Human foie gras

If you want to make foie gras, you feed ducks and geese copious quantities of grains, such as corn and wheat.

The carbohydrate-rich diet causes fat deposition in the liver via processes such as de novo lipogenesis, the conversion of carbohydrates to triglycerides. Ducks and geese are particularly good at this, since they store plentiful fats in the liver to draw from during sustained periods of not eating during annual migration.

Modern humans are trying awfully hard to create their own version of foie gras-yielding livers. While nobody is shoving a tube down our gullets, the modern lifestyle of grotesque carbohydrate overconsumption, like soft drinks, chips, pretzels, crackers, and--yes--"healthy whole grains" causes fat accumulation in the human liver.

Over the past few years, there has been an explosion of non-alcoholic fatty liver disease and non-alcoholic steatosis, two forms of liver disease that result from excess fat deposition. The situation gets so bad in some people that it progresses to cirrhosis, i.e., a hard, poorly-functioning liver that paints a very ugly health picture. The end-result is identical to that experienced by longstanding alcoholics.



While Hannibal Lecter might celebrate the proliferation of human fatty livers with a glass of claret, fatty liver disease is an entirely preventable condition. All it requires is not eating the foods that create it in the first place.

Let go of my love handles

When is fat not just fat?

When it's visceral fat. Visceral fat is the fat that infiltrates the intestinal lining, the liver, kidneys, even your heart. It's the stuff of love handles, the flabby fat that hangs over your belt, or what I call "wheat belly."

Unlike visceral fat, the fat in your thighs or bottom is metabolically quiescent. Thigh and bottom fat may prevent you from fitting into your "skinny jeans," but its mainly a passive repository for excess calories.

Visceral fat, on the other hand, is metabolically active. It produces large quantities of inflammatory signals ("cytokines"), such as various interleukins, leptin, and tumor necrosis factor, that can trigger inflammatory responses in other parts of the body. Visceral fat also oddly fails to produce the protective cytokine, adiponectin, that protects us from diabetes, cancer, and heart disease.

Visceral fat also allows free fatty acids to leave and enter fat cells, resulting in a flood of fatty acids and triglycerides (= 3 fatty acids on a glycerol "backbone") in the bloodstream. This worsens insulin responses ("insulin resistance") and contributes to fatty liver. The situation is worsened when the very powerful process of de novo lipogenesis is triggered, the liver's conversion of sugar to triglycerides.

Visceral fat is also itself inflamed. Biopsies of visceral fat show plenty of inflammatory white blood cells (macrophages) infiltrating its structure.

So what causes visceral fat? Anything that triggers abnormal increases in blood glucose, followed by insulin, will cause visceral fat to grow.

It follows logically that foods that increase blood glucose the most will thereby trigger the greatest increase in visceral fat. Eggs don't lead to visceral fat, nor do salmon, olive oil, beef, broccoli, or almonds. But wheat, cornstarch, potato starch, rice starch, tapioca starch, and sugars will all trigger glucose-insulin that leads to visceral fat accumulation.

Fructose is also an extravagant trigger of visceral fat. Fructose is found in sucrose (50% fructose), high-fructose corn syrup, agave syrup, maple syrup, and honey.

Increased visceral fat can be suggested by increased waist circumference. The inflammatory hotbed created by excess visceral fat has therefore been associated with increased likelihood of heart attack, cardiovascular mortality, diabetes, cancer, and total mortality.

So I'm not so worried that you can't squeeze your bottom into your size 8 jeans. I am worried, however, when you need to let your belt out a notch . . . or two or three.

Surviving a widow maker

Gwen came to me 5 years ago. In her late 60s, she'd been having feelings of chest pressure for the past 4 weeks with small physical efforts, such as climbing a flight of stairs or lifting her grandchildren.

She sat in my office, heaving small sobs, accompanied by her daughter.

Gwen had already undergone a heart catheterization at a hospital near home by a cardiologist who I knew to be honest and competent. She'd been told that she had a 90% stenosis ("blockage") of her proximal left anterior descending (LAD) coronary artery. He called it a "widow maker," since closure of the artery at this point can be fatal within minutes. He advised bypass surgery as soon as possible. Though a stent could be placed at this location, he felt that its proximity to the left main stem (i.e., the "trunk" that divides into the LAD and circumflex arteries) might be jeopardized by expanding a stent in this bulky plaque, what I felt was a reasonable concern.

I reviewed the images that she brought with her. Yes, indeed: a widow maker. The portion of the left ventricle (heart muscle) fed by the LAD was also impaired ("hypokinetic"), reflecting reduced flow through the artery.

I advised Gwen that her first cardiologist's advice was sound: This was a potentially dangerous and severe condition. Either a bypass or stent should be performed near-future, the less delay the better.

But Gwen and her daughter would have no talk of any more procedures. She'd come to me because she heard about the (then rudimentary) effort I'd been making at reversing coronary plaque. "I admire your commitment, Gwen, but I am concerned that there may not be sufficient time to implement a program of prevention or reversal. Prevention is very powerful, but very slow. When symptoms like yours are active, also, it can mean that we won't have full control over the plaque causing the symptoms. This risks closure of the vessel, since flow characteristics in the plaque are abnormal. I think that you should go through a stent or bypass. We can then start your prevention/reversal program once we know you're safe."

Gwen would still have none of it. I asked her to return in a few days after thinking it over. In the meantime, we drew her lipoprotein blood samples while she added fish oil, l-arginine (back then I used a lot of l-arginine for its endothelial health effects), and began the Track Your Plaque diet a la 2004. This was in addition to the aspirin, beta blocker, and statin prescribed by the first cardiologist.

Several days later, Gwen and her daughter returned, as committed as ever to not having a procedure and proceeding with our prevention/reversal efforts.

So off we went. I was nervous about Gwen's safety, but she had clearly made her mind made up. Gwen's lipoprotein analysis revealed a severe small LDL pattern along with markers for prediabetes (high insulin, high blood glucose, hypertension, along with the loose tummy of visceral fat). So I counseled her intensively in diet and added niacin.

Within 2 weeks, Gwen no longer had chest pain. Whether this was due to her efforts or to some resolution of an intraplaque phenomenon (e.g., resorption of internal plaque hemorrhage), I don't know. But her symptoms did not return.

As the program evolved, we added the new strategies along the way--vitamin D supplementation; elimination of all wheat along with other changes in diet; iodine and thyroid normalization; as well as discontinuing l-arginine after the initial two years. She also got rid of the statin drug after losing around 20 lbs on the diet.

It's now been six years with her "widow maker" and Gwen has been fine: no recurrence of her symptoms, all stress tests performed have been normal, reflecting normal blood flow in her coronary arteries.

Should ALL people with symptomatic widow makers undergo such an effort and avoid procedures? No, not yet. Prevention and reversal efforts are indeed powerful, but slow. Some people just may not have sufficient time to accomplish what Gwen did. The fact that Gwen showed evidence for reduced flow in the LAD worried me in particular. There is no question that mortality benefits for stenting or bypass of this location are not as large as previously thought (see here, for instance), but each case needs to be viewed individually, factoring in flow characteristics in the artery, appearance of "stability" or "instability" of the plaque itself, not to mention commitment of the person.

But it can be done.

Fred Hahn's Slow Burn

I just had a workout with personal trainer and fitness expert, Fred Hahn. After a workout that quickly taught me that I had a lot to learn about exercise and strength training, Fred and I had a nice low-carbohydrate dinner at a Manhattan restaurant and shared ideas.

Fred is coauthor of Slow Burn Fitness Revolution: The slow motion exercise that will change your body in 30 minutes a week, written in collaboration with the Drs. Eades, Michael and Mary Dan. Fred also blogs here.

I had heard about Fred's "slow-burn" concept in past, but made little of it. I then met Fred on Jimmy Moore's low-carb cruise this past year, where I gave a talk on how carbohydrate-reduced diets reduce small LDL particles. Fred provided a group demonstration on his slow-burn techniques. I watched the demonstration, even tried it a few times back home in the gym, but never really applied them, losing patience most of the time and just going back to my usual routine.

Well, Fred showed me today how to do his slow-burn. In a nutshell, it is the slow, methodical use of weight resistance until the muscle is exhausted. It involves slow movement--e.g., 5 seconds for a lat pulldown from top to bottom--repeated until exhaustion using a weight that allows, perhaps, 6 repetitions over a 60-second effort.

I've been strength training since I was a teenager. I've seen lots of bad training techniques, injuries, and hocum when it comes to how to use resistance training techniques. But I believe that Fred Hahn's slow-burn technique really provides something unique that I hadn't experienced before.

For one, the burn is nothing like I've felt before. Two, there appears to be nearly zero risk for injury, since the usual momentum-driven, herky-jerky motion often employed with weight machines is entirely gone. Three, if what Fred is seeing is true--enhanced visceral (abdominal) fat loss, reduced blood glucose, increased HDL, decreased LDL/total cholesterol--then there's something really interesting going on here.

I also discovered that Fred is no ordinary personal trainer. He has insights into metabolism that I found truly impressive. After all, he's been hanging around with Mike Eades, who's a pretty sharp guy. What Mike Eades is to metabolic insights is what Fred Hahn is to exercise physiology.

I'm going to take Fred's slow burn training insights home with me. I'll let you know how it goes. Some aspects I'd like to explore: Will strength, muscle mass, and blood sugar responses change?



Fred Hahn's latest book, adapting slow burn techniques for kids.

Can I stop my Coumadin?

Here I go again.

While I will try to keep this blog on topic, i.e., coronary heart disease prevention and reversal using nutritional and other natural strategies, I believe that a "critical mass" of frequently asked, though off topic, questions keep cropping up.

One such question revolves around Coumadin, or warfarin.

Somehow, my Nattokinase scam blog post draws traffic about Coumadin. I tried to make the point that a conventional blood thinning agent like Coumadin that undoubtedly has undesirable side-effects cannot be replaced by an agent that has an uncertain track record. In the case of nattokinase, no track record.

To illustrate how far wrong the "nattokinase as replacement for Coumadin" idea can go, here is a question from Anna:


I came across your blog while perusing.

I am a bit bummed because I have been on Coumadin (warfarin) for around 22 years since I was 6 years old. I have a mechanical heart valve (St. Jude's), as I have heart-related issues, including hypertrophic obstructive cardiomyopathy.

Well, it is just that the warfarin seems to interact with nearly everything. I feel like I can not get the nutrients my body requires. I desire to consume more raw foods and vegan foods, though I do not want anything to damage my heart valve or risk a stroke/heart attack or internal bleeding.

I have been underweight the majority of my life, malnourished , currently am still somewhat underweight, though enjoying food again, as I had what mimicked Crohn's Disease for several years (horrendous pain), from which I am in remission now. I was diagnosed with osteoporosis, which may or may not be caused from consuming warfarin.

Is it possible to get off of warfarin and effectively keep my blood thinned ? I currently take 1.5 mg to 2 mg dosage. Does the warfarin destroy Vitamin K and if so does that mean while on warfarin I never get the Vitamin K nutrients even if I did consume foods with it in it?

Thank you
Anna


No, sorry, Anna. Stopping Coumadin with your unique issues, i.e., a prosthetic mechanical heart valve (likely mitral, judging by your history of hypertrophic obstructive cardiomyopathy, in which the patterns of blood flow ejected from the heart disrupt the natural mitral valve function) and cardiomyopathy, can be fatal. Without blood thinning, the mechanical heart valve can trigger blood clot formation, since it is a foreign object implanted into the bloodstream.

There are no natural alternatives available with track records confident enough to bet your life on. Aspirin nor Plavix are blood thinners, but platelet inhibitors. These two agents, while they work for other forms of arterial (but not venous) blood clot inhibition, will not work for your unique situation.

Likewise, a purported oral lytic agent like nattokinase should not be substituted for Coumadin. Even if there was plausible science behind it, you should demand substantial evidence that it provides at least blood thinning equivalent to Coumadin. Should a blood clot, even a small one, form in or around the prosthetic valve, the valve can stop working within seconds. This can lead to death within minutes.

I believe it would be foolhardy to bet your life based on the marketing--let me repeat: MARKETING--of a "nutritional supplement" by supplement manufacturers eager to make a buck.

Nor are there any other nutritional supplements that can safely replace the Coumadin. I wish that were NOT true, as I am no stranger to the long-term dangers of Coumadin and I am a big believer, in general, in nutritional supplements. I am a BIGGER believer, however, in the truth. Weighing the options available to us today, there really is no rational choice but to remain on Coumadin.

By the way, I tell my patients to eat a substantial amount of green vegetables while they take Coumadin. I know that conventional advice is to reduce or eliminate green vegetables due to their content of Coumadin-antagonizing vitamin K. I think this is wrong, also. Green vegetables are the best foods on earth. They reduce risk for cancer, diabetes, bone disease, and coronary heart disease.

To obtain the benefits of green vegetables without mucking up your blood thinning (your "protime" or International Normalized Ratio, INR), I advise my patients who take Coumadin to eat green vegetables--but do so every day in relatively consistent quantities, so that the protime or INR is not disrupted and remains reasonably constant. It may mean that your total dose of Coumadin may be somewhat higher, e.g., 3 or 4 mg instead of 2 mg, but the dose is immaterial outside of blood thinning. That way, you obtain all the wonderful health benefits of green vegetables while maintaining fairly consistent blood thinning/protime/INR. Coumadin does not block all the health benefits of vegetables, only those related to vitamins K1 and K2.

With regards to protecting yourself from the osteoporosis promoting effects of Coumadin, I would be sure to follow a program of natural bone health, such as the one I discussed in Homegrown osteoporosis prevention and reversal. You will have to be extra careful, however, with the vitamin K2. Ideally, you have a doctor knowledgeable about vitamin K2 who can assist you in managing K2 intake while on Coumadin. This is something you can definitely NOT manage on your own. (I am a big believer in self-managed care, but this is way beyond the limit.)

Lastly, it is my belief that anyone with an inflammatory bowel condition, such as Crohn's disease or ulcerative colitis, should absolutely, positively, and meticulously AVOID WHEAT and all other gluten sources (such as rye, barley, and oats). Even if you test negative for celiac markers (e.g., anti-gliadin antibodies, emdomysium and transglutaminase antibodies), the enhanced intestinal permeability will allow wheat proteins, such as gluten, to gain ready entry into the bloodstream. Not to mention that wheat should have no place in the human diet anyway, in my view.

Homegrown osteoporosis prevention and reversal

I don't like to stray too far off course from discussions of heart disease and related issues in this blog. But the question of bone health comes up so often that I thought I'd discuss the strategies available to everybody to stop, even reverse, osteoporosis.

Coronary atherosclerotic plaque and bone health are intimately interwoven. People who have coronary plaque usually have osteoporosis; people who have osteoporosis usually have coronary plaque. (The association is strongest in females.) The worse the osteoporosis, the greater the quantity of coronary plaque, and vice versa. The two seemingly unconnected conditions share common causes and thereby respond to similar treatments.

Incredibly, rarely will your doctor tell you about these strategies. Your doctor orders a bone density test, the value shows osteopenia or osteoporosis, and a drug like Fosamax or Boniva is prescribed. As many people are learning, drugs like this can be associated with severe side-effects, such as jaw necrosis (death of the jaw bone), a dangerous and disfiguring condition that leads to loss of teeth and disfigurement, followed by reconstructive surgery of the jaw and face. These are not trivial effects.

Note that drugs are approved by the FDA based on assessment of efficacy and safety, NOT proven equivalence or superiority to natural treatments.

In order of importance (greatest to least), here are strategies that I believe are important to regain or maintain bone health. Indeed, I have seen many women increase bone density using these strategies . . . without drugs of any sort.

1) Vitamin D restoration--Vitamin D is the most important control factor over bone calcium metabolism, as well as parathyroid function. As readers of this blog already know, gelcap forms of vitamin D work best, aiming for a 25-hydroxy vitamin level of 60-70 ng/ml. This usually requires 6000 units per day, though there is great individual variation in need.

2) Vitamin K2--If you lived in Japan, you would be prescribed vitamin K2. While it's odd that K2 is a "drug" in Japan, it means that it enjoys the validation required for approval through their FDA-equivalent. Prescription K2 (as MK-4 or menatetranone) at doses of 15,000-45,000 mcg per day (15-45 mg), improves bone architecture, even when administered by itself. However, K2 works best when part of a broader program of bone health. I advise 1000 mcg per day, preferably a mixture of the short-acting MK-4 and long-acting MK-7. (Emerging data measuring bone resorption markers suggest that lower doses may work nearly as well as the high-dose prescription.)

3) Magnesium--I generally advise supplementation with the well-absorbed forms, magnesium glycinate (400 mg twice per day) or magnesium malate (1200 mg twice per day). Because they are well-absorbed, they are least likely to lead to diarrhea (as magnesium oxide commonly does).

4) Alkaline potassium salts--Potassium as the bicarbonate or the citrate, i.e., alkalinizing forms, are wonderfully effective for preservation or reversal of bone density. Because potassium in large doses is potentially fatal, over-the-counter supplements contain only 99 mg potassium per capsule. I have patients take two capsules twice per day, provided kidney function is normal and there is no history of high potassium.

5) An alkalinizing diet--Animal products are acidic, vegetables and fruits are alkaline. Put them together and you should obtain a slightly net alkaline body pH that preserves bone health. Throw grains like wheat, carbonated soft drinks, or other acids into the mix and you shift the pH balance towards net acid. This powerfully erodes bone. Therefore, avoid grains and never consume carbonated soft drinks. (Readers of this blog know that "healthy, whole grains" should be included in the list of Scams of the Century, along with Bernie Madoff and mortgage-backed securities.)

6) Strength training--Bone density follows muscle mass. Restoring youthful muscle mass with strength training can increase bone density over time. The time and energy needs are modest, e.g., 20 minutes twice per week.

Note that calcium may or may not be on the list. If on the list at all, it is dead last. When vitamin D has been restored, intestinal absorption of calcium is as much as quadrupled. The era of force-feeding high-doses of calcium are long-gone. In fact, calcium supplementation in the age of vitamin D can lead to abnormal high calcium blood levels and increased heart attack risk.

These are benign and easily incorporated strategies. They are also inexpensive. I challenge any drug to match or exceed the benefits of this combination of strategies. Keep in mind that strategies like vitamin D restoration provide an extensive panel of health benefits that range far beyond bone health, an effect definitely NOT shared by prescription drugs.

Your enlarged aorta

The thoracic aorta lives happily within the chest.

The aorta is the main artery of the body that emerges from the heart, located just under the sternum. It is the "tree trunk" from which all the major arteries branch off to the rest of the body: the arms, brain, abdominal organs, pelvis, and legs. The aorta receives the high-pressure blood ejected directly out of the heart muscle.

However, there are evil forces in the body that work to weaken the aorta. When the aorta is weakened, it enlarges. Enlarged aortas also tend to grow atherosclerotic plaque. Plaque in the aorta poses long-term risk for stroke and and mini-strokes ("transient ischemic attacks," or TIAs), due to fragmentation.

There are many enlarged aortas in this world. I see at least several every week. It is fairly common, particularly in people with high blood pressure and cholesterol abnormalities, as well as those who are overweight. Smokers get it really bad.

Conventional thinking is that, once an aorta enlarges, it will inevitably continue to enlarge at the average rate of 2.0 mm per year (resulting in 1.0 cm enlargement over 5 years). For this reason, conventional discussions on the topic of thoracic aortic aneurysms all say something like "Enlarged aortas should be monitored yearly. Surgical replacement should proceed when the aorta reaches a diameter of 5.5 cm."

This is because an aortic diameter of 5.5 cm is associated with much greater likelihood that the aorta will rupture (fatal within minutes) or the internal lining will tear, a "dissection." The surgery is a major undertaking that involves opening the chest and usually replacing the aortic valve and inserting a synthetic aorta. The procedure is high-risk, especially if any branch arteries are involved.

So putting a stop to any further aortic enlargement is a worthwhile goal. Unfortunately, conventional thought is that there is nothing you can do to stop the inevitable growth of the thoracic aorta.

Nonsense. There are a number of efforts you can make to halt further increase in aortic diameter. (My experience in this is anecdotal and unpublished, but now numbers several hundred patients.)

There are two categories of factors that cause the aorta to increase in diameter:

1) Internal pressure--Think of blood pressure as the internal inflating pressure on this "balloon." Keeping the "inflating pressure," i.e., blood pressure, low exerts substantial effect on slowing growth of aortic diameter. I aim for normal BP or lowish BP (less than 130/80, preferably 100/70).

2) Factors that weaken the aortic wall--Processes like inflammation, glycation, lipoprotein deposition, and nutritional deficiencies will serve to weaken the supportive tissue of the aorta. For that reason, correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)), reductions in carbohydrate intake and thereby blood glucose/glycation, and "normalization" of vitamin D, vitamin C supplementation (for collagen crosslinking), and omega-3 fatty acids all play a role.

To push even farther, there may be additional advantage to following strategies that impair the production and activity of a crucial enzyme that lives within the aortic wall: matrix metalloproteinase, or MMP. MMP degrades the collagen and other supportive tissues within the aorta, weakening it and permitting expansion. Blocking MMP may prove to be among the most powerful new strategies to halt aortic expansion.

Compounds that have potential MMP-inhibiting effects include:
--Vitamin D--A substantial effect
--Resveratrol--One of the polyphenols from red wine
--Doxycycline--This old antibiotic often used for acne treatment has, in preliminary studies, shown important MMP-blocking effects and slowed aortic expansion.

Anyway, there you have it. A bit complicated, but a "recipe" that has failed me only rarely.

Extreme carbohydrate intolerance

Here's an interesting example of what you might call "extreme carbohydrate intolerance."

May is a 44-year woman who has now had her 7th stent placed in her coronary arteries. She lives on a diet dominated by breads, breakfast cereals, muffins, rice, corn products, along with some real foods.

Her conventional lipid panel and other lab values:

Total cholesterol 346 mg/dl
Triglycerides: 877 mg/dl
HDL cholesterol: 22 mg/dl
LDL cholesterol: incalculable
(Recall that LDL cholesterol is usually a calculated, not a measured value. The excessively high triglycerides make the standard calculation invalid--more invalid than usual.)

Fasting blood glucose: 210 mg/dl
HbA1c (a reflection of previous 60-90 days average glucose): 7.2% (desirable 4.5% or less)
ALT (a "liver enzyme"): 438 (about five-fold normal)


At 5 ft even and 138 lbs (BMI 27.0), May appears small. But the modest excess weight is all concentrated in her abdomen, i.e., in visceral fat.

By lipoprotein analysis via NMR (Liposcience), May's LDL particle number was 2912 nmol/L, or what I would call a "true" LDL of 291 mg/dl. (Drop the last digit.) Of the 2912 nmol/L LDL particles, 2678 nmol/L, or 92%, were small.

The bad news: This pattern of extremely high triglycerides, extremely high LDL particle number, low HDL, predominant small LDL, and diabetes poses high-risk for heart disease--no surprise. It earned her 7 stents so far. (Unfortunately, she has made no effort whatsoever to correct these patterns, despite repeated advice to do so.)

The good news: This collection is wonderfully responsive to diet. LDL particle number, small LDL, triglycerides, blood glucose, and HbA1c drop dramatically, while HDL increases. Heart disease will at least slow, if not stop.

It's amazing how far off human metabolism can go while indulging in carbohydrates, particularly a genetically carbohydrate-intolerance person. (Actually, I wouldn't be surprised if May's diet, as bad as it seems to you and me, still fits within the dictates of the USDA food pyramid.) The crucial step in diet to correct this smorgasbord of disaster is elimination of carbohydrates, especially that from wheat, cornstarch, and sugars.

What's for breakfast? Egg bake

Heart Scan Blog reader and dietitian, Lisa Grudzielanek, provided this recipe in response to the post, What's for breakfast?

Lisa, by the way, is one of the rare dietitians who understands that organizations like the American Dietetic Association have made themselves irrelevant. She therefore advocates diet principles that work, not just echoing the idiocy that emanates from such organizations, often driven by economics more than science. Lisa works in the Milwaukee area and has proven a useful resource person for my patients who have required extra coaching in the Track Your Plaque diet principles.

Egg Bake
My favorite breakfast is what I call an "egg bake." Others may refer to it as a "quiche."

Take a variety of fresh vegetables. This time of year is great for farmers' markets.

I typically use fresh chopped organic spinach, bell peppers, red & white onions, scallions, broccoli, mushrooms, cherry tomatoes halved and, if desired, meat (nitrite-free ham or leftover chicken breasts).

1) Chop veggies and place in casserole dish.
2) Add meat and handful of cheese of your choice.
3) Scramble 8 eggs & little bit of milk & pepper.
4) Add to casserole dish and mix/coat veggies with egg mixture.
5) Put in oven at 450 degress for 30 minutes.

Yummy, ready to eat breakfast that is so easy for the work week.

What's for breakfast?

If you eliminate wheat from breakfast and otherwise adhere to a low-carbohydrate dietary approach, what is there to eat for breakfast?

If you take out English muffins, bagels, all breakfast cereals, pancakes, waffles, and toast, what's left to eat?

Actually, there's plenty left to eat. It just may not look like the traditional American notion of "breakfast." (The traditional idea of breakfast was is, in part, due to the legacy of Dr. John Harvey Kellogg, who, in the latter part of the 19th century, ran a sanitarium in Battle Creek Michigan. He and his brother, Will Keith Kellogg, discovered the idea of turning grains into flakes, the birth of the breakfast cereal. Subscribe to the idea of breakfast cereal for breakfast and you subscribe to the ideas of a man who would administer four enemas for you today to cure your cancer or rheumatism.)

Here are a few ideas. By no means is this meant to be a comprehensive list, just a starting point for a few new breakfast food ideas.

--Eggs--Of course, eat the yolk. Eat three yolks. Scrambled, "fried," (not really deep-fried, of course), hard-boiled, poached, as an omelette. Add pesto, olive oil, vegetables, mushrooms, salsa.

--Ground flaxseed--As a hot cereal with your choice of water, milk (not my favorite because of insulin effects; the fat is immaterial), full-fat soy milk (yeah, yeah, I know), unsweetened almond milk. Add walnuts, blueberries, etc. Ground flaxseed is the only grain I know of that contains no digestible carbohydrates.

--Lunch and dinner--Yes, if you cannot have breakfast foods for breakfast, then have lunch and dinner, meaning incorporating foods you ordinarily regard as lunch and dinner foods into your day's first meal. This means salads, leftover chicken from last night, soup, raw vegetables dipped in hummus or guacamole, stir fry, etc.

--Cheese--For something quick, grab a chunk of gouda or emmentaler along with a handful of raw almonds, walnuts, or pecans. Because of the excess acidity of cheese (along with meats, among the most acidifying of foods), I usually try to include something like a raw pepper or avocado, foods that are net alkaline.

--Avocados--Cut in half, scoop out contents. They're quick and delicious, when available.

I hesitate to mention it, but I sometimes will have tofu, cubed and flavored with whatever is available--soy sauce, miso, pickled vegetables. My mother was Japanese, so I'm comfortable with this, though many people are not.

Anyway, that's a partial list that nonetheless can get you started on a wheat-free, low-carb breakfast.

If you are just starting out, you will notice a number of fundamental changes. You may first experience the characteristic "withdrawal" effect: mental fog and fatigue that lasts about a week. Energy then picks up, often substantially. This is followed by gradually reduced appetite: You will be far less hungry. You will require less food, less often, since appetite will be driven by physiologic need, not the appetite-stimulating properties of wheat (and cornstarch, high-fructose cornsyrup and sucrose).

By the way, do not skip breakfast unless it's part of an occasional fasting effort. Skip breakfast, wind down metabolism, get fat. I am impressed at how consistent skipping breakfast backfires in those who think that it helps you control weight.

I also welcome any suggestions on what you eat as part of your wheat-free, low-carb breakfast. (Thanks for the great suggestions on the last blog post, Anna.)
What would life be like . . . ?

What would life be like . . . ?

What if coronary heart disease could be prevented--no eliminated--applying methods that were accessible, easy, and cheap?

What if coronary heart disease and, thereby, angina, heart attack, sudden cardiac death, ventricular tachycardia, heart failure, and the cerebrovascular equivalent, stroke, could be eliminated using readily available tools available to virtually everyone in the U.S.? And, over a year, it cost less than a once-a-week latte at Starbucks?

How would the healthcare landscape change? What would become of hospitals, manufacturers of the billions of dollars of hospital equipment necessary to supply the cardiovascular hospital industry (e.g., stent manufacturers, catheter manufacturers, defibrillator and pacemaker manufacturers, pharmaceutical manufacturers who no longer have to produce the volume of antiplatelet agents, inotropic drugs, antiarrhythmic agents, etc.)?

How would our lives change? What would the end of life look like if people stopped dying of heart attack, sudden cardiac death, congestive heart failure at age 55, 65, or 75, but lived out their lives to die of something unrelated?

What if the solution had little or nothing to do with drugs but evolved from simple nutritional strategies, supplements meant to correct the deficiencies that accompany modern lifestyles, and a few unique strategies targeted towards the genetic predispositions that lead to heart disease?

What if all this were possible at a cost of a few hundred dollars per year?

It would certainly be a cataclysmic change. Hospitals would shrink to a small remnant of their current gargantuan, dozens-per-city presence. The need for hospital staff would be slashed by over half. The rare cardiologist would tend to congenital heart disease sufferers and other unusual forms of heart disease and he or she might have a colleague or two in all of a major city.

Healthcare costs would plummet, no longer having to sustain the enormous cardiovascular healthcare machine of hospitals, staff, industry, and long-term care. Health insurance, private or public, would drop by 50%.

It would free up nearly a trillion dollars that could be redirected towards other pursuits, like schools and research. Extraordinary leaps forward in quality of life and science would emerge, given that magnitude of funding.

It's not as grand a thought experiment as Alan Weisman's The World Without Us, in which he imagines what the world would be like without humans altogether.

How long would it take to recover lost ground and restore Eden to the way it must have gleamed and smelled the day before Adam, or Homo habilis, appeared? Could nature ever obliterate all our traces? How would it undo our monumental cities and public works, and reduce our myriad plastics and toxic synthetics back to benign, basic elements?

But I believe this thought experiment--what would life be like without heart disease because it was eliminated using inexpensive tools-- is more plausible, more likely to occur. In fact, it has already begun to occur.

See those vines growing up the side of the hospital?

Comments (16) -

  • Jenny

    7/29/2009 12:39:12 PM |

    What would life be like without CVD deaths?

    For a while, the way you describe. But as more people lived into their 80s and 90s the rate of dementia would rise dramatically.

    If you visit any dementia facility you will find it is full of normal weight people many of whom are in otherwise "excellent" health--that's what got them to live to 88 or 92.

    But once demented, their lives are tragic. Saddest are those who are just demented enough to be totally confused, but not enough that they are oblivious to their condition. All people with moderate dementia  need round the clock care which is not covered by Medicare unless they have no assets. This depletes the savings of humble people who have worked for decades who are left with nothing to leave their children.  Depending on the cause of their dementia people may need full time care for a decade. Once they have no money they are turned over to the warehousing of nursing homes, many of which are horrendous  where those who are still conscious may pray daily for death.

    Right now one half of those in the 80-100 age group are demented. The humiliation  dementia inflicts on loved ones is so terrible that anyone who has a relative in this condition (and we have two in our family) will pray that they have enough heart disease to take them out before they go through that long, slow degrading decline.

    Many people have unrealistic ideas that they could take care of a loved one with dementia which stem from not having been put face to face with it since the truly demented are usually locked away somewhere.

    Note too that though there are attempts to blame dementia on diabetes, I don't buy it. The rate of dementia has climbed with the climb in lifespan though "senile dementia" has always been the fat of a good portion of those who lived to be old-old.

    The diabetes diagnosed late in life is part of the gradual failing of their organs and often not the same as diabetes diagnosed in the 40s. It may be associated with dementia but it is far from proven that it is causative.

    Beside that, eliminate CVD and the rate of people dying from the prolonged agony of cancer would go up too, because the older people get the more likely they are to develop cancers. Something many people don't know is that chemotherapy administered to older people id prone to cause dementia. It causes mild cognitive problems  in younger people too, but in the old-old it is much more likely to take out their memories.

    I'm all for eliminating the kind of CVD that takes people out young, especially since it is so often linked to genetic abnormalities.  But for those in their 70s and beyond, eliminating CVD might simply be to trade one condition for another far worse.

    No one lives forever.

  • Lucy

    7/29/2009 1:21:40 PM |

    It sure doesn't seem like that will happen anytime soon, at least not here... I spent all day calling around to local docs (including cardiologists) and NO ONE had even heard of advanced lipid testing...  I'm ashamed to say that I work for a large hospital system that wants to be "cutting edge" and all about research yet they have no knowledge of basic preventative care in regards to the leading cause of death in our country?!!

    Is advanced lipid testing really that advanced?

  • JPB

    7/29/2009 3:25:12 PM |

    That is part of my dream, too. But first, people have to have access to correct information, stop being so passive with medical professionals  and then take an active role in establishing and maintaining their own heath.  The real "health" care reform would do everything that you say but would come directly from the people who are receiving so-called medical "care."

    Of course, the vested interests will fight this tooth and nail but it would be tough to stop if our population would finally wake up to the way they are being manipulated!

  • Dr. William Davis

    7/29/2009 4:26:06 PM |

    Hi, Jenny--

    Thanks for your thoughts.

    But I would rather succumb to dementia at age 90 (that I helped delay with vitamin D and other mental-preservation methods) than heart attack at age 59, bypass at age 60, three stents at 63, four more at age 68, living a life of hospital revolving doors. Don't forget about the defibrillator that aborts the ventricular tachycardia that comes from the scar in your left myocardium from the original heart attack.

    Millions of people live this way and have not been told that it doesn't have to be this way. That's what I'm talking about.

  • Dr. William Davis

    7/29/2009 4:28:29 PM |

    Lucy--

    NOT having advanced lipid testing impairs the identification of the causes of heart disease. It is a big step towards better control over heart disease risk. It identifies treatments that often have nothing to do with more need for medication--that's why your doctors don't know about it.

    You probably already know that the bulk of medical "education" does not come from journals or scientific publications, but from the pretty drug representative with dinner invitation in hand waiting in the doctor's waiting room.

  • Anne

    7/29/2009 4:36:15 PM |

    Dear Dr Davis,

    Your mention of congenital heart disease sufferers made me wonder if you could possibly write a blog about how people with congenital heart disease can improve their heart health please.

    Anne

  • Helena

    7/29/2009 5:51:55 PM |

    Dr. Davis

    I am with you! And to be honest – it is actually horrible WRONG that we are not yet there. We (or at least many people) already know how to escape the dreadful C V and D. Why it is not already implemented in every hospital, doctors’ office, and even in education is scary! But most of it has got to do with a short-term money flow, I would guess.

    As boldly as I think we can put most cardiologists out of business I also believe we can eliminate many cancer diseases by natural remedies!

    No one has to believe me, but sometimes we are to do ourselves a favor and listen to those who have the degrees to say and act upon statements. What about these well selected and bold statements:

    John P. Cook M.D. Ph.D. in his book “The Cardiovascular Cure – How to strengthen your self defense against heart attack and stroke” In his book you can read this: “There is magic within all of us. It comes in the shape of a molecule known as nitric oxide.  A substance so powerful that it can actually protect you from heart attack and stroke.  Best of all your body can make it on its own.  Nitric oxide is your body’s best defense against heart disease.  The body is capable of healing itself.  What you do with the magic is up to you.”

    Dr. Louis J. Ignarro; Nobel Prize Laureate in Medicine, 1998; “NO more heart disease – How Nitric Oxide can prevent, even reverse, heart disease and stroke” and you can read this in the book: "You do not have to wait for the rest of the world to see the light--and the drug companies to put new Nitric Oxide-based prescription drugs on the market--in order to take advantage of what Nitric Oxide has to offer.  Even if you have high blood pressure, have suffered a heart attack, or are at high risk...You can beat the odds.  The power to lead an entirely new and healthier life is in your hands.  Carpe Diem--Seize the day!  Start boosting your Nitric Oxide production right now!“

    Dr. Jonathan S. Stamler; Professor of Medicine; Duke University Medical Center - "It [Nitric Oxide] does everything, everywhere. You cannot name a major cellular response or physiological effect in which [Nitric Oxide] is not implicated today. It's involved in complex behavioral changes in the brain, airway relaxation, beating of the heart, dilation of blood vessels, regulation of intestinal movement, function of blood cells, the immune system, even how fingers and arms move.“
            
    What these gentlemen are talking about is Arginine (arginine transforms into Nitric Oxide once in your body). And Arginine has also been found to: “Improve Memory & Cognitive Functions” (J Physiol Pharmacol 1999), and “May inhibit the division and proliferation of cancer cells” (Br J Surg. 1997)

    The list goes on and on… Arginine 5gr or more a day along with Citruline and antioxidants on a daily regularly basis can do all these things and we can at the same time fight cancer and dementia! It is all out there in the nature for us to use!!!

    Thanks again for a wonderful blog – if anyone is interested in learning about different product options they can email me (don’t want to advertise anything here – this is about people, not money) Helena.mathis@hotmail.com.

  • Helena

    7/29/2009 5:52:31 PM |

    Dr. Davis

    I am with you! And to be honest – it is actually horrible WRONG that we are not yet there. We (or at least many people) already know how to escape the dreadful C V and D. Why it is not already implemented in every hospital, doctors’ office, and even in education is scary! But most of it has got to do with a short-term money flow, I would guess.

    As boldly as I think we can put most cardiologists out of business I also believe we can eliminate many cancer diseases by natural remedies!

    No one has to believe me, but sometimes we are to do ourselves a favor and listen to those who have the degrees to say and act upon statements. What about these well selected and bold statements:

    John P. Cook M.D. Ph.D. in his book “The Cardiovascular Cure – How to strengthen your self defense against heart attack and stroke” In his book you can read this: “There is magic within all of us. It comes in the shape of a molecule known as nitric oxide.  A substance so powerful that it can actually protect you from heart attack and stroke.  Best of all your body can make it on its own.  Nitric oxide is your body’s best defense against heart disease.  The body is capable of healing itself.  What you do with the magic is up to you.”

    Dr. Louis J. Ignarro; Nobel Prize Laureate in Medicine, 1998; “NO more heart disease – How Nitric Oxide can prevent, even reverse, heart disease and stroke” and you can read this in the book: "You do not have to wait for the rest of the world to see the light--and the drug companies to put new Nitric Oxide-based prescription drugs on the market--in order to take advantage of what Nitric Oxide has to offer.  Even if you have high blood pressure, have suffered a heart attack, or are at high risk...You can beat the odds.  The power to lead an entirely new and healthier life is in your hands.  Carpe Diem--Seize the day!  Start boosting your Nitric Oxide production right now!“

    Dr. Jonathan S. Stamler; Professor of Medicine; Duke University Medical Center - "It [Nitric Oxide] does everything, everywhere. You cannot name a major cellular response or physiological effect in which [Nitric Oxide] is not implicated today. It's involved in complex behavioral changes in the brain, airway relaxation, beating of the heart, dilation of blood vessels, regulation of intestinal movement, function of blood cells, the immune system, even how fingers and arms move.“
            
    What these gentlemen are talking about is Arginine (arginine transforms into Nitric Oxide once in your body). And Arginine has also been found to: “Improve Memory & Cognitive Functions” (J Physiol Pharmacol 1999), and “May inhibit the division and proliferation of cancer cells” (Br J Surg. 1997)

    The list goes on and on… Arginine 5gr or more a day along with Citruline and antioxidants on a daily regularly basis can do all these things and we can at the same time fight cancer and dementia! It is all out there in the nature for us to use!!!

    Thanks again for a wonderful blog – if anyone is interested in learning about different product options they can email me (don’t want to advertise anything here – this is about people, not money) Helena.mathis@hotmail.com.

  • Tom

    7/29/2009 5:57:35 PM |

    Alzheimer's and heart disease are thought to be connected -- they may both be the result of arterosclerosis.

    So a world with fewer CHD victims might not be a world with more dementia patients.

  • trinkwasser

    7/29/2009 6:41:32 PM |

    Yes I see both your points. I strongly suspect I am going to die significantly younger than others in my family thanks to the clueless doctors who decided not to diagnose my diabetes, and worse, put me on a high carb low fat diet to "cure" my appalling lipids.

    On the one hand going quick of a heart attack while in my prime would be far preferable to what happened to one of my mother's friends: after a quad bypass she gradually declined from being a fit active sociable person to someone who was blind, deaf and incapable but whose heart would NOT stop and give her the release she prayed for. Once you get into that state they can warehouse you for years.

  • Roger

    7/30/2009 3:10:19 AM |

    My mom was one who met Jenny's tragic fate.  She did Pritikin and McDougall for years, decades actually.  Though she was a lawyer, played piano and read constantly, Alzheimer's (or a similar dementia) overtook her in her 70s.  She spent several years with caregivers in her home, and then six long years in a deluxe nursing home, burning up all the assets she had saved her entire life.  All we could do was watch.

    I believe the low-fat diet she followed wasn't what her brain needed.  She was probably chronically starved for EFAs, especially Omega-3.  But we didn't know what we know now, so we couldn't help.  Of course, I can't know for sure this was the causative factor...maybe this is just my defense mechanism.  But I think Dr. Davis's point is that addressing CVD in no way excludes also addressing dementia.  There's tons of exciting research being done.  Plenty of folks make it to the very end with all their faculties intact.  Why?

  • Tara

    7/30/2009 3:15:35 PM |

    Dr. Davis,

    What is your opinion on genetic testing and it's potential effect on the treatment of both CVD and (since it's been mentioned in this discussion) dementia?   I know both my ApoE and KIF6, and find it all very fascinating.  I am a 4/3 and a noncarrier for the risky form of KIF6.  I do think there are some potential ethical concerns with genetic testing, but I do see benefits as well.  For instance, supposedly my KIF6 result means that I would likely not benefit from a statin.  So, it's extra leverage in my mind when discussing treatment options with my cardiologist.

  • trinkwasser

    7/30/2009 3:29:34 PM |

    "I believe the low-fat diet she followed wasn't what her brain needed. She was probably chronically starved for EFAs, especially Omega-3"

    My God, that's an excellent point! Nursing home/hospital food is almost always high carb low fat (and cheap)

  • Miki Ben Dor

    7/30/2009 9:41:55 PM |

    Dr. Davis
    From what I have learned here and in other like minded blogs (Eads, Stephan, Hyperlipid, BG and others)it seem that the whole metabolic syndrome can be prevented + autoimmune diseases and probably many cancers. This has the potential of really emptying out the hospitals and leaving maily the preventative medicine heroes like yourself and Eads in the front where you belong
    I have recently started a blog in Israel, translating to Hebrew some of your (and  the other's) posts. The spreading of ideas resemble sometimes the spread of epidemics. It picks up suddenly so lets be optimistic!
    keep up the good work!
    Miki Ben Dor http//

  • DIB

    8/6/2009 4:31:53 AM |

    Dr. Davis,

    Life without CVD is not something that can be dreamed about, but rather something that existed in the recent past.  I have heard stories from MD's who served in the US military during the Korean and Vietnamese wars, and while over there, and in Japan, during those years, were asked by local doctors to call them when the military MD was treating a patient (usually American) for a heart attack or having a heart problem, because they had never or very infrequently seen those kinds of problems in their practices, and wanted to see what it was all about.  So, some parts of the world escaped CVD problems already!

    DIB

  • Dr. William Davis

    8/6/2009 12:18:28 PM |

    Hi, DIB--

    Excellent point!

    I agree: Many lessons are being RE-learned.

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