CIS: Carbohydrate intolerance syndrome

28. January 2009 William Davis (28)
Carbohydrate intolerance comes in many shades and colors, shapes and sizes.

I call all of its varieties the Carbohydrate Intolerance Syndrome, or CIS. (Not to be confused with CSI, or Crime Scene Investigation . . . though, come to think of it, perhaps there are some interesting parallels!)

At its extreme, it is called type II diabetes, in which any carbohydrate generates an extravant increase in blood sugar, followed by the domino effect of increased triglycerides, reduction in HDL, creation of small LDL, heightened inflammation, etc. and eventually to kidney disease, coronary atherosclerosis, neuropathies, etc.

An intermediate form of carbohydrate intolerance is called metabolic syndrome, or pre-diabetes. These people, for the most part, look and act like diabetics, though their reaction to carbohydrate intake is not as bad. Blood sugar, for instance, might be 125 mg/dl fasting, 160 mg/dl after eating. The semi-arbitrary definition of metabolic syndrome includes at least three of the following: HDL <40 mg/dl in men, <50 mg/dl in women; triglycerides 150 mg/dl or greater; BP 135/80 or greater; waist circumference >40 inches in men, >35 inches in women; fasting glucose >100 mg/dl.

This is where the conventional definitions stop: Either you are diabetic or have metabolic syndrome, or you have nothing at all.

Unfortunately, this means that the millions of people with patterns not severe enough to match the standard definition of metabolic syndrome are often neglected.

How about Kevin?

Kevin, a 56 year old financial planner, is 5 ft 7 inches, 180 lbs (BMI 28.2). His basic measures:

HDL 36 mg/dl
Triglycerides 333 mg/dl
BP 132/78
Waist circumference 34 inches
Blood sugar 98 mg/dl

Kevin meets the criteria for metabolic syndrome on only two of the five criteria and therefore does not "qualify" for the diagnosis.

Kevin's basic lipids showed LDL 170 mg/dl, HDL 36 mg/dl, triglycerides 333 mg/dl.

But take a look at his underlying lipoprotein patterns (NMR):

LDL particle number 2231 nmol/L (equivalent to a "true" LDL of 223 mg/dl)
Small LDL 1811 nmol/l
Large HDL 0.0 mg/dl


In other words, small LDL constitutes 81% of all LDL particles (1811/2231), a severe pattern. Large HDL is the healthy, protective fraction and Kevin has none. These are high-risk patterns for heart disease. These, too, are patterns of carbohydrate intolerance.

Foods that trigger small LDL and reduction in healthy, large HDL include sugars, wheat, and cornstarch. Kevin is carbohydrate-intolerant, although he lacks the (fasting) blood sugar aspect of carbohydrate intolerance. But he shows all the underlying lipoprotein and other metabolic phenomena associated with carbohydrate intolerance.

We could also cast all three conditions under the umbrella of "insulin resistance." But I prefer Carbohydrate Intolerance Syndrome, or CIS, since it immediately suggests the basic underlying cause: eating carbohydrates, especially those that trigger rapid and substantial surges in blood sugar.

CIS is the Disease of the Century, judging by the figures (both numbers and humans) we are seeing. It will dominate healthcare in its various forms for many years to come.

The first treatment for the Carbohydrate Intolerance Syndrome? Some would say the TZD class of drugs like Avandia. Others would say a DASH or TLC (American Heart Association) diet. How about liposuction, twice-daily Byetta injections, or even the emerging class of drugs to manipulate leptin and adiponectin? How do "heart healthy" foods like Cheerios and Cocoa Puffs fit into this? (Don't believe me? The American Heart Association says they're heart healthy!)

The first treatment for the Carbohydrate Intolerance Syndrome is elimination of carbohydrates, except those that come from raw nuts and seeds, vegetables, occasional real fruit (not those green fake grapes), wine, and dark chocolates.
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Comments (28) -

  • Sarah

    1/28/2009 2:45:00 PM |

    What's a "fake grape"?

  • Anonymous

    1/28/2009 4:19:00 PM |

    Do you think instant oats, or rolled oats, are ok?

    How about grits?  

    A Southerner trying to find something to replace cheerios or bagel for breakfast!  Already gave up eggs and bacon!

  • Anonymous

    1/28/2009 6:19:00 PM |

    "green fake grapes"
    - can you expand on this or provide a link to another blog entry that explains what is wrong with these? Thanks.

  • Diana Hsieh

    1/29/2009 1:09:00 AM |

    Anonymous -- Why give up eggs and bacon?  Reducing carbs requires increasing fat intake -- and contrary to the conventional wisdom, that's a good thing for your health.  (See Gary Taubes' _Good Calories, Bad Calories_.)

  • Anonymous

    1/29/2009 1:43:00 AM |

    Green grapes:  negligible amounts of reversatol.

    AJL

  • Anonymous

    1/29/2009 2:30:00 AM |

    Yes, I'd like to know if carbs like whole, cooked oat groats and/or wild rice are okay on TYP?  These are the only grains my cardiologist allows on his program.

    Also, what about oat bran, both cooked and uncooked?

    And lastly, ground flax seed?

    madcook

  • Anne

    1/29/2009 3:06:00 AM |

    Anonymous ~ bring back the eggs. add some veges and cheese and that makes a great breakfast. When I eat bacon I buy the stuff without the nitrites. My breakfast often looks like my dinner - lots of low carb veges and protein.

    I am a Southerner and grits are too high carb for me - shoots my blood sugar up to 200. Yup, I have CIS or maybe it is T2DM. Whatever I have, keeping my carbs low seems to be working well.

  • Anonymous

    1/29/2009 4:05:00 AM |

    what's a fake grape?

  • Anna

    1/29/2009 7:59:00 AM |

    Salmon is great for breakfast, either leftover from dinner or cured salmon (gravlax).  So is a salami and cheese plate now and then, for variety.  Breakfast doesn't have to be sweet or  grainy, if one can get out of that mindset.  

    Avocado omelet, sausage (make 2-3 days worth at one time and reheat), baked custard, smoothies.  There are all sorts of great non-grain breakfasts.

  • Grapes of wrath

    1/29/2009 12:22:00 PM |

    Can't say I have heard of fake grapes, well maybe the plastic ones.

  • keith

    1/29/2009 1:17:00 PM |

    fake grapes are seedless green grapes that are effectively candy. fruit with seeds that are close to the way they occurred in nature before we mass produced them are healthier.

  • Dr. William Davis

    1/29/2009 2:19:00 PM |

    Madcook--

    All are fine, with little rise in blood sugar except for the oat products, which can raise blood sugar in very carb-sensitive people.

    Ground flaxseed is the very best, with pure protein, oils (including linolenic acid), and fiber but with no digestible starches.

  • Anonymous

    1/29/2009 3:37:00 PM |

    This blog is great, that's why I added it to my top ten health blogs. www.mydailywellnesstip.com

    Jean-Luc Boissonneault

  • Frederick

    1/29/2009 7:01:00 PM |

    Dr. Davis,

    I recently received some curious results on my blood panels and am curious for your feedback. I am sorry to trouble you with my personal story but am not sure where else to go for info. I appreciate any help you can provide, in addition to what you have already done with this blog, which is a terrific resource.

    In May 2007 my blood panel looked like this:

    Total cholesterol 155
    Trigylcerides 65
    HDL 50
    LDL (calc) 92

    In Jan 2009 I received the following:

    Total cholesterol 311!
    Trigylcerides 43
    HDL 88
    LDL (calc) 214!

    I am currently 41, athletic, do high intensity short duration exercise 3-4 times/wk, low body fat, fairly good health. I changed my diet in Jan 2008 from a standard "healthy" diet to paleo style after reading Cordain's book. I followed Cordain's recommendations fairly closely for about six months, eating lots of fruits and veggies, lean meat (trimming the fat), very few starches, and nuts seeds avocados, olive oil, etc. In summer I began reading some blogs and books which recommended a diet higher in sat fats, lower in protein and lower in PUFAs, so I made some changes by severely limiting PUFAs (no more nuts, less fatty chicken and pork) and eating fattier red meat, coconut oil. I also cut down on veggies and fruits and added starches and white rice.

    While I would consider myself a little skeptical about the meaning of cholesterol tests, I am by no means an expert and was amazed by the increase in cholesterol and am very curious what this means and why. I understand that some of the numbers here (e.g. total cholesterol) don't mean much, that some of the numbers (e.g. hdl/tris ratio) are good, that LDL calc is often inaccurate, and that based on my low tris, my LDL is likely to be large and fluffy instead of small and dense. But I am still amazed by the rise and curious what it means. Should I be concerned? Why did this happen so fast? Thanks again for any guidance you can provide.

  • Dr. William Davis

    1/29/2009 10:33:00 PM |

    Frederick--

    While I don't make a habit out of responding to personal questions (because they would overwhelm time demands), your changes are quite profound.

    However, there are a number of underlying processes that could account for such a change. One solution would be to obtain lipoprotein analysis to see what the true, underlying patterns are, e.g., what is measured LDL?

    Also, consider thyroid issues.

    Also consider consulting the Track Your Plaque program, in which these discussions are conducted in detail every day.

  • Anna

    1/29/2009 11:13:00 PM |

    Frederick,

    While my numbers are not exactly the same as yours (past and present), they show a similar trend since I have adopted a more paleo-oriented diet, starting about 5 years ago.  The main difference is that I am female, 47 yo (not menopausal yet, and I wouldn't call myself athletic.  I really haven't been worried about the lab numbers, though they raise my endocrinologists eyebrows.  I had my first coronary calcium scan in Dec '08 and my score was 0, no evidence of coronary artery plaque.

    Have you had a coronary calcium scan yet?  That should tell you if your coronary arteries are building plaque or not.  And of course, the detailed analysis of your lipoproteins needs to be done, too, as Dr.Davis mentioned.  

    Keep in mind, the vast majority of the studies and references for  "good" or "bad" lab results in "Westernized" people come from people who *don't* eat paleo.  So there really isn't much of a comparison data base for those Westerners who eat paleo.  Peter at Hyperlipid blog has some discussion of this "lack of comparison data issue".

  • Anonymous

    1/30/2009 4:49:00 AM |

    Frederick,

    Please join us over on the Track Your Plaque membership website.  We routinely discuss issues such as yours, there is a wealth of information there beyond Dr. Davis' book, and we are a friendly, supportive, and well informed group.

    That aside, it appears you have gotten standard blood testing.  Please get an NMR lipoprofile, Berkeley or VAP test done... you will learn so much more.

    You were eating Paleo, but then you've cut out nuts and I see this little kicker: " I also cut down on veggies and fruits and added starches and white rice."  Hummmm... that is definitely not Paleo anymore, and if you are indeed carb sensitive, those additions could completely tip the cart and put you where you appear to be now.

    And I see that Dr. Davis has mentioned thyroid issues... get your doctor to test for those.  You are now "of an age" where these issues begin to express themselves.

    If you have not had one, go get a heart scan.  You will then know where you stand with regard to plaque formation.  BTW, I am talking about a simple heart scan, not the whiz bang 64-slice thing with the big dose of radiation.  Knowledge is power in this regard.

    I have no affiliation with Dr. Davis nor Track Your Plaque, other than as a very satisfied member/subscriber for the past several years.  I would feel alone and bewildered by such issues, were it not for TYP, which is IMO the most cutting edge program available.

    Good luck to you in finding answers to your personal situation.

    madcook

  • Nameless

    1/30/2009 9:25:00 PM |

    Frederick--

    Your rise in LDL... could it simply because you increased saturated fat intake? Your HDL also increased, which would make sense too. And trigs went down.

    Whether or not this is a good thing, I'm not sure. But increased animal fats usually equals higher LDL, higher HDL, lowered trigs (assuming fats replace carb intake).

    Have you measured your C-reactive protein before and after this diet change? I'm curious if saturated fats cause more inflammation, or less.

  • Dr. B G

    1/31/2009 2:12:00 AM |

    Frederick, Diana Hsieh:

    I don't worry about your LDL -- again it is a faulty inaccurate measure as Dr. D talked about in the 'Tale of Two LDL's post.

    Your TGs are Excellent!!

    Your HDLS totally ROCK and are the envy of anyone who knows anything about heart disease (or cancer).

    If you NMR'd or VAP'd your particles -- you would find that they are ALL Large, nice fluffy PHAT buoyant particles (just like Jimmy Moore's who has a similar diet/lifestyle as you two -- no grains, low carb, mod prot, mod-high fat and exercise).

    Likewise, you'll likely find that your HDL2b which are the regressive particles and necessary for optimal longevity and health will be stunning and awesome.

    Keep up the strong work and let us know if you get a particle count and density evaluated (~$99).

    -G

  • Dr. B G

    1/31/2009 2:12:00 AM |

    Frederick, Diana Hsieh:

    I don't worry about your LDL -- again it is a faulty inaccurate measure as Dr. D talked about in the 'Tale of Two LDL's post.

    Your TGs are Excellent!!

    Your HDLS totally ROCK and are the envy of anyone who knows anything about heart disease (or cancer).

    If you NMR'd or VAP'd your particles -- you would find that they are ALL Large, nice fluffy PHAT buoyant particles (just like Jimmy Moore's who has a similar diet/lifestyle as you two -- no grains, low carb, mod prot, mod-high fat and exercise).

    Likewise, you'll likely find that your HDL2b which are the regressive particles and necessary for optimal longevity and health will be stunning and awesome.

    Keep up the strong work and let us know if you get a particle count and density evaluated (~$99).

    -G

  • Anonymous

    1/31/2009 9:05:00 PM |

    Frederick-

    I think your changes are a simple result of "added starches and white rice".
    As you can see from this post from Dr. Davis just days ago, lipid levels can change dramatically and quickly with the added starches.


    http://heartscanblog.blogspot.com/2009/01/making-sense-out-of-lipid-changes.html

  • Trinkwasser

    2/2/2009 6:57:00 PM |

    Here's a big amen! to this post. My FBG is usually under 90 and never over 100. My GTT came back at 193 so "not diabetic" (I've since managed "truly" diabetic numbers by eating on top of a liver dump, but they are unofficial, measured on my own meter.)

    BMI about 22 so not overweight. Fit and active.

    So the ADA calculator still tells me I am at "low risk of diabetes" and that's what doctors have told me all my life despite the most horrendous lipids, including gallstones in my twenties, rising BP, episodes going back 50 years of what I now know to be reactive hypoglycemia (they knock my A1c right down)including ferocious night sweats in childhood. And of course all the other symptoms of diabetes, nocturia, chronic skin infections etc. all blown off because I didn't show that magic FBG rise.

    Curiously all these "neurotic" "hypochondriac" "anxiety" "depression" "pretending to be ill for sympathy" "personality disorder" symptoms have normalised by doing one thing: eating the exact opposite of the "Heart Healthy" diet - so long as I keep carbs to about 60g with the odd excursion to 100g or so I produce better numbers than a lot of "normies".

    Genealogical research shows the family is riddled with "metabolic syndrome" in non-obese people along with other diabetics who were also skinny Type 2s. I don't know how many other families, let alone individuals, have these obvious but not diagnosed type patterns.

    Or how many of them could be so comparatively easily treated.

    Well OK I cheat a bit, an ARB and a statin helps with the BP and LDL but they might not have been necessary if the thing had been caught earlier, or its comparatively slow progression hadn't been speeded up courtesy of the dietician.

    Yes it doesn't take a CSI to diagnose CIS. Just someone who looks at the Big Picture.

    My worst carbohydrate is wheat, spikes my BG about as bad as sugar, I can manage small quantities in the evening though. Fruit is nearly as bad except for berries.

    I shudder at all that healthy muesli I used to shovel into my face for breakfast and swill down with orange juice. I shudder more when I see the dietician's smile of approval.

    I can handle small quantities of oatcakes at breakfast, I favour high protein moderate fat and especially fish and salad, with other meats as a change. I can do ryebread in small quantities by lunchtime. I'd eat eggs if I could stand the taste.

    Carb input goes up on a slope from 15g at breakfast to 30g and sometimes 50g by evening. Masses of veggies, fish, meat, nuts and cheese and the occasional 85% chocolate make up the rest of my diet (oh and the coffee, and red wine, so not entirely paleo).

    None of this came from Medical Professionals in real life, it all came from the interweb and was run past my BG meter. Maybe by the 22nd century it will be mainstream and the Heart Healthy High Carb Low Fat diet will be consigned to the history books as a failed experiment on an entire population.

  • Dr. William Davis

    2/2/2009 10:38:00 PM |

    Trinkwasser--

    Thanks for sharing your wonderfully insightful experience.

    Do I have your permission to feature your comment as the focus of a blog post?

  • Trinkwasser

    2/6/2009 9:07:00 PM |

    You're more than welcome! I like to get my story out as it is a direct opposite of the standard "you made yourself ill through sloth and gluttony" accusation. Big major thanks must go to my late Aunt who did a lot of the genealogical research which discovered the pattern (she was told at 80 she had the blood pressure of a 30 year old, I was the exact opposite!) and died at 88 of an aneurysm: this despite being slightly overweight. So the genes can be survivable so long as we are careful!

  • Small business web site design

    4/3/2009 12:29:00 PM |

    nice  collection

  • Timothy Murphy, MD

    4/18/2009 4:14:00 PM |

    The amazing story of the ascent of the Keys Hypothesis regarding the connection between dietary fat and heart disease is well documented in "Good Calories, Bad Calories", by Gary Taubes.

    As a pediatrician, I do not often counsel about heart disease. But I do deal with obesity in children, and as I am now in my 50's, I am caring more because of my own health.

    The bottom line is that virtually everything we learned about preventing heart disease in medical school is wrong or untested, and an alternative hypothesis has existed that has been largely untested - yet is simpler (and therefore better).

    The role of glucose and insulin in the evolution of obesity and the development of heart disease is finally becoming clear(er), and with the definition of the Metabolic Syndrome, is becoming more "main stream". But the primary drivers of policy (NIH/NHLBI, FDA and ASDA) will not change their recommendations regarding carbohydrate intake.

    It is time for individuals to take charge of their own diet, and the information I have found here is all to the good. I am glad I found this blog.

    TM, Pittsburgh

  • Kelvin

    9/4/2009 12:45:22 PM |

    I am a classic CSI class and after running 5km for 1 1/2 years my blood stayed CSI classic as well, I didn'y follow a good diet but kept my weight down due to excerise - so then it happened - ventricle fibrulation - down for 6 min not breathing while I was shocked and had CPR - had bypass surgery - 46 yrs - read my story google "A hug for his life savers". Following a low card diet now my email is kwillikj@gmail.com

  • buy jeans

    11/3/2010 2:41:40 PM |

    Foods that trigger small LDL and reduction in healthy, large HDL include sugars, wheat, and cornstarch. Kevin is carbohydrate-intolerant, although he lacks the (fasting) blood sugar aspect of carbohydrate intolerance. But he shows all the underlying lipoprotein and other metabolic phenomena associated with carbohydrate intolerance.

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Why healthy can make us fat

13. September 2007 William Davis (0)

Brian Wansink, author of Mindless Eating: Why we eat more than we think (see yesterday's Heart Scan Blog post), also has a Blog. Despite the bland advice offered on much of the Prevention Magazine and website, Wansink's Food Think Blog is a winner.

In a recent post, Wansink quotes a report from Science Daily that described a study he recently published in the Journal of Consumer Research. Wansink's study describes how just applying the label "healthy" to fast food choices increased consumers' calorie intake:


"When we see a fast-food restaurant like Subway advertising its low-calorie sandwiches, we think, 'It's OK: I can eat a sandwich there and then have a high-calorie dessert,' when, in fact, some Subway sandwiches contain more calories than a Big Mac."

In one study, Chandon and Wansink had consumers guess how many calories are in sandwiches from two restaurants. They estimated that sandwiches contain 35% fewer calories when they come from restaurants claiming to be healthy than when they are from restaurants not making this claim.

The result of this calorie underestimation? Consumers then chose beverages, side dishes, and desserts containing up to 131% more calories when the main course was positioned as "healthy" compared to when it was not--even though, in the study, the "healthy" main course already contained 50% more calories than the "unhealthy" one.

"These studies help explain why the success of fast-food restaurants serving lower-calorie foods has not led to the expected reduction in total calorie intake and in obesity rates," the authors write.

Interesting. In fact, I've had many patients say that they eat at Subway or similar chains and choose the "healthy" options. "That's got to be better than a cheeseburger and fries!" Perhaps not. (Of course, you can't leave Subway or other fast food operation feasting on wheat products.)

Wansink can be counted on for some truly fascinating observations into many behaviors that are subconscious but explain at least part of the reason why we're so fat. Though his Blog has a relatively short history of posts, there's lots of great commentary.

Pierre Chandon and Brian Wansink. "The Biasing Health Halos of Fast Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption Intentions" Journal of Consumer Research, October 2007.

Outsmarting the enemy

12. September 2007 William Davis (2)

"Everyone--every single one of us--eats how much we eat largely because of what's around us. We overeat not because of hunger but because of family and friends, packages and plates, names and numbers, labels and lights, colors and candles, shapes and smells, distractions and distances, cupboards and containers. This list is almost as endless as it's invisible.

Invisible?

Most of us are blissfully unaware of what influences how much we eat . . . We all think we're too smart to be tricked by packages, lighting, or plates. We might acknowledge that others could be tricked, but not us. That is what makes mindless eating so dangerous. We are almost never aware that it is happening to us."


So opens Brian Wansink's book, Mindless Eating: Why we eat more than we think.

Wansink studies consumer behavior at Cornell University. He's the guy who scrutinizes in excruciating detail why we eat what we do, what factors determine what we eat like food color and smell, the company we keep, product packaging. He works without food industry funding, though there are plenty of researchers who do this sort of research funded by the likes of Kraft, Nabisco, and Kellogg's.

His book is packed full of the conclusions he and his team have come to over the years studying our buying and eating habits. While this information could (and is) be easily used by the food industry to coerce us to eat more and more, understanding many of the concepts Wansink talks about can also open your eyes to their clever tactics.

He especially details how our internal satiety signals fail us when external cues are present that easily trip us up. He talks about one experiment he ran in which soup bowls were rigged with concealed rubber tubes in the bottom that continually replenished the soup as the person consumed it. Thus, with the bowl continually refilled, the eater had no idea how much he or she had consumed. When the quantity of soup eaten from the endless bowl was compared to people eating from standard bowls, there was as much as a three-fold increase in the quantity and calories eaten.

Just be aware that, while Wansink is an expert in consumer eating behavior, he is not necessarily an expert in nutrition. Just as a card shark can show you lots of clever tricks to hoodwink your opponent, he might not be the best person to teach you how to play bridge.

For a great hint at some of the interesting and all-too-human observations Wansink makes, the online Prevention Magazine posted a brief video:

http://link.brightcove.com/services/link/bcpid1155399889/bclid1171884988/bctid1113465050

We might not be able to stop Big Food from selling garbage foods, but we can at least be armed with insight into how we are subconsciously coerced into eating more.

Test Of Scanner Saves A Doctor's Life

11. September 2007 William Davis (5)

















Read the story online at http://www.courant.com/news/health/hc-luckydoc.artsep10,0,7572510.story?coll=hc_features_promo

I personally hate these stories, the ones that turn heart scans into drama by describing how someone had a heart scan, then turned out to have so much coronary plaque that they had to have bypass surgery.

But I point this one out because the story is related in an interesting way. It highlights the utter ignorance that operates in heart disease detection.

The story highlights how a 50-year-old, 5 ft 8, 150 lb slender, exercising neurologist underwent a CT coronary angiogram in a newly installed device in a Hartford, Connecticut hospital (not a heart scan) that detected entirely unsuspected severe and diffuse coronary disease. You know the rest: abnormal stress test, heart catheterization, bypass surgery of the hapless doctor-now-patient, followed by grateful patient saying things like "This machine saved my life."

It probably is true. You've seen these stories before. I've witnessed these sorts of headline-makers for the past decade. I remain surprised that it still happens.

The doctor is not some ignorant, uninformed man who can't even fill out his income tax forms. Yet how does a man like this walk around with life-threatening disease and not know it? Why does it still make headlines?

Anyway, despite all my jawing about heart scans and early heart disease detection, many physicians and the public remain in the stone age of heart disease. Even though this neurologist's story made headlines, the many other people who 1) identified their heart disease earlier with a simple heart scan, then 2) took action to put a stop to it, do not make headlines. But that's the way to go.

Why isn't the rest of the story being told? Why was this man's heart disease uncovered only in its late phases? Hartford, Connecticut is not some backwater. I've been there. It's a major city with large hospitals and a University Medical Center. But a professional with presumed knowledge of health and his doctor(s) allowed this to happen?

In other words, this is not a story of success, but of failure--failure to identify coronary disease years earlier when preventive action would have prevented bypass. But that's not such a compelling headline, is it?

As an aside, I'll bet you that this man has lipoprotein(a), a severe small LDL pattern, and severe deficiency of vitamin D. Correct these and it's unlikely he'll need bypass again. But that's kind of boring, isn't it?

The great food industry deception

8. September 2007 William Davis (1)
I'd forgotten what a powerful report Peter Jennings and ABC News produced about the enormous deception perpetrated by the food industry and its effects on health until Dr. Joe Mercola posted the YouTube clips from the report on Mercola.com.

(This is not meant to be an endorsement of everything Dr. Mercola has to say. He says lots of things; I agree with only a fraction of it. But this is a gem.)

Although made in 2004, the report remains every bit as relevant today as it was then. It concerns me deeply that, despite reports like this being broadcast to Americans, the obesity epidemic continues unabated. In fact, it's worse just in the short three years since then.

Be aware of what the food industry is up to. They intensively market high profit margin foods to us--and especially our children--to increase sales. As Jennings points out, the U.S. government (USDA) is, for a variety of reasons both good and bad, complicit with this massive deception. While many media reports continue to focus on lack of exercise as the root cause for the obesity epidemic, it is really the active and purposeful selling of processed junk foods to Americans that is principally to blame.

By the way, how many of these foods proudly boast the American Heart Association Check Mark of approval?



Part 1





Part 2




Part 3




Part 4




Part 5

Dr. Joseph Prendergast and l-arginine

7. September 2007 William Davis (21)
In response to a discussion started by Track Your Plaque Member, Rich, on the Member Forum, I tracked down Dr. Joseph Prendergast, who had posted a video on his unique experiences, both personal and professional, with l-arginine.

Dr. Prendergast describes some of this in a brief webcast. Here, I quote Rich:

“This 90-second video by a Palo Alto physician (internal/endocrine, diabetes specialist) will totally blow your mind.

http://enews.endocrinemetabolic.com/2007/08/16-12-years.html

You will see in the link below that he reversed his personal atherosclerotic disease, diagnosed in abdominal aorta at age 37—completely reversed. He's now much older."

http://www.endocrinemetabolic.com/about/press/larginine.pdf



I contacted Dr. Prendergast to find out more.

Dr. Joseph Predergast is founder of the Endocrine Metabolic Medical Center in Palo Alto, California, focused on providing care for people with diabetes. In addition to the website, he provides Blogs and newsletters, though most of his conversation is about diabetes issues. Dr. Predergast’s website is located at http://www.endocrinemetabolic.com.

I asked Dr. Prendergast several questions about his l-arginine experience. His brief answers are below.



1) What dose of l-arginine have you employed in your patients and why this dose?

The dose is 3 - 6 grams as suggested by the Stanford Cardiovascular Research Department Chairman John Cooke. http://med.stanford.edu/profiles/John_Cooke/

2) I gather that you have preference for specific preparations of l-arginine. Can you say why some preparations seem superior to others in your experience?

I started with pharmaceutical l-arginine from the pharmacy. I gradually began to add components that would augment the power of the l-arginine and have gone through 12–15 different products. I have completely reversed my own very severe atherosclerosis discovered at age 37 and there has been less than 0.05% cardiovascular disease in my endocrine practice in almost 17 years. Both my exams were evaluated with CT technology. I am now using ProArgi9 Plus that includes several anti-aging components and will likely never switch. http://www.synergyworldwide.com/synergycorp/home.aspx

3) Are you employing any other unique practices in your patients to reduce cardiovascular events?

Withdrawing as many prescription drugs as possible.




Interesting. Of course, I also advocate l-arginine as a facilitator of atherosclerotic plaque regression, though I am not as ebullient about its use as Dr. Prendergast.

Instead, I see l-arginine as a method that yields forced normalization of “endothelial dysfunction,” the abnormal constriction and other effects that develop when abnormal lipoproteins and unhealthy food by-products are present in the circulation. Endothelial dysfunction is an inevitable accompaniment of plaque.

However, unlike Dr. Predergast’s experience, despite our use of doses higher than he uses, I have never seen plaque regression just using l-arginine alone. Nonetheless, it’s good to hear that others are seeing at least some positive effects.

By the way, we have also had some positive posts on our Forum about the ProArgi9 product he uses.

Dr. Dwight Lundell on omega-3s and CLA

7. September 2007 William Davis (15)


An interview with Dr. Dwight Lundell, cardiac surgeon and author of the new book, "The Cure for Heart Disease."


Dr. Lundell comes to us with a unique pedigree. He is a cardiothoracic surgeon practicing in the Phoenix, Arizona, area. Despite having performed thousands of coronary bypass operations, including numerous "off-pump" procedures earning him a place in the Beating Heart Hall of Fame and a listing in Phoenix Magazine’s Top Doctors for 10 years, more recently Dr. Lundell has turned his attentions away from traditional surgical treatment and towards prevention of heart disease and.

In particular, Dr. Lundell is a vocal advocate for omega-3 fatty acids from fish oil and conjugated linoleic acid, or CLA.

When I heard about Dr. Lundell’s unique perspectives, I asked him if he’d like to tell us a little more about his ideas. Here follows a brief interview with Dr. Lundell.



You’re a vocal advocate of the role of omega-3 fatty acids from fish oil in heart disease prevention. Can you tell us how you use it?

In my book, I recommend 3 g of fish oil daily. This would normally yield about 1000 mg of EPA and DHA depending on the concentration of the supplement. This is approximately the dose that reduced sudden cardiac death by 50%, and all cause death, by 25% in patients with previous heart attack.

In patients with signs of chronic inflammation such as heart disease, obesity, arthritis, metabolic syndrome or depression or in those patients with elevation of CRP, I would recommend higher doses, 2000 to 3000 mg per day of EPA and DHA. The FDA has approved up to 3400 mg for treating patients with severely elevated triglycerides.

I personally take a 2000 mg EPA and DHA per day because I have calcium in my coronary arteries.




Of course, in the Track Your Plaque program we track coronary calcium scores. Do you track any measures of atherosclerosis in your patients to chart progression or regression?

Carotid ultrasound with measurement of IMT [intimal-medial thickness] has been shown to be a good surrogate marker for coronary disease, as has vascular reactivity in the arm. CT scanning with calcium scoring is a direct marker of coronary disease. CT does not differentiate between stable or unstable plaque but there is no good noninvasive way of doing this.

The dramatic value of CT scan calcium scoring is to demonstrate to people that they actually do have coronary disease and to motivate them to make the necessary lifestyle and nutritional changes to reduce it. CT scan with calcium scoring is a direct way to measure the progression or regression of coronary artery disease. If there is a choice between a direct measurement and indirect measurement, always choose the direct method.

Every patient treated with CLA in my clinic, experienced significant reductions in C-reactive protein. These patients were also on a weight-loss program, so I can't prove whether it was the CLA or the weight-loss that improved their inflammatory markers. In the animal model for arteriosclerosis, CLA has a dramatic effect of reducing and preventing plaque. This has not yet been proven in humans.

Normally, when people lose weight 20% or more of the loss is lean body mass (muscle) this lowers the metabolic rate and frustrates further weight-loss. My patient, from teenagers to retirees, lost no lean body mass and continued to have satisfactory weight-loss when CLA was used as part of the plan.



In reading your book, your use of conjugated linoleic acid (CLA) as a principal ingredient struck me. Can you elaborate on why you choose to have your patients take CLA?

My enthusiasm for CLA is based on:

1) Safety?this is of paramount importance. Animal toxicity studies have been done, as well as multiple parameters measured in human studies, both of these are well reviewed recently in the American Journal of Clinical Nutrition (2004:79(suppl)1132s). CLA, a naturally-occurring substance, is not toxic or harmful to animals or humans. The only negative report is by Riserus in Circulation (2002), where he found an elevated c- reactive protein; however, he used a preparation that is not commercially available and not found in nature as a single isomer.

2) Effectiveness?also critically important. A recent meta-analysis [a reanalysis of compiled data] in the American Journal of Clinical Nutrition (2007; 85:1203-1211) demonstrated the effectiveness of CLA in causing loss of body fat in humans. The study also reconfirmed the safety of CLA.

Since we now know that atherosclerosis is an inflammatory disorder, any strategy that reduces low-grade inflammation without significant side effects would seem to be beneficial in the treatment and prevention of atherosclerosis. CLA not only has antioxidant properties, but it modulates inflammatory cascade at multiple points. CLA reduces PGE2 (in much the same way as omega-3) CLA also has been shown to reduce IL-2, tumor necrosis factor-alpha and Cox–2. It reduces platelet deposition and macrophage accumulation in plaques. It also has some beneficial effect in the PPAR [peroxisome proliferator-activated receptors, important for lipid and inflammatory-mediator metabolism] area.

Part of the effect of CLA may be because it reduces fat mass and thus the amount of pro-inflammatory cytokines produced by fat cells.

I reiterate and fully admit that CLA has not been shown to have any effect on atherosclerosis in human beings. However, the results in the standard animal models for atherosclerosis (rabbits, hamsters,APO-E knockout mice) are very dramatic.

From all I know, it appears that the effective dose for weight loss and the animal studies in atherosclerosis would be equal to about 3 g of CLA per day. The anti-inflammatory properties of CLA seem to work better in the presence of adequate blood levels of omega-3.



I’m curious how and why a busy cardiothoracic surgeon would transform his practice so dramatically. Was there a specific event that triggered your change?

The transition from a very busy surgical practice to writing and speaking about the prevention of coronary disease has not been particularly easy, but it has been very interesting. I can't really point to any specific epiphany, it was a general feeling of frustration that we were not making any progress in curing heart disease, which is what I thought I was doing when I began my medical career.

Of course, I enjoyed the technical advances, the dramatic life-saving things that you do and I did on a daily basis. American medicine is spectacularly good at managing crises and spectacularly horrible at preventing those crises.

The lipid hypothesis is old and tired, even the most aggressive statin therapy reduces risk of heart attack by about 30% in a relatively small subset of people. It's interesting that we're now looking at statins as an anti-inflammatory agent.


Thanks, Dr. Lundell. We look forward to future conversations as your experience with CLA and heart disease prevention and reversal develops!


More about Dr. Lundell's book, The Cure for Heart Disease can be found at http://www.thecureforheartdisease.net.


Note: We are planning a full Special Report on CLA for the Track Your Plaque website in future.

High-tech heart attack proofing

5. September 2007 William Davis (7)

I was reminiscing the other day about what I was taught about heart disease in medical school some 20 years ago.

In the 1980s, the world was still (and remains) fascinated with this (then) novel "solution" to heart disease called coronary bypass surgery. As medical students, we all fought for a chance to watch a bypass operation being performed. And there was lots of opportunity. I was a medical student at St. Louis University School of Medicine, a center that boasted of a busy thoracic surgery service, performing up to 10 bypass operations every day.

Back then, coronary angioplasty was just a twinkle in Andreas Gruentzig's eye, still contemplating whether it was possible to put an inflatable device in the blockages of coronary arteries to re-establish blood flow. Risk detection for heart disease consisted of EKGs, screening for symptoms, detection of heart failure, and tests that are long forgotten in the dust bin of medical curiosities, tests like systolic-time intervals, phonocardiography (using amplified sound to detect abnormal heart sounds), and detailed physical examination. Treatment for heart attack involved nitroglycerin and extended bedrest. Bypass surgery would come after you recovered.

In other words, NONE of the tools we now use in the Track Your Plaque program for heart disease control and reversal were available just twenty years ago. There was no lipoprotein testing, no CT heart scans. Nobody recognized the power of omega-3 fatty acids (although epidemiologic observations were just beginning to suggest that eating fish might be the source of reduced risk for heart attack and cardiovascular death). Vitamin D? Why, that's in your milk so your babies don't get rickets.

So much of what we do today was not available then, nor were they even in the crystal ball of forward-looking people. I certainly had no idea whatsoever that I'd be talking and obsessing today about reversal of heart disease based on what I saw and learned back then.

Things have certainly come a long way and all for the better. The problem is that much of the world is stuck in 1985 and haven't yet heard that coronary disease is a manageable and reversible process. They've been sidetracked by the fiction propagated by the likes of Dr. Dean Ornish, the nonsense of low-fat diets aided and abetted by the food manufacturing industry and the USDA, the extravagant claims of some practitioners and the supplement industry. They haven't yet stumbled on the real-life experiences that are chronicled here in this Blog and the accompanying Track Your Plaque website.

Our program has been criticized for being too "high-tech," involving too many sophisticated measures like small LDL, lipoprotein(a) treatment, vitamin D blood levels. But when you see a woman reduce her heart scan score 63%, or a school principal's score plummet 51%, then that's reward in itself.

It's all about plaque

5. September 2007 William Davis (0)
Just to keep my finger on the pulse of what is being said in the world of heart disease by the media, I subscribe to many publications.

Conversations abound about cholesterol, low-fat diets, now low-carb diets, not smoking, inflammation, etc. No doubt, these all have some importance in the conversation.

But the great majority of discussions fail to identify the one truly crucial factor to identify and track: coronary atherosclerotic plaque.

Sugar for breakfast

2. September 2007 William Davis (17)
We were reviewing Stuart's diet because of his persistent small LDL, low HDL, modestly elevated triglycerides, and blood sugar of 107 mg/dl.

"I've changed my diet, doc. No kidding. We never fry our foods. No butter, no goodies. I don't know what else I can possibly do."

"Okay. Let's review your diet. What did you have for breakfast?"

"Orange juice, a big glass. Gotta get my potassium. Then cereal like Cheerios or Shredded Wheat, sometimes Kashi or Raisin Bran, always in skim milk. Gotta have my one slice of toast, no butter. I'll put some fruit preserves on it. You know, real fruit. Only whole wheat bread, never white. On Sundays, we always go out for pancakes, but now we order only whole wheat."

Many of us have gotten into a peculiar habit: Having what amounts to pure sugar for breakfast. Perhaps there's a little fiber thrown in with it, but many people indulge in breakfasts that are sugar and plenty of it. That's precisely what Stuart is doing: A breakfast that, while it doesn't contain a huge amount of sugar outside of the orange juice, is promptly converted to sugar. If we were to check his blood sugar just after his standard breakfast, it would rise substantially.

This pattern has become deeply ingrained into the American psyche. Some people will act like I've suggested we overthrow the government when I suggest that breakfast cereals need to be eliminated from their lives. We all share memories of Tony the Tiger, the leprechaun on Lucky Charms ("They're magically delicious!), reading the brightly colored boxes often including games and prizes. Breakfast cereals seem as American as apple pie. But the wheat and corn content ensures a big rise in blood sugar, the sort that create small LDL, low HDL, etc.--all the patterns Stuart is showing--and make us fat.

Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

Toast? Any diabetic who monitors their blood sugar after meals will tell you: Even one slice of bread, ANY bread, skyrockets blood sugar. Add the fruit preserves made with sugar syrup and it's doubly worse.

Pancakes? Even if made with plenty of fiber, blood sugars go absolutely berserk after a meal like this, especially if maple syrup is added.

In other words, the seemingly healthy breakfast Stuart eats guarantees that he fails to control all his patterns that contribute to his coronary plaque growth.

After I pointed out Stuart's dietary faux pas, he asked, "Then what the heck can I eat?"

"There's actually lots of good choices: Eggs (preferably free-range, if available, or the 'omega-3' enriched) or Egg Beaters; oat products, but true oat products like slow-cooked oatmeal, or the best of all, oat bran, used as a hot cereal; ground flaxseed as a hot cereal with added fruit, berries, nuts; a handful of raw almonds, walnuts, pecans; some cheese, preferably traditional fermented cheese and not processed; low-fat cottage cheese; low-fat yogurt that you flavor yourself with berries and nuts; raw seeds like sunflower and pumpkin.

"Try and save some of your dinner foods for breakfast. For instance, save some green peppers and onions from your salad and put it in your scrambled eggs along with some olive oil. Save some of the chicken and add it to your breakfast. Save some of the cooked vegetables and have them as they are. You'll be surprised how filling dinner foods can be when eaten for breakfast."

It's not that tough. But Stuart and many other people need to break the hold that the food manufacturers have created. If you're hoping to seize hold of your heart scan score, get rid of the sugar foods in your morning, even the ones cleverly disguised as healthy.

The Low-Carb Man

31. August 2007 William Davis (4)
If ever there was an enthusiastic disciple of deceased Dr. Robert Atkins of Atkins' Diet fame, it's Mr. Jimmy Moore.








Jimmy tells the story of how he was transformed by the Atkins' approach, losing 180 lbs in the course of one year. He continues to develop this conversation, in many ways elaborating on the conversation in more sophisticated ways than even Atkins did in his lifetime.

Though we've agreed to disagree on some points of nutrition, Jimmy and I had a recent discussion about heart disease, the mis-guided ways of conventional cardiac care,and the evils of processed carbohydrates. We do differ on the role of saturated fat in heart disease and health, but beyond that difference I was impressed (reading his Blog and listening to his many webcasts) with his level of understanding of the issues. Jimmy is not some over-enthusiastic dieter. He has a grasp of the issues that exceeds that of 99% of my colleagues.

If you are interested in reading our discussion or just perusing a really fun, informative Blog/website, go to LivinLaVidaLowCarb.com. The interview is posted at:

http://livinlavidalocarb.blogspot.com/2007/08/davis-wanna-cut-plaque-in-your-arteries.html


See Jimmy Moore's before and after pictures at http://livinlavidalocarb.blogspot.com/2005/07/my-before-pictures.html. He's quite an entertaining read.