It's too bad that there is not a randomized, controlled trial to show the superiority of this strategy.  

Aside from assimilating scattered studies with surrogate endpoints, what would it take to definitively show that this strategy actually does improve cardiovascular morbidity and mortality?  

If Dr. Davis can convince many in the "thinking" public, surely someone in the health care industry or NIH would be interested in pursuing this.

Magnesium and Chromium are also important minerals.  Neither are particular common in most diets.  Perhaps, they would fit into a top 10 list.

I think regular testing is the most important strategy. If your tests come out okay, then there is no reason for anything else. If the test show problems, then address the problems in a methodical.

Many people don't appear to have any problems with wheat. I'm 50 and spent perhaps 10 years in my 30's getting most of my calories from pasta, and another ten years in my 40's getting most of my calories from oats. I was never more than 10 lbs overweight and I haven't visited a doctor in 30 years, other than for an ear wax buildup about 20 years ago. My test scores recently were good and I have good glucose tolerance according to the glucose monitor I recently bought (reli-on from walmart).

The reason I started investigating diet issues is that I felt lousy during two months on the Appalachian Trail this past fall. My diet on the trail consisted of nothing but a pound per day of instant rice and another pound of dry-roasted peanuts plus a multivitamin, and then a gallon of ice cream and a package or two of cookies and maybe some candy bars and cheese whenever I stopped off at town. Like most of the other hikers, my problem was not gaining weight but rather losing too much. Those binges on ice cream made me feel very sick afterwards. I began to have cravings for oats, which I think helps to keep the blood vessels clear. Now that I've gotten back to civilization, I've been eating lots of vegetables and oats and my blood pressure is typically under 100/70 (I bought a sphygomanometer as soon as I got home from the trail and my initial BP was 120/70). I think people who exercise as much as a typical backpacker have no problems with complex carbs. A gallon of ice cream and a full package of iced oatmeal cookies at one sitting is another story.

I found this blog after a search in April 2008 because my Fasting glucose had broken 100 (105) and I was worried I would end up a type 2 diabetic like my 90 year old dad. I began following the advice here: almost no wheat or grains, little sugar/fructose, added 8000 Vit D3, 12.5mg Iodoral, 2800mg omega-3 fish oil.  Now, my fasting glucose is 97, my Vit D went from 13(!) to 75.  I quit my statin and although my LDL went from 111 to 135, my HDL went from 60 to 74 and Trig from 108 to 62.  Lost 10 lbs without trying and now need to wear a belt.  The only thing I can complain about is my BP seems to stay around 130/74. Otherwise I'm convinced. Thank you, Dr. Davis.
Jay in CA.

Hi Dr. Davis

i've looked around your blog but did not find information on buckwheat flour, chickpeas flour and water chestnut flour.

i understand they are safe for celiacs to consume but how far are they consistent with the heart-good diet i've picked up from your blog so far? e.g. consumption amount per day if they are fine? things to watch out.

Thanks

revelo,

Have you had an NMR lipo test done? By your own description, being on such a high carb diet, your LDL particle numbers might shock you.

And don't fall into the same trap that most prototypical thin men fall into.  Just because you are thin and active does not give you a pass on following these strategies.  Look at this blog post by Dr. Davis:

Here's the prototypical male with lipoprotein(a)

"Several features stand out in the majority of men with lipoprotein(a), Lp(a):

Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

Intelligent--Above average to way above average intelligence is the rule.

Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

I would recommend Nordic walking as an exercise.

Do you have information about the interference of wheat (or other neolithic pathogens) on thyroid-function? I would guess that either phytates hinder the absorbtion of iodine (both in humans as well as in animals we eat), or that gluten/gliadins/etc directly interfere with thyroid function, or trigger an autoimmune reaction (or all of the above...).

And from an similar area: You don't know by chance of any papers linking wheat with adrenal-gland problems?

Hi, Andrew--

In fact, I contemplated a "six strategies" that included magnesium.

I agree: magnesium is indeed near the top of the list for heart health.

Hi, Jay--

Good news: With the favorable changes you've witnessed, the calculated (or what I call "fictional") LDL cholesterol increases, while the genuine measurement (e.g., NMR LDL particle number or apo B) drops.

Of course, don't count on your friendly drug company to tell you this.


Hi, Tony--

The only connection I know of between wheat (gluten, in this case) and thyroid disease is that wheat exposure can activate (or at least be associated with) Hashimoto's thyroiditis, i.e., thyroid gland inflammation.

dr davis,

are you saying wheat mainly, that other carbs could be eaten and still some benefit could be had from just omitting wheat from diet?

What kind of magnesium is best for those who have the old "Phillips Milk of Magnesia" effect with normal magnesium supplements?

This is craaaaazy!!! Four days ago my BP was 150/100- I took your recommendations to hear, along with other supplements (whey, blueberries, coQ10, magnesium, olive leaf) + low carb + exercise and my blood pressure has dropped to 129/90. I cannot believe this.

What is most incredible is that all docs said my BP was 100% genetic and there was nothing I could do (probably b/c i'm thin and young).

I am blogging my progress. The goal is to get off that goddamn atenolol once and for all.

Here's a rundown of what I am doing. Any advice from anyone would be super welcome.

http://superhighbloodpressure.blogspot.com/p/details-of-experiment.html

BTW the one thing I am NOT doing is supplementing with iodine. Is this necessary? How does one know if thyroid function is wack? Any recommendations on what type of iodine to take?

You ever tire of your Sisyphean struggles, Dr D? Many people in the medical industrial complex simply do not give credence to your findings.

For example, I shared your point #1 (re wheat) with a research pathologist friend -- yes, the same fellow whose knowledge you believe might be circa 1985 -- and he said...
"The statements that you list are at best applicable under select circumstances.  I doubt there is any scientific evidence (study in a peer reviewed journal) to support your claims. If you stop eating, your triglycerides, weight, and  LDL will go down, nothing to do with stopping wheat. Similarly, in >99% of individuals, CRP levels are not related to diet, especially wheat eating. The only time eating wheat would make a difference is if you cannot tolerate wheat for any reason."

Which brings me back to my opening question. "Peer reviewed journal"...? I mean, c'mon, that is akin to waiting until everyone is bullish and owns a stock before you finally buy.

I found this abstract (with relation to celiac disease patients - poor bastards):

The American Journal of Gastroenterology (2001) 96, 751–757; doi:10.1111/j.1572-0241.2001.03617.x
Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study
http://www.nature.com/ajg/journal/v96/n3/abs/ajg2001173a.html

OBJECTIVES:
Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function.

METHODS:
A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies.

RESULTS:
Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later.

CONCLUSIONS:
The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.

You want to know, how to make exercise fun: check this one out: http://www.youtube.com/watch?v=2lXh2n0aPyw

Dr Davies

What do you think about consuming the Swedish innovation Oatly (trademark) that is a special  oatmilk with an elevated amount of betaglucans?
Professor Rickard Öste has developed this type of oatmilk.

Thank you for your efforts and blog.

RE Omega 3s, you recommend fish oil.  Is that preferable to getting Omega 3s from walnuts and ground flaxseed, both of which I understand to also provide Omega 3s?  Is there a benefit to fish oil vs. these other options?

Thank you.

Tom

Hi, David--

Great points.

Perhaps your pathologist friend should consider spending some time with the living.


Tom--

Those are two different things. Walnuts and flax do NOT provide the same effects as the omega-3s from fish, just as the oil in your car's engine cannot be used to be put in the gas tank. Two different, though related, things.

Ok, got'ca on the wheat, but what about oats? Same deal, or are they OK? I can cut out wheat without any problems, but I do like my oat porridge... ;)

Niacin was near the top  of your protocol list earlier.  Has this fallen out of favour?  Or is it just the insurance abuse which keeps it off the list?

I have recently been diagnosed with wheat & gluten IgE sensitivity.  So I will finally stop resisting the #1 rec.  After 4 days I am seeing some changes in eosinophilic esophaghitis, gingivitis, and rhinitis.

Oatlover?

Oats are an entirely different issue. They cause blood sugar to skyrocket.


Steve--

The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably.

I'd put a caution note for the fish oil, we now know some of us get very bad opposite effect.

Okay, I'm not really that hung up on oats. But oat porridge is a main staple of mine. I'll take your advise and cut out wheat and oat for at least a few weeks and see what it's like.
I'm healthy and have no heart problems or blood sugar issues of any kind, but as I'm not getting any younger (about to turn 40), I'm hoping to prevent any future problems by finetuning my diet.

@Oatlover,

I had been eating oats as part of what I thought was a "healthy diet," but stopped when I started tracking my blood glucose and watched it consistently soar afterwards. I found oat bran had the same effect on my blood glucose. Since giving them up, I no longer get the light-headed tired hunger that used to force me to take lunch early. Since giving up wheat as well, I've never felt better.

Well wishes for your trial!

Dr Davis,

What you mean by: The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably?
What is the relationship between wheat/corn starch and sugar and niacin dosage?
Is a lower dose of niacin efficient when wheat/corn and sugar are eliminated?

Stelucia

Here is the conventional wisdom of max 1,000 IU Vitamin D via the NYT: LINK

BALANCED DIET

Some time ago, I decided to try to understand the origin of the phrase "Balanced Diet". After a lot of Google searching, I landed on a page that sketched out the use of the term, and have since lost the link.

The term became popular, evidently, in about the 1920's and it was associated with the rapid discovery of many vitamins in foods. At that time, vitamin discoveries would seemingly pop up out of the blue.

One writer, the first in a chain, remerked that "under the circumstances (unknown vitamins lurking in the food supply), we should therefore eat as broadly as possible so as to take in as many potential vitamins as possible."

"Balanced Diet", under this interpretation, arose out of dietary ignorance, not dietary fact.

I understand that you don't like wheat and other grains.  Are beans good or bad?  

Yes, they are carbohydrate, but they're low glycemic index.  Are they a food which both anti-grain and USDA pyramid can agree are good, or do they have a down-side (other than gas)?

Could you replace wheat with oats or other grains?

For that matter, how about quinoa or polenta?

Thanks.

Hi, Ari--

No, no, no, and no.

These grains increase blood sugar to high levels in the majority of adults.

I will be discussing such grains in an upcoming post.

Hello DR WD.

Today I have for the first time read  "The Heart-Scan Blog" and was interested to read of your recommendations as to the five most powerful heart disease prevention strategies.  In my case "prevention" is a little late in the day since I was diagnosed with severe Congestive Heart Failure  in the autumn of 2008. My EF at that time was just 15% to 20% and a considerable area of the heart muscle was  a-kinetic.   Although the usual heart drugs were prescribed,   after a few months of feeling lack-lustre and devoid of energy, I decided to stop taking them and instead changed my diet and supplemented,  primarily with Ubiquinol. From barely being able to shuffle 20 metres or so I now readily walk about 4 miles a day. The diet  has seen one or two changes along the way but has  for the best part of the last two years been grain free. Lean and fatty meats and eggs by the dozen  are consumed  each and every week  as are lots of vegetables  and  oily fish.  Coconut oil, natural sea salt,  apple cider vinegar,  turmeric, cayenne pepper and Italian tinned tomatoes  all go into delicious home-made salsas that spice up the blandest of vegetables.   Processed oils are avoided but raw butter enjoyed without any restriction whilst  British, French and Swiss unpasteurised cheeses   figure strongly on my menu. All I can add is that on that diet I feel wonderfully reinvigorated.

Now we know who the sesinlbe one is here. Great post!

I had no idea how to approach this before—now I’m locked and leoadd.

tGQ3Jq  onymtvlhovpl

I found just what I was needed, and it was entertianing!

Alaakzaam—information found, problem solved, thanks!

Fantastic, Dr Davis!  I read the article earlier today and was thinking of sending in my own response but yours is ever so much better and comes with greater credibility which is important.   I hope they publish your letter.

Thanks, HS4!

But don''t hesitate to add your voice. The more they hear this message, the more likely others hear it, too.

There were some comments in past postings regarding ancient vartieties of wheat, such as Emmer and Einkorn. Although these types still pose problems from a total health perspective I was thinking perhaps an original form of barley might also provide better health benefits with less metabolic damage than the newer varieties.

There are recipes where the addition of grains in relatively small amounts can improve texture and flavor and I have used barley for this purpose extensively in the past.


Are ther sources of information or supply of older or alternative forms of barley?

Go Doc!

I would like to know if Dr Davis would be interested in doing a 30 min tele lunch and learn workshop, we own a wellness company with 000's  of users on our health portal.  It would be a great way to promote his books/blogs.

[...] wheat from your diet. Give it a try for 2 or 3 weeks and see how you feel.    Here's why:  My letter to the Wall Street Journal: It’s NOT just about gluten | Track Your Plaque Blog  "1) The gliadin protein of wheat has been modified by geneticists through their work to [...]

[...] I'm suggesting.   What about WHEAT?  Wheat has been a Frankenfood for the last 40 years, bcfromfl:  My letter to the Wall Street Journal: It’s NOT just about gluten | Track Your Plaque Blog  "1) The gliadin protein of wheat has been modified by geneticists through their work to [...]

Dr Davis,

I believe you have it reversed when you say: "Using these values, 10.9% of participants taking the higher dose of drug experienced an event, compared to 8.7% on the lower dose..." According to http://www.cardiosource.com/clinicaltrials/trial.asp?trialID=1255

"The primary composite endpoint of major cardiovascular event occurred less frequently in the 80 mg group (8.7% vs. 10.9%, hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.69-0.89, p<0.001)"

Where can I find the re-analysis info vis-a-vis the HDL levels of the trial participants?

Thanks!

Thanks for pointing out the mistake.

The reference:

Barter P et al. N Engl J Med 2007 Sep 27;357(13):1301-10. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events.

However, when the groups were re-analyzed by HDL cholesterol levels, higher HDLs remained predictive of less heart attack and other events, with the group having the highest HDL of ≥55 mg/dl experiencing 25% less events. Most interestingly, this effect was upheld even in participants with very low LDL cholesterols of <70 mg/dl.

Thank you Dr. Davis.  Your efforts on behalf of patients are very much appreciated.

I wondered if you would be willing to submit a comment regarding the new USDA guidelines for food intake.  Your experiences with improving and reversing heart disease using diet (cutting out wheat, starch and sugar, etc) are very important.  People like McDougall are still pushing the low fat vegan approach and being listened to, and the members of the committee are all low fat dogmatists.  I think your experiences as a practitioner would hold more weight than anything I could say (though I submitted my two cents anyway). See http://www.cnpp.usda.gov/dietaryguidelines.htm to submit comments.

Thanks again for your efforts.

Cynthia

At the least, we should ask that the recommendations be based on research and not industry demands.

Jeanne

Regardless of which of the three motivations was at work here, they're all inexcusable. A disservice was done to this man: he had an unnecessary procedure, incurred some risk of complication in the process, and gained nothing.

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