Fat Head: Tom Naughton's manifesto for low-carb eating

12. March 2010 William Davis (16)
I just got back from Jimmy Moore's low-carb cruise to the Bahamas.

Among the many interesting people I met on the cruise was the creator of the documentary film, Fat Head, Tom Naughton.

Tom brings both creative insights into low-carbohydrate eating as well as humor. Low-carb eating can be a pretty contentious issue, but Tom made it fun. He will make you laugh about many of the odd notions we have about diet.

Among the best parts of Fat Head is Tom's portrayal of the effects of carbohydrates on insulin and fat metabolism:






Fat Head joins the ranks of films like Food, Inc, that make nutrition information entertaining. For anyone interested in a unvarnished look at diet, weight loss, along with a few laughs along the way, Tom Naughton's Fat Head is worth viewing.

Oatmeal: Good or bad?

11. March 2010 William Davis (67)

You've heard it before: oatmeal reduces cholesterol. Oatmeal producers have obtained permission from the FDA to use a cholesterol-reducing claim. The American Heart Association provides a (paid) endorsement of Quaker Oats.

I've lost count of the times I've asked someone whether they ate a healthy breakfast and the answer was "Sure. I had oatmeal."

Is this true? Is oatmeal heart healthy because it reduces LDL cholesterol?

I don't think so. Try this: Have a serving of slow-cooked (e.g., steel-cut, Irish, etc.) oatmeal. Most people will consume oatmeal with skim or 1% milk and some dried or fresh fruit. Wait an hour, then check your blood sugar.

If you are not diabetic and have a fasting blood sugar in the "normal" range (<100 mg/dl), you will typically have a 1-hour blood glucose of 150-180 mg/dl--very high. If you have mildly increased fasting blood sugars between 100 and 126 mg/dl, postprandial (after-eating) blood sugars will easily exceed 180 mg/dl. If you have diabetes, hold onto your hat because, even if you take medications, blood sugar one hour after oatmeal will usually be between 200 and 300 mg/dl.

This is because oatmeal is converted rapidly to sugar, and a lot of it. Even if you were to repeat the experiment with no dried or fresh fruit, you will still witness high blood sugars in these ranges. Do like some people and pile on the raisins, dried cranberries, or brown sugar, and you will see blood sugars go even higher.

Blood sugars this high, experienced repetitively, will damage the delicate insulin-producing beta cells of your pancreas (glucose toxicity). It also glycates proteins of the eyes and vascular walls. The blood glucose effects of oatmeal really don't differ much from a large Snickers bar or bowl of jelly beans.

If you are like most people, you too will show high blood sugars after oatmeal. It's easy to find out . . . check your postprandial blood sugar.

In past, I recommended oat products, specifically oat bran, to reduce LDL, especially small LDL. I've changed my mind: I now no longer recommend any oat product due to its blood sugar-increasing effects.

Better choices: eggs, ground flaxseed as a hot cereal, cheese (the one dairy product that does not excessively trigger insulin), raw nuts, salads, leftovers from last evening's dinner.

Mustard: Super health food?

6. March 2010 William Davis (32)
Could mustard--yes, the yellow condiment you smear on hot dogs--be a super heart healthy food in disguise?

Consider that mustard contains:

Vinegar

Turmeric

No appreciable sugar


The vinegar slows gastric emptying, resulting in slower absorption of any carbohydrates and a reduced glucose area-under-the-curve. Of the little fats contained (about 3 grams per 1/4 cup), most are desirable monounsaturates. Mustards are relatively rich in selenium, with 20 mcg per 1/4 cup, helpful for protection against cancer and thyroid disease, and magnesium, 31 mg per 1/4 cup.

Turmeric is added to most mustards. One of the constituents of turmeric, curcumin, the substance that confers the bright yellow color, has been a focus of interest for its anti-inflammatory effects. Curcumin has been documented to reduce activity of the inflammatory enzymes cyclooxygenase-2 (COX-2), lipoxygenase, and reduce activity of inflammatory signal molecules, tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1,2,6,8, and 12, and monocyte chemoattractant protein (MCP). Curcumin also has been shown to reduce LDL oxidation, a potentially important step in atherosclerotic plaque formation. Turmeric is used as a tea by Okinawans. (Hmmmm . . . )

Turmeric content of mustard can vary, of course. Likewise, sugar content. Look for mustards that are not sweetened, so avoid honey mustard in particular. Look for hot, brown, horseradish, Dijon, etc. If there is a downside to mustard, it's sodium content, though the 709 mg per 1/4 cup should only be a problem for those who are sodium-sensitive (African Americans, in particular).

So perhaps mustard isn't exactly a super health food. But it may have some bona fide health effects and should be used generously especially if you are concerned about blood sugar and inflammatory phenomena.

Exercise and blood sugar

5. March 2010 William Davis (30)
There is no doubt that exercise yields benefits across a spectrum of health: reduced blood pressure,  reduced inflammation, reduced blood coagulation, better weight control, stronger bones, less depression, reduced risk for heart attack.

Exercise also influences blood sugar. Diabetics understand this best: Exercise reduces blood sugar 20, 30, 50 or more milligrams. A starting blood sugar, for instance, of 160 mg/dl can be reduced to 80 mg/dl by jogging or riding a bicycle. (I recently had brunch at an Indian restaurant with my family. Blood sugar one-hour postprandial: 134 mg/dl. I was sleepy and foggy. I got on my stationary bike and pedalled at a moderate clip for 60 minutes. Blood sugar: 90 mg/dl.)

Could the reduction of blood sugar with exercise be THE reason that exercise and physical activity provide such substantial benefits?

Think about it. Reduced blood sugar:

1) Reduces risk for future cardiovascular events.
2) Reduces glycation of proteins, i.e., reduced glucose binding to proteins like the ones in artery walls and the lenses of your eyes.
3) Reduces blood coagulation
4) Reduces endothelial dysfunction (abnormal artery constriction that leads to atherosclerosis)

This might explain why it doesn't require high levels of aerobic activity to derive benefit from exercise, since even modest efforts (e.g., a 15-minute walk after eating) reduce blood sugar substantially.

The incredible 33-year, 18,000-participant Whitehall study tells us that a postprandial (after-eating) blood sugar of an impossibly-difficult 83 mg/dl is required to erase the excess cardiovascular risk of blood sugar. Could this simply be telling us that physical activity or exercise is required to suppress blood sugars to these low levels?

It makes me wonder if an index of the adequacy of exercise is your post-exercise blood glucose.

The most important weight loss tool

4. March 2010 William Davis (15)

Question: What is the most effective tool available to help you lose weight? 


A pedometer (walk 10,000 steps, etc.)?

A treadmill? 




A bicycle?






No. None of the above. 

The most important tool you can use to achieve weight loss is your glucose monitor:



Timing of blood sugars

3. March 2010 William Davis (5)
Because different foods generate different blood sugar (glucose) responses, the timing of your blood sugar is an important factor to consider.

This question has come up a number of times. Commenters have asked whether the one-hour postprandial glucose is timed with the start of the meal or the conclusion of the meal.

In my view, if we simply ignored all aspects of meal composition, then blood glucose should be obtained one hour after the conclusion of a meal. This is because most mixed meals (i.e., mixed in composition among proteins, fats, and carbohydrates) yield peak blood glucose levels at 60-90 minutes after consumption. Timing blood glucose to 60 minutes after the conclusion of a meal puts the sample right about at the peak.

But this is an oversimplification. For instance, here is the blood glucose behavior after so-called "complex" carbohydrates wheat bread, rye bread, rye made with beta glucan, and whole wheat pasta (50 grams carbohydrates each) in slender, healthy volunteers, mean age 29 years:


From Juntunen et al 2002

Note that blood glucose peaks at 35 minutes postprandial. (To convert glucose in mmol/L to mg/dl, multiple by 18. Thus, whole wheat bread increased blood glucose from 94 mg/dl to 122 mg/dl. Also note the lower peak glucose for pasta, but sustained higher glucose levels hours later.)

In another study, older (mean age 64 years), overweight (BMI 27.9) females with diabetes were given 50 grams carbohydrate, 50 grams carbohydrate with olive oil, or 50 grams carbohydrate with butter:


From Thomsen et al 2003. Control meal of soup plus 50 g carbohydrates ({blacktriangledown}), the control meal plus 80 g olive oil ({circ}), and the control meal plus 100 g butter (•).

In this experience, note that postprandial glucose peaks 60-120 minutes after the meals (consumed within 10 minutes), delayed more when either oil is included. Blood glucose started at 144 mg/dl and peaked as high as 230 mg/dl with carbohydrates only; peaks were reduced (along with AUC) when oil was included. (Note the differential effect, olive oil vs. butter.)

These two sets of observations give you a range of blood glucose behavior. One side lesson: Carbohydrates should never consumed by themselves, else you will pay with a high blood sugar (not to mention the hypoglycemic response later for many).

Psssst . . . There's sugar in there

1. March 2010 William Davis (13)
You non-diabetics who check your postprandial blood sugars already know: There are hidden sources of sugar in so many foods.

By now, everybody should know that foods like breakfast cereals, breads, bagels, pretzels, and crackers cause blood sugar to skyrocket after you eat them. But sometimes you eat something you thought was safe only to find you're showing blood sugars of 120, 130, 150+ mg/dl.

Where can you find such "stealth" sources of sugars that can screw up your postprandial blood sugars, small LDL, inflammation, blood pressure, and cause you to grow visceral fat? Here's a few:

Balsamic vinaigrette
Many commercially-prepared balsamic vinaigrettes, especially the "light" varieties, have 3 or more grams carbohydrates per tablespoon. Generous use of a sugar-added vinaigrette can therefore provide 12+ grams carbs. (Some, like Emeril's and Wish Bone, also contain high-fructose corn syrup.)

Hamburgers
I learned this lesson the hard way by taking my blood sugar after having a hamburger, turkey burger, or vegetarian burger (without bun): blood sugar would go way up. The effect is due to bread crumbs added to the meat or soy.

Tomato soup
If it were just tomatoes, it would still be somewhat high in sugars. But commercially-prepared tomato soup often contains added high-fructose corn syrup, sucrose, and wheat flour, bringing sugar totals to 12 to 20+ grams per half-cup. A typical 2-cup bowl of tomato soup can have upwards of 80 grams of sugar.

Granola
Sure, granola contains a lot of fiber. But most granolas come packed with sugars in various forms. One cup of Kellogg's Low-fat Granola with Raisins contains an incredible 72 grams (net) carbohydrates, of which 25 grams are sugar.


Given modern appetites and serving sizes, you can see that it is very easy to get carried away and, before you know it, get exposed to extraordinary amounts of sugar and carbohydrates eating foods you thought were healthy.

And don't be fooled by claims of "natural" sugar. Sugar is sugar--Just check your blood sugar and you'll see. So raw cane sugar, beet sugar, and brown sugar have the same impact as white table sugar. Honey, maple syrup, and agave? They're worse (due to fructose).

How low should blood sugar be?

28. February 2010 William Davis (0)
What should your blood sugar (glucose) be after eating?

Take a look at the data from the Whitehall study reported in 2006. The Whitehall Study stands apart from other studies in that it was very large (over 18,000 participants) who were observed for an unusually long time (33 years). All participants were administered a 50 gram glucose "challenge" at the start with glucose levels checked after the glucose challenge.

Here's what they found:




From Brunner et al 2006.
Jimmy Moore's thyroid adventure

Jimmy Moore's thyroid adventure

10. January 2010 William Davis (17)
My friend, Jimmy Moore of Living La Vida Low Carb, describes his thyroid experience here.

As Jimmy points out, he was looking for a way to jump-start a 50-lb weight loss. In my experience, low thyroid hormone levels ("hypothyroidism") are an exceptionally common cause for weight gain. Correcting even marginal hypothyroidism can facilitate weight loss, often resulting in 10 or more pounds of weight loss within the first month.

Unfortunately, Jimmy's thyroid hormone panel proved normal: TSH 1.3, thyroid hormones free T3 and free T4 in the mid- to upper-half of the reference range.

I say "unfortunately" because it is really an easy, inexpensive, and benign solution for losing weight. (I don't, of course, wish that Jimmy or anyone else develops a thyroid condition. But it really can provide gratifying weight loss results when thyroid function is low.) Jimmy might consider taking his oral temperature first thing in the morning as another means of assessing the adequacy of thyroid function.

Perhaps you will be luckier than Jimmy and have thyroid dysfunction that can be corrected and jump-start your weight loss program. Fingerstick thyroid test kits like the one Jimmy used are available here from Track Your Plaque.
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Comments (17) -

  • Jimmy Moore

    1/10/2010 3:10:02 AM |

    Actually, I have been taking my temperature first thing in the morning for the past two weeks, Dr. Davis.  The average reading when you throw out the highest and the lowest is 96.5.  What does this mean and what can I do to correct the issue?

  • Jenny

    1/10/2010 2:43:19 PM |

    Long term LC does something to some of us that isn't detectable by any lab test including the fancy ones but it is very real. That is why I can't  eat at VLC levels for prolonged periods any more. It took over 2 years of VLC eating to develop symptoms the first time, a year the second time and now after 2 months of VLC I'm half dead and freezing cold.

    Some kind of controlled carb cycling might help. I have been experimenting with modified alternate day fasting to do intense calorie changes which seems to be raising my body temperature, but unfortunately, it is tough to do with unstable blood sugars.

    It makes sense that the body responds to prolonged weight loss by slowing everything down to conserve energy and keep us alive and that this is happening in a way that involves ALL the hormones that regulate weight, which includes a lot more stuff than thyroid.

  • Anonymous

    1/10/2010 3:07:05 PM |

    My basal temp in the mornings averages about 96. My doctor wrote a prescription for Armour Thyroid, but it has been back ordered at the pharmacy for months.
    All I can do is wait to try this.

    Jeanne

  • William Trumbower

    1/10/2010 6:19:01 PM |

    I believe the temps indicate an hypometabolic state.  The most common is hypothyroidism type 2.  My first step is to supplement with Iodine such as Iodarol 12.5 daily.  The next step is to try and eliminate the toxins in your diet that inhibit thyroid function.   See the list in Dr. Stars book.  If your temps stay low, consider supplementing with desiccated thyroid (if you can get it) The best product is naturethroid by RLC labs.  I would start low (30mg or 1/2gr) and slowly increase using your symptoms and temps to guide you.  Don't forget to test your hormones.  Low testosterone can cause a hypometabolic state.  If you supplement with natural testosterone, you should consider a small amount of progesterone and a product like Testanex to help decrease the aromatization of testosterone to estradiol.

  • Marco

    1/10/2010 9:57:45 PM |

    Dr. Davis - I think I am in the same boat - my T3 is normal (326), but T4 & TSH are borderline low (0.68 & 1.49) with morning temp of 97.3.  My doctor says these levels are "normal", but I suspect they are partly causing my abdominal fat issues.  So what exactly is your "easy, inexpensive, and benign solution"?

  • Anonymous

    1/11/2010 8:55:19 AM |

    I just used this method over 2 months or so to get iodine levels up....using around 1/3 bottle of tincture of iodine.

    http://www.noaw.com/Iodine%20Def/tincture_of_iodine.htm

    Did notice some increased mental clarity...I think.  No extra weight loss that I can tell...though I did change my diet.

  • Diana Hsieh

    1/11/2010 7:19:56 PM |

    Hi Jimmy,

    I've been reading up on your thyroid testing, and I'm curious as to whether you have any of the other classic symptoms of hypothyroidism apart from the weight gain -- like lethargy, poor memory, feeling cold, muscle pains, depression, etc.  

    I was diagnosed as hypothyroid in November.  I've been on 50 mcg of Synthroid, with absolutely zero effect so far.  (I got new labs done last week, including a reverse T3.  I'm waiting to hear from my doctor about the results.)  My numbers aren't terribly bad, although my TSH was 3.23 in November.  And I have those symptoms I mentioned above in spades, such that I've been unable to work.  (I'm very unhappy about that!)  Also, I have a single-nodule goiter.  My temperatures are like yours -- averaging 96.5 a few weeks ago, and now just slightly over 97.

    I posted more details here:

    http://www.dianahsieh.com/blog/2009/11/lethargic-fat-pained-and-cold.shtml

    http://www.dianahsieh.com/blog/2009/11/thyroid-update.shtml

    http://www.dianahsieh.com/blog/2010/01/another-thyroid-update.shtml

    I've found a local source of desiccated thyroid, so I definitely want to switch to that.  

    I've learned that hypothyroidism is rampant in the women of the family, and both my mother and sister have a goiter.  I suspect that iodine deficiency -- brought to my attention by Dr. Davis (thank you!) -- is part of my problem.

    A friend of mine has similar symptoms (albeit milder), but her TSH is normal.  And I've read tons of accounts from people with fairly normal lab values, but with pretty clear hypothyroid symptoms.  (I'm not sure if their Free T3 and T4 were good, or if just their TSH was normal.)  Oddly, my Free T3 and T4 aren't terrible, although in the lower-middle of the reference range, despite my elevated TSH.

    In any case, I just wanted to encourage you to keep us apprised of what you discover.

    Thanks to you and Dr. Davis!

  • Dr. William Davis

    1/11/2010 8:51:42 PM |

    Hi, Jimmy--

    Personally, I would first take iodine supplements (e.g., kelp or drops) for 2-3 months and reassess. You might then opt for a low dose of thyroid, preferably both T3 and T4 if thyroid does not improve.

  • Electronic Medical Records

    2/10/2010 6:34:59 PM |

    Hilarious but true...the weight loss factor of this disease is really beneficial...hard to deal with the rest though.

  • lynn

    2/18/2010 6:21:26 PM |

    Dr. Davis, Jimmy has thyroid antinbodies. You may say they are low, but do you think it is healthy to have antibodies against one’s thyroid!? Seriously... Jimmy DOES have a thyroid problem and it is called Hashimotos.

    Furthermore, iodine can worse Hashimotos, so a person with Hashi’s should make sure to test their levels before supplementing iodine.

    Also, most hypothyroid patients need their FT3 to be at the TOP of the range; not just mid range.

    Finally, Jimmy has many of the clinical signs and symptoms of a thyroid problem: weight issues, high total cholesterol, coldness and fatigue.

  • Jeans

    11/2/2010 9:29:04 PM |

    Perhaps you will be luckier than Jimmy and have thyroid dysfunction that can be corrected and jump-start your weight loss program. Fingerstick thyroid test kits like the one Jimmy used are available here from Track Your Plaque.

  • Breast Augmentation Los Angeles

    11/30/2010 1:06:18 PM |

    That is true that there is a definite loss of weight when struck with thyroid.But that is the least there are other much worse symptoms which better be avoided.

  • porcine thyroid

    2/8/2011 10:25:47 AM |

    Hi!I have mixed symptoms of hypo and hyper thryoid. I take porcine thyroid daily. I feel much much better now

  • Anonymous

    3/18/2011 4:13:07 PM |

    My morning temperature is usually around 96.7.  My TSH is 1.244. Free T3 is 11.0.  Free T4 is 3.5.  I have mild adrenal fatigue.  I need to lose 5-7 pounds, and it is very difficult.  I have given up grains and junk food.  I mainly eat eggs, meat, vegetables, and nuts - no fruit. Most people who eat like me would be very thin.  My gynecologist suggested going on a low dose of Armour Thyroid.  I am confused.  He says my T3 and T4 are high; so why would I go on Armour?  Any suggestions or ideas will be greatly appreciated. I have not been able to find a doctor that I trust.
    P.S.  I am taking kelp capsules daily.
    Sandra

  • Anonymous

    3/18/2011 4:49:54 PM |

    I'm Sandra; I just posted earlier.  My doctor's assistant just called and said that she gave me T4 and T3 numbers, not Free T4 and Free T3.
    My Free T3 is 2.1 and my Free T4 is 1.5.  My TSH is 1.244. So, from my understanding, my T3 is below normal. This makes more sense to me.  I asked them if I could go on Naturethroid instead of Armour.  She is checking with the doctor.  Still would appreciate suggestions or ideas.
    Sandra
    P.S.  Dr. Davis, I  appreciate your blog.  I check it regularly.

  • Allen Sawyer

    3/28/2011 5:57:53 AM |

    This is I think one of the best blogs I've come across this year. Keep up.

    Medicine Reminder

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