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.
Is pomegranate juice healthy?

Is pomegranate juice healthy?

19. July 2009 William Davis (20)

Pomegranate juice, 8 oz:

Sugars, total 31.50 g

Sucrose 0.00 g

Glucose (dextrose) 15.64 g

Fructose 15.86 g




In your quest to increase the flavonoids in your diet, do you overexpose yourself to fructose?

Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!


(Coming on the Track Your Plaque website: A full in-depth Special Report on fructose in all its glorious forms and whether this is truly an issue for your health. Fructose tables and the scientific data to establish a safe "threshold" value will be included.)

Image courtesy Wikipedia
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Comments (20) -

  • Anonymous

    7/19/2009 1:45:42 PM |

    all should keep in mind that 4 grams of sugar is equal to one teaspoon.  31 grams is 7 teaspoons plus; not exactly what one would think in what is promoted to be a healthful product!

  • John

    7/19/2009 2:15:04 PM |

    Like most juices, pomegranate juice just has too much sugar.  There is a reason why a juice glass is very small!

    I don't buy pomgrante juice anymore, and when I did I would water it down.  100% is very expensive too.

    Another thing about pomegranate juice, people might be surprised to find that many of them are not 100% pomegranate, but a blend of several juices.

  • Andrew

    7/19/2009 3:59:34 PM |

    At what point do the positive health benefits of pomegranate outweigh the bad parts of fructose?

  • Tom

    7/19/2009 4:20:58 PM |

    Thanks for your great blog! Your information on wheat and sugar is a must read for anyone serious about their health. I like your blog so much, I added a link to it at my blog at http://eatingandfasting.blogspot.com/

  • Anonymous

    7/19/2009 6:07:12 PM |

    Dr. Davis,

    Are you implying that there is no difference between a glass of Kool-ade and a glass of fresh Orange Juice?

    IMO, the problem is not fructose. The problem is highly refined sugar sources that are isolated from their highly complex natural matrix of fiber, vitamins, minerals, flavanoids, antioxidants, enzymes, amino acids--all which act in synergy together.

    That's why PJ reduced atherosclerosis by 35% compared to control group, lowered BP by 20%, increased antioxidant status, and did not raise blood sugar.

    (FYI, I happen to have heterozygous FH and drink daily one full glass of PJ along with one full glass of concord grape juice, and 97% of my LDL particle size remains large, my blood sugar is perfect, and my apo B is not too high. I do avoid refined sugars and carbs, however.)

    So please, Dr. Davis, don't compare an apple with a candy bar.

  • AJ

    7/20/2009 4:52:14 AM |

    Guava juice used to be my particular poison - literally speaking. But it's just not worth the hit to my metabolism. It's been awhile since I last drank any fruit juice and it will be never before I drink it again.

    It's an uphill battle to get people to realise the dangers of fructose, particularly when food manufacturers are allowed to put "No sugar added" on the label. Have them put the grammes of sugars the whole bottle contains on the front of the container in large bright type. It won't stop everyone, but it may help a few people make healthier choices.

  • JC

    7/20/2009 10:55:48 AM |

    Pomegranate juice more than triples PSA doubling time.Is that significant?

  • Peter

    7/20/2009 1:56:43 PM |

    I like to dilute the pomegranate juice with vodka.  That way I only use a couple of ounces of juice at a time, minimizing the fructose but still getting some flavanoids.  Of course once the long term study on this regimen comes out I may have to revise my view.

  • Dr. William Davis

    7/21/2009 3:28:52 AM |

    It's the same flawed logic of "healthy whole grains": If it contains something good (B vitamins, fiber), then it must be good. And it must be even better when consumed in greater quantities.

    Just because it contains one or two desirable ingredients doesn't mean that the entire "package" is desirable,

  • niner

    7/21/2009 5:00:09 AM |

    There's always pomegranate extracts.  You can get the polyphenols in a pill without all the sugar.  I'd be interested in what Dr. D thinks about this form of "sugar-free pomegranate".

  • JC

    7/21/2009 11:19:40 AM |

    Dr Davis,What about the research on pomegranate juice and PSA doubling time?

    Can you also comment on the reported benefits of cranberry juice in preventing urinary infection?

    Thanks,JC

  • Jonathan Byron

    7/21/2009 3:12:18 PM |

    You are absolutely right that fruit can contain large amounts of fruit sugar, and that large amounts of fructose can have serious consequences. The idea that fruit juice must be good (in any quantity) is not supported by the evidence.

    But fruits are more than sugar and moderate amounts of fruits and fructose are not inherently bad - the question is what is reasonable. For those of us with fatty liver, certain patterns of dyslipidemia, or a GI fructose intolerance, the ideal amount is very low. For those who don't fall into that category, the ideal amount of fruit is somewhat greater (but probably less than most people assume).

  • Anna

    7/22/2009 10:22:04 PM |

    I can't remember the last time I saw someone outside my household drink juice from a small juice glass.  Most people I see drinking juice are consuming quantities of juice that practically rival a 7-Eleven Big Gulp.

    Many days I squeeze a half orange to make a couple ounces of OJ to mix with cod liver oil to make the CLO palatable for my young son.  

    To fill a 4 oz juice glass (with about 3-3.5 oz juice), it takes 1-2 oranges, which means that larger glasses of OJ contain the sugar of a whole lot of oranges!  Who would ever eat that many whole oranges in one sitting?

    Also, I know from using a glucose meter that OJ sugar is nearly instantly into my blood stream (and that isn't even measuring the affect of the fructose portion of sugars.  The glucose spikes an insulin response and later a nasty feeling low BG.  So I approach fruit juices with extreme caution and limitations on both quantity and frequency.  I eat whole lower sugar fruits in extreme moderation (avoiding higher sugar tropical fruits).  I focus more on non-starchy veggies rather than fruit, anyway, because veggies are high in the nutrients I want without the excess sugar that fruit has.        

    Not long ago I was in waiting in line at a Starbucks to order an Americano (lack of local coffee shops at that particular suburban area) and right next to me a dad was reading aloud to his young daughter the number of grams of sugar from her “fresh-squeezed 100% fruit juice” bottle label. He noted incredulously there were 30-something grams of sugars per serving and there were 2.5 servings per bottle. He said  â€œwow, that’s a lot of sugar in that bottle”. I thought to myself, wow, here’s a dad who is “getting it”, so I said to him, “there’s 4 grams of sugar to a teaspoon, so that’s at least 7-9 teaspoons of sugar per serving, very nearly the sugar content in soda.”

    His response was, “but it’s fruit sugar, and she doesn’t eat enough fruits and vegetables, so I guess that’s ok.” Sigh. I let it go, and ordered my Americano (unsweetened).

    I've had many interesting conversations with a glycobiologist colleague of my husband's.  He has confirmed I'd be wise to keep all sources of fructose intake to a minimum, as well as being especially wary of concentrated sources of fructose.    I'm sure he follows his own advice; he's looks at least 15 years younger than his 60 years - lack of AGEing, I guess.

  • trinkwasser

    7/29/2009 6:04:30 PM |

    Tell this stuff to a dietician and they won't believe you "but it's low fat!"

    My BG meter tells me fruit juice is an exceedingly toxic substance, and most of my once favourite fruits aren't much better.

    Fortunately it permits me to eat a few berries, but I'd rather get my bioflavinoids etc. from vegetables.

    IMO there's a balancing point between the beneficial and non-beneficial properties of many foods, we probably evolved to deal with small acute doses of toxins but fall apart with chronic exposure to high levels of the same stuff, and all the bioflavinoids and vitamins don't outweigh the damage.

    I just stuffed some strawberries in my face following my lamb chops and runner beans, but only a few, and I washed them down with a fine Bordeaux, that'll about achieve a balance.

  • Barrry

    2/22/2010 12:58:33 PM |

    i have been using Pomegranate juice for 3 years every day after i had 2 stents placed. i also had type 2 diabetes. It has worked very well for me and has not effected my A1c in the least. My cardilogical nuclear studies have been perfect. i am a believer my opinion this stuff can save your life.

  • EMR

    2/24/2010 1:33:43 PM |

    ink it should be avoided by sugar patients.It contains almost a spoon of sugar...though with wheat bread the whole effect of the meal is balanced.

  • Anonymous

    3/8/2010 3:03:37 PM |

    http://www.nutraingredients-usa.com/Research/Pomegranate-juice-shows-possible-diabetes-benefits

    Quit being sugar paranoid.

  • buy jeans

    11/3/2010 3:09:20 PM |

    Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!

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