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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Braing fogm clogged nose and slower bowel movement.

Why i dont get diarrhea when eating wheat?

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

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

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

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

And then I read your post!

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

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

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

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

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

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

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

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

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

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

The comments to this blog post and poll are incredible!

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

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

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

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

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

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

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

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

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

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


.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Still others say there is no such thing."

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

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

Again, 90% of this is pure mental.

Interesting the vote results are mostly on GI distress.

I'd suggest a couple additional matrixes:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I'll submit "other".

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

Suits me.

Jack

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

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

And here is an interesting article on this food:

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

Dr. Davis,

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Davis,

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

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

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

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

there are hundreds of centers for research on heart, cancer, aids etc. etc. Thyroid has been over looked for some strange reason by all of the medical authorities. This is a disease which incapacitates one socially, physically, mentally and economically. this disease is a silent killer which kills the patient slowly through using other diseases such as high blood pressure, cancer, cholesterol,memory loss,eczema, hypoadrenia and list goes on and on. the sad thing is that this is curable with simple and cheapest available medications and minerals. thyroid is one of the biggest overlooked, stubbornness by our medical system which is costing the governments and population billions economical and lots of grieve socially because this disease also effects one's decision making ability too. i and my family has suffered with hypothyroid conditions. we have been to many doctors but no help. every doctor failed to recognize the symptoms because of the stupid TSH test excuse. finally when i started getting heart problems problems despite the facts that i was in the gym 7 days a week and still gaining weight. i took some time off and started to educating my self through the internet and books. changed my family's doctors. now, every body in the family feels normal. no more quick temper, sleepless nights, weight gain, skin problems, cholesterol,blood pressure, menstrual irregularities, flu,hair loss, too much calcium in the blood, eczema to name a few. even my 8 year old dog is stopped shedding hair and is less scared of the thunder now after D3 and kelp. my 74 year old mother says that she never felt this way in her entire life. my university going son feels 100 times calm now. kelp, iodine, tyrosine, multi vitamins, liquid thermometer and dessicated hormones are not that expensive. my favorite doctors are Dr. david Derry (retired), Dr Star, Dr. william Davis, Dr. Lowe, Dr. Rind to name a few who have the balls and soul to say the way it is. I just want to say that thank you Dr. William and please keep it up.

You know, now that I am "tuned into" hypothyroidism, I see people all the time that I think have a slight or even obvious goiter or enlargement of the thyroid gland, both in person and on TV.  And I don't mean fat necks, I mean a goitrous neck, often on relatively thin people (though not always).  One of the TV people that stood out to me was a reality show former model (with a really narcissistic personality) who has a clothing line.  I think her name was Kimora and her clothing line was Phat, but don't quote me -  I was watching her neck more than the show (I was channel surfing and her swollen neck caught my attention).

On the rare occasion when I have a chance to talk about thyroid conditions with someone who has  what looks like a slight goiter to me (if we are talking about health or I mention my low thyroid condition), I don't ask outright or suggest they look like they have a goiter, but invariably they say they don't have a thyroid problem because their doctor suspected it, checked it out, and the lab says it's fine (I don't mention what I see on their neck, of course, but my tongue is black and blue later from biting back how my doctors missed my thyroid condition for so many years    ).  

Between people reducing salt (iodized salt); eating processed soy ingredients on a regular basis (soy's a goitrogen - thyroid inhibitor);  constantly stressing (running on adrenaline, burning the candles at both ends - which skews all the other hormones); and the poor state of thyroid treatment with conventional medicine, it's not surprising to see goitrous necks commonly around town on a regular basis.

This book can be found online at Project Gutenberg www.gutenberg.org/etext/18467

Dr. Davis, Your goiter blog posting brought to mind the issue of evolution of the medical profession from "art and craft" to "science based.......".

I can better understand a comment read long ago. It said that until about the 1930's and the advent of sulfa drugs, you stood less than a 50% chance of benefiting from a visit to the doctor's office.

Somewhere in the past, we did pass that threshold (I hope), and I wonder what decade would you attribute that to, and what thing or things put it over the mark.

Dr. Davis, can you comment on why you are using images of people from istockphoto to represent the faces from your TESTIMONIAL sections on the TYP website?

Isn't that unethical? I mean, these are supposedly "real" accounts from "real" people, using the TYP program. If they are real, then why do you feel the need to use stock photo images as the pictures of them?

You can find my links to these cases on todayiatea.blogspot.com/2009/05/dr-davis-heart-scan-blog-and-russian.html or simply go to www.todayiatea.blogspot.com and search for the May 17th post.

Pooti--

Simple.

In past, when I approached people to allow us to use their photos, they would not grant permission. Most cited reluctance to let everyone know they had heart disease. Same with their names. This happened time and again. Obviously, we cannot go against their wishes for both ethical reasons and the HIPAA privacy act. In fact, posting private health information is a violation of the law which can even lead to jail time. The government means business.

In short, we gave up trying to obtain permission to allow people to use their real names and photos. So the photos and names are fake. The stories are very real, though all--ALL--potentially identifying information has been changed. If, for instance, someone's Lp(a) is really 167 nmol/L, we might say it's something like 157 nmol/L, so that nothing can be personally tagged.

This is just the reality of this project. Unlike weight loss testimonials in which people are thrilled to have their before and after pictures posted, such is not the case with heart disease.

Does anyone here volunter to be the first to allow your photo and name, along with details of your health, to be posted?

Dr. Davis I have a serious problem with this unethical behavior. You can not LEGALLY nor ETHICALLY call it a "testimonial" if you've changed every fact and nothing about the entire story is actually based on truth. The most you can call each of these examples (note they are not "testimonials") is a "recreation based on similar patient accounts" (i.e. fictional account). You would then need to follow that with your disclaimer that individual results may very dramatically among each person.

Dr. Davis I think you do your patients a disservice. You can tell "stories" of success. But you cannot call them Testimonials. It's misleading advertising practises. In short it's called lying for gain.

BTW, Heidi Diaz aka Kimkins did the same thing on her website and she has a class action lawsuit going against her right now. You may argue she lied about more than her testimonials and testimonial photos. However...you are doing no better. And so you have now corrupted your message as a healer.
Not good, doctor. Whomever it was who advised you to take this path on your website should be given the boot and a big fat "your fired." It's indefensibly poor advice.

www.todayiatea.blogspot.com

BTW, Dr. Davis? I can tell you that if I were one of your patients, and you helped me reduce my atherosclerotic plaque buildup in my arteries by 63%, I would be your best advertising. Not only would I allow you to use my story and my image to help others realize this type of incredible result, but I would be a marketers' dream child.

In advertising and marketing - rule 101 is to convert an interested prospect into a client, and from a client into repeat client, and from a repeat client into an advocate.

An advocate is someone who takes your success personally and will go beyond the norm in order to help ensure your success. In other words they have a personal interest in your success. So they do things like speak highly of you every place they can. They recommend you to friends. They send you members of their family. They are gold. Priceless beyond measure.

That is a universal truth, regardless of the industry. Hell, look at Farah Fawcett and she has the most physically embarrassing problem in the world and she's out there shouting from the roof about it. So I really fail to see how your patients whom you have helped so dramatically, could possibly resist an appeal to use their true testimonial in order to help others live...

pooti,

These are interesting points that you bring up, and perhaps worthwhile exploring.  

There are numerous reasons why someone might allow their story to be told, but not want to be personally identified on the WWW.  At the same time, he/she might be very open with family, friends, neighbors, etc., but that's at his/her discretion.  That's the way I am about some health issues, very open when it feels right, but clammed up on other occasions.  It's my choice.  

I can't help feeling this issue is more of a molehill than a mountain...but obviously you feel differently.

@Anne,
Well spotted! The clothes line is called Baby Phat.
Follow the link below and click on the thumbnail of the front view, zoom in all the way by double clicking on the image and observe the inept Photoshopping round her neck to hide the goitre!
http://idn.efashionsolutions.com/asset/imageset/id/BP-D2G00134_H09_zoom
Had Google this one after your description.

Michael,

Here's a photo of Kimora Lee that is probably not Photoshopped and shows the front neck swelling more noticeably (at least I hope it isn't Photoshopped, because I've never seen her on the TV show with the skinny arms that appear in the fashion shoots).

www.babyphat.com/landingpages/landing.php?page=maternity&dept=plus

Google Kimora Lee goiter and the search results show I'm not the only one speculating that she has a goiter...oh jeeze, I need to get a life.  I  can't believe I'm googling celebrity necks now .  But I see necks like this ALL the time around town, on women of all sizes.  It's like a traffic wreck, so hard NOT to sneak a peek!

Anna, with all due respect, it really doesn't matter so much what either of us think about it. Dr. Davis actually risks his license by making these types of claims without proper designation of them as "dramatizations" or "actors" or "advertorials". Because the FTC (Federal Trade Commission) clearly outlines the rules for the use of Consumer Testimonials and Endorsements:

Part B is the relevent portion but they skirt dangerously close to the other rules as well:

http://www.ftc.gov/bcp/guides/endorse.htm

§255.2 Consumer endorsements.

(a) An advertisement employing an endorsement reflecting the experience of an individual or a group of consumers on a central or key attribute of the product or service will be interpreted as representing that the endorser's experience is representative of what consumers will generally achieve with the advertised product in actual, albeit variable, conditions of use. Therefore, unless the advertiser possesses and relies upon adequate substantiation for this representation, the advertisement should either clearly and conspicuously disclose what the generally expected performance would be in the depicted circumstances or clearly and conspicuously disclose the limited applicability of the endorser's experience to what consumers may generally expect to achieve. The Commission's position regarding the acceptance of disclaimers or disclosures is described in the preamble to these Guides published in the Federal Register on January 18, 1980.

(b) Advertisements presenting endorsements by what are represented, directly or by implication, to be ``actual consumers'' should utilize actual consumers, in both the audio and video or clearly and conspicuously disclose that the persons in such advertisements are not actual consumers of the advertised product.

(c) Claims concerning the efficacy of any drug or device as defined in the Federal Trade Commission Act, 15 U.S.C. 55, shall not be made in lay endorsements unless (1) the advertiser has adequate scientific substantiation for such claims and (2) the claims are not inconsistent with any determination that has been made by the Food and Drug Administration with respect to the drug or device that is the subject of the claim.

@Anna,
spot on! But it's still a "goitre" for me and the rest of the world. Same as "centre" and "metre". One cannot honour Yankee spelling!

@Pooti,
It's a bit over-the-top to compare Dr Davis with Heidi Diaz! Can you state, hand on heart, you're not a drug company troll?? Just wondering.

BTW, having looked up Pooti's website, he does not appear to be a drug company troll.
While I'm on Dr Davis' side here, I think that no harm is done shining a light on the issue of before & after stories. But on balance, I think Pootie is over-reacting here. For example change 160 to 157 is not falsifying the data within the error range of the measurement. However, labelling stock photos as such would probably be a good idea.

I'm with everyone that thinks Pooti is overreacting. All that need to be put on the site is something along the lines of "photographs and medical details have been changed in the interest of patient privacy". Maybe even throw something in about HIPAA. It happens all thin time with things involving medical information - the stories are real, but the details have been altered a bit to protect the privacy of the people involved. I don't see anything wrong with that. I'd have to think long and hard before putting my real face, name, and medical conditions on the internet. I did it once before in a place, much to my eventual detriment.

i am regular visitor of your site and you are writing very nice so keep posting university admission

The heart scan is a rapid assessment tool for the identification of hemodynamically significant cardiac abnormalities in the ICU. Like the evaluation focused on trauma ultrasound for the concept, but directed at the center instead of the abdomen. Often called calcium scanning provides a score that can be used to determine the risk of a coronary event. Unlike an electrocardiogram (which mostly shows the results of recent heart attack) and thallium stress test (which appears only advanced blockages of 70% or more.) Is an excellent way to determine if a person has coronary artery disease.

there are hundreds of centers for research on heart, cancer, aids etc. etc. Thyroid has been over looked for some strange reason by all of the medical authorities. This is a disease which incapacitates one socially, physically, mentally and economically. this disease is a silent killer which kills the patient slowly through using other diseases such as high blood pressure, cancer, cholesterol,memory loss,eczema, hypoadrenia and list goes on and on. the sad thing is that this is curable with simple and cheapest available medications and minerals. thyroid is one of the biggest overlooked, stubbornness by our medical system which is costing the governments and population billions economical and lots of grieve socially because this disease also effects one's decision making ability too.

Really you’re doing great job nice blog with very useful templates. Thanks for sharing it with all.Rebreathing Bag

But is there any real evidence that small LDL is a *cause* of heart disease? Correlation alone isn't sufficient, of course, and Chris Masterjohn has said that even the correlation largely disappears when traditional "risk factors" such as HDL, LDL, and triglycerides are added to the model.

I ask in part because I am about to arm wrestle with my primary care doctor about my recent cholesterol panel:

Total: 382
HDL: 157
LDL: 217 (calculated)
Triglycerides: 39

He's upset about the LDL, of course, especially since it's progressively risen over time (coinciding with dietary changes pretty compatible with TYP and including quite a bit of sat fat after years as a low-fat vegetarian). Naturally, he wants me to reduce my fat consumption and retest in four months, and I'm sure a statin drug recommendation will follow just as the sunset inevitably follows the sunrise.

I am thinking of asking for a full lipoprotein panel, with the expectation that it will calm him down by showing 1) much lower real, measured LDL with my rock bottom triglycerides and 2) strong Pattern A LDL with my sky high HDL and low triglycerides.

But I'm not certain if I can really make a convincing empirical case to him that Pattern A is benign with a high LDL. (I'm also hesitating after hearing Chris Masterjohn say that LDL particle size measurements are hugely dependent on the type of assay used and that as a result it's not clear what, biologically, any given result means until these methodological discrepancies are sorted out.)

The article you cite says the number of LDL particles may be more important than the size.  Is that your experience?

@Bill : Chris Masterjohn also mentioned in a recent podcast that the current measurement technology for LDL particle size is just not sufficiently accurate to be useful.

what is your feeling on oxidized ldl?

@howard
yes, based on the hour to hour, day to day, week to week, and month to month natural fluctuations of lipids in the blood it is difficult to make any real judgements about cholesterol readings without doing multiple panels over a period of time.  the whole medical community seems to be screwed up in this respect.

I have no idea what Dr. Davis' response will be, but if you're interested in getting an NMR profile done on your own dime (and if there is a convenient location near you), check out directlabs.com for their September special.  An NMR profile will only set you back $79 (reg $127).  I've been waiting for this "sale" and am getting it done to show my own doctor.  Your health is ultimately in your hands - keep up the good fight!
Best,
Kathy

Dr D,
I totally agree small LDL is driven by excess carbohydrate intake and postprandial
triglycerides. However there is a substantial subset of people whose small LDL
is genetically driven. I believe you are aware of this phenomena.
Please let these folks know what their options are to address this important issue!
There can be a good deal of frustration when carbs and triglycerides are addressed but
with little lowering of small LDL.
Please help this substantial number of people out by outlining their options...
Gib

Thanks for that information, Kathy.

It ain't good,  just ask Wikipedia.   From the Wiki page re 'Chronic endothelial injury hypothesis':
"Once LDL accumulates in the subendothelial space, it tends to become modified or oxidized.[5] This oxidized LDL plays several key roles in furthering the course of the inflammatory process. It is chemotactic to monocytes; oxidized LDL causes endothelial cells to secrete molecules that cause monocytes to penetrate between the endothelial cells and accumulate in the intima.[6]

Oxidized LDL promotes death of endothelial cells by augmenting apoptosis. Also, through the activation of collagenases, ox-LDL contributes to a process which may lead to the rupture of the fibrous plaque[7] Oxidized LDL decreases the availability of endothelial nitric oxide (NO), which, in turn, increases the adhesion of monocytes to the endothelium.[8] Moreover, NO is involved in paracrine signalling between the endothelium and the smooth muscle that maintains vascular tone; without it, the muscle will not relax, and the blood vessel remains constricted. Thus, oxidized LDL also contributes to the hypertension often seen with atherosclerosis."

Test reply

Yes, French cardiologist Guy-Andre Pelouze MD. at the recent Ancestral Health Symposium said in his presentation "Paleodiet and atheroma: A Cardiovascular Surgeon’s Perspective" that:

1. Native (the reduced form of) LDL cholesterol is NOT atherogenic, only the oxidized form leads to atheroma, atherogenesis & arterial plaque formation.

2. Without oxidized cholesterol it's very difficult to have arterial plaque formation

3. Anti-oxidants are ineffective in preventing atheroma.

4. SDLDL easily enter the subendothelial space because SDLDL are less than 25 nm in diameter and the subendothelial space is 26 nm.

5. Subendothelial space in humans is very different in humans than other mammals due to the large amount of smooth muscle in the arterial media below the the intima layer.

And there's much more.  To see a video of Dr. Pelouze's presentation hosted on the Ancestral Health page at Vimeo just google 'vimeo, paleodiet and atheroma', then scroll to video number 33 in the right side box.

Do you REALLY believe that? We have the ability to measure the distance between the earth and the moon almost down to the millimeter, and certainly down to the centimeter. We have the ability to measure individual atoms with electron and other types of microscopy used in materials engineering and computer chip manufacturing.  Medical, biochemical & physiological textbooks are full of descriptions of the sizes of white and red blood cells, bacteria and viruses, etc. ad infinitum.  Do you REALLY think we lack the ability to measure SDLDL?  Don't be so ready to believe something just because somebody says something about it.  Use your own brain, put together everything you know and can learn on your own and connect ALL the dots before drawing a conclusion.  

Furthermore, what's the point of a statement like that?  Should we just give up measuring and trying to understand how SDLDL causes atheroma just because ONE guy says we can't measure them to his degree of satisfaction?  Should we just give up worrying about what we eat, and what we are being sold as foods that are arbitrarily declared to be safe to eat by some anonymous bureaucrat at the FDA?  Should we just ignore the ever increasing incidence rates of cancer, heart disease and atherosclerosis that by all applications of observation and simple logic are known to be entirely due to the modern industrial foods diet in every society and the peoples that subsist on them?  

I don't think so.  Homey don't play that anymore, at least this one doesn't.

@Bill,  Google and see this study: 'Detection of low density lipoprotein particle fusion by proton nuclear magnetic resonance spectroscopy'.    
"Abstract: Recent evidence suggests that fusion of low density lipoprotein (LDL) particles is a key process in the initial accumulation of lipid in the arterial intima. In order to gain a better understanding of this early event in the development of atherosclerosis, it would thus be necessary to characterize the process of LDL fusion in detail. Such studies, however, pose severe methodological difficulties, such as differentiation of particle fusion from aggregation. In this paper we describe the use of novel methodology, based on 1H NMR spectroscopy, to study lipoprotein particle fusion."

Bill,
You have no worry since your triglycerides are quite low and therefore your LDL particles are of healthy size.  Your correctly calculated LDL is only 161 using the Iranian formula (used if triglycerides low).  See LDL calculator here:
http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

And never use statins, just cut carbs.
Don

"About 80% of cholesterol is composed of fats and oils (Current Atherosclerosis Reports 2004). The
majority of an arterial clog, 55%, comes from defective cooking oils, containing mainly damaged omega 6. Most of us unknowingly purchase these oils in the cooking oil section of the supermarket. These are the oils we fry with and the oils added to most packaged foods; both fresh and frozen.

Here’s another shocker. It’s not the saturated fat —it’s the adulterated omega-6 from food processing that clogs arteries! Contrary to what we have heard for decades, it is not the saturated fat you eat that clogs your arteries! How do we know this? A 1994 Lancet article reported investigating the components of arterial plaques. In an aortic artery clog, they found that there are over ten different compounds in arterial plaque, but NO saturated fat. This means the bacon, eggs, cheese, steak, whipped cream, etc. isn’t the reason for a clogged artery. These natural saturated fats are actually good for you. You need them for body structure.

With the consumption and transport of defective processed oils, LDL cholesterol acts like a “poison delivery system,” bringing deadly transfats and other ruined oils  into the cells. It is primarily the oxidized (adulterated) omega-6 that clogs the arteries, NOT saturated fat!"  

For more just google 'Brian Peskin saturated fat' and read the day away to your heart's content.

"just because somebody says something about it. Use your own brain, put together everything you know and can learn on your own and connect ALL the dots before drawing a conclusion. "

lol. you must not know who CMast is.

Yeah, I do, and that's why I said that.

Hi, Gib--

The strategies that reduce small LDL are the same whether it's genetically-driven or acquired. However, when (presumptively) genetically-driven, it's just harder and requires a more meticulous effort.

We are now seeing more and more people achieve zero or near-zero small LDL with strict carb reduction. The big exception is apo E4 people, who can still struggle because of the peculiar physiologic effects of this pattern.

Big issue. Note that the real culprit in causing plaque may be glycated oxidized LDL.

Hi, Peter--

No, I think that is wrong. It might be correct if small LDL is regarded in a dichotomous way, i.e., pattern A vs. pattern B. But, when viewed quantitatively, I believe the real culprit is quantity of small LDL.

No question: The various lipoprotein testing companies need to talk and standardize their definitions. But this does not invalidate the concepts.

Chris Masterjohn is a very bright guy. But on this I disagree. I believe it is wrong to assume that triglycerides and HDL behave in perfect tandem with small LDL. While they do indeed correlate, they do not correlate perfectly and demonstrate independent behavior depending on postprandial phenomena and genetic factors like apo E and apo C.

This has nothing to do with LDL, but I don't know where else to ask this, so I'll dive right in.

I am reading and enjoying your book Wheat Belly, but don't understand why you lump chia seed in with other non-gluten grains to avoid or minimize. .  In my mind it is closer to flax.  Chia is truly an oil-seed and not a grain according to Dr. Coates, the "father" of chia seed research.  I have used it generously, and feel it aids in weight loss.  Chia seed is high in protein and fiber and low in carbs.  Why are you telling us to avoid or limit it?  I feel it is healthier than flax even.

Please, can you clarify your stance on chia?  I was very disappointed to read that in your book.  Other than that, I really enjoyed Wheat Belly, having avoided gluten for a few years now.

P.S.  According to calorieking.com website, 1 oz. raw chia contains 0 carbs and 1 oz. dried chia contains only 1 gram of useable carb.

Not everybody who has good HDL, good TG and eats a low carb paleo diet will have low small particle LDL numbers which is why an NMR LipoProfile is important.  People with gut issues, yeast issues,  H. Pylori or an otherwise compromised liver can have unhealthy LDL despite doing everything right on the diet front.  Getting to the root of these issues is critical to resolving it.

Thanks, Joyce. But I don't remember lumping chia with the bad stuff.

In fact, as you point out, chia belongs with flaxseed as one of the few truly healthy, low-carb foods.

Dr. Davies, on p. 212 of your book, chia is lumped in with other non gluten grains.  Maybe in future editions, the publisher can remove that?

Although I have been gluten free for years, my husband is finally going gluten free..ALL BECAUSE OF YOUR BOOK!  He has some health issues, so for that I humbly thank you.

Also, his next Toastmasters speech will be on "Wheat Belly"...how about that!

Thank you so much for a wonderful book.  Your recipes are awesome.  I look forward to a Wheat Belly cookbook!!!!

There are so many well read and brilliant posters here that I am going to jump in and ask a question totally off topic. This is not Dr. Davis' area of expertise, so I hope others may help.
I do believe I am dealing with a bone/heel spur. Too much treadmilling, trying to increase speed, etc. I have done research on the condition and I read that turmeric, taken 2-3 times a day, is helpful. I just recently began taking D3 as well, 5000 IU a day. Will the Vit D3 help as well?
Any thoughts? No, I am choosing not to visit a doctor for a cortisone shot. I am using NSAIDS for the pain and that works very well.

I've just spotted this post.  Never tried chia and wonder what you thought.  Have your patients reported similar effects?

Nina

We are now seeing more and more people achieve zero or near-zero small LDL with strict carb reduction. The big exception is apo E4 people, who can still struggle because of the peculiar physiologic effects of this pattern

Could you go in to more depth as to what strict carb reduction menas?  Is it no more than 50grams of starchy carbs such as rice or potatoes, or 100Grams?  I am guessing it is individualized, but some range of restricitons with those who have been successful would be helpful.  
I have always had a low level of Trigs- never higher tnah 75 even on a hi carb diet, and was surprised to find the NMR showing all small particles!  So Dr. Davis is right to say low Trgs not always indicative of having large LDL.  Switched to elimination of most carbs and totally changed the profile.  Only issue that is while i produced lots of particles with carb diet, i also produce lots of LDL particles with carb restriction.  Genetics i guess!  I am an ApoE 3/3, which was a surprise.  
Thanks for the good work Dr. D.  Have gotten several to buy Wheat Belly.  It will have an impact!

Nina, I am not Dr. Davis (wish I had his knowlege!), and I hope he doesn't mind me jumping in here, but I leaned about chia a few years ago when I read a book by Dr. Wayne Coates on the subject.  Chia has definitely helped me lose weight.  It is very filling.  When mixed with fluids, the chia seeds expand, and they really help to fill you up.  I've found all sorts of wonderful chia recipes on the web - from Chia "Tapioca" to beverages, etc.  I mix  it into many foods.  I think it enhances their taste.  I feel the chia seeds help with weight loss because of their appetite suppressant potential.  I hope this helped, and my apology to the good doctor for hogging the thread.

Your post doesn't provide a lot of info, but if I were to guess I would say your problem is more likely related to walking/running incorrectly than nutritional (assuming you are in reasonable physical condition).  The human foot wasn't designed to be encased in the heavily cushioned shoes we typically wear today.   As a result many of us don't know how to walk or run correctly.

Some of the better shoe stores will video tape you on a treadmill.  Just seeing the tape may be enough for you to realize what you are doing wrong.  If that doesn't help, there are professionals who should be able to figure out what might be happening.  

Also consider reading "Born to Run" if you haven't already (it's a good read even for non-runners).  It probably won't give you a direct solution, but it may give you some ideas on where to look.  Good luck.

Dr. Davis,
   I am 56 and have a strong history of heart disease in my family. I have been eating low carb for a couple of years... ( around 60 gms carb per day average..no pasta, no potato, almost no grain)  My most recent lipid panel showed LDL of 140. HDL 81, Triglycerides 43, CRP 0.2. .  I requested a test to show size of LDL. My doctor declined to order this, saying all LDL is bad.  Instead I was sent for a heart scan  ( paid out of pocket) and my calcium score was 0.  
  So now I'm trying to lower my LDL by lowering saturated fat.  Hard to do when you eat low carb. I wonder if I might be one of those Apo E 4 types that you mention, so thought I should try,.
  Here are my questions:
     Can I test my LDL size myself, through a home test? Or should I try to find out if I have Apo E 4?
      Do I really need to lower LDL if my calcium score is 0?
Louise

For the last year I have eaten zero fruit, zero grains, zero sugar. Have mostly eaten beef, occasionally eggs cooked in butter. Have done two VAP tests the last year. When I started a year ago, trigs were 115, now 142. HDL was 50, now 46. My LDL did show a change of going from pattern A/B to pattern A.
Any ideas why a diet for a year devoid of fruit, sugar, grains, would show an increase in trigs, and a slight decrease in HDL. If I have Apo E4 would my ldl go from A/B to A.
I have lost 25 lbs. in the past year. Could this be a reason my numbers seem to be off?
Thanks,
Bob

Hi, Bob--

Yes, blood drawn in the midst of weight loss can be very misleading.

Transient effects include increased triglycerides, reduced HDL, even much higher blood sugar. Thankfully, it all gets much better once weight plateaus for a couple of months.

Hi, Louise--

Sad that you have to educate your doctor.

I find it unacceptable that a nice person engaged in health is refused a simple, helpful test. Tell your doctor goodbye and find one willing to act as your partner and advocate in health, not an obstruction.

Yes, you can test it yourself through services like PrivateMDLabs.com. My view is to 1) identify how much, if any small LDL there is, then 2) reduce small LDL with diet. If you have only large LDL, you will absolutely need an LDL particle number by NMR or an apoprotein B to know what the REAL value is.

Thanks for the help, Joyce!

Thanks, Steve.

There are a number of posts on this blog that detail how to gauge individual carbohydrate sensitivity. The best way is to check 1-hour after-eating blood sugars. Second best: count carb with the cutoff being determined individually. Just go back over the past 6 months and you will find several discussions.

Hi, Joyce--

Thank you!

If chia is listed as among undesirable non-gluten grains, that was my error. Remember what Mark Twain said: "Don't read about health, else you might die of a typo."

Thanks for your response Joyce.  

The part that fascinated me was the idea that chia triggers a drop in blood sugars without a pre-spike.  I can't find anything on the net about that and wondered if other people had similar experiences.

Nina

Thanks for the reply Dr. Davis. I have a blood test scheduled six months from now, and hopefully I will see better numbers. My LDL shows pattern A so at least I did see one positive change.
Love your blog. Have learned a lot and it was the reason I gave up grains and sugar. 1 full year, no cheats.

Consider also going barefoot as much as possible - around the house, etc. You don't necessarily have to run barefoot (unless you work into it *gradually* and choose to continue it). I've recovered from heel spurs with stretching my achilles, with emphasis on stretching the soleus, and letting my feet bear my weight without any props underneath. For stretches, Anderson & Anderson have a very good book - Stretching - available on amazon.com. You didn't develop the spurs overnight, and they won't clear that quickly, either. Be patient and work with your body.

You may also wish to consider vitamin K2, very good for ensuring calcium deposition occurs in the correct locations.

Hi Doctor Davis, I talked to your about a year ago and you were kind enough then to comment on my blood results saying there was nothing to worry about - according to the Iranian formula.  I would greatly appreciate if you looked at my new results, they scared my whole family, I certainly am not going to show to the family physician, and I don't even want to think about changing from paleo style of eating to some kind of low fat cholesterol lowering diet, and taking any drugs/supplements. But may be I have to? I am 36 y.o., 5'4 and weigh 104lb.
Glucose 85
VAP TEST:
Lipids
LDL Cholesterol 149!
HDL 130
VLDL 14
CHOLESTEROL, Total 293!
Triglycerides 48
Non HDL Col (LDL+VLDL) 163!
apoB100-calc 96
IDL Cholest 4
Remnant Lipo. (IDL+VLDL3) 12
Sub-Class Information:
HDL-2  35
HDL-3  95
VLDL-3  8
LDL1 Pattern A 3.1
LDL2 Pattern A 26.0
LDL3 Pattern B  71.0
LDL 4 Pattern B  31.4

The ordinary, non-VAP Lipid panel shows:
Cholest TOTAL 279 !
Triglycerides 48
HDL Cholest 144
VLDL Cholest Cal 10
LDL Cholest Calc 125 !

Also, I can't understand how my vit. D can be so low - 29.0, when I have been sun tanning all summer here in Orange County, California, at peak hours. Is there anything that you know of that may inhibit the vit. D conversion from the sun?
Again, I greatly appreciate any insight that you can give me on this situation...

Dr Davis,
  Thank you for your reply.  For now, I found a lab I can go to and get myself tested. Two hours away.. (Oddly, I must leave NY state to get this done due to billing law.). I'm going to do this! Do you agree that my best choice is the NMR?

Hi Gib,

Option 1 will be cutting the saturated fat and cholesterol from the diet in addition to cutting the carbs. I tried eliminating eggs and cheese and my total cholesterol down from 400 to 260. By adding back "one egg a day", it went back to 320 (that's the impact of the dietary cholesterol on me, confirmed twice). I am currrently trying to replacing all saturated fat with mono unsaturated fat (olive+canola), just want to see how big the impact is. I am also going to test coconut oil separately, it is a cholesterol-free plant based medium-chain saturated fat, there is a chance I might respond to it differently.

Option 2 will be taking Statin drugs. I know it has side effects, but that's better than small dense LDL. Based on Dr Davis's previous response, for apoE, sometimes we have to go to Statin for the rescue. (My doc was pushing statin really hard on me, and I have been resisting that for the last year)

otter

Dr. Davis, you are so funny.  We'll take your book....typos and all!  Now...how about a cookbook to compliment Wheat Belly/  PLEASE????

Sorry I missed the link:

http://suzanneloomscreativity.blogspot.com/2011/09/lowering-blood-sugar.html

Nina

Hi Kira,

Just out of curiosity, could you summarize your "paleo style of eating".  I have a good friend of mine who has similar numbers (low trigs, high HDL, high LDL).  I would describe her diet as "low-carb (no sugar, no grains), low-veggie (under 15%), high meat, high sat-fat (particularly cheese, eggs and coconut)".  Is your diet somewhat similar?  I would be interested to know how the two of you compare.

NMR is my preferred method, since it yields the LDL particle number, what I believe should be the gold standard.

Thanks for asking, Joyce! I've had very preliminary conversations with my editor, but nothing firm yet.

In the meantime, in addition to the discussion on this blog, see the Wheat Belly Blog, where I will publish recipes one by one.

Hi, Kira--

You have a surprising dominance of small LDL particles, despite your slender build and lifestyle (LDL 3+4 divided by "real" LDL). This is likely genetically-determined. The means of correcting this is beyond the scope of this blog, unfortunately. You might consider joining the discussion in the Track Your Plaque website.

The vitamin D issue is common, an impaired or lost ability to activate vit D in the skin. It means doing it orally.

Thanks, Bob!

On 50 more years to go!

Dr. Davis. I'm a type 1 diabetic who is on a low carb diet (mostly primal-esque) with only meat and veg. No fruit, no grains, no legumes. I lost 14 kgs in the first three months, then stabalized at around 89 kgs. Granted my fat is going down a wee bit as muscle mass increases (doing the slow burn exercises, plus HIIT training and martial arts). That is the background.

The reason I'm posting here is confusion about cholesterol. I just got my latest results back from the lab, and they are the same. While my HbA1C is 5.3 (not bad), my cholesterol numbers don't look hot. Tryglicerides are fine (as I've stopped losing weight quickly), but HDL is low at 39, and LDL (doctor forgot to put in particle size check, but it cna't be that good as I'm a diabetic) was 150 on the spot. This was measured, not calculated.

I take ~7k miligrams (or whatever the measurement is) of fish oil a day. Well, 7k of EHA/DHA, more in total quanity including inert substances. With my exercise, low carb diet, and fish oil supplements, how is it that my HDL are still so low? Any advice?

Thanks!

Hi, Adam--

How timely! See the next post after the one you responded to in which I discuss the transient effects of weight loss, including drops in HDL that rebound over time.

Also, have you address vitamin D normalization? I aim for 60-70 ng/ml, which usually requires around 6000 units per day (gelcaps or drops only); the HDL-raising effect develops over a year or longer.

Dr Davis,

A pleasure to make your (virtual) acquaintance! My vitamin D, according to my last test (results came in yesterday, as I mentioned) levels are 59. A wee bit low, but not too bad, I think.

I've been consistently 88/89kg for three months (I've been low carb/primal for 6 months total), so haven't lost any weight in the past three months, but still my HDL levels are very low. Do you have any suggestions?

Cheers,

Adam

P.S. I'm pretty sure I've stabalized, as my triglycerides were at 29 or 39 (can't remember off hand, but pretty low). But still I had the low HDL and high LDL?

Hi, Adam--

Of course, you are wheat-free, low-carb in addition to your vitamin D? Omega-3 fatty acids?

Note that doing the diet and taking the vitamin D yield rises over 1-2 years. Patience is required.

Consider a little red wine and dark chocolate, as well.

Thanks for the response! Yes, I am completely wheat free (and was before I read your book, which was excellent). I am very low carb due to the diabetes. My HDL did go from 29 to 39 this last test (after 6 months), so I suppose, as long as maintaining this diet will continue to increase my HDL, I am ok. My concern isn't immediate gratification but more continuous improvement.

I'll come bug you again in 3 months if my HDL doesn't continue to increase

Many thanks!
---Adam

P.S. I've never been accused of not drinking enough red wine While I've been beer free for 6 or 7 months now, I do go through ~2 bottles of red a week.

I'm hoping patience pays, Adam!

Hah! Me too, because if my HDL doesn't start going up I'm gonna freak as I don't know what else to about my numbers. Diet is about as stripped down as it can be, and I'm exercising as much as is reasonable.

--Adam

HI Peter. I would say  that my diet could pretty similar, with the exception that I am still eating some low-glycmic fruit everyday (some cantaloup, grapefruits, berries) and eat lots of veggies.

Dr. Davis, thnx for your reply. I understand this is a blog and it is hard to go into details here, but would you say that it is worth for me to try change this situation by changing the die to using less saturated fat? and would NMR test clarify anything?

PS How do I further discuss this issue "by joining the discussion in the Track Your Plaque website"?

Thnx AGAIN

My numbers are like Bill's.  I was diagnosed as pre-diabetic in February, 2008 (today, I'd have been diagnosed as Type 2; my A1c was 6.5, and my FBGs were 127 and 123).  Started low-carbing shortly after that:  cut out grains, starchy veggies, almost all fruit, all milk (still use heavy cream and eat cheese).   My most recent blood lipids (accounting for some variation, but roughly consistent in pattern over the past three years):

TC:  381
LDL (direct):  279 (291 calculated)
HDL:  80 (was 40 at diagnosis)
Trigs:  52

(At diagnosis, my numbers were:
TC: 281
LDL (direct) 215
HDL: 40
Trig: 142)

I lost 65 pounds in the first 9 months after diagnosis, and, since then, have regained approximately 25 pounds (mostly muscle).  Weight has been stable for months.  My doctor is talking statins, again--which I plan to continue resisting.  I have ordered an NMR test, and will see what it has to say about my particle size.

Hi, Shottle--

Good plan. I wouldn't be surprised if NMR sheds an entirely different light on your values.

They drew the blood this morning.

Dr. Davis, I had my NMR test and the doctor who looked at it suggests that I have familial hypercholesterolemia. My LDL-P 3158
LDL-C 280 HDL-C 58, TGL 105, HDL-P 28.0 small LDL-P 1122,
LDL 21.7, LP-IR-33. I have been on no carb, no sugar, no wheat, or fruit for the last 14 months. Have been eating fatty meat twice a day and also eggs. Before I started eating beef, I was eating low carb, very little sat. fat. I was eating a lot of skinless chicken breast, and canned salmon, veggies, nuts, fruit but almost no beef. My LDL according to the basic lipid test was a little high but not crazy high. My HDL was in mid 30's. and trigs were high. I changed to a high saturated fat diet to raise HDL and lower trigs. I have been taking 1 gram of fish oil 2X daily. Is it possible that the fish oil is having an effect on my LDL? Not sure what to do about my diet. Obviously I won't go back to sugar and wheat but what about all the meat I have been eating. Would it be better to go back to skinless chicken and egg beaters even if it means my HDL going down? Just not sure what to do. Doctor believes I am at high risk since my father died at age 62 of sudden death.
Thanks,
Bob

Hi, Bob--

This is a tough situation that, unfortunately, cannot be remedied diet alone. I hate saying that.

Like people with apo E4, familial heterozygous hypercholesterolemia people are fat sensitive. First order of nutritional business remains carb-restriction to minimize small LDL particles, but you can still show large increases in large LDL with fat intake. If apo E4 is present, too, then even something as great as fish oil can increase LDL measures. However, the dose of fish oil you are using is very small and not a likely factor.

Thanks for the reply Dr. Davis. I know I won't go back to carbs and sugar, but what about beef. I have eaten almost nothing but beef the last 14 months. Would I be better off going back to skinless chicken breast? Egg Beaters, instead of eggs? Olive oil instead of butter? I know in the past when I limited saturated fat my HDL dropped to mid 30's.
Bob

Hi, Bob--

I think we could make a strong argument in favor of variety in diet and that includes meat sources. Yes, I think a broader range of meats (if you eat them; I don't want to sound like a bloodthirsty carnivore; I don't even like meat, personally) is better--fish, shellfish, fowl, pork, as well as eggs.

Results came back today:
TC:  373 mg/dL (ref <200)
LDL-C:  282 mg/dL (ref = 40)
Trigs:  47 mg/dL (ref < 150)
Large VLDL:  <0.7 (ref <=2.7)
LDL-P:  1793 nmol/L (ref = 30.5)
Large HDL-P:  14.2 umol/L (ref >=4.8)
Small LDL-P:  146 nmol/L (ref  20.5)
HDL size:  10.0 nm (ref >=9.2)
VLDL concentration was too low to determine a size
According to the interpretive information:
My HDL-P (total) of 39.1 places me in the lowest category of risk (it is beyone "high")
My small LDL-P places me well below the 25th percentile (while slightly higher than the "low" level of 117), and is indicative of lower risk for CVD
My LDL size places me well above the 75th percentile, and well into Pattern A territory (75th percentile level is 20.6), and is indicative of lower risk for CVD

Correction:  My LDL-C was 282, vs. a reference of " 40"

I give up.  I am typing things in correctly, and the comment system is dropping words (maybe it's interpreting my use of "greater than" and "less than" symbols as markup code?).  My HDL-C was 82.  The reference level is greater than 40.  My LDL-C was 282; the reference level is less than 100.

I see it dropped more information than I thought at first.  No matter, the conclusion stays the same: except for my LDL particle number and concentration, all of my lipid values indicate that I am at lower (or much lower) than average risk of CVD.  Now if only my body takes that to heart . . ..

LDL particle size was 22.1
HDL-P was 39.1 umol/L

Hi, Shottle--

Your values highlight this tremendous void we have in knowing just what to do about nearly "pure" large LDL particles.

In other words, you have lots of LDL particles, but they are nearly all the more benign large variety. What level of large LDL particles are "allowable" before they contribute to atherosclerotic plaque formation? Not known. My preference would be, given the extreme abundance of large LDL, to reduce with statin drug. I hate to say this, but this is the occasional exception in which I believe that statins might indeed be beneficial. This is not to be confused with the general and absurd overuse of the drugs, but an application for a very specific genetic variant.

At last I have had an NMR.  Thank you for the suggestion of PrivateMDlabs.com.  I can recommend this
to others who find their doctor unwilling to order tests.
I am pondering my results, trying to figure out if they are okay, or if I need to cut back on fat now, or go lower with carb reduction. What are your thoughts, Dr Davis?
   LDL Particle Number  1091  ( IS this too high??)
    Small LDL - P    129
      LDL size     21
    Large VLDL - P   < 0.7
       Large HDL - P        12.1
        HDL size           9.7
      LP - IR score    11
Triglycerides are 32  ( lower since I"ve gone completely
grain free since my last lipid panel)

These values are excellent, Louise! The only less than perfect value is the large HDL, but this tends to drift higher very slowly.

Seems particle size doesn't matter as much as particle number. According to Dr. Peter Attia, a particle is a particle.  More than 1000 is a risk factor whether they're small, medium or large and fluffy.