I don't have a "re-exposure story", rather an avoidance story.

I used to have terrible cold weather, exercise induced asthma.  After nordic skiing I would be wheezing, coughing, sucking on albuterol and begging for low dose corticosteroids.  I also had terrible acid reflux.

Fast forward:Wheat free for over 6 months.  No more asthma, no reflux.  Period.  End of story.

Is it the wheat?  Can't say for sure, but it's awfully suspicious.

Reflux -- starts a day later and goes for up to a week.  And Bloat:2-5 inches on my waistline in a day, lasting up to three.  Miserable.  And why, having experienced this once, have I done it often enough to verify the connection with certainty?  I am working on that one.

Last year, I had a cookie after a few months' being wheat-free. It gave me a stomach ache, acid reflux for two days and sinus congestion for four. No more wheat for me.

Wheat increased hunger with even with only a small amount. Crackers in soup was enough to set it off.

Also, when I was trying to get off wheat, I noticed that 2eggs and 2bacon and I could go 5 hours before hunger, or 2eggs and 2bacon and toast was good for three hours before hunger. That was the final step to giving up wheat. Now three years and 59 Kg loss later, there is no doubt in my mind that wheat is evil, and I do not regard it as suitable for human food. I speculate that it increases ghrelin or cortisol.

For me, in the two years since I began eating Gluten-Free (Low Carb for 6 years), the few times I've had re-exposure to wheat, I've experienced fast onset and intense abdominal pain (known exposure during the daytime) and heartburn, indigestion, intense nausea, and disrupted sleep (exposures during evening meal not discovered until the next day).  

My husband wants to think he's fine with wheat (though I know that he has at least one gene that predisposes to celiac), but IMO, he isn't.  He eats no wheat at home because that's the default, and he's OK with that.  But if he goes out to dinner at a restaurant that serves "good" artisan bread, he  will indulge in a few bites (he does restrict his carb intake, so it's still a limited amount).  More often than not, he will sleep fitfully on those nights, snore more, and wake in the night with indigestion.  He wants to bury his head in the sand and will only acknowledge the discomfort being due to eating too many carbs, not the wheat itself.  I notice he sleeps fine if he eats a small amount of potato or rice.  Go figure.  

Our 12 yo son has been eating GF for two years also.  About 6 months into GF, he unknowingly ate wheat a number of times (licorice candy laces at a friend's house), which  resulted in outbreaks of canker sores in his mouth each time.   He also exhibits mood and behavior changes when he eats wheat, which is what prompted me to test him for gluten intolerance in the first place.

I need to be able to choose more than 1 option in the poll. The top 3 choices are me. If I just eat a little, I only get GI symptoms followed by sinus headache. If I eat more, then I get arthritis symptoms (first diagnosed when I was 13. Now that I avoid wheat, it's gone unless I re-expose myself).

I see now that I should have added two more choices: 1) More than one of the above, and 2) "other," i.e., effects not listed.

Anyway, we'll have to make do. I believe we can still get a useful non-scientific sense of what readers have experienced.

I eliminated wheat on your suggestion over a year ago. Occasional re-exposure (usually dining out) has no effect on me.

If I go for 3-4 days without wheat, grains or sugar and then go out and binge on a pizza and ice cream or something like that I become explosive within 20 minutes to an hour.  It's like a wheat and sugar rage.(I'm not saying this is an excuse for rage, I'm saying it has happened to me and I believe partly do to re-exposure)  It seems the combination of the wheat plus sugar can be the worst.  
I get red rashes around my neck sometimes right away and sometimes up to a day or later and sometimes get bad diarrhea.  
I think it can be almost dangerous to cut things like gluten and sugar suddenly out of the diet without being very serious about keeping them out. I have found it very hard to cut out wheat without binging on it later after 4 or 5 days. I don't believe that my symptoms are just psychological either.
I was also diagnosed with ADHD as a young kid and then rediagnosed with adult ADHD by 3 different doctors.  I also have bouts of mania at times too.  I am considering trying to go completely gluten/refined carbohydrate free to see if it helps with the symptoms and gives me some relief.
I have never been tested for celiac or gluten intolerance but I would like to be. I think it would help explain to my girlfriend, family and friends why I can't go out and eat pizza or have a beer or ice cream.  Right now they all think I'm a hypochondriac.

Braing fogm clogged nose and slower bowel movement.

Why i dont get diarrhea when eating wheat?

Would like to add at times I have experienced an intense fatigue the next day like I can't wake up and also sharp pains in my body and headaches.

I ditched wheat a year ago after my wife was diagnosed celiac. I immediately experienced a number of health improvements (blood lipids, sleep, allergies, etc.).

Fast forward: We all suffered some inadvertent wheat exposure yesterday via some chocolate covered Brazil nuts (of all things). This accidental A-B-A experimental design resulted in the following:

1. My celiac wife experienced what she calls "the flip" within an hour of exposure(i.e., intense GI distress).
2. My five-year-old son went to bed with some wicked reflux.
3. I woke up with some twinges in my lower back and an ache in my football-weary left shoulder. I was also complaining to my wife about fuzzy-headedness that refused to respond to caffeine or hydration. I could only describe it as "carb  flu"...

And then I read your post!

Depression, agitation and brain fog if I get glutened. Some times this comes with abdominal pain and a rash on my back - I think it is dose dependent. Cross contamination with wheat is a big issue when eating out. Needless to say, I eat out infrequently and then try to stick with the restaurants that are the most aware of gluten issues.

Several weeks ago, I started Robb Wolf's 30 day challenge.

The first two weeks were brutal - calling it a withdrawal flu was a massive understatement. So, I thought I would try some wheat and see what happened (could not be worse, I thought). Well, it was.

I still felt extremely crappy, but I was now MASSIVELY GASSY - AMAZINGLY GASSY, for about 48 hours - flatulence on wheels, in spades.  I did not go out at all in those 48 hours - when the gas came on, it went out, LONG, and QUICKLY and LOUDLY.

I am easing back into wheat and grain free. I am gluten free today and tomorrow (Sunday and Monday). I expect to try a small amount of wheat on Thursday, then maybe a little more the following Thursday.

After being wheat-free for almost a year, I have intestinal pain and inflammation after re-exposure to wheat. And higher blood glucose for a day or two (type 2 diabetic).

reading this makes me wonder- how many people with re-exposure symptoms actually have a problem with gluten versus just wheat?

It would be interesting to see if some of you are still symptom free if you ingest say barley, or rye, while remaining wheat free.  
Just a thought...I do agree with all Dr D says about wheat, but it does beg the question as to how many are truly GLUTEN intolerant.

I have limited wheat consumption severely over the last 8 months. I have lost 120 pounds, no longer have bouts of illness, asthma, depression, or low energy. I also take vitamin D and other supplements that have helped (many are from your blog recommendations).

Last week I ate a small piece of cake and dessert pizza. Shortly thereafter I started sneezing, had a scratchy throat, and runny nose. I called off sick the next day for fear of being contagious. My symptoms subsided quickly and I am now attributing them to the processed flour eaten at my work luncheon. I think it was an allergic reaction since I recall having much more severe symptoms fairly regularly in my wheat eating days. Those were attributed to an "allergy" of unknown origin back then.

The comments to this blog post and poll are incredible!

I should re-post them in a blog post to highlight all the varied versions of wheat re-exposure.

The range of benefits with wheat elimination and the effects of wheat re-exposure are truly incredible. Look at what commenter Donald Kjellberg had to say: 120 lbs lost!

Not everybody, of course, loses 120 lbs. But what other food, when eliminated, has the power to do this in select individuals? Then makes them sick on re-exposure?

I suffered from Ankylosing Spondylitis, Iritis, Plantar Fasciits, etc for a number of years. I restricted carbs, especially wheat and I've been symptom free for the past two years now.

The whole story on the KickAS forums here: http://www.kickas.org/ubbthreads/ubbthreads.php?ubb=showflat&Number=427748#Post427748

Lot's of confounders to consider. Lest I be thought of as a wheat apologist troll my wheat and grain consumption is limited (rice less so).

Any food item we omit will shift our gut bacteria away from those that thrived on that food. Others will then pre-dominate;  and so, to re-expose after (say) 3 days some of us won't have the same % protein degrading bacteria to handle the wheat protein fragments and more gaseous fermentative bacteria.

Wheat preparation is another thing and ingredients consumed at the same time can also make a difference. I think of yogurt/kefir and white/brown sugar as modulators; rather than meats/vegetables, which can interact with digestion in their own way and alter the synergy. This is not to contradict individual testimonials of their reactions; nor contest an experiment where wheat all alone is eaten and neither to ignore genetic factors .

Then there is the doseage factor regarding how much at one time is ingested. Some are prone to inflammatory reactions; their threshold may be linked to excessively stimulating co-existant fungii colonizing their intestine.

The breeding of wheat is something this blog has helped me understand. Cutting it out entirely for health reasons is for many a simple strategy I hadn't seen clinicaly used. It won't make sense to third world poor however; largely since the "hygenic" hypothesis implicates our immune systems as part of the problem.


.

My nemesis is processed grains.  Have always tended toward obesity and have only been able to control my weight by minimizing processed foods and by doing a lot of exercise.  Low carb didn't work for me.

My other nemesis is my 92 yr-old mother's sweet tooth.  Don't have the will power to resist all the junk food she demands, yet I'm her caregiver, and don't have the heart to deny her her sweets.  Have gained about 25# since moving in with her.  She may outlive me.

Am now experimenting with substituting chia seed for my usual oat/barley porridge.

I found wheat to be one of the worst things for giving me gas bloating and acid reflux, and I'd had sinus and nasal congestion my whole life. When I ate that cookie, it just re-introduced old problems. I can occasionally eat a gluten-free, grainy goody at my party place without any side effects. I also have a little sprouted rice protein powder every day.

Another odd thing about wheat: it was hard for me to stop eating it once I started. I could go through a whole box of cookies in one sitting, even though I wasn't a binge eater. But I can have a couple of gluten-free cookies and stop.

Except for one slip up this recently past holiday season, I've been sugar-grain-starch free since July 2008.  Mental fog was the most noticable re-exposure symptom I had.

My mom has had the worst acid-reflux for 40-plus years.  It had become so bad that she was on three medications just to deal with the symptoms. After much training and coaxing, I finally got across to her how to totally get off wheat.  Not at all to my surprise, after being wheat free for a few weeks, she lost weight and her acid reflux was GONE!

But she had been addicted to wheat for so long, she relapsed, and the reflux fire soon returned.  Wheat must be akin to heroin with some people.  Even though they know it's very bad for them, they can't help themselves.

Re-exposure often leads to diarrhea for me, or such a heavy feeling of tiredness that all I can do is lay down and pass out. A local pizzeria makes a darn good pie, but since I started practicing wheat-avoidance, I can't keep my eyes open after eating there. I can't say for sure that it's the wheat causing it, but definitely something in the crust. Diarrhea, on the other hand, is definitely triggered by the wheat for me.

My mom complained of gastric reflux for years, but never filled the prescriptions that her doctors would give her. I suggested wheat-avoidance- gastric reflux disappeared within 3 days and hasn't returned (has been 6 months now). I've already commented elsewhere on this blog about how much weight and bloating she has lost...

Some readers have suggested that changes in gut bacteria play a role here, and I tend to agree. When my mother stopped eating wheat, her years of gastric reflux symptoms ceased. Yet, her blood test for H. Pylori, taken one month after stopping wheat and cessation of symptoms, was positive for antibodies (indicating past or present infection) and her subsequent breath test was positive for current infection.

So, for my mother, H. Pylori + wheat = gastric reflux symptoms, and H. Pylori without wheat = no symptoms. It would be interesting to know if the H. Pylori would have disappeared after a longer period without wheat as her intestinal bacteria changed...

Interesting that I should sit down, turn on my computer and find your poll. Having gone several weeks, maybe months, avoiding gluten, I took my daughter and her boyfriend out to eat because my wife has been working late at the office lately. Although I was thinking I would just eat my steak and chicken, I succumbed to the temptation of eating about a dozen greasy, breaded shrimp that my daughter and her boyfriend ordered. It's 1:39am and I still do not feel sleepy. My left nostril is completely blocked, my stomach feels bloated, really, really full and I've been burping. In your poll I checked sinus problems but could have chose gastrointestinal or nervous problems just as well. A few weeks ago my daughter brought home a pizza and, once again, despite my knowing that I shouldn't, I ate a couple of pieces. I was sick for two days. The pain in what I think was my transverse colon was so bad I thought I might have to go to ther emergency room. Before I ate the pizza I had never gone grain-free that long before. I did this after reading Robb Wolf's book. I AM CONVINCED. No more wheat for me! Please, Lord, give me strength.

It is very interesting to read the comments here.  I have been LC for almost 4 years but have cheated sometimes (at restaurants).  I have had intestinal distress but never considered that it was from the wheat...

RE: Pizza - Just don't eat the crust.  We still get pizza and eat the toppings with a fork!

"Still others say there is no such thing."

Really?  I hadn't noticed anyone saying that.  I, like a few others, reported that I, myself, did not experience symptoms from very occasional wheat re-exposure.

When I eat wheat, I often have diarrhea the next day. And I am hungrier, I believe.

Again, 90% of this is pure mental.

Interesting the vote results are mostly on GI distress.

I'd suggest a couple additional matrixes:

1:  How long have you gone without wheat
2:  How much wheat did you consume?
3:  How neutrotic are you?

I went without wheat for 2-3 days last week.  Had a bad day on Thursday -- stuck at home with little food to eat, so had some WASA whole wheat crackers. Yuck.  Noticed some gassiness but nothing rising to the level of pain.

I do suspect it mostly is internal flora, but that shouldn't change in 2-3 days.  If you are cramping and shitting after eating some breadcrumps, you either have celiac or some severe mental problems.

Remains a good idea to advise people to give up wheat -- so prevalent is US diet and easy way to lose weight.  Hard to see it being a long term problem if not abused.

I remember stories of Indians during 1940's famine being unable to eat wheat while starving. Extreme example -- people who didn't eat wheat for 6000+ years being forced into it.  However, 50 years later common diet item.  Obesity is out of control but that is as much from 10x as many caloric units being available as in the 1930 (i.e. people don't starve to death like they used to)

"Effects not listed" for me.  I am OK on minimal wheat but when I cross a certain threshold, my eczema flares a week or two later, and my asthma sometimes returns.

On January 31, 2011, Charlie said... "Again, 90% of this is pure mental."

Your psychic ability or your plain old unfounded, indeed unfoundable, presumptuousness would be really funny - if you were trying to be funny.

But, I think you really mean "Again, 90% of this is pure mental."  Even though you do not have a clue as to whether or not anything described by others on this or any other blog really is, "90% of this is pure mental."

I think the main question you should ask yourself is, "3: How neutrotic are you?" Charlie, can you figure out how to use a spell checker? "neutrotic". HAH.

Charlie, you actually made the statement, "Again, 90% of this is pure mental." You know NOTHING about most, if not ALL, of the people who comment here. Yet, that you actually think you know what goes on in their minds! Do you use a crystal ball to make your divinations, Charlie?  

You even made the more ridiculous statement that, “you either have celiac or some severe mental problems.” Your POMPOUS, SELF-RIGHTEOUS PRETENTIOUSNESS is risible, Charlie, RISIBLE!  If anyone on this post has “severe mental problems” Charlie, it is you, and only YOU.  

I expect you are the same “Charlie” who made a complete fool out of himself on Stephan Guyenet’s blog by spewing similar complete and utter nonsense about “honesty”.

What you are doing here, as on SG’s site, is called “projection”. What you do not like about yourself, but are afraid to acknowledge in yourself, you project onto others, and claim it is they who have  â€œsevere mental problems” and that “90% of this is pure mental”. So, Charlie; it is YOU who should deal with YOUR mental state, and stop projecting it onto other people, whom you know NOTHING about!

Just like Might-o'chondri-al (what a mouthful!) mentioned, it's hard to tease out the confounders. I don't sit down and munch on some wheat stalks on my off days. These are the occasions when I allow myself to indulge in delicious croissants, scrumptious shortbread tarts and traditional Australian carrot cake (if you do something bad, you might as well be good at it). These very occasional indulgences, apart from containing wheat, also have other NADs, to use Dr Kurt's phrase, that I routinely avoid: sugar, maybe HFCS, maybe some trans fats, maybe some other additives/chemicals I'm not aware of. I know the fall-out: pimples within 24 hrs, flatulence, ankle oedema and headache. I would be hesitant to blame just one ingredient as tempting as it is to indict wheat. But I am not prepared to run an experiment involving me, wheat husks and gluten-free cookies

I'll submit "other".

No overt symptoms, but since limiting
carbs generally, wheat specifically,
my A1C stays in the low 5s, and my
insulin requirement is half what it was...

Suits me.

Jack

What if you have multiple symptoms? Grains are a disaster for a lot of people I know: http://www.cutthecarb.com/your-daily-bread-pasta-and-pizza-are-killing-you/

For those worried about their blood sugar levels, may I recommend this: chana dal

And here is an interesting article on this food:

http://www.mendosa.com/chanadal.html

From: http://www.mendosa.com/chanadal.html

"Tim writes, "While I was in Tesco ( Britain's largest supermarket) I checked on the nutritional information panel on the back of a packet of Chana Dal. It was:

        "100g = 1404kj or 332kcal
        protein 23.1g
        carbo 48.2g
        fat 6.5g
        fibre 10.0g""

But the Chana Dal currently on sale states the nutritional composition as:

Energy kCal 298kCal
Energy kJ 1,264kJ
Protein 24.0g
Carbohydrate 59.7g
of which sugars 2.2g
Fat 3.1g
of which saturates 0.3g
Fibre 16.1g
Sodium Trace


http://www.mysupermarket.co.uk/tesco-price-comparison/Rice_Pulses_And_Grain/Natco_Chana_Dal_2Kg.html

What don't I experience!  I typically avoid wheat (and gluten for that matter) as I'm pretty sure it makes me sick, but when I slip (or someone else slips me some) I end up with massive amounts of joint swelling and tenderness, diarhea, cramping, gas, bloating and brain fog.  I'm absolutely miserable.  Just that alone is enough to keep me off gluten. I have RA, so if I have repeated exposures I'll have a flare which SUCKS!

Like clockwork, I get massive pain in one or both hips with certain movements when I deviate from a low-wheat regimen. I also get heartburn, and difficulty sleeping as well. All are very good reasons to stay off the grain, for me.

depends if it is a fleeting re exposure of prolonged. no symptoms in former and in latter i get weight gain and a crackling but not painful back but im young so that explains the the painlessness. 26 yo.quiv

The varied responses to wheat re-exposure could literally fill a book.

What is amazing is that this is just a "food"--it's not a poison, medication, or some foreign chemical like a pesticide. It's just wheat.

I know that someone like Charlie would come on and say something like "it's all in your head." I hear this all the time.

I'm wondering your views on wheat products contained in cooking flavorings such as soy-sauce etc.
I've cut out wheat from bread and flour however going through all my condiments there is a small amount (~4-8% ) of wheat in these.  The physical amounts are obviously quite small in cooking so for example 8% wheat in soy-sauce would translate to about 1.5 grams out of a 20ml tablespoon serving.
It would be very hard to go the extra step and cut out my cooking condiments.
I’m not wheat intolerant, obviously.  Your thoughts?
Thanks

I have severe joint pain, especially in my knees and hips, when reexposed to gluten.  I also had GI issues in the form of slowing things down.  I went gluten free last April 2010 and had 1 exposure in September and that was enough for me to cut it out for good.  All my tests show no reaction to gluten (blood/stool), but I know there is something there my body does not like!

ps:  I agree with others who wrote about gastrointestinal flora.  I believe we need to address these issues in a broader way.   A person could have a bacterial or parasitic overgrowth (or yeast for that matter) that are "carb" feeding, causing GI distress when wheat is consumed.

Dr. Davis,

Your blog has been educational and inspirational to me as a medical professional.  I have been lurking for several months, perusing old blogs and waiting for new ones.  The conversations in the comments are interesting, sometimes heartbreaking with the illness that people have suffered before the true cause has been found.

I write now because the improvements in health the removal of wheat, and various reactions with the re-introduction of it is something that has been known in the field of Environmental Medicine for over 40 years.  

Foods other than wheat, as well as environmental chemicals, can cause similar problems with ill health.  An older, but still useful, book on the subject is 'Alternative Approach to Allergies' by Theron Randolph, MD.  In it, Dr. Randolph describes his work with food and chemically sensitive patients, his theories on why this happens, and his observations on treatment.  Because these sensitivities are highly individual, the gold standard multi-centered double-blinded placebo-controlled studies are impossible to do.

As with many doctors who practice outside the 'normal' medical paradigm, I have family and personal experience with food and chemical sensitivities.

My father had had cluster headaches since he was a young man.  He saw Dr. Randolph in the early 1980's, when I was a freshman in medical school.  Dr. Randolph diagnosed sensitivity to wheat and corn (not sure of the technique).  My father also found orange juice triggered headaches.  

When he removed these foods from his diet and went on a strict four day rotation diet, his headaches quit.  That is not the natural history of cluster headaches.  When I mentioned this to anyone at school, I was told that it was the wrong diagnosis, or it was a coincidence.  It is best to not rock the boat, so I kept quiet after a while.  

The next year, as a sophomore, I had a chemical exposure from new carpet in my apartment.  Whether it was the glue or the finish, it made me very ill.  I became confused, developed nasal allergies, couldn't do simple drug dose computations, and depressed.  My mother had to come and help me move.  Very embarrassing for a 20-something to need mommy, but I did.  

I eventually recovered almost back to normal, but even now my memory and ability to concentrate on technical materials is not what is used to be.  

My dad went back on a conventional diet after 4 years, and his headaches did not return.  He has developed diabetes, arthritis, and balance problems.  I suggested his diet might have something to do with all of this, but he is unwilling to change.  It is hard to convince an 87 year old man that he shouldn't eat his wheaties!

Extrinsic Asthma is triggered by pollen, chemicals or some other external agent; Intrinsic Asthma is triggered by boggy membranes, congested tissues, or other native causes… even adrenalin stress or exertion.

I really wish that I had tangible reasons to avoid wheat, but after a fast-food experiment at the end of last year, I had no problems to report whatsoever. So I have to rely on the theoretical information I have to motivate my avoidance of wheat.

My goodness, I didn't even know wheat can cause these. I just found ways to cure arthritis. Anyway, prevention is better than cure.

Dr. Davis,

My name is Barbara and I have been going to you for several years.  I have been using benecol light on my husbands sweet and white potatoes.  After seeing your blog on plant sterols I am worried that I am giving him something thats not in his best interests.  Would you please comment.

My son and I both have asthma, and we manage with a combination of conventional medicine and some alternative treatments like respitrol for asthma.

Nin Jiom Pei Pa Koa (http://ninjiom-hk.cwahi.net/) may be another choice. i know alot of people use it, its also non alcoholic, though it's effectiveness is not as good as alcohol based cough medicine, but it's still good to use on not so serious scratchy throat.

I started gluten/wheat free 5 days ago. But two days in and I started having terrible flatulence and loose stools. Are they connected?? Patellofemoral arthritis in both knees feeling great tho.

Back in 2004 I was seeing a Cardiologist because of AFib (since "cured" by an ablation).  The good Doctor wanted to put me on a Statin for reasons having to do with unexplained multiple "risk factors". Not being a big fan of legal drugs, I asked if I could try diet first. He said, "Sure, you can try the American Heart Association diet but...it never works".  Undaunted I tried it anyway and sure enough 3 months later I had gained 15 lbs and my LDL was even higher (I couldn't stop eating).  BTW, I quit the Statin 2 years ago and have been Paleo since. - Jay

No thank you,
bananas spike my glucose above 140, he he!!!

I think you are taking the article completely out of context. The monkeys were on the American Heart Association diet and then they added in high frutcose corn syrup. The monkeys got fatter because of the carbs from the corn syrup, not from the AHA diet. Personally I am paleo, but you are pulling a Glenn Beck here.

The point is not whether HFCS or wheat was the cause, but rather that all simple and refined carbohydrates will create the pot belly that Shiva and most of Americans have.  The animal cruelty police should spend their efforts in Washington protesting the plethora of garbage advice that is forced on us by organizations like the AHA and cut their funding.  By doing so, it will have a significant positive impact and help reverse the upward trends of obesity, diabetes and heart disease that your tax dollars go to perpetuate.  The AHA is one of the most corrupt and lobbied groups by special interests agriculture, the same folks who bring you the refined carbs.  Once the agriculture industry checks clear in the AHA bank account, the AHA "heart Healthy" seal of approval is on the box.  If you bother to look most of the AHA "Heart Healthy" cereals have refined cereals grains and high fructose corn syrup.

Researchers in England and Singapore have developed a device which can assess the risk of heart disease.

http://insideireland.ie/2011/02/21/watch-like-device-to-assess-heart-disease-risk-9317/

I have followed this blog for sometime. I do appreciate Dr Davis's efforts and the comments made in the blog.
But I think he needs to address the criticisms made in the previous blog entry. Completely ignoring the comments and questions and moving onto a new topic seems to point toward an unseemly arrogance and a lack of respect for the readers.

Um, click on the link, but prepare for a very sad sight, the poor guy, (or girl) looks miserable.

What's Dr. Davis' alternative to AHA? Is it in a book or something?

As an alternative to the AHA and the ADA dietary guidelines,see Jenny Ruhl's two sites for a start.

Blood sugar 101
http://www.phlaunt.com/diabetes/

Low carb dieting
http://www.phlaunt.com/lowcarb/index.php

To all the entitled anonymous douchebags, if you don't like what Dr. Davis says in his blog leave! Dr. Davis doesn't work for you.

Two weeks after no dairy, no wheat and some really delicious juicy steaks I am five pounds lighter and feel great.
I don't give a rip what my lipids are because I am not going to do anything any differently anyways!

Blood sugars never break 100.

@second Anonymous- try reading the article before criticizing Dr. Davis for mischaracterizing it.  You'll see he was correct.

@Anonymous #2, the group on the HFCS drinks (among other things) and the group on the AHA diet were two different groups of monkeys:

"Dr. Grove [of Oregon Health and Science University] and researchers at some other centers say the high-fructose corn syrup appears to accelerate the development of obesity and diabetes....

“'It wasn’t until we added those carbs that we got all those other changes, including those changes in body fat', said Anthony G. Comuzzie, who helped create an obese baboon colony at the Southwest National Primate Research Center in San Antonio.

"Still, about 40 percent do not put on a lot of weight.

"Barbara C. Hansen of the University of South Florida said calories, but not high fat, were important. 'To suggest that humans and monkeys get fat because of a high-fat diet is not a good suggestion', she said.

"Dr. Hansen, who has been doing research on obese monkeys for four decades, prefers animals that become naturally obese with age, just as many humans do. Fat Albert, one of her monkeys who she said was at one time the world’s heaviest rhesus, at 70 pounds, ate 'nothing but an American Heart Association-recommended diet', she said."

The article goes on to refer to the first diet as "high fat," even though it's only 33% fat, and the way the article is written, it's hard to tell the groups apart.

Take the banana; a banana a day for one year offers hormetic (small bit of bad does good) low dose radiation of +/- 3.6 milli-rems for the entire year. Low dose radiation boosts the cytokine activity of NK (Natural Killer), the tumor stopper. A chest x-ray doses out 10 milli-rems by comparison.

Potassium , found in bannanas, is 0.0118% K40 isotope potassium. It emits mostly gamma radiation (when proton snags an extra electron) and some beta particles (when neutron mass spins off an electron and neutron becomes a proton); which are "slow" in collision with things, like a cell.

To a recent "Anonymous":

Dr Davis does have have an obligation to his readers. By convention, he is expected to explain himself and respond to polite and appropriate questions regarding his blog. That is why the interaction is provided, and he seems usually to encourage the dialogue. Dr Davis could have just as easily established this blog without the interactive feature. Currently, among usual glowing reader comments and often enlightening questions has come some criticism. His response to this criticism is what is currently lacking ... of course, this is only my opinion.

By the way, I am not exactly sure what "entitled anonymous douchebags" have to do with anything.

RE: “blah blah ... completely ignoring the comments and questions and moving onto a new topic seems to point toward an unseemly arrogance and a lack of respect for the readers.” by anonymous.

Fortunately, commentary on this excellent blog is for the most part constructive and informative. However a comment like this is frankly annoying because it’s mean-spirited, disingenuous, cowardly, and clearly not helpful. The poster is not obliged to read this blog, let alone dump on it like this anonymously!

Interesting!  I have been advising a woman who works in a chimpanzee sanctuary in the North West.  There is one chimp who had blood sugars of 1000.  

Sadly, they have put this chimp on Crystal Light and Tofu as a remedy.  

Chimps share 99% DNA with humans.  We know that aspartame and soy are both dangerous to the human body.  

The most interesting thing is, she rebelled when her goodies were taken away.  

They too are addicts just like us.

You're the only doctor I trust. The more i see the changes in my BP and overall health following your advice, plus the more I learn about what should first be done to treat hypertension, the more pissed off I get.
What jerk puts a young woman on atenolol without even asking for some tests or if she eats too much salt or if she's wound high at the dr's office!!?? What the hell!?

BTW, my blood pressure has dropped even more- an average of around 121/81- from 151/102. This is with 12mg of atenolol which I should hopefully kick to the curb soon

Hi Misty,
Although chimps and humans share 96% identical proteins the implication of our intervention is complicated. Here's why.

We actually have 40 million genome variables, including 500
DNA repair/apoptosis pathway proteins. 5% of proteins show different splice variations; we have different arrangements of coding regions on the chromosomes we share.

Chimps have 2.5 splice variations in places where humans only 1.5 gene splicing possibilities. 80 proteins we share similar gene intron segments for the chimp's intron is longer. Humans have more genetic activity post-translation to further modify events.

Humans don't have Neu5Gc (N-glycolyl-neuraminic acid) which is a sialic acid binding immuno-
globulin-like lectin (Siglec). This mediates molecules of sialic acid to perform differently. It directs what gets bound; the result is spleen macrophage response for chimps immune system works differently.

The chimp ligand (thing that binds to something) processing mechanism extends to how they metabolize estrogen and phyto-estrogen iso-flavenoids (like soybeans contain). They pass both ligands, like wheat lectins, and estrogens more fully in their urine than humans do.

For chimps a high fat diet causes less urinary excretion of estrogen, as well as less of the fragments of peptides from lectin ligands. To be precise high protein and high carbohydrate diets also diminish those metabolites % in chimp urine; just less so than high fat.

Dr Davis,

I have just found your blog because I have only recently begun searching for dietary info in order to guide me in rebuilding my skeletal muscle (and brain) after a so-far-11-month bout of severe adverse effects to a statin.  (When prescribed my readings were: Total Chol 297, HDL 117, LDL 165, triglycerides 73 – after 2 months of little exercise as the result of pneumonia and eye surgery.)

The widespread acceptance of the "Paleo" diet interested me greatly, because I independently came to some of the same conclusions several years ago.  There is, however, a big Something that I don't understand and that I haven't seen addressed.  I hope you can – briefly, I know – educate me.  Why such severe restrictions on carbs when they were so important in our survival?

The characterization of Paleo as high protein, high fat, low low carbs doesn't square with my college science courses and subsequent reading.  Early, early man would have grubbed around for whatever he could find, and, yes grubs would have been eaten were he lucky enough to find them, as well as other insects, wounded  small game, carrion, and fruit/berries/nuts.  Early man would also have discovered ROOTS and TUBERS very early on, and wild pea pods and the like, long, LONG before he was capable of running down game alone or in concert, or could even be sure of modest, reliable supplies of protein and fat.

And once he was a hunter, then what?  Not much fat on wild monkeys and stressed hooved animals (lots of other predators were after them, too), and one had to live between those perhaps widely spaced hunts that were successful and had to be shared.  More ROOTS and TUBERS – because fruit alone tends to leave you hungry for more (the fructose), whereas a nice raw potato, a few carrots, could calm the gnawing in the stomach.

Yes, I see that we now need considerable protein and a lot of fat (compared to current guidelines) because as we progressed  our expanded diet of increased amounts of protein and fat permitted our brains, especially, and our bodies to evolve to take advantage of such nutrients.  But I can't agree with the demonization of a large segment of our natural food supply.  Cut out grains.  I can see that.  But the sweet potato?  In the skin?  With generous amounts of butter gilding its fiber-rich goodness?

Why?

This may clarify, in their recent 2010 paper, M Konner and SB Eaton, estimate the ancestral diet (as % of daily energy) composed of
   35-40 acrbohydate,
   25-30 protein, and
   20-35 fat.
They comment that the carbohydrate source for “hunter-gatherers” (HG) was from fruit, vegetables, and nuts, not from grains. They go on to say that the reduction of carbohydrates to extremely low levels is not consistent with the HG model, but neither is a high-carbohydrate, “meat as a condiment” type of diet.

Konner and Eaton, both physicians, published their seminal paper on Paleolithic nutrition in 1985. The statistic above comes from their most recent paper of 2010. For those interested in how the popular interpretation of scientific research tends to “spin” the original detail, references to both their papers are below. Unfortunately, the 1985 article in the New England Journal of Medicine is restricted to paid subscribers only, while the recent invited article in Nutrition in Clinical Practice is available free online.

Eaton SB, Konner M. Paleolithic Nutrition: A consideration of its nature and current implications. N Engl J Med. 1985 312:282-289.

Eaton SB, Konner M. Paleolithic Nutrition: Twenty-five years later. Nutr Clin Pract 2010 25:594-606. http://ncp.sagepub.com/content/25/6/594

There seem to be a few anonymous people making posts giving their opinion about how this blog should be run. Some of their assertions remind me of the entitlement mentality ruining this country.

First, Dr. Davis is under no obligation to answer anyone's comments or questions.  How much do you pay to come here and read? I thought so.

Second, when he chooses to respond, understand it is taking time out of his day that could go to his medical practice, (Real clients who pay for his services) his family, or without knowing the man personally, his hobbies or other interests.  How much time do you think it would take to write an answer to each person who poses a question in the response section on this blog?  Keep in mind how much slower writing is than speaking! It would take hours.

Maybe it hasn't occurred to some of you that an answer to one person in the comments section won't be seen by very many people.  A much better use of his time is to write a short blog post at some time in the future that will be seen by many, and will be search-able, rather than answering the same question over and over again in the comments section.

It's not all about you, people. Get a life.

Worldinside, first, there's no one paleo diet. At certain times and places, like Cro-magnon Europe, the diet was nearly all meat. Paleolithic humans ate animals (snout to tail, not just muscle meat), fruit (in season), and, yes, tubers when they were available.

Second, probably unlike Paleolithic humans, many readers of this blog don't have normal blood glucose reactions to carbohydrates. As you probably know, carbohydrate consumption spikes blood sugar even in normal, healthy people. In people with diabetes or metabolic syndrome, eating a tuber can cause BG levels that can lead to organ and tissue damage. Overconsumption of carbs over a month in such people can lead to high triglycerides as well--not to mention weight gain.

While it's useful to look at how Paleolithic humans ate, we also need to look at medical science and keep our own individual quirks in mind. Humans need to eat protein. We also need to eat fat; we can't make essential fatty acids ourselves, and dietary fats have a unique ability to allow us to absorb vitamins A, D, E, and K. But there's no such thing as an essential carbohydrate (people who have hypoglycemia aside). Our liver can make blood glucose from protein. And just because something is natural and somebody else can eat loads of it, doesn't mean everybody can eat it.

Assuming your goal is longevity and health in old age, it doesn't matter what our hunter-gatherer ancestors ate, because they didn't live much beyond age 70, which is quite young by modern standards. Living to 100 and being healthy in your 90's is very unnatural, so it follows that those of us who want to live that long should eat unnaturally. All the evidence I've see suggests that being lean and conditioned is the way to go, regardless of diet, but that a mostly vegetables diet is most conducive to longevity. Eating mostly grains is also okay. Eating high-fat or high-meat is NOT conducive to longevity.

If you are not lean and conditioned, then first priority is to become lean and conditioned, and any diet which helps towards this primary goal is a good diet. Only after you become lean and conditioned do you really need to start worrying about diet.

… as always such enlightening comments …

In my neighborhood, it is generally accepted that the life expectancy at birth for preindustrial populations was 30-35 years. This was due not to the absence of older people but due to the extremely high infant and child mortality. Deaths overwhelmingly were due to infectious diseases that are now under control, more or less. With the longer average life spans came the advent of the diseases of civilization: atherosclerotic cardiovascular diseases, type 2 diabetes mellitus, chronic obstructive pulmonary disease, lung and colon cancers, essential hypertension, obesity, diverticulitis, and even dental carries. As of 2011, US life expectancy at birth is 78 years.

For sure, aerobic fitness is essential to health and longevity in the modern world however, medical science has demonstrated that many of the diseases of civilization would be minimized with appropriate dietary modification. Yes, the same medical science that we are throwing rocks at in the current “cutesy” survey of the AHA offered in this blog session.

One method of analysis in medical research is the examination of the Paleolithic diet supporting the discordance hypothesis that tries to explain that the mismatch in our modern diet from that what our genome has evolved is the cause of some chronic diseases. As an example, consider the modification of sodium intake. Studies of our ancestors diet estimates their sodium intake at about 800 mg/day, compared to a current adult average of 10,000 mg/day estimated by the WHO. Well-validated computer simulations predict that a reduction of 3000 mg/day (30%) in sodium intake would result in 40,000 to 90,000 fewer deaths from coronary heart and stroke each year in the US. On the other hand, moderate ethanol intake has been shown to reduce cardiovascular risk. Ethanol consumption was probably nonexistence before the invention of agriculture and not part of the paleo lifestyle.

No one has all the answers but blindly following any particular lifestyle or lifestyle advocate will probably not get you to a healthy 9th decade or simply a healthy older life. However, with a little luck and the judicious adoption of demonstrated healthy habits in fitness, nutrition, and lifestyle we all may get there.

I think the problem people have with The Heart Scan Blog is that they forget the doctor is referring to people who have metabolic problems. I've met many people who are fat and who eat potatoes and fruits yet keep their cals low and lose a ridiculous amount of weight. But at the same time I know people who, if they ate the same way, they would gain weight.

In general, the info on this blog is really good. Sure there are times where it seems that the doctor has recanted his hate of weight so much that he begins going after the most random stuff (i.e.. butter), but realize that this is a blog and that - as mentioned previously - everyone is different.

Closing anecdote: My grandfather is 94. He's incredibly healthy (runs a whole mango farm in Asia). His diet would be deemed bad by most of the people on this blog. He eats oatmeal topped with mangoes for breakfast, Hawaiian Bread with SPAM sandwich (because he's out on the farm), and he eats white rice for dinner. His cholesterol is perfectly fine. His heart is perfectly fine. In fact, the doctors are always amazed at how healthy it is.

So it goes to show, it depends on YOU. Do your research, see what info is out there, don't rely entirely on any one source of info. So a doctor recommended you a diet you don't agree with? Guess what? Go see another doctor! Just be sure you aren't going from one doctor to another until you hear the answer you WANT to hear as opposed to the one you NEED to hear.

Thank you to all the  Anonymousi, Lori and Revelo who replied to my question, especially the first responder.  I've downloaded the paper and am looking forward to reading it.  I was pleased to note that, as I believed, those early diets were pretty well balanced.

And thanks, Lori and another, for pointing out that this site is intended largely for people with CVD and/or metabolic disorders.  (That explains the every 15 min BG readings!)

I was not questioning because I was confused about which diet to follow, but rather, was confused by the way the term "Paleo" [diet] was being thrown around on this site by several commenters, as in "I've been Paleo for two months now and feel great.  No more carbs for me."  And I wondered if that was the site terminology for the diet plan envisioned by Dr Davis.

Revelo, I don't think I agree with your statement, " Only after you become lean and conditioned do you really need to start worrying about diet."  First of all, unless you've a metabolic disorder I think you should be mindful rather than worrying about your diet.  Second, I'm inclined to believe that once you're conditioned that's when you can stop worrying, if you were so inclined.  You've cranked up the mitochondria and they're working away at increased effectiveness even while you're not working out.

By the way, I used to love oatmeal in the morning.   Several years ago I started what turned out to be about two years of oatmeal for breakfast every single morning – with half and half or cream and brown sugar.  Then I stopped as suddenly as I had started.  I think my body needed something the oats supplied, and then it no longer did.  And I stayed slim all that time.  Now I don't touch fructose except in fresh fruit (Thank you, Dr Lustig), so no sugar either white or brown should I ever again get the oatmeal urge.

To all the "anonymous" posters-

After reading Dr. Davis' blog for some time now, I can assure you he will respond if the comment is worth his time.

General bad mouthing is rampant on a blog and if he spent most of his time refuting narrow minded opinions he wouldn't have time to be a cardiologist or write. So chill out or go elsewhere.

Also- his views aren't directed to just people with metabolic syndrome. It's for people who seem to be the American picture of "health" but are a ticking time bomb for diabetes, stroke, heart attack. His knowledge delves deeper than just a typical lipid panel (LDL, HDL, triglycerides).

People should know what they speak of, before the pop of at the mouth about topics they aren't well suited to debate.

Good post Dr. Davis.

Anonymous February 23, 2011, said "…. after looking it over following a very strong recommendation, I can say that I will not be back."

Thank you anonymous - based on your silly comment from which I took the quote, you have absolutely NOTHING to say. I am delighted you are going.

r Davis, thank you for yet another informative, intelligent post.

Some are not abreast of the science and how it is clinically relevant. A 33 year 14,000 patient study of Danes, published 18 Feb 2011 in Annals of Neurology, indicates Doc's insistance is well founded.

(In case you wonder why neurologists' data are relevant it is because 87% of fatal strokes are ischemic strokes. Now on to the science reported.)

Danes followed those with strokes over 33 years and found that NON-fasting triglyceride levels were more of an indicator than cholesterol level.
Specificly: women and men with over 89 mg/dl NON-fasting triglycerides had 1.2 times more stroke risk.

Doc's rants about blood sugar after eating, including butter induced spike, are in line with NON-fasting triglycerides being
a risk factor. He does detail
triglyrerides in other posts and goes into the VLDL mechanism too. My layman's focus on LDL & genetics overlooked what this blog clued me in to.

Laboratory lipid blood work shows the fasting trigylceride number. Doc pushes home test of
post-meal blood sugar since it is a surrogate of VLDL and NON-fasting triglycerides getting elevated (or not).

Non-diabetics, like me, think blood sugar science is for the other guy. Doc seems to be trying to hammer it home that it is relevant to some more of us.

Let's focus on coronary problems, like multi-vessel coronary disease, although it is all tied in to cardio-vascular "events". A meta-analysis of 20 studies covering 90,000 non-diabetics is worth summarizing.

Over 12 years those 90,000 non-diabetics' heart risk (multi-vessel coronary artery disease) correlated exponentially with both fasting and post-meal blood glucose levels. This was irregardless of the person not meeting the diagnostic criteria for being diabetic; and irregardless of "normal" fasting blood sugar, or even signs of glucose intolerance. In other words, the +/- 2 hour span of blood sugar dynamic is connected to cardio-vascular events.

(Multi-vessel coronary disease is when the left ventricle functions, but there is +/- 70% stenosis narrowing of blood vessel from plaque.)

European Diabetes Epidemiology Group's 2003 "DECODE" research shows that the interplay  of blood sugar and cardio-vascular risk can start even in the "normal" blood sugar range. The risk progresses in a linear
fashion, yet there is no specific point where can say individual has passed the point of no return into danger.

Again, the DECODE data's
significance is that post-prandial (after meal) glycemia, and to a lesser extent fasting blood sugar level, is relevant to cardio-vascular events even in some non-diabetics.

Non-diabetics can still share some of the 30 risky genes with type II diabetics and yet not become diabetic. We don't know which of us has what of those allelo-morphs (a.k.a. allele; a DNA sequence on a chromosome).

So, non-diabetics (specificly those with the alleles similar to diabetics) may have normal fasting &/or normal post-prandial blood sugar yet be at risk of a cardio-vascular event. Furthermore, non-diabetics with suspiciously elevated fasting blood sugar are thought to be manifesting one of those genetic SNPs (single nucleotide polymorphism, a.k.a. mutation).

Clinically 35% of diabetics have cardio-vascular events and 5 years later 35% of those go on to have a fatal incident. In comparison 24% of non-diabetics have cardio-vascular events, yet 5 years later 33% of those who share the risky allele(s)go on to have a fatal incident. In other words, everybody who took a first "hit" has virtually the same chance of dying; speculation is the non-diabetics who go on to die share the dying
diabetics risky allele(s).

Discussing what (say) grand-dads
eating habits is annecdotal; as is we non-diabetics assumption time won't alter things for us.
Many of us do not share genes with any diabetic risk, so Doc's "gluco-phobia" is irrelevant. He obviously
sees plenty, diabetic and non-diabetic, who come to him so they won't die unnecessarily.

For you who may live long enough to see routine testing, or doing research, here is a list of the 10 alleles most associated with European ancestry adult onset diabetes relevant to what was discussed above.

It bears mentioning that each may have up to 3 allele sub-variations for each risk
gene. In no particular order, they are:
FTO rs8050136, IGFBP2 rs4402960,
CDKAL1 rs7754840, HHEX rs1111875,
SVC30A8 rs13266634, PPARG
rs1801282, KCNJ11 rs5219, TCF7L2
rs7903146, CDKN2A/B rs10811661and rs93000039.

Wow. I see I enter a fascinating conversation.

In response to a question posed by Worldinside: The difficulty with carbohydrates differs substantially from person to person, based on 1) genetics, e.g., apo E2, 2) intensity of physical activity, 3) preceding lifelong carbohydrate exposure, 4) current weight and insulin sensitivity, 5) vitamin D status, 6) lectin content of consumed foods. There are other factors.

Point: There cannot be a one-size-fits-all approach to diet. This is one of the main reasons I advocate postprandial glucose checks, a means to assess a specific individual's carbohydrate tolerance.

And thank you, Eric and Terrence, for understanding that this is a blog and that I do my best to respond, given my time constraints. I've just finished a 10 hour day in the office, spent 2 hours starting in the early a.m. editing a new book (to be released by Rodale in fall). I now turn to website responsibilities until late tonite.

There's only so much you and I can fit into a day.

Can't wait for the new book, the first one was truly a God send.

Does it have a title yet?

I find this blog to be very helpful in sorting out what to eat and how it may effect me.  
I have increased the amount of Vit D and fish oil that I take daily.
He is providing a good public service with the blog for which I thank him.

Dr. Davis- I've been following your blog for a while now and always enjoy your posts! Informative for sure - both the posts and all of the comments.  Your sign off question gave me a good giggle.  Keep up the good work!


artsynina.blogspot.com

@Kent

You can read the already written chapers of the book if you log in to the TYP site: trackyourplaque.com.

This blog is always giving good information. This is really good health blog. This is also really good article.

The American Heart Association had always given good advice on caring for one's heart. It is up to us if we heed them or not.

buy pgx