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.

The most important weight loss tool

4. March 2010 William Davis (15)

Question: What is the most effective tool available to help you lose weight? 


A pedometer (walk 10,000 steps, etc.)?

A treadmill? 




A bicycle?






No. None of the above. 

The most important tool you can use to achieve weight loss is your glucose monitor:



Timing of blood sugars

3. March 2010 William Davis (5)
Because different foods generate different blood sugar (glucose) responses, the timing of your blood sugar is an important factor to consider.

This question has come up a number of times. Commenters have asked whether the one-hour postprandial glucose is timed with the start of the meal or the conclusion of the meal.

In my view, if we simply ignored all aspects of meal composition, then blood glucose should be obtained one hour after the conclusion of a meal. This is because most mixed meals (i.e., mixed in composition among proteins, fats, and carbohydrates) yield peak blood glucose levels at 60-90 minutes after consumption. Timing blood glucose to 60 minutes after the conclusion of a meal puts the sample right about at the peak.

But this is an oversimplification. For instance, here is the blood glucose behavior after so-called "complex" carbohydrates wheat bread, rye bread, rye made with beta glucan, and whole wheat pasta (50 grams carbohydrates each) in slender, healthy volunteers, mean age 29 years:


From Juntunen et al 2002

Note that blood glucose peaks at 35 minutes postprandial. (To convert glucose in mmol/L to mg/dl, multiple by 18. Thus, whole wheat bread increased blood glucose from 94 mg/dl to 122 mg/dl. Also note the lower peak glucose for pasta, but sustained higher glucose levels hours later.)

In another study, older (mean age 64 years), overweight (BMI 27.9) females with diabetes were given 50 grams carbohydrate, 50 grams carbohydrate with olive oil, or 50 grams carbohydrate with butter:


From Thomsen et al 2003. Control meal of soup plus 50 g carbohydrates ({blacktriangledown}), the control meal plus 80 g olive oil ({circ}), and the control meal plus 100 g butter (•).

In this experience, note that postprandial glucose peaks 60-120 minutes after the meals (consumed within 10 minutes), delayed more when either oil is included. Blood glucose started at 144 mg/dl and peaked as high as 230 mg/dl with carbohydrates only; peaks were reduced (along with AUC) when oil was included. (Note the differential effect, olive oil vs. butter.)

These two sets of observations give you a range of blood glucose behavior. One side lesson: Carbohydrates should never consumed by themselves, else you will pay with a high blood sugar (not to mention the hypoglycemic response later for many).

Psssst . . . There's sugar in there

1. March 2010 William Davis (13)
You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.

By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl.

Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:

Balsamic vinaigrette
Many commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.)

Hamburgers
I learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy.

Tomato soup
If it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar.

Granola
Sure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar.


Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy.

And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).

How low should blood sugar be?

28. February 2010 William Davis (0)
What should your blood sugar (glucose) be after eating?

Take a look at the data from the Whitehall study reported in 2006. The Whitehall Study stands apart from other studies in that it was very large (over 18,000 participants) who were observed for an unusually long time (33 years). All participants were administered a 50 gram glucose "challenge" at the start with glucose levels checked after the glucose challenge.

Here's what they found:




From Brunner et al 2006.
CRP House of Cards

CRP House of Cards

4. May 2009 William Davis (15)
Lew has coronary plaque with a heart scan score of 393. At age 53, that's in the 90th percentile (higher score than 90% of men in his age group).

On our search for causes of his coronary plaque, we identify low HDL of 41 mg/dl, high triglycerides of 202 mg/dl, small LDL (83% of total), calculated LDL of 133 mg/dl, and severe vitamin D deficiency with a starting blood level of 25-hydroxy vitamin D of 19 ng/ml.

His c-reactive protein: 4.1 mg/dl--above the cut-off of 2.0 mg/dl that the pharmaceutical industry is targeting as a mandate for statin therapy, particularly given the JUPITER data.

Lew instead eliminates wheat and other small LDL-provoking foods and, as a result, loses 28 lbs in 3 months; adds omega-3 fatty acids from fish oil; supplements vitamin D sufficient to increase his blood level to 70 ng/ml.

Along with dramatic correction of his starting abnormalities, his c-reactive protein: 0.4 mg/dl--no statin drug.

In my view, increased CRP is nothing more than a surrogate for the inflammatory phenomena that arise from high-carbohydrate diets, overweight, and small LDL. Correct those and CRP drops off a cliff. In fact, it is exceptionally rare for CRP to not drop to very low levels following this formula.

I believe that CRP is one more item on the list of reasons--the house of cards--the pharmaceutical industry is building to persuade us to take more and more statin drugs. LDL not low enough? Take more statin. Diabetic with low cholesterol? Take a statin. Inflammation? Take a statin.

Enough already.
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Comments (15) -

  • Scott W

    5/4/2009 2:23:00 PM |

    Dr. Davis:

    Wondering if you could clarify your thoughts a bit. You promote elimination of wheat and corn starch (which I fully believe in) but then also comment on the elimination of carbohydrate (in the aggregate) as being a key factor for health. I'm not convinced that all carb is problematic for a person with a normal metabolism. Of course, it doesn't hurt anything; just wondering at your experience with those who don't go low carb but do drop the wheat.

    Thanks.

    Scott

  • JPB

    5/4/2009 3:59:00 PM |

    So why have so many doctors bought into this whole statin thing?  If you question the need for a statin, you are first bullied to take them and second shown the door if you continue to resist!

  • Ricardo

    5/4/2009 4:02:00 PM |

    Dear Dr. Davis, the improvement you describe for Mr. Lew is mainly because of wheat elimination, fish oil supplements or 25-hydroxy vitamin D increased levels? Or is just because of the significant weight loss and hypocaloric diet? In other words, from your experience, would you expect similar results in other people, for example, with the same approach but with no weight loss at all?

  • Roger

    5/4/2009 4:49:00 PM |

    Dr. Davis,

    Are you still recommending Niacin?  I haven't seen it mentioned for low HDL in a while.

  • Nick

    5/4/2009 8:41:00 PM |

    It would be interesting to know how long Lew's dietary/supplemental changes were in effect before his hsCRP impressively dropped from 4.1 mg/dl to .4 mg/dl?

    Two months into a LC diet and two weeks without grains my hsCRP was 2.43 mg/dl, HDL-75, TGs-82, calculated LDL-105, VLDL-16. Yes, my doctor advised me to go on a statin and a low-fat, high fiber diet to lower my LDL number to <75 (not going to happen). In my case, I do not need to lose weight, just manage blood sugar.

    Still, it would be interesting to know when to expect a lowering of CRP and what other factors beside coronary plaque determine the measured hsCRP when one is mimicking Lew's strategy?

  • Anne

    5/4/2009 11:51:00 PM |

    I have had a dramatic improvement in my hs-CRP, but it occurred slowly. Nine years ago my hs-CRP was over 13 and I was having one stent after another and ultimately bypass. As I made lifestyle changes, my hs-CRP started to fall a little. In 2003 I stopped eating gluten(wheat, barley and rye) and by 2005 my hs-CRP dropped to 4.98.

    Now I have given up all grains because of blood sugar issues and my hs-CRP is 2.19 - not perfect but heading in the right direction. My vitamin D is now 54ng/ml instead of 24. I do take fish oil.

    I doubt a statin could lower hs-CRP from 13 to 2.19

  • steve

    5/5/2009 1:25:00 AM |

    i have been looking to join the track your plaque website,but the site that asks for a credit card does not appear to be secure/encrypted; it is not an https site for example.  Therefore any data you put in for a credit card is out there in cyber space.  any suggestions?

  • Dr. William Davis

    5/5/2009 1:42:00 AM |

    Great results, Anne!

    In general, CRP reductions occur over several months. The phenomenon that both exerts profound effects but can slow the process down is WEIGHT LOSS.

    Scott--It depends on whether there are metabolic measures that reflect intolerance to wheat and other carbohydrates, such as small LDL or increased CRP.

  • vin

    5/5/2009 8:19:00 AM |

    Dr. Davis,

    when you say eliminate wheat and other food that cause small LDL : which other foods are you referring to? Is it all simple carbs such as sugars, processed foods etc. or something else?

    Thanks.

  • Dr. William Davis

    5/5/2009 10:38:00 AM |

    Vin--

    Eliminating wheat means just that: anything made with wheat. Otherwise, the effect does not kick in.

  • Anonymous

    5/5/2009 9:25:00 PM |

    The ml/dl units for CRP levels are likely a typo, one that is widely found in the medical literature and confusing for the novice attempting to determine normal serum CRP levels.  Levels above 2 or 3 mg/L are often cited as indicative of increased cardiac risk and levels at or above 2 mg/L (0.2 mg/dl) were required for eligibility in the Jupiter study.

  • Anonymous

    5/6/2009 4:54:00 AM |

    Dr Davis,

    I've been on a Low carb diet for the last six months.  My triglycerides is 60, HDL 61 but my direct LDL is 174, APOPROTEIN B is 119. My CRP was .6.  Should I be worried about the APOPROTEIN B score of 119?  My doctor recommended that I take a Statin drug....with the high LDL score and APO_B score.  I don't eat any grains and currently taking fish oil, niacin and vitamin D gel based pills.  I would like to stay away from statins....but I'm getting frustrated in not being able to lower my LDLs through diet.

  • Anna

    5/10/2009 3:59:00 PM |

    To those of you who have eliminated grains; reduced your fear of naturally saturated fat (be wary of trans fats and most vegetable oils, though); have seen your HDL go up; etc., but are still worried about what seems like an elevated LDL (remember, it's probably just a calculated number, not a direct measurement), then consider that few primary care docs even see people who eat like that, so  they don't know what to do with the unusual profile that comes up.  They rec a statin as a knee-jerk reaction to any "elevated" LDL number, despite all the other "risk factors" that look fine - it's to cover their you know whats (one doc even said that to me).

    I ran into this with my endo who noted in my file the high calculated LDL and total cholesterol numbers (but the ratios and triglyc are great and far better than they were 5 ya before I got my BG under control by restricting carbs, then eliminating wheat).  

    In response to the suggestion I consider a statin, despite no other reason besides the high "calculated" (estimated) LDL number, I said, "then let's take a closer look at that LDL.  Please order a detailed cholesterol lipoprotein panel [same as TYP recommends] to directly count and measure the LDL particles, because I think it's highly likely the LDL will be few in number plus will be the large fluffy kind not associated with CVD."  At that point I did know that my atypical high fat, low carb diet that I followed to manage my BG tended to promote the right LDL and minimize the small dense LDL particle formation.  So I wasn't worried at all about the LDL number, but probably most people are conditioned to worry about LDL these days.

    That was before I knew about heart scans.  Now that I've had a heart scan with an unsurprising 0 score.  So if I get another statin recommendation (prob less likely now),  I'll say that "there is no measurable plaque in my coronary arteries,  so no thanks" (not to mention the questionable benefit of statins for women, anyway).  

    These days, before I consider taking *any* treatment that wasn't needed on an emergency basis, I look into it thoroughly
    from ALL angles and make sure no stone is unturned - to be sure I truly will benefit from it and not be harmed (and that means a direct look at the so-called risk factors and side effects or undesireable outcomes, not just an estimate or calculation.  We've been programmed to fear any high LDL number, but we need LDL; that's why we make it -  it serves a physiological function.  We just have to get past the oversimplification of "good and bad" cholesterol and make sure we make the the healthier forms.

  • Trinkwasser

    5/16/2009 12:59:00 PM |

    Good going Anna!

    The cluefulness factor varies a lot between doctors. One of mine noted "weird" lipids without relating them to what was obvious "diabetic dyslipidemia". Many in the UK will only look at TChol.

    My current one is more competent than many, she agrees that my slightly high LDL is not dangerous since my trigs and HDL have become so good. But she is adamant that I cannot have CRP or homocysteine tested and lipoprotein panel is totally unavailable. Not entirely her fault, it's those accountants.

    I'm trying to educate her into the benefits of carb lowering. She's coming round to understanding my point of view but is restricted by protocols from recommending it to others. I'm getting through better with the nurses who seem more able to suggest useful techniques without fear of being disciplined or losing their jobs.

  • AE

    1/6/2012 9:11:49 PM |

    Hello Dr. Davis,

    I'm on a ketogenic diet and in the process of weight loss. Went to the doc and got my blood test to find out that my cholesterol numbers were good, however, I had high CRP (5.5). The doctor immediately suggested statins. No additional tests to rule out an infection or other strategies to determine the cause of the inflammation.

    I'm aware that during weight loss the blood test results can be skewed. (You talk about this here: http://www.trackyourplaque.com/blog/2011/09/what-is-this-wacky-thing-called-weight-loss.html) However, given that my cholesterol results are good, I'm wondering why the CRP would be high.

    You can get a more detailed background about my case here (which includes blood test results): http://www.reddit.com/r/keto/comments/o4lk8/bloodwork_after_3_months_of_keto/

    Sincerely,

    A.E.

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