Diarrhea, asthma, arthritis--What is your wheat re-exposure syndrome?

Have you experienced a wheat re-exposure syndrome?

As I recently discussed, gastrointestinal distress--cramps, gas, diarrhea--is the most common "syndrome" that results from re-exposure to wheat after a period of elimination.

Others experience asthma, sinus congestion and infections, mental "fogginess" and difficulty concentrating, or joint pains and/or overt swelling.

Still others say there is no such thing.

Let's take a poll and find out what readers say.

Comments (52) -

  • d

    1/30/2011 2:09:02 PM |

    I don't have a "re-exposure story", rather an avoidance story.

    I used to have terrible cold weather, exercise induced asthma.  After nordic skiing I would be wheezing, coughing, sucking on albuterol and begging for low dose corticosteroids.  I also had terrible acid reflux.

    Fast forward:Wheat free for over 6 months.  No more asthma, no reflux.  Period.  End of story.

    Is it the wheat?  Can't say for sure, but it's awfully suspicious.

  • Sassy

    1/30/2011 2:33:05 PM |

    Reflux -- starts a day later and goes for up to a week.  And Bloat:2-5 inches on my waistline in a day, lasting up to three.  Miserable.  And why, having experienced this once, have I done it often enough to verify the connection with certainty?  I am working on that one.

  • Lori Miller

    1/30/2011 3:21:09 PM |

    Last year, I had a cookie after a few months' being wheat-free. It gave me a stomach ache, acid reflux for two days and sinus congestion for four. No more wheat for me.

  • Anonymous

    1/30/2011 3:26:17 PM |

    Wheat increased hunger with even with only a small amount. Crackers in soup was enough to set it off.

    Also, when I was trying to get off wheat, I noticed that 2eggs and 2bacon and I could go 5 hours before hunger, or 2eggs and 2bacon and toast was good for three hours before hunger. That was the final step to giving up wheat. Now three years and 59 Kg loss later, there is no doubt in my mind that wheat is evil, and I do not regard it as suitable for human food. I speculate that it increases ghrelin or cortisol.

  • Anna

    1/30/2011 4:42:54 PM |

    For me, in the two years since I began eating Gluten-Free (Low Carb for 6 years), the few times I've had re-exposure to wheat, I've experienced fast onset and intense abdominal pain (known exposure during the daytime) and heartburn, indigestion, intense nausea, and disrupted sleep (exposures during evening meal not discovered until the next day).  

    My husband wants to think he's fine with wheat (though I know that he has at least one gene that predisposes to celiac), but IMO, he isn't.  He eats no wheat at home because that's the default, and he's OK with that.  But if he goes out to dinner at a restaurant that serves "good" artisan bread, he  will indulge in a few bites (he does restrict his carb intake, so it's still a limited amount).  More often than not, he will sleep fitfully on those nights, snore more, and wake in the night with indigestion.  He wants to bury his head in the sand and will only acknowledge the discomfort being due to eating too many carbs, not the wheat itself.  I notice he sleeps fine if he eats a small amount of potato or rice.  Go figure.  

    Our 12 yo son has been eating GF for two years also.  About 6 months into GF, he unknowingly ate wheat a number of times (licorice candy laces at a friend's house), which  resulted in outbreaks of canker sores in his mouth each time.   He also exhibits mood and behavior changes when he eats wheat, which is what prompted me to test him for gluten intolerance in the first place.

  • Anonymous

    1/30/2011 5:15:49 PM |

    I need to be able to choose more than 1 option in the poll. The top 3 choices are me. If I just eat a little, I only get GI symptoms followed by sinus headache. If I eat more, then I get arthritis symptoms (first diagnosed when I was 13. Now that I avoid wheat, it's gone unless I re-expose myself).

  • Dr. William Davis

    1/30/2011 5:56:07 PM |

    I see now that I should have added two more choices: 1) More than one of the above, and 2) "other," i.e., effects not listed.

    Anyway, we'll have to make do. I believe we can still get a useful non-scientific sense of what readers have experienced.

  • Kurt

    1/30/2011 6:18:10 PM |

    I eliminated wheat on your suggestion over a year ago. Occasional re-exposure (usually dining out) has no effect on me.

  • Mark__S

    1/30/2011 7:14:17 PM |

    If I go for 3-4 days without wheat, grains or sugar and then go out and binge on a pizza and ice cream or something like that I become explosive within 20 minutes to an hour.  It's like a wheat and sugar rage.(I'm not saying this is an excuse for rage, I'm saying it has happened to me and I believe partly do to re-exposure)  It seems the combination of the wheat plus sugar can be the worst.  
    I get red rashes around my neck sometimes right away and sometimes up to a day or later and sometimes get bad diarrhea.  
    I think it can be almost dangerous to cut things like gluten and sugar suddenly out of the diet without being very serious about keeping them out. I have found it very hard to cut out wheat without binging on it later after 4 or 5 days. I don't believe that my symptoms are just psychological either.
    I was also diagnosed with ADHD as a young kid and then rediagnosed with adult ADHD by 3 different doctors.  I also have bouts of mania at times too.  I am considering trying to go completely gluten/refined carbohydrate free to see if it helps with the symptoms and gives me some relief.
    I have never been tested for celiac or gluten intolerance but I would like to be. I think it would help explain to my girlfriend, family and friends why I can't go out and eat pizza or have a beer or ice cream.  Right now they all think I'm a hypochondriac.

  • Anonymous

    1/30/2011 7:20:19 PM |

    Braing fogm clogged nose and slower bowel movement.

    Why i dont get diarrhea when eating wheat?

  • Mark__S

    1/30/2011 7:29:44 PM |

    Would like to add at times I have experienced an intense fatigue the next day like I can't wake up and also sharp pains in my body and headaches.

  • Anonymous

    1/30/2011 7:36:50 PM |

    I ditched wheat a year ago after my wife was diagnosed celiac. I immediately experienced a number of health improvements (blood lipids, sleep, allergies, etc.).

    Fast forward: We all suffered some inadvertent wheat exposure yesterday via some chocolate covered Brazil nuts (of all things). This accidental A-B-A experimental design resulted in the following:

    1. My celiac wife experienced what she calls "the flip" within an hour of exposure(i.e., intense GI distress).
    2. My five-year-old son went to bed with some wicked reflux.
    3. I woke up with some twinges in my lower back and an ache in my football-weary left shoulder. I was also complaining to my wife about fuzzy-headedness that refused to respond to caffeine or hydration. I could only describe it as "carb  flu"...

    And then I read your post!

  • Anne

    1/30/2011 8:13:38 PM |

    Depression, agitation and brain fog if I get glutened. Some times this comes with abdominal pain and a rash on my back - I think it is dose dependent. Cross contamination with wheat is a big issue when eating out. Needless to say, I eat out infrequently and then try to stick with the restaurants that are the most aware of gluten issues.

  • terrence

    1/30/2011 8:42:03 PM |

    Several weeks ago, I started Robb Wolf's 30 day challenge.

    The first two weeks were brutal - calling it a withdrawal flu was a massive understatement. So, I thought I would try some wheat and see what happened (could not be worse, I thought). Well, it was.

    I still felt extremely crappy, but I was now MASSIVELY GASSY - AMAZINGLY GASSY, for about 48 hours - flatulence on wheels, in spades.  I did not go out at all in those 48 hours - when the gas came on, it went out, LONG, and QUICKLY and LOUDLY.

    I am easing back into wheat and grain free. I am gluten free today and tomorrow (Sunday and Monday). I expect to try a small amount of wheat on Thursday, then maybe a little more the following Thursday.

  • Anonymous

    1/30/2011 8:42:45 PM |

    After being wheat-free for almost a year, I have intestinal pain and inflammation after re-exposure to wheat. And higher blood glucose for a day or two (type 2 diabetic).

  • reikime

    1/30/2011 9:50:05 PM |

    reading this makes me wonder- how many people with re-exposure symptoms actually have a problem with gluten versus just wheat?

    It would be interesting to see if some of you are still symptom free if you ingest say barley, or rye, while remaining wheat free.  
    Just a thought...I do agree with all Dr D says about wheat, but it does beg the question as to how many are truly GLUTEN intolerant.

  • Donald Kjellberg

    1/30/2011 10:43:09 PM |

    I have limited wheat consumption severely over the last 8 months. I have lost 120 pounds, no longer have bouts of illness, asthma, depression, or low energy. I also take vitamin D and other supplements that have helped (many are from your blog recommendations).

    Last week I ate a small piece of cake and dessert pizza. Shortly thereafter I started sneezing, had a scratchy throat, and runny nose. I called off sick the next day for fear of being contagious. My symptoms subsided quickly and I am now attributing them to the processed flour eaten at my work luncheon. I think it was an allergic reaction since I recall having much more severe symptoms fairly regularly in my wheat eating days. Those were attributed to an "allergy" of unknown origin back then.

  • Dr. William Davis

    1/31/2011 1:04:30 AM |

    The comments to this blog post and poll are incredible!

    I should re-post them in a blog post to highlight all the varied versions of wheat re-exposure.

    The range of benefits with wheat elimination and the effects of wheat re-exposure are truly incredible. Look at what commenter Donald Kjellberg had to say: 120 lbs lost!

    Not everybody, of course, loses 120 lbs. But what other food, when eliminated, has the power to do this in select individuals? Then makes them sick on re-exposure?

  • John Fernandes

    1/31/2011 1:42:24 AM |

    I suffered from Ankylosing Spondylitis, Iritis, Plantar Fasciits, etc for a number of years. I restricted carbs, especially wheat and I've been symptom free for the past two years now.

    The whole story on the KickAS forums here: http://www.kickas.org/ubbthreads/ubbthreads.php?ubb=showflat&Number=427748#Post427748

  • Might-o'chondri-AL

    1/31/2011 2:20:31 AM |

    Lot's of confounders to consider. Lest I be thought of as a wheat apologist troll my wheat and grain consumption is limited (rice less so).

    Any food item we omit will shift our gut bacteria away from those that thrived on that food. Others will then pre-dominate;  and so, to re-expose after (say) 3 days some of us won't have the same % protein degrading bacteria to handle the wheat protein fragments and more gaseous fermentative bacteria.

    Wheat preparation is another thing and ingredients consumed at the same time can also make a difference. I think of yogurt/kefir and white/brown sugar as modulators; rather than meats/vegetables, which can interact with digestion in their own way and alter the synergy. This is not to contradict individual testimonials of their reactions; nor contest an experiment where wheat all alone is eaten and neither to ignore genetic factors .

    Then there is the doseage factor regarding how much at one time is ingested. Some are prone to inflammatory reactions; their threshold may be linked to excessively stimulating co-existant fungii colonizing their intestine.

    The breeding of wheat is something this blog has helped me understand. Cutting it out entirely for health reasons is for many a simple strategy I hadn't seen clinicaly used. It won't make sense to third world poor however; largely since the "hygenic" hypothesis implicates our immune systems as part of the problem.


  • Anonymous

    1/31/2011 2:27:57 AM |

    My nemesis is processed grains.  Have always tended toward obesity and have only been able to control my weight by minimizing processed foods and by doing a lot of exercise.  Low carb didn't work for me.

    My other nemesis is my 92 yr-old mother's sweet tooth.  Don't have the will power to resist all the junk food she demands, yet I'm her caregiver, and don't have the heart to deny her her sweets.  Have gained about 25# since moving in with her.  She may outlive me.

    Am now experimenting with substituting chia seed for my usual oat/barley porridge.

  • Lori Miller

    1/31/2011 4:21:43 AM |

    I found wheat to be one of the worst things for giving me gas bloating and acid reflux, and I'd had sinus and nasal congestion my whole life. When I ate that cookie, it just re-introduced old problems. I can occasionally eat a gluten-free, grainy goody at my party place without any side effects. I also have a little sprouted rice protein powder every day.

    Another odd thing about wheat: it was hard for me to stop eating it once I started. I could go through a whole box of cookies in one sitting, even though I wasn't a binge eater. But I can have a couple of gluten-free cookies and stop.

  • Paul

    1/31/2011 4:51:19 AM |

    Except for one slip up this recently past holiday season, I've been sugar-grain-starch free since July 2008.  Mental fog was the most noticable re-exposure symptom I had.

    My mom has had the worst acid-reflux for 40-plus years.  It had become so bad that she was on three medications just to deal with the symptoms. After much training and coaxing, I finally got across to her how to totally get off wheat.  Not at all to my surprise, after being wheat free for a few weeks, she lost weight and her acid reflux was GONE!

    But she had been addicted to wheat for so long, she relapsed, and the reflux fire soon returned.  Wheat must be akin to heroin with some people.  Even though they know it's very bad for them, they can't help themselves.

  • Onschedule

    1/31/2011 6:51:39 AM |

    Re-exposure often leads to diarrhea for me, or such a heavy feeling of tiredness that all I can do is lay down and pass out. A local pizzeria makes a darn good pie, but since I started practicing wheat-avoidance, I can't keep my eyes open after eating there. I can't say for sure that it's the wheat causing it, but definitely something in the crust. Diarrhea, on the other hand, is definitely triggered by the wheat for me.

    My mom complained of gastric reflux for years, but never filled the prescriptions that her doctors would give her. I suggested wheat-avoidance- gastric reflux disappeared within 3 days and hasn't returned (has been 6 months now). I've already commented elsewhere on this blog about how much weight and bloating she has lost...

  • Onschedule

    1/31/2011 6:59:38 AM |

    Some readers have suggested that changes in gut bacteria play a role here, and I tend to agree. When my mother stopped eating wheat, her years of gastric reflux symptoms ceased. Yet, her blood test for H. Pylori, taken one month after stopping wheat and cessation of symptoms, was positive for antibodies (indicating past or present infection) and her subsequent breath test was positive for current infection.

    So, for my mother, H. Pylori + wheat = gastric reflux symptoms, and H. Pylori without wheat = no symptoms. It would be interesting to know if the H. Pylori would have disappeared after a longer period without wheat as her intestinal bacteria changed...

  • steve.brand

    1/31/2011 9:47:03 AM |

    Interesting that I should sit down, turn on my computer and find your poll. Having gone several weeks, maybe months, avoiding gluten, I took my daughter and her boyfriend out to eat because my wife has been working late at the office lately. Although I was thinking I would just eat my steak and chicken, I succumbed to the temptation of eating about a dozen greasy, breaded shrimp that my daughter and her boyfriend ordered. It's 1:39am and I still do not feel sleepy. My left nostril is completely blocked, my stomach feels bloated, really, really full and I've been burping. In your poll I checked sinus problems but could have chose gastrointestinal or nervous problems just as well. A few weeks ago my daughter brought home a pizza and, once again, despite my knowing that I shouldn't, I ate a couple of pieces. I was sick for two days. The pain in what I think was my transverse colon was so bad I thought I might have to go to ther emergency room. Before I ate the pizza I had never gone grain-free that long before. I did this after reading Robb Wolf's book. I AM CONVINCED. No more wheat for me! Please, Lord, give me strength.

  • Judy B

    1/31/2011 2:35:58 PM |

    It is very interesting to read the comments here.  I have been LC for almost 4 years but have cheated sometimes (at restaurants).  I have had intestinal distress but never considered that it was from the wheat...

    RE: Pizza - Just don't eat the crust.  We still get pizza and eat the toppings with a fork!

  • brec

    1/31/2011 3:28:42 PM |

    "Still others say there is no such thing."

    Really?  I hadn't noticed anyone saying that.  I, like a few others, reported that I, myself, did not experience symptoms from very occasional wheat re-exposure.

  • msluyter

    1/31/2011 3:39:47 PM |

    When I eat wheat, I often have diarrhea the next day. And I am hungrier, I believe.

  • charlie

    1/31/2011 5:21:38 PM |

    Again, 90% of this is pure mental.

    Interesting the vote results are mostly on GI distress.

    I'd suggest a couple additional matrixes:

    1:  How long have you gone without wheat
    2:  How much wheat did you consume?
    3:  How neutrotic are you?

    I went without wheat for 2-3 days last week.  Had a bad day on Thursday -- stuck at home with little food to eat, so had some WASA whole wheat crackers. Yuck.  Noticed some gassiness but nothing rising to the level of pain.

    I do suspect it mostly is internal flora, but that shouldn't change in 2-3 days.  If you are cramping and shitting after eating some breadcrumps, you either have celiac or some severe mental problems.

    Remains a good idea to advise people to give up wheat -- so prevalent is US diet and easy way to lose weight.  Hard to see it being a long term problem if not abused.

    I remember stories of Indians during 1940's famine being unable to eat wheat while starving. Extreme example -- people who didn't eat wheat for 6000+ years being forced into it.  However, 50 years later common diet item.  Obesity is out of control but that is as much from 10x as many caloric units being available as in the 1930 (i.e. people don't starve to death like they used to)

  • Matt

    1/31/2011 5:37:14 PM |

    "Effects not listed" for me.  I am OK on minimal wheat but when I cross a certain threshold, my eczema flares a week or two later, and my asthma sometimes returns.

  • terrence

    1/31/2011 6:13:37 PM |

    On January 31, 2011, Charlie said... "Again, 90% of this is pure mental."

    Your psychic ability or your plain old unfounded, indeed unfoundable, presumptuousness would be really funny - if you were trying to be funny.

    But, I think you really mean "Again, 90% of this is pure mental."  Even though you do not have a clue as to whether or not anything described by others on this or any other blog really is, "90% of this is pure mental."

    I think the main question you should ask yourself is, "3: How neutrotic are you?" Charlie, can you figure out how to use a spell checker? "neutrotic". HAH.

    Charlie, you actually made the statement, "Again, 90% of this is pure mental." You know NOTHING about most, if not ALL, of the people who comment here. Yet, that you actually think you know what goes on in their minds! Do you use a crystal ball to make your divinations, Charlie?  

    You even made the more ridiculous statement that, “you either have celiac or some severe mental problems.” Your POMPOUS, SELF-RIGHTEOUS PRETENTIOUSNESS is risible, Charlie, RISIBLE!  If anyone on this post has “severe mental problems” Charlie, it is you, and only YOU.  

    I expect you are the same “Charlie” who made a complete fool out of himself on Stephan Guyenet’s blog by spewing similar complete and utter nonsense about “honesty”.

    What you are doing here, as on SG’s site, is called “projection”. What you do not like about yourself, but are afraid to acknowledge in yourself, you project onto others, and claim it is they who have  â€œsevere mental problems” and that “90% of this is pure mental”. So, Charlie; it is YOU who should deal with YOUR mental state, and stop projecting it onto other people, whom you know NOTHING about!

  • Anastasia

    2/1/2011 12:36:37 AM |

    Just like Might-o'chondri-al (what a mouthful!) mentioned, it's hard to tease out the confounders. I don't sit down and munch on some wheat stalks on my off days. These are the occasions when I allow myself to indulge in delicious croissants, scrumptious shortbread tarts and traditional Australian carrot cake (if you do something bad, you might as well be good at it). These very occasional indulgences, apart from containing wheat, also have other NADs, to use Dr Kurt's phrase, that I routinely avoid: sugar, maybe HFCS, maybe some trans fats, maybe some other additives/chemicals I'm not aware of. I know the fall-out: pimples within 24 hrs, flatulence, ankle oedema and headache. I would be hesitant to blame just one ingredient as tempting as it is to indict wheat. But I am not prepared to run an experiment involving me, wheat husks and gluten-free cookies Smile

  • Anonymous

    2/1/2011 1:44:25 AM |

    I'll submit "other".

    No overt symptoms, but since limiting
    carbs generally, wheat specifically,
    my A1C stays in the low 5s, and my
    insulin requirement is half what it was...

    Suits me.


  • Hans Keer

    2/1/2011 8:53:13 AM |

    What if you have multiple symptoms? Grains are a disaster for a lot of people I know: http://www.cutthecarb.com/your-daily-bread-pasta-and-pizza-are-killing-you/

  • Laura

    2/1/2011 1:48:20 PM |

    For those worried about their blood sugar levels, may I recommend this: chana dal

    And here is an interesting article on this food:


  • Anonymous

    2/1/2011 2:00:27 PM |

    From: http://www.mendosa.com/chanadal.html

    "Tim writes, "While I was in Tesco ( Britain's largest supermarket) I checked on the nutritional information panel on the back of a packet of Chana Dal. It was:

            "100g = 1404kj or 332kcal
            protein 23.1g
            carbo 48.2g
            fat 6.5g
            fibre 10.0g""

    But the Chana Dal currently on sale states the nutritional composition as:

    Energy kCal 298kCal
    Energy kJ 1,264kJ
    Protein 24.0g
    Carbohydrate 59.7g
    of which sugars 2.2g
    Fat 3.1g
    of which saturates 0.3g
    Fibre 16.1g
    Sodium Trace


  • LV

    2/1/2011 3:12:11 PM |

    What don't I experience!  I typically avoid wheat (and gluten for that matter) as I'm pretty sure it makes me sick, but when I slip (or someone else slips me some) I end up with massive amounts of joint swelling and tenderness, diarhea, cramping, gas, bloating and brain fog.  I'm absolutely miserable.  Just that alone is enough to keep me off gluten. I have RA, so if I have repeated exposures I'll have a flare which SUCKS!

  • Anonymous

    2/1/2011 6:36:36 PM |

    Like clockwork, I get massive pain in one or both hips with certain movements when I deviate from a low-wheat regimen. I also get heartburn, and difficulty sleeping as well. All are very good reasons to stay off the grain, for me.

  • Anonymous

    2/1/2011 6:51:03 PM |

    depends if it is a fleeting re exposure of prolonged. no symptoms in former and in latter i get weight gain and a crackling but not painful back but im young so that explains the the painlessness. 26 yo.quiv

  • Dr. William Davis

    2/2/2011 12:36:16 AM |

    The varied responses to wheat re-exposure could literally fill a book.

    What is amazing is that this is just a "food"--it's not a poison, medication, or some foreign chemical like a pesticide. It's just wheat.

    I know that someone like Charlie would come on and say something like "it's all in your head." I hear this all the time.

  • Anonymous

    2/2/2011 6:58:44 AM |

    I'm wondering your views on wheat products contained in cooking flavorings such as soy-sauce etc.
    I've cut out wheat from bread and flour however going through all my condiments there is a small amount (~4-8% ) of wheat in these.  The physical amounts are obviously quite small in cooking so for example 8% wheat in soy-sauce would translate to about 1.5 grams out of a 20ml tablespoon serving.
    It would be very hard to go the extra step and cut out my cooking condiments.
    I’m not wheat intolerant, obviously.  Your thoughts?

  • Kelly Scanlon

    2/2/2011 12:43:53 PM |

    I have severe joint pain, especially in my knees and hips, when reexposed to gluten.  I also had GI issues in the form of slowing things down.  I went gluten free last April 2010 and had 1 exposure in September and that was enough for me to cut it out for good.  All my tests show no reaction to gluten (blood/stool), but I know there is something there my body does not like!

  • Kelly Scanlon

    2/2/2011 1:10:27 PM |

    ps:  I agree with others who wrote about gastrointestinal flora.  I believe we need to address these issues in a broader way.   A person could have a bacterial or parasitic overgrowth (or yeast for that matter) that are "carb" feeding, causing GI distress when wheat is consumed.

  • Anonymous

    2/3/2011 4:05:09 AM |

    Dr. Davis,

    Your blog has been educational and inspirational to me as a medical professional.  I have been lurking for several months, perusing old blogs and waiting for new ones.  The conversations in the comments are interesting, sometimes heartbreaking with the illness that people have suffered before the true cause has been found.

    I write now because the improvements in health the removal of wheat, and various reactions with the re-introduction of it is something that has been known in the field of Environmental Medicine for over 40 years.  

    Foods other than wheat, as well as environmental chemicals, can cause similar problems with ill health.  An older, but still useful, book on the subject is 'Alternative Approach to Allergies' by Theron Randolph, MD.  In it, Dr. Randolph describes his work with food and chemically sensitive patients, his theories on why this happens, and his observations on treatment.  Because these sensitivities are highly individual, the gold standard multi-centered double-blinded placebo-controlled studies are impossible to do.

    As with many doctors who practice outside the 'normal' medical paradigm, I have family and personal experience with food and chemical sensitivities.

    My father had had cluster headaches since he was a young man.  He saw Dr. Randolph in the early 1980's, when I was a freshman in medical school.  Dr. Randolph diagnosed sensitivity to wheat and corn (not sure of the technique).  My father also found orange juice triggered headaches.  

    When he removed these foods from his diet and went on a strict four day rotation diet, his headaches quit.  That is not the natural history of cluster headaches.  When I mentioned this to anyone at school, I was told that it was the wrong diagnosis, or it was a coincidence.  It is best to not rock the boat, so I kept quiet after a while.  

    The next year, as a sophomore, I had a chemical exposure from new carpet in my apartment.  Whether it was the glue or the finish, it made me very ill.  I became confused, developed nasal allergies, couldn't do simple drug dose computations, and depressed.  My mother had to come and help me move.  Very embarrassing for a 20-something to need mommy, but I did.  

    I eventually recovered almost back to normal, but even now my memory and ability to concentrate on technical materials is not what is used to be.  

    My dad went back on a conventional diet after 4 years, and his headaches did not return.  He has developed diabetes, arthritis, and balance problems.  I suggested his diet might have something to do with all of this, but he is unwilling to change.  It is hard to convince an 87 year old man that he shouldn't eat his wheaties!

  • eye lift guide

    2/3/2011 11:47:51 AM |

    Extrinsic Asthma is triggered by pollen, chemicals or some other external agent; Intrinsic Asthma is triggered by boggy membranes, congested tissues, or other native causes… even adrenalin stress or exertion.

  • Jezwyn

    2/4/2011 3:25:39 AM |

    I really wish that I had tangible reasons to avoid wheat, but after a fast-food experiment at the end of last year, I had no problems to report whatsoever. So I have to rely on the theoretical information I have to motivate my avoidance of wheat.

  • An

    2/4/2011 9:03:05 AM |

    My goodness, I didn't even know wheat can cause these. I just found ways to cure arthritis. Anyway, prevention is better than cure.

  • Anonymous

    2/16/2011 1:00:34 AM |

    Dr. Davis,

    My name is Barbara and I have been going to you for several years.  I have been using benecol light on my husbands sweet and white potatoes.  After seeing your blog on plant sterols I am worried that I am giving him something thats not in his best interests.  Would you please comment.

  • dancilhoney

    2/22/2011 7:28:04 AM |

    My son and I both have asthma, and we manage with a combination of conventional medicine and some alternative treatments like respitrol for asthma.

  • Bette

    3/24/2011 4:12:13 AM |

    Nin Jiom Pei Pa Koa (http://ninjiom-hk.cwahi.net/) may be another choice. i know alot of people use it, its also non alcoholic, though it's effectiveness is not as good as alcohol based cough medicine, but it's still good to use on not so serious scratchy throat.

  • Karen

    7/8/2011 2:31:05 AM |

    I started gluten/wheat free 5 days ago. But two days in and I started having terrible flatulence and loose stools. Are they connected?? Patellofemoral arthritis in both knees feeling great tho.

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Do heart scans cause cancer?

Another in a series of data extrapolations that attempt to predict long-term cancer risk from medical radiation exposure was published in the July 13, 2009 Archives of Internal Medicine, viewable here.

Over the years, I've fussed about the radiation dose used by some centers for CT heart scans. (Note: I'm talking about CT heart scans, not CT coronary angiograms, an entirely different test with different radiation exposure.) In the "old" days, when electron-beam devices (EBT) were the best on the block, the old single-slice CT scanners (the predecessor of the current 64-slice MDCT scanners) exposed patients to ungodly quantities of radiation, while the EBT devices required very small quantities (0.5 mSv or about the equivalent of 4 standard chest x-rays or one mammogram).

But CT technology has advanced considerably. While EBT has been phased out (although it was an exceptional technology, GE acquired the small California manufacturer, then promptly scrapped the operation; you can guess why), multi-detector CT (MDCT) technology has improved in speed, image quality, and radiation exposure.

While it has improved, radiation exposure still remains an issue. The authors of the study applied the scanning protocols used at three hospitals and those in several CT heart scan studies, then calculated radiation exposure. They found a more than ten-fold range of exposure, from 0.8 mSv to 10.5 mSv. (All scanners were MDCT, none EBT.)

That's precisely what I've been worrying about: In the rapid rush to develop new devices, radiation exposure has often been a neglected issue. While some scan centers do an excellent job and take steps to minimize exposure, others barely lift a finger and consequently expose their patients to unnecessary radiation.

However, it's not as bad as it sounds. For one, the study included 16-slice MDCT scanners, a scanner type that I warned people to not use because of radiation. On the current most popular 64-slice devices, much lower radiation exposure is possible, on the order of 0.8-1.2 mSv routinely--if the center takes the effort.

This study, while eye-opening, will achieve some good: CT heart scans are here to stay. But the day-to-day practice of heart scanning should be:

1) standardized
2) conducted with radiation exposure as low as possible, preferably <0.8 mSv

To read more about this issue, below I've reprinted a 2007 full Track Your Plaque Special Report, CT Heart Scans and Radiation: The Real Story.

CT heart scans and radiation: The real story

“My personal opinion is that many patients today who are receiving multiple CT scans may well be getting at least comparable doses to subjects that have now developed malignancies from x-ray radiation received in the 1930s and '40s. And, similar to those days when the doses were unknown, the dose that patients receive today over a course of years of multiple CT scans is also completely unknown . . .

“I recommend that all healthcare providers become familiar with the concept that 1 in 1000 CT studies of the chest, abdomen, or pelvis may result in cancer.”

Richard C. Semelka, MD
Professor and Vice Chairman, Department of Radiology
University of North Carolina–Chapel Hill

Is this just hype to generate headlines? Or is the truth buried in the enormous marketing clout of the medical device industry, among which the imaging device manufacturers reign supreme?

It’s been over 110 years since radiation was first used for medical imaging. Over those years, it has had its share of misadventures.

In the 1930s and 1940s, before the dangers of radiation were recognized, shoe shoppers had shoes fitted using an x-ray device of the foot to assess fit. High doses of radiation were used to shrink enlarged tonsils and extinguish overactive thyroid glands. Attitudes towards radiation were so lax that doctors commonly permitted themselves to be exposed without protection day after day, year after year, until an unexpected rise in blood cancers like leukemia was observed. As recently as the 1970s and 1980s, cancers like Hodgkins’ disease were treated with high doses of radiation, also leading to radiation-induced diseases decades later.

Not all radiation is bad. Radiation can also be used as a therapeutic tool and even today remains a useful and reasonably effective method to reduce the size, sometimes eliminate, certain types of cancer. Forty percent of people with cancer now receive some form of radiation as part of their treatment (Ron E 2003).

Just how much does medical radiation add to our exposure?

Estimates vary, but most experts estimate that medical imaging provides approximately 15% of total lifetime exposure. In other words, radiation exposure from medical imaging is simply a small portion of total exposure that develops over the years of life. Exposure can be much higher, however, in a specific individual who undergoes repeated radiation imaging or treatment of one sort or another.

For all of us, exposure to medical radiation is part of lifetime exposure from multiple sources, added to the radiation we receive from the world around us. Just by living on earth, we are exposed to radiation from space and naturally-occurring radioactive compounds, and receive somewhere around 3.0 mSv per year (U.S. Nuclear Regulatory Commission). (Doses for radiation exposure are commonly expressed in milliSieverts, mSv, a measure that reflects whole-body radiation exposure.) People living in high-altitude locales like Colorado get exposed to an additional 30–50% ambient radiation (1.0–1.5 mSv more per year).

Much of the information on radiation exposure comes from studies like the Life Span Study that, since 1961, has tracked 120,000 Japanese exposed to radiation from the atomic bombs dropped in 1945 (Preston DL et al 2003). Although regarded as a high-dose exposure study for obvious reasons, there are actually thousands of people in this study who were exposed to lesser quantities of radiation (because of distance from the bomb sites) who still display a “dose-response” increased risk for cancer many years later in life. Radiation exposures of as little as 5–20 mSv showed a slight increase in lifetime risk.

Occupational and excessive medical exposure to radiation also provides a “laboratory” to examine radiation risk. Miners exposed to radon gas; patients exposed to the imaging agent, Thorotrast, containing radioactive isotope thorium dioxide and used as an x-ray contrast agent in the 1930s and 1940s and possesses the curious property of lingering in the body for over 30 years after administration; radium injections administered between 1945 and 1955 to treat diseases like ankylosing spondylitis and tuberculosis, all provide researchers an opportunity to study the long-term effects of various types of radiation exposure over many years (Harrison JD et al 2003).

The excess exposure of workers and several hundred thousand nearby residents to the Mayak nuclear plant in Russia has also revealed a “dose-response” relationship, with increasing exposure leading to more cancers, including leukemia and solid cancers of the bone, liver, and lung (Shilnikova NS et al 2003). Nuclear waste released into the Techa river between 1948 and 1956 contaminated drinking water used by over 100,000 Russians. A plant explosion in 1957 also released an excess of radiation into the atmosphere, yielding exposure via inhalation. Some sources estimate that at least 272,000 people have been affected by radiation from the Mayak plant. This unfortunate situation has, however, yielded plenty of data on radiation exposure and its long-term effects.

It’s also been known for several decades that people who receive therapeutic radiation for treatment of cancer, even with the reduced doses now employed, are subject to increased risk of a second cancer consequent to the radiation treatment.

From experiences like this, radiation experts estimate that an exposure of 10 mSv increases a population’s risk for cancer by 1 in 1000 (Semelka RC et al 2007).

This question was recently thrust into the spotlight with publication of a study from Columbia University in New York suggesting that a 20-year old woman would be exposed to a lifetime risk of cancer as high as 1 in 143 consequent to the radiation received during a CT coronary angiogram. (Important note: This was estimated risk from a CT coronary angiogram, not a simple heart scan that we advocate for the Track Your Plaque program.) The risk at the low end of the spectrum would be in an 80-year old man (because of the shorter period of time to develop cancer), with a risk of 1 in 5017. If “gating” to the EKG is added (which many scan centers do indeed perform nowadays), risk for a 60-year old woman is estimated at 1 in 715; risk for a 60-year old male, 1 in 1911 (Einstein AJ et al 2007). This study generated some criticism, since it did not directly involve human subjects, but used “phantoms” or x-ray dummies to simulate x-ray exposure. Nonetheless, the point was made: CT coronary angiograms in current practice do indeed expose the patient to substantial quantities of radiation, sufficient to pose a lifetime risk of cancer.

The media frenzy

The NY Times ran an article called With Rise in Radiation Exposure, Experts Urge Caution on Tests in which they stated:

"According to a new study, the per-capita dose of ionizing radiation from clinical imaging exams in the United States increased almost 600 percent from 1980 to 2006. In the past, natural background radiation was the leading source of human exposure; that has been displaced by diagnostic imaging procedures, the authors said."

“This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”

Radiation is a widely used imaging tool in medicine. Although CT scans of the brain, bones, chest, abdomen, and pelvis account for only 5% of all medical radiation procedures, they are responsible for nearly 50% of medical radiation used. It’s been known for years that increasing radiation exposure increases cancer risk over many years, but the boom of newer, faster devices that provide more detailed images has opened the floodgates to expanded use of CT scanners.

But before we join in the hysteria, let's first take a look at exposure measured for different sorts of tests:

Typical effective radiation dose values for common tests

Computed Tomography

Head CT 1 – 2 mSv
Pelvis CT 3 – 4 mSv
Chest CT 5 – 7 mSv
Abdomen CT 5 – 7 mSv
Abdomen/pelvis CT 8 – 11 mSv
Coronary CT angiography 5 – 12 mSv


Hand radiograph Less than 0.1 mSv
Chest radiograph Less than 0.1 mSv
Mammogram 0.3 – 0.6 mSv
Barium enema exam 3 – 6 mSv
Coronary angiogram 5 – 10 mSv
Sestamibi myocardial perfusion (per injection) 6 – 9 mSv
Thallium myocardial perfusion (per injection) 26 – 35 mSv

Source: Cynthia H. McCullough, Ph.D., Mayo Clinic, Rochester, MN

A plain, everyday chest x-ray, providing less than 0.1 mSv exposure, provides about the same quantity of radiation exposure as flying in an airplane for four hours, or the same amount of radiation from exposure to our surroundings for 11–12 days. Similar exposure arises from dental x-rays.

If you have a heart scan on an EBT device, then your exposure is 0.5-0.6 mSv, roughly the same as a mammogram or several standard chest x-rays.

With a heart scan on a 16- or 64-slice multidetector device, exposure is ideally around 1.0-2.0 mSv, about the same as 2-3 mammograms, though dose can vary with this technology depending on how it is performed (gated to the EKG, device settings, etc.)

CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 or more chest x-rays or 20 mammograms. Now, that's a problem.

The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legitimate medical questions. They are not screening tests to be applied broadly and used year after year.

It’s also worth giving second thought to any full body scan you might be considering. These screening studies include scans of the chest, abdomen, and pelvis. These scans, performed for screening, expose the recipient to approximately 10 mSv of radiation (Radiological Society of North American, 2007). Debate continues on whether the radiation exposure is justified, given the generally asymptomatic people who generally undergo these tests.

Always be mindful of your radiation exposure, as the NY Times article rightly advises. However, don't be so frightened that you are kept from obtaining truly useful information from, for instance, a CT heart scan (not angiography) at a modest radiation cost.

Heart scans, CT coronary angiograms and the future

Unfortunately, practicing physicians and those involved in providing CT scans are generally unconcerned with radiation exposure. The majority, in fact, are entirely unaware of the dose of radiation required for most CT scan studies and unaware of the cancer risk involved. It is therefore up to the individual to insist on a discussion of the type of scanner being used, the radiation dose delivered (at least in general terms), the necessity of the test, alternative methods to obtain the same diagnostic information, all in the context of lifetime radiation exposure.

Our concerns about radiation exposure all boil down to concern over lifetime risk for cancer, a disease that strikes approximately 20% of all Americans. Many factors contribute to cancer risk, including obesity, excessive saturated fat intake, low fiber intake, lack of vitamin D, repeated sunburns, excessive alcohol use, smoking, exposure to pesticides and other organochemicals, asbestos and other industrial exposures, electromagnetic wave exposure, and genetics. Radiation is just one source of risk, though to some degree a controllable one.

Some people, on hearing this somewhat disturbing discussion, refuse to ever have another medical test requiring radiation. That’s the wrong attitude. It makes no more sense than wearing lead shielding on your body 24 hours a day to reduce exposure from the atmosphere. Taken in the larger context of life, radiation exposure is just one item on a list of potentially harmful factors.

It is, however, worth some effort to minimize radiation exposure over your lifetime, particularly before age 60, and by submitting to high-dose testing only when truly necessary, or when the potential benefits outweigh the risks. Thus, with heart scans and CT coronary angiography, some thought to the potential benefits of knowing your score or the information gained from the CT angiogram need to be considered before undergoing the test. Often the practical difficulty, of course, is that your risk for heart disease simply cannot be known until after the test.

In our view, in the vast majority of instances a simple CT heart scan can serve the simple but crucial role of quantifying risk for heart attack and atherosclerotic plaque. CT heart scans yield this information with less than a tenth of the radiation exposure of a CT coronary angiogram. In people without symptoms and a normal stress test, there is rarely a need for CT coronary angiography with present day levels of radiation exposure. Perhaps as technology advances and the radiation required to generate images is reduced, then we should reconsider.

Early experiences are suggesting that the newest 256-slice scanners, now being developed but not yet available, will cut the dose exposure of 64-slice CT angiograms in half (from 27.8 mSv to 14.1 mSv in a recent Japanese study). The 256-slice scanners will allow scanning that is faster over a larger area in a given period of time.

Thankfully, the scanner manufacturers are increasingly sensitive to the radiation issue and have been working on methods to reduce radiation exposure. However, it still remains substantial.

Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007 Jul 18;298(3):317–323.

Harrison JD, Muirhead CR. Quantitative comparisons of cancer induction in humans by internally deposited radionuclides and external radiation. Int J Radiat Biol 2003 Jan;79(1):1–13.

Hausleiter J, Meyer T, Hadamitzyky M et al. Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates. Circulation 2006;113:1305–1310.

Kalra MK, Maher MM, Toth TL, Hamberg LM, Blake MA, Shepard J, Saini S. Strategies for CT radiation dose optimization. Radiology 2004;230:619–628.

Mayo JR, Aldrich J, Müller NL. Radiation exposure at chest CT: A statement of the Fleischner Society. Radiology 2003; 228:15–21.

Mori S, Nishizawa K, Kondo C, Ohno M, Akahane K, Endo M. Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner. Eur J Radiol 2007 Jul 10; [Epub ahead of print].

Preston DL, Pierce DA, Shimizu Y, Ron E, Mabuchi K. Dose response and temporal patterns of radiation-associated solid cancer risks. Health Phys 2003 Jul;85(1):43–46.

Ron E. Cancer risks from medical radiation. Health Phys 2003 Jul;85(1):47–59.

Shilnikova NS, Preston DL, Ron E et al. Cancer mortality risk among workers at the Mayak nuclear complex. Radiation Res 2003 Jun;159(6):787–798.

Semelka RC, Armao DM, Elias J Jr, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007 May;25(5):900–9090.

Copyright 2007, Track Your Plaque.

Comments (3) -

  • Anne

    7/16/2009 11:38:08 AM |

    I remember those x-ray devices at the shoe store. It was fun looking at the bones in my feet. I also got to play with mercury when I visited an amateur chemist in the neighborhood. He would pour a little mercury in our hands and we would roll it around.

    I wonder what my radiation dose was in the years I was having coronary blockage. I went through 6 coronary caths - 4 were stents. Then I had bypass. Yearly mammograms and dental xrays. Bone density testing every 3 yrs. There are websites where one can add up all their radiation exposure including and estimate of environmental exposure too.

  • Brate

    7/17/2009 5:46:33 AM |

    Sometimes for a patient, it is more a comfort than the technology which we generally try to run for. And does it really matter for a heart patient having an artery blockage or having their valves dismantled that what amount of radiation they are incurring. The question is, is there any feasible reason to question the ability of such tests. These tests have been a boon for both doctors to help them diagnose the problems, and for the patients to help them have a better life. But yes, advancements in the technology should be a possible solution. But it’s not always the best solution to the problem. Advancements in the technology have greatly diversified the perception of people towards healthcare. People used to be frightened when they were prescribed for any test, or were forwarded to hospital. But now, because of the amount of advancements in technology and also the amount of soft-care has changed the age-old perception of healthcare. Now, people feel free to have a medical checkup. The amount of comfort they feel though surrounded by some most complex machineries in the world is the achievement that technology has got. The concepts like concierge medicine and Boutique medical practice has revolutionized the basic fundamentals of healthcare. Many hospitals and medical service providers: Cleveland clinic, Mayo Clinic, Elite health, to name a few, have completely revolutionized the concept of older concierge medicine. The amount of care added with treatment makes a trip to hospital a better journey. All the requirements starting from transportation, stay in the hotel, appointments, etc are one phone away with these concierge plans. Increasingly people are opting for concierge facilities. The overall information regarding concierge plan is described here:

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    11/3/2010 4:57:15 PM |

    However, it's not as bad as it sounds. For one, the study included 16-slice MDCT scanners, a scanner type that I warned people to not use because of radiation. On the current most popular 64-slice devices, much lower radiation exposure is possible, on the order of 0.8-1.2 mSv routinely--if the center takes the effort.