Cholesterol effects of carbohydrates

24. March 2009 William Davis (31)
Let's take a hypothetical person, say, a 50-year old male. 5 ft 10 inches, 160 lbs, BMI 23.0. He's slender and in good health.

Our hypothetical man eats a simple diet of vegetables, some fruit, nuts, and meats but avoids processed industrial foods. By macronutrient composition, his diet is approximately 30% protein, 40-50% fat, 20-30% carbohydrate. His starting lipid panel:

Total cholesterol 149 mg/dl
LDL cholesterol 80 mg/dl
HDL 60 mg/dl
Triglycerides 45 mg/dl

His starting lipids are quite favorable (though I don't often see this kind of starting panel nowadays except in athletes). We begin here because this hypothetical man is going to serve as our test subject.

We ask our hypothetical man to load his diet up on "healthy whole grains." He complies by eating whole grain cereals for breakfast, whole wheat toast; sandwiches made with whole grain bread; dinners of whole wheat pasta; snacks of granola bars, whole wheat pretzels and crackers.

Three months later, his lipids show:

Total cholesterol 175 mg/dl
LDL cholesterol 130 mg/dl
HDL 45 mg/dl
Triglycerides 150 mg/dl


You can see that LDL cholesterol has increased, HDL has dropped, and triglycerides have increased. This wave of change is the hallmark of carbohydrate excess, but more specifically of overreliance on wheat products. Beyond his lipid panel, the man has gained 10 lbs, all concentrated in a soft roll around his abdomen, his blood sugar is now in the "borderline range" of between 110 and 126 mg/dl, i.e., pre-diabetic.

If we were to examine this man's advanced lipoproteins (e.g., NMR from Liposcience, or VAP from Atherotech), we would see that there has been an explosive increase in small LDL particles, along with a shift of large HDL to small, and the appearance of multiple abnormal classes of particles called VLDL and IDL (signalling abnormally slowed clearance of dietary by-products from the blood).

Familiar scenario? The "after-carbohydrate" situation is the rule among the people who I first meet who claim to be eating a "healthy" diet, though their patterns are usually much worse, with higher LDL, lower HDL, and much higher triglycerides, an exaggeration of our hypothetical man's abnormalities.

What if our hypothetical man now goes to his conventionally thinking (read "taught medicine by the pharmaceutical industry") physician? What will likely be the advice he receives? Reduce his saturated fat intake, eat plenty of healthy whole grains, take a statin drug.

Although my illustrative man is hypothetical, I've seen this scenario play out many thousands of times. It happens in real life all the time. It is predictable, it is highly manipulable. Sadly, it is rarely recognized for what it is: the result of excess carbohydrates, or what I call "Carbohydrate Intolerance Syndrome."

The misinterpretation of this condition has created 1) an epidemic of diabetes and pre-diabetes, 2) a nation of frustrated obese Americans, 3) a $27 billion per year statin industry, 4) another growth opportunity for the drug industry in diabetes drugs.

Wheat Belly Revisited

23. March 2009 William Davis (24)
Do you have a wheat belly?

When I first coined this phrase back in July, 2007, I had witnessed the phenomenal health effects of wheat elimination in several hundred patients.

In the nearly two years that have passed since my original post, I have witnessed hundreds more people who have done the same: eliminate pretzels, crackers, breads of all sorts, bagels, pasta, muffins, waffles, pancakes, etc.

If anything, I am convinced now more than ever that wheat is among the most destructive foods in the human diet. At least 70% of people who eliminate wheat from their diet obtain at least one, if not several, substantial health benefits.

Now, if I were trying to sell you something, say, an alternative to wheat, then you should be skeptical. If I tell you that drug or nutritional supplement X is great and you should take it, only to follow it with a sales pitch, you should be skeptical.

What am I selling? Nothing. I gain nothing by telling everyone to avoid wheat. In fact, I wish it wasn't true. Wheat foods taste good. Wheat flour makes great comfort foods. In years past, I spent many hours sitting at the bagel shop reviewing papers over a cup of coffee and a bagel. No longer.

So here, back by popular demand, the original Wheat Belly post:



Wheat Belly

You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer.

How about "wheat belly"?

That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta.



(By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.)

It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc.

How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere.

Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner.

"But that's what they told us to eat after Dan left the hospital after his last stent!"

Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc.

I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world.

As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.

Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.

You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.

Thank you, Crestor

20. March 2009 William Davis (9)
I'm sure everyone by now has seen the Crestor ads run by drugmaker, AstraZeneca. TV ads, magazine ads, and the Crestor website all echoing the same message:

"While I was busy building my life, something else was busy building in my arteries: dangerous plaque."

While previous drug trials with Mevacor, Pravachol, Zocor, and Lipitor have focused mostly on examining whether the drugs reduced incidence of cardiovascular events, Crestor studies have also focused on effects on atherosclerotic plaque volume. The best example is the ASTEROID trial that demonstrated approximately 7% reduction in plaque volume by intracoronary ultrasound.

So the AstraZeneca decision makers took the leap from cholesterol reduction to plaque reduction.

I'm sure this switch wasn't taken lightly, but was the topic of discussion at many meetings before the decision to make plaque reduction the focus of hundreds of millions of dollars of advertising. After all, billions of dollars are at stake in this bloated statin market.

Ordinarily, I couldn't care less about how the drug manufacturers conduct their advertising campaigns. But this one I paid attention to because the Crestor ads are helping fuel a new way of thinking about coronary heart disease: It's not about the cholesterol; it's about the atherosclerotic plaque that accumulates in arteries.

It's not cholesterol that grows, limits coronary blood flow, and causes angina. It's not cholesterol that "ruptures" its internal contents to the surface within the interior of the blood vessel and causes blood clot and heart attack. It's not cholesterol that fragments from the carotid arteries and showers debris to the brain, causing stroke. It's all plaque.

I took the same leap years ago, though not backed by hundreds of millions of dollars of marketing money. When I first called my book Track Your Plaque, some of the feedback I got from editors included comments like "I thought this was a book about teeth!" Even now, the word "plaque" in the book title and website is responsible for confusion.

But AstraZeneca is helping me clear up the confusion. As the word plaque gains hold in public consciousness, it will become increasingly clear that cholesterol reduction is not what we're after. We are looking for reduction of plaque.

If you are trying to develop an effective means to reduce or reverse coronary heart disease, then there are two simple equations to keep in mind:


Plaque = coronary heart disease

Cholesterol ? coronary heart disease


Plaque is the disease, cholesterol is not. Cholesterol is simply a crude risk for plaque.

While I'm no friend to the drug industry nor to AstraZeneca, some good will come of their efforts.

Supermarkets and buggy whips

17. March 2009 William Davis (17)
Will supermarkets eventually phase out, joining the history books as a phenomenon of the past? Or are supermarkets here to stay, an emblem of the industrialization of our food--easy access to foods that are convenient, suit the undiscriminating masses, stripped of nutritional value despite the prominent health claim on the package front?

Anna left an insightful comment on the last Heart Scan Blog post, Sterols should be outlawed, along with some useful advice on how to avoid this trap for poor health called a supermarket:


I rarely shop in regular supermarkets anymore (farm subscription for veggies, meat bought in bulk for the freezer, eggs from a local individual, fish from a fish market, freshly roasted coffee from a local coffee place, etc.). What little else I need comes from quirky Trader Joe's (dark chocolate!), the fish market, farmer's markets, a small natural foods store, or mail order.

When I do need to go into one of the many huge supermarkets near me, not being a regular shopper there, I never know where anything is, so I have to ramble a bit around the aisles before I find what I'm looking for (and I almost always can grab a hand basket, instead of a trolley cart).

It's almost like being on another planet! There's always so many new products (most of them I hesitate to even call food). It's really a shock to the senses now to see how much stuff supermarkets sell that I wouldn't even pick up to read the label, let alone put in a cart or want to taste. I'm not even tempted by 99% of the tasting samples handed out by the sweet senior ladies in at Costco anymore (only thing I remember tasting at Costco in at least 6 mos was the Kerrygold Irish cheese, because I know their cows have pasture access and it's real food).

What's really shocking to me is how large some sections of the markets have become in recent years. While Americans got larger, so did some sections of the supermarket (hint - good idea to limit the consumption of products from those areas). Meat and seafood counters have shrunk, though. Produce areas seem to be about the same size as always (but more of it is pre-prepped and RTE in packaging.

But the chilled juice section is h-u-g-e! And no, I don't think there is a Florida orange grove behind the cases. Come on, how much juice do people need? Juice glasses used to be teeny tiny, for a good reason. To me it looks like a long wall stocked full of sugar water. Avoiding that section will put a nice dent in the grocery expenses.

The yogurt case is also e-n-o-r-m-o-u-s! Your 115 yo Bulgarian "grandmother" wouldn't know what to make of all these "pseudo-yogurts"! Chock full of every possible variety, but very little fit to eat. The only yogurts I'll look at are made with plain whole milk, without added gums, emulsifiers, or non-fat milk solids, and live cultures (I mostly buy yogurt now and then to refresh my starter culture at home). I can flavor them at home if needed. The sterols are showing up in processed yogurts, too, along with patented new strains of probiotic cultures (I'll stick to my old fashioned, but time-proven homemade lacto-cultured veggies and yogurt instead).

I found the same "cooler spread" in the butter & "spread" section. The spread options were just grotesque sounding. Actually, the butter options weren't much better, as many were blended with other ingredients to increase spreadability, reduce calories or cholesterol/saturated fat, etc. A few plain butters were enhanced with "butter flavor" - say what? And on no package could it be determined if the butter came from cows that were naturally fed on pasture or on grain in confined pens.


Well said, Anna.

There's a huge supermarket about 1 mile away from my house similar to the one Anna describes with aisle after aisle of eye-catching cellophane-wrapped foods. I go there about every 3 or 4 months, and then I only go to get something I need in a pinch. Every time I go, I too am reminded just how many products there are that look more like junk food than real food.

But there's no real money in real food. Who gets rich off of selling green peppers, tomatoes, and eggs?

Supermarkets sell these modern industrial foods because people buy it: Look around you. You don't get to be a 250 lb 5 ft 2 inch-woman by eating too many cucumbers.

Like Anna, I drive an additional several miles to Trader Joes', buy at farmers' markets whenever possible, buy some odds and ends like wine and cheese and raw nuts at specialty stores. I grow my own basil in a big pot I keep in the kitchen and we are just about to start turning over the soil in the back yard for our vegetable garden. I don't need nor do I miss having the choice among 40 different chips, 25 brands of ready-made microwavable dinners, an entire aisle of breakfast cereasl (all of which are virtually the same with different names and labels), or 75 varieties of salad dressing.

The supermarket for me--and I hope for many of you--has become a place rarely frequented, and only for the odd forgotten item. Oh, I forgot the dog chewies the grocery does have--my dogs love them. So perhaps they are good for something after all.

Sterols should be outlawed

14. March 2009 William Davis (10)
While sterols occur naturally in small quantities in food (nuts, vegetables, oils), food manufacturers are adding them to processed foods in order to earn a "heart healthy" claim.

The FDA approved a cholesterol-reducing indication for sterols , the American Heart Association recommends 200 mg per day as part of its Therapeutic Lifestyle Change diet, and WebMD gushes about the LDL-reducing benefits of sterols added to foods.


Sterols--the same substance that, when absorbed to high levels into the blood in a genetic disorder called "sitosterolemia"--causes extravagant atherosclerosis in young people.

The case against sterols, studies documenting its coronary disease- and valve disease-promoting effects, is building:

Higher blood levels of sterols increase cardiovascular events:
Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study.

Sterols can be recovered from diseased aortic valves:
Accumulation of cholesterol precursors and plant sterols in human stenotic aortic valves.

Sterols are incorporated into carotid atherosclerotic plaque:
Plant sterols in serum and in atherosclerotic plaques of patients undergoing carotid endarterectomy.




Though the data are mixed:

Moderately elevated plant sterol levels are associated with reduced cardiovascular risk--the LASA study.

No association between plasma levels of plant sterols and atherosclerosis in mice and men.




The food industry has vigorously pursued the sterol-as-heart-healthy strategy, based on studies conclusively demonstrating LDL-reducing effects. But do sterols that gain entry into the blood increase atherosclerosis regardless of LDL reduction? That's the huge unanswered question.

Despite the uncertainties, the list of sterol-supplemented foods is expanding rapidly:




Each Nature Valley Healthy Heart Bar contains 400 mg sterols.












HeartWise orange juice contains 1000 mg sterols per 8 oz serving.













Promise SuperShots contains 400 mg sterols per container.














Corozonas has an entire line of chips that contain added sterols, 400 mg per 1 oz serving.














MonaVie Acai juice, "Pulse," contains 400 mg sterols per 2 oz serving.














Kardea olive oil has 500 mg sterols per 14 gram serving.










WebMD has a table that they say can help you choose "foods" that are sterol-rich.

In my view, sterols should not have been approved without more extensive safety data. Just as Vioxx's potential for increasing heart attack did not become apparent until after FDA approval and widespread use, I fear the same may be ahead for sterols: dissemination throughout the processed food supply, people using large, unnatural quantities from multiple products, eventually . . . increased heart attacks, strokes, aortic valve disease.

Until there is clarification on this issue, I would urge everyone to avoid sterol-added "heart healthy" products.


Some more info on sterols in a previous Heart Scan Blog post: Are sterols the new trans fat? .

Texas today, tomorrow . . . the world?

10. March 2009 William Davis (0)
Texas state representative, Rene Oliveira, has introduced legislation that mandates heart scans for adults in the state of Texas.

Rep. Oliveira

A press release from the SHAPE Society ( Society for Heart Attack Prevention and Eradication) reads:

Assessment of heart attack risk on the basis of traditional risk factors alone such as high cholesterol and high blood pressure and so forth, while useful, misses many who are at high risk and also incorrectly flags some for high risk who are in fact at very low risk of near term heart attack; on the other hand detection of atherosclerosis by non-invasive imaging, as suggested by the SHAPE group, accurately identifies plaque and improves the ability to identify at-risk individuals who could benefit from aggressive preventive intervention while sparing low-risk subjects from unnecessary aggressive medical therapy," said Dr. P.K. Shah, Director of Cardiology at Cedars Sinai Heart Institute in Los Angeles, a leading member of the SHAPE Task Force who is also an active member of the American Heart Association. "Sadly, these vulnerable patients go undetected until struck by a heart attack, because insurance companies don't cover the newer heart attack screening imaging tests."


Rep. Oliveira, whose coronary disease was first uncovered by a heart scan and prompted a bypass operation, states:

"It is about time that we cover preventive screening for the number one killer in Texas, and take action to reduce healthcare costs through preventive healthcare. Right now, we are extending the lives of those who can afford the procedure while hundreds of thousands of Texans with hidden heart disease go undetected because of antiquated thinking. The time has come for this change."


Is this what we've come to? Since practicing physicians are either so entranced by the drug and procedural solutions to heart disease, do we need to resort to heart scan by legislation?

It does indeed appear that we've come to this point. Should this trend catch on, it will surely mean an upfront increase in healthcare costs to cover the expense of heart scans. But in the long run, it will mean reduction in healthcare costs--dramatic reduction--if heart scans prompt effective preventive action.

What your doctor doesn't know about heart disease

9. March 2009 William Davis (12)
What causes coronary heart disease or coronary atherosclerotic plaque, this thing that we track with heart scans?

Well, here are a few little-publicized facts about heart disease that you are unlikely to hear from your When's-the-next-stent? cardiologist or the What is there besides statins? primary care doctor.

(Since everybody knows that smoking is a modifiable risk for heart disease that can be readily identified, let's focus on the blood tests that reveal heart disease causes.)


What's the number one most common cause for heart disease?

Small LDL particles. The proliferation and popularity of the snack food/processed food culture, compounded with the "eat more healthy whole grain " propaganda has launched small LDL solidly to first place as the most common reason to have heart attacks, stents, and bypass. All that advice to increase your "healthy whole grain" intake? It increases heart attack risk.


What's the number one most aggressive cause for heart disease?

That's lipoprotein(a), or Lp(a). It's certainly not high cholesterol, though the drug industry loves that you think that. We could argue over whether smoking is more aggressive, but the two are pretty darned close. Combine the two--Lp(a) in a smoker--and the combination is an explosively powerful trigger for heart disease and stroke.


What's the number two cause for heart disease?

After small LDL comes low HDL cholesterol. Ask anyone who has had a heart attack: What was your cholesterol panel like? 9 out of 10 will say "My LDL cholesterol was 135 mg/dl" while knowing little or nothing about HDL, which is commonly in the 30-42 mg/dl range--sufficient to contribute to heart disease risk considerably.


Can "normal" thyroid hormone tests still contribute to heart disease?

Yes. Hypothyroidism is an exceptionally powerful risk factor for heart disease. Many people have been told that their thyroid tests are "normal," when in reality risk for heart disease may be as much as tripled from low thyroid with thyroid blood tests in the "normal" range.


Does a "balanced, healthy diet" prevent heart disease?

No, it does not. In fact, the modern notion of a "balanced, healthy diet" increases risk for heart disease. Of course, the dangers of such diets vary, depending on how you define it. If it's the diet advocated by the USDA Food Pyramid, then it is an enormously destructive diet that causes your health to careen towards both diabetes and heart disease. The American Heart Association TLC diet is little better.


Does eating fish twice a month reduce heart attack risk?

Yes, it does--but just barely. Unfortunately, large studies that show that eating fish as infrequently as twice per month reduce risk for dying from heart attack have led some authorities to suggest that's all you need to do. What they fail to understand is that the benefit is dose-dependent--the greater the intake of omega-3 fatty acids, the greater the benefit (within reason, of course). So, while the effect can be detected by eating fish twice per month, it doesn't mean that full benefits are achieved with this "dose." Full benefits are obtained by mimicking the omega-3 intake of the Japanese.


Do nutritional supplements reduce risk for heart attack?

If you are referring to vitamin D, then, yes, nutritional supplements reduce risk for heart attack . . . enormously. We need more data to validate this phenomenon, though epidemiologic observations strongly bear this out, including the Health Professionals Follow-up Study, the Framingham Heart Study and NHANES, all of which demonstrate a graded effect: the lower the vitamin D blood level, the greater the risk for heart attack.

Over the years, we've experienced more than our share of disappointments in nutritional supplements for heart disease, including vitamin E and B vitamins to reduce homocysteine. But I believe that nothing approaches the solid feel of vitamin D--no other nutritional supplement raises HDL, reduces triglycerides, reduces blood sugar, enhances insulin responses, reduces the inflammatory C-reactive protein, reduces blood pressure like vitamin D. Vitamin D is here to stay--and I'm very grateful.

And don't forget omega-3 fatty acids from fish oil, yet another supplement with unquestioned benefits for reduction of heart attack and death from heart attack.


Why didn't your doctor counsel you on the importance of these issues?

The primary reasons your doctor didn't tell you any of the above:

1) He/she has been persuaded that only drugs are of any real use in health. Nutritional supplements? Hah!

2) Neither the number one cause of heart disease in the U.S.--small LDL particles--nor the most aggressive cause for heart disease--Lp(a)--are corrected by patent-protectable, high profit pharmaceutical agents promoted to your doctor. Instead, these abnormalities can be corrected inexpensively, without prescription. That means no expensive commercials, no media spots, no write-ups in magazines.

3) Your doctor's business is to treat crisis: sore throat, broken ankle, lung tumor, heart attack. Prevent heart disease 10 or 20 years before it shows itself? Heck, no (unless the marketing pull of the drug industry is involved, of course).


It's best that you bear in mind: What your doctor doesn't know can kill you.

Thank you, Dr. Eades

6. March 2009 William Davis (7)

Thanks to some readers of The Heart Scan Blog, I've become acquainted with Dr. Michael Eades' wonderful blog, Health and Nutrition by Dr. Michael R. Eades, MD.

Dr. Eades is co-author (with his wife, Mary Dan Eades, MD) of Protein Power

In one of his conversations, I stumbled on this exchange between Dr. Eades and one of his readers:



Reader: Regarding EBT scans, I looked up the topic on Google and read an informative 5-page article: EBT (Ultrafast CT) Scans - Godsend, or Scam? Dr. Fogoros says that false positives (where the EBT shows the presence of calcium, but the patient has little coronary artery blockage) occur about 50 percent of the time. The next step, if the EBT is positive, is to do a heart catherterization to find out whether there actually is coronary artery blockage. So the odds are that I’d have to worry!

Dr. Michael Eades: The info you got from Google is one of the reasons one shouldn’t get medical information online. As far as I’m concerned the EBT is the BEST way to determine the presence of plaque. If you have a positive calcium score, you have plaque, and there’s an end on’t (as Samuel Johnson would say). Now you may have a low calcium score for your age or you may have a calcium score that doesn’t change, which means you have stable plaque, but if you have a positive calcium score, you have some amount of plaque in your coronary arteries.

And whoever says that the next step to take if you receive a positive calcium score is a coronary artery cath is a real moron. That’s probably the last thing you would want to do if you are asymptomatic. All the cath procedure does is shows whether or not you have a blockage - you can have huge amounts of plaque (which are a disaster waiting to happen) and have a normal cardiac cath.

If you want to get a little more information on the validity of EBT than what you find on Google, take a look at Dr. Davis’ blog or get a copy of his book: Track Your Plaque. I’m not crazy about all of Dr. Davis’ dietary recommendations because he comes to diet from a different perspective than I, but the EBT info in his book is terrific.

Cheers–

Dr. Eades "gets" it. He understands that quantification of coronary plaque is a tool for prevention, not something to be subverted into the service of procedures for the financial benefit of my colleagues.

And I think that he is absolutely correct on the diet discussed in Track Your Plaque--it's due for a revision. I wrote the book in 2003, while we were still locked into the low-fat mindset. Much has changed.

Since then, our enormous experience in metabolic manipulation and lipoprotein analysis has shown that there is a far better way to correct the causes of coronary plaque and seizing hold of heart scan scores. In particular, the explosion of small LDL has prompted major changes in the diet, specifically removal of wheat and cornstarch, the foods that trigger small LDL particles.

(I am still in the midst of negotiations for release of a bigger and better Track Your Plaque II. In the meantime, Track Your Plaque Members can refer to the New Track Your Plaque Diet, Parts I, II, and III.)

Can millet make you diabetic?

5. March 2009 William Davis (10)















If wheat is so bad, what about all the other grains?

First of all, I demonize wheat because of its top-of-the-list role in triggering:

--Appetite--Wheat increases hunger dramatically
--Insulin
--Blood sugar--Wheat is worse than table sugar in triggering a rapid, large rise in blood sugar
--Triglycerides
--Small LDL particles--the number one cause for heart disease in the U.S.
--Reduced HDL
--Diabetes
--Autoimmune diseases--Most notably celiac disease and thyroiditis.

Most other "healthy, whole grains" aren't quite as bad. It's a matter of degree.

Millet, quinoa, oats, sorghum, bulghur, spelt, barley, cornmeal--While they don't trigger appetite nor autoimmune diseases like wheat does (oat can in some people), they still pose a significant carbohydrate load sufficient to generate the other phenomena like excessive insulin and blood sugar responses. The grams of carbohydrate of these grains are virtually identical to wheat: 43.5 grams per 1/2 cup (uncooked). The exceptions are barley, which is especially loaded with carbohydrates: 104 grams per 1/2 cup, while oats are lower: 33 g per 1/2 cup.

It's all a matter of degree. Some people who are exceptionally carbohydrate-sensitive (like me) can have diabetic blood sugars with just slow-cooked oatmeal or quinoa. Others aren't quite so sensitive and can get away with eating them.

People with high blood sugars (100 mg/dl or greater) can be very sensitive to the blood sugar effects of these grain carbohydrates. The best marker of all are small LDL particles measured on a lipoprotein panel, such as NMR. Small LDL particles are exquisitely sensitive to your carbohydrate intake: small LDL gets worse with excessive sensitivity to grain carbohydrates, gets better with reduction or elimination.

Flagrant small LDL, in combination with low HDL, high triglycerides, and pre-diabetic or diabetic patterns all develop from carbohydrate indulgence, along with "wheat belly."

Don't believe it? The prove it to yourself: Go to Walmart and buy an inexpensive glucose meter and check your blood sugar one hour after eating. You can gauge the health of these foods by observing the blood sugar increases. (Small LDL closely parallels blood sugar rises.)

The grain that fails to trigger any of these abnormal patterns? Flaxseed. Flaxseed is entirely protein, fiber, and healthy oils, with virtually no digestible starches. In fact, flaxseed is one of the few foods that reduces the quantity of small LDL particles.

Are you a tree?

5. March 2009 William Davis (6)
I assume you answered no. Then why would you consider taking the plant form of vitamin D (ergocalciferol)? That's the prescription form of vitamin D, often dispensed as 50,000 unit tablets.

There's nothing wrong with plants. Some of my favorite foods are plants, full of nutritional value.

Then why shouldn't vitamin D2 from plants be every bit as good as the human form of vitamin D?

I believe the issue boils down to taking hormones from non-human sources. (Remember: Vitamin D is a hormone, a very powerful one at that.) Plants can be wonderful sources of flavonoids, fibers, protein, fats, vitamins, minerals, and other healthy components. But hormones?

There are other examples of non-human hormones being given to humans with undesirable or unpredictable effects:

--Xenoestrogens, phytoestrogens, and non-human mammalian estrogens--While non-human estrogens may partially mimic human estrogens, they can also block estrogen effects, or exert altogether novel effects. Non-human mammalian estrogens like Premarin can exert very peculiar (side-)effects, despite their role as prescription estrogen supplementation in humans.

--Progestins--The synthetic versions of human progesterone, like their non-human estrogen counterparts, exert weird effects that are a world apart from real progesterone.

--Sterols--Similar in structure to human cholesterol (while not a hormone, a building block for hormones), sterols have been used to reduce intestinal cholesterol absorption. However, if sterols are absorbed into the blood, they can enormously accelerate growth of atherosclerotic plaque.

--Anabolic steroids--These modifications of the testosterone molecule build muscle, but also cause liver cancer, kidney failure, violent behavior, suicide and homicidal behavior. That's not normal.

Outside of a pharmacologic effect (e.g., prednisone in place of human cortisol), there is no reason to take a non-human hormone in place of a human hormone. For that same reason, there is NO reason to take plant vitamin D2 (prescription or over-the-counter) in place of human vitamin D3.

If the non-human hormone is identical to the human form, then there is no difficulty. The best example of this are thyroid hormones from pigs. That's what Armour Thyroid is, a thyroid hormone replacement that works wonderfully well.

You will notice that virtually all of the examples of non-human hormones substituted for human hormones share one common motivation: profit. Synthetic or modified versions are more readily patent-protectable, unlike their natural counterparts which are not.

Vitamin D2 is an anemic facsimile of the real human hormone, vitamin D3 (cholecalciferol). Stay away from it.
What is a healthy vitamin D blood level?

What is a healthy vitamin D blood level?

9. November 2009 William Davis (32)
When measuring blood levels of vitamin D (as 25-hydroxy vitamin D), what constitutes a desirable level?

There's no study that directly examines this question, no study that enrolled thousands of people and assigned a placebo group and groups receiving escalating doses of vitamin D and/or achieved higher levels of vitamin D, then observed for development of cancer, diabetes, depression, heart disease, multiple sclerosis, osteoporosis, osteoarthritis, etc. Such a study would requires many thousands of participants (particularly to observe cancer and multiple sclerosis incidence), many years of observation, and many tens of millions of dollars. Nope, only a drug company could afford such costs.

So we have to piece together various observations and extrapolate what we believe to be the ideal level of vitamin D. Epidemiologic observations in several cancers (breast, colon, prostate, and bladder) suggest that a 25-hydroxy vitamin D level of 30 ng/ml or higher is desirable (with less cancer incidence above this level). Other data suggest a level of 52 ng/ml or greater is desirable. Unfortunately, much cancer research looked at intake of vitamin D from food and supplement sources, rather than actual blood levels. We also have to factor in the great individual variation in vitamin D metabolism, with a single dose yielding variable blood levels (as much as a 10-fold difference). There's also the variation introduced by vitamin D-receptor variation (genetic polymorphisms).

A new study using vitamin D administration helps chart the desirable levels of vitamin D.

Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient - a randomised, placebo-controlled trial.

In this New Zealand study, 42 women (23 to 68 years old) were given 4000 units vitamin D, 39 women given placebo. Median 25-hydroxy vitamin D levels increased from 21 nmol/L (8.4 ng/ml) to 75 nmol/L (30 ng/ml). Both HOMA (a measure of insulin sensitivity) and fasting insulin levels improved, with greatest improvement seen at 25-hydroxy vitamin D levels of 80-119 nmol/L (32-47.6 ng/ml) or greater.

We also know that a vacation on a Caribbean beach in a bathing suit will increase vitamin D blood levels to the 80-110 ng/ml range without ill-effect (at least in young people who maintain the capacity to activate vitamin D in the skin, a phenomenon that declines as we age).

So do we really know the truly ideal level of vitamin D to achieve? I believe that, given the above observations, it is reasonable to extrapolate that the ideal vitamin D blood level likely lies somewhere above 50 ng/ml. We also know that vitamin D toxicity (i.e., hypercalcemia) is virtually unheard of until vitamin D blood levels approach 150 ng/ml, and even then is inconsistent. The health benefits of vitamin D supplementation are so tremendous, that I am not willing to wait for the prospective data to explore this question fully. For now, I aim for a blood level of vitamin D of 60-70 ng/ml (150-175 nmol/L).
Tags :

Comments (32) -

  • karl

    11/9/2009 3:29:40 PM |

    The question I have, is 60-70 ng/ml enough? Are we being too conservative?

    I'm thinking a target of 80 ng/ml might eventually pan out.

  • Daniel

    11/9/2009 4:17:11 PM |

    There is also Melamed's study showing a sharp increase in mortality above 50ng/ml or so.  Small sample size and residual confounding probably, but worth considering nonetheless.

  • Anonymous

    11/9/2009 4:30:31 PM |

    I wonder if it is really true that Vitamin D production decrease is really a function of aging, rather than a consequence of eating the SAD for so long.

    It would be very useful to have a properly conducted study to address this question. Could elimination of gluten, excess fructose, correcting O-6/O-3 imbalance, and other hyperinsulinemia/inflammation sources in even the aged allow large amounts of D3 production?

  • mike V

    11/9/2009 7:26:17 PM |

    Progress report:
    Over about 5 years I have gradually ramped up vitamin D3. Initially, tablet form. Last 18mo capsule form.
    Started noticing cold/virus improvements over entire period.
    Finger/prick Lab work: (GrassRootsHealth.com)
    Results:
    Mar 2009  50ng/dL  prior dose 4000iu 3mo.
    Sept2009  60ng/dL  6mo dose   6000iu

    Current dose for H1N1 Winter 8000iu. Target: 70-80ng/dL by next fall.
    Age 73
    Weight 190
    Race W.
    Sex  M
    Meds. Armour Thyroid.
    Colds: Only hints lasting two days
    early in the season. Otherwise cold/flu/infection free.
    Hospitalizations: None.  
    Vaccinations none in five years.

    Hope some one finds this useful.

    In my carefully considered (but not so humble) opinion, if most people would follow Dr Davis's recommendations, most US health care cost and availability problems would disappear in less than a generation, Bill or no Bill.

    Mike

  • AMK

    11/10/2009 2:32:07 AM |

    Supplements can be of great help in getting rid of free radicals  to our body.  A good source of vitamins and antioxidants to suffice what we lack from food intake.

  • mongander

    11/10/2009 2:33:20 AM |

    I take 10,000iu in winter and 5,000iu other seasons.

    My last grassroots test: 79 ng/ml.

    Age 70

    Never get colds or flu but have medium grade prostate cancer.  Doing "watchful waiting".  May get foreign "HIFU" treatment.

  • ob

    11/10/2009 6:07:01 AM |

    The perfect blood range will proove to be that of people wearing little clothing in a sunny climate who are tanned and avoiding being burnt ie 80-100ng/ml. Looking at it through the lens of evolution (since animals can out of the sea and forwards)- it has to be that this is what we will be best adapted too.

  • Helena

    11/10/2009 4:06:21 PM |

    I like it! I had the 76ng/ml last month when I checked (first time in my life actually checking).

    I have been taking at least 5000 IU every day (liquid) for the past year and a half. But have recently increased it to 11000 IU once or twice a week. I can feel the winter is coming.

    Thanks for a much important post as we are getting closer to winter and flu season.

  • scall0way

    11/10/2009 8:10:02 PM |

    6 months of supplementing with 5000IU D3 gelcaps daily has gotten my D up to a level of 58 (it was 46 after 8 weeks of supplementing)so I'm getting there. I'm just trying to decide if I should bump the dose. It's just trying to establish priorities now that I know I'll be losing my job, my income and my reasonable health insurance sometime in the next few months.

    And I was just diagnosed with Hashimoto's disease this WEEK, so now have to contend with getting my thyroid sorted out too. Always some darn thing or another. :-D

  • mike V

    11/11/2009 5:40:00 AM |

    Scall0way:
    I empathize with you in you situation.
    If you require thyroid medication, ask your doctor for for Armour Thyroid.
    Continue to follow Dr D's recommendations regarding Vitamin D3, fish oil, iodine.
    Consider curcumin/turmeric, quercetin, NSAIDS. Avoid omega 6 etc
    Hope you get Hashimoto under control before insurance ends.
    Maintain vitamin D3 at all costs. Should help to regulate autoimmunity. Best bang for the healthcare buck.
    Good luck!
    Mike V
    Visit drbganimalpharm.blogspot.com

  • Chloe

    11/11/2009 6:57:14 AM |

    March 2007 D test was 7 ng/ml, and after supplementing with 8000 units Carlson's D3 per day, my grassrootshealth test is 94.  Yahoo! Going to keep it there as I have had SAD (the seasonal kind and the dietary kind in the past) for over 60 years, and the vitamin D supplementation has helped with the seasonal kind of SAD (along with bright full-spectrum light in the morning and blue blocking glasses at night).

  • Lere

    11/11/2009 7:30:36 PM |

    Vitamin D and homeostasis " a homeostatic mechanism keeps the level of vitamin D in our bloodstream within a certain range. When UV-B light is always intense, as in the tropics, the level seems to be 50-75 nmol/L in young adults and progressively lower in older age groups. The more sunlight varies seasonally, the more the body will produce vitamin D in summer in order to maintain at least 50 nmol/L in winter—a level well below the recommended minimum of 75 nmol/L and even further below the 150 nmol/L now being advocated by vitamin-D proponents.

    This homeostatic mechanism breaks down if we daily ingest 10,000 IU of vitamin D or more (Vieth, 1999). It seems that the human body has never naturally encountered such intakes, at least not on a continual basis.

    In a recent review article, Robins (2009) presents evidence for a second homeostatic mechanism. Even when the level of vitamin D varies in the bloodstream, the second mechanism ensures that these divergent levels will translate into the same concentration of the biologically active 1,25-(OH)2D metabolite."

  • Valerie

    11/11/2009 11:01:13 PM |

    Dear Dr. Davis,
       Are you still recommending Vitamin D for Aortic Valve Stenosis? Do you have any updates on whether it helps the calcification to regress, as you mentioned in your articles from 2007? I just found out I have a very severe case of this, and your blog is the first place I've seen any hope of improving it other than heart valve replacement. But I also saw that some people say Vitamin D makes it worse! It's so hard to know what to do. So could you let me know how it's going on this since 2007? Have your patients gotten better from the Vitamin D and the calcification regress? At the moment I don't take any Vitamin D at all. Tx very much.

  • Dr. William Davis

    11/12/2009 2:20:35 AM |

    Hi, Valerie-

    I am definitely continuing to advise vitamin D normalization for nearly everybody, including those with aortic valve disease.

    I now have about 30 people who have normalized vitamin D and have aortic valve disease. The overall trend is a dramatic slowing of deterioration. Vitamin D does NOT cause worsening unless you take it to toxic levels. That is what is causing the confusion: Rat studies in which toxic levels of vitamin D were used to cause aortic valve disease.

  • sue

    11/14/2009 1:47:45 AM |

    Dr. Davis,
    Do you know whether D3 supplementation can affect the BU/CR Ratio on a CBC? I read that steroids can cause a rise in BUN and that D3 is considered a steroid?

    I finally got my D3 levels up to 57 ng/mL with daily 6,000 IU d3 (from mid September)and also added fish oil a month later. Had blood levels checked end of October and got a flag on the BU/CR ratio of 25.0, lab range 6-22. BUN was 17 and Creatinine was 0.68. No other chemistry components outside normal range.

    I should mention that I am also post-menopausal and on HRT - (Divigel transdermal & Prometrium) -- and mildly hypothyroid (Synthroid 50 mcg).

  • moblogs

    11/14/2009 4:27:57 PM |

    I'm 30yrs old from London, England with naturally tanned skin and have a maternal history of primarily bone and heart problems.
    My pre-supplement D value was just 10nmol/L. 5000IU took me to 76nmol/L, whereas 10000IU took me to an acceptable 141nmol/L.
    Not only has my PTH decreased but my second ever DEXA scan (I am given them as precaution) showed a 7% increase in bone density even though it was fine before and my cholesterol profile changed to show an increase in HDL and a reduction in cholesterol ratio. Of course particle size isn't measured here but I'm sure vit D isn't dis-servicing me by what I've observed so far.

  • Anonymous

    11/14/2009 10:58:22 PM |

    Dr. Davis,

    I've tried 3 different forms of supplemental Vitamin D(dry tabs, gel caps and now liquid ddrops). For some reason I seem to experience slight tightness of chest and shallow breathing after I take any form of vitamin D. The higher the dose, the more pronounced the side effects are and for a longer duration(last weekend I took 4000iu's and it seemed to last for most of the day).

    Would you advise I stop supplementation? I was considering taking it before bed so that any minor side effects wouldn't be as noticeable when I sleep.

    Mike

  • Dr. William Davis

    11/15/2009 1:02:36 PM |

    Hi, Mo--

    Great results. I wished that I'd known about vitamin D at your age.

    I'm grateful that we finally have come to appreciate what an extraordinary thing vitamin D is.

  • Dr. William Davis

    11/15/2009 1:03:58 PM |

    Mike-

    Once in a while, I'll see somebody with sternal (breastbone) awareness of vitamin D deficiency or replacement, both resulting in pain. While harmless, it can be very frightening.

    However, you might still want to consult your doctor about this. Hopefully, he/she understands how important vitamin D replacement is.

  • Anonymous

    11/15/2009 10:20:29 PM |

    Thank you Dr. Davis.

    Unfortunately my current physician isn't too receptive to the increasing popularity of Vitamin D these days.

  • Neonomide

    11/15/2009 10:54:13 PM |

    Heike-Bischoff-Ferrari et al. (2008):

    http://www.ajcn.org/cgi/content/full/84/1/18/F1


    As you can see, over 50 year old white-skinned persons who had higher than 100 nmol/l had _lower_ bone mass density than those about at 100 nmol/l.

    I think this should be taken into consideration when determining optimal 25(OH)D levels, don't you think ?

    Full text here:
    http://www.ajcn.org/cgi/content/full/84/1/18

  • Anonymous

    11/16/2009 1:37:39 PM |

    Dr. Davis, I've been supplementing 10k iu per day for nearly 1 year using a gel cap supplement. I still only managed to achieve a level of 52 ng/ml. Is it safe to take a higher dosage. In your practice have you found this to be common. I have had my gallbladder removed and use nexium for GERDs. Otherwise im healthy 50 year old male. Thanks for taking the time to read.

  • Olga

    12/2/2009 3:42:01 PM |

    Hi Dr. Davis:
    I had an unnecessary hemithyroidectomy about 5 years ago for a benign goiter after my second pregnancy (both winter pregnancies) and have felt unwell ever since.  I could never find a dose of synthroid that would work well.  I would need a dosage adjustment upwards in the late fall and then in the spring I would feel hyper and need to lower the dose.  This went on for 3 years in a row and I finally asked my Dr. if this could be due to Vitamin D since it's the only seasonal variation that made sense to me.  She of course said that was unlikely.

    I did lots of reading on the topic and found that many people that have half a thyroid don't need supplementation, so I asked her if I could try going off the meds to see if my thyroid could make enough hormone on it's own.  Other than being tired and having heavy periods I felt not too bad.  At 3 months I was iron deficient so I started consuming liver once or twice per month for about 3 months and started feeling ill with joint pain, digestive problems, fatigue, insomnia.  It took me another 6 months to figure out that people who have familial hyperlipidemia have a tendency to overdose on levels of vit A that would be fine for most people.  Here's are a few of the papers that finally gave me some answers:
    http://www.annals.org/cgi/content/abstract/105/6/877

    http://www.ajcn.org/cgi/content/full/71/4/878#R25

    And again the symptoms worsened in the fall.  I developed a cold that lasted 4 months!  Finally I insisted my DR. check my vitamin D level and in September it was 72 nmol/L.  She was surprised and put me on 1000 IU of vit D3.  Over the next year I waffled between taking synthroid or Armour and going off it because I felt so awful and didn't know what was wrong.  I think the Vitamin A was confounding the recovery process.  A major breakthrough came a couple of months ago.  I was on the lowest dose of synthroid (in the fall of course), my thyroid function had improved enough over the past 2 years that the lowest dose was enough, and I started taking 5000 IU of vitamin D.  Within 2 weeks, I started having severe hyperthyroid symptoms.  I told my Dr. that I thought the vit D was improving thyroid function and that I wanted to go off the synthroid yet again.  Within 2 weeks the hyper feeling slowly subsided and I am waiting 3 months before having my thyroid levels and vit D checked.  My only remaining symptoms are joint pain (less now than a year ago), mild fatigue, insomnia, and constant hunger despite being on a low carb diet (which made me feel great before the surgery).  My mood is much better and my mental clarity has improved.  Over the past year my TSH off medication has dropped from 12 to 4.  I am hoping that in 3 months or so it will be almost normal.

    Here is one of a few papers I found about low levels of Vitamin D following a hemithyroidectomy:
    http://content.karger.com/ProdukteDB/produkte.asp?Doi=182696

    I had my iodine levels tested and they were found to be normal.  I wonder now if the nodule was cause by low levels of vit D during two winter pregnancies along with a prenatal supplement which was high in Vitamin A relative to Vitamin D in a Vitamin A toxicity susceptible person.  I found a few papers on-line which suggest vit A can be a cause of thyroid goiter.
    Thanks for this excellent blog.

  • Bumper

    12/8/2009 4:35:13 AM |

    How or what may I take to get adequate iodine? Tks.

  • Olga

    12/8/2009 5:05:51 PM |

    Hi Bumper:

    The best methods of getting iodine are Lugol's iodine, Iodorol, or Kelp.  Salt isn't really a good source, the iodine is volatile and eventually dissipates.  You should have an iodine loading test done to determine if you are in fact iodine deficient.  You can order one on-line yourself, or go to a naturopathic Doctor who can order one.  I hope this helps.

  • Di

    12/21/2009 7:50:27 AM |

    I am so pleased to have found this blog! I was diagnosed with mild arotic valve stenois and afraid there was no treatment approach, until reading about Vitamin D here. I have am taking between 1,000 - 2000 i.u. of D3 per day for reducing fatigue and improving calcium absorption(I also have osteopenia and take Fosomax once a week; am age 59.) Dr. Davis, how much more Vit D can I safely take? I do not know how to to calculate the ng/ml levels that I am reading about here. How would you suggest I get started with this approach?

  • DougCuk

    1/11/2010 1:00:31 PM |

    The only way to tell how much Vitamin D3 supplement you need to take is by a blood test - either via your doctor or take a look at this website www.grassrootshealth.net/ which offers cost price blood tests.

    I have put together a summary of current advice on Vitamin D blood levels and guidance on response to supplement intake: www.stargateuk.info/vitamind/Blood_Levels.htm

    For a general overview of Vitamin D health benefits take a look at my website: www.stargateuk.info/vitamind

  • Henry Lahore

    1/15/2010 4:10:29 PM |

    Excellent article

    You can find in-depth information at http://www.henrylahore.com/VitD.html.  

    Actively creating a wiki where everyone can share vitamin D information.

  • Tracie P

    1/16/2010 2:19:04 AM |

    Okay, I am totally new to the Vitamin D issue.  My sister had a full workup and her dr found that she had very low levels of Vit D (19).  She's always extremely tired.  I have been working out with a personal trainer and decided to go to the dr to get a full physical (I'm also tired often but thought it was because I have a 3yr old).  I specifically asked about Vit D and the dr said they don't normally test it.  I told him I was tired often and he said that was a symptom and ordered blood work.  Well, apparently mine is a little lower than my sister's.  The dr said my Vit D levels should be between 35-100 and mine was 16.  Now, what should I do???  Where should my levels be (I'm almost 40, white, healthy).  Appreciate any help!

  • Anonymous

    2/11/2010 8:23:08 PM |

    This is the most comprehensive info re: vitamin D levels I've found on line. Most posts are 50-70ng/ml and bumping up, but my D Total is 19. My dr's asked me to see her, but can she prescribe anything I haven't already learned: take 1-2000 iu's D, cod-liver oil/more fish & sun? Thx!

  • Anonymous

    10/20/2010 6:22:14 AM |

    I'm concerned that my vitamin d is too high! It's 84.9 ng/ML. I'm a 27 year old female and take 2000 IU per day (along with whatever vitamin d is in two citrical pills). Should I back off? Thoughts?

  • buy jeans

    11/3/2010 10:30:38 PM |

    We also know that a vacation on a Caribbean beach in a bathing suit will increase vitamin D blood levels to the 80-110 ng/ml range without ill-effect (at least in young people who maintain the capacity to activate vitamin D in the skin, a phenomenon that declines as we age).

Add comment

Loading