Who lost weight?

The results of the latest Heart Scan Blog poll are in.


I went wheat-free and I . . .


Gained weight 6 (3%)

Lost no weight 41 (21%)

Lost less than 10 lbs 28 (14%)

Lost more than 10 lbs 34 (17%)

Lost more than 20 lbs 22 (11%)

Lost more than 30 lbs 28 (14%)

I'm still losing weight! 30 (15%)

(189 respondents)


This means that, by eliminating wheat:

24% had no success

31% had moderate success (less than 10 lbs or more than 10 lbs)

25% had extravagant results with 20 lbs or more lost


It would be interesting to know where along the weight-loss spectrum the last category, "I'm still losing weight," group falls. (Anyone with a good story please speak up!)

I believe we can conclude from this casual exercise that, as a simple strategy, wheat elimination is surprisingly effective.

Why would 3% gain weight? Well, without knowing the details, there are several possible explanations:

1) Weight gain developed through other foods. For instance, I've had people eliminate wheat only to replace it with fattening gluten-free alternatives. Remember: wheat-free is not gluten-free. Others load up on the wrong foods, e.g., Craisins and other dried fruit; overdo dairy; or snack on wheat-free but unhealthy foods like ice cream and chips.

2) Too much alcohol

3) Hypothyroidism--A lot more common than you'd think. In fact, this has been the case with a majority of people who have done everything right, yet either failed to lose weight or gained weight.

Those are the biggies.

I'd like to hear your personal stories of wheat elimination--the ups and downs, your success or failure, how you felt during the process, how easy or difficult, your eventual results. Just post them as a response to this blog post.

A niacin primer

A reader of Life Extension reminded me of a piece I wrote about niacin a couple of years back.

Anyone desiring a primer on how and why to use niacin to correct lipid and lipoprotein patterns might find this useful.

While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.


Q: I recently had a cholesterol profile blood test and learned that I may be at risk of heart disease because my levels of beneficial HDL (high-density lipoprotein) are too low. I read that niacin could help increase my HDL, but my doctor said niacin is dangerous. Whom should I believe?

A: Your doctor would be right—if we were still living in 1985. Since then, however, we have learned how to use niacin (vitamin B3) safely and effectively. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that cholesterol-lowering statin drugs are the only way to decrease cardiovascular disease risk. I have personally prescribed niacin for thousands of patients as part of our program to reverse coronary disease. In fact, niacin is the closest thing we have available to a perfect treatment that corrects most of the causes of coronary heart disease.

Continued here.

What would life be like . . . ?

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

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

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

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

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

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

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

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

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

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

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

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

See those vines growing up the side of the hospital?

Are jelly beans heart healthy?

Total Fat

3 g or less

Less than 6.5 g





Saturated Fat



1 g or less

1 g or less





Cholesterol

20 mg or less

20 mg or less





Sodium

480 mg or less per RACC* & labeled serving

480 mg or less per RACC* & labeled serving





Nutrients

Contain 10 percent or more of the daily value of 1 of 6 nutrients; vitamin A, vitamin C, iron, calcium, protein or dietary fiber



Contain 10 percent or more of the daily value of 1of 6 nutrients; vitamin A, vitamin C, iron, calcium, protein or dietary fiber





Trans fat

Less than 0.5 g per RACC* and labeled serving



Less than 0.5 g per RACC* and labeled serving





Whole Grain

N/A



51 percent by weight/RACC*







Minimum Dietary Fiber



N/A

1.7 g/RACC of 30 g

2.5 g/RACC of 45 g

2.8 g/RACC of 50 g

3.0 g/RACC of 55 g





(RACC=Reference Amount Customarily Consumed)

Thyroid correction: The woeful prevailing standard

Rich has been taking Synthroid or levothyroxine for many years.

When Rich came to my office for continuing management 10 years after his bypass surgery, I checked his thyroid panel:

TSH 7.44 uIU/L

Free T4 1.88 ng/dl (Ref range 0.80-1.90 ng/dl)

Free T3 2.0 pg/ml (Ref range 2.3-4.2 pg/ml)


Rich's thyroid hormone distortions--high TSH, low T3--are sufficient to account for a tripling of heart attack risk long-term.

As Richs' thyroid was being managed by his primary care physician, I notified this doctor of Rich's panel. He therefore increased Rich's levothyroxine from 75 mcg per day to 100 mcg per day. Another thyroid panel several months later showed:

TSH 0.98 uIU/L

Free T4 2.38 ng/dl

Free T3 2.0 pg/ml



As you would expect, increasing the intake of the T4 hormone (levothyroxine) increased free T4 and suppressed TSH.

But what about T3? It's unchanged.

Indeed, Rich says that he feels no better and, in fact, wakes up in the morning foggy and requires a nap in the afternoon.

In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.

Rich's increased levothyroxine dose decreased (calculated) LDL cholesterol by 10 mg/dl. Based on my experience, I'll bet that his lipid panel would likely be further improved with T3 correction.

What I find incredible is the absolutely rabid resistance waged by primary care physicians and endocrinologists against this notion of T3, mostly due to fears of the remote likelihood of inducing atrial fibrillation and osteoporosis, while they are ready to prescribe lifelong statin drugs without a moment's hesitation.

Launch of new Track Your Plaque newsletter: Cardiac Confidential

Track Your Plaque has just launched a new version of our newsletter. We call it Cardiac Confidential.

Cardiac Confidential is meant to be a no-holds-barred, go-for-the-throat exposé of the world of heart disease. We will expose the dishonest, reveal what we view as the underlying truth. We'll even have an occasional "undercover" report of what goes on in hospitals and the go-for-the-money world of heart procedures.

Read the first issue here (open to everyone) in which "Laurie" describes her encounter with a sleazy, profiteering cardiologist. She survives, but not without paying a dear price.

Thyroid: Be a perfectionist

If you'd like to reduce LDL cholesterol with nearly as much power as a statin drug, think thyroid.

When thyroid is corrected to ideal levels, LDL cholesterol drops 20, 30, 40 mg/dl or more, depending on how poor thyroid function and how high LDL are at the start. The poorer the thyroid function (the higher the TSH or the lower the T3 and T4) and the higher the LDL cholesterol, the more LDL drops with thyroid correction.

(For those of you minding LDL particle size, such as Track Your Plaque Members, the "dominant" LDL species will drop: If you are genetic small LDL, small LDL will drop. If you have mostly large LDL because of being wheat-free and sugar-free, then large LDL will drop.)

One of the problems is that many healthcare providers blindly follow what the laboratory says is "normal" or the "reference range," which is usually nothing more than a population average (actually the mean +/- 2 standard deviations, a common method of developing references ranges). In other words, a substantial degree of low thyroid function, or hypothyroidism, can be present when your doctor adheres to the reference range provided by the laboratory.

What does it mean to achieve ideal thyroid status? My list includes:

--Normal oral temperature of 97.3 F first upon arising. (The thyroid is the body's thermoregulatory organ.)
--TSH 1.0 mIU/L or less
--Free T3 upper half "normal" range
--Free T4 upper half "normal" range
--You feel good: mental clarity, energy, upbeat mood. You lose weight when you try.

Iodine replacement should be part of any thyroid health effort. Iodine is not an optional trace mineral, no more than vitamin C is optional (else your teeth fall out). The only dangers to iodine replacement are to those who have been starved of iodine for many years; increase iodine and the thyroid can over-respond. I've seen this happen in 2 of the last 300 people who have supplemented iodine.

In my view, neglecting T3 replacement is absurd. While it is not clear to me why many otherwise healthy people have low T3 at the low range of "normal" or even in the below-normal range, people feel better and have better health--faster weight loss, reduced LDL, reduced triglycerides, they are happier and enjoy more energy--when T3 is increased to the upper half of the reference range. (Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one.)

It pays to be a perfectionist when it comes to thyroid. Not only do you feel better, but LDL cholesterol can drop with a statin-like magnitude, but with none of the adverse effects.

If interested, Track Your Plaque offers fingerstick blood spot testing that you can perform in your own home. Each test kit will test for: TSH, free T3, free T4, along with a thyroid peroxidase antibody (a marker for Hashimoto's thyroiditis, an autoimmune inflammatory condition of the thyroid).

Nutrition Syllogism

What do you think of these chains of logic?

Cyanide is a potent lethal poison; carbon monoxide is a less lethal poison.
Therefore: plenty of carbon monoxide is good.




Having uterine cancer is a bad thing. Having uterine fibroids is a less bad thing.
Therefore: plenty of uterine fibroids are good.



These are obvious examples of seriously flawed logic. Students of logic and philosophy will recognize the above erroneous sequences as examples of the twisted arguments often used to persuade an argumentative opponent of the logic of a premise. As long ago as 335 B.C., Greek philosopher, Aristotle, recognized the pitfalls of thinking in such arguments. You think we’d know better by now.

Try this one:

White enriched flour is a bad for health; whole grains are less bad for health.
Therefore: plenty of whole grains are good for health.



Ouch!

In the 1960s, we all ate hot dogs on white buns, white flour Wonder Bread® sandwiches, Mom made cookies and cupcakes with white flour. Then, during the 1970s and 1980s, clinical studies were performed demonstrating that whole wheat and whole grains reduced colon cancer, high blood pressure, diabetes, and heart disease compared to white flour. In other words, add back fiber and B vitamins and health benefits develop: No argument here.

Therefore: whole grains must be good for health. Further, lots of whole grains?unlimited quantities of whole grains many times per day, every day?must be even better. Even the USDA says so on their nutrition pyramid, with 8-11 servings of grains per day, 4 of which should be whole grains, at the widest portion of the pyramid.

But what happens when you follow this logic through and fill your diet with whole grains?

Look around you and it’s easy to see: Appetite increases, people become obese, blood sugar increases, diabetes develops, HDL cholesterol plummets, triglycerides skyrocket, inflammatory patterns (e.g., c-reactive protein, or CRP) increase, small LDL (the number one cause for heart disease in the obese U.S.!) shoots through the roof.

I would no more fill my diet with “healthy whole grains” than I would close my garage door with the car running.

Is pomegranate juice healthy?


Pomegranate juice, 8 oz:

Sugars, total 31.50 g

Sucrose 0.00 g

Glucose (dextrose) 15.64 g

Fructose 15.86 g




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

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


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

Image courtesy Wikipedia

Honeydew melon


Honeydew melon:

Sugars, total 51.97 g

Sucrose 15.87 g

Glucose 17.15 g

Fructose 18.94 g

Because sucrose is half fructose (the other half is glucose), there are approximately 26 grams of fructose per one-half honeydew melon.



Image courtesy Wikipedia
De Novo Lipo-what?

De Novo Lipo-what?

Humans have limited capacity to store carbohydrates. Beyond the glucose and glycogen in our blood and tissues, we have relatively little carbohydrate to draw from in time of energy need. That's why long-distance runners and triathletes have to carry sugar sources to keep blood sugar from plummeting.

Fat, of course, is different. We have virtually unlimited capacity to store energy as fat.

Because we have limited carbohydrate storage capacity, what can the body do with the excessive quantities of carbohydrates that Americans ingest? What becomes of a bagel for breakfast, wheat crackers for snacks, a whole wheat sandwich for lunch, pretzels, and whole wheat pasta that many people eat every day, not to mention the chips, soft drinks, and juices?

Excess carbohydrates are diverted to an interesting metabolic pathway called de novo lipogenesis (DNL). This refers to the liver's ability to make triglycerides from excessive carbohydrates in the diet. Triglycerides are packaged for release into the blood as VLDL. VLDL, in turn, interacts with other lipoproteins, creating small LDL particles, reduced HDL and smaller, less protective HDL. High VLDL will be measured on a standard cholesterol panel as higher triglycerides.

A University of California (Berkeley, San Francisco) group has done much of the work describing DNL.

A diet weighed towards carbohydrates, especially if 50% or greater calories are carbohydrate, is sufficient to provoke plenty of DNL, even in slender people. DNL is a big part of the reason why low-fat (and, thereby, high-carbohydrate) diets result in higher triglycerides. DNL really gets turned on many-fold if the carbohydrates are "simple," rather than "complex."

Overweight people, however, can demonstrate five-fold greater DNL even with lesser quantities of carbohydrate intake (e.g., 40% fat, 46% carbohydrate, 14% protein):





From Schwarz et al 2003. Mean (± SEM) fractional de novo lipogenesis in lean normoinsulinemic (NI), obese NI, and obese hyperinsulinemic (HI) subjects after 5 d of consuming a high-fat, low-carbohydrate diet and in different lean NI and obese HI subjects after 5 d of consuming a low-fat, high-carbohydrate diet. Values with different superscript letters are significantly different.


Excessive carbohydrates, a la standard low-fat diets, are good for nobody. The concept of de novo lipogenesis fills in a theoretical hole that now explains why people who eat carbohydrates have higher triglycerides, VLDL, and, eventually, insulin resistance and diabetes.

Comments (16) -

  • Dave

    1/5/2010 5:11:24 PM |

    Just how do higher VLDL and higher triglycerides promote insulin resistance?

  • Anonymous

    1/5/2010 6:03:32 PM |

    Dr. Davis, I've just recently stumbled upon this blog and I love it.  Thank you for so generously sharing your insights.

    I was wondering if would suggest any different dietary guidelines for people with familial hypercholesterolemia.  In particular, I have heterozygous FH for which I am taking 40mg Crestor, but I am an otherwise healthy, lean 25 year old male with lipid numbers of 47 Trig / 169 LDL (calculated)/ 73 HDL.  I closely follow a paleo/primal diet and fitness routine so I am hoping the LDL is the large and in little danger of oxidation.

    To any other FHers out there, I would be happy to hear about your experiences.

    Thanks!

  • Anonymous

    1/5/2010 9:54:50 PM |

    46% carbs is still high in my opinion. I tend to agree with Dr. Eades in the book Protein Power where your carb requirements should not exceed 1.3 times your protein requirements and that should be based on lean body mass and activity level. The rest fat, mostly saturated animal fat. Tropical oils are great too.

  • Anonymous

    1/5/2010 10:45:04 PM |

    Does this chart, which shows that HI people have much higher DNL on a low-carb diet, explain Gretchen's result in your previous article?  She is HI (hyperinsulinemic), right?

    So people on a low-carb/high-fat diet who have normal levels of insulin will not experience the post-prandial spike in triglycerides that Gretchen did.

  • Anonymous

    1/6/2010 1:56:22 PM |

    DNL really gets turned on many-fold if the triglycerides are "simple," rather than "complex."

    Could you please explain the difference between 'simple' and 'complex' triglycerides.

    Thanks!

  • LynneC

    1/6/2010 7:27:38 PM |

    Anonymous re familial Hz hypercholesterolemia.  I, too, am Hz and started with the Track your Plaque (Dr Davis') program about 4 months ago. I think that you have stumbled upon the best diet for this condition. (paleo/ low-carb) I am trying to find that balance of the least amount of Crestor that I can take vs how much sat fat I can add to my diet while keeping my LDL in line.
    I was on a weekly total of 80 mg Crestor, and my LDL-c was 170 as of 2 weeks ago. My LDL particle count is still too high, so I have just started to add another 20mg dose per week.  I take it every other day, so my new weekly total of Crestor will be 100mg.

    You should consider joing the Track your Plaque program that is run by Dr Davis.  There many great discussions there and some very sharp minds that contribute to the discussion forum.

    At the very least, get an NMR lipid profile done; this will let you know the most important aspect of your LDL, which is the number of particles that comprise it.

  • Dr. William Davis

    1/7/2010 3:27:39 AM |

    A point of clarification: Fat intake leads to high postprandial triglycerides--there is absolutely no doubt about this. This occurs regardless of insulin sensitivity, body weight, carbohydrate content of the meal, etc.

    Fat = triglycerides. When you eat fat, triglycerides go up postprandially.

  • Dr. William Davis

    1/7/2010 3:29:18 AM |

    Anon--

    Simple carbohydrates = simple sugars like candy, soft drinks, juices: immediately absorbed, no fiber

    Complex carbohydrates = carbohydrates that occur in polymers or bound up in fibers, less rapidly absorbed.

    In my mind, both are undesirable, though complex are less undesirable.

  • Dave

    1/7/2010 5:43:55 AM |

    Dr. Davis, surely you don't mean *all* complex carbohydrates are undesirable, do you?  Carbohydrates from, say, sweet potatoes and oat bran must be (more than) just fine, on balance.  And as to fat, might the solution be to increase good fat (mono and omega-3) but avoid saturated and trans fat?

  • Dr.A

    1/7/2010 12:14:22 PM |

    Great post! I have just completed a university nutrition course... knowing that carbs turn to fat easily I was stunned to find the following in my course text:
    The amount of glycogen that can be stored is quite limited(no more than a few hundred grams in total), so the stores are filled quite quickly and if more glucose is available, then the excess could be converted into fat for storage. Fat stores in the body are effectively unlimited. However, it appears that excess carbohydrate is normally used for energy rather than being converted to fat.

  • Ryan Koch @ Health Matters to Me

    1/9/2010 6:42:36 PM |

    Dr. Davis,

    Aren't the results of the study questionable due to the fact that the participants' diet was prepared in a laboratory and may have consisted of health-altering foods (i.e. gluten, artificial fructose, trans fats, veggie oils)?  Do they list the diet composition in the study?  I may have missed it.

    Also, regarding runners and their fuel sources: I've read that Ethiopian runners don't hit "the wall" like runners in more modern cultures do.  This means they have an efficient fat-burning metabolism, correct?  Their diet composition is mostly starchy non-gluten carbs:

    "Diet was high in carbohydrate (76.5%, 0.4 g/kg BM per day) and low in fat (13.4 %)."
    Food and macronutrient intake of elite kenyan distance runners

    Interesting?

  • Anonymous

    3/29/2010 9:49:16 AM |

    "However, it appears that excess carbohydrate is normally used for energy rather than being converted to fat."

    That's true. The biggest impact of carbs is that they are used for energy first, which means more of the fat consumed can be stored. This has been proven with radioactive studies that show that most of the fat in your body comes from fat in food, not from carbs. Of course, if you consume enough carbs, then those too will be converted to fat. Also, whether carbs directly become fat or not, the outcome is the same: more fat is stored in presence of more carbs.

  • MachineGhost

    5/25/2010 5:44:55 AM |

    Much of the confusion here seems to be the unawareness that different saturated fat subtypes have different post-prandial effects.  This was demonstrated by Hegsted eons ago and formulated into an equation.  Google it.

    Clearly, the predominant subtype of saturated fat in fatty meats is HARMFUL.  A HEALTHY high fat, low carbohydrate diet is EQUALLY BALANCED among the three fat macrotypes, not EXTREME to saturated fat.  Typically, studies just use the Atkins version of extreme high satirated fat, low carb.  A recent study showed that eating 1-2 slices of processed lunchmeat or 1 hot dog a day increases heart disease risk by 40% and diabetes by 20%, and that's on top of the increased risk of cancer from the nitrates.

    As far the high carb, low fat diet (S.A.D.), the culprit is the lack of soluble fiber which slows down post-prandial absorption.  The best at ameliorating this role is glucomannan.

    But people, don't kid yourself.  There are SEVENTEEN independent risk factors for heart disease.  You have to circumvent ALL of them to completely eliminate the risk.  A low, unrefined carb diet (<25% calories) with the remaining calories from balanced, unrefined fats and lean protein is a big part, but the rest involves influencing biochemistry and genetic expression via supplementation.

  • buy jeans

    11/3/2010 2:31:42 PM |

    A diet weighed towards carbohydrates, especially if 50% or greater calories are carbohydrate, is sufficient to provoke plenty of DNL, even in slender people. DNL is a big part of the reason why low-fat (and, thereby, high-carbohydrate) diets result in higher triglycerides. DNL really gets turned on many-fold if the triglycerides are "simple," rather than "complex.

  • ron

    1/1/2012 9:02:20 PM |

    Eat your complex carbs, and take a vegan algae-derived DHA/EPA supplement. Your triglycerides, if they're high, will drop like a stone. The healthiest, longest-lived, large populations on the planet eat starch-based diets.

  • Kirk

    1/4/2012 10:40:50 PM |

    If the problem with carbs is DNL, this implies that an amount up to where DNL is triggered is safe.  So I see why you recommend no more than 15 net carbs per meal.  Would this amount change for a (natural) body builder?  For example, i do 30 min strength training with weights at double my body weight.  I would like to replenish my muscles to prevent glycogen depletion.  Do you think it would be safe to increase the amount of carbs consumed in the post work out meal to 30 or 50g of complex carbs?

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