Saw this in my RSS reader.  Are they correct, and if so, can you recommend any other non-wheat whole grains we should consume?

"Your arteries are happy when you eat whole grains" is patent nonsense, imy view. There are indeed subgroups of people who can do fine eating whole grains, but the majority of people do miserably.

Oats and flaxseed are the only grains that I would recommend. Otherwise, more than sufficient fiber and nutrients come from vegetables, fruit, and raw nuts and seeds.

Avoiding wheat is something I'm familiar with.  I never thought I'd be on a wheat free diet for heart health though.  Having had a sever intestinal problem for most of my  life, gastrologists have prescribed a gluten free (wheat, barely, rye free) diet many many times.  

Being on a wheat free diet is easier today than in the past.  That's because it used to be believed that celiac sprue was a rare condition, with possibly 1 in 3000 having the condition.  Now with DNA testing it has been found that as many as 1 in 100 have the condition.  Happly, food processors have noticed, and label more foods as being gluten free.    

It used to be believed that only thin people with diarrhea had celiac, but now it is known that over weight constipated patients can have the genetic condition too.  This has led to some to suggest that celiac might be one of the most under-diagnosed conditions in America.  

I've read that celiacs are much more likely to have heart disease compared to the general public.  So reading this bog makes me wonder if those that do much better on a wheat free diet for heart health could also be undiagnosed celiac.

Thanks Dr. Davis.  I really appreciate your advice and your blogging.

regarding the article

"Your arteries are happy when you eat whole grains"

It is odd that they dont say  compared to what ? compare to no wheat ? compared to refined wheat ?

It is all relative, so maybe they are comparing refined grains, compared to whole grains ? They leave that out. Maybe on purpose as  an intententional form of manipulation to imply that eating grains is healthy.

It would be like saying "organic mercury is healthy for you" when they compare it to methyl mercury, but leaving out the part about the methyl mercury. Both are extremely toxic, but someone reading it might think the less evil form is healthy for you. Pure deception.

I have been gluten free for the past 4 years. I had heart bypass 7 years ago. Before I went gluten free I was having pitting edema in my legs, fatigued and shortness of breath. I stopped eating gluten and those symptoms, along with many others. disappeared. In fact, I feel my best when I stay away from all grains - especially processed grains.

I don't know how happy my arteries are now, but I am much happier. I think they are too.

The article on whole grains is typical of how I see this terms used.  Some studies show that a diet in whole grains is healthier than a diet in refined grains (never mind they can't compare to vegetables).

First thing I notice on that page is a picture of a bowl of cereal, looks like flaked wheat.  Does anyone even KNOW that the word "whole" means?  

You cannot take a flaked wheat out in the yard and plant it and have it grow.  This is cause it's not a whole grain.  Everyone does this silliness, the AHA, the ADA, etc.  

General Mills would freak out if people REALLY started eating wheat berries instead of Cheerios.

Besides oats and flaxseeds, barley is a very good grain too.

about 1950, the drug lords made it practically illegal in the usa for doctors to learn about, study, and use (and tell people about) vitamin c which did, does and will prevent heart disease. big pharma so much prefers profit to health, they will simply let millions die if it means more $$$ for them.  See a spanish document translated by google for the verification, et al such as m.salaman and max gerson and linus pauling. signed jeff elohim

It's contrary to conventional wisdom. It's counter to the USDA Food Pyramid. It's certainly not what the American Heart Association says. It could potentially disrupt the economics and politics of the enormously powerful food industry.

Hi Dr. Davis:

Are you familiar with Dr. Wolfgang Lutz from Austria.  He has a book entitled "Life Without Bread."  He has been treating patients with a low carbohydrates diet for over 40 years and he has seen improvements in the same conditions in his patients.  In his book he presents data from his patients over the last 40 years and it's very impressive.  Here is the amazon.com link to the book:
http://www.amazon.com/Life-Without-Bread-Low-Carbohydrate-Diet/dp/0658001701/ref=sr_1_1?ie=UTF8&s=books&qid=1253192708&sr=8-1

Thanks so much for writing this blog.

I absolutely agree with what you're saying here--for the most part, I do not eat wheat, but I must tell you, the desire for any wheat product never leaves (in my case, anyway) and is frequently craved--but what a punishment for indulging, even once in a great while:
A few days ago, whilst enjoying a delicious mostly protein and fat dinner at Outback, my wheat devil got the best of me, and I took a mere slice of that delicious bread they put on the table, with a generous pat of butter.  Within 5-10 minutes, I literally felt my nose and sinuses swelling up on me.  Not fair, but reality.
Hmmph.

Oh this is so true! I love myself when I stop eating wheat and a lot of sugars - can't get enough sex och have much more energy!

But from time to time I fall back and just crave that pasta... and every time I do, I regret it; Stomach cramps is always what will be served for dessert!

Dairy and lots of sugar.
But wheat might be the worst.

Two years ago, my knees hurt so badly that I avoided sitting in low chairs (I couldn't get out of them) and I was "one-footing" stairs. Then I went on a low-carb diet and the pain cleared up. I failed to put two and two together until a trip to France where I "allowed" myself small amounts of bread and suddenly it became important to know if a metro stop had an escalator. Now I know that eating wheat will result in knee pain 48 hours later.

Fast forward to this summer when my 24-year-old daughter was having stomach pain--it was after meals, but sometimes the pain woke her in the night. "Heartburn," said her physician, maybe related to stress, and put her on Nexium for a month to see if it cleared up. It did, but returned when her prescription was over. Having read about the side effects of PPI use, I suggested to my daughter that she consider eliminating gluten and/or milk products for a while to see if that helped. She did (although she whimpered a bit about giving up beer). The pain disappeared almost immediately, and a bit of experimentation showed that it was wheat and only wheat that caused the pain (cheers).

When my daughter described the pain, I realized that I had the same symptom when I was her age, but I didn't have it looked into because it never lasted long enough to bother with (I'm one of those doctors' kids who avoid doctors).

So my question is, in light of all of the signs that point to wheat intolerance as a cause of gastrointestinal distress and joint pain and a whole lot of other things, why is eliminating wheat not the first course of action?

By the way, I found the recent article in Scientific American on celiac disease, leaky gut and automimmune disease to be very interesting.

Does wheat elimination include eliminating beer, particularly, wheat beer?

It's the only wheat--or grain for that matter--in my regular diet.

"after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people."

I gave up wheat a long time ago when I found it triggered acid reflux. And I found just the opposite.

As long as I didn't eat wheat regularly, I could have the occasional wheat with no problems.

Does anyone know if Ezekial 100% sprouted whole grain bread (yes contains some sprouted wheat + many other grains) is still considered "wheat" as I want to have a zero wheat diet.  Hmmm  think I just answered by own question.  thanks!

Hi, Chris--

Beer is clearly the least desirable of all alcoholic beverages, partly because of its wheat origin. However, perhaps because of fermentation or some other modification, it doesn't seem to exert all the adverse effects of other products, though celiacs will still react to the gluten.

Anon--

Likewise with Ezekiel. I believe it's better, though not necessarily perfect. It still trigers carbohydrate responses.

Hi, Olga--

Amazing how we are re-learning many lessons learned previously before drugs and fancy hospital procedures.

Another factor in the increased libido may be a reversal of very early nerve damage from high glucose levels. Peripheral neuropathy starts at blood glucose levels that are not really very high at all -- around 140mg/dL, which a person may be seeing after meals for YEARS before they hit the diabetic diagnostic criteria of 180mg/dL after meals or 126mg/dL fasting (and very many diabetics do have measurable neuropathy at diagnosis, for exactly this reason). People worry about their feet when they're considering diabetic neuropathy, but ALL the nerves are adversely affected by being bathed in excessive glucose, and those in the sexual organs are among the most sensitive; I think it's a reasonable theory that one would see a decrease of sensation there even before you have measurable effects in the hands and feet. Fortunately, if neuropathy isn't very advanced, it can be reversed by getting blood glucose under control, and of course that would improve sensation and increase the enjoyability of sexual activity, which would naturally factor into the desire for same. I'm sure there's more to the story, including some or all of the factors you've named, but I think this is probably part of it too.

How do the various grains compare: wheat, rye, barley, corn, rice etc.?

It's called wheat allergy, look it up.  Different antibodies to celiac, different symptoms, but same cause and same cure.

There are gluten free beers available, based on sorgum.  Budweiser makes one called Red Bridge, but there are others on the market.    My sister has active celiac and so I eat an anti-inflamatory gluten-free diet.  Last year at my highschool reunion I had pizza and beer with the boys.  I had bloody stools for several days after!  I believe that most of us are gluten intolerant, that is we cannot really digest the gluten molecule. Many of us develop "leaky gut" from the gluten and then go on to antibody production against the gluten-gliadin molecule.  This protein has several key amino acid sequences in common with tissue proteins in many various organ systems (thyroid, pancreas, adrenal,gut, skin, uterus, placenta  etc) and autoimmune disease begins.  Which organ system is affected depends on your genetic make up.   The persistance of GI docs in refusing to diagnose gluten enteropathy without a small bowel biopsy is amazing to me.  see enterolab.com

A lifelong depression lifted when I went wheat and gluten free 6 yrs ago. I am 66 years old and I wake up with no joint pain. Peripheral neuropathy is better, but not perfect. I have a long list of health improvements.

As far as my heart, dropping wheat and gluten totally relieved my pitting leg edema and shortness of breath. I had cardiac bypass over 9 years ago, but I did not start to heal until I went gluten free. I am sure that gluten contributed to my CAD.

I have no idea what would happen if I were to eat a wheat cracker or a slice of wheat bread. I never want to feel that sick again so I have not been tempted to try even one bite. An accidental crumb is enough to cause my brain to fog and my energy level to bottom out.

This past year I dropped sugars and all grains in order to level out my blood glucose - this has worked well.

I have heard the celiac experts say that no one is able to digest wheat well.

Dr. Davis,
A majority of beer recipes are based on Barley, not wheat. Sure it could contain wheat as an ingredient and most "summer" beers often contain a malted barley/malted wheat mix with the latter as a minor component. Beer (at least other than the generic mass market brews like coors, bud etc) contain substantial polyphenols from hops which I would assume have antioxidant value.

I don't buy this obsession approach that everything that might contain a grain is probably bad. H1N1 is called the "swine flu" so what has happened; people have stopped eating pork.......  I am grateful for the discussion on this site but just sometimes I get a little disheartened with the  generalizations.
Trevor

Dr. Davis, my diabetic friend just announced to me today that her Triglycerides dropped from 400 to 200, her total cholesterol dropped to 178 and all other blood values are now within normal range just by changing her diet and eliminating all starchy foods (white and brown rice, all wheat products, etc.). Her wheat-free diet truly gave her some unexpected effects. Josephine

Dr. Davis
I'm 66 years and was diagnosed with migrene from 20. At 62 I startet to eat lowcarb and high fat. My migrene was gone after 14 days. I thougt that sugar was the worst, but I have come to understand that wheat and barley trigger my headaches more than sugar does.
Other pleasant side effects are no more anal- itching and nearly no more nightly peeing.

My concern about the sprouted grain breads is the inclusion of soy.  I am not sure that the sprouting process eliminates all the toxins from soy (phytic acid, estrogen, goiterogens, protease inhibitors etc. ). Traditional cultures often soaked grains, sprouted them, and then used lactofermentation (sourdough)  methods to prepare their breads or porridges.  This reduced many of the toxic portions of the grains, but soy is much more resistant.  Traditional Asian cultures often fermented soy for months before using as food.

Before the phrase "wheat-belly" was phrased, there was the phrase "beer-belly." Personally, I don't care if it's made from barley or wheat, beer poses a clear danger either way.

I suffered from IBS for years, and discovered the "cure" when I went on Atkins in 1999.  I'm afraid, though that in my case, eliminating wheat alone isn't sufficient, I seem to have problems with any grain that is high in fiber. One or two amaranth based cookies was enough to trigger IBS symptoms for a whole weekend.

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Regardless of Rationale.

Susan,
couple weeks ago, I had to take a trip and drove for 8 hours right after my hard work out at gym. didnt have time to eat at my regular time. that night i had stomich spasm, so bad that it almost made me cry. (now i am completely wheat free for more than 10 months now). only thing that helped me immediate,was powdered Magnesium. the pain would start around 2am and stay on until I take liquid magnesium. the pain wouldnt go away for week or so. funny thing is that in the morning i would go to gym and workout hard with no pain at all. 4 days ago I had to see my doctor and he put me on on Nexium. That was the first night that there was no pain how ever the side effects of Nexium were sharp headache and stomach spasm for 5 minutes. I think that when body is firing on all cylinders, it is important to eat regularly, small meals, more often.

Dr. Davis,

I have seen the mention of eliminating wheat from the diet in many of your articles. Does that mean something like rice is not as bad as wheat namely is wheat is the worst among the grains rice, barley, corn etc ?

Thanks!

-Suresh

Sara,

I found your comments extremely interesting and would like to know more about your research, especially relative to this:
"those in the sexual organs are among the most sensitive"  Do you have reference I can follow?

I've been reading about periperhal neuropathy and autonomic neuropathy and this article was particularly interesting:

Unlike PN, AN is often asymptomatic. Among symptomatic patients (55%), erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.  

pns.ucsd.edu/JPNS/Ravaglia.accepted.06.16.04.pdf

An improvement in his ED was definitely an unexpected results of a gluten free diet (wheat free was not enough), but my spouse saw further improvements without dairy and soy.

William,
Your comment on the fermentation of soy in Asian cultures appears to imply that this is important to render "safe" food from Soy.  So do you make the same generalization about cow's milk.....? IE it should be cheese and yoghurt before consumption?

Donny,
what is the scientific relation between "wheat belly" and "beer belly" ? none, I would argue. Other than both are not desirable and result from over indulgence.

There are a surprising number of people who are sensitive to specific foods.  I love sushi.  My wife is allergic to raw seafood yet she can down a piece of wheat gluten (seitan) with no affects. I have friends who can't go near gluten without severe cramps. My wife can also eat beef yet it gives me terrible gas. On the other hand, beans have absolutely no impact to my gas productivity.  I write this to highlight that many many people have issues with certain foods while other remain unaffected. YMMV as the saying goes, so lets celebrate those who find relief in changing their diets but lets not claim panacea
Trevor

Suresh--

Yes, wheat stands out as a uniquely destructive grain. While other grains can also increase blood sugar and trigger adverse patterns, wheat is undoubtedly the worst. I know of no other grain than wheat that is accompanied by addictive behavior, also.

Re: beer and barley

Barley also contains gluten, so if you're avoiding wheat because of the gluten, you'll need to avoid barley (and rye) as well.

Re: rice

The data that the idiotic "China Study" book is allegedly based on suggest that rice is the best grain to eat if you're going to eat grain. The highest rate of heart disease in China is found in the province where wheat is a dietary staple and little meat is consumed.

1:100 may have celiac disease, but estimates of those with non-celiac gluten sensitivity range from 10-40% of the population.

It is true, if you want to be tested for celiac disease(villous atrophy), then you do need to keep eating gluten until the testing is completed. If the tests come out negative it does not mean that you have no problem with gluten. You may still have latent celiac disease, non-celiac gluten sensitivity, wheat allergy or wheat intolerance. I am beginning to see more journal articles about gluten sensitivity. Dr. Green recently wrote in the JAMA that more attention needs to be given to gluten sensitivity.

I did not go through blood a biopsy testing as my doctors refused to run these tests. I used Enterolab to confirm I have antibodies to gluten. This was enough proof for me. Enterolab cannot diagnose celiac disease, but it can tell you if you are reacting to gluten and you can be wheat/gluten free for up to 2 years for this test.

There is nothing dangerous about a gluten free or wheat free diet and, luckily, we don't need a doctor's prescription to change our diet. A gluten free diet can be as healthy or as unhealthy as one wants to make it. Along with gluten free, I follow Dr. Davis' recommendation of a low sugar diet to keep my blood glucose in check.

Ouch! much sugar? Damn! diabetes is you will get.

Dr. Davis,

Okay... wheat is BAD.  But... does this include wheat bran, often used as a source of fiber in the diet?  I mean the bran only, NOT wheat germ, or whole wheat, or wheat flours.

Thanks for all you do!

madcook

Hi, Mad--

No, wheat bran is essentially inert. It does not interact with anything and so does not exert any adverse effects. It's like eating wood.

I disagree with wheat bran being inert.  It is a source of phytic acid which has mineral binding properties.  Also, reading sites like FiberMenace.com, bran fiber is certainly not benign.

@Anonymous (before me)

I agree with your statement. Its a fact, try read health book.

I have to mention one more benefit to your list, that I noticed:

- hugely improved dental health and self-healing (sealing) of damaged teeth.

We know that wheat's agglutins (WGA) affect and reduce D3 transport, I have a suspicion that wheat may be also interfering with K2 (thus teeth) but haven't seen much esearch on this yet.

Stan (Heretic)

Re FiberMenace author Konstantin Monastyrsky
Perhaps those wishing to make a value judgement out this website might first want to checkout Jimmy Moore's blog
Jimmy's interview with Konstantin Monastyrsky
and then compare/contrast it with this one in which a certain Dr Davis is interviewed

TedHutchinson, there are many other sources that agree that fiber is not beneficial and is indeed harmful if you don't care for the one referenced.

Nevertheless, Dr. Davis is incorrect about bran being inert.  It does contain phytic acid which interferes with mineral absorption.  Another reason wheat avoidance helps teeth and bones.

@taemo

haha. you're right.. control use of sugar to avoid diabetes.

@Thomas

it has different nutrition level and most of all, its taste.

I have a question: after spending a year in France, I realized that yes, French people are typically lean and thin, however, they eat so much wheat! Pastries, white pastas, cereals...
Do French people display the same numbers when it comes to celiacs disease and wheat intolerance? I am curious to know. Or might it have more to do with volume or the fact that their breads are more often homemade? Thoughts?

I went gluten free for nearly two years and then have been dabbling back into spelt and wheat. My primary reasons for trying the elimination were skin-related (itch, chronic eczema). Sad to say, it don't help much, though I did feel pretty healthy. I just ate a croissant the other day from an organic bakery that stone mills. It was heavan. I didn't feel foggy or anything, so perhaps the key is moderation?
Anyway, great site, very informative. Looking forward to hearing your thoughts on those skinny french people.
PS-I don't have a weight problem and ironically I didn't lose weight when I went gluten free. Ended up eating more meat (allergic to nuts)...

Interesting that inflammation would appear to be a component of nearly all these symptoms which wheat elimination "cures".

My depression and mood swings appear to be closely correlated with blood glucose swings, which may be why that also improves.

I'm another one for whom wheat bran is not inert: it generates BG spikes, although not to the degree of whole wheat. Lectins, phytic acid or wheat germ agglutinin?

http://high-fat-nutrition.blogspot.com/2007/11/how-toxic-is-wheat-well-first-point-is.html

Ted,
Thanks for the link to the livin lavida low carb site interview with Dr. Davis.  Your links are always informative.
In my opinion, all newbies visiting this web site should be directed to this reference for a great summary of what is important in taking care of your heart via diet changes. v.cool, thanks
Trevor

I've just found your blog via Feed the Animal, and I'm so happy I did!  Thank you so much for you posts, I'll be reading often.  

You have a few comments here, but I figured I'd add to your collection of anecdotal evidence:  I'd gone paleo for about a month when I took one 24 hour period off (dinner to dinner).  3/4 of a medium pizza, a snickers bar, 1/2 can pringles, and a dozen chocolate coated gingerbread cookies ended up on the menu.  Within 30 minutes of eating the pizza my heartburn had returned, withing hours of eating bits of the rest I was in PAIN.  Why I kept eating this junk for the next day, I have no idea.  The more of it I ate the worse my stomache got.  Severe upset stomache, badly sufuric burps, bowel discomfort, you name it!  And after that 24 hours I finally reached a level of toxicity where my body literally rejected the food.  So toxic was this junk that use to be "normal" food, that my body threw it up in self defense.  

Needless to say I'm totally commited to the paleo eating now!

What element in wheat are you referring to? everyone needs fiber which is a major component of wheat, people can't be allergic to fiber as their digestive system would pack up if you didn't have any.

Does abstaining from wheat include staying away from spelt and kammut and Emmer wheat as well..or is it the GMO wheat that is the problem?
Some doctors believe spelt is more digestable than regular wheat.

Jenny,

Not true at all. I eat very little fiber and am more regular and have less digestive issues than I ever have. As long as one eats enough fat, there is no need for fiber.

You can get Gluten-Free beer.  One brand is called Red Bridge.  There's another, but I forget the name.  I drink the Red Bridge.  Not bad.

Besides, you can get your "roughage" from raw veggies and salad.  I've been low-carb for about 6 wks. now; haven't had any bread, rice, pasta, wheat, etc.  I've never felt better and have more energy.  My brain is functioning better, too.  Also, have lost 4 lbs.

Beverly

Hi Dr Davis,
Thanks for a great blog.
I just wanted to share my experience of wheat free (I actually went paleo so fully grain and legume free)
No more swelling knees. Probably mild auto-immune, mother has it also.
Large - I mean large and multiple bumps - ganglion cyst that I had for 10 years shrank and disappeared.
PMS with horrid breast pain - gone.
Menstrual pain - less with fish oil, gone with paleo.
Constipation - gone
Pre-menopausal spotting the week prior to menstruation, had this for 10 years - gone.
Lost weight - that last 3 pounds that make me look my best.

I wrote about it here, I for one want to spread the news as a nutritionist.
http://paleozonenutrition.wordpress.com/2010/05/24/my-nutrition-journey/

Is whole grain wheat also harmful?

Thank your very much for all your information.

So people just give up having

1. bread and butter with meals or crusty bread with pasta
2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
3. pancakes

That seems hard to give up.

As an experiment and in an attempt to lose weight, I put my whole family on a low-carb diet. Cutting out wheat was part of it.
My husband has suffered from a mild type of colitis for the last 15 years. One year ago an awful smell developed with the colitis. Whenever he went to the toilet or passed wind an obnoxious, sour smell like old cheese/rotten eggs lingered a long time after. It caused me to move out of our bedroom, as the smell would cause me to wake up repeatedly. 3 weeks on the wheat-free diet the smell was suddenly gone. It was nothing short of a miracle. It was not something I had expected from the diet, but a very welcome side-effect indeed, as I hate bad smells. By the way - can anyone tell me what generates that particular sour, rotten smell?

legend 018 said:
So people just give up having

1. bread and butter with meals or crusty bread with pasta
2. peanut butter and jelly sandwiches, tuna fish sandwiches etc.
3. pancakes

That seems hard to give up.



Yes. They are addictive, aren't they? Isn't that the point? Wheat is addictive.

A criticism, then a question:
Any food you give up for months will cause diarrhea and cramping when you come back to it, because you've lost the bacteria that help you digest it.  I've experienced this with dairy, meat, and potatoes.  I am skeptical that wheat is any different than other foods in that regard.
I have family members who have experienced benefits from gluten free diets, but don't want to give it up altogether, for various reasons.  Does cutting back-- say, not eating bread but not actively eliminating gluten from all your food choices-- have lesser but similar effects?

Thank you so much Dr. Davis.  You have confirmed our worst fears that seemingly "healthy" wheat is actually a form of subtle malnutrition.  Please mention that it is the gluten that causes the problems.  Not in the allergic sense, but by blocking the important nutrients from fruits and veggies to vitamins and minerals.  Gluten forms a mucoid plaque which covers the small intestine thus causing subtle malnutrition and is therefore responsible for dozens of illnesses.

I have given up wheat because of its effects on myself including acid reflux, rapid heart beat, irritated hemmoroids.  

All of the effects you have mentioned have been documented as far back as 1995.  This is especially true of RA. I remember articles in the nutrition press stating that wheat was one of the triggers for RA. Thanks for all the information.

Hello Dr. Davis,

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Please check it out! Thank you. http://daiasolgaia.com/?p=2212

... fingers: type "submit"... thank you.

I wish this was the case for me.  I have suffered with IBS for 27 years.  I have gone on gluten elimination diets for up to 30 days twice in the past 15 years with no change.  Incorporating it back in, the only thing I noticed was a little bit of heartburn if I had wheat in the morning. I've tested negative for Celiac's and wheat allergies.
I'm not saying your are wrong. But for me a wheat free diet was no cure for IBS.    (I WISH!)
-Karen

I could see this might be a problem if gut health was compromised; exogenous AGEs would then have a pathway to get into our tissues.  Assuming someone is on a low carbohydrate paleolithic style diet, what evidence is there that the exogenous AGEs do anything other than merely pass through the digestive system?

Hi August, I echo the same question. Is there any research on exogenous AGE's absorbing in to our bodies?

Dr. Davis,

Are palm oils/hydrogenated oils a significant source of AGE's like butter?

What about clarified butter (ghee)?

Dr. Davis, now you're delving into the unknown with your suggestion of an anti-AGE diet. You don't know. You're suggesting we eat that diet but you haven't any data to support such a suggestion. Don't do like they did with saturated fat. Think of the alternative we adopted then that brought us here. Think of the alternative we will adopt now that will bring us who knows where.

If the advice of the day is to avoid AGEs in food, what kind of food will we eat then? Since meat contains a boatload of AGEs, that's out but what will replace it, soy? See how your advice is already turning on itself?

Stick to what works on the TYP program as a good doctor should and leave the speculation to the speculators.

Martin, there have been numerous studies connecting the association of AGEs with various health issues. There is nothing novel or or new about this.

Avoiding AGEs doesn't mean you can't eat meat. All you have to do is eat good fresh meat and don't over cook it until it is well done or overbrowned. If you like your meat chared and well done, then you may have to make a sacrifice.

Yes even properly prepared meat has some AGEs in it. But no one food or diet is perfect. You just do the best you can and try to avoid the big mistakes. Just my opinion for what it is worth.

Doc - with regards to exogenous AGEs, it sounds like this could be the new cholesterol-is-bad-for-you theory. My apologies if I have overlooked something in your post, but I don't see any logical argument leading to the conclusion that exogenous AGEs affect your health. Your previous post on butter also makes you sound like an alarmist. Of course, if you have a diet coming up, this is understandable.

what do stomach acid and bile do to ingested ages?? ...and the rest of the digestive process? sss

One of the primary AGE components of milk products is pyrraline:

Glycation in food and metabolic transit of dietary
AGEs

Here are some quotes from this study:

"Given the data for pyrraline excretion, it
can be concluded that dietary pyrraline is nearly completely
released and resorbed during digestion, followed by rapid
elimination via the kidneys, thus leading to nearly complete
recovery of dietary pyrraline in the urine. This indicates that,
in contrast with Amadori products, of which only up to 5%
are recovered in the urine [24,25], pyrraline obviously is not
metabolized within the body."

"Above all, however,
it has to be realized that the term ‘AGE’ comprises a large
number of individual amino acid derivatives, of which only a
minority have been identified and quantified either in foods
or in vivo."

Now that everyone is speculating in the last two posts, is it possible that some AGEs are much more harmful than others? (As the previous study indicates?)

Are we distinguishing the types of AGEs when we measure them? (Or are we lumping them all together like what was done with cholesterol?)

Are food derived AGEs eaten as part of a meal less harmful then analogues produced in a lab and fed in isolation? (Like most AGE studies I've read?)

Again, if butter is as bad as these measurements indicate, why hasn't it been identified epidemiologically as such a bad food? Those with the highest butter consumption tend to be the healthiest (although I suppose because it displaces margarine).

I can understand why all AGEs might be harmful to someone with compromised kidneys, but I agree with Martin Levac that we're really delving into the unknown.

"Martin, there have been numerous studies connecting the association of AGEs with various health issues. There is nothing novel or or new about this."

Please give us a study. This sort of broad statement is hard to counter argue otherwise!

I'm not really convinced AGEs you eat are a problem. But if you're enamored of low temperature cooking, looking into Sous Vide cooking. It yields delicious results by cooking at much lower temperatures than normal.

Speaking of endogenous AGEs, caused by high blood glucose levels, here is an interesting factoid - blood glucose levels in birds are very high yet their HbA1c levels are low:

http://healthcorrelator.blogspot.com/2010/10/blood-glucose-levels-in-birds-are-high.html

There are a few possible reasons for this. One of the most interesting mechanisms is vitamin C synthesis. Not only is vitamin C a powerful antioxidant, but it also has the ability to reversibly bind to proteins at the sites where glycation would occur.

All humans cook food and have done so for thousands of years. This is natural for us. If you've ever cooked meat on a camp fire, you know that the some of the meat becomes very crisp. Paleo people didn't have temperature gauges so I'm very sure there were plenty of exogenous AGE's. In fact, I would suggest, since these pieces of foods tend to taste very good to humans that they are an important piece of our nutrition not the opposite.

"High blood glucose (any blood sugar above 100 mg/dl) will permit glycation"

I would love to know some research that backs this claim. I have seen it numerous times but have not been able to find any research that specifically deals with it.  Also, just guessing, but I would bet that damage occurs at considerably lower blood sugar levels for those eating a conventional, nutrient sparse diet as compared to those replete w/ vitamins, minerals, phyto-nutrients etc who eat a diet containing very large amounts of "real food" particularly non-starchy vegetables

Has anyone ever taken an A1C of a grain-feed cow?  Maybe that high AGE butter was from a diabetic cow!

I don't know if AGEs are harmful either, but a pressure cooker is great for low-temperature cooking. It's also much faster and keeps in the juices better than oven roasting.

Re: sausage (from the last post), the list of ingredients from the chorizo I eat is pork, water, salt, paprika, spices and garlic powder. "No nitrates, MSG, preservatives, sugar or soy," reads the label. I don't understand why this is worse than any other meat.

Sausage could be a problem because,

1)The meat is ground up so more of the surface area was exposed to oxygen. More of the meat is oxidized.

2)Sausage unlike unground cuts of meat must be cooked through because of bacterial contamination. The more you cook meat the more you get AGEs.

3)Some sausages as with hot dogs are pre cooked. Then you cook them again. This should also increase AGEs.

There are indeed studies that 1) measure serum levels of AGEs in humans after consumption of exogenous sources, and 2) relate AGE levels to biologic effect, e.g., endothelial response.

There is no question that the exogenous AGE conversation requires more exploration. I've followed this conversation for some years, but I believe it is gathering real momentum and looks and feels like a genuinely meaningful issue.

We need more info, no doubt. The notion of endogenous AGEs already fits quite nicely into our observations of the benefits of a low-carb diet. But  exogenous AGEs have potential for taking us one step farther in crafting an ideal diet. Recall that the "Paleo" approach is one reconstructed to mimic ancient behaviors, not necessarily one to achieve a new set of modern goals, such as reversal of coronary disease or osteoporosis.

It's clear that in the US we eat lots of carbs and get lots of heart disease and diabetes.  But there are lots of traditional cultures that eat even higher percentages of carbs (cassava, beans, rice and others) but that don't get those diseases.  How does the AGE theory explain that?

Dear Dr Davis,

I know your opinion against butter, but disagree, based on a lifelong experience, as a skin chronic healed by milkfats and (land)animal fats.

For the first 40 years of my life I was never free of allergic reactions and imflammated skin symptoms. Raw food helped not, vegetables and salads helped not, and the official healthy lifestyle helped not either. 10 years ago, when the stsart of Zonish lowcarb (much like your style) finally helped me incredibly much... Yet my skin has healed fully only after I switched to very, very buttery and egg-yolky diet close to Jan Kwasniewski.

I live far up North, but have no symptoms of vitamin D deficiency, in spite of not eating the pills and not having much sun for the better part of the year. Furthermore, I cannot eat fish, and do no longer supplement with fish oil either, due to problems induced by it. Yet my skin has never been as good as now, fully without irritation or other symptoms. And unlike my frends and colleagues, I no longer seem to catch seasonal colds, either.

So far the only thing I can blame for the last few years of well-being is increased use of milkfat and non-muscle parts of animals (fat, marrow, liver and skin collagen). Of these the milkfats make up a major part of the daily calories, often more than 50 E%.

I'm interested to hear your thought on possible causes, which make this butter strategy work the best of all that we've ever tried; both for myself and for others in our family

With regards,
LeenaS

I am a Type 2 Diabetic with normal blood sugar who takes -0- drugs and -0- insulin.

I experienced tremendous benefits from going low carb primal. I won't detail them here but I have not been sick in 20 mos.

This summer I performed a one week dairy fast (I'd been off milk for almost a year) and then added back butter.

Butter was very inflammatory. I no longer eat it. Clarified butter or Ghee and Cheese are not inflammatory and I eat it occasionally.

So for me, I agree with butter.

Anonymous, thanks for the info on sausage. I buy raw sausage and I'm careful to avoid over-cooking any meat, mostly because it gets like shoe leather.

Another question: is cream high in AGEs? Does the churning action required for butter contribute to oxidation or AGEs?

What's the consensus on carnosine ? I've read some articles claiming it helps with AGE factors.

Dr. Davis, it's fine to have data on a diet that contains AGEs, but where's the data on a diet that avoids AGEs? Where is the justification for adopting such a diet? Avoiding something leads to adopting something else. What will that be? You can't predict. Nobody can predict. This is the danger of advising to avoid something just like that was the danger of advising to avoid saturated fat and pretty much all animal fat altogether in one big swoop.

If we can't eat fat, we must eat sugar. There's no other alternative. If we can't eat meat, we must eat some other form of protein. What will that be, soy, wheat, any other grain, legumes? If we can't eat meat, we must eat some other form of those essential nutrients like B12 and EFAs. But where can we get such a high quality source of those nutrients but in animal flesh? The quick answer is nowhere.

When you advise to avoid AGEs without giving us a safety threshold, the safe course is to avoid all AGEs, not just a little bit. When you give a safety threshold, it doesn't matter because the substance has been declared bad entirely anyway so the safe course is the same.

We can see this with animal fat and pretty much any kind of fat. Fat is bad, so any fat is bad, so less fat is good or better, but no fat is best. That's how it works in spite of having some form of safety threshold we can abide by like say 10g of saturated fat per day maximum. Why is that? The safety threshold is declared as a maximum with no minimum.

So tell us Dr. Davis, what is the maximum and the minimum amount of AGEs you advise we eat? But more relevant to the discussion, how can we find out exactly how much AGEs is in the food we eat every day so that we can make an informed decision on exactly how much AGEs we eat every day? Is there a tool that will allow me to find that out? The point is that even if you give us a precise number on how much AGEs we can and cannot eat, we can't even control how much AGEs we eat. Accordingly, the best course of action is to avoid all AGEs and not just a little bit just to be safe because the contention is that lots of AGEs is worse than none.

With endogenous AGEs production due to high blood glucose and other simple sugars like fructose, the problem is much simpler. That's because this AGEs aspect of sugars is merely the last installment of How Sugars Kill Us Slowly. We already know that sugars kill us slowly and we already know just how much of it will do it and how long it will take and etc. But until you find out exactly how much exogenous AGEs we must avoid and exactly how much we can get away with and how to measure the AGEs in the food we eat, this problem will remain unresolved and unresolvable.

In other words, the best course of action with exogenous AGEs is to just ignore them outright. After all, we've been ignoring them outright for the past couple million years without so much trouble.

Bill,

Butter is high in AGEs? Wow - why? What about Ghee?

Do you know what the AGEs are in smoked meats like smoked trout?

Does the canning process increases ages as in canned wild caught salmon?

Hi, Fred-

I believe that smoked fish tend to be moderately high in exogenous AGEs.

One of the difficulties with quantification of AGEs in foods is we have limited data on the AGE content of various foods. It's not like grams fats or carbohydrates listed in plain sight on the label.

I find the AGE conversation a fascinating new potential insight into helping us decide how to best manage food choices, as well as food preparation.

As with all new ideas, it will cause upheaval in preconceived notions.

Given some of the previous blog posts, the largest preconceived notion might be yours toward butter. So, it's no big deal if you aren't up to the challenge of defending what you posted. That's okay. Trying to be coy about it, not so much.

Count me as a skeptic on this one.

Very good review on AGEs. Dr. Davis is 100% right to be concerned.

http://biomedgerontology.oxfordjournals.org/content/65A/9/963.full#ref-109

Chris Masterjohn has the skinny on AGEs in butter:

The Daily Lipid: Is Butter High in AGEs?

People are confusing exogeneous AGEs which are generally harmless compared to the dangerous endogenous AGEs.

Endogenous AGEs are created by proteins in our bodies reacting with reducing sugars.  Practically the only sources of dietary reducing sugars are fructose (table sugar, HFCS) and  cooked starches. The obvious solution is to eat far more meat and butter and drastically reduce carbohydrates.

Humans have been eating cooked food for 1.8 million years and are very well adapted to them. The novel foods in the human diet are large quantities of plant proteins, starches and sugars.

I'm surprised you think kale and spinach are so wonderful. Renowned toxicologist Dr Bruce Ames says that there are considerable amounts of natural toxins and carcinogens present in all food plants.
http://www.fortfreedom.org/n16.htm

Any potential benefits from eating kale is likely to be due to hormesis.

In fact there is absolutely nil direct scientific evidence that eating fruit and vegetable has any health benefits whatseover. The benefits of vegetables have only been found in a few poorly designed population studies. Any observed 'benefits' of eating vegetables are probably just due to confounding variables - people who eat vegetables smoke less, drink less alcohol, are more active and eat less sugar and junk foods.

Gary Taubes is skeptical of the claims about exogenous AGES

http://www.healthcentral.com/diabetes/c/36758/17729/gary-taubes

Hi Apra,

In 'The Diet Delusion' Gary Taubes says that the natural diet of humans is almost purely carnivore with a few berries. Taubes studied physics at Harvard and aerospace engineering at Stanford before becoming a journalist. Because he was properly trained in using rigorous scientific methods he can readily see the flaws in nutrition research.

I've read the sole paper that lists butter as a high-AGE food: "Advanced Glycoxidation End Products in Commonly Consumed Foods" (2004, Journal of the American Dietetic Association, via Google Scholar cache).

The data is in Table 1, which refers to "foods prepared by standard cooking methods" (these include frying), but the table says nothing specific about how the butter was processed. I am willing to bet that the butter in question had been treated at high temperature (maybe used in frying).

Consider these values:

Milk, cow, whole .... 0.05 kU/mL
Butter .............. 265 kU/g

Expecting high AGEs in uncooked butter -- over 5000 times the level in milk! -- would make little sense.

Would you consider revising your post in light of this?

The data table lists butter as 100 gm serving, or over 3 ounces (23,000 - 26,000).  In the serving size database, the amount of AGEs normalize a bit, at 1100 - 1300.  I wish they had done organic vs commercial butters, but maybe next time we can see that data.  No surprise on pan fried bacon at 91,577 for 3 ounces and 11,905 for the serving size (2 slices is the norm).   As with all foods, moderation.  And thank you for your blog - it is very informative!

Er...it appears Pumpkin free too.

I would add about a teaspoon or so of vanilla to this recipe.

Since almonds make me barf, what's a good substitute for almond flour?

Hi Ananymous,
I have successfully used hazelnut flour & walnut flour in my low carb baking.  If you cannot find commercially - you can buy the raw nut and grind up in food processor or a blender.

I made this today and it was delicious. The whole family liked it, even the carb eater.

Is the folly of an RDA for vitamin D at least partly because it is a hormone?

I am also sure that different people absorb vitamins and hormones differently; and a person probably absorbs them  differently at different times, as well. Another reason an RDA won't work very well, if at all.

Any undiagnosed kidney problems/disease?

I've read that something like 25% of people have undiagnosed kidney disease and that this can impact the conversion rate of D to the active form.

I posit that the main factor that determines the resulting 25-hydroxy vitamin D level is dietary fat intake.

How do I find out how much I need?

After 2 years of every 6 months blood tests, I've settled on 10,000iu/day.

Found great price for 10,000iu gelcaps here: http://www.nutritionland.com/p10930/Healthy-Origins---Vitamin-D3-10000-IU-360-SoftGels.html

Caution...they tried to improperly charge me sales tax.

there are heaps of vitamin D isonomers, you don't know what proportions of the different isonomers and toxisterols are in the supplements and also they are quite fragile and really need a preservative like sodium sulfite which has become unfashionable

this problem of what vitamin D actually is has zero research done on it, let alone what is in supplements!

it's at least 20 years away before a reasonably informed RDA can be given

Genetics does have it's opportunity to alter things. The unactivated D's  binding receptor has to co-function with the retinoid-X-receptors and get to the D response element of our mutable genes to start transcription of activated D.

There are 8 D pathways and several known vitamin D receptor gene variations. The receptor variants show pronounced association with different population lineages. The level of circulating (measureable) activated D is affected - and then too the 1/2 life of active D is not a long cycle even in ideal metabolism.

In the kidney making active D, the 1,25(OH)2D3 type, needs the enzyme "CYP27B1" to respond to the parathyroid hormone.

Curiously the same enzyme in our macrophages induces synthesis of active D there (outside our kidneys). Certain noxious bacteria (not the parathyroid) in our system trigger Toll-like receptors that start this cascade. This too is a geneticly varied immune function.

The following is a comment on the Vitamin D Council's website where Dr. John Cannell discusses cofactors required for proper vitamin D metabolism:

"Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:

•magnesium
•zinc
•vitamin K2
•boron
•a tiny amount of vitamin A

Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

http://www.vitamindcouncil.org/

My Vitamin D3, 25-OH, levels were 29 ng/ml so I took 4000 IU a day for a year and it rose to 39 ng/ml  (+10ng/ml change).

I'm shooting for 50ng/ml, so I'll do another year at 4000iu, at which point I think 2000iu/day will maintain that level.

Don't forget differences in nutrition.  Do they eat the same food? How much grains, fish, meat, and so on?

Paul mentions Vitamin K2 as a cofactor. These Vitamins don't work in isolation, but are part of the grand metabolism show.

Dr. Davis, what do most "conventional" Md's deam "toxic levels of vit d"?

Reason I ask, my girflriend has been supplementing with vit d. 2-4000 iu per day with some breaks here and there for the last 6 months.
Recent blood test she was told by her MD that vit d levels are way to high. We have been waiting for a week to have them give us the reading....hopefully they will call next week.

My levels are 63 ngl and I'm curious if many Md's would find that level too high.
Your feedback is very much appreciated and thank you for al you do.

Marc

@Martin Levac: vitamin D3 is not dependent on fat as a tranporter (D2 is however).

another reason for bad absorption could be undiagnosed (or silent) celiac. the absorpion of D mainly happens on the tips of the villi, and if they're damanged, absorption is massively disturbed.

another reason could be chronic infection, which can use up a lot of D in the concerned tissues/cells for fighting it, or increased degradation of 25-OH-D in the liver.

another question would be if one man's 25ng, is the same as another man's 25ng. could be that inividual levels in the blood are actually not really compareable at all due to genetics, and that the second man's 25ng is actually more like 100ng for him, and therefore the liver desperately tries to bring down the level.

What is the name of the test for 25-hydroxy vitamin D level? I found a lab that will do this test: Vitamin D 25 Hyrdroxy LC-MS  (Vitamin D 25-Hydroxy, D2 + D3 ).

Your sample size is small to warrant this conclusion, "Vitamin D is an individual issue that must be addressed on a person-by-person basis," no?

Dr. Davis,

Whether or not you agree with the specific value of the RDA, interindividual variation in requirement does not in any way invalidate the concept of the RDA, because the RDA is not meant to be a one-size-fits-all recommendation.

On the contrary, the RDA incorporates the concept of a distribution in requirements, and attempts to cover the needs of most people.  The IOM is pretty explicit about that.  

You could certainly argue that the current RDA is not sufficient to meet the needs of most people, but that's another issue.

Chris

Great post. I completely agree. Vitamin D is simply too complicated to be addressed in just one number. Most everyone's level of understanding is so superficial that it doesn't extend beyond that one number. When a number like that is created, it takes on more power than it should because most who access it don't know its faults and limitations.
I know someone who concluded that his bizarre behavior after drinking two bottles of apple juice was from "Too much Vitamin C." He had drank two bottles, each bottle had 2 servings, and each serving had 100% the daily value of Vitamin C. Beyond the giant sugar bolus, in his mind, he had just taken 4x the recommended amount of Vitamin C. Based on his level of understanding, he concluded he may have ingested a toxic amount of Vitamin C. He needed a scapegoat and he found one.
More damage is done by attempting to dumb down Vitamin D to one number than any benefit an RDA creates. It's simply too complex.  Frankly, it's pretty pathethic that Vitamin D deficiency remains rampant. It says an awful lot about our healthcare system that such a huge percent of the population remains Vitamin D deficient while taking far sketchier prescription drugs for the host of conditions associated with Vitamin D deficiency.

For people with money, insurance, and education, jit makes sense to look at each person's individual needs.  For everybody else, RDA sounds to me like a reasonable idea.

Dr. Davis,

Would blood calcium levels be an accurate indicator of sufficient Vitamin D intake?

Quailia,

We were thinking along the same lines... undiagnosed malabsorptive disorders could be responsible for alot of low levels in spite of supplementation.

Celiac alone affects approx. 1-133! throw in fructose malabsorbtion, UC etc. and no wonder we have an epidemic of low D levels.

@Qualia,

Do you mean to say that vitamin D3 is not fat soluble? Everywhere else it says D3 is fat soluble. Do you know something the rest of the world doesn't?

I wonder if I may be overdoing it with 5000IU for about half the year (Oregon). I eat natto and 3 cups of steamed spinach per day, so I should be ingesting all of the cofactors in substantial amounts.
I wonder if it would be more efficient to go to an endocrinologist in order to get this and a proper lipid panel done.

If the IOM has achieved any good at all, it is to further stoke constructive discussion around vitamin D.

I am quite impressed with the level of comments here. Compare that to the conversations we were having just 2 or 3 years ago. We've come a long way.

Vitamin D remains on my list of "most incredible health effects ever seen."

A belated thank you for all your articles on Vitamin D. I read about the importance of taking Vitamin D in many books but was never willing to go through the hassle of getting my levels checked.

Well, reading your blog several months convinced me to give it a shot. Turns out that it took 10,000 IU a day just to get me to 54 ng/ml. I am now on 14,000 IU a day to see if I can get into the 60 to 80 ng/ml range.

I have thus far managed to get through this winter without contracting a cold when half the people I work with are taking turns being out sick with one they've spread amongst themselves. By adding D and CLO (and making dietary changes), my total cholesterol dropped from 215 to 169, my HDL went up from 44 to 50, and my VLDL dropped from 24 to 9. My triglycerides dropped from 143 to 53. Given that I'm only halfway through my weight loss I expect greater improvements yet. Thanks again.

This is great, brilliant and knowledgeable post. I agree with your conclusions and will eagerly look forward to your next updates. Just saying thanks will not just be enough, for the wonderful clarity in your writing.

Here is "The Peoples Chemist" Vitamin D link:

http://thepeopleschemist.com/blog/the-vitamin-d-scam

Dr. Davis, I have had great lipid results, overall health benefits with going to a lower carb, paleo diet as well as supplementing with vitamin D getting to the the mid 50's mg/dl range from the low 30's on 8000 mg vitamin D for the last 2 years. Not sure if related, but one downside has been the 3 occurences of kidney stones in last 18 months. It seems the current recommendations for the stones implicates higher protein diets and increased vitamin D. Have you run into this with any of your patients, what is available to address this?

Margarine and Phytosterolemia

Stephan Wholehealthfoodsource also has a recent interesting blog on this topic.

The more I read about processed foods, the more I stick to whole foods. I was part of the trans fat experiment. I am not willing to take part in the sterol test.

Most medical blogs, though useful, give us a "Choose your guru" kind of model. This post exemplifies an approach that can be summarised as: "Here's what I think, and why; you can follow my recommendations, or you can do your own research; and what's more I'll give you some pointers to get you started." Great stuff. Thank you.

On the issue of plant sterols, the standard argumentation appears to be: "Cholesterol is bad. Anything that displaces cholesterol must be good. We're not interested in what the substances displacing cholesterol might be doing." Unfortunately, the argument is usually tacit; otherwise, it would be immediately obvious how misguided this line of thought is.

Here they go again.  They try to solve a non-existant problem and just make things worse.

There's big $$$$$$ in cholesterol and this is all about $$$$$, not health.

I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.).  What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.  

When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).  

It's almost like being on another planet!  There's always so many new products (most of them I hesitate to even call food).   It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste.  I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold  Irish cheese, because I know their cows have pasture access and it's real food).

What's really shocking to me is how large some sections of the markets have become in recent years.  While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas).  Meat and seafood counters have shrunk, though.  Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

But the chilled juice section is h-u-g-e!  And no, I don't think there is a Florida orange grove behind the cases.  Come on, how much juice do people need?  Juice glasses used to be teeny tiny, for a good reason.  To me it looks like a long wall stocked full of sugar water.  Avoiding that section will put a nice dent in the grocery expenses.

The yogurt case is also e-n-o-r-m-o-u-s!   Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"!  Chock full of every possible variety, but very little fit to eat.  The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home).  I can flavor them at home if needed.   The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

I found the same "cooler spread" in the butter & "spread" section.  The spread options were just grotesque sounding.  Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc.  A few plain butters were enhanced with "butter flavor" - say what?  And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.

Are sterols the same as plant stanol esters, as in Benecol (http://www.benecol.co.uk/new/light-nutrition-information.htm)?

Is beta-sitosterol, found in anti-BPH supplements in the amount of about 500 mg., okay?

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


Joannah

http://myscones.com/

One of your articles cited concludes:

"However, the role of dietary plant sterols in the development of atherosclerotic plaque is not known."

Basically, there is no evidence that adsorption of sterols into serum did anything negative here. The presence of sterols is not a smoking gun.

I take your warning as a caution, but I am not sure I believe you any more than the opposite side of this story, and yet I am by example proof that sterols have reduced my bad cholesterol levels.

By the way, the Promise Active Supershots actually have 2 GRAMS of sterols, not 400 mg as you stated. Also, that product is being taken off the market at the end of August 2009 due to lack of market response (so I am told by Unilever).

This study, piled on top of the worrisome literature that precede it, are enough for me: No more tin cans (which are lined with BPA), no more hard plastics labeled with recycling code #7 or #3, no more polycarbonate water bottles (the hard ones, often brightly colored). Microwaveable-safe may also mean human-unsafe, as highlighted by this damning assurance from the Tupperware people that BPA is not a health hazard.

Did you know the VDR-knockout mice have miniscule amounts of visceral fat?  They're hyperphagic and also have low SC fat, very high UCP1, and poor general health--a very high Ca diet helps some.  I'm not really sure how to extract any useful information from the studies on those mice though.

10 days ago in journal Radiology 2011, 260(3): "The association of pericardial fat with coronary artery plaque index at MRI imaging...":
(quote) "... this is the first study to determine the association of pericardial fat on coronary artery plaque burden in asymptomatic individuals."
(quote) "The coronary artery eccentricity (ratio of maximal to minimal coronary artery wall thickness) was determined by using magnetic resonance (MR) imaging and served as an index of plaque burden. The pericardial fat volume was determined by using computed tomography."
Pericardial fat refers to fat around the heart in case wording confuses anyone.

I've lost ~65 pounds in the last 7 months, but that doggone visceral fat is still hanging on for dear life, unfortunately, even with my internal organs trying hard to evict it, too.
I'm determined to get rid of it all, plus the few remaining pounds of subcutaneous fat I have left, mostly in the form of "love handles," come hell or high water.

Joe

PS: UPS just delivered my copy of your new book, Wheat Belly, a few minutes ago, Dr. Davis, that I ordered mostly for my brother-in-law, who still eats massive amounts of cereals, bread, pasta, etc. (and who has an ever increasing "wheat belly").  Maybe it'll offer a few tips on how to lose VF specifically...

Is wheat driven small LDL dose dependant?
If I eat one sandwich a day, do I get no benefit from reduced wheat at all?
How long must one be wheat free to get a reduction in small LDL?
Thank you

I'm making this post in this thread because the vitamin D thread appears to be shut down:

Dr. Davis:
Stenosis is when the valve fails to fully open, and insufficiency is when the valve fails to fully close (as I understand it). Presumably, both result in decreased blood flow from the heart.

On that assumption, anything that can be done to strengthen the heart muscle itself would seem appropriate, including participating in vigorous exercise, taking various heart-beneficial supplements, like magnesium and vitamin D ("contractility"), CoQ-10, fish oils (may affect "palpitations, fibrillation and arrhythmias"), etc. And losing weight, of course.

Which has been my chosen course of action. I'm 68 years old. I've lost ~65 pounds over the past 7 months, I now run 5K+ 3-4 times per week (I feel great!), I do some upper-body weight-lifting to conserve muscle mass during weight loss, I take the above supplements (including 6000 IUs of vitamin D, plus I get almost daily sun exposure during my runs, walks, etc.), and I pray a lot. The only symptom(s) I appear to be experiencing are some mild palpitations from time to time. Other than that, nada.

I've been unable to find in the literature any specific ways to treat insufficiency other than valve replacement or repair, both of which require open-heart surgery - and which just ain't gonna happen.  No way, Jose.  My plan is to "keep on keeping on" (as described above)  for as long as I can, and hope for the best.

Eventually, I will succumb to heart failure, I presume, but I'm hoping to push that eventuality as far into the future as I possibly can. My second echo stress test is scheduled for next March, and I'm hoping that the numbers will show some progress, but I'll settle for no slippage. I feel like I'm "in training" for the event, and I'm a competitive guy. I also hope that my aggressive approach is the right one, but I have no way of knowing if it is or not because of a lack of information in the literature. My cardiologist gave me a "no restrictions" edict regarding exercise, but didn't have much more to add. I've taken those words literally; I have taken my MHR up to 165bpm, but I am hesitant to take it any higher at this point, for obvious reasons. But I think I've still got more in the tank, so to speak. I now have a RHR in the 50s. My BP now averages ~115/62. With numbers like that, I have to keep reminding myself that I have "heart disease."

Dr. Davis, what is the longest that any of your insufficiency patients have been able to put off the inevitable (inevitable in this case should be considered to be heart failure or valve replacement/repair)? What other supplements might help me out? Is it feasible that I could get another 10 years out this regimen, or am I just kidding myself?

How's that for putting you on the spot, Doc?

Joe

Joe...I don't understand your aversion or fear of surgery. You have an 'easy' fix solution. Most people with CAD would trade places with you.

Your valve problem is mechanical and not in the same category as arteries being occluded.
No amount of exercise or supplementation and nutrition will correct your current situation, albeit a great protocol for CHD prevention.

That's my 2 cents...while you await Bill Davis to respond to your concerns...good luck.

Joe,

My 2 year old daughter had her aortic stenosis fixed via a valvuplasty. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC324896/
I am not a doc but thought I'd throw that out there. Regarding my daughter she is 25 years old living a normal healthy life. Her initial assessment by another cardiac surgeon was open hear surgery to repair the stenosis along with a life with no child birth and drugs for her lifetime.  Good luck to you!

Hi, Joe--

While I have been seeing incredible effects in aortic valve stenosis patients (essentially stopping progression in most, reversing a few, a few continuing to progress), the handful of people with aortic valve insufficiency don't really add up to a real experience. Nonetheless, I have indeed seen several stop progressing, a couple actually improve. My colleagues will dispute this, calling it quackery, since I have not yet published any of this.

That said, vitamin D is wonderful for overall health. Vitamin K2 is also proving to be a fascinating nutrient with potential for substantial bone and artery/valve effects, also. Neither are harmful. So I believe nothing is lost except a few dollars by giving it a try.

Great, Joe! 65 pounds over 7 months is absolutely spectacular!

For those interested, here is a way to tell the difference between subcutaneous and visceral fat: http://bit.ly/pJxgLH

Nice topic. I think not everyone know the difference between these 2 kind of fats. And the difference is really important.

Rob

I'm confused by your post.  From what I understand, the CT angiogram provides a superset of the data provided calcium scoring CT.  So when I got a CT angiogram this summer, I got a calcium score with it.  (Is that not standard?)

Also, I worry that you're overstaing the radiation dose of the CT angiogram.  In a prior blog post, you wrote:

"CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 chest x-rays or 20 mammograms. Now that's a problem.

"The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legimate medical questions. They are not screening tests to be applied broadly and used year after year."

I agree with your analysis that the CT angiogram delivers too much radiation to be used as a yearly screening test, but your radiation comparison numbers are way different in the two posts by a factor of four.  While such numbers may not be precise, that seems like a bit much.

Full disclosure: My husband is a radiologist.  (He's msk not a body guy, so heart scans aren't his thing.)  His group performs both kinds of tests.  I'm definitely not promoting CT angiograms over CT calcium scoring.

OH OH!  I misread your post.  You said that "after four years" -- hence the four-fold increase in radiation.  Duh.  

My question about the calcium scoring as part of the angiogram remains, however.  (I could repost that as its own comment if you prefer, however.)

This is done with the help of a device called the catheter which is a thin, narrow, tube-like structure. Now, the images are studied to understand corrective measures needed to re-instill proper functioning of the heart.   Angiography hospital in Thailand

Dr. Davis,

I don't have Type 1, but I have to use insulin to cover anything more than a trivial amount of carbs.

The problem with Mexican food is the beans, rice and tortillas.

In fact, most supposedly "low glycemic" foods like beans raise my blood sugar a lot, just a bit later than does white bread.  A person with an intact 2nd phase insulin release would not see a spike from these low glycemic foods, though they would need to secrete a LOT of insulin to cover them.

The people who create the GI lists only test at an hour or two after eating. So if a food spikes someone high at 3 or 4 hours, they miss it.

That's why if you are looking for a diet that really keeps native insulin secretion low you want to count absolute carbs, NOT look at the glycemic index.

I have heard other diabetics mention that chinese food is the worst when it comes to their blood sugar. Rice/noodles/sweet sauces/corn starch thickener = too many carbs. I wonder what else is used?

There are some big surprises when checking ingredients. An example would be the McDonald's hamburger and grilled chicken. The hamburger is beef, salt and pepper. If you think the grilled chicken is only chicken, you are wrong. Take a look. There are about 20 ingredients. Some are polysorbate 80, corn gluten, wheat gluten, sodium benzoate...and the list goes on and on. http://www.mcdonalds.com/app_controller.nutrition.categories.ingredients.index.html

Living gluten free and needing to check all labels and ingredients has been a real eye opener for me.
Anne

the key ingredient (my Shanghai cooking teacher taught me) in wok cooking cabbage was sugar and caramelise it with the cabbage.

Diabetes occurs because the body can't use glucose properly, either owing to a lack of the hormone insulin, or because the insulin available doesn't work effectively.
only way That control your diet.

I second Anne's comments about gluten. My spouse was recently Dx as gluten intolerant. We'd been eating low carb, and had successfully controlled his blood sugar, but now that we are asking for the gluten free menus I can see lots of carbs on the menu in places I would not have imagined!

Did your friend say whether his dosage requirements were the same for a particular kind of food whether it was made at home from scratch, or prepared at a restaurant, or from a grocery store ready-to-make box/bag?

"Personally, though I love the taste of Americanized Chinese food, I've always been suspicious of what exactly goes into these dishes. But I was unaware of the blood sugar implications."
Type 2 diabetic with relatively low insulin resistance:
I can go to a Chinese buffet and select what expect to be proteins (meats) and vegetables.  After so many attempts with spikes I have about given up on Chinese foods.

Frank Roy

The problem with Chinese eaten out is it's mostly noodles and rice - just starch.  Even those dishes that look like it's just meat and veggies comes swimming in a sauce full of sugar and corn starch.

Chinese food is OK when I make it myself.  I stirfry meats and veggies in avocado oil and season with some fresh ginger, garlic and tamari.  Without rice to soak up the flavorings, you don't have to use piles of tamari, so don't have to thicken the sauce particularly and don't need corn starch.  It's very yummy, actually more flavorful than what you can get when eating out, and a minimal impact on bg.  

And cabbage carmelizes just fine without sugar.  A stirfry of just hamburger, shredded cabbage, ginger, garlic and tamari is a favorite around here.  It's one of the favorite meals of my husband who does not low-carb.

This is the thing wrt to dosing insulin, you *can't* dose for a high carb diet (though what is high carb may vary from person to person).  

If I eat "normally" (which is pretty low-carb), I dose my insulin according to rules I have figured out for myself.  With these rules, my blood glucose *never* goes too high.  Of course it rises some with the meal (usually into the 120-140 range), but then settles back down before the next meal (to 80-110 or so).

If I eat a "cheat" meal, there's no right amount of insulin to take.  If I use the same rules to dose, my blood glucose goes up over 200, sometimes WAY over.  But it still returns to normal, it just takes a bit longer.  

The amount of insulin it would take to keep my bg low after a meal would be *huge* - enough to cause me to go hypoglyemic after the peak.  And hypoglycemia is a *lot* more dangerous than running a bit high.  

So what's the answer for a diabetic?  You just don't cheat very often.  High bg causes damage, you can't afford to do it much.  You cheat just often enough to keep yourself eating normally the rest of the time without building up  cravings that lead to binges.  

The other thing is... what happens to a diabetic injecting insulin *also* happens to non-diabetics!  You just don't see it cause you're not filling a syringe.  But your body is pumping out piles of insulin to handle the carbs you eat, so if you indulge in carby foods, your insulin levels rise.  

This causes a host of problems... including increasing the risk of heart disease and other problems associated with inflammation.  

Even if your body *does* handle glucose properly, keep raising your insulin levels and eventually your cells start to become resistant.  Increasing insulin resistance therefore increases the chances you'll become frankly diabetic.  

In short, while most folks can eat way more carbs than I can, no one needs to eat gobs of carby foods.

There's LOTS of good food to eat that isn't full of sugar and starch, which are really pretty bland foods anyways.

The secret ingredient in restaurant cooking is transfats.  Our favorite restaurant Long Life Veggie House in Berkeley (next door to the campus) uses it.  My husband loves that place! Every dish is DELICIOUS. They don't use MSG but they deepfry in hydrogenated veggie oils. *Deep fried* broccoli sure tastes much better than non-deep fried    Even if non hydrogenated veggie oils are used, the high amount of oil combined with really high carbs can really cause some severe metabolic changes.

The other ingredient is cornstarch and sugar -- it's not a lot but anyone insulin resistant may experience glucose excursions quickly.  Cornstarch makes food more tender b/c it coats the meat as it's stir fried (or deep-fried) which seals in flavor and moisture.

Pre marinating in sugar is like brining -- it also enhances flavor and moisture.  Have you ever had a brined Thanksgiving turkey??  WOW, it's awesome.  And you can't mess it up (ie, overroast or over bake)!

MSG -- this makes the food even more tasty -- and hard to resist! My mom's old Chinese cookbooks list MSG 1 tsp in almost EVERY recipe!

Homemade Chinese food is a lot more healthier but the rice portions can get pretty outrageously excessive in terms of carb/glycemic load and glycemic index.  

-G

The secret ingredient in restaurant cooking is transfats.  Our favorite restaurant Long Life Veggie House in Berkeley (next door to the campus) uses it.  My husband loves that place! Every dish is DELICIOUS. They don't use MSG but they deepfry in hydrogenated veggie oils. *Deep fried* broccoli sure tastes much better than non-deep fried    Even if non hydrogenated veggie oils are used, the high amount of oil combined with really high carbs can really cause some severe metabolic changes.

The other ingredient is cornstarch and sugar -- it's not a lot but anyone insulin resistant may experience glucose excursions quickly.  Cornstarch makes food more tender b/c it coats the meat as it's stir fried (or deep-fried) which seals in flavor and moisture.

Pre marinating in sugar is like brining -- it also enhances flavor and moisture.  Have you ever had a brined Thanksgiving turkey??  WOW, it's awesome.  And you can't mess it up (ie, overroast or over bake)!

MSG -- this makes the food even more tasty -- and hard to resist! My mom's old Chinese cookbooks list MSG 1 tsp in almost EVERY recipe!

Homemade Chinese food is a lot more healthier but the rice portions can get pretty outrageously excessive in terms of carb/glycemic load and glycemic index.  

-G

I just returned from a two week stay in Italy, doing a bit of my own "Mediterranean Diet" experiments.  When practical, we sought out food sources and places to eat that were typical for the local area, and tried as much as possible/practical to stay away from establishments that mostly catered to tourist tastes.  I was really curious to see how the mythical "Mediterranean Diet" we Americans are urged to follow compared to the foods really consumed in Italy.

The first week, we stayed in a rural Tuscan farmhouse apartment (agriturismo), so many, if not most of our meals were prepared by me with ingredients I bought at the local grocery store (Coop) or the outdoor market in Siena.  In addition, I purchased really  fantastic free range eggs from the farm where we were staying (between some language issues and seasonality, eggs and wine were what we could buy from them - though I was tantalized by the not-quite-ripe figs heavy on many trees).  Mostly, our meals consisted of simple and easily prepared fresh fruits and vegetables, rustic cured meats (salami, proscuitto, pancetta, etc.) hand-sliced at the deli down the road, fresh sausages, various Italian cheeses, plus plenty of espresso.    It was a bit disappointing to find underripe fruit & tomatoes as well as old green beans in the grocery stores, not to mention too many low fat and highly processed foods, but all over Europe the food supply is becoming more industrialized, more centralized, and homogenous, so I'm not too surprised that it happens even in Italy.  But even with the smaller grocery store size, the amount of in-season produce was abundant, yet one still was better off shipping from the perimeter of the store, venturing into the aisles only for spices, olive oil, vinegar, coffee, etc.  Without the knowledge of where to go and the language to really talk in depth about food with people, I wasn't able to find truly direct and local sources for as many foods as I would have liked, but still, we ate well enough!

The first week I maintained blood sugar levels very similar to those I get at home, because except for the Italian specialties, we ate much like we always do.  A few rare exceptions to my normal BG tests were after indulging in locally made gelato or a evening limoncello cordial, but even then, the BG rise was relatively modest and to me, acceptable under the circumstance.  Even with the gelato indulgences, it felt like I might have even lost a few pounds by the end of the first week and my FBG didn't rise much over 100.

The second week we stayed in two cities (Florence & Rome), and I didn't prepare any of my own food because I didn't have a kitchen/fridge.  I found it impossible to get eggs anywhere for breakfast, and the tickets our hotels provided for a "continental" breakfast at a nearby café/bar was always for a coffee  or hot chocolate drink and some sort of bread or roll (croissant, brioche, danish, etc.).  At first I just paid extra for a plate of salami and cheese if that was available - or went to a small grocery store for some plain yogurt), but then I decided to go off LC and conduct a short term experiment, though I didn't consume nearly as many carbs as a typical Italian or tourist would.

So I breakfasted with a broiche roll or plain croissant for breakfast with my cappuccino, but unfortunately no additional butter was available.  I didn't feel "full" enough with such a breakfast and I was usually starving an hour or two later.  Additionally, when I ate the "continental" breakfast, I noticed immediate water retention - my ankles,  lower legs, and knees looked like someone else's at the end of a day walking and sightseeing, swollen heavy.  Exercising my feet and lower legs while waiting in lines or sitting didn't seem to help.

Food is much more expensive in Europe than in the US, and the declining US$ made everything especially expensive (not to mention the higher cost of dining out rather than cooking at home), so we tried to manage food costs by eating simple lunches at local take-away places, avoiding the corporate fast food chains.  I was getting tired of salami/proscuitto & cheese plates, but the typical "quick" option was usually a panini (sandwich).  At first I tried to find alternatives to paninis, but the available salads were designed for side dishes, not main meals and rarely had any protein, and the fillings of the expensive sandwiches were too skimpy to just eat without the bread.  So I started to eat panini, although I sometimes removed as much as half of the bread (though it was nearly always very excellent quality pan toasted flatbreads or crusty baguette rolls, not sliced America bread).  So of course, my post prandial BGs rose, as did my FBG.  I also found my hunger tended to come back much too soon and I think overall I ate more than usual in terms of volume.

Then we deviated from the "Italian" lunch foods and found a better midday meal option (quick, cheaper, and easier to customize for LC) - stopping at one of the numerous kebab shops and ordering a kebab plate with salad, hold the bread (not Italian, but still Mediterranean, I guess).  I felt much better fueled on kebab plates (more filling and enough protein) than paninis, though I must say I still appreciated the taste of caprese paninis (slices of fresh mozzerella and tomato, basil leaves, mustard dressing on crusty, pan-toasted flat bread).  If I followed my appetite, I could have eaten two caprese paninis.

We had some great evening dinners, at places also frequented by locals.  This often was a fixed price dinner of several courses ("we feed you what we want you to eat").  Multi-course meals included house wine, and invariably consisted of antipasta (usually LC, such as a cold meat and cheese plate), pasta course (much smaller servings than typical US pasta dishes), main course plus some side vegetables, and dessert/coffee.   These were often the best meals we experienced, full of local flavor and tradition (sometimes with a grandmotherly type doing the cooking), and definitely of very good quality, though we noticed the saltiness overall tended to be on the high side.  I ate from every course, including some of the excellent bread (dipped in plenty of olive oil) and usually about half of the pasta served (2 oz dry?), plus about half of the dessert.   After these meals I always ran BGs higher than usual, varying from moderately high (120-160 - at home I would consider this very high for me) to very high (over 180).  By late in the week, my FBG was into the 115 range every morning (usually I can keep it 90-100 on LC food).  Nearly everything that week was delicious, well-prepared food, but the high carb items definitely were not good for my BG control in the long run.  

And most days I was doing plenty of walking, sprinting for the Metro subway trains, stair climbing (4th and 5/6th floor hotel rooms!), etc. but since I didn't have my usual housework to do, it probably wasn't too different from my usual exertion level.

So it was very interesting to experience the "Mediterranean Diet" first hand.  Meats and cheeses were plentiful, fruits and vegetables played a much more minor role (main courses didn't come with vegetables other than what was in the sauce, but had to be ordered as additional items), but the overall carbs were decidedly too many.  As I expected, it wasn't nearly as pasta-heavy as is portrayed in the US media/health press, but it is still full of too much grain and sugar, IMO.  Low fat has become the norm in many dairy products, sadly, and if the grocery stores are any indication, modern families are gravitating towards highly processed, industrial foods.  Sugar seems to be in everything (I quickly learned to order my caffe freddo con panno or latte sensa zuccero - iced coffee with cream or milk without sugar) after realizing that adding lots of sugar was the norm).  

And, after several days of breakfasting at the café near our Rome hotel (where carbs were the only option in the morning), I learned that our very buff, muscular, very flat-stomached, café owner doesn't eat pasta (said as he proudly patted his 6 pack abs).   I probably could have stuck closer to the carb intake I know works better for my BG control, but I figured if I was going to go off my LC way of eating and experiment, this was the time and place.

And yes, there were far fewer really obese people than in the US and lots of very slender people, but I could still see there were *plenty* of overweight, probably pre-diabetic and diabetic Italians (very visible problems with lower extremities, ranging from what looked like diabetic skin issues, walking problems, acanthosis nigricans, etc.).  Older people do seem to be generally more fit than in the US (fit from everyday life, not exercise regimes), but there were plenty of "wheat bellies" on men old and young, even more young women with "muffin tops", and simply too many overweight children (very worrisome trend).  So it may well be more the relaxed Italian way of living life (or a combination of other factors such as less air conditioning, strong family bonds, lots of sun, etc?) that keeps Italian CVD rates lower than the American rates, more than the mythical "Mediterranean diet".

Hi, Anna--

Your story is so well told that I'd like to post it in a future blog post.

Anna,

You R-O-C-K Girl!!  

I love reading all your insightful thoughts and stories ... and now I know how to order high octane caffeine in italian (in addition (!!) to how to feed my feline friend ground whole bones + meat (ie vit D + protein, respectively) to prevent deficiencies.

-BG

Anna,

You R-O-C-K Girl!!  

I love reading all your insightful thoughts and stories ... and now I know how to order high octane caffeine in italian (in addition (!!) to how to feed my feline friend ground whole bones + meat (ie vit D + protein, respectively) to prevent deficiencies.

-BG

BG,

I  R-O-C-K?  Wow - tell my son, but I doubt he'll believe you.  He was so tired of hearing me say what/who/where Rick Steves' travel book recommends...

Are you ready to try some Coratella?  I suggest you  look it up before you order .  I sought out a recommended restaurant near the old South Roma stockyards in Testaccio, known for their special "fifth quarter" dishes, you know, for the "trippa of a lifetime".  The waiter wouldn't let me order the Animelle a sale e pepe.  Maybe next time...