Slash carbs . . . What happens?

Cut the carbohydrates in your diet and what sorts of results can you expect?

Carbohydrate reduction results in:

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

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

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

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

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

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


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

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

Comments (20) -

  • Emily

    3/26/2010 4:17:02 PM |

    you forgot one more benefit- effortless wieght loss! at least for many of us...

  • Tony

    3/26/2010 4:28:57 PM |

    I've eliminated almost all sugar, and all refined grains, but I still  eat brown rice, oatmeal, and whole spelt bread. On my recent VAP test, my triglycerides were 78, HDL was 63, and my LDL was Pattern A (large, buoyant LDL). Also, my Cardiac C Reactive Protein was .84. I'm concluding that some whole grains are appropriate for me, and I use the blood glucose monitor to monitor postprandial glucose.

    By the way, thank you for all the info.

  • JustJoeP

    3/26/2010 4:47:04 PM |

    Dr. Davis, following your advice as well as several other clarion voices in the nutritional wilderness, over the last 9 months I went from:
    HbA1C 6.6, Fasting glucose 125mg/dl, BP135/85, LDL nearly 200, HDL below 30, body weight 245 (6ft tall, 40 in waist) on a mainly carb diet, to:

    HbA1C 5.5, Fasting glucose 105mg/dl, BP115/70, LDL nearly in 1/2, HDL above 65, body weight 204 (still 6ft tall, but a 33 in waist) on a very low carb diet.

    I've got 4 friends - all males in their 40s - who have also moved their personal numbers in these directions by greatly reducing carbs.  I'm trying to get my severely type II diabetic father to follow the same regimen, but his Medicare provided dietitian is fighting me every step of the way, with a diet based upon bread!  The struggle continues.

    Thank you for being a consistent, well informed, voice of reason.  You've helped more people than you know.  (linked to you here).  Be well.

  • Isaac

    3/26/2010 5:18:11 PM |

    And I'm so unimpressed with the lack of any good hard endpoint data associated with the insulin sensitizers and such.  These dietary options really need to be explored further but, sadly, won't so long as physicians aren't reimbursed for it.

  • Daniel

    3/26/2010 5:45:40 PM |

    I agree regarding fructose.  

    In people with impaired glucose tolerance, slashing starch too may indeed be beneficial.  But is there any evidence that slashing starch benefits people who have a healthy liver and pancreas?  In such people, I suspect slashing starch is just treating numbers and has nothing to do with health.  Otherwise, how do you explain Kitava, Peru, and Asia?

  • jandro

    3/26/2010 8:25:13 PM |

    Sometimes I think that the results given with these studies are mostly due to the reduction of grains (lectins) and refined sugar and not carbohydrates themselves. I want to believe it is as simple as reducing carbohydrates but it doesn't explain how populations like Kuna and Kitava have good health markers even though they eat a high carb diet. Dr. WD, do you have any ideas related to this specific topic?

    ** I am not debating the results of low carb (I personally do paleo), and if your metabolism is already damaged low carb is the only way, but what if it is not? (you were never obese, diabetic, started healthy habits at a young age, etc).

  • Anonymous

    3/26/2010 10:28:29 PM |

    Would these benefits also accrue to someone who does not get postprandial spikes in blood glucose on a low-carb diet - like the regular commentator "DrStrange"?

  • Ned Kock

    3/26/2010 10:57:59 PM |

    Actually, in the study reviewed in the post below, a 2-week replacement of refined carbs and sugars with dietary fat (mostly saturated) and cholesterol, led to a significant increase in HDL (14 percent increase in HDL from baseline for men).

    http://healthcorrelator.blogspot.com/2010/02/want-to-improve-your-cholesterol.html

    That was two weeks only.

    In my own experience, higher consumption of saturated fat and dietary cholesterol has immediate effects on HDL, and those effects are especially strong with elimination of refined carbs and sugars.

  • gindie

    3/26/2010 10:59:00 PM |

    Dr. Davis,

    You mentioned Vitamin D.  I just got tested, level is 14.  However, I get episodes of calcium-based kidney stones (every 3-4 years or so).  How do you treat such patients?

  • Anonymous

    3/27/2010 12:15:47 AM |

    One thing I don't understand is if all these benefits are independent or if they are all linked to glucose level.
    If a particular carbohidrate causes little glucose spike will it still cause the other poblems?
    Or if carbohidrate intake is followed by intense physic actvity which seems to take BG down does it still causes all the other problems?

  • I Pull 400 Watts

    3/27/2010 12:32:49 AM |

    Just letting you know, very nice post!

  • Kim

    3/27/2010 2:53:35 AM |

    I totally agree.  I continued to struggle with my cholesterol the first year or so on a low carb diet.  After 3 years, my HDL has gone from 40 to 87 and my LDL has improved.  My blood pressure also improved over time.  My triglycerides were never high, but are usually in the 35 range now.  It's an awesome thing!

  • Stan (Heretic)

    3/27/2010 3:50:02 AM |

    Welcome to Low Carb Dr. Davis!  From now on, your life will never be the the same

    8-Smile

    In addition to what you have listed, which I can confirm in 100%, more beneficial effects will become apparent, such as:

    - self-healing of teeth with no need for dental intervention, and roughly twice as fast healing of broken bones.

    - healing of common cardiovascular diseases (arteriosclerosis, cardio myopathy and arrhythmia)

    - rapid self-healing of hepatic diseases (i.e post hep-C cirrhosis healed in 6 months),

    - improved kidney disease recovery (I heard of a patient  surviving on Optimal Diet without dialalysis with only 1/3 of 1 kidney left)

    - normalization of one's body weight (obese loose, underweight gain),

    - much stronger immune system (for instance, I never had a flu since yr 2000, before - twice a year)

    - stronger more benign reaction to stress, no more paralyzing panic, no more total body vascular contraction and probably related better resistance to cold temperature.  

    - no need to drink water frequently (fat metabolism releases water as an end product)

    - never feel hungry again, no need to snack, eating once or twice a day becomes the norm.   For me no breakfast, no supper, only lunch and dinner, typically.  

    - improved ability to hold breath longer when diving, generally we also naturally breath less frequently,

    - different (improved) mood, subtle changes in the way one thinks, solves problems and react to life events, as no doubts, you will find out...  8-Smile

    Regards,
    Stan (Heretic)

  • Lori Miller

    3/27/2010 1:59:21 PM |

    Daniel, I've tested my own blood glucose before and after meals and it's normal. However, I cut way back on all carbs a couple of months ago, and now eat around 47 grams of carbs per day. Results: I find that I don't need Sudafed or acid blockers at all now and I rarely take ibuprofin (an anti-inflammatory). The twinge in my shoulder and knee are gone. I've lost 10 pounds while working out *less.* I seldom get headaches, and when I do, they're mild. I also need a lot less sleep.

    Should anyone care for details, I've chronicled my experience in my blog.

  • Stan (Heretic)

    3/27/2010 3:26:56 PM |

    jandro - it is a very good question.  I wonder too but the studies I am reading (see for example Lancet. 1996 ) seem to indicate that carbohydrate reduction is beneficial in all cases, including healthy rural young populations.  

    I see it now in the same light as for example alcohol consumption: if you are healthy and young, a  harm may be minimal and some wine  (in moderation) may even provide you with some calories and micronutrients (i.e. resveratrol), but why bother consuming all that starchy and sugary plant food that we are not that well adapted for, that is useful only if we have nothing else to eat and that was probably meant for us only as a temporary food to get us over some rough periods of fauna decline.

      Since there is so little modern research done specifically on this subject we are still largely in the domain of hypotheses and theories. However not all that is speculative.  For example existing archaeological research does show us that paleolithic human diet consisted typically over 2/3 of meat!  We are talking about millions of years of human adaptation.

    ---

    Dr. Davis,  I forgot to add to my above list of benefits the following point:

    - reliable improvement (in almost every case) in treating the autoimmune diseases such as rheumatoid arthritis, asthma, eczema, psoriasis etc,

    - intestinal disease (Crohns, IBS , very high fat only!).  

    - Multiple sclerosis (not 100% especially if nerve damage is too advanced but improvement in most cases)

    There is a lot of patient cases (hundreds) of the above disease reported by Dr. Jan Kwasniewski, from his medical practice in the 1980-ties, described in his books, especially "Homo Optimus" and "Optimal Nutrition".  

    I think you will find those books extremely interesting, highly recommended.  

    Stan

  • Ellen

    3/27/2010 8:03:15 PM |

    Um Heretic.. I think Dr. Davis has been low carb for quite a while now. No need to welcome him to something he's already quite familiar with Smile

  • jandro

    3/27/2010 10:55:06 PM |

    Stan, thanks for your response:

    I read the abstract of the study you link and don't see how it is related to what I mentioned. It is comparing a vegetarian population with one that eats around a pound of fish a day. Seriously, is there a question there as to which is healthier? I also don't think they are healthier primarily because they consume less carbohydrates, but rather because they consume a pound of fish a day compared to no animal fat/flesh in the other group.

    If you read my original post again you will notice I am not saying a vegetarian diet (in fact, I eat over a pound of meat a day), I am just questioning whether the true problem is carbohydrates or if it is lectins, assuming you have a generous amount of animal fat and protein. I personally eat around 20% carbs, mostly coming from tubers and squashes as I find fruits too sweet (I agree that fructose should be reduced). Generally eat one piece of fruit a day.

    I also don't see any evidence to your claim that humans are not adapted to plant foods. We are omnivores, and that's how we have succeeded. We are adapted to a diet similar to what equatorial hunter gatherers have, since we evolved in a similar environment. People bring many archeological references of sites located outside of Africa not realizing that the environment outside of Africa is nearly as new to us as grains are. Most HGs living in Africa have plant food present on their diet. The information you tell yourself claims 2/3 of our diet was meat, what happened to the other 1/3?

  • Anonymous

    3/29/2010 8:33:04 AM |

    And what if someone goes really lowcarb (mostly meat) and his LDL rises up to 500? No info on the the LDL size. The remaining bloodwork results are  really good. Is this something to be worried about?

  • scall0way

    4/21/2010 7:21:12 PM |

    Hmm, well I eliminated wheat and all glutens from my diet in January 2009. I eliminated sugar at the same time. I also eliminated high Omega-6 vegetable oils. I basically eat low carb. I love to use coconut oil. Smile I've lost over 100 pounds.

    But my cholesterol just goes UP and UP! At least total and LDL - HDL remains in the 58-62 range and triglycerides remain in the 60-70 range. But Total cholesterol went from 229 6 months ago to 279 3 months ago, to 280 today, and LDL went from 165 6 months ago, to 190 3 months ago, to 206 today.

    And I can't understand why! Of course my doctor is rabid to put me on stations and crazy with me that I refuse, and looks at me cross-eyed when I request an NMR/VAP test for LDL particle size.

    But it still bothers me that it continues to go up and up and up, as I feel like I'm doing all I can to lower it. I was also diagnosed with Hashimoto's 6 months ago and put on 50 mcg of Levoxyl. Then three months ago it was upped to 75 mcg. Today it was upped to 88 mcg.

    Slashing carbs eliminating the bad stuff sure is not helping my total numbers, which means a huge argument with the doctor every visit, and I hate to argue. :-(

  • julianne

    9/7/2010 1:42:40 AM |

    I'm so glad I found this post!. I've had a group of clients take on paleo eating as a 6 week trial, doing so has naturally decreased their carbs. I had each person do before and after blood tests and I was concerned that 80% had a reduction in HDL. They also had reductions in Triglycerides and LDL and blood pressure and significant weight loss - but couldn't figure this one out. Thanks so much for keeping us informed of what goes on for your clients, so I know what is happening with mine is normal.

    Julianne
    By the way here are some of the results in people's own words
    http://paleozonenutrition.wordpress.com/2010/09/01/6-week-paleo-trial-results/

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Heart scan book



There are only two books on heart scans available.

One, of course, is Track Your Plaque.

The other is the basic book on heart scans, What Does My Heart Scan Show?

Lost in the navigation column to the left on this blog is the link to get the electronic version of the book. In case you didn't know, we make this available for free.

If you're interested, just go here. This book can provide many basic answers to the questions that often arise regarding heart scans, such as the expected rate of increase in score, how your score compares to other people, when should a stress test be considered. Many heart scan centers use this book for educational purposes to help patients understand the importance of their heart scan scores.

(The sign-up for the book requires that an e-mail address be entered.)

The hard copy of What Does My Heart Scan Show? is available from Amazon, also, for $12.99.

Lies, damned lies, and statistics

In the last Heart Scan Blog post, I discussed the question of whether statin drugs provide incremental benefit when excellent lipid values are already achieved without drugs.

But I admit that I was guilty of oversimplification.

One peculiar phenomenon is that, when plaque-causing small LDL particles are reduced or eliminated and leave relatively benign large LDL particles in their place, conventional calculated LDL overestimates true LDL.

In other words, eliminate wheat from your diet, lose 25 lbs. Small LDL is reduced as a result, leaving large LDL. Now the LDL cholesterol from your doctor's office overestimates the true value.

Anne raised this issue in her comment on the discussion:

I eliminated wheat - and all grains - from my diet nearly three years ago (I eat low carb Paleo). My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John's or Sam's:

LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl

My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.



However, if we were to measure LDL, not just calculate it from the miserably inaccurate Friedewald equation, we would likely discover that her true LDL is far lower, certainly <100 mg/dl. (My preferred method is the bull's eye accurate NMR LDL particle number; alternatives include apoprotein B, the main apoprotein on LDL.)

So Anne, don't despair. You are yet another victim of the misleading inaccuracy of standard LDL cholesterol determination, a number that I believe should no longer be used at all, but eliminated. Unfortunately, it would further confuse your poor primary care doctor or cardiologist, who--still believe in the sanctity of LDL cholesterol.

By the way, the so-called "ratios" (i.e., total cholesterol to HDL and the like) are absurd notions of risk. Take weak statistical predictors, manipulate them, and try to squeeze better predictive value out of them. This is no better than suggesting that, since you've installed new brakes on your car, you no longer are at risk for a car accident. It may reduce risk, but there are too many other variables that have nothing to do with your new brakes. Likewise cholesterol ratios.

Aspirin, Lipitor, and a low-fat diet

Despite all the hoopla heart disease receives in the media, I continue to marvel at how many people I meet who still think that aspirin, Lipitor, and a low-fat diet constitute an effective heart attack prevention program.

It doesn't. No more than washing your hands prevents all human infections. It helps, but it is a sad substitute for a real prevention program.

Of course, aspirin, Lipitor, and a low-fat diet is the same recipe followed by the unfortunate Tim Russert and his doctors. You know how that turned out. Mr. Russert's experience is far from unique.

What is so magical about aspirin, Lipitor and a low-fat diet?

There is a simple rationale behind this approach. Aspirin doesn't reduce atherosclerotic plaque growth, but it inhibits the propagation of a blood clot on top of a coronary plaque that has "ruptured," thereby reducing likelihood of heart attack (which occurs when the clot fills the artery). So aspirin only provides benefit if and when a plaque ruptures.

Lipitor and other statin drugs reduce LDL cholesterol, promote a modest relaxation of constricted plaque-filled arteries (normalization of endothelial dysfunction), and exerts other effects, such as inflammation suppression.

A low-fat diet is intended to reduce saturated fat that triggers LDL cholesterol formation and to encourage intake of whole grains that reduce cardiovascular events and LDL cholesterol.

If that is the extent of your heart disease prevention program, you will have a heart attack, bypass surgery, or stent--period. It may not be tomorrow or next Friday, or even next month. Aspirin, Lipitor, and a low-fat diet may delay your heart attack or procedure for a few years, but it will not stop it.

Some flaws in the aspirin, Lipitor, low-fat program:

--Aspirin can only exert so much blood clot-blocking effect. It can be overwhelmed by many other factors, such as increased blood viscosity, increased fibrinogen (a blood clotting protein that also triggers plaque), and plaque inflammation.
--Lipitor reduces LDL, but does not discriminate between the relatively harmless large LDL and the truly plaque-triggering small LDL--it reduces all LDL, but small LDL can still persist, even at extravagant levels since neither aspirin nor Lipitor specifically reduces small LDL, while a low-fat diet increases small LDL.
--Low-fat diet--A diet reduced in fat and loaded with plenty of "healthy whole grains" will trigger increased small LDL (an enormous effect), c-reactive protein, high blood sugar, resistance to insulin, high blood pressure, and an expanding abdomen ("wheat belly").


Aspirin, Lipitor and a low-fat diet do not address:

--Vitamin D deficiency
--Omega-3 fatty acid deficiency and the eicosanoid path to inflammation
--High triglycerides
--Small LDL particles
--Distortions of HDL "architecture"
--Lipoprotein(a)--the worst coronary risk factor nobody's heard of
--Thyroid status

In other words, the simple-minded, though hugely financially successful, conventional model of heart disease prevention is woefully inadequate.

Don't fall for it.

Statin drugs for everybody?

Who is better off?

John takes Crestor, 40 mg per day:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl




Or Sam:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl


who obtained these values through vitamin D normalization (to increase HDL); wheat elimination (to reduce triglycerides and LDL); and omega-3 fatty acids (to reduce triglycerides).


Believe the drug industry (motto: If some statin is good, more statin is better!), then John is clearly better off: He has obtained all the "benefits" of statin drugs. They refer to the "pleiotropic" effects of statin drugs, the presumed benefits that extend outside of cholesterol reduction. The most recent example are the JUPITER data that demonstrated 55% reduction in cardiovascular events in people with increased c-reactive protein (CRP). Media reports now unashamedly gush at the benefits of Crestor to reduce inflammation.

However, on Sam's program, elimination of wheat and vitamin D both exert anti-inflammatory effects on CRP, typically yielding drops of 70-90%--consistently, rapidly, and durably.

So which approach is really better?

In my experience, there is no comparison: Sam is far better off. While John will reduce his cardiovascular risk with a statin drug, he fails to obtain all the other benefits of Sam's broader, more natural program. John will not enjoy the same cancer protection, osteoporosis and arthritis protection, relief from depression and winter "blues," and increased mental and physical performance that Sam will.

If our goal is dramatic correction of cholesterol patterns and reduction of cardiovascular risk, for many, many people statin drugs are simply not necessary.

No BS weight loss

If there's something out there on the market for weight loss, we've tried it. By we, I mean myself along with many people and patients around me willing to try various new strategies.

Maybe you say: "Well that's not a clinical trial. How can we know that there aren't small effects?"

Who cares about small effects? If a weight loss strategy causes you to lose 1.2 lbs over 3 months--who cares? Sure, it may count towards a slight measure of health in a 230 lb 5 ft 3 inch woman. But it is insufficient to engage that person's interest and keep them on track. That little result, in fact, will discourage interest in weight loss and cause someone to return to previous behaviors.

What I'm talking about is BIG weight loss--20 lbs the first month, 40 lbs over 4 months, 50-60 lbs over 6 months.

Right now, there are only three things that I know of that yield such enormous effects:

1) Elimination of wheat, cornstarch, and sugars

2) Thyroid normalization (I don't mean following what the laboratory says is "normal")

3) Intermittent fasting


Combine all three in various ways and the results are accelerated even more.

Self-directed health is ALREADY here

It can't happen.

People are too stupid/ignorant/lazy or simply don't care.

It is irresponsible. People will misuse, abuse, misdiagnose, fail to recognize all manner of medical conditions.



It's all true. Most of the medical establishment believes it. And it is self-fulfulling: If you believe it, it will happen.

But it's not true for everybody. If readers of this blog, for instance, were to view the conversations we have in our Track Your Plaque Forum, you would immediately recognize that we have a following that is more sophisticated and knowledgeable about coronary heart disease than 90% of cardiologists. That is really something. Perhaps they can't put in a stent or defibrillator, but they understand an enormous amount about this disease we are all trying to control and reverse, sufficient to seize control over much of their own healthcare for this process and related conditons.

Anyway, self-directed health is already here. And it's happening on an incredible scale.

Witness:

--Nutritional supplements--Now a $21 billion (annual revenues) phenomenon, booming sales of nutritional supplements are a powerful testimonial to the enthuasiasm of the public for self-directed health treatments. Sure, there are plenty of junk supplements out there, but there are also many spectacularly effective products. Information, not marketing, will help tell the difference. Over the long-run, the truth will win out.

The 1994 Dietary Supplement Health and Education Act has allowed the definition of “nutritional supplement” to be stretched to the limit. "Nutritional supplements" includes obviously non-nutritional (though still potentially interesting) products like the hormones pregnenolone, dehydroepiandrosterone (DHEA), and melatonin to be sold on the same shelf as vitamin C. There are also amino acids, polysaccharides, minerals and trace minerals, herbal preparations, flavonoids, carotenoids, antioxidants, phytonutrients.

In fact, I believe that the nutritional supplement pipeline is likely to yield far more exciting and effective products than the drug research pipeline! And you will have access to all of it--without your doctor's involvement.

--Self-ordered laboratory testing--In every state except New York and California, an individual can obtain his or her own laboratory testing. New services are appearing to service this consumer segment. As more people become frustrated with the silly gatekeeping function of their primary care physician and as more people gain more control over some of their healthcare dollars through medical savings accounts, flex-spending, and high-deductible health insurance, more are shopping for cost-saving, self-ordered lab testing. Even at-home lab tests are becoming available, such as ZRT Lab tests we make available through Track Your Plaque.

(In California, a doctor's order, or an order from a health professional allowed to prescribe, is still required which, for most people, is just a formality. Just ask your doctor to sign the form with the tests you'd like. Only the most cretinous of physicians will refuse, in which case you should say goodbye. New York is the only state in the U.S. that still dunks women to see if they float, divines the entrails of sacrificial cows, and prohibits lab self-testing.)

--Self-ordered medical imaging--Heart scans, full body scans; ultrasound screening for abdominal aneurysms, carotid disease, osteoporosis such as that offered by LifeLine Screening (who does a great job). There's plenty of room here for entrepreneurial types to develop new services, though there will also be battles to fight with hospitals, radiologists, and others invested in the status quo. But it is happening and it will grow.

(By the way, since I've previously been accused of making bundles of money from medical imaging: I have never--NEVER--owned and do not currently own any medical imaging facility.)


So the question is not "will it happen?" It is already happening. The question is how fast will it grow to include a larger segment of the public? How much more of conventional healthcare can it include? How can we develop better unbiased information sources, untainted by marketing, that guide people through the maze of choices?

Fire your stockbroker, fire your doctor

Is it yet time to fire your doctor?

I advocate a model of self-directed health, a style of healthcare in which individuals have the right to direct his or her own healthcare with only the occasional assistance of a physician or healthcare provider.

Healthcare would not be the first industry that converted to such a self-directed model. Remember travel agents? Only 15 years ago, making travel plans meant calling your travel agent to book your arrangements. This was a flawed system, because they worked on commission, thereby impairing incentive to search for the best prices. You were, in effect, at their mercy.

The investment industry is another such example, though on a larger scale.

Up until the 1980s, individual investment was managed by a stockbroker or other money manager. Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, etc. Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. Individuals had no choice but to engage the services of a professional investor. This was also a flawed system. Like travel agents, stockbrokers worked on commission. We've all heard horror stories in which stockbrokers churned accounts, making thousands of dollars in commissions while their clients' portfolios shrunk.

That has all changed.

Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that didn’t even exist 20 years ago. Companies like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

Travel agents, stockbrokers . . . is healthcare next? Can we convert from the paternalistic, “I’m-the-doctor, you’re the patient” relationship to what in which you self-direct your own healthcare and turn to the healthcare system only in unique situations?

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will ripple more broadly through the fabric of American life. Health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need than the investment industry.

I predict that the emergence of health directed by the individual, just as the emergence of self-directed investment, will dominate in the coming years.

While I hope you've already fired your stockbroker, and I doubt that anyone on the internet still uses a travel agent, I wouldn't yet fire your doctor altogether. But I believe that we are approaching a time in which you should begin to take control over your own health and begin to reduce reliance on doctors, drugs, and hospitals.

Blast small LDL to oblivion

Here's a graphic demonstration of the power of wheat elimination to reduce small LDL particles, now the number one cause for heart disease in the U.S.

Lee had suffered a stroke due to an atherosclerotic plaque in a brain artery. She also had plenty of coronary plaque with a heart scan score of 322.

Lee began with an LDL particle number (the "gold standard" for measuring LDL, far superior to conventional calculated LDL) of 2234 nmol/L. This is exceptionally high, the equivalent of an LDL cholesterol of 223 mg/dl (drop the last digit). Of this 2234 nmol/L, 90% were abnormally small, with 1998 nmol/L of small LDL particles.

Lee eliminated wheat products from her diet, as well as cutting out sugars and cornstarch. Six months later, her results:

LDL particle number: 1082 nmol/L--a 52% reduction from the starting value and equivalent to an LDL of 108 mg/dl. Small LDL: zero--yes, zero.

In other words, 100% of Lee's LDL particles had shifted to the more benign large LDL simply with elimination of these foods---NO statin drug. (In addition to wheat elimination, she was also taking vitamin D and omega-3 fatty acids at our recommended doses.)

While not everybody responds quite so vigorously due to genetic variation, nor does everyone try as hard as Lee did to eliminate the foods that trigger small LDL, her case provides a great illustration of the power of this strategy.

Buy local, get a goiter

The notion of buying food locally--"buy local"--i.e., food produced in your area, state, or region, is catching on.

And for good reason: Not only do you support your local economy, buying locally saves energy, since food doesn't have to be transported from South America or other faraway locations.

But what about those of us in the Midwest, particularly around the Great Lakes basin, i.e., the region previously known as the "goiter belt"? In the early 20th century, up to a third of the residents of this region had enlarged thyroid glands, or goiters, due to iodine deficiency. Lack of iodine causes the thyroid to enlarge, or "hypertrophy," in an effort to more efficiently extract any available iodine in the blood.

Well, there's been a resurgence of iodine deficiency nationwide with 11.3% of the population severely deficient, representing a four-fold increase since the 1970s.

Why an iodine deficiency? Because more people are avoiding iodized salt, the principal source of iodine for Americans since the FDA introduced its voluntary program for iodization of table salt back in 1924. Approximately 90% of the patients I ask now declare that they use very little iodized table salt. While a few take multimineral or multivitamin supplements that contain iodine, the majority do not. The globalization of the food supply--eat global--however, has softened the blow, since we eat tomatoes from Mexico, blueberries from Argentina, lettuce from the Salinas Valley of California.

Now, we have the growing trend to eat local. In the Midwest, it means that the vegetables, fruits, and meats grown locally will also be iodine depleted, since the soil is also iodine-poor, being so far from the sea.

Ironically, two healthy trends--avoiding salt and eating local--will be accounting for a surge in unsightly neck bulges in the Midwest, as well as an increase in thyroid disease.

The lesson: Avoid salt, eat local, but mind your iodine.

Self-directed thyroid management

Is there an at-home test you can do to gauge thyroid status?

Yes. Measure your temperature.

Unlike a snake or alligator that relies on the sun or its surroundings to regulate body temperature, you and I can internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.

Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been subject to a good deal of unscientific discussions.

How should temperature be measured? The temperature you really desire is between 3 am and 6 am, while still asleep. However, this is difficult to do, since it would require your bed partner to surreptitiously insert a thermometer into some body orifice without disturbing you. A practical solution is to measure temperature first upon arising in the morning, before drinking water, coffee, making the bed, etc.--immediately.

While traditionalists (followers of Dr. Broda Barnes, who first suggested that temperature reflects thyroid function) still advocate axillary (armpit) temperatures, in 2009 it is clear that axillary temperatures are unreliable. Axillary temperatures are inconsistent, vary substantially with the clothing you wear, vary from right to left armpit, ambient temperature, sweat or lack of sweat, and other factors. It also can commonly be 2-3 degrees Fahrenheit below internal ("core") temperature and does not track with internal temperatures through the circadian rhythms of the day (high temperature early evening, lowest temperature 3-6 am).

Rectal, urine, esophageal, tympanic membrane (ear), and forehead are other means to measure body temperature, but are either inconvenient (rectal) or require correction factors to track internal temperature (e.g., forehead and ear). For these reasons, we use oral temperatures. Oral temperatures (on either side of the underside of the tongue) are convenient, track reasonably well with internal temperatures, and are familiar to most people.

Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that the often-suggested cutoff of 97.6 degrees Fahrenheit, or 36.4 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp <97.6 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.6 F.

But be careful: There are many factors that can influence oral temperature, including clothing, season, level of fitness, "morningness" (morning people) vs. "nightness" (night owls), relation to menstrual cycle, concurrent medical conditions.

Also, be sure that your thermometer can detect low temperatures. Just because it shows low temperatures of, say 94.0 degrees F, doesn't mean that it can really measure that low. If in doubt, dip your thermometer in cold water for one minute. If an improbable temperature is registered, say, 97.0 F, then you know that your device is incapable of detecting low temps.

A full in-depth Special Report on thermoregulation will be coming soon on the Track Your Plaque website.