What to Eat: The diet is defined by small LDL

9. April 2010 William Davis (15)
I approach diet from the perspective of small LDL particles.

Small LDL particles have exploded in frequency and severity in Americans. It is not at all uncommon to see 70% or more small LDL particles (i.e., 70% of total LDL particle number or Apo B) on lipoprotein testing. (I saw two people today who began with over 95% small LDL.)

Small LDL particles are:
--More likely to persist in the bloodstream longer than large LDL particles.
--More likely to adhere to components of atherosclerotic plaque.
--More likely to gain entry to plaque.
--More likely to be taken up by inflammatory white blood cells which, in turn, become the mast cells that fill coronary plaque.
--More likely to be oxidized.
--More likely to be glycated (8-fold more likely than large)

To add insult to injury, foods that trigger small LDL formation--i.e., carbohydrates--also cause high postprandial blood sugars. High postprandial blood sugars, in turn, glycate small LDL. That combination of events accelerates 1) plaque growth, 2) plaque instability, and 3) aging.

So carbohydrates trigger this sequence, carbohydrates of all stripes and colors. Not just "white" carbohydrates, but ALL carbohydrates. It's all a matter of degree and quantity. So, yes, even quinoa, bulghur, and sorghum trigger this process. I've only recently appreciated just how bad oats and oatmeal are in this regard--really bad.

Foods that trigger small LDL also trigger higher blood sugars; foods that trigger higher blood sugars also trigger small LDL. Small LDL and blood sugar are two different things, but they track each other very closely.

So, in the Track Your Plaque approach to diet, we craft diet based on these simple principles:

1) Eliminate wheat, cornstarch, and sugars--These are the most flagrant triggers of small LDL, blood sugar, and, therefore, LDL glycation.
2) The inclusion of other carbohydrates, such as oatmeal, quinoa, rye, etc. depends on individual sensitivity. Individual sensitivity is best gauged by assessing one-hour postprandial glucose.

Stay tuned for more in this series. Also, Track Your Plaque Members: We will be having an in-depth webinar detailing more on thees principles in the next couple of weeks.
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Comments (15) -

  • Anonymous

    4/9/2010 8:44:03 PM |

    How ia ApoB test used to know small LDL? Particle count exams aren't available in my area but ApoB is. So I'd like to know how to read this test.

    thankyou

  • Dana Law

    4/10/2010 12:45:03 AM |

    Dr. Davis,
    Please give us an eating plan.  You rant about people making lousy decisions with food.  We need some direction.  What are you eating?  Please tell us.  I find this part the most difficult.  I know I've improved in my quality of food.  Three times a day I need to make the best choices.  It's like being married to a nymphomaniac. You have to have to satisfy the healthy needs of your body, everyday!
    I believe you know what you are talking about.  You've improved our lives but tell us, please, what you are doing personally, day by day, to make those LDL particles small.  
    Sincerely,
    Dana Law
    San Diego, Ca
    P.S. This is a rant.  We need your help.

  • Taylor

    4/10/2010 5:48:55 AM |

    Love your blog, sir. I've been reading up over the last couple weeks--one question I couldn't find answered, though, was which glucose monitor you'd personally recommend? There are a lot of them out there on the market and I'm completely at a loss for how to tell them apart!

    Thanks for all the important work you do.

    --T.

  • ET

    4/10/2010 11:04:36 AM |

    For me, reducing carbs to <90g/day did little to improve my small, dense LDL.  My LDL particle number was over 2,000 and my small, dense LDL >1,600.  Increasing my saturated fat intake and niacin dropped my small, dense LDL to <120 in less than a year.

  • JC

    4/10/2010 11:26:38 AM |

    Many of those who live in the "green zones" have a high carb diet and yet live long healthy lives.Maybe the type of carb really is important.

  • Peter

    4/10/2010 11:47:32 AM |

    Re: the cultures that eat high carb but have low rates of diabetes (Japan) do they have low post-prandial scores and low small LDL particles despite lots of rice or corn and beans?

    I'm wondering why some very high carb cultures have so little obesity, heart disease, and diabetes.

  • Lou

    4/10/2010 2:09:54 PM |

    For people who are confused of what to eat, etc - check out Whole Health Source website. Very helpful.  Check out diabetes and diet under LABELS on the right side that Stephan explains in more details why, how, what, etc works.

    If there's a diet book that you can buy from a bookstore, Paleo Diet would probably be the best but it's not perfect. It says to avoid but it's perfectly fine and even the author changed his mind and it's fine to consume them.

    Free The Animal website has helpful information on how to make dinners.

    Dana Law, there's not need to eat 3 times a day. It's not really required. You can have two very nutritional meal with high amount of fat and feel satisfied for a long time, preferably break fast and dinner with maybe handful of snack like pecan, almond, walnut. That's pretty much how I eat. We're not programmed to eat that often anyway. That's how blood sugar stays low.

    JC and Peter, you need to be more specific... are we talking about percentage of meal high in carbs or total amount of carbs? Two entirely different things. We eat way more carbs than those people, I bet. I'd have to travel to those places to see that myself because I don't believe anything media tells us.

  • Paula

    4/11/2010 12:25:10 AM |

    Dana,
    Dr. Davis's "eating plan" is available to Track Your Plaque members.  I've been a member for over a year, and I can't tell you how much I've learned.  Check out the website at trackyourplaque.com and sign up!

  • Anonymous

    4/11/2010 7:35:20 AM |

    Dana, stop your ranting.  Your air of entitlement is annoying.  The fact that Dr. Davis graciously gives of his time to post some of his insights and advice does not make him a servant at your beck and call.

  • Anonymous

    4/11/2010 1:30:51 PM |

    ET, thanks for your post.  Some folks get carried away with Paleolithic diet or nothing. For those of us who prefer to limit our meat consumption, 2-3grms/day Niacin is a must.

    Dr D is always solid about whether his information is anecdotal or based on clinical trials.  If you would like additional supporting evidence for Niacin and its effects on LDL particle size, check out lipdsonline.org and search "niacin"

    " As in previous studies, niacin therapy had no significant effect on LDL cholesterol concentrations; however, after 3 months of treatment the number of small and medium sized LDL cholesterol particles was significantly decreased in those given niacin compared with those given placebo"

    Trevor

  • Tom

    4/11/2010 2:35:58 PM |

    I agree that I find it pathetic that someone would rant on a free website and some of the very best information available anywhere.  Please stop it now.

    Other posters who are asking about meters, etc:  please review the prior blogs that are listed alphabetically on the left.  Jeez folks, make some effort will you?

    Tom C.

  • Gina

    4/12/2010 4:28:27 AM |

    Yeah! So good to hear you speak out re the quinoa, oats and other carbs. Seems I can get clients to consider letting go of wheat (surprising) but  they now think quinoa is the nectar of the gods. 15 years ago I had a hard time selling even a handful of quinoa and now it is the sweetheart of grains. go figure...oh yet  again it is about who is pushing the stuff. You suppose Ornish is involved ;)
    Great post yet again Doc!

  • Anonymous

    4/12/2010 6:45:36 PM |

    I don't see what is wrong with Dana's post..... maybe we are just a tad more relaxed, those of us who don't eat too much meat Smile
    Trevor

  • April

    4/13/2010 4:42:17 AM |

    yes,I agree that a diet high on carbohydrates and sugar makes people obese and increases the risk for them to be diabetic.

  • Anonymous

    6/26/2010 6:36:17 PM |

    Do any of the home cholesterol meters (Cholesetch , Cardiochek, etc.) measure LDL particle number (i.e. small dense vs. the large not-so-dangerous kind)?

    Would be nice to conveniently measure real ldl once a day!

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Another interview with Livin' La Vida Low Carb's Jimmy Moore

7. January 2009 William Davis (4)
I recently provided another interview for Livin' La Vida Low Carb's Jimmy Moore.

You may remember Jimmy as the irrepressible host of the Livin' La Vida Low Carb Show who lost around 200 lbs, dropping from 410 to 230 lbs on a low-carbohydrate diet.

In this hour-long interview, we discussed some of the dietary strategies that we use in the Track Your Plaque program.

Jimmy's website is definitely worth exploring. It's loaded with great interviews, including with Good Calories, Bad Calories author, Gary Taubes.

"Millions of needless deaths"

6. January 2009 William Davis (4)
"Millions of needless deaths" is the title of an editorial by Life Extension Magazine's Bill Faloon.

". . . If vitamin D’s only benefit was to reduce coronary heart attack rates by 142%, the net savings (after deducting the cost of the vitamin D) if every American supplemented properly would be around $84 billion each year. That’s enough to put a major dent in the health care cost crisis that is forecast to bankrupt Medicare and many private insurance plans."

Although I don't agree with all the over-the-top commentary that issues from Mr. Faloon or Life Extension (although I sit on their Medical Advisory Board), I agree with virtually all of the issues he raises with vitamin D.

Despite the enormously compelling observations of vitamin D potential effects in populations, the medical community's reluctance comes from the lack of treatment data. In other words, what we lack are long-term data on vitamin D supplementation vs. placebo on rate of heart attack, vitamin D vs. placebo on risk of colon cancer, etc.

The data that exists connecting vitamin D levels with cardiovascular risk originate from three population observations:

1) The NHANES data in 16,000 participants showed 20% increased risk of cardiovascular events in those with vitamin D levels <20>20 ng/ml after factoring in all standard risk factors.

Another NHANES analysis showed the high prevalence of vitamin D deficiency in those with cardiovascular disease.

2) A German study of 2500 participants that showed showed the lowest quartile of vitamin D levels (<13.3>28.4 ng/ml.

3) The Health Professionals' Follow-Up Study of 18,000 males showed a 2.4-fold increase in cardiovascular events in those with vitamin D levels <15>30 ng/ml.

While we lack treatment data (vitamin D vs. placebo) in a large population, we do have data that Suzie Rockway, Mary Kwasny (both from Rush University, Chicago) and I generated on the effect of vitamin D as a part of a broader treatment program on coronary calcium scores:

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. Amer J Ther 2008 (Dec 15).

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 >/= 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 /=60 mg/dL; and vitamin D3 supplementation to achieve serum levels of >/=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.


I also summed up the data as of early 2008 in a Life Extension article:

Vitamin D's Crucial Role in Cardiovascular Protection


I do agree with Mr. Faloon: It's time to take the vitamin D issue very seriously. Personally, I think it is foolhardy to not correct vitamin D deficiency, even in the absence of long-term treatment data.

Should we subject people living in tropical climates with vitamin D blood levels of 90 ng/ml to long-term observation? Though that has not yet been done, it has been done--in effect--through observations on the prevalence of diabetes, heart disease, and various cancers by latitude: the farther away from the equator, the greater the prevalence of these diseases.

That's more than good enough for me.

Thiazide diuretics: Treatment of choice for high blood pressure?

5. January 2009 William Davis (14)
Thiazide diuretics are a popular first-line treatment for hypertension among the primary care set.

This practice became especially well-established with the 2002 publication of the ALLHAT Study (Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic:The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)).

ALLHAT showed that an inexpensive diuretic like chlorthalidone (a weak diuretic in the thiazide class, similar to hydrochlorothiazide) as first-line treatment for hypertension achieved equivalent reductions in cardiovascular events (cardiovasular death and heart attack) as non-thiazide antihypertensives, lisinopril (an ACE inhibitor) and amlodipine (a calcium channel blocker, better known as Norvasc).

After 7 years of treatment, there was 14% death or heart attack among all three groups--no difference.

This was interpreted to mean that inexpensive thiazide diuretics like chlorthalidone offer as much benefit as other blood pressure medications at reduced cost.

On the surface, that's great. Anything that detracts from the ubiquitous pharmaceutical industry propaganda of bigger, better, more expensive drugs to replace old, inexpensive, generic drugs is fine by me.

But you knew there'd be more to this issue! If we accept that thiazides are equivalent to other single-drug treatments for high blood pressure, what do we do with the following issues:

--Thiazides deplete body potassium-This effect can be profound. In fact, built into the ALLHAT mortality rate is an expected death rate from potassium depletion. When potassium in the body and blood go low, the heart becomes electrically unstable and dangerous rhythms develop.

--Thiazides deplete magnesium--Similar in implication to the potassium loss, magnesium loss also creates electrical instability in the heart, not to mention exaggeration of insulin resistance, rise in triglycerides, reduction in HDL.

--Thiazides reduce HDL cholesterol

--Thiazides increase triglycerides

--Thiazides increase small LDL particles--You know, the number one cause for heart disease in the U.S.

--Thiazides increase uric acid--Uric acid is increasingly looking like a coronary risk factor: The higher the uric acid blood level, the greater the risk for heart attack. Thiazides have long been known to increase uric acid, occasionally sufficient to trigger attacks of gout (uric acid crystals that precipitate in joints, like rock candy). (Fully detailed Special Report on uric acid coming this week on the Track Your Plaque website.)

What about the advice we commonly give people to hydrate themselves generously? Yet we give them diuretics? Which is it: More hydration or less hydration? You can't have both.

Do thiazides exert an apparent cardiovascular risk reduction in a society due to its flagrant sodium obsession?

Thus, there are a number of inconsistencies in the thinking surrounding thiazides. In my experience, I have seen more harm done than good using these agents. While I cannot fully reconcile the reported benefit seen in ALLHAT with what I see in real life, all too often I see people having to take another drug to make up for a side-effect of a thiazide diuretic (e.g., high-dose prescription potassium to replace lost potassium, allopurinol to reduce uric acid, etc.). I have seen many people get hospitalized, even suffer near-fatal or fatal events from extremely low potassium or magnesium levels.

My personal view: ALLHAT or no, avoid thiazide diuretics like the plague. Sure, it might save money on a population basis, but I suspect that the ALLHAT data are deeply misleading.

What's better than a thiazide, calcium blocker, or ACE inhibitor? How about vitamin D restoration, thyroid normalization, wheat elimination?

"High-dose" Vitamin D

30. December 2008 William Davis (43)
I stumbled on one of the growing number of local media stories on the power of vitamin D.

In one story, a purported "expert" was talking about the benefits of "high-dose" vitamin D, meaning up to 1000, even 2000 units per day.

I regard this as high-dose---for an infant.

Judging by my experiences, now numbering well over 1000 patients over three years time, I'd regard this dose range not as "high dose," nor moderate dose, perhaps not even low dose. I'd regard it as barely adequate.

Though needs vary widely, the majority of men require 6000 units per day, women 5000 units per day. Only then do most men and women achieve what I'd define as desirable: 60-70 ng/ml 25-hydroxy vitamin D blood level.

I base this target level by extrapolating from several simple observations:

--In epidemiologic studies, a blood level of 52 ng/ml seems to be an eerily consistent value: >52 ng/ml and cancer of the colon, breast, and prostate become far less common; <52 ng/ml and cancers are far more likely. I don't know about you, but I'd like to have a little larger margin of safety than just achieving 52.1 ng/ml.

--Young people (not older people >40 years old, who have lost most of the capacity to activate vitamin D in the skin) who obtain several days to weeks of tropical sun typically have 25-hydroxy vitamin D blood levels of 80-100 ng/ml without adverse effect.

More recently, having achieved this target blood level in many people, I can tell you confidently that achieving this blood level of vitamin D achieves:

--Virtual elimination of "winter blues" and seasonal affective disorder in the great majority
--Dramatic increases in HDL cholesterol (though full effect can require a year to develop)
--Reduction in triglycerides
--Modest reduction in blood pressure
--Dramatic reduction in c-reactive protein (far greater than achieved with Crestor, JUPITER trial or no)
--Increased bone density (improved osteoporosis/osteopenia)
--Halting or reversal of aortic valve disease

(I don't see enough cancer in my cardiology practice to gauge whether or not there has been an impact on cancer incidence.)

My colleagues who have bothered to participate in the vitamin D conversation have issued warnings about not going "overboard" with vitamin D, generally meaning a level of >30 ng/ml.

I know of no rational basis for these cautions. If hypercalcemia (increased blood calcium) is the concern, then calcium levels can be monitored. I can reassure them that calcium levels virtually never go up in people (without rare diseases like sarcoid or hyperparathyroidism). Then why any hesitation in recreating blood levels that are enjoyed by tropical inhabitants exposed to plentiful sun that achieve these extraordinary health effects?

For the present, I have applied the target level of 60-70 ng/ml without apparent ill-effect. In fact, I have witnessed nothing but hugely positive effects.

Vitamin D Home Test

29. December 2008 William Davis (13)
The ever-resourceful Dr. John Cannell of the Vitamin D Council has announced the availability of an at-home, self-ordered vitamin D test kit for $65. The Vitamin D Council newsletter is reprinted below.

(However, please note that, as wonderful as the advice Dr. Cannell provides, I don't agree on several small points, such as the lack of need for vitamin D if you use a tanning bed or obtain "sufficient" sun; I have seen many people with dark tans, virtually all over 40 years old, who are still severely deficient. I attribute this to the lost capacity for vitamin D activation as we age.)

I have not used this service. Should anyone choose to try it, please let us know how it goes.



The Vitamin D Newsletter
December 28, 2008

The Vitamin D Council is happy to announce that we have partnered with ZRT Laboratory to provide an inexpensive, $65.00, in-home, accurate, vitamin D [25(OH)D] test. The usual cost for this test is between $100.00 and $200.00.

If you read this newsletter, you know about our interest in accurate vitamin D testing. In the next few weeks, you may read about the Vitamin D Council's quest for accurate vitamin D blood tests in the national media. Before we partnered with ZRT, we verified, repeatedly, that ZRT provides accurate and reliable vitamin D tests and that their method corresponds very well to the gold standard of vitamin D blood tests, the DiaSorin RIA.

Our ZRT service is not just inexpensive, it means no more worrying about your doctor ordering the right test or interpreting it correctly. You buy the test kit on the internet or by phone, a few days later the kit comes in the mail, you or a nurse friend do a finger stick, collect a few drops of blood, and send the blotter paper back to ZRT in the postage paid envelope provided with the kit. A week later you get results back in the mail and know accurate 25-hydroxy-vitamin D levels of you and your family.

For every test you order, ZRT will donate $10.00 to the Vitamin D Council. Please read the new page hyperlinked below on our website as it both explains the procedure and how to order the test.

http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml

Executive summary: keep your family's 25-hydroxy-vitamin D blood test above 50 ng/ml, year around. Most adults need at least 5,000 IU per day, especially this time of year. Most children need at least 1,000 IU per day per every 25 pounds of body weight. Bio Tech Pharmacal provides high quality and inexpensive vitamin D. Currently Bio Tech Pharmacal is providing vitamin D for numerous scientific studies. To see their prices and for ordering, click the hyperlink below.

http://www.bio-tech-pharm.com/catalog.aspx?cat_id=2

As a gift to our readers for the New Year, Thorne publications have provided a free download to a basic paper about vitamin D. I wrote it earlier this year for educated lay people as well as health care practitioners. Please read this paper carefully, your family's well-being, even lives, may depend on you understanding it.

http://www.thorne.com/altmedrev/.fulltext/13/1/6.pdf

Seasons Greetings
John Cannell, MD
vitamindcouncil.org

Where do Track Your Plaque membership revenues go?

26. December 2008 William Davis (9)
People pay about $90 per year to become Members on the Track Your Plaque website. This provide access to our in-depth Special Reports, guides, webinars, and our proprietary software data tracking tools. Members can also participate in online discussions, such as those in the Track Your Plaque Forum and chats.

Why is there a charge for membership in the program and where does the money go?

Money raised from membership fees goes towards:

1) The costs of doing business, e.g., server fees, software purchases, legal fees. Hosting webinars, for instance, costs us about $99 per month for the GoToWebinar software service.

2) Software development--Our most recent round of software data tracking tools, for instance, cost us nearly $30,000. That may not be a lot from big business standards, but it is onerous enough that obtaining membership dues really helps.

3) Graphics development--A website without graphics would be awfully dull, regardless of the quality of the textual content. Some of the newest tools on the Track Your Plaque website require photography and graphics work, which can add up very quickly.


Where membership fees do NOT go:

1) In our pockets--In fact, except for the various contractors who are paid for their services (e.g., software developers), NOBODY on the Track Your Plaque staff are paid: not me, nor any of the behind-the-scenes staff. Some of the staff overlap with my office staff, but they are paid purely out of the office revenues, not out of Track Your Plaque membership dues.

2) Towards overhead costs beyond those listed above--For example, membership fees do not pay for office lease, utilities, phones, etc.


We rely on membership fees because we have chosen to remain as free of commercial bias as possible. We host no advertising, we have no behind-the-scenes corporate or institutional agendas, we show no favoritism to any business or commercial operation. We believe this permits editorial freedom that few other health websites can enjoy. (In fact, I know of no other that is so free of commercial bias, outside of small blogs or narrow-interest websites.)

If you want to see what damage commercial bias can create, just go to a health website like WebMD. I challenge you to find information that is not flagrantly biased by commercial influence, namely that of the drug industry. (According to the WebMD SEC filings, in fact, the great majority--approximately 80%--of their $331 million revenues (2007) were derived directly or indirectly from the drug industry.) This commercial bias reaches into all of WebMD's related businesses, including MedicineNet.com, RxList.com, Medscape.com, and several others.

Preventing heart disease is not a money maker, sad to say. It is, from the perspective of conventional heart care, a big money loser. Undergo a heart catheterization, hospitalization, stent or bypass for anywhere from $14,000 to well over $100,000---or pay $90 for in-depth health information that dramatically reduces the potential need for the hospital and its procedures, minimizes need for prescription medication (statins alone, of course, are a $27 billion annual revenue phenomenon), and achieves all this by maximizing nutrition, self-purchased nutritional supplements, and inexpensive heart scans. Nobody is going to make a bundle off of this approach.

So that is why we charge a membership fee. I often get a laugh from some of the comments of people on this blog or even in my office who believe that we are rolling in money from the website from membership dues. The opposite is true: We don't pay ourselves. Virtually every penny is reinvested back into the website to better serve the Members.

Getting your dose of fish oil right

23. December 2008 William Davis (11)
Confusion often stems from the simplest of calculations: dose of fish oil.

Actually, you and I don't take fish oil for fish oil. We take fish oil for its content of omega-3 fatty acids, the dominant ones being EPA and DHA. The contents of fish oil outside of its EPA + DHA content likely exert little or no benefit (beyond that of other dietary oils).

To determine what you are currently taking, simply examine the back of your fish oil bottle and look for the EPA + DHA composition. This should be clearly and prominently labeled. If not, don't buy that brand again. Add up the EPA + DHA content per capsule, then multiply by the number of capsules you take per day. That yields your daily EPA + DHA intake.

The only other substantial source of omega-3 fatty acids is fish. Other food sources, such as non-fish meats, eggs, etc., contribute little or none. Processed foods that bear health claims of "contains heart healthy omega-3" often contain linolenic acid or flaxseed oil, which contributes very little to total EPA + DHA, or contain relatively trivial quantities of DHA. What are you doing eating processed foods, anyway?

What should the total daily dose of EPA + DHA dose be? That depends on what your goals are.

If your goal is to modestly reduce the risk of dying from heart attack, then just eating fish a couple of times per month will begin to exert an effect, or just taking a dose of 300 mg EPA + DHA per day from a low-potency capsule will do it. However, that's an awfully unambitious goal.

Our starting omega-3 dose in the Track Your Plaque program has, over the years, increased and now stands at 1800 mg EPA + DHA per day. However, the dose for 1) full reduction of triglycerides and/or triglyceride-containing abnormal lipoproteins, 2) reduction of Lp(a), and 3) the ideal dose for coronary and carotid plaque control are substantially higher.

But once you know your desired daily target of total EPA + DHA, you can easily determine the quantity of capsules to take by doing the above arithemetic, totaling the EPA + DHA per capsule. For example, if you have been instructed to take 6000 mg per day EPA + DHA, and your capsule contains 750 mg EPA + DHA, then you will need to take 8 capsules per day (6000/750).

Flat tummy . . . or, Why your dietitian is fat

19. December 2008 William Davis (19)
When I go to the hospital, I am continually amazed at some of the hospital staff: 5 ft 4 inch nurses weighing over 200 lbs, etc.

But what I find particularly bothersome are some (not all) hospital dietitans--presumably experts at the day-to-day of healthy eating--who waddle through the halls, easily 40, 50, or more pounds overweight. It is, to say the least, credibility-challenging for an obese dietitian to be providing nutritional advice to men or women recovering after bypass or stent while clearly not in command of nutritional health herself.

What's behind this perverse situation? How can a person charged to dispense "healthy" nutritional information clearly display such clear-cut evidence of poor nutrition?

How would you view a success coach dressed in rags? Or a reading coach who can barely read a sentence?

Easy: She follows her own advice.

Hospital dietitians are essentially forced to adhere to nutritional guidelines of "official" organizations, such as the American Heart Association and the USDA. There is some reason behind this. Imagine a rogue dietitian decides to advocate some crazy diet that yields dangerous effects, e.g., high-potassium diets in people with kidney disease. There is a role for oversite on the information any hospital staff member dispenses.

The problem, of course, doesn't lie with the dietitian, but with the organizations drafting the guidelines. For years, the mantra of hospital diets was "low-fat." More recently, this dated message has begun--only begun--to falter, but now replaced with the "healthy, whole grain" mantra. And that is the advice the hapless dietitian follows herself, unwittingly indulging in foods that make us fat.

Sadly, the "healthy, whole grain" message also contributes to heart disease via drop in HDL, increased triglycerides, a huge surge in small LDL, rise in blood sugar, increased resistance to insulin, tummy fat, and diabetes. Yes, the diet provided to survivors of heart attack increases risk.

The "healthy, whole grain" message also enjoys apparent "validation" through the enormous proliferation of commercial products cleverly disguised as healthy: Cheerios, Raisin Bran, whole grain bread, whole wheat pasta, etc. The "healthy, whole grain" message, while a health disaster, is undoubtedly a commercial success.

I'll bet that our fat dietitian friend enjoys a breakfast of healthy, whole grains in skim milk, followed by a lunch of low-fat chicken breast on two slices of whole grain bread, and ends her day with a healthy meal of whole wheat pasta. She then ascribes her continually climbing weight and size 16 figure to slow metabolism, lack of exercise, or the once-a-week piece of chocolate.

Wheat has no role in the Track Your Plaque program for coronary plaque control and reversal. In fact, my personal view is that wheat has no role in the human diet whatsoever.

More on this concept can be found at:

What's worse than sugar?

The Wheat-Deficiency Syndrome


Nutritional approaches: Large vs. Small LDL

Are you wheat-free?

Statin drug revolt

16. December 2008 William Davis (28)
I sense a growing revolt against the intrusion of statin drugs into our lives.

No doubt, the statin drug industry is, at least from an economic perspective, a huge success: $27 billion annual revenues at last accounting. The latest big plug for more and more statins was the JUPITER trial that showed reduced cardiovascular events on Crestor in people with "normal" LDL cholesterol levels and increased c-reactive protein.

It seems that not one day passes that doesn't include some news story about the "benefits" of statin drugs: reduction in heart attack, stroke, colon cancer, osteoporosis, heart failure, etc.

Ironically, the overwhelming economic success of the statin drug industry also seems to be encouraging a grassroots revolt.





More and more people are coming to the office, more people commenting on the web over how they want to avoid statin drugs, stop a drug they are already taking, or at least reduce the dose of an ongoing drug.

My day-to-day experience with coronary plaque control and reversal is that, while statin drugs are helpful tools, they are not necessary tools for full benefit of a prevention program. "Need" for statin drugs can differ by the patterns measured, though not the usual patterns suggested by the drug industry. For instance, using C-reactive protein, a la JUPITER, as justification for statin prescription is, in my view, totally absurd and makes no sense whatsoever, since inflammatory responses can be effective reduced with plenty of other strategies besides statin drugs. Conventional LDL, likewise, is a fictitious number that often bear little or no resemblance to the true and genuine measured value (apoprotein B or LDL particle number).

So here are a number of strategies that can help reduce or eliminate the "need" for a statin drug:

--Elimination of wheat and cornstarch--This is no namby-pamby dietary strategy, as low-fat diets were. This is a powerful, enormously effective strategy, particularly if LDL is in the small category. Small LDL drops like a stone when these foods are eliminated. This means no breads, pasta, breakfast cereals, pretzels, crackers, chips, tacos, wraps, etc.
--Non-wheat fibers--Especially raw nuts, ground flaxseed, and oat bran.
--Vitamin D restoration
--Fish oil
--Weight loss
--Niacin

There are additional strategies that focus on specific subsets of LDL cholesterol (e.g., Lp(a) masquerading as LDL). But the above list can reduce LDL cholesterol substantially, reducing the apparent "need" for a statin drug.

You will notice that there are few money makers in the above list, compared to the billions of dollars reaped by the statin drug industry. There is therefore little incentive to allow a pretty sales rep to go to your doctor and pitch the use of over-the-counter vitamin D or make changes in diet.

Statin drugs in my view need to be shoved back into their more limited role as drugs to be used on occasion when necessary (e.g., heterozygous familial hypercholesterolemia with LDL cholesterol values of 250 mg/dl in a person with measurable coronary plaque). These should never have achieved the "celebrity" status they enjoy, complete with gushing endorsements by TV personalities, daily news stories, and back-to-back TV commercials.

Join the revolt!

Lovaza Rip-off

14. December 2008 William Davis (107)
Lovaza is GlaxoSmithKline's prescription fish oil, an ethyl ester modification to allow higher concentration of omega-3 fatty acids, EPA + DHA, per capsule. Each capsule contains 840 mg EPA + DHA.

It is FDA-approved for treatment of high triglycerides (>500 mg/dl). In their marketing, they claim "Unlike LOVAZA, dietary supplements are not FDA approved to treat any disease." They also highlight the "patented five-step" purification process that eliminates any concerns over mercury or pesticide residues.

What does Lovaza cost? In Milwaukee, it costs about $70 per capsule per month (PCPM). Most people are taking four capsules per day: $280 per month, or $3360 per year to obtain 3360 mg of EPA + DHA per day. (Funny coincidence with the numbers.)

Did you catch that? $3360 per year, just for one person to take Lovaza.

What if I instead went to Costco and bought their high-potency fish oil. This is also an ethyl ester form. It costs $14.99 for 180 capsules, or $2.50 PCPM; each capsule contains 684 mg EPA + DHA. I would therefore have to take five capsules per day to obtain the same 3360 mg EPA + DHA per day. This would cost me 5 x $2.50 = $12.50 per month, or $150 per year.

$3360 per year vs. $150 per year to obtain the same dose of omega-3 fatty acids, or a 22.4-fold difference.

Lovaza is FDA-approved for treatment of high triglycerides. But I am seeing more and more people take it for other reasons at this four-capsule-per-day dose. Regardless, this "drug" is adding $3360 per year costs to our healthcare. A school teacher, for instance, recently commented to me that she didn't care about the costs, since her insurance (in Milwaukee county, teachers have unbelievably generous healthcare coverage) covers Lovaza. I've heard this from others: insurance covers it, so they don't care how much it costs.

Guess who eventually has to pay the $3360 per year per person costs? Yup, you and me. We all bitch and moan about the costs of healthcare and health insurance, but many of us are more than willing to shift the costs to our friends and neighbors to save a few bucks. You think Lipitor makes a bundle of money for Pfizer at about $120 per month? Lovaza is making a bundle of money for GlaxoSmithKline, and all because people are cheap and willing to selfishly shift costs to other people.

Keep in mind that $3360 per year is just for fish oil. It's not for surgery, it's not for hospital care, it's just for stinking fish oil.
Why do morphine-blocking drugs make you lose weight?

Why do morphine-blocking drugs make you lose weight?

10. November 2010 William Davis (24)
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.
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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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