Wheat brain

30. March 2011 William Davis (52)
Among the most common effects of wheat are those on the brain.

Consume wheat and susceptible individuals will experience a subtle euphoria. Others experience mental cloudiness or sleepiness. (This is what I personally get.)

It gets worse. Children with ADHD and autism have difficulty concentrating on a task and have behavioral outbursts after a cookie. Schizophrenics experience paranoid delusions, auditory hallucinations, and worsening of social detachment. People with bipolar disorder can have the manic phase triggered by a breadcrumb. All these effects are blocked by administering drugs that block the brain's opiate receptors. (This is why, by the way, a drug company is planning to release an oral agent, naltrexone, formerly administered to heroin addicts to help control addiction, for weight loss: block the euphoric effect, take away the temptation, lose weight.)

Here is Heart Scan Blog reader, Nicole's, mental fog story:

I have been grain-free (no gluten free grains either) for quite a long time (about a year and a half). Earlier this week, I decided to try white bread and pasta. The experiment only lasted two days. I had horrible terminal insomnia both nights, causing me on the second night to wake up at 2:30 am unable to get back to sleep at all. I felt drugged and in a mind-fog all the next day and even dozed off a few times! Luckily I had the day off work.

I had very bad forgetfulness also. I forgot that I left my bag and groceries at work, so I had to go back for them. Then I had to use my husband's keys to get in because I thought my keys were in my bag, but it turns out they were in my pocket. Then I got my bag, set the alarm, locked the door and then realized I forgot my groceries. So I had to re-open the door, unset the alarm, and go back for the groceries. Then I locked the door, forgetting to set the alarm, so I had to unlock it, open up and set the alarm. It was just ridiculous, I am NEVER like that!

In addition to the insomnia and forgetfulness, I also had horrible anxiety and paranoia, almost to the point of panic. Which I NEVER have, I am usually very easy-going, even-tempered, and worry-free. But this was horrible, I really was quite paranoid and anxious about everything. Weird!

And the worst, was that in just two days of eating wheat, I gained 4 lbs and 2% bodyfat!! It's two days wheat-free now, and it's finally going back down, but wow. Just two days of wheat-eating caused that much weight and fat gain!

Anyway, I've learned my lesson and will continue to avoid grains (including gluten free grains) entirely.

Eat more "healthy whole grains"? Modern dwarf Triticum aestivum, perverted even further by agricultural geneticists and modern agribusiness, subsidized by the U.S. government to permit $5 pizza, is better than any terrorist plot to discombobulate the health and performance of the American people.

The Westman Diet

27. March 2011 William Davis (71)
Dr. Eric Westman has been a vocal proponent of carbohydrate restriction to gain control over diabetes, as have Drs. Richard Bernstein, Mary Vernon, Richard Feinman, and Jeff Volek.

Several studies over the years have demonstrated that reductions in carbohydrate content of the diet yield reductions in weight and HbA1c (glycated hemoglobin, a reflection of average blood glucose over the preceding 60-90 days).

Among the more important recent clinical studies is a small experience from Duke University's Dr. Eric Westman. In this study, obese type 2 diabetics reduced carbohydrate intake to 20 grams per day or less: no wheat, oats, cornstarch, or sugars. Participants ate nuts, cheese, meats, eggs, and non-starchy vegetables.

After 6 months, average weight loss was 24.4 lbs, BMI was reduced from 37.8 to 34.4. At the end of the study, 95% of participants on this severe carbohydrate restriction reduced or eliminated their diabetes medications.

That was only after 6 months. Note that the ending BMI was still quite well into the obese range. Imagine what another 6-12 months would do, or achieving BMI somewhere closer to ideal.

Curiously, this idea of severe low-carbohydrate restriction to cure or minimize diabetes is not new. Sir William Osler, one of the founders of Johns Hopkins Hospital and author of the longstanding authoritative text, Principles and Practice of Medicine, advocated an diet identical to Dr. Westman's diet. So did Dr. Frederick Banting, discoverer of the pancreatic extract, insulin, to treat childhood diabetics. Before insulin, Banting and his colleagues at the University of Toronto used carbohydrate elimination (less than 10 g per day) to prolong the lives of children with diabetes.

This lesson was also learned many times during war time, when staples like bread were unavailable. The Siege of Paris in 1870 yielded cures for diabetes in many (or at least they stopped passing urine that tasted--yes, tasted--sweet and attracted flies), only to have it recur after the siege was over.

These are lessons we will have to relearn. As long as the American Diabetes Association and most physicians continue to advocate a diet of reduced fat, increased carbohydrate that includes plenty of "healthy whole grains," diabetics will continue to be diabetics, taking their insulin and multiple medications while developing neuropathy (nervous system degeneration), nephropathy (kidney disease and failure), atherosclerosis and heart attack, cataracts, and die 8 to 10 years earlier than non-diabetics.

All the while, we've had the combined wisdom from antiquity onwards: Carbohydrates cause diabetes; elimination of carbohydrates cures diabetes.

(This applies, of course, only to adult overweight type 2 diabetics, not type 1 or some of the other variants.)

Handy dandy carb index

25. March 2011 William Davis (21)
There are a number of ways to gauge your dietary carbohydrate exposure and its physiologic consequences.

One of my favorite ways is to do fingerstick blood sugars for a one-hour postprandial glucose. I like this because it provides real-time feedback on the glucose consequences of your last meal. This can pinpoint problem areas in your diet.

Another way is to measure small LDL particles. Because small LDL particles are created through a cascade that begins with carbohydrate consumption, measuring them provides an index of both carbohydrate exposure and sensitivity. Drawback: Getting access to the test.

For many people, the most practical and widely available gauge of carbohydrate intake and sensitivity is your hemoglobin A1c, or HbA1c.

HbA1c reflects the previous 60 to 90 days blood sugar fluctuations, since hemoglobin is irreversibly glycated by blood glucose. (Glycation is also the phenomenon responsible for formation of cataracts from glycation of lens proteins, kidney disease, arthritis from glycation of cartilage proteins, atherosclerosis from LDL glycation and components of the arterial wall, and many other conditions.)

HbA1c of a primitive hunter-gatherer foraging for leaves, roots, berries, and hunting for elk, ibex, wild boar, reptiles, and fish: 4.5% or less.

HbA1c of an average American: 5.2% (In the population I see, however, it is typically 5.6%, with many 6.0% and higher.)

HbA1c of diabetics: 6.5% or greater.

Don't be falsely reassured by not having a HbA1c that meets "official" criteria for diabetes. A HbA1c of 5.8%, for example, means that many of the complications suffered by diabetics--kidney disease, heightened risk for atherosclerosis, osteoarthritis, cataracts--are experienced at nearly the same rate as diabetics.

With our wheat-free, cornstarch-free, sugar-free diet, we have been aiming to reduce HbA1c to 4.8% or less, much as if you spent your days tracking wild boar.

Battery acid and oatmeal

23. March 2011 William Davis (38)
Ever notice the warnings on your car's battery? "Danger: Sulfuric acid. Protective eyewear advised. Serious injury possible."

Sulfuric acid is among the most powerful and potentially harmful acids known. Get even a dilute quantity in your eyes and you will suffer serious burns and possibly loss of eyesight. Ingest it and you can sustain fatal injury to the mouth and esophagus. Sulfuric acid's potent tendency to react with other compounds is one of the reasons that it is used in industrial processes like petroleum refining. Sulfuric acid is also a component of the harsh atmosphere of Venus.

Know what food is the most potent source of sulfuric acid in the body? Oats.

Yes: Oatmeal, oat bran, and foods made from oats (you know what breakfast cereal I'm talking about) are the most potent sources of sulfuric acid in the human diet.

Why is this important? In the transition made by humans from net-alkaline hunter-gatherer diet to net-acid modern overloaded-with-grains diet, oats tip the scales heavily towards a drop in pH, i.e., more acidic.

The more acidic your diet, the more likely it is you develop osteoporosis and other bone diseases, oxalate kidney stones, and possibly other diseases.

Here's one reference for this effect.

What'll it be: Olive oil or bread?

21. March 2011 William Davis (0)
We frequently discuss the advisability of consuming fats, carbohydrates, and various types within each category.

But what's the worst of all? Combining fats with carbohydrates.

Putting aside the wheat-is-worst form of carbohydrate issue and treating bread as a prototypical carbohydrate, let's play out a typical scenario, a make-believe feeding study in which a theoretical person is fed specific foods.

John is our test person, a 40-year old, 5 ft 10 inch, 210 lb, BMI 27.7 (roughly the mean for the U.S.) He starts with an average American diet of approximately 55% carbohydrates and 30% fat. Starting lipoproteins (NMR):

LDL particle number 1800 nmol/L
Small LDL 923 nmol/L


(The LDL particle number of 1800 nmol/L translates to measured LDL cholesterol of 180 mg/dl, i.e., drop last digit or divide by 10.)

Also, calculated LDL cholesterol is 167 mg/dl (yes, underestimating "true" measured LDL), HDL 42 mg/dl, triglycerides 170 mg/dl.

We feed him a diet increased in carbohydrates and reduced in fat, especially saturated fat, with more breakfast cereals, breads and other wheat products, pasta, fruit juices and fruit, and potatoes. After four weeks:

LDL particle number 2200 nmol/L
Small LDL 1378 nmol/L

Note that LDL particle number has increased by 400 nmol/L due entirely to the increase in small LDL particles triggered by carbohydrate consumption. Lipids show calculated LDL cholesterol 159 mg/dl--yes, a decrease, HDL 40 mg/dl, triglycerides 189 mg/dl. (At this point, if John's primary care doctor saw these numbers, he would congratulate John on reducing his LDL cholesterol and/or suggest a fibrate drug to reduce triglycerides.)

John takes a rest for four weeks during which his lipoproteins revert back to their starting values. We then repeat the process, this time replacing most carbohydrate calories with fats, weighed heavily in favor of saturated fats like fatty red meats, butter and other full-fat dairy products. After four weeks:

LDL particle number 2400 nmol/L


Let's

Chocolate peanut butter cup smoothie

19. March 2011 William Davis (18)
Here's a simple recipe for chocolate peanut butter cup smoothie.

The coconut milk, nut butter, and flaxseed make this smoothie exceptionally filling. If you are a fan of cocoa flavonoids for reducing blood pressure, then this provides a wallop. Approximately 10% of cocoa by weight consists of the various cocoa flavonoids, like procyanidins (polymers of catechin and epicatechin) and quercetin, the components like responsible for many of the health benefits of cocoa.


Ingredients:
1/2 cup coconut milk
1 cup unsweetened almond milk
2 tablespoons cocoa powder (without alkali)
2 tablespoons shredded coconut (unsweetened)
1 tablespoon ground flaxseed
1 teaspoon almond extract
1 1/2 tablespoons natural peanut, almond, or sunflower seed butter
Non-nutritive sweetener to taste (stevia, Truvia, sucralose, xylitol, erythritol)
4 ice cubes

Combine ingredients in blender. Blend and serve.

If you plan to set any of the smoothie aside, then leave out the flaxseed, as it absorbs water and will expand and solidify if left to stand.

For an easy variation, try adding vanilla extract or 1/4 cup of sugar-free (sucralose) vanilla or coconut syrup from Torani or DaVinci and leave out the added sweetener.

The compromise I draw here is the use of non-nutritive sweeteners. Beware that they can increase appetite, since they likely trigger insulin release. However, this smoothie is so filling that I don't believe you will experience this effect with this recipe.

Letter from the insurance company

18. March 2011 William Davis (24)
Claudia got this letter from her health insurance company:

Dear Ms. ------,

Based on a recent review of your cholesterol panel of January 12, 2011, we feel that you should strongly consider speaking to your doctor about cholesterol treatment.

Reducing cholesterol values to healthy levels has been shown to reduce heart attack risk . . .

Okay. So the health insurer wants Claudia to take a cholesterol drug in the hopes that it will reduce their exposure to the costs for her future heart catheterization, angioplasty and stent, or bypass surgery. This is understandable, given the extraordinary costs of such hospital services, typically running from $40,000 for a several hour-long outpatient catheterization procedure, to as much as $200,000 for a several day long stay for coronary bypass surgery.

So what's the problem?

Here are Claudia's most recent lipid values:

LDL cholesterol 196 mg/dl
HDL 88 mg/dl
Triglycerides 37 mg/dl
Total cholesterol 291 mg/dl

By the criteria followed by her health insurer, both total and LDL cholesterol are much too high. Note, of course, that LDL cholesterol was a calculated value, not measured.

Here are Claudia's lipoproteins, drawn simultaneously with her lipids:

LDL particle number 898 nmol/L
Small LDL particle number less than 90 nmol/L (Values less than 90 are not reported by Liposcience)

LDL particle number is, by far and away, the best measure of LDL particles, an actual count of particles, rather than a guesstimate of LDL particles gauged by measuring cholesterol in the low-density fraction of lipoproteins (i.e., LDL cholesterol). It is also measured and is highly reproducible.

To convert LDL particle number in nmol/L to an LDL cholesterol-like value in mg/dl, divide by ten (or just drop the last digit).

Claudia's measured LDL is therefore 89 mg/dl--54% lower than the crude calculated LDL suggests.

This is because virtually all of Claudia's LDL particles are large, with little or no small. This situation throws off the crude assumptions built into the LDL calculation, making it appear that she has very high LDL cholesterol.

Do you think that Big Pharma advertises this phenomenon?

Healthy smoothies

15. March 2011 William Davis (51)
I've now seen several people who have either caused themselves to be diabetic or to have other phenomena associated with excessive consumption of carbohydrates, all by innocently indulging in a carbohydrate-packed smoothie every morning.

Kay, for instance, has a smoothie of a half-pint blueberries, a banana, a scoop of whey, low-fat yogurt, a cup of milk every morning. The rest of her diet was fairly healthy: salads with oil-based dressing for lunch, salmon and asparagus for dinner, only an occasional carbohydrate indulgence outside of her morning smoothie ritual. Yet she had a HbA1c (a reflection of prior 60 to 90 days average blood sugar) at the near-diabetic range of 5.9%.

The mistake most people make when making smoothies is relying too heavily on carbohydrates like fruit. A smoothie like the one made by Kay can easily top 50, 60, or 70 grams carbohydrates per serving, more than sufficient to send blood sugars up to 150 mg/dl or more.

So what can you put in your smoothie and not send you over the edge to diabetes, small LDL, and all the other undesirable phenomena of excessive carbohydrates? Here's a list:

--coconut milk, unsweetened almond milk. Less desirable: milk, full-fat soymilk
--ground flaxseed
--oils: flaxseed oil, coconut oil (melted), extra-light olive oil, walnut oil
--dried coconut
--extracts: vanilla, almond, coconut, cherry, hazelnut
--spices: cinnamon, nutmeg, ginger
--herbs: mint leaves, cilantro
--cocoa powder (unsweetened)
--nut or seed butters (peanut butter, almond butter, sunflower seed butter)
--tofu
--exotic ingredients (ingredients you wouldn't expect in a smoothie): spinach, kale, cucumber

How do you sweeten a smoothie? This is what trips up most people. If you resort to fruit like bananas, pineapple, or apple, you will readily send your blood sugar skyward. Honey, agave syrup, and sugar, of course, all increase blood sugar and/or have the adverse effects of fructose. Be careful of yogurt, also, for similar reasons.

Therefore, to sweeten your smoothie, consider:

--Small servings of berries, e.g., 8-10 blueberries, 2 strawberries, a few wedges of apple, half a kiwi
--Non-nutritive sweeteners like stevia, Truvia, sucralose, xylitol, erythritol. Also, sugar-free (sucralose-based) syrups like those from DaVinci and Torani are useful. (Just be aware that non-nutritive sweeteners can increase appetite--use sparingly.)

Also, note that, if you have divorced yourself from wheat, cornstarch, and sugars, your desire for sweet should be much reduced. Foods other people find just right will taste sickeningly sweet to you. You might therefore find that foods like peanut butter or coconut milk have a mild natural sweetness; added sweetness is only minimally necessary.

Coming next: I'll share a smoothie recipe or two of mine. Anyone want to share a recipe?

Insulin secretagogue

14. March 2011 William Davis (34)
Dairy products have the peculiar property of triggering pancreatic release of insulin. The research group at Lund University in Sweden have contributed the most to documenting this phenomenon:




Mean (±SEM) incremental changes (?) in serum insulin in response to equal amounts of carbohydrate from a white-wheat-bread reference meal (x) and test meals of whey (?), milk (?), cheese (?), cod (?), gluten-low (?), and gluten-high (?) meals. From Nilsson 2004.

Note that it is the area under the curve (AUC), not the peak value, that assumes greatest importance.

Dairy products, especially milk, whey, and yogurt, are insulin secretagogues: they stimulate pancreatic release of insulin. The effect is likely due to amino acids and/or polypeptides in dairy products. (The effect is less prominent with cheese. Also see this study.)

By conventional wisdom, this may be a good thing, since the excess insulin will blunt the glucose rise after consumption. However, in my book, this is not such a good thing, since most of us have tired, beaten, overworked pancreatic beta cells from our decades of carbohydrate overconsumption. I fear that the effect of dairy products just take us a bit closer to beta cell failure: diabetes.

Good news: The effect is least with cheese.

Be gluten-free without "gluten-free"

9. March 2011 William Davis (23)
While I've discussed this before, it is such a confusing issue that I'd like to discuss it again.

I advocate wheat elimination because consumption of products made from modern dwarf Triticum aestivum:

--Triggers formation of extravagant quantities of small LDL and LDL particle number (or apoprotein B)
--Triggers inflammatory phenomena like c-reactive protein, increases leptin resistance, and reduction of the protective adipocytokine, adiponectin.
--Encourages accumulation of deep visceral fat ("wheat belly") that is inflammatory and causes resistance to insulin
--Increases blood sugar more than nearly all other foods--higher than a Milky Way bar, higher than a Snickers bar, higher than table sugar.
--Is being linked to a growing number of immune-mediated diseases, including celiac disease (quadrupled over past 50 years), type 1 diabetes in children, and cerebellar ataxia and peripheral neuropathies.

This last group of wheat-related phenomena are primarily due to gluten, the collection of 50+ proteins found in each wheat plant. For this reason, people diagnosed with celiac disease are advised to eliminate gluten from wheat and other sources (barley, rye, triticale, bulgur) and to eat gluten-free foods.

Gluten-free has therefore come to be viewed as wheat-free and problem-free. It ain't so.

Among the few foods that increase blood glucose higher than wheat: cornstarch, rice starch, potato starch, and tapioca starch--Yup: the ingredients commonly used to replace wheat in gluten-free foods. They are also flagrant triggers of the small LDL pattern, along with increased triglycerides, reduced HDL, increased visceral fat, increased blood pressure. In short, gluten-free foods lack the immune and brain effects of wheat gluten, but still make you fat, hypertensive, and diabetic.

I tell patients to view gluten-free foods like jelly beans: Gluten-free pancakes, muffins, breads, etc. are indulgences, not healthy replacements for wheat. It's okay to have a few jelly beans now and then. But they should not be part of a frequent or daily routine. Same with gluten-free foods.
Risks for coronary disease 2008

Risks for coronary disease 2008

31. December 2007 William Davis (27)
According to conventional thinking, there are identifiable risks for coronary disease and heart attack. These risk factors are:

* smoking
* high blood pressure
* high blood cholesterol and excessive saturated fat intake
* diabetes
* being overweight or obese
* physical inactivity

I'd agree with all the factors listed (though I would argue about the importance of high blood cholesterol and saturated fat; they are not as important as commonly made to be.)

Is the list complete?

From the unique perspectives gained in the Track Your Plaque program, I'd offer a significantly different list. Trying to stop or reduce coronary atherosclerotic plaque and heart scan scores makes you a whole lot smarter about what works and what doesn't work.

So, in addition to the risk factors listed above, I would add:

* Small LDL particles--Lots of small LDL particles is MORE important than high LDL.
* High blood pressure with exercise
* Excessive wheat intake and other processed carbohydrates--An issue of explosive importance today. Wheat creates large numbers of small LDL particles, among other adverse effects.
* Vitamin D deficiency--Among the most powerful risks I know of. It belongs at the top of the list.
* Vitamin K2 deficiency
* Low HDL cholesterol
* Blood sugar >100 mg/dl
* High triglycerides--While some argue about whether triglycerides are a risk that behaves independently of patterns like low HDL, they are neglecting the potent force of this risk. Sure, it occurs in tandem with low HDL (usually, though not always), but it is a factor that can leave you with risk even when HDL is raised to healthy levels.
* Lipoprotein(a)--It is eminently, positively crystal clear that lipoprotein(a) is a powerful risk for heart disease. The lack of a profitable treatment keeps it hidden in the shadows.
* Pessimism--Be happy, do better. Be a constantly angry, frustrated, complaining sourpuss and you are more likely to succumb to heart disease, cancer, or other undesirable fate.


These are the risk factors that we address through the Track Your Plaque program, a list that yields a far more powerful and comprehensive approach to control over coronary plaque/atherosclerosis, sufficient to achieve reversal in many (though not in all) instances.

I view the list of conventional risk factors as a "no brainer" list. Sure, smoking is a risk factor. But there are virtually no smokers in the Track Your Plaque program. If you smoke, you clearly don't care enough to engage in a high-intensity prevention program like this.

Saturated fat? Perhaps, but the battlefield of heart disease is riddled with the bodies of those who employed this as their sole strategy and failed catastrophically.

Diabetes, hypertension, and overweight all represent a continuum of risk; the solutions offered in the conventional scheme (i.e., low-fat diet, etc.) make these patterns worse, not better.

The conventional response to heart disease risk is trapped somewhere in 1973 and has not changed in over 30 years. Heart disease continues to be a growth industry for hospitals and the pharmaceutical and medical device industries. The "official" organizations continue to deliver an antiquated, outdated message.

If you want heart disease, follow the American Heart Association diet. If you want established heart disease to get worse, follow the American Heart Association diet. If you want diabetes or, if you already have diabetes or pre-diabetes, if you want it to worsen and develop organ damage (eyes, kidneys, nervous system, etc.), then follow the American Diabetes Association diet. USDA food pyramid? Loosen your belt!

The list of conventional risk factors for heart disease is woefully inadequate. If that is as far as your prevention program takes you, heart disease will not be controlled or prevented. At best, it might be slowed; at worst--and more likely--it might be accelerated.
Tags :

Comments (27) -

  • Ross

    1/1/2008 11:13:00 PM |

    From the two lists you've provided (and the critical caveat about dietary cholesterol and saturated fat), it seems so simple to reduce my risk of heart problems.  Lose weight on a carb-restricted diet (I've lost 25 pounds towards a 35 pound goal so far) and:

    1) blood pressure falls
    2) blood glucose, insulin, and diabetes risk falls
    3) triglycerides fall
    4) HDL rises
    5) LDL composition improves
    6) Lp(a) falls
    7) Athletics are easier and more enjoyable.
    8) I feel better about my appearance (anti-pessimism).

    How in the world can anyone still say that low-carb (high-fat) diets are bad for you or increase your risk of heart disease, heart attack, or stroke?

    And yet, this is what I keep hearing over and over and over again.  

    I'm learning to not talk about my diet (cooking eggs in butter, drinking whole milk, etc.) because almost everyone who hears me describe how I'm losing weight gets very defensive about the established advice to cut fat in order to lose weight.  All of my assurances that the science doesn't actually back up the US Government's (or the AHA, ADA, etc.) position fall on deaf ears.  The fact that I'm losing weight and getting regular blood tests to verify progress on cholesterol and some inflammatory markers seems to have no effect on anyone.

    Shutting up and just improving my own health seem to be the best way to keep the peace.  Sigh.

  • chickadeenorth

    1/2/2008 2:29:00 AM |

    Dr D what are your thoughts on the chol ratios ?It used to be thought that it was more significant.
    You're right on with those thoughts mentioned about AHA and ADA.

  • Dr. Davis

    1/2/2008 12:03:00 PM |

    Hi, Chickadee-
    I find that the standard numbers like total cholesterol and LDL very limited in predictive value. Ratios like total cholesterol to HDL are simply manipulations of these basic numbers. They improve predictive confidence for heart disease and heart events, but they are simply statistical manipulations. If you are using lipoproteins (e.g., NMR), you've already far surpassed the limited value of these ratios.

  • MAC

    1/2/2008 12:22:00 PM |

    Wonder if you have ever seen this study where rye turned on certain genes that prevent diabetes, control blood sugar, and wheat and oats and potato had the opposite effect and turned them off?
    http://www.ajcn.org/cgi/content/abstract/85/5/1417?maxtoshow=&HITS=80&hits=80&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=85&resourcetype=HWCIT

    American Journal of Clinical Nutrition, Vol. 85, No. 5, 1417-1427, May 2007

    I don't know if you can infer from this that oats and potatoes may be just as bad as wheat but it was interesting.

    Also, I know you have blogged about some HDL subfractions having issues as well. Is that a consideration as well? Article: Sizing up your HDL. http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=heart.disease&conitem=c31a99edbbbd201099edbbbd2010cfe793cd____

  • wccaguy

    1/2/2008 1:43:00 PM |

    Hi Dr. Davis,

    What a fantastic post to start off the New Year.

    I see that Vitamin K2 has now made the short list.  I'd noticed that you were talking about it more recently.

    Do you think this has the potential to become another "D3-like" sleeper for risk control?

    Thanks for all you do.

  • g

    1/2/2008 4:03:00 PM |

    Can't the rest of the world catch up to your progressive pace Dr. Davis?

    Obviously you enjoy figuring out and solving puzzles. Have you seen National Treasure yet?
    Dr. Davis, y-o-u are our National Treasure.

    As Heart Hawk says it... 'Jack, Smack and WHACK that Plaque!'

    I like that... kinda Tony Soprano-style *ha ha* Smile

    Happy New Year to you and your family and all the TYP-ers and Early Adopters!  
    g

  • Dr. Davis

    1/2/2008 6:01:00 PM |

    Hi, MAC--

    Interesting. I wonder if rye deserves a reconsideration. I have to admit that I've dismissed rye since it nearly always occurs as part of wheat-containing products. Perhaps this was throwing out the "baby with the bath water" sort of issue.

    HDL sub-fractions are indeed something we pay attention to, though the therapeutic efforts to correct them are virtually the same as those that correct small LDL.

  • Dr. Davis

    1/2/2008 6:04:00 PM |

    Wcaguy--

    The more I use vitamin K2, review what data exists, and observe its effects, the more I am convinced there is a real effect here.

    However, K2 does not appear to exert the broad array of benefits that D3 does, such as resolution of winter blues, metabolic syndrome, increased HDL, drops in blood sugar, decreased inflammatory responses, etc. K2's effects are more confined and narrow.

    I'm hoping this preliminary experience holds. I think it may have been responsible for heart scan score reduction in a couple of people, but it's often hard to know when people are doing multiple things all at once.

  • Anonymous

    1/2/2008 6:48:00 PM |

    I know you were reading "Good calories, bad calories" and wonder after reading that if you still feel saturated fat is bad?

  • Dr. Davis

    1/2/2008 6:59:00 PM |

    I loved Mr. Taubes' book.

    However, I am not prepared to endorse the full embrace of saturated fat. I am going to go back to the original literature before I (re-)make up my mind on this issue. I'm well aware of the arguments on both sides of the issue, but there's nothing like the real sources.

  • MAC

    1/3/2008 12:23:00 AM |

    How is it that the focus is still on total LDL and not the size of the LDL particles? The inverse relationship between HDL and triglycerides per Taubes book was presented in 1961.

    I was a test subject in the early 80s for Quaker Oats research to claim that eating oats would lower your cholesterol and even then my blood work came back with sub fractions. So over 25 years ago they were interested in these subfractions.

    Second question. If you have bad subfractions of HDL do you always have bad subfractions of VLDL and vice versa? As you have indicated the therapeutic efforts to correct  both are the same. Just curious.

  • Dr. Davis

    1/3/2008 12:34:00 AM |

    In my view, lipoprotein testing is an absolutely crucial part of determination of risk for heart disease. The reasons for its lack of use by practicing physicians are several, but principally 1) complexity, 2) no big bucks for promoting any specific treatment from a drug company.

    Lipoproteins do tend to travel in "packs". HDL subclasses do follow LDL subclasses which follow VLDL--they do tend to track together, though they can also diverge.

  • wccaguy

    1/3/2008 6:22:00 AM |

    Hi Dr. Davis,

    I don't take issue with you often, if ever, but I must object to your point that lipoprotein testing and analysis is "complex" and that's a reason why practicing physicians don't do it more often and/or effectively.

    You've made this point before and it struck me that this point was wrong and I figured out how to show that it was wrong but then forgot about it.  Your making the point again jogged my memory.

    I'll bet you that I could explain generally how lipoprotein subfraction distributions impact risk of CAD to my 10 year old daughter and a few of her friends (all 5th graders) and they could understand it and explain it's importance.  

    Admittedly, the explanations wouldn't be on a par with what one would expect from an adult with a scientific bent.  I'm hoping that you wouldn't insist that their explanations would need to be on a par with a practicing physician for me to demonstrate the point.

    The point is that it's NOT difficult to grasp the concept that lipoprotein subfraction distributions have an extremely significant impact on CAD risk.

    I must insist that you cease and desist making this point or you will force me to make a video that I post on the web showing some young teens explaining the importance of lipoprotein subfraction testing and analysis.

    Smile

  • Dr. Davis

    1/3/2008 1:31:00 PM |

    You know, it took over 20 years for the cholesterol concept to be incorporated into daily clinical practice of the average primary care physician, despite enormous marketing budgets from the drug companies.

    Lipoprotein testing, I agree, is really not that complicated. Just a few months of education and someone could diagnose and treat quite confidently. It is, however, a significant hurdle to a primary care physician dispensing flu vaccine, prescriptions for arthritis, doing pap smears, treating colitis, etc., just one more new thing to learn among many.

    I believe that the new generation of "lipidologists" will be a practical solution, since my colleagues, the cardiologists, are too focused on the next exciting procedure and the primary care physician is spread too thin. It's also the reason why I've gone straight to the person most interested in lipoproteins--you and other readers--to provide this information.

  • Anonymous

    1/3/2008 2:18:00 PM |

    Dr.D,
    In your list of risk factors, what do you mean by "high blood pressure with exercise"?  Do you mean that blood pressure is high only during exercise or that blood pressure is high even though you exercise?  
    Thanks for a great blog.
    Kate

  • wccaguy

    1/3/2008 2:56:00 PM |

    Dr. D.

    I think your last response really begins to get to the heart of the problem.

    Wikipedia says that "cardiology is the branch of medicine pertaining to the heart and the vascular system of the human body."

    I didn't read the whole Wikipedia entry on the subject, but I'm pretty certain that "next exciting procedure" is not descriptive of any limitation of the subject matter that it might be assumed cardiologists should be expected to know something about.

    Seems to me you're right in pointing out that Primary Care Physicians are spread thin and can't be faulted too much for not knowing detailed treatment nuances of every disease.  Even for them, however, one would think there would be greater interest in treatment of the single most significant cause of death in the US and most of the industrialized world.

    But it's also understandable that Primary Care Physicians have expected to be able to look to their cardiologist colleagues for leadership in promotion of the best treatment regimes for CAD.

    In my view, the problem is that cardiologists, in general, have utterly failed to provide the kind of knowledge leadership the current state of the science of lipoproteins ought to require.

    I'm not certain about what kind of doctors run the AHA and the ADA but if they are run primarily by cardiologists then I'd be hard pressed not to come to the conclusion that the general failure of this profession is even more massive for all the reasons you find fault with those organizations.

    I think THAT is what is so hard for all of us to fathom:  How could it be that such a large and seemingly smart and educated group of people fail to "get it", about diet at the ADA and the AHA, about lipoprotein education leadership for the colleagues, etc.

    Given the tragic consequences of that general failure, is it possible even to argue that there is another group of white collar professionals who have failed more than the cardiologists?

  • Dr. Davis

    1/3/2008 9:46:00 PM |

    Hi, Kate--

    I'm referring to blood pressure measured during a stress test. It's too difficult to assess your own BP while exercising. It has to be done by someone else in the midst of exercise, meaning a stress test. However, this effect can be an important "coronary risk."

  • Dr. Davis

    1/4/2008 1:26:00 AM |

    WC--

    It is dismaying, I agree.

    I do feel that my colleagues have been sidetracked by the promise of financial gain, probably no different than the mortgage lenders making unwise sub-prime loans, stockbrokers churning accounts for commissions, pharmaceutical manufacturers inflating drug prices in the U.S. while charging far less in more cost-conscious countries.  

    It's the profit motive, alive and well. It is through conversations like this that help all of us break out of the profit-driven bounds of the conventional approach.

  • moblogs

    1/5/2008 9:12:00 PM |

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2075568

    Someone posted an article with a similar finding in one of your earlier posts.
    If this is true, it's absolutely astounding that statins could simply be pricey analogues of cheap-ass (pardon my French) vitamin D.

    I also believe calcium channel blockers used for epilepsy, which clearly simply block calcium from entering the desired part of the body, could be replaced by D. Instead of blocking calcium, it's probably best to ensure proper metabolism.

  • Anonymous

    1/6/2008 10:39:00 PM |

    We know that wheat intake is not good for people with lots of small ldl, what about psyllium ? Is it good bad or indifferent as far as small ldl partcles ?

  • Dr. Davis

    1/6/2008 11:21:00 PM |

    Indifferent: psyllium reduces all LDL particles, regardless of size.

  • Anonymous

    1/8/2008 7:24:00 PM |

    Dr. you mention high blood pressure with excercise as a risk factor and then go on to say that this is something that would be found out during a stress test. My question is surely everybodies blood pressure raises during excercise what level would be "high" for someone during this stess test ?

  • Dr. Davis

    1/8/2008 9:47:00 PM |

    "High" depends on the level of exercise on a formal exercise "protocol". However, we use a crude cut-off of any BP >170/80 as clearly high.

  • Red Sphynx

    1/9/2008 9:08:00 PM |

    Dr Davis,

    Good list.  But I was wondering about some other factors that others list that don't appear either in your list or the conventional one:
    * Inflammation - as measured especially by C-reactive protein, or other measures.
    * Advance glycation endproducts (AGE) as measured by pentosidine, skin autofluorescence, etc.  Sure it correlates with blood sugar, but other factors (antioxidant status, fructose in the diet, dietary intakes of oxidized oils) throw the correlation off.

  • Dr. Davis

    1/10/2008 12:14:00 AM |

    Yes, good point.

    We do address inflammation, but only occasionally does it emerge as something that requires specific action, e.g., suppression of matrix metalloproteinase. Otherwise, all the steps we take to correct the other factors also correct inflammatory responses.

    AGE's are a fascinating issue, but not one we've specifically addressed for purposes of plaque reversal.

  • Anonymous

    4/26/2008 6:39:00 PM |

    Dr. Davis,

    Wanted to make a friendly suggestion.  I have been printing pages from your blog to hand out to others.  
    I was thinking if possible to do, it would be helpful if there was a "print button" for blog posts.  Also it would be good for the printed  page to have your web sight highlighted somewhere on the print.

  • Daniel

    2/16/2010 6:54:20 PM |

    Dr D,

    First time reader and I am excited to see a cardiologist that is actually standing up for correct Western Medicine. I have a question about this post ( a year late I know), but wanted to discuss. You state "* High blood pressure with exercise" as being another problem. In one of the comments you stated that this can be under 170/80. I have been treated with beta blockers and thiazidines to reduce my BP. It's been "working" for 10 years now, yet I was severly overweight. Recently I started to eat a grain free diet under the Primal Blueprint method and amped up real totally body fitness. I lost about 40 lbs since and feel amazing.

    Recently I went back to my cardiologist and began discussion about lowering my dosages since I get winded and shortness of breath during my workouts.

    Anyways, I asked the Dr. to lower the meds and then told me that I was going to die if I stopped taking them. Told me to eliminate caffeine, and sodium to lower it. Said I needed to eat more vegetables.

    Can you explain why BP would not lower with proper diet and 6 days of exercise a week for almost a year?

    Thanks!
    dan

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