I stopped eating wheat and sugar after I read Gary Taubes's book (Good Calories, Bad Calories).  I haven't lost any weight, but I suspect it's still a good thing: it's not like there's a shortage of things to choose from.  But it's hard to imagine that my body was designed for refined food products.

I'm trying to explain low carb to my fiance and could use some help. I tried the Atkins diet a few years back, lost nearly 30 lbs and dropped my slightly over 200 cholesterol to 150 IIRC. I was working out a lot as well.

The problem is that she and her dad tried Atkins and the father ended up in the hospital and she got sick. The Dr. said that since Atkins/lo carb became popular they had more problems with colon issues.

They apparently were getting enough fiber and water. I'm thinking potassium might be an issue for her as at some point in her life they said she was low and needed to eat more potassium rich foods.

In the Voleck study, low carb was 12% carbs but what was called low fat was 24% fat.  My experience and research by McDougall, Ornish, Esseltyn, etc indicates that if a truly low fat diet (10% fat; the difference made up by adding more complex carbs) were tested the results would be at least as good as if not superior to the low carb diet.

In answer to your last question: Because the American Heart Association derives a significant fraction of it's funding from Cargill, ADM, General Mills, and other agribusiness giants.  If the AHA changed to a set of dietary recommendations that didn't help line the pockets of agribusiness by creating demand for highly processed foods (whole foods are notoriously unprofitable), it would mean the end of their funding stream.

Follow the money and most mysteries are solved...

Keep up the great work Anne & Dr. Davis!

Hi, see some of my posts at www.dailyrantingspot.blogspot.com where I talk about some of the boring science of low carb.  Anne's experiences are common for people who eliminate carbs from their diet.

This is why South Beach is a bit better, because of the emphasis on vegetables with fiber, and drinking enough.  I know my husband's triglycerides have plummeted to low normal.  A low fat diet doesn't "satiate" you enough that you can stand not to eat.  Obese people get used to eating, and that's a problem for attempting to lose weight.

I don't know if ornish, etc. is truly superior.  I think that superior would have to be sustainable.  For all but probably 5% (pure guess here) of the population, that type of very low fat, vegan, diet is not sustainable or maintainable.

I think that wheat free, no sugar, low carb, real foods diet is much more sustainable/maintainable for a great percentage of the population.  And, a lot of Esselstyn's work was with low dose Chol. meds.  Dr. Davis appears to take the no-meds approach.

As an experiement of 1, my labs on a very near Esselstyn diet were further from the 60/60/60 goal of Dr. Davis than they were on a very near TYP diet that included quite a few more carbs than likely recommended.

Drstrange, for 50 years I tried to eat the so called healthy diet.  My favorites were McDougal and Ornish among 25 other low fat high carb gurus.  I gained after yo-yowing, 60 pounds and along the way I developed diabetes type 2 and kidney disease.  Thanks to Dr. Davis and my kidney doctor who is an advocate for low carb diets and turned me on to this blog and now writes his own www.nephropal.blogspot.com, I have been eating low carb for 7 months now and I am down 50 pounds and now have an hbA1c of 4.7.  While I know that kidney disease can't be cured, some of my kidney disease numbers have improved.  Forget about high carb and low fat, that's what is killing us.

We now see more and more products jumping onto Omega 3 health benefits to market fundamentally unhealthy foods.

Kellogg’s Live Bright Brain Bars contain 100 mg of DHA which is one-third of the 300 mg of DHA/ EPA recommended by the American Heart Association.

But if you look at the ingredients of these bars you find.
Coating Sugar, Partially Hydrogenated Palm Kernel Oil, Cocoa Processed with Alkali, Whey, Nonfat Milk, Soy Lecithin, Sorbitan Monostearate, Salt, Artificial Flavor, Polysorbate 60 , High Fructose Corn Syrup , Whey Protein Isolate , Soy Protein Isolate , Maltodextrin , Semisweet Chocolate Sugar, Chocolate, Cocoa Butter , Corn Syrup , Sugar , Palm Oil with TBHQ for Freshness , Cellulose , Sunflower Oil , Cocoa , Glycerin , Algal Oil Natural Source of DHA , Natural and Artificial Flavor , Salt , Sodium Ascorbate Vitamin C , Vitamin E Acetate , Soy Lecithin , Mono- and Diglycerides , Citric Acid , Folic Acid , Bleached Wheat Flour , Partially Defatted Peanut Flour , Mixed Tocopherols for Freshness , Pyridoxine Hydrochloride Vitamin B6 , Ascorbic Acid for Freshness , Vitamin B12

It really is outrageous that products like this are promoted as Brain Health Bars. While I am certain that no one reading this blog will be under any illusions that consuming Omega 3 rich crap is anything other than crap, I am concerned that there are people who will think that these foods are making a meaningful contribution to the omega 3 intake and will not be aware that omega 3<>omega 6 ratio will still be distorted or that omega 6 intake has to reduce to around 4% of calories before the adverse effects of omega 6 are negated.

I think it is totally dependent on individual physiology.  I believe, w/ nothing to back me up, that there is a bell shaped curve and that most people (the big part of the bell), can do well on either low carb/high fat or low fat/high carb.  The tails of the bell are the few who can only do well on one or the other.  I do great on low fat!  My numbers are excellent and I feel good. On low carb I am always tired, irritable, brain fogged and feel like I am starving. My wife is the opposite.  If she eats more than a few grams of carbs per day she blows up w/ phlegm and fatigue and digestive problems.  Not just gluten grains but any carbs at all except veg.  She also must minimize fruit or pay the price.  So we are Jack Sprat and Spouse.

I have seen this in several people.  There are a few out there who just do not process fats well and some who do not process carbs well.  And I also know people who have done both and felt great on both.  The key is that "combining the two" ie high carb/high fat is what really will kill everyone!

So far as I know, the only way to know is to experiment on yourself as you have done and listen to your body because it never lies.  When you find one that works for you then you are home.

Is sprouted wheat bread also to be avoided?

Hi Dr. Davis,

I wanted to let you know there is an excellent discussion on weight gain, located at
http://www.dhslides.org/mgr/mgr060509f/f.htm

It is a lecture at a Hospital by Gary Taubes, the author of "Good Calories, Bad Calories"

I read the book, and really enjoyed watching this hour-long lecture.

Dr. Davis, have you seen this, posted June 25th 2009...

"High Carbohydrate Foods Can Cause Heart Attacks!

In a landmark study, new research from Tel Aviv University now shows exactly how these high carb foods increase the risk for heart problems.
Enormous peaks indicating arterial stress were found in the high glycemic index groups: the cornflakes and sugar group. "We knew high glycemic foods were bad for the heart. Now we have a mechanism that shows how," says Dr. Shechter. "Foods like cornflakes, white bread, french fries, and sweetened soda all put undue stress on our arteries. We've explained for the first time how high glycemic carbs can affect the progression of heart disease." During the consumption of foods high in sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the arteries.
Endothelial health can be traced back to almost every disorder and disease in the body. It is "the riskiest of the risk factors," says Dr. Shechter, who practices at the Chaim Sheba Medical Center — Tel Hashomer Hospital. There he offers a treatment that can show patients — in real time — if they have a high risk for heart attacks. "Medical tourists" from America regularly visit to take the heart test.
The take-away message? Dr. Shechter says to stick to foods like oatmeal, fruits and vegetables, legumes and nuts, which have a low glycemic index. Exercising every day for at least 30 minutes, he adds, is an extra heart-smart action to take."
....from conditioningresearch.com

From ConditioningResearch.com 6/25/09

In a landmark study, new research from Tel Aviv University now shows exactly how these high carb foods increase the risk for heart problems.
Enormous peaks indicating arterial stress were found in the high glycemic index groups: the cornflakes and sugar group. "We knew high glycemic foods were bad for the heart. Now we have a mechanism that shows how," says Dr. Shechter. "Foods like cornflakes, white bread, french fries, and sweetened soda all put undue stress on our arteries. We've explained for the first time how high glycemic carbs can affect the progression of heart disease." During the consumption of foods high in sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the arteries.
Endothelial health can be traced back to almost every disorder and disease in the body. It is "the riskiest of the risk factors," says Dr. Shechter, who practices at the Chaim Sheba Medical Center — Tel Hashomer Hospital. There he offers a treatment that can show patients — in real time — if they have a high risk for heart attacks. "Medical tourists" from America regularly visit to take the heart test.
The take-away message? Dr. Shechter says to stick to foods like oatmeal, fruits and vegetables, legumes and nuts, which have a low glycemic index. Exercising every day for at least 30 minutes, he adds, is an extra heart-smart action to take.

Eat what ever you want. I have had 3 heart attacks. Life is short and it mostly sucks so be a glutton like me.

I'm insanely jealous of that LDL!

Statins knocked mine down but diet doubled my HDL and decimated my trigs (not a Heart Healthy diet, obviously, but a truly heart healthy diet of low carbs and masses of fat protein and veggies)

Sadly my latest experiment failed - dropping the statin whacked my TChol back up, and the *receptionist* cancelled my A1c and Full Lipid Panel so I have had to see the doctor to authorise the correct tests, results in about a week. I suspect HDL will have further improved but LDL is the major culprit so I may end up restatinating myself.

Another excellent paper from Jeff Volek looking at some more obscure cardiovascular markers

http://www.nutritionandmetabolism.com/content/3/1/19

It is "the riskiest of the risk factors," says Dr. Shechter, who practices at the Chaim Sheba Medical Center — Tel Hashomer Hospital. There he offers a treatment that can show patients — in real time — if they have a high risk for heart attacks. "Medical tourists" from America regularly visit to take the heart test.

A patient of mine recently alerted me to Dr. Davis's blog and I am delighted to read some of the entries. It is fantastic that some members of the medical community have the guts to think for themselves and tell it like it is. I've told my patients for years that the recommendations of the American Heart Association will give you a heart attack and the American diabetes association will give you diabetes. If you actually read the textbooks in medical school, it is plain to see that carbohydrades  trigger insulin which is a fat-storing hormone. After 30 years of low fat propaganda it is uplifting to see that some common sense is making the news. Whole foods is the only food your body knows what to do with. Keep it up. Dr. Davis.

I just came across your blog, but I really like it already!  I think you have a great topic, and you address it really well.  I look forward to being a new reader!

Visit my blog if you get a chance as well- http://asizableapple.blogspot.com

Hey Doc, leave my Count Chocula and Cocoa Puffs alone, man! Well, at least you didn't go after my beloved Cocoa Pebbles! (This is what I was raised on...wonder why I'm addicted to sugar??)
I'm just kiddin ya, you know that. It just annoys me when you bring these things to light-the AHA witholding support of a diet (or lifestyle perhaps?) that is obviously so much better than their program. This is a group of supposedly intelligent professionals who you would think would want what's best for the American people as a whole.
Enjoyed reading this post, but I still wish they'd invent 'Mediterranean Cocoa Pebbles' or something. LOL
Adam

Uh huh. Now I see what has been going on when my husband has been in the hospital for a 4 in 1 heart procedure (aortic valve replacement, one bypass, MAZE {?} procedure and restructuring of a portion of a heart chamber). I invariably raised my eyebrows at his food tray, but finally flipped out when a breakfast tray had french toast with syrup, Frosted Flakes and apple juice, in addition to eggs, sausage and milk. My husband loved every bit of it because he rarely gets that type of food at home. In fact, Frosted Flakes and their kin are strictly banned in this house since we're both fighting a tendency toward high blood sugar.
Then there was the hospital version of chicken fried steak, with gravy yet. Pork chop another day, with gravy of course. Plenty of gravy on potatoes and butter for rice and rolls. A turkey sandwich on white bread for an evening snack, with a hefty packet of mayo. Smuckers peanut butter. And on and on I could go.
I wanted to run through the hospital kitchens screaming, "Are you people nuts? Or are you trying to assure repeat visits?"
Incidently, this was the "regular" hospital diet which my husband's heart surgeon allows during his patient's recovery period.
Another week or two of this at home and then he's supposed to buckle down and eat right. Oooookay. But Frosted Flakes are still banned.

No diet is necessary if you just change white carbs for whole grains and bad fat for good fat. And weight will be gone for sure. And of course exercise must be included too. No diet is as successful as this.

In other words, remove all the processed foods, and the AHA diet pretty closely resembles the Mediterranean diet. There are differences but they tend to be relatively small. If the only major difference is the presence of processed foods, wouldn't you therefore expect the AHA to embrace the Mediterranean diet?

I agree with the need for some sort of unbiased but brand/manufacturer-oriented guidance.  I guess my question would be, if this content is not based on your specific experience, what criteria would you apply to determine how to assure some level of credibility?  With advertising, the criteria is generally willingness to pay the price of the advertising.  If you want to maintain higher standards than that, won't it require someone with either understanding or technical expertise or direct experience to assess whether the producer is credible and trustworthy?

As it stands, I am looking for someone whose opinion I can trust regarding which supplement suppliers to turn to.  I have been impressed and surprised by the degree of your willingness to tell it the way you see it, including naming names of product manufacturers that you have found to supply products that seem to work for your patient population.  I hope you'll keep that up no matter what.  And I'm interested in how this idea develops.

Thanks for the helpful thoughts.

I wonder if a user comment method would work. In other words, say a product manufacturer makes a claim and sells their product to you (Track Your Plaque would not sell it), there will be comments from people who have tried the product and their supplier before.

Such a system would not be as certain as providing our own stamp of endorsement (which we could still do, of course), but it would encourage an open conversation. Hopefully, any undesirable products would be rapidly identified as such.

My concern is that, with hundreds or thousands of products out there, we end up saying "We've never tried it" all too often.

Dr. Davis for as much time and effort that is put in the TYP program, why not i'am sure the snake oil salesman would not want his product under the gun like people on this progran would do, frank discussions on supplements is not a bad thing as a example i'am the person who asked you about PGX fiber, its called WellBeX and is marketed by Natural Factors, one more example would be i use a insulin mimetic R-alpha lipoic acid with biotin (also a very good antioxidant) i can buy the brand name Insulow or i can use a different brand (Glucophase),for less money that does the same thing, being a type 2 i test all of the time and sometimes go days eating the same thing at the same time i know that i can get between 10 and 12 points with either one.  i know their are a lot of supplements but we only talk about a few, and like i said before why not, my biggest concern on buying supplements are they selling what they say they are selling or is it different item that will not work, or is made up with a different material than is is advertized. why not get some add revenue, their are good products out their, Upsher-Smith Slo Niacin, Endurance's Endur-acin SR both are good nicotinic Acid products, Insulow makes a good product, one more example would be the Vitamin Shoppe sells a  good Vitamin D softgel under their store brand this is a good product, but they also sell under their store brand a no flush Niacin in their heart supplement area , this product is worthless for the TYP program, I would say start with the products, that we know, and expand a little at a time, also how about Direct access testing for blood work, i use Lab Corp to get my NMR lipoprofile i'am sure that their are others full speed ahead, I think increased revenue could have some good outcomes
Eugene

Great thoughts.

I think, if and when we proceed with such a process, that we:

1) Have some sort of checklist for approval of quality, price, availability, purity, etc. and provide our stamp of approval.

2) Convey our comments in addition to info provided by the manufacturer or distributor.

3) Permit all the Track Your Plaque participants to leave their own comments, much like Amazon does with books.

A record holder in plaque reduction has now been acheived.  What brand of supplements was the member using? What brand of fish oil? This is when a recommendation would be welcomed!!

Nothing magical: He used Sam's Club fish oil.

There is a romanian guy that promotes healthy life style with low carb and other paleo ideas.

http://www.cristianmargarit.ro/

On his forum, a schizo girl was asking about suplemments, but she was really amazed by Dr Davis prescriptions, 6000 UI/zi, she said that NowFoods recomand a 5000 UI gelcap /3 days.

But Cristian (the body builder from the link) replies:

"It happened that I had once 100.000 UI on a day of vitamin D. Yes, one hundred thousands! When you try to adjust the level for certain deficencies, the therapeuthical doses can be a lot higher than the usual doses, that look like jokes for healthy people."

Readind the article that Dr Davis just published, I assume he has a point, but 100.000 on a day!?!

hi Dr. Davis

could you sum up the benefits of vitamin d for non heart patients?

im in early twenties and have my vit d at 18!

i feel normal. what can i expect with higher blood levels of this vitamin?

i have some source naturals 2000 ui powdered caps is that effective?

Thanks

There is evidence to suggest a correlation between high circulating Vitamin D blood levels (>40ng/ml) and rare cancers (pancreatic, etc):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892544/?tool=pmcentrez&report=abstract

http://cancerres.aacrjournals.org/cgi/content/full/66/20/9802

http://cancerres.aacrjournals.org/cgi/content/abstract/69/4/1439

http://aje.oxfordjournals.org/cgi/content/abstract/kwq114

My Vit. D level 2 years ago was 42, I started supplementing with 6K per day.  I retested this spring and had decreased to 41.  

I was amazed and confused.

After some communications with the Vit. D council,  I found out that the Tretinoin Cream I was using for my splotching skin was interfering with absorption of Vit. D.

I have since stopped the cream, increased to 12K per day and get 1 hour of sun without any sunscreen.
I am sure my Dermatologist won't be happy with my tan.

Did you call her PCP?

2 questions about vitamin d. Should I take it in the summer months. I work outside all day long? Whats the differences between vitamin d with cod liver oil  and without ? thanks...

What about taking Vitamin A to counter balance Vitamin D?

It has been determined that toxicity concerns for VD3 occur somewhere around 200 ng/ml.  (www.grassrootshealth.net)

Vitamin D experts recommend between 70-90 ng/ml depending on the doctor.  Some even higher. For instance - Dr. Cannell of The Vitamin D Council (www.vitamindcouncil.org) recommends at least 90-100 ng/ml for cancer survivors.

Dr. Cannell is also on the board of GRH - both non-profit advocacy groups promoting the health benefits of VD3.

Grassroots Health is running a five year study on VD3 that is well worth joining.  Anyone can join - find the details at their website.

Dr. Cannell warns that vitamin A "antagonizes the action" of VD3.  He says you don't need to supplement with vitamin A outside of a good diet.

Not quite halfway down in this newsletter post:
http://www.vitamindcouncil.org/newsletter/2008-june.shtml

I read a study recently where they measured the actual amount of vit. D present in various name brands. They varied in strength from 1% to 82%.
That's very weak on the mfgs. part and would only encourage the use of prescription D.
Here is the link:
http://www.medpagetoday.com/MeetingCoverage/CMSC-ACTRIMS/20522

Enliteener - a quote from the study at the second link you provide:
( 7). Ecologic data are not supportive of a strong positive association between vitamin D and pancreatic cancer as sunnier regions do not have higher rates of pancreatic cancer. In fact, the opposite is true, in the United States, relatively high pancreatic cancer rates are observed in states where UV exposure is low.

as much I respect dr. Davis he is like all the docs obsessed with numbers and stability and "safety". Unfortunatelly it ignores the basic properties of vitamin D which is an essential , perhaps most important hormone in all the living beings. First of all , vitamin D gets activated in kidneys first and if kidneys get saturated in tissues where all the healing properties of vitamin D occur. Second of all , there is a reason why oral supplementation is possible throughout life as opposed to simple skin synthesis. Then our bodies can absorb much more orally at once than through the skin which leads me to believe that we are designed to take much larger doses at once to correct deficiencies. Lastly vitamin D is fat soluble so it stays with you for 2 months at least. Having said all that , it doesn't make any sense to supplement every day with lesser doses than you can synthesize in the skin or to follow some magical numbers.
I have dealt with a very stubborn case of psoriasis for 3 years but in a few days I am taking a big vitamin D experiment, 30 days / 500 000 IU daily, 15 million in a month. Indeed if you search google archives you can find newspaper clippings from 30's and 40's when doctors were more liberal and less obsessed with money of such doses reversing psoriasis and arthritis and other auto immune conditions.

Dr Davis, A great post yet again. I guess that is the one single line I have forgotten to tell people "it is not the dose, it is the blood level that matter"!! GREAT! Thank you.

Sara,
There is a big concern for supplements on the market as they are not being checked by any agencies, and just like Dr Davis previous have been reporting on - some Vitamin D3 over the counter are not what they say they are. However in this study that you refer to (the part that I was able to read) they do not list the name brands or the type of Vitamin D (pill, gel cap, liquid) as that also plays a big role. I think it is a big separation from the message in the report of saying to only take Vitamin D2 (which is the prescription vitamin D) when we know D2 is not natural to us humans nor is it better. I suggest you read a little bit more about D2 and D3 before deciding what is best for you.

Hello Dr. Davis.

Let me point out a few things based on research on vitamin D. Not all agree with what you said in your post, but then again you may well be right and the research wrong:

- Indeed, toxicity signs do not seem to occur until one reaches the 50,000 IU/d level of intake.

- Among the elderly (i.e., those aged 65 or above) pre-sunburn full-body exposure to sunlight is equivalent to an oral vitamin D intake of 218 µg (8,700 IU). That is close to 90 percent of what a 20-year-old would produce.

- People on average will plateau at 130 nmol/L, after months of 10,000 IU/d supplementation. That is 52 ng/mL. Assuming a normal distribution with a standard deviation of about 20 percent the peak mean (a rough guesstimate), one would expect 68 percent of the population to be in the 42 to 63 ng/mL range. That might be the range most of us should expect to be in at an intake of 10,000 IU/d.

As we know, some people are outliers. A person who is two standard deviations above the mean would be at around 73 ng/mL. Three SDs above the mean would be 83 ng/mL. These are outliers; non-average people.

There are other factors that may have affected the results for this patient. Being overweight tends to reduce D levels. Sunscreen also does that. Excess cortisol may also be affecting D levels.

Below are two links with more details:

http://healthcorrelator.blogspot.com/2010/02/vitamin-d-levels-sunlight-age-and.html

http://healthcorrelator.blogspot.com/2010/01/vitamin-d-deficiency-seasonal.html

I wonder what levels are found in smokers? I know smokers aren't supposed to supplement with beta-carotene as it statistically increases their risk of developing lung cancer.

What about vitamin D? Is there any data on this as it relates to people who smoke cigarettes or other tobacco products?

This is so off topic, but for some reason I cannot find the Pharmax website for fish oil. Can anyone help?  Thank you
From an old person who is not tech savvy.

There is a graph of vitamin D blood levels on the video by Dr. Michael Holl+
ick that shows the knee of the runaway blood levels is around 10,000 IU per day, and he recommends no more than that on an ongoing basis.

For me, 5000 iu per day stopped my gums from bleeding when I brushed, and ended decades of dysthymia.

http://www.youtube.com/watch?v=Cq1t9WqOD-0
http://www.uvadvantage.org/

Dr Davis,
You are absolutely right that "it is not the dose, it is the blood level that matters”. But, what about the blood level of calcium? One of the causes of the toxicity of Vit D is that it may cause high calcium levels in blood. So, should we not measure also the calcium level, and if it is high then should we not stop taking D, even though  its blood level may be normal or low? Thank you.

How does a dosage of Vitamin D3 supplementation totaling 2,260,000 IU over 56 days averaging daily to about 40,000 IU sound?? Resulting in a blood level of 239.0 ng/mL?? This is no fiction...but my personal experience...and I have never felt more better since then! I got rid of my pre-diabetes, Metabolic Syndrome and other fancy new-age potential diseases...  Read all about it at gkwellness.wordpress.com.

Perhaps it would be well for others to read what Dr Cannell has to say about massive doses of vitamin D.

Warning: If you intend to take massive doses of vitamin D based on this newsletter, which I highly recommend you do not, read the entire newsletter. In addition, accurate determination of side effects of massive doses of vitamin D was not available in the early 1930s, nor was accurate determination of the true amount in each pill possible.

You'll find the Vitamin D Council newsletter at this link.
Gary Null and Vitamin D Toxicity

I've been taking 10,000 IUs a day for the last 3 months.  Got my results back today:  I went from 51ng/dL to 65 ng/dL.  I eat strictly paleo and I also get regular sun.  I expected a greater increase.  I also had a CMP run to check for hypercalcemia - all good.

I recently went to a doctor for pre-diabetes and high cholestrol and found my vitamin d level is 17 and I am breastfeeding. Does anyone know what a safe amount would be for me to take. I am taking 5000 d3, liquid dropper full. I am very tan, and out in the sun...why am I not absorbing or making the hormone? My crp level was 24, they said that wasn;t normal. Could this be a effect of this wheat allergy I am reading about? What do you think Dr. Davis?

I too got the same reaction from my doctor when I told him I take 10,000IU daily.  But I HAVE to in order to reach that optimal level you're talking about.  Two years ago my D3 was 42, so I went on a 6-month Vitamin D3 gelcaps regimen to get it up to 68.  Wanting to find the balance of how much to take, I backed off to 6,000IU for about 8 months and my D3 level dropped back down to 50.  So I've been on 10,000IU daily again for the past 8 months and look forward to seeing my levels return into the 60s where they need to be.  THANK YOU Dr. Davis for leading the way on this important issue.  My wife Christine had a D3 level of 9 before starting 10,000IU herself--today her D3 is 54 and she's completely off of her Paxil medicine.  WOO HOO!

I can't find the link but I recall reading something, possibly by Dr. Cannell urging people who are taking higher quantities of vitamin D to ALSO take extra Magnesium and Potassium to prevent kidney stones(which may occur with higher dosing of Vitamin D).

If this is the case, how much mag and potassium should one take to prevent stones?

Vitamin D3 decreased relapse rate by 50% in Crohn's disease patients in a 12 month randomized controlled trial:

http://www.ncbi.nlm.nih.gov/pubmed/20491740


I knew this for almost two years already and got to ditch my meds, just by taking enough Vitamin D3. If everything in healthcare was this simple we would not have major healthcare problems, yes ?

Dr D.
It has probably by now come to your attention that there is some evidence for a U shaped mortality curve with vitamin D in elderly men, esp cancer.

Here is one report:
*Plasma vitamin D and mortality in older men: a community-based prospective cohort study.*

Michaëlsson K, Baron JA, Snellman G, Gedeborg R, Byberg L, Sundström J, Berglund L, Arnlöv J, Hellman P, Blomhoff R, Wolk A, Garmo H, Holmberg L, Melhus H.

Am J Clin Nutr. 2010 Aug 18. [Epub ahead of print]PMID: 20720256 [PubMed - as supplied by publisher]Related citations

My suspicion is that it may  be related to insufficent vitamin K2, which of course may relate to typical elderly diets.

Please comment, and/or refer us to earlier comments you may have made.
Thank you
Mike V

How to Optimize Vitamin D Supplementation to Prevent Cancer, Based on Cellular Adaptation and Hydroxylase Enzymology
At the most northerly latitudes such as Sweden, where the study Mike V linked to was done and Finland where P Tuohimaa has reported similar findings, we have to appreciate the people with the highest vitamin D status probably have the largest changes in status over the year.
Vieth provides a hypothesis that explains how people with extreme changes in status experience longer periods of imbalance between the forces controlling cell proliferation.
Vieth suggests keeping 25(OH)D BOTH HIGH and STABLE is the safest option that way there is little or no CHANGE in status through the year, so no periods where dis-regulation of the counterbalancing forces could occur.

Ted,

If I'm reading what you posted correctly, Vieth is indicating that one should maintain higher serum d-levels year round as opposed to allowing them fluctuate?

I'm sure this has been asked before but what's a suitable dosing strategy for someone who just flat out refuses to get their 25(OH)D3 levels checked? My brother is 28, I've convinced him to start supplementing with vitamin D but her refuses to go to the doctor to get blood drawn and when I suggested he order a kit online and do it himself he looked at me like I was crazy.

I have him on average taking 5000 to 6000 units per day.

Mike

@ Vieth is indicating that one should maintain higher serum d-levels year round as opposed to allowing them fluctuate?

Vieth says so long as serum 25(OH)D concentrations are in a phase of decline, there can be no full achievement of tissue 1,25(OH)2D to match its ideal set-point concentration.

There have been a couple of papers recently showing ANNUAL vitamin D supplementation (raising status with high intakes before winter) only makes matters worse because it creates a longer period of declining 25(OH)D.

Note also that because Ergocalciferol has a shorter half life than D3 it amplifies this problem so should be avoided.

Supplementing DAILY or WEEKLY reduces the potential for fluctuation so are ideal but fortnightly or even monthly supplementation with D3 probably avoid the periods of declining status, if the person concerned really isn't capable of more regular dosing.

The amount of vitamin D made in the skin varies with 25(OH)D status This reduces the summer rise in status but if you get lots of sun in summer (unlike the UK)it may be sensible to REDUCE (but not stop) vitamin D supplements while you are also getting near full body sun exposure, and then resume the full amount of supplementation as soon as sun exposure reduces.

I think people who live furthest from the equator have to be particularly careful when taking winter sun holidays in the tropics.
As Vitamin D is itself photoprotective it's worth supplementing with vitamin D before a winter sun break rather than relying on the holiday sun to raise status. Then reduce intake while sunning in the tropics but resume supplementation as soon as you return. Careful supplementation increases serum 25(OH)D concentrations and reduces the effect of the seasonal amplitude in 25(OH)D on the tissue fluctuations in 1,25(OH)2D.

@ Mike
Grassrootshealth graph of typical responses to various vitamin D intakes

Startling Findings About Vitamin D Levels in Life Extension® Members

The graphs at the above links show 5000~6000iu/daily gets most people above insufficiency status and doesn't raise status above a safe amount.

The range of response to regular D3 supplements is about 100ng/ml so without a few 25(OH)D tests it's impossible for anyone to say if you're at the lowest or highest end of that response scale.

If you're diabetic or celiac then it's likely you're a poor responder but there are people reading this with inflammatory conditions who've taken very modest vitamin D3 amounts but had extremely high 25(OH)D test results.

It's so simple to put a couple of drops of blood on a test strip and post if off that I'm surprised everyone doesn't get it done.

Once you've had a few tests done you can more or less predict what the result will be, but there have been instances where people have changed brands of D3, been tested and discovered problems.

Only if you've had a test can you be certain the brand/batch/amount/dosing regime of D3 you are taking is working for you.

Thanks for the helpful posts, Ted.
Is it your interpretation that variability still remains important, even if one's 25(OH)D does not fall below say 30 or 40 ng/mL over the year, or do you think the the lower excursion limit would have to drop to a deficient level at least for a part of the year? It would seem to me that storage in body fat would be a consideration in minimizing variability.
Have you come across any studies on U curve effects  performed at lower latitudes, or perhaps on those supplementing?

I am a vintage Brit, living in the "Deep South", and whose last readings were between 60 and 70 ng/ml so I have no personal concerns.
Last winter I was using 8000iu, but I drop back to 4-6000 in the Summer months, when we typically have highs between 90 and 100F.
FWIW I have been gradually escalating my dose over a period of more than 10 years. Now in 75th year.
regards
Mike V

@ It would seem to me that storage in body fat would be a consideration in minimizing variability. I agree.
Bear in mind we don't see significant stored D3 reserves below 40ng/ml but at 50~60ng/ml reserves are measurable.
I stay around 60ng/ml with 5000iu/d + regular full body UVB/SUN exposure.
I'm not aware of any data on Ushaped curve at lower latitudes or with people maintaining a steady state 25(OH)D by avoiding declines in 25(OH)D.
I'd be more than willing to participate in any trial, providing I'm assured of remaining on the high end arm of the study.

Thank you.
One more question.
It appears that UVB/sun exposure is useful way to 'top off' supplementation in a natural or controlled way.
Seems we evolved our African metabolisms getting a heavy daily full body dose.

Are you aware of any data suggesting that UVB sourced D has any other advantages over presumingly well managed supplementation?
Thanks again
I appreciate your awareness of, and facility at quoting relevant studies.
Mike V

UVR is likely suppressing disease independent of vitamin D production, and that vitamin D supplementation alone may not replace the ability of sunlight to reduce MS susceptibility.

Cholesterol levels are lower in summer than winter so it's reasonable to suppose some of the benefit of UV exposure is the reduction of cholesterol when converted into vitamin D.

I suspect it's also possible that the conversion of cholesterol to vitamin D3 Cholecalciferol alone may be simplistic.

It could be that other types or subtypes of the vitamin D family or its analogues are created that, at the moment, we are not aware of and which may provide benefits that are greater than those provided just by vitamin D3 alone. That is one of the reasons why I prefer to get my basic D3 needs met from supplements but also use sunlight/uvb exposure to top up my stores as naturally as possible.
Sorry no time at the moment to provide supporting links for that hypothesis.

Ted, you bring up an interesting point regarding different dosing methods. Here's a study comparing daily vs. weekly vs. monthly dosing of D3.

http://jcem.endojournals.org/cgi/content/full/93/9/3430

Seasonal fluctuations may be of importance but the overall 25(OH)D levels still seem most important.

The Framingham Study data and other papers have already pointed out that not only total mortality, but also bone health seems best in about 35-40 ng/ml, not more. Similarly, not-so-rare cancers like in prostate and pancreas (kills practically everyone) may well increase in susceptiple populations ie in smokers.

There are also racial differences that may be of huge importance. Not only CHD risk and 25(OH)D does follow the skin color pretty closely, but native Africans also have rather low 25(OH)D levels which perhaps explains the association. Even doctor Cannell wrote previously about this:

"Dr. Freedman and his Wake forest colleagues measured vitamin D levels and plaque (the build-up in your arteries) on 340 diabetic, obese (BMI 35) African Americans and found higher vitamin D levels were associated with more plaque build up in the arteries."

http://www.vitamindcouncil.org/newsletter/vitamin-d-race-and-cardiovascular-disease.shtml


Infants in Nigeria have much higher 25(OH)D levels, yet as Nigerian people get older, their 25(OH)D levels drop a lot.

I'd imagine that tremendous UVB exposure for decades makes it progressively harder to make Vitamin D and that seems to be the simplest explanation. Elderly white-skinned people may on the other hand make a lot more Vit D as a recent study shows. I'd die to know if the same works out for native Africans as well - which I very much doubt.

Vitamin D has tens of metabolites that form only in the skin. This may be the single biggest challenge to the claim that Vitamin D supplementation fixes "everything".

A quick googling on a wide array of problems people have had when supplementing more than 2000 IU a day is dazzling. So D3 may be a wonder vitamin, but it's benefits are dose dependent and probably highly dependent of other nutriotional factors as well, since D3 affects the absorption of minerals, expression of hundreds of genes and so on.

Food rep

@ you bring up an interesting point regarding different dosing methods ...Comparison of Daily, Weekly, and Monthly Vitamin D3
Perhaps that is because I regard the natural level at which humans produce vitamin D replete breast milk, achieve 25(OH)D equilibrium and maintain a stored reserve of vitamin d3 as ideal, not the level used in that study that barely ever provides sufficient even for basic daily needs.

Health professionals may aim for a level that maximises health service interventions. I want a level that minimises my need to use those services.

Bankers make more money from people who frequently use overdraft and loan services. I prefer to save up, keep a reserve of cash in an instant access savings account, only every pay cash and get discounted prices.

You may be happy to manage your Vitamin D account without ever having any spare reserves available for emergency use but IMO that is neither prudent or safe.

Why on earth would your skin produce 10~20000iu in a relatively short time if only 1500iu were required?

Food Rep:
Suggest you take as a baseline levels that are thought to be closer to the equatorial 25(OH)D blood levels we evolved with. Not minimal levels to mitigate some particular symptom or disease.
  Yes, achieving this goal largely by supplements, can be complicated depending on skin color, genetics, latitude, age, body fat, but in my judgment it is well worth achieving, and it will become easier as time goes on.

IMHO, Ted and Dr Davis have it about right.

Do you visit www.grassrootshealth.net?
If not I recommend you do so... soon. IMHO there is not a more authoritative resource on this topic.
Mike V
By the way, vitamin D does not *cause* calcification. It does enable homeostasis.

Ted,

I only posted that study above to show that different dosing schedules (daily, weekly, monthly) all seem like viable approaches in maintaining 25(OH)D3 levels granted you are consistent with it. I wasn't trying to suggest that the actual doses they were administering were adequate.

I just trying to have ripped abs.  I am not taking any supplements or anything like that but the literature here suggests that taking some substances could actually have an adverse affect on your body even though they are supposed to be healthy.

Ted, Dr D.
I suggest that vitamin 2K should be considered in association with Vitamin D where the cancer mortality curve is in question.
**
http://www.lef.org/magazine/mag2009/jan2009_Vitamin-K-Protection-Against-Arterial-Calcification-Bone-Loss-Cancer-Aging_03.htm
**
note: I believe I am right insaying that the first 15 references cited in this article relate to cancer.
Mike

Mike V

good article.

I recently did the Vitamin D Council blood spot test. It cost $70.00 including shipping I think. It was painful and two weeks later, my finger still hurts. If I ever do another blood spot test, I'll try to draw blood from my forearm, although the test requires at least 2 large blood drops. I have no results yet. I am 114 lbs and take 2400 IU a day (softgels). I don't really plan to test ever again, especially on my finger, so I'll play it safe and keep my level around 40. Obviously, I'll have to adjust accordingly, once I get the results. I don't have the luxury of a good doctor. Doctors around here are virtually useless.

Hi there,
Been researching Vit D here on the heartscan blog and others such as Vit D counsil, Dr. Ben Kims' site,getting good info to stay away from D2 of course.
  But this site, "The Peoples Chemist"- Shane Ellison and blog poster "Chuck" say we all should stay away from any man-made D3(sheep wool) included. They back it up stating specific chemical biological changes in the body.  They say it just isn't the same and can do more harm in the long run. The site states basically that we should be using only food for Vit D3. meats, eggs, cod-liver oil(w/o the vitamins depleted or added)ect...
   This is real important for all of us if this is true.  Please Heart scan Bloggers/Dr. Davis read the info @ Vit D on Shanes site... Thanks

Hi there,
Been researching Vit D here on the heartscan blog and others such as Vit D counsil, Dr. Ben Kims' site,getting good info to stay away from D2 of course.
  But this site, "The Peoples Chemist"- Shane Ellison and blog poster "Chuck" say we all should stay away from any man-made D3(sheep wool) included. They back it up stating specific chemical biological changes in the body.  They say it just isn't the same and can do more harm in the long run. The site states basically that we should be using only food for Vit D3. meats, eggs, cod-liver oil(w/o the vitamins depleted or added)ect...
   This is real important for all of us if this is true.  Please Heart scan Bloggers/Dr. Davis read the info @ Vit D on Shanes site... Thanks

If our vite D levels show up low 20every year ,even when take 4000/day, then
are we not absorbing or are we using it up. It sounds like some websearch showed up maybe
additional testing such as also 1,25 OH in additon to the 25OH
Thanks for any info

does this include eating celery or cucumbers as a snack, or other veggies?

I began checking my blood sugar after reading about it here a few weeks ago, and was surprised to find that my blood sugar peaked a full two hours after a meal. At first I'd been doing the 1-hour, which this site suggests, but then I read fully the directions that came with my reader, and it said to check 2 hours after a meal.

Of course, these directions are aimed at diabetics, and I'm assuming this site is aimed at folks who are either normal or perhaps pre-diabetic. I was a little disturbed to find that my insulin response appears to react in a diabetic way, although my actual blood sugars are still in the pre-diabetic range. Either way, I'm watching this a lot more carefully now, and this whole experience is the first thing in years that has really inspired me to work at getting off my lifelong sugar addiction. Thanks Doc!

Dr. Davis,

In cases where lean meat is included with vegetables and some fat, would this lead to an even more gradual rise in blood glucose?

For several years now I have been in the habit of never consuming carbohydrates alone and always make sure to include either 20-30g protein + vegetables or 20-30g protein + vegetables + fat with any carbohydrates ingested.

Bill Virdon

In your last LEF Magazine article about Frailty was a little strange to me not find Q10 when you talk about energy boosters. I usually recommend Q10 Ubiquinol for this purpose to old people. Anyway, thanks for your work, I hope one day I can read next parts of "Understanding Risk Factors for Heart Disease" you started in August 2009 in this great magazine.

You'll have to determine when your own peaks occur after meals, but ours are consistently within the range of 30 to 60 minutes, depending on the meal. Of course, if the meal includes a dessert, etc., then you'll get multiple peaks. And if the meal is prolonged, such as a holiday meal, then all bets are off. But for those consuming lots of small meals during the day (to keep peaks low), 60 minutes is almost certainly too long to wait.

Dear Dr. Davis,

I am a 49-year-old woman. I have a 21-year-old mentally handicapped child and a son who is starting at GA TECH this Fall. I homeschooled both of them most of the way through school. I now help my husband run a home-based business. Needless to say, I spent many years pretty much ignoring my health needs. In February, 2007, I became very ill with strep from which I was not recovering well. My FP did blood work and discovered that my blood sugar was 477, my triglycerides 261, my HDL 42, and my LDL 129 (Total cholesterol: 223). He prescribed Metformin (2 extended release per day), and I embarked on a diet and exercise program. I have lost over 30 pounds, and my new lab results from 2 weeks ago were: blood sugar - 102, triglycerides - 119, HDL - 47, LDL - 150, and total cholesterol - 221. I have been taken off of Hydrochlorothiazide and am being switched slowly from Atenolol to Prinivil. My blood pressure is usually around 100/65 now.

My doctor wants to put me on Simvastatin, but I prefer to try some natural means of normalizing my cholesterol before adding yet another med with another set of side effects.

I have been eating very little bread, a little fruit (mostly berries or cantaloupe), lots of salad (very little dressing), green veggies, lean meat (mostly chicken or fish), and some beans (lima, garbanzo, pinto, or black).

I would love further suggestions from you.

Glenda Parkman

Hi, Glenda--

Those are spectacular results and testimony to what lifestyle changes alone can accomplish.

Please note that this Blog accompanies the conversations on the Track Your Plaque website. It is not meant to be a source for the full discussion. Please refer to the website.

Dear Dr. Davis,

I have relatives in Waukesha and Madison that are looking for a doctor that follows your protocols.  I would greatly appreciate any suggestions you could make.

Sincerely

How ia ApoB test used to know small LDL? Particle count exams aren't available in my area but ApoB is. So I'd like to know how to read this test.

thankyou

Dr. Davis,
Please give us an eating plan.  You rant about people making lousy decisions with food.  We need some direction.  What are you eating?  Please tell us.  I find this part the most difficult.  I know I've improved in my quality of food.  Three times a day I need to make the best choices.  It's like being married to a nymphomaniac. You have to have to satisfy the healthy needs of your body, everyday!
I believe you know what you are talking about.  You've improved our lives but tell us, please, what you are doing personally, day by day, to make those LDL particles small.  
Sincerely,
Dana Law
San Diego, Ca
P.S. This is a rant.  We need your help.

Love your blog, sir. I've been reading up over the last couple weeks--one question I couldn't find answered, though, was which glucose monitor you'd personally recommend? There are a lot of them out there on the market and I'm completely at a loss for how to tell them apart!

Thanks for all the important work you do.

--T.

For me, reducing carbs to <90g/day did little to improve my small, dense LDL.  My LDL particle number was over 2,000 and my small, dense LDL >1,600.  Increasing my saturated fat intake and niacin dropped my small, dense LDL to <120 in less than a year.

Many of those who live in the "green zones" have a high carb diet and yet live long healthy lives.Maybe the type of carb really is important.

Re: the cultures that eat high carb but have low rates of diabetes (Japan) do they have low post-prandial scores and low small LDL particles despite lots of rice or corn and beans?

I'm wondering why some very high carb cultures have so little obesity, heart disease, and diabetes.

For people who are confused of what to eat, etc - check out Whole Health Source website. Very helpful.  Check out diabetes and diet under LABELS on the right side that Stephan explains in more details why, how, what, etc works.

If there's a diet book that you can buy from a bookstore, Paleo Diet would probably be the best but it's not perfect. It says to avoid but it's perfectly fine and even the author changed his mind and it's fine to consume them.

Free The Animal website has helpful information on how to make dinners.

Dana Law, there's not need to eat 3 times a day. It's not really required. You can have two very nutritional meal with high amount of fat and feel satisfied for a long time, preferably break fast and dinner with maybe handful of snack like pecan, almond, walnut. That's pretty much how I eat. We're not programmed to eat that often anyway. That's how blood sugar stays low.

JC and Peter, you need to be more specific... are we talking about percentage of meal high in carbs or total amount of carbs? Two entirely different things. We eat way more carbs than those people, I bet. I'd have to travel to those places to see that myself because I don't believe anything media tells us.

Dana,
Dr. Davis's "eating plan" is available to Track Your Plaque members.  I've been a member for over a year, and I can't tell you how much I've learned.  Check out the website at trackyourplaque.com and sign up!

Dana, stop your ranting.  Your air of entitlement is annoying.  The fact that Dr. Davis graciously gives of his time to post some of his insights and advice does not make him a servant at your beck and call.

ET, thanks for your post.  Some folks get carried away with Paleolithic diet or nothing. For those of us who prefer to limit our meat consumption, 2-3grms/day Niacin is a must.

Dr D is always solid about whether his information is anecdotal or based on clinical trials.  If you would like additional supporting evidence for Niacin and its effects on LDL particle size, check out lipdsonline.org and search "niacin"

" As in previous studies, niacin therapy had no significant effect on LDL cholesterol concentrations; however, after 3 months of treatment the number of small and medium sized LDL cholesterol particles was significantly decreased in those given niacin compared with those given placebo"

Trevor

I agree that I find it pathetic that someone would rant on a free website and some of the very best information available anywhere.  Please stop it now.

Other posters who are asking about meters, etc:  please review the prior blogs that are listed alphabetically on the left.  Jeez folks, make some effort will you?

Tom C.

Yeah! So good to hear you speak out re the quinoa, oats and other carbs. Seems I can get clients to consider letting go of wheat (surprising) but  they now think quinoa is the nectar of the gods. 15 years ago I had a hard time selling even a handful of quinoa and now it is the sweetheart of grains. go figure...oh yet  again it is about who is pushing the stuff. You suppose Ornish is involved ;)
Great post yet again Doc!

I don't see what is wrong with Dana's post..... maybe we are just a tad more relaxed, those of us who don't eat too much meat
Trevor

yes,I agree that a diet high on carbohydrates and sugar makes people obese and increases the risk for them to be diabetic.

Do any of the home cholesterol meters (Cholesetch , Cardiochek, etc.) measure LDL particle number (i.e. small dense vs. the large not-so-dangerous kind)?

Would be nice to conveniently measure real ldl once a day!