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.
Psssst . . . There's sugar in there

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).
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Comments (13) -

  • Benpercent

    3/1/2010 10:04:29 PM |

    Regarding the hamburgers: Was the blood sugar increase due to some sort of recipe used or did you purchase the ground beef not knowing bread was added to it? A strange place to find it I'd say! I'll probably switch to grinding my own now.

  • Steve Cooksey

    3/1/2010 10:32:17 PM |

    Doctor Davis... YOU ROCK!!

    I'm a T1.5... who lost 78lbs, I have normal blood sugar ...for non-diabetics.

    NO meds, NO insulin... Keep Spreading the word... to ALL.

    Love your blog ...

    Steve

  • Anna

    3/2/2010 12:10:43 AM |

    I can pretty much count on higher BG readings when I eat at group meal gatherings away from home, unless I bring and eat only my own food.  I don't normally eat much processed convenience food, so I forget that boxed heat & serve breakfast sausage links can be full of sugar.  I also now know to steer clear of table grapes and fruit trays (I used to make sure to have fruit with the bacon or sausage and eggs for breakfast to deflect the comments from others, but now I don't bother with the fruit  because it's always too high-sugar.  

    At restaurants I ask for dressing on the side if I use dressing at all.  I dip my fork in the dressing before spearing a bite - that provides enough flavor without all the dressing.  Most of the time I avoid the dressings because they are made with soybean or canola oil anyway.  I ask for Olive Oil and Vinegar - not vinaigrette, which is often sweetened.  

    At home I always make salad dressing or simply toss with EVOO and a good vinegar, freshly ground SS & BP.  It's been years since I bought salad dressing.  Homemade is a breeze to make (even Ranch style) and economical, too.

    Frozen yogurt is far worse than full fat high quality ice cream.  Frozen yogurt almost always has more sugar and no fat or eggs to slow the absorption of the sugar.  Homemade ice cream is the best because you can control the sweetness level and use more cream and egg yolks (commercial is too sweet-tasting for me anymore, BG notwithstanding).  

    OJ - like a glass of pure sugar - absorbs into the blood stream nearly instantly.  I have a valencia orange tree in my garden but I don't dare drink the juice straight.  I put a tiny splash of freshly squeezed OJ or drop a squeezed orange wedge in a tall glass of Gerolsteiner sparkling mineral water (good source of magnesium).

    BBQ sauce & catsup - loaded with sugars - watch out for honey mustard sauce, too.

  • Anonymous

    3/2/2010 12:48:34 AM |

    Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.

    http://www.reuters.com/article/idUSTRE6205AQ20100301

    Michael

  • zach

    3/2/2010 1:23:16 AM |

    I looked at the back of my vinegar and it has 5 grams of carbs per tablespoon, 2 of which are sugars. But the only ingredients listed are red wine vinegar and grape musts.

  • David

    3/2/2010 4:24:59 AM |

    Michael,

    That article isn't talking about a new study per se, but rather a review of several select studies. In other words, it's not really providing any new information. It's a (biased) interpretation of a sampling of the existing data.

    I found this quote from the article to be pretty funny:

    "Now, if there are specific instances of vitamin D or calcium deficiency, then that's a separate issue that should be discussed with a personal physician."

    Uh, except it's hardly a separate issue since nearly everyone is deficient in vitamin D.

    David

  • Anonymous

    3/2/2010 9:03:07 AM |

    grape musts? That should have given you a clue. Grapes are very high in sugar. It always comes down to the same thing: Always read the labels. Carefully. Never trust anything that is processed. Not even if you buy it in Health Food shops.

  • Peter

    3/2/2010 1:17:18 PM |

    You don't need to test your blood sugar.  You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most.  

    Mostly this is because you ingest those in greater quantities since you like them, but partly because you choose those because the blood sugar rushes feel good.

  • David

    3/2/2010 4:50:50 PM |

    "You don't need to test your blood sugar. You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most."

    No. This is not a reliable way to go about things, as it isn't always true. It's never good to simply trust your feelings. Being objective with a glucometer isn't difficult or expensive. There's nothing to lose.

  • caphuff

    3/2/2010 5:46:18 PM |

    re hamburgers, also watch out for worcestershire sauce! Just discovered (much to my dismay) that the brand I had been using contains molasses and high fructose corn syrup. Yech!

  • Nigel Kinbrum

    3/3/2010 10:23:18 AM |

    Michael said...
    "Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.
    Calcium, vitamin D pills don't help heart: study"
    The RDA for Vitamin D is set for bone health. Therefore, an RDA dose of Vitamin D makes no difference to anything except bone health. It takes a dose about ten times the RDA to be effective elsewhere.

    If you give people one tenth the correct dose of a medication, would you be surprised that the medication is ineffective?

    Nige.

  • Kathy

    3/3/2010 11:13:22 AM |

    so easy to make homemade tomato soup, still a little high in carb's but nowhere near store boguht, handy if you absolutely must have a bowl of tomato soup.  Use tomato paste, water and some heavy cream and salt to taste.  you don't need the cream, but it tastes better.  One of the fastest "homemade' soups.  Keep in mind that tomatoes do have carbs, about 4 per 2 tbsp of paste.  You can add splenda to sweeten a little

  • renegadediabetic

    3/4/2010 2:26:14 PM |

    It's infuriating that sugar and starch show up in places you would least expect them.  You have to read labels very carefully.  I've been burned by failing to read labels.  Even better, eat real food prepared from scratch.

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