Statin stupid

19. March 2010 William Davis (0)
If we followed the lead of the pharmaceutical industry and my cardiology colleagues, we would all subscribe to the "statins for all" philosophy. There is now $2 billion of clinical "research" to back up this "evidence-based" practice.

I do not endorse this "statins for all" philosophy. I believe it is a product of the raw profiteering of the pharmaceutical industry, who are adept at recruiting physicians to their cause.

But lost in the confusion of tainted studies and over-the-top media saturation is the fact that there are small groups of people who likely do obtain benefit from statin drugs. They would certainly benefit from better informed scrutiny of their lipoprotein and metabolic abnormalities. But treatment may involve statins.

This is entirely distinct from the "statins for all" argument, the simpleminded rule that primary care physicians and cardiologist are told to follow.

Groups who may indeed benefit from statin therapy include:

Homozygous or heterozygous familial hypercholesterolemia--Lacking a receptor for LDL particles, LDL piles up to very high levels in these people. LDLs of 300+ are common and lead to heart disease and stroke at relatively young ages.

Combined mixed hyperlipidemia--Among the one or more genetic defects underlying this condition involves excessive production of apoprotein B and VLDL particles. This leads to high risk for heart disease.

People unable to follow a diet to correct their lipid disorder--I have 80+-year old patients, for instance, who say, "I've eaten this way for 82 years. I'm not going to change now!" In the absence of diet and other efforts (e.g., omega-3 fatty acids from fish oil), drugs may be the answer.

In other words, of the $27 billion annual bill for statin drugs, perhaps a tiny fraction is truly necessary. The majority of people taking statin drugs would not really need them if they had the real answers. But don't let that confuse us: There are some people who do indeed benefit.

Butter and insulin

19. March 2010 William Davis (83)
In a previous post, Atkins Diet: Common Errors, I commented on butter's unusual ability to provoke insulin responses. I offer this as a possible reason why, after a period of effective weight loss on a low-carbohydrate program, inclusion of some foods, such as butter, will trigger weight gain or stall weight loss efforts.

This develops because of butter's insulin-triggering effect, doubling or tripling insulin responses (postprandial area-under-the-curve). If insulin is triggered, fat gain follows.

Here's one such study documenting this effect: Distinctive postprandial modulation of ß cell function and insulin sensitivity by dietary fats: monounsaturated compared with saturated fatty acids

López et al 2008


From Lopez et al 2008. Mean (± SD) plasma glucose, insulin, triglyceride, and free fatty acid (FFA) concentrations during glucose and triglyceride tolerance test meal (GTTTM) with no fat (control), enriched in monounsaturated fatty acids (MUFAs) from refined olive oil (ROO meal), with added butter, with a mixture of vegetable and fish oils (VEFO) or with high-palmitic sunflower oil (HPSO). N = 14.

The postprandial (after-eating) area-under-the-curve is substantially greater when butter is included in the mixed composition meal. This effect is not unique to butter, but is shared by most other dairy products.

Fat, in general, does not make you fat. But butter makes you fat.

Vitamin D as a cardiovascular risk factor gains ground

18. March 2010 William Davis (0)
If you were reading The Heart Scan Blog back in 2007, or read my Life Extension article on vitamin D deficiency as a cardiovascular risk factor, you already knew that vitamin D deficiency is rampant and adds to cardiovascular risk.

Results of a study from the Intermountain Medical Center Heart Institute in Utah bolster the concept that vitamin D deficiency is a cardiovascular risk factor, vitamin D normalization/supplementation reduces cardiovascular risk.

Science Daily reported:

For the first study, researchers followed two groups of patients for an average of one year each. In the first study group, over 9,400 patients, mostly female, reported low initial vitamin D levels, and had at least one follow up exam during that time period. Researchers found that 47 percent of the patients who increased their levels of vitamin D between the two visits showed a reduced risk for cardiovascular disease.


In the second study, researchers placed over 31,000 patients into three categories based on their levels of vitamin D. The patients in each category who increased their vitamin D levels to 43 nanograms per milliliter of blood or higher had lower rates of death, diabetes, cardiovascular disease, myocardial infarction, heart failure, high blood pressure, depression, and kidney failure. Currently, a level of 30 nanograms per milliliter is considered "normal."


Over the past 4 years, people in our program have been enjoying the extravagant benefits of vitamin D restoration. Cardiovascular benefits are becoming better documented and the bone health, cancer-preventing, insulin-normalizing, mood-adjusting, and anti-inflammatory effects likewise.

Atkins Diet: Common errors

18. March 2010 William Davis (74)
No doubt: The diet approach advocated by the late Dr. Robert Atkins was a heck of a lot closer to an ideal diet than the knuckleheaded advice emitting from the USDA, American Heart Association, American Diabetes Association, and the Surgeon General's office.

But having just spent a week with Atkins low-carbers, here are some common errors that I see many make, errors that I believe have long-term health consequences, including impairment of weight loss.

Excessive consumption of animal products--Non-restriction of fat often leads to over-reliance on animal products. Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers. It is not a fat issue; it is an animal product issue. We should consume less meat, more vegetables and other plant-sourced foods.

Consumption of cured meats--Cured, processed meats, such as sausage, hot dogs, salami, bologna, and bacon, have a color fixative called sodium nitrite, an additive that has been confidently linked to gastrointestinal cancers. Risk is likely dose-dependent: The more you ingest, the greater the long-term risk.

Overconsumption of dairy products--Dairy products, especially milk, yogurt, cottage cheese, and butter, are potent insulinotropic foods, i.e., foods that trigger insulin release. There can be up to a tripling of insulin (area-under-the-curve) levels. This is not good in a world populated with tired, overworked pancreases, exhausted from a lifetime of high-carbohydrate eating.

Too many calories--While I agree that "a calorie is a calorie" and "calories in, calories out" are faulty concepts, I have anecdotally observed that long-time low-carbers often trend towards unlimited consumption of food, a phenomenon that seems to result in weight gain, especially in the sedentary. I wonder if this is a reflection of the insulinotropic action of dairy products and other proteins, compounded by the poor insulin responsiveness that develops with lack of physical activity. Factor into this conversation that lower calorie intake extends life, probably substantially (Sirt-2 activation and related phenomena, a la resveratrol). If lower calorie intake extends life, unlimited calorie intake likely shortens life.

Please don't hear this as low-carb bashing--it is not. It is a call to improve diets and not stumble into common traps that can impair heart health, weight loss, and longevity.

Fat Head: Tom Naughton's manifesto for low-carb eating

12. March 2010 William Davis (16)
I just got back from Jimmy Moore's low-carb cruise to the Bahamas.

Among the many interesting people I met on the cruise was the creator of the documentary film, Fat Head, Tom Naughton.

Tom brings both creative insights into low-carbohydrate eating as well as humor. Low-carb eating can be a pretty contentious issue, but Tom made it fun. He will make you laugh about many of the odd notions we have about diet.

Among the best parts of Fat Head is Tom's portrayal of the effects of carbohydrates on insulin and fat metabolism:






Fat Head joins the ranks of films like Food, Inc, that make nutrition information entertaining. For anyone interested in a unvarnished look at diet, weight loss, along with a few laughs along the way, Tom Naughton's Fat Head is worth viewing.

Oatmeal: Good or bad?

11. March 2010 William Davis (67)

You've heard it before: oatmeal reduces cholesterol. Oatmeal producers have obtained permission from the FDA to use a cholesterol-reducing claim. The American Heart Association provides a (paid) endorsement of Quaker Oats.

I've lost count of the times I've asked someone whether they ate a healthy breakfast and the answer was "Sure. I had oatmeal."

Is this true? Is oatmeal heart healthy because it reduces LDL cholesterol?

I don't think so. Try this: Have a serving of slow-cooked (e.g., steel-cut, Irish, etc.) oatmeal. Most people will consume oatmeal with skim or 1% milk and some dried or fresh fruit. Wait an hour, then check your blood sugar.

If you are not diabetic and have a fasting blood sugar in the "normal" range (<100 mg/dl), you will typically have a 1-hour blood glucose of 150-180 mg/dl--very high. If you have mildly increased fasting blood sugars between 100 and 126 mg/dl, postprandial (after-eating) blood sugars will easily exceed 180 mg/dl. If you have diabetes, hold onto your hat because, even if you take medications, blood sugar one hour after oatmeal will usually be between 200 and 300 mg/dl.

This is because oatmeal is converted rapidly to sugar, and a lot of it. Even if you were to repeat the experiment with no dried or fresh fruit, you will still witness high blood sugars in these ranges. Do like some people and pile on the raisins, dried cranberries, or brown sugar, and you will see blood sugars go even higher.

Blood sugars this high, experienced repetitively, will damage the delicate insulin-producing beta cells of your pancreas (glucose toxicity). It also glycates proteins of the eyes and vascular walls. The blood glucose effects of oatmeal really don't differ much from a large Snickers bar or bowl of jelly beans.

If you are like most people, you too will show high blood sugars after oatmeal. It's easy to find out . . . check your postprandial blood sugar.

In past, I recommended oat products, specifically oat bran, to reduce LDL, especially small LDL. I've changed my mind: I now no longer recommend any oat product due to its blood sugar-increasing effects.

Better choices: eggs, ground flaxseed as a hot cereal, cheese (the one dairy product that does not excessively trigger insulin), raw nuts, salads, leftovers from last evening's dinner.

Mustard: Super health food?

6. March 2010 William Davis (32)
Could mustard--yes, the yellow condiment you smear on hot dogs--be a super heart healthy food in disguise?

Consider that mustard contains:

Vinegar

Turmeric

No appreciable sugar


The vinegar slows gastric emptying, resulting in slower absorption of any carbohydrates and a reduced glucose area-under-the-curve. Of the little fats contained (about 3 grams per 1/4 cup), most are desirable monounsaturates. Mustards are relatively rich in selenium, with 20 mcg per 1/4 cup, helpful for protection against cancer and thyroid disease, and magnesium, 31 mg per 1/4 cup.

Turmeric is added to most mustards. One of the constituents of turmeric, curcumin, the substance that confers the bright yellow color, has been a focus of interest for its anti-inflammatory effects. Curcumin has been documented to reduce activity of the inflammatory enzymes cyclooxygenase-2 (COX-2), lipoxygenase, and reduce activity of inflammatory signal molecules, tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1,2,6,8, and 12, and monocyte chemoattractant protein (MCP). Curcumin also has been shown to reduce LDL oxidation, a potentially important step in atherosclerotic plaque formation. Turmeric is used as a tea by Okinawans. (Hmmmm . . . )

Turmeric content of mustard can vary, of course. Likewise, sugar content. Look for mustards that are not sweetened, so avoid honey mustard in particular. Look for hot, brown, horseradish, Dijon, etc. If there is a downside to mustard, it's sodium content, though the 709 mg per 1/4 cup should only be a problem for those who are sodium-sensitive (African Americans, in particular).

So perhaps mustard isn't exactly a super health food. But it may have some bona fide health effects and should be used generously especially if you are concerned about blood sugar and inflammatory phenomena.

Exercise and blood sugar

5. March 2010 William Davis (30)
There is no doubt that exercise yields benefits across a spectrum of health: reduced blood pressure,  reduced inflammation, reduced blood coagulation, better weight control, stronger bones, less depression, reduced risk for heart attack.

Exercise also influences blood sugar. Diabetics understand this best: Exercise reduces blood sugar 20, 30, 50 or more milligrams. A starting blood sugar, for instance, of 160 mg/dl can be reduced to 80 mg/dl by jogging or riding a bicycle. (I recently had brunch at an Indian restaurant with my family. Blood sugar one-hour postprandial: 134 mg/dl. I was sleepy and foggy. I got on my stationary bike and pedalled at a moderate clip for 60 minutes. Blood sugar: 90 mg/dl.)

Could the reduction of blood sugar with exercise be THE reason that exercise and physical activity provide such substantial benefits?

Think about it. Reduced blood sugar:

1) Reduces risk for future cardiovascular events.
2) Reduces glycation of proteins, i.e., reduced glucose binding to proteins like the ones in artery walls and the lenses of your eyes.
3) Reduces blood coagulation
4) Reduces endothelial dysfunction (abnormal artery constriction that leads to atherosclerosis)

This might explain why it doesn't require high levels of aerobic activity to derive benefit from exercise, since even modest efforts (e.g., a 15-minute walk after eating) reduce blood sugar substantially.

The incredible 33-year, 18,000-participant Whitehall study tells us that a postprandial (after-eating) blood sugar of an impossibly-difficult 83 mg/dl is required to erase the excess cardiovascular risk of blood sugar. Could this simply be telling us that physical activity or exercise is required to suppress blood sugars to these low levels?

It makes me wonder if an index of the adequacy of exercise is your post-exercise blood glucose.
Dr. Michael Eades on the Paleolithic diet

Dr. Michael Eades on the Paleolithic diet

18. February 2009 William Davis (16)
Dr. Michael Eades has posted an absolutely spectacular commentary on the Paleolithic diet concept:

Rapid health improvements with a Paleolithic diet

The post was prompted by publication of a study that tried to recreate a Paleolithic-like diet experience over a brief study period:

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.

Dr. Eades discussion is wonderfully insightful and comprehensive and there's little to say to improve on his discussion.

I'd make one small point: From what I see in my experience, the improvements in lipid patterns seen in the brief period of this study are very likely to have been primarily due to the removal of wheat. Followers of this blog know that wheat elimination is among the most powerful cholesterol-reducing strategies available.
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Comments (16) -

  • Scott Miller

    2/18/2009 10:13:00 PM |

    Without doubt, a primary benefit of the paleo diet is the elimination of grains (which contain inflammatory protein--gluten--and plant-defense toxins called lectins).

    The high (good) fat aspect of the paleo diet also plays a big role in increasing HDL and lowering triglycerides. These good fats including animal fats, saturated fats (mistaken painted as bad-guy fats), omega-3's, omega-9's (like olive oil and avocado oil), while greatly reducing the inflammatory processed omega-6 oils (corn and soy oil, among numerous others).

    The paleo diet also rules out any processed form of fructose:
    http://www.thorne.com/altmedrev/.fulltext/10/4/294.pdf

  • steve

    2/19/2009 1:41:00 AM |

    i have eliminated wheat and all grains as you have suggested and my lipid profile from recent NMR has improved: HDL jumped from 40to 54; LDLC of 94 up from 93, and Trg dropped to 20 from 37 and large HDL-P increased from 3.3 to 14.8, particle number dropped from1795 to 1305, but they still remain all small particles.  LDL particle size unchanged at 19.7. So some good things from elimination of wheat and grains, but no change in particle size.  At 5'6" male and 145lbs, hard to lose weight.  Any suggestions on how to change particle size and lower number of particles further? diet is meat fish eggs poultry, whey powder, hard cheese, greek 2% yogurt and fruit and veggies, some red wine and dark(85%+ chocolate)  Vitamin D3 measures at 38(25oh). with family history, doc wants 20 mg Lipitor.  Excellent post in both cases. Perhpas Paleo not work for all, although Eades would say i should add more sat fat to diet

  • rabagley

    2/19/2009 8:25:00 AM |

    I love reading in more and more places that saturated fats are not evil!

    The word is getting out, and one of these days, dietary researchers won't have to apologize about their results or come up with elaborate strategies to make sure that they can't be perceived as saying that saturated fat might be (gasp!) good for you.

    Remember the Okinawans.  Previous generations of Okinawans are among the longest lived people on the planet.  Pork, fish, non-starchy vegetables (cooked in lard), and a little bit of rice make up almost all of their diet.

    Dr. Davis, it wasn't that long ago that you were very cautious about fats and saturated fats, but I've seen a substantial shift in your comments over the past several months.  I salute your resolve to really understand what is good for our hearts and then going beyond that by doing your best to communicate what you've learned back to everyone who will listen/read.

  • Anonymous

    2/19/2009 12:40:00 PM |

    This is the first time I have seen someone call out Gluten as the component of wheat that causes inflammation response.  Good to know as it is often a primary source of protein for vegetarians.

    I don't see the fructose argument though.  This is a simple sugar that is broken down to glucose in the digestive tract like any other sugar eaten; according to high-school human biology......

  • Tom

    2/19/2009 2:16:00 PM |

    Dr Davis,

    Do low carb eaters need to be concerned about the aging effects of oxoaldehydes such as methylglyoxal?

    I read recently that the concentration of such compounds increases during ketosis and that they are much more reactive than glucose, readily forming protein cross links which age the body.

    -- Tom

  • TedHutchinson

    2/19/2009 3:21:00 PM |

    Some people may be wondering how it was that eating wheat and other high fibre grains caused humans to become weaker, shorter and fatter.

    This paper http://www.ncbi.nlm.nih.gov/pubmed/6299329 Reduced plasma half-life of radio-labelled 25-hydroxyvitamin D3 in subjects receiving a high-fibre diet.
    unearthed by Stephan at Whole Health Source, provides one possible explanation as it shows a high-fibre diet reduces the half-life of 25(OH)D3 thus speeding up vitamin d deficiency.

  • Nancy LC

    2/19/2009 5:30:00 PM |

    Yes!  I thoroughly enjoyed Dr. Eades commentary on that study.  Although I do wish that study authors wouldn't obsess so much over saturated fat.

    Steven from http://wholehealthsource.blogspot.com/ also did a bang up review.  His blog is also quite fantastic.  He did a series on Tokelau Island migrant studies that was very interesting.  They are a people that eat quite a lot of saturated fat, from coconut, and yet had virtually no heart disease.

  • Kevin

    2/19/2009 7:07:00 PM |

    I cut out wheat a long time ago but haven't had blood work recently.  If cholesterol has nothing to do with heart disease, why worry about it?  Why eliminate saturated fats if they're not contributing to atherosclerosis?

    kevin

  • Trinkwasser

    2/20/2009 3:41:00 PM |

    The wheat connection is interesting, it's far and away the worst grain for spiking my glucose levels, even wheat bran will do it.

    My athlete cousin is already showing signs of the familial insulin resistance in her thirties and while she stuffs her body with far more carbs than I do she has noticed a marked improvement from avoiding wheat.

    The horrible irony is that a diabetic colleague diagnosed my diabetes over twenty years ago and a friend who knew my diet suggested I might be wheat intolerant. My doctor wrote that I had "fanciful notions" and hypochondria. Now here I am. Meanwhile the GP died "unexpectedly" which was ironic

    I wonder if wheat has always been this (comparatively) toxic or if it's the modern strains specifically. Originally it was a transgenic cross, kind of natural GM, with far more chromosomes than is good for it, but has been majorly tweaked over the years to provide current yields

  • Maxx

    2/22/2009 3:52:00 AM |

    It's odd to me how often folks state that there's no proof that saturated fat intake causes heart disease. I know the standard arguments, I've read Good Calories, Bad Calories and many of the websites dedicated to disproving the lipid hypothetesis.

    But the fact is, there are quite a few studies that demonstrate that saturated fat intake IS associated with higher incidence of heart disease (not just cholesterol profiles).

    A few examples:
    http://content.nejm.org/cgi/content/abstract/337/21/1491

    http://content.nejm.org/cgi/content/abstract/337/21/1491

    http://www.ajcn.org/cgi/content/full/70/6/1001

    The majority of the studies I've seen on low carbohydrate, high fat diets have all been pretty short-term and didn't actually measure heart disease. They just measured cholesterol and, occasionally, inflammation.

  • rabagley

    2/22/2009 6:16:00 AM |

    To Anonymous's question about fructose.  It's very important that you understand the metabolic pathway for fructose.

    Fructose is carried by the blood from your gut directly to your liver.  Once detected, your liver stops everything else and converts fructose to triglycerides.  It does this because fructose is a highly reactive sugar and is treated as a dangerous substance by your body.  Triglycerides aren't nearly as bad (but if you've been reading this blog, you know that they're pretty bad, too).  

    Most of the triglycerides are released into the blood (where they represent the wrong side of the HDL/triglycerides heart health ratio), while some small fraction remain trapped in the liver tissues.  If you keep hitting your liver with triglycerides (via fructose), and live long enough, those triglycerides get stored in the liver and you'll end up with fatty liver disease.

    Fructose is all sorts of bad news for your health.  Sucrose, HFCS, honey, cane solids, corn syrup solids, etc: all contain significant quantities of fructose, and over time, all pose a risk to your heart, your liver, and via insulin resistance and glycation reactions, your entire body.

  • Anonymous

    2/25/2009 3:57:00 AM |

    I am new to trying to understand the most healthy diet and just finished reading Dr. Eades book (who does not eschew whole grains in his meal plans).  I am reminded of Michael Pollan's comments that preface his book - 'In Defense of Food' in which he claims there is much ideology with regard to diet and nutrition.  

    I understand many people have strong opinions, but I am hoping someone can provide insight into this website that includes whole wheat as one of the most important foods in our diet -- http://www.whfoods.com/genpage.php?tname=foodspice&dbid=141.

    I am not asking this to be controversial, but would genuinely like to hear some factual counterpoints.

  • Ricardo Carvalho

    4/2/2009 10:58:00 PM |

    This is great news for the paleolithic community: the British Medical Association has just recognised the importance of paleolithic diets in this recent report (see pages 5/6): http://www.bma.org.uk/health_promotion_ethics/child_health/earlylifenutrition.jsp

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    9/15/2010 5:56:36 AM |

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    10/29/2010 9:39:23 AM |

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  • buy jeans

    11/3/2010 9:58:13 PM |

    This is the first time I have seen someone call out Gluten as the component of wheat that causes inflammation response. Good to know as it is often a primary source of protein for vegetarians.

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