Do stents prevent reversal?

27. January 2007 William Davis (3)
I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.

Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents.

Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent?

These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.

At what score should I have a heart cath?

25. January 2007 William Davis (0)
This question comes up frequently: At what specific heart scan score should a heart catheterization be performed? In other words, is there a specific cut-off that automatically triggers a need for catheterization?

In my view, there is no such score. We can't say, for instance, that everybody with a score above 1000 should have a catheterization. It is true that the higher your score, the greater the likelihood of a plaque blocking flow. A score of 1000 carries an approximately 25-30% likelihood of reduced blood flow sufficient to consider a stent or bypass. This can nearly always be settled with a stress test. Recall that, despite their pitfalls for uncovering hidden heart disease in the first place, stress tests are useful as gauges of coronary blood flow.

But even a score of 1000 carries a 70-75% likelihood that a procedure will not be necesary. This is too high to justify doing heart catheterizations willy-nilly.

Unfortunately, some my colleagues will say that any heart scan score justifies a heart cath. I believe this is absolutely, unquestionably, and inexcusably wrong. More often than not, this attitude is borne out of ignorance, laziness, or a desire for profit.

Does every lump or bump justify surgery, radiation, and chemotherapy on the chance it could represent cancer? Of course not. There is indeed a time and place for these things, but judgment is involved.

In my view, no heart scan score should autmatically prompt a major heart procedure like heart catheterization in a person without symptoms.

Niacin makes NY Times

24. January 2007 William Davis (0)
In the wake of the crash and burn of Pfizer's torcetrapib, media attention has turned up the miracles of . . .good old niacin. The NY Times carried a well-written report on niacin in its recent report, An Old Cholesterol Remedy Is New Again.


(Read the entire report at http://www.nytimes.com/2007/01/23/health/23consume.html?em&ex=1169701200&en=670fa84ae2ea648c&ei=5087%0A)

Among their comments:

...torcetrapib worked primarily by increasing HDL, or good cholesterol. Among other functions, HDL carries dangerous forms of cholesterol from artery walls to the liver for excretion. The process, called reverse cholesterol transport, is thought to be crucial to preventing clogged arteries.

Many scientists still believe that a statin combined with a drug that raises HDL would mark a significant advance in the treatment of heart disease. But for patients now at high risk of heart attack or stroke, the news is better than it sounds. An effective HDL booster already exists.

It is niacin, the ordinary B vitamin.

In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent. Its principal side effect is an irritating flush caused by the vitamin’s dilation of blood vessels.

Despite its effectiveness, niacin has been the ugly duckling of heart medications, an old remedy that few scientists cared to examine. But that seems likely to change.

“There’s a great unfilled need for something that raises HDL,” said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic and president of the American College of Cardiology. “Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective.”

In 1975, long before statins, a landmark study of 8,341 men who had suffered heart attacks found that niacin was the only treatment among five tested that prevented second heart attacks. Compared with men on placebos, those on niacin had a 26 percent reduction in heart attacks and a 27 percent reduction in strokes. Fifteen years later, the mortality rate among the men on niacin was 11 percent lower than among those who had received placebos.

'Here you have a drug that was about as effective as the early statins, and it just never caught on,' said Dr. B. Greg Brown, professor of medicine at the University of Washington in Seattle. 'It’s a mystery to me. But if you’re a drug company, I guess you can’t make money on a vitamin.'


Of course, you and I don't have to wait for the media to endorse something. I'm nonetheless thrilled that this hugely helpful vitamin is gaining greater recognition. My preferred form nowadays is over-the-counter SloNiacin (Upsher Smith). Weve seen no liver side-effects and a minimal quantity of flushing. It's also reasonably priced, $13.99 for 100 tablets of 500 mg at Walgreen's. That's a lot cheaper than prescription Niaspan at $130 for 60 tablets.

Perhaps the notoriety will cut back on the silly responses from some physicians that I still hear about from patients: "My doctor said to stop the niacin because it's going to destroy my liver."

Wheat: the nicotine of food

24. January 2007 William Davis (1)
Yes, we know that wheat contributes to creating small LDL, drops HDL, raises triglycerides, and VLDL. We also know it indirectly slows the clearance of after-eating fats from the blood (curious, I know). Wheat products also increase inflammation (C-reactive protein), raise blood sugar, and contribute tremendously to diabetes.

What many people don't know is that wheat products also have an addictive quality: have one donut and you want another. It's true for bread, breakfast cereals, pretzels, cookies, etc. How many times have you had just one Oreo cookie?

Curiously, elimination of wheat products, unlike elimination of nicotine, usually causes the cravings to disappear. In other words, if you stop smoking cigarettes, the desire to smoke doesn't go away. With wheat products, the often overwhelming desire for more wheat products often just goes away.

But most people are simply unable to dramatically reduce or eliminate wheat products from their daily diet and therefore struggle each and every day with excessive cravings for bagels, donuts, cookies, breads, etc.

Try this useful experiment: Eliminate wheat products for a month and see what happens. Most people drop blood pressure, lose the tummy excess, feel more alert, see a drop in blood sugar, experience improvements in lipoproteins, and regain control over appetite.

Good time for a heart attack?

22. January 2007 William Davis (0)
Man Has Heart Attack At Right Place, Right Time

If Robert Ricard had picked the wrong restaurant for lunch, he might have died.

The 71-year-old Michigan man suffered a heart attack shortly after ordering a glass of wine with friends at Bentley's Roadhouse on Saturday.

Luckily, a disaster medical team was sitting nearby.


A TV station in Michigan reported the above story. You've heard these "if it wasn't for ___, so and so would have died" stories. They're reported in all cities at one time or another.

What amazes me about these common local stories is that they're accepted at all. The question that comes to my mind is "Why couldn't the heart attack have been averted in the first place?" Early identification then, as close as humanly possible, elimination of risk would have been a preferable path.

Of course, it may not be the role of the media to cast judgement on why and how the entire episode could have been completely prevented from occurring. But you shouldn't fall into the same trap of complacency. We cannot expect others to save us when the "big one" hits. Your best assurance is to never have one in the first place.

How good is the South Beach Diet?

21. January 2007 William Davis (2)
I'm a fan of the South Beach Diet.

Though it is billed as a program for weight loss (for which it is very effective), it is really a program for health. The basic approach of South Beach involves:

Eat good fats — Choose good fats from olive oil, canola oil, peanut oil, flaxseed oil, walnut oil, avocados, nuts, and fish. Omega-3 (fish oil) supplements are also fine.


Eat good carbs — Good carbs include high-fiber, nutrient-dense fruits, vegetables, legumes, and whole grains.

Eat lean protein — Good sources include eggs, low-fat dairy, nuts, seeds, legumes, skinless white-meat poultry, fish, shellfish, lean cuts of meat, and vegetarian options such as tofu.

(From The South Beach Diet, Dr. Arthur Agatston)


There's no doubt that South Beach can yield dramatic weight loss. In my experience, the success in weight loss depends on 1) how unhealthy your diet was in the first place, and 2) how long you can stick to Phase I, the inital phase during which weight loss is most dramatic. Some people have to periodically cycle back to Phase I to break a "plateau" or to lose faster.

But South Beach is also healthy. It has all the ingredients of a healthy eating program: Low saturated and hydrogenated fats, rich in monounsaturated fats, high fiber, low- to moderate- glycemic index, vegetables and fruits, lean proteins.

The Atkins' diet, in contrast, while very effective for weiglht loss, is an unhealthy process. I've seen lots of bladder infections, constipation, skin rashes, and kidney stones. That's just in the short term. If you stick to the "induction phase" (the no carbohydrate, low fiber, indiscriminate fat initial phase) for an extended period, I suspect that other adverse internal phenemena also develop that might not show for years, like cancer. But--it does work for weight loss!

South Beach's Phase I is also carbohydrate restricted, but steers you towards healthier foods, such as healthy oils from olive and canola, raw or dry roasted nuts, and lean proteins and vegetables.

What really makes South Beach special, however, are its clever recipes. Dr. Arthur Agatston (the author) involved chefs from the restaurants in the South Beach area of Miami to help create healthy yet delicious recipes. We've tried many of them and, while they are different from traditional fare, are delicious and satisfying for the most part.

Criticisms? None, really. But, when my patients choose South Beach (which I often encourage), I often have to impress on them that the Track Your Plaque program is not about weight loss. It is about seizing control of a potentially life-threatening disease. It is a far more important goal with greater implications. Weight loss is just one aspect of a coronary plaque control effort. For this reason, we sometimes have to make changes in the South Beach program to allow for correction of specific lipoprotein patterns.

The most common modification is in people with small LDL particles. This pattern often does indeed respond to weight loss and/or niacin. However, it occasionally persists despite these efforts. We then will ask the patient to continue to restrict the re-introduction of wheat products, though it is allowed after Phase I in South Beach. In other words, for this specific and sometimes difficult to control lipoprotein pattern, a spedific modification of the off-the-shelf South Beach program is sometimes necessary. Of course, the diet is created to suit everybody. Lipoprotein analysis permits detailed insight into your patterns and it's only to be expected that specific modifications might be needed.

But, as written, you can do quite well in your plaque control program by sticking to South Beach.

Be patient with niacin

19. January 2007 William Davis (0)
Mel's HDL started at 37 mg/dl one year ago. Mel had several other abnormal lipoprotein patterns along with his HDL (inc. small LDL and Lp(a)), but HDL was clearly a crucial factor in his panel.

With a heart scan score of 1166, we needed to raise Mel's HDL to the Track Your Plaque target of 60 mg/dl. So Mel started niacin, our number one method to raise HDL, in addition to reducing his exposure to wheat products and other high glycemic index foods; increasing his physical activity; trying to reduce his excess tummy fat; fish oil; dark chocolate (2 oz per day) and red wine (1-2 glasses per day, preferably dark French reds). The form of niacin we often choose is SloNiacin (Upsher Smith), available over-the-counter for about $12-14 per 100 tablets.

Mel started out with niacin 500 mg per day at dinner, increased to 1000 mg at dinner after four weeks. Although this is usually too soon to reassess HDL, Mel insisted. His HDL 41 mg/dl. Mel's disappointment was palpable. He was the usual type A personality: he wanted his HDL higher--now! So Mel insisted that we increase niacin to 1500 mg per day. (We never go higher than this if low HDL or small LDL is the indication for niacin; only when Lp(a) is present do we go higher.)

Six months into this process, HDL: 45 mg/dl. Still a sluggish response.

One year later, HDL: 68 mg/dl. Finally!

That is typical for niacin, as well as combination of lifestyle changes Mel made. None of them result in an immediate rise in HDL; all take months to 1-2 years to exert full HDL-raising effect.

Think of HDL as the 82-year old grandma who takes a long time to cross the street-she does get there!

Note: Doses of niacin >500 mg per day should be taken with medical supervision.

Can vitamin D be a SOLE risk factor?

18. January 2007 William Davis (6)
Here's a crazy question. It occurred to me as I was talking to Drew, a slender, active 54-year old dentist with no bad habits including no smoking.

Drew's heart scan score was 222. His lipoprotein analysis mostly revealed a lot of nothing, which is unusual. The only pattern that showed up was a modestly high LDL of 122 mg/dl with a very slight excess of small LDL. That's it. I would not be satisfied that these were sufficient cause for Drew's level of coronary plaque.

Drew's 25-OH-vitamin D3 level: 15 ng/ml--severe deficiency--despite the fact that his doctor had suggested that he take a vitamin D2 preparation. In other words, Drew had been profoundly deficient, probably for years.

Given the unimpressive cholesterol and lipoprotein values, could vitamin D serve as a trigger for coronary plaque all by itself?

I don't have an answer and know of nobody else who does. However, my opinion is that vitamin D is indeed a potent risk that can cause heart disease as a sole risk factor.

Perhaps it's another piece of circumstantial evidence suggesting that vitamin D has an enormous influence on health, including coronary plaque. Interestingly, the only other health problem Drew has had is prostate cancer, treated a few years ago with prostate removal and radiation. Good evidence suggests that vitamin D deficiency escalates risk of prostate cancer substantially.

By the way, I've seen people taking vitamin D2 preparations, called "ergocalciferol," who are every bit as deficient as those who take no vitamin D at all. Avoid D2 or ergocalciferol preparations: they're worthless.

Does fish oil raise LDL cholesterol?

17. January 2007 William Davis (1)
Katie had an LDL (conventionally calculated) of 87 mg/dl, HDL of 48 mg/dl.

She added fish oil, 6000 mg per day. Three months later her LDL was 118 mg/dl, HDL 54 mg/dl. In other words, LDL increased by 31 mg. What gives?

Several studies have, indeed, shown that fish oil raises LDL cholesterol, usually by 5-10 mg/dl. Occasionally, it may be as much as 20-30.

Unfortunately, many physicians often assume that it's the (minor) cholesterol content of fish oil capsules, or some vague, undesirable effect of fish oil. It's nothing of the kind.

Since we based Katie's program on (NMR) lipoprotein analysis, not conventional lipids (HDL, calculated LDL, triglycerides, total cholesterol), I knew that Katie also had a severe excess of intermediate-density lipoprotein, or IDL, and very-low density lipoproteins, VLDL. This signifies that after a meal, dietary fats persist for 12, 24,or more hours. Fish oil is a very effective method to clear IDL and VLDL, though sometimes it also causes a shift of some IDL and VLDL into the LDL class. Thus, the apparent increase in LDL.

Another contributor: Conventional LDL is a calculated value, not measured. The calculation for LDL is thrown off by any reduction in HDL or rise in triglycerides. In Katie's case, the rise in HDL from 48 to 54 means that calculated LDL is becoming more accurate and rising towards the true measured value. At the start, Katie's true measured LDL was 122 mg/dl, 35 mg higher than the calculated value. Calculated LDL is therefore approximating measured LDL more accurately as HDL rises.

The most important lesson to learn is that, if LDL rises significantly on fish oil and you haven't had lipoproteins formally measured, there may have been a substantial postprandial abnormality like IDL that was unrecognized.

Heart disease is everywhere

16. January 2007 William Davis (0)
If you ever need convincing that heart disease is everywhere, you should do what I do: subscribe to Google Alerts and have them forward news anytime the search phrase "heart attack" crosses the web. (Just go to Google, click on "more" to the right of the search bar, and follow the links.)


Some recent samples:


Workmates resuscitate driver after heart attack

A woman coal mine truck driver had a heart attack and required resuscitation with a defibrillator 3 times on the way to the hospital.





Heart attack kills groom at reception
A 34-year old man died during his wedding reception, leaving behind his 26-year old new wife.






Heart attack ruled as cause of crash

An Alabama man drove his pick-up truck into oncoming traffic while suffering a heart attack.






Heart-attack victim to return to Hamburg stage


Country music artist, Michael Harding, suffered a heart attack and cardiac arrest during a performance. He is apparently recovered and returning to the stage.



That's just a sample from the last two days. While you and I are carry on a conversation on reversal of heart disease, our neighbors and friends drop over every day. Even though I witness successful heart disease reversal routinely, the rest of the world is not participating.

Pass it on: Coronary disease is identifiable, preventable, controllable, and reversible.
Have some more

Have some more

7. April 2011 William Davis (37)
Wheat, via exorphin effects, is an appetite stimulant. Eat a whole wheat bagel or bran muffin, you want another. You also want more of other foods. You also want something to eat every two hours due to widely-swinging insulin-glucose responses: blood sugar high followed by a sharp downturn that triggers a powerful impulse to eat (thus the cravings for a snack at 9 and 11 a.m. after a 7 a.m. breakfast).

If wheat is a stimulant of appetite, then removing it should yield reduced appetite and reduced calorie intake. That is precisely what happens.

When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.

400 calories per day results in 21 lbs lost over 6 months, based just on calories. (3500 calories per pound lost.) That is what happens in wheat elimination diets: 21-26 lbs lost over 6 months.

Wheat is the processed food industry's nicotine, a means of ensuring repeat food purchases. It's also low-cost (subsidized by the U.S. government), high-yield, an ingredient that even has its very own withdrawal syndrome should you miss a "hit."
Tags :

Comments (37) -

  • Steve

    4/7/2011 2:49:30 PM |

    The reduced appetite after wheat withdrawal is exactly what I'm experiencing. A very low carbs (and so very low wheat) diet is the first diet that I can stay on because I don't get hunger pangs. I'm down about 20 lbs. (10%) since finding this blog and going wheat-less.

  • Anonymous

    4/7/2011 3:31:35 PM |

    Hmmm... I've been wheat free (grain-free, actually) for almost 3 weeks now. I started off being mildly hungry all the time, and that has faded. I wonder if that's what you're talking about there!! Terrific!

    Keep the articles coming... love them.

    Diana

  • Steve

    4/7/2011 4:16:45 PM |

    I started just before Christmas. The first week or so was unpleasant ... hungry, groggy ... wheat withdrawal. The "no hunger pangs" showed up after that and made it possible for me to stay on this diet. It's the first time I've been able to consistently lose weight.

  • Real Food RD

    4/7/2011 4:44:52 PM |

    When I first went off wheat it took a good 3-4 weeks for the withdrawl to stop.  During that time I was ravenously hungry and ate constantly.  I know my body was just hoping I'd eventually eat some bread.  I gained probably 10 pounds, but it came back off (I don't have any other weight to lose).

    Was that a study you are referencing or clinical experience?  Would love to have more details.

  • Might-o'chondri-AL

    4/7/2011 5:08:06 PM |

    Biblical wheat and remote regional "landrace" wheat strains are not the same as tetra-ploid wheat we're sold. Tetraploid varieties have been grown for less than 500 years; and di-ploid varieties around for 500 to 1,000 years.

  • Megaera

    4/7/2011 5:23:28 PM |

    Look, I'm glad that this works for some/lots of people - but I've been doing this since before Christmas, 4 months now, and I haven't lost a pound.  My status is a good deal worse in a number of subtle and not-so-subtle respects, and frankly nothing of substance has actually improved in any way.  Recommendations of iodine supplementation were an unqualified disaster.  And I effectively have nowhere to go, now -- I'm stuck with this mode, because I have every reason to believe that going back to grain in any degree will yield uncontrollable weight gain.  I'm really not trying to be negative, but the point  has to be made, amid all the rosy predictions of magic pounds disappearing (that's just calories-in-calories-out which is supposed to be BS, according to the new Received Wisdom, no?) that this regimen doesn't work for everyone.

  • ChicagoGirl1

    4/7/2011 6:06:43 PM |

    How is wheat different from just carbs in general? Don't they all create this problem?

  • brec

    4/7/2011 7:09:57 PM |

    "...has its very own withdrawal syndrome should you miss a 'hit.'"

    If you follow the link, you'll see that this unqualified statement is based on self-selected (Dr. Davis's blog commenters) anecdotal evidence.

  • Anonymous

    4/7/2011 7:42:27 PM |

    brec:

    If you keep following those links back, you'll eventually land here:

    http://www.jbc.org/content/254/7/2446.full.pdf+html

  • Dani

    4/7/2011 8:25:31 PM |

    I agree. I can't stop once i start eating crackers or croissants.

    In your opinion, do other grains like corn and rice have the same effect?

  • Gene K

    4/7/2011 9:44:27 PM |

    @Megaera

    I used to eat a lot of bread. For the first four months of my grain-free and carbs-from-veggie-only life and policing my blood sugar I gained about 10lbs. My NMR profile got significantly worse, too. Dr Davis checked my APOE and it was type 4, so he told me to limit fats and changed my medications. In addition, I stopped being a vegetarian and increased the amount of lean proteins in my diet. I also changed my exercise routine according to slow-burn. Four months later - 14 lbs have been lost and NMR profile improved drastically.

    I am saying it, because there is a happy path of losing weight when you stop eating wheat, but certain people may need to make an additional effort. So you need to look further.

  • Might-o'chondri-AL

    4/7/2011 10:03:45 PM |

    Japanese children (290) aged 5 - 18 had MRI of brain to see if breakfast centered on white bread vs. white rice differ. The study adjusted for confounding factors.

    The older white rice breakfasters showed a larger grey matter in relation to cranium volume; in some brain areas white bread eaters had more grey matter.In the youngest there was not a statistical differenece in grey matter volume between the groups.

    Rice breakfasters' MRI showed more grey matter in left superior temporal gyrus, left inferior temporal gyrus,right pre-central gyrus, left superior caudate  nuclei and the bilateral caudate nuclei. Caudate volume is associated with a subset of verbal IQ ( POI component); the rice breakfasters had higher POI scoring. And in addition they had higher IQ than the bread group; IQ is associated with prefrontal and orbito-facial corteces and the cingulate gyrus.

    Bread breakfasters MRI showed more grey matter in the postcentral gyrus, right precentral gyrus, right fronto- parietal orbit, and bilateral orbito-frontal corteces. Their MRI showed more white matter in
    the right pre-frontal gyrus  and post-central guyrus; otherwise the two diets showed no white matter % differences between the groups.

  • Just Joan

    4/8/2011 1:00:06 AM |

    My experience has been exactly like Steve's. Since going completely wheat-free (as well as ditching the sugar and most fruit), I'm down 15 lbs. and still losing. The best part of all is that my hypoglycemia symptoms have completely disappeared, my energy is through the roof, and I no longer get uncontrollable hunger pangs.

  • Dr. William Davis

    4/8/2011 1:01:57 AM |

    As Steve and 1st Anonymous point out, this approach can work for many, if not most, people with extravagant weight loss and health benefits.

    However, as the frustration expressed by Meg suggests, there may be confounding factors. As Gene points out, apo E4, for instance, can modify the response. But this was not the focus of the post.

    This is a blog. Each post makes a point. Don't mistake this for a one-on-one healthcare encounter.

  • Dr. William Davis

    4/8/2011 1:03:27 AM |

    Hi, Real Food-

    I was referring to the collective experience demonstrated in gluten-elimination diets in celiac patients.

    I will summarize this literature in my upcoming book from Rodale, Wheat Belly.

  • mongander

    4/8/2011 1:32:32 AM |

    I've relented and switched from oats to swallowing about 1 oz of chia seed for breakfast.  The rest of the day I mainly rely on cabbage/veggie soup (no starches)...snack on roasted peanuts & boiled eggs.  Am losing weight.

  • Frank Hagan

    4/8/2011 2:01:10 AM |

    Dr. Davis - I posted today about leptin resistance, and how high triglyceride levels have been implicated in stopping leptin from its normal "hunger stopping" function. Have you seen a dramatic decrease in triglycerides from those that simply refrain from wheat, without intentionally counting other carbs?

  • WheatlessX

    4/8/2011 2:23:20 AM |

    A few months ago, I read a post on this blog which suggested getting a BG meter in order to see what effect things like wheat had on BG. The results of my first meal (whole wheat pasta with red sauce, broccoli, and whole wheat toast) showed 183 at 1hr PP and 149 at 2hr! What was really surprising to me, however, was that despite the 2 hour number being as high as it was, I was still very hungry.

    Based on this and subsequent tests, along with increased awareness of satiety, I've made some pretty significant changes in the types of foods I eat. Mostly, I've cut back on all the grains (even "whole grain") and added fats (I no longer believe the "low fat" recommendations).

    The result is that in about 3 months I've lost roughly 15 lbs. (mostly in my belly), despite having no sense of being deprived. It doesn't hurt that my lipids have improved, as well (TC, LDL and trigs all lower).

    I had been skeptical of Dr. Davis's claims about wheat at first, but I am now convinced that for me at least, wheat is not my friend.

  • Anonymous

    4/8/2011 3:33:36 AM |

    What if that happens to me with prety much every thing. I want another almond, another egg, another piece of cheese, another wine, more chocolatte, another sushi, a bit more of meat....

  • David Evans

    4/8/2011 8:16:16 AM |

    I started to cut down on my bread intake about 3 years ago and am now almost completely grain free (apart from accidental consumption). I have lost over 50lb and feel like a diifferent person.

    One of the biggest bonuses of cutting wheat from my diet is the improvement in my mood and temperament. I used to be quite a moody and slightly unpredictable type of personality, but now everything is calm and serene.

    Quite a few scientific papers show a connection between schizophrenia and cereal intake. http://healthydietsandscience.blogspot.com/search/label/Cereals%20and%20Schizophrenia

    This may help to explain the improvement in my personality.

  • Anonymous

    4/8/2011 11:10:35 AM |

    I've been mostly wheat-free for over a year, and have lost exactly zero pounds. I still don't eat it, since I believe there are a lot of benefits to leaving it out (all my blood-work #'s were fine before, but improved a bit more after awhile of high-fat/low carb). The biggest improvement I've seen is in my mood -- no more depression. However, I'm still 100 lbs overweight. Frown

  • CarbSane

    4/8/2011 12:27:43 PM |

    When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.


    I would be interested in one study demonstrating that just cutting wheat from the diet resulted in 350-400 cal/day spontaneous reductions in intake.  Preferably controlled for protein content by substituting other carbs for normal wheat content.  

    The VLC diet studies don't count as too many variables are changed there to attribute most, if even any, of the decreased intake to reductions in wheat intake.

    If wheat is addictive, and whole wheat supposedly contains more addictive substances, why don't people gravitate towards whole wheat pasta and bread and binge on
    those?

  • Eric

    4/8/2011 3:12:46 PM |

    CarbSane-

    You stated "The VLC diet studies don't count as too many variables are changed there to attribute most, if even any, of the decreased intake to reductions in wheat intake."

    Same could be said for the studies that cholesterol and fat are the sole reasons for our obesity, diabetes, heart disease, etc- yes?

    I also don't buy your suggestion that people don't binge on whole wheat containing foods as I've seen it countless times at bagel shops, healthy Asian noodle bowl places, pizzerias, etc. People trying to eat "Healthy" often over indulge on "healthy" pizzas, bagels, breads and pasts all while thinking they are doing eating exactly what the AHA recommends. Something that is more than likely silently killing them.

    I've done all this before and all it got me was a plethora of trips to a cardiologist, anxiety, depression, bloating and countless Rx pills that did absolutely nothing. And I'm not an unhealthy guy by any means.

    You may feel Dr. Davis' posts are all anecdotal and that's fine. His new Track Your Plaque book has all the evidence and studies I need to support his claims and it was the anecdotal evidence that he posts that spoke volumes to me. It was the first place I found that explained exactly what I was going thru (30 years old, extremely hypertensive, depressed, slightly overweight and angry with atherosclerosis that seriously a 30 year old should not be suffering from). From that point on I've read his book, followed his plan and have replaced all my worthless Rx's for a daily dose of VD3, Omega3 and steer clear of "Healthy" grains... and I couldn't be happier.

    Of course this is my own "anecdotal" experience, that four of my previous cardiologists couldn't achieve...

  • Steve

    4/8/2011 4:01:05 PM |

    In posts above I didn’t make clear that I am actively “dieting” as in “trying to lose weight”.

    My diet: Two Atkins shakes for breakfast with vitamins and two more for lunch. An Atkins shake for snacks, as needed. Dinner is a leafy greens salad with vinaigrette and maybe nuts, peppers, tomatoes, cheese, minced garlic plus a meat portion and sometimes a low-carb vegetable. A 30 minute after-dinner walk with my dog most  evenings. A 15 minute walk/run some mornings before my weigh-in.

    I believe the only reason I can stay on this tough diet is the “no hunger pangs” effect that I get with very-low-carbs. For example, I can have the Atkins shakes for breakfast and easily go until lunch with no cravings. To accelerate weight loss, I can even skip breakfast – no hunger pangs means I can go from dinner to lunch without cravings – I’m hungry but I can do it – I’ve done it every day this week.

    I’m about 5’8”. I found this blog on Dec. 17th and I weighed 204 lbs. On Jan. 29th I weighed 189. Today, April 8th, I weighed in at 179.8! I hadn’t been in the 190s in years. The 180s? The 170s? They were just dreams to me.

    I have gone off the diet; typically after multiple social events in a row. Example -- alumni social Thursday eve, extended-family dinner at a restaurant Friday eve, sports event Saturday, why-not-keep-eating Sunday. Then, I want to keep losing weight so I get back on the diet. I go through wheat-withdrawal again but now I know it’s just a temporary phase and that helps me get through it. It takes about 10 days to get back to where I was and then I keep dieting.

    Disclaimers – On a tough diet like this I am weaker than normal but I can function and I put up with it because, after my initial success, I see this works & I want to lose the weight. I have a desk job so I can probably better handle the reduced energy levels than someone with a more active job. My family is supportive and we eat dinners that work with the diet. So I have intangible factors helping me.

    One definition of hack is “a clever solution to a tricky problem”. To me, very-low-carbs is an empowering “hack” of my metabolism that lets me control my weight. Hallelujah!

  • Might-o'chondri-AL

    4/8/2011 5:01:12 PM |

    A single variety of modern tetra-ploid wheat has 100s of different gluten proteins. This equates to 10s of thousands of variations of peptide sequences one can ingest from wheat.

    The molecules formed depend on how trans-amin-dation (cross linking proteins) binds the free residues of glutamine. This potential bond is genetic for each strain of wheat, since involves the positioning of Carbon terminals (located on any of those peptides, as a proline residue). Tetra-ploid wheat has many unique proline residues that cross-link (ex: alpha gliadin) in a way that can resist our digestion.

    Plasticity is a term used to describe the human brains ongoing adaptability. The nerve axons are in a outer (extra-cellular) matrix of gluco-proteins; this includes the proteo-glycan chondroitin sulfate ( glycan = poly-saccharides & oligo-saccharides; hence "glyc-").

    Chondroitin sulfate's residue (wing) of N-acetyl-galactos-amine provide a place for lectins to bind to (ex: lectins most infamous  trans-amididation incarnation is the gliadin molecule, a type of glyco-protein). Thus different glyco-proteins, with unique derivative glycos-amino-glycan molecular chains are going to affect brain neurons differently.

    Anti-bodies for uOR (natural opiod receptor)detected in circulation are indicative of a reaction to some lectin. This means a lectin is binding to the uOR; Doc calls this an "exorphin effect" with one end result being appetite stimulation.

    Neo-striata cells in the brain work off of input from the cortex; the neo-striatum has a part called the matrix (note: here matrix is a brain structure & not to be confused with terms like extra-cellular matrix) and another part called the striosome. The matrix neo-striata gets input from the pre-frontal brain and senori-motor regions; while the striosome input is from pre-limbic, infra-limbic and pre-motor corteces.

    The matrix neo-striata neuro-chemistry is  integral to behavior involved in self-initiated action, goal directed behavior, sensory integration and motor programs. During post-natal (growing child) brain development the striosome neo-striatum cells have a high degree of involvement with glyco-proteins; which may partly explain the Japan school children brain development differences due to breakfast of rice vs. bread (detailed above).

  • CarbSane

    4/8/2011 6:29:24 PM |

    @Eric, I agree.  Don't know where I've claimed such.  Dr. Davis made a claim (and he preceded that with "When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing-").  Study?  One?  

    I'm just asking for a study that demonstrates this claim.  I don't refute that a good many people could benefit from avoiding wheat.

  • Eric

    4/8/2011 7:59:13 PM |

    My apologies CarbSane, I didn't mean for reply to come across as combative.

    Dr. Davis may have a study that he can refer you to.

    But it is a well known fact that foods that trigger a surge in blood sugar and after-meal crashing also lead to increased hunger more frequently.

    Foods that lead to the surge are carbs in (either healthy or processed) grain or sugar form.

    Sometimes all the anecdotal evidence should stand above the biased studies attempting to maintain the status quo. Just my .02

  • Nick

    4/9/2011 4:38:03 AM |

    I reduced my CHO intake about three years ago and lost about 8 pounds in the first three months.  At about the three month point, I removed wheat and all other grains from my diet.  I have lost no additional weight since I gave up wheat.  

    I would say that I have not reduced my caloric intake by 400 calories a day.

  • CarbSane

    4/9/2011 11:09:24 AM |

    @Eric, no apology necessary, I didn't take your post as combative at all.  I just find Dr.Davis making sensationalistic claims a matter of routine lately.  I do a lot of literature searching and I've not, to my memory, ever come across one study that just looked at eliminating wheat and intake.  I'd be curious to see the results of such a study done in a well controlled manner.

  • Dr. William Davis

    4/9/2011 4:36:30 PM |

    In response to several commenters:

    Citing studies in which calorie intake is reduced by strictly eliminating wheat while not imposing any other restrictions does not necessarily mean that this is the most healthy way to eat.

    In other words, if I eliminate wheat but replace lost calories with corn chips, jelly beans, and Coca Cola, then of course I will not lose weight nor obtain health benefits beyond elimination of gluten and other undesirable ingredients in wheat.

    A better approach would be to 1) eliminate wheat, then 2) reduce carbohydrates, especially cornstarch, oats, and sugar, then 3) eat other whole healthy foods.

    My point is that, sans wheat, the drive for consumption is diminished for many, though not all, people.

  • Might-o'chondri-AL

    4/9/2011 4:55:03 PM |

    MRI of adult brain while eating shows a response according to an individuals BMI variation. I had this as a well composed comment at WholeHealthSource, but can't retrace it; so, roughly, from my notes now.  

    High BMI individuals have more brain activity in the left posterior insula, supramarginal gyrus, para-central lobule and the cerebellum's uvula/declive/tonsil structures. Cerebellum response involves how one likes the looks/smell of food; more blood flowing in the cerebellum coincides with increased appetite.

    Low BMI individuals have more brain activity in the anterior insula, posterior hypothalamus, amygdala, thalamus, pons and mid-brain structures.

    The Vagus nerve (dorsal) leads from our "gut" up into the pons sub-nucleus of our brains dorsal raphe. In obese individuals this link shuts down when eating. Contrary to the obese, this link is open in lean individuals when they (non-obese) are eating.

    The Pons, which inputs into most of the other brain structures, shows more functioning with slower eating. In addition, stuffing with excess food in a meal slows the pons interaction with the brain.

    The Amygdala, part of our limbic system, sets the emotional response to things ingested. It gets plenty of neuro-signals from the gut, and is implicated in binge eating.

    The Posterior Insula recieves input from both the amygdala and hypothalamus (regulator of amount we ingest). In obese individuals both the posterior and middle insula trigger (on)into action when they see the meal; as contrasted to normal BMI individuals, where these brain structures remain unaffected when they (non-obese) see a meal.  

    In obese individuals there is comparatively more dopamine activity in the neurological circuits of the hypothalamus, amygdala, mid-brain and thalamus (arousal response). So, all in all, it seems quite possible Doc's nemesis (tetra-ploid wheat's molecules) can play antagonistic roles in the brain.

  • CarbSane

    4/9/2011 5:37:21 PM |

    But Dr. Davis, you said there are multiple studies demonstrating a similar drop in caloric intake from eliminating wheat "without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing-"

    Are you walking that back?  Or do such studies exist.

  • Might-o'chondri-AL

    4/10/2011 12:39:51 AM |

    Hi CarbSane,
    Doc's rant is about the "undesireable ingredients"
    in modern wheat. If would you forgive me for sounding like a know-it-all, then, my comments show some brain responses that go beyond "x" number of calories, "x" amount of carbohydrates, "x" level of exercise and "x" amount of meals.

    It is modern wheat's assorted agglutin fractions, the way they bind glycans (like chitotriose, Beta-1-4-linked N-acetyl glucosamine) and how they cleave off "rogue" metabolites that has an effect on the brain cells. These metabolites have to get inside the brain cells cytoplasm by trans-duction; they are not ions.

    These "undesireable" cleaved metabolites have exposed glucosamine (GlcNAc) wings (residues) that bind to GLcNAc receptors on the cell; this fosters their trans-duction (carrying) past the cell membrane and any intervening endothelial (blood vessel wall) barriers.

    The "undesireable" metabolite then out binds Lysosome C; thus normal lysosomal "housekeeping" endo-cytosis (engulfing) action is inhibited from destroying (ie: no opportunity to hydrolyse apart bonds in the metabolite) that metabolite. This gives the metabolite the time to act like a Heat Shock Protein (ie: it has
    physically blocked that brain cell's usual heat shock protein ever since it locked onto that cell's GluNAc receptor); and thus, that "undesireable" metabolite can ferry (translocate) it's glycan/peptide right to the Endoplasmic Reticulum inside of that brain cell.

    Once the endoplasmic reticulum
    (in a brain cell) recieves an
    "undesireable" peptide/glycan complex it (endoplasmic reticulum) is not able to do a
    "normal" job with it; which job is to properly fold (ratchet into explicit configurations) the normal proteins the  brain cell passes to it (endoplasmic reticulum). Any alternate fold in a protein means it (protein)will react differently in the cascades it participates in.

    How this translates into each of the physical alterations in specific brain structures that I mentioned is beyond my understanding. This comment is to explain one of the ways those
    changes can get initiated in human brain cells by modern wheat; and also, to show our schooling on calories/carbs/ exercise/meals/cleansing misdirect us Doc insists he sees clinical results.

  • Onschedule

    4/10/2011 6:23:53 AM |

    @Might,

    I have enjoyed many of your comments; you have a keen talent in selecting and presenting information which dovetails nicely with Dr. Davis's blog entries. I found this one particularly fascinating.

    Thanks!

  • rcdyoga

    5/6/2011 3:22:45 AM |

    Here is my wheat story. I have been "mostly" avoiding wheat for 3 years and when finally being diagnosed with Hashimoto's decided to go completely wheat free. My doctor suggested a gluten challenge for a definitive diagnoses of celiac or gluten intolerance.  Unfortunately, I agreed. Six weeks into the 3 month challenge I quit due to problems that began during the gluten challenge (joint pain, severe digestive distress, insomnia, adhesive capsulitis, nightsweats). Unfortunately the gluten caused some damage and I developed new food intolerances to dairy and nightshades, which have not resolved in 7 months of being grain free.

  • Yvonne

    8/2/2011 10:42:30 AM |

    Sorry this reply comes so late! I hope you see it. May I suggest that you try magnesium oil? It's a mixture of mag chloride and water that you apply to your skin. You may be mag deficient and, if so, that could explain why you're not losing weight.

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Fish oil: The natural triglyceride form is better

2. February 2011 William Davis (43)
If you have a choice, the triglyceride form of fish oil is preferable. The triglyceride form, i.e., 3 omega-3 fatty acids on a glycerol "backbone," is the form found in the body of fish that protects them from cold temperatures (i.e., they remain liquid at low ambient temperatures).

Most fish oils on the market are the ethyl ester form. This means that the omega-3 fatty acids have been removed from the glycerol backbone; the fatty acids are then reacted with ethanol to form the ethyl ester.

If the form is not specified on your fish oil bottle, it is likely ethyl ester, since the triglyceride form is more costly to process and most manufacturers therefore boast about it. Also, prescription Lovaza--nearly 20 times more costly than the most expensive fish oil triglyceride liquid on a milligram for milligram basis--is the ethyl ester form. That's not even factoring in reduced absorption of ethyl esters compared to triglyceride forms. Remember: FDA approval is not necessarily a stamp of superiority. It just means somebody had the money and ambition to pursue FDA approval. Period.

Taking any kind of fish oil, provided it is not overly oxidized (and thereby yields a smelly fish odor), is better than taking none at all. All fish oil will reduce triglycerides, accelerate clearance of postprandial (after-eating) lipoprotein byproducts of a meal (via activation of lipoprotein lipase), enhance endothelial responsiveness, reduce small LDL particles, and provide a physical stabilizing effect on atherosclerotic plaque.

But if you desire enhanced absorption and potentially lower dose to achieve equivalent RBC omega-3 levels, then triglyceride forms are better.

Here are cut-and-pasted abstracts of two of the studies comparing forms of fish oil.

Bioavailability of marine n-3 fatty acid formulations.

Dyerberg J, Madsen P, Moller JM et al. 
Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

The use of marine n-3 polyunsaturated fatty acids (n-3 PUFA) as supplements has prompted the development of concentrated formulations to overcome compliance problems. The present study compares three concentrated preparations - ethyl esters, free fatty acids and re-esterified triglycerides - with placebo oil in a double-blinded design, and with fish body oil and cod liver oil in single-blinded arms. Seventy-two volunteers were given approximately 3.3g of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily for 2 weeks. Increases in absolute amounts of EPA and DHA in fasting serum triglycerides, cholesterol esters and phospholipids were examined. Bioavailability of EPA+DHA from re-esterified triglycerides was superior (124%) compared with natural fish oil, whereas the bioavailability from ethyl esters was inferior (73%). Free fatty acid bioavailability (91%) did not differ significantly from natural triglycerides. The stereochemistry of fatty acid in acylglycerols did not influence the bioavailability of EPA and DHA.
(Full text of the Dyerberg et al study made available at the Nordic Naturals website here.)



Eur J Clin Nutr 2010 Nov 10. 

Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacylglycerides versus ethyl esters.

Neubronner J, Schuchardt JP, Kressel G et al. 
Institute of Food Science and Human Nutrition, Leibniz Universität Hannover, Am Kleinen Felde 30, Hannover, Germany.

Abstract

There is a debate currently about whether different chemical forms of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are absorbed in an identical way. The objective of this study was to investigate the response of the omega-3 index, the percentage of EPA+DHA in red blood cell membranes, to supplementation with two different omega-3 fatty acid (n-3 FA) formulations in humans. The study was conducted as a double-blinded placebo-controlled trial. A total of 150 volunteers was randomly assigned to one of the three groups: (1) fish oil concentrate with EPA+DHA (1.01?g+0.67?g) given as reesterified triacylglycerides (rTAG group); (2) corn oil (placebo group) or (3) fish oil concentrate with EPA+DHA (1.01?g+0.67?g) given as ethyl ester (EE group). Volunteers consumed four gelatine-coated soft capsules daily over a period of six months. The omega-3 index was determined at baseline (t(0)) after three months (t(3)) and at the end of the intervention period (t(6)). The omega-3 index increased significantly in both groups treated with n-3 FAs from baseline to t(3) and t(6) (P < 0.001). The omega-3 index increased to a greater extent in the rTAG group than in the EE group (t(3): 186 versus 161% (P < 0.001); t(6): 197 versus 171% (P < 0.01)). Conclusion: A six-month supplementation of identical doses of EPA+DHA led to a faster and higher increase in the omega-3 index when consumed as triacylglycerides than when consumed as ethyl esters.

Diarrhea, asthma, arthritis--What is your wheat re-exposure syndrome?

30. January 2011 William Davis (52)
Have you experienced a wheat re-exposure syndrome?

As I recently discussed, gastrointestinal distress--cramps, gas, diarrhea--is the most common "syndrome" that results from re-exposure to wheat after a period of elimination.

Others experience asthma, sinus congestion and infections, mental "fogginess" and difficulty concentrating, or joint pains and/or overt swelling.

Still others say there is no such thing.

Let's take a poll and find out what readers say.

Marathoners, triathletes, and heart disease

30. January 2011 William Davis (0)
Curious thing: People with lipoprotein(a) gravitate towards elite levels of exercise.

I tell my lipoprotein(a) patients that, if they want to see a lot of other people with lipoprotein(a), go to a marathon or triathlon.

This effect applies more to males than to females, just as the fascination with numbers seems to be confined to men, too. That's why I've posted in past about the "prototypical" lipoprotein(a) male.

I believe this is a big part, perhaps the only, reason why there seems to be a modest increased risk for cardiovascular events despite high exercise levels in marathoners. It has nothing to do with the exercise itself; it has to do with the kind of people who choose to exercise at this level.

The best fish oil

29. January 2011 William Davis (30)
The best fish oils available are the liquid forms. Contrary to many people's expectations, the best liquid fish oils have no fishy odor or taste.

I use a lot of liquid fish oils because of the higher doses we use in the Track Your Plaque program, as well as our strategy of high-dose fish oil to reduce lipoprotein(a). Women, in particular, don't like taking the oodles of capsules required to achieve the higher doses we need. So the ladies really like the liquid forms.

The best liquid fish oils are non-fishy, highly-concentrated, and come in the better absorbed triglyceride form. Many capsules, including prescription Lovaza, are the less well-absorbed ethyl ester form. Several studies, such as this one, have now demonstrated that the naturally-occurring triglyceride form yields higher blood (RBC) levels of omega-3 fatty acids, likely due to more efficient digestion via pancreatic lipase.

While there are many good forms of fish oil and only a few bad, these are the best of the best:

Pharmax
The Pharmax Finest Pure Fish Oil with Essential Oil of Orange contains 1800 mg EPA + DHA per teaspoon. This is the preparation I've been taking.

Nordic Naturals
The Nordic Naturals lemon-flavored ProOmega Liquid contains 2752 mg EPA + DHA per teaspoon, the most concentrated of any fish oil I've seen.

(This list is not exclusive. These are just two brands I've used extensively with good results.)

These highly-concentrated, triglyceride forms are more expensive, due to their concentrated nature. 1 teaspoon Pharmax fish oil, for example, provides an equivalent quantity of omega-3 fatty acids as 6 standard fish oil capsules on a milligram for milligram basis, but more like 8 to 9 capsules when absorption efficiency is factored in. The triglyceride form is also more laborious to manufacture. On our Track Your Plaque Marketplace, our Pharmax 500 ml runs $58.95 list. (500 ml provides 100 teaspoons or 600-capsule equivalent.)

Note that, minus the protection of the capsule, liquid fish oils will oxidize if not refrigerated. So be sure to keep your liquid fish oil in the fridge.

What do Salmonella, E coli, and bread have in common?

28. January 2011 William Davis (22)
Say you happen to eat some chicken fingers contaminated with bacteria because the 19-year old kid behind the counter failed to wash his hands after using the toilet, or because the kitchen is poorly managed with unwashed counters and cutting boards, or because the food is undercooked. You get a bout of diarrhea and cramps, along with a desire to banish chicken from your life.

Here's yet another odd wheat phenomenon: About 30% of people who eliminate wheat from their lives experience an acute food poisoning-like effect on re-exposure. You've been wheat-free for, say, 6 months. You've lost 25 lbs from your wheat belly, you've regained energy, joints feel better. You go to an office party where they're serving some really yummy looking bruschetta. Surely a couple won't hurt! Within a hour, you're getting that awful rumbling and unease that precede the explosion.

The majority of people who experience a wheat re-exposure syndrome will have diarrhea and cramps that can last from hours to days, similar to food poisoning. (Why? Why would a common food trigger a food poisoning-like effect? It happens too fast to attribute to inflammation.) Others experience asthma attacks, joint pains that last 48 hours to a week, mental fogginess, emotional distress, even rage (in males).

Wheat re-exposure in the susceptible provides a tidy demonstration of the effects of this peculiar product of genetic research. So if you are wheat-free but entertain an occasional indulgence, don't be surprised if you have to make a beeline to the toilet.

The world of intermediate carbohydrates

28. January 2011 William Davis (0)
There are clear-cut bad carbohydrates: wheat, oats, cornstarch, and sucrose. (Fructose, too, but in a class of bad all its own.)

Wheat: The worst. Not only does wheat flour increase blood sugar higher than nearly all other carbohydrates, it invites celiac disease, neurologic impairment, mental and emotional effects, addictive (i.e., exorphin) effects, asthma, irritable bowel syndrome, acid reflux, sleepiness, sleep disruption, arthritis . . . just to name a few.

Oats: Yeah, yeah, I know: "Lowers cholesterol." But nobody told you that oats, including slow-cooked oatmeal, causes blood sugar to skyrocket.

Cornstarch: Like wheat, cornstarch flagrantly increases blood sugar.It also stimulates appetite. That's why food manufacturers put it in everything from soups to frozen dinners.

Sucrose: Not only does sucrose create a desire for more food, it is also 50% fructose, the peculiar sugar that makes us fat, increases small LDL particles, increases triglycerides, slows the metabolism of other foods, encourages diabetes, and causes more glycation than any other sugar.

But there are a large world of "other" natural carbohydrates that don't fall into the really bad category. This includes starchy beans like black, kidney, and pinto; rices such as white, brown, and wild; potatoes, including white, red, sweet, and yams; and fruits. It includes "alternative" grains like quinoa, spelt, triticale, amaranth, and barley.

For lack of a better term, I call these "intermediate" carbohydrates. They are not as bad as wheat, etc., but nor are they good. They will still increase blood glucose, small LDL, triglycerides, etc., just not as much as the worst carbohydrates.

The difference is relative. Say we compare the one-hour blood glucose effects of 1 cup of wheat flour product vs. one cup of quinoa. Typical blood sugar after wheat product: 180 mg/dl. Typical blood sugar after quinoa: 160 mg/dl--better but still pretty bad.

Some people are so carb-sensitive that they should avoid even these so-called intermediate carbohydrates. Others can have small indulgences, e.g., 1/2 cup, and not generate high blood sugars.

Heroin, Oxycontin, and a whole wheat bagel

25. January 2011 William Davis (27)
For a substantial proportion of people who remove wheat from their diet, there is a distinct and unpleasant withdrawal syndrome. Here are the comments of Heart Scan Blog reader, Scott, from Texas:

Hello Dr. Davis,

I've been experimenting with diet, converging upon a Paleo type diet, but I keep running into problems. I have isolated the problem to cutting out wheat.

Sugar, rice, fruit, corn, potatoes, etc. are relatively ok to add or remove from the diet, but cutting out wheat in particular brings on a moderate headache with heavy fatigue all day long. This resembles the wheat withdrawal symptoms I found on your blog. As I write this, I'm on day 8 of wheat-free. I consume a fair variety of meat and veggies each day with a moderate amount of white rice for carbs. Perhaps a bowl of corn flakes with milk and half a bar of dark chocolate a day. I've learned from experience over the past 5 months or so that none of these foods affect the withdrawal. It's purely wheat.

My question is, what is the range of times for withdrawal symptoms that you've heard from different people? Has there been anyone who never recovered from the wheat withdrawal symptoms even after many months?

It's very tough to get work done like this, and even though my body and head feel much healthier in general, my sinuses have cleared, don't have to take a big nap after I eat, etc., I don't want to go down a path where this is the way things are going to be forever. 


People who have never experienced wheat withdrawal pooh-pooh the effect. But, for about 30% of people, wheat withdrawal is a real, palpable, and sometimes incapacitating experience.

Beyond removing an exceptionally digestible carbohydrate that yields blood sugar rises higher than nearly any other known food (due to the unique amylopectin structure of wheat-derived carbohydrate), wheat withdrawal is a form of opiate withdrawal, somewhat like stopping heroin, Oxycontin, and other opiates. Stop eating whole wheat toast for breakfast, whole grain sandwiches for lunch, or whole grain pasta for dinner, and the flow of exorphins, i.e., exogenous morphine-like compounds, stops. You experience dysphoria (sadness, unhappiness), mental "fog," inability to concentrate, fatigue, and decreased capacity to exercise. It is milder than withdrawal from prescription opiates. Unlike withdrawal from more powerful opiates like heroine, there are, thankfully, no seizures or hallucinations. There are also no deaths.

In my experience, most people get through with wheat withdrawal in about 5 days. An occasional person will struggle for as long as 4 weeks. Thankfully for Scott, I've never seen it last longer than 4 weeks. (Interestingly, people who survive the withdrawal syndrome are often prone to a peculiar re-exposure phenomenon that I will discuss in future, i.e., they get sick upon re-exposure.)

The modern dwarf mutant variant of Triticum aestivum (that our USDA urges us to eat more of) contains greater proportions of gluten proteins compared to wheat pre-1970; glutens are the source of wheat-derived exorphins.

Incidentally, a drug company should be releasing a drug in the next year that will contain naltrexone, an oral opiate blocking drug, for a weight loss indication. They claim it is a blocker of the "mesolimbic reward system." I say it's a blocker of wheat exorphins.

The five most powerful heart disease prevention strategies

24. January 2011 William Davis (39)
You've seen such lists before: 5 steps to prevent heart disease or some such thing. These lists usually say things like "cut your saturated fat," eat a "balanced diet" (whatever the heck that means), exercise, and don't smoke.

I would offer a different list. You already know that smoking is a supremely idiotic habit, so I won't repeat that. Here are the 5 most important strategies I know of that help you prevent heart disease and heart attack:

1) Eliminate wheat from the diet--Provided you don't do something stupid, like allow M&M's, Coca Cola, and corn chips to dominate your diet, elimination of wheat is an enormously effective means to reduce small LDL particles, reduce triglycerides, increase HDL, reduce inflammatory measures like c-reactive protein, lose weight (inflammation-driving visceral fat), reduce blood sugar, and reduce blood pressure. I know of no other single dietary strategy that packs as much punch. This has become even more true over the past 20 years, ever since the dwarf variant of modern wheat has come to dominate.

2) Achieve a desirable 25-hydroxy vitamin D level--Contrary to the inane comments of the Institute of Medicine, vitamin D supplementation increases HDL, reduces small LDL, normalizes insulin and reduces blood sugar, reduces blood pressure, and exerts potent anti-inflammatory effects on c-reactive protein, matrix metalloproteinase, and other inflammmatory mediators. While we also have drugs that mimic some of these effects, vitamin D does so without side-effects.

3) Supplement omega-3 fatty acids from fish oil--Omega-3 fatty acids reduce triglycerides, accelerate postprandial (after-meal) clearance of lipoprotein byproducts like chylomicron remnants, and have a physical stabilizing effect on atherosclerotic plaque.

4) Normalize thyroid function--Start with obtaining sufficient iodine. Iodine is not optional; it is an essential trace mineral to maintain normal thyroid function, protect the thyroid from the hundreds of thyroid disrupters in our environment (e.g., perchlorates from fertilizer residues in produce), as well as other functions such as anti-bacterial effects. Thyroid dysfunction is epidemic; correction of subtle degrees of hypothyroidism reduces LDL, reduces triglycerides, reduces small LDL, facilitates weight loss, reduces blood pressure, normalizes endothelial responses, and reduces oxidized LDL particles.

5) Make exercise fun--Not just exercise for the sake of exercise, but physical activity or exercise for the sake of having a good time. It's the difference between resigning yourself to 30 minutes of torture and boredom on the treadmill versus engaging in an activity you enjoy and look forward to: go dancing, walk with a friend, organize a paintball tournament outdoors, Zumba class, plant a new garden, etc. It's a distinction that spells the difference between finding every excuse not to do it, compared to making time for it because you enjoy it.

Note what is not on the list: cut your fat, eat more "healthy whole grains," take a cholesterol drug, take aspirin. That's the list you'd follow if you feel your hospital needs your $100,000 contribution, otherwise known as coronary bypass surgery.

Topping up your vitamin D tank

22. January 2011 William Davis (17)
Now that my vitamin D replacement experience dates back nearly 5 years, I've been witnessing an unusual phenomenon:

The longer you take vitamin D, the less you need.

Let me explain. You take 10,000 units D3 in gelcap form. 25-hydroxy vitamin D levels, checked every 6 months, have remained consistently between 60 and 70 ng/ml. Three years into your vitamin D experience and 25-hydroxy vitamin D level rises to 98 ng/ml--an apparent need for less vitamin D.

So we cut your intake from 10,000 units per day to 8000 units per day. Another 25-hydroxy vitamin D level 6 months later: 94 ng/ml. We cut dose again to 6000 units, followed by another 25-hydroxy vitamin D level of 66 ng/ml.

This has now happened in approximately 20% of the people who have been taking vitamin D for 3 or more years. I know of no formal analysis of this effect, what I call the "topping up" phenomenon. Reasoned simply, it seems to me that, once your vitamin D "tank" is topped up (i.e., tissue stores have been replenished), it requires less to keep it full.

No one has experienced any adverse consequence of this topping up effect though it has potential for some people to develop toxic levels if 25-hydroxy vitamin D levels are not monitored long-term. In my office, I measure 25-hydroxy vitamin D levels every 6 months.

It means that long-term monitoring of 25-hydroxy vitamin D is crucial to maintain favorable and safe levels.

Thirteen catheterizations later

21. January 2011 William Davis (16)
When I first met her, Janet couldn't stop sobbing. She'd just been through her 10th heart catheterization in two years.

It started with chest pains at age 56, prompting her first heart catheterization that uncovered severe atherosclerotic blockages in all three coronary arteries. Her cardiologist advised a bypass operation.

Six months after the bypass operation, Janet was back with more chest pains, just as bad as before. Another heart catherization showed that two of the three bypass grafts had failed. The third bypass graft contained a severe blockage that required a stent, along with multiple stents in the two now unbypassed arteries.

In the ensuing 18 months, Janet returned for 8 additional catheterizations, each time leaving the hospital with one or more stents.

Janet's doctor was puzzled as to why her disease was progressing so aggressively despite Lipitor and the low-fat diet provided by the hospital dietitian. So he had Janet undergo lipoprotein testing (NMR):

LDL particle number: 3363 nmol/L
Small LDL particle number: 2865 nmol/L
HDL cholesterol: 32 mg/dl
Triglycerides: 344 mg/dl
Fasting blood glucose 118 mg/dl
HbA1c 5.8%

Unfortunately, Janet's doctor didn't understand what these values meant. He pretty much threw his arms up in frustration. That's when I met Janet.

From her lipoprotein panel and other values, it was clear to me that Janet was miserably carbohydrate-sensitive and carbohydrate-indulgent, as demonstrated by the extravagant quantity (2865 nmol/L) and proportion (2865/3363, or 85%) of small LDL, the form of LDL particles created by carbohydrate exposure. Janet struggled with depression over the years and had been using carbohydrate foods as "comfort" foods, often resorting to cookies, pies, cakes, breads, and other wheat-containing foods for emotional solace.

It took a bit of persuasion to convince Janet that it was low-fat, "healthy whole grains," as well as comfort foods, that had led her down this path. I also helped Janet correct her severe vitamin D deficiency, mild thyroid dysfunction, and lack of omega-3 fatty acids.

Since meeting Janet and instituting her new prevention program, she has undergone three additional catheterizations (performed by another cardiologist), all performed for chest pain symptoms that struck during periods of emotional stress. All showed . . . no significant blockage. (Apparently, the repeated "need" for stents triggered a Pavlovian response: chest pain = "need" for yet more stents.)

In short, correction of the causes of coronary atherosclerotic plaque--small LDL, vitamin D deficiency, omega-3 fatty acid deficiency, and thyroid dysfunction--and Janet's disease essentially ground to a halt.

Imagine, instead, that Janet had undergone 1) a heart scan to identify hidden coronary plaque 5-10 years before her first heart procedure, then 2) corrected the causes before they triggered symptoms and posed danger. She might have been spared an extraordinary amount of life crises, hospital procedures, expense (nearly $1 million), and emotional suffering.