Looking for health in all the wrong places

The American public now has unprecedented freedom to explore new directions in health.

Never before have we had the enormous resources now available to add to our health experience: nutritional supplements, endless books on health and diet, the internet, online discussion groups, insurance products to permit spending on self-directed health services like medical savings accounts and flex-spending. The Track Your Plaque program is just one facet of this emerging and exciting area of self-empowerment in health. Compare what you can achieve with such a program with the situation of just 25 years ago, when the most you might get to reduce your risk for heart disease was to take the (largely ineffective) drug cholestyramine, probucol, and a low-cholesterol, low-fat diet.

Unfortunately, it also means that people have unrestrained potential to be tripped up, to be misled down some dead end of health that fails to accomplish desired goals, maybe even dangerous. The more freedom we have, the greater the choices, the more room we have to screw up.

Among the unproductive strategies I've witnessed recently:

--Nattokinase--The staying power of this scam continues to shock me. There is no rational basis for its use. A woman today declared that she would like to stop the warfarin that she was taking to prevent stroke from atrial fibrillation by taking nattokinase. This would be a mistake that could cost her a major and disabling, even fatal, stroke. Though warfarin is far from perfect, it at least achieves its goal of reducing stroke risk. Nattokinase does not. Nattokinase does nothing but make money for the people who sell it.

--Poly-nutritional supplements. You've heard of polypharmacy, the phenomenon of taking numerous medications with overlapping effects and side-effects, usually because of multiple doctors, each prescribing drugs without knowledge or interest in what colleagues are prescribing. I'm seeing the same phenomenon with supplements: 20,30, or more supplements per day, all in the hopes of heightening health. A focused few supplements is, in my view, superior to a shotgun approach of trying to improve health by taking hawthorne, silymarin, chrysin, calcium, Chinese herbs, and 25 other supplements.

--Chelation--Based on the notion that heavy metal toxicity causes heart disease; removal of heavy metals cures it. I've read some of the books on chelation, in addition to the slim scientific data, to decide whether there was anything to it. In my view, it is a complete and utter scam. It does make money for its practitioners, however. That's not to say that heavy-metal chelation doesn't have a role in health--it does. But it serves no purpose in coronary disease prevention and control.

--Colonic purges--Achieved by a number of routes, some oral, others via enema. Promotions for purging are often accompanied by a pile of scum that apparently lined somebody's intestinal tract. Purges purportedly, well, purge it from the intestine. This is also plain nonsense. There is no such toxic scum lining anybody's intestinal tract. However, if calorie restriction or a fast results inadvertently from the effort, perhaps some good comes from it.

--Statin drug alternatives--The unprecedented $27 billion dollar a year success of the statin drug industry, accompanied by the enormous marketing push by their manufacturers, has spawned an entire industry of statin alternatives. They range from red yeast rice, to guggulipid, to various concoctions of sterol esters, Chinese herbs, chitosan, and a variety of others. Some actually do reduce cholesterol a few points. Preparations like red yeast rice even pose a side-effect profile not too different from the prescription statin agents. Unfortunately, even among those agents that work, the effects tend to be small to trivial. While I am no lover of statin drugs nor the statin drug industry, I find these preparations to be anemic imitators. You'd be better off with raw nuts and ground flaxseed than wasting your money on these cheap imitations.

--Worries about liver toxicity--A day doesn't go by that I don't have at least several questions about suffering toxic liver effects from niacin, vitamin D, statin drugs, etc. I have treated thousands of patients for heart disease in its various stages and forms and have used many different strategies. How many times have I seen serious liver toxicity? A handful of times and usually from either mis-use of the agent or drug, or in a person with several other coexisting diseases. (Other serious health conditions, like kidney failure, raise the toxicity of drugs and supplements.) Liver toxicity in the vast majority of otherwise healthy people is close to being a non-concern.


Readers of The Heart Scan Blog and of the Track Your Plaque website know that I celebrate expansion of knowledge and information access to the public. However, I am concerned that the flip side of this growing self-empowerment is expanding potential for mistakes. It reminds me of an attorney friend, who, when diagnosed with prostate cancer, explored all manner of alternative treatments, from laetrile to heavy metal chelation to high-dose lycopene tablets. At the initial stage of diagnosis, his cancer was readily treatable. He now has widely metastatic cancer.

Maintain an open mind, but think before you commit to some crazed claim of cure, some "secret" to health, somebody's brazen but concealed attempt at steering profits in their direction.

With freedom comes responsibility. Otherwise, you might be looking for love . . .oops, I mean health . . . in all the wrong places.

Comments (11) -

  • Anonymous

    2/12/2008 6:52:00 AM |

    What are your views on certain supplements that show promise in regard to heart health, but haven't been fully proven yet? Such as resveratrol, grape seed extract,  pomegranate, green tea, krill oil, aged garlic, cocoa, etc.

    Are they safe and worthwhile to take,  or would you consider them a risk for certain patients?

    Unfortunately, we can't always go to our family doctor or cardiologist (at least generally speaking), give them a list of supplements that potentially could be beneficial, and ask their opinion. 99% of the time they'll be clueless, or simply give vague suggestions, or possibly worse, give bad advice. I had one cardiologist recommend flush-free niacin to me  (the non-beneficial type), for instance.

  • ALANSD

    2/12/2008 5:52:00 PM |

    Its very hard as a health conscious consumer, to know what supplements to use, and at what dosage. There is so much conflicting information available.
    I take a small handful of vitamins, amino acids and minerals daily. I eat really well, and exercise regularly, and still have trouble controlling my hypertension.My recent heart scan showed a score of 99.  I have been looking to supplements to help, but so far the help has been minimal. Am I looking for help in all the wrong places too?

  • GerryL

    2/12/2008 7:32:00 PM |

    It can get frustrating even for those with a long time interest in nutrition and health. Along with my dietary and exercise regimen I take folic acid to help lower triglycerides. Then I come across a report from a newsletter that cited the Norwegian Vitamin Trial (NORVIT) and said " Folic acid supplementation was found to lower homocysteine levels by 28%., but to increase relative risks of heart attack, stroke, and death by 20%, along with a more than a 30% increase in cancer." The source recommends that NO folic acid supplements be taken outside of naturally occurring food sources.
    Another newsletter by another doctor advises against  any supplementation of Vitamin D outside of natural sunshine.
    Frustrating.

  • Anonymous

    2/12/2008 9:20:00 PM |

    Please clarify your comments on Nattokinase: is this not the same food item that's high in vitamin K2, which if I understand it correctly, helps to put calcium into the bones (along with D3), so that there's less calcium going to the arteries and causing plaque.

    If my understanding of K3, and that nattokinase has very high amouns of K3 in it, is correct, then are you saying that Nattokinase is not a suitable replacement for blood thinners or stroke prevention, but that it does have desirable effects for directing calcium to bones, instead of arterial plaques?

    I went in for a colonoscopy recently, and did various preps for it, the most powerful one for me was the mag citrate. My photos from the colonoscopy showed pink healthy looking tissue (whew), which led me to think that expensive colon cleanses probably weren't necessary. I'd never done one, but had read about them in the past.

    When I did read about them, I remember wondering if hydrogen peroxide enemas did the same thing as those oxy-cleansers. Thankfully I've never had to perform one of the more 'exotic' enemas, but I do remember our teachers warning us to use plastic gowns and stand clear if we ever had to give one.

    S

  • moblogs

    2/12/2008 11:33:00 PM |

    I think it's desperation that often leads to the wrong places. I don't have any heart problems but it is an almost certified route to the grave in my family tree later in life, so with remaining youth I'm able to research things calmly. I visit here mainly as my own research gels with things you say.
    I think the key thing is to entertain claims that are referenced and peer reviewed; even a good 'oddball' thought makes it into PubMed. And then there's no reason why an abstract couldn't be printed and discussed with an open minded doctor to look at a route that might be best for the patient.
    I think in a sadistic way we like doctors to be fairly arrogant and say "this is your problem, do as I say", but we also know that at the end of the day it's you who cares about you the most. And it's simply terror that leads people into the first arms of saviour they see.

  • jpatti

    2/13/2008 10:06:00 AM |

    My opinion regarding "resveratrol, grape seed extract, pomegranate, green tea, krill oil, aged garlic, cocoa, etc." is... these are not supplements, these are foods.  

    A whole heck of a lot of folks take a lot of ridiculously expensive "supplements" that can easily be replaced by actual food.

    You know what phosphatidyl choline is?  An expensive supplement... or a dead-cheap product lecithin used in baking to assist emulsification.  In short, it makes your smoothies smoother for almost no money.

    Cocoa?  Who would *supplement* cocoa? I mean... COCOA?  Is eating chocolate now some sort of chore that is easier to accomplish by taking a pill?  I eschew sugar, but don't find it difficult to get sufficient cocoa in my diet even so.  I seriously doubt there's many folks running around suffering cocoa deficiencies.  I mean, if you deeply despise chocolate, maybe take a cocoa supplement, but for the rest of us, eating cocoa is generally a lot more pleasant when it's NOT wrapped in a capsule.

    I take supplements.  In fact, I take rather a lot of them.  I take a multivitamin (without iron), vitamin D3 (just started a supplement with K2 also), and fish oil, which I recommend to everyone, most especially those with metabolic syndrome.  These are cheap and sure don't hurt - one of the easiest things you can do for your health.

    I also take a B complex, panthothenic acid, niacin, calcium, CoQ10 and milk thistle - each for specific reasons relative to my own health.  

    But resveratol and cocoa?  Why not a glass of wine and a piece of dark chocolate?  

    Why take a pomegranate supplement, eating pomegrantaes works pretty darned well for me.  Pomegrantaes are darned yummy.

    Turmeric, cinnamon and garlic are all lovely foods - and were so before anyone ever did any research into them.  

    CLA is the new wonder fatty acid - and you can get gobs of it by eating pasture-raised meat and dairy, which is a heck of a lot more pleasant than swallowing pills.

    Food is better than pills.  

    OK, we know about vitamin K2 now, but it's a fairly new discovery.  People who just went around eating cheese were getting it even before it was in pills.  

    The nutrients that will be discovered next month, next year and next decade are in foods *today*.  

    Just eat good food... a wide variety of organic vegetables, as much fruit as your blood glucose tolerates, lots of wholesome meat and dairy from pasture-raised or wild animals, good fats like olive and avocado oils, grains like barley and buckwheat, nuts and seeds, lots of fresh herbs and spices - you'll "cover" all the supplements they aren't even selling yet.

  • Anonymous

    2/13/2008 2:08:00 PM |

    I meant "K2" in my comment above.

    S

  • Anonymous

    2/13/2008 5:39:00 PM |

    My opinion regarding "resveratrol, grape seed extract, pomegranate, green tea, krill oil, aged garlic, cocoa, etc." is... these are not supplements, these are foods.

    ------------

    As the originator of the post with reference to the above 'supplements', I somewhat agree -- I just used a general term of 'supplement' to describe them. You can get some of them via food.

    But I can't drink wine, so resveratrol and grape seed would have to be in capsule form. And for high doses of resveratrol, supplements are the only way, as it would take several bottles of red wine daily. Aged garlic is different than regular garlic, and is a lot easier to take as a supplement. It's also a lot kinder on your breath and digestion.  And I don't think many people will be sitting down and eating a nice bowl of krill.

    My main question was in regard to them being considered worthwhile to take (in any form), and how do we go about verifying what is beneficial, without a doctor to rely on.

  • Anonymous

    2/13/2008 10:29:00 PM |

    Decrying all supplements is similar to running down all prescription drugs. One has to be selective. Some prescription drugs are helpful for some people. So it is with supplements. If the supplement supplies something your body needs it may help. For example, 15 years ago I found that Saw Palmeto helped my prostate. It still does today, and others have found it helpful too.

  • Rich

    2/15/2008 5:50:00 AM |

    The NIH study on chelation should have some results soon.

    http://nccam.nih.gov/news/2002/chelation/pressrelease.htm

    Rich

  • HeartCipher

    5/8/2008 9:13:00 PM |

    There seems to be a clear correlation in my ALT value between my taking the LEF Mega Silymarin product.  When I've taken it, my ALT goes down.  But I've usually stopped taking it after just a few months.

    I'm now thinking that I need to give it a good 6 month to a year trial.

    The "Jedi Master" I've been working with just today told me that I need to be cautious about the possibility of having NAFLD.

    So, it seems to me that Mega Silymarin is a must do.

Loading
Butter and insulin

Butter and insulin

In a previous post, Atkins Diet: Common Errors, I commented on butter's unusual ability to provoke insulin responses. I offer this as a possible reason why, after a period of effective weight loss on a low-carbohydrate program, inclusion of some foods, such as butter, will trigger weight gain or stall weight loss efforts.

This develops because of butter's insulin-triggering effect, doubling or tripling insulin responses (postprandial area-under-the-curve). If insulin is triggered, fat gain follows.

Here's one such study documenting this effect: Distinctive postprandial modulation of ß cell function and insulin sensitivity by dietary fats: monounsaturated compared with saturated fatty acids

López et al 2008


From Lopez et al 2008. Mean (± SD) plasma glucose, insulin, triglyceride, and free fatty acid (FFA) concentrations during glucose and triglyceride tolerance test meal (GTTTM) with no fat (control), enriched in monounsaturated fatty acids (MUFAs) from refined olive oil (ROO meal), with added butter, with a mixture of vegetable and fish oils (VEFO) or with high-palmitic sunflower oil (HPSO). N = 14.

The postprandial (after-eating) area-under-the-curve is substantially greater when butter is included in the mixed composition meal. This effect is not unique to butter, but is shared by most other dairy products.

Fat, in general, does not make you fat. But butter makes you fat.

Comments (83) -

  • Miki

    3/19/2010 5:48:56 PM |

    I wander if the effect is due to the milk solids or the type of fatty acids. If it is the milk solids making ghee will solve the problem.

  • Anonymous

    3/19/2010 5:54:39 PM |

    So the low fat control meal of pasta and bread gives the LEAST amount of insulin response!

    So, to avoid insulin spikes you must minimize all types of fats.

    Fat+Pasta seem to trigger the insulin.  The glucose response does not seem to matter all that much.

  • jd

    3/19/2010 5:54:39 PM |

    Thanks for the great info as always.

    Is it correct to say, in view of the graphs, that this type of dairy-induced insulin elevation is not mirrored by blood glucose readings, so we couldn't check for it at home with a glucose meter?

  • John

    3/19/2010 5:56:08 PM |

    butyric acid causes an insulin response, as does casein...interestingly, although i can't find it, i saw a paper that showed the insulin response to white bread was actually less when combined with butter...

  • daniel the smith

    3/19/2010 6:06:21 PM |

    What if you eat it without any carbs (e.g., like I do with my eggs in the morning)? If there's nothing to trigger the insulin in the first place, butter can't make it worse, right? Or am I wrong?

  • Lucy

    3/19/2010 6:16:20 PM |

    That's an interesting study indeed.  It seems to indicate that eating no fat at all (the control meal) provided better results in every category except glucose rise, and then it was only with the rest of a fairly tight pack.  Adding any fat at all spiked the insulin significantly higher.   This is consistent with the charts in your post "The Timing of Blood Sugars".  Yet you concluded there that carbohydrates should never be consumed without fat.  Based on these studies, it sure looks like a person is trading a little glucose rise for a larger insulin spike when consuming fat.  Which begs the question, which is worse?  Does insulin cause more problems than glucose?   You did say it was the insulin that triggered weight gain...

    I remain unconvinced that I should rush out and follow Ornish.

  • Diana Hsieh

    3/19/2010 6:34:54 PM |

    Interesting post -- and my experience confirms it.  Here's something that I recently posted to the OEvolve e-mail list:

    As folks might know, I've been struggling with my weight due to my hypothyroidism.  Even though many of my symptoms have improved, I continued to gain weight at the very consistent rate of 3 pounds per month.  Sometimes, mostly due to a bit of fasting, I'd be down a pound or two, but then I'd suddenly gain back all that weight plus more within a day or two, so that I'd be on that steady upward slope again.  

    In late February, I was up to just over 150 pounds; that was my pre-paleo weight.  That's not so terrible in and of itself -- although I hated it -- but the continued upward progression was really alarming.  Plus, I'd outgrown almost all my pants!

    After listening to Robb Wolf talk about the growth-promoting, insulin-spiking effects of dairy, I realized that I'd been eating a huge amount of dairy lately -- far more than ever before.  I've been buying those huge blocks of cheese from Costco, not to mention those delectable half gallons of cream.  So instead of eating meat-and-veggie leftovers for lunch, I was usually eating some high-fat dairy.  And for breakfast, I would eat cheese rather than meat with my eggs.  

    A few weeks ago, I decided to cut my dairy down dramatically -- to basically just one serving per day at most.  So I'll have a cup of raw milk kefir or cheese on meatza, but not much more than that.  That was really hard for me to do for the first week, as I really was used to eating it as a staple.  I'm also not eating nuts, absent some "must have food as I run out the door" emergency, as I know they can hamper weight loss for me.

    The results have been good so far.  I've not gained any more weight in the last two weeks.  Instead, I've lost four pounds.  Given what I had been experiencing, that's pretty remarkable.

    I'm not sure how much more weight I'll lose just due to cutting back the dairy.  I definitely think my metabolism isn't quite up to speed yet due to the hypothyroidism. However, my experience suggests that eating boatloads of dairy -- even good-quality, high-fat dairy -- is an excellent way to gain weight.

    That being said, I don't think that it's necessary to cut out all dairy to lose weight.  I'm still eating some dairy, and I'm losing weight.  Plus, I lost my original 18 pounds with my 1.5 shares of raw milk -- that's 1.5 gallons per week.  (I'm now down to just 1/2 shares, meaning 1/2 gallon per week.)  I just think dairy is something to consider reducing if you're not meeting your weight loss goals.

    ***

    I've not lost much more weight since writing that, but I'm definitely not gaining any weight.  That's huge: I was petrified that I'd be 200 pounds by next summer.  

    I've probably stalled in that weight loss because my metabolism is still screwy due to my not-yet-fully-managed hypothyroidism.  Plus, I'm not seriously trying to lose weight right now: I don't want to stress my already over-stressed body.  But perhaps cutting out dairy entirely would make a difference.

    Anyway, thanks for putting some science behind my experience, Dr. Davis!  I'll definitely add a link to it in the discussion of dairy on the principles page of Modern Paleo.

    -- Diana Hsieh (Modern Paleo)

  • StephenB

    3/19/2010 6:40:08 PM |

    My working assumption has been that I don't need to worry about any increased insulin resistance with high saturated fat intake since I don't eat foods which spike my glucose. Am I correct?

  • Darrin Carlson

    3/19/2010 6:47:03 PM |

    Yikes! Never would have thought butter could do this. Are there any other non-carbohydrate foods that are known to cause insulin secretion?

  • Christian W

    3/19/2010 6:47:03 PM |

    If anything, it seems like the study supports the idea that all fats are bad, doesn't it?

    The zero fat control meal does better than all the fatty meals. Look at insulin for instance.

  • howardh

    3/19/2010 7:54:46 PM |

    I notice that you conveniently ignored the pasta (sugar/gluten) in the study, and attributed ALL of the negative effects to butter. Try again, this one failed.

  • Anonymous

    3/19/2010 8:35:11 PM |

    Hmmmm, Wheat Pasta and Wheat Bread?
    All bets are off. Would be curious to have conducted tests without either of those included.

  • Andrew

    3/19/2010 8:46:58 PM |

    Could butter still make you fat if you're eating below BMR?  It seems to me that if you were eating 1000 calories per day consisting of only butter, and your BMR was 1800, you would still lose weight.  Is there anything that scientifically proves this to be false?

  • Nostril Damus

    3/19/2010 9:00:35 PM |

    Any ideas why ?

    I believe insulin drives the rate of ageing, and this would certainly make me scale back my butter consumption.  

    But what part of butter causes this ?

  • Marielize

    3/19/2010 9:02:16 PM |

    Dear Dr Williams, I find this topic very interesting, but being a lay person would like to know a bit more. What would the "meal" they talk about be? Would that be grains? Is the resuls they got from combining grains with cream or butter? Would butter or dairy products have the same effect in the absence of grains?

  • Donald Duck

    3/19/2010 9:35:38 PM |

    Doesn't this study mainly show that butter is a bad idea when eaten together with lots of carbs?

    Is it really likely you would get the same insulin response if the butter was eaten without all that carbs?

  • Mark

    3/19/2010 9:44:04 PM |

    After removing dairy, grains, and anything else processed. I'd imagine it would be hard to eat too many calories when all you're left is meat, veggies, and fruit but not too much. Just curious, is that all we have to choose from?

  • K Walt

    3/19/2010 10:26:25 PM |

    Interesting.

    But the meals were carb-heavy, too.

    "The subjects then ingested, within 15 min, a fat-rich meal consisting of dietary fat [50 g/m2 body surface area of butter, refined olive oil (ROO), high-palmitic sunflower oil (HPSO) or a mixture of vegetable and fish oils (VEFO) along with a portion of plain pasta (30 g/m2 body surface area), one slice of brown bread, and one container of skim yogurt.

    I wonder if the same effect would be noted if were JUST butter, or oil.

    Is it the butter? Or the wheat pasta, brown wheat bread and lactosey yogurt?

  • sonagi92

    3/19/2010 10:26:26 PM |

    Thanks for taking the time to post a response to inquiring commenters.

  • pyker

    3/19/2010 10:26:26 PM |

    Interesting. Here are the numbers from the study for insulin AUC:

    19960 +- 2766 control
    27970 +- 2107 VEFO
    29619 +- 4975 MUFA
    34749 +- 1167 HPSO
    37582 +- 4364 SFA (butter!)

    Unless I've misread the study, the "control" meal has no fat at all, and is not isocaloric with the test meals. "the macronutrient profile was as follows: 72% fat, 22% carbohydrate, and 6% protein (see Table S1 under "Supplemental data" in the online issue). The subjects also consumed the same test meal containing no fat as a control meal". So the butter test meal has nearly 4x as many calories as the control meal. The AUC for insulin between the two is about double for the butter, but that seems like a useless measure.

    Comparing like-for-like, the spread between average insulin AUC for butter meal and the isocaloric alternate fat meals  shows the butter to be about 34% higher than VEFO and only 8% higher than HPSO. (I have to be pedantic here and point out the spread between averages is not as good as would be the average spread, but I can't get that unless I have the raw data from the study.)

    If you want to claim that butter has some unique ability to raise insulin vs. other fats, this is not strong support.

    You say "butter's insulin-triggering effect, doubling or tripling insulin responses", and "butter makes you fat". I don't see support for either claim when I read that study.

  • Neonomide

    3/19/2010 10:44:24 PM |

    Why ?

    How about cream and fatty milk, or other dairy products ?

    I guess coconut is again the safest bet here...

  • Beth@WeightMaven

    3/19/2010 10:58:06 PM |

    I'm not an MD nor a research scientist. But decades ago, I was a math major. If I read the study and do my math right, the subjects ate an 800 kcal meal of which 72% was fat, for 576 kcals worth of fat (the other control meal components were pasta, bread, and skim milk yogurt).

    576 kcals worth is nearly 6T of butter -- or 3/4 of a stick! To me, that is important additional context for the increased AUC for both the insulin and the triglycerides.

    Considering my typical use (~1T/meal) and considering the potential downside of replacing carb calories with more PUFAs (and omega 6s -- even 1T of EVOO has over 1g of omega 6), I'm not ready to throw out my ghee just yet.

  • Cheryl

    3/19/2010 11:43:30 PM |

    Is it the milk solids that do it?  if so, then ghee may be an alternative.

  • Anonymous

    3/20/2010 12:52:10 AM |

    as a  personal anecdote - eating butter (even in amounts of 200 g. a day) speeds up my fat loss - i feel as if i'm burning inside (elevated metabolism?)...

  • Dr. William Davis

    3/20/2010 12:56:53 AM |

    I see that I touched a nerve.

    This study is not meant to stand on its own, but taken in the context of other studies.

    I think that you should eat butter . . . in small quantities and occasionally. I do not believe that the data argue for liberal use every day, or else you chance triggering insulin. Remember: It's the interpretation of the data in the context of the broader experience that leads you to practical conclusions.

  • Catherine

    3/20/2010 1:39:53 AM |

    What about coconut oil as a butter substitute? There is a lot of hype and hoopla about it being a "safe" medium-chain saturated fat to use as a butter substitute.  Anyone tested if it spikes glucose?

  • zach

    3/20/2010 3:57:00 AM |

    Pastured butter rocks. My belief with butter is "a stick a day keeps the doctor away."

    It's as though the more butter I eat the leaner I get!

    The anthropological evidence really contradicts the data you and loren cordain cite. The pancreases of many people in traditional cultures carried them toward 100 years old, reacting to dairy every day, multiple times per day.

    Here is a 112 year old woman from a very long lived people who use dairy as a staple.

    http://news.bbc.co.uk/2/hi/europe/8550374.stm

  • Sue

    3/20/2010 7:49:50 AM |

    "Fat, in general, does not make you fat. But butter makes you fat."

    Why make such a comment in regards to butter?

  • Adam

    3/20/2010 8:18:10 AM |

    Dr Davis.

    First of all, thank you for your wonderful site and your willingness to impart life changing and saving advice for anyone to access.

    Peter at hyperlipid has written a counter on this particular blog entry of your.

    Would you care to comment?

    http://high-fat-nutrition.blogspot.com/2010/03/butter-insulin-and-dr-davis.html

  • CK

    3/20/2010 8:42:10 AM |

    So let me get this straight: Ingesting carbohydrates including the bad guy wheat does not do much to blood glucose levels and insulin response. But adding fat to the mix at least doubles, or, in the case of butter, quadruples the peak insulin response? That seems like the best refutation of all the low carb/paleo/primal/ef approaches I've ever seen. So where is the catch?

  • Anonymous

    3/20/2010 9:15:05 AM |

    The last sentence made me cry.

  • Donald Duck

    3/20/2010 9:54:54 AM |

    It seems like butter (or cream) without carbs does not create insulin spikes according to the study that Peter at Hyperlipid discusses here:

    http://high-fat-nutrition.blogspot.com/2010/03/butter-insulin-and-dr-davis.html

  • Anonymous

    3/20/2010 10:39:02 AM |

    If you eat fat, ASP levels will rise, which will make you gain fat. ASP levels increase in response to an oral fat load, and ASP is one of the most potent stimulant of triglyceride synthesis.

    So, if you eat carbs, insulin secretes and you store it as fat, if you eat fat, ASP levels rise and you store it as fat. Why is it only the insulin's fault?

    http://www.jlr.org/cgi/content/abstract/30/11/1727

  • But I thought...

    3/20/2010 11:03:43 AM |

    The oracle's take on your post doc:

    http://high-fat-nutrition.blogspot.com/2010/03/butter-insulin-and-dr-davis.html

  • Lori Miller

    3/20/2010 2:08:13 PM |

    I don't know about the effect of butter, but when I eat a fatty meal (like a cheesy omelet with an avacado), my BG goes down several points.

  • kilton9

    3/20/2010 2:23:42 PM |

    Here's a study that isolates cream and shows a very small insulin response: http://drbganimalpharm.blogspot.com/2009/12/insulin-and-aging-how-paleo-works.html

  • Alfredo E.

    3/20/2010 3:01:02 PM |

    This is becoming more confusing by the minute. First, no carbs,only fats and protein.

    Now, no butter, no dairy, no, carbs, just a few drops of fat and protein.

    I am going to cry, like the previous poster.

  • Hilary

    3/20/2010 3:05:41 PM |

    "Fat, in general, does not make you fat. But butter makes you fat."

    This seems wrong. When I eat more butter, I lose fat/weight. Eat more carbs, gain fat/weight. Been noticing this for years. Sure, put a load of butter on noodles or rice, and you'll gain plenty, but just keep the carbs low and there's no problem. This seems like a case of being blinded by science. Maybe the science isn't exactly wrong, but just incomplete or misapplied.

  • pmpctek

    3/20/2010 3:05:41 PM |

    I think I fugured it out...

    The AMA or AHA has kidnapped Dr Davis and they are forcing him to post these confusing refutations.

    What will we see next?  Studies that show how Cocoa Puffs actually will help reach our 60-60-60 goal after all?

  • Joseph

    3/20/2010 3:07:15 PM |

    After reading your post and the hyperlipid post I'm left with a few questions.

    1.The big one, why is butter raising insulin so much? I had previously thought it was only high GI carbs that did that. Hyperlipid seems to think it was the small amounts of casein.

    2.Is it right to say that since the control carb meal only contained 174 calories compared to the butter meal which contained 800 this study is fairly useless? It raises some interesting questions but you can't conclude anything until you have a proper control containing the same amount of calories.

    3. Are there any studies which measure insulin secretion after a pure butter meal with no carbs?

    Even though the study is inconclusive, I'm lowering my butter consumption until I'm sure it isn't causing an agrovated insulin response. Even though butter causes much higher levels of FFA's which mean more of the fat is being burned, insulin levels that high can't be healthy

  • Miles

    3/20/2010 3:52:22 PM |

    All this information hurts my brain...ugh. All I know is when I eat low carb... I lose weight... feel better and more energetic. Sometimes there's just too much analysis and information about what constitutes a healthy diet. It's all opinion and based on research. Then other research refutes that idea.

    My Grandma used to say, "Eat when you're hungry and drink when you're dry."

    BTW... Grandma lived to be 95.

  • Helen

    3/20/2010 3:54:17 PM |

    Dr. Davis,

    I'm not too sure this is right.  I don't have the time to hunt down the links right now, but there was a study on Swedish children recently that showed those eating full-fat dairy (butter fat) were leaner than those who ate low-fat dairy.  Also, butter contains a lot of CLA, which is now being sold as a fat-loss supplement.  I can't parse this study on its own merits like Peter or Pyker (though I thank them for doing so), but I remain unconvinced.  

    I also agree with other posters about the in-vivo, long-term evidence of dairy-reliant cultures and their longevity.  

    Again, with so many cautions of what not to eat, I'd love to see a Dr. Davis-approved diet plan.  If I were just following all the Don'ts, I'd go crazy (and hungry).

  • Anonymous

    3/20/2010 5:39:12 PM |

    The palmitic acid content of the butter would probably trigger  insulin when there is an abundant source of glucose in a meal.  But, if you look at this post by Stephan you will see that the body stores dietary fats when there is a glucose source of energy available.  

    http://wholehealthsource.blogspot.com/search/label/fats

    As the glucose is depleted the fat is released to be used as energy.  The graph in Stephan's post clearly shows the cycling that occurs in normal metabolism.


    The information Dr. Davis presented showed an insulin spike, not continual high levels of insulin that would inhibit the release of FA as an energy source.
    I believe it was Dr. Eades who recently posted about the constant exchange of fats in and out of storage, and the implication is that storage is only a problem when cells remain saturated with glucose.  The fat never comes out because it isn't needed.  In this scenario insulin resistance and fat storage is protective.

    http://high-fat-nutrition.blogspot.com/2010/03/getting-fat-is-good-official.html

    My understanding of this subject is, by limiting carbs, especially the sugar surrogates that are refined grain products, you can keep the normal cycling of energy sources going.

    When everything is working right, your body signals hunger and satiety appropriately, and the body runs at an equilibrium level of energy intake and energy expenditure.

    I suspect that the FA composition of butter makes it available as an energy source sooner than the other FA's tested in the study.  Hence the higher insulin level.


    I don't see where a moderate amount of butter, when there is a limited or low availability of glucose sources will make you fat, expecially if you are VLC or on a ketogenic diet.  I can see where it could be a problem if you were eating 150 or more grams of carbs per day and have metabolic syndrome.  Then high levels of insulin would spike even higher prompting the liver to pump out more glucose, and the fat just has no where to go except into storage.

    Take your vitamin D3 to get your adiponectin levels up.  Take fish oil while limiting Omega-6's to normalize inflammatory responses. Limit carbs, and get the glucose-FA cycle working for you.

  • Nigel Kinbrum

    3/20/2010 6:19:20 PM |

    Eating carbs with butter produces a big insulin response because butter induces temporary insulin resistance (IR) which means that more insulin has to be secreted to get the same net effect. Looking at the blood glucose response, the net effect is the same. So stop panicking. The temporary IR lasts for only a few hours.

  • Gretchen

    3/20/2010 7:49:28 PM |

    "Fat, in general, does not make you fat. But butter makes you fat."

    If you based your conclusion on the graph in this study, all fats make you fat.

    Protein also stimulates insulin, so protein makes you fat.

    Carbs stimulate insulin, so carbs make you fat.

    Conclusion: Food makes you fat.

    It's known that fatty acids acutely stimulate insulin synthesis. With chronic exposure to fatty acids (as occurs in obesity), insulin synthesis is blunted.

    I've never understood the body's rationale for this, unless a sudden infusion of fat makes it think it had better store the fat for the future, but with chronic stimulation it figures it has enough.

    I don't know how ingested fat is related to fatty acids in the blood, whether or not this is linear.

    Whatever, it doesn't look to me as if butter is much different from the other fats, and as others have pointed out, the amounts used in this study (on top of about 44 g of carb, which I wouldn't call a low-carb meal) were enormous.

    The other odd thing is that usually fats slow down a carb-stimulated blood sugar peak, and they didn't in this study.

  • Neil

    3/20/2010 10:33:31 PM |

    This is what is considered 'butter' in the study you refer to above Dr Davis and ultimately what this study uses to prove its point:

    "The subjects then ingested, within 15 min, a fat-rich meal consisting of dietary fat [50 g/m2 body surface area of butter, refined olive oil (ROO), high-palmitic sunflower oil (HPSO) or a mixture of vegetable and fish oils (VEFO) along with a portion of plain pasta (30 g/m2 body surface area), one slice of brown bread, and one container of skim yogurt]."

    Yep, that would be my definition of 'butter' as well!

    If that pile of c**p didn't raise your insulin levels what would?

    In addition: "The average total energy provided by the meals was 800 kcal (10 kcal/kg), and the macronutrient profile was as follows: 72% fat, 22% carbohydrate, and 6% protein"

    Only 22% carbohydrate, no chance of that increasing insulin levels either I suppose!

    It has to be the 'butter'

  • Peter

    3/21/2010 12:02:51 AM |

    @Helen: I couldn't have said it any better myself. I too remain unconvinced.

    You get fat from pasta, bread and butter in combination? Not really groundbreaking work.

  • Peter

    3/21/2010 12:19:14 AM |

    @Helen: I found the study you are referring to I believe.

    "BMI correlated strongly to fat mass and leptin was the best marker of overweight and fat mass in 8-year-olds. Food choice was similar to that at 4 years of age. An intake of fat fish once a week was associated with higher serum concentrations of n-3 fatty acids. The intake of saturated fat and full fat milk were inversely associated with BMI."

    The study was made at the University of Gothenburg.

    http://gupea.ub.gu.se/dspace/bitstream/2077/20457/2/gupea_2077_20457_2.pdf

  • Sue

    3/21/2010 12:51:41 AM |

    I'm sorry Dr Davis but you really didn't analyse this study properly before jumping to conclusions.

  • Anonymous

    3/21/2010 2:24:49 AM |

    Just wondering if you had seen this recent study about higher levels of Vit D being associated with increased arterial calcification in the African American population: http://www.eurekalert.org/pub_releases/2010-03/wfub-vdl031110.php

  • Mike

    3/21/2010 3:44:28 AM |

    Looking at insulin alone can be very misleading. If glucagon is released along with the insulin ,as happens when eating protein, then the fat storing effects of insulin are negated.

    For low carbers, the study is meaningless as it was done with lots of carbs. I will continue to eat butter and cheese until I see a meaningful study that shows that they cause a real problem.

  • PRIDE MAFIA

    3/21/2010 6:02:42 AM |

    Maybe DR Davis saw something on that "low carb cruise" that didn't sit well with him and he's rethinking certain principles?

  • W. Bacon

    3/21/2010 8:19:58 AM |

    Dr. Davis' goof is discussed here:

    http://high-fat-nutrition.blogspot.com/2010/03/butter-insulin-and-dr-davis.html

  • Anonymous

    3/21/2010 5:25:38 PM |

    No, Neil, the 'butter' was just butter. They didn't have "that pile of c**p" at one time: each item in the list was a separate meal & separate data point. Unfortunately, the wording of the paper is in places not very good.

  • Helen

    3/21/2010 8:28:26 PM |

    "Anonymous said...

    Just wondering if you had seen this recent study about higher levels of Vit D being associated with increased arterial calcification in the African American population: http://www.eurekalert.org/pub_releases/2010-03/wfub-vdl031110.php"

    I saw it, and was hoping to discuss it in the pro-D blogosphere.

    I have two ideas why this might be the case.

    (1)  Because people of African descent are adapted to live nearer the equator, where the sun is all you need for enough vitamin D, they may not be as adapted as Europeans to use dietary vitamin D (supplements being an analogue), which Europeans probably relied on during winter months.  Thus, too much supplemental vitamin D may be harmful to African Americans, at least in the case of arterial calcification.  (I hedge, because I've also read recently that African American children with low D status have higher rates of asthma. http://www.sciencedaily.com/releases/2010/03/100317112055.htm)

    (2) There is also the possibility that somewhat different dietary patterns between European Americans and African Americans may offer some explanation.  I can't imagine what this might be, but maybe something having to do with vitamin K2, which helps prevent calcium deposits in the arteries?  There are two possibilities here:

    (a) Maybe African Americans consume (or produce in the gut - from eating greens, a traditional part of the African American diet) more K2 than European Americans, and this is why they have less arterial calcification with lower D status - they don't need the D as much for arterial health, and more dietary D just upsets the balance.

    (b) Maybe they eat less K2 than European Americans (maybe eat less hard cheeses?), and thus vitamin D supplementation, which may require a certain level of K2 to be beneficial, might be harmful instead.

    This sentence leads me to believe it's more likely to be (a):  "Despite these lower vitamin D levels and dietary calcium ingestion, blacks naturally experience lower rates of osteoporosis and have far less calcium in their arteries."  The strong bones and clear arteries make me think African Americans may have better K2 status.  

    It's possible that vitamin A status also plays a role.

  • Helen

    3/21/2010 8:56:30 PM |

    Another thought on the question of African Americans and vitamin D - perhaps *because* they consumed less calcium their vitamin D requirements were lower, so the supplemented amounts were excessive.

  • Dr. William Davis

    3/21/2010 9:55:55 PM |

    The point is not whether glucagon is stimulated. That is, in my view, immaterial.

    The point is that your poor, tired pancreas, likely operating at a fraction of its original beta cell capacity from the years of the beating it took while you ate Cheerios and Cocoa puffs, ate sandwiches, and drank Coca Cola with your pizza, is being stimulated to produce more insulin.

  • Nigel Kinbrum

    3/22/2010 9:05:25 AM |

    Regarding calcification, I think that Helen has hit the nail well & truly on the head regarding Vitamin K2. "If it calcifies, think K2" is what I always say (along with "If it spasms, think Magnesium").

    Taking large amounts of Vitamin D3 and nothing else probably exposes deficiencies in the other fat-soluble vitamins A, E & K2.

    Having cured Lumbar osteoporosis in three years using Ca, Mg, D3 & K2 (and no Alendronate), I will never stop taking Ca, Mg, D3 & K2.

  • Anonymous

    3/22/2010 8:15:10 PM |

    Why eat carbs together with fat?
    They ate 44 g glucose which means the P-glucose could reach >48 mM without insulin i 70 kg person. Of course the disaster hormone insulin increases to block all lipolysis as well as proteinolysis to try to burn off all the totally unnecessary carbohydrates they added.
    If contol diet (gluose) did not change glucose and thus insulin level it must be fake.

    Just another totally stupid study.

  • Anonymous

    3/22/2010 8:53:10 PM |

    I guess I am going to become a breatharian....someone who survives only on air.....since I have learned that butter and fat stimulates my insulin, protein stimulates my insulin, carbs stimulate my insulin and thus I am doomed to be fat....and leptin is stimulated by all three but my brain doesn't register that I am full.  

    Ingesting air is the only thing that will not make me fat.

    Go here to be a Breathairian http://www.breatharian.com
    You can even go to a $1 million dollar seminar that must be completed prior to Dec 21, 2012.

  • Dana Seilhan

    3/22/2010 10:20:44 PM |

    When I'm low-carbing, a favorite meal is a tenderloin cooked medium-rare, sliced thin, and dipped in butter.

    I lose weight anyway.

    Also, what kind of butter was used in the study?  Was it regular grocery-store butter, or was it organic and/or grass-fed butter?  The FDA claims there's no difference between dairy produced with rBGH and dairy produced without, but I'm given to understand that rBGH-produced dairy has higher levels of IGF-1.  What would be the effect on insulin of all that exposure to insulinlike growth factor?

    And I'll second Miki's question of whether the milk solids wouldn't make a difference.

    And to the person who mentioned "all that lactose-y yogurt"--if you make yogurt correctly, it should have hardly any lactose in it at all.

  • Dana Seilhan

    3/22/2010 10:22:01 PM |

    I suspect that the FA composition of butter makes it available as an energy source sooner than the other FA's tested in the study. Hence the higher insulin level.

    Fatty acids by themselves don't prompt insulin release.  Protein does (but the insulin is balanced out by glucagon), and of course carbs do, but there's nothing inherently dangerous in a fatty acid that would prompt the body to store it away immediately.

  • Anonymous

    3/23/2010 7:02:21 PM |

    It seems like no one has a handle on how the metabolic parts fit together to make the whole. My experience from converting from whole grains and no-fat dairy to full-fat dairy has been weight loss and increased energy, particularly after eating a selection of artisan cheese. I often get up, have a bowl of full-fat yoghurt or kefir with 100% chocolate nibs and fresh-roasted nuts, then sample several artisan cheeses, and go cycling 44 km before getting back to make everyone else breakfast. My body seems geared to fat as fuel and I never get blood sugar lows. If this is raising my insulin, it apparently does not affect my blood sugar.

    Murray

  • Apolloswabbie

    3/25/2010 7:38:15 PM |

    Usually, I learn all I need to from Dr. Davis' posts.  My thanks to the other contributors today for illustrating that context is everything.  We have reason to believe that dairy from the industrial food chain would not be as good a food as if we could get true grass fed dairy cow products - but this seems out of context with other info I've seen which shows only moderate insulin response to dairy fats.  Bottom line: measure the markers which indicate insulin levels over time as a gauge of whether your diet does/doesn't work (unless you are losing weight - in which case, you know it is working).

  • Anna Delin

    3/26/2010 9:42:22 AM |

    It seems that whatever butter does to my insulin levels, this does not curb the very positive effects I experience from eating butter. When I cut carbs and replaced them with generous amounts of cream and butter (organic preferably) I lost 14 kg. Moreover, when in "carb country", i.e. airports, airplanes, trains and the like, I can keep my energy up by eating the small amounts of butter and cheese available. Butter also has a way of keeping me feeling full for a very long time. This implies that the fat is not stored away in my fat cells but instead made available for burning. Perhaps other people are more sensitive.

  • ET

    3/26/2010 11:46:15 AM |

    While I often disagree with the conclusions you post, I always enjoy the discussions and research raised by your blogs.  It's one reason I keep coming back for more.  It's keeps me searching for answers.

  • Star Trek TNG

    3/28/2010 6:13:00 PM |

    I still prefer coconut oil for fat loss used in a no-carb diet. I'll find that ghee, which I've also tried, isn't so effective for weight-loss perhaps because it's not so fatty. But it does have to be in a no-carb diet, not a low-carb one. Everyone's got a switch which is triggered by carbs, but no-one knows where it is, not exactly. So unless a study is rabidly no-carbs, none at all, I don't really see what can be learned.

    BB

  • Nancy

    4/8/2010 12:53:02 AM |

    Dr William
    your response to the commentors seems to indicate that butter will make you fat IF you have abused your body with carbohydrates because of a compromised pancreas.  I am willing to suppose this could be true, but what about people who his ave not abused their bodies, what about children being raised low carb from the start, would butter be fattening for them?  Your response would lead me to believe your answer will be no.  I really appreciate your blog and recommend it to all, but please clarify this issue.  Maybe a whole new blog on this would be a good idea, since the entire low carb community is talking about it.

    To everyone else I have to say there is nothing like testing something for yourself.  If you have an insulin tester, have some butter and test yourself and make a chart.  See how YOU are affected.

  • Alejo Hausner

    4/9/2010 1:28:50 PM |

    The work was funded by the Fundación Centro de Excelencia en Investigación sobre Aceite de Oliva y Salud (“Center of excellence for research on olive oil and health”).

    Notice that they end up concluding that olive oil raised glucose and insulin less than butter. Had this study been done by French researchers and not Spanish researchers, it would have found that butter is better for you than olive oil!

    Alejo

  • jpatti

    5/7/2010 7:58:00 AM |

    Pasture-raised butter is a good source of vitamins A, D and K2 plus CLA.

    And it makes veggies yummy.  

    As Julia Child said... butter is better.

  • info

    5/16/2010 6:10:09 AM |

    Little test
    I'm a very low carber. 80% of my calory intake come from fat. I eat less than 20 grams of carbs. I did a little test. For a week I took tallow and coconut oil instead of butter. In that week I lost three pounds. Conclusion: Butter seem to have a sort of effect.

  • kimberly

    9/16/2010 1:46:12 AM |

    I love to prepare some recipe that contain many cream.  although i know that a person can gain weight I don´t matter because i love the taste, Simply delicous. And when i cook, my husband usually is very happy.
    Actually i was looking information about how tobuy viagra  but i reached this blog, i really enjoyed reading.

  • buy jeans

    11/2/2010 8:24:56 PM |

    The postprandial (after-eating) area-under-the-curve is substantially greater when butter is included in the mixed composition meal. This effect is not unique to butter, but is shared by most other dairy products.

  • Chester The Bear

    1/19/2011 10:55:45 PM |

    Um... Sorry... I see the data differently.
    In the fat meals in the study, the amount of fat intake was the same, yet butter delivers higher serum FFAs, indicating that fat might stimulate lipolysis, even though it appears to induce a short term insulin spike.
    Carbohydrate might promote a lower insulin response, but it blocks lipolysis.
    Finally, there's a lot more going on here than just insulin.  To take it out of context is meaningless.

  • racing games

    1/20/2011 11:15:13 AM |

    but my question is what is the reason behind this insulin triggering effect of butter? can anyone answer this?

  • liposculpture guide

    1/26/2011 7:18:57 AM |

    It's always good to challenge deeply held beliefs in case we are wrong. I do have a soft spot for butter and hope it is an outlier as far as blood glucose.

  • francisco camps

    2/5/2011 8:41:02 PM |

    I am scary with butter now...lol

  • ABBEY

    3/5/2011 6:27:47 AM |

    As people know, I've been struggling with my weight due to my hypothyroidism. Although many of my symptoms have improved, I kept the weight gain in very consistent rate of 3 pounds per month. Sometimes, mostly due to a little fast, would be a pound or two, but then suddenly I would like to recover all that weight plus more than a day or two, so it would be in this constant uphill again.

    people searches

  • Matt Titus

    5/6/2011 3:42:50 AM |

    I wonder if the results would be the same with raw butter?

  • Paula Nedved

    10/3/2011 2:30:40 AM |

    Peter over at Hyperlipid has done a critique of this post of your, Dr. Davis.
    Entitled "Butter insulin and Dr. Davis"    He dunna believe you.

  • Nancy

    10/20/2011 4:57:58 PM |

    I'm stunned by your absolute condemnation of butter based on this one study.  Geez, have you been paid off by Wesson or Crisco?   You need to consider all the confounding variables in this study.  Your blog post should be retracted and/or rewritten.  This is very disappointing after your carefully researched examination of wheat.

    In my experience, butter and butter fat are good for you.  I have lost considerable body fat and gained much muscle this year on an eating plan that involves a lot of raw milk and cream from grass-fed cows, 3 to 4 glasses of milk and up to a cup of cream per day.  Butter fat is not making ME fat, quite the opposite.

  • Karl Schmidt

    9/27/2012 6:35:46 PM |

    Insulin goes down faster because the vegetable fats are stored in the fat tissue faster..

    A better understanding of butter is here :

    http://high-fat-nutrition.blogspot.com/2012/09/protons-pancreas.html

  • Karl Schmidt

    12/1/2012 9:41:46 PM |

    There is another problem with that study - people do not keto adapt in 8 hours - it takes 4- 6 weeks to fully adapt to a low carb diet.

    Once adapted, low-carbers are BETTER able to clear FA as the liver revs up it's fat metabolic capabilities.  Low carbers also tend to eat less frequently - reducing the exposure to both BG and FA - only when both are elevated do we see the pronounced toxic effects of the fats.

Loading
Drama with the Dr. Oz Show

Drama with the Dr. Oz Show

A producer from the Dr. Oz show recently contacted my office. They asked whether we could supply them with a volunteer patient from either my practice or the Track Your Plaque program who would be willing to appear on the show and discuss heart disease prevention. They needed someone to commit within 24 hours.

Despite the short notice, we identified a volunteer. He flew to New York the following week where he was interviewed along with several other men and women, all of whom had heart disease (heart attacks, stents, etc.). However, as this young man is very slender and follows most of the Track Your Plaque principles (e.g., vitamin D and omega-3 fatty acid supplementation; no wheat, cornstarch, or sugars, no restriction of fat, etc.), he apparently received less attention than the overweight, I-know-nothing-about-diet interviewees.

Then there was an odd turn of events: Dr. Dean Ornish, apparently a friend of Dr. Oz, will be providing the dietary counseling. The producer had made no mention of Dr. Ornish.

Now that's an odd collision of philosophies: Our Track Your Plaque version of low-carb with the guru of low-fat, Dr. Ornish.

The following week, Dr. Ornish called me and graciously asked whether I was okay with this. I'm not sure just how much he knew about the philosophy I advocate, nor how much I have bashed his program as a destructive approach to diet, nor whether he knew that I gained 30 lbs on the Ornish diet, along with a drop in HDL to 27 mg/dl, increased triglycerides to 350 mg/dl, and type II diabetes that I've talked about on this blog and the Track Your Plaque book and website. I suspect he knew little to none of this.

Anyway, I tried to diplomatically explain that my patient's cause for coronary plaque was small LDL particles that he expressed despite his very slender build, likely from excessive carbohydrates, controlled with carbohydrate restriction. Dr. Ornish maintained his usual arguments: Grains are good, provided they are whole grains, heart disease is "reversed" with his diet program, etc. (I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)

We agreed to disagree. This leaves my poor patient in an odd position: Being asked by Dr. Ornish and the Dr. Oz show to follow a low-fat program for the sake of entertainment, or adhering to the advice we follow that has so far served him well, given his small LDL particle size tendencies.

We'll see where this little drama leads.

Comments (27) -

  • preserve

    4/11/2010 2:10:12 PM |

    This can be very educational.  We can find out the effects of Dr. Ornish's diet, directly prescribed by him.  This provides a pretty comparison test.

  • Anne

    4/11/2010 3:12:55 PM |

    If I had been the person flown to NYC for the show and was told they wanted me to follow the Ornish plan, I would have told them "No way." and walked out.

    I tried the Ornish diet when I first started having problems with CAD and multiple stents. I found the diet very difficult and it left me hungry. I did the meditation too.  I don't know what my lipid levels were at that time. I then went to the AHA diet that caused my triglycerides, cholesterol and weight to all rise and the answer was to get on statins and I went on to have bypass.

    In 2008 I started following a TYP lifestyle plan. Here is what happened http://heartscanblog.blogspot.com/2009/06/beating-heart-association-diet-is.html

  • Ned Kock

    4/11/2010 3:54:15 PM |

    Interesting, particularly the involvement of Dr. Ornish. Dr. Oz seems to be changing his tone lately - less critical of fats or more of refined carbs.

    By the way, you mentioned several times on your blog that the  Friedewald equation is very imprecise, providing a fictitious measure of LDL, particularly as TGs go down.

    What is your opinion of the Iranian equation? It seems to be more precise for those with low TGs, and maybe more precise in general, as its parameters were estimated through multiple linear regression:

    http://healthcorrelator.blogspot.com/2010/04/friedewald-and-iranian-equations.html

    Of course, a VAP or equivalent test would be better, but a lot of people would like to have a more precise number based on their standard lipid profile results.

  • JD

    4/11/2010 3:57:26 PM |

    Dr. Oz's wife Lisa is a vegetarian and IIRC a producer of his radio show. Dr. Oz has been quoted as saying that "everything he knows about nutrition he learned from his wife". Given his source of nutrition education I am not surprised he is on good terms with Dr. Ornish. As Dr. Eades says, "Jesus wept".

  • Mark

    4/11/2010 4:06:06 PM |

    Subjects on Dr. Oz are chosen w/entertainment value in mind.  Dr. Oz consistently gives contradicting advice at different times aimed at large audiences with the air that one size fits all. I will stay with my individualized TYP approach and leave him and his advice to entertain the masses.

  • Alcinda (Cindy) Moore

    4/11/2010 5:25:48 PM |

    If it was me, no contest. I'd stick with you! I am not a fan or Oz....and can't stand Ornish!

  • Rantin' Rog

    4/11/2010 5:31:38 PM |

    While I don't agree with Ornish, I think this is an exciting development.  Maybe he will learn something from your patient!  Any common ground and exchange of ideas is a good thing.

  • Brett

    4/11/2010 9:08:37 PM |

    Why didn't Oz or Ornish simply invite you, Dr. Davis, to be on the show? You're (cough) down with the low-fat program, right?

  • pjnoir

    4/12/2010 2:13:45 AM |

    AMBUSH. Low FAT will always win the debate because they set the facts- its just like Alice in Wonderland. Nothing good can come of this. I saw Doc OZ pour some cooking oil in his hand and say to a women- see,image this running through your veins. If thats the case- Id hate to see what Oatmeal looks like in those veins. And don't get me started on DO.

  • Gina

    4/12/2010 4:17:48 AM |

    This is the reason I turned my TV off for good over 9 years ago!
    Oz and Ornish and entertainment...why do people believe every word theses guys say? Oh maybe because Oprha says they're the best. Good God, with a computer and internet available to almost anyone who can view a TV why don't they ask some questions and do some research. Oh maybe because this is all in the name of entertainment.
    Keep up the great work Doc. I love the blog!

  • Dr. William Davis

    4/12/2010 11:31:47 AM |

    I remind myself that Dr. Ornish et al are all trying to work towards the same goal: reduction of heart disease risk. It's just that we disagree on how we get there. I think his heart is in the right place, but I worry that he perpetuates a message that is outdated and, in many cases, destructive.

    Ned--

    The "Iranian equation" is definitely an improvement, despite being nothing more than a manipulation of numbers. However, it does not uncover the hidden sources of risk that are NOT expressed by the basic lipid numbers, no matter how much you massage them.

  • Peter

    4/12/2010 11:47:49 AM |

    I don't think your disagreements with Ornish are as black and white as you suggest: he has been telling people for thirty years to stop eating sugar and other refined carbohydrates, he thinks well enough of heart scans to have one himself (scored zero), and both you and he choose whole foods over processed foods in a heartbeat (that was a joke about heartbeat.) This is not to say that your views are the same.

  • Dr. William Davis

    4/12/2010 11:58:05 AM |

    I agree, Peter.

    While the differences are fundamental, there is perhaps 70% overlap. And we are indeed aiming for the same goal.

  • George

    4/12/2010 5:03:09 PM |

    Dr. Davis, Hopefully something good will come from this. I would love to see status updates of what develops here. Beginning/Ending lipid profiles, what changes your volunteer makes in their diet based on Ornish, etc. Very, very interesting, looking forward to see what happens. Do we know when this will possibly air?

  • Anonymous

    4/12/2010 5:38:02 PM |

    pjnoir is correct.  It is an ambush.

    Ornish is not 'growing', and Oz is not about to admit he's been wrong all this time.

    You are about to be mocked and held up as a quack.

    It is a shame that they have the megaphone and you don't, but that is our perverted medical/money/fame/power system.

  • Health Test Dummy

    4/12/2010 8:07:33 PM |

    Not that I think these types of doctors are 'dumb', per-say, however, it angers me as to their 'ignorance'. I have absolutely the highest respect for all doctors who search for the 'proactive' solution. I think anyone who sticks with the 'lemmings-style' mantra, in regards to science, is only asking for humiliation and self-destruction down the road. The Ansel Keys-inspired lipid hypothesis, I believe, has been absolutely shot down by CORRECT scientific methods for analyzing it's true health benefits. Throwing together some generalized 'meta-analysis' and touting it as 'truth' for the past 50 years shows us just how 'lemming-like' we truly are as a society. This information is a type of regurgitated (telephone game) bit of information that sticks to everything like glue, due to bad media and doctors who refuse to proactively search for alternative solutions based on true scientific formulas (have we all forgotten the 7th grade science class teachings of 'control group' and other forms of scientific analysis?).

    Anyway, it blows my mind. Meanwhile, I will continue to be mocked and viewed upon by my peers as 'weird' or 'out there', whilst they are all 10% + bodyfat % above me.

  • John

    4/12/2010 9:45:40 PM |

    I can vouch for the wisdom of Dr. Davis, I recently switched cardiologists to one that would listen to me about how I changed my diet since November of last year alas with the recommendations on this website I was so fortunate to come across.

    In November  
    Total Cholesterol 295
    LDL 191
    HDL 56
    TG 235
    I was immediately put on 5 mg of Crestor daily.

    Now today... after changing my diet (no wheat, no HFCS, low carbs) ( I cheat every once in awhile  but rarely, sushi with rice is my weakness..but one meal a week if at all) and still take the Crestor... after getting bloodwork from new cardiologist.

    New Numbers
    Total Cholesterol 200
    LDL 121
    HDL 61
    TG 90

    And the best part... I dropped 27 lbs and dropped a pants size...not bad for a 45 year old guy. At 6'4" and 209 pounds I'm ecstatic. Goal weight is 195 lbs that I was 15 years ago when I got married.

    Best thing is... my new cardiologist told me to take the 5 mg of Crestor EVERY OTHER DAY NOW... very happy about that. He said what you're doing with your diet and some exercise is reaping positive changes. He finished with we'll see you in 6 months to reevaluate your progress and go from there. Obviously my goal is to get off the statin for good and I think I can accomplish that with eating the Dr. Davis way.

    Thanks for the great advice you give Dr. Davis.

  • Lou

    4/13/2010 12:01:39 AM |

    Hope your patient is well prepared to provide information why she/he is doing all of that that you had him/her doing. Hope it turns out well for your patient and you.

  • Dr. William Davis

    4/13/2010 1:45:20 AM |

    I'm told that the Dr. Oz show featuring our patient will be aired Wednesday, April 14th.

    I'm not too worried about any bad press it might create. I have always been confident that the truth will win out.

  • Rob

    4/13/2010 9:37:38 PM |

    That is unfortunate. It would have been a great study, but unfortunately Dean Ornish's diet has no evidence to support it is healthy. I would politely refuse to have anything to do with that low-fat diet crap.

    http://productreviewratings.com/2010/02/fat-and-cholesterol-are-good-for-you/

  • Anonymous

    4/14/2010 5:08:46 PM |

    I just checked my Tivo and found this particular Dr. Oz show will be aired on WFLD in Chicago on April 14th at 4:00 pm and then once again on April 15th at 10:00 am.

    David

  • kdhartt

    4/15/2010 1:10:21 AM |

    Just watched it. Fish oil made the cut, not pills even, but something to have with your salad. 30 min exercise. Some yoga for stress. Impressive animations of arteries and plaque and rupture. A lot of low-fat dogma. I must say I learned nothing.

  • rhc

    4/15/2010 3:17:18 AM |

    I just watched the show and I must say it was VERY convincing since Dr. Oz had photos of the improved arteries of two of the patients. In addition, one of Dr. Ornish's original patients  who had been on the heart transplant list 25 years ago was also there - looking quite radiant and healthy. They showed pictures of his heart before and after as well.

    It is all so confusing to me since both sides have their 'proof' and scientific evidence. And let's face it most people will believe the benefits of 'lowfat' over 'highfat' any day.

    Dr. Davis could you please explain your answer to Dr. Ornish:
    “(I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)”

    I have no medical training, so forgive my ignorance, but it seems to me that if a diet reverses heart disease it doesn’t matter wether it is by reversing plaque or by reversing a dysfunction – the end result is what counts…doesn't it?

  • Anonymous

    4/15/2010 4:27:47 PM |

    Well I watched the show and couldnt tell which guest was the one that Dr D recommended.
    But certainly heart disease reversal was the predominate theme. Interesting graphics were used to explain plaque build up and blockage. But nothing on the components of cholesteral or small LDL. Nothing about blood sugar monitoring. On reversal startegies, weight control and exercise were trotted out as important elements ... not particularly new or enlightening. But when it came to diet there was almost a whole hearted endorsement of carbs ... oatmeal with plenty of fruit for breakfast, whole grain bread, rice etc.   Curiously fish oils where mentioned only briefly (almost in passing), and there was nothng on Vitamin D or Niacin.
    Not even statins (pro or con) were mentioned.

    All in all not at all informative! ... perhaps even misleading by what was not said ... a very poor performance imho.

  • Dr. William Davis

    4/15/2010 6:36:25 PM |

    I've so far only been able to view some of the introductory dietary comments, the "whole wheat cereal for breakfast" and "low-fat granola bar" for a snack.

    That little bit made me shudder. It brought back memories of all the low-fat blunders we made 15 years ago until we saw that substantial numbers of people were made pre-diabetic or diabetic with this routine.

  • kdhartt

    4/15/2010 10:46:31 PM |

    There was a 70% carbs, 10% fat pie chart. Must do to reverse heart disease. Nutritious meal (for six) portrayed as a death wish. Ornish as god. Not our cup of tea.

  • Anonymous

    4/16/2010 6:37:28 AM |

    Hey, at least they didn't attack you, Dr. D.  That's what I was thinking would happen.

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