How important is high blood pressure?

24. June 2006 William Davis (0)

Control of blood pressure is crucial for coronary plaque control and stopping your heart scan score from increasing.

Dr. Mehmet Oz (of Oprah fame and a cardiac transplant surgeon at Columbia University) made graphic point of this on the ABC TV news show, 20/20, last evening on an episode called "Our Bodies: Myths, Lies, and Straight Talk". (See a summary on the ABC News 20/20 website at http://abcnews.go.com/2020/story?id=2109291&page=1)

Although I believe he somewhat overstated the case for hypertension (proclaiming "If you're going to remember one number, if you're going to focus and fixate on one number in your entire health profile, it better be your blood pressure"), he made the point that a blood pressure of 115/75 is what you should have for optimal health.

I couldn't agree more. Unfortunately, the old advice that desirable blood is 140/90 or less is absolutely wrong. At this level, we see flagrant increases in heart scan scores. We also progressive enlargement of the thoracic aorta, the large vessel that leaves the heart and branches to provide the major arteries of the body. Growth of the aorta to an aneurysm is also common at these formerly acceptable blood pressure. (The diameter of your aorta in the chest is an easily obtainable measure on your CT heart scan.)

The blood pressure you need for halting and reversing plaque growth on your heart scan is indeed 115/75 or less. (Not so low, however, that you're lightheaded.) This is the blood pressure that you were meant to have evolutionarily. It's also the blood pressure that helps tremendously in keeping your aorta from enlarging.

Watch for an upcoming exhaustive report on blood pressure and its plaque-raising effects and how to reduce it using nutritional strategies on the www.cureality.com membership website.

Is your doctor in cahoots with the hospital?

21. June 2006 William Davis (0)
I got a call from a doctor about a patient we've seen in past.

"I've got Tricia in the office. She's been having some kind of chest and abdominal pain. I think it's esophageal reflux, but just to be safe I'm sending her to the hospital."

I advised this physician that, given Tricia's low heart scan score, she was unlikely to be having a coronary "event" like heart attack or unstable symptoms. It wasn't impossible, but just highly unlikely.

As the patient was without symptoms at the moment and had driven herself to his office, I offered to perform a stress test immediately. (Though stress tests are of limited usefulness in people without symptoms, they can be useful provocative maneuvers in people with symptoms of uncertain significance.)

The doctor declined. Tricia was, after all, in his office and he was responsible for any decisions despite any objections I voiced. Well, Tricia was directed by her doctor to go to a local hospital, though one with an especially notorious reputation for putting virtually anyone they can get their hands on through as many procedures as possible.

As you might guess, this doctor was closely associated with this hospital. He and his colleagues obtain incentives (or are penalized) if they do not generate revenue-producing procedures for the hospital.

So, guess what? Tricia ended up with several procedures, all of which yielded nothing--except $30,000 in revenues from Tricia's insurance company.

I harp on this deplorable state of affairs because it is utterly, painfully, and shamefully TRUE. Just look at the hospital and you'd better brace yourself for a series of tests that could cost you the equivalent of a nice 3 bedroom home. If they were truly necessary after the failure of preventive and other simple efforts, fine. But, all too often, they are driven by profit motives.

Could I have stopped this somehow from occurring? After all, Tricia was reasonably aware of the way we do things around here. I fear that even this failed to serve Tricia well. But I remain hopeful that, as we build broader awareness of these issues, that more and more people and physicians will stand up and refuse to tolerate the status quo.

Where is the Track Your Plaque program going?

21. June 2006 William Davis (1)
I spend a lot of time worrying about how people can be helped to navigate through this program.

Take, for instance, the man in rural Texas who, while traveling in Dallas, got a heart scan on a whim. His score was 990. When he took the report back to his doctor, he got a smirk--and that's all. When he came to the Track Your Plaque program, he lacked a physician advocate to help him.

Or the woman from Florida who sought opinions from two reputable cardiologists for her heart scan score of 377. Both advised her that she needed a heart catheterization--despite her lack of symptoms, her 5-day-a-week exercise program, and normal stress test. She also lacks a physician advocate who acts on her behalf, helping her achieve success, rather than just churning her for money from hospital procedures.

For people like this and for others, I see the Track Your Plaque program evolving in several directions:

1) An online clinic--You enter and we take your "hand" and lead you step by step through the process, not only at the beginning, but over the months and years. This would help clear up some of the confusion and zigzags that some people experience trying to navigate through the program.

2) Develop physician and non-physician partners--The woman in Florida, for instance, could be referred to a doctor nearby who understands the program and is able to assist her. At present, this is virtually impossible because of the bias towards heart procedures, drugs as the sole treatment for heart disease risk, and the superficial physician-patient relationship. The majority of practicing physicians just don't understand the program despite the fact that it is based on sound clinical and experimental data. But it will in time.

Looking back, we've come a long way. I remember first having patients undergo heart scans 10 years ago. My colleagues laughed or called it "silly". The general public didn't know what they meant.

Now we're talking about how to broadcast the most powerful heart disease prevention program available in the world to a larger audience, but making it easier and more accessible. Mass media like Oprah's two hour-long spots helped, but we need to make the next leap. Not just identifying hidden heart disease to feed the hungry cardiovascular hospital procedure monster, but to educate/inform/empower the public on what to do with the scan once they've had it.

Who cares about triglycerides?

19. June 2006 William Davis (0)
Walter's triglycerides were 231 mg. His LDL cholesterol was "favorable" at 111 mg, HDL likewise at 49 mg.

"Everything looks good," his doctor declared.

"Do you think the triglycerides are okay, too?" Walter asked.

"Well, the guidelines do say that triglycerides should be less than 150, but I believe you're close enough. Anyway, triglycerides don't really cause heart disease."


When I met Walter, I made several comments. First of all, in light of his heart scan score of 713, none of his numbers--HDL, LDL, or triglycerides-- were acceptable. But the triglycerides were glaringly and terribly too high.

Why? What exactly are triglycerides?

Triglycerides are a basic fat particle that, though they do not cause heart disease directly, trigger the formation of an array of abnormal lipoprotein particles in the blood that are among the most potent causes of heart disease known.

These abnormal lipoprotein particles include small LDL, VLDL, and IDL (intermediate-density lipoprotein--a really bad pattern). Excess triglycerides also cause HDL to drop. They also cause a distortion of HDL structure, causing the particles to become abnormally small. Small HDL is also useless HDL, unable to provide the protection that HDL is designed to do.

So Walter's elevated triglycerides are, in reality, a substantial red flag for an entire panel of abnormal particles that contribute to the growth of his coronary plaque.

So, if you get this kind of commentary on your triglycerides, ask for another opinion. (Track Your Plaque Members: Also see Triglycerides: Mother of meddlesome particles at http://www.cureality.com/library/fl_dp002triglycerides.asp.)

Total cholesterol and heart scans

19. June 2006 William Davis (0)
Andy was fearful of heart disease in his life. At age 52, he'd already had four CT heart scans--one each year on or near his birthday.

Yet, when I looked at Andy's scans, his scores had been increasing 20-24% per year. Each and every score was greater by 20% or more over the previous.

So I asked Andy what steps he had taken to stop this relentless progression. "Well, I've always been real health conscious. But ever since my first scan, I really started sticking to a healthy diet, exercising nearly every day, and I take a bunch of supplements."

"What did your doctor advise?" I asked.

"Well, Dr. ---- said that nothing needed to be done, since my total cholesterol was always below 200."



Men's Health magazine's fabulous story about the folly of using total cholesterol to gauge heart disease risk.




Aaaauuuggghhh!! Wrong!

This man was, in fact, at rapidly escalating risk for heart attack. This rate of growth simply can't continue forever without igniting this bomb.

A total cholesterol below 200 is meaningless, as Andy's increasing coronary plaque proved. For instance, you can have a total cholesterol of 165 mg but with an HDL cholesterol of 27 mg. This would constitute very high risk for heart disease despite the low total cholesterol. The low HDL pattern is among the most common reasons for a misleading total cholesterol. Small LDL, high triglycerides, and lipoprotein (a) are other frequent reasons.

Andy, run the other way! Do not heed this doctor's advice! You need a solid answer to the question: Why exactly do I have coronary plaque in the first place?

Then, agree on a treatment program that corrects your specific causes.

Cardiologists out of touch

17. June 2006 William Davis (0)
This weekend, I'm fulfilling some responsiblities I have every so often to some of the local hospitals. It gives me a chance to interact with many of my colleagues who are likewise "on call" for the weekend.

I tried to strike up several conversations with colleagues about how they were managing heart disease prevention. I received blank stares, puzzled looks, indifference. One colleague declared that 80 mg of Lipitor is all you need to know.

These same colleagues are the ones scrambling for the heart attack patients in the emergency room, climbing over one another for consultation in the hospital for patients with chest pain and heart failure. They're consumed with expanding the range of procedures they can perform.

Carotid stenting is hot. So is stenting of the leg arteries. Defibrillators have been a financial bonanza. Opportunities abound on how to add these procedures to a cardiologist's abilities.

But heart disease prevention? How about heart disease reversal?

Frankly, I'm embarassed by my colleagues' lack of interest. Imagine we had a cure for breast cancer--not a palliative therapy that just slows the disease down or prolongs life, but actually cures it once and for all. I would hope that all physicians and oncologists would learn how to accomplish this. What if instead they focused on learning new ways to remove breasts, administer new toxic chemotherapies, etc. but ignored the whole idea of cure?

This is what is happening with coronary plaque reversal. The answer is right in front of them, but the vast majority (99%) of cardiologists choose to ignore it. After all, prevention and reversal simply don't pay the bills.

That means that, in 2006, you simply cannot rely on your cardiologist to counsel you on how to achieve regression or reversal of coronary plaque. How about your internist, family physician, or primary care doctor? Well, they're busy doing pneumovax injections, Pap smears, managing knee and hip arthritis, low back pain, diarrhea, headaches, sinus infections and . . yes, dabbling in heart disease prevention.

And, for the most part, doing a miserable job of it. What you generally get echoes the drug manufacturers pitch: Take a statin drug, cut the fat in your diet.

Until the majority of doctors catch on, you're going to have to rely on sources like the Track Your Plaque program for better information.

What if your lipoproteins are perfect?

16. June 2006 William Davis (0)


Sandy is a 56-year old woman--fit, slender, physically active, with no bad habits. A retired teacher, she has time to devote to her health. She bikes several days per week, mountain bikes, walks, and takes fitness classes. In short, she's the picture of perfect health.

Her heart scan score was not terribly impressive: 41. However, at her age, this modest score placed her in the 77th percentile. This suggested a heart attack risk of around 2-3% per year.

So we measured Sandy's lipoproteins. They were shockingly normal. In fact, Sandy is among the very rare person with absolutely no small LDL particles. All other patterns were just as favorable, including an HDL in the 80s.

This may seem like good news, but I find it disturbing. People are often initially upset by seeing multiple abnormal lipoprotein patterns. But lipoprotein abnormalities are the tools that we use to gain control over coronary plaque.

So what do we do when there are no abnormalities?

There are several issues to consider:

1) Your heart scan score reflects the sum total of your life up until that point. What if you were 20 lbs heavier 10 years earlier and your lipoproteins were abnormal during that period? Or you smoked until age 45 and quit? As helpful as they are, lipoproteins and related patterns are only a snapshot in time, unlike the heart scan score.

2) You have a vitamin D deficiency. This is unusual as a sole cause of coronary plaque. Much more commonly, it is a co-conspirator.

3) The heart scan is wrong--highly unlikely. Heart scans are actually quite easy, straightforward tests. (The only time this tends to happen is when scoring that appears in the circumflex coronary artery is actually in the nearby mitral valve. This really occurs only when there's very minimal calcium in the valve.)

4) There's a yet unidentified source of risk. Probably very rare but conceivable. For instance, there's an emerging sense that phopholipid patterns may prove to be coronary risks. One clinically available measure that we've not found very useful is phospholipase A2, known by the proprietary name "PLAC" test. (See http://www.plactest.com for more information from the manufacturer/distributor of the test.) But there's probably lots of others that may prove useful in future.

How often does it happen that someone fails to show any identifiable source for their coronary plaque? I can count the number of instances on two fingers--very unusual. (Thank goodness!)

Sandy's case is therefore quite unique. How should we approach her coronary plaque? In this unusual circumstance, lacking a cause, we tend to introduce therapies that may regress plaque independent of any measurable lipoprotein parameters. But that's a whole new conversation.

Fly to India for a bypass operation?

16. June 2006 William Davis (1)

In the June 19, 2006 issue of People Magazine, there's an article called "The Doctor is in . . .INDIA". The report talks about how, with health care costs in the U.S. spiralling out of control, more and more Americans are leaving the country to have their procedure performed.

They tell the story of Mr. Carlo Gislimberti of New Mexico and cite these numbers:

Heart Surgery
Cost in U.S.: $200,000

Cost in India: $10,000

Mr. Gislimberti opted to have his coronary bypass operation in India for cost reasons.

But the People magazine report left out one other option: The Track Your Plaque program: $39.00

Do your part to save ballooning health care costs: Engage in a truly powerful program of heart disease prevention like the Track Your Plaque program. The cost difference is laughably huge. And you won't require a 12-inch chest incision.

Follow conventional guidelines and guess what? You're going to have a heart attack. Follow the American Heart Association diet and you'll have heart disease.

Cut to the chase. The only program that is able to detect, track, and control coronary plaque better than any other process I know of is this program.

Note: I am not proposing that a heart disease prevention program like Track Your Plaque can replace a procedure like coronary bypass when a dangerous situation has developed. The Track Your Plaque program is designed to be implemented in the years before heart surgery is required. That's when you have the greatest control over your fate.

Surprise: Heart scan score reversal

14. June 2006 William Davis (0)
Gene is a jovial, fun-loving railroad worker who didn't take anything too seriously--including his heart scan score of 767.

This score placed Gene solidly in the 99th percentile (in the worst 1%). It came as no surprise to Gene. After all, his father died at age 36 of a heart attack and Gene's brother died at 60 of a heart attack. So Gene took life as it came and long ago decided not to fret about his fate.

But Gene's wife prodded him and prodded him to get the heart scan. That's when I met him.

Of course, Gene had been prescribed Lipitor by his doctor for a somewhat high LDL cholesterol. Our assessment uncovered several additional patterns including lipoprotein (a), small LDL, a pre-diabetic tendency, and a severe deficiency of vitamin D.

At 224 lb and 5 ft 6 inches in height, I felt that Gene was at least 40 lbs overweight.

One year later and with reasonable correction of all his patterns except weight loss and Gene's heart scan score was 590--a reduction of 23%!

Gene was thrilled, as was I. But, frankly, I was also surprised. Dramatic regression of coronary plaque tends to not occur so readily as long as pre-diabetic patterns persist and weight is not controlled.

The lesson: Often the only way to tell if you've achieved control or regression of coronary plaque is to have another heart scan. The tremendous variation in human responses never ceases to amaze me.

Call me when you're having chest pain

13. June 2006 William Davis (0)

I met a patient, Anna, yesterday. She was quite frustrated and frightened.

At age 50, Anna suffered a heart attack and received a stent to her left anterior descending coronary artery. What she found upsetting is that, because several members of her family had suffered heart attacks in their 40s (Dad--heart attack at age 45, paternal uncle--heart attack age 40, and even another uncle with heart attack in his late 20s), she had repeatedly asked her doctor whether she was okay.

She received the usual array of false assurances: "You're feeling fine, right? Then don't worry about it." "Look. Your cholesterol is in the normal range. Even your cholesterol/HDL ratio is fine." "Women don't get heart disease until later in life."

All proved absolutely false. As we talked, Anna exclaimed, "I think what I've been told all along is that we'll take you seriously when you finally have a heart attack!"

She's exactly right. The vast majority of times, heart disease is discovered by accident, usually because of an "event" like heart attack. This is like changing the oil in your car when it finally breaks down--it's too late.

CT heart scan, followed by lipoprotein testing and associated values, then correction of your specific causes. It's that simple.

Restaurant eating: A fructose landmine

13. January 2011 William Davis (25)
There is no remaining question that fructose is among the worst possible things humans can consume.

Followers of the Heart Scan Blog already know this, from conversations like The LDL-Fructose Disconnect, Where do you find fructose?, and Goodbye, fructose.

But fructose, usually as either high-fructose corn syrup (44%, 55%, occasionally higher percentage fructose) or sucrose (50% fructose), is ubiquitous. I've seen it in the most improbable places, including cole slaw, mustard, and dill pickles.

It's reasonably straightforward to avoid or minimize fructose exposure while eating at home, provided you check labels and focus on foods that don't require labels (like green peppers, salmon, and olive oil, i.e., unprocessed foods). But when you choose to eat at a restaurant, then all hell can break loose and fructose exposure can explode.

So what are some common and unsuspected fructose sources when eating at a restaurant?

Salad dressings--Dressings in all stripes and flavors are now made with high-fructose corn syrup and/or sucrose. This is especially true of low-fat, non-fat, or "lite" dressings, meaning oils have been replaced by high-fructose corn syrup. It can also be true of traditional non-low-fat dressings, too, since high-fructose corn syrup is just plain cheap.

Olive oil and vinegar are still your safest bets. I will often use salsa as a dressing, which works well.

Sauces and gravies--Not only can sauces be thickened with cornstarch, many pre-mixed sauces are also made with high-fructose corn syrup or sweetened with sucrose. Barbecue sauce is a particular landmine, since it is now a rare barbecue sauce not made with high-fructose corn syrup as the first or second ingredient. Sauces for dipping are nearly always high-fructose corn syrup-based.

Ketchup--Yup. Good old ketchup even is now made with high-fructose corn syrup. In fact, you should be suspicious of any condiment.

Highball, Bloody Mary, Margarita, Daiquiri, beer--Even the before-dinner or dinner drink can have plenty of fructose, particularly if a mix is used to make it. While Blood Marys seem the most benign of all, adorned with celery, pickle, and olive, just take a look at the ingredient label on the mix used: high-fructose corn syrup.

Fructose is a stealth poison: It doesn't immediately increase blood sugar; it doesn't trigger any perceptible effect like increased energy or sleepiness. But it is responsible for an incredible amount of the health struggles in the U.S., from obesity, to diabetes, to hyperlipidemias and heart disease, to arthritis, to cataracts.

A glycation rock and a hard place

12. January 2011 William Davis (15)
Advanced Glycation End-products, or AGEs, the stuff of aging that mucks up brains, kidneys, and arteries, develop via two different routes: endogenous (from within the body) and exogenous (from outside the body).

Endogenous AGEs develop via glycation. Glycation of proteins in the body occurs when there are glucose excursions above normal. For instance, a blood glucose of 150 mg/dl after your bowl of stone-ground oatmeal causes glycation of proteins left and right, from the proteins in the lens of your eyes (cataracts), to the proteins in your kidneys (proteinuria and kidney dysfunction), to skin cells (wrinkles), to cartilage (brittle cartilage followed by arthritis), to LDL particles, especially small LDL particles (atherosclerosis).

At what blood sugar level does glycation occur? It occurs even at "normal" glucose levels below 100 mg/dl (with measurable long-term cardiovascular effects as low as 83 mg/dl). In other words, some level of glycation proceeds even at blood glucose levels regarded as normal.

There's nothing we can do about the low-level of glycation that occurs at low blood sugar levels of, say, 90 mg/dl or less. However, we can indeed do a lot to not allow glycation to proceed more rapidly, as it inevitably will at blood sugar levels higher than 90 mg/dl.

How do you keep blood sugars below 90 mg/dl to prevent excessive glycation? Avoid or minimize the foods that cause such rises in blood sugar: carbohydrates.

What food increases blood sugar higher than nearly all other known foods? Wheat.

Is einkorn the answer?

11. January 2011 William Davis (14)
People ask: "What if I would like a piece of bread or other baked product just once in a while? What is safe?"

Eli Rogosa, Director of The Heritage Wheat Conservancy, believes that a return to the wheat of our ancestors in the Fertile Crescent, circa 10,000 years ago, is the answer.

Former science teacher, now organic farmer, farm researcher, and advocate of sustainable agriculture, Eli has been reviving "heritage" crops farmed under organic conditions, some of her research USDA-funded.

In particular, Eli has been cultivating original 14-chromosome ("diploid") einkorn wheat. Although einkorn contains gluten (in lesser quantities despite the higher total protein content), the group of proteins that trigger the immune abnormalities of celiac disease and other immune phenomena, Eli tells me that she has witnessed many people with a variety of wheat intolerances, including celiac disease, tolerate foods made with einkorn wheat. (The variety of glutens in einkorn differ from the glutens of the dwarf mutant that now dominate supermarket shelves.)

Eli travels to Israel every year, returning with "heritage" seeds for wheat and other crops. She formerly worked in the Israel GenBank as Director of the Ancient Wheat Program. She has written a brochure that describes her einkorn wheat.

Eli sent me 2 lb of her einkorn grain that nutritionist, Margaret Pfeiffer, and I ground into bread. Our experience is detailed here. My subsequent blood sugar misadventure, comparing einkorn bread to conventional organic whole wheat bread is detailed here, followed by the odd neurologic effects I experienced here.

Anyone else wishing to try this little ancient wheat experiment with einkorn can also obtain either the unground grain or ground flour through Eli's website, www.growseed.org. Most recently, einkorn pasta is being retailed under the Jovial brand at Whole Foods Market.

If anyone else makes bread or any other food with Eli's einkorn wheat, please let me know:

1) Your blood sugar response (before and 1 hour after consumption)
2) Whether you experienced any evidence of wheat intolerance similar to what you experienced with conventional wheat, e.g., rash, acid reflux, gas and cramping, moodiness, asthma, etc.

But remember: Wheat effects or no, einkorn is still a grain. My belief is that humans do best with little or no grain. The einkorn experience is an effort to identify reasonable compromises so that you and I can have a piece of birthday cake once a year without getting sick.

Genetic incompatibility

10. January 2011 William Davis (29)
Peter has lipoprotein(a), or Lp(a), a genetic pattern shared by 11% of Americans.

It means that Peter inherited a gene that codes for a protein, called apoprotein(a), that attaches to LDL particles, forming the combined particle Lp(a). It also means that his overall pattern responds well to a high-fat, high-protein, low-carbohydrate diet: The small LDL particles that accompany Lp(a) over 90% of the time are reduced, Lp(a) itself is modestly reduced, other abnormalities like high triglycerides (that facilitate Lp(a)'s adverse effects) are corrected. Small LDL particles are, by the way, part of the genetic "package" of Lp(a) in most carriers.

Peter also has another gene for Apo E4, another genetically-determined pattern shared by 19% of Americans. (Another 2% of Americans have two "doses" of Apo E4, i.e., they are homozygotes for E4.) This means that the Apo E protein, normally responsible for liver uptake and disposal of lipoproteins (especially VLDL), is defective. In people with Apo E4, the higher the fat intake, the more LDL particles accumulate. (The explanation for this effect is not entirely clear, but it may represent excessive defective Apo E-enriched VLDL that competes with LDL for liver uptake.) People with Apo E4 therefore drop LDL (and LDL particle number and apoprotein B) with reductions in fat intake.

This is a genetic rock-and-a-hard-place, or what I call a genetic incompatibility. If Peter increases fat and reduces carbohydrates to reduce Lp(a)/small LDL, then LDL measures like LDL particle number, apoprotein B, and LDL cholesterol will increase. Paradoxically, sometimes small LDL particles will even increase in some genetically predisposed people.

If Peter decreases fat and increases carbohydrates, LDL particle number, apoprotein B, and LDL cholesterol will decrease, but the proportion of small LDL will increase and Lp(a) may increase.

Thankfully, such "genetic incompatibilities" are uncommon. In my large practice, for instance, I have about 5 such people.

The message: If you witness paradoxic responses that don't make sense or follow the usual pattern, e.g., reductions in LDL particle number, apoprotein B, and small LDL with reductions in their dietary triggers (i.e., carbohydrates, especially wheat), then consider a competing genetic trait such as Apo E4.

The folly of an RDA for vitamin D

9. January 2011 William Davis (26)
Tom is a 50-year old, 198-lb white male. At the start, his 25-hydroxy vitamin D level was 28.8 ng/ml in July. Tom supplements vitamin D, 2000 units per day, in gelcap form. Six months later in January (winter), Tom's 25-hydroxy vitamin D level: 67.4 ng/ml.

Jerry is another 50-year old white male with similar build and weight. Jerry's starting summer 25-hydroxy vitamin D level: 26.4 ng/ml. Jerry takes 12,000 units vitamin D per day, also in gelcap form. In winter, six months later, Jerry's 25-hydroxy vitamin D level: 63.2 ng/ml.

Two men, similar builds, similar body weight, both Caucasian, similar starting levels of 25-hydroxy vitamin D. Yet they have markedly different needs for vitamin D dose to achieve a similar level of 25-hydroxy vitamin D. Why?

It's unlikely to be due to variation in vitamin D supplement preparations, since I monitor vitamin D levels at least every 6 months and, even with changes in preparations, dose needs remain fairly constant.

The differences in this situation are likely genetically-determined. To my knowledge, however, the precise means by which genetic variation accounts for it has not been worked out.

This highlights the folly of specifying a one-size-fits-all Recommended Daily Allowance (RDA) for vitamin D. The variation in need can be incredible. While needs are partly determined by body size and proportion body fat (the bigger you are, the more you need), I've also seen 105 lb women require 14,000 units and 320-lb men require 1000 units to achieve the same level of 25-hydroxy vitamin D.

An RDA for everyone? Ridiculous. Vitamin D is an individual issue that must be addressed on a person-by-person basis.

Heart scan: Standard of care?

6. January 2011 William Davis (0)
If coronary disease is easy to detect by measuring coronary calcium, shouldn't this represent the standard of care?

In other words, if you've been seeing your doctor and he/she has been monitoring cholesterol levels and, inevitably, talks about statin drugs, then you have a heart attack, unstable angina, or die--yet never knew you had heart disease--isn't this negligence?

Coronary calcium, and thereby coronary atherosclerotic plaque, are markers for the disease itself. Unlike cholesterol, high blood pressure, etc., that represent risk factors for coronary atherosclerotic plaque, coronary calcium is a measure of total plaque: "soft" elements like lipid collections, necrotic tissue, fibrous tissue, as well as "hard" elements like calcium. Because calcium occupies 20% of total atherosclerotic plaque volume, it can be used as an indirect "dipstick" for total plaque.

So why isn't an unexpected heart attack, hospitalization for unstable heart symptions, emergency bypass, etc., not regarded as potential malpractice? These are not benign events, but potentially life-threatening.

The costs of doing drug business?

6. January 2011 William Davis (28)
Here's a telling situation.

Liz had been on prescription niacin, Niaspan, 1500 mg per day (3 x 500 mg tablets) for several years to treat her severe small LDL pattern and familial hypertriglyceridemia (triglycerides 500-1000 mg/dl). Because her health insurance had been paying for the "drug," she insisted on taking the prescription form.

A change in insurance, however, meant that the Niaspan was no longer covered. Her pharmacy wanted to charge $227 per month.

Liz came to the office in tears, worried that she was going to have to choke up $227 per month. I reminded her that, as I had told her several years ago, she could easily replace the Niaspan with over-the-counter Sloniacin or Enduracin. Both release niacin over approximately 6 hours, just like Niaspan.

Here are the prices I've seen with Sloniacin, 100 tablets of 500 mg:

Walgreens: $15.99
Walmart: $12.99
Costco: $8.99

So the most expensive source, Walgreens, would cost Liz just under $15.99 per month to take 1500 mg per day.

$15.99 versus $227.00 per month for preparations that are highly similar. Hmmmmmm.

I wonder what the $211.01 extra per month goes towards? Admittedly, Abbott Labs, the current company selling Niaspan (after Abbott acquired Kos), has invested in a few clinical trials, such as ARBITER-HALTS6. But does supporting research justify this much difference, a difference that amounts to $2532 over a year? If just 100,000 patients are prescribed Niaspan at this dose (a typical dose), this generates $253 million.

Is the cost of developing and marketing a supplement-turned-drug that great? Is this justifiable? Is it any wonder that our health insurance premiums continue to balloon?

I use Sloniacin and Enduracin almost exclusively.

Measurement

4. January 2011 William Davis (9)
A crucial component of self-empowerment in healthcare is to be able to measure various health parameters. More and more measurement tools are entering the direct-to-consumer arena.

Quantification of various phenomena is important in managing many aspects of health. Imagine a carpenter trying to build a house without the use of a tape measure, level, or other measuring tools. In health, as in building a house, measurement, adjustment, and correction are critical.

Among the most helpful health measurement tools:

Blood glucose meters--Blood glucose meters aren't just for diabetics. They are among the most powerful weight loss tools available.

Blood pressure cuffs--There's no better way to assess blood pressure than to assess it under all the varied conditions of life: When you're tired, when you're excited, when you're upset, when you're happy, hungry, stomach full, morning, night. This is a lot better than the one isolated measure in the doctor's office.

Digital thermometers--Your first a.m. oral temperature is a great way to assess thyroid status. We aim to maintain first a.m. oral temperature around 97.3 degrees F, the normal human temperature upon arising that reflects normal thyroid function. (No, Dr. Broda Barnes fans, axillary temperatures should NOT be used due to flagrant variation from right armpit to left armpit, modifying effects of clothing and ambient temperature, etc. Oral temperature tracks internal, "core," temperature fluctuations reliably, including circadian variation, far better than axillary temperatures.)

Fingerstick blood tests--An incredible number of blood tests are now available just by performing a simple fingerstick in your kitchen or bathroom. You can get 25-hydroxy vitamin D, lipids, thyroid measures (TSH, free T3, free T4), hormones (DHEA, testosterone, estrogens). And the list is growing rapidly. Salivary tests are also growing in number for many of the same measures.

A variation on fingerstick blood tests are devices like CardioChek that allow you to do a fingerstick, but also run the test on your own device at home. (The CardioChek device tests total cholesterol, triglycerides, and HDL.)

Urine pH--You can dipstick your own urine to assess the relative acidity or alkalinity of your lifestyle. Acid pH (7 or below) suggests that diet is weighed too heavily in favor of animal products and grains. An alkaline pH (above 7) suggests plentiful vegetables and fruits, not counteracted by animal products and grains.

There are many more, including the ZEO device to monitor sleep quality, RESPeRATE for reduction of blood pressure, HeartMath to manage stress and augment the parasympathatic (relaxation) response. We've come a long way compared to the health monitoring devices of just 25-30 years ago.

Anyway, that's a partial list. Given the rapid advances in technology that allow such home tests, I anticipate a much longer list in the coming few years.

For some perspective on how far these devices have come, here's a great graphic of an early sphygmomanometer, or blood pressure gauge.


Courtesy Wellcome Library, London

I lost 37 lbs with a fingerstick

30. December 2010 William Davis (34)
Jack needed to lose weight.

At 5 ft 7 inches, he weighed in at 273 lbs, putting his BMI at a sobering 42.8. (A BMI of 30 or above is classified as "obese.") In addition to lipoprotein(a), Jack had an extravagant quantity of small LDL (the evil "partner" of lipoprotein(a)), high triglycerides, and blood sugars in the diabetic range. With a heart scan score of 1670, Jack had little room for compromises.

Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order.

So I taught Jack how to check his blood sugars using a fingerstick device, what I call the most important weight loss tool available. I asked Jack to check his pre-meal blood glucose and his one-hour after-meal blood glucose and not allow the after-meal blood glucose to rise any higher than the pre-meal. For example, if blood glucose pre-meal was 115 mg/dl, after-meal blood glucose should be no higher than 115 mg/dl.

If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.

Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.

What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise.

Six months later, Jack came back 37 lbs lighter. And he got there without calorie-counting, without regulating portion sizes, without hunger.

The two kinds of small LDL

27. December 2010 William Davis (17)
You won't find this in any publication nor description (at least ones that I've come across) about the ubiquitous small LDL particles. It's an observation I've made having obtained thousands of advanced lipoprotein panels of the sort that break lipoproteins down by size. I've discussed this issue previously here. But small LDL is so ubiquitous, not addressed by conventional strategies like statin drugs or fat restriction (it is made worse, in fact, by reducing fat in the diet), that it is worth keeping at the top of everyone's consciousness.

(Because most of the lipoprotein analyses performed in my office are done via NMR, I will discuss in terms relevant to NMR. This does not necessarily mean that similar observations cannot be made with centrifugation, i.e, VAP from Atherotech, or gel electropheresis from Berkeley, Boston Heart Lab, Spectracell, and others).

There are two basic varieties of small LDL particles:

1) Genetically-programmed--e.g., via cholesteryl-ester transfer protein (CETP) activity
2) Acquired--via carbohydrate consumption


It means that people with acquired small LDL from carbohydrate consumption can reduce small LDL to zero with reduction of carbohydrates, especially the most small LDL-provoking foods of all: wheat, cornstarch, and sucrose.

It also means that people who have small LDL for genetically-determined reasons can only minimize, not eliminate, small LDL. By NMR, we struggle to keep small LDL in the 300-600 nmol/L range when genetically-determined. (People typically start with 1400-3000 nmol/L small LDL particles prior to diet changes and other efforts.) We can only presumptively identify genetically-determined small LDL when all the appropriate efforts have been made, including reduction in weight to ideal, yet small LDL persists.

Here is where we need better tools: when you've done everything possible, yet small LDL persists.

While we break LDL particles (NOT LDL cholesterol, the crude and misleading way of viewing atherosclerosis causation) down by size, it's really about all the undesirable characteristics that accompany small size:

--Distortion of Apo B conformation--i.e., the primary protein that directs LDL particle fate is distorted, making it less likely to be cleared by the liver but more likely to be taken up by inflammatory (macrophages) in the artery wall, creating plaque. It means that small LDL particles linger for a longer time than larger particles.

--Small LDLs are more oxidation-prone. Oxidized LDL are more avidly taken up by inflammatory macrophages.

--Small LDLs are more glycation-prone.

--Small LDLs are more adherent to structural tissues, e.g., glycosaminoglycans, that reside in the artery wall.

You and I cannot measure such phenomena, so we resort to distinguishing LDL particles by size.

The drug industry believes it may have a solution to small LDL in the form of CETP-inhibiting drugs, like anacetrapib. In the way of nutritional solutions beyond carbohydrate reduction, weight loss/exercise, niacin, vitamin D normalization, and omega-3 fatty acid supplementation, there are exciting but very preliminary data surrounding the possibility that anthocyanins may inhibit CETP activity. Having toyed with this concept for the past 6 months, I remain uncertain how meaningful the effect truly is, but it is harmless, since we obtain anthocyanins from foods colored purple or purplish, such as blackberries, blueberries, cherries, red leaf lettuce, red cabbage, etc.

I welcome any unique observations on this issue.
"I gained 30 lbs from one cracker"

"I gained 30 lbs from one cracker"

23. May 2008 William Davis (19)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Next week's story:

California woman claims: My children are aliens!


Just kidding.


Copyright 2008 William Davis, MD
Tags :

Comments (19) -

  • Kristen's Raw

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

    Hi, I just found your blog. Very interesting Smile

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

    Cheers,
    Kristen Suzanne

  • Chainey

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

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

  • Jenny

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

    Dr Davis,

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

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

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

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

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

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

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

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

    --Jenny Ruhl

  • Dr. William Davis

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

    Hi, Jenny--

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

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

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

  • JoeEO

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

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

    Peace

    Joe E O

  • Anonymous

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

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

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

  • Darcy Elliott

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

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

    Darcy

  • Anne

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

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

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

    Anne

  • Anonymous

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

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

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

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

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

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

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

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

    chick

  • Anonymous

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

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

    Vita

  • liefman

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

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

  • Jenny

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

    Dr. Davis,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Anne

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

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

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

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

  • Sue

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

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

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

    (BTW I like your blog).

  • Stephan

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

    Dr. Davis,

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

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

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

  • Bruce K

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

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

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

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

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

  • jpatti

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Bruce K

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

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

  • buy jeans

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

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

Add comment

Loading