Vitamin D toxicity

6. February 2008 William Davis (26)
It is the craziest thing.

The notion of vitamin D being easily and readily toxic has grabbed hold of many people, including my colleagues who were taught that vitamin D was toxic in medical school based on the skimpiest (and often misinterpreted) observations in a handful of unusual cases.

In my practice and in the Track Your Plaque program, we routinely use doses of 2000-10,000 units per day, occasionally more. We are guided by blood levels of 25(OH) vitamin D3. I have personally never witnessed vitamin D toxicity.

Here's an interesting graph from Dr. Reinhold Vieth. Those of you familiar with the vitamin D argument know that Dr. Vieth is among the few genuine gurus in the vitamin D world.



















From Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 1999;69:842-856. (Full text is available without charge.)

In the graph, the X's represent toxicity; circles fall within the non-toxic range. (Toxicity is generally defined as a level sufficient to raise blood calcium levels, "hypercalcemia.") Note that the 25(OH) vitamin D3 levels are given in nmol/L; to convert to ng/ml units that are customary in the U.S., divide the nmol/L value by a factor of 2.5.

You will notice that toxicity is virtually unheard of until the dose exceeds 10,000 units per day. Beyond 10,000 units per day, the curve heads upward sharply and toxicity does become a possibility, though not an absolute (since there are circles above 10,000 units).

You may also notice that the curve is relatively flat from vitamin D doses between 200 units and 10,000 units (log scale on x axis; arithmetic scale on y), the range of most common doses for vitamin D supplementation.

Another perspective on vitamin D blood levels is to examine the blood levels of people who are young and obtain plentiful sun exposure. Lifeguards, for instance, have blood levels of 84 ng/ml (210 nmol/L) without ill-effect. (Sun exposure cannot generate vitamin D toxicity, because of a feedback safety mechanism in skin.) While this may not represent an ideal level since they represent an extreme, it does provide reassurance that such levels are non-toxic. I also point out these levels occur in the youthful since most people lose 75% or more of vitamin D activating capacity in the skin by their 70s. Most of us over 40 are kidding ourselves if we think that a suntan provides sufficient vitamin D.

Keep in mind that it is not necessarily the dose of vitamin D that is toxic, but the blood level it generates. I take 10,000 units of vitamin D as a gelcap per day to maintain my blood level between 50-60 ng/ml (125-150 nmol/L). This strategy helps me keep my HDL in the 70-80 mg/dl range, my blood sugar around 90 mg/dl, my blood pressure <120/80, and I no longer experience colds nor winter "blues."


Copyright 2008 William Davis, MD

Turning plaque into profit

3. February 2008 William Davis (7)
For reasons unknown to me, I received a solicitation to invest in a company called Prescient Medical, with a slogan that caught my eye:


Detect and treat heart attacks before they occur.


The glossy brochure details their technology development strategy:

Predict(TM) Optical Catheter System--A catheter introduced into the coronary artery during a catheterization procedure to determine whether a specific plaque or vessel area is "vulnerable," i.e., prone to rupture in future.

Protect(TM) Luminal Shield--A stent-like metal device deployed into the coronary artery at the region of vulnerable plaque to prevent future plaque rupture.

The company anticipates FDA approval for their systems by 2009 and sales to begin by 2010. They predict sales of $7 billion.

Let's stop and think about this for a moment. It seems to me that, rather than pursuing the market of another stent for a "severe blockage," this company is going after the untapped procedural market of vulnerable plaque. In other words, their technology (an optical sensor technology that emits and analyzes light wavelengths to map specific plaque characteristics) identifies plaque that may rupture in months or years, followed by implantation of stent(s) that presumably prevent plaque rupture.

Thus, conceivably, many 20%, 30%, 40% etc. "blockages", atherosclerotic plaques that do not block flow and thereby pose no need for a conventional stent, will end up with this new type of stent. One patient could therefore receive multiple "Luminal Shields" in a single procedure.

When would these devices be employed? One pathway I could conceive of that my colleagues will be sure to exploit is 1) identify plaque by CT angiography, then 2) bring patient to the catheterization laboratory and perform this procedure for whatever hot, vulnerable plaques are identified. In other words, symptoms are no longer necessary. Reduced blood flow is no longer necessary. An abnormal stress test is no longer necessary. All that is required is that you have plaque. If the plaque is then determined to be vulnerable, then it is stented.

What bothers me about all this is the emerging effort to exploit this untapped market--a big one--of early heart disease as identified by coronary atherosclerotic plaque. As heart scans have demonstrated, there is an enormous amount of hidden heart disease in this world. This company has discovered a way to turn plaque into a profit opportunity, much as the statin drug industry found a way to "turn cholesterol into money."

The conventional stent market has plateaued and now has been, to some degree, battered by the drug-coated stent argument. Prescient has found a new and significant market for procedures and stents.

Is this really necessary? Why does plaque have to become a procedural disease? Doesn't it make more sense that, if vulnerable plaque is identified, that clinical trials are then designed to develop treatment strategies that modify vulnerable characteristics? Shockingly, this has not been done to any significant extent. Instead, the easiest path to a profit opportunity is to implant a "Luminal Shield."

You and I are able to inactivate, disempower, and essentially shut down plaque, while others are working furiously to convert it into a procedural profit opportunity. I personally find this so distasteful that I would sooner endorse a high-dose statin strategy than this approach.

You can view a video of my colleague, Dr. Martin Leon, on the Prescient Medical website, (or click here to go directly to the video), talking about how this technology will "change the treatment paradigm of the interventionalist from reactive to proactive." Scary stuff. Dr. Leon has made millions of dollars (probably more like tens of millions of dollars) from his support of technology companies for the interventional coronary device market.

My hope is that word of the sorts of techniques we use in the Track Your Plaque program disseminate before this sort of luminal coating idiocy gets off the ground.

(In actuality, a different version of this approach has been available for years using intravascular ultrasound (IVUS), another procedure that involves threading a catheter down each coronary artery during a catheterization procedure. IVUS can also cross-sectionally map a plaque's anatomy and identify "vulnerable" features, like a thin cap overlying a collection of semi-liquid fat ("lipid pool"). There has been some discussion of using this approach to identify vulnerable plaque followed by stent implantation, but it has never gotten off the ground and has certainly not found validation in any clinical study. By the way, any stent prevents plaque rupture, since by their very nature, the plaque contents are compressed, modified, and excluded to the exterior of the stent. Plaque rupture within a stent is very rare in its few millimeters of length. It may therefore not require some new technology to prevent plaque rupture.)

Statin mono-failure

1. February 2008 William Davis (6)
Evan's first heart scan score in November, 2006 yielded a high score for a 56-year old male: 542.

So he put up little fuss when his doctor prescribed simvastatin at a high dose.

Evan's LDL cholesterol before simvastatin: 158 mg/dl

Evan's LDL cholesterol on simvastatin: 72 mg/dl.

By conventional standards, Evan has had an excellent response. The rest of his lipid (cholesterol) panel was unrevealing: HDL 62 mg/dl, triglycerides 78 mg/dl. Evan doesn't smoke, has a normal blood pressure, and he is not diabetic. That should do it, right?

So his doctor thought. So Evan asked if another heart scan was in order. In December, 2007, after one year of simvastatin, his second heart scan score: 705--a 30% increase over one year.

Recall that, with no effort at prevention whatsoever, the natural progression of heart scan scores is a 30% per year increase. Did simvastatin do nothing?

This is quite typical of people who do nothing more than take a statin drug. While some people do slow plaque growth (we say "decelerate") modestly on a statin drug, Evan's experience is not unusual: plaque continues to grow despite high-dose statin drug and an apparently favorable cholesterol panel.

In fact, I can count the number of people who reduced their heart scan scores taking a statin drug alone on one finger.

Statins do not represent a cure for heart disease. They cannot be used as sole therapy to reduce risk for heart attack. In fact, given sufficient time, the majority of people who do nothing more than follow this standard line of treatment (along with the equally lame low-fat diet, etc.) will have done nothing more than postpone their heart attack. Elimination of risk? Nope.

This is among the reasons we developed the Track Your Plaque approach. While not foolproof, I know of no better approach to seize control over plaque growth.

Additional conversations on clinical studies which, as with Evan's experience, demonstrated how statin drugs fail to slow plaque growth can be found in previous Heart Scan Blog posts:

Don't be satisfied with "deceleration"

Study review: Yet another Lipitor study



Copyright 2008 William Davis, MD

Triglyceride traps

31. January 2008 William Davis (17)
Triglycerides are a potent trigger for coronary plaque growth.

Triglycerides in and of themselves probably do not cause plaque growth. Instead, triglycerides contribute to the formation of abnormal lipoproteins in the blood that, in turn, trigger coronary plaque, like VLDL, intermediate-density lipoprotein (IDL), and small LDL. Excess triglycerides also modify HDL structure and cause you to lose HDL in the urine.

I see plenty of people who begin with triglycerides of 200 mg/dl, 300, 700, even over 1000 mg/dl. It doesn't take long before you learn what works, what doesn't to reduce triglycerides. This is especially true in the Track Your Plaque approach, in which our target for triglycerides is 60 mg/dl or less.

Here's a list of things to consider if you are trying to gain control of your triglycerides:

--Fish oil--A mainstay of treatment. The omega-3 fatty acids from fish oil are the number one most potent treatment for high triglycerides.

--Reduction of high-glycemic index foods--Most notably wheat. Everybody knows that we shouldn't eat Snickers bars or bags of licorice. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they are causing triglycerides to skyrocket, dropping HDL, forming small LDL, increaaing blood sugar and blood pressure, and increasing obesity.

--Eliminating fructose and high-fructose corn syrup--This ubiquitous sweetener is now consumed in enormous quantities by the average American, nearly 80 lbs per year per person. You'll find it in soft drinks, ketchup, beer, breads, breakfast cereals, and many other processed foods. You'll find none in green peppers, cucumbers, and raw nuts. Fructose causes large rises in triglycerides, as well as diabetic patterns. Don't let "fat-free" claims fool you. Take a look at the ingredients in Kraft Fat-Free Caesar Italian salad dressing, for instance:

Kraft Fat-Free Caesar Italian

Ingredients:
Water, Vinegar, High Fructose Corn Syrup, Corn Syrup, Salt, Parmesan Cheese, Part-Skim Milk, Cheese Culture, Salt, Enzymes, Contains less than 2% of Garlic, Whey, Onion Juice, Autolyzed Yeast Extract, Phosphoric Acid, Worcestershire Sauce, Vinegar, Molasses, Corn Syrup, Water, Salt, Caramel Color, Dried Garlic, Sugar ,Spices, Tamarind, Natural Flavors, Hydrolyzed Soy Protein, Xanthan Gum, Potassium Sorbate and Calcium Disodium EDTA as Preservatives, Dried Garlic, Buttermilk, Spice, Dried Parsley, Caramel Color, Sodium Phosphate, Oleoresin Paprika.



--Alcohol--While a couple of drinks a day raises HDL, exerts anti-inflammatory effects, and reduces blood pressure, more than this begins to raise triglycerides. Although I've come across no formal studies on this question, my gut sense is that beer, in particular, raises triglycerides more than wine or other alcoholic beverages. Could it be the wheat source of beer? Or its high-fructose corn syrup? I don't know, but beer is the least desirable form of alcohol of the choices we have.


Following these simple steps, it is unusual in my experience that you cannot achieve a triglyceride level <60 mg/dl. Rarely do we need to add fibrate drugs or other prescription agents to reduce triglycerides.



Copyright 2008 William Davis, MD

High-dose fish oil for Lp(a)

30. January 2008 William Davis (16)
Lipoprotein(a), or Lp(a), is a problem area in coronary plaque reversal.

While our current Track Your Plaque record holder for largest percentage reduction in heart scan score has Lp(a), it remains among the more troublesome lipoprotein patterns.

One unique treatment for Lp(a) is high-dose omega-3 fatty acids from fish oil. While the data are relatively meager, there is one solid study from Lp(a) expert, Dr. Santica Marcovina of the University of Washington, called "The Lugalawa Study."

In this unique set of observations, 1300 members of a Bantu tribe living in Tanzania were studied. What made this population unusual is the fact that two groups of Bantus lived under different circumstances. One group lived on Nyasa Lake (3rd largest lake in Africa and reputed to have the greatest number of species of fish of any lake in the world) and ate large quantities of freshwater fish providing up to 500 mg of omega-3s, EPA and DHA, per day. Another Bantu group lived away from the lake as farmers, eating a pure vegetarian diet without fish.

Nyasa Lake












This situation among genetically similar stock provided a unique learning opportunity, a chance to assess whether different diets influenced Lp(a) levels.

The results: The fish-eating Bantus had an average Lp(a) level of 14.0 mg/dl. The farming, non-fish eating Bantus had an average Lp(a) of 27.0--a 48% difference. Curiously, a comparison of the apo(a) component of Lp(a) between the groups also showed that the fisherman expressed fewer dangerous small apo(a) forms, despite equal potential to express both.

The Lugalawa Study opens the question of whether similar results can be obtained not by moving to Tanzania and fishing Nyasa Lake, but by mimicking their experience by supplementing high doses of omega-3 fatty acids.

It's an intriguing question. In the Track Your Plaque program, we have no specific experience with this strategy, but it is certainly worth exploring further.

Watch for two upcoming Special Reports on the Track Your Plaque website in which we will be detailing 1)unique strategies for Lp(a) reduction, and 2) the usefulness of high-dose fish oil for coronary plaque reversal.

Interesting enough for a Virtual Clinical Trial?


Image courtesy Wikipedia.


Copyright 2008 William Davis, MD

The many faces of LDL

29. January 2008 William Davis (0)
Pam has an LDL cholesterol of 144 mg/dl.

To most people, this means that she has a mildly elevated LDL value. Many people would respond by cutting the saturated fat in their diet. Most physicians would concur and talk about prescribing a statin drug.

Let me tell you what an LDL cholesterol of 144 mg/dl means to me:

1) It could mean an LDL of all large particles (which is good) or an LDL of all small particles (which is very bad). Or, perhaps it's some combination of big and small. I can't tell which just by knowing that LDL is 144.

Small LDL responds to a diet reduced in processed carbohydrates and wheat flour; large LDL does not. Small LDL responds in an exagerrated way to niacin; large LDL does not. It makes a difference.

2) It could mean that, hidden within LDL, is lipoprotein(a), or Lp(a). Recall that Lp(a) is a high-risk genetic pattern that can provide the false appearance of high LDL cholesterol. If Pam were prescribed a statin drug, it would have little effect and little benefit. (See Red flags for Lipoprotein(a).)

Knowing that Pam has Lp(a) can point us in an entirely different direction than just LDL cholesterol. It might mean high-dose fish oil, a more serious approach to niacin, hormonal treatments like DHEA or testosterone. It might mean more attention to warning your children about the possibility that they, too, might share this genetic trait.

3) It could mean both small LDL and Lp(a) are present simultaneously, an especially dangerous combined pattern that is among the highest risks for heart disease known.

4) Because Pam's LDL of 144 mg/dl was not measured, but calculated, it means that it is subject to tremendous inaccuracy.

In my office, calculated LDL cholesterols can be inaccurate by 50 or 100 mg/dl--commonly. So Pam's LDL of 144 mg/dl could really be 70 mg/dl, or it could be 244 mg/dl. Once again, it's a big difference.


Just like The Three Faces of Eve, the 1957 film in which Joanne Woodward played the three wildly different sides of Eve's personality--the daytime Eve White, the fun-loving and daring Eve Black, and Jane--so can LDL assume several different faces, all with different personalities, different implications.

Accepting LDL cholesterol as LDL cholesterol is a fool's game. It is only a starting point, nothing more. Accepting a statin drug based on LDL is, likewise, a trap fraught with uncertainty, the potential for limited or ineffective results, the price being your heart and health.

Drive-by angioplasty

26. January 2008 William Davis (7)
Don had an angioplasty 6 months ago. When asked about the symptoms that prompted him to go to the hospital, he explained:

"I remember feeling really tired for about a week before I went. I'd read that fatigue can sometimes be a sign of heart disease. But then I had some trouble breathing. You know, like not being able to get a deep breath."

"My wife and I were planning on going on vacation. So I wanted to be certain something wasn't going on in my heart. That's when my wife insisted that she take me to the hospital.

"I kind of remember going there and arriving in the emergency room, but then I don't remember anything. Next thing I know, I'm waking up in a hospital bed. My wife and kids were there, looking all concerned. They said that I just got two stents and that the doctor just barely saved my life."

Happy story, happy ending? Not quite.

I reviewed the angiograms made during Don's hospital stay. They did, indeed, show some plaque, but not anywhere close to the amount necessary to account for symptoms like fatigue or breathlessness. For symptoms like this to occur without physical exertion, say, at your desk or relaxing at home, a critical >90% blockage would be required.

The worst "blockage" Don had was 50% at most. The leap was made to connect his relatively vague symptoms with these "blockages," leading to the implantation of two stents.

This is not as uncommon as you think. Yes, the practice of cardiology can be a life of acute procedures, urgent situations, and crises. Unfortunately, some people with questionable need for these procedures also get swept up in the wave. Sometimes it's due simply to the doctor's need to do "something," nervous family waiting in the wings. Sometiems it's intellectual laziness: putting in two stents seems to satisfy many patients' needs to have something "fixed," even when symptoms like fatigue could be due to anemia, sleep deprivation, a thyroid disorder, or any other myriad conditions that require a diagnostic effort (otherwise known as thinking). And sometimes it's simply done with financial motives, since angiplasty and related procedures pay well.

I call this "drive-by angioplasty," the impulsive, poorly considered coronary procedure that really should never have happened. How often does this happen? What percentage of heart procedures fall into this category? There are no clear-cut estimates. There are crude attempts by independent agencies that have put the number of unnecessary heart catheterizations up to 20% of the total number performed. The proportion of angioplasty procedures, stents, etc. that are not necessary is a tougher number to pinpoint, given the uncertainties surrounding the indications for these procedures, physician judgment that factors into the decision-making process, and the fact that many decisions are made on a qualitative basis, not precise quantification.

In real life, I would put the proportion of flagrant drive-by procedures at no more than 10%. However, that is 10% of an enormous number. The annual cardiovascular healthcare bill is $400 billion. 10% of that is $40 billion--an unimaginable sum. It also adds up to tens of thousands of people per year needlessly subjected to procedures. Consider that 10,000 heart procedures were performed today alone.

Should we push for legislation to control how and when heart procedures are performed? I don't think so. Despite my criticisms of the status quo in heart care, I still favor the freedom and rapid development of a free-market approach. However, you as a healthcare consumer need to be armed with information. You don't go to the car dealer unarmed with information on prices and comparative performance of the car you want. You should do the same with health. Information is your weapon, your defense against becoming the victim of the next drive-by heart procedure.

"Heart Healthy" and other lies

23. January 2008 William Davis (7)
"Bankers believe liquidation has run its course and advise purchases."

New York Times headline, Oct 30, 1929, at the start of the Great Depression.






"I did not have sexual relations with that woman, Ms Lewinsky."

Former President Bill Clinton at a Washington Press Conference, 1998.






"The third quarter is going to be great."

Enron CEO, Ken Lay, just before the company reported a $638 million third-quarter loss, triggering the company's collapse.




Should we add the following to the list?


Heart Healthy Bisquick





















Heart Healthy snacks according to the National Heart, Lung, and Blood Institute:

Animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, graham crackers, vanilla or lemon wafers

Angel food cake or other lowfat cakes

Low fat frozen yogurt, ice milk, fruit ices, sorbet, sherbet

Pudding (make it with fat free or 1% milk), gelatin desserts

Popcorn without butter or oil; pretzels, baked tortilla chips






67% digestible carbohydrates/sugars from corn syrup, sugar, raisins, and honey. Oh, yes . . . and it contains plant sterols.





"Heartzels are a healthy snack alternative for anyone wanting to control fat intake and add fiber to their diet," said Tracy LaRosiliere, a Frito-Lay vice president of marketing. "What better time for Frito-Lay to launch its first heart-healthy snack than during American Heart Month and just in time for Valentine's Day."

The relationship with the American Heart Association and the launch of Rold Gold Heartzels Pretzels is the latest move by Frito-Lay to continue its commitment to offering a wide variety of low-fat and better-for-you snacks nationally, which like the company's assortment of regular chips can be enjoyed as part of a healthy diet and lifestyle.

Calcium chaos

23. January 2008 William Davis (30)

Imagine that I'm planning to build a wall of bricks. I start by throwing cement at a pile of bricks, hoping that it forms a nice, orderly brick wall.

Fat chance, you say.

I believe that is what appears to be emerging as the situation with calcium supplementation.

A recent study from New Zealand reported an experience with 1,471 postmenopausal women, mean age of 74 years, who were randomized to treatment with either calcium supplements or placebo. Calcium was supplied as calcium citrate (Citrical) to provide 1000 mg of (elemental) calcium per day (400 mg morning, 600 mg evening).

(Bolland MJ, Barber PA, Doughty RN et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Brit Med J BMJ, doi:10.1136/bmj.39440.525752.BE; published 15 January 2008)

Over 5 years, women taking calcium had twice the risk of having a heart attack compared with women taking the placebo; women taking calcium had a 47 percent higher risk of having any one of three "events" (heart attack, stroke or sudden death) than women in the placebo group.

The findings of this study run counter to what we've been telling people all these years: Calcium supplementation, usually taken to halt deteriorating bone health and osteoporosis, modestly reduces blood pressure, reduces LDL and raises HDL cholesterol. At first blush, we might thereby presume that it also reduces cardiovascular events.

This study suggests that calcium supplementation does not result in reduction of cardiovascular events, perhaps even increases risk.

Certainly, this new finding will serve to confuse the public even more than it is already, particularly when it comes to strategies that modify risk for heart attack. However, this may make more sense once we stop and think for a moment.

Calcium supplementation inarguably slows, occasionally halts, calcium resorption from bone (through suppression of parathyroid hormone). Calcium also accumulates as part of atherosclerotic plaque in coronary and other arteries.

How does oral calcium know where to go--bones, not arteries or kidneys, in addition to serving all its other crucial functions?

Keep in mind that, in many roles, calcium is passive, something that responds to control exerted by some other factor. Vitamin D is that factor. Vitamin D controls the absorption of calcium in the intestinal tract (calcium aborption quadruples when vitamin D is restored to normal), it controls whether calcium is deposited in bone or extracted from arteries. It is the master control over the fate of calcium. Calcium just goes along for the ride.

Bone and arterial health do indeed intersect via calcium, but not through calcium supplementation. Instead, the control exerted by vitamin D (and vitamin K2, another conversation) connects the seemingly unrelated processes.

At what calcium dose threshold do the benefits stop and the adverse effects begin? That remains unanswered, particularly in light of this new study. However, this study calls into serious question the wisdom of supplementing calcium at a dose of 1000 mg, particularly when taken without normalization of vitamin D.

Calcium is therefore emerging as an important player in artery health. But just taking calcium makes no more sense than our brick wall and cement analogy. You might regard vitamin D as the mason that skillfully lays down both brick and cement in a neat, orderly way.

Another big Track Your Plaque success story

22. January 2008 William Davis (2)
Lorenzo is an 81-year old retired manufacturing engineer whose intial heart scan score in late 2006 was an alarming 1102.

Recall that, despite feeling well and having a normal stress test, Lorenzo was facing a heart attack and death risk that was as high as 25% per year without preventive action.

Lorenzo was moderately interested in the Track Your Plaque concepts. While not exactly the most highly motivated, he did see the rationale in our approach. But he came to us mostly because his primary care doctor told him to.

Nonetheless, one year later, he underwent another heart scan. His score: 588--a 46.6% drop in score, nearly cutting his plaque in half. While Lorenzo didn't set any new records in terms of percentage drop in score, he has reduced his score in real numbers more than anybody else before: a 514 point drop in score.

Lorenzo joins the ranks of our current record holders, Amy, with a 63% drop in heart scan score, and Neal with a 51% drop in score. Both of these Track Your Plaque record holders, while achieving larger percentage reductions in score, achieved less when viewed on an absolute number basis.

Now, breaking records is not necessary to succeed in the Track Your Plaque program or at heart disease reversal. Even 1% reversal is still a big success, certainly more than is achieved in conventional practice.

No special commitment was necessary in Lorenzo's case. All he required was a little of the right kind of information. I can tell what he didn't do: Lorenzo did not follow a low-fat American Heart Association diet, he did not take high-dose statin drug, he did not deprive himself of food, he did not exercise to extremes. He just applied some simple strategies from the Track Your Plaque program.

I play these sorts of games just to make a point and to show just what is possible. While the world of hospital procedures and emergency management of coronary disease marches on, we are quietly reversing the disease. Sometimes, we achieve results that even surprise ourselves.

Lorenzo's full story will be detailed in the February 2008 Track Your Plaque newsletter. If you are not yet a subscriber, you can sign up (without cost)here.


Copyright 2008 William Davis, MD
Atkins Diet: Common errors

Atkins Diet: Common errors

18. March 2010 William Davis (74)
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.
Tags :

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.
    Cheap Calorad

  • 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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