Americans could obtain sufficient iodine through liberal use of iodized salt. Public health officials urged Americans to use salt. Morton's salt label proudly bore the slogan "Help keep your family goiter free!"

It worked. Goiters largely became a thing of the past.

How about today? The American Heart Association recommends limiting salt, recently announcing that they would like to limit intake to 1500 mg per day. The American Medical Association has been lobbying the FDA to set lower salt limit guidelines. The FDA has been clamping down on food manufacturers to reduce the quantity of salt in processed foods.

Why limit salt? The concern is that there are segments of the population (not all) that are salt sensitive, particularly African Americans, people with certain genetic forms of high blood pressure, conditions that cause water retention, and any degree of heart or kidney failure. Salt in these peoplem, in fact, can be disastrous.
So adding iodine to salt was the solution to epidemic goiter. And it worked.

But salt is not a perfect solution, just one that served its purpose back in 1924. What we need is a 21st century solution.
You will find that in the various iodine supplements at your health food store. My favorite is kelp--inexpensive, available, and a form that mimics the way Japanese people obtain iodine (though by eating seaweed, rather than with tablets).


Image of kelp courtesy Wikipedia

Thumb your nose at swine flu

29. April 2009 William Davis (35)
Judging from what we know about vitamin D, it is highly probable that it confers substantial protection from viral infections, including swine flu.

Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com) first connected the dots, identifying the possibility of an influence of vitamin D on incidence of flu.

In 2006, Dr. Cannell reports noticing that the patients in his psychiatric ward in northern California were completely spared from the influenza epidemic of that year, while plenty of patients in adjacent wards were coming down with flu. Dr. Cannell proposed that the apparent immunity to flu in his patients may have been due to the modest dose of 2000 units vitamin D per day he had prescribed that the patients in other wards had not been given. (Since the hospital was run by the state of California, Dr. Cannell apparently had only so much leeway with vitamin D dosing.) While it’s not proof, it’s nonetheless a fascinating and compelling observation.

A similar conclusion was reached in a recent analysis of the National Health and Nutrition Examination Survey demonstrating that the higher the vitamin D blood level, the less likely respiratory infections were.

Personally, I used to suffer through 2 or 3 episodes of a runny nose, sore throat, hacking cough, fevers and feeling crumby every winter. Over the last 3 years since I’ve supplemented vitamin D, I haven’t been sick even once. The past two years I didn’t bother with the flu vaccine, since I suspected that my immunity had been heightened: no flu either winter.

And so it has been with the majority of my patients. Since I began having patients supplement vitamin D to achieve normal blood levels (we aim for 60-70 ng/ml), viral and bacterial infections have become rare.

New research is uncovering myriad new ways that vitamin D enhances natural immune responses to numerous infections, including tuberculosis, bacteria such as those causing periodontal disease and lung infections, and viruses like the influenza virus. Enhanced immunity against cancer is also an intensive area of research on vitamin D.

Will vitamin D supplementation sufficient to achieve desirable blood levels confer sufficient immunity to swine flu should it come to your door? From what we know and what we’ve seen in the few years of vitamin D experience, I think it will in the majority. But I do believe that we should still heed public health warnings to avoid contact with others, minimize exposure to crowds, avoid travel to affected areas, etc.

Will the real LDL please stand up?

26. April 2009 William Davis (13)
The results of the latest Heart Scan Blog poll are in.

The question: How has your LDL been measured? The 187 responses broke down as:


I have only had a conventional calculated value
108 (57%)

NMR LDL particle number
35 (18%)

Apoprotein B
21 (11%)

Direct LDL cholesterol
21 (11%)

Non-HDL cholesterol
8 (4%)

I don't know what you're talking about
23 (12%)


Remember the TV game show, To Tell the Truth? Celebrities would have to guess which of three guests represented the real person, such as the notorious con man, Frank Abagnale, Jr., or Mad Magazine publisher, William M. Gaines (who stumped celebrity Kitty Carlisle, heard to exclaim, "I never figured it was him. I mean look at the way he's dressed. I was looking for someone who ran a very successful magazine, so I thought it couldn't be him!")

The celebrities playing the game were permitted to ask the three guests a series of questions, hoping to discern who was the real person vs. the two impostors. At the end, each celebrity had to guess who was truly the person of interest. "Will the real Frank Abagnale, Jr. please stand up!"

If we were to act as the celebrities in our LDL game, we quickly discover some telling facts:

--Conventional LDL cholesterol (the only value 57% of our poll respondents have had) is calculated, not measured. LDL is calculated using the 40-year old Friedewald calculation.

--Directly measured LDL cholesterol (the value 11% of respondents had) is just that: directly measured. It eliminates some of the uncertainties of calculated LDL.

--Apoprotein B-Every LDL and VLDL particle produced by the liver contains one apoprotein B molecule. ApoB therefore provides a crude particle count measure of LDL and VLDL particles. Of course, it includes VLDL and is not completely the same as just an LDL measure. Some lipid authorities Like Dr. Peter Kwiterovich have advocated that apoB replace calculated LDL, and that calculated LDL essentially be discarded.

--Non-HDL cholesterol--I mention this more for completeness. Hardly anybody uses this crude value in practice--Indeed, only 4% of our poll respondents had this measure/calculation. Non-HDL is simply total cholesterol minus HDL cholesterol = Non-HDL cholesterol. It is thus a combination of cholesterol in LDL and VLDL (triglycerides), similar to apoprotein B. While, like apoB, it is a bit different in that it includes VLDL, it has proven a superior measure of risk.

--LDL particle number--In my view, this is the gold standard for LDL and risk measurement, obtained by only 18% of our poll respondents. LDL particle number is proving superior for discriminating who is truly at risk for a cardiovascular event, particularly when metabolic syndrome or diabetes is part of the picture, i.e., when HDL and triglycerides are considerably distorted, leading to substantial corruption of calculated LDL.


While 18% is a minority, it still represents growth in recognition that conventional calculated LDL cholesterol is an unreliable, inaccurate, and outdated value. If the real LDL were to stand up, I believe that it is LDL particle number that would spring to its feet.

Vitamin D and inflammation

25. April 2009 William Davis (9)
We already know that vitamin D reduces inflammatory processes, since several markers, including c-reactive protein and IL-6 have previously been shown to drop substantially with vitamin D. Inflammation underlies coronary atherosclerotic plaque growth, as well as plaque rupture that triggers heart attack.

A German group has now shown that the important inflammatory marker, tumor necrosis factor (TNF), is also reduced by vitamin D supplementation. Many studies have implicated increased TNF levels in promoting cancer.

In this study, a modest vitamin D dose of 3320 units (83 micrograms) was given vs. placebo. The 25-hydroxy D level reached in the treated group was 34.2 ng/ml (85.5 nmol/L), which resulted in a 26.5% reduction in TNF compared with 18.7% reduction (?) in the placebo group.


Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers.

Zitterman A, Frisch S et al.

BACKGROUND: High blood concentrations of parathyroid hormone and low concentrations of the vitamin D metabolites 25-hydroxyvitamin D [25(OH)D] and calcitriol are considered new cardiovascular disease risk markers. However, there is also evidence that calcitriol increases lipogenesis and decreases lipolysis.
OBJECTIVE: We investigated the effect of vitamin D on weight loss and traditional and nontraditional cardiovascular disease risk markers in overweight subjects.
DESIGN: Healthy overweight subjects (n = 200) with mean 25(OH)D concentrations of 30 nmol/L (12 ng/mL) received vitamin D (83 microg/d) or placebo in a double-blind manner for 12 mo while participating in a weight-reduction program.
RESULTS: Weight loss was not affected significantly by vitamin D supplementation (-5.7 +/- 5.8 kg) or placebo (-6.4 +/- 5.6 kg). However, mean 25(OH)D and calcitriol concentrations increased by 55.5 nmol/L and 40.0 pmol/L, respectively, in the vitamin D group but by only 11.8 nmol/L and 9.3 pmol/L, respectively, in the placebo group.


(Calcitriol = 1,25-dihydroxy vitamin D.)


Knowing your vitamin D blood level is crucial, as individual need for vitamin D varies widely from one person to the next. You can get your vitamin D tested at home by going to Grassroots Health or the Track Your Plaque Marketplace.

Even monkeys do it

24. April 2009 William Davis (6)

It all started back in the 1960s, when ape-watching anthropologists, Drs. Jane Goodall and Richard Wrangham, observed chimps foraging for a specific variety of leaf, which they consumed whole while wrinkling their noses in presumed disgust. Subsequent study showed that the leaves contained a powerful anti-parasitic compound.

A similar observation followed in 1987 by Dr. Michael Huffman from the University of Kyoto. During his year of living in the jungles of Tanzania, he observed chimpanzees in their native habitat. On one unexpected morning, he observed a female chimp, Chausiku:

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Dr. Michael Huffman’s description of Chausiku documents a fascinating example of animal self-medication what some call "zoopharmacognosy."
In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds. Chimps in this region commonly suffer infestations of parasites like Strongyloides fuelleborni (thread worm), Trichuris trichiura (whip worm), and Oesophagostomum stephanostomum (nodular worm). They have somehow stumbled onto a treatment that they administer themselves.

Chimpanzees have inhabited earth for over 6 million years. Who knows how long they and other primates have practiced some form of self-medication.

If chimpanzees can do it, I believe that we, as human primates, can also practice a similar form of self-directed health--homopharmacognosy?



Image courtesy Wikipedia

Cath lab energy costs

22. April 2009 William Davis (6)
In honor of Earth Day, I thought I'd highlight the unexpectedly high carbon costs of activities in hospitals, specifically the cardiac catheterization laboratory.

A patient enters the cath lab. The groin is shaved using a plastic disposable razor, the site cleaned with a plastic sponge, then the site draped with an 8 ft by 5 ft composite paper and plastic material (to replace the old-fashioned, reusable cloth drapes). A multitude of plastic supplies are loaded onto the utility table, including plastic sheaths to insert into the femoral artery (which comes equipped with a plastic inner cannula and plastic stopcock), a multi-stopcock manifold that allows selective entry or removal of fluids through the sheath, a plastic syringe to inject x-ray dye, plastic tubing to connect all the devices (total of about 5 feet), and multiple plastic catheters (3 for a standard diagnostic catheterization, more if unusual arterial anatomy is encountered).

All these various pieces come packed in elaborate plastic (polyethylene terephthalate or other polymers) containers, which also come encased in cardboard packaging.

Should angioplasty, stenting, or similar procedure be undertaken, then more catheters are required, such as the plastic "guide" catheters that contain a larger internal lumen to allow passage of angioplasty equipment. An additional quantity of tubing is added to the manifold and stopcock apparatus, as well as a plastic Tuohy-Borst valve to permit rapid entry and exit of various devices into the sheath.

Several new packages of cardboard and plastic are opened which contain the angioplasty balloon, packaging which is usually about 4 feet in length. The stent likewise comes packaged in an 18-inch or so long package with its own elaborate cardboard and plastic housing.

At the conclusion of the procedure, another cardboard/plastic package is opened, this one containing the closure device consisting of several pieces of plastic tubes and tabs.

If the procedure is complicated, the number of catheters and devices used can quickly multiply several-fold.

By the conclusion of the procedure, there are usually two large, industrial-sized trash bins packed full of cardboard, plastic packaging, and discarded tubing and catheters. The trash is so plentiful that it is emptied following each and every procedure. None of it is recycled, given the contamination with human body fluids.

That's just one procedure. The amount of trash generated by these procedures is staggering, much of it plastic. I don't know how much of the U.S.'s annual plastic trash burden of 62 billion pounds (source: EPA) originates from the the cath lab, but I suspect it is a big number in total.

So if you are truly interested in reducing your carbon footprint and doing your part to be "green," avoid a trip (or many) to the cath lab.

Wag the Dog

20. April 2009 William Davis (7)
What if the system to provide heart care has already gotten as big as it should be?

Worse (for hospitals), what if it’s already far larger than it needs to be? Can the system continue to increase revenues if they’ve already attained titanic proportions and outgrown demand? After all, darn it, there are only so many sick people around.

Hospital administrators might have to face an unpleasant choice: downsize to strip excess capacity and suffer the consequences in a competitive market, or . . . fabricate demand for their services.

Like the Dustin Hoffman and Robert DeNiro characters in the movie, Wag the Dog, about how two media-manipulators divert public attention away from a Presidential sex scandal by fabricating a war, spin is everything. It’s enough to sidetrack public attention from a scandal, obscure a truth, send us on a useless detour.

If healthcare for the heart isn’t driven by need, but many still desire to reap the benefits of the procedure-focused system, why not increase the perceived need?

That’s precisely the course that many hospital systems have chosen to follow. If the market you serve has been tapped to its full potential, then grow the market.

Imagine if a company like General Motors were to operate this way. In 2006, for instance, GM sold 9.1 million automobiles. If GM executives were to decide that they’d like to outstrip Toyota by boosting sales by 10% to 10 million, how would they do it? They would first have to determine whether it was feasible to grow demand for their product. If deemed possible, the company would need to ramp up manufacturing capacity to anticipate increased demand. If they miscalculate, GM could be stuck with a costly surplus and have to swallow the costs, maybe selling leftovers at a loss. (We don’t mean to pick specifically on GM; they’re a fine company as far as we’re concerned. This is just a hypothetical illustration.)

But what if a company could concoct some sort of scheme to persuade the car-buying public that they just had to have their cars or trucks? In other words, they could, in effect, create demand for their products.

As perverse as it sounds, that is exactly what occurs in healthcare for heart disease. The system long ago exceeded the necessary level of infrastructure to maintain a high-quality level of care accessible to most Americans. Instead, it continues to grow through a distortion of perception, delivering more services of increasing complexity to larger and larger numbers of people.

The size of the market is therefore a manipulable thing, something that can be massaged and cultivated. There are a variety of clever ways to exaggerate the need for heart procedures.

Why not raise the alarm for heart disease every chance you get? When a local sports figure survived a heart attack here in Milwaukee, St. _____ marketing department was right there, broadcasting the process in TV ads after his recovery. What could be more American than baseball, apple pie . . . and St. _____ Hospital? After his hospital discharge, the 57-year old local icon was shown on the sidelines with his team, back on the job, and at home with family, all beaming, just three months after a bypass operation. “I received only the very best care at St. _____ Hospital. They treated me like family. St. _____ doctors and nurses are the best!” Predictably, a two-month long spike in hospital testing followed filled with people worried whether they, too, might be in imminent danger. Several local cardiologists boasted of the many sports figures who came through the stress testing and heart catheterization labs, though virtually all checked out to be fine.

Though it can serve a legitimate purpose in some situations, stress tests are the ultimate example of a heart scam built on the perception of danger. Pull people in with promises of reassuring them whether or not they have heart disease, only to provide murky results that usually do no such thing. The pitfalls of the test are turned to advantage. The all too common equivocal or mildly abnormal result can be converted into a hospital procedure. (Imagine you could perform such alchemy on the uncertain calculations on your income taxes.)

With millions of stress tests performed every year and the push to perform more and more screening tests, the market has, in effect, been expanded—even though no increase in the disease itself has actually occurred.

Beware: As the scramble for heart patients intensifies, you are going to feel like you are being pulled closer and closer into the jaws of this hungry monster called the American cardiovascular healthcare machine.
Unexpected effects of a wheat-free diet

Unexpected effects of a wheat-free diet

17. September 2009 William Davis (59)
Wheat elimination continues to yield explosive and unexpected health benefits.

I initially asked patients in the office to eliminate wheat because I wanted to help them reduce blood sugar and pre-diabetic tendencies.

A patient would come to the office, for example, with a blood sugar of 118 mg/dl (in the pre-diabetic range) and the other phenomena of pre-diabetes or metabolic syndrome (high blood pressure, high inflammation/c-reactive protein, low HDL, high triglycerides, small LDL), and the characteristic wheat belly. Eliminate wheat and, within three months, they lose 30 lbs, blood sugar drops to normal, blood pressure drops, triglycerides drop by several hundred milligrams, HDL goes up, small LDL plummets, c-reactive protein drops.

People also felt better, with flat tummies and more energy. But they also developed benefits I did not anticipate:

--Improved rheumatoid arthritis--I have seen this time and time again. Eliminate wheat and the painful thumbs, fingers, and other joints clear up dramatically. Many former rheumatoid sufferers people tell me that one cracker or pretzel will trigger a painful throbbing reminder that lasts a couple of hours.

--Improved ulcerative colitis--People incapacitated with pain, cramping, and diarrhea of ulcerative colitis (who are negative for the antibodies for celiac disease) can experience marked improvement. I've seen people be able to stop all their nasty colitis medications just by eliminating wheat.

--Reduction or elimination of irritable bowel syndrome

--Reduction or elimination of gastroesophageal reflux

--Better mood--Eliminating wheat makes you happier and experience more stable moods. Just as wheat is responsible for a subset of schizophrenia and bipolar illness (this is fact), and wheat elimination generates dramatic improvement, when you or I eliminate wheat, we also experience a "smoothing" of mood swings.

--Better libido--I'm not sure whether this is a consequence of losing a belly the size of a watermelon or improvement in sex hormones (esp. testosterone) or endothelial responses, but more interest in sex typically develops.

--Better complexion--I'm not entirely sure why, but various rashes will often dissipate, bags under the eyes are reduced, itching in funny places stops.


It's also peculiar how, after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people.

Obviously, people with celiac disease, who can even die of exposure to wheat, are even worse. What other common food do you know of that makes us sick so often, even occasionally with fatal outcome?
Tags :

Comments (59) -

  • Olga

    9/17/2009 1:08:20 PM |

    Hi Dr. Davis:

    Are you familiar with Dr. Wolfgang Lutz from Austria.  He has a book entitled "Life Without Bread."  He has been treating patients with a low carbohydrates diet for over 40 years and he has seen improvements in the same conditions in his patients.  In his book he presents data from his patients over the last 40 years and it's very impressive.  Here is the amazon.com link to the book:
    http://www.amazon.com/Life-Without-Bread-Low-Carbohydrate-Diet/dp/0658001701/ref=sr_1_1?ie=UTF8&s=books&qid=1253192708&sr=8-1

    Thanks so much for writing this blog.

  • Adam Wilk

    9/17/2009 1:23:39 PM |

    I absolutely agree with what you're saying here--for the most part, I do not eat wheat, but I must tell you, the desire for any wheat product never leaves (in my case, anyway) and is frequently craved--but what a punishment for indulging, even once in a great while:
    A few days ago, whilst enjoying a delicious mostly protein and fat dinner at Outback, my wheat devil got the best of me, and I took a mere slice of that delicious bread they put on the table, with a generous pat of butter.  Within 5-10 minutes, I literally felt my nose and sinuses swelling up on me.  Not fair, but reality.
    Hmmph.

  • Helena

    9/17/2009 1:43:44 PM |

    Oh this is so true! I love myself when I stop eating wheat and a lot of sugars - can't get enough sex och have much more energy!

    But from time to time I fall back and just crave that pasta... and every time I do, I regret it; Stomach cramps is always what will be served for dessert!

  • Anonymous

    9/17/2009 2:35:30 PM |

    Dairy and lots of sugar.
    But wheat might be the worst.

  • Susan

    9/17/2009 2:48:41 PM |

    Two years ago, my knees hurt so badly that I avoided sitting in low chairs (I couldn't get out of them) and I was "one-footing" stairs. Then I went on a low-carb diet and the pain cleared up. I failed to put two and two together until a trip to France where I "allowed" myself small amounts of bread and suddenly it became important to know if a metro stop had an escalator. Now I know that eating wheat will result in knee pain 48 hours later.

    Fast forward to this summer when my 24-year-old daughter was having stomach pain--it was after meals, but sometimes the pain woke her in the night. "Heartburn," said her physician, maybe related to stress, and put her on Nexium for a month to see if it cleared up. It did, but returned when her prescription was over. Having read about the side effects of PPI use, I suggested to my daughter that she consider eliminating gluten and/or milk products for a while to see if that helped. She did (although she whimpered a bit about giving up beer). The pain disappeared almost immediately, and a bit of experimentation showed that it was wheat and only wheat that caused the pain (cheers).

    When my daughter described the pain, I realized that I had the same symptom when I was her age, but I didn't have it looked into because it never lasted long enough to bother with (I'm one of those doctors' kids who avoid doctors).

    So my question is, in light of all of the signs that point to wheat intolerance as a cause of gastrointestinal distress and joint pain and a whole lot of other things, why is eliminating wheat not the first course of action?

    By the way, I found the recent article in Scientific American on celiac disease, leaky gut and automimmune disease to be very interesting.

  • Chris

    9/17/2009 3:37:49 PM |

    Does wheat elimination include eliminating beer, particularly, wheat beer?

    It's the only wheat--or grain for that matter--in my regular diet.

  • Gretchen

    9/17/2009 6:25:00 PM |

    "after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people."

    I gave up wheat a long time ago when I found it triggered acid reflux. And I found just the opposite.

    As long as I didn't eat wheat regularly, I could have the occasional wheat with no problems.

  • Anonymous

    9/17/2009 8:01:42 PM |

    Does anyone know if Ezekial 100% sprouted whole grain bread (yes contains some sprouted wheat + many other grains) is still considered "wheat" as I want to have a zero wheat diet.  Hmmm  think I just answered by own question.  thanks!

  • Dr. William Davis

    9/17/2009 9:06:54 PM |

    Hi, Chris--

    Beer is clearly the least desirable of all alcoholic beverages, partly because of its wheat origin. However, perhaps because of fermentation or some other modification, it doesn't seem to exert all the adverse effects of other products, though celiacs will still react to the gluten.

    Anon--

    Likewise with Ezekiel. I believe it's better, though not necessarily perfect. It still trigers carbohydrate responses.

  • Dr. William Davis

    9/17/2009 9:07:33 PM |

    Hi, Olga--

    Amazing how we are re-learning many lessons learned previously before drugs and fancy hospital procedures.

  • Sara

    9/17/2009 9:29:02 PM |

    Another factor in the increased libido may be a reversal of very early nerve damage from high glucose levels. Peripheral neuropathy starts at blood glucose levels that are not really very high at all -- around 140mg/dL, which a person may be seeing after meals for YEARS before they hit the diabetic diagnostic criteria of 180mg/dL after meals or 126mg/dL fasting (and very many diabetics do have measurable neuropathy at diagnosis, for exactly this reason). People worry about their feet when they're considering diabetic neuropathy, but ALL the nerves are adversely affected by being bathed in excessive glucose, and those in the sexual organs are among the most sensitive; I think it's a reasonable theory that one would see a decrease of sensation there even before you have measurable effects in the hands and feet. Fortunately, if neuropathy isn't very advanced, it can be reversed by getting blood glucose under control, and of course that would improve sensation and increase the enjoyability of sexual activity, which would naturally factor into the desire for same. I'm sure there's more to the story, including some or all of the factors you've named, but I think this is probably part of it too.

  • Thomas

    9/17/2009 10:11:38 PM |

    How do the various grains compare: wheat, rye, barley, corn, rice etc.?

  • Robert McLeod

    9/17/2009 10:16:22 PM |

    It's called wheat allergy, look it up.  Different antibodies to celiac, different symptoms, but same cause and same cure.

  • William Trumbower

    9/17/2009 11:13:05 PM |

    There are gluten free beers available, based on sorgum.  Budweiser makes one called Red Bridge, but there are others on the market.    My sister has active celiac and so I eat an anti-inflamatory gluten-free diet.  Last year at my highschool reunion I had pizza and beer with the boys.  I had bloody stools for several days after!  I believe that most of us are gluten intolerant, that is we cannot really digest the gluten molecule. Many of us develop "leaky gut" from the gluten and then go on to antibody production against the gluten-gliadin molecule.  This protein has several key amino acid sequences in common with tissue proteins in many various organ systems (thyroid, pancreas, adrenal,gut, skin, uterus, placenta  etc) and autoimmune disease begins.  Which organ system is affected depends on your genetic make up.   The persistance of GI docs in refusing to diagnose gluten enteropathy without a small bowel biopsy is amazing to me.  see enterolab.com

  • Anne

    9/18/2009 2:21:33 AM |

    A lifelong depression lifted when I went wheat and gluten free 6 yrs ago. I am 66 years old and I wake up with no joint pain. Peripheral neuropathy is better, but not perfect. I have a long list of health improvements.

    As far as my heart, dropping wheat and gluten totally relieved my pitting leg edema and shortness of breath. I had cardiac bypass over 9 years ago, but I did not start to heal until I went gluten free. I am sure that gluten contributed to my CAD.

    I have no idea what would happen if I were to eat a wheat cracker or a slice of wheat bread. I never want to feel that sick again so I have not been tempted to try even one bite. An accidental crumb is enough to cause my brain to fog and my energy level to bottom out.

    This past year I dropped sugars and all grains in order to level out my blood glucose - this has worked well.

    I have heard the celiac experts say that no one is able to digest wheat well.

  • Anonymous

    9/18/2009 3:30:27 AM |

    Dr. Davis,
    A majority of beer recipes are based on Barley, not wheat. Sure it could contain wheat as an ingredient and most "summer" beers often contain a malted barley/malted wheat mix with the latter as a minor component. Beer (at least other than the generic mass market brews like coors, bud etc) contain substantial polyphenols from hops which I would assume have antioxidant value.

    I don't buy this obsession approach that everything that might contain a grain is probably bad. H1N1 is called the "swine flu" so what has happened; people have stopped eating pork.......  I am grateful for the discussion on this site but just sometimes I get a little disheartened with the  generalizations.
    Trevor

  • Anonymous

    9/18/2009 5:18:01 AM |

    Dr. Davis, my diabetic friend just announced to me today that her Triglycerides dropped from 400 to 200, her total cholesterol dropped to 178 and all other blood values are now within normal range just by changing her diet and eliminating all starchy foods (white and brown rice, all wheat products, etc.). Her wheat-free diet truly gave her some unexpected effects. Josephine

  • Anonymous

    9/18/2009 10:08:32 AM |

    Dr. Davis
    I'm 66 years and was diagnosed with migrene from 20. At 62 I startet to eat lowcarb and high fat. My migrene was gone after 14 days. I thougt that sugar was the worst, but I have come to understand that wheat and barley trigger my headaches more than sugar does.
    Other pleasant side effects are no more anal- itching and nearly no more nightly peeing.

  • William Trumbower

    9/18/2009 1:14:22 PM |

    My concern about the sprouted grain breads is the inclusion of soy.  I am not sure that the sprouting process eliminates all the toxins from soy (phytic acid, estrogen, goiterogens, protease inhibitors etc. ). Traditional cultures often soaked grains, sprouted them, and then used lactofermentation (sourdough)  methods to prepare their breads or porridges.  This reduced many of the toxic portions of the grains, but soy is much more resistant.  Traditional Asian cultures often fermented soy for months before using as food.

  • donny

    9/18/2009 1:33:52 PM |

    Before the phrase "wheat-belly" was phrased, there was the phrase "beer-belly." Personally, I don't care if it's made from barley or wheat, beer poses a clear danger either way.

  • pooklaroux

    9/18/2009 4:50:34 PM |

    I suffered from IBS for years, and discovered the "cure" when I went on Atkins in 1999.  I'm afraid, though that in my case, eliminating wheat alone isn't sufficient, I seem to have problems with any grain that is high in fiber. One or two amaranth based cookies was enough to trigger IBS symptoms for a whole weekend.

  • DropYourAllergies

    9/18/2009 5:34:49 PM |

    Gluten >> Allergy ? > InTolerance ? > Celiac ?

    Did YOU Know / Have you been told ?

    That > If YOU suspect that You have a Gluten InTolerance / Celiac Disease > Do NOT begin a Gluten Free DIET > Until You have been Medically Diagnosed ( See Below ).

    IF ..
    You would like information regarding a >  Personal Use >  Self Test / Finger Stick Kit > That will test You for presence of Celiac AntiBody ..
    Contact / CALL >  DropYourAllergies.com

    > FDA Approval Status ? > In the Works > But already used extensively WorldWide by Medical Communities to Screen their populations for Celiac Disease ...
    And this Test > CAN be obtained for YOUR Personal Use... NOW !

    Why Wait ? > Certainly > Your Celiac Disease and HEALTH Will Not.

    Research indicates that > Children will visit 6 Pediatricians BEFORE their Celiac Disease is Diagnosed... WHY ?

    ALSO > Allergy Mothers of Allergy Children > Who wish to > Take the FEAR Out of FOOD > i.e. Eat a Peanut = Trouble for their Child > Need only visit their Primary Care Dr. for an Insurance covered, FOOD Allergy Blood Test.

    Test to Determine if InTolerance of ALLERGY.

    Once Test ID’ed > You receive a Custom FOOD allergy DIET Plan > Suggesting FOODs to Eat, Not Eat, Restrict & ReIntroduce > All based on EACH Patient’s unique Test Result.

    And..
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    STOP ! > A Lifetime of Medicating Your allergy SYMPTOMs > While your Enviro Allergy Disease > Continues / Exacerbates UnAbated ..

    Leading EACH Sufferer on a LifeTime, Slippery Slope of “Allergy Driven” diseases ( allergic ASTHMA to Name One ), recalcitrant Health Issues & compromised Quality of Life / Poor Self Image. > Achoo & OUCH !  

    YES > You CAN take ALLERGIES > Out of Your Child's Future ...

    Best Health = Wealth Regards

    Stephen
    DropYourAllergies.com

    Celiac Information:

    > Serology ( Blood testing ) as well as Biopsy requires the presence of antibodies to gluten.

    > A gluten-free diet reduces circulating antibodies thus compromising a proper diagnosis.  There are no clear guidelines for a proper gluten challenge to ensure sufficient circulating antibodies for a positive result; some individuals requires 1 month, other years.  

    > Key Take HOME Message !

    With 1 in 100 being affected,
    Rule out Celiac Disease > Before going Gluten-Free
    Regardless of Rationale.

  • kris

    9/18/2009 7:55:11 PM |

    Susan,
    couple weeks ago, I had to take a trip and drove for 8 hours right after my hard work out at gym. didnt have time to eat at my regular time. that night i had stomich spasm, so bad that it almost made me cry. (now i am completely wheat free for more than 10 months now). only thing that helped me immediate,was powdered Magnesium. the pain would start around 2am and stay on until I take liquid magnesium. the pain wouldnt go away for week or so. funny thing is that in the morning i would go to gym and workout hard with no pain at all. 4 days ago I had to see my doctor and he put me on on Nexium. That was the first night that there was no pain how ever the side effects of Nexium were sharp headache and stomach spasm for 5 minutes. I think that when body is firing on all cylinders, it is important to eat regularly, small meals, more often.

  • Suresh

    9/18/2009 8:38:46 PM |

    Dr. Davis,

    I have seen the mention of eliminating wheat from the diet in many of your articles. Does that mean something like rice is not as bad as wheat namely is wheat is the worst among the grains rice, barley, corn etc ?

    Thanks!

    -Suresh

  • water

    9/18/2009 9:04:16 PM |

    Sara,

    I found your comments extremely interesting and would like to know more about your research, especially relative to this:
    "those in the sexual organs are among the most sensitive"  Do you have reference I can follow?

    I've been reading about periperhal neuropathy and autonomic neuropathy and this article was particularly interesting:

    Unlike PN, AN is often asymptomatic. Among symptomatic patients (55%), erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.  

    pns.ucsd.edu/JPNS/Ravaglia.accepted.06.16.04.pdf

    An improvement in his ED was definitely an unexpected results of a gluten free diet (wheat free was not enough), but my spouse saw further improvements without dairy and soy.

  • Anonymous

    9/19/2009 3:23:47 AM |

    William,
    Your comment on the fermentation of soy in Asian cultures appears to imply that this is important to render "safe" food from Soy.  So do you make the same generalization about cow's milk.....? IE it should be cheese and yoghurt before consumption?

    Donny,
    what is the scientific relation between "wheat belly" and "beer belly" ? none, I would argue. Other than both are not desirable and result from over indulgence.

    There are a surprising number of people who are sensitive to specific foods.  I love sushi.  My wife is allergic to raw seafood yet she can down a piece of wheat gluten (seitan) with no affects. I have friends who can't go near gluten without severe cramps. My wife can also eat beef yet it gives me terrible gas. On the other hand, beans have absolutely no impact to my gas productivity.  I write this to highlight that many many people have issues with certain foods while other remain unaffected. YMMV as the saying goes, so lets celebrate those who find relief in changing their diets but lets not claim panacea
    Trevor

  • Dr. William Davis

    9/19/2009 1:59:09 PM |

    Suresh--

    Yes, wheat stands out as a uniquely destructive grain. While other grains can also increase blood sugar and trigger adverse patterns, wheat is undoubtedly the worst. I know of no other grain than wheat that is accompanied by addictive behavior, also.

  • Anonymous

    9/19/2009 3:24:20 PM |

    Re: beer and barley

    Barley also contains gluten, so if you're avoiding wheat because of the gluten, you'll need to avoid barley (and rye) as well.

    Re: rice

    The data that the idiotic "China Study" book is allegedly based on suggest that rice is the best grain to eat if you're going to eat grain. The highest rate of heart disease in China is found in the province where wheat is a dietary staple and little meat is consumed.

  • Anne

    9/19/2009 4:27:57 PM |

    1:100 may have celiac disease, but estimates of those with non-celiac gluten sensitivity range from 10-40% of the population.

    It is true, if you want to be tested for celiac disease(villous atrophy), then you do need to keep eating gluten until the testing is completed. If the tests come out negative it does not mean that you have no problem with gluten. You may still have latent celiac disease, non-celiac gluten sensitivity, wheat allergy or wheat intolerance. I am beginning to see more journal articles about gluten sensitivity. Dr. Green recently wrote in the JAMA that more attention needs to be given to gluten sensitivity.

    I did not go through blood a biopsy testing as my doctors refused to run these tests. I used Enterolab to confirm I have antibodies to gluten. This was enough proof for me. Enterolab cannot diagnose celiac disease, but it can tell you if you are reacting to gluten and you can be wheat/gluten free for up to 2 years for this test.

    There is nothing dangerous about a gluten free or wheat free diet and, luckily, we don't need a doctor's prescription to change our diet. A gluten free diet can be as healthy or as unhealthy as one wants to make it. Along with gluten free, I follow Dr. Davis' recommendation of a low sugar diet to keep my blood glucose in check.

  • taemo

    9/21/2009 1:23:30 PM |

    Ouch! much sugar? Damn! diabetes is you will get.

  • Anonymous

    9/21/2009 5:20:19 PM |

    Dr. Davis,

    Okay... wheat is BAD.  But... does this include wheat bran, often used as a source of fiber in the diet?  I mean the bran only, NOT wheat germ, or whole wheat, or wheat flours.

    Thanks for all you do!

    madcook

  • Dr. William Davis

    9/21/2009 9:43:47 PM |

    Hi, Mad--

    No, wheat bran is essentially inert. It does not interact with anything and so does not exert any adverse effects. It's like eating wood.

  • Anonymous

    9/22/2009 9:25:21 PM |

    I disagree with wheat bran being inert.  It is a source of phytic acid which has mineral binding properties.  Also, reading sites like FiberMenace.com, bran fiber is certainly not benign.

  • denparser

    9/22/2009 11:40:04 PM |

    @Anonymous (before me)

    I agree with your statement. Its a fact, try read health book.

  • Stan (Heretic)

    9/23/2009 11:48:20 AM |

    I have to mention one more benefit to your list, that I noticed:

    - hugely improved dental health and self-healing (sealing) of damaged teeth.

    We know that wheat's agglutins (WGA) affect and reduce D3 transport, I have a suspicion that wheat may be also interfering with K2 (thus teeth) but haven't seen much esearch on this yet.

    Stan (Heretic)

  • Anonymous

    9/24/2009 7:41:01 PM |

    TedHutchinson, there are many other sources that agree that fiber is not beneficial and is indeed harmful if you don't care for the one referenced.

    Nevertheless, Dr. Davis is incorrect about bran being inert.  It does contain phytic acid which interferes with mineral absorption.  Another reason wheat avoidance helps teeth and bones.

  • dves

    9/27/2009 12:53:06 PM |

    @taemo

    haha. you're right.. control use of sugar to avoid diabetes.

  • denparser

    9/27/2009 12:54:22 PM |

    @Thomas

    it has different nutrition level and most of all, its taste.

  • Anonymous

    9/28/2009 5:34:44 PM |

    I have a question: after spending a year in France, I realized that yes, French people are typically lean and thin, however, they eat so much wheat! Pastries, white pastas, cereals...
    Do French people display the same numbers when it comes to celiacs disease and wheat intolerance? I am curious to know. Or might it have more to do with volume or the fact that their breads are more often homemade? Thoughts?

    I went gluten free for nearly two years and then have been dabbling back into spelt and wheat. My primary reasons for trying the elimination were skin-related (itch, chronic eczema). Sad to say, it don't help much, though I did feel pretty healthy. I just ate a croissant the other day from an organic bakery that stone mills. It was heavan. I didn't feel foggy or anything, so perhaps the key is moderation?
    Anyway, great site, very informative. Looking forward to hearing your thoughts on those skinny french people.
    PS-I don't have a weight problem and ironically I didn't lose weight when I went gluten free. Ended up eating more meat (allergic to nuts)...

  • trinkwasser

    10/2/2009 4:03:33 PM |

    Interesting that inflammation would appear to be a component of nearly all these symptoms which wheat elimination "cures".

    My depression and mood swings appear to be closely correlated with blood glucose swings, which may be why that also improves.

    I'm another one for whom wheat bran is not inert: it generates BG spikes, although not to the degree of whole wheat. Lectins, phytic acid or wheat germ agglutinin?

    http://high-fat-nutrition.blogspot.com/2007/11/how-toxic-is-wheat-well-first-point-is.html

  • Anonymous

    10/3/2009 2:40:52 AM |

    Ted,
    Thanks for the link to the livin lavida low carb site interview with Dr. Davis.  Your links are always informative.
    In my opinion, all newbies visiting this web site should be directed to this reference for a great summary of what is important in taking care of your heart via diet changes. v.cool, thanks
    Trevor

  • Sew Bee It

    10/6/2009 10:28:46 PM |

    I've just found your blog via Feed the Animal, and I'm so happy I did!  Thank you so much for you posts, I'll be reading often.  

    You have a few comments here, but I figured I'd add to your collection of anecdotal evidence:  I'd gone paleo for about a month when I took one 24 hour period off (dinner to dinner).  3/4 of a medium pizza, a snickers bar, 1/2 can pringles, and a dozen chocolate coated gingerbread cookies ended up on the menu.  Within 30 minutes of eating the pizza my heartburn had returned, withing hours of eating bits of the rest I was in PAIN.  Why I kept eating this junk for the next day, I have no idea.  The more of it I ate the worse my stomache got.  Severe upset stomache, badly sufuric burps, bowel discomfort, you name it!  And after that 24 hours I finally reached a level of toxicity where my body literally rejected the food.  So toxic was this junk that use to be "normal" food, that my body threw it up in self defense.  

    Needless to say I'm totally commited to the paleo eating now!

  • Jenny

    10/10/2009 12:59:02 AM |

    What element in wheat are you referring to? everyone needs fiber which is a major component of wheat, people can't be allergic to fiber as their digestive system would pack up if you didn't have any.

  • Anonymous

    10/12/2009 11:24:02 PM |

    Does abstaining from wheat include staying away from spelt and kammut and Emmer wheat as well..or is it the GMO wheat that is the problem?
    Some doctors believe spelt is more digestable than regular wheat.

  • Jamie

    11/2/2009 1:06:55 AM |

    Jenny,

    Not true at all. I eat very little fiber and am more regular and have less digestive issues than I ever have. As long as one eats enough fat, there is no need for fiber.

  • Beverly

    3/28/2010 6:24:41 PM |

    You can get Gluten-Free beer.  One brand is called Red Bridge.  There's another, but I forget the name.  I drink the Red Bridge.  Not bad.

  • Beverly

    3/28/2010 6:48:23 PM |

    Besides, you can get your "roughage" from raw veggies and salad.  I've been low-carb for about 6 wks. now; haven't had any bread, rice, pasta, wheat, etc.  I've never felt better and have more energy.  My brain is functioning better, too.  Also, have lost 4 lbs.

    Beverly

  • Julianne

    6/25/2010 11:17:42 PM |

    Hi Dr Davis,
    Thanks for a great blog.
    I just wanted to share my experience of wheat free (I actually went paleo so fully grain and legume free)
    No more swelling knees. Probably mild auto-immune, mother has it also.
    Large - I mean large and multiple bumps - ganglion cyst that I had for 10 years shrank and disappeared.
    PMS with horrid breast pain - gone.
    Menstrual pain - less with fish oil, gone with paleo.
    Constipation - gone
    Pre-menopausal spotting the week prior to menstruation, had this for 10 years - gone.
    Lost weight - that last 3 pounds that make me look my best.

    I wrote about it here, I for one want to spread the news as a nutritionist.
    http://paleozonenutrition.wordpress.com/2010/05/24/my-nutrition-journey/

  • Alina M

    9/7/2010 1:51:47 PM |

    Is whole grain wheat also harmful?

    Thank your very much for all your information.

  • legend_018

    9/10/2010 1:16:13 AM |

    So people just give up having

    1. bread and butter with meals or crusty bread with pasta
    2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
    3. pancakes

    That seems hard to give up.

  • Anonymous

    9/12/2010 10:03:37 AM |

    As an experiment and in an attempt to lose weight, I put my whole family on a low-carb diet. Cutting out wheat was part of it.
    My husband has suffered from a mild type of colitis for the last 15 years. One year ago an awful smell developed with the colitis. Whenever he went to the toilet or passed wind an obnoxious, sour smell like old cheese/rotten eggs lingered a long time after. It caused me to move out of our bedroom, as the smell would cause me to wake up repeatedly. 3 weeks on the wheat-free diet the smell was suddenly gone. It was nothing short of a miracle. It was not something I had expected from the diet, but a very welcome side-effect indeed, as I hate bad smells. By the way - can anyone tell me what generates that particular sour, rotten smell?

  • Rusa

    9/28/2010 11:51:02 PM |

    legend 018 said:
    So people just give up having

    1. bread and butter with meals or crusty bread with pasta
    2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
    3. pancakes

    That seems hard to give up.



    Yes. They are addictive, aren't they? Isn't that the point? Wheat is addictive.

  • KMebust

    11/9/2010 4:16:59 PM |

    A criticism, then a question:
    Any food you give up for months will cause diarrhea and cramping when you come back to it, because you've lost the bacteria that help you digest it.  I've experienced this with dairy, meat, and potatoes.  I am skeptical that wheat is any different than other foods in that regard.
    I have family members who have experienced benefits from gluten free diets, but don't want to give it up altogether, for various reasons.  Does cutting back-- say, not eating bread but not actively eliminating gluten from all your food choices-- have lesser but similar effects?

  • Anonymous

    12/17/2010 7:55:34 PM |

    Thank you so much Dr. Davis.  You have confirmed our worst fears that seemingly "healthy" wheat is actually a form of subtle malnutrition.  Please mention that it is the gluten that causes the problems.  Not in the allergic sense, but by blocking the important nutrients from fruits and veggies to vitamins and minerals.  Gluten forms a mucoid plaque which covers the small intestine thus causing subtle malnutrition and is therefore responsible for dozens of illnesses.

  • James

    1/18/2011 8:13:42 PM |

    I have given up wheat because of its effects on myself including acid reflux, rapid heart beat, irritated hemmoroids.  

    All of the effects you have mentioned have been documented as far back as 1995.  This is especially true of RA. I remember articles in the nutrition press stating that wheat was one of the triggers for RA. Thanks for all the information.

  • Ravi

    2/9/2011 5:28:47 PM |

    Hello Dr. Davis,

    We would like to invite you to summit your exceptional posts to our new ParadigmShift BlogShare at DaiaSolGaia.  
    Please check it out! Thank you. http://daiasolgaia.com/?p=2212

  • Ravi

    2/9/2011 5:30:25 PM |

    ... fingers: type "submit"... thank you. Wink

  • Pixie

    3/11/2011 10:59:55 PM |

    I wish this was the case for me.  I have suffered with IBS for 27 years.  I have gone on gluten elimination diets for up to 30 days twice in the past 15 years with no change.  Incorporating it back in, the only thing I noticed was a little bit of heartburn if I had wheat in the morning. I've tested negative for Celiac's and wheat allergies.
    I'm not saying your are wrong. But for me a wheat free diet was no cure for IBS.  Frown  (I WISH!)
    -Karen

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All posts by william-davis

What to eat: Part I

6. April 2010 William Davis (0)
I've spent a good number of Heart Scan Blog posts detailing what foods to limit or avoid.

The list of unquestionably bad foods to avoid include foods made of wheat, cornstarch, and sugars. Fructose is proving to be an exceptionally bad form of sugar, worse than any other. I've issued warnings about levels of carbohydrates that can be determined by postprandial testing.

In response to several requests to clarify what foods to eat, this post begins a series discussing what foods are good to eat.

I believe that a strong case can be made for eating vegetables in nearly all its varied forms, from cucumbers to peppers to leafy vegetables to eggplant to alliums like onions. The only form we avoid are red and white potatoes due to the blood sugar-increasing effects.

While this seems obvious, I am impressed how many people who follow low-carb diets find themselves following a high-animal product diet with vegetables as the sideline. It should be the other way around: A high vegetable diet with animal products as the sideline.

Vegetables are your principal source of:

1) Flavonoids and polyphenols--e.g., anthocyanins and catechins. All the recently appreciated effects of flavonoids and polyphenols highlight the wonderful effects of compounds originating in plant foods. This includes the anthocyanins and resveratrol in red wine; the catechins and epicatechins cocoa and green tea; the hydroxytyrosol, phenolic acid, and flavonoids of olive oil.

2) Fiber--Fiber is essentially a plant phenomenon, since there is virtually none in chicken, fish, and beef. The benefits of fiber are, I believe, undisputed. Neglecting fiber can, at the very least, lead to a nasty case of hemorrhoids. At the worst, it is related to various cancers, especially colon cancer.

3) Vitamin C--While vitamin C may be old and boring in light of new, exciting discoveries like flavonoids, neglect leads to bad things.

Vegetables are generally classified as carbohydrate foods, since they are low in protein and fat. But this is the source of carbohydrates you do not want to sacrifice in a low-carbohydrate diet. There's just too much good from vegetables.

Notice that I didn't say "fruits and vegetables." This is a fundamental mistake made by many: Oveconsumption of fruits. I've even seen people who follow an otherwise good diet develop diabetes--just from too much fruit.

Vegetables should be the cornerstone of the human diet. But I'll bet you knew that already.

Carbohydrates and LDL

4. April 2010 William Davis (16)
There's a curious and powerful relationship between carbohydrates and LDL particles. Understanding this relationship is crucial to gaining control over heart disease risk.

(Note that I did not say "LDL cholesterol"--This is what confuses people, the notion that cholesterol is used as a surrogate marker to quantify various lipoproteins, including low-density lipoproteins, LDL. I'm NOT interested in the cholesterol; I'm interested in the behavior of the low-density lipoprotein particle. There's a difference.)

Carbohydrates:

1) Increase triglycerides and very low-density lipoprotein particles (VLDL)
2) Triglyceride-rich VLDL interact with LDL particles, making them smaller. (A process mediated by several enzymes, such as cholesteryl-ester transfer protein.)
3) Smaller LDL particles are more oxidizable--Oxidized LDL particles are the sort that are taken up by inflammatory white blood cells residing in the artery wall and atherosclerotic plaque.
4) Smaller LDL particles are more glycatable--Glycation of LDL is an important phenomenon that makes the LDL particle more atherogenic (plaque-causing). Glycated LDLs are not recognized by the LDL receptor, causing them to persist in the bloodstream longer than non-glcyated LDL. Glycated LDL is therefore taken up by inflammatory white blood cells in plaque.

Of course, carbohydrates also make you fat, further fueling the fire of this sequence.

The key is to break this chain: Cut out the carbohydrates. Cut carbohydrates and VLDL and triglycerides drop (dramatically), VLDL are unavailable to transform large LDL into small LDL, small LDL is no longer available to become oxidized and glycated, blood sugar is reduced to allow less glycation. Voila: Less atherosclerotic plaque growth.

Yet the USDA, American Heart Association, and the Surgeon General's office all advise you to eat more carbohydrates. The American Diabetes Association tells you to eat 70 grams or so carbohydrates per meal. (Yes: Diabetes, the condition that is MOST susceptible to these carbohydrate effects.) Follow their advice and you gain weight; triglycerides and VLDL go up; calculated (Friedewald) LDL may or may not go up, but true measured LDL (NMR LDL particle number or apoprotein B) goes way up; small LDL is triggered . . . You know the rest.

The dance between carbohydrates and LDL particles requires the participation of both. Allow one partner to drop out of the dance and LDL particles will sit this dance out.

Strange but true: Part II

4. April 2010 William Davis (0)
Here's the second part of the Heart Scan Blog post I wrote a couple of years back describing the wacky origins of this thing that has so changed the face of heart care in the U.S., the cardiac catheterization.

Heart catheterization: Strange, but true

3. April 2010 William Davis (1)
It's a couple of years old, but this post from March, 2008, remains relevant.

It details the curious origins of heart catheterization, the procedure that has saved some lives, but also been responsible for the proliferation of unnecessary heart procedures.



The modern era of heart disease care was born from an accident, quirky personalities, and even a little daring.

The notion of heart catheterization to visualize the human heart began rather ignominiously in 1929 at the Auguste-Viktoria Hospital in Eberswalde, Germany, a technological backwater of the day. Inspired by descriptions of a French physician who inserted a tube into the jugular vein of a horse and felt transmitted heart impulses outside the body, Dr. Werner Forssmann, an eager 25-year old physician-in-training, was intent on proving that access to the human heart could be safely gained through a surface blood vessel. No one knew if passing a catheter into the human heart would be safe, or whether it would become tangled in the heart’s chambers and cause it to stop beating. On voicing his intentions, Forssmann was ordered by superiors not to proceed. But he was determined to settle the question, especially since his ambitions captured the interest of nurse Gerda Ditzen, who willingly even offered to become the first human subject of his little experiment.

Secretly gathering the necessary supplies, he made his first attempt in private. After applying a local anesthetic, he used a scalpel to make an incision in his left elbow. He then inserted a hollow tube, a catheter intended for the bladder, into the vein exposed under the skin. After passing the catheter 14 inches into his arm, however, he experienced cold feet and pulled it out.



One week later, Forssman regained his resolve and repeated the process. Nurse Ditzen begged to be the subject, but Forssmann, in order to allow himself to be the first subject, tricked her into being strapped down and proceeded to work on himself while she helplessly watched. After stanching the oozing blood from the wound, he threaded the catheter slowly and painfully into the cephalic vein, up through the bicep, past the shoulder and subclavian vein, then down towards the heart. He knew that simply nudging the rubber catheter forward would be sufficient to direct it to the heart, since all veins of the body lead there. With the catheter buried 25 inches into his body, Forssmann untied the fuming Ditzen. Both then ran to the hospital’s basement x-ray department and injected x-ray dye into the catheter, yielding an image of the right side of his heart, the first made in a living human.

Thus, the very first catheterization of the heart was performed.

An x-ray image was made to document the accomplishment. Upon hearing of the experiment, Forssmann was promptly fired by superiors for his brazen act of self-experimentation. Deflated, Forssmann abandoned his experimentation and went on to practice urology. He became a member of the Nazi party in World War II Germany and served in the German army. Though condemned as crazy by some, physicians in Europe and the U.S., after hearing of his experience, furthered the effort and continued to explore the potential of the technique. Forssmann himself was never invited to speak of his experiences outside of Germany, as he had been labeled a Nazi.

Many years after his furtive experiments, the once intrepid Dr. Forssmann was living a quiet life practicing small town medicine. He received an unexpected phone call informing him that he was one of three physicians chosen to receive the 1956 Nobel Prize for Medicine for his pioneering work performing the world’s first heart catheterization, along with Drs. André Cournand and Dickinson W. Richards, both of whom had furthered Forssmann’s early work. Forssmann remarked to a reporter that he felt like a village pastor who was made a cardinal.

Strange, but true.

Rerun: To let low-carb right, you must check POSTPRANDIAL blood sugars

2. April 2010 William Davis (12)
Checking postprandial (after-eating) blood sugars yields extraordinary advantage in creating better diets for many people.

This idea has proven so powerful that I am running a previous Heart Scan Blog post on this practice to bring any newcomers up-to-date on this powerful way to improve diet, lose weight, reduce small LDL, reduce triglycerides, and reduce blood pressure.



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

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

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

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

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

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

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

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

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

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

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

LDL glycation

1. April 2010 William Davis (11)
The proteins of the body are subject to the process of glycation, modification of protein structures by glucose (blood sugar). In the last Heart Scan Blog post, I discussed how glycated hemoglobin, available as a common test called HbA1c, can serve as a reflection of protein glycation (though it does not indicate actual Advanced Glycation End-products, or AGEs, just a surrogate indicator).

There is one very important protein that is subject to glycation: Apoprotein B.

Apoprotein B, or Apo B, is the principal protein of VLDL and LDL particles. Because there is one Apo B molecule per VLDL or LDL particle, Apo B can serve as a virtual VLDL/LDL particle count. The higher the Apo B, the greater the number of VLDL and LDL particles.

Because Apo B is a protein, it too is subject to the process of glycation. The interesting thing about the glycation of Apo B is that its "glycatability" depends on LDL particle size: The smaller the LDL particle, the more glycation-prone the Apo B contained within.

Younis et al have documented an extraordinary variation in glycatability between large and small LDL, with small LDL showing an 8-fold increased potential.

Think about it: Carbohydrates in the diet, such as wheat products and sugars, trigger formation of small LDL particles. Small LDL particles are then more glycation-prone by up to a factor of 8. Interestingly, HbA1c is tightly correlated with glycation of Apo B. Diabetics with high HbA1c, in particular, have the greatest quantity of glycated Apo B. They are also the group most likely to develop coronary atherosclerosis, as well as other consequences of excessive AGEs.

No matter how you spin it, the story of carbohydrates is getting uglier and uglier. Carbohydrates, such as those in your whole grain bagel, drive small LDL up, while making them prone to a glycating process that makes them more likely to contribute to formation of coronary atherosclerotic plaque.

High HbA1c: You're getting older . . . faster

28. March 2010 William Davis (16)
Over the years, we all accumulate Advanced Glycation End-products, or AGEs.

AGEs are part of aging; they are part of human disease. AGEs are the result of modification of proteins by glucose. AGEs form the basis for many disease conditions.

Accumulated AGEs have been associated with aging, dementia, cataracts, osteoporosis, deafness, cancer, and atherosclerosis. Most of the complications of diabetes have been attributable to AGEs.

There's one readily available method to assess your recent AGE status: HbA1c.

Hemoglobin is the oxygen-carrying protein of red blood cells. Like other proteins, hemoglobin becomes glycated in the presence of glucose. Hemoglobin glycation increases linearly with glucose: The higher the serum or tissue glucose level, the more glycation of hemoglobin develops. Glycated hemoglobin is available as the common test, HbA1c.

Ideal HbA1c is 4.5% or less, i.e., 4.5% of hemoglobin molecules are glycated. Diabetics typically have HbA1c 7.0% or greater, not uncommonly greater than 10%.

In other words, repetitive and sustained high blood glucose leads to greater hemoglobin glycation, higher HbA1c, and indicates greater glycation of proteins in nerve cells, the lens of your eye, proteins lining arteries, and apoprotein B in LDL cholesterol particles.

If AGEs accumulate as a sign of aging, and high blood sugars lead to greater degrees of glycation, it only follows that higher HbA1c marks a tendency for accelerated aging and disease.

Indeed, that is what plays out in real life. People with diabetes, for instance, have kidney failure, heart disease, stroke, cataracts, etc. at a much higher rate than people without diabetes. People with pre-diabetes likewise.

The higher your HbA1c, the greater the degree of glycation of other proteins beyond hemoglobin, the faster you are aging and subject to all the phenomena that accompany aging. So that blood glucose of 175 mg/dl you experience after oatmeal is not a good idea. 

The lesson: Keep HbA1c really low. First, slash carbohydrates, the only foods that substantially increase blood glucose. Second, maintain ideal weight, since normal insulin responsiveness requires normal body weight. Third, stay physically active, since exercise and physical activity exerts a powerful glucose-reducing effect. Fourth, consider use of glucose-reducing supplements, an issue for another day.

While HbA1c cannot indicate cumulative AGE status, it can reflect your recent (preceding 60 to 90 days) exposure to this age-accelerating thing called glucose.

If your doctor refuses to accommodate your request for a HbA1c test, you can perform your own fingerstick test.

Slash carbs . . . What happens?

26. March 2010 William Davis (20)
Cut the carbohydrates in your diet and what sorts of results can you expect?

Carbohydrate reduction results in:

Reduced small LDL--This effect is profound. Carbohydrates increase small LDL; reduction of carbohydrates reduce small LDL. People are often confused by this because the effect will not be evident in the crude, calculated (Friedewald) LDL that your doctor provides.

Increased HDL--The HDL-increasing effect of carbohydrate reduction may require 1-2 years. In fact, in the first 2 months, HDL will drop, only to be followed by a slow, gradual increase. This is the reason why, in a number of low-carb diet studies, HDL was shown to be reduced.--Had the timeline been longer, HDL would show a significant increase.

Decreased triglycerides--Like reduction of small LDL, the effect is substantial. Triglyceride reductions of several hundred milligrams are not at all uncommon. In people with familial hypertriglyceridemia with triglyceride levels in the thousands of milligrams per deciliter, triglyceride levels will plummet with carbohydrate restriction. (Ironically, conventional treatment for familial hypertriglyceridemia is fat restriction, a practice that can reduce triglycerides modestly in these people, but not anywhere near as effectively as carbohydrate restriction.) Triglyceride reduction is crucial, because triglycerides are required by the process to make small LDL--less triglycerides, less small LDL.

Decreased inflammation--This will be reflected in the crude surface marker, c-reactive protein--Yes, the test that the drug industry has tried to convince you to take statins drugs to reduce. In my view, it is an absurd notion that you need to take a drug like Crestor to reduce risk associated with increased CRP. If you want to reduce CRP to the floor, eliminate wheat and other junk carbohydrates. (You should also add vitamin D, another potent CRP-reducing strategy.)

Reduced blood pressure--Like HDL, blood pressure will respond over an extended period of months to years, not days or weeks. The blood pressure reduction will be proportion to the amount of reduction in your "wheat belly."

Reduced blood sugar--Whether you watch fasting blood sugar, postprandial (after-meal) blood sugars, or HbA1c, you will witness dramatic reductions by eliminating or reducing the foods that generate the high blood sugar responses in the first place. Diabetics, in particular, will see the biggest reductions, despite the fact that the American Diabetes Association persists in advising diabetics to eat all the carbohydrates they want. Reductions in postprandial (after-eating) blood sugars, in particular, will reduce the process of LDL glycation, the modification of LDL particles by glucose that makes them more plaque-causing.


You may notice that the above list corresponds to the list of common plagues targeted by the pharmaceutical industry: blood pressure, diabetes (diabetes being the growth industry of the 21st century), high cholesterol. In other words, high-carbohydrate, low-fat foods from the food industry create the list of problems; the pharmaceutical industry steps in to treat the consequences.

In the Track Your Plaque approach, we focus specifically on elimination of wheat, cornstarch, and sugars, the most offensive among the carbohydrates. The need to avoid other carbohydrates, e.g., barley, oats, quinoa, spelt, etc., depends on individual carbohydrate sensitivty, though I tend to suggest minimal exposure.

Normal fasting glucose with high HbA1c

23. March 2010 William Davis (24)
Jonathan's fasting glucose: 85 mg/dl
His HbA1c: 6.7%

Jonathan's high HbA1c reflects blood glucose fluctuations over the preceding 60-90 days and can be used to calculate an estimated average glucose (eAG) with the following equation:

eAG = 28.7 X A1c – 46.7

(For glucose in mmol/L, the equation is eAG = 1.59 × A1C - 2.59)

Jonathan's HbA1c therefore equates to an eAG of 145.59 mg/dl--yet his fasting glucose value is 85 mg/dl. 

This is a common situation: Normal fasting glucose, high HbA1c. It comes from high postprandial glucose values, high values after meals. 

It suggests that, despite having normal glucose while fasting, Jonathan experiences high postprandial glucose values after many or most of his meals. After a breakfast of oatmeal, for instance, he likely has a blood glucose of 150 mg/dl or greater. After breakfast cereal, blood glucose likely exceeds 180 mg/dl. With two slices of whole wheat bread, glucose likewise likely runs 150-180 mg/dl. 

The best measure of all is a postprandial glucose one hour after the completion of a meal, a measure you can easily obtain yourself with a home glucose meter. Second best: fasting glucose with HbA1c.

Gain control over this phenomenon and you 1) reduce fasting blood sugar, 2) reduce expression of small LDL particles, and 3) lose weight.  

Can you handle fat?

21. March 2010 William Davis (19)
No question: Low-carbohydrate diets generate improved postprandial lipoprotein responses.

Here's a graph from one of Jeff Volek's great studies:



Participants followed a low-carb diet of less than 50 g per day carbohydrate ("ketogenic") with 61% fat.   The curves were generated by administering a 123 g fat challenge with triglyceride levels assessed postprandially. The solid line represents the postprandial response at the start; dotted line after the 6-week low-carb effort.

Note that:

1) The postprandial triglyceride (area-under-the-curve) response was reduced by 29% in the low-carb diet.  That's a good thing.

2) The large fat challenge generated high triglycerides of greater than 160 mg/dl even in the low-carb group. That's a bad thing. 

In other words, low-carb improves postprandial responses substantially--but postprandial phenomena still occur. Postprandial triglycerides of 88 mg/dl or greater are associated with greater heart attack risk because they signify the presence of greater quantities of atherogenic (plaque-causing) postprandial lipoproteins.

A full discussion of these phenomena can be found in the Track Your Plaque Special Report, Postprandial Responses: The Storm After the Quiet!, part of a 3-part series on postprandial phenomena.