Hi, I just found your blog. Very interesting

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

Cheers,
Kristen Suzanne

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

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

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.

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

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.

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

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

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

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

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 . . .

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!

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.

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).

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.

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.

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.

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.

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.