The world of intermediate carbohydrates

28. January 2011 William Davis (0)
There are clear-cut bad carbohydrates: wheat, oats, cornstarch, and sucrose. (Fructose, too, but in a class of bad all its own.)

Wheat: The worst. Not only does wheat flour increase blood sugar higher than nearly all other carbohydrates, it invites celiac disease, neurologic impairment, mental and emotional effects, addictive (i.e., exorphin) effects, asthma, irritable bowel syndrome, acid reflux, sleepiness, sleep disruption, arthritis . . . just to name a few.

Oats: Yeah, yeah, I know: "Lowers cholesterol." But nobody told you that oats, including slow-cooked oatmeal, causes blood sugar to skyrocket.

Cornstarch: Like wheat, cornstarch flagrantly increases blood sugar.It also stimulates appetite. That's why food manufacturers put it in everything from soups to frozen dinners.

Sucrose: Not only does sucrose create a desire for more food, it is also 50% fructose, the peculiar sugar that makes us fat, increases small LDL particles, increases triglycerides, slows the metabolism of other foods, encourages diabetes, and causes more glycation than any other sugar.

But there are a large world of "other" natural carbohydrates that don't fall into the really bad category. This includes starchy beans like black, kidney, and pinto; rices such as white, brown, and wild; potatoes, including white, red, sweet, and yams; and fruits. It includes "alternative" grains like quinoa, spelt, triticale, amaranth, and barley.

For lack of a better term, I call these "intermediate" carbohydrates. They are not as bad as wheat, etc., but nor are they good. They will still increase blood glucose, small LDL, triglycerides, etc., just not as much as the worst carbohydrates.

The difference is relative. Say we compare the one-hour blood glucose effects of 1 cup of wheat flour product vs. one cup of quinoa. Typical blood sugar after wheat product: 180 mg/dl. Typical blood sugar after quinoa: 160 mg/dl--better but still pretty bad.

Some people are so carb-sensitive that they should avoid even these so-called intermediate carbohydrates. Others can have small indulgences, e.g., 1/2 cup, and not generate high blood sugars.
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Angioplasty Special: Get it while it's hot!

Comments (6) -

  • Jim Purdy

    11/21/2009 11:36:58 AM |

    I've already been an angioplasty victim ... excuse me, I mean angioplasty patient ... and doctors want me to go through a second angiomutilation ... I mean angioplasty.

    Ain't no way they're gonna do that to me again. Even though they would get big bucks from my insurance.

  • TedHutchinson

    11/22/2009 3:42:13 PM |

    Angioplasty is being promoted as a cure for Multiple Sclerosis Based on Paolo Zamboni's work.
    Free download here
    Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes
    Candian TV program on the subject.
    The Liberation Treatment: A whole new approach to MS

    I'd be very interested to know if any Track Your Plaque users have MS and whether they have seen improvements in venous blood flow and reduction of MS progression as a result of the program.

    Higher levels of vitamin D may well have an impact on the damaging consequences of iron.
    By raising adiponectin levels would vitamin D improve bloods anti coagulating properties?
    High omega 3 intake should improve blood flow.
    Would Niacin also act as a vasodilator and improve blood flow?

  • shel

    11/22/2009 7:59:32 PM |

    "get that feeling of doing something"

    says it all...

  • Anonymous

    11/23/2009 9:12:30 AM |

    Angioplasty is not completely useless. As the poster points out "proven useless unless you are in the middle of a heart attack...". It can save lives in such cases.

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    11/3/2010 9:53:50 PM |

    Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?

  • Hetal Patel

    11/9/2010 12:43:07 PM |

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

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Ignoring your heart scan is medical negligence

Ignoring your heart scan is medical negligence

26. October 2006 William Davis (0)
I continue to be dumbfounded that many doctors continue to pooh-pooh or ignore CT heart scans when people get them.

I can't count the number of people I've seen or talked to through the Track Your Plaque program who've been told to ignore their heart scan scores. The most extreme example was a man whose physician told him his heart scan score of nearly 4000 was nothing to worry about!


A real-life story of a retired public defense attorney whose heart scan score of 1200 was ignored, followed two years later by sudden unstable heart symptoms and urgent bypass prompted us to write this fictitious lawsuit. Though it's not real, it could easily become real. To our knowledge, no single act of ignorance about heart scans has yet prompted such a lawsuit, but it's bound to happen given the number of scans being performed every year and the continued stubbornness of many physicians to acknowledge their importance.



Major Malpractice Class Action Lawsuit Looms for Doctors Who Ignore Heart Scan Tests

It's been several years since new medical discoveries have debunked old theories regarding heart disease and heart attack and have verified the efficacy of CT heart scans for detecting both early and advanced heart disease. Doctors who fail to keep apprised of these finding or refuse to change their practice for financial reasons put themselves at risk for becoming defendants in a major malpractice class action lawsuit. The plaintiffs will be a growing class of persons who were debilitated by avoidable heart attacks and heart procedures and the heirs and estates of those who have died.
Milwaukee , WI (PRWEB) November 29, 2005 -- This press release outlines a template for a potential class action lawsuit that may be on the horizon for the medical industry. The class of plaintiffs for this theoretical action remains latent but is growing on a daily basis. However, it requires only one such plaintiff to find an attorney who recognizes the scale and magnitude of the potential damages and move forward on a contingency basis. In real terms, this class could include 80% of those who had a heart attack, underwent a heart procedure, or subsequently died. According to the latest American Heart Association statistics, this number is estimated to be a least 865,000 persons and the entire class could easily be 10 times that number. Using a conservative estimate of $500,000 in damages per class member, the total damages could exceed $400 billion.

The plaintiffs, defendants, third parties, and facts surrounding the following moot complaint represent an actual incident. The names, specific health information, and dates have been changed to protect potential litigants.

Plaintiff, through his attorneys, brings this action on behalf of himself and all others similarly situated, and on personal knowledge as to himself and his activities, and on information and belief as to all other matters, based on investigation conducted by counsel, hereby alleges as follows:

NATURE OF THE ACTION

1.Plaintiff brings this class action on behalf of himself and all other persons who suffered physical damages or mental distress as a result of receiving a medical diagnosis indicating they had no identifiable heart disease, elevated risk for heat attack, or who were prescribed medications not suited to treat their heart disease once detected.

2.Substantial and irrefutable medical evidence has established that cardiac stress testing is an ineffective method for detecting heart disease of the type that is the root cause in over 90% of all heart attacks and other complications of heart disease that result in death or debilitating injury. A readily available and well-publicized test known as “CT heart scanning” is capable of detecting virtually all heart disease of this nature. It has also been established that simple cholesterol testing often fails to detect persons like likely to develop serious heart disease and prevents them from receiving common treatments capable of reducing or eliminating the source of their undetected heart disease. Readily available blood testing techniques exist that are capable of detecting non-cholesterol related sources of heart disease.

3.The medical community has made significant investments in outdated methods of detecting and treating heart disease. They rely on the revenue streams generated by providing these treatments to persons whose heart disease has progressed to the stage that intervention is required to prevent death or debilitation. Any change in diagnostic or treatment methods resulting in the prevention of heart disease would require substantial investments in new technologies and would severely reduce the market for current treatments. Plaintiffs believe this is a motivating factor in the neglect and willful suppression of readily available technology capable of detecting and preventing heart disease and represents gross medical malpractice.

SUBSTANTIVE ALLEGATIONS

On January 23, 1999, Plaintiff underwent a CT Heart Scan which was interpreted by a cardiologist at the ABC Scan Center . Plaintiff received a report from the Scan Center cardiologist indicating that his “calcium score” placed him in the top 1% for heart attack risk among men in his age group. The report also included the comment “Patient has a high risk of having at least one major stenosis (50% or greater blockage) in his Left Anterior Descending (LAD) artery and is urged to consult with a physician regarding this finding.”

On March 3, 1999 Plaintiff presented Defendant with the results of the January 23, 1999 CT Heart Scan. Defendant told Plaintiff to disregard the CT Heart Scan Results and ordered a physical including a stress test and cholesterol blood test.

On April 1, 2005, Plaintiff had a heart attack and a subsequent coronary angiography that confirmed multiple obstructive coronary plaques in his LAD. Plaintiff received an emergency balloon angioplasty to relieve his acute condition. Substantial damage to plaintiff's heart was incurred before emergency angioplasty could be instituted.

On April 3, 2005, per Defendant's recommendation, Plaintiff underwent open heart surgery to insert three bypasses in his LAD to resolve substantial obstructive heart disease, the same artery identified as having likely obstructive heart disease over 5 years earlier via CT heart scan.

On July 7, 2005, Plaintiff independently obtained additional blood testing not ordered by Plaintiff and was found to have several additional blood abnormalities not discovered by Defendant that are known to contribute to the development of heart disease and were readily treatable using lifestyle changes, nutritional supplements, and prescription drugs.

As early as September, 1996, the American Heart Association (AHA) issued a “Scientific Statement” to health professionals acknowledging the strong link between heart attacks and high calcium scores in asymptomatic patients. Extensive studies and references have confirmed the ineffectiveness of stress testing to reveal early heart disease in asymptomatic patients.

Plaintiff alleges that Defendant failed to utilize readily available medical tests and protocols to identify, aggressively treat, and potentially delay, halt, or reverse advanced heart disease that later resulted in extensive physical and emotional trauma to the Defendant.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff herein demands judgment:

A. Declaring this action to be a proper class action maintainable pursuant to Rule 23 of the Federal Rules of Civil Procedure and declaring Plaintiff to be a proper Class representative;

B. Awarding damages against each defendant, joint and severally, and in favor of Plaintiff and all other members of the Class, in an amount determined to have been sustained by them, awarding money damages as appropriate, plus pre-judgment interest;

C. Awarding Plaintiff and the Class the costs and other disbursements of this suit, including without limitation, reasonable fees for attorneys, accountants, experts; and

JURY DEMAND

Plaintiff hereby demands a trial by jury.
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Omega-3 MUST be from fish oil

Omega-3 MUST be from fish oil

7. March 2008 William Davis (14)
Despite my rants in this blog and elsewhere, at least once a day I'll have a patient say, "I cut back (or eliminated) my fish oil because I get my omega-3s from _______ (insert your choice of flaxseed oil, walnuts, yogurt, mayonnaise, bread, etc.)."

(See prior Heart Scan Blog post: Everything has omega-3.)

When I point out to them that the "omega-3s" in these products are not the same as the EPA and DHA from fish oil, they invariably declare, "But it says so here on the label: 'Contains 200 mg of omega-3 fatty acids'!"

Apparently, some of my colleagues have even endorsed this concept of replacing the omega-3s from fish oil with these "alternatives."

It's simply not true. The linolenic acid that is being labeled as omega-3, while it may indeed provide health benefits of its own, cannot replace the EPA and DHA that fish oil provides.

The most graphic example of the differences between the two classes of oils is in people with a condition called familial hypertriglyceridemia. People with this condition have triglyceride levels of 400, 600, even thousands of mg/dl--very high. Fish oil, usually providing EPA and DHA doses of 1800 mg per day and higher, reduce triglycerides dramatically. A person with a starting triglyceride level of, say, 900 mg/dl, may take 2400 mg of EPA and DHA from fish oil and triglycerides plummet to 150 mg/dl. This person then decides to replace fish oil with a linolenic acid source like flaxseed oil. Triglycerides? 900 mg/dl--no effect whatsoever.

Familial hypertriglyceridemia represents an exagerrated example of the differences between the two oils. Even if you don't have this genetic condition, the differences between the oils still apply.

EPA and DHA are activators of the enzyme, lipoprotein lipase, that accelerates clearance of triglycerides from the blood. Linolenic acid from flaxseed oil, walnuts, and other food sources does not. EPA and DHA block after-eating (post-prandial) accumulation of food by-products that can contribute to coronary and carotid plaque. Linolenic acid does not. EPA and DHA block platelets, reduce fibrinogen, and exert other healthy blood clot-inhibiting effects. Linolenic does not.

The 11,000-participant GISSI-Prevenzione Trial that showed 28% reduction in heart attack, 45% reduction in cardiovascular death with omega-3s used . . . fish oil.

The 18,000 participant JELIS trial that showed 19% reduction in cardiovascular events when omega-3s were added to statin therapy used . . . fish oil. (Actually, in JELIS, they used only EPA wtihout DHA.)

Linolenic acid is not a waste, however. It may exert anti-inflammatory benefits of its own, for instance. But it exerts none of the triglyceride-modifying effects of EPA or DHA.

EPA and DHA from fish oil and linolenic acid from foods each provide benefits in their own way. Ideally, you include both forms of oils--fish oil and linolenic acid sources--in your daily diet and obtain full benefit from each separate class. But they are not interchangeable.


Copyright 2008 William Davis, MD
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Comments (14) -

  • Michael

    3/7/2008 2:59:00 AM |

    Anyone have any experience using krill oil, and how does it compare to fish oil?

    As for other forms of omega-3s, isn't flax considered dangerous for men, due to ALA content? There are conflicting studies, but I recall at least one that said ALA caused a rise in the rate or prostate cancer.

  • Zubin

    3/7/2008 3:31:00 AM |

    Is there any way for a vegetarian to replace fish oil and get the same benefits?

  • Missbossy

    3/7/2008 5:01:00 AM |

    I am definitely down with the fact that Fish Oil is vastly superior to Flax Oil. I've seen quite a few people touting flax oil lately so I'm glad you put that to bed.

    Question: You mention recommended doses of EPA and DHA for those with elevated triglycerides. Can you offer any guidance for supplement levels when triglycerides aren't an issue? IE a level for good preventative nutrition? I've looked around and recommendations are all over the shop.

    Thanks.

  • Anonymous

    3/7/2008 12:53:00 PM |

    I've read a few other articles about the differences between fish oil omega-3s and other sources, but this article spells it out very clearly about how those differences apply directly to heart disease. I'll be printing this one for my family. Thanks!

    S

  • Anonymous

    3/7/2008 2:11:00 PM |

    Vegetarian DHA is available. It is cultured from algae. That's where the fish get. EPA may be available now too.

  • Anonymous

    3/7/2008 3:52:00 PM |

    zubin:

    There are vegetarian DHA/EPA supplements made from algae.

  • Liss

    3/8/2008 12:09:00 AM |

    Zubin, when I followed a vegetarian diet I was able to find DHA supplements derived from algae, but EPA is harder to come by.  V-Pure is the only one I found that contained both EPA and DHA.  The capsules are costly, but might be a good option for you if you aren't comfortable taking krill or fish oil.

  • Zubin

    3/9/2008 2:06:00 PM |

    Thanks all, I will look into the algae supplements!

  • Anonymous

    5/12/2008 1:03:00 PM |

    As a newcomer to your blog please forgive me if this topic has been brought up before.
    There is a scathing attack in an article by Ray Peat,a noted Biology professor, on the damaging effects of fish oil.
    A few people have stopped taking fish oil after reading the article.
    Can you please comment?
    http://raypeat.com/articles/articles/fishoil.shtml

  • Anonymous

    7/8/2008 4:05:00 AM |

    http://www.westonaprice.org/knowyourfats/essentialfattyaciddef.html
    A Reply to Ray Peat
    on Essential Fatty Acid Deficiency

    By Mary G. Enig, PhD

    Ray Peat, PhD, is an influential health writer who claims that there is no such thing as essential fatty acid (EFA) deficiency. According to Peat, the body can make its own EFAs; furthermore, he claims that EFAs in the body become rancid and therefore cause cancer.

    Unfortunately, Peat does not understand the use of EFA by the human body. He is trained in hormone therapy and his training in fats and oils has been limited to misinformation as far as the polyunsaturated fats and oils are concerned.

    Research on EFAs is voluminous and consistent: EFAs are types of fatty acids that the body cannot make, but must obtain from food. We do not make them because they exist in virtually all foods, and the body needs them only in small amounts. The body does make saturated and monounsaturated fatty acids because it needs these in large amounts and cannot count on getting all it needs from food.

    There are two types of EFAs, those of the omega-6 family and those of the omega-3 family. The basic omega-6 fatty acid is called linoleic acid and it contains two double bonds. It is found in virtually all foods, but especially in nuts and seeds. The basic omega-3 fatty acid is called linolenic acid and it contains three double bonds. It is found in some grains (such as wheat) and nuts (such as walnuts) as well as in eggs, organ meats and fish if these animals are raised naturally, and in green vegetables if the plants are raised organically.

    Essential fatty acids have two principal roles. The first is as a constituent of the cell membrane. Each cell in the body is surrounded by a membrane composed of billions of fatty acids. About half of these fatty acids are saturated or monounsaturated to provide stability to the membrane. The other half are polyunsaturated, mostly EFAs , which provide flexibility and participate in a number of biochemical processes. The other vital role for EFAs is as a precursor for prostaglandins or local tissue hormones, which control different physiological functions including inflammation and blood clotting.

    Scientists have induced EFA deficiency in animals by feeding them fully hydrogenated coconut oil as their only fat. (Full hydrogenation gets rid of all the EFAs; coconut oil is used because it is the only fat that can be fully hydrogenated and still be soft enough to eat.) The animals developed dry coats and skin and slowly declined in health, dying prematurely. (Interestingly, representatives of the vegetable oil industry blame the health problems on coconut oil, not on fatty acid deficiency!)

    In a situation of fatty acid deficiency, the body tries to compensate by producing a fatty acid called Mead acid out of the monounsaturated oleic acid. It is a 20-carbon fatty acid with three double bonds named after James Mead, a lipids researcher at the University of California at Los Angeles who first identified it. An elevated level of Mead acid in the body is a marker of EFA deficiency.

    According to Peat, elevated levels of Mead acid constitute proof that your body can make EFAs. However, the Mead acid acts as a "filler" fatty acid that cannot serve the functions that the original EFA are needed for. Peat claims that Mead acid has a full spectrum of protective anti-inflammatory effects; however, the body cannot convert Mead acid into the elongated fatty acids that the body needs for making the various anti-inflammatory prostaglandins.

    Peat also asserts that polyunsaturated fatty acids become rancid in our bodies. This is not true; the polyunsaturated fatty acids in our cell membranes go through different stages of controlled oxidation. To say that these fatty acids become "rancid" is misleading. Of course, EFAs can become rancid through high temperature processing and it is not healthy to consume these types of fats. But the EFAs that we take in through fresh, unprocessed food are not rancid and do not become rancid in the body. In small amounts, they are essential for good health. In large amounts, they can pose health problems which is why we need to avoid all the commercial vegetable oils containing high levels of polyunsaturates.

    Peat’s reasoning has led him to claim that cod liver oil causes cancer because cod liver oil contains polyunsaturated fatty acids. Actually, the main fatty acid in cod liver oil is a monounsaturated fatty acid. The two main polyunsaturated fatty acids in cod liver oil are the elongated omega-3 fatty acids called EPA and DHA, which play many vital roles in the body and actually can help protect against cancer. Furthermore, cod liver oil is our best dietary source of vitamins A and D, which also protect us against cancer.

    Actually, Peat’s argument that polyunsaturated fatty acids become harmful in the body and hence cause cancer simply does not make sense. It is impossible to avoid polyunsaturated fatty acids because they are in all foods.

    EFAs are, however, harmful in large amounts and the many research papers cited by Peat showing immune problems, increased cancer and premature aging from feeding of polyunsaturates simply corroborate this fact. But Peat has taken studies indicating that large amounts of EFAs are bad for us (a now well-established fact) and used them to argue that we don’t need any at all.

    Finally, it should be stressed that certain components of the diet actually reduce (but do not eliminate) our requirements for EFAs. The main one is saturated fatty acids which help us conserve EFAs and put them in the tissues where they belong. Some studies indicate that vitamin B6 can ameliorate the problems caused by EFA deficiency, possibly by helping us use them more efficiently.

    About the Author
    Mary G. Enig, PhDMary G. Enig, PhD is an expert of international renown in the field of lipid biochemistry. She has headed a number of studies on the content and effects of trans fatty acids in America and Israel, and has successfully challenged government assertions that dietary animal fat causes cancer and heart disease. Recent scientific and media attention on the possible adverse health effects of trans fatty acids has brought increased attention to her work. She is a licensed nutritionist, certified by the Certification Board for Nutrition Specialists, a qualified expert witness, nutrition consultant to individuals, industry and state and federal governments, contributing editor to a number of scientific publications, Fellow of the American College of Nutrition and President of the Maryland Nutritionists Association. She is the author of over 60 technical papers and presentations, as well as a popular lecturer. Dr. Enig is currently working on the exploratory development of an adjunct therapy for AIDS using complete medium chain saturated fatty acids from whole foods. She is Vice-President of the Weston A Price Foundation and Scientific Editor of Wise Traditions as well as the author of Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol, Bethesda Press, May 2000. She is the mother of three healthy children brought up on whole foods including butter, cream, eggs and meat.

    IMPORTANT CORRECTION

    In the Winter 2004 "Know Your Fats" column we stated that Siberian pinenut oil was a good source of gamma-linolenic acid (GLA). This was indicated from fatty acid analyses performed in Siberia. We have since performed further tests on the oil and found that it does not contain significant amounts of GLA but rather a fatty acid called pinoleic acid, an 18-carbon fatty acid with three double bonds but with the first double bond on the fifth carbon, not the sixth, as in GLA. We are sorry for any inconvenience this may have caused.

    http://www.westonaprice.org/knowyourfats/essentialfattyaciddef.html

  • Arlie

    6/5/2009 4:26:30 PM |

    I'm a 57 year old grandma and have been vegan for over 6 years. I've run 3 marathons since turning 50, but took at 18 month hiatus to care for a grandson.  I was slowly trying to get back into running by starting out with 20 min. jogs and 3 minutes of jumping rope. Last October I developed painful tendinitis in my knee...my M.D. encouraged me to try O.T.C. painkillers (aspirin, acetaminophen, and ibuprofen) and take glucosamine all to no avail...he sent me to a physical therapist who gave me a few exercises said I shouldn't run at all, ever...that he quit running at age 30 and advises walking only. At that point my doctor wanted to prescribe some NSAID and give me a 2nd prescription for something that would allow my stomach to handle the prescription NSAID.   Without my M.D.'s recommendation I went to an acupuncturist for 3 months...no luck there.  Then a few months ago, again without my M.D.'s referral, I went to a chiropractor.  Since I was vegan, he prescribed flax oil, which seemed to help only a little, although the chiropractor said he really thought I would benefit the most from fish liver oil. Yesterday, in desperation, I took fish oil and felt much better.  I'm not pain free yet...but the improvement was quite dramatic.  I'll have to see how it goes.  I was vegan for personal, ethical reasons as opposed to health concerns...so even though this is a bit of a disappointment for me and my veganism...I think I will continue to use the fish oil and see if I benefit further.  By the way I had been taking vegan DHA for years from either "Omega Zen" or "Deva". Many, many years ago I heard that the playwright George Bernard Shaw had to take liver for a B-12 deficiency.  As the story goes someone said to him, "Is that liver you're eating...I thought you were a vegetarian."  Shaw replied "I am, this is my medicine."

  • Anonymous

    2/15/2010 9:11:25 PM |

    Ah, This is exactly what I was looking for! Clears up
    a few misnomers I've read

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    11/3/2010 10:44:47 PM |

    Dr. Goldstrich has proven especially adept at understanding how to incorporate new findings from clinical studies in our framework of coronary atherosclerotic plaque management strategies.

  • moseley2010

    12/8/2010 4:40:26 PM |

    I have heard about acai berries and acai berry supplements containing sufficient Omega 3. I found out about this while I was looking for great alternatives for kids. Because for sure, they don't like fish oil supplements as they are huge and smelly, but I also believe they need the Omega 3 and all the good it brings. I found out about acai berry powder with Omega 3. I admit I am almost convinced.

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Heart health consultation with Dr. Joe D. Goldstrich

Heart health consultation with Dr. Joe D. Goldstrich

20. June 2010 William Davis (3)
Cardiologist, nutritionist, and lipidologist, Dr. Joe D. Goldstrich, is a frequent contributor to the Track Your Plaque Forum, where we discuss the full range of issues relevant to coronary health and coronary plaque reversal.

I have come to value Dr. Goldstrich's unique insights, especially in nutrition. Formerly National Director of Education and Community Programs for the American Heart Association and a physician at the Pritikin Center, his dietary philosophy has evolved away from low-fat and towards a low-carbohydrate focus, much as we use in Track Your Plaque. Like TYP, Dr. Goldstrich is always searching for better answers to gain control over coronary health. His unique blend of ideas and background has helped us craft new ideas and strategies. Dr. Goldstrich has proven especially adept at understanding how to incorporate new findings from clinical studies in our framework of coronary atherosclerotic plaque management strategies.

Dr. Goldstrich is offering to share his expertise with our online community. If you would like a one-on-one phone consultation with Dr. Goldstrich, you can arrange to speak with him at his HealthyHeartConsultant.com website.
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Comments (3) -

  • Home Energy

    8/22/2010 10:10:15 AM |

    Heart health is more important so we must take care of that. We should provide intentions for that.

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    11/3/2010 10:43:59 PM |

    Buy jeans from our clothing store online!

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Newsweek, Time, and other fronts for the drug industry

Newsweek, Time, and other fronts for the drug industry

15. June 2009 William Davis (0)
I used to believe that conventional print media--newspapers, magazines--were unbiased, untouchable flames of truth. Perhaps there was a time when this was true, when the young reporter, eager to change the world, uncovered the story that righted some huge wrong.

Those days are drawing to a close.

Today, the once powerful print media are collapsing due to the competition of the cheaper, broader reach of the internet.
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The folly of an RDA for vitamin D

The folly of an RDA for vitamin D

9. January 2011 William Davis (26)
Tom is a 50-year old, 198-lb white male. At the start, his 25-hydroxy vitamin D level was 28.8 ng/ml in July. Tom supplements vitamin D, 2000 units per day, in gelcap form. Six months later in January (winter), Tom's 25-hydroxy vitamin D level: 67.4 ng/ml.

Jerry is another 50-year old white male with similar build and weight. Jerry's starting summer 25-hydroxy vitamin D level: 26.4 ng/ml. Jerry takes 12,000 units vitamin D per day, also in gelcap form. In winter, six months later, Jerry's 25-hydroxy vitamin D level: 63.2 ng/ml.

Two men, similar builds, similar body weight, both Caucasian, similar starting levels of 25-hydroxy vitamin D. Yet they have markedly different needs for vitamin D dose to achieve a similar level of 25-hydroxy vitamin D. Why?

It's unlikely to be due to variation in vitamin D supplement preparations, since I monitor vitamin D levels at least every 6 months and, even with changes in preparations, dose needs remain fairly constant.

The differences in this situation are likely genetically-determined. To my knowledge, however, the precise means by which genetic variation accounts for it has not been worked out.

This highlights the folly of specifying a one-size-fits-all Recommended Daily Allowance (RDA) for vitamin D. The variation in need can be incredible. While needs are partly determined by body size and proportion body fat (the bigger you are, the more you need), I've also seen 105 lb women require 14,000 units and 320-lb men require 1000 units to achieve the same level of 25-hydroxy vitamin D.

An RDA for everyone? Ridiculous. Vitamin D is an individual issue that must be addressed on a person-by-person basis.
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Comments (26) -

  • terrence

    1/9/2011 1:11:23 AM |

    Is the folly of an RDA for vitamin D at least partly because it is a hormone?

    I am also sure that different people absorb vitamins and hormones differently; and a person probably absorbs them  differently at different times, as well. Another reason an RDA won't work very well, if at all.

  • Stephen

    1/9/2011 1:32:15 AM |

    Any undiagnosed kidney problems/disease?

    I've read that something like 25% of people have undiagnosed kidney disease and that this can impact the conversion rate of D to the active form.

  • Martin Levac

    1/9/2011 3:10:14 AM |

    I posit that the main factor that determines the resulting 25-hydroxy vitamin D level is dietary fat intake.

  • Anonymous

    1/9/2011 3:19:20 AM |

    How do I find out how much I need?

  • Anonymous

    1/9/2011 3:33:25 AM |

    After 2 years of every 6 months blood tests, I've settled on 10,000iu/day.

    Found great price for 10,000iu gelcaps here: http://www.nutritionland.com/p10930/Healthy-Origins---Vitamin-D3-10000-IU-360-SoftGels.html

    Caution...they tried to improperly charge me sales tax.

  • Andrew

    1/9/2011 3:57:16 AM |

    there are heaps of vitamin D isonomers, you don't know what proportions of the different isonomers and toxisterols are in the supplements and also they are quite fragile and really need a preservative like sodium sulfite which has become unfashionable

    this problem of what vitamin D actually is has zero research done on it, let alone what is in supplements!

    it's at least 20 years away before a reasonably informed RDA can be given

  • Might-o'chondri-AL

    1/9/2011 4:37:53 AM |

    Genetics does have it's opportunity to alter things. The unactivated D's  binding receptor has to co-function with the retinoid-X-receptors and get to the D response element of our mutable genes to start transcription of activated D.

    There are 8 D pathways and several known vitamin D receptor gene variations. The receptor variants show pronounced association with different population lineages. The level of circulating (measureable) activated D is affected - and then too the 1/2 life of active D is not a long cycle even in ideal metabolism.

    In the kidney making active D, the 1,25(OH)2D3 type, needs the enzyme "CYP27B1" to respond to the parathyroid hormone.

    Curiously the same enzyme in our macrophages induces synthesis of active D there (outside our kidneys). Certain noxious bacteria (not the parathyroid) in our system trigger Toll-like receptors that start this cascade. This too is a geneticly varied immune function.

  • Paul

    1/9/2011 5:46:37 AM |

    The following is a comment on the Vitamin D Council's website where Dr. John Cannell discusses cofactors required for proper vitamin D metabolism:

    "Vitamin D has co-factors that the body needs in order to utilize vitamin D properly. They are:

    •magnesium
    •zinc
    •vitamin K2
    •boron
    •a tiny amount of vitamin A

    Magnesium is the most important of these co-factors. In fact, it is common for rising vitamin D levels to exacerbate an underlying magnesium deficiency. If one is having problems supplementing with vitamin D, a magnesium deficiency could be the reason why."

    http://www.vitamindcouncil.org/

  • ben

    1/9/2011 5:58:29 AM |

    My Vitamin D3, 25-OH, levels were 29 ng/ml so I took 4000 IU a day for a year and it rose to 39 ng/ml  (+10ng/ml change).

    I'm shooting for 50ng/ml, so I'll do another year at 4000iu, at which point I think 2000iu/day will maintain that level.

  • Tony

    1/9/2011 11:18:10 AM |

    Don't forget differences in nutrition.  Do they eat the same food? How much grains, fish, meat, and so on?

    Paul mentions Vitamin K2 as a cofactor. These Vitamins don't work in isolation, but are part of the grand metabolism show.

  • Marc

    1/9/2011 3:26:49 PM |

    Dr. Davis, what do most "conventional" Md's deam "toxic levels of vit d"?

    Reason I ask, my girflriend has been supplementing with vit d. 2-4000 iu per day with some breaks here and there for the last 6 months.
    Recent blood test she was told by her MD that vit d levels are way to high. We have been waiting for a week to have them give us the reading....hopefully they will call next week.

    My levels are 63 ngl and I'm curious if many Md's would find that level too high.
    Your feedback is very much appreciated and thank you for al you do.

    Marc

  • qualia

    1/9/2011 5:05:36 PM |

    @Martin Levac: vitamin D3 is not dependent on fat as a tranporter (D2 is however).

    another reason for bad absorption could be undiagnosed (or silent) celiac. the absorpion of D mainly happens on the tips of the villi, and if they're damanged, absorption is massively disturbed.

    another reason could be chronic infection, which can use up a lot of D in the concerned tissues/cells for fighting it, or increased degradation of 25-OH-D in the liver.

    another question would be if one man's 25ng, is the same as another man's 25ng. could be that inividual levels in the blood are actually not really compareable at all due to genetics, and that the second man's 25ng is actually more like 100ng for him, and therefore the liver desperately tries to bring down the level.

  • Ken

    1/9/2011 5:30:03 PM |

    What is the name of the test for 25-hydroxy vitamin D level? I found a lab that will do this test: Vitamin D 25 Hyrdroxy LC-MS  (Vitamin D 25-Hydroxy, D2 + D3 ).

  • Kevin

    1/9/2011 6:17:54 PM |

    Your sample size is small to warrant this conclusion, "Vitamin D is an individual issue that must be addressed on a person-by-person basis," no?

  • Chris Masterjohn

    1/9/2011 6:44:56 PM |

    Dr. Davis,

    Whether or not you agree with the specific value of the RDA, interindividual variation in requirement does not in any way invalidate the concept of the RDA, because the RDA is not meant to be a one-size-fits-all recommendation.

    On the contrary, the RDA incorporates the concept of a distribution in requirements, and attempts to cover the needs of most people.  The IOM is pretty explicit about that.  

    You could certainly argue that the current RDA is not sufficient to meet the needs of most people, but that's another issue.

    Chris

  • Daniel A. Clinton, RN, BSN

    1/9/2011 11:58:25 PM |

    Great post. I completely agree. Vitamin D is simply too complicated to be addressed in just one number. Most everyone's level of understanding is so superficial that it doesn't extend beyond that one number. When a number like that is created, it takes on more power than it should because most who access it don't know its faults and limitations.
    I know someone who concluded that his bizarre behavior after drinking two bottles of apple juice was from "Too much Vitamin C." He had drank two bottles, each bottle had 2 servings, and each serving had 100% the daily value of Vitamin C. Beyond the giant sugar bolus, in his mind, he had just taken 4x the recommended amount of Vitamin C. Based on his level of understanding, he concluded he may have ingested a toxic amount of Vitamin C. He needed a scapegoat and he found one.
    More damage is done by attempting to dumb down Vitamin D to one number than any benefit an RDA creates. It's simply too complex.  Frankly, it's pretty pathethic that Vitamin D deficiency remains rampant. It says an awful lot about our healthcare system that such a huge percent of the population remains Vitamin D deficient while taking far sketchier prescription drugs for the host of conditions associated with Vitamin D deficiency.

  • Peter

    1/10/2011 1:51:14 AM |

    For people with money, insurance, and education, jit makes sense to look at each person's individual needs.  For everybody else, RDA sounds to me like a reasonable idea.

  • Davide Palmer

    1/10/2011 3:59:10 AM |

    Dr. Davis,

    Would blood calcium levels be an accurate indicator of sufficient Vitamin D intake?

  • reikime

    1/10/2011 4:59:53 AM |

    Quailia,

    We were thinking along the same lines... undiagnosed malabsorptive disorders could be responsible for alot of low levels in spite of supplementation.

    Celiac alone affects approx. 1-133! throw in fructose malabsorbtion, UC etc. and no wonder we have an epidemic of low D levels.

  • Martin Levac

    1/10/2011 8:19:08 AM |

    @Qualia,

    Do you mean to say that vitamin D3 is not fat soluble? Everywhere else it says D3 is fat soluble. Do you know something the rest of the world doesn't?

  • Travis Culp

    1/10/2011 8:43:34 PM |

    I wonder if I may be overdoing it with 5000IU for about half the year (Oregon). I eat natto and 3 cups of steamed spinach per day, so I should be ingesting all of the cofactors in substantial amounts.
    I wonder if it would be more efficient to go to an endocrinologist in order to get this and a proper lipid panel done.

  • Dr. William Davis

    1/10/2011 11:02:15 PM |

    If the IOM has achieved any good at all, it is to further stoke constructive discussion around vitamin D.

    I am quite impressed with the level of comments here. Compare that to the conversations we were having just 2 or 3 years ago. We've come a long way.

    Vitamin D remains on my list of "most incredible health effects ever seen."

  • Carlos

    1/13/2011 5:23:07 AM |

    A belated thank you for all your articles on Vitamin D. I read about the importance of taking Vitamin D in many books but was never willing to go through the hassle of getting my levels checked.

    Well, reading your blog several months convinced me to give it a shot. Turns out that it took 10,000 IU a day just to get me to 54 ng/ml. I am now on 14,000 IU a day to see if I can get into the 60 to 80 ng/ml range.

    I have thus far managed to get through this winter without contracting a cold when half the people I work with are taking turns being out sick with one they've spread amongst themselves. By adding D and CLO (and making dietary changes), my total cholesterol dropped from 215 to 169, my HDL went up from 44 to 50, and my VLDL dropped from 24 to 9. My triglycerides dropped from 143 to 53. Given that I'm only halfway through my weight loss I expect greater improvements yet. Thanks again.

  • liposculpture guide

    1/13/2011 11:11:46 AM |

    This is great, brilliant and knowledgeable post. I agree with your conclusions and will eagerly look forward to your next updates. Just saying thanks will not just be enough, for the wonderful clarity in your writing.

  • Anonymous

    1/21/2011 5:23:28 PM |

    Here is "The Peoples Chemist" Vitamin D link:

    http://thepeopleschemist.com/blog/the-vitamin-d-scam

  • George

    2/7/2011 9:29:30 PM |

    Dr. Davis, I have had great lipid results, overall health benefits with going to a lower carb, paleo diet as well as supplementing with vitamin D getting to the the mid 50's mg/dl range from the low 30's on 8000 mg vitamin D for the last 2 years. Not sure if related, but one downside has been the 3 occurences of kidney stones in last 18 months. It seems the current recommendations for the stones implicates higher protein diets and increased vitamin D. Have you run into this with any of your patients, what is available to address this?

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