Dr Davis, What would be your reaction to another Dr's blog site quoting the latest NCEP report of 9/07 that lowering LP(a) is not necessary unless it is in the 80-90th percentile? He also states that the report says raising HDL is only an "option" but not a proven deterrent. I don't have the credentials to argue this point but.... I certainly want to disagree with him.   Over&Out

If the question is whether this physician is properly reiterating NCEP guidelines, he is right.

I regard NCEP as being as least 10 years behind the times and a consensus opinion driven as much by big science as big pharma.

It is also based on outcome studies, what I would call "body count" studies, rather than studies based on surrogate measures like heart scans. If we wish to wait for people to die in order to understand whether a treatment works or not, then his comments hold water. If our desire is to not gamble our lives away waiting for consensus opinions, then taking reasonable action based on available data is, in my view, a more rationale approach.

The problem with following surrogate markers is they are just that.  The danger is illustrated well with the Torcetrapib story:  the drug did raise HDL the surrogate marker but the trial had to be halted because adverse events were so high.  It made "sense" to raise HDL and it is not clear what the exact mechanism of the excess deaths are (elevation in BP which the drug caused or ?).  Random controlled trials are still the best way to move forward no matter how long or messy they may be.

On the subject of people having to decide in real time what treatment strategy they want to follow I believe one can make informed guesses but ultimately people should realize they are only guesses and may or may not prove to be correct.

Yes, I agree with your second statement.

However, I think we're talking apples and oranges here.

With torcetrapib, we're not talking surrogate markers, but introducing a foreign substance with generally unknown extent of effects. With heart scanning, we're talking about a surrogate measure of the disease, and one certainly far closer to the disease than the rather "distant" HDL-to-event relationship.

My name is Giulia White and i would like to show you my personal experience with Lipitor.

I have taken for 9 years. I am 60 years old. I took 20 mg for 9 years and I told numerous physicians about my pain and stiffness and was told that I had arthritis and to keep taking it. I left it at home by accident when we went on vacation and within 3 days, the pain in my legs began to go away. After 2 weeks I knew it was a very dangerous medication. I went to my new physician and he wanted me to try Pravachol. Afer 4 days on it, I was in a fog and thought I had the flu. I have been off it for just 36 hours and feel better. I am an RN and should have known that I was experiencing side effects with Lipitor, but you listen to your Doctor because you trust him. I now tell my patients to trust what their bodies are telling them. Statins can't be good for anyone but the drug companies!!!!!!!!!! They keep lowering the recommended levels so that almost everyone is considered to have "high" cholesterol. If someone is 30 and on this for 30 or 40 years there is not telling what the long term effects will be.

I have experienced some of these side effects-
Joint and Muscle Pain / Stiffness.

I hope this information will be useful to others,
Giulia White

(Note what is missing from the treatment regimen: efforts to raise HDL (starting average HDL 51 mg/dl); reduce triglycerides (starting average 140 mg/dl); identify those whose LDL was false elevated by lipoprotein(a); omega-3 fatty acids from fish oil; correction of other factors like vitamin D deficiency.)

As a woman with undiagnosed, and worsening hypothyroidism for at least 12-15 years (I've been treated for 2.5 years with much improvement), I'm so glad you posted this.  

My TSH levels were checked many times while I was experiencing infertility for many years, but the results were always in the upper half of my lab's "normal" range (.5 - 5.5), so my results were never flagged and hypothyroidism was always dismissed, despite classic hypothyroid symptoms that worsened steadily as my TSH crept up over the years (nurses used to joke about my "icy temps".  Of course, the focus was always on the blood lipid tests, as they kept pace with the TSH!  Currently, conventional medicine treats not the patient, but the lab test results, when it comes to hypothyroid issues.  

I talk to women (late 30s - late 40s) all the time who describe classic hypothyroid symptoms (chronically cold  - even in So Cal, low body temps, constant fatigue, trouble with mental concentration, sleep disruption, not sweating, etc.) and they all say the same thing I said for a decade, "my doctor tested me and he/she says my TSH is just fine".   Frankly, we get tired of telling our doctors we don't feel right anymore and being told "your test results are all normal so there there's nothing wrong with you, here are some samples of anti-depressants, time is up, bye-bye".  I had to find treatment from a doctor outside of my network and without insurance reimbursement initially to get the care I needed to feel better (T4-T3 combo).  It was hard to "keep at it" until I found the right doctor and care, but it made a huge difference in my daily life and that of my family and was well worth the extra effort.  

I realize hypothyroidism symptoms are also common with other conditions, but I find it ironic that all sorts of Rx are written for serious and potential dangerous drugs to manage these common mid-life symptoms, yet a trial of thyroid hormone is considered too dangerous.  

Additionally, many primary care doctors and labs seem to be very "behind the times" when it comes to recent thyroid research, AACE and NACL recommendations, not to mention thyroid hormone supplementation options.  My own networks lab is very proud of their brand new, ultra-sensitive machines, but the supervisor of the lab wasn't even aware that the AACE and NACL had recommended lowering the upper level of the TSH reference range several years ago.  He promised to look into the reference range issue and get back to me, but of course he hasn't.

I won't even get started on the sad state of how thyroid hormone is common prescribed in such a one-option-fits-all manner.

Untreated and under-treated hypothyroidism is a risk factor for heart disease and is much more common than most people (even doctors) think.  You are doing people a great service in writing about this.  Thanks!

I've been reading a little on thyroid issues. All the women in my family but me are on thyroid medication. I have refused to have it checked. The thing is, I believe if you treat the body right it will usually heal. The problem is, when I search on the internet for what I can do to improve the health of my thyroid, all I really find is endless amounts of ads and talk about thyroid medications.

I see the constant prescription of thyroid for low-thyroid as akin to drugs that allegedly will lower cholesterol or something. I know they help people, but why is nobody interested in what might be causing it or how to naturally work at solving it??

Interesting.  Could an increased TSH be a proxy for insulin resistance? Does insulin resistance mean thyroid hormone resistance as well, necessitating an overproduction of TSH?  Could all the above be a proxy for excessive carbohydrate consumption?   I wonder if that connection (i.e. thyroid and carbohydrates) has ever been studied?

Stan(Heretic)

Could it be possible that simply isolating TSH levels isn't enough? Shouldn't we look at the system in its entirety?

If normal levels are still contributing to ill effects, it would seem that a new definition of normal is needed (not what I would personally prescribe) or a view of the whole system to identify what is causing the normal levels to still be related to ill effects.

As the "Master Gland" of the endocrine system, it would seem to have wide-ranging ability to promote homeostasis. As other hormones enter hypo- or hyper-status, the TSH would have the ability to over-ride and protect the system.

I'm not an endocrinologist, but it seems to me the isolation of a single hormone in a complex system makes it difficult to identify ranges of normal - as evidenced in this study.

Love your stuff. Keep up the great work.

Brian

Hmmm,  I find the idea that a healthy diet and lifestyle might "heal" hypothyroidism very appealing, but if there is such a way to improve a bona fide hypothyroid condition without thyroid hormone, I have yet to find it, despite reading everything I could get my hands on in both conventional sources as well as alternative.  Certainly, healthy lifestyle and diet are important supporting factors for any person with a thyroid condition,  but I can find no indication that they alone are enough to override an autoimmune attack on the thyroid gland, for instance, or undo many years of insufficient thyroid function.  And believe me, there are plenty of ideas out there for non-Rx treatment of thyroid issues.  I've looked into quite a few of them.

My TSH levels were checked for more than 12 years, due to infertility and later, fatigue/unusual weight gain.  It was always the first test my former primary doc ran when I said I wasn't sleeping well, was always tired, had trouble concentrating and remembering, and not feeling "quite right", among other things.  She always said my thyroid checked out fine.  So did the reproductive endo I saw (for two rounds of infertility testing). During that time I spent years on a high carb diet (with some weight gain) followed by several years on a low carb diet (with weight loss).  My TSH continued to creep up (though continually in the higher end of the "normal range) and my hypothyroidism symptoms became much worse.  When just dropped from lack of "oomph" and began to research thyroid conditions, I had been on a low carb (little to no grain, starch, or sugar) whole food diet (primarily home prepared) already for several years, which was effectively keeping my impaired glucose regulation in the normal range (without meds) and my weight in a normal range (I think I am first phase insulin insufficient, not insulin resistant, at this point).  No, I don't think low carb caused the thyroid problems, that had started much earlier when I was making homemade pasta and baking whole wheat bread.  I now actually think it probably started at age 29 (17 years ago) when I went through a brief but exceptionally stressful time in my life.  Nothing about my metabolism was the same afterwards when the stressful situation was resolved.  

I subscribe to a farm vegetable box and get meat and eggs from a local farm.   Believe me, I eat good, real food from good sources whenever I can, instead of industrial, factory farmed food.  Good food alone isn't enough to keep my thyroid happy.

The vit & supplement dept folks tried to convince me that all I needed was iodine and raw gland products.  Too much iodine can cause problems, too, so that is a tricky way to self-treat.  I don't use iodized salt, but I do use unrefined sea salt and some kelp seasoning.  I tried acupuncture, too.  I tried coconut oil.  

The only thing that makes a difference for me in any measurable way (both in lab tests and in symptoms and quality of life) is an appropriate dose of  T4 with a small dose of compounded timed-release natural thyroid extract to provide a bit of T3.  A bit of regular, daily sunshine exposure (not enough to burn or tan) helps, too, but as a support, not primary treatment.  Two years in a row, I have had a recurrence of some hypothyroid symptoms at the same time of the year (mid-September) which were alleviated with a minor T4-T3 dose increase, later dropped in the late spring.  There is clearly a seasonal component to my own hypothyroid condition, even living in mild coastal So Cal (my thyroid doctor notices this in many of his Boston area patients, but even more pronouced), perhaps due to reduced daylight hours more than temp changes.  I am finally not dragging myself through the school year (I have 1 elem school age child) and only perking up a bit during the summer.

If hypothyroidism was like iron or protein deficiency and I could improve the condition with food, I would.  I tried that route when I couldn't get my former primary care doctor to consider it really was my thyroid, as I'm not one to take a medications lightly.  I'm quite open to alternative ideas besides medications, but in my experience, if my thyroid gland isn't producing the levels I need to function well, then my best bet is to supplement with T4 and T3 and take the strain off it (I don't have a goiter, but my gland aches when it is straining to keep up).   I don't even think of the thyroid hormone supplementation as medication, I think of it like a nutrient in which I am deficient and can't make or get another way.  Taking thyroid hormone is in no way like a taking a statin medication that interferes with cholesterol production.  Diet and lifestyle (getting enough sleep and maintaining skeletal muscle strength, especially) are certainly important support components, but simply aren't not enough on their own when the gland just isn't functioning well or the inactive T4 just isn't being converted to the active form, T3, in the body's tissues.  

There is a lot of evidence that environmental factors over which we have little or no control, are significant factors in the development of hypothyroidism, too.

Certainly a new definition of "normal" is needed.  I don't even like the term "normal"; I prefer "reference range".  Currently, the reference range my lab uses is akin to measuring a bunch of feet, determining that the size range of the group is size 4-11, lopping off the smallest and largest 2.5% of sizes on either end of the range, and saying that all sizes in between are fine and one should be able to function wearing all the sizes in the ref range.  When I spoke to the lab supervisor about their TSH testing, he was most focussed on the sensitivity and accuracy of the machines (machine a & b should get the same result from the same sample) and he wasn't even aware that there was controversy or a new recommendation concerning the upper half of the reference range.   If the labs can't get it right, how can we expect the primary care doctors who only looked for flagged lab results to get it right?

But if I wear a size 7 or 8, even if a 10 is "normal", it isn't a good fit for me, is it?  And what if most of the sizes fall between 5-8, but there are a few very large feet that skew the range?  

Primary care docs seem to think they know all about thyroid conditions, but the ones I have seen clearly don't know very much of the latest research and treat like one-size-fits-all.  Both endos I have seen, as well as the reading I have done, indicate that the vast majority of "normal" TSHs are around or under 1.0 mIU/L.  What they tend not to agree on is resolution of symptoms and if only synthetic T4 is enough or adequate treatment.  Over my thyroid treatment time (about 2.25 years), I have determined I don't begin to have enough resolution of symptoms until my TSH is no higher than 1.0, preferably a bit below.

Stan, You might be interested in reference #9 in the Hunt research study: "The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects."
Lynn

Dr. Davis, I started reading your blog a few weeks ago.  I thought the fact that you hadn't addressed the relationship between thyroid health and lipid issues undermined your credibility. You had left a big factor of heart health out of consideration, and I was waiting for the right place to comment about that oversight.  Then lo and behold, here is your TSH blog.

As a 61 year old woman who has taken thyroid supplementation for 59 years, I have seen an obvious relationship between my thyroid hormone levels and LDL/HDL levels.  It's nice to see the scientific confirmation.  

Although TSH is now the most commonly used index of the adequacy of thyroid gland function, it is nevertheless a very flawed indicator, as my personal experience and that of many on various thyroid boards attests to.  There are a myriad of factors that interfere with the negative feedback loop.  Inadequate hypothalamus and pituitary function, iodine insufficiency, cortisol insufficiency, selenium insufficiency, thyroid antibodies, and thyroid supplementation can all throw off the feedback loop and make TSH meaningless.  

A far better test of thyroid health is to directly measure the hormones that the thyroid actually produces, those being thyroxine (T4) and triodo-l-thyronine (T3).  Any blood test is still inadequate, because they don't measure what is happening at the cellular level.  But measuring the biologically active components of what the thyroid produces, the Free T3 and Free T4, plus looking at clinical symptoms, is much more informative than just looking at TSH values.

And as Anna alluded to, once a person can get a hypothyroidism diagnosis, getting adequate treatment is another sorry story.  Most of the medical community doesn't seem to recognize that the body can only use T4 after it's been converted to T3 and there are places in the body such as the brain that can't convert T4 to T3, T3 must be supplied directly. The usually prescribed T4-only medication (levothyroxine, best known as Synthroid) doesn't do the job.

If people were correctly diagnosed and treated, I think a lot of antidepressants, statins, other drugs, and doctor visits would be unnecessary.  It's said untreated or undertreated hypo are a gold mine for doctors.

Lynn

pj,
As to what may be causing thyroid issues, some factors are within our personal control. Iodine sufficiency (well beyond the 150 mcg RDA), selenium sufficiency, and a health style that lends itself to adrenal health (esp. avoidance of refined foods and overstress) are all within our personal control.

However, we are exposed to many factors that are are not within our control that harm thyroid function - e.g. fluorides, soy, bisphenol A, and perchlorate in foods and water.  It's not enough to treat the body right if you're damaged by things beyond your control.  

Thyroid is something the body naturally produces. Drugs to control cholesterol are not, and I don't think taking a form of thyroid that is comparable to what your own thyroid would produce is comparable to taking statins.

Lynn

Stan,

Hypothyroid people do have problems processing carbohydrates.  I don't know if it's been studied, but I have seen it recognized.  But I think that even with diminished carbohydrate consumption they still remain hypothyroid.

You know, I sense that we are all zigzagging towards a program of regaining health that uses more and more endogenous (internal, naturally-occuring) substances, such as thyroid hormone, vitamin D, and omega-3 fatty acids, and away from exogenous (external, foreign) substances like statin agents, osteoporosis drugs, and the like.

Of course, with thyroid issues, the great unanswered question is: Why is this happening in the first place? Why is there such widespread thyroid deficiency? Mineral (e.g., selenium) deficiency, fluoride exposure, pesticide and other organic chemical exposure, etc.?

Thanks, all, for the wonderful articulate and enlightening comments.

I think these comments demonstrate the potential vast improvements in Hypothyroidism (prevention of and of course tx depending on current structural integrity) that can occur with Track Your Plaque.

Brian -- from my extensive reviewing of PubMed to find answers to why TYP is so effective, (and Dr. Davis needs a Nobel ;D not joking) it appears that every facet of TYP strengthens steroid nuclear receptors.  I think you are absolutely right. TR (thyroid hormone receptor) does not work alone.  It 'crosstalks' with ALL the other NRs (nuclear receptors).

Anna -- are you the same Anna in San Diego who's hubby studies apoptosis? Thanks for all your insights if so!

TRs are immensely supported by the other NRs PPAR, ER (estrogen receptor), GR (glucocorticoid receptor), VDR (vit D receptor) and RXR/RAR (vit A/carotenoid receptors) for the sole purpose of growth, fertility, reproduction and longevity.

Guess what degrades and reduces the presence of PPAR?
--movement deficiency
--strength training deficiency
--sedentary lifestyles
--high carb reliant diets
--wheat due to insulin surges, inflammation, more ox stress, silent/latent CD, etc
--obesity (fat is an endocrine tissue and the signals it produces kills off PPAR and other NRs)

Guess what degrades and reduces ER?
--menopause (which leads to the 'menopot' on the belly)
--lack of steroid storage forms/ depot in body (secondary to elevated cortisol, vit D defic, etc)

Guess what degrades GR?
--'overstress' as Lynn puts it (I *heart* that phrase!)

Guess what degrades VDR?
--Vitamin D deficiency (25(OH)D < 50-60 ng/ml)
--Obesity
--'Overstress'

Guess what degrades RXR/RAR?
--Carotenoid deficiency from poor diet
--Vitamin A deficiency from poor diet
--Inflammation


Why does Track Your Plaque work?

All the recommendations optimize the functions of all these receptors and their maximal integrity:
--movement (30-60min minimum daily and more)
--grain-free Paleo diet (low carb, rich in the trace nutrients discussed here -- iodine,Mg,Zn,Bs,etc)
--vitamin 'O' for reducing 'over stress' (omg -- that word is GREAT)
--E2 as needed
--vitamin D3 as needed
--vitamin A/carotenoids as needed (see the blog)
--multiple modalities to reduce internal inflammation/cortisol -- including IF, high vegs intake, fish oil, certain nutritional factors, etc

Wouldn't you agree?

-G

I think these comments demonstrate the potential vast improvements in Hypothyroidism (prevention of and of course tx depending on current structural integrity) that can occur with Track Your Plaque.

Brian -- from my extensive reviewing of PubMed to find answers to why TYP is so effective, (and Dr. Davis needs a Nobel ;D not joking) it appears that every facet of TYP strengthens steroid nuclear receptors.  I think you are absolutely right. TR (thyroid hormone receptor) does not work alone.  It 'crosstalks' with ALL the other NRs (nuclear receptors).

Anna -- are you the same Anna in San Diego who's hubby studies apoptosis? Thanks for all your insights if so!

TRs are immensely supported by the other NRs PPAR, ER (estrogen receptor), GR (glucocorticoid receptor), VDR (vit D receptor) and RXR/RAR (vit A/carotenoid receptors) for the sole purpose of growth, fertility, reproduction and longevity.

Guess what degrades and reduces the presence of PPAR?
--movement deficiency
--strength training deficiency
--sedentary lifestyles
--high carb reliant diets
--wheat due to insulin surges, inflammation, more ox stress, silent/latent CD, etc
--obesity (fat is an endocrine tissue and the signals it produces kills off PPAR and other NRs)

Guess what degrades and reduces ER?
--menopause (which leads to the 'menopot' on the belly)
--lack of steroid storage forms/ depot in body (secondary to elevated cortisol, vit D defic, etc)

Guess what degrades GR?
--'overstress' as Lynn puts it (I *heart* that phrase!)

Guess what degrades VDR?
--Vitamin D deficiency (25(OH)D < 50-60 ng/ml)
--Obesity
--'Overstress'

Guess what degrades RXR/RAR?
--Carotenoid deficiency from poor diet
--Vitamin A deficiency from poor diet
--Inflammation


Why does Track Your Plaque work?

All the recommendations optimize the functions of all these receptors and their maximal integrity:
--movement (30-60min minimum daily and more)
--grain-free Paleo diet (low carb, rich in the trace nutrients discussed here -- iodine,Mg,Zn,Bs,etc)
--vitamin 'O' for reducing 'over stress' (omg -- that word is GREAT)
--E2 as needed
--vitamin D3 as needed
--vitamin A/carotenoids as needed (see the blog)
--multiple modalities to reduce internal inflammation/cortisol -- including IF, high vegs intake, fish oil, certain nutritional factors, etc

Wouldn't you agree?

-G

Dr. B G,

Yup, that's me.

I support most of Anna's observations. I started off with synthetic T4 about more than thirty years ago. Most doctors I have encountered were taught (and insist on) treating the (TSH) number and not the patient.
About 12 years ago I became aware of a few studies that suggested the addition of a small amount of T3 was beneficial, especially in mood and mental performance.
With the help of a couple of  cooperative docs (who had not been aware of this at the time) I tried a small amount of T3 (cytomel or triiodothyronine). This was helpful, and eventually I switched to Armour Thyroid (pork derived) which contains natural T3. This may not be appropriate for everyone since pig thyroids are said to produce a somewhat higher proportion of T3 than human.

These years of experience now allow me to self "tweak" my dose.occasionaly. Invariably my TSH turns out to be between 1 and 2 when I am feeling at my best.
Many doctors experienced in the "art" of thyroid treatment now recognize a condition known as "subclinical hypothyroidism". Google it.
Also, Google "Mary Shomon" She is a well known  thyroid journalist and advocate, who is herself a long term thyroid patient. She frequently interviews (and maintains a list of) doctors who provide specialized thyroid care.
One final suggestion: don't overlook heredity as a factor. My late mother  and four brothers and sisters have all suffered from hypothyroidism. While many people "get by" with standard thyroid treatment, many (especially women) need careful individual treatment.
Fortunately for me, my approach seems to have worked well. At 72, I have a zero plaque score, and take no other meds. While I have  generally eaten a healthy diet, I personally have never found diet or supplementation to be a significant influence on my TSH score. Perhaps if you start early  enough?          
I hope someone will find these comments helpful.
MikeV

There's an issue of the Vitamin D Council Newsletter where a woman whose mother was taking synthetic thyroid writes in. Her mother started supplementing vitamin d, and her TSH levels went up. The mother's doctor raised the dose for the thyroid, and the woman's mother ended up with hyperthyroid symptoms (the one I remember is increased heartrate.) That got me poking around, and it looks like there are some studies where vitamin d increased TSH output. In people whose thyroids respond to TSH as they should, maybe this is part of why vitamin d increases hdl?
I've read that vitamin d can increase the output of insulin (this makes a lot of low carb dieters cringe, but 1)some people don't put out enough insulin, and 2)I think it's possible that strategically increased output of insulin, at just the right time, might actually decrease 24-hour insulin under the curve.

Dr. BG opened my eyes to the potential vit D/TSH interaction.

I believe that there is indeed a real-life effect here (vit D raising TSH). That alone might account for much of the benefit of vitamin D supplementation/normalization.

Donny -- That's interesting. It's unusual that TSH  would increase. (did they document that free T4 actually decreased, in the newsletter? Perhaps they were only treating a 'lab #' and it was only a transient effect) Though I think that Vit D3 may increase TSH (and worsen hypothyroidism) theoretically if the vitamin D dose or blood level is excessive. It is important to check blood 25(OH)D routinely if one is on supplementation to avoid excessively high doses. Again, at supratherapeutic levels, it can cause the conditions it actually ameliorates --  like calcifications).  And potentially thyroid dysregulation too.

I didn't know vitamin D can raise insulin! But that makes sense and explains why it's is effective as part of a diabetic treatment.

In trials, many hormones raise vitamin D blood levels (see below citations):
--estrogen
--(genistein (phytoestrogen from soy -- as advised in the TYP plan)
--thyroid hormones
--testosterone

And VICE VERSA! Vitamin D raises the above hormone levels. In fact, after menopause (after the eggs have complete atresed and no longer provide estrogen), estrogen sources come from subcutaneous fat.  After skin activation of vitamin D -- estrogen levels then increase as a function of autocrine regulation (thank goodness!). Vitamin D indeed affects the synthesis of nearly all the other hormones.

-G

++++++++++++++++++++++++++++++++
Gallagher JC, Riggs BL, DeLuca HF.
Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis.J Clin Endocrinol Metab. 1980 Dec;51(6):1359-64.
PMID: 6255005
van Hoof HJ, et al.Hormone replacement therapy increases serum 1,25-dihydroxyvitamin D: A 2-year prospective study.Calcif Tissue Int. 1994 Dec;55(6):417-9.
PMID: 7895179
van Hoof HJ, et al.Female sex hormone replacement therapy increases serum free 1,25-dihydroxyvitamin D3: a 1-year prospective study.Clin Endocrinol (Oxf). 1999 Apr;50(4):511-6.PMID: 10468912

Cross HS, et al.Phytoestrogens and vitamin D metabolism: a new concept for the prevention and therapy of colorectal, prostate, and mammary carcinomas.J Nutr. 2004 May;134(5):1207S-1212S. Review.PMID: 15113973

Weisman Y, et al.Decreased 1,25-dihydroxycholecalciferol and increased 25-hydroxy- and 24,25-dihydroxycholecalciferol in tissues of rats treated with thyroxine.Calcif Tissue Int. 1981;33(4):445-7.PMID: 6271357

Otremski I, et al.The metabolism of vitamin D3 in response to testosterone.Calcif Tissue Int. 1997 May;60(5):485-7.PMID: 9115169

Donny -- That's interesting. It's unusual that TSH  would increase. (did they document that free T4 actually decreased, in the newsletter? Perhaps they were only treating a 'lab #' and it was only a transient effect) Though I think that Vit D3 may increase TSH (and worsen hypothyroidism) theoretically if the vitamin D dose or blood level is excessive. It is important to check blood 25(OH)D routinely if one is on supplementation to avoid excessively high doses. Again, at supratherapeutic levels, it can cause the conditions it actually ameliorates --  like calcifications).  And potentially thyroid dysregulation too.

I didn't know vitamin D can raise insulin! But that makes sense and explains why it's is effective as part of a diabetic treatment.

In trials, many hormones raise vitamin D blood levels (see below citations):
--estrogen
--(genistein (phytoestrogen from soy -- as advised in the TYP plan)
--thyroid hormones
--testosterone

And VICE VERSA! Vitamin D raises the above hormone levels. In fact, after menopause (after the eggs have complete atresed and no longer provide estrogen), estrogen sources come from subcutaneous fat.  After skin activation of vitamin D -- estrogen levels then increase as a function of autocrine regulation (thank goodness!). Vitamin D indeed affects the synthesis of nearly all the other hormones.

-G

++++++++++++++++++++++++++++++++
Gallagher JC, Riggs BL, DeLuca HF.
Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis.J Clin Endocrinol Metab. 1980 Dec;51(6):1359-64.
PMID: 6255005
van Hoof HJ, et al.Hormone replacement therapy increases serum 1,25-dihydroxyvitamin D: A 2-year prospective study.Calcif Tissue Int. 1994 Dec;55(6):417-9.
PMID: 7895179
van Hoof HJ, et al.Female sex hormone replacement therapy increases serum free 1,25-dihydroxyvitamin D3: a 1-year prospective study.Clin Endocrinol (Oxf). 1999 Apr;50(4):511-6.PMID: 10468912

Cross HS, et al.Phytoestrogens and vitamin D metabolism: a new concept for the prevention and therapy of colorectal, prostate, and mammary carcinomas.J Nutr. 2004 May;134(5):1207S-1212S. Review.PMID: 15113973

Weisman Y, et al.Decreased 1,25-dihydroxycholecalciferol and increased 25-hydroxy- and 24,25-dihydroxycholecalciferol in tissues of rats treated with thyroxine.Calcif Tissue Int. 1981;33(4):445-7.PMID: 6271357

Otremski I, et al.The metabolism of vitamin D3 in response to testosterone.Calcif Tissue Int. 1997 May;60(5):485-7.PMID: 9115169

Very interesting.  All I know is that at the same time that I was diagnosed with Hashimoto's disease with a TSH which had jumped from 2.25 to 6.61, my LDL, which normally hovered around 115, jumped to 180.  After two months of thyroid replacement, my LDL dropped back to 112.  My doctor said the 180 must have been a lab error.  I'm not so sure.

I am a 60 year old female and was finally diagnosed as hypothyroid almost two years ago when my internist put the symptoms together.

I was freezing cold at anything below 80 degrees, totally exhausted and was nearly starving myself on low carb to maintain my weight.  This was after losing 70 lbs. and having no trouble maintaining my weight.

He ran the full thyroid panel, including free T3 and free T4.  My TSH and free T4 were normal but my free T3 was very low and out of range.

I was immediately sent to one of the top endocrinologists here in Milwaukee.  He ran more tests and even with several low and out of range scores in his hands he told me I was getting old and there's no cure for that!  From there his comments became more absurd but I won't bore you with the details.  I'm sure you've got the picture.

It took quite some time to find a doctor who practices "outside the box" using both traditional and holistic medicine to get a proper diagnosis.  He treats by symptoms and uses the lab values for reference only.  He says most patients feel best with TSH below 1.0 and medicates based on symptoms.

Unfortunately, neither Armour Thyroid or Cytomel is working for me and my free T3 continues to drop even lower.  I have now been diagnosed with adrenal fatigue based on cortisol saliva tests, which explains why the thyroid meds aren't working.  All of my hormones are badly out of balance and low.

Much to my surprise he has recommended most of the same things you do...  low carbing, high-dose vitamin D, DHEA, testosterone, etc.

The only thing that was normal and excellent was my cholesterol.  By low carbing I got it into excellent territory in 2004, where it stayed until all my hormones went out of balance.  My HDL in the high 70's was even higher than my LDL and my Trigs were in the low 40's.

Having fought high cholesterol for most of my adult life I was astonished to find that it is now too low at 142.

We can't look at just TSH and just thyroid.  The entire endoctrine system MUST be evaluated.

Many of us who are hypothyroid don't respond to treatment because our adrenal glands are not working properly.  Finding appropriate treatment there is even worse than trying to find help with thyroid issues.

Since both of them have serious long-ranging effects on our heart health they must be properly addressed.  We shouldn't have to beg for treatment and almost become our own physicians.

My heart scan this week came in with a calcium score of 7.94.  I suspect that my untreated hypothyroid and adrenal fatigue are part of the picture and too many doctors ignore them.

I am more than thrilled to see that you are finally addressing these issues, which have been ignored for far too long.

Based on my reading and comments from my internist I continually recommend your blog to anyone and everyone.  Keep up the great work!

Donna said:

I am a 56 year old female, and was diagnosed with Hashimotos Thyroiditis, along with Graves diasease, giving me a dual diagnosis.  

I am currently, and have been very frustrated over the last five years, due to the fact that:

I remain fatigued, have sleep interruption, suffer periodically from muscle pain in my mid-back, as well as my neck, have heart palpitations on and off, and my TSH and Free T4 are close to the top of the reference range, with my T3 being close to the bottom.  I get muscle aches in my back, some so extreme, that in a few cases, I have gone to the emergency room, but they can't find what causes the pain. In addition, I have gained approximately 15 pounds over the last year, and I just get told I should exercise more and eat less.  I have a very restricted diet to begin with, due to a surgeon nicking my pancreatic duct during an ERCP procedure, which blew out six weeks later, giving me acute pancreatitis.  

My primary care doctor tells me that "thyroid" cannot cause muscle pain, and I disagree with him.

Last year I saw an ndocronologist, and he thought I had musco-skeletel problems.  The only thing they uncovered was some arthritis in my spine and neck.

In 2001 I had an I131 Uptake, because my TSH and T4 were opposite of my T3, according to the doctor.  

Ever since, my weight has just crept upward, no matter how little I eat, how much I exercise or don't exercise.  There is no explanation.

What would you suggest?  Would it make sense that my TSH, T4 and T3 are doing the same thing again?

Thank you Dr. Davis for posting this.  As a woman who has managed her own Hypothroidism for more than 20 years now, I am happy to see a western doctor finally state that 'normal' means nothing.

I can tell you that my body functions best when my TSH is at 1.0 - 1.15.  All of my hypothryoid symptoms disapper.  As soon as it begins to creep up and reaches anything over 2 the symptoms return.

Because no doctor would actually listen to me I have managed my thyroid naturally for years by taking herbs to balance my hormones and my endocrine system.

As a Natural Healer (I was also glad to read today's post about becoming our own doctors (I'm paraphrasing - yes.) with a degree in true naturopathic medicine and western herbs I am glad that I had the awareness and personal power to trust and know what my body needed but so many people put blind faith in their doctor and turn over their power.

Thanks again for posting this article.  I trust that it will be helpful to many who are told they have 'normal' thyroid function yet know something is not right in their own bodies.

Christine Agro
The Conscious Mom's Guide
www.theconsciousmomsguide.com
blog.theconsciousmomsguide.com

The current accepted range is ridiculous. Fortunately, I found a doctor who believes that the normal level for a 21-year-old girl is around 1.

I have had Hypothyroidism since I was 9 years old, I am now a 41 year old woman who has had a complete hysterectomy.  I take Estroven, Vitamin A, D3, B12 and Levothroid (112mcg) I have always noticed even the slightest change in my TSH levels, my hair starts falling out, I get excessively tired, get really dry skin and heart palpitations and I become extra nervous.  I got a blood test the other day because I wasn’t feeling right again… my TSH was 13.60uIU/mL!  My Doctor just had me switch my Levothroid back to 125mcg starting tomorrow. I also have a family history of heart disease.  How dangerous is my situation? I bounce between the two levels of Levothroid about 2 to 3 times a year.  My results so far this year are 2/09 0.86, 7/09 4.78 & 11/09 13.60.  Thank you for the help! I think my doctor thinks I am crazy when I say I can feel it, sometimes I am not even off enough to switch to the next level.

My TSH levels came in at 7.75 and the T4 (I think) was normal.  I had biopsies done on 3 nodules two years ago and the only recommendation was to follow up with regular check ups.  I don't seem to have any of the symptoms of hypothyroidism - feeling cold, weight gain etc.  I am a regular runner and eat well so I have no idea what I should be asking for in terms of treatment.  Any suggestions?

For anyone who still has doubt about the importance of getting thyroid right; there's this:

*Subclinical hypothyroidism and the risk of coronary heart disease and mortality*
JAMA. 2010 Sep 22;304(12):1365-74.

http://www.ncbi.nlm.nih.gov/pubmed/20858880?dopt=Abstract

Regards
MikeV

I fixed my thyroid naturally by finding a source of natural untreated water (no fluoride or chloride) and taking LOTS of iodine (8 Lugol's drops per day). (My doctor regularly tested iodine levels using a 24hour urine test to see how much of 8 drops is absorbed). After 6 months my doctor told me I could stop taking my thyroid supplememt. I also was taking astragalus and chitosan as a telomerase activator at the time and I think this might have helped regenerate my thyroid activity as well. I also was put onto physiologic doses of cortisol + DHEA, as adrenal dysfunction goes hand in hand with thyroid function, and supporting the rest of the endocrine system helps the thyroid. I could not believe how much iodine I needed; after 6 months it started to taste metallic and I could reduce my dose (8 drops a week).

Anonymous, 10/12/10

Interesting.
I would be interested to learn how long you had been 'hypo', prior to beginning this process, and your age.
Were there any 'hyper' symptoms before your doc dropped your thyroid med?
Was your doctor specializing in this approach?
Thanks
Mike V

In other words, the findings of this substantial observation suggest that the ranges of TSH usually regarded as normal contribute to coronary events, cardiac death, as well as lipid patterns. While several other studies have likewise shown a relationship of higher TSH/lower thyroid function with lipid abnormalities and overt heart disease, no previous study has plumbed the depth of TSH to this low level and to such a large scale.

Another excellent post.  You sound a little like Al Gore in the end there.

http://cgi.ebay.com/ws/eBayISAPI.dll?ViewItem&ssPageName=STRK:MESELX:IT&item=260360854853

This is a charity link to an auction for American Heart Association. 75 % of the final sale will go to AHA. Thank you for your time and support.

Please pass this information on if you can.

My copy was delivered to my PC Kindle reader first thing this morning. Look forward to reading it. Thanks.
Bill

Congratulations Dr. Davis! I just listened to you on Robb Wolf's podcast and I'll be downloading the Kindle version for my iPad this evening. I hope you have a best seller and I hope it starts a trend toward a healthier country.
Guy

Congratulations...it's so exciting to read all the breakthroughs you are making with heart disease.I bet the drug companies don't like you to much..hahah.  I enjoyed my almond-flour blueberry muffin this morning...no more wheat at our house. We are actually looking forward to our physicals in a few months.
Jana

Congratulations Dr. Davis.  I have you book tucked away in my Kindle and it looks to be very enlightening.  I've also alerted my followers on Twitter.  I have a personal friend who has been off wheat and sugar for years to reverse pretty serious medical problems, so was a believer even before I found your work.  Best of luck with the release!!

Congrats!  Looking forward to reading the book!

Michael:

There is nothing "easy" about open-heart surgery.  I have many friends, relatives, and colleagues (of my own generation) who have had various bypass operations, and to a man (and a few women), when asked if they'd ever have another one, the answer is no. No way, Jose, in fact. Too much pain, too many "complications," too much reduction in "quality of life," etc.  Plus, valve repair or replacement operations (according to the literature) are also rife with similar "complications," e.g., leakage, mechanical malfunction, etc. Nope, I have no desire to become a cyborg.

Now, if I was, say, 25, and not 68, maybe I'd think differently about it. I've already outlived the projected average lifespan for a person born in 1943 (63.95 years). I've had a pretty good life, and I have no desire to live as an incapacitated individual, mostly dependent on others for my care, etc. I'm divorced, and have no children, so no one is dependent on my survival. I also have Alzheimer's in the family tree (three uncles and two aunts).

Plus, Dr. Davis has suggested that vitamin D, for one, may help put off the inevitable for those of us with aortic insufficiency, based on his own clinical experience. It gives me some additional hope that I may be able to fight this off for a few more years, which will give me time to arrange my affairs, etc. And serving as an n=1 experiment, and then seeing what happens, may be helpful to others facing the same decision.

You said that "no amount of exercise or supplementation and nutrition will correct your current situation." Perhaps you're right, but how do you know that with any degree of certainty? Maybe it won't "correct" the situation, but maybe it will postpone the inevitable? Dr. Davis suggests that it just might do that. And getting  another 5-10 years would be a satisfactory resolution, at least it would for me. Provided I was generally healthy and independent for that entire time, and was physically able to continue the exercise, etc.

So I hope Dr. Davis will add some additional insight regarding my situation.

Joe

PS: Apparently there is only one live thread at a time here.  I wanted to reply to Michael Goroncy in the Bad Fat-Good Fat thread, but this is the only thread that will accept it. I keep getting "500" errors otherwise.

PPS: I received my copy of the "Wheat Belly" book yesterday.  It's mostly for my brother-in-law, who subsists mostly on cereal, bread, and pasta, and who has a "wheat belly" of growing proportions.  Maybe it'll help him see the light. But I may also learn a few things myself.

Thanks, Joe!

Hi, Jana-

That's okay. I'm not sure I'd like any drug company to be my friend, anyway!

Thank you kindly, Guy!

Hey, uncle Bill! Good to see you here!

Congratulations on the new book and for getting it featured in "Woman's World" cover recently.

Where else to put a new idea on eating and weight control but in a magazine that for years has featured endless weight loss articles?  I think it is a great move to get exposure there.

I'll be ordering my book soon, but will be gone for a week long bicycle camping trip as part of my keep in shape because I am too old to fall out of shape and get back easily. Then, when I rest up, I'll want the book.

I really enjoyed the wheat articles you have posted, and am beginning to feel that my escalating blood glucose reading are linkable to the previous day's carb and wheat content.  However, there is so much variability in the function of my home blood glucose monitors that I can't yet be sure of such associations being real, yet.

Bought the Woman's World yesterday. Read it in the pm today. And I Nook-ed WHEAT BELLY about 10 mins ago. Gonna read it after supper.

Thanks, Doc!

I also asked this question in the Vit D post from a few days ago.

I began experiencing tightness and soreness in my hips and lower back this year. Have been low carbing for over three years, and, except for a short period of stupidity earlier this year, have not consumed any flour products. My multi-vitamin contains only 500 IU of D3, so I am adding this to my daily supplementing. Should I start slowly, 1000 IU a day for a month, and slowly increase? Is D3 toxic? BTW I am in my late 60′s, and I do exercise 5-6 days a week as well.
I do not hang out in doctors' offices unless it is absolutely totally necessary, so I am choosing not to have any testing done.

Hi, Linda--

The best way to think of vitamin D is as sunlight exposure. However, the vitamin D in your multivitamin is, more than likely, an unabsorbable or poorly absorbed form. It should be taken as gelcap.

I know of no advantage to doing it slowly. Embrace the D!

100% wheat-free, I hope, Princess!

Hi, Dr. Buch--

I am mindful of what Woman's World is, seeing it in the checkout line at the grocery store. Please know that I did not "place" it there; I simply responded to questions posed by the reporter.

I can, with every confidence, assure you that wheat in the diet exerts outsized effects on blood glucose due to the unique configuration of branching of the glucose polymers in the amylopectin A unique to wheat.

In reply to Joe
You are 68 yo....”hope to get another 5-10yrs”
Gosh! Your attitude is negative and perhaps a different outlook may be the biggest weapon in your arsenal of 'tricks' that you have at the moment. From what you have said..I can't see why you can't be looking at  20-30 yrs more.
You can run 5k+ 3-4 p/w....I would have to wake up early and hope to get back by sunset to walk 5k.

My heart problems (self inflicted) are a tad different than yours...
MI and CAGB at age 37 (25yrs ago) Pumping on LAD and collaterals currently. Treated with medication and a similar nutrition and supplement list as your own.
Have smoked since 15yo and still do..insane! I know..will make first attempt to quit by years end..simply tired of being breathless and feeling ordinary. Also drink a litre of red wine daily (to take the edge off)
Needless to say am not qualified to be a mentor to anybody (just sharing thoughts and experiences)

Now back to you and your 'faulty parachutes'....
(1) Consult an interventional cardiologist and a holistic cardio man for opinions on surgery (write a list of all your questions beforehand)
(2) Seek other patients that have been in your position to get their feedback (google away)
(3) CHD is a scary disease that draws us into a feeling of doom and if you can cross this barrier...zippidy -do-da.

If certain farmers started growing the "old" type wheat would this eliminate the problems of  "modern" wheat?
Maybe some entrepreneurial farmers could fill this niche market at least as far as flour for home use, then we could eat bread without concern. It's hard to completely give up the all the crunchy stuff. Drinking and smoking is easier to quit  (no joke).

Congratulations, Dr. Davis. Looking forward to reading your book.
BTW, do you know if Europe has switched to the dwarf variety too?

Hi, Stip--

Yes, most farmers in Europe and Asia, big and small, have converted to the semi-dwarf variant. I'm told this by wheat breeding experts, as well as by Dr. Gary Vocke at the USDA, who collects all data relative to wheat worldwide.

Hi, Wayne--

Yes, it can be difficult psychologically for many.

Wheat in all its forms has been a problem for as long as humans have eaten it. We have records suggesting, for instance, that celiac disease was described in 100 AD. The modern forms have made it much, much worse, however.

I believe that a return to the forms of wheat--einkorn, emmer, non-genetically-manipulated "heritage" cultivars of wheat--would be far better, though it would not be perfect since some people will still respond with abnormal immune responses, while others react to the carbohydrates. But it would indeed be somewhat better.

Hi Dr. Davis,
I just read Tom's review over at his 'Fat Head' blog and I'm looking forward to reading the book. Do you have any idea why the Kindle version isn't available in Canada? Hopefully it's just a timing issue and it will be available shortly.

To Michael Gorancy:

No, Michael, my attitude is extremely positive. But I'm also a realist. I just don't have a desire to undergo open-heart surgery, and I never expected to live forever anyway. I'm already past my anticipated expiration date.

I'm sorry to hear about your problems; yes, they seem self-inflicted.  Most of our health problems are. I smoked for about 15 years, early in life, and thankfully quit about 38 years ago. And that you continue to smoke in your condition, well, that seems pretty negative to me. I'm fighting back; you seem to be giving up. But it's definitely your decision to do so, as it is mine.

Another "20-30" years? I don't think so. That would mean I'd be 88-98 years old at death.  Are you serious? As stated before, I have Alzheimer's in my family, and there may not be a worse disease than that. Dropping dead from a sudden heart attack or heart failure (say, while out jogging) versus perhaps decades of not even knowing who I am, needing to be confined for my own safety, and a burden to others? That's a no-brainer for me, Michael.

Your points:
1. I've already decided not to have open-heart surgery.
2. Yes, I wish I could find such patients.  But as Dr. Davis has said, it's apparently a rare condition. I can't find anything in the literature or on the Internet that's been any real help in that area.
3. Again, I don't have a feeling of doom. Quite the contrary, in fact. Someone once said that "life is not a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a ride!"  I want to be able to "skid in broadside" when I go, not be forced to lie in a bed in my own feces.

I wish you the best of luck, Michael! But I sure wish you'd stop smoking!

Joe

I suggested to my mother-in-law that she eliminated sugar and flour from her diet.  She is overweight, and has hypertension, IBS, depression, hypothyroidism and fatigue (and, I believe, undiagnosed low cortisol based on an at-home salivary test)- she is a delight for the drug firms.  Without any exercise, she has now lost 23 pounds in about 4 months.  She is a lot better mentally and has more energy.  We will have to wait and see with her other problems pan out.

I have ordered the book from Amazon and looking forward to its arrival. It is hard to argue against bread with its biblical endorsement - your book changes this.

Was 30 pounds overweight and suffered frequent heartburn.  I ate a lot of bread and pasta as I though it was healthy.  WRONG!  After reading Dr. Davis' "Have some more" I gave up wheat entirely and lost 20 pounds of fat in four months (muscle strength has remained constant.)  I eat as Dr. Davis recommends and am never hungry.  Friends have commented that I look quite robust (I am 58.)  No more heartburn to boot!  I am spreading the word about this great site to whoever will listen.  Thank you very much!

Hello and gratz on the book.

I heard your interview on Robb Wolf's podcast. A fantastic show i must say and extremely interesting with all these stories of what wheat can do.

My son who is 1½ years old has been suffering from som nasty wounds in his head for the last 6 months.
The doctors have given the diagnosis Ofujis disease. Do you have any knowledge if this disease could be caused by wheat?
I can find nothing on the disease besides it's rare and there seem to be no cure.

Keep up the good work,

best regards
Your knew danish fan

Got the book yesterday from Amazon and already a few chapters into it. Congrats, Dr. Davis!

Left it on the dining table for friends and family to read. People have read parts of it (my plan is working!) and the verdict: it's scary. They should be scared.

Dr. Davis any comments on the CNN show last weekend with Dr. Gupta called 'Last Heart Attack'? There was an awful lot of disturbing talk about eating healthy whole grains and avoiding meats and oils. At least they talked a lot about calcium scans and interviewed Dr. Agatston. Wish they'd interviewed you instead of Ornish. Too bad.

I would also enjoy reading your opinion regarding "The Last Heart Attack". It has been discussed on other blogs as well. Many of us feel that our former president looks awful. Not at all healthy or robust. He's been taking the advice of Ornish for quite awhile and has had heart problems at the same time. Perhaps he needs a new physician!

I got my copy in the mail and read the first section before looking at the rest of the mail.  Following your advice from just this blog I've lost 70 lbs, raised my hdl and got my triglycerides to 80 and lowered my total cholesterol. I don't think any words are enough to say how thankful I am for your advice.  You're not only helping people lose weight and feel better, you're extending their lives.

I've been waiting for a post to comment on and this seemed like a good one...

Hi Michael G.,
Smoking generates myelo-peroxidase enzymes that oxidize the Apo A1 lipo-protein and then the ApoA1 component of HDL doesn't function well ... maybe you know this already.

Good work.

The book is turning up all over the place.

http://suzanneloomscreativity.blogspot.com/2011/09/roaming-ancestors-standing-still.html

Nina

Congrats Dr. Davis on the new book!  Look forward to learning more about the problems wheat can cause the body.

Dr. Davis,
I just posted a review of Wheat Belly on my blog ( see below).  I think the release of Wheat Belly will be a watershed event.  With the increased focus that has occurred recently on low carb diets and now this, the indictment of wheat as the primary culprit, I think many Americans will finally see a way out of this health nightmare.

http://cravingsugar.net/wheat-belly-book-review-william-davis-gluten-intolerance-diet.php

As I read your book I kept on running across the thoughts that "that happened to me" or "so that's what happened to one of my friends".  I think many will get the same reactions.

Congratulations on publishing such an important book!
...Joe...

+1.  As someone thats new to the paleo/primal diet and a young heart attack survivor I'm very concerned and confused after watching this.

This was meant to be in response to "The Last Heart Attack" comment above.

RE: The Last Heart Attack, my suspicion is that any diet that gets people off of factory produced food is a giant step in the right direction, whether it's Dr. Davis's, or Ornish's, or Esselstyn's or Agaston's.  These doctors all blame different foods, but they all advocate eating natural foods and staying away from processed ones.

Wow, Joe! You wrote a basic primer on the Wheat Belly project!

Very nice. And thanks!

Thanks, soul! Stay tuned. On both The Heart Scan Blog and the Wheat Belly Blog, I will continue to chronicle the growing wheat-free experience, as well as better ways to enjoy diet while remaining 100% wheat-free!

Hi, Nina--

That's great . . . provided I don't receive any unmarked packages with a ticking sound!

Thank you, Tom, for sharing your experience. Simply telling your story will catch the attention of a few more people, who will then return and post their experiences, which will then . . . and that's how you and I build this grassroots effort to buck the nonsensical "cut the fat and eat more healthy whole grains" nonsense that passes for dietary advice today.

Hi, Vin--Thank you!

What I told Linda a few comments above applies here as well. The world has been misled by the faulty logic: If something bad (white processed flour) is replaced by something less bad (whole grains), then more of the less bad thing is great. This is faulty, and potentially fatal, logic, but the basis for the entire nationwide advice to "cut your fat and eat more healthy whole grains." Gupta fell for it, hook, line and sinker.

Hi, Linda--

I admire Gupta's intentions. But he fell for the same nonsense that passes for conventional advice in health and heart disease prevention.

In particular, the world has been misled by the faulty logic: If something bad (white processed flour) is replaced by something less bad (whole grains), then more of the less bad thing is great. This is faulty, and potentially fatal, logic, but the basis for the entire nationwide advice to "cut your fat and eat more healthy whole grains."

I obviously don't have access to Mr. Clinton's health records, but he has every sign of being a small LDL particle kind of guy. He might also have Lp(a). I'd be surprised if either of these have been identified.

Interestingly, while I admire much of Arthur Agatston's work, he has stated publicly that coronary calcium cannot be reduced. Anyone following these discussions knows that this is not true: coronary calcium can be reduced, even to extreme degrees. But the solution does not involve cutting fat, whole grains, and does not necessarily involve statin drugs.

Thank you, Jesper. Sorry, I know of no association of wheat consumption and your son's condition. However, I have to say that the reach of wheat into multiple health conditions even continues to surprise me.

I wish the best for your son.

Thanks, Dave! And thank you for coming back to share your experience.

It's stories like yours that build the experience. Please continue to come back and report your progress!

Hi, Paul--

Congratulations to your mother-in-law!

In Wheat Belly, you will learn that the wheat of the Bible is different from the stuff being passed off to us today--it's completely different.

Hi, Mike--

Sorry, no idea. I can't imagine that will continue.

Did you notice Bill Clinton's odd red face? While it could be that he simply drinks too much, I've seen this rash in many, many people who have odd responses to wheat; accordingly, the rash goes away with wheat elimination. Interesting. I suspect Clinton has a wheat addiction, since programs like that advocated by Ornish cultivate this sort of thing.

Hi Dr. Davis. I'm reading "Wheat Belly", and one thing that really jumped out at me were the studies about reduction of intake of wheat-based foods from naloxone administration. Did these studies have any control to measure the amount of appetite reduction for non-wheat foods? Thanks.

Hi, Dave--
The researchers didn't look specifically at wheat foods, but made statements like "the reduction in unhealthy fatty and sugar foods like cakes, cupcakes, and pie were reduced." So there was a bit of extrapolation on my part, but the final message, I thought, was pretty clear even though the investigators with their pre-existing dietary biases did not see it.

Yes, Peter. I agree.

An argument could be made for this approach in some genetic types, e.g., apo E4. Note also that neither of these docs are cardiologists and have probably treated as many heart attacks or dealt with real heart disease as the kid working at Home Depot.

We should learn from them what lessons might be useful for people outside of the exceptional apo E4. It was the Ornish diet that, 20 years ago, made me gain 30 lbs, pushed my HDL to 27 mg/dl, increased my triglycerides to 350 mg/dl, and made me diabetic. Going off their diet and eliminating all wheat and sugars corrected everything, including no more diabetes. Having seen a similar scenario play out many, many times, these guys are, in my view, flogging a dead horse. The horse ran a good race while it was alive, but now it's dead.

Dr Davis, you seem to have nailed it in my opinion.  Still trying to get my wife on board.  It was that (Ornish) diet that gave me a heart attack two years ago (34 yo and 155 lbs).  HDL was 16!  TC 115!  I just very recently found the whole Paleo, or eat fats, not grains, diet and I really hope this works for me.  I am very very confident it will.

Right. And presumably they were looking at binge eaters, and I suspect most people don't have a problem binging on foods which don't contain wheat and/or refined sugar.

Just as an FYI, from my Canadian IP, going to the Kindle version of the page ( http://www.amazon.com/Wheat-Belly-Weight-Health-ebook/dp/B00571F26Y ), it says "This title is _not available_ for customers from Canada". The 'not available' links to the following explanation: "Due to copyright restrictions, certain Kindle Titles are not available everywhere...". So it appears to be something to do with the publisher.

Dr. Davis,

I heard your interview on Robb Wolf's podcast and I'm eager to read your book after your very convincing appearance! As a Cardiothoracic Surgeon (in Norway), I've put my head on the block by both publicly and on my blog recommending people to take grains out of the diet. Imagine my disappointment when I found that I can't buy the e-book because I'm situated in Norway! Is there any way I can get around "the ban of Europe"?

Best regards,

tg

I'm looking forward to reading the new book. I'm going to download it to Kindle as soon as I finish The Art and Science of Low-Carb Living. Based on what I've read on you blog in the past, I'm sure I will be recommending it to our RDs and Personal Trainers at Life Time Fitness.

Thanks, Tom!

Dr. Geisner--

I saw your question over on the Wheat Belly Blog. I will need to check into what is going on.

Thanks for asking!

Looks like a great book. It's startling to know--for a beginner like me how twisted the food production process has become from the books and documentaries i've seen since i've converted to eating healthy.

Perhaps William Davis is correct in the claims he makes in Wheat Belly. And perhaps not. Time will tell. Many have made nutritional proclamations about a number of things, including the “fact” that eggs should be avoided, or that red meat can and will certainly cause heart disease, or that we must stay away from anything white, including flour, milk, and yogurt. And now the claim is that wheat is an opiate that must be eschewed at all costs.
Has wheat been genetically engineered—with deleterious effects—for mass production? Probably. But what hasn’t been? Davis recommends eating salmon…is that wild caught or farm raised? Even if advertised as wild caught, how do we know this? There has been some unresolved controversy over mislabeling, and serious concerns over mercury and PCB content in some salmon. Eggs are recommended by Davis— “not in the once a week” style as we’ve been taught—but as often as one’s body tells one to eat them. But what kind of chickens produce these eggs and what are they eating? How do we know? The same holds true for the other recommended items on the Davis diet. Even if all of the “cage-free, grass-fed, wild-caught, organic, super organic, sustainable, pesticide-free” goods were accessible and affordable to the average American (a separate topic, of course), there are all sorts of issues about authenticity—some of which probably won’t surface for years. It’s not necessarily possible for us to each have a plot of land with our own chickens, cows, pigs, vegetable gardens, and spring water.
Among other issues, there are two things that are especially troubling about Davis’s work. One is the polemical tone that allows for nothing less than everyone going off of every form of wheat--and not having wheat in any quantity ever again (unless one wants to face uncomfortable and even dire side effects). Regardless of family history, exercise, indigenous foods, cultural background, etc., the message is the same for everyone. The second troubling feature is that those who write positive reviews on Davis’s blogs are often commended by him, while those who write in to say that perhaps his stance is a little extreme are not even addressed (and perhaps not included?). “Pascal” from Davis’s blog on oatmeal, for example, writes in to say that his glucose level after eating a regular serving of oatmeal is nowhere near what Davis prophesied that it would be—and says that his is not an isolated case. There was no response to this.
Walter Willett, MD, and Chair of the Department of Nutrition at the Harvard Public Health Department, argues that it’s not at the starting line that we determine whether or not a particular diet is effective. It is not over the course of three or six months, or even a year or two. All the “before” and “after” pictures in the world don’t really matter if five or ten years down the line, the individuals in question have gone back to their “before” weight and numbers—or worse. What counts is that which can be sustained over a lifetime…and this takes time and resources to chart and scientifically assess. (As a sidebar, Willett promotes certain types and quantities of whole grains, in conjunction with a number of other food types, as well as exercise).
Time will tell whether or not Davis’s work is the best thing since sliced bread—or not.

If you're going to go on like that, I think it would be best to leave a name or identifier. Nothing like throwing rocks and then running.

One issue: There is absolutely no question that wheat has changed genetically. Ask any agricultural geneticist. This is not concealed; in fact, it is openly talked about, even proudly. The incredible thing is that it is not seen as the cause of multiple health problems.

And I have to pick my battles. Some are simply not worth fighting.

Please forgive me if my response seemed too strong. As I say, you may be right about everything in your book; you certainly make some fine points and have given people good things to think about. My point was simply that some claims in Wheat Belly may need to be mitigated or adjusted over time—and that there are medical professionals, researchers, and scientists with varying opinions on the topics you present.  Hopefully that is a good thing in that it encourages further thought and study in an ever-changing field. Your diet may work perfectly for some people, and that is great. For others, perhaps your recommendations work in modified form. And for yet others, maybe another nutritional plan works best. Hopefully that’s okay. Thank you for taking the time to respond, and for helping people to consider such an important topic. And thank you for helping me to think carefully about some new ideas.

Ah, THAT anon.

Please keep in mind that it is a book. It is not a round table discussion.

From where I view the world, wheat looks to me like the biggest nutritional blunder ever committed on a large scale. Removal of it yields some of the most incredible weight and health turnarounds I have ever seen. It doesn't have to work for everybody and it's okay with me if this makes some people angry. My concern is that people need to hear the side of the argument that few are talking about . . . while being inundated with proclamation of the benefits of "healthy whole grains."

I just bought your book today.  I'm only about a quarter-way through it, and it's excellent so far.  Intriguing, and very well written.  

I'm full blooded Mexican born and raised in the US on a pretty typical American diet.  Rice and beans were staples in my house, but we favored bread and flour tortillas over corn tortillas like good Americans.  Everyone in my family has struggled to varying degrees with weight.  I'm by far the thinnest because I've worked very hard to stay fit and trim.  I work out about 4-5 times a week, lifting and doing cardio.  I can't eat like most other guys who seem to be able to consume 50% more than I do, workout less, and look just as good or even better.  When I was younger I thought maybe Mexicans were just prone to more pudge around the middle.  Even at my thinnest, fittest, and buffest I still maintain some semblance of a belly.  It's frustrating.

When I was 15 I traveled to Mexico for the first time to visit extended family.  I wasn't in as good of shape then as I am now (at 35), and had more belly fat.  A very curious thing happened on that trip:  In spite of eating copious amounts of my grandmother's delicious food for a solid month - 3 hearty meals a day including "cena", the last Mexican meal of the day which happens right before bed - I shed pounds.  To my American friends this seemed implausible.  "But Mexican food is soooo fattening!"  "Eating right before bed?  That's the worst!"  "All that cheese?"  etc.  Still I lost weight without any physical effort, and while eating way more than I did as a self-conscious teenager back in the States.  

I've since traveled to Mexico more times than I can count, and every single time without fail, I eat more and lose weight, noting the difference especially in my belly.  Chilaquiles (fried strips of corn tortilla with cheese), chiles rellenos (stuffed peppers with cheese), tamales made with lard (yes, lard), etc.  Doesn't matter.  Pounds come off without additional exercise, indeed without the exercise I'm used to in the States.  It dawned on me one day that maybe there's something about the American diet and our processed food that makes it so challenging for me to stave off gut flab.

I just spent a month there this summer, and this time I did do a little exercise (push ups and sit ups in my hotel 3 times a week and running on the beach just a few times - far less than I do at home), but I certainly didn't skimp on food.  By the end of my trip, my stomach was the flattest it's ever been in my life, finally exposing those two elusive cans on my lower abdomen to reveal my six pack.

A couple of weeks after my return to the States, I was back to my four pack in spite of eating much less and ostensibly healthier food, and working my ass off at the gym.

All this to say, maybe it's the wheat.  (You nod.)  When I'm in Mexico my main source of carbs is corn not wheat.  Could it be that that simple switch is why my belly flattens out when I'm in my ancestral homeland?  I'm going to put it to the test, and will let you know how it goes.  

Hi, Alejandro--

Wonderful observations! You seem to have a gift for connecting cause-effect relationship.

While corn is, by no means, without its own set of concerns, given a choice of corn vs. wheat, I'd pick the corn. Perhaps that's at least part of the reason you experience the weight loss with each trip.

"But small LDL is so ubiquitous, not addressed by conventional strategies like statin drugs or fat restriction (it is made worse, in fact, but reducing fat in the diet)"

Just to be clear about the above quote. You say "it is made worse, in fact, but reducing fat." Did you mean "by" reducing fat?

Also, if that is the case, is that because of the fat itself or because less fat means replacing it with carbs?

In addition to CETP inhibition, some other benefits of red/blue/purple foods (that also include polyphenols other than the anthocyanins - elligitanins, etc) include:

1) inhibition of amylase - less of a blood sugar spike after eating starchy foods, less aberrant glycation and AGEs.
http://www.ncbi.nlm.nih.gov/pubmed/15796622

2) Estrogenic activity - anthocyanin stimulates the beta-estrogen receptors in blood vessels and bone, not much activity in the alpha receptors in breast, uterus.
http://www.ncbi.nlm.nih.gov/pubmed/20049322

3) Phosphodiesterase inhibition!
http://www.ncbi.nlm.nih.gov/pubmed/15769121

I was surprised that Ron Krauss, who did a lot of research on small particle LDL and recently published a mega-study supposedly showing saturated fat is unrelated to heart disease, made these comments in a recent interview:

People should limit saturated fat to 10% of their diet, though some can get away with more.

Optimal carbs intake: 35 to 40%.

People used to get heart disease from high cholesterol, but now its mainly high carbs.

The interview is here, and those ideas are toward the end:

http://www.meandmydiabetes.com/2010/03/26/ldl-cholesterol-ron-krauss-md/

I would love to know if you have any comment.

This is worth knowing about! Low cost (relatively) lab tests without needing a doc visit/prescription

https://summitcountymedicalsociety.prepaidlab.com/

All tests performed by LabCorp

sometimes it comes down to our health being all about our genetics. As a result of the recomendations of this blog with regard to wheat and sugar elimination, normalizing vitamin D i have taken down my LDL from 1810, all small to 609 of which 346 are small; i can only lower my particles with statins- diet alone will not do it.  My understanding of the research is that at low levels, size does not matter. I will note that when my particles were sky high i thought i was follwoing a very healthy low fat, grain oriented diet.  Now, i eat now grains and have a fair amount of mono fats from avocado and olive oil, some sat fat from lean meats, poultry and eggs, and hope i have minimized the progression of artery plaque that shocked me when i found out i had it when i followed healthy heart diet, exercise and maintained a very lean body weight.  Gentics are tough to overcome, but the risks can be minimzed via diet and meds.

Different segments of the same carotid artery can apparently be affected by a different gene. Each segment is itself susceptable to different pathological processes, like shear rate of the near inner arterial wall. Artherosclerosis at different arterial segments seem to predict if pathological event will be ischemic stroke or myocardial infarction.

The North Manhattan Study tried to tweak 145 genes modulated by 702 single nucleotide polymorphisms. That study and the San Antonio, Erasmo Rucphen and Framingham have led to opinions that 30% to 60% of the thickness of the carotid artery's intima-media is geneticly inherited. Then for carotid plaque +/- 28% is passed on geneticly.

Sex of the individual and racial ethnicity are other genetic variables. Doc Davis' clinical observation is telling us something equally important about small LDL's genetic variation.

Is small LDL the "VLDL" on blood results?

Hi, Tommy--

Yes, indeed. Just a typo.

Probably both.

Hi, Jonathan--

Excellent! Yes, the conversation surrounding anthocyanins is becoming increasingly interesting.



Hi, Peter--

I don't personally know Ron Krauss, but I too have been puzzled by the fact that his public comments don't seem to reflect his research findings. If he were to echo the important findings of his research, he would indeed be a low-carb, high-fat advocate.

Steve--

Wonderful results! The diet approach works, no doubt about it.


Hi, Ryan--

No, two different things.

Hello Dr.Davis,
Your comments sound very similar to Dr Ray Strand...do you read his work? If not, I think you would enjoy his thoughts. His website is www.drraystrand.com
Cheers,
Sue in BC Canada

Question for all you Small Particle techies out there.  Always had "Good" lipid panels, even though overweight and borderline type 2 under control with a low carb diet.

Numbers usually average:
Total Cholesterol 125
LDL  65
HDL  45
Tri  90  

Just got first particle size test done, results in VAP format:  

LDL-1 3
LDL-2 0
LDL-3(B) 36
LDL-4(B) 34

I know particle size goes down as the LDL- number goes up, but how do these numbers translate to the NMR numbers Dr. Davis listed as a target for those of us genetically pre-disposed to pattern B LDL?

^I'm interested in the same thing

Brent,

Your small LDL makes up 96% of your total LDL particles. This is a severe pattern.

Also, your HDL is too low and your triglycerides are a tad too high. Dr. Davis' Track Your Plaque goal of 60-60-60 is a good rule of thumb. LDL down to 60, HDL up to 60, trigs down to 60.

If you're currently following a low-carb diet and still have all of this small LDL, your small LDL pattern is probably the genetic type that Dr. Davis talks about here.

David

ThatÂ’s not just logic. ThatÂ’s ralley sensible.

IJWTS wow! Why can't I think of thnigs like that?

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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.