(Lack of ) Quality of nutritional supplements

16. May 2007 William Davis (0)
In my last post, I blogged about how we must not confuse marketing with truth. They are often two different things.

A patient I saw today was absolutely convinced that his fish oil was the best available in the world: purer, uncontaminated by mercury or pesticides--"not like that other crap on the shelves." I asked him how he knew this. "They say so," he proudly declared.

Do you recognize this? He fell for the marketing. While there may be some truth in the manufacturer's claims, you can't believe it from the mouth of the manufacturer. True judgements about quality and purity have to come from an independent source like Consumer Reports, Consumer Lab, or the FDA.

But the FDA doesn't regulate the quality and purity of nutritional supplements. On the positive side, this has allowed supplement manufacturers to keep costs down, not having to navigate arcane and complex regulatory restrictions.

On the negative side, a fair number of supplement manufacturers get away with 1) producing supplements that fail to contain the stated amounts of ingredients, occasionally containing none of the essential ingredient(s), 2) contain contaminants like lead, and 3) make extravagant and often unfounded claims like "superior", "more effective", and "purer". (DHEA, for instance, is a particular landmine of poor quality. I recently suggested that a patient take DHEA; despite consistently taking 50 mg of a specific brand for several months, the blood level of DHEA-S didn't budge one bit--there was likely little or none in the capsule.)

The Fanatic Cook at http://fanaticcook.blogspot.com has posted some very insightful discussions on this issue and the proposed FDA regulations of supplements. They're worth perusing.

I really wish regulation weren't necessary and that the industry could have policed itself. But it clearly has failed and perhaps federal oversight is not such a bad thing, as long as the FDA regulations restrict themselves to oversight over quality and purity and not to efficacy. It's the efficacy regulation that could hogtie innovation in supplement development.
Tags :

Add comment

Loading
Why are heart attacks still happening?

Why are heart attacks still happening?

4. March 2012 William Davis (10)
I'm a cardiologist. I see patients with heart disease in the form of coronary artery disease every day.

These are people who have undergone bypass surgery, received one or more stents or undergone other forms of angioplasty, have survived heart attacks or sudden cardiac death, or have high heart scan scores. In short, I see patients every day who are at high-risk for heart attack and death from heart disease.

But I see virtually no heart attacks. And nobody is dying from heart disease. (I'm referring to the people who follow the strategies I advocate, not the guy who thinks that smoking a pack of cigarettes a day is still okay, or the woman who thinks the diet is unnecessary because she's slender.)

Two high-profile deaths from heart attacks occurred this week:

Davy Jones--The iconic singer from the 1960s pop group, the Monkees, suffered sudden cardiac death after a large heart attack, just hours after experiencing chest pain.

Andrew Breitbart--The conservative blogger and controversy-generating media personality suffered what was believed to be sudden cardiac death while walking.

It's a darn shame and it shouldn't happen. The tools to identify the potential for heart attack are available, inexpensive, and simple. The strategies to reduce, even eliminate, risk are likewise available, inexpensive, and cultivate overall health.

The followers of the Track Your Plaque program who

1) get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
2) identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
3) correct the causes

enjoy virtual elimination of risk.
Tags :

Comments (10) -

  • Alexandra

    3/4/2012 1:02:04 PM |

    Just read this about Davy Jones:
    http://blog.sfgate.com/dailydish/2012/03/01/micky-dolenz-bewildered-by-davy-jones-death/

  • nina

    3/4/2012 9:30:09 PM |

    I saw some recent photos of Davy Jones and thought ''wheat belly''.  Sad, but avoidable.

  • PeteKl

    3/4/2012 11:00:30 PM |

    I don''t claim to entirely know the answer to this question, but I am willing to venture a guess to what might be part of the answer.  My suspicion is that in the end, for better or worse, most people value the opinions of their social group more than they value their health.  Currently Doctor, your recommendations are just too far from mainstream opinion and sadly will be ignored by all but the most thoughtful people.

    As anyone who has tried to modify their diet has probably discovered, the greatest challenge often isn''t dealing with cravings for a missing food.  Instead it is dealing with the social backlash to your lifestyle change from friends and family.  

    At first everyone is interested in knowing why you have made the change and they attempt to accommodate your choice.  However eventually they become annoyed as they realize the change you made is permanent.  I can''t tell you how many times I have heard some variation on the following when deciding where to eat with friends (usually given with a thinly veiled snide tone of voice):

    “I would really like to check out that new Italian restaurant, but Pete won''t eat pasta, so I guess we have to go back to the usual place.”

    It doesn''t matter how many times I tell people that I can always find something to eat no matter where we go.  Someone will still insist on making an issue of my dietary choices.  Things aren''t always this blatant, but it is frequent enough that I eventually start wondering whether I should change my eating habits or stop eating with friends.

    While dietary modifications elicit the most direct response, these types of responses seems to occur with almost any health related change.  If your friends and family aren''t themselves doing something or think the change is a dumb idea (no matter how flimsy the reasoning), most people will avoid making a change.  

    Even my own partner, whose father died suddenly of a heart attack last month and whose relatively young mother has been diagnosed with chronic heart failure ignores my suggestions (which are based on your recommendations).  He has asked me several times for advice that might help his mother and the response to my suggestions is always that it won''t work.

    I finally realized that he simply doesn''t want to challenge the rest of the family.  His older brother, a pharmaceutical representative, is viewed as the “expert” on family health issues and my partner refuses to butt heads with him despite what is at stake.  So I keep quiet and wish his mother the best.

    Much of this is understandable.  Humans are social animals and we have evolved to depend on our social group for survival.  On a savannah in Africa 50,000 years ago this made perfect sense.  But in a modern world of science and technology these natural social instincts are increasingly an obstacle to our health and many of us know it.

    Yet it still takes a strong, independent personality to ignore these impulses.  While I have been able to make a number of changes in my life based on your recommendations, it has still been difficult to consistently follow through.  

    Just a few days ago I was invited over to someone''s house to celebrate a birthday.  So what was on the menu?  Several wheat pizza''s, of course.  So did I tell the host that because of my heart problems I no longer eat wheat?  Sorry Doctor, I didn''t.  Instead I shut up, ate the pizza and  proceeded to raise my small LDL particle level for the next week (http://www.trackyourplaque.com/blog/2011/11/friday-is-my-bad-day.html).

  • Robert

    3/5/2012 7:42:48 PM |

    Since adopting a paleo/low carb diet in the last year, I am looking into getting an NMR lipoprofile test to get a baseline of how my particle count looks.  Under the section of treatment options on this particular site, the first line of start with eating right reads "Eat more whole grains, fruits and vegetables."  The very first thing listed is whole grains.  This is so frustrating to see on a site promoting a very useful tool in CVD risk evaluation.  I have read "wheat belly" and "track your plaque", both very good books.  I am also reading primal body, primal mind.  Heart disease runs heavily in my family and I''m pretty much going against what most people in my famliy do by following low carb/paleo eating habits.  I just dont understand why these larger blood test companies, even with all the evidence continuing to pile up, still suggest foods that will worsen the problem the tests are evaluating in the first place.  I guess you have to have confidence in the test they provide (NMR), but just ignore what they say are the best options for treating abnormalities of that test?

  • Dr. William Davis

    3/6/2012 3:47:32 AM |

    It is unbelievable, isn''t it, with all their insights?

    Give them time and they''ll catch on. In the meantime, ignore this nonsense, Robert.

  • Julie

    3/6/2012 6:40:58 AM |

    Dr. Davis,
    What would you recommend for someone who had recently one stent put in and is currently on a statin and plavix post -op?
    Is it necessary to take statins in this case? Any additional supplements etc.?

    Thank you in advance for your help!
    P.S. Loved your book!

  • Catherine

    3/7/2012 12:41:32 AM |

    Dr. Davis,
    Could you please consider changing your "categories" back to the old way you had them organized--single file, alphabetical and one type size? Although it may give a more creative look to the website, it is harder to find the material being sought. I send many new people to your site and they often complain about it.

  • Dr. William Davis

    3/10/2012 3:51:20 PM |

    Hi, Julie--

    This is precisely what the Track Your Plaque program is about.

    In a nutshell:

    1) Identify the causes specific to you, including lipoprotein abnormalties/lipoprotein(a)
    2) Supplement and normalize vitamin D and iodine/thyroid status
    3) Supplement omega-3 fatty acids
    4) Do the diet

  • The Worst Habits for Your Heart - Christian Forums

    5/30/2012 7:50:36 PM |

    [...] patients so that they avoid having a cardiac.   "Why are heart attacks still happening?"  Why are heart attacks still happening? | Track Your Plaque Blog     I’m a cardiologist. I see patients with heart disease in the form of coronary artery [...]

  • margaret

    5/25/2013 6:05:53 AM |

    Dr Davis
    Just found your interesting website.  I am trying to get my partner to cut out wheat (overweight, high chol and high BP).  Unfortunately, I can't find a doctor who conducts the tests you recommend.  Do you know of such in Australia (particularly Western Australia)?  

    Many thanks and I'll continue reading till we catch up down here!!

Add comment

Loading
Success--Slow but sure

Success--Slow but sure

12. October 2007 William Davis (5)
John is a gentleman.

At age 76, he continues to teach at a local college. He's a delight to talk to, having written several scholarly books on religious topics. He's a fountain of knowledge on religious history and the roots of faith.

John is one of those incurably optimistic people, always greeting me with a smile and a warm handshake. I can't help but linger for a hour or so to talk with John, unfortunately disrupting my office schedule miserably.

John is another Track Your Plaque success story. Though he didn't set any records in reduction of his heart scan score, he did it simply by adhering to the program over a period of two years, succeeding slowly but surely.

John's first heart scan score: 1190, a score that carries as much as a 25% annual risk for heart attack. Among the list of causes was an LDL cholesterol in the 170 mg/dl range, along with an LDL particle number that verified the accuracy of LDL.

Among John's suggested treatments was a statin drug, since I was not confident he could reduce LDL with diet and nutritional modifications sufficiently to safely reduce both LDL and his risk for heart attack. But he proved terribly intolerant to any dose of any statin, with incapacitating and strange side-effects, like head-to-toe itching, abdominal cramps and diarrhea. It was clear: John needed to do the program without benefit of a statin drug.

I therefore asked John to maximize all efforts that reduce LDL, 70% of which were small LDL paricles despite his very slender build. He used oat bran and ground flaxseed daily, raw nuts, a soy protein smoothie every morning, and eliminated wheat and other high-glycemic index foods (including the Oreos he loved to snack on). Because the mis-adventures with statin drugs wasted nearly a year, I asked John to undergo another heart scan. Score 2: 1383, a 16% increase.

I asked John to keep on going. Thankfully, he did manage to tolerate fish oil, niacin (though it required over a year just to get to a 1000 mg per day dose), and vitamin D. With all these efforts, he did reduce LDL to the 80-90 mg/dl range. Of course, John's unflagging optimism was crucial. He did express his occasional anxiety over his heart scan score, but dealt with it in a logical, philosophical way. He understood that there was no role for prophylactic stents or bypass, and he accepted that much of his program rested on his ability to adhere to the strategies we advised.

Another year later, a 3rd heart scan: 1210, a 12% reduction.

I'm very proud of John and his success. When you think about it, he succeeded in conquering heart disease with some very simple tools, minus statin drugs. It can be done, but requires consistency and patience--and an optimistic outlook.
Tags :

Comments (5) -

  • katkarma

    10/12/2007 6:37:00 PM |

    I try to follow your regimen of Fish Oil, Vitamin D, niacin and eat oat bran w/flax seeds also, but I use whey protein shakes in the morning because of the taste.   Is  this amount of soy really helping to lower LDL?  Is whey protein ok to use?

  • Dr. Davis

    10/13/2007 1:51:00 AM |

    Yes, I believe whey is fine.

    The LDL-reducing effect of soy is very modest, usually no more than 10 mg/dl. I like it because of the protein that permits low-glycemic index foods to be created with it. I also grew up with soy products since I was a kid and am very comfortable with its many forms.

  • wccaguy

    10/13/2007 2:17:00 AM |

    Just to follow up on katkarma's question...

    Is there any reason to use soy protein rather than whey protein other than that modest LDL lowering effect?

    Any reason not to use whey protein as a surrogate for soy protein?

  • Dr. Davis

    10/16/2007 10:52:00 PM |

    To my knowledge, whey protein is fine, though without direct effects on such things as LDL/small LDL.

  • Scott Parrish

    10/17/2007 1:09:00 PM |

    Kaayla Daniel, in her book "The Whole Soy Story," makes the best for avoiding soy unless fermented. Fermented options including natto, miso, tempeh, but NOT soy protein isolate, tofu, soy milk and other popular soy forms. Problems with soy include estrogenic activity, certain mineral absorption problems, thyroid problems, increased risk for certain cancers.

Add comment

Loading
Wheat one-liners

Wheat one-liners

26. November 2010 William Davis (22)
If you're having difficulty convincing a loved one or someone else that wheat should be eliminated from the human diet, here are some useful one-liners to use:

Wheat makes your boobs big.
(This is true. Priceless for women to use on their husbands.)

Wheat causes dementia.
(And confirmed on examination of brain tissue at autopsy. Yes, autopsy.)

Wheat makes you look pregnant.
(The visceral fat of a wheat belly does a darn good imitation of a near-term infant.)

The first sign of wheat intolerance can be wetting your pants.
(Cerebellar ataxia, i.e., destruction and atrophy of the cerebellum, caused by wheat leads to loss of coordination and bladder control. Average age of onset: 53 years old.)

White flour bad, whole grain better; just as Marlboros are bad, Salems are better.
(The flawed syllogism that led to the "eat more healthy whole grain" colossal blunder.)

Wheat is the only food with its very own mortality rate.
(Celiac disease, osteoporotic hip fractures, and the neurologic diseases triggered by wheat can be fatal.)

"Wheat" is no longer wheat; it's the dwarf mutant that came from genetics research in the 1960s.
(Over 99% of all wheat today comes from the 18-inch tall dwarf mutant.)

Wheat increases blood sugar higher than nearly all other foods.
(Higher than Milky Way bars, higher than Snickers bars, higher than table sugar.)


There you have it: A full arsenal of one-liners to shoot at your husband, wife, or friend when they roll their eyes at your refusal to consume this thing called "wheat."
Tags :

Comments (22) -

  • Anonymous

    11/26/2010 3:21:15 PM |

    Dr. Davis:

    As part of my low carb diet. When my family has pasta (2x per month or so) I have Dreamfields pasta which claims to "lock up" the carbs so they become indigestible. By testing, I know this does not cause a spike in my blood sugar like a normal pasta meal would. I have no wheat sensitivity at all that I can detect, but lately I've become concerned that this may still contribute to small particle LDL, even though it does not spike my blood sugar. Will I still have negative effects from eating this?  P.S. Sorry to be "Anonymous" but I'm not signed up for any of the other options.

  • Anonymous

    11/26/2010 3:53:36 PM |

    You need to test up to 5 hours after eating the pasta. It may be slowing, but not eliminating the spike

  • Lori Miller

    11/26/2010 4:07:33 PM |

    I find wheat to be an appetite stimulant, congesting, it leads to bloating, a few pounds of water weight gain, and a lot of crud on my teeth. If a slightly flatter chest is the price I have to pay to avoid all this, I call it a bargain.

  • Steve Cooksey

    11/26/2010 4:17:47 PM |

    ... but other than all those reasons....wheat's ok right? Cause we need fiber....right??

    LOL!!! I am a Type 2 Diabetic with normal blood sugar and CDE's have told me I should start eating grains.... for FIBER!

    I should take drugs & insulin ....for fiber...

    Thanks Dr. Davis!!!

  • Anand Srivastava

    11/26/2010 6:29:12 PM |

    So women who want big ones should eat wheat Wink. Just saying.

  • Anonymous

    11/26/2010 7:13:05 PM |

    "So women who want big ones should eat wheat Wink. Just saying."

    Didn't work for me!  I've had size A cup boobies before and after wheat.  I do have a nice, flat stomach now though so it was a net gain (loss actually)!

    I also got rid of allergies, skin problems, joint pains and other minor health complaints.

    To the person above eating Dreamfields pasta, it is still loaded with glutens, which cause a host of problems associated with wheat. It's not just the carb content of wheat that is bad.

  • Anonymous

    11/26/2010 7:17:13 PM |

    im a new persona after quiting wheat but doctor what are the usual minerals low in a person consuming wheat which they should supplement after stopping wheat... eg iron/iodine?

  • Dr. William Davis

    11/26/2010 8:41:01 PM |

    Hi, Anonymous--

    See Anonymous' response. It's right on.

    We've had mostly good experiences with the Dreamfields, though some have had modest increases in blood glucose.

  • Dr. William Davis

    11/26/2010 8:42:35 PM |

    Yet another Anonymous--

    Great question about the deficiencies that develop with wheat consumption.

    I'll cover that in an upcoming Heart Scan Blog post.

  • Ed

    11/26/2010 9:21:18 PM |

    As you say, "'Wheat' is no longer wheat".

    Here's a paper that shows varying wheat toxicity, as you observed with einkorn:

    "Natural variation in toxicity of wheat: potential for selection of nontoxic varieties for celiac disease patients."

    http://ukpmc.ac.uk/abstract/MED/16143119

    Different species and varieties, all (usually) called by the same name: not helpful for reality-based thinking.

  • Chris

    11/27/2010 1:34:46 AM |

    Robert DeNiro used Pasta to gain, what was it? 70lbs? for "raging Bull"
    ...worth an Oscar, I guess Smile

  • Eric Edberg

    11/27/2010 2:13:07 AM |

    "Wheat causes dementia."  What's the documentation for that?  I've read all over the place that the evidence for dementia causes, including dietary causes, is inconclusive.  (I also understand that big pharm would have us believe that the problem is insufficient levels of Namenda and Aricept, etc.)

    It's confusing.  My mother has significant dementia.  My dad had a huge belly, all sorts of diabetes complications, heart disease, etc., which killed him, but never developed dementia.  

    Anyway, enjoy your blog and am almost there on eliminating wheat from my diet.  

    Thanks!

  • Desia

    11/27/2010 2:17:22 AM |

    The first sign of wheat intolerance can be wetting your pants.
    (Cerebellar ataxia, i.e., destruction and atrophy of the cerebellum, caused by wheat leads to loss of coordination and bladder control. Average age of onset: 53 years old.)
    Where can I find more info on the above? I've been googling but cannot find something substantial.
    Thanks!

  • Dave

    11/27/2010 6:12:49 AM |

    I think it might be more catchy to think of "healthy whole grains" as the equivalent not of Salems but of "healthy low tar" cigarettes.

  • William Trumbower

    11/27/2010 12:06:29 PM |

    The increased visceral fat (wheat Belly) caused by the high wheat SAD does cause men to aromatize their testosterone to estradiol and get man-boobs, but in women it converts their estradiol to testosterone causing hair growth abnormalities etc.   The SAD causes men to look like women and women to look like men.

  • Dr. William Davis

    11/27/2010 1:50:41 PM |

    Hi, Eric--

    A clarification: I don't believe that I can argue that ALL dementia, or even most dementia, is caused by wheat. But the Mayo Clinic has published a study demonstrating that it has this potential. Nobody knows how common this is.


    Hi, Desia--

    Go to Pubmed.com and enter "cerebellar ataxia" and "gluten" and you will come up with the extensive work of Hadjivasilliou et al.


    Dr. Trumbower--

    Good to hear from you!

    Excellent distinction. I should have added: "Wheat makes women grow mustaches."

  • sr

    11/27/2010 4:09:37 PM |

    The new poster boy for the wheat industry:

    http://1.bp.blogspot.com/_gv9eOOyFf8Q/SAP0wrd5E6I/AAAAAAAAB0g/vht-QdRvPZQ/s1600-h/76e41476b9ecd0ed6e386edb0e9e0fccfb3b2b77.jpg

  • Desia

    11/27/2010 6:10:41 PM |

    Thanks for the reply Dr. Davis.

  • Paul

    11/27/2010 7:11:18 PM |

    I fell off the wagon this Thanksgiving.

    All my family and friends completely reject the very idea of wheat abstention. Although, I did succeed in convincing my mom to go LC for a little while. She lost eight lbs. and two 1/2 inches off her waist in two weeks. She fell off the wagon soon after and quickly regained the weight. She said she was going to "try it" again.

    This holiday I was asked to two Thanksgiving meals and the usual villains where there in abundance; breaded turkey stuffing, thick-starchy gravy, puffy white butter rolls, and a variety of pies drowned in sugar.

    After 31 straight months abstaining from all things wheat, starch, and sugar, I succumbed to the prodding of my hosts to fully participate in the carb filled feasts (although I did so only in small portions.)

    By the time I got home later that afternoon, I felt so lethargic and foggy all I wanted to do was lay down and go to sleep. If I didn't know any better, I would have sworn someone slipped me a drug, but I knew it was only a reaction to the carbs, especially after being (at or near) a ketogenic state for so long.

    Instead, I got the dumbbells out and did some heavy lunges, presses, and pull-ups and I quickly felt much better.

    I think the adoption of wheat in western societies is so accepted and so prolific, and even highly revered and dispensed as a health food by medical and dietary establishments, the war for minds and bodies (literally) against this enemy is going to involve very long arduous battles.

    Oh, and I'll think very hard when ever again my family or friends offer up a bowl of stuffing, gravy, or butter rolls.

  • Hans Keer

    11/28/2010 5:23:49 PM |

    Thanks for the ammunition doc. My experience however is that apart from my partner, children and closest friends, second line relatives and friends are not so willing to listen to this kind of advice. Fortunately a lot of blog readers and Facebook friends are very willing to pick up the information (in this case http://bit.ly/cyKHre) and do something with it.

  • Anonymous

    11/29/2010 5:20:10 PM |

    One minor modification to the Salems quip:  Healthy whole grains are the "light" cigarettes of our age!

  • Freida Pinto

    12/2/2010 12:24:49 PM |

    Very good analysis for the diet, family. Really good. Go natural...






    Freida Pinto

Add comment

Loading
Wheat-free pie crust

Wheat-free pie crust

9. December 2010 William Davis (17)
I've been working on wheat-free yet healthy recipes these past two months.

You can buy wheat-free, gluten-free foods at the store, of course. But the majority of these products are unhealthy because cornstarch, rice starch, potato starch, or tapioca starch are commonly used in place of wheat. Recall that these are among the few foods that increase blood glucose higher than even wheat.

Here's a simple recipe for wheat-free pie crust that works best for cheesecake, pumpkin pie, and cream pies, but not for berry or other fruit pies like apple.

You will need:
?
1½ cups ground pecans
6 tablespoons melted butter?or melted coconut oil
1 teaspoon vanilla extract?
2 teaspoons cinnamon
1 medium egg
2 tablespoons Truvia™ or ½ teaspoon stevia extract or ½ cup Splenda®

Mix all ingredients thoroughly in bowl. Pour mixture into pie pan and press onto bottom and sides.

Fill pie crust with desired filling. You can fill it with your favorite cheesecake recipe (e.g., Neufchatel or cream cheese, sour cream, eggs, vanilla, and stevia; add pumpkin for pumpkin cheesecake) and bake, usually at 350 degrees F for one hour. 

Yes, the butter provokes insulin and artificial sweeteners can trigger appetite. But, for the holidays, a slice or two of pie made with this crust will not increase blood sugar nor trigger the uncontrolled impulse eating that wheat crust will trigger.
Tags :

Comments (17) -

  • Jack

    12/9/2010 4:11:10 PM |

    you just had to throw in that bit about butter and artificial sweeteners. butter is a staple. 2 tablespoons a day (minimum) for me. and sometimes working up an appetite isn't a bad thing. you gotta eat, right? but stevia is not artificial anyway.

    by the way... this looks like a yummy pie crust. i am forwarding this to my wife right now

    Thanks Doc!
    Jack K

  • Anonymous

    12/9/2010 4:54:39 PM |

    The recipes looks easy and delish but heads up on baking with truvia.I baked a batch of gluten free cookies with it then ate those cookies - a few each night with my bedtime tea.I had a cytokine cascade that a year later I can still describe in complete detail.It took a month to get over!

    There are three ingredients in truvia the last being natural flavors = they claim it's a secret propitiatory blend = weasel words.I got my money back for the product and was interviewed at legnth by the company medical representative who insisted the erythitol caused it.He refused to tell me what the 'natural flavors' contain.

    I suspect msg or a derivative of aspartame which is even more toxic when heated.What ever it is what I do know is it was a powerful neuro-toxin to me.I now use REAL stevia and temper it with xylitol or a little coconut sugar and am a happy baker!

  • Kathryn

    12/9/2010 5:50:23 PM |

    You could always use coconut oil, which is very healthy.

    I have extreme reactions to Splenda.  I don't think it is healthy for anyone, tho most people do not respond to it the way i do.  If anything, if you use Splenda at all, please notify guests that it is in products.  I was inadvertently poisoned by Splenda at a potluck last year.  That one landed me in ER.

  • Anna

    12/9/2010 5:52:48 PM |

    Why sweeten a pie crust?  Most of my pies are crustless anyway.

  • Anonymous

    12/9/2010 6:47:15 PM |

    I'd take my chances with a the occasion, small amount of minimally processed cane sugar, honey or maple syrup (used by humans for millenia) than something new, fresh out of the laboratory.

    And butter? Get the best butter you can afford and eat it. I use Irish butter from grass fed cows. Yum.

  • Anonymous

    12/9/2010 7:29:56 PM |

    Love this blog! This recipe sounds awesome. I would love it if you posted a picture next time you make it!
    Penny

  • Anonymous

    12/10/2010 3:12:40 AM |

    In regards to the reference to butter. What about pastaurized butter or grass fed butter? That would be ok in general to eat right?

  • Frank Hagan

    12/10/2010 4:30:33 AM |

    Great post!  Pecans and almonds can both be used for pie crusts.

    I found another great pie crust recipe in the 1967 Better Homes and Garden cookbook.  Called a "Nut Brown Crust", it can be made using almond meal (or almond flour):

    * 1 cup almond meal
    * 1 1/2 Tablespoons soft butter (or sub coconut oil)
    * 1 teaspoon liquid sucralose (optional)

    You mix the almond meal and butter together, then press it into a pie pan like a graham cracker crust, pushing it up the sides and forming it.  Then bake at 400 F for 8 to 10 minutes.  It works great with custard style fillings (I make mini-pumpkin pies in tart pans ... see an example on my blog.

  • Pat D.

    12/10/2010 5:37:19 AM |

    I need a recipe like this - thank you for posting it.  I can't use artificial sweeteners though.  I'll probably use one tablespoon brown sugar instead.  It might even be fine without any sweetening.  Pecans have a nice natural sweetness to them - I'll have to try it.

  • PJNOIR

    12/10/2010 2:32:34 PM |

    trivia is eighty per cent sugar, find a real stavia product.

  • Anonymous

    12/10/2010 2:35:01 PM |

    Please-no artificial sweetners (yuck)!

  • Anonymous

    12/10/2010 4:36:35 PM |

    Are you going to come out with a cookbook, Doctor Davis?  Or are they going to be for the Track Your Plaque website?
    Char

  • Anonymous

    12/10/2010 6:11:39 PM |

    How do you post about a "healthy" pie crust, and then talk about the insulin response from butter?  Seems a bit counterproductive.  Individuals who are actually worried about the insulin response from butter probably have no interest in a "healthy" pie crust.

  • Anonymous

    12/29/2010 9:54:58 PM |

    Here is an easy Pie Crust you might like
    1/4 cup oat bran
    1/3 cup almond meal
    3 tbsp. finely ground coconut
    2 tbsp. butter
    2 tsp. palm sugar or sweetener of choice
    Combine dry ingredients, then  cut in butter until it resembles a fine meal. Pat mixutre  into the bottom of springform pan which has been lined with parchment.Bake at 350 degrees for 10 minutes then fill with your favourite cheese cake filling.

    Joan Mercantini

  • Anonymous

    1/24/2011 7:44:24 AM |

    eating a wheat crust pie never triggered uncontrolled impulse eating in me.  you might be an extremist.

  • Sheila Korup

    12/13/2011 1:32:14 PM |

    Where is your pumpkin pie recipe?  I can't find it.  Thanks Doc.

  • Dr. William Davis

    12/14/2011 2:47:50 AM |

    I posted it on the Wheat Belly Blog just before Thanksgiving, Sheila.

Add comment

Loading
Unforgiving small LDL particles

Unforgiving small LDL particles

21. October 2011 William Davis (39)
Small LDL particles are triggered by carbohydrates in the diet: Eat carbohydrates, small LDL particles go up. Cut carbohydrates, small LDL particles go down.

A typical scenario would be someone starts with, say, 2000 nmol/L small LDL (by NMR) because they've been drinking the national Kool Aid of eating more "healthy whole grains" and consuming somewhere around 200 grams carbohydrates per day, including the destructive amylopectin A of wheat. This person slashes wheat followed by limiting other carbohydrates and takes in, say, 40-50 grams per day. Small LDL: 200 nmol/L.

In other words, reducing carbohydrate exposure slashes the expression of small LDL particles, since carbohydrate deprivation disables the liver process of de novo lipogenesis that forms triglycerides. Abnormal or exaggerated postprandial (after-eating) lipoproteins that are packed with triglycerides are also reduced. Because triglycerides provide the first lipoprotein "domino" that cascades into the formation of small LDL particles, carbohydrate reduction results in marked reduction in small LDL particle formation.

So let's say you are doing great and you've slashed carbohydrates. Small LDL particles are now down to zero--no small LDL whatsoever. What LDL particles you have are the more benign large variety, say, 1200 nmol/L (LDL particle number), all large, none small. You are due for some more blood work on Thursday. On Tuesday, however, you have four crackers because, what the heck, you've been doing great, you've lost 43 pounds, and have been enjoying dramatic correction of your lipoprotein abnormalities.

Your next lipoprotein panel: LDL particle number 1800 nmol/L, small LDL 700 nmo/L--substantially worse, with a major uptick in small LDL.

That's how sensitive small LDL particles can be to carbohydrate intake. And the small LDL particles can last for up to several days, since small LDL particles are not just smaller in size, they also differ in conformation, making them unrecognizable by the normal liver receptor. The small LDL particles triggered by the 4 crackers therefore linger, outlasting the normal-conformation large LDL particles that are readily cleared by the liver.

This phenomenon is responsible for great confusion when following lipoprotein panels, since a 98% perfect diet can yield dismaying results just from a minor indulgence. But, buried in this simple observation is the notion that small LDL particles are also extremely unforgiving, being triggered by the smallest carbohydrate indulgence, lasting longer and wreaking their atherosclerotic plaque havoc.
Tags :

Comments (39) -

  • ChrisB

    10/21/2011 3:45:39 PM |

    Great Article.  As I'm sure you know by now, I've been kind of a lipidpanelaholic since having a MI 2 yrs ago.  The hardest information to find is that of how long it takes for lipids to respond to diet changes and how sensitive they can be to even the smallest amount of carbs.

  • Howard

    10/21/2011 4:44:48 PM |

    Are you sure that sort of response is not due to gluten/gliadin/lectin/transfat? Four crackers doesn't sound to me like much of a carb load, but for a gluten-sensitive person like me, that could set off some inflammation.

  • Marc

    10/21/2011 7:08:35 PM |

    Dr. Davis,
    How does alcohol fit in to the above "equation"? Specifically wine.

    Marc

  • Sam Sinderson

    10/22/2011 12:12:39 AM |

    I have been on a wheat-free and carb restricted diet for about 7 weeks, and being concerned that I might be Apo E4, and therefor need to also limit saturate fat as you explained in an earlier blog, I asked my doctor to order a small LDL test.  No independent lab here that I consulted knew what that was, nor obviously did my doctor, since he just ordered "small LDL".  The local hospital lab finally found the following, which is what I will have blood drawn for tomorrow:
    Lipoprotein Fractionation Panel 1, Ion Mobility
    Which includes:
    Choesterol; HDL Cholesterol; Triglicerides; :Lipoprotein (a); Lipoprotein Fractionation Panel 2, Ion Mobility (LDL, Total; LDL, Medium and Small; LDL, VerySmall; HDL, Large; LDL Peak Diameter, LDL Phenotype)

    I hope that this is what I need.  Probably it is overkill, but in this case apparently my Medicare Advantage plan will cover it since it has been more than 3 months, since I had a simple panel done.

    Is there a simpler test for small LDL?  By the way the CPT codes are 80061, 83695, 83704

  • Fat Guy Weight Loss

    10/22/2011 4:41:38 AM |

    Sounds like cheat days may not be that good of an idea...

  • Dr. William Davis

    10/22/2011 12:39:39 PM |

    Yes, it does cast cheat days in a new light!

  • Dr. William Davis

    10/22/2011 12:45:11 PM |

    That's it, Sam.

    It shouldn't be that hard. The information is actually fairly straightforward and provides crucial information.

  • Dr. William Davis

    10/22/2011 12:51:45 PM |

    Hi, Marc--

    Alcohol does indeed slow or stop weight loss, especially if more than a serving or two are consumed. So it pays to minimize during a weight loss effort.

  • Dr. William Davis

    10/22/2011 12:56:34 PM |

    Probably not, Howard, since those components have not been associated with triggering of small LDL. The trans fat component can indeed trigger small LDL, but it seems to occur even with foods minus trans fats.

    However, I am impressed that gluten/gliadin/lectin rolled off your tongue!

  • STG

    10/22/2011 1:36:14 PM |

    The problem is carb creep. I experienced this a few months ago when I received the results of my HbA1c test. I was still in the prediabetic range and it was higher than the HbA1c test I had a few years earlier. I didn't get it? I thought I was consuming less carbs then I was. When I actually looked at my diet there were carbs creeping in: dark chocolate and small "safe starches" (e.g, potatoes, yams). Another factor that may have impacted my blood sugar was the stress of travel/visiting family during that three month time period. My understanding is that elevated cortisol levels can raise blood sugar. In any case, my recent HbA1c is in normal range. I think this is because I eliminated even small amounts of dark chocolate and "safe starches" (see Jimmy Moore's comments about safe starches).

  • jethro

    10/22/2011 2:01:01 PM |

    How low should we go in carbohydrates to avoid increasing small LDL?

  • Davide

    10/22/2011 3:01:26 PM |

    I'm not sure that wheat has this acute effect on everybody. In fact, I know it doesn't happen with me. I keep a close eye on my lipids and my small LDL particles remain "relatively" low despite the fact that I consume wheat/sugar products. Then again,  my blood sugar does not significantly rise after carbohydrates, so maybe that's why. If I eat a massive plate of pasta, a glass of fruit juice, and dessert, my blood sugar may (keyword, "may") rise to 120, if that, but then it goes down to about 80 about 45 minutes after the meal. No joke. In other words, I'm thinking this effect may have to do with the degree of people's volatility to rising blood sugars. Just a guess.

    Fyi, I'm the apo E/4 person who's LDL amount/particle number (226, 2,000) is extremely sensitive to saturated fats and thus I'm always lost in the conundrum of balancing fats with carbs. Difficult!

  • Teresa

    10/22/2011 3:05:34 PM |

    I know that if weight loss is involved, it can take a few months after weight stabilizes for lipids to normalize.  If minimal or no weight loss is involved, how long does it take?

  • Fat Guy Weight Loss

    10/22/2011 5:31:19 PM |

    With the example about 4 crackers would be as low as 10g carbs.  Curious of the overall effects of say 10g carbs of sweet potatoes....

  • Dr. William Davis

    10/23/2011 11:49:09 PM |

    Then it depends on which parameter you are talking about, Teresa.

    Small LDL requires just days to respond, while triglycerides require weeks to months, while HDL requires months to years.

  • Dr. William Davis

    10/23/2011 11:51:13 PM |

    Hi, Davide--

    No doubt: Individual tolerances to various foods, including carbohydrates, can differ. And the apo E4 person has a tougher time of it.

  • Dr. William Davis

    10/23/2011 11:53:40 PM |

    Unfortunately, Jethro, there's no quick and easy way to decide this, since individual sensitivity varies.

    Although imperfect, you can use HbA1c, an index of glucose and not of small LDL, to gauge whether you've been triggering higher blood sugars that often parallel the triggering of small LDL particles. You could, of course, obtain lipoprotein testing 48 hours after ingesting a known amount of carbohydrates, e.g., 20 grams, but that is logistically difficult.

    That all said, most people can get away with 15 grams carbohydrates per meal, while some can't tolerate more than 10, yet others do fine with 30+ grams.

  • Dr. William Davis

    10/23/2011 11:54:15 PM |

    Excellent point, STG! And I like the "carb creep"!

  • Barbara

    10/24/2011 12:14:06 AM |

    Did you see this, Dr. Davis?

    http://medicalxpress.com/news/2011-10-common-link-autism-diabetes.html

  • Teresa

    10/24/2011 1:14:14 AM |

    And it takes years to unlearn all the inaccurate stuff learned in school, and to find and learn the good stuff that is out there.  Thanks.

  • Stephanie

    10/24/2011 2:27:52 PM |

    How does one check to see if they are apo E4?

  • ChrisB

    10/25/2011 1:19:25 PM |

    How does it affect lipid results?

  • steve

    10/25/2011 10:52:06 PM |

    Dr Davis:  What is the small LDL profile for native populations that consume tons of of carbs and no signs of heart disease; also, the Japanese consume lots of carbs- easily 3 cups of rice per day which is about 120 carbs from rice alone.  Low level of CAD; what are their levels of small LDL.  I know for myself ApoE 3/3 that carbs do affect the small LDL level i have and in any event in the absence of a statin i produce tons of LDL particles large or small depending upon carb levels.  I believe genetics plays a large role.
    Thanks

  • Dr. William Davis

    10/26/2011 3:19:22 AM |

    No doubt, Steve.

    However, I'm unaware of lipoprotein assessment done to answer these questions. That would be interesting, however.

  • Dr. William Davis

    10/26/2011 3:21:50 AM |

    Yes, agreed, Teresa: New lessons to learn every day in this Information Age!

  • Dr. William Davis

    10/26/2011 3:23:44 AM |

    Thanks, Barbara. No, I hadn't seen this. But I'm not the least bit surprised!

    I find it wonderfully satisfying that the puzzle pieces are falling in place, just like that 1000-piece jigsaw puzzle we struggled to put together, with the last few pieces fit just perfectly!

  • Dee

    10/28/2011 1:57:49 PM |

    Dr. Davis,
    Have you heard or read about Lumbrokinase helping to lower small "a" particles?
    Just wondering.
    Dee

  • Tim

    10/28/2011 7:14:08 PM |

    Dr. Davis,

    There seems to be a lot of mention of the E4 ApoE genotype.  What about those of us that are E2/E4?  Any different instructions for us?

    Thanks.

  • Dr. William Davis

    10/29/2011 10:48:39 PM |

    With this very tough pattern, you are best following lipoproteins and glucose measures like HbA1c to gauge response to various dietary manipulations. The basic diet approach, however, is largely the same; it just may require some adjustments, e.g., fat intake.

  • Dr. William Davis

    10/29/2011 10:49:12 PM |

    Sorry, Dee, no info.

    Where did you hear this?

  • Dee

    10/30/2011 5:20:26 PM |

    Here is the quote.  Appently it just helps lower the LP[a]  and does not have any terrrble side effects.  I may try it, nothing else is working.  My little a is 43 and rising in spite of all I do.

    "The one nutraceutical that has shown promising clinical results in actually lowering Lp(a) is a lumbrokinase product made by Canada RNA Biochemical called Boluoke. Like its chemical cousin nattokinase, lumbrokinase is an enzyme that helps break up fibrin—a fibrous protein that helps form blood clots—to avoid too much clotting and keep blood flowing optimally."

    :

    Dee

  • Sam Sinderson

    10/31/2011 7:32:29 PM |

    I have my results.  My PCP reported these to me "for my records" with no further comment.  Maybe he can't interpret them?
    Total Cholesterol: 231 (My PCP surely would think this is high.)
    I find it strange that they did not report LDL direct, though perhaps it is not done because of the breakdown below.  
    Calculated LDL: 133 H MG/DL
    HDL: 85 Mg/dl  This is higher than I have ever had measured.
    Triglycerides: 64 Mg/Dl  Even Simvastatin only got it down to 84.  I conclude that I am not Apo E4.
    The range after \ below  is the range they cite, I presume, as normal.
    Lipoprotein Innocent: <10  NMOL/L \ <75  I presume this is a good result.
    LDL, Total: 2268 H NMOL/L  \ 440-1600
    LDL, medium and small: 651 NMOL/L \ 144-787
    LDL, Very Small: 277 NMOL/L \ 75-419
    HDL large: 9315 H NMOL/L  \ 469-5258
    LDL Peak Diameter: 227.5 Angstrom  \216.-234.3
    LDL Phenotype A  Pattern A     I believe this to be the preferred pattern, low small LD and Triglycerides.  Ref: Obesity (2009) 17 9, 1768–1775. doi:10.1038/oby.2009.146--Reversal of Small, Dense LDL Subclass Phenotype by Normalization of Adiposity
    Patty W. Siri-Tarino1, Paul T. Williams2, Harriet S. Fernstrom1, Robin S. Rawlings1 and Ronald M. Krauss1

    Does this calculate to large LDL = 2268-651 =1617 (Not including medium)?
    When should I do this test again?
    Comment?

  • Dr. William Davis

    11/1/2011 2:03:32 AM |

    Hi, Sam--

    The "pattern A" comment is misleading. About 40% of your LDL particles are small, too much.

    It means going back to the strategies to reduce small LDL, such as wheat elimination and limiting carbohydrate exposure. It is worth repeating about 2 months after weight has stabilized following a diet change.

  • Sam Sinderson

    11/1/2011 12:49:43 PM |

    I have been on a no-wheat, limited, very-low carb, diet now for 6 to 7 weeks already.  I cringe to think of what the numbers may have been before.  I initially lost about 12 pounds in less than 2 weeks to get to 148, I am 72-in tall, and have stabalized there by eating more high-fat non-carb stuff.  You say 40% small.  You must be using the medium and small (640) over total (2268) to get 40%.  Apparently medium and small includes the very small, which must be a fraction of small?  How long should it take for the very small to approach zero?  Isn't that the more important number?  I will be out of the country for 2 weeks.

    Thanks

  • Dr. William Davis

    11/2/2011 1:43:14 AM |

    Yes, exactly, Sam: Combine medium and small.

    Dietary and weight changes usually exert effects on small LDL within a few weeks, much faster than most other parameters.

  • pb

    2/6/2012 3:47:25 PM |

    Get a VAP test....this measures your small particle/large particle LDL.
    labcorp code 804500

  • pb

    2/6/2012 3:51:39 PM |

    I am going to try to get a VAP test.  No doctors know of it....only folks on the web.  Why?  It seems like a very important test to measure your LDL properly.  Can someone elaborate on this further?

  • Dr. William Davis

    2/7/2012 3:18:11 AM |

    Easy, Pb: There are no drugs--read: "no financial incentive"--to treat the abnormalities generally uncovered by lipoprotein testing like VAP. Thus, no push to get it tested.

Add comment

Loading