No flush = No effect

13. November 2006 William Davis (3)


"Inositol Hexanicotinate is the true 'flushless niacin.' Unlike 'sustained-release' niacin, which is just regular niacin in a pill which dissolves more slowly, Inositol Hexanicotinate is a niacin complex, formed with the B-vitamin-like inositol. When you take an IHN supplement, the central inositol ring gradually releases niacin molecules, one at a time delivering true niacin. This, like “sustained-release” niacin, allows you to take niacin at clinically-proven doses without going crazy with the itch."


That above bit of nonsense adorns one manufacturers sales pitch for its no-flush niacin. No-flush niacin is one of the biggest scams in the health food store.

Ordinarily, I love health food stores. There's lots of fun and interesting things available that pack real power for your health program. Unfortunately, there's also outright nonsense. No-flush niacin is absolute nonsennse.

No-flush niacin is inositol hexaniacinate, or an inositol molecule complexed with 6 niacin molecules. So it really does contain niacin. However, although it works in rats, it exerts no known effect in humans.

Just Friday, a 41-year old woman came to my office for consultation because her doctor didn't know what to do with lipoprotein(a). She had seen a cardiologist who told her to take no-flush niacin. Both the cardiologist and the patient were therefore puzzled when lipoprotein(a) showed no drop and, in fact, was slightly higher on the no-flush preparation.

The lack of any observable effect and no studies whatsoever showing a positive effect (there is one study demonstrating no effect), manufacturers continue to manufacture it and health food stores continue to push it as an alternative to niacin that causes the flush. It's quite expensive, commonly costing $30-$50 for 100 tablets.

Don't fall for this gimmick. Niacin is among the most helpful of treatments for gaining control over coronary plaque. It raises HDL, corrects small LDL, reduces triglycerides (along with its friend, fish oil, of course), reduces lipoprotein(a), and dramatically contributes to reduced heart attack risk. No-flush niacin does none of this. Track Your Plaque Members: For a thorough discussion of niacin--how to use it, what preparations work and which do not, read Niacin: Ins and outs, ups and downs on the www.cureality.com website.

"Black holes" on heart scan

11. November 2006 William Davis (1)

Lots of smokers, especially younger smokers, rationalize their habit by telling themselves that they'll stop if and when any hint of adverse health effects develop.

The problem is that, even in the first decade of smoking, dramatic and profound effects can develop--but you won't know it.

One of the most graphic examples of this I see every day in people who have heart scans. While CT heart scans are, of course, for identification of coronary plaque/coronary disease, they're also great for visualizing the lungs.

This man is a light smoker. The lungs are the black tissues (that's normal) on either side of the (white) heart in the center. Now, note the holes in the lung tissue. That's what they literally are: holes left by the destrucive, tissue-eating effects of cigarette smoking.

How common are the holes (or emphysematous "blebs", as they're called in medical lingo)? Very common. You'll even see them in 30-somethings who've smoked only a few years.

These are holes that have nothing in them. The lung tissue that was destroyed to create the hole will never grow back, even when smoking stops. The holes in this example are actually small to average in size. I've seen much bigger. And this only represents the early stages of lung tissue destruction. A long-time heavy smoker shows all other sorts of abnormalities.

Whenever I show these "black holes" to people who smoke, they are horrified and I've actually gotten many people to quit. Take the opportunity to quit as soon as you can if you smoke.

Small LDL--a persistent bugger

10. November 2006 William Davis (1)
Sometimes, small LDL is easy to get rid of. Take niacin, for instance, and it can simply disappear from your body.

But other times, it can be aggravatingly persistent. Several times every day, in fact, I need to run through the checklist of strategies to reduce small LDL with patients.

How important is small LDL? In my experience, it is among the most potent causes behind coronary plaque known. It's a big part of the explanation why some people at an LDL of cholesterol of X mg/dl will have heart disease, while others with the same X mg/dl of LDL will not. When present, small LDL particles are much more likely to trigger atherosclerotic plaque formation. Small LDL particles magnify Lp(a)'s ill-effects tremendously. The data vary but small LDL probably increases heart attack risk at least three-fold.



Here's a checklist of strategies that I advise patients to consider to minimize the small LDL pattern:


--Lose weight to ideal weight--This is very important and effective.


--Fish oil--A relatively small effect unless triglycerides are high to begin with.




--Reduction of wheat products--This can provide a BIG effect. More precisely, a reduction in high-glycemic index foods is effective. But the biggest day-to-day high-glycemic food culprits are wheat products like breads, pasta, crackers, chips, pretzels, and breakfast cereals. "You mean whole wheat bread makes small LDL?!" Yup.


--Reduction of sweets--For the same reasons as reducing wheat products.


--Add raw almonds and walnuts--1/4 to 1/2 cup per day.




--Replace wheat products with OAT products, especially oat bran. This does NOT mean oat-containing breakfast cereals with added sugar and wheat, e.g., Honey Nut Cheerios, Cracklin' Oat Bran Cereal, etc. You might as well eat candy. Buy oat bran as plain oat bran--nothing added. Use it as a hot cereal or added to yogurt, "breading" for chicken, etc.




--Vitamin D--A variable effect, likely resulting from its beneficial effects on "insulin resistance".


--Exercise


--Niacin--Very effective but not always enough.


Among the choices, my favorites are weight loss, niacin, and reduction of wheat products. Those will give you the biggest bang for your buck.

Red badge of courage

8. November 2006 William Davis (0)
A group of 60- and 70-somethings were standing in the anteroom to the cardiac rehabilitation center. All (males) had their T-shirts pulled up, comparing their coronary bypass scars.

It reminds me of war veterans comparing their war wounds. The scars of suffering, of having "conquered" and won a war with a common enemy, a badge of courage.

This is part of the broad social acceptance of bypass surgery and other major procedures for heart disease. Hospitals support it. They do it for the psychological support for patients enduring a difficult process. Often, talking about a shared experience can be a helpful purge for the fears and frustrations of a traumatic event.

Curious thing, though. I've actually had people request bypass surgery simply because all their friends have had one. No kidding. "I just figure my time is coming. I might as well get it over with."

Get the picture? We've had a battle with heart disease and the hospitals have won. The enormous success of hospitals over the last 20 years is not because of delivering babies, it's not from psychiatric hospitalization, it's not from cancer treatment. It's from heart disease. The largest floors in the hospital are usually the cardiac floors. The bulk of revenues and profit are from heart disease.

If I manufacture widgets and each widget I sell makes me scads of money, guess what? I want to sell more and more widgets. I'll persuade people they need my widgets even if they don't. Perhaps I'll even persuade them that buying one is a noble cause. Maybe I'll subtly suggest that I am a charitable operation and I only sell my products for the public good. I could even name my company after a saint. Personal profit--absolutely not!

Ignore the hype. See hospitals and their "products" for what they are: A necessary service--some of the time; profitable products that they hope to sell to more and more people most of the time.

"We don't believe in heart scans"

7. November 2006 William Davis (0)
Tim's CT heart scan score was an earth-shattering 3,447, clearly in the upper stratosphere of percentile rank. Risk of heart attack: 25% per year. At age 58, it was a wonder that nothing had happened yet.

Tim went to the Cleveland Clinic for an opinion, long a powerful bastion of heart procedures. The consulting cardiologist told Tim, "We don't believe in heart scans. They're wrong too often."

An opinion from a widely-respected cardiovascular center. If they don't "believe" in heart scans, does that mean they "believe" in stents and bypass surgery? Does it mean that the thousands of research studies that have now been published on the value of heart scanning are pure fiction? Is there a choice to believe or not believe?

I continue to be shocked at the extraordinary ignorance on the topic of heart scanning among my colleagues. The number one killer of Americans and you still rely on stress tests?

Why this perception that heart scans are "wrong too often"? What this cardiologist means, I believe, is that when people are taken to the cath lab for catheterization, a substantial number of those with positive heart scan scores don't have "blockage". But I could have told him that even before the heart catheterization.

There is an expected and well-documented likelihood of finding significant "blockage" based on your heart scan score. At Tim's scary score of 3,447, what is the likelihood of "blockage" of 50% or more? It's around 40-50%. That means that half the people at this score will have a blockage sufficient to justify inserting stents or undergoing bypass surgery, half will not. There will indeed be many plaques, but none severe enough to block flow.

Does that make the heart scan wrong? I don't think it does. Just because you don't need a major procedure to "fix" blockages does not mean that no heart disease is present. Without preventive efforts, Tim's heart attack risk remains an alarming 25% per year--whether or not he gets stents or bypass. The only treatments that substantially reduce this risk (in an asymptomatic person) are preventive efforts, not procedures.

Yet cardiologists like the one Tim consulted at the Cleveland Clinic regard heart scans as something "he doesn't believe in". I would suggest a return to the textbooks and published literature and re-thinking how heart disease should be managed.

Heart scans should provide an opportunity for prevention, not an opportunity for profit.

More on the “Rule of 60”

6. November 2006 William Davis (0)
Despite its apparent simplicity, there’s a lot of thought and wisdom in the Rule of 60.

What if you achieve only a single value in the Track Your Plaque “Rule of 60”? What if, for instance, you got LDL down to 60 mg/dl, but ignored the fact that your HDL was 41 mg/dl and triglycerides were up to 145 mg/dl? Can you still do pretty well?

Probably not. In fact, this specific combination of low HDL and high triglycerides tells me several things:

1) LDL is really much higher than suggested by the 60 mg/dl, which is a calculated value, often much higher. Recall that calculated LDL is prone to immense inaccuracy. When measured, the LDL is commonly somewhere between 120 and 160 mg/dl. However, when you raise HDL to 60 and reduce triglycerides to 60, much of the inaccuracy is removed, i.e., calculated LDL becomes more accurate. LDL can be measured as LDL particle number (NMR), apoprotein B, or direct LDL.

2) LDL particles are small. This is yet another reason why the weight-based LDL measures can be inaccurate. Imagine you have two identical glass jars full of marbles. One jar has small marbles, the other has large marbles, but both jars have the same weight in marbles. Which jar has more marbles? The one with small marbles, of course. The same phenomenon occurs with LDL particles: at the same weight, you can have different numbers of LDL particles. It’s the number of particles that better determine risk for heart disease, not the weight.

3) Triglycerides of 145 mg/dl is actually below the target advised by the National Cholesterol Education Panel Adult Treatment Panel-III guidelines, i.e., you’re okay by conventional standard. But look beneath the surface, and you’ll find that triglycerides at 145 mg/dl are associated with flagrant excesses of VLDL lipoprotein particles and a greater likelihood of a postprandial (after-eating) disorder (increased IDL or postprandial triglycerides), both of which add to coronary plaque.

4) This pattern is also commonly associated with higher blood sugar, higher blood pressure, increased inflammation (e.g., C-reactive protein), increased fibrinogen—all the facets of the metabolic syndrome, or pre-diabetes.

In fact, some of the most aggressive plaque growth—increasing heart scan scores—will occur with this specific pattern. So just achieving one facet of the Track Your Plaque Rule of 60 does not suffice. It’s the whole package that really stacks the odds in your favor of stopping or dropping your heart scan score.

The Track Your Plaque “Rule of 60”

6. November 2006 William Davis (0)
The Track Your Plaque recommended targets for conventional lipids (i.e., LDL, HDL, triglycerides) are LDL 60 mg/dl, HDL 60 mg/dl, and triglycerides 60 mg/dl: 60-60-60.

Not only is this set of values easy to remember—60-60-60—but is grounded in science and the results of clinical trials.

LDL 60 mg/dl
The LDL target is based on experiences such as that of the Reversal Trial, the PROVE-IT Trial, and the Asteroid Trial, all of which showed that LDL cholesterol values in the range of 60 mg/dl dramatically enhance the likelihood of stopping plaque growth or achieving regression, reducing risk of heart attack more than more lenient LDL targets.


HDL 60 mg/dl
Achieving HDL cholesterol of 60 mg/dl is not as well grounded as LDL targets, mostly because increasing HDL is more difficult. There’s also no tremendously profitable way to raise HDL, as there is for reducing LDL (statin drugs). But epidemiologic observations strongly suggest that HDL of 60 mg/dl provides maximum control over both coronary plaque growth, as well as slashing rates of heart attack. Numerous smaller trials have borne this phenomenon out.


Triglycerides 60 mg/dl
Triglycerides of 60 mg/dl is based principally on studies that have shown a virtual elimination of abnormal lipoproteins, especially small LDL, when this value is achieved. Reduction of triglycerides is an effective means to reduce hidden lipoproteins like small LDL and VLDL. Triglycerides in the conventionally acceptable range of 100-150 mg/dl can be associated with dramatic abnormalities of lipoproteins.


Thus, the Track Your Plaque “Rule of 60”. In our day to day experience of trying to stamp out plaque growth from its terrifyingly rapid 30% per year, or reversing it—-dropping your heart scan score—-the Rule of 60 has held up time and again. Getting your lipids to 60 mg/dl does not guarantee that plaque growth stops, but it appears to be a necessary requirement that tips the scales heavily in your favor.

Those of you who’ve discussed lipid targets with your doctor will quickly recognize that the Track Your Plaque targets appear laughably ambitious, perhaps unnecessary. Recall that your doctor likely has no idea of what coronary plaque regression means. He/she likely conforms to the lax targets set by the National Cholesterol Education Panel (NCEP). (These targets depend on a number of factors such as whether you’re diabetic, sex, risk factors, etc.) Based on trial experiences like the few mentioned above, as well as my experience with purposeful coronary plaque reversal, the lipid guidelines as advocated by NCEP guarantee heart disease. Let me emphasize that again: Follow the guidelines set by the NCEP for your doctor to follow, and progression of heart disease is a virtual certainty. At best, it may slow growth of plaque and delay your heart attack or bypass surgery, but it will not stop it.

Now, that point made, let me make another: Just knowing about the targets and even becoming a member of the Track Your Plaque program does not mean that your lipids with automatically go to 60-60-60. We’ve actually had an occasional person tell us that they were disappointed that, by becoming Members, why hadn’t their lipids gone to 60-60-60?

Knowing that the 60-60-60 targets provide real advantage is not the same as actually achieving them.

A little bit of fish oil

5. November 2006 William Davis (12)

The British National Health Service (NHS) has announced that, in light of the substantial data documenting that omega-3 fatty acid intake from fish reduces likelihood of cardiovascular events by around 40%, that Brits discharged from hospital following a heart attack should be "prescribed" 1000 mg of prescription fish oil per day.

Hardly a revolutionary concept. Part of the timidity of the British NHS seems to relate to the potential cost to the government, since apparently much of the cost will be borne by the government-subsidized health system.

But prescription fish oil? Why prescription fish oil? Prescription Omacor, one capsule per day, costs around $70 (U.S.) per month. If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form.

Omacor is clearly more concentrated. But is the prescription form better--more effective, more purified, less contaminated, etc.? I have seen no independent verification of this. Of course, manufacturers make all sorts of claims. The only independent, unbiased testing I'm aware of comes from organizations like Consumer Reports and www.consumerlabs.com. Omacor has not been compared to non-prescription fish oil in any of their analyses. Head-to-head comparison of Omacor to nutritional supplement fish oil is unlikely to come from Solvay, the manufacturer of Omacor. Drug companies powerfully resist head-to-head comparisons, fearing it will not play out in their favor. Let the public remain ignorant and hope marketing conquers all.

Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.

Nonetheless, despite the filthy politics and under-the-table dealings, some good comes out of the NHS's action: broader recognition of the power of fish oil. Perhaps when a British patient or an American patient gets discharged with a prescription for Omacor, the patient will take the initiative and go to the health food store instead and save him (or his insurer) $67.50 per month.

For your coronary plaque control program and control and/or reversal of your heart scan score, we start at 4000 mg per day of standard fish oil, providing 1200 mg per day of omega-3 oils. This amount as a nutritional supplement costs only a few dollars a month. And you have the satisfaction of not only taking a powerful step for your health, but also not enriching the overflowing pockets of drug companies.

AHA: Doctors don't have time for prevention

3. November 2006 William Davis (0)
Doctors "don't have enough time to educate their patients and to stop and think about what measures the patient really needs," says Dr. Raymond Gibbons, new head of the American Heart Association.

Dr. Gibbons highlighted how the system reimburses generously for performing procedures, but reimburses relatively little (often just a few dollars) for providing preventive counseling. He claims to have several ideas for solutions.

Good for Dr. Gibbons. There's no doubt that the lack of truly effective preventive information and counseling is a systemic, built-in flaw in the current medical environment. It is especially true in heart disease.

Another problem: "If a doctor didn't say it, it must not be true." That's the attitude of many of my colleagues. Despite their broad and systematic failure to provide preventive counseling, most physicians (my colleagues the cardiologists especially) pooh-pooh information that comes from other sources. Yet, it's my prediction that much of healthcare will go the way of optometry--direct access to care, often delivered in non-healthcare settings like a store or mall. People are hungry for truly self-empowering health information. Too many physicians can't or won't provide it. You've got to turn elsewhere for it.

That's one of the main reasons I set up the Track Your Plaque program. It's direct access to self-empowering information. A flaw: You still require the assistance of a physician to obtain lab values, lipoproteins, and to monitor certain treatments (e.g., niacin at higher doses). If I knew of a way around this, I'd tell you. But right now I don't. We remain constrained by legal and moral obligations.

Nonetheless, phenomena like CT heart scanning and the Track Your Plaque program are just a taste of things to come.

Confusion about Lp(a)

3. November 2006 William Davis (2)
Since the recent reader question about Lp(a), I've had several other instances of confusion over Lp(a).

To help you navigate through some of the often confusing issues behind this complex genetic abnormality, here are some common sense rules to follow. When you ask your doctor to draw a Lp(a), try to be certain that:

--the same laboratory is always used. Just going from lab to lab can account for huge variation in Lp(a). As standardization proceeds internationally, this will be become less important. But in 2006, it's still an issue.

--you and your doctor resist the temptation to check Lp(a) frequently. I saw a patient recently who was having Lp(a) levels nearly every month. This is pointless. Lp(a) changes very slowly. Checking it frequently will not allow any treatment to be fully reflected. All you'll observe is random variation that can be frustrating. We wait at least 6 months before re-checking after a new treatment is introduced.

If you have a choice, I would recommend you opt for the measure provided by Liposcience (NMR). The technique they use is a particle count measure, rather than a weight-based measure. This may be more accurate, particularly when Lp(a) is small.

Lp(a) remains among the more difficult patterns to understand and correct. Don't be surprised if you encounter a lot of confusion from your doctor, as well. You may end up providing much of his/her education.
How to become diabetic in 5 easy steps

How to become diabetic in 5 easy steps

14. January 2011 William Davis (35)
If you would like to become diabetic in as short a time as possible, or if you have someone you don't like--ex-spouse, nasty neighbor, cranky mother-in-law--whose health you'd like to booby trap, then here's an easy-to-follow 5-step plan to make you or your target diabetic.


1) Cut your fat and eat healthy, whole grains--Yes, reduce satiety-inducing foods and replace the calories with appetite-increasing foods, such as whole grain bread, that skyrocket blood sugar higher than a candy bar.

2) Consume one or more servings of juice or soda per day--The fructose from the sucrose or high-fructose corn syrup will grow visceral fat and cultivate resistance to insulin.

3) Follow the Institute of Medicine's advice on vitamin D--Take no more than 600 units vitamin D per day. This will allow abnormal levels of insulin resistance to persist, driving up blood sugar, grow visceral fat, and allow abnormal inflammatory phenomena to persist.

4) Have a bowl of oatmeal or oat cereal every morning--Because oat products skyrocket blood sugar, the repeated high sugars will damage the pancreatic beta cells ("glucose toxicity"), eventually impairing pancreatic insulin production. (Entice your target even further: "Would you like a little honey with your oatmeal?") To make your diabetes-creating breakfast concoction even more effective, make the oatmeal using bottled water. Many popular bottled waters, like Coca Cola's Dasani or Pepsi's Aquafina, are filtered waters. This means they are devoid of magnesium, a mineral important for regulating insulin responses.

5) Take a diuretic (like hydrochlorothiazide, or HCTZ) or beta blocker (like metoprolol or atenolol) for blood pressure--Likelihood of diabetes increases 30% with these common blood pressure agents.

There you have it! Perhaps we should assemble a convenient do-it-yourself-at-home diabetes kit to help, complete with several servings of whole grain bread, a big bottle of cranberry juice, some 600 unit vitamin D tablets, a container of Irish oatmeal, and some nice bottled water.
Tags :

Comments (35) -

  • Anonymous

    1/14/2011 12:26:58 PM |

    When someone dies suspiciously, and someone else benefits, (e.g. big insurance payoff) that "someone" is the first suspect.
    But not if you've been known to promote a heart healthy diet for the deceased...

    Jeanne

  • Anonymous

    1/14/2011 12:44:34 PM |

    You've recommended oat bran in the past for other reasons. Is cooked oat bran a suitable breakfast food?

  • Matt Stone

    1/14/2011 1:16:59 PM |

    This list is way off.  To become a type 2 the most important things that you do are:

    1) Get insufficient sleep
    2) Subject yourself to maximal levels of stress
    3) Do insane amounts of endurance exercise punctuated by long periods of total sedantarism
    4) Eat a low-carb diet punctuated by repeated bouts of carbohydrate bingeing, or a low-fat diet punctuated by bouts of high-fat bingeing
    5) And most importantly, cycle your weight up and down by restricting calories followed by bingeing followed by restricting calories followed by bingeing

    Those are the most effective ways to increase visceral fat, although the soda does help.  You got that one right at least.  Off to eat oatmeal for breakfast and have my blood glucose spike all the way to a ghastly 80 mg/dl afterward.

  • Anonymous

    1/14/2011 1:55:46 PM |

    Dasani has minerals added back in.

  • allison

    1/14/2011 3:23:27 PM |

    I hope the Good Doctor is including saturated fat in his tongue-in-cheek recommendation.

  • Dream_Puppy

    1/14/2011 4:37:37 PM |

    I have eat low carb, am thin, lift weights and do HIIT but have high blood pressure due to genetics (140/100)- I take 12mg of atenolol a day....is there anything else you would recommend to do instead? I have to take something : /

  • Eric

    1/14/2011 5:45:17 PM |

    I've been following Dr. Davis' advise to improve heart health as I'm 34 years old and dealing with calcification of my aorta and chronic hypertension.

    In 2 weeks without grain and oatmeal and taking D3+K2 w/ Fish Oil and my BP has been normal 128/54 and I've already lost 4lbs.

    Some of us follow the advise to save our lives and not over eat the oatmeal to get the pretty beach muscles.

    Thanks Dr. Davis

  • vic

    1/14/2011 5:51:29 PM |

    New to the blog.. the only thing that  I'm a bit surprised about is the no grain thing.

    Aren't whole grains good for insoluble fiber and don't raise your blood sugar like processed (white) flour?   I suppose if you are gluten sensitive you should avoid wheat, but for blood sugar?

    Similarly, doesn't oatmeals' soluble fiber slow down the insulin spike?

    For about 7 years I've been eating the same wheat/oatmeal cereal that has 7g of sugar, 6g of insoluble fiber, and 6g of soluble fiber  (12g of dietary fiber).    I work at a desk so I don't get much (if any) exercise.  

    I don't take supplements (vit. d or otherwise) and drink a soda or two occasionally.  

    I could probably stand to lose a few pounds but I have normal blood sugar levels.  

    Why am I not diabetic if I'm following the 5 easy steps?

  • Nigel Kinbrum

    1/14/2011 6:02:51 PM |

    vic said...
    "New to the blog.." Try reading the blog before posting.

    "Why am I not diabetic if I'm following the 5 easy steps?" Luck? Genes? Who knows?

  • Eric

    1/14/2011 6:10:35 PM |

    Also, Dr. Davis could you expound upon how taking HCTZ and Metropolol affects blood sugar- I currently take both of these to treat (not well) my hypertension?

    Thanks again!

    Eric

  • revelo

    1/14/2011 6:24:47 PM |

    I have a hard time accepting this theory of the pancreas beta cells "wearing out" like the tires on a car because they are asked to produce a little insulin now and then. The problem, IMO, is not asking the pancreas to do what it is designed to do (produce insulin) but rather insulin resistance in the muscles, and that comes from being obese and not exercising. If you maintain a proper weight and get enough exercise to maintain your insulin sensitivity, you shouldn't develop insulin resistance, which means you can eat carbs without problems. When you eat carbs, blood sugar will begin to rise, the pancreas will produce a small amount of insulin, this small amount of insulin will push the blood sugar into the muscles, and blood sugar will stop rising.

    People have been eating wheat and other grains and living long healthy lives, without diabetes, in much of the world. The key is that they don't overeat and they get exercise, and hence they don't develop insulin resistance. The traditional people of Sardinia and Crete, for example, were extraordinarily healthy and long-lived, despite eating a huge amount of wheat products. By contrast, modern Mediterranean peoples are developing diabetes at a phenomenal rate, due to overeating and insufficient exercise.

  • Peter

    1/14/2011 7:01:49 PM |

    Re: oat bran question.  I used to eat tons of oat bran back when Dr. Davis said it was the best cholesterol lower around.  Then I became anemic. Then I read somehere that oat bran blocks iron absorption, so I quit the oat bran, and the anemia went away immediately.  Of course, that might not have been why, you never know.

    Re: the Institute of Medicine didn't say "limit yourself to 600 iu of Vitamin D", that was a minimum not a maximum.

  • Onschedule

    1/14/2011 8:27:51 PM |

    @Peter re Institute of Medicine Vitamin D guidelines

    The chart on the Institute of Medicine's website lists 600 IU/day as the "Recommended Dietary Allowance" and 4000 IU/day as the "Upper Level Intake" for almost all age categories 9 years old and older.

    The way I read this, 600 IU/day is their recommendation, and 4000 IU/day is their upper limit caution. As such, I think Dr. Davis's characterization of 600 IU/day as the Institute of Medicine's recommendation is accurate. While the IoM is not saying "don't intake more than 600 IU/day," they are implying that their 600 IU dietary recommendation is adequate.

  • David

    1/14/2011 10:20:22 PM |

    @Eric- These antihypertensive drugs impair glucose metabolism. See this study here: http://care.diabetesjournals.org/content/31/5/982.long

  • c

    1/15/2011 4:00:42 AM |

    Matt Stone....let see some proof of your 80mg/dl postprandial oatmeal reading....I seriously doubt it.

  • LynP

    1/15/2011 4:32:12 AM |

    I'm obese & still losing (low carb), take Maxzide for lower leg edema.  Every time I stop taking it, I gain 2-3#s (yeah fluid) and get short of breath.  With apnea, I don't need anything else making me anxious about breathing.  Any other diuretics reduce lower leg edema and don't mess with glucose control? I drink low-sodium V8 & eat a lot of parsley to keep my potassium levels in the normal range. Suggestions?  I exercise, take mag citrate, take 15,000 IU D3/day to keep levels 60+, 1500 mg metformin XR/day, 88 mg levothyroxin.

  • revelo

    1/15/2011 5:49:03 AM |

    Per Dr Davis recommendation to test blood sugar (I have no reason to believe I'm diabetic, but I am interested in longevity so I'm following many of his recommendations), I ordered and today received a blood glucose monitoring system. Included in the package was a free sample of a Slim-Fast bar, whose ingredients are as follows:

    sugar, corn syrup, dry roasted peanuts, milk chocolate coating (sugar, partially hydrogenated vegetable oil ...

    Perfect diet for a diabetic, eh?

  • Anton

    1/15/2011 1:56:09 PM |

    Suggesting we stay away from wheat and other cereals is interesting, and following such a diet would certainly a radical departure for a species that has had bread and other grain products as a dietary staple for over 3,000 years.

  • Dr. William Davis

    1/15/2011 3:06:27 PM |

    Several commenters--

    Diuretics and beta blockers (metoprolol, atenolol, etc.) can be replaced in many people by other agents that do not provoke diabetes. However, some people do indeed require these agents for specific problems, e.g., water retention, atrial fibrillation, other abnormal rhythm issues.

    Elimination of wheat on the background of a low-carbohydrate diet is, however, a marvelously effective way to reduce BP (though it requires many months to work).

  • PaleoMom

    1/15/2011 6:57:33 PM |

    @Anton: Mankind, at least SOME of it, has eaten grains for  centuries BUT not nearly in the quantity we eat it in the Western world. When baked into breads, wheat was frequently soaked or sprouted, either on purpose or incidentally through more time in the fields before silage or drier silage, which deactivates the phytates in grains and seeds (and nuts) and makes them more digestible. Bread dough was raised more slowly before fast-acting yeast, giving the moisture in the dough time to do the same with the wheat flour; sourdough serves a similar function today. In some parts of the world today we still see grains treated in what we would consider primitive ways, like soaking and fermenting grains and treating corn with lime - pellagra, anyone? - while we Westerners eat copious amounts of industrially processed grain products without a second thought. This is not the way early agrarian man consumed grains, and not the way most humans did until the last few decades in our evolution.

    What do you suppose man primarily subsisted on for the millennia (not centuries, but millennia!) before becoming agrarian and growing grains? Yep - meat, vegetables, greens, nuts, seeds, and fruits. Maybe the odd serving of grain here and there if enough could be gathered to be mealworthy. Oh, and no dairy, either. It might be suggested that grains themselves are the "radical departure" from a much longer evolutionary background of a very different diet for mankind.

    I would like to know more about the sugar-spiking effect of oats compared to other grains. We do sometimes have them soaked and sprouted first, as porridge or in bread or the odd pancakes, but I've seen my daughter's behavior go crazy on oats before we knew about that practice and that part of this entry rang a bell there. Smile

  • Might-o'chondri-AL

    1/15/2011 7:26:24 PM |

    Oats were a boon crop for the rural Scottish and Irish. The people relished warm belly food in the morning.  

    Then everybody got up and went to perform physical work/chores. They used the glucose for available energy until they were fortunate enough to eat again.

    Moderns get up from the table and lead sedentary lives. Athletes training hard can still get up from breakfast and "feel their oats".

  • Anonymous

    1/15/2011 11:16:03 PM |

    What about oats groats?

  • Helen

    1/16/2011 12:30:37 AM |

    I wrote a long response to this yesterday that didn't go through the system.  Perhaps I'll try again tomorrow.  For now, suffice it to say that I am mildly diabetic and have found, through trial and error, that oatmeal at breakfast does NOT spike my blood sugar.  At one hour it may be 110-135, and at two hours I've had readings from 75 to 100.  (I take no meds.) It does not give me higher readings as the day wears on, either.  This is if I eat very little fat (about 8 grams total) as part of my breakfast.

    After 9 months on a low-carb (about 60 carbs a day, usually) diet, following my diagnosis in May, I found, thanks to dietary changes to address gallbladder trouble, that I am a diabetic whose blood sugars are messed up by fat, not carbs.  

    I respect Dr. Davis' work, but diabetes - high blood glucose and poor glycemic control - is more than one disease.  You can come to the same "diagnosis" through different genetic routes.  The part of your system that is malfunctioning may be very different from the part malfunctioning in the person sitting next to you at the endocrinologist's.  Your best bet is to check your meter after meals.  Many diabetics cannot deal with carbs.  Some cannot deal with fat.

    @ Concerns about anemia: phytic acid in oatmeal, which blocks mineral absorption, is a real concern.  I soak mine overnight with yogurt and buckwheat flour to break down the phytic acid.  I eat gluten-free oatmeal, as I have celiac disease.  

    @ Wearing out the pancreas:  The reality is that chronic high blood sugars (not carbs per se - you have to be hampered in your ability to deal with an influx of glucose to begin with) can and do destroy insulin-producing beta cells in the pancreas, creating a terrible feedback loop and diabetic progression.  People susceptible to diabetes generally have less capacity to produce more and/or larger beta cells in response to greater insulin demands.  This is why most obese people, while not healthy, actually do not develop diabetes, while others can become diabetic when slim.

  • Sandy

    1/16/2011 5:19:13 AM |

    Hi @PaleoMom, in reference to your daughter's behavior after eating the occasional oats, I can totally relate. I have experienced severe brain fog, ADD-like symptoms, and lethargy whenever I've eaten any high carb meal-whether it's whole grain or not.  

    Off the top of my head, I'd suspect 2 things:

    1. Does your brand of oats  specifically say "gluten free?"  There is usually cross-contamination with wheat via containers and equipment.  This is where I would look first. Bob's Red Mill has Gluten Free oats.

    2. It is also possible that your daughter could be particularly sensitive to the effects of carbs. Try adding butter, cream, coconut milk, or some other fat to the oatmeal (+ a dash of cinnamon).

    Hope this helps!

  • Anonymous

    1/17/2011 6:19:43 PM |

    I'd certainly like to read a response to Helen's post. I've never heard of fat driving up BG levels unless it was consumed with plenty of carbs. Helen, can you give personal/specific examples?

  • Helen

    1/18/2011 2:34:32 PM |

    Response to Anonymous, Part I:

    Anonymous -

    I'll give a snapshot here of my evidence, though I can't include everything.

    One point:  It's not the fat that drives up my glucose per se (although I believe it drives up my fasting glucose).  It's that fat impairs my ability either secrete insulin or for my cells to accept glucose, or both.  

    So carbs in the presence of a high-fat diet spike me more, *even small amounts of carbs.*

    First example:  When I had gestational diabetes three years ago, toward the end of my pregnancy, there was a possibility I was developing intrahepatic cholestasis of pregnancy.  I adopted a low-fat diet, which is thought to help mitigate the risks.  I was on insulin and checking my blood sugar about eight times a day.  I found my insulin requirements over the last several weeks of my pregnancy plummeting, until I required none on the day I delivered.

    Although I had had that experience, when I was diagnosed with diabetes last spring, I discounted that and adopted a low-carb diet.  I saw no improvements in my glucose control.  From May to November, I saw my A1C drop from only 6.4 to 6.0, despite increased exercise, a 25-pound weight loss (I'd been only 10 pounds over my ideal weight range at diagnosis), and watching carbs very carefully.  In contrast, my father-in-law saw a drop in his A1C from 11 to 5.7 basically just taking Metformin!  (I think he's particularly lucky.)  Metformin didn't work for me.

    Second example:  I have a log of a day on which I'd had a fasting glucose of 126, had a breakfast of cottage cheese with olive oil, consuming about 7 g carbs total, and ended up with my glucose spiking to 183 at 1/2 hour, with it coming down to 148 at one hour and 122 at two.

  • Helen

    1/18/2011 2:35:18 PM |

    Response to Anonymous, Part II:

    In the interest of full disclosure, I found something similar happened yesterday, when I checked my glucose a little earlier than at one hour.  It went up to about 183, but then came down to 110 by 90 minutes or so post-prandial.  But I'd eaten at least 60 grams of carbohydrates.  

    I think that my glucose may be spiking higher at 30 minutes, but is pretty darn good at 1 hour pp, whether I'm on a low-fat diet or a low-carb diet.  The difference may be that it comes down faster and goes and stays lower on low-fat.  For a few days I was on an almost no-fat diet (though I heard that was actually bad for my gallbladder and stopped).  I had trouble keeping my blood glucose UP.  That's when I saw two-hour readings of 75 after a hearty bowl of oatmeal.  My readings aren't as wonderful now that I'm eating low-fat, not no fat, but they're still much better than high-fat.  I'm certain that on average, it's  at least a 10 point difference, possibly 15.  And I no longer have to live with the insanity of having ever more vanishing quantities of carbs spike me.  

    I'm not and have never been an anti-fat person.  When I was diagnosed I had been following a WAPF-type diet, was gluten-free and nearly grain-free, trending toward Paleo.  I'd been telling everyone I knew not to be afraid of fat, especially saturated fat.  The irony!

    Jenny Ruhl at Blood Sugar 101/Diabetes Update has heard of others like me, though she says it's quite rare.

    Peter at Hyperlipid hypothesized that there may be people like me, since there are some rodents that respond to fat this way.  As you probably know, he's pro-fat, but open-minded.  

    I do think I have something other than a "typical" Type II diabetes. I had a genetic test for monogenic glucokinase-deficient diabetes (MODY 2), but didn't have that.  My insurance is not going to pay for another specialized test.  I'm not sure what I'd ask to be tested for, anyway.

  • Dana Seilhan

    1/22/2011 12:07:32 AM |

    According to the Weston A. Price Foundation, oats are the grain with the highest phytate content.  Eating them without proper preparation not only spikes your blood sugar but chelates the minerals your body needs to stave off diabetes before you've even had a chance to absorb them.

    If you follow the typical "healthy" advice to cut fats out of your diet, you'll eat the oatmeal made with water instead of milk or cream, exacerbating the problem.

    Studiously ignoring Matt's claim about low-carb diets.  Eating low-carb for part of the year and higher-carb for part of the year would approximate the prehistoric European experience of having mostly meats available for food in the winter but lots of plant foods in the summer.  Amazing that type 2 diabetes in particular has never been a problem in Europe up to modern times, despite their long history (post-agricultural revolution) with famines.

    Anyone following a low-fat diet is at increased risk of diabetes because they lack the fat-soluble vitamins and the minerals necessary to sustain endocrine health.  Why anyone still endorses low-fat as healthy for, well, anyone really is beyond my comprehension.  If you can tolerate a higher carb intake that's one thing (and if I were you I would favor starchy tubers over grains and beans), but no human being should have to do without dietary fat, and it's unhealthy to attempt it.  Even people who are missing their gallbladders or who suffer from gallstones can eat certain types of fats without too much worry.

  • Gallbladder Gone

    1/22/2011 5:06:59 AM |

    @Dana Seilhan:

    I'm 51 years old, and I just had my gallbladder removed due to rather severe gallstone problems (I tried to avoid the surgery, but it became an emergency, and I had no choice).

    Can you provide links to good materials on what kinds of fats to avoid, and why?  My wife and I eat a moderate low-carb, high protein diet and don't shy away from fats.  

    I'm concerned about long-term health issues, but I've not found good educational materials on the what, how, and why of post-gallbladder removal fat-related health problems, short or long term.

    Thanks for any guidance you can provide.

  • Helen

    1/22/2011 3:09:04 PM |

    @Dana -

    Actually, without a gallbladder, most people don't have to follow a low-fat diet at all.  It's when you have gallstones or a sludgy gallbladder that fat can exacerbate symptoms.  This doesn't mean that it causes gallbladder trouble, but that it causes pain from stimulating gallbladder contractions, which it's supposed to do.  When you have sludge or gallstones in there, though, that can hurt.

    I'm going to work at making sure I have the fat-soluble vitamins I need, and I'm pretty educated about this.  But my experience has shown me that the WAPF and Dr. Davis' points of view, though they may be helpful to many people, unfortunately don't apply to me.  I realize that lot of people who have found that a certain approach works best for them will think it will work for everyone, and that I'm just ignorant, but I've studied this all pretty deeply for a layperson, tried different approaches, and have finally had to follow the evidence of my own glucose meter and other health indicators.  My diabetes couldn't have been caused by a low-fat diet because I'd not been on one until recently.  

    Agreed about properly preparing oatmeal.  

    I think a problem with so much of the health advice I see, whether it's low-fat or pro-fat or low-carb, is that it makes blanket recommendations.  Different people whose physiologies are malfunctioning may have them malfunctioning for different reasons.

    You can find somewhere a "traditional" diet to support just about any claims you want.  I think the common denominators in healthy traditional diets are really not high-fat vs. low-fat, but lack of industrial vegetable oils, refined sugars, and refined carbohydrates.  I do think improperly prepared grains and gluten (however prepared) are nearly universally problematic.

    If you look Stephan Guyenet's Whole Health Source, he has examples of populations on high-carb diets that do not have poor glucose tolerance or elevated incidence of diabetes.  You also have to look at the possibility that traditional peoples had more homogeneous gene pools, and perhaps therefore their diets and genes meshed more than peoples' today.

    They also had less exposure to toxic chemicals in the modern environment, and other factors like social isolation and disrupted circadian rhythms, all of which can wreak havoc with endocrine function.

  • Anonymous

    1/23/2011 10:24:09 PM |

    I eat oatmeal and I only spike to 120 or less, so that doesn't seem too bad to me. I think it's only bad if it spikes too high. Fruit is a problem for me, however. I would imagine if I ate fruit mixed with protein I might be able to handle it.

  • Sophie

    1/29/2011 3:06:01 AM |

    Diabetes is one of the leading cause of death listed on U.S. I am afraid that this will increase if people will not be aware of the factors that leads to diabetes. Information dissemination is a must. People need to be active and learn to know the foods to be avoided as well.

  • jodi

    5/2/2011 6:52:07 PM |

    you may not be diabetic, YET, but you are headed down that path.  give it time.

  • Gary Snow

    7/15/2012 8:07:43 PM |

    Helen..Excessive carbs DID cause my T2 Diabetes..and yes, oatmeal DID spike your BG..9Damage begins at 140) Take it down to less than 30 carbs @ day and you will reap the benefits!

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