Super size me in little bits and pieces

17. October 2006 William Davis (1)


Alvin came into the office for consultation on his cholesterol values: LDL 198 mg/dl, HDL, 43 mg/dl, triglycerides 143 mg/dl. He says that he doesn't really try to choose healthy foods but he restricts his overall calorie intake by following the Weight Watcher's exchange approach.

Every morning, 7 days a week, Alvin eats a Sausage McMuffin for breakfast. He justified this by skipping lunch to make up for the 450 calories in the Sausage McMuffin, and not eating anything until dinner.

Can this work? Can you eat foods with unhealthy ingredients but make up the excessive calories by cutting back elsewhere?

The nutritional composition of McDonald's Sausage McMuffin includes 27 grams of total fat (10 gm saturated); 255 mg cholesterol; 950 mg sodium; 31 gm carbohydrate; 2 grams fiber. In other words, it's essentially the same as butter with sugar on it--pure fat, processed wheat, with little fiber or nutritive value.

For Alvin, this is an extremely unhealthy way to eat. His lipid patterns are just the tip of the iceberg: multiple hidden factors are also at work to create heart disease, atherosclerosis in other territories outside the heart, diabetes, high blood pressure, and cancer.

I think the effects are not much different than what Morgan Spurlock achieved in his Super Size Me documentary, but in little bits and pieces. Eating at McDonald's "restaurants" three times a day yielded frightening changes in his lipids, liver function, kidney function, not to mention his appearance and the way he felt. Alvin is doing the same thing, though in less dramatic fashion.

I see this very frequently: people mimicking the experience of Spurlock, just a little at a time, with overindulgence in processed fats and starches.

When you seen a set of Mcdonald's golden arches (or any fast food restaurant, for that matter), run as fast as you can in the other direction. Such indulgences, even in small bits and pieces, still creates a mess of your health.

View from the precipice

15. October 2006 William Davis (0)

Many people, upon first learning of their CT heart scan score, feel like they're on the edge of a sharp drop. It can feel like you're facing a vast, unknown abyss. At the bottom, all those dreaded things that can happen to you: heart attack, heart failure, hospitals, even dying.

I've encountered this "deer in the headlights" look many times. It truly can be frightening to hear that your heart scan score is 300, or 500, or whatever.

What I find truly frightening, however, is when your score prompts the usual array of misinformation commonly dispensed by physicians: "That's so bad you need a heart catheterization", "Nobody knows why people get calcified plaque", or "Reversal is impossible". All absolute bunk.

Let your fear motivate you to do something about your risk for heart disease. Aim for reversal of your coronary plaque and seek out the tools to achieve this. It is possible and, in fact, we do it all the time. I can't claim 100% success, but the majority of people who engage in an effort like the Track Your Plaque program to reverse coronary plaque succeed. Even a substantial slowing of plaque growth from the expected 30% per year is better than submitting to the conventional approach.

At the very least, get both LDL and HDL cholesterol around 60 mg/dl. This alone is a major plus in reducing the risks associated with your heart scan score. It doesn't guaranteee reversal, but it sure tips the odds in your favor.

Organic Rice Krispies?

13. October 2006 William Davis (0)


Breakfast cereal manufacturing giant, Kelloggs, is launching a line of three cereals that will carry the "organic" designation: Organic Rice Krispies, Organic Raisin Bran, and Organic Frosted Mini-Wheats.

This reminds me of the advertisements I've seen for "fresh fried chicken", or "fresh from the can", or "contains only pure cane sugar". How about organic tobacco? Would that make cigarettes healthier?

The TV ad ends with the slogan "Childood is calling!" Oh, those marketers are a shrewd, clever bunch. I worry that they're so clever that most people will fall for these ludicrous tricks.

Don't fall for these thinly-shrouded marketing shenanigans. Organic? Who cares. These foods remain unhealthy whether or not they contain pesticide residues. Take a look at the nutritional composition: Rice Krispies, organic or not, is sugar to your body. It is the sort of food that creates pre-diabetes, diabetes, makes us fat, and fans the flames of lipoprotein patterns like small LDL, VLDL, and postprandial particles, all of which is like throwing cow manure on the weed patch of your coronary plaque.

Nuts as functional foods

13. October 2006 William Davis (0)
Food manufacturers gave nuts a bad name when they started adding evil ingredients to them. "Party mix", "honey-roasted", mixed nuts, etc., are made with added hydrogenated oils, salt, sugar, excessive quantities of raisins, or other added ingredients that turned a healthy food--nuts--into something that made us fat and hypertensive, raised LDL, dropped HDL, and raised blood pressure.

But nuts themselves are, for the most part, very healthy foods. The very best are nuts with a brown fiber coating like almonds, walnuts, and pecans. Nearly all nuts also come rich in monounsaturated oils similar to that in olive oil. Although calorie-dense, nuts tend to be very filling and slash your appetite for other foods. I have never seen anyone gain weight by adding raw nuts to their diet. In fact, I find adding raw nuts cuts craving for sweets.

Nuts are also among the most concentrated sources of magnesium, containing around 150 mg per 1/2 cup serving. As most Americans are at least marginally if not severely deficient in magnesium, this really helps. Magnesium deficiency is a prominent aspect of "metabolic syndrome" and resistance to insulin.




Some nuts have added benefits like the l-arginine content of almonds or the linolenic acid content of walnuts. However, I think the real health "punch" comes from the fiber and monounsaturate content.

Add 1/4-1/2 cup of raw almonds, walnuts, or pecans per day to your diet and what can you expect? The effects that I see every day that are relevant to plaque control/heart scan score-reducing efforts include:

--Reduction in LDL--usually a 20 mg/dl drop, sometimes more.

--Reduction in triglycerides, especially if nuts replace processed carbohydrate calories. This may be because the fiber and monounsaturate content of nuts reduces blood sugar and the effective glycemic index of any accompanying foods.

--Modest blood pressure reduction.

--Though somewhat inconsistent, partial suppression of the dreaded small LDL particle pattern. We struggle with turning off the small LDL pattern in some people, and raw nuts can provide a real advantage.

If that isn't enough, the fiber content also makes your bowels regular.

Unless there's some reason to avoid nuts (e.g., allergy), nuts should be a part of your heart scan score reducing program. Shop around, as prices can vary wildly. I've been paying $12.99 for a 3 lb bag of raw almonds from Sam's Club, though I've seen almonds elsewhere for up to $12.99 per pound.

For additional commentary, go to one of my favorite Blogs, http://fanaticcook.blogspot.com. The Fanatic Cook's recent post, The Season for Walnuts , provides additional discussion on walnuts and the recent study showing how they improve "endothelial function". The nutritionist behind this Blog has fabulous insights into food, including the concept of "functional foods", i.e., using foods as a treatment tool. She is also unfailingly entertaining.

Can you tell the difference?

12. October 2006 William Davis (0)
Stan is 55 years old. He feels fine, is in moderately good physical condition. His LDL cholesterol is 135 mg/dl, HDL 43 mg/dl, triglycerides 167 mg/dl, total cholesterol 211 mg/dl.

Can you tell me whether Stan has heart disease or not?

How about Charles? Charles has an LDL cholesterol of 127 mg/dl, HDL of 44 mg/dl, triglycerides of 98 mg/dl, and total cholesterol of 191 mg/dl. He is also reasonably fit and feels fine. Can you tell whether Charles has heart disease?

If you can't, don't feel bad. Neither can your doctor. But this is the folly of using cholesterol for risk prediction.

Stan's heart scan score: 0

Charles' heart scan score: 978

Look even more closely at Stan's and Charles' cholesterol numbers. Is there some fine distinction we overlooked? What if we calculated total cholesterol to HDL ratio? Or LDL/HDL ratio?

No matter how you squeeze it, shake it, beat it with a stick, you simply cannot use cholesterol numbers to predict heart disease in specific individuals. Yes, the higher your LDL cholesterol and lower your HDL, the higehr your total cholesterol to HDL ratio, the greater the likelihood of heart disease. But you can simply cannot tell in a specific individual at a specific point in time. If you've seen your doctor puzzle over the numbers, understand that he/she is trying to make sense out of something that doesn't make sense, no matter how hard he/she tries.

You simply need to measure the disease itself: get a CT heart scan, the only measure of atherosclerotic coronary plaque that you have access to.

By the way, if you haven't seen it yet, go to the Track Your Plaque website (www.cureality.com) to see the news piece reporting the American Heart Association's much overdue position statement on CT heart scanning. The AHA has finally released a statement which, in effect, provides their "official" endorsement. Blocked by political shenanigans behind the scenes for several years, the guidelines finally made it to press. The only real difference it makes to me is that my patients may finally get their heart scans paid for by insurance, once the insurance companies realize that it's getting tougher and tougher to dodge their responsibility.

Statin agents and muscle aches

11. October 2006 William Davis (2)
How common are muscle aches with the statin drugs?

It depends on who you ask. If you ask the drug manufacturers, they will tell you no more than 2% of people who take them. They back this up with the experience in tens of thousands of people in published clinical trials.

What if we ask people who take them outside of clinical trials. How many then? I estimate, from my large experience, over 80%! In other words, muscle aches are inevitable in nearly everyone who takes them. The longer you take them, the higher your dose, the more likely muscle aches are going to be.

Why the disconnect between published data and real-world experience? I really don't know. In some instances, the differences are dramatic. The ASTEROID trial, for instance, in which Crestor, 40 mg, was given for two years, only resulted in 8% of people dropping out because of side-effects. My experience: everybody--nobody can tolerate this dose for any length of time.

Let me qualify what "muscle aches" mean. It means achiness and/or weakness, usually mild, occasionally moderate to severe, worse upon awakening and less with use. It can affect many muscles or it can involve only one. Rarely is it incapacitating but it is commonly annoying and frightening. It commonly shows up as gradually diminishing strength with exercise. Strength usually returns promptly upon stopping the offending drug.

"Rhabdomyolysis", or true muscle destruction is, fortunately, very unusual in otherwise well people. People with abnormal kidney function, diabetes, and other concurrent illnesses are somewhat more prone. But in reality, rhabdomyolysis is unusual. I've personally seen it twice, both in people sick for other reasons.

Coenzyme Q10 (CoQ10) supplementation has been a godsend for us. At least 4 out of 5 people who require statins and develop muscle aches respond favorably, but it requires 100 mg per day. The preparation must be oil-based to work, not powder in a capsule which exerts no effect. Some people get by with less; some require as much as 300 mg per day. I've had favorable experiences with the CoQ10 from Sam's Club, GNC, Vitamin Shoppe, and Life Extension (www.LEF.org).

The Track Your Plaque target for LDL cholesterol is 60 mg/dl. Many people do indeed use statins to achieve this level, the level of LDL that amplifies your chances of heart disease reversal, i.e., reduction of heart scan score. The only drawback that I'm aware of with CoQ10 replacement is cost. Beyond this, it's a benign supplement that even supplies higher energy for some people who take it.

More catheterizations would make me happy!

11. October 2006 William Davis (0)
I received this fax today from a cardiologist seeking a position:

"I would prefer to perform as many interventions [stents, angioplasties, etc.] as possible..."

That about sums it up, doesn't it? The goal of this young man, trained in major universities including Columbia University, Harvard, and Emory, is not to pursue an avenue of investigation or healthcare that yields real answers. His goal is to perform as many procedures as possible.

This attitude is deeply ingrained in cardiologists. It's also shared by all procedural medical specialties: the drive to do more and more procedures. It's not because it does more good for the public, but it fulfills a primitive impulse to spread your influence, enlarge your territory, and--of course--make more money.

Personally, I find this impulse repulsive. The fact that this young cardiologist looking for a position is willing to make this statement out in the open demonstrates how widely accepted this attitude is. Imagine your cancer surgeon, looking for a new job, said, "I'm looking to remove as many tumors as I can."

My colleagues have lost sight of the fact that we're trying to reduce or eliminate disease, not enrich our pockets or service some primitive impulse to beat others at our game.

"I hate fish oil!"

9. October 2006 William Davis (1)
I get this comment occasionally, usually from the fishy belching that can occur, rarely because of other crazy effects like rash, fishy body odor, etc.

In the vast majority, fish oil is a benign but wonderfully effective agent. Track Your Plaque followers know that fish oil, starting at 4000 mg per day of a standard 1000 mg capsule preparation, dramatically reduces triglycerides and thereby raises HDL, partially suppresses small LDL, and is the best agent available for reducing postprandial (after eating) abnormalities like IDL and certain VLDL fractions.

However, an occasional person (about 1 in 20) just doesn't like the effects. Are there alternatives? Fish oil packs such a wallop of beneficial effects that can not be replaced by any other single agent or lifestyle practice. For this reason, we have a number of easy strategies to enhance your tolerance for fish oil. (Of course, if your and/or you doctor determine that you're allergic to fish oil, then you should indeed avoid it; thankfully, this is rare.)

Helpful strategies include:

--Refrigerate fish oil capsules--this cuts back on fish belching.
--Take only with meals. This also may increase fish oil's benefits on suppressing after-eating lipoprotein abnormalities.
--Take an enteric-coated preparation--this delays breakdown of the tablet/capsule, making fishy belching less of an issue. Sam's Club has an inexpensive preparation.
--Take liquid fish oil. Usually orange or lemon flavored, liquid fish oil may be a faint fishy taste and odor, but usually not as prominent as the capsules. There's also less stomach upset.
--Coromega--a paste form of fish oil available at health food stores or through http://www.coromega.com. Coromega tastes fruity and comes in little squeeze envelopes.
--Frutol--Pharmax, a British company, makes another fruity fish oil that is non-oily and tastes like apricot. It's actually fairly reasonably priced, too. However, it is hard to find. The only way I know to get is to go online at www.pharmaxllc.com. You may have to actually order through a health care provider.

When using any preparation of fish oil, the best way to determine your dose is to add up the EPA and DHA content. For instance, if you use a fish oil liquid that contains 320 mg EPA and 240 mg DHA per teaspoon, you will need two teaspoons a day to achieve the equivalent of our starting dose of 1200 mg of EPA+DHA, usually provided by 4000 mg total in 4 capsules. Note that some lipid and lipoprotein disorders will require higher doses, e.g., 1800 mg EPA+DHA for high triglycerides (>200 mg/dl) or high IDL.

Sudden death in athletes

6. October 2006 William Davis (0)
A recent report in the Journal of the American Medical Association details how a group in the Veneto region of Italy cut back on the incidence of sudden cardiac death in athletes by a simple screening program.



You can read the abstract of the article at http://jama.ama-assn.org/cgi/content/full/296/13/1593.

Although sudden death in athletes is still a rare event, it is especially tragic when it happens. In this population, the incidence was 3.6 deaths per 100,000 athletes aged 12 to 35 years. By implementing a simple screening program that involved only a physical examination and an EKG, an astounding 89% reduction in sudden death was documented.

What lessons does this hold for those of us interested in coronary plaque reversal? Beyond the obvious lesson of pointing out the great benefit of simple screening of athletes, I believe that it tells us the value of simple screening tools for heart disease in general. It is my strong belief that, if we were to implement CT heart scans among the broad population of men 40 years and over, women 50 years and over--without regard to cholesterol or other relatively lame risk identifiers--we could slash the risk for heart attack and death 90% or more. Putting CT heart scans into the hands of the public makes your coronary risk obvious. It takes the guesswork out of risk predictors like cholesterol and high blood pressure.

But heart scans are already available, you say! Yes, of course they are. But the lack of insurance reimbursement continues to be a restricting factor for many people, despite the number of lives that could be potentially saved and the money that would be saved in the long run by reducing need for major heart procedures. The continuing resistance to prevention by my cardiology colleagues and the persistent ignorance of primary care physicians also remain major impediments.

But it's getting better. You don't have to be chained by ignorance. Put your CT heart scan to good use.

My heart scan was wrong!

6. October 2006 William Davis (0)


Tom came into the office ready for a confrontation.

Tom's wife insisted that he see me to discuss the implications of his CT heart scan score of 459. At age 50, this was clearly bad news that placed Tom in the 99th percentile (worst 1% of men in his age group).

But Tom had already undergone a stress test. There had apparently been a small abnormality, and a heart catheterization had been performed by another cardiologist. "They told me they didn't need to do anything. No stent, no ballon, no bypass, nothing!"

I asked, "Did they tell you that there was any plaque or blockages seen?"

"Yeah, but he said it was nothing. So the heart scan was wrong!"

I've been here many times before. I explained to Tom that, no, his heart scan was not wrong. All the tests he'd undergone siimply provided a different perspective on the same disease. You could say:

--The stress test, being a test of blood flow, may have been abnormal because of the abnormal constrictive behavior of arteries containing plaque, known as "endothelial dysfunction", because the inner lining of arteries (the endothelium) control the tone of the artery. Abnormal constriction in arteries with plaque is quite common.

--The catheterization simply showed that no plaque had collected in a configuration to block flow, thus no stent, etc., since flow was normal. But there was indeed plaque.

All three tests were right; none were wrong. They all provided a little different perspective on the same process. Of course, I favor the heart scan as the means to identify, precisely measure, and track the atherosclerotic plaque in your arteries. The stress test is too crude and only measures flow, the catheterization is not something you'd want to undergo year after year. Catheterization also is too crude a measure to precisely track plaque growth or reversal.

So I explained to Tom that, even though a stent or similar procedure was unnecessary, he remained at substantial risk for heart attack due to plaque "rupture". In fact, Tom's heart attack risk was 5% per year, or approximately 50% over the next decade. That is, indeed, substantial. In fact, you might say that, of the three tests Tom underwent, only the heart scan revealed his true risk.

I had a heart attack--and I don't know why!

25. October 2006 William Davis (0)
Kevin came to my office for another opinion.

A husband and father of two teenagers, Kevin had his first heart attack at age 39. Kevin received two stents to his right coronary artery. The entire process took place in a flurry with little explanation over 48 hours, start to finish.

He smoked a pack of cigarettes a day, but the only history of heart disease in his family was his father, who, also a smoker, had his heart disease uncovered in his late 70s.

His internist subsequently prescribed Zocor even though Kevin's LDL cholesterol was a relatively unimpressive 128 mg/dl.

Kevin subsequently asked his cardiologist, "Where did I get the heart disease from?"

"Cigarettes. And genetics. You can quit the first. There's nothing you can do about the second." End of explanation.

This left Kevin frightened and demoralized. If much of the cause of his heart disease couldn't be identified, why bother quitting smoking? Why not enjoy what time he had left?

Kevin was understandably shocked when I told him that genetic causes were 1)identifiable, 2)quantifiable, and 3) correctable.

Kevin's full lipoprotein analysis subsequently showed the most dire combination that commonly accounts for coronary disease in young people: Lp(a) with small LDL particles. This, along with smoking, fully accounted for this young father of two's heart disease.

Along with starting Kevin on a new program for correction of his patterns, I also persuaded him to get a heart scan. What usefulness is a heart scan after the fact? Plenty. Even though Kevin's right coronary was no longer "scorable" because the steel in the stent obscured our measurements, the two remaining unstented arteries would still yield a score. This provides a baseline for future comparison. Even after a stent, Kevin could "track his plaque".

Butter basics

24. October 2006 William Davis (3)
There’s lot of confusion about butter, margarines, and their substitutes. Butter/margarine substitutes that avoid the negative aspects and provide modest health benefits are available, but I find that people confuse what's what. So here’s a brief primer.


Butter--Avoid it. Plain and simple. Butter is a rich source of saturated fat. Of 11.5 grams total fat per tablespoon, 7.3 grams are saturated. It is not better than margarine, contrary to simple-minded reports from some media sources. Butter raises LDL cholesterol, raises blood pressure, and has been related to various cancers.

Margarine--Not better than butter, arguably worse. Some argue that the trans-fatty acids, or hydrogenated oils, used to solidify vegetable oils to make margarine solid are worse than butter. In addition to the ill-effects of butter, margarine reduces HDL and raises cancer risk, perhaps even more than saturated fats. Hydrogenation yields a very unnatural structure that modifies cellular behavior of the sort that may promote the appearance of cancer cells. More recently, however, some of the major manufacturers, like Blue Bonnet, have produced soft spread products without hydrogenation. These are reasonable substitutes when used sparingly.

Smart Balance--This is a product made with canola oil, a source of monounsaturates (the best oil source after omega-3s), but manufactured without hydrogenation and therefore has no trans-fats. It does have, in my view, a bit too much saturated fat (1.5 gm per tbsp. in the 37% Light Spread; 2.5 gm per tbsp in the 67% regular spread). This is a reasonable product to use in small quantities.

There is also a Smart Balance Omega PLUS product that contains added flaxseed oil and sterol esters. I do not recommend this product because of the sterol content (see below). I also object to the manufacturers who label their products “rich in omega-3s” when they mean linolenic acid (in flaxseed), which is converted to a trivial quantity of omega-3s. Linolenic acid may pose unique benefits of its own, but it should not be listed as an omega-3 source.

Benecol--This is a butter substitute that contains stanol esters, a substance that reduces total and LDL cholesterol. Two tablespoons a day reduces LDL around 20 mg/dl, more or less depending on your starting cholesterol.
There’s a light and regular spread. The light contains 20 calories less per tablespoon but somewhat less monounsaturates, but the same LDL-reducing stanol esters. The manufacturer does hydrogenate the oils, yielding 0.5 mg trans-fats per tablespoon--a small drawback.

Take Control--Similar to Benecol, but made with sterol esters. Take Control also reduces LDL cholesterol. However, data from several high-quality studies from Finland suggest that sterol esters may, in some people, be absorbed into the blood. This is potentially concerning. There is a rare disease called sitosterolemia that results in coronary disease in teenagers and young adults in their 20s from increased absorption of sterol esters. While you can’t acquire this genetic disease, some people have the capacity to absorb sterol esters from their intestines very efficiently. I find it very disturbing and I suggest that you stay away this product and other sterol-containing products like HeartWise orange juice and Smart Balance Omega PLUS until the issue is clarified and safety assured.

Brummel and Brown--A blend of vegetable oils (soybean and partially hydrogenated soybean) with calories and fats reduced by blending in yogurt. This is an okay product. The hydrogenation yields trans-fats below the FDA required declaration limit of 1.0 mg.
There’s also 1.0 mg each of saturated and monounsaturated fats. The calories are relatively low as a consequence of the added yogurt, only 45 calories per tablespoon. This makes the Brummel and Brown a reasonable choice.


Other products are making their way out to supermarkets. Look for the type of oil used. Canola, olive, and flaxseed are the best. Also look for trans-fats and saturated fat content; both should be low, preferably <1.0 mg per tablespoon, ideally none.

The best choice among the above products in my view is Benecol, though it’s also the most expensive. It will yield substantial drops in LDL cholesterol. All the products in our informal tastings taste a lot like butter, or at least as well as we can remember what butter tasted like! The key with all of these products is use in moderation, since they all provide between 45?80 calories per tablespoon.

Let Dr. Friedewald rest in peace

24. October 2006 William Davis (1)
In the 1960s, doctors struggled with the concept of cholesterol and its relationship to heart disease. It was becoming clear that higher levels of cholesterol were predictive of heart disease. It was also becoming clear that the low-density fraction of cholesterol, or LDL, was somewhat better than total cholesterol in predicting heart attack.

Cholesterol was easily measurable in the 1960s. LDL was not. So, Dr. Friedewald, a noted lipid researcher at the National Institutes of Health, proposed an easy method to calculate LDL cholesterol from total choleseterol, HDL, and triglycerides:

LDL cholesterol = Total cholesterol – HDL cholesterol – triglycerides/5

This simple manipulation would put LDL cholesterols into the hands of the practicing physician and the American public. Dr. Friedewald recognized that this calculation only represented an approximation of LDL cholesterol and that it was thrown off, sometimes substantially, by any abnormal rise in triglycerides or reduction in HDL. But it served its purpose at an age when most doctors hadn’t even heard of cholesterol and the public was still sold on whole milk and “farm-fresh” butter, and Chesterfields were the cigarette choice of most doctors.



The world has since changed. Most doctors have heard about cholesterol and, along with the public, have been drowned in drug company marketing for cholesterol-reducing drugs. Most people with some level of common sense and health awareness no longer use butter or whole milk, and no longer believe that the brand of cigarette you choose can be healthy. But we’re still using Dr. Friedewald’s original calculation for LDL cholesterol. When you get an LDL cholesterol from your clinic, doctor, or hospital, >99% of the time it is obtained using Dr. Friedewald’s calculation.

Is it because there’s nothing better available? No, it’s not. There’s two reasons why your neighborhood primary care physician or cardiologist is still using this dinosaur of testing called LDL:

1) The lag in science to practice is 20 years. Accept that most primary care doctors are 20 years behind the times on many issues, LDL cholesterol included.

2) Insurance companies vigorously discourage testing beyond conventional lipids. The array of objections we get from insurance companies is mind-boggling. It would be funny if human life and finances weren’t at stake. These “new” tests are “experimental”, “unproven”, not endorsed by standard guidelines, not approved by some internal committee, or simply “We don’t know what this test is” ?we’ve heard them all.

What are the tests that are superior to Dr. Friendewald’s calculated LDL? There are several, listed here in order of best to worst:

1) LDL particle number--the value generated by NMR lipoprotein testing. This is the gold standard, most reliable test available, and the one I recommend.

2) Apoprotein B--More widely available even from conventional laboratories in hospitals. Not as accurate as NMR LDL particle number, but a pretty good choice. Apo B is the principal protein in LDL, VLDL, and IDL particles, and so it’s a better reflector of risk from all of these lipoprotein fractions, not just LDL.

3) “Direct” LDL--This is LDL that is actually measured. Unfortunately, it ignores the issues of LDL size and has some other pitfalls, but it’s still better than calculated LDL

4) Non-HDL cholesterol--So-called because it incorporates all undesirable cholesterol-containing lipids except good HDL, thus “non-HDL”. This is another calculation, though better than LDL (because it sums up the risk from other apoprotein B-containing lipoproteins). Non-HDL is calculated from Total cholesterol – HDL. It’s therefore available from any standard lipid panel. It’s little used in everyday practice, however, because most people and their physicians find it confusing.

5) Friedewald calculated LDL--You can see that calculated LDL is last on a list of choices. Yet this is the measure that doctors use day in, day out. It’s the measure that drug companies base billions of dollars of revenue and profits on.

It’s an everyday occurrence in my office that calculated LDL is 89 mg/dl, but the real value is somewhere between 160 and 200 mg/dl. That’s a big difference. Imagine your realtor tells you your house’s estimated value is $200,000 and that’s what you sell it for to an eager buyer. After closing, you find out your house was really worth $300,000. You’d be upset. But that’s what you’re often getting with LDL cholesterol?a bum deal.

It’s part of the reason people will say, “My doctor said my cholesterol was fine and that no cause for my heart disease can be found. He said it was genetic.” In reality, they could have sky-high LDL cholesterol revealed by LDL particle number or apoprotein B.

Use LDL cholesterol in a pinch when you’ve got nothing else. It’s also helpful to gauge any treatment effect of diet, functional foods, drugs, etc. But it is a seriously flawed tool to diagnose your initial level of risk.

The key to losing weight

23. October 2006 William Davis (0)
I saw three people this past week, all of whom set off on an effort to lose substantial quantities of weight. And all seriously needed to.

All three started with at least 70 lbs. excess weight; all showed substantial weight-sensitive lipoprotein patterns like low HDL, small LDL, high triglycerides, VLDL, and pre-diabetic levels of blood sugar. They also all shared high blood pressure.

All three also had high heart scan scores. Kate’s score was just over 1200. Tom, a 58-year old real estate developer, had a score of nearly 600. Susan, the youngest of the three at 52, had a heart scan score of 377¾99th percentile at this age. Losing weight was an absolute requirement for their plaque control program. Because their lipoprotein abnormalities and pre-diabetic patterns were triggered by weight, weight loss would provide powerful correction. Each and every one of them would need to lose much of their excess weight¾at least 50 lbs¾if they hoped to halt the relentless progression of their heart scan scores.

All three of them returned after 6-8 weeks, and all had lost between 17-24 lbs: spectacular results.

There’s no secret to weight loss. Each of them achieved their weight loss in slightly different ways. But they also shared several critical ingredients in their weight-loss efforts:

1) All three dramatically slashed their intake of wheat flour-containing foods and other processed carbohydrates and did so consistently. All also avoided the usual high-fat, high caloric-density foods like butter, margarine, fried foods, greasy foods, nuts roasted in oil, etc. They concentrated on vegetables, salads, raw nuts, lean proteins (inc. turkey, chicken, fish, lean red meats, low-fat cottage cheese and yogurt).

2) They stopped using food as a reward or as a consolation tool.

3) Exercise for one hour a day at least 5 days a week. The exercise in 2 of 3 of these people was just walking. It wasn’t strenuous, it wasn’t expensive. The women both liked walking with friends or their spouse. Tom followed a more common male path of more strenuous work on his treadmill, elliptical, and biking at the fitness club. But they all did it religiously and missed rare sessions.

4) They refrained from any and all alcoholic beverages. Yes, there are some advantages to 1-2 glasses of wine per day, but it stalls weight loss efforts.

5) They didn’t allow themselves any major indiscretions. There were no binges, major pig-outs at weddings, barbecues, or all-you-can-eat buffets. They did allow themselves an occasional “treat” but did so in small portions.

That’s it. But for most people, that’s simply too much. Adhering to an effort to lose dramatic weight requires day-after-day consistency. Nobody can lose the equivalent of 70,000 calories (20 lbs.) just by skipping a meal, a 20-minute walk, skipping the mashed potatoes at dinner.

It can be done. You’ve just got to be consistent about it.

How can I get my lipoproteins tested?

20. October 2006 William Davis (0)
This question came up on our recent online chat session and comes up frequently in phone calls and e-mails.

If lipoprotein testing is the best way to uncover hidden causes of coronary heart disease, but your doctor is unable, unknowledgeable, or unwilling to help you, then what can you do?

There are several options:

1) Get the names of physicians who will obtain and interpret the test for you. Go to the websites for the three labs that actually perform the lipoprotein tests: www.liposcience.com (NMR); www.berkeleyheartlab.com (electropheresis or GGE); www.atherotech.com (VAP or centrifugation). None of them will provide you with the names of actual physicians. They will provide you with the name of a local representative who will know who the doctors in your area who are well-acquainted with their technology. I prefer this route to just having a representative identify a laboratory in your area where the blood sample can be drawn, because you will still need a physician to interpret the results¾this is crucial. The test is of no use to you unless someone interprets it intelligently and understands the range of treatment possibilities available. Don’t be persuaded by your doctor if he/she agrees to have the blood drawn but has never seen the test before. This will be a waste of your time. That’s like hoping the kid next door can fix your car just because he says he fixed his Mom’s car once. Interpretation of lipoproteins takes time, education, and experience.
2) Seek out a lipidologist. Lipidologists are the new breed of physician who has sought out additional training and certification in lipid and lipoprotein disorders. Sometimes they’re listed in the yellow pages, or you can search online in your area.
3) Contact us. I frankly don’t like doing this because I feel that I can only provide limited information through this method. I provide a written discussion of the implications and choices for treatment with the caveat to discuss them with your doctor, since I can’t provide medical advice without a formal medical relationship. We also charge $75 for the interpretation. But it’s a lot better than nothing.
4) Make do with basic testing. Basic lipids along with a lipoprotein(a), C-reactive protein, fibrinogen, and homocysteine would provide a reasonable facsimile of lipoprotein testing. You’ll still lack small LDL and postprandial (after-eating) information, but you can still do reasonably well if you try to achieve the Track Your Plaque targets of 60-60-60.

In 20 years, this will be a lot easier. But for now, you can still obtain reasonably good results choosing one of the above alternatives.

What do you think about those heart scans?

20. October 2006 William Davis (1)
52-year old Jerry came in for a stress test. He displayed the usual apprehension: fidgeting while he sat on the bed, examining his surroundings, asking lots of questions.

“Your doctor asked you have have a stress test?” I asked.

“All the males in my family have had heart attacks by age 56, so my doctor suggested I have a stress test,” Jerry explained.

Jerry went on to tell me that he had exercised vigorously this morning for 45 minutes without symptoms. He had, in fact, gone surfing just several weeks earlier and described how aerobically challenging it was keeping up with the 20 year olds. “But I did it!” he proudly declared.

As he neared the end of his brisk walk on the treadmill, Jerry asked, “What do you think about those heart scans?”

Jerry had asked his primary care physician the same question. His doctor had apparently told him that they were just a gimmick. “We’ll get you a real test.”

Of course, Jerry’s stress test proved entirely normal. The likelihood of an abnormal stress test with his history of vigorous exercise was <2%. I explained to Jerry that not getting heart scan would be a mistake. In fact, a heart scan was the only easily obtainable test that would uncover hidden heart disease. In truth, the stress test was a waste of time—and an unneeded exposure to radiation.

If Jerry’s heart scan score turned out to be zero, great! He was probably spared the genes from the other males in his family, and his risk of heart attack in the next decade was nearly zero.

If his heart scan turned out be 1000, then an urgent scramble to uncover the causes and correct them to create a truly effective prevention program would be crucial for his long term health. Or, perhaps his score lies somewhere in between, but Jerry would then know how far along he stood on his way to heart disease.

Don’t be a victim of the ignorance of your doctor. Despite all the attention heart scans have received, the majority of doctors remain miserably, inexcusably in the dark. I say inexcusable because CT heart scans can uncover the number one killer of Americans, the number one cause of all deaths in any primary care physician’s practices, and it’s laughably easy. How can a physician not advise patients on the value of heart scans?

If given a choice and you’re without symptoms, a heart scan is far and away the superior test.

Olive oil for gourmets

19. October 2006 William Davis (0)
"The finest extra-virgin olive oils should not be used as a medium for hot cooking, but rather as a condiment or a finisher on top of your favorite savory foods. They are expensive, but if stored properly they will last for up to a year..."

You all know that olive oil is among the preferred oils to use: rich in monounsaturates, low in saturates, high in polyphenols.




For a fascinating perspective for the olive oil gourmet, go to www.npr.org, the website for National Public Radio. (Scroll down to the article or enter olive oil into their site search.) Their article, "Like fine wines, fine olive oils boast subtle joys" provides an insightful discussion on squeezing maximum enjoyment out of this wonderful "functional food".

As we emerge from the mis-directed low-fat craze of the past 20 years, we're re-discovering the joys of healthy oils. You'll find some great thoughts here

Vitamin D must be oil-based

18. October 2006 William Davis (10)
As part of the Track Your Plaque coronary plaque reversal program, we advocate vitamin D supplementation. Vitamin D has been shown to reduce blood sugar and reduce pre-diabetic tendencies, reduce blood pressure (it's a renin antagonist, a blood pressure hormone), it's far more important for bone health than calcium, and it may help prevent colon cancer, prostate cancer, and multiple sclerosis.

And, oh yes, it may facilitate coronary plaque regression.

One lesson I've learned is that vitamin D MUST be taken as a oil-based capsule or gelcap. You'll recognize it as a transparent or translucent, sometimes opaque, capsule. The list of ingredients may say something like "cholecalciferol [vitamin D] in a base of soybean oil", indicating that the active ingredient is oil-based. Oil-based vitamin D3 skyrockets blood levels of 25-OH-vitamin D3 in to the normal range reliably and easily.


Tablets are a different story. These are generally white powdery tablets. The rise in blood levels of vitamin D3 are minimal, sometimes none. Women will often say "I get vitamin D with my calcium tablets."


People taking this form almost always have blood levels of vitamin D that are low, as if they were taking nothing.
If you're going to take vitamin D, the oil-based tablets are the way to go. They're not necessarily any more expensive. We've had good experiences with the Nature's Life 2000 unit capsule, as well as preparations from Life Extension. We have had negative experiences with the preparations from GNC, Sam's Club, and Walgreen's, all tablets and non-oil-based.

When is LDL cholesterol NOT LDL cholesterol?

18. October 2006 William Davis (0)
Darlene had a high LDL cholesterol, at times as high as 200 mg/dl. Her primary care doctor first tried Mevacor, then Pravachol, then Zocor, then Lipitor. Every statin drug failed to reduce Darlene's LDL below 160 mg/dl, even when maximum doses were used. The higher doses also resulted in nearly intolerable muscle aches and weakness.

When we sent Darlene's blood sample off for lipoprotein analysis, a surprise came back: she had a high lipoprotein(a), or Lp(a). This explained a lot.

LDL cholesterol is not always just LDL cholesterol. One of the particles that can masquerade as LDL is Lp(a). Darlene's story is typical of many people who've had high cholesterol levels poorly responsive to the statin drugs. That's because their LDL conceals Lp(a), which does not respond to these agents. LDL cholesterol does drop some because there's also some real LDL mixed in.

A poor response to statin agents or to nutritional strategies to reduce LDL is a tip-off that Lp(a) may be hidden. The answer: just measure Lp(a)! If you and your doctor don't measure it, you won't know whether or not you have it. Rather than a statin drug, we put Darlen on niacin. Not only did her Lp(a) drop, but her LDL also plummeted.

What is a desirable triglyceride level?

17. October 2006 William Davis (0)

Though well-intended, the National Cholesterol Education Panel's Adult Treatment Panel, or ATP-III, (whew!) guidelines for cholesterol have been responsible for loads of misinformation.

The intention was to educate the internist or family doctor who treats sore throats, performs Pap smears, administers pneumovax vaccine, treats arthritic knees---and dabbles in heart disease prevention. The ATP-III guidelines are the "Cholesterol for Dummies" approach.

What standard guidelines definitely do not represent are the ideal values to achieve. They do not ensure protection from heart disease. This is particularly true of the ATP-III advice to keep triglycerides at or below the "desirable" level of 150 mg/dl.

In the Track Your Plaque program, we ask "What is necessary to tip the odds in favor of coronary plaque regresion or reduction of heart scan score?" This is not achieved with a triglyceride of 150. In fact, triglycerides at this level are associated with flagrant abnormalities of lipoprotein patterns. It usually means that processed carbohydrates, particularly wheat products, are occupying too prominent a role in your food choices. It could mean that you're making excessive use of processed foods containining high-fructose corn syrup. It will not respond to a low-fat diet. It will, however, respond vigorously to fish oil.

Triglycerides are a crucial aspect of your plaque control program. We aim for 60 mg/dl or less. The ideal level is actually 45 mg/dl. At this level, all abnormal triglyceride-containing lipoproteins finally go away.
Have some more

Have some more

7. April 2011 William Davis (37)
Wheat, via exorphin effects, is an appetite stimulant. Eat a whole wheat bagel or bran muffin, you want another. You also want more of other foods. You also want something to eat every two hours due to widely-swinging insulin-glucose responses: blood sugar high followed by a sharp downturn that triggers a powerful impulse to eat (thus the cravings for a snack at 9 and 11 a.m. after a 7 a.m. breakfast).

If wheat is a stimulant of appetite, then removing it should yield reduced appetite and reduced calorie intake. That is precisely what happens.

When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.

400 calories per day results in 21 lbs lost over 6 months, based just on calories. (3500 calories per pound lost.) That is what happens in wheat elimination diets: 21-26 lbs lost over 6 months.

Wheat is the processed food industry's nicotine, a means of ensuring repeat food purchases. It's also low-cost (subsidized by the U.S. government), high-yield, an ingredient that even has its very own withdrawal syndrome should you miss a "hit."
Tags :

Comments (37) -

  • Steve

    4/7/2011 2:49:30 PM |

    The reduced appetite after wheat withdrawal is exactly what I'm experiencing. A very low carbs (and so very low wheat) diet is the first diet that I can stay on because I don't get hunger pangs. I'm down about 20 lbs. (10%) since finding this blog and going wheat-less.

  • Anonymous

    4/7/2011 3:31:35 PM |

    Hmmm... I've been wheat free (grain-free, actually) for almost 3 weeks now. I started off being mildly hungry all the time, and that has faded. I wonder if that's what you're talking about there!! Terrific!

    Keep the articles coming... love them.

    Diana

  • Steve

    4/7/2011 4:16:45 PM |

    I started just before Christmas. The first week or so was unpleasant ... hungry, groggy ... wheat withdrawal. The "no hunger pangs" showed up after that and made it possible for me to stay on this diet. It's the first time I've been able to consistently lose weight.

  • Real Food RD

    4/7/2011 4:44:52 PM |

    When I first went off wheat it took a good 3-4 weeks for the withdrawl to stop.  During that time I was ravenously hungry and ate constantly.  I know my body was just hoping I'd eventually eat some bread.  I gained probably 10 pounds, but it came back off (I don't have any other weight to lose).

    Was that a study you are referencing or clinical experience?  Would love to have more details.

  • Might-o'chondri-AL

    4/7/2011 5:08:06 PM |

    Biblical wheat and remote regional "landrace" wheat strains are not the same as tetra-ploid wheat we're sold. Tetraploid varieties have been grown for less than 500 years; and di-ploid varieties around for 500 to 1,000 years.

  • Megaera

    4/7/2011 5:23:28 PM |

    Look, I'm glad that this works for some/lots of people - but I've been doing this since before Christmas, 4 months now, and I haven't lost a pound.  My status is a good deal worse in a number of subtle and not-so-subtle respects, and frankly nothing of substance has actually improved in any way.  Recommendations of iodine supplementation were an unqualified disaster.  And I effectively have nowhere to go, now -- I'm stuck with this mode, because I have every reason to believe that going back to grain in any degree will yield uncontrollable weight gain.  I'm really not trying to be negative, but the point  has to be made, amid all the rosy predictions of magic pounds disappearing (that's just calories-in-calories-out which is supposed to be BS, according to the new Received Wisdom, no?) that this regimen doesn't work for everyone.

  • ChicagoGirl1

    4/7/2011 6:06:43 PM |

    How is wheat different from just carbs in general? Don't they all create this problem?

  • brec

    4/7/2011 7:09:57 PM |

    "...has its very own withdrawal syndrome should you miss a 'hit.'"

    If you follow the link, you'll see that this unqualified statement is based on self-selected (Dr. Davis's blog commenters) anecdotal evidence.

  • Anonymous

    4/7/2011 7:42:27 PM |

    brec:

    If you keep following those links back, you'll eventually land here:

    http://www.jbc.org/content/254/7/2446.full.pdf+html

  • Dani

    4/7/2011 8:25:31 PM |

    I agree. I can't stop once i start eating crackers or croissants.

    In your opinion, do other grains like corn and rice have the same effect?

  • Gene K

    4/7/2011 9:44:27 PM |

    @Megaera

    I used to eat a lot of bread. For the first four months of my grain-free and carbs-from-veggie-only life and policing my blood sugar I gained about 10lbs. My NMR profile got significantly worse, too. Dr Davis checked my APOE and it was type 4, so he told me to limit fats and changed my medications. In addition, I stopped being a vegetarian and increased the amount of lean proteins in my diet. I also changed my exercise routine according to slow-burn. Four months later - 14 lbs have been lost and NMR profile improved drastically.

    I am saying it, because there is a happy path of losing weight when you stop eating wheat, but certain people may need to make an additional effort. So you need to look further.

  • Might-o'chondri-AL

    4/7/2011 10:03:45 PM |

    Japanese children (290) aged 5 - 18 had MRI of brain to see if breakfast centered on white bread vs. white rice differ. The study adjusted for confounding factors.

    The older white rice breakfasters showed a larger grey matter in relation to cranium volume; in some brain areas white bread eaters had more grey matter.In the youngest there was not a statistical differenece in grey matter volume between the groups.

    Rice breakfasters' MRI showed more grey matter in left superior temporal gyrus, left inferior temporal gyrus,right pre-central gyrus, left superior caudate  nuclei and the bilateral caudate nuclei. Caudate volume is associated with a subset of verbal IQ ( POI component); the rice breakfasters had higher POI scoring. And in addition they had higher IQ than the bread group; IQ is associated with prefrontal and orbito-facial corteces and the cingulate gyrus.

    Bread breakfasters MRI showed more grey matter in the postcentral gyrus, right precentral gyrus, right fronto- parietal orbit, and bilateral orbito-frontal corteces. Their MRI showed more white matter in
    the right pre-frontal gyrus  and post-central guyrus; otherwise the two diets showed no white matter % differences between the groups.

  • Just Joan

    4/8/2011 1:00:06 AM |

    My experience has been exactly like Steve's. Since going completely wheat-free (as well as ditching the sugar and most fruit), I'm down 15 lbs. and still losing. The best part of all is that my hypoglycemia symptoms have completely disappeared, my energy is through the roof, and I no longer get uncontrollable hunger pangs.

  • Dr. William Davis

    4/8/2011 1:01:57 AM |

    As Steve and 1st Anonymous point out, this approach can work for many, if not most, people with extravagant weight loss and health benefits.

    However, as the frustration expressed by Meg suggests, there may be confounding factors. As Gene points out, apo E4, for instance, can modify the response. But this was not the focus of the post.

    This is a blog. Each post makes a point. Don't mistake this for a one-on-one healthcare encounter.

  • Dr. William Davis

    4/8/2011 1:03:27 AM |

    Hi, Real Food-

    I was referring to the collective experience demonstrated in gluten-elimination diets in celiac patients.

    I will summarize this literature in my upcoming book from Rodale, Wheat Belly.

  • mongander

    4/8/2011 1:32:32 AM |

    I've relented and switched from oats to swallowing about 1 oz of chia seed for breakfast.  The rest of the day I mainly rely on cabbage/veggie soup (no starches)...snack on roasted peanuts & boiled eggs.  Am losing weight.

  • Frank Hagan

    4/8/2011 2:01:10 AM |

    Dr. Davis - I posted today about leptin resistance, and how high triglyceride levels have been implicated in stopping leptin from its normal "hunger stopping" function. Have you seen a dramatic decrease in triglycerides from those that simply refrain from wheat, without intentionally counting other carbs?

  • WheatlessX

    4/8/2011 2:23:20 AM |

    A few months ago, I read a post on this blog which suggested getting a BG meter in order to see what effect things like wheat had on BG. The results of my first meal (whole wheat pasta with red sauce, broccoli, and whole wheat toast) showed 183 at 1hr PP and 149 at 2hr! What was really surprising to me, however, was that despite the 2 hour number being as high as it was, I was still very hungry.

    Based on this and subsequent tests, along with increased awareness of satiety, I've made some pretty significant changes in the types of foods I eat. Mostly, I've cut back on all the grains (even "whole grain") and added fats (I no longer believe the "low fat" recommendations).

    The result is that in about 3 months I've lost roughly 15 lbs. (mostly in my belly), despite having no sense of being deprived. It doesn't hurt that my lipids have improved, as well (TC, LDL and trigs all lower).

    I had been skeptical of Dr. Davis's claims about wheat at first, but I am now convinced that for me at least, wheat is not my friend.

  • Anonymous

    4/8/2011 3:33:36 AM |

    What if that happens to me with prety much every thing. I want another almond, another egg, another piece of cheese, another wine, more chocolatte, another sushi, a bit more of meat....

  • David Evans

    4/8/2011 8:16:16 AM |

    I started to cut down on my bread intake about 3 years ago and am now almost completely grain free (apart from accidental consumption). I have lost over 50lb and feel like a diifferent person.

    One of the biggest bonuses of cutting wheat from my diet is the improvement in my mood and temperament. I used to be quite a moody and slightly unpredictable type of personality, but now everything is calm and serene.

    Quite a few scientific papers show a connection between schizophrenia and cereal intake. http://healthydietsandscience.blogspot.com/search/label/Cereals%20and%20Schizophrenia

    This may help to explain the improvement in my personality.

  • Anonymous

    4/8/2011 11:10:35 AM |

    I've been mostly wheat-free for over a year, and have lost exactly zero pounds. I still don't eat it, since I believe there are a lot of benefits to leaving it out (all my blood-work #'s were fine before, but improved a bit more after awhile of high-fat/low carb). The biggest improvement I've seen is in my mood -- no more depression. However, I'm still 100 lbs overweight. Frown

  • CarbSane

    4/8/2011 12:27:43 PM |

    When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.


    I would be interested in one study demonstrating that just cutting wheat from the diet resulted in 350-400 cal/day spontaneous reductions in intake.  Preferably controlled for protein content by substituting other carbs for normal wheat content.  

    The VLC diet studies don't count as too many variables are changed there to attribute most, if even any, of the decreased intake to reductions in wheat intake.

    If wheat is addictive, and whole wheat supposedly contains more addictive substances, why don't people gravitate towards whole wheat pasta and bread and binge on
    those?

  • Eric

    4/8/2011 3:12:46 PM |

    CarbSane-

    You stated "The VLC diet studies don't count as too many variables are changed there to attribute most, if even any, of the decreased intake to reductions in wheat intake."

    Same could be said for the studies that cholesterol and fat are the sole reasons for our obesity, diabetes, heart disease, etc- yes?

    I also don't buy your suggestion that people don't binge on whole wheat containing foods as I've seen it countless times at bagel shops, healthy Asian noodle bowl places, pizzerias, etc. People trying to eat "Healthy" often over indulge on "healthy" pizzas, bagels, breads and pasts all while thinking they are doing eating exactly what the AHA recommends. Something that is more than likely silently killing them.

    I've done all this before and all it got me was a plethora of trips to a cardiologist, anxiety, depression, bloating and countless Rx pills that did absolutely nothing. And I'm not an unhealthy guy by any means.

    You may feel Dr. Davis' posts are all anecdotal and that's fine. His new Track Your Plaque book has all the evidence and studies I need to support his claims and it was the anecdotal evidence that he posts that spoke volumes to me. It was the first place I found that explained exactly what I was going thru (30 years old, extremely hypertensive, depressed, slightly overweight and angry with atherosclerosis that seriously a 30 year old should not be suffering from). From that point on I've read his book, followed his plan and have replaced all my worthless Rx's for a daily dose of VD3, Omega3 and steer clear of "Healthy" grains... and I couldn't be happier.

    Of course this is my own "anecdotal" experience, that four of my previous cardiologists couldn't achieve...

  • Steve

    4/8/2011 4:01:05 PM |

    In posts above I didn’t make clear that I am actively “dieting” as in “trying to lose weight”.

    My diet: Two Atkins shakes for breakfast with vitamins and two more for lunch. An Atkins shake for snacks, as needed. Dinner is a leafy greens salad with vinaigrette and maybe nuts, peppers, tomatoes, cheese, minced garlic plus a meat portion and sometimes a low-carb vegetable. A 30 minute after-dinner walk with my dog most  evenings. A 15 minute walk/run some mornings before my weigh-in.

    I believe the only reason I can stay on this tough diet is the “no hunger pangs” effect that I get with very-low-carbs. For example, I can have the Atkins shakes for breakfast and easily go until lunch with no cravings. To accelerate weight loss, I can even skip breakfast – no hunger pangs means I can go from dinner to lunch without cravings – I’m hungry but I can do it – I’ve done it every day this week.

    I’m about 5’8”. I found this blog on Dec. 17th and I weighed 204 lbs. On Jan. 29th I weighed 189. Today, April 8th, I weighed in at 179.8! I hadn’t been in the 190s in years. The 180s? The 170s? They were just dreams to me.

    I have gone off the diet; typically after multiple social events in a row. Example -- alumni social Thursday eve, extended-family dinner at a restaurant Friday eve, sports event Saturday, why-not-keep-eating Sunday. Then, I want to keep losing weight so I get back on the diet. I go through wheat-withdrawal again but now I know it’s just a temporary phase and that helps me get through it. It takes about 10 days to get back to where I was and then I keep dieting.

    Disclaimers – On a tough diet like this I am weaker than normal but I can function and I put up with it because, after my initial success, I see this works & I want to lose the weight. I have a desk job so I can probably better handle the reduced energy levels than someone with a more active job. My family is supportive and we eat dinners that work with the diet. So I have intangible factors helping me.

    One definition of hack is “a clever solution to a tricky problem”. To me, very-low-carbs is an empowering “hack” of my metabolism that lets me control my weight. Hallelujah!

  • Might-o'chondri-AL

    4/8/2011 5:01:12 PM |

    A single variety of modern tetra-ploid wheat has 100s of different gluten proteins. This equates to 10s of thousands of variations of peptide sequences one can ingest from wheat.

    The molecules formed depend on how trans-amin-dation (cross linking proteins) binds the free residues of glutamine. This potential bond is genetic for each strain of wheat, since involves the positioning of Carbon terminals (located on any of those peptides, as a proline residue). Tetra-ploid wheat has many unique proline residues that cross-link (ex: alpha gliadin) in a way that can resist our digestion.

    Plasticity is a term used to describe the human brains ongoing adaptability. The nerve axons are in a outer (extra-cellular) matrix of gluco-proteins; this includes the proteo-glycan chondroitin sulfate ( glycan = poly-saccharides & oligo-saccharides; hence "glyc-").

    Chondroitin sulfate's residue (wing) of N-acetyl-galactos-amine provide a place for lectins to bind to (ex: lectins most infamous  trans-amididation incarnation is the gliadin molecule, a type of glyco-protein). Thus different glyco-proteins, with unique derivative glycos-amino-glycan molecular chains are going to affect brain neurons differently.

    Anti-bodies for uOR (natural opiod receptor)detected in circulation are indicative of a reaction to some lectin. This means a lectin is binding to the uOR; Doc calls this an "exorphin effect" with one end result being appetite stimulation.

    Neo-striata cells in the brain work off of input from the cortex; the neo-striatum has a part called the matrix (note: here matrix is a brain structure & not to be confused with terms like extra-cellular matrix) and another part called the striosome. The matrix neo-striata gets input from the pre-frontal brain and senori-motor regions; while the striosome input is from pre-limbic, infra-limbic and pre-motor corteces.

    The matrix neo-striata neuro-chemistry is  integral to behavior involved in self-initiated action, goal directed behavior, sensory integration and motor programs. During post-natal (growing child) brain development the striosome neo-striatum cells have a high degree of involvement with glyco-proteins; which may partly explain the Japan school children brain development differences due to breakfast of rice vs. bread (detailed above).

  • CarbSane

    4/8/2011 6:29:24 PM |

    @Eric, I agree.  Don't know where I've claimed such.  Dr. Davis made a claim (and he preceded that with "When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing-").  Study?  One?  

    I'm just asking for a study that demonstrates this claim.  I don't refute that a good many people could benefit from avoiding wheat.

  • Eric

    4/8/2011 7:59:13 PM |

    My apologies CarbSane, I didn't mean for reply to come across as combative.

    Dr. Davis may have a study that he can refer you to.

    But it is a well known fact that foods that trigger a surge in blood sugar and after-meal crashing also lead to increased hunger more frequently.

    Foods that lead to the surge are carbs in (either healthy or processed) grain or sugar form.

    Sometimes all the anecdotal evidence should stand above the biased studies attempting to maintain the status quo. Just my .02

  • Nick

    4/9/2011 4:38:03 AM |

    I reduced my CHO intake about three years ago and lost about 8 pounds in the first three months.  At about the three month point, I removed wheat and all other grains from my diet.  I have lost no additional weight since I gave up wheat.  

    I would say that I have not reduced my caloric intake by 400 calories a day.

  • CarbSane

    4/9/2011 11:09:24 AM |

    @Eric, no apology necessary, I didn't take your post as combative at all.  I just find Dr.Davis making sensationalistic claims a matter of routine lately.  I do a lot of literature searching and I've not, to my memory, ever come across one study that just looked at eliminating wheat and intake.  I'd be curious to see the results of such a study done in a well controlled manner.

  • Dr. William Davis

    4/9/2011 4:36:30 PM |

    In response to several commenters:

    Citing studies in which calorie intake is reduced by strictly eliminating wheat while not imposing any other restrictions does not necessarily mean that this is the most healthy way to eat.

    In other words, if I eliminate wheat but replace lost calories with corn chips, jelly beans, and Coca Cola, then of course I will not lose weight nor obtain health benefits beyond elimination of gluten and other undesirable ingredients in wheat.

    A better approach would be to 1) eliminate wheat, then 2) reduce carbohydrates, especially cornstarch, oats, and sugar, then 3) eat other whole healthy foods.

    My point is that, sans wheat, the drive for consumption is diminished for many, though not all, people.

  • Might-o'chondri-AL

    4/9/2011 4:55:03 PM |

    MRI of adult brain while eating shows a response according to an individuals BMI variation. I had this as a well composed comment at WholeHealthSource, but can't retrace it; so, roughly, from my notes now.  

    High BMI individuals have more brain activity in the left posterior insula, supramarginal gyrus, para-central lobule and the cerebellum's uvula/declive/tonsil structures. Cerebellum response involves how one likes the looks/smell of food; more blood flowing in the cerebellum coincides with increased appetite.

    Low BMI individuals have more brain activity in the anterior insula, posterior hypothalamus, amygdala, thalamus, pons and mid-brain structures.

    The Vagus nerve (dorsal) leads from our "gut" up into the pons sub-nucleus of our brains dorsal raphe. In obese individuals this link shuts down when eating. Contrary to the obese, this link is open in lean individuals when they (non-obese) are eating.

    The Pons, which inputs into most of the other brain structures, shows more functioning with slower eating. In addition, stuffing with excess food in a meal slows the pons interaction with the brain.

    The Amygdala, part of our limbic system, sets the emotional response to things ingested. It gets plenty of neuro-signals from the gut, and is implicated in binge eating.

    The Posterior Insula recieves input from both the amygdala and hypothalamus (regulator of amount we ingest). In obese individuals both the posterior and middle insula trigger (on)into action when they see the meal; as contrasted to normal BMI individuals, where these brain structures remain unaffected when they (non-obese) see a meal.  

    In obese individuals there is comparatively more dopamine activity in the neurological circuits of the hypothalamus, amygdala, mid-brain and thalamus (arousal response). So, all in all, it seems quite possible Doc's nemesis (tetra-ploid wheat's molecules) can play antagonistic roles in the brain.

  • CarbSane

    4/9/2011 5:37:21 PM |

    But Dr. Davis, you said there are multiple studies demonstrating a similar drop in caloric intake from eliminating wheat "without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing-"

    Are you walking that back?  Or do such studies exist.

  • Might-o'chondri-AL

    4/10/2011 12:39:51 AM |

    Hi CarbSane,
    Doc's rant is about the "undesireable ingredients"
    in modern wheat. If would you forgive me for sounding like a know-it-all, then, my comments show some brain responses that go beyond "x" number of calories, "x" amount of carbohydrates, "x" level of exercise and "x" amount of meals.

    It is modern wheat's assorted agglutin fractions, the way they bind glycans (like chitotriose, Beta-1-4-linked N-acetyl glucosamine) and how they cleave off "rogue" metabolites that has an effect on the brain cells. These metabolites have to get inside the brain cells cytoplasm by trans-duction; they are not ions.

    These "undesireable" cleaved metabolites have exposed glucosamine (GlcNAc) wings (residues) that bind to GLcNAc receptors on the cell; this fosters their trans-duction (carrying) past the cell membrane and any intervening endothelial (blood vessel wall) barriers.

    The "undesireable" metabolite then out binds Lysosome C; thus normal lysosomal "housekeeping" endo-cytosis (engulfing) action is inhibited from destroying (ie: no opportunity to hydrolyse apart bonds in the metabolite) that metabolite. This gives the metabolite the time to act like a Heat Shock Protein (ie: it has
    physically blocked that brain cell's usual heat shock protein ever since it locked onto that cell's GluNAc receptor); and thus, that "undesireable" metabolite can ferry (translocate) it's glycan/peptide right to the Endoplasmic Reticulum inside of that brain cell.

    Once the endoplasmic reticulum
    (in a brain cell) recieves an
    "undesireable" peptide/glycan complex it (endoplasmic reticulum) is not able to do a
    "normal" job with it; which job is to properly fold (ratchet into explicit configurations) the normal proteins the  brain cell passes to it (endoplasmic reticulum). Any alternate fold in a protein means it (protein)will react differently in the cascades it participates in.

    How this translates into each of the physical alterations in specific brain structures that I mentioned is beyond my understanding. This comment is to explain one of the ways those
    changes can get initiated in human brain cells by modern wheat; and also, to show our schooling on calories/carbs/ exercise/meals/cleansing misdirect us Doc insists he sees clinical results.

  • Onschedule

    4/10/2011 6:23:53 AM |

    @Might,

    I have enjoyed many of your comments; you have a keen talent in selecting and presenting information which dovetails nicely with Dr. Davis's blog entries. I found this one particularly fascinating.

    Thanks!

  • rcdyoga

    5/6/2011 3:22:45 AM |

    Here is my wheat story. I have been "mostly" avoiding wheat for 3 years and when finally being diagnosed with Hashimoto's decided to go completely wheat free. My doctor suggested a gluten challenge for a definitive diagnoses of celiac or gluten intolerance.  Unfortunately, I agreed. Six weeks into the 3 month challenge I quit due to problems that began during the gluten challenge (joint pain, severe digestive distress, insomnia, adhesive capsulitis, nightsweats). Unfortunately the gluten caused some damage and I developed new food intolerances to dairy and nightshades, which have not resolved in 7 months of being grain free.

  • Yvonne

    8/2/2011 10:42:30 AM |

    Sorry this reply comes so late! I hope you see it. May I suggest that you try magnesium oil? It's a mixture of mag chloride and water that you apply to your skin. You may be mag deficient and, if so, that could explain why you're not losing weight.

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