Are you hungry?

Eliminate modern high-yield semi-dwarf Triticum aestivum . . . and what is the effect on appetite?

A reduction in appetite is among the most common and profound experiences resulting from wheat elimination. I know that I have personally felt it: Wake up in the morning, little interest in breakfast for several hours. Lunch? Maybe I'll have a few bites of something. Dinner . . . well, I'd like to exercise first.

The wheatless report that:

--Appetite diminishes to the point where you can't remember whether you've eaten or not. It is not uncommon to miss a meal, perfectly content. Calorie intake drops by 400 calories per day, on average, calories you otherwise would not have needed but all went to . . . you know where.
--Hunger feels different: It's not the gnawing, rumbling hunger that plagues you every 2 hours. In its place, you will find that hunger feels like a soft reminder that, gee, maybe it's time to have something to eat because you haven't had anything in--what?--4 to 6 hours. And it's a subtle reminder, not a desperate hunt that makes you knock people aside at the food bar, steal coworkers' lunches stored in the refrigerator, salivating at the mere thought of food.
--The simplest foods satisfy--It no longer requires an all-you-can-eat buffet to satisfy, but a few small pieces of healthy food. (Yeah, but what happens to revenues at Kraft, Nabisco, and Kelloggs, not to mention the revenues at agribusiness giants ADM and Monsanto? Slash consumption by, say, 30%, you likewise slash revenues by 30%. What would shareholders say?)
--Even prolonged periods of not eating, i.e., fasting, is endured with ease.

Hunger and the relentless search for something to eat disappear for most people. By eliminating the appetite-stimulating properties of wheat, we return to a natural state of eating for sustenance, to satisfy physiologic need. We are no longer victims of this incredibly powerful appetite-stimulant called gliadin from wheat.

This is why many diets fail: They fail to remove this powerful appetite stimulant. You might eat only lean meats, limit your calories, and exercise 90 minutes per day, but as long as the gliadin protein is pushing your appetite button, you will want to eat more or you will have to mount monumental willpower to resist it. You can lose 20 pounds on phase 1 of the South Beach diet, for instance, only to regain it in phases 2 and 3 when "healthy whole grains" are added back.

So the key is to remove the gliadin protein from your life, i.e., eliminate all things wheat.

 

Comments (43) -

  • SamK

    12/6/2011 6:14:11 PM |

    Dr. Davis,
    The question arises - why has nature put the gliadin protein in a seed. If it is an appetite stimulant it is likely a predator will want more and more of it. That is not in the interest of the seed whose purpose is to propagate itself. Please let us know your thoughts.  Thank you for all that you do.

  • Howard

    12/6/2011 6:25:31 PM |

    The elimination of wheat may or may not have been what decreased my appetite enough to allow me to lose 100 lbs without much effort, but I did notice one effect that was even more important to me. I wrote about the complete remission of crippling arthritis in my post on http://guestdietblog.com/2011/05/a-story-about-gluten/

  • Kurt

    12/6/2011 6:39:55 PM |

    This hasn't been true for me. Your advice has helped me improve my cholesterol profile dramatically, lower my fasting blood sugar, lower my blood pressure, etc. However, there's been no change in my appetite, and I eat a larger volume of food now because I cut down on some high calorie foods like butter, cheese, etc.

  • Phyllis

    12/6/2011 6:56:35 PM |

    I too have noticed the diminished appetite, but also I have noticed a new and very pleasant feeling *after* eating. The feeling of fullness... of having had enough food, without the overstuffed feeling that I used to experience.
    It is truely a nice, warm, satisflied feeling.
    Going from a size 16 to a size 4 jeans is a nice feeling as well!

  • Princess Dieter

    12/6/2011 8:44:45 PM |

    I did notice an appetite reduction. Hubby did not. Maybe because I'd had a freaky bingey appetite and he never had...well...more noticeable. I could eat 5K calories a day, EASY, if I had wheat back in. For sure.  I do fine with 1500, 1600 now.

  • Mark Sanders

    12/6/2011 9:15:35 PM |

    One item I don't see mentioned here is heartburn.  I used to have severe episodes when I'd have to down a bunch of Tums and milk to deal with them, and they could occur anytime day or night.  I stopped eating wheat about 2 years ago,  for other reasons, and it took me about 2 months before I realized I wasn't having anymore heartburn episodes.  The occasional times my stomach might feel upset, I just drink water and it goes away.  Even though I've been free of these for the last 2 years, I still carry Tums around with me because I'm still paranoid it's going to happen again.

  • Ute

    12/6/2011 11:45:28 PM |

    Kurt, are you eating enough fats and proteins? I went paleo about a year ago, and I increased fats and protein. Lost almost 30lbs and my hunger is just as described in this post.

  • Donald Kjellberg

    12/7/2011 2:21:02 AM |

    It had a similar effect on my heartburn. I find it fascinating that one of the causes of heartburn is completely missed by my doctor and generally, the medical establishment. I also believe that I was eating much more, (due to appetite alterations, food reward, etc.), my full stomach, and excess fat also played a role in exacerbating the symptoms. Target the etiology and the problem vanishes. Much improved over targeting the symptoms allowing the precipitant to return again and again and again . . . .

  • Shreela

    12/7/2011 4:52:27 AM |

    Wow, I never put wheat and heartburn together, but now that they've been brought up together, I believe wheat may have been causing my heartburn too, which reappears whenever I fall off the wheat-wagon. BTW, whenever I fall off the wheat-wagon, my hypoglycemic symptoms are more likely to reappear too.

  • Might-O'chondri-AL

    12/7/2011 5:12:18 AM |

    Hi Howard,
    +/- 4% of the cell protein in wheat grain is LEA (late embryo-genesis abundant protein) that helps the plant bear up without osomotic failure when temperatures drop & also keeps the grain proteins from melding together when conditions get very dry. Modern wheat breeding has manipulated LEA protein conformations to improve crop cultivation habits; I think this fits into what Doc calls a "frankengrain" .

    The group 3 variety of LEA protein's high molecular weight molecules are not broken down readily by proteo-lysis in the gut . When they are taken up by the body the LEA protein is capable of "sensitizing" some individuals to it like an antigen irritant. We don't know what precise amino acid wings the LEA we ingest in a modern wheat breed have. And stripping gluten from the grain doesn't necessarily mean the LEA molecule is also removed.

    LEA can bind to IgE (immunolo-globulin E) from our joint's synovial mast cells. The subsequent release of histamine in the joint tissue incurs the auto-immune  response of  inflammation with  subsequent pain. I think LEA  "sensitization" is what you experience as arthritis due to wheat..

  • Dacia Felix

    12/7/2011 9:55:12 AM |

    For me, one of the effects of elimination of wheat was the  disappearing of dandruff. My dandruff was really bad and no special shampoos or treatments could alleviate the problem. A few months after giving up wheat,  I noticed that I no longer had dandruff!!!!  I even kept my hair unwashed for nearly a month, yet my hair remained dandruff free. Nowadays I wash my hair once a week instead of every day.

  • Susan Clarke

    12/7/2011 6:41:01 PM |

    Yeah, but chasing symptoms rather than looking for causes is the modus operandi of the entire US medical system. Well, most of it anyway.  Don't try to figure out what's causing the problem, just throw another drug at it.

  • puddle

    12/7/2011 7:27:19 PM |

    Yup. (and yup and yup and YUP)

  • calma60

    12/8/2011 12:05:14 AM |

    Just started eliminating wheat and reducing high carb foods around Thanksgiving. My fasting blood sugar used to be around 150; now it's 123. I actually have blood sugar readings after meals that are between 95-115. Once in awhile I get hungry, but I don't crave sweets like I used to. This program overall feels like something I can make a permanent change to.

  • Might-O'chondri-AL

    12/8/2011 12:13:05 AM |

    Hi D. Felilx,
    Dandruff relief from quitting wheat is likely due to eliminating the non-digestible wheat protein fragments  that you were sensitive to. Those wheat fragments had been going on to bind with  IgE put out from local basophils (basophils are +/- 0.6%, or 0.006,  of our bone marrow generated white blood cells). The degree of itchy scalp is a factor of the amount of histamine put out from those basophils. Usually a itch response is to hot extremes of both water and air; but some are wired to itch in response to cold extremes of water/air.

    When wheat protein fragments activate the basophil's IgE this causes the hair follicle wall to respond in an immunological manner & inflammatory cells in the follicle wall hold more sebum oil; with different dandruff results. In most individuals that sebum oil isn't used enough to normally  re-lubricate the surrounding scalp because the local increase of  sebum fatty acids gets taken advantage of and hijacked by the common scalp  yeast Pithyrosporum ovale. With the fast replication of lipo-phylic (fat loving)  P. ovale there is a lot of new progeny & sloughing off of  obsolete P. ovale cells, plus shed (lipid deprived) skin cells that we see as small "snowy" dandruff ; & this is usually accompanied by itching. The other situation is when the building up sebum seeps  to the surrounding scalp skin &  in this case the dandruff manifests as thick scales that usually doesn't provoke much itching; this is a scalp seborrhea & has a genetic predisposition to run in some families.

  • Dr. William Davis

    12/9/2011 3:25:32 AM |

    I don't think that wheat is aware that humans are a "predator."

    And the gliadin protein of modern wheat is not the natural form; it is the form created by geneticists.

  • Dr. William Davis

    12/9/2011 3:27:30 AM |

    The relief from acid reflux and "heartburn" is a very frequent accompaniment to elimination of wheat, as is relief from the cramps and diarrhea of "irritable bowel syndrome."

    Of course, it makes you wonder what else wheat is capable of in the gastrointestinal tract if this occurs so commonly.

  • Dr. William Davis

    12/9/2011 3:29:21 AM |

    This has happened to enough people, Dacia, that I believe it is likely to be a real association.

    This is a lesson I've learned about here and other online forums, as it's not something I purposely track in the office experience.

    This is yet another manifestation of how incredibly varied the skin expression of wheat's health disruptive effects can be.

  • Bob

    12/9/2011 4:17:23 AM |

    What about oat bran and steel cut oat meal? Are they as bad as wheat. They are supposed to be good for cutting LDL.
    Thanks

  • Annie

    12/11/2011 11:23:08 PM |

    Why would wheat be a pre curser to heart burn? I too suffer from bad heart burn on a regular basis and I can't seem to stop it.

  • Kurt

    12/12/2011 8:27:58 PM |

    Yes, I am eating enough fats and proteins.

  • Patrick

    12/12/2011 10:45:00 PM |

    No you are not...eat more butter and cheese!  Preferably from grass fed animals, as the "fat profile"  is proven MUCH better for human consumption.   Fat will NOT ruin your health...though it will ruin your cholesterol reading with those "cheapy" tests that ESTIMATE LDL measures.  NMR profiles are generally improved.   Check into Dr. Davis's archives for more on these topics.
    Yum.  Loves me some FAT!

  • Carl Crawford

    12/13/2011 9:20:07 PM |

    I believe you have a problem.
    I am not receiving your blog posts.
    Feedburner notifies me that my email addresses is in your database, but I receive no email notifications from your site.
    This has been a problem since you changed your site several months ago. Before that time I was receiving your emails.
    Could you look into this issue please?

    Regards, Carl

  • Dr. William Davis

    12/14/2011 2:52:22 AM |

    Oat products do not provoke appetite nor abnormal intestinal permeability like wheat. However, oats send your blood sugar sky-high. That's why we avoid it.

  • Lee Woodruff

    12/15/2011 2:32:28 PM |

    When I saw my Doctor eight months ago and told her my weight loss had stalled, she smiled and said "well you have  just reached an age where you can't loose a weight", and prescribed me a statin. In a sense she was right. Post 50+ the hormones are running against you. Well I'm now 28 lbs lighter, and at the lower end of my BMI and my tummy almost flat. Thanks basically to intermittent fasting, keeping the carbs down, oh and elimination wheat. The statin prescription went in the bin by the way,

  • Martyn

    12/15/2011 9:01:04 PM |

    A more general end-of-year thanks to you, Dr Davis, for the work you have done on the blog, and on Wheat Belly. I believe your work in practical preventative medicine is quite brilliant, and way ahead of its time.

    I have read every post, and look forward to reading more from you in 2012.

    Many Thanks

  • Lindas

    12/15/2011 9:16:12 PM |

    Dr. I have to take cranberry juice, (organic, concentrate, no sugar) for Urinary track infection,  BS goes to 119-127)  what to do?
    Also, D- Mannose, helps also, but know its a sugar?
    Prescribed Cipro, but cautious to take after reading side effects.

  • Lindas

    12/15/2011 9:19:47 PM |

    Yes, Doctor, I also want to thank you for the "against the grain" courageous stance you've taken!!!!!
    Much happiness and joy for you and your family in the year ahead.

  • Julie

    12/20/2011 5:51:38 AM |

    Sorry, my question is off-topic.
    But my father just had a stress test done because he had chest pain when exercising. Unfortunately, the test results were positive (abnormal). His doctor suggested doing Coronary angiography and possibly putting a stent in. As well as adding a beta-blocker. My father is already taking a statin.
    These results really scared me. What should he do to reduce the risk of a heart attack? Would you recommend any additional tests? Is it worth it to make a heart scan in this case?

    Thank you very much!!!!

  • Sam Sinderson

    12/20/2011 10:30:39 PM |

    Low carb is fine and doing so has "normalized" my blood sugar, reduced my hemoroid, increased hair growth and decreased nasel infections.  However, in doing a diet anaylsis I find I am eating 120 to 170 grams of protein, because of the addition of meat of all kinds and also cheese to my diet, which according to several other sources, Dr. Rosedale for one, is detremental.  If I limit my protein to 1 gm per kg of weight , I have seen recommended several places, plus a little becasue of my rather rigerous excercise program, I would be at 70 gm of protein per day.  Yesterday I did that, and I literally have to eat either olive oil or coconut oil by the tablespoon to get my calorie level up to 2200 or so to maintain my weight at 145 lbs and that is after 4 tbls of oil cooking two eggs in the morning!  Does Dr. Davis's protocal have any limits on protein?  My wife thinks I'm nuts eating coconut oil, which melts in ones mouth and is actually quite tasty.

  • Might-o'chondri-AL

    12/21/2011 10:02:35 PM |

    Dec. 2012  The Journal of the Norwegian Medical Association report of Arnold Berstad & Jørgen Valeur of Lovisenberg Diakonale Hospital explain that a meal's glucose monitored in the stomach registers in the brainstem which then reflexively signals the muscles in the stomach wall to relax.
    Quote: “... it can decrease the pressure on the stomach and reduce the sensation of being full....The problem is that ...the brakes on carbohydrate consumption are five metres further down, at the lower end of the small intestine....Fat, however, is absorbed higher up in the system and triggers a high-placed brake. It makes you quickly full."

  • Might-o'chondri-AL

    12/21/2011 10:04:18 PM |

    Journal's date should be 2011 Dec.

  • James

    12/23/2011 5:54:29 PM |

    I have eliminated wheat and all sugars & carbs for about 6 months. I have lost almost 30# (from 200 to 173) in those 6 months. But now I am stalled. I have been at 173 for almost a month and have done nothing different. I want to lose another 10-15#. I am 5' 6" and still have some abdomal buldge. My weight loss was an almost straight line down for 6 months. What causes this plateau? I understand that my caloric needs will have changed due to the loss of 30# and I have adjusted for that. Anyone have any ideas?

  • Might-o'chondri-AL

    12/24/2011 4:09:18 AM |

    Hi James,
          I can only relate an interpretation of my experimentation this last year plus. Since I never have struggled with my weight it may not translate to others. My goal was mainly to see what changes were possible in MNR tests of lipid particles I could achieve with Doc's insight (excellent results I'd say).
           I recently completed several months when my only fat intake daily was a combination of coconut oil (2 tablespoons daily , as 28 grams total fat) , plus fish oil (4.5 grams total fat, as 1 teaspoon = 1.5 gr. EPA + 0.75 gr. DHA), plus 90% chocolate's cocoa butter (60 grams, as 33 grams total fat), plus some olive and restaurants' cooking oils. And I also specify that there was no intake of animal fat (ie: no meat) , fowl fat  (ie: no chicken or eggs) or dairy fat (ie: only fat free dairy) - unless a restaurant used some in their food preparation.
           My experience without any low calorie restraint, nor over eating,  was that I lost weight and  continued to do so beyond what I find suitable. In other words I had to periodically resort to over ingesting carbohydrate calories to stop from getting too thin. Of course I made sure to keep my daily protein intake consistently high enough all throughout the year.
         When I started my experiment it was by daily using only 1 tablespoon of  raw unrefined coconut oil  & lost weight at nights.  I took my first ever MNR test after a handfull of months of this.
         After the initial MNR test I added the daily 1 teaspoon of fish oil , kept to the 1 tablespoon coconut oil (14 gr. fat) , but an irregular chocolate intake was daily limited to 40 grams (22 gr. fat) &  even lost more weight. I took a 2nd MNR test after 4 months of that to see what was doing with my lipids.
         Then I upped the daily raw coconut oil to 2 tablespoons, chocolate up to regularly 60 grams & kept fish oil at same 4.5 grams for 7 months before I took a 3rd MNR test . It was during this latest stretch of experimentation that I sometimes needed to regulate my weight upwards by deliberately adding back more carbohydrates - & I was not pursuing a daily very low carb intake anyway.
          All that staged experimentation seems to indicate that using coconut oil as my primary fat is what drove my weight loss. When I added in fish oil the weight loss rate was not noticeably accelerated & I can't distinguish it from the pattern  begun with coconut oil. However when I eventually  went up to 2 tablespoons of coconut oil daily I sometimes had to fight to just hold on to my weight. The chocolate intake seems to be less of a factor in my weight loss.
          So retrospectively, in my case I think the exclusion of animal/fowl/dairy fat kept certain specific fatty acids out of play and then the distinct fatty acids in coconut oil were both metabolized and incorporated in unique ways that resulted in sustained weight loss for me. I was concerned  that 2 tablespoons of coconut oil a day might be excessive yet last MNR done is superb (I don't seem to be ApoE 4).
         Doc, you may know, has several posts about using finger stick testing of your blood sugar before and after meals. He explains how to use a simple home glucose meter to know which meals spike your blood sugar and lose weight by controlling after eating glucose "excursions".

  • Might-o'chondri-AL

    12/24/2011 8:03:09 AM |

    Hi S. Sinderson,
    Since Doc hasn't answered you about his protein protocol yet this may orientate you. Protein intake can't exceed the ability of liver enzymes to make urea as a consequence of liver's nitrogen metabolism. Basically, if one is healthy,  beyond 3.9 grams protein daily per kg. of our body weight we can't  urinate all nitrogen "waste" from the kidneys adequately.
    1973 Rudman set a periodic daily physiologically safe upper limit of 3.8 gr./kg one weighs (ie: not always every day) .... 2000 Metges calculated a top long term daily protein limit should be 2 gr/kg one weighs .... 1996 Eades pegged exercisers wanting to lose weight should use 1.7 gr./kg one weighs....2010 Speth analysis of paleo-anthropology suggests no more than 35% of calories were ever from protein (ie: less than 3.9 gr/kg hunter weighed daily).

  • Kathy

    12/31/2011 4:42:45 PM |

    So.........
    Has this blog been abandoned by Dr. Davis, in favor of the Wheat Belly blog?

  • Laura

    12/31/2011 11:52:15 PM |

    Hi Might - regarding your 12/24 post on the coconut oil, etc. experiement.  If you did not eat dairy, meat, fowl or eggs (?) for protein what did you eat for protein.  I am very curious because I have been in a stall for a loooonnngggg time (about 6 months).  I also take coconut oil daily (2 tsp) and Omega 3 fish oil (950 mg of EPA & DHA combined).  I also should mention that I am diabetic (T2).  My carb intake is 30-60 grams per day.
    I am trying to find a way to break this stall and your post intrigued me greatly.  
    Thank you,

  • Might-o'chondri-AL

    1/3/2012 6:07:11 AM |

    Hi Laura,
        I buy 1 gallon of fat free milk & culture it into Kefir, which I then drain the whey from and go on to eat the milk solids. I roughly weigh the kefir "quark" that goes into the refrigerator because each batch will have it's own variable amount of whey remaining . Once I know the batch weight I do a simple calculation to divide the  total weight of that batch by 6 to know roughly how much protein is in a 1/6th portion.
        When I know much 1/6 of the kefir quark made from tthat 1 gallon of milk I will then eat one of those 1/6th proportioned amounts in the morning, again during the day a  2nd 1/6th amount  and  then a 3rd  final 1/6th amount of the kefir quark.  
       The result is that in 1 single day the milk solids are equal to 1/2 gallon of fat free milk.  I approximate this as containing, in total,  around 70 grams of protein which for me is a good minimum protein requirement . Then any other protein I eat in the day is not crucial & usually in form of nuts, hummus or  some stray egg ingredient which can't measure reliably. I think my daily protein consumption is around 120 grams or more protein daily  (I certainly am not eating only 1 gram protein per kg of my weight).
         In terms of people stalling on low carb & pseudo-paleo diets I do have some nuanced ideas if you'd like, but I don't know how applicable the research might be. It isn't like a formula & needs longer context to elaborate .

  • Might-o'chondri-AL

    1/3/2012 11:55:02 PM |

    Hi Laura,
    Please see what I also tagged you at Doc's next thread (1st in 2012) on this same blog.

  • Anna

    1/17/2012 6:04:22 PM |

    Dr. Davis....what do you say to people who claim they are emotional eaters and can eat over the "no appetite" feeling?
    Thanks.

  • pjnoir

    2/18/2012 12:10:49 AM |

    nothing satisfies hunger better than homemade beef or chicken stock,with beef being the best. One of my diet secrest when doing my low carb/Paleo regiment.

  • Are you hungry? | Paleo Primal Post

    10/24/2012 5:36:33 PM |

    [...] more here: Are you hungry? | Track Your Plaque Blog. .nrelate_related .nr_sponsored{ left:0px !important; }     /*     No Comments - Leave a Comment!   [...]

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Alternatives to fish oil capsules

Occasionally, someone will be unable to take fish oil due to the large capsule size, excessive fishy belching, or stomach upset. The easiest solution is usually just to try a different brand, e.g., Sam's Club (Makers' Mark brand) enteric-coated.

However, sometimes liquid fish oil preparations may be preferred. Here'a list of products we've used successfully. All cost more than plain old fish oil capsules, but fish oil is so crucial to your heart scan/coronary plaque control efforts, that it really pays to search out alternatives.



Liquid fish oil alternatives to capsules:

Liquid fish oil--e.g., Carlson's liquid fish oil. Most liquid fish oil comes flavored either lemon or orange.



Frutol--A very clever re-formulation of fish oil that makes it water-soluble and non-oily. The Pharmax company has put their fish oil into a fruit flavored base that tastes pretty good and is not too expensive.
Go to www.pharmaxllx.com for more information. Unfortunately, I do not believe it's available in stores.





Coromega--another non-oily preparation, though available in some health food stores. Coromega comes in little single-serving foil dispensers. It tastes kind of fruity (though I personally like the Frutol better for taste and consistency). It's kind of pricey ($1.40 per day for two packets).



Regardless of what preparation you choose, you can determine the dose needed by adding up the EPA+DHA content. For the basic prevention effect, the starting dose for the Track Your Plaque program, you need a total of 1200 mg per day of EPA+DHA. Higher doses, e.g., 1800-2400 mg per day, may be required for correction of high triglyceres or postprandial (after-eating) abnormalities.

Ignoring your heart scan is medical negligence

I continue to be dumbfounded that many doctors continue to pooh-pooh or ignore CT heart scans when people get them.

I can't count the number of people I've seen or talked to through the Track Your Plaque program who've been told to ignore their heart scan scores. The most extreme example was a man whose physician told him his heart scan score of nearly 4000 was nothing to worry about!


A real-life story of a retired public defense attorney whose heart scan score of 1200 was ignored, followed two years later by sudden unstable heart symptoms and urgent bypass prompted us to write this fictitious lawsuit. Though it's not real, it could easily become real. To our knowledge, no single act of ignorance about heart scans has yet prompted such a lawsuit, but it's bound to happen given the number of scans being performed every year and the continued stubbornness of many physicians to acknowledge their importance.



Major Malpractice Class Action Lawsuit Looms for Doctors Who Ignore Heart Scan Tests

It's been several years since new medical discoveries have debunked old theories regarding heart disease and heart attack and have verified the efficacy of CT heart scans for detecting both early and advanced heart disease. Doctors who fail to keep apprised of these finding or refuse to change their practice for financial reasons put themselves at risk for becoming defendants in a major malpractice class action lawsuit. The plaintiffs will be a growing class of persons who were debilitated by avoidable heart attacks and heart procedures and the heirs and estates of those who have died.
Milwaukee , WI (PRWEB) November 29, 2005 -- This press release outlines a template for a potential class action lawsuit that may be on the horizon for the medical industry. The class of plaintiffs for this theoretical action remains latent but is growing on a daily basis. However, it requires only one such plaintiff to find an attorney who recognizes the scale and magnitude of the potential damages and move forward on a contingency basis. In real terms, this class could include 80% of those who had a heart attack, underwent a heart procedure, or subsequently died. According to the latest American Heart Association statistics, this number is estimated to be a least 865,000 persons and the entire class could easily be 10 times that number. Using a conservative estimate of $500,000 in damages per class member, the total damages could exceed $400 billion.

The plaintiffs, defendants, third parties, and facts surrounding the following moot complaint represent an actual incident. The names, specific health information, and dates have been changed to protect potential litigants.

Plaintiff, through his attorneys, brings this action on behalf of himself and all others similarly situated, and on personal knowledge as to himself and his activities, and on information and belief as to all other matters, based on investigation conducted by counsel, hereby alleges as follows:

NATURE OF THE ACTION

1.Plaintiff brings this class action on behalf of himself and all other persons who suffered physical damages or mental distress as a result of receiving a medical diagnosis indicating they had no identifiable heart disease, elevated risk for heat attack, or who were prescribed medications not suited to treat their heart disease once detected.

2.Substantial and irrefutable medical evidence has established that cardiac stress testing is an ineffective method for detecting heart disease of the type that is the root cause in over 90% of all heart attacks and other complications of heart disease that result in death or debilitating injury. A readily available and well-publicized test known as “CT heart scanning” is capable of detecting virtually all heart disease of this nature. It has also been established that simple cholesterol testing often fails to detect persons like likely to develop serious heart disease and prevents them from receiving common treatments capable of reducing or eliminating the source of their undetected heart disease. Readily available blood testing techniques exist that are capable of detecting non-cholesterol related sources of heart disease.

3.The medical community has made significant investments in outdated methods of detecting and treating heart disease. They rely on the revenue streams generated by providing these treatments to persons whose heart disease has progressed to the stage that intervention is required to prevent death or debilitation. Any change in diagnostic or treatment methods resulting in the prevention of heart disease would require substantial investments in new technologies and would severely reduce the market for current treatments. Plaintiffs believe this is a motivating factor in the neglect and willful suppression of readily available technology capable of detecting and preventing heart disease and represents gross medical malpractice.

SUBSTANTIVE ALLEGATIONS

On January 23, 1999, Plaintiff underwent a CT Heart Scan which was interpreted by a cardiologist at the ABC Scan Center . Plaintiff received a report from the Scan Center cardiologist indicating that his “calcium score” placed him in the top 1% for heart attack risk among men in his age group. The report also included the comment “Patient has a high risk of having at least one major stenosis (50% or greater blockage) in his Left Anterior Descending (LAD) artery and is urged to consult with a physician regarding this finding.”

On March 3, 1999 Plaintiff presented Defendant with the results of the January 23, 1999 CT Heart Scan. Defendant told Plaintiff to disregard the CT Heart Scan Results and ordered a physical including a stress test and cholesterol blood test.

On April 1, 2005, Plaintiff had a heart attack and a subsequent coronary angiography that confirmed multiple obstructive coronary plaques in his LAD. Plaintiff received an emergency balloon angioplasty to relieve his acute condition. Substantial damage to plaintiff's heart was incurred before emergency angioplasty could be instituted.

On April 3, 2005, per Defendant's recommendation, Plaintiff underwent open heart surgery to insert three bypasses in his LAD to resolve substantial obstructive heart disease, the same artery identified as having likely obstructive heart disease over 5 years earlier via CT heart scan.

On July 7, 2005, Plaintiff independently obtained additional blood testing not ordered by Plaintiff and was found to have several additional blood abnormalities not discovered by Defendant that are known to contribute to the development of heart disease and were readily treatable using lifestyle changes, nutritional supplements, and prescription drugs.

As early as September, 1996, the American Heart Association (AHA) issued a “Scientific Statement” to health professionals acknowledging the strong link between heart attacks and high calcium scores in asymptomatic patients. Extensive studies and references have confirmed the ineffectiveness of stress testing to reveal early heart disease in asymptomatic patients.

Plaintiff alleges that Defendant failed to utilize readily available medical tests and protocols to identify, aggressively treat, and potentially delay, halt, or reverse advanced heart disease that later resulted in extensive physical and emotional trauma to the Defendant.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff herein demands judgment:

A. Declaring this action to be a proper class action maintainable pursuant to Rule 23 of the Federal Rules of Civil Procedure and declaring Plaintiff to be a proper Class representative;

B. Awarding damages against each defendant, joint and severally, and in favor of Plaintiff and all other members of the Class, in an amount determined to have been sustained by them, awarding money damages as appropriate, plus pre-judgment interest;

C. Awarding Plaintiff and the Class the costs and other disbursements of this suit, including without limitation, reasonable fees for attorneys, accountants, experts; and

JURY DEMAND

Plaintiff hereby demands a trial by jury.

Light the fuse of heart disease

Father Bob, despite his calling as a priest and counselor, led a stressful life. His average day was packed tightly with commitments: counseling members of his congregation, visiting the hospital, more official priest and church duties.

At age 53, his heart scan score of 799 came as a complete surprise. Even more of a surprise, his stress test was dramatically abnormal showing poor flow in the front of his heart at a level of exercise that wouldn't challenge most 75 year olds. His blood pressure with exericse: 230/100. Bob was shocked.

A few stents to the LDL later, Bob was trying to turn a new leaf on lifestyle. His life prior to the diagnosis of heart disease was driven by convenience. Because his day was so filled with commitments, he simply grabbed what he could from hospital cafeterias, fast foods, etc.

But after his procedure, Bob committed to choosing healthier foods, walk every day, and resist the food temptations presented by convenience.

However, temptation defeated him twice in the first few weeks after his stents. On the first occasion, Bob gave into eating a cheeseburger. On the second, Bob was at a fish fry (this is Wisconsin, after all) and ate a large serving of deep-fried fish.

On both occasions, Bob started feeling awful within minutes after eating: foggy, bloated, gassy, and fatigued. He took his blood pressure after each incident: 210/90, even though his blood pressure had more recently been trending down towards 130/80.

What happened? Grotesquely unhealthy foods like the deep-fried fish and cheeseburger provoke an abnormal constrictive process body wide. Some call this "endothelial dysfunction". Regardless, it is a graphic and frightening demonstration of the power of these sorts of unhealthy foods to wreak immediate and dangerous effects. Father Bob's response was more exagerrated than most, but it happens to all of us.

Eat badly and your body will pay the price. Even that occasional hot chocolate sundae or Egg McMuffin will yield cumulative injury, among which will be a rise in your heart scan score.

"I don't know what I'm doing here"

Jim came to the office at the prompting of his wife.

At age 52, Jim was semi-retired, having to work only a few hours a week to maintain his business. He'd had a high cholesterol identified about 10 years earlier and had been taking one or another statin drug ever since.

However, Jim's wife was a pretty savvy girl and understood the inadequacies of the conventional approach to heart disease prevention. Nonetheless, when Jim came in, he declared, "I feel great. I don't know what I'm doing here!"

I persuaded Jim to undergo a heart scan. His score: 2211, in the 99th percentile (the worst 1% for men in his age group). However, it was worse than that. Any score above 1000 carries a heart attack risk of 25% per year unless prevention issues are fully addressed.

Indeed, Jim proved to have far more than a high LDL cholesterol. Among the patterns uncovered with his lipoprotein analysis were small LDL, the postprandial (after-eating) abnormality of intermediate-density lipoprotein (IDL), and high triglycerides and VLDL. All would require correction if Jim is to hope to gain control of his extensive coronary plaque.

The message: Trying to discern risk for heart disease from cholesterol is complete folly. This man was going to die or have an urgent major heart procedure within the next year or two, all while taking his statin drug.

Discard the silly notion that cholesterol tells you everything you need to know about heart attack risk. It does not. It helps a little but leaves vast voids in risk determination. Fill those gaps with a heart scan, plain and simple.

I had a heart attack--and I don't know why!

Kevin came to my office for another opinion.

A husband and father of two teenagers, Kevin had his first heart attack at age 39. Kevin received two stents to his right coronary artery. The entire process took place in a flurry with little explanation over 48 hours, start to finish.

He smoked a pack of cigarettes a day, but the only history of heart disease in his family was his father, who, also a smoker, had his heart disease uncovered in his late 70s.

His internist subsequently prescribed Zocor even though Kevin's LDL cholesterol was a relatively unimpressive 128 mg/dl.

Kevin subsequently asked his cardiologist, "Where did I get the heart disease from?"

"Cigarettes. And genetics. You can quit the first. There's nothing you can do about the second." End of explanation.

This left Kevin frightened and demoralized. If much of the cause of his heart disease couldn't be identified, why bother quitting smoking? Why not enjoy what time he had left?

Kevin was understandably shocked when I told him that genetic causes were 1)identifiable, 2)quantifiable, and 3) correctable.

Kevin's full lipoprotein analysis subsequently showed the most dire combination that commonly accounts for coronary disease in young people: Lp(a) with small LDL particles. This, along with smoking, fully accounted for this young father of two's heart disease.

Along with starting Kevin on a new program for correction of his patterns, I also persuaded him to get a heart scan. What usefulness is a heart scan after the fact? Plenty. Even though Kevin's right coronary was no longer "scorable" because the steel in the stent obscured our measurements, the two remaining unstented arteries would still yield a score. This provides a baseline for future comparison. Even after a stent, Kevin could "track his plaque".

Butter basics

There’s lot of confusion about butter, margarines, and their substitutes. Butter/margarine substitutes that avoid the negative aspects and provide modest health benefits are available, but I find that people confuse what's what. So here’s a brief primer.


Butter--Avoid it. Plain and simple. Butter is a rich source of saturated fat. Of 11.5 grams total fat per tablespoon, 7.3 grams are saturated. It is not better than margarine, contrary to simple-minded reports from some media sources. Butter raises LDL cholesterol, raises blood pressure, and has been related to various cancers.

Margarine--Not better than butter, arguably worse. Some argue that the trans-fatty acids, or hydrogenated oils, used to solidify vegetable oils to make margarine solid are worse than butter. In addition to the ill-effects of butter, margarine reduces HDL and raises cancer risk, perhaps even more than saturated fats. Hydrogenation yields a very unnatural structure that modifies cellular behavior of the sort that may promote the appearance of cancer cells. More recently, however, some of the major manufacturers, like Blue Bonnet, have produced soft spread products without hydrogenation. These are reasonable substitutes when used sparingly.

Smart Balance--This is a product made with canola oil, a source of monounsaturates (the best oil source after omega-3s), but manufactured without hydrogenation and therefore has no trans-fats. It does have, in my view, a bit too much saturated fat (1.5 gm per tbsp. in the 37% Light Spread; 2.5 gm per tbsp in the 67% regular spread). This is a reasonable product to use in small quantities.

There is also a Smart Balance Omega PLUS product that contains added flaxseed oil and sterol esters. I do not recommend this product because of the sterol content (see below). I also object to the manufacturers who label their products “rich in omega-3s” when they mean linolenic acid (in flaxseed), which is converted to a trivial quantity of omega-3s. Linolenic acid may pose unique benefits of its own, but it should not be listed as an omega-3 source.

Benecol--This is a butter substitute that contains stanol esters, a substance that reduces total and LDL cholesterol. Two tablespoons a day reduces LDL around 20 mg/dl, more or less depending on your starting cholesterol.
There’s a light and regular spread. The light contains 20 calories less per tablespoon but somewhat less monounsaturates, but the same LDL-reducing stanol esters. The manufacturer does hydrogenate the oils, yielding 0.5 mg trans-fats per tablespoon--a small drawback.

Take Control--Similar to Benecol, but made with sterol esters. Take Control also reduces LDL cholesterol. However, data from several high-quality studies from Finland suggest that sterol esters may, in some people, be absorbed into the blood. This is potentially concerning. There is a rare disease called sitosterolemia that results in coronary disease in teenagers and young adults in their 20s from increased absorption of sterol esters. While you can’t acquire this genetic disease, some people have the capacity to absorb sterol esters from their intestines very efficiently. I find it very disturbing and I suggest that you stay away this product and other sterol-containing products like HeartWise orange juice and Smart Balance Omega PLUS until the issue is clarified and safety assured.

Brummel and Brown--A blend of vegetable oils (soybean and partially hydrogenated soybean) with calories and fats reduced by blending in yogurt. This is an okay product. The hydrogenation yields trans-fats below the FDA required declaration limit of 1.0 mg.
There’s also 1.0 mg each of saturated and monounsaturated fats. The calories are relatively low as a consequence of the added yogurt, only 45 calories per tablespoon. This makes the Brummel and Brown a reasonable choice.


Other products are making their way out to supermarkets. Look for the type of oil used. Canola, olive, and flaxseed are the best. Also look for trans-fats and saturated fat content; both should be low, preferably <1.0 mg per tablespoon, ideally none.

The best choice among the above products in my view is Benecol, though it’s also the most expensive. It will yield substantial drops in LDL cholesterol. All the products in our informal tastings taste a lot like butter, or at least as well as we can remember what butter tasted like! The key with all of these products is use in moderation, since they all provide between 45?80 calories per tablespoon.

Let Dr. Friedewald rest in peace

In the 1960s, doctors struggled with the concept of cholesterol and its relationship to heart disease. It was becoming clear that higher levels of cholesterol were predictive of heart disease. It was also becoming clear that the low-density fraction of cholesterol, or LDL, was somewhat better than total cholesterol in predicting heart attack.

Cholesterol was easily measurable in the 1960s. LDL was not. So, Dr. Friedewald, a noted lipid researcher at the National Institutes of Health, proposed an easy method to calculate LDL cholesterol from total choleseterol, HDL, and triglycerides:

LDL cholesterol = Total cholesterol – HDL cholesterol – triglycerides/5

This simple manipulation would put LDL cholesterols into the hands of the practicing physician and the American public. Dr. Friedewald recognized that this calculation only represented an approximation of LDL cholesterol and that it was thrown off, sometimes substantially, by any abnormal rise in triglycerides or reduction in HDL. But it served its purpose at an age when most doctors hadn’t even heard of cholesterol and the public was still sold on whole milk and “farm-fresh” butter, and Chesterfields were the cigarette choice of most doctors.



The world has since changed. Most doctors have heard about cholesterol and, along with the public, have been drowned in drug company marketing for cholesterol-reducing drugs. Most people with some level of common sense and health awareness no longer use butter or whole milk, and no longer believe that the brand of cigarette you choose can be healthy. But we’re still using Dr. Friedewald’s original calculation for LDL cholesterol. When you get an LDL cholesterol from your clinic, doctor, or hospital, >99% of the time it is obtained using Dr. Friedewald’s calculation.

Is it because there’s nothing better available? No, it’s not. There’s two reasons why your neighborhood primary care physician or cardiologist is still using this dinosaur of testing called LDL:

1) The lag in science to practice is 20 years. Accept that most primary care doctors are 20 years behind the times on many issues, LDL cholesterol included.

2) Insurance companies vigorously discourage testing beyond conventional lipids. The array of objections we get from insurance companies is mind-boggling. It would be funny if human life and finances weren’t at stake. These “new” tests are “experimental”, “unproven”, not endorsed by standard guidelines, not approved by some internal committee, or simply “We don’t know what this test is” ?we’ve heard them all.

What are the tests that are superior to Dr. Friendewald’s calculated LDL? There are several, listed here in order of best to worst:

1) LDL particle number--the value generated by NMR lipoprotein testing. This is the gold standard, most reliable test available, and the one I recommend.

2) Apoprotein B--More widely available even from conventional laboratories in hospitals. Not as accurate as NMR LDL particle number, but a pretty good choice. Apo B is the principal protein in LDL, VLDL, and IDL particles, and so it’s a better reflector of risk from all of these lipoprotein fractions, not just LDL.

3) “Direct” LDL--This is LDL that is actually measured. Unfortunately, it ignores the issues of LDL size and has some other pitfalls, but it’s still better than calculated LDL

4) Non-HDL cholesterol--So-called because it incorporates all undesirable cholesterol-containing lipids except good HDL, thus “non-HDL”. This is another calculation, though better than LDL (because it sums up the risk from other apoprotein B-containing lipoproteins). Non-HDL is calculated from Total cholesterol – HDL. It’s therefore available from any standard lipid panel. It’s little used in everyday practice, however, because most people and their physicians find it confusing.

5) Friedewald calculated LDL--You can see that calculated LDL is last on a list of choices. Yet this is the measure that doctors use day in, day out. It’s the measure that drug companies base billions of dollars of revenue and profits on.

It’s an everyday occurrence in my office that calculated LDL is 89 mg/dl, but the real value is somewhere between 160 and 200 mg/dl. That’s a big difference. Imagine your realtor tells you your house’s estimated value is $200,000 and that’s what you sell it for to an eager buyer. After closing, you find out your house was really worth $300,000. You’d be upset. But that’s what you’re often getting with LDL cholesterol?a bum deal.

It’s part of the reason people will say, “My doctor said my cholesterol was fine and that no cause for my heart disease can be found. He said it was genetic.” In reality, they could have sky-high LDL cholesterol revealed by LDL particle number or apoprotein B.

Use LDL cholesterol in a pinch when you’ve got nothing else. It’s also helpful to gauge any treatment effect of diet, functional foods, drugs, etc. But it is a seriously flawed tool to diagnose your initial level of risk.

The key to losing weight

I saw three people this past week, all of whom set off on an effort to lose substantial quantities of weight. And all seriously needed to.

All three started with at least 70 lbs. excess weight; all showed substantial weight-sensitive lipoprotein patterns like low HDL, small LDL, high triglycerides, VLDL, and pre-diabetic levels of blood sugar. They also all shared high blood pressure.

All three also had high heart scan scores. Kate’s score was just over 1200. Tom, a 58-year old real estate developer, had a score of nearly 600. Susan, the youngest of the three at 52, had a heart scan score of 377¾99th percentile at this age. Losing weight was an absolute requirement for their plaque control program. Because their lipoprotein abnormalities and pre-diabetic patterns were triggered by weight, weight loss would provide powerful correction. Each and every one of them would need to lose much of their excess weight¾at least 50 lbs¾if they hoped to halt the relentless progression of their heart scan scores.

All three of them returned after 6-8 weeks, and all had lost between 17-24 lbs: spectacular results.

There’s no secret to weight loss. Each of them achieved their weight loss in slightly different ways. But they also shared several critical ingredients in their weight-loss efforts:

1) All three dramatically slashed their intake of wheat flour-containing foods and other processed carbohydrates and did so consistently. All also avoided the usual high-fat, high caloric-density foods like butter, margarine, fried foods, greasy foods, nuts roasted in oil, etc. They concentrated on vegetables, salads, raw nuts, lean proteins (inc. turkey, chicken, fish, lean red meats, low-fat cottage cheese and yogurt).

2) They stopped using food as a reward or as a consolation tool.

3) Exercise for one hour a day at least 5 days a week. The exercise in 2 of 3 of these people was just walking. It wasn’t strenuous, it wasn’t expensive. The women both liked walking with friends or their spouse. Tom followed a more common male path of more strenuous work on his treadmill, elliptical, and biking at the fitness club. But they all did it religiously and missed rare sessions.

4) They refrained from any and all alcoholic beverages. Yes, there are some advantages to 1-2 glasses of wine per day, but it stalls weight loss efforts.

5) They didn’t allow themselves any major indiscretions. There were no binges, major pig-outs at weddings, barbecues, or all-you-can-eat buffets. They did allow themselves an occasional “treat” but did so in small portions.

That’s it. But for most people, that’s simply too much. Adhering to an effort to lose dramatic weight requires day-after-day consistency. Nobody can lose the equivalent of 70,000 calories (20 lbs.) just by skipping a meal, a 20-minute walk, skipping the mashed potatoes at dinner.

It can be done. You’ve just got to be consistent about it.

How can I get my lipoproteins tested?

This question came up on our recent online chat session and comes up frequently in phone calls and e-mails.

If lipoprotein testing is the best way to uncover hidden causes of coronary heart disease, but your doctor is unable, unknowledgeable, or unwilling to help you, then what can you do?

There are several options:

1) Get the names of physicians who will obtain and interpret the test for you. Go to the websites for the three labs that actually perform the lipoprotein tests: www.liposcience.com (NMR); www.berkeleyheartlab.com (electropheresis or GGE); www.atherotech.com (VAP or centrifugation). None of them will provide you with the names of actual physicians. They will provide you with the name of a local representative who will know who the doctors in your area who are well-acquainted with their technology. I prefer this route to just having a representative identify a laboratory in your area where the blood sample can be drawn, because you will still need a physician to interpret the results¾this is crucial. The test is of no use to you unless someone interprets it intelligently and understands the range of treatment possibilities available. Don’t be persuaded by your doctor if he/she agrees to have the blood drawn but has never seen the test before. This will be a waste of your time. That’s like hoping the kid next door can fix your car just because he says he fixed his Mom’s car once. Interpretation of lipoproteins takes time, education, and experience.
2) Seek out a lipidologist. Lipidologists are the new breed of physician who has sought out additional training and certification in lipid and lipoprotein disorders. Sometimes they’re listed in the yellow pages, or you can search online in your area.
3) Contact us. I frankly don’t like doing this because I feel that I can only provide limited information through this method. I provide a written discussion of the implications and choices for treatment with the caveat to discuss them with your doctor, since I can’t provide medical advice without a formal medical relationship. We also charge $75 for the interpretation. But it’s a lot better than nothing.
4) Make do with basic testing. Basic lipids along with a lipoprotein(a), C-reactive protein, fibrinogen, and homocysteine would provide a reasonable facsimile of lipoprotein testing. You’ll still lack small LDL and postprandial (after-eating) information, but you can still do reasonably well if you try to achieve the Track Your Plaque targets of 60-60-60.

In 20 years, this will be a lot easier. But for now, you can still obtain reasonably good results choosing one of the above alternatives.

What do you think about those heart scans?

52-year old Jerry came in for a stress test. He displayed the usual apprehension: fidgeting while he sat on the bed, examining his surroundings, asking lots of questions.

“Your doctor asked you have have a stress test?” I asked.

“All the males in my family have had heart attacks by age 56, so my doctor suggested I have a stress test,” Jerry explained.

Jerry went on to tell me that he had exercised vigorously this morning for 45 minutes without symptoms. He had, in fact, gone surfing just several weeks earlier and described how aerobically challenging it was keeping up with the 20 year olds. “But I did it!” he proudly declared.

As he neared the end of his brisk walk on the treadmill, Jerry asked, “What do you think about those heart scans?”

Jerry had asked his primary care physician the same question. His doctor had apparently told him that they were just a gimmick. “We’ll get you a real test.”

Of course, Jerry’s stress test proved entirely normal. The likelihood of an abnormal stress test with his history of vigorous exercise was <2%. I explained to Jerry that not getting heart scan would be a mistake. In fact, a heart scan was the only easily obtainable test that would uncover hidden heart disease. In truth, the stress test was a waste of time—and an unneeded exposure to radiation.

If Jerry’s heart scan score turned out to be zero, great! He was probably spared the genes from the other males in his family, and his risk of heart attack in the next decade was nearly zero.

If his heart scan turned out be 1000, then an urgent scramble to uncover the causes and correct them to create a truly effective prevention program would be crucial for his long term health. Or, perhaps his score lies somewhere in between, but Jerry would then know how far along he stood on his way to heart disease.

Don’t be a victim of the ignorance of your doctor. Despite all the attention heart scans have received, the majority of doctors remain miserably, inexcusably in the dark. I say inexcusable because CT heart scans can uncover the number one killer of Americans, the number one cause of all deaths in any primary care physician’s practices, and it’s laughably easy. How can a physician not advise patients on the value of heart scans?

If given a choice and you’re without symptoms, a heart scan is far and away the superior test.