Why do the Japanese have less heart disease?

24. April 2011 William Davis (49)
We should look to the Japanese to teach us a few lessons about preventing heart disease. A Japanese male has only 65% of the risk of an American male (despite 40% of Japanese men being smokers), while a Japanese woman has 80% less risk than an American woman. While the U.S. is near the top of the list of nations with highest cardiovascular risk, Japan is the lowest.

What are they doing right?

There is no one explanation, but several. Genetics probably does not play a substantial role, by the way, as demonstrated by observations of Japanese people who emigrate to Western cultures. People of Japanese heritage living in Hawaii, for instance, develop the same cardiovascular risk as non-Japanese living in Hawaii. They also develop obesity and diabetes.

Among the factors that likely contribute to reduced risk in Japanese people:

--A style of eating that does not include a lot of sweet foods. No breakfast cereal or donuts for breakfast, for instance, but miso soup with tofu, fish, green onions, and daikon (as takuan, or pickled radish).
--Seaweed--It's probably a combination of the green phytonutrients and iodine. Typical daily iodine intake is in the neighborhood of 5000 mcg per day from nori, kombu, wakame, and other seaweed forms. (The average American obtains 125 mcg per day of iodine from diet.)
--Seafood--Fish in many forms not seen in the U.S. are popular.
--Green tea--Consumption of green tea has been confidently linked to reduced cardiovascular risk, probably via visceral fat-reducing, anti-oxidative, and anti-inflammatory effects. Although tea in Japan is often the less flavonoid-rich oolong tea, softer benefits from this form are likely.
--Soy--Tofu, miso, and soy sauce are staples. It's not clear to me whether soy is intrinsically beneficial or whether it is beneficial because it serves to replace unhealthy alternatives. (Genetic modification may change this effect.)
--Reduced exposure to cooked animal products (except seafood). This is not a saturated fat issue, but probably an advanced glycation end-product/lipoxidation issue that result from cooking.
--The lack of a "eat more healthy whole grain" mentality, the advice that has plunged the entire U.S. into the depths of a diabetes and obesity crisis (along with high-fructose corn syrup and sugar). Noodles like udon and ramen do have a place in their diet, as do some dessert foods. But the overall wheat exposure is less--no bagels, sandwiches, and breakfast cereals.
--Less overweight and obesity--The above eating style leads to less weight gain.

Japanese foods have a unique taste, consistency, and mouth-feel that go well with saltiness, thus the downside of their diet: salt consumption. On a broad scale, high salt consumption has been associated with hypertension and gastric cancer. But the tradeoff has, on the whole, been a favorable one.


One study trying to find some answers:

Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study.

Shimazu T, Kuriyama S, Hozawa A et al.
Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Japan.


We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994.
During 7 years of follow-up, 801 participants died of CVD.

Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not.

The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.

Niacin: What forms are safe?

20. April 2011 William Davis (52)
Niacin, or vitamin B3, remains a confusing issue for many people. It shouldn't be.

It doesn't help that most physicians and many pharmacists also do not understand the basic issues surrounding niacin. The only reason why there is any level of prevailing knowledge about niacin is that Kos Pharmaceuticals managed to "pharmaceuticalize" a niacin preparation, prescription Niaspan, that provided the revenue to fund professional "education."

Niacin can be helpful to increase HDL, reduce small LDL particles and shift them towards the more benign large particles, reduce triglycerides, and reduce lipoprotein(a).

So here's a brief description of the various forms that you will find niacin:

Immediate-release niacin--Also called crystalline niacin or just niacin. This is the original niacin that releases within minutes of ingestion. Because it releases rapidly, it triggers the most intense "hot flush." While this form of niacin works wonderfully well, is the safest, and is dirt cheap, the majority of people are simply unable to tolerate the intense flush. It also works best taken twice a day, generating two intolerable flushes per day.

Slow-release niacin--These preparations were popular in the 1980s, since the slow 12 to 24 hour pattern of release minimized the annoying hot flush. But, with prolonged use, it also became apparent that an unnaceptable frequency of liver toxicity developed. Unfortunately, this means that any niacin preparation that trickles niacin out over an extended period, including many of the slow-release preparations now sold in health food stores and pharmacies, have potential for liver toxicity. These preparations should be avoided.

6-hour release niacin--Releasing niacin more slowly than immediate-release niacin but more rapidly than slow-release niacin, 6-hour release (or what the Niaspan people call "extended-release" niacin) is nearly as effective as immediate-release niacin with approximately the same low potential for liver toxicity. It is far less liver toxic than slow-release niacin. 6-hour release niacin therefore offers the best balance between effectiveness and safety. Preparations that show this pattern of release include Niaspan ($180 per month), the poorly-named Sloniacin (about $8 per month), and Enduracin (about $7 per month) for 1000 mg per day. (Some Track Your Plaque Members have also determined that several other over-the-counter preparations have been demonstrated to share a similar pattern of release.)

Then there are the scam products that have no useful effect at all:

Flush-free or no-flush niacin--Inositol hexaniacinate, or 6 niacin molecules bound to the sugar, inositol, has no effect in humans, at least not with the dozen or so preparations that I've seen used. Nor are there any data to document the effectiveness of flush-free niacin. It's also more expensive.

Nicotinamide--This niacin derivative likewise has no effect on the usual targets for niacin treatment.

While I used to prescribe Niaspan, the ridiculous pricing and aggressive marketing really turned me off. I now advise my patients and our online followers to use only Sloniacin or Enduracin, unless you can tolerate immediate-release niacin.

Introduction to the New Track Your Plaque book, version 2.0

18. April 2011 William Davis (0)

Out with the old,
in with the new  



“I believe that you are suffering from what is called a fatty degeneration of the heart.”

Dr. Tertius Lydgate to Mr. Casaubon on making a diagnosis with the new medical device, the stethoscope.

George Elliot
Middlemarch, 1871





Old notions in medicine have a peculiar way of lingering.

In 1882, Dr. Robert Koch discovered the tubercle bacillus in tissues of people with “consumption.” By connecting a bacterium with the disease, he usurped the long held notion that tuberculosis was a degenerative disease caused by lack of fresh air. But, for decades after Dr. Koch’s revelation, the “bad air” belief persisted. Surgical collapse of the lung, a painful and barbaric treatment for tuberculosis, persisted well into the 1960s, years after effective antibiotics were discovered in 1947.

The medical community of the 19th century viewed mental illness as the hereditary end-product of ancestral nervousness, alcoholism, prostitution and criminal behavior, a bias that remained widespread well into the mid-20th century. Nazi physicians invoked the theory of heritable “mental degeneration” to justify wholesale extermination of schizophrenics. Electro-convulsive therapy (ECT, or “electroshock therapy”) was widely applied to treat schizophrenia, depression, homosexuality, and criminal behavior for over 30 years, gradually abandoned (at least in its original form) after years of abusive application to subdue patients, demonized in the 1975 movie, “One Flew Over the Cuckoo’s Nest,” depicting the author’s real-life experience with ECT.

Long after a theory or practice has been discredited, it can persist, refusing to die. The new and improved may not be adopted into mainstream practice for years, even decades.

Back to the 21st century: What if you realized that, by quirks of human nature and the uneven adoption of health information, your doctor practiced medicine appropriate for 1985? 1975?

While digital information nowadays is transmitted at the speed of light, disseminating as fast as it takes the next juicy tidbit to be “virally” reproduced via social networking websites, it’s the human factor that still operates with the inertia of human behavior. Habits and attitudes slow the adoption of new information in time measured not in seconds, but in years or decades.

A century ago, 20 years were required for the new technology of blood pressure measurement to be adopted after its introduction in the U.S. in 1910, since physicians were long comfortable with the practice of “pulse palpation” (feeling the pulse). (The arcane language of pulse palpation persists to this day, terms like “pulsus parvus et tardus,” the slow rising pulse of a stiff aortic valve; and the "water-hammer" pulse of a leaking aortic valve.)

The discovery of new, health-changing information today in the 21st century disseminates through the ranks of modern healthcare providers at much the same pace as measuring blood pressure did in the early 20th century.

It’s also tempting to paint American medicine as a fiefdom intent on maintaining exclusive rein over health information. Look back over the hierarchical relationship of medicine over nursing in the past century: When blood pressure measurement was adopted on a broad scale in the 1930s, it was practiced only by physicians, since nurses were deemed incapable. (Modern-day nurses should surely have a hearty laugh over this.) Stethoscopes, around even longer than blood pressure cuffs, weren’t permitted to fall into the hands of nurses until the 1960s, since the medical community feared that nurses might command too much control over patient care. Even after nurses were permitted to have their own stethoscopes, great pains were taken to be certain the nurses’ version was readily distinguishable from the “real” tool wielded by physicians; nurses’ stethoscopes were therefore labeled “nurse-o-scopes,” or “assistoscopes,” and were required to be smaller and flimsier.

Old and ineffective doesn’t always give way to new and better at once; it is slowed by habit as well as an unwillingness to relinquish control.

Somehow technology marches on. But it does so unevenly, sweeping some along in its first wave, others in its wake, some never at all.

Just as effective antibiotics to cure tuberculosis were available for 20 years while surgeons continued to remove patients’ lungs, so better solutions to heart disease are already available but not yet employed by your neighborhood physician. The primary care physician may have heard about some of the newest means to prevent heart disease, but is too overwhelmed with the day-to-day of sore throats, diarrhea, and rashes. Cardiologists, intent on inserting the next best stent or defibrillator, have little but passing interest in strategies that might halt or reverse the heart disease that can be “managed,” no matter how imperfectly, with procedural solutions like angioplasty and bypass surgery. We should bear these flawed human tendencies in mind as we explore the world of heart disease prevention.

We need look no farther than the front page of the newspaper to find evidence of the failure of present-day heart disease detection and management. Over the past several years, headlines have carried the likes of Tim Russert, Bill Clinton, Larry King, Dick Cheney, David Letterman, Tommy Lasorda, Ed Bradley, Mike Ditka, Walter Cronkite, Alberto Salazar, all heart disease sufferers. Some, like talk show host David Letterman, survived their brush with heart catastrophe and underwent successful bypass surgery. Others, like marathoners Fixx and Salazar, raised none of the conventional red flags for heart disease. All received standard, “modern” medical care . . . all the way up to their heart attack, bypass surgery, or untimely death.

Like the sphygnomanometer (blood pressure) cuffs of 1910, Track Your Plaque represents an example of the new. But, unlike the simple practice of taking blood pressure in the early 20th century, Track Your Plaque represents an entirely new way to look at coronary heart disease: a new way to measure it, a new way to identify its causes, and a new way to seize control over it, often to the point of achieving reversal of the process. It also puts control over much of this process into your hands and away from hospitals, cardiologists, and heart procedures. 

I could speak of revealing “secrets,” but that’s not true. In Track Your Plaque, I simply convey information about heart disease that you were likely unaware existed, strategies that doctors fail to discuss. I assemble them into a “package” that, together, create an enormously empowering unique approach to prevent heart disease and heart attack.

Track Your Plaque also challenges the high-tech status quo, practices that occupy exalted places in the enormous cardiovascular healthcare machine that has dominated American healthcare for the past 40 years. I propose that high-tech hospital procedures should join the practice of ECT for homosexuality and insanity¾and become yet another relic of the past.

What are "normal" triglycerides?

12. April 2011 William Davis (67)
Among the most neglected yet enormously helpful values on any standard cholesterol panel is the triglyceride value.

Triglycerides traverse the bloodstream by hitching a ride on water (serum)-soluble lipoproteins, or lipid-carrying proteins. We measure triglycerides as an indirect index of triglyceride-containing lipoproteins.

Triglycerides are a basic currency of energy. While the average American ingests around 300 mg of cholesterol per day, he or she also ingests 60,000-120,000 mg (60-120 grams) of triglycerides, i.e., 200 to 400 times greater amounts, from fat intake. Zero triglycerides in the diet or in the bloodstream is not an option.

But what represents too much triglycerides in the bloodstream? There are several observations to help us make this determination:

1) When fasting triglycerides are 133 mg/dl or greater, 80% of people will show show at least some degree of small LDL particles.

2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

3) When fasting triglycerides are 200 mg/dl or greater, small LDL particles will dominate and large LDL particles will be in the minority or be gone entirely.

4) When triglycerides are 88 mg/dl or greater after eating, then risk for heart attack is doubled. Non-fasting triglycerides in the 400+ mg/dl range are associated with 17-fold greater risk for heart attack.



From Austin et al 1990. "Phenotype A" means that large LDL particles dominate; "phenotype B" means that small LDL particles dominate.

Note that conventional "wisdom" (i.e., NCEP ATP-3 guidelines) is that triglycerides of up to 150 mg/dl are okay, a level that virtually guarantees expression of small LDL particles and increased cardiovascular risk.

Based on observations like these, in the Track Your Plaque program we aim for fasting triglycerides of no higher than 60 mg/dl and postprandial (after-meal) triglycerides of no more than 90 mg/dl.

Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role. That will be an issue for another day.

1985: The Year of Whole Grains

9. April 2011 William Davis (30)
In 1985, the National Cholesterol Education Panel delivered its Adult Treatment Panel guidelines to Americans, advice to cut cholesterol intake, reduce saturated fat, and increase "healthy whole grains" to reduce the incidence of heart attack and other cardiovascular events.

Per capita wheat consumption increased accordingly. Wheat consumption today is 26 lbs per year greater than in 1970 and now totals 133 lbs per person per year. (Because infants and children are lumped together with adults, average adult consumption is likely greater than 200 lbs per year, or the equivalent of approximately 300 loaves of bread per year.) Another twist: The mid- and late-1980s also marks the widespread adoption of the genetically-altered dwarf variants of wheat to replace standard-height wheat.

In 1985, the Centers for Disease Control also began to track multiple health conditions, including diabetes. Here is the curve for diabetes:


Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward. (Not shown is the data point for 2010, an even steeper upward ascent.) Now diabetes is skyrocketing, projected to afflict 1 in 3 adults in the coming decades.

You think there's a relationship?

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."

When MIGHT statins be helpful?

7. April 2011 William Davis (17)
I spend a lot of my day bashing statin drugs and helping people get rid of them.

But are there instances in which statin drugs do indeed provide real advantage? If someone follows the diet I've articulated in these posts and in the Track Your Plaque program, supplements omega-3 fatty acids and vitamin D, normalizes thyroid measures, and identifies and corrects hidden genetic sources of cardiovascular risk (e.g., Lp(a)), then are there any people who obtain incremental benefit from use of a statin drug?

I believe there are some groups of people who do indeed do better with statin drugs. These include:

Apoprotein E4 homozygotes

Apoprotein E2 homozygotes

Familial combined hyperlipidemia (apoprotein B overproduction and/or defective degradation)

Cholesteryl ester transfer protein homozygotes (though occasionally manageable strictly with diet)

Familial heterozygous hypercholesterolemia, familial homozygous hypercholesterolemia

Other rare variants, e.g., apo B and C variants

The vast majority of people now taking statin drugs do NOT have the above genetic diagnoses. The majority either have increased LDL from the absurd "cut your fat, eat more healthy whole grains" diet that introduces grotesque distortions into metabolism (like skyrocketing apo B/VLDL and small LDL particles) or have misleading calculated LDL cholesterol values (since conventional LDL is calculated, not measured).

As time passes, we are witnessing more and more people slow, stop, or reverse coronary plaque using no statin drugs.

Like antibiotics and other drugs, there may be an appropriate time and situation in which they are helpful, but not for every sneeze, runny nose, or chill. Same with statin drugs: There may be an occasional person who, for genetically-determined reasons, is unable to, for example, clear postprandial (after-eating) lipoproteins from the bloodstream and thereby develops coronary atherosclerotic plaque and heart attack at age 40. But these people are the exception.

Advanced topics in nutrition

5. April 2011 William Davis (0)
Nutrition in the modern world has become an increasingly problematic topic. From genetic modification to commercialized methods of mass production, we are having to navigate all manner of complex issues in food choices, particularly if ideal health, including maximal control over coronary plaque, is among our goals.

We will therefore be releasing a series of discussions on the Track Your Plaque website in the coming months, a series I call "Track Your Plaque Advanced Topics in Nutrition." These will be, as the series title suggests, discussions for anyone interested in more than the "eat a balanced diet" nonsense that issues from "official" sources. Among the topics to be covered:

1)Advanced Glycation End-products--both endogenous and exogenous, including peripheral issues like lipoxidation and acrylamides.

2)Dietary influences on LDL oxidation--including the concept of "glycoxidation." Protection from oxidative phenomena is not just about taking antioxidants.

3) Foods you MUST eat--We've talked a lot about foods that you shouldn't eat. How about foods you should eat?

The New Track Your Plaque Guide now available

4. April 2011 William Davis (5)
The New Track Your Plaque Guide is now available!

The Track Your Plaque program has evolved over its 8 year history. While the original Track Your Plaque book reflected the program details that got the program started back in 2003-2004, plenty has changed.

This new version of the book, what I call the program Guide, represents version 2.0 of Track Your Plaque and includes:

--Updated lipoprotein treatment strategies--including new and expanded treatment choices for small LDL and lipoprotein(a).

--An entire chapter on vitamin D and its crucial role in cardiovascular health and plaque control.

--A new and expanded diet--All the reasons why the New Track Your Plaque Diet can achieve spectacular improvement in lipids/lipoproteins, reversal of insulin resistance/pre-diabetes/diabetes, weight loss, reduction in blood pressure, etc. are discussed in considerable detail. The diet is crafted to achieve maximum control over both metabolic responses and coronary plaque.

--An entire chapter on the role of omega-3 fatty acids is included.

--A detailed discussion on the role of iodine and thyroid health--One of the newest additions to the Track Your Plaque menu of strategies is to achieve and maintain ideal thyroid health. This tips the scales in your favor for improved control over lipids/lipoproteins, weight, blood sugar, and coronary plaque.


The new guide, as well as our new Member kits that include the new Track Your Plaque Recipe Book, At-Home Lab Test kits, and nutritional supplements, are all available in the Track Your Plaque Marketplace.

Don't wet yourself

3. April 2011 William Davis (13)
While there is more to wheat's adverse effects on human health than celiac disease, studying celiac disease provides important insights into why and how wheat--the gluten component of wheat, in this case--is so destructive to human health.

Modern wheat, in particular, is capable of causing "celiac disease" without intestinal symptoms---no cramping or diarrhea--but instead shows itself as brain injury (ataxia, dementia), peripheral nervous system damage (peripheral neuropathy), joint and muscle inflammation (rheumatoid arthritis, polymyalgia rheumatica and others), and gastrointestinal cancers.

One neurological manifestation of wheat's effect on the human brain is a condition called cerebellar ataxia. This is a condition that can affect adults (average age 48 years) and children and consists of incoordination, falls, and incontinence.

Because brain tissue has limited capacity for healing and regeneration, symptoms of cerebellar ataxia usually improve slowly and modestly with meticulous elimination of wheat and other gluten sources.

Such observations are relevant even to people without celiac disease. Celiac disease sufferers are more susceptible to such extra-intestinal phenomena, but it can also happen in people without positive celiac antibodies.



Some references:

Neurological symptoms in patients with biopsy proven celiac disease

A total of 72 patients with biopsy proven celiac disease (CD) (mean age 51 +/- 15 years, mean disease duration 8 +/- 11 years) were recruited through advertisements. All participants adhered to a gluten-free diet. Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpal tunnel syndrome (20%), vestibular dysfunction (8%), seizures (6%), and myelitis (3%). Interestingly, 35% of patients with CD reported of a history of psychiatric disease including depression, personality changes, or even psychosis. Physical examination yielded stance and gait problems in about one third of patients that could be attributed to afferent ataxia in 26%, vestibular dysfunction in 6%, and cerebellar ataxia in 6%. Other motor features such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus were infrequent. 35% of patients with CD showed deep sensory loss and reduced ankle reflexes in 14%. Gait disturbances in CD do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment.



Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics

Two hundred and twenty-four patients with various causes of ataxia from North Trent (59 familial and/or positive testing for spinocerebellar ataxias 1, 2, 3, 6 and 7, and Friedreich's ataxia, 132 sporadic idiopathic and 33 clinically probable cerebellar variant of multiple system atrophy MSA-C) and 44 patients with sporadic idiopathic ataxia from The Institute of Neurology, London, were screened for the presence of antigliadin antibodies. A total of 1200 volunteers were screened as normal controls. The prevalence of antigliadin antibodies in the familial group was eight out of 59 (14%), 54 out of 132 (41%) in the sporadic idiopathic group, five out of 33 (15%) in the MSA-C group and 149 out of 1200 (12%) in the normal controls. The prevalence in the sporadic idiopathic group from London was 14 out of 44 (32%). The difference in prevalence between the idiopathic sporadic groups and the other groups was highly significant (P < 0.0001 and P < 0.003, respectively). The clinical characteristics of 68 patients with gluten ataxia were as follows: the mean age at onset of the ataxia was 48 years (range 14-81 years) with a mean duration of the ataxia of 9.7 years (range 1-40 years). Ocular signs were observed in 84% and dysarthria in 66%. Upper limb ataxia was evident in 75%, lower limb ataxia in 90% and gait ataxia in 100% of patients. Gastrointestinal symptoms were present in only 13%. MRI revealed atrophy of the cerebellum in 79% and white matter hyperintensities in 19%. Forty-five percent of patients had neurophysiological evidence of a sensorimotor axonal neuropathy. Gluten-sensitive enteropathy was found in 24%. HLA DQ2 was present in 72% of patients. Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.
Bread equals sugar

Bread equals sugar

22. June 2011 William Davis (36)
Bread, gluten-free or gluten-containing, in terms of carbohydrate content, is equivalent to sugar.

Two slices of store-bought whole grain bread, such as the gluten-free bread I discussed in my last post, equals 5- 6 teaspoons of table sugar:








 

 

 

 

 

 

 

 

Some breads can contain up to twice this quantity, i.e., 10-12 teaspoons equivalent readily-digestible carbohydrate.
Tags :

Comments (36) -

  • A.B. Dada

    6/22/2011 4:35:12 PM |

    Whoa, that's a lot of photos of spoons, hah.

    I definitely get a worse effect from eating bread (historically, I don't anymore) than I have from eating table sugar (say in coffee or sprinkled on strawberries, neither of which I do anymore, either).

  • Chris Cornell

    6/22/2011 5:07:56 PM |

    And... is sugar bad?

  • Kristie Campbell

    6/22/2011 6:40:28 PM |

    I can think of tastier options for consuming that much sugar, but only on my cheat days! -Kristie

  • Carl

    6/22/2011 6:40:34 PM |

    Wrong. Table sugar is 50% fructose. Does bread starch break down to 50% fructose? Fructose and glucose are metabolized quite differently. The former only in the liver if I understand correctly.

  • Mary

    6/22/2011 7:04:49 PM |

    What about bread made from sprouted grains -- e.g., Ezekiel Bread?  I understand there's still gluten in it, but this particular bread actually has a short, easily understandable ingredient list -- seems far better than the highly processed "whole wheat" bread out there.  Any thoughts?

  • Jack Kronk

    6/22/2011 7:52:54 PM |

    Bread does not equal sugar. This is a too simplistic Doc, and you know it.

    Of course we all know that bread starch does indeed break down as glucose in the body, but there is so much more to bread than just that. Of all people, in the entire blogosphere, I would expect this post from you the least. You know ALL about wheat and bread. You post more on wheat than any other blogger. Yet you say bread equals sugar. I know what you mean, for sure. I get it, but I would like to suggest to you that sometimes people seriously take you word for word, especially when you have a large following of daily readers that know you're a Doctor and maybe don't understand the differences. Then they are gonna run out and tell their friends and family that eating bread is just like eating sugar.

    As another commenter mentioned, sugar is half fructose, and although the fructose is mostly bound to the glucose, some of it still definitely goes into your liver. A huge sugar overload is going to have drastically different effects on metabolism as a huge bread overload. Neither are good for you in any way. The bread comes with all kinds of problems that the sugar doesn't have. I'm not sure which is worse, but they're not equal to each other.

  • Princess Dieter

    6/22/2011 8:46:29 PM |

    I think I just spurted out a bunch of insulin looking at those pics. ; )

  • Cary

    6/22/2011 9:46:45 PM |

    Wow, take a chill-pill folks.

    It states in the very first sentence that he is speaking in terms of carbohydrate content.

    I don't believe for a second that the good doc's readers only read the headline and then run off making nutritional recommendations to their friends and family.

    Thanks for another great post. Smile

  • Dr. William Davis

    6/23/2011 1:18:30 AM |

    Thanks, Cary.

    It never ceases to amaze that talking about food is like insulting your mother: virtual fist fights inevitably break out.

    I was lumping wheat bread and gluten-free bread together. That is indeed misleading, because wheat-containing bread is far WORSE than sugar. The point I was trying to make, perhaps awkwardly, was that both wheat bread and gluten-free bread are, in effect, large carbohydrate loads. And I didn't insult your mother.

  • Shiveka

    6/23/2011 1:29:23 AM |

    Although 2 slices of bread are generally equivalent to 30 g carbohydrate (although some are less and some are more), they are not necessarily equal to 6 tsp of sugar/2 tbsp of sugar.  The carbohydrate in bread is not all sugar.  Bread, especially whole grain bread has fiber which is an indigestible carbohydrate.  2 slices of whole grain bread have 4g of fiber generally, which you will not find in table sugar.  Additionally, this fiber helps to slow down the absorption of the carbohydrate or sugar in the bread.  Therefore, plain table sugar (just glucose + fructose) is far more easily digested than 2 slices of whole grain bread.  Therefore, from the pov that whole grain bread is not 100% composed of sugar nor is it digested in the same manner as sugar (in terms of their glycemic index/how long it takes for the sugar to enter the bloodstream), it seems incorrect to say that 2 slices of whole grain bread= 6 tsp of sugar.  I understand the logic of your reasoning in the sense that all digestible carbohydrate eventually breaks down into glucose, however, fiber (found in whole grain bread) does not and therefore its erroneous to say that they are equivalent to each other and may be misleading to individuals reading this article.

  • huh

    6/23/2011 7:02:18 AM |

    Was there no point to this post but to keep the blog going and selling stuff?  What is going on here?

  • Stipetic

    6/23/2011 8:43:44 AM |

    What was that you said about my mother?

  • Moo

    6/23/2011 1:35:17 PM |

    Did you look at a table of glycemic indexes? Most bread, including whole wheat bread, has approximately the same glycemic index as table sugar.

  • Tyns

    6/23/2011 3:51:01 PM |

    Reduced/absence of fructose makes the bread less toxic, but I'm guessing this post was written from the perspective of the resulting insulin response - in which case, referring to six teaspoons of sugar is accurate for comparison purposes.

    I watched Nurse Jackie this week (or maybe last week?) and the head nurse was 'educating' overweight children.  She named a bunch of candy bars/candies and asked what they all had in common.  A child responded "Sugar?".  "Correct!" she replied.  She then told them that when she wants a snack, she eats "These" - then holds up a box of raisins.  Oh, and the children were all holding apples.

  • Jack Kronk

    6/23/2011 4:07:05 PM |

    you've covered this general concept in many of your other posts about bread and/or wheat in general. everybody knows that bread is carb heavy. but a carb is a carb is a carb is simply not true. besides that, i think the nasty ingredients in most gluten free breads are far worse than the carbohydrate content of the starch.

  • EMR

    6/23/2011 5:22:21 PM |

    We are just blind to many other foods when trying to avoid sugar to save us from diabetes.I think we must consult a specialist to formulate our diet which would be healthy and accurate.

  • Annabel

    6/23/2011 7:03:07 PM |

    If only it were true that "everyone" knows that bread is carb-heavy, or that starches convert to sugar, or even that fruits are carbs! I asked my brother to tell me what he eats in a typical day. "I don't eat a lot of carbs... For breakfast, two breakfast tacos on flour tortillas and a Sprite, for lunch I just eat an apple and another Sprite, and dinner is maybe chicken-fried [breaded] steak and some cornbread, or maybe mashed potatoes." I asked him if he thought soft drinks don't have carbs, and he said he thought clear sodas "don't count"--just colas have carbs. To say nothing of the flour, potatoes, corn, or fruit.

    That's a more typical (mis)understanding of carbs than we want to think. And that's why I dont mind reading posts like this.

  • HS4

    6/23/2011 10:52:09 PM |

    There are many ways to skin a cat, as the saying goes.  I, for one, appreciate Dr Davis attempts to get the message across by putting it out there in many different ways and using different analogies.  You never know which description will hit home with someone or at least make him stop and think.

    Many times I've come across exactly what Annabel describes - so many people lack even a basic understanding of which foods are carbohydrate-rich.  I was astounded when my husband mentioned that he'd always thought fruits were not carbs (and he's a scientist!).   To him, carbs are starches, only - bread, pasta, maybe potatoes, etc...

  • Jim Anderson

    6/24/2011 2:01:16 PM |

    I used to eat a lot of bread.  Now, none.  I don't have a problem passing up ordinary, store-bought, mass-produced loaves, but when I'm in a deli or restaurant with quality breads -- well, that's harder.  Still, I know I will get a lot hungrier a lot sooner if I eat the bread than if I don't, and so I don't.  It seems paradoxical that eating more food makes you hungrier sooner; knowing that is the key.

  • steve

    6/24/2011 3:59:02 PM |

    Doctor Davis:  It would be helpful to see a post of how you would construct a daily diet for heart health that minimizes the carbs.  There seems to be a full range of low carb alternatives ranging from Atkins like to Rosedale(high fat), etc.  Thanks,

  • Stcrim

    6/24/2011 6:46:03 PM |

    When I first started following Dr. Davis and the TYP eating guidelines, I had a hard time giving up wheat - hell it's in everything!!!  Plus it's a hard addiction to break.  

    Now that I'm wheat free thanks to Dr. Davis' recommendations you couldn't pay me any amount of money to go back.

    The debate over glucose vs. fructose is interesting but the only thing that's really important is how I feel.

    -s-

  • nightrite

    6/25/2011 1:34:53 PM |

    I used to be a wheat addict but no anymore.  I've had one wheat product in the last 6 months and since then have lost 30 pounds.  I've done nothing different in my diet or exercise program - just ditched the wheat.  The weight dropped off easily.  Dr. Davis rocks!!!

  • lucky Angel

    6/25/2011 8:39:45 PM |

    That is messed up
    fresh apples are better for children.  All of us.  Everyone.

    But, raisins are a better alternative to candy/packedged/processed food...even organic.  or hydroponic.  I say kids.  Eat the apple.

  • Marianne

    6/26/2011 1:14:45 AM |

    I stumbled across this blog quite a while ago and remain a casual reader of it.  What attracted my attention is how eliminating wheat was what I needed to do to get rid of my belly.  I have been sorely disappointed!  I am a 60 yo female, 5'7", weigh 132, small frame, have always been thin but started gaining weight around midsection in my 50s.  One year ago I gave up my daily glass of wine, and 8 months ago eliminated wheat from my diet.  That was hard!  I agree that I feel better and the hunger is not as intense, but I have long zero weight.  I walk briskly, as briskly as my bad knees allow (former jogger) every morning.  I eat fruit, yogurt and nuts for breakfast, a bowl of raw veggies for lunch (no dressing) and some protein and more veggies for dinner.  Will I ever lose this 5 to 7 pounds around my middle?  Thank you for letting me vent!

  • Lori

    6/26/2011 4:29:51 PM |

    Marianne, you're still running on carbs instead of dietary fat. Most fruit and yogurt and sugar bombs. And without dressing or other fat, you won't absorb the vitamins A, D, E or K in your vegetables. Eliminating wheat is great--and I admire your dedication--but I don't see much fat or protein in your diet. Try adding a boiled egg or two and some dressing to your salad for lunch, some fatty fish or other fatty meat and buttered veg for dinner, and leftovers for breakfast. Give it a two-week trial.

  • Joe

    6/26/2011 4:54:58 PM |

    I agree with Lori...not enough fat and protein, too many carbs.

    You might enjoy reading Dr.(s) Eades book, "The 6 Week Cure For The Middle Aged Middle."  You should be able to get rid of those 5-7 pounds in a couple of weeks.  At your age, it may be mostly visceral fat, not subcutaneous fat, and visceral fat is far more worrisome to your overall health because it's connected to inflammation.

    Joe

  • Lori

    6/26/2011 6:47:41 PM |

    Another thing: various studies and a lot of anecdotal evidence have shown that aerobic exercise is ineffective for losing weight. IME, it's just as overrated for weight loss as whole grains are for health. Weight training is better for improving your physique and possibly improving insulin resistance. The Eadeses also wrote a book, along with Fred Hahn, called Slow Burn; Dr. Davis has some posts on this.

  • majkinetor

    6/27/2011 11:03:46 AM |

    That doesn't give us any information about metabolic effects of the food.

  • majkinetor

    6/27/2011 11:10:03 AM |

    Don't eat fruit.  Use some caffeine creme.  Have a cheat day.
    When things get confusing, you have to log everything - you will be surprised, thats for sure.

  • majkinetor

    6/27/2011 11:15:18 AM |

    Yes, that seems to be truth. I would go for high intensity training as fast twitch muscles drain glucose much faster then slow twitch muscle, plus, its much more doable given the modern time constraints.

    There is a problem tho  - high probability for injury, with any type of exercise. Injury equals to even more sedentary life then before exercise.

    In Marrianes case, I guess, however, that lots of effort needs to be devoted to solving menopausal hormonal disturbances which promote weight gain. This is, to my knowledge done with concentrating to food quality rather then quantity.  Supplementation is essential.

  • Joe

    6/27/2011 5:05:11 PM |

    Lori, I don't think even weight training will rid her of her "middle-aged middle." Only a proper diet can do that (and pretty quickly, too), especially if it's all visceral fat, as is likely.

    Weight training will give her a stronger mid-section, of course, but it'll mostly remain hidden under the fat.

    Joe

  • Lori

    6/27/2011 5:57:30 PM |

    Agreed--weight training won't get rid of fat, but it'll make you generally firmer.

    One thing I really like about Fred Hahn's weight training method is that it's easy on the joints. In the doorknob squats, for instance, your feet are a little in front of your knees and you hold a door knob for support, making for a challenging exercise that doesn't hurt your knees.

  • Joe

    6/27/2011 7:33:56 PM |

    Still, I don't think she could do enough ab work to get rid of her "middle-aged middle," which she claims is her remaining objective.

    That's going to require a special diet, like the one the Eades recommend, for example.

    By the way, the best ab workout, in my opinion, is sprinting. Spend a little less time walking or jogging, and a little more time sprinting (provided you're already in relatively good shape). I'm about to enter my 8th decade, and I'm still sprinting.

    Works for me.

    Joe

  • jpatti

    7/9/2011 6:46:40 AM |

    I disagree that wheat is worse than sugar, generally.  

    Sure it's worse for celiacs, and others with gluten intolerance.  And sure it will raise worse than the equal "net carbs" of sugar since starch is a glucose polymer.

    But sugar is half fructose which is a LOT of fructose.  And fructose is very bad for fatty liver, for diabetes, for triglycerdies, for adiposity, for everything...

    On the other hand, this is sort of like arguing whether arsenic or cyanide is worse... doesn't really matter.

  • Dr. William Davis

    7/9/2011 2:41:02 PM |

    Hi, Jpatti--

    This is a confusing issue. It is the reason why I wrote Wheat Belly that will be hitting bookstore shelves in early September, 2011.

    I believe that, once you hear the entire rationale, you will agree that, not only is wheat worse than sugar, it is the most incredibly bad thing ever created by modern genetics and agribusiness and is responsible for more disease and suffering than any war ever waged.

  • Joe Lindley

    7/26/2011 6:19:16 PM |

    I'm looking forward to your book.  I had heavy whole wheat bread (plus butter and jam) for breakfast for years thinking I was being health conscious (mostly because it was fibrous enough that I didn't snack till lunch).   How wrong I was!  Now that I've gotten educated on the metabolism of carbohydrates plus the dangers in wheat, I realize how unhealthy that was.

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