Dr. Davis,

Have you written a letter to the ADA or even better to the ADA's Diabetes Care journal, protesting these damaging carbohydrate recommendations?

Us regular folks are completely shut out of access to the ADA. We're supposed to send them money and shut up. But the are practicing medicine, and you're a doctor, so you CAN squawk.  

Please do! And get your MD friends doing the same thing. When an organization has this much power over medical practice the only way it can be reformed is if doctors stand up and take that power back.

I'm not a diabetic, but I guess I don't see what is so egregious about the ADA recommendations.

Let's do the math.  45g x 4 calories per gram x 3 meals means 540 carb calories a day.  For a 2000/day calorie diet, that means 27% coming from carbohydrate, far lower than the average American diet.  Since the other 73% has to be protein or fat, it gets tricky going with a percentage much lower than this.

60g would make more carbs of course, 720 calories, or 36%. That's  still not particularly high.  Of course it depends what kind of carbs they are talking about.

Nickname--

What you call "not so egregious" is responsible for the modern epidemic of obesity and diabetes.

I'd call that pretty damn egregious. The fact that  you've bought into the good carbs vs. bad carbs argument tells me that they have succeeded in propagating the low-fat diet argument to the detriment of your health.

Nickname--

What you call "not so egregious" is responsible for the modern epidemic of obesity and diabetes.

I'd call that pretty damn egregious. The fact that  you've bought into the good carbs vs. bad carbs argument tells me that they have succeeded in propagating the low-fat diet argument to the detriment of your health.

I disagree.  Americans aren't obese because they are eating only 135 grams of carbohydrate per day.  They are eating way more than that. A 1994 study showed that Americans ate, on average, 2100 calories, 50% which came from carbs.  So that would make 1050 calories, or about 262 grams, almost double the ADA's lower recommendation.  It's probably even more now.

And  yes, I do believe there is a big difference between overdosing on unhelpful carbs such as sugar, flour, baked goods and sodas, and eating a small to moderate amount of low-glycemic fruits, vegetables, alcohol and intact grains, which can easily add up to 135g of carbs over the course of a day.  Bear in mind, athletes and active people may need more than 2000 calories a day, and therefore the 135 grams would be an even lower percentage of total calories.

I don't understand the comment about low-fat; if you are eating less than a third of your calories from carbs, then it would be virtually impossible to also eat "low-fat."

45g carbohydrate per meal is too much for a diabetic.

How do you come up with this one.  Santa Clause is working for the drug industry.  If he is, then we all need to ask Santa for our dosage of drugs to avoid heart problems.  As it stems from over the years of indulgence, so now we need to retract and ask Santa for healthy items.  I for one will make sure to get some.  Benigna Marko

Dr. Davis,

I have a question to you. I am seeing a lot of research lately linking low Vitamin D blood levels in obese people to a multitude of conditions.

However, someone whose research chops I respect told me that it is possible that factors associated with the obesity is suppressing the vitamin D level rather than the obesity resulting from it.  

I understand how raising Vitamin D might be very effective in cardiovascular conditions where calcium metabolism is awry, extending the issue further, but I wonder if you have any thoughts on whether raising Vitamin D would have any impact on obesity and its associated maladies without other steps being taken like lowering carbohydrates and blood sugar.

One study I found suggests, for example, it may be that something about having diabetes lowers Vitamin D levels, rather than that Vitamin D improves insulin sensitivity.

A study in which people who were deficient in Vitamin D were given glucose tolerance tests and then given a massive dose of Vitamin D which raised their levels to normal after which they were given follow up glucose tolerance tests found no change in blood sugar or insulin sensitivity after Vitamin D was normalized.

Glucose tolerance and vitamin D: Effects of treating vitamin D deficiency Kamilia Tai. Nutrition. Volume 24, Issue 10, Pages 950-956 (October 2008).

I take Vitamin D for SAD! ;) It's really helped. I take 1k iu 3X a day. Along with alot of other supplements.

That is awesome - hope Seth continues to heal. This info needs to get out to other physicians.

I am seeing more and more patients who have been tested for vitamin D deficiency. That is good. But many of them are being told to stop the vitamin D once the level comes up to "normal" or stop after a month without further blood testing. One person had started and stopped vitamin D 3 times - she said her doctor told her he did not know why it kept dropping. It is sad that most physicians know so little about vitamins, supplements and nutrition.

Hi, Jenny--

Perhaps it's both.

I can tell you that, from my perspective in the "trenches," reduction of blood sugar and presumed sensitization to insulin is very real, obese or no.

It is also true that the more fat present, the greater the need. This has been thought to be due to sequestration in fat tissue, but that is pure speculation.

Also, I have never seen vitamin D go up more than minimally with weight loss. I believe there is a rise, but that says nothing about the path of causality.

dr Davis,

I understand calcification of the valves plays a role.

Decalcification of bone is a result of high levels of 1,25D (calcitriol), which may play a major role in the calcification of these valves.

Did you measure the levels of 1,25D in these patients and how high were those levels ?

Sincerely, Frans

My Georgia teacher's Blue-Cross charged me $225 for a LabCorp Vitamin D, 25-Hydroxy test.

Life Extension's test for $62.67 may be a bargin:
http://www.lef.org/Vitamins-Supplements/ItemLC081950/Vitamin-D-25-Hydroxy-Blood-Test.html

Matt

You say a formal trial at some point would be invaluable.  Why not do it?  I consider it rather unethical for a physcian to post anecdotal case reports like this on the Web.  Why not at least submit a letter or case report collection to a peer-reviewed medical journal where it could get proper scrutiny?  Posting it in a blog puts this in the hands of lay people who could inappropriately apply this to their own situation and perhaps do more harm than good.

While Seth's last echocardiogram showed a severely leaky aortic valve, the most recent echo showed mild leakiness ("mild aortic insufficiency")--a dramatic reduction.