The world of intermediate carbohydrates

28. January 2011 William Davis (0)
There are clear-cut bad carbohydrates: wheat, oats, cornstarch, and sucrose. (Fructose, too, but in a class of bad all its own.)

Wheat: The worst. Not only does wheat flour increase blood sugar higher than nearly all other carbohydrates, it invites celiac disease, neurologic impairment, mental and emotional effects, addictive (i.e., exorphin) effects, asthma, irritable bowel syndrome, acid reflux, sleepiness, sleep disruption, arthritis . . . just to name a few.

Oats: Yeah, yeah, I know: "Lowers cholesterol." But nobody told you that oats, including slow-cooked oatmeal, causes blood sugar to skyrocket.

Cornstarch: Like wheat, cornstarch flagrantly increases blood sugar.It also stimulates appetite. That's why food manufacturers put it in everything from soups to frozen dinners.

Sucrose: Not only does sucrose create a desire for more food, it is also 50% fructose, the peculiar sugar that makes us fat, increases small LDL particles, increases triglycerides, slows the metabolism of other foods, encourages diabetes, and causes more glycation than any other sugar.

But there are a large world of "other" natural carbohydrates that don't fall into the really bad category. This includes starchy beans like black, kidney, and pinto; rices such as white, brown, and wild; potatoes, including white, red, sweet, and yams; and fruits. It includes "alternative" grains like quinoa, spelt, triticale, amaranth, and barley.

For lack of a better term, I call these "intermediate" carbohydrates. They are not as bad as wheat, etc., but nor are they good. They will still increase blood glucose, small LDL, triglycerides, etc., just not as much as the worst carbohydrates.

The difference is relative. Say we compare the one-hour blood glucose effects of 1 cup of wheat flour product vs. one cup of quinoa. Typical blood sugar after wheat product: 180 mg/dl. Typical blood sugar after quinoa: 160 mg/dl--better but still pretty bad.

Some people are so carb-sensitive that they should avoid even these so-called intermediate carbohydrates. Others can have small indulgences, e.g., 1/2 cup, and not generate high blood sugars.
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Vitamin D: New Miracle Drug

Vitamin D: New Miracle Drug

6. December 2006 William Davis (0)
At the meetings of the American Society of Bone and Mineral Research, Dr. Bruce Troen of the University of Miami detailed his views on the extraordinary benefits of vitamin D replacement. He also talked about the enormous problem of unrecognized vitamin deficiency.

“There’s a huge epidemic of hypovitaminosis D, and the real key here is not just that it’ll benefit you from a bone and neuromuscular standpoint, but if you correct hypovitaminosis D and the corresponding secondary hyperparathyroidism, then you’re going to decrease prostate cancer, colon cancer—actually “up to 17 different cancers, breast cancer included.”

Unfortunately, Dr. Troen did not talk much about the heart benefits of vitamin D, likely since the data is scant, nearly non-existent. However, if the Track Your Plaque experience means anything, I predict that vitamin D replacement will become among the most powerful tools you can use to gain control over coronary plaque.

Read the text of a report from the Internal Medicine World Report to read more of Dr. Troen's comments.


http://www.imwr.com/article.php?s=IMWR/2006/11&p=40
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Is niacin as bad as it sounds?

Is niacin as bad as it sounds?

20. October 2007 William Davis (0)
A popular health newsletter, Everyday Health, carried this headline:

A Cholesterol-Busting Vitamin?
Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter?
Find out how niacin can help reduce choleseterol.

At doses way above the Recommended Dietary Allowance — say 1,000–2,500 mg a day (1–2.5 grams) — crystalline nicotinic acid acts as a drug instead of a vitamin. It can reduce total cholesterol levels by up to 25%, lowering LDL and raising HDL levels, and can rapidly lower the blood level of triglycerides. It does so by reducing the liver’s production of VLDL, which is ordinarily converted into LDL.


I'd agree with that, except that it is rare to require doses higher than 1000-1500 mg per day unless you are treating lipoprotein(a) and using niacin as a tool for dramatic drops in LDL. But for just raising HDL, shifting HDL into the healthy large class, reducing small LDL, and for reduction of heart attack risk, 1000-1500 mg is usually sufficient; taking more yields little or no further effect.

But after that positive comment comes this:

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.


Strange. After a headline clearly designed to pull readers in, clearly stating niacin's benefits, the article then proceeds to share the pants off you with side-effects.

But look to the side and above the text: Ah . . . two prominent advertisements for Lipitor, complete with Dr. Robert Jarvik's photo. "I've studied the human heart for a lifetime. I trust Lipitor to keep my heart healthy."

Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

Who is Dr. Jarvik, anyway, that he stands as the spokesman (or at least figurehead) for this $13 billion dollar a year drug. Of course, he is the 1982 inventor of the Jarvik artificial heart, surely an admirable accomplishment. But does that qualify him to speak about heart disease prevention and cholesterol drugs? Jarvik has, never actually prescribed Lipitor, since he never completed any formal medical training beyond obtaining his Medical Doctor degree, nor has he ever had a license to practice medicine. He does, however, continue in his effort to provide artificial heart devices, principally for implantation as a "bridge" to transplantation, i.e., to sustain a patient temporarily who is dying of end-stage heart failure.

So where does his expertise in heart disease prevention come from?
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What is this wacky thing called "weight loss"?

What is this wacky thing called "weight loss"?

20. September 2011 William Davis (41)
I've discussed this before, but it has proven such an (encouragingly!) frequent issue that I thought it was worth discussing once again.

What happens when you lose weight?

The process of weight loss is characterized by multiple shifts in metabolic patterns that can be confusing. To the uninitiated eye, weight loss can look like a disastrous distortion in metabolism. The naive doctor on seeing your lab values, for instance, might insist you take a statin drug, a fibrate like Tricor (to reduce triglycerides or increase HDL), or simply berate you for your bad health habits--when it's actually a good thing you've accomplished.

So when you lose weight, say, 30 pounds in 3 months, what have you accomplished?

Energy stored as fat, especially from visceral fat stores, is mobilized into the bloodstream. It floods the bloodstream as fatty acids and triglycerides. These fatty acids and triglycerides don't occur in isolation, but interact with other particles and metabolic patterns. The resulting blood patterns include:

--Increased triglycerides--An increase in triglycerides, for instance, from 90 mg/dl to 200 mg/dl in the midst of weight loss is common.

--Reduced HDL--The flood of triglycerides leads to increased degradation of HDL, thus a drop. A drop in HDL from, say, 40 mg/dl to 27 mg/dl--very frightening to people--is exceptionally common.

--Increased blood sugar--The flood of fatty acids and triglycerides results in insulin resistance, leading to higher blood sugars. It is not uncommon for someone with pre-diabetes to develop diabetic-range blood sugars, or a non-diabetic to show pre-diabetic blood sugars.

--Increased small LDL particles--Though small LDL is highly variable during weight loss. When it does happen, it's probably from the interaction of VLDL (triglycerides) with LDL particles and the reaction that overloads LDL particles with triglycerides and conversion to small LDL particles.

So why don't doctors often recognize these patterns when a patient loses weight? Because they rarely see it. Most of my colleagues are accustomed to having patients come back with weight gain, getting heavier and heavier each time. Lose weight? Impossible! So they just don't recognize weight loss effects when they see it. As followers of The Heart Scan Blog know, a frequent conversation around here is "Am I too skinny?" or "How do I stop losing weight?"

The solution: Be patient. Be patient and wait about two months after a weight plateau has been achieved. That's when the numbers "settle down" and you see marked drops in triglycerides, increases in HDL, drops in blood sugar, reductions in small LDL.

As with many things, it's all about timing.
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Comments (41) -

  • chuck

    9/20/2011 2:02:02 AM |

    Isn't the form of storage fat saturated fat?  maybe this is how they came up with the theory saturated fat is bad for you.  look at all those symptoms when all that sat fat is released into the blood ;)

  • Dee Miles

    9/20/2011 3:18:39 AM |

    Wow!  I'm so glad you explained this very topic because that's exactly what happened to me recently.  For the past 8 weeks I've not had any grains or sugars and I've kept my carb level about 20g per day. I've lost 15 lbs so far.  I visited my Dr. in May (prior to any weight loss, and maybe during some gain), and the lipid panel was like this: LDL 84, HDL 76, Trig 40.  When I had another blood test in early Sept, I was shocked to see the markers worse!  LDL 122, HDL 48, Trig 88.  Boy was I disappointed in those latest numbers.  Thank you for explaining how this works while losing weight.  At one point recently I was really discouraged but now I'm really glad about the timing of the tests and your post.  My next blood draw is scheduled for 3 months out from last week, at the request of my Dr.  Maybe then the numbers will have shown some improvement.
    Also, glad to hear the you will be on the low carb cruise in May.  My hubby and I are looking forward to hearing you speak and hopefully meeting you then.

  • Donald Kjellberg

    9/20/2011 5:18:03 AM |

    I experienced this very thing. After losing serious weight from the eliminating wheat, processed, and sugary foods (1 year in total) I lost 130 pounds (this is an update from a previous post per your request Dr. Williams). When I was nearly finished I went to see my doctor. He wanted to put me on statins. I explained to him how the data does not support application to me (no evidence of heart disease) and I got the mantra about standards of practice, etc, etc. I held my ground and decided I am much happier eating dairy, eggs, grass fed beef, wild caught fish, and as much raw foods (nuts, veggies, fruits) as my body desires to treat my health parameters.

    Maintaining weight, it is easy. My BMI (23 down from 40) has remained constant for a few month now. You are right, metabolic processes definitely change. I no longer have sensations of glucose fluctuations or an uncontrolled appetite. I can only imagine the improved hormone regulation and metabolic communication going on inside my body. The symptoms from obesity, all gone. Goodbye sleep apnea, hypertension, hemorrhoids, arrhythmias, gastroinestinal disruptions, smelly body, chaffing thighs, and others not mentioned.

    The positive effects are just as dramatic, but I don't want to ramble on.

    Weight loss? What is it?
    Getting your life back!

  • Dr. William Davis

    9/20/2011 12:30:01 PM |

    Excellent, excellent, excellent, Donald!

    I'm glad you got your life back and deprived Big Food and Big Pharma of revenues.

  • Dr. William Davis

    9/20/2011 12:31:07 PM |

    Yup, happens time and again. And your doctor will have no idea what this pink elephant is.

    Yes, see you on the cruise!

  • Buckaroo Banzai

    9/20/2011 1:45:43 PM |

    Would the same lipid response happen if one were replacing body fat with muscle and remain at roughly the same weight?

  • kathyj333

    9/20/2011 1:51:53 PM |

    When I lost a large amount of weight, I had a gallbladder attack. I had my cholesterol levels done during this time, and, yes, the LDL was high. Thanks for this post.

  • Jack Kronk

    9/20/2011 2:16:45 PM |

    Dr Davis,

    I began VLC back in Aug 2010 and transitioned until December. During that time, I went from a slightly pudgy and undefined 163 to a slim and muscular 148 (meaning that I likely lost more than 15 pounds of fat since I was gaining muscle at the same time.)

    My weight has remained stable but very graudally increased since December 2010 because I do heavy resistance weight training consistently and take a whey protein powder supplement. Currently I weigh in at about 155 and I have very little flab, if any.

    With respect to my lipid numbers, is my body still in some kind of transition phase?
    http://paleohacks.com/questions/64890/hack-jack-kronks-latest-lab-results-sept-2011

    Thanks,
    JK

  • Haggus

    9/20/2011 7:23:52 PM |

    I went through this back some 3 years ago and was put on a statin as a result.  While it seems out of fashion now with Dr. Davis, at least with those with blood sugar issues, I used oat bran to drive my LDL to 38 from 193mg/dl, thereby bettering Dr. Davis's 60/60/60 guidelines.

    Other effects: My trigs actually went down from 55 to 15mg/dl, my a1c increased from 4.8 to 4.9% and finally, I became anemic.

    Would I do it again if need be?  Yes, for me, life without the use of a statin trumps most everything else.  Thankfully, these days I still have better 60/60/60 numbers without the heavy use of oat bran which keeps my doctor and the blood bank happy.

  • Linda

    9/20/2011 9:20:57 PM |

    Dr. Davis................
    Another question regarding D3................
    Is there any benefit derived from taking D3 and glaucoma? Does it help relieve eye pressure in any way?

    [I am facing laser surgery, so I am really wondering if the D3 will help.]

  • Joe

    9/20/2011 9:31:43 PM |

    I don't think there's anything in the literature about D3 helping prevent glaucoma. There is some correlation between D3 and prevention of macular degeneration, but the jury is still out on it.

  • Dr. William Davis

    9/20/2011 11:05:11 PM |

    Sorry, Linda: Way out of my area of expertise.

    However, vitamin D is beneficial across so many aspects of health that it's worth doing regardless.

  • Dr. William Davis

    9/20/2011 11:25:13 PM |

    Hi, Jack--

    If your VAP doesn't reflect recent weight loss, consider:

    1) On the surface, your pattern looks like excessive carbohydrate intake for your genetic susceptibility (small LDL, low HDL, high triglycerides).
    2) Apo E2
    3) Another condition has entered the picture, such as kidney disease. Unlikely, thank goodness, but worth thinking about.

    Let me know what comes of this.

  • Dr. William Davis

    9/20/2011 11:25:38 PM |

    Yes, Buck, since the fat still needs to be mobilized into the bloodstream.

  • Ellen

    9/21/2011 2:47:16 AM |

    THANK YOU, Dr. Davis for posting this!   I've been trying to find supporting information on what happens during weight loss, because I get questions about changes in blood work from the readers of my websites.   It made sense to me that trigs would increase because of stored fat mobilization, but I searched all over pubmed and could not find a single paper to support that hypothesis.   Thanks again for confirming this!

  • Bob

    9/21/2011 3:37:37 AM |

    Dr. Davis, I posted last week about high numbers after being on a no carb, no sugar, no wheat diet for a year. You posted back that it could be weight loss and not to worry. I just heard back from two different doctors who looked at my last two VAP tests and they both suggested that I start statins as soon as possible. They are both doctors who specialize in lipids and also believe in not eating carbs sugar etc. They both want me to take a NMR test which would give them a clearer picture of what is going on. I have lost 25 lbs. over the last year. Do you think that after a year of losing weight it would still have an effect on my numbers? They are worried about apo B which I guess is why they want to see NMR. I don't mind taking the statin if I really need it but I am worried that if my apoB is high because of weight loss I am making a big mistake because once I start there will be reason to be taken off of them. I am also worried that if I don't take the statin now, if I wait another 6 months for another test, I am risking my health. I am 59 with two young children.
    Thanks

  • Jack Kronk

    9/21/2011 2:55:39 PM |

    ApoE2? I thought I was more in the running for ApoE4. Isn't 4 the one where it gets a bit dicey with dietary fats?

    Also, kidney disease? what makes you say that. I have had 7 kidney stones (all calcium oxalate. all "pre paleo").  I have several hypotheses about why I don't get them anymore, but my best guess is due to the increase in VitK2, since K2 sort of 'directs' where calcium goes. So I figured my kidneys were much happier with my new diet than with my SAD.

    As for excessive carbohydrate intake, yah that may be true, but I think you make an important reference about genetic susceptibility, as many people can do just fine with my carb intake as it does not produce these numbers for them.

    We have some interesting things brewing over there on PaleoHacks about what might be affecting my lipids. Travis Culp is kind of leading the charge right now and Dr K is in the mix as well.

    http://paleohacks.com/questions/66154/medium-chain-fatty-acids-appear-to-raise-vldl-triglycerides

    Thanks for your thoughts Doc.

    -JK

  • Dr. William Davis

    9/21/2011 9:36:04 PM |

    Hi, Jack--

    If the 150 grams carbohydrates mentioned in the blog post was referring to your intake, then that is definitely at least part, if not all. of the underlying cause.

    Apo E2 would serve to exaggerate this effect, mostly by way of delayed clearance of postprandial lipoproteins. This could be apo E4 but it would be a very atypical pattern, since there are low HDL/high triglycerides.

    Kidney stones in and of themselves would be insufficient; it would have to involve overt kidney dysfunction.

    Anyway, please let me know what comes of this.

  • Dr. William Davis

    9/21/2011 9:40:23 PM |

    Hi, Bob--

    It's not so much the period of time required to lose the weight, but whether the blood was drawn too soon (less than 2 months) after weight plateaued. If drawn too soon, it will yield confusing or alarming numbers to the weight loss-uninitiated.

    Getting an NMR is always a good idea, since it yields the most confident value, LDL particle number.

    Have you gotten a heart scan? Remember, it's more about coronary plaque than about calculated LDL or apo B.

  • Dr. William Davis

    9/21/2011 9:42:40 PM |

    Hi, Ellen--

    Surprising, isn't it? Perhaps it's something we should do!

    Anyway, it is critical to recognize this, else people get mad and throw things and think that the diet is destructive when, in reality, it works like crazy--if you know when to draw the blood sample.

  • Bob

    9/21/2011 10:28:03 PM |

    Dr. Davis,
    I had a heart scan thanks to your blog about 4 years ago with a score of zero. At the time I was on Lipitor following low carb diet but with little sat. fat. I was mostly eating skinless chicken, salmon with mayo. Now I am on high sat. fat diet. Beef and more beef. My weight is still dropping. I started at 186 and now I am 159. I have no idea when my weight will plateau. I feel I am in a bad position as two lipid doctors feel I should be on statins now yet I believe the numbers are not accurate because of the weight loss. If I wait for weight loss to stop I may be putting myself at risk but I don't want to go on statins if not necessary.
    Tomorrow I am planning on the NMR test.
    Thanks

  • Gene K

    9/22/2011 2:25:42 AM |

    Since I consistently get a server error trying to post this comment to the small LDL post, I am posting it here.

    Dr Davis,

    Do you think at some point you will drop the TYP target for LDL to be 700 or less in favour of a target amount or percentage of small LDL?

    Thank you.

  • Kat

    9/22/2011 8:38:16 PM |

    I've got to show this article to my mom. My mom has struggled with her weight for a long time. Her doctor told her she would give her 6 months to try and improve her numbers through diet and exercise. If they didn't go down she would have to start taking statins which my mom did not want to do. My mom did manage to lose a considerable amount of weight (about 50 pounds) in that 6 months period. She went to see her doctor, had a lipid panel done and the doc said her lipid panel numbers were worst than before. The doctor blamed her for not eating the right stuff  and said she needed to start statins now or die. It really scared my mom and she got frustrated. She ended up taking the statins because she didn't feel she had a choice and reverted back to her old lifestyle. Maybe if she knew this information she wouldn't have been so discouraged.

  • Dr. William Davis

    9/23/2011 12:35:53 AM |

    Oh, boy, Kat. It sounds like this is precisely what happened.

    I truly find it incredible that weight loss for my colleagues is such an uncommon thing that they don't even recognize it.

  • Dr. William Davis

    9/23/2011 12:37:46 AM |

    Hi, Gene--

    Yes, I am trending in that direction. However, it remains unclear what the safe threshold is for LDL particle number or apo B when small LDL is minimized or eliminated. BIG question with no current answer.

  • Dr. William Davis

    9/23/2011 12:47:36 AM |

    Hi, Bob--

    Be careful: Even the NMR is subject to the confusing and transient changes that occur during weight loss. In fact, you can observe these effects in ALL lipoprotein testing techniques.

    I know of no way to subtract the effect of weight loss except to be patient and wait for weight to plateau.

  • Dr. William Davis

    9/23/2011 12:49:06 AM |

    Donald--

    I loved your comment so much I'd like to make it the focus of a blog post!

  • Tom

    9/24/2011 3:17:32 PM |

    I' ve cut out wheat from my diet and my wheat belly has disappeared. Unfortunately there is still fat around the hips/thighs. Still, I'm very pleased. Thanks!

  • Dr. William Davis

    9/25/2011 12:08:12 AM |

    Great, Tom!

    Just be patient. It tends to come with time.

  • Suze

    10/2/2011 1:31:41 PM |

    This post brought tears to my eyes. Thank you SO VERY MUCH for posting this. I have been going crazy trying to figure out what the heck is going on.
    I went to see my doc in mid-June, who put me on lovastatin (added to blood pressure meds, Ambien, and Prilosec). He had done labs and was unhappy with my cholesterol.
    I went on low carb in early June, about a week before the doc visit. I have done low carb before and knew it would drop my cholesterol, but went along for now. For 6 weeks all was fine and I lost nearly 20 pounds. Started feeling better - was able to get off Ambien and sleep better. Was able to stop the Prilosec also (my GERD disappeared). Because I was trying to get into ketosis to burn fat, I was monitoring my blood sugar. At about 6 weeks into it, I hit a stall and have had to fight like heck to keep losing any weight. But the worst part (for me) was my glucose level. Inexplicably, my fasting glucose crept up just over 100 and stayed there most days. I was horrified - I was not eating any excess sugars, in fact, trying to stay under 20-30 carbs a day. I am a nurse and I know what a fasting glucose over 100 will get me diagnosed with - diabetes. My goal is to get OFF all meds, not get labeled with diabetes and put on more of them. To top it off, my doc wanted new labs after 6 weeks on lovastatin, and I refuse to go until I figured out what the heck was going on with my glucose and fixed the problem. My doc is nice, but I highly doubt he is evolved enough to listen to this argument. He still subscribes to the high cholesterol theory of heart disease, after all.
    I Googled my head off and tried to figure it out. Lots of theories out there. I tried all kinds of supplements supposed to regulate your glucose, and experimented with timing of food and activity. Even stranger, my glucose would RISE after exercise in the morning (still fasting!), but lower if done in the afternoon. I thought maybe I wasn't eating enough carbs and my liver was kicking out glycogen during the night. The day I came home from work after a just-over-100 fasting that morning and checked my glucose and it was 90 (!) 4 hours after lunch, I wanted to go get the damn labs done, but they were closed.
    I knew blood pressure, cholesterol levels and glucose are all tied together, but it had not occurred to me that losing weight mobilized fats into the bloodstream and may be behind my glucose being a pain. Makes me wonder what the lovastatin did for the 60 days I was on it, lol. But my dilemma is that to find out, if I go with an elevated glucose, I will be hosed. :-( So I guess I'll go find a home cholesterol kit and see, and be patient on the glucose issue.
    I also found some interesting info on low stomach acid - I had been on Tums, Zantac and then Prilosec for some time, and I found my glucose issues started around the time I *stopped* taking that stuff... More food for thought.
    Anyway, thank you so much for posting this - at least I am not in a panic at the moment. I am not done yet, though - I still have about 45-50 pounds to go. I am not sure I can hold off the labs that long. I plan to keep an eye on my fasting (97 this morning) and when it's well under 100 will try to get the damn labs done.

  • Dr. William Davis

    10/2/2011 2:32:28 PM |

    That's great, Suze!

    Yes, we have to be properly armed against our doctors!

  • Kelly

    10/9/2011 1:09:15 PM |

    What defines a weight plateau? I was diagnosed with gestational diabetes while pregnant. I left the hospital 20 pounds lighter than I was pre-pregnancy thanks to a lower-carb diet. Over the next 6 months, I lost an additional 25-30 pounds. I'm not losing weight drastically any longer -- I'm now well within the "normal" range for my BMI. However I am still dropping a pound or two every month or so (still breastfeeding). When I tested my blood sugar about 4 months ago, my fasting number was 104. I'm now 11 months postpartum, so its been about 5 months of very gradual weight loss. Would this still change my numbers because I'm technically still losing weight?

  • Dr. William Davis

    10/9/2011 10:59:32 PM |

    Probably not, Kelly.

    I don't know why, but weight loss that has "decelerated" to this degree seems to not be associated with distortion of metabolic markers. It doesn't mean that continued weight loss won't yield further improvement, but that the current numbers are indeed true.

  • DanD

    10/12/2011 4:48:46 PM |

    Donald, congratulations on these tremendous improvements.  Your experience makes me think that I can do the same if I keep at it.

  • Wanda E

    10/18/2011 1:59:06 PM |

    Dr. Davis, I really appreciate all the work you put into the Wheat Belly book.  It is an eye opener.  I have a question.  My husband is diabetic (2 shots per day) also he has Mysenthia Gravis.  Do you have any information regarding Mysenthia Gravis.  Will  eliminating wheat help get rid of or lessen the effects of this disease.  My husband and I are deleting the wheat and i already feel better.  Thank you.

  • Dr. William Davis

    10/19/2011 1:28:44 AM |

    Thanks. Wanda.

    There are, unfortunately, no formal clinical observations that combine wheat/gluten elimination with markers for myasthenia gravis.

    On the most anecdotal level, I have one patient with myasthenia gravis who tells me that her symptoms are substantially improved, though not entirely relieved, with wheat elimination. This seems to be true of nearly all neurologic phenomena that do not have wheat as their original cause: at least partial improvement.

    It is certainly worth trying for this as well as a host of other reasons.

  • Jo

    10/22/2011 2:25:09 AM |

    Thank you for posting this. I think I'm going through this right now. I've lost 63 lbs since being diagnosed with DM last Nov and my A1C is down to 5.5 from over 13.3.  My weight loss has slowed to about 5 lbs per month now and I have low thyroid symptoms but all my doctor cares about is putting me on statins. I'm seeing a new doc next month to try to get more than a TSH test but I know he's going to be concerned about my lipid profile, too. I'm going to ask for either a VAP or NMR test. I don't know how bad these numbers really are but they made the last doctor flip out. I keep under 30 carbs per day, am off all wheat now, and walk at least a mile a day. Here are the most recent numbers and the change from 8 months ago:
    Total: 338 (+58)
    Trigs: 138 (-39)
    HDL: 50 (+10)
    VLDL: 35 (+4)
    LDL: 253 (+44)
    %HDL: 15 (+1)
    Chol:HDL Ratio: 7 (no change)

    I'm not sure what to do in the meantime while I wait for the next appointment, other than be patient, but I'm going to print this post out, anyway.

  • Dr. William Davis

    10/22/2011 12:42:39 PM |

    Very nice result on your weight and diabetes, Jo!

    It looks like you have a genetically-determined pattern, either familial heterozygous hypercholesterolemia and/or apo E4. Sadly, in this situation, diet efforts cannot fully disable the impaired handling of fats that arises from these genetic variants. Statins in this case may not be a bad idea. You may be the occasional exception. Statins are overused and abused, but your situation is one in which they may be appropriate.

  • Suze

    10/23/2011 3:34:55 PM |

    Well, I finally went to get the labs done, and it's a mixed result. After 4 months on low carb and nearly wheat-free:
    cholesterol - 368 to 282 (-86)
    HDL - 40 to 61 (+21 :-D)
    LDL - 287 to 185 (-102)
    ratio - 9.2 to 4.6 (cut in half!)
    VLDL - 41 to 36 (-5)
    triglycerides - 207 to 179 (-28)
    Pretty good improvement in 4 months, I think. The first two months I was on lovastatin, and the last two months, all diet/exercise. I really do not want to go back on statins.
    However, my fasting glucose was 104, despite my efforts to get it lower before getting labs. Now I will have to argue with my doc, I am sure. I got an A1c and it was 5.2, which is totally normal, so at least I am armed with something!!!
    Suze

  • Suze

    10/23/2011 4:04:17 PM |

    P.S. - I have also lost almost 30 pounds!
    And - I just ordered Wheat Belly to read on my Nook. I can't wait! I think you are SO right about all of this!

  • Dr. William Davis

    10/23/2011 11:46:11 PM |

    Wow, Suze!

    Stupendous progress! Keep going.

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At what score should I have a heart cath?

At what score should I have a heart cath?

25. January 2007 William Davis (0)
This question comes up frequently: At what specific heart scan score should a heart catheterization be performed? In other words, is there a specific cut-off that automatically triggers a need for catheterization?

In my view, there is no such score. We can't say, for instance, that everybody with a score above 1000 should have a catheterization. It is true that the higher your score, the greater the likelihood of a plaque blocking flow. A score of 1000 carries an approximately 25-30% likelihood of reduced blood flow sufficient to consider a stent or bypass. This can nearly always be settled with a stress test. Recall that, despite their pitfalls for uncovering hidden heart disease in the first place, stress tests are useful as gauges of coronary blood flow.

But even a score of 1000 carries a 70-75% likelihood that a procedure will not be necesary. This is too high to justify doing heart catheterizations willy-nilly.

Unfortunately, some my colleagues will say that any heart scan score justifies a heart cath. I believe this is absolutely, unquestionably, and inexcusably wrong. More often than not, this attitude is borne out of ignorance, laziness, or a desire for profit.

Does every lump or bump justify surgery, radiation, and chemotherapy on the chance it could represent cancer? Of course not. There is indeed a time and place for these things, but judgment is involved.

In my view, no heart scan score should autmatically prompt a major heart procedure like heart catheterization in a person without symptoms.
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Pre-diabetes: An explanation for explosive coronary plaque growth

Pre-diabetes: An explanation for explosive coronary plaque growth

1. June 2006 William Davis (0)
Art's first CT heart scan in March, 2006 yielded a concerning score of 1336. He felt fine--no chest discomfort, no breathlessness, etc.

Art agreed to take the statin cholesterol drug his primary care doctor prescribed. He also agreed to take the fish oil, niacin, and some of the nutritional supplements that we advised. But Art just couldn't bring himself to make the commitment to lose weight.

At the start of his program, Art--at 5 ft. 8 inches--was 40 lbs overweight (212 lb). This was important since his blood sugar wavered in the pre-diabetic range, going as high as 130 mg. (The American Diabetes Assn. defines diabetes as a blood glucose of 126 mg or greater.)

One year later, Art's lipid and lipoprotein values were corrected to perfection. But he still weighed in at a hefty 209 lbs--essentially no change. His blood sugar likewise hovered in the 120's.

I felt Art need to be prodded, so I asked him to undergo another heart scan. His score: 1935--a 600 point increase, or 45%!

Only now has Art begun to comprehend to power of diabetes and pre-diabetes to fan the flames of plaque growth. Recent published data, in fact, show that the majority of recently diagnosed diabetics already have well-established coronary artery disease.

Don't let this happen to you. Do not dismiss diabetic patterns as they will catch up to you. If Art can lose the 30-40 lbs in the abdominal weight that is creating the diabetic pattern, he will likely succeed in stopping plaque growth. Otherwise, it's just a matter of time before his heart attack, stent, or bypass.
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What if heart scans become obsolete?

What if heart scans become obsolete?

19. February 2008 William Davis (3)
What will we do if or when CT heart scans become outdated and something better comes along?

Heart scans are, after all, our principal tool for detection and precise quantification of coronary atherosclerotic plaque. They provide the basis for the Track Your Plaque program: serial heart scans to track progression or regression of coronary plaque.

So what the heck will we do if heart scans become obsolete, if some other technology proves superior for precise lengthwise quantification of coronary plaque?

Simple: Then we will convert to that measure.

Say, for instance, that in 5 years, MRI advances to the point where it is quick and precise, despite the rapid motion of the heart that has, in past, caused this technology to stumble for plaque quantification. Instead of obtaining a heart scan score of, say, 350, instead an MRI might yield information like:

Calcium volume: 350 cubic mm
Soft plaque elements: 200 cubic mm
Fibrous tissue: 700 cubic mm

In other words, while a CT heart scan provides a calcium score that serves as a surrogate measure of total plaque volume, perhaps the next wave of technology will directly measure total plaque volume.

Don't CT coronary angiograms already measure total plaque volume?

No, they definitely do not. At present, the best they can do is visualize the non-calcific elements and suggest the diameter reduction created by plaque at a specific point. Thus, results like "50% blockage in the mid-left anterior descending." What they do not provide is a lengthwise total volume of plaque and all its elements. Perhaps some software manipulation in future will yield such information (and I think it will, though I personally have been unable to accomplish it).

So neither the Track Your Plaque program nor the Heart Scan Blog are necessarily bound to heart scans. But heart scans, in 2008, remain the number one best tool for plaque quantification that is easy, precise, available, and inexpensive. For those reasons, CT heart scans continue to serve as the basis for these programs, and not CT angiograms, MRI, or other non-quantitative technology.
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Comments (3) -

  • Rich

    2/21/2008 4:05:00 AM |

    Dr. Davis:

    Should we infer from your comparison of existing scans to future MRIs (350=350) that our Agatston calcium score denotes cubic mm of calcium?

    Thanks, Rich

  • Jack

    2/21/2008 1:05:00 PM |

    What about CIMT ultrasounds to identify cardiovascular risk and then moniter with follow-up CIMT ultrasounds to track regression?  I know that Dr. Jim Stein is a big fan of CIMT ultrasound.

  • Ziaul

    2/21/2008 1:49:00 PM |

    Hi Dr. Davis,
    I just had a heart attack and triple by-pass late January. I'm 40 years old and am on the following medicines: Altace, Cordarone, Lipitor, Lopressor. Is your program right for me? Will I still be able to track my plaque and know that I am reducing my risk? Will I still be able to take these "tests" while on my medicines?
    Thanks for your help.

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Drama with the Dr. Oz Show

Drama with the Dr. Oz Show

11. April 2010 William Davis (27)
A producer from the Dr. Oz show recently contacted my office. They asked whether we could supply them with a volunteer patient from either my practice or the Track Your Plaque program who would be willing to appear on the show and discuss heart disease prevention. They needed someone to commit within 24 hours.

Despite the short notice, we identified a volunteer. He flew to New York the following week where he was interviewed along with several other men and women, all of whom had heart disease (heart attacks, stents, etc.). However, as this young man is very slender and follows most of the Track Your Plaque principles (e.g., vitamin D and omega-3 fatty acid supplementation; no wheat, cornstarch, or sugars, no restriction of fat, etc.), he apparently received less attention than the overweight, I-know-nothing-about-diet interviewees.

Then there was an odd turn of events: Dr. Dean Ornish, apparently a friend of Dr. Oz, will be providing the dietary counseling. The producer had made no mention of Dr. Ornish.

Now that's an odd collision of philosophies: Our Track Your Plaque version of low-carb with the guru of low-fat, Dr. Ornish.

The following week, Dr. Ornish called me and graciously asked whether I was okay with this. I'm not sure just how much he knew about the philosophy I advocate, nor how much I have bashed his program as a destructive approach to diet, nor whether he knew that I gained 30 lbs on the Ornish diet, along with a drop in HDL to 27 mg/dl, increased triglycerides to 350 mg/dl, and type II diabetes that I've talked about on this blog and the Track Your Plaque book and website. I suspect he knew little to none of this.

Anyway, I tried to diplomatically explain that my patient's cause for coronary plaque was small LDL particles that he expressed despite his very slender build, likely from excessive carbohydrates, controlled with carbohydrate restriction. Dr. Ornish maintained his usual arguments: Grains are good, provided they are whole grains, heart disease is "reversed" with his diet program, etc. (I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)

We agreed to disagree. This leaves my poor patient in an odd position: Being asked by Dr. Ornish and the Dr. Oz show to follow a low-fat program for the sake of entertainment, or adhering to the advice we follow that has so far served him well, given his small LDL particle size tendencies.

We'll see where this little drama leads.
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Comments (27) -

  • preserve

    4/11/2010 2:10:12 PM |

    This can be very educational.  We can find out the effects of Dr. Ornish's diet, directly prescribed by him.  This provides a pretty comparison test.

  • Anne

    4/11/2010 3:12:55 PM |

    If I had been the person flown to NYC for the show and was told they wanted me to follow the Ornish plan, I would have told them "No way." and walked out.

    I tried the Ornish diet when I first started having problems with CAD and multiple stents. I found the diet very difficult and it left me hungry. I did the meditation too.  I don't know what my lipid levels were at that time. I then went to the AHA diet that caused my triglycerides, cholesterol and weight to all rise and the answer was to get on statins and I went on to have bypass.

    In 2008 I started following a TYP lifestyle plan. Here is what happened http://heartscanblog.blogspot.com/2009/06/beating-heart-association-diet-is.html

  • Ned Kock

    4/11/2010 3:54:15 PM |

    Interesting, particularly the involvement of Dr. Ornish. Dr. Oz seems to be changing his tone lately - less critical of fats or more of refined carbs.

    By the way, you mentioned several times on your blog that the  Friedewald equation is very imprecise, providing a fictitious measure of LDL, particularly as TGs go down.

    What is your opinion of the Iranian equation? It seems to be more precise for those with low TGs, and maybe more precise in general, as its parameters were estimated through multiple linear regression:

    http://healthcorrelator.blogspot.com/2010/04/friedewald-and-iranian-equations.html

    Of course, a VAP or equivalent test would be better, but a lot of people would like to have a more precise number based on their standard lipid profile results.

  • JD

    4/11/2010 3:57:26 PM |

    Dr. Oz's wife Lisa is a vegetarian and IIRC a producer of his radio show. Dr. Oz has been quoted as saying that "everything he knows about nutrition he learned from his wife". Given his source of nutrition education I am not surprised he is on good terms with Dr. Ornish. As Dr. Eades says, "Jesus wept".

  • Mark

    4/11/2010 4:06:06 PM |

    Subjects on Dr. Oz are chosen w/entertainment value in mind.  Dr. Oz consistently gives contradicting advice at different times aimed at large audiences with the air that one size fits all. I will stay with my individualized TYP approach and leave him and his advice to entertain the masses.

  • Alcinda (Cindy) Moore

    4/11/2010 5:25:48 PM |

    If it was me, no contest. I'd stick with you! I am not a fan or Oz....and can't stand Ornish!

  • Rantin' Rog

    4/11/2010 5:31:38 PM |

    While I don't agree with Ornish, I think this is an exciting development.  Maybe he will learn something from your patient!  Any common ground and exchange of ideas is a good thing.

  • Brett

    4/11/2010 9:08:37 PM |

    Why didn't Oz or Ornish simply invite you, Dr. Davis, to be on the show? You're (cough) down with the low-fat program, right?

  • pjnoir

    4/12/2010 2:13:45 AM |

    AMBUSH. Low FAT will always win the debate because they set the facts- its just like Alice in Wonderland. Nothing good can come of this. I saw Doc OZ pour some cooking oil in his hand and say to a women- see,image this running through your veins. If thats the case- Id hate to see what Oatmeal looks like in those veins. And don't get me started on DO.

  • Gina

    4/12/2010 4:17:48 AM |

    This is the reason I turned my TV off for good over 9 years ago!
    Oz and Ornish and entertainment...why do people believe every word theses guys say? Oh maybe because Oprha says they're the best. Good God, with a computer and internet available to almost anyone who can view a TV why don't they ask some questions and do some research. Oh maybe because this is all in the name of entertainment.
    Keep up the great work Doc. I love the blog!

  • Dr. William Davis

    4/12/2010 11:31:47 AM |

    I remind myself that Dr. Ornish et al are all trying to work towards the same goal: reduction of heart disease risk. It's just that we disagree on how we get there. I think his heart is in the right place, but I worry that he perpetuates a message that is outdated and, in many cases, destructive.

    Ned--

    The "Iranian equation" is definitely an improvement, despite being nothing more than a manipulation of numbers. However, it does not uncover the hidden sources of risk that are NOT expressed by the basic lipid numbers, no matter how much you massage them.

  • Peter

    4/12/2010 11:47:49 AM |

    I don't think your disagreements with Ornish are as black and white as you suggest: he has been telling people for thirty years to stop eating sugar and other refined carbohydrates, he thinks well enough of heart scans to have one himself (scored zero), and both you and he choose whole foods over processed foods in a heartbeat (that was a joke about heartbeat.) This is not to say that your views are the same.

  • Dr. William Davis

    4/12/2010 11:58:05 AM |

    I agree, Peter.

    While the differences are fundamental, there is perhaps 70% overlap. And we are indeed aiming for the same goal.

  • George

    4/12/2010 5:03:09 PM |

    Dr. Davis, Hopefully something good will come from this. I would love to see status updates of what develops here. Beginning/Ending lipid profiles, what changes your volunteer makes in their diet based on Ornish, etc. Very, very interesting, looking forward to see what happens. Do we know when this will possibly air?

  • Anonymous

    4/12/2010 5:38:02 PM |

    pjnoir is correct.  It is an ambush.

    Ornish is not 'growing', and Oz is not about to admit he's been wrong all this time.

    You are about to be mocked and held up as a quack.

    It is a shame that they have the megaphone and you don't, but that is our perverted medical/money/fame/power system.

  • Health Test Dummy

    4/12/2010 8:07:33 PM |

    Not that I think these types of doctors are 'dumb', per-say, however, it angers me as to their 'ignorance'. I have absolutely the highest respect for all doctors who search for the 'proactive' solution. I think anyone who sticks with the 'lemmings-style' mantra, in regards to science, is only asking for humiliation and self-destruction down the road. The Ansel Keys-inspired lipid hypothesis, I believe, has been absolutely shot down by CORRECT scientific methods for analyzing it's true health benefits. Throwing together some generalized 'meta-analysis' and touting it as 'truth' for the past 50 years shows us just how 'lemming-like' we truly are as a society. This information is a type of regurgitated (telephone game) bit of information that sticks to everything like glue, due to bad media and doctors who refuse to proactively search for alternative solutions based on true scientific formulas (have we all forgotten the 7th grade science class teachings of 'control group' and other forms of scientific analysis?).

    Anyway, it blows my mind. Meanwhile, I will continue to be mocked and viewed upon by my peers as 'weird' or 'out there', whilst they are all 10% + bodyfat % above me.

  • John

    4/12/2010 9:45:40 PM |

    I can vouch for the wisdom of Dr. Davis, I recently switched cardiologists to one that would listen to me about how I changed my diet since November of last year alas with the recommendations on this website I was so fortunate to come across.

    In November  
    Total Cholesterol 295
    LDL 191
    HDL 56
    TG 235
    I was immediately put on 5 mg of Crestor daily.

    Now today... after changing my diet (no wheat, no HFCS, low carbs) ( I cheat every once in awhile  but rarely, sushi with rice is my weakness..but one meal a week if at all) and still take the Crestor... after getting bloodwork from new cardiologist.

    New Numbers
    Total Cholesterol 200
    LDL 121
    HDL 61
    TG 90

    And the best part... I dropped 27 lbs and dropped a pants size...not bad for a 45 year old guy. At 6'4" and 209 pounds I'm ecstatic. Goal weight is 195 lbs that I was 15 years ago when I got married.

    Best thing is... my new cardiologist told me to take the 5 mg of Crestor EVERY OTHER DAY NOW... very happy about that. He said what you're doing with your diet and some exercise is reaping positive changes. He finished with we'll see you in 6 months to reevaluate your progress and go from there. Obviously my goal is to get off the statin for good and I think I can accomplish that with eating the Dr. Davis way.

    Thanks for the great advice you give Dr. Davis.

  • Lou

    4/13/2010 12:01:39 AM |

    Hope your patient is well prepared to provide information why she/he is doing all of that that you had him/her doing. Hope it turns out well for your patient and you.

  • Dr. William Davis

    4/13/2010 1:45:20 AM |

    I'm told that the Dr. Oz show featuring our patient will be aired Wednesday, April 14th.

    I'm not too worried about any bad press it might create. I have always been confident that the truth will win out.

  • Rob

    4/13/2010 9:37:38 PM |

    That is unfortunate. It would have been a great study, but unfortunately Dean Ornish's diet has no evidence to support it is healthy. I would politely refuse to have anything to do with that low-fat diet crap.

    http://productreviewratings.com/2010/02/fat-and-cholesterol-are-good-for-you/

  • Anonymous

    4/14/2010 5:08:46 PM |

    I just checked my Tivo and found this particular Dr. Oz show will be aired on WFLD in Chicago on April 14th at 4:00 pm and then once again on April 15th at 10:00 am.

    David

  • kdhartt

    4/15/2010 1:10:21 AM |

    Just watched it. Fish oil made the cut, not pills even, but something to have with your salad. 30 min exercise. Some yoga for stress. Impressive animations of arteries and plaque and rupture. A lot of low-fat dogma. I must say I learned nothing.

  • rhc

    4/15/2010 3:17:18 AM |

    I just watched the show and I must say it was VERY convincing since Dr. Oz had photos of the improved arteries of two of the patients. In addition, one of Dr. Ornish's original patients  who had been on the heart transplant list 25 years ago was also there - looking quite radiant and healthy. They showed pictures of his heart before and after as well.

    It is all so confusing to me since both sides have their 'proof' and scientific evidence. And let's face it most people will believe the benefits of 'lowfat' over 'highfat' any day.

    Dr. Davis could you please explain your answer to Dr. Ornish:
    “(I didn't want to challenge him in a phone call and tell him that he never actually reversed coronary plaque, but just reversed endothelial dysfunction. But, as Dr. Ornish is not a cardiologist, I wasn't sure how far his understanding of these issues went.)”

    I have no medical training, so forgive my ignorance, but it seems to me that if a diet reverses heart disease it doesn’t matter wether it is by reversing plaque or by reversing a dysfunction – the end result is what counts…doesn't it?

  • Anonymous

    4/15/2010 4:27:47 PM |

    Well I watched the show and couldnt tell which guest was the one that Dr D recommended.
    But certainly heart disease reversal was the predominate theme. Interesting graphics were used to explain plaque build up and blockage. But nothing on the components of cholesteral or small LDL. Nothing about blood sugar monitoring. On reversal startegies, weight control and exercise were trotted out as important elements ... not particularly new or enlightening. But when it came to diet there was almost a whole hearted endorsement of carbs ... oatmeal with plenty of fruit for breakfast, whole grain bread, rice etc.   Curiously fish oils where mentioned only briefly (almost in passing), and there was nothng on Vitamin D or Niacin.
    Not even statins (pro or con) were mentioned.

    All in all not at all informative! ... perhaps even misleading by what was not said ... a very poor performance imho.

  • Dr. William Davis

    4/15/2010 6:36:25 PM |

    I've so far only been able to view some of the introductory dietary comments, the "whole wheat cereal for breakfast" and "low-fat granola bar" for a snack.

    That little bit made me shudder. It brought back memories of all the low-fat blunders we made 15 years ago until we saw that substantial numbers of people were made pre-diabetic or diabetic with this routine.

  • kdhartt

    4/15/2010 10:46:31 PM |

    There was a 70% carbs, 10% fat pie chart. Must do to reverse heart disease. Nutritious meal (for six) portrayed as a death wish. Ornish as god. Not our cup of tea.

  • Anonymous

    4/16/2010 6:37:28 AM |

    Hey, at least they didn't attack you, Dr. D.  That's what I was thinking would happen.

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And you thought gasoline was expensive

And you thought gasoline was expensive

2. June 2009 William Davis (5)
In 1995, the Palmaz coronary stent was introduced, the brainchild of Drs. Julio Palmaz and Richard Schatz. Medical device manufacturer, Johnson & Johnson, priced the device at $2500 per stent.

Let's put this into perspective: At just 0.05 grams per 15 millimeter stent, that put the price of the common stainless steel used to manufacture the stent at $22,650,000 per pound.

Only after several competing stents finally made it to market did J&J reduce its price to its bargain price of $1200, or $10,872,000 per pound. And to think that most of us were shocked to find out that the U.S. military paid $200 for a hammer.

Since 1995, a competitive market for stents has developed, pushing prices down. Now, you can purchase a brand-new coronary stent for as little as $4,000,000 per pound.

Medical device manufacturers have been guilty of a degree of greed that would make many Wall Street bankers blush. That's why I call medical devices "the industry of infinite markups."
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Comments (5) -

  • Skeeter The Dog

    6/2/2009 1:03:34 PM |

    Interesting observation considering that medical doctors in the United States are part of one of the most successful cartels in human history.  OPEC ain't got nuthin' on the AMA!

    All humans are greedy; it is simply a matter of whether one's form of greed has greater positive than negative externalities as whether we call someone greedy or not.  But we are all greedy.

  • homebray

    6/2/2009 1:56:09 PM |

    I hope that you are suggesting that an ounce or prevention is worth a pound (in this case many pounds) of cure.

    Medical devices manufactures have very high engineering and regulatory costs which are all designed to ensure beneficial rather detrimental products. We can debate whether or not they are succeeding in this.

    However, don't you wish this same level of engineering and regulations were applied to manufactured "foods".  

    BTW they are made of Nitinol not Stainless Steel.

  • JD

    6/2/2009 2:32:17 PM |

    Interesting study posted on Dr. Eades' twitter.

    An inverse relationship between plasma n-3 fatty acids and C-reactive protein in healthy individuals

    http://www.nature.com/ejcn/journal/vaop/ncurrent/abs/ejcn200920a.html

  • Dr. William Davis

    6/2/2009 5:15:57 PM |

    Homebray--Yes. I wish I thought of that, the "ounce of prevention . . ."

    Palmaz-Schatz are stainless steel. Nitinol came several years later.

  • homebray

    6/2/2009 7:26:45 PM |

    Ah!  my mistake, sorry.

    I didn't' think you were suggesting that stents should be sold in bulk by the pound! Smile

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