Not to beat a dead horse, but sleep apnea is a often overlooked symptom of hypothyroidism, too.  

One does not have to be overweight to have sleep apnea, either (& lack of  excess obesity may lead physicians to dismiss apnea as a diagnosis).  

Untreated or undertreated hypothyroidism can result in weak muscles at the back of the throat (soft palate area) that close down during sleep.  

For me, the sleep apnea presented as repeated violent nighttime coughing fits that would significantly disrupt my sleep (and my husband's).  Unfortunately, it was too easy to assume for too many years it was simply allergic post-nasal drip (doc was happy to Rx for that, of course, but nothing helped, nor did dusting .

A lot of weird, annoying breathing issues improved considerably once on a good dose of T4/T3 - excessive, uncontrollable yawning when reading aloud to my son (but strangely, not while talking), excessive sighing during the day (I was unaware, but my husband noticed it), etc.

What a fascinating insight!

That's one I've never come across before.

I'd like to file a complaint against the department of Mother Nature for creating excessive noise for the past 2 weeks.  This springs weather has been crazy in the mid-west with all the lightning, flooding, and tornado sirens.  Bring on the hot sticky summer weather, I'll get more sleep with it than I have with this excessively stormy spring.

This week I was reminded that my brother in law does not sleep and that isn't an exaggeration.  The family is having a reunion this week and most are gathered at my folks house.  Instead of sleeping at night my brother in law just wonders around, gets on the computer, goes for a walk, etc.  About the only time I've seen him rest is when the TV is on.  He has what the hospital calls border line high blood pressure, 140 over something, I don't remember.  His cholesterol #s are not good also.  This is all in despite of being a marathon running, lifts weights, has little body fat.

A month or so ago he began some parts of the TYP program.  Hopefully what he does will help.  His father had the same sleep problem and he passed away from a sudden heart attack in his mid50s.

Hi all
Just want to say that I am impressed by the information here. Also the friendliness of the posts. You are all working together for everyones benifits. Kudos!
Since I was a very young child I have had insomnia, restless leg, migrains, anxiety. All of these things I have had since before starting school. All of these things, except the migrains did not have a name back then. I remember my mother coming in the morning to wake me, and i was still awake! I have also always had heart palpitations, always when I am at rest, never when I am exerting myself. Only in the last few years have "they" put names to these things. And only in the last few years have there been any information on help for same.
A number of years ago i started Atkins, I have always been overweight. I am tall, Long fine bones, but always have had a "belly". Over time Atkins became for me Low -carb, I did not stay true to Atkins, I found low carb healthier and recipes for making delishis food is now all over the internet
BUT always the issues of anxiety, insomnia, restless legs, migrains. I have always felt that they are all related. Of course my G.P. thinks I need to be on antidepresants .... which i was on for a number of years, then took myself off... thats a whole other story. But Because of the low carb diet a co worker lent me the wheat belly book... OMG!, then I found this blog. So now I am taking Vit. D, Magnesium, zinc, kelp,omega 3s, and about to start melitonin. Am stickin to the low carb forever, sans the wheat and grains. Am hopeing the next 57 yrs (thats how old I am ) will be healtier than the first.
Thank you Dr. Davis, and everyone who contributes to the blog.

This is very good - just mixed up a large glass full (minus the flaxseed).  And, that's my question, do you use finely ground flax seed?  I also tossed in a fist-full of blueberries - should be able to tolerate them well; I just had a very intense resistance training session

I'd love to see more recipes for some ideas.  I disagree with those who wrote in on the earlier post, characterizing smoothies as "not real food."  I'm a big fan for time-challenged mornings and post-workout nourishment.

Bill

I can't believe you passed up a perfectly good opportunity to embed a cheesy 80's Reese's commercial in this post.

http://www.youtube.com/watch?v=DJLDF6qZUX0

Anon--

Yes, I used a finely-ground flaxseed.

The berries are a great idea, provided quantity is small.

Just a cautionary note -

Sucralose/Splenda can have severe reactions.

I seem to respond/react to things severely.  Sucralose has caused both allergic reaction (swollen mucus membranes) and severe migraine for me.  In fact, as a frequent migraine sufferer (tho much less now that i've removed gluten and sulfites), the migraine i got from sucralose was by far the worst i've ever had.  

Personally, i am of the belief that if it effects me so strongly, it is probably not good for anyone, but the damage it does is much less pronounced in other people.

I stick to stevia for a no-calorie sweetener.

http://jstevens.wordpress.com/2008/02/20/how-sucralose-aka-splenda-is-made-and-why-you-want-to-avoid-it/

"How Sucralose (aka Splenda) Is Made And Why You Want To Avoid It

...I wanted to comment on Splenda.  Splenda, also known as sucralose, was created accidentally when some chemists were trying to produce an insecticide.  Here is the process by which they produce the formula sold in stores:

“1.  Sucrose is tritylated with trityl chloride in the presence of dimethylformamide and 4-methylmorpholine, and the tritylated sucrose is then acetylated with acetic anhydride.

2.  The resulting sucrose molecule TRISPA is chlorinated with hydrogen chlorine in the presence of tolulene.

3.  The resulting 4-PAS is heated in the presence of methyl isobutyl ketone and acetic acid.

4.  The resulting 6-PAS is chlorinated with thionyl chloride in the presence of toluene and benzyltriethylammonium chloride.

5.  The resulting TOSPA is treated with methanol in the presence of sodium methoxide to produce sucralose.”  (Note that methanol, wood alcohol aka paint remover,  is one of the questionable ingredients in aspartame.)

In addition, the bags and packets of Splenda commercially available are not pure sucralose.  They also contain bulking agents.  All artificial sweeteners use bulking agents.  Do you know what they use?  Sugar.  Dextrose, sucrose, and maltodextrin.  (Maltodextrin is corn syrup solids composed primarily from fructose and glucose in a starch form.)   All sweetener packets are at least 96 percent sugar.  Splenda is 99% sugar.

The packets are labelled calorie free as a result of manipulating a loophole in the food labeling laws.  The product can be described as sugar free if a serving contains less than 5 grams of sugar, and calorie free if a serving is less than 5 calories.  So they set the serving size on bags at .5 grams  and the packets contain a serving of 1 gram.  A one gram packet contains 4 calories.   This can be confirmed on the manufacturer’s website in the FAQ section:  â€œLike many no and low calorie sweeteners, each serving of SPLENDA® No Calorie Sweetener contains a very small amount of common food ingredients, e.g., dextrose and/or maltodextrin, for volume. Because the amount of these ingredients is so small, SPLENDA® No Calorie Sweetener still has an insignificant calorie value per serving and meets FDA’s standards for “no calorie” sweeteners. “

To make matters worse, when sucralose was shown to not raise blood sugars, it was the pure substance that was tested, not the mixture that is sold to the public.  Dextrose, sucrose, and/or maltodextrin are definitely going to raise a diabetic’s blood sugar.  There is also a great deal of evidence that artificial sweeteners actually cause an increase in appetite, causing people who consume them to take in more calories than they would otherwise.

Stevia, on the other hand, lowers blood sugar, making it a much better choice.  If you have tried stevia in the past and did not like the flavor, you might want to try another brand. ..."

If your looking for a more nutritious "sweetner" you should try adding half a cup of coconut water. Delicious!

Ps. I love your blog. Keep up the great work!

Tapioca starch in the almond milk, but not enough to hurt you.

I enjoy your blog. You have a good thread about the hazards of hyperglycemia.
However, this recipe is not one I would recommend to patients attempting to reverse metabolic syndrome, T2D, or IR.
Their main concern is the inflammation caused by the above listed disorders. The omega 6 content of the peanut butter, sunflower seed, and to an extent, almond butter would exacerbate the inflammation mitigated by the hyperglycemia.
In addition, sugar alcohols (xylitol, erythritol) tend to cause GI upset (gas, diarrhea). Also the hazards of Sucralose are intuitively obvious....it contains chlorine molecules....commonly found in many household cleaners, and of course used in WWI as a pulmonary choking agent.
I would only use macadamia nuts/nut butter, and Stevia to sweeten.
Dr. John

Thanks, Dr. John.

I hear you on the sucralose issue. I've actually been having positive experiences with stevia, xylitol, and erythritol. The important thing is that people have some good choices nowadays, unlike 20 years ago when we had saccharine . . . period.

There is no question that mannitol and sorbitol have greater potential for both GI distress (diarrhea) as well as increases in blood glucose, so these are clearly on the no-no list (unless you need a quick laxative).

Sucralose is not metabolized.  Most of it is excreted unchanged in the feces.  A small percentage is absorbed and excreted unchanged in urine.  

Sodium in food is more of a concern for a person who experiences migraine headaches.  Over-activity of muscles activated by the Trigeminal nerve due to airway resistance secondary to water retention is a greater concern.  Various factors are present both anatomically and physiologically in people who experience migraine.  The only way to determine if sucralose is actually the cause of a migraine is to consume sucralose on its own.

What concerns me is what happens to the sucralose in the environment.  The addition of a chlorine atom, (not a molecule, Dr. John) results in a molecule which cannot be metabolized by bacteria.  If environmental degradation is possible, then sucralose excreted by human beings is not an issue.  But if it persists in the environment, then it is a pollutant.

I am practically a fruitarian, so much of what I like would be off limits.
Is there an article here on what IS recommended?

Yes, atoms, not molecules...ie. precisely 3 atoms of chlorine/molecule of sucrose...

An interesting thing about this selective halogenation of sucrose, is the fact that sucralose (being 600 times as sweet as sucrose), increases the HbA1c numbers in my patients. This demonstrates a lessening of diabetic control. Thus, hemoglobin gets glycated and fasting blood sugar increases....with the attendant hyperglycemia issues as mentioned, and this excellent blog site.

For this reason I do not recommend sucralose for diabetics nor anyone wanting to keep blood sugar levels within normal limits. The current cost and future costs for diabetes will cripple our healthcare structure. Here are ADA numbers:

$174 billion: Total costs of diagnosed diabetes in the United States in 2007
$116 billion for direct medical costs
$58 billion for indirect costs (disability, work loss, premature mortality)

Dr. John

Dr. John, is it possible that other factors contribute to higher H1ac levels in your type 2 diabetic patients?  

Since sucrolose is not metabolically active and does not act as a laxative, then there could be other endocrinological and neurological reasons for higher glucose levels.

Here's an abstract on sucralose and Type 2 diabetes:

Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003 Dec;103(12):1607-12.

OBJECTIVE: To investigate the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes. DESIGN: A multicenter, double-blind, placebo-controlled, randomized study, consisting of a 6-week screening phase, a 13-week test phase, and a 4-week follow-up phase. SUBJECTS/SETTING: Subjects with type 2 diabetes (age range 31 to 70 years) entered the test phase of this study; 128 subjects completed the study. The subjects were recruited from 5 medical centers across the United States and were, on average, obese. INTERVENTION: Subjects were randomly assigned to receive either placebo (cellulose) capsules (n=69) or 667 mg encapsulated sucralose (n=67) daily for the 13-week test phase. All subjects blindly received placebo capsules during the last 4 weeks of the screening phase and for the entire 4-week follow-up phase. MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA1c), fasting plasma glucose, and fasting serum C-peptide were measured approximately every 2 weeks to evaluate blood glucose homeostasis. Data were analyzed by analysis of variance using repeated measures. RESULTS: There were no significant differences between the sucralose and placebo groups in HbA1c, fasting plasma glucose, or fasting serum C-peptide changes from baseline. There were no clinically meaningful differences between the groups in any safety measure. CONCLUSIONS: This study demonstrated that, similar to cellulose, sucralose consumption for 3 months at doses of 7.5 mg/kg/day, which is approximately three times the estimated maximum intake, had no effect on glucose homeostasis in individuals with type 2 diabetes. Additionally, this study showed that sucralose was as well-tolerated by the study subjects as was the placebo.

PMID: 14647086 [PubMed - indexed for MEDLINE]

Now, I can understand how sugar alcohols taken in large quantities might have some effect on blood sugar because they are laxative and increase gut motility and cause discofort or pain, both of which will spike blood sugar values. the liver dumps glucose into the bloodstream when the body is under stress like this.  And of course, the pancreas reacts very sluggishly to endogenous glucose.

I think type 2 diabetics should have routine sleep study screening to determine whether breathing issues during sleep may be upramping the sympathetic nervous system and causing high sugar levels during sleep. We can't just help these people improve their life quality by looking at only one parameter.

They need otolaryngological evaluation for anything from deviated nasal septa to chronic allergies, enlarged adenoids and tonsils.  The size of their jaws, how they function and tongue posture also factors in.

Not to mention, anyone with pulmonary issues would have increased effort on breathing...asthma, pulmonary hypertension etc.  The existance of chronic pain and anxiety conditions also influence how the body produces its own glucose.  

Patient's require a multi-disciplinary workup to determine the multiple factors that result in the development of type 2 diabetes.  It's not merely diet because these people have an awfully hard time changing their diets without having other problems addressed.

Excellent! Dr. Davis, you have had many posts of what not to eat but very few on what we should eat. Taking something out of our diet means we have to replace it with something. This post seems to be in the right spirit. I am going to try this soon. Now if only you can post a similar substitute for Keva Juice's Oreo Speedwagon smoothie! Yes, I know they are hazardous to your health but they are wickedly good!

-- Boris

I'm not totally convinced why sucralose, a chloro-carbon, similar to DDT and PCBs, would elevate the HgA1c levels. My guess would be a neurological response to an ingested poison. Sucralose does kill intestinal beneficial bacteria...lactobacillus, bifidobacteria, and bacteroides...of varying amounts of 37-67%...and the enteric nervous system would react by elevating cortisol/adrenaline/glucagon: while at the same time not delaying gastric emptying.
Body perception is stress....glycation of RBCs result, with CVD and sudden cardiac death.

Studies that use diabetic, and obese subjects in the assessment of A1c elevation are biased from the start. These individuals have already lost glycemic control and as a result would not have normal A1c levels to begin with...let alone studying their response 13 weeks later.

McNeil Nutritionals, maker of SPLENDA® Brand products, stated it has provided the American Diabetes Association (ADA) with a sponsorship to support the Association's efforts to fund research, information and advocacy programs on behalf of people with diabetes.
And McNeil Nuts. are owned by Johnson and Johnson, who are large contributors to the ADA...the journal of the previously listed biased study showing the sucralose doesn't affect A1c levels...in spite of the fact in clinical results showing the opposite.

Anything, sucrose or sucralose, that elevates A1c levels is cardio-lethal...and is best avoided.

Dr. D,
Do you use regular coconut milk or the lite? Does it make a difference, except calorically?

Thanks!

Jeanne

I am allergic to the artificial sweeteners. Thought I could tolerate sucralose but it just took a little time for a reaction. My mouth and throat became inflamed and I had sore bumps all over the inside of my throat and back of my mouth after about a week.

I don't like stevia or the other natural no calorie sweeteners either...they just don't taste sweet to me or have odd flavors.

But I found something.  It is not calorie free, but it has low glycemic index and tastes just like sugar.  It is "Organic Blue Agave". What are a few calories in exchange for some actual taste.

I bought it at Costco.

""Organic Blue Agave". What are a few calories in exchange for some actual taste."

High fructose corn syrup (HFCS) is about 55% fructose and cause inflammation, insulin resistance, and elevates triglycerides.  Agave syrup is often 70% or higher (possibly as high as 90%) fructose!  Marketing scam...

Hmmn - reminds me of a book I read called "Coronary: A True Story of Medicine Gone Awry," recommended by you, Dr. Davis.  Unnecessary procedures for profits.

It's a scary world out there in medical land.

The local heart hospital has a "Heartsaver CT" http://www.heartsaverct.com/index.aspx?CORE_ElementID=HSCT_AHH_Home

Is this the same as the CT Heart Scan?

I saw another car Bill had worked on this month.  My father and I have an auto hobby shop were we'll bang away on making our own hot rod cars and from time to time a friend or friend of a friend in this case will ask to bring a car by for inspection.  The guy has been having many problems with his hot rod and for repairs had been taking it to Bill's place.  I had an idea of what to expect.  Sure enough Bill had done it again.  Bill's scam is that he will splice a weaker gage wire into a hidden unseen area.  The weak gage can not handle the power load for long and once the wire melts and the part stops working, he explains that the engine part broke, new parts need to be ordered and of course that intales hours of labor costs.  
    

After reading this blog it reminded me of scammer auto shops.  Hospitals have their scams too.    I wish I could walk into a doctor’s office and expect that only the best, least expensive, treatment will be offered me - but I now know that isn't the case.  I can't be lazy.  I need to educate myself in the basics of medical care to ensure I receive the best treatment for me.  Thanks for being a good teacher Dr. Davis.

Yes, it looks like it is the real thing, a simple heart scan, judging from their comment that "There are no needles, no dyes, no injections and no exercise." CT angiograms require needles, dye, and injections.

The CT angiogram makers are generating lots of reports on how great their machines are.

http://www.theheart.org/viewArticle.do?primaryKey=830205&nl_id=tho28nov07

They certainly are. Big bucks, big marketing.

I do believe, in all honesty, that the new devices really represent great advances in diagnostic imaging. It's their mis-use and over-use that I object to. Of course, the manufacturers keep their lips closed about it because overuse drives more sales.

Hi Dr. Davis,

I've learned from reading your blog that typically 20% of TOTAL PLAQUE is calcified or "hard". Is that a steadfast rule - or is that an average? What if someone has a calcium score of zero (or close to it)? Can it be assume that that person also has very little in the way of "soft" plaque?

Thanks!

Paul

Speaking generally, people with zero heart scan scores have heart attack rates of near zero (if asymptomatic).

The likelihood of detecting pure "soft" plaque in someone without symptoms and a zero heart scan score is <5%. It does happen, particularly when certain severe risks for heart disease are present (e.g., very high LDL/small LDL). It is exceptional, however.

Since I can't afford the current local price of a 64 slice CT scan ($1100), I've decided to get a lipoprotein breakdown to determine my risk.   I can use your "treatment" protocol of supplements to try and achieve the 60-60-60 values when I see the results.   Is this a good plan?

Hi, Noreen--

I'm afraid that you may regret not getting the scan a few years from now. After you've successfully corrected lipoproteins, you may want to know if you've also successfully controlled plaque growth, the MORE IMPORTANT parameter.

Have you thought about looking elsewhere for a scan? In Milwaukee, for instance, scans can be obtained for as little as $79. (Though the low-priced scans also come with a sales pitch for CT coronary angiography. Just say "no thanks.")

I am 72 and pretty healthy.
This year I have been seeing a cardio because of some nocturnal palpitations. He has subjected me to a series of tests-sleep-ultrasound-both negative, and a nuclear stress test which gave a hint of possible blockage. He recommended either an angiography or a CTA scan. I chose the latter, and was rated "normal".
I asked if this meant normal for my age. He said "no, normal for any age, I couldn' find any trace of hard or soft plaque". Yes he is part of a large group.

My father died of a second heart attack at 76.
I have taken vitamin D, fish oil, magnesium, pantethine, flaxseed, co-Q10, lutein, olive oil, for some years.
I am trying hard not to feel smug, but should I feel safe?
We are still working on the nocturnal palpitations which seem to be dependent on sleep position.
I have bradycardia, and no other obvious health 'problems'.

With regard to the 20% value for calcified plaque, if you look at figure 1 from Rumberger’s classic 1995 paper (Circulation. 1995;92:2157-2162.), it shows the plaque area and calcium areas for each of 13 hearts that were examined on autopsy. If you take the points in this graph and determine the areas for each heart, the data shows that the calcium area and calcium percentage increases with plaque area. Unfortunately the paper doesn’t say what the calcium scores were for each heart, only the calcium areas and total plaque areas. However, over the range of plaque areas of the 13 hearts, the percentage of calcium in plaque increased from 0% to 14% for the 9 hearts with with plaque areas less than 150 square mm to 14% to 28% for the hearts with the plaque areas greater than 230 square mm. So from that we can conclude that the 20% value is an average, and that the calcium percentage increases as more and more plaque accumulates.

Harry35

Sehr interessant!