To Pedro  (posted here since Server blocked),
Journal Biological Chemistry 2003,278:54-63  "A Type 1 Diabetes-related Protein from Wheat" that refers to globulin (a storage molecule of wheat) being antigenic for autoimmune problems was where I saw wheat genome estimated in 2002 to be 16.5 gigabase. I read that article when tried to track down Doc's reason to declare wheat implicated in Type 1 diabetes. Full article at www. jbc.org/content/278/1/54.full

A 2010 reference to wheat genome is in journal Cytogenic and Genome Research, Vol. 129, No. 1-3, 2010 abstract's 1st sentence refers to wheat genome as 1C-17Gbp. English abstract at http://content.karger.com/
produktedb/produkte.asp?doi=313072

As I understand it 1 giga-base   =  109 base pairs, and mega-base =  106 base pairs; it's not a formula like that used to compare computer bytes of giga-bytes and mega-bytes.

You might have research use for the Harvard Gene Index Project's Computational Biology & Functional Genomics Laboratory; if use link below look at top of page and see a category for "Gene Indices", click there to then choose from subjects "Plants", "Animal" or several other indices.
http://compbio.dfci.harvard.edu/tgi

To Pedro  (Server blocked elsewhere),
Journal Biological Chemistry 2003,278:54-63  "A Type 1 Diabetes-related Protein from Wheat" that refers to globulin (a storage molecule of wheat) being antigenic for autoimmune problems was where I saw wheat genome estimated in 2002 to be 16.5 gigabase. I read that article when tried to track down Doc's reason to declare wheat implicated in Type 1 diabetes. Full article at www. jbc.org/content/278/1/54.full

Dr.Davis,

Just listened to the podcast, that's fantastic !

I have been diagnosed with TD2 last Sept, and since then being on the very low carb. Everything went well except my total cholesterol went out of control, and in January it was 400.

What I don't understand is my Lp(a) is close to 0 ( less than 5.0 mg/dL as it was reported).

Here is my latest direct measurements from SPECTRACELL LAB in Huston.

VLDL Particels: 122 nmol/L (needs to be < 85)
Total LDL Particles : 1271 nmol/L (needs to be < 900)
Non-HDL Particles: 1394 nmol/L (needs to be < 1000)
RLP(Remnant Lipoprotein) 205 nmol/L (needs to be < 150)
Small Dense LDL III: 552 nmol/L (needs to be < 300, marked as very high risk right now)
Small Dense LDL IV: 96 nmol/L (needs to be  7000)
Large Buoyant HDL 2b: 2045 nmol/L (needs to be > 1500)

Apo B-100: 127 mg/dL (needs to be < 80)
Lp(a) : less than 5 mg/dL (needs to be < 30)
C-Reactive Protein-hs : 0.2 mg/L (needs to be < 1)
Insulin: less than 4.0 uIU/mL (needs to be < 35)
Homocycteine: 12.3 umol/L (needs to be < 11)

Total Cholesterol: 259 mg/dL
LDL: 159 mg/dL
HDL: 59 mg/dL
Triglycerides: 118 mg/dL
Non-HDL-Chol : 200 mg/dL


I already removed the cheese and eggs from the diet, I suspect I am APOE 4.

Any comments on my pattern ?

thanks!

otterotter

To DCMarc  (server blocked where belongs),
Benfotiamine, a synthetic thiamine used in diabetic neuropathy, increases enzyme trans-keto-lase inside a cell. The use in diabetics and neuro-degeneration may (?) require professional consideration in cancer cases. Trans-keto-lase spurs cells to go into aerobic glycolysis (aerobic here refers to cell performing glycolysis despite oxygen being around for performing normal mitochondrial oxidative phosphorylation) for processing cells glucose; this aerobic glycolysis is the  famous Warburg effect and experimentally administering trans-keto-lase augments cancer cell proliferation (likewise experimentally spiking up thiamin increases trans-keto-lase).

Trans-keto-lase works for diabetics & in neuro-degeneration because  it pushes cell's glucose (via transcription once cAMP binds to it)  into the hexose mono-phosphate shunt ( of D-glucose-6p to D-glucono-lactone 6P to D-glycr-aldhehyde-3-phosphate) called the Pentose  Pathway (where hexose forms into pentose). This  process generates NADPH which boosts anti-oxidant glutathione ( & thioredoxin) production inside the cell. Also NADPH brings on the  activation of  the cell's endoplasmic reticulum's Unfolded Protein Response which helps the endoplasmic reticulum (ER) tolerate dangerous endoplasmic reticulum stress (ER stress is significant in diabetes and neuro-degeneration).

ER stress, with protein folding complications, sees NADP+ accumulate and so augmenting trans-keto-lase pushes quicker output of NADPH to keep pace; this  triggers the Unfolded Protein Response to induce Cu,ZnSOD expression that then alleviates the ER stress (ie: helps ER tolerate demanding conditions).  This helps in that it  keeps the stressed ER  ( a state that coincides with more local super-oxide O--),  from seeding the dangerous (and largely un-neutralizable) hydroxyl radicals (hydroxyl radicals come about when super-oxide related hydrogen peroxide  provokes Fenton  & Haber/Weiss reactions reducing Cu++ or Fe+++ ). This is similarly how trans-keto-lase also benefits cancer cells ( rampant cancer cell growth demands protein folding that formally stresses the ER); the prevention against reactive oxygen species means cancer cells don't suffer apoptosis (cell death).

Diabetics use of Befotiamine ( a dynamic fat soluble thiamine trans-keto-lase booster) will  help them similarly with their ER stress . In  their case the shift to using their regularly high glucose in the Pentose Pathway will mean quicker degradation of that glucose than if cells used mitochondrial oxidative phosphorylation. This also means the glycation (Doc warns against this from high glucose)  and thus tissue cells levels of advanced glycation end products (AGE) will be less; blunting the amount of AGE messing with monocytes and less endothelial dysfunction  amount to less inflammation, less diabetic oxidative stress and likewise less alteration of the vascular tissue such as atherosclerosis.

Experimentally induced diabetes is often done by feeding a very high  fat diet. Much of the fat in a very high fat diet  acts to drive down the level of trans-keto-lase due to a transcription adaptationum within 8 weeks in rodents. For humans thiamine (B1) is often recommended to diabetics; cauliflower is a nice thiamine source to make into trans-keto-lase.

To  B. Smith (Server won't post where belongs ),
Glutamine, an amino acid, is used by cancer cells to keep apoptosis (cell death) from happening in several ways. One way is how glutamine keeps the cell nucleus from condensing and stops the capsase 3 & capsase 8 cascades from starting apoptosis. The other way is how there is an increase in the  anti-oxidant glutathione synthesis when glutamine elevates NADPH (see comment above for ER stress).

Tumor Necrosis Factor alpha (TNF) works to destroy a cancer cell by running down that cell's mitochondrial glutathione level; this needs to be replenished with glutathione from that cell's cytosol. Once there is a 35% plunge in mitochondrial glutathione that  alters the mitochondrial membrane so that it stops bringing in glutathione to the mitochondria and starts leaking out cytochrome c into that cell's cytosol (which can jump start an apoptosis program). Cancer cells' rapid growth strains the normal oxidative stress limits of a cell, so cancer cells draw in lots of glutamine to boost the level of ready glutathione inside that cell; then the cytosol can continually shore up the mitochondrial glutathione levels to prevent one of the apoptosis scenarios from starting .

A cancer cell at some point has to "transform" to progress and needs lots of DNA at that stage; glutamine is needed for synthesis of cellular RNA & DNA. The bio-synthesis of nucleotides utilizes glutamine; and having lots of de-oxy-ribo-nucleotides around favors DNA replication at that cancer's key "transformation" stage (ie: S-phase). The use of glutamine by a cancer cell for converting into energy to run on, like some normal cells do, is not why cancer cells take up so much glutamine.

@ Might-o'chondri-AL
Dear Might, do you mind to tell what do you think about that cancer research result?
l http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117136/?tool=pubmed

My cardiologist said, "look, I don't know about nutrition.  If you want to talk about nutrion, go talk to a nutritionist"

Hi GalinaL,
Cancer undergoes several oncongenic processes wherein the so-called epithelilial pheno-type cell (epithelial cells are +/-85% of cancer substrate cells) gets it's cell nucleus histones acetylated, which creates what is called "stemness"  (the ability of that cell to renew itself with potency, like our stem cells). This leads to a phase called epithelial-mesenchymal transition (where the morphing cell can go either way, either back to benign epithelial pheno-type or onward to dangerous mesenchymal pheno-type). It is when the enzyme histone acetyl-transferase no longer keeps that epithelial histone acetylated ( a sort of  limbo) that the epithelial cell's genetic expression gets knocked down permitting the further shift into full mesenchymal pheno-type .

What is important to realize about cancer cell's taking over a cell's nuclear DNA is that when the pheno-type goes from epithelial to mesenchymal the cancer cell's mesenchymal pheno-type somehow still retains the ability to perform the stem cell "stemness" of indefinite replication. Your cited authors point out that keotones boost tumor growth (+/-2.5 times) and lactate boosts tumor metastasis (+/- 10 times); and  also that their metabolic use raises a cell's Acetyl-CoA and this increases the acetylation of histones causing more gene expressio. And so authors report limiting ketones and lactate in cancer seem to be the "achilles heel" to cut off in order to stop cancer's "stemness" (ie: inherent potential); their extrapolation from this is interesting as a theory..

There are other processes beyond histone modification which show oncongenesis is not lineal. When the cancer cell is still just an epithelial pheno-type cell unit micro RNA (miRNA) of the miRNA-200 family group is un-methylated; and thus holds the epithelial pheno-type steady, because un-methylated miRNA isn't reactive enough for messenger RNA (mRNA) transcription. A 2nd stage is seen once hyper-methylation  occurs, while at the same time less miRNA is put out; this morphs the cancer cell into the mesenchymal pheno-type and at that stage metastasis is possible. While an advanced 3rd stage comes about when miRNA resurges somewhat; this is what makes extensive metastasis of cancer cells that have migrated start happening. (Lineal thinking about cancer is a trap, since it is methylation that lets cancer cells get going but later de-methylation that let's them thrive and patient outcome worsen).

Warburg effect is suggested, by cited study, to be almost a lineal concept; which they propose to re-define as desireable if it simply limits lactate and ketone production in a cell. This theory has it's own trap because in the Warburg effect +/-60% of the carbon from glucose undergoing aerobic glycolysis in cancer cells is actually being used by cancer cells as a carbon scaffolding for "de novo" fatty acid synthesis to feed into fatty acid oxidation. In other words the elevated amount of cancer cell's aerobic glycolysis (Warburg effect) is really fostering fatty acid oxidation; and fatty acid oxidation increases cancer resistance.

The cancer cells uncouple the mitochondria oxidative phosphorylation of glucose so that the a lot of the processing of glucose doesn't go all the way to normal completion of ATP production; instead cancer cells use the initial steps that perform oxidation of glucose to cleave off the carbon atoms from that glucose to use. In other words it is the mitochondrial uncoupling protein up-regulated by that cancer cell's genetic  transcription which, down the line, forces that cell to continue to escalate Warburg's aerobic glycolysis in order to keep up with energy demands as carbon skeletons get used up.

Metaformin's use in cancer treatment was suggested by study's authors to support their "reverse Warburg" theory : that it is by forcing Warburg's aerobic glycolysis to occur, due to Metaformin,  which accounts for cancer control seen. This seems too lineal an interpretation of the events; especially with regard to preceding paragraph's explanation of how Warburg relates to unpredictable carbon molecule usage. Metaformin reliably does inhibit the mitochondrial complex 1; and this will stymie glucose (and also glutamate, which cancer cells prodigiously take in ) from going on to produce ATP. I would suggest that this also stops the oxidizing of glucose molecules and thus sparse carbon skeletons are available to make into fatty acids for burning.

In addition Metaformin inhibiting mitochondrial complex 1 will also reduce fatty acid oxidation; this is because  NADH oxidation at that complex needs to happen in fatty acid oxidation. NAD+ is a crucial rate limiter in  fatty acid oxidation , but unless NADH can subsequently be re-oxidized as a molecule in the mitochondrial complex 1 it can't keep on driving fatty acid oxidation by lending out NAD+.  Metaformin use in cancer is even more complicated, because if the cancer has p53 then when glucose supply is low it manages to actually use more fatty acids to run on and then use auto-phagy house cleaning to avoid apoptosis death. Whereas, if a cancer does not have much p53 then Metaformin seems to be more effective in treating cancer.

Yup, and the nutritionist hawks the usual "cut your fat, eat more whole grains" line.

It's a comedy of misinformation with advice from agencies paid for by your tax dollars.

Hi, otter--

Obviously, I can provide only limited advice in a blog post.

But I agree: Apo E4 is a prime consideration. However, keep in mind that small LDL remains the most atherogenic (plaque-causing) of all your patterns and still deserves the primary focus. Also, if this blood sample was drawn with ongoing weight loss, this alone can provide substantial distortions.

Wow! I don't know who else would dissect that article like you did! I really, really appreciate you decision to replay on my question. Looks like  Metaformin could be healthful in more than one way in treating cancer.

Thank you for your efforts on topics like this! It's just not right that supposed experts are pushing this wheat and cereal garbage. Thankfully my wife has tapped in to some really good almond and coconut flour recipes recently, I don't miss wheat at all!

Glyco-sylation occurs inside a cell's endoplasmic reticulum lumen when certain  carbohydrates  (in the form of N-linked oligo-saccharides) meld with a newly folded protein that gets translated into  a glyco-protein.  There are different rates of activation and de-activation  between glyco-sylated and un-glycosylated proteins; this affects how that protein migrates as it tries to perform it's job and how  glycation can induce degenerative states.  Tissue cells with endoplasmic reticulum stress can exasperate certain disease progression because such "stress" there promotes more glycosylation.

I couldn't agree more with the advice to test every 15 minutes as a means of discovering your own "sugar curve." When I tried this, I found that my own peak falls pretty consistently at 75 minutes after beginning a meal. Testing at 2 hours completely overlooks my highest blood glucose levels.

It's a particularly good technique for those folks whose A1c levels are higher than their fingersticks would predict...it's almost surely because they're doing their sticks way past their glucose peak.

When test strips cost up to a buck apiece, it may feel hard to justify using six or eight of them on a single meal--but what you learn may save tens of thousands in medical bills!

Another great article - thank you! I'm curious about your thoughts on controlled 1 hour blood sugars (mine are rarely over 110) but baseline levels that aren't much lower. Typically in the 95-105 range. I will get something in the 80s occasionally, but 100 is more common. I never really spike - even a high carb meal will only get me to 130s or so and that never really happens as I don't eat much sugar/starch at all.

Another quick question: You've mentioned a couple times recently about this way of eating being particularly good for VISCERAL fat. That is exactly what I've found. Tremendous benefits and I feel great. I have leveled out for a while (months) in fat loss, however, with a good amount of subcutaneous fat still present. Is there another protocol for getting after this type of fat? I'm already no wheat, low carb, paleo.

Thanks again for your excellent articles! Always learning something new.......

Do you have citations to support your statement that glycation occurs at BGs of 100 or more?  This is one of the more-commonly discussed issues on diabetes discussion boards--but folks are wont to ask for backup.

Regarding glycation specifically...

1. Do you agree that fructose ("frucation") causes more AGE than glucose?
2. What to you make of Ray Peat's assertion that poly-fats are much more glycalating than glucose?

"The so-called "advanced glycation end products," that have been blamed on glucose excess, are mostly derived from the peroxidation of the "essential fatty acids." The name, “glycation,” indicates the addition of sugar groups to proteins, such as occurs in diabetes and old age, but when tested in a controlled experiment, lipid peroxidation of polyunsaturated fatty acids produces the protein damage about 23 times faster than the simple sugars do." (Fu, et al., 1996)." - Ray Peat

Thanks for the great article!
I've just begun tracking blood sugars closely, changed my diet to one very low in carbs and no grains, and am determined to find ways to keep at it. I've started a blog just track my progress and keep me honest: http://transformation-transformative.blogspot.com/
I'll also try the 15 minute testing to see where my personal peak in blood sugar occurs.
Again, many thanks!

Hi Dr. Davis:  What is the relationship between fasting BG taken at the Dr's office and A!C?  My fasting BG level is 73.5 but my A1C is 5.4.  I would have expected the A1C to more correspond to the fasting measurement; in the case of my wife it does.  Is it related more to the red blood cells lingering around longer or lipoprotein particles which increases the chance of glycation?  Recently had a larger than normal amount of carbs in a meal- rice and blueberries and BG spiked to 119, not to bad, but will experiment with carb portion to keep under 100 as BG may be a contributing factor to my CAD.  I am also a hyperabsorber of fat despite being an ApoE 3/3.

As an aside, i have sent around a link of one of your interviews regarding Wheat Belly and many eyes have been opened as well as many looking to buy the book.  Might not be a bad idea to have a link to any of your interviews on Wheat Belly posted to this site.
Thanks for the enlightening good work!

Well said, Annabel!

Hi, Shottle--
This will be the topic of an upcoming discussion. The documentation of this effect is quite extensive. It is no longer a matter of "if" but "how much."

Hi, Jeff--
This is one of oranges and apples comparisons.
Fructose does indeed induce flagrant glycation. Glucose induces glycation, though less vigorously.

However, there is a separate but very poorly named process called exogenous glycation which has less to do with glycation than with oxidation of fats.

This will be the topic of future discussions.

My first thought is that, if weight loss is ongoing, there is a temporary situation of insulin resistance that generally dissipates with weight stabilization.

It's also possible that your pancreas has inadequate baseline production of insulin. I'm hoping it's the first possibility.

Hi, Steve-

You will find that, if you did frequent fingersticks around the clock, the highish A1c reflects the higher blood glucose values that occur after meals.

Thanks for the feedback on the Wheat Belly project. I will indeed crosslink some of the more relevant discussions.

Advanced glycation end products (AGE) involve some of haemoglobin's hydro-carbon Beta side chain valine residue linking up to non-polar "glucose" aldehyde compounds and certain non-"glucose" aldehydes. Various pathological kinds of AGEs can occur from distinct events; in one situation it is macrophage activity producing enzymatic myelo-peroxidase, which can activate hypochlorite favoring a serine amino acid wing to form up to make the AGE called glyco-aldehyde.

Probably the AGE called methyl-glyoxal is the one most relevant to diabetes prevention; since Type 1 diabetics blood serum levels of methyl-glyoxal is +/- 6 times higher than normal. This AGE can be formed when the byproduct triose-phosphate (triose = subset of carbs) is generated from the glycolytic pathway called  Embden-Meyerhof; this  byproduct risks being made into methyl-glyoxal.

Maybe the most well known AGEs are the non-enzymatic Amadori products formed via hydrolysis; one is called glyoxal coming from glucose oxidation. And the other Amadori type AGE is 3-deoxy-glucosone (3DG), which requires fructo-selysine and the fructos-amine 3 kinase cascade to shuffle together 3DG.

Diabetes reveals the problem with AGEs; this is because diabetics risk incurring kidney nephro-pathy, One of the pathological results is oxidative kidney stress, which limits sodium (Na) excretion thereby fostering  hyper-tension . When AGEs like 3DG, glyoxal & methyl-glyoxal  (among others, like pentosidine ) circulate into the kidneys their carbonyl compounds  are hard to clear by the kidneys; the side effect is to engender  uric uremia problems and meanwhile levels of carbonyls build up in what is called "carbonyl stress".
Japan research of the plant compound chamaemeloside found that in humans it lowered levels of the AGEs 3DG & pentosidne better than any other natural remedy; optimal response was reduction of down to 1/5 th of subject's starting levels.  Chamaemeloside is the active compound in chamomile (Anthemis noblis); the extraction formula was 1 Kg of chamomile flowers steeped covered in 20 Lt. water for 3 hours at 80* celcius ( a lab temperature probably not critical for home remedy preparation).

Volek and Phinney in their new book about carbohydrate restriction think that as you increase  fat from 30% to 60% of your diet, insulin resistance increases, then it drops when you go above 60%.  It seems that among the most experienced researchers of carbohydrate restriction, there's little consensus about the optimal amount of fat or carbs.  Ron Krausse, for instance, thinks 35% to 45% is optimal.

Peter:
When these researchers talk about carb levels are they considering vegetables to be carbs, or just fruits, grains, potatoes?

You must mean, "can exacerbate certain disease progression...." meaning: to increase the severity, violence, or bitterness of; aggravate

This is wonderful information BUT I wonder if it might be unfortunate if folks who routinely have post-prandials of 120 to 140 take your 100 level as a sign of "failure"...things are seldom so cut and dried, black and white. I don't know if I'm hitting 100 or less  after every meal, but my A1C has dropped from 7.5 to 5.8 since last November restricting carbs. And I've lost 30 pounds. I will begin to be more dogmatic about one-hour glucose checks but my rough sense is that I'm not at 100 or less a majority of the time. But I might be wrong about that. Do you see what I'm getting at? Glucose control is an ongoing process that includes lots of self education since most GP's are not keen AT ALL on restricting carbs, including mine. When I read your post, my initial feeling was, "Cripes, 100 after EVERY meal? Don't think I can do that...."

From another commentator here, in an  earlier thread of Dr. Davis' here is how to use HbA1c to determine your average blood glucose level (note: this is not a morning "fasting" level) .
1st: multiply your HbA1c by 28.7
2nd: subtract 46.7 from 1st amount
3rd: take last number as your average waking hours mg/dL blood glucose over last  few months  
ex:  HbA1c of 5.4 x 28.7 = 159.98 minus 46.7 = 108.28 mg/dL of average blood glucose level

They don't count non-starchy vegetable as carbs.

Thanks for the heads up!

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Dr. Davis,
I have found that if I take my carb level too low (below 50g per day) that my fasting blood glucose levels actually go up rather than down.  If my carb intake is closer to 70-80, my fasting glucose is lower.

Have you had this experience with some of your patients?  Can you shed any light onto what might be happening?

Thanks!
Stephanie

Non-starchy vegetables do have carbs and I do have to count them. A half cup of broccoli can have about 6 carbs and since I limit my carbs to no more than 15g/meal, that broccoli on my plate is significant.

I found getting a scale that reads carbs too was an important tool for me. I found I was ofter overestimating how much of a low carb veggie I could eat. If my blood sugar starts to rise, I go back to measuring and that seems to get me back on track.

Anne

I think thats normal, its commonly encountered on paleo forums/blogs. It has something to do with physiological insulin resistance, Petro @ Hyperlipid talked about. Look here:

http://high-fat-nutrition.blogspot.com/2007/10/physiological-insulin-resistance.html

I wouldn't suggest that everybody blindly follow CHO < 50g / day. As always, its about the context. People usually forget that. We mostly extrapolate from results of people who already have metabolic problems.

Anyway, I am currently perfectly healthy apart from some minor dermatology problems (eczema).
When I have prolonged periods of reduced CHO input (around 50g / day), I eventually start having some mucus problems. Dry eyes particularly, but also joint pain. I am not 100% sure if its about low carb diet, but it looks like it. Now I target 75g < CHO < 100g per day by adding small potato and a bit more chocolate to my diet.

I think overemphasizing carb reduction is not good thing for most people. Carbs should go down by pretty big amount for most people, but not to extreme. In anyway, its better to measure then to guess. My sugar is never above 110 after meal and fasting is always around 95.

I decided to take this advice and have been tracking my 60 mins postprandial blood glucose for the past two days to see if all the years I've been low carbing have been making any difference. Especially working my way through different foods to see how they affect me and I've ranged from 64 mg/dl to 97 mg/dl so I'm pretty hapy.

However this evening 60 minutes after my dinner of panfried steak with a creamy cajun sauce I got a reading of just 55 mg/dl. A lot of websites say this is too low. I'm 32, healthy male, 5,9", weigh 160 lbs, not diabetic and I don't feel sick so I'm not sure what to make of this low reading. The only thing I did was finish a hard CrossFit workout about 30 mins before I had dinner... so a total of 90 minutes before the blood glucose test.

Any advice on what this "low" reading means? I'm hoping it's normal and means I'm burning fat!

I'm not surprised at all. I've "met" people on forums that are on this, and they rave about how much better it is than non-prescription fish oil.

Reminds me of years ago, when patients were given (in my area) "Anacin" in the hospital, then would ONLY take it for pain....other brands, or heaven forbid generic just didn't work as well!

Amazing, huh?

On the other hand, like you say, at least now they're giving it to patients.

Now how about Mg? CoQ10? Are they starting to show up too?

Not sure if you find this interesting or not, but after stumbling on your blog not knowing anything about Pectus Excavatum, I went googlin' and got a bit depressed, as it's not as benign a malformation as I was led to believe.

But I found this site http://www.ctds.info/pectus_excavatum.html which suggests that Vit D deficiency/rickets causes the malformation in many cases, and also that celiac disease might cause rickets in some due to malabsorbtion of vitamins/minerals etc.  I thought it was interesting as you've been posting about wheat and vitamin D and heart health, while perhaps they are also necessary for chest wall health.  I take heparin and low dose aspirin while pregnant to prevent fetal demise due to antiphospholipid antibody syndome (aware of that? causes blood clots), but I'm wondering if it somehow inhibited Vit D absorbtion in me when pregnant, couldn't have been a normal deficiency I was gardening in the sun during the entire pregnancy and I don't use sun block. I assume some of your patients are on blood thinners as I was? I know it effects calcium.

As for fish oils, Udo's blends are supposed to be incredible, several moms I know use it on themselves for exhaustion and over all health, and many moms swear that fish oils have helped their toddlers with speech delays.

Let me know if you'd rather I didn't yammer at your blog, I've linked to it from my little blog because I find your blog fascinating.

Happy 2007

As for hospitals, well, there's a reason homebirthers and women into birth politics are as passionately anti-hospital as they are, many bad medical practises continue in the litigation crazed society of the USA medical system, from what I read. Forward thinking countries like Germany and Sweden incorporate natural remedies and holistic medicine right in with the mainstream medical system...great role models for us north americans, but impossible in a litigation-mad culture. But, the pharmaceutical companies are to blame too, though that discussion requires tin oil hats.

Coenzyme Q10, no. Magnesium, yes. In fact, magnesium is pretty routinely checked and replaced via intravenous supplementation to avoid diarrhea. However, magnesium levels are checked because of heart rhythm disorders, not for general health.

I know of no interaction between blood thinners and vitamin D. However, you're absolutely right on the increased likelihood of vitamin D deficiency in the presence of bowel diseases like celiac.

I use RxList.com to check any and all medications I am prescribed (or friends/family are prescribed).

This about Omacor on their site:
The empirical formula of DHA ethyl ester is C24H36O2, and the molecular weight of DHA ethyl ester is 356.55. Omacor®  capsules also contain the following inactive ingredients: 4 mg α-tocopherol (in a carrier of partially hydrogenated vegetable oils including soybean oil), and gelatin, glycerol, and purified water (components of the capsule shell).

I mentioned in another comment that I am intolerant to soy, so I avoid it whenever possible.....but to put hydrogenated oils in a preparation touted as "pure"????

I realise it's a very small amount....but from what I've read on trans-fats, the only amount of transfat that is good for us is NONE!!!

Of course, the AHA also promotes foods that contain transfats in their "No Fad Diet" (see Regina Wilshire's blog post here: http://weightoftheevidence.blogspot.com/2005/07/aha-includes-trans-fats-in-heart.html)

As a follower of your blog and TRP recommendations, which I am doing, I added a small iodine supplement in a kelp tablet.  I have low thyroid and take Armour thyroid everyday.  Just recently I have read different doctors saying that taking iodine makes low thyroid worse and should not be done.  Am I inhibiting the action of the medication by taking the kelp tab?

Jan

i was looking for (UI) urine iodine testing kit. i found the next line which didn't surprise me. the UI kit was priced,
" Price is set at 2 USD excluding postage and tax on delivery".
the web site adress.
http://www.il.mahidol.ac.th/eng/index.php/resources/test-kits.html
this is from Thailand Mahidol University.
it also sells test kit for iodine in the kitchen salt.
i can never imagine purchasing something in north america with 2bucks.

iodine test kit.
i just got mixed up. the us 2$ was the price for iodine in salt testing kit not the UI testing as i wrote earlier. can you please change the info? thanks.

Dr D.

Can you please give us a clue as to what happens to the unstable iodide?
Does it evaporate, or combine with some impurity to produce a non-absorbable form?

Curious Non chemistry major

After reading about iodine here, I started eating nori (dried seaweed). I don't know what catagory that puts me in, or how much iodine I am getting.

Jeanne

Jan--

That's an absurd and outdated notion.

It is true that initial supplementation yields a paradoxic increase in TSH that subsides over a few months. But iodine is essential for health.

Remember: Most physicians think supplements are stupid and a waste of money. If it came with a prescription and a good-looking representative, they would suddenly be prescribing it galore.

Hi, Mike--

See the Track Your Plaque Special Report, Does iodine deficiency contribute to plaque growth.

There is a graph that shows the degradation of iodine due to volatilization (evaporation). See it athttp://www.trackyourplaque.com/library/fl_03-017iodine.asp (open access).

Dr. Davis, I have been following this thread with interest.  After being on Synthroid for several years, I was switched to Armour Thyroid and had a bad experience with it. I decided to consult an endocrinologist rather than continue going to my PCP for my thyroid issues.  The endocrinologist DC'd the Armour, and put me back on Synthroid.  Told me  she was opposed to use of Armour and of Cytomel, and under no circumstances to take an Iodine supplement.  I have to say that I appear to be better off without the Armour, but my TSH has not come back down to an acceptable level yet--new dose increase today, so another wait for labs. I don't know what my next step should be, but in this area I am not confident enough of the facts or how they might apply to my situation to dose myself with Iodine.  It's not as clear-cut to me as the case for dosoing myself with Vitamin D.  If anyone knows of an open-minded Iodine-friendly physician in North Carolina, I would consult with her/him, but otherwise I would be afraid to do it.  I believe that some people have very bad reactions to Iodine, or is this misinformation?

What dose and type of supplement do you recommend, doc?

Re: Vanishing iodide.

Thanks for that Doc.
I presume keeping your salt stash in a a zip-loc bag in the refrigerator would lengthen its effective life.
I wonder if there is a problem with short lifetime on any of the supplement forms?
MikeV

PS What are the odds of rejuvenating aging (hypo)thyroid glands that have been successfully supplemented for many years?

PPS I truly appreciate your work in breaking down the blood-brain barrier between 'Medicine' and intelligent nutrition/prevention.

Hi, Mike--

Tightly storing iodized salt in an air-tight container would likely preserve iodine content.

To my knowledge, the degradation of iodine-containing supplements or medications has not been formally examined. But it is probably best to keep tightly closed in a cool place to be safe.

Jenny,

I think the bad reaction to iodine you refer to could have 2 origins.  There are people who are allergic to iodine and can have severe reactions to ingesting iodine. They don't eat shellfish and cannot have iodine dye injected for x-rays,etc.  Also, as I related to Dr.D in my post here, (see 1st post) recently I have read about drs saying patients should not take iodine if they have low thryroid because it will cause lower production of thyroid hormone.  Dr. D responded to my post here and like you, I wasn't sure about dosing myself. I will continue to take a small amount in an organic kelp tab, take my Armour thyroid everyday and get levels checked at appropriate intervals. My PCP is really only involved in testing my levels and working with me on rx meds. I make supplementation decisions based on my own research. Hard to find a dr who values an integrated approach.
Good luck!
Jan

jenny.
some times the problem with adrenal gland may  give bad experience with armour. adrenal have to be fixed first before armour can be given. and some times, it is just adrenal issue and not hypothyroid issue at all.
http://thyroid.about.com/od/drdavidderry/l/bl11.htm

also.
ALWAYS treat your adrenals first!
        If the adrenals are weak, replacing thyroid hormone first would most likely make a person feel much worse and may stir up 'hyperthyroid' symptoms bu increasing the metabolism and initiate an adrenal crisis. The adrenals must be strong enough to cope with the increase in metabolism. This is the most common mistake made in the medical management of these conditions.

http://www.livingnetwork.co.za/healingnetwork/adrenals_thyroid.html

from personal experience the supporting "B" vitamins and magnesium must be started first before starting on dessicated hormones. but it must be decided first that if you are truly hypothyroid?
when i started the thyroid hormones, it felt like starting up an old motor with different timing  belt. body, brain, heart and several other cells were going through adjustment of control and distribution of the energy. it took about 6 months or so for me to deiced the right dose and timing of vitamins, iodine and dessicated thyroid hormones. i felt that above dosing and timing can not be decided by a doctor. it is only the patient can figure it out with a learning curve. it is lots of work but believe me it is worth it.

jenny.
i forgot to add the list of suggested thyroid doctors in us and canada.
http://www.thyroid-info.com/topdrs/

What do you think about Kelp and tyrosine in combination?

NOW has a thyroid supplement that combines these. What do you think?

http://www.bulknutrition.com/?products_id=1366

Hi Mike,

http://chem-eng.utoronto.ca/~diosady/sltstblty.html

here is a paper on the loss of Iodine from salt.  It compares Potassium Iodide to the Iodate with the latter being more stable at higher temps and in high humidity. The two environmental factors mentioned are key to degradation and loss of Iodine from the table salt.  Not only should you store your salt in a sealed container in refrigerator, but you should ensure the salt you buy is in a vapor barrier lined package so that it is in the best condition when you purchase it.
cheers
Trevor

Kelp warning?

http://www.curezone.com/faq/q.asp?a=13,281,2962&q=657

Researchers at the University of California/Davis found that eight out of nine kelp supplements contained abnormal levels of arsenic (Env. Health Perspectives, April, 2007).

Thanks for the info on the home testing kit...I live in Europe and it's sometimes hard to find these. I've been taking kelp (along with culinary practice) for iodine issues.

People should know that genetically susceptible individuals can give themselves graves disease by taking iodine supplements such as Lugols. While supplementation may be healthful for some people, it can really ruin your life if you happen to be one of them.

I am heartened by the number of respondents taking iodine in some form. After all, iodine is an essential trace mineral. Without it and health suffers, often dramatically.

Since I was diagnosed with hypothyroid disease, I started taking porcine thyroid supplements for my hormone deficiency. I feel energized now.

I would love to see your answers to her questions.

Welcome to my world... only as a dietitian it is WAY worse.  Trust me.

Not only do we have to deal with bogus "evidence-based guidelines," the loss of respect of colleagues, and risk of losing our license... We have to do it all with less than a quarter of the salary that the average physician makes and much, much less respect.

I'm so frustrated in this field, but I'm at a loss as to what to do...

Timely. I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and  again suggest niacin. Again, he says he knows better. She is right...it is a sad state of affairs.

@Tommy
Maybe your doc needs to watch Tom's latest post.
http://www.fathead-movie.com/index.php/2010/10/28/video-of-the-big-fat-fiasco-speech/

And maybe your doc doesn't need to be your doc anymore.

Wow-Thank you Theresa. We need more like you!

Theresa, I'm not a health care provider, just someone who leads an independent life and writes a humble blog on solving one's own health problems, so take this FWIW.

How do you think for yourself and do things your way? Study the Socratic method. Go by results. Look at how conclusions were arrived at, and weak links in the chain. Don't hang around with people who are dishonest or have stopped thinking for themselves. Always admit your mistakes instead of justifying them.

If colleagues disapprove of you, check yourself and see if the criticism is valid. Going by what you've said, you'll probably have to choose between professional camaraderie and the best interests of your patients.

A couple of books that are good tools for thinking for yourself: The Consolations of Philosophy by Alain de Botton and Mistakes were Made (but not by me).

I know exactly how Theresa feels. After losing 95 pounds, reversing hypertension, and arrhythmias, I have returned to school for an advanced degree as a FNP. My hope is also to provide an approach of health and wellness through nutrition, education, and exercise.
I have the feeling that there are going to be more of us than the pharmaceutical companies know what to do with. Maybe I am a hopeful optimist, but the influence of a sustainable evidenced based approach as propagated here is already having it's effects.

I agree with Sassy, I would love to see your answers.  I am a second year medical student and am struggling with similar issues.  
You aren't the only one Theresa! Good luck!

Theresa,

The practice model you are seeking already exists.  Check out the Institute for Functional Medicine at www.functionalmedicine.org .  After reading your letter to Dr. Davis, I think you'll find IFM exciting.  Good Luck.

Medicine isn't the only field like that. Clinical & school psychology is just as rigid with its hierarchy of gurus and 'prescriptions for care' that are questionable. I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed unceremoniously. Those smiling faces have knives behind their backs. Where do you turn for straight answers? As always, you have to find them yourself. (My identity is anonymous because my username/password is being rejected. Wonder if 'they' have gotten to blogger dotcom too. JK.)

A typo in my last post; should have read:

I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

Theresa, please tell me you will practice in Arizona. I need a doctor just like you. Im sick of being offered bandaids to cover up symptoms instead of figuring out a cause for the symptoms. I wish you the best and hope there are more out there like you and Dr. Davis.

Just hearing one account of a student upset with the status quo definitely makes me more hopeful for the future. Eventually these voices accumulate and change happens.

I was in the field for 10 yrs,Medicine isn't the only field like that, before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  

So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.

Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  

Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  
  So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.
  Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
  Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about your writings.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
  Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures - as if I have a choice in the matter - they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

Hi, Sassy--

This was my simple response. I operate in the real world, too, and do not have perfect solutions. I also invited her to my office to see what it is I do and how I do it.


Sadly, your criticisms and concerns are right on the money.

The problem: It will take 30 years and legions of our colleagues before there is a "sea change" of practice patterns and what we do becomes the norm. In the meantime, you have a satisfying and honest career to carve out.

Training will try to push your round shape into a square hole, forcing you to mimic the thinking of conventional medicine. It may be a compromise you have to draw. I know of few good opportunities to break out of this mold. I believe that University of Arizona offers some sort of holistic medicine training. More of these programs are popping up. While they may not be precisely what you are looking for, perhaps they offer more leeway and less dogmatic training.

I do sense that more and more of the primary care community are slowly rejecting conventional approaches, but I estimate it's less than 5%. But it used to be practically nobody. So it's a start.

One good thing to know: I do what I do with little friction from colleagues. Most have no idea what it is you're talking about, but most stop arguing when they see what you can accomplish. Then they kind of turn a blind eye to how you did it, rarely asking why you did worked and their approach didn't.

Anonymous from Meijers--

I hear you. I agree wholeheartedly that there is a huge and growing role for self-empowerment in health. It certainly will not come from conventional health channels, but from unconventional sources, such as online health information, direct-to-consumer testing, and other growing services.

Hi, Tara--

I empathize.

I know several very excellent dietitians, all of whom are affiliated with hospital systems (the only ones who hire), who are deeply frustrated as you are.

I can only hope that we achieve a "critical mass" sometime soon, numbers of dissenters sufficient to be heard and not shunned, criticized, or fired.

My dad is a family physician (MD) for 30+ years and over the past few years has been implementing many more natural approaches to preventing illness. It is a DIFFICULT path to take and one that is fought every day in the exam rooms with the patients and in the hallways with other doctors.

What amazes me is other doctors willingness to RX medications that JUST CAME OUT ON THE MARKET without having done their due research, yet they very quickly judge and frown upon my dad's approach to medicine which he arrived at after many, many months of reading and researching these alternative therapies.

While they claim to not doubt his intentions, its clear they disapprove of his methods, even in the face of proven results (less flu, fewer office visits for his patients, improved lab results).

The reality is, he studies more in one evening (after seeing patients all day) than others study in a year. When he employs a therapy, its because he's researched the hell out of it and he's convinced it's the right approach to take. He understands the science behind HOW it works.

Taking a preventative approach is difficult enough, but enduring the constant judgment from others who practice big-pharma medicine is what makes my dad the top-notch physician that he is. He doesn't back down from a good opportunity to educate both patients and other physicians alike about why he's decided to prevent disease instead of simply treating it.

How refreshing to see others (especially younger physicians) who are also enduring this difficult path. It is the right thing to do.

(P.S. Dr Davis- Vitamin D, Magnesium, Iodine, and now Lipoprotein A....you and my dad are following similar paths. I tried getting him to check lipoprotein As on his patients about a year ago (after studying them on your blog), but he was coming up to speed on Iodine at that time. Now he's embraced lipoprotein A and I know it's going to save lives. THANK YOU!)

If a physician steps outside guideline-based medicine (statins for MI), he/she would open themselves up for the lawyers if the patient had an event.  

The system is defective, but in some situations, the fear of getting sued is stronger than any influence from pharma.  

Also, many training programs do not allow interaction with pharma reps at this time (from what I have heard).  This has been a new development in the last 1-2 years.

Interesting comments from this med student.  Welcome to the wonderful world of marketing-based medicine!

But we live in hope! Many medical schools are in fact taking action to address the pervasive influence of Big Pharma on medical education.

For example, here in Canada pharmaceutical companies have long supplied free lunches – and even fridges to store them in – in the student lounges of all Canadian medical schools.

But if the association that represents Canada’s medical schools has anything to say about it, there really will be no such thing as a free lunch anymore – at least for medical students.

This also means no more talks given by physician experts paid by pharmaceutical companies. No more unsupervised meetings with drug reps.

The Association of Faculties of Medicine of Canada say that their aim is to limit the influence that the pharmaceutical industry has on medical students and residents, as well as to address the public’s concerns about the perceived coziness between medical schools and Big Pharma.

Dr. Irving Gold of the AFMC described the potential impact of drug company relationships on these students:

“There’s no question that the environment within which you’re trained will have an impact on the way you perceive these issues. The public has to trust that the doctors they see do not have any debts to pay to individual pharmaceutical companies or to the sector as a whole.”

More on this at "Pens, Pizza, Parties: How Big Pharma Freebies Impact Your Doctor" on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED - http://ethicalnag.org/2009/12/08/pens-pizza-parties/

Hang in there Theresa M.
You have to do what your heart tells you to.

Anyway.... about Dieticians and Hospital food.
Does the average dietician really, truly, believe that the food they serve is really nutrititional ?
Does Monsanto dictate the cirriculum ?
We've all seen Cancer patients being fed juice, milk, bread, cereal, canned (dead) food, potatoes, cookies, cold cuts, etc.
How can a dietician with a conscience, be part of this ?
Not trying to be offensive, I'm just asking, as they have to know the whole paradigm is wrong.

Thank you, Theresa, for speaking out! Hopefully, we'll see more and more medical students like you who really care about patients' health versus playing the Big Pharma, imaging and "slice 'em up"  marketing games. Unfortunately, with all the greed I see in this world, I don't have high hopes. But please don't let that stop you!

It doesn't help that I was victimized by the medical profession in a big way. My ob/gyn of 20 years rushed me into surgery for possible ovarian cancer. Despite a benign frozen section, he proceeded to remove all my female organs. I suspect part of the reason was to train two gyn residents. This experience has shown me how corrupt the medical profession can be. Many things in the oncologist's records gave the appearance of collusion with my ob/gyn. I now realize that the oncologist was protecting his referral base to the permanent detriment of my health. A complaint to my state's medical board resulted in no disciplinary action. The outcome of a complaint I filed with my insurance company was confidential but the doctor is still in their network.  

After many problems from the assault on my endocrine system amd anatomy (aging 15 years overnight along with profound depression and anxiety which I'd never experienced), I started frequenting hysterectomy forums. That's when I discovered that my story is quite common. If women were getting informed consent from their gynecologists, 1 in 3 women would not be hysterectomized by age 60 (1 in 2 by age 65). 73% of women are castrated at the time of hysterectomy. These women have a much greater risk of all-cause mortality. Yet, the carnage continues to the tune of a hysterectomy every minute in the U.S.  

The book "The Treatment Trap" is a real eye-opener into the dark side of medicine. I highly recommend it.

Here's an article - Lies, Damned Lies, and Medical Science - about the flaws of medical studies:

http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269

Per the article, a leading expert in medical research credibility estimates that up to 90% of published medical information is flawed.

@ Larry

I work in outpatient, but I can go ahead and tell you that the inpatient dietitians don't actually "serve" the food, nor do the prepare it or even choose it.  The food service company (typically Aramark or Morrison) is responsible for the selection, preparation, and serving of food to patients.  An inpatient dietitian's job is to oversee patient care related to nutrition in various disease states, calculate needs, educate, and in some cases order/manage TPN or tube feedings.

Many of us HATE the awful food that is served in hospitals, but we have no say in the matter.  Hospitals are run like businesses, so the quality of food is not as important as the cost.  When my dad had his bypass surgery, I cooked and brought him food from home.

Hi, Tara--

You know, the plight of enlightened dietitians today reminds me of the way the German people must have felt when the National Socialism movement coerced them to follow their dictates on pain of imprisonment.

The whisperings of neighbors was all it took to have the Gestapo knocking on your door at night.

Your experience, by the way, would be a great conversation for this blog. Please tell us more.

I was friends with two Indonesian medical graduates. In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies. Before graduation they must deliver a minimum of 100 babies!

Hi Tara,
with respect being a dietitian or other health practitioner is simply not comparable with practising medicine. I should know because I studied exercise physiology as a postgraduate. My academic workload was probably less than 1/4 that of a medical student.

The fact is that allied health degrees like nursing, dietitics and exercise physiology are actually quite easy.

The amount of underlying theoretical knowledge, the workload and responsibility is vastly greater in medicine than in any other health related profession.

The reality is you get 1/4 the pay of a doctor because your job is 1/4 as hard. You don't have to work nights, weekends and public holidays. You also don't have to be on call, work 36 hour shifts, make instantaneous life and death decisions or deal with grieving relatives like doctors do.

"In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies."

But only on adults who ask to be circumcised, right?

I certainly hope the mutilation of nonconsenting infants is not the standard of care in Indonesia.

Hi Anonymous. Indonesia is a Muslim, country so circumcision is routine for babies.

I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and again suggest niacin.

@blogblog

I think you missed my point... My post wasn't to complain about the difference in our salaries.  My point was that because we are in a lower position, we have an even tougher fight ahead.  It's hard to make a change when your grassroots efforts are poorly funded and your profession is not respected.

Tara,

I'm sure that you are well intentioned and wish to help people but you aren't in a position to do that within the conventional dietetics framework.

The only really influential and widely respected professionals in health care are senior medical specialists working in teaching hospitals. The opinions and knowledge of others is often deemed irrelevant.

I am speaking from the Australian perspective so my comments may not be relevant to you.

The dietetics profession has an extremely unethical relationship with the food processing industry. Many food manufacturers employ dietitians primarily as effective PR personnel to give their extremely unhealthy products some credibility.

The Dietitians Association of Australia actively endorses the type of unhealthy products manufactured by their commercial partners. In the recent past the DAA has even actively promoted confectionery as part of a 'balanced' diet for children.

@Tara -- you're not alone! I too am a "rogue" dietitian and am so frustrated with my colleagues. I am lucky in that I work at a naturopathic practice where my nutritional point of view is in sync with the doctors I work for. So, I am not expected or criticized for straying from the ADA/USDA grain-dairy model. I hear your frustrations with the field. Luckily, there is so much you can do with it though. I had to find my own way.

During my internship, I had reservations about having to give diet advice I didn't believe to be prudent -- eat a low fat diet, drink lots of milk, etc. Instead, I changed the script and focused on other pieces of advice. For example, for heart patients I focused on getting them to eat more vegetables, and ditching the margarine, and "forgot" to mention the parts I don't agree with. Or for diabetics, eating fewer carbs and focusing on gluten-free sources like potatoes, brown rice, etc. My preceptors were thrilled I was getting people to eat more vegetables, and I didn't feel like I sold out. Good luck to you.

Dr. Davis, I have only recently discovered your blog but am enjoying it. I have some non-traditional ideas on heart health I would love to dialog with you about sometime.

Hi, Rogue--

That's great! A clever, "stealth," way to say what you believe.

You are welcome to post recipes here or to go to www.trackyourplaque.com and use the "contact" link. I look forward to seeing what you've come up with.

I would love to see your answers to her questions.
buy viagra online

I learned a long time ago that 99.9% of doctors are worse than useless. I don't plan to ever see a doctor again. Sadly, I'll soon be forced into the medical system, like most Americans.

Well after reading your blog and the comment from all the expert i will love to visit this blog to get update about good healthy habits

Anonymous, no one's being forced into the medical system. They're being made to pay for insurance.  No one says you have to go to the doctor.

I was startled to learn there are actually sound economic reasons for making everyone buy into health insurance in a given country.  Too long to explain here but the book I learned this from, well predated the "health care reform" debate.  In a nutshell, if you didn't want to have to buy a health insurance plan, you should have supported the idea of single-payer coverage.  But you didn't want that, because it was "socialist," if you are like most Americans.  So this is the alternative everybody gets to live with, since they decided it was more important to have health insurance companies than to fund health care like we do police and fire departments.  Dem's de breaks.

HI Tara
I work with a dietician who, like you, has a real passion for her job. She told me that she feels like she has participate in "tragedies unfolding every day" when the doctors send patients to her expecting the usual advice. She is fighting back, though. She has a health radio show you can listen to: http://www.wkxl1450.com/site/index.php?option=com_content&task=view&id=4182

I encourage you to seek out doctors who think outside the box in your area. I have been so grateful to have Chris available for my patients, and I know other doctors would be grateful for someone like you, too!
(PS I am relocating soon to Napa, CA, you don't happen to be there...?)

Not meaning to be a s*&t disturber, but then why do an alarming number of doctors seem to only know 1/4 of what other allied health practitioners do?? Are they being taught too much 'feather' and not enough chicken??

I have a sister who doesn't understand much about biochemistry.  She asks me for advice all the time with various issues/problems.  Vast majority of my advice is dietary/supplements.  Sometimes, my advice is for prescription meds, which I can usually locate without a doctor (not talking narcotics or anything).

But my advice to her in a ACUTE situation is... don't wait to ask me, do what the doctor says.  IMO, if you have a broken bone, or are actively having a heart attack, or have a big infected boil, mainstream medicine is OK, pretty much the best we've got.  

When you have a CHRONIC disorder, or are trying to preempt having one, that is when taking your health into your own hands is good.  That is when you look up all the prescribing info for the drug they want to put you on before taking it.  That is when you become more of an expert on your disease than they are.  

I had a CABG several years back, I've been a T2 diabetic for years, I had a bad rT3 problem, and adrenal insufficiency (reversed both the rT3 and adrenal issues and am weaned off meds), I have low sex hormones (E, P and T), I have systemic yeast.  I know more about my COMBINATION of diseases than any doctor cause I'm more INTERESTED and have GOBS of time to research each issue and the endocrinology (which includes nutrition. since cholesterol and vitamins A, D3 and K2 all profoundly effect hormones) and of how they all interact.  I can spend hours looking at a diagram of steroidogenesis and trying to figure out myself.

So... if a doctor wants me to use more insulin for tighter control, I know I need more K-Dur to counteract the K loss from insulin else my BP will go skyhigh.  They don't.  They just see my BP go high and want to put me back on Lisinopril (which never lowered it, after 2 years of increasing doses).  I know niacin fixes my lipid panel better than statins - and that I can climb stairs on niacin.  I know that high omega 3 intake, and high vitamins A, D3 and K2, and lots of CoQ10 are absolutely required for my health.

I DO know more than they do about my chronic stuff, and my sister's chronic stuff, and my daughter's and husband's issues.  If it's anything chronic, I WILL know more in a few weeks time than any doctor treating me.  Cause... no one can be an expert on EVERYTHING and I CARE more when it effects me or mine than they do.  I'm one of 30 patients they are seeing today; I'm the only me I've got.  I just flat out CARE more.

But in an acute situation, I trust them.  My sister needs an MRI on her back, I agreed she needs it, and just said, "Do whatever they tell you if it's based on the MRI."  Cause... I can't become an expert in 10 minutes, and the acute stuff, they are mostly pretty good at.  Someone has to decide in those situations, and you don't have time to become an expert.

There's other stuff mainstream medicine has gotten right.  Antibiotics as an example... though the overuse of them is what they got wrong.  Similarly, while I think we overdo vaccinations, the fact is that when polio came through a town and killed or crippled most of the children, that was some bad stuff.  Mainstream medicine gets some things right.

The problem with medicine is that it is not evidence-based, though they say it is.  At BEST, it takes 10-15 years for good research info to change the practice of medicine.  At worst, if there is no profit motive, good research info may NEVER change the face of medicine.  

IMO, with mainstream medicine, you take what is good and leave the rest.  But throwing out the baby with the bathwater makes no sense.  Doctors do have their uses.  No matter how we rant against their stupidity, there is some worthwhile stuff there.

One of MY reasons for hanging out here is that Dr. Davis changes.  When I started hanging on this blog and his website and bought his first book, he wasn't discussing thyroid, or K2, and his dietary ideas were quite a bit different than today (though the anti-wheat stuff was there even then).  

Not that I agree with him 100% about everything, but... he DOES change the way medicine does not; he actually DOES do evidence-based medicine, based on actual evidence, not just evidence provided by pharmaceutical studies.  And since evidence changes over time, and he keeps learning, his recommendations change.  That gives me confidence in his latest ideas, to go research them for myself.  

And for those who can't really research for themselves, without a solid science background and an understanding of how to read studies, if they have cardio issues, I just tell them to go do what he says.  I've told people to read his books, sent them to the blog and website, I've even sent a few people to see him, cause they were local to him and able to get there.  Cause even if I don't agree 100% about everything, he's the only cardiologist I know who is actually reversing CHD.  

Granted, Dr. D is a maverick and himself rants against mainstream medicine.  But... he rants agaisnt specific stupidity.  I'm sure if you were having an actual MI right now, he'd recommend a procedure to save you.  Just... he'd rather you not have the MI in the first place, which is why he rants.

But... baby and bath water...

Fantastic, Dr Davis!  I read the article earlier today and was thinking of sending in my own response but yours is ever so much better and comes with greater credibility which is important.   I hope they publish your letter.

Thanks, HS4!

But don''t hesitate to add your voice. The more they hear this message, the more likely others hear it, too.

There were some comments in past postings regarding ancient vartieties of wheat, such as Emmer and Einkorn. Although these types still pose problems from a total health perspective I was thinking perhaps an original form of barley might also provide better health benefits with less metabolic damage than the newer varieties.

There are recipes where the addition of grains in relatively small amounts can improve texture and flavor and I have used barley for this purpose extensively in the past.


Are ther sources of information or supply of older or alternative forms of barley?

Go Doc!

I would like to know if Dr Davis would be interested in doing a 30 min tele lunch and learn workshop, we own a wellness company with 000's  of users on our health portal.  It would be a great way to promote his books/blogs.

[...] wheat from your diet. Give it a try for 2 or 3 weeks and see how you feel.    Here's why:  My letter to the Wall Street Journal: It’s NOT just about gluten | Track Your Plaque Blog  "1) The gliadin protein of wheat has been modified by geneticists through their work to [...]

[...] I'm suggesting.   What about WHEAT?  Wheat has been a Frankenfood for the last 40 years, bcfromfl:  My letter to the Wall Street Journal: It’s NOT just about gluten | Track Your Plaque Blog  "1) The gliadin protein of wheat has been modified by geneticists through their work to [...]

I can attest to the fact that doctors ignore what happens to blood glucose after eating. My fasting BG has always been normal but my glucose tolerance tests have always been high. My last glucose tolerance test a few yrs ago went to 201. My doctors told me I had some insulin resistance but assured me that I did not have to do anything about it because my fasting was OK.

About 1 year ago, after reading this blog and others, I bought a glucometer. Yes, my fasting was "normal" but I could easily push it up to 200 by eating. I did just what Dr. Davis recommends. I used the glucometer to figure out what I can eat and how much I can eat. I am able to keep my blood glucose below 120 now. The glucometer is a powerful tool.

Is it possible my ignored elevated post meal blood sugars did damage? Well, lets see, I have peripheral neuropathy and have had cardiac bypass. Giving up gluten 6 yrs ago greatly improved my PN and relieved my of shortness of breath and pitting edema. Getting my blood glucose down will make a difference too.

I recommend Blood Sugar 101 http://www.phlaunt.com/diabetes/

Going to get a glucose meter today and start checking.  Is there a desirable number or range for glucose before and after or is it about how much or how little it rises without regard to the number?
Seems like somewhere around a 100 is what you are advocating.  

If a person is not diabetic, is it helpful at all to know your A1C when getting routine blood work done?  Just wondering...

Thanks.

Jan

You can get Wavesense Keynote test strips from Amazon for about 35 cents per strip -- the best deal I've ever seen.  (The meter is about $35 there.)  

I am curious about the right time to test.  If blood sugar goes to 160 at 30 minutes, but is down to, say, 100 at one hour, is that ok? Why is one hour (not 30 mins or 2 hours) the key number?

Ground meat is often cut with breadcrumbs. I won't eat ground meat or meatloaf at a restaurant or potluck supper.

Balsamic vinegar contains up to 3 g of glucose per tablespoon. And most people do add sugar to salad dressings. One restaurant I went to boiled down cider vinegar until it was sweet.

You can use those urine glucose test strips to test foods for the presence of glucose before you eat them. If it's starch, you have to chew the food a bit first to break down the starch. See Richard Bernstein's "Diabetes Solution."

When exactly do you take the measurement?  One hour after the start of a meal or one hour after the end?  Sometimes when we eat out, a meal can take an hour or more to finish.

One caution is that blood sugar meters are only accurate to plus or minus 20% which is a huge variance.  Also, many (probably worst w/ the Walmart Relion or similar budget meters) are not very consistent so you can't just compare to a lab test and calibrate.  

What I generally do is take 3 (or even 4) readings within a few seconds of each other, toss any wild outliers, then average what is left.  If you try this a few times, depending on your meter, you may be shocked at how much difference there is between the readings.

Dr. Davis--Great post--I totally agree. Even if someone isn't diabetic or prediabetic (myself),  investing in a glucose meter, then self-testing (especially post postprandial) has got to be one of the absolute best investments one can make in personal health.

I once read that if most diabetics (and I'll add prediabetics too) had invested in a meter years before their diagnosis, mostly likely they could have/would have avoided many of their accompanying negative health conditions today.  

That said, there is still a lot of "cognitive dissonance" with regards to diet and health--I think the meter really helps to reinforce the cognition portion of that phrase thereby reducing the dissonance half.  

And using a glucose meter can actually be fun!

Here's an example of carbo loading on yam and plantain - there was a 7 hour "fast" prior to eating and then taking the measurements.

http://tinyurl.com/bg-set-001

mg/dL is marked at a few key points on the right hand side.

What I don't get is how to interpret the second rise and fall after the two hour mark ... though it is still inside the post-absorptive window (which closes 3-5 hours after eating, IIRC).

I'm pretty certain a glass of red wine explains the initial drop to 65 mg/dL, btw.

Also, for those that would like to make their own graph, it's easy to grab the url and fill in your own data (it's a google charts thing).

Will there still be production of small LDL from excess blood glucose even if there is ample available glycogen storage space? That is, will the liver simultaneously manufacture LDL and glycogen?

When do you start to count your one hour.  From the time of your first bite of food, or when you have  finished your last bite.  Since it takes about 20-30 minutes to finish eating, when to start the one hour count down is important.

Hi, Anne--

What a perfect example of the power of postprandial testing!

Yes, Jenny Ruhl at http://diabetesupdate.blogspot.com  provides a wealth of insight into blood sugar issues. We will also be releasing an in-depth Special Report on this issue on the www.trackyourplaque.com website.

In answer to the questions on timing of blood sugar checks:

I am guilty of oversimplification. The peak timing of blood sugar varies on the foods consumed and the mix of foods consumed. It will also vary from individual to individual. I believe a reasonable way to start out is to check 60 minutes from the completion of a meal. Even better, you might occasionally perform your own time-course study: Check blood sugars every 30 minutes to determine when you tend to peak.

Since an LC diet causes insulin resistance, (Actually a GOOD and protective thing within the context of an LC diet)wouldn't a long-term low carber get a sort of "false positive" reading of high blood sugar from ANY high carb meal?

Also, what do you think of the theory (that seems to really be gathering momentum lately) that fructose is the actual cause of insulin resistance, while on a "high carb" diet, and that glucose/starch is relatively benign?

I got a blood glucose monitor after I starting taking niacin for HDL (had read that niacin could raise blood glucose) and it was an eye opener. Now I know what foods to avoid.

Jeanne

Gretchen--

Great thoughts. I forgot about the bread crumbs in ground meat issue.

Coach--

I think it's a matter of degree: While fructose is clearly a very bad player, glucose/starch are not benign, just less bad. Look at the responses we can generate with glucose tolerance testing using 75 grams of glucose.

Since a simple way to reduce after-meal glucose readings is to eat smaller meals and eat more often, I don't quite understand why you think it's a bad idea.

Bloodsugar101 suggests timing from the start of the meal. I always set a timer anyway, and it is easier to do before beginning to eat than at the end of the meal. This can feel awkward at first in restaurants, but I look at it as a way to get the word out.

The occasional checks every 30 minutes is an excellent suggestion. Anytime you go over 140, you're causing damage. Even if it is only for brief periods, you want to be sure this is not one of your staple foods!

What has happended to your trackyourplaque forum? I can't reach it anymore? Server crash without any backups? :-(

hmmm. How painful is it to check the blood sugar that often?

I'm curious to know how to interpret blood sugar readings on the background of a healthy weight and a low-carb diet, with no known diabetes.  

My fasting sugar is the same as it was before going low-carb (mid-70s).  However, it now takes a lot fewer carbs to spike my postprandial sugars.  

An example: after 25 grams of carb in the form of a small serving of sweet potato with butter, my 45 minute postprandial reading, measured in triplicate, was 135.  I'm guessing the peak was even higher.  In case it matters, I'm a 36yo woman with a BMI of 18.9.  

Should I be unconcerned by this kind of spike as long as my typical meals don't spike my sugar?  Is this just the normal insulin resistance caused by a low-carb diet, as Coach Jeff mentioned in his comment?

Dr. Davis, you said, "While fructose is clearly a very bad player, glucose/starch are not benign, just less bad. Look at the responses we can generate with glucose tolerance testing using 75 grams of glucose."

This does not prove anything about what causes insulin resistance in the first place though.  The person having a response to glucose during a tolerance test may have originally gotten their insulin resistance from fructose.  You can't use fructose in the test since it doesn't raise blood sugar, you can only use glucose.  

To put it another way, people who don't have insulin resistance don't have abnormal responses to glucose during glucose tolerance tests.  Does that exonerate glucose?  Not really.  

What I'm saying is you can't indict glucose OR fructose based solely on what is seen in a glucose tolerance test.

Anon--

Blood sugars are too high. Either too much carbohydrate in the diet or something has caused an abnormal insulin response. While the dangers are not acute, there are long-term consequences of blood sugars this high.

Dr. Davis, if you can spare a moment I hope you would comment on this:

http://fanaticcook.blogspot.com/2010/01/should-you-take-vitamin-d2-or-vitamin.html

where Dr. Michael Holick (Mr. Vitamin D, from the look of his pedigree) claims D2 is equally as effective as D3 in raising and maintaining 25OHD levels?

There are two main causes of insulin resistance, dietary fat and possibly fructose.  Fructose is not a cause for many as they can eat a mostly fruit diet without issues but for some it is a big factor.  There are "must have" essential fatty acids needed in proper amounts and ratio, perhaps a bit more fat is needed.  Beyond that minimum amount, any additional adds to insulin resistance. The amounts and ratios are all present in an all plant diet without the addition of any add oils or fats and that w/ minimal nuts/seeds (maybe an ounce of flax).

After being on strict McDougall diet (total dietary fat approx 10% and no refined carbs, no animal products, no junk) for about 18 months, I did a 75 gm glucose tolerance test and had them do an extra point at 30 minutes just in case. My highest peak was 114.  Previously, on low carb diet I would go to 185 or higher. [I am 5'3" and 110 pounds so small body mass; lbs body per gm glucose if that makes any difference]

@ frogfarm said...
I find it very strange people take this particular study seriously.

At the end of the trial none of the participants had 25(OH)D levels above 30ng/ml, so they all remained vitamin D insufficient.
IMO it is unacceptable medical practice to knowingly give people an amount of a supplement that leaves them at such a low 25(OH)D level they remain unable to properly absorb calcium and well below the 58.8ng/ml level at which human breast milk flows replete with D3.
So too little vitamin D of any kind leaves you vitamin D deficient.
Is that such a remarkable finding?

BUY DISCOUNT Ostoforte 50,000 IU (also called Drisdol) ONLINE 50,000 IU (100 capsules)  $168.99 USD
or you can choose
Vitamin D3 $26.95 for 100 X 50,000iu capsules.
Who, but a fool, chooses to pay $169 when there's a better, cheaper alternative costing only $27?
Or choosing an oilbased gelcap still saves loads of money.
Healthy Origins, Vitamin D3, 10,000 IU, 360 Softgels $23.95

I'm not sure of the point or the common sense, involved in trying to prove a synthetic drug, humans have to convert to D3 anyway, may, in trivial amounts too low to get anybody out of insufficiency, may be as good as a natural, cheaper, product or that equivalence seen in a few persons at a very low dose level, also applies at the sensible, natural levels, desirable for optimum health outcomes.

While there are cases like this listed in Pubmed it is clear some people do not absorb nor are able to use Vitamin D2.
We report a case of a 56-year-old woman who received supratherapeutic doses of ergocalciferol (150,000 IU orally daily) for 28 years without toxicity.

A small trial of just 68 people is unlikely to pick up cases like the above.

Grassrootshealth Banner Graph shows the amounts people have been taking and the 25(OH)D levels they have achieved.
6000~8000iu approx 1000iu/daily for each 25lbs you weigh generally produces a natural level at which the body is able to store a sufficient reserve of D3 to be effective at times of crisis.
This LEF study is another example showing 5000iu/d is not sufficient to get most people above 50ng/ml.

As Holick knows perfectly well human skin naturally makes 10,000iu/daily given a few minutes full body UVB exposure. It does that for a purpose. Only when researchers start using equivalent EFFECTIVE amounts of the same NATURAL Vitamin D3 biologically identical to the form human skin NATURALLY makes, will we see an improvement rates of chronic illness.

Dr Strange, if you're eating low carb, you have to prep for a GTT by carb-loading for 3-5 days beforehand.  Your pancreas won't be prepared to handle 75g of carb unless you give it a few days to rev up insulin production first.

The reason that you had no problem with the GTT while McDougalling was that your body was used to high-carb loads, and so the test posed no challenge to your pancreas.

Testing in Pairs
Although this idea is for diabetics I feel it may also be useful for others wanting to see how particular food/exercise choices affect their numbers.
There is also a short video, a downloadable record form and an example to consider.

I can support what others are saying: before I went low carb, I could eat carbs and my blood glucose would never go above 120; now I eat pretty low carb and a single sweet potato can take me to 150.  I guess one should either eat extremely low carb or extremely high carb to avoid glucose spikes.

I worry that chronically eating high-carbohydrate, while generating an "accommodation" response that blunts postprandial blood sugars, will generate pancreatic BURNOUT by constantly challenging the pancreas to overproduce insulin.

I too find that my post-meal glucose goes up much more after I do have carbs, if I'm eating low carb than high carb.  It's kind of amazing, and a little worry-some.

However, if I eat very low carb, my fasting glucose is in the low 80s, while if I have more carbs, it's in the high 90s the next morning.  For example, I have (following the blog's advice) had absolutely no wheat and minimal sugar since Dec 27.  My fasting glucose had fallen into the low to mid 80s.  Two days ago, I had a large cookie after lunch --  My first wheat/sugar in 3 weeks.  The next morning, my fasting glucose was 98.

Insulin resistance is the key here and dietary fat is a major contributor to IR.  I simultaneously took insulin levels w/ the blood sugar readings in the 75 gm glucose tolerance test above, and they were consistently low normal to slightly below normal, starting w/ undetectable level at fasting. Readings were:

fasting < 2
30 minutes = 3
60 minutes = 5
120 minutes = 14
180 minutes = 8


reference ranges given on lab report:
fasting  < 17
30 minutes = 6-86
60 minutes = 8-112
120 minutes = 5-55
180 minutes = 3-20


Doesn't seem like too much risk of burn out there!  And again, the reason for the low insulin output generating a fairly flat and low sugar curve was that without excess dietary fat (7-10% of total calories), there is dramatically reduced insulin resistance.

Thanks for bringing up the importance of blood sugar levels. I've done the same thing with my followers in my recent eBook on type 2 Diabetes, Metabolic Syndrome, and Prediabetes.

What I have done is take it a step further. Instead of noting what my blood sugar reaction is to a large meal full of high GI starch and trying to avoid it, my focus has been finding ways to improve my glucose tolerance to such a meal.

My glucose response to food is now far better than any single person following the advice of this blog. That much I can guarantee. It is not luck. It is not genetics. I watched my numbers fall as I followed insights that I gained from several years of intense investigation on the subject.

The big thing that low-carb authors are missing is that unrefined carbohydrates can improve glucose response to food, even if they cause a larger rise in blood sugar in the short-term.

My blood sugar now peaks at levels below 80 mg/dl after meals, something that the medical and nutrition-sphere probably considers to be impossible. But it's not. It's glucose metabolism perfection, but it's not achieved through limiting glucose intake. In fact, that can make your response to glucose worse, not better.

When you say low carb, what percentage of your calories are coming from carbs? Talking under 30% here?

Off topic here but wish you would discuss salt and its effect on heart disease. There has just been a well publicized news story on it:

http://www.cnn.com/2010/HEALTH/01/21/salt.intake/

Do you recommend cutting salt intake to your patients?

Great blog!

"...if I eat very low carb, my fasting glucose is in the low 80s...  Two days ago, I had a large cookie after lunch -- My first wheat/sugar in 3 weeks. The next morning, my fasting glucose was 98."

Yes, the high fat content of low-carb diet causes insulin resistance!  If you ate low fat (around 10% total calories max) for a couple weeks then you would maintain the lower fasting sugar after a carb load. Though if that cookie had a lot of fat in it, that could be enough to kick up the insulin resistance again.  One other possibility is if you are gluten intolerant, the stress to your system of eating wheat cookie could make fasting bg higher.

Dr. Strange, Do you have any evidence that a diet high in healthy fats -- I'm a vegetarian, so I get little saturated fat -- causes insulin resistance?  I've never seen that theory propounded, and the mechanism seems implausible to me.

@ DrStrange
Re the high fat content of low-carb diet causes insulin resistance!
Maybe in some cases.

Most readers here will be following Dr Davis's advice regarding omega 3 intake
Fish oil prevents insulin resistance induced by high-fat feeding
it is also the case
Medium-chain fatty acids ameliorate insulin resistance

EPA and DHA are associated with lower HOMA-IR, while the opposite is true for n-6 FAs

It is misleading to assume increasing fat content of diet inevitably raises insulin resistance.

Dr. Strange-

Interesting thoughts and you are right to question low-carb dogma as well as to show that insulin resistance is the core problem - and that a very high-fat, low-carb diet worsens the core problem.

Anyone questioning this has not researched the issue thoroughly enough.


However, you are making the same mistake. Eating a high-carb, low-fat diet for an extended period of time, while lowering your fasting glucose and insulin levels, also makes your glucose tolerance worse.

Let me explain...

If you have a basline meal, let's say, a slab of baby back ribs with cornbread and baked beans, and your 1-hour pp is 140 mg/dl, fasting the next day is 100, then you have good base numbers to track improvement.

Eat low-carb, high-fat for 10 weeks, eat that same meal (ribs), and both your fasting and pp glucose levels will be higher than they were before you went low-carb. This means you're in worse shape than before the experiment.

If you eat low-fat, high-carb for 10 weeks, and you eat a slab of ribs, cornbread, and baked beans...
You're pp and FG will measure into the stratosphere (my 1-hour pp actually hit 173 mg/dl breaking a low-fat escapade...nutritarian).

Both diets made your glucose metabolism worse in response to your baseline meal.  In other words, both strategies give you better numbers in the interim while making you fundamentally unhealthier (not to mention eating low-fat will make you crave more fat and low-carb will make you crave more carbs).

What I've found is how to improve your glucose levels and insulin sensitivity in response to normal mixed food ratios. That's where real healing is achieved. A low-carber or a "low-fatter" will never get to a point where he or she can eat a large mixed meal with lots of fat, carbohdyrates, protein, and calories without having high postprandial spikes and high fasting glucose levels. Only someone who can eat 2 baked potatoes with 2T of butter and an 8-ounce untrimmed ribeye with fasting levels in the 70's and pp's in the 70-90 range is truly healthy and free of insulin resistance. I've found the secret to achieving that, and it is not low-fat, low-carb, or low-calorie.

If such a meal sends your blood sugar half way to Mars, then you need to fix that!  Not avoid it!

@ Matt Stone:

Stop spamming! Yes, "everyone is wrong but I have figured it all out but for won't tell you what it is unless you go to my web site and pay me" is a spam, plain and simple. Please stop it.

MattStone said: "Only someone who can eat 2 baked potatoes with 2T of butter and an 8-ounce untrimmed ribeye with fasting levels in the 70's and pp's in the 70-90 range is truly healthy and free of insulin resistance."

That is somewhat how I used to eat and my fasting sugar level was creeping skyward.  Switched to low carb and felt gradually worse and worse for the 9 months I did it.  Switched to low-fat/starch based diet and have been feeling very well and not craving fat at all.  I do eat a little over an ounce per day of flax and pumpkin seeds for EFA boost.

On 4 different occasions over the past couple years I have sent my blood sugar way up from one meal of moderate fat intake.  One was from eating all the seeds in a medium sized Delicata squash in one meal, maybe 1/2 cup or a bit more.

Admittedly my liver is not in the best of shape due to much solvent exposure working in surfboard industry years ago and this my contribute...

Don't have evidence handy but my understanding is that saturated fat is the biggest contributor to IR, much more so than unsaturated. There is some saturated fat in veg foods, some are very high in fact like coconut.

Matt, Have read some on your blog site and think I get the overall picture of what you are doing but...

What about the demographic data showing increasing cancer rates w/ increasing consumption of animal protein?  And the at least transient damage from meals high in sat. fat?:

http://content.onlinejacc.org/cgi/content/short/48/4/715
Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High-Density Lipoproteins and Endothelial Function
CONCLUSIONS: Consumption of a saturated fat reduces the anti-inflammatory potential of HDL and impairs arterial endothelial function. In contrast, the anti-inflammatory activity of HDL improves after consumption of polyunsaturated fat. These findings highlight novel mechanisms by which different dietary fatty acids may influence key atherogenic processes.

And this one is a little concerning (its title tells the tale):
http://www.ncbi.nlm.nih.gov/pubmed/18263705
Glucose and leptin induce apoptosis in human beta-cells and impair glucose-stimulated insulin secretion through activation of c-Jun N-terminal kinases.

More on low fat diet and atherosclerosis:

http://www.heartattackproof.com/resolving_cade.htm

It is a fascinating concept that increasing leptin dramatically reduces insulin resistance.  Leptin secretion seems to be induced by increasing glucose level, so eating starch (unrefined carbs like potatoes, whole grains, etc)which converts directly to glucose, should raise leptin level.  What I do not understand is the need for high fat and saturated fat in the diet, nor the need for "overfeeding."  We do need a certain amount of fat in our diets, but a plant based diet, with the addition of an ounce or so of selected seeds/nuts does seem to cover the 10-15% calories from fat we need without the increased disease risks of higher fat intake, and the risks from intake of large amounts of animal protein.

All 42 comments are amazing,

Lots of varied comments here.  How do you suppose we all arrived here in the first place?  Our genes traveled through the ages,  without the benefit of all of this information.  How did they do this you might ask?  Simple, our ancient ancestors ate what their genes required for survival, full fat wild animal product, supplemented by a few wild not very starchy roots pulled from the ground, and seasonal wild not very sweet tree fruit.  This progressed throughout the last 2.5 million years.  That is how we got here.  Where we went wrong is when agriculture and farming started about 10,000 years ago followed by industry.  Our genes did not change much in the last 2.5 million years of eating high saturated fat including all high fat organs and marrow from the bones, with limited seasonal veggies and fruit.  They did not have the benefit of the sage advice of modern traditional medicine, or electronic devices to guide them, relative to the easy to treat by lifestyle change metabolic syndrome diseases.  Weren't they lucky?  Lest you think I am disparaging all doctors, I am not.  G-d forbid you have a broken leg or a disease that is congenital or inherited  that is difficult or near impossible to treat and need a physician, this group of dedicated highly trained professionals are  a life raft, and much appreciated.  I practice what I preach.  I went from a very ill patient to one that has reversed many of the metabolic syndrome illness that I suffered.  I trust the wisdom of my ancient ancestors and my doctors who practice out of the box evolutionary medicine to guide me.

Billy E

The information and anecdotes you provide about various heart disease issues is very interesting and useful. There is a registered dietitian in the Kansas City Area that has produced a series of informational videos about weight loss, nutrition and healthy living that you may be interested in. Here is her latest Nutrition 101 Video Series: http://www.youtube.com/watch?v=7KZCjcCTCOE&feature=related

Thank you and happy heart month!

@ Dr Strange
Nutrition and Metabolism  Dietary fat research
Perhaps you haven't yet read the Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Patty W Siri-Tarino, Qi Sun, Frank B Hu, and Ronald M Krauss, Jan. 2010
showing there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.

With reference to Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties
The mitochondria of people new to consuming coconut oil will not be  adjusted to it. It takes time to acquire appropriate gut flora. A single ingestion of an unfamiliar dietary substance will have different effects from long term use of the same substance.

Any single trial comparing an omega 6 frequently consumed with a type of saturated fat the general public are not generally accustomed to will fail to spot the long term benefits of MCT (coconut oil, saturated fat) consumption.
MCTs suppress fat deposition through enhanced thermogenesis and fat oxidation. MCT's preserve insulin sensitivity. MCTs regulate production of adipocytokines (e.g., adiponectin.

Billye, you might want to read these.  It is true that ancestors ate full fat wild game, which is very very lean.  Also, 100% of it ate its natural diet and not corn, soy, and synthetic supplements and drugs.  Also, they most likely ate primarily a lot of starchy roots, leaves, flowers, insects, whatever they could collect and some meat when they could get that.  The meaty, beefy, caveman is a romantic fantasy.  They also did not live very long so degenerative diseases of aging were not an issue

http://diabetesupdate.blogspot.com/2009/09/lets-not-twist-history-to-support-our.html

http://diabetesupdate.blogspot.com/2009/11/saying-something-over-and-over-doesnt.html

Dr. Strange,

The reasons that ancient peoples expired at a relatively young age was because diseases that are cured today through the use of antibiotics such as malaria along with the many natural disasters that occurred throughout the ages account for this fact.  However, what they did not die from were the diseases of the metabolic syndrome that you attribute inaccurately to degenerative diseases of old age. They are brought on by the standard American diet.  The degenerative diseases that you mention are first found in ancient egyptians from about 12,000 years ago after the advent of agriculture.  The patients can do their own trials under the watchful eye and monitored by their doctors.  The plain fact is that when switching to an ancient evolutionary lifestyle most of the diseases of the metabolic syndrome  reverse themselves.  This is being accomplished by thousands of people all over the world today, including my self.  You might read the well documented by clinical trials, Good Calories Bad Calories by G. Taubes, and Trick and Treat by B. Groves.  

Billy E

DR.Strange,

This is a P.S.  Archaeologists have found many human bones that had cut marks inflicted by other waring clans, along with the fact that the population of those times was very small compared to today's populations.  This is in contrast to the huge carnivore animal populations that walked the earth devouring humans who were in their food chain.  Also of note was the proven fact that ancient populations prized the fattest parts of the animal, brains, organs, and marrow from the bones etc.

Billy E

Dr Richard Bernstein is in his mid-70s, and has type I diabetes. His diet is around 30 grams of carbohydrate a day, and he has no fear of saturated fat. It beggars the imagination that a man like him, whose pancreas hasn't produced any of it's own insulin in over half a century, should live to a ripe old age (as a male type one diabetic, he's already done this, and he ain't done yet.), but that the same diet should be deadly to the non-diabetic. Maybe he's lucky; but, before he learned to tightly control his own blood sugars, (and with as little insulin as possible), he suffered all kinds of complications, hardening of the arteries, high triglycerides, low hdl, early kidney disease, etc. I think Dr Bernstein and his patients provide proof of concept for what Dr Davis is trying to accomplish here for those suffering insulin resistance, whether they happen to be diabetic or not.
Matt, you can't test insulin levels with a glucose meter. You also can't test any possibly progressive damage to glucose homeostasis that *might* be caused by a high everything diet over the course of years or even decades in a matter of weeks or months. Nor can you say flat out that your metabolism has been "healed" by such a diet. Has your system healed, or was it just healthy enough in the first place that over time it was capable of making the hormonal adjustments necessary to function well on a mixed diet? Can everybody make that leap?
The thing about leptin and insulin resistance... one of the effects of leptin is to decrease the appetite for carbohydrate. (Maybe by increasing ketosis? or at least lipolysis.) It's almost like carbohydrate restriction is built right into the system.;)

"...of note was the proven fact that ancient populations prized the fattest parts of the animal, brains, organs, and marrow from the bones..."

Proven?  How they do that?

FYI, a few tips I have picked up in the years I have been testing my BG,

For the least amount of pain sensation when lancing my finger, I take the blood sample from the *side* of my finger tip, *not* on the pad or the tip.    

If you have chronially cold hands it can be hard to get a good enough sample.  Wash hands with warm water first, dry well.  Swing arm in a big arc few times if necessary, to force more blood to the hands.  Sometimes my house is a bitt chilly but my car is warm from the sun in the driveway.  A few minutes sitting in the sunny car warms up my hands considerably, making a blood drop easy to get.

It's ok to slightly "milk" the finger from the palm to the tip once, but with warm hands and a few pre-lancing "swings" (described above), that shouldn't be necessary.  It shouldn't take a lot of "milking" to get a good enough sample.

There's no need to change the lancet tip for each test sample if you are the only one using the lancet (with clean hands, of course).  In fact, the lancet tips become more comfortable with use.  I change the tip only when it becomes dull and uncomfortable.  It goes without saying the lancet tip should always be changed if it is used to get a blood sample for another person.

Speaking of clean hands, be sure there is no sugar on your hands or it can affect your results.  

@ Dr Strange
Proven? How they do that?
A comparison of Paleo-Eskima and medieval Norse Bone Fat exploitation in Western Greenland. Alan Outram
He has a more recent paper "A New Approach to Identifying Bone Marrow and Grease Exploitation: Why the “Indeterminate” Fragments should not be Ignored" that goes into the proof in more detail but I can't find the full text free online.
His more recent work is also interesting.
The earliest horse harnessing and milking.

@ Anna
Thanks for tips. I've just started testing (following Dr D's suggestion)
Bit surprised at some of the numbers.
5.7=102mg/dl premeal
8.1=146mg/dl 1hr after meal
Chicken portion in curry sauce + carrots
Probably tikka sauce (bought ready meal sugar listed 3rd in marinade and in sauce. Won't buy that again.
Generally between 6.1 and 6.9 110mg/dl~125mg/dl

Dr. Strange,

There is so much Paleolithic archaeological proof that ancient populations prized brains, organs, and marrow from bones, that it boggles the mind.  Have you not read about the thousands of bones along with tools found in ancient caves? They were smashed to get at the brains and marrow.  I call your attention to the Quarterly Review Of Biology, Vol 79, No1 March 2004, one of the many studies and reports out there.  Meat eating - dietary shift to increased regular consumption of fatty animal tissues in the course of hominid evolution as mediated by selection for "meat adaptive" genes.  This selection conferred resistance to disease risks associated with meat eating also in life expectancy.  The data was produced at the University of southern California, Los Angeles California.  This argument is long over, unless you wish to ignore all of the indisputable archaeological proof available.  Lets get on with out of the box medicine which supports health.  

Billy E, nephropal.com

Coach Jeff said: Since an LC diet causes insulin resistance, (Actually a GOOD and protective thing within the context of an LC diet) . . .

I am new to this blog, got the link from the Taubes Talk yahoogroups board, and I am curious about this statement.  Why is IR good and protective?  I eat a very high fat diet, as well as low carb, as that is what seems to control my hypoglycemia the best, and so this statement seems counter-intuitive.  Or am I mistaken in thinking that hypoglycemia is a sign that one is developing insulin resistance?  If so, then it would seem that if something relieves the symptoms of hypoglycemia, then it is not leading to further insulin resistance.

Following Dr Davis's suggestion I bought a Lifescan Onetouch Ultraeasy from Ebay.
With too many readings higher than I expected, I needed a better way of recording numbers.
The people at the freephone number at this link
Lifescan Onetouch will send a cable and software to load and record your readings quickly and easily directly from the meter together with a simple Quick Start Manual.
As they don't charge for the disk it's quicker and easier than downloading the software, the cable makes the data transfer from meter even quicker.

People with different makes of meter may like to download the software anyway and enter their figures manually.
When you have entered a few days readings, the graphs make it easier to see trends.

I've always been skeptical about the concept that saturated fat increases insulin resistance and here's an article that addresses that fact directly:

http://wholehealthsource.blogspot.com/2010/02/saturated-fat-and-insulin-sensitivity.html

"I've always been skeptical about the concept that saturated fat increases insulin resistance..."

Compared to mono fat, not much if any difference.  Try comparing to very low fat diet ie about 10% of total calories and you will clearly see that fat in and of itself, if too much in diet, will indeed greatly increase IR.

@ Dr StrangeTry comparing to very low fat diet ie about 10% of total calories and you will clearly see that fat in and of itself, if too much in diet, will indeed greatly increase IR.
A between-group comparison also shows reduced body weight, WC, and homeostasis model assessment of insulin resistance in the MCT group compared with the LCT group at the end of the study.

Are you implying that all fats are equally bad?

Interesting to see what happens in practice when you compare low carb with low fat.
The Battle of the Diets: Is Anyone Winning (At Losing?)Christopher Gardner

Dr. Davis, I followed your advice and bought a glucometer. I got severe cravings from time to time. So last time I could not resist I checked my blood sugar. That was after I ate about 300g of nuts, drank a bottle of red wine and ate a big family chocolate bar. The glucometer showed 86 mg/dl which is within normal range. How is that possible?

Do you have any further recommendations what to look out for in a case like this? I would really like to find the reason and overcome those cravings. I'm not overweight, in fact more the athletic kind of guy. I started eating paleo/EF about a year ok and am doing mostly great except for the cravings.

Thank you!
Andreas

I have been using a vitamin supplement from Top Form Nutrition that contains Borage Seed oil, Flax Seed oil and Fish oil. It seems to work very well, i can feel an increase in energy.

Also i feel like im a little happier and in a better mood more often since taking it. Anyone else had similiar results taking a flax or fish oil supplement ?
http://www.mytopform.com/essential-fatty-acids.html

nice post

Flaxseed oil, or linolenic acid concentrate for that matter, do not accomplish any of these effects, all crucial if you are to gain control over your coronary plaque.