A glycation rock and a hard place

12. January 2011 William Davis (15)
Advanced Glycation End-products, or AGEs, the stuff of aging that mucks up brains, kidneys, and arteries, develop via two different routes: endogenous (from within the body) and exogenous (from outside the body).

Endogenous AGEs develop via glycation. Glycation of proteins in the body occurs when there are glucose excursions above normal. For instance, a blood glucose of 150 mg/dl after your bowl of stone-ground oatmeal causes glycation of proteins left and right, from the proteins in the lens of your eyes (cataracts), to the proteins in your kidneys (proteinuria and kidney dysfunction), to skin cells (wrinkles), to cartilage (brittle cartilage followed by arthritis), to LDL particles, especially small LDL particles (atherosclerosis).

At what blood sugar level does glycation occur? It occurs even at "normal" glucose levels below 100 mg/dl (with measurable long-term cardiovascular effects as low as 83 mg/dl). In other words, some level of glycation proceeds even at blood glucose levels regarded as normal.

There's nothing we can do about the low-level of glycation that occurs at low blood sugar levels of, say, 90 mg/dl or less. However, we can indeed do a lot to not allow glycation to proceed more rapidly, as it inevitably will at blood sugar levels higher than 90 mg/dl.

How do you keep blood sugars below 90 mg/dl to prevent excessive glycation? Avoid or minimize the foods that cause such rises in blood sugar: carbohydrates.

What food increases blood sugar higher than nearly all other known foods? Wheat.
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Comments (15) -

  • soiltosustenance

    1/12/2011 3:19:52 PM |

    I have been doing some experiments with Blood Glucose control over the past 2 months and have made a huge difference by cutting out grains completely.  Between the reduction in carbs and the addition of some moderate strength training, I have been able to eliminate BG spikes above 150 (now normal highs are in the 120s) and the duration is shorter as well.

  • Anonymous

    1/12/2011 5:01:24 PM |

    Dr Davis I as a neurosurgeon scientist completely agree with you about carbs wheat and glycation but from the literature of diabetics I am far more concerned with lipid peroxidation from PUFA's.  Espcially the omega 6 and 9's which are known to cause six times the "glycation" that glucose does.  I believe a meta analysis was done for Circulation recently and it caused a firestorm in the AHA ACA because of sponsorship issues.  I am more concerned with the guidelines we physcians need to advocate than guidelines that are subject to market forces more than scientific ones.

    Dr. K

  • Anonymous

    1/12/2011 10:05:44 PM |

    Dr. K,

    I tried to find that meta analysis in Circulation and couldn't find it. Could you please provide the reference. Thanks

  • Anonymous

    1/12/2011 11:15:11 PM |

    I have to say I've found giving up wheat, even cutting down substantially, to be damn difficult because it's so widespread and simple habit. I aim for more lean meats and things like rice for carbs, but so dearly love my breakfast cereal and pizza!

    Does anyone have thoughts on aminoguanidine relative to the glycation issue. I took it for some months a few years ago until it got a bit too pricey.

  • revelo

    1/13/2011 12:37:42 AM |

    If wheat and omega-9 fatty acids are so unhealthy, why do the southern europeans live so long? Wheat and olive oil are a huge part of the traditional Mediterranean diet.

  • Anonymous

    1/13/2011 3:55:31 AM |

    Meta-analysis Reveals “Heart Healthy Omega-6 Fat” Increases Risk of Heart Disease
    Bottom Line: The research upon which the American Heart Association based their "eat-your-omega-6-fat" advisory, is fatally flawed, according to the results of a meta-analysis study, which showed that a steady diet of omega-6 polyunsaturated fatty acids increases the risk of heart disease and death, especially for women [1]. British J Nutr. Dec 2010.

           [Here's a link to the full post http://www.scribd.com/doc/44601571 ]
    DR. K

  • Anonymous

    1/13/2011 3:57:10 AM |

    http://omega-6-omega-3-balance.omegaoptimize.com/2010/12/03/metaanalysis-reveals-heart-healthy-omega6-fat-ups-risk-of-heart-disease.aspx

  • Might-o'chondri-AL

    1/13/2011 5:01:36 AM |

    Advanced glycation of peroxidized poly-unsaturated fat rate has definitely been claimed to be significantly higher than rate of glucose advanced glycation.

    Dr. Davis' tactic of glucose control does seem easier for patients to see how they can make changes that matter. They are then more open to following his complete program.

    A recent autopsy analysis (2010) of ruptured plaque said there was always iron in there; and yet no iron in the intact plaque. Iron cleaved from the blood is a suspected activator of omega-6 lipid peroxidation at the epithelium. When the fibrin polymerizes it seems iron gets trapped.

    People's genetics make me wonder if some mega-dose multi-vitamin takers are over doing the iron; vitamin C even boosts it's uptake. Old "southern Europeans" probably never took complex vitamin pills until recently. Wheat germ has soluble iron and those old timers ate white flour products if they could.

  • D.M.

    1/13/2011 9:00:32 AM |

    @Anonymous neurosurgeon scientist.
    Isn't omega 9 MUFA rather than PUFA?
    Also there's no reason why a LCHF diet couldn't also minimise PUFA, in preference to SFA/MUFA.

  • Dr. William Davis

    1/13/2011 1:04:46 PM |

    While this post was about endogenous glycation, there is indeed a parallel path of exogenous "glycation," poorly named because many of the so-called exogenous "advanced glycation end-products" do not involve glycation.

    I agree with Dr. K that many of the exogenous factors leading to heart disease, aging, and other phenomena are those that lead to LDL oxidation. Oxidized polyunsaturates, AGEs, and oxidized cholesterol are underappreciated phenomena.

    A topic for future.

  • Anonymous

    1/13/2011 10:08:11 PM |

    Although I had given up oats and other grains because of their adverse effect on blood glucose,I had not been able to give up toast(sprouted wheat). I finally found a great solution--organic frozen green beans. They are easy to cook and go well with eggs. I have been wheat-free for about a month.I feel good and I don't get hungry as often.

  • Alberto

    1/13/2011 11:26:13 PM |

    As revelo, I am curious as how is it that italians eat tons of pasta (they use hard grains) and seem to be healthy.

  • allison

    1/14/2011 5:16:48 AM |

    Peter at Hyperlipid has written about this fasting glucose paradox in carb-restricted individuals.  

    I have been Paleo (<60 grams of carbs) for two years.  I eat no sugar, fructose or grains of any kind.  Yet my fasting glucose is 90 with all other diabetic indicators normal.  Apparently, high normal fasting glucose is common among LCHF diets.  

    I haven't researched this, but since a LCHF diet produces large, fluffy oxidation-resistant LDL, I wonder whether there is a beneficial effect downstream from glycation? Otherwise both a low fat, high carb diet and a LCHF diet would produce the same bad result.  That doesn't quite add up.

  • allison

    2/3/2011 5:28:43 AM |

    Glycation refers only to the initial step of one glucose molecule attaching to a protein without the mediation of an enzyme.  If blood glucose levels are low enough--as would be the case with a HFLC diet--the glucose and protein will disengage and no damage will be done.  If blood glucose remains elevated, the cascade to advance glycation end products will continue to protein cross-linking and all the downstream deleterious effects.  The unavoidable glycation referenced by Dr. Davis is harmless, as long as you avoid refined carbohydrates.  No conundrum there.

  • Kirk

    9/12/2012 6:58:44 PM |

    Couldn't you also keep your blood sugar low through a lot of exercise (if you're so inclined)?  60g of complex carbs going into a sedentary person with 50% bodyfat is going to have a different effect than the same 60g going into a sub-3 hour marathon runner.

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What goes up can't come down

What goes up can't come down

28. November 2009 William Davis (13)
According to conventional wisdom, heart scan scores cannot be reduced.

In other words, say you begin with a heart scan score of 300. Conventional wisdom says you should take aspirin and a statin drug, eat a low-fat "heart healthy" diet, and take high blood pressure medications, if necessary.

If your heart scan score goes up in a year or two, especially at an annual rate of 20% or more, then you are at very high risk for heart attack. If the heart scan score stays the same, then your risk is much reduced. These observations are well-established.

But more than 99% of physicians will tell you that reducing your heart scan score is impossible. Don't even try: Heart scan scores can go up, but they can't go down.

Baloney. Heart scan scores can indeed go down. And they can go down dramatically.

It is true that, following conventional advice like taking a statin drug, following a low-fat diet, and taking aspirin will fail to reduce your heart scan score. A more rational approach that 1) identifies all causes of coronary plaque, 2) corrects all causes while including crucial strategies like omega-3 fatty acid supplementation, vitamin D supplementation, and thyroid function normalization, is far more likely to yield a halt or reduction in score.

While not everybody who undertakes the Track Your Plaque program will succeed in reducing their heart scan score, a growing number are enjoying success.

A small portion of our experience was documented this past summer. (I collected and analyzed the data with the help of Rush University nutrition scientist, Dr. Susie Rockway, and statistician, Dr. Mary Kwasny.)


Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults.

Davis W, Rockway S, Kwasny M.

The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS of > or = 50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides < or = 60 mg/dL; high-density lipoprotein > or = 60 mg/dL; and vitamin D3 supplementation to achieve serum levels of > or = 50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%-29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%-71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.
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Comments (13) -

  • karl

    11/28/2009 8:01:01 PM |

    Where is this published?

  • Nigel Kinbrum BSc(Hons)Eng

    11/28/2009 9:09:40 PM |

    Has anyone investigated the effect of Vitamin K2 on CCS?

  • Dr. William Davis

    11/28/2009 9:23:30 PM |

    Karl--

    In the American Journal of Therpeutics 2009 Jul-Aug;16(4):326-32.

    For abstract, go to Pubmed and enter "Davis + Rockway" into the search.

  • Dr. William Davis

    11/28/2009 9:24:14 PM |

    Hi, Nigel--

    There are no studies in which K2 vs. placebo have been administered, only observations studies in which lower K2 intake has been related to greater risk for cardiovascular events.

  • David

    11/29/2009 2:17:29 AM |

    Hi Dr. Davis,

    Do you have any insight into what separated those that had reversal from that those that had slow and rapid progression?

    Thanks,
    David

  • drake

    11/29/2009 2:24:04 AM |

    My cardiologist said essentially the very point of your first sentence.  I had pestered my PCP to order a heart scan a month ago.  He relented only by stating that I should then go see a cardiologist.  

    The cardio stated that scores can't be decreased unless "they change the software reading the scan."  He further stated, "calcium is calcium; where's it going to go?"  Needless to say, he placed very little value on heart scans but it made for some lively discussion between he and I.

  • Paul Smith

    11/29/2009 2:36:20 AM |

    Dr. Davis - I'm 36YO in Australia with a 50% blockage on my LAD (vulnerable plaque). I have 1 tiny spec of calcium on a branch of my LAD so not much of a calcium score. I realise this is a serious problem.
    I guess 'track you plaque' would be harder for my with such a low calcium score so I haven't joined up.
    I've been using your techniques for 3months now - I'm sugar and carb free and I'm very close to 60/60/60 as you have recommend.
    With reference to your most recent posting, what is your experience with Vulnerable Plaque reduction in people with low or no calcium score? Its a bit harder to track I would have thought? PS - TIP for new bloggers - don't take 500mg of Niacin if its the first time your doing it! Ouch.

  • Red Sphynx

    11/29/2009 2:59:29 AM |

    Wow.

    Any general insight as to why this worked so markedly well for some of your patients, less well for others, and not at all for 3?  Obesity?  Tobacco?  Stress? Not taking their meds? Diabetes? Working in a refinery?  Or is It more about choosing the right ancestors?

  • Anonymous

    11/29/2009 4:48:45 AM |

    A major question remains: "Why are some patients NOT responsive to the TYP protocol"?

    Is their coronary artery disease being driven by a different cause?

  • billye

    11/29/2009 6:12:09 PM |

    Hi Dr. Davis,
    As usual you always provide great information.  I have been following a life style change that features the diet of our ancient ancestors, with great results for the last 12 month.  I use saturated fats exclusively, including MCT and coconut oil, Weight loss 55 pounds, Diabetes type 2 cured (A1c's of 4.7,4.8,and 5.0 all without medication). My doctor stopped all Staten's. I recently received the results of a VAP test 11/16/09.
    Some of the pertinent results are:
    Tot. LDL-C Direct 154 mg/dl
    Tot. HDL-C Direct  63 mg/dl
    Tot. TG    Direct  63 mg/dl
    Sum Tot. Cholesterol 233
    Real-LDL sz. Pat. A large buoyant
    Remnant Lipo (IDL+VLDL3) 26
    HDL-2(large,buoyant) 18
    HDL-3(small, dense)  45
    VLDL-3 (remnant lipo)9
    Recommendation: Consider lowering LDL-C goal.

    Because I am not a doctor, I am having trouble analyzing this VAP test.  I have started a course of Usher Smith 500mg SLO NIACIN.  Any other suggestions?  Is this  enough to  
    lower my LDL? I very much value your opinion, any input will be greatly appreciated.  Thanks in advance.
    Bill Eisenberg

  • Dr. William Davis

    11/29/2009 6:35:07 PM |

    Paul--

    I believe you may be misinterpreting what Track Your Plaque is intended to do. It is NOT  a program to reduce the amount of calcium in the coronary arteries; it is a program that uses the surrogate marker of coronary calcium as a means of reducing plaque.

    All the strategies we use in the program still apply, regardless of the proportion of calcium to non-calcified elements.

  • Anonymous

    12/8/2009 3:09:48 AM |

    new book is available when ?

  • buy jeans

    11/3/2010 10:05:27 PM |

    A small portion of our experience was documented this past summer. (I collected and analyzed the data with the help of Rush University nutrition scientist, Dr. Susie Rockway, and statistician, Dr. Mary Kwasny.)

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