Can I see your linea alba?

2. November 2010 William Davis (19)
As more and more people are eliminating wheat from their diet and losing their "wheat bellies," i.e., the muffin top around their waists along with the visceral fat beneath, I am frequently seeing something I haven't seen in years: the linea alba.

Linea alba, or "white line," refers to the band of connective tissue running vertically from sternum to pubic area. It underlies the depression that separates the horizontal abdominal rectus muscles of the "six pack" abdomen.

It's like digging in your closet and finding something you thought you'd lost years earlier. Surprise! It's been there all along. Buried deep beneath the abdominal fat from dozens of deep-crust pizzas, whole wheat pasta, and whole grain sandwiches is this pleasing anatomical feature long lost from most peoples' anteriors.


Can you see your linea alba?

Dwarf mutant wheat

31. October 2010 William Davis (13)
Here's my 12-year old standing next to dwarf wheat grown near my house. The wheat is full-grown, harvested about 2 weeks after I took this photo.

Wheat is no longer the 4-foot tall "amber waves of grain" of the 20th century. Over 99% of all wheat grown worldwide is now the 18- to 24-inch tall dwarf. New size, new biochemistry, new effects on humans. I call it dwarf "mutant" wheat despite its lack of extra limbs or eyes because of the dramatic transformation required to breed this unique synthetic plant. 

Short-stature means less stalk, faster growing. The stockier stalk also means that the heavy seed head won't cause the plant to "buckle," as 4-foot tall wheat used to. 





The thousand-plus proteins of wheat that have been transformed to generate this dwarf mutant also changed wheat's relationship to consuming humans.

Medical education in the days of Big Pharma

30. October 2010 William Davis (43)
I received this detailed email from an unexpected source: a 3rd-year medical student.

In her email, Theresa describes her frustrations in what she is witnessing for the first time, proceeding through her training and getting exposed to the realities of medical life.

Medical training, particularly clinical training from the 3rd and 4th years of medical school, onwards through internship, residency, and fellowship training, consists largely of bullying, "pimping" (meaning rapid-fire grilling of questions at trainees), and sleep deprivation. It is an extended hazing period meant to demoralize and inculcate the trainee into following the lead of superiors. Buck the system and you're . . . out. Imagine you've just sunk $190,000 and 8 years of college into getting to your internship. You are not going to chance being thrown out on principle. So you just swallow your pride, go along with the game, and echo all the answers they want you to repeat.

While Theresa laments the sad state of modern American pharmaceutical- and procedure-obsessed medicine, she provides me with hope that some young people training to practice medicine today will carve out their own paths, not the one laid for them by the pharmaceutical industry, nor fall for the temptation of higher-paying procedural specialties like orthopedics and cardiology. I am impressed with her ability to see this so early in her career.


Dr. Davis,

I am a 3rd year medical student at ________ University. I came across
your blog today, and I'm very glad I did. I appreciate the value of your time,
so I want to be as succinct as possible while still getting across what I'm
really thinking and feeling:

From what I gathered exploring your blog for a while this afternoon, the
wellness strategies you incorporate into your practice are some of the exact
things I want to do with my future patients. Personally, I strongly believe in
staying healthy by eating right, staying active, etc. For instance, I don't eat
grains or much in the way of starches and sugars. So I love the fact that you
are helping your patients make these powerful and foundational changes in their
lives.

As I'm sure was your experience, a full appreciation of nutrition and lifestyle
as a first-line health strategy is not something that was taught to me in
medical school. I came to school with this deep conviction already in my heart
and mind, and now, on my 3rd year rotations, I am still conflicted and at a loss
as to how I'm going to be able to practice medicine the way I want to, which is
to incorporate these all-important principles into the care of my patients.

What I've come to understand about the medical field today is that the
information that exists is primarily subsidized by the pharmaceutical industry,
and dictated to medical professionals as "evidence-based" treatment guidelines
and recommendations by organizations with sincere and official sounding names
like American Heart Association and American Cancer Society. Add to that the
pressure of potential malpractice litigation and the complexities of the
insurance reimbursement game, and it seems to me like what you get is a bunch of
diagnostic and medication management algorithms that any half-trained monkey
could follow. In his sleep. Which I guess would be alright if at least they
weren't algorithms based on misguided, self-serving, profit-seeking Big Pharma,
Food Inc, insurance conglomerates, and agri-politics (I think I just made that
word up.)

A lot of well-intentioned physicians are just parroting the party
line, as their patients dutifully and gratefully chomp down their statins and
diabetes drugs and blood pressure pills. And I'm sorry, but "diabetes
education" programs with curriculum put together by drug companies? How is that
even legal? Massive corporations raking in massive profits that are dependent
on uncontrolled blood sugars telling people how to best control their blood
sugars?!

Anyway, forgive my rant. What I'm getting at is this: How can I practice
medicine, with the freedom to educate/coach/treat my patients with diet and
lifestyle changes to mitigate/reverse their chronic health conditions? Without
feeling like I automatically have to first and foremost prescribe the litany of
drugs dictated by "evidence-based" guidelines? Without excessive fear of
litigation or loss of credibility among my peers? Without having to lie through
my teeth to my patients, and tell them that eating low-fat and heart-healthy
whole grains is the best way (implication also being the only scientifically
proven way) to control their diabetes, lower their cholesterol, etc, etc, etc?

I want my patients to have the full benefit of honest nutrition and lifestyle
information, and medications and surgery as necessary. I'm afraid that there
isn't room for this kind of holistic emphasis in the medical profession today.
Are there residencies that include this kind of training or at least respect
these "unconventional" philosophies? Are there clinics or practice groups that
would allow me to practice with this emphasis, or is there a bias against docs
who do not necessarily conform to the party position? Will I have no other
option but to go it alone under the auspices of my own shingle? How do you
handle these kinds of issues in your professional life?

Sincerely,
Theresa M.


A ray of hope! Perhaps Theresa is just the first among many more medical students who refuse to submit to the brainwashing practices of the pharmaceutical industry, the same mind manipulation that has hopelessly turned most of my colleagues into their unwitting puppets.

I'll be interested in watching how Theresa's experience unfolds. I've asked her to keep us informed every so often.

The Great Low-Carb Connector

28. October 2010 William Davis (15)
The effusive Jimmy Moore of Livin' La Vida Low-Carb asked me to help get the word out about his new podcast subscription service, The Livin' La Vida Low-Carb Show Fan Club.

Jimmy has been The Great Connector for the low-carb discussion, from his ubiquitous online and social media presence, to his annual low-carb cruise. He has also broadcast first class interviews of nutritional notables like Gary Taubes, Dr. Robert Lustig, and blogger Stephan Guyenet. His Fan Club expands listener involvement in the podcast process and, potentially, greater access to his guests:

My faithful listeners have long been asking me about how they can become even more engaged in the behind-the-scenes workings of the show to get the inside scoop about what’s coming next. I’ve heard people ask specifically for access to transcripts of the most popular podcasts, a listing of the interviews I’m currently working on with the ability to ask questions of those guests, to have sneak peek of audio from not-yet-released interviews and more. My amazing podcast producer, Kevin Kennedy-Spaein, and I have been discussing how to best do this for a while in an effort to meet the demands of our biggest fans and we think we’ve got just the answer for you. Introducing The Livin’ La Vida Low-Carb Show Fan Club!

This is for all intents and purposes the quintessential destination for people who can’t get enough of this podcast that goes much deeper than discussion about the low-carb lifestyle. Yes, I speak with a lot of people who are supporters of carbohydrate-restricted diets, but I also talk with fitness gurus, people who support alternative eating plans, those who have interesting theories and beliefs regarding health and much more. Wouldn’t you love to have a chance to know who’s coming up in my schedule to be able to ask them questions BEFORE I interview them? Keep in mind that my interviews are pre-recorded and air sometimes as much as 5-6 months afterwards. Members of the “fan club” would know all about who’s coming and likely will have their question asked on the air just for signing up to be a part of this exciting new addition to “The Livin’ La Vida Low-Carb Show.”

Jimmy is the guy who is bringing this disparate and widely-spread community together. He's the guy we all know, he knows "everybody." I'm looking forward to seeing how this new project makes a more involved, personal delivery of interaction possible.

New Track Your Plaque record!

27. October 2010 William Davis (19)
The record for the largest drop in heart scan score (by percentage of starting score) has been held for around three years, with 63% reduction in score.

Well, the longstanding record was broken this week: 75% reduction in score.

At the start, Freddie has disastrous lipid values:

LDL cholesterol 263 mg/dl
HDL 26 mg/dl
Triglycerides 323 mg/dl
Total cholesterol 354 mg/dl

Lipoproteins (NMR) were worse:

LDL particle number 3360 nmol/L
Small LDL 2677 nmol/L

Heart scan score: 732

Interestingly, Freddie had virtually no vitamin D in his body, with a 25-hydroxy vitamin D level that was unmeasurable.

Freddie was miserably intolerant to statin drugs, with even the smallest dose resulting in intolerable muscle aches. That's when his doctor sent him to me.

Because I felt that the dominant abnormality in Freddie's lipids and lipoproteins was small LDL particles, representing 80% of total LDL particle number, we focused his program on correcting this parameter. Freddie's program was therefore focused elimination of wheat, cornstarch, oats, and sugars, along with an eventual vitamin D dose of 20,000 units to finally achieve a 25-hydroxy vitamin D level of 66 ng/ml. No statin drug in sight.

43 lbs of weight loss and 18 months later, a second heart scan score: 183--a 75% reduction.

While the rest of the world continues to insist that coronary calcium (heart scan) scores cannot be reduced, I am seeing records being broken. I add Freddie's experience to the rapidly growing list of people who have not just stopped coronary plaque from growing, but are seizing control and reducing it, sometimes to dramatic degrees.

The Anti-AGEing Diet

22. October 2010 William Davis (36)
Advanced Glycation End-products, AGEs, are a diverse collection of compounds that have been associated with endothelial dysfunction, cataracts, kidney disease, and atherosclerosis in both animal models and human studies. Not all involve glycation nor glucose, but the catch-all name has stuck.

There are a number of actively-held theories of aging, such as the idea that aging is the result of accumulated products of oxidative injury; a genetically pre-programmed script of declining hormones and other phenomena; genetic "mis-reading" that results in disordered gene expression, debris, and uncontrolled cell proliferation (e.g., cancer); among others.

One of the fascinating theories of aging is, cutely, the AGEing theory of aging, i.e., the accumulation of AGE debris in various tissues. Such AGEs have been recovered in lenses from the eyes, atherosclerotic plaque in arteries, kidney and liver tissue, even brain tissue of people with Alzheimer's dementia. AGEs perform no known useful physiologic function: They are relatively inert once formed (especially polymeric AGEs), they do not participate in communication, they make no contribution of significance. They simply gum up the works--debris. (AGEs are to health as the USDA food pyramid is to dietary advice: material for the junkyard.)

There are two general ways to develop AGEs:

1) Endogenous--High blood glucose (any blood sugar above 100 mg/dl) will permit glycation of the various proteins of the body. The higher the blood glucose, the more glycation will proceed. Glycation also occurs at low velocity at blood glucose levels below 100 mg/dl, though this would therefore represent the "normal," expected rate of glycation. Endogenous glycation explains why people with diabetes appear to age and develop all the phenomena of aging faster than non-diabetics (kidney disease, eye diseases, atherosclerosis, dementia, etc.). Hemoglobin A1c, HbA1c, is a readily-obtainable blood test that can show how enthusiastically you have been glycating proteins (hemoglobin, in this case) over the last 2 to 3 months.

A low-carbohydrate diet is the nutritional path that limits endogenous glycation leading to AGE formation. Restricting the most obnoxious carbohydrates, the ones that increase blood sugar the most, such as wheat, cornstarch, rice starch, potato starch, tapioca starch, and sucrose, will limit endogenous AGE formation.

2) Exogenous--AGEs (here especially is where the "AGE" label is misleading, since many other reactions besides glycation lead to such compounds) are formed with cooking at high temperatures, especially meats and animal products. Therefore, a rare steak will have far less than a well-done steak. A thoroughly baked piece of salmon will have greater AGE content than sashimi.

The forms of cooking that increase AGE content the most: roasting,deep-frying, and barbecuing. Temperatures of 350 degrees Fahrenheit and greater increase AGE formation.

Therefore, cooking foods at lower temperature (e.g., baking, sauteeing, or boiling), eating meats rare whenever possible (not chicken or pork, of course), eating raw foods whenever possible (e.g., nuts) are all strategies that limit exogenous AGE exposure. And minimize or avoid butter use, if we are to believe the data that suggest that it contains the highest exogenous AGE content of any known food.

If we connect the dots and limit exposure to both endogenous and exogenous AGEs, we will therefore not trigger this collection of debris that is likely associated with disease and aging. So following a low-AGE diet may also be an anti-aging strategy.

The New Track Your Plaque Diet, soon to be released on the Track Your Plaque website, has incorporated strategies to limit both endogenous as well as exogenous AGEs.

Butter: Just because it's low-carb doesn't mean it's good

21. October 2010 William Davis (59)
The diet I advocate in the Track Your Plaque program to gain control over the factors that lead us to coronary plaque and heart attack is a low-carbohydrate diet. We begin with elimination of wheat, cornstarch, oats, and sugars in the context of an overall carbohydrate-reduced diet. We refine the program by monitoring postprandial (after-meal) glucoses.

But not everything low-carb is good for you. Fried sausages, for instance, are exceptionally unhealthy, despite having little to no carbohydrates.

An emerging but potentially very powerful issue is that of Advanced Glycation End-products, or AGEs. There are two general varieties of AGEs: endogenous (formed within the body) and exogenous (formed in food that is consumed).

Endogenous AGEs form in the body as a result of high blood glucose, i.e., glycation. When exposed to any blood glucose level of 100 mg/dl or greater, some measure of glycation will develop due to a reaction between glucose and various proteins, e.g., proteins in the lens of the eye, forming cataracts over time.

Exogenous AGEs form in food, generally as a result of heating to high-temperature. (AGEs is really a catch-all term; there are actually a number of reactions that occur in foods, not all of them involving sugars. However, the "AGE" label is used to signify all the various related compounds. The values quoted here are from Dr. Helen Vlassara's Mt. Sinai Hospital laboratory; reference below.)

Beef cooked to high-temperature yields plentiful AGEs. One gram of roast beef, for instance, contains 306,238 units. This means that an 8-oz serving yields 13.8 million units AGEs. Compare this to a boiled egg with 573 units per gram, raw tomato with 234 units per gram.

Butter contains an impressive 264,873 units AGEs per gram, the highest content per gram in the entire list of 250 foods tested in the Mt. Sinai study. A couple pats of butter (10 g) therefore contains 2.64 million units. A stick of butter that you might add to cake batter to make a cake therefore yields 30 million units of AGEs.

So there's nothing wrong with the fat of butter. It's AGEs that appear to be responsible for the endothelial dysfunction/artery-constricting, insulin-blocking, oxidation and inflammation reactions that are triggered. Among all of our food choices, butter is among the worst from this viewpoint.

Throw in the peculiar "insulinotrophic" effect of butter, and you have potent distortion of metabolic pathways, courtesy of the butter on your lobster.

(AGE data from Goldberg 2004. In this analysis, carboxymethyllysine was the marker used for AGE content.)

Incidentally, the new Track Your Plaque diet will soon be released as chapter 9 of the new Track Your Plaque book on the website.

Einkorn now in Whole Foods

16. October 2010 William Davis (19)
I just saw this at Whole Foods: einkorn pasta.

In my einkorn bread experience (In search of wheat: We bake einkorn bread), I was spared the high blood glucose and neurologic and gastrointestinal effects of conventional whole wheat grain (dwarf Triticum aestivum). I shared the einkorn bread  with four other people with histories of acute wheat sensitivities, only one of whom experienced a mild diffuse joint reaction, the other three not experiencing any symptoms.

Anyone wishing to try einkorn can now obtain commercial pasta from Jovial, an Italy-based manufacturer. It comes in spaghetti, linguine, rigatoni, fusilli, and penne rigate shapes.

Eli Rogosa, founder of The Heritage Wheat Conservancy, tells me that, in her experience, celiac suffers seem to not experience immunologic phenomena triggered by conventional wheat.

However, we've got to be careful here. The so-called ("diploid") "A" genome of einkorn shares many of the same genes as the ("hexaploid") "ABD" genomes of modern wheat, including overlap in the sequences coding for the 50-or so different glutens and glutenins. Most of the genes that code for the glutens that cause celiac and related illnesses reside in the "D" genome that are absent in the einkorn "A" genome. However, the "A" genome still codes for glutens. So there is potential for activating celiac disease in some people. Insufficient research has been devoted to this question. It is a question of extreme importance to people with celiac and other immune-mediated conditions, since re-exposure to the wrong form of gluten can increase risk of intestinal lymphoma 77-fold, as well as risk of other gastrointestinal cancers.

So einkorn should not be viewed as a cure-all for all things wheat, but as something to consider for a carbohydrate indulgence. Yes, indeed: It is a carbohydrate, with 61 grams ("net") carbs per 4 oz (uncooked) serving.
Should anyone give it a try, please be sure to report back your experience, especially if you have a history of wheat intolerance. If you have a glucose meter, pre- and 1-hour post values are the ones to measure to gauge the blood sugar effects of consumption. Because pasta tends to cause long sustained blood sugar rises, another value at 2-4 hours might be interesting.

Noodles without the headaches

14. October 2010 William Davis (26)
If you are looking for a wheat-free noodle or pasta, shirataki noodles are worth a try.

Shirataki noodles are low-carbohydrate (less than 3 g per 8 oz package) and, of course, do not trigger all the unhealthy effects of wheat--no blood sugar/insulin provocation, no addictive brain effects (exorphins), no gluten-mediated inflammatory effects.

(I advise avoiding gluten-free pasta alternatives made with rice flour and other common gluten alternatives, since they trigger blood sugar, small LDL, and growth of visceral fat just like wheat.)

I made a stir-fry using the shirataki-tofu noodles, shown below. (Tofu is added to make the noodles more noodly in consistency, as opposed to the chewier non-tofu variety.) The noodles were a lot like the ramen I used to eat as a kid. They were filling and tasted great in the sesame oil, soy sauce, tofu, and vegetables I used.


The noodles are easy to use. Just drain liquid out of package. (The noodles come in water.) Rinse in collander 30 seconds, then boil for 3 minutes. Add to your stir-fry or other dish. Some manufacturers, such as House Foods, also have angel hair and fettucine style noodles.

You're fried

13. October 2010 William Davis (26)
If I could invent a food that illustrates nearly all of the shortcomings of the American diet, it would be French fries, the familiar fixture of fast food.

What we have come to view as French fries contain just about every one of the unhealthy ingredients that lead us down the path of obesity, diabetes, heart disease, high blood pressure, etc.

Let's take them one by one:

Potato starch--Potato starch exerts an effect on blood sugar similar to that of table sugar, only worse. (Glycemic index french fries 75; glycemic index sucrose 65.)

Advanced Glycation End-products (AGEs)--AGEs form when proteins and fats are subjected to high temperature cooking; the longer the high temperature, the more the food reaction creating AGEs proceeds. AGEs are the likely culprit in roasted and fried foods that made it appear that saturated fats were bad, when it was really AGEs all along. AGEs have been shown to block insulin's effects, increase blood sugar, cause endothelial dysfunction and high blood pressure.

Acrylamides--Acrylamides, like AGEs, are created through high-temperature heating. French fries are unusually rich in AGEs. Brewed coffee also contains a small quantity, while French fries contain 82-fold greater quantities, among the highest of all known sources of acrylamides.

Oxidized oils--The amount of oxidized oils will depend on what sort of oil was used for frying. As more restaurants are trying to get away from hydrogenated oils, many are turning back to polyunsaturates. Others are turning to commercial-grade oils that contain both hydrogenated and polyunsaturates. If oils are permitted to oxidize, then they will trigger oxidative phenomena in your body upon consumptions, e.g., LDL oxidation (Staprans 1994).

In other words, the innocent appearing French fry unavoidably triggers oxidation, all the phenomena triggered by high blood glucose (high insulin, glycation, visceral fat accumulation), along with the cascade of effects arising from AGEs and acrylamides.

Top your French fries with some ketchup made with high-fructose corn syrup that exagerrates AGE formation, visceral fat, and distorts postprandial (after-eating) effects.

Is it any wonder that we've lost control over diet?
Normal fasting glucose with high HbA1c

Normal fasting glucose with high HbA1c

23. March 2010 William Davis (24)
Jonathan's fasting glucose: 85 mg/dl
His HbA1c: 6.7%

Jonathan's high HbA1c reflects blood glucose fluctuations over the preceding 60-90 days and can be used to calculate an estimated average glucose (eAG) with the following equation:

eAG = 28.7 X A1c – 46.7

(For glucose in mmol/L, the equation is eAG = 1.59 × A1C - 2.59)

Jonathan's HbA1c therefore equates to an eAG of 145.59 mg/dl--yet his fasting glucose value is 85 mg/dl. 

This is a common situation: Normal fasting glucose, high HbA1c. It comes from high postprandial glucose values, high values after meals. 

It suggests that, despite having normal glucose while fasting, Jonathan experiences high postprandial glucose values after many or most of his meals. After a breakfast of oatmeal, for instance, he likely has a blood glucose of 150 mg/dl or greater. After breakfast cereal, blood glucose likely exceeds 180 mg/dl. With two slices of whole wheat bread, glucose likewise likely runs 150-180 mg/dl. 

The best measure of all is a postprandial glucose one hour after the completion of a meal, a measure you can easily obtain yourself with a home glucose meter. Second best: fasting glucose with HbA1c.

Gain control over this phenomenon and you 1) reduce fasting blood sugar, 2) reduce expression of small LDL particles, and 3) lose weight.  

Tags :

Comments (24) -

  • Mark

    3/23/2010 5:56:04 PM |

    So what is the basic recommendation here?
    Eat meat, nuts, vegetables, no starch, no fruit? A ketogenic diet?

    It looks like the recommendation is to avoid blood sugar spikes primarily. I would think that insulin is less of a worry because insulin doesn't necessarily mean that sugar is in the system (dairy for example).

    Some clarification would be greatly appreciated. Thanks

  • Anonymous

    3/23/2010 6:44:31 PM |

    Dr. Davis, my husband has the opposite problem, can you (or anyone else) explain it?  His 1-hour postprandial glucose never exceeds 90 and yet he has an HBA1C of 5.9.  We have checked his glucose at different times and it never goes over 100.  He is on a very low carb diet.  

    His HBA1C indicates an average blood glucose of 123, but we never see readings this high.  Is there something else that can glycating hemoglobin and thus show an elevated HBA1C reading?

  • Anonymous

    3/23/2010 7:03:19 PM |

    What would be considered an optimal (or at least good) HbA1c level? And same for fasting glucose?

    I have noticed my fasting glucose tends to vary, between 80-95, with my HbA1c at 4.6.

    Curious also if there is any data on HbA1c correlating directly with triglyceride levels.

    My own trig values are higher than I like, around 125-150, yet I limit carbs, use fish oil, and think my HbA1c number is relatively decent.  So wondering if carbs/glucose isn't my problem, what else raises triglycerides?

  • Jake P.

    3/23/2010 10:30:18 PM |

    Dr Davis, do you have any recommendations on blood glucose test meters, as far as brand/model? Also, I'd prefer something that doesn't require a prescription, if possible.

  • Dr. William Davis

    3/24/2010 1:41:43 AM |

    Anon--

    The only two causes I am aware of are 1) iron deficiency anemia, and 2) hemoglobin variants.

    Also, are you confident of the accuracy of your blood glucose meter? You can check it by running side-by-side glucoses with a blood draw.

  • Dr. William Davis

    3/24/2010 1:42:31 AM |

    I've had good experiences with One Touch Ultramini, Aviva, Relion, and Accuchek meters. All are available without prescription.

  • Anonymous

    3/24/2010 5:26:17 AM |

    This is exactly why everybody should have a blood glucose meter, and know their numbers.

    While I have not been diagnosed as having type 2 diabetes, I was darned close.  My meter, and the information found here and in the blogs that link to and from it, have helped me to lose about 3 pounds per week for the past 6 months, and not be hungry or feel deprived.

    I was like Jonathan.  Until 6 months ago my fasting glucose was always under 100.  Now that I am managing to keep my average BG reading, including post prandial readings, under 95, I have stopped suffering from the inflammatory symptoms I've had for a decade.

    My meter and initial 100 test strips was the best under $50 purchase I've ever made.

    Thanks for the USEFUL information I get at The Heart Scan Blog.

  • Alfredo E.

    3/24/2010 2:52:07 PM |

    Hi All. I eat a low carbs diet and I have the a high fasting glucose, 95-105, but a low postprandial, 85-100.

    I also exercise everyday and do Intermittent Fasting.

    What could be the mechanism working here?

    Thanks for your ideas.

    Alfredo E.

  • Anonymous

    3/24/2010 3:20:00 PM |

    David Mendosa has a good blog/site/comments... on diabeties for many things A1C, food, low carb, etc. Check him out at www.mendosa.com
    Look under "health central" or

    http://www.healthcentral.com/diabetes/c/17/75106/david-guide-a1c-6-0

    For A1C guidance.

    He seems to lean away from strict AHA, ADA, and government things that do not work for him.

    His meter data is getting a little dated, and he does not specify exact things like he states vitamin D, as opposed to stating: D3. And he seems to be a little soft about major statements, possible law suit shy.

  • Anonymous

    3/24/2010 4:01:15 PM |

    I'm curious why you believe that gaining control over postprandial glucose will result in lower *fasting* glucose.  Is there a mechanism for this?  I've found that my fasting glucose hasn't fallen since I started the TYP diet 3 months ago; it's still in the mid to high 90s -- even though my one hour glucose is rarely much higher than that.

  • Anonymous

    3/24/2010 6:40:34 PM |

    Responding to Dr. Davis' comment:
    "The only two causes I am aware of are 1) iron deficiency anemia, and 2) hemoglobin variants.

    Also, are you confident of the accuracy of your blood glucose meter? You can check it by running side-by-side glucoses with a blood draw."

    I don't think he has iron deficiency anemia unless high ferritin level indicates that?  His ferritin level was 320 at the time he got the HBA1C of 5.9.  What are hemoglobin variants?

    We have the Accuchek meter and have also had fasting and post-prandial lab tests done and the meter seems to be in the ballpark.

    Thank you very much for your reply.

  • Anne

    3/24/2010 9:28:20 PM |

    My fasting was below 100. My A1C was 6.5. A OGTT spiked at 202. My doctors told me as long as my fasting BG was good, I did not have to worry as I only had insulin resistance not diabetes. That was 10 yrs ago.

    A year ago I bought a glucometer and started eliminating foods that spike my BG. My last A1C was 5.5.

    I wish I could get a hold of the results of my OGTT from 40 yrs ago. I was told it was slightly abnormal but I did not have diabetes. How much damage has been done from elevated postprandial blood sugars?

  • Anonymous

    3/25/2010 12:20:28 AM |

    Dr. Davis,

    Would you anticipate that a healthy 25 year old would obtains similarly high postprandial sugars to those meals?  Or do young, healthly, slim people have high glucose tolerance, and hence low postprandial responses to sugar?  I've seen many articles featuring sports stars who subsist on high carb, low fat diets, such as rafael nadal, roger federer, tiger woods... I find it hard to believe they exceed 120 mg/dl postprandially...

    David

  • mikyy748

    3/27/2010 5:31:11 AM |

    Please help with an explanation ! My last meal of the day (with NO carbs) is around 4PM. At 9-10PM, my glucose test shows about 100-105. But... in the morning the test shows 125-130. How is it possible?!

  • Anonymous

    4/10/2010 4:37:12 AM |

    Veeerrrrry interesting!

    I have been on an extremely resrricted carb diet for several months.  My One Touch (and my wife's, she's T1 on a pump) my glucose levels never vary from 100-120 with the vast majority right around 110-113. Tests are run about once a day at various times including 1-2 hours post prandial.

    At my PCP's office (she's also an endocrinologist) today, her office machine complained of an HbA1C of 20+ and wouldn't give a reading, while it did report my other lipid levels, most moderately elevated as usual.

    Tubes were drawn for processing by a lab.  Of course it's the weekend and I'm obsessing about it... sigh.
    I worry that my low carb lifestyle might be masking what would be high glucose readings which is not very logical, or if something is wrong with my blood such as anemia.  A quick google and here I am.

    I wonder if this is common for extremely low-carber diabetics?

    Am on low doses of Diovan, HCTZ and colchicine...

    Thanks to all for any thoughts.
    -Ron

  • Anonymous

    4/13/2010 2:26:58 PM |

    Thanks to all who commented ;)

    Lab work came back with an HbA1C of 5.9, so the office machine was just being stupid as hoped/mostly expected.

    Good luck to everyone else.

  • mongander

    4/27/2010 11:22:25 PM |

    This MedScape article doesn't make sense.  It claims that <6 may be too low...That >7 has a better all cause mortality.
    http://www.medscape.com/viewarticle/720391

  • William A. Ryan

    7/15/2010 1:32:59 PM |

    FYI, another possible cause of abnormally high HbA1c is Vitamin B12 and/or folate deficiency.  This causes anemia with low red blood cell turnover, so any given Hb molecule is floating around longer, and thus has a higher probability of glycation.

  • Helena

    9/29/2010 11:01:56 PM |

    So.. I just started testing my blood sugar again today... first reading was 90
    Then I had lunch. Rice and curry with coconut milk (probably loaded with sugar) and it went from 156 to 258 to 124 in 2.5 hours after that meal... I am a little concerned.

    Think I will go back on my low carb diet ASAP!

  • Helena

    9/30/2010 3:22:01 PM |

    Let me correct my numbers... I didn't have them in front of me when I wrote the previous post so here they are:

    Lunch was Rice, shrimp, coconut milk based curry pot

    Blood levels:
    60 min after - 193
    90 min after - 217
    130 min after - 258
    2.5 hrs after - 140

    This morning I had a reading of 89 and after having my protein shake with cream and water it was 106...

    Def going to go back to my low carb diet asap!
    Thanks for a great blog full of valuable information and help to get back on track.

  • Anonymous

    10/15/2010 2:05:41 PM |

    This is a recent day of testing. 90 minutes after eating 50 grams of processed brown flax, my BG was about 117, but it also depends on what I eat the night before. 2 hrs after eating 8 oz hummus with tahini, my BG was 101. 1 hr after eating a 143 gram (quick rolled) oat cake with 95 grams chocolate syrup with a lot of sugar and water, my BG was 120. Next day fasting BG was 120. Carbs do a good job of BG stabilization, although I'm trying to decrease some carbs and lower my fasting BG. I will try soymilk, and less carbs.

  • H Saleem

    11/22/2010 9:04:14 PM |

    Hi, Let me add my 2Cs. The objectives for diabetics and pre-diabetics are poles apart and confusing the two can  lead to irreparable loss for the pre-diabetics and those with insulin resistance.  

    For diabetics, when the disease is well established, the focus is on minimizing the harm i.e. to minimize the blood sugar level. Elevated blood sugar does so much harm in the long run that it should be kept under control through any means possible: diet, exercise, medicine, weight loss etc. When one plan and/or drug regimen fails to control the blood glucose level, it is replaced by another, all the time focusing on maintaining optimum blood glucose levels resulting in normal (for diabetics) readings on fasting glucose, HbA1C etc. I am not fully aware but possibly there is no mainstream healthcare regimen or drug that focuses on  reversing the disease or trying to minimize diabetes damages (other than those caused by high blood glucose) like destruction of pancreatic cells.

    For pre-diabetics and those with insulin resistance, the focus should NOT be on lowering blood glucose level DIRECTLY. For pre-diabetes, it is possible to keep on "travelling" towards diabetes in reality but assuming otherwise just because some "local" interference does not let the blood sugar rise. So if you start taking any alpha-glucidase, your postprandial reading will not rise much. But this does not mean that you have controlled pre-diabetes. The causes are all there like being over-weight, lack of exercise bla bla. And your body's normal ability to regulate blood sugar keeps on deteriorating ultimately leading to a point when the alpha-glucidase alone will not be sufficient. So when pre-diabetes is treated like diabetes, it can lead to actual diabetes. This is because here the focus should not be on lowering blood glucose levels or "treating" the condition but REVERSING it. In other words the goal should be to transform the body back to the point where it can naturally process the foods while keeping the blood glucose levels and HbA1C levels in normal range. All this without the help of any drugs or special diet or aids. And for this the usual solutions are already well known: weight-loss, exercise etc.

    The moral of the story is that if you are pre-diabetic, you can keep yourself happy by eating almonds, vinegar or psyllium with meals to "show" you that your post-prandial glucose levels are in range. This can be done by eating a low-carn diet or taking diabetes drugs. But if keep the same weight, continue the same eating habbits, and do no exercise then you are possibly doing nothing to prevent a preventable disease.

  • H Saleem

    11/22/2010 9:04:58 PM |

    Hi, Let me add my 2Cs. The objectives for diabetics and pre-diabetics are poles apart and confusing the two can  lead to irreparable loss for the pre-diabetics and those with insulin resistance.  

    For diabetics, when the disease is well established, the focus is on minimizing the harm i.e. to minimize the blood sugar level. Elevated blood sugar does so much harm in the long run that it should be kept under control through any means possible: diet, exercise, medicine, weight loss etc. When one plan and/or drug regimen fails to control the blood glucose level, it is replaced by another, all the time focusing on maintaining optimum blood glucose levels resulting in normal (for diabetics) readings on fasting glucose, HbA1C etc. I am not fully aware but possibly there is no mainstream healthcare regimen or drug that focuses on  reversing the disease or trying to minimize diabetes damages (other than those caused by high blood glucose) like destruction of pancreatic cells.

    For pre-diabetics and those with insulin resistance, the focus should NOT be on lowering blood glucose level DIRECTLY. For pre-diabetes, it is possible to keep on "travelling" towards diabetes in reality but assuming otherwise just because some "local" interference does not let the blood sugar rise. So if you start taking any alpha-glucidase, your postprandial reading will not rise much. But this does not mean that you have controlled pre-diabetes. The causes are all there like being over-weight, lack of exercise bla bla. And your body's normal ability to regulate blood sugar keeps on deteriorating ultimately leading to a point when the alpha-glucidase alone will not be sufficient. So when pre-diabetes is treated like diabetes, it can lead to actual diabetes. This is because here the focus should not be on lowering blood glucose levels or "treating" the condition but REVERSING it. In other words the goal should be to transform the body back to the point where it can naturally process the foods while keeping the blood glucose levels and HbA1C levels in normal range. All this without the help of any drugs or special diet or aids. And for this the usual solutions are already well known: weight-loss, exercise etc.

    The moral of the story is that if you are pre-diabetic, you can keep yourself happy by eating almonds, vinegar or psyllium with meals to "show" you that your post-prandial glucose levels are in range. This can be done by eating a low-carn diet or taking diabetes drugs. But if keep the same weight, continue the same eating habbits, and do no exercise then you are possibly doing nothing to prevent a preventable disease.

  • KDL

    12/12/2010 9:50:40 PM |

    I have a 16 year old daughter who HBA1c is 11.7 (yes very high).  I have been working with her especialist to bring it down.  The problem is her daily readings are normal for a type 1 diabetic. I know the monitors can be cheated however I am pretty confident that most of the time she does the right thing.  I also know that sometimes she does not.  However I am wondering if there are any other things that can cause this annomoly?

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