I think it's kind of funny sometimes reading low-carb forums and recipe sites.

It's incredible how much time they spend on inventing all sorts of "gluten-free" or "low-carb" cakes, muffins, pancakes and all sorts of stuff that definitely doesn't look healthy even though it might technically be "gluten-free or low-carb".

These things surely aren't the real, wholesome foods that we need to be healthy. Like you say, good as rare indulgences though.

This is spot-on.

What are your latest thoughts on Einkorn flour?

I think the paleo/primal people have it right - remove all grains and processed foods.

Don't substitute a SAD for a GF SAD.

I started to heal when I removed gluten, but doing even better grain free and sugar free.

When i read the ingredients of a shampoo and hair styling products i saw wheat protein. Is this safe applying to my hair?

I started a Paleo/Primal version of tastespotting and while most people have submitted Paleo friendly recipes, I was really surprised at how many recipes we have had to reject because they were Paleo or Primal remakes of some kind of dessert or bread.

Hi, Kris--

I agree. A return to real, whole food is the right path.

Interestingly, I was recently strongly encouraged by an editor of a forthcoming book I'm working on to develop wheat-free, low-carb recipes. I also walked down this path, having to develop recipes that mimicked wheat-containing dishes.

After a 3-month exercise in cooking, cooking again, with several disasters along the way, I continue to believe that these wheat-free, low-carb dishes like "breads" and "muffins" are, at best, meant to be occasional indulgences.


Hi, Tuck-

Thanks.


Hi, Vick--

I continue to believe that einkorn is an interesting replacement for wheat for some, but not all, people.

It raises the question: Are humans meant to consume wheat at all, regardless of form? I believe that most people can get away with occasional consumption of einkorn, but that the majority of people cannot safely consume modern dwarf Triticum aestivum.

I classify einkorn not too far from gluten-free foods: it lacks many of the immunogenic properties of modern wheat, but it still a carbohydrate.

Ideally, I continue to believe that the ideal diet is something close to what Anne is articulating.

Doctor,
How often is "now and then"?

Personally, I eat a one or two small bread rolls on the Sabbath and that's the extent of my wheat consumption.  Does that count as "now and then"?

There are recipes for flax bread made from flax seed meal. Here is one example --
http://lowcarbdiets.about.com/od/breads/r/flaxbasicfoc.htm

I started using Coconut or Almond flour for the occasional dessert type dish with excellent results.

Problems though with making a sauce since there isn't a real substitute that thickens correctly. I rely more on home made-legal marinades for flavor.  

Now that I have been grain free since May, I find any exposure will cause intense illness that lasts for hours.

Hi, Ari--

Provided you have no abnormal celiac markers to wheat, occasional consumption likely has no adverse consequences beyond the "re-exposure syndromes" of gastrointestinal distress, asthma, joint paints/arthralgias, and transient behavioral effects.

There is no threshold to stay below except to individualize your exposure tolerance by such things as blood glucose control, expression of small LDL, triglycerides, etc. Most people can get away with one a month or so exposure.

Long time "listener" first time "caller". Dr. Davis, thank you so very much for all the info you provide here. I am a 42 yr old 4th generation Type 2 diabetic. Six months ago I largely gave up wheat (still have pizza on occasion) and it is the ONLY thing that has EVER dropped my A1c since diagnosis 7 years ago - despite adding medications, etc. It dropped from 6.9 to 6.6. I am currently under an endo's care and am shooting for 6.0 with some tweaking and fine-tuning. As a younger diabetic, I plan to live a long life with this disease so good control is vital to me.

I also wanted to thank you for the info on Vit D. I requested that test and found out I'm deficient - at 20 and 28 is the cutoff to normal. I know now that I had some pretty major symptoms of a deficiency - odd muscle pains, unexplained bone pain around January every year, etc. Not a huge surprise I'm deficient since I live in South Dakota and now coat myself in sunscreen thanks to basal cell carcinoma. My GP wanted me on the VitD2 horse pills to correct the deficiency but I refused. I raised it 8 points in 4 weeks by taking 1000iu/day of Vit D3 gelcaps (I metabolize meds extremely quickly so started small). Nobody could believe it. I did I am taking 2000iu/day now and shooting for a much higher, normal number.

Heart disease is the cancer in both sides of my family so your blog is a Godsend to me. Thank you so very much for the information you provide on this blog.

How do you feel about arrowroot as a thickener to replace cornstarch, etc.?

Hi doc

I have vit d level of 16 but blood calcium of 10. How much milk can i drink daily and what should be my starting dose for vit d

Prachi: Try
D3(IU) = Weight(lbs) * 40
For example, a 150 lb person would take 6000IU D3 per day. Works well for many people.

I have heard from others (on Dr. Bernstein's diabetes discussion forum) that Konjac flour works well as a thickener, without affecting blood glucose levels.

Hi,Jeanne--

Way too much carbohydrate in arrowroot.

Shottle makes a good suggestion: konjac root, similar to that used to make shirataki noodles.

I've got a question..it's not really germane to the blog post but here goes:  I've given up grains, only using natural organic products when possible, take CLO, and a myriad of vitamins including magnesium and all the rest.  I just started taking MK-7 about a week ago and noticed within 24 hours my blood pressure dropped substantially, my energy surged, and my mood has increased a ton.  Can I attribute this to the MK-7 or am I just experiencing a quasi-manic / placebo effect state?

Dr. Davis:

I see einkorn as a great choice when you feel you have a need for that slice of bread or waffle.  When you slip and feel you need a grain... choose einkorn.

I make a small loaf of bread that is sliced and then frozen.  It lasts my wife and I a minimum of 2 weeks.  

We treat as a good choice when we are going to fall off the wagon.

Hi Dr.D,
In your reply to Ari, you mention "re-exposure" syndromes. IMHO, these represent gluten or wheat intolerance and certainly excludes gluten in those testing positive for celiac.
However, even in the non-celiac gluten sensitive population, new studies show damage occuring to joints, increased risks of lymphoma,neurological changes, just as if the person was diagnosed celiac.

Cutting edge wisdom believes if you have any symptoms or re-exposure symptoms you should eliminate it before you either : 1. become celiac 2. develop an autoimmune disease, or 3. neurological damage.

BTW, I agree wholeheartedly with avoiding the gluten free food traps. SO many fall headfirst into them.

More people from the Celiac sites should read this post.

I've found this to be a highly pertinent article for me, gluten-free for four and a half months now. We recently got a new supermarket in town with a big gluten-free section, and bless their hearts, I had several friends tell me about it.

But going there and reading the labels reveals they are very high in sugar and starch; so as a happy low carber, they do me no good at all!

I've gotten a new mixer and am exploring the many ways of Rev Rolls, instead.

Tried to go wheat-free several times, but the withdrawls including insomnia, constipation, head buzz and brain fog, were hell and I gave up. Each time I ate gluten-free breads. Has anyone else experienced this?

I saw lots of people who are getting better after how many days because of gluten free diet and even sugar free. Most people are following the most recommended diet and its gluten free and dairy free.

I am not a fan of any drugs, and as a result, I change primary care physician regularly, usually after two visits.
ON THE FIRST VISIT, I explain to the new doctor that I do not, and will not, take prescription medications. I explain that the only reason I am in their office is to get orders for lab work, so that I can review the results and make my own decisions about lifestyle changes, especially diet. The doctor then calls me" non-compliant" and prints numerous computer-generated prescriptions anyway. Obviously, it is the doctor who is non-compliant, since I have already said I do not want drugs.
ON THE SECOND VISIT, the doctor asks, "Have you been taking your medications as ordered?" When I tell the doctor again, as I did at the first visit, that I do not take medications, the doctor says, "You're crazy and suicidal." I then find the next doctor, and the cycle starts over.
As I see things, I have two choices when I feel ill:
1. I could attack my body with some bizarre BigPharma chemicals that our ancestors' bodies have never dealt with in millions of years of evolution (Oxycodone, hydrocodone? Really? Are doctors nuts?).
2. Or I could get out of the way and let my body heal itself as has been done over many millions of years of evolution. All I want to do is support that process by making sure to give my body the proper nutrition in the form of the appropriate whole foods.

Wow, Jim. Creepy.

Don't despair: I'm confident that you will eventually find a healthcare practitioner who will act as your advocate, not a provider of drugs. It may take, unfortunately, going through quite a few practitioners before you come on such a person.

Great post. I am starting to think there are two kinds of people - those who seek drugs and those who run from them. LOL.
Among other occupations, I am an OR nurse. I have been wined and dined by the best reps ever, to buy their wares for surgery. It's all about the money.The drug companies have a lot to lose if we all quit taking their meds. Which is exactly what I want to do. I do not want to be a slave to a diagnosis and accompanying pill bottle. I want to be freeeeee.
This is not to say there is a time and place for medicine. There IS. But not for every sniffle.

Boy Suze, I can relate!  I'm a nurse as well and spent lots of years in NICU, but a change to chemical dependancy/psych was eye opening and downright disgusting in the amount of meds handed out.

I used to ask patients if they were hungry when dispensing a 6oz. Cup FULL of various pills before breakfast!
Couldn't take it and quit. Couldn't be a party to pharm management over real therapy.  I also take as few pills as possible, especially antibiotics.

Hi Doc,

I just visited my parents, and my mom shared her recent blood work with me.
Her cholesterol was a mere 210, and her doc (general practitioner), put her on a statin !!!
I told her about your blog a bit and particle size, but of course she's hesitant since her doctor obviously has more credibility than me.

Outside of eating better, what next steps should I advise her to take?  She agreed to request a cholesterol particle size test (is there an official name for this?).

Yes, N: Lipoprotein testing, such as NMR Lipoprofile or Atherotech VAP.

It really shouldn't be that tough, but we are battling the incredible ignorance in the primary care community who is spread too thin to master any one area.

The World Health Organization changed impaired fasting glucose levels from 6.9 to 6.1 in 1999.  The curve used to illustrate the incidence of diagnosed type 2 diabetes indicates a steepening at this time.  If data would have been collected for all patients prior to 1999 and utilized as a retrospective for type 2 diabetes in the population, the incidence rate prior to 1999 would likely have been significantly higher.

Very true, Dr. Davis.  Wheat consumption is up since 1970.  The strange thing is, it was much higher in the 19th century...something like 225 pounds per capita.

historical wheat consumption

Maybe we were eating fewer total carbs then, or expending more energy, if in fact the recent increase in diabetes is wheat-related.

I think since so much wheat is eaten in products that are mixtures of wheat, sugar, and vegetable oil, there's no way to know what the culprit is.

Well the reason is that wheat is the most important factor for our lives.

Hi, Anon--

Yes, indeed. Human life was different for at least rural people.

Also, wheat has changed. This is a crucial, crucial point that explains much of this phenomenon, I believe.

It would be interesting to plot diabetes rates against various possible culprits (pointing out on the graph when diagnostic cutoff changed): wheat, all carbohydrates, size of sodas, computer ownership, average size of restaurant meals, bicycle ownership, hours spent commuting, population older than 65, exposure to Agent Orange, service in Gulf War, and some really silly things like hair length and popular nailpolish colors.

If only wheat consumption seemed correlated, this would be suggestive.

Wre there ads for All Bran bars and wheat links on this site?

Wheat is ingrained in us, beginning with bread as the "staff of life."

correlation does not equal causation.

I don't eat wheat, I suffer from all of the problems you describe and it's also related to my psoriasis.  Good hypothesis with all your measurements of post consumption measurement of blood sugars, but someone needs to do a mass study.

The graph on this post is also very educational:
http://www.gnolls.org/1086/the-lipid-hypothesis-has-officially-failed-part-1-of-many/

The concentrations of zinc, iron, copper and magnesium remained stable between 1845 and the mid 1960s, but since then have decreased significantly, which coincided with the introduction of semi-dwarf, high-yielding cultivars.
at the same time
wheat breeding may have contributed to increased prevalence of celiac disease. and other conditions.
Perhaps other readers are not aware that MAGNESIUM deficiency increases iron absorption so there is increasing danger of Iron Behaving Badly and resulting damage to mitochondrial function.

Hi, Ted--

Great find!

I wasn't aware of these data. Yet another way that increased yield comes at a price.

Dramatic changes in the slope of a curve are easy to see if you're looking for them, but you've displayed an arithmetic, not a logarmitic axis.  Your point would be better made if you could switch the axis and if we still see the association between the variables.

Gretchen - Well said.

I think many things in our modern environment play a role in tipping the scales toward diabetes - including disrupted circadian cycles and environmental toxins, such as fire retardants, plasticizers, and pesticides.  (I don't have time right now to find links from stuff I've read on this - but try Googling these things - the research is there.)  

Jenny Ruhl claimed a short time ago that while prediabetes has risen, actual diabetes has not.  She is a good resource and I would take her arguments on most things diabetes pretty seriously.  Check her blog if interested:  Diabetes Update.  

As a mother of a kid with celiac disease, and for other reasons, I am hardly pro-wheat or pro-gluten, but I'm not convinced grains have caused a rise in diabetes.  My daughter's gastroenterologist, however, has Type I diabetes and says that eliminating gluten has greatly improved her glucose control.

When I eyeball this figure, it looks like the change occurs around 1993-1996.

Helen has a point that under counting of who is "pre-diabetic" is quite possible skewing the data. The CDC changed it's diabetes diagnosis criteria; 1985 wasn't when they did that however.

CDC took their raw 1995 - 1997 data and in 1998 decided to only use fasting glucose, and not the old standard oral glucose tolerance test, as the CDC diabetes template. For all individuals  whose data was showing greater than ( or equal to) 126 mg/dl fasting glucose they were then counted as diabetic by the CDC.

This methodology caused CDC to say U.S.A. diabetics went from 8 million in 1995 to 10.3 million diabetics in 1997; a statistically massive 2 year jump of diabetics. And furthermore, the number of un-diagnosed diabetics was claimed to have gone down (in same period of time); they cut out a whole slew of "pre-diabetics", so to speak.

The other criteria CDC website shows from 1998 is, that when non-fasting glucose hits 200  mg/dl (or more) they are considered diabetic. The reproduced graph Doc posted shows an exponential climb upward right at the time CDC  began using it's altered criteria.

"Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward."

As I look at the presented graph, from 1986 to about 1991 the trend decelerated slightly, then resumed its prior long-term value, then accelerated in about 1997

However, I must admit that 1997 is "after 1985."

Other suspects that became prevalent in the food stream in the 1980s were high-fructose corn syrup and artificial trans-fatty acids, both of which are linked to hepatic insulin resistance and metabolic syndrome.

I think of all the intelligent, scientifically-reasoned arguments all lead back to the commonsensical notion "Don't eat junk." To start, anything with enriched (aka processed) flour, partially hydrogenated oils, or high fructose corn syrup qualifies as junk. Which isn't to say all disease eminates from just those three ingredients, but I believe completely eliminating those three ingredients would yield a large health benefit to most Americans.

It takes years for type 2 diabetes to develop. A shift in the rate at which people are diagnosed with it would be caused by something that happened some time before the shift.

1960 to 1970 is also the time frame that chemical fertilizer came into the mainstream. On the farm I was raised on, along with chemical fertilizers came mineral supplements for the hogs that were living on the fertilized barley. They "failed to prosper" on fertilized barley, where they did just fine on unfertilized barley. By the why, fertilized barley produced over twice the volume of grain, and I assume the same mineral absorption. You can blame the grain, but I believe it could be the fertilizer.

@  justdoinglife
You can blame the grain, but I believe it could be the fertilizer.
Does early-life exposure to organophosphate insecticides lead to prediabetes and obesity?
Slotkin TA.

The chart for the growth of the national debt looks the exact same. I wonder if there is a correlation between the advance of socialism and the cultural ascendancy of the Lipid hypothesis? I'd bet the ranch that the destruction of American health and the destruction of the American economy is not a coincidence.

Duke university 2008 study fed new born rats 0.1 mg/kg body weight of the organophosphate pesticide parathion, for 4 days. When the rats were adults and fed a high fat diet they noticed a different response among the sexes.

In the adult females the high fat diet resulted in a 30% higher weight gain ( vs. high fat fed males' 10% weight gain) over controls (according to respective sex) on the same diet. This type of pesticide exposure to young children may be part of how obesity is rising; the standard western fare is high in generic fat content.

For the parathion early exposed adult male rats fed on a normal diet (ie: not high fat) the results also seem troubling. They gained weight, glucose levels rose, fat break down was inhibited and they were pre-diabetic; as compared to male controls.

Counter-intuitively, another group of male new born rats fed parathion at 0.2 mg/kg body weight (4 days) when fed a normal diet as male adults actually weighed less than their male controls. Whereas, the female rats (fed normal diet in this case) who got both 0.1 & 0.2 mg/kg parathion (4 days) all weighed less than their female controls. Mothers, don't try this at home.

Another culprit:

SSRIs.  Prozac was first marketed in 1988.  (It was not the first, however - some came on the market slightly earlier that decade.)  SSRIs impair glucose tolerance and are associated with an increased risk of diabetes.  

I think there are some modern-day smoking guns more convincing that increased grain consumption for increased obesity, insulin resistance, and risk of diabetes.  Although they are a neolithic food some of us may not be exquisitely adapted for, they have been around for 5,000 years, while the obesity epidemic is quite recent.

Hi Helen,
In 1938 there was a U.S.A. National Conference of Governmental Industrial Hygienists ; since 1941 the word national was replaced by "American" (ie: now is the ACGIH). 1946 the ACGIH set maximum limits on 148 compounds; which in 1956 became their "Threshold Limit Value", (TLV).

TLV is not saying "x" level is always safe; just what is supposedly tolerable exposure for most "healthy" adults. ACGIH lays their TLV data out for industrial hygenists to use in their field, not for laymen's general use.

2-butoxy-ethanol TLV (as a gas or evaporating vapor) is set at 20 ppm. This chemical is the favorite solvent in household spray and wipe cleaning products.

It makes me wonder if the U.S.A. adult female house cleaner suffers metabolic syndrome at a higher rate than other individuals. If so then might not close decades of breathing 2-butoxyethanol droplets have had/has epigenetic synergy?

1971 O.S.H.A. took 470 TLVs from ACGIH data and now calls those TLV by the phrase "Permissible Exposure Limit" (PEL). Meanwhile, as of 2010 there are 642 TLVs set out by ACGIH.

The European Union has a registry of 143,000 chemicals in use (or used); and there are +/- 50,000,000 chemicals known to exist (as per Chemical Abstract Service Registry). The EPA has more details; for searching if you're curios: www.epa.gov/grtlakes/toxteam.
pbtrept/pbtreport.htm

2012 the European Union is set to report on chemical testing of all chemicals manufactured in excess of 1,000 tons annually. You'll see that as data reported from "REACH" (Registration, Evaluation, Authorization and Restriction of Chemical Substances).

If you want to track down what chemical is in a product then search out the manufacturers "MSDS" (material safety data sheet). Some claim "trade secret" ingredients and then you can only guess on what is involved.

I love the triglyceride posts as I have been working on mine for a number of months.  Was well over 1000.  On low carb, virtually no grains, tricor (200mg), and a healthy dose of fish oil I was still at 233.  I am wondering if it will take my body/metabolism some time to heal before I can get lower.  As you might imagine I am sporting an HDL below 25.  I am working it diligently, have lost a ton of weight and get healthier by the day.  I should be sending Dr Davis a stipend for my improvement!

Dr. Davis,
please kick out of your spam filter the post I just sent on the 12th saying "Hi Helen,". It had resources for her interest in modern chemicals.

To Helen,
If my 12th post doesn't show up soon (2 days?) and you request it on this thread I will try to recreate it here. Maybe you've moved on to newer threads; I don't usually monitor old threads, but I will this for a few days.

Unfortunately, it doesn't seem like this ascent is going to slow down anytime soon.  Even if people in recent years seem to be taking a more health-savvy approach to their eating habits, it wouldn't be surprisingly to see this trend continue regardless.

Western countries have also seen a rise in sugar consumption along with wheat consumption over the same time period.

Taubes has just published a piece
"Is Sugar Toxic" and winds his way through diseases of Western cultures from sugar causing metabolic syndrome to sugar be implicated in cancer formation.
http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=1&_r=2&ref=magazine

No where was there any mention of wheat..I don't think we can isolate wheat as the primary culprit in Diseases of Civilization.  Wheat Plus Sugar, the double whammy.

The government advice to "eat more healthy whole grains" is not off-base.  But that's not what Americans did.  Instead they ate more fructose and replaced saturated fats with more polyunsaturated fats.  This is totally fundamentally different than eating a low-fat, high-carbohydrate diet like that of the rural Zulu tribe studied by T.L. Cleave or the Africans studied by Denis Burkitt and Hugh Trowell that were diabetes and obesity-free.  

Americans are still not even coming close to the grain consumption of a century ago, when such diseases were exceedingly rare.

This video is very good:

"Vitamin D and Diabetes-Can We Prevent it?"

http://www.youtube.com/watch?v=wTtmvMvgfl0

At this link you'll find the slides of a short presentation on
The Influence of high vs. low sugar cereal on children's breakfast consumption.
There are some surprising findings.

I found it at Cerealfacts.org website

The situation in the UK is much the same. The breakfast cereals most likely to find at discounted prices are those with the most sugar.

It's  often the case the choice of cereal going into the trolley is made by the child rather than the parent. There should be more restrictions on the promotion of pre-sweetened cereals to kids.

In my early 60s I notice that I don't get much "kick" out of sugary foods as I might have earlier.  I've gotten to the point where I can't believe the amount of sugar in say cookies or ice cream...which I no longer buy.  

I do now take several phyto-extracts...pomegranate...blueberry...cocoa...resveratrol...green tea...grape seed...etc.

Pomegranate at least has been shown to moderate insulin response and maybe reverse atherosclerosis.

http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=114814

Great post!
I've just blogged about my eating history too...  years of low-fat, high starch, high fruit eating led me to the brink of diabetes. I'm amazed I survived childhood!

Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? [Unless progenitor cells are also damaged...]

Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)?  It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it.

"Interesting, but this leaves out neogenesis within the pancreas. Assuming that glucose intake is reduced, wouldn't new beta cells be undamaged and have full functionality? "

That explains why my obese elderly mom has normal blood sugars even though she has always eaten diet high in simple carbs.

Dr. A, your previous diet was indeed low fat and starch based but there was not much actual, real food in it!  I am missing the connection both here on this thread and in your blog, between people eating manufactured, food like substances that don't have much fat in them and are loaded w/ refined/highly processed starch carbs w/ almost zero fiber or nutrients in them, and the eating of actual whole grains, either fully intact or minimally processed.

"Wouldn't this be more along the lines of adult onset type 1 diabetes (insulin dependent)? It seems like that is growing too but the real swell seems to be in Type 2 diabetes where you produce copious amounts of insulin but your tissues are resistant to it."

If you haven't already, check out Jenny Ruhr's blog, Diabetes Update, and her related website, Diabetes 101.  Type II is being subdivided according to short and long-term beta cell function and insulin resistance.  Different genes cause different impairments.  Emerging is MODY (mature onset diabetes of the young), or type 1.5.  A defining characteristic is that the ability of the pancreas to secrete insulin declines slowly over time, rather than suddenly as in type I, but it declines no matter what the treatment.

I am a Ketosis Prone Type 2 diabetic and it isn't necessarily true that glucose toxicity leads to permanent loss of pancreas functioning.

Typically, we will lose all pancreas secretion and will go DKA, at that point we are essentially type 1's. We need insulin to survive but after 2 to twelve weeks of normal blood sugars we can be taken off insulin and we will have near normal blood sugars.

Weird, yes, but there are thousands of us out there so this isn't uncommon.

Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus
http://www.annals.org/content/144/5/350.abstract

My blog has more information, if you are interested.

We seem to be severely intolerant of carbs so I too wonder what would have been the case, if years ago the carbs were taken out of my diet.

Michael Barker - your blog is fascinating. Thanks for the pointer. Will you be allowing comments?

What a great resource!

Matt Stone said...
"The government advice to "eat more healthy whole grains" is not off-base. But that's not what Americans did." The public were conned. Manufacturers turned whole grains into dust and formed the dust into junk. Because everything that was in the grain was in the junk, they called the junk "whole grain".

Sadly, this is what happened to me. I had glucose problems by age 15, but they told me for years I was fine. There was less information available in those days. I stopped all soda and junk, but it was too late, my fate was sealed. My pancreas and teeth were damaged. Somehow I managed to eat fruit without getting headaches years later, so I thought fruit in moderation was healthy. I though my fatigue was from my mercury fillings, but now I realize some of my fatigue was from fruit sugar. I blame society and my parents, although I forgive my parents. I was fed tons of soda and every type of high glycemic junk food you can imagine.

they also drink alcohol daily

I wouldn't entirely dismiss genetic factors to.

I believe the Japanese apo e profile may be better than caucasian (on average) --

A racial difference in apolipoprotein E allele frequencies between the Japanese and Caucasian populations

http://onlinelibrary.wiley.com/doi/10.1111/j.1399-0004.1986.tb01901.x/abstract

A bad Western diet may trump this genetic profile, hence why those who leave Japan/eat poorly still get heart disease.

But there could be some genetics in play too.

Bear in mind that the soy they consume is typically fermented, including natto, which is extremely high in vitamin K2 - MK7.

I just returned to the US after having spent the last 10 years there.  Some observations:

(1) While it is true that consumption of breakfast cereal or donuts for breakfast is exceedingly rare, virtually nobody under the age of 70 eats miso soup with tofu, fish, green onions, etc. for breakfast.  The typically breakfast for younger people nowadays is a fried egg, white toast, and coffee.  And lunch and dinner often includes white rice and/or wheat noodles.

(2) Contrary to what the first anonymous said, the typical Japanese does NOT drink alcohol everyday.

(3) Contrary to what the third anonymous said, most soy is consumed in the form of tofu, and only a relatively small percentage of Japanese eat natto on a regular basis.

(4) The amount of refined wheat products consumed by the average Japanese is large and growing.  For example, you will see a huge number of bread, cake, pastry, etc. shops in virtually every neighborhood in Japan nowadays.  Take a stroll down a supermarket aisle in Japan and you will see large amounts of goods made from refined wheat products (bread, cookies, etc).

(5) US fast food chains are ubiquitous and always packed with young people.

Based on the eating habits among young people I've observed there, my guess is that we'll be seeing an increase in heart disease to rival that of the US.

If Japanese consume K2 a lot, this might be big part of the solution to this enigma (since natto is the best source of K2 in the world). Calcification of soft tissues is one of the major CV problems and eliminating it from equation changes the scene.

I wonder what is the reference for "less sugary foods" claim.

It was the main issue in Alan Aragon's bashing of "Sugar: The bitter truth" video by Lustig. While I think that Alans review is junk, it has some interesting points, among others, the suspicious claim that Japanese people don't consume suggary food.

Japan Public Health Center 1990 dietary highlights for 40,000 men and women +/- 48 - 50 years old. All were without cardio vascular disease and had BMI of +/- 23.5.

The women:
calories/d = 1,227-1,491
rice gr/d  = 164-182
fish gr/d  = 31-54
% miso 3x/d= 18-33% did

The men:
calories/d = 1,910-2,344
rice gr/d  = 294-336
fish gr/d  = 38-66
% miso 3x/d= 23-46% did

Nationwide for Japan in 1990 3% of adults had a BMI of 30 or more (obese); and at that time, 20% of women plus 24% of men had a BMI of 25-29 (overweight).

Compared to 1960 statistics by 1994 there were 4 times the number of overweight adults; and the increase in overweight adults was higher among the rural population.
A Japan National Survey (exact year not in my notes) stated the average adult protein intake was +/- 60 grams of protein per day; with 1/2 of that protein coming from rice.

1. Re salt. I read an article recently showing that in people with diabetes, the higher the salt intake, the lower the overall mortality. This is only one study and might be a fluke, but it's interesting.

2. Re sugar. This is annecdotal. Many moons ago, in early 1960s when I was in college, I lived in a Coop dorm where we did all the cooking. One night a friend and I were trying to make a casserole that ended up bland, so we kept adding things to improve the taste. It got worse and worse, and there was no time to start over again.

Finally, when the rest of the dorm was nagging us to get the food on the table, we threw in a can of pineapple.

A student then said to us, "I hope dinner is extra good tonight, because I have a friend from Japan visiting, and I want to impress her." We were very embarrassed.

Afterward the Japanese woman came up and asked if we'd cooked the meal. We had to say yes. She said, "Oh thank you so much! This is the first food I've had in America that was sweet enough."

Now, maybe she was unusual. Maybe her family was adopting American tastes. But it's made me question comments about Japanese not eating sugar.

I suspect the key may be the amount of food consumed in meals. Those beautifully displayed boxes of food don't actually contain a lot. Maybe they like sweet things but don't eat a lot of them.

Natto is said to be more popular in the east of Japan, like Tokyo; and less popular in Osaka & Kobe regions. Here's the average natto consumption for select decades I have:

1960 =  0.45 kg/yr/person
1970 =  1.1 kg/yr/person
1980 =  1.3 kg/yr/person

Natto generally is sold in +/- 40 gram unit packets; so 365 days in a year x 40 gr. natto = 1.46 kg/yr/person , which would be the contemporary natto eaters intake. One gram of Natto +/- =  0.17 gr. protein + 0.14 gr. carbohydrate + 0.108 gr. total fat (0.016 gr. saturated fat) + 10 mcg. Mk-7 + 0.84 mcg. Mk-8 + 0.0072 gr. nattokinase +  0.55 gr. water.

By mid 2000s there were Japanese newspaper reports that the natto consumption was trending downward.
Apparently, the natto industry response was to make hybrid natto food products to attract the younger Japanese market.

I agree with Anonymous. Japanese people have begun eating lots of puffy white bread/pastries. It will take some time for this to be reflected in the heart disease stats.

I've lived in Japan for the past three years in southern Osaka. The claim that Japanese people (below, say the age of 60 or so) don't eat many sweet things is patently false.

There, I think, has been a huge shift in diet trends over the past generation or two, with the older generation still eating mostly as the article suggests, and the younger generations eating progressively more and more like westerners.

Most people I talk to consider fluffy white sweet bread (lots of sweetener in the dough itself) topped with extra sweet jam or jelly with some orange juice or heavily sweetened coffee breakfast.

Even some slightly more traditional dishes like sukiyaki are cloyingly sweet as prepared by most people, or if made from packaged mixes (fewer people can / are interested in cooking, especially from scratch, nowadays).

Another example that comes to mind is Kimchi. That Korean stuff is a tangy, spicy, fermented delight, white most of it found in Japanese supermarkets is filled with sugar -- sometimes even as the second or third ingredient after hakusai!

It's true, however, that the "heart healthy whole grains" message is largely absent here, and that there is really no fear of fatty meat (yakiniku!).

Regardless, the article flies in the face of what contemporary Japan actually eats; the article sounds more like a stereotype of what people ate just before or just after WW2.

Besides, the Okinawans have (or rather had) the longest life expectancy of all, and they practically revered pork fat! Pork, fish, sea vegetables, tubers, and veggies, is what their traditional diet is purported to be.

(end ramble)

Several commenters make the crucial point that the Japanese diet is changing. I agree: Western influence, from Dunkin Donuts to McDonalds, has infiltrated their culture. I expect that we will see the cardiovascular advantage of the Japanese erode over the coming decades. But the point remains: At least at one time, they followed a diet that likely provided at least part of the reason for their reduced risk for heart disease.

I am Japanese and, when we were kids, we lived on tofu, taukuan, rice, omeboshi, natto, and all the other foods from Japan that we could get from shops in New York. We did eat rice cakes containing sweet beans, but sweet was simply, at least in that period, not a prominent part of the diet. Salt was, however.

I would be interested to know what this dietary pattern consisted of since it was also associated with an increase in CVD:  "The 'animal food' dietary pattern was associated with an increased risk of CVD"

Stephanie A.

I have heard that they have a much higher incidence of stroke.  I'm not sure if this is true or not but I have seen data suggesting it is 5X as likely in Japan as it is in the U.S.  I have also heard that dying from heart disease is considered less honorable than dying from stroke.  There is some speculation that the Japanese diagnose death due to stroke at higher rates.  The two can be difficult to diagnose correctly.  Stroke and heart disease are the same problem.  I think their diet in general is less stroke/heart prone than the US but their arteries may not be as unclogged as the heart disease numbers suggest.

I'm another long-time Japanese resident. While taking care of my wife in the hospital here, I noticed what seemed like an epidemic of diabetes. So even without massive obesity, and without the same level of heart disease, the modern Japanese diet (toast for breakfast, lots of white rice) is having its effects.

Once again, I really believe it comes down to eating as many whole foods as possible while reducing the amount of processed products.  This article on the Japanese lifestyle coincides with my conviction.

We do not necessarily have to adopt the exact regimens they follow, but understand that the closer we align ourselves with whole, natural foods, the closer we will be to improving health.

"It's the small things in life"; seems worth noting, since we in the west overlook what we don't have a frame of reference for. A Japanese meal is traditionally accompanied by things we don't think much of.

Old style pickles ("Nukazuke") were food items embeded (buried) in a rice bran medium; the "bed" innoculated the pickles with micro-organisms. It could be interpreted to be a pro-biotic dietary practise. (I have an easy rice bran pickle recipe if anyone wants.)

Miso's many substrates, and some pickles (ex: eggplant; recipe on request) are made by embedding the substrate in Koji. Koji is usually rice innoculated with a fungus strain of Aspergillus oryzae.

Soybean miso is the most commonly known miso,in one form or another, in the west; people attribute it's benefit to what they know (the soy). Actually the koji is what lowers the per-oxidation of linoleic acid; and it is the koji fraction that provides the beneficial scavenger activity against our cell oxidants.

Koji in miso is infused with the fungal (A. oryzae's) tri-acyl-glycerol lipase gene and gluco-amylase pro-chymosin gene. It can make some of the miso substrate's medium chain fatty acids into a form we can absorb (ie: esterified); with  attendant anti-oxidant properties.

Oh, and those lectins in grains and beans people seem to disparage these day? Well fungi, like A. oryzae, have enzymes to break lectins down; so koji fermented foods enhance mineral bio-availability.

For east coast USA Koji and Natto contact "Katagiri" Japanes Grocery in N.Y.C. (on an east 70+ street, near Bloomingdales). For west coast USA bulk (35 lbs. box or six 1 lb. tubs box) white rice Koji contact producer  "Miyako" Oriental Foods in Baldwin Park (near L.A.). For Japanese cultures to make your own contact "G.E.M." Cultures, now in Wash. state. I have no financial interest in any venture; gotta go check on today's natto batch....

Why is more Iodine helpfull?

edit needed for my last comment above, see the 6th paragraph (next to last)....
Replace the word "lectin" with "phytates" ; and then the enzyme which fungi have are going to be a "phytase", the type of enzyme with ability to break down "phytates".

Rice consumption cited in one comment above clearly indicate that rice consumption has inverse association to increasing cvd. It again sugggest that increased consumption of other foods such as more animal foods, more fat, junk, McDOnalds, sugar etc, which probably replaced rice therefore increasing incidence of CVD.

@ Might-o...where can I get instructions. Do they come with the order? Or are you offering some here? I'd love to make some. Great post...again.

I have been here 10 plus years and even in that time I have seen a  visible increase  in the number of overweight and the recent  "Metabo"  metabolic syndrome craze.

Go to any supermarket: it's aisle of processed grains, snacks, cookies and cakes for miles.
Go to any convenience store and see one whole aisles of "Snack pun" - snack bread. This stuff is hideous. 400-600 calories of bleached white bread,  margarine and sugar rich fillings. Its essentially mostly sugar and this  kind of thing is replacing the fish and  miso breakfast. A staggering  large percentage of teens and young adults consider this a decent  breakfast or lunch.
As a teacher I frequently see  students buying two snack puns at the cafeteria  and that's their lunch.  1000  calories of basically sugar.
Instant Noodles are hugely popular and not helping either.
This current generation is going to  seriously dent  the  precedent of statistics their grandparents and great grandparents.

As for the good stuff, yes still more fish consumed on the whole than  elsewhere but huge amounts of grain fed overproceesed meats.
Seaweed- yes still about and definitely  beneficial and the ubiquitous onigiri is still popular, though  at the convenience store  the snack breads seem to rule in terms of selection these days.
An for grains have you seen the standard food pyramid in Japan? or the spinning top as it's called.
Very grain heavy.

http://www.mhlw.go.jp/bunya/kenkou/pdf/eiyou-syokuji5.pdf

More walking - much much more walking in Japan compared to the  USA has more to do with it I suspect!

The Japanese used to eat a lot less than us. I bet eating 2700 calories a day average of any diet ups your cvd risk.

What about chlorine in the Japanese water supply - do they use as much chlorine as we do in the US?

chlorine? A heavily industrialized nation like Japan? you better believe it! but it  does vary to place to  place.
Some cities  it's like the water is coming straight out of a swimming pool.
The tap water is ok to drink after some basic filtration.

Hi rhc,
I am not selling anything; the sources for specialty items are all places I have bought from. If you can't track them down online then I'll get you contact details; assuming Doctor Davis doesn't object.

To make your own Natto it is really easy. Koji making involves more steps, but there are a lot of different things you can do with it.

Rice bran pickles are the simplest of all to crank out daily, once your rice bran "bed" builds up it's microbial flora. The rice bran "bed" needs to be stirred (ideally)daily to keep funky microbes from taking over; but if you put some (say)veggies in the rice bran bed you can hand stir it then and enjoy those "pickles" later the same day. Sacks of rice bran are sold in many Japanese groceries (like Katagiri) and I've used "Bob's Red Mill" brand rice bran (health food store/mail order).

G.E.M. Cultures is now run by Gorden E. McBride's daughter up in Washington state. They mail order the pure Japanese Natto spores I've used for years and send instructions a novice can follow. (I have some incubating now at +/- 105* Farenheit in a covered dish set up over a scrapped food dehydrator's heat coil base.)

G.E.M. also provides the culture for making Koji; they actually have several Koji strains, depending on what end product you want to make - instructions always are included. To make white rice  Koji from scratch you want to be able to get "sticky" white rice (ex: "Hakubai" or "Wel-Pac" Sweet Rice, from JFC International) and steam cook it.

G.E.M. also sells the already innoculated Koji and a little bit doesn't really go very far except for experimenting. Miyako Oriental Foods is a modern Koji "factory"; they sell rice Koji (and Miso) to places like Katagiri in individual tubs under the label "Cold Mountain". Koji has a very long shelf life (dry stored, no direct heat), so refrigeration is not absolutely essential.

For those who have lived in Japan, do the Japanese do any formal exercise? walk a lot?

It would be interesting to hear your thoughts on French diet as they too have a much lower incidence of heart diseas( not as low as Japanese), but their diet is western oriented.  My guess would be lack of sugar, junk food, and minimum Omega 6 intake.  They do eat wheat, but not in quantities similar to those in U.S.

@ might-o... Thanks so much for the additional info. I've printed it all out and will start investigating the sources and processes.

@ Steve:

http://wholehealthsource.blogspot.com/2010/11/observations-from-france.html

http://wholehealthsource.blogspot.com/2010/05/does-red-wine-protect-cardiovascular.html

http://www.vinopic.com/index.php/roger-corder/roger-corder-intrinsic-quotient#red-wine-quality

Cheers!

The body's internal ratio of Magnesium (Mg) to Calcium  (Ca) in East Asia and the USA
typically differ; with African Americans having even lower Mg % than their caucasian countrymen. Specificly the East Asians statisticly have/had more Mg relative to Ca; and conversely Americans had less Mg relative to Ca in their bodies.

The Japanese living outside of Japan (or those eating more like the west inside) Japan could be having less Mg %; this could explain several things. Low Mg is implicated in inflammation, insulin resistance, metabolic syndrome & Type II diabetes; 2000 data for U.S.A. showed 79% were below MDR Mg.

In other words the American diet supplying much more Ca in relation to more sparse Mg creates a ratio, that in the body is involved in the dynamic of pathological development. Ca is not "bad" in itself, but in the context of too little Mg the inflammatory underpinning of many diseases wrecks havoc (ex: coronary heart disease, insulin resistance, Type II diabetes, etc.).

Ca has systemic roles in signalling for various cell cycles. Mg plays a role in (among other things) DNA repair and lowering insulin levels. Special gut ion uptake channels  with the gene TRPM 7 (transient receptor potential melastatin) regulate Mg.++ balance; shear volume of Ca++ can interfere with that ion channel taking up the Mg (Ca & Mg ion charges tend to compete).

One researcher thinks the really low Mg to strong Ca ratio explains the African American susceptibility to more coronary events. Maybe this Mg:Ca ratio explains some (not all) of the  data showing Japan has/had less heart disease; and also a big factor why Japanese in the west are/were relatively more prone to heart disease.

Might--

Fascinating detail on the organisms used to ferment!

I'm also quite impressed that you can actually eat natto. Even though I was exposed to it by my Mom as a kid, I still can't stomach the stuff.

The Birth Control Pill only recently became legal in Japan. To me it points to the sudden increase in heart disease among Japanese women.
~ Sue Ek, BOMA-USA

Physical activity is more fundamental than diet.

East Asia = 1 Magnesium  per 1.6 Calcium
U.S.A.    = 1 Mg. per 2.8 Ca
Of course, those are statistical generalizations of vast regions of people. One researcher speculates the "American Heart Healthy" diet benefit, of eating more whole grains, might be due to their extra Mg.

Meta-analysis of adult women taking Ca supplements may provide another clue. For every 1,000 women taking Ca supplements over 5 years time there were 6 extra heart problems (strokes and infarctions); while for the same scenario (1,000 over 5 years) the Ca supplementing only prevented 3 fractures.

That analysis went on to speculate it is not the exact dose of Ca that mattered; since the risk factor went up whether taking less than 500 mg. Ca or 1,000 mg. Ca. daily. The theory proposed was that it was the 5 years of abrupt blood Ca loading that created the risk.

Data was that (with Ca pill) the risk of myocardial infarction
rose 25 - 30 % and the stroke risk rose 15 - 20 %; with obese women having less fatal events than their non-obese counterparts (more tissue mass to stash the Ca load ?). If wondering, the addition of vitamin D to the Ca supplement seemed not to be a factor in mitigating or increasing the risk.

If the Ca supplement implications
(women only studied) are suggestive and we add to the body equation a poor base line Mg ratio to Ca maybe this explains some of the historical pattern of heart disease. America went in big for non-whole grain food and favored dairy (ie: Ca)in the post-wars 1900s; Japan during that same epoch wasn't big on milk and had (in theory?) better Mg. intake ratio.

Interesting how many readers have lived in Japan. My wife is Japanese, so I have some first hand experience, besides living there for a ferw years.

Not mentioned so far is the close and cohesive social network that most Japanese enjoy. While in Okinawa I saw lots of old people gathering daily, doing things together, playing games, ball, eating together and generally share the news and gossip. This kind of social web is heart-protecting. We know from studies that loneliness and hostility is detrimental to cardiac health. Possible physiological mechanism: Stress hormone Cortisol would go down, Oxytocin would go up.
Another factor: "Hara hachibu", this means literally "Stomach 80%".
It refers to the habit of filling your stomach only 80% and not 100%. Thus eating less and therefore practicing a mild form of caloric restriction, which we know, is clearly life extending.  
In all, I think it is a mix of everything mentioned here and each part is contributing.
Renfrew

Might-

I couldn't agree with you more about the calcium/magnesium link to heart problems.  I've thought that for years after doing a minor study of magnesium related issues.  In fact the clear implications of magnesium deficiency is astonishing. When you consider the large number of processes that it is responsible for and the lack of it in the American diet it becomes increasing obvious that it has a very important part to play in all of this.

Marc

My sister lives in Japan, and she sent my kids some Japanese Chocolates for Christmas. The Japanese Chocolate was not nearly as sweet as American Chocolate. I think Americans have a problem with moderation. We want to much of a 'good' thing. The sugar in Japanese chocolate is just a small example, but could be an indicator that there are small differences in everything they do that add up to make a difference.

Dr. Davis,

I note that in your post you OMIT the fact that the staple food of the Japanese is rice, and that carbs traditionally comprise 80% of the Japanese diet.

Stop lying to and misleading people about carbs and weight gain.

You and I are on the same side about sugar and refined junk carbs.

OK?

Diana, I note that in your post you OMIT any links or proof that the Japanese eat an 80% carb diet. If you are going to make statements and claim them as "fact", you need to prove them. Otherwise, it's just your opinion.

If I eat much rice my blood sugar goes way up.  Did that happen to Japanese on the traditional diet?

The Japanese eat seaweed.

It can't even be said with 100% certainty that the high amont of salt they may consume is bad.

Very interesting point! Yes, he did not mention rice, but the other components are all very good for you. Great posting, Dr.

Gosh, I wish I would have had that infrmoation earlier!

And I was just wnodeirng about that too!

IJWTS wow! Why can't I think of thgins like that?

To think, I was confused a mtinue ago.

In visiting France (Cannes and Paris), I noticed that there is a focus on fresh (whole) foods everywhere, and I mean EVERYWHERE.  Only in highly populated urban areas did I see availability of processed snacks and junk food.  Fresh vegetables and free-range meats were what i found.  Most importantly, the portion sizes were small (similar to Japanese).  Though they did eat numerous times through the day, portions were small.  Sweets are big in France, but no one ever over-indulges.  They take the time to savor and enjoy their sweets from a patisserie or cafe.  It''s their food culture from the ground up that has led to their long lives and, quite frankly, very attractive frames.

I am a bit confused by the mention of soy sauce......Kikkoman ingredients read, "Water, WHEAT .........."  thought the idea was to stay away from wheat