I can attest to the fact that doctors ignore what happens to blood glucose after eating. My fasting BG has always been normal but my glucose tolerance tests have always been high. My last glucose tolerance test a few yrs ago went to 201. My doctors told me I had some insulin resistance but assured me that I did not have to do anything about it because my fasting was OK.

About 1 year ago, after reading this blog and others, I bought a glucometer. Yes, my fasting was "normal" but I could easily push it up to 200 by eating. I did just what Dr. Davis recommends. I used the glucometer to figure out what I can eat and how much I can eat. I am able to keep my blood glucose below 120 now. The glucometer is a powerful tool.

Is it possible my ignored elevated post meal blood sugars did damage? Well, lets see, I have peripheral neuropathy and have had cardiac bypass. Giving up gluten 6 yrs ago greatly improved my PN and relieved my of shortness of breath and pitting edema. Getting my blood glucose down will make a difference too.

I recommend Blood Sugar 101 http://www.phlaunt.com/diabetes/

Going to get a glucose meter today and start checking.  Is there a desirable number or range for glucose before and after or is it about how much or how little it rises without regard to the number?
Seems like somewhere around a 100 is what you are advocating.  

If a person is not diabetic, is it helpful at all to know your A1C when getting routine blood work done?  Just wondering...

Thanks.

Jan

You can get Wavesense Keynote test strips from Amazon for about 35 cents per strip -- the best deal I've ever seen.  (The meter is about $35 there.)  

I am curious about the right time to test.  If blood sugar goes to 160 at 30 minutes, but is down to, say, 100 at one hour, is that ok? Why is one hour (not 30 mins or 2 hours) the key number?

Ground meat is often cut with breadcrumbs. I won't eat ground meat or meatloaf at a restaurant or potluck supper.

Balsamic vinegar contains up to 3 g of glucose per tablespoon. And most people do add sugar to salad dressings. One restaurant I went to boiled down cider vinegar until it was sweet.

You can use those urine glucose test strips to test foods for the presence of glucose before you eat them. If it's starch, you have to chew the food a bit first to break down the starch. See Richard Bernstein's "Diabetes Solution."

When exactly do you take the measurement?  One hour after the start of a meal or one hour after the end?  Sometimes when we eat out, a meal can take an hour or more to finish.

One caution is that blood sugar meters are only accurate to plus or minus 20% which is a huge variance.  Also, many (probably worst w/ the Walmart Relion or similar budget meters) are not very consistent so you can't just compare to a lab test and calibrate.  

What I generally do is take 3 (or even 4) readings within a few seconds of each other, toss any wild outliers, then average what is left.  If you try this a few times, depending on your meter, you may be shocked at how much difference there is between the readings.

Dr. Davis--Great post--I totally agree. Even if someone isn't diabetic or prediabetic (myself),  investing in a glucose meter, then self-testing (especially post postprandial) has got to be one of the absolute best investments one can make in personal health.

I once read that if most diabetics (and I'll add prediabetics too) had invested in a meter years before their diagnosis, mostly likely they could have/would have avoided many of their accompanying negative health conditions today.  

That said, there is still a lot of "cognitive dissonance" with regards to diet and health--I think the meter really helps to reinforce the cognition portion of that phrase thereby reducing the dissonance half.  

And using a glucose meter can actually be fun!

Here's an example of carbo loading on yam and plantain - there was a 7 hour "fast" prior to eating and then taking the measurements.

http://tinyurl.com/bg-set-001

mg/dL is marked at a few key points on the right hand side.

What I don't get is how to interpret the second rise and fall after the two hour mark ... though it is still inside the post-absorptive window (which closes 3-5 hours after eating, IIRC).

I'm pretty certain a glass of red wine explains the initial drop to 65 mg/dL, btw.

Also, for those that would like to make their own graph, it's easy to grab the url and fill in your own data (it's a google charts thing).

Will there still be production of small LDL from excess blood glucose even if there is ample available glycogen storage space? That is, will the liver simultaneously manufacture LDL and glycogen?

When do you start to count your one hour.  From the time of your first bite of food, or when you have  finished your last bite.  Since it takes about 20-30 minutes to finish eating, when to start the one hour count down is important.

Hi, Anne--

What a perfect example of the power of postprandial testing!

Yes, Jenny Ruhl at http://diabetesupdate.blogspot.com  provides a wealth of insight into blood sugar issues. We will also be releasing an in-depth Special Report on this issue on the www.trackyourplaque.com website.

In answer to the questions on timing of blood sugar checks:

I am guilty of oversimplification. The peak timing of blood sugar varies on the foods consumed and the mix of foods consumed. It will also vary from individual to individual. I believe a reasonable way to start out is to check 60 minutes from the completion of a meal. Even better, you might occasionally perform your own time-course study: Check blood sugars every 30 minutes to determine when you tend to peak.

Since an LC diet causes insulin resistance, (Actually a GOOD and protective thing within the context of an LC diet)wouldn't a long-term low carber get a sort of "false positive" reading of high blood sugar from ANY high carb meal?

Also, what do you think of the theory (that seems to really be gathering momentum lately) that fructose is the actual cause of insulin resistance, while on a "high carb" diet, and that glucose/starch is relatively benign?

I got a blood glucose monitor after I starting taking niacin for HDL (had read that niacin could raise blood glucose) and it was an eye opener. Now I know what foods to avoid.

Jeanne

Gretchen--

Great thoughts. I forgot about the bread crumbs in ground meat issue.

Coach--

I think it's a matter of degree: While fructose is clearly a very bad player, glucose/starch are not benign, just less bad. Look at the responses we can generate with glucose tolerance testing using 75 grams of glucose.

Since a simple way to reduce after-meal glucose readings is to eat smaller meals and eat more often, I don't quite understand why you think it's a bad idea.

Bloodsugar101 suggests timing from the start of the meal. I always set a timer anyway, and it is easier to do before beginning to eat than at the end of the meal. This can feel awkward at first in restaurants, but I look at it as a way to get the word out.

The occasional checks every 30 minutes is an excellent suggestion. Anytime you go over 140, you're causing damage. Even if it is only for brief periods, you want to be sure this is not one of your staple foods!

What has happended to your trackyourplaque forum? I can't reach it anymore? Server crash without any backups? :-(

hmmm. How painful is it to check the blood sugar that often?

I'm curious to know how to interpret blood sugar readings on the background of a healthy weight and a low-carb diet, with no known diabetes.  

My fasting sugar is the same as it was before going low-carb (mid-70s).  However, it now takes a lot fewer carbs to spike my postprandial sugars.  

An example: after 25 grams of carb in the form of a small serving of sweet potato with butter, my 45 minute postprandial reading, measured in triplicate, was 135.  I'm guessing the peak was even higher.  In case it matters, I'm a 36yo woman with a BMI of 18.9.  

Should I be unconcerned by this kind of spike as long as my typical meals don't spike my sugar?  Is this just the normal insulin resistance caused by a low-carb diet, as Coach Jeff mentioned in his comment?

Dr. Davis, you said, "While fructose is clearly a very bad player, glucose/starch are not benign, just less bad. Look at the responses we can generate with glucose tolerance testing using 75 grams of glucose."

This does not prove anything about what causes insulin resistance in the first place though.  The person having a response to glucose during a tolerance test may have originally gotten their insulin resistance from fructose.  You can't use fructose in the test since it doesn't raise blood sugar, you can only use glucose.  

To put it another way, people who don't have insulin resistance don't have abnormal responses to glucose during glucose tolerance tests.  Does that exonerate glucose?  Not really.  

What I'm saying is you can't indict glucose OR fructose based solely on what is seen in a glucose tolerance test.

Anon--

Blood sugars are too high. Either too much carbohydrate in the diet or something has caused an abnormal insulin response. While the dangers are not acute, there are long-term consequences of blood sugars this high.

Dr. Davis, if you can spare a moment I hope you would comment on this:

http://fanaticcook.blogspot.com/2010/01/should-you-take-vitamin-d2-or-vitamin.html

where Dr. Michael Holick (Mr. Vitamin D, from the look of his pedigree) claims D2 is equally as effective as D3 in raising and maintaining 25OHD levels?

There are two main causes of insulin resistance, dietary fat and possibly fructose.  Fructose is not a cause for many as they can eat a mostly fruit diet without issues but for some it is a big factor.  There are "must have" essential fatty acids needed in proper amounts and ratio, perhaps a bit more fat is needed.  Beyond that minimum amount, any additional adds to insulin resistance. The amounts and ratios are all present in an all plant diet without the addition of any add oils or fats and that w/ minimal nuts/seeds (maybe an ounce of flax).

After being on strict McDougall diet (total dietary fat approx 10% and no refined carbs, no animal products, no junk) for about 18 months, I did a 75 gm glucose tolerance test and had them do an extra point at 30 minutes just in case. My highest peak was 114.  Previously, on low carb diet I would go to 185 or higher. [I am 5'3" and 110 pounds so small body mass; lbs body per gm glucose if that makes any difference]

@ frogfarm said...
I find it very strange people take this particular study seriously.

At the end of the trial none of the participants had 25(OH)D levels above 30ng/ml, so they all remained vitamin D insufficient.
IMO it is unacceptable medical practice to knowingly give people an amount of a supplement that leaves them at such a low 25(OH)D level they remain unable to properly absorb calcium and well below the 58.8ng/ml level at which human breast milk flows replete with D3.
So too little vitamin D of any kind leaves you vitamin D deficient.
Is that such a remarkable finding?

BUY DISCOUNT Ostoforte 50,000 IU (also called Drisdol) ONLINE 50,000 IU (100 capsules)  $168.99 USD
or you can choose
Vitamin D3 $26.95 for 100 X 50,000iu capsules.
Who, but a fool, chooses to pay $169 when there's a better, cheaper alternative costing only $27?
Or choosing an oilbased gelcap still saves loads of money.
Healthy Origins, Vitamin D3, 10,000 IU, 360 Softgels $23.95

I'm not sure of the point or the common sense, involved in trying to prove a synthetic drug, humans have to convert to D3 anyway, may, in trivial amounts too low to get anybody out of insufficiency, may be as good as a natural, cheaper, product or that equivalence seen in a few persons at a very low dose level, also applies at the sensible, natural levels, desirable for optimum health outcomes.

While there are cases like this listed in Pubmed it is clear some people do not absorb nor are able to use Vitamin D2.
We report a case of a 56-year-old woman who received supratherapeutic doses of ergocalciferol (150,000 IU orally daily) for 28 years without toxicity.

A small trial of just 68 people is unlikely to pick up cases like the above.

Grassrootshealth Banner Graph shows the amounts people have been taking and the 25(OH)D levels they have achieved.
6000~8000iu approx 1000iu/daily for each 25lbs you weigh generally produces a natural level at which the body is able to store a sufficient reserve of D3 to be effective at times of crisis.
This LEF study is another example showing 5000iu/d is not sufficient to get most people above 50ng/ml.

As Holick knows perfectly well human skin naturally makes 10,000iu/daily given a few minutes full body UVB exposure. It does that for a purpose. Only when researchers start using equivalent EFFECTIVE amounts of the same NATURAL Vitamin D3 biologically identical to the form human skin NATURALLY makes, will we see an improvement rates of chronic illness.

Dr Strange, if you're eating low carb, you have to prep for a GTT by carb-loading for 3-5 days beforehand.  Your pancreas won't be prepared to handle 75g of carb unless you give it a few days to rev up insulin production first.

The reason that you had no problem with the GTT while McDougalling was that your body was used to high-carb loads, and so the test posed no challenge to your pancreas.

Testing in Pairs
Although this idea is for diabetics I feel it may also be useful for others wanting to see how particular food/exercise choices affect their numbers.
There is also a short video, a downloadable record form and an example to consider.

I can support what others are saying: before I went low carb, I could eat carbs and my blood glucose would never go above 120; now I eat pretty low carb and a single sweet potato can take me to 150.  I guess one should either eat extremely low carb or extremely high carb to avoid glucose spikes.

I worry that chronically eating high-carbohydrate, while generating an "accommodation" response that blunts postprandial blood sugars, will generate pancreatic BURNOUT by constantly challenging the pancreas to overproduce insulin.

I too find that my post-meal glucose goes up much more after I do have carbs, if I'm eating low carb than high carb.  It's kind of amazing, and a little worry-some.

However, if I eat very low carb, my fasting glucose is in the low 80s, while if I have more carbs, it's in the high 90s the next morning.  For example, I have (following the blog's advice) had absolutely no wheat and minimal sugar since Dec 27.  My fasting glucose had fallen into the low to mid 80s.  Two days ago, I had a large cookie after lunch --  My first wheat/sugar in 3 weeks.  The next morning, my fasting glucose was 98.

Insulin resistance is the key here and dietary fat is a major contributor to IR.  I simultaneously took insulin levels w/ the blood sugar readings in the 75 gm glucose tolerance test above, and they were consistently low normal to slightly below normal, starting w/ undetectable level at fasting. Readings were:

fasting < 2
30 minutes = 3
60 minutes = 5
120 minutes = 14
180 minutes = 8


reference ranges given on lab report:
fasting  < 17
30 minutes = 6-86
60 minutes = 8-112
120 minutes = 5-55
180 minutes = 3-20


Doesn't seem like too much risk of burn out there!  And again, the reason for the low insulin output generating a fairly flat and low sugar curve was that without excess dietary fat (7-10% of total calories), there is dramatically reduced insulin resistance.

Thanks for bringing up the importance of blood sugar levels. I've done the same thing with my followers in my recent eBook on type 2 Diabetes, Metabolic Syndrome, and Prediabetes.

What I have done is take it a step further. Instead of noting what my blood sugar reaction is to a large meal full of high GI starch and trying to avoid it, my focus has been finding ways to improve my glucose tolerance to such a meal.

My glucose response to food is now far better than any single person following the advice of this blog. That much I can guarantee. It is not luck. It is not genetics. I watched my numbers fall as I followed insights that I gained from several years of intense investigation on the subject.

The big thing that low-carb authors are missing is that unrefined carbohydrates can improve glucose response to food, even if they cause a larger rise in blood sugar in the short-term.

My blood sugar now peaks at levels below 80 mg/dl after meals, something that the medical and nutrition-sphere probably considers to be impossible. But it's not. It's glucose metabolism perfection, but it's not achieved through limiting glucose intake. In fact, that can make your response to glucose worse, not better.

When you say low carb, what percentage of your calories are coming from carbs? Talking under 30% here?

Off topic here but wish you would discuss salt and its effect on heart disease. There has just been a well publicized news story on it:

http://www.cnn.com/2010/HEALTH/01/21/salt.intake/

Do you recommend cutting salt intake to your patients?

Great blog!

"...if I eat very low carb, my fasting glucose is in the low 80s...  Two days ago, I had a large cookie after lunch -- My first wheat/sugar in 3 weeks. The next morning, my fasting glucose was 98."

Yes, the high fat content of low-carb diet causes insulin resistance!  If you ate low fat (around 10% total calories max) for a couple weeks then you would maintain the lower fasting sugar after a carb load. Though if that cookie had a lot of fat in it, that could be enough to kick up the insulin resistance again.  One other possibility is if you are gluten intolerant, the stress to your system of eating wheat cookie could make fasting bg higher.

Dr. Strange, Do you have any evidence that a diet high in healthy fats -- I'm a vegetarian, so I get little saturated fat -- causes insulin resistance?  I've never seen that theory propounded, and the mechanism seems implausible to me.

@ DrStrange
Re the high fat content of low-carb diet causes insulin resistance!
Maybe in some cases.

Most readers here will be following Dr Davis's advice regarding omega 3 intake
Fish oil prevents insulin resistance induced by high-fat feeding
it is also the case
Medium-chain fatty acids ameliorate insulin resistance

EPA and DHA are associated with lower HOMA-IR, while the opposite is true for n-6 FAs

It is misleading to assume increasing fat content of diet inevitably raises insulin resistance.

Dr. Strange-

Interesting thoughts and you are right to question low-carb dogma as well as to show that insulin resistance is the core problem - and that a very high-fat, low-carb diet worsens the core problem.

Anyone questioning this has not researched the issue thoroughly enough.


However, you are making the same mistake. Eating a high-carb, low-fat diet for an extended period of time, while lowering your fasting glucose and insulin levels, also makes your glucose tolerance worse.

Let me explain...

If you have a basline meal, let's say, a slab of baby back ribs with cornbread and baked beans, and your 1-hour pp is 140 mg/dl, fasting the next day is 100, then you have good base numbers to track improvement.

Eat low-carb, high-fat for 10 weeks, eat that same meal (ribs), and both your fasting and pp glucose levels will be higher than they were before you went low-carb. This means you're in worse shape than before the experiment.

If you eat low-fat, high-carb for 10 weeks, and you eat a slab of ribs, cornbread, and baked beans...
You're pp and FG will measure into the stratosphere (my 1-hour pp actually hit 173 mg/dl breaking a low-fat escapade...nutritarian).

Both diets made your glucose metabolism worse in response to your baseline meal.  In other words, both strategies give you better numbers in the interim while making you fundamentally unhealthier (not to mention eating low-fat will make you crave more fat and low-carb will make you crave more carbs).

What I've found is how to improve your glucose levels and insulin sensitivity in response to normal mixed food ratios. That's where real healing is achieved. A low-carber or a "low-fatter" will never get to a point where he or she can eat a large mixed meal with lots of fat, carbohdyrates, protein, and calories without having high postprandial spikes and high fasting glucose levels. Only someone who can eat 2 baked potatoes with 2T of butter and an 8-ounce untrimmed ribeye with fasting levels in the 70's and pp's in the 70-90 range is truly healthy and free of insulin resistance. I've found the secret to achieving that, and it is not low-fat, low-carb, or low-calorie.

If such a meal sends your blood sugar half way to Mars, then you need to fix that!  Not avoid it!

@ Matt Stone:

Stop spamming! Yes, "everyone is wrong but I have figured it all out but for won't tell you what it is unless you go to my web site and pay me" is a spam, plain and simple. Please stop it.

MattStone said: "Only someone who can eat 2 baked potatoes with 2T of butter and an 8-ounce untrimmed ribeye with fasting levels in the 70's and pp's in the 70-90 range is truly healthy and free of insulin resistance."

That is somewhat how I used to eat and my fasting sugar level was creeping skyward.  Switched to low carb and felt gradually worse and worse for the 9 months I did it.  Switched to low-fat/starch based diet and have been feeling very well and not craving fat at all.  I do eat a little over an ounce per day of flax and pumpkin seeds for EFA boost.

On 4 different occasions over the past couple years I have sent my blood sugar way up from one meal of moderate fat intake.  One was from eating all the seeds in a medium sized Delicata squash in one meal, maybe 1/2 cup or a bit more.

Admittedly my liver is not in the best of shape due to much solvent exposure working in surfboard industry years ago and this my contribute...

Don't have evidence handy but my understanding is that saturated fat is the biggest contributor to IR, much more so than unsaturated. There is some saturated fat in veg foods, some are very high in fact like coconut.

Matt, Have read some on your blog site and think I get the overall picture of what you are doing but...

What about the demographic data showing increasing cancer rates w/ increasing consumption of animal protein?  And the at least transient damage from meals high in sat. fat?:

http://content.onlinejacc.org/cgi/content/short/48/4/715
Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High-Density Lipoproteins and Endothelial Function
CONCLUSIONS: Consumption of a saturated fat reduces the anti-inflammatory potential of HDL and impairs arterial endothelial function. In contrast, the anti-inflammatory activity of HDL improves after consumption of polyunsaturated fat. These findings highlight novel mechanisms by which different dietary fatty acids may influence key atherogenic processes.

And this one is a little concerning (its title tells the tale):
http://www.ncbi.nlm.nih.gov/pubmed/18263705
Glucose and leptin induce apoptosis in human beta-cells and impair glucose-stimulated insulin secretion through activation of c-Jun N-terminal kinases.

More on low fat diet and atherosclerosis:

http://www.heartattackproof.com/resolving_cade.htm

It is a fascinating concept that increasing leptin dramatically reduces insulin resistance.  Leptin secretion seems to be induced by increasing glucose level, so eating starch (unrefined carbs like potatoes, whole grains, etc)which converts directly to glucose, should raise leptin level.  What I do not understand is the need for high fat and saturated fat in the diet, nor the need for "overfeeding."  We do need a certain amount of fat in our diets, but a plant based diet, with the addition of an ounce or so of selected seeds/nuts does seem to cover the 10-15% calories from fat we need without the increased disease risks of higher fat intake, and the risks from intake of large amounts of animal protein.

All 42 comments are amazing,

Lots of varied comments here.  How do you suppose we all arrived here in the first place?  Our genes traveled through the ages,  without the benefit of all of this information.  How did they do this you might ask?  Simple, our ancient ancestors ate what their genes required for survival, full fat wild animal product, supplemented by a few wild not very starchy roots pulled from the ground, and seasonal wild not very sweet tree fruit.  This progressed throughout the last 2.5 million years.  That is how we got here.  Where we went wrong is when agriculture and farming started about 10,000 years ago followed by industry.  Our genes did not change much in the last 2.5 million years of eating high saturated fat including all high fat organs and marrow from the bones, with limited seasonal veggies and fruit.  They did not have the benefit of the sage advice of modern traditional medicine, or electronic devices to guide them, relative to the easy to treat by lifestyle change metabolic syndrome diseases.  Weren't they lucky?  Lest you think I am disparaging all doctors, I am not.  G-d forbid you have a broken leg or a disease that is congenital or inherited  that is difficult or near impossible to treat and need a physician, this group of dedicated highly trained professionals are  a life raft, and much appreciated.  I practice what I preach.  I went from a very ill patient to one that has reversed many of the metabolic syndrome illness that I suffered.  I trust the wisdom of my ancient ancestors and my doctors who practice out of the box evolutionary medicine to guide me.

Billy E

The information and anecdotes you provide about various heart disease issues is very interesting and useful. There is a registered dietitian in the Kansas City Area that has produced a series of informational videos about weight loss, nutrition and healthy living that you may be interested in. Here is her latest Nutrition 101 Video Series: http://www.youtube.com/watch?v=7KZCjcCTCOE&feature=related

Thank you and happy heart month!

@ Dr Strange
Nutrition and Metabolism  Dietary fat research
Perhaps you haven't yet read the Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease Patty W Siri-Tarino, Qi Sun, Frank B Hu, and Ronald M Krauss, Jan. 2010
showing there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.

With reference to Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties
The mitochondria of people new to consuming coconut oil will not be  adjusted to it. It takes time to acquire appropriate gut flora. A single ingestion of an unfamiliar dietary substance will have different effects from long term use of the same substance.

Any single trial comparing an omega 6 frequently consumed with a type of saturated fat the general public are not generally accustomed to will fail to spot the long term benefits of MCT (coconut oil, saturated fat) consumption.
MCTs suppress fat deposition through enhanced thermogenesis and fat oxidation. MCT's preserve insulin sensitivity. MCTs regulate production of adipocytokines (e.g., adiponectin.

Billye, you might want to read these.  It is true that ancestors ate full fat wild game, which is very very lean.  Also, 100% of it ate its natural diet and not corn, soy, and synthetic supplements and drugs.  Also, they most likely ate primarily a lot of starchy roots, leaves, flowers, insects, whatever they could collect and some meat when they could get that.  The meaty, beefy, caveman is a romantic fantasy.  They also did not live very long so degenerative diseases of aging were not an issue

http://diabetesupdate.blogspot.com/2009/09/lets-not-twist-history-to-support-our.html

http://diabetesupdate.blogspot.com/2009/11/saying-something-over-and-over-doesnt.html

Dr. Strange,

The reasons that ancient peoples expired at a relatively young age was because diseases that are cured today through the use of antibiotics such as malaria along with the many natural disasters that occurred throughout the ages account for this fact.  However, what they did not die from were the diseases of the metabolic syndrome that you attribute inaccurately to degenerative diseases of old age. They are brought on by the standard American diet.  The degenerative diseases that you mention are first found in ancient egyptians from about 12,000 years ago after the advent of agriculture.  The patients can do their own trials under the watchful eye and monitored by their doctors.  The plain fact is that when switching to an ancient evolutionary lifestyle most of the diseases of the metabolic syndrome  reverse themselves.  This is being accomplished by thousands of people all over the world today, including my self.  You might read the well documented by clinical trials, Good Calories Bad Calories by G. Taubes, and Trick and Treat by B. Groves.  

Billy E

DR.Strange,

This is a P.S.  Archaeologists have found many human bones that had cut marks inflicted by other waring clans, along with the fact that the population of those times was very small compared to today's populations.  This is in contrast to the huge carnivore animal populations that walked the earth devouring humans who were in their food chain.  Also of note was the proven fact that ancient populations prized the fattest parts of the animal, brains, organs, and marrow from the bones etc.

Billy E

Dr Richard Bernstein is in his mid-70s, and has type I diabetes. His diet is around 30 grams of carbohydrate a day, and he has no fear of saturated fat. It beggars the imagination that a man like him, whose pancreas hasn't produced any of it's own insulin in over half a century, should live to a ripe old age (as a male type one diabetic, he's already done this, and he ain't done yet.), but that the same diet should be deadly to the non-diabetic. Maybe he's lucky; but, before he learned to tightly control his own blood sugars, (and with as little insulin as possible), he suffered all kinds of complications, hardening of the arteries, high triglycerides, low hdl, early kidney disease, etc. I think Dr Bernstein and his patients provide proof of concept for what Dr Davis is trying to accomplish here for those suffering insulin resistance, whether they happen to be diabetic or not.
Matt, you can't test insulin levels with a glucose meter. You also can't test any possibly progressive damage to glucose homeostasis that *might* be caused by a high everything diet over the course of years or even decades in a matter of weeks or months. Nor can you say flat out that your metabolism has been "healed" by such a diet. Has your system healed, or was it just healthy enough in the first place that over time it was capable of making the hormonal adjustments necessary to function well on a mixed diet? Can everybody make that leap?
The thing about leptin and insulin resistance... one of the effects of leptin is to decrease the appetite for carbohydrate. (Maybe by increasing ketosis? or at least lipolysis.) It's almost like carbohydrate restriction is built right into the system.;)

"...of note was the proven fact that ancient populations prized the fattest parts of the animal, brains, organs, and marrow from the bones..."

Proven?  How they do that?

FYI, a few tips I have picked up in the years I have been testing my BG,

For the least amount of pain sensation when lancing my finger, I take the blood sample from the *side* of my finger tip, *not* on the pad or the tip.    

If you have chronially cold hands it can be hard to get a good enough sample.  Wash hands with warm water first, dry well.  Swing arm in a big arc few times if necessary, to force more blood to the hands.  Sometimes my house is a bitt chilly but my car is warm from the sun in the driveway.  A few minutes sitting in the sunny car warms up my hands considerably, making a blood drop easy to get.

It's ok to slightly "milk" the finger from the palm to the tip once, but with warm hands and a few pre-lancing "swings" (described above), that shouldn't be necessary.  It shouldn't take a lot of "milking" to get a good enough sample.

There's no need to change the lancet tip for each test sample if you are the only one using the lancet (with clean hands, of course).  In fact, the lancet tips become more comfortable with use.  I change the tip only when it becomes dull and uncomfortable.  It goes without saying the lancet tip should always be changed if it is used to get a blood sample for another person.

Speaking of clean hands, be sure there is no sugar on your hands or it can affect your results.  

@ Dr Strange
Proven? How they do that?
A comparison of Paleo-Eskima and medieval Norse Bone Fat exploitation in Western Greenland. Alan Outram
He has a more recent paper "A New Approach to Identifying Bone Marrow and Grease Exploitation: Why the “Indeterminate” Fragments should not be Ignored" that goes into the proof in more detail but I can't find the full text free online.
His more recent work is also interesting.
The earliest horse harnessing and milking.

@ Anna
Thanks for tips. I've just started testing (following Dr D's suggestion)
Bit surprised at some of the numbers.
5.7=102mg/dl premeal
8.1=146mg/dl 1hr after meal
Chicken portion in curry sauce + carrots
Probably tikka sauce (bought ready meal sugar listed 3rd in marinade and in sauce. Won't buy that again.
Generally between 6.1 and 6.9 110mg/dl~125mg/dl

Dr. Strange,

There is so much Paleolithic archaeological proof that ancient populations prized brains, organs, and marrow from bones, that it boggles the mind.  Have you not read about the thousands of bones along with tools found in ancient caves? They were smashed to get at the brains and marrow.  I call your attention to the Quarterly Review Of Biology, Vol 79, No1 March 2004, one of the many studies and reports out there.  Meat eating - dietary shift to increased regular consumption of fatty animal tissues in the course of hominid evolution as mediated by selection for "meat adaptive" genes.  This selection conferred resistance to disease risks associated with meat eating also in life expectancy.  The data was produced at the University of southern California, Los Angeles California.  This argument is long over, unless you wish to ignore all of the indisputable archaeological proof available.  Lets get on with out of the box medicine which supports health.  

Billy E, nephropal.com

Coach Jeff said: Since an LC diet causes insulin resistance, (Actually a GOOD and protective thing within the context of an LC diet) . . .

I am new to this blog, got the link from the Taubes Talk yahoogroups board, and I am curious about this statement.  Why is IR good and protective?  I eat a very high fat diet, as well as low carb, as that is what seems to control my hypoglycemia the best, and so this statement seems counter-intuitive.  Or am I mistaken in thinking that hypoglycemia is a sign that one is developing insulin resistance?  If so, then it would seem that if something relieves the symptoms of hypoglycemia, then it is not leading to further insulin resistance.

Following Dr Davis's suggestion I bought a Lifescan Onetouch Ultraeasy from Ebay.
With too many readings higher than I expected, I needed a better way of recording numbers.
The people at the freephone number at this link
Lifescan Onetouch will send a cable and software to load and record your readings quickly and easily directly from the meter together with a simple Quick Start Manual.
As they don't charge for the disk it's quicker and easier than downloading the software, the cable makes the data transfer from meter even quicker.

People with different makes of meter may like to download the software anyway and enter their figures manually.
When you have entered a few days readings, the graphs make it easier to see trends.

I've always been skeptical about the concept that saturated fat increases insulin resistance and here's an article that addresses that fact directly:

http://wholehealthsource.blogspot.com/2010/02/saturated-fat-and-insulin-sensitivity.html

"I've always been skeptical about the concept that saturated fat increases insulin resistance..."

Compared to mono fat, not much if any difference.  Try comparing to very low fat diet ie about 10% of total calories and you will clearly see that fat in and of itself, if too much in diet, will indeed greatly increase IR.

@ Dr StrangeTry comparing to very low fat diet ie about 10% of total calories and you will clearly see that fat in and of itself, if too much in diet, will indeed greatly increase IR.
A between-group comparison also shows reduced body weight, WC, and homeostasis model assessment of insulin resistance in the MCT group compared with the LCT group at the end of the study.

Are you implying that all fats are equally bad?

Interesting to see what happens in practice when you compare low carb with low fat.
The Battle of the Diets: Is Anyone Winning (At Losing?)Christopher Gardner

Dr. Davis, I followed your advice and bought a glucometer. I got severe cravings from time to time. So last time I could not resist I checked my blood sugar. That was after I ate about 300g of nuts, drank a bottle of red wine and ate a big family chocolate bar. The glucometer showed 86 mg/dl which is within normal range. How is that possible?

Do you have any further recommendations what to look out for in a case like this? I would really like to find the reason and overcome those cravings. I'm not overweight, in fact more the athletic kind of guy. I started eating paleo/EF about a year ok and am doing mostly great except for the cravings.

Thank you!
Andreas

I find this post amusing because it was my exact question after my bypass... how do you *reduce* arterial blockages?  Looking for an answer to that question is what led me to this blog, your book, and the TYP site.

Personally, modifying my diet and swallowing a few pills of fish oil, vitamin-D and niacin is a heck of a lot preferable to a bypass!  By my scale, this program is *easy*.

Doc, would like your opinion on the efficacy of carotid IMT test measuring plaque?

Please see numerous prior posts about this question.

These red flags are not perfect. If you lack any of them, it doesn't necessarily rule out the possbility of having Lp(a). They simply serve as signs to suggest that Lp(a) may be lurking.

The headlines could have sais IOM raises RDA of Vitamin D 50%.

There is as yet NO study where supplementation with Vitamin D was shwon to reverse or improve any of the conditions with which the deficiency is associated.

We can't call for evidence based medicine and then dismiss that call when the evidence isn't there to support our pet theories.

I have not found any studies suggesting that Vitamin D improves blood sugar control in people who had low levels, and though I get an avalanche of mail from the diabetes community I have not heard from anyone whose blood sugar improved after taking it.

So my conclusion is that it is not the cure all that some people would like it to be. With the unhappy history of Vitamin A, C, and E supplementation (which turn out to be ineffective or in the case of the antioxidants correlate with higher mortality) the people making these kinds of recommendations are right to be cautious.

And given the very bad outcome with the megadose injections, and the poor quality of the expensive supplements, it's probably good they didn't endorse it more enthusiastically. More study is needed, particularly in regard to setting doses so people don't end up with milk alkali syndrome.

I'm somewhat convinced I've experienced many health benefits from D supplementation.  I'm also somewhat convinced it's played a significant role in my body's new habit of making kidney stones.

Isn't the burden of proof on vitamin D proponents to show supplementation has a unambiguously positive effect, particularly when there is concern that there may be negative effects?  Your response here unfortunately doesn't give us much to stand on as vitamin D users, in terms of any rigorous data-based conclusions (as opposed to observational conclusions).  That is somewhat concerning.

Here is one article on the ISM panel's conclusions.  I am re-posting it here, as it my previous comment with the link was deleted from the previous post on this blog:

http://www.nytimes.com/2010/11/30/health/30vitamin.html?src=me&ref=homepage

From the article:

"But Andrew Shao, an executive vice president at the Council for Responsible Nutrition, a trade group, said the panel was being overly cautious, especially in its recommendations about vitamin D.  He said there was no convincing evidence that people were being harmed by taking supplements, and he said higher levels of vitamin D, in particular, could be beneficial.

Such claims “are not supported by the available evidence,” the committee wrote. They were based on studies that observed populations and concluded that people with lower levels of the vitamin had more of various diseases. Such studies have been misleading and most scientists agree that they cannot determine cause and effect.

It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies, which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels — 40 to 50 nanograms or even higher — were needed.

After reviewing the data, the committee concluded that the evidence for the benefits of high levels of vitamin D was “inconsistent and/or conflicting and did not demonstrate causality.”

Evidence also suggests that high levels of vitamin D can increase the risks for fractures and the overall death rate and can raise the risk for other diseases. While those studies are not conclusive, any risk looms large when there is no demonstrable benefit. Those hints of risk are “challenging the concept that ‘more is better,’ ” the committee wrote.

That is what surprised Dr. Black. “We thought that probably higher is better,” he said.

He has changed his mind, and expects others will too: “I think this report will make people more cautious.”

Just wanted to say that I really appreciate what Dr. Davis brings to this site.  

And I also appreciate the community here that is not afraid to push back from time to time with thoughtful opposing comments.  

After what we have seen in the last 30 years, at this point, it should take a lot of convincing any time vitamin x or food y is offered up as the next great health wonder.

Jenny: "There is as yet NO study where supplementation with Vitamin D was shwon to reverse or improve any of the conditions with which the deficiency is associated."
I disagree. See Vitamin D3: Studies from 2005 to present.

Jenny: "I have not found any studies suggesting that Vitamin D improves blood sugar control in people who had low levels..."
Have you seen A double-blind, randomized, placebo-controlled trial of the short-term effect of vitamin D3 supplementation on insulin sensitivity in apparently healthy, middle-aged, centrally obese men? I'm sure I reported vastly improved OGTT results after 5,000iu/day Vit D3 supplementation in a comment on your blog.

@anonymous kidney stone former: Inappropriate calcification is often due to a deficiency in Vitamin K2.

@jenny i really can't take your comments seriously. you doesn't seem to know what you're talking about at all.

"poor quality of the expensive supplements"

SERIOUSLY?? vitamin D3 is one of the cheapest and simplest supplement you can get on the market. a years supply of 5000IU even from high-quality, reputable brands rarely costs more than 15-20$ on-line. wtf are you talking about?

Jenny's right, when I take anything above 1500 IU/day (conservative according to more and more proponents of D3 supplementation) I get sign of hypercalcaemia immediately.

And yes, I have tried adding K2, makes no difference.

I'm from Northern European heritage and suspect that we need very little D.

Anonymous said...
"Jenny's right, when I take anything above 1500 IU/day (conservative according to more and more proponents of D3 supplementation) I get sign of hypercalcaemia immediately.

And yes, I have tried adding K2, makes no difference.

I'm from Northern European heritage and suspect that we need very little D."

I'm descended from Poles & Lithuanians and have normal serum Calcium (by blood test) on 5,000iu/day D3. Have you been tested for Sarcoidosis, Primary Hyperparathyroidism, Milk-alkali Syndrome or any other medical condition that can result in hypercalcaemia?

K2 doesn't prevent hypercalcaemia. It only reduces inappropriate calcification that can occur even with normocalcaemia.

When taking supplements that should not cause problems normally, and you experience problems there is normally an underlying problem.

My brother was detected Hashimoto's when supplementing iodine.

My wife has a single kidney, and very high doses of vitamin D causes her problem. But 4000IU is not a problem.

If you are getting a problem at 1500IU, you should get yourself tested for hyperparathyroidism. It is a pretty common result of Vitamin D supplementation. There may be other reasons why Vitmain D3 may cause problems, particularly in renal system.

It is good to take these vitamin once in a higher dose to determine if you have any problem related to their dosage.

Jenny - Here's a study: 'Vitamin D and diabetes Improvement of glycemic control with vitamin D3 repletion':

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426990/

Anyone here ever read "The Real Truth About Vitamins and Antioxidants" by Judith DeCava ?

Most "vitamins" are actually very high doses of only parts or fractions of naturally occuring vitamins. Therefore they act like drugs, not like nutrition. They CANNOT help organs heal.
Dr. Gus

I weigh 114 lbs and take 2400 IU daily (softgels). I recently tested at 56 after 2 years of supplementation. Although, last summer I took 5000 IU daily. I am concerned about excess D, but I don't have a doctor. I won't be stabbing my fingers again since my finger still hasn't recovered from a home test. It still hurts after 6 weeks. I believe vitamin D has helped me, and I don't really want to cut back on the dose. However, I'm reducing the dose to an average of 2000 IU daily. I will try to test with Life Extension next time if I can find a lab around here - definitely vein jab only! I wish I had a good doctor.

Well I guess most of the time we Canadians are in lock-stock with our neighbors on the continent

http://www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php

that is a big improvement though.  The 4000IU max is half what I take but then again, this is a recommendation for a healthy individual not someone with a family history of heart disease like me.

K2 max is about a quarter of my daily:-
http://webprod.hc-sc.gc.ca/nhpid-bdipsn/singredReq.do?id=546&lang=eng

But apparently for fish oil I am on target:-
http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/monograph/mono_fish_oil_huile_poisson-eng.php

I tell people about this site every chance I get

There is one study referred to in The Perfect Health Diet (which parallels the advice in this blog very closely) that people who had blood levels of Vitamin D over 80 had triple the heart disease.  This from southern India.

and what do you expect from a self styled government organization?
At least people with any sort of common sense and knowledge will know to disregard their "advice". And there is really no difference between 20 or 30 or 50 to 60. The gene transcription only starts after 100, I know I am supplementing vitamin D up to a million units per day to deal with various issues and I must say it works. I feel that vitamin D in such doses has a real effect on athletic abilities, I am sprinting like a teenager again and many other health improvements. Bottom line Dr. Davis, don't lose your time and nerves with the noise from governments and various "experts" , that's just barking up a wrong tree. They have an agenda to rule over us and it's only a matter of whether we allow them or not.

I put as much stock in the Institute of Medicine's advice on vitamin D, or any other vitamin for that matter, as I do the advice of the USDA on nutrition. Both have declared themselves irrelevant by their almost ridiculous detachment from reality.

The data are overwhelming: Vitamin D is intimately associated with multiple facets of health.

Another issue: The committee appears to be applying a drug-like standard to vitamin D: They require placebo vs. treatment clinical trials, a standard that other vitamins have not been held up to.

Goodness!  All of this focus on "science."  There really should be focus on just getting enough of this nutrient on a regular basis without interference from sunshine phobia and the lack of good nutrition from fats.

Sorry, Jenny, but I believe that you are flat wrong.

While the studies tend to be small, there are indeed studies that have shown reversal of various conditions, including reversal of blood markers for bone resorption, insulin resistance, c-reactive protein, hyperparathyroidism, hypercalcemia, etc.

Just because vitamin D has not enjoyed the deep-pocketed budget of a drug company's backing and therefore does not yet have a vitamin D vs placebo trial does not mean that humans do not need it or don't need more of it.

I am personally appalled at the committee's closed-mindedness at what I believe is an incredibly important "supplement." Frankly, I don't care what the IOM says; I continue to do what I believe is right and what has worked for me and my patients time and time again.

Dr. Davis,
Do you routinely monitor blood calcium levels in your vitamin D-supplemented patients?  Thanks.

This new recommendation accomplishes absolutely nothing. Those who are still ignorant as to the absurd irrelevance of consensus opinions by government health offices or medical professional organizations will continue to be Vitamin D deficient. And those of us who are really good at interpreting data and have thoroughly researched Vitamin D will trust our read of the data over all the propaganda.  All this does is show that we are at least 15 years ahead of most everyone else, and that's actually really sad, and something I refuse to accept because America deserves better.

Regarding the above mentioned statement by Dr. Cannell of the Vitamin D Council: Today, the FNB has failed millions... - Toward the end, Dr. Cannell discusses his intention to have the suppressed reports - by Vitamin D experts associated with the decision by the FNB - made public.  Which would be great.

Hey, if they go on "progressing" that way the RDA will be quite allright in...em... 250 years...
Let's celebrate!

Many of the studies that have been done have used very small doses of vit D, so the failure to show unequivocal results is not surprising.  The associational studies don't prove causation of course but certainly provide hypotheses for testing.  So the conservative approach (CYA) is to recommend low doses still.  A search of clinicaltrials.gov for vit D trials shows a ton of trials being initiated.  We will have to wait a few years for the results to be reported and interpreted.  Meanwhile, I supplement with 5000 units per day but don't take calcium as that doesn't seem to be necessary with adequate D levels, and my calcium level is right where it should be.  

Cynthia

I'm tempted to write a faux press release from the IOM saying that there is little conclusive evidence that Vitamin C is related to scurvy and that we should be cautious in making radical arguments for fruit in the navy. ;)

I agree with Dr. Davis on D3.

Primarily due to my own experience. I supplement with Vit D3 (4-6k) and Omega 3 Daily.

I am a type 2 diabetic who has normal blood sugar AND I take -0- drugs and -0- insulin.

One study that would be very cheap and fast would be to test Dr.Davis's observation that vitamin D from tablets doesn't reliably raise blood levels like gelcaps do.

The Vitamin D issue is becoming the Global Warming controversy of the medical world. I haven't seen such sharp divisions in the medical community over the efficacy of any other drug/supplement as this one. The usual way this goes is that for any non-pharmaceutical/non-prescription item, there always strong push back from the governing medical bodies, despite empirical data suggesting benefit.

I have no doubt whatsoever that vitamin D achieves substantial benefits in health with virtually no downside, provided 25-hydroxy vitamin D levels are monitored.

Don't you think such statements are a tad cavalier? Literature certainly does not give one such level of confidence. There are several indicators that some cancers increase with increasing Vit. D. Plus, there are bound to be ethnic and gender differences in response to vit. D. And you have no doubt that treating everyone the same to achieve the same and largely random number is a good thing? Wow, just wow.

This seems scary, Vitamin D associated with increased risk of pancreatic cancer:

http://fanaticcook.blogspot.com/2010/11/vitamin-d-linked-to-pancreatic-cancer.html

Just wait until there is a Lovaza-like pharmaceutical D3 that costs 1000 dollars a month and suddenly the RDA will rise to where it should be.

Jenny,

  I have seen HbA1c improve in couple of cases with Vitamin D supplementation. Here's a reference to a similar observation http://timesofindia.indiatimes.com/home/science/Lack-of-vitamin-D-poses-diabetes-risk/articleshow/6922336.cms

-- DK

@Jenny: Here's another RCT showing the benefits of Vitamin D supplementation on Insulin Resistance. Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient – a randomised, placebo-controlled trial.

Anonymous said...
"This seems scary, Vitamin D associated with increased risk of pancreatic cancer: http://fanaticcook.blogspot.com/2010/11/vitamin-d-linked-to-pancreatic-cancer.html"

Peter of Hyperlipid has posted about what can cause a positive association between increasing serum 25(OH)D and the relative risk of certain cancers (and how to rectify the problem) on Vitamin D and UV fluctuations.

That and Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. is why I supplement daily.

Make sure to avoid vitamin A supplements (including cod liver oil), unless you're truly deficient. Excess vitamin A blocks vitamin D benefits. I read this on the vitamin D council site.

Relevant articles:

"Anticancer Vitamins du Jour—The ABCED's So Far"

http://aje.oxfordjournals.org/content/172/1/1.full

"Vitamin D in Cancer Patients: Above All, Do No Harm"
http://jco.ascopubs.org/content/27/13/2117.full?ijkey=e5433c6693ba2181f407767e5368af0d4a110ea5&keytype2=tf_ipsecsha

There are only 8 trials on vitamin D and Diabetes, and some of them are null - http://www.ncbi.nlm.nih.gov/pubmed?term=vitamin%20d[title]%20AND%20diabetes[title]%20AND%20%28Clinical%20Trial[ptyp]%20OR%20Randomized%20Controlled%20Trial[ptyp]%29

RE Null Trials:-
In Avenell et al, only 800iu/day was used.
In de Boer et al, only 400iu/day was used.
In Orwoll et al, calcitriol 1ug/day for only 4 days was used.

Nigel, thanks for the correction. I truly believe vitamin D supplementaion and more exposure is beneficial. The full IOM ob-line report is available here - http://www.nap.edu/catalog.php?record_id=13050

The "desirable" levels this institute assumed are not based on evolutionary evidence, they only considered the minimum level to avoid rickets. Here is a free 29-page pdf summary of the report: http://www.nap.edu/nap-cgi/report.cgi?record_id=13050&type=pdfxsum

I don't know what Jenny means by studies done on vitamin A.  They did a study on beta carotene and smokers.  I have my own pet hypothesis about that:  there's some thinking that cancers eat so much glucose not only because it's the only fuel many of the cancer types can use, but because it protects them from oxidation.  It makes me wonder if beta carotene encouraged lung cancer in that smokers study because the cancer cells were vulnerable to oxidative damage and the BC protected them!

Be that as it may, beta carotene is not vitamin A, any more than clay is a brick.

I cured a three-year run of excessive menstruation by supplementing retinol from fish liver oil.  Anecdotal evidence, I know, but the more I dig around on Science Daily and similar websites, the more I find connections between vitamin A and reproductive health, including sound development of the embryo and fetus.  I don't know where researchers get the notion that vitamin A causes birth defects;  it may actually do the exact opposite.

I have heard criticisms that where researchers have made claims about the harmfulness of vitamin A, they are doing so based on data about synthetic vitamin A.  Fish liver oil--and hey, land-animal liver if you like to eat it--shouldn't be a problem then.

And anyone who intakes the fat-soluble vitamins all out of balance is going to have a problem.  I'd recommend reading the Weston A. Price Foundation's information on the subject.  For instance, the ratio of vitamin A to vitamin D intake in the diet should be at least 10 to 1 or better (9 to 1, 8 to 1, etc.).

There is still so much we don't know about these vitamins.  But in healthy populations with low dental caries and birth defect rates and with ideal or near-ideal development of facial bone structure, the intake of fat-solubles was several times the American intake in the early 1900s, when it was still considerably higher than it is in the U.S. today!  They had lab tests back then for all the fat-solubles except K, which was discovered later.  So this was documented.

More recent studies have shown that calcium is not as well absorbed in a diet that is too high in fiber relative to fat intake.  WAPF claims that fat-soluble vitamins are necessary for the assimilation of minerals;  we've seen that with vitamin D and calcium and (if I'm not mistaken) vitamin A and iron.  There are definite connections between FS vitamins and health, even if no one's handed stone tablets down from heaven to show us either way.  There is evidence.  You just have to want to see it.

Dr. Davis, I had an interesting anecdotal experience from taking vitamin D.  I have suffered from canker sores since I was a young child. I'm in my sixties now and they seem to be getting worse and more frequent with multiple outbreaks to the point sometimes it was hard to speak.  Recently my MD tested my vitamin D levels and said they were too high (100) and I should cut back. I cut back and 2 days later I got 3 canker sores.  I hadn't even realized I didn't have one in the 8 months I'd been taking vitamin D.  I know the experts need to see all the clinical studies. The rest of us just want to be healthy! ( Prevention Magazine said broccoli could protect against cancer in the 1960s. Its taken the experts 50 years to catch up. )

In light of the fact that the body can synthesis 10,000 IU of D3 in a short time exposed to UVB (AKA, Sunlight)...With no adverse effects, I dont understand how supplementing with say 5000IU daily, is a bad thing.

These paltry, overly conservative recommendations are coming from  organization(s) who have got a whole lot of things wrong in the past regarding diet etc. And for the most part still are.

Its funny that we live in a society that has a complete meltdown about supplementation issues, but doesn't generate the same hysteria or debate about the amount of diet soda, cheetos, processed foods in general, that are consumed. Funny time we are living in.

Along the lines of Dana's comment, here's an interesting blog article by Chris Masterjohn on the topic of D, A and K.
http://foundation.westonaprice.org/blogs/is-vitamin-d-safe-still-depends-on-vitamins-a-and-k-testimonials-and-a-human-study.html

Dr Davis, I have had good lipid results, overall health with a lowercarb, nonprocessed food, no wheat diet and vitamin D suppplementation over the last 3 years. Unfortunately, have also discovered the agony of calcium oxalate kidney stones (3 episodes/3 years). Have seen some studies implicating higher protein diets and vitamin d supplementation. Have you run into kidney stones with any of your patients on vitamin d supplemention?

To whom it may concern.  I began supplementing with Vitamin D3 a few years ago.  Right at first, I was having a considerable amount of restless legs and restless sleep.  There were other side effects that included increased muscular spasms.  Upon further research, I started supplementing with extra Magnesium. ( I was already taking MagOx which obviously was not getting absorbed).  The magnesium was a highly absorbable magnesium malate. (Magnesium glycinate is good too).  Anyway, after a few weeks the side effects disappeared and I have not had those problems since.  Vitamin D3 increases calcium absorption.  We must have an increase of magnesium to balance calcium.  Just a little FYI for those of you having kidney stones or other side effects from your vitamin D3 supplementation.