Who lost weight?

The results of the latest Heart Scan Blog poll are in.


I went wheat-free and I . . .


Gained weight 6 (3%)

Lost no weight 41 (21%)

Lost less than 10 lbs 28 (14%)

Lost more than 10 lbs 34 (17%)

Lost more than 20 lbs 22 (11%)

Lost more than 30 lbs 28 (14%)

I'm still losing weight! 30 (15%)

(189 respondents)


This means that, by eliminating wheat:

24% had no success

31% had moderate success (less than 10 lbs or more than 10 lbs)

25% had extravagant results with 20 lbs or more lost


It would be interesting to know where along the weight-loss spectrum the last category, "I'm still losing weight," group falls. (Anyone with a good story please speak up!)

I believe we can conclude from this casual exercise that, as a simple strategy, wheat elimination is surprisingly effective.

Why would 3% gain weight? Well, without knowing the details, there are several possible explanations:

1) Weight gain developed through other foods. For instance, I've had people eliminate wheat only to replace it with fattening gluten-free alternatives. Remember: wheat-free is not gluten-free. Others load up on the wrong foods, e.g., Craisins and other dried fruit; overdo dairy; or snack on wheat-free but unhealthy foods like ice cream and chips.

2) Too much alcohol

3) Hypothyroidism--A lot more common than you'd think. In fact, this has been the case with a majority of people who have done everything right, yet either failed to lose weight or gained weight.

Those are the biggies.

I'd like to hear your personal stories of wheat elimination--the ups and downs, your success or failure, how you felt during the process, how easy or difficult, your eventual results. Just post them as a response to this blog post.

A niacin primer

A reader of Life Extension reminded me of a piece I wrote about niacin a couple of years back.

Anyone desiring a primer on how and why to use niacin to correct lipid and lipoprotein patterns might find this useful.

While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.


Q: I recently had a cholesterol profile blood test and learned that I may be at risk of heart disease because my levels of beneficial HDL (high-density lipoprotein) are too low. I read that niacin could help increase my HDL, but my doctor said niacin is dangerous. Whom should I believe?

A: Your doctor would be right—if we were still living in 1985. Since then, however, we have learned how to use niacin (vitamin B3) safely and effectively. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that cholesterol-lowering statin drugs are the only way to decrease cardiovascular disease risk. I have personally prescribed niacin for thousands of patients as part of our program to reverse coronary disease. In fact, niacin is the closest thing we have available to a perfect treatment that corrects most of the causes of coronary heart disease.

Continued here.

What would life be like . . . ?

What if coronary heart disease could be prevented--no eliminated--applying methods that were accessible, easy, and cheap?

What if coronary heart disease and, thereby, angina, heart attack, sudden cardiac death, ventricular tachycardia, heart failure, and the cerebrovascular equivalent, stroke, could be eliminated using readily available tools available to virtually everyone in the U.S.? And, over a year, it cost less than a once-a-week latte at Starbucks?

How would the healthcare landscape change? What would become of hospitals, manufacturers of the billions of dollars of hospital equipment necessary to supply the cardiovascular hospital industry (e.g., stent manufacturers, catheter manufacturers, defibrillator and pacemaker manufacturers, pharmaceutical manufacturers who no longer have to produce the volume of antiplatelet agents, inotropic drugs, antiarrhythmic agents, etc.)?

How would our lives change? What would the end of life look like if people stopped dying of heart attack, sudden cardiac death, congestive heart failure at age 55, 65, or 75, but lived out their lives to die of something unrelated?

What if the solution had little or nothing to do with drugs but evolved from simple nutritional strategies, supplements meant to correct the deficiencies that accompany modern lifestyles, and a few unique strategies targeted towards the genetic predispositions that lead to heart disease?

What if all this were possible at a cost of a few hundred dollars per year?

It would certainly be a cataclysmic change. Hospitals would shrink to a small remnant of their current gargantuan, dozens-per-city presence. The need for hospital staff would be slashed by over half. The rare cardiologist would tend to congenital heart disease sufferers and other unusual forms of heart disease and he or she might have a colleague or two in all of a major city.

Healthcare costs would plummet, no longer having to sustain the enormous cardiovascular healthcare machine of hospitals, staff, industry, and long-term care. Health insurance, private or public, would drop by 50%.

It would free up nearly a trillion dollars that could be redirected towards other pursuits, like schools and research. Extraordinary leaps forward in quality of life and science would emerge, given that magnitude of funding.

It's not as grand a thought experiment as Alan Weisman's The World Without Us, in which he imagines what the world would be like without humans altogether.

How long would it take to recover lost ground and restore Eden to the way it must have gleamed and smelled the day before Adam, or Homo habilis, appeared? Could nature ever obliterate all our traces? How would it undo our monumental cities and public works, and reduce our myriad plastics and toxic synthetics back to benign, basic elements?

But I believe this thought experiment--what would life be like without heart disease because it was eliminated using inexpensive tools-- is more plausible, more likely to occur. In fact, it has already begun to occur.

See those vines growing up the side of the hospital?

Are jelly beans heart healthy?

Total Fat

3 g or less

Less than 6.5 g





Saturated Fat



1 g or less

1 g or less





Cholesterol

20 mg or less

20 mg or less





Sodium

480 mg or less per RACC* & labeled serving

480 mg or less per RACC* & labeled serving





Nutrients

Contain 10 percent or more of the daily value of 1 of 6 nutrients; vitamin A, vitamin C, iron, calcium, protein or dietary fiber



Contain 10 percent or more of the daily value of 1of 6 nutrients; vitamin A, vitamin C, iron, calcium, protein or dietary fiber





Trans fat

Less than 0.5 g per RACC* and labeled serving



Less than 0.5 g per RACC* and labeled serving





Whole Grain

N/A



51 percent by weight/RACC*







Minimum Dietary Fiber



N/A

1.7 g/RACC of 30 g

2.5 g/RACC of 45 g

2.8 g/RACC of 50 g

3.0 g/RACC of 55 g





(RACC=Reference Amount Customarily Consumed)

Thyroid correction: The woeful prevailing standard

Rich has been taking Synthroid or levothyroxine for many years.

When Rich came to my office for continuing management 10 years after his bypass surgery, I checked his thyroid panel:

TSH 7.44 uIU/L

Free T4 1.88 ng/dl (Ref range 0.80-1.90 ng/dl)

Free T3 2.0 pg/ml (Ref range 2.3-4.2 pg/ml)


Rich's thyroid hormone distortions--high TSH, low T3--are sufficient to account for a tripling of heart attack risk long-term.

As Richs' thyroid was being managed by his primary care physician, I notified this doctor of Rich's panel. He therefore increased Rich's levothyroxine from 75 mcg per day to 100 mcg per day. Another thyroid panel several months later showed:

TSH 0.98 uIU/L

Free T4 2.38 ng/dl

Free T3 2.0 pg/ml



As you would expect, increasing the intake of the T4 hormone (levothyroxine) increased free T4 and suppressed TSH.

But what about T3? It's unchanged.

Indeed, Rich says that he feels no better and, in fact, wakes up in the morning foggy and requires a nap in the afternoon.

In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.

Rich's increased levothyroxine dose decreased (calculated) LDL cholesterol by 10 mg/dl. Based on my experience, I'll bet that his lipid panel would likely be further improved with T3 correction.

What I find incredible is the absolutely rabid resistance waged by primary care physicians and endocrinologists against this notion of T3, mostly due to fears of the remote likelihood of inducing atrial fibrillation and osteoporosis, while they are ready to prescribe lifelong statin drugs without a moment's hesitation.

Launch of new Track Your Plaque newsletter: Cardiac Confidential

Track Your Plaque has just launched a new version of our newsletter. We call it Cardiac Confidential.

Cardiac Confidential is meant to be a no-holds-barred, go-for-the-throat exposé of the world of heart disease. We will expose the dishonest, reveal what we view as the underlying truth. We'll even have an occasional "undercover" report of what goes on in hospitals and the go-for-the-money world of heart procedures.

Read the first issue here (open to everyone) in which "Laurie" describes her encounter with a sleazy, profiteering cardiologist. She survives, but not without paying a dear price.

Thyroid: Be a perfectionist

If you'd like to reduce LDL cholesterol with nearly as much power as a statin drug, think thyroid.

When thyroid is corrected to ideal levels, LDL cholesterol drops 20, 30, 40 mg/dl or more, depending on how poor thyroid function and how high LDL are at the start. The poorer the thyroid function (the higher the TSH or the lower the T3 and T4) and the higher the LDL cholesterol, the more LDL drops with thyroid correction.

(For those of you minding LDL particle size, such as Track Your Plaque Members, the "dominant" LDL species will drop: If you are genetic small LDL, small LDL will drop. If you have mostly large LDL because of being wheat-free and sugar-free, then large LDL will drop.)

One of the problems is that many healthcare providers blindly follow what the laboratory says is "normal" or the "reference range," which is usually nothing more than a population average (actually the mean +/- 2 standard deviations, a common method of developing references ranges). In other words, a substantial degree of low thyroid function, or hypothyroidism, can be present when your doctor adheres to the reference range provided by the laboratory.

What does it mean to achieve ideal thyroid status? My list includes:

--Normal oral temperature of 97.3 F first upon arising. (The thyroid is the body's thermoregulatory organ.)
--TSH 1.0 mIU/L or less
--Free T3 upper half "normal" range
--Free T4 upper half "normal" range
--You feel good: mental clarity, energy, upbeat mood. You lose weight when you try.

Iodine replacement should be part of any thyroid health effort. Iodine is not an optional trace mineral, no more than vitamin C is optional (else your teeth fall out). The only dangers to iodine replacement are to those who have been starved of iodine for many years; increase iodine and the thyroid can over-respond. I've seen this happen in 2 of the last 300 people who have supplemented iodine.

In my view, neglecting T3 replacement is absurd. While it is not clear to me why many otherwise healthy people have low T3 at the low range of "normal" or even in the below-normal range, people feel better and have better health--faster weight loss, reduced LDL, reduced triglycerides, they are happier and enjoy more energy--when T3 is increased to the upper half of the reference range. (Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one.)

It pays to be a perfectionist when it comes to thyroid. Not only do you feel better, but LDL cholesterol can drop with a statin-like magnitude, but with none of the adverse effects.

If interested, Track Your Plaque offers fingerstick blood spot testing that you can perform in your own home. Each test kit will test for: TSH, free T3, free T4, along with a thyroid peroxidase antibody (a marker for Hashimoto's thyroiditis, an autoimmune inflammatory condition of the thyroid).

Nutrition Syllogism

What do you think of these chains of logic?

Cyanide is a potent lethal poison; carbon monoxide is a less lethal poison.
Therefore: plenty of carbon monoxide is good.




Having uterine cancer is a bad thing. Having uterine fibroids is a less bad thing.
Therefore: plenty of uterine fibroids are good.



These are obvious examples of seriously flawed logic. Students of logic and philosophy will recognize the above erroneous sequences as examples of the twisted arguments often used to persuade an argumentative opponent of the logic of a premise. As long ago as 335 B.C., Greek philosopher, Aristotle, recognized the pitfalls of thinking in such arguments. You think we’d know better by now.

Try this one:

White enriched flour is a bad for health; whole grains are less bad for health.
Therefore: plenty of whole grains are good for health.



Ouch!

In the 1960s, we all ate hot dogs on white buns, white flour Wonder Bread® sandwiches, Mom made cookies and cupcakes with white flour. Then, during the 1970s and 1980s, clinical studies were performed demonstrating that whole wheat and whole grains reduced colon cancer, high blood pressure, diabetes, and heart disease compared to white flour. In other words, add back fiber and B vitamins and health benefits develop: No argument here.

Therefore: whole grains must be good for health. Further, lots of whole grains?unlimited quantities of whole grains many times per day, every day?must be even better. Even the USDA says so on their nutrition pyramid, with 8-11 servings of grains per day, 4 of which should be whole grains, at the widest portion of the pyramid.

But what happens when you follow this logic through and fill your diet with whole grains?

Look around you and it’s easy to see: Appetite increases, people become obese, blood sugar increases, diabetes develops, HDL cholesterol plummets, triglycerides skyrocket, inflammatory patterns (e.g., c-reactive protein, or CRP) increase, small LDL (the number one cause for heart disease in the obese U.S.!) shoots through the roof.

I would no more fill my diet with “healthy whole grains” than I would close my garage door with the car running.

Is pomegranate juice healthy?


Pomegranate juice, 8 oz:

Sugars, total 31.50 g

Sucrose 0.00 g

Glucose (dextrose) 15.64 g

Fructose 15.86 g




In your quest to increase the flavonoids in your diet, do you overexpose yourself to fructose?

Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!


(Coming on the Track Your Plaque website: A full in-depth Special Report on fructose in all its glorious forms and whether this is truly an issue for your health. Fructose tables and the scientific data to establish a safe "threshold" value will be included.)

Image courtesy Wikipedia

Honeydew melon


Honeydew melon:

Sugars, total 51.97 g

Sucrose 15.87 g

Glucose 17.15 g

Fructose 18.94 g

Because sucrose is half fructose (the other half is glucose), there are approximately 26 grams of fructose per one-half honeydew melon.



Image courtesy Wikipedia
Nutritional approaches: Large vs. small LDL

Nutritional approaches: Large vs. small LDL














It is now a rare person who does not have at least some proportion of their LDL cholesterol as small particles. I estimate that, of the people who come to the office or report their data on the Track Your Plaque website, 90% have at least 40-50% small LDL particles. Some people have 100% small LDL particles. The sample NMR lipoprotein report shows the result for someone with a severe small LDL pattern (the tallest red bar labeled 1354 nmol/L, compared to the 74 nmol/L of the tiny red bar of large LDL.)

The nutritional approach for small vs. large LDL differs. Small LDL particles are most sensitive to carbohydrate intake; large LDL particles are more sensitive to saturated fats.

The conventional "heart healthy" diet that restricts saturated fat reduces large LDL but exerts no effect on small LDL. Thus, a diet that is restricted in saturated fat and weighed more heavily with "healthy whole grains" triggers small LDL particles. Followers of the conversations here recognize that small LDL particles are flagrant triggers for coronary plaque; they have, in fact, become the number one most common cause for heart disease in the U.S.

When you have lipoproteins tested, you can therefore gauge the likely result obtained when specific dietary changes are made. Follow the low saturated fat advice, large LDL will drop modestly, but small LDL skyrockets.













(Image courtesy Liposcience, Inc.)


Eliminate sugars, wheat, and cornstarch and you will see small LDL plummet (along with total LDL).

As an aside, my personal observation is that the "need" for statin cholesterol drugs can be reduced dramatically by paying attention to this important LDL size distinction.

Comments (13) -

  • craig&jan

    11/10/2008 8:50:00 PM |

    I was wondering what your thoughts are on the information recently released on the c-reactive protein study and statins.  Do you feel that inflammation in itself is a condition that should be treated with statins? Which comes first the plaque or the rise in crp?

    Thanks.

    Jan Jones

  • Anonymous

    11/11/2008 4:08:00 AM |

    will this approach work in the majority, or all people?  I have heard that diet deemphasizing carbs will only affect LDL particle size in a small number of the population.
    how much sat fat is ok, and does fruit count as sugar in the diet?

  • Peter Silverman

    11/11/2008 12:45:00 PM |

    How does rice affect large and small LDL?

  • Anonymous

    11/11/2008 1:43:00 PM |

    Ive read some time agoon Dr. Eades blog, that one can reduce inflammation with L-Argenine. (no statins needed).

    Jeanne Shepard

  • Anonymous

    11/11/2008 2:03:00 PM |

    I would love to see a post about the nutritional implications for the varying ApoE genotypes... I have been told that my 3/4 alleles indicate that I need a low-fat (20%) diet, which I know you normally don't recommend.

  • Anonymous

    11/11/2008 6:28:00 PM |

    Jan Jones, Thanks for mentioning this. I too have been interested in the CPR and statin studies.
    18 months ago my C-Reactive Protein was 4.6. Since then I have followed the excellent dietary advice of Dr. Davis as well as walking 3-5 miles a day. I believe this helps considerably with controlling blood sugar/insulin.
    I also learned that my Vitamin D was very low (tested through Life Extension) and with more sunlight and supplementation it has now increased.  Interestingly, my blood pressure is much lower in summer months.

    My C-reactive protein tested last week is now reduced to 0.89 with NO statins.  

    One of the foremost statin researchers is Dr. Beatrice Golomb, MD at the University of California. My understanding is that she takes no pharmaceutical funding for her extensive research.  Many of her findings can be read online or search  â€œBeatrice Golomb” on You Tube.

    Thanks again, Dr. Davis!

  • Dr. S

    11/12/2008 4:48:00 PM |

    Ahh, interesting.... but mixes and conflates data.  Corn starch, sugar are not on any barely reasonable diet.  Wheat I think is a no go for most though they don't know it.  

    It would be really interesting to see the difference between in LDL types broken out with tightly controlled intake of different starches/carbs.  

    Also, carbs plus fat is very problematic, but carbs and true low fat MAY not be.  

    By far most of the studies claiming to look at low fat diet use 25 or 30% as the low fat and that is much too high to count as anything but high fat.  

    I would not be surprised if fat induced insulin resistance is somehow connected to the explosion of the small LDL particles.  It might even be that many more are ok w/ whole, unprocessed wheat berries it the fat intake is low enough so no IR.  

    Should be organic too, though a different issue-- wheat is one of the more pesticide and fumigant treated food crops and research labs that use fruit flies must feed them only organic or the residues kill the little buggers right quick.

    Any answers/responses here?

    Thanks

  • Amadeus

    11/13/2008 6:15:00 AM |

    Maybe yes, maybe no.

    HDL has been thought of as the good cholesterol but as in everything there is more to the story. it is much more than just a number.

    There are subfractions of HDL and some are good, some not so good.

    In recently published research on men in a three-week low fat program, blood tests showed that on entry the men (typical high-fat American-style eaters) had normal amounts of HDL, but the HDL tended to be pro-inflammatory. Pro-inflammatory HDL promotes plaque build-up in the arteries.

    But after three weeks on a healthy low fat diet, exit blood tests showed the HDL had been converted from having pro-inflammatory qualities to having anti-inflammatory qualities despite the fact that total levels of HDL had on average gone down a little. Anti-inflammatory HDL is beneficial because it does a good job of removing LDL from the arterial system.

    The lead author Dr. Christian K Roberts and colleagues at UCLA concluded, "Pay attention to the quality of HDL, not the quantity, The function of HDL may be more important than the steady-state plasma [blood] levels.”

    Journal of Applied Physiology, 2006; 101: 1727.

    In addition other new research found that even one meal rich in saturated fat could interfere with the ability of “good” HDL cholesterol to protect against damage to arteries.

    In the study, scientists at the Heart Research Institute in Sydney, Australia fed subjects 2 different meals. One meal was high in saturated fat. Three and six hours after each meal, the scientists measured blood flow and assessed how well HDL was protecting arteries from inflammation. The saturated fat meal essentially turned “good” HDL cholesterol into “bad” HDL cholesterol particles. Instead of being anti-inflammatory, they become pro-inflammatory.

    Journal of the American College of Cardiology, 2006; 48: 715.

    Another study measured reverse cholesterol transport (RCT) which is the ability of HDL to remove cholesterol. When the subject were put in a healthy low fat diet, the level of HDL went down but the RCT stayed the same. This showed than while the absolute number may have dropped somewhat, the efficiency of the HDL went up.

    In other words, having a high HDL from a higher fat diet, may not be a good thing and may in fact, be a bad thing. Yet, having a lower HDL from a healthy lower fat diet, may not be a bad thing and in fact may be a good thing.

  • Anna

    11/15/2008 7:11:00 PM |

    Hmmm, those studies on "high fat" meals have never been very convincing to me, using milk shakes for high fat meals, etc., plus the number of participants and length of study are so limited.  It's so artificial.  I'm just not sure how meaningful many of these studies are in the context of a lifetime of eating.

    Viewed historically (not just a few 100 or 1000s of years, but looking back 50,000, 100,000, or a million of years ago), while quite varied depending on geographic location, the human diet until quite recently often wasn't restricted in saturated fat, in fact, the parts of hunted animals with the most saturated fats were often most prized and consumed first, or saved for later use, such as organs/offal and the fat that surrounds the kidneys, respectively.

  • Deb J

    12/23/2008 3:13:00 PM |

    Dr. Davis. Thank you for your blog. I have been on low carb <30 g/d since Jan 1, 2008 and vlc <15 g/d since May 2008, and zc (meat,fat and water) <5 g/d since 10/28/08. Most recent lipid profile was Nov 14,2008.
    TC-461,HDL-72,TRG-126,LDL-364

    Jan 4, 2007 and I wasn't real good about my diet during the Holidays.
    TC-280,HDL-60,TRG-139,LDL-192

    Why would you suspect my TC and LDL to have gone so high and my TRG's to not have improved more? The only thing that did what I expected was HDL.

  • sal

    12/23/2009 6:47:36 AM |

    Just watched this youtube video, and was referred to your blog. http://www.youtube.com/watch?v=dBnniua6-oM

    Lots of info here

  • buy jeans

    11/3/2010 6:35:14 PM |

    The conventional "heart healthy" diet that restricts saturated fat reduces large LDL but exerts no effect on small LDL. Thus, a diet that is restricted in saturated fat and weighed more heavily with "healthy whole grains" triggers small LDL particles. Followers of the conversations here recognize that small LDL particles are flagrant triggers for coronary plaque; they have, in fact, become the number one most common cause for heart disease in the U.S.

  • glutaminl

    2/8/2011 11:34:21 AM |

    Muscles built by ingesting lot of protein and exercising frequently and mightily. In order to be able to exercise, we have to have energy, thus list of best muscle building foods include some complex carbohydrates and natural, unrefined sugars, such as those found in fruit. Slower digesting carbohydrates take longer to breakdown into energy, so they don't spike blood sugar & increase insulin requirements.

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