Can I stop my Coumadin?

5. September 2010 William Davis (20)
Here I go again.

While I will try to keep this blog on topic, i.e., coronary heart disease prevention and reversal using nutritional and other natural strategies, I believe that a "critical mass" of frequently asked, though off topic, questions keep cropping up.

One such question revolves around Coumadin, or warfarin.

Somehow, my Nattokinase scam blog post draws traffic about Coumadin. I tried to make the point that a conventional blood thinning agent like Coumadin that undoubtedly has undesirable side-effects cannot be replaced by an agent that has an uncertain track record. In the case of nattokinase, no track record.

To illustrate how far wrong the "nattokinase as replacement for Coumadin" idea can go, here is a question from Anna:


I came across your blog while perusing.

I am a bit bummed because I have been on Coumadin (warfarin) for around 22 years since I was 6 years old. I have a mechanical heart valve (St. Jude's), as I have heart-related issues, including hypertrophic obstructive cardiomyopathy.

Well, it is just that the warfarin seems to interact with nearly everything. I feel like I can not get the nutrients my body requires. I desire to consume more raw foods and vegan foods, though I do not want anything to damage my heart valve or risk a stroke/heart attack or internal bleeding.

I have been underweight the majority of my life, malnourished , currently am still somewhat underweight, though enjoying food again, as I had what mimicked Crohn's Disease for several years (horrendous pain), from which I am in remission now. I was diagnosed with osteoporosis, which may or may not be caused from consuming warfarin.

Is it possible to get off of warfarin and effectively keep my blood thinned ? I currently take 1.5 mg to 2 mg dosage. Does the warfarin destroy Vitamin K and if so does that mean while on warfarin I never get the Vitamin K nutrients even if I did consume foods with it in it?

Thank you
Anna

No, sorry, Anna. Stopping Coumadin with your unique issues, i.e., a prosthetic mechanical heart valve (likely mitral, judging by your history of hypertrophic obstructive cardiomyopathy, in which the patterns of blood flow ejected from the heart disrupt the natural mitral valve function) and cardiomyopathy, can be fatal. Without blood thinning, the mechanical heart valve can trigger blood clot formation, since it is a foreign object implanted into the bloodstream.

There are no natural alternatives available with track records confident enough to bet your life on. Aspirin nor Plavix are blood thinners, but platelet inhibitors. These two agents, while they work for other forms of arterial (but not venous) blood clot inhibition, will not work for your unique situation.

Likewise, a purported oral lytic agent like nattokinase should not be substituted for Coumadin. Even if there was plausible science behind it, you should demand substantial evidence that it provides at least blood thinning equivalent to Coumadin. Should a blood clot, even a small one, form in or around the prosthetic valve, the valve can stop working within seconds. This can lead to death within minutes.

I believe it would be foolhardy to bet your life based on the marketing--let me repeat: MARKETING--of a "nutritional supplement" by supplement manufacturers eager to make a buck.

Nor are there any other nutritional supplements that can safely replace the Coumadin. I wish that were NOT true, as I am no stranger to the long-term dangers of Coumadin and I am a big believer, in general, in nutritional supplements. I am a BIGGER believer, however, in the truth. Weighing the options available to us today, there really is no rational choice but to remain on Coumadin.

By the way, I tell my patients to eat a substantial amount of green vegetables while they take Coumadin. I know that conventional advice is to reduce or eliminate green vegetables due to their content of Coumadin-antagonizing vitamin K. I think this is wrong, also. Green vegetables are the best foods on earth. They reduce risk for cancer, diabetes, bone disease, and coronary heart disease.

To obtain the benefits of green vegetables without mucking up your blood thinning (your "protime" or International Normalized Ratio, INR), I advise my patients who take Coumadin to eat green vegetables--but do so every day in relatively consistent quantities, so that the protime or INR is not disrupted and remains reasonably constant. It may mean that your total dose of Coumadin may be somewhat higher, e.g., 3 or 4 mg instead of 2 mg, but the dose is immaterial outside of blood thinning. That way, you obtain all the wonderful health benefits of green vegetables while maintaining fairly consistent blood thinning/protime/INR. Coumadin does not block all the health benefits of vegetables, only those related to vitamins K1 and K2.

With regards to protecting yourself from the osteoporosis promoting effects of Coumadin, I would be sure to follow a program of natural bone health, such as the one I discussed in Homegrown osteoporosis prevention and reversal. You will have to be extra careful, however, with the vitamin K2. Ideally, you have a doctor knowledgeable about vitamin K2 who can assist you in managing K2 intake while on Coumadin. This is something you can definitely NOT manage on your own. (I am a big believer in self-managed care, but this is way beyond the limit.)

Lastly, it is my belief that anyone with an inflammatory bowel condition, such as Crohn's disease or ulcerative colitis, should absolutely, positively, and meticulously AVOID WHEAT and all other gluten sources (such as rye, barley, and oats). Even if you test negative for celiac markers (e.g., anti-gliadin antibodies, emdomysium and transglutaminase antibodies), the enhanced intestinal permeability will allow wheat proteins, such as gluten, to gain ready entry into the bloodstream. Not to mention that wheat should have no place in the human diet anyway, in my view.

Homegrown osteoporosis prevention and reversal

1. September 2010 William Davis (58)
I don't like to stray too far off course from discussions of heart disease and related issues in this blog. But the question of bone health comes up so often that I thought I'd discuss the strategies available to everybody to stop, even reverse, osteoporosis.

Coronary atherosclerotic plaque and bone health are intimately interwoven. People who have coronary plaque usually have osteoporosis; people who have osteoporosis usually have coronary plaque. (The association is strongest in females.) The worse the osteoporosis, the greater the quantity of coronary plaque, and vice versa. The two seemingly unconnected conditions share common causes and thereby respond to similar treatments.

Incredibly, rarely will your doctor tell you about these strategies. Your doctor orders a bone density test, the value shows osteopenia or osteoporosis, and a drug like Fosamax or Boniva is prescribed. As many people are learning, drugs like this can be associated with severe side-effects, such as jaw necrosis (death of the jaw bone), a dangerous and disfiguring condition that leads to loss of teeth and disfigurement, followed by reconstructive surgery of the jaw and face. These are not trivial effects.

Note that drugs are approved by the FDA based on assessment of efficacy and safety, NOT proven equivalence or superiority to natural treatments.

In order of importance (greatest to least), here are strategies that I believe are important to regain or maintain bone health. Indeed, I have seen many women increase bone density using these strategies . . . without drugs of any sort.

1) Vitamin D restoration--Vitamin D is the most important control factor over bone calcium metabolism, as well as parathyroid function. As readers of this blog already know, gelcap forms of vitamin D work best, aiming for a 25-hydroxy vitamin level of 60-70 ng/ml. This usually requires 6000 units per day, though there is great individual variation in need.

2) Vitamin K2--If you lived in Japan, you would be prescribed vitamin K2. While it's odd that K2 is a "drug" in Japan, it means that it enjoys the validation required for approval through their FDA-equivalent. Prescription K2 (as MK-4 or menatetranone) at doses of 15,000-45,000 mcg per day (15-45 mg), improves bone architecture, even when administered by itself. However, K2 works best when part of a broader program of bone health. I advise 1000 mcg per day, preferably a mixture of the short-acting MK-4 and long-acting MK-7. (Emerging data measuring bone resorption markers suggest that lower doses may work nearly as well as the high-dose prescription.)

3) Magnesium--I generally advise supplementation with the well-absorbed forms, magnesium glycinate (400 mg twice per day) or magnesium malate (1200 mg twice per day). Because they are well-absorbed, they are least likely to lead to diarrhea (as magnesium oxide commonly does).

4) Alkaline potassium salts--Potassium as the bicarbonate or the citrate, i.e., alkalinizing forms, are wonderfully effective for preservation or reversal of bone density. Because potassium in large doses is potentially fatal, over-the-counter supplements contain only 99 mg potassium per capsule. I have patients take two capsules twice per day, provided kidney function is normal and there is no history of high potassium.

5) An alkalinizing diet--Animal products are acidic, vegetables and fruits are alkaline. Put them together and you should obtain a slightly net alkaline body pH that preserves bone health. Throw grains like wheat, carbonated soft drinks, or other acids into the mix and you shift the pH balance towards net acid. This powerfully erodes bone. Therefore, avoid grains and never consume carbonated soft drinks. (Readers of this blog know that "healthy, whole grains" should be included in the list of Scams of the Century, along with Bernie Madoff and mortgage-backed securities.)

6) Strength training--Bone density follows muscle mass. Restoring youthful muscle mass with strength training can increase bone density over time. The time and energy needs are modest, e.g., 20 minutes twice per week.

Note that calcium may or may not be on the list. If on the list at all, it is dead last. When vitamin D has been restored, intestinal absorption of calcium is as much as quadrupled. The era of force-feeding high-doses of calcium are long-gone. In fact, calcium supplementation in the age of vitamin D can lead to abnormal high calcium blood levels and increased heart attack risk.

These are benign and easily incorporated strategies. They are also inexpensive. I challenge any drug to match or exceed the benefits of this combination of strategies. Keep in mind that strategies like vitamin D restoration provide an extensive panel of health benefits that range far beyond bone health, an effect definitely NOT shared by prescription drugs.

Your enlarged aorta

27. August 2010 William Davis (19)
The thoracic aorta lives happily within the chest.

The aorta is the main artery of the body that emerges from the heart, located just under the sternum. It is the "tree trunk" from which all the major arteries branch off to the rest of the body: the arms, brain, abdominal organs, pelvis, and legs. The aorta receives the high-pressure blood ejected directly out of the heart muscle.

However, there are evil forces in the body that work to weaken the aorta. When the aorta is weakened, it enlarges. Enlarged aortas also tend to grow atherosclerotic plaque. Plaque in the aorta poses long-term risk for stroke and and mini-strokes ("transient ischemic attacks," or TIAs), due to fragmentation.

There are many enlarged aortas in this world. I see at least several every week. It is fairly common, particularly in people with high blood pressure and cholesterol abnormalities, as well as those who are overweight. Smokers get it really bad.

Conventional thinking is that, once an aorta enlarges, it will inevitably continue to enlarge at the average rate of 2.0 mm per year (resulting in 1.0 cm enlargement over 5 years). For this reason, conventional discussions on the topic of thoracic aortic aneurysms all say something like "Enlarged aortas should be monitored yearly. Surgical replacement should proceed when the aorta reaches a diameter of 5.5 cm."

This is because an aortic diameter of 5.5 cm is associated with much greater likelihood that the aorta will rupture (fatal within minutes) or the internal lining will tear, a "dissection." The surgery is a major undertaking that involves opening the chest and usually replacing the aortic valve and inserting a synthetic aorta. The procedure is high-risk, especially if any branch arteries are involved.

So putting a stop to any further aortic enlargement is a worthwhile goal. Unfortunately, conventional thought is that there is nothing you can do to stop the inevitable growth of the thoracic aorta.

Nonsense. There are a number of efforts you can make to halt further increase in aortic diameter. (My experience in this is anecdotal and unpublished, but now numbers several hundred patients.)

There are two categories of factors that cause the aorta to increase in diameter:

1) Internal pressure--Think of blood pressure as the internal inflating pressure on this "balloon." Keeping the "inflating pressure," i.e., blood pressure, low exerts substantial effect on slowing growth of aortic diameter. I aim for normal BP or lowish BP (less than 130/80, preferably 100/70).

2) Factors that weaken the aortic wall--Processes like inflammation, glycation, lipoprotein deposition, and nutritional deficiencies will serve to weaken the supportive tissue of the aorta. For that reason, correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)), reductions in carbohydrate intake and thereby blood glucose/glycation, and "normalization" of vitamin D, vitamin C supplementation (for collagen crosslinking), and omega-3 fatty acids all play a role.

To push even farther, there may be additional advantage to following strategies that impair the production and activity of a crucial enzyme that lives within the aortic wall: matrix metalloproteinase, or MMP. MMP degrades the collagen and other supportive tissues within the aorta, weakening it and permitting expansion. Blocking MMP may prove to be among the most powerful new strategies to halt aortic expansion.

Compounds that have potential MMP-inhibiting effects include:
--Vitamin D--A substantial effect
--Resveratrol--One of the polyphenols from red wine
--Doxycycline--This old antibiotic often used for acne treatment has, in preliminary studies, shown important MMP-blocking effects and slowed aortic expansion.

Anyway, there you have it. A bit complicated, but a "recipe" that has failed me only rarely.

Extreme carbohydrate intolerance

25. August 2010 William Davis (26)
Here's an interesting example of what you might call "extreme carbohydrate intolerance."

May is a 44-year woman who has now had her 7th stent placed in her coronary arteries. She lives on a diet dominated by breads, breakfast cereals, muffins, rice, corn products, along with some real foods.

Her conventional lipid panel and other lab values:

Total cholesterol 346 mg/dl
Triglycerides: 877 mg/dl
HDL cholesterol: 22 mg/dl
LDL cholesterol: incalculable
(Recall that LDL cholesterol is usually a calculated, not a measured value. The excessively high triglycerides make the standard calculation invalid--more invalid than usual.)

Fasting blood glucose: 210 mg/dl
HbA1c (a reflection of previous 60-90 days average glucose): 7.2% (desirable 4.5% or less)
ALT (a "liver enzyme"): 438 (about five-fold normal)


At 5 ft even and 138 lbs (BMI 27.0), May appears small. But the modest excess weight is all concentrated in her abdomen, i.e., in visceral fat.

By lipoprotein analysis via NMR (Liposcience), May's LDL particle number was 2912 nmol/L, or what I would call a "true" LDL of 291 mg/dl. (Drop the last digit.) Of the 2912 nmol/L LDL particles, 2678 nmol/L, or 92%, were small.

The bad news: This pattern of extremely high triglycerides, extremely high LDL particle number, low HDL, predominant small LDL, and diabetes poses high-risk for heart disease--no surprise. It earned her 7 stents so far. (Unfortunately, she has made no effort whatsoever to correct these patterns, despite repeated advice to do so.)

The good news: This collection is wonderfully responsive to diet. LDL particle number, small LDL, triglycerides, blood glucose, and HbA1c drop dramatically, while HDL increases. Heart disease will at least slow, if not stop.

It's amazing how far off human metabolism can go while indulging in carbohydrates, particularly a genetically carbohydrate-intolerance person. (Actually, I wouldn't be surprised if May's diet, as bad as it seems to you and me, still fits within the dictates of the USDA food pyramid.) The crucial step in diet to correct this smorgasbord of disaster is elimination of carbohydrates, especially that from wheat, cornstarch, and sugars.

What's for breakfast? Egg bake

20. August 2010 William Davis (42)
Heart Scan Blog reader and dietitian, Lisa Grudzielanek, provided this recipe in response to the post, What's for breakfast?

Lisa, by the way, is one of the rare dietitians who understands that organizations like the American Dietetic Association have made themselves irrelevant. She therefore advocates diet principles that work, not just echoing the idiocy that emanates from such organizations, often driven by economics more than science. Lisa works in the Milwaukee area and has proven a useful resource person for my patients who have required extra coaching in the Track Your Plaque diet principles.

Egg Bake
My favorite breakfast is what I call an "egg bake." Others may refer to it as a "quiche."

Take a variety of fresh vegetables. This time of year is great for farmers' markets.

I typically use fresh chopped organic spinach, bell peppers, red & white onions, scallions, broccoli, mushrooms, cherry tomatoes halved and, if desired, meat (nitrite-free ham or leftover chicken breasts).

1) Chop veggies and place in casserole dish.
2) Add meat and handful of cheese of your choice.
3) Scramble 8 eggs & little bit of milk & pepper.
4) Add to casserole dish and mix/coat veggies with egg mixture.
5) Put in oven at 450 degress for 30 minutes.

Yummy, ready to eat breakfast that is so easy for the work week.

What's for breakfast?

14. August 2010 William Davis (0)
If you eliminate wheat from breakfast and otherwise adhere to a low-carbohydrate dietary approach, what is there to eat for breakfast?

If you take out English muffins, bagels, all breakfast cereals, pancakes, waffles, and toast, what's left to eat?

Actually, there's plenty left to eat. It just may not look like the traditional American notion of "breakfast." (The traditional idea of breakfast was is, in part, due to the legacy of Dr. John Harvey Kellogg, who, in the latter part of the 19th century, ran a sanitarium in Battle Creek Michigan. He and his brother, Will Keith Kellogg, discovered the idea of turning grains into flakes, the birth of the breakfast cereal. Subscribe to the idea of breakfast cereal for breakfast and you subscribe to the ideas of a man who would administer four enemas for you today to cure your cancer or rheumatism.)

Here are a few ideas. By no means is this meant to be a comprehensive list, just a starting point for a few new breakfast food ideas.

--Eggs--Of course, eat the yolk. Eat three yolks. Scrambled, "fried," (not really deep-fried, of course), hard-boiled, poached, as an omelette. Add pesto, olive oil, vegetables, mushrooms, salsa.

--Ground flaxseed--As a hot cereal with your choice of water, milk (not my favorite because of insulin effects; the fat is immaterial), full-fat soy milk (yeah, yeah, I know), unsweetened almond milk. Add walnuts, blueberries, etc. Ground flaxseed is the only grain I know of that contains no digestible carbohydrates.

--Lunch and dinner--Yes, if you cannot have breakfast foods for breakfast, then have lunch and dinner, meaning incorporating foods you ordinarily regard as lunch and dinner foods into your day's first meal. This means salads, leftover chicken from last night, soup, raw vegetables dipped in hummus or guacamole, stir fry, etc.

--Cheese--For something quick, grab a chunk of gouda or emmentaler along with a handful of raw almonds, walnuts, or pecans. Because of the excess acidity of cheese (along with meats, among the most acidifying of foods), I usually try to include something like a raw pepper or avocado, foods that are net alkaline.

--Avocados--Cut in half, scoop out contents. They're quick and delicious, when available.

I hesitate to mention it, but I sometimes will have tofu, cubed and flavored with whatever is available--soy sauce, miso, pickled vegetables. My mother was Japanese, so I'm comfortable with this, though many people are not.

Anyway, that's a partial list that nonetheless can get you started on a wheat-free, low-carb breakfast.

If you are just starting out, you will notice a number of fundamental changes. You may first experience the characteristic "withdrawal" effect: mental fog and fatigue that lasts about a week. Energy then picks up, often substantially. This is followed by gradually reduced appetite: You will be far less hungry. You will require less food, less often, since appetite will be driven by physiologic need, not the appetite-stimulating properties of wheat (and cornstarch, high-fructose cornsyrup and sucrose).

By the way, do not skip breakfast unless it's part of an occasional fasting effort. Skip breakfast, wind down metabolism, get fat. I am impressed at how consistent skipping breakfast backfires in those who think that it helps you control weight.

I also welcome any suggestions on what you eat as part of your wheat-free, low-carb breakfast. (Thanks for the great suggestions on the last blog post, Anna.)

Wheat hip

10. August 2010 William Davis (39)
You've heard of wheat belly. How about wheat hip?

Recall that the innocent appearing wheat belly is actually a hotbed of inflammatory activity beneath the surface. The visceral fat of the wheat belly, i.e., fat kidneys, fat liver, fat intestines, fat pancreas, produces abnormal inflammatory signals, such as various interleukins, tumor necrosis factor, and leptin. These are the inflammatory signals that create insulin resistance and diabetes, heart disease, hypertension, and cancer.

These same inflammatory mediators are able to enter the joint spaces, such as those in your hips, knees, and hands. This leads to osteoarthritis, the exceptionally common form of arthritis that affects 1 in 7 Americans. In particular, the level of leptin in joints mirrors that in blood, a phenomenon that has been associated with joint destruction.

The previously widely-held notion that arthritis is simply a wear-and-tear phenomenon due to the mechanical stress of excess weight is proving to be an oversimplification. Arthritis is also part of the carbohydrate-driven, weight-increasing, inflammatory condition of insulin resistance or metabolic syndrome.

Throw into this cytokine storm the fact that glycation, i.e., glucose modification of proteins, also causes cartilage destruction. The cells of human cartilage lack the ability to divide, so the cartilage cells you had at age 18 are the cartilage cells that you will hopefully still have at age 80. However, high blood sugars (glucose) glycate the proteins in cartilage. (Wheat raises blood glucose higher than almost all other foods, higher than a Milky Way bar, higher than a Snickers bar.) The process is irreversible and cumulative. Because cartilage has next to no capacity for repair or regeneration, it becomes brittle. Over years, it essentially crumbles, leading to the "bone on bone" that prompts conversations about total hip and total knee replacement.

So that ciabatta or blueberry muffin in your mouth takes you a step or two closer to joint destruction via heightened inflammation arising from the visceral fat of the wheat belly, worsened by glycation of high blood sugars after carbohydrate consumption.

My solution: Lose the ciabatta.

Men's lingerie is on the second floor

7. August 2010 William Davis (33)
Consume wheat products, like poppyseed muffins, raisin bagels, and whole grain bread, and you trigger the 90- to 120-minute glucose-insulin cycle.

Blood glucose goes way up (more than almost any other known food), triggering insulin release from the pancreas. Glucose enters cells as a result, blood glucose plummets. You get hungry, shaky, and crabby, reach for another wheat or other sugar-generating food to start the roller coaster ride all over again.

Repetitive insulin triggering grows this thing I call a "wheat belly," the protuberant, hang-over-the-belt fat you see everywhere nowadays. Wheat belly fat is really visceral fat. Visceral fat means you have fat kidneys, fat intestines, fat pancreas, and fat liver, all causing the belly to protrude in the familiar way we've all come to recognize.

Visceral fat is special fat. Unlike the fat in the backside, thighs, or arms, visceral fat triggers inflammatory responses that are evident in such measures as tumor necrosis factor, interleukins, and leptin, as well as drops in the protective hormone, adiponectin.

Visceral fat also, oddly, triggers estrogen release. Estrogen triggers growth of breast tissue. That's why females with wheat bellies have up to four-fold (400%) greater likelihood of breast cancer.

Men also experience excess estrogen from the visceral fat wheat belly, causing "man boobs." This B-cup phenomenon means that inflammation is raging beneath the surface, all due to this thing you're wearing around your waist.

I wasn't aware until recently that male breast reduction surgery is a booming business growing at double-digit rates. So are special clothes to help men conceal their expansive breasts.

Perhaps the USDA is in cahoots with Playtex.

10,000 units of vitamin D

3. August 2010 William Davis (47)
Joanne started with a 25-hydroxy vitamin D level of 23 ng/ml--severe deficiency.

What made this starting value even worse was that it was drawn in August after a moderately sunny summer spent outdoors. (Last summer, not this summer.) It therefore represented her high for the year, since vitamin D levels trend lower as fall and winter set in. This suggests that her winter level was likely in the teens or even single digits. In addition, note that, at age 43, Joanne has lost much of her ability to activate vitamin D in the skin.

So I advised that she take 6000 units of an oil-based gelcap per day, a dose likely to generate the desired blood level, which I believe is 60-70 ng/ml.

Four months later, her 25-hydroxy vitamin D level: 39.9 ng/ml--still too low. So I advised her to increase her dose to 10,000 units per day. Several months later, her 25-hydroxy vitamin D level: 63.8 ng/ml--perfect.

However, on hearing that she was taking 10,000 units vitamin D per day, Joanne's primary care physician was shocked: "What? Stop that immediately! You're taking a toxic dose!" So Joanne called me to find out if this was true.

No, of course it's not true. It's not the dose that's toxic, but the blood level it generates. Although it varies, vitamin D toxicity, as evidenced by increased blood calcium levels, generally does not even begin to get underway until at least 120-130 ng/ml, perhaps higher. Rarely, a dose of 2000 units per day will generate a level this high. In others, it may require 24,000 or more units per day to generate such a high level.

So it's not the dose that's toxic, but the blood level of 25-hydroxy vitamin D it generates.

Provided you and/or your doctor are monitoring 25-hydroxy vitamin D blood levels, the dose is immaterial. It's the blood level you're interested in.
"I gained 30 lbs from one cracker"

"I gained 30 lbs from one cracker"

23. May 2008 William Davis (19)

Let me tell you a story, a tale of a woman who gained 30 lbs by eating one cracker.

At age 50, Claire's health was a disaster. Her initial lipoprotein patterns were a mess, including HDL 36 mg/dl, triglycerides 297 mg/dl, blood sugar 122 mg/dl (pre-diabetic range), blood pressure 155/99. Small LDL comprised over 90% of all LDL particles.

At 5 feet 3 inches, she weighed 210 lbs--90 lbs over her ideal weight. Her face was flushed and red, her eyes swollen and weighted down with bags, her eyes dull. While interested in hearing about how to improve her health, I would hardly call her enthusiastic.

We talked about how removing wheat products entirely from her diet could result in weight loss--enormous weight loss--yet with reduced appetite, increased energy, less daytime sleepiness and fogginess, improved sleep quality. Removing wheat would also allow substantial correction of her lipoprotein patterns with minimal medication.

At first, she seemed confused by this advice. After all, it ran directly opposite to what she'd been told by her family doctor, not to mention the advice from TV, food ads, and food packages.

To my surprise, Claire did it. She didn't return to the office for another 5 months. But she came in, a big beaming smile on her face.

Even at 167 lbs--still overweight--Claire looked great. She glowed. She'd already dropped nearly 2 1/2 inches from her waist. She felt lighter on her feet, discovered energy she thought she'd lost 10 years earlier. Her blood results matched, with dramatic shifts in each and every pattern.

I quizzed Claire on her diet, and she had indeed made substantial changes. In addition to eliminating all foods made of wheat flour, she also eliminated foods made with cornstarch, rice flour, snacks, and other sweets. She ate her fill of vegetables, fruits, raw nuts, lean meats, and healthy oils. She was less hungry while eating less. Even her husband, skeptical at first, joined Claire after the first two months and her initial 20 lbs of weight loss. He, too, was well on his way to dropping to ideal weight.

But a dinner party invitation came. In the few that Claire and her husband had gone to over the few months, she had religiously stuck to her program, choosing cheese, pickles, olives, vegetables that she dipped, but avoided the pretzels, breads, Doritos, potato chips, and others.

This time, a tray of whole wheat crackers was laid on the buffet table, covered with some sort of sweetened cheese. She had just one. She savored the taste that she'd missed. "Maybe one more. I'll be extra good this weekend,'" she told herself.

Now Claire was hungry. The bruschetta covered with tomatoes and mozzarella looked awfully good. "It's got some good things on it, too!" she thought. She had three.

The floodgates opened. I saw Claire three months later, weighing just shy of 200 lbs. "I almost cancelled this appointment," she whispered quietly, tears at the corner of her eyes. "I don't know what happened. I just lost control. After losing all that weight and feeling so good, I blew it!"

I've seen it before: Fabulous success eliminating the foods that created the situation--the insatiable appetite, the endless cycle of hunger, brief satiety, the rolling, rumbling hunger--followed by temptation, then disaster. The weight lost comes right back.

It's experiences like Claire's that have absolutely, positively convinced me: Wheat products are addictive. It's not true for everybody, but it's true for many people, certainly most people who have weight struggles. It triggers some sort of appetite button, a signal to eat more . . . and more, and more. Keep it up long enough, and you have drops in HDL, increases in triglycerides, upward jumps in blood sugar and blood pressure, diabetes, etc. It doesn't matter if it's whole grain, 7-grain, or 12-grain. Yes, the whole grains contain more fiber and more B vitamins. But they all share one characteristic: They trigger a desire for more.

So that's the story of how one whole wheat cracker caused one woman to gain 30 lbs.


Next week's story:

California woman claims: My children are aliens!


Just kidding.


Copyright 2008 William Davis, MD
Tags :

Comments (19) -

  • Kristen's Raw

    5/23/2008 7:24:00 AM |

    Hi, I just found your blog. Very interesting Smile

    I'm curious...on average, what percent of your patients follow a vegan diet?

    Cheers,
    Kristen Suzanne

  • Chainey

    5/23/2008 8:01:00 AM |

    Interesting. Do you think the same applies to potatoes? I know that french fries are a major downfall for many people.

  • Jenny

    5/23/2008 11:21:00 AM |

    Dr Davis,

    If your patient had a fasting blood sugar of 122 she was most certainly fully diabetic, and her post-meal blood sugars, with carbs were likely in the high 200s.

    So the problem with that cracker might not have been that wheat is addictive but that in a person with diabetes the blood sugar spike caused by eating carbs causes relentless overwhelming physiological hunger.

    If that is understood, it is much easier to stop the cycle. If people interpret the physiological hunger as emotional--a personal weakness--it is much harder to deal with.

    But most importantly, this woman needed to be monitoring her post-meal blood sugar spikes no matter what she was eating. Had she seen the spike, she would have understood why she was so hungry, and if she was able to flatten that spike, she could have avoided the regain.

    I do not believe wheat is addictive, and I also believe VERY strongly after ten years of dealing with a low carb diet that if a person does not learn how to deal with the occasional off-plan day, and the resulting physiological hunger, it is only a matter of time until they DO crash off the diet.

    I've seen it far too often. People go two or three years on the diet and then, because they haven't learned how to go on and off it, they fail dramatically.

    So rather than demonizing wheat or carbs, let's put some effort into teaching people how to deal with the inevitable hunger that results from creating a high blood sugar spike so that they can lose their fear of carby foods and maintain the diet for many years.

    P.S. I learned this lesson the very hard way--three years of perfection, total regain, and now heading into year 6 of doing much better because I can go on and off the very low carb diet without regain.

    --Jenny Ruhl

  • Dr. William Davis

    5/23/2008 12:33:00 PM |

    Hi, Jenny--

    Thanks for your comments. I agree with your observations on her blood sugar.

    However, I strong disagree with the "wheat is not addictive" idea. I would warn you that it is dangerous to extrapolate broad truths from your single, personal experience. I have witnessed this in over 500 patients now. It is not true for everybody, but it is very true for many. Wheat products are unique. They also exert peculiar and exaggerated effects on lipoproteins, particularly small LDL. Even without the addictive quality, if you watch lipoproteins, you will see large effects just with elimination of wheat, effects that extend far beyond blood sugar.  

    I suspect that you do not have a wheat addiction. The comments from people who are spared this pattern are incomprehension or opposition. But, for some people, it is like a cloud lifted. And it is largely specific for wheat.

  • JoeEO

    5/23/2008 12:53:00 PM |

    I have to second Dr Davis opinion on wheat. I have found that eating any type of wheat -  even the 100% Bran crackers suitable for diabetics gives me a insatiable hunger. I don't get the same effect from eating a comparable amount of carbs via starchy vegetables or oat bran cereal

    Peace

    Joe E O

  • Anonymous

    5/23/2008 3:14:00 PM |

    I didn't think it was possible, but after seeing it, believe my mom is a wheataholic.  She has avoid wheat     a # of times, and each times she has done so she lost weight, and her blood pressure dropped nicely.  Unfortunately she has not been able to stick with the diet.  She goes  back to her old wheat eating ways and the weight came back.    

    This morning I heard mom and dad got into a somewhat heated debate over a bran muffin mom was eying.  Never thought I would see the day a bran muffin caused an argument.

  • Darcy Elliott

    5/23/2008 4:59:00 PM |

    Totally agree with you doc. We see a major wheat addiction problem with several of our patients. Not all of them, but a substantial percentage really struggle giving it up. There's some info "out there" on gluten exorphins - have you ever looked into it?

    Darcy

  • Anne

    5/23/2008 10:41:00 PM |

    Wheat protein contains a number of opiod peptides which can be released during digestion. Some of these are thought to affect the central and peripheral nervous systems.

    When I gave up gluten, I felt much worse for a few days. This is a very common reaction in those who stop eating gluten cold turkey.

    Anne

  • Anonymous

    5/24/2008 1:34:00 AM |

    I have low carbed since 03 and thought I was a master, no wheat passed these lips. Then one Christmas they did and since then, 06 I struggle to stay on my low carb clean program, I wish I had never 'fallen" off the wagon.

    Eating wheat was the trigger as it triggered cravings for me............ that were worse than in my "fat" yrs.

    I liken the addiction is same as drugs or booze, to me its no different. I come from a background of numerous alcoholics, diabetics and have nursing and psychology background.I am diabetic. I can see both things play a role with me, but have to say that to me wheat is like an addiction.

    I believe these soft comfort foods  escalate the bg, also signal to our brain the soothing of any emotions and very quickly we become psychologically and physiologically addicted to higher carb foods like wheat.

    Our first food is pablum, baby biscuits, the brain learns quickly this sweet soft food is soothing and quickly we become addicted to this.

    When I am really stressed my "drug" of choice is wheat products, yet I am educated, I know the drill yet my body craves something with wheat.
    Its an addiction to me, I have control of this addiction and craving if I keep my bg within normal so struggle with living with this insight.

    Sometimes my bg goes up after bigger low carb meal but doesn't provoke cravings as much as having just a cracker or 2 while I am out..it makes me want to have more..I can identify 110% with Claire.

    chick

  • Anonymous

    5/24/2008 3:10:00 AM |

    Well, I had such a strong craving to wheat that I switched to rice products, thinking that anything would be better than wheat. But I became just as addicted to rice as wheat. In fact, I don't even miss wheat products because there are so many rice products. I imagine if more baked goods were made of corn, instead of wheat or rice, then I'd be addicted to that. I agree there is a wheat addition for many, but for me it's the sugar high or the temporary good feelings I derive simply from eating a flour product.

    Vita

  • liefman

    5/24/2008 3:41:00 AM |

    I just saw an interesting piece of research suggesting also that artificial sweeteners have an effect on the brain that triggers sugar/carb craving. This was in rodents; anyone aware of human studies? Certainly nothing the makers of splenda or nutrasweet are going to fund . . .

  • Jenny

    5/26/2008 1:52:00 PM |

    Dr. Davis,

    I've been thinking about your response to my earlier comment, and wanted to raise a couple more issues.

    Though I cited my own experiences in the comment, I've been active in online discussion groups for both low carb diets and diabetes for almost a decade now. And what I've observed over this period is that people who are low carbing who do NOT have diabetes or who have diabetes controlled only by a low carb diet are almost always the people who report "wheat addiction. "

    But what is fascinating--and was a real "Aha!" for me, is that hundreds of people with diabetes active online who gauge what they can eat by measuring their blood sugar after meals and eliminating blood sugar spikes, even mild ones,  with a combination of diet, safe meds and insulin do NOT report this wheat addiction issue, and most interestingly, they do manage to eat small amounts of wheat without going off the rails.  Most of them do not eat more than 120 g of carbs a day and many eat far less.  

    The only thing people with diabetes do report occasionally about wheat is that wheat ramps up heart burn.

    But people with diabetes have access to drugs, including insulin, that can flatten blood sugar which people without it do not have. And many of us find that even though we did not think our blood sugar spikes were that bad while controlling on diet alone--I sure didn't--when we add appropriate drugs we realize that we were experiencing a lot of hunger and that with the right meds it abates dramatically.

    This, not only my own experience, is why I believe that wheat addiction may really be pointing to blood sugar spiking and the related relentless hunger. Wheat is among the very fastest carbs--much faster than rice or most forms of cooked potatoes. This must not be underestimated.

    You say people who haven't experienced wheat addiction cannot imagine it. But what I'm saying is that people who have not experienced blood sugar-related hunger can have NO idea how overwhelming it can be and how it can push a person into a binge that is very hard to end. The two may be more related than you think. When I was controlling with diet alone wheat always made me terribly hungry. Add a bit of meal-time insulin timed properly and suddenly  wheat is just another food.

    Over my decade of watching people try to do the Low Carb WOE without blood sugar meds I have seen that very very few people are able to stick with the diet for more than 5 years and that the binge that gets out of control is all too frequent.

    So I think anyone who is trying to help people with their carb issues HAS to address the problem of teaching people how to get back on plan when they go off and how to deal with the hunger that comes from unaccustomed blood sugar spiking. Even if wheat addiction turns out to be a true physiological problem, people ARE going to eat wheat eventually, and if they panic and believe that they are now helpless in the face of their addiction, which is the kind of thinking that the addiction model tends to encourage that isn't helpful!

    So rather than build a fear of food  it is much more skillful to give people the tools they need to get back on track after they eat something that kicks up physiological hunger. This involves a combination of physiological and psychological tools.

    The people who succeed long term on the low carb diet do appear to be hose who learn how to get back on after they go off.

    And what I have learned in my years online is that the people with diabetes who have controlled carb intake very well for very long periods of time are those who take a more relaxed approach and have learned how to recover from overdoing it. That is why over my own decade of eating LC, I've moved from a very strict to a much more flexible approach that does not demonize any food on keeping a flat blood sugar no matter what is eaten.

    I am hearing recently from quite a few medical professionals who have gotten religion about cutting carbs over the past few years, and I'm very glad they have, but I think there is a certain extremism that we all go through that is an obstacle to making it through the decades of tight control we need to preserve health.

    I'm very glad that you do take the positions you take, my comments are mostly directed at making it possible for your current patients to continue their success a decade and two or three decades hence!

  • Anne

    5/26/2008 10:34:00 PM |

    Isn't if possible that wheat can be addictive, raise blood glucose. cause antibody reactions, damage organs and syetems and worsen lipids? That does not mean that everyone who eats wheat will have all or any of these reactions. There are hundreds of complex proteins in wheat. It makes sense they could cause multiple effects.

    I have an antibody reaction to wheat (gluten) and do have to watch out for the smallest crumb as it will make me ill.  Before I went gluten free, wheat was my favorite food. I craved it constantly. Perhaps this craving was related to increased blood glucose (BG) levels as I have found out that starches and sugars cause BG spikes. I have been able to  level them out with diet alone so far. I will never find out what wheat would do to my BG. As a person who is gluten sensitive, wheat is my enemy.

    Approximately 1% of the population has celiac disease - this is an autoimmune disease cause by wheat and other related grains. A growing number of doctors are saying that non-celiac gluten sensitivity affects at least 10% of the population.

  • Sue

    5/27/2008 3:19:00 AM |

    Jenny,
    You say "people ARE going to eat wheat eventually".

    Why do you think this is?  Why not just avoid wheat?  If a diabetic can eat wheat because they are medicated doesn't that mean without medication wheat causes too many cravings.  So for us un-medicated lot its probably better to avoid wheat.

    (BTW I like your blog).

  • Stephan

    5/29/2008 12:39:00 AM |

    Dr. Davis,

      I share your feeling that wheat is unique.  My opinion comes from researching and comparing different pre-industrial populations throughout the world.  Many of them eat high-carb diets and do just fine, but as soon as you throw wheat and sugar into the mix, they become overweight and unhealthy.  The story has repeated itself over and over again throughout history, and I've posted about it on my blog several times.

    I sometimes speculate on why this may be.  I have two ideas: first, the lectin wheat germ agglutinin (WGA) has an affinity for the leptin receptor, and can be found in the serum of some people.  It competes with leptin for binding at the receptor.  Overweight people are typically leptin-resistant.  I think you can understand the implications!  This hasn't been demonstrated in vivo.

    The second mechanism is through damage of the upper intestinal tract.  Gluten (and possibly other wheat toxins as well) is probably not good for anyone, and Celiac patients are probably just one end of the spectrum.  Innate immune responses are observed even in non-Celiac patient gut biopsies challenged with gliadin fragments.  The upper small intestine is intimately involved in regulating satiety and insulin release/sensitivity through hormone release and vagal signals to the brain/liver.  Thus, immune activation and/or frank damage could pervert these signals.

  • Bruce K

    6/1/2008 9:54:00 AM |

    Jenny: "Even if wheat addiction turns out to be a true physiological problem, people ARE going to eat wheat eventually,"

    This sounds like saying that people are going to drink alcohol, even if they know they are alcoholic. Smart people would eliminate a food if it caused them to suffer cravings and frequent binges. Many people should realize they are addicted to sugar, and milk. For example, anybody who routinely gobbles down a pint/quart of ice cream in a day or two. Those people should never eat milk/sugar. You are right that many of them do, or will, but this is self-delusion, like an alcoholic saying "just one" drink, then stopping at five.

    "The people who succeed long term on the low carb diet do appear to be hose who learn how to get back on after they go off."

    Change low-carb to alcohol-free and see if that theory still applies. I think if a food causes cravings and binges, it should be eliminated for ever. Some people can eat junk food in moderation, or they can binge on it and not become fat, because they have a fast metabolism. That should not imply that junk food is healthy or that people need to learn how to recover from a binge. They need to fortify their diet with nutritious, satisfying food, so they don't have any inclination to binge. Bingeing is caused by deficiencies, IMO. You don't binge or have any interest in bad food when you are eating right.

  • jpatti

    6/4/2008 4:24:00 PM |

    I have a carb addiction myself and I agree with Jenny.

    The reason I say I have an "addiction" to carbs is because of my experience when I did a low-fat diet for a few years.  If I had a bad day, extra pasta seemed to make me feel better.  If I couldn't sleep, a bagel would knock me right out.  This is not a "normal" reaction to carbs; this is more how people use alcohol than carbs.  For *me*, carbs are like a drug.

    Every time I go off low-carb, when I go back on, I have horrible cravings, headaches and feel sickly for a few days.  It's exactly like a withdrawal process.  The misery of going through induction again is often what keeps me *on* my diet, not wanting to feel that way.  It's not just that my bg will be high for a day or two if I cheat, but that I'll feel like crap for several days.

    So I low-carb, but not *very* low-carb.  Around 60-80g/day most of the time, which lets me have small servings of fruit and my preferred grains, barely and buckwheat, and a low-carb tortilla now and then.  This is as low as I can go long-term which is why I don't do seriously strict low-carb ala Bernstein; this is what I can live with.

    But I do cheat sometimes.  The longer the cheat, the longer I feel like hell when I go back on low-carb.  I can "afford" to cheat once a month for *one* meal and get back on low-carb with only a day of feeling minorly poorly, but if I "cheat" for a whole day, I feel badly for 2-3 days before being OK.

    I also agree with Jenny about managing cheats.  This is the deal... I'm just not ever going to agree to never, ever eat a cracker again!  I don't even *like* crackers that much, but if I have to *never* eat them again, I'm going to be craving them immediately!  I'll be having dreams about Ritz and thinking about Saltines all day and start fantasizing about Sociables instead of sex!  

    This is actually why I *do* plan to "cheat" once a month.  Psychologically, I can't deal with "never", but I can deal with postponing for a couple weeks.    Having cheated LOADS of times is how I *know* I can "afford" it for exactly *one* meal per month without going off the wagon or screwing my bg up too badly.  

    It's not specifically about wheat for me.  I tolerate low-carb tortillas 2-3x/week in my normal diet just fine without falling off the wagon.  I can use a bit of wheat flour or cornstarch to thicken a dish without any problem - if it's little enough over a bunch of servings.  

    Conversely, ANY type of carb can cause me to fall off the wagon - potatoes, sugar itself, even fruit.  Once the straw that broke the camel's back for me was tangerines, a normally healthy food, but not so much if you're diabetic and on your third one.  

    For me, it's about insulin resistance (IR).  When bg is elevated, the pancreas keeps producing insulin in an attempt to reduce bg.  Meanwhile, the high bg itself increases IR, so in spite of the insulin, very little glucose enters the cells.  In short, you have both insulin-induced hunger *and* a cellular-level hunger occurring.

    If you give in to your hunger and eat, bg rises, therefore increasing insulin and further reducing it's effectiveness.  

    With your cells not getting fed, you're fatigued and weak too.  So you not only overeat and get fat, but are "lazy" also.  

    It's a very, very vicious circle that you can only break by cutting the carbs and going through withdrawal until your bg is controlled again.  

    For me, the type of hunger I feel on a high-carb diet is literally painful, it can wake me from sleep.  It takes a lot of willpower to ignore that, which is part of what makes reinducting so difficult (besides that it feels awful).  

    On the other hand, on low-carb, hunger is a very minor feeling that I can easily ignore all day if I'm busy or distracted.  It's a whole other ballgame.  

    I know some people have very specific wheat issues, such as gluten intolerance.  

    But I don't see anything in your description of this lady's problem from the cracker that distinguishes it from problems I've seen other low-carb folks suffer from potato chips.  Like Jenny, I've been on low-carb forums and newsgroups for years.  I can't even tell you how many times someone comes back after being gone a few months or years and sheepishly admits they fell off the wagon and gained back 100 lbs.  It doesn't have to be wheat that kickstarted the binge, could be sugar, potatoes, corn - like I said, for me personally, once it was tangerines.  

    Wheat is a very pervasive carb source due to baked products, so it's *often* wheat that causes the problem.  But I bet that lady could've had the same reaction from a chocolate candy bar.

  • Bruce K

    6/14/2008 5:45:00 PM |

    There's an old saying: "If you fail to plan, you plan to fail." Why eat foods that cause even a day of less health and quality of life? You say you can't deal with "never" eating another cracker, but do not really like crackers. I haven't eaten any crackers in years. If you have to eat grains, there are better foods like sprouted breads or yeast-free sourdough from a health store. Why not eat those instead of crackers? The foods you "can't live without" are probably the foods you need to avoid. If crackers disappeared from the face of the Earth, you wouldn't die the next day from stress. You'd simply eat other foods. Why's it so hard to do that? Pretend there's no such thing as crackers, cookies, or other baked goods. The world is not going to end if those foods go away forever. Neither are you.

  • buy jeans

    11/3/2010 10:23:18 PM |

    Even at 167 lbs--still overweight--Claire looked great. She glowed. She'd already dropped nearly 2 1/2 inches from her waist. She felt lighter on her feet, discovered energy she thought she'd lost 10 years earlier. Her blood results matched, with dramatic shifts in each and every pattern.

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