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.
Creatine: Not just for muscle heads

Creatine: Not just for muscle heads

5. July 2009 William Davis (29)
Even if you’re not interested in building big muscles like a bodybuilder, there are health benefits to increasing muscle mass: increased bone density, better balance, and fewer injuries. Greater muscle mass means higher metabolic rate, improved insulin responsiveness, lower blood sugar. The inevitable loss of muscle mass of aging can lead to frailty, an increasingly common situation for the elderly. Muscle loss be reversed, health improved as a result.

Since its introduction in 1994, creatine has exploded in popularity, particularly among bodybuilders and athletes interested in gaining muscle mass and strength. But creatine is not just for young weight lifters. If you are just interested in increasing muscle mass for its health benefits, then creatine is something to consider.

A study of creatine supplementation in men, average age 70 years, demonstrated that, when creatine was combined with strength training, it increased muscle mass 250% better than placebo (7.26 lb muscle vs 2.86 lb muscle), along with improved leg strength and endurance. The same group also demonstrated 3.2% increased bone density (measured using dual energy X-ray absorptiometry) after 12 weeks in participants taking creatine with strength training, while the control (no strength training, no creatine) group decreased by 1.0%.

Benefits are not confined to men. Similar results were observed in another study that included women (age 65 and older), with outcomes in females comparable to males. This is especially important for females, given the common development of osteopenia and osteoporosis in postmenopausal females.

Other studies have shown that benefits are maintained after stopping creatine supplementation.

The most popular form of creatine is the monohydrate, generally taken as a “loading” phase of 15-20 grams per day (generally split into 3-4 doses of 5 grams) for 5-7 days, followed by weeks to months of 2-5 grams per day.

An alternative form, polyethylene glycosylated creatine (PEG-creatine) provides similar effects at one-fourth to one-half the dose of creatine, i.e., 1.25-2.5 grams per day.

Despite previous concerns about kidney toxicity with prolonged use, another study showed that athletes taking creatine for up to 21 months have shown no adverse effects on kidney function, lipid (cholesterol) values, or other basic health measures.

Having healthy muscle mass doesn't make you bulge like a bodybuilder. With modest efforts at strength training, augmented with creatine supplementation, you have a wonderful tool to feel better, reduce injury, increase bone density, and combat abnormal insulin resistance, not to mention accelerate weight loss, since lean muscle mass consumes energy.
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Comments (29) -

  • Chris

    7/5/2009 7:57:53 PM |

    I go thorugh phases of taking creatine every now and again and it does make me feel stronger and look better....but it also makes me get cramps and urinate a lot and I am not sure if that is healthy?

  • Lena

    7/5/2009 10:00:12 PM |

    There is also good evidence that for people who have kidney disease and are on a low-protein diet, supplementing with carnitine, amino acids and keto acids significantly improves health and slows kidney function decline. Some nephrologists had been recommending against a low-protein diet for kidney patients as on its own it decreases health basically due to wasting, but with the supplements this risk is removed and overall health improves.

    There is an American doctor working in Malaysia with people who can barely afford dialysis who is a big advocate of this approach, since the supplements are cheap and can delay the start of dialysis by years.

    http://jasn.asnjournals.org/cgi/reprint/2/7/1178.pdf

    http://www.pkdiet.com/pdf/SavingFailingKidneys.pdf

  • Lynn M.

    7/5/2009 10:32:19 PM |

    Too bad there wasn't a control group of strength training but no creatine to separate out the effects of strength training vs. creatine.

  • Anonymous

    7/5/2009 10:58:21 PM |

    My husband gained massively in strength and size by taking creatine and weightlifting so I'm convinced that it works. However, he says that it takes a lot glucose to activate it and since I was low carbing with the hopes that it might improve my Crohn's,  I wanted to avoid drinking all the juice, a pint or more, that he disolves the creatine in when he takes it.

    Karen

  • Fitness-Diet-Info!

    7/5/2009 11:15:36 PM |

    Nice looking blog. Great article on Creatine. www.Fitness-Diet-Info.blogspot.com

  • kris

    7/6/2009 1:46:49 AM |

    I wonder if any positive/negative effects for hypo/hyper thyroid?

  • Anonymous

    7/6/2009 2:43:57 AM |

    Dr. D,

    I think you made a typo in paragraph 6. I believe you meant to say grams (not milligrams).

    Also, I think you left out the word, "can" in the last sentence of your first paragraph.

    Keep up the good work!

    JohnM

    P.S. I hope someday you will share a story if any of your patients have ever reversed their scan all the way down to zero. I know you have mentioned big reductions, but I am assuming those are people with pretty big scores to begin with. I was always curious if any of them ever made it all the way back down to zero..

  • dr j

    7/6/2009 12:17:03 PM |

    I maybe am wrong....
    read this loading as
    0.3-g Cr.kg(-1) body weight per day for the first week
    for a 70 kg male, 70x0.3=21 g per day
    could someone correct me pls?

  • Anonymous

    7/6/2009 3:35:47 PM |

    Dr Davis:
    Thought that Creatine needed to be taken with carbs/sugar.  what is the corect way to take it

  • Joe E O

    7/6/2009 3:36:04 PM |

    Dr Davis,
    I can't agree more. Not taking creatine while strength training (especially for folks over the age of 40 who may be taking a statin ) is like going out in the the rain without an umbrella.

    Personally - I would put strength training while using creatine right up there with the normalization of Vitamin D as far as improving my quality of life.

    Peace

    Joe E O

  • Anonymous

    7/6/2009 3:48:23 PM |

    Typos: In the monohydrate paragraph, you say mg where you mean grams.

  • karl

    7/6/2009 3:52:40 PM |

    Yes - I think your units are off -- should be g - not mg.

  • Dr. William Davis

    7/6/2009 4:15:07 PM |

    Thanks for catching the typos.

    Yes: Creatine doses should be in grams, not milligrams.

  • pmpctek

    7/6/2009 6:45:52 PM |

    To those asking if creatine must be taken with carbs, in one word, no.

    Yes, creatine taken w/simple carbs has proven to cause faster and more complete absorption. But, when we're talking 15-20 grams/d during the loading phase, we're going to maximize our body's stores within an extra day or two anyway, without having to spike our insulin.

    My only concern with creatine is that it causes initial weight gain to be almost entirely due to increased water volume within the muscles and blood vessels.  That may be concerning for people trying to lower their blood pressure. The studies I've read have proven it does not increase bp.  But I have also read anecdotal reports that it may have caused acute elevated bp in some people after starting creatine.

  • Dr. William Davis

    7/6/2009 10:39:26 PM |

    By the way, I've also written a full-length article for Life Extension Magazine called Superhuman that will detail creatine use, along with HMB, BCAA, and other performance-enhancing supplements for non-bodybuilders.

  • darnoconrad

    7/7/2009 5:29:46 AM |

    Dr. William Davis,

    Does the increased production of creatinine cause concern?

    There was a product created to subvert the production of Creatinine called Kre-Alkalyn which fused ash with creatine-monohydrate in order to produce a pH balanced Creatine product which would not breakdown into Creatinine in the body. The pH of Kre-Alkalyn is at around 14. According to the company that holds the patent, as little as only 1-3g is needed in place of the 15-20g of creatine-monohydrate. According to studies posted on their own site, the Kre-Alkalyn users out perform the creatine-monohydrate users.

    I would like you to comment critically or share any information that you have on these subjects please.

    Thank You!

  • Zach

    7/8/2009 2:03:06 AM |

    Dr. Mike,
    I had kidney stones last year.  I am on the paleo diet/EF diet.  Once a week or so, in addition to supplements of a multivitamin, antioxidants, and vitamin D I take some ginger extract, which really makes my whole kidney area feel cleaned out.  I'm going to have to try out the creatine.
    Best Regards,
    Zach

  • Andrew

    7/8/2009 7:39:14 AM |

    Two comments as an avid creatine user:

    It's not necessary to load creatine.  All the loading phase does is saturate your body more quickly.  However, many people, myself included find the loading phase not only annoying, but also causes a significant amount of bloat.  IMO, you can just take it in 5g doses to start and kind of ease into it.  There's no real reason not to do it this way, as loading is just faster, not better.

    There are a few forms of creatine.  I prefer supplements made with Creapure, as it seems to go down more smoothly.  I also use powder for quicker absorption, instead of pills.  I generally just put the creatine dose in my mouth and then chug some water.  Creatine doesn't have any taste, so it's really just a matter of texture if you can stand it.  The primary thing I aim for is about 1 gal of water per day.  This isn't as daunting as it sounds, as you should be drinking close to that amount, anyway.

    Dr. Davis - If possible, could you do a post about Beta Alanine?

  • Anonymous

    7/15/2009 5:39:18 PM |

    Supplementation with creatine greatly increases ones chances for developing rhabdomyolysis. Beware, especially if you are taking it in combination with a statin.

  • Anonymous

    7/16/2009 2:03:57 AM |

    quitting the statin for a few months is a good idea anyhow.  I am lucky to have the support of an enlightened PCPhys.  She provides guidance and support when I ask to make changes to my Statin or add a supplement.  I don't need her permission to stop taking it but in consultation, she will ask what my goal for the change is and tell me what to look out for.  Get y'rself one of these consultative Docs, they are true gems.

  • william Trumbower

    8/25/2009 9:01:40 PM |

    After reading your post I added creatine along with D-Ribose twice a day.  I do an Ultrafit work out twice weekly and was astonished at the increase in my strength.  I had no side effects at all.  I eat lowcarb-gluten free.

  • Anonymous

    12/5/2009 6:19:03 PM |

    Hey are you a professional journalist? This article is very well written, as compared to most other blogs i saw today….
    anyhow thanks for the good read!

  • Jolly

    2/16/2010 1:16:21 AM |

    Any idea when your Superhuman article will be published?

  • Anonymous

    4/1/2010 1:56:55 AM |

    The doc should compare kre-alkalyn to all studies compaired to creatine are very promising.

  • Anonymous

    7/22/2010 7:21:34 AM |

    Im 16 yrs old and i have osteoperosis. i go to a world class doctor who specializes in kidneys. i took a bone density test and 24hr urine test. i took creatine for weightlifting trying to get bigger. when he told me the results he said everything was normal except one thing. i was excreting too much calcium and not retaining too much citrate. (or something). this leads to kidney stones and other problems. creatine is horrible for you. it lowers bone density long term and puts stress on your kidneys. same with shakes. if you have a good diet thats enough protein already. when you take more protein it sits in your stomach waiting to be processed and is terrible for your kidneys. all this info is from my doctor.....just a heads up. i thought it was safe. but i was wrong.

  • Scott

    9/13/2010 6:28:50 PM |

    Good post.

    http://www.threeblendcreatine.co.uk

  • buy jeans

    11/3/2010 9:15:01 PM |

    Benefits are not confined to men. Similar results were observed in another study that included women (age 65 and older), with outcomes in females comparable to males. This is especially important for females, given the common development of osteopenia and osteoporosis in postmenopausal females.

  • David

    12/23/2010 6:38:46 PM |

    ATP is a long name for a phosphate that increases muscle contraction. Creatine in NO way is harmful, as you can find Creatine in red meats like the steak you eat after your workout. If taken properly (5mg a day), you will notice increases in size, power, as well as weight.

  • Harry

    12/28/2010 12:05:53 PM |

    I took a supplement containing creatine one evening and the next morning I woke up with chest pounding arrythmia. I went to the ER, was diagnosed with Atrial Fibrillation with rapid ventricular response and Rhabdomyolysis (creatine kinase 17000 u/L with a normal range 40-170 u/L) and got admitted to the hospital. The A-Fib lasted 24 hours and the rhabdomyolysis lasted 7 days. I had not associated the creatine with this episode, until a few months later I came across an article titled "Lone atrial fibrillation associated with creatine monohydrate supplementation"
    http://www.ncbi.nlm.nih.gov/pubmed/15899738
    So, before you supplement with creatinine, keep in mind the danger of atrial fibrillation.

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