Handy dandy carb index

Reprinted here is the unfailingly informative Vitamin D Newsletter from Dr. John Cannell. Although there's little here specifically about heart disease, there's so much great information about vitamin D that I thought most would still appreciate it.

The Vitamin D Newsletter

May, 2008

Yesterday's Washington Post article, Too-Good-To-Be-True Nutrient?, sums up the April 9th vitamin D symposium at UCSD in San Diego, which was nothing short of spectacular. Carole Baggerly outdid herself organizing it and explaining how she got involved. Make no mistake; Carole is both serious and energetic. She told about her efforts to introduce resolutions at upcoming meetings of various professional groups. Then she introduced the volunteers from the San Diego Black Nurses Association who made sure the conference went off without a hitch. Then Carole introduced the four speakers. The slides of each speaker are available at Grassroots Health.

Before I tell you the highlights of the conference, I'd like to tell you about another conference, this one in Germany, this May 17th and 18th. It is the Third International Symposium on Vitamin D Analogs in Cancer Prevention and Therapy. Readers know how I feel about giving analogs to vitamin D deficient patients instead of vitamin D but speakers include Michael Holick, Reinhold Veith, Bill Grant, Tai Chen, Heidi Cross, David Feldman, and Roger Bouillon, all of whom know the importance of the nutrient. Most of this conference is for scientists, not lay people. However, Michael Holick is the first speaker and if you have not heard his latest talk about vitamin D, it might be worth a trip to Germany.

The first San Diego speaker was Dr. William Grant. Since leaving NASA to begin a full-time career as a vitamin D researcher, Bill has published dozens of studies and has another dozen in the works. Using ecological studies (from Greek oikos, house + German -logie, study or studying your own house) of UVB irradiance and cancer, Bill reported that 15 cancers (colon, esophageal, gallbladder, gastric, pancreatic, rectal, small intestinal, bladder, kidney, prostate, breast, endometrial, ovarian, Hodgkin's lymphoma, and non-Hodgkin's lymphoma) are associated with lower UVB light. He concluded that 257,000 cancer deaths in 2007 in the USA were accounted for by inadequate vitamin D levels. Of course the problem with ecological studies is that it easy to be vitamin D deficient in Miami, all you have to do is listen to your doctor's advice and stay out of the sun. Recently, a group from the Arizona Cancer Center found almost 80% of Arizonians had levels below 30 ng/ml. So much for sunny spots.

Jacobs ET, et al. Vitamin D insufficiency in southern Arizona. Am J Clin Nutr. 2008 Mar;87(3):608-13.

The next speaker was Professor Cedric Garland. I found myself wondering how he did it. I became convinced that vitamin D prevents cancer five years ago. Cedric and his brother Frank and his colleague Ed Gorham knew it 30 years ago! I know what it is like to tell someone that vitamin D prevents cancer and see them think, "Here we go again, another miracle vitamin." I know what it is like to try and explain and watch people die unnecessarily. But I've only had that experience for five years. Cedric has dealt with that frustration for thirty years. Almost thirty years ago, Cedric and Frank Garland published evidence that vitamin D prevents cancer. In fact, it was Cedric's first publication. Thankfully, the paper was recently recognized as being so important that it was republished in 2006 by the International Journal of Epidemiology. You can read the entire paper for free by clicking on the second link below and then clicking on "free final text", courtesy of Oxford Journals.

Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980 Sep;9(3):227-31.

Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 2006 Apr;35(2):217-20.

Cedric began by showing the incidence of type-1 diabetes and multiple sclerosis by latitude. I had no idea that the latitudinal data was so strong for type 1 diabetes in children. This disease is almost nonexistent around the equator. Type-1 diabetes is but one of the three modern childhood epidemics caused by the sunlight-hating dermatologists, the other two, I think, are autism and asthma. Next he showed latitude and 25(OH)D levels, which reminded me to be suspicious of high levels, unless they use accurate methods of detecting 25(OH)D. Some methods used, even in this country, are over detecting vitamin D and telling patients their levels are above 50 ng/ml when they are, in reality, much lower. Cedric's data showed Thailand had mean levels of 70 ng/ml, which I doubt and suspect were due to inaccurate 25(OH)D tests. He then reviewed evidence of the 25(OH)D levels needed to prevent numerous cancers. The safest levels are somewhere above 50 ng/ml. Cedric spent most of his time presenting an entirely new theory of carcinogenesis, one dependent on vitamin D maintaining cellular junctions. I suspect this paper will also be reprinted in 20 years. The only disagreement I have is with his recommendation for cancer patients to start at fairly low doses. For reasons I recently explained, the risk benefit analysis indicates cancer patients should take 5,000 to 10,000 IU per day and they may have no time to lose. Why worry about the phantom of vitamin D toxicity if you may be dying of cancer? Just have your calcium checked along with frequent 25(OH)D levels. Get your levels up to 70-90 ng/ml if you have cancer.

Does vitamin D treat cancer?

The next speaker was Professor Bruce Hollis. He reviewed basic physiology of vitamin D and emphasized that the entire system is designed to deal with an excess not with an insufficiency of vitamin D. Numerous mechanisms are available in your body to prevent vitamin D toxicity but few are available to deal with insufficiency. Then he briefly mentioned one of the most important discoveries about vitamin D in the last few years, one where Professor Neil Binkley of the University of Wisconsin was senior author. (In the last four years, Professor Binkley has become a prolific vitamin D expert and I hope Carol Baggerly is able to get him to speak at some of the upcoming conferences she hopes to sponsor.) As I have pointed out before, Hollis and Binkley's crucial discovery was that the body doesn't start storing the parent compound, cholecalciferol, until 25(OH)D levels reach about 50 ng/ml. They showed, using basic steroid pharmacology, that 50 ng/ml should be considered the lower limit of adequate 25(OH)D levels.

Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4.

Bruce kept the audience enthralled with a review of all the disease states that indicate 25(OH)D levels need to be much higher than they are now, that is, the multiple biomarkers that suggest the lower limit of 25(OH)D levels should be above 40 ng/ml and closer to 50 ng/ml. Then Professor Hollis spoke of his ongoing study in pregnant women and how he got approval to use 4,000 IU of vitamin D per day back in 2003, quite an accomplishment. He also reviewed another one of his research projects, one that answered an age old question, why is breast milk a poor source of vitamin D? How were prehistoric infants supposed to get their vitamin D, by lying out in the sun where saber tooth tigers would eat them? No, they were hidden in caves and had to have another source or the human race would have died out long ago because rickets destroys a woman's and infant's chance to live through childbirth due to rachitic deformations of the mother's pelvis. Carol Wagner and Bruce Hollis, together with their colleagues, answered that age old question, human breast milk is a poor vitamin D source because virtually all modern mothers are vitamin D deficient. That is, when pregnant women keep their levels where we think prehistoric human levels were, about 50 ng/ml, breast milk becomes a rich source of vitamin D. First Carol and Bruce gave 2,000 IU per day, then 4,000 IU per day and finally 6400 IU of D3 per day to lactating women. Only at 6400 of D3/day did the women maintain both their own 25(OH)D levels and the levels of their breast feeding babies above 50 ng/ml. On 6400 IU/day, the vitamin D activity of the breast milk went from about 80 to 800 IU/L. Quite a discovery, and another reason for all of us to keep our levels above 50 ng/ml.

Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006 Summer;1(2):59-70.

Professor Robert Heaney went last, discussing 74 slides. So much of what we know about vitamin D today is due to Robert's unceasing dedication to vitamin D, the most recent example being his and Joanne Lappe's randomized controlled trial showing that increasing baseline levels from 29 to 38 ng/ml reduced the risk of getting cancer by around 70%. He again pointed out that the body does not begin to consistently store much vitamin D until your levels get to around 50 ng/ml. He also went through multiple biomarkers of vitamin D. That is, what level or intakes do you have to have to reduce the incidence of multiple diseases? He covered calcium absorption, osteoporosis, risk of falling, muscle function, death and disability of the aged, TB, influenza, cardiovascular disease, hypertension, diabetes, cancer, multiple sclerosis, and gum disease. How can one vitamin be involved in so many diseases? Simple said Dr. Heaney, "vitamin D is the key that unlocks the DNA library." He then reviewed toxicity and concluded there is no evidence that it occurs at levels below 200 ng/ml or with intakes (total) below 30,000 IU per day. Of course, we have no reason to think anyone needs 30,000 IU per day or levels of 200 ng/ml, which would be irresponsible. But someone with a serious cancer should consider getting their level up to 70-90 ng/ml and that may take 10,000 IU per day or even more in some people. As a rule of thumb, 1,000 IU will raise 25(OH)D levels by about 10 ng/ml.

Then Professor Heaney addressed a public health question. How much would we have to give all Americans to get 98% of people above 32 ng/ml without causing toxicity in anybody? The answer: 2,000 IU per day. Of course 32 ng/ml is not adequate but it would be a great first step. Furthermore, of the people left out, a high percentage would be African Americans. In fact, Dr. Talwar recently reported that 40% of African American women fail to achieve a level of 30 ng/ml even after taking 2,000 IU/day for a year.

Talwar SA, Aloia JF, Pollack S, Yeh JK. Dose response to vitamin D supplementation among postmenopausal African American women. Am J Clin Nutr. 2007 Dec;86(6):1657-62.

He also discussed his recent study giving healthy adults 100,000 IU as a single dose. If you start with a baseline level of 28 ng/ml and take 100,000 IU as a single dose, mean levels will remain above 32 ng/ml for two months. If you rely on such stoss doses, but you start with a lower level, or want your levels above 50 ng/ml, how often do you need to take 100,000 IU? We don't know the answer to the last question but we know that Grey et al gave 50,000 IU per week for four weeks then 50,000 per month for a year to 21 patients with hyperparathyroidism. Blood levels rose from a mean of 11 ng/ml at baseline to 30 ng/ml at one year and levels did not continue to rise after six months. Remember, that means half the patients had levels lower than 30 ng/ml at the end of the year. Also remember that the metabolic clearance (how quickly you use it up) might be higher in certain disease states.

Grey A, et al. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab. 2005 Apr;90(4):2122-6.

That last point, metabolic clearance, is only one of a number of reasons that patients vary in their response to vitamin D. Remember, a surprising number of patients will tell their physician they are taking vitamin D when they are not, some will be taking preparations that have less in it than the label says, some will not absorb it, and some people weigh more than others. As Dr. Heaney points out, even if you know patients took 100,000 IU, great variably exists in individual response. At the end of two months some will have shown a minimal response and other much more. This is a field where little is known. Do different disease states use up vitamin D quickly? The answer is probably yes. Furthermore, variability also exists in how one metabolizes and catabolizes (breaks down) vitamin D. Also, what is the interactive effect of drugs that use the same liver enzymes for catabolism? We just don't know and that is why vitamin D blood testing is crucial. Remember, the only test to have is a 25-hydroxy-vitamin D. Do not let anyone get a 1,25-dihydroxy-vitamin D; it will not tell you if you are vitamin D deficient and is usually only indicated in evaluating high blood calcium.

As far as 25(OH)D levels go, many of you have written complaining about the high cost of a 25(OH)D levels at some labs. I've got some good news. For the next month, Life Extension Foundation is having a sale on their 25(OH)D blood tests, only $32.25, including the fee for drawing the blood. (No, we don't get funding from Life Extension, I wish we did.) Life Extension uses LabCorp, which, in turn, uses an accurate method to determine 25(OH)D levels, the DiaSorin Laiason method. The only problem is that DiaSorin, LabCorp, and Life Extension all say that 30 ng/ml is acceptable. It is not. Take enough vitamin D or get enough UVB radiation to get your levels above 50 ng/ml. To order the test, call Life Extension at 800 208-3444. Unfortunately, this offer is not available in New York, New Jersey or Rhode Island.

Also, Dr. James Dowd has written a fine book about vitamin D, The Vitamin D Cure. Get this, he is board certified in internal medicine, adult rheumatology, and pediatric rheumatology, an associate professor at Michigan State University, and runs his own Arthritis Institute and the Michigan Arthritis Research Center. He gives a formula for how much vitamin D you need but stresses the importance of testing to know for sure. He uses the formula of 2000 IU for every 100 pounds of body weight, which is as accurate an estimation as one can make without knowing baseline levels. Of course it depends on so many things, as Dr. Dowd points out, such as percentage body fat, latitude, skin type, sun exposure and age. He gives case after case examples of how vitamin D not just prevents disease, but seems to have a treatment effect. He also stresses three other things I've written about before, acid base balance, magnesium and potassium. If you can't get eat enough fruits and green leafy vegetables to obtain your potassium and magnesium and to get rid of low-grade chronic metabolic acidosis, then you should consider magnesium supplements and potassium bicarbonate supplements.

With these four experts and with this month's vitamin D news articles about breast cancer, brain function, artery blockage in the legs, soft skulls in babies, peripheral neuropathy in diabetics, childhood type-1 diabetes, colon cancer, and stress fractures and with the increasing number of scientists around the world jumping on the vitamin D express, why doesn't the government do something? What will it take? Like Carole says it will take a grassroots effort.

The first thing to do is tell your family and friends about vitamin D. Tell your doctor. Get your family's 25(OH)D tested, including your children. Once people begin to see it works, they will get their family and friends to take it. They will feel better and then the word will spread. All the government can do is make vitamin D illegal or limit the amount in each pill. The first is unlikely but not the second. With 5,000 IU capsules widely available, many people give no thought to taking one a day. But if the government limits the sale of anything over 400 IU and people had to take 12 of the 400 IU tablets, instead of one of the 5,000 IU, they might balk at so many pills. Before our officials in Washington take such a step, let's hope they read the Washington Post.

John Cannell, MD
The Vitamin D Council

This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. This newsletter is not copyrighted. Please reproduce it and post it on Internet sites. We are a nonprofit tax-exempt educational organization and depend on your donations.

The Vitamin D Council
9100 San Gregorio road
Atascadero, CA 93422

From Mukuddem-Petersen J, Oosthuizen1 W, Jerling JC. J Nutr 2005.

If you haven't yet done so, adding raw nuts to your health program yields a broad panel of health benefits.

Contrary to conventional advice, nuts can be eaten in unlimited quantities. Provided they are raw--unroasted, unsalted (since salting only accompanies roasted nuts), not roasted in unhealthy oils like hydrogenated cottonseed or soybean (very common)--they do not make you fat, regardless of the quantity consumed. Beer nuts, honey-roasted nuts, mixed nuts roasted in unhealthy oils with salt added are either fattening or exert other unhealthy effects (e.g., hypertension, rise in Lp(a), and cancer from the hydrogenated fats).

Some notable observations from the chart:

--Hazelnuts and macadamians are the richest in monounsaturates
--Walnuts are the richest in the omega-6 linoleic acid, while also richest in the "omega-3" linolenic acid.
--From a fat composition standpoint, raw cashews and dry roasted peanuts aren't so bad.
--Pistachios figure pretty favorably in this analysis, rich in monounsaturates.
--Coconuts are unusually rich in saturated fat, though about half is lauric acid--an issue for future conversation.

Here's a listing of the fiber composition of nuts per 1 oz serving (about a handful):

Almonds (24 nuts) 3.5 g
Brazilnuts, dried (6-8 nuts) 2.1 g
Cashew nuts, dry roasted, with salt added (18 nuts) 0.9 g
Hazelnuts or filberts 2.7 g
Macadamia nuts, dry roasted, with salt added (10-12 nuts) 2.3 g
Mixed nuts, dry roasted, with peanuts, with salt added 2.6 g
Peanuts, all types, dry-roasted, without salt 2.3 g
Pecans (20 halves) 2.7 g
Pine nuts, dried 1.0 g
Pistachio nuts, dry roasted, with salt added (47 nuts) 2.9 g
Walnuts, English (14 halves) 1.9 g

Data courtesy USDA Nutrient Database

Note that almonds are the winners with 3.5 grams fiber per ounce, pistachios a close second. Pine nuts and cashews place last on the fiber content chart.

Not addressed by the charts is protein content of nuts, as well as the low sugar content, all additional beneficial aspects of nuts. Nuts are also a moderate source of magnesium (though seeds like pumpkin and sunflower shine in the magnesium content area).

Rather than micromanage the specific fat and fiber content of your diet, why not get a little of the good of everything on the list and just mix and match the nuts? (Mixed and matched on your own, of course, not a hydrogenated cottonseed oil nut mixture).

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.

Anonymous
11/7/2007 8:57:00 PM |

Dr. Davis,
Sorry, this isn't about high blood pressure and exercise. Do you believe there is a connection between high blood pressure and tinnitus? Also, do you think that there are any vitamins or minerals that could relieve tinnitus?

Dr. Davis
11/7/2007 10:02:00 PM |

I know very little about tinnitus. However, I have seen some people get relief with niacin (immediate-release).

Sara
5/5/2009 11:02:00 PM |

Dr. Davis:

What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop, or a slight rise in systolic but a slight drop in diastolic, even with moderately vigorous exercise; my doctor doesn't think it's a concern (he's only worried about it being high, and I run 115/75 on average when just sitting around), and I haven't been able to find anything on my own. I'd like to know more about what conditions it can signal, and that I should therefore ask my doctor about specifically.

blood pressure medications
8/19/2009 9:02:48 AM |

What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop,High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

Anonymous
6/20/2010 8:06:42 AM |

Just chiming in on the enzyme called serrapeptase. I have the capsules and only use it when any of my dogs get bitten by a centipede. As soon as they come into the house squirming and licking the bitten paw, I give them one capsule and w/in a few minutes, they stop squirming and licking and fall asleep. So I think it works even if the stomach acid might destroy some of it. BTW, I used to take 1000 mgs of bromelain at night before bed and once when I was taking it regularly for about a week, I took a cholesterol lab test and my results came back showing a big decrease in my LDL and Total cholesterol numbers. The only change I could think of that might have caused the decrease was taking the bromelain.

Brian
9/15/2010 10:26:52 AM |

I have the same problem as Paul. Low/Good blood pressure while sitting around, but extremely high blood pressure after/during exercising, going up stairs, playing the trumpet, etc.

Although I understand and agree with all of the natural remedies you listed for lowering blood pressure (exercise, lower carbs, etc), why do you recommend low saturated fat intake? Are there any sources/studies that indicate that saturated fat has a direct effect on BP, and if so, that it's a bad thing? And would these studies take into account other variables such as carbohydrates and trans fats?

Any information you have would be GREATLY appreciated! Thanks.

Brian

buy jeans
11/3/2010 3:11:53 PM |

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

Brian
11/3/2010 3:31:04 PM |

I can understand the weight loss, exercise, and reduction of carbs (although not just processed, IMO) as well as magnesium and Vitamin D supplementation, but why the lower saturated fat? If you're trying to link lower sat fat intake to weight loss, I'd have to ask for a good source of information before I would believe you. In my practical experience in weight loss, I have lost tons of weight even though lots of my calories came from fat, and fat is needed for energy.

Mark "High Blood Pressure Causes " Lampson
3/26/2011 4:27:59 AM |

Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

Anonymous
5/1/2008 5:12:00 PM |

The letter points out how critical adequate Vitamin D intake is when pregnant or lactating.

To add to that point: an unfortunately large number of women experience pre-eclampsia during pregnancy, which often is fatal without aggressive and rapid medical intervention. In Sept 2007, a study reported that women will low level of Vitamin D increased their likelihood of pre-eclampsia by FIVE-FOLD.

Also, perinatal cardio myopathy occurs with 1 in 3000 women in the USA, and the rate is hire for black women. It would not be surprising if it turns out this is linked to Vitamin D also.

With the massive amount of info and research supporting the importance of vitamin D, it seems that the failure to prescribe adequate amounts of vitamin D intake is nearly criminal.

Anonymous
5/2/2008 4:18:00 AM |

I was wondering if there is benefit to taking Vitamin D if ones level is in the normal range?

Anna
12/1/2008 4:00:00 AM |

Great chart!

But it's getting hard to find truly raw nuts anymore, unless one has or knows someone with a nut tree (cashews, even when labeled raw,  are always heat treated to remove their toxic skin).

Industrially produced almonds in California's Central Valley had some food-borne illness contamination problems a while back and now must be pasteurized by steam or gassing, with a  few exceptions for very small producers.  Driving through that area and seeing the trees trimmed straight across for mechanical harvesting machines and the mountains of almonds by the side of the road waiting for pickup, it's a far cry from way our hunter-gatherer ancestors sourced their nuts.

For the freshest nuts (least damaged PUFA oils), buy them in the shell and shell them at home.  It's hard to overindulge in nuts when one has to shell them.

Additionally, nuts contain substances that inhibit digestion and nutrient absorption (these prevent the nut germ from sprouting prematurely).  The best way to prepare raw nuts for consumption is to soak them in salted water for hours or overnight (depending on the nut variety) to activate the sprouting enzymes and neutralize the anti-nutrients, then drain and dry.  A food dehydrator is very efficient for drying nuts, but it can also be done in the oven.  I soak and dry about 4 pounds at time, using sheet pans and setting the oven on the lowest possible temp (170Â°F on my oven), then cracking the door open with a wooden spoon to keep the temperature no higher than 150Â°F and allow for moisture evaporation.  It varies on how long the nuts must be dried, but 24 hours is a good average.  For safety I turn the oven off overnight or if I leave the house (keeping the door cracked open) and turn it back on when I am around and can keep an eye on things.  Otherwise, it is very passive hands off  "work" and can easily fit into other activities at home.

The resulting nuts are not roasted, so the delicate oils aren't damaged, and are easier to digest than plain raw nuts, as well as being tasty and crunchy.  My husband and son love these "crispy nuts".  We always have a few pounds of several varieties on hand for snacking, school lunches, salad toppings, etc.

Anonymous
12/1/2008 5:49:00 AM |

Ornish, McDougall, et al., advise not eating nuts if you have atherosclerosis. Why the disagreement?

Zbig
12/1/2008 10:36:00 AM |

dear doc,
apart from nuts(some of which, btw, are always in my fridge and I eat them daily)
- what do you think about the Pauling's protocol - could you spare a post on it some time?

Micawber
12/1/2008 1:15:00 PM |

Dr. Davis,

I absolutely love your blog - thank you so much for such an invaluable source of information.

I'm wondering whether dry (& lightly) roasted (trader joes) almonds are okay? Or if it's essential to eat them raw?

Thanks!

Gretchen
12/1/2008 2:27:00 PM |

This is a little confusing: "Provided they are raw--unroasted, unsalted (since salting only accompanies roasted nuts), not roasted in unhealthy oils like hydrogenated cottonseed or soybean."

If they're unroasted, obviously they're not roasted in unhealthy oils.

Please clarify your position on dry-roasted nuts. Is it the heat of roasting that is the problem? Or just the oils they're roasted in.

BTW, I find that almonds, which I dry roast myself, are a great antidote to the constipation that often accompanies low-carb diets.

steve
12/1/2008 3:12:00 PM |

interesting, but not to those of us allergic to nuts! We lose out. I for one can eat peanuts which are really legumes, but raw peanuts i have heard are not good for you. Hard to tell what oil it is roasted in as well.

Is non hydrogentated peanut butter with no salt ok?

IggyDalrymple
12/2/2008 12:22:00 AM |

This physician claims that coconut oil improved her husband's Alzheimer's.

http://www.tampabay.com/news/aging/article879333.ece

Anonymous
12/2/2008 12:26:00 AM |

I also am curious about dry-roasted vs. raw nuts and hope for some clarification on this subject.

Healthy Diet for Quick Weight Loss
12/2/2008 9:14:00 AM |

Great post......I like your blog so much...... Thanks for your valuable efforts. Good Job.....

Quick Weight Loss

Thanks!

stephen_b
12/2/2008 10:55:00 PM |

Instead of peanut butter which is roasted, try raw almond butter. I don't miss peanut butter now.

StephenB

Andrew
12/3/2008 8:28:00 PM |

I enjoy salted nuts, but I am a bit concerned about the hypertension effects. As stated in the chart, lots of salt is bad. So, I was wondering about doing some home-roasting of raw nuts in something like peanut oil or palm oil and mixture of salt and potassium chloride salt substitute.

Scott Miller
12/5/2008 12:16:00 AM |

Here's what I do, as a nutty nut fan:

Buy several types of raw nuts at a local market and/or whole foods. Also include Brazilian nuts, pine nuts, sunflower seeds and pumpkin seeds (none of these on the chart, but each has a healthy fat profile).

I mix all of these in roughly equal quantities in a large bowl. Then I add several tablespoons of olive oil. Why, to make the nuts sticky for what comes next: seasonings! I'll add black pepper, cayenne (chili) pepper, and sea salt -- all to taste, but I use a lot of sea salt. (Note, sea salt is not like table salt, which is 99% sodium chloride and not healthy. Sea Salt is a composition of numerous mineral salts, and not only healthy, but required for longevity.)

I also throw in about 50 grams of unflavored egg white protein powder, which, when everything is all shaken up, helps keep the nuts from feeling oily to the touch.

Dr. B G
12/6/2008 3:56:00 PM |

Scott,

Thanks for the delish recipe!

We just switched to sea salt (for the Mag and electrolytes) -- GREAT TYP!!

What an interesting way to use egg white powder (besides making royal icing).

-G

Pablo
11/6/2009 9:00:39 AM |

Dr. Davis,

I'm wondering about your comment that "Contrary to conventional advice, nuts can be eaten in unlimited quantities. Provided they are raw..."

You see, 100 grams of Cashews has approx. 550 calories. While I'd love to eat a pound of 'em, that'd be over 2,000 calories.

Your thoughts, sir?

Paul

Anonymous
10/20/2010 2:54:05 AM |

I can't eat nuts, they are too high glycemic and give me headaches. Almonds are supposed to be low glycemic, but my headache after eating almonds is proof that nuts spike my blood sugar. I hope to mix nut butter with a fiber complex to lower the glycemic response in the future. I'll stick with seeds for now, like sesame.

buy jeans
11/3/2010 3:41:47 PM |

Not addressed by the charts is protein content of nuts, as well as the low sugar content, all additional beneficial aspects of nuts. Nuts are also a moderate source of magnesium (though seeds like pumpkin and sunflower shine in the magnesium content area).

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