This is your brain on wheat II

In the original Heart Scan Blog post, This is your brain on wheat, I discussed how opioid peptides (i.e., small proteins that act like opiates such as heroine or morphine) that result from digestion of wheat cause unique effects on the human brain, particularly addictive behaviors. I also briefly reviewed how elimination of wheat has been shown to reduce auditory hallucinations and other psychotic behaviors in a subset of people with paranoid schizophrenia.

These two phenomena, addictions and schizophrenia, are most likely the result of exorphins that cross the blood-brain barrier. Exorphins--exogenous morphine-like compounds--can be blocked by opiate-blocking drugs like naloxone and naltrexone. Naloxone is used in hospitals to reverse morphine or heroine overdoses; naltrexone is being repackaged into a weight loss drug, since blocking wheat-derived exorphins reduces appetite. (Yes: The USDA tells us to eat more wheat, the drug industry sells us the antidote.)

There's another way that wheat can affect the brain and nervous system: immune-activated damage.

This is similar to the effect seen in celiac. There's even overlap with some of the antibody markers used to diagnose celiac, like the anti-gliadin antibodies and the anti-endomysium antibodies.

The most common immune neurological syndrome consequent to wheat consumption is cerebellar ataxia, a condition in which an immune response causes damage to the Purkinje cells of the cerebellum, the portion of the brain responsible for balance and coordination. This results in stumbling, incoordination, incontinence, and eventually leads to reliance on a cane or walker and wearing a diaper. Average age of onset: 53 years. A shrunken, atrophied cerebellum can be seen on an MRI of the brain.

Problem: Most people with central nervous system damage caused by wheat do not have any intestinal symptoms, like diarrhea and abdominal pain, the sort of symptoms usually associated with celiac disease. It means the first sign of wheat-induced brain damage may be bumping into walls and wetting your pants.

Comments (24) -

  • LeonRover

    7/28/2010 9:18:57 PM |

    Being Irish an' all, my jeans will only allow me to thrive on a few spuds served with lashin's of butter an' onions and o' course sides of bacon and eggs washed down with Whiskey Go Leor, sometimes called The Juice o' the Barley.

    Minimal wheat.

  • Thrasymachus

    7/28/2010 10:35:34 PM |

    It only makes sense that there are vast numbers of people actually addicted to food, not metaphorically, but in the same way people are addicted to drugs and nicotine. A good start would be stop subsidizing this addiction, but since we have a government of the grain farmers, by the grain farmers, and for the grain farmers, that's not likely.

  • Anonymous

    7/29/2010 4:26:28 AM |

    Is wheat induced brain damage reversible, if one goes off wheat say at 50.?

  • Anonymous

    7/29/2010 5:34:31 AM |

    I would bet good money that this post will get more people off wheat than all your posts about wheat and heart disease combined!

  • Hans Keer

    7/29/2010 6:35:47 AM |

    You are totally right the devastating effects of wheat and its palls goes from gut to brain http://bit.ly/cAbZry VBR

  • Anonymous

    7/29/2010 10:22:18 AM |

    Dr. Davis

    As usual you are SPOT ON. exactly right with the symptoms and age. Just amazing all clinical symptoms described were seen by me in my father from 53 (stumbling and falling) to 58 (requiring help walking) to 60 (epilepsy hallucinations and fears)to 61 (bedridden) to 64 (last year November) death.

    Come to think, it was so simple to save him. It is just unreal.

  • Yogi Sinzapatos

    7/29/2010 3:55:16 PM |

    Sprouted wheat however is I believe extremely good for health.

  • Anonymous

    7/29/2010 3:59:26 PM |

    YOU HAVE DEFINITELY MADE YOUR POINT QUITE CLEAR.  NO NO MORE WHEAT.

    Does anyone how tequila is made?

  • lisa32989

    7/29/2010 6:16:37 PM |

    No wheat in tequila Smile

  • stop smoking help

    7/29/2010 9:05:39 PM |

    Is it time to join the bandwagon? No more drinking, no more smoking, no more wheat? Really, did I just write that? I have to say, I really enjoy my PB&J on whole grain wheat bread, as do my kids.

    Eating wheat is like apple pie and July 4th fireworks. How can we possibly do without and find a relatively cheap substitute? Is rice any good or is that a bad carb too?

    To eat healthy, is it just you need to eat organic and nonwheat foods and watch your carb-mix?

    Does it have to be this complicated? Has anyone written a book with easy to find, cheap/healthy ingredients that is easy to prepare in 30 minutes or less and feeds a family of 4?

    Right now, we're basically down to grilled chicken/fish/pork with steamed fresh brocolli/green beans and long-grain rice. That's pretty much all we eat anymore, with the occassional cheeseburger/steak indulgence.

  • Anonymous

    7/29/2010 9:38:25 PM |

    I started Low Dose Naltrexone 2 months ago to help with Autoimmune Disease.  I started at 1.5 and now am at 3.0
    I will increase to 4.5 in 2 weeks.

    I eliminated grains and dairy 1 month ago.

    I have lost 10 pounds.

    I could be as simple as the diet changes but I think more is going on.

    I have less pain which allows me to sleep through the night.
    I have more energy.
    I am more active and actually exercising.
    I am supplementing Vit. D and getting daily sun exposure (my Vit. D level was 41).
    My moods have greatly improved.

    Ironically, any time I have been prescribed an opiate pain medication, I have had severe allergic reactions.

    As far as the Neuro symptoms, I do have Meniere's complete with dizziness and vertigo.  So far I have not noticed any positive impact but still hopeful.

    Thanks Dr. Davis for all your information.

    J9

  • Anne

    7/30/2010 2:36:19 AM |

    "This results in stumbling, incoordination, incontinence, "

    I know you are right on. I was having mild ataxia and stress incontinence. Off gluten for 7 years and balance is better and no stress incontinence.

    This also affects dogs. My 12 year old cairn terrier was stumbling, falling over and urinating in her sleep. Got her off grains 2 years ago and she improved immediately.

  • Anonymous

    7/30/2010 4:35:39 AM |

    I can not say it enough times..............  Be healthy, not Paranoid.

    Dr. D emphasizes extremes for effect.  Do not fall into either side of the trap. Complacency nor paranoia.  informed decisions are critical for you and your family's well being

    Trevor

  • Anonymous

    7/30/2010 7:28:00 AM |

    i'd agree with Trevor as well.

    sourdough wheat (traditional preparation) and boiled raw milk go together.

    sourdoughing helps breakdown anti nutrients in wheat making the nutrients more bio available. Further Raw milk takes care of the rest by providing necessary enzymes (phystase etc) to digest wheat completely.

    pasteurized milk and wheat consumed without sourdoughing give both milk and wheat a bad name and will improve health when stopped simultaneously.

    traditional preparations eliminate such problems to a large extent.

  • Parag

    7/30/2010 9:55:55 AM |

    Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food.  Is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.
    celiac disease symptoms

  • Alex

    7/30/2010 10:48:56 AM |

    Sprouting wheat begins the process of breaking down gluten, but it is not a complete process. Same goes for fermenting. Making a suboptimal food less bad for you does not mean that food is now good for you.

    As for boiled raw milk, taking raw milk to a boil heats it to an even higher temperature than is done during regular, non-UHT pasteurization, and it keeps it at that high temperature for a much longer time than any commercial pasteurization process. Raw milk that's been pasteurized at home at a higher temperature for a much longer time is not somehow magically superior to commercially pasteurized milk.

  • Anonymous

    7/30/2010 2:51:05 PM |

    I'd personally like to see an experiment on sourdough whole wheat combined with boiled raw milk to see what Dr Davis notes. That should settle it.

    Alex share your experience rather than float around in clouds.

  • Anonymous

    7/30/2010 5:08:37 PM |

    Just out of curiosity, I would like to know what is the point of buying something raw (supposedly because "raw" holds more benefits) only to then get it home and cook it. Boiling raw milk, in my estimation, defeats the purpose of consuming raw milk. Boiling kills everything. I buy raw milk weekly and I drink it "raw." That's why I buy it.  
    Am I missing something? (serious question).

  • Alex

    7/30/2010 5:33:10 PM |

    Anonymous, I don't have acute gluten sensitivity, but I've read enough about gluten sensitivity to know that sprouting and fermentation are not 100% effective at making wheat a tolerable food for people with gluten sensitivity.

    Why cling desperately to consumption of a crap quality food when it's so much easier and simpler to just not eat it at all? One personal experience I can draw on is the addictive nature of wheat. I've been addicted to both tobacco and alcohol, but the most addiction-triggering image I can visualize in my mind is a loaf of locally made, crusty Italian bread. I think people cling to wheat consumption because it's addictive, plus it's deeply embedded in human culture.

  • Anonymous

    7/30/2010 5:45:51 PM |

    raw milk is a relatively new fad in usa while india is the highest wheat and milk consumer since hundreds of years. The way they consume raw milk, is, after boiling it and the way they consume whole wheat is after making sourdough.

    I personally consume raw milk without boiling but whats important is to understand the effects of consuming wheat and milk traditionally on health viz a viz consuming it in modern style.

  • Anonymous

    7/30/2010 6:15:05 PM |

    Alex wheat is sub optimal as are many other foods. the only complete food is milk, everything else is had in combination with a complementary food.

    Wheat is also not easy to avoid while its consumed traditionally  daily in the east, it is everywhere in its modern avatar in the west.

    its not a bad idea to figure out wheats' complement and how it works than declare wheat suboptimal and write it off.

  • Tommy

    7/30/2010 8:13:55 PM |

    I think that more than the problems wheat may cause for some, the problem is the amount of wheat we consume. Consuming the bulk of your calories from wheat (or grain) is a problem, even for those who don't have any existing conditions. Drinking beer all day or more than you should isn't good either but that doesn't mean that a beer here and there or even one per day is a big deal. For an alcoholic one beer is a bad thing but for the average person 1 or 2 isn't. For someone with a problem, wheat is bad; for the average person a little here and there in moderation isn't. There are a lot of things modern man eats that he didn't eat at one time. But then again, there are many things in life in general that modern man does that we didn't do years ago. We will always look to make things easier and in doing so compromise ourselves in some way. The best thing is to be educated enough to make good decisions but not get too carried away in either direction.
    Eating store bought chicken and meat tainted and chemically enhanced isn't good either. What does that do to us long term? What about our children. Eat less wheat and grains and avoid one illness but get another from mystery meat. So I guess we can't win no matter what we do. We can't get crazy, we just have to make good decisions.
    Middle of the road always seems like a good starting point.

  • Anonymous

    8/3/2010 2:59:12 AM |

    "The most common immune neurological syndrome consequent to wheat consumption is cerebellar ataxia"

    Where is the study or other reference that supports this statement? How common is this neurological syndrome in the American general population?

    Thank you.

  • elwiemo

    8/18/2010 10:43:52 PM |

    How exactly are the Purkinje cells damaged, and how specific is the effect to gluten/wheat?  What is your source for this?

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What Mr. Clinton did NOT do

What Mr. Clinton did NOT do

You've likely already heard that former President Bill Clinton underwent a heart catheterization today during which one of the bypass grafts to his coronary arteries was found to be occluded. The original coronary artery was therefore stented.

Dr. Alan Schwartz, Mr. Clinton's cardiologist, announced to the gathered press that Mr. Clinton had followed a good diet, had adopted a regular exercise program, but that his condition is a "chronic disease" like hypertension that is not cured by these efforts.



Needing a stent just 6 years after four bypass grafts are inserted is awfully soon. I would propose that it has less to do with having a "chronic disease" and more to do with all the things that Mr. Clinton likely is NOT doing. (In addition to all the other things that Mr. Clinton did not do.) In other words, in the Track Your Plaque world, procedures are a rarity, heart attacks virtually unheard of. I would wager that Mr. Clinton has been doing none of the following:

--Taking fish oil. Or, if his doctor was "advanced" enough to have advised him to take fish oil, not taking enough.
--Vitamin D--Followers of the Heart Scan Blog already know that vitamin D is the most incredible health find of the last 50 years, including its effects on reducing heart disease risk. Unless Mr. Clinton runs naked in a tropical sun, he is vitamin D deficient. A typical dose for a man his size is 8000 units per day (gelcap only!).
--Eating a true heart healthy diet. I'll bet Mr. Clinton's doctor, trying to do the "right" thing, follows the prudent course of advising a "balanced diet" that is low in fat--you know, the diet that causes heart disease. Judging by Mr. Clinton's body shape (central body fat), it is a virtual certainty that he conceals a severe small LDL pattern, the sort that is worsened by grains, improved with their elimination.
--Making sure that hidden causes are addressed--In addition to the "hidden" small LDL, lipoprotein(a) is another biggie. Lp(a) tends to be the province of people with greater than average intelligence. I believe Mr. Clinton qualifies in this regard. I would not be at all surprised if Mr. Clinton conceals a substantial lipoprotein(a) pattern, worsened in the presence of small LDL.
--Controlling after-meal blood sugars--Postprandial (after-eating) blood sugars are a major trigger for atherosclerotic plaque growth. There are easy-to-follow methods to blunt the after-meal rise of blood sugar. (This will be the subject of an in-depth upcoming Track Your Plaque Special Report.)
--Thyroid normalization--It might be as simple as taking iodine; it might involve a little more effort, such as supplemental T3. Regardless, thyroid normalization is an easy means to substantially reduce coronary risk and slow or stop coronary plaque growth.


It's not that tough to take a few steps to avoid bypass surgery in the first place. Or, if you've already had a procedure, a few additional steps (of the sort your doctor will likely not tell you about) and you can make your first bypass your only bypass.

Comments (36) -

  • Cheryl

    2/12/2010 4:27:19 AM |

    Dr. Davis,

    You mentioned gelcap VitD. Isn't the liquid form administered via dropper easier to take, and better assimilated?

  • Marc

    2/12/2010 11:20:09 AM |

    Would Pres. Clinton have the courage to go against the grain of conventional wisdom? I don't know the answer to that question, my hunch is that it is just "easier" to get treated then to take charge and responsibility.

    My sister 46 (highly highly educated) will not listen to me at all. Won't even take the time to read some of the resources I point her to. Result? She just has been put on beta blockers for high blood pressure and a heart that beats to "fast and erratically" (her words)

    Thank you Doc., for the wealth of knowledge and information you so freely share.
    Have a great weekend.

    Marc

  • Anonymous

    2/12/2010 2:47:26 PM |

    Thank you for this post!

    I am getting so tired of the pontificating statinators who practically blame the patient, or say there is no cure for heart disease, this can't be arrested, interventional cardiology is the only way, etc., while they either withhold the vital therapies you mentioned, or worse yet, don't even KNOW about them.

    I just keep wondering how such a smart guy can have so little intellectual curiosity about the origins and ALL the modes of treatment of the disease that has come to rule his life.

    Each of his events is a teaching moment, but unfortunately, what is being taught is intervention oriented, not oriented to stopping or reversing the progression of his disease, and that's just a pity.

    Dr. Davis, you are a voice in the wilderness. Keep on Tracking, because many of us ARE listening, even if Mr. Clinton and his doctors aren't!

    madcook

  • Kyle Schneider

    2/12/2010 3:45:20 PM |

    Dr. Davis:

    Re: Vitamin D, why do you recommend only the gel capsules and not the liquid drops (Carlson's drops are in coconut oil I believe)? Much thanks, great great blog.

    -Kyle Schneider

  • Michael R. Eades, M.D.

    2/12/2010 4:12:39 PM |

    Great post, Dr. Davis.  Just about everything one needs to know to avoid heart disease all in one short list. Should be read by everyone. Thanks for taking the time to put it up.

  • Pascal

    2/12/2010 4:37:17 PM |

    Dr. Davis, it would appear that people with heart disease risk fall into two categories.
    1. Metabolic Syndrome: High TG, low HDL, high fasting glucose etc. In these people small LDL is very high contributing to heart disease risk.
    2. High Lp(a): These people may not have high blood glucose levels yet because of their high Lp(a) levels they are at risk for heart disease.

    Mr. Clinton's triglycerides were at around 53 many years back. While he clearly has coronary artery disease he does NOT appear to exhibit signs of metabolic syndrome, i.e. high TG, low HDL, high fasting glucose etc. There are many people in this category that do not have metabolic syndrome yet show advanced coronary artery disease (possibly due to a high Lp(a) level).

    Now Dr. Davis, you have stated that one of the ways to track small LDL and other risk coronary risk factors is to track blood sugars. However, in Mr. Clinton's case it appears (from his TG numbers) that both his fasting and possibly postprandial glucose levels are reasonable. His small LDL should thus be reasonably normal. He may very well have significantly high Lp(a) levels which appear to be independent of whether a person has metabolic syndrome. Therefore in Mr. Clinton's case heart disease appears to be a result of a high inherited Lp(a) than his value of small LDL.

    Please correct me if you disagree with any of the above.

  • escee

    2/12/2010 4:38:07 PM |

    It is a sad testament to cardiac care in the U.S., but I  completely agree with everything you commented on. I would be willing to bet that at his last check-up he was told he was doing  well and everything was fine.

    I wish you could do a Q&A session with his cardiologist and we could see just what had been done or not done.

  • Lori Miller

    2/12/2010 5:56:15 PM |

    Thanks for posting this. I'll print it and show it to my father.

    Slightly off topic, but I took advantage of Porter Hospital's $99 CT scan special since four generations of my family have had strokes. They seemed confused because I didn't have a doctor's order for the scan.

  • Barkeater

    2/12/2010 8:02:54 PM |

    I bet he trusted his heart to Lipitor, or some such statin, and presented with a nice low LDL-C of 105.  That is the average LDL-C of people hospitalized for heart issues (see G. Fonarow et al).  (I am not saying the statin didn't help him, but it ain't the be-all and end-all, and neither is low LDL-C.)

    Further in the direction pointed by Dr. Davis, I bet bubba's triglycerides are consistently well over 100, suggesting issues with carbs.  So, eating low fat would lead him (like others) to higher carbs, leading to where he ended up.  Probably wheat -- "healthy" whole wheat -- in particular.

    I hope he was taking niacin to do what help he could to HDL.

  • Tony

    2/12/2010 8:06:52 PM |

    I'd be interested in your thoughts on this recent article in The New York Times, particularly regarding calcification in blood vessels:

    excerpt: "The scientific community continues to debate the optimum level of vitamin D. In general, people are considered to be deficient if they have blood levels below 15 or 20 nanograms per milliliter. But many doctors now believe vitamin D levels should be above 30. The ideal level isn’t known, nor is it known at what point a person is getting too much vitamin D, which can lead to kidney stones, calcification in blood vessels and other problems."

  • Barkeater

    2/12/2010 8:11:29 PM |

    Celebrity medicine -- a celebrity gets the most esteemed doctors, but they may not be the best.

    April 14, 1865 -- Lincoln was shot in the head with a low velocity bullet.  His celebrity doctors then went probing around in the wound.  He died.  The case has been made that Civil War battlefield doctors had learned not to probe a head wound, and if Lincoln had been treated by one of those doctors there was a decent chance he could have survived.

    Dr. Davis and other preventative cardiologists are the battlefield doctors of the current generation, desperately seeking that which works and rejecting that which doesn't as fast as possible, in the midst of the carnage of heart disease.

  • Anonymous

    2/12/2010 8:47:12 PM |

    An old article of Clinton's health report just before the 1992 election:

    TC: 184
    TG: 59
    Normal BP
    Normal treadmill ECG

    http://www.nytimes.com/1992/10/15/us/1992-campaign-candidate-s-health-doctors-call-clinton-healthy-campaign-offers.html?pagewanted=1

  • Anonymous

    2/12/2010 9:15:36 PM |

    Tell us more about thyroid normalization, please?

  • sonagi92

    2/12/2010 10:00:00 PM |

    "Unless Mr. Clinton runs naked in a tropical sun, he is vitamin D deficient. "

    Mr. Clinton, like me, has very pale skin that is not well-suited to the tropical sun.  I recall reading that either the Norwegians or the Swedes had very high levels of D owing to fish consumption.  I supplement with D, but my Irish ancestors did not, and they didn't get much sun either.

  • Ludwig Johnson

    2/12/2010 10:13:32 PM |

    MAGNESIUM. Thats what fmr prsident did not do. Did not take 500mg of Magnesium Oxide daily. With all the above he would have had his heart problem anyway. But not with Magnesium. Wigh is the mineral that his metabolic Type does not handle well. Cops of GENETICS.
    www.ludwigjohnson.blogspot.com

  • Ludwig Johnson

    2/12/2010 10:13:32 PM |

    MAGNESIUM. Thats what fmr prsident did not do. Did not take 500mg of Magnesium Oxide daily. With all the above he would have had his heart problem anyway. But not with Magnesium. Wigh is the mineral that his metabolic Type does not handle well. Cops of GENETICS.
    www.ludwigjohnson.blogspot.com

  • Anonymous

    2/13/2010 12:19:17 AM |

    Today the PMRI (Preventive Medicine Research Institute) announced:

    "Dr. Dean Ornish will appear on the Larry King Live show on CNN tonight to discuss new findings in heart disease."

    No doubt that he will be asked about his take on Mr. Clinton's situation.  I would hazard a guess that it will probably involve advocating an extremely low fat diet, liberal amounts of grains, but perhaps there will be new input from the Doctor, i.e. those "new findings".

  • bronkupper

    2/13/2010 1:38:05 AM |

    Hi Guys - Clinton's diet doctor is non else than "ultra low fat" Dr. Dean Ornish!

  • Anne

    2/13/2010 6:03:31 AM |

    A couple of years ago, the pastry chef at the White House published a book about his 25 year experience. I have heard that in the book he said Pres. Clinton was allergic to wheat and chocolate. I wonder if he has been sticking to a wheat/gluten free diet? Of course if you have a pastry chef, sugar intake is probably very high.

    I am working hard to make my bypass my last heart procedure. I am 10 yrs out and doing great...I hope.

  • Richard A.

    2/13/2010 6:08:50 AM |

    A Simple Health-Care Fix Fizzles Out

    http://online.wsj.com/article/SB10001424052748703652104574652401818092212.html

  • Anonymous

    2/13/2010 11:24:40 AM |

    Dr. Davis, did you get a chance to read this article?
    http://www.cortlandtforum.com/Healthday-Article/section/955/?CID=8D70113C&NFID=P&articleId=635663

  • Eddie Vos

    2/13/2010 2:09:51 PM |

    What is Clinton's homocysteine level??  That molecule, as opposed to cholesterol that is essential for health, is universally accepted as an artery structure corrosive and underlying cause of slowly building heart disease.

    The ONLY therapy to reduce it is a multivitamin pill with high levels of  the B vitamins.  Nobody argues this, nobody.

    So, they "bypassed" the problem areas but the disease process continues unabated.  This is the medical equivalent of bypassing Bin Laden by invading Iraq.

    Clearly, the amount and the diameter of LDL are not the problem; it is what you put INSIDE the LDL emulsion globules that matters: omega-3 or trans fat, good or evil.  Also, LDL is a Trojan Horse for homocysteine.  

    Clinton may be taking a statin to reduce the amount of LDL but that does not alter its composition or homocysteine level.  My independent take on cholesterol and homocysteine are here:
    http://www.health-heart.org/cholesterol.htm and
    http://www.health-heart.org/why.htm

    Did Clinton take such multivitamin? Agree: a multi does not quickly repair existing damage but it slows the process of decline while some repair [first seen in fewer strokes] DOES take place.

  • Alfredo E.

    2/13/2010 2:58:35 PM |

    Very opportune post Dr. Davis. I would like to have an idea to how much fish oil you have to take per day in order to keep your omega 3 Index above 10%. Just a practical example.

  • Anonymous

    2/13/2010 3:47:53 PM |

    Some years ago, Clinton said he was following Dean Ornish's plan. He isn't much of an advertisment for the success of that.

    Jeanne S

  • Dr. William Davis

    2/13/2010 10:59:47 PM |

    I wasn't aware that Dean Ornish was part of the Clinton picture.

    It will be interesting to see what his comments will be.

    Just as lungs would be removed to treat tuberculosis, or heart disease treated with removal of the thyroid gland, so low-fat diets like Dr. Ornish's need to be sent to the junk heap of failed practices.

  • Mike

    2/14/2010 1:28:43 AM |

    The iodine suggestion makes me wonder if the push to eliminate table salt from diets is resulting in abnormally low iodine levels. Putting iodine in table salt was done to fix the problem of low iodine levels in the food that most Americans were eating. Eating lots of seafood will fix the iodine and omega-3 deficiencies.

  • Myron

    2/14/2010 5:56:09 PM |

    Nice summary of things to do for a really healthy cardiovascular life style.   Specifically for Billy, I'm suggesting that his chronic is Wheat Allergies [beer and bagles].  All chronic inflamation is cause for any degenerative disease, certainlly cancer, cardiovascular, arthritis etc.  

    Each person has to address their chronic inflammation--often it comes from the dirtiest part of the body, the mouth [some say the brain] both need to be well.

  • Anonymous

    2/14/2010 6:09:33 PM |

    John McDougall, MD has written an open letter to Bill Clinton (one of a series over the years) regarding the care he receives from his intervention-oriented cardiologists.

    I was absolutely right there with Dr. McDougall... well until the last two paragraphs, where Dr. McDougall gets to the point of his letter and advocates a "healthy low-fat diet" like Pritikin, McDougall, Ornish, or Esselstyn.

    OHHHHH... I thought Mr. Clinton HAS BEEN on such a program... under the tutelage of Dr. Ornish, who as much as said so on the Larry King program the other evening.

    Dr. McDougall makes some very strong points regarding the interventional care Mr. Clinton has received and will continue to receive... it's just that extremely low-fat, vegetarian to veganish focus where we diverge.

    http://www.drmcdougall.com/misc/2010other/news/clinton.htm

    Happy Valentines Day... may all our hearts be strong and healthy!

    madcook

  • Myron

    2/14/2010 6:11:10 PM |

    Interesting comments, thank you for including the homocysteine and B vitamin perspective, and usually the allergy to chocolate is milk not the bean.    Bill should definitely eat more fish and more curry foods for the Turmeric, COX-2inhibitor.  Mag Oxide is great diarrhea, does it even absorb?   Chlorophyll is a chelated Mg and rebuilds the mitochondria.  Concerned about Abd. fats and Metabolic syndrome--get you Free Testosterone normalized!

  • Peter

    2/15/2010 2:04:34 PM |

    Re: wheat, it's curious to me that in northern India where people eat lots of wheat they have a fraction of the heart disease that they do in southern India, where people eat rice.  If anybody understands this, please reply.

  • Eduardo

    2/15/2010 4:30:35 PM |

    Dr. Davis: Your comment about a possible link between higher Lp(a) and higher intelligence sent me on a very brief ego trip, as tests showed that I do have both, but a more rational explanation may be that those of higher intelligence are more likely to get engaged in their own health, search for answers (as the readers here do) and find out that they have a elevated Lp(a), while others may never know they have it. Also, the March 2010 issue of Men's Health has a positive article about a pro-cycling team's switch to a gluten free diet, a favorite subject of yours, thanks for the blog.

  • Jen

    2/15/2010 9:13:09 PM |

    I would like to know more information regarding this statement;

    "Lp(a) tends to be the province of people with greater than average intelligence."

    Can you point me in a direction that would explain more about this?

    Thank you,
    JenE

  • Amelia

    2/16/2010 1:19:54 AM |

    Re North India:  They do use quite a bit of mustard seed oil in N. Indian cuisine.

    http://www.ajcn.org/cgi/content/full/79/4/582

  • EddieVos

    2/16/2010 1:37:48 PM |

    Mustard seed oil has antiarrhythmic omega-3  It is in that respect like canola/rapeseed .. or any brassica family seed oil [turnip, et al].

    The northeners may also get more vitamin B12, allowing homocysteine to be lower, a MASSIVE problem in India, massive.  In New Delhi in early 20 year olds, homocysteine is about 3x higher than currently in Americans youth in their teens.

  • Bob

    2/16/2010 5:24:05 PM |

    I second JenE's question re lp(a) - correlation with IQ. Thanks!

  • buy jeans

    11/3/2010 9:14:28 PM |

    It's not that tough to take a few steps to avoid bypass surgery in the first place. Or, if you've already had a procedure, a few additional steps (of the sort your doctor will likely not tell you about) and you can make your first bypass your only bypass.

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Mammogram for your heart

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.
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The case against vitamin D2

The case against vitamin D2

Why would vitamin D be prescribed when vitamin D3 is available over-the-counter?

Let's review the known differences between vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol):

--D3 is the human form; D2 is the non-human form found in plants.

--Dose for dose, D3 is more effective at raising blood levels of 25-hydroxy vitamin D than D2. It requires roughly twice to 250% of the dose of D2 to match that of D3 (Trang H et al 1998).

--D2 blood levels don't yield long-term sustained levels of 25-hydroxy vitamin D as does D3. When examined as a 28-day area under the curve (AUC--a superior measure of biologic exposure), D3 yields better than a 300% increased potency compared to D2. This means that it requires around 50,000 units D2 to match the effects of 15,000 units D3 (Armas LA et al 2004).

--D2 has lower binding affinity for vitamin D-binding protein, compared to D3

--Mitochondrial vitamin D 25-hydroxylase converts D3 to the 25-hydroxylated form five times more rapidly than D2.

--As we age, the ability to metabolize D2 is dramatically reduced, while D3 is not subject to this phenomenon (Harris SS et al 2002).




From Armas LA, Hollis BW, Heaney RP 2004


While there are dissenters on this view, the bulk of evidence suggests that D2 is an inferior form of D3.

Then why is D2 prescribed by many doctors when the natural, human, and superior D3 is available over-the-counter?

You already know the answer: Much of your doctor's education did not come from scientific lectures nor from reading scientific studies. It came from the pretty drug representative in the waiting room who hands the doctor reprints of the "studies" performed by the drug industry to support the use of their drugs. There is no such nutritional supplement representative in the waiting room. This preference for the "drug" D2 over the supplement D3 also stems from the inherent preference of physicians for things they can control, whether or not there is proof of superiority.

In my view, there is absolutely no reason to take vitamin D2 over D3 except to enrich the drug industry.

Comments (40) -

  • Barkeater

    8/11/2009 1:08:02 PM |

    I recently had a discussion with a relative who got a prescription for Vitamin D.  (This after I bought her a Vitamin D test from Grassroots showing a level of 19.)  I told her the prescription was a bad idea as it was surely Vitamin D2.  She looked into it and came back and told me, no, it was D3.  I have not seen it, but I am asking now - is it really true that prescriptions are invariably D2?  She claimed it was 50k IU of D3, once a week.

    Separately, I see it stated here and there that the Vitamin D added to milk is D2.  Most milk labels I see show it as D3.

  • Anne

    8/11/2009 2:41:22 PM |

    A bit of information that the drug reps don't tell the physician is people need to be on a maintenance dose. I have seen so many people who were prescribed D2 for a few months. Once the vitamin D level rose to over 30, they were told they could discontinue taking the D2.

    One person told me that she had started and stopped D2 three times. She said her doctor could not figure out why her vitamin D level keeps dropping when the D is stopped. At least she was retested. The other people who were told to stop taking D2, were never retested once their D hit "normal".  

    I have a friend who told her doctor she would get her vitamin D as D3 OTC. She said he expressed surprise that it could be bought without a prescription.

  • Richard A.

    8/11/2009 5:06:19 PM |

    The study you site appears to use the dry form of vitamin D3.

  • Tony Kenck

    8/11/2009 5:06:41 PM |

    So is D2 a prescription medicine?

  • TedHutchinson

    8/11/2009 5:13:14 PM |

    Here is an abstract providing an example of the total lack of effect of D2 in a patient.
    The lack of vitamin D toxicity with megadose of daily ergocalciferol (D2) therapy:
    The maximum daily dose of vitamin D currently recommended is 2000 IU. Ergocalciferol (D2) 50,000 IU orally weekly for 8-12 weeks is often used to treat vitamin D deficient patients (25(OH) vitamin D <20 ng/mL).
    The lack of vitamin D toxicity after massive doses of ergocalciferol has yet to be reported in the literature.
    We report a case of a 56-year-old woman who received supratherapeutic doses of ergocalciferol (150,000 IU orally daily) for 28 years without toxicity. We discuss the possible mechanisms which may account for a lack of toxicity despite intake of massive daily doses of ergocalciferol in this patient.


    The sad aspect to this story is that as Vitamin D2 at that ridiculously high intake didn't do her harm, it's also probable that her body did not recognise it at all, so it probably didn't do her any good either. As there have been other accounts of people taking large (but not as huge as this case) amounts of D2 and it not having any noticeable effect on Vitamin d deficiency symptoms it seems just pointless to risk using it, when there is a cheaper, more reliable, alternative readily available.

  • billye

    8/11/2009 8:23:28 PM |

    I think it is up to the patient who is tuned in to this fine blog and several other like minded blogs who preach as you do, such  as "nephropal.blogspot.com" to bring your information to their primary doctors.  My primary doctor still takes a Staten drug even though he knows and marvels at the health gains that I have achieved through supplementation with high dose vitamin D3 and high dose omega 3fish oil, along with a cave man like diet.  I asked him why he take a Staten drug when they work by increasing his vitamin D level? I said just take vitamin D3 instead of the Staten drug.  His answer was that he only takes a little Staten drug.  When he found my wife to be vitamin D deficient, he in fact ordered a script for vitamin D2.  I insisted that she take OTC vitamin D3 and after a tussle he gave in.  

    I am sorry to say that only we the patients can change the system.  I don't blame the very over worked primary care physicians who have no time to read the necessary science.  We the patients have to bring the relevant data to them.  After all it's our health that is being impacted.

  • Dr. William Davis

    8/11/2009 10:53:05 PM |

    Bark--

    There is indeed a prescription D3.

    Now, why a prescription form is necessary is beyond me. I suppose we could make prescription vitamin C, too, and charge $120 per month.

  • Dr. William Davis

    8/11/2009 10:53:51 PM |

    Hi, Anne-

    Yes, I also see this incredible blunder occuring around me.

    I'm not sure what they're thinking.

  • Anonymous

    8/12/2009 12:28:05 AM |

    Vitamin D3 1000 IU 240 tablets per bottle x 2 bottles purchased from Costco is dirt cheap.  $5.20 Cdn.  Very cheap $ U.S. dollars.

    I take 3,000 to 5,000 IU daily and associate it with stopping hot flashes.

    Inadvertently 'experiments' by running out of D3 for several weeks at a time resulted in really terrific hot flashes. Nothing is quite as unpleasant as having a hot flash as soon as I wake up, for example. Clearly I have not done double blind studies.  I am (sort of) menopausal.  No periods from September 2008 to June 2009.  Now, back. Frown

    No vitamin D3 intake during summer of 2008:  terrible terrible hot flahses. Then started taking D3 3000 IU in August 2008. Ran out of D3 sometime in Januray.  Hot flashes started up sometime later.  However, no hot flashes since end of March 2009.  No hot flashes from September to January.  Stopped taking D3 because too lazy to go to Costco to buy more.  Then started taking D3 and then stopped with the hot flashes and have not had another one in months even though obviously the hormones are fluctuating.

    I used to think that HRT would stop hot flashes.  HRT does nothing for the hot flashes.  Vitamin D3 appears to work much more effectively.  

    Dr. G. Kadar
    Toronto, Canada

  • Dr. William Davis

    8/12/2009 1:58:52 AM |

    Dr. Kadar--

    Fascinating observation!

    Any other ladies who've made similar observations? Or perhaps taken vitamin D yet continued to experience hot flashes?

  • Anne

    8/12/2009 2:31:35 AM |

    Tony ~ D2 can be bought as an OTC too.

    Dr. Kader ~ I have a co-worker who says her hot flashes disappear when she takes vitamin D.
    Anne

  • Peter

    8/12/2009 9:58:46 AM |

    I wonder if there is any research on your view that the tablets don't work, only the gelcaps, for raising vitamin D levles.  It seems like it would be very easy to show whether or not this is true, and very important since lots of people take the tablets.

  • Dr. William Davis

    8/12/2009 12:15:34 PM |

    Hi, Peter-

    To my knowledge, there is no research on this topic. However, having tested vitamin D blood levels thousands of times, I can say with confidence that the tablets are inconsistently absorbed--sometimes they work, often they don't, or they increase blood levels less effectively. Levels also vary widely, due to inconsistent absorption.

    Gelcaps--i.e.,oil-based--are absorbed consistently.

  • Anonymous

    8/12/2009 1:59:08 PM |

    What are some good brands of OTC D3?  I see the Costco mentioned, but has it been independently tested?  I know the Costco brand fish oil is supposedly decent, so it would make since that the D3 is as well.

    I usually order online (vitacost.com) and I like the NSI brands.  Are they good?

  • billye

    8/12/2009 4:24:24 PM |

    Dr. Kadar

    Thanks for sharing about your success with vitamin D3 bringing relief for your hot flashes.  I have a daughter who was suffering with hot flashes and refused to take the dangerous medically recommended hormones to alleviate the problem.  Instead she started to take black cohosh. when I pulled a negative study from Pub Med she stopped. She continued to suffer and not in silence.  In the meantime, understanding the health benefits, I convinced her to start taking 6000 IU of vitamin D3 soft gels.  It never dawned on me that this could be so positive relative to hot flashes.  This morning I asked her how come I don't hear any hot flash complaints and she answered that she hasn't had an episode in a very very long time.  It seems likely that we now can put a face on the reason why.  Yet another use for the miracle health supporting hormone vitamin D3.  

    It truly is a fascinating observation,as Dr. Davis remarked.  Thanks for solving this mystery.

  • Nameless

    8/12/2009 5:19:25 PM |

    It's just a guess, but the inconsistent absorption of dry  D3 sounds like it's due to fats (or lack of fats) consumed when dosing. So if patients take it with fish oil, or right after a fatty meal, it may work.

    But I see no reason to stay on dry anyway as gels are very cheap. There are also liquid drops (usually with a fat carrier) for those who dislike pills.

    I'm just waiting for a company to put out a D3/K2 gel next. They seem like logical partners.

  • Diana

    8/12/2009 6:54:38 PM |

    I have a blogsite where I am tracking successes regarding the usage of vitamin D.  Will you tell your success story?  I am an advocate and educator for using Vitamin D3.  I personally take 6000-8000 to keep my levels of D3 at the appropriate level.  

    I will never stop!  It manages the SAD disorder that I had without knowing for over 25 years.  It has changed my life.  My sense of wellbeing has increased to 100%.  Before, it was always a struggle to shake off the feeling that something always felt off, or wrong. It never felt like depression, and my outlook has always been upbeat.  But I still carried around, what I only know how to discribe as almost a sadness, or a feeling that something was wrong but I couldn't put my finger on it.  After taking the Vitamin D3, it just disappeared.  So, now I am an advocate, and believe firmly that this information must be disemminated out into the communities.  

    If you have a story to tell I would appreciate it if you would add it to my blog site:

    http://dactionhealth.ning.com/

    Best~Diana~

  • Diana

    8/12/2009 7:02:19 PM |

    There are also D3 available in liquid form.  It is great for those who can't swallow pills.  I believe it is through Biotics Research.  It is 2000U a drop.  I put 3 to 4 on my finger, and it is done. Nice to have the option and works better for children.

  • Anonymous

    8/12/2009 10:22:05 PM |

    I recently discovered while shopping for my D3 that there is also a D3 version made from sheep lanolin.  Is this as effective as the D3 from fish oil?  Is there any reason why one would be preferred over the other?  I go for the fish oil source because I just don't know anything about the other.

    I've been taking anywhere from 4,000 iu to 10,000 iu per day since February 2009 when my test revealed a level of 27 ng/dl. Last month I asked my dr for another test and he said they normally don't test again, which I just don't understand!(kaiser insurance). I still have my hot flashes but now that I think about it they are few and far between and less intense.
    Nancy

  • Anonymous

    8/12/2009 10:41:32 PM |

    Probably taking vitamin D3 tablets with a meal containing fat helps with absorption.

    I've got patients using the drops.  They butter their toast and add the relevent number of drops of D3 1000 IU per drop to their buttered toast. (I recommend 100% rye sourdough bread for those patients who must eat their bread.)

    I am now asking female patients experiencing intrusive hot flashes to take vitamin D3.  I'll wait for feedback from them.  Also for perimenopausal mood fluctuations.

    Looked at another way:  D3 is a hormone replacement therapy.  

    I do also tell patients about vitamin K2 and how it is also necessary for bone metabolism.  If they take therapeutic doses of
    vitamin D3, then they also must eat eggs (and cheese, liver, etc.)  But minimally, they must eat egg yolks.  In Canada, K2 is not available in any serious way as a supplement.  

    Dr. G. Kadar
    Toronto, Canada

  • Sue

    8/13/2009 2:35:08 PM |

    I would love to take my D3 in gelcap form, but have thus far been unable to find any here in Canada.  I sometimes take the liquid, but get hung up on what constitutes 'a drop,'  so usually settle for tablets along with fish or krill oil.  Anyone know of a Canadian source for gelcaps?

  • Neonomide

    8/13/2009 10:22:50 PM |

    Dr. William Davis said...

    "I can say with confidence that the tablets are inconsistently absorbed--sometimes they work, often they don't, or they increase blood levels less effectively. Levels also vary widely, due to inconsistent absorption.

    Gelcaps--i.e.,oil-based--are absorbed consistently."


    I cannot say anything about hot flashes since I'm a man (but can and will tell these interesting observations to PMP women I know), yet I have something to say about tablet versus powder versus gelcaps issue that may be of interest.

    I have moderate level Crohn's disease and got great help from D3 supplements for over 7 months now. I started with gelcaps (dosage 25-75 µg/d), then abruptly moved into powder form (Vit D Max, dosage 125 µg/d) and observed GREAT improvement in a couple of weeks. Even my BP dropped so much - from 145/95 to 115/75 and I even got dizzy during daytime. (I also took some melatonin to be fair).

    Then - after about 4 months - I changed back to gelcap form and kept the dosage and experienced somewhat more symptoms - if only for a while.

    Is it possible that powder form may work more quickly, or did my powder D3 contain more D3 than mentioned? I honestly don't know.

    I wrote for Dr B G about my Crohn improvement a while ago but she seems to be on holiday as we're speaking? Smile

    - Neo

  • Anonymous

    8/13/2009 11:18:11 PM |

    I buy small easy to dissolve capsules of D3 (dry powder, not oil) made by Bio-Tech from Dr. Eades' Protein Power site (no affliation other than as a reader).  The cost for the dose is very, very good ($8 for 100 capsules) and the bottles are small.  I was able to buy 11 bottles for the same shipping price as 1 bottle, so I stocked up and shared with family members (my experience is that middle aged adults need at least 5000iu per day year round to keep 25 (OH)D levels above 50 ng/mL).  I test at least twice a year, so I know that the D3 is absorbing.  

    I also usually take the D3 around the same time I am consuming some fat, which probably helps with absorption.  Other family members take Carlson's oil capsules with good results.  We avoid hard tablets.

    Bio-tech also makes a non-prescription D3 in a 50,000iU dose, 12 capsules for about $18 (plus shipping), which is a very competitive price compared to high dose Rx D2.

  • rendev

    8/14/2009 5:07:29 AM |

    Hi
    Really a nice blog!
    Needs stuff to to!

  • TedHutchinson

    8/15/2009 6:29:52 PM |

    Readers who are using Vitamin D3 for cancer prevention may be interested in this new paper from Vieth
    How to Optimize Vitamin D Supplementation
    to Prevent Cancer, Based on Cellular
    Adaptation and Hydroxylase Enzymology

    The hypothesis seeks to answer some of the Dilemmas that challenge the vitamin D/Cancer hypothesis regarding prostate/pancreatic cancers.
    1)How can the vitamin D hypothesis explain the U-shaped risk curve for prostate cancer when the data suggest that the average 25(OH)D
    concentrations in countries with relatively high rates of prostate cancer are apparently the optimal concentrations for preventing prostate
    cancer?
    2 What plausible mechanism, other than vitamin D, could account for the association between greater lifetime sun exposure and diminished risk of prostate cancer ?
    3 How can latitude and environmental ultraviolet light be associated with increased risk of prostate cancer, and pancreatic cancer, yet not be a significant contributor to the lower average 25(OH)D concentrations theorized to be the key component of the mechanism that relates latitude to cancer risk?
    4 Why is summer season of diagnosis, or a higher serum 25(OH)D associated with better prognosis of prostate cancer?
    5 If vitamin D is adverse for prostate cancer, then why is the rate of rise in prostate-specific antigen (PSA) slower in summer  than in other seasons and why would vitamin D supplementation slow the rate of rise in PSA ?
    6 Why, in regions of the United States where environmental UVB is low, is there a positive association between pancreatic cancer versus serum 25(OH)D, while at the same time, in regions where UVB is high (presumably providing even higher serum 25(OH)D levels), is there no relationship with 25(OH)D ?
    7 If 25(OH)D is antiproliferative in cell cultures of prostate cells in vitro  and pancreatic cells, then why would it contribute to the development of cancer in vivo?

    Vieth suggests that as circulating 25(OH)D levels rise and fall, 1,25-dihydroxyvitamin D  concentrations  need to be adjusted and the balance between 25(OH)D-1-hydroxylase [CYP27B1](tumor surpressing) and the catabolic enzyme, 1,25(OH)2D-24-hydroxylase [CYP24](oncogene) may for a while become disrupted.

    Any time there is a delay in cellular adaptation, or lag time in the fine tuning of  1,25(OH)2D  in response to fluctuating 25(OH)d concentrations there is the potential for too little of the tumor suppressor enzyme and too much of the oncogene CYP24.

    Regular daily supplementation with D3 keeps levels high.
    Regular 25(OH)D testing will enable you to see your levels are remaining steady.
    It may be  sensible for people living further North to have a lower summer intake and higher winter amount in order to reduce the amplitude between summer highs and winter low 25(OH)D levels.

    Those who go for Winter sunshine breaks may want to think about increasing D3 intakes before they fly off, reducing supplement intake while under the tropical sunshine and resuming supplementing immediately on returning home to prevent sudden changes in status and limit the extent of gains/losses.

    25(OH)D levels need to be both high and stable.

    The graph Dr Davis shows how D2 levels dropped steeply (indeed levels at the end of the month were  lower than before supplementing started) so the fact that D2 increases the rate at which 25(OH)D depletes making the fluctuation in level more acute, is a further reason to avoid it.

  • Sabio Lantz

    8/16/2009 11:33:35 AM |

    Dr. Davis,
    I just got my labs back after 7 months on low-carb, high-fat diet.  Chol was 337 (my labs are here).
    I was wondering if you or readers could point me to 5 or 6 links that would help educate me on this issue so I can see if I need to make any changes in the next 7 months.  Thank you for your time.

  • epistemology

    10/27/2009 1:43:39 AM |

    Why do doctors prescribe Vitamin D2?
    They don't very often. Calcitriol (most common brand, Rocaltrol) is the most often prescribed Vitamin D around here (near Philadelphia).

    Why do we need a prescription Vitamin D when OTC Vitamin D is just as good?
    Two reasons:
    1. Without a prescription, patients take medicine less reliably,
    2. More importantly, many of my patients are poor, and OTC meds are not paid for, but prescriptions are.

  • Anonymous

    10/29/2009 11:35:25 PM |

    I take D2 (and get as much midday sun as is safe) because of the horrible way the sheep are treated.

    http://www.savethesheep.com/animals.asp

  • Jim

    12/2/2009 5:38:41 AM |

    I know a nurse practitioner who practices in Phoenix, Arizona. She has done hundreds of blood draws for nutrient levels and has noted that some 99% of people were vitamin D deficient.

    She went on to explain that a lot of these people were construction workers and did not even wear sunscreen. Again, this is in Phoenix where the sun shines intensely nearly every single day of the year. If those people are not getting enough D, I think it's pretty safe to say that you are at least at risk.

  • Anonymous

    12/7/2009 4:38:54 PM |

    D2 comes from plant sources. D3 comes from animal sources, primarily animal skins. If you are vegetarian you would not want to take D3.

    The primary reason the prescription form is D2 is because D2 is much safer. Too much vitamin D is worse than too little. The standard prescription dose is very high, 50,000 units. High doses like that of D3 would be extremely dangerous. Your body is much better able to regulate it's absorbtion of D2.

    I would never take D3. It might take a bit higher dose of D2  to achieve the same result (studies do not agree on this) but I am never going to poison myself. I expect sereous negative health consequences in the future as a result of the marketing of D3. D3 is pretty much all you can find over the counter these days. I assume that it is more about promoting animal agriculture than human health.

  • Dr. J.

    12/16/2009 8:24:54 PM |

    It is true that the pharmaceutical industry has at times had undue sway over the medical profession.  To say that physicians are educated by "pretty representatives" is insulting and undermines the credibility of the author.  I agree that vitamin D3 is more "natural" and technically more potent.  The reason why vitamin D2 is more often prescribed is at least three-fold.
    1. Vitamin D2 is available in a prescription strength that allows for a more rapid repletion of vitamin D levels.  (It is hard to find a prescription vitamin D3)  In other words, it would take longer to replete vitamin D with over-the-counter doses of vitamin D3.  So why not just take a bunch of D3 capsules?  The dosing schedule for repletion of vitamin D with D3 is not as well worked out as it is with vitamin D2.  As soon as someone does a large scale study using vitamin D3, we will all be willing to switch.  Doctors are hesitant to make up regimens where effective ones already exist (re: risk of patient harm/legal liabilities)  
    2. Vitamin D2 has been prescribed for decades. We as physicians are more familiar with its effect on patients.  
    3.  Finally, vitamin D3 used to be more expensive--another reason D2 was preferred over D3.  Doctors, like everyone else, are often resistant to change.
    One thing is certain.  The author's assertion that physicians are not guided by science is false.  What we need is large scale clinical trial with vitamin D3.  The problem here is funding.  Who will pay for it?  Until then, the most we can say is that vitamin D3 is more "natural" and more potent.  Vitamin D2 however is effective and has not been shown to be injurious.

  • Dr. William Davis

    12/17/2009 12:22:06 AM |

    Dr. J--

    Allow me to insult you again: It has been my experience that many of our colleagues are miserably susceptible to the smile of a pretty representative. Perhaps you are not, but I see it all the time.

    I'm afraid that I believe you are way off base on the D2. I recommend that you read the existing literature. I believe that there's only one conclusion: D2 is markedly inferior. While better than nothing, why would anyone take a non-human form over a human form?

    Having replaced vitamin D in approximately 2000 patients using D3, I can tell you it is safe and reliable. In the handful of patients taking D2, I've seen everything from modest increases in blood level so 25-hydroxy vitamin D to no increase at all.

  • Deana

    3/20/2010 4:14:53 PM |

    Twice I have been on prescription strength Vit d2(50,000 units first for 8 weeks since my level was 30  and then rose to 66 with RxI took good quality Vit D3 in between 2000 units daily faithfully,eat a good diet (also take ERT age 65) and after serveral months^ my level again fell to 33 now have beenplaced on Vit D2 for 12 weeks, blood level 64 and will repeat test in 6 months.I am now taking 4000 units of D3. I DO NOT seem to be absorbing Vit D3 and wonder why or if I need even more daily

  • Gypsy Boheme

    7/14/2010 1:09:54 AM |

    Why wouldn't you just obtain your Vit D through food sources? sardines, salmon, tuna, liver, egg yolk, cod liver oil, fatty fish, dairy

  • Mary

    10/16/2010 1:27:55 AM |

    I HAVE to say something.  There are some valid health related reasons why some people/children have to take D2.  My daughter has to take D2 (her levels are at 33) so her DAN doc wants her D supplemented.  She also has some gastritis/EE he is hoping to heal in her tummy w it.  He wishes and we all wish she could take D3--I know its way better than D2.  BUT--she can't take D3--she is allergic to both fish and lanolin . . . so . . . therefore she has to take D2 right?  No other D3 option out there for her right--please answer if there is another option for her.  She is allergic to all the natural foods with D3 as well--egg etc.  D2 is all thats left.  I PRAY its helping her a little. We use a local company in WI called Cty Line Pharmaceuticals--the D2 is liquid, its D2 dissolved in propylene gycol with NOTHING else added.  Its a bit spicy but my daughter "Gags" it down as she  surely be allergic to anything added to flavor it.

  • buy jeans

    11/3/2010 3:44:48 PM |

    There is no such nutritional supplement representative in the waiting room. This preference for the "drug" D2 over the supplement D3 also stems from the inherent preference of physicians for things they can control, whether or not there is proof of superiority.

  • Anonymous

    12/13/2010 4:25:32 PM |

    I was vit D deficient at a level 12. I was told to take over the counter D3 1,000 a day for 5 mths, retest. It raised to only 23. I was told to take Vit D 3 at 2,000 a day for another 4 mths and the result was I went back down to 18. Finally took the presciption D2 at 50,000 a wk and I am mid normal. My 2 daughters were recently diagnosed with D deficiency as well. I walk a dog daily yet my 85 yr old mother who does not really see the sun and when does wears sunscreen takes no Vit D and is not deficient. Go figure.

    P.S. Yes Vit D did reduce hot flashes as well.

  • Sidney Lohr, Ph.D.

    12/16/2010 4:43:10 AM |

    In 1972, one year after starting my Medical Education {Psychology}, I attended the yearly "National Health Federation" {Monrovia, California} Convention. I was already prescribing High Doses of Vitamin D, and I attended a lecture by a  Physician who was already known as THE EXPERT in Vitamin D research!! To this day, I don't remember his Name. The Subject of this particular presentation,  was that Vitamin D2 was toxic to the Kidneys & caused Kidney Damage; Primarily Kidney Stones! His Research was solid and alarming! I bought the 90-minute Tape of his entire Presentation, but misplaced it approximately 5 years later. His presentation  was a Classic, and I'd pay $50.00 to $100.00 for a copy of the Tape today! If anyone has this tape, PLEASE contact me!!
    Meanwhile, NEVER take any amount of Vitamin D2. He proved that Vitamin D3 was safe, and that Vitamin D2 should never be ingested!

  • Provillus

    5/2/2011 5:43:57 AM |

    I find this very interesting because on the one hand they are giving up control over what their advertisement says, but on the other hand the ads that people come up with are probably even more relevant to the readers.

  • sex pills

    7/26/2011 7:31:33 PM |

    Very good blog, support, only the future health!

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The first lawsuit?

The first lawsuit?


The closing arguments in actor John Ritter's wrongful death lawsuit are over and the two doctors charged with negligence cleared, five years after his death from a dissection (tear of the inner lining) of the thoracic aorta. The family sought $67 million in damages, claiming that the aortic dissection was misdiagnosed as a heart attack and that the enlarged aorta should have been reported to Mr. Ritter two years earlier during a full body scan.

The AP story can be viewed at http://ap.google.com/article/ALeqM5gmv6HnJJPBee2gWgEYResT5m6YkAD8VDF9CO0


Well, perhaps this is the start of a trend. Up until now, it has been commonplace for doctors to ignore many of the important findings on heart scans, full body scans, and similar direct-to-the-public imaging services. For instance, similar to John Ritter's case, enlarged thoracic aortas are commonly ignored. I'd even say that as a rule they are ignored. I have seen many patients in consultation who have had large aortas identified on heart scans, yet nothing--not a thing--was done about it. While the doctors escaped a lawsuit this time, it might not happen a second time.

I truly hope that Mr. Ritter's unfortunate experience and the consequent lawsuit do not trigger the usual defensive medicine response of resorting to major procedural "solutions."

A better response would be to 1) identify the problem--enlarged aorta in this case, 2) identify the causes, then 3) correct the causes. It does not necessarily mean that a major procedure like replacing the aorta (a horrendous surgery, by the way) needs to be pursued each and every time.

It is possible that Mr. Ritter's lawsuit is just the first. Over the next several years, it could trigger an avalanche of lawsuits for all the neglected findings on tests like heart scans, body scans, and other imaging methods that are gaining expanded direct-to-consumer access.


Images courtesy Wikipedia.

Comments (1) -

  • Anonymous

    3/16/2008 2:32:00 PM |

    I wondered about the cases outcome.  Looks like Rittter's physicians dodged a bullet this time.  Hopefully others will not be as lucky next time.

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Wheat-free pumpkin bread

Wheat-free pumpkin bread

Try this recipe for a wheat-free, gluten-free yet healthy "bread." Unlike many gluten-free foods that send blood sugar skyward, this will not.

Ingredients:
2 cups ground almond meal (Buy it from Trader Joe's--70% cheaper than other grocery stores.)
1/2 cup ground flaxseed
1/2 cup sour cream (full-fat, of course)
15 oz canned pumpkin (Trader Joe's is bisphenol A-free)
2 medium to large eggs
1/2 cup chopped walnuts or pecans
4 tablespoons butter, melted
2 teaspoons baking powder
2 teaspoons cinnamon
1 teaspoon nutmeg or allspice
Dash of salt
Choice of non-nutritive sweetener (I used 3 teaspoons Trader Joe's stevia extract powder, the one mixed with lactose. Two tablespoons of Truvia, 1/2 teaspoon of the more concentrated stevia extract, or 1/2 cup Splenda are other choices. You can taste the mixed batter to gauge sweetness if in doubt.)

Preheat oven to 350 degrees F. Grease baking pan (e.g., 10 x 6 inch). The pan should be big enough so that the mix will not be more than 2 inches deep, else it will require much longer to bake. (If you have only smaller pans, you will need to cook longer while the pan is covered with aluminum foil.)

Mix all ingredients thoroughly in large bowl. Pour mix into greased baking pan.

Cover with aluminum foil and bake for 30 minutes. Remove foil and bake for additional 30 minutes or until inserted toothpick or knife comes out dry.

Serve with cream cheese or as is.

(I'd have some pictures, but the kids and I ate it up before I thought to take any photographs.)

Comments (5) -

  • Haggus

    12/25/2010 4:10:16 PM |

    Er...it appears Pumpkin free too.

  • Richard A.

    12/26/2010 12:09:44 AM |

    I would add about a teaspoon or so of vanilla to this recipe.

  • Anonymous

    12/30/2010 6:03:41 PM |

    Since almonds make me barf, what's a good substitute for almond flour?

  • Laura

    12/31/2010 4:46:37 PM |

    Hi Ananymous,
    I have successfully used hazelnut flour & walnut flour in my low carb baking.  If you cannot find commercially - you can buy the raw nut and grind up in food processor or a blender.

  • Christie

    1/9/2011 12:27:33 AM |

    I made this today and it was delicious. The whole family liked it, even the carb eater.

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Saturated fat and large LDL

Saturated fat and large LDL

Here's a half-truth I often encounter in low-carb discussions:

Saturated fat increases large LDL particles


For those of you unfamiliar with the argument, I advocate a low-carbohydrate approach, specifically elimination of all wheat, cornstarch, and sugars, to reduce expression of the small LDL pattern (not to mention reduction of triglycerides, relief from acid reflux and irritable bowel, weight loss, various rashes, diabetes, etc). Small LDL particles have become the most common cause for heart disease in the U.S., exploding on the scene ever since agencies like the USDA and American Heart Association have been advising the public to increase consumption of "healthy whole grains."

This has led some to make the pronouncement that saturated fat increases large LDL, thereby representing a benign effect.

Is this true?

It is true, but only partly. Let me explain.

There are two general categories of factors causing small LDL particles: lifestyle (overweight, excess carbohydrates) and genetics (e.g., variants of the gene coding for cholesteryl-ester transfer protein, or CETP).

If small LDL is purely driven by excess carbohydrates, then adding saturated fat will reduce small LDL and increase large LDL.

If, on the other hand, your small LDL is genetically programmed, then saturated fat will increase small LDL. In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL. If your dominant genetically-determined form is small, then saturated fat increases small LDL particles.

So to say that saturated fat increases large LDL is an oversimplification, one that can have dire consequences in the wrong situation.

Comments (44) -

  • Anonymous

    2/16/2010 10:02:36 PM |

    Is there an inexpensive way of finding out which form you have?

  • Anonymous

    2/16/2010 11:02:49 PM |

    is there any truth to the idea that if your trig/HDL ratio is under 2.0 that your LDL type is predominantly large/buoyant?

  • Laura

    2/16/2010 11:37:17 PM |

    Is there a way to determine whether small LDL production is carb- or genetics-caused?

  • Anonymous

    2/16/2010 11:43:41 PM |

    Is this the same for poly/mono unsaturated fatty acids?

  • Anonymous

    2/16/2010 11:46:43 PM |

    Dr. Davis,

    Does the form of saturated fat have any impact on this in the case of genetic predisposition to small LDL formation? For example, does it matter if the fatty acids are lauric acid and stearic acid versus something like palmitic acid?

    Rick Braden

  • Daniel

    2/16/2010 11:50:11 PM |

    Dr. Davis,
    That's very interesting!!  Any chance you could provide the reference?
    Thanks, Dan

  • jtkeith

    2/17/2010 12:26:14 AM |

    This naturally leads to the question about understanding our personal genetic coding.  Without that coding information it seems difficult make an informed decision about the consequences of lowering carbohydrate and increasing fat (and saturated fat) until the consequences are upon you!

  • David

    2/17/2010 12:38:19 AM |

    This definitely needs a follow-up post. I've not seen this distinction until now. If true, Dr. Davis, does it not present a difficult dilemma for those who have both genetic sdLDL and Lp(a)? If saturated fat needs to be restricted for genetically high sdLDL, would this not leave the Lp(a) (which responds best to saturated fat intake) unopposed? What is your proposal to address this?

  • Ellen

    2/17/2010 1:09:25 AM |

    Interesting post, Dr. Davis. How would one find out if they are genetically predisposed to react to saturated fat intake with an increase in small LDL?

  • Harold

    2/17/2010 1:38:12 AM |

    Do you have some specific references for LDLa and saturated fat? Is it essentially congenital hypercholesterolemia that reacts with the sat fat?

  • steve

    2/17/2010 1:49:56 AM |

    this is a long overview discussion. thank you!  What would dietary recommendation be for someone if small LDL is genetic in origin?  Also, wouldn't this pattern possibly require statins to get LDL particle count as low as possible since it is unlikely that diet will do the job?  In my case, i need Lipitor and Zetia; otherwise my particle count mostly small remains high despite Vit D, normal weight,no wheat cornstarch or sugar.  Great post!

  • Anonymous

    2/17/2010 1:50:56 AM |

    Doc -

    Good post but -

    Hard to understand post without the background basis on which the statement is made.

    Is your statement based on clinical observations? Or is it based on opinion only?

  • switters

    2/17/2010 4:44:09 AM |

    Yes, references supporting your premise in this article would be very welcome.

  • Paul

    2/17/2010 9:46:22 AM |

    This post concerns me because as a low carber I find it difficult to maintain a low carb diet without saturated fat sources. Perhaps this is driving the concern and questions from others also.

  • Rabbi HIrsch Meisels

    2/17/2010 2:14:23 PM |

    Count me in those who are waiting to see data where this is coming from.
    Thanks for all your blogs posts.

  • zach

    2/17/2010 3:26:16 PM |

    Yes, I hope this isn't a hit and run post. Many learned people, such as Peter at hyperlipid would probably disagree. Do you have any references?

  • Alfredo E.

    2/17/2010 3:48:38 PM |

    So what do we do if we should not eat but a few carbos and up to certain amount of protein?

    The rest have to be saturated fats, isn't it?

    Please, some more practical information before we all run over the cliff.

  • Anonymous

    2/17/2010 5:48:11 PM |

    Harold, I am also interested in the familial hypercholesterolemia question.  After a quick search, I found this http://www.jlr.org/cgi/reprint/23/8/1196.pdf with a quote: "LDL has been
    found to be cholesterol-enriched and triglyceride-poor
    (5, 6), and in one study, the peak flotation rate of FH LDL
    has been found to be higher than in normals (6),
    implying decreased density, increased size, or both.
    However, these results are difficult to assess, since there
    is considerable heterogeneity of LDL in normal subjects,
    although size, flotation rate, and composition"

    So, FH people may be predisposed to large, fluffy LDL.  However, I do not know whether FHs handle saturated fats better than normals, and this is an important question.  

    -Aaron

  • Anonymous

    2/17/2010 5:54:55 PM |

    A question on triglycerides...if high TGs are a trigger for small, dense LDL and should be minimized, are there any ways to reduce area-under-the-curve TGs after a meal (other than the usual low carb, omega-3, etc. recommendations).  Are large, infrequent meals better than small, frequent meals?  Does fiber change the shape of the post-meal TG curve?

    Also, does fasting TG tell the whole story?  Could one have, say, <50 mg/dL fasting TG but have elevated TG throughout the day as a result of large, high-fat meals?  

    -Aaron

  • Anonymous

    2/17/2010 7:04:29 PM |

    Thank you Dr. Davis!  Finally a voice of sanity in this whole sat fat hoopla.

    I for one, although not neurotic about it, do not favor saturated fats and will eat a good non-hydrogenated margarine (like Smart Balance) over butter any day.

    Please keep up this sane blog and give us the WHOLE enchilada, not just what some want to hear.

  • Dr. William Davis

    2/17/2010 7:47:07 PM |

    Search PubMed or Google Scholar and you will find NO data on this issue. To my knowledge, there are none that distinguish genetically -driven small LDL vs. lifestyle-induced.

    This is based on having tested lipoproteins in thousands of people over the past 10+ years.

    Prototypical "genetic small LDL" person: 5 ft 10 inch, 140 lb male who eats low-carb. In other words this person is at ideal weight and does not eat foods that trigger small LDL--yet has 90% small LDL by NMR (e.g., 1200 nmol/L, LDL particle number 1550 nmol/L). Should this person overindulge in saturated fat, small LDL will go up.

  • Scott Miller

    2/17/2010 8:46:27 PM |

    Dr. Davis, how do you know it is saturated fats that are the cause? For example, most low-carbers also have elevated intake of inflammatory polyunsaturated fatty acids, which I would be much more likely to blame.  But, in either case, it seems there are too many uncontrolled variables involved (as far as food intake) to pin any of them to the wall.

    It's very difficult for me to believe saturated fat is the cause, while other possibilities exist.

  • Anonymous

    2/17/2010 9:08:19 PM |

    For everyone worrying about this, just get yourself a VAP or NMR test.  If you have LP(a) or sdLDL, that will show it.  You don't need genetic testing.

  • Anonymous

    2/17/2010 10:27:45 PM |

    What's are the trig and HDL numbers for the prototypical "genetic small LDL" person?

  • Anonymous

    2/17/2010 11:09:09 PM |

    Thanks Dr. Davis for another insightful post from your clinical experience, giving the kind of information that helps elucidate why saturated fat works for some and not for others - and the kind of information you can't get anywhere else.  Ignore the pro saturated fat/anti-polyunsaturated fat zealots, who can't be persuaded by any evidence or logic.

  • Anonymous

    2/17/2010 11:10:11 PM |

    "What's are the trig and HDL numbers for the prototypical "genetic small LDL" person?"

    I'd like to second that - can one have high HDL and low trigs and still have a small LDL pattern?

  • Kurt G. Harris MD

    2/18/2010 12:56:55 AM |

    Hello Dr. Davis

    You said:

    "Should this person overindulge in saturated fat, small LDL will go up."

    Just to be clear, are you saying you have observed low carb subjects (how low?) that have added saturated fat to their diets and then on subsequent testing you have seen sdLDL rise in absolute and percentage terms?

    If they were truly LC, were they already high sat fat at the time of the NMR or were they high PUFA (South Beach?)

    May I ask how many such cases you have seen?

    You should definitely publish this, or if you don't think it is publishable maybe you could give us all the data in a blog post.

    Thanks, this is very interesting.

  • Dr. William Davis

    2/18/2010 1:52:52 AM |

    In people with presumptive genetically-determined small LDL, HDL can be 70 mg/dl or greater, triglycerides 45 mg/dl or less, yet small LDL persists, usually at 600 nmol/L (NMR).

    I have approximately 100 patients like this. They tend to be very thin with BMI's of 23 or so, yet small LDL persists.

  • Stephen

    2/18/2010 3:11:53 AM |

    Hi Dr. Davis,

    This post really intrigues me. I am a first year medical student (24 yo) with familial hypercholesterolemia. I am on a low carb paleo diet, taking omega 3, vit D and just recently added magnesium to the mix as well. I went off Lipitor two months ago just an experiment to go along with this new eating plan, and received blood work only a few days ago. Numbers about 450 on total and 285 for LDL. My CT scan already showed plaque buildup in the coronary arteries, aorta, and one valve. While I am not looking for medical advice per se (since I know you prefer not to give it over your blog) I was just curious as to how your track the plaque plan and recommendations are effected with this type of genetic disorder. My cardiologist says if I dont go on drugs immediately I'll have a cardiac event at 40 years of age. I could use some advice and direction to persue. Is it impossible to avoid genetics, and the use of drugs are unavoidable? Thanks. Really appreciate it.

  • Anonymous

    2/18/2010 3:15:38 AM |

    How do you know how much small LDL you have?

  • Bonnie

    2/18/2010 3:53:00 AM |

    ""I'd like to second that - can one have high HDL and low trigs and still have a small LDL pattern?""

    Well - just speaking for myself, I have high HDL and low trigs, and always had a mix of small/large (A/B) pattern LDL.  When I stopped eating wheat, my LDL all became large.  

    I also have high Lp(a), which was uneffected by my eliminating wheat.

    You can drive yourself crazy figuring out what's OK to eat and what's not.  I don't worry about it anymore.  I rarely eat wheat because I've seen results from Not eating it, try not to overdo the sugar and fruit, get plenty of veggies and protein.  

    I get my VAP test once or twice a year to make sure everything is where it should be, more or less.

    I'm just not going to worry about it beyond that.  

    Bonnie

  • LeenaS

    2/18/2010 4:12:28 AM |

    Dr. Harris:

    Are these customers of yours lean lowcarbers eating plenty of LA or very, very much protein in their diet? If not, then what do they eat?

    With regards,
    LeenaS

  • Mike

    2/18/2010 4:26:28 AM |

    Interesting, and concerning, since I fit that description:

    Chol: 6.35mmol/L
    HDL: 1.88
    LDL: 4.2
    Triglycerides: 0.66
    Chol/HDL ratio: 3.4
    American Values:  TG 58.47 LDL 162.54 HDL 72.75
    Triglyceride/HDL ratio: 0.8
    Hieght: 6'0
    Wieght: 165lbs
    BF 8%

    I've had other opinions on these numbers; should I be pursuing more accurate particle numbers?  I go out of my way to consume large amounts of red meat, coconut oil, butter, and eggs.  I'm fitter and healthier (subjectively) than I ever have been at 36 than I was in my 20's.  I find it disconcerting than I could potentially be doing something detrimental.

  • Kurt G. Harris MD

    2/18/2010 4:43:49 AM |

    Hi Dr. Davis

    In the original post you said:

    "saturated fat will increase small LDL.  In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL."

    So, if I follow this correctly, you are saying that these 100 patients all had increases in their sdLDL after documented increases in saturated fat in their diets? In other words you had two data points for each subject, correct?

    If the subjects did not all have documented increases in sLDL then by "persist", do you mean their sdLDL went down with LC eating (like 800 to 600, say) or do you just mean that they had a single high value and it was only measured once, but it was high?

    If it is the latter, I could see how it's fair to say that some LC eaters have a higher sdLDL than we might predict (for whatever reason) but it seems like a non sequiter to conclude that the sdLDL would be made higher with more sat fat consumption.

    I just want to make sure I get this straight so I understand it correctly.

  • Paul

    2/18/2010 6:19:52 AM |

    Thin. Nice. I'm less concerned. lol

  • Anonymous

    2/18/2010 1:22:06 PM |

    Does this group of people also have elevated blood sugar, as might be predicted by another of your blog postings?

    http://heartscanblog.blogspot.com/2009/12/to-track-small-ldl-track-blood-sugar.html

  • David

    2/19/2010 3:10:43 AM |

    Dr. Davis,

    I concur with Dr. Harris in that more details would be nice to better understand exactly what you're saying.

    Are other variables accounted for? Were many, most, or all of these patients on statin drugs, which could have prevented a shift in particle size if triglycerides were low and insulin sensitivity was high?

    Again, if there is such a phenomenon going on, is the "genetic sdLDL" clearly atherogenic in the same way that "environmental sdLDL" seems to be?

    If so, I ask again, what is the solution for someone who is afflicted by both Lp(a) and genetic sdLDL? The "profile" for genetic sdLDL is similar to the profile for those with Lp(a), and there is probably a lot of crossover. Saturated fat lowers Lp(a), but (presumably) raises genetic sdLDL. This is a fierce dilemma! Would not the better choice be to choose the diet that opposes the more vicious of the two, which is Lp(a)? What is the priority?

    Has a high SFA diet only increased sdLDL per NMR, or has it also clearly been shown to increase CAC scores? In other words, does it clearly progress the disease itself?

    David

  • pmpctek

    3/7/2010 5:50:15 PM |

    Saturated fats not linked to heart disease: Meta-analysis - American Society for Clinical Nutrition (January 13, 2010). doi:10.3945/ajcn.2009.27725 © 2010

    It would really be interesting to know what the primary sources of saturated fat are for these "100 patients".  There may be a single (widely available) common source of sat fat that these specific patients are consuming, do we even know that?  I agree, by what has been revealed, that there are too many variables to know conclusively that saturated fat is the cause of their persistently elevated small LDL.

    Mark me down as someone who is not convinced that CLA, n3 rich organic, free range, and wild animal sources of fat could possibly in any way be detrimental to anyone.

  • Anonymous

    4/19/2010 1:45:33 PM |

    When will people stop worrying about cholesterol numbers? They really don't mean anything.

    Until someone explains a plausible mechanism through which lipoproteins directly kill me I will ignore it any suggestion that they do. This is what a good scientist would do.

  • buy jeans

    11/3/2010 6:44:37 PM |

    If, on the other hand, your small LDL is genetically programmed, then saturated fat will increase small LDL. In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL. If your dominant genetically-determined form is small, then saturated fat increases small LDL particles.

  • Chris Kresser

    11/3/2010 6:55:04 PM |

    buy jeans: I'd love to see clinical evidence supporting that claim.

  • gastric bypass surgery Los Angeles

    2/28/2011 2:33:52 PM |

    Heart diseases are a major matter of concern these days therefore all that can be done to correct the diet and make it benefit good health should be taken to.

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Will the real LDL please stand up?

Will the real LDL please stand up?

The results of the latest Heart Scan Blog poll are in.

The question: How has your LDL been measured? The 187 responses broke down as:


I have only had a conventional calculated value
108 (57%)

NMR LDL particle number
35 (18%)

Apoprotein B
21 (11%)

Direct LDL cholesterol
21 (11%)

Non-HDL cholesterol
8 (4%)

I don't know what you're talking about
23 (12%)


Remember the TV game show, To Tell the Truth? Celebrities would have to guess which of three guests represented the real person, such as the notorious con man, Frank Abagnale, Jr., or Mad Magazine publisher, William M. Gaines (who stumped celebrity Kitty Carlisle, heard to exclaim, "I never figured it was him. I mean look at the way he's dressed. I was looking for someone who ran a very successful magazine, so I thought it couldn't be him!")

The celebrities playing the game were permitted to ask the three guests a series of questions, hoping to discern who was the real person vs. the two impostors. At the end, each celebrity had to guess who was truly the person of interest. "Will the real Frank Abagnale, Jr. please stand up!"

If we were to act as the celebrities in our LDL game, we quickly discover some telling facts:

--Conventional LDL cholesterol (the only value 57% of our poll respondents have had) is calculated, not measured. LDL is calculated using the 40-year old Friedewald calculation.

--Directly measured LDL cholesterol (the value 11% of respondents had) is just that: directly measured. It eliminates some of the uncertainties of calculated LDL.

--Apoprotein B-Every LDL and VLDL particle produced by the liver contains one apoprotein B molecule. ApoB therefore provides a crude particle count measure of LDL and VLDL particles. Of course, it includes VLDL and is not completely the same as just an LDL measure. Some lipid authorities Like Dr. Peter Kwiterovich have advocated that apoB replace calculated LDL, and that calculated LDL essentially be discarded.

--Non-HDL cholesterol--I mention this more for completeness. Hardly anybody uses this crude value in practice--Indeed, only 4% of our poll respondents had this measure/calculation. Non-HDL is simply total cholesterol minus HDL cholesterol = Non-HDL cholesterol. It is thus a combination of cholesterol in LDL and VLDL (triglycerides), similar to apoprotein B. While, like apoB, it is a bit different in that it includes VLDL, it has proven a superior measure of risk.

--LDL particle number--In my view, this is the gold standard for LDL and risk measurement, obtained by only 18% of our poll respondents. LDL particle number is proving superior for discriminating who is truly at risk for a cardiovascular event, particularly when metabolic syndrome or diabetes is part of the picture, i.e., when HDL and triglycerides are considerably distorted, leading to substantial corruption of calculated LDL.


While 18% is a minority, it still represents growth in recognition that conventional calculated LDL cholesterol is an unreliable, inaccurate, and outdated value. If the real LDL were to stand up, I believe that it is LDL particle number that would spring to its feet.

Comments (13) -

  • Jan Jones, M.A.in Education, B.S. in Education

    4/28/2009 3:48:00 PM |

    This post comes with great timing for me, in a way...
    I just went to my dr last week to have my cholesterol checked since I have been on Dr. Davis' recommended protocol for 3 months and wanted to get accurate results to determine my current progress. In January my dr was recommending statins for me due to a slightly elevated LDL with an HDL of 65
    /trig-80/tot-235.

    At my appt. I asked her to do the test to get specific results for my LDL naming the best tests mentioned here. She looked at me as if I was from Mars and told me she never heard of such tests and those type of results would be of no benefit to any course of treatment and my insurance probably wouldn't pay for them because they may be experimental...got the picture.  Lots of resistance.  She then asked me where I got all of these ideas and so I told her about this "blog" well you can imagine her little grin as the dreaded internet doctoring reared its ugly head.  So, she said let's go to my office and look up this "blog" so I can see exactly what this LDL test is.  Low and behold as she put in the heartscan blog address, it came back ACCESS DENIED.  She tried several times and could not get in because the Scripps Medical Group system has it blocked.  

    So, I ended up getting a regular lipid panel and she added a Lp(a) test and kept saying something about fluffy particles. I don't have results yet but I am definitely feeling a lack of confidence in this physician who seems very together in a busy practice, yet isn't up on things to manage preventative care in a knowledgeable way.  How do we find primary care drs who know what they are doing?  For those of us in our 50's it is crucial to get these things under control to lead healthy lives and avoid many common problems that plague people as they get older.

    My husband and I don't want to wait until we need a cardiologist to get the type of information we are getting here.  

    Jan

  • Kiwi

    4/28/2009 11:58:00 PM |

    Jan,
    Even my cardiologist is ignorant about LDL particle sizes so what hope for the poor local Dr.

  • mark

    4/29/2009 2:04:00 AM |

    I thought the whole basis for cholesterol being bad was centered on lipoproteins and not on cholesterol itself.  It is the Friedewald equation which has been used in arguing for cholesterol being bad.  So even though cholesterol tests are inaccurate, it doesn't matter, becasue the whole basis for the lipid hypothesis was based around lipoproteins and that Friedewald equation.

    Would the same studies implicate cholesterol (in the lipoprotein) if more accurate tests were used?  

    It could explain why in so many studies, HDL and LDL have conflicting correlations.  In one set of individuals, high LDL indicates high LDL cholesterol.  That is to say, for a certain lifestyle and environmental and genetic factors, the individuals with high LDL will also have high LDL cholesterol.  

    Then in other populations, their lifestyle (and other factors) makes it so that high LDL lipoproteins does not coincide with high LDL cholesterol.  

    Or some individuals with low LDL can have high LDL cholesterol.  

    Mark.

  • Drs. Cynthia and David

    4/29/2009 8:37:00 AM |

    Sadly, I suspect much of the reason for sticking with the inaccurate and misleading LDL #s is that much of the research is paid for by drug companies pushing LDL lowering drugs, so of course it is not in their interest to have the truth come out that LDL per se is not really important.  Does taking a statin reduce the number of LDL particles? or just the amount of cholesterol in the particles?

    It's also horrifying (as Jan comments above) that this site is blocked by the medical establishment.  No wonder the doctors don't know anything- they can't even look up information easily!

    Thanks for all your educational posts.  There is still a lot of resistance out there,  but I think you are making progress.

    Cynthia

  • vin

    4/29/2009 11:07:00 AM |

    18% is very unlikely to be true for the total population. I think the actual number is much lower.
    The question should really be put to health care people : which test do they use for their patients?

  • steve k

    4/30/2009 12:36:00 AM |

    can you explain the difference between 25(0h)2 vs. 1.25?  What does it mean if the 1.25 is high and not the 25(oh)2 which you say should be measured.  I have been taking D3 and agree with all the benefits cited.  Thank you

  • Trinkwasser

    4/30/2009 8:19:00 AM |

    In many parts of the UK you can only get TChol. Lipid panels are "too expensive". They need to save money on the tests to afford the statins. My GP is clueful enough to turn a blind eye when I biro in the Full Lipid Panel, and also to interpret the results (LDL is nominally over limit but is trumped by my excellent trigs and HDL) but her cluefulness is very constrained by the accountants. They pay bribes to get a certain % of patients on statins irrespective.

  • homertobias

    4/30/2009 4:51:00 PM |

    Jan
    Was it Scripps Clinic or Scripps La Jolla?  Was it simply that her in house computer was blocked from surfing the internet?  This is very common.  Lab corp or Quest (better) will run your NMR.  Just have your doctor order it and find a draw station.  Blood needs to be spun and needs a YELLOW and BLACK tube.

  • Jan Jones, M.A.in Education, B.S. in Education

    5/1/2009 2:03:00 PM |

    homertobias,

    The dr is with Scripps Clinic and she had access to the internet in her private office without any apparent problems.  When she entered the address of the blog it was blocked and when a google search of dr. davis found the blog that too would not open.  

    I had written down all of the tests that dr davis recommends here and she had no idea what that was about. I asked for NMR  and she didn't know what to order, which was why she wanted to go to the blog to see it for herself.

    I got my lipid panel results yesterday but the Lp(a) test she ordered did not come back.  They're checking on that one.  

    Thanks for the info.

    Jan

  • RyanVM

    5/1/2009 11:20:00 PM |

    I'm betting they just have a generic block on blog sites (blogger, wordpress, etc).

  • Mark K. Sprengel

    6/18/2009 12:19:04 AM |

    I'm pretty sure my insurance uses the calculated LDL value. It's rather irritating as our annual blood test scores are used along with a series of questions about diet/exercise etc. to determine how much of a credit we get on our paychecks. They also use the BMI which I've read is very innacurate for athletic/lean bodies. Our human resources rep had no answer when I pointed out it would probably put me at overweight if I was 210 lbs at 6' tall but 10% bodyfat even though I would be healthier.

  • Trinkwasser

    7/14/2009 1:41:43 PM |

    This is useful. I can't remember who posted it but all credit to them. The Iranian Formula corrects for the low trigs I hope we all have where the Friedewald Equation falls apart

    http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

  • Robin

    11/2/2012 3:54:08 AM |

    If they were interested enough, they'd look it up on their own computers when they got home. If they had only a business laptop, which would lock them out of helpful sites, then they'd find a way of doing their own research - just like the rest of us have to when not relying on the medical establishment.

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