In search of wheat: We bake einkorn bread

With the assistance of dietitian and health educator, Margaret Pfeiffer,MS RD CD, author of Smart 4 Your Heart and very capable chef and breadmaker (previously, before she gave up wheat), we made a loaf of bread using Eli Rogosa's einkorn wheat. Recall that einkorn wheat is the primordial 14-chromosome wheat similar to the wild wheat harvested by Neolithic humans and eaten as porridge.

The essential question: Has wheat always been bad for humans or have the thousands of hybridization experiments of the last 50 years changed the structure of gluten and other proteins in Triticum aestivum and turned the "staff of life" into poison? I turn to einkorn wheat, the "original" wheat unaltered by human manipulations, to figure this out. While einkorn wheat is still a source of carbohydrates, is it something we might indulge in once in a while without triggering the adverse phenomena associated with modern wheat?   

Here's what we did:

This is the einkorn grain as we received it from Eli's farm. This was enough to make one loaf (approximately 3 cups).











The einkorn grain is a dark golden color. I tried chewing them. They taste slightly nutty. They soften as they sit in your mouth.





Here's Margaret putting the einkorn grain into the electric grinder.









We tried to grind the grain by hand with mortar and pestle, but this proved far more laborious than I anticipated. After about 15 minutes of grinding, this is what I got:



Barely 2 tablespoons. That's when Margaret fired up the electric grinder. (I can't imagine having to grind up enough flour by hand for an entire family. Perhaps that's why ancient cultures were thin despite eating wheat. They were just exhausted!)

We added water, salt, and yeast, then put the mix into an electric breadmaker to knead the dough and keep it warm.

We let the dough rise for 90 minutes, much longer than conventional dough. The einkorn dough "rose" very little. Margaret tells me that most dough made with conventional flour rises to double its size. The einkorn dough increased no more than 20-30%.

The einkorn dough also distinctly smelled like peanut butter.





After rising, we baked the dough at 350 degrees F for 30 minutes. This is the final product.

Because I want to gauge health effects, not taste, the bread we made had no added sugar or anything else to modify taste or physiologic effect.

On first tasting, the einkorn bread is mildly nutty and heavy. It had an unusual sour or astringent taste at the end, but overall tasted quite good.

Next: What happens when we eat it? I'm going to give the einkorn bread (I've got to make some more) to people who experience acute reactions to conventional wheat and see if the einkorn does the same. I will also assess blood sugar effects since, after all, hybridizations or no, it is still a carbohydrate.



Margaret Pfeiffer's book is available on Amazon:

Ezekiel said what?

Some people are reluctant to give up wheat because it is talked about in the Bible. But the wheat of the Bible is not the same as the wheat of today. (See In search of wheat and Emmer, einkorn and agribusiness.) Comparing einkorn to modern wheat, for example, means a difference of chromosome number (14 chromosomes in einkorn vs. 42 chromosomes in modern strains of Triticum aestivum), thousands of genes, and differing gluten content and structure.

How about Ezekiel bread, the sprouted wheat bread that is purported to be based on a "recipe" articulated in the Bible?

Despite the claims of lower glycemic index, we've had bad experiences with this product, with triggering of high blood sugars, small LDL, and triglycerides not much different from conventional bread.

David Rostollan of Health for Life sent me this interesting perspective on Ezekiel bread from an article he wrote about wheat and the Bible. David argues that the entire concept of Ezekiel bread is based on a flawed interpretation.

"I Want to Eat the Food in the Bible."


Are you sure about that?

Some people, still wanting to be faithful to the Bible, will discard the "no grain/wheat" message on the basis of biblical example. After all, God told Ezekiel to make bread, he gave the Israelites "bread from heaven," and then Jesus (who is called the "Bread of Life"!) multiplied bread, and even instituted the New Covenant with what? Bread and wine! If you're going to live the Bible, it seems that bread and/or wheat is going to play a part.

But this is unnecessary. Sure, the Bible can and does tell us how to live, but this doesn't mean that everything in the Bible is meant to be copied verbatim. Applying the Bible to our lives requires wisdom, not a Xerox machine.

The Bible was written in a historical context, and the setting happened to be an agricultural one. Because of this, the language used to describe blessing spoke of things like fields full of grain, or barns overflowing with wheat. Had the Bible been written in the context of a hunter-gatherer culture, the language describing blessing probably would have been about the abundance of wild game, or baskets full of vegetables. Whatever is most valuable in your time and in your culture is a blessing. God accommodated His message to the culture as it existed at the time. This is done throughout Scripture.

There is a danger, then, in merely copying what the Bible says, instead of extracting the principles by which to live. Take the above example of Ezekiel, for instance. There's a whole product line in health food stores called "Ezekiel Bread" that supposedly copies the recipe given in Ezekiel 4:9. This is from the website:

"Inspired by the Holy Scripture verse Ezekiel 4:9., 'Take also unto thee Wheat, and Barley, and beans, and lentils, and millet, and Spelt, and put them in one vessel, and make bread of it...'"

Believing that this "recipe" has some kind of special power just because it's in the Bible is ridiculous. How ridiculous is it? I'll tell you in a moment, but first let me say that this is why it's so important not to confuse descriptives with prescriptives. Is the Bible telling a story, or is it telling us to do something? We would be well-advised not to confuse the two.

In the case of the Ezekiel Bread, what is going on in the passage? There's a siege going on, with impending famine, and Ezekiel is consigned to eating what was considered back then to be some of the worst possible food. It was basically animal chow. But that's not the worst thing going on in this passage. Apparently, when the makers of Ezekiel Bread were gleaning their inspiration for the perfect recipe, they stopped short
of verse 12:

"And thou shalt eat it as barley cakes, and thou shalt bake it with dung that cometh out of man, in their sight."

Um...what? Well, there was a good reason for this. God was judging His people, and by polluting this really bad bread with dung (which was a violation of Mosaic law; Lev. 5:3), He was saying that they were no different from the unclean Gentiles.

So why would we take this story and extrapolate a bread recipe from it? Beats me. If you were going to be consistent, though, here's what you'd have to end up with:



Let that be a lesson to you. We don't just go and do everything that we see in the Bible.

Low-carb gynecologist

I met infertility specialist, Dr. Michael Fox, on Jimmy Moore's low-carb cruise just this past March.

Dr. Fox is quiet and unassuming, but had incredible things to say about his experience with carbohydrate restriction in female infertility and pregnancy. While readers of The Heart Scan Blog already know that I advocate a diet free of wheat, cornstarch, and sugar for heart health and correction of multiple lipoprotein abnormalities, it was fascinating to hear how a similar approach seems to yield extraordinary benefits in this entirely unrelated area of female health. Obviously, female infertility and pregnancy are unrelated to heart health, but the extraordinary benefits witnessed by Dr. Fox in this area suggest that some fundamental lessons in human physiology can be learned. The results are so incredible that we are all sure to hear more about this approach as experience grows.

So I tracked Dr. Fox down in his busy Jacksonville, Florida practice to fill us in on some details.

WD: Dr. Fox, could you tell us something about yourself and what led you to use carbohydrate restriction in your female patients?

MF: I have been in practice as a reproductive endocrinologist for 15 years. During that time, I have seen our specialty move from a broad based practice of reproductive endocrinology to a narrow IVF [in vitro fertilization] focus, with patients being pushed through IVF in a cookie-cutter fashion without any emphasis on non-medical therapy.

Our focus has been to remain as a broad practice where we individualize care and attempt in every case to achieve pregnancy short of IVF. Five years ago, this continued quest for better care led us into the insulin resistance, low-carbohydrate metabolic world that has transformed our practice, although our practice offers all aspects of reproductive endocrinology including sub-specialized minimally invasive surgery, and all available infertility options.


WD: I have been intrigued by your comments about improved fertility with the low-carb diet. Could you elaborate on this?

MF: Yes, five years ago, as more information regarding Polycystic Ovarian Disease or Syndrome (PCOD/S) and its relationship to insulin resistance (high insulin levels) was emerging, we had a simple realization. As we've known for some time, insulin stimulates excess male hormone levels in the ovary, which disrupts ovulation and fertility. Then our job was to lower or virtually eliminate high insulin levels. Again, in simple fashion, we looked at physiology and realized that insulin is released only in response to dietary carbohydrates. Thus, elimination of carbohydrates should resolve the problem. This, in fact, is the effect that we have seen.

In our previous approaches to PCOD, we utilized oral ovulation medicines generating pregnancy rates in the 40% range overall. Now, with the nutritional approach, for those patients that follow our recommendations, our pregnancy rates are over 90%! This has dramatically reduced the need for in vitro fertilization in these patients.

To extend this idea further, we first started with relative low-carbohydrate diets, such as the South Beach diet, but quickly realized this didn't produce a metabolic effect. Over time, it has borne out that only the very low-carbohydrate diet (VLCD) approach produces significant metabolic change. Our impression then was that the current U.S. nutritional exposure probably increases insulin levels and that this has a detrimental effect on fertility.

To counter this effect, we now recommend the VLCD to all fertility patients and their spouses. The pregnancy rates do seem much better overall, as well as seeing a reduction in miscarriage rates. For the first time at our national meeting last year, there were three articles that showed improved pregnancy rates in patients without PCOD or insulin resistance in IVF when Glucophage was used. This drug decreases insulin. This supports the idea that our entire population is subjected to fertility-reducing high-carbohydrate diet.

WD: Do you see any other changes in these patients on the diet?

MF: Yes. All metabolic parameters, as well as many common complaints, improve. Cholesterol and triglyceride levels improve, while "good" HDL cholesterol levels increase. Weight drops at a pace of 12 lbs per month very steadily and we have many many patients who have experienced 50lb wt loss. Blood pressure decreases steadily in these patients and we are often able to get them off of cholesterol and blood pressure medicines. Common symptoms such as anxiety, sleep disturbances, decreased energy, migraine headaches and depression all dramatically improve. Again we can often get patients off depression and migraine suppression medications. So this approach helps in a multitude of areas.



WD: I was also interested in hearing more about your experience with morning sickness and the effects of a low-carb diet. Could you tell us more about this? Also, any thoughts on why this happens?

MF: As we continued to expand our thoughts about VLCD and fertility/pregnancy, we began to extend the nutritional approach into pregnancy. We know that pregnancy hormones dramatically worsen insulin resistance that is responsible for the condition, gestational diabetes. If insulin resistance is worsened, then reactive hypoglycemia is worsened. One of the biggest symptoms of hypoglycemia is nausea. So, in response to this, we have counseled our patients on the diet in pregnancy and have found a dramatic reduction in nausea. We recommend snacking every two hours in pregnancy.

The other "traditional" issue in pregnancy are cravings. These also likely stem from hypoglycemia. I have had many husbands tell us later that their wives, in contrast to friends etc, were calm and not moody or anxious during their pregnancies. Hypoglycemia probably is a serious issue for the fetus as well and may be the "signal" that turns on the insulin-resistant gene. Many theorists feel this might be an activated gene during the pregnancy.


WD: Do you use any unique approaches to the low-carbohydrate approach, e.g., inclusion of dairy, meal frequency, "induction" strategies (i.e., induction to the diet, not of labor!), etc.?

MF: Yes. As I'm sure everyone who works in the VLCD world does, we also have some tricks to make this work better. My biggest push, although hard to get patients to agree, is to see a counselor along with our follow-up in order to deal with "addictive behaviors" and "stress eating" that so many of our patients relate to us. Good stress management and cognitive behavioral therapy go a long way in helping this become a permanent change.

We also really push frequent calorie intake or "snacking." I think again that hypoglycemia produces an inborn drive to "cure" or "fix" starvation and leads to dramatic overeating. We have a short list of snacks that we recommend. The concept of hunger is offered as a failure of the program. We aim to eliminate hunger, as it represents hypoglycemia. The analogy I use is, if you drove your car until you ran out of gas before you ever sought to find gas, your life would be miserable. So it is the same with your metabolic engine: If you let it run out, the measures your system takes to fix it are very detrimental to life and certainly to nutritional health.

Our other big push is fat. People can wrap themselves around protein and vegetables, but they totally miss the high-fat (animal fat) part of the conversation. We have to really push that aspect. In regards to dairy, we allow for non-processed cheeses and minimal milk. An alternative is to mix about 4 oz whole milk with 4 oz of heavy whipping and 4 oz of water to create a "milk" with less sugar. Similarly, shakes and smoothies can be made with heavy whipping cream with pure whey protein powder added to create a liquid meal for those who "don't have time" to cook.


WD: Thanks, Dr. Fox. We look forward to hearing more about your approach in future.

Contact information:

Michael D. Fox, MD
Jacksonville Center
Reproductive Medicine
www.JCRM.org
Phone 904-493-2229

Track Your Plaque reduces healthcare costs 35%

Allow me to wear my Track Your Plaque hat for this post.

Mr. Richard Rawle is CEO of Utah company, Tosh, Inc. Mr. Rawle has been an avid follower of the Track Your Plaque program and has introduced the program to company employees. Here's what he has to say about the experience:

“Our company has been utilizing the principles of TYP [Track Your Plaque] for over a year and has experienced great results that have positively impacted the lives of our employees and our health care costs.

Since we began our wellness program, we have presented the TYP diet and lifestyle guidelines to all of our employees and their families. Although the overwhelming majority of our employees do not have cardiovascular issues, the preventative nature of TYP is too important not to be utilized. The TYP principles along with our increased focus on healthy living have already changed our group’s blood chemistry. HDL levels in particular have increased significantly and resulted in a large percentage of our employees having HDL levels of 60 or higher. Vitamin D levels have substantially increased and LDL levels have significantly decreased in the majority of our employees. Subsequently, in the 12 months just ended, our health care costs are some 35% less than other groups of comparable size and age.

I believe the TYP program has been an integral part of the success of our company's vast improvement in employee health/wellness, resulting in significant health care cost reductions."

Richard Rawle
CEO Tosh Inc.


Track Your Plaque saves lives. Track Your Plaque also saves money . . . lots of it. Despite the upfront costs of some additional blood testing and a heart scan, the dramatic reduction in need for medications, reduced heart attack, diabetes, and many other chronic conditions add up to a huge cost savings, much as Tosh, Inc. employees have enjoyed.

The Federal government has been looking towards large hospital systems to lead the way in healthcare delivery, systems that employ their physicians and possess economies of scale. But I say the answer to reducing healthcare costs will NEVER be found in hospital systems. Healthcare cost savings will be realized by delivering truly effective health solutions directly to people themselves, much as we do in Track Your Plaque.

In search of wheat

Many people ask: "How can wheat be bad if it's in the Bible?"

Wheat is indeed mentioned many times in the Bible, sometimes literally as bread, sometimes metaphorically for times of plenty or freedom from starvation. Moses declared the Promised Land "a land of wheat, and barley, and vines, and fig trees, and pomegranates; a land of oil olive, and honey" (Deuteronomy 8:8).

Wheat is a fixture of religious ceremony: sacramental bread in the Eucharist of the Christian church, the host of the Holy Communion in the Catholic church, matzoh for Jewish Passover, barbari and sangak are often part of Muslim ritual. Wheat products have played such roles for millenia.

So how can wheat be bad?

What we call wheat today is quite different from the wheat of Biblical times. Emmer and einkorn wheat were the original grains harvested from wild growths, then cultivated. Triticum aestivum, the natural hybrid of emmer and goatgrass, also entered the picture, gradually replacing emmer and einkorn.

The 25,000+ wheat strains now populating the farmlands of the world are considerably different from the bread wheat of Egyptians, different in gluten content, different in gluten structure, different in dozens of other non-gluten proteins, different in carbohydrate content. Modern wheat has been hybridized, introgressed, and back-bred to increase yield, make a shorter stalk in order to hold up to greater seed yield, along with many other characteristics. Much of the genetic work to create modern wheat strains are well-intended to feed the world, as well as to provide patent-protected seeds for agribusiness.

What is not clear to me is whether original emmer, einkorn, and Triticum aestivum share the adverse health effects of modern wheat.

Make no mistake about it: Modern wheat underlies an incredible range of modern illnesses. But do these primitive wheats, especially the granddaddy of them all, einkorn, also share these effects or is it a safe alternative--if you can get it?

I've ordered 2 lb of einkorn grain, unground, from Massachusetts organic farmer, Eli Rogosa, who obtained einkorn seed from the Golan Heights in the Middle East. We will be hand-grinding the wheat and making einkorn bread. We will eat it and see what happens.

Super-carbohydrate

Wheat starches are composed of polymers (repeating chains) of the sugar, glucose. 75% of wheat carbohydrate is the chain of branching glucose units, amylopectin, and 25% is the linear chain of glucose units, amylose.

Both amylopectin and amylose are digested by the salivary and stomach enzyme, amylase, in the human gastrointestinal tract. Amylopectin is more efficiently digested to glucose, while amylose is less efficiently digested, some of it making its way to the colon undigested.

Amylopectin is therefore the “complex carbohydrate” in wheat that is most closely linked to its blood sugar-increasing effect. But not all amylopectin is created equal. The structure of amylopectin varies depending on its source, differing in its branching structure and thereby efficiency of amylase accessibility.

Legumes like kidney beans contain amylopectin C, the least digestible—hence the gas characteristic of beans, since undigested amylopectin fragments make their way to the colon, whereupon colonic bacteria feast on the undigested starches and generate gas, making the sugars unavailable for you to absorb.

Amylopectin B is the form found in bananas and potatoes and, while more digestible than bean amylopectin C, still resists digestion to some degree.

The most digestible is amylopectin A, the form found in wheat. Because it is the most readily digested by amylase, it is the form that most enthusiastically increases blood sugar. This explains why, gram for gram, wheat increases blood sugar to a much greater degree than, say, chickpeas.

The amylopectin A of wheat products, “complex” or no, might be regarded as a super-carbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all other carbohydrate foods.

Emmer, einkorn, and agribusiness

10,000 years ago, Neolithic humans did not obtain wheat products from the bagel shop, grocery store, or Krispy Kreme. They obtained wheat by locating a nearby wild-growing field of wild emmer or einkorn wheat grass, then harvesting it with their stone sickles.

Neolithic humans, such as the Natufians of the Fertile Crescent, carried their freshly-cut wheat home, then ground it by hand using homemade mortar and pestle. As yeast-raised bread was still some 5000 years in the future, emmer and einkorn wheat was not used to bake bread, but was consumed as a porridge in bowls. Einkorn has the simplest genetic code of 14 chromosomes, while emmer has 28 chromosomes.

A third variety of wheat appeared on the scene around 9000 years ago, a natural hybridization between emmer and goat grass, yielding the 42-chromosome Triticum aestivum species. Egyptians learned how to cause wheat to rise around 3000 BC, yielding bread, rather than the unleavened flatbreads of their predecessors.

From the original three basic varieties of wheat available to Neolithic man, over the past 30 years wheat has exploded to over 25,000 varieties. Where did the other 24,997+ strains come from?

In the 1980s, thousands of new wheat strains arose from hybridization experiments, many of them conducted in Mexico. Then, in the late 1980s, genetic engineering quietly got underway in which geneticists inserted or deleted single genes, mostly designed to generate specific characteristics, such as height, yield per acre, drought resistance, but especially resistance to various pesticides and weed killers. The fruits of these efforts were introduced into the market in 1994. Most of the genetically modified foods were thought to be only minor modifications of the unmodified original and thus no safety testing in animals or humans was conducted.

We now have many thousands of wheat strains that are different in important ways from original emmer, einkorn, and Triticum aestivum wheat. Interestingly, it has been suggested that einkorn wheat fails to provoke the same immune response characteristic of celiac disease provoked by modern wheat gluten, suggesting a different amino acid structure in gluten proteins. Another difference: Emmer wheat is up to 40% protein, compared to around 12% protein for modern wheat.

In other words, the wheat of earlier agricultural humans, including the wheat of Biblical times, is NOT the wheat of 2010. Modern wheat is quite a different thing with differing numbers of chromosomes, different genes due to human manipulation, varying gluten protein composition, perhaps other differences.

Somewhere in the shuffle and genetic sleight-of-hand that has occurred over the last 30 years, wheat changed. What might have been the "staff of life" has now become the cause of an incredible array of diseases of "wheat" intolerance.

Near-death experience with nattokinase

This is a true story that I personally witnessed.

A 60-some year old man heard that nattokinase "thinned the blood." So he had been taking it for the past 6 months.

One week before he came to see me, he abruptly became quite breathless. He was unable to walk more than 20 feet or bend over to tie his shoes due to the breathlessness.

He came to see me in the office. I was alarmed by how breathless he was without signs of heart failure or other obvious explanation. I sent him for an immediate CT pulmonary angiogram. Within 30 minutes, we had the diagnosis: a large "saddle" pulmonary embolus, meaning a large blood clot that straddled the right and left main pulmonary arteries. One wrong move and . . . bang! He would have been dead within a couple of minutes, since a large clot can completely occlude the large arteries feeding the lung, essentially corking any blood circuiting through the lungs and back to the left side of the heart. (Causing, incidentally, electromechanical dissociation, in which the heart keeps beating for a few minutes but no blood is being pumped. CPR can keep you alive for a few minutes, then it's over.)

When I advised the patient of the diagnosis (after initiating the REAL anticoagulants), he said, "But I was taking nattokinase!"

Exactly. Blood clots are no laughing matter. They are potentially fatal events. Betting your life on some company's advertisement is nothing short of foolish.

Anyone who reads The Heart Scan Blog knows that I am an avid supporter of nutritional supplements. I even write articles and consult for the supplement industry. But I truly despise hearing unfounded marketing claims that some supplement companies will make in the pursuit of a fast buck.

There is no doubt that we need better, safer methods to deal with dangerous blood clots, whether in the lung, pelvis, or other areas. But, before anyone takes a leap based on the extravagant marketing claims made by a supplement manufacturer, you want to be damn sure there are real data--not marketing claims, REAL data--before you use something like nattokinase in place of a proven therapy.

Don't confuse the very interesting, though unpalatable, natto with nattokinase. Natto contains vitamin K2 and some other interesting compounds, including nattokinase.

Blame the gluten?

Wheat is among the most destructive components of the human diet, a food that is responsible for inflammatory disease, diabetes, heart disease, several forms of intestinal diseases, schizophrenia, bipolar illness, ADHD, behavioral outbursts in autistic children . . . just to name a few.

But why?

Wheat is mostly carbohydrate. That explains its capacity to cause blood sugar to increase after eating, say, a turkey sandwich on whole wheat bread. The rapid release of sugars likely underlies its capacity to create visceral fat, what I call "wheat belly."

But neither the carbohydrate nor the other components, like bran and B vitamins, can explain all the other adverse health phenomena of wheat. So what is it in wheat that, for instance, worsens auditory hallucinations in paranoid schizophrenics? Is it the gluten?

First of all, what is gluten?

Gluten protein is the focus of most wheat research conducted by food manufacturers and food scientists, since it is the component of wheat that confers the unique properties of dough, allowing a pizza maker to roll and toss pizza crust in the air and mold it into shape. The distinctive “doughy” quality of the simple mix of wheat flour and water, unlike cornstarch or rice starch, for instance, properties that food scientists call “viscoelasticity” and “cohesiveness,” are due to the gluten. Wheat is mostly carbohydrate, but the 10-15% protein content is approximately 80% gluten. Wheat without gluten would lose its unique qualities that make it desirable to bakers and pizza makers. Gluten is also the component of wheat most confidently linked to immune diseases like celiac.

The structure of gluten proteins has proven frustratingly elusive to characterize, as it changes over time and varies from strain to strain. But an understanding of gluten structure may be part, perhaps most, of the answer to the question of why wheat provokes negative effects in humans.

The term “gluten” encompasses two primary families of proteins, the gliadins and the glutenens. The gliadins, one of the protein groups that trigger the immune response in celiac disease, has three subtypes: a/ß-gliadins, ?-gliadins, and ?-gliadins. The glutenins are repeating structures, or polymers, of more basic protein structures.

Beyond gluten, the other 20% or so of non-gluten proteins in wheat include albumins, prolamins, and globulins, each of which can also vary from strain to strain. In total, there are over 1000 other proteins that serve functions from protection of the grain from pathogens, to water resistance, to reproductive functions. There are agglutinins, peroxidases, a-amylases, serpins, and acyl CoA oxidases, not to mention five forms of glycerinaldehyde-3-phosphate dehydrogenases. I shouldn’t neglect to mention the globulins, ß-purothionin, puroindolines a and b, tritin, and starch synthases.

As if this protein/enzyme smorgasbord weren’t enough, food processors have also turned to fungal enzymes, such as cellulases, glucoamylases, xylanases, and ß-xylosidases to enhance leavening and texture. Many bakers also add soy flour to enhance mixing and whiteness, which introduces yet another collection of proteins and enzymes.

In short, wheat is not just a simple gluten protein with some starch and bran. It is a complex collection of biological material that varies according to its genetic code.

While wheat is primarily carbohydrate, it is also a mix of gluten protein which can vary in structure from strain to strain, as well as a highly variable mix of non-gluten proteins. Wheat has evolved naturally to only a modest degree, but it has changed dramatically under the influence of agricultural scientists. With human intervention, wheat strains are bred and genetically manipulated to obtain desirable characteristics, such as height (ranging from 18 inches to over 4 feet tall), “clinginess” of the seeds, yield per acre, and baking or viscoelastic properties of the dough. Various chemicals are also administered to fight off potential pathogens, such as fungi, and to activate the expression of protective enzymes within the wheat itself to “inoculate” itself against invading organisms.

From the original two strains of wheat consumed by Neolithic humans in the Fertile Crescent 9000 years ago (Emmer and Einkorn), we now have over 200,000 strains of wheat virtually all of which are the product of genetic manipulations that have modified the protein structure of wheat. The extraordinary complexity of wheat proteins have therefore created a huge black box of uncertainty in pinpointing which protein causes what.

But there's an easy cure for the uncertainty: Don't eat it.

Glycemic gobbledygook

The concept of glycemic index is meant to help determine what foods raise blood sugar a lot vs. what foods raise blood sugar a little. Dr. Jennie Brand-Miller's searchable database can be found here.

I have to admit that glycemic index provided me with a sense of false assurance for some years. It screwed up my health until I came to understand the issues a lot better.

For those of you just starting out in nutritional conversations, glycemic index (GI) represents a comparison of the blood glucose area-under-the-curve (AUC) over 2 hours after consuming 50 grams of the food in question compared to the AUC of glucose or white bread. Volunteers involved in developing these values are healthy people who are generally of normal weight.

Glucose, by definition, has a GI of 100. An equal quantity of sucrose (50% glucose, 50% fructose) has a GI of 60, lower than glucose. An equal quantity of whole wheat bread has a GI of 68-77 (Yes: The GI of whole wheat is higher than sucrose). Non-carbohydrate foods, such as eggs or avocado, have no GI since they do not impact on blood glucose.

Because the GI is also sensitive to how much carbohydrate is contained, the concept of Glycemic Load (GL) was introduced:

GL = (GI x amount of carbohydrate) / 100

GL is therefore the GI that incorporates the glycemic potential of the food of interest. GI does not vary with portion size; GL varies with portion size.

Let's take whole wheat pasta, a food regarded by most people as a healthy choice. Whole wheat pasta has a GI of 55--fairly low--and a GL of 29. A serving of 180 g (approximately 6 oz cooked) provides 50 g carbohydrates.

People who advocate that low-glycemic index foods would say that this is a desirable profile and should therefore replace high-glycemic index foods.

I say WRONG. First of all, most of us are not slender 20-somethings. We will therefore not show the same response as a young, slender person (like the GI volunteers), but will show exagerrated blood sugar responses. So this much low-glyemic index whole wheat pasta will typically yield a blood sugar of 120-200 mg/dl in non-diabetic people, high enough to trigger glycation. Sure, a high-glycemic index food, such as white flour birthday cake with plenty of sugary icing, might trigger a blood sugar of 140-250 mg/dl, much worse. But that doesn't make the lower blood sugar following pasta any less bad--it's still terrible.

Another issue: GI is assessed over a 2-hour timeline. What if blood sugar remains high in a sustained way, say, over 6 hours? That's precisely what whole wheat pasta will do: Keep blood sugar high for an extended period.

So not only does a low-glycemic index food like pasta increase blood sugar in most of us extravagantly, it does so in a sustained way.

Lastly, low-glycemic index pasta still triggers small LDL particles to an extreme degree, as I discussed in the previous Heart Scan Blog post, Small LDL: Complex vs. simple carbohydrates.

Don't be false reassured by the notion of low GI or GL. In fact, I'd go so far as to say that NO glycemic index is a GOOD glycemic index (or load). The foods we want to dominate our diet are the foods that aren't even listed in the GI database.
Do your part to save on healthcare costs

Do your part to save on healthcare costs

While many of the factors that drive the relentless increase in health care costs are beyond individual control, you are still able to exert personal influence over costs. Just as in political elections, your one vote alone may not count; it's the collective effort of many people who share similar opinions that results in real change.

I just got the new monthly premium for my high-deductible health insurance: Up $300 per month, putting my family's total premium over $2000 per month---for four healthy people. (My son fractured his wrist playing high school hockey earlier this year; that may explain at least some of the increase.)

I'm going to shop around for a better deal. However, shopping is likely to only stall the process. It will not address the systemic problems with healthcare that continue to drive premiums up and up and up.

So what can you do to help keep costs down? Here are a few thoughts:

Never accept a prescription for fish oil, i.e., Lovaza. Just buy far less costly over-the-counter fish oil. I treat complex hyperlipidemias, including familial hypertriglyceridemia, ever day. I NEVER use prescription fish oil. A typical 4 capsule per day Lovaza prescription adds around $280 to $520 per month to overall health costs (though your direct out-of-pocket costs may be less, since you shove the costs onto others in your plan).

Never accept a prescription for vitamin D. Prescription vitamin D is the mushroom or invertebrate form anyway. Just buy the human (cholecalciferol, D3) form from your health food store or "big box" store. They yield consistent increases in 25-hydroxy vitamin D levels, superior to the prescription form. And they're wonderfully inexpensive.

Eliminate wheat from your diet. If there is a dietary strategy that yields unexpected and outsized benefits across a wide spectrum of health, it's elimination of this thing we're sold called "wheat," you know, the genetically-transformed, high-yield dwarf mutant that now represents 99% of all wheat sold. Blood sugar drops, pre-diabetics become non-prediabetics, diabetics reduce need for medication or become non-diabetic, cholesterol values plummet, arthritis improves, acid reflux and irritable bowel symptoms improve or disappear, just to mention a few. Wheat elimination alone, I believe, would result in incalculable savings in both healthcare costs and lives saved.

Be sure to obtain iodine. In the fuss to cut salt use, everyone forgot about iodine. Lack of iodine leads to thyroid disease, usually hypothyroidism, that, in turn, causes cholesterol values to increase, weight to increase, and heart disease risk to double, triple, or quadruple. Iodine supplementation is easy and wonderfully inexpensive.

Over time, I hope that all of us can help develop the effort to self-direct more and more of our own health. Our Track Your Plaque program has shown me that, not only can people take the initiative to direct aspects of their own health, they can do it better than 99% of doctors.  

I'm sure there are many, many other ways to help reduce costs. Any suggestions?

Comments (37) -

  • Chuck

    12/13/2010 4:07:49 AM |

    don't rush to the doctor for every sniffle, sneeze, bump or bruise.  too many see their doctors way too often.  also, don't rush to the ER everytime your kid cries for more than 60 seconds.

    get a plan that has a health savings account.  these typically have a very high deductible ($250 per individual) and cover one check up per year.  a lot of health care costs end up being out of pocket.  makes you think twice about frivolous health care expenditures.  also causes you to want to be a healthier person.

  • Patty

    12/13/2010 4:14:31 AM |

    Our premium for our the highest deductible option we could get health insurance, for 2 adults, went up $500. And neither of us have had any medical procedures, we take no prescriptions, and never even entered a doctor's office last year.  At some point, it's no longer insurance...it's highway robbery.  

    And we eliminated all grains from our diet earlier this year, so hopefully we will go another year without needing a doctor.  Really makes it hard to keeping paying that premium...

  • Ailu

    12/13/2010 4:57:49 AM |

    You are so right... it's crazy.  Our insurance premiums got so high we couldn't pay our other bills.. our deductible was $9800.  Add to that our regular Dr. bills and it was insane.  

    The clincher was when the naturalist lady down the street was dying of malignant melanoma. It had reached her lymph nodes.  Her family told me the drs insisted on operating to take them out, plus chemo.  But what does this crazy lady do?  She says "no way, I'm gonna go the natural route".  I mean, this lady is DYING.  She even smells like death.  Three weeks later I see her at the grocery store, and she looks like she just came from the gym.  "My goodness, you look so much better! What have you been doing?" She says "Oh, eating a lot of greens, I am so sick of greens! But it's keeping my PH between 7.2 & 7.4.  My naturopath said hardly no one dies of cancer, they just die of acidosis." It's now 3 months later, and the woman is running around like a teenager.  

    Well this was always my great fear. Cancer - w/o insurance. So now, I ask myself, why the heck am I going broke trying to pay for this insurance?  Stick a fork in me, I'm done. Feed me some greens.

  • terrence

    12/13/2010 5:01:06 AM |

    Come you guys, Saint Obama FIXED the American Health Care System. Didn't he... He really did, didn't he - he SAID he would...

  • Anonymous

    12/13/2010 6:37:50 AM |

    Dr. Davis, you forgot to mention that another big saver is never to buy prescription Niaspan, but instead buy over the counter Slo-Niacin or Endur-acin.

    One other big money saver is to invest in a pill cutter as most drugs cost the same for all dosage options. Have your Doc double your dosage and then just cut the pills in half and save 50% right off the bat.

  • Hans Keer

    12/13/2010 7:20:55 AM |

    I would say, start living a low-carb paleo lifestyle and you won't need supplementation and medical care (except from healing that wrist Smile ) at all. How do you do this? http://www.cutthecarb.com/getting-started/

  • Anne

    12/13/2010 8:41:56 AM |

    I really enjoy this blog and have got a lot of useful information from it over the years. But goodness, I know for sure that America is a dreadful place to live for health care ! I feel much safer in the United Kingdom where I know I get an excellent service from the National Health Service.

    Also, vitamin D3, oil based cholecalciferol, has recently become available here on prescription. It's a German manufacture called Dekristol and is good value - 50 capsules of 20,000 IU each costs about £20 to the NHS (l£7.20 directly to the patient). That's cheaper than any health food shop over here !

  • Dr. William Davis

    12/13/2010 1:01:20 PM |

    Yes, no Niaspan! That one completely slipped my mind.

    I used to be the largest prescriber of Niaspan in Wisconsin. Now I use Sloniacin or Enduracin exclusively. Compared to about $150-$170 per month for two tablets of Niaspan, the equivalent quantity of Sloniacin or Enduracin costs around $8.

    Thanks for reminding me, Anon.

  • Dr. William Davis

    12/13/2010 1:03:16 PM |

    Hi, Chuck-- Yes, indeed. In fact, that is probably what I am going to do personally.


    Hi, Patty--I've had that same impulse. Unfortunately, one hospitalization is enough to bankrupt most people, or at least strip you of all your savings and retirement money. That's yet another part of the story.

  • Roger

    12/13/2010 1:21:26 PM |

    I won't go to doctors that overcharge the insurance company. I changed plans and needed a refill of Flonase, which my previous doctor prescribed for hay fever. My new doctor wouldn't write the prescription unless I came in for an office visit, for which he billed the insursance company $500. He used the time to pitch his surgery services, saying if I was ever in the hospital and needed surgery, I could request him. I signed up for a different doctor.

  • Chuck

    12/13/2010 1:24:29 PM |

    i apologize if i mislead anyone.  our deductible is $2500 per indvidual not $250.  our family of 4 max is $3500.  once we reach that for the year for everyone, we have no more out of pocket.  the most we have spent out of pocket in a year (3 years on the plan) is about $500.  we have been fortunate.

  • Chris

    12/13/2010 2:41:23 PM |

    Unfortunately, I train a client whose doc insists he take niaspan and not an over the counter prep, even regular niacin, which I personally take. Even with insurance it still costs him $60.00 a month.

  • Judy B

    12/13/2010 3:18:44 PM |

    My husband and I try to avoid doctors except when it's absolutely necessary! We have found that eating low-carb and supplementing with D3, kelp, etc. that we are rarely ill.

  • Ken

    12/13/2010 3:33:38 PM |

    Dr. Davis
    Great advice! I am a midwestern hospital CEO, we employ about 2000 people. I had meetings recently to discuss next year's health plan changes and told everyone this stunning fact: 1% of our staff account for 35% of our plan expenses!
    I see little evidence of motivation to change behaviors. Like most Americans they are going to come to a doctor like you and want a pill to fix it.
    Keep up the good work

  • Anonymous

    12/13/2010 4:01:12 PM |

    In our company's employee benefits meeting last week, after they announced premium increases one of my buddies blurted out, "Hey, I'm on Obama-care.  Aren't you supposed to be paying me now?"  Pretty funny.

  • Anonymous

    12/13/2010 6:28:42 PM |

    exercise - even walking a few miles a day makes you healthier (1000 steps equals one mile) - eliminate the gym membership and do your own housework, gardening to stretch and strain a little for free

  • donna

    12/13/2010 6:29:00 PM |

    Don't know if this is helpful, but just ran across it:

    http://www.amazon.com/Prescription-Alternatives-Hundreds-Prescription-Free-Remedies/dp/0071600310/ref=sr_1_5?ie=UTF8&qid=1292264829&sr=8-5

  • Anonymous

    12/13/2010 8:06:12 PM |

    What is the best way to supplement iodine and how much?  Since cutting Mortons for sea salt I am sure I am not getting Iodine (except in occasional shell fish)  Any suggestions?  BTW my T4 Thyroxine was way below the reference range last visit to the DR.

  • Anonymous

    12/13/2010 9:37:43 PM |

    Agree with most of your recommendations, but not sure iodine supplementation is the best idea:
    http://thehealthyskeptic.org/category/health-conditions/thyroid-disorders/page/2
    Amy

  • Lori Miller

    12/14/2010 1:26:54 AM |

    Two words: Google Scholar. A lot of my former health problems were due to lack of vitamins and poor absorption. The medical papers and abstracts there helped me figure out why I wasn't absorbing them and what to do about it. Eliminating grain helps with this--grain is full of anti-nutrients. There have been a lot of other little things I've done to help absorb them.

    As for walking, I suppose 1000 steps equals a mile if you take 5'-3" steps.

  • Anonymous

    12/14/2010 2:01:41 AM |

    Ken says:
    "1% of our staff account for 35% of our plan expenses"
    Is it possible that they are sicker? I mean of no fault of their own making?
    "I see little evidence of motivation to change behaviors. Like most Americans they are going to come to a doctor like you and want a pill to fix it"
    Don't get me started on this one.
    BTW, Ken, what is your salary as a CEO? Isn't it driving the cost of health care?
    Well, Americans who think that universal health care equals "socialism," that history is dead, that "the rich are rich because they deserve to be rich," that an illiterate apparatchik (sorry, manager) can one day be  president of an university and another - CEO of some steel plant and yes, that life is simple and "it's up to you - to be healthy or not among other things" are getting what they  probably deserve. Yes, of course, there countless innocent victims, sadly the most sophisticated and decent.

  • Daniel A. Clinton, RN, BSN

    12/14/2010 5:02:00 AM |

    These suggestions all make sense, and will do absolutely nothing. The bottom line is that the United States spend 17.6% of our gross domestic product on healthcare (the highest % of GDP of any country in the world) to the tune of 2.5 trillion dollars. Until we remove profit from the equation and recognize that access to healthcare is a fundamental, universal right of every citizen in the year 2010, and establish a universal government-run healthcare plan, these suggestions will do nothing. They won't actually generate healthcare savings; they'll add profit to those who allow 44,789 Americans to needlessly die every year to preserve the perverse private insurer system that torments our country.

  • Anonymous

    12/14/2010 5:03:35 AM |

    I'd like to know where you keep getting the idea that wheat is genetically modified. None of the commercially available wheat is genetically modified. The varieties we have on the market are the result of selecting breeding practices. Selective breeding is not the same as genetic modification in scientific terms. Furthermore, hybridisation of varieties is not genetic modification, it occurs naturally. Here is an exert from one of my recent publications:

    The BBAADD genome was derived by hybridisation of a female tetraploid (2n = 4x = 28; genome BBAA) and a male diploid [Triticum tauschii L. (2n = 2x = 14; genome DD)] (Kihar 1944; McFadden and Sears 1944, 1946a, b; Kimber and Feldman 1987; Kimber and Sears 1987; Dvorak et al. 1998). The A genome originated from Triticum urartu L., while Aegilops speltoides L. is reportedly the donor of the B genome for both tetraploid and hexaploid wheats (Dvorak et al. 1988; Wang et al. 1997).

  • Paul

    12/14/2010 6:04:53 AM |

    "What is the best way to supplement iodine and how much?" - anonymous

    Judy B. gave you a hint... kelp.  It has the highest amount of iodine of any natural dietary source, AFAIK. I buy the dry powder form sold by Now Foods.  An 8oz. bottle only costs me $4 and lasts six months... not bad.

    A quarter teaspoon has 300 mcg (200% DV) of iodine, so that's what I put in my little BCAA/whey protein shake every morning to ward off any thyroid problems, and so far so good at 50 y.o.  However, you may need a much different dosage protcol if you already have thyroid problems.  Dr. Davis has some blog posts on the subject.

  • Dr. William Davis

    12/14/2010 12:44:38 PM |

    Anonymous about wheat's genetic profile:

    1) You're off topic here.

    2) Nonetheless, I've never said that genetic modification yielded modern wheat. It has been the extensive hybridizations that have yielded this modern monstrosity called "wheat," the hexaploid dwarf that makes millions sick.

    However, I suspect that this argument only matters to people who work in the wheat-generating industry. Who gives a damn how it was created if you have a debilitating illness from it?

  • kris

    12/14/2010 3:25:39 PM |

    I too have gone to the high deductible health care plan. It is a 10,000 deductible for each member but gives you a free annual exam with some standard bloodwork. Also gives a free gynecological exam, mamogram and pap test for women. An interesting difference with these policies is that they give you unlimited prescription coverage once you meet deductible where as prescription coverage on most taps out at $2000, a lot of which you paid for with prescription coverage. There are lower deductibles. With the $10,000 deductible, I pay around $370 per month for my husband and myself and opted to put my son on full coverage since it is so inexpensive for a young person.

  • Peter

    12/14/2010 4:10:47 PM |

    Since I've been following your advice my LDL has shot up, and a bunch of other markers are all improved: CRP, HgA1c, triglycerides, HDL, fasting glucose.  How can I tell if this is a good trade or a bad one?

  • Might-o'chondri-AL

    12/15/2010 2:17:42 AM |

    Iodine from the seaweed Kombu, Laminaria japonica gets stewed into anything you cook with it.
    Take a small piece, say an inch square and simmer it for extraction. Dr. Davis probably ate it as Dashi when a boy.

    Don't bother swallowing the cooked seaweed; you'll need unique genetics to digest it's poly-saccharide. Kombu has, among other good things, arsenate.

    Kelp digestability raw is dubious; maybe the surface iodine could dissolve for you. And kelp, which can incorporate arsenic, does not contain arsenate; which is what binds to arsenic to keep it from bio-availability.

  • Anonymous

    12/15/2010 5:05:35 AM |

    Rachael Ray on CBS today once again was pushing whole grains (especially wheat) as an important dietary component which “has been shown to reduce cholesterol 25%”. She doesn’t explain what type of cholesterol, nor provide her sources. This woman has done this often enough that I suspect she’s getting paid off by the industry.

  • Anonymous

    12/15/2010 6:45:11 AM |

    I quit Lovaza after I learned of the absurd mark-up. Life Extension seems to work fine.  I recently added niacin (rotten triglycerides and low HDL). I had tried the flush free junk for over a year. Now I use plain old immediate release Rugby, which runs about $20 a year at 1 gram a day. That would buy maybe four days worth of Niaspan. My next project is switching from Androgel to compounded testosterone. I have good insurance but it's insane that someone is paying $13,000 a year for a few hundred dollars worth of raw material and no real research innovation.

  • Anonymous

    12/16/2010 3:23:59 AM |

    I haven't seen a doctor in years. They won't give me herbs or real medicine - all they offer is toxic drugs. Conventional doctors are the enemy. They test for things behind your back and are essentially agents of the government. All medical information is used against you. Doctors hate me, because I won't go along with their way of doing things. They won't test vitamin D, hormones, or anything else I'm interested in. Doctors are very interested in my vaccinations and alcohol and illegal drug use, however. Marijuana is legal in my state for medical use, but I'd probably have to be on my deathbed to get a prescription from a regular doctor in this state. But they are more than happy to write a script for a toxic anti-depressant.

  • Anonymous

    12/16/2010 3:41:05 AM |

    Anonymous - For iodine, I use kelp capsules from Nature's Way and also Life Extension Sea-iodine capsules. My thyroid seems fine, so I guess they work for me. I average about 800 mcg iodine daily.

  • Anonymous

    12/18/2010 6:19:26 PM |

    Sorry, doc, but your advice really isn't entirely accurate.  Lovaza may only cost some patients a 30 buck copay per month which may be less than the cost of the appropriate dose of OTC fish oil if one takes it in the proper dose (which may be 8-10 caps per day as opposed to 2 BID of Lovaza).  Speaking of which compliance is therefore better with Lovaza too.  Personally, Walmart fish oil gives me terrible reflux and heartburn while I can't even tell I'm taking Lovaza.  Also, D2 in the form of prescription ergocalciferol is generic and the dose is 50000 Units per month at a cost of 15-20 bucks per year which is cheaper than D3 OTC.  There is also some reason to believe that D2 is more effective than OTC D3.  Cost efficient care needs to be individualized.  I am a physician and try to provide my patients with good medical advice that is cost effective as well.  And, BTW, I have no connections to the drug industry.

  • Dr. William Davis

    12/18/2010 9:40:34 PM |

    Anonymous Doc--

    Wow. Your comments are so far from the truth that I don't know where to start.

    If you read many of the previous posts on this blog, I hope you will see how far out of touch your comments are. D2 better than D3? Since when is the mushroom or invertebrate form of anything better than the real HUMAN form?

    Note that the discussion is how to save money for the overall system, not just keep more money in your pocket.

    Next time leave a name.

  • Chuck

    12/19/2010 2:54:13 PM |

    call me ignorant because i am not certain of this answer.  if the patient has a copay of say $30 on a prescription does the insurance also pay a certain amount for that prescription?

  • Dr. William Davis

    12/19/2010 3:10:01 PM |

    Yes, indeed, Chuck.

    Insurance will then cover another $100 or so. This is the cost we all bear through our health insurance premiums. This money goes straight into the pocket of GlaxoSmithKline, who are presently salivating over the great print-more-money franchise they have, thanks to the ignorance of the American public.

    I find it incredible that here and in related posts people have made comments like "So what? My insurance covers Lovaza." That is precisely the point: We all share the costs eventually, copay or no, with crippling health insurance premiums, while the drug industry makes out like bandits.

    How about a fly-the-entire-sales-force-to-the-Bahamas sales meeting this year?

  • Anonymous

    12/19/2010 5:53:32 PM |

    What's up with the coconut picture at the head of this blog?

    I searched and didn't find any posting about coconuts...

    Personally I have a severe coconut addiction and the picture flares it further.

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