Human foie gras

If you want to make foie gras, you feed ducks and geese copious quantities of grains, such as corn and wheat.

The carbohydrate-rich diet causes fat deposition in the liver via processes such as de novo lipogenesis, the conversion of carbohydrates to triglycerides. Ducks and geese are particularly good at this, since they store plentiful fats in the liver to draw from during sustained periods of not eating during annual migration.

Modern humans are trying awfully hard to create their own version of foie gras-yielding livers. While nobody is shoving a tube down our gullets, the modern lifestyle of grotesque carbohydrate overconsumption, like soft drinks, chips, pretzels, crackers, and--yes--"healthy whole grains" causes fat accumulation in the human liver.

Over the past few years, there has been an explosion of non-alcoholic fatty liver disease and non-alcoholic steatosis, two forms of liver disease that result from excess fat deposition. The situation gets so bad in some people that it progresses to cirrhosis, i.e., a hard, poorly-functioning liver that paints a very ugly health picture. The end-result is identical to that experienced by longstanding alcoholics.



While Hannibal Lecter might celebrate the proliferation of human fatty livers with a glass of claret, fatty liver disease is an entirely preventable condition. All it requires is not eating the foods that create it in the first place.

Let go of my love handles

When is fat not just fat?

When it's visceral fat. Visceral fat is the fat that infiltrates the intestinal lining, the liver, kidneys, even your heart. It's the stuff of love handles, the flabby fat that hangs over your belt, or what I call "wheat belly."

Unlike visceral fat, the fat in your thighs or bottom is metabolically quiescent. Thigh and bottom fat may prevent you from fitting into your "skinny jeans," but its mainly a passive repository for excess calories.

Visceral fat, on the other hand, is metabolically active. It produces large quantities of inflammatory signals ("cytokines"), such as various interleukins, leptin, and tumor necrosis factor, that can trigger inflammatory responses in other parts of the body. Visceral fat also oddly fails to produce the protective cytokine, adiponectin, that protects us from diabetes, cancer, and heart disease.

Visceral fat also allows free fatty acids to leave and enter fat cells, resulting in a flood of fatty acids and triglycerides (= 3 fatty acids on a glycerol "backbone") in the bloodstream. This worsens insulin responses ("insulin resistance") and contributes to fatty liver. The situation is worsened when the very powerful process of de novo lipogenesis is triggered, the liver's conversion of sugar to triglycerides.

Visceral fat is also itself inflamed. Biopsies of visceral fat show plenty of inflammatory white blood cells (macrophages) infiltrating its structure.

So what causes visceral fat? Anything that triggers abnormal increases in blood glucose, followed by insulin, will cause visceral fat to grow.

It follows logically that foods that increase blood glucose the most will thereby trigger the greatest increase in visceral fat. Eggs don't lead to visceral fat, nor do salmon, olive oil, beef, broccoli, or almonds. But wheat, cornstarch, potato starch, rice starch, tapioca starch, and sugars will all trigger glucose-insulin that leads to visceral fat accumulation.

Fructose is also an extravagant trigger of visceral fat. Fructose is found in sucrose (50% fructose), high-fructose corn syrup, agave syrup, maple syrup, and honey.

Increased visceral fat can be suggested by increased waist circumference. The inflammatory hotbed created by excess visceral fat has therefore been associated with increased likelihood of heart attack, cardiovascular mortality, diabetes, cancer, and total mortality.

So I'm not so worried that you can't squeeze your bottom into your size 8 jeans. I am worried, however, when you need to let your belt out a notch . . . or two or three.

Surviving a widow maker

Gwen came to me 5 years ago. In her late 60s, she'd been having feelings of chest pressure for the past 4 weeks with small physical efforts, such as climbing a flight of stairs or lifting her grandchildren.

She sat in my office, heaving small sobs, accompanied by her daughter.

Gwen had already undergone a heart catheterization at a hospital near home by a cardiologist who I knew to be honest and competent. She'd been told that she had a 90% stenosis ("blockage") of her proximal left anterior descending (LAD) coronary artery. He called it a "widow maker," since closure of the artery at this point can be fatal within minutes. He advised bypass surgery as soon as possible. Though a stent could be placed at this location, he felt that its proximity to the left main stem (i.e., the "trunk" that divides into the LAD and circumflex arteries) might be jeopardized by expanding a stent in this bulky plaque, what I felt was a reasonable concern.

I reviewed the images that she brought with her. Yes, indeed: a widow maker. The portion of the left ventricle (heart muscle) fed by the LAD was also impaired ("hypokinetic"), reflecting reduced flow through the artery.

I advised Gwen that her first cardiologist's advice was sound: This was a potentially dangerous and severe condition. Either a bypass or stent should be performed near-future, the less delay the better.

But Gwen and her daughter would have no talk of any more procedures. She'd come to me because she heard about the (then rudimentary) effort I'd been making at reversing coronary plaque. "I admire your commitment, Gwen, but I am concerned that there may not be sufficient time to implement a program of prevention or reversal. Prevention is very powerful, but very slow. When symptoms like yours are active, also, it can mean that we won't have full control over the plaque causing the symptoms. This risks closure of the vessel, since flow characteristics in the plaque are abnormal. I think that you should go through a stent or bypass. We can then start your prevention/reversal program once we know you're safe."

Gwen would still have none of it. I asked her to return in a few days after thinking it over. In the meantime, we drew her lipoprotein blood samples while she added fish oil, l-arginine (back then I used a lot of l-arginine for its endothelial health effects), and began the Track Your Plaque diet a la 2004. This was in addition to the aspirin, beta blocker, and statin prescribed by the first cardiologist.

Several days later, Gwen and her daughter returned, as committed as ever to not having a procedure and proceeding with our prevention/reversal efforts.

So off we went. I was nervous about Gwen's safety, but she had clearly made her mind made up. Gwen's lipoprotein analysis revealed a severe small LDL pattern along with markers for prediabetes (high insulin, high blood glucose, hypertension, along with the loose tummy of visceral fat). So I counseled her intensively in diet and added niacin.

Within 2 weeks, Gwen no longer had chest pain. Whether this was due to her efforts or to some resolution of an intraplaque phenomenon (e.g., resorption of internal plaque hemorrhage), I don't know. But her symptoms did not return.

As the program evolved, we added the new strategies along the way--vitamin D supplementation; elimination of all wheat along with other changes in diet; iodine and thyroid normalization; as well as discontinuing l-arginine after the initial two years. She also got rid of the statin drug after losing around 20 lbs on the diet.

It's now been six years with her "widow maker" and Gwen has been fine: no recurrence of her symptoms, all stress tests performed have been normal, reflecting normal blood flow in her coronary arteries.

Should ALL people with symptomatic widow makers undergo such an effort and avoid procedures? No, not yet. Prevention and reversal efforts are indeed powerful, but slow. Some people just may not have sufficient time to accomplish what Gwen did. The fact that Gwen showed evidence for reduced flow in the LAD worried me in particular. There is no question that mortality benefits for stenting or bypass of this location are not as large as previously thought (see here, for instance), but each case needs to be viewed individually, factoring in flow characteristics in the artery, appearance of "stability" or "instability" of the plaque itself, not to mention commitment of the person.

But it can be done.

Fred Hahn's Slow Burn

I just had a workout with personal trainer and fitness expert, Fred Hahn. After a workout that quickly taught me that I had a lot to learn about exercise and strength training, Fred and I had a nice low-carbohydrate dinner at a Manhattan restaurant and shared ideas.

Fred is coauthor of Slow Burn Fitness Revolution: The slow motion exercise that will change your body in 30 minutes a week, written in collaboration with the Drs. Eades, Michael and Mary Dan. Fred also blogs here.

I had heard about Fred's "slow-burn" concept in past, but made little of it. I then met Fred on Jimmy Moore's low-carb cruise this past year, where I gave a talk on how carbohydrate-reduced diets reduce small LDL particles. Fred provided a group demonstration on his slow-burn techniques. I watched the demonstration, even tried it a few times back home in the gym, but never really applied them, losing patience most of the time and just going back to my usual routine.

Well, Fred showed me today how to do his slow-burn. In a nutshell, it is the slow, methodical use of weight resistance until the muscle is exhausted. It involves slow movement--e.g., 5 seconds for a lat pulldown from top to bottom--repeated until exhaustion using a weight that allows, perhaps, 6 repetitions over a 60-second effort.

I've been strength training since I was a teenager. I've seen lots of bad training techniques, injuries, and hocum when it comes to how to use resistance training techniques. But I believe that Fred Hahn's slow-burn technique really provides something unique that I hadn't experienced before.

For one, the burn is nothing like I've felt before. Two, there appears to be nearly zero risk for injury, since the usual momentum-driven, herky-jerky motion often employed with weight machines is entirely gone. Three, if what Fred is seeing is true--enhanced visceral (abdominal) fat loss, reduced blood glucose, increased HDL, decreased LDL/total cholesterol--then there's something really interesting going on here.

I also discovered that Fred is no ordinary personal trainer. He has insights into metabolism that I found truly impressive. After all, he's been hanging around with Mike Eades, who's a pretty sharp guy. What Mike Eades is to metabolic insights is what Fred Hahn is to exercise physiology.

I'm going to take Fred's slow burn training insights home with me. I'll let you know how it goes. Some aspects I'd like to explore: Will strength, muscle mass, and blood sugar responses change?



Fred Hahn's latest book, adapting slow burn techniques for kids.

Can I stop my Coumadin?

Here I go again.

While I will try to keep this blog on topic, i.e., coronary heart disease prevention and reversal using nutritional and other natural strategies, I believe that a "critical mass" of frequently asked, though off topic, questions keep cropping up.

One such question revolves around Coumadin, or warfarin.

Somehow, my Nattokinase scam blog post draws traffic about Coumadin. I tried to make the point that a conventional blood thinning agent like Coumadin that undoubtedly has undesirable side-effects cannot be replaced by an agent that has an uncertain track record. In the case of nattokinase, no track record.

To illustrate how far wrong the "nattokinase as replacement for Coumadin" idea can go, here is a question from Anna:


I came across your blog while perusing.

I am a bit bummed because I have been on Coumadin (warfarin) for around 22 years since I was 6 years old. I have a mechanical heart valve (St. Jude's), as I have heart-related issues, including hypertrophic obstructive cardiomyopathy.

Well, it is just that the warfarin seems to interact with nearly everything. I feel like I can not get the nutrients my body requires. I desire to consume more raw foods and vegan foods, though I do not want anything to damage my heart valve or risk a stroke/heart attack or internal bleeding.

I have been underweight the majority of my life, malnourished , currently am still somewhat underweight, though enjoying food again, as I had what mimicked Crohn's Disease for several years (horrendous pain), from which I am in remission now. I was diagnosed with osteoporosis, which may or may not be caused from consuming warfarin.

Is it possible to get off of warfarin and effectively keep my blood thinned ? I currently take 1.5 mg to 2 mg dosage. Does the warfarin destroy Vitamin K and if so does that mean while on warfarin I never get the Vitamin K nutrients even if I did consume foods with it in it?

Thank you
Anna


No, sorry, Anna. Stopping Coumadin with your unique issues, i.e., a prosthetic mechanical heart valve (likely mitral, judging by your history of hypertrophic obstructive cardiomyopathy, in which the patterns of blood flow ejected from the heart disrupt the natural mitral valve function) and cardiomyopathy, can be fatal. Without blood thinning, the mechanical heart valve can trigger blood clot formation, since it is a foreign object implanted into the bloodstream.

There are no natural alternatives available with track records confident enough to bet your life on. Aspirin nor Plavix are blood thinners, but platelet inhibitors. These two agents, while they work for other forms of arterial (but not venous) blood clot inhibition, will not work for your unique situation.

Likewise, a purported oral lytic agent like nattokinase should not be substituted for Coumadin. Even if there was plausible science behind it, you should demand substantial evidence that it provides at least blood thinning equivalent to Coumadin. Should a blood clot, even a small one, form in or around the prosthetic valve, the valve can stop working within seconds. This can lead to death within minutes.

I believe it would be foolhardy to bet your life based on the marketing--let me repeat: MARKETING--of a "nutritional supplement" by supplement manufacturers eager to make a buck.

Nor are there any other nutritional supplements that can safely replace the Coumadin. I wish that were NOT true, as I am no stranger to the long-term dangers of Coumadin and I am a big believer, in general, in nutritional supplements. I am a BIGGER believer, however, in the truth. Weighing the options available to us today, there really is no rational choice but to remain on Coumadin.

By the way, I tell my patients to eat a substantial amount of green vegetables while they take Coumadin. I know that conventional advice is to reduce or eliminate green vegetables due to their content of Coumadin-antagonizing vitamin K. I think this is wrong, also. Green vegetables are the best foods on earth. They reduce risk for cancer, diabetes, bone disease, and coronary heart disease.

To obtain the benefits of green vegetables without mucking up your blood thinning (your "protime" or International Normalized Ratio, INR), I advise my patients who take Coumadin to eat green vegetables--but do so every day in relatively consistent quantities, so that the protime or INR is not disrupted and remains reasonably constant. It may mean that your total dose of Coumadin may be somewhat higher, e.g., 3 or 4 mg instead of 2 mg, but the dose is immaterial outside of blood thinning. That way, you obtain all the wonderful health benefits of green vegetables while maintaining fairly consistent blood thinning/protime/INR. Coumadin does not block all the health benefits of vegetables, only those related to vitamins K1 and K2.

With regards to protecting yourself from the osteoporosis promoting effects of Coumadin, I would be sure to follow a program of natural bone health, such as the one I discussed in Homegrown osteoporosis prevention and reversal. You will have to be extra careful, however, with the vitamin K2. Ideally, you have a doctor knowledgeable about vitamin K2 who can assist you in managing K2 intake while on Coumadin. This is something you can definitely NOT manage on your own. (I am a big believer in self-managed care, but this is way beyond the limit.)

Lastly, it is my belief that anyone with an inflammatory bowel condition, such as Crohn's disease or ulcerative colitis, should absolutely, positively, and meticulously AVOID WHEAT and all other gluten sources (such as rye, barley, and oats). Even if you test negative for celiac markers (e.g., anti-gliadin antibodies, emdomysium and transglutaminase antibodies), the enhanced intestinal permeability will allow wheat proteins, such as gluten, to gain ready entry into the bloodstream. Not to mention that wheat should have no place in the human diet anyway, in my view.

Homegrown osteoporosis prevention and reversal

I don't like to stray too far off course from discussions of heart disease and related issues in this blog. But the question of bone health comes up so often that I thought I'd discuss the strategies available to everybody to stop, even reverse, osteoporosis.

Coronary atherosclerotic plaque and bone health are intimately interwoven. People who have coronary plaque usually have osteoporosis; people who have osteoporosis usually have coronary plaque. (The association is strongest in females.) The worse the osteoporosis, the greater the quantity of coronary plaque, and vice versa. The two seemingly unconnected conditions share common causes and thereby respond to similar treatments.

Incredibly, rarely will your doctor tell you about these strategies. Your doctor orders a bone density test, the value shows osteopenia or osteoporosis, and a drug like Fosamax or Boniva is prescribed. As many people are learning, drugs like this can be associated with severe side-effects, such as jaw necrosis (death of the jaw bone), a dangerous and disfiguring condition that leads to loss of teeth and disfigurement, followed by reconstructive surgery of the jaw and face. These are not trivial effects.

Note that drugs are approved by the FDA based on assessment of efficacy and safety, NOT proven equivalence or superiority to natural treatments.

In order of importance (greatest to least), here are strategies that I believe are important to regain or maintain bone health. Indeed, I have seen many women increase bone density using these strategies . . . without drugs of any sort.

1) Vitamin D restoration--Vitamin D is the most important control factor over bone calcium metabolism, as well as parathyroid function. As readers of this blog already know, gelcap forms of vitamin D work best, aiming for a 25-hydroxy vitamin level of 60-70 ng/ml. This usually requires 6000 units per day, though there is great individual variation in need.

2) Vitamin K2--If you lived in Japan, you would be prescribed vitamin K2. While it's odd that K2 is a "drug" in Japan, it means that it enjoys the validation required for approval through their FDA-equivalent. Prescription K2 (as MK-4 or menatetranone) at doses of 15,000-45,000 mcg per day (15-45 mg), improves bone architecture, even when administered by itself. However, K2 works best when part of a broader program of bone health. I advise 1000 mcg per day, preferably a mixture of the short-acting MK-4 and long-acting MK-7. (Emerging data measuring bone resorption markers suggest that lower doses may work nearly as well as the high-dose prescription.)

3) Magnesium--I generally advise supplementation with the well-absorbed forms, magnesium glycinate (400 mg twice per day) or magnesium malate (1200 mg twice per day). Because they are well-absorbed, they are least likely to lead to diarrhea (as magnesium oxide commonly does).

4) Alkaline potassium salts--Potassium as the bicarbonate or the citrate, i.e., alkalinizing forms, are wonderfully effective for preservation or reversal of bone density. Because potassium in large doses is potentially fatal, over-the-counter supplements contain only 99 mg potassium per capsule. I have patients take two capsules twice per day, provided kidney function is normal and there is no history of high potassium.

5) An alkalinizing diet--Animal products are acidic, vegetables and fruits are alkaline. Put them together and you should obtain a slightly net alkaline body pH that preserves bone health. Throw grains like wheat, carbonated soft drinks, or other acids into the mix and you shift the pH balance towards net acid. This powerfully erodes bone. Therefore, avoid grains and never consume carbonated soft drinks. (Readers of this blog know that "healthy, whole grains" should be included in the list of Scams of the Century, along with Bernie Madoff and mortgage-backed securities.)

6) Strength training--Bone density follows muscle mass. Restoring youthful muscle mass with strength training can increase bone density over time. The time and energy needs are modest, e.g., 20 minutes twice per week.

Note that calcium may or may not be on the list. If on the list at all, it is dead last. When vitamin D has been restored, intestinal absorption of calcium is as much as quadrupled. The era of force-feeding high-doses of calcium are long-gone. In fact, calcium supplementation in the age of vitamin D can lead to abnormal high calcium blood levels and increased heart attack risk.

These are benign and easily incorporated strategies. They are also inexpensive. I challenge any drug to match or exceed the benefits of this combination of strategies. Keep in mind that strategies like vitamin D restoration provide an extensive panel of health benefits that range far beyond bone health, an effect definitely NOT shared by prescription drugs.

Your enlarged aorta

The thoracic aorta lives happily within the chest.

The aorta is the main artery of the body that emerges from the heart, located just under the sternum. It is the "tree trunk" from which all the major arteries branch off to the rest of the body: the arms, brain, abdominal organs, pelvis, and legs. The aorta receives the high-pressure blood ejected directly out of the heart muscle.

However, there are evil forces in the body that work to weaken the aorta. When the aorta is weakened, it enlarges. Enlarged aortas also tend to grow atherosclerotic plaque. Plaque in the aorta poses long-term risk for stroke and and mini-strokes ("transient ischemic attacks," or TIAs), due to fragmentation.

There are many enlarged aortas in this world. I see at least several every week. It is fairly common, particularly in people with high blood pressure and cholesterol abnormalities, as well as those who are overweight. Smokers get it really bad.

Conventional thinking is that, once an aorta enlarges, it will inevitably continue to enlarge at the average rate of 2.0 mm per year (resulting in 1.0 cm enlargement over 5 years). For this reason, conventional discussions on the topic of thoracic aortic aneurysms all say something like "Enlarged aortas should be monitored yearly. Surgical replacement should proceed when the aorta reaches a diameter of 5.5 cm."

This is because an aortic diameter of 5.5 cm is associated with much greater likelihood that the aorta will rupture (fatal within minutes) or the internal lining will tear, a "dissection." The surgery is a major undertaking that involves opening the chest and usually replacing the aortic valve and inserting a synthetic aorta. The procedure is high-risk, especially if any branch arteries are involved.

So putting a stop to any further aortic enlargement is a worthwhile goal. Unfortunately, conventional thought is that there is nothing you can do to stop the inevitable growth of the thoracic aorta.

Nonsense. There are a number of efforts you can make to halt further increase in aortic diameter. (My experience in this is anecdotal and unpublished, but now numbers several hundred patients.)

There are two categories of factors that cause the aorta to increase in diameter:

1) Internal pressure--Think of blood pressure as the internal inflating pressure on this "balloon." Keeping the "inflating pressure," i.e., blood pressure, low exerts substantial effect on slowing growth of aortic diameter. I aim for normal BP or lowish BP (less than 130/80, preferably 100/70).

2) Factors that weaken the aortic wall--Processes like inflammation, glycation, lipoprotein deposition, and nutritional deficiencies will serve to weaken the supportive tissue of the aorta. For that reason, correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)), reductions in carbohydrate intake and thereby blood glucose/glycation, and "normalization" of vitamin D, vitamin C supplementation (for collagen crosslinking), and omega-3 fatty acids all play a role.

To push even farther, there may be additional advantage to following strategies that impair the production and activity of a crucial enzyme that lives within the aortic wall: matrix metalloproteinase, or MMP. MMP degrades the collagen and other supportive tissues within the aorta, weakening it and permitting expansion. Blocking MMP may prove to be among the most powerful new strategies to halt aortic expansion.

Compounds that have potential MMP-inhibiting effects include:
--Vitamin D--A substantial effect
--Resveratrol--One of the polyphenols from red wine
--Doxycycline--This old antibiotic often used for acne treatment has, in preliminary studies, shown important MMP-blocking effects and slowed aortic expansion.

Anyway, there you have it. A bit complicated, but a "recipe" that has failed me only rarely.

Extreme carbohydrate intolerance

Here's an interesting example of what you might call "extreme carbohydrate intolerance."

May is a 44-year woman who has now had her 7th stent placed in her coronary arteries. She lives on a diet dominated by breads, breakfast cereals, muffins, rice, corn products, along with some real foods.

Her conventional lipid panel and other lab values:

Total cholesterol 346 mg/dl
Triglycerides: 877 mg/dl
HDL cholesterol: 22 mg/dl
LDL cholesterol: incalculable
(Recall that LDL cholesterol is usually a calculated, not a measured value. The excessively high triglycerides make the standard calculation invalid--more invalid than usual.)

Fasting blood glucose: 210 mg/dl
HbA1c (a reflection of previous 60-90 days average glucose): 7.2% (desirable 4.5% or less)
ALT (a "liver enzyme"): 438 (about five-fold normal)


At 5 ft even and 138 lbs (BMI 27.0), May appears small. But the modest excess weight is all concentrated in her abdomen, i.e., in visceral fat.

By lipoprotein analysis via NMR (Liposcience), May's LDL particle number was 2912 nmol/L, or what I would call a "true" LDL of 291 mg/dl. (Drop the last digit.) Of the 2912 nmol/L LDL particles, 2678 nmol/L, or 92%, were small.

The bad news: This pattern of extremely high triglycerides, extremely high LDL particle number, low HDL, predominant small LDL, and diabetes poses high-risk for heart disease--no surprise. It earned her 7 stents so far. (Unfortunately, she has made no effort whatsoever to correct these patterns, despite repeated advice to do so.)

The good news: This collection is wonderfully responsive to diet. LDL particle number, small LDL, triglycerides, blood glucose, and HbA1c drop dramatically, while HDL increases. Heart disease will at least slow, if not stop.

It's amazing how far off human metabolism can go while indulging in carbohydrates, particularly a genetically carbohydrate-intolerance person. (Actually, I wouldn't be surprised if May's diet, as bad as it seems to you and me, still fits within the dictates of the USDA food pyramid.) The crucial step in diet to correct this smorgasbord of disaster is elimination of carbohydrates, especially that from wheat, cornstarch, and sugars.

What's for breakfast? Egg bake

Heart Scan Blog reader and dietitian, Lisa Grudzielanek, provided this recipe in response to the post, What's for breakfast?

Lisa, by the way, is one of the rare dietitians who understands that organizations like the American Dietetic Association have made themselves irrelevant. She therefore advocates diet principles that work, not just echoing the idiocy that emanates from such organizations, often driven by economics more than science. Lisa works in the Milwaukee area and has proven a useful resource person for my patients who have required extra coaching in the Track Your Plaque diet principles.

Egg Bake
My favorite breakfast is what I call an "egg bake." Others may refer to it as a "quiche."

Take a variety of fresh vegetables. This time of year is great for farmers' markets.

I typically use fresh chopped organic spinach, bell peppers, red & white onions, scallions, broccoli, mushrooms, cherry tomatoes halved and, if desired, meat (nitrite-free ham or leftover chicken breasts).

1) Chop veggies and place in casserole dish.
2) Add meat and handful of cheese of your choice.
3) Scramble 8 eggs & little bit of milk & pepper.
4) Add to casserole dish and mix/coat veggies with egg mixture.
5) Put in oven at 450 degress for 30 minutes.

Yummy, ready to eat breakfast that is so easy for the work week.

What's for breakfast?

If you eliminate wheat from breakfast and otherwise adhere to a low-carbohydrate dietary approach, what is there to eat for breakfast?

If you take out English muffins, bagels, all breakfast cereals, pancakes, waffles, and toast, what's left to eat?

Actually, there's plenty left to eat. It just may not look like the traditional American notion of "breakfast." (The traditional idea of breakfast was is, in part, due to the legacy of Dr. John Harvey Kellogg, who, in the latter part of the 19th century, ran a sanitarium in Battle Creek Michigan. He and his brother, Will Keith Kellogg, discovered the idea of turning grains into flakes, the birth of the breakfast cereal. Subscribe to the idea of breakfast cereal for breakfast and you subscribe to the ideas of a man who would administer four enemas for you today to cure your cancer or rheumatism.)

Here are a few ideas. By no means is this meant to be a comprehensive list, just a starting point for a few new breakfast food ideas.

--Eggs--Of course, eat the yolk. Eat three yolks. Scrambled, "fried," (not really deep-fried, of course), hard-boiled, poached, as an omelette. Add pesto, olive oil, vegetables, mushrooms, salsa.

--Ground flaxseed--As a hot cereal with your choice of water, milk (not my favorite because of insulin effects; the fat is immaterial), full-fat soy milk (yeah, yeah, I know), unsweetened almond milk. Add walnuts, blueberries, etc. Ground flaxseed is the only grain I know of that contains no digestible carbohydrates.

--Lunch and dinner--Yes, if you cannot have breakfast foods for breakfast, then have lunch and dinner, meaning incorporating foods you ordinarily regard as lunch and dinner foods into your day's first meal. This means salads, leftover chicken from last night, soup, raw vegetables dipped in hummus or guacamole, stir fry, etc.

--Cheese--For something quick, grab a chunk of gouda or emmentaler along with a handful of raw almonds, walnuts, or pecans. Because of the excess acidity of cheese (along with meats, among the most acidifying of foods), I usually try to include something like a raw pepper or avocado, foods that are net alkaline.

--Avocados--Cut in half, scoop out contents. They're quick and delicious, when available.

I hesitate to mention it, but I sometimes will have tofu, cubed and flavored with whatever is available--soy sauce, miso, pickled vegetables. My mother was Japanese, so I'm comfortable with this, though many people are not.

Anyway, that's a partial list that nonetheless can get you started on a wheat-free, low-carb breakfast.

If you are just starting out, you will notice a number of fundamental changes. You may first experience the characteristic "withdrawal" effect: mental fog and fatigue that lasts about a week. Energy then picks up, often substantially. This is followed by gradually reduced appetite: You will be far less hungry. You will require less food, less often, since appetite will be driven by physiologic need, not the appetite-stimulating properties of wheat (and cornstarch, high-fructose cornsyrup and sucrose).

By the way, do not skip breakfast unless it's part of an occasional fasting effort. Skip breakfast, wind down metabolism, get fat. I am impressed at how consistent skipping breakfast backfires in those who think that it helps you control weight.

I also welcome any suggestions on what you eat as part of your wheat-free, low-carb breakfast. (Thanks for the great suggestions on the last blog post, Anna.)
Atkins Diet: Common errors

Atkins Diet: Common errors

No doubt: The diet approach advocated by the late Dr. Robert Atkins was a heck of a lot closer to an ideal diet than the knuckleheaded advice emitting from the USDA, American Heart Association, American Diabetes Association, and the Surgeon General's office.

But having just spent a week with Atkins low-carbers, here are some common errors that I see many make, errors that I believe have long-term health consequences, including impairment of weight loss.

Excessive consumption of animal products--Non-restriction of fat often leads to over-reliance on animal products. Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers. It is not a fat issue; it is an animal product issue. We should consume less meat, more vegetables and other plant-sourced foods.

Consumption of cured meats--Cured, processed meats, such as sausage, hot dogs, salami, bologna, and bacon, have a color fixative called sodium nitrite, an additive that has been confidently linked to gastrointestinal cancers. Risk is likely dose-dependent: The more you ingest, the greater the long-term risk.

Overconsumption of dairy products--Dairy products, especially milk, yogurt, cottage cheese, and butter, are potent insulinotropic foods, i.e., foods that trigger insulin release. There can be up to a tripling of insulin (area-under-the-curve) levels. This is not good in a world populated with tired, overworked pancreases, exhausted from a lifetime of high-carbohydrate eating.

Too many calories--While I agree that "a calorie is a calorie" and "calories in, calories out" are faulty concepts, I have anecdotally observed that long-time low-carbers often trend towards unlimited consumption of food, a phenomenon that seems to result in weight gain, especially in the sedentary. I wonder if this is a reflection of the insulinotropic action of dairy products and other proteins, compounded by the poor insulin responsiveness that develops with lack of physical activity. Factor into this conversation that lower calorie intake extends life, probably substantially (Sirt-2 activation and related phenomena, a la resveratrol). If lower calorie intake extends life, unlimited calorie intake likely shortens life.

Please don't hear this as low-carb bashing--it is not. It is a call to improve diets and not stumble into common traps that can impair heart health, weight loss, and longevity.

Comments (74) -

  • Fred Hahn

    3/18/2010 1:02:21 PM |

    Nice post Bill. People really need to get this info into their heads.

    Great meeting you  on the cruise!

  • thequickbrownfox

    3/18/2010 1:14:09 PM |

    Please could you provide links to the interventional controlled (not observational) studies that have shown a link between eating meat and cancer risk, that separate the effect from eating junk food, and the fact that vegetarians are more likely to eat healthily in general than meat eaters due to the widespread and incorrect belief that saturated fat is harmful to health.

    Also, could you explain lack of cancer in traditional tribal societies with a high meat intake? You would need to do this before stating that meat intake necessarily increases cancer risk.

  • maxwell

    3/18/2010 1:25:40 PM |

    Hi doc,

    Great blog. How do you explain the Inuit, Masaai, Komi (Siberia), Native American and similar cultural groups whose diets seemed to subsist primarily on animal products? ie. including my ancestors.

    Perhaps its an emphasis on wild/grass-fed/raw dairy(or as close to) animal products as opposed to the grain-fed animal products which encompass the majority of the US that you need to be addressing?

    Thanks.

  • ET

    3/18/2010 1:31:21 PM |

    Interesting point of view.  Can you please provide references to support your claims?

  • Sandra Anderson

    3/18/2010 1:38:14 PM |

    Great diet, and yes, it seems that we should talk about healthy eating instead of weight loss or diets. Anyway the purpose of any diet is to move your eating habits to new healthy level.

    Thanks for sharing and possibility to comment! Welcome to visit Ideal Weight Blog to find some recipes and great articles! Thanks!

  • Mario Renato

    3/18/2010 1:40:29 PM |

    Just on the nitrate/nitrite subject: as far as I know nitrate is a naturally occurring compound and the human exposure to it is mostly through  consumption of vegetables, and to a lesser extent water and other foods...

    http://www.efsa.europa.eu/en/scdocs/scdoc/689.htm

  • Matt Stone

    3/18/2010 1:48:56 PM |

    I would say there are 3 primary pitfalls of low-carb dieting:

    1) Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet "tends to shut down the thyroid."  

    2) Too much protein - this strains the thyroid as well, and encourages gluconeogenesis, which is also problematic - especially when in ketosis and insulin resistance is extreme.  

    3) Extremely high in omega 6 polyunsaturated fat.  Eating a low carb diet with lots of pork fat, chicken skin, peanut butter, and nuts - the typical standbys of many low-carb dieters, provides an astronomical amount of omega 6.

    By my best guesses, I was consuming 15+ grams of omega 6 while on a low-carb diet.  I've since cut that back to less than 3 grams per day and the change has been dramatic.  Of course the 400 grams of carbs per day helps too.

  • Dana Law

    3/18/2010 2:14:43 PM |

    Dr. Davis,
    Thank you for this post.  I'm certainly culpable of the "common errors" you mention.  I find that making daily decisions on what to eat difficult. I want to eat healthy and have some variety. Here's the question.  What do you eat?  What did you have for breakfast this morning?  What did you eat last night?  What do you keep in the fridge and on the counter to make following your dictates easier.
    I don't want to over-think it but all this information is overwhelming.  I feel like a scientist and my body is the research subject.
    Thank you for your blog.  I've learned a lot but need some direct guidance.
    Sincerely,
    Dana Law
    San Diego, Ca

  • Andrew

    3/18/2010 2:21:17 PM |

    Why is "Calories in vs. calories out" a faulty concept?

  • Tim

    3/18/2010 3:03:47 PM |

    Have you really read the meat leading to cancer literature carefully or do you just think it's like that? Others like Gary Taubes and Eades (who I really trust when it comes to research) have found no evidence that meat cause cancer.

    On sodium nitrate, I totally agree. I get so mad when I'm walking in the grocery stores. All meat has sodium nitrate added. Grrr.

    I share your thought about dairy. But do you really mean that butter triggers insulin spikes?

  • Daniel

    3/18/2010 3:11:55 PM |

    Most nitrite is form your own spit and originally ingested by eating vegetables.  

    I believe the epidemiological studies (which also typically find fat to have bad associations...) have more to do with a lack of fruits/vegetables/polyphenols than anything that is bad about meat.  

    Also, I don't think glycemic index or the insulinotropic nature of certain proteins matters one lick for people that are healthy.  I can eat a boiled potato for breakfast without my blood sugar breaking 100... I don't think diabetes is an overuse injury - more likely, it is cause by damage to the liver and then pancreas from PUFA and fructose overconsumption.  

    I think Matt Stone is correct about the top three problems with Atkins.

  • Lena

    3/18/2010 3:17:06 PM |

    If you're really concerned about your nitrite intake, watch your celery, arugula and spinach (and many other vegetables) consumption, too. Nitrites galore. Though it's not nitrites and nitrates in and of themselves that are linked to cancer, it's the nitrosamines that can form from them.

    Sodium nitrite isn't primarily a colour fixative, it's a an anti-bacterial agent. Meats cured with sodium chloride only have to be done quite carefully to avoid botulism. Nitrite has been used since the 16th century to preserve meat. Modern cured meats also add sodium ascorbate, and ascorbates have been shown to inhibit nitrosation reactions and thus the nitroamine level in these cured meats is usually at undetecable levels.

    Nitrites are produced in our mouths from bacterial reactions to the nitrates in food and water, and at least 70% of our dietary nitrite comes from this salivary nitrite (which came from our food and water). The nitrites and nitrates we then ingest are mostly either excreted fairly promptly or used to make nitric oxide. Human gastric secretions have a pH which isn't condusive to nitrosamine formation, and also include ascorbates which reduce nitrosamine formation, and keeping one's vitamin C at good levels will also have an effect. People with achlorhydria will obviously be more susceptible to nitrosamine formation. But interestingly, there are studies which now suggest that nitrite consumption is a good thing: http://www.ncbi.nlm.nih.gov/pubmed/20005970 - and branched-chain amino acids are also suggested as suppressing the effect of nitrosamines. However the amount of nitrosamines you get from smoking is definitely Not Good, and no amount of ascorbate will ameliorate it.

    So, a good intake of nitrates and nitrites primarily through vegetables, some fruit, and some cured meat is good: the vegetables and fruit contain ascorbates as does your body, and most of hte meat should have it added also, minimising the formation of nitrosamines, leaving your body to get on with making use of the nitr*tes to make needed nitric oxide. (Oral nitric oxide/arginine supplements are rubbish though - the studies showing their benefit used intravenous/injected supplement.)

    Personally, I'll take nitrites over botulism, thanks.

  • Anna

    3/18/2010 4:00:07 PM |

    Hmmm, I've never been on a cruise, but if I did go on one, I'll bet I'd have to eat somewhat differently than I do at home, regardless of the carb count.  Between not having access to the pastured bison and wild game, raw dairy, "backyard" eggs, and organic CSA produce subscription, and so on that make up most of my family's daily diet, and no access to a kitchen, my meals on a cruise would hardly be representative of my usual diet.  

    I'll bet LC cruisers are as prone to anyone when it comes to the excesses of endless supply of prepared foods on cruises, but I'm not sure we can assume that's the way they always eat.  Most people  eat somewhat differently on vacation, whether it's because they are on somewhat of a "diet vacation", or because they have to make the best of what's available.  When I was on vacation in Italy I had a gelato every day, but I certainly don't do that at home (it was a conscious decision to take a slight vacation from my diet and enjoy a local specialty for a limited time).  And I've been places where it was impossible to get eggs cooked in real butter instead of the ubiquitous "griddle grease" hydrogenated veggie oil, let alone pastured eggs and humanely produced bacon (seriously, we breakfasted at a tiny roadside diner outside Twenty-Nine Palms that had NO butter on the premises).  

    And not all LC eaters are following an Atkin's diet plan, though I understand the Atkins label has become be a generic term for LC eating.  I've read an Atkins book (as well as at least a half dozen other LC diet books).  I eat LC (& GF now) but I've never followed specifically an Atkin's diet plan, nor do I describe myself as at Atkin's dieter.

    I think the points you make point out that even on low carb, people can and do still rely on far too much industrial food.  It's convenient and it's everywhere (hard to avoid, esp when dining away from home).  Frankly, one of the reasons cruise vacations hold little appeal to me is the idea of having to nothing to eat all week but cr@p industrial food, no matter how talented the chefs may be at making it look and taste good.   I may be making a sweeping assumption, but somehow I don't imagine that cruise chefs are simmering their own bone broth stocks, curing charcuterie themselves, and making their own cheese (or even sourcing from small artisan vendors  very much).    I'd be extremely surprised if cruise ship food ingredients weren't offloaded from US Food tractor trailer trucks.  That's what I've seen at many land-based resorts.  When I travel,  as much as possible, I want to try the local traditional foods and specialties, prepared as authentically as possible.  That might mean eating more of something than usual (and less, too).

  • Anonymous

    3/18/2010 4:15:55 PM |

    Isn't it also an Atkins diet error that low-carb eaters tend to be on a constant and frantic quest for processed fake food items that are pretend substitutes for the food that got them in trouble in the first place?  And many of them have made Jimmy Moore, a huge hawker of low-carb substitutes and a less-than-successful low-carber, their role model.  

    I noticed on Swedish physician Dr. Andreas Eenfeldt's blog that his description of his experience on the cruise was that "[t]he big difference with Sweden is that many are fond of low-carb versions of traditional junk food, sugar, and so. Low carb cake, low carb icecream, low carb potato chips, diet sodas ... In my eyes seemed to just those participants who ate such did not have the same persuasive power of the diet. To put it nicely. Perhaps it was the roundest of them all, the man [Andrew DiMino -- Carbsmart.com?] who handed out the various "low carb" products that are advertising for his company. [Google translation]

    People I know who have been totally unsuccessful on Atkins have gleefully loaded up on "substitutes" that probably have derailed them.  And the Atkins company that sells this crap will forever keep the Atkins mantra from the gaining the credibility it probably deserves.

  • Emily

    3/18/2010 4:15:55 PM |

    also curious as to how butter could cause a rise in insulin. butter has even less/no carbs compared to cheese, and in previous posts you've said cheese doesnt cause blood sugar rises...

  • Emily

    3/18/2010 4:20:11 PM |

    also many health food stores, grocery co-ops, and whole foods and trader joes sell either no nitrate-added or uncured deli meats and bacon. applegate and niman ranch are brands that sell these foods.

  • Fred Hahn

    3/18/2010 4:48:10 PM |

    Bill you said:

    "Excessive consumption of animal products--Non-restriction of fat often leads to over-reliance on animal products. Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers. It is not a fat issue; it is an animal product issue. We should consume less meat, more vegetables and other plant-sourced foods."

    I don't think this is true Bill. As far as I'm aware, there is no good evidence to support protein as cancer causing. Dr. Eades has debunked this on his blog.

  • Beth@WeightMaven

    3/18/2010 5:15:58 PM |

    Andrew, scroll down and see the section on conservation of energy for why calories in vs out is faulty: http://entropyproduction.blogspot.com/2009/02/all-medical-science-is-wrong-within-95.html

  • Beth@WeightMaven

    3/18/2010 5:19:08 PM |

    Ditto what Tim said. My understanding is that it's the whey in dairy that is insulinogenic (tho it's a bit like the glycemic index ... it depends on when and what you eat it with).

    Butter should not be as big a problem. One of my go-tos is ghee from grass-fed cows. The small amount of milk solids left in butter are removed when ghee is made.

  • Gretchen

    3/18/2010 6:27:26 PM |

    If you cut out animal protein, dairy, and carbs, there's not much left to eat.

    The protein sources favored by vegetarians, beans, rice, and grains, make blood sugar increase too much for people with diabetes.

    One can not live on tofu and fat alone, and anyway some people say too much soy is not good.

    I don't know why people have a prejudice against dairy. See this:

    http://care.diabetesjournals.org/content/29/7/1579.full

    If you have a diabetic tendency, it means your beta cells aren't producing enough insulin, so a food that helps them along is good.

  • Jimmy Moore

    3/18/2010 6:30:13 PM |

    Well said Dr. Davis!  We were certainly appreciative of your presence on the Low-Carb Cruise.  THANK YOU so much for all of your contributions...we need to get you back on the podcast later this year. Smile

  • zach

    3/18/2010 6:32:46 PM |

    Too many calories on a high fat diet? Good luck keeping that up. I can't get 2000 most days. Too full.

    Why were there traditional societies that used dairy as a staple yet were free of CVD and diabetes, including the super long lived people on the border of Eastern Europe and Central Asia?

    Copy and paste the above argument for "eating too much meat."

    Low carb may not be for everyone, but the biggest problem with some low carbers is probably too much n-6 from processed meat. Lots of nuts aren't that good for you either.

  • Anonymous

    3/18/2010 6:46:12 PM |

    What is the alternative for animal protein? Soy, gluten,beans, nuts all cause other problems?

    Please suggest some sample of improved Atkin diet.

  • PJNOIR

    3/18/2010 6:54:50 PM |

    Again Low carb is NOT zero carb. Many atkins folks don't really read the diet. I used atkins succesfully last year and eat more veggies then I ever did. It is not all about meqat meat meat or even high protein. And as much as I enjoy your blog- you still have a huge fear of fat. With Atkins I have improved my metabolic problems.

  • Helen

    3/18/2010 7:12:05 PM |

    I've been concerned to learn, here and elsewhere, that dairy products are insulinogenic, particularly since I can't seem to manage a reasonable diet without a fair amount of them.  (Nuts don't do well with me, soy is a no-go, I can only eat so much meat, my family has egg-allergy issues, and the fish that is non-contaminated, sustainably caught, not-BPA-canned, not-fed omega-6 and dioxin-laced stuff in a disgusting fish farm, is wicked expensive and logistically impossible to get fresh for my family more than once a week....)

    On the other hand, there are several dairy-reliant cultures that are quite long-lived and healthy, and dairy-consuming people in our own culture tend to be healthier than non-dairy eaters.  So maybe something mitigates the insulin question with dairy.  Just saying.

    In the end, you have to eat something, and sometimes reading this blog I feel I can't eat anything.  Like Dana Law, I'd like a better picture of what an ideal, or at least acceptable, day's or week's diet would look like from your point of view.

  • Jenny

    3/18/2010 8:56:12 PM |

    I've followed Atkins for these last three years, losing 80lbs in the process, so am quite familiar with what's permitted and not.

    Atkins did not recommend consuming any milk, nor was much yogurt or cottage cheese permitted. Hard cheese, cream cheese and heavy cream are allowed, but the Atkins diet permits less than 2-3 oz per day.

    Butter is allowed liberally, but is 100% fat so can't be very insunlinotropic, if at all.

    Because I raise dairy goats, until three years ago, I drank goat milk freel.  Now I never drink it, though I do have a glass of very sour kefir now and then, after the probiotics have cultured most of the lactose into lactic acid.  The kefir I drink is very tart. Most people don't like it that sour. lol

    The "Atkins is High-Protein" myth is often bandied about by anti-low-carb groups. I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended; even 20% protein is not especially high protein.

    My carbs come mostly from eggs, green vegetables, heavy cream for coffee, berries and other LC fruit, and certain nuts and seeds, like flax.  Peanut butter is very carby, and not freely allowed in Atkins.

    I recommend reading the old Atkins book to understand what his diet really contains. Read the 1972 version, as the newer books (after 1999) were changed by Atkins Nutritionals to allow low-carb junk food that they conveniently sell.

  • Dr. William Davis

    3/18/2010 9:51:41 PM |

    I don't want anybody to hear "don't eat meat" here.

    I think that you should eat meat. I am a former vegetarian and I don't particularly like meat. Despite this, I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat.

  • Haggus

    3/18/2010 9:58:20 PM |

    Dr. Davis, you sure it was "Atkins low-carbers" you were with?

    "Excessive consumption of animal products"

    At least with DANDR 2002, as you go up higher on the rungs, meat is replaced somewhat by veggies.  Personally, I eat around 200g of meat per day.  Of that, less than 90g is red meat (the rest is fish.)

    "Consumption of cured meat"

    I love bacon as much as the next guy, but in even Dr. Atkins stated in DANDR 20002 that one should "try to avoid meat and fish products cured with nitrates, which are known carcinogens."

    As for dairy, it's not taboo but still has to be fitted into the carbs you are allowed per day.

    This is the second blog post since the trip you have me scratching my head.  I hit your 60-60-60 markers using oat bran all the while being IGT and sporting an A1c of 4.8%.  (And before anyone asks, in DANDR 2002 Dr. Atkins mentions oat bran to bring down your cholesterol levels.)

  • zach

    3/18/2010 10:12:54 PM |

    Dr. Davis says:

    "I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

    Try to do that for an extended period of time. I lasted about 2 weeks. Now I have a very small meaty breakfast, and a modest size meaty dinner, and I'm STUFFED. Been like this for years. Can't eat lunch-not hungry.

    You prefer plant foods which is great, but you're not in a carnivore's shoes. From our perspective, what you say is rather silly because many of us actually worry about not getting enough calories! Fat is filling. I'm a 6ft, 165 lb male and I can barely get 2000 calories I feel so full.

  • homeskillet

    3/18/2010 10:40:42 PM |

    Amen to Zach. I'm a PUFA-phobe, and if there's no grass-fed meat or butter in my diet, where am I going to get my fat?
    Nuts? (PUFAs)
    Soy? (Won't eat it unless it's fermented--like miso)
    SUPER-skeptical about your claim regarding insulinotropic dairy. If it is so chronic disease-inducing, wouldn't the Swiss of the Loetschental Valley been prematurely "toes up in the dirt" of the emerald green countryside before Weston Price would have arrived to find out how spectacular their health was because of the dairy they consumed?

    Brilliance abounds here: http://www.paleonu.com/panu-weblog/2010/3/18/sat-fat-or-pufa-which-one-do-you-fear.html

  • Helen

    3/18/2010 10:47:42 PM |

    Hey, Gretchen,

    Thanks for the link!  Good to know, and I was wondering about whether producing more insulin would be good or bad for me.  I had gestational diabetes, so I do have a diabetic tendency.  I'll keep eating my yogurt, then.

    Helen

  • kilton9

    3/18/2010 10:49:35 PM |

    Here's a good take on the conventional "wisdom" of nitrates: http://junkfoodscience.blogspot.com/2008/07/does-banning-hotdogs-and-bacon-make.html

    Matt:

    "Being too low in carbohydrates - being in ketosis is anti-metabolic and induces insulin resistance, and probably why Atkins suggested that his diet 'tends to shut down the thyroid.'"

    I generally find your thoughts to be spot-on, so there's no need to manipulate Atkins' quote to enhance your point.  What he said was that dieting in general tends to shut down the thyroid.

    "[P]rolonged dieting [including ‘this one’] tends to shut down thyroid function."

  • Paul

    3/18/2010 10:59:54 PM |

    Dr Davis -
    Could you please post your "typical" breakfast, lunch, and dinner? I've been reading this blog for awhile (and it's great), and have read a lot of what NOT to eat, but haven't read much on what TO eat. What should our 3 square meals/day look like?

  • sonagi92

    3/18/2010 11:25:42 PM |

    I knew that dairy was insulinotropic, but like Emily, I was surprised to see butter on the list as butter is mostly fat, and clarified butter entirely fat.  As I understand, it is protein-rich foods like beef, chicken, and fish, that provoke unexpectedly high insulin responses, so I thought it was either the sugars or the protein in dairy, not the fat, that spiked a rise in blood sugar.  Is butter really insulinotropic like other dairy products containing lactose sugars and proteins?

  • sonagi92

    3/18/2010 11:39:43 PM |

    Another comment about dairy and weight gain:

    I have noticed that melted cheese in particular - a warm, creamy fat with some carbs and protein - is highly palatable.  Full-fat yogurt, whipped cream, and guacamole are similarly irresistible.  I could not consume more than a couple tablespoons of olive oil yet have no trouble gobbling down a few slices of cheese melted onto a piece of chicken or beef.  I'm trying to shave off 5 more pounds to reach my goal, so I've given up all dairy except for clarified butter, which I use to saute veggies.  Will see if this works.

  • Sue

    3/18/2010 11:55:11 PM |

    Most of the low-carbers on the cruise seemed to be overweight.  I don't know if some of them were just starting eating low carb.  I think this is what prompted Davis' post.  If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?

  • Dr. William Davis

    3/19/2010 12:58:36 AM |

    Hi, Fred!

    We had some great conversations. I learned a lot from your "slow-burn" discussions and I've been applying them to my workouts.

    Good to see you here! I will be detailing some of the fat/animal product/cancer discussions in future.

  • frogfarm

    3/19/2010 12:58:37 AM |

    "I do feel that humans are meant to be carnivorous. I just don't believe that piling your plate high with animal products several times per day is the ideal way to eat."

    I'm scratching my head trying to reconcile these two statements.

    How about eating animal products to hunger once or twice a day?

  • Dr. William Davis

    3/19/2010 1:00:10 AM |

    Haggus--

    Excellent point.

    What Bob Atkins called "the Atkins Diet" was somewhat different from what is commonly practiced as "the Atkins Diet."

    As time passes, I continue to marvel at how much he got right.

  • Anonymous

    3/19/2010 1:01:16 AM |

    How high is "too high?" I say this not to be a smart aleck or to overlook the wisdom in "you'll know it when you see it," but this is a bit too vague to be of much use.

    Clearly a largely plant-based diet supplemented with a decent amount of animal protein will trump loading up heavily on animal products to the exclusion of plant-based foods. But there's far too many vague generalizations being bandied about by so-called dietary experts these days and not a lot of concrete recommendations that can be tailored to fit a person's unique context.

    -Bob Sutcliff

  • Rick

    3/19/2010 1:54:31 AM |

    Wow. Echoing a few other commenters, I'd really like some guidelines on what a good diet would look like.

  • Anonymous

    3/19/2010 3:23:10 AM |

    Jenny said: "I track my daily intake on FitDay and it's usually about 15-18% protein, 65-70% fat, and 10-20% carbs... pretty much what Atkins recommended...."

    Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)

    I'm sure most of you can straighten me out on this once and for all. Thanks!

  • Renfrew

    3/19/2010 10:36:00 AM |

    Dr. Davis,

    it would be great after such lengthy and detailed discussions about this topic to give us a typical sample food or meal list for a day of yours.
    Looking forward to it.

    Renfrew

  • Peter

    3/19/2010 1:11:35 PM |

    Fred Hahn: I'm mixed up about your two posts here, "People need to get this into their heads" and "Not true."

  • Lucy

    3/19/2010 1:46:53 PM |

    I would also like to see a typical day in the life of Dr. Davis.

    Anon-  Yes, they mean a % of total calories.  You can figure it this way:

    1g Protein = 4 cals
    1g Carb = 4 cals
    1g Fat = 9 cals

    So if a person eats 2000 cals/day and 18% was from protein, then that person ate approximately 360 cals of protein.  Divide 360 by 4 and you get 90 grams of protein.

  • scall0way

    3/19/2010 2:29:51 PM |

    I agree that there are many low carbers who follow their eating plan less than optimally. I see them posting on the low carb forums I follow. But as one who was also on the cruise, I don't think you can really equate cruise eating with what people eat on a normal day-to-day basis!

    I had resolved to eat only "real food" on the cruise, as I almost always do at home, and I had resolved not to snack. And I was pretty good about my resolve. I didn't snack, ate only three meals a day, avoided the flour, sugar, even the sugar-free cheesecake and other things provided.

    But did I eat exactly the way I would eat at home? No, I didn't. I undoubtedly ate more than I would have eaten at home, and probably certainly more protein sources than I would have eaten at home. The last night of the cruise I even broke down and had one of the sugar-free margaritas, and I had a half glass of red wine at the comedy show.

    And I'm sure my PUFA intake was higher than I would normally like. We had no control over how foods were prepared in the kitchen after all, or very little.

    But this was 5 days out of my life, not a lifetime of eating. Smile I didn't gain any weight on the cruise and indeed have even hit a new low this week since being back. Overall I've lost more than 100 pounds.  

    I'm not convinced of the meat/cancer link either - though too much protein raises my blood sugar so I don't normal OD on protein much. I was never a vegetarian but often thought I could have gone that way as I'm not all that crazy about meat. But now I have an "It's them or me" attitude and look for meats I  enjoy better - just not too much.

    Apparently Matt Stone has challenged my son to try out a super-low-calorie, essentially fat-free diet, based on 1930s research by Evans and Strang, and I'm following his progress with interest. But at the moment it's not for me. I still love my butter and coconut oil.

    But we are all so different, and what works for one may not work well for another. But I wonder how many low carbers eat at home the same way they ate on the cruise?

  • Anonymous

    3/19/2010 2:34:39 PM |

    Well said Dr. Davis!

    Jimmy this is not at all what you promote.  I am confused by your comment.

    Dr. Davis, are you choosing to ignore all those who have asked you to defend your claims (and the great questions asked).  This is the first post I have ever read by you that makes me shake my head.  

    Sally Sue

  • Jenny

    3/19/2010 3:01:52 PM |

    Anon said: "Whenever I read this sort of thing, I get confused. 15-18% of WHAT? the total calories? and if so then how do I translate that percentage into actual amounts (like grams or ounces?)"

    Percentages of my daily food intake. I used percentages because everyone has a different calorie ceiling where we stop losing weight. The ceiling calorie limit usually changes as you lose weight; but the percentage of Protein, Fat and Carbohydrates should remain the same.

    My daily calorie limit is now around 1500 calories; when I weighed 80 lbs more, it was closer to 2000 calories; and at 2000 calories back then I was losing 3-4 lbs a week.  Either way, the grams/oz of Potein/Fat/Carbs that I eat probably won't relate well to you; but percentages can and will.

    By the way, I use a food-tracking program called FitDay, that calculates your food entries into P/F/C, and into grams/oz and percentages, and also gives daily vitamin/mineral counts as well as for individual foods.  It's really quite interesting to compare the nutrition counts of different foods; that way you can see what's really worth eating.  Meat contains a lot more than just protein... it has a lot of essential vitamins and minerals, actually.

    FitDay is free online, but the purchased version is much more convenient; I paid $25 three years ago and consider the money well spent.

    You should track your own food intake to see for yourself what percentages your current diet contains... you might be surprised. Food tracking, whether through FitDay or some other program, is the single most useful thing that helps keep me on track.

  • Nancy

    3/19/2010 3:40:20 PM |

    Red meat and intestinal cancer isn't strongly linked.  In fact, it seems to be dissolving under tougher scrutiny.

    http://www.medicalnewstoday.com/articles/73040.php

    "Recent studies published in the journal Cancer Science have disproved the common myth that consumption of red meat increases colorectal cancer  risk."

  • Martin Levac

    3/19/2010 5:29:56 PM |

    Eat for health, not for weight loss. I agree.

    However, if, perchance, you believed that you ate for health, yet the same diet kept you fat, or God forbid kept you emaciated, would you really be eating for health then?

  • Anonymous

    3/19/2010 7:07:20 PM |

    Re Anonymous and "percentages."  This drives me crazy too.  Without a total daily calorie count, percentages are meaningless.  So what if I eat "10%" carbs, if I am noshing on 6000 calories a day?

    To answer your question: yes, you do have to do some simple math.  First, figure out the number of calories in the given percentage, using a hypothetical total daily caloric intake.  40% of 2,000 calories, for example, would be 800 calories.  A carb has roughly 4-5 calories per gram, so that would equate to around 200 grams of carbs.  Protein is similar.  Fat, on the other hand, has 9 calories per gram.  So those 800 calories would be slightly less than 90 grams of fat.

    Once you start doing it, it gets easier.  Practice on food labels!

  • HSL

    3/19/2010 8:11:21 PM |

    Anon - most food values are given as a % of calories.  For example if you are eating 2000 calories/day of which 70% is fat, then you're eating about 155 gms of fat per day (2000 x 0.70 = 1400/9 = 155 gms). Fat has about 9 calories/gm; carbs & protein each have about 4 calories/gm.

    As for "...15 to 18% of what" that would depend on what you're eating.  Three ounces of white fish (raw) has about 16 gms of protein; 3 oz of beef chuck (raw) has about 28 gms of protein.

  • Andrew

    3/19/2010 8:39:27 PM |

    Beth:

    That doesn't prove that calories in vs. calories out is faulty.  The calories in vs. calories out concept is simply the theory that you will lose weight if you eat below BMR, regardless of what foods you eat.  The Thermodynamics argument is misapplied to this concept, IMO.

    Perhaps we are simply thinking of two different concepts.

  • Lori Miller

    3/20/2010 12:24:31 AM |

    Some highlighted words from the original post: overconsumption, excessive consumption, and too many calories. The point seems to be that a little rich food goes a long way. Oh, and don't eat food that causes cancer.

  • Kim

    3/20/2010 2:59:58 AM |

    Sue said,"Most of the low-carbers on the cruise seemed to be overweight. I don't know if some of them were just starting eating low carb. I think this is what prompted Davis' post. If you are still overweight doing low-carb - are you doing something wrong? Should slimness be a goal every low-carber can meet (apart from all the other health benefits)?"

    I was on the cruise and yes, many of the cruisers were overweight.  Some are just starting a low carb lifestyle, and some are not.  I personally have lost over 150 lbs on low carb and maintained that loss for nearly 2 years now.  I consider that a success, however, I am not thin by any means and am working on about 50 more lbs.  I took the advice from many of the speakers, Dr. Davis included, and have worked it into my daily routines.  As a registered nurse, I am aware of nutrition both mainstream and low carb.  I do my research.  I try to eat cleanly most of the time.  Life interferes sometimes, much as is does for anyone who is human and as I know it has for some of the individuals who were on the cruise.  I do believe individuals who are or have been morbidly obese are vastly different from your average American with 30 lbs to lose.  Everything happens on a grander scale.  We lose weight bigger and gain weight bigger.  All I know is I've lost 100+ lbs using the Standard American Diet--twice.  Within a year I gained it back--twice.  Finding a low carb diet has saved my life.  I eat in normal portion sizes, I maintain. Is it for everyone? No.  Is it the only way? No.  But it is one way that works for many people who really need it.  

    Thanks Dr. Davis, for your presentation.  I truly enjoyed it.

  • Hilary

    3/20/2010 3:08:32 PM |

    "Higher intakes of red meats (heme proteins?) have been strongly associated with increased risk for colon and other gastrointestinal tract cancers."

    Really? Strong association? If that's true, then how do you explain this?:
    http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1

  • Edward

    3/20/2010 8:36:45 PM |

    Hilary said:

    "Really? Strong association? If that's true, then how do you explain this?:
    http://www.ajcn.org/cgi/content/abstract/ajcn.2008.26838v1"

    Hilary, I have not formed an opinion one way or the other on this issue yet, but the study you cite was "Supported in part by the Cattlemen's Beef Board, through the National Cattlemen's Beef Association, and the National Pork Board."

  • Anonymous

    3/20/2010 10:36:51 PM |

    Re my question as to how to translate percentages of protein, fat and carbs into grams, I should've have asked my trusted friend "google" instead of taking up someone's time here. So please forgive me.

    But Thanks! to those who responded. Your explanations were very helpful.

    Meanwhile, I found a site which will do all that computation for me and thought I'd pass it on.
    http://www.freedieting.com/tools/nutrient_calculator.htm

  • Anonymous

    3/21/2010 1:09:02 AM |

    Hi I was on the cruise and thoroughly enjoyed it. Sue, Yes I am overweight according to my BMI of 29, I was on the cruise the first year by the second i was 20 pound lighter by the time I got on this years cruise since last year I have lost 54 pound. Yes I am still as you say overweight but I am doing something about it. Sorry I wasn't "normal" for this year but I will be for next year. Snacks were handed out but the message was clear that these are treats and a preferable treat than something high carb and sugar loaded. There were new people there and others who have been doing it a while and of those we are all less than when we started. We had some excellent speakers i.e. Dana Carpender who spends her life educating us how to make foods using our own ingredients she even said you can put weight on eating low carb as we still can make the wrong choices. We all have the same problem with food do we not but we are prepared to be educated by the fabulous speakers who went to help us and gave their time freely to pass on their knowledge.

    A big big thank you to them and you Dr Davis

    Ailsa who came one the cruise all the way from the UK.

  • Mike Turco

    3/22/2010 2:21:16 AM |

    I've been reading your blog for a couple years and really enjoy doing so. I think you've got it wrong on the Atkins diet, though. I don't know where you got your information and I'm pretty sure you didn't read the books. Milk and yogurt aren't on the "diet". Atkins also told you to not eat cured meats. As far as calories are concerned, Atkins also told people to not eat too much! So... I'm having a lot of difficulty with this article in particular & wanted to pipe up. I'll go back to readin' the rest of your blog now. Thanks for all your efforts in keeping this blog up and running. -- Mike

  • George

    3/22/2010 3:46:11 PM |

    Dr. Davis, have greatly enjoyed your insights on this blog over the year. Have had your book for a couple of years. Have noticed great benefits from your vitamin D recommendations. When is your updated Track Your Plaque book coming out? I thought it was coming out toward the end of last year? Any ETA on it? Very interested in seeing your recommendations as it relates to diet? Typical recommended breakfasts, lunchs, and dinners?

    George

  • Owen

    3/28/2010 12:13:24 PM |

    This seems consistent with Ray Peat's advice as far as meat meat is concerned- he recommends balancing meat intake with gelatin so as to not get too much iron (hemeprotein afterall) as well as the fact that it has a less inflammatory amino acid profile (muscle is high in tryptophan and histidine wheras gelatin has no tryptophan and lots of glycine and proline...)

    Also he mentions that he always drinks coffee when he eats red meat so as to block iron overload even more!

    Of course he has no problems with milk, butter and cheese consumption but prefers the latter b/c curds have a better amino profile than whey.

  • Anonymous

    3/28/2010 5:35:14 PM |

    Over the years, I've looked closely at the studies associating red meat with colorectal cancer, and it appears to be impossible from them to separate the effects of modern meat production practices from that of the meat. In other words, it is as likely as not that what's wrong with the red meat is what we put into it, and how it is grown, versus any attribute of the meat itself.

    However, whatever the cause of the problem, it pays to at least limit consumption of red meat that you buy in a supermarket.

  • Atkins Diet

    4/24/2010 11:14:47 PM |

    Hi Dr Davis,

    Thanks for sharing your comments. I am a big Atkins Diet follower, and we all need to remind ourselves to keep the intake of "processed" meat & foods to a minimum. Vegetables are a good way to go! Thanks for providing us <a href ="http://atkinsdietinformation.blogspot.com>Atkins Diet</a> followers with such relevant and important information

    Cheers,

    John

  • jpatti

    5/7/2010 8:27:28 AM |

    I think it's bizarre to associate ANYONE'S eating habits on a cruise with what their day-to-day life is like.

    My normal food would not be available on a cruise: homemade yogurt and kefir made from fresh raw whole milk mixed with berries, pastured eggs with dark yellow yolks cooked in pastured butter, pastured meat, fresh organic fruits and vegetables, homemade chocolate made with coconut oil, cocoa, almonds and stevia... I don't see a cruise line providing food like this.

    So, I'd probably do sugar-free cheesecake too, or wind up overeating fresh fruit, just cause there'd not be any of my food there.

    When I travel, I do Wendy's burgers using the lettuce as a bun if hitting a drive-through or really crappy salad bars with not much beyond iceberg lettuce.

    Sometimes, you do the best you can with the circumstances... cause to eat really WELL, you pretty much need a kitchen.

  • R. Eductil

    6/7/2010 6:08:32 PM |

    This article contains huge inventory of knowledge and telling about the diet and what to eat or not.

  • suzan

    6/8/2010 11:06:10 AM |

    healthty diet is important..nice article about diet

  • Atkins Diet Copy

    7/11/2010 11:09:15 PM |

    Thanks for sharing this very useful tips.

  • cheapcalorad

    10/22/2010 10:58:27 AM |

    Really some truth to the fact that people from Mediterranean areas are seldom obese despite eating a very high fat diet? Did science get it all wrong before? Was there a national conspiracy to force people to eat boring, healthy foods? Thanks for your good suggestion.

    Welcome to visit-
    weight loss accelerator.
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  • Anonymous

    11/2/2010 11:54:28 PM |

    I haven't eaten meat or dairy in long time. Humans don't need meat or dairy. I think meat is disgusting and I'm glad I don't have to eat it. I've seen meat-eaters B-12 deficient, so this shows eating meat doesn't necessarily make someone sufficient in B-12. Methylcobalamin B-12 works great. Eating red meat apparently increases colon and breast cancer risk. I think meat was meant to be an option, just like grains or legumes. Humans were designed to survive on many different things. Plant foods are affordable and bearable for me - meat is not.

  • buy jeans

    11/3/2010 2:21:15 PM |

    Overconsumption of dairy products--Dairy products, especially milk, yogurt, cottage cheese, and butter, are potent insulinotropic foods, i.e., foods that trigger insulin release. There can be up to a tripling of insulin (area-under-the-curve) levels. This is not good in a world populated with tired, overworked pancreases, exhausted from a lifetime of high-carbohydrate eating.

  • atkins diet plan

    12/7/2010 12:42:49 PM |

    hey guys,
    you out there had some great conversations that help me learn a lot from your, atkins diet, "slow-burn" discussions, meat consumption and being vegetarian.

    Nice exchange of great ideas, keep going guys and thanks Dr. Davis.

  • Lance Strish

    9/25/2011 8:44:37 AM |

    What do you make of this 'physiological insulin resistance' and its role in creeping weight gain on too low carb
    http://www.lowcarbconversations.com/344/22-barbara-rose-dean-dwyer-paleo-guy-weston-price-gal-discuss-body-image-more/#comment-306963040

  • Dr. William Davis

    9/25/2011 1:26:12 PM |

    Hi, Lance--

    I've not heard this argument before. If you've got the references for the studies showing this effect, I'd be happy to take a look.

    In real life, I've not seen this play out. People who restrict carbs, lose visceral fat, drop HbA1c, glucose, and insulin. Maintaining the diet does not, over the years, allow recrudescence of the phenomena of insulin resistance.

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