Goiter and the Golden Medical Discovery

17. May 2009 William Davis (19)

Thick neck, or goitre . . . consists of an enlargement of the thyroid gland, which lies over and on each side of the trachea, or windpipe, between the prominence known as "Adam's apple" and the breast bone. The tumor gradually increases in front and laterally, until it produces great deformity, and often interferes with respiration and the act of swallowing. From its pressure on the great blood vessels running to and from the head, there is a constant liability to engorgement of blood in the brain, and to apoplexy, epilepsy, etc.

The causes of the affection are not well understood. The use of snow water, or water impregnated with some particular saline or calcareous matter, has been assigned as a cause. It has also been attributed to the use of water in which there is not a trace of iron, iodine, or bromine. . . The disease is often due to an impeded circulation in the large veins of the neck, from pressure of the clothing, or from the head being bent forward, a position which is often seen in school children.


Treatment

We have obtained excellent results in many cases, not too far advanced, by a method of treatment which consists in the employment of electrolysis. . . Many cases at the present time are operated upon with entire success.

Those who are afflicted with this disease and unable to avail themselves of special treatment cannot do better than to take Doctor Pierce's Alterative Extract, or Golden Medical Discovery, and apply over the skin around the tumor, night and morning, the following, which may be prepared at any drug store:

Resublimed Iodine--One dram
Iodide of Potassium--Four drams
Soft Water--Three ounces 


Apply to the tumor, twice daily, with feather or camel hair pencil.


From The People's Common Sense Medical Adviser by R.V. Pierce, MD; 1918.
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Comments (19) -

  • kris

    5/17/2009 11:43:00 PM |

    there are hundreds of centers for research on heart, cancer, aids etc. etc. Thyroid has been over looked for some strange reason by all of the medical authorities. This is a disease which incapacitates one socially, physically, mentally and economically. this disease is a silent killer which kills the patient slowly through using other diseases such as high blood pressure, cancer, cholesterol,memory loss,eczema, hypoadrenia and list goes on and on. the sad thing is that this is curable with simple and cheapest available medications and minerals. thyroid is one of the biggest overlooked, stubbornness by our medical system which is costing the governments and population billions economical and lots of grieve socially because this disease also effects one's decision making ability too. i and my family has suffered with hypothyroid conditions. we have been to many doctors but no help. every doctor failed to recognize the symptoms because of the stupid TSH test excuse. finally when i started getting heart problems problems despite the facts that i was in the gym 7 days a week and still gaining weight. i took some time off and started to educating my self through the internet and books. changed my family's doctors. now, every body in the family feels normal. no more quick temper, sleepless nights, weight gain, skin problems, cholesterol,blood pressure, menstrual irregularities, flu,hair loss, too much calcium in the blood, eczema to name a few. even my 8 year old dog is stopped shedding hair and is less scared of the thunder now after D3 and kelp. my 74 year old mother says that she never felt this way in her entire life. my university going son feels 100 times calm now. kelp, iodine, tyrosine, multi vitamins, liquid thermometer and dessicated hormones are not that expensive. my favorite doctors are Dr. david Derry (retired), Dr Star, Dr. william Davis, Dr. Lowe, Dr. Rind to name a few who have the balls and soul to say the way it is. I just want to say that thank you Dr. William and please keep it up.

  • Anna

    5/18/2009 3:27:00 AM |

    You know, now that I am "tuned into" hypothyroidism, I see people all the time that I think have a slight or even obvious goiter or enlargement of the thyroid gland, both in person and on TV.  And I don't mean fat necks, I mean a goitrous neck, often on relatively thin people (though not always).  One of the TV people that stood out to me was a reality show former model (with a really narcissistic personality) who has a clothing line.  I think her name was Kimora and her clothing line was Phat, but don't quote me -  I was watching her neck more than the show (I was channel surfing and her swollen neck caught my attention).

    On the rare occasion when I have a chance to talk about thyroid conditions with someone who has  what looks like a slight goiter to me (if we are talking about health or I mention my low thyroid condition), I don't ask outright or suggest they look like they have a goiter, but invariably they say they don't have a thyroid problem because their doctor suspected it, checked it out, and the lab says it's fine (I don't mention what I see on their neck, of course, but my tongue is black and blue later from biting back how my doctors missed my thyroid condition for so many years  Smile  ).  

    Between people reducing salt (iodized salt); eating processed soy ingredients on a regular basis (soy's a goitrogen - thyroid inhibitor);  constantly stressing (running on adrenaline, burning the candles at both ends - which skews all the other hormones); and the poor state of thyroid treatment with conventional medicine, it's not surprising to see goitrous necks commonly around town on a regular basis.

  • Anne

    5/18/2009 3:47:00 AM |

    This book can be found online at Project Gutenberg www.gutenberg.org/etext/18467

  • Materialguy

    5/19/2009 1:04:00 AM |

    Dr. Davis, Your goiter blog posting brought to mind the issue of evolution of the medical profession from "art and craft" to "science based.......".

    I can better understand a comment read long ago. It said that until about the 1930's and the advent of sulfa drugs, you stood less than a 50% chance of benefiting from a visit to the doctor's office.

    Somewhere in the past, we did pass that threshold (I hope), and I wonder what decade would you attribute that to, and what thing or things put it over the mark.

  • pooti

    5/19/2009 12:54:00 PM |

    Dr. Davis, can you comment on why you are using images of people from istockphoto to represent the faces from your TESTIMONIAL sections on the TYP website?

    Isn't that unethical? I mean, these are supposedly "real" accounts from "real" people, using the TYP program. If they are real, then why do you feel the need to use stock photo images as the pictures of them?

    You can find my links to these cases on todayiatea.blogspot.com/2009/05/dr-davis-heart-scan-blog-and-russian.html or simply go to www.todayiatea.blogspot.com and search for the May 17th post.

  • Dr. William Davis

    5/19/2009 10:50:01 PM |

    Pooti--

    Simple.

    In past, when I approached people to allow us to use their photos, they would not grant permission. Most cited reluctance to let everyone know they had heart disease. Same with their names. This happened time and again. Obviously, we cannot go against their wishes for both ethical reasons and the HIPAA privacy act. In fact, posting private health information is a violation of the law which can even lead to jail time. The government means business.

    In short, we gave up trying to obtain permission to allow people to use their real names and photos. So the photos and names are fake. The stories are very real, though all--ALL--potentially identifying information has been changed. If, for instance, someone's Lp(a) is really 167 nmol/L, we might say it's something like 157 nmol/L, so that nothing can be personally tagged.

    This is just the reality of this project. Unlike weight loss testimonials in which people are thrilled to have their before and after pictures posted, such is not the case with heart disease.

    Does anyone here volunter to be the first to allow your photo and name, along with details of your health, to be posted?

  • pooti

    5/20/2009 2:12:05 AM |

    Dr. Davis I have a serious problem with this unethical behavior. You can not LEGALLY nor ETHICALLY call it a "testimonial" if you've changed every fact and nothing about the entire story is actually based on truth. The most you can call each of these examples (note they are not "testimonials") is a "recreation based on similar patient accounts" (i.e. fictional account). You would then need to follow that with your disclaimer that individual results may very dramatically among each person.

    Dr. Davis I think you do your patients a disservice. You can tell "stories" of success. But you cannot call them Testimonials. It's misleading advertising practises. In short it's called lying for gain.

    BTW, Heidi Diaz aka Kimkins did the same thing on her website and she has a class action lawsuit going against her right now. You may argue she lied about more than her testimonials and testimonial photos. However...you are doing no better. And so you have now corrupted your message as a healer.
    Not good, doctor. Whomever it was who advised you to take this path on your website should be given the boot and a big fat "your fired." It's indefensibly poor advice.

    www.todayiatea.blogspot.com

  • i.pooticus

    5/20/2009 2:30:11 AM |

    BTW, Dr. Davis? I can tell you that if I were one of your patients, and you helped me reduce my atherosclerotic plaque buildup in my arteries by 63%, I would be your best advertising. Not only would I allow you to use my story and my image to help others realize this type of incredible result, but I would be a marketers' dream child.

    In advertising and marketing - rule 101 is to convert an interested prospect into a client, and from a client into repeat client, and from a repeat client into an advocate.

    An advocate is someone who takes your success personally and will go beyond the norm in order to help ensure your success. In other words they have a personal interest in your success. So they do things like speak highly of you every place they can. They recommend you to friends. They send you members of their family. They are gold. Priceless beyond measure.

    That is a universal truth, regardless of the industry. Hell, look at Farah Fawcett and she has the most physically embarrassing problem in the world and she's out there shouting from the roof about it. So I really fail to see how your patients whom you have helped so dramatically, could possibly resist an appeal to use their true testimonial in order to help others live...

  • Anna

    5/20/2009 3:31:30 PM |

    pooti,

    These are interesting points that you bring up, and perhaps worthwhile exploring.  

    There are numerous reasons why someone might allow their story to be told, but not want to be personally identified on the WWW.  At the same time, he/she might be very open with family, friends, neighbors, etc., but that's at his/her discretion.  That's the way I am about some health issues, very open when it feels right, but clammed up on other occasions.  It's my choice.  

    I can't help feeling this issue is more of a molehill than a mountain...but obviously you feel differently.

  • Michael

    5/21/2009 6:02:58 AM |

    @Anne,
    Well spotted! The clothes line is called Baby Phat.
    Follow the link below and click on the thumbnail of the front view, zoom in all the way by double clicking on the image and observe the inept Photoshopping round her neck to hide the goitre!
    http://idn.efashionsolutions.com/asset/imageset/id/BP-D2G00134_H09_zoom
    Had Google this one after your description.

  • Anna

    5/22/2009 12:20:56 AM |

    Michael,

    Here's a photo of Kimora Lee that is probably not Photoshopped and shows the front neck swelling more noticeably (at least I hope it isn't Photoshopped, because I've never seen her on the TV show with the skinny arms that appear in the fashion shoots).

    www.babyphat.com/landingpages/landing.php?page=maternity&dept=plus

    Google Kimora Lee goiter and the search results show I'm not the only one speculating that she has a goiter...oh jeeze, I need to get a life.  I  can't believe I'm googling celebrity necks now Wink.  But I see necks like this ALL the time around town, on women of all sizes.  It's like a traffic wreck, so hard NOT to sneak a peek!

  • pooti

    5/22/2009 12:34:37 AM |

    Anna, with all due respect, it really doesn't matter so much what either of us think about it. Dr. Davis actually risks his license by making these types of claims without proper designation of them as "dramatizations" or "actors" or "advertorials". Because the FTC (Federal Trade Commission) clearly outlines the rules for the use of Consumer Testimonials and Endorsements:

    Part B is the relevent portion but they skirt dangerously close to the other rules as well:

    http://www.ftc.gov/bcp/guides/endorse.htm

    §255.2 Consumer endorsements.

    (a) An advertisement employing an endorsement reflecting the experience of an individual or a group of consumers on a central or key attribute of the product or service will be interpreted as representing that the endorser's experience is representative of what consumers will generally achieve with the advertised product in actual, albeit variable, conditions of use. Therefore, unless the advertiser possesses and relies upon adequate substantiation for this representation, the advertisement should either clearly and conspicuously disclose what the generally expected performance would be in the depicted circumstances or clearly and conspicuously disclose the limited applicability of the endorser's experience to what consumers may generally expect to achieve. The Commission's position regarding the acceptance of disclaimers or disclosures is described in the preamble to these Guides published in the Federal Register on January 18, 1980.

    (b) Advertisements presenting endorsements by what are represented, directly or by implication, to be ``actual consumers'' should utilize actual consumers, in both the audio and video or clearly and conspicuously disclose that the persons in such advertisements are not actual consumers of the advertised product.

    (c) Claims concerning the efficacy of any drug or device as defined in the Federal Trade Commission Act, 15 U.S.C. 55, shall not be made in lay endorsements unless (1) the advertiser has adequate scientific substantiation for such claims and (2) the claims are not inconsistent with any determination that has been made by the Food and Drug Administration with respect to the drug or device that is the subject of the claim.

  • Michael

    5/22/2009 3:30:46 AM |

    @Anna,
    spot on! But it's still a "goitre" for me and the rest of the world. Same as "centre" and "metre". One cannot honour Yankee spelling!

    @Pooti,
    It's a bit over-the-top to compare Dr Davis with Heidi Diaz! Can you state, hand on heart, you're not a drug company troll?? Just wondering.

  • Michael

    5/24/2009 2:08:00 AM |

    BTW, having looked up Pooti's website, he does not appear to be a drug company troll.
    While I'm on Dr Davis' side here, I think that no harm is done shining a light on the issue of before & after stories. But on balance, I think Pootie is over-reacting here. For example change 160 to 157 is not falsifying the data within the error range of the measurement. However, labelling stock photos as such would probably be a good idea.

  • bovinedefenestration

    5/31/2009 10:13:08 AM |

    I'm with everyone that thinks Pooti is overreacting. All that need to be put on the site is something along the lines of "photographs and medical details have been changed in the interest of patient privacy". Maybe even throw something in about HIPAA. It happens all thin time with things involving medical information - the stories are real, but the details have been altered a bit to protect the privacy of the people involved. I don't see anything wrong with that. I'd have to think long and hard before putting my real face, name, and medical conditions on the internet. I did it once before in a place, much to my eventual detriment.

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    8/3/2010 12:43:05 PM |

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  • kashif ali

    8/3/2010 12:56:04 PM |

    The heart scan is a rapid assessment tool for the identification of hemodynamically significant cardiac abnormalities in the ICU. Like the evaluation focused on trauma ultrasound for the concept, but directed at the center instead of the abdomen. Often called calcium scanning provides a score that can be used to determine the risk of a coronary event. Unlike an electrocardiogram (which mostly shows the results of recent heart attack) and thallium stress test (which appears only advanced blockages of 70% or more.) Is an excellent way to determine if a person has coronary artery disease.

  • buy jeans

    11/3/2010 7:00:05 PM |

    there are hundreds of centers for research on heart, cancer, aids etc. etc. Thyroid has been over looked for some strange reason by all of the medical authorities. This is a disease which incapacitates one socially, physically, mentally and economically. this disease is a silent killer which kills the patient slowly through using other diseases such as high blood pressure, cancer, cholesterol,memory loss,eczema, hypoadrenia and list goes on and on. the sad thing is that this is curable with simple and cheapest available medications and minerals. thyroid is one of the biggest overlooked, stubbornness by our medical system which is costing the governments and population billions economical and lots of grieve socially because this disease also effects one's decision making ability too.

  • Max

    2/15/2011 7:00:55 AM |

    Really you’re doing great job nice blog with very useful templates. Thanks for sharing it with all.Rebreathing Bag

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Heart Scan Blog Redux: Cheers to flavonoids

13. November 2009 William Davis (32)
Because in Track Your Plaque we've been thinking a lot about anthocyanins, here's a rerun of a previous Heart Scan Blog post about red wine. (Anthocyanins are among the interesting flavonoids in red wine, along with resveratrol and quercetin.)


The case in favor of healthful flavonoids seems to grow bit by bit.

Flavonoids such as procyanadins in wine and chocolate, catechins in tea, and those in walnuts, pomegranates, and pycnogenol (pine bark extract) are suspected to block oxidation of LDL (preventing its entry into plaque), normalize abnormal endothelial constriction, and yield platelet-blocking effects (preventing blood clots).

Dr. Roger Corder is a prolific author of many scientific papers detailing his research into the flavonoids of foods, but wine in particular. He summarizes his findings in a recent book, The Red Wine Diet. Contrary to the obvious vying-for-prime-time title, Dr. Corder's compilation is probably the best mainstream discussion of flavonoids in foods and wines that I've come across. Although it would have been more entertaining if peppered with more wit and humans interest, given the topic, its straightfoward, semi-academic telling of the story makes his points effectively.

Among the important observations Corder makes is that regions of the world with the greatest longevity also correspond to regions with the highest procyanidin flavonoids in their wines.




Regarding the variable flavonoid content of wines, he states:

Although differences in the amount of procyanidins in red wine clearly occur because of the grape variety and the vineyard environment, the winemaker holds the key to what ends up in the bottle. The most important aspect of the winemaking process for ensuring high procyanidins in red wines is the contact time between the liquid and the grape seeds during fermentation when the alcohol concentration reaches about 6 percent. Depending on the fermentation temperature, it may be two to three days or more before this extraction process starts. Grape skins float and seeds sink, so the number of times they are pushed down and stirred into the fermenting wine also increases extraction of procyanidins. Even so, extraction is a slow process and, after fermentation is complete, many red wines are left to macerate with their seeds and skins for days or even weeks in order to extract all the color, flavor, and tannins. Wines that have a contact time of less than seven days will have a relatively low level of procyanidins. Wines with a contact time of ten to fourteen days have decent levels, and those with contact times of three weeks or more have the highest.

He points out that deeply-colored reds are more likely to be richer in procyanidins; mass-produced wines that are usually "house-grade" served at bars and restaurants tend to be low. Some are close to zero.

Wines rich in procyanidins provide several-fold more, such that a single glass can provide the same purported health benefit as several glasses of a procyanidin-poor wine.

So how do various wines stack up in procyanidin content? Here's an abbreviated list from his book:

Australian--tend to be low, except for Australian Cabernet Sauvignon which is moderate.

Chile--only Cabernet Sauvignon stands out, then only moderate in content.

France--Where to start? The French, of course, are the perennial masters of wine, and prolonged contact with skins and seeds is usually taken for granted in many varieties of wine. Each wine region (French wines are generally designated by region, not by variety of grape) can also vary widely in flavonoid content. Nonetheless, Bordeaux rate moderately; Burgundy low to moderate (except the village of Pommard); Languedoc-Roussillon moderate to high (and many great bargains in my experience, since these producers live in the shadow of its northern Bordeaux neighbors); Rhone (Cote du Rhone) moderate to high, though beware of their powerful "barnyard" character upon opening; decanting is wise.

Italy--Much red Italian wine is made from the Sangiovese grape and called variously Chianti, Valpolicella, and "super-Tuscan" when blended with other varietals. Corder rates the southern Italian wines from Sicily, Sardinia, and the mainland as high in procyanidins; most northern varieties are moderate.

Spain--Moderate in general.

United States--Though his comments are disappointingly scanty on the U.S., he points out that Cabernet Sauvignon is the standout for procyanidin content. He mentions only the Napa/Sonoma regions, unfortunately. (I'd like to know how the San Diego-Temecula and Virginian wines fare, for instance.)

The winner in procyanidin content is a variety grown in the Gers region of southwest France, a region with superior longevity of its residents. The wines here are made with the tannat grape within the Madiran appellation; wines labeled "Madiran" must contain 40% or more tannat to be so labeled (such is a quirk of French wine regulation). Among the producers Dr. Corder lists are Chateau de Sabazan, Chateau Saint-Go, Chateau du Bascou, Domaine Labranche Laffont, and Chateau d'Aydie. (A more complete list can be found in his book.)

How does this all figure into the Track Your Plaque program? Can you succeed without red wine? Of course you can. I doubt you could do it, however, without some attention to flavonoid-rich food sources, whether they come from spinach, tea, chocolate, beets, pomegranates, or red wine.

Though my wife and I love wine, I confess that I've never personally drank or even seen a French Madiran wine. Any wine afficionados with some advice?

Can wheat elimination cure ulcerative colitis?

13. November 2009 William Davis (0)
Tammy is a 36-year old mother of three young children. Since age 20, she has suffered with the debilitating symptoms of ulcerative colitis: constant, gnawing abdominal pain; frequent diarrhea, often bloody.



Tammy has had to take several medications, some with significant side-effects, all of which provided only partial relief from the pain and diarrhea. Her gastroenterologist and surgeon were planning a colectomy (removal of the colon) with creation of an ileostomy (rerouting of the small intestine to the abdominal surface, which would require Tammy to wear an ileostomy bag under her clothes for the rest of her life).



Although Tammy had previously tested negative for celiac disease (an allergic sensitivity to the gluten in wheat products), I urged her to attempt a trial of a wheat-free diet. Having witnessed many people experience relief from irritable bowel syndrome, acid reflux, and other common gastrointestinal complaints, all while trying to reduce blood sugar and small LDL, I'd hoped that Tammy would obtain at least some small improvement in her terrible symptoms.



I therefore urged Tammy to try it. After all, what was there to lose? Tammy grudgingly agreed.



She returned 6 months later. Her report: She had lost 38 lbs, virtually all of it within the first 6-8 weeks. Her diarrhea and cramping were not better, but gone. She was down to a single medicine from her former list of drugs.



I am unsure what proportion of people with ulcerative colitis or other inflammatory bowel diseases like Crohn's will experience a result like Tammy's. Perhaps it's only a minority. But I take this another piece of evidence that this enormously destructive thing called wheat has no place in the human diet.



We have no facts or figures on the prevalence of various forms of wheat intolerance in the U.S. When I contacted the Celiac Disease Foundation, they had no figures on the number of fatalities per year in the U.S. from celiac disease. But if there are 2-3 million Americans with celiac disease, there are probably 100 times that many people with various forms of wheat intolerance.



Postprandial pile-up with fructose

12. November 2009 William Davis (20)
Heart disease is likely caused in the after-eating, postprandial period. That's why the practice of grazing, eating many small meals throughout the day, can potentially increase heart disease risk. Eating often can lead to the phenomenon I call triglyceride and chylomicron "stacking," or the piling up of postprandial breakdown products in the blood stream.

Different fatty acid fractions generate different postprandial patterns. But so do different sugars. Fructose, in particular, is an especially potent agent that magnifies the postprandial patterns. (See Goodbye, fructose.)

Take a look at the graphs from the exhaustive University of California study by Stanhope et al, 2009:



From Stanhope KL et al, J Clin Invest 2009. Click on image to make larger.

The left graphs show the triglyceride effects of adding glucose-sweetened drinks (not sucrose) to the study participants' diets. The right graphs show the triglyceride effects of adding fructose-sweetened drinks.

Note that fructose causes enormous "stacking" of triglycerides, meaning that postprandial chylomicrons and VLDL particles are accumulating. (This study also showed a 4-fold greater increase in abdominal fat and 45% increase in small LDL particles with fructose.)

It means that low-fat salad dressings, sodas, ketchup, spaghetti sauce, and all the other foods made with high-fructose corn syrup not only make you fat, but also magnifies the severity of postprandial lipoprotein stacking, a phenomenon that leads to more atherosclerotic plaque.

Track Your Plaque: Safer at any score

11. November 2009 William Davis (0)
Imagine two people.

Tom is a 50-year old man. Tom's initial heart scan score was 500--a concerning score that carries a 5% risk for heart attack per year.

Harry is also 50 years old. His heart scan score is 100--also a concerning score, but not to the same degree as Tom's much higher score.

Tom follows the Track Your Plaque program. He achieves the 60:60:60 lipid targets; chooses healthy foods, including elimination of wheat; takes fish oil at a therapeutic dose; increase his blood vitamin D level to 60-70 ng/ml, etc. One year later, Tom's heart scan score is 400, representing a 20% reduction from his starting score.

Harry, on the other hand, doesn't understand the implications of his score. Neither does his doctor. He's casually provided a prescription for a cholesterol drug by his doctor, a brief admonition to follow a low-fat diet, and little else. One year later, Harry's heart scan score is 200, a doubling (100% increase) of the original score.

At this point, we're left with Tom having a score of 400, Harry with a score of 200. That is, Tom has twice Harry's score, 200 points higher. Who's better off?

Tom with the score of 400 is better off. Even though he has a significantly higher score, Tom's plaque is regressing. Tom's plaque is therefore quiescent with active components being extracted, inflammation subsiding, the artery in a more relaxed state, etc.

Harry's plaque, in contrast, is active and growing: inflammatory cells are abundant and producing enzymes that degrade supportive tissue, constrictive factors are released that cause the artery to pinch partially closed, fatty materials accumulate and trigger a cascade of abnormal responses.

So it's not just the score--the quantity of atherosclerotic plaque present--but the state of activity of the plaque: Is it growing, is it being reduced? Is there escalating or subsiding inflammation? Is plaque filled with degradative enzymes or quiescent?

Following the Track Your Plaque program therefore leads us to the notion that it's not the score that's most important; the most important thing is what you're doing about it. We sometimes say that Track Your Plaque makes you safer at any score.

Triglyceride and chylomicron "stacking"

10. November 2009 William Davis (24)
Continuing the comments started in Grazing is for cattle, here's an interesting study from the Oxford Center for Diabetes, Endocrinology and Metabolism.

Volunteers were fed a test meal breakfast of Rice Krispies, a banana, and a chocolate milkshake (76.4 grams carbohydrates, 51.9 grams fat, 12.2 grams protein). Lunch was served 5 hours later and consisted of a cheese sandwich and a second chocolate milkshake 43.4 grams carbohydrates, 49.6 grams fat, 24.0 grams protein). Frequent blood samples were then assessed over the day. (Don't try this at home: These are obviously very dangerous foods!)

Here's the pattern of triglycerides that was observed (1st dotted vertical line = breakfast, 2nd dotted vertical line = lunch):



Note that triglycerides only begin to decline 3-4 hours after breakfast, only to peak higher after lunch.


Here's the pattern observed for chylomicrons, the "granddaddy" of lipoproteins that derives from intestinal absorption of fatty acids:



Both graphs from Heath RB et al Am J Phyiol Endocrinol Metab 2006.


With chylomicrons, note a similar pattern to triglycerides: Chylomicrons begin to decline at 3-4 hours, only to peak higher after lunch.

This is the first study to examine the effect of sequential meals on such postprandial (after-eating) patterns. But it makes the graphic point that, if insufficient time is permitted between meals, both triglycerides and chylomicrons will "stack" themselves higher and higher. (Chylomicrons are subjected to processing by the enzyme, lipoprotein lipase, to form highly atherogenic, or plaque-causing, chylomicron remnants.)

While not examined in this study, my bet is that "grazing," i.e., eating small meals or snacks frequently, is an extreme instance of triglyceride, chylomicron, and chylomicron remnant stacking. That can only lead to one thing: accelerated heart and vascular plaque.

What is a healthy vitamin D blood level?

9. November 2009 William Davis (32)
When measuring blood levels of vitamin D (as 25-hydroxy vitamin D), what constitutes a desirable level?

There's no study that directly examines this question, no study that enrolled thousands of people and assigned a placebo group and groups receiving escalating doses of vitamin D and/or achieved higher levels of vitamin D, then observed for development of cancer, diabetes, depression, heart disease, multiple sclerosis, osteoporosis, osteoarthritis, etc. Such a study would requires many thousands of participants (particularly to observe cancer and multiple sclerosis incidence), many years of observation, and many tens of millions of dollars. Nope, only a drug company could afford such costs.

So we have to piece together various observations and extrapolate what we believe to be the ideal level of vitamin D. Epidemiologic observations in several cancers (breast, colon, prostate, and bladder) suggest that a 25-hydroxy vitamin D level of 30 ng/ml or higher is desirable (with less cancer incidence above this level). Other data suggest a level of 52 ng/ml or greater is desirable. Unfortunately, much cancer research looked at intake of vitamin D from food and supplement sources, rather than actual blood levels. We also have to factor in the great individual variation in vitamin D metabolism, with a single dose yielding variable blood levels (as much as a 10-fold difference). There's also the variation introduced by vitamin D-receptor variation (genetic polymorphisms).

A new study using vitamin D administration helps chart the desirable levels of vitamin D.

Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient - a randomised, placebo-controlled trial.

In this New Zealand study, 42 women (23 to 68 years old) were given 4000 units vitamin D, 39 women given placebo. Median 25-hydroxy vitamin D levels increased from 21 nmol/L (8.4 ng/ml) to 75 nmol/L (30 ng/ml). Both HOMA (a measure of insulin sensitivity) and fasting insulin levels improved, with greatest improvement seen at 25-hydroxy vitamin D levels of 80-119 nmol/L (32-47.6 ng/ml) or greater.

We also know that a vacation on a Caribbean beach in a bathing suit will increase vitamin D blood levels to the 80-110 ng/ml range without ill-effect (at least in young people who maintain the capacity to activate vitamin D in the skin, a phenomenon that declines as we age).

So do we really know the truly ideal level of vitamin D to achieve? I believe that, given the above observations, it is reasonable to extrapolate that the ideal vitamin D blood level likely lies somewhere above 50 ng/ml. We also know that vitamin D toxicity (i.e., hypercalcemia) is virtually unheard of until vitamin D blood levels approach 150 ng/ml, and even then is inconsistent. The health benefits of vitamin D supplementation are so tremendous, that I am not willing to wait for the prospective data to explore this question fully. For now, I aim for a blood level of vitamin D of 60-70 ng/ml (150-175 nmol/L).

Grazing is for cattle

5. November 2009 William Davis (17)
Many dietitians and nutritionists advise many people today to "graze," i.e., to eat small snacks every couple of hours. They argue that it blocks the drop in insulin and blood sugar that can trigger greater appetite and claim it can facilitate weight loss.



This is an absurd notion. Humans are not meant to graze. Humans are meant to find a wild boar or other animal, kill it, gorge on the meat, organs, and fat, then revert to berries, roots, leaves, and other foraged foods until the next kill. A human living in the wild does not have a cupboard or refrigerator full of ready-to-eat snacks to graze on.

The several hours after a meal is the most dangerous for creating coronary atherosclerotic plaque, i.e., the post-prandial period. In other words, eat dinner and, for the next 6-12 hours, your intestinal tract degrades the food; food byproducts are absorbed into the blood or lymph system. The blood is literally flooded with the byproducts of your meal.

Postprandial abnormalities are emerging to be a potent, and much underappreciated, means of causing heart disease and atherosclerosis in other vascular territories (especially carotid arteries and thoracic aorta).

Not eating--i.e., the fasting state--for extended periods is good for you. Encouraging people to graze amplifies atherosclerotic risk, since it creates an abnormal prolonged postprandial state.

The disastrous results of a low-fat diet

4. November 2009 William Davis (16)
Rob was never that committed to following the program in the first place.

I met Rob because of a modest heart scan score and consultation for a cholesterol abnormality. Rob had been cycled through all the statin agents by his primary care physician, all of which resulted in terrible muscle aches that he found intolerable.

I started out, as usual, characterizing his cholesterol abnormality with lipoprotein testing (NMR):

LDL particle number 1489 nmol/L
LDL cholesterol (Friedewald calculation) 143 mg/dl
Small LDL 52% of total LDL
HDL 50 mg/dl
Triglycerides 82 mg/dl

(LDL particle number is the emerging gold standard for LDL quantification, superior to calculated or Friedewald LDL cholesterol for prediction of cardiovascular events.)

Rob is a busy guy. After only a couple of brief visits, life and work got in the way and Rob let his attentions drift away from heart health. Since the information I provided made little impact on his thinking, he reverted to the low-fat diet his primary care doctor had originally prescribed and that he read about in magazines and food packages. He also ran out of the basic supplements I had advised, including fish oil and vitamin D, and just never restarted them.

A couple of years passed and Rob decided that just poking around on his own might not cut it. So he came back to the office. We repeated his NMR lipoprotein analysis:

LDL particle number 2699 nmol/L
LDL cholesterol (Friedewald calculation) 229 mg/dl
Small LDL 81% of total LDL
HDL 53 mg/dl
Triglycerides 78 mg/dl


Two years of a low-fat diet had caused Rob's LDL particle number to skyrocket by 81%, nearly all due to an explosion of small LDL. Recall that small LDL is more susceptible to oxidation, more inflammation-provoking, more adhesive--the form of LDL particles most likely to cause heart disease.

Also, note that, despite the enormous increase in small LDL, HDL and triglycerides remained favorable. This counters the popular rule-of-thumb offered by some that small LDL is not present when HDL is "normal."

Low-fat diets as commonly practiced are enormously destructive. In Rob's case, a low-fat diet caused both calculated Friedewald LDL as well as LDL particle number to increase dramatically. In many other people, low-fat diets increase calculated Friedewald LDL modestly or not at all, but cause the more accurate LDL particle number to increase significantly, all due to small LDL.

I'm happy to say that, once Rob witnessed how far wrong he could go on the wrong program, he's back on Track. (Sorry, pun intended.) He has resumed his supplements and eliminated the food triggers of small LDL--wheat, cornstarch, and sugars.

Dr. David Grimes reminds us of vitamin D

3. November 2009 William Davis (13)
In response to the Heart Scan Blog post, Fish oil makes you happy: Psychological distress and omega-3 index, Dr. David Grimes offered the following argument.

Dr. Grimes is a physician in northwest England at the Blackburn Royal Infirmary, Lancashire. He is author of the wonderfully cheeky 2006 Lancet editorial, Are statins analogues of vitamin D?, questioning whether the benefits of statin drugs simply work by way of increased vitamin D blood levels.


There is a fashionable interest in Omega-3 fatty acids, and these become equated with fish oil.

But fish oil is much more. Plankton synthesise the related squalene (shark oil) which, in turn, is converted into 7-dehydrocholesterol (7-DHC). The sun now comes into play and it converts 7-DHC into vitamin D (a physico-chemical process).

Small fish eat plankton, large fish eat small fish, and we eat large fish. So vitamin D passes through the food chain.

This has been a vital source of vitamin D for the the Inuits and also for the Scots and other dwellers of northwest Europe. (Edinburgh is on the same latitude as Hudson Bay and Alaska, further north than anywhere in China). In these locations there is not adequate sunlight energy to guarantee synthesis of adequate amounts of vitamin D, again by the action of sunlight on 7-DHC in the skin.

When the Scots moved from coastal fishing villages to industrial cities such as Glasgow, they became seriously deficient in vitamin D, and so the emergence of rickets. This was followed by a variety of other diseases resulting from vitamin D deficiency: tuberculosis, dental decay, coronary heart disease, and even multiple sclerosis and depression (the Glasgow syndrome).

And so it was with the Inuits. When their diet changed from fish for breakfast, fish for lunch, fish for dinner, they became deficient of vitamin D and they developed diseases characteristic of industrial cities, where there is indoor work for long hours, indoor activities, and atmospheric pollution.

It is the vitamin D component of fish and fish oils that is important.

I recently saw an elderly lady from Bangladesh living in northwest England. I would have expected her to have a very low blood level of vitamin D, as her exposure to the sun was minimal. However the blood level was 47ng/ml, not 4 as expected. She eats oily fish from Bangladesh every day, showing its value as a source of vitamin D with subsequent good health. I expect her blood levels of omega-3 fatty acids would also be high.

But it is unfashionable vitamin D that is important, not fashionable omega-3.

David Grimes
www.vitamindandcholesterol.com


Excellent point. The health effects of omega-3 and vitamin D are intimately intertwined when examining populations that consume fish.

In this study of Inuits, it is indeed impossible to dissect out how much psychological distress was due to reduced vitamin D, how much due to reduced omega-3s. My bet is that it's both. Thankfully, we also have data examining the use of pure omega-3 fatty acids in capsule (not intact fish) form, including studies like GISSI Prevenzione.

Nonetheless, Dr. Grimes reminds us that both vitamin D and omega-3 fatty acids from fish oil play crucial roles in mental health and other aspects of health, and that it's the combination that may account for the extravagant health effects previously ascribed only to omega-3s.

Why does fish oil reduce triglycerides?

2. November 2009 William Davis (9)
Beyond its ability to slash risk for cardiovascular events, omega-3 fatty acids from fish oil also reduce triglycerides.

There's no remaining question that omega-3s do this quite effectively. After all, the FDA approved prescription fish oil, Lovaza, to treat a condition called familial hypertriglyceridemia, an inherited condition in which very high triglycerides in the 100s or 1000s of milligrams typically develop.

The omega-3 fraction of fatty acids are unique for their triglyceride-reducing property. No other fraction of fatty acids, such as omega-6 or saturated, can match the triglyceride-reducing effect of omega-3s.

But why does fish oil reduce triglycerides?

First of all, what are triglycerides? As their name suggests, triglycerides consist of three ("tri-") fatty acids lined up along a glycerol (sugar) "backbone." Triglycerides are the form in which most fatty acids occur in the bloodstream, liver, and other organs. (Fatty acids, like omega-3, omega-6, mono- or polyunsaturated, or saturated, rarely occur as free fatty acids unbound to glycerol.) In various lipoproteins in the blood, like LDL, VLDL, and HDL, fatty acids occur as triglycerides.

Of all lipoproteins, chylomicrons (the large particle formed through intestinal absorption of fatty acids and transported to the liver via the lymph system) and VLDL (very low-density lipoprotein, very low-density because they are mostly fat and little protein) particles are richest in triglycerides. Thus, we would expect that omega-3s exert their triglyceride-reducing effect via reductions in either chylomicrons or VLDL.

Indeed, that seems to be the case. The emerging evidence suggests that omega-3 fatty acids from fish oil reduce triglycerides through:

--Reduced VLDL production by the liver (Harris 1989)
--Accelerating chylomicron and VLDL elimination from the blood
--Activation of peroxisome proliferator-activated receptor gamma (PPAR-gamma)--Omega-3s ramp up the cellular equipment used to convert fatty acids to energy (oxidation) (Gani 2008)

Combine omega-3 fatty acids from fish oil with wheat elimination and you have an extremely potent means of reducing triglycerides. Read a previous Heart Scan Blog post here to read how a patient reduced triglycerides 93.5% from 3100 mg/dl to 210 mg/dl in just a few weeks using fish oil and wheat elimination.