Hammers and nails

I'm sure you've heard the old saying that,

To a man with a hammer, everything looks like a nail.


It couldn't be truer than in heart procedures (the man with the hammer) and heart disease (the nail).

What does it take in 2008 to become an interventional cardiologist trained in all the techniques of angioplasty, stenting, intracoronary ultrasound, etc.? Start with your undergraduate degree (4 years), then medical school (another 4 years), then training in internal medicine (3 years), then general cardiology taining (3 years), then an additional year in interventional cardiology. Each step along the way also involves competing for these spaces, a process that requires much time, money, and sweat.

The total time investment is 15 years after high school. Many if not most college students graduate with debt. Pile on the substantial cost of medical school. Training after medical school pays a modest salary, enough for a single person. Many trainees by then have spouses and a family, would like to buy a house, have bills to pay. (I managed to buy my first house for $69,000 in Columbus, Ohio and paid my mortgage by sleeping only every other night and moonlighting on my off nights.)

By the time the interventional cardiologist-in-training finishes his/her 15 years, they are hungry for a hefty increase in income. After such a time and money investment, I do believe that there is at least some justification for generous income for the years of work involved.

Back to our hammer and nail metaphor. Not only do we now have a man or woman with a hammer, but a really expensive hammer that required a substantial amount of effort to obtain. Now, our hapless hammer-bearer is desperate to see everything in sight as a nail.

You're seen in consultation by this fresh interventional cardiologist in practice for only a few years. Guess what he/she advises? Go straight to the catheterization laboratory, of course. Throw in the fact that insurance reimbursement is most generous for heart procedures, far more than for consulting in the office, doing a stress test, or other simpler, non-invasive tests, and the incentives are clear.

The system, you see, is set up to follow such a path. The path to the cath lab is heavily incentivized, paths in the other direction discouraged, disparaged, or just ignored.

My message: Don't get nailed.

Comments (4) -

  • Anonymous

    2/28/2008 7:15:00 PM |

    Yup.  "Hammers and nails"!

    I am 65 years old.  I had a stent inserted in the "widow-maker" artery (80% blockage) a year ago.  I had passed out a couple of times (heart rate dangerously low - 30s).  I rode to the hospital in an ambulance.  Tests revealed short LBBB episodes; mild mitral regurgitation, mild tricuspid regurgitation. Catherization showed 3 vessel CAD. I was told that a medicated stent was absolutely necessary given the situation; regardless, I have to accept that.   A pacemaker was installed to prevent bradycardia and keeps heart rate from dropping below 60.   I have 20% L distal main blockage and 90% lesion of the high first obtuse marginal at the takeoff.  The right coronary had 60% posterior lateral branch stenosis.  

    Since then I have reduced TG from 360 to 60,  LDL from 89 to 82 (although a few months ago it was in the mid-70s), and increased HDL from 30 to 46.  I went from 365lbs to 190lbs and hope to eventually get to 180lb this Spring.  I did it by progressing from walking to trotting (slow run) and dietstyle changes (low-GI veggies, fruits, etc.) .

    On a recent visit the cardiologist said the the LDL needs to be 70 or below to "freeze" the 90% blockage and gave me a prescription for Lipitor.  I asked if there were alternatives, like diet, supplements, etc.  He admitted that he did not know about those alternative but did know Lipitor.   When the only tool you have is a hammer then everything is a nail.  I understand that the 90% blockage is important but will not take the Lipitor to achieve the 12 points reduction.  Seems like an overkill.  

    I asked him if there was a way to evaluate my current condition.  I was told there was no way.  Basically, if I have no symptoms, good.  If I have symptoms then it will have to be evaluated.  Death could be the only symptom.   I swear he was about to say bypass surgery ($$$$$$!) was inevitable.  Something is wrong with this "fly-in-the-fog-and-hope-you-don't- hit-a-mountain" approach. Hope is not a strategy!

    I am confident that I can reduce LDL to below 70 based on eliminating wheat-products in my diet plus increasing oat bran in my diet.  I also take fish oil daily (EPA/DHA-2g).  I am looking for a new cardiologist.  I just recently purchased your book and find it very instructive.  In the meantime I have an appointment with my primary care physician to discuss implementing the Track Your Plaque program.  I realize that the one stent will skew the scan numbers but can be used as a baseline number.

    Anyway, onward . . .

  • mike V

    2/29/2008 4:49:00 PM |

    As an ancient engineer, I often use your aphorism.
    Your publicly expressed viewpoint must earn a lot of criticism from your colleagues, and undoubtedly there have been financial and other sacrifices on your part.
    I would like to offer heart felt appreciation for what you do.
    I assume that many colleagues share your point of view. Are there others who have the 'cojones' to speak out?  Is there any degree of cooperation?

    I would like to know something of your perspective on potential solutions for cardiology in particular, and healthcare in general. In fact, on the whole "medical-pharmaceutical-insurance-government complex" (to paraphrase the warnings of Dwight Eisenhower).
    I grew up under British socialized medicine, and while the delivery to the people is more even, it is not a  solution. Do you foresee some kind of compromise as workable? Should the solution be patient driven? Business driven? Govt. driven?
    I recall that in the UK, doctors and the system tend to be viewed as almost god like in their authority, although a few individual Dr. rebels such as. Malcolm Kendrick come to mind.

    Yes, I know. This is far too big a topic for your blog, but with the elections coming up, my curiosity just got the better of me!
    Note: I promise not to ask any more difficult questions until next Feruary 29!
    MikeV

  • Anna

    3/2/2008 8:50:00 PM |

    I'd like to echo the comment by Mike V.  The current health care situation in the US is so "unsustainable", to borrow an agricultural phrase, yet having a good view of the UK's NHS (I have English in-laws) doesn't inspire me to wish all of that on myself or the US public, either.  My in-laws in Norway seem to have it better in many ways, but I see some dangerous aspects creeping in over there, too.  We need better options for our nations's healthcare, but I only seem to hear about how well our current system works (for some people) with all the costly high-tech procedures and diagnostics or else warmed-over versions of the UK and Canadian systems, which has some serious flaws, too.

    I want healthcare that takes prevention and health promotion into account, not just "disease care" that catches disease "just in time".  I don't want "checkbook science" or "concensus science" dictating what options I have or what information is available to me.  I don't want a "nanny" nor do I want my care determined by healthcare industry lobbyists.  

    There must be something better, that does a better job of balancing promotion of good health with treatment of disease, with balancing good intentions without nannyism, with balancing  access to care without over treatment.  We need a system that allows medical personnel to make the best decisions for each individual patient, with a better way of managing the associated costs and compensation for all participants.   It is very hard for physicians to "buck the trends" these days.

    As an insider with an insightful view from the trenches of the healthcare industry, I'd love to read more of your thoughts on these issues in future posts, Dr. Davis (your busy schedule allowing, of course).  How can we reform healthcare without pushing the pendulum too far into another harmful direction, in a way that it beneficial to all - patients, medical personnel, medical institutions, medical research, etc?

    And then, how do we make it happen?

  • Anonymous

    1/1/2010 8:05:29 PM |

    Webmaster, I love your site. Thank you sooo much for working on it.

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If you take niacin, you must exercise

If you take niacin, you must exercise

We use a lot of niacin in the Track Your Plaque program.

Niacin:

--Increases HDL and shifts HDL towards the large, protective fraction

--Reduces small LDL--In fact, niacin is the best treatment we have to reduce small LDL after wheat elimination and carbohydrate reduction.

--Reduces fasting and postprandial (after-eating) triglycerides

--Reduces heart attack risk by 20-28%--even as a sole agent.


But . . . niacin also triggers higher blood sugar because it partially blocks the effects of insulin (insulin "resistance").

While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

Yes, through exercise. Here's one interesting observation in obese (BMI 34.0), sedentary men given placebo, exercise, niacin (1500 mg Niaspan, once per day), or niacin + exercise:





From Plaisance et al 2008.

Blood was drawn following a high-fat meal challenge. (Yes, a high-fat challenge, not a carbohydrate challenge. In this study, there were only 17 grams carbohydrates in the test meal, but 100 grams fat. More on this in future.) Exercise consisted of walking for 50 minutes at a moderate pace one hour prior to the meal challenge.

You can see from the graph that exercise partially corrected the increased insulin level provoked by niacin.

Judging from this and other studies, exercise can help minimize the insulin-blocking effects of niacin. It doesn't take much, just moderate exercise for at least 30 minutes.

Adequate sleep can also help, since sleep deprivation is a potent trigger for insulin resistance, only worsened in the presence of niacin. Vitamin D supplementation to achieve desirable blood levels (which I define as 60-70 ng/ml) is also an effective means to minimize this effect.

Comments (23) -

  • karl

    12/29/2009 11:16:55 PM |

    What about adding P-5-P to the Niacin?

    I've heard things about cinnamon lowering Blood sugar, but I'm not convinced.

  • Grandma S.

    12/30/2009 1:59:12 PM |

    Thank you for posting this.  I am exercising everyday sometimes twice a day to equal 45-60 minutes and see some help with the glucose level.  My LDLs continue to be around 100 and my Dr. wants to increase the Niacin.  Will that help?  It's a fine line, keep the sugars down and get the LDLs down. I appreciate your blog!

  • Renrew

    12/30/2009 2:42:42 PM |

    Cinnamon does reduce blood sugar but the effect is minimal, even at higher doses.

  • Adolfo David

    12/30/2009 3:06:07 PM |

    About Karl comment, you can add many supplements to niacin to counteract this effect. Chromium, resveratrol, standarized cinnamon, green tea extract... Life Extension has launched a niacin with quercetin for example (but now out of stock).

  • Nigel Kinbrum BSc(Hons)Eng

    12/30/2009 3:19:47 PM |

    Would reducing sugary/starchy carbohydrate intake be an effective way to reduce hyperglycaemia?

  • Anonymous

    12/30/2009 10:00:47 PM |

    Thanks for posting Dr. Davis.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should  the 1500 be taken all at once?

  • Anonymous

    12/31/2009 1:13:38 AM |

    Both times I started Niacin, I developed Gout.
    The second time I cut the tablets in half hoping to avoid another bout but still, Gout in a different joint.

  • Mark

    12/31/2009 4:56:24 AM |

    It has been my experience that over time (2-3 Months)the Slo-Niacin I use has less effects on raising blood glucose levels like it does at the onset. It is well advised that everyone should get in the exercise regardless of niacin intake.

  • Boris

    1/1/2010 3:48:15 PM |

    I took 500mg of Niacin every day to get my HDL up. Plus, there was niacin in my multivitamin. My HDL didn't go up at all. I exercise plenty too. All I got out of it were a few itchy flushes that made my ears feel clogged. I'm going to finish my bottle of Slo-Niacin and try a red yeast rice that was tested by Consumerlab.com.

  • Anonymous

    1/1/2010 8:29:23 PM |

    Regarding splitting the dose of Niacin.  I am pretty sure I have seen a post from Dr.D saying to take all at once.  

    I used to split my dose. I thought I was being smart by distributing the Niacin over the day.  My local pharmacist told me not to split the dose because of impacts to Liver function.

  • Anonymous

    1/2/2010 2:10:06 PM |

    I avoid sustained release niacin.

    I get around 80 mg niacin per day in a multivitamin and don't want to add extra.

    http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114620

    pomegranate...

    Despite the patients’ advanced atherosclerosis, ingesting pomegranate juice produced statistically significant reductions in the thickness of their carotid artery walls, which is correlated with decreased risk for heart attack and stroke. After only three months, the average thickness declined by 13%, and after 12 months, the thickness dropped 35% compared to baseline. During this same 12-month period, the average carotid artery thickness of the placebo group increased by 9%.

  • Anonymous

    1/2/2010 2:39:54 PM |

    Thank you so much for posting this!  I have bee na niacin devotee for about 15 years, and wanted to get my LDL back up after a dx of T2D (with Antibodies) ... and having my niacin "taken away" by my internist.  MY Endo put me back on a lower dose of slo-niacin ... exercise is helping but I may need to up my anti-IR meds.

  • Anonymous

    1/4/2010 4:14:05 AM |

    When is the best time to take niacin?

    morning or night?

    before or after exercise or meals?

  • Dr. William Davis

    1/4/2010 11:27:02 PM |

    We've had best results dosing niacin with dinner or the largest meal of the day.

  • Anonymous

    1/12/2010 2:37:54 PM |

    Dr.Davis

    Just asking this again, could you could please help me out.

    Is splitting 1500 mg of Niacin to two 750mg doses,one in morning, one in evening ok?
    Or should the 1500 be taken all at once?

  • Anonymous

    3/19/2010 4:24:19 PM |

    I had a terrible time with Niacin and insulin resistance.

    I tried exercising but to keep my BG down, I would have to exercise 3 or 4 times a DAY, which is simply not feasible.  Oh, and I am a low-caber, too.

    I would exercise extreme caution in starting to use this, with any Diabetes. (I am a T1.5).

  • lnoonan

    5/19/2010 4:14:15 PM |

    Dr Davis,

    What kind of exercise would you recommend for a Senior lady who is handicapped?  It is difficult for her to do any exercise, so do you know of something she would be able to do while she is taking niacin?  Or, would it be better for her to stop the niacin since exercise is difficult and try other supplements?  Thanks for your help.

  • Anonymous

    5/27/2010 5:00:58 AM |

    Assuming your recommended Slo-niacin...is it better to split your doses up (500 mg morning and 500 mg at night) or take all 1000mg at once? If its better to take all at once is night or morning better?

  • kimberly

    8/11/2010 5:57:09 PM |

    I love to practice exercise, i think this activity is the best option to keep our total welfare and it is very fun. When we exercise frequently we can notice a change not only in our shape but in our mood too. Actually we can improve our sexual performance. When some cases when the erectil dysfunction present like a problem  to buy viagra is a great alternative, how ever you must to combine it with exercises and a good feed.

  • buy jeans

    11/4/2010 5:11:30 PM |

    While the net effect of niacin remains positive, the provocation of insulin resistance is not such a good thing. Can it be minimized or eliminated?

  • Anonymous

    12/15/2010 1:49:29 PM |

    Taking niacin before vigorous exercise has one benefit for me.  The flusing is minimized or even eliminated.

    I've seen different recommendations for dosing frequency.  Three times a day is the "standard" dosing regimen.  However, when I haved switched to three times a day dosing, I have experienced elevated liver enzymes.  I've never had a problem with twice a day dosing.

  • bob

    2/7/2011 4:55:57 AM |

    I am not aware of any data to support 24% risk reduction for MI with the use of Niacin, can you provide citations?

    Primary or secondary prevention?

    Bob Hansen MD

  • John

    6/2/2011 5:01:34 PM |

    Cinnamon doesn't lower blood sugar per se.  The apparent mechanism occurring here is a slowing down of carbohydrate absorption in the gut.  The mechanism is believed to involve a class of molecules known as flavonoids, which either reversibly compete for the glucose receptor or have their own receptor on the GLUT 2 (glucose transport 2) protein.  This action only slows down the absorption of carbohydrates, but all (that's 100%) sugar is absorbed into the body.  It is the only thing you intake that is absorbed 100% and it doesn't matter if it's glucose, sucrose, fructose, or a complex carb.  Anywho, not that I want to debate the finer points of carbohydrate biochemistry.  For more on flavonoids and GLUT2 you can look up this paper (Kwon O., Eck P., Chen S., Corpe C., Lee J-h., Kruhlak M., Levine M. (2007) Inhibition of the intestinal glucose transporter GLUT 2 by flavonoids. FASEB Journal 21, 366-77.).

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"I can't do it"

"I can't do it"

Anne sat across from me, bent over and sobbing.

"I can't do it. I just can't do it! I cut out the breads and pasta for two days, then I start dreaming about it!

"And my husband is no help. He knows I'm trying to get off the wheat. But then he brings home a bunch of Danish or something. He knows I can't help myself!"

Having asked hundreds of people to completely remove wheat from their diet, I witness 30% of them go through such emotional and physical turmoil, not uncommonly to the point of tears. For about 10-20% of people who try, it is as hard as quitting cigarettes.

Make no mistake about it: For many people, wheat is addictive. It meets all the criteria for an addictive product: People crave it, consuming it creates a desire for more, lacking it triggers a withdrawal phenomenon. If wheat were illegal, there would surely be an active underground trafficking illicit bagels and pretzels.

Withdrawal consists of fatigue and mental fogginess that usually lasts 5-7 days. Just like quitting smoking, wheat withdrawal is harmless but no less profound in severity.

People who lack an addictive relationship with wheat usually have no idea what I'm talking about. To them, wheat is simply a grain, no different than oats.

But wheat addicts immediately know who they are. They are the ones who can't resist the warm dinner rolls served at the Italian restaurant, need to include something made of wheat at every meal, and crave it every 2 hours (matching the cycle of blood sugar peaks and valleys, the "valley" triggering the craving). When they stop the flow of immediately-released glucose that comes from wheat (with blood sugar peaks that occur higher and faster than table sugar), irresistible cravings kick in. Then watch out: They'll bite your hand off if you reach for that roll before they do.

Break the cycle and the body is confused: Where's the sugar? The body is accustomed to receiving a constant flow of easily-digested sugars.

Once the constant influx of sugars ceases, it takes 5-7 days for metabolism to shift towards fat mobilization as a source of energy. But along with fat mobilization comes a shrinking tummy, reducing the characteristic wheat belly.

If you try to quit smoking, you've got "crutches" like nicotine patches and gum, Zyban, Chantix, hypnosis, and group therapy sessions. If you try and quit wheat, what have you got? Nothing, to my knowledge. Nothing but sheer will power to divorce yourself from this enormously destructive, diabetes-causing, small LDL-increasing, inflammation-provoking, and addictive substance.

Comments (20) -

  • Ghost

    5/30/2009 5:00:26 PM |

    I totally went through that. It took me several tries to quit wheat, and I still mess and have a cookie or a sandwich once every few months-- generally while eating at someone else's house. One thing that helps keep me straight: the ONLY time I get acne anymore is when I eat wheat or chocolate. So now when I think about how much I want a dinner roll, I try to imagine how many spots I will get on my face if I eat it, and ask myself if it's worth it.

    I have read in other sources that wheat, like A1 dairy (from Holstein cows, rather than A2 from Jersey or Guernsey or goats) contains opioid-like molecules, and this is why some people exhibit addictive behaviors in response to them-- and that people who are addicted to wheat also tend to react that way to milk. This certainly matches my own experience.

  • Nancy LC

    5/30/2009 5:15:50 PM |

    When I found out I have a reaction to gluten what I did was repeat to myself "Poison" every time I saw something with wheat (or gluten) in it.  When I smelled it, same thing.  Sometimes I'd use visualizations to imagine it was green and moldering like something poisonous.  It really worked to reprogram me.  I haven't once broken my conditioning and voluntarily ingested gluten, and I don't have the extreme reactions some people do, they can be pretty subtle and take a long time to really make themselves known.

    Maybe it's a technique that other people could find useful.

  • Gretchen

    5/30/2009 6:30:07 PM |

    If it takes a week, maybe you could try some weeklong retreats at which no wheat was available. People would have social support as well as a lack of temptation.

  • Anonymous

    5/30/2009 6:37:44 PM |

    Low Dose Naltrexone might help..

  • thania

    5/30/2009 6:53:33 PM |

    I understand that, I quit smoking 67 days ago, doing low carb, I dont miss as much wheat but rice yes. I have put on 20 lbs low carbing?? I havent ate more that before 1200-1800 cal, depending on the day. But I am a bit depressed dont feel like moving , so less work outs. The heavier I become the less I feel like moving, and I also am having hormonal changes...,
    I feel very unhappy, but dont want to smoke again, this time is for ever.

  • Anne

    5/30/2009 8:21:30 PM |

    I am not the Anne in your post, but I was addicted to wheat. It was my favorite food. I lived on and for breads. Then I discovered I was gluten sensitive and I did go through a withdrawal of about 4 days. After 4 days I noticed my health problems were disappearing. Depression, brain fog and joint pain are 3 of the many symptoms that disappeared. That was 6 yrs ago.  

    Of course giving up gluten does not mean I gave up sugar. I still got my sugar fix with candies and alternative grains. Then I found out my blood sugar was too high so I started eliminating anything that spiked it. I easily lost 20 lbs with low carb eating that got my blood sugar under control.

    Tell Anne that I had dreams about bread in the beginning - they will pass. Now the donuts, breads, cookies and cakes in the stores and at work don't even look good. In fact, I don't like the smell of bread anymore. It takes time, but the cravings do pass.

  • Tom

    5/30/2009 8:49:44 PM |

    I agree, although this leaves open the question of why some people get addicted to things and some people don't (the 10%-20%).

    Meditation and problem-solving seem to be effective cures for all varieties of addiction. Exercise might be used as a substitute for meditation.

  • Lena

    5/30/2009 9:36:50 PM |

    I cut out everything with gluten pretty much immediately once I figured out it made me very ill. That wasn't hard. As for reducing intake of other carbohydrates, I just did that gradually and avoided the desperate cravings. I don't see any particular need to cut down on wheat and refined carbohydrates in one drastic move. Maybe first week, reduce intake by 20%, then another 20% the next week, then in about a month you'll probably be doing fine.

  • Ed

    5/30/2009 10:08:58 PM |

    I've heard "wheat spikes blood sugar more than sucrose" before, and upon reflection, I'm not sure I understand it.

    I assume this is for an equal amount of carbohydrate, ie 100 grams starch (not 100 grams wheat) vs. 100 grams sucrose.

    The problem I see is you're comparing 100 grams of glucose to 50 grams glucose + 50 grams fructose. After looking at it that way, wouldn't you expect your blood *glucose* levels to spike higher with starch than with sugar?

    (Suggesting that sugar is the same as other carbohydrates has become my pet peeve. Technically fructose is a carbohydrate, but the human body processes it totally differently than glucose. It's like saying oleic acid is equivalent to linoleic acid because they're both lipids.)

    Anyway, I have worked grains, sugar and "vegetable" oils out of my diet and my waist just sort of evaporated, while not going hungry -- eating pretty much as much of anything else I want. I would offer moral support for anyone else trying to do the same. Keep at it, the effort is worth the result.

  • Captain Mikee

    5/31/2009 12:06:16 AM |

    Actually, if you are lucky enough to live near a chapter of Food Addicts Anonymous, I think you can get help there. Unfortunately, I do not.

  • Scott W

    5/31/2009 1:45:35 AM |

    I completely agree that wheat is addictive to many and I personally never eat it. However, I'm not sure that your basis for this position, as stated in your posting, passes the credibility test. You have related the addictive capacity of wheat to its starch load, rather than its gluten content.

    If the only reason that wheat is addictive is its starch, then the same position could be taken on potatoes, rice or bananas. But no one ever says they are addicted to boiled potatoes.

    Now, if the patient has a compromised metabolism (type 2 diabetic), then they truly do have a problem with all carbs - not just wheat - and the blood sugar swings that can result.

    However, I think that for a person of normal metabolism (good blood sugar control), it's not the carb content of wheat but its gluten that cause the addiction and other issues.

    Thanks for your ongoing willingness to share your insights from your medical practice.

    Scott W

  • mongander

    5/31/2009 3:25:09 AM |

    In addition to following Dr Davis, I also follow Dr Gabe Mirkin.  So I have compromised and quit wheat, but continue to eat whole intact barley and oats.  Have done well, losing over 60lbs, with the help of exercise.  Haven't had the comprehensive lipid tests nor the heartscan but at age 70, feel good.  Last total cholesterol was 158. Also take niacin, K2, and fish oil.

  • stern

    5/31/2009 4:30:57 PM |

    we need to restrict from carbs since we started with the poisenios wheat ,but we can get along with healthy carbs which is organic whole einkorn sourdough bread ,does any have a tip on how to rise it without yeast please let hear from you

  • Anonymous

    6/3/2009 2:24:54 AM |

    For rising sourdough try Kefir !

  • Shreela

    6/4/2009 12:35:42 PM |

    While waiting for my doctors to diagnose my gut ailment, I thought it sounded like I had a few gluten-intolerance symptoms and was desperate enough to try cutting gluten from my diet to see if I could stop the terrible pain.

    The pain did stop fairly soon after stopping wheat/gluten, so it seemed I had Celiac, so I continued being wheat/gluten free.

    After reading about how difficult it was for people because of the cravings, I searched for gluten free substitutes for baked goods and pasta. They were pretty expensive online, and that's not factoring in shipping prices. So I thought I'd tough it out if I got the cravings.

    I did get them. It was rough for about 2-3 days, then faded a little. Watching TV didn't help either! I decided to try out some local health food places and found one that carried a nice selection of gluten free baking mixes and pasta.

    My husband almost laughed as I fought off tears when I ate gluten-free muffins, after eating NO muffins for at least a month.

    And eating those gluten-substitute baked goods and pasta DID help reduce my cravings! So I'm guessing that once I past the rough first few days, maybe I was craving foods I used to enjoy but could no longer eat.

    Although Dr. Davis warns about gluten-free products still being high-glycemic and spiking blood sugars, I'm still suggesting that if you're not diabetic, and want an easier time going off the wheat, try gluten-free products to see if they offset your cravings, for it might be a combination-craving of both gluten, as well as comfort foods. After a few weeks off the gluten altogether, then wean down the gluten-free products if needed for normalizing blood sugars, weight-loss, and not spending so much on expensive gluten-free products.

    Meanwhile, my gluten-intolerance bloodwork returned negative! It looks like it was IBS triggered by insoluble fibers in whole wheats (and some other foods). But even though I discovered I can tolerate processed flour, I don't eat nearly as much flour/gluten as I did before this experience, since my borderline A1C dropped a lot after being off wheat products.

  • Anonymous

    6/4/2009 12:47:05 PM |

    In response to the sourdough , do you have a recipe using the Kefir? Thanks

  • Trinkwasser

    6/17/2009 12:56:14 PM |

    "If you try to quit smoking, you've got "crutches" like nicotine patches and gum, Zyban, Chantix, hypnosis, and group therapy sessions. If you try and quit wheat, what have you got? Nothing, to my knowledge. Nothing but sheer will power to divorce yourself from this enormously destructive, diabetes-causing, small LDL-increasing, inflammation-provoking, and addictive substance."

    It's worse! With wheat you have friends, relatives, bakeries and especially *mothers*, pushers all

    grrrrr

  • jpatti

    7/24/2009 11:57:04 AM |

    I've done induction to go back to low-carb several times when I'd gotten off track.  For me, it does feel like a withdrawal, and I tend to feel sick 2-3 days if I do it strictly, whereas otherwise I feel crappy for a week.

    I choose a time when my life will be relatively low-stress, roast a whole turkey and buy a bunch of pepperoni for snacking on.  Going meat-only for a few days makes the withdrawal pass faster.  

    After a few days of turkey and pepperoni, I add back in vegetables, then a few days later dairy, then later still, low-sugar fruits.  

    IME, that's fastest way to get through the ickiness.  

    And REMEMBERING the withdrawal is the best way to avoid having to go through it again.

  • Anonymous

    12/26/2009 3:09:37 PM |

    Hi, I can’t understand how to add your site in my rss reader. Can you Help me, please Smile

  • hopeful geranium

    5/19/2010 11:27:35 PM |

    Tom, the 10-20% addicts are not the same people for every drug.
    I was junkie, speedfreak, benzo addict, alcoholic, ether sniffer for years (decades). I chain-smoked when high (lucky to be alive smoking on ether) but always went off tobacco when sober - I could never get hooked on cigarretes, never had withdrawals, don't smoke now, but if I chose to once, it would be the only time.
    Apparently 20% of people don't have the tobacco addiction gene. Most don't smoke at all, but I enjoyed changing my consciousness with tobacco while high on other things. 20% of men where I come from are red-green color blind - I wonder if this is connected to the gene for no nicotine addiction.
    Perhaps nicotine, for all its effects, didn't interact with endorphin receptors, and for addicts, there is a link? This is known to be important for determining who gets alcoholism.

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This is your brain on wheat

This is your brain on wheat

Here's just a smattering of the studies performed over the past 30 years on the psychological effects of wheat consumption.

Oddly, this never makes the popular press. But wheat underlies schizophrenia, bipolar illness, behavioral outbursts in autism, Huntington's disease, and attention deficit hyperactivity disorder (ADHD).

The relationship is especially compelling with schizophrenia:

Opioid peptides derived from food proteins: The exorphins.
Zioudrou C et al 1979
"Wheat gluten has been implicated by Dohan and his colleagues in the etiology of schizophrenia and supporting evidence has been provided by others. Our experiments provide a plausible biochemical mechanism for such a role, in the demonstration of the conversion of gluten into peptides with potential central nerovus system actions."


Wheat gluten as a pathogenic factor in schizophrenia
Singh MM et al 1976
"Schizophrenics maintained on a cereal grain-free and milk-free diet and receiving optimal treatment with neuropleptics showed an interruption or reversal of their therapeutic progress during a period of "blind" wheat gluten challenge. The exacerbation of the disease process was not due to variations in neuroleptic doses. After termination of the gluten challenge, the course of improvement was reinstated. The observed effects seemed to be due to a primary schizophrenia-promoting effect of wheat gluten."


Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates
Huebner FR et al 1984


Is schizophrenia rare if grain is rare?
Dohan FC et al 1984
"Epidemiologic studies demonstrated a strong, dose-dependent relationship between grain intake and the occurrence of schizophrenia."

Comments (32) -

  • Mike

    12/9/2009 11:27:37 PM |

    Dr. Davis,

       Excellent post!  It's quite apparent the auto-immune stimulating qualities of WGA are behind a plethora of chronic diseases.

    Regarding both cardiovascular disease and obesity, though, is it a similar mechanism, strictly related to inflammation, or a combination of autoimmunity AND inflammation?  I'm often asked why wheat is "worse" than other forms of dense carbohydrates, but I'm at a loss for a simplistic explanation.

  • Charles R.

    12/10/2009 12:24:59 AM |

    You don't have to convince me.

    A number of years ago, I realized wheat was causing me problems, mostly at that time energy problems. If I ate a breakfast with toast, I would get tired almost immediately after. It was probably carbs in general, but I just stopped eating all wheat.

    About 5-6 months after that, I came home, saw a box of saltines on the counter, and devoured them. Within an half-hour, I was going through an incredible depressive episode to the point of having suicidal thoughts. It was like someone had turned on a crazy switch in my brain.

    Totally anecdotal of course, but I tried the same thing a couple of other times and really noticed immediate changes in my ideation and feelings, so got the message and stopped wheat altogether.

  • Michael

    12/10/2009 1:55:00 AM |

    I use wheat grass tablets from Pines.  Is wheat grass harmful like wheat?  I assume the answer is no because there is no gluten in wheat grass.  Am I correct?

  • Kennedy

    12/10/2009 2:31:57 PM |

    Very scary.

  • Anonymous

    12/10/2009 4:11:37 PM |

    How interesting! Thank you for sharing this.

  • Zach

    12/10/2009 4:59:49 PM |

    Dr. Davis,
    I hope you take this as a compliment!  I follow your blog regularly.  Thanks for all of the great info and wisdom that you've shared over the last year with me since I've been an avid reader of your site.

    I also follow Jimmy Moore's site, and saw your picture/name as a participant for an upcoming Low Carb/Fitness Cruise.  I was struck by how your face has really leaned out and is much more muscular/healthy looking.  The picture you currently have on your blog looks good!  I was just wondering whether since your blog picture was taken whether you've leaned out since really bearing down and following a gluten-free diet especially over the last 12+ months?

    Wish I could join you on this cruise, maybe next time.  Thanks again for being at the front of the "normal carb" revolution.

    Best Regards,
    Zach (over at The Paleo Garden)

  • Drs. Cynthia and David

    12/11/2009 12:48:52 AM |

    Here is another report for your list (from Eric Westman at Duke): "Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652467/?tool=pubmed

    They report the resolution of long standing schizophrenia using a ketogenic diet.

  • Anne

    12/11/2009 4:21:13 AM |

    My brain on wheat(gluten) was fogged and depressed. In fact, I did not know how depressed I was until I stopped eating gluten. I never knew I could feel so good.

    It is well established that gluten can cause seizures and other neurological problems. You can read articles and abstracts about the neurological effects of gluten in The Gluten File http://jccglutenfree.googlepages.com/theneurologicalmanifestationsofgluten

    What does this have to do with my heart? Well, my pitting edema and shortness of breath disappeared when I stopped eating wheat.

  • Michael

    12/11/2009 4:35:39 AM |

    I take wheat grass tablets by Pines.  Is wheat grass harmful like wheat?

  • Adam

    12/11/2009 6:44:24 AM |

    I've been on a no wheat diet for over a month now. Unfortunately, I can't say I've felt anything in the way of mental benefits. Or any benefits at all really.

    But then, I'm pretty healthy overall. I exercise at least an hour a day, and I'm relatively young.

    I must conclude that abstaining from wheat is either most beneficial to the unhealthy/elderly, or is a bunch of a hooey Smile

  • Tim

    12/11/2009 12:06:50 PM |

    Do you have more information on wheat and Huntington's Disease? Has anyone been able to prevent this disease by eliminating wheat from the diet? What evidence is there?

    Thanks

  • Dr. William Davis

    12/11/2009 12:52:47 PM |

    Wheat grass and breads like Ezekiel, to my knowledge, have no gluten. This makes them less harmful, though the bread still poses carbohydrate challenge issues.

  • Dr. William Davis

    12/11/2009 12:53:58 PM |

    Tim--

    Dr. Loren Cordain of The Paleo Diet has talked about the relationship of wheat and Huntington's recently in his latest newsletter. He sums up the literature very nicely.

  • Nigel Kinbrum BSc(Hons)Eng

    12/11/2009 6:42:49 PM |

    According to Cereal Grains:
    Humanity’s Double-Edged Sword,
    gluten can cause C(o)eliac Disease, Dermatitis Herpetiformis, Sjogren's Syndrome and Cerebellar Ataxia.

    My ex-G/F used to get intensely itchy spots on her skin and she also had dry eyes. When she went gluten-free on my suggestion, the itchy spots disappeared and her eyes got a little less dry, but she still has to use artificial tears. She also commented that her belly was less bloated since going gluten-free. Result!

    A lady I know has a son with Xeroderma Pigmentosum and Cerebellar Ataxia. When she put her son on a gluten-free diet after reading the above article that I'd e-mailed her a link to, he improved dramatically and began doing things that his mum thought he would never be able to do, as he was previously deteriorating. Result!

  • Aileen

    12/11/2009 11:15:55 PM |

    I think this is a bit extremist. Whilst those effects do exist in some people, along with problems with other food groups such as Solanaceae they are not ubiquitous by any means.  There are lots of people out there who can eat anything including wheat, dairy and other food groups with gay abandon and suffer NO adverse effects. Opioid peptides are also acknowledged as occurring in other foods such as eggs and OATS and when you think about it the potential is there for them to come out of ANY protein since all proteins are broken down into peptides for digestion.

    So, whilst people do need to be aware that they can have intolerances to a wide range of foods for various reasons I think making blanket statements such as this that may compel people to exclude large numbers of food products from their diet for perhaps no good reason, is dangerous and irresponsible.

    Anyone suspecting problems with food groups should see an allergist and go through the process of a proper food elimination diet.

    I do also appreciate that food intolerances can come and go for a range of reasons.

  • Anne

    12/11/2009 11:31:23 PM |

    Food for Life makes Ezekiel bread and it is not the list of gluten free products. http://www.foodforlife.com/our-products.html

    Other breads that people often ask about are Sami's and Delands. Although they contain no gluten grains, when tested they showed high amounts of gluten.

    So if you have celiac disease or gluten sensitivity, you need to avoid these products.

    Wheat grass would be gluten free as long as there are no seeds.

  • Dr. William Davis

    12/12/2009 12:04:02 AM |

    Hi, Zach--

    Started thyroid replacement when my T3 went real low. I think that did it.

    Thanks for noticing.

  • Dr. William Davis

    12/12/2009 12:06:12 AM |

    Sorry, Aileen. All proteins do not break down into the same polypeptides, since there are numerous and varying sequences of amino acids that differ, say, between oats, wheat, beef, nuts, etc.

    So a polypeptide is not always the same polypeptide. Referring to a basic biochemistry text would show this quite clearly.

    If you think you've escaped the ill-effects of this ubiquitous, more often than not you're wrong. You just haven't realized it yet.

  • JPB

    12/12/2009 2:09:30 AM |

    Now you should write a post on the effects of wheat plus statins....

  • Aileen

    12/12/2009 6:37:26 AM |

    I do know my biochemistry thanks!  I didn't say all proteins break down into the same peptides. Also having been through a proper elimination diet in te past I can say with certainty that gluten/wheat/dairy give me no ill effects.

    As with all things in life everyone is different, different populations of receptors in the brain hence different sensitivities and responses.  You can't blanket say gluten (or anything else) is bad for you.

    And as with many other things in life - often you don't find stuff out till you look for it.  How many studies on red wine are quoted and its only now they are beginning to look at white wine and find many of the same effects!

  • Anonymous

    12/13/2009 9:05:50 PM |

    Aileen, YOU GO GIRL!  Dr D., you were a bit quick on the put down.

    I like that Dr Davis is passionate about CAD risk reduction but I frequently post here when I see generalizations based on limited or cherry picked studies. That is the sort of thing, oh I don't know, big pharma would do.

    We don't all have to live like Inuit, there are plenty of vegetarians that are healthy and have no ill effects from eating wheat gluten every day. Or does someone have a study to say all vegetarians are lethargic and overweight?

    Trevor

  • Anonymous

    12/15/2009 12:40:28 AM |

    Hi there,

    Just wondering if you are a member of THINCS (http://www.thincs.org/) run by Dr.Uffe Ravnskov,

  • Anonymous

    1/30/2010 4:27:51 PM |

    Aileen,

    Yes of course not all will get mental illnesses from gluten and a big proportion will not get immediate reaction to gluten. However, it has been shown that it can cause schizophrenia in a small part of the population. Around 30% of normal healthy people produce antibodies to gluten that can be measured in the stool. There are even reports of disappearance of schizophrenia, all sorts of unexplained fatigue and other mental illnesses. There is a strong correlation between gluten consumption and schizophrenia as well.

    Now, cannabis has been shows to cause schizophrenia and other mental problems too. Not all will get it and a lot of people can live reasonable lives with it. Would you say cannabis is bad and causes mental illnesses, when similar to gluten it causes various mental problems in a significant proportion of the population? The difference between them is that cannabis has immediate psychoactive properties in almost everyone, so people have no problem believing it's problematic. Gluten does contain exorphins, which do have opioid-like activities. Also the immunogenic factor causing gut malfunction and nutrient malabsorption. How you will handle the opioids and what effects the antibodies and immune system activation will have on your body, no one knows.

    Even if you don't get immediate reactions from wheat, I wouldn't bet my life on its harmfulness.

  • lib

    4/17/2010 10:03:30 AM |

    3 months ago i began to eliminate processed food and alchohol from my diet.It has been hard but i have lost 7 kilos and have been feeling great.
    Yesterday i was excessively bad ,gave in (the story of my life) and had 3 weetbix,foccacia bread,2 jam donuts.2 beers and 2 pieces of white flat bread.
    Well today i feel dreadful.This afternoon i yelled,slammed doors,verbally abused my husband went into depression and had suicidal thoughts.
    I have suffered from depression in the past but never as severe as this!
    I strongly believe it was due to the wheat consumption,so I went on to the web and typed in 'wheat and depression" and found your site.After reading a few of the blogs i thought i muat be right.Incredible.
    Well i will be avoiding wheat now as i have another reason too not just for weight loss.
    I'll introduce wheat say in another 2 months time and see if i get the same reaction.It may not be pleasant but will convince me.

  • Anonymous

    7/12/2010 7:39:24 PM |

    Hi, just found your site.  A year ago after going thru horrible female issues and tons of unexplained medical problems I met a nurse who told me to cut out wheat.  I was in the process of having biopsies because no Dr. could figure out what was wrong with me.  

    I have no cancerSmile I won't list all the things wrong with me at the time but it was bad, and I was doubting my sanity.  I've always struggled with depression. Cutting out the wheat has helped so much. Most of my health problems went away.  

    I may eat a little bit here and there, but not often. I find myself in tears soon after and the depression and body aches come back.

    It is a shame that so many Dr.'s know nothing of this or tell me it's all hype. Thank God for the internet, at least now we know we aren't crazy and the wheat problem is finally getting some attention.

  • buy jeans

    11/3/2010 9:10:14 PM |

    Oddly, this never makes the popular press. But wheat underlies schizophrenia, bipolar illness, behavioral outbursts in autism, Huntington's disease, and attention deficit hyperactivity disorder (ADHD).

  • Anonymous

    2/8/2011 6:51:25 PM |

    Aileen,

    If people limited all gluten grains to just 2 or 3% of their diet it would probably be fine.  BUT, the huge problem is that people think their cereal is healthy.  Then they think their whole wheat bread is healthy.  Then they think their pasta is healthy.  By now we are approaching 50 to 75% of their diet.  Then people serve breaded chicken nuggets to their kids.  It is literally killing people.

    Dr. Davis is a hero!  Many Drs. do not even take the time to care.

  • majkinetor

    3/9/2011 9:49:18 AM |

    Anonimous said: "Now, cannabis has been shows to cause schizophrenia and other mental problems too. Not all will get it and a lot of people can live reasonable lives with it".

    Cannabis DOES NOT cause schizophrenia, that is outdated and probably politicized research. The marijuana smoking is a symptom rather then cause of schizophrenia. Brain CB1 receptors are endogenously used by Anandamide neurotransmitter which is very low in schizophrenic people. THC is more potent version of Anandamide and thats the reason schizophrenic people use it more then regular people who already have normal levels of endogenous version. Cannabis is used as a medicine for most of the history.

  • JT

    7/11/2011 12:11:31 PM |

    Seriously?
    Crackers make you want to kill yourself?
    Your problems stretch far beyond wheat, sir.

  • stuart

    8/24/2011 3:55:54 PM |

    JT,

    Just because you don't understand the entirety of the problem, try not to belittle Charles.  Charles may have been exaggerating a bit.  Yes, the problems extend far beyond wheat because wheat infects almost all junk food, processed food, fast food, and "premium" prepared foods.  

    Maybe it is time you wise up JT.  Just go to a restaurant with a Gluten free menu.  Then compare all the offerings on that menu to the regular menu.  You guessed it JT,  EVERYTHING else has gluten.  Even the minestrone soup, coffee creamer, ice cream, etc.  Why?  Wheat is the quickest and cheapest way to "thicken" and to make products seem "rich".  

    Wheat is just another method of control.  Keeping the rich wealthy and the poor dumb and sick.

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