This is very good - just mixed up a large glass full (minus the flaxseed).  And, that's my question, do you use finely ground flax seed?  I also tossed in a fist-full of blueberries - should be able to tolerate them well; I just had a very intense resistance training session

I'd love to see more recipes for some ideas.  I disagree with those who wrote in on the earlier post, characterizing smoothies as "not real food."  I'm a big fan for time-challenged mornings and post-workout nourishment.

Bill

I can't believe you passed up a perfectly good opportunity to embed a cheesy 80's Reese's commercial in this post.

http://www.youtube.com/watch?v=DJLDF6qZUX0

Anon--

Yes, I used a finely-ground flaxseed.

The berries are a great idea, provided quantity is small.

Just a cautionary note -

Sucralose/Splenda can have severe reactions.

I seem to respond/react to things severely.  Sucralose has caused both allergic reaction (swollen mucus membranes) and severe migraine for me.  In fact, as a frequent migraine sufferer (tho much less now that i've removed gluten and sulfites), the migraine i got from sucralose was by far the worst i've ever had.  

Personally, i am of the belief that if it effects me so strongly, it is probably not good for anyone, but the damage it does is much less pronounced in other people.

I stick to stevia for a no-calorie sweetener.

http://jstevens.wordpress.com/2008/02/20/how-sucralose-aka-splenda-is-made-and-why-you-want-to-avoid-it/

"How Sucralose (aka Splenda) Is Made And Why You Want To Avoid It

...I wanted to comment on Splenda.  Splenda, also known as sucralose, was created accidentally when some chemists were trying to produce an insecticide.  Here is the process by which they produce the formula sold in stores:

“1.  Sucrose is tritylated with trityl chloride in the presence of dimethylformamide and 4-methylmorpholine, and the tritylated sucrose is then acetylated with acetic anhydride.

2.  The resulting sucrose molecule TRISPA is chlorinated with hydrogen chlorine in the presence of tolulene.

3.  The resulting 4-PAS is heated in the presence of methyl isobutyl ketone and acetic acid.

4.  The resulting 6-PAS is chlorinated with thionyl chloride in the presence of toluene and benzyltriethylammonium chloride.

5.  The resulting TOSPA is treated with methanol in the presence of sodium methoxide to produce sucralose.”  (Note that methanol, wood alcohol aka paint remover,  is one of the questionable ingredients in aspartame.)

In addition, the bags and packets of Splenda commercially available are not pure sucralose.  They also contain bulking agents.  All artificial sweeteners use bulking agents.  Do you know what they use?  Sugar.  Dextrose, sucrose, and maltodextrin.  (Maltodextrin is corn syrup solids composed primarily from fructose and glucose in a starch form.)   All sweetener packets are at least 96 percent sugar.  Splenda is 99% sugar.

The packets are labelled calorie free as a result of manipulating a loophole in the food labeling laws.  The product can be described as sugar free if a serving contains less than 5 grams of sugar, and calorie free if a serving is less than 5 calories.  So they set the serving size on bags at .5 grams  and the packets contain a serving of 1 gram.  A one gram packet contains 4 calories.   This can be confirmed on the manufacturer’s website in the FAQ section:  â€œLike many no and low calorie sweeteners, each serving of SPLENDA® No Calorie Sweetener contains a very small amount of common food ingredients, e.g., dextrose and/or maltodextrin, for volume. Because the amount of these ingredients is so small, SPLENDA® No Calorie Sweetener still has an insignificant calorie value per serving and meets FDA’s standards for “no calorie” sweeteners. “

To make matters worse, when sucralose was shown to not raise blood sugars, it was the pure substance that was tested, not the mixture that is sold to the public.  Dextrose, sucrose, and/or maltodextrin are definitely going to raise a diabetic’s blood sugar.  There is also a great deal of evidence that artificial sweeteners actually cause an increase in appetite, causing people who consume them to take in more calories than they would otherwise.

Stevia, on the other hand, lowers blood sugar, making it a much better choice.  If you have tried stevia in the past and did not like the flavor, you might want to try another brand. ..."

If your looking for a more nutritious "sweetner" you should try adding half a cup of coconut water. Delicious!

Ps. I love your blog. Keep up the great work!

Tapioca starch in the almond milk, but not enough to hurt you.

I enjoy your blog. You have a good thread about the hazards of hyperglycemia.
However, this recipe is not one I would recommend to patients attempting to reverse metabolic syndrome, T2D, or IR.
Their main concern is the inflammation caused by the above listed disorders. The omega 6 content of the peanut butter, sunflower seed, and to an extent, almond butter would exacerbate the inflammation mitigated by the hyperglycemia.
In addition, sugar alcohols (xylitol, erythritol) tend to cause GI upset (gas, diarrhea). Also the hazards of Sucralose are intuitively obvious....it contains chlorine molecules....commonly found in many household cleaners, and of course used in WWI as a pulmonary choking agent.
I would only use macadamia nuts/nut butter, and Stevia to sweeten.
Dr. John

Thanks, Dr. John.

I hear you on the sucralose issue. I've actually been having positive experiences with stevia, xylitol, and erythritol. The important thing is that people have some good choices nowadays, unlike 20 years ago when we had saccharine . . . period.

There is no question that mannitol and sorbitol have greater potential for both GI distress (diarrhea) as well as increases in blood glucose, so these are clearly on the no-no list (unless you need a quick laxative).

Sucralose is not metabolized.  Most of it is excreted unchanged in the feces.  A small percentage is absorbed and excreted unchanged in urine.  

Sodium in food is more of a concern for a person who experiences migraine headaches.  Over-activity of muscles activated by the Trigeminal nerve due to airway resistance secondary to water retention is a greater concern.  Various factors are present both anatomically and physiologically in people who experience migraine.  The only way to determine if sucralose is actually the cause of a migraine is to consume sucralose on its own.

What concerns me is what happens to the sucralose in the environment.  The addition of a chlorine atom, (not a molecule, Dr. John) results in a molecule which cannot be metabolized by bacteria.  If environmental degradation is possible, then sucralose excreted by human beings is not an issue.  But if it persists in the environment, then it is a pollutant.

I am practically a fruitarian, so much of what I like would be off limits.
Is there an article here on what IS recommended?

Yes, atoms, not molecules...ie. precisely 3 atoms of chlorine/molecule of sucrose...

An interesting thing about this selective halogenation of sucrose, is the fact that sucralose (being 600 times as sweet as sucrose), increases the HbA1c numbers in my patients. This demonstrates a lessening of diabetic control. Thus, hemoglobin gets glycated and fasting blood sugar increases....with the attendant hyperglycemia issues as mentioned, and this excellent blog site.

For this reason I do not recommend sucralose for diabetics nor anyone wanting to keep blood sugar levels within normal limits. The current cost and future costs for diabetes will cripple our healthcare structure. Here are ADA numbers:

$174 billion: Total costs of diagnosed diabetes in the United States in 2007
$116 billion for direct medical costs
$58 billion for indirect costs (disability, work loss, premature mortality)

Dr. John

Dr. John, is it possible that other factors contribute to higher H1ac levels in your type 2 diabetic patients?  

Since sucrolose is not metabolically active and does not act as a laxative, then there could be other endocrinological and neurological reasons for higher glucose levels.

Here's an abstract on sucralose and Type 2 diabetes:

Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003 Dec;103(12):1607-12.

OBJECTIVE: To investigate the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes. DESIGN: A multicenter, double-blind, placebo-controlled, randomized study, consisting of a 6-week screening phase, a 13-week test phase, and a 4-week follow-up phase. SUBJECTS/SETTING: Subjects with type 2 diabetes (age range 31 to 70 years) entered the test phase of this study; 128 subjects completed the study. The subjects were recruited from 5 medical centers across the United States and were, on average, obese. INTERVENTION: Subjects were randomly assigned to receive either placebo (cellulose) capsules (n=69) or 667 mg encapsulated sucralose (n=67) daily for the 13-week test phase. All subjects blindly received placebo capsules during the last 4 weeks of the screening phase and for the entire 4-week follow-up phase. MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA1c), fasting plasma glucose, and fasting serum C-peptide were measured approximately every 2 weeks to evaluate blood glucose homeostasis. Data were analyzed by analysis of variance using repeated measures. RESULTS: There were no significant differences between the sucralose and placebo groups in HbA1c, fasting plasma glucose, or fasting serum C-peptide changes from baseline. There were no clinically meaningful differences between the groups in any safety measure. CONCLUSIONS: This study demonstrated that, similar to cellulose, sucralose consumption for 3 months at doses of 7.5 mg/kg/day, which is approximately three times the estimated maximum intake, had no effect on glucose homeostasis in individuals with type 2 diabetes. Additionally, this study showed that sucralose was as well-tolerated by the study subjects as was the placebo.

PMID: 14647086 [PubMed - indexed for MEDLINE]

Now, I can understand how sugar alcohols taken in large quantities might have some effect on blood sugar because they are laxative and increase gut motility and cause discofort or pain, both of which will spike blood sugar values. the liver dumps glucose into the bloodstream when the body is under stress like this.  And of course, the pancreas reacts very sluggishly to endogenous glucose.

I think type 2 diabetics should have routine sleep study screening to determine whether breathing issues during sleep may be upramping the sympathetic nervous system and causing high sugar levels during sleep. We can't just help these people improve their life quality by looking at only one parameter.

They need otolaryngological evaluation for anything from deviated nasal septa to chronic allergies, enlarged adenoids and tonsils.  The size of their jaws, how they function and tongue posture also factors in.

Not to mention, anyone with pulmonary issues would have increased effort on breathing...asthma, pulmonary hypertension etc.  The existance of chronic pain and anxiety conditions also influence how the body produces its own glucose.  

Patient's require a multi-disciplinary workup to determine the multiple factors that result in the development of type 2 diabetes.  It's not merely diet because these people have an awfully hard time changing their diets without having other problems addressed.

Excellent! Dr. Davis, you have had many posts of what not to eat but very few on what we should eat. Taking something out of our diet means we have to replace it with something. This post seems to be in the right spirit. I am going to try this soon. Now if only you can post a similar substitute for Keva Juice's Oreo Speedwagon smoothie! Yes, I know they are hazardous to your health but they are wickedly good!

-- Boris

I'm not totally convinced why sucralose, a chloro-carbon, similar to DDT and PCBs, would elevate the HgA1c levels. My guess would be a neurological response to an ingested poison. Sucralose does kill intestinal beneficial bacteria...lactobacillus, bifidobacteria, and bacteroides...of varying amounts of 37-67%...and the enteric nervous system would react by elevating cortisol/adrenaline/glucagon: while at the same time not delaying gastric emptying.
Body perception is stress....glycation of RBCs result, with CVD and sudden cardiac death.

Studies that use diabetic, and obese subjects in the assessment of A1c elevation are biased from the start. These individuals have already lost glycemic control and as a result would not have normal A1c levels to begin with...let alone studying their response 13 weeks later.

McNeil Nutritionals, maker of SPLENDA® Brand products, stated it has provided the American Diabetes Association (ADA) with a sponsorship to support the Association's efforts to fund research, information and advocacy programs on behalf of people with diabetes.
And McNeil Nuts. are owned by Johnson and Johnson, who are large contributors to the ADA...the journal of the previously listed biased study showing the sucralose doesn't affect A1c levels...in spite of the fact in clinical results showing the opposite.

Anything, sucrose or sucralose, that elevates A1c levels is cardio-lethal...and is best avoided.

Dr. D,
Do you use regular coconut milk or the lite? Does it make a difference, except calorically?

Thanks!

Jeanne

I am allergic to the artificial sweeteners. Thought I could tolerate sucralose but it just took a little time for a reaction. My mouth and throat became inflamed and I had sore bumps all over the inside of my throat and back of my mouth after about a week.

I don't like stevia or the other natural no calorie sweeteners either...they just don't taste sweet to me or have odd flavors.

But I found something.  It is not calorie free, but it has low glycemic index and tastes just like sugar.  It is "Organic Blue Agave". What are a few calories in exchange for some actual taste.

I bought it at Costco.

""Organic Blue Agave". What are a few calories in exchange for some actual taste."

High fructose corn syrup (HFCS) is about 55% fructose and cause inflammation, insulin resistance, and elevates triglycerides.  Agave syrup is often 70% or higher (possibly as high as 90%) fructose!  Marketing scam...

Not to beat a dead horse, but sleep apnea is a often overlooked symptom of hypothyroidism, too.  

One does not have to be overweight to have sleep apnea, either (& lack of  excess obesity may lead physicians to dismiss apnea as a diagnosis).  

Untreated or undertreated hypothyroidism can result in weak muscles at the back of the throat (soft palate area) that close down during sleep.  

For me, the sleep apnea presented as repeated violent nighttime coughing fits that would significantly disrupt my sleep (and my husband's).  Unfortunately, it was too easy to assume for too many years it was simply allergic post-nasal drip (doc was happy to Rx for that, of course, but nothing helped, nor did dusting .

A lot of weird, annoying breathing issues improved considerably once on a good dose of T4/T3 - excessive, uncontrollable yawning when reading aloud to my son (but strangely, not while talking), excessive sighing during the day (I was unaware, but my husband noticed it), etc.

What a fascinating insight!

That's one I've never come across before.

I'd like to file a complaint against the department of Mother Nature for creating excessive noise for the past 2 weeks.  This springs weather has been crazy in the mid-west with all the lightning, flooding, and tornado sirens.  Bring on the hot sticky summer weather, I'll get more sleep with it than I have with this excessively stormy spring.

This week I was reminded that my brother in law does not sleep and that isn't an exaggeration.  The family is having a reunion this week and most are gathered at my folks house.  Instead of sleeping at night my brother in law just wonders around, gets on the computer, goes for a walk, etc.  About the only time I've seen him rest is when the TV is on.  He has what the hospital calls border line high blood pressure, 140 over something, I don't remember.  His cholesterol #s are not good also.  This is all in despite of being a marathon running, lifts weights, has little body fat.

A month or so ago he began some parts of the TYP program.  Hopefully what he does will help.  His father had the same sleep problem and he passed away from a sudden heart attack in his mid50s.

Hi all
Just want to say that I am impressed by the information here. Also the friendliness of the posts. You are all working together for everyones benifits. Kudos!
Since I was a very young child I have had insomnia, restless leg, migrains, anxiety. All of these things I have had since before starting school. All of these things, except the migrains did not have a name back then. I remember my mother coming in the morning to wake me, and i was still awake! I have also always had heart palpitations, always when I am at rest, never when I am exerting myself. Only in the last few years have "they" put names to these things. And only in the last few years have there been any information on help for same.
A number of years ago i started Atkins, I have always been overweight. I am tall, Long fine bones, but always have had a "belly". Over time Atkins became for me Low -carb, I did not stay true to Atkins, I found low carb healthier and recipes for making delishis food is now all over the internet
BUT always the issues of anxiety, insomnia, restless legs, migrains. I have always felt that they are all related. Of course my G.P. thinks I need to be on antidepresants .... which i was on for a number of years, then took myself off... thats a whole other story. But Because of the low carb diet a co worker lent me the wheat belly book... OMG!, then I found this blog. So now I am taking Vit. D, Magnesium, zinc, kelp,omega 3s, and about to start melitonin. Am stickin to the low carb forever, sans the wheat and grains. Am hopeing the next 57 yrs (thats how old I am ) will be healtier than the first.
Thank you Dr. Davis, and everyone who contributes to the blog.

Thanks for the excellent post! Bookmarked! Will come back again…

Do you take the 8,000 units *daily*?  I started out with a serum vitamin D level of 12 ng/ml and was prescribed 50,000 units per *week*.  That got me up to 27 ng/ml (which the doctor considered acceptable).  At that point, a different doctor advised me to take 1,000 units a day, but I started taking 2,000 units and have now reached 60 ng/ml.  I was concerned that 2,000 might be excessive, and now that I have reached a good level of serum D, I thought maybe I should cut back to 1,000.  But you take 8,000 daily?

D.S. 8000 daily x 7 days = 56000 weekly, not all that different from 50000 weekly.

Love the post Dr. Davis.
I have NOT been sick in 2+ years... seriously.  I tell people, I don't know if it's the 'low carb primal' meal plan ... or the almost daily exercise ... or the daily D3.  Most likely a combination of all 3.    I take 4-8k daily depending on the season and 'sunlight' exposure.

Thriving!... not just surviving.

Steve

This may be another case of everyone being different. Over the course of three years on 2,000, then 4,000 units a day I got to 48 then 63 ng/ml. When I upped it to 6,000 units I hit exactly 100 ng/ml. When I was at the lower levels I felt fantastic, at 100 I did not.  I recommend frequent testing to see what amount brings you to the ideal level and keeps you there.

Would it be beneficial to take K2 along with D3 just in case ?
Vitamin D boosts calcium availability and I wouldn't want it to finish on wrong places.

Yes, K2, magnesium and zinc should also be taken if you  suspect that your diet might be low in these. I discovered that I do not absorb supplements very well unless they are in liquid form.

DS and Johan--

Be careful: You're confusing cholecalciferol (D3), the human form of vitamin D, with ergocalciferol (D2), the non-human plant or mushroom form.

Vitamin D is a (pro)hormone. Humans should ONLY take the human form, never the plant form. For one thing, 50,000 units of D2 is apprximately equivalent to 15,000 units D3, because it's different. It is inferior.

If a doctor prescribes D2, it's because he has no idea what he/she is doing. There is absolutely NO reason to favor D2 over D3.

Great, Steve!

I've personally been enjoying the same experience.

Absolutely. Checking every 6 months has worked out very well for us.

There are reports that high intake of D3 will cause calcification of arteries and heart valves. The reported levels are over 50-60 ng in the serum D3. So there seems to be s diminishing effect of high D3 intake. Also it seems that taking K2 will mitigate or offset this effect. There are conflicting reports on this though. Any thoughts?
Renfrew

That's true of the plant forms of all the fat-soluble vitamins.  We have been badly misled.

The statistics and study summaries I've read seem to indicate that somewhere between 40 and 50 percent of the population cannot convert beta carotene to vitamin A in large enough amounts for BC to be useful as an A source.  If the respondents in those studies were only healthy people, the total percentage is far higher;  diabetics and hypothyroid people can't make the conversion.  And that's only adults.  Infants and young children can't make the conversion either, which pushes the percentage even higher.  Vitamin A has many tasks it performs in the growing fetus; helping the urinary tract develop is one of those tasks.  The Mayo Clinic tells us on its website that urinary tract defects are the most common class of defects in the United States.  Vitamin A is also important in eye and tooth enamel development, among the many, many other functions it performs.  How many people are walking around with eyeglasses, and how many young children are getting cavities now?

The Rotterdam study showed that vitamin K1 in plants does nothing to mitigate heart disease risk, whereas K2 from animal organs and dairy does.  I have heard from other sources that the K2 in natto (mk-7) does not cross the placenta, telling me it's less important to our health than the K2 from organs and dairy (mk-4 or menatetrenone).  K2/mk-4 is important in insulin sensitivity as well as heart health and bone and tooth strength.  But most experts focus on K1 or on the K2 in natto, to our detriment.

A, D, and K are so vitally important to good physical development and avoiding chronic disease.  The information is out there, in study after study.  If the experts won't admit to it, we need to educate ourselves.

100 ng/ml is too high for anybody.  Dr. Davis probably hits the high end of acceptable.  No wonder you felt bad.

I insist on supplementing three of the four fat-soluble vitamins because I've found out the hard way that the plant precursors of those vitamins DO NOT work well for me.  I suspect my experience is more in the majority than the minority, too.  Here's my regimen:

Vitamin A from fish liver oil (read the label):  8000 IU
Vitamin D3: 5000 IU
Vitamin K2, analog mk-4 (menatetrenone): 1-5 drops of a liquid supplement in MCT oil.  This company suggests taking 15 drops a day, which is over 10,000 of the recommended daily intake, and I see no point in going that high.

If I could afford no other supplements, I always take these.  I suffered from a subclinical (at least according to mainstream medical practice) vitamin A deficiency from 2004 on up to 2007 or 2008 that manifested as reproductive health problems and also birth defects in my daughter.  No one suspected an A shortage as the problem.  I figured it out by happy accident.  I am apparently not a good converter of beta carotene and my daughter paid the price.  I don't like liver, and dairy and eggs are not high enough in the vitamin, so this is what I do.  And this way the vitamins all work together synergistically  and I don't have to worry about toxicity.

Yeah, I know, but I was taking 50,000 units weekly to rectify a profound *deficiency*, not as a maintenance dose.

I don't know if it was D2 or D3 when I was taking 50,000 units per week (by prescription; this was over a year ago), but the 2,000 units (OTC) I now take daily are D3.  If this dose has me maintained at 60 ng/ml, it's amazing how the 8,000 units you (Dr. Davis) take isn't too much.  I guess this goes to show that monitoring is crucial, and there's no one-size-fits-all in supplements.

vit D and sleep apnea
http://www.musclechatroom.com/forum/showthread.php?18736-quot-Vitamin-quot-D-is-a-Hormone.-It-Cures-Sleep-disorders-amp-many-ailments

Long time followers of this blog will recall that Dr Davis has discussed vitamin D and K2-related issues many times here. You can find many answers to your questions by following the search links http://www.trackyourplaque.com/blog/category/vitamin-d and http://www.trackyourplaque.com/blog/category/vitamin-k2. Not all posts will be directly related to this discussion, but you will know what is related and what is not.

I guess Vit D can also be gained freely from the nature.

To Jack K. ... posted here since Server blocked this where belongs.
Hi Jack K.,
You once mentioned being ApoE4 (I think), thus are specially interested; and are in your "prime" dedicated to physical culture. Frankly I have no insight into how modified fasting or limiting snack fuel would let a body builder achieve their goals. (Doc recently stated how hard it was for athletes to restrict quick energy foods, like carbs.)

HDL heritability  in the Dutch ERASMUS study was put at 43% and the study of isolated Italian's from Linosa put HDL heritability at 54% (and for those Italians having both high triglycerides and low HDL that dual heritability was 31%). When one considers the ApoA2 percentage in HDL in relation to the amount of ApoA1 in HDL then that detail is going to involve the copy number of ApoA2 genes the individual has; and what is eaten, but not the type of protein one chooses, because it is more lipids (as fatty acid derivatives) that are involved in key signaling roles.

Doc & others ( ex: WholeHealthSource) tell us saturated fat intake boosts total cholesterol, but more so HDL than LDL; conversely when restrict saturated fat HDL level falls . For those with ApoE4 however Doc repeatedly has mentioned that for them it may be best to decidedly limit fat. In which case triglyceride levels are seemingly something one must work around.

Restricting saturated fat intake sees a decrease in  ApoA1 because without those fatty acid derivatives (lipid signalers) ApoA1 undergoes more breakdown, and in addition there is less ApoA1 secretion (not only does ApoA1 degrade faster than ApoA2 but the kidneys apparently don't excrete ApoA2, like the kidneys do to ApoA1). This is how statistically low HDL is associated with a higher percentage of ApoA2  in it's make up. Yet genetics can conceivably tweak this dynamic because fatty acid derivatives (lipid signalers) have to up-regulate PPAR alpha (subject to genetic variation), which then acts on the ApoA2 gene regulatory  element "J" (subject to genetic variation) before ApoA2 gets made in the liver (& a bit in intestine).

Experimentally when PUFA  made up 40% of total dietary fat intake there was less measurable ApoA1 mRNA & less liver secretion of ApoA1; while if 30% of total dietary fat is mono-saturated & PUFA there is usually no change in amount of ApoA1 mRNA, nor less liver secretion of ApoA1. When diet is classified as low fat and fat only 9% of total calorie intake ApoA1 levels usually decrease; I don't know if this is the fat level Doc advises his ApoE4 patients to try. I am not aware of any relevance of dietary protein to ApoA1 levels; however there is some recent indication that iso-flavone plant phyto-sterols (ex: genisten & daidzein from soy) may alter ApoA1 & ApoA2 levels (in contrast to older studies showing no benefit). I garnish food with a dry palmfull of Japanese black soy  fermented 1 year in Koji, called "Tochi", specially imported from Japan for Japanese restaurants by Miyako Foods  626-962-9633 (no financial interest for me); they also make this into a nice specialty miso - but I do not know how it compares in iso-flavone content to other soy forms.

2011:  Male rhesus monkey's  ApoA1 g/l went up from 2.34 when fed soy stripped of iso-flavones to 2.75 when their soy had iso-flavones; and their ApoA2 g/l went up from 0.20 when fed  iso-flavone free soy to 0.22 when their soy had iso-flavones....Female rhesus monkey's ApoA1 g/l went from 2.19 when fed iso-flavone free soy to 2.75 when fed soy with iso-flavones; and their ApoA2 g/l went up from 0.16 on iso-flavone free soy to 0.19 on soy containing iso-flavones. (As for Lipo-a : that also went down with iso-flavones.) The female 15% boost in HDL (90% of HDL = ApoA1 + ApoA2) being greater than the males is attributed to the fact that some of the males went from pre-puberty to puberty during experiment and there are often sex related variations in HDL; and to be precise the authors stipulate that iso-flavones may not work the same when the subject has either familial hyper-cholesterol or those with ApoE4.

Doc has given those with ApoE4 and low HDL a little appreciated strategy when he exhorts them not to eat oats, potatoes and wheat bread; these are common foods that increase levels of an asymmetrical lipid called lyso-phosphatidyl-choline (lysoPC). Remember that HDL also contains glycero-phospho-lipids; well, inside a cell the enzyme cPLA2 (cytosolic phospholipase A2) spins off phospho-lipids (another fatty acid derivative). And unfortunately it is usually individuals with low HDL tend to have more lysoPC than normal; which is considered pro-atherogenic when the lysoPC is configured in a "bad" molecular form (and yet other "good" lysoPC  configurations carry desirable DHA across the brain blood barrier).

It was shown that eating fatty fish 4-5 times a week decreases the total level of lysoPC, and both lowers the amount of  "bad" lysoPC, while raising the "good" configurations of lysoPC; which is another reason to follow Doc's high fish oil suggestion (inter-daily fatty fish might be a lot of mercury intake). I believe Doc is allowing fish oil and  maybe some fish for his ApoE4 patients. This experiment ruled out saturated fat beneficially influencing those lysoPC  molecular variations because subjects avoided all dairy fat, cream or butter.

The lysoPC that is carried in oxidized LDL molecules negatively affects one's tricky macrophages and also the smooth muscle cells of the artery; lyso-lipids not only invoke signals but can themselves be transformed. Certain lysoPC  yield a lot of  the platelet activating factor (alkyl-acetyphosphatidyl-choline) which contributes to sustaining inflammation, and so sets stage for atherosclerotic plaque. High levels of HDL usually conveniently equates with reduced levels of TNF alpha, a condition resulting in fewer undesirable adhesion proteins on the blood vessel's endothelium;  so, conversely those individuals with ApoE4 related low HDL are statistically prone to more endothelial adhesion proteins, and thus should try to do what they can to keep as much "bad" lysoPC controlled with diet.

Precisely, DS. I've got people who require 20,000 units to achieve this blood level, I've got a rare person who needs none.

The individual variation in need is quite wide. That's why the concept of an RDA for this hormone is, in a word, absurd.

I find that even low doses of vitamin D leave me feeling terrible. I get these weird chest pains and lower back pain as well. It also causes pretty bad breakouts for me. I've tried different preparations and brands but it all ends up leading to the same symptoms. This usually happens after I've accumulated a couple of weeks of supplement usage. I haven't experimented with different dosing strategies yet(weekly, bi-weekly or even monthly). I made sure to supplement with magnesium and K2 as well. It sucks because I really like all of the preventative benefits that D3 has to offer but it just doesn't seem to agree with me.
Mike

Dr. Davis:

Any chance that you'll be writing more about the positive results you're seeing in your clinic from increased doses of vitamin D on aortic insufficiency?

Joe

Since D activates immune function a lot, could it be that you have some chronic infection and effects you are experiencing are because of bacterial endotoxins which are released when bacteria dies ?

Have you done the D test ?

If so, perhaps taking some detox supplement would help like huge doses of Vitamin C, clay, NAC etc...

Sure, good idea. However, the majority of experiences have been in aortic stenosis, not insufficiency, only because I've got about 10 people with stenosis for every 1 with insufficiency--just too uncommon.

Hi, Mike--
Sorry about your struggles. I've seen this once or twice, but I'm not sure about why. You might ask your doctor to at least investigate parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols. These might booby trap a vitamin D effort. After all, taking vitamin D should be no more dangerous than getting a nice tan.

Are you suggesting that my reaction could be from some sort of bacterial "die off?"

Interesting. I never really thought about it. I did get my levels checked during the few months I was supplementing and it was only 52ng/ml.

Mike, are you getting enough quality Vitamin A? Vitamin A and D work together. Chris Masterjohn had a post about it on the Weston A. Price website, they have a lot of info there about A and D levels and how they work together. Other people have had reactions to D also and found that they deficient in A, mostly, I think, by evaluating their diet and seeing there were few good sources of A there. Also, older people and some just not so lucky folks don't process beta carotene into vitamin A, it's age and genetics.

It was recommended that I take additional magnesium and vitamin k2 to see if it would make a difference. I've never taken additional vitamin A though because according to the  vitamin d council, additional vitamin A can be toxic.

I have read that Masterjohn article before though.

I just wanted to add my experience on Vit. D3 supplementation.

Two years ago in July I started supplementing 5,000 i.u. Vit. D3 a day.  My sister had been found low, I live relatively the same lifestyle, and thought, "what the heck, I'll start and get my blood tested in late winter next year".  

That next March I had a blood test and found my blood levels to be at a whopping  32 ng/ml.  My doctor said "fine, you're within range" and I thought, "no, that's not fine" and started to take 15,000 i.u. a day.  In March again this year I had a blood draw, and expected to see a very high ng/ml of Vit. D.  My actual result?  It had raised to 45 ng/ml.  I was floored that with that amount, my levels had only raised such a small amount.  

I will add that I am obese.   I just wanted to give you my experience with D3 supplementation in case it helps someone else.  I have now upped my supplementation once more to 20,000 i.u. a day, and if my next blood test is appreciably better, will hold at that level or drop back some.  I will add that I haven't had many if any colds this past year, so even if I have not attained a more optimal level (perhaps I can't due to obesity)  it's still doing me a lot of good.

Oh, I forgot to mention. A friend of mine suggested I try applying liquid vitamin D on my skin and then checking to see if that raises/maintains my blood levels.

I'm thinking about applying 5 to 8k per day to the skin AFTER I shower so that it gets plenty of time to absorb in the skin. Then re-test my levels after a few months to see if it works.

Please let me know what becomes of your experience! We've not tried this specific strategy.

Hi, Jennifer--

Yes, indeed: The individual experiences with vitamin D can vary widely. You may also note that, 3 or so years into the experience, your needs will diminish, sometimes dramatically, with less vit D required to generate the same blood level.

I began experiencing tightness and soreness in my hips and lower back this year. Have been low carbing for over three years, and, except for a short period of stupidity earlier this year, have not consumed any flour products. My multi-vitamin contains only 500 IU of D3, so I am adding this to my daily supplementing. Should I start slowly, 1000 IU a day for a month, and slowly increase? Is D3 toxic? BTW I am in my late 60's, and I do exercise 5-6 days a week as well.

I have read that 20-25ng/ml is optimal.
"Although numerous studies have not
observed any adverse effects of higher
vitamin D status, a few have. Historically,
the main health risks associated with
excessive vitamin D are linked with
abnormal plasma calcium concentrations.
Excessive vitamin D is recognized to
cause hypercalcemia by increasing intestinal
calcium absorption or by increasing
mobilization of bone calcium. Although
hypercalcemia is uncommon with intakes
less than 10 000 IU/d,3 knowledge of
non-calcium-related adverse events is
limited. At least some evidence suggests
that high vitamin D status may be associated
with increased risk of some cancers.
In a large case control study of prostate
cancer in Finland and Norway, both
low (32 ng/mL)
25(OH)D concentrations were reported
to be associated with an increased incidence
of prostate cancer (50% and 70%,
respectively) compared with individuals
with serum 25(OH)D concentrations
between 16 and 24 ng/mL.4 A direct relationship
between higher vitamin D status
and the development of esophageal
carcinoma also has been observed in
Chinese men.5 Interestingly, all the participants,
including those in the highest
quintile, were vitamin D deficient (26.2
ng/mL) with a 3-fold increased risk of
pancreatic cancer compared to individuals
with the lowest baseline status (<12.8
ng/mL). Overall, these studies suggest
there may be an optimum status and that
values below or above may increase risk
of certain types of cancer.
Adverse events associated with high vitamin
D status other than cancer also have
been observed. Recent data from large
epidemiologic studies, including the Third
National Health and Nutrition Examination
Survey (NHANES III) and the Framingham
Heart Study, suggest that a “U-shaped
curve” relationship exists with all-cause
mortality and the incidence of cardiovascular
disease because both low and high
25(OH)D concentrations elevated risk.7,8
In the NHANES III study, higher mortality
risk was observed in participants
with 25(OH)D above 49 ng/mL. In the
Framingham study, the lowest cardiovascular
disease risks were found in
participants with baseline 25(OH)D levels
of 20 to 25 ng/mL but increased with both
lower and higher values,8 thus suggesting
that increased cardiovascular risk occurred
at levels below 30 ng/mL. Furthermore,
the optimal 25(OH)D levels for protection
against cardiovascular disease and certain
types of cancer may differ from those
for bone metabolism or normal parathyroid
hormone physiology."
from 'too much.pdf' in http://is.gd/vT4Ogh Studies from DrGreger collection.

DrGreger has since changed his recommendation from 4000IU to 2000IU/day:
http://www.facebook.com/NutritionFacts.org/posts/193068787424836 yesterday's update

As knowledge marches forward, there will always be differing observations made, some good, some bad, some indifferent.

However, if we weigh the totality of evidence (and I throw in my experience that now amounts to several thousand patients), there has never been any strategy as powerful as vitamin D--except for elimination of wheat in the human diet, the two most spectacular new health strategies I have encountered in my career.

what happened to my post?

I posted 30Aug11 about a concern I have concerning D3 toxicity, but the message disappeared. I have been following for some two years a daily D3 regimen (4000-8000mg) without incident. I recently experienced unusual chest pains over a week and ended up getting a thorough checkup which found no apparent heart problems. However upon disclosing my protracted D3 intake (considered “very high!") it was suggested I suspend D3 for awhile on the off chance D3 toxicity may be the source of my symptoms. I was wondering if anyone else here has had this experience. As I look into this more, I have learned that D3 toxicity is more subtle and prevalent than I had thought, and is not something to be taken lightly. Clearly as Dr Davis has cautioned, adjusting to the right dosage varies from person to person, and given the latent build up of D3 in fat tissue over time, it is not as straight forward getting it right as one might think. In my case the jury is still out.

re previous message: 4000-8000 mg = 4000-8000iu's

I swear by vitamin D3. It helps me avoid asthma flare ups and kick bugs before they can make me wheeze. In the warm months, I make sure to get outside as much as possible as there are other things produced by the sun in addition to Vitamin D, some of which may be important. Then in the winter, I supplement 2-5k ius a day, increasing to 20k ius when sick.

M

Is taking a high dose of Vitamin D3 during pregnancy safe? I know most of the "recommendations" are to take 200 IU, but I have some 5000 IU pills in my cabinet, and am wondering if those would be safe or not. Or should I find a lower dosage pill?

Hi, Melinda--

Sadly, there are next to no data for how to best manage vitamin D and pregnancy. However, common sense would suggest that achieving a desirable blood vitamin D level should not be harmful, else getting a tan while pregnancy would be harmful, too.

A dose of 5000 units typically yields a healthy blood vitamin D level in the majority of females.

Hi Mike & Dr. Davis!

Can you please tell me, has anything worked for you yet? I too do not like the feeling I get on Vit D3 but I am only at 31 and need  to start taking 8,000 a day as well.

Also Doctor Davis can you please please elaborate on these: "parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols". and why they would booby trap the Vit D3 efforts? How does someone work around this ang take Vit D3?? I found out yesterday I happen to have a high Reverse T3 and need to go on thyroid meds and also have adrenal issues. As well as low insulin levels. So I might be the one who is getting booby trapped.

Any help appreciated

Thank you!

Hi Mike & Dr. Davis!

Doctor Davis can you please please elaborate on these: "parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols". and why they would booby trap the Vit D3 efforts? How does someone work around this ang take Vit D3?? I found out yesterday I happen to have a high Reverse T3 and need to go on thyroid meds and also have adrenal issues. As well as low insulin levels. So I might be the one who is getting booby trapped.
My Vit D3 is only at 31 and have been prescribed 10,000  a day. I really want to start but I have not liked how I have felt in the past on Vit D3.
Any help appreciated

Thank you!

Hi, Rose--

The key here is to find someone who can guide you along while monitoring and interpreting these factors. The greatest difficulty: finding a healthcare practitioner with the knowledge, experience, and interest in doing so.

As crude as it is, you are still best with word of mouth: asking friends and family who has been a helpful advocate with health problems, especially those involving vitamin D.

See below.

Hi Dr. D,
I posted a question on another thread about vitamin D and calcium levels and now I think this thread is more current and probably relevant .
I am being worked up at the moment for a possible parathyroid adenoma. My serum calcium has been trending up for the past few years and is now 10.3 (x2).
  Way back in 2005 I started reading about the benefits of supplementing with D and used 1000iu/day, as well as 400-800 magnesium and Life Extension's K2. Fast forward to 2009 and imagine my surprise at my D levels being 26!  Increased it to 5-6k per day and went to 43.
Dr. James Norman is considered to be the foremost expert on all things parathyroid here in the US , and his website : parathyroid.com.  was very informative for me, but concerned me regarding blanket supplementation of vitamin D.
I respect your opinions greatly and would like your thoughts as to his information.

Thanks!
Reikime (RN)

Hi, Reikime--

I am obviously no authority on parathyroid tumors. Dr. Norman's website is very interesting and makes great sense. I, too, in looking at vitamin D, calcium, and PTH levels have uncovered several parathyroid tumors. It appears to be a lot more common than previously thought.

The only issue I would disagree strongly with is the statement that the ONLY purpose of vitamin D is to increase intestinal absorption of calcium. In fact, among the most exciting areas of research with vitamin D are a new appreciation for the widespread, multi-faceted effects vit D has in multiple, perhaps all, organ systems.

Hi Dr Davis,
It seems that a finnish University is doing a major study on Vitamin D, check this out!

"The FIND will be a randomized, double-blind, placebo-controlled, 5-y supplementation study of the benefits and risks of vitamin D in the primary prevention of CVD and cancer among 18000 men ≥60 y and women ≥65 y. The participants will be randomized to 3 groups with 6000 in each, with daily supplementation of either: 1) 40 µg/d (1600 IU) of vitamin D3, 2) 80 µg/d (3200 IU) of vitamin D3, or 3) placebo. Compliance, use of non-study drugs or supplements, diet, development of endpoints, and CVD and cancer risk factors will be assessed by questionnaires. Blood samples will be collected for assessment of effect modification by baseline 25-hydroxyvitamin D, as well as for future ancillary studies of genetic/biochemical hypotheses."

https://www.uef.fi/nutritionepidemiologists/find2

Looks awesome to me. What do you think? Highest dose arm 80 µg a day for 5 years is more than VITAL.

Hi, Johnny--

Excellent!

In the meantime, the effects I continue to witness are so powerful that I still advocate correcting vitamin D to 60-70 ng/ml.

Hi Doc,

A quick question on vitamin D:
I recently tested at 17 ng/ml for vit d.  (had been supplementing w/ 2000 iu of D3 for 2 weeks previous to that).
The doc is recommending I take 40,000 IU once a week for several months until it stabilizes, and then switching to lower supplementation.

A few questions:
(1)  Obviously this will be D2 not D3 since it's prescribed - just go with it?  I believe I read a study somewhere that showed D2 ended up being as effective as D3 despite being slower.
(2)  Thoughts on taking these large "catchup" doses rather than a more consistent 10,000 IU/day regimen?

My other stats:  Age 31, 160lbs, Total Cholesterol = 204, HDL = 60, Triglycerides around 100.

You are closer to the truth, N, than your doctor. Clearly your doctor is fairly ignorant of the emerging issues with vitamin D.

While dosing can vary, depending on body size, race, genetics, etc., 10,000 units per day of D3 would be a typical effective dose.

I had read that about 20-30 minutes of sunlight daily were required for Vitamin D absorption.    Having already gone through Mohs surgery for a tiny basal cell carcinoma on my nose - and being "melanin challenged" - I have always tried to cover up or stay out of direct sun.  Sun blocks apparently have some questionable compounds in them.  I jog 2 miles every day if its not raining or snowing.  So on a sunny day that's 20-30 minutes of exposure.  Should Vitamin D dosage be varied according to daily sun exposure ?   Self-prescribing dosage of supplements is a real headache for me.  I don't have a clue.   It would sure help if there were affordable food sources of sufficient Vitamin D.   What about dairy ?