Be gluten-free without "gluten-free"

While I've discussed this before, it is such a confusing issue that I'd like to discuss it again.

I advocate wheat elimination because consumption of products made from modern dwarf Triticum aestivum:

--Triggers formation of extravagant quantities of small LDL and LDL particle number (or apoprotein B)
--Triggers inflammatory phenomena like c-reactive protein, increases leptin resistance, and reduction of the protective adipocytokine, adiponectin.
--Encourages accumulation of deep visceral fat ("wheat belly") that is inflammatory and causes resistance to insulin
--Increases blood sugar more than nearly all other foods--higher than a Milky Way bar, higher than a Snickers bar, higher than table sugar.
--Is being linked to a growing number of immune-mediated diseases, including celiac disease (quadrupled over past 50 years), type 1 diabetes in children, and cerebellar ataxia and peripheral neuropathies.

This last group of wheat-related phenomena are primarily due to gluten, the collection of 50+ proteins found in each wheat plant. For this reason, people diagnosed with celiac disease are advised to eliminate gluten from wheat and other sources (barley, rye, triticale, bulgur) and to eat gluten-free foods.

Gluten-free has therefore come to be viewed as wheat-free and problem-free. It ain't so.

Among the few foods that increase blood glucose higher than wheat: cornstarch, rice starch, potato starch, and tapioca starch--Yup: the ingredients commonly used to replace wheat in gluten-free foods. They are also flagrant triggers of the small LDL pattern, along with increased triglycerides, reduced HDL, increased visceral fat, increased blood pressure. In short, gluten-free foods lack the immune and brain effects of wheat gluten, but still make you fat, hypertensive, and diabetic.

I tell patients to view gluten-free foods like jelly beans: Gluten-free pancakes, muffins, breads, etc. are indulgences, not healthy replacements for wheat. It's okay to have a few jelly beans now and then. But they should not be part of a frequent or daily routine. Same with gluten-free foods.

Comments (23) -

  • Kris @ Health Blog

    3/8/2011 10:12:04 PM |

    I think it's kind of funny sometimes reading low-carb forums and recipe sites.

    It's incredible how much time they spend on inventing all sorts of "gluten-free" or "low-carb" cakes, muffins, pancakes and all sorts of stuff that definitely doesn't look healthy even though it might technically be "gluten-free or low-carb".

    These things surely aren't the real, wholesome foods that we need to be healthy. Like you say, good as rare indulgences though.

  • Tuck

    3/8/2011 10:22:59 PM |

    This is spot-on.

  • Vick

    3/8/2011 11:08:01 PM |

    What are your latest thoughts on Einkorn flour?

  • Anne

    3/8/2011 11:23:24 PM |

    I think the paleo/primal people have it right - remove all grains and processed foods.

    Don't substitute a SAD for a GF SAD.

    I started to heal when I removed gluten, but doing even better grain free and sugar free.

  • Batang Regla

    3/9/2011 12:26:42 AM |

    When i read the ingredients of a shampoo and hair styling products i saw wheat protein. Is this safe applying to my hair?

  • Patty

    3/9/2011 12:38:40 AM |

    I started a Paleo/Primal version of tastespotting and while most people have submitted Paleo friendly recipes, I was really surprised at how many recipes we have had to reject because they were Paleo or Primal remakes of some kind of dessert or bread.

  • Dr. William Davis

    3/9/2011 1:49:36 AM |

    Hi, Kris--

    I agree. A return to real, whole food is the right path.

    Interestingly, I was recently strongly encouraged by an editor of a forthcoming book I'm working on to develop wheat-free, low-carb recipes. I also walked down this path, having to develop recipes that mimicked wheat-containing dishes.

    After a 3-month exercise in cooking, cooking again, with several disasters along the way, I continue to believe that these wheat-free, low-carb dishes like "breads" and "muffins" are, at best, meant to be occasional indulgences.


    Hi, Tuck-

    Thanks.


    Hi, Vick--

    I continue to believe that einkorn is an interesting replacement for wheat for some, but not all, people.

    It raises the question: Are humans meant to consume wheat at all, regardless of form? I believe that most people can get away with occasional consumption of einkorn, but that the majority of people cannot safely consume modern dwarf Triticum aestivum.

    I classify einkorn not too far from gluten-free foods: it lacks many of the immunogenic properties of modern wheat, but it still a carbohydrate.

    Ideally, I continue to believe that the ideal diet is something close to what Anne is articulating.

  • Ari

    3/9/2011 1:50:34 AM |

    Doctor,
    How often is "now and then"?

    Personally, I eat a one or two small bread rolls on the Sabbath and that's the extent of my wheat consumption.  Does that count as "now and then"?

  • Richard A.

    3/9/2011 2:30:10 AM |

    There are recipes for flax bread made from flax seed meal. Here is one example --
    http://lowcarbdiets.about.com/od/breads/r/flaxbasicfoc.htm

  • Amber

    3/9/2011 1:53:49 PM |

    I started using Coconut or Almond flour for the occasional dessert type dish with excellent results.

    Problems though with making a sauce since there isn't a real substitute that thickens correctly. I rely more on home made-legal marinades for flavor.  

    Now that I have been grain free since May, I find any exposure will cause intense illness that lasts for hours.

  • Dr. William Davis

    3/9/2011 3:52:05 PM |

    Hi, Ari--

    Provided you have no abnormal celiac markers to wheat, occasional consumption likely has no adverse consequences beyond the "re-exposure syndromes" of gastrointestinal distress, asthma, joint paints/arthralgias, and transient behavioral effects.

    There is no threshold to stay below except to individualize your exposure tolerance by such things as blood glucose control, expression of small LDL, triglycerides, etc. Most people can get away with one a month or so exposure.

  • Misty

    3/9/2011 9:11:18 PM |

    Long time "listener" first time "caller". Dr. Davis, thank you so very much for all the info you provide here. I am a 42 yr old 4th generation Type 2 diabetic. Six months ago I largely gave up wheat (still have pizza on occasion) and it is the ONLY thing that has EVER dropped my A1c since diagnosis 7 years ago - despite adding medications, etc. It dropped from 6.9 to 6.6. I am currently under an endo's care and am shooting for 6.0 with some tweaking and fine-tuning. As a younger diabetic, I plan to live a long life with this disease so good control is vital to me.

    I also wanted to thank you for the info on Vit D. I requested that test and found out I'm deficient - at 20 and 28 is the cutoff to normal. I know now that I had some pretty major symptoms of a deficiency - odd muscle pains, unexplained bone pain around January every year, etc. Not a huge surprise I'm deficient since I live in South Dakota and now coat myself in sunscreen thanks to basal cell carcinoma. My GP wanted me on the VitD2 horse pills to correct the deficiency but I refused. I raised it 8 points in 4 weeks by taking 1000iu/day of Vit D3 gelcaps (I metabolize meds extremely quickly so started small). Nobody could believe it. I did Smile I am taking 2000iu/day now and shooting for a much higher, normal number.

    Heart disease is the cancer in both sides of my family so your blog is a Godsend to me. Thank you so very much for the information you provide on this blog.

  • Jeanne

    3/9/2011 9:13:55 PM |

    How do you feel about arrowroot as a thickener to replace cornstarch, etc.?

  • Prachi

    3/10/2011 9:36:39 PM |

    Hi doc

    I have vit d level of 16 but blood calcium of 10. How much milk can i drink daily and what should be my starting dose for vit d

  • Anonymous

    3/10/2011 11:23:56 PM |

    Prachi: Try
    D3(IU) = Weight(lbs) * 40
    For example, a 150 lb person would take 6000IU D3 per day. Works well for many people.

  • ShottleBop

    3/11/2011 3:10:30 PM |

    I have heard from others (on Dr. Bernstein's diabetes discussion forum) that Konjac flour works well as a thickener, without affecting blood glucose levels.

  • Dr. William Davis

    3/11/2011 10:07:44 PM |

    Hi,Jeanne--

    Way too much carbohydrate in arrowroot.

    Shottle makes a good suggestion: konjac root, similar to that used to make shirataki noodles.

  • Anonymous

    3/12/2011 3:13:33 PM |

    I've got a question..it's not really germane to the blog post but here goes:  I've given up grains, only using natural organic products when possible, take CLO, and a myriad of vitamins including magnesium and all the rest.  I just started taking MK-7 about a week ago and noticed within 24 hours my blood pressure dropped substantially, my energy surged, and my mood has increased a ton.  Can I attribute this to the MK-7 or am I just experiencing a quasi-manic / placebo effect state?

  • Vick

    3/13/2011 2:58:59 AM |

    Dr. Davis:

    I see einkorn as a great choice when you feel you have a need for that slice of bread or waffle.  When you slip and feel you need a grain... choose einkorn.

    I make a small loaf of bread that is sliced and then frozen.  It lasts my wife and I a minimum of 2 weeks.  

    We treat as a good choice when we are going to fall off the wagon.

  • reikime

    3/15/2011 5:04:06 AM |

    Hi Dr.D,
    In your reply to Ari, you mention "re-exposure" syndromes. IMHO, these represent gluten or wheat intolerance and certainly excludes gluten in those testing positive for celiac.
    However, even in the non-celiac gluten sensitive population, new studies show damage occuring to joints, increased risks of lymphoma,neurological changes, just as if the person was diagnosed celiac.

    Cutting edge wisdom believes if you have any symptoms or re-exposure symptoms you should eliminate it before you either : 1. become celiac 2. develop an autoimmune disease, or 3. neurological damage.

    BTW, I agree wholeheartedly with avoiding the gluten free food traps. SO many fall headfirst into them.

    More people from the Celiac sites should read this post.

  • WereBear

    4/30/2011 1:12:05 PM |

    I've found this to be a highly pertinent article for me, gluten-free for four and a half months now. We recently got a new supermarket in town with a big gluten-free section, and bless their hearts, I had several friends tell me about it.

    But going there and reading the labels reveals they are very high in sugar and starch; so as a happy low carber, they do me no good at all!

    I've gotten a new mixer and am exploring the many ways of Rev Rolls, instead.

  • Shoiley

    5/6/2011 4:07:34 PM |

    Tried to go wheat-free several times, but the withdrawls including insomnia, constipation, head buzz and brain fog, were hell and I gave up. Each time I ate gluten-free breads. Has anyone else experienced this?

  • Gluten Intolerance

    5/10/2011 11:58:41 PM |

    I saw lots of people who are getting better after how many days because of gluten free diet and even sugar free. Most people are following the most recommended diet and its gluten free and dairy free.

Loading
We got the drug industry we deserve

We got the drug industry we deserve

A biting commentary on just who is writing treatment guidelines for diabetes and cardiovascular disease was published in the British Medical Journal, summarized in theHeart.org's HeartWire here.

"About half the experts serving on the committees that wrote national clinical guidelines for diabetes and hyperlipidemia over the past decade had potential financial conflicts of interest (COI), and about 4% had conflicts that were not disclosed.

"Five of the guidelines did not include a declaration of the panel members' conflicts of interest, but 138 of the 288 panel members (48%) reported conflicts of interest at the time of the publication of the guideline. Eight reported more than one conflict. Of those who declared conflicts, 93% reported receiving honoraria, speaker's fees, and/or other kinds of payments or stock ownership from drug manufacturers with an interest in diabetes or hyperlipidemia, and 7% reported receiving only research funding. Six panelists who declared conflicts were chairs of their committee.

"Of the 73 panelists who had a chance to declare a conflict of interest but declared none, eight had undeclared COI that the researchers identified by searching other sources. Among the 77 panel members who did not have an opportunity to publicly declare COI in the guidelines documents, four were found to have COI.
"

The closing quote by Dr. Edwin Gale of the UK is priceless:
"Legislation will not change the situation, for the smart money is always one step ahead. What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette. Until then, the drug industry will continue to model its behavior on that of its consumers, and we will continue to get the drug industry we deserve."

It's like having Kellogg's tell us what to each for breakfast, or Toyota telling us what car to drive. The sway of the drug industry is huge. Even to this day, I observe colleagues kowtow to the sexy sales rep hawking her wares. But that's the least of it. Far worse, even the "experts" who we had trusted to have objectively reviewed the evidence to help the practitioner on Main Street appears to be little more than a hired lackey for Big Pharma, hoping for that extra few hundred thousand dollars.

Comments (6) -

  • Jim Purdy

    10/14/2011 1:36:03 AM |

    I am not a fan of any drugs, and as a result, I change primary care physician regularly, usually after two visits.
    ON THE FIRST VISIT, I explain to the new doctor that I do not, and will not, take prescription medications. I explain that the only reason I am in their office is to get orders for lab work, so that I can review the results and make my own decisions about lifestyle changes, especially diet. The doctor then calls me" non-compliant" and prints numerous computer-generated prescriptions anyway. Obviously, it is the doctor who is non-compliant, since I have already said I do not want drugs.
    ON THE SECOND VISIT, the doctor asks, "Have you been taking your medications as ordered?" When I tell the doctor again, as I did at the first visit, that I do not take medications, the doctor says, "You're crazy and suicidal." I then find the next doctor, and the cycle starts over.
    As I see things, I have two choices when I feel ill:
    1. I could attack my body with some bizarre BigPharma chemicals that our ancestors' bodies have never dealt with in millions of years of evolution (Oxycodone, hydrocodone? Really? Are doctors nuts?).
    2. Or I could get out of the way and let my body heal itself as has been done over many millions of years of evolution. All I want to do is support that process by making sure to give my body the proper nutrition in the form of the appropriate whole foods.

  • Dr. William Davis

    10/14/2011 3:40:23 AM |

    Wow, Jim. Creepy.

    Don't despair: I'm confident that you will eventually find a healthcare practitioner who will act as your advocate, not a provider of drugs. It may take, unfortunately, going through quite a few practitioners before you come on such a person.

  • Suze

    10/19/2011 1:44:46 AM |

    Great post. I am starting to think there are two kinds of people - those who seek drugs and those who run from them. LOL.
    Among other occupations, I am an OR nurse. I have been wined and dined by the best reps ever, to buy their wares for surgery. It's all about the money.The drug companies have a lot to lose if we all quit taking their meds. Which is exactly what I want to do. I do not want to be a slave to a diagnosis and accompanying pill bottle. I want to be freeeeee.
    This is not to say there is a time and place for medicine. There IS. But not for every sniffle.

  • Jeanne

    10/20/2011 11:44:20 AM |

    Boy Suze, I can relate!  I'm a nurse as well and spent lots of years in NICU, but a change to chemical dependancy/psych was eye opening and downright disgusting in the amount of meds handed out.

    I used to ask patients if they were hungry when dispensing a 6oz. Cup FULL of various pills before breakfast!
    Couldn't take it and quit. Couldn't be a party to pharm management over real therapy.  I also take as few pills as possible, especially antibiotics.

  • N

    11/30/2011 6:36:01 PM |

    Hi Doc,

    I just visited my parents, and my mom shared her recent blood work with me.
    Her cholesterol was a mere 210, and her doc (general practitioner), put her on a statin !!!
    I told her about your blog a bit and particle size, but of course she's hesitant since her doctor obviously has more credibility than me.

    Outside of eating better, what next steps should I advise her to take?  She agreed to request a cholesterol particle size test (is there an official name for this?).

  • Dr. William Davis

    12/1/2011 4:22:01 AM |

    Yes, N: Lipoprotein testing, such as NMR Lipoprofile or Atherotech VAP.

    It really shouldn't be that tough, but we are battling the incredible ignorance in the primary care community who is spread too thin to master any one area.

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1985: The Year of Whole Grains

1985: The Year of Whole Grains

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

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

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


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

You think there's a relationship?

Comments (30) -

  • Gabriella Kadar

    4/9/2011 7:30:55 PM |

    The World Health Organization changed impaired fasting glucose levels from 6.9 to 6.1 in 1999.  The curve used to illustrate the incidence of diagnosed type 2 diabetes indicates a steepening at this time.  If data would have been collected for all patients prior to 1999 and utilized as a retrospective for type 2 diabetes in the population, the incidence rate prior to 1999 would likely have been significantly higher.

  • Anonymous

    4/9/2011 8:00:57 PM |

    Very true, Dr. Davis.  Wheat consumption is up since 1970.  The strange thing is, it was much higher in the 19th century...something like 225 pounds per capita.

    historical wheat consumption

    Maybe we were eating fewer total carbs then, or expending more energy, if in fact the recent increase in diabetes is wheat-related.

  • Peter

    4/9/2011 8:11:56 PM |

    I think since so much wheat is eaten in products that are mixtures of wheat, sugar, and vegetable oil, there's no way to know what the culprit is.

  • Botiquin DE Primeros Auxilios

    4/9/2011 9:37:29 PM |

    Well the reason is that wheat is the most important factor for our lives.

  • Dr. William Davis

    4/9/2011 11:59:26 PM |

    Hi, Anon--

    Yes, indeed. Human life was different for at least rural people.

    Also, wheat has changed. This is a crucial, crucial point that explains much of this phenomenon, I believe.

  • Gretchen

    4/10/2011 1:00:56 AM |

    It would be interesting to plot diabetes rates against various possible culprits (pointing out on the graph when diagnostic cutoff changed): wheat, all carbohydrates, size of sodas, computer ownership, average size of restaurant meals, bicycle ownership, hours spent commuting, population older than 65, exposure to Agent Orange, service in Gulf War, and some really silly things like hair length and popular nailpolish colors.

    If only wheat consumption seemed correlated, this would be suggestive.

  • Anonymous

    4/10/2011 4:35:15 AM |

    Wre there ads for All Bran bars and wheat links on this site?

  • Anonymous

    4/10/2011 5:04:08 AM |

    Wheat is ingrained in us, beginning with bread as the "staff of life."

  • Anonymous

    4/10/2011 8:15:51 AM |

    correlation does not equal causation.

    I don't eat wheat, I suffer from all of the problems you describe and it's also related to my psoriasis.  Good hypothesis with all your measurements of post consumption measurement of blood sugars, but someone needs to do a mass study.

  • O Primitivo

    4/10/2011 9:54:59 AM |

    The graph on this post is also very educational:
    http://www.gnolls.org/1086/the-lipid-hypothesis-has-officially-failed-part-1-of-many/

  • Dr. William Davis

    4/10/2011 2:20:27 PM |

    Hi, Ted--

    Great find!

    I wasn't aware of these data. Yet another way that increased yield comes at a price.

  • Anonymous

    4/10/2011 3:19:02 PM |

    Dramatic changes in the slope of a curve are easy to see if you're looking for them, but you've displayed an arithmetic, not a logarmitic axis.  Your point would be better made if you could switch the axis and if we still see the association between the variables.

  • Helen

    4/10/2011 5:39:22 PM |

    Gretchen - Well said.

    I think many things in our modern environment play a role in tipping the scales toward diabetes - including disrupted circadian cycles and environmental toxins, such as fire retardants, plasticizers, and pesticides.  (I don't have time right now to find links from stuff I've read on this - but try Googling these things - the research is there.)  

    Jenny Ruhl claimed a short time ago that while prediabetes has risen, actual diabetes has not.  She is a good resource and I would take her arguments on most things diabetes pretty seriously.  Check her blog if interested:  Diabetes Update.  

    As a mother of a kid with celiac disease, and for other reasons, I am hardly pro-wheat or pro-gluten, but I'm not convinced grains have caused a rise in diabetes.  My daughter's gastroenterologist, however, has Type I diabetes and says that eliminating gluten has greatly improved her glucose control.

  • Anonymous

    4/10/2011 6:54:41 PM |

    When I eyeball this figure, it looks like the change occurs around 1993-1996.

  • Might-o'chondri-AL

    4/10/2011 10:44:35 PM |

    Helen has a point that under counting of who is "pre-diabetic" is quite possible skewing the data. The CDC changed it's diabetes diagnosis criteria; 1985 wasn't when they did that however.

    CDC took their raw 1995 - 1997 data and in 1998 decided to only use fasting glucose, and not the old standard oral glucose tolerance test, as the CDC diabetes template. For all individuals  whose data was showing greater than ( or equal to) 126 mg/dl fasting glucose they were then counted as diabetic by the CDC.

    This methodology caused CDC to say U.S.A. diabetics went from 8 million in 1995 to 10.3 million diabetics in 1997; a statistically massive 2 year jump of diabetics. And furthermore, the number of un-diagnosed diabetics was claimed to have gone down (in same period of time); they cut out a whole slew of "pre-diabetics", so to speak.

    The other criteria CDC website shows from 1998 is, that when non-fasting glucose hits 200  mg/dl (or more) they are considered diabetic. The reproduced graph Doc posted shows an exponential climb upward right at the time CDC  began using it's altered criteria.

  • brec

    4/11/2011 12:02:06 AM |

    "Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward."

    As I look at the presented graph, from 1986 to about 1991 the trend decelerated slightly, then resumed its prior long-term value, then accelerated in about 1997

    However, I must admit that 1997 is "after 1985."

  • Helen

    4/11/2011 12:51:04 AM |

    Other suspects that became prevalent in the food stream in the 1980s were high-fructose corn syrup and artificial trans-fatty acids, both of which are linked to hepatic insulin resistance and metabolic syndrome.

  • Daniel A. Clinton, RN, BSN

    4/11/2011 2:43:28 AM |

    I think of all the intelligent, scientifically-reasoned arguments all lead back to the commonsensical notion "Don't eat junk." To start, anything with enriched (aka processed) flour, partially hydrogenated oils, or high fructose corn syrup qualifies as junk. Which isn't to say all disease eminates from just those three ingredients, but I believe completely eliminating those three ingredients would yield a large health benefit to most Americans.

  • Mike

    4/11/2011 2:57:36 AM |

    It takes years for type 2 diabetes to develop. A shift in the rate at which people are diagnosed with it would be caused by something that happened some time before the shift.

  • justdoinglife

    4/11/2011 2:57:59 AM |

    1960 to 1970 is also the time frame that chemical fertilizer came into the mainstream. On the farm I was raised on, along with chemical fertilizers came mineral supplements for the hogs that were living on the fertilized barley. They "failed to prosper" on fertilized barley, where they did just fine on unfertilized barley. By the why, fertilized barley produced over twice the volume of grain, and I assume the same mineral absorption. You can blame the grain, but I believe it could be the fertilizer.

  • madmax

    4/11/2011 5:32:07 PM |

    The chart for the growth of the national debt looks the exact same. I wonder if there is a correlation between the advance of socialism and the cultural ascendancy of the Lipid hypothesis? I'd bet the ranch that the destruction of American health and the destruction of the American economy is not a coincidence.

  • Might-o'chondri-AL

    4/11/2011 6:15:13 PM |

    Duke university 2008 study fed new born rats 0.1 mg/kg body weight of the organophosphate pesticide parathion, for 4 days. When the rats were adults and fed a high fat diet they noticed a different response among the sexes.

    In the adult females the high fat diet resulted in a 30% higher weight gain ( vs. high fat fed males' 10% weight gain) over controls (according to respective sex) on the same diet. This type of pesticide exposure to young children may be part of how obesity is rising; the standard western fare is high in generic fat content.

    For the parathion early exposed adult male rats fed on a normal diet (ie: not high fat) the results also seem troubling. They gained weight, glucose levels rose, fat break down was inhibited and they were pre-diabetic; as compared to male controls.

    Counter-intuitively, another group of male new born rats fed parathion at 0.2 mg/kg body weight (4 days) when fed a normal diet as male adults actually weighed less than their male controls. Whereas, the female rats (fed normal diet in this case) who got both 0.1 & 0.2 mg/kg parathion (4 days) all weighed less than their female controls. Mothers, don't try this at home.

  • Helen

    4/12/2011 1:17:41 AM |

    Another culprit:

    SSRIs.  Prozac was first marketed in 1988.  (It was not the first, however - some came on the market slightly earlier that decade.)  SSRIs impair glucose tolerance and are associated with an increased risk of diabetes.  

    I think there are some modern-day smoking guns more convincing that increased grain consumption for increased obesity, insulin resistance, and risk of diabetes.  Although they are a neolithic food some of us may not be exquisitely adapted for, they have been around for 5,000 years, while the obesity epidemic is quite recent.

  • Might-o'chondri-AL

    4/12/2011 4:11:35 AM |

    Hi Helen,
    In 1938 there was a U.S.A. National Conference of Governmental Industrial Hygienists ; since 1941 the word national was replaced by "American" (ie: now is the ACGIH). 1946 the ACGIH set maximum limits on 148 compounds; which in 1956 became their "Threshold Limit Value", (TLV).

    TLV is not saying "x" level is always safe; just what is supposedly tolerable exposure for most "healthy" adults. ACGIH lays their TLV data out for industrial hygenists to use in their field, not for laymen's general use.

    2-butoxy-ethanol TLV (as a gas or evaporating vapor) is set at 20 ppm. This chemical is the favorite solvent in household spray and wipe cleaning products.

    It makes me wonder if the U.S.A. adult female house cleaner suffers metabolic syndrome at a higher rate than other individuals. If so then might not close decades of breathing 2-butoxyethanol droplets have had/has epigenetic synergy?

    1971 O.S.H.A. took 470 TLVs from ACGIH data and now calls those TLV by the phrase "Permissible Exposure Limit" (PEL). Meanwhile, as of 2010 there are 642 TLVs set out by ACGIH.

    The European Union has a registry of 143,000 chemicals in use (or used); and there are +/- 50,000,000 chemicals known to exist (as per Chemical Abstract Service Registry). The EPA has more details; for searching if you're curios: www.epa.gov/grtlakes/toxteam.
    pbtrept/pbtreport.htm

    2012 the European Union is set to report on chemical testing of all chemicals manufactured in excess of 1,000 tons annually. You'll see that as data reported from "REACH" (Registration, Evaluation, Authorization and Restriction of Chemical Substances).

    If you want to track down what chemical is in a product then search out the manufacturers "MSDS" (material safety data sheet). Some claim "trade secret" ingredients and then you can only guess on what is involved.

  • Ensues

    4/12/2011 1:13:53 PM |

    I love the triglyceride posts as I have been working on mine for a number of months.  Was well over 1000.  On low carb, virtually no grains, tricor (200mg), and a healthy dose of fish oil I was still at 233.  I am wondering if it will take my body/metabolism some time to heal before I can get lower.  As you might imagine I am sporting an HDL below 25.  I am working it diligently, have lost a ton of weight and get healthier by the day.  I should be sending Dr Davis a stipend for my improvement!

  • Might-o'chondri-AL

    4/12/2011 3:41:28 PM |

    Dr. Davis,
    please kick out of your spam filter the post I just sent on the 12th saying "Hi Helen,". It had resources for her interest in modern chemicals.

    To Helen,
    If my 12th post doesn't show up soon (2 days?) and you request it on this thread I will try to recreate it here. Maybe you've moved on to newer threads; I don't usually monitor old threads, but I will this for a few days.

  • Medicomp INC.

    4/12/2011 4:03:13 PM |

    Unfortunately, it doesn't seem like this ascent is going to slow down anytime soon.  Even if people in recent years seem to be taking a more health-savvy approach to their eating habits, it wouldn't be surprisingly to see this trend continue regardless.

  • dextery

    4/13/2011 5:34:40 PM |

    Western countries have also seen a rise in sugar consumption along with wheat consumption over the same time period.

    Taubes has just published a piece
    "Is Sugar Toxic" and winds his way through diseases of Western cultures from sugar causing metabolic syndrome to sugar be implicated in cancer formation.
    http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=1&_r=2&ref=magazine

    No where was there any mention of wheat..I don't think we can isolate wheat as the primary culprit in Diseases of Civilization.  Wheat Plus Sugar, the double whammy.

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The dark side of CT heart scans

The dark side of CT heart scans

"I just got a heart scan!" declared Eric to his doctor. He handed the report to him.

"Oh my. Your score is 154." The doctor paused, then looked at Eric with a serious look on his face. "If we're going to understand whether or not you're in danger, you'll need a heart catheterization."


I've seen this happen countless times. How can I say this diplomatically? THIS IS WRONG!! In my view, it's absolutely criminal for this to happen. Physician ignorance, profiteering, whatever--it is wrong.

There's very few reasons why someone who has no symptoms should go directly to the cath lab for a procedure. (A rare exception might be an exceptional quantity of plaque in the left mainstem artery, e.g., >100. This is highly unusual.)

Even a nuclear stress test (e.g., thallium) at this level of scoring is only 10-15% likely to be abnormal. That means 85-90% likelihood of being normal. There's rare reasons to perform a heart catheterization in a person with no symptoms and an entirely normal stress test. The vast majority of people like Eric do not need a heart catheterization to discern risk.

If Eric's doctor had been up-to-date on the published literature on the prognostic value of heart scans, he could have advised Eric what the risks were--without a catheterization. Many doctors simply don't want to be bothered. Or, they opt for the more profitable method--a hospital procedure.

Always discuss your heart scan with your doctor--but be armed with information in case your doctor is uninformed or unscrupulous. Unfortunately, that's not uncommon. The Track Your Plaque program is your advocate, a source for unbiased information.
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Green tea: friend or faux?

Green tea: friend or faux?

The www.HealthCastle.com website is a helpful website on healthy eating that sends out a free newsletter. The content is all produced by licensed dietitions and nutritionists. Although I don't agree with everything said on the site, there's still some good information.

I'm a fan of green tea. Although I believe the effects are relatively modest (weight reduction, cholesterol reduction, anti-oxidation, etc., with theaflavin and/or green tea as a beverage,) they alerted me to the fact that the Lipton Green Tea product is one you should steer clear of. Here are their comments:



"More like Soft drink than Green Tea!With 200 calories, 13 teaspoons of added sugar and a long list of artificial ingredients, Lipton Iced Green Tea is more like a bottle of soft drink than tea, in our opinion."


The Lipton website lists the ingredients:

Water, high fructose corn syrup, citric acid, green tea, sodium hexametaphosphate, ascorbic acid (to protect flavor), honey, natural flavors, phosphoric acid, sodium benzoate (preserves freshness), potassium sorbate (preserves freshness), calcium disodium edta (to protect flavor), caramel color, tallow 5, blue1.

An 8 oz serving yields 21 grams of sugar. If you drink the full 20 oz. bottle (not hard to do!), that yields 52.5 grams of sugar! You will also notice that the second ingredient listed after water is high fructose corn syrup. This ingredient, you may recall, causes triglycerides to skyrocket, causes an insatiable sweet tooth, and is a probable contributor to obesity and diabetes.

In their defense, the Lipton people do also offer a sugar-free alternative without the excessive sweeteners and empty calories.

Do the Lipton products offer the same kind of benefits from green tea catechins (flavonoids) offered by freshly brewed teas? This product has not been formally tested by an independent lab to my knowledge, though, in general, commercially prepared and bottled teas tend to have dramatically less catechin/flavonoid content compared to brewed. (The USDA website provides access to an extraordinary collection of flavonoid food content at their USDA Database for the Flavonoid Content of Selected Foods - 2003. You'll find it at http://www.ars.usda.gov/Services/docs.htm?docid=6231.)

I think the HealthCastle people got it right: Brew your own, making sure to steep for at least 3 minutes. Alternatively, a green tea or theaflavin supplement provides many of the benefits. (Theaflavin has been used in trials at doses of 375 to 900 mg per day.) An in-depth report on green tea will be coming in a future Special Report on the www.cureality.com Membership website.
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Is your doctor a hospital employee?

Is your doctor a hospital employee?

There's a disturbing trend that's growing--silently but rapidly.

In Milwaukee, three hospital systems compete for the local health care dollar. To gain more control over revenues and the routing of patients, the hospitals are aggressively hiring physicians to work for them. I've witnessed many of my cardiology colleagues, primary care doctors, and a substantial number of procedural specialists enticed by the offers made by hospital employers.

This phenomenon is not unique to Milwaukee but is being used in many, perhaps most, major cities in the U.S.

This means that physicians are employees of the hospital. That way, employee-physicians are obliged to use only the hospital system that employs them. In the old days, your doctor could use any hospital he/she desired, depending on the quality, location, facilities, etc. Now, many physician-employees are given no choice but to use the hospital that pays their salary.

That by itself is not necessarily bad. But combine salary with incentives for bringing in patients for hospitalization and procedures--that the rub. In other words, physician-employees are incentivized to generate more revenue for the system, just as employees in many other industries.

If you're a salesman for an insurance company, your job is to bring in more business. If you're a worker on an auto production line, you're expected to meet certain quotas. These same principles are now being applied to many physicians.

How does this affect you? Well, if your physician--especially procedure-driven specialists like cardiologists, general surgeons, orthopedists, etc.--is a hospital employee, BEWARE! Do you really need that procedure, or is your doctor suggesting you have a procedure because it will add to his track record?

Prevention? In this model of health care, why bother? It certainly doesn't pay for a hospital to keep you well. Then why should your physician-employee?

Be careful who you're dealing with. If your physician is a hospital-employee, don't bet on getting preventive care. It's more likely you're that just a future source of revenue when it's time for your bypass operation, hip replacement, carotid endarterectomy, etc.

What more powerful argument is there for increased self-empowerment and information for health care consumers?
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The wisdom of the masses

The wisdom of the masses

My sister sent me these quotes:



"We don't like their sound, and guitar music is on the way out."

Decca Recording Co. rejecting the Beatles, 1962


"Stocks have reached what looks like a permanently high plateau."

Irving Fisher, Professor of Economics, Yale University, 1929


"Airplanes are interesting toys but of no military value."

Marechal Ferdinand Foch, Professor of Strategy, Ecole Superieure de Guerre, France


"Everything that can be invented has been invented."

Charles H. Duell, Commissioner, US Office of Patents, 1899



No doubt, conventional wisdom can often be laughably (tragically?) wrong. The problem is that, as absurd as all the above sentiments seem to us now and in retrospect, they represented the view of many people years ago. These views were held by many, including many people in positions of power and decision-making responsibility.

A more relevant but nonetheless laughable and widely held belief in 2007: coronary heart disease should be treated with hospital procedures.

Why is a disease that requires 30 years to develop treated only at the final moments with a procedure? Do you only change your car's oil when the engine is on its last legs? Or, do periodic, relatively effortless oil changes during the life of the car make better sense?

I witness just how brainwashed the public has become with this crazed notion when I meet someone socially at, say a fundraiser or cocktail party. When they ask what I do, I tell them I'm a cardiologist. The invariable response: "Oh, what hospital do you work out of?"

I tell them I don't, that I take care of the majority of heart disease right from the office. 99% of the time I get a puzzled look. If we had comic bubbles above our heads revealing our internal thoughts, it would read "Yeah, right. What a kook."

The notion that coronary heart disease is something that is manageable with simple tools for the majority of us in the early stages is entirely foreign to almost everybody. The hospitals and the medical industry have so succeeded in dazzling the public with images of staff in scrubs, rushing from emergency to emergency, lights flashing, scalpels flying. . . how can you possibly accomplish this at home or anywhere outside of the high-tech world of the hospital?

Well, I'm a cardiologist and I do it every day. We all need a figurative dose of electroshock therapy to shake ourselves of this crazy notion.
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Carbohydrate sins of the past

Carbohydrate sins of the past

Fifty years ago, diabetes was a relatively uncommon disease. Today, the latest estimates are that 50% of Americans are now diabetic or pre-diabetic.

There are some obvious explanations: excess weight, inactivity, the proliferation of fructose in our diets. It is also my firm belief that the diets advocated by official agencies, like the USDA, the American Heart Association, the American Dietetic Association, and the American Diabetes Association, have also contributed with their advice to eat more “healthy whole grains.”

When I was a kid, I ate Lucky Charms® or Cocoa Puffs® for breakfast, carried Hoho’s® and Scooter Pies® in my lunchbox, along with a peanut butter sandwich on white bread. We ate TV dinners, biscuits, instant mashed potatoes for dinner. Back then, it was a matter of novelty, convenience, and, yes, taste.

What did we do to our pancreases eating such insulin-stimulating foods through childhood, teenage years, and into early adulthood? Did our eating habits as children and young adults create diabetes many years later? Could sugary breakfast cereals, snacks, and candy in virtually unlimited quantities have impaired our pancreas’ ability to produce insulin, leading to pre-diabetes and diabetes many years later?

A phenomenon called glucose toxicity underlies the development of diabetes and pre-diabetes. Glucose toxicity refers to the damaging effect that high blood sugars (glucose) have on the delicate beta cells of the pancreas, the cells that produce insulin. This damage isirreversible: once it occurs, it cannot be undone, and the beta cells stop producing insulin and die. The destructive effect of high glucose levels on pancreatic beta cells likely occurs through oxidative damage, with injury from toxic oxidative compounds like superoxide anion and peroxide. The pancreas is uniquely ill-equipped to resist oxidative injury, lacking little more than rudimentary anti-oxidative protection mechanisms.

Glucose toxicity that occurs over many years eventually leaves you with a pancreas that retains only 50% or less of its original insulin producing capacity. That’s when diabetes develops, when impaired pancreatic insulin production can no longer keep up with the demands put on it.

(Interesting but unanswered question: If oxidative injury leads to beta cell dysfunction and destruction, can antioxidants prevent such injury? Studies in cell preparations and animals suggest that anti-oxidative agents, such as astaxanthin and acetylcysteine, may block beta cell oxidative injury. However, no human studies have yet been performed. This may prove to be a fascinating area for future.)

Now that 50% of American have diabetes or pre-diabetes, how much should we blame on eating habits when we were younger? I would wager that eating habits of youth play a large part in determining potential for diabetes or pre-diabetes as an adult.

The lesson: Don’t allow children to repeat our mistakes. Letting them indulge in a lifestyle of soft drinks, candy, pretzels, and other processed junk carbohydrates has the potential to cause diabetes 20 or 30 years later, shortening their life by 10 years. Kids are not impervious to the effects of high sugar, including the cumulative damaging effects of glucose toxicity.

Comments (15) -

  • Matt Stone

    2/18/2010 3:13:57 AM |

    The government advice to "eat more healthy whole grains" is not off-base.  But that's not what Americans did.  Instead they ate more fructose and replaced saturated fats with more polyunsaturated fats.  This is totally fundamentally different than eating a low-fat, high-carbohydrate diet like that of the rural Zulu tribe studied by T.L. Cleave or the Africans studied by Denis Burkitt and Hugh Trowell that were diabetes and obesity-free.  

    Americans are still not even coming close to the grain consumption of a century ago, when such diseases were exceedingly rare.

  • Mat

    2/18/2010 5:38:50 AM |

    This video is very good:

    "Vitamin D and Diabetes-Can We Prevent it?"

    http://www.youtube.com/watch?v=wTtmvMvgfl0

  • TedHutchinson

    2/18/2010 9:54:56 AM |

    At this link you'll find the slides of a short presentation on
    The Influence of high vs. low sugar cereal on children's breakfast consumption.
    There are some surprising findings.

    I found it at Cerealfacts.org website

    The situation in the UK is much the same. The breakfast cereals most likely to find at discounted prices are those with the most sugar.

    It's  often the case the choice of cereal going into the trolley is made by the child rather than the parent. There should be more restrictions on the promotion of pre-sweetened cereals to kids.

  • Anonymous

    2/18/2010 12:36:43 PM |

    In my early 60s I notice that I don't get much "kick" out of sugary foods as I might have earlier.  I've gotten to the point where I can't believe the amount of sugar in say cookies or ice cream...which I no longer buy.  

    I do now take several phyto-extracts...pomegranate...blueberry...cocoa...resveratrol...green tea...grape seed...etc.

    Pomegranate at least has been shown to moderate insulin response and maybe reverse atherosclerosis.

    http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114814

  • Dr.A

    2/18/2010 2:04:35 PM |

    Great post!
    I've just blogged about my eating history too...  years of low-fat, high starch, high fruit eating led me to the brink of diabetes. I'm amazed I survived childhood!

  • SuzyCoQ

    2/18/2010 5:34:51 PM |

    Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? [Unless progenitor cells are also damaged...]

  • Nancy

    2/18/2010 8:15:00 PM |

    Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)?  It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it.

  • whatsonthemenu

    2/18/2010 10:28:00 PM |

    "Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? "

    That explains why my obese elderly mom has normal blood sugars even though she has always eaten diet high in simple carbs.

  • DrStrange

    2/19/2010 5:46:28 PM |

    Dr. A, your previous diet was indeed low fat and starch based but there was not much actual, real food in it!  I am missing the connection both here on this thread and in your blog, between people eating manufactured, food like substances that don't have much fat in them and are loaded w/ refined/highly processed starch carbs w/ almost zero fiber or nutrients in them, and the eating of actual whole grains, either fully intact or minimally processed.

  • whatsonthemenu

    2/19/2010 9:43:28 PM |

    "Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)? It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it."

    If you haven't already, check out Jenny Ruhr's blog, Diabetes Update, and her related website, Diabetes 101.  Type II is being subdivided according to short and long-term beta cell function and insulin resistance.  Different genes cause different impairments.  Emerging is MODY (mature onset diabetes of the young), or type 1.5.  A defining characteristic is that the ability of the pancreas to secrete insulin declines slowly over time, rather than suddenly as in type I, but it declines no matter what the treatment.

  • Michael Barker

    2/20/2010 5:40:01 AM |

    I am a Ketosis Prone Type 2 diabetic and it isn't necessarily true that glucose toxicity leads to permanent loss of pancreas functioning.

    Typically, we will lose all pancreas secretion and will go DKA, at that point we are essentially type 1's. We need insulin to survive but after 2 to twelve weeks of normal blood sugars we can be taken off insulin and we will have near normal blood sugars.

    Weird, yes, but there are thousands of us out there so this isn't uncommon.

    Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus
    http://www.annals.org/content/144/5/350.abstract

    My blog has more information, if you are interested.

    We seem to be severely intolerant of carbs so I too wonder what would have been the case, if years ago the carbs were taken out of my diet.

  • Anonymous

    2/22/2010 5:20:40 AM |

    Michael Barker - your blog is fascinating. Thanks for the pointer. Will you be allowing comments?

  • Anonymous

    2/26/2010 9:30:44 PM |

    What a great resource!

  • Nigel Kinbrum

    2/27/2010 3:35:57 PM |

    Matt Stone said...
    "The government advice to "eat more healthy whole grains" is not off-base. But that's not what Americans did." The public were conned. Manufacturers turned whole grains into dust and formed the dust into junk. Because everything that was in the grain was in the junk, they called the junk "whole grain".

  • Anonymous

    10/20/2010 3:35:26 AM |

    Sadly, this is what happened to me. I had glucose problems by age 15, but they told me for years I was fine. There was less information available in those days. I stopped all soda and junk, but it was too late, my fate was sealed. My pancreas and teeth were damaged. Somehow I managed to eat fruit without getting headaches years later, so I thought fruit in moderation was healthy. I though my fatigue was from my mercury fillings, but now I realize some of my fatigue was from fruit sugar. I blame society and my parents, although I forgive my parents. I was fed tons of soda and every type of high glycemic junk food you can imagine.

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Call me when you're having chest pain

Call me when you're having chest pain


I met a patient, Anna, yesterday. She was quite frustrated and frightened.

At age 50, Anna suffered a heart attack and received a stent to her left anterior descending coronary artery. What she found upsetting is that, because several members of her family had suffered heart attacks in their 40s (Dad--heart attack at age 45, paternal uncle--heart attack age 40, and even another uncle with heart attack in his late 20s), she had repeatedly asked her doctor whether she was okay.

She received the usual array of false assurances: "You're feeling fine, right? Then don't worry about it." "Look. Your cholesterol is in the normal range. Even your cholesterol/HDL ratio is fine." "Women don't get heart disease until later in life."

All proved absolutely false. As we talked, Anna exclaimed, "I think what I've been told all along is that we'll take you seriously when you finally have a heart attack!"

She's exactly right. The vast majority of times, heart disease is discovered by accident, usually because of an "event" like heart attack. This is like changing the oil in your car when it finally breaks down--it's too late.

CT heart scan, followed by lipoprotein testing and associated values, then correction of your specific causes. It's that simple.
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