Fat Head: Tom Naughton's manifesto for low-carb eating

12. March 2010 William Davis (16)
I just got back from Jimmy Moore's low-carb cruise to the Bahamas.

Among the many interesting people I met on the cruise was the creator of the documentary film, Fat Head, Tom Naughton.

Tom brings both creative insights into low-carbohydrate eating as well as humor. Low-carb eating can be a pretty contentious issue, but Tom made it fun. He will make you laugh about many of the odd notions we have about diet.

Among the best parts of Fat Head is Tom's portrayal of the effects of carbohydrates on insulin and fat metabolism:






Fat Head joins the ranks of films like Food, Inc, that make nutrition information entertaining. For anyone interested in a unvarnished look at diet, weight loss, along with a few laughs along the way, Tom Naughton's Fat Head is worth viewing.

Oatmeal: Good or bad?

11. March 2010 William Davis (67)

You've heard it before: oatmeal reduces cholesterol. Oatmeal producers have obtained permission from the FDA to use a cholesterol-reducing claim. The American Heart Association provides a (paid) endorsement of Quaker Oats.

I've lost count of the times I've asked someone whether they ate a healthy breakfast and the answer was "Sure. I had oatmeal."

Is this true? Is oatmeal heart healthy because it reduces LDL cholesterol?

I don't think so. Try this: Have a serving of slow-cooked (e.g., steel-cut, Irish, etc.) oatmeal. Most people will consume oatmeal with skim or 1% milk and some dried or fresh fruit. Wait an hour, then check your blood sugar.

If you are not diabetic and have a fasting blood sugar in the "normal" range (<100 mg/dl), you will typically have a 1-hour blood glucose of 150-180 mg/dl--very high. If you have mildly increased fasting blood sugars between 100 and 126 mg/dl, postprandial (after-eating) blood sugars will easily exceed 180 mg/dl. If you have diabetes, hold onto your hat because, even if you take medications, blood sugar one hour after oatmeal will usually be between 200 and 300 mg/dl.

This is because oatmeal is converted rapidly to sugar, and a lot of it. Even if you were to repeat the experiment with no dried or fresh fruit, you will still witness high blood sugars in these ranges. Do like some people and pile on the raisins, dried cranberries, or brown sugar, and you will see blood sugars go even higher.

Blood sugars this high, experienced repetitively, will damage the delicate insulin-producing beta cells of your pancreas (glucose toxicity). It also glycates proteins of the eyes and vascular walls. The blood glucose effects of oatmeal really don't differ much from a large Snickers bar or bowl of jelly beans.

If you are like most people, you too will show high blood sugars after oatmeal. It's easy to find out . . . check your postprandial blood sugar.

In past, I recommended oat products, specifically oat bran, to reduce LDL, especially small LDL. I've changed my mind: I now no longer recommend any oat product due to its blood sugar-increasing effects.

Better choices: eggs, ground flaxseed as a hot cereal, cheese (the one dairy product that does not excessively trigger insulin), raw nuts, salads, leftovers from last evening's dinner.

Mustard: Super health food?

6. March 2010 William Davis (32)
Could mustard--yes, the yellow condiment you smear on hot dogs--be a super heart healthy food in disguise?

Consider that mustard contains:

Vinegar

Turmeric

No appreciable sugar


The vinegar slows gastric emptying, resulting in slower absorption of any carbohydrates and a reduced glucose area-under-the-curve. Of the little fats contained (about 3 grams per 1/4 cup), most are desirable monounsaturates. Mustards are relatively rich in selenium, with 20 mcg per 1/4 cup, helpful for protection against cancer and thyroid disease, and magnesium, 31 mg per 1/4 cup.

Turmeric is added to most mustards. One of the constituents of turmeric, curcumin, the substance that confers the bright yellow color, has been a focus of interest for its anti-inflammatory effects. Curcumin has been documented to reduce activity of the inflammatory enzymes cyclooxygenase-2 (COX-2), lipoxygenase, and reduce activity of inflammatory signal molecules, tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1,2,6,8, and 12, and monocyte chemoattractant protein (MCP). Curcumin also has been shown to reduce LDL oxidation, a potentially important step in atherosclerotic plaque formation. Turmeric is used as a tea by Okinawans. (Hmmmm . . . )

Turmeric content of mustard can vary, of course. Likewise, sugar content. Look for mustards that are not sweetened, so avoid honey mustard in particular. Look for hot, brown, horseradish, Dijon, etc. If there is a downside to mustard, it's sodium content, though the 709 mg per 1/4 cup should only be a problem for those who are sodium-sensitive (African Americans, in particular).

So perhaps mustard isn't exactly a super health food. But it may have some bona fide health effects and should be used generously especially if you are concerned about blood sugar and inflammatory phenomena.

Exercise and blood sugar

5. March 2010 William Davis (30)
There is no doubt that exercise yields benefits across a spectrum of health: reduced blood pressure,  reduced inflammation, reduced blood coagulation, better weight control, stronger bones, less depression, reduced risk for heart attack.

Exercise also influences blood sugar. Diabetics understand this best: Exercise reduces blood sugar 20, 30, 50 or more milligrams. A starting blood sugar, for instance, of 160 mg/dl can be reduced to 80 mg/dl by jogging or riding a bicycle. (I recently had brunch at an Indian restaurant with my family. Blood sugar one-hour postprandial: 134 mg/dl. I was sleepy and foggy. I got on my stationary bike and pedalled at a moderate clip for 60 minutes. Blood sugar: 90 mg/dl.)

Could the reduction of blood sugar with exercise be THE reason that exercise and physical activity provide such substantial benefits?

Think about it. Reduced blood sugar:

1) Reduces risk for future cardiovascular events.
2) Reduces glycation of proteins, i.e., reduced glucose binding to proteins like the ones in artery walls and the lenses of your eyes.
3) Reduces blood coagulation
4) Reduces endothelial dysfunction (abnormal artery constriction that leads to atherosclerosis)

This might explain why it doesn't require high levels of aerobic activity to derive benefit from exercise, since even modest efforts (e.g., a 15-minute walk after eating) reduce blood sugar substantially.

The incredible 33-year, 18,000-participant Whitehall study tells us that a postprandial (after-eating) blood sugar of an impossibly-difficult 83 mg/dl is required to erase the excess cardiovascular risk of blood sugar. Could this simply be telling us that physical activity or exercise is required to suppress blood sugars to these low levels?

It makes me wonder if an index of the adequacy of exercise is your post-exercise blood glucose.

The most important weight loss tool

4. March 2010 William Davis (15)

Question: What is the most effective tool available to help you lose weight? 


A pedometer (walk 10,000 steps, etc.)?

A treadmill? 




A bicycle?






No. None of the above. 

The most important tool you can use to achieve weight loss is your glucose monitor:



Timing of blood sugars

3. March 2010 William Davis (5)
Because different foods generate different blood sugar (glucose) responses, the timing of your blood sugar is an important factor to consider.

This question has come up a number of times. Commenters have asked whether the one-hour postprandial glucose is timed with the start of the meal or the conclusion of the meal.

In my view, if we simply ignored all aspects of meal composition, then blood glucose should be obtained one hour after the conclusion of a meal. This is because most mixed meals (i.e., mixed in composition among proteins, fats, and carbohydrates) yield peak blood glucose levels at 60-90 minutes after consumption. Timing blood glucose to 60 minutes after the conclusion of a meal puts the sample right about at the peak.

But this is an oversimplification. For instance, here is the blood glucose behavior after so-called "complex" carbohydrates wheat bread, rye bread, rye made with beta glucan, and whole wheat pasta (50 grams carbohydrates each) in slender, healthy volunteers, mean age 29 years:


From Juntunen et al 2002

Note that blood glucose peaks at 35 minutes postprandial. (To convert glucose in mmol/L to mg/dl, multiple by 18. Thus, whole wheat bread increased blood glucose from 94 mg/dl to 122 mg/dl. Also note the lower peak glucose for pasta, but sustained higher glucose levels hours later.)

In another study, older (mean age 64 years), overweight (BMI 27.9) females with diabetes were given 50 grams carbohydrate, 50 grams carbohydrate with olive oil, or 50 grams carbohydrate with butter:


From Thomsen et al 2003. Control meal of soup plus 50 g carbohydrates ({blacktriangledown}), the control meal plus 80 g olive oil ({circ}), and the control meal plus 100 g butter (•).

In this experience, note that postprandial glucose peaks 60-120 minutes after the meals (consumed within 10 minutes), delayed more when either oil is included. Blood glucose started at 144 mg/dl and peaked as high as 230 mg/dl with carbohydrates only; peaks were reduced (along with AUC) when oil was included. (Note the differential effect, olive oil vs. butter.)

These two sets of observations give you a range of blood glucose behavior. One side lesson: Carbohydrates should never consumed by themselves, else you will pay with a high blood sugar (not to mention the hypoglycemic response later for many).

Psssst . . . There's sugar in there

1. March 2010 William Davis (13)
You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.

By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl.

Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:

Balsamic vinaigrette
Many commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.)

Hamburgers
I learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy.

Tomato soup
If it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar.

Granola
Sure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar.


Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy.

And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).

How low should blood sugar be?

28. February 2010 William Davis (0)
What should your blood sugar (glucose) be after eating?

Take a look at the data from the Whitehall study reported in 2006. The Whitehall Study stands apart from other studies in that it was very large (over 18,000 participants) who were observed for an unusually long time (33 years). All participants were administered a 50 gram glucose "challenge" at the start with glucose levels checked after the glucose challenge.

Here's what they found:




From Brunner et al 2006.
Equal calories, different effects

Equal calories, different effects

9. January 2008 William Davis (15)
A great study was just published in the Journal of the American College of Cardiology:

Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects.

88 obese adults with metabolic syndrome were placed on either of two diets:

1) A very low-carbohydrate, high-fat diet (VLCHF): 4% calories from carbohydrates (truly low-carb); 35% protein; 61% fat, of which 20% were saturated. In the first 8 weeks, carbohydrate intake was severely limited to <20 grams per day, then <40 grams per day thereafter.

2) A high-carbohydrate, low-fat diet (HCLF): 46% calories from carbohydrates; 24% protein; 30% total fat, of which <8% were saturated.

Both diets were equal in calories (around 1400 calories per day--rather restrictive) and participants were maintained on the program for six months.

At the end of the six month period, participants on the VLCHF diet lost 26.4 lb, those on the HCLF diet 22.2 lbs (though the difference did not reach statistical significance). Thus, both approaches were spectacularly successful at weight loss.

Surprisingly, blood pressure, blood sugar, insulin and insulin sensitivity (a measure called HOMA) were all improved with both diets equally. Thus, these measures seemed to respond more to weight loss and less to the food composition.

Lipids differed between the two diets, however:


VLCHF:
Total cholesterol: initial 208.4 mg/dl final 207.7 mg/dl

LDL: initial 125 mg/dl final 123 mg/dl

HDL: initial 55 mg/dl final 64.5 mg/dl

Triglycerides: initial 144 mg/dl final 74 mg/dl

Apoprotein B: initial 98 mg/dl final 96 mg/dl


HCLF
Total cholesterol: initial 208.4 mg/dl final 187.5 mg/dl

LDL: initial 126 mg/dl final 108 mg/dl

HDL: initial 51 mg/dl final 54.5 mg/dl

Triglycerides: initial 157.6 mg/dl final 111 mg/dl

Apoprotein B: initial 100 mg/dl final 95 mg/dl


Some interesting differences became apparent:
--The VLCHF diet more effectively reduced triglycerides and raised HDL.
--The HCLF diet more effectively reduced total and LDL.
--There was no difference in Apo B (no statistical difference).

The investigators also made the observation that individual responsiveness to the diets differed substantially. They concluded that both diets appeared to exert no adverse effect on any of the parameters measured, both were approximately equally effective in weight loss with slight advantage with the carbohydrate restricted diet, and that lipid effects were indeed somewhat different.


What lessons can we learn from this study? I would propose/extrapolate several:

When calories are severely restricted, the composition of diet may be less important. However, when calories are not so severely restricted, then composition may assume a larger role. When calories are unrestricted, I would propose that the carbohydrate restriction approach may yield larger effects on weight loss and on lipids when compared to a low-fat diet.

The changes in total cholesterol are virtually meaningless. Part of the reason that it didn't drop with the VLCHF diet is that HDL cholesterol increased. In other words, total cholesterol = LDL + HDL + trig/5. A rise in HDL raises total cholesterol.

Despite no change in Apo B, if NMR lipoprotein analysis had been performed (or other assessment of LDL particle size made), then there would almost certainly have seen a dramatic shift from undesirable small LDL to less harmful large LDL particles on the VLCHF diet, less change on the HCLF diet.

The lack of restriction of saturated fat in the VLCHF that failed to yield adverse effects is interesting. It would be conssistent with the re-analysis of saturated fat as not-the-villain-we thought-it-was put forward by people like Gary Taubes (Good Calories, Bad Calories).

In the Track Your Plaque experience, small LDL is among the most important measures of all for coronary plaque reversal and control. Unfortunately, although this study was well designed and does add to the developing scientific exploration of diet, it doesn't add to our insight into small LDL effects. But if I had to make a choice, I'd choose the low-carbohydrate, high-fat approach for overall benefit.
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Comments (15) -

  • MAC

    1/9/2008 1:55:00 AM |

    Dr. Davis,
        You have to check out Dr. Eades blog on the same study. You both had different takes but came to the same conclusion. http://www.proteinpower.com/drmike/

  • Dr. Davis

    1/9/2008 3:22:00 AM |

    Hi, MAC--

    Thanks for pointing out Dr. Eades post.

    I've lately come to read his posts regularly, as I have been thoroughly impressed with his insights.

    It's good to know there's some real thinkers out there!

  • rick

    1/9/2008 4:37:00 AM |

    Had the HCLF group enjoyed the same nearly 50% drop in TG as the VLCHF group, their calculated LDL would have dropped to 117 rather than 108.  So part of their comparative advantage is not a benefit at all.

  • Anonymous

    1/9/2008 5:33:00 AM |

    Hello,

    Dr. Davis, what is your viewpoint on saturated fat intake and arterial damage? Although perhaps saturated fat doesn't affect lipid values too negatively (in fact, it seems to raise HDL), maybe it can eventually lead to heart disease by other means -- inflammation/damage to arteries, leading to plaque build-up?

    There is a reference to a study here, which you've probably seen:

    http://www.sciencedaily.com/releases/2006/08/060808091635.htm

    I'm curious on your viewpoints, as we know not all fats are bad, but it seems a little muddy as to if certain saturated fats are bad or not.

  • chcikadeenorth

    1/9/2008 5:37:00 AM |

    Hi, you commented once on my high hdl..68...it happened after I low carbed, high calories( plus 1800 a day) and hi fat but under 20 gr of sat fat a day.My Ldl went up but lipoprotein(a) was still within the norm not for TYP but for lab values,
    I hear nothing but good results  with LC going back to Atkins,Bernsteins, Eades, Westman and you Dr D so keep plodding along. Soon everyone will know what a wheat belly is and rather than plod you'll be galloping writing another book SmileThnx for all.

  • Dr. Davis

    1/9/2008 1:33:00 PM |

    Most of the feeding studies like the one you cited are flawed in that they claim to have isolated the effect of saturated fat on some measure, brachial forearm dilatation, in this instance. Unfortunately, they did no such thing. They did not control well for carbohydrate effects. Gary Taubes would point out that they presumed that carbohydrates are good and therefore all adverse effects must be from the saturated fat component.

    We are planning a thorough review of the issue in future.

  • g

    1/9/2008 4:50:00 PM |

    You know... I'd love to see the CAC scores (or even IMT if possible?) for people on Protein Power?  Has that ever been studied?  Mac, have you ever had an EBT/CT scan? (are you > 40 yr?)

    I think that would be very very COOL data Smile   Thanks for sharing -- I've checked DR. Eades out since you started posting...  His wife does a nice 'tablescape' like Sandra Lee!  
    I loved his post on foie gras!  That's what I tell my elevated liver test patients -- they are making their fatty livers into FOIE GRAS (and good think I'm not Hannibal... but I like chianti *ha ahaaa*).

    g

  • andyj

    1/9/2008 5:53:00 PM |

    While I would dearly love to try this myself, I am still (as always) having a mental problem with the high-fat part.  I am currently trying to fine tune a plan to do a calorie-restricted diet (about 1600 calories) but I'm not sure how low I can get the carbohydrate segment to go  -- certainly not under 10%.   Most of the fat will be from nuts and chocolate (and salmon and sardines) and I will certainly do a NMR after the fact.  The biggest problem is crafting something you can actually live with for an extended period of time, not just a couple of months.  Therein lies the real problem.  Maybe we should just stop eating altogether!  I have plans for a blog entry on just this subject --  what if we ate only when we truly had to?  Some days I'd have no problem dropping down to about 1000 calories a day, but of course then exercise would be out of the question.  Yeah, this plan still needs some tinkering before I attempt it.  
              andysheart.blogspot.com

  • MAC

    1/9/2008 8:01:00 PM |

    Dr. Davis,
       New paper on Vitamin D and heart diseases. Paper says they cannot recommend testing for Vit D nor recommend supplementaion for those with a known deficiency.
    http://www.sciencedaily.com/releases
    /2008/01/080107181600.htm

    To g: I am over 40 and only low carbing recently. Previous to that used vegan diet to lose weight successfully. Have not had a heart scan yet but seriously thinking of it as my father was diagnosed with Type 2 at 65 and had quadruple bypass.

    P.S. Went to doc the other day and we decided to do some blood work since it had been while and unbeknownst to me until I looked at the paper work he had ordered a Vit D 25OH test and I got him to order a lipoprotein analysis for the lipid part. No discussion, he agreed. I think he keeps up on  latest research.

  • Dr. Davis

    1/9/2008 8:25:00 PM |

    Hi, MAC--

    Progress!

  • MAC

    1/9/2008 11:18:00 PM |

    FYI.

    Posted by me on Dr. Eades site:

    "You and Dr. Davis both reviewed the same study in your respective blogs on the same day. Bit of different takes but same conclusion. http://heartscanblog.blogspot.com/

    Hi MAC–

    I’m a reader of Dr. Davis’ blog from time to time. I guess today that great minds thought alike.

  • g

    1/10/2008 4:20:00 AM |

    MAC -- it sounds like you have a biochem background too?  Yes, I agree many great thinkers are coming up with vastly similar conclusions!  I think that the best balance betw being fed and 'fasting' maybe key (didn't u discuss earlier?). Where is that? maybe being mildly ketotic? at 5-10? or 0-20?  for CAD who knows yet?

    Here's an example of industry looking for a single drug ligand/target (a $325 million one)...  The answer has already been discovered.  you've found it, dude!  I'm not sure about the relationship betw protein and plaque and CAD yet...  do you have some insights?

    http://blogs.wsj.com/health/2008/01/08/rna-mania-genzyme-drops-325-million-on-cholesterol-shot/#comment-60086

    THANKS!! g

  • MAC

    1/10/2008 3:24:00 PM |

    To g: I think you have me confused with another poster. Sorry don't think that was me. Maybe Peter? Minor in chemistry and lots of science courses but no biochem.

    BTW, the great mind in this case was Dr. Davis, and that was Dr. Eades paying him the compliment.

  • g

    1/10/2008 8:49:00 PM |

    Sorry for the confusion -- so many quality post-ers here!  It's great that you're considering starting on vit D -- it improved insulin sensivity in a small trial 60% (that's more than any drug out there like metformin or Actos).

  • chickadeenorth

    1/11/2008 7:45:00 PM |

    g et al  do you have some reading material about Vit D improving insulin resistance I could take to my doc. I am on 4000 units a day, haven't noticed any difference but it is only about 2 weeks now.

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