Throw away total cholesterol!

Richard's total cholesterol without treatment was 186 mg/dl. "That's great!" his doctor declared, referring to the conventional dictum that total cholesterols less than 200 carry low risk. Several fingersticks in a mall kiosk set up by a local hospital to check total cholesterols confirmed Richard's low number.

But after Richard's unexpected hospitalization and two stents for severe coronary blockages, he demanded better answers.

Tragically, the answer was there all along: Despite a "favorable" total cholesterol, his HDL ("good") cholesterol was a miserable 32 mg (ideal >60 mg).

Total cholesterol is actually the sum total of HDL cholesterol, LDL cholesterol, with a contribution from triglycerides. That's why a low total cholesterol can conceal a low HDL.

This situation is quite common. And low HDL is accompanied by a constellation of other undesirable causes of heart disease, most notably small LDL.

Don't accept total cholesterol as your sole measure of risk. It's nearly worthless. If you live in Bangladesh or a third world country, well perhaps that's the best you can get. But if you live in the U.S. or developed world, it's absurd to rely on total cholesterol.

Smart Start not so smart




Kellogg's has crafted a campaign to support the American Heart Association featuring acress Sela Ward. Her attractive face, familiar to many TV and movie viewers, does add a comforting face to their efforts.

What's in this cereal made by the manufacturers of Pop-Tarts, Cheez-It, Rice Krispies, and Chips Deluxe cookies?

There are, indeed, some healthy ingredients: oat bran, potassium; you can even get a version made with soy protein. But there's sugar listed as the second ingredient. High-fructose corn syrup is also listed prominently. (Remember this issue? High-fructose corn syrup causes overwhelming sugar cravings, causes your triglycerides to skyrocket, and is probably among the principal food ingredients that make you obese.)

Upon detailed questioning of my patients struggling to lose weight, this and products like it are often among the "healthy" foods they've gravitated towards. We spend a great deal of time dissuading them of this idea.

A one-cup serving of Smart Start is low in fat (1 gram) but contains 43 grams of carbohydates, of which there are 14 grams of sugar. There are a meager 3 grams of fiber. To me, this sounds like a cupcake.

The Kellogg's people are exceptionally clever marketers. Partner with the American Heart Association and movie stars? Brilliant!

You should trust food manufacturer advertising about as much as you trust drug manufacturer advertising, which is to say not at all.

Kellogg's sold $10 billion dollars of food products last year. They are the world's leading producer of breakfast cereals. They are a leading producer of convenience foods: cookies, crackers, cereal bars, and frozen waffles under the brands Keebler, Pop-Tarts, Eggo, Cheez-It, Nutri-Grain, Rice Krispies, Famous Amos, and Kashi.

Can they cash in on healthy trends? They'll certainly try.

Does anybody have a normal vitamin D level?

We now routinely check everyone's vitamin D blood level at the start of the program. (The measure to obtain is 25-OH-Vitamin D3. This is not to be confused with 1,25-OH2-vitamin D3, which is a kidney function measure.)

Of the 10 people with levels drawn today, none were even close to normal levels (which we define as 50 ng/ml)--not a single one.

The majority were in the range of severe deficiency (<20 ng/ml). Only two had levels in the 30s. None had higher. (Remember: I'm talking about people in Wisconsin, a terribly sunlight-deprived area much of the year. This might not apply quite as vigorously to Florida residents or others in sun-exposed regions.)

Curiously, I've also seen several people this week who had extraordinary quantities of coronary plaque on their heart scans (scores >1000), all of whom had extremely low vitamin D levels. One of these people had fairly unimpressive lipoproteins, with very minimal abnormalities identified. (This is quite unusual, by the way.) It makes you wonder if a profound deficiency of vitamin D is sufficient to act on its own as an instigator of coronary plaque.

The more we examine the issue of vitamin D deficiency, the more fascinating it gets. I suspect we've just scratched the surface and there's a lot more to learn about this tremendously interesting nutrient. Nonetheless, with what we're seeing in our experience, I'm urging everyone to get a blood vitamin D level.

Don't believe your LDL cholesterol!

Harry's case is typical. For years, his doctor told him his LDL cholesterol of 123 mg was okay. But a heart scan score of 490 (90th percentile at age 52) made him question just where his coronary plaque came from.

Lipoprotein analysis told a very different story: His LDL particle number was 2400 nmol, meaning his trueLDL was more like 240 mg, nearly double the value of LDL obtained through his doctor. Harry had other sources of risk, too, but the LDL particle number was a clear stand-out.

Why does this happen? How can LDL cholesterol be so terribly inaccurate?

LDL cholesterols obtained in virtually all labs are not measured, they're calculated. The calculation was developed in the 1960s by Dr. Friedewald at the National Institutes of Health and therefore goes by his name (the Friedewald calculation). Dr. Friedewald derived this simple calculation to permit doctors across the U.S. to obtain LDL cholesterols, which were technically difficult to measure in those days by using measured HDL, total cholesterol and triglycerides.

Doctors were told that the only time that the Friedewald calculated LDL was inaccurate was when triglycerides exceeded 400 mg. So most family practitioners and internists still believe that calculated LDL's are, for the most part, quite accurate.

Nothing could be further from the truth. When LDL's are actually meaured, you find that LDL is rarely accurate. In fact, in our experience, inaccuracy of 30-50% is the rule, sometimes 100%. The one telltale hint that calculated LDL is wrong is when HDL is <50 mg--that's nearly everybody.

So what's your LDL? You won't really know unless it's measured. Our preferred method is NMR (LipoScience) LDL particle number, probably the most accurate of all. Second best: apoprotein B, direct measured LDL, and non-HDL. (We'll cover this issue much more extensively in an upcoming report on the www.cureality.com website in an extensive Special Report.)

Are you the exception?


I read about 40 heart scans this morning. In the stack was a 41-year old man with a heart scan score of 841.

That's terribly high for anyone, let alone a 41-year old person. He's lucky to find out about this before catastrophe strikes.

People like this worry me. In general, we advise men to consider a heart scan age 40 and older; women 50 and older. If there's anything exceptional about your family history or your own history, then you might notch these numbers down another 5-10 years. For instance, if your Dad had a heart attack at age 43, you might consider a scan at age 35. Or, if you've had diabetes for several years and you're a 42-year old woman, you might think about a scan. (Men tend to develop measurable plaque by heart scans 10 years before women.)

There are no hard and fast rules. It's unusual for a male to have a score >0 before age 40. Likewise, it's very uncommon for a woman to have a score >0 before age 50. But there are occasional exceptions--but they can be very important exceptions.

Our 41-year old man with the score of 841, for instance, probably had a high score since his mid-30s. I've seen several women without any obvious risk factors with scores in the several hundred range in their early 40s.

My rule: When in doubt, opt for safety. Every day, I still read about people in their 30s, 40s, and 50s dying of heart attacks. It shouldn't happen.

When in doubt, get the heart scan. The most you'll lose is the cost of the scan and a modest exposure to radiation. If your score is zero, you know you're safe for the next 5 or more years. But if you have an exceptional score at a young age, take preventive action.

Self-empowerment in health: The new wave in health care

Track Your Plaque is just one facet of the broad and powerful emerging wave of self-empowerment in health.

Hospitals, drug and device manufacturers, and the medical establishment don't like this idea. People managing their own health? That's ridiculous! Dangerous! But mostly unprofitable.

Self-empowerment means having easy access to simple, safe, and inexpensive diagnostic tests like heart scans, carotid scans, bone densitometry (for osteoporosis), cholesterol tests, abdominal ultrasound, even brain scans (e.g., CT or MRI) for people with a family history of brain aneurysm.

Opponents of this idea worry about the "false-positives" that come about with broad testing, i.e, detection of abnormalities that are artifactual. Our experience is that false-positives are only an occasional problem with any test. Instead, we find that most people have many true-positives. In CT heart scanning, for example, we find many unsuspected enlarged aortas (potential future aneurysms), valve disorders, and aortic calcium. These are all important in a preventive program. Unfortunately, your doctor's definition of false-positive often means that no corrective procedure or operation is required.

Other evidence that self-empowerment in health is growing:

--The nutritional supplement movement. What better example of power in managing your own health is there than the fabulous array of nutritional supplements available?

--Medications moving to over-the-counter status. Gradually, more and more medications are trickling into availability for you to obtain without a doctor's prescription.

--What I call "retail imaging", i.e. screening ultrasound, heart scans, full body scans, etc. that are available in most states without a doctor's order.

--The Internet. The rapidity and depth of information available on the Internet today is mind-boggling. It will fuel the self-empowerment movement by providing sophisticated information to the health care consumer previously available only through your physician.

--High-deductible health insurance plans. If health care consumers will bear more and more of the costs of health care, they will seize greater responsibility for early identification and prevention to minimize long-term costs.

There are more. But the movement is powerful and broad--and unstoppable. Let the establishment with vested interests in preserving the status quo fuss and complain, just like horse and buggy manufacturers did in the early 1900's when the autmobile came along.

Vitamin D deficiency is rampant

Today alone I've seen several people with severe deficiencies of vitamin D.

We're now checking everyone's blood vitamin D level at the start of the program. The measure that most accurately reflects your vitamin D status is 25-OH-vitamin D3. This is very confusing to many physicians, who traditionally have thought of 1,25-di-Hydroxy vitamin D3 as the standard test to measure. What they're failing to recognize is that this second measure is a kidney product, not a reflection of vitamin D status.

Using 25-OH-vitamin D3, several people today alone had levels of <10 ng/ml, clearly in the category of severe deficiency (generally regarded as <20ng/ml).

The majority of people we see in the office are Wisconsin residents. It's no wonder they're deficient. Although it's mid-May, we've seen the sun only a handful of days this year. And most of the days have been too chilly to wear short sleeves and shorts to permit sufficient surface area for UV exposure.

Living in a sunny climate, however, is no guarantee that you have sufficient blood vitamin D levels. Two recent studies have shown that 30-50% of the residents of sunny southern Florida and Hawaii are also deficient. (Why, I'm not sure.)

Although our experience thus far is anecdotal in several hundred people, my impression is that people who have normal blood levels of vitamin D (we regard normal as 45-50 ng/ml) have a far easier time of halting or regressing coronary plaque.

Vitamin D is among the most exciting nutritional tools we've come across in a long time. The conversation is making the media, which impresses me tremendously, given the fact that nobody stands to profit financially to any significant degree through vitamin D supplementation.

For a wonderful collection of discussions on vitamin D, go to Dr. John Cannell's website, www.vitaminDcouncil.com. You'll find a huge quantity of scientific background and conversation on the whole idea. I believe you will be thoroughly impressed with just how powerful the argument in favor of vitamin D has become.

What if wheat products were illegal?

Imagine if anything made of wheat were illegal: bread, bagels, crackers, pasta, pretzels, donuts, Shredded Wheat cereal, Raisin Bran, pastry, cookies, cakes, cupcakes. . . Your grocery store would then be unable to carry any of these products.

How empty would the grocery store shelves be?

There would be very little. The stores would be filled instead with vegetables and fruits, meats, and dairy products. But aisle after aisle would be empty. There'd be no cereal aisle. There'd be no snack chip aisle. The ordinarily overcrowded bread shelves wouldn't be there.

Bakery? Nope, not there either. Pasta and noodles? Empty. How about cakes and pastries? Also gone.

Getting the picture? American groceries are dominated by wheat products. What would happen to your health and the health of your family if wheat were abruptly removed from your choices? Would you be less healthy?

No. In fact, your health would be hugely improved. You'd lose a significant quantity of weight. Extraordinary numbers of people would lose diabetic or pre-diabetic tendencies. Feelings of sluggishness, sleepiness, and moodiness would dissolve. Blood pressure would be reduced. The incidence of cancer, skin disease, and inflammatory diseases would plumet.

From a plaque control perspective, your HDL cholesterol would rise, triglycerides drop. Small LDL would improve dramatically.

The message: Slash wheat products from your diet. Yes, you'll miss the smell and taste of freshly baked bread. But you'll do it for many more healthy years. And you may do it without a 14 inch scar in your chest.

The sobering tale of small LDL

Every day, I learn to respect small LDL more and more.

Small LDL particles, and its evil partner, low HDL, is among the most common reasons why someone fails to fully gain control of coronary plaque and heart disease risk.

Just yesterday, I saw a slender businessman (6 feet 1 inch in height, 186 lb.) whose small pattern persisted despite niacin, fish oil, oat bran, and raw almonds. We generally think of small LDL as an overweight person's pattern, but in some people the genetics are quite powerful and it can be expressed even in slender people.

The solution: More physical activity and exercise; cut back on processed carbohydrates, particularly wheat products like breads, pasta, crackers, breakfast cereals; think about magnesium (see our two recent reports on magnesium on the www.cureality.com membership website, the latest report to be posted this week); be sure sleep is adequate (gauge this by whether you're energetic during the day and don't fall asleep watching TV or movies). Lack of sufficient physical activity in people with sedentary jobs is probably among the most common reason the small LDL pattern persists.

Ignore small LDL and it can be like a hidden cancer in your body, growing and metastasizing (not literally, of course), fueling coronary plaque growth. Be sure your doctor assesses whether you have small LDL if you hope to gain control of your coronary risk.

Burn off the fat

If you've ever wondered just how many calories you're burning with various activities like yard work, driving, climbing stairs, etc. go to this great website that will calculate it for you: http://www.caloriecontrol.org/exercalc.html.

Here are some examples:


Dancing for 30 minutes(fast, e.g., tango): 193 calories
Yoga for 30 minutes: 204 calories
Washing the car for 30 minutes: 173 calories
Vacuuming for 30 minutes: 88 calories

(All are for a 170 lb person.)

As you see, physical activity does not necessarily have to consist of exercise. It doesn't require fancy equipment or expensive outfits. But it does require you to keep moving. Sedentary work is among the most common reasons I see in my patients for failing to control weight and its associated lipoprotein patterns, like low HDL and small LDL.

If your work is sedentary, then a minimum of 60 minutes of physical activity per day is necessary to begin to correct weight-related patterns. If you gauge by calories burned, then a useful goal is 500 calories per day in physical activity--at a minimum.
Why do morphine-blocking drugs make you lose weight?

Why do morphine-blocking drugs make you lose weight?

Naloxone (IV) and naltrexone (oral) are drugs that block the action of morphine.

If you were an inner city heroine addict and got knifed during a drug deal, you'd be dragged into the local emergency room. You're high, irrational, and combative. The ER staff restrain you, inject you with naloxone and you are instantly not high. Or, if you overdosed on morphine and stopped breathing, an injection of naloxone would reverse the effect immediately, making you sit bolt upright and wondering what the heck was going on.

So what do morphine-blocking drugs have to do with weight loss?

An odd series of clinical studies conducted over the past 40 years has demonstrated that foods can have opiate-like properties. Opiate blockers, like naloxone, can thereby block appetite. One such study demonstrated 28% reduction in caloric intake after naloxone administration. But opiate blocking drugs don't block desire for all foods, just some.

What food is known to be broken down into opiate-like polypeptides?

Wheat. On digestion in the gastrointestinal tract, wheat gluten is broken down into a collection of polypeptides that are released into the bloodstream. These gluten-derived polypeptides are able to cross the blood-brain barrier and enter the brain. Their binding to brain cells can be blocked by naloxone or naltrexone administration. These polypeptides have been named exorphins, since they exert morphine-like activity on the brain. While you may not be "high," many people experience a subtle reward, a low-grade pleasure or euphoria.

For the same reasons, 30% of people who stop consuming wheat experience withdrawal, i.e., sadness, mental fog, and fatigue.

Wouldn't you know that the pharmaceutical industry would eventually catch on? Drug company startup, Orexigen, will be making FDA application for its drug, Contrave, a combination of naltrexone and the antidepressant, buproprion. It is billed as a blocker of the "mesolimbic reward system" that enhances weight loss.

Step back a moment and think about this: We are urged by the USDA and other "official" sources of nutritional advice to eat more "healthy whole grains." Such advice creates a nation of obese Americans, many the unwitting victims of the new generation of exorphin-generating, high-yield dwarf mutant wheat. A desperate, obese public now turns to the drug industry to provide drugs that can turn off the addictive behavior of the USDA-endorsed food.

There is no question that wheat has addictive properties. You will soon be able to take a drug to block its effects. That way, the food industry profits, the drug industry profits, and you pay for it all.

Comments (24) -

  • praguestepchild

    11/10/2010 3:49:28 PM |

    A doctor friend of mine was telling me about this, junkies hate it because it makes them instantly sober. Interesting that it would block the same receptors involved in wheat addiction.

  • Anonymous

    11/10/2010 4:29:57 PM |

    Thank you for explaining/exposing this.  For years I've wondered how food addictions work, especially wheat.  That our representative government is serving profit seeking corporate interests no longer surprises me though.

  • Anonymous

    11/10/2010 4:30:30 PM |

    Thesis + antithesis = synthesis.

  • arnoud

    11/10/2010 7:12:13 PM |

    Thank you for these interesting insights.  

    Now I also know why I couldn't just eat one cookie - - had to continue and eat the whole box.

    Now, without that first cookie, I totally don't care about them at all.

  • Anonymous

    11/10/2010 7:32:04 PM |

    BTW, naltrexone is also used to treat alcoholism in protocol known as The Sinclair Method.  You take the naltrexone an hour before drinking and then drink normally.  The naltrexone blocks the opoid receptors in the brain and the endorphins released by the drinking find no room at the inn.  Over time, the addiction is extinguished.

  • terrence

    11/10/2010 7:35:08 PM |

    I do not think I could have made up something like this! If I could I would be very rich, and maybe own a Big Pharma company or two.

    BTW, awhile ago, I read about a clinical study done in the UK. It had three groups of heron addicts - one group stayed on heroin, another was given methadone, the third was given a placebo (that they were told was methadone).

    Not surprisingly, the first group remained addicted to heroin, and the second group remained addicted to Methadone. The third group ALL got over their previous addiction to heroin, and with NO withdrawal symptoms, NONE, not one of them.

    Some commentators pointed out that The Heroin Establishment has a very large financial interest in keeping the story alive that heroin is hard to stop.

    I also know someone who was addicted to heroin. But, he realized that he was messing up his life (lost his wife, kids, etc). So, just stopped taking it - NO withdrawal issues, NONE.

  • Steve Cooksey

    11/10/2010 7:59:52 PM |

    Smile

    I love it when you rant against the MACHINE!!!  (in a dignified manner of course) Smile

    I'm a Type 2 Diabetic, with normal blood sugar and I take -0- drugs , -0- insulin.

    I follow a Very Low Carb, Gluten Free "Primal" meal plan....and I LOVE IT!

  • Dr. William Davis

    11/10/2010 11:04:21 PM |

    It's not clear to me how much of this is intentional, i.e., is wheat now a ubiquitous component of processed food precisely because of its addictive potential?

    Regardless, wheat stands apart from all other foods for this effect on humans.

  • mrfreddy

    11/11/2010 12:41:41 PM |

    interesting!

    and to think, the Ornishes, Furhmans, and Campbells of the world would have us believe that meat is addictive. Ha!

  • Anonymous

    11/11/2010 2:52:43 PM |

    Naltrexone..really?  Do some research on this drug and you will find that used over a long period of time it will cause changes to the receptors so that we feel no euphoria ever!  Bad Bad news.

  • Chet

    11/11/2010 6:13:47 PM |

    Eating wheat bread by itself is not very addicting but if sugar is thrown in the mix, you can get a nice mood lift.  This is because sugar(along with the wheat) spike insulin which drives tryptophan into the brain, where it converts to serotonin, the feel good neurotransmitter.

  • Kevin

    11/11/2010 9:58:03 PM |

    I may experiment.  I have some naltrexone that is about to expire.  I might give myself an injection and see if it makes me less interested in bread.  At the most I might eat two slices of whole wheat once or twice a week.  Would it work for other carbs like potatoes?

  • Dr. William Davis

    11/12/2010 1:32:06 AM |

    HI, Kevin--

    I'm impressed that you've got naltrexone! Please let us know what becomes of the experiment.

    Wheat stands apart for this effect. The only other foods that have been shown to exert a morphine-like effect are dairy products ("caseomorphin"), though the potency is many times less than that exerted by wheat.

  • Anonymous

    11/12/2010 3:09:49 AM |

    I eliminated grains, switched to Almond milk, cut out coffee and all artificial sweeteners.

    I started LDN in June and have easily lost 23 pounds, a feat almost unheard of in a Hashimoto's patient.

    Just a small amount of some protein and veggies will satisfy me but so could a handful of unsalted nuts.
    My appetite is no longer an issue.
    I would say I don't really have an interest in food anymore.
    I no longer have any blood sugar swings but those disappeared when I eliminated grains. I just feel LDN was helping in the appetite area, now your post confirms what I had been feeling.

    Now that my thyroid medication has been switched ( Armour to Synthroid due to manufacturing issues) and adding Cytomel plus LDN, I feel better.

    I am waiting of lab results to see where my Vit. D level is ( was at 42 aiming for 60) and to see what impact 6 months of no grains has done to my cholesterol.
    I am hopeful!  And that's another thing about LDN, depression is a thing of the past.
      
    My holistic MD thinks because the dosage is so small, LDN is acting in a homeopathic manner.  
    Many Hashimoto's patients have to decrease the amount of hormone they take because of LDN's effect on the thyroid.  
    I should know if my thyroid is happier by the end of the month. It might even be too happy.

  • Anne

    11/12/2010 3:28:40 AM |

    Chet - you say wheat is not addicting. My experience is not proof but when I gave up wheat I had about 3 days of withdrawal symptoms.  I felt really terrible and I was still eating sugar and high carb foods. A few years later I gave up the sugars. Although it took a while to lose the cravings for sweets, I did not have a period of feeling ill like I did when I gave up wheat.  

    Giving up wheat eliminated my depression. The tiniest amount of accidental wheat causes my mood to drop for a few days.

  • Anonymous

    11/12/2010 6:22:05 AM |

    Wrong explanation. By antagonizing opioid receptors, naltrexone disrupts flow in reward circuit. Which we know is central to the development of addiction. Wheat or no wheat. The weight loss appears to be at least in part something else. In combination with buproprion (AKA Zyban, an effective quit smoking drug) it significantly reduces food intake (by blocking hunger signal and reducing cravings). Again, wheat or no wheat.

  • Peter

    11/12/2010 5:40:16 PM |

    I'm trying to understand trade-offs.  Since quitting meat my weight hasn't changed, my blood sugar has improved, and my LDL is worse.

  • Kevin

    11/12/2010 7:35:40 PM |

    I took a closer look.  It's naloxone, not naltrexone.  Very rarely I see a dog that's ingested opiates.  That's why I have it but as I said, the dozen vials have reached the expiration date.

    kevin

  • Sue

    11/13/2010 3:22:52 AM |

    Sorry, completely off topic but did you see the article in HeartWire re reducing LDL even more.
    http://www.theheart.org/article/1145175.do

  • ilaçlama

    11/13/2010 11:03:45 AM |

    Thanx For subject

  • Anonymous

    11/13/2010 1:55:04 PM |

    ANNE
    I suffer from depression and would like to know more about how giving up wheat has helped you. Do u mind emailing me? If you don't scooby43215@yahoo.com. Thanks in advance.

  • Denny Barnes

    11/17/2010 8:50:40 AM |

    The diabetes guru Dr. Bernstein has written about low dose naltrexone therapy (LDN) to help diabetics lose weight.  Have you used LDN with your patients?  I understand that a low dose of naltrexone taken at night at first inhibits endorphin release and then stimulates it.  Presumably, increased endorphins eliminates the need for addictive foods and lowers inflammation.  Your thoughts?

  • elpi

    11/18/2010 1:30:57 AM |

    I just need to exercise and a healthy diet for me to lose weight. .That's all

  • Rene Sugar

    11/29/2010 6:25:35 PM |

    There is a Scientific American article that says negative emotions and pain-induced negative emotion are processed in the same brain areas so pain medication also relieves emotional pain.

    If wheat has opiate like effects, it might explain "emotional eating".

    http://www.scientificamerican.com/article.cfm?id=how-pain-can-make-you-fee

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