The World Health Organization changed impaired fasting glucose levels from 6.9 to 6.1 in 1999.  The curve used to illustrate the incidence of diagnosed type 2 diabetes indicates a steepening at this time.  If data would have been collected for all patients prior to 1999 and utilized as a retrospective for type 2 diabetes in the population, the incidence rate prior to 1999 would likely have been significantly higher.

Very true, Dr. Davis.  Wheat consumption is up since 1970.  The strange thing is, it was much higher in the 19th century...something like 225 pounds per capita.

historical wheat consumption

Maybe we were eating fewer total carbs then, or expending more energy, if in fact the recent increase in diabetes is wheat-related.

I think since so much wheat is eaten in products that are mixtures of wheat, sugar, and vegetable oil, there's no way to know what the culprit is.

Well the reason is that wheat is the most important factor for our lives.

Hi, Anon--

Yes, indeed. Human life was different for at least rural people.

Also, wheat has changed. This is a crucial, crucial point that explains much of this phenomenon, I believe.

It would be interesting to plot diabetes rates against various possible culprits (pointing out on the graph when diagnostic cutoff changed): wheat, all carbohydrates, size of sodas, computer ownership, average size of restaurant meals, bicycle ownership, hours spent commuting, population older than 65, exposure to Agent Orange, service in Gulf War, and some really silly things like hair length and popular nailpolish colors.

If only wheat consumption seemed correlated, this would be suggestive.

Wre there ads for All Bran bars and wheat links on this site?

Wheat is ingrained in us, beginning with bread as the "staff of life."

correlation does not equal causation.

I don't eat wheat, I suffer from all of the problems you describe and it's also related to my psoriasis.  Good hypothesis with all your measurements of post consumption measurement of blood sugars, but someone needs to do a mass study.

The graph on this post is also very educational:
http://www.gnolls.org/1086/the-lipid-hypothesis-has-officially-failed-part-1-of-many/

The concentrations of zinc, iron, copper and magnesium remained stable between 1845 and the mid 1960s, but since then have decreased significantly, which coincided with the introduction of semi-dwarf, high-yielding cultivars.
at the same time
wheat breeding may have contributed to increased prevalence of celiac disease. and other conditions.
Perhaps other readers are not aware that MAGNESIUM deficiency increases iron absorption so there is increasing danger of Iron Behaving Badly and resulting damage to mitochondrial function.

Hi, Ted--

Great find!

I wasn't aware of these data. Yet another way that increased yield comes at a price.

Dramatic changes in the slope of a curve are easy to see if you're looking for them, but you've displayed an arithmetic, not a logarmitic axis.  Your point would be better made if you could switch the axis and if we still see the association between the variables.

Gretchen - Well said.

I think many things in our modern environment play a role in tipping the scales toward diabetes - including disrupted circadian cycles and environmental toxins, such as fire retardants, plasticizers, and pesticides.  (I don't have time right now to find links from stuff I've read on this - but try Googling these things - the research is there.)  

Jenny Ruhl claimed a short time ago that while prediabetes has risen, actual diabetes has not.  She is a good resource and I would take her arguments on most things diabetes pretty seriously.  Check her blog if interested:  Diabetes Update.  

As a mother of a kid with celiac disease, and for other reasons, I am hardly pro-wheat or pro-gluten, but I'm not convinced grains have caused a rise in diabetes.  My daughter's gastroenterologist, however, has Type I diabetes and says that eliminating gluten has greatly improved her glucose control.

When I eyeball this figure, it looks like the change occurs around 1993-1996.

Helen has a point that under counting of who is "pre-diabetic" is quite possible skewing the data. The CDC changed it's diabetes diagnosis criteria; 1985 wasn't when they did that however.

CDC took their raw 1995 - 1997 data and in 1998 decided to only use fasting glucose, and not the old standard oral glucose tolerance test, as the CDC diabetes template. For all individuals  whose data was showing greater than ( or equal to) 126 mg/dl fasting glucose they were then counted as diabetic by the CDC.

This methodology caused CDC to say U.S.A. diabetics went from 8 million in 1995 to 10.3 million diabetics in 1997; a statistically massive 2 year jump of diabetics. And furthermore, the number of un-diagnosed diabetics was claimed to have gone down (in same period of time); they cut out a whole slew of "pre-diabetics", so to speak.

The other criteria CDC website shows from 1998 is, that when non-fasting glucose hits 200  mg/dl (or more) they are considered diabetic. The reproduced graph Doc posted shows an exponential climb upward right at the time CDC  began using it's altered criteria.

"Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward."

As I look at the presented graph, from 1986 to about 1991 the trend decelerated slightly, then resumed its prior long-term value, then accelerated in about 1997

However, I must admit that 1997 is "after 1985."

Other suspects that became prevalent in the food stream in the 1980s were high-fructose corn syrup and artificial trans-fatty acids, both of which are linked to hepatic insulin resistance and metabolic syndrome.

I think of all the intelligent, scientifically-reasoned arguments all lead back to the commonsensical notion "Don't eat junk." To start, anything with enriched (aka processed) flour, partially hydrogenated oils, or high fructose corn syrup qualifies as junk. Which isn't to say all disease eminates from just those three ingredients, but I believe completely eliminating those three ingredients would yield a large health benefit to most Americans.

It takes years for type 2 diabetes to develop. A shift in the rate at which people are diagnosed with it would be caused by something that happened some time before the shift.

1960 to 1970 is also the time frame that chemical fertilizer came into the mainstream. On the farm I was raised on, along with chemical fertilizers came mineral supplements for the hogs that were living on the fertilized barley. They "failed to prosper" on fertilized barley, where they did just fine on unfertilized barley. By the why, fertilized barley produced over twice the volume of grain, and I assume the same mineral absorption. You can blame the grain, but I believe it could be the fertilizer.

@  justdoinglife
You can blame the grain, but I believe it could be the fertilizer.
Does early-life exposure to organophosphate insecticides lead to prediabetes and obesity?
Slotkin TA.

The chart for the growth of the national debt looks the exact same. I wonder if there is a correlation between the advance of socialism and the cultural ascendancy of the Lipid hypothesis? I'd bet the ranch that the destruction of American health and the destruction of the American economy is not a coincidence.

Duke university 2008 study fed new born rats 0.1 mg/kg body weight of the organophosphate pesticide parathion, for 4 days. When the rats were adults and fed a high fat diet they noticed a different response among the sexes.

In the adult females the high fat diet resulted in a 30% higher weight gain ( vs. high fat fed males' 10% weight gain) over controls (according to respective sex) on the same diet. This type of pesticide exposure to young children may be part of how obesity is rising; the standard western fare is high in generic fat content.

For the parathion early exposed adult male rats fed on a normal diet (ie: not high fat) the results also seem troubling. They gained weight, glucose levels rose, fat break down was inhibited and they were pre-diabetic; as compared to male controls.

Counter-intuitively, another group of male new born rats fed parathion at 0.2 mg/kg body weight (4 days) when fed a normal diet as male adults actually weighed less than their male controls. Whereas, the female rats (fed normal diet in this case) who got both 0.1 & 0.2 mg/kg parathion (4 days) all weighed less than their female controls. Mothers, don't try this at home.

Another culprit:

SSRIs.  Prozac was first marketed in 1988.  (It was not the first, however - some came on the market slightly earlier that decade.)  SSRIs impair glucose tolerance and are associated with an increased risk of diabetes.  

I think there are some modern-day smoking guns more convincing that increased grain consumption for increased obesity, insulin resistance, and risk of diabetes.  Although they are a neolithic food some of us may not be exquisitely adapted for, they have been around for 5,000 years, while the obesity epidemic is quite recent.

Hi Helen,
In 1938 there was a U.S.A. National Conference of Governmental Industrial Hygienists ; since 1941 the word national was replaced by "American" (ie: now is the ACGIH). 1946 the ACGIH set maximum limits on 148 compounds; which in 1956 became their "Threshold Limit Value", (TLV).

TLV is not saying "x" level is always safe; just what is supposedly tolerable exposure for most "healthy" adults. ACGIH lays their TLV data out for industrial hygenists to use in their field, not for laymen's general use.

2-butoxy-ethanol TLV (as a gas or evaporating vapor) is set at 20 ppm. This chemical is the favorite solvent in household spray and wipe cleaning products.

It makes me wonder if the U.S.A. adult female house cleaner suffers metabolic syndrome at a higher rate than other individuals. If so then might not close decades of breathing 2-butoxyethanol droplets have had/has epigenetic synergy?

1971 O.S.H.A. took 470 TLVs from ACGIH data and now calls those TLV by the phrase "Permissible Exposure Limit" (PEL). Meanwhile, as of 2010 there are 642 TLVs set out by ACGIH.

The European Union has a registry of 143,000 chemicals in use (or used); and there are +/- 50,000,000 chemicals known to exist (as per Chemical Abstract Service Registry). The EPA has more details; for searching if you're curios: www.epa.gov/grtlakes/toxteam.
pbtrept/pbtreport.htm

2012 the European Union is set to report on chemical testing of all chemicals manufactured in excess of 1,000 tons annually. You'll see that as data reported from "REACH" (Registration, Evaluation, Authorization and Restriction of Chemical Substances).

If you want to track down what chemical is in a product then search out the manufacturers "MSDS" (material safety data sheet). Some claim "trade secret" ingredients and then you can only guess on what is involved.

I love the triglyceride posts as I have been working on mine for a number of months.  Was well over 1000.  On low carb, virtually no grains, tricor (200mg), and a healthy dose of fish oil I was still at 233.  I am wondering if it will take my body/metabolism some time to heal before I can get lower.  As you might imagine I am sporting an HDL below 25.  I am working it diligently, have lost a ton of weight and get healthier by the day.  I should be sending Dr Davis a stipend for my improvement!

Dr. Davis,
please kick out of your spam filter the post I just sent on the 12th saying "Hi Helen,". It had resources for her interest in modern chemicals.

To Helen,
If my 12th post doesn't show up soon (2 days?) and you request it on this thread I will try to recreate it here. Maybe you've moved on to newer threads; I don't usually monitor old threads, but I will this for a few days.

Unfortunately, it doesn't seem like this ascent is going to slow down anytime soon.  Even if people in recent years seem to be taking a more health-savvy approach to their eating habits, it wouldn't be surprisingly to see this trend continue regardless.

Western countries have also seen a rise in sugar consumption along with wheat consumption over the same time period.

Taubes has just published a piece
"Is Sugar Toxic" and winds his way through diseases of Western cultures from sugar causing metabolic syndrome to sugar be implicated in cancer formation.
http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=1&_r=2&ref=magazine

No where was there any mention of wheat..I don't think we can isolate wheat as the primary culprit in Diseases of Civilization.  Wheat Plus Sugar, the double whammy.

One step forward, two steps back.

Chocolate Cheerios are good for the heart. If you don't believe this go here http://www.cheerios.com/ourCereals/ChocolateCheerios/ChocolateCheerios_home.aspx

I had a bowl of bran flakes and checked my blood sugar. 141. Yikes!

I have been down on wheat family of grains for a long time, but for other reasons than the health consequences tied to peak blood sugar elevations [and consequent hypoglycemic phases].  I'm down on the inflammatory oils and the allergy aspects.

Have you investigated HEMP SEED?  It is high in protein and packed with good oils.   How does it rate with your diet suggestions?    Would it be good to run some trials?

CEREAL FACTS This site has some interesting factsheets about the different cereals.

In particular I found this The influence of high vs. low sugar cereal on children’s breakfast consumption shows what kids will eat away from home and provided with sugary cereals or not.
These are the cereals most heavily promoted to kids
and here is their sugar content.

AHA Nutritional Criteria for Certified Foods

"they have blundered big time by pushing low-fat ... it is time to quietly start backpedaling."

They're backpedaling all right, but it's not because they are abandoning the low fat message.  The average consumer is not quite ignorant enough to believe Cocoa Puffs are healthy, and they don't want that 60% that are affected by their check mark to drop.

Just got an AHA solicitation in the mail this week.  Like so many other organizations, they do not act in the best interest of the people they claim to serve.  My money and time are better spent pursuing the more promising preventative practices such as those promoted by TYP.

A colleague eats a Quaker oatmeal square for breakfast every morning.  Among the ingredients listed on the label is partially hydrogenated soybean oil, not enough, apparently, to bump the transfat content above .5 grams, so the nutrition label lists 0 grams of transfat.  No amount of transfat is healthy, yet this product has the AHA seal of approval. I used to eat granola bars when I thought they were healthy.  I read labels and noticed that quite a few use partially hydrogenated oils, including brands that boast of high fiber or Omega 3 content.

Maybe the people at Cocoa Puffs stopped writing checks. Who needs an endorsement when your product contains wheat, sugar and chocolate and is marketed to kids in an I-want-to-be-my-child's-friend mileau?

As if these cereals aren't bad enough...
KFC is selling their fried chicken in Pink "Buckets for the Cure" for Breast Cancer fund raising.
It left me speechless.
I've said it before... we're on our own.

http://www.cnn.com/2010/LIVING/homestyle/04/28/kfc.pink.bucket.campaign/

The site Ted linked to (www.cerealfacts.org) has a list of Top 10 Cereals by Nutrition Score.  None of those top 10 are on the AHA list of heart-healthy cereals.

Scientific American Magazine - April 27, 2010, Title: "Carbs against Cardio: More Evidence that Refined Carbohydrates, not Fats, Threaten the Heart"

Dr Davis,

This question is off the topic. I read your book Track your plaque a month back and had been to AZ heart institute and got my plaque measured.

I am a Type 2 Diabetic for the past 11 years and am actively low carbing (<30g carbs per day) and 100% grain avoiding since May 2008.

My calcium score was 0.

But the staff was not able to say whether the machine they used was EBT/MDCT. They said it is newer than EBT. The machine had GE 64 slice VCT printed on it. Can you confirm if this is the one you are asking people to have it calcium scored?

I live in Phoenix, AZ and had been to AZ Heart Institute (got the information from "Track your plaque" book).

Please let me know if I got calcium score done in a machine in which I am supposed to do.

Thanks for all the help.

Thanks

Venkat

IS VERY GOOD..............................

> I had a bowl of bran flakes and checked my blood sugar. 141. Yikes

It is a great idea to check blood glucose levels after meals, just bear in mind that they can vary rather erratically:

http://healthcorrelator.blogspot.com/2010/05/blood-glucose-variations-in-normal.html

Oats, oats, oats is the common thread of the "survivors." Either the oat industry is doing an excellent coordinated marketing attack or there is something to the claim that oats are good for cardiovascular health.

I don't eat cereal of any kind. Have no desire to. A much healthier choice altogether would be cottage cheese with fruit or just fruit, scrambled eggs or even bacon cooked extra crispy.

There are  thousands of websites which provides information  about  
how is angioplasty done.
But dilseindia is one  of the websites where one can get good info about the  angioplasty.

Thanks for this article.

I can't accept NPR's statement that 25% of firefighters have no health insurance. I think that all permanent public employees everwhere in the US have health insurance. A firefighter's union would certainly secure this benefit.

Dr. Davis, I agree Tom has hit on something HUGE with his film FAT HEAD which is why I asked him to join us on the cruise to show his film.  THANK YOU for your incredible contributions during the conference and I am grateful to you for your generous donation of time to join us.

The low-carb manifesto tries to convince you that fat doesn't matter and therefore calories don't matter.  LC books pander to the people who can't or won't control their appetites, telling them, 'It's not your fault, have some brie instead of a cookie'.

But ingested fat being twice the calorie density of carb or protein does eventually add to the fat stores.  Those LC dieters who lose weight and maintain have CCK's effect on satiety to thank.  

kevin

Tom Naughton's diet related blog is also worth keeping an eye on.
Always interesting, sometimes extremely funny, he believes in straight talking so doesn't mince his words.
Tom's other blog is also interesting

This is great! Check out my blog post on blood sugar and metabolic syndrome...http://tinyurl.com/y9tr8va

It is a good film and the animation of how fats get into cells made it easier to understand. Tom's blog is always an entertaining and educational read. http://www.fathead-movie.com/

I so wish I could have been on the cruise - maybe next time.

Hi Dr. Davis,
this is a comment for your fish oil article.  I have a curious case: one has very high triglycerides (above 1000 mg/dL) and recurrent acute pancreatitis since 20s, have been taking 9grams of omega-3 in combination with 145mg tricor, 40mg simvastatin and niacin (1g) per day for 1 year and haven't successfully lowered the triglycerides.  His LDL and cholesterol are both normal with very low HDL (<20). No liver, kidney, pancreas or thyroid disease.  Underweight, not drinking, follow a strict low fat, complex carb, good protein, high veggie diet.  What do you recommend?

freyal, just wondering what your goals are with your patient?  If you are trying to kill him, you are doing a good job.  

A low-fat, high "complex" carb diet will keep the triglycerides high and the HDL low, as you have proven.  It doesn't matter how much fish oil, statins, or niacin you add, until you re-align your thinking with regard to diet, you are never going to help this guy.

Have you actually read this blog?  Because your question is ridiculous if you have.

Thanks for your response!  I actually just started reading this blog more extensively after posting my comment above.  I see Dr. Davis's point on limiting carb.  So do you recommend low-fat low carb diet?  He actually tried low-carb high protein diet sometime ago but without much success.  Because it is hard to just eat protein (will be very high protein here for 2000-cal daily intake) without fat and carbs.  Maybe the failure was because he couldn't limit fat as strictly as in the low-fat, carb+protein diet.  His TG is very sensitive to dietary fat too.  But now we will try low fat, low carb and high protein diet and see if there is a reduction.


Another problem is, what do you recommend for the "gas" problem associated with high protein diet?  Thanks for your help!!

Freyal, so you are saying his chylomicrons don't get cleared from the blood within reasonable time?

freyal, no, high-protein/low-fat is not good either (look up "rabbit starvation").  Use a very low-carb/ moderate-protein/high-fat diet.  The best fats to raise HDL and lower triglycerides are saturated fats like butter, tallow and coconut oil.  Stay away from vegetable and most nut oils, especially because they are high in inflammatory omega 6 oils.

Gas (usually caused by fermentable carbohydrates, including lactose if he is eating dairy) may not be much of a problem when you correct the diet but if it is, try digestive enzymes and betaine HCL.  

Check out some other blogs on Primal or Paleo diets.  http://www.paleonu.com/ is one of the best, click on "Get Started" to see the diet then check out the rest of the blog!

Hi Anna,
yes.  His TG remains above 1000 with healthy diet and TG lowering medications.  His TG would only come down to normal level after several days of fasting during hospitalization due to acute pancreatitis.

Hi Anonymous,
thanks for the rabbit starvation info.  I thought high protein-low fat-low carb would be lacking a lot of essential nutrients.  

But about your point that "The best fats to raise HDL and lower triglycerides are saturated fats like butter, tallow and coconut oil.", I have never heard about this and could not find any source.  Could you please point me to some studies that support this claim?  Thanks!

freyal - is the patient gluten free instead of just wheat free?

Hi,
he is not gluten free or wheat free.  He tried moderate-fat, low carb, high protein diet, and also low-fat, moderate complex carb + moderate protein diet.  Both did not work to lower his TG.  He is not allergic to gluten I believe.

Someone above mentioned high saturated fat (butter palm oil etc) works better to lower TG.  I'm not sure about this approach.  Even if there are studies supporting this (I only found one so far),they were all done with normal people.  He is not normal in terms of TG, he has genetically very high TG and is very sensitive to dietary fat (be it saturated or unsaturated) and would get acute pancreatitis every time following a large heavy greasy meal.  
I appreciate all your comments, please leave more if you have thoughts about this patient, thank you!

freyal - start with the PaNu blog and then look at the following blogs http://high-fat-nutrition.blogspot.com/, http://drbganimalpharm.blogspot.com/. http://www.nephropal.blogspot.com/ - you will see hundreds of studies analyzed.

the niacin is too low.  it should be 3gms/day.  ensure it is niacinic acid.

http://www.lipidsonline.org/slides/slide01.cfm?q=niacin

and

McKenney JM, McCormick LS, Schaefer EJ, et al. Effects of niacin and atorvastatin on lipoprotein subclasses in patients with atherogenic dyslipidemia. Am J Cardiol 2001;88:270-274.