Heart Scan Curiosities #6
















This is a "slice" from a normal heart scan in a 58 year old woman. Heart scan score zero. Look at the lungs, the dark areas left and right of the heart in the center. The lungs are also normal. Black represents normal density, healthy lung tissue. The white streaking is just normal lung blood vessels. This person doesn't smoke.


















This woman smokes a pack of cigarettes a day and has done so for 45 years ("45 pack-years"). She had a surprisingly low heart scan score (at age 64) of only 71, despite the smoking. However, look at this woman's lungs. It's a little tough to make out, since the computer graphics loses some of the resolution. But you can see the near absence of lung tissue on both sides. This is an advanced phase of the destructive lung disease, emphysema, from smoking. Even if she quit smoking today, the destroyed lung tissue never grows back. She literally has huge gaps or holes in her lungs where lung tissue used to be.

Smoking is among the most destructive, terrible things you can do to your body, short of swallowing strychnine or jumping off a building. Stay as far the heck away from cigarettes as you possibly can. If you are exposed to "secondary" smoke, insist that the person never smoke in your presence. It's not the smell that destroys your lungs or causes coronary plaque (though it is indeed foul), it's the actual smoke.
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Drug industry "Deep Throat"

Drug industry "Deep Throat"

A Heart Scan Blog reader brought the following letter from a former pharmaceutical sales representative to congress to my attention.

Interesting excerpts:

As a former drug representative for Eli Lilly, I spent 20 months increasing the market share of my company’s drugs. I was recruited fresh from college with an eager desire to employ my degree in molecular biology and biochemistry. Shortly after my hiring, it became clearly apparent that a drug sale had much more to do with establishing personal relationships than it did with understanding the latest science. However, any doubts I held regarding the effectiveness of such methods were dispelled by the results of my persuasiveness and the financial rewards I received for my efforts. The latter also helped me rationalize the many ethically dubious situations I routinely encountered in my work. Upon my departure from the industry, I began working for the public’s health. Seven years later, as a result of my experiences and education I am more convinced than ever that the goals of the pharmaceutical industry often stand in direct conflict with the practice of ethical and responsible medicine. Nothing in my recent research causes me to believe that my experiences were anything but typical of the training and practice of the majority of drug reps plying their trade today.


“There’s a big bucket of money sitting in every [doctor’s] office.” – Michael Zubillaga, Astra Zeneca Regional Sales Director, Oncology


The majority of drug reps entering the work force today are young and attractive. The ranks of reps are replete with sexual icons: former cheerleaders, ex-military, models, athletes. Of course, as a sales job, the reps must be eloquent and convincing. Depending on the population, certain ethnicities are preferred either to make the rep distinct among other reps or to provide them with a cultural advantage in connecting with their clients. Noticeably lacking among most new reps is any significant scientific understanding. My personal case illustrates this point rather vividly: In my training class for Eli Lilly's elite neuroscience division, selling two products that constituted over 50% of the company's profits at the time, none of my 21 classmates nor our two trainers had any college level scientific education. In fact, that first day of training, I taught my class and my instructors the very basic but crucial process by which two nerve cells communicate with one another. It is very likely that the majority of my class couldn't explain the difference between a neuron and a neutron prior to sales school. While it's certainly a bonus to have a scientifically educated representative, it is far from a primary recruitment criterion. Youth is a much higher criterion for the sales position.

Sales representative trainers are almost always veteran sales representatives and consequently, much of the training they offer is implicit in the anecdotes they give. This informal training parallels the standard training offered by the industry and in many ways compliments it. It is tacitly accepted by management and perceived as the "real" training by many veteran sale representatives. Among the more dubious "unofficial" lessons a new rep learns are: how to manipulate an expense report to exceed the spending limit for important clients, how to use free samples to leverage sales, how to use friendship to foster an implied "quid pro quo" relationship, the importance of sexual tension, and how to maneuver yourself to becoming a necessity to an office or clinic.

The most troubling aspect of pharmaceutical sales is systematic befriending of our clients. In addition to the psychological profiling mentioned above, drug reps are taught to constantly be on the lookout for personal effects that will help us connect to our doctors. When entering an office for the first time, we nonchalantly survey it for clues to ingratiate ourselves with our client. Similarly, conversations are intentionally steered into the realm of personal details such as religion, family, or hobbies to acquire similar information. As a matter of training, we collect this data subtly. In the course of a conversation with clients, we may glean facts about their prescribing preferences, the dates of their children’s birthdays, where they were born, or what music they enjoy. Training encourages us to commit these details to memory just long enough to return to our cars and instantly type up a “call report” listing the details of our conversation. On a daily basis, we connect our computers to a central database that uploads the information we’ve acquired, allowing us to share it with our partner drug reps and company marketers. Subsequently, drug reps interweave pieces of conversation specifically tailored to appeal to their client drawn from personal information that wasn’t necessarily shared with them. For example, Dr. Jones will be nothing but grateful when I supply him with a cake celebrating his children’s birthday when, in fact, he told my partner (and not me) the birthdates several months prior in a personal conversation.


The writer's comments ring true: The relentless attention-grab of sales representatives, using clever tactics that include access to detailed records of physician prescribing habits, big smiles and eye-winking, are detailed perfectly.

There's nothing wrong with a business doing its job by marketing its products and services. What is so wrong about this picture is that one side is so well-equipped, heavily funded, with access to extraordinary resources that the other side (physicians) don't have. And the physicians aren't the victims--YOU are.

A middle-aged, receding hairline physician, faced with a 28-year old attractive woman asking all manner of ingratiating questions but knowing full well what she is doing, having strategized for weeks on how to manipulate the behavior of her "mark," is helpless.

Like the mortgage-backed security crisis, we've reached another phenomenon of crisis proportions. Direct-to-consumer drug advertising, drugs for non-conditions and well people, pinpoint marketing of drugs to physicians--it's all gone too far.

Personally, drug representatives are not welcome in my office. This generally prompts puzzled, followed by angry, looks from the representatives, often traveling with a district supervisor hoping to help polish their pitch. If patients didn't request free samples, the reps would not step foot in the office.

Comments (16) -

  • Anonymous

    6/18/2009 1:53:18 PM |

    It sounds like doctors need salesmen/women residence training!

    I used to be a purchaser for our family company and later a large multi-national food firm and what is written here rings true with my experience too.  Most of the sales people were young ladies, that would come to my office, asking all kinds of personal questions, wanting to get to know me better, taking me to meals, concerts, sometimes just calling me up to chat.  

    You have to realize that she/he is doing their job.  And you need to realize what your job is, which in my case was doing best for the company.  I suppose fortunately for me, my father was a salesman.  I had an idea of how the sales pitch works.  

    I wish more doctors thought as you do.  As you mention, as a patient I don't buy from the drug company reps.  I purchase what the doctor recommends.  That is where the buck should stop.

  • John

    6/18/2009 1:55:01 PM |

    I know this to be true, since I know a very beautiful young RN that got out of nursing to be a pharmaceutical rep.  She later got back in to nursing, when one of her clients (a Dr. at a medical spa) made her an offer she couldn't refuse!  She didn't stay with that job even a year though.  I'm sure you guess by that she is back in the pharmaceutical business!

    She told me that in my town of about 50 doctors, that only a couple of them would allow the reps to stop in.  Most of the doctors here are like you and do not welcome the reps.

    You can always tell which doctors go for this, because they will have a room full of samples and every kind of prescription drug poster imaginable hanging thoughout the office, especially in the exam rooms!

    As a patient, I find it really annoying to see almost as many reps waiting to see the Dr. as their are patients!  

    Everyone I know assumes that the doctors who welcome the reps do get something in return, and probably more than just a birthday cake.  I'm thinking free vacations for prescribing certain drugs.  

    Could that be possible?  No one will ever talk about the "benefits" a doctor receives for welcoming in the reps, but it sure would be interesting to know.

    Thanks for he very interesting "deep throat" post!

  • Get Primal

    6/18/2009 2:14:16 PM |

    Dr. Davis,

    I enjoy your blog very much, but there are a couple issues I'd like to follow up on.  Full disclosure, I am a medical device sales rep.

    The first issue is regarding a post a couple weeks ago regarding the greed of medical device companies.  You referenced the initial price of drug eluting stents versus the prices today.  There isn't an industry in the world that doesn't price their hot new technology at a premium.  As other competitors come to market the prices obviously come down due to the competitive matrix.  How much did your flat screen TV cost when it first came out versus what it could be purchased for today?  How about calculators?  Or anything else?  You can argue that we're talking about something much more important than TV's, and we are, but these corporations are not set up to help hospitals remain profitable.  They are responsible to their shareholders first and foremost.  Quoting the price per gram of stainless steel stents is clever (and I enjoyed seeing the numbers), but it doesn't even come close to telling the true story.  Do you have any idea how much money it takes to bring one of these stents to market?  Once it gets to market do you have any idea how much it costs to pay a massive team to support it?  I cannot speak for the pharmaceutical industry and reps as I do not work in that sector, but the medical device reps are a critical part of the equation and are a major cost to an organization.

    The other issue, which I found more entertaining than irritating, was regarding the helpless middle aged doctors.  Are you telling me than a balding, middle aged doctor should be expected to simply melt in front of an attractive 28 year old drug rep?  I would immediately lose all respect for one that did.

    Thanks for letting me vent, keep up the great work on the blog!

  • kris

    6/18/2009 3:02:15 PM |

    LoL, Dr Davis, come on, now don't be too hard on 28 years old good looking women?
    there must be a study out there which would show that having good looking people around you (male or female (LOL)) creates a competitive environment to look better which partly leads to paying attention to his or her's own body  which ultimately (hopefully)will lead to a gym close by?
    (although i got your point)
    No wonder the heading "Deep Throat" and the look of the Drug rep came in the same article.
    But point well taken. i will be smiling for years to come when  ever i hear from some body that they are Drug reps specially the good looking ones.
    i read some where that humor is the best medicine (although you have touched a real issue out there which is effecting all of our lives big time).

  • kris

    6/18/2009 3:12:11 PM |

    LoL
    Now come on Dr. davis, dont be too hard on the 28 years old good looking people? there must be study out there to prove that having good looking people around creates a competitive environment and leads one to pay attention to their own body which  ultimately (hopefully) leads them to a nearest GYM.
    (Although i got your point)
    No wonder the the line "Deep Throat" and "28 year old good looking" "hair line Doc" came in the same article but only a thyroid corrective human can put together all the pieces of a puzzle together.
    i believe in that above all, humor is the best medicine and this article will put smile on my face for years to come, when ever i see a good looking Rep.
    (you have touched an issue which is effecting all of us big time our health and our pockets, well done)

  • Charles R.

    6/18/2009 3:38:17 PM |

    Dr. Davis, I love your blog, and find your ideas an approach incredibly useful, and I despise the tactics of Big Pharma, but your conclusions here seem pretty ridiculous.

    Saying that a physician is "helpless" in the face of a good 28-year-old female salesperson is just silly. everything this letter describes is just Sales 101, and is the kind of thing taught in many industries to their salespeople.

    Any doctor succumbing to these kinds of tactics is choosing to do so, and is fully responsible for his/her actions. I have known a lot of physicians, and few of them struck me as being shrinking violets. In fact they were often pretty arrogant and quite convinced of their own superior knowledge. At least around patients.

    If a physician doesn't ask the hard questions, or can't say "No" to manipulative tactics, then all the responsibility is the physician's, not the big, bad salespeople. Physicians are far from helpless, given their extensive education, experience, and positions.

    Many people in many professions have to deal with skilled salespeople in their work, and many manage to act responsibly. "The devil made me do it" isn't an excuse.

  • shel

    6/18/2009 6:18:34 PM |

    your blog is getting better all the time. you have a unique angle as a doctor within the mainstream, speaking out against mainstream activities.

    keep this up and you'll be famous.

  • Anonymous

    6/18/2009 7:19:14 PM |

    We also do not see drug reps in our office.

    We do not accept samples and (even before it became illegal) we've never accepted non-educational paraphernalia (clocks, facial tissue, paper clip holders, etc).

    Occasionally pens would make it into circulation at our office, but we would put them in the back, not for patient use, but for staff use.

    We prescribe generics meds whenever possible. We do not carry samples because it adds an unnecessary dimension to the decision making process for the provider; patients are less likely to actually fill their prescription; if they fill it, they're less likely to remain on it due to the increased copay and it would be expensive to administer samples due to the increased workload it creates for support staff (especially patient phone calls inquiring about needing more samples "until they can get their RX filled").

    I worked with a local GI office during a technology upgrade, and in ONE day over a 30 min period during lunch, the doc had to come up from the GI lab to sign the necessary paperwork from FOUR drug reps so that his staff could get lunch (that he didn't even get to enjoy) and so they could leave samples.

    There were FOUR drug reps in the breakroom, standing around waiting for the doc to finish his last scope. FOUR. I went into the breakroom (unaware of what I was about to walk into) to grab a drink and HOLY COW was it intimidating. Four nice looking, well dressed and social 20-somethings waiting around for the doctor.

    They asked who I was (they know EVERYONE in the office, so being an outsider, I was like fresh meat to them I guess!) and I opened with, "I work at another doctors office, but we don't see drug reps, so I'm not used to being ambushed while taking a break! I feel like a celebrity! You'll have to forgive me *smile*"

    They laughed and then proceeded to question why we don't allow reps.

    I explained the aforementioned reasons and one person asked, "how do your patients who don't have much money afford care without free samples?"

    Simple: "We're a family practice office that is open every day of the year. Every Saturday. Every Sunday. Every Holiday. Patients can see us every day of the year and pay their $10 copay rather than incurring the cost of an ER visit. With the money that saves them, they can afford the generic medications we most often prescribe."

    It was quick end to a slightly uncomfortable conversation!

    -JL

  • kris

    6/18/2009 9:19:09 PM |

    i was hopping the you do that. thanks

  • Dr. William Davis

    6/18/2009 9:55:15 PM |

    I believe that the drug reps intentionally prey on vanity--they appeal to the doctor's need to show their knowledge, the need to exert their "alpha male" dominance. And it works.

    Such is human weakness.

  • Ganesh Kumar

    6/19/2009 3:53:53 AM |

    I think Dr Davis is right! I knew pretty women being hired by Citibank worldwide as "Relationship Managers" to get customers to fork out monies on various bank schemes and mutual funds...did not realize this has penetrated even the drug industry! Possibly due to same "string of owners" owning both industry? Just a food for thought!

  • Anonymous

    6/19/2009 5:54:34 AM |

    Although an exaggeration (somewhat) here is a humorous take on this topic from the daily show:

    Dr. Spin, Medicine Woman

    Thanks to Cristin Duren, pharmaceutical rep and Miss Florida 2006, Dan's now on Lipitor, Zyrtec, Nexium, Celebrex and Wellbutrin; also, he's had an erection for over 96 hours.

    http://www.thedailyshow.com/video/index.jhtml?videoId=117138&title=Dr.-Spin,-Medicine-Woman

  • Lee

    6/19/2009 9:31:53 AM |

    My brother used to be a pacemaker sales rep. These reps are usually made more welcome, since they help administer the devices and there are differences between companies' offerings which need explanation. Even so, he said the industry is based on bribery. The bribes are usually offered in the form of paid trips to conferences or sporting events.

    He said some doctors only accept trips to events that they consider professionally legitimate and do not intend to reward the salesman. But the salesman is not disappointed; he knows that he has still caught his fish. It is impossible for the doctor not to feel grateful. Sooner or later, the doctor will give the company's product a trial.

  • Sifter

    6/19/2009 6:35:09 PM |

    C'mon, you never bought a piece of jewerly from that hottie behind the counter? Sex appeal works, for all business, why should Big Pharma be any different?

    I generally agree with most of your criticisms.... my dad is a retired pharmacist, he'd be the first to denounce the bad antics and overpricing of meds, but that's the way it is.

    By the way, my doctor buddy in Glenview used to get cute reps taking him out Friday nights to get his name put on microbrewed beers, not to mention the $300 'dinners' at Hugo's Frog Bar for taking a 1 hour 'interview.'  Better to expose the side effects of Lipitor, etc then to bust some 28 year old for trying to make a living.

  • Dr. William Davis

    6/20/2009 12:30:49 AM |

    Sifter--

    You "c'mon":

    This sounds much like the testimony offered by tobacco industry representatives when asked why they continued to promote cigarette smoking when they had crystal-clear data implicating cancer causation: "Well, I had to pay my mortgage!"

    The ends do NOT justify the means. In my experience, drug industry representatives are a self-serving, money-grubbing lot out to advance their own careers. If they have to sell their souls and compromise their conscience and the health of other people . . .well, the truth be damned.

    I don't buy it.

  • Anonymous

    6/20/2009 3:54:15 AM |

    This excerpt is so true.  I was just on a vacation and met a really attractive young couple who sell pharma.  She was a model and he is former military, just like the article said. LOL

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What increases blood sugar more than wheat?

What increases blood sugar more than wheat?

Take a look at these glycemic indexes (GI):


White bread 69
Whole wheat bread 72
Sucrose 59
Mars bar 68
White rice 72
Brown rice 66


I've made issue in past of whole wheat's high GI--higher than white bread. Roughly in the same glycemic league as bread are shredded wheat cereal, brown rice, and a Mars candy bar.

With few exceptions, wheat products have among the highest GIs compared to the majority of other foods. For instance:


Kidney beans 29
Chick peas 36
Apple 39
Ice cream 36
Snickers Bar 40


Yes, by the crazy logic of glycemic index, Snickers is a low-glycemic index food.

While I do not believe that low GI makes a food good or desirable, since low GI foods still provoke high blood sugars, small LDL particles, trigger glycation, and other abnormal phenomena, they are clearly less obnoxious than the items in the first list.

Take a look at this list:

Cornflakes 80
Rice cakes 80
Rice Krispies 82
Rice pasta, 92
Instant potatoes 83
Tapioca 81



Starches that are dried and/or pulverized, such as cornstarch, potato starch, rice starch, and tapioca starch (cassava root) will increase blood sugar even more than wheat. Foods with these starches have GI's of 80-100.

Cornstarch, potato starch, rice starch, and tapioca starch: Sound familiar? These are the main starches used in "gluten-free" foods. A hint of the high GI behavior of these dried starches is seen in the GI for cornflakes of 80.

So remember: Wheat-free is not the same as gluten-free. Gluten-free identifies junk carbohydrates masquerading as healthy because they don't contain one unhealthy ingredient, i.e. wheat.

Comments (38) -

  • Anonymous

    7/15/2010 3:20:49 PM |

    These are the reasons to go grain-free, except for flaxseed.

  • Suzan

    7/15/2010 3:46:32 PM |

    As a gluten intolerant person, I can say that those gluten-free foods make me ill. I favor a grain-free Primal diet.

  • Anonymous

    7/15/2010 3:48:19 PM |

    Is it also accurate to say that high glycemic index only applies to wheat, and not unrefined WHOLE wheat, or wheat KERNELS?

    Aaccording to this, wheat kernels's GI is less than 50:
    http://www.southbeach-diet-plan.com/glycemicfoodchart.htm

    Also, eating whole wheat makes you feel fuller longer, which is a benefit, no?

  • Peter

    7/15/2010 3:48:30 PM |

    I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease.  I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes.  anyone have a theory?

  • DrStrange

    7/15/2010 4:01:44 PM |

    "I wonder why many traditional diets in Africa are mainly composed of starch, yet don't seem to lead to heart disease. I 'm assuming manioc and other starches also raise their blood sugar, yet that doesn't translate into heart disease and diabetes. anyone have a theory?"

    There seems a stubborn tendency on this site to confound refined carbs ie flour products w/ intact, whole grain carbs.  They do behave differently in the body. Also, significant differences in some people's physiologies, individual, personal, differences that must be accounted for.  And probably most importantly, for the Africa etc question, total calorie intake is a huge factor.  If you eat more than your body needs, calories become excess blood sugar; spikes, triglycerides, etc.  US and western Europe, esp US, people just eat way to many calories because they are eating nutrient poor, manufactured, refined, imitation foods that do not satisfy the body's needs for nutrition in terms of micronutrients and oversupply calories.  If you only eat starches/carbs in the form of whole intact grains and starchy veg IN THE CONTEXT of a diet emphasizing micronutrient rich, nonstarchy veg, then you just will not have all the problems.

  • Jenny

    7/15/2010 5:47:17 PM |

    The glycemic index is a poor guide to carbohydrate impact because it is based on the fallacy that carbs that don't raise blood sugar at 1 hour after eating don't matter.

    They do.

    The carbs in many supposedly low glycemic foods WILL metabolise into glucose over a period of anywhere from 1.5 to 5 hours (Pasta) and when they do, they require insulin secretion to be dispersed.

    Also, "Glycemic Index" values for identical foods vary from study to study because the reading depends on the blood sugar status of the subjects used to test the foods. It is a junk measurement created by the food companies to fight the success of the low carb movement.

    Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health.

  • Pallav

    7/15/2010 6:19:28 PM |

    Dr Davis

    Dont be so stubborn. Get a hold of cooking practises as practised outside of your country too. If america is consuming wheat the wrong way, or you are consuming wheat in a wrong way don't implicate wheat in its entirety.

  • Pallav

    7/15/2010 6:21:32 PM |

    Imagine if i consume fish day and night cooked in hydrogenated vegetable oils and then implicate fish for my health problems. How stupid would that be?

  • John

    7/15/2010 6:51:53 PM |

    Hello, what happens if you consume bread with a fat or protein e.g. butter or cottage cheese.

    Will the bread contribute too much to insulin pike or will it be buffered by the fat/protein in the same serving?

    Thanks.

  • Carl

    7/15/2010 9:58:41 PM |

    Glycemic index if flawed in that it counts fructose as a carb for the denominator but uses glucose as the numerator -- at least as I understand it.

    Fructose follows a different metabolic path, but it is more destructive when in the blood than glucose -- which is probably why the liver does all the fructose metabolism.


    I revised glycemic index which used glucose and glucose based starches only in the denominator would be a better index to determine which foods slowly feed glucose into the body.

    Or, you can use glycemic index and just not look at fructose and sucrose containing foods.

  • Matt Stone

    7/15/2010 10:05:33 PM |

    Peter-

    Starches do not raise blood sugar or cause hyperinsulinemia in people on traditional diets because they are not insulin resistant like modern man on low-nutrient, refined-carbohydrate, vegetable and trans fat laden fare with a vast array of other complications.  

    Kitavans for example ate 69% of their food as unrefined carbohydrate, most of it as starch, yet the average fasting glucose is less than 70 mg/dl with zero documented cases of hyperglycemia or type 2 diabetes...

    http://180degreehealth.blogspot.com/2010/06/staffan-lindeberg.html

  • Dr. William Davis

    7/15/2010 10:10:58 PM |

    I have yet to meet a wheat product I liked.

    In my experience, they ALL increase blood sugar to one extravagant degree or another.

    Wheat also triggers inflammatory phenomenon more than any other food known. Celiac disease just one manifestation of wheat-triggered diseases.

  • Dr. William Davis

    7/15/2010 10:13:55 PM |

    Hi, Jenny--

    I agree wholeheartedly.

    We do the exact same thing as you: Count carbohydrate grams or check 1-hour postprandial glucoses. Works far better than the misleading glycemic index or glycemic load.

  • Anne

    7/15/2010 10:54:28 PM |

    After going gluten free I quickly discovered I felt better if I avoided all grains. I became very serious about eliminating grains after I found they all raised my blood glucose even if I ate them with fat and protein. I am now on a fairly simple primal-like diet.

    I run a support group for gluten intolerance and I tell people that the gluten free diet can be a healthy or as unhealthy as they want to make it. Sadly, many people who go gluten free don't want to change their diet other than to substitute gluten free products for their favorite wheat products. The market for gluten free foods has exploded and still growing. The most recent addition is Gluten Free Bisquick.

  • Lori Miller

    7/16/2010 12:42:56 AM |

    When I cut out wheat in January, my appetite ratcheted down and my bloating went away. That's reason enough for me to leave wheat alone.

    Since I cut way down on carbs in late February (probably less than 50g per day), a lot of aches and pains suddenly disappeared. The one in my left shoulder returns if I eat quite a bit of carb. For me, at least, it's carbs in general that seem to be inflammatory.

  • Lori Miller

    7/16/2010 12:51:06 AM |

    Jenny said, "Count the non-fiber carbs in your food, rather than the glycemic index values and you'll get a MUCH better idea of what impact foods will have on your health."

    This is what my mother and I have been doing for the past few months since we went low-carb. It's worked for us. (She's diabetic and I'm prone to acid reflux, so non-fiber carbs give us a smackdown very quickly if we eat too many of them.) It's easy, too, since it just involves looking at a label and doing a bit of subtraction. I never quite understood how the index worked--maybe because it doesn't?

  • Lori Miller

    7/16/2010 1:41:39 AM |

    For a thickener, I use xanthan gum. All the carbs in it are fiber. It's expensive, but a little goes a long way. I use half a teaspoon to thicken my protein/peanut butter shake, which is around 12 ounces.

  • julianne

    7/16/2010 3:20:33 AM |

    I have followed a low Glycemic load diet (always with protein and moderate carbs at each meal, plus a little good fat) in two different ways, for 12 years I used small amounts of grains including wheat (Zone Diet). 14 months ago I removed grains and legumes (but kept to Zone ratio as it works well for me) after reading this outstanding paper by Loren Cordain.
    "Cereal Grains: Humanities double edged sword"
    http://www.thepaleodiet.com/articles/Cereal%20article.pdf

    The difference was amazing - no more PMS breast pain, no more menstrual cramps, no more joint swelling, some fat loss, ganglion cyst that I'd had for 10 years shrank, no more constipation, all I can say is: try it - grain free is a cut above managing glycemic load with grains.
    Even fruit and it's fructose content is fine in moderate amounts (2 -3 serves day)

  • Anonymous

    7/16/2010 3:58:51 AM |

    I have celiac and type II diabetes, the fastest way to get my blood sugar in the danger zone is to eat "gluten-free" foods.  1/2 of a gluten free 6 inch pizza on a recent camping trip when we stopped in town for lunch sent me over 200. The only answer is to stick with real food, and skip anything with tapioca starch!

  • Bilal Shanti

    7/16/2010 10:18:01 AM |

    For people who respond well to low-carb diets, it’s important to sort out the nutritional value of a food from its affect on blood sugar. For someone who is (take your pick as they mean similar things): sensitive to sugar, prediabetic, Type 2 diabetic, insulin resistant, or has metabolic syndrome, keeping blood glucose stable is an important priority for health. In that way, it’s not much different from any condition that is treated by diet tradeoffs must be made. Someone who is allergic to wheat, for example, can still eat a balanced, healthy diet without harming their body. So can someone who strives for stable, normal levels of blood sugar.

    My Social Bookmarks: Bilal Shanti Facebook, Dr. Bilal Shanti Wordpress, Bilal Shanti MD Vitals, Dr. Bilal Shanti MD SiliconIndia, Bilal Shanti 123people, Bilal Shanti MD LinkedIn

  • Food, flora and felines

    7/16/2010 1:36:51 PM |

    @ Peter: Maybe it's the letcins? I came across a bit on how lectins may promote obesity (and so metabolic syndrome) in the whole food health source recently;

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins.html

    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins-part-ii.html

  • DrStrange

    7/16/2010 3:50:39 PM |

    anonymous: "The only answer is to stick with real food...!"

    ALWAYS!!!

  • help to stop smoking

    7/16/2010 6:22:54 PM |

    For most people, this is just interesting, albeit, a little confusing. It is for me anyway. I don't pay attention to anything I eat, except I try to avoid desserts (when possible).

    I'm curious, are there simple guidelines for those who are gluten intolerant or have similar food "issues". Also, don't most people who "feel" they are gluten allergic, not?

    I read somewhere that it takes an endoscopic biopsy to officially diagnosis someone as gluten intolerant? For instance, a family member thinks she is because she thinks bread gives her gas. Weird, huh? Last time I checked, EVERYTHING gave her gas! Smile

    But apparently the internet has many sites just waiting to fill her head with crazy ideas.

  • Dr. William Davis

    7/16/2010 6:42:37 PM |

    Hi, Help to stop--

    My personal view is that all humans should stop consuming wheat. There is more to wheat intolerance than celiac disease, the conventionally accepted health problem provoked by wheat gluten.

    But there are so many other expressions of wheat intolerance that are rarely diagnosed, from childhood behavioral disorders to unexplained ataxias (imbalances due to neurologic deterioration) to peripheral neuropathies to diabetes to heart disease . . . and the list goes on and on.

    The difficult thing is that the majority of these people with non-celiac wheat intolerances test negative for celiac markers like anti-endomysial antibodies and anti-gliadin IgG.

  • Anonymous

    7/16/2010 10:24:18 PM |

    As I understand it the glycemic index was set using only slender healthy college age men, hardly a model for me!

  • Lori Miller

    7/17/2010 12:22:13 AM |

    @Help to Stop, according to Norm Robillard, a microbiologist, carbohydrates produce gas in the digestive tract. Fat and protein, not so much. In my case, wheat--especially whole wheat--made me so bloated I looked like I was pregnant. (Look up "wheat belly" on this site.) Since cutting out almost all the starchy, sugary carbs, I no longer have this problem. I recommend your family member with the gas problem try a low carb diet and avoid dairy products.

  • Pallav

    7/17/2010 4:50:20 PM |

    Dr. Davis.

    "wheat is not for human consumption"
    .
    knock knock! anyone home?
    cooking styles? perhaps?
    .
    Hydrolysis and depolymerization of gluten proteins during sourdough fermentation
    http://pubs.acs.org/doi/abs/10.1021/jf034470z
    .
    Sourdough Bread Made from Wheat and Nontoxic Flours and Started with Selected Lactobacilli Is Tolerated in Celiac Sprue Patients http://aem.asm.org/cgi/content/abstract/70/2/1088
    .
    Potential of sourdough for healthier cereal products http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHY-4F6CRDT-2&_user=10&_coverDate=03%2F31%2F2005&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383360&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c744a61e5abbed1ed60c4a079ff39fb5.
    .
    Prolonged Fermentation of Whole Wheat Sourdough Reduces Phytate Level and Increases Soluble Magnesium http://pubs.acs.org/doi/abs/10.1021/jf001255z
    .
    Phytase activity in sourdough lactic acid bacteria: purification and characterization of a phytase from Lactobacillus sanfranciscensis  CB1
    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4846KTT-11&_user=10&_coverDate=11%2F01%2F2003&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1403383734&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b30d3245227db0269ca748da5d73c62f
    .
    Article
    Moderate Decrease of pH by Sourdough Fermentation Is Sufficient To Reduce Phytate Content of Whole Wheat Flour through Endogenous Phytase Activity http://pubs.acs.org/doi/abs/10.1021/jf049193q

    i'm curious why wheat is still unsuitable after neutralizing gluten and phytic acid?

    kindly explain the science dr. davis!

  • TomF

    7/17/2010 9:23:30 PM |

    Can you successfully build muscle mass on a grain free/low-carb diet?  I am eating to gain weight, but I'm concerned my diet is not optimal (i.e. heavy in carbs).  However, I'm afraid that if I drop the carbs down I could end up doing myself a disservice in terms of building muscle mass.

  • Lori Miller

    7/18/2010 1:41:41 PM |

    Tom F, I was a Body-for-Lifer for six years. For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go.

    Recently, I started the Slow Burn program by Fred Hahn. It's a strength training program. Having done weightlifting for six years, I was fairly strong, but I've found these exercises very challenging--especially the one-legged squats. With the BFL exercises, I was at the limit of what my joints, not muscles, would take. With Slow Burn, the exercises are easier on your joints, so my muscles are getting more of a workout.

    A few people have written about the Slow Burn program: Dr. Michael Eades (he's a co-author of the book: http://www.proteinpower.com/drmike/uncategorized/slow-burn-fitness-for-boomers/

    Tom Naughton: http://www.fathead-movie.com/index.php/2009/10/01/taking-the-6-week-cure-almost/

    and me (see comments too, Fred Hahn was kind enough to make some suggestions).
    http://relievemypain.blogspot.com/2010/07/exercise-without-joint-pain.html

  • DrStrange

    7/18/2010 3:16:59 PM |

    "For health reasons, I traded the low-fat, high carb diet for a high-fat, low-carb one. It took me a few weeks to get back the energy to sprint across the street, for example, but for ordinary, day-to-day stuff, I had more get-up-and-go. "

    It's all about individual physiology and uniqueness.  I basically had the opposite reaction when I did this, going from moderate fat fairly high carb "health food "diet. After about 9 months on low carb (approx 30 grams/day total) high fat diet, I felt like I was dragging an anchor all day every day. Gradually worse as time passed. If I did even mild exercise ie Nordic Walking for a couple miles, I would be totally wasted to the point I would almost have to sleep for a couple hours then continue to feel exhausted for another 24 hours or so.  Finally got smart and went the other way first McDougall and got my energy back then "upgraded" to Fuhrman and finally stabilized blood sugar etc.

  • Dr. William Davis

    7/18/2010 4:47:52 PM |

    Pallav-

    Please read the past posts in this blog.

    Wheat is not just about gluten, though gluten proteins are indeed a major part of the adverse reaction to wheat.

    We also have neurologic phenomena attributable to wheat, only some of which may be gluten-mediated. We have amylopectin A, among the most highly digestible starches known, accounting for wheat ability to increase blood sugar more than just about all other carbohydrates.

  • rmarie

    7/19/2010 3:50:35 AM |

    @ Dr. Strange
    We know each other from the McDougall forum. I left, because I couldn't take the constant hunger any more, even though I ate practically all day long. I lost so much weight that my BMI was down to 17.5. I did McD for almost 1 1/2 years. At the end I weighed 3 pounds less than when I was 17 - which was 50 years ago!

    (note to others, I'm 4'11" started McDougall weighing 93 lbs and within 3 months was down to 88 and then actually went down to 85lbs. That's when I said 'no more' and went over to the low(er) carb community (60-80g).

    Unlike most people I have never had any aches or pains, joint problems or digestive problems in my life.
    And I've always been very active with lots of energy both with low-fat/high carb or low-carb/high fat. I see no difference except that I can now often go 3-4 hours between meals before I get hungry.

    But I did not adopt the american way of eating (junkfood and sodas) after coming here from Europe. I started McDougall starch based diet because of its promise to lower blood sugar (he does have many success stories, helped change people's lives in more than 30 years and offers many well researched science based articles to support his position). It is so confusing when each side is certain they have the answer WITH STUDIES TO PROVE IT.

    I have been pre-diabetic for at least 10 years that I know of. Doc never said much because the cut off number was 126 and I was well below that.

    Low-fat, high carb surprisingly did not change my BS much either way. I certainly did NOT have the reaction Dr. Davis talks about.

    Everyone reacts differently (maybe there is something to the metabolic typing after all?

  • Pallav

    7/19/2010 9:05:31 AM |

    Dr davis

    Thanks for your reply. what wheat contains is probably not entirely known, ill give it to you because of the clinical results coming through but wheats culpibility in the crime is quite interesting and certainly whether some component of wheat is responsible for the results you are observing or whether it is just a matter of preparation would certainly call for further investigation.

  • JTownsend

    7/21/2010 10:07:28 PM |

    Inspired by the good doctor I have essentially eliminated all grains from my diet, particularily wheat, with positive results. But I must admit that I do still enjoy a cold beer and am loath to
    forsake this one precious pleasure. Where does beer fit in I wonder? It is a grain product I guess just like bread or cereal. So is it on the banned list for cardiac health?

  • Anonymous

    7/23/2010 3:41:22 PM |

    Is there a safe sandwich bread out there in most local stores?  I eat sandwiches most every day and I'm trying to figure out how to follow your advice re wheat.

  • Anonymous

    8/26/2010 4:23:10 PM |

    Try Glucose Level by Sprunk-Jansen.

    GLUCOSE LEVEL helps to support glucose metabolism and to maintain insulin levels already within the normal range. GLUCOSE LEVEL uses four plant extracts - nettle, salt bush, walnut and olive - which work together to help bring your blood sugar levels into alignment.

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DHA: the crucial omega-3

DHA: the crucial omega-3

Of the two omega-3 fatty acids that are best explored, EPA and DHA, it is likely DHA that exerts the most blood pressure- and heart rate-reducing effects. Here are the data of Mori et al in which 4000 mg of olive oil, purified EPA only, or purified DHA only were administered over 6 weeks:



□ indicates baseline SBP; ▪, postintervention SBP; ○, baseline DBP; •, postintervention DBP; ⋄, baseline HR; and ♦, postintervention HR.

In this group of 56 overweight men with normal starting blood pressures, only DHA reduced systolic BP by 5.8 mmHg, diastolic by 3.3 mmHg.

While each omega-3 fatty acid has important effects, it may be DHA that has an outsized benefit. So how can you get more DHA? Well, this observation from Schuchardt et al is important:

DHA in the triglyceride and phospholipid forms are 3-fold better absorbed, as compared to the ethyl ester form (compared by area-under-the-curve). In other words, fish oil that has been reconstituted to the naturally-occurring triglyceride form (i.e., the form found in fresh fish) provides 3-fold greater blood levels of DHA than the more common ethyl ester form found in most capsules. (The phospholipid form of DHA found in krill is also well-absorbed, but occurs in such small quantities that it is not a practical means of obtaining omega-3 fatty acids, putting aside the astaxanthin issue.)

So if the superior health effects of DHA are desired in a form that is absorbed, the ideal way to do this is either to eat fish or to supplement fish oil in the triglyceride, not ethyl ester, form. The most common and popular forms of fish oil sold are ethyl esters, including Sam's Club Triple-Strength, Costco, Nature Made, Nature's Bounty, as well as prescription Lovaza. (That's right: prescription fish oil, from this and several other perspectives, is an inferior product.)

What sources of triglyceride fish oil with greater DHA content/absorption are available to us? My favorites are, in this order:

Ascenta NutraSea
CEO and founder, Marc St. Onge, is a friend. Having visited his production facility in Nova Scotia, I was impressed with the meticulous methods of preparation. At every step of the way, every effort was made to limit any potential oxidation, including packaging in a vacuum environment. The Ascenta line of triglyceride fish oils are also richer in DHA content. Their NutraSea High DHA liquid, for instance, contains 500 mg EPA and 1000 mg DHA per teaspoon, a 1:2 EPA:DHA ratio, rather than the more typical 3:2 EPA:DHA ratio of ethyl ester forms.

Pharmax (now Seroyal) also has a fine product with a 1.4:1 EPA:DHA ratio.

Nordic Naturals has a fine liquid triglyceride product, though it is 2:1 EPA:DHA.





Comments (5) -

  • Jakub Polec

    5/22/2013 5:59:53 PM |

    In some DHA, or DHA+EPA supplements one can find additions with for lipase-enhanced digestion which support absorption of n-3 FA. Therefore any supplements with > 1g/d DHA+EPA (or purely DHA) should influence our health.

  • Susie

    5/30/2013 1:02:21 PM |

    Dr. Davis,

    Very happy to learn this distinction between forms of the fats. Are triglyceride and phospholipid two different forms or are they the same? Do you happen to know anything about the Swanson brand which has an EcoMarine trademark?

    Thank you,

    Susie

  • john pop

    6/11/2013 12:33:21 AM |

    Dr Davis, what about Nordic Naturals DHA Xtra Strawberry softgels?

  • Annette

    6/11/2013 2:35:31 AM |

    I've been totally grain-free and dairy-free for over a yr.  My total chol is 177, HDL is 83, LDL is 88, Triglycerides are 30 and risk factor 2.7, but a 64-slice heart scan done in May 08 showed plaque to two coronary arteries.  I had a stroke in my 40's and lost the sight of one eye.  My dad died of a stroke at age 35.  My grandfather died at 68 of a heart attack.  I'm 70+.  On my insulin sensitivity score ranging from 0-100, I scored 1.  Dr Douglas Brown, Brookfield said, "I've never seen such a low score for insulin sensitivity or triglycerides.  My BP fluctuates wildly.  Some days I don't require any Lisinopril and other days I require 20+ mg.  He thinks I should have a heart cath, but with such great labs, I highly doubt that Medicare would approve.  I wish I knew what to do about the BP.  I do go to Pulmonary Rehab classes for bronchiectasis, but I'm chronically fatigued.  We've had both radon and mold remediation done at our home and a Naturopathic dr told me I have an extreme amt of lead toxicity.  I need advice.

    I have your book and your CD's.  Listening to the CD's is what made my husband decide to go off grains, other than a little rice occasionally.  He dropped 20lbs fairly quickly.

  • DDR

    6/23/2013 12:59:33 PM |

    I get very itchy skin when taking more that 2 capsules of Nordic naturals. Any reason for this? Advice?

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Butter: Just because it's low-carb doesn't mean it's good

Butter: Just because it's low-carb doesn't mean it's good

The diet I advocate in the Track Your Plaque program to gain control over the factors that lead us to coronary plaque and heart attack is a low-carbohydrate diet. We begin with elimination of wheat, cornstarch, oats, and sugars in the context of an overall carbohydrate-reduced diet. We refine the program by monitoring postprandial (after-meal) glucoses.

But not everything low-carb is good for you. Fried sausages, for instance, are exceptionally unhealthy, despite having little to no carbohydrates.

An emerging but potentially very powerful issue is that of Advanced Glycation End-products, or AGEs. There are two general varieties of AGEs: endogenous (formed within the body) and exogenous (formed in food that is consumed).

Endogenous AGEs form in the body as a result of high blood glucose, i.e., glycation. When exposed to any blood glucose level of 100 mg/dl or greater, some measure of glycation will develop due to a reaction between glucose and various proteins, e.g., proteins in the lens of the eye, forming cataracts over time.

Exogenous AGEs form in food, generally as a result of heating to high-temperature. (AGEs is really a catch-all term; there are actually a number of reactions that occur in foods, not all of them involving sugars. However, the "AGE" label is used to signify all the various related compounds. The values quoted here are from Dr. Helen Vlassara's Mt. Sinai Hospital laboratory; reference below.)

Beef cooked to high-temperature yields plentiful AGEs. One gram of roast beef, for instance, contains 306,238 units. This means that an 8-oz serving yields 13.8 million units AGEs. Compare this to a boiled egg with 573 units per gram, raw tomato with 234 units per gram.

Butter contains an impressive 264,873 units AGEs per gram, the highest content per gram in the entire list of 250 foods tested in the Mt. Sinai study. A couple pats of butter (10 g) therefore contains 2.64 million units. A stick of butter that you might add to cake batter to make a cake therefore yields 30 million units of AGEs.

So there's nothing wrong with the fat of butter. It's AGEs that appear to be responsible for the endothelial dysfunction/artery-constricting, insulin-blocking, oxidation and inflammation reactions that are triggered. Among all of our food choices, butter is among the worst from this viewpoint.

Throw in the peculiar "insulinotrophic" effect of butter, and you have potent distortion of metabolic pathways, courtesy of the butter on your lobster.

(AGE data from Goldberg 2004. In this analysis, carboxymethyllysine was the marker used for AGE content.)

Incidentally, the new Track Your Plaque diet will soon be released as chapter 9 of the new Track Your Plaque book on the website.

Comments (59) -

  • rhc

    10/20/2010 10:15:00 PM |

    Are you talking about cold butter consumed without heating?

  • GK

    10/20/2010 10:20:53 PM |

    And do exogenous AGEs make it into systemic circulation, or are they broken down into simpler forms on digestion?  That would be the crucial thing to know.

  • Anonymous

    10/20/2010 10:28:55 PM |

    food gone and water gone... we are to survive on air? no wait thats polluted too..

  • Anonymous

    10/20/2010 10:34:19 PM |

    Is there a way to mitigate potential damage caused by exogenous AGEs?

  • Tuck

    10/20/2010 11:20:34 PM |

    "The results indicate that diet can be a significant environmental source of AGEs, which may constitute a chronic risk factor for cardiovascular and kidney damage."

    I'll start worrying when they can do a little better than "may".

    We're back to the "Eating fat makes you fat" mindset here...

  • Cameron

    10/20/2010 11:29:46 PM |

    I'd echo the question about whether or not this issue is limited to over-heated butter or butter in general.

    Also, is there enough information in the source data to indicate whether or not clarifying the butter into ghee would offer any improvement?

  • Bill

    10/20/2010 11:50:56 PM |

    Funny.
    You promote soy, which is known to be bad for you, but dump on butter which is known to be good for you....
    Strange?

  • Anonymous

    10/21/2010 12:22:02 AM |

    From the article:
    "...(AGEs), the derivatives of glucose-protein or glucose-lipid interactions"

    Can anyone explain the glucose-lipid interactions in ...butter?! Sheesh! Talk about bad science, those people did not follow the DEFINITION, never mind the protocols!

  • Daniel

    10/21/2010 12:55:44 AM |

    Exogenous AGEs are handily dealt with my people with healthy metabolims.  

    I know that's not many of your patients, so if you consider this a patient blog, ignore my comment.  

    Many people think of this blog as a "paleo blog" or a "low-carb blog" but in recent months, you've been basing many of your posts (and thinking) on the metabolically impaired.

    I can eat a plain mashed potato for breafast without seeing my blood glucose go over 100.  Are potatoes bad for me?  I really don't think so.  2 million years of evolution suggests otherwise.  Are potatoes bad for your patients that have been poisoned by years of fructose and PUFA induced metabolic carnage?  Yes.

    Same for butter.  It's a convenient and healthy source of good quality fat.  It has a lot of AGEs, but you have presented ZERO evidence that dietary AGES are unhealthy for otherwise healthy PEOPLE.    In fact, such evidence doesn't exist.  

    So, Doctor, are you treating sick patients or trying to remain a figure in the world of the super healthy?

  • Jared M Johnson

    10/21/2010 1:25:41 AM |

    Is the high level of AGEs in butter due to pasteurization?

  • Anonymous

    10/21/2010 3:15:43 AM |

    not buyin' it

  • Robin

    10/21/2010 4:02:41 AM |

    You are slowly hacking away at all I hold dear. Sausages! Butter! Sigh.

  • Joel

    10/21/2010 4:30:49 AM |

    Dr. Eades addressed this issue in 2008 and came to a different conclusion:

    http://www.proteinpower.com/drmike/low-carb-library/low-carb-diets-reduce-oxidative-stress/

    He specifically addresses the Goldberg 2004 study in the first comment:

    "I agree that there are vastly more AGEs in cooked foods, especially meats. What I’m not so sure about is whether or not the AGEs we eat end up as AGEs in us. The transit through the extreme acidity of the stomach would, I imagine, reduce the AGEs to their components, which we would absorb. The healthy human GI tract doesn’t have the ability to absorb large molecules. Even diglycerides (sugars composed of two other sugars, sucrose, for example) must be broken down to monoglycerides before being absorbed, so I seriously doubt that complex molecules such as AGEs could be absorbed in there native state. As a consequence, I’m not particularly worried about the AGEs I eat – I much more worried about the AGEs I create within."

    He also cites studies indicating that ketogenic diets reduce oxidative stress, despite butter and fried sausage being very common components of a ketogenic diet.

  • Joel

    10/21/2010 4:41:56 AM |

    Another one showing how vegetarians have higher levels of AGEs than omnivores:

    http://www.proteinpower.com/drmike/sugar-and-sweeteners/vegetarians-age-faster-2/

    Most likely due to a high fructose intake.

  • Anonymous

    10/21/2010 6:20:16 AM |

    What about butter from grass-few cows, ghee, goat's butter, or high vitamin butter oil? Do you relate to them in the same way?

  • Hans Keer

    10/21/2010 7:17:02 AM |

    Are we talking about heated butter here? Dietary AGEs should not be a problem; unless you have a leaky gut, they don't make it into the bloodstream. The problem with butter is that it, like all dairy, raises insulin and it still contains growth hormones and dangerous proteins.

  • D.M.

    10/21/2010 7:53:04 AM |

    Couple of points.
    First, that very paper says that only about 10% of exogenous AGEs actually make it into circulation, so that automatically takes butter down to 26.5KU/g. Of course if a patient has advanced kidney failure then worry about exogenous AGEs should be a concern, but so should protein, potassium etc etc.

    Secondly, the focus on exogenous AGEs in this table is obviously one-sided. Saying that butter contains more AGEs than a bowl of fructose, ignores the fact that once inside the body, the carbohydrate will cause immeasurably more glycation than the fat. These researchers are quite obviously pushing an lipophobic agenda here and I wouldn't fall for it.

    Third, it's not just butter apparently, but olive oil is also 120KU/ml or about 900 times more than an apple. But it would surely be absurb to think that apples will glycate less then olive oil?

    Fourtly, there something extremely suspect about the fact that whole milk contains 5300 times less AGE than butter. This should make us think twice before thinking that there's something uniquely bad about dairy fat that this study has discovered.

  • medeldist

    10/21/2010 8:03:21 AM |

    I find it hard to believe that butter (you do mean butter made from cow-milk, not margarine?) and red meat, two natural products, could be unhealthy for you. Anecdotal evidence says otherwise.

  • JLL

    10/21/2010 9:20:08 AM |

    The studies on AGEs are most often done on animals that have problems to begin with (e.g. diabetes). It's not clear at all whether consuming (a reasonable amount of) AGEs is harmful for healthy individuals.

    I've also reported about the AGE content of butter (see the list of AGEs in various foods) and I don't quite understand how they got such a high reading for butter. Did they heat it up? The processing of butter doesn't seem like it should result in much AGEs since milk is pretty low in AGEs.

    Like most commenters, I'm more worried about AGEs produced inside the body than AGEs from foods. And I'm even more worried about ALEs (Advanced Lipid peroxidation End-products) than AGEs.

    See my blog for more posts on glycation and lipid peroxidation (and how to avoid them).

  • Greensmu

    10/21/2010 12:05:28 PM |

    With the combination of A1 beta casein and AGEs in typical butter I think clarified butter/ghee with the cholesterol, lactose, and casein removed should be an improvement.

    But I second D.M. on the milk/butter thing, even though (like everyone else apparently =p) I have not checked the study referenced. It would follow that if they are both pasteurized they should be similarly high in AGEs.

  • Peter

    10/21/2010 12:06:22 PM |

    How do we know that eating more AGE's damages our cardiovascular system?

  • Stephen

    10/21/2010 1:08:00 PM |

    This sounds rather similar to "eating cholesterol results in an increase in cholesterol in the blood which causes heart disease and thus death."

    And butter is bad while soy is good? I'm not buying it.

    As others have mentioned - what population are we talking about here?

  • Alfredo E.

    10/21/2010 1:39:40 PM |

    Very illuminating post. I had no idea that butter had all those AGEs, I use it liberally in my cooking. I wonder what to use now instead of butter, lard?

    It would be very illustrative to educate us in ways to cook meat at low temperature.

    Thanks for the wonderful information.

  • Anna Delin

    10/21/2010 2:02:45 PM |

    Would a measurement of CRP reveal the inflammation potentially caused by the AGEs i eat? If I maintain an ideal CRP for years on a butter-rich diet, should I still worry?

  • Anand Srivastava

    10/21/2010 2:54:41 PM |

    I wonder why we love the taste of roasted meat when it is supposedly so unhealthy.

    It makes sense that the AGEs will not reach the blood stream if you have a good digestive system. If not well everything is a poison.

    Still Meat and Fat would be less of a poison than lectins from grains and legumes or even vegetables.

  • Martin Levac

    10/21/2010 3:34:39 PM |

    Dr. Davis, I'm confused. It's all your fault. If I just stick to low carb, it's all fine. But as soon as you start blaming butter, this low carb idea stops making any sense. Why would a low carb diet return me to good health when this very same low carb diet is blamed for disease?

    Clean slate. Start over. Fact, a  low carb diet returns me, and pretty much everybody else, to good health. Fact, a low carb diet contains lots of fat especially saturated animal fat. Fact, butter is one such fat and now we find that it contains lots of AGEs. Fact, in spite of this butter returns me to good health because it's part of a low carb diet. Logical conclusion, whatever I find in butter must be why I am now in good health.

    So why are you saying that butter is now bad for me?

  • Diana

    10/21/2010 4:41:17 PM |

    WoW great blog good to know since i love butter... but i totaly dont understand the whole Can anyone explain the glucose-lipid interaction thing.... thanks!

  • zach

    10/21/2010 6:13:00 PM |

    Butter is better for normal humans under normal circumstances than any plant food in existence. Butter: Food of the gods.

  • Eric

    10/21/2010 8:13:50 PM |

    I would also wonder if it's due to pasteurization.

  • Jack

    10/21/2010 8:38:18 PM |

    well dr davis, clearly you are ruffling the feathers of your readers with this one. nothing wrong with that in particular, except for when, as in this case, the information presented ruffles feathers because we all know it's just not possible. people have been eating (and studying the effects of) butter for a reaaallly long time. pretty much all whole food health gurus (meaning the awesome new wave of nutrionist/doctor bloggers that has sprung up this past decade) agree that full fat butter is very healthy to consume even in fairly substantial amounts. in fact, they ARE consuming it, and living very well while doing so. grass fed butter in particular, as you are well aware, has been tested and studied extensively, and the fat soluable vitamins and nutrients are so rich its astounding.

    just because something is found to have high AGEs before consumption, doesn't mean that particular item is causing the problems that you blame butter for here. be careful not to attack one of the most hallowed health foods unless you have have absolutely rock solid information that people can stand on.

    i only say this because i know you run a well articulated blog here and your name gets around on many other similar minded blog sites. i have read many of your articles, but reading articles like this make me (and many of your other 'faithfuls') cringe, because we really cannot agree with this.

  • Dr. William Davis

    10/21/2010 10:37:41 PM |

    Unfortunately, the data do not specify how or what was done to the butter, if anything. I suspect it was just off-the-shelf butter.

  • Dr. William Davis

    10/21/2010 10:44:27 PM |

    There seems to be a lot of misunderstandings here about what Vlassara et al's data are showing. This one perspective reported here does not do justice to this fascinating topic, which is clearly worth pursuing further.

    It's not my role to indulge anyone's low-carb fantasies. I am trying to interpret observations and data to employ in as effective a diet approach as possible.

    The data stand: Butter has some problems, despite fitting into most people's conception of low-carb.

  • Anonymous

    10/21/2010 11:31:39 PM |

    This can be interesting news, apparently not all paleo people had a paleodiet
    http://www.dailymail.co.uk/sciencetech/article-1321844/Stone-Age-man-ate-bread-just-meat.html

  • Joel

    10/22/2010 12:56:48 AM |

    Somebody correct me if I'm wrong, but every study on AGEs I've managed to dig up involves feeding humans or rats a lab "preparation" of AGEs, rather than actual real food.

    Some of the earliest arguments against a high protein diet came from  experiments with feedings of pure casein or liquid protein powders. When these experiments are repeated with whole food, the results are markedly different.

    "It's not my role to indulge anyone's low-carb fantasies."

    You're shunning of butter seems to follow this chain of association:

    1) Certain AGEs in the body are  bad.
    2) Butter contains significant AGEs (type of butter? type of AGEs?).
    3) Feeding pure AGE solutions to humans increases AGEs in the body.
    4) Ergo, eating butter increases AGEs in the body.

    However, certain AGEs such as pyrraline (commonly found in milk products) have been shown NOT to be metabolized in the body:

    http://www.biochemsoctrans.org/bst/031/1383/0311383.pdf

    Are we getting the full picture here? Until a study shows that feeding butter significantly increases AGEs in the body, I think we're in the land of speculation.

  • Martin Levac

    10/22/2010 2:09:15 AM |

    Dr. Davis, the kind of data you presented in your "case against butter" is merely the sort that explains how it works and what it's made of, not the sort that tells us whether butter is good or bad. We can figure out if something's good or bad without knowing how it works, we just feed it to somebody and wait for a result. We can also learn how it works without knowing if it's good or bad. We just feed it to somebody and draw some blood.

    The data you rely on here is the latter kind. It doesn't tell us whether butter is good or bad, it merely tells us how butter works and what it's made of. Now you believe that some of what it's made of, and some ways it works, is bad for us and you conclude that because of this butter is also bad for us. But in order to fully believe this you must also ignore the data that says that butter is good for us.

    Dr. Davis, you of all people should know health is not merely a measure of what's in the blood, let alone the measure of a single blood parameter.

    What we should conclude instead is that our understanding of the data regarding butter has problems.

  • Anonymous

    10/22/2010 3:20:12 AM |

    diglycerides (sugars composed of two other sugars, sucrose, for example)

    Eades really wrote that??? LOL. He should go back and study some Biochem 101 to find out the difference between diglycerides and disaccharides.

  • escee

    10/22/2010 3:30:15 AM |

    I might have seen this article referenced at this site previously, but I think it is worth revisiting in view of the topic.

    Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up

    Abstract: Coronary heart disease is associated with diet. Nutritional recommendations are frequently provided, but few long term studies on the effect of food choices on heart disease are available. We followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study. Dietary choices were assessed at baseline with a 15-item food questionnaire. 138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up. Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption (odds ratio 0.39, 95% CI 0.21-0.73), but not when combined with a low dairy fat consumption (odds ratio 1.70, 95% CI 0.97-2.98). Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome.
    Int. J. Environ. Res. Public Health 2009, 6, 2626-2638;

  • greensmu

    10/22/2010 2:11:29 PM |

    @Martin levac

    It doesn't tell us what butter is made of because we don't know if it was pasteurized or heated/cooked. My guess would be heated since that's what the study in question is looking at, heated foods. It's also known that butter has a very low smoking point.

  • Anonymous

    10/22/2010 3:46:00 PM |

    This is very interseting about butter. I have avoided butter because it is a non paleo food. It always seems that there are problems with these "new foods"

    Some things that I wonder though, are has this AGE content be measured accurately? Are there other studies that confirm this high level of AGEs in butter? Could butter from  pasteurized milk be higher in AGEs? Also could the level of freshness and the time it was frozen have some impact? These are some of the questions to consider.

    So far as the contention by some here that these chemicals don't pass into your system through your digestive system. The literature that I have seen clearly shows that they do pass through into your system.

  • Chuck

    10/22/2010 6:00:48 PM |

    questions about butter.  first as many have asked, was the butter heated for patuerization? my guess is yes.  second, what were the cows feed?  standard grain feed would probably lead to ore endogenous AGE in cows compared to a diet of grass.  as for now, i am sticking with my grass fed, non pasteurized butter.

  • Anonymous

    10/24/2010 7:21:18 AM |

    Nothing wrong with saying "Whoops.  My bad.  Thanks for correcting me with your comments guys and gals".

  • Anonymous

    10/24/2010 6:10:30 PM |

    Sorry Doc,

    This has been one of your least helpful, and nearly destructive blogs, I've ever seen. If you truly believe butter is not good, why not research how it could be 'better', such as clarifying it into ghee, or buying only grass-fed butter.

    So then what do YOU suggest instead as the best possible source of dietary fat???

    You must realize that the majority of people buy that horrible slow-poison known as margarine, because it has been billed as 'healthier', and your blog will only strengthen that perception.

    It seems like occasionally you go on vacation, and let the TYP committee post an article for you. This one stunk.

    The 6-year old study you quoted sounds like it was paid for by the vegetable oil industry.
    Anything we swallow gets nearly destroyed by our stomach acids, and who says that carboxymethyllysine (prior to digestion) is a proper marker for eventual AGE cell damage? Wouldn't Uric Acid have an even greater role? OR Hydrogen Peroxide induced in the blood or tissues? Doesn't Glucose, by far, cause the greatest destruction? Remind me what the G in AGE stands for?

    Weakly researched or justified blogs like this one make us lose faith in you as an expert.

  • Dr. William Davis

    10/25/2010 2:45:23 AM |

    No apologies from me.

    Just because you wish it weren't true, or that the data should be better sorted out, doesn't make it so.

    Until we obtain more clarification, butter remains on my list of "watch out."

    Wheat is unquestionably bad. Some foods, like spinach and kale, are unquestionably good. Other foods, like butter and other dairy products, have mixed effects.

    I'm talking butter here. I'm not insulting your aunt.

  • Anonymous

    10/25/2010 7:54:06 AM |

    I'm not that much of a fan of butter since I've got an autoimmune disorder which seems to get slightly worse with dairy, but, wouldn't ghee/clarified butter remove all/most of the AGEs throught seperation and physical removal of the sugars and proteins, leaving only the pure fat?
    Even AGEs from super-heated pasturized butter would be removed...
    Unless the fat itself gets glycated
    (this is the first time I've heard of this but it seems plausible, and ghee won't get rid of oxidized unsaturated fats from pasturized butter)

    Here's something else I don't understand: what makes butter so special in regard to external A.G.E.s as opposed to other low-carb, high-fat foods that it would warrant special attention?
    If butter can be filled with A.G.E.s, wouldn't a bunch of other low-carb foods considered healthy now become suspect?
    Or is the heating process itself that makes the pasteurized butter they likely tested on the culprit?
    (In the same way canola and soybean oils are hot-pressed to reduce toxins and therefore are highly oxidized)

  • Stephen

    10/25/2010 7:51:35 PM |

    I thought that the butter used in that study was whipped butter. If so, the measured AGE content might be drastically different from normal butter.

  • travis t

    10/26/2010 7:37:57 PM |

    Am I missing something, I thought AGEs were a combination of sugars and proteins. The label of my butter says zero carbs and zero protein. So what is glycated ?

  • Jack

    10/27/2010 4:59:46 PM |

    "No apologies from me."

    “It's not my role to indulge anyone's low-carb fantasies.”

    “I'm not insulting your aunt.”

    interesting attitude. i'm not real certain that an apology is in order specifically for your article, but perhaps a more in depth look at the 'data' is. the type of people who come here have a veracious appetite to find the real truth, and you are ignoring a host of excellent replies that directly negate the 'data' and 'facts' that you are standing on.

    i am not seeing "i love justifying my high fat foods because i am hopelessly addicted to butter" kind of replies here. i am seeing well researched, well articulated points about why the 'data' you presented here (and in your other previous article where you do state as a fact that "butter makes you fat") are not holding up well. And therefore, the quotes from you that I point out above do actually seem to be a bit insulting to your readers. your reply is quite pompous as well.

    please keep in mind that we (meaning the collective group of caring folk who frequent your blog) are only making noise on this one for everyone’s good. you may not want to be so hasty in shunning good responses that question your findings, but, uh, it's your call doc, and your reputation.

    as always, i appreciate the work you do. even with my disagreement about an article like this, i believe you do a great service to the health community and i sincerely thank you for it.

  • Sebastien

    10/28/2010 9:34:50 AM |

    It's funny you mentioned that spinach and kale are unquestionably good. I can easily find plenty of bad in those two vegetables. High levels of oxalates is one. Kale is also highly goitrogenic. Those two vegetables are also some the most pesticide laden. On top of the pesticides, spinach is often irradiated.

    I'll stick with occasional greens and frequent butter consumption.

  • Olga

    10/28/2010 5:32:11 PM |

    Hi Dr. Davis:

    Please take a look at the daily lipid's post from today, on AGE's.  Here is the link:
    http://blog.cholesterol-and-health.com/2010/10/is-butter-high-in-ages.html

  • blogblog

    10/31/2010 12:59:32 AM |

    To paraphrase Henry Ford "nutrition is bunk". No statistically valid long term dietary clinical trial has ever been performed on humans. So we have no statistically valid evidence-based science on what constitutes a healthy diet. In particular the recommendations for eating fruit and vegetables is totally irrational. All vegetables are full of toxins and contain large quantities of known carcinogens. In fact the EPA would be required by law to ban the consumption and sale all vegetables if they were man made.

    Nutrition 'science' consists entirely of extremely dubious experiments on rats, meaningless population studies and irrelevant test tube experiments.

  • Anonymous

    11/3/2010 9:23:11 PM |

    @blogblog

    What you say is ridicolous.
    Consumption of vegetables has always been found to have nothing but extremely positive effects and not even one negative effect, except for people with Chrons.

    Not even one evidence of cangerous or toxic effect.

  • Ed

    11/16/2010 5:23:50 AM |

    The source of the butter data is this paper: "Advanced Glycoxidation End Products in Commonly Consumed Foods" (2004, Journal of the American Dietetic Association, via Google Scholar cache).

    Here are some numbers from Table 1:

    Milk, cow, whole .... 0.05 kU/mL
    Butter .............. 265 kU/g

    The table caption refers to "foods prepared by standard cooking methods" (these include frying). Expecting high AGEs in uncooked butter -- over 5000 times the level in milk! -- would make little sense. There's every reason to think that this butter had been exposed to high temperatures.

  • Jack

    11/17/2010 6:27:41 PM |

    @anonymous (Nov 3 comment)
    Actually, what you say is ridiculous too. I'd be careful not to make blanket statements like that. Built-in defense mechanisms are not reserved for Venus Fly-traps only. Vegetables, like many other plants, have them too.

    PLANTS BITE BACK

  • Joe

    12/7/2010 1:22:29 PM |

    What do you think about this from Dr Mercola?

    Good-old-fashioned butter, when made from grass-fed cows, is a rich in a substance called conjugated linoleic acid (CLA). CLA is not only known to help fight cancer and diabetes, it may even help you to lose weight, which cannot be said for its trans-fat substitutes.

    http://articles.mercola.com/sites/articles/archive/2010/12/07/why-is-butter-better.aspx

  • Anonymous

    12/7/2010 6:32:42 PM |

    According to the chart, a frankfurter or a serving of roast beef is quite a bit worse than a serving of butter.
    http://inhumanexperiment.blogspot.com/2009/09/age-content-of-foods.html

  • jpatti

    6/18/2011 9:42:06 PM |

    Butter is not good because it's low carb.  Butter is good because it's butter.  

    Before I ever heard of low-carb, or vitamins or minerals or any of that, when ALL I knew about nutrition was that sugar was bad and veggies good cause mom said so, butter was good.  Butter made me WANT to eat an artichoke.  And... it still works today!

    If there were no other benefit to butter than it made vegetables palatable, butter would be an unqualified good.  I would not eat 1/10th the veggies I do if not for butter.  

    Since I am stubbornly of the opinion that eating at least half the diet (by volume) as nonstarchy vegetables is the main thing anyone can do for health, butter is an unqualified good in my world.  

    If it makes people voluntarily eat their veggies, it's good.  

    *********************************************************************

    While just the veggie intake with butter in the diet is a HUGE good; butter is better than just the vegetables that go with it.  

    Butter is the number one source of butyric acid, a fatty acid that is a major constituent of the GI tract and often deficient in folks with GI disturbances like celiac and Chron's and systemic Candida.  IMO, the number one thing anyone with GI issues can do is eat lots of butter.  If you want to heal even faster, don't just eat it, but take it in both ends, so to speak.  

    Butyric acid also counteracts inflammation, the main underlying issue with heart disease as I understand, and the apparent underlying issue with the epidemic of autoimmune disorders we're seeing.

    My grandmother's generation ate GOBS of bread, wheat was a mainstay of their diet.  But they didn't have all the gluten-intolerance this generation has.  IMO, the reason is cause they slathered butter on their bread.  

    Anyways, she lived to 102, so must've done SOMeTHING right.  And she never believed the hype about margarine, always overate butter like crazy.

    Butyric acid has other interesting effects... it lowers total cholesterol 25%, serum triglycerides 50%, fasting insulin 25%, and increases insulin sensitivity 300% - there's a bunch of pubmed references listed here: http://wholehealthsource.blogspot.com/2009/12/butyric-acid-ancient-controller-of.html

    Note that "metabolic syndrome," the precursor to T2 diabetes, is pretty much insulin resistance and high triglycerides.  When metabolic syndrome is the question, apparently, butter is the answer.

    *********************************************************************

    Butter is particularly good from pasture-raised animals, which maximizes the vitamins A, D3 and K2 in it.  

    Very few of us get enough vitamin A.  Many of us, diabetics being an example I'm terrifically familair with, do not convert beta-carotene to vitamin A well at all.  In general, omnivores and carnivores don't do this efficiently, even the healthy ones with good genes.  

    Herbivores do it wonderfully.  All the gorgeous colors of the pasture convert into lots of real vitamin A for us to eat.  You can take nasty cod liver oil, or you can just melt yummy butter on your veggies.

    I do not spend 16 hours in the sun in summer.  But I rent a small house on a farm and am surrounded by cattle, and they do.  They walk about, eating pasture, chewing cud and the calves frolicking across the fields, in the sunshine all day, where they also are making loads of vitamin D3 - the real stuff, not the crappy D2 they "fortify" factory farmed milk with.

    Butter from cows eating rapidly growing grass is also the best known source of K2 other than natto.  Just like Vitamin A, we are not good at making K2, but cows are.

    *********************************************************************

    IMO, butter is a near-miraculous food, one of the true health foods.  

    I buy from a farm that makes butter from cream from cows on pasture, with no ingredients except cream.  When the beta-carotene content is highest, it turns darker, which is also when the vitamin A, D3 and K2 is highest.  When it gets like that, I buy 40 lbs and stick it in my freezer for consumption over the next year.  When I run out, I just buy it weekly again until it gets dark again.

    I eat between 1/2 - 1 lb butter every week. It's yummy.  As noted, it's wonderful on vegetables.  But it's also nice just melted over some over-easy eggs, or a pat melted on a burger or steak.  

    Also, pasture-raised butter tastes better.  The stuff I buy comes in tubs, not sticks, but hubby being a truck driver finds sticks more convenient.  He buttered a dish with his butter recently before he served it to me and... well, I added the real butter.  His butter just wasn't... buttery enough.  

    Butter is... just awesome stuff.  And for those who REALLY disagree, my advice is to heed Julia Child who said, "If you're afraid of butter, use cream."

  • Florent Berthet

    2/7/2012 6:04:57 PM |

    Like Olga, I''d be very interested to hear your opinion on this daily lipid''s post:
    http://blog.cholesterol-and-health.com/2010/10/is-butter-high-in-ages.html

    Also, what about ghee?

  • Alex Tahti

    11/5/2012 7:21:42 PM |

    Apparently the AGEs in the study cited by Dr. Davis were measured using anti-body immunoassay which is an indirect method that is susceptible to distortions.   A mass spectrometer, a direct measurement, was used to analysis AGE in butter in this study http://biomedgerontology.oxfordjournals.org/content/65A/9/963.full and found: "The CML concentrations of various foods vary widely from about 0.35–0.37 mg CML/kg food for pasteurized skimmed milk and butter to about 11 mg CML/kg food for fried minced beef and 37 mg CML/kg food for white bread crust".

    So wheat in the form of white bread crust is a factor of 100 more than butter in CML AGE.

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