Handy dandy carb index

There are a number of ways to gauge your dietary carbohydrate exposure and its physiologic consequences.

One of my favorite ways is to do fingerstick blood sugars for a one-hour postprandial glucose. I like this because it provides real-time feedback on the glucose consequences of your last meal. This can pinpoint problem areas in your diet.

Another way is to measure small LDL particles. Because small LDL particles are created through a cascade that begins with carbohydrate consumption, measuring them provides an index of both carbohydrate exposure and sensitivity. Drawback: Getting access to the test.

For many people, the most practical and widely available gauge of carbohydrate intake and sensitivity is your hemoglobin A1c, or HbA1c.

HbA1c reflects the previous 60 to 90 days blood sugar fluctuations, since hemoglobin is irreversibly glycated by blood glucose. (Glycation is also the phenomenon responsible for formation of cataracts from glycation of lens proteins, kidney disease, arthritis from glycation of cartilage proteins, atherosclerosis from LDL glycation and components of the arterial wall, and many other conditions.)

HbA1c of a primitive hunter-gatherer foraging for leaves, roots, berries, and hunting for elk, ibex, wild boar, reptiles, and fish: 4.5% or less.

HbA1c of an average American: 5.2% (In the population I see, however, it is typically 5.6%, with many 6.0% and higher.)

HbA1c of diabetics: 6.5% or greater.

Don't be falsely reassured by not having a HbA1c that meets "official" criteria for diabetes. A HbA1c of 5.8%, for example, means that many of the complications suffered by diabetics--kidney disease, heightened risk for atherosclerosis, osteoarthritis, cataracts--are experienced at nearly the same rate as diabetics.

With our wheat-free, cornstarch-free, sugar-free diet, we have been aiming to reduce HbA1c to 4.8% or less, much as if you spent your days tracking wild boar.

Comments (21) -

  • Anonymous

    3/25/2011 3:19:26 AM |

    Dr. Davis,

    Can someone have a good HbA1c but still have an undesirable amount of small particle LDL? ..Like perhaps someone with FHC that has their LDL particles floating around longer in the bloodstream and hence exposed longer to oxidants.

    Thank you.

    John M.

  • Tyler

    3/25/2011 3:51:56 AM |

    I love your blog but I have to clarify on this point. Check out the post by chris kresser: http://chriskresser.com/blog/why-hemoglobin-a1c-is-not-a-reliable-marker/

    a1c is not reliable for many people because of the variation in RBC life length. healthy people's red blood cells may live as over 4 months whereas diabetic's live only as 60 days. This results in vast discrepancies.

    For example my fasting BG averages 77 and postprandial peak is 85-90, but my hemoglobin A1c is 5.7

    This doesn't make sense unless you account for differences in RBC lifetime.

  • Kris @ Health Blog

    3/25/2011 11:45:32 AM |

    I'm wondering what your opinion is of glycation and aging.

    I've been reading that a major part of the aging process might be caused by glycation of proteins in the body, mostly caused by elevated blood sugar.

    Do you believe that practically, one could expect a longer life expectancy to correlate with lower blood sugar levels?

  • Larry

    3/25/2011 12:09:46 PM |

    The other day on the tv show, "The Doctors", they profiled a young woman concerned about her FBG.
    She said that Diabetes ran in her family.
    They did a bloodtest and announced that her FBG was 111.
    The scary part was when they told her that reading was okay.
    With that FBG, one can assume that everytime she eats, her post-prandial FBG is heading into dangerous territory.
    But they told her not to worry.
    She was right about her concern...as Diabetes will continue to run in her family.
    Especially with that advice.

  • Jonathan

    3/25/2011 2:44:03 PM |

    I found Walmart carries a Bayer at home A1c test kit that gives results in 5 minutes.  It came with two test cartridges so I was able to take one when I started lowcarb and another one 4 months later to see how much it came down.  (I came down from 8.3 to 5.2 in 4 months)

  • revelo

    3/25/2011 4:45:55 PM |

    What is HbA1c for those long-lived okinawans with their rice-based diet, or those long-lived cretans with their wheat-based diet?

    Wouldn't a lean healthy body (especially if there is occasional fasting) eventually clean up glycated and otherwise damaged proteins?

  • Might-o'chondri-AL

    3/25/2011 6:22:18 PM |

    Glycation picks on the amino acid valine "wing" on the molecule of haemoglobin's B-chain portion. Aldehydes, both glucose aldehydes and non-glucose ones can become bound to that valine.

    This can occur several ways. Glucose oxidation yields a byproduct, called gly-oxal; this is what most people monitor. In the glyco-lytic pathway called Embden-Meyerhof triose-phosphate drives gly-oxal into the molecule methyl-glyoxal (MG).

    Type 1 diabetics have circulating methyl-glyoxal (MG) levels that are +/- 6 times greater normal. MG is a glycation end product.

    Tyler's comment links to a discussion of fructosamine monitoring. This is from a non-enzyme driven reaction, called Amadori, where fructo-selysine and the fructos-amine 3 kinase cascade generates 3 De-oxy-glucos-ane (3DG); another glycation end product.

    Enzymatic glycation occurs in pathological states. Macrophage activity spins off  the enzyme myelo-peroxidase; this generates hypo-chlorite. Hypo-chlorite pulls in the amino acid serine and then together they cause the formation of certain advanced glycation end-products; namely glyco-aldehyde and glycer-aldehyde.

    Yet another non-enzyme chain of events can generate advanced glycation end products. This is when the molecule per-oxy-nitrite (ONOO-)gets stalled inside the cell and it induces the formation of gly-oxal/gluco-sone/aldehyde molecules that can contribute to glycation.

    ONOO- normally is part of healthy cell signaling. When a metabolic processes is under sustained "stress" it (ONOO-) can't shift the cell function over to what it (the cell) needs to do (in order to adapt and cope). Instead of briefly signalling, signing off and going away ONOO-
    lingers in the cell; a situation that may also be related to ageing.

  • Anonymous

    3/25/2011 7:10:22 PM |

    I wonder if Dr. Davis can comment on situations where carb intake is reasonable and the patient has a decent HBA1c, yet still has higher than normal triglycerides and small LDL?

    My own HBA1c has been in the 4.5-4.6 range, yet my trigs hover around 140-150, and I still have more small LDL than I'd like.

    If restricting carbs doesn't work, D levels normalized, etc. what else could be the cause of higher than optimal triglycerides?

    I know people with HBA1cs in the 5.4+ range, eat many more carbs than I do, yet still have lower trig numbers.

  • Might-o'chondri-AL

    3/25/2011 8:58:10 PM |

    Hi Revelo,
    Vitis vinifera leaf inhibits advanced glycation end product (AGE) formation. That is what many cultures, like Crete, eat wrapped around their cereal grain; we call it Grape Leaves in English (ex: stuffed grape leaves, a.k.a. Dolma in Greek).

    Japan researchers (2009?) took 1 kilogram of dried grape leaves in 20 liters of water and stirred it for 3 hours at 80*Celcius. They administered the decoction in various dosages and found it can reduce the AGE of 3DG (3 de-oxy-gluco-sone) and also a marker of AGE in kidney disease, pentosidine, down to 1/5th the level from that study's AGE control levels.

    The same study experimented with Anthemis nobilis using the same extraction technique detailed above. They propose the active ingredient responsible for the AGE inhibition is the compound called chamaemoliside.

    Chamomile is the name of this plant in English; I suspect it is drunk as a tea in Crete. In the range of AGE inhibitors that they tested Chamomile was better acting than any other; grape leaves efficacy came in second.

    Plants studied that inhibit AGE forming, in no particular order of effectiveness may interest you. These are: Crataegus oxyacantha (English = Hawthorn berry), Houttuynia cordata (English = Chameleon plant) and Astragalus membranaceous (English = Astragalus). Chameleon plant is a regular condiment used in Vietnamese and some south-east asian food; it smells kind of "fishy".

  • revelo

    3/25/2011 9:02:19 PM |

    According to Steven Gundry MD, it is MEAT which is the primary cause of AGE's. (He doesn't cite any references for this in his "Diet Evolution" book.) He recommends Atkin's style low-carb/high-protein to lose weight, then low-fat (15% of calories from fat) as the maintenance diet. He is not too keen on grains, tubers or fruit, but rather emphasizes green vegetables.

  • Tyler

    3/25/2011 9:50:41 PM |

    Thanks for the nice explanations Might-o'chondri-AL

  • Might-o'chondri-AL

    3/25/2011 10:46:23 PM |

    Diabetic nephro-pathy (ie: kidney complication), and kidney disease have elevated AGE. These are monitored as pento-sidine, gly-oxal, methyl-gly-oxal and 3 de-oxy-gluco-sane; which the body tries to excrete as carbonyly compounds.

    Carbonyl compounds are hard to get through the kidney filters and cause an increase in uric uremia, which can be toxic. Too many carbonyls can cause, the so called, "carbonyl stress" of diabetic nephro-pathy.

    Diabetic patients' kidneys eventually can't excrete enough sodium (Na); and that contributes to the high blood pressure (hyper-tension) diabetics tend to suffer from.

    Ketones merit mentioning too. One of the markers for AGE in the kidneys is N-carb-oxy-ethl-lysine; which may (or may not) be a side effect of ketones. Type 1 diabetics do show elevated ketone levels incidently.

    I am not able to offer any perspective on ketogenic diets and AGE however. However, vitamin C is known to decrease ketone bodies. (In the previous post, "Battery acid ...", more
    diabetic responses to vitamin C appears among the comments.)

  • Anonymous

    3/26/2011 4:46:17 AM |

    I've been eating low-carb (basically paleo) for the last 4-5 mo and just got my lipid panel results.  They sky-rocketed.

    Cholesterol 300
      
    Triglyceride 150  
        
    HDL          33
        
    LDL             237


    Every number got worse.  The part that really sucks, is that the diet makes me feel great and nearly all my body fat is gone.  I'm 37, 5'11, 180 lbs and probably about 9% body fat.  Now I'm wondering what kind of trade-off I'm making.  Any thoughts, doc?

  • Peter

    3/26/2011 12:55:22 PM |

    Testing different foods one hour after meals, it seems like a good rule of thumb for me is that each ounce of carbs raises my blood sugar about 10 mg,and that the kind of carb doesn't matter nearly as much as the quantity.

  • Might-o'chondri-AL

    3/26/2011 6:31:09 PM |

    Paradoxical low carb yet relatively high HbA1c & higher carb but relatively lower HbA1c is reported by Annon. Doc assuredly deals with cases like these and has to resolve their enigma one by one.  

    The gene HFE (human hemochromatosis protein, nicknamed High Fe  where iron = Fe)can have a variation (reference code = HFE rs1800562). This variation is seen in +/- 5% of Caucasians, but is not found in East Asian nor African genes.

    More hemoglobin is in circulation for those having this HFE genetic variation. In this case, the same amount of blood sugar that can contribute to glycation of hemoglobin has more hemoglobin surfaces to glycate. Think of it as the glycation has to spread itself thin; the dilution of it's effect makes the % of Hb1Ac less (ie: lower Hb1Ac % measured in the blood sample).

    On the other hand, genetic variation rs855791 of the gene TMPRSS6 (trans-membrane protease, serine 6)is implicated in anemia. In these individuals Hb1Ac readings range higher; there is less hemoglobin relative to the glycation potential in their blood stream. Think of it as the relatively low proportion of hemoglobin which has to bear all the glycation burden
    (ie: Hb1Ac % is higher in their blood sample).

    Anemic (hemolytic) tendency is also driven by variation of gene HK1 (hexo-kinase 1). This enzyme modulates how glucose inside the cell goes through  it's processing pathways.

    This gene (HK1) codes for the unique iso-form of erythrocytes; erythrocyte configuration can figure in to low hemoglobin. In other words it is also a factor in high Hb1Ac readings; glycation potential in the blood over burdens the limited amount of hemoglobin around.

  • Dr. William Davis

    3/26/2011 6:34:23 PM |

    In response to several questions about the potential disconnect between small LDL/triglycerides and HbA1c: Yes, there are people in which one measure is more resistant. It varies based on the mix of underlying genetic predispositions, so it's hard to generalize.


    Might-o'-chondri-AL--

    Great discussion. Thanks, as always. You bring an incredibly sophisticated perspective!

  • Dr. William Davis

    3/26/2011 6:35:48 PM |

    Jonathan--

    Spectacular! And within an unusually brief timeline for HbA1c.


    Revelo--

    Might-o'chondri-AL is referring to endogenous glycation. You are citing a discussion about exogenous glycation, two separate phenomena.

  • Might-o'chondri-AL

    3/27/2011 1:31:59 AM |

    Might Jenny's observation and Nigel's study reference be reconciled somewhat ? I'll tag on my disclaimer of being unqualified to judge low carb or specific diets; since I've never struggled with weight or diabetes, and am not a doctor.

    The study Nigel linked was done with all Kuwaiti subjects. In that country co-sanguinity in marriage is practised by +/- 54.3 % of Kuwaitis. And 1 in 5 are reported to be diabetic.

    The data is very admirable; my suggestion is that the data trend may not exactly transfer to a modern Caucasian population; which is essentially interbred from migration and war (rape). This may be why Jenny sees a +/- 6 month plateau among her respondents and the co-sanguine Kuwaitis saw changes continue for a year +.

    Genetic poly-morphisms influence fasting glucose (GCK, G6PC2 and MTNR1B), are implicated in Hb1Ac, triglyceride levels, HDL levels & so on. That said, I personally would try the low carb approach if I was diabetic.

  • Might-o'chondri-AL

    3/27/2011 1:32:47 AM |

    oops posted this in wrong thread

  • Anonymous

    3/27/2011 3:12:44 AM |

    Re: Anonymous with Cholesterol 300,  Triglycerides 150,  HDL 33 ...

    Suggest you try a technique many dieabetics find helpful to understand food consumption influence on their blood sugar profile,"eating to your meter".
    For a few days, record your blood sugar level immediately before eating a "normal" meal, and then after the meal get 1-hour and 2-hour post-meal blood sugar readings. Separate meals by at least 4 hours. Concentrate on monitoring your main meals and ignore snacking for the first go around. Better however, if you can actually avoid all snaking during period of the testing. Also you will want to add to your journal the foods, ammount consumed, and time it was consumed. If post-meal blood sugar values are high, then to determine a pattern folllowing a meal do a series of hourly post-meal readings until you reach 85 mg/dL or so. As a graph, these results should be helpful to you. Expect that the results will be revealing to you with unexpected high blood sugar values even after following a paleo diet. And if so, it does mean that paleo is not for you, only that you need to more discriminating in what and how much you actually consume.

    I would be interested in hearing about your findings. By the way, you did not mention the blood glucose or HbA1c results of your recent lab tests.

    My regards and good luck ... spo

    BTW: practice good technique with the finger sticks. Do a quick but good hand wash using soap and a warm water rinse prior to a stick. Dry hands well. Dont squeeze hard at the site to encourage blood flow. The original stick should be sufficent to raise a drop of blood for the test strip. Using alcohol swabs and changing out lancets is not necessry when only working on youtself. Keep the test strip vial tightly closed other then when removing the current test strip. If you encounter an "extreme" value, retest for confirmation but clean hands again prior to the retest. My experiences regarding unexpected readings seems to usually invovle hand and finger contamination of some form.

    Finally, on Amazon.com I am able to purchase unexpired test strips in 50 strip lots for my old AcuCheK Confort Curve meter for less than $0.16 or so a strip and often with free shipping. You just have to broswe around a bit.

  • Jonathan

    3/30/2011 2:47:32 PM |

    @ Anonymous with 300 TC
    I would say it could possibly be your liver cleaning itself out (it could have been getting fatty).  The higher Trig might be a sign you are getting too many carbs from somewhere (at least till your sugar stores empty some and insulin sensitivity goes back up) but it could be the liver cleaning out as well.  I think HyperLipid posted something about this once.

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Apple Cranberry Crumble

Apple Cranberry Crumble

Apple, cranberry, and cinnamon: the perfect combination of tastes and scents for winter holidays!

I took a bit of carbohydrate liberties with this recipe. The entire recipe yields a delicious cheesecake-like crumble with 59 “net” grams carbohydrates (total carbs – fiber); divided among 10 slices, that’s 5.9 grams net carbs per serving, a quantity most tolerate just fine. (To reduce carbohydrates, the molasses in the crumble is optional, reducing total carbohydrate by 11 grams.)

Other good choices for sweeteners include liquid stevia, stevia glycerite, powdered stevia (pure or inulin-based, not maltodextrin-based), Truvía, Swerve, and erythritol. And always taste your batter to test sweetness, since sweeteners vary in sweetness from brand to brand and your individual sensitivity to sweetness depends on how long you’ve been wheat-free. (The longer you’ve been wheat-free, the less sweetness you desire.)


Crust and crumble topping
3 cups almond meal
1 stick (8 tablespoons) butter, softened
1 cup xylitol (or other sweetener equivalent to 1 cup sugar)
1½ teaspoons ground cinnamon
1 tablespoon molasses
1½ teaspoons vanilla extract
Dash sea salt

Filling
16 ounces cream cheese, softened
2 large eggs
½ cup xylitol (or other sweetener equivalent to ½ cup sugar)
1 Granny Smith apple (or other variety)
1 teaspoon ground cinnamon
1 cup fresh cranberries

Preheat oven to 350° F.

In large bowl, combine almond meal, butter, sweetener, cinnamon, molasses, vanilla, and salt and mix.

Grease a 9½-inch tart or pie pan. Using approximately 1 cup of the almond meal mixture, form a thin bottom crust with your hands or spoon.

In another bowl, combine cream cheese, eggs, and sweetener and mix with spoon or mixer at low-speed. Pour into tart or pie pan.

Core apple and slice into very thin sections. Arrange in circles around the edge of the cream cheese mixture, working inwards. Distribute cranberries over top, then sprinkle cinnamon over entire mixture.

Gently layer remaining almond meal crumble evenly over top. Bake for 30 minutes or until topping lightly browned.
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Diarrhea, runny noses, and rage: Poll results

Diarrhea, runny noses, and rage: Poll results

Here are the results of the week-long poll asking the question:

Have you experienced a wheat re-exposure syndrome?
Yes, undesirable gastrointestinal effects 223 (41%)

Yes, asthma or sinus problems 51 (9%)

Yes, joint pains and/or swelling 85 (15%)

Yes, emotional or other nervous system effects 59 (10%)
No, nothing, nada  107 (19%)

No. Wheat is sacred and you're all nuts  13 (2%)


There are several interesting observations to make from this informal poll. First, as I have observed, the most common wheat re-exposure syndrome is gastrointestinal, usually involving cramps, diarrhea, and lame explanations to your dinner partner.

Second most common: joint pains and/or swelling.

Third: asthma or sinus congestion.

The incidence of emotional or nervous system effects surprised me a bit. I didn't expect 10% of people to share this effect. This is an effect I also experience personally, along with the gastrointestinal consequences.

To be sure, this is a skewed poll, since many people likely come to this blog in the first place because of such issues. But I was nonetheless impressed with the relatively modest proportion of people who did not share such a re-exposure syndrome: only 19%.

Beyond the interesting numbers provided by readers, a good many also provided some fascinating and graphic comments. Here's a sample:




Sassy said:

Reflux -- starts a day later and goes for up to a week. And Bloat:2-5 inches on my waistline in a day, lasting up to three. Miserable. And why, having experienced this once, have I done it often enough to verify the connection with certainty? I am working on that one.



Anonymous said:
Wheat increased hunger with even with only a small amount. Crackers in soup was enough to set it off.

Also, when I was trying to get off wheat, I noticed that 2 eggs and 2 bacon and I could go 5 hours before hunger, or 2 eggs and 2 bacon and toast was good for three hours before hunger. That was the final step to giving up wheat. Now three years and 59 Kg [130 lbs!] loss later, there is no doubt in my mind that wheat is evil, and I do not regard it as suitable for human food. I speculate that it increases ghrelin or cortisol.

Anna said:
For me, in the two years since I began eating Gluten-Free (Low Carb for 6 years), the few times I've had re-exposure to wheat, I've experienced fast onset and intense abdominal pain (known exposure during the daytime) and heartburn, indigestion, intense nausea, and disrupted sleep (exposures during evening meal not discovered until the next day).

My husband wants to think he's fine with wheat (though I know that he has at least one gene that predisposes to celiac), but IMO, he isn't. He eats no wheat at home because that's the default, and he's OK with that. But if he goes out to dinner at a restaurant that serves "good" artisan bread, he will indulge in a few bites (he does restrict his carb intake, so it's still a limited amount). More often than not, he will sleep fitfully on those nights, snore more, and wake in the night with indigestion. He wants to bury his head in the sand and will only acknowledge the discomfort being due to eating too many carbs, not the wheat itself. I notice he sleeps fine if he eats a small amount of potato or rice. Go figure.

Our 12 yo son has been eating GF for two years also. About 6 months into GF, he unknowingly ate wheat a number of times (licorice candy laces at a friend's house), which resulted in outbreaks of canker sores in his mouth each time. He also exhibits mood and behavior changes when he eats wheat, which is what prompted me to test him for gluten intolerance in the first place.

Mark said:
If I go for 3-4 days without wheat, grains or sugar and then go out and binge on a pizza and ice cream or something like that I become explosive within 20 minutes to an hour. It's like a wheat and sugar rage.(I'm not saying this is an excuse for rage, I'm saying it has happened to me and I believe partly do to re-exposure) It seems the combination of the wheat plus sugar can be the worst.

I get red rashes around my neck sometimes right away and sometimes up to a day or later and sometimes get bad diarrhea. 
I think it can be almost dangerous to cut things like gluten and sugar suddenly out of the diet without being very serious about keeping them out. I have found it very hard to cut out wheat without binging on it later after 4 or 5 days. I don't believe that my symptoms are just psychological either.

I was also diagnosed with ADHD as a young kid and then rediagnosed with adult ADHD by 3 different doctors. I also have bouts of mania at times too. I am considering trying to go completely gluten/refined carbohydrate free to see if it helps with the symptoms and gives me some relief.

I have never been tested for celiac or gluten intolerance but I would like to be. I think it would help explain to my girlfriend, family and friends why I can't go out and eat pizza or have a beer or ice cream. Right now they all think I'm a hypochondriac. At times I have experienced an intense fatigue the next day like I can't wake up and also sharp pains in my body and headaches.

Anonymous said:
I ditched wheat a year ago after my wife was diagnosed celiac. I immediately experienced a number of health improvements (blood lipids, sleep, allergies, etc.).

Fast forward: We all suffered some inadvertent wheat exposure yesterday via some chocolate covered Brazil nuts (of all things). This accidental A-B-A experimental design resulted in the following:

1. My celiac wife experienced what she calls "the flip" within an hour of exposure (i.e., intense GI distress).
2. My five-year old son went to bed with some wicked reflux.
3. I woke up with some twinges in my lower back and an ache in my football-weary left shoulder. I was also complaining to my wife about fuzzy-headedness that refused to respond to caffeine or hydration. I could only describe it as "carb flu"...

And then I read your post!

Anne said:
Depression, agitation and brain fog if I get glutened. Some times this comes with abdominal pain and a rash on my back - I think it is dose dependent. Cross contamination with wheat is a big issue when eating out. Needless to say, I eat out infrequently and then try to stick with the restaurants that are the most aware of gluten issues.

Terrence said:
Several weeks ago, I started Robb Wolf's 30 day challenge.

The first two weeks were brutal - calling it a withdrawal flu was a massive understatement. So, I thought I would try some wheat and see what happened (could not be worse, I thought). Well, it was.

I still felt extremely crappy, but I was now MASSIVELY GASSY - AMAZINGLY GASSY, for about 48 hours - flatulence on wheels, in spades. I did not go out at all in those 48 hours - when the gas came on, it went out, LONG, and QUICKLY and LOUDLY.

I am easing back into wheat and grain free. I am gluten free today and tomorrow (Sunday and Monday). I expect to try a small amount of wheat on Thursday, then maybe a little more the following Thursday.

Donald said:
I have limited wheat consumption severely over the last 8 months. I have lost 120 pounds, no longer have bouts of illness, asthma, depression, or low energy. I also take vitamin D and other supplements that have helped (many are from your blog recommendations).

Last week I ate a small piece of cake and dessert pizza. Shortly thereafter I started sneezing, had a scratchy throat, and runny nose. I called off sick the next day for fear of being contagious. My symptoms subsided quickly and I am now attributing them to the processed flour eaten at my work luncheon. I think it was an allergic reaction since I recall having much more severe symptoms fairly regularly in my wheat eating days. Those were attributed to an "allergy" of unknown origin back then.

John said:
I suffered from Ankylosing Spondylitis, Iritis, Plantar Fasciits, etc for a number of years. I restricted carbs, especially wheat and I've been symptom free for the past two years now.

Lori said:
I found wheat to be one of the worst things for giving me gas bloating and acid reflux, and I'd had sinus and nasal congestion my whole life. When I ate that cookie, it just re-introduced old problems. I can occasionally eat a gluten-free, grainy goody at my party place without any side effects. I also have a little sprouted rice protein powder every day.

Another odd thing about wheat: it was hard for me to stop eating it once I started. I could go through a whole box of cookies in one sitting, even though I wasn't a binge eater. But I can have a couple of gluten-free cookies and stop.

Paul said:
Except for one slip up this recently past holiday season, I've been sugar-grain-starch free since July 2008. Mental fog was the most noticable re-exposure symptom I had.

My mom has had the worst acid-reflux for 40-plus years. It had become so bad that she was on three medications just to deal with the symptoms. After much training and coaxing, I finally got across to her 
how to totally get off wheat. Not at all to my surprise, after being wheat free for a few weeks, she lost weight and her acid reflux was GONE!

But she had been addicted to wheat for so long, she relapsed, and the reflux fire soon returned. Wheat must be akin to heroin with some people. Even though they know it's very bad for them, they can't help themselves.

Onschedule said:
Re-exposure often leads to diarrhea for me, or such a heavy feeling of tiredness that all I can do is lay down and pass out. A local pizzeria makes a darn good pie, but since I started practicing wheat-avoidance, I can't keep my eyes open after eating there. I can't say for sure that it's the wheat causing it, but definitely something in the crust. Diarrhea, on the other hand, is definitely triggered by the wheat for me.

My mom complained of gastric reflux for years, but never filled the prescriptions that her doctors would give her. I suggested wheat-avoidance- gastric reflux disappeared within 3 days and hasn't returned (has been 6 months now). I've already commented elsewhere on this blog about how much weight and bloating she has lost...

Steve said:
Interesting that I should sit down, turn on my computer and find your poll. Having gone several weeks, maybe months, avoiding gluten, I took my daughter and her boyfriend out to eat because my wife has been working late at the office lately. Although I was thinking I would just eat my steak and chicken, I succumbed to the temptation of eating about a dozen greasy, breaded shrimp that my daughter and her boyfriend ordered. It's 1:39am and I still do not feel sleepy. My left nostril is completely blocked, my stomach feels bloated, really, really full and I've been burping. In your poll I checked sinus problems but could have chose gastrointestinal or nervous problems just as well. 


A few weeks ago my daughter brought home a pizza and, once again, despite my knowing that I shouldn't, I ate a couple of pieces. I was sick for two days. The pain in what I think was my transverse colon was so bad I thought I might have to go to ther emergency room. Before I ate the pizza I had never gone grain-free that long before. I did this after reading Robb Wolf's book. 


I AM CONVINCED. No more wheat for me! Please, Lord, give me strength.

LV said:
What don't I experience! I typically avoid wheat (and gluten for that matter) as I'm pretty sure it makes me sick, but when I slip (or someone else slips me some) I end up with massive amounts of joint swelling and tenderness, diarhea, cramping, gas, bloating and brain fog. I'm absolutely miserable. Just that alone is enough to keep me off gluten. I have RA, so if I have repeated exposures I'll have a flare which SUCKS!

Comments (19) -

  • Anonymous

    2/6/2011 2:06:13 AM |

    One voter commented about what I would call acute increase in hunger shortly after consuming wheat. If that had been an option in the voting, I would have marked that. I find it certainly increases my hunger after having it. Otherwise I experience no effects from consuming it.

  • Anonymous

    2/6/2011 2:21:11 AM |

    I missed your poll but I banished wheat shortly after I found this site maybe 1 1/2 to 2 years ago.  My sisters talked me into having one lousy piece of cake for my birthday last year and boy was I sorry.  When I wasn't flat on the bed with a migraine (the first in over a year), I was running to the bathroom with IBS (also not experienced for over a year) all the next day.  Never again!

  • Rachael

    2/6/2011 3:17:55 AM |

    I have to add that since I have been gluten free my sleep apnea/UARS is worlds better.  I only need to use my CPAP when I am glutened, have a cold, or drink too much.  My BMI is 25, I am youngish (41) and not a usual candidate for sleep apnea.  My theory is that Celiac caused chronic respiratory inflammation, and being GF has reduced the inflammation enough that my breathing improved.  However, it's equally likely that there are neurological benefits to being GF that reduce the over reaction to airway disruption.

  • Anonymous

    2/6/2011 3:28:52 AM |

    Thought that this recent article was quite interesting in regards to your recent posts:

    Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial.

    Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR.

    Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia.
    Abstract

    OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.

    METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.

    RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.

    CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.Am J Gastroenterol advance online publication, 11 January 2011; doi:10.1038/ajg.2010.487.

  • Missy

    2/6/2011 2:40:13 PM |

    I was one of the 19% who said "nothing, nada". Because I only had increased hunger the evening after a glutenous lunch.

    I should have waited another day to take the survey, because apparently the gastrointestinal effects can take 48 hours. It was two mornings later that I spent some quality reading time in the bathroom.

    But even before the explosive morning, I'd gone back to gluten-free after that one piece of pizza and the hunger that followed.

  • Becky

    2/6/2011 5:49:18 PM |

    Had I been around to vote, I would have checked every yes box available. I can handle the gastro side effects, and the swelling, but dear Lord...I have a sandwich and within 2 hours I'm having a panic attack. I still have the hint of panic attacks without wheat due to GAD, but they never manifest into anything beyond a slightly funny little worry. With wheat, I'm pacing back and forth begging my husband to take me to the E.R. for a heart attack.

  • Anonymous

    2/6/2011 6:11:00 PM |

    A different twist from your good article about wheat and the distress it can cause for many -  having had IBS for a number of years I've wondered about the relationship wheat has with milk.  It is just a curiosity of mine.  I've wonder if it would be possible for people to eat, day after day, wheat with out consuming a milk item with it?  

    Wheat and milk are two foods that tend to go hand in hand.  Chances are if you ate an item with wheat in it, you also had dairy.  Some examples of that common food combination; bowl of breakfast cereal with milk, toast with butter, pizza, spaghetti with parmesan cheese, cheese burger, etc.  

    Other grains, rice and corn, tend to not be eaten with milk items.  And these grains tend to be easier to tolerate.  

    I'm just mentioning this wheat milk combination because on this Superbowl Sunday, known for its TV commercials, I'm sure to see a probiotic item or two for sale in order to sooth over a grumpy gut.  Jamie Lee Curtis will likely make an appearance with her yogurt.  

    Probiotics are common items taken by people suffering from IBS.  Calcium tablet is another supplement IBS-D suffers take in large quantities to find relief.  And of course milk, and in particular cultured milk items, tend to be naturally high in both probiotics & calcium.  

    My wild guess is with out milk in the western diet, I think wheat would be even more distressful on our GI tract.

  • Anonymous

    2/7/2011 12:54:31 AM |

    Frequently reader here.  

      I just wanted to let you know that celiac.com is an excellent resource to scour if you have the free time.

      I was shocked by the amount of people who have psychological symptoms from gluten ingestion.  I'm talking about pages of testimonies talking about severe anxiety, rage, irritability, bipolar, schizophrenia (familial cure stories, check it out!) n so much more.  

    http://www.celiac.com/gluten-free/topic/55415-panic-attacks-gluten/

      http://www.celiac.com/gluten-free/topic/34917-anger-quick-temper-depression/

  • Anonymous

    2/7/2011 2:51:23 AM |

    I skipped the poll, since I haven't had wheat exposure during the three months I've been gluten-free.  But I'm another one who had frequent reflux issues for over thirty years.  When I finally tried giving up the gluten, the reflux vanished almost instantly.

  • Dr. William Davis

    2/7/2011 1:26:03 PM |

    As several commenters point out, hunger is indeed a powerful effect arising from wheat consumption. That was yet another item I could have added to the poll!

  • Anonymous

    2/7/2011 3:52:20 PM |

    Severe menstrual cramps stopped completely when I gave up wheat. When I reintroduced them, I had the most intense cramps ever. My breast-fed baby had rashes and eczema when I ate wheat.

  • Anonymous

    2/7/2011 3:58:45 PM |

    After going gluten free I can drink as much wine as I like; but a couple beers will cause me to wake up in cold sweats during the night...

    -mike h

  • Anonymous

    2/7/2011 4:51:58 PM |

    Small correction - 21% said No. Smile

  • Anonymous

    2/8/2011 10:05:55 AM |

    Reflux, fluid retention/ hot swollen ands and feet/ restless legs, wheezing, sore stomach, soreness all over my body, increased hunger, racing, jumping heart.

    These symptoms are what I lived with daily (and there were others) until I cut out gluten. Corn causes me a milder version of the same symptoms interestingly. I was needing ventolin round the clock and still constantly wheezy, now I am drug free. The hunger was uncontrollable, and even if I ate little I gained weight.

    I am currently sore and stiff all over as I ate some gluten free bread which contained a small amount of corn, 8 days ago. The other symptoms come on within hours, but the soreness comes 4 days after and then lasts for a few days.

    When I was wheat free I wondered why beer brought on symptoms, but wine didn't. Now I know, it's gluten.

  • Anonymous

    2/8/2011 6:38:29 PM |

    gluten is not even the only problem with wheat. Grains are the seed of the plant, as such they will protect themselves from predation with a variety of toxic chemicals. Gluten is one of them. The others are gliadin, lectins, WGA (wheat germ aglutinnin).

    WGA binds to N Acetyl Glucosamine, modifying its structure, thereby destroying it. N Acetyl Glucosamine is what the cell walls of bacteria and fungi are made of. The exoskeleton of insects is composed of N Acetyl Glucosamine. In humans it is essential for joints, cartilage and bones. Grains fight off all these predators by binding to their structures with WGA and destroying them. Hence why humans have arthritis and joint problems with grains.

    In addition grains contain anti-nutrients such as phytic acid (phytates), and contain excitotoxins glutamic acid and aspartic acid (what MSG mimics). These excitotoxins fry your brain nerves.

    grains, are seeds, they are the most vulnerable and crucial part of the plant, they will protect themselves. They are not grown as ready made "healthy" foods for us to conveniently eat.

    for references regarding the above toxins:

    http://healthfreedoms.org/2010/03/24/opening-pandoras-bread-box-the-critical-role-of-wheat-lectin-in-human-disease/

  • Anonymous

    2/16/2011 4:00:34 AM |

    I have some long term skin issues that have cleared up since I went grain free 3.5 months ago.  I haven't seen any of these mentioned in other posts:  Very thin and fragile skin on my shins and bald head that injure easily and heal slowly, now seem to be tougher and definitely heal faster from surface wounds (I'm a klutz!).  Dry, cracked soles of  my feet now are fine without any oils or lotions.  Also, I have had hemorrhoids that would bleed every time I had constipation and that seems to have stopped (although less constipation with grains...) Wheat free is great and I think grain free is even better.

  • Megaera

    2/24/2011 6:52:11 PM |

    Actually, since a good deal of your respondents are probably self-reinforcing, the 19% isn't really that surprising.  The placebo effect works both ways, you know.  If you are a true believer, you will find bad effects from a killer exposure just as you will find good effects from a beneficial exposure.  I'm definitely one of the 19%; I'm also one of the ones who's still scanning the horizon in vain for even one of those magnificently beneficial effects of abandoning wheat and sugar that you tout, but I have yet, after several months, to see any of.  At all.  Zero weight loss.  Zero change in blood sugar -- in fact, it may have changed for the worse, since it used to be lower.  I actually have nothing to show for all my effort, which pretty much comports with past experience ... guess I should have known better.

  • Jane Kaylor

    3/7/2011 9:52:20 AM |

    I am one of those people prone to headaches, migraine and colds. Usually, my first recourse is White Flower Embrocation (embrocation.50webs.com), also called White Flower Oil

  • Lindas

    9/27/2011 9:06:53 PM |

    I feel an increased , nawing, listless hunger. Low Blood sugar like. Blurred vision and increased stomach and belly-bloat. Sense of forboding and depression. Restless and edgy.    At times just don't feel well.

    I have a lot of problems with MSG , I think it is wheat based, in some of its forms.  eg. " Hydrygolized" (sp?) wheat protein  etc.     ..........it totally effects my heart and body.     MSG is much easier (although still much watch closely) to avoid with "track your plaque" way of eating  .    Linda

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Lessons about omega-3s from Japan

Lessons about omega-3s from Japan















Image courtesy of apc33.

Japan provides a useful "laboratory" for studying the effect of a culture that relies heavily on eating fish.

The JELIS Trial, the topic of a previous Heart Scan Blog post, showed that supplementation with the single omega-3 fatty acid, EPA, 1800 mg per day (the equivalent of 10 capsules of 'standard' fish oil that contains 180 mg per day of EPA, 120 mg of DHA) significantly reduced heart attack in a Japanese population. Interestingly, this benefit was additive to the already substantial intake of omega-3 fatty acids among the general Japanese population, a population with a fraction of the heart attacks found in western populations like the U.S. (approximately 3% over 5 years in Japanese compared to several-fold higher in a comparable American group).

While there may be genetic and other cultural and lifestyle reasons behind the dramatically reduced cardiovascular risk in Japanese, it is undeniably at least partially due to the increased intake of omega-3 fatty acids from fish. Incidentally, the purported benefits of omega-3 fatty acids provide a vigorous counter-argument to the idea that all humans should be vegetarians.

Anyway, if we were to take some lessons from the Japanese and their greater habitual intake of omega-3 fatty acids from fish, they might include:

--Rural and coastal Japanese are the sub-populations with the highest reliance on fish, about a quarter-pound a day. (Gives new meaning to the idea of a "Quarter Pounder," doesn't it?) This is at least five-times greater than the intake of an average American.

--Likewise, the blood level of omega-3s in the blood of Japanese is 5-fold higher than in Americans.

--The average intake of omega-3s (EPA + DHA) among a broadly-selected population of Japanese is 850 mg per day (320 mg EPA; 520 mg DHA). Intake ranges from 300 mg per day all the way up to 3100 mg per day.

--Greater omega-3 intake (EPA + DHA) is associated with lesser carotid intimal-medial thickness, an index of body-wide atherosclerosis.

--Japanese have far less heart attack and stroke despite greater prevalence of smoking (nearly half of Japanese) and drinking.

--Total fat intake (percent of calories) is nearly identical between Americans and Japanese. It's the proportion of fat calories from omega-3 that is greater, the proportion of omega-6 that is less in Japanese.


The Japanese eat their fish in ways that we do not: As sashimi (raw, as with sushi in its various forms like Nigiri and Chirashi); fried in tempura; shaved, dried fish sprinkled on about anything you can imagine (it's not as bad as it sounds); as a snack, as in dried cuttlefish (which you can purchase in packages as a portable, sweetened fish that you eat on-the-run--I know it sounds awful, but don't poke fun at it until you've tried it); in "soups" with soba noodles. Fish is commonly consumed with rice and soy sauce, as well as other soy-based foods, such as tofu, miso (soy bean paste), or natto. 


I believe that there are some lessons to take from the Japanese and their fish-consuming habits:

1) An omega-3 fatty acid intake of at least 1000 mg per day yields measurable cardiovascular benefits. 

2) Despite the fears over mercury and pesticide residues in fish, this seems to not have played out to be a real-life effect in the Japanese, who consume five-fold greater quantities of fish. 

3) My mother was right after all when she encouraged us to eat more fish. 


Comments (7) -

  • Juhana Harju

    7/23/2008 2:24:00 PM |

    Currently the Japanese get 25 percent of their calories from fat which means that it is lower in fat than the average American diet. Traditionally the Japanese diet has been very low fat, only about 10 E% from fat. Taking into account that degenerative illnesses have a time lag, the previous consumption of very low fat diets is still affecting to the health of Japanese people.

  • Ross

    7/23/2008 3:43:00 PM |

    The French and Spanish have a substantially higher fraction of calories from fat than Americans and also enjoy a lower rate of heart disease.

    Hint: fat and saturated fat are probably not to blame for heart problems.

  • LeenaS

    7/24/2008 8:20:00 AM |

    Japanese may have eaten low-fat, but even there the increase in fat did increase the life span, too.

    Okinawans were not only known for their longevity but also for their food that was regarded very fatty in terms of the general Japanese food culture.

  • Gyan

    7/24/2008 11:24:00 AM |

    1) Cant canola/rapeseed oil provide ALA (DHA/EPA precursor).
    In a low-PUFA diet, the conversion is supposed to be efficient.
    2) Some researchers claim that EPA is not required in human body though DHA is necessary.
    3)The high levels of DHA/EPA intake might reduce heart disease but could they cause other problems such as cancer, strokes etc.
    What is the optimal level of omega-3 intake?

  • Jeff Consiglio

    7/24/2008 2:33:00 PM |

    My understanding is that the Japanese have lower rates of heart attacks, but higher rates of hemorrhagic stroke than in the US. Anyone else heard this?

  • Anonymous

    7/25/2008 4:42:00 PM |

    --Omega-3 intake (EPA + DHA) is associated with carotid intimal-medial thickness, an index of body-wide atherosclerosis.

    I assume you meant to say a reduced cartoid intimal-thickness? Or would an increased thickness = less atherosclerosis?

    And the increased rate of  hemorrhagic (bleeding type) stroke would make some sense, as I believe Eskimos had the same problem. But the risk of heart disease or other types of strokes are much more of a risk factor anyway.

  • Dr. William Davis

    7/26/2008 1:36:00 PM |

    Yes. I should have said that EPA + DHA are inversely associated with carotid intimal-medial thickness.

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