Condition Afflicts Millions: Do you have “YBS”?

12. May 2014 Lisa G Nutrition (0)
After one of the harshest winters, spring has finally arrived.  The welcomed warmer temperatures and longer daylight hours infuse us with a sense of renewal and new beginnings.   Low and behold we begin to come out of hibernation and start the mad dash to engage in positive lifestyle changes such as eating better, exercising, proper sleep and taking appropriate nutritional supplements.  But invariably, life happens.  

Yep, just when you were about to get started, it happens.  YBS sets in.   I see this “condition” all too often with clients attempting to enter or re-enter into any number of behavior changes.  I will go so far as to say we all have been afflicted at one point or another in our lives.  I call this condition Yeah But Syndrome, or “YBS”.    It is often paralyzing and prevents those afflicted from moving into action, instead remaining in a state of inertia.  

There are many symptoms of YBS but the following are some of the most common.  

• Yeah I planned to go to the gym today BUT, the kids needed a ride to practice.  
• Yeah I really want to eat better BUT I don’t have the time.   
• Yeah I didn’t plan to eat the cake BUT my husband wanted too, so I did also.   
• Yeah I really meant to go to the grocery shopping BUT I was too tired, so I hit the drive- thru.  
• Or this is a good one. Yeah I meant to start today BUT, I’ll start tomorrow.  

But tomorrow never comes.  You get the drift.  We can all come up with a million yeah buts, in other words, excuses.    The good news is the treatment for YBS is simple--just do it!  Take action.  The reality of today’s 24-7 planet is there will always be something.  The kids, work commitments, family obligations and various projects that need your attention will perpetually be present in some shape or form.  The difference to make the difference is to learn to dance in the rain, not wait for the rain to pass.  When will all the stars align so that your world will be “just right” to start?  If not NOW, WHEN will you begin?  

The key word here is begin.   Far too frequently, I coach clients that shoot themselves in the foot before they start.   Instead of consuming yourself with all the barriers to entry, select reasonable, low-hanging fruit that is “doable.”    The art of lifestyle change is to avoid all-or-nothing thinking and begin to appreciate what you CAN do, versus focusing energy on what you can’t do.  What is one action you can do TODAY to move toward your wellness goal(s)?  Start to focus on what you can do in the mist of your existing life demands. This mantra is a friendly reminder: BE-DO-HAVE.  Be committed.  Do what it takes.  And you will have results.  

Lastly, if you think removing cereal from your morning routine it is too difficult and you can’t do it. Guess what-- you’re likely right.   What you think is what you get!   But what if you think instead, “I can do this.  There are many truly healthy options for breakfast to replace cereal such as eggs and veggies that will help me look and feel my best.”  Then guess what--you will!  This simple change in mind-set can start a tidal wave of change and prevent you from abandoning ship when life tosses you into rough waters.  Ongoing support is hugely important to sustain lifestyle changes.  Join the conversations in the Cureality Forum to engage the support of health coaches and Cureality Members to stay on track. 

We Need More.....Kettlebell

8. May 2014 Amber B Exercise (0)
You either love them or you hate them.

When you are in love with kettlebells, like I am, you enjoy the multi-muscle group movements.  Kettlebell workouts are fluid, like a dance, putting together a chain of movements that leave your heart pounding and sweat pouring.  Yes, there’s some sneaky cardio component to a kettlebell workout.   A great blend of aerobic and anaerobic conditioning.

If you hate kettlebells it’s because kettlebell exercises keep you honest with proper exercise execution.  Form is imperative to moves like the kettlebell swing or the kettlebell snatch.  Do it incorrectly and you’ll be either sore or have bruised wrists the next day.  But this is no reason to shy away from the kettlebell.  You have way too much to gain from this odd looking piece of exercise equipment.  

You will get a mega -caloric burn.  The American council on Exercise states that the average kettlebell workout burns 20 calories per minute.  That’s 1200 calories in just one hour.   Kettlebell workouts utilize many muscle groups to give you an efficient, total body conditioning workout.  

If you’re looking for a toned back side get a kettlebell.  The classic kettlebell swing works all the posterior muscles like your glutes, hamstrings, and lower back.  But only if you use correct form.  Otherwise you'll find yourself with nagging back pain, instead of a better butt.  

Kettlebell exercises are functional movements that will allow you to play hard without getting injured.  If you are an athlete, a nature enthusiast, or just want to keep up with the kids then you need to give kettlebells a try.  During a workout, the exercises will target movements that will make getting up and down off the floor easier, as well as bending over to pick something up.

If you are interested in doing kettlebell workouts start with a coach or take class.  You can’t fake form with kettlebell exercises or you could end up hurt.  I’m not trying to scare anyone away because good form is easy to learn.   Your body will memorize the correct movement pattern and you’ll be on your way to a successful kettlebell workout.  

Thyroid and the gut: Hidden health partners

8. May 2014 Chris K Thyroid (0)
Though I have personally dealt with both auto-immune thyroiditis (Hashomoto’s) and several gut issues (wheat sensitivity, gastritis, etc.), it was not until recently that I discovered how close the thyroid and gut work together to keep you healthy – and how problems with one can affect the other along with your overall health.
 
Most of us understand that the primary function of the gut, that 25 to 30 feet of “tubing” that includes everything from your stomach to your large intestines, is to process the food we eat and allow the “good stuff” (essential nutrients) to pass into our blood stream while keeping the “bad stuff” (harmful proteins) out. However, it may surprise some that the gut also holds as much as 70% of all the immune tissue in the body.
 
Now, imagine all the health havoc that could ensue if, suddenly, the gut stopped doing its job – particularly if it failed to stop toxic proteins from entering the blood stream and then mounted an overzealous immune response against them.  Sometimes, those overzealous immune responses reach beyond their intended targets to attack otherwise healthy tissues and organs – like the thyroid gland.
 
Recent studies indicate that thyroid hormones play a significant role in maintaining gut integrity, preventing leaky gut that can, in some cases, lead to auto-immune attacks against the thyroid.  A properly functioning gut also aids the production of thyroid hormones by converting some of the inactive “T4” thyroid hormone into the functional “T3” hormone.  Failure to simultaneously maintain both a healthy gut and a healthy thyroid can create a vicious cycle leading to chronic health problems and declining vitality.
 
What it all means is that to enjoy optimal health, you must promote good thyroid health to promote good gut health and vice versa.  Unfortunately, traditional medicine tends to focus on one issue to the exclusion of others.  A typical endocrinologist may treat your under active thyroid without spending a moment to address underlying gut issues.  A gastroenterologist will work alleviate a gut problem but will rarely address a potential thyroid problem.
 
This illustrates, once again, how our bodies work as a system and why it is necessary to bridge the “healthcare gaps” in traditional medicine by becoming personally responsible for your health.  I encourage everyone to consult the Cureality Program Guide and online Cureality Diet and Thyroid Health Tracks to learn more about how to optimize both your gut and thyroid health on your journey to realizing complete, whole-body health.

Omega-3 fatty acids likely NOT associated with prostate cancer

18. July 2013 William Davis Omega-3 fatty acids (6)
A weakly constructed study was reported recently that purportedly associated higher levels of omega-3 fatty acid blood levels and prostate cancer. See this CBS News report, for instance.

Lipid and omega-3 fat expert, Dr. William Harris, posted this concise critique of the study, exposing some fundamental problems:

First, the reported EPA+DHA level in the plasma phospholipids in this study was 3.62% in the no-cancer control group, 3.66% in the total cancer group, 3.67% in the low grade cancer group, and 3.74% in the high-grade group. These differences between cases and controls are very small and would have no meaning clinically as they are within the normal variation. Based on experiments in our lab, the lowest quartile would correspond to an HS-Omega-3 Index of <3.16% and the highest to an Index of >4.77%). These values are obviously low, and virtually none of the subjects was in “danger” of having an HS-Omega-3 Index of >8%. So to conclude that regular consumption of 2 oily fish meals a week or taking fish oil supplements (both of which would result in an Index above the observed range) would increase risk for prostate cancer is extrapolating beyond the data.

This study did not test the question of whether giving fish oil supplements (or eating more oily fish) increased PC risk; it looked only a blood levels of omega-3 which are determined by intake, other dietary factors, metabolism and genetics.

The authors also failed to present the fuller story taught by the literature. The same team reported in 2010 that the use of fish oil supplements was not associated with any increased risk for prostate cancer. A 2010 meta-analysis of fish consumption and prostate cancer reported a reduction in late stage or fatal cancer among cohort studies, but no overall relationship between prostate cancer and fish intake. Terry et al. in 2001 reported higher fish intake was associated with lower risk for prostate cancer incidence and death, and Leitzmann et al. in 2004 reported similar findings. Higher intakes of canned, preserved fish were reported to be associated with reduced risk for prostate cancer. Epstein et al found that a higher omega-3 fatty acid intake predicted better survival for men who already had prostate cancer, and increased fish intake was associated with a 63% reduction in risk for aggressive prostate cancer in a case-control study by Fradet et al). So there is considerable evidence actually FAVORING an increase in fish intake for prostate cancer risk reduction.

Another piece of the picture is to compare prostate cancer rates in Japan vs the US. Here is a quote from the World Foundation of Urology:

"[Prostate cancer] incidence is really high in North America and Northern Europe (e.g., 63 X 100,000 white men and 102 X 100,000 Afro-Americans in the United States), but very low in Asia (e.g., 10 X 100,000 men in Japan).”

Since the Japanese typically eat about 8x more omega-3 fatty acids than Americans do and their
blood levels are twice as high, you’d think their prostate cancer risk would be much higher...
but the opposite is the case.

Omega-3 fatty acids are physiologically necessary, normalizing multiple metabolic phenomena including augmentation of parasympathetic tone, reductions of postprandial (after-meal) lipoprotein excursions, and endothelial function. It would indeed make no sense that nutrients that are necessary for life and health exert an adverse effect such as prostate cancer at such low blood levels. (Recall that an omega-3 RBC index of 6.0% or greater is associated with reduced potential for sudden cardiac death.)

I personally take 3600 mg per day of EPA + DHA in highly-purified, non-oxidized triglyceride form (Ascenta Nutrasea liquid) that yields an RBC omega-3 index of just over 10%, the level that I believe the overwhelming bulk of data suggest is the ideal level for humans.

Are statins and omega-3s incompatible?

18. June 2013 William Davis (4)
French researcher, Dr. Michel de Lorgeril, has been in the forefront of thinking and research into nutritional issues, including the Mediterranean Diet, the French Paradox, and the role of fat intake in cardiovascular health. In a recent review entitled Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3?, he explores the question of whether statin drugs are, in effect, incompatible with omega-3 fatty acids.

Dr. Lorgeril makes several arguments:

1) Earlier studies, such as GISSI-Prevenzione, demonstrated reduction in cardiovascular events with omega-3 fatty acid supplementation, consistent with the biological and physiological benefits observed in animals, experimental preparations, and epidemiologic observations in free-living populations.

2) More recent studies (and meta-analyses) examining the effects of omega-3 fatty acids have failed to demonstrate cardiovascular benefit showing, at most, non-significant trends towards benefit.

He points out that the more recent studies were conducted post-GISSI and after agencies like the American Heart Association's advised people to consume more fish, which prompted broad increases in omega-3 intake. The populations studied therefore had increased intake of omega-3 fatty acids at the start of the studies, verified by higher levels of omega-3 RBC levels in participants.

In addition, he raises the provocative idea that the benefits of omega-3 fatty acids appear to be confined to those not taking statin agents, as suggested, for instance, in the Alpha Omega Trial. He speculates that the potential for statins to ablate the benefits of omega-3s (and vice versa) might be based on several phenomena:

--Statins increase arachidonic acid content of cell membranes, a potentially inflammatory omega-6 fatty acid that competes with omega-3 fatty acids. (Insulin provocation and greater linoleic acid/omega-6 oils do likewise.)
--Statins induce impaired mitochondrial function, while omega-3s improve mitochondrial function. (Impaired mitochondrial function is evidenced, for instance, by reduced coenzyme Q10 levels, with partial relief from muscle weakness and discomfort by supplementing coenzyme Q10.)
--Statins commonly provoke muscle weakness and discomfort which can, in turn, lead to reduced levels of physical activity and increased resistance to insulin. (Thus the recently reported increases in diabetes with statin drug use.)

Are the physiologic effects of omega-3 fatty acids, present and necessary for health, at odds with the non-physiologic effects of statin drugs?

I fear we don't have sufficient data to come to firm conclusions yet, but my perception is that the case against statins is building. Yes, they have benefits in specific subsets of people (none in others), but the notion that everybody needs a statin drug is, I believe, not only dead wrong, but may have effects that are distinctly negative. And I believe that the arguments in favor of omega-3 fatty acid supplementation, EPA and DHA (and perhaps DPA), make better sense.



DHA: the crucial omega-3

22. May 2013 William Davis (5)
Of the two omega-3 fatty acids that are best explored, EPA and DHA, it is likely DHA that exerts the most blood pressure- and heart rate-reducing effects. Here are the data of Mori et al in which 4000 mg of olive oil, purified EPA only, or purified DHA only were administered over 6 weeks:



□ indicates baseline SBP; ▪, postintervention SBP; ○, baseline DBP; •, postintervention DBP; ⋄, baseline HR; and ♦, postintervention HR.

In this group of 56 overweight men with normal starting blood pressures, only DHA reduced systolic BP by 5.8 mmHg, diastolic by 3.3 mmHg.

While each omega-3 fatty acid has important effects, it may be DHA that has an outsized benefit. So how can you get more DHA? Well, this observation from Schuchardt et al is important:

DHA in the triglyceride and phospholipid forms are 3-fold better absorbed, as compared to the ethyl ester form (compared by area-under-the-curve). In other words, fish oil that has been reconstituted to the naturally-occurring triglyceride form (i.e., the form found in fresh fish) provides 3-fold greater blood levels of DHA than the more common ethyl ester form found in most capsules. (The phospholipid form of DHA found in krill is also well-absorbed, but occurs in such small quantities that it is not a practical means of obtaining omega-3 fatty acids, putting aside the astaxanthin issue.)

So if the superior health effects of DHA are desired in a form that is absorbed, the ideal way to do this is either to eat fish or to supplement fish oil in the triglyceride, not ethyl ester, form. The most common and popular forms of fish oil sold are ethyl esters, including Sam's Club Triple-Strength, Costco, Nature Made, Nature's Bounty, as well as prescription Lovaza. (That's right: prescription fish oil, from this and several other perspectives, is an inferior product.)

What sources of triglyceride fish oil with greater DHA content/absorption are available to us? My favorites are, in this order:

Ascenta NutraSea
CEO and founder, Marc St. Onge, is a friend. Having visited his production facility in Nova Scotia, I was impressed with the meticulous methods of preparation. At every step of the way, every effort was made to limit any potential oxidation, including packaging in a vacuum environment. The Ascenta line of triglyceride fish oils are also richer in DHA content. Their NutraSea High DHA liquid, for instance, contains 500 mg EPA and 1000 mg DHA per teaspoon, a 1:2 EPA:DHA ratio, rather than the more typical 3:2 EPA:DHA ratio of ethyl ester forms.

Pharmax (now Seroyal) also has a fine product with a 1.4:1 EPA:DHA ratio.

Nordic Naturals has a fine liquid triglyceride product, though it is 2:1 EPA:DHA.





Krill oil: Do the math

21. May 2013 William Davis (0)
The manufacturers of krill oil claim that the phospholipid form of omega-3 fatty acids, EPA and DHA, enhance their absorption. There are indeed some data to that effect:


Here are some representative krill oil preparations available on the market:


MegaRed Krill Oil:
EPA 50 mg
DHA 24 mg
Total omega-3s (EPA + DHA + other forms) 90 mg
Price: $28.99 for 60 softgels

Source Naturals (a fine company otherwise, by the way):

EPA 150 mg
DHA 90 mg
Total omega-3 fatty acids 300 mg
Price: $24.99 for 60 softgels

Alright, let's do some simple math:

Average volume of blood in the human body (all components): 5000 cc
Percentage of red blood cells (RBCs) by volume: 45%
Total volume RBCs: 2250 cc
Percentage of total volume RBCs occupied by fatty acids:

What tests are MORE important than cholesterol?

12. May 2013 William Davis (8)
In the conventional practice of early heart disease prevention, cholesterol testing takes center stage. Rarely does it go any further, aside from questions about family history and obvious sources of modifiable risk such as smoking and sedentary lifestyle.

So standard practice is to usually look at your LDL cholesterol, the value that is calculated, not measured, then--almost without fail--prescribe a statin drug. While there are indeed useful values in the standard cholesterol panel--HDL cholesterol and triglycerides--they are typically ignored or prompt no specific action.

But a genuine effort at heart disease prevention should go farther than an assessment of calculated LDL cholesterol, as there are many ways that humans develop coronary atherosclerosis. Among the tests to consider in order to craft a truly effect heart disease prevention program are:

--Lipoprotein testing--Rather than using the amount of cholesterol in the various fractions of blood as a crude surrogate for lipoproteins in the bloodstream, why not measure lipoproteins themselves? These techniques have been around for over 20 years, but are simply not part of standard practice.

Lipoprotein testing especially allows you to understand what proportion of LDL particles are the truly unhealthy small LDL particles (that are oxidation- and glycation-prone). It also identifies whether or not you have lipoprotein(a), the heritable factor that confers superior survival capacity in a wild environment ("The Perfect Carnivore"), but makes the holder of this genetic pattern the least tolerant to the modern diet dominated by grains and sugars, devoid of fat and organ meats.

--25-hydroxy vitamin D--The data documenting the health power of vitamin D restoration continue to grow, with benefits on blood sugar and insulin, blood pressure, bone density, protection from winter "blues" (seasonal affective disorder), decrease in falls and fractures, decrease in cancer, decrease in cardiovascular events. I aim to keep 25-hydroxy vitamin D at a level of 60 to 70 ng/ml. This generally requires 4000-8000 units per day in gelcap form, at least for the first 3 or so years, after which there is a decrease in need. Daily supplementation is better than weekly, monthly, or other less-frequent regimens. The D3 (cholecalciferol) form is superior to the non-human D2 (ergocalciferol) form.

--Hemoglobin A1c (HbA1c)--HbA1c represents glycated hemoglobin, i.e., hemoglobin molecules within red blood cells that are irreversibly modified by glucose, or blood sugar. It therefore provides an index of endogenous glycation of all proteins of the body: proteins in the lenses of the eyes that lead to cataracts; proteins in the cartilage of the knees and hips that lead to brittle cartilage and arthritis; proteins in kidney tissue leading to kidney dysfunction.

HbA1c provides an incredibly clear snapshot of health: It reflects the amount of glycation you have been exposed to over the past 90 or so days. We therefore aim for an ideal level: 5.0% or less, the amount of "ambient" glycation that occurs just with living life. We reject the notion that a HbA1c level of 6.0% is acceptable just because you don't "need" diabetes medication, the thinking that drives conventional medical practice.

--RBC Omega-3 Index--The average American consumes very little omega-3 fatty acids, EPA and DHA, such that a typical omega-3 RBC Index, i.e., the proportion of fatty acids in the red blood cell occupied by omega-3 fatty acids, is around 2-3%, a level associated with increased potential for sudden cardiac death (death!). Levels of 6% or greater are associated with reduced potential for sudden cardiac death; 10% or greater are associated with reduced other cardiovascular events.

Evidence therefore suggests that an RBC Omega-3 Index of 10% or greater is desirable, a level generally achieved by obtaining 3000-3600 mg EPA + DHA per day (more or less, depending on the form consumed, an issue for future discussion).

--Thyroid testing (TSH, free T3, free T4)--Even subtle degrees of thyroid dysfunction can double, triple, even quadruple cardiovascular risk. TSH values, for instance, within the previously presumed "normal" range, pose increased risk for cardiovascular death; a TSH level of 4.0 mIU, for instance, is associated with more than double the relative risk of a level of 1.0.

Sad fact: the endocrinology community, not keeping abreast of the concerning issues coming from the toxicological community regarding perchlorates, polyfluorooctanoic acid and other fluorinated hydrocarbons, polybrominated diphenyl ethers (PDBEs), and other thyroid-toxic compounds, tend to ignore these issues, while the public is increasingly exposed to the increased cardiovascular risk of even modest degrees of thyroid dysfunction. Don't commit the same crime of ignorance: Thyroid dysfunction in this age of endocrine disruption can be crucial to cardiovascular and overall health.


All in all, there are a number of common blood tests that are relevant--no, crucial--for achieving heart health. Last on the list: standard cholesterol testing.

Cranberry Sauce

21. November 2012 William Davis (3)
Happy Thanksgiving 2012, everyone, from all the staff at Track Your Plaque!

Here’s a zesty version of traditional cranberry sauce, minus the sugar. The orange, cinnamon, and other spices, along with the crunch of walnuts, make this one of my favorite holiday side dishes.

There are 31.5 grams total “net” carbohydrates in this entire recipe, or 5.25 grams per serving (serves 6). To further reduce carbs, you can leave out the orange juice and, optionally, use more zest.

1 cup water
12 ounces fresh whole cranberries
Sweetener equivalent to 1 cup sugar (I used 6 tablespoons Truvía)
1 tablespoon orange zest + juice of half an orange
½ cup chopped walnuts
1 teaspoon ground cinnamon
½ teaspoon ground nutmeg
¼ teaspoon ground cloves

In small to medium saucepan, bring water to boil. Turn heat down and add cranberries. Cover and cook at low-heat for 10 minutes or until all cranberries have popped. Stir in sweetener. Remove from heat.

Stir in orange zest and juice, walnuts, cinnamon, nutmeg, and cloves.

Transfer mixture to bowl, cool, and serve.


Apple Cranberry Crumble

18. November 2012 William Davis (0)
Apple, cranberry, and cinnamon: the perfect combination of tastes and scents for winter holidays!

I took a bit of carbohydrate liberties with this recipe. The entire recipe yields a delicious cheesecake-like crumble with 59 “net” grams carbohydrates (total carbs – fiber); divided among 10 slices, that’s 5.9 grams net carbs per serving, a quantity most tolerate just fine. (To reduce carbohydrates, the molasses in the crumble is optional, reducing total carbohydrate by 11 grams.)

Other good choices for sweeteners include liquid stevia, stevia glycerite, powdered stevia (pure or inulin-based, not maltodextrin-based), Truvía, Swerve, and erythritol. And always taste your batter to test sweetness, since sweeteners vary in sweetness from brand to brand and your individual sensitivity to sweetness depends on how long you’ve been wheat-free. (The longer you’ve been wheat-free, the less sweetness you desire.)


Crust and crumble topping
3 cups almond meal
1 stick (8 tablespoons) butter, softened
1 cup xylitol (or other sweetener equivalent to 1 cup sugar)
1½ teaspoons ground cinnamon
1 tablespoon molasses
1½ teaspoons vanilla extract
Dash sea salt

Filling
16 ounces cream cheese, softened
2 large eggs
½ cup xylitol (or other sweetener equivalent to ½ cup sugar)
1 Granny Smith apple (or other variety)
1 teaspoon ground cinnamon
1 cup fresh cranberries

Preheat oven to 350° F.

In large bowl, combine almond meal, butter, sweetener, cinnamon, molasses, vanilla, and salt and mix.

Grease a 9½-inch tart or pie pan. Using approximately 1 cup of the almond meal mixture, form a thin bottom crust with your hands or spoon.

In another bowl, combine cream cheese, eggs, and sweetener and mix with spoon or mixer at low-speed. Pour into tart or pie pan.

Core apple and slice into very thin sections. Arrange in circles around the edge of the cream cheese mixture, working inwards. Distribute cranberries over top, then sprinkle cinnamon over entire mixture.

Gently layer remaining almond meal crumble evenly over top. Bake for 30 minutes or until topping lightly browned.
Blood sugar: Fasting vs. postprandial

Blood sugar: Fasting vs. postprandial

5. February 2010 William Davis (23)
Peter's fasting blood glucose: 89 mg/dl--perfect.

After one whole wheat bagel, apple, black coffee: 157 mg/dl--diabetic-range.

How common is this: Normal fasting blood sugar with diabetic range postprandial (after-eating) blood sugar?

It is shockingly common.

The endocrinologists have known this for some years, since a number of studies using oral glucose tolerance testing (OGTT) have demonstrated that fasting glucose is not a good method of screening people for diabetes or pre-diabetes, nor does it predict the magnitude of postprandial glucose. (In an OGTT, you usually drink 75 grams of glucose as a cola drink, followed by blood sugar checks. The conventional cut off for "impaired glucose tolerance" is 140-200 mg/dl; diabetes is 200 mg/dl or greater.) People with glucose levels during OGTT as high as 200 mg/dl may have normal fasting values below 100 mg/dl.

High postprandial glucose values are a coronary risk factor. While conventional guidelines say that a postprandial glucose (i.e., during OGTT) of 140 mg/dl or greater is a concern, coronary risk starts well below this. Risk is increased approximately 50% at 126 mg/dl. Risk may begin with postprandial glucoses as low as 100 mg/dl.

For this reason, postprandial (not OGTT) glucose checks are becoming an integral part of the Track Your Plaque program. We encourage postprandial blood glucose checks, followed by efforts to reduce postprandial glucose if they are high. More on this in future.
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Comments (23) -

  • Jenny

    2/5/2010 2:26:07 PM |

    Dr. Davis,

    157 one hour after eating is NOT the diabetic range by any standard.

    To be considered diabetic a person must go over 200 mg/dl.

    The data collected by Dr. Christensen's CGMS studies suggest that 160 at one hour is the top of the normal range if the blood sugar drops back in the next hour.

    That 157 is "prediabetic" though the term is a misnomer because most people with "prediabetic" blood sugars will NEVER become diabetic since they lack the necessary genetic flaws that produce true diabetes.

    I mention this not to discourage people from lowering their carb intake and blood sugar--that's a very good tack to take, but because I hear from hundreds of people who obsess about being diabetic when they are not some of whom end up spending a lot of unnecessary money on doctor appointments that produce nothing useful.

    The latest research suggests that keeping blood sugar under 155 mg/dl at all times will control the blood sugar related component of heart disease. But to diagnose even "pre-diabetes" you have to look at the 2 hour reading. It is the inability to reduce a spike within 2 hours that appears to be associated with most diabetic complications.

  • Anonymous

    2/5/2010 2:57:04 PM |

    When do you recommend taking postprandial glucose measurements?  45 mintues, 1 hour, 2 hours?  And are they timed from the start of the meal, or the end of the meal?

  • Onschedule

    2/5/2010 3:57:11 PM |

    For those of us who do not eat wheat, avoid grains, and restrict sugar intake, it is important to know that the pancreas gets used to dispensing a certain (lower) amount of insulin. Therefore, if you decide to test postprandial glucose after eating a meal with significantly more carbohydrate/sugar, be aware that you will likely get scary-high readings. When preparing for an oral glucose tolerance test, a patient is normally told "do not restrict carbs" or "eat a normal diet" during the week preceding the test in order to allow the pancreas to adjust its phase 1 insulin response. (when they say "normal diet" they are sadly not referring to *our* normal).

    Following Dr. Davis's life-saving advice, I have been wheat-free since last August and avoid grains, and restrict sugar intake. The first time I tested my postprandial glucose after an uncharacteristic meal, I was convinced I had become diabetic. (meal was corn chips, rice, beans, chicken fajitas, and a large margarita). After several consecutive days of eating higher-carb, the same meal generated significantly lower postprandial glucose. (Of course I knew before testing that this meal was a *bad* choice for me).

    Using postprandial glucose levels as Dr. Davis recommends to discover which foods cause your blood glucose to spike (and hence trigger small-dense LDL) is wonderful advice. I have learned that I do not tolerate oat bran! Just be careful not to self-diagnose diabetes based on high readings resulting from uncharacteristic meals. I know Dr. Davis has never recommended this - I only mention it because I really scared myself the first time I measured postprandial sugar, and have since discovered that at least two of my "low-carb" friends had the same experience...

  • zach

    2/5/2010 5:43:05 PM |

    Do you measure one hour after eating?

  • Anonymous

    2/5/2010 5:57:42 PM |

    When you say your patient was at 157 mg/dl postpranial, do you mean right after eating?  Or are you talking about a 2 hour test?  What's the time frame for measuring?  And if you don't do OGTT, how do you control how many grams of carbohydrate you're giving the patient?  Does the load matter?

  • Derek S.

    2/5/2010 7:36:27 PM |

    If coronary risk is increased by 50% at a glucose level of only 126 postprandial, then there is no hope of a heart-healthy diet that takes any form other than Low-Carb or Paleo.  I challenge anyone out there to show me someone who can eat an entire bagel, an apple and coffee (likely sweetened for most people) and maintain postprandial glucose of 100.  Totally impossible.

    Postprandial glucose is not the problem...it's the food that's the problem.  The glucose is only the symptom.  Cut out the bagels (and all grains for that matter), fruit (except in small amounts), sugar, processed starch, omega-6 oils while keeping carb intake (via whole foods only) to 20% of calories or less and the postprandial glucose will take care of itself given enough time.

  • davide

    2/6/2010 1:49:01 AM |

    Dr. Davis,

    I'm curious as to whether genetic predisposition plays a factor in how one's body naturally reacts to sugar.

    I happen to have very high LDL cholesterol(220), the vast majority (i think 98%) being very large particles. Yet, I happen to eat a good amount of wheat, juice and fruit, and it doesn't seem to affect my blood sugar or particle size.

    Is this typical with some of your patients?

  • Helen

    2/6/2010 3:28:41 PM |

    Eating low-carb can give you a bigger glucose spike when you do eat more carbs.  (As onschedule noted.)  There may be more than one dietary pattern that keeps blood glucose in a good range for the non-diabetic among us (though I don't think low-fat is it).

    It is possible, as Derek suggested, that the type of carb eaten may be causing some bad change in CVD risk factors (such as grains, sugar, and fruit vs. root vegetables, for instance).  An interesting hypothesis.

  • Jedi

    2/6/2010 5:47:37 PM |

    Derek S I have been checking my fasting and post prandial glucose for a month and i frequently have 100 or less after a carb heavy meal. It is not impossible!

  • ET

    3/16/2010 10:46:23 AM |

    On a low-carb diet, my post-prandial blood glucose level is always 90 or less.

    Several weeks ago, when I donated blood, my blood sugar measured 63 after losing a pint of blood.  Wierd thing is that I felt fine, no shakiness, hunger, or any other symptom of low blood sugar.

    There is a down side to eating low-carb though.  Even a moderate amount of sugar sends my blood sugar through the roof.  My blood pressure increases significantly and I turn beet red and feel awful.  

    I tell my wife that the secret of not eating sugar is to not eat sugar.

  • handsewn

    4/1/2010 1:28:10 PM |

    Thank goodness I found you guys and gals. My daughter has been following a low carb diet to control her type 1 diabetes and she ate a handful of chocolate chips and spiked to 375 almost immediately. I didn't realize that eating low carb can make you super sensitive to carbs. Thank-you for providing this important piece of the puzzle for me!

  • Electronic Medical Records

    5/12/2010 5:26:51 AM |

    Thanks for discussing this...there are so many going through the same situation of ill health and shocking medical reports and not knowing it is common in the world.

  • jignesh

    10/11/2010 7:34:11 AM |

    how to measure after eating...
    Jignesh.

  • karan

    10/22/2010 6:20:17 PM |

    same question by my how to measure it please reply to it i want to inform this thing to my friend

  • buy jeans

    11/3/2010 7:36:08 PM |

    For this reason, postprandial (not OGTT) glucose checks are becoming an integral part of the Track Your Plaque program. We encourage postprandial blood glucose checks, followed by efforts to reduce postprandial glucose if they are high. More on this in future.

  • Anonymous

    11/17/2010 6:59:41 PM |

    I recently saw an article on veg oil and hexane which eventually led to this blog and others of the same bent, Whole Health Source, www.cholesterol-and-health.com, as a result I completely changed my diet. I now eat only meat, whole milk, heavy cream, fresh vegatables, broccoli, spinach, asparagus, salads with balsamic and olive oil, with yams, carrots, or beets once a day for carbs. I eliminated wheat, breads, cerials, sugars, and coffe. Prior to this diet never abused sugar no sodas, occasional ice cream. About a month into this diet I decided to buy a glucose meter and scared myself to serious anxiety as my fasting numbers range from 129-160. The strange thing is that my postprandial numbers if I walk a little after eating range any where from 87-120 usually. and almost never get past 135. Any thoughts?

  • Anonymous

    1/17/2011 4:00:45 PM |

    No one has yet answered the key question - *when* do you measure your one hour and two hour readings? from the start of a meal? End? Mid-way?

    Bloodsugar101 says from the start of a meal, but If you eat and chew slowly - which is sensible - the timing presumably makes BG readings vary quite a lot.

    When I sit down to a meal, it is probably 45minutes from first bite of main course to last bite of fruit/cheese afterward.

  • Anonymous

    1/29/2011 6:38:43 PM |

    Second part of my comment above:

    Also, my resting heart rate came down to 48 bpm. And I plan to get a new lipid profile done soon. My bP was already 120/80, but maybe it has decreased now.


    Pre-diabetes can be reversed with lifestyle modifications. I am not really following a low-carb diet, just a low-calorie, no-junk-food diet. And with only about 45 minutes of exercise on weekdays, it is possible to turn things around.

  • Anonymous

    1/29/2011 6:41:05 PM |

    On Nov 10, 2010, I went for a routine physical checkup while visiting my family in India. I am a lacto-ovo vegatarian. My mother was diagnosed recently with diabetes at 62. I am 40, so I decided to start checking my vitals. My lipids turned out to be (in mg/dL) TC: 170, HDL: 46, LDL: 106; TriGL: 88 and my BMI was 26.2 and resting heart rate 72 beats/minute.

    But my Glucose numbers were not so good:

    Fasting: 98 mg/dL
    2-hr post-prandial OGTT (75g glucose solution): 119 mg/dL

    Since they seemed high, I asked the doctor about this, and he brushed it off saying it was in the normal range of 60-100 for fasting, and less than 145 for the 2-hr test. He also said since the lipid profile was good I should not worry about it.

    An interesting article caught my eye:

    "Extremely short duration high intensity interval training substantially improves insulin action in young healthy males"

    http://www.biomedcentral.com/1472-6823/9/3

    as did the following study by Dr. Christensen:

    http://www.phlaunt.com/diabetes/16422495.php

    I did a lot, and I mean a lot, of online research about nutrition, exercise, types of exercise, caloric restriction, glucose toxicity etc. I must have read at least 200-300 papers and/or articles and 10 different books.

    I used to eat a lot of refined carbs like chips, bagels etc and lots of diet colas (1 can a day). Being a vegetarian, I decided to do things my own way, since none of the existing diets really suited me.  I adopted the following diet and exercise schedule:

    Breakfast: Nutritious Living Hi-lo cereal (low GI low-carb 7g + high protein 12g per serving) along with Soymilk and a sprinkling of walnuts, almonds, pecans, peanuts and chestnuts.

    Lunch: 1 Granola bar (140 cals, 19g carbs) + salad (greens including baby spinach leaves, and vegetables like tomatoes, onions, beans, asparagus, peas, artichokes, beets, brussels, cucumbers, lentils etc) with olive oil dressing + one fruit (orange, pear or apple).

    Snack: 1 fruit and sugar-less black tea.

    Dinner: Two slices of sprouted rye or whole wheat bread, with hummus and some salsa + a few nuts, or mixed vegetable Indian foods (many choices there).

    Water: 2-2.5 liters/day

    Exercise: mornings after getting up and on empty stomach before breakfast, only on weekdays.

    * 15 minute 6.5 mph run on the treadmill to exhaust glycogen stores taking about 225 kCal.

    * 15 minutes weight training with dumbbells (lower-body/upper body on alternate days). Only two sets of 10 reps with medium weights (a pair of 20 or 30 pound dumbbells) in a circuit, making for a vigorous workout.

    * 10 minutes high-intensity interval training on an exercise bicycle. The pattern being, 2 minute warm-up, 6 10-second, extremely intense, all-out sprints at the beginning of each minute, and then a 3 minute cool-down at moderate intensity. At the end of each sprint, my heart-rate would be around 190 bpm, slightly beyond my theoretical max level (220-40 = 180 bpm).

    The result? On Jan 1, 2011, after just 7 weeks of the above routine, my numbers were:

    BMI: 22.6
    Fasting blood glucose: 77 mg/dL
    2-hr post-breakfast (Kellog's raisin bran cereal + nuts + soymilk): 94 mg/dL

    I intend to keep going until I get to:

    BMI: 21.0
    Fasting/2hr-PP: 75/85 mg/dL

  • Anonymous

    1/29/2011 6:42:15 PM |

    Not sure why my two comments above ended up in the reverse order.

  • Anonymous

    2/12/2011 10:56:05 PM |

    To: Anonymous, posting Jan. 29, 2011...
    Very good job w/ changing your #'s via diet / exercise. I've made similar changes, & my numbers are also good. I think the challenge will be ongoing consistency & maintenance.
    Exercise & diet are both huge.

  • vanessa taylor

    8/24/2011 4:29:37 PM |

    Hi, my name is vanessa.  What is normal for blood glucose readings?.  I was told that two hour postprandial was okay as long as it wasn't over 180.  Is this correct?.

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