A glycation rock and a hard place

12. January 2011 William Davis (15)
Advanced Glycation End-products, or AGEs, the stuff of aging that mucks up brains, kidneys, and arteries, develop via two different routes: endogenous (from within the body) and exogenous (from outside the body).

Endogenous AGEs develop via glycation. Glycation of proteins in the body occurs when there are glucose excursions above normal. For instance, a blood glucose of 150 mg/dl after your bowl of stone-ground oatmeal causes glycation of proteins left and right, from the proteins in the lens of your eyes (cataracts), to the proteins in your kidneys (proteinuria and kidney dysfunction), to skin cells (wrinkles), to cartilage (brittle cartilage followed by arthritis), to LDL particles, especially small LDL particles (atherosclerosis).

At what blood sugar level does glycation occur? It occurs even at "normal" glucose levels below 100 mg/dl (with measurable long-term cardiovascular effects as low as 83 mg/dl). In other words, some level of glycation proceeds even at blood glucose levels regarded as normal.

There's nothing we can do about the low-level of glycation that occurs at low blood sugar levels of, say, 90 mg/dl or less. However, we can indeed do a lot to not allow glycation to proceed more rapidly, as it inevitably will at blood sugar levels higher than 90 mg/dl.

How do you keep blood sugars below 90 mg/dl to prevent excessive glycation? Avoid or minimize the foods that cause such rises in blood sugar: carbohydrates.

What food increases blood sugar higher than nearly all other known foods? Wheat.
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Comments (15) -

  • soiltosustenance

    1/12/2011 3:19:52 PM |

    I have been doing some experiments with Blood Glucose control over the past 2 months and have made a huge difference by cutting out grains completely.  Between the reduction in carbs and the addition of some moderate strength training, I have been able to eliminate BG spikes above 150 (now normal highs are in the 120s) and the duration is shorter as well.

  • Anonymous

    1/12/2011 5:01:24 PM |

    Dr Davis I as a neurosurgeon scientist completely agree with you about carbs wheat and glycation but from the literature of diabetics I am far more concerned with lipid peroxidation from PUFA's.  Espcially the omega 6 and 9's which are known to cause six times the "glycation" that glucose does.  I believe a meta analysis was done for Circulation recently and it caused a firestorm in the AHA ACA because of sponsorship issues.  I am more concerned with the guidelines we physcians need to advocate than guidelines that are subject to market forces more than scientific ones.

    Dr. K

  • Anonymous

    1/12/2011 10:05:44 PM |

    Dr. K,

    I tried to find that meta analysis in Circulation and couldn't find it. Could you please provide the reference. Thanks

  • Anonymous

    1/12/2011 11:15:11 PM |

    I have to say I've found giving up wheat, even cutting down substantially, to be damn difficult because it's so widespread and simple habit. I aim for more lean meats and things like rice for carbs, but so dearly love my breakfast cereal and pizza!

    Does anyone have thoughts on aminoguanidine relative to the glycation issue. I took it for some months a few years ago until it got a bit too pricey.

  • revelo

    1/13/2011 12:37:42 AM |

    If wheat and omega-9 fatty acids are so unhealthy, why do the southern europeans live so long? Wheat and olive oil are a huge part of the traditional Mediterranean diet.

  • Anonymous

    1/13/2011 3:55:31 AM |

    Meta-analysis Reveals “Heart Healthy Omega-6 Fat” Increases Risk of Heart Disease
    Bottom Line: The research upon which the American Heart Association based their "eat-your-omega-6-fat" advisory, is fatally flawed, according to the results of a meta-analysis study, which showed that a steady diet of omega-6 polyunsaturated fatty acids increases the risk of heart disease and death, especially for women [1]. British J Nutr. Dec 2010.

           [Here's a link to the full post http://www.scribd.com/doc/44601571 ]
    DR. K

  • Anonymous

    1/13/2011 3:57:10 AM |

    http://omega-6-omega-3-balance.omegaoptimize.com/2010/12/03/metaanalysis-reveals-heart-healthy-omega6-fat-ups-risk-of-heart-disease.aspx

  • Might-o'chondri-AL

    1/13/2011 5:01:36 AM |

    Advanced glycation of peroxidized poly-unsaturated fat rate has definitely been claimed to be significantly higher than rate of glucose advanced glycation.

    Dr. Davis' tactic of glucose control does seem easier for patients to see how they can make changes that matter. They are then more open to following his complete program.

    A recent autopsy analysis (2010) of ruptured plaque said there was always iron in there; and yet no iron in the intact plaque. Iron cleaved from the blood is a suspected activator of omega-6 lipid peroxidation at the epithelium. When the fibrin polymerizes it seems iron gets trapped.

    People's genetics make me wonder if some mega-dose multi-vitamin takers are over doing the iron; vitamin C even boosts it's uptake. Old "southern Europeans" probably never took complex vitamin pills until recently. Wheat germ has soluble iron and those old timers ate white flour products if they could.

  • D.M.

    1/13/2011 9:00:32 AM |

    @Anonymous neurosurgeon scientist.
    Isn't omega 9 MUFA rather than PUFA?
    Also there's no reason why a LCHF diet couldn't also minimise PUFA, in preference to SFA/MUFA.

  • Dr. William Davis

    1/13/2011 1:04:46 PM |

    While this post was about endogenous glycation, there is indeed a parallel path of exogenous "glycation," poorly named because many of the so-called exogenous "advanced glycation end-products" do not involve glycation.

    I agree with Dr. K that many of the exogenous factors leading to heart disease, aging, and other phenomena are those that lead to LDL oxidation. Oxidized polyunsaturates, AGEs, and oxidized cholesterol are underappreciated phenomena.

    A topic for future.

  • Anonymous

    1/13/2011 10:08:11 PM |

    Although I had given up oats and other grains because of their adverse effect on blood glucose,I had not been able to give up toast(sprouted wheat). I finally found a great solution--organic frozen green beans. They are easy to cook and go well with eggs. I have been wheat-free for about a month.I feel good and I don't get hungry as often.

  • Alberto

    1/13/2011 11:26:13 PM |

    As revelo, I am curious as how is it that italians eat tons of pasta (they use hard grains) and seem to be healthy.

  • allison

    1/14/2011 5:16:48 AM |

    Peter at Hyperlipid has written about this fasting glucose paradox in carb-restricted individuals.  

    I have been Paleo (<60 grams of carbs) for two years.  I eat no sugar, fructose or grains of any kind.  Yet my fasting glucose is 90 with all other diabetic indicators normal.  Apparently, high normal fasting glucose is common among LCHF diets.  

    I haven't researched this, but since a LCHF diet produces large, fluffy oxidation-resistant LDL, I wonder whether there is a beneficial effect downstream from glycation? Otherwise both a low fat, high carb diet and a LCHF diet would produce the same bad result.  That doesn't quite add up.

  • allison

    2/3/2011 5:28:43 AM |

    Glycation refers only to the initial step of one glucose molecule attaching to a protein without the mediation of an enzyme.  If blood glucose levels are low enough--as would be the case with a HFLC diet--the glucose and protein will disengage and no damage will be done.  If blood glucose remains elevated, the cascade to advance glycation end products will continue to protein cross-linking and all the downstream deleterious effects.  The unavoidable glycation referenced by Dr. Davis is harmless, as long as you avoid refined carbohydrates.  No conundrum there.

  • Kirk

    9/12/2012 6:58:44 PM |

    Couldn't you also keep your blood sugar low through a lot of exercise (if you're so inclined)?  60g of complex carbs going into a sedentary person with 50% bodyfat is going to have a different effect than the same 60g going into a sub-3 hour marathon runner.

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The New Track Your Plaque Guide now available

The New Track Your Plaque Guide now available

4. April 2011 William Davis (5)
The New Track Your Plaque Guide is now available!

The Track Your Plaque program has evolved over its 8 year history. While the original Track Your Plaque book reflected the program details that got the program started back in 2003-2004, plenty has changed.

This new version of the book, what I call the program Guide, represents version 2.0 of Track Your Plaque and includes:

--Updated lipoprotein treatment strategies--including new and expanded treatment choices for small LDL and lipoprotein(a).

--An entire chapter on vitamin D and its crucial role in cardiovascular health and plaque control.

--A new and expanded diet--All the reasons why the New Track Your Plaque Diet can achieve spectacular improvement in lipids/lipoproteins, reversal of insulin resistance/pre-diabetes/diabetes, weight loss, reduction in blood pressure, etc. are discussed in considerable detail. The diet is crafted to achieve maximum control over both metabolic responses and coronary plaque.

--An entire chapter on the role of omega-3 fatty acids is included.

--A detailed discussion on the role of iodine and thyroid health--One of the newest additions to the Track Your Plaque menu of strategies is to achieve and maintain ideal thyroid health. This tips the scales in your favor for improved control over lipids/lipoproteins, weight, blood sugar, and coronary plaque.


The new guide, as well as our new Member kits that include the new Track Your Plaque Recipe Book, At-Home Lab Test kits, and nutritional supplements, are all available in the Track Your Plaque Marketplace.
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Comments (5) -

  • Bill

    4/4/2011 7:48:43 PM |

    Dr Davis.

    I would like to buy your new book but I am not prepared to pay $107.95 for shipping it to New Zealand!

  • Renfrew

    4/5/2011 9:30:54 AM |

    Dr. Davis,

    I would love to order your new "Track your plaque" guide. But I am living in Germany and I just saw that shipping rate to Germany is above $100. That sounds impossible for shipping a book.
    Can you make this book available either as a .pdf file or via AMAZON ?

    Thanks.
    Renfrew

  • Dr. William Davis

    4/5/2011 2:44:10 PM |

    Hi, Renfrew--

    Yes, the Track Your Plaque book will be available as a downloadable PDF in the coming couple of weeks.

    I will announce it in these pages.

  • Anonymous

    4/6/2011 1:39:53 PM |

    How about a making a copy available on Barnes & Noble for us Nook readers??

  • Dr. William Davis

    4/7/2011 12:47:32 PM |

    Hi, Anon--

    Unfortunately, this new Guide will be available ONLY through our website.

    A big part of the reason is the contract I have with my publisher for an upcoming book (fall, 2011) that prohibits me from putting up our program Guide on sources like Amazon.

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The battle for asymptomatic disease

The battle for asymptomatic disease

31. October 2007 William Davis (10)
The heart disease revenue pie is shrinking. So is the "serving size" being shared by competing hospitals.

In other words, as more hospitals open heart programs, there is more competition for the same heart patient. Throw into the mix the drop in "acute" presentations of disease, probably due to the now widespread prescribing of statin drugs. When I first started cardiology practice 15 years ago, for instance, days and nights spent taking care of heart attacks coming through the emergency room was a common event. It still happens, but far less frequently. (I don't mean to suggest that the actual prevalence of coronary heart disease has decreased, just the acute, catastrophic version of it.)

Throw into this mix the results of the COURAGE Trial that has put a damper on the value of stents and angioplasty vs. "optimal" medical therapy in people with stable anginal symptoms, since there was little advantage of procedures. Though it has not stopped the practice, it has reduced the enthusiasm for procedures. Though data are hard to come by, I've heard talk of 10% or greater drops in total procedural volume over the past year.

It's not uncommon for hospitals to have overbuilt heart facilities in anticipation of continued growth of this--until recently--growth industry called heart disease. However, factors are converging that may provide a new profit opportunity for hospitals.

One such opportunity is CT coronary angiography. The usual scenario: Man or woman without symptoms is persuaded somehow--an ad, primary care physician, next door neighbor with a scary event, Dr. Mehmet Oz gushing about this sexy new technology on yet another Oprah episode--to undergo a CT coronary angiogram. A "severe" blockage is found, despite the lack of symptoms, and voila! A stent patient or bypass patient is created out of nothing! Do this repeatedly and systematically, and a hospital can regain its former high-procedural volume glory.

Heart scans, though I believe deeply in them and they are the basis for the Track Your Plaque prevention and reversal program, can also be used and abused this way. Asymptomatic person has a score 150. Concerned, they go to their physician who orders a nuclear stress test. An "inferior perfusion defect" is seen, presumably representing poor flow through the right coronary artery (but often just means that the diaphragm overlaps the heart muscle and yields this apparition, a "false positive" or misleading result). "But--wink--we've got to find out if there's a severe blockage, don't we? You don't want to end up in an early grave!"

Thus, the battle for new patients with asymptomatic disease is getting underway in earnest. The scramble for cardiologists to learn how to use CT coronary angiograms is proceeding at breakneck speed, with new training courses being offered nationwide several times and places every month. CT coronary angiography is a useful test, but it is also subject to enormous abuse. It also provides the ticket for the unscrupulous physician and the revenue-hungry hospital eager to expand its patient volume.

Many people believe that this cannot happen commonly in 2007, given scrutiny of practices, litigiousness, and the expectation of a moral sense in medicine. However, I've witnessed such incidents several times this month alone. If you need graphic proof of just how far this can go before action is taken, read Coronary, Stephen Klaidman's chilling tale of a cardiologist and cardiothoracic surgeon in small-town northern California who built an enormous heart center based on fabricated heart disease diagnoses. You'll also find their story in Shannon Brownlee's recently released Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.





Of course, the Track Your Plaque program is meant principally for people without symptoms, also. But we are advocating that asymptomatic disease is a reason for prevention, not procedures. There's a difference.

By the way, the two practitioners who engineered the escapade detailed in these books, cardiologist Chae Hyun Moon and cardiac surgeon Fidel Realyvasquez, walked away with a monetary fine and suspension of their California medical licenses. It is likely that many people died because of their abusive practices, but the state struggled to make a sufficiently persuasive case for reasons that I still don't understand.
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Comments (10) -

  • G

    11/2/2007 6:36:00 AM |

    Poor Oprah, she's on the yellow brick road and doesn't even know it! I hope your results validating CT scans and dramatic primary CAD reduction bring on a revolution. It could not be soon enough. Personally, I find it so hard to teach my diabetes patients about wheat-elimination with the goal to improve their diabetes, reduce insulin doses and lose weight. (Not to mention, of course, other benefits like reducing early death -- esp the silent fatal heart attack kind) It's like trying to treat an obese child -- you look at the parents -- then realize you need to treat the parents first. To save lives from heart disease (which is increased five-fold in people with diabetes), I think the whole Western society needs to be educated and exposed to the TYP program!  i greatly think Oprah needs your help (at least get her out of the hands of M&M, you know, that sugar-coated pair Mehmet and Mike)  *ha haaa haa*  What a great help she would be if she was also convinced, and moved the TYP plan to the forefront?  PBS is good, but n-o-t-h-i-n-g is as good as Oprah ;)

    Your writings are mandatory reading for all my patients! Keep up the strong work!

  • Dr. Davis

    11/2/2007 10:41:00 AM |

    Thanks, G.

    Love your analogy of the obese and child and parents.

    I agree. It's a long uphill climb and one that runs against the winds of what the hospitals and powers that be tell us. Imagine how slow the climb would be without the information disseminating powers of the internet!

  • G

    11/2/2007 11:17:00 PM |

    Dr. D

    Thank God for the powers of the Internet!  I was researching estrogen (for a talk at a pharmacy school I teach at) and came across your blog under Sue Shellenbergers Wallstreet J article in March. What a fluke!! I went through all the archives almost as fast as I was hooked and addicted to watching Lord of the Rings.  You are undoubtedly the BEST health resource that I have come across -- including primary literature and cardiolgy texts.  I love your ex-interventionalist rhetoric and rants. You approach the whole body including mental health (LOVE the 'be happy' blog!) and emphasize heart prudent OPTIMAL nutrition.  Because I've lived it and I've seen health improvements with the basic low carb TYP rx on my DM patients (you know the 1-2% that actually aren't nonadherent), I know with 200% certainty IT works. Your explanations and references are always great in illustrating who they work for the heart and vasculature.

    I have faith that you will demonstrate compelling outcomes and data on how all these components work together (D replacement, nuts, vegetarianism, low GI foods, oat bran, fish oil, etc).  Without a doubht that seminal cardiology publication when it finally hits the stands will change e-v-e-r-y-t-h-i-n-g. (at least it will stir the establishment up a bit *what entertainment value THAT will have!!!* the suspense...)

    OK, i know you don't do individual consults, but I have a patient that I need help on...  his cardiologists have given up -- he's had multiple surgical interventions (s/p stents about 1-2 mos ago). I've implored him to read and study the TYP book and blog (he better be reading this).  Diffuse CAD still cause DOE and SOB. Within DAYS after the last stents were put in, the symptoms returned again. (drug-coated no less *YECK*)  He's doing the whole aggressive medical management thing (with me). he's eliminating all refined processed carbs (he misses his biscotti), we've added B3 (still titrating), D3 4000 Iu/d (baseline=37 ng/ml) and 3400mg EPA+DHA, oat bran and raw nuts. he's on Vytorin 10/80 for the heck of it. I hope to obtain 60/60/60/60 in 3-6mos. his a1c is almost < 6.5% (from 8.5%).

    My question for you is -- will he ever get off of the short or long acting nitrates? (at this point it's not apparently helping anyway) will the DOE always be there?!  what dramatic reversal in CAD have you seen?  he's a fit avid soccer player, but can't play at all right now.

    When you use Slo-niacin, can you get them to therapeutic doses faster? he's on short acting right now.  I am so grateful for your generosity in sharing your compelling and honest insights. You are totally making a difference...  

    Thank you in advance for your feedback.  Take care! G

  • Dr. Davis

    11/3/2007 1:24:00 AM |

    Hi, G--

    Thank you kindly!

    Interestingly, simply articulating the concept or philosophy of obtaining reversal, of at least setting that as a goal, can truly turn someone's view of themselves and their disease completely around.

    Some thoughts for the patient you discuss:

    1) Time is crucial. It may simply require several months.

    2) Consider using therapeutic fasting for the fastest means to resolution of symptoms. There is a report on this approach on the www.trackyourplaque.com website, or see Joel Fuhrman's book,
    Fasting and Eating for Health. (Ignore the low-fat eating comments in the book, however.)

    3) Consider l-arginine to accelerate anti-inflammatory and endothelial-normalizing effects.

    4) Unfortunately, I never use immediate release niacin, but I imagine that a 500 mg increase every two weeks could be tried, similar to the accelerated course we sometimes use with SloNiacin or Niaspan.

    5) Consider doxycycline for its matrix metalloproteinase-suppressing activity. See the associated report on the website, also.

    Nitrates in my view are just Band Aids that provide little genuine therapeutic benefit beyond temporary symptom relief.

  • G

    11/3/2007 4:17:00 AM |

    No matter what the results are, I'm eternally grateful (and he will be too). I'm going to approach his doc on Monday... THANK YOU VERY VERY VERY MUCH! G

  • Anonymous

    11/3/2007 1:38:00 PM |

    Boy G you are the first dietitian I know who promos low carb for diabetes, goodonya, do you read Dr Bernsteins Diabetic Solution. His book and webcasts and TYP are my bibles.

    Is Oprah's weight gain due to following Dr Oz.

    Here;s a story for you that is scary for a pateint with undiagnsoed chest pain:

    I had undiagnosed chest pain for several months, quit Actos ( it started around time I went on Actos)but it remained after quitting for 6 weeks actually, and they did a stress test and said nada but I know from your book I need another calcium score done so am pushing for that.

    In the meantime this Dr who is new to town told me I must stay on Actos no matter what the side effects are and sometimes you just have to take risks to stay on drugs!!  

    I actually only asked for Actos to try get my A1C to a 4.5 from a 5.4 as Dr Bernstein recommends that diabetics have the same rights to normal bg as non diabetics, so then I didn't see him again and saw his wife. They are both new Dr from South Africa.

    She put me on nitro spray, didn't even see me, called me out of the blue and said maybe I should use it,would aid in her diagnosis if it worked!! yet they won't give me a repeat Rx for metphormin which I have been on for 15 yr (over the phone)!!!!

    I didn't want to use it but the pain scares me as it is harsh, bends me over and I live out of town and fear if I am having a MI I am at higher risk, so the next time  I had the chest pain, I tried the nitro once and my bp dropped to 84/58 and I almost went into shock, so I dumped her and have a new young doc who tries to practise cardiology along with her caseload.

    My Dr of 21 yr moved so its been awful living rural in small town and not enough Dr, she seems intelligent, listens and I think I can bend her ear towards TYP.

    I am going to push for advanced lipid profile again,and another EBCT, my pain is lessening as my high stress job finished, I can't believe that crippling pain was due to stress and fear the Actos set me up for something.

    I am the therapist that got the referrals for those appearing in emerg thinking they are having a heart attack and they wern't, it was anxiety induced. I tried all the relaxation techniques I taught and it didn't help my chest pain so I was scared so used the nitro much against my better judgment and won't ever again.


    The stress test showed nothing wrong, good recovery, the ecg showed no heart attack.

    I had a Pulse Wave analysis test done at a conference I went to on menopause. This conference follows the programs of Dr John Lee who also thought outside the box like you do Dr D and he had good results and not the side effects from hormone trtment like oral drugs has.

    He suggests bio identical creams only so if you search out Jackie Harvey and the workshops she does called Heart to Heart for women and the medical profession, you will learn about menopause help that is also non traditional.

    This new doc I found supports her ideas, will support the saliva test and prescribe bio identical progesterone cream if your test suggests you need it as you have estrogen dominance, and it does seem to help.

    Tell me if you think this Pulse wave analysis is right on, they recommend a liquid L arginine as say it absorbs better but boy is it pricey.

    BTW I don't have a goggle acct and don't really know how to set one up so come under anonymous so it makes a few of us, sorry.


    Thank you for this siteSmile

  • Dr. Davis

    11/3/2007 7:06:00 PM |

    Reluctantly Anonymous via Google--

    Actually, what you are describing--chest pains around the menopausal years with some gauge of "endothelial dysfunction," i.e., abnormal coronary artery constriction--is how I first came to appreciate the power of l-arginine about 15 years ago.

    Back then, research from the NIH uncovered a poorly-named entity in perimenopausal women called "microvascular angina." It is wonderfully responsive to l-arginine. That's the situation in which I also learned that arginine only works when taken on an empty stomach.

  • gc

    11/3/2007 11:42:00 PM |

    Wow thank you for that info, Smile
    RA

  • Anonymous

    11/11/2007 2:31:00 AM |

    Thank you Dr. Davis for posting about the book "Coronary," which I ordered after reading about it on your website.

    It is one of the most chilling books I have read.  One would like to think that the unnecessary angioplasties and heart bypasses that the book described were anomalies, limited to two amoral out-of-control doctors in a small Northern California town.  But you write that you have seen it in your city in the Midwest.

    It makes me cynical about the entire medical profession.  By the way, I have seen the same amoral greediness from many so-called "alternative medicine" doctors in Los Angeles.  It may not be on the same scale as Drs. Moon and Realyvasquez, since these so-called anti-aging gurus are only pushing unnecessary supplements (which they sell at great markup in their offices) and unnecessary blood work and saliva tests (I have no doubt whatsoever that they are getting illegal kickbacks from the labs), not surgery and invasive procedures.  I guess it's the difference between a little shoplifting and armed bank robbery, but still it does make one cynical about the whole medical profession.

    Thank goodness for your blog, which at least helps laypeople have a fighting chance.

  • Dr. Davis

    11/11/2007 2:51:00 AM |

    I like your analogy: shoplifting vs. armed bank robbery.

    Legislating against such excesses is an impossible task. In my view, the solution is education.

    An informed, educated consumer is one who can make his/her own choice, whether it's to pursue acupuncture, chiropractic, take hawthorne, undergo coronary angioplasty, or some other path.

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