America: The world’s diet laboratory

Low-fat, low-carb, high-protein, Pritikin, Ornish, Atkins, South Beach, Sonoma, Sugar-Busters, Weight Watchers, vegetarian . . . Have Americans tried them all?

We’ve witnessed the relative success of diet habits in selected regions world-wide: the longevity of the Japanese on a spare soy and fish-based diet; the reduced heart disease incidence of the French despite an indulgent food-centered culture; the extreme heart disease-free lives of the Cretan Greeks.

Contrast this with the startling failure of the American diet experiment: We’re all (speaking for the collective whole) fat, diabetic, and miserably mired in the diseases of obesity. We’ve experimented with every possible iteration of diet from grapefruit or cabbage only, to calorie deprivation (a al Weight Watchers), to restricting this or that element of diet. The “official” organizations have made their contributions, as well: the American Heart Association’s Therapeutic Lifestyle Changes (formerly Step I and II diets), a program eerily similar to what Americans are already eating and resulting in failure; the American Diabetes Association diet, incomprehensibly embracing carbohydrates when they are the root of the nutrition-habit-gone-wrong that caused the disease in the first place; the USDA and their Food Pyramid, encompassing a design that contains the germ of wisdom but is so heavily overweighted in grains that it is a sure-fire way to increase weight and heart disease were you to follow their recommendations.

What have we learned from our grand experiment, our nationwide misadventure in nutrition?

I believe that we’ve learned how not to eat: Processed snack foods, meals delivered in a fast-food setting with the offer to “super-size” your order, make-believe food ingested in your car eaten for the sake of staving off the inevitable hunger pangs. Few would argue that these are certain paths to obesity and poor health.

Certainly, if we’ve learned how not to eat, can we extrapolate just how to eat? And not just for weight loss, since most diets focus just on that, but on health, particularly heart health?

If Americans have so far failed to learn the lessons of the nutritional world, we certainly have not failed at talking about it. From books to blogs, websites, information gurus to infomercials, we certainly celebrate the capacity to share our experiences, our grief over our nutritional “misfortune,” despite a world of plenty.

Yet we swim in a sea of information. Can we sift through the chaff to discover the essential truth?

Let me articulate an extreme (extreme meaning closer to the truth, I hope) interpretation of nutritional wisdom:

--If it requires a label or nutritional analysis, reject it. The wondrous green pepper, or bottle of olive oil, for instance, require no such qualifications. Some exceptions: milk, yogurt, cottage cheese (unless, of course, you purchase straight from a local producer). I am always impressed with the contortions and frustrations people experience trying to decipher labels. Ironically, the healthiest foods don’t even require labels.

--If it is ingested in a rush, it’s likely to add to poor health. True food is meant to be consumed at leisure, not in haste to satisfy some irrational, unthinking impulse.

--Search for natural, whole foods. Natural, whole foods require no marketing. You pay a premium for a company to adorn a product with glitz, glamour, and appeal. Repackage Cocoa Puffs as chocolate flavored, round overly-processed wheat flour, sans marketing spin, and what is left? Processed foods are?intentionally?addictive. They are added to, modified, high-fructose corn syruped, etc. to increase desirability, but also create addiction. Eliminate them just as a smoker eliminates cigarettes.

--A corollary to the above issue: purchase foods that appear as if you had grown it or raised it yourself. If you were to grow corn in your backyard garden, you would eat it on the cob or some similar way. You would not grind it, pulverize, process it, nor serve it as cornstarch and add to a pile of chemicals to make breakfast cereal. Eat foods in their natural state, not the highly processed food-product that requires a colorful package and advertising to sell.

--Don’t keep bags of chips, boxes of breakfast cereal and crackers, frozen dinners, all “just in case.” Don’t allow yourself that opportunity because you will more than likely seize it. An alcoholic who keeps a secret bottle of gin hidden in the cabinet is well aware that it’s there and will eventually give in to impulse.

--When you eat meat, try to find free-range, organic products. Even better, purchase from a local producer who you trust.

--For anyone with patterns like low HDL, small LDL, high triglycerides, and blood sugar >100 mg/dl, following a diet that is as free of wheat products as possible will yield enormous benefits. Wheat is a part of all breads, virtually all breakfast cereals, pretzels, crackers, bagels, cookies, cupcakes, pancakes, waffles, etc. Going wheat-free is also a surprisingly effective weight loss strategy.

That’s just a few thoughts. The approach we use in the Track Your Plaque program helps achieve weight loss, but also helps correct lipoprotein patterns, often dramatically.

Many diets have failed to keep pace with the changing nutritional habits of Americans. In 1960, we ingested close to zero high-fructose corn syrup. We’re now approaching 80 lbs per year per American. Breakfast cereal in 1950 consisted of a handful of products, eaten intermittently; today, it is a staple with enough products to fill a modern supermarket’s entire aisle. Meats have changed, thanks to the factory farm phenomenon feeding its animals corn in inhumanely restricted conditions, a dietary shift for livestock that has modified the fat composition to something far different than 50 years ago, not to mention the antibiotics and other chemicals used to accelerate growth and fight off infection from the artificial, overcrowded conditions.

The American nutritional shift, along with rampant obesity, have also caused a relatively new cause of coronary heart disease to explode: small LDL particles. The contribution of small LDL has been enormously underestimated, since most physicians don’t know what it is, don’t know how to check for it, and don’t know what to do with it. Yet it has emerged as the number one cause for heart attack and heart disease nationwide.

Stay tuned for our rewritten New Track Your Plaque diet to be released as a Special Report on the www.cureality.com website in future.

Comments (14) -

  • jpatti

    10/23/2007 2:34:00 AM |

    I agree wholeheartedly!

    I've been very heavily studying diet the past few months - reading widely from a lot of sources with a lot of different biases.

    The main conclusion I've come to is that hardly anyone one eats enough fresh low-sugar fruits and non-starchy vegetables; they should be the bottom of everyone's food pyramid.  

    We eat so much junk that you can't tease out what the problems are.  For instance, people say if there were a problem with artificial sweeteners, we'd have discovered it by now.  Well, we *have* discovered increasing rates of obesity, diabetes and heart disease.  We can't know it's the artificial sweeteners specifically anymore than we can know that it's any of the other individual things that have changed in the diet in the past 50 years or so.  Maybe some are worst than others, who knows?  There's too many changes to be able to tell exactly what the problems are in detail.  But we do know that all these lifestyle diseases increased tremendously when we all began eating so many highly-processed foods.  

    I think a lot of the problems in the typical western diet are additive - lost good effect from an unknown micronutrient in real foods plus bad effects from highly-processed stuff.

    So... maybe aspartame is perfectly safe, but I quit the Diet Pepsi for stevia-sweetened lemonade and limeade anyway.  Cause I *do* know that real whole foods are healthy, so I don't have to know the ultimate truth about aspartame.

  • Anonymous

    10/23/2007 4:24:00 AM |

    Excellent post, and you are quite right about high-fructose corn syrup.

    Michael Pollan's book "The Omnivore Dilemma's" has quite a lot of information about corn in the US.

    --Michael G.R. / michaelgr.com

  • Sue

    10/23/2007 8:11:00 AM |

    I agree with all this food tips.

  • Peter

    10/23/2007 8:29:00 AM |

    Hi Dr Davis,

    The only information I have been able to find on soy intake in Japan estimates that in men it is 8.00 g/d and in women 6.88g/d. I realise that quoting two decimal places from a food frequency questionnaire is a bit silly. The standard deviation is around 5g/d. This does not seem like very much to me. To suggest that 8g per day is associated with longevity makes soy protein powerful stuff, literally beyond belief. Are there any better data than this?

    I got my info from the bottom line of table 1 in the results section of:

    Nagata C, Takatsuka N, Kurisu Y, Shimizu H (1998) Decreased serum total cholesterol concentration is associated with high intake of soy products in Japanese men and women. J Nutr. 128(2):209-13

    Peter

  • Alan

    10/23/2007 10:18:00 AM |

    Thanks Doc.

    When choosing foods for purchase I use a fairly simple rule. I try to choose foods that owe more to the farmer than to the chemist for their production, and do as much of the processing as I can in my own kitchen rather than accept the results of a factory kitchen.

    As a diabetic I believe that cooking for oneself improves one's health. That way you get to choose exactly what you eat and there are no hidden surprises.

    You already know my thoughts on the AHA/ADA/USDA nutrition guidelines for cardiac and diabetic patients.

    Thanks for a marvellous post, which I will be passing on to many others.

    Cheers, Alan, Type 2 diabetes, Australia

  • Dr. Davis

    10/23/2007 11:52:00 AM |

    Actually, I'm referring to the epidemiologic data on length of life and incidence of cardiovascular events in Japanese. Obviously, pinpointing the aspect of diet--or other component of lifestyle or genetics--that confers longevity is not revealed by these observations. However, though I like soy products, I don't think they are responsible for the difference.

  • Anonymous

    10/23/2007 1:40:00 PM |

    I think you are a fan of the south beach diet except that he uses too much wheat. What do you think of his south beach diet
    "products" and why do you think he created them?
    Also- can you comment on the use of Splenda.
    Thanks!

  • Dr. Davis

    10/23/2007 5:06:00 PM |

    Yes, the South Beach Diet is a reasonable way to lose weight and improve lipoprotein patterns, provided you don't proceed fully to phase 3, in which grains are added back in abundance. Many people regain their weight in phase 3.

    I doubt Arthur Agatston plays much of a role in developing his packaged products. Nearly all of these are outsourced or licensed products, with which I suspect he has just passing acquaintance. I don't think they are good products, at least the ones I've seen and tried.

  • Dr. Davis

    10/23/2007 7:16:00 PM |

    Also, so far I've not witnessed nor heard of any ill-effects specific to Splenda. So far, so good.

  • Anonymous

    10/23/2007 8:53:00 PM |

    Dr. Davis have you readf the excellent new book Good Calories Bad Calories? If so I would love to hear your oppinion.

  • Dr. Davis

    10/23/2007 9:06:00 PM |

    I'm several chapters into Gary Taubes' book and loving every page. I have to say that many studies I accepted as gospel do indeed appear suspect when recast in his skeptical light. After reading the entire book, I believe a re-examination of the old studies will be necessary.

  • Anonymous

    10/24/2007 5:39:00 AM |

    Is there a practical diet available today that a normal, average person in US can follow to maintain decent health without getting bogged down with the ever increasing "DO NOT EAT" list?

    I think that this is a very tough question to answer; I hope you can share your thoughts on this issue in a future article.

    I have realized lately that people   like me who are conscientious of following a healthy lifestyle, would not realize the impact of religiously following the common
    health options propounded by the food industry.  

    Examples of healthy choices we think we are making:
    - eat more whole wheat, multi grain instead of white bread
    - drink fruit juice (with vitamin attractions) instead of soda pop or other beverages
    - eat more cereals (with vitamin, mineral benefits) and whole wheat, raisin bagels instead of eggs, bacon and cream cheese.

    But thanks to Track the plague research program, we now know that even these cause issues to our health.

    As I read about your total grain elimination diet, I keep wondering - What CAN one *practically* eat from a preventative aspect to maintain decent health?

    If you walk into any cafe, there is an abundance of sandwiches, snacks, pastry etc. What does one do in such cases? It's a common situation that I think we all must be facing from time to time, and I wonder what acceptable choice can we make in such situations?

    I believe that's why there should a new diet approach/guideline that both follows the principles as outlined in Track Your Plague or your blog, and also emphasizes on being practical for an average person. These guidelines will empower the average health conscious public to make healthy  diet choices.

    I find this analogous to our fuel situation today - Everybody knows that ideally we must stop our fuel consumption and switch over to alternative energy sources.
    Since this is not a feasible option today, an alternative practical approach (eg: hybrid cars) comes into place to start the slow but gradual transition

    Some questions/options that I would expect that this practical diet approach to answer/provide: -

    Breakfast options
    Ideal: Avoid all cereals, grains (But again, what would one eat then instead?)
    Acceptable (while on the road): oats, water, peanut butter on multi-grain bread, cereals, fruit juice
    Avoid: bacon

    Brunch options:
    seeds, nuts

    Lunch options
    Ideal: have lean meat, whole fruit
    Acceptable: fruit juice, sandwitch on multi-grain bread
    Avoid: fried food

    etc...

    If you know of any such guidelines that are published or available, I would be appreciate some pointers.

    Personally for a 28 year old person like me, just trying to stay on multi-grain and not trying any fried foods has been a major challenge for me to follow diet wise, but nevertheless I have still been able to maintain the discipline to continue on this.

    I am glad to know that elimination of all grains will bring a lot of health benefits; however it also reminds me on how gloomy the situation is for me when I have to eat outside; the choices then become extremely limited or in some cases the healthy options become non existent.

    thanks Doc. Keep up the good work!

  • Dr. Davis

    10/24/2007 11:59:00 AM |

    Thanks for the wonderful thoughts.

    The forthcoming new Track Your Plaque Diet will articulate many of the issues you discuss above. However, I need to emphasize that the diet is not meant for the average person to follow. It is meant to be part of an effort to seize control of heart disease risk, while providing an health effect. There is a difference.

    Also, I find it easier to understand food products offered in stores and restaurants when you see them as vehicles for profit, not health. Health claims often parrot the popular issue of the day, but the product is sold for profit.

  • Sue

    10/25/2007 11:59:00 PM |

    Good Calories, Bad Calories is brilliant - I hope a lot more professionals read it.

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Letter from the insurance company

Letter from the insurance company

Claudia got this letter from her health insurance company:

Dear Ms. ------,

Based on a recent review of your cholesterol panel of January 12, 2011, we feel that you should strongly consider speaking to your doctor about cholesterol treatment.

Reducing cholesterol values to healthy levels has been shown to reduce heart attack risk . . .


Okay. So the health insurer wants Claudia to take a cholesterol drug in the hopes that it will reduce their exposure to the costs for her future heart catheterization, angioplasty and stent, or bypass surgery. This is understandable, given the extraordinary costs of such hospital services, typically running from $40,000 for a several hour-long outpatient catheterization procedure, to as much as $200,000 for a several day long stay for coronary bypass surgery.

So what's the problem?

Here are Claudia's most recent lipid values:

LDL cholesterol 196 mg/dl
HDL 88 mg/dl
Triglycerides 37 mg/dl
Total cholesterol 291 mg/dl

By the criteria followed by her health insurer, both total and LDL cholesterol are much too high. Note, of course, that LDL cholesterol was a calculated value, not measured.

Here are Claudia's lipoproteins, drawn simultaneously with her lipids:

LDL particle number 898 nmol/L
Small LDL particle number less than 90 nmol/L (Values less than 90 are not reported by Liposcience)

LDL particle number is, by far and away, the best measure of LDL particles, an actual count of particles, rather than a guesstimate of LDL particles gauged by measuring cholesterol in the low-density fraction of lipoproteins (i.e., LDL cholesterol). It is also measured and is highly reproducible.

To convert LDL particle number in nmol/L to an LDL cholesterol-like value in mg/dl, divide by ten (or just drop the last digit).

Claudia's measured LDL is therefore 89 mg/dl--54% lower than the crude calculated LDL suggests.

This is because virtually all of Claudia's LDL particles are large, with little or no small. This situation throws off the crude assumptions built into the LDL calculation, making it appear that she has very high LDL cholesterol.

Do you think that Big Pharma advertises this phenomenon?

Comments (24) -

  • Anonymous

    3/18/2011 1:49:34 AM |

    Dr. Davis,

    I think total cholesterol should be 290, perhaps, and not 29?

    I have started using the lipoprofile in my practice.  Patients with relatively normal lipid profiles are startled with the results.  Getting them to make any changes is another thing, but I will keep trying.

    Teresa

  • Anne

    3/18/2011 7:42:37 AM |

    I live in the UK under the National Health Service but I also  have private medical insurance. I know that neither my private medical insurance company, nor the NHS itself, know my cholesterol numbers - they are known only to the lab, my doctors and me. How is it that patient information, which should be confidential, is given to insurance companies ? I find that a very worrisome aspect of this.

  • Kris @ Health Blog

    3/18/2011 8:08:05 AM |

    I find it kind of strange how obsessed american doctors are with cholesterol levels, in my country (Iceland) this is not such a big deal.

    It's almost as if the doctors in America are going out of their way to find something wrong with their patient so that they can treat it.

    For example high cholesterol, thyroid disorders. I pretty much never hear people talk about those things here.

  • Anonymous

    3/18/2011 11:55:23 AM |

    and when she refuses to do as ordered, her insurance company will find out about that, and will then terminate her coverage. Anybody want to make a bet? So much for privilege and confidentiality in the ole US of A.

  • Peter

    3/18/2011 1:29:41 PM |

    Seems very odd, I've had health insurance fornforty years, and they've never given me any advice or indication that they read my lab results.

  • Marg

    3/18/2011 2:22:16 PM |

    Some insurance companies routinely require physical examinations before they will write life insurance and are happy to find any reason not to write the insurance. Could this have been a life insurance company?

  • Galina L.

    3/18/2011 2:33:23 PM |

    What do you think is the best line of defense for the patient? My husband has similar calculated LDL - 181, the rest of numbers are excellent and he is in a very good health at 50 years old. Blood pressure is excellent(115/65), pulse is 45 at rest, fasting BS is 76. Our doctor admits it, but recommends Lipitor anyway. Our health insurance is about to be changed and it makes me worry about perspective pressure from insurance people on my husband to take that Lipitor.

  • Anonymous

    3/18/2011 2:37:48 PM |

    How does an individual give honest answers on health questionaires when applying for new or additional life or health insurance?  If they ask my PCP they would be told that I am low risk for heart attack.   If they look at my CT scan score they would see that I am in the 90th percentile - high risk.
    These are hypothetical questions at this point but my inclination would be to base my answer on my PCP's opinion rather than my calcium score, in part because medical insurance does not cover CT scans (apparently because they don't consider them to be a reliable predictor of risk) and in part because I have taken steps to significantly reduce my risk.

  • Anonymous

    3/18/2011 2:41:21 PM |

    Let's name names!  I have coverage by United Health Care through an employer.  I have gotten several letters in the past couple of years telling me I NEED this test, or that that test, to maintain my good health!  [However, never anything about the value of lipoprofile testing!]

    I consider this an abhorrent practice, an invasion of my privacy, and totally reject their "advice".  Advice should be coming from my doctor, and in fact it is.  I don't need their nurse "case manager" nor this advocacy for excessive testing.

    There's nothing like a letter from an insurance company to raise blood pressure!

    madcook

  • Barbara

    3/18/2011 4:35:25 PM |

    It is very disturbing to me that 1) her health insurance has access to her medical records and 2) that a for-profit organization is getting involved in her healthcare. Having moved from Australia about five years ago, everything about American health care disturbs me. I trust no one; they all seem to be desiring a profit and therefore paperwork is their main concern, not patient care, health, or longevity.

  • Jonathan

    3/18/2011 6:31:50 PM |

    My last test showed calculate LDL at 208, however the one from three months ago was "directly measured lipid" and showed 263 LDL direct, so might the calculated version be wrong in either direction?  I have pattern A and am FH.

  • susan

    3/18/2011 6:53:21 PM |

    I'm for naming names too!  I have Aetna health insurance through my employer. I don't get letters from them, but I get emails. Just today, I told my email program to automatically delete any further emails from the "Simple Steps to a Healthier Life" program. Plus whenever I sign into the online portal, I get nagged to have all kinds of tests, fill out questionnaires, and join health improvement programs.  I got so tired of the demand that I "fill out a health assessment questionnaire" I finally gave in, hoping it would be removed from the page. It just opened a new can of worms: now I have a half dozen new "suggestions" on my "to do list". Bah humbug!

    I'm of the "live and let live" school.  Why go looking for trouble?  As long as I'm not having symptoms, I feel no need to undergo all of these tests.

    Thank God my doctor is beginning to understand that I'm not going to be taking any of those Pharma-pushed poisons just because my lab results don't meet someone's criteria. Once again, I say Bah humbug!

  • Dr. William Davis

    3/18/2011 7:15:53 PM |

    Thanks for catching that, Teresa.

    It is indeed an eye-opener, isn't it?

  • Dr. William Davis

    3/18/2011 7:17:42 PM |

    Anne and Kris--

    Fascinating non-American perspectives.

    Insurance companies have incredible info on us. I'm always surprised more is not made of this issue.

    Remember: The more they know, the better they are at denying coverage.

  • Anonymous

    3/18/2011 8:19:22 PM |

    Dr. Davis,

    I didn't want to put this here (not sure if I could post it elsewhere) , but I thought you would find this interesting if you haven't seen it yet.

    http://www.psychologytoday.com/blog/p-nu/201103/cardio-may-cause-heart-disease-part-i

    RyanH

  • Anonymous

    3/18/2011 8:25:47 PM |

    Anonymous1 said:
    "I have coverage by United Health Care through an employer"
    Ah, United. I have Oxford/United. '
    Several years ago, when everyone at Oxford (and patients) worked toward a noble goal of "salary" for their CEO of 1.6 Billion a year, they sent me several letters suggesting that I have basic check up. I followed their suggestion. Then, I started to receive letters ... refusing to pay - 100% refusal. Each time, I had to call and ask nicely and politely: "Are you nuts?" They paid.

  • Dr. William Davis

    3/18/2011 10:52:16 PM |

    Though I am not in the habit of defending health insurers, I have found that they tend to provide a benign "you should speak to your doctor about . . ." kind of approach.

    I often wonder, however, if at some point they start to be more coercive. Something like: "You should strongly consider a cholesterol-reducing drug. We anticipate that your premiums may be higher if you do not."

    That would be scary.

  • Anonymous

    3/19/2011 12:50:53 AM |

    Ah, I should have continued.
    In a way, Oxford achieved their goal. What they paid was minimal, but they avoided bigger cost at that time.
    They scared me to death - if they don't pay for what they send to ( with letters firmly printed) which is basic, stated officially in some book as my right, they probably won't pay for anything else. I neglected all symptoms and asked for medical attention when I really didn't have any choice (and in a slightly new climate)
    I was diagnosed with two quite serious conditions - neither curable, but one was preventable and the other was at this time preventable to a degree. I mean the condition would be one only (the result of "bad" accumulation +genes?), less serious and correctable.

  • Contemplationist

    3/19/2011 3:16:40 AM |

    An insurance company has a tremendous incentive to reduce its costs and hence a great incentive to find out the truth. If they are not, it means that something is fishy. Why are insurers not commissioning their own studies? Are they not allowed to? Is it the regulators who are holding them back? Or are they actually stupid?

  • Anonymous

    3/19/2011 3:59:39 AM |

    I have not had any insurers say they know what a patient's lipid numbers are, but they can pretty well tell from claims data what tests have been done, and what medications are prescribed.

    We get faxes all the time recommending that meds be changed or weaned or made as needed rather than routine.  Yes, I know Mrs. Jones has been on an ulcer medicine for 6 months, and we should try to wean it.  What they don't know is that she won't change her diet and lose some weight, so maybe her symptoms would stop, and her symptoms get horribly worse without her ulcer medication.

    Teresa

  • jkim

    3/19/2011 2:57:41 PM |

    Dr. Davis,

    Based on Claudia's numbers, I guess I should expect a letter from my insurance company and a prescription from my doc for a statin. I won't fill the scrip.

    I'm 65, slim, eat VLC, and haven't been afraid of  saturated fat. But I just got my labs and TC was 476, HDL 146, Triglycerides 79 (I'd had wine with dinner--they're usually in the 30s), and LDL 314!!!

    How worried should I be about these numbers?

  • susan

    3/21/2011 1:57:39 AM |

    Hey Dr. Davis,

    At my last visit, my doctor mentioned my lipid numbers; but even he had to admit that my LDL (157) and TC (234) had improved (from 177 and 255), and the rest of my labs were all WNL. I generally eat low carb -- other than my recent indulgence in mini PB cups -- so I suspect that, as you indicated, the actual numbers are better than the official calculated numbers.

    My doc didn’t try to prescribe any meds this time. But at other visits he’s tried to guilt me into following the accepted guidelines by telling me his “performance score” is determined by how well he adheres to those guidelines, including prescribing all the meds and tests recommended by the so-called experts for a patient of my age with my lab results.

    I also fear that things are changing in this regard – and not for the better. Our government has now decided that we all must have insurance or pay a fine. If I refuse to follow the recommended guidelines, either my insurance company or my doctor, or both, may “fire” me. The truth is, I really don’t give a fig which entity it is (doctor, insurance company, or government panel) that tries to hector me into following guidelines promulgated by “experts” who believe in the lipid hypothesis. I simply choose to believe that I’m in charge of my body and that I get to determine whether to take a recommended med or have a recommended test.

    As for insurance companies getting lab results, I don’t know whether the doctor’s office or Quest Labs has been feeding my results to my insurance company, but when I look at my online health info on the insurance company’s web site, all my lab results are listed. And I’m sure the company is basing at least some of its many recommendations on those results.

    I must admit, having the results online makes it easy for me to keep track of them; but given the ease with which records can be hacked, I fear for my health privacy. And I resent the big brother attitude of the insurance company. I'm a well-informed, healthy adult. Treat me like one.

  • ShottleBop

    3/21/2011 4:50:53 AM |

    Just this past week, my insurance company (Aetna), which has paying for my test strips for the past year and a half, sent me a letter suggesting that I might have diabetes, and should talk to my doctor.

  • jkim

    3/21/2011 1:39:31 PM |

    Hi Dr. Davis,

    I spent the weekend reading your older posts about LDL. I guess I need to get a test done to determine my LDL particle number before my doc and I have a discussion. Thanks for posting that info in such detail on your blog.

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Postprandial pile-up with fructose

Postprandial pile-up with fructose

Heart disease is likely caused in the after-eating, postprandial period. That's why the practice of grazing, eating many small meals throughout the day, can potentially increase heart disease risk. Eating often can lead to the phenomenon I call triglyceride and chylomicron "stacking," or the piling up of postprandial breakdown products in the blood stream.

Different fatty acid fractions generate different postprandial patterns. But so do different sugars. Fructose, in particular, is an especially potent agent that magnifies the postprandial patterns. (See Goodbye, fructose.)

Take a look at the graphs from the exhaustive University of California study by Stanhope et al, 2009:



From Stanhope KL et al, J Clin Invest 2009. Click on image to make larger.

The left graphs show the triglyceride effects of adding glucose-sweetened drinks (not sucrose) to the study participants' diets. The right graphs show the triglyceride effects of adding fructose-sweetened drinks.

Note that fructose causes enormous "stacking" of triglycerides, meaning that postprandial chylomicrons and VLDL particles are accumulating. (This study also showed a 4-fold greater increase in abdominal fat and 45% increase in small LDL particles with fructose.)

It means that low-fat salad dressings, sodas, ketchup, spaghetti sauce, and all the other foods made with high-fructose corn syrup not only make you fat, but also magnifies the severity of postprandial lipoprotein stacking, a phenomenon that leads to more atherosclerotic plaque.

Comments (20) -

  • KENNY10021

    11/12/2009 2:01:55 PM |

    What if spaghetti sauce is NOT made with HFCS? I love my spaghetti sauce over my chicken.......in moderation.

  • LynneC

    11/12/2009 2:58:34 PM |

    Nice find.... this really demonstrates the insidious nature of HFCS, on multiple fronts.

  • homertobias

    11/12/2009 3:04:43 PM |

    Dr. Ron Krauss again.  Any research with his name on it is superb in my book.  I wonder if he knows Dr. Lustig (UCTV Fructose lecture).  They are neighbors.  So is BG.  Thanks for the whole reference.

  • LPaForLife

    11/12/2009 3:50:40 PM |

    Dr. Davis,

    Given this information. If someone has a good BMI and good overall diet without grains, how much fruit should they limit themselves to in a day. Should they only eat this fruit with a meal and not eat it alone between meals?

  • Anonymous

    11/12/2009 5:47:48 PM |

    Is Grazing on protein and vegetables also bad?

    Thanks,
    Penny

  • Will

    11/12/2009 9:42:57 PM |

    Wow. I guess fructose of any source would be bad, not just HFCS but eating an apple as well? It's hard to rationalize why something that is found in nature, is a whole food, and appeals to our sense of taste, would be bad for us. Maybe the fact that the fructose in the the study was in liquid form, versus being held up in some fiber, had something to do with the results but this isn't the first time that I have read that fruit is bad for you.

  • Dr. William Davis

    11/12/2009 10:32:50 PM |

    Keep in mind that the design of studies like this are often meant to yield exagerrated effects for the purposes of clean observations. It does not necessarily mean that every time you eat, you get similar postprandial phenomena.

    Nonetheless, I believe there are important lessons from such studies.

  • Anonymous

    11/12/2009 11:39:36 PM |

    This study suggests that a rice cracker or a potato (converted directly to gluclose) might be more healthful than a piece of fruit

  • pmpctek

    11/13/2009 3:33:20 AM |

    I've been able to adapt relatively easily to everything in your TYP program Dr. Davis, but this one seems to be the toughest for me.

    I don't think I can eat one meal a day.  I have always been blessed with a fast metabolism and need at least 3,000 (LC) calories even on a moderately active day, or I start to lose weight, which at 5' 9" 165# @ 8% BMI, I don't want to do, and probably shouldn't.

    3,000 calories is simply too much for me to eat in one meal.  Plus, it seems so counter-intuitive to good health, like maintaining a good energy/thermogenic/glucose/insulin/nitrogen balance throughout the day.  It just seems a perfect recipe for storing fat at the expense of lean mass, which is the complete opposite of paleolithic man's highly muscular, lean composition. I don't know, maybe just I wouldn't survive well back then...

  • Anonymous

    11/13/2009 9:43:58 AM |

    This is an excellent point- the reverse of intermittent fasting and variation in calorific consumption. Excess macronutirent calories, in the wrong form, at frequent intervals. No surprise there are adverse implications. OB

  • moblogs

    11/13/2009 10:40:00 AM |

    It rings a bell. My maternal grandfather died not long after a meal.

  • LynneC

    11/13/2009 2:29:51 PM |

    Re fructose from fruit vs HFCS, I don't think that there's much comparison.

    There are benefits to eating fruit (antioxidants, fiber, vitamins).  There is no benefit to consuming HFCS.

    Choose your fruits carefully and eat in moderation...

  • Helen

    11/14/2009 12:27:30 AM |

    I doubt that eating fruit is the same as eating refined fructose.  Not all fruit is high in fructose, for instance.  Also, the fiber in the fruit slows absorption, and this may give time for the fructose to be fermented by bacteria in the gut, producing, for instance, acetic acid, which may be beneficial to fat deposition patterns. (This is just a personal theory of mine.)  

    Furthermore, fruit contains vitamins, minerals, antioxidants, and flavoniods, which can benefit glucose metabolism, prevent lipid oxidization, and dampen the tide of free radicals and advanced glycation end-products (AGEs) produced by glucose and fructose metabolism.

    Those concerned with the effects of fructose from fruit should focus on eating whole fruits only (no juice), and eat mostly berries (low in fructose, high in flavonoids).

    I think it would be wise to separate the valid concerns about refined fructose from fruit.  We could be as off-base about vilifying fruit as people were about eggs.

    Just because a food contains a substance that can is harmful when it's been refined from its source doesn't mean that it has the same effect when found in a whole food.  The digestion and metabolism of whole foods is far more complex than can be understood by studying a single factor.

    If it's something humans have eaten for millennia, and it's safe to say that fruit is, I think it's probably innocent until proven guilty.  Just don't eat refined stuff (including juice), and you'll be fine.

  • Jim Purdy

    11/14/2009 11:13:36 AM |

    I am now trying to eat a diet that is very low in carbohydrates, moderate in protein, and high in fats like butter, omega-3 eggs, and cream cheese.

    This kind of diet seems to prevent the blood glucose spikes and the very unpleasant tachycardia that I get from high-carb meals.

    And it is frequent small meals that best control my blood glucose and the tachycardia.

  • Dr. William Davis

    11/14/2009 1:47:09 PM |

    Pmp--

    Eating once a day was not the intended message.

    This discussion is simply part of a larger discussion on the effects of various foods on postprandial patterns. We must all eat and preferably do so 3 times a day.

  • camilynn

    11/19/2009 7:08:46 AM |

    Good one on "Postprandial pile-up with fructose".I'm using the methods from http://debtfreeliving.lose20.com to reduce weight and it really works.

    Thanks,
    Edwin-   Lose 20 - Losing weight may save your life

  • Walter

    11/27/2009 6:00:10 AM |

    Hey, not all  spaghetti sauce has added fructose. Those made with sugar and or fructose cost more, because they are cheating on the ingredients.

    And yes, sugar is (half) fructose.

    Dr. William Davis, do we have any studies that show 3 times a day is optimal? One could hardly do a double blind study on this.

  • Anonymous

    10/19/2010 10:29:18 PM |

    I ate 50 grams of grapefruit (with extra fiber), with my last meal of the day and it spiked my blood sugar from 120 to 170 in 1 hr and I think I felt the beta cell damage for several hours - fruit is worse than oatmeal WITH sugar! I am pre-diabetic. I am trying to give up all bad things, but I am starving and I have to eat. I have chewing problems, so this complicates things. I tried soymilk, but it seemed to destabilize me, which is not good - I'll try it with fiber next time. I am underweight now. I am in a real bad place. I can't eat fruit anymore and even veggies give me problems. I hope I can avoid scurvy. Does anyone know if vitamin C pills truly prevent scurvy?

  • Documentaries

    11/1/2010 9:06:16 PM |

    I don't think I can eat one meal a day. I have always been blessed with a fast metabolism and need at least 3,000 calories

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Low HDL makes Dr. Friedewald a liar

Low HDL makes Dr. Friedewald a liar

There's a $22 billion industry based on treating LDL cholesterol, a fictitious number.

LDL cholesterol is calculated from the following equation:

LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5

So when your doctor tells you that your LDL cholesterol is X, 99% of the time it has been calculated. This is based on the empiric calculation developed by Dr. Friedwald in the 1960s. Back then, it was a reasonable solution, just like bacon and eggs was a reasonable breakfast and a '62 Rambler was a reasonable automobile.

One of the problems with Dr. Friedewald's calculation is that the lower HDL cholesterol, the less accurate LDL cholesterol becomes. If it were just a few points, so what? But what if it were commonly 50 to 100 mg/dl inaccurate? In other words, your doctor tells you that your LDL is 120 mg/dl, but the real number is somewhere between 170 and 220 mg/dl. Does this happen?

You bet it does. In my experience, it is an everyday event. In fact, I'm actually surprised when the Friedewald calculated LDL closely approximates true LDL--it's the exception.

Dr. Friedewald would likely have explained that, when applied to a large population of, say, 10,000 people, calculated LDL is a good representation of true LDL. However, just like saying that the average weight for an American woman is 176 lbs (that's true, by the way), does that mean if you weigh 125 lbs that you are "off" by 41 lbs? No, but it shows how you cannot apply the statistical observations made in large populations to a single individual.

The lower HDL goes, the more inaccurate LDL becomes. This would be acceptable if most HDLs still permitted reasonable estimation of LDL--but it does not. LDL begins to become significantly inaccurate with HDL below 60 mg/dl.

How to get around this antiquated formula? In order of most accurate to least accurate:

--LDL particle number (NMR)--the most accurate by far.

--Apoprotein B--available in most laboratories.

--"Direct" LDL

--Non-HDL--i.e., the calculation of total cholesterol minus HDL. But it's still a calculated with built-in flaws.

--LDL by Friedewald calculation.

My personal view: you need to get an NMR if you want to know what your LDL truly is. A month of Lipitor costs around $80-120. A basic NMR costs less than $90. It's a relative bargain.

Comments (5) -

  • Mike

    3/18/2007 1:52:00 AM |

    What is shocking is that enormous prescriptions for statins are written based on the calculated LDL.

  • Dr. Davis

    3/18/2007 1:16:00 PM |

    Yes, $22 billion last year, in fact. All prescribed for a number that is a crude estimate, sometimes a complete fiction. Imagine your state trooper ticketed you because his radar device said you were doing 60 mph when you were really doing 35 mph.

  • Anonymous

    2/6/2008 1:37:00 AM |

    Why NMR over the other tests Berkeley Heart Lab or VAP?

  • Anonymous

    7/2/2008 7:02:00 PM |

    I don't understand.  If in this example, the doctor (wrongly) thinks the LDL number is 120mg/dl, how does that cause the prescription of Lipitor? Unless I'm reading it backwards, and the doctor is actually telling the patient their LDL is 170mg-220mg, but unwittingly, it's actually 120mg/dl.

    And, if a low HDL causes the LDL number to be inaccurate, does that also cause the total cholesterol number to be inaccurate too?

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Does fish oil cause blood thinning?

Does fish oil cause blood thinning?

Omega-3 fatty acids from fish oil have the capacity to "thin the blood." In reality, omega-3s exert a mild platelet-blocking effect (platelet activation and "clumping" are part of clot formation), while also inhibiting arachidonic acid formation and thromboxane.

But can fish oil cause excessive bleeding?

This question comes up frequently in the office, particularly when my colleagues see the doses of fish oil we use for cardiovascular protection. "Why so much fish oil? That's too much blood thinning!"

The most recent addition to the conversation comes from a Philadelphia experience reported in the American Journal of Cardiology:

Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel--versus--aspirin + clopidogrel in patients with cardiovascular disease.(Watson et al; Am J Cardiol 2009 Oct 15;104(8):1052-4).

All 364 subjects in the study took aspirin and Plavix (a platelet-inhibiting drug), mostly for coronary disease. Mean dose aspirin = 161 mg/day; mean dose Plavix = 75 mg/day. 182 of the subjects were also taking fish oil, mean dose 3000 mg with unspecified omega-3 content.

During nearly 3 years of observation, there was no excess of bleeding events in the group taking fish oil. (In fact, the group not taking fish oil had more bleeding events, though the difference fell short of achieving statistical significance.) Thus, 3000 mg per day of fish oil appeared to exert no observable increase in risk for bleeding. This is consistent with several other studies, including that including Coumadin (warfarin), with no increased bleeding risk when fish oil is added.

Rather than causing blood thinning, I prefer to think that omega-3 fatty acids from fish oil restore protection from abnormal clotting. Taking omega-3 fatty acids from fish oil simply restores a normal level of omega-3 fatty acids in the blood sufficient to strike a healthy balance between blood "thinning" and healthy blood clotting.

Comments (20) -

  • Marc

    10/26/2009 9:46:32 PM |

    Long time reader, first comment.
    Thank you for so freely sharing all the information.

    Marc

  • Daniel

    10/26/2009 11:02:46 PM |

    Thank you for this!  I have had this question for a long time given the number of things I take that "thin the blood."

  • Kevin

    10/26/2009 11:44:45 PM |

    As a veterinarian I've dispensed fish oil capsules for several years.  Some owners give so many that the dogs smell 'fishy' when seen for routine care.  The owner doesn't smell it since they're with the dog a lot.  The coats are gorgeous, something that doesn't often happen in Wyoming at 7000ft altitude.

  • Dr. William Davis

    10/26/2009 11:47:45 PM |

    Hi, Kevin--

    My two Boston terriers jump for their fish oil capsules, two every day!

    I'm glad to hear from a veterinarian that the coat sheen is indeed from the fish oil.

  • Rich

    10/27/2009 1:27:09 AM |

    Due to an afib episode a couple of years ago, I was taking 20 mg of warfarin per day, plus around 5000 mg of EPA+DHA, and never had bleeding issues.  

    My INR was always a stable 2.0.

    As I've not had an afib reoccurrence, I've replaced the 20mg coumadin with 325mg aspirin daily, and still take around 5000 mg EPA+DHA.  No bleeding issues with that combo either.

  • Catherine

    10/27/2009 3:55:32 AM |

    Glad this topic came up.
    Over the last 5 years, I've had to periodically eliminate my fish oil intake as I would start to bruise badly. My internist said she has seen this occasionally with fish oil and called it "capillary fragility." I bruise easily anyway, but it would really get bad with fish oil. So there must be some quality in fish oil that influences this.

    Then about 6 months ago I started a strong supplement change to help with my low bone density--already taking magnesium and calcium but added:
    Boron, K2, silica,pomegrantate juice, and BIG increase in vitamin D.
    I also increased omegas to 3,000 a day which I was not able to tolerate before.

    It has been over 4 months since I have had ANY bruise---which is just unheard of for me. I usually have 3-4 different bruises on arms/legs. So something in these supplements  strengthened my capillaries I guess, and I can now take high fish oil doses!
    Anyone else had a bruising problem with fish oil?

  • Dr. William Davis

    10/27/2009 11:04:59 AM |

    Hi, Catherine--

    Fascinating observation!

    I'll bet it has something to do with the vitamin D, more than anything else. Vitamin D seems to strengthen structural tissues in bones, muscle, heart valves, and perhaps capillaries and other small blood vessels.

  • trix

    10/27/2009 11:59:37 AM |

    Several years ago I bruised easily for a while and attributed it to taking garlic supplements daily.  I started taking Vit C and the bruising stopped.  I don't think it had to do with fish oil (in my case); I don't think I was taking fish oil at the time.

  • Daniel

    10/27/2009 9:37:33 PM |

    I too achieve rapid blood thinning when taking 2400mg of EPA/DHA per day. That's only 4 pharmaceutical grade capsules. Even after my vitamin d levels were normalized I still got bruising.

    I now take Vitamin K2 (MK-7 natto extract) twice a week and it's allowed me to bump my EPA/DHA up to 3600mg with no ill effects or bruising.

    It was either supplement or eat a lot of aged cheese, they both seemed to do the trick in my particular case.

  • Healthy Oil Guy

    10/27/2009 9:53:51 PM |

    Thank you for sharing this study with us.  It helps clarify whether there is a risk for blood thinning from taking fish oils.  This information may help individuals who are taking blood thinning medications and considering adding fish oils to their daily diet.

  • Dave

    10/28/2009 2:22:01 AM |

    Catherine,

    Without a doubt, your cessation of bruising was due to vitamin k2. I routinely take nattokinase, large doses of fish oil, curcumin, and other blood thinning agents, and if I don't take vitamin K2, I will begin bruising. (I also take high doses of Vitamin D). When I take K2, I have absolutely no bruising.

    Vitamin K2 has many clinical trials showing that it helps endothelium  integrity and elasticity.

    Also, grapeseed extract and pine bark extract (specifically oligomeric proanthcyanins) has the same beneficial effect.

  • Catherine

    10/28/2009 4:41:41 PM |

    Daniel,

    That's really interesting! There is a lot of research on K2's effect on strengthening weak bones. Bone fractures go down considerably when high doses of K2 are used (Japan is using K2 as osteoporosis treatment) BUT studies show it needs to be in conjunction with adequate calcium and Vitamin D---they work synergistically for bone strength.  So it makes sense that K2 and D could do the same with strengthening fragile capillaries. I am also taking the M7 natto form.

  • Catherine

    10/29/2009 12:01:36 AM |

    Dave,

    Thanks for sharing your experience with this, you've really confirmed it now for me.  I can't believe I have suffered with this for most of my life with no answers (tried high dose Vit C, grape seed, etc) and now within months on K2, there's no bruising and I can tolerate fish oil. Hope my bones are responding this well!
    This blog is so helpful....

  • Mina

    10/29/2009 12:21:31 PM |

    Thanks for posting this. The question recently came up in our office. I like your assertion that omega-3s restore the blood to normal and remove abnormal clotting. And to comment on a post above, our dog has a beautifully shiny coat and takes 2 pure EPA capsules each day!

  • Term papers

    1/26/2010 3:40:08 PM |

    I have enjoyed reading That During nearly 3 years of observation, there was no excess of bleeding events in the group taking fish oil. (In fact, the group not taking fish oil had more bleeding events, though the difference fell short of achieving statistical significance.

  • Viagra Online

    8/23/2010 6:41:39 PM |

    I've been drinking fish oil for many year and I don't have any chance in my body people use to said me that but I think it is just a rumor.

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    11/3/2010 10:19:55 PM |

    I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!

  • moseley2010

    12/7/2010 2:37:16 AM |

    I haven't heard of this problem
    fish oil supplements. But now we know what to tell them when this sort of concern comes up. Fish oil or Omega-3 is really beneficial to health. It's just important that it comes from clean waters.

  • Jack

    3/12/2013 7:03:38 PM |

    What is an appropriate dose of fish oil for someone taking coumadin?

  • dorange

    6/15/2014 3:53:03 PM |

    Dr. Davis, when  person is taking Tamoxifen...
    (1) is it safe to take vitamin k2 or K1?
    (2) will fish oil have a role in preventing blood clots?

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Video teleconference with Dr. Davis

Video teleconference with Dr. Davis


Dr. Davis is available for personal
one-on-one video teleconferencing

to discuss your heart health issues.


You can obtain Dr. Davis' expertise on issues important to your health, including:

Lipoprotein assessment

Heart scans and coronary calcium scores

Diet and nutrition

Weight loss

Vitamin D supplementation for optimal health

Proper use of omega-3 fatty acids/fish oil



Each personalized session is 30 minutes long and by appointment only. To arrange for a Video Teleconference, go to our Contact Page and specify Video Teleconference in your e-mail. We will contact you as soon as possible on how to arrange the teleconference.


The cost for each 30-minute session is $375, payable in advance. 30-minute follow-up sessions are $275.

(Track Your Plaque Members: Our Member cost is $300 for a 30-minute session; 30-minute follow-up sessions are $200.)

After the completion of your Video Teleconference session, a summary of the important issues discussed will be sent to you.

The Video Teleconference is not meant to replace the opinion of your doctor, nor diagnose or treat any condition. It is simply meant to provide additional discussion about your health issues that should be discussed further with your healthcare provider. Prescriptions cannot be provided.

Note: For an optimal experience, you will need a computer equipped with a microphone and video camera. (Video camera is optional; you will be able to see Dr. Davis, but he will not be able to see you if you lack a camera.)

We use Skype for video teleconferencing. If you do not have Skype or are unfamiliar with this service, our staff will walk you through the few steps required.

Comments (4) -

  • Diana Hsieh

    2/10/2010 5:46:45 PM |

    Wonderful!  

    Unless they have some particular questions, I suspect that many regular readers of your blog wouldn't need a consultation with you, as they're already pretty well-informed and/or in good health.

    However, I can see that someone's less-informed mother, father, friend, or whatnot might benefit hugely from such a consultation.  It might make a great gift for Mother's Day or Father's Day!

  • tareq

    2/14/2010 5:14:40 PM |

    you should also give your email ID and some weekly diet plan to be sent through email

  • buy jeans

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

    The Video Teleconference is not meant to replace the opinion of your doctor, nor diagnose or treat any condition. It is simply meant to provide additional discussion about your health issues that should be discussed further with your healthcare provider. Prescriptions cannot be provided.

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