There are lot of unusual and interesting formulations you are using, but I really can't understand the meaning of this one:

"Glycation and of LDL particles."

Maybe my english is not the best (I am no native english speaker).Maybe you could enlighten me?

About the article. Now I realize that during 35 years of life, I had lots of such glycemic  values and not having any idea about effects.
Do you have any ideea about glycemic index if I eat quite a lot of fruits? (can't control it lately).

Thank you!

Hi Pater_F.,
I just read this post too, so see your quote shows a word to edit out. Remove the word "and", then it reads correctly "Glycation of LDL ...."

Hi Dr. Davis,

What do you think is a safe amount of carbs to eat in one sitting? No more than 50 maybe? What really gets me is the aging!! I do not want wrinkles!

For a 5'4, 125lb woman, what would you recommend is the top limit of carbs to have per meal to avoid this?

Thanks for the info about how the body handles high glucose levels. Funny you should mention a glucose of 160…

I generally stay with the low carb lifestyle. I’ve been checking my glucose on a fairly regular basis and it generally runs in the high 80s to high 90s. Exercise can bring it down to mid 70s. Fasting levels are creeping up into the low 100s.

Late yesterday afternoon, however -- after a good low carb day -- I succumbed to my baser urges and consumed several handfuls of mini Reese’s PB cups. Pretty dumb, I know.  

2 hours later, BG = 161  -- whoa, I guess that was even dumber than I thought
After a good low carb dinner, BG = 99  -- respectable, considering  
This morning’s AM Fasting BG = 150 – what the heck??  (it’s been running a little high, but not that high
Large coffee w/ cream on the way to work, BG = 118  -- getting there, slowly  
Low carb breakfast and lunch, BG = 113  -- wow! Never dreamed it would take this long  

Well, I knew it was a stupid thing to do. Now I know how stupid it really was. I’m sure my BG will continue to come back down to a reasonable level. I’ve been toying with the idea of rejoining the gym and starting the Slow Burn program. Guess it’s time.

Thanks for catching the typo, Pater and Might.

HI, Flavia--

It is truly an individual thing. For some, it's 20, 30, or 50 grams. For others, it's zero.

Body size, age, genetics, recent exercise, et. all enter into the equation. This is why I am a fan of checking postprandial blood glucoses.


Hi, Susan--

It can really be a sobering experience. When this happens to me, I feel awful for several hours, sometimes all day. I've learned that it's not worth the momentary indulgence.

Yes insulin lowers blood sugar levels by converting glucose to glycogen which is stored in the liver and by increasing cell permeability to glucose.

Individual liver condition may influence how dangerous the blood sugar reaction actually is.

"Fasting, overnight, trigs (triglycerides) are mostly bound to VLDL. But once eat there are trigs complexed to chylomicrons (from the intestine), IDL (intermediate density  lipo-protein, a VLDL spin off), in standard VLDL and even HDL.

HDL, "good" lipo-protein, is the returner of cholesterol from the peripheral regions of the body back to the liver; it too carries trigs. In the liver hepatic trig lipase enzymes hydrolize (cleave) off the HDL's trig load; and those trigs can then get complexed to both IDL and chylomicrons.

The re-circulated trigs add to the new trigs certain foods generate. When we look specificly at LDL bound trigs those trigs were passed on over from VLDL trigs, whether if were freshly tagged onto VLDL or from overnight fasting VLDL trigs.

In the case of chylomicron trigs and IDL trigs the lipase enzymes in the adipose (fat) tissue and
intestine, as well as triglyceride lipase enzymes in the liver, cleave those trigs into component free fatty acids and glycerol. In practical terms that's when we get fat in a form we can "get fat" from.

Fat in the liver tissue also causes extra fatty acids to go out into the blood stream and, among other tissue, into skeletal muscles. The muscles of course do have the potential to use fat as fuel.

Only problem is when insulin resistance starts to develop progressively in the liver, when fat in there messes with our trig balancing act. The back log concentration of intra-hepatic trigs is one of the conditions
when post meal hyper-insulinism is dangerous.

Then there is a further complication. When insulin resistance starts to go on outside the liver those peripheral tissues keep performing lypolysis. They are
trying to burn fat while waiting on blood glucose stuck outside their cells. So even more freed up fatty acids go back in the blood to burden the liver.

At this stage the liver
can't re-esterfy (break back down) the burden of free fatty acids into trigs. So more gets built into fat inside the liver and eventually can lead to blockages (steatosis). It is a vicious cycle looping trigs and free fatty acids in a double "whammy" on the liver.

To recap the immediately preceeding. A new/young/healthy liver takes in a meal, produces some extra trigs and sends it out tagged to VLDL. Once liver damaged/old/fat there are high levels of free fatty acids in circulation, the liver response to insulin drops (liver insulin resistance), the liver passes along meals glucose but the skeletal muscles are full of trig derivatives (di-acyl-glycerides, to be precise), so the muscles don't pick up the glucose either.

Once an individual's liver fat is interfering with things to an even worse degree there are further complications. Namely the trigs complexed to VLDL get out of the liver less and it is mostly chylomicron trig and IDL trig complexes circulating in the blood.

In fact, a measurement where total trigs keeps dropping can
indicate chronic liver disease. And in hepatitis the physical synthesis of VLDL is
progressively reduced; the virus inhibits protein movement in the liver microsome needed for VLDL production.

Remember there is a liver triglyceride lipase enzyme. It has several functions and can act as a binder for many other lipoproteins, including LDL.

Individuals who geneticly, or due to pathology (like in hepatitis), produce too little of this enzyme have another problem. This enzyme insufficiency makes the blood
level of HDL complexed trigs keep rising (trig can't be cleaved off HDL who brought it back to liver)so HDL can't do it's "good" cholesterol job.

The same enzyme insufficiency also lets trigs complexed to LDL, IDL and chylomircrons become elevated in the blood stream.

Cut off my post's theory, too long.

If individual has no fat in the liver (or minimal liver fat that is not enough to mess up trig metabolism), then blood sugar spike generated trigs not a problem. This can be genetic propensity, liver circadian rhythm co-incidence &/or life style.

Those laying down liver fat, geneticly impinged &/or life style disadvantaged seem to be getting good advice from Doc.

Watch out if you are in intensive care. The American College of Physicians now recommends that blood sugar be maintained between 140-200mg/dL. Their main concern is blood sugar going too low. In Hospital Blood Sugar Levels Should be Higher

They will also feed you an ADA approved high carbohydrate diet to guarantee those highs.

@Dr. Davis: Are those your own BG readings after eating oatmeal? If low-carb/keto adapted, eating a pile of carbs is a bad idea as glycolytic pathways are down-regulated.

@Anne: How about wearing a bracelet with important medical information on it in the event of becoming unconscious?

These recent blog entries regarding blood sugar are extremely simple even to the point of being vague.

I have found a site that goes into great detail regarding blood sugar, its control, and the problems associated with both high and low blood sugar levels. The blogs entries are so successful that they were edited and published as a book.

The author continues to blog weekly and includes practical detail, as well as references to current medical science. Don't let the label "diabetes" throw you. There is a tremendous amount of information regarding how to avoid T2DM with improved blood sugar control. How and when to check your blood sugar, using your meter to determine the impact of what you eat on blood sugar, the deleterious effects of higher than normal blood sugars, even what is normal sugar are all addressed and in useful detail...there are even discussions regarding low carb and paleolithic diets. If you want 5-10 quickly and poorly written sentences on a topic, read the HeartScan blog. If you are interested in reading entire well written intelligent essays visit these sites below. I think that the "MD" label misleads many readers. Don't let the fact that the writer of the Blood Sugar 101 sites is not an "MD" throw you. She is a diabetic and has lived with it for several years. Her approach to medical treatment is that it should be "evidence-based" which seems often missing from other sites.

Take a few minutes to review,

Blood sugar 101 (general information site)
http://www.phlaunt.com/diabetes/

Associated blog site
http://diabetesupdate.blogspot.com/

What happened to the post about the Blood Sugar site? It seems to have been deleted. I am sute that I saw it here earlier. Does anyone know the url for the site. it looked interesting.

yeah i saw it too. seems poster was a bit critical of Dr. Davis last several postings. sorry don't have the web sites mentioned. didn't know that you could delete a post that you don't like.

@ Anne,

In the ICU, there is risk with both too high and too low a blood sugar.  Perhaps 140-200 is an unhappy medium where risks are balanced.

'Recent research, including a study in the Feb. 15 issue of the Annals of Internal Medicine, has found that the use of intensive insulin therapy comes with an increased risk of low blood sugar (hypoglycemia) which can be deadly. The study also concluded that using intensive insulin therapy to significantly lower blood sugar levels isn't associated with greater improvements in health outcomes.'

Many ICU patients aren't eating anything anyway.  It isn't until after they are on the general medical floor that the ADA diet is given, and their sugars chased down to a lower range with insulin and/or drugs!

Teresa

11,000 Koreans studied by Stamford's Sun Kim, M.D. published in Journal Clinical Endocrinology (2011):

27% had fatty liver (ultrasound diagnosis); 47% of those with fatty liver had high fasting insulin vs. only 17% of those without fatty liver having high fasting insulin. All subjects with fatty liver also had high blood sugar, high trigs and low HDL.

Participants followed for 5 years; and data correlated on those with, and those without fatty liver who became clinically diabetic. Study conclusion is that fatty liver in participants preceeds Type 2 Diabetes by +/- 5 years in a statistically significant number (ie: no fatty liver = less risk of developing adult onset diabetes).

Doc undoubtably has new patients and blog readers who have mildly fatty livers that don't think he's right. He should make them hire Revelo to put them through their paces instead.(Joke attempt there Revelo, not a personal digg.)

I am familiar with the web sites that were mentioned in the deleted post. I did not think the post was very critical at all. It only said that these sites provided more detailed information regarding the recent blood-sugar related topics being discussed here. By the way, these sites contain a good deal information that you will only see around here at the Doctor’s pay-to-join blog.

The martinet in me would be happy to whip anyone into shape who needs it. Seriously though, even the most extreme exercise program is child's play compared to what happens when you get sick. Imagine someone saying to you: "First I'm going to saw through your ribcage, and then I'm going to slice through your arteries..." It's like something out of a horror movie. And yet that is what happens during open heart surgery. And then there are those ailments for which there is no medical relief, surgical or otherwise. Be afraid of getting sick, be very afraid. Be willing to endure any sort of diet and exercise regime to avoid getting sick.

Ni, Nigel--

No, not my personal blood sugars, but typical responses I've seen in many patients.


Re: deleted comments
I have no problem with criticisms. I do have problems with people saying things like "you're an asshole" or similar comments that add nothing to the conversation.

I now have a zero-tolerance policy for rudeness, but NOT criticism.

@ Nigel - I like MediAlert bracelets.

@ Teresa - IMHO, the ADA meal plan is much too high in carbohydrates. It does not make sense to me to cause an elevated blood sugar and then use a medication to bring it down. How about lower the carbohydrate load and use minimal medication? You can find this program in Dr. Richard K Bernstein's book "Diabetes Solution".

I am T2 and am able to keep my blood sugars in a good range by diet alone by greatly limiting my carbohydrates.  

I understand those in the ICU present with many challenges to obtaining optimal blood sugar control.

@ Anne,

I was concerned that anyone without medical training who didn't look at the article linked to in your post wouldn't realize that there are risks to both too low and too high blood sugars in the intensive care unit.

The comment about the ADA diet and using insulin and drugs to control blood sugars, was meant to poke fun at the ADA.  I apologize.  

Teresa

I don't doubt that high blood sugars are harmful, but I do wonder if when they are very transient if the effect is so terrible.  I have always had poor glycemic control.  In terms of going to 200 on a glucose tolerance test, I have diabetes.  But my blood sugars have been lower on a low-fat diet than they were on a low-carb one.  It also now takes me three times as many carbs to get to 175 or so than when I was on a low-carb diet and they are disposed of very quickly - I get down to 75-90 within an hour and a half.  I do think I have a MODY-like form of diabetes - that I'm not particularly insulin resistant.  I'm still not sure what all is going on, but I've been checking my blood sugar rather compulsively for 10 months, and this is what I've found.  

I'm nearly 45 years old, have great blood pressure, triglycerides of 44 (this may be part of my particular MODY diabetes profile - a few types have genetically low triglycerides), high HDL and low LDL.  I look young for my age.  I don't have any microvascular complications.  I'm still very concerned about my glucose levels, but whatever diet I'm on my BG goes up above 160 with nearly every meal (I can catch it if I test at just the right time), but transiently.  A high-carb diet makes my fasting glucose and between-meal readings much lower, so the overall average is lower.

Perhaps M-Al is right, if you are  storing fat in your liver, or if you are insulin resistant, it's a different story.  Perhaps anti-oxidant status, overall diet quality, and other lifestyle factors have an impact that large-scale studies don't pick up, since the numbers and outcomes of those with a Dunkin Donuts diet are averaged in with those with a whole foods diet, one along the lines of what Stephan Guyenet suggests.  

I do think I'm not normal, and a "normal" person with the blood sugars Dr. Davis cites is courting trouble.  But I'm worried about getting too obsessive about my normal, since there's only so much I can do to control it.  It might be that I can be healthy even given the givens.  

I also think it's worth considering that someone on a low-carb diet often is going to have more trouble disposing of a sudden influx of carbs.  It takes about three days of consistently higher carbs before the body adjusts.  Some people clearly develop higher triglyerides and other trouble on a high-carb diet.  My point is just that the context of one's particular phenotype is important - and sometimes tough to figure out.

Hi Helen,
I don't want to over step blog protocol, so this is just feedback. The blood test for glycated hemoglobin shows how the blood glucose dynamic is playing out the last couple of months.

HbA1c is that test and, I believe, Doc set a result over 5.5% is undesireable. Maybe it would give you some insight to how your ranges of blood sugar are playing out.

Someone here (thank you sir) recommended summitcountymedicalsociety.prepaidlab.com ; I recently used them. Credit card payment gets you an email prescription (to print out) for blood tests, they've cooperating independent
blood drawing clinics nationwide and lab results are emailed to you. (I needed their 800 phone # help some and they resolved every issue promptly.)

Charge = US$13 for HbA1c test plus +/- $16 for processing fee(one fee for unlimited tests, it seemed). Their prices were so much cheaper than other online options.

Thanks, M-Al -

At initial Dx, my A1C was 6.4.  After seven months on a strict low-carb diet (like 60 g carbs/day) and a 20 lb weight loss (I'd only been 10 lbs overweight at Dx, for the first time in my life, but I lost 20 during that time.  I've now lost nearly 30, not all for good reasons.) it was down to 6.0.  I'm monitored quarterly and am due for another A1c.  We'll see if my lower readings are borne out by the test.  I don't expect miracles, but I'm doing the best I can.  Some people's blood sugars only come down so much.  Metformin was ineffective for me and insulin would probably be dangerous, since my BG dips so far on its own post-prandially after peaking.

DISCLAIMER, MY ENGLISH IS NOT VERY GOOD and this is loong SO BARE WITH ME ON THIS,I HAVE READ @ printed all this BLOG AND DROVE MY FAMILY(DOCTORS) and FRIENDS @  CARZY 1 ! THANKS!

So i finally got my  glucometer:  OneTouch Ultra (ahh) + brand new strips (ouch) not cheap here where i live...  my old man  (doctor, lives on a diet of coffee, diet soda, bread pasta, cookies, candy etc, etc, etc + a few drugs... and is tall and "lean") thinks im completely crazy. ( im 33, 78kgr, also lean and muscular)

so my pattern: OMP-day  fasting
( 23h, 24h, 27h, 30 hrs regular fasts) + 3 day wrkts
(home, chin ups, push ups, squats) rest of the tm im mostly sedentary

my readings so far...

D1: 13-4

10:00 >  71mg/dL >  FS@BS (prior that  day ate a bit of candies... pascuas)

11:00 >  ERROR (didnt put the right code, got pissed @ didn't test)

D2: 14-4  (no carb)

3:07 > 70mg/dL >  FS@BS

EAT: meat (+)yolks(+) cheese (+) butter (-) water

4:05  > 81 mg/dL > AE@BS

5:05  > 77 mg/dL > AE@BS

D3 15-4 "workout" day (chin ups)  + carb
ERROR, 2 little blood, !"·$%didn't test  (assumed 70mg/dL  FS@BS)



11:00 >EAT: (pWRKOUT)

meat(-) yolks (+) cheese(-) butter (-) tomato juice (+) 350CC Whole MILK+ 100G " 60% CHOCOLATE"  ( 37g carbs. aprox 20@30g sucrose + milk sugars )
this baby

http://www.chocolatesaguila.com.ar/uploads/info_nutricional/tabletas_rellenas_3344.pdf

( copy paste if u care)

11:00 >EAT

12:05 >  75 mg/dL > AE@BS

12:20 > 72 mg/dL  > AE@BS

1:06 >  82 mg/dL > AE@BS  
( waited 2 long there?)

2:09  > 70 mg/dL > AE@BS

6:12 > 67 mg/dL > AE@BS

D3 16-4  
("rest day" upped the carbs anyway)

"FS@BS"  (didn't bother to test. low as usual, i guess)

1:00 > ??? mg/dL
EAT: salted peanuts... roasted in vegetable oil... 100gr (could not find my chocolate...)

2:00 > ??? mg/dL
EAT:
one lean, small cut of meat+ ham+ 6 yolks omelet fried in butter,  the usual 100g cheeses- Roquefort, sardo, pategras,cuartirolo,feta, 6tbs tomato juice, salt, peeper, (napolitanta)

Dessert: -2-  ice cold glasses of 300CC WHOLE MILK + 2 TBS of Cheap sugary cocoa powder  (approx 20@30g sucrose total + milk sugars)

3:05 > 107 mg/dL (!)

- moved my arse a bit and did 2  slow sets of dumbbell squats, (40 reps with16k w total, super slow and easy)

3:36 > 83 mg/dL

4:37 > 66 mg/dL

ok, any comments ? are my number ok?  what makes more sense , eating chocolate ( fiber, slower absrs possible less sucrose, or drinking  milk?  (talking desert here) i do not  eat vegetables, ( just, pepers, tomato juice and mushrooms) do not  eat fruit, and of course do not even touch gluten nor refined crap, and always try to limit my PUFA, and fructose load.

also im thinking i should test my BS levels differently?  maybe  eating one (large) H fat, H 2 moderate protein, meal per day changes things a bit?  so maybe waiting 1 hrs is not enough ( thats why i used milk x 2 today, and did not wrkout to speed things a bit)

edit, im 68 kgr ( not 78) ... always do the same mistake, maybe i need to gain weight!

OneTouch Ultra Meter
Eating pattern: OMP-day  
( 23h, 24h, 27h, 30 hrs  fasts)


D1 REST DAY

3:07 > 70mg/dL >  FS@BS

EAT: meat (+)  yolks (+) cheese (+) butter ( -)  water

4:05  > 81 mg/dL > AE@BS

5:05  > 77 mg/dL > AE@BS


D2 WRK DAY

11:00 >  71mg/dL  FS@BS

EAT: meat (-) yolks (+) cheese(-) butter (-) tomato juice (+)  +  350CC Wf MILK + 100G " 60% dark chocolate"

12:05 >  75 mg/dL > AE@BS

12:20 > 72 mg/dL  > AE@BS

1:06 >  82 mg/dL > AE@BS

2:09  > 70 mg/dL > AE@BS

6:12 > 67 mg/dL > AE@BS


D3  REST DAY (upped the carbs, + added liquid sugar, wrst  case)


1:00 > ??? mg/dL
EAT: salted peanuts... roasted in vegetable oil... 100gr

2:00 > ??? mg/dL
EAT:one lean, small cut of meat+ ham+ 6 yolks omelet fried in butter, 140g cheese, 6tbs tomato juice,  (napolitanta) 2  ice cold glasses of 300CC W MILK WITH 2 TBS of Cheap sugary cocoa powder  (aprox 20@30g sucrose + milk sugars)

3:05 > 107 mg/dL (!)

-did 2   slow sets of dumbbell squats, (40 reps with16k w total, no effort)

3:36 > 83 mg/dL

4:37 >  66 mg/dL

Hypoglycemia?
any opinions about my numbers, (imm33) should i ditch the milk @dark chocolate and eat "healthy vegetables" and "fruit" (no)


should i wait longer 2 test my BS? (slower digestion time, one meal and all)

today


17-4 > WRKT

9:00 > 69 mg/dL

10:58 > EAT (6 YOLKS, CHEESE, BUTTER, 1TBS TOMATO JUICE - OMELET + 400GR MINCED MEAT, 6 STRIPS BACON, 5TBS TOMATO JUICE, BUTTER)

2:07 > END

DISHWASHING

2:16 > 350cc WHOLE MILK

2:21 > 100G 60% chocolate

2:34 > END

2:40 > 300cc WHOLE MILK + 1 TBS SUGAR (nesquik)

3:01 > 71mg/dL

3:36 > 74mg/dL

4:39 > 83mg/dL

5:42 > 74mg/dL

650cc milk + lots of  sucrose... where is the zomg 160 blood glucose doctor? (btw i had been eating sucrose @ and grains like crazy 90% of my life, now im eating waay less sugar and 0 grains)

edit,

1:58 > EAT  (not 10:58...)

Dr. Davis,

Thanks for this information. So many "alternative" medicine people promote chelation that without your experience, it would be very tempting to try it.

Jim

The Graphs are too small to read even when clicked on.

It's not solely the fault of de novo lipogenesis, as even on a high fructose meal with radio-nucleotide labeled carbon in the fructose, only like 20 % of the triglycerides in the blood are from DNL.  Glucose consumption doesn't seem to result in DNL unless the liver is already full of glycogen.

Insulin is known to down-regulate acylation stimulating peptide (ASP), which is the paracrine hormone that regulates uptake of lipoprotein (i.e. "cholesterol") micelles into fat cells.

Dr. Mike Eades wrote a while back that fats, especially saturated fats go into the lymph system after digestion, and not immediately into the bloodstream.

Why is it then that "since fat must be absorbed via chylomicrons into the bloodstream" is an "accepted" notion?  You implied it was wrong, without actually saying so...Do most medical practioners really not know how fat is absorbed into the body?

You MUST look at this in context!  Excess dietary fat, especially saturated fat, causes insulin resistance.  It takes about 2 weeks of consistently eating approx 10% calories from fat, not more and not cheating, to remove that huge component of insulin resistance.  If the study were done in that context the results would be quite different.  How do I know?  I have done it several times on myself!!!

oops, forget to request email follow-ups. So now I have.

@ darnoconrad
Dr Davis did say "full-text here hoping people would follow the link, download the PDF, and have their own copy to enlarge as required.

Hi Dr. Davis,

Thanks for posting this.  It answered a question I've had for a while now.  The palmitate is interesting as well.

Very interesting and kind of scary, with family members of mine with heart disease pounding down the carbs and cutting the fat.  

I'm a bit confused by the Track Your Plaque Program, though.  In some of the info on the main site, saturated fats are described as inflammatory and something to be avoided.  But you seem to consider them okay - am I right?  And Dr. B G at AnimalPharm, who says she is counseling her clients with the TYP program, is big on saturated fats.  Can you explain the discrepancy?

Hi, Helen--

The Track Your Plaque program stand on a number of issues, including saturated fat, has evolved over the years. We now do not restrict them, but nor do we suggest a carte blanche  approach, since we do continue to maintain rather strict LDL targets for plaque reversal.

I believe that Dr. BG was expressing her own opinion in the Animal Pharm blog. While she's got plenty of great thoughts on this issue, it does not represent the "official" stand of the program.

Is it possible that the higher fat diet hit an optimum fat/carb mixture, where carbs were low enough to keep fasting TGs low and fats weren't high enough to spike post-prandial TGs?

Hi, Nigel--

Good question. Stay tuned--plenty more on this conversation to come.

The entire world of postprandial metabolism is truly a fascinating, though complex area, that is only beginning to yield to investigation. The Oxford group has made enormous contributions to this understanding.

Thanks for this, Gretchen, that's a lot of work!

It's interesting that my husband's endocrinologist, whom he is seeing for high blood pressure, insists on non-fasting labs.  He has my husband get his tests (blood and urine) one hour after a meal.  He says the fasting tests are very misleading.

Another question on saturated fats.  I know they raise LDL, and lately I've been reading that they raise the benign kind, not the vLDL.  But I have read in many places (including the Track Your Plaque article I mentioned) that they are "inflammatory."

Is that a false accusation, confusing saturated fats with trans-fats (since hydrogenated fats were used in some experiments regarding saturated fats)?

Or is it one of those things that depends - on other dietary factors or disease states, such as diabetes, etc.?  Or is it unknown?

It's hard for me to believe that nature would only want us to eat monounsaturated and omega-3 fats (as omega-6's are inflammatory, too).  That would seem fairly limiting for an omnivore.  Of course, it could be a proportion thing, too.

Helen wrote:
"Another question on saturated fats. I know they raise LDL"

The above may not be true. There may be a small near term rise, but long term I don't believe they have no impact or even lower LDL. You might find this blog entry interesting.

Rather interesting site you've got here. Thank you for it. I like such themes and anything that is connected to this matter. BTW, try to add some images .

It's counterintuitive: Postprandial lipoproteins, you'd think, would be plentiful after ingesting a large quantity of fat, since fat must be absorbed via chylomicrons into the bloodstream. But it's carbohydrates (and obesity, a huge effect; more on that in future) that figure most prominently in determining the pattern and magnitude of postprandial triglycerides and lipoproteins. Much of this effect develops by way of de novo lipogenesis, the generation of new lipoproteins like VLDL after carbohydrate ingestion.

Consequently, one of the advantages of glucose and other carbohydrates is that they can enter into the oxidation process much more quickly and provide energy more rapidly.

I guess it could be said that a flaw some have is a willingness to take advantage of the uneducated.  

On the niacin, my guess is that the over the counter Slo Niacin is manufactured by the same company in the same facility as the prescription form.  The machines used would be different as the FDA wants this, but the manufacturing procedures and source product would be the same.  I don't know this for a fact, but it would not surprise me if it were true.  

For fish oil, there are only a couple facilities in the world that manufacture fish oil.  The products these facilities sell are pretty much all the same in quality.  Everyone buys from the same places.  The facilities that encapsulate pharmaceuticals often times also manufacture health foods in the same plant.  The exact machines used for encapsulating pharmaceutical fish oil and store shelf fish oil will need to be different for government purposes but basic manufacturing practices followed will be about the same.

I was in a unique situation to witness a Germany company sell a product as a health food - and at the same time was going through the FDA drug approval process with the same exact patent protected product.  The product never did make it through testing in the end.  Phase 3 (I think that is what it is called) human studies at the Cleveland Clinic were a bust as too many people stopped taking the product. (Reportedly the product worked so well that people stopped taking it as they felt healed.)  I remember the German company planned to make “large” amounts of money off of their product if it passed testing as they would be able to charge a premium.  After testing fell through they decided to not try again.  A large American firm took on their product and placed it into every store in America, - and that was good enough for them.

http://www.ajcn.org/cgi/content/abstract/84/4/694
The case against ergocalciferol (vitamin D2) as a vitamin supplement provides more information which may interest some.
http://www.ajcn.org/cgi/content/full/85/1/6
Risk Assessment for Vitamin D shows that up to 10,000iu daily produces no observable adverse events but readers should note that actual harm occurs is 40,000iu are consumed daily.
However as you body uses only 4000iu daily http://www.ajcn.org/cgi/content/full/77/1/204 there has to be good reason to take more than 4000iu daily.

Dear Dr. Davis,

I've been reading your blog for sometime, since I found the link on Regina Wilshire's blog. I've learned a lot and want to thank you for sharing your insights and expertise with everyone. I imagine (and hope) that there are many, many more people reading it than are posting. I think what you and your colleagues are doing with Track Your Plaque is phenomenal. Interesting that there seem to be none of these services in New England, that bastion of tradition.

I've been fascinated by your articles on Vitamin D.  In looking around at Vitamin D3 (cholecalciferol) to purchase online (I can't find gelcaps locally), I came across the "Wilderness Family Naturals" web site.  In their article on cod liver oil ( http://www.wildernessfamilynaturals.com/cod-liver-oil-health-benefits.htm ), they state:
"Cholecalciferol is the form found in vitamin supplements and fortified dairy products and not the hormonal form of vitamin D, namely 1,25-dihydroxycholecalciferol."
The also state: "The form of vitamin D that we get from supplements is not fully active."

Can you talk about this for us?

In any case, my question is: can't I just take my cod liver oil to get my Vitamin D? Do I need the gelcaps of D3 in addition?

Thanks again,
Barbara

Wow! Thanks for the helpful commentary.

Barbara-
It's really very simple once you start checking blood levels on everybody--you quickly begin to learn what works and what doesn't.

Vitamin D3 (cholecalciferol) is what you need. Don't be confused by the comment about the "real" form, 1,25-diOH-vitamin D3. This is a kidney metabolite. We all still need vitamin D3.

It's best to find D3, not cod liver oil. I remain skeptical about the safety of cod liver oil due to some reports of preparations with excessive pesticide residues.

Try www.vitaminshoppe.com or look for Carlson's preparation, both 2000 unit gelcaps of D3.

I take D3 and have been for at least 3 months. I've been taking 3000iu/day and just had a blood test that indicates my blood level is only 33 (22 - 67 is the reference level).

I'm out in the sun at least 15 min a day, not including driving, walking to and from, etc.

So...how much Vit D should I be taking? I believe you recommend a level of 50-60?

Cindy--
We commonly use 5000-6000 when situations like this arise and generate desirable levels. Also, the values of "normal" in the reference range you provide suggests that your laboratory also runs an outdated method of measurement. (The newer methods tend to show "references ranges" of 20-100, or something close to that range.)

Thanks!! I've made several changes recently thanks to your posts!!

Hi Dr. Davis,
I see both Vitamin D and Vitamin D3 supplements being sold:

Vitamin D

Do I need to assume that supplements labeled as simply Vitamin D are, in fact, D2?  Are there other forms that it could be?
Thanks,
Mike

Mike-
No, you can not assume D is D3.

Always look for:
1) gelcaps, not tablets
2) D3 or cholecalciferol
3) Never D2 or ergocalciferol.

Those little attentions to detail will help a bunch and ensure you get the right stuff.

Thanks!

I was diagnosed with a defiency in vitamin D in january . My total level was 12ng/mL . I started taking supplementation, 800 IU daily of Vitamin D3 (cholcalciferul), and a Centrum multi-vitamin which has another 400 IU . I took that for over 6 months. I just had my level checked again . It is only 15ng/mL still !
How much D3 should I be taking ?
And what would be a good target for a 31 year old male ?

There's no "one-size"fits-all" in dose for vitamin D. However:

1) The vitamin D in multivitamins doesn't work at all.

2) You're therefore taking 800 units per day, the dose for a small child.

3) Most adults require 2000-6000 units per day. The D must be in capsule form, not tablet.

4) In the Track Your Plaque program, we aim for a blood level of 50 ng/ml.

Thanks, Dr.

1) Can you expand on why that is re. multi-vitamins inefficacy of vitamin D ? Does this apply only to the vitamin D in them ?
Are the liquid forms of multi-vitamins any better than the tablets (eg. centrum liquid) ?

2-3) I thought according to the FDA, the recommended daily dose was 400 IU for an adult and the safe dose was 2000 IU. How did you come up with your numbers ?

3) You guessed it - I had been taking Vitamin D in tablet form only. I can certainly believe that they were not effective given my test results. But can you explain why the tablet forms don't work ?

Tonight I looked for vitamin D in liquid form . I had to go to 4 places - Costco, my Kaiser pharmacy, Longs, and finally Walgreen's, which had some softgels from fish oil. I bought 100 softgels of 1000 IU each for $7.99.

The tablets I have are Nature made brand. I have about 300 left. As far as tablets go, how do you rate them ? Would you just throw them away and just take the gels ? Or take some gels and tabs ? I hate to just waste the tabs.

4) Thanks !

Please refer to the several previous posts under "Vitamin D" or our extensive discussion on the www.trackyourplaque.com website.

Vitamin D should always be either "D3" or cholecalciferol, NEVER "D2" or ergocalciferol, since D2 exerts negligible benefits.

If your preparation fails to specify which form, look for another that does.

Hello I'm a vegan from Germany and like to respond to the argument that is circling through the web relating to D2. Since I'm vegan don't use D3 since that is produced by irridating butchers-wool with UV-light, an information that is often left out when touting this version of vitamin D as the "natural" one. Because of all the negative rap D2 has gotten, it has now in fact disappeared as a supplement in the EU, effectively starving vegans and other vegetarians of vitamin D. I was thus forced to look for alternatives to have my winter supply of vitamin D. What I do is grow my own delicatessen mushrooms right here at home and either dry them in the sun or irridate them with the Utra Vitalux 300 Watt UVB - Lightbulb after harvest which makes them a very rich source for vitamin D2.  Now here comes the interesting part. My previously utter deficient 25(OH)D below detection level, measured at the end of summer -I'm not the outside type and almost never get enough UV-exposure from sunlight- has after a year gone up to 105 nmol/L. Given that I have nowhere near enough sun exposure, and as a vegan no other dietary source of vitamin D, it is clear to me that the vitamin D2 from my sun-dried or irridated mushrooms is responsible for my recovery from hypovitaminosis D.

Now I don't know if there's a difference of vitamin D2 in mushrooms or the pharmacological D2 in pills, all I know is that Vitamin D2 is *my* primary source of vitamin D and it's giving me excellent levels of 25(OH)D.

What I find highly irritating is the meme like argument flying around that vitamin D3 is the one "naturally appearing in the body". Duh. Vitamin D2 is also converted into vitamin D3 so the fact that D2 is not "naturally in the human body" should be as relevant that Vitamin C is not "naturally in the human body" and has to by sourced from diet. There are many nutrients that are "not natural" in the human body and which we need to source from diet, for example the essential amino acid. Besides, since when does "natural" equate to being good? If a Uranium miner has "natural" radioactivity in his body because he is exposed to it during work, is that good? I don't think so.

The reason I'm irritated is because the information about vitamin D2 being bad (when that is, at least in my case *not* true) has real implications and discriminatory effect on vegans and other vegetarians because not everybody of us has the patience and curiousity to produce their own Vitamin D at home, and perhaps some people don't enjoy eating mushrooms.

There is one more point and then I'll end my rant. Every time us vegans were informed that a particular plant based nutrient like vitamin A (beta-carot.) or iron was inferior because it has a lower bio-availability, later research discovered that that lower bio-availability has actually real benefits. I wouldn't be surprised if the same appears to be true for vitamin D2. I have already come across research which noted one of the D2 metabolites to have anti cancer properties, although this study is based on non-human animals meaning it has little to no relevance to humans and is based on the exploitation and death of rats.

For those who (despite reading this on an electronic network of computers) lay any importance on _naturality_ regarding nutrients, you may want to consider my method of just drying mushrooms in the sun. That's certainly more natural than killing sheep, stripping the hair grease of their wool and irridating that with UV-B light, which is the standard method of how vitamin D3 is produced - a byproduct of butchers waste.

Fascinating solution!

However, I stick by my claim that, for most people, vitamin D2 supplementation does not work. I have seen many people on as much as 50,000 units of D2 per day with zero or near zero levels of conversion to the active D3, all proven by blood levels.

However, for a vegan, I do not have any useful non-animal solutions beyond getting sun.

My Vitamin D levels, when first tested, were 12.  I have been using a Vitamin D lamp to try to raise the levels, which are now 32-33.  Initially, I took Puritan's Pride Vitamin D, which made me feel like a new person, but I quickly learned that it interfered with the efficacy of Cytomel, which I take because Synthroid interferes with yet a different medication.  Do you know of any form of Vitamin D that might not interfere with Cytomel?  

Thank you.

I just found out my vitamin D level is abysmally low from a blood test. My endocrinologist gave me a prescription for 50,000 units of vitamin D.  After reading about the subject here, I don't know whether to fill the prescription or go the the health food store and get a bottle of vitamin D3 capsules and disobey doctor's orders. We are investigating whether I have disturbances in my cortisol levels.  So far, testing has shown very low morning cortisol levels.

I went from sickly to healthy from taking 50,000IU (once a week) of Calciferol, proven by my recent bloodwork.  My D level was 18 in November,  and 4 months later it was 38!!!  Taking D2 has changed my life and I continue to take it without hesitation or reservation.

I have read that I should be taking a cal/mag supplement to increase absorbtion but I have not done so . . . your thoughts please.

Maybe the lab you use for blood tests isn't DEQAS certified, and isn't accurate.  I don't know how else to explain why a recent study contradicts what you're saying about D2:

http://jcem.endojournals.org/cgi/rapidpdf/jc.2007-2308v1.pdf

Hello, can you tell me what form of D3 is best and why.

Ergocalciferol (D2) has a kenetic half life of 10 days.  Calcitriol (D3) has a half life of 3 days. I am surgically hypoparathyroid and replaced 100% of that function with calcitriol or ergocalciferol for 30+ years. I find the D3 form is smoother on my body, until I forget to take my dose on any particular day. Then my mood, energy, stamina, sense of well being etc noticably deteriorate. I lived quite easily on D2 for nearly 28 years until medicare decided this life essential medication was a non life essential vitamin and forced a change to the more expensive calcitriol they would pay for. So now I painfully die in 10 days without D3 instead of 30 days if taking D2. This is germane when the price of ergocalciferol in 1991 was $1.99/100 50000IUs dose. After several years of repeated "offshore supply problems" the price is now $125/100 forn teh identical medication. Sometimes I'd drive 75 miles to another pharmacy (dealer - lol) to refill the D2 when the supply dried up. On correct fo the supply problem the price would double or triple (WTF???). Oh well - rather that a "DNR" I insist on a "JSM" (just shoot me).

Hi everyone,

Firstly, I must say I agree with ava reactions being irritated above, even if not being vegan myself, but vegetarian.

I would like also to point out that health is definitly not numbers on a paper coming from tests but is how we can feel and act.

Good health is about feeling balanced and in a state that allows personal accomplishment. It is not, not at all, about obtaining or aiming a level of that molecule or this other one in a blood test.
You can take two people with same amount of that molecule, or with similar tests results and having one feeling very healthy and being really so and the other one being and feeling desperetly ill. Blood tests reflect only very poorly what is really happening in the vast universe of our cells and tissues. It does not indicate at all how plenty of important biological reactions are going in us.

It makes me smile when I read 50,000 IU of D2 did not increase D3 levels. When you place carrots in your dish, you do not have sprouts !! The purpose of taking D2 is not about raising D3 and D3 metabolites levels but D2 and D2 metabolites ones. D2 and D3 molecules react in same biological fields, and D2 is beeing used with success for decades. It is not honnest to omit that and to pretend D2 is worthless because D3 levels do not raise : it is a false demonstration.

In my view solar exposition is the most important factor for everyone, but when not getting enough D from sun, the plant-form D (D2) is perfectly suiting. I have never read any animal study that tends to show D3 supplementation is preferable to D2; on the contrary toxicity is shown to be a lot greater with D3 hypervitaminosis than with D2 hypervitaminosis (a lot more calcifications with D3 than with D2). Plants represent the reference in food because everything we need, even B12 for example, can be found in the plant kingdom; that is not the case if the animal kingdom is taken as food. Then ask your intuition about D2 and D3 being the most desirable form of Vit. D when not receiving enough sun...

Readers should remind that there is two different 25(OH)D : the one with D2 and the one with D3, and also two 1,25(OH)2D. Measuring the D3 forms (most commonly measured in blood tests) is meaningless if you take D2 supplements. It is NATURAL having in the blood less 25(OH)D in its D3 form during winter than during summer because at that time there is less sun activity. Correcting lowering Vitamine D activity during winter with D3 supplementation rather than with D2 is illogical and unatural.

R. Jehl
Naturotherapist in France

Individualized Vit D supplementation is necessary. The arguments regardind D2, D3, single Hydroxy and double hydroxy depend on your body and its current disease status. For example, giving a D2 or D3 to a patient without kidney function is useless because they cannot convert it to the ACTIVE form of 1,25(0H)2D3. Kidney patients must take activated or the final form of vitamin D 1,25(0H)2D3. Liver dysfunction patients cannot convert the D3 to the single hydroxylated form, which the kidney needs in order for its metabolism. So, really, blank statements as given by the French provider indicating D2 for all is FALSE. Look up the metabolic pathway. If you are stone cold normal and only have low Vit D, then you can take either form of regular D2 or D3. If you have a disease, GI malabsorption, liver or kidney disease, granulomatous disease etc you should consult a professional to guide your dosage for proper results. I do like combining some fast acting forms with some slower acting forms to help folks feel better faster and then long term treating with slower forms if they can metabolize them. Everyone is unique and sometimes trial and error are required.

I have read through these posts with interest. I am new to this site, looking for a solution to my 'no beef' diet and insufficiencies in Vitamin D (3 mostly). I am on synthroid, but never knew of the Vitamin D correlation.

I find that in the US there appears to be NO 50,000 Vitamin D without bovine capsules. I cannot find a veggie tab surrounding even the D2.

Can anyone advise where I might 50,000 units of Vitamin D3 with no 'cow' gelatin coating?

Do you have any recommendations for those who are vitamin D deficient but cannot tolerate oil based capsules but have no problem with fortified foods?  Is the UV lamp a safe alternative?  Is there a powder form of D that is effective?

I've read this discussion with a great deal of interest.  I've been supplementing with Vital Nutrients capsules which are vegetarian.  They make 2000iu capsules and 5000iu capsules. http://www.vitalnutrients.net/vnestore/detail.asp?product_id=VNVD2

Hello this is Ava again from Germany, I posted a long rant into this thread some while ago.

I'd just like update that I've switched from irradiated mushrooms to a vitamin D2 supplement as drops ( Sterogyl 2,000,000 ergocalciferol ) and my 25(OH)D levels are really nice in winter at 156 nmol/L or 62 ng/ml! In France it's availalbe without perscription and we've been able to get it Germany too. It's very cheap around 2 Euro for 400,000 IUs despite the name. I started out with 13 drops / 5200 IU for 14 days, then I took a single mega dose of 300,000 IUs. Since that I've been taking 70.000 IUs once a week. I'm very tall at 6' flat and this is the dose my body needs to achieve good levels.

It's also possible to just keep on taking 3500 to 5000 every day, however it then takes much longer to reach desired serum levels.

If you have access to this cheap product and take 5200 every day, the 2.50 Euro or so will still last you almost 3 months.

Vitamin D3 Iu:

NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 Iu on discount at NutroVita.com.

For more details please visit:
http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively

Dr. Eades also has an interesting take on this study on his blog.  
http://www.proteinpower.com/drmike/weight-loss/low-carb-diet-trumps-low-fat-diet-yet-again/#more-1286
Many comments responding to it are interesting and worth reading as well, (Dr. Eades appears to have many readers with the same ability to cut through BS as those of the HeartScanBlog )  but two that I found especially revealing deal with how this study was reported by the press outside the US.  According to one commenter, in the UK the Daily Telegraph headline said, "Low-fat diets 'not as effective for weight loss'", and the Daily Mail's, "the controversial Atkins Diet is 'safe and far more effective than a low-fat one',study shows".   Another commenter said that in the Philippines, the Philippine Inquirer said "Low-carb diet proven best for weight control." In this country even the way an "objective" report on this subject is titled in the press seems colored by  distaste (fear?) and reluctance to give the facts their due.

You have an interesting blog that I have been following for some time already. Personally I am a proponent of Mediterranean diet, but I would like to say that I do not agree with your claim that low fat diets are dead.

It should be noticed that the DIRECT study was a weight loss diet for people who were obese (average BMI 31). It is well known that low fat diets are not ideal for people who are overweight or people with insulin resistance. However, low fat diets can be quite suitable for lean and active people. Japan is a good example of a population where the diet is still low fat and its coronary heart disease risk is low.

This study didn't prove much.  Look at the weight gain that occurred after 1 year on the diet (2 year study).  When is there going to be a true study done on a nutrient dense low fat diet (not 30% of calories like was done in this study) vs a paleo type diet and a not a vegetarian atkins-esc diet.  This study just adds to confusion.

Japan may have lower heart attacks but they are suffering from thyroid problems from so called health food "soy".

Anonymous wrote:

"Japan may have lower heart attacks but they are suffering from thyroid problems from so called health food 'soy'."

Soy has some harmful effects but I think that the benefial effects of soy outweigh them. Japan has one of the highest life-expectancies and the highest healthy life-expectancy in the world. For me this shows that much of what they are doing is probably right inspite of their stressful working life.

PS. The blog takes very long to download, probably due to the Digg application and many other features.

I found it interesting that certain biomarkers became less favorable within the low carb group, when they upped carbs to a mere 120 grams per day. That sure is motivation to watch one's intake of carbs! BTW, I love your take on the AHA. Cocoa Puffs are "heart friendly" just because they are low in fat? Pleeeease!

I wonder if Dr. Davis could comment or rebut Dr. Ornish's expected rebuttal to this study in the latest newsweek issue. Here is the link http://www.newsweek.com/id/146641

Great blog, great information

Gee, if they are making that much from endorsements, disclaimers are appropriate every time they push a diet that connects to an endorsement.

http://www.proteinpower.com/drmike/wp-content/uploads/2008/07/taubes-response-to-bray-ob-reviews.pdf

was great too.

However, most people who are concerned with diet are those who are overweight.

Juhana, yes, when I had time to exercise 20+ hours a week, an entirely different pattern of eating was appropriate than when I had a job and many fewer hours.

I don't see the point.  Few of us are currently competitive athletes right now.

Stephen, Japanese are doing fine without 20 hours of exercise a week.

In my opinion, reducing carbs is necessary only when you already have an abnormal glucose metabolism due to overeating, high intake of refined carbs and sedentary lifestyle. High prevalance of overweight, obese and diabetic people is clearly a modern phenomenon.

I too am not sure that low fat is dead.  I still hear a lot of low fat nonsense everywhere I turn.

Low fat should be dead, but there are too many folks in the medical-dietary establishement who want to keep it on life support.

My friend and I were recently talking about the prevalence of technology in our day to day lives. Reading this post makes me think back to that discussion we had, and just how inseparable from electronics we have all become.


I don't mean this in a bad way, of course! Ethical concerns aside... I just hope that as the price of memory falls, the possibility of transferring our brains onto a digital medium becomes a true reality. It's one of the things I really wish I could experience in my lifetime.


(Posted on Nintendo DS running [url=http://kwstar88.livejournal.com/491.html]R4 SDHC[/url] DS FPost)

Low-carb diets help to lose weight in a matter of time but these help to keep the body healthy and strong. buy viagra viagra

The Mediterranean diet was a moderate-fat diet rich in vegetables, with reduced red meat, and poultry and fish replacing beef and lamb. Total calories from fat of 35% per day or less was the goal, with most fat calories from olive oil and a handful of nuts. Like the low-fat program, calories were limited to 1500 kcal per day for women, 1800 kcal per day for men.

Could you please quote sources that show that the Japanese have a thyroid problem induced by soy.  I think that soy bashing is a bunch of hype.