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.
No BS weight loss

No BS weight loss

13. April 2009 William Davis (18)
If there's something out there on the market for weight loss, we've tried it. By we, I mean myself along with many people and patients around me willing to try various new strategies.

Maybe you say: "Well that's not a clinical trial. How can we know that there aren't small effects?"

Who cares about small effects? If a weight loss strategy causes you to lose 1.2 lbs over 3 months--who cares? Sure, it may count towards a slight measure of health in a 230 lb 5 ft 3 inch woman. But it is insufficient to engage that person's interest and keep them on track. That little result, in fact, will discourage interest in weight loss and cause someone to return to previous behaviors.

What I'm talking about is BIG weight loss--20 lbs the first month, 40 lbs over 4 months, 50-60 lbs over 6 months.

Right now, there are only three things that I know of that yield such enormous effects:

1) Elimination of wheat, cornstarch, and sugars

2) Thyroid normalization (I don't mean following what the laboratory says is "normal")

3) Intermittent fasting


Combine all three in various ways and the results are accelerated even more.
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Comments (18) -

  • TedHutchinson

    4/13/2009 11:48:00 AM |

    January last year I eliminated wheat,cornstarch and sugars.
    I started Dr Dalhqvist's way of eating
    Jan 28th at 205lbs Target weight 160lbs was achieved July 2008 and since maintained.
    Height: 69inches
    before after photos on Jimmy Moore's forum
    I think we all know what the waistline in the before  photo predicts.
    2.25lbs lost each week over 20 weeks. I lost a bit more after but then restarted drinking red wine and that seems to have stopped further weight loss.
    Because I suffer from late effects of polio I am unable to exercise much so all this weight loss was through changing the TYPE not amount of food I was eating NOT by increasing the exercise I do. Those who can exercise will obtain extra health benefits but extra calorie burning is IMO the least of those advantages.
    I found eliminating wheat stopped my food cravings. I didn't snack between meals. Reduced hunger also meant it was easy to Intermittent fast when I thought weight loss may be slowing.

    I didn't calorie or carb count at all.

    I did start using Coconut oil.

    I had previously corrected Vitamin D, Omega 3 status I think reducing Omega-6 Linoleic Acid vegetable oils also improved matters
    Stephan WholeHealthSource "Omega-6 Linoleic Acid Suppresses Thyroid Signaling"

    Looking back I really don't know why I resisted eliminating wheat for so long. I had been reading this blog for long enough so I can't say I didn't know.

  • Dr. David Robinson

    4/13/2009 1:48:00 PM |

    Your three points for greater weight loss are commendable.    Having been a D.C. and cert. personal trainer for over 15 years, I only wish there were more of a push to educate the public, i.e. "weight loss" vs. "body contouring" and "deiting" vs. "proper nutrition", in order to inform them about the realities of mere weight loss and dieting vs. proper exercise and proper nutrition.  This is something I go into in my book (StrategicBookPublsihing.com/TransformingBodyMindAndSpirit.html) and have always educated clients on. Thank You, Dr. David Robnson

  • dogscapes

    4/13/2009 3:10:00 PM |

    I would like clarification on the thyroid levels mentioned in some of your posts, as well as the Hunt Study.  Should the tsh level be at 1.5 or below?  Is the higher the level the higher the risk of heart attack? I'm on thyroid rx(armour90mgs)and my test shows levels in the normal range, not sure the exact level but I will check.  If I am higher than 1.5 tsh should I lower my dose to bring that down?

    Thanks.

  • David Govett

    4/13/2009 7:51:00 PM |

    The essential first step to permanent weight loss is to have a doctor scare you to your core. Without that crucial step, diets are foredoomed because of the magic of denial. As long as you believe that somehow, despite all your bad habits, you might prove the exception and not have to pay for your foolishness, you will not change permanently.

  • Kismet

    4/13/2009 7:59:00 PM |

    Isn't slower weight-loss healthier? I believe that if someone's morbidly obese and/or obese and suffers from CVD (-risk factors), losing weight ASAP is the way to go.
    But if someone's rather healthy and only a little on the chubby side? I'd rather go with slow weight-loss whenever possible. When CRd animals lose weight too quickly, many if not all benefits of CR are lost. Maybe strict CR as a life extension diet is not comparable to a simple obesity avoidance diet, but I believe caution won't hurt.

  • xenolith_pm

    4/14/2009 1:04:00 AM |

    Notice that Dr. Davis did not say anything about calorie restriction.

    Nine months ago I stopped eating anything with any amount of grains, sugar, starch, or HFCS.  I even abstained from eating any of the very sweet fruits like bananas, mangoes, or oranges.

    I'm a 5'9" 47 y.o. male and I had started at 192 lbs., had 15% body-fat (skin fold method), and had a 34 inch waist.  I'm now at 167 lbs., have 6% body-fat, and have a 29 inch waist.

    The volume and intensity of my exercise routines remained about the same. I believe I have gained a small amount of muscle while losing a significant amount of abdominal fat.  I used no kind of fat burning supplement.  I can actually see my abdominal muscles for the first time since I was 16 years old.

    And the biggest irony is... my total daily fat and calorie intake over this period of time went up!

  • CosmicRainbowColours

    4/14/2009 11:01:00 AM |

    I only wish I had known about the connection between unexplained fluctuating weight and the thyroid, instead it took many years and in turn much weight gain before my official diagnosis of hypothyroidism. No wonder none of the diets I had tried had worked!!

  • RichE95

    4/14/2009 1:51:00 PM |

    After my heart scan it was obvious I needed to lose weight - that was about a year ago.  Along with your recommended supplements I did change my eating habits to significantly reduce fat consumption, especially saturated.  That seemed to carry a calorie reduction along with it and. The weight loss was a painless and respectable 20 pounds (210 to 190) along with the amazing reduction in cholesteral, tryglicerides, etc.  I can't wait to see heart scan results in June.

  • Megan Bagwell

    4/16/2009 7:18:00 PM |

    Have you personally tried Fat Fasting?  The 90% fat diet.  I use that to jump start some seriously fast weight loss (like after having babies, in my case.)  When I do this I go for a few days of "Fat Fasting" followed by a few days of normal low carbing (40 grams or below/day)  I've also thrown IFing in the mix, too.  Needless to say, those 3 things took the baby weight off nice and quickly and I kept muscle, too!  I'm now pregnant with my 3rd and I'll be returning to these shortly after giving birth to get to my desired weight/size, now that I know what works...it won't take as much work, though, as I'm keeping a much lower carb, whole foods diet while pregnant than before.

  • David

    4/18/2009 3:51:00 AM |

    @Megan--

    Dr. Atkins promoted the "fat fast" for those who had trouble getting into noticeable ketosis. It works really well, but is usually recommended as a pretty short-term endeavor.

    Interestingly, Dr. Eades talks about an "all meat" diet (along with Intermittent Fasting, which I believe is a revolutionary concept-- especially when combined with Paleo/low-carb) for times when weight loss has hit a plateau. This appears to be safe and effective, even for extended periods (see Stefansson, 1929).

    Dr. Jan Kwasniewski (the Optimal Diet) promotes fat intake of 70% or above-- with spectacular results.

  • D

    4/29/2009 8:05:00 PM |

    great blog. I’m on a diet right now, so this really helps

    http://f07928-c3omazme8bd-bkbnh0u.hop.clickbank.net/

  • Jamie Krause

    6/1/2009 1:07:10 AM |

    Thank you for the useful information. Nice blog!

  • Lose Weight Quick

    6/18/2009 8:36:46 AM |

    Hi Dr,

    great read i agree people wanting to lose weight ideally want to see results early on in the program,
    if it takes a person over 3 months to lose 1.2lbs it is highly unlikely they will continue to give 100%

  • Auto 1

    6/20/2009 11:36:22 AM |

    Hello Dr

    interesting read there... i agree with what Ted said it's certainly not how much you eat it's what you eat i'm all for a snack so long as it's an apple or something like that

  • Nissan 4x4

    6/23/2009 7:32:25 AM |

    Great information here, i have just started a diet.. and i agree coconut oil is better for you.. thanks for the tips this will help me..

  • Rx Pharmacy

    7/1/2009 10:50:21 AM |

    Your post is really great. Its will be help for those person who wants to lose weight. Thank you

  • Nicole M., MS, RD, LD

    7/29/2009 11:00:45 PM |

    Sorry, I completely disagree with your recommended weight-loss. Twenty pounds in 30 days for an average, overweight/obese American is not optimal. And 90% fat in the diet, especially saturated fat (coconut oil!?), is NOT heart-healthy!

  • Megaera

    2/23/2011 9:09:00 PM |

    Um, I call BS on this whole post.  Don't believe a word of it.  The people who lose weight on it are people who will lose weight on any diet.  But there are people like me and others who post on your website -- who you ignore because they don't fit your pattern -- who don't lose weight on this diet.  Sucks to be us, right?

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