The Track Your Plaque guide to getting grotesquely overweight

15. August 2006 William Davis (0)
If you'd like to gain huge quantities of weight, here's a number of helpful tips:

1) Follow the advice of food manufacturers and eat the products they label "healthy", or "heart healthy", or "part of a nutritious breakfast" etc., like Shredded Wheat cereal, pretzels ("a low-fat snack"!), low- or non-fat salad dressings.

2) Cut your morning calorie intake by skipping breakfast.

3) Hang around with other heavy people. They will confirm that it's okay to be overweight.

4) Call walking your dog "exercise".

5) Get a sedentary desk job. Use your swivel desk chair to scoot about whenever possible, rather than getting up to do things.

6) Say "I've worked hard all week long. Weekends are for relaxing, not for physical activities. I deserve a rest."

7) Eat foods without thinking about it: Eat chips while watching football, eat while on the phone, daydream over the sink.

8) Eat to provide comfort when stressed.

9) Eat foods that have sentimental value, whether or not they're good for you: Freshly-baked cakes that remind you of Mom, Pop Tarts that you used to carry in your lunchbox when you were a kid, hot dogs just like Dad would buy at the baseball stadium.

10) Cut back on sleep and generate insatiable starch cravings.

11) Stack your shelves at home with great variety. That way, you'll always have something to suit your mood.

12) Say to your spouse: "It's none of your damn business what I eat! I'm a grown man/woman!" Prove it by over-indulging in obviously unhealthy foods.

13) Tell yourself that you're just too busy to pay attention to food choices. Just grab whatever you can out of a convenience store or vending machine.

See, it's easy! And that just a start.

Of course, I don't really want you to do any of these things. But if you see yourself in any of the above, and you're struggling with weight, you should seriously rethink your approach.

Your heart scan is just a "false positive"

15. August 2006 William Davis (0)
I've seen this happen many times. Despite the great media exposure and the growing acceptance of my colleagues, heart scans still trigger wrong advice. I had another example in the office today.

Henry got a CT heart scan in 2004. His score: 574. In his mid-50s, this placed him in the 90th percentile, with a heart attack risk of 4% per year. Henry was advised to see a cardiologist.

The cardiologist advised Henry, "Oh, that's just a 'false positive'. It's not true. You don't have any heart disease. Sometimes calcium just accumulates on the outside of the arteries and gives you these misleading tests. I wish they'd stop doing them." He then proceeded to advise Henry that he needed a nuclear stress test every two years ($4000 each time, by the way). No attempt was made to question why his heart scan score was high, since the entire process was outright dismissed as nonsense.

I'm still shocked when I hear this, despite having heard these inane responses for the past decade. Of course, Henry's heart scan was not a false positive, it was a completely true positive. I'm grateful that nothing bad happened to Henry through two years of negligence, though his heart scan score is likely around 970, given the expected, untreated rate of increase of 30%.

The cardiologist did a grave disservice to Henry: He misled him due to his ignorance and lack of understanding. I wish Henry had asked the cardiologist whether he had read any of the thousands of studies now available validating CT heart scans. I doubt he's bothered to read more than the title. The cardiologist is lucky (as is Henry) that nothing bad happened in those two years.

Do false positives occur as the cardiologist suggested? They do, but they're very rare. There's a rare phenomenon of "medial calcification" that occurs in smokers and others, but it is quite unusual. >99% of the time, coronary calcium means you have coronary plaque--even if the doctor is too poorly informed to recognize it.

What's better than a heart scan?

13. August 2006 William Davis (0)

Do you know what's better than a heart scan?

Two heart scans. No other method can provide better feedback on the results of your program.

Say you've made efforts to correct high LDL; lost weight to raise HDL and reduce small LDL; added soluble fibers, nuts, and dramatically reduced wheat products; take fish oil, vitamin D, and follow a flavonoid-rich diet. Has it worked?

After a year or so of your program, that's when another heart scan can give you invaluable feedback on whether it's been successful. I tell my patients that it's relatively easy to correct lipid and lipoprotein abnormalities. The difficult part is to know when it's good enough. Is your LDL of 67 mg/dl and HDL of 50 mg/dl good enough? Another heart scan score is the best way I know of to find out.

Variation in plaque growth differs hugely from one person to another, even at equivalent lipoprotein values. Why? Lots of reasons. Humans are inconsistent day to day. Lipoproteins, being a snapshot in time and not a cumulative value, change somewhat from day to day. There's also the possibility of unmeasured, unrecognized factors that influence coronary plaque growth. We may not be smart enough to identify these hidden factors yet. But your heart scan score will incorporate the effects of these hidden factors.

Ideally, we aim for zero growth in plaque (no change in score) or a reduction. But, particularly in the first year, 10% or less plaque growth is still a good result that predicts much reduced risk of heart attack. More than 20% per year and your program needs more work--or else you know what's ahead.

Lipids are snapshots in time; heart scans are cumulative

12. August 2006 William Davis (0)
Let me paint a picture. It's fictional, though a very real portrait of how things truly happen in life.

Michael is an unsuspecting 40-year old man. He hasn't undergone any testing: no heart scan, no lipids or lipoproteins. But we have x-ray vision, and we can see what's going on inside of him. (We can't, of course, but we're just pretending.) Average build, average lifestyle habits, nothing extraordinary about him. His lipids/lipoproteins at age 40:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

At age 40, with this panel, his heart scan score is 100. That's high for a 40-year old male.

Fast forward 10 years. Michael is now 50 years old. Michael prides himself on the fact that, over the past 10 years, he's felt fine, hasn't gained a single pound, and remains as active at 50 as he did in 40. In other words, nothing has changed except that he's 10 years older. His lipids and lipoproteins:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

Some of you might correctly point out that just simple aging can cause some deterioration in lipids and lipoproteins, but we're going to ignore these relatively modest issues for now.)

Lipids and lipoproteins are, therefore, unchanged. Michael's heart scan score: 1380, or an approximate 30% annual increase in score. (Since Michael didn't know about his score, he took no corrective/preventive action.)

My point: If we were to make our judgment about Michael's heart disease risk by looking at lipids or lipoproteins, they would'nt tell us where he stood with regards to heart disease risk. His lipids and lipoproteins were, in fact, the same at age 50 as they were at age 40. That's because measures of risk like this are snapshots in time.

In contrast, the heart scan score reflects the cumulative effects of life and lipids/lipoproteins up until the day you got your scan.

Which measure do you think is a better gauge of heart attack risk? I think the answer's obvious.

11. August 2006 William Davis (0)
The recognition of the metabolic syndrome as a distinct collection of factors that raise heart disease risk has been a great step forward in helping us understand many of the causes behind heart disease.

Curiously, there's not complete agreement on precisely how to define metabolic syndrome. The American Heart Association and the National Heart, Lung, and Blood Institute issued a concensus statement in 2005 that "defined" metabolic syndrome as anyone having any 3 of the 5 following signs:





Waist size 40 inches or greater in men; 35 inches or greater in women

Triglycerides 150 mg/dL or greater (or treatment for high triglycerides)

HDL-C <40 mg/dL in men; <50 mg/dL in women (or treatment for reduced HDL-C)

Blood Pressure >130 mmHg systolic; or >85 mmHg diastolic (or drug treatment for hypertension)

Glucose (fasting) >100 mg/dL (or drug treatment for elevated glucose)


Using this definition, it has become clear that meeting these criteria triple your risk of heart attack.

But can you have the risk of metabolic syndrome even without meeting the criteria? What if your waste size (male) is, 36 inches, not the 40 inches required to meet that criterion; and your triglycerides are 160, but you meet none of the other requirements?

In our experience, you certainly can carry the same risk. Why? The crude criteria developed for the primary practitioner tries to employ pedestrian, everyday measures.

We see people every day who do not meet the criteria of the metabolic syndrome yet have hidden factors that still confer the same risk. This includes small LDL; a lack of healthy large HDL despite a normal total HDL; postprandial IDL; exercise-induced high blood pressure; and inflammation. These are all associated with the metabolic syndrome, too, but they are not part of the standard definition.

I take issue in particular with the waist requirement. This one measure has, in fact, gotten lots of press lately. Some people have even claimed that waist size is the only requirement necessary to diagnose metabolic syndrome.

Our experience is that features of the metabolic syndrome can occur at any waist size, though it increases in likelihood and severity the larger the waist size. I have seen hundreds of instances in which waist size was 32-38 inches in a male, far less than 35 inches in a female, yet small LDL is wildly out of control, IDL is sky high, and C-reactive protein is markedly increased. These people obtain substantial risk from these patterns, though they don't meet the standard definition.

To me, having to meet the waist requirement for recogition of metabolic syndrome is like finally accepting that you have breast cancer when you feel the two-inch mass in your breast--it's too late.

Recognize that the standard definition when you seen it is a crude tool meant for broad consumption. You and I can do far better.

What role DHEA?

9. August 2006 William Davis (2)



DHEA, the adrenal gland hormone, has suffered its share of ups and downs over the years.

Initially, DHEA was held up as the fountain of youth with hopes of turning back the clock 20 years. Such extravagant dreams have not held up. But DHEA can still be helpful for your program.

All of us had oodles of DHEA in our bodies when we were in our 20s and 30s. Gradually diminishing levels usually reach nearly blood levels of around zero by age 70.



In our heart disease prevention program, of course, we aim to stop or reduce your CT heart scan score. Does DHEA reduce your score? No, it most certainly does not. But it can be helpful for gaining control over some of the causes behind coronary plaque.

For instance, DHEA can:

--Help reduce abdominal fat and increase muscle mass (slightly)
--Provide more physical stamina.
--Boost mood.
--It may modestly reduce some of the phenomena associated with the metabolic syndrome (high blood pressure, high blood sugar, high insulin, low HDL, small LDL, etc.)

In my experience, people who feel better do better on their overall program. If you're always tired and run down and run out of steam by 3 pm, I won't see you riding your bicycle outdoors or at the aerobics class. But if you're bursting with energy until you put your head on the pillow, you're more inclined to walk, bike, dance, play with the kids, dance, take Tai Chi, etc.

Some downsides to DHEA: Some people experience aggression. Backing off on the dose usually relieves it. Also, sleeplessness. Taking your DHEA in the morning usually fixes it.



The dose is best tailored to your age and blood levels. People less than 40 years old should not take DHEA. The older you are, the higher the dose, though we rarely ever have to exceed 50 mg per day. If you've never had a blood level and your doctor refuses to obtain one, 25 mg per day is a reasonable dose (10-15 mg in women 40-50 years old). It's always best to discuss your supplement use, particularly agents like DHEA, with your doctor.

Track Your Plaque Members: Stay tuned to the www.cureality.com website for a Special Report more completely detailing the hows and whys behind DHEA.

Brainwashed!

9. August 2006 William Davis (0)
At a social gathering this weekend, as we humans like to do, someone asked me what I did for a living. I told him I was a cardiologist.

"What hospital do you work at?" he asked.

This is invariably the response I get whenever I tell people what I do. I wouldn't make much of it except that it happens just about every time.

This indicates to me just how successful hospitals, my colleagues, cardiac device manufacturers, and others supporting the status quo in heart care, have been in persuading us that the place for heart disease is the hospital--period.

Tense families, drama, high-tech...It all takes place in the hospital.

Yet the people destined to be the fodder for hospital heart care are presently well, mostly unaware of what the future holds. Also unaware that heart disease is readily, easily, inexpensively, and accurately identifiable. Ask anyone in the Track Your Plaque program who's had a CT heart scan.

We all need to rid ourselves of the idea that the hospital is the place for heart disease. If the coronary plaque behind heart attack is easy to detect and controllable, there's little or no need for the hospital for the vast majority of us.

In the majority of instances of coronary disease, the hospital should be the place for the non-compliant and the ill-informed, and not for those of us sufficiently motivated to know and do better. The formula is simple: 1) Quantify plaque with a CT heart scan, 2) Identify the causes, then 3) Correct the causes.

The Fanatic Cook: A fabulous Blog about food and nutrition

7. August 2006 William Davis (0)
I came across this Blog authored by a nutritionist when it was highlighted on Blogger as an interesting site:

The Fanatic Cook at http://fanaticcook.blogspot.com/

I was thoroughly impressed with the insightful and entertaining commentary. I'd highly recommend this site to you for reading on nutrition. In particular, her coenzyme Q10 column was exceptionally well written and clear.(http://fanaticcook.blogspot.com/2005/02/statins-and-not-well-publicized-side.html)

Also read her column, Super NonFoods at http://fanaticcook.blogspot.com/2005/07/super-nonfoods.html.

There's also oodles of recipes, all for the taking.

Eggs: Good, bad, or indifferent?

5. August 2006 William Davis (3)
Eggs have been in the center of the cholesterol controversy almost from the very start.

The traditional argument against eggs went that eggs, high in cholesterol (210-275 mg per egg)and with some saturated fat (1.5-2.5 grams per egg), raised blood cholesterol (and LDL). Out went the daily fried, scrambled, poached eggs that many Americans indulged in most mornings. (We replaced it with more breakfast cereals and other carbohydrate conveniences, then got enormously overweight.)





A large Harvard epidemiologic study in 1999 called this observation into question. They tracked the fate of 117,000 thousand people and then compared the rate of heart attack, death, and other cardiovascular events among various people correlated to the "dose" of eggs they ate. Egg intake varied from none to 7 or more per week. Lo and behold, people who ate more eggs appeared to not suffer more events.

This study, large and well-conducted by an internationally respected group of investigators, seem to reopen the gates for more egg consumption, though most Americans still consume eggs cautiously.

Deeper down in this study, however, was another observation: People with diabetes who ate 1 egg per day had double the risk of heart attack. Because this study was observational, no specific conclusion as to why could be drawn.

A new study conducted by a Brazilian group may shed some light. Healthy (non-diabetic) men were fed an emulsion of several eggs. Inclusion of plentiful yolks caused a dramatic slowing of fat clearance from the blood. Specifically, "chylomicron remnants" were abnormally persistent in the blood. Chylomicron remnants are potent causes of coronary plaque. (Chylomicron remnants can be measured fairly well by intermediate-density lipoprotein and VLDL by NMR, or IDL by VAP.)

Diabetics are know to have substantial disorders of after-meal fat clearance, including an excess of chylomicron remnants. Could the Brazilian observation be the explanation for the increased event rate in diabetics in the Harvard study? Interesting to speculate.

We continue to tell our patients that eating eggs in moderation is probably safe. After all, there are good things in eggs: the high protein in the egg white, lecithin in the yolk. It is the yolk's contents that are in question, not the white. Thus, you and I can eat all the egg whites (e.g., Egg Beaters) we want. It's the safety of yolks that are uncertain.

The abnormal after-eating effect suggested by the Brazilians opens up some very interesting questions and confirms that we should still be cautious in our intake of egg yolks. One yolk per day is clearly too much. What is safe? The exisitng information would suggest that, if you have diabetes, pre-diabetes, or a postprandial disorder (IDL, VLDL), you should minimize your egg yolk use, perhaps no more than 3 or so per week, preferably not all at one but spaced out to avoid the after-eating effect.

Others without postprandial disorders may safely eat more, perhaps 5 per week, but also not all at one but spaced out.

Track Your Plaque Members: Be sure to read our upcoming Special Report on Postprandial Disorders. It contains lots of info on what this important pattern is all about. Postprandial disorders are largely unexplored territory that hold great promise for tools to inhibit coronary plaque growth and drop your heart scan score. The Brazilian study is just one of many future studies that are likely to be released in future about this very fascinating area.




Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC.A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999 Apr 21;281(15):1387-94.

Cesar TB, Oliveira MR, Mesquita CH, Maranhao RC. High cholesterol intake modifies chylomicron metabolism in normolipidemic young men. J Nutr. 2006 Apr;136(4):971-6.

Diabetes is Track Your Plaque's Kryptonite!

3. August 2006 William Davis (0)

If there's one thing I truly fear from a heart scan score reduction/coronary plaque regression standpoint, it's diabetes.

I saw a graphic illustration of this today. Roy came into the office after his 2nd heart scan. His first scan 14 months ago showed a score of 162. Roy started out weighing well over 300 lbs and with newly-diagnosed adult diabetes.

Roy put extraordinary effort into his program. He lost nearly 70 lbs by walking; cutting processed carbohydrates, greasy foods, and slashing overall calories. His lipoproteins, disastrous in the beginning, were falling into line, though HDL was still lagging in the low 40s, as Roy remains around 60 lbs overweight, even after the initial 70 lb loss.

Unfortunately, despite the huge loss in weight, Roy remains diabetic. On a drug called Actos, which enhances sensitivity to insulin, along with vitamin D to also enhance insulin response, his blood sugars remained in the overtly diabetic range.

Roy's repeat heart scan showed a score of 482--a tripling of his original score.

Obviously, major changes in Roy's program are going to be required to keep this rate of growth from continuing. But I tell Roy's story to illustrate the frightening power of diabetes to trigger coronary plaque growth.

Like Kryptonite to Superman (remember George Reeves crumbling and falling to his knees when the bad guys got a hold of some?), diabetes is the one thing I fear greatly when it comes to reducing your heart scan score. As you see with Roy's case, diabetes can be responsible for explosive plaque growth, more than anything else I know.

The best protection from diabetes is to never get it in the first place. (See my earlier Blog, "Diabetes is a choice you make".)
Baby your pancreas

Baby your pancreas

1. July 2011 William Davis (35)
There it is, sitting quietly tucked under your diaphragm, nestled beneath layers of stomach and intestines, doing its job of monitoring blood sugar, producing insulin, and secreting the digestive enzymes that allow you to convert a fried egg, tomato, or dill pickle into the components that compose you.

But, if you've lived the life of most Americans, your pancreas has had a hard life. Starting as a child, it was forced into the equivalent of hard labor by your eating carbohydrate-rich foods like Lucky Charms, Cocoa Puffs, Hoho's, Ding Dongs, Scooter Pies, and macaroni and cheese. Into adolescent years and college, it was whipped into subservient labor with pizza, beer, pretzels, and ramen noodles. As an adult, the USDA, Surgeon General's office and other assorted purveyors of nutritional advice urged us to cut our fat, cholesterol, and eat more "healthy whole grains"; you complied, exposing your overworked pancreas to keep up its relentless work pace, spewing out insulin to accommodate the endless flow of carbohydrate-rich foods.

So here we are, middle aged or so, with pancreases that are beaten, worn, hobbling around with a walker, heaving and gasping due to having lost 50% or more of its insulin-producing beta cells. If continued to be forced to work overtime, it will fail, breathing its last breath as you and your doctor come to its rescue with metformin, Actos, Januvia, shots of Byetta, and eventually insulin, all aimed at corralling the blood sugar that your failed pancreas was meant to contain.

What if you don't want to rescue your flagging pancreas with drugs? What if you want to salvage your poor, wrinkled, exhausted pancreas, eaking out whatever is left out of the few beta cells you have left?

Well, then, baby your pancreas. If this were a car with 90,000 miles on it, but you want it to last 100,000, then change the oil frequently, keep it tuned, and otherwise baby your car, not subjecting it to extremes and neglect to accelerate its demise. Same with your pancreas: Allow it to rest, not subjecting it to the extremes of insulin production required by carbohydrate consumption. Don't expose it to foods like wheat flour, cornstarch, oats, rice starch, potatoes, and sucrose that demand overtime and hard labor out of your poor pancreas. Go after the foods that allow your pancreas to sleep through a meal like eggs, spinach, cucumbers, olive oil, and walnuts. Give your pancreas a nice back massage and steer clear of "healthy whole grains," the nutritional equivalent of a 26-mile marathon. Pay your pancreas a compliment or two and allow it to have occasional vacations with a brief fast.
Tags :

Comments (35) -

  • Anthony

    7/1/2011 1:13:47 PM |

    Dr. Davis:

    what relationships, if any, exist between the nutritional history you've depicted in your post and pancreatic cancer.

  • Jana Miller

    7/1/2011 1:48:54 PM |

    Is there any way to heal our pancreas? I have a friend with pancreatic cancer and it's incredibly painful. I would love some preventative care for myself if you have any tips.
    Jana

  • Steve Parker, M.D.

    7/1/2011 2:06:14 PM |

    Pretty good advice, doctor.

    The Centers for Disease Control has predicted that one of every three Americans born in 2000 will eventually develop diabetes (mostly type 2).  Your dietary advice, along with regular exercise and avoidance of obesity, would prevent many cases.

    -Steve

  • Renfrew

    7/1/2011 3:04:06 PM |

    Great article! Yes, our pancreas is neglected badly. It is working hard, day in, day out and we don't even notice this hard labor.
    One can measure if the pancreas is still working ok by measuring "C-Peptid". A sensitive marker of insulin production. Mine is 1.0 (a little low), so I want to support my pancreas.
    Does anybody know how to increase or re-generate beta-cells?
    There is a herb (among others), called GYMNEMA SYLVESTRE that has supposedly regenerative capabilites. Has anybody tried this?
    Thanks.

  • steve

    7/1/2011 3:06:19 PM |

    Doctor Davis:
    No rice or potatoes?  Are you advocating a zero carb (except carbs found in veggies and fruit)?  Many of us are allergic to nuts so foods like walnuts are out, but peanuts are ok since they are legumes, but many seem to say stay away from them.  Be helpful to get more detail on your daily diet suggestions.

    Thanks!

  • Michael

    7/1/2011 3:57:09 PM |

    Doesn't the pancreas work to produce insulin and glucogen even on low-carb meals?  I thought the problem with high-carb diets was the elevated level of insulin in the blood and the various metabolic syndrome problems that causes, not necessarily that it overworks the pancreas.

  • Joe Lindley

    7/1/2011 4:25:34 PM |

    Agreed!  Please correct me if I'm wrong, but isn't there the a danger that as a person gains weight and the body is experiencing continuing high insulin levels, some tissues become insulin resistant, so the pancreas is forced to produce  even more insulin to keep the glucose levels in the blood under control.  That, I understand, becomes a  "slippery slope" and difficult to recover from.  I don't mean to be alarmist - but it is downright scary.

  • cancerclasses

    7/1/2011 7:02:35 PM |

    Dr. Jack Kruse: Via current clinical (testing) methods by the time someone is diagnosed with Type 2 #diabetes, 50% of their beta cells are already destroyed. http://goo.gl/MAhVU

  • cancerclasses

    7/1/2011 7:31:57 PM |

    It's mostly the overwork, here's a little known pancreas fact: "Only 1% of the beta cells in the pancreas are devoted to producing insulin for handling sugars, 99% of the pancreas is devoted to handling the digestion of fats and proteins."   http://goo.gl/WlLML  and  http://goo.gl/wUcEB  

    From Wikipedia: "The islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas. There are about one million islets in a healthy adult human pancreas, which are distributed throughout the organ; their combined mass is 1 to 1.5 grams."   And in rats, only 65 to 80% of those cells are devoted to producing insulin & amylin.  http://goo.gl/3zrHa

    So when you consider these facts along with what Dr Jack Kruse says: "Via current clinical (testing) methods by the time someone is diagnosed with Type 2 #diabetes, 50% of their beta cells are already destroyed.", then YES, BABY YOUR PANCREAS!!   http://goo.gl/MAhVU

  • Geoffrey Levens, L.Ac.

    7/1/2011 7:48:54 PM |

    FWIW: I was spiking to 185-210 at one hour post prandial on Dr Fuhrman's greens/beans etc diet.  I added Gymnema from Pure Encapsulations Gymnema sylvestre extract (leaf) (75%)250 mg, one capsule, 3X/day and after about 5 months my highest spikes have been in the low 120's after BIG meals, same diet, no grains but plenty of fruit and some root veg and lots of beans.  Even a good sized serving of oatmeal only get my sugar reading to the mid 120's. Seems to me, likely some beta cell rejuvenation has gone on.  How much the gymnema and how much the diet is anybody's guess.

  • Steve Cooksey

    7/1/2011 8:48:03 PM |

    Agreed! And it's why I eat only 1-2 meals most days. AND ... very low carb.

    Usually sub 20g of carbs per day!

    Baby that THANG! Smile

  • Jeff

    7/1/2011 11:55:46 PM |

    Could a high SHBG level be caused by a worn out pancreas?

  • cancerclasses

    7/2/2011 2:44:34 AM |

    Oops, wrong quote.  here's the right one.    "In addition, glucose sticks to proteins in the blood (glycosylation). These glycosylated proteins are sticky and slow down the blood flow through the capillaries and veins, preventing oxygenation. It has been shown that people with diabetes have higher rates of cancer and mortality due to cancer as compared to those without diabetics. The strongest correlation was for pancreatic cancer. Notably, it has been found that the higher the fasting glucose one has, the higher the risk for cancer."  http://goo.gl/PnJoU

    Also see the article Tom Naughton wrote on his Fat Head blog about ‘Super-Sticky’ Cholesterol and Diabetics here:  http://goo.gl/JTi75

  • CarbSane

    7/2/2011 11:43:02 AM |

    There's no evidence that using your pancreas is what leads to reductions in beta cell mass and function.   Have you looked at any of the peer review research demonstrating that drugs like Byetta can actually increase beta cell mass and increase insulin sensitivity?

  • Might-o'chondri-AL

    7/2/2011 4:24:07 PM |

    2,000 - 3,000 Beta cell work to coordinate insulin put out every +/- 4 minutes; post-prandial there is a 1st response insulin spike, then smaller steady secretion, and in time a lesser 2nd insulin spike.  Some Type 2 diabetics don't  put out the 1st insulin spike, their blood sugar stays high and then eventually they do put out that late 2nd insulin spike.

    "Amylin"  or IAPP (islet amyloid poly-peptide) is co-secreted with all insulin;  if  "amylin" goes on oligomerize into a  tangle of fibrils around the individual Beta cells this messes with their signal synchronization.  As the "amylin" kinks up with other amylin the Beta cells are pushed apart and those Beta cells change size; without Beta cell group co-ordination the individual cells' mitochondrial house keeping repairs risks compounding recycling errors and that cell goes into programmed cell death (apoptosis).

    Zinc is what binds to an individual "amylin" fibril  in a central position and keeps that fibril from oligomerizing with other fibrils; too little zinc in pancreas lets tangles occur. Yet too much zinc in pancreas also lets tangling get going; this is due to when a 2nd zinc clings elsewhere on  the same fibril the first zinc already is bound to.  See  recent "Journal Molecular Biology", vol 410, 2, 294-306

  • Anne

    7/2/2011 6:22:29 PM |

    Do you have a reference for that? Not a mouse study. Thanks.

  • kenneth

    7/2/2011 8:08:17 PM |

    http://diabetes.webmd.com/news/20110624/very-low-calorie-diet-may-reverse-diabetes

    Damned interesting study if it bears out. It seems that a couple months of hard starvation lowers fat levels in the pancreas and can actually reverse diabetes, at least in people who are not too far along in the disease process.

  • Geoffrey Levens, L.Ac.

    7/2/2011 8:39:14 PM |

    It does not take anything like the starvation in the above linked study to reverse insulin resistance and effectively eliminate T2 diabetes.  There are a number of doctors who have been having that result for many years w/ a lowish fat, plant based diet, eliminating REFINED carbs, animal fat, saturated fat, and manufactured junk food.  See Fuhrman, McDougall, Barnard, Esselstyn, Shitani, etc. They all have books out and a track record easy to find.

  • Mark. Gooley

    7/3/2011 1:01:05 AM |

    Now I have Weird Al Yankovic's song "Pancreas" going through my head...

  • PeggyC

    7/3/2011 1:38:41 AM |

    No need to starve to "cure" type 2 diabetes.  Just cut the carbohydrates, particularly the starchy kinds from grains, legumes, and potatoes.  No need to eliminate animal fat/sat fat, either. Natural fats have no effect on blood glucose and do not stimulate insulin production.  If you eliminate all the things Fuhrman et al say to eliminate, there isn't much left to eat and you will end up on a starvation diet anyway!

  • Might-o'chondri-AL

    7/3/2011 2:32:58 AM |

    Might some of Doc's diabetics be getting their relief from eliminating wheat be due to more zinc absorption (and thus less "amylin" tangles) ? In theory  phytates  have the potential to excessively bind up zinc; although I hesitate to say one scenario fits all situations.

    Zinc deficiency in the pancreas is hard to assess, since we use zinc all over ; specific tissue levels are a guess,  because we are physiologically designed to keep a baseline amount of zinc in our blood. In other words,  zinc can actually be retrieved from body tissue and put back into circulation;  maybe  some individuals have a disposition to leach zinc out of their pancreas and then their "amylin"  tangling worsens.  Constant adult doses of over 100 mg per day really merits caution and, aside from other side effects, may tag "amylin" fibrils with 2nd zinc that provokes  "amylin" tangles; I am not suggesting any specific dosage for anyone here.  

    Meanwhile,  other individuals possibly avoid Beta cell death due to genetic propensity to maintain enough zinc in their pancreas;   and,  also some may have gut bacteria strains that slowly pass the  intestine zinc the bacteria cleaved from phytates' hold.  Not every overweight person, nor  grain/legume/nut phytate  consumer goes on to develop diabetes; there may just be some age related Beta cell decline  that is normal and not pathological.

  • Dr. William Davis

    7/3/2011 2:04:43 PM |

    The whole notion of beta cell regeneration, while tantalizing, is uncharted territory. I propose carb-limitation not so much for its beta cell regenerating potential, but for its ability to simply not challenge a compromised pancreas.

    Might-o-chondrial's proposal that grain phytates block absorption of zinc is interesting. However, I don't know how much of a genuine role it plays in the entire picture. I can say that the end clinical effects include HbA1c's of 5.0 or less, fasting glucoses of 90 mg/dl or less.

  • Geoffrey Levens, L.Ac.

    7/3/2011 3:24:41 PM |

    "If you eliminate all the things Fuhrman et al say to eliminate, there isn’t much left to eat and you will end up on a starvation diet anyway!"

    Lack of imagination/creativity is a terrible thing.  The only thing Fuhrman et al say to eliminate is manufactured, highly processed, refined, chemicalized, "food like substances" (that are not really food at all).  I eat basic Fuhrman diet and can easily adjust my calorie intake up or down by 1000 calories or more just by substituting higher or lower calorie density real foods.  It isn't difficult, and even at lower calorie intake, no sense of deprivation at all after the first bit of breaking addictions and retuning taste buds.

  • Might-o'chondri-AL

    7/3/2011 6:48:26 PM |

    60 - 80% of new Type 1 diabetics show anti-bodies for Zinc Transporter 8; there are 10 different zinc transporters (ZnT) in mammals.  ZnT works with the movement of zinc from a cell's cytoplasm to sites of action inside that cell and also moves zinc outside that cell (bringing zinc into cell is not directly mediated by ZnT).

    A genetic polymorphism of ZnT 8 (SLC 30A8  rs13266634) causes less pro-insulin made into insulin (crystalization of insulin for stockpiling  involves zinc)  and when high blood sugar malfunctions;  if less insulin
    stash in insulin storage granules then it's secretion on instant demand (ex: 1st post-prandial insulin pulse)  is impaired.  Normally lots of ZnT 8 is active in pancreatic  Beta cells and actually prevents Beta cells from dying off due to zinc deficiency;  as well  as  lots of ZnT 8 activity expression inducing more  insulin put out in response to blood glucose loads.

    High blood glucose down-regulates ZnT8 and , on the contrary, up-regulates ZnT 3;  Doc is right to be concerned with excessive post-prandial blood sugar because ZnT3 and ZnT8  have different dynamics.  ZnT3 is linked to amyloid tangling in the brain (hippocampus has lots of ZnT3) and recent research find it is active in the pancreatic islets; so I wonder if it's transporter genetics (gene SLC 30A3) is how  zinc becomes a problem outside the cell,  and integral to how "amylin" fibrils then can kink into tangled oligomers that push Beta cells too far apart.

  • Paul Lee

    7/5/2011 4:57:11 AM |

    Did they need to be starved as well. Surely just reducing the carb would have sufficed?

  • Might-o'chondri-AL

    7/5/2011 5:24:27 PM |

    Glad to see T. H.  back .... for Melatonin synthesis we use zinc and taking zinc raises one's melatonin output (2003  journal Acta Physiologica Hungarica, 90(4),335-339).  Pancreatic lipase enzymes that help cleave fat we've eaten also  uses zinc.

    I have no zinc guide lines for anyone, and definitely  am not claiming zinc is the only relevant parameter in pancreatic dynamics.  For home evaluation  of zinc status please see Dr. Dereck Bryce-Smith's  "ZTT"  technique; it is a 10 second mouth swish of 2 teaspoons of zinc sulfate mono-hydrate and how one's response ranges in four gradients  going from tasteless to metallic.

  • Jack Kronk

    7/6/2011 3:33:27 PM |

    Fuhrman? Have you seen how he handles commenters on his site that challenge anything he says. He responds like a childish buffoon. Besides he is very much anti animal fat and anti saturated fat. No thanks.

  • Dr. Haney

    7/6/2011 5:06:51 PM |

    I am just about convinced that I have experienced some amount of beta cell duplication as a result of many months of low carb dieting, as noted in an earlier post by Might-o in March regarding the formation of new, larger beta cells in the absence of hyper-glycemia.  After trying many diets to address my type 2 diabetes, I settled on a low carb diet of 65% fat 25% protien and 10% carb after extensive research on the effects of the different micronutrients on blood sugar.  For almost a year, my A1C has been 5.4, and I lost 40 lbs in that time period.

    However, after feeling that I had lost some strength in weightlifting, I did some additional research on maintaining strength while on a low-carb diet, and it was suggested that on weekends, to eat anywhere from 100-500 grams of carbs to restore my glycogen levels.  To make a long story short, I ate half of a large pizza, and tested my blood glucose before and one hour after.  Before, it was 82mg/dl.  After? 67 mg/dl.  I tested this again the next day with a few tacos, which would have normally shot my blood glucose numbers in the 100's and it produced the same effect.  

    One concern that I have is that my pancreas is producing excessive insulin, which is a problem for us diabetics who have been abusing our pancreas for so many years.   However, I believe that I have recovered some insulin sensitivity by giving my pancreas a rest and keeping my insulin levels low.  Does that mean that I'm cured and I should start gorgeing on pizza, cakes, sodas, french fries, mashed potatoes, pancakes and fried chicken like I used to? (I know, I brought diabetes on to myself)  The answer is no.  But it is a good idea to preserve our existing working beta cells by giving it a rest.

  • cancerclasses

    7/6/2011 6:51:21 PM |

    Some nutritionists & dietitians recommend no more than 10 or 12 teaspoons of  *added*  sugar a day, as in addition to your regular daily diet, others say 10 to 12 teaspoons total sugars per day, with no additional.

    Since only 1 percent of your pancrease is used to produce insulin to process blood sugars, and since the average human body contains 5 liters of blood which is equal to around 1000 teaspoons, and a homeostatic fasted blood sugar level of 60 to 90 mg. per deciliter equates to a little less than 1 teaspoon, the theory is the less sugar consumed is the better option.  A handy formula to memorize is the 1-5-20 rule, which means 1 teaspoon of sugar equals 5 grams which equals 20 calories, then just do a little multiplication or division to convert the grams & calories of carbs on food labels into a teaspoon equivalent that's easier to wrap your brain around, and as a good visual aid to understand how much glucose you're dumping on your pancreas all at once.

    I seriously doubt Dr. Davis advocates *NO* carbs, very few people that understand how to exploit the macronutrients do, especially doctors.  Most people have poor long term results & can't sustain a food denial strategy, so rather than think in terms of carb denial it's better to just have limited amounts of the carbs you like while keeping in mind the total glucose content, glycemic index and glycemic load of those foods and the stress placed on your pancreas by overindulging.

    There's a great carb intake chart over on Mark Sisson's website that explains the optimum carb intake levels, to see it scroll down the page here:  http://goo.gl/CYD1n

    Just remember that carbs have 4 calories per gram, so to get the total calories by carbs per day just multiply the grams by 4.

  • Tara

    7/6/2011 7:24:31 PM |

    Good advice, as usual.

    I was wondering if you could plan a future post around Microvascular Disease, particularly in women.  I understand the symptoms are different, and was hoping that you may be able to shed light on which lifestyle factors are most effective.  I'm seeing more and more thin, active women (many younger than 65) with "perfect" lipids in cardiac rehab.

  • Mindy

    7/7/2011 4:15:19 AM |

    I have been taking metformin for polycystic ovarian syndrome. I have been low-carb/primal for a year now. Blood work (sugar and trig/hdl) look great. Any idea what I am doing to my pancreas by continuing the metformin? I have already decreased the dose since my blood sugar was getting too low. How do I know if I don't need to take it anymore? I am not taking metformin to control blood sugar.

  • Alan Redd

    7/7/2011 4:10:54 PM |

    Thank you for the valuable  information Dr. Davis.  I am using much of it.

    Another way to baby your pancreas is to avoid, where possible, dysglycemic drugs--two examples include: quinolines (antimalarials) and fluoroquinolones (FQs, e.g. ciprofloxacin, levofloxacin, moxifloxacin).  Bactericidal antibiotics produce more oxidative stress than do bacteriostatic antibiotics.  FQs produce a lot of oxidative stress, probably more than others and they are handed out like candy.  FQs also deplete and mutate mammalian mitochondria.  

    Interestingly, B-cells in the  pancreas have very low levels of antioxidant enzymes (glutathione peroxidase and catalase both mop up reactive oxygen species)  comprising only 1% of the levels in the liver.   This favors H2O2 accumulation which can mess up H2O2 signal transduction.

    I wonder why our pancreas B-cells  do not have more antioxidant protection than do cells in the liver?  Maybe the difference is the amount of zinc and iron between the pancreas and liver?  Zinc is a potent antioxidant by itself and a cofactor for the third major antioxidant enzyme of our bodes--super oxidase dismutase.  Iron is highly risky for oxidative stress particularly in combination with a hydroxyl radical--this is an explosive combination.

    How much the rapid increase in diabetes is associated with  the overuse of prescription medications that are tough on the pancreas?

    I have references for all of the above if anyone is interested.

  • Might-o'chondri-AL

    7/8/2011 2:34:39 AM |

    Hi Redd,
    You may be interested that it is MnSOD (manganese superoxide dismutase) which makes risky super-oxide molecules into molecules of H2O2 (hydrogen peroxide); the net effect of having more MnSOD activity is lower levels of super-oxide but more H2O2.

  • Geoffrey Levens, L.Ac.

    7/8/2011 2:55:14 PM |

    "I ate half of a large pizza, and tested my blood glucose before and one hour after. Before, it was 82mg/dl. After? 67 mg/dl. I tested this again the next day with a few tacos, which would have normally shot my blood glucose numbers in the 100′s and it produced the same effect."
    Hope you have previously tested those same foods at 30 minute intervals because blood glucose peak timing can vary greatly depending on specific food/meal and individual physiology. Pizza is one of the worst for long delayed but very high peak

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