Hi Dr. Davis,

What is the maximum postprandial glucose level that we can see without seeing increased risk of heart/diabetes problems? I thought I saw 120 mg/dl somewhere. Is that it? It's hard to keep track of hundreds of blogs. I just learned about Heart Scan Blog last week.

I have tested my postprandial glucose per your suggestion, and it has been very helpful, but I wanted to note that neither oatmeal (1/2 cup dry) or bananas & apples raise my blood sugar above 115.

Truly normal, non-diabetic people will rarely if ever see a postprandial glucose peak much above 125, even with Cheerios.

Postprandial hyperglycemia is widespread in populations eating an industrial diet. Those of us who have been officially diagnosed with diabetes are just the tip of the iceberg.

It is interesting that you confirm that thin slender people which  you identify as "Lp(a)" types are so much less tolerant against high refined carbohydrates!

  In my subjective observation some of the most robust people on the standard (high carb medium fat) diet are of heavy set build ( Kapha/Phlegmatic).  

They are able to easily increase their adipose tissue which probably is their main defense against high blood glucose.

This protection comes at the price of putting up weight, sometimes a lot of weight. In some  rare cases their body weight can grow above 500lb before this protection mechanism stops, their adipose tissue stops expanding, and then - and only then - they get diabetes!  Not before, not while their fatty tissue is still growing!

In my personal opinion the only difference between the heavy set type people and us ("ascetic" body types) is that our adipose tissue is for some reason (genetic?) incapable of growing beyond a minimum (in my case I was only able to put up ~10lb extra at most) therefore our fatty tissue  is not able to scoop up as much excessive glucose out of our bloodstream as their therefore we get diabetes, on a very high refined carb diet, earlier and more severe than them.  

Our ONLY defense is as you have found too - minimize consumption of high carb food such as cereals, wheat, but also fruit and starches! I personally replaced such food with animal fat, eleven years ago and all my health problems, including mild angina, disappeared as if by miracle.

Regards,
Stan (Heretic)

So, Dr. Davis, would you say that one should never have foods that raise blood sugar?  I have a 1/2 banana and rice cake post workout with protein. Do you think I should stop this practice?

I might add that the Thanksgiving post-feast lethargy, conventionally attributed to tryptophan-overload, is likely due instead to carb overload (stuffing, mashed potatoes, cranberry sauce, two helpings of pie). Since I've been low carb, I've generally filled up on turkey and salad at such meals (much more turkey than my dining companions), and also had much more post-prandial energy.

Why in the world would anyone put skim milk in oatmeal (or anything else, for that matter)? Drinking skim milk and consuming lean protein without adequate fat is an excellent way to spike your blood sugar and deplete your body's fat soluble nutrients.  I'd be curious to see how much oatmeal raises blood sugar when eaten with butter and cream. Maybe I'll do that experiment myself.

I forgot to add that I tried cheerios experiment. My BG went from fasting 86 to PPG 140. I do stay active (lifting weights and running) but lately my diet has been terrible past two years. I actually used to follow low to moderate carbohydrates but being married and having an infant to deal with knocked me off the wagon. I recently got back on the wagon but I have to admit it, it has been rough start... Just have to make it to day 14th (I always found it to be much easier after 14th day or so).

Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?

Is this a one-hour reading or a two-hour reading that we're talking about?  And is 120 the best cut off to use?

We have several 'feral' apple trees around the property here. They don't make large fruits, but I've eaten up to 3 at a time (golf ball sized) and they never made me have a +40 spike. Other varieties of large store apples do, however. I was taught that the ADA recommends a 1 hour reading of no more than 180, and a 2 hour reading of no more than 140, where the 'after' reading is also less than 40 points higher than the beginning reading. So if you began at 100, you should never break 140. My standards, however, are quite a bit lower. Bring on the bacon and eggs, and I'll wait until Nature here provides me with small apples.

Technically, if a person gets two random blood sugars over 200 mg/dl it is enough to diagnose them as diabetic. That's according to the diagnostic criteria published by the ultra conservative American Diabetes Association.

Based on the research I've seen on this topic, any blood sugar over 163 mg/dl one hour after eating a high carb meal and/or over 120 mg/dl at two hours after the meal is abnormal.

Truly normal people will be back into the mid 80s two hours after eating a high carb meal. Their highest blood sugar will be about 120, which not so incidentally, is the level at which the incretin hormones seem to kick in and stimulate insulin release.

Dr. Davis, love the blog, am learning lots. And per your suggestion, have picked up a blood glucose meter to check how I respond to various carbs.

Just a minor title quibble tho. Are there really a lot of people eating oatmeal, Cheerios, apples or bananas that think they are low-carb?

Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

Amused and surprised that you have Quaker Oats ads running between your posts...flashing images of huge bowls of oatmeal filled with fruit.  I know it costs money to run a blog but how about screening advertisers to those who promote what you believe in and are advising folks to do?

Yes, it does show how corporate America lies to the public, but in a way you are assisting them with a platform.  Would you accept ads from Lovaza, Niaspan, etc?  

I guess it demonstrates why doctors partner with big pharma and others even when they know it's not beneficial...$$$.

Tony,

You probably still have an intact glucose regulation system, so your insulin production is robust and your insulin sensitivity is good.  You might be lucky enough to always have intact BG with grains.  

Many don't, though, and furthermore, most don't know it.  Insulin insufficiently and insulin resistance are very, very common.

I know from experience that one can seem to be quite healthy yet BG trouble is brewing below the surface for many years.  Even with a history of gestational diabetes (treated well with a LC diet), my doctors later had no idea how high my post-prandial BG goes (Cheerios can raise it to the mid-200s) because they tend to only suspect BG issues in obese patients and  they only checked FBG, which remain at the high end of normal because of my low carb intake.  

My own testing with Cheerios leads me to view it and other cold breakfast cereals as bowls of predigested sugar that creates roller coaster BG levels that don't feel good at all.  Steel-cut cooked oatmeal result in somewhat less high BG, but it still goes too high for too long.  For my own long-term health, my glucose meter tells me to ditch the cereals.

Those foods you listed Dr. Davis are not low-carb at all. I never eat them. What makes you think those are low-carb? Cheerios? Bananas? Oatmeal?

Switters--

Although I do not advocate using skim milk, most people do. So I chose that because it's so common.


Ellen--

No, I would regard that as a very high-sugar breakfast. It eventually catches up to you.


Beth--

Yes. While YOU may realize they do not belong in a low-carb diet, an incredible number of people think they do.

"Should we check our blood glucose 1 hour after the start of eating, or 1 hour after the end of our meal?"  I am bumping this question up as i would also love to have a definitive answer on it.  I know two people can sit to eat identical meals and one finish in 15 minutes and the other take 45-60.  This would make a large difference in the measurements depending on where you start time "zero"

Oatmeal & banana/blueberries ups my count by only 10 or so, less if I use oat bran; but I always have high-quality whole milk yogurt as the dairy portion.

Is there an A1C level that good glucose control would correspond to, given that your recommendations for post prandial glucose are significantly lower than the usual 140/1hour and 120/2 hour?

Dr Davis: I am confused how large populations of Chinese and Japanese people who eat a high starch diet continue to have relatively low rates of heart disease. I would think that white rice would cause a high post postprandial response.
I enjoy your posts but I need a full explanation to be convinced that you are correct on this point. Very sincerely, Bobby

Ok..., I'm really lost. Recently diagnosed with type 2 on oral meds and Byetta. I don't want my children to follow my path. Thought I was being a good Mom feeding them Cheerios and Oatmeal. So now what??? WHAT DO I FEED THEM???? DR. DAVIS WHERE DO I FIND A DIET PLAN FOR THEM???

I thought oatmeal was ok for some reason, because it's oatmeal, you know like what grandpa ate?
Spiked my sugar to 190.

I haven't eaten cereals, white breads or any potato products only for the last 3 weeks and my blood sugar has responded favorably.
Morning test was usually a 100-105 (yikes) now it's 85-90. I'm not sure of the ideal low end but maybe I can see 70 in a few months.

Great blog on diabetes, Jenny.

I wonder which yields a more accurate view of what's likely to happen as you get older?

Fasting blood sugar.
Post-prandial blood sugar.
Ha1c test.

All of these issues, including when to check blood sugar, what constitutes a desirable number, etc. are all addressed in detail in the Track Your Plaque Special Report, Postprandial Responses:
Part 3 - Carbohydrates and postprandial blood sugar at http://www.trackyourplaque.com/library/fl_04-022postprandialcarbs.asp in the open content section (first 8 or so pages).

Here's a comment on oatmeal - BG before breakfast - 125. Bowl of Quaker weight control Maple and Brown Sugar oatmeal (29 carbs, 6 g fiber, 1g sugar), 1 tablespoon of chia seeds (4 carbs,4 g Fiber), 1 scoop of flax seed (5 carbs, 4 G Fiber). Handful of pecans, splash of 2 percent milk.  BG reading 2 hours later - 181. No doubt, 210+ after an hour, but I didn't check then.  Despite all the fiber and the pecans as a source of fat to slow down the sugar rush, still no go. Moral of this story (for me) - back to eggs and meats.

Dr Davis: I have read the entire report and it doesn't address the issue that was the basis of my question: Why do starch based oriental cultures have a low incidence of heart disease. They also eat a low fat diet.
I look forward to your response. Many thanks, Bobby

Add me to the ranks of the low-carb eaters. I was taking Aciphex for acid reflux and discovered that PPIs have side effects such as osteoporosis, iron deficiency anemia and hip fracture. Other side effects of low stomach acid are too numerous to list here. I stopped taking them and read that high-glycemic foods (read: starchy, sugary carbs like fruit and grains) cause reflux. (See http://heartburncured.com/) By experimenting with my diet the past few days, I've found this to be true. Goodbye, starches and sugars.

I'm making a believer out of my diabetic mom, too. The other day, she had a few bites of a bagel, some apple sauce, oatmeal--and BG of 268. She slept all day, stoned on sugar. Today, after I told her 100 times that it's the carbs, she's having bacon, cottage cheese and an egg--and a lucid state of mind.

Bobby,

It could be that they are not really consuming high amount of starch carbohydrates. Media always made it sound like they consume a lot of carbohydrates but the reality is that they may not really be consuming. However, things are changing as it's cheaper to produce processed foods so things will likely change for those people one day. It could be that they are more active as well slowing down heart disease progression. Cancers may get them first before heart disease happens. It's hard to know unless you actually travel there and observe them in person. It may not be what you think. It's really apple vs orange. Dr. Davis is specifically talking about USA population.

Do you think that postprandial glucose response to a fixed meal is a good way to evaluate the effectiveness of a diet regimen?  I'm wondering how I can compare various diet alternatives (intermittent fasting vs. paleo, for example, because I don't have the willpower to do both) with simple tests.  Blood glucose tests are very appealing to me because they are easy to do at home.

http://patrissimo.livejournal.com/1313795.html

I feel like I am whipping a dead pony here but feel I must repeat this:  Increasing dietary fat increases insulin resistance.  It takes several weeks (at bare minimum 10-14 days) of dietary fat intake of 8-10% (and no more fat than that) for the body to adjust.  Once that happens, your readings will be totally different for a high UNrefined carb meal.  And I must emphasize that only one higher fat meal may re-establish your previous level of insulin resistance for several days to weeks once again.  Eating eggs, meats, high fat diet day after day and then one high carb meal is an altogether different experiment and does not tell you in any way how you would fair on a consistently low fat, high UNrefined carb diet.

Really, once insulin resistance is reduced you will get totally different readings even for a refined carb meal as in a glucose tolerance test.

Bobby,

There's so much more to it than simply the amount of starch in the diet.  Starch is probably fine if the metabolism is functioning as it should.  But western diet and lifestyles often lead to a high amount of metabolic dysfunction, which eventually progresses to impaired glucose (& starch)  tolerance and finally diabetes.  Note that even in industrial Japan (where the diet has changed much in the past several decades), the rate of T2 diabetes incidence is quickly rising in the young.  

This is a huge topic and there isn't enough discussion about it when various "traditional" diets are compared.

Dr. Strange--

Sorry, but I don't buy it.

I've seen the opposite effect play out countless times: High fasting glucoses and high postprandial glucoses normalize with reductions in carbohydrates, increases in fats.

I saw this effect in myself over 15 years ago when I was diabetic. Now, I am no longer diabetic due to increased fats, dramatically reduced carbohydrates.

Bobby--

Perhaps a topic for a future discussion.

Being part Japanese, I can tell you that rice is typicaly eaten sprinkled with rice vinegar. That alone can modify glycemic responses.

Also, I don't believe that the Japanese diet is that high-carbohydrate. Miso, nori, mebushi, fish, natto, tofu, etc.--aside from rice, these staples are low-carb or zero-carb.

Also, check your blood sugar after rice; Nothing like wheat or sugars.

Dr. Davis: Thanks for the reply. I would love you discuss this topic in more detail in the future.
Respectfully, I do take issue with your statement that the Japanese diet is not primarily a high carb diet. I lived in Japan for a few months and even lived with a family there. Our diet was primarily rice. Seaweeds and small amounts of fish were added, but it was basically a low carb, low fat diet. I absolutely agree that wheat played not part in their diet.
I have enjoyed the topic. Bobby

Dr.Davis, yes of course your blood sugar normalized when you drastically reduced carbs and increased fat!  You stopped eating foods directly convert to blood glucose!  The body can run on primarily glucose from carbs or by converting fats via ketosis, yes?

What I am talking about takes a couple weeks at minimum to occur and that is a dramatic reduction in insulin resistance when dietary fats are consistently reduced to 8-10% total calories.

The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once.  That seems to be where the big problems arise and is the SAD, high carb/high fat diet.  Also of course, SAD is high junk, fake food which greatly exacerbates the problems.

The misunderstanding comes and is continually repeated because people try one meal of high carb after eating high fat over time so their body has fairly high IR.  You must eat very low fat, every single meal, for a couple weeks minimum to see the effect I am talking about and some people take longer than that for their bodies to loose the IR

Of topic, for which I apologise Dr. Davis, but here is an article in the mainstream media which questions the efficacy of omega-3 likening the taking of it to a "cult". - The cult of omega-3

http://news.bbc.co.uk/1/hi/magazine/8543172.stm

From the article: "There's no evidence that omega-3 reduces the risk of death or heart attack or stroke or anything like that in those of us who have not recently had a heart attack,"

Somewhat tangential, but anyone see the report on President Obama's cholesterol checkup:

138 LDL
62 HDL
  9 (calc from TC)

209 TC

It is interesting that even the President gets just the same old calculated rather than measured cholesterol test.

Dr. Strange--

Fifteen years ago, I went on the Ornish diet: no meat, no oils, just vegetables, fruits, legumes, and whole grains. I also jogged 5-8 miles per day.

I gained 30 lbs and became diabetic with blood sugars of 167 mg/dl or so.

While my personal experience does not prove or disprove the concept, I've witnessed this phenomenon many, many times.

Conversely, I have never seen anybody become a diabetic on a high-fat diet.

FWIW, I measured BG before & after a breakfast of 1/2 cup oatmeal -- 94 before, 115 (1 hour) after.  That was with 1/4 cup ground flax, a handful of frozen cranberries (whole, no sugar) and 2 T of heavy cream.

I have read that eating fat with carb lowers the effective glycemic index, which may help explain why the BG didn't rise much.

Beth

I learn so much from your blog here and at Health Central, Dr. Davis.  Thank you for the time you put into these free blogs.
I am not diabetic but had gestational diabetes with each of my three pregnancies so I am very interested in doing things to help me not become diabetic.  I have tested my blood sugar after eating old fashioned oatmeal with nuts and a dash of milk and it stays below 100, very surprising.  However if I eat a meal of tomato soup and grilled cheese sandwich it will go over 160.  In testing like I do, I am learning what I can eat and what food combinations work for now.  I'll keep checking as time goes on.
Char

Well, I bought a $10 'True" meter at Walgreens. Fasting reading after 9 hours of no food or drink,(morning) 91.  Ate two eggs cooked in butter, had a bagel ( I know, I know) with Skippy peanut butter on it. Waited 70  minutes, got a reading of 93. Hmmmm......I'm pretty sure everything is calibrated right. Does that second reading make sense?

Dr Strange:

"The body seems to work either way, running primarily on carbs OR primarily on fats BUT NOT on both at once."

That's right but how can you control how much fat or glucose your body uses? As Dr. Davis mentioned Ornish type diet + aerobic exercise does not work.

I don't say that you are complete wrong of course. Insulin resistance is usually related to increased fatty acid avaibility and that will lead to the wise comment made by Stan (Heretic). When your subcutaneous adipose tissue functions normally you do not accumulate visceral fat and get metabolic syndrome and/or T2DM.

I don't know if low carb will eventually restore health but it will certainly give more time and low blood glucose rapidly. But there may be limitations to low carb also since you have only limited access to decide what your body does with ingested foods.

Westie, actually an Ornish type diet does work IF you do NOT eat refined carbs.  You have to only eat real, whole plant foods, as close to intact as possible.  Refined carbs will alway spike bg and raise triglyerides etc.  Some people do not do well on low carb diets.  I did Bernstein's version, very strict, for about 9 months and felt worse and worse as time went on.  Low low energy, irritable, post exercise exhaustion that would last 24-48 hours, absolutely no endurance.  Yes my blood sugar was good but it is even better on McDougall (Ornish type) diet.  My lipid profile is good.  I feel much better in every respect, much more healthy.  The diet does work and well!

DrStrange, loss of energy is very bad thing and I'm glad you found a way to overcome that.

McDougall diet sounds very...hmmm...American. Avoiding fats and cholesterol seems to be a main goal. That seems to me quite stupid but I'm not a doctor so lack of knowledge could explain that.

Like most diets designed by professionals McDougall diet has very good points but McDougall +fat +cholesterol +animal protein could do better.

I don't know where these guys have come to the conclusion that if you don't eat fat you don't "have it". Every day most of the energy one uses comes from fats even on a McDougall diet.

McDougall diet does not avoid fat, only no added, extracted fat.  Whatever is present already in plants is good for you and necessary.  Some people (me)(not all) add an ounce or so of flax or chia to get some additional omega 3 to balance the predominance of omega 6 in most veg and grains.  And no, you are not getting most of your calories from fat as the starches in the complex carbs convert quickly directly to glucose which is your energy source.  If you stuff yourself and overeat and get too many calories, then yes you get conversion of glucose to fat but it will go to storage.  Eating that kind of diet, your physiology is tuned to burning glucose and you will have plenty of glucose to burn, so you will store that fat.  Also, if you eat refined carbs, added sweeteners, dried fruit, things that spike blood sugar too high, then some of that will be converted to triglycerides and fat.

Dr McDougall calls his diet "starch centered" as that is the source of fuel, starch converted to glucose.  This as opposed to a fat centered diet ie low carb, where you get your calories from burning fat.  Really not "American" but global as most traditional diets were/are starch centered with small amounts of animal products and mostly a wide variety of produce.

DrStrange- you seem to be ignoring Dr. Davis's comment- Ornish did not work well for him (or for most people that I'm aware of).  I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet.  There are people with carnitine defiencies or genetic defects that reduce fatty acid translocation across the mitochondria (such as palmitoylcarnitine transferase deficiency) who cannot use fatty acids effectively for fuel and must eat a high carb diet for energy.  But those people and types of metabolism are rare.  Perhaps you are one of them.

Cynthia

DrStrange, if you eat low fat de novo lipogenesis increases automaticly. Fatty acid formation increases both in liver and in adipose tissue. With healthy insulin  sensitivity there are no problems with that. It's totally fine and healthy.

Thinking that avoiding fat and staying on starch keeps fat out of the body is simple wrong and it is usually part of intentional marketing or unintentional black & white type thinking (stupidity?).

Avoiding fat in fact leads to "hardening" of your lipid profile in AT since glucose is metabolized to palmitic acid in the liver and then transported to storage.

McDougall diet has excellent ingredients but thinking that cholesterol or animal fat will automaticly lead to overweight and disease is truely false. You can claim it to be true and believe it but I'm sorry to say it seems to be false.

Glucose and fats both makes important fuels and I personally love them both.

Cynthia wrote:

"I can't imagine anyone with "normal" metabolism who would not do better on a low carb diet."

If a persons health is dependent on some kind of a restricting diet can you say that person has a healthy metabolism? It can be seen as "normal" but it sure isn't healthy. For type 2 diabetics low carb will bring lot of help and quite fast but will it make carbs bad? Not in my opinion.

Things that cause metabolic syndrome, heart disease or other illnesses should be blaimed. Loss of insulin sensitivity is bad and restricting low calorie diets are bad. Most natural way to heal your metabolism is not through restriction, but through giving your body what it needs to recover and stay in good health and shape.

I use to be a vegetarian.  I went months of eating nothing but whole grain (not just "brown" but things like millet and such) and veggies and fruit along with low or no fat protein sources like beans (I soaked them myself so they weren't even canned).  The only oils came from the very small amount of olive or canola oil I used in cooking.  My total fat was right about 10%.  After about 6 months my triglicerides had skyrocketed, my cholesterol was the same as it was before I started, my weight had increased and I was diagnosed with hypothyroidism, which I believe was directly correlated with the amount of "healthy, whole, natural" carbohydrates in my very low fat "healthy" diet.  I subsequently was also diagnosed diabetic.  I am now a 2 year low-carber.  My triglicerides have plummeted, my cholesterol is lower, and my HgA1C is under 6.0.  I have also lost 70 lbs.  Some people may or may not do better with low fat, non-refined carbs, but for me it not only did not improve my health, it nearly killed me.

Here is a link from my website (www.dsolve.com) with some charts/graphs of what normal blood sugars look like compared to diabetics:
http://www.dsolve.com/news-aamp-info-othermenu-60/23-diabetes-solution/159-news

Hope this is a useful reference for what is "normal".

I've been so fatigued that will mean that I'm diabetic is because every time I ate sweet things I comes to feel a little bit bad

First of all very thanks for providing this nice tips list.one has to follow it strictly to get good health.


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Oatmeal yields high blood sugars. Even if your fasting blood sugar is 90 mg/dl, a bowl of oatmeal with skim milk, walnuts, and some berries will yield blood sugars of 150-200 mg/dl in many people.

Um. What is it with all this talk of skim milk and 2%? Are you guys serious? I don't mess around with that white poison anymore. Use raw milk or cream. Never pasteurized milk.

Also, soaking oats in an acidic base drastically changes the composition of the oats, reducing phytates and improving digestion and nutrient absorption.

Here's my oatmeal:
- soak raw oats in raw whey overnight
- dehydrate at 150 degress until crisp/dry
- one cup of prepared oatmeal in a bowl.
- one tablespoon of grass fed pasture butter
- three tablespoons of heavy cream (no additives of any kind) or raw grass fed whole milk.
- one teaspoon of raw unprocessed honey and maybe a pinch of pure stevia powder.

optionals:
- 4 or 5 soaked/dehyrdated raw almonds or pecans
- 4 or 5 blueberries

Carb heavy? maybe a bit, but it's also loaded with high quality fats and proteins.

I certainly wouldn't eat this daily because it's too many carbs and too much fiber, but 1-2 times a week of this type of oatmeal is fine and quite nutrient dense.

Wow! even better. Don't dehydrate the oats. Just drain after soaking in water (with whey) and put the soaked oats in a glass casserole dish.

Add in some coconut oil, maybe a bit of raw honey and/or stevia, cinnamon, real vanilla, and bake at 350 degrees for 35 minutes.

Cut a nice piece out and add some cream and pasture butter, maybe a few blueberries.

#1 your whole house will smell like the holiday season.

#2 you will have a nutrient filled serving of soaked oatmeal.

I'd imagine though, with the honey and the oats, that even a normal sized serving will be on the higher side in carbs, so you wouldn't want to eat this all the time and you wouldn't want to have carb heavy foods for the remainder of your day.

I know Dr Davis doesn't recommend oatmeal or butter, but if you're gonna do it you may as well do it right and I think this is leagues better than the instant garbage most people eat every single day. blucchhkk!

-Jack K.

Dr Davis,

What do you recommend for carbs for athletes?

I work out 5 days, extremely hard (crossfit/weightlifting type of stuff)

If I dip too low, I am super sluggish. Even after months of trying to be very high fat Paleo.

My Blog, low carb-high fat never worked for me.  I struggled with it and tried to "make" my body adapt for 9 months and just continually felt worse and worse.  If I worked out even moderately for an hour or so I would have to sleep after and then be wasted the rest of the day and sometimes even part of the next day.

I now eat the diet proposed by Joel Fuhrman, M.D. (Eat to Live aka ETL) with zero refined carbs but a lot of carbs some starchy vegetables and lots of beans. Raw seeds and nuts for fat and EFA.  I do supplement omega 3 (vegan DHA) and vitamins D and B-12. I do eat meat but only very small amounts occasionally.  I have plenty of energy and all my test numbers are excellent.

Of course, what a great site and informative posts, I will add backlink - bookmark this site? Regards, Reader.

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Hi, I just found your blog. Very interesting

I'm curious...on average, what percent of your patients follow a vegan diet?

Cheers,
Kristen Suzanne

Interesting. Do you think the same applies to potatoes? I know that french fries are a major downfall for many people.

Dr Davis,

If your patient had a fasting blood sugar of 122 she was most certainly fully diabetic, and her post-meal blood sugars, with carbs were likely in the high 200s.

So the problem with that cracker might not have been that wheat is addictive but that in a person with diabetes the blood sugar spike caused by eating carbs causes relentless overwhelming physiological hunger.

If that is understood, it is much easier to stop the cycle. If people interpret the physiological hunger as emotional--a personal weakness--it is much harder to deal with.

But most importantly, this woman needed to be monitoring her post-meal blood sugar spikes no matter what she was eating. Had she seen the spike, she would have understood why she was so hungry, and if she was able to flatten that spike, she could have avoided the regain.

I do not believe wheat is addictive, and I also believe VERY strongly after ten years of dealing with a low carb diet that if a person does not learn how to deal with the occasional off-plan day, and the resulting physiological hunger, it is only a matter of time until they DO crash off the diet.

I've seen it far too often. People go two or three years on the diet and then, because they haven't learned how to go on and off it, they fail dramatically.

So rather than demonizing wheat or carbs, let's put some effort into teaching people how to deal with the inevitable hunger that results from creating a high blood sugar spike so that they can lose their fear of carby foods and maintain the diet for many years.

P.S. I learned this lesson the very hard way--three years of perfection, total regain, and now heading into year 6 of doing much better because I can go on and off the very low carb diet without regain.

--Jenny Ruhl

Hi, Jenny--

Thanks for your comments. I agree with your observations on her blood sugar.

However, I strong disagree with the "wheat is not addictive" idea. I would warn you that it is dangerous to extrapolate broad truths from your single, personal experience. I have witnessed this in over 500 patients now. It is not true for everybody, but it is very true for many. Wheat products are unique. They also exert peculiar and exaggerated effects on lipoproteins, particularly small LDL. Even without the addictive quality, if you watch lipoproteins, you will see large effects just with elimination of wheat, effects that extend far beyond blood sugar.  

I suspect that you do not have a wheat addiction. The comments from people who are spared this pattern are incomprehension or opposition. But, for some people, it is like a cloud lifted. And it is largely specific for wheat.

I have to second Dr Davis opinion on wheat. I have found that eating any type of wheat -  even the 100% Bran crackers suitable for diabetics gives me a insatiable hunger. I don't get the same effect from eating a comparable amount of carbs via starchy vegetables or oat bran cereal

Peace

Joe E O

I didn't think it was possible, but after seeing it, believe my mom is a wheataholic.  She has avoid wheat     a # of times, and each times she has done so she lost weight, and her blood pressure dropped nicely.  Unfortunately she has not been able to stick with the diet.  She goes  back to her old wheat eating ways and the weight came back.    

This morning I heard mom and dad got into a somewhat heated debate over a bran muffin mom was eying.  Never thought I would see the day a bran muffin caused an argument.

Totally agree with you doc. We see a major wheat addiction problem with several of our patients. Not all of them, but a substantial percentage really struggle giving it up. There's some info "out there" on gluten exorphins - have you ever looked into it?

Darcy

Wheat protein contains a number of opiod peptides which can be released during digestion. Some of these are thought to affect the central and peripheral nervous systems.

When I gave up gluten, I felt much worse for a few days. This is a very common reaction in those who stop eating gluten cold turkey.

Anne

I have low carbed since 03 and thought I was a master, no wheat passed these lips. Then one Christmas they did and since then, 06 I struggle to stay on my low carb clean program, I wish I had never 'fallen" off the wagon.

Eating wheat was the trigger as it triggered cravings for me............ that were worse than in my "fat" yrs.

I liken the addiction is same as drugs or booze, to me its no different. I come from a background of numerous alcoholics, diabetics and have nursing and psychology background.I am diabetic. I can see both things play a role with me, but have to say that to me wheat is like an addiction.

I believe these soft comfort foods  escalate the bg, also signal to our brain the soothing of any emotions and very quickly we become psychologically and physiologically addicted to higher carb foods like wheat.

Our first food is pablum, baby biscuits, the brain learns quickly this sweet soft food is soothing and quickly we become addicted to this.

When I am really stressed my "drug" of choice is wheat products, yet I am educated, I know the drill yet my body craves something with wheat.
Its an addiction to me, I have control of this addiction and craving if I keep my bg within normal so struggle with living with this insight.

Sometimes my bg goes up after bigger low carb meal but doesn't provoke cravings as much as having just a cracker or 2 while I am out..it makes me want to have more..I can identify 110% with Claire.

chick

Well, I had such a strong craving to wheat that I switched to rice products, thinking that anything would be better than wheat. But I became just as addicted to rice as wheat. In fact, I don't even miss wheat products because there are so many rice products. I imagine if more baked goods were made of corn, instead of wheat or rice, then I'd be addicted to that. I agree there is a wheat addition for many, but for me it's the sugar high or the temporary good feelings I derive simply from eating a flour product.

Vita

I just saw an interesting piece of research suggesting also that artificial sweeteners have an effect on the brain that triggers sugar/carb craving. This was in rodents; anyone aware of human studies? Certainly nothing the makers of splenda or nutrasweet are going to fund . . .

Dr. Davis,

I've been thinking about your response to my earlier comment, and wanted to raise a couple more issues.

Though I cited my own experiences in the comment, I've been active in online discussion groups for both low carb diets and diabetes for almost a decade now. And what I've observed over this period is that people who are low carbing who do NOT have diabetes or who have diabetes controlled only by a low carb diet are almost always the people who report "wheat addiction. "

But what is fascinating--and was a real "Aha!" for me, is that hundreds of people with diabetes active online who gauge what they can eat by measuring their blood sugar after meals and eliminating blood sugar spikes, even mild ones,  with a combination of diet, safe meds and insulin do NOT report this wheat addiction issue, and most interestingly, they do manage to eat small amounts of wheat without going off the rails.  Most of them do not eat more than 120 g of carbs a day and many eat far less.  

The only thing people with diabetes do report occasionally about wheat is that wheat ramps up heart burn.

But people with diabetes have access to drugs, including insulin, that can flatten blood sugar which people without it do not have. And many of us find that even though we did not think our blood sugar spikes were that bad while controlling on diet alone--I sure didn't--when we add appropriate drugs we realize that we were experiencing a lot of hunger and that with the right meds it abates dramatically.

This, not only my own experience, is why I believe that wheat addiction may really be pointing to blood sugar spiking and the related relentless hunger. Wheat is among the very fastest carbs--much faster than rice or most forms of cooked potatoes. This must not be underestimated.

You say people who haven't experienced wheat addiction cannot imagine it. But what I'm saying is that people who have not experienced blood sugar-related hunger can have NO idea how overwhelming it can be and how it can push a person into a binge that is very hard to end. The two may be more related than you think. When I was controlling with diet alone wheat always made me terribly hungry. Add a bit of meal-time insulin timed properly and suddenly  wheat is just another food.

Over my decade of watching people try to do the Low Carb WOE without blood sugar meds I have seen that very very few people are able to stick with the diet for more than 5 years and that the binge that gets out of control is all too frequent.

So I think anyone who is trying to help people with their carb issues HAS to address the problem of teaching people how to get back on plan when they go off and how to deal with the hunger that comes from unaccustomed blood sugar spiking. Even if wheat addiction turns out to be a true physiological problem, people ARE going to eat wheat eventually, and if they panic and believe that they are now helpless in the face of their addiction, which is the kind of thinking that the addiction model tends to encourage that isn't helpful!

So rather than build a fear of food  it is much more skillful to give people the tools they need to get back on track after they eat something that kicks up physiological hunger. This involves a combination of physiological and psychological tools.

The people who succeed long term on the low carb diet do appear to be hose who learn how to get back on after they go off.

And what I have learned in my years online is that the people with diabetes who have controlled carb intake very well for very long periods of time are those who take a more relaxed approach and have learned how to recover from overdoing it. That is why over my own decade of eating LC, I've moved from a very strict to a much more flexible approach that does not demonize any food on keeping a flat blood sugar no matter what is eaten.

I am hearing recently from quite a few medical professionals who have gotten religion about cutting carbs over the past few years, and I'm very glad they have, but I think there is a certain extremism that we all go through that is an obstacle to making it through the decades of tight control we need to preserve health.

I'm very glad that you do take the positions you take, my comments are mostly directed at making it possible for your current patients to continue their success a decade and two or three decades hence!

Isn't if possible that wheat can be addictive, raise blood glucose. cause antibody reactions, damage organs and syetems and worsen lipids? That does not mean that everyone who eats wheat will have all or any of these reactions. There are hundreds of complex proteins in wheat. It makes sense they could cause multiple effects.

I have an antibody reaction to wheat (gluten) and do have to watch out for the smallest crumb as it will make me ill.  Before I went gluten free, wheat was my favorite food. I craved it constantly. Perhaps this craving was related to increased blood glucose (BG) levels as I have found out that starches and sugars cause BG spikes. I have been able to  level them out with diet alone so far. I will never find out what wheat would do to my BG. As a person who is gluten sensitive, wheat is my enemy.

Approximately 1% of the population has celiac disease - this is an autoimmune disease cause by wheat and other related grains. A growing number of doctors are saying that non-celiac gluten sensitivity affects at least 10% of the population.

Jenny,
You say "people ARE going to eat wheat eventually".

Why do you think this is?  Why not just avoid wheat?  If a diabetic can eat wheat because they are medicated doesn't that mean without medication wheat causes too many cravings.  So for us un-medicated lot its probably better to avoid wheat.

(BTW I like your blog).

Dr. Davis,

  I share your feeling that wheat is unique.  My opinion comes from researching and comparing different pre-industrial populations throughout the world.  Many of them eat high-carb diets and do just fine, but as soon as you throw wheat and sugar into the mix, they become overweight and unhealthy.  The story has repeated itself over and over again throughout history, and I've posted about it on my blog several times.

I sometimes speculate on why this may be.  I have two ideas: first, the lectin wheat germ agglutinin (WGA) has an affinity for the leptin receptor, and can be found in the serum of some people.  It competes with leptin for binding at the receptor.  Overweight people are typically leptin-resistant.  I think you can understand the implications!  This hasn't been demonstrated in vivo.

The second mechanism is through damage of the upper intestinal tract.  Gluten (and possibly other wheat toxins as well) is probably not good for anyone, and Celiac patients are probably just one end of the spectrum.  Innate immune responses are observed even in non-Celiac patient gut biopsies challenged with gliadin fragments.  The upper small intestine is intimately involved in regulating satiety and insulin release/sensitivity through hormone release and vagal signals to the brain/liver.  Thus, immune activation and/or frank damage could pervert these signals.

Jenny: "Even if wheat addiction turns out to be a true physiological problem, people ARE going to eat wheat eventually,"

This sounds like saying that people are going to drink alcohol, even if they know they are alcoholic. Smart people would eliminate a food if it caused them to suffer cravings and frequent binges. Many people should realize they are addicted to sugar, and milk. For example, anybody who routinely gobbles down a pint/quart of ice cream in a day or two. Those people should never eat milk/sugar. You are right that many of them do, or will, but this is self-delusion, like an alcoholic saying "just one" drink, then stopping at five.

"The people who succeed long term on the low carb diet do appear to be hose who learn how to get back on after they go off."

Change low-carb to alcohol-free and see if that theory still applies. I think if a food causes cravings and binges, it should be eliminated for ever. Some people can eat junk food in moderation, or they can binge on it and not become fat, because they have a fast metabolism. That should not imply that junk food is healthy or that people need to learn how to recover from a binge. They need to fortify their diet with nutritious, satisfying food, so they don't have any inclination to binge. Bingeing is caused by deficiencies, IMO. You don't binge or have any interest in bad food when you are eating right.

I have a carb addiction myself and I agree with Jenny.

The reason I say I have an "addiction" to carbs is because of my experience when I did a low-fat diet for a few years.  If I had a bad day, extra pasta seemed to make me feel better.  If I couldn't sleep, a bagel would knock me right out.  This is not a "normal" reaction to carbs; this is more how people use alcohol than carbs.  For *me*, carbs are like a drug.

Every time I go off low-carb, when I go back on, I have horrible cravings, headaches and feel sickly for a few days.  It's exactly like a withdrawal process.  The misery of going through induction again is often what keeps me *on* my diet, not wanting to feel that way.  It's not just that my bg will be high for a day or two if I cheat, but that I'll feel like crap for several days.

So I low-carb, but not *very* low-carb.  Around 60-80g/day most of the time, which lets me have small servings of fruit and my preferred grains, barely and buckwheat, and a low-carb tortilla now and then.  This is as low as I can go long-term which is why I don't do seriously strict low-carb ala Bernstein; this is what I can live with.

But I do cheat sometimes.  The longer the cheat, the longer I feel like hell when I go back on low-carb.  I can "afford" to cheat once a month for *one* meal and get back on low-carb with only a day of feeling minorly poorly, but if I "cheat" for a whole day, I feel badly for 2-3 days before being OK.

I also agree with Jenny about managing cheats.  This is the deal... I'm just not ever going to agree to never, ever eat a cracker again!  I don't even *like* crackers that much, but if I have to *never* eat them again, I'm going to be craving them immediately!  I'll be having dreams about Ritz and thinking about Saltines all day and start fantasizing about Sociables instead of sex!  

This is actually why I *do* plan to "cheat" once a month.  Psychologically, I can't deal with "never", but I can deal with postponing for a couple weeks.    Having cheated LOADS of times is how I *know* I can "afford" it for exactly *one* meal per month without going off the wagon or screwing my bg up too badly.  

It's not specifically about wheat for me.  I tolerate low-carb tortillas 2-3x/week in my normal diet just fine without falling off the wagon.  I can use a bit of wheat flour or cornstarch to thicken a dish without any problem - if it's little enough over a bunch of servings.  

Conversely, ANY type of carb can cause me to fall off the wagon - potatoes, sugar itself, even fruit.  Once the straw that broke the camel's back for me was tangerines, a normally healthy food, but not so much if you're diabetic and on your third one.  

For me, it's about insulin resistance (IR).  When bg is elevated, the pancreas keeps producing insulin in an attempt to reduce bg.  Meanwhile, the high bg itself increases IR, so in spite of the insulin, very little glucose enters the cells.  In short, you have both insulin-induced hunger *and* a cellular-level hunger occurring.

If you give in to your hunger and eat, bg rises, therefore increasing insulin and further reducing it's effectiveness.  

With your cells not getting fed, you're fatigued and weak too.  So you not only overeat and get fat, but are "lazy" also.  

It's a very, very vicious circle that you can only break by cutting the carbs and going through withdrawal until your bg is controlled again.  

For me, the type of hunger I feel on a high-carb diet is literally painful, it can wake me from sleep.  It takes a lot of willpower to ignore that, which is part of what makes reinducting so difficult (besides that it feels awful).  

On the other hand, on low-carb, hunger is a very minor feeling that I can easily ignore all day if I'm busy or distracted.  It's a whole other ballgame.  

I know some people have very specific wheat issues, such as gluten intolerance.  

But I don't see anything in your description of this lady's problem from the cracker that distinguishes it from problems I've seen other low-carb folks suffer from potato chips.  Like Jenny, I've been on low-carb forums and newsgroups for years.  I can't even tell you how many times someone comes back after being gone a few months or years and sheepishly admits they fell off the wagon and gained back 100 lbs.  It doesn't have to be wheat that kickstarted the binge, could be sugar, potatoes, corn - like I said, for me personally, once it was tangerines.  

Wheat is a very pervasive carb source due to baked products, so it's *often* wheat that causes the problem.  But I bet that lady could've had the same reaction from a chocolate candy bar.

There's an old saying: "If you fail to plan, you plan to fail." Why eat foods that cause even a day of less health and quality of life? You say you can't deal with "never" eating another cracker, but do not really like crackers. I haven't eaten any crackers in years. If you have to eat grains, there are better foods like sprouted breads or yeast-free sourdough from a health store. Why not eat those instead of crackers? The foods you "can't live without" are probably the foods you need to avoid. If crackers disappeared from the face of the Earth, you wouldn't die the next day from stress. You'd simply eat other foods. Why's it so hard to do that? Pretend there's no such thing as crackers, cookies, or other baked goods. The world is not going to end if those foods go away forever. Neither are you.

Even at 167 lbs--still overweight--Claire looked great. She glowed. She'd already dropped nearly 2 1/2 inches from her waist. She felt lighter on her feet, discovered energy she thought she'd lost 10 years earlier. Her blood results matched, with dramatic shifts in each and every pattern.

Your comment “have a longer lasting durability than a stent which could buy you a couple of years before your next procedure or heart castarophe” blew my socks off! Almost two years ago I had what was called a minor heart attack resulting in a stent. Unlike the profile you describe though (ie “free and easy life…”), I was always a keen exerciser and was careful with my diet (no meat for example) … and now even more so, following many of the regimens you recommend. So maybe my chances are better than “a couple of years”. What’s your view?

Yes, you are not the average patient after angioplasty.

Most remain miserably trapped in the American lifestyle and/or victims  of the Heart Association's mis-guided diet and lifestyle recommendations.

For every one person like you, there are hundreds of people who either don't care enough to make a difference in their lives, or follow the unwise advice from conventional sources.

I appreciated your quick reply. I'm wondering from your treatment experience just how long you would say a stent is expected to last trouble free, for those who are generally fit, and abide by the 'track your plaque' lifestyle. Or perhaps you know of a source that has such information.

I'm afraid that the Track Your Plaque program has dramatic effects on the inhibiting growth of plaque in coronary arteries, not necessarily in an area with a stent, which is subject to a whole new set of rules.

Unfortunately, there is NO health program that has any effect on growth of tissue in stents in the first year or two, thus drug-coated stents and the like.

The statin or Apo A1 milano reversal studies showed regression by IVUS.  Regression as cited on this site refers to a score from a scan.  What is the correlation between the calcium scores and plaque volume as measured by IVUS.  

While I agree with almost everything you popularize on your site and believe in the lifestyle changes I am not sure the world will accept this without a double blind trial of lifestyle changes you espouse and with endpoints measured by both hard events and indirect measures such as IVUS.

You are absolutely right. There are no data comparing the effects of IVUS vs. CT heart scan scores.

It can be done, obviously, but the logistical difficulties would be considerable. I have done nearly a thousand intracoronary ultrasound procedures. They are invasive procedures that carry real risk. CT heart scans are like an EKG--simple, virtually no risk. Each test would have to be done twice: once at the beginning, and then again at the end of a treatment program.

Dr Davis
I am confused. In one blog (about Mel) you are concerned his 799 score poses a real threat but in another blog ( about Grady ) his high (1000+score)
is brought down 17% and he has little to fear,
according to you.
Wouldn't Grady with a still higher score than Mel
be at a real threat also.
Thanks
Gene Mc

That's absolutely right.

When you are tracking heart scan scores, it's the relative change, not the absolute score, that assumes prime importance. I blogged about this phenomenon some time back in I wrote about this phemonenon in a previous Blog: When is a heart scan score of 400 better than 200?  at http://heartscanblog.blogspot.com/
2006_09_01_archive.html. (I know, I've got to organize these posts better.)

Because it's your way to stack the odds enormously in your favor of 1) surviving the appearance of symptoms, 2) avoiding the prospect of heart procedures, which are not as clean and easy as they often seem, 3) have a longer lasting durability than a stent which could buy you a couple of years before your next procedure or heart catastrophe, and 4) it's the right thing to do for the sake of the huge societal cost of heart disease.

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