"You've got 10 minutes"

20. May 2009 William Davis (0)
There's a new trend in office healthcare in Milwaukee: Time-restricted office visits.



I'm told by several physicians who are employed by a major healthcare system here in town that they are peridically watched--physically watched by an administrator--to make sure that they do not exceed the allotted 10 minutes of time. My cardiologist colleagues, I gather, were at first incredulous at such intrusions into their practices, but apparently had no choice: They were employees.



Goiter, goiter everywhere

20. May 2009 William Davis (25)
The results of the recent Heart Scan Blog poll are in.

The question:

Do you used iodized salt?

The responses:

Yes, I use iodized salt every day
94 (28%)

Yes, I use iodized salt occasionally
56 (16%)

No, I do not use any iodized salt
41 (12%)

No, I use a non-iodized salt (sea salt, Kosher)
126 (37%)

No, I use a non- or low-sodium substitute
15 (4%)


Thanks for your responses.

If only 28% of people are regular users of iodized salt, that means that the remainder--72%--are at risk for iodine deficiency if they are not getting iodine from an alternative source, such as a multivitamin or multimineral.

Even the occasional users of salt can be at risk. The common perception is that occasional use is probably sufficient to provide iodine. This is probably not true and not just because of the lower quantity of ingestion. Occasional users of salt tend to have their salt canister on the shelf for extended periods. The iodine is then lost, since iodine is volatile. In fact, iodine is virtually undetectable four weeks after a package is opened.

In my office, now that I'm looking for them much more systematically and carefully, I am finding about 2 people with goiters every day. They are not the obvious grotesque goiters of the early 20th century (when quack therapies like the last post, the Golden Medical Discovery, were popular). The goiters I am detecting are small and spongy. Yesterday alone I found 5 people with goiters, one of them visible to the eye and very distressing to the patient.

It seems to me that iodine deficiency is more prevalent than I ever thought. It is also something that is so simple to remedy, though not by increasing salt intake. Kelp tablets--cheap, available--have been working quite well in the office population. My sense is that the Recommended Daily Allowance of 150 mcg per day for adults is low and that many benefit from greater quantities, e.g., 500 mcg. What is is the ideal dose? To my knowledge, nobody has yet generated that data.

Thyroid issues being relatively new to my thinking, I now find it incredible that endocrinologists and the American Thyroid Association are not broadcasting this problem at the top of their lungs. This issue needs to be brought to the top of everyone's attention, or else we'll have history repeating itself and have goiters and thyroid dysfunction galore.

For more on this topic, see the previous Heart Scan Blog post, "Help keep your family goiter free."

Goiter and the Golden Medical Discovery

17. May 2009 William Davis (19)

Thick neck, or goitre . . . consists of an enlargement of the thyroid gland, which lies over and on each side of the trachea, or windpipe, between the prominence known as "Adam's apple" and the breast bone. The tumor gradually increases in front and laterally, until it produces great deformity, and often interferes with respiration and the act of swallowing. From its pressure on the great blood vessels running to and from the head, there is a constant liability to engorgement of blood in the brain, and to apoplexy, epilepsy, etc.

The causes of the affection are not well understood. The use of snow water, or water impregnated with some particular saline or calcareous matter, has been assigned as a cause. It has also been attributed to the use of water in which there is not a trace of iron, iodine, or bromine. . . The disease is often due to an impeded circulation in the large veins of the neck, from pressure of the clothing, or from the head being bent forward, a position which is often seen in school children.


Treatment

We have obtained excellent results in many cases, not too far advanced, by a method of treatment which consists in the employment of electrolysis. . . Many cases at the present time are operated upon with entire success.

Those who are afflicted with this disease and unable to avail themselves of special treatment cannot do better than to take Doctor Pierce's Alterative Extract, or Golden Medical Discovery, and apply over the skin around the tumor, night and morning, the following, which may be prepared at any drug store:

Resublimed Iodine--One dram
Iodide of Potassium--Four drams
Soft Water--Three ounces 


Apply to the tumor, twice daily, with feather or camel hair pencil.


From The People's Common Sense Medical Adviser by R.V. Pierce, MD; 1918.

Magnesium and you-Part I

15. May 2009 William Davis (11)
If this were 10,000 B.C., you'd get your drinking water from streams, rivers, and lakes, all rich in mineral content. Humans became reliant on obtaining a considerable proportion of daily mineral needs from natural water sources.

21st century: We obtain drinking water from a spigot or plastic bottle. Pesticides and other chemicals seep into the water supply. Municipal water purification facilities have intensified water purification in most communities to remove contaminants like lead, pesticide residues, and nitrates. (For a really neat listing of the water quality of various cities, the University of Cincinnati makes this data available.)

But intensive water treatment also removes minerals like calcium and magnesium.

Many people have added water filters or purifiers to their homes,, like reverse osmosis and distillation, that are efficient at extracting any remaining minerals, converting “hard” into “soft” water. In fact, manufacturers of such devices boast of their power to yield pure water free of any “contaminant,” minerals like magnesium included. The magnesium content of water after passing through most commercial filters is zero.

Modern enthusiasm for bottled water has compounded the problem. Americans consumed a lot of bottled water, nearly 8 billion gallons last year. In the U.S., nearly all bottled water has little or no magnesium.

The result is that we can no longer rely on drinking water to provide magnesium. The Recommended Daily Allowance (RDA)—the amount required to prevent severe deficiency—for magnesium is 420 mg per day for men, 320 mg/day for women. In cities with the highest magnesium water content, only 30% of the RDA can be obtained by drinking two liters of tap water per day. In most cities, only a meager 10–20% of the daily requirement can be obtained. That leaves between 70–90% that needs to come from other sources. As a result, the average American ingests substantially less than the RDA.

Blast triglycerides

15. May 2009 William Davis (0)
The conventional answers to high triglycerides levels are generally: low-fat diet, a fibrate drug (Tricor, Lopid), a statin drug, and--most recently--prescription fish oil.

This is the regimen to take if you want the drug industry to get even richer and more powerful than they already are. After all, what CEO of a pharmaceutical company can stand to have his salary and benefits slashed to below $200 million this year? It's outrageous!

If you really want to blast the heck out of your triglycerides and achieve numbers like 50 mg/dl, then the regimen to consider consists of:

--Elimination of sugars, wheat, and cornstarch
--Fish oil--Sam's Club would do fine at $8 for 350 capsules, or the high-potency at $14.99 for 180 capsules (at 680 mg EPA +DHA, nearly the same potency as prescription Lovaza at 842 mg)
--Vitamin D supplementation sufficient to achieve normal blood levels (60-70 ng/ml)

Those three strategies alone can reduce triglycerides far more than any drug combination. In fact, it is rare for someone with triglycerides as high as 900 mg/dl to not reduce them to the <100 mg/dl range.

Cheerios: Prescription required?

13. May 2009 William Davis (15)
Followers of The Heart Scan Blog know my feelings about Cheerios:


Can you say "sugar"?

Cheerios and heart health


There's an interesting tussle going on between the makers of Cheerios, General Mills, and the FDA.

The FDA says that the Cheerios' package claims of:

• "you can Lower Your Cholesterol 4% in 6 weeks"
• "Did you know that in just 6 weeks Cheerios can reduce bad cholesterol by an average of 4 percent? Cheerios is ... clinically proven to lower cholesterol. A clinical study showed that eating two 1 1/2 cup servings daily of Cheerios cereal reduced bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol."

constitute a medical claim, i.e., trying to promote Cheerios as a drug.

I'm glad that the FDA has come down on General Mills. But I find this entire episode laughable: The debate is over the purported health benefits of what I would regard as pure junk food, no better in my view than claiming that a cupcake has health benefits, or a carton of ice cream.

In my experience, Cheerios does not 1) reduce risk for heart disease, nor 2) reduce cholesterol.

It does, however, cause blood sugar to skyrocket and increase the small type of LDL--you know, the type that causes heart disease.

"Placebos are frequently of value"

12. May 2009 William Davis (1)
The treatment of angina pectoris, generally speaking, is unsatisfactory.

Any procedure that relieves mental tension is valuable. Since patients suffer particularly during the winter, I encourage winter vacations in a southern climate.

I insist that obese patients lose weight, and have found small doses of benzedrine, 10 to 20 mg. daily, helpful in curbing the appetite.

I generally forbid smoking. This is a particularly disturbing task for many patients to carry out. In such cases, I suggest that 3 or 4 cigarettes be smoked daily, knowing full well that regardless of what I say or recommend, the patients is going to continue to smoke.

Innumerable drugs, most of which are of questionable value, have been used to prevent attacks of angina pectoris. In fact, placebos are frequently of value.

Testosterone--The male sex hormone has been effective in my experience. Whether it acts as a vasodilator or merely by promoting a sense of well-being is not known.

Alcohol--Alcohol (whiskey, brandy, rum) has been used for many years in the treatment of angina pectoris. I have prescribed it in moderate quantity--an ounce several times a day--and while I have not made alcoholics of any of my patients, I also have not cured any of them with it. Preparations, such as creme de menthe, are of value in relieving "gas" of which so many patients complain.


From Heart Disease Diagnosis and Treatment
Emanuel Goldberger, MD
1951

Iodine is not salt

12. May 2009 William Davis (3)
I've noticed a point of confusion recently, something I hadn't noticed in my patients before: Because of the public health advice from the FDA, American Heart Association, and Surgeon General's office to reduce sodium/salt intake, people have thought this meant reducing iodine, too.

I believe that people have drawn an equation in their minds:


Sodium = iodine


Of course, they are two entirely unrelated things.

Recall that the only reason iodine is added to many (not all) salt products is because it was a public health solution to solve the substantial nationwide iodine deficiency prevalent during the 20th century. But it was a solution conceived in 1924, when the FDA thought this was the best way to get iodine into Americans. And it worked.

Unfortunately, sodium does indeed present adverse effects in some people. As a result, "get your iodine from salt" has evolved into "reduce your sodium intake." Everyone forgot about the iodine: They forgot about the large disfiguring goiters, the poor school performance in iodine-deficient schoolchildren, the mentally-impaired offspring of iodine-deficient mothers.

So don't confuse sodium with iodine. You may need less of the former, but more of the latter.

For more on this, see "Help keep your family goiter free."

"You can't reduce coronary plaque"

10. May 2009 William Davis (9)
"I told my cardiologst that I stumbled on a program called 'Track Your Plaque' that claims to be able to help reduce your coronary calcium score.

"My cardiologist said, 'That's impossible. You cannot reduce coronary plaque. I've never seen anyone reduce a heart scan score."

Who's right here?

The commenter is right; the cardiologist is wrong.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Quantify and work to reduce the atherosclerotic plaque? No way! That's work, requires thinking, some sophisticated testing (like lipoprotein testing), even some new ideas like vitamin D. "They didn't teach that to me in medical school (back in 1980)!"

Welcome to the new age.

Atherosclerotic plaque is 1) measurable, 2) trackable, and 3) can be reduced.

We do it all the time. (Amy still holds our record: 63% reduction in plaque/heart scan score.)

Though I pooh-pooh the value of statin drug studies, there's even data from the conventional statin world documenting coronary plaque reversal. The ASTEROID Trial of rosuvastatin (Crestor), 40 mg per day for one year, demonstrated 7% reduction of atherosclerotic plaque using intracoronary ultrasound.

I have NEVER seen a heart attack or appearance of heart symptoms (angina, unstable angina) in a person who has reversed coronary plaque (unless, of course, they pitched the whole effort and returned to bad habits--that has happened). Stick to the program and coronary risk, for all practical purposes, been eliminated.

A heart scan score is not a death sentence. It is simply a tool to empower your prevention program, a measuring stick to gauge plaque progression, stabilization, or regression. Don't accept anything less.

Lethal lipids

8. May 2009 William Davis (15)
There's a specific combination of lipids/lipoproteins that confers especially high risk for heart disease. That combination is:

Low HDL--generally less than 50 mg/dl

Small LDL--especially if 50% or more of total LDL

Lipoprotein(a)--an aggressive risk factor by itself


This combination is a virtual guarantee for heart disease, often at a young age. It's not clear whether each risk factor exerts its own brand of undesirable effect, or whether the combined presence of each cause some adverse interaction.

For instance, lipoprotein(a), or Lp(a), by itself is the most aggressive risk factor known (that nobody's heard about--there's no blockbuster revenue-generating drug for it). Each Lp(a) molecule is a combination of an LDL cholesterol molecule with a specific genetically-determined protein, apoprotein(a). If the LDL component of Lp(a) is small, then the combination of Lp(a) with small LDL is somehow much worse, kind of like the two neighborhood kids who are naughty on their own, but really bad when they're together.

Interestingly, the evil trio responds as a whole to many of the same corrective treatments:

Niacin--increases HDL, reduces small LDL, and reduces Lp(a)

Elimination of wheat, cornstarch, and sugars--Best for reducing small LDL; less potent for Lp(a) reduction.

High-fat intake--Like niacin, effective for all three.

High-dose fish oil--Higher doses of EPA + DHA north of 3000 mg per day also can positively affect all three, especially Lp(a).


If you have this combination, it ought to be taken very seriously. Don't let anybody tell you that it is uncorrectable--just because there may be no big revenue-generating drug to treat it on TV does not mean that there aren't effective treatments for it. In fact, some of our biggest successes in reducing heart scan scores have had this precise combination.
All posts by william-davis

Vitamin D--A coronary risk factor

27. May 2006 William Davis (1)
Look up "coronary risk factors" in any text and you'll find high cholesterol, smoking, diabetes, and high blood pressure listed. You won't find deficiency of vitamin D listed.

Ask 99% of physicians if a deficiency of vitamin D is a coronary risk factor and you'll get rolling eyes and a sigh.

Yet, in the Track Your Plaque experience, vitamin D is emerging as a very important factor in coronary plaque development. We have observed that there are a substantial number of people whose lipids and lipoproteins are not abnormal enough to fully explain their heart scan score. In other words, there seems to be something else necessary to satisfactorily explain the magnitude of coronary plaque.

I believe that severe vitamin D deficiency is at least one of the most important factors. We've seen many people with blood levels of vitamin in the range of severe deficiency (<20 ng/ml of 25-OH-Vitamin D3) yet bland lipids and lipoproteins.

Correcting vitamin D blood levels to 50 ng/ml also seems to be among the required factors in stopping coronary plaque growth, or stopping your heart scan score from increasing.

Keep your eye on this extremely important and exciting issue. Sadly, it won't be propelled into the media like the conversation about cholesterol or high-tech procedures, since no company stands to profit from it. But you and I don't have to play that game.

Cholesterol is dead!

26. May 2006 William Davis (0)
I saw a patient in the office yesterday. He came to me for an opinion regarding his high heart scan score of 525, putting him in the 90th percentile (5% annual risk of heart attack).

His doctor had been puzzled because his LDL cholesterols had ranged from 110 to 131 mg--actually below average. (The average LDL for the U.S. is 132 mg.) Likewise, HDL was a favorable 63 mg.

Lipoprotein analysis told the story loud and clear. His LDL particle number, a far more precise measure of LDL, was 2448 nmol/l. This means that his true LDL was more like 240-250 mg! (You can get a sense for what the true LDL is from LDL particle number by dropping the last digit: 2448 becomes 244.) Conventional LDL was therefore inaccurate by over 100 mg.

He also had a severe small LDL particle pattern. The cause of his coronary plaque was a large excess of small LDL particles. LDL cholesterol (and total cholesterol, likewise) didn't even hint at this pattern. Nor did his favorable HDL.

Think of LDL particle number as an actual count of LDL particles per volume, e.g., number of particles per cc of blood. This makes it easier to conceptualize. LDL particle number is the measure you get when you have an NMR lipoprotein profile, our preferred method of lipoprotein testing. If this is unavailable to you, apoprotein B is a reasonable second choice, though not as accurate in my view. More info on NMR is available at their website, www.lipoprofile.com.

How to make a $1 million in cardiology

26. May 2006 William Davis (0)
Want to make a $1,000,000 as a cardiologist in the next year? It's easy. All you have to do is:

1) Perform heart catheterizations or other procedures on anybody you can, even if it's not necessary. Perform them even if the patient has no symptoms and the stress test is normal.

2) Perform heart catheterizations if the patient is too timid or ill-informed to object.

3) Insert coronary stents in blockages, even when they're minor and it's not necessary.

4) Turn every heart procedure into a revenue-producing stream by looking for other profit opportunties, such as minor kidney artery blockages.

5) Heart disease is frightening. Scare the heck out of patients by exagerrating the dangers so they'll go through testing and procedures gratefully.


Sound absurd? Well, it would be if these weren't all true.

These are real examples, as awful as it sounds. I've witnessed all these behaviors. Not just occasionally, but with regularity.

Just today, I encountered a colleague who performs heart catheterizations routinely (up to several per day) when any symptom is present and the stress test is entirely normal. This is grossly inappropriate.

Your protection is being better-informed and avoid being sucked into the vast and frightening cardiovascular machine of revenue-yielding procedures. Part of your protection is to get a CT heart scan, then engage in a program of heart disease prevention.

Doctor, do I have lipoprotein (a)?

25. May 2006 William Davis (0)
I met Joyce today for a 2nd opinion. She told me about this conversation she'd had with her cardiologist:

"Doctor, do you think I could have lipoprotein (a)? I read about how it can cause heart attacks even when cholesterol is controlled."

"What does it matter? Even if you have it, there's nothing we can do about it. There's no treatment for it."

Joyce was understandably groping for some means to prevent her coronary disease from causing more danger. At 56, she'd already survived a heart attack that resulted in two stents to her left anterior descending. Around 9 months later, she received a 3rd stent to another artery.

Her doctor had put her on Pravachol and said that was enough. "We know that cholesterol causes heart disease and the Pravachol reduces it. Why do we need to know anything more?"

So Joyce came to me for another view. I explained to her that there are, in fact, several ways to deal with lipoprotein(a). It is, without a doubt, among the more difficult patterns to manage--but not impossible. In fact, we have a growing list of participants in the Track Your Plaque program who have stopped or reduced their heart scan scores.

I continue to be horrified at the level of ignorance that prevails among my colleagues, the cardiologists, and the primary care community. If your doctor gives you advice like this, get a new doctor.

Is it mainstream or alternative?

24. May 2006 William Davis (0)
A question I get about once a week: "Is your program a kind of alternative medicine?"

Our program for control and reversal of coronary plaque using CT heart scans applies an eclectic panel of tools to achieve its goals. We use high-tech methods like lipoprotein analysis and CT heart scans; nutritional supplements like fish oil, vitamin D, and l-arginine; diet strategies and "functional foods" (using foods as a therapeutic tool); and conventional medication.

I don't consider this approach "alternative" in the sense that it uses unmeasurable or spiritual strategies. But I don't consider it mainstream, either, since current mainstream practice of heart disease prevention is far less rigorous with far less satisfactory results.

I think I can sum up the Track Your Plaque approach by saying that we use tools that work. Our measure of success is whether or not your heart scan score is stopped or reduced--that's hard to fudge. You can call it what you will, but I call it the best program for heart disease prevention I know of, alternative or mainstream.

Want to see someone turn diabetic?

24. May 2006 William Davis (0)
If you want to witness the transformation of someone into a pre-diabetic or diabetic, put them on a low fat diet.

Dr. Dean Ornish's program, detailed in his books, Dr. Dean Ornish's Program for Reversal of Heart Disease and Eat More, Weigh Less , are woefully outdated in 2006. Yet the low fat notion continues to show up in the consciousness of people I talk to about heart disease reversal.

"I'm already on a low fat diet. Do you think my heart scan score has reversed?"

Highly unlikely. What Dr. Ornish (as a non-cardiologist, by the way) failed to recognize is that what he did manage to reverse in a small number of people is something called "endothelial dysfunction", but he did not reverse or shrink coronary plaque.

Given the limitations of technology when the Ornish concept got its start, it appeared as if reversal was obtained. In reality, all his approach accomplished was a relaxation in tone of abnormally constricted arteries, thus giving the appearance of reversal. Increased artery tone, or endothelial dysfunction, is extremely common when atherosclerotic plaque is present.

Any cardiologist will tell you that there are many ways to reverse endothelial dysfunction: exercise, weight loss, cholesterol drugs, drugs for high blood pressure, fish oil, hormonal therapy, vitamin C, l-arginine, etc. There is nothing special about a low fat diet.

In fact, Track Your Plaque followers will recognize that a low fat diet is, in fact, potentially harmful, particularly when low HDL or small LDL is part of your pattern.

Let's bury the outdated ideas of the Ornish low fat diet once and for all. It doesn't work. All it may do is confuse you and set you back from your real coronary plaque reversal program.

Inulin: A fiber for weight loss

23. May 2006 William Davis (10)
Here's an interesting product that seems to be gaining some popularity for weight loss: Inulin.

Not to be confused with "insulin", with which it is completely unrelated, inulin is a naturally-occurring plant fiber. It's found in broccoli, asparagus, celery, etc. Like beta-glucan from oats or pectin, inulin is a so-called soluble fiber, a fiber that assumes a gel-like consistency when exposed to water.

Inulin has the effect of increasing satiety, or the sensation of fullness. This cuts your craving for foods. I've tried it recently and I prefer it over glucomannan, another soluble fiber for satiety.

The people at Stonyfield Farms have been adding inulin to their yogurts from some time. The nutritionist at the company tells me that there's 2-3 grams of inulin per 6 ounce container of their yogurt.

You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies. I came across a neat product called Fiber Choice that's now being distributed widely throughout the U.S. I tried their Weight Management version. It was a delicous strawberry taste. The label says take two chewable tablets twice a day, but I found that two tablets three times a day somewhat better. It's best taken around 30-60 minutes prior to each meal and it causes you to be fuller with less food. One caution: It'll cause loads of gas, especially in the beginning. For that reason, you might try starting with a smaller dose, or start on the weekends when you have the option of some privacy!

More info on the Fiber Choice product can be found at their website, http://www.fiberchoice.com.

Disclaimer: I have no relationship with the manufacturer of this product. I'm simply passing on some thoughts on my experience with this interesting possibility for weight loss.

Will you recognize the truth when you see it?

23. May 2006 William Davis (0)
Do you ever wonder that, if the truth were given to you, that you'd recognize it as such? Or would you dismiss it as just another bunch of nonsense?

After all, you and I live in the Information Age. It means that we have access to mountains of information like never before in human history. But it also means that the truth is often drowned out by an avalanche of mis-truths, sales pitches and marketing, and just plain nonsense.

This struck me the other day when I was talking to a patient.

64 years old with a high heart scan score placing her at significant risk, she looked confused. I'd just described the multitude of causes of coronary plaque that we'd uncovered. The heart scan alone had been a shocker.

"I don't understand. My doctor told me that I had nothing to worry about. I've known him for years and he knows me really well. He did a stress test. That was fine. I don't get all this other stuff you're telling me--lipoprotein whatever..."

Despite my efforts to help her gain an understanding of our intensive approach, she just became increasingly more frustrated. "I just don't think I can do this."

That's the last I've heard from her. As far as I know, she's returned to the comfort of her family doctor who has reassured her over the years. And perhaps there's some good in that. But I do fear for the day when, unexpectedly, she suffers some catastrophe that we told her was coming sooner or later unless real preventive efforts were started.

You could say that she failed to recognize the truth when it was given to her-- boldly, unadorned, and with far greater scientific certainty than the casual reassurances she was accustomed to. But, unfortunately, that's all that some people want.

Don't neglect the basics in your heart disease reversal program

23. May 2006 William Davis (0)
Carl loved new ideas and novel approaches. You could tell by the sheer number of nutritional supplements he took. His list had grown to 18 different supplements over the past two years.

Carl came to me for coronary plaque regression. Lipoprotein analysis did uncover several previously unsuspected abnormalties, most notably small LDL particles and lipoprotein(a). In addition, Carl's LDL cholesterol ranged between 111 mg-156 mg and he was clearly hypertensive, with systolic blood pressures consistently around 150-160. (Recall that people with Lp(a) are more prone to hypertension.)

Carl was more than willing to have his lipoprotein(a) reduced. We did so with niacin and testosterone and the level dropped to near zero. Likewise, we corrected his small LDL pattern with niacin, fish oil, and a reduction in processed carbohydrates.

But Carl really resisted doing much about his LDL cholesterol and high blood pressure. I got the sense that these "boring" issues simply didn't interest him. After all, LDL cholesterol and blood pressure were the stuff of TV commercials and the popular conversation propagated by drug companies.

Carl's follow-up heart scan, however, finally persuaded him: a 24% increase in one year, likely due to the neglect of the basic issues.

I liken Carl's case to being like the teenager with a new car who polishes the paint to a bright finish, puts new wheels and tires on it, spruces up the interior with various doodads--but then fails to change the oil. Sometimes it's the most basic issues that can diminish your success.

Issues like LDL cholesterol and high blood pressure aren't the most glamorous, but they do count in your coronary plaque control program.

Is your doctor a hospital employee?

21. May 2006 William Davis (0)
There's a disturbing trend that's growing--silently but rapidly.

In Milwaukee, three hospital systems compete for the local health care dollar. To gain more control over revenues and the routing of patients, the hospitals are aggressively hiring physicians to work for them. I've witnessed many of my cardiology colleagues, primary care doctors, and a substantial number of procedural specialists enticed by the offers made by hospital employers.

This phenomenon is not unique to Milwaukee but is being used in many, perhaps most, major cities in the U.S.

This means that physicians are employees of the hospital. That way, employee-physicians are obliged to use only the hospital system that employs them. In the old days, your doctor could use any hospital he/she desired, depending on the quality, location, facilities, etc. Now, many physician-employees are given no choice but to use the hospital that pays their salary.

That by itself is not necessarily bad. But combine salary with incentives for bringing in patients for hospitalization and procedures--that the rub. In other words, physician-employees are incentivized to generate more revenue for the system, just as employees in many other industries.

If you're a salesman for an insurance company, your job is to bring in more business. If you're a worker on an auto production line, you're expected to meet certain quotas. These same principles are now being applied to many physicians.

How does this affect you? Well, if your physician--especially procedure-driven specialists like cardiologists, general surgeons, orthopedists, etc.--is a hospital employee, BEWARE! Do you really need that procedure, or is your doctor suggesting you have a procedure because it will add to his track record?

Prevention? In this model of health care, why bother? It certainly doesn't pay for a hospital to keep you well. Then why should your physician-employee?

Be careful who you're dealing with. If your physician is a hospital-employee, don't bet on getting preventive care. It's more likely you're that just a future source of revenue when it's time for your bypass operation, hip replacement, carotid endarterectomy, etc.

What more powerful argument is there for increased self-empowerment and information for health care consumers?
What increases blood sugar more than wheat?

What increases blood sugar more than wheat?

15. July 2010 William Davis (38)
Take a look at these glycemic indexes (GI):


White bread 69
Whole wheat bread 72
Sucrose 59
Mars bar 68
White rice 72
Brown rice 66


I've made issue in past of whole wheat's high GI--higher than white bread. Roughly in the same glycemic league as bread are shredded wheat cereal, brown rice, and a Mars candy bar.

With few exceptions, wheat products have among the highest GIs compared to the majority of other foods. For instance:


Kidney beans 29
Chick peas 36
Apple 39
Ice cream 36
Snickers Bar 40


Yes, by the crazy logic of glycemic index, Snickers is a low-glycemic index food.

While I do not believe that low GI makes a food good or desirable, since low GI foods still provoke high blood sugars, small LDL particles, trigger glycation, and other abnormal phenomena, they are clearly less obnoxious than the items in the first list.

Take a look at this list:

Cornflakes 80
Rice cakes 80
Rice Krispies 82
Rice pasta, 92
Instant potatoes 83
Tapioca 81



Starches that are dried and/or pulverized, such as cornstarch, potato starch, rice starch, and tapioca starch (cassava root) will increase blood sugar even more than wheat. Foods with these starches have GI's of 80-100.

Cornstarch, potato starch, rice starch, and tapioca starch: Sound familiar? These are the main starches used in "gluten-free" foods. A hint of the high GI behavior of these dried starches is seen in the GI for cornflakes of 80.

So remember: Wheat-free is not the same as gluten-free. Gluten-free identifies junk carbohydrates masquerading as healthy because they don't contain one unhealthy ingredient, i.e. wheat.
Tags :

Comments (38) -

  • Anonymous

    7/15/2010 3:20:49 PM |

    These are the reasons to go grain-free, except for flaxseed.

  • Suzan

    7/15/2010 3:46:32 PM |

    As a gluten intolerant person, I can say that those gluten-free foods make me ill. I favor a grain-free Primal diet.

  • Anonymous

    7/15/2010 3:48:19 PM |

    Is it also accurate to say that high glycemic index only applies to wheat, and not unrefined WHOLE wheat, or wheat KERNELS?

    Aaccording to this, wheat kernels's GI is less than 50:
    http://www.southbeach-diet-plan.com/glycemicfoodchart.htm

    Also, eating whole wheat makes you feel fuller longer, which is a benefit, no?

  • Peter

    7/15/2010 3:48:30 PM |

    I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease.  I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes.  anyone have a theory?

  • DrStrange

    7/15/2010 4:01:44 PM |

    "I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease. I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes. anyone have a theory?"

    There seems a stubborn tendency on this site to confound refined carbs ie flour products w/ intact, whole grain carbs.  They do behave differently in the body. Also, significant differences in some people's physiologies, individual, personal, differences that must be accounted for.  And probably most importantly, for the Africa etc question, total calorie intake is a huge factor.  If you eat more than your body needs, calories become excess blood sugar; spikes, triglycerides, etc.  US and western Europe, esp US, people just eat way to many calories because they are eating nutrient poor, manufactured, refined, imitation foods that do not satisfy the body's needs for nutrition in terms of micronutrients and oversupply calories.  If you only eat starches/carbs in the form of whole intact grains and starchy veg IN THE CONTEXT of a diet emphasizing micronutrient rich, nonstarchy veg, then you just will not have all the problems.

  • Jenny

    7/15/2010 5:47:17 PM |

    The glycemic index is a poor guide to carbohydrate impact because it is based on the fallacy that carbs that don't raise blood sugar at 1 hour after eating don't matter.

    They do.

    The carbs in many supposedly low glycemic foods WILL metabolise into glucose over a period of anywhere from 1.5 to 5 hours (Pasta) and when they do, they require insulin secretion to be dispersed.

    Also, "Glycemic Index" values for identical foods vary from study to study because the reading depends on the blood sugar status of the subjects used to test the foods. It is a junk measurement created by the food companies to fight the success of the low carb movement.

    Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health.

  • Pallav

    7/15/2010 6:19:28 PM |

    Dr Davis

    Dont be so stubborn. Get a hold of cooking practises as practised outside of your country too. If america is consuming wheat the wrong way, or you are consuming wheat in a wrong way don't implicate wheat in its entirety.

  • Pallav

    7/15/2010 6:21:32 PM |

    Imagine if i consume fish day and night cooked in hydrogenated vegetable oils and then implicate fish for my health problems. How stupid would that be?

  • John

    7/15/2010 6:51:53 PM |

    Hello, what happens if you consume bread with a fat or protein e.g. butter or cottage cheese.

    Will the bread contribute too much to insulin pike or will it be buffered by the fat/protein in the same serving?

    Thanks.

  • Carl

    7/15/2010 9:58:41 PM |

    Glycemic index if flawed in that it counts fructose as a carb for the denominator but uses glucose as the numerator -- at least as I understand it.

    Fructose follows a different metabolic path, but it is more destructive when in the blood than glucose -- which is probably why the liver does all the fructose metabolism.


    I revised glycemic index which used glucose and glucose based starches only in the denominator would be a better index to determine which foods slowly feed glucose into the body.

    Or, you can use glycemic index and just not look at fructose and sucrose containing foods.

  • Matt Stone

    7/15/2010 10:05:33 PM |

    Peter-

    Starches do not raise blood sugar or cause hyperinsulinemia in people on traditional diets because they are not insulin resistant like modern man on low-nutrient, refined-carbohydrate, vegetable and trans fat laden fare with a vast array of other complications.  

    Kitavans for example ate 69% of their food as unrefined carbohydrate, most of it as starch, yet the average fasting glucose is less than 70 mg/dl with zero documented cases of hyperglycemia or type 2 diabetes...

    http://180degreehealth.blogspot.com/2010/06/staffan-lindeberg.html

  • Dr. William Davis

    7/15/2010 10:10:58 PM |

    I have yet to meet a wheat product I liked.

    In my experience, they ALL increase blood sugar to one extravagant degree or another.

    Wheat also triggers inflammatory phenomenon more than any other food known. Celiac disease just one manifestation of wheat-triggered diseases.

  • Dr. William Davis

    7/15/2010 10:13:55 PM |

    Hi, Jenny--

    I agree wholeheartedly.

    We do the exact same thing as you: Count carbohydrate grams or check 1-hour postprandial glucoses. Works far better than the misleading glycemic index or glycemic load.

  • Anne

    7/15/2010 10:54:28 PM |

    After going gluten free I quickly discovered I felt better if I avoided all grains. I became very serious about eliminating grains after I found they all raised my blood glucose even if I ate them with fat and protein. I am now on a fairly simple primal-like diet.

    I run a support group for gluten intolerance and I tell people that the gluten free diet can be a healthy or as unhealthy as they want to make it. Sadly, many people who go gluten free don't want to change their diet other than to substitute gluten free products for their favorite wheat products. The market for gluten free foods has exploded and still growing. The most recent addition is Gluten Free Bisquick.

  • Lori Miller

    7/16/2010 12:42:56 AM |

    When I cut out wheat in January, my appetite ratcheted down and my bloating went away. That's reason enough for me to leave wheat alone.

    Since I cut way down on carbs in late February (probably less than 50g per day), a lot of aches and pains suddenly disappeared. The one in my left shoulder returns if I eat quite a bit of carb. For me, at least, it's carbs in general that seem to be inflammatory.

  • Lori Miller

    7/16/2010 12:51:06 AM |

    Jenny said, "Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health."

    This is what my mother and I have been doing for the past few months since we went low-carb. It's worked for us. (She's diabetic and I'm prone to acid reflux, so non-fiber carbs give us a smackdown very quickly if we eat too many of them.) It's easy, too, since it just involves looking at a label and doing a bit of subtraction. I never quite understood how the index worked--maybe because it doesn't?

  • Lori Miller

    7/16/2010 1:41:39 AM |

    For a thickener, I use xanthan gum. All the carbs in it are fiber. It's expensive, but a little goes a long way. I use half a teaspoon to thicken my protein/peanut butter shake, which is around 12 ounces.

  • julianne

    7/16/2010 3:20:33 AM |

    I have followed a low Glycemic load diet (always with protein and moderate carbs at each meal, plus a little good fat) in two different ways, for 12 years I used small amounts of grains including wheat (Zone Diet). 14 months ago I removed grains and legumes (but kept to Zone ratio as it works well for me) after reading this outstanding paper by Loren Cordain.
    "Cereal Grains: Humanities double edged sword"
    http://www.thepaleodiet.com/articles/Cereal%20article.pdf

    The difference was amazing - no more PMS breast pain, no more menstrual cramps, no more joint swelling, some fat loss, ganglion cyst that I'd had for 10 years shrank, no more constipation, all I can say is: try it - grain free is a cut above managing glycemic load with grains.
    Even fruit and it's fructose content is fine in moderate amounts (2 -3 serves day)

  • Anonymous

    7/16/2010 3:58:51 AM |

    I have celiac and type II diabetes, the fastest way to get my blood sugar in the danger zone is to eat "gluten-free" foods.  1/2 of a gluten free 6 inch pizza on a recent camping trip when we stopped in town for lunch sent me over 200. The only answer is to stick with real food, and skip anything with tapioca starch!

  • Bilal Shanti

    7/16/2010 10:18:01 AM |

    For people who respond well to low-carb diets, it’s important to sort out the nutritional value of a food from its affect on blood sugar. For someone who is (take your pick as they mean similar things): sensitive to sugar, prediabetic, Type 2 diabetic, insulin resistant, or has metabolic syndrome, keeping blood glucose stable is an important priority for health. In that way, it’s not much different from any condition that is treated by diet tradeoffs must be made. Someone who is allergic to wheat, for example, can still eat a balanced, healthy diet without harming their body. So can someone who strives for stable, normal levels of blood sugar.

    My Social Bookmarks: Bilal Shanti Facebook, Dr. Bilal Shanti Wordpress, Bilal Shanti MD Vitals, Dr. Bilal Shanti MD SiliconIndia, Bilal Shanti 123people, Bilal Shanti MD LinkedIn

  • Food, flora and felines

    7/16/2010 1:36:51 PM |

    @ Peter: Maybe it's the letcins? I came across a bit on how lectins may promote obesity (and so metabolic syndrome) in the whole food health source recently;

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins.html

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins-part-ii.html

  • DrStrange

    7/16/2010 3:50:39 PM |

    anonymous: "The only answer is to stick with real food...!"

    ALWAYS!!!

  • help to stop smoking

    7/16/2010 6:22:54 PM |

    For most people, this is just interesting, albeit, a little confusing. It is for me anyway. I don't pay attention to anything I eat, except I try to avoid desserts (when possible).

    I'm curious, are there simple guidelines for those who are gluten intolerant or have similar food "issues". Also, don't most people who "feel" they are gluten allergic, not?

    I read somewhere that it takes an endoscopic biopsy to officially diagnosis someone as gluten intolerant? For instance, a family member thinks she is because she thinks bread gives her gas. Weird, huh? Last time I checked, EVERYTHING gave her gas! Smile

    But apparently the internet has many sites just waiting to fill her head with crazy ideas.

  • Dr. William Davis

    7/16/2010 6:42:37 PM |

    Hi, Help to stop--

    My personal view is that all humans should stop consuming wheat. There is more to wheat intolerance than celiac disease, the conventionally accepted health problem provoked by wheat gluten.

    But there are so many other expressions of wheat intolerance that are rarely diagnosed, from childhood behavioral disorders to unexplained ataxias (imbalances due to neurologic deterioration) to peripheral neuropathies to diabetes to heart disease . . . and the list goes on and on.

    The difficult thing is that the majority of these people with non-celiac wheat intolerances test negative for celiac markers like anti-endomysial antibodies and anti-gliadin IgG.

  • Anonymous

    7/16/2010 10:24:18 PM |

    As I understand it the glycemic index was set using only slender healthy college age men, hardly a model for me!

  • Lori Miller

    7/17/2010 12:22:13 AM |

    @Help to Stop, according to Norm Robillard, a microbiologist, carbohydrates produce gas in the digestive tract. Fat and protein, not so much. In my case, wheat--especially whole wheat--made me so bloated I looked like I was pregnant. (Look up "wheat belly" on this site.) Since cutting out almost all the starchy, sugary carbs, I no longer have this problem. I recommend your family member with the gas problem try a low carb diet and avoid dairy products.

  • Pallav

    7/17/2010 4:50:20 PM |

    Dr. Davis.

    "wheat is not for human consumption"
    .
    knock knock! anyone home?
    cooking styles? perhaps?
    .
    Hydrolysis and depolymerization of gluten proteins during sourdough fermentation
    http://pubs.acs.org/doi/abs/10.1021/jf034470z
    .
    Sourdough Bread Made from Wheat and Nontoxic Flours and Started with Selected Lactobacilli Is Tolerated in Celiac Sprue Patients http://aem.asm.org/cgi/content/abstract/70/2/1088
    .
    Potential of sourdough for healthier cereal products http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHY-4F6CRDT-2&_user=10&_coverDate=03%2F31%2F2005&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383360&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c744a61e5abbed1ed60c4a079ff39fb5.
    .
    Prolonged Fermentation of Whole Wheat Sourdough Reduces Phytate Level and Increases Soluble Magnesium http://pubs.acs.org/doi/abs/10.1021/jf001255z
    .
    Phytase activity in sourdough lactic acid bacteria: purification and characterization of a phytase from Lactobacillus sanfranciscensis  CB1
    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4846KTT-11&_user=10&_coverDate=11%2F01%2F2003&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383734&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b30d3245227db0269ca748da5d73c62f
    .
    Article
    Moderate Decrease of pH by Sourdough Fermentation Is Sufficient To Reduce Phytate Content of Whole Wheat Flour through Endogenous Phytase Activity http://pubs.acs.org/doi/abs/10.1021/jf049193q

    i'm curious why wheat is still unsuitable after neutralizing gluten and phytic acid?

    kindly explain the science dr. davis!

  • TomF

    7/17/2010 9:23:30 PM |

    Can you successfully build muscle mass on a grain free/low-carb diet?  I am eating to gain weight, but I'm concerned my diet is not optimal (i.e. heavy in carbs).  However, I'm afraid that if I drop the carbs down I could end up doing myself a disservice in terms of building muscle mass.

  • Lori Miller

    7/18/2010 1:41:41 PM |

    Tom F, I was a Body-for-Lifer for six years. For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go.

    Recently, I started the Slow Burn program by Fred Hahn. It's a strength training program. Having done weightlifting for six years, I was fairly strong, but I've found these exercises very challenging--especially the one-legged squats. With the BFL exercises, I was at the limit of what my joints, not muscles, would take. With Slow Burn, the exercises are easier on your joints, so my muscles are getting more of a workout.

    A few people have written about the Slow Burn program: Dr. Michael Eades (he's a co-author of the book: http://www.proteinpower.com/drmike/uncategorized/slow-burn-fitness-for-boomers/

    Tom Naughton: http://www.fathead-movie.com/index.php/2009/10/01/taking-the-6-week-cure-almost/

    and me (see comments too, Fred Hahn was kind enough to make some suggestions).
    http://relievemypain.blogspot.com/2010/07/exercise-without-joint-pain.html

  • DrStrange

    7/18/2010 3:16:59 PM |

    "For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go. "

    It's all about individual physiology and uniqueness.  I basically had the opposite reaction when I did this, going from moderate fat fairly high carb "health food "diet. After about 9 months on low carb (approx 30 grams/day total) high fat diet, I felt like I was dragging an anchor all day every day. Gradually worse as time passed. If I did even mild exercise ie Nordic Walking for a couple miles, I would be totally wasted to the point I would almost have to sleep for a couple hours then continue to feel exhausted for another 24 hours or so.  Finally got smart and went the other way first McDougall and got my energy back then "upgraded" to Fuhrman and finally stabilized blood sugar etc.

  • Dr. William Davis

    7/18/2010 4:47:52 PM |

    Pallav-

    Please read the past posts in this blog.

    Wheat is not just about gluten, though gluten proteins are indeed a major part of the adverse reaction to wheat.

    We also have neurologic phenomena attributable to wheat, only some of which may be gluten-mediated. We have amylopectin A, among the most highly digestible starches known, accounting for wheat ability to increase blood sugar more than just about all other carbohydrates.

  • rmarie

    7/19/2010 3:50:35 AM |

    @ Dr. Strange
    We know each other from the McDougall forum. I left, because I couldn't take the constant hunger any more, even though I ate practically all day long. I lost so much weight that my BMI was down to 17.5. I did McD for almost 1 1/2 years. At the end I weighed 3 pounds less than when I was 17 - which was 50 years ago!

    (note to others, I'm 4'11" started McDougall weighing 93 lbs and within 3 months was down to 88 and then actually went down to 85lbs. That's when I said 'no more' and went over to the low(er) carb community (60-80g).

    Unlike most people I have never had any aches or pains, joint problems or digestive problems in my life.
    And I've always been very active with lots of energy both with low-fat/high carb or low-carb/high fat. I see no difference except that I can now often go 3-4 hours between meals before I get hungry.

    But I did not adopt the american way of eating (junkfood and sodas) after coming here from Europe. I started McDougall starch based diet because of its promise to lower blood sugar (he does have many success stories, helped change people's lives in more than 30 years and offers many well researched science based articles to support his position). It is so confusing when each side is certain they have the answer WITH STUDIES TO PROVE IT.

    I have been pre-diabetic for at least 10 years that I know of. Doc never said much because the cut off number was 126 and I was well below that.

    Low-fat, high carb surprisingly did not change my BS much either way. I certainly did NOT have the reaction Dr. Davis talks about.

    Everyone reacts differently (maybe there is something to the metabolic typing after all?

  • Pallav

    7/19/2010 9:05:31 AM |

    Dr davis

    Thanks for your reply. what wheat contains is probably not entirely known, ill give it to you because of the clinical results coming through but wheats culpibility in the crime is quite interesting and certainly whether some component of wheat is responsible for the results you are observing or whether it is just a matter of preparation would certainly call for further investigation.

  • JTownsend

    7/21/2010 10:07:28 PM |

    Inspired by the good doctor I have essentially eliminated all grains from my diet, particularily wheat, with positive results. But I must admit that I do still enjoy a cold beer and am loath to
    forsake this one precious pleasure. Where does beer fit in I wonder? It is a grain product I guess just like bread or cereal. So is it on the banned list for cardiac health?

  • Anonymous

    7/23/2010 3:41:22 PM |

    Is there a safe sandwich bread out there in most local stores?  I eat sandwiches most every day and I'm trying to figure out how to follow your advice re wheat.

  • Anonymous

    8/26/2010 4:23:10 PM |

    Try Glucose Level by Sprunk-Jansen.

    GLUCOSE LEVEL helps to support glucose metabolism and to maintain insulin levels already within the normal range. GLUCOSE LEVEL uses four plant extracts - nettle, salt bush, walnut and olive - which work together to help bring your blood sugar levels into alignment.

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