I am extremely skeptical of drug company boasts, but I do wonder if they have a point here.... since supplements are not regulated at all, how DO you know you're getting the right omega-3 and the right dosage? they could give you sugar and arsenic... how could you know?

Hi Doc:
Two questions please:

1  It's well known that cutting carbohydrates also lowers trigs. significantly.
Do you consider increasing omega 3s your primary attack?

2 In this case is controlling omega 6/omega 3 ratio an issue, as it is in controlling inflammation?

Thanks

Mike V

"But insurance covers it in most cases!"

I wonder how much of the rise in health care costs can be attributed to this mentality? Why use a cheap, effective, non-patentable alternative when you can get something more expensive "for free" through your insurance? I think insurance coverage has had the unintended effect of causing health care to cost more and more since there's been ready money from insurers to cover the costs.

Interesting ... I lowered by triglycerides from 344 to 106 mg/l in 6 weeks, but I'm not sure what the mechanism actually was.  I had been taking 1500mg of niacin per day for quite a while with little effect, but started a low carb diet (<30 grams of carbs per day) and taking 1600 mg of EPA in fish oil per day.  Within 6 weeks my test results showed the decrease.  

I've heard both low carb diets and fish oil help lower triglycerides.  I'm hesitant to change anything ... thinking perhaps that its a "magical mix" of approaches that is working.

I'm sure readers here will be aware of Vitamin D3 and it's role reducing MMP9's. Here are a couple of examples.
  Vitamin-D insufficiency is associated with increased circulating MMP2,9 and CRP, correctable by supplementation.

Vitamin D and its derivatives can evidently influence invasive processes by two means: (a) decreasing the expression and activity of cell invasion-associated serine proteases and metalloproteinases; and (b) inducing their inhibitors.
When one considers the role of MMP9's in other conditions as well as heart disease, such as MS and cancer, it makes you wonder why fish oil and vitamin D aren't even considered as potentially useful additions to treatment or prevention of conditions where MMP's wreak such havoc.
Both D3 and omega 3 are cheap and safe and there is good science explaining why they may help, so why the reluctance to correct deficiency states?

Thanks for the article Dr. By the way, does the fish oil increase Uric acid in (certain) individuals?

In my case, I noticed that when I started on fish oil capsules, Uric acid jumped from 5.5 to 8.0 and hence the concern.

Thanks

Venkat

We face similar ridicule from specialists. They not only get upset with us for managing our own patients (cardiology wants referrals for high cholesterol, psychiatry wants us to refer to them our average depressed patient, GI wants referrals for initial GERD) but they also very quickly dismiss our efforts to manage patients using generic medications and Vitamin D. We are family physicians. We MANAGE patients.

A rheumatologist stopped by our office the other day to meet our providers.

I witnessed his introduction to each provider (so I heard the same speech 5 times) and each time, the second or third sentence began with a list of 2-3 new drugs that the FDA just approved for treatment of XYZ condition, which he is already incorporating into his practice.

After allowing him the courtesy to make his case, two of our providers questioned his experience with Vit D. His tone turned sour (as did the conversation) and he very quickly rushed through D (commenting that the results of managing D are "mixed" and "the jury is still out on that").

He specifically asked how we manage patients who fail bisphosphonate therapy, to which one doc replied, "I haven't written for a bisphosphonate in almost 18 months, so I can't say that I've had any patients recently that fail a therapy I haven't put them on. I manage their osteo_____ by cranking up their D level. It's great! I've seen several patients with T-scores that increase 6-8%! Patients go from losing bone to making bone! We didn’t just slow their bone degeneration; we actually made new bone! With the bisphosphonates, you're preventing a natural process from occurring, plus the half life of at least 10 years doesn't sit well with most patients."

To which the specialist replied, "oh sure. Which is why each patient must go on a drug holiday after 5 years."

DRUG HOLIDAY? I'd never heard such a term.

My doc went onto discuss how his patients have been very successfully treated for many types of arthritis without the use of prescription drugs.

The conversation got especially tense when the specialist questioned how a patient could be “ethically” treated for osteo____ without the use of FDA approved pharmaceuticals.

Needless to say, the specialist concluded with a comment about how we could stand around and argue medicine all day but he would appreciate more referrals from us.

Yikes.

(He also mentioned on more than one occasion how he can see our patients same day. A same day rheumatology referral? I'm struggling to picture a rheumatology referral that would require same day access.....

He is also only 1 of 2 rheumatologists within 50 miles....and he has same day access and has been in the area for more than 2 years? Leads me to believe that maybe those services are becoming less needed due to D. Just a thought.)

-JL

Low carb, low glycemic index, also help reduce tryglicerides:

http://jn.nutrition.org/cgi/reprint/131/10/2772S.pdf
http://jcem.endojournals.org/cgi/reprint/85/9/3085.pdf
http://www.ebmonline.org/cgi/reprint/225/3/178.pdf

That is such a typical specialist reaction to the hormone D issue.  I experience this frequently.

BTW, Lovaza is marketed by GSK, not AZ.

In the migraine world, the concept of a "drug holiday" is pretty common. It isn't fun - you avoid all meds but it helps avoid rebound or medication overuse headaches.

JL--
Thanks for your great story! Tell us more.


Anonymous--

GSK, AZ--Can you tell the difference? I certainly cannot.

Their representatives are the same smiling-to-your-face, can-I-please-my-supervisor-and-make-my-bonus? sorts of people after one thing: their own career advancement--whether or not health is served.

Here is an interesting letter to congress from a former drug rep--

http://aging.senate.gov/events/hr190sa.pdf

I ran across a forum for drug reps, while randomly searching for info on a specific drug --

http://www.cafepharma.com/boards/forumdisplay.php?f=3

Their practices are scary and they basically come across, for lack of a better term, as evil. Sell their drug, whatever it takes.

I really appreciate this blog but seriously, some times it just scares me into a semi-anxiety attack.
( Oh where oh where is my valium, LOL)
TY Dr. Davis and all who provide such great information.  Keep up the good work!

Yes, and everyone wants the free samples.....So the beat goes on.  Doctors are well aware of the tactics that are being used. Most feel that perhaps their colleagues may fall for drug rep tactics.  Doctors underestimate their own vulnerability.  These days the most a drug rep can provide is a free take out lunch for the staff, free pens or a cup of coffee. Most docs don't realize that some drug reps and most of their supervisors make more money than the doctors do!  No wonder lovaza is so expensive.

My trigs roller coastered between 300 and 650.  I was on extreme diets, statins, and Lovaza.  Nothing touched it.  My cardiologist blamed it on genes and said there's nothing much more we can do.  The LAST time I visted him, we argued about it to the point he finally agreed to run a series of blood tests.  Hypothyroidism...  I've been on thyroid medicine for about 5 months and the last two cholesterol screens came back normal in ALL aspects!
Rich

Result! Send him to read this blog!

Yes there are stories of woeful undertreatment of thyroid. My current doctors are very proactive on it - a pleasant change - and report finding problems quite often, increasing with age and female gender but present in others as well.

This should be a relatively low incidence area - high selenium soil content and iodine from seafood - but there is a large (active) elderly population which might slant the numbers the other way - but they don't have comparative information from other areas to check due to diagnostic bias.

i have high triglycerides too.  i learned a lot from this website:
http://loweryourtriglycerides.blogspot.com/

Thanks Dr. Davis for your blog and efforts to make people healthy. I think you will find this blog (if you haven't seen it) by Dr. Mike Eades very interesting as it fits right in with your "Triglyceride buster" blog.

Four patients who changed my life. (blog by Dr. Eades)

Things are looking up.  This was posted on the CafePharma Board yesterday.
"Not to burst your bubble, but there are 120,000 reps out of work. Don't bother. Even people with GREAT credentials are finding nothing. Companies will continue to cut back. Access is harder than ever. The only reps that do well with getting even 2 minutes of time have some HOT sample with excellent formulary coverage. Device reps bust their ass and work from 6 am to 7 pm, 5 and even 6 days a week. I am hospital and leave at 6 am to 8 am and come home at 6 pm, on the road from 2 to 5 hours a day. It takes me 30 phone calls/emails to get ONE apppointment and when I show up, I better provide something valuable to the HCP or they will NEVER see me again. Hence, I spend my weekends studying and preparing for work. If I was under age 40, I would go back to school for a tech or nursing degree."

Being a nurse, I never thought I would see this day. Actual doctors (Dr. Davis and others) promoting alternative therapies that are really not alternative but wholistic in nature. I am just beginning my own journey with self directed preventive care and cannot say enough about the fantastic information available. Looking forward to seeing how this develops. So far my weight has dropped 35 pounds, triglycerides reduced from 323  to 151 and this is just the beginning.

Well I have heard plenty of stories about Omega-3's I have looked into them all including Lovaza and found that only one stands up to the test that truly helps triglycerides to be lowered. OceanBlueProfessional.com has their Omega-3 2100 product that has such a high potency of omega-3 if you take the suggested dosage it really works I take it every day and recommend it to everyone I know.

My father has a high level of Triglyceride, and we are all worried about him, I know he takes Omega-3 but I believe he should increase the dose.

I am continually surprised at the number of people with high triglycerides who are still treated with a fibrate drug, like Tricor, or a statin drug, when fish oil--widely available, essentially free of side-effects, with a proven cardiovascular risk-reducing track record--should clearly be the first choice by a long stretch.

QUOTE:
"... gram for gram, wheat increases blood sugar to a much greater degree than, say, chickpeas. "

Well, that ain't good.

I've really enjoyed these last couple of posts about wheat. Very informative and accessible. Thanks for taking the time to make this kind of info available to the wider audience.

David

fascinating

WOW- a classic lose-lose. 25% remains in your colon, to become a bacteria feast and the rest (75%) increases blood sugar and insulin production to store it as a fat cell.  hmmmmm, thank goodness for science, we may save ourselves.

Dr. Davis,

While not on a directly related note, do you have any general feelings on moderate consumption of buckwheat as a carbohydrate source? From what I have read, this "pseudo" grain seems to be far less problematic than true grains. It would still not give most folks a license to consume it ad libitum, but I am curious if you'd consider this a decent choice in controlled amounts (with the actual amount varying by context and the overall health of the person in question).

-Dave Balon

Excellent explaination, Dr Davis.

I'm really enjoying your posts about wheat.  Very interesting.  Thanks

Yet another study was just recently published showing a link between a high-carb diet and cancer:

Available Carbohydrates, Glycemic Load, and Pancreatic Cancer: Is There a Link?

I found this particularly interesting:

"The positive association for available carbohydrate intake was observed during the first 4 years of follow-up (HR(<2 years) = 2.60, 95% CI: 1.34, 5.06; HR(2-<4 years) = 1.94, 95% CI: 1.06, 3.55) but not subsequently (HR = 0.86, 95% CI: 0.52, 1.44); the opposite pattern was observed for total fat and saturated fat intake.

Another study:

Glycemic load, glycemic index, and pancreatic cancer risk in the Netherlands Cohort Study

Another study:

Dietary glycemic load and risk of colorectal cancer in the Women's Health Study

And another study:

Soft Drink and Juice Consumption and Risk of Pancreatic Cancer: The Singapore Chinese Health Study

Thank you Dr. D

Dear Heart Scan Blog,

I am a student at the  University of Rochester working on an internship project in conjunction with RateADrug.com to collect primary user data about side effects and benefits from commonly used treatments for Atherosclerosis & Arterial Disease.  The goal is to build a large, public access database of unbiased, anecdotal data about Atherosclerosis & Arterial Disease treatments.

We want to let both patients and practitioners know about how they can participate in or benefit from the project.  Users can add their experiences with a treatment and learn more about how the treatment is affecting them by taking a short, confidential survey. They can also use RateADrug to compare aggregate data for different Atherosclerosis & Arterial Disease treatments- both conventional and alternative (http://www.rateadrug.com/Atherosclerosis-and-Arterial-Disease-symptoms-feedback.aspx) - and forward the results of their own surveys to their doctors or family members.

Rateadrug is an independent data gathering and information website that does not accept funding or advertisement from drug companies.

Would it be possible for you to make this information available to your viewers so they can help us collect important data on Atherosclerosis & Arterial Disease treatments?

Thank you in advance. I'd be happy to speak with you if you have any questions or comments.

University of Rochester
www.RateADrug.com student intern
jillian@radpprep2.com

Hi, Paul--

Yes, indeed. The data relating high-carbohydrate intake with multiple forms of cancer is getting very scary.

Wow, I am a long time fan of heartscanblog, but Paul's citation is the most misleading EVER.   The authors found that carbs were associated with pancreatic cancer only in the FIRST FOUR years of follow-up, whereas fat and saturated fat were associated with pancreatic cancer during follow-up GREATER than four years.  Since pancreatic cancer takes years to develop, the authors conclude that carbohydrates are NOT CAUSAL to pancreatic cancer - fat may be.

"The data relating high-carbohydrate intake with multiple forms of cancer is getting very scary."

I would think at least in part from the higher blood sugars.  Much less problematic w/ whole, intact grains (boiled vs ground into flour and refined (and then higher temp. baked or fried)!

I love your blog.  We have switched out diets to something much closer to what you recommend due to the fact that my husband's psoriasis gets so much better if he avoids wheat,potatoes, corn, refined sugars, and dairy.  We figure it's better than using steroids for the problem.  We also have one son who has been biopsied for celiac after is blood work and we were told he doesn't have the correct atrophy but does have a damaged intestine.  

So we are committed to eating this way.  But one thing I have wondered about is if you feel that carb blockers work for blocking starch.  There are times when I would kill for a baked potato but try not to because it starts a negative cycle.  And now I know that it's not so hot for my heart either.  

This post made me wonder if there isn't some merit in them.

Thanks for discussing this.I thought whet is sort of better than the white bread for the diabetic and the heart patients.

This is one of greatest blogs I’ve read since ever. Your site contains a lot of useful information and I’m sure many people will like it as I do. I'll keep visiting your blog very frequently.

This is one of greatest blogs I’ve read since ever. Your site contains a lot of useful information and I’m sure many people will like it as I do. I’ll keep visiting your blog very frequently.

Bill and I found our Wheatbelly book and have been off gluten for 9 months, it was hard at first but we now
feel so different, Bill's blood sugar dropped 25 points, and we look at all our food so differently now!
The display of wheat rolls and pastry at our buffet looks more and more like hidden poison.
We are off sugar, too it is so tempting but our body says, Thank you Dr. Davis!

Here's one theory:

http://wholehealthsource.blogspot.com/2008/12/omega-6-linoleic-acid-suppresses.html

For my last thyroid test my TSH came back at .752 - which I believe is good.  I get cold relatively easy so figured before testing that my results would come back problematic.  

Then again I'm thin, with little body fat.  

Don't know if this means anything for thyroid results, but I've noticed a dramatic feeling in coldness when I eat milk products.  If I have milk product, I become deeply chilled in the winter time.  So I've avoided milk for around 20 years for that and other reasons.  

Since a feeling of cold goes along with hypothyroidism I've wondered if cows milk can cause thyroid issues.

Funny, the symptoms you describe are basically the same as those of my dog when she developed thyroid problems.  She was very weary and down, unable to do much, always cold, etc.  However, I suspect that you didn't have the problems with your fur like she did.  

Going on thyroid meds gave her a new lease on life: it took years off of her life in very short order.  I can only imagine how much of a difference it made for her mental state from the inside -- and I wish that we'd caught it sooner.  

For a person, the ordeal would have been even worse.  At least my dog didn't know any better.

One theory floating around in the hypothyroid circle...Antibiotics have kept more of us alive than would have prior to antibiotics being invented. Poor thyroid function will lead to poor immune system function. Take away the antibiotics we were given as children for our various ear infections and strep throat and many of us grown adults would not have made it to adulthood. Now we're just grown adults with wide-spread thyroid problems.

All that stress may have caused some adrenal fatigue which will lower tissue responsiveness to thyroid hormone. It would be interesting to know what your Reverse T3 was, as adrenal fatigue will reverse the T3 making it useless at the tissue level but still measurable as a normal total T3. With continuing adrenal fatigue and exogenous thyroid hormone you may start feeling "hyper" in the future even with normal numbers. Heart palpitations were my "hyper" symptoms while on thyroid for Hashimoto's but with still lowish lab numbers. This was then misdiagnosed as "anxiety" (palpitations do cause anxiety) and I was put on an SSRI. Years later I addressed the adrenal fatigue, am off the SSRI, and can tolerate exogenous thyroid without palpitations.

Hi Dr. Davis:

I was very interested in this post.  I have recently found out that the thyroid nodule I had excised 4 years ago was most likely a nodular goitre due to iodine deficiency.  I have never felt well since the surgery.  I was put on synthroid.  More recently I've been on Armour, since I consulted a complimentary physician.  He discovered that my iodine levels were very low.  I've started supplementing with Lugol's and now I've been able to go off the thyroid meds and I'm feeling much better.  I too have had thyroid problems every fall/winter since the surgery which resolve with the coming of spring.  Once I look forward to having my lipids rechecked once my iodine levels are normalized to see if it has any effect.  I was diagnosed with familial hypercholesterolemia 20 years ago.  Your blog has been a wealth of information.  Thanks so much.

Olga

Have you considered that perhaps stress and lack of sleep simply caused your thyroid functions to become 'sluggish'?

So instead of your thyroid being the cause of your symptoms, it was your lack of sleep + stress, which then caused your thyroid to work less effectively? Meaning... your thyroid issues, if there are any, were temporary, and restoration of sleep, etc. would result in an improvement?

Armour would improve your symptoms under such a scenario too. But perhaps simply sleeping more, etc. would have done the same. Although this is a bad analogy, it's as if you took lots of caffeine or an amphetamine to keep yourself awake, more alert, etc. Yes, you would feel better, but taking better care of yourself, sleeping more, less stress would be the better option.

Your hormone numbers are actually pretty good, by the way. I mean, no Endo or familty doctor would ever treat you with a TSH that close to perfect, and your hormone levels, although not perhaps ideal, really weren't that bad. And TSH, T3 and T4 all do fluctuate, not only day to day, but in the same day. Your TSH could come back close to 1.0 after a couple of night's of good sleep.

Did you have your thyroid antibodies tested? That is the main cause of hypothyroidism, and can cause symptoms on their own, regardless of thyroid hormone levels (as least that's what I believe, but some doctors may think differently).

I don't mean to sound negative with these comments, but I'm just playing Devil's advocate. It does sort of sound like you are finding thyroid disease everywhere, even in yourself, when it may not exist.

Generally, for a proper  thyroid disease diagnosis, you can't go by a single test if your TSH is close to normal like that. A TSH >2-3, raised thyroid antibodies, and an ultrasound are usually used. If you come back abnormal on a couple of those, then yeah, you probably have Hashimoto's or some sort of thyroid problem.

If you have been low carbing, there is something I read about called Euthyroid Syndrome where your thyroid slows as response to the ketogenic state--the body thinks it is starving and slows down.

This is different from thyroid disease. Very common.

Unfortunately, it is impossible for us ordinary mortals who don't have prescription pads to get the thyroid hormone we need.  Doctors see the normal test results and refuse to prescribe.

For me, the only cure is to up the carbs again (with insulin) since I can't get treatment.

A lot of the Armour/natural throid fans and proponents say that your FT3 should ideally be at the top of the range, and FT4 at least in the top third. So, by the looks of it, you were in fact having something of a thyroid dip.

So...how do you convince a doctor to prescribe thyroid when your lab results don't support it?

All great comments.

However, I've told everyone only part of the story. For instance, in patients we are seeing marked reductions in LDL and lipoprotein(a), not to mention improved energy, weight loss acceleration, and mood.

As time passes, I am becoming more and more convinced that first a.m. oral temperature is the best way to identify low thyroid.

Improvements in lipid scores is another matter. It's not subjective anymore then.

The question of why it's so common then is an interesting issue. You can't just assume it's lifestyle or lack of D, etc.  It is possible that's the cause, but it'd be a guess and not really scientific.

I mean, we can safely assume you are following your own plan, yet  your thyroid may be sluggish there too.

For Euthyroid Syndrome, you'd want to get your reverse T3 tested. At least that's what my doc said to test for. And as for getting treatment when your labs don't support it... umm... it's a problem. It's difficult enough getting treatment when your labs are abnormal.

I'm glad Dr. Davis mentioned that there are patients with reduced LDL after treatment. I've recently been diagnosed with Hashimoto's -- TSH routinely >3 this past year, elevated antibodies, and two abormal ultrasounds later, an Endo is finally treating me. My lipids have been extremely stubborn, even though I follow a low carb, very little wheat diet, fish oil, normalized D, exercise, etc. My trigs won't go below 150 & LDL is in the 120ish range. Thankfully my Lp(a) has always been low 4-5. We'll see after treatment (assuming my endo doses me enough) if my numbers improve.

The free t3 result you posted was low.  Very low.  This can cause a spiral of damage & disease.

I am one who had a normal TSH even when my free t3 falls below the normal range.  The HPA Axis is at fault.  

This situation is not as rare as some doctors like to think.  

I do not believe doctors should rely only on TSH (a pituitary hormone.)  Free t3 is THE active thyroid hormone, and deserves the strongest attention.  

I like to keep my ft3 at or just above the midpoint of the lab's reference range.

Dr Dach reviews the book "Stop the Thyroid Madness" and links to other books and websites concerning thyroid/synthroid/armour issues. http://jeffreydach.com/2009/02/06/stop-the-thyroid-madness-by-jamie-bowthorpe.aspx

I have been on Synthroid for years and now wonder if I would feel better on Armour. I am always cold and my skin, although less dry, it is still dry. I lost hair at one time. I am no longer losing hair, but I never grew back what I lost.

Not long ago my son and I were tested for gluten (IgA antibodies, anti-tissue transglutaminase IgA, and genes, and we both tested positive but with a slightly different combination of genes that predispose.  

Then it occurred to me that the hypothyroid symptoms greatly worsened during the years when I was eating the most gluten, at the end of my "bread machine phase" (bread machine recipes often specify high gluten wheat flours and added wheat gluten to boost rising performance and enhance texture) and when I was low carbing, but consuming LC bread products that contained not only soy, but added wheat gluten to boost protein and reduce starch content.  Gluten sensitivity and thyroid conditions often are related, but of course, I was not checked for anti-thyroid antibodies at the time.  

I still eat LC, but a few years ago I did drop the LC bread and wheat products (and basically grains altogether) because they didn't fit into my goal to eat less industrially processed (fake) foods.  I'm not entirely paleo, but definitely eat in that direction, with very good results.  Wish I could say that was enough for my thyroid function to improve without added thyroid hormone supplementation, but I still take thyroid hormone (T4 and T3) to feel better.

Unfortunately, it is impossible for us ordinary mortals who don't have prescription pads to get the thyroid hormone we need.

For those in jurisdictions in which importation is allowed (or for those willing to risk ordering a medication that is probably not a high priority for prosecution):

U.K. source
S. Africa source

I've heard a lot of similar stories in the UK - in many areas thyroid is not treated unless TSH is over 5 or even in double figures, and T3 and T4 tests are unavailable.

Some people simply do not do well unless TSH is around 1 and it often takes a geographical move to obtain treatment, the effects of which can be dramatic and may include improved BG and "treatment resistant" depression resolving.

Yet others need more subtle rebalancing until T3 and T4 are in range.

As to causal factors, no clue, but this seems commoner that it's supposed to be.

Dr. Davis I'd be interested in your experiences with patients with low testosterone levels and its relation to heart disease, plaque progression and metabolic syndrome. Has restoration to "normal" levels led to improved cardiovascular health?

Regarding Euthyroid Syndrome. The full name is Euthyoid Stress Syndrome. Dr. Eades says he did not see this effect in his patients. See the comments section of this link for further information. http://www.proteinpower.com/drmike/uncategorized/vampire-myths/

People practicing CRON, calorie restriction with optimal nutrition, also report low T3 levels.  In fact, they say low T3 levels is associated with longevity and seem to think it's a good thing.

Yes there is a school of thought that Free T3 should be at the top of the range and free T4 mid range or higher. Since this is the school of thought that actually has success with patients feeling better, I would go with that. My TSH was totally normal like yours but my antibodies were pretty high. Although, that being said I have read that a TSH over 1 in a woman and 1.5 in a man is already in the danger zone http://www.thyroid-info.com/articles/dommisse.htm. Have you had your antibodies tested?

There is a thyroid scandal going on all around the world where those of us with hypothyroidism are neither being diagnosed nor adequately treated.

My temps have been in the 96's for years. God knows how long my thyroid gland has been being attacked.

FYI it has been reported that most pateints feel their best on 3-5 grains of armour. There is even a theory that in healthy individals TSH is very, very low and that TSH only activates as a kindof emergency response.

Here is a good NYTimes overview on treatment and controversy. 3/28/09

http://preview.tinyurl.com/ckg6uq

MikeV

I could be a poster child for what no T3 can do to you.  I wonder if you could address the recent lack of availability of Armour thyroid and the disinformation regarding such.  I have resorted to ordering glandulars from NutriMeds but I am already suffering from a week of having to go back on levoxyl because of Armour not being available.  I have called many pharmacists and physicians and asked them what they are being told and virtually EVERYONE SAID NOTHING.  Any comments appreciated on this.  To me, this borders on criminal to abruptly stop the availability with confusing and contradicting reasons and all they will say is take a syhthetic.

MyGalSal,

The thyroid shortage is most acute at the corporate chain drugs stores.  They almost always order via dtisributers (middlemen) rather than direct from the maker.  

Try a compounding pharmacy, either local or via online/mail order.  If you don't know of one, try this site:  www.iacprx.org/  Compounding pharmacies make individual preparations for all sorts of reasons.  They are often located near major medical centers.

Many compounding pharmacies still have natural thyroid supplies (though they may be limiting refills to give everyone a chance during the shortage).  Compounding pharmacies also can compound a thyroid preparation specifically for you (though it is more naturally expensive than buying ready-made pills) if they still have a supply of the bulk thyroid extract powder, but your doctor will have to know how to write a prescription for compounded meds (my HMO endo didn't know how, I had to find out for him!).

I've been able to get Nature-throid via a compounding pharmacy (they mail it to me), though lately I've had to be flexible and split larger dose tablets in half or take two of a smaller dose.  I don't mind, as long as I can still get Naturethroid.

Janie Bowthorpe at Stop the Thyroid Madness blog has tips for maintaining your access to natural desiccated thyroid hormone, including having your doctor write your prescription as "broadly" as possible to so that the pharmacy can fill it with different brands or tablets cut in half, etc.  YOu may have to think outside of the "shopping center drugstore box" though.  

I haven't tried this yet, but many people are having good luck ordering thyroid hormone from Canada (there is NO thyroid hormone shortage in Canada and Europe).  Again, Janie at STTM blog has posted specifics and communication with a Canadian manufacturer if you decide to try this route

Good luck.

It's your discovery, good job!

A fantastic read….very literate and informative. Many thanks….what theme is this you are using and also, where is your RSS button ?

With regards to adrenal fatigue, there’s a new web site that gathers much of the information from Val, who’s been helping people treat adrenal fatigue and hypothyroidism, including rT3 issues, for a long time: http://nthadrenalsweb.org

Highly recommended.

Well Whattadya know, yet another great site to add to my reader!
Hypnose or hypnosis

It's been a tough winter in Wisconsin. Let's face it: It's Wisconsin. But it's been tough even for this region, with weeks of temperatures consistently below 10 degrees. Even so, I was having a heck of a time keeping warm. Extra shirts, socks, soaking my hands in hot water--none of it worked and I was freezing.

Pardon me for sounding bitter, but you got to resolve effortlessly symptoms I had to endure for four years (actually they were much worse, but it took 3 years of being told I had perfectly normal TSH levels, so shut up, and then another year to get an appointment with an endocrinologist who said, why yes, yes, you do have a goiter, we'll try synthroidl.  Two years on that crap, which didn't help at all, eventually some t3 which didn't either, and finally a minimal dose of Armour Thyroid (1 grain) which keeps me from feeling quite so crap, but I can't lose weight -- ever -- and can't ever stay warm in winter, or regulate my body temp in summer.  I HATE doctors.  And no, I can't change endos, there are't any more endocrinologists in this area, I'm damned lucky I got this one.

I was diagnosed with Hypothyroidism April 2006. My doctor started me on 100 mc of synthetic drug a day. After being on the dose for 2 months TSH level was down to 1.4 and my area normal range is 0.2-4.5. My doctor decided to keep me on the 100mc Thyroxine a day to see how i went. 4 weeks later i started to feel alarming symptoms as if i had Hyperthyroid. So I decided to switched to bovine thyroid, so far I gained positive results.

I think the key will be if you continue to see good results over a period of a year or so.  Changes in your workout approach, whether it is more volume, less volume, slower, more explosive etc. tend to produce good initial gains because you are doing something new and different, it's always good to mix it up once in a while.

"I think the key will be if you continue to see good results over a period of a year or so. Changes in your workout approach, whether it is more volume, less volume, slower, more explosive etc. tend to produce good initial gains because you are doing something new and different, it's always good to mix it up once in a while."

I beg to differ on this. When something works, it works. There is no reason to "mix it up" if results are what you are after. If exercise is something you are using for entertainment then yes you'll need a variety of things to keep you interested.

If you allow for recovery, sleep and eat healthfully, eventually strength gains slow to a crawl no matter what technique you use. In fact, once you see your strength gains slow and halt, you know you are on the RIGHT track. Sometimes it will take multiple attempts with the same weight load before progress resumes. Stay the course. Don't jump ship because you are not making the same gains you did early on in your training program - so long as your training is sound.

Here's a good paper discussing in part the non need for "mixing it up."

http://bit.ly/dIexZi

I had good results with slow burn after reading Fred's book. After a while, my strength gains stalled. Fred then recommended adding more fat to my diet and 'microloading'.  I got some 1.25 pound magnets and used those to more gradually increase the weight at each workout.  It worked very well and I lost another 10 pounds of fat and added another 30% of resistance across the board.

Doug McGuff's book Body by Science also has a lot of good information.

After many years of training to stay in shape, I think mixing it up is good for the mental part of it all, the "mo".
No doubt slow burn works and is very practical compared to the 90 minutes done 5 days or more a week of P90X which is quite popular right now.
In my teens I did a Bob Hoffman work out from Strength & Health Magazine, that consisted of very heavy weights, with low reps done slowly & breathing deeply. I gained a lot of muscle doing that, and could hardly walk after the squats.

I've been doing Fred's Slow Burn for over three and a half years now after a recommendation from  Dr Mike Eades and I love it. Also read Doug McGuff's book Body by Science a while back and it's a really useful addition. I follow a low carb Paleo diet. I have a diagnosis of osteoporosis and this was the initial reason I took up Slow Burn but it has improved my overall health no end. I used to do it at home but now at a gym so I can lift heavier weights. I must look strange - a middle aged woman doing her weight lifting in slow motion but I don't mind

I haven't tried Slow Burn, but I've had good results with Body by Science (which was my first introduction to HIT). I was impressed with how quickly it made my arms look more athletic (I'm female) and I was pretty surprised to get the metabolic training effect out of something so slow.

As far as "mixing it up" goes, as I understand it the concept of periodization came about to allow athletes to focus on strength, explosiveness, metabolic conditioning, etc. at different times so as to improve in multiple ways over the longer term without overtraining
(patterns like Westside Barbell training try to address the same problem a different way). If your goal is to maintain muscle mass for health and appearance, as Fred says you really don't need to worry about it even though your progress will eventually slow.

I've been doing a slightly modified version of 'Slow Burn' (modified to suit my own interests and physical needs), with great success.  I agree with Mr. Hahn that if one is following a properly designed routine, there is absolutely no need to "mix it up" every now and then, as the P90X ("muscle confusion) infomercials would maintain; there's simply no scientifically derived evidence to support the point.  That said, Dr. Davis, if you would be willing, I'd love to see a few of the specifics of your workout routine (e.g., exercises, exercise order, etc.).  Thanks for the blog.  Will.

Wow. After 15 years, you just caught up with it? Now you know why exercise science in college is terrible. No difference than nutrition. Most of information are from USSR or its surrounding area way back in time. Ever wonder why they used to dominate Olympic games? They were way way way ahead of USA in exercise science despite inferior genetics. After the break up of USSR, USA started to get all the information over exercise science but not everyone caught on quickly.

Anyway, it's good to mix things up mainly to beat boredom. It's different for everybody so go with whatever you want.

Slow burn will never work for athletes though. The movements demand quick sudden movement so it's good idea to mix things up, not solely on slow movement. It doesn't work in REAL LIFE. Basically, you're being taught to move slowly.... Not really a good idea.

I want to add one example of how learning USSR's exercise science and others will get you very far...

http://www.defrancostraining.com/index.php


VERY GOOD trainer for athletes.

I bought Mr. Hahn's book and was very interested in the assertion that slow burn is the only (or perhaps best way) to train fast twitch muscles. My cross-fit instructor is skeptical. Other than this book, does anyone know of additional research that supports this?

I tried "Slow Burn" at home, and frankly, it was too hard for me to keep doing. It is intense! Next I tried the children's versian, still couldn't make my self do it, even though I could tell it was working.
Finally, I asked Fred Hahn for a recommendation for a person trainer in this method in the Seattle area, and he gave me Greg Anderson's, Serious Strength gym. I've been training there since April and am very happy to go in and work out with personal attention and encouragement for about 10 minutes a week, and with the results.     Jeanne

"Basically, you're being taught to move slowly.... Not really a good idea."

I don't buy this notion. I use slow-burn to build strength, and it's the only formal exercise I do. I'm 54 yrs old and I indulge in two sports that require both stamina and speed-surfing and skiing, and I have plenty of both.

"Slow burn will never work for athletes though. The movements demand quick sudden movement so it's good idea to mix things up, not solely on slow movement. It doesn't work in REAL LIFE. Basically, you're being taught to move slowly.... Not really a good idea."

Slow Burn is a method of resistance training designed to build muscle and thus strength and endurance. Any athlete who becomes stronger than he is already will experience a benefit in her chosen sport.

A stronger athlete is a better athlete IOW.

The two requirements for improvements in a sport skill is the exact practice of that skill and improvements of the body (being stronger, leaner, etc.)

Training fast with weights does not make one faster on the field. Slow and fast twitch muscle fibers are both recruited towards the end of an intense set of an exercise. These terms slow twitch and fast twitch refer to the fibers fatigue characteristics not their ability to move the body slowly or quickly. Many coaches and trainers misunderstand this.

It's been said that the best program is the one you can stick with.  There is no single optimum system IMHO.  If one tries this system and enjoys it, it is a good system for that person.    Also, there is much written about the benefits of slow movement training, as related to central nervous system training.  The safety factor would also be attractive to middle-aged people to whom injury prevention is a priority. For serious athletes (probably 0% of commenters) training crossover is probably exaggerated. If you want to get good at football, play football.  If you want to get good at lifting weights slowly, lift weights slowly.

I get a lot of strange looks when I'm doing the slow burn at the gym.  I do an upper body workout one day and lower body/core two days later.  Three days I week I do Mercola 8's HIIT on a treadmill.  I'm already seeing improvements in my running but nothing new in the mirrors yet.

kevin

"The two requirements for improvements in a sport skill is the exact practice of that skill and improvements of the body"

I agree with this and I don't see the relation between "strength" training and other sports specific training. Strength is strength no matter how you get it.  To train "athletically" then you need to train as close as possible to that end which fits into other parts of a complete regimen. There are ways to train weights sports specific which would bring it closer to, and work more toward your chosen endeavor but then you would still need separate strength training. Or at least can benefit from it.  So when training for strength, what difference does it make how fast or how slow you lift (as it applies to your sport)?  None IMO. It only matters as far as "weight training" results are concerned.  And getting stronger and more fit never hurt any part of sport (IMO).

Kevin you said:

"I get a lot of strange looks when I'm doing the slow burn at the gym. I do an upper body workout one day and lower body/core two days later. Three days I week I do Mercola 8's HIIT on a treadmill. I'm already seeing improvements in my running but nothing new in the mirrors yet."

I really suggest that you consider ditching the HIIT stuff. You're hindering your ability to build muscle with that stuff.

As for looking leaner, that is diet. What is your diet like?

About the comment that slow burn teaches to move slowly. So what? That's how we learn motions. We learn motions independently of speed. As we repeat the motion, we become more proficient. As our proficiency increases, we can do the motion faster. But we learn the motion at slow speed first.

We don't learn to move slowly. We learn the motions slowly, then we can increase speed at will.

Once we've learned a motion, it's difficult to learn a similar but different motion at full speed. That's because the previous motion takes over as an automatism. Something like the golf swing for example. It's difficult to learn to swing a certain way when we've been swinging a different way for years. But it's possible, if we do the motions slowly first.

However, Slow Burn is not about learning the motions slowly, then increasing speed at will. Yet there is nothing preventing us from doing the same motions at full speed outside of the Slow Burn workout. If anything, since we've "practiced" the motions during the workout, we are now more proficient in these same motions and can execute them with more precision at higher speeds.

About the comment that slow burn teaches to move slowly I remember reading that chi kung standing meditation is suppost to be one of the most effective exercises to build speed. Not too fun to stand still for an hour a day though.
For me 2 workouts a week sound like too little, I don't doubt they're effective, I'm just sure I'd miss the activity the other 5 days of the week. Would probably feel lazy and tired. As a computer worker one of the reasons I enjoy working out is the high energy feeling it provides.
Is there a complementary activity that is suggested? I see in a previous comment that HIIT isn't.

The inevitable comments about a slow-movement workout making you slow always leave me puzzled. The slow movement makes your muscles work harder and prevents you from relying on momentum to move the weights. Your muscle memory of faster movements aren't erased.

My previous workout plan (Body for Life) consisted of more, faster reps. If the argument that slow workouts make you slow were true, my dancing would have gotten slower. It hasn't. I've built up strength with no joint pain and fewer workouts.

As for two workouts per week versus five being a problem--now I've heard everything. Go out and have some fun!

Muscle stem cells (in skeletal muscles) promotes a muscle transcription factor. With under use and age fast twitch fibers undergo more stem cell loss relative to the rate which slow twitch lose their % of stem cells.

Exerting the muscle to endure being used constantly over a time period increases the number of muscle stem cells. This applies to men and women. For both, fat and fibrosity infiltrated into muscle down regulates stem cells.

The anabolic effects of sex hormones show that endurance use at moderate intensity raises testosterone and the amount of muscle stem cells. Men lose +/- 1.6% testosterone annually after their very late 30's.

Women lose 90% of their estrogen at menopause, so their muscle loss pattern differs. Endurance training done by women to maximize anabolic bonus for stem cells is less simple. However, straining exertion at an incline triggers estrogen receptors and these instigate stem cell boost.

In both sexes the loss of non-postural fast twitch muscles is more rapid than the loss of slow twitch fibers. Yet not all human muscles lose stem cells at the same rate. These myogenic stem cells are called "satellite cells".

"anonymous'..... the Soviets excelled for years because their athletes were 'roided to the gills. C'mon, man, some of their women looked like Mad Dog Vachon, for cryin' out loud!

I'd like to give Slow Burn a try, but the Ken Hutchins-style workout places are usually located in tony 'hoods like Lake Forest, IL, out of reach for the majority of us. I'm also .... curious....I've hear that both the joints and nervous system can get fried over time with this method due to 'going to failure' all the time. Comments please.....

"I've hear that both the joints and nervous system can get fried over time with this method due to 'going to failure' all the time. Comments please....."

Nonsense. Utter nonsense.

"As for two workouts per week versus five being a problem--now I've heard everything. "

Really? Never heard that before? ok then, go tell any of this kids he can exercise only 30 minutes per week. http://www.youtube.com/watch?v=1malgZpYKn8

I enjoy the fact that I only need to do this once a week.
The rest of the week I figure skate and horseback ride, and enjoy the fact that I have a lot of energy and strength for my very physical job.
I don't want to spend my whole life in a gym.

Jeanne

Bingo Jeanne.

"Really? Never heard that before? ok then, go tell any of this kids he can exercise only 30 minutes per week. http://www.youtube.com/watch?v=1malgZpYKn8"

We're talking about resistance training for 30 minutes a week not sports play. And these kids do not need ANY amount of exercise for sports play other than for skill practice of soccer.

Fred Hahn said...
Kevin you said:

. I'm already seeing improvements in my running but nothing new in the mirrors yet."

I really suggest that you consider ditching the HIIT stuff. You're hindering your ability to build muscle with that stuff.

As for looking leaner, that is diet. What is your diet like?


Fred, Thanks for the reply.  At my age--54--I have to reconcile myself to the inevitable slow physical decline.  Slow Burn keeps me from overdoing the weights and self-injury.  HIIT does the same for my cardio.  Dr Mercola wrote that his HIIT protocal stimulates over 500% increase in Growth Hormone.  

In part because of this website I've quit most all meat and dairy.  I admit to over-indulging in cookies and cakes this time of year.  In the past it didn't matter because running 50-80 miles every week kept my weight under control.  I've had to stop that due to a torn achilles;  Vibram Five-Finger Shoes were the cause.

A checkup and treadmill stress test last year showed I was at 20% body fat but a better stress-test number than 90% of men my age.  

My comment about nothing new in the mirrors yet was a joke but the point is I'm not seeing any new muscles yet from the Slow Burn.  But my resting heart rate has slowed since being on the Mercola 8's.  

Again, thanks for the note.

kevin

"Fred, Thanks for the reply. At my age--54--I have to reconcile myself to the inevitable slow physical decline. Slow Burn keeps me from overdoing the weights and self-injury. HIIT does the same for my cardio. Dr Mercola wrote that his HIIT protocal stimulates over 500% increase in Growth Hormone."

I don't believe that for a second. He would need to provide proof of this and you know he won't.

"In part because of this website I've quit most all meat and dairy."


WHAT? ALL meat?! That is an enormous mistake. Grass fed meats and wild caught fish are essential to your health. The dairy is fine.

"I admit to over-indulging in cookies and cakes this time of year. In the past it didn't matter because running 50-80 miles every week kept my weight under control. I've had to stop that due to a torn achilles; Vibram Five-Finger Shoes were the cause."

All I can say is running like that is terrible for your health hormonally and orthopedically.

"My comment about nothing new in the mirrors yet was a joke but the point is I'm not seeing any new muscles yet from the Slow Burn."

Your not eating any meat! How can you get benefits from any strength training program if you are not ingesting the necessary nutrients?

"But my resting heart rate has slowed since being on the Mercola 8's."

This doesn't mean a thing. I for one do not believe that a low RHR means improved health. In fact, I think quite the opposite.

I just tried doing push ups and body squats very slowly.  Although the body squats didn't seem very hard at all, after doing quite a few reps, I was sore.  I will continue this and see how it goes.

Fred Hahn said..  

I've quit most all meat and dairy."


WHAT? ALL meat?! That is an enormous mistake. Grass fed meats and wild caught fish are essential to your health. The dairy is fine.

"I admit to over-indulging in cookies and cakes this time of year. In the past it didn't matter because running 50-80 miles every week kept my weight under control. I've had to stop that due to a torn achilles; Vibram Five-Finger Shoes were the cause."

All I can say is running like that is terrible for your health hormonally and orthopedically.

"My comment about nothing new in the mirrors yet was a joke but the point is I'm not seeing any new muscles yet from the Slow Burn."

Your not eating any meat! How can you get benefits from any strength training program if you are not ingesting the necessary nutrients?

"But my resting heart rate has slowed since being on the Mercola 8's."

This doesn't mean a thing. I for one do not believe that a low RHR means improved health. In fact, I think quite the opposite.
  
Hi again Fred,

I'm sorry to argue but I could
cite plenty of studies showing the value of a lower resting heart rate.  That's basically the goal of all endurance athletes.  At high heart rates you're burning just glycogen.  At low heart rates you're burning mainly fats.  Trained marathon runners have such a low heart rate that they're burning mostly fat at speeds that have the rest of us still burning glycogen.  

I eat hi-protein veggies and supplement with B12 injections.  I'll have scrambled eggs once a week.  I'n not a tree-hugging vegan nutcase.  Like Clinton, I'm  trying to make up for a lifetime of poor eating habits.  For me that means no dairy,  no soy, very little sat fats, and once the silly season is over, no wheat products.  

kevin

"I'm sorry to argue but I could
cite plenty of studies showing the value of a lower resting heart rate."

Please do cite some.

"That's basically the goal of all endurance athletes. At high heart rates you're burning just glycogen. At low heart rates you're burning mainly fats. Trained marathon runners have such a low heart rate that they're burning mostly fat at speeds that have the rest of us still burning glycogen."

Please can you cite some full text papers that support this claim. Thanks.

Guys I've enjoyed the mental pingpong but it's lunch time and  the sun is shining for first time in weeks.  So I'm changing into my running shorts and going out to make some Vitamin D.  I just wish it wasn't 15 degrees but that's Wyoming.

kevin

Kevin - I don't think you're going to be able to make any vitamin D this time of year and at your latitude !

Anne, I got a 90 minute run, my face and legs are mildly sunburned.  At 7000ft altitude with no clouds or shade anywhere on the track I'm hoping for a lot of VitD.  But I wouldn't argue the point.  I run for other reasons and supplement with Vit D oil caps.

kevin

"@Anonymous said...
'As for two workouts per week versus five being a problem--now I've heard everything'.

Really? Never heard that before? ok then, go tell any of this kids he can exercise only 30 minutes per week. http://www.youtube.com/watch?v=1malgZpYKn8"

Never heard of it--I guess I don't hang around a gym enough.

The little kids playing soccer is an example of what I meant when I said "go out and have some fun." Workout = strength training. Fun in this case = dance, soccer, skating, or whatever makes you enjoy working up a sweat.

I'm the only person at my gym doing slow, controlled lifts with my iPod tuned to a metronome. I get a lot of funny looks, which makes me chuckle to myself.

I'm happy with the results I've been getting in the two months I've been doing Fred's workout style, especially considering how little time it takes out of my week.

My one complaint is that it takes a lot of mental energy to be that focused for the duration of my workout. It was much easier to get to the gym when I knew I'd be doing a bunch of mindless reps and resting between sets while listening to music on my headphones. I'm also noticing how unfocused other people at the gym are, and the cardio people on the treadmills are suddenly driving me nuts.

I guess that's not really a complaint, just an observation. It makes me wonder what the atmosphere is like at Fred's gym. Too bad I don't live in New York.

Dr. Bill, I didn't know you were a Jersey boy. Gosh, we were practically neighbors back when you were young.

I've also been doing Fred's Slow Burn method for the last few months - only once a week, and I've only been doing it about 20 minutes. No changes on the scale (and I need changes, sob) but my jeans seem to get looser every day - and when I'm out going for birdwalks I find I have far more stamina than I have had in a long time.

Hi Kevin,

I'm sure the experts will correct me if I'm wrong, but the sun's ray's need to strike your skin at a particular angle for you to be able to make vitamin D, and that angle is not acute enough at northern latitudes in winter. Even though you can get sunburn in winter that is not the same part of the sun's rays which make vitamin D.

Hmm,  During the summer I run midday.  The sun is directly overhead and the tan is darkest on my shoulders and the tops of my feet;  I run in VFF sandals.  If an imaginary line directly overhead is zero degrees and the horizon is 90 degrees, this time of year the sun is never higher than about 45 degrees.  When running midday now the sun is hitting my face and legs at an angle similar to what it does during Summer.  I know I can have my Vit D levels tested.  I may do that soon.  

kevin

Appropriate to this Slow Burn thread, I'm a veterinarian practicing since 1984.

I was at the gym just finishing my SlowBurn arms and shoulders workout when the clinic called to say there was an emergency.  The workout involves using eight different machines.  When it's done I can barely lift my arms.  

I got to the clinic and found a patient I'd spayed two days ago had chewed out her stitches, all three layers and her intestines were hanging from the six inch long open wound.  The owner had come home for lunch and found her like that and rushed her to the clinic.

I took her right to surgery.  The owner stayed to watch.  Having just finished a Slow Burn workout I didn't have much control over my arms.  They shook like St Vitus Dance.  It took an effort of will it control my surgical tools as I debrided the raw wound, cleaned the exposed bowels and replaced them.  

As I worked I overheard the owner murmer to the nurse, "He really cares, doesn't he."

This morning, patient doing well.

I've done slow burn workouts - I've become convinced that the key is the amount of time that the muscle is working and to stimulate growth you need to work it until if is starting to fail.

If you do 10 quick reps you end up spending more of you time between reps rather than working out.

I do a mix these days - 8 quick reps followed by two ultra slow reps - until the muscle collapses.

Most of the folks in the gym are embarrassed to push to collapse - but that seems to be what stimulates growth.

Hi Fred:

I'm not familiar with your book but I plan on changing that.

I started resistance training for the first time 18 months ago.  I'm 54.  I apply the Body by Science concepts, however I've evolved my program to where I do one body part a week.  On a 6 week cycle I do lat pulldown, overhead press, leg press, seated row, chest press and leg press.  

I continue to see gains in TUL or load every workout.  

This with a paleo diet, has improved my overall fitness by an amazing degree.

Sifter said: I'd like to give Slow Burn a try, but the Ken Hutchins-style workout places are usually located in tony 'hoods like Lake Forest, IL, out of reach for the majority of us.

Exercise Coach has facilities in Lake Zurich, Buffalo Grove, and Arlington Heights IL, and features Super Slow style workouts.

I work out at a 24hr Fitness.  If there's an opposite to 'tony' that's probably it.

Fred,
How can 'slow burn' exercise benefit someone who is pre-diabetic, HAS NEVER BEEN OVERWEIGHT (and does not want to lose weight) but uses a combination of aerobic/resistance exercises along with low-carb eating to control blood sugar? Exercising only once or twice a week doesn't seem enough to do the job. I have never tried this type of exercise only read about it.

acanthusbk - I live in the the UK where there are no Slow Burn or Super Slow gym facilities. I just used Fred's book and asked him questions over the net, he was so helpful. When I went to a gym I found out how to use the machines correctly from a trainer there and then simply used the Slow Burn technique.

rmarie - in addition to other health problems I am atypical type 2 diabetic, thin, never been overweight, who eats very low carb Paleo diet. I do Slow Burn/Superslow twice a week and walk three or four miles a day. My blood glucose control is excellent.

Ann, thank you for your very helpful and informative answers! Maybe Fred has something to add as well.

"How can 'slow burn' exercise benefit someone who is pre-diabetic, HAS NEVER BEEN OVERWEIGHT (and does not want to lose weight) but uses a combination of aerobic/resistance exercises along with low-carb eating to control blood sugar?"

Well it helps the way any resistance training program helps. IMHO, SB is a better way to perform your resistance training program. I also strongly believe from years of experience that high intensity resistance training produces better results than high volume, low intensity training.

"Exercising only once or twice a week doesn't seem enough to do the job. I have never tried this type of exercise only read about it."

Twice a week, not once, is best. If you have never done it then how do you know it won't do the trick? And yes you should stay active too.

Now when you say low carb, how low carb are you? If you are pre-diabetic, I wouldn't go above 30-60 grams of carbs a day all from nonstarchy veggies.

45 year old Bernard Hopkin's bulky (but undefined) body boxed against the sculpted 18 year younger light heavy weight division champion in Canada Sat. night.

Many don't like boxing and have their reasons. The muscle response involved is very impressive though.

Maybe someone can tell me if any
of the boxers' important training steps would be akin to slow burns.

"45 year old Bernard Hopkin's bulky (but undefined) body boxed against the sculpted 18 year younger light heavy weight division champion in Canada Sat. night.

Many don't like boxing and have their reasons. The muscle response involved is very impressive though.

Maybe someone can tell me if any
of the boxers' important training "steps would be akin to slow burns.

Not sure what you mean by this Mito.

Slow Burn is a way to lift weights. Boxing is boxing.

I think this was addressed in the edition of Slow Burn that I have.  Weight lifters can become as large as NFL linemen but the weight lifters don't have the explosive power of those linemen.  The lineman are training those fast twitch fibers while weight lifters aren't.   Slow Burn works all muscle fibers.  I could be wrong.  I don't have the book handy.

I think this was addressed in the edition of Slow Burn that I have.  Weight lifters can become as large as NFL linemen but the weight lifters don't have the explosive power of those linemen.  The lineman are training those fast twitch fibers while weight lifters aren't.   Slow Burn works all muscle fibers.  I could be wrong.  I don't have the book handy.

Supposedly all boxers move weights around in some way sometimes in their training regimen. I've seen promotional shots of guys on their backs slowly pushing oversize tires up with their legs.

Explosive ability is a good description of a special capability they'd want to develop. A counter punch is often a fight changer. I'd like to hear if slow burn method might improve any aptitude over another weight technique.

If this is too far off topic or doen't merit discussion there is no need to respond. I don't box, but often see physique disparities in contenders in a match.

((I always think of lifting weights as a solution to our contemporary lifestyle - it meets a need and serves individual goals. Nobody considered it where I worked as a longshoreman; we man handled each sack and box in jumbles using giant rope nets inside and outside fetid holds of ships.))

You play Xbox?

I've been using the NatureMade fish oil because it's frequently 2-for-1 at Rite Aid. My VAP cholesterol test was excellent while on the product, but I suppose that doesn't ensure that the product is doing anything. Thanks for the info.

Fresh fish does not smell like fish. Only when the fish tissue starts to decompose does it start to smell like "fish".

First of all, Doc, thanks for taking the time to do this blog. It's great to have such an expert "in the trenches" practitioner helping ordinary people like me make much better decisions on keeping my heart going!
Specifically on this post, when you write these companies, I'd suggest writing a letter and sending it by post right to the CEO.
I've found that usually gets a better, more personalized response to my concerns.

What is a person with very low Vitamin D levels, but prone to kidney stones, to do?

I wonder if that letter was generated by a worker at an overseas customer service center who, as you suggested, just opened a file and inserted text.  How many hits does your blog get?

I've wondered if the USP seal on vitamins actually means anything -- apparently, it doesn't count for much.

I have had a company actually admit to a problem with their supplements once (Jarrow), where their Ubiquinol gelcaps were leaking (found goo at the bottom of my bottle). They admitted the capsules were faulty and they planned to change the manufacturer of their gels, and even sent me a replacement bottle. So... some companies will actually admit to problems and take care of them, but that is still probably the minority.

Hi Dr. Davis,

Have your patients had any experience with CostCo's 2000 IU vitamin D3 gelcaps?

In Italy, Vit D3 drugs are available over the counter at pharmacy. They are ultra cheap. I go for an injection every 2 months as 5 vial cost less than five €.
What prevent US consumers from going to a pharmacy and buy registered drugs instead of supplements?
Quality control for drug companies is surely a bit harsher than for supplement companies.
Then, regulation can be different.

good to know, I used to buy Nature Made all the time... now I am wondering if the "gummy bear" vitamins and vitamin D I give my kids actually are vitamins.  What if they are just candy.  How can you tell for sure?

Impudent--

Great idea.

Perhaps I will send future emails and say that there are thousands of people reading this blog who will await their response!

Gary--

Because we have only one Costco (i.e., only one store), we have had too few people buying this product to say with any confidence.

It never hurts to have your blood level checked.

You might consider me 'weird' but  I actually like to chew my fish oil capsules - I like the taste of the oil and the capsule itself. This has an added important benefit: I can taste if it's fresh BEFORE I swallow. I must say I've never had a rancid one yet. Presently am using Spring Valley from Walmart. I often do the same with my liquid vit D3 caps as well.

Dr. Davis, thank you so much for all the info you put out for us.

I am a fan of your blog, but honestly this is a very low standard of "proof" that you are using. If you feel strongly about it why not get a certificate of analysis done yourself?

I'm a psych NP. My patient took 7000iu Naturemade tabs with no effect on blood level after 2 months. Have heard tabs don't absorb, so have stearing people away from them. Thanks for the info on their softgels.

If I had to get a "certifcate of analysis" performed for every supplement I questioned, we'd go bankrupt just on the testing.

I'll be interested to see what organizations like Consumer Lab, who test a broad range of supplements, come up with.

I subscribe to Consumerlabs.

When they tested vitamin D3  (1/18/10) they only tested up to 1000iu/d capsules/tablet/liquid and also some combination products.

I'm sure readers here are all aware  1000iu/daily can, at best, only raise 25(OH)D 10ng/ml = 25nmol/l.
Most readers require significantly more than that to reach >50ng/ml+ ensuring their body has an emergency stored reserve supply of Vitamin D3.

People who are overweight or suffer diabetes, Celiac or any other inflammatory condition will generally require even more than 1000iu/daily/D3 per 25lbs weight.

The LEF report Startling Findings About Vitamin D Levels in Life Extension® Members By William Faloon shows IN PRACTICE 5000iu/daily/D3 averages only just above 42ng/ml so if we are trying to achieve a level that does more that just meet our daily requirements but also enables the body to store Vitamin D for emergencies, then we require MORE THAN just 5000iu daily/vitamin D3.

At latitude 52 with a BMI just under 25 I take 5000iu/daily + regular short full body prone uvb/winter/sun/summer exposure
My 25(OH)D stays @ 64ng/ml.

I am not convinced Consumerlabs testing of tablet formulations of 400iu or even up to 1000iu has any relevance to correcting vitamin D insufficiency.

Dr. Davis

My name is Douglas Jones, I am with in Corporate Communications at Pharmavite the makers of Nature Made Vitamins.  We take your comments very seriously and need the information that Marissa asked for in her e mail.

All of our products are tested fully before they are shipped to our customers.

Please feel free to contact me directly at djones@pharmavite.net

Thank you

Thank you, Mr. Jones.

Because I identify these cases one by one over months, I don't have my patients bring in their bottles.

I have to say that I am also impressed that I got beyond the girl in the cubicle on this one.

In future, I will ask patients to bring the bottles in. If I know this leads somewhere, then it's worth the extra effort.

However, I remain confident that there is a problem.

Do you recommend multivitamins and/ or Vitamin D brands?

I am 34 years old and at an ideal body weight but had moderately low HDL when blood work was done...Just following your blog and trying to figure out ways to raise my HDL and to help prevent heart disease (My mother is in her 50s and has been on statins for bad cholesterol, a path I don't want to follow).

heatherlbrandt(at) verizon (dot) net

I had been using NatureMade fish oils for years and no belchback. I got a batch that both my wife and I had bad belching with fish taste. Called the company and they said I had been using the enteric coated. I bought some of the enteric and they don't belch back, they also are not what we had been taking. Looks like I will be switching to a different company too.

My friends have been using NatureMade fish oil for over a year now. She told me that it is very effective. I think I am guess I will giving it a try.

Hi, nice post. I have been thinking about this topic,so thanks for sharing. I will likely be coming back to your blog. Keep up the good work
termpapers99@gmail.com

In Nature Made's defense, I've been using 2,000 Vitamin D from Nature Made for the past 6 months, and my Vitamin D levels have risen about 20 points.  I've been very happy with the result, so I just started using their fish oil. I'm sitting here with a brand new bottle of their fish oil enteric coating 1200 mg pills, and smell no odor at all.  This doesn't mean other people haven't had different experiences, but it might be very dependent on your individual body chemistry, and I would suggest doing blood tests every 6 months to determine if the Vit. D you are taking is working for you.  And no, I do not work for Nature Made, and have no connections to them

I just have to say that letter show what they think of customers and how they have made made their mind to deal with any complaints. They did not even bother to get a competent person who could write a letter. Forget that. They did not even bother to prepare a template response.

There is interesting research on omega 3 bioavailability.

After mixed results with various fish oil capsules resulting in low-tide burps or flatus, i moved to Coromega.  Wonderful product.

Re Costco 2,000 iu oil capsules, i've raised my serum levels to 88 ng/ml with them.

However, given the wide range of factors that affect D uptake/utilization, titrating to standard is the only useful methodology. Blind dosing, especially at very low serum levels, might not raise serum levels at all.

Omega-3 structure may affect bioavailability: Study

By Nathan Gray, 14-Jan-2011

Related topics: Research

The type of omega-3 we take may have a distinct affect on how much is actually absorbed, according to new research.


The study, published in the European Journal of Lipid Science and Technology, suggests that omega-3 concentrates – such as triacylglycerides – have much better bioavailability than purified fish oild

The team of Spanish researchers said that the study contributes to knowledge on the intestinal lipolysis of omega-3 sources, which can be found in many commercial forms, from purified fish oil to concentrates of free fatty acids and ethyl esters.

They said that despite differences regarding their intestinal metabolism, there is lack of information about the specific composition of the absorbable fraction from omega-3-TAG or omega-3-EE concentrates.

“This comparative study showed that the in vitro bioaccesibility of omega-3-polyunsaturated fatty acid (PUFA) seems to be better as omega-3-TAG concentrates than purified fish oils,” said the researchers, led by Dr. Diana Martin from the Universidad Autónoma de Madrid, Spain.

Fish oil

Consumption of fatty acids from the omega-3 family – particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – have been advised due to their beneficial role as anti-thrombotic, anti-inflamatory, and hypolipidemic fatty acids.

The authors noted, however, that in many populations consumption of fish is quite low and does not achieve levels adequate for reaching the minimal intake level of EPA and DHA. They added that because of this, an easy way of increasing omega-3-polyunsaturated fatty acids (PUFA) intake is by the fish oils supplements oils.

They said that recent studies have produced contradictory evidence for the in vitro metabolism of fish oils and omega-3-concentrates,

The new study compared the in vitro bioaccesibility of omega-3-oils from different sources. The researchers tested salmon oil, tuna oil, enriched-omega-3 oil as triacylglycerols (omega-3-TAG), and enriched-omega-3 oil as ethyl ester (omega-3-EE).

Study details

Dr Martin and colleagues reported the rate of hydrolysis of omega-3-TAG concentrates was continuous throughout the time of reaction, whereas the digestion of salmon oil and tuna oil was initially faster but stopped after 10 min.

They added that poor hydrolysis took place for the enriched-omega-3 oil as omega-3-EE.

The breakdown of omega-3-TAG oil, salmon oil, and tuna oil mainly consisted of free fatty acids (FFAs) and monoacylglycerides, whereas the breakdown from digested omega-3-EE oil consisted of free fatty acids and undigested ethyl esters.

“This comparative study showed that the in vitro intestinal digestion of omega-3 (EPA and DHA) sources as fish oil, triacylglycerides, or ethyl ester concentrates was different,” said Martin and colleagues.

“The highest degree of hydrolysis and inclusion of lipid products … was found for the omega-3-TAG oil, but compared to fish oils long times of digestion were required,” they added.

Source: European Journal of Lipid Science and Technology
Volume 112, Issue 12, pages 1315–1322, doi: 10.1002/ejlt.201000329
“Intestinal digestion of fish oils and ω-3 concentrates under in vitro conditions”
Authors: D. Martin, J.A. Nieto-Fuentes, F.J. Señoráns, G. Reglero, C. Soler-Rivas

http://www.adajournal.org/article/S0002-8223(09)00293-4/abstract

Re vitamin D uptake & utilization, diet (taking D with a meal doubles uptake), existing D levels (see Holick re substrate starvation), D form (D2 v D3), exposure, lifestyle, age (over 50 produce less in skin), obesity (excess bf sequesters D), co-factors (affect utilization), genes, bathing (bathing strips oils off skin), etc. affect D serum levels.

http://www.scribd.com/doc/38595990/D2-D3

http://www.scribd.com/doc/37319962/Vieth-Vit-D

http://www.scribd.com/doc/36940698/D-Test-and-Treat

http://www.scribd.com/doc/45004628/D-review

http://www.scribd.com/doc/49369766/Garland-021811

"Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:
magnesium
zinc
vitamin K2
boron
a tiny amount of vitamin A
Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

Dr. I came across your site while looking for someone who was having the same problem w/ their Vitamin D levels and not finding a solution.  In fact, the brand you mentioned has done nothing for me in any of the vitamin area!  However I did come across a vitamin that has taken care of my Vit D problem and other problems.  Honestly I think the brand I am taking is the ONLY brand that is actually helping people.  Everyone I know who gets on them has had great results!  Rob Dillon - rdillon4@cox.net

Incidentally, I like the way you have structured your site, it is super and very easy to follow. I have bookmarked you and will be back regularly. Thank you

i too have suffered from kidney stones. i did a 24 hour urine test and my calcium urine level was 3 times normal. shock horror all round.
i began to take 5000iu of vitamin d3 daily and in a few weeks my calcium urine level was normal, my urologist was amazed that this had happened but i did not tell him why because english doctors do not believe in supplements and he would have had a hissy fit!!.
since then, no more stones!

The video link doesn't work. [You've got an "o" at the end instead of a "0".]
Here's the right one:
http://www.youtube.com/watch?feature=player_embedded&v=y1RXvBveht0

Dear Dr. Davis,
Thank you for providing such life-saving info.  
My husband's uncle is 69 and has already had one bypass and also suffers from advanced renal carcinoma.  In the past, his docs suggested the typical zero fat, very low protein diet.  His heart disease advanced.  Now he is able to eat more protein because he is on dialysis.  His cancer is under control and his doc have informed him that his greaterst health threat is heart disease.  He wants to reverse his placque but conventional medicine and wrong diet advice have failed him.  He is the type who is extremely motivated and will absolutely comply with a big diet overhaul plus exercise (he currently walks half a mile per day but was extremely athletic into his 50s until kidney cancer struck -- then heart disease) and I would like to suggest that he sign up for your Track Your Plaque program and refer him to your blog as well as that of Nephropal.  He lives in Boston and I am wondering if you have  any collegues there who could help him implement and oversee the Track Your Plaque strategies given his grave situation.  He understands that there are no guarantees but what he's done in the past has failed miserably so is ready to try a new approach and is able to eat decent amounts of protein now.  Any suggestions you may have would be most appreciated.

Thanks for catching that John.

I'm very excited to read what sounds like a possible change in your position on saturated fat (agreed: it's only one of a list of many other beneficial dietary practices, and I shouldn't focus too much on that one).  

My own substantial weight loss, achieved by substituting fat (and saturated fat) for carbs while keeping protein intake moderate, has been such a revelation to me.  It's been quite difficult to believe that what we've been told by dietary authorities is not only incorrect, but is most likely exactly backwards.  Fat has not made me fat.  Fat has and continues to make me full.  Being full got me to a BMI of 23.  Becoming slender again has restored my athletic performance as well as improving the blood markers that most of your readers track.

Taken as a whole, this list of dietary advice might possibly be summed up as, "Enjoy good eating in moderation."  IMHO, at the end of the day, a balanced approach is an essential part of any sustainable lifestyle.

I have had what I consider great results with raising my HDL from 312 a few years ago following my physician's AHA recommendations to 51 now by doing most of the things you suggest in this blog (I am male).  My question is,  how good is this as a heart health indicator?  Even though your book suggests that only a scan will tell, I am nervous about X-rays and the cost of a scan.  Can I take some solace in my dramatically increased HDL?

I almost totally agree.

The only minor disagreement is that I would extend "wheat products" to include the other grains and starchy carbs. I am very cautious about all of that group.

My major disagreement is the omission of Australia from your list of excellent dry red wine producers

Cheers, Alan, T2 Diabetic, Australia

Anonymous re: HDL--

No, sorry, absolutely not. It is an indicator, not the real thing, meaning plaque.

If you advise eating saturated fats, then why specify "lean meats"?.

What percentage of your patients don't respond to the HDL boosting therapy you advise?

I raised my vit D level to 56, dropped wheat, increased exercise, took niaspan (albeit at only 500mg), took 3 grams omega-3/daily, took a wine extract supplement, ate  a small amount dark chocolate daily....

And my HDL went down 1 point. My weight isn't an  issue, I think, as I'm 6'1"", about 175 lbs. My body fat is approx. 15% (not sure if that's good or not). I eventually had to drop the niaspan, as I was getting heart palpitations, but it didn't seem to be doing much for my HDL anyway.

What is recommended for patients when their HDL won't seem to budge? And a better question... why isn't it raising on the therapies you recommend, when it does work for most patients? Are there any rare causes for low HDL, outside of genetically low HDL?

I can echo the last post. I have tried all of Dr. Davis' strategies, plus others, and it's resulted in slight reductions in my already low ldl and triglycerides but no change in my low hdl. I'm in great shape, eat well, exercise regularly, no heart issues or risk factors besides the low hdl, which I assume in my case is genetic.

I didn't know where else to post this question.  Is this true?

"Another way to know if abundant HDL is valuable is to look at its particle size -- smaller is better. A large study has found that people with high HDL (above 70 mg/dL) but very large particles had more risk of heart disease than people with low HDL (under 40), probably because larger particles aren't as active. But again, there's no easy commercial test for that."  This quote appeared today at http://www.oregonlive.com/health/index.ssf/2009/09/you_docs_answering_questions_a_2.html.  Mehmet Oz is usually suspect to me, anyway, but I am still curious about this statement.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

Cool Post !!!!!


smith ALan