Overweight, hungry, diabetic, and fat-free

15. December 2009 William Davis (52)
Let me tell you about my low-fat experience from 20 years ago.

At the time, I was living in Cleveland, Ohio, and served on the faculty at a large metropolitan university-affiliated hospital, supervising fellows-in-training and developing high-tech cath lab procedures like directional athererectomy and excimer laser coronary angioplasty. (Yes, another life.)

I was concerned about personal heart disease risk, though I knew next to nothing about lipids and coronary risk prediction outside of the little I learned in training and what the drug industry promoted.

I heard Dr. Dean Ornish talk while attending the American College of Cardiology meetings in Atlanta. Dr. Ornish spoke persuasively about the dangers of fat in the diet and how he "reversed" coronary disease using a low-fat, no added oils, no meat, vegetarian diet that included plenty of whole grains. So I thought I'd give it a try.

I eliminated all oils; I removed all meat, eggs, and fish from my diet. I shunned all nuts. I ate only low-fat products like low-fat yogurt and cottage cheese; and focused on vegetables, fruit, and whole grains. Beans and brown or wild rice were a frequent staple. I loved oatmeal cookies--low-fat, of course!

After one year of this low-fat program, I had gained a total of 31 lbs, going from 155 lbs to 186 lbs. I reassessed some basic labs:

HDL 28 mg/dl
Triglycerides 336 mg/dl
Blood sugar 151 mg/dl (fasting)


I became a diabetic. All through this time, I was also jogging. I ran on the beautiful paths along the Chagrin River in suburban Cleveland for miles north and south. I ran 5 miles per day most days of the week.

It was diabetes that hit me alongside the head: I was eating low-fat meticulously, exercising more than 90% of the population, yet I got fat and diabetic!

I have since changed course in diet. Last time I checked, my lipid values on NO statin agent:

HDL 67 mg/dl
Triglycerides 57 mg/dl
Blood sugar 91 mg/dl

That was my lesson that fat restriction is a destructive, misguided notion. The data since then have confirmed that restricting total fat is unnecessary, even undesirable, when fat calories are replaced by carbohydrate calories.

This is your brain on wheat

10. December 2009 William Davis (32)
Here's just a smattering of the studies performed over the past 30 years on the psychological effects of wheat consumption.

Oddly, this never makes the popular press. But wheat underlies schizophrenia, bipolar illness, behavioral outbursts in autism, Huntington's disease, and attention deficit hyperactivity disorder (ADHD).

The relationship is especially compelling with schizophrenia:

Opioid peptides derived from food proteins: The exorphins.
Zioudrou C et al 1979
"Wheat gluten has been implicated by Dohan and his colleagues in the etiology of schizophrenia and supporting evidence has been provided by others. Our experiments provide a plausible biochemical mechanism for such a role, in the demonstration of the conversion of gluten into peptides with potential central nerovus system actions."


Wheat gluten as a pathogenic factor in schizophrenia
Singh MM et al 1976
"Schizophrenics maintained on a cereal grain-free and milk-free diet and receiving optimal treatment with neuropleptics showed an interruption or reversal of their therapeutic progress during a period of "blind" wheat gluten challenge. The exacerbation of the disease process was not due to variations in neuroleptic doses. After termination of the gluten challenge, the course of improvement was reinstated. The observed effects seemed to be due to a primary schizophrenia-promoting effect of wheat gluten."


Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates
Huebner FR et al 1984


Is schizophrenia rare if grain is rare?
Dohan FC et al 1984
"Epidemiologic studies demonstrated a strong, dose-dependent relationship between grain intake and the occurrence of schizophrenia."

Small LDL: Perfect index of carbohydrate intake

8. December 2009 William Davis (15)
Measuring the number of small LDL particles is the best index of carbohydrate intake I know of, better than even blood sugar and triglycerides.

In other words, increase carbohydrate intake and small LDL particles increase. Decrease carbohydrates and small LDL particles decrease.

Why?

Carbohydrates increase small LDL via a multistep process:

First step: Increased fatty acid and apoprotein B production in the liver, which leads to increased VLDL production. (Apoprotein B is the principal protein of VLDL and LDL)

Second step: Greater VLDL availability causes triglyceride-rich VLDL to interact with other particles, namely LDL and HDL, enriching them in triglycerides (via the action of cholesteryl-ester transfer protein, or CETP). Much VLDL is converted to LDL.

Third step: Triglyceride-rich LDL is "remodeled" by enzymes like hepatic lipase, which create small LDL.


Carbohydrates, especially if they contain fructose, also prolong the period of time that triglyceride-rich VLDL particles persist in the blood, allowing more time for VLDL to interact with LDL.

Many people are confused by this. "You mean to tell me that reducing carbohydrates reduces LDL cholesterol?" Yes, absolutely. While the world talks about cutting saturated fats and taking statin drugs, cutting carbohydrates, especially wheat (the most offensive of all), cornstarch, and sugars, is the real key to dropping LDL.

However, the effect will not be fully evident if you just look at the crude conventional calculated (Friedewald) LDL cholesterol. This is because restricting carbohydrates not only reduces small LDL, it also increases LDL particle size. This make the calculated Friedewald go up, or it blunts its decrease. Conventional calculated LDL will therefore either underestimate or even conceal the real LDL-reducing effect.

The reduction in LDL is readily apparent if you look at the superior measures, LDL particle number (by NMR) or apoprotein B. Dramatic reductions will be apparent with a reduction in carbohydrates.

Small LDL therefore serves as a sensitive index of carbohydrate intake, one that responds literally within hours of a change in food choices. Anyone following the crude Friedewald calculated LDL will likely not see this. This includes the thousands of clinical studies that rely on this unreliable measure and come to the conclusion that a low-fat diet reduces LDL cholesterol.

Fat "conditioning"

4. December 2009 William Davis (0)
Here's a great study from the prolific laboratory of Dr. Jeff Volek from the University of Connecticut. (Full text here.)


http://jn.nutrition.org/cgi/content/full/134/4/880

Video Teleconference with Dr. William Davis

2. December 2009 William Davis (0)

Dr. Davis is available for personal
one-on-one video teleconferencing

to discuss your heart health issues.


You can obtain Dr. Davis' expertise on issues important to your health, including:

Lipoprotein assessment

Heart scans and coronary calcium scores

Diet and nutrition

Weight loss

Vitamin D supplementation for optimal health

Proper use of omega-3 fatty acids/fish oil


Each personalized session is 30 minutes long and by appointment only. To arrange for a Video Teleconference, go to our Contact Page and specify Video Teleconference in your e-mail. We will contact you as soon as possible on how to arrange the teleconference.


The cost for each 30-minute session is $375, payable in advance. 30-minute follow-up sessions are $275.

(Track Your Plaque Members: Our Member cost is $300 for a 30-minute session; 30-minute follow-up sessions are $200.)

After the completion of your Video Teleconference session, a summary of the important issues discussed will be sent to you.

The Video Teleconference is not meant to replace the opinion of your doctor, nor diagnose or treat any condition. It is simply meant to provide additional discussion about your health issues that should be discussed further with your healthcare provider. Prescriptions cannot be provided.

Note: For an optimal experience, you will need a computer equipped with a microphone and video camera. (Video camera is optional; you will be able to see Dr. Davis, but he will not be able to see you if you lack a camera.)

We use Skype for video teleconferencing. If you do not have Skype or are unfamiliar with this service, our staff will walk you through the few steps required.

Track Your Plaque challenges

1. December 2009 William Davis (31)
Of all the various factors we correct in the Track Your Plaque program in the name of achieving reversal of coronary plaque, there are two factors that are proving to be our greatest challenges:

1) Genetic small LDL

2) Lipoprotein(a)

More and more people are enjoying at least marked slowing, if not zero change or reduction, in heart scan scores following the Track Your Plaque program. We achieve this by correcting a number of factors. Some factors, like vitamin D deficiency, are easily corrected to perfection--supplement sufficient vitamin D to achieve a blood level of 25-hydroxy vitamin D of 60-70 ng/ml. Correcting standard lipid values--LDL cholesterol, HDL cholesterol, and triglycerides--child's play, even to our strict targets of 60-60-60.

However, what I call "genetic small LDL" and a subset of lipoprotein(a) are proving to be the most resistant of all.

Let's first consider genetic small LDL. Small LDL is generally the pattern of the carbohydrate-ingesting, overweight person. It has exploded in severity over the past decade due to overconsumption of carbohydrates due to the ridiculous low-fat notion. Reduce or eliminate carbohydrates, especially wheat, which permits weight loss, and small LDL drops like a stone. But there is a unique subset of people who express the small LDL pattern who start at or near ideal weight. Take Chad, for instance. At 6' 2" and 152 lbs and BMI of 19.6, there's no way excess weight could be triggering his small LDL. Yet he starts with 100% small LDL particles. All efforts to reduce small LDL, such as wheat, cornstarch, and sugar elimination; niacin; vitamin D normalization; thyroid normalization; and several supplements that yield variable effects, such as phosphatidylcholine, all leave Chad with more than 90% small LDL.

Lipoprotein(a) is a bit different. Over the past 5 years, our choices in ways to reduce Lp(a) expression have improved dramatically. Beyond niacin, we now have high-dose EPA + DHA, thyroid normalization that includes use of T3, and hormonal manipulation. In the Track Your Plaque experience, approximately 70% of people with Lp(a) respond with a reduction in Lp(a). (In fact, the 4 out of the 5 record holders for reduction of heart scan scores have Lp(a) that was successfully treated.) But about 30% of people with Lp(a) prove resistant to all these treatments--they begin with a Lp(a) of, say, 260 nmol/L and, despite niacin, high-dose EPA + DHA, and various hormones, stay at 260 nmol/L. It can be frustrating and frightening.

So these are the two true problem areas for the Track Your Plaque program, genetic small LDL and a subset of Lp(a).

We are actively searching for better options for these two problem areas. Given the collective exploration and wisdom that develops from such collaborative efforts as the Track Your Plaque Forum, I am optimistic that we will have better answers for these two stumbling blocks to plaque reversal in the future.

I'll supply the tar if you supply the feathers

30. November 2009 William Davis (13)
The results of the latest Heart Scan Blog poll are in.


DIRECT-TO-CONSUMER PHARMACEUTICAL ADVERTISING HAS:

Increased public awareness of medical conditions and their treatment
19 (11%)

Has had little overall effect on health and healthcare
29 (18%)

Needlessly increased healthcare costs
81 (50%)

Further empowered the revenue-obsessed pharmaceutical industry
130 (81%)


Clearly, there's a lot of negative sentiment against direct-to-consumer (DTC) drug advertising.

It looks as if a small minority believe that good has come from DTC advertising, judging by the meager 11% who voted for increased awareness. In fact, the poll results are heavily weighed towards the negative: 50% voted for "needlessly increased healthcare costs," while an astounding 81% voted for "empowered the revenue-obsessed pharmaceutical industry."

It is, indeed, an odd situation: Pharmaceutical agents available only by prescription being hyped directly to the consumer.

Personally, I would vote for choices 1,3, and 4. While awareness has increased, it has come with a hefty price, not all of it well spent. I believe the pharmaceutical industry still adheres to the rule that, for every $1 spent on advertising, $4 is made in revenue. They are, in effect, printing money.

What goes up can't come down

28. November 2009 William Davis (13)
According to conventional wisdom, heart scan scores cannot be reduced.

In other words, say you begin with a heart scan score of 300. Conventional wisdom says you should take aspirin and a statin drug, eat a low-fat "heart healthy" diet, and take high blood pressure medications, if necessary.

If your heart scan score goes up in a year or two, especially at an annual rate of 20% or more, then you are at very high risk for heart attack. If the heart scan score stays the same, then your risk is much reduced. These observations are well-established.

But more than 99% of physicians will tell you that reducing your heart scan score is impossible. Don't even try: Heart scan scores can go up, but they can't go down.

Baloney. Heart scan scores can indeed go down. And they can go down dramatically.

It is true that, following conventional advice like taking a statin drug, following a low-fat diet, and taking aspirin will fail to reduce your heart scan score. A more rational approach that 1) identifies all causes of coronary plaque, 2) corrects all causes while including crucial strategies like omega-3 fatty acid supplementation, vitamin D supplementation, and thyroid function normalization, is far more likely to yield a halt or reduction in score.

While not everybody who undertakes the Track Your Plaque program will succeed in reducing their heart scan score, a growing number are enjoying success.

A small portion of our experience was documented this past summer. (I collected and analyzed the data with the help of Rush University nutrition scientist, Dr. Susie Rockway, and statistician, Dr. Mary Kwasny.)


Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults.

Davis W, Rockway S, Kwasny M.

The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS of > or = 50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides < or = 60 mg/dL; high-density lipoprotein > or = 60 mg/dL; and vitamin D3 supplementation to achieve serum levels of > or = 50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%-29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%-71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.

Gretchen's postprandial diet experiment

27. November 2009 William Davis (11)
Gretchen sent me the results of a little experiment she ran on herself. She measured blood glucose and triglycerides after 1) a low-fat diet and 2) a low-carb diet.









Gretchen describes her experience:

Several years ago I received a windfall of triglyceride strips that would expire in a week or so. I hated to waste them, so I decided to use them to test my triglyceride and BG responses to two different diets: low carb and low fat.

The first day I followed a low-fat diet. For breakfast I ate a lot of carbohydrate, including 1 oz of spaghetti cooked al dente and ¾ cup of white rice. For the rest of the day I ate less carbohydrate but continued to eat low fat.

The second day I followed a low-carb diet. For breakfast I ate a lot of fat, including a sausage, mushrooms fried in butter, 2 slices of bacon, and ¼ cup of the creamy topping of whole-milk yogurt. For the rest of the day I ate less fat, especially less saturated fat, but continued to eat low carb.

Both days I measured both BG and triglyceride levels every hour until I went to bed. On the low-carb day I had 3 meals. On the low-fat day, I was constantly hungry, had 4 meals, and kept snacking.

You can see the results in Figure 1. On the low-fat diet, after a “healthy” low-fat breakfast of low-glycemic pasta with low-fat sauce, my BG levels shot up to over 200 mg/dL and took more than 6 hours to come down. My triglycerides, however, remained low, and at first I thought perhaps the low-fat diet might be better overall. However, after about 6 hours, the triglyceride levels started to increase steadily, and by the next morning, they were higher than they had been the day before.
On the low-carb diet, my BG levels stayed low all day. However, after meals, the triglyceride levels skyrocketed. After meals they came down, and by the next morning they were lower than they had been the day before.

As I interpret these results, the high triglyceride levels after eating the high-fat meals represent chylomicrons, the lipoproteins that transport fat from your meals to the cells of your body. The high triglyceride levels the morning after eating the low-fat meals represent very low density lipoprotein, which takes the cholesterol your liver synthesizes when your intake of dietary cholesterol is low and distributes it to cells that need it, or again, to the fat for storage.

There are several interesting factors to consider here. First, when you have a lipid test done at the lab, it’s usually done fasting, which means first thing in the morning after not eating for 8 to 12 hours. It tells you nothing about what your triglyceride levels were all day.

Second, the low-carb diet resulted in lower fasting triglyceride levels, but much higher postprandial triglyceride levels. Which are more dangerous? I’m afraid I don’t know. You should also note that the high-fat, low-carb breakfast was extremely high in fat, including saturated fat. I don’t normally eat that much fat but wanted to test extremes.

Third, although the low-fat diet didn’t produce the very high postprandial triglyceride levels that the high-fat diet did, it produced extremely high BG levels that persisted for 6 hours. Some people think that it’s oxidized and glycated lipids that are the dangerous ones, so high BG levels and normal triglyceride levels might be more dangerous than very high triglyceride levels and normal BG levels. Note that high BG levels also contribute to oxidation rates.

Fourth, this shows the results of an experiment with a sample size of one. My physiology might not be typical. If you want to know how your own body’s lipids respond to different types of diets, you should get a lipid meter and test yourself. Unfortunately, your insurance is unlikely to want to pay for this, so it will be an expensive experiment.

The main point of this is that the results of different diets are complex. We have to eat. And what we eat can affect many different systems in our bodies. Finding the ideal diet that matches our own physiology and results in the best lipid levels as well as BG levels is a real challenge.



This was a lot of effort for one person. Thanks to Gretchen for sharing her interesting experience.

Gretchen makes a crucial point: Some of the effects of diet changes evolve over time, much as triglyceride levels changed substantially for her on the day following her experiment. Wouldn't it be interesting to see how postprandial patterns develop over time if levels were observed sequentially, day after day?

The stark contrast in blood sugars is impressive--Low-carb clearly has the advantage here. Are there manipulations in diet composition in low-carb meals that we can make to blunt the early (3-6 hour) postprandial lipoprotein (triglyceride) peak? That's a topic we will consider in future.

More of Gretchen's thoughts can be found at:

http://wildlyfluctuating.blogspot.com
http://www.healthcentral.com/diabetes/c/5068

After-eating effects: Carbohydrates vs. fats

25. November 2009 William Davis (17)
In the ongoing debate over whether it's fat or carbohydrate restriction that leads to weight loss and health, here's another study from the Oxford group examining the postprandial (after-eating) effects of a low-fat vs. low-carbohydrate diet. (Roberts R et al, 2008; full-text here.)

High-carbohydrate was defined as 15% protein; 10% fat; 75% carbohydrate (by calories), with starch:sugar 70:30.

High-fat was defined as 15% protein; 40% fat; 45% carbohydrate, with starch:sugar 70:30. (Yes, I know. By our standards, the "high-fat" diet was moderate-fat, moderate-carbohydrate--too high in carbohydrates.)

Blood was drawn over 6 hours following the test meal.




Roberts R et al. Am J Clin Nutr 2008

The upper left graph is the one of interest. Note that, after the high-carbohydrate diet (solid circles), triglyceride levels are twice that occurring after the high-fat diet (open circles). Triglycerides are a surrogate for chylomicron and VLDL postprandial lipoproteins; thus, after the high-carbohydrate diet, postprandial particles are present at much higher levels than after the high-fat diet. (It would have been interesting to have seen a true low-carbohydrate diet for comparison.) Also note that, not only are triglyceride levels higher after high-carbohydrate intake, but they remain sustained at the 6-hour mark, unlike the sharper decline after high-fat.

It's counterintuitive: Postprandial lipoproteins, you'd think, would be plentiful after ingesting a large quantity of fat, since fat must be absorbed via chylomicrons into the bloodstream. But it's carbohydrates (and obesity, a huge effect; more on that in future) that figure most prominently in determining the pattern and magnitude of postprandial triglycerides and lipoproteins. Much of this effect develops by way of de novo lipogenesis, the generation of new lipoproteins like VLDL after carbohydrate ingestion.

We also see this in our Track Your Plaque experience. Rather than formal postprandial meal-testing, we use intermediate-density lipoprotein (IDL) as our surrogate for postprandial measures. A low-carbohydrate diet reduces IDL dramatically, as do omega-3 fatty acids from fish oil.
Increased blood calcium and vitamin D

Increased blood calcium and vitamin D

21. June 2010 William Davis (50)
Conventional advice tells us to supplement calcium, 1200 mg per day, to preserve bone health and reduce blood pressure.

Here's a curious observation I've now witnessed a number of times: Some people who supplement this dose of calcium while also supplementing vitamin D sufficient to increase 25-hydroxy vitamin D blood levels to 60-70 ng/ml develop abnormally high levels of blood calcium, hypercalcemia.

This makes sense when you realize that intestinal absorption of calcium doubles or quadruples when vitamin D approaches desirable levels. Full restoration of vitamin D therefore causes a large quantity of calcium to be absorbed, more than you may need. In addition, two studies from New Zealand suggest that 1200-1300 mg calcium with vitamin D per day doubles heart attack risk.

We have 20 years of clinical studies demonstrating the very small benefits of supplementing calcium to stop or slow the deterioration of bone density (osteopenia, osteoporosis). These studies were performed with no vitamin D or with trivial doses, too small to make a difference. I believe those data have been made irrelevant in the modern age in which we "normalize" vitamin D.

Should hypercalcemia develop, it is not good for you. Over long periods of time, abnormal calcium deposition can occur, leading to kidney stones, atherosclerosis, and arthritis.

Until we have clarification on this issue, I have been advising patients to take no more than 600 mg calcium supplements per day. I suspect, however, that the vast majority of us require no calcium at all, provided an overall healthy diet is followed, especially one that does not leach out bone calcium. This means no foods like those made with wheat or containing powerful acids, such as those in carbonated drinks.
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Comments (50) -

  • renegadediabetic

    6/21/2010 1:18:12 PM |

    Sometimes I think that the RDAs only apply to the current high refined carb, nutrient depleting diet most americans eat.  

    This is just more proof that the current calcium "requirements" are overstated and probably intended to market dairy products or calcium fortified processed foods.

  • Katie

    6/21/2010 1:42:19 PM |

    I always thought the recommendations for supplementing with calcium were probably wrong.  I've heard that Americans eat more calcium-rich foods and supplement with more calcium than other Western countries, but yet suffer from the highest amount of osteoporosis/osteopenia.  

    This wouldn't surprise me, given the importance of having the right amounts of calcium, Vitamin D, and Vitamin K2.  I've seen other doctors/researchers recommend that Vitamin D always be taken in connection with sufficient intake of Vitamin K2 to help prevent hypercalcemia.  I do not supplement with calcium, but I do supplement with D3 and K2 and have had no problems

  • Anonymous

    6/21/2010 1:45:19 PM |

    Dr. Davis is wheat a bad idea because of the phosphates which demineralize bones ? If so then lentils and peas and beans would be quite high in phosphates too? would the recommendation be to lower their consumption as well?

    Thanks.!

  • PJNOIR

    6/21/2010 2:56:32 PM |

    Calcium as a supplement is one of the toughest to assimilate in the body- I can't see how an accurate number can be assessed as too much (or too little)

  • scott

    6/21/2010 3:28:53 PM |

    I wonder how much calcium is in Gerolsteiner Water.  Dr. Davis has recommended this in the past, but probably for the magnesium content.

  • Anonymous

    6/21/2010 3:37:16 PM |

    1) It would seem that anyone speaking of vitamin D, is being a little misleading as we should most likely be talking about D-2 or D-3. Or never talking about D-2 and always about D-3 as it is the more bio-active.
    2) Increase K-2 to take care of the D-3 / calcium problem.
    3) Blood tests to keep track of all three of them.

  • miannotta

    6/21/2010 4:51:37 PM |

    Would supplementing with vitamin K2 help alleviate the problem of too much calcium in the blood? It's function is to redirect blood calcium to the bones. Or is the jury still out on this?

  • Anonymous

    6/21/2010 5:20:33 PM |

    This is a point also made in the current posting of "Diabetes Update"

  • Steve

    6/21/2010 6:11:04 PM |

    Apparently alot of people are reporting issues with vitamin d supplementation. You may have hit the nail on the head, Dr Davis. Here is a website that has over 200 comments from people experiencing issues.
    http://ctheblog.cforyourself.com/2008/12/overdosing-on-vitamin-d-side-effects.html

    Steve

  • Jenny

    6/21/2010 6:55:53 PM |

    Since I ran into just this problem (and blogged about it elsewhere) I want to add this:  You don't have to be supplementing with pills to run into this problem.

    If you are eating a classic low carb diet and eating cheese rather than meat for much of your protein your calcium intake can get high pretty fast.

  • Bobber

    6/21/2010 7:19:02 PM |

    Are you familiar with Dr. Cordain's work on Acid/Base balance?
    http://thepaleodiet.com/nutritional_tools/acid.shtml

  • Anonymous

    6/21/2010 10:17:14 PM |

    http://www.ncbi.nlm.nih.gov/pubmed/19113911

    Men don't need more than 626 mg/day calcium, and women with D > 20 ng/ml don't need more than 566 mg/day.

  • Jessica

    6/22/2010 12:43:32 AM |

    We usually recommend that individuals stop taking a calcium supplement once they've reached the target D level (70-90 ng/mL).

    We always draw a serum calcium with a 25(OH) level.

    Detected several cancers in our patients this way (hypercalcemic prior to starting D supplementation).

    Also, I'm about 8 months pregnant with our first child and you think cardiology is behind the times with Vitamin D, try OB! They're living in the dark ages.

    Fortunately my OB is more versed than most and the fact that I take 10,000 IU daily doesn't make him too uncomfortable (obviously not since he didn't offer to check my D level...I had to ask for it).

    I'm also taking 500 mg QD of elemental magnesium (no preeclampsia for me) and (when I remember), 12.5 mg of Iodoral/week (I worry about taking it everyday due to potential for "heavy metal dumping" since I wasn't routinely taking it prior to pregnancy).

    I still take a pre-natal, but I worry more about not taking the other supplements more than i worry about missing a dose of the pre-natal.

    Thanks for all you continue to do in healthcare!

  • cardiology emr

    6/22/2010 1:08:33 AM |

    Thank you so much for the advice I will try having an supplement calcium, to preserve bone health and reduce blood pressure for my own good.

    mjd

  • Anonymous

    6/22/2010 2:09:39 AM |

    interesting. So does this mean that those areas where the calcium levels in drinking water are high : "hard" or "temporary hard", are areas where high vitamin D could work against residents trying to maintain healthy arteries?

    Trevor

  • Anonymous

    6/22/2010 5:02:05 AM |

    I'm 37 and have been taking 6,000 i.u. of vitamin D per day for the last several months.  I started urinating blood last night and have a CT scan in a few days to see the likely cause of it all - kidney stones.

    My Dad also had them. I think the vitamin D may have contributed in bringing this about.

    Coincidently, I'd started taking Tums (rich in calcium) every now and then for heartburn about a month or two ago.  

    Timely post doc!

  • Anne

    6/22/2010 7:17:17 AM |

    Dear Dr Davis,

    Please can you quote the links to the studies you mention in this blog. I have both osteoporosis and a heart valve defect (bicuspid aortic valve) and calcification is being deposited on the aortic valve. My levels of 25(OH)D range from 60 to 100 ng/ml. I have my bone profile tested every time I have my 25(OH)D tested and so far my serum calcium levels have been in the normal range but your post worries me considerably.

    Anne

  • moblogs

    6/22/2010 9:03:29 AM |

    I would agree that we probably need no dairy based calcium at all, since it is only necessary at birth through mother's milk.
    Even so, I do like my dairy products in moderation so that's all I take - no additional calcium supplements; and my blood calcium level and bone density has benefited from just D on top.

  • steve

    6/22/2010 3:31:52 PM |

    while current blood levels of D3 may appear to be inadequate, there is no science to demonstrate what the higher levels shuld be.  While a blood level of 60 coming from the sun may be wonderful, there are no studies, let alone ones of any duration, that show that supplementing with large doses of D3 to get to a 60 level do not pose any negative health consequences.  As we have learned with other vitamin supplementation, more is not always better; adverse consequences can arise, and there is not always a way to detect them such as blood calcium levels.  Caution should be the watchword.

  • Steve

    6/22/2010 3:50:56 PM |

    Dr Davis, what is your opinion of the supplement MSM? Does vitamin D have an effect on this also?

    Steve

  • Anonymous

    6/22/2010 4:24:11 PM |

    Dr. Davis,

    Magnesium competes with calcium absorption, and therefore is crucial to keeping calcium levels at bay.

  • Peter

    6/22/2010 8:11:05 PM |

    I noticed that a study this week found a correlation between very high vitamin D levels and increased risk of pancreatic cancer.
    http://media-newswire.com/release_1121308.html

  • nightrite

    6/22/2010 9:53:05 PM |

    I too had trouble with kidney stones untill I began supplementing with magnesium.  I take 600mg of various forms of mag and no longer have any problems with kidney stones.  I also take 6000 units of D3 and 180 of K2.  I have not had my serum calcium checked but don't eat too much dairy.

  • Anonymous

    6/22/2010 10:19:44 PM |

    What about high phytic acid foods like the raw almonds and cocoa advocated here?  Don't those contain as much or more calcium binding phytic acid as wheat?  I eat very low carb and no dairy products whatsoever.  My indulgences have been raw hazelnuts and cocoa -- now I'm wondering if this has been damaging in some way.  My understanding is that serum calcium represents only 1% of body's calcium and that an ionized calcium test is more accurate.  My doc drew blood today to re-check my vitamin d status but would not check mineral status.

  • Anonymous

    6/22/2010 10:26:31 PM |

    Different take on the calcium for me.  When I develop a faint, "fluttery", tachycardia (up to about 142 for a 63-year-old, and I feel absolutely horrible) I take about 500 mg of calcium citrate with about 1000 mg of vitamin C (for absorption of the calcium) and the heart beat gets stronger and the rate comes down.  Sometimes I have to repeat.  I found only one internet reference to this phenomenon below:

    http://www.ithyroid.com/ca_and_mg.htm

    I do not have access to health care as I am one of the working poor.  Perhaps you can comment, Dr. Davis.  Thanks, Catherine

  • Dr. William Davis

    6/22/2010 10:30:07 PM |

    Hi, Jessica--

    I think that you and your group are managing the calcium/vit D issue the right way.

    Unfortunately, some people are wrongly interpreting this to mean that vitamin D causes hypercalcemia. It simply means that calcium is unnecessary when D is restored.

  • Dr. William Davis

    6/22/2010 10:31:32 PM |

    Jenny--

    Thanks for the clarification.

    Thankfully, your situation is the exception. Most people maintain normal calcium levels even while consuming dairy and other calcium-rich foods.

    Several responders here make the point about magnesium, which I agree with. Have you addressed magnesium? Magnesium deficiency is exceptionally common, since it has been taken out of most drinking water.

  • Anonymous

    6/23/2010 2:29:29 AM |

    I noticed that a study this week found a correlation between very high vitamin D levels and increased risk of pancreatic cancer.

    Cited are NOT very high levels! The claim is higher rates of pancreatic cancers with >100 nmol/ml - which translates into 40 ng/ml, a level considerably lower than the one recommended here by Dr. Davis (~60-70 ng/ml if I remember correctly). Another claim is NO difference in rates of several other cancers across a large range of 25(OH)D concentrations.

  • LeonRover

    6/23/2010 9:11:25 AM |

    Peter's comment above led me to read the newswire report referred to.

    This study was trying to establish any epidemiological association of increased levels of Vit D with reduced incidences of various cancers. No such associations were observed. Rather in the case of pancreatic cancer only, it was observed that when the  level of Vitamin D was GREATER than 100 nmol per litre, there was higher incidence of this disease. Another way of looking at this observation is that at levels below 100 nmol per litre there was no association of pancreatic cancer with levels of Vit D LOWER than 100 nmol per litre.

    As far as cancers are concerned there is no point in considering Vit D status as long as it below 100 nmol per litre.

  • Mike

    6/23/2010 10:07:09 PM |

    This is timely. I just had blood work done recently and my Dr.'s staff ordered the wrong test. Instead of measuring D3, they measured D2 calcitriol. I don't know what to make of the result: 120.8 pg/mL on a scale of 10.0-75.0. It's extremely high.  The last time I had my vitamin D3 tested, it was 59.2 ng/mL on a scale of 32-100.
    FWIW, I follow a low carbohydrate Paleo diet and consume very little dairy. I do take a multivitamin 3-5 days per week, but it only provides 300 mg of calcium (along with 210 mg of magnesium). I also take 500 mg of magnesium citrate every evening.
    I'd sure like to know what to make of this.

  • TedHutchinson

    6/24/2010 7:54:39 AM |

    @ LeonRover
    The information on pancreatic cancer & vitamin D status comes from Finland

    The further from the equator the greater the swing from high to low status. To have a good shower requires tight regulation of both hot and cold water supplies and a reserve store of both hot and cold supply so neither ever runs out.

    Vieth explains in this paper.
    How to Optimize Vitamin D Supplementation to Prevent Cancer

    In the same way fluctuating concentrations of 25(OH)D may also be a problem, Regions at high latitude or with low environmental
    ultraviolet light can be associated with the greater risks reported for prostate and pancreatic cancers. At temperate latitudes, higher summertime 25(OH)D levels are followed by sharper declines in 25(OH)D, causing inappropriately low 1-hydroxylase and high 24-hydroxylase, resulting in tissue 1,25(OH)2D below its ideal set-point.
    The answer is to keep levels BOTH HIGH and STABLE.
    Humans only build a stored reserve of D3 in tissue above 40ng/ml = 100nmol/l. Only around 60ng/ml are there sufficient D3 reserves for lactating mothers to pass to babies in breast milk. At latitude 32 it takes modern women 6400iu/daily/D3 to provide naturally replete vitamin D breast milk.

  • Mike

    6/24/2010 8:30:44 PM |

    Thanks Ted. That clarifies the role of calcitriol, but I am still wondering why my level measured so high, if even transiently.

  • Anonymous

    6/24/2010 8:37:38 PM |

    I'm anonymous from above who talked about kidney stones and blood in my urine.

    I had the CT scan done yesterday. I have stones, one of them a whopping 1.4 cm.  

    Be careful people.

  • Catherine

    6/25/2010 10:07:09 PM |

    (I am a different Catherine than the one above with tachycardia)

    For years because I had osteopenia, I was advised to take loads of calcium.  Later they told us to add vitamin D with it.  I am now FULL of calcium deposits all over my body.

    A year ago, Dr. Davis advised me to try magnesium for a bad arrhythmia problem, and it not only quickly cured my arrhythmia, insomnia, and RLS, but I have much less grinding sounds and arthritis pain. I was the poster girl for magnesium deficiency and no one except Dr. Davis even mentioned trying it.

    I think along with K2, magnesium is of upmost importance to balance the D and calcium. I only take 500 mg a day now since I don't consume dairy, but after this article, I may totally stop supplementing any calcium and let the K2 and magnesium perhaps reduce some of the deposits..

  • Anonymous

    6/27/2010 12:24:40 AM |

    @Mike -- I have the same issue/question.  My 25 OH was 62 but the 125 test was sky high.  My serium calcium was normal.  I wonder if Holick's new book gives detailed info on how to interpret lab tests.  His first book just said that the correcxt test is the 25 OH but didn't explain if there is any danger is a sky high 125.

  • Crystal

    7/4/2010 6:44:07 AM |

    This is an awesome post. Great post. Thanks for sharing this. Looking forward to read more from you.
    Green Tea

  • josephmoss

    7/29/2010 5:35:01 AM |

    Vitamin D3:

    NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 on discount at NutroVita.com.

    For more details please visit:
    http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

  • TedHutchinson

    7/29/2010 9:09:26 AM |

    UK readers need to be aware that estimated shipping cost to UK from Nutrovita = $26.50
    whereas
    Item cost IHERB= $4.96 + International Airmail = $4.00
    If you haven't used IHERB before code WAB666 saves $5.
    Remember UK customs apply VAT on orders £18 and above + UK PO charge £8 handling fee so I make orders up to around £17.50 before shipping to avoid that happening.
    To use GOOGLE toolbar to convert currency enter
    4.96 USD in GBP

  • Anonymous

    12/27/2010 7:27:18 PM |

    Dr. Davis,
    Since increasing my Vitamin D, Magesium and Melatonin I suddenly have very brittle, splitting fingernails.  Any idea which if any of these caused this?  Any suggestions?
    Thanks

    Love your blog!!!!!

  • Jack

    3/4/2011 4:13:40 PM |

    Chances are the calcium supplement you are taking now is a rock source of calcium. The label will say "calcium carbonate", which is nothing more than limestone. AlgaeCal Plus contains an organic, plant-sourced calcium form derived from a unique South American marine algae called Algas Calcareasâ„¢.

  • Emr reviews

    4/2/2011 12:01:36 AM |

    think one of the greatest hurdles is overcoming misconceptions in the minds of regulators, doctors and patients alike. I just returned from a trip to Germany and colleagues there are amused about America's 3rd World-like medical records situation

  • Anonymous

    4/2/2011 8:43:46 PM |

    I have celiac disease and osteopenia in my spine and no bone loss in my hips. I have a strong family history of osteoporosis as well.

    Because my calcium intake is less than or equal to 500 mg I take:

    600 mg calcium citrate at two seperate meals

    1200 IU's D3

    500 mg magnesium citrate

    I track using fitday. I'm grain, legume, dairy, sugar and processed food free and follow a paleo type dietary plan.

    Is this okay?

  • Anonymous

    4/2/2011 11:04:23 PM |

    I meant:

    600 mg calcium citrate in total but dosage is split between two seperate meals.

  • Dave

    5/2/2011 11:25:59 PM |

    I've seen research that shows the body produces more MGP and other calcium handling proteins with higher doses of Vitamin D.  You would expect this effect as a evolutionary collaboration with Vitamin D activity.  Higher doses of Vitamin K2 are needed to carboxylate these proteins and make them active.  These proteins are active in various places in the body like the arteries and the kidneys.  I have a theory that taking Vitamin K2 helps prevent kidney stones and maybe gallbladder stones of the calcium type.

    Uncarboxylated MGP is actually worse than the fully carboxylated MGP.  Guinea pigs are given cholesterol and high levels of Vitamin D in research to give them artery disease by exceeding their Vitamin K2 levels thus creating low carboxylation levels.

    More Vitamin K2 may well be good for those kidney stones.

  • Dave

    5/3/2011 12:14:43 AM |

    There is recent and startling Dutch research to the point that Vitamin K2 is specifically used to carboxylate calcium handling proteins that remove calcium from the arteries and promote heart health.  If you are taking extra Vitamin D, the body also generates more of these calcium handling proteins so the need for Vitamin K2 also increases.

    I had good experience over six months with taking Vitamin K2 and found my running speed increased by 8% and the itching or other mild, variable sensations in my chest have decreased 98%.  I suspect this is connected to reduction of calcification.  I noticed a reduction in my symptoms after six weeks.

    My Vitamin K2 has:
      1300 mcg Vitamin K2, Mk-4
       100 mcg Vitamin K2, MK-7
      1000 mcg Vitamin K (the ordinary stuff)

  • Reikime

    9/22/2011 2:02:34 AM |

    Reading all these posts I used to think of vitamin D and magnesium and K2 the same a most posters. Intuitively never took calcium, was up to 6000 mg of D3/ day to achieve a level of 43- up from 26.

    That said, my serum calcium has trended upward to 10.3. I am now having a few blood tests to check  for hyperparathyroidism!  The foremost parathyroid doc in the USA is Dr. James Norman from Tampa, and his website is very informative and puts a different spin on what I thought I knew of these matters. Parathyroids is ALL he and his 2 colleagues do all day every day. Please give this a look to be fully informed on the matter of Vitamin D supplementation.       www.parathyroid.com
    I have no connection, but if I find out I have an adenoma on one of my parathyroids, this is where I will have it removed!
    Jeanne ( RN,BSN)

  • Reikime

    9/22/2011 2:05:44 AM |

    Oops,  meant to add I have also supplemented with 400-800mg of magnesium and 1 Life Extension K2 in addition to the Vitamin D for several years.

    Reikime

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