Handy dandy carb index

There are a number of ways to gauge your dietary carbohydrate exposure and its physiologic consequences.

One of my favorite ways is to do fingerstick blood sugars for a one-hour postprandial glucose. I like this because it provides real-time feedback on the glucose consequences of your last meal. This can pinpoint problem areas in your diet.

Another way is to measure small LDL particles. Because small LDL particles are created through a cascade that begins with carbohydrate consumption, measuring them provides an index of both carbohydrate exposure and sensitivity. Drawback: Getting access to the test.

For many people, the most practical and widely available gauge of carbohydrate intake and sensitivity is your hemoglobin A1c, or HbA1c.

HbA1c reflects the previous 60 to 90 days blood sugar fluctuations, since hemoglobin is irreversibly glycated by blood glucose. (Glycation is also the phenomenon responsible for formation of cataracts from glycation of lens proteins, kidney disease, arthritis from glycation of cartilage proteins, atherosclerosis from LDL glycation and components of the arterial wall, and many other conditions.)

HbA1c of a primitive hunter-gatherer foraging for leaves, roots, berries, and hunting for elk, ibex, wild boar, reptiles, and fish: 4.5% or less.

HbA1c of an average American: 5.2% (In the population I see, however, it is typically 5.6%, with many 6.0% and higher.)

HbA1c of diabetics: 6.5% or greater.

Don't be falsely reassured by not having a HbA1c that meets "official" criteria for diabetes. A HbA1c of 5.8%, for example, means that many of the complications suffered by diabetics--kidney disease, heightened risk for atherosclerosis, osteoarthritis, cataracts--are experienced at nearly the same rate as diabetics.

With our wheat-free, cornstarch-free, sugar-free diet, we have been aiming to reduce HbA1c to 4.8% or less, much as if you spent your days tracking wild boar.

Comments (21) -

  • Anonymous

    3/25/2011 3:19:26 AM |

    Dr. Davis,

    Can someone have a good HbA1c but still have an undesirable amount of small particle LDL? ..Like perhaps someone with FHC that has their LDL particles floating around longer in the bloodstream and hence exposed longer to oxidants.

    Thank you.

    John M.

  • Tyler

    3/25/2011 3:51:56 AM |

    I love your blog but I have to clarify on this point. Check out the post by chris kresser: http://chriskresser.com/blog/why-hemoglobin-a1c-is-not-a-reliable-marker/

    a1c is not reliable for many people because of the variation in RBC life length. healthy people's red blood cells may live as over 4 months whereas diabetic's live only as 60 days. This results in vast discrepancies.

    For example my fasting BG averages 77 and postprandial peak is 85-90, but my hemoglobin A1c is 5.7

    This doesn't make sense unless you account for differences in RBC lifetime.

  • Kris @ Health Blog

    3/25/2011 11:45:32 AM |

    I'm wondering what your opinion is of glycation and aging.

    I've been reading that a major part of the aging process might be caused by glycation of proteins in the body, mostly caused by elevated blood sugar.

    Do you believe that practically, one could expect a longer life expectancy to correlate with lower blood sugar levels?

  • Larry

    3/25/2011 12:09:46 PM |

    The other day on the tv show, "The Doctors", they profiled a young woman concerned about her FBG.
    She said that Diabetes ran in her family.
    They did a bloodtest and announced that her FBG was 111.
    The scary part was when they told her that reading was okay.
    With that FBG, one can assume that everytime she eats, her post-prandial FBG is heading into dangerous territory.
    But they told her not to worry.
    She was right about her concern...as Diabetes will continue to run in her family.
    Especially with that advice.

  • Jonathan

    3/25/2011 2:44:03 PM |

    I found Walmart carries a Bayer at home A1c test kit that gives results in 5 minutes.  It came with two test cartridges so I was able to take one when I started lowcarb and another one 4 months later to see how much it came down.  (I came down from 8.3 to 5.2 in 4 months)

  • revelo

    3/25/2011 4:45:55 PM |

    What is HbA1c for those long-lived okinawans with their rice-based diet, or those long-lived cretans with their wheat-based diet?

    Wouldn't a lean healthy body (especially if there is occasional fasting) eventually clean up glycated and otherwise damaged proteins?

  • Might-o'chondri-AL

    3/25/2011 6:22:18 PM |

    Glycation picks on the amino acid valine "wing" on the molecule of haemoglobin's B-chain portion. Aldehydes, both glucose aldehydes and non-glucose ones can become bound to that valine.

    This can occur several ways. Glucose oxidation yields a byproduct, called gly-oxal; this is what most people monitor. In the glyco-lytic pathway called Embden-Meyerhof triose-phosphate drives gly-oxal into the molecule methyl-glyoxal (MG).

    Type 1 diabetics have circulating methyl-glyoxal (MG) levels that are +/- 6 times greater normal. MG is a glycation end product.

    Tyler's comment links to a discussion of fructosamine monitoring. This is from a non-enzyme driven reaction, called Amadori, where fructo-selysine and the fructos-amine 3 kinase cascade generates 3 De-oxy-glucos-ane (3DG); another glycation end product.

    Enzymatic glycation occurs in pathological states. Macrophage activity spins off  the enzyme myelo-peroxidase; this generates hypo-chlorite. Hypo-chlorite pulls in the amino acid serine and then together they cause the formation of certain advanced glycation end-products; namely glyco-aldehyde and glycer-aldehyde.

    Yet another non-enzyme chain of events can generate advanced glycation end products. This is when the molecule per-oxy-nitrite (ONOO-)gets stalled inside the cell and it induces the formation of gly-oxal/gluco-sone/aldehyde molecules that can contribute to glycation.

    ONOO- normally is part of healthy cell signaling. When a metabolic processes is under sustained "stress" it (ONOO-) can't shift the cell function over to what it (the cell) needs to do (in order to adapt and cope). Instead of briefly signalling, signing off and going away ONOO-
    lingers in the cell; a situation that may also be related to ageing.

  • Anonymous

    3/25/2011 7:10:22 PM |

    I wonder if Dr. Davis can comment on situations where carb intake is reasonable and the patient has a decent HBA1c, yet still has higher than normal triglycerides and small LDL?

    My own HBA1c has been in the 4.5-4.6 range, yet my trigs hover around 140-150, and I still have more small LDL than I'd like.

    If restricting carbs doesn't work, D levels normalized, etc. what else could be the cause of higher than optimal triglycerides?

    I know people with HBA1cs in the 5.4+ range, eat many more carbs than I do, yet still have lower trig numbers.

  • Might-o'chondri-AL

    3/25/2011 8:58:10 PM |

    Hi Revelo,
    Vitis vinifera leaf inhibits advanced glycation end product (AGE) formation. That is what many cultures, like Crete, eat wrapped around their cereal grain; we call it Grape Leaves in English (ex: stuffed grape leaves, a.k.a. Dolma in Greek).

    Japan researchers (2009?) took 1 kilogram of dried grape leaves in 20 liters of water and stirred it for 3 hours at 80*Celcius. They administered the decoction in various dosages and found it can reduce the AGE of 3DG (3 de-oxy-gluco-sone) and also a marker of AGE in kidney disease, pentosidine, down to 1/5th the level from that study's AGE control levels.

    The same study experimented with Anthemis nobilis using the same extraction technique detailed above. They propose the active ingredient responsible for the AGE inhibition is the compound called chamaemoliside.

    Chamomile is the name of this plant in English; I suspect it is drunk as a tea in Crete. In the range of AGE inhibitors that they tested Chamomile was better acting than any other; grape leaves efficacy came in second.

    Plants studied that inhibit AGE forming, in no particular order of effectiveness may interest you. These are: Crataegus oxyacantha (English = Hawthorn berry), Houttuynia cordata (English = Chameleon plant) and Astragalus membranaceous (English = Astragalus). Chameleon plant is a regular condiment used in Vietnamese and some south-east asian food; it smells kind of "fishy".

  • revelo

    3/25/2011 9:02:19 PM |

    According to Steven Gundry MD, it is MEAT which is the primary cause of AGE's. (He doesn't cite any references for this in his "Diet Evolution" book.) He recommends Atkin's style low-carb/high-protein to lose weight, then low-fat (15% of calories from fat) as the maintenance diet. He is not too keen on grains, tubers or fruit, but rather emphasizes green vegetables.

  • Tyler

    3/25/2011 9:50:41 PM |

    Thanks for the nice explanations Might-o'chondri-AL

  • Might-o'chondri-AL

    3/25/2011 10:46:23 PM |

    Diabetic nephro-pathy (ie: kidney complication), and kidney disease have elevated AGE. These are monitored as pento-sidine, gly-oxal, methyl-gly-oxal and 3 de-oxy-gluco-sane; which the body tries to excrete as carbonyly compounds.

    Carbonyl compounds are hard to get through the kidney filters and cause an increase in uric uremia, which can be toxic. Too many carbonyls can cause, the so called, "carbonyl stress" of diabetic nephro-pathy.

    Diabetic patients' kidneys eventually can't excrete enough sodium (Na); and that contributes to the high blood pressure (hyper-tension) diabetics tend to suffer from.

    Ketones merit mentioning too. One of the markers for AGE in the kidneys is N-carb-oxy-ethl-lysine; which may (or may not) be a side effect of ketones. Type 1 diabetics do show elevated ketone levels incidently.

    I am not able to offer any perspective on ketogenic diets and AGE however. However, vitamin C is known to decrease ketone bodies. (In the previous post, "Battery acid ...", more
    diabetic responses to vitamin C appears among the comments.)

  • Anonymous

    3/26/2011 4:46:17 AM |

    I've been eating low-carb (basically paleo) for the last 4-5 mo and just got my lipid panel results.  They sky-rocketed.

    Cholesterol 300
      
    Triglyceride 150  
        
    HDL          33
        
    LDL             237


    Every number got worse.  The part that really sucks, is that the diet makes me feel great and nearly all my body fat is gone.  I'm 37, 5'11, 180 lbs and probably about 9% body fat.  Now I'm wondering what kind of trade-off I'm making.  Any thoughts, doc?

  • Peter

    3/26/2011 12:55:22 PM |

    Testing different foods one hour after meals, it seems like a good rule of thumb for me is that each ounce of carbs raises my blood sugar about 10 mg,and that the kind of carb doesn't matter nearly as much as the quantity.

  • Might-o'chondri-AL

    3/26/2011 6:31:09 PM |

    Paradoxical low carb yet relatively high HbA1c & higher carb but relatively lower HbA1c is reported by Annon. Doc assuredly deals with cases like these and has to resolve their enigma one by one.  

    The gene HFE (human hemochromatosis protein, nicknamed High Fe  where iron = Fe)can have a variation (reference code = HFE rs1800562). This variation is seen in +/- 5% of Caucasians, but is not found in East Asian nor African genes.

    More hemoglobin is in circulation for those having this HFE genetic variation. In this case, the same amount of blood sugar that can contribute to glycation of hemoglobin has more hemoglobin surfaces to glycate. Think of it as the glycation has to spread itself thin; the dilution of it's effect makes the % of Hb1Ac less (ie: lower Hb1Ac % measured in the blood sample).

    On the other hand, genetic variation rs855791 of the gene TMPRSS6 (trans-membrane protease, serine 6)is implicated in anemia. In these individuals Hb1Ac readings range higher; there is less hemoglobin relative to the glycation potential in their blood stream. Think of it as the relatively low proportion of hemoglobin which has to bear all the glycation burden
    (ie: Hb1Ac % is higher in their blood sample).

    Anemic (hemolytic) tendency is also driven by variation of gene HK1 (hexo-kinase 1). This enzyme modulates how glucose inside the cell goes through  it's processing pathways.

    This gene (HK1) codes for the unique iso-form of erythrocytes; erythrocyte configuration can figure in to low hemoglobin. In other words it is also a factor in high Hb1Ac readings; glycation potential in the blood over burdens the limited amount of hemoglobin around.

  • Dr. William Davis

    3/26/2011 6:34:23 PM |

    In response to several questions about the potential disconnect between small LDL/triglycerides and HbA1c: Yes, there are people in which one measure is more resistant. It varies based on the mix of underlying genetic predispositions, so it's hard to generalize.


    Might-o'-chondri-AL--

    Great discussion. Thanks, as always. You bring an incredibly sophisticated perspective!

  • Dr. William Davis

    3/26/2011 6:35:48 PM |

    Jonathan--

    Spectacular! And within an unusually brief timeline for HbA1c.


    Revelo--

    Might-o'chondri-AL is referring to endogenous glycation. You are citing a discussion about exogenous glycation, two separate phenomena.

  • Might-o'chondri-AL

    3/27/2011 1:31:59 AM |

    Might Jenny's observation and Nigel's study reference be reconciled somewhat ? I'll tag on my disclaimer of being unqualified to judge low carb or specific diets; since I've never struggled with weight or diabetes, and am not a doctor.

    The study Nigel linked was done with all Kuwaiti subjects. In that country co-sanguinity in marriage is practised by +/- 54.3 % of Kuwaitis. And 1 in 5 are reported to be diabetic.

    The data is very admirable; my suggestion is that the data trend may not exactly transfer to a modern Caucasian population; which is essentially interbred from migration and war (rape). This may be why Jenny sees a +/- 6 month plateau among her respondents and the co-sanguine Kuwaitis saw changes continue for a year +.

    Genetic poly-morphisms influence fasting glucose (GCK, G6PC2 and MTNR1B), are implicated in Hb1Ac, triglyceride levels, HDL levels & so on. That said, I personally would try the low carb approach if I was diabetic.

  • Might-o'chondri-AL

    3/27/2011 1:32:47 AM |

    oops posted this in wrong thread

  • Anonymous

    3/27/2011 3:12:44 AM |

    Re: Anonymous with Cholesterol 300,  Triglycerides 150,  HDL 33 ...

    Suggest you try a technique many dieabetics find helpful to understand food consumption influence on their blood sugar profile,"eating to your meter".
    For a few days, record your blood sugar level immediately before eating a "normal" meal, and then after the meal get 1-hour and 2-hour post-meal blood sugar readings. Separate meals by at least 4 hours. Concentrate on monitoring your main meals and ignore snacking for the first go around. Better however, if you can actually avoid all snaking during period of the testing. Also you will want to add to your journal the foods, ammount consumed, and time it was consumed. If post-meal blood sugar values are high, then to determine a pattern folllowing a meal do a series of hourly post-meal readings until you reach 85 mg/dL or so. As a graph, these results should be helpful to you. Expect that the results will be revealing to you with unexpected high blood sugar values even after following a paleo diet. And if so, it does mean that paleo is not for you, only that you need to more discriminating in what and how much you actually consume.

    I would be interested in hearing about your findings. By the way, you did not mention the blood glucose or HbA1c results of your recent lab tests.

    My regards and good luck ... spo

    BTW: practice good technique with the finger sticks. Do a quick but good hand wash using soap and a warm water rinse prior to a stick. Dry hands well. Dont squeeze hard at the site to encourage blood flow. The original stick should be sufficent to raise a drop of blood for the test strip. Using alcohol swabs and changing out lancets is not necessry when only working on youtself. Keep the test strip vial tightly closed other then when removing the current test strip. If you encounter an "extreme" value, retest for confirmation but clean hands again prior to the retest. My experiences regarding unexpected readings seems to usually invovle hand and finger contamination of some form.

    Finally, on Amazon.com I am able to purchase unexpired test strips in 50 strip lots for my old AcuCheK Confort Curve meter for less than $0.16 or so a strip and often with free shipping. You just have to broswe around a bit.

  • Jonathan

    3/30/2011 2:47:32 PM |

    @ Anonymous with 300 TC
    I would say it could possibly be your liver cleaning itself out (it could have been getting fatty).  The higher Trig might be a sign you are getting too many carbs from somewhere (at least till your sugar stores empty some and insulin sensitivity goes back up) but it could be the liver cleaning out as well.  I think HyperLipid posted something about this once.

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Second heart scan and heart attack risk

Second heart scan and heart attack risk

At first, Joe felt disappointed, defeated, and frightened. After his heart scan, a radiologist at the center told him that his score of 264 was moderately high. He told Joe that he was at moderate risk for heart attack and that a nuclear stress test was going to be required.

This left Joe feeling confused. After all he'd had a heart scan 18 months earlier and his score was 278, 5% higher.

I reassured Joe that the radiologist had not been aware that Joe had a prior heart scan. The radiologist didn't know that Joe's heart scan score had actually been reduced.

In fact, Joe's risk for heart attack was not moderate--it is now very low, since his score was 5% lower. While growing plaque is active plaque, shrinking plaque is inactive plaque and thereby at far less risk for heart attack.

I wrote about this phemonenon in a previous Blog: When is a heart scan score of 400 better than 200? at http://heartscanblog.blogspot.com/2006_09_01_archive.html. When you've had more than one scan, the risk for heart attack suggested by the score takes a back seat to the rate of change of your score. In other words, even though Joe's score of 264 represented a moderate risk (of approximately 3% per year, roughly 30% over 10 years), this no longer held true, since it actually represented a 5% decrease over a previous score.

Joe's risk for heart attack is probably close to zero. ALWAYS view your second (or any subsequent) heart scan score in the context of your previous score, not in isolation.

Track Your Plaque newsletter subscribers: We will detail more of Joe's story in the coming January 2007 newsletter. If you'd like to read or subscribe to the newsletter, go to http://www.cureality.com/f_scanshow.asp.
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Why wheat makes you fat

Why wheat makes you fat

How is it that a blueberry muffin or onion bagel can trigger weight gain? Why do people who exercise, soccer Moms, and other everyday people who cut their fat and eat more "healthy whole grains" get fatter and fatter? And why weight gain specifically in the abdomen, the deep visceral fat that I call a "wheat belly"?

There are several fairly straightforward ways that wheat in all its varied forms--whole wheat bread, white bread, multigrain bread, sprouted bread, sourdough bread, pasta, noodles, bagels, ciabatta, pizza, etc. etc.--lead to substantial weight gain:

High glucose and high insulin--This effect is not unique to wheat, but shared with other high-glycemic index foods (yes: whole wheat has a very high-glycemic index) like cornstarch and rice starch (yes, the stuff used to make gluten-free foods). The high-glycemic index means high blood glucose triggers high blood insulin. This occurs in 90- to 120-minute cycles. The high insulin that inevitably accompanies high blood sugar, over time and occurring repeatedly, induces insulin resistance in the tissues of the body. Insulin resistance causes fat accumulation, specifically in abdominal visceral fat, as well as diabetes and pre-diabetes. The more visceral fat you accumulate, the worse insulin resistance becomes; thus the vicious cycle ensues.

Cycles of satiety and hunger--The 90- to 120-minute glucose/insulin cycle is concluded with a precipitous drop in blood sugar. This is the foggy, irritable, hungry hypoglycemia that occurs 2 hours after your breakfast cereal or English muffin. The hypoglyemia is remedied with another dose of carbohydrate, starting the cycle over again . . . and again, and again, and again.

Gliadin proteins--The gliadin proteins unique to wheat, now increased in quantity and altered in amino acid structure from their non-genetically-altered predecessors, act as appetite stimulants. This is because gliadins are degraded to exorphins, morphine-like polypeptides that enter the brain. Exorphins can be blocked by opiate-blocking drugs like naltrexone. A drug company has filed an application with the FDA for a weight loss indication for naltrexone based on their clinical studies demonstrating 22 pounds weight loss after 6 months treatment. Overweight people given an opiate blocker reduce calorie intake 400 calories per day. But why? There's only one food that yields substantial quantities of opiate-like compounds in the bloodstream and brain: wheat gliadin.

Leptin resistance--Though the data are preliminary, the lectin in wheat, wheat germ agglutinin, has the potential to block the leptin receptor. Leptin resistance is increasingly looking like a fundamental reason why people struggle to lose weight. This might explain why eliminating, say, 500 calories of wheat consumption per day yields 3500 calories of weight loss.

And, as in many things wheat, the whole is greater than the sum of the parts. Despite all we know about this re-engineered thing called wheat, eliminating it yields health benefits, including weight loss, that seem to be larger than what you'd predict with knowledge of all its nasty little individual pieces.

Comments (32) -

  • Dee Miles

    10/1/2011 4:30:14 PM |

    I'm very interested in the leptin research and hope that it can help people figure out how to overcome their hurdles to weight loss. In your experience can someone correct the leptin resistance with diet? I've been grain and sugar free for 11 weeks and have even energy all day. No more cravings and eat pretty much only when I'm hungry (4-5 hours between meals). The weight loss is slow but I realize that being 43, hormones probably play a role as well.

    Thanks for doing what you do to help educate others on this topic.

  • Frank Hagan

    10/1/2011 6:04:31 PM |

    Great post, Dr. Davis.

    I blogged on leptin resistance at http://goo.gl/4lHbi, but my primary interest was the effect of high triglycerides due to a "standard American diet". There is some evidence that the high triglyceride levels block leptin from crossing the blood brain barrier and therefore prevent it from signaling that you have had enough to eat. In my own experience, going low carb eliminated the constant hunger I faced when I was 40 pounds heavier (and my trigylcerides were at 440).  Going low carb meant that I effectively eliminated wheat, as I eliminated nearly all bread, etc., and focused on animal protein and  green veggies exclusively. The effect happened very quickly, within a week, so I wonder if the wheat lectin was a factor here as well.

  • Howard Lee Harkness

    10/1/2011 9:52:54 PM |

    When I eliminated wheat from my diet in 1999 as part of my low-carb liftestyle chage, my arthritis went away (that alone provided more than enough motivation to stick with the diet for over a decade now), and I dropped 100 lbs with practically no effort. The problem is that I needed to lose *150* lbs, and that last 50 lbs refuses to budge, even on a low-carb diet. I'm beginning to wonder if I have permanently damaged my metabolism. I've noticed that I can drop about 10 lbs, and my morning body temperature goes below 80F, and eventually, I gain the 10 lbs back.

    Your advice?

  • Dr. William Davis

    10/2/2011 2:39:14 PM |

    Hi, Howard--

    This sounds an awfully lot like a thyroid issue. While I doubt that your temperature actually drops to 80 degrees F (since that is fatal), low temperatures can signal hypothyroidism. This can easily throw you off your weight plateau.

  • Dr. William Davis

    10/2/2011 2:40:55 PM |

    Hi, Frank--

    The wheat lectin-leptin connection would indeed explain many things, especially why hunger drops and weight drops so quickly when wheat is eliminated, far larger effects than can be accounted for simply by wheat's carbohydrate content.

  • Dr. William Davis

    10/2/2011 2:43:07 PM |

    Thanks for the feedback, Dee!

    Yes, you can correct leptin resistance with diet, though the effects are highly variable. In general, however, weight correlates quite cleanly with leptin serum levels.

    A tougher question is how to deal with leptin resistance that somehow causes a weight loss effort to stall. A discussion for another day!

  • Olga

    10/2/2011 4:07:23 PM |

    Hi Dr. Davis:
    Have you seen this new study?
    http://www.ncbi.nlm.nih.gov/pubmed/21943927

  • Geoffrey Levens, L.Ac.

    10/2/2011 8:02:23 PM |

    So what the heck does this mean?  Eating wild caught and pastured meats and non starchy veg as almost my only food (added coconut and olive oil), rarely a piece of fruit, I weighed 138 lbs.  As soon as I switched to an all plants, whole intact grains and potatoes and sweet potatoes based diet my weight dropped to 125 with zero change in activity level.  I have since switched most of the grains and potatoes for legumes and by more strenuous working out seem to have lost "hidden" fat and converted it to muscle.  Still at 120 but much more muscular...  This seems to be the opposite of what you espouse as  eat approximately 280 grams of carbs/day though probably 800 or so calories less than when I was eating meat, fat, and non starchy veg... Am I just an anomaly?

  • harlan

    10/3/2011 1:24:20 PM |

    Is it possible that eliminating proteins resulted in the loss of muscle?

  • Kim D

    10/3/2011 7:33:40 PM |

    A question for you Doc,

    Hoping you can give me some clarity on the genes issues of Celiac disease.  I have long suspected that I was wheat intolerant.  I suffered severe constipation since my teens, was laxitive dependant for lots of year taking handfuls a night just to be "regular".  I was able to get off the laxitives after 20 years by grinding my own wheat (and other grains).  It made all the difference in the world getting off pre-packaged foods, and dairy ( I am EXTREMELY dairy intolerant).  However, I never got "better".  I now know from your book that switching from a bad thing, to a less bad thing is not the answer, is advantagous, but still not the best .

    I have known deep down inside that something was wrong with wheat because I am like a heroin addict when I eat it... I cannnot get enough, but since it did help me get off the laxitives, I kind of argued with myself over it my having "real" systemic issue with it.  My other health issues.. skin rash (chronic) which looked and felt like DH, dermititis herpetiformus.  Dermatologist said biopsy was not going to be 100% sure to diagnose it, so I should just get the gene test to see if I had DQ2 or DQ8.  My tests came back negative to both... but I still had a terrible chronic rash for going on 15 years on my legs, lower back and occasionally my torso, like a mirror, effecting both sides of my body in the same areas.  Dermatologist just shrugged and said he couldnt tell me what it was, but he put me on dapsone, and it cleared.  I finally had relief for the first time in a long time, but couldnt stay on the dapsone, due to liver enzyme issues.

    Now, years later, and more health issues like osteoarthritis in my hands and spine and rib joints, BTW, I am only 43!!  I wind up back to questioning the wheat!!  When I found that you had written Wheat Belly, I thought, "maybe he knows something about wheat that I have been unable to find out"!?  After I read it (2 weeks ago) I immediatly changed my diet to a totally gluten free one.   ( we do not eat GMO's, and eat lots of veggies, green smoothies ect.. but I didnt realize just HOW genetically altered our wheat was.)

    I am NOT an "undiagnosed" celiac for sure, as I do NOT have the DQ genes.  The biggest change I feel from being off the wheat is less drive to eat like a maniac.  I have not had any "health" changes, but it has only been 2 weeks.  I unfortunately am noticing the constipation creeping back up though, when I am off the milled wheat.

    In your book, you seem to be speaking largely to people who have been told they do not have Celiac disease due to being misdiagnosed, or told they were NOT celiac due to false blood test results, or lack of proper biopsies...  What is y our opinion of serious immune system/ health issues happenning to folks like me, who are DQ2,DQ8 negative?  I know people WITH those genes can be reactiing (immune system) to wheat even if they are NOT actively in a Celiac disease state... but what about those of us who are not even ever going to get celiac?

    I hope my questions dont sound stupid, perhaps I need to read the book again, or I just missed this specific issue of  where we, who are without the celiac genes, fit into this picture.  Could it be that there are other genes that we dont know about?  Or, are the genes simply irrelevant, due to the fact that the gluten content, and other harmful proteins and lectins are just so out of proportion to natural unmodified wheat?
    I know for sure that my addiction is real, and has caused me much yo yo dieting in the past, never able to lose this pesky 30lbs, because once I eat a slice of toast, or a whole wheat muffin, I become like ravenous beast, who cant stop eating!!  I do know also, that to only be 43, and have such health issues already, that something has to be wrong...  Perhaps years of laxitives have injured my system... glad to have been off of them for 5 years now, but I really think your book has surely pointed me in the right direction of getting off the dwarf wheat!

  • Dr. William Davis

    10/4/2011 2:44:29 AM |

    Hi, Kim--

    There is plenty more to this thing called wheat than "just" immune phenomena. I believe it is pure folly to believe that all potential adverse effects of wheat can be identified via HLA DQ markers or celiac blood markers. There are just too many undesirable components of this thing that are not identified with currently available blood tests.

    You could be HLA DQ2 or DQ8 negative, with negative celiac markers, yet still have life-threatening disease reversed with wheat elimination.

  • Dr. William Davis

    10/4/2011 2:47:01 AM |

    Interesting, Olga.

    If we were to extrapolate this to us hairless mice, it means that an extreme low-carb restriction makes it MUCH harder to express diabetes.

  • smgj

    10/4/2011 1:49:57 PM |

    1) Only rectal temperature readings should be considered accurate. With other types of readings you have a certain heat loss - most for armpit readings, less for under tongue.
    2) You should look into euthyroid sick syndrome/reverse T3 which is a possibility if you drop the carbs all the way...? Some research suggests that we should leave about 50g carbohydrates in the daily allowance to avoid this possibility.

  • Barb

    10/4/2011 6:07:06 PM |

    Hi Dr. Davis!

    First of all, I have to say that I love your book! The information is a God-send and the way that it is presented is clear with just enough humor to be riveting (at least, for a nerd like me).

    I have a question tho’, and I hope that I am not being repetitive or redundant. All I hear and read is that by cutting wheat from the diet, a person can expect weight loss. I have read wonderful testimonials from people who have cut wheat and have lost 50 pounds in 6 months without doing anything else (exercise or caloric restriction).

    But, this does not work for me. My diet is quite strict paleo since last spring (a la Robb Wolf). I eat NO grains (including quinoa or buckwheat or other “grain-ish” items). No dairy with the exception of cream in coffee (about 3 to 4 cups per day). No peanuts, legumes or beans. No rice, potatoes, corn or peas.  No fruit (again, at Robb Wolf’s suggestion that people who need to lose should eschew fruits until their goal is reached). Of course, nothing processed, no sugar and artificial sweeteners are kept to a minimum. I drink water as needed.

    I eat nuts and seeds, eggs, all meats, fish and seafoods, green and colourful vegetables as well as coconut products (oil, milk and meat), avocados, fish oil and olive oil.

    I am 43, and feel great as long as I eat this way. I am not celiac and have not been diagnosed with any medical problems by my doctor (MD). I do however have a strong family tendency towards DMT2. So far, I seem to be OK there, but do suspect insulin resistance due to physical features. I do notice that eating grains results in stomach upsets, water retention, RAPID weight gain, mood swings and a wicked distended belly (I have been congratulated on my pregnancy... LOL!)

    I am very careful about my food intake, so I know that there are no hidden grains, sugars, etc. slipping in. This is very easy when you don’t eat anything processed. I take in, on average, about 1500 calories daily, and currently work out with weights 3 times per week. In the past, I have tried doing tremendous amounts of cardio... Again, no real results.

    I also see an ND, and he has recently requested a saliva panel to check my adrenal hormones, notably AM DHEA’s, Cortisol Curve = C1,C2, C3,C4. I am 5’6” tall and weigh 190 pounds and gain weight mostly in the mid section. I obviously need to lose weight, but everything I try results in a small weight loss (< 10 pounds), followed by a frustrated week or 2 off of my diet, which only results in a big weight gain. Seriously... I went to Mexico for 10 days a year ago. I ate and did the same as everyone else. I GAINED 15 POUNDS. Everyone else’s weight stayed the same, or showed a very small gain... only about 3 pounds.

    My regular doctor, when presented with this information shrugged his shoulders and said, “Weight loss is hard.” I am getting seriously stressed about this... This can’t possibly be normal. Close family and friends have observed and made comments like, “The way you eat and work out, you should have a near perfect body!”
    I know that you would require much more detailed information about me, but is there anything that is striking to you, or have you encountered this before? Any info that I can pass along to my MD or my ND would be so much appreciated!

    Barb

  • Roberto

    10/4/2011 6:23:32 PM |

    Dr. Davis,

    Mat Lalonde gave a speech at the ancestral health symposium called "An Organic Chemist's Perspective on Paleo" - it was mostly about bad science circulating in the Paleo community. In his speech, he mentions an interesting study that demonstrates that wheat germ agglutinin is completely destroyed in the cooking process - literally not a trace is detectable. I can't provide you a reference, because none was given, naturally, during the speech. Perhaps you could get in touch with him and get the reference. I will try myself, and get back to you if I am able to. But if that is true, I seriously doubt WGA is relevant to weight gain, because I can't think of a single wheat product that people eat raw.

    Nor do I believe that the high glycemic index of wheat is a cause of weight gain in people with healthy metabolisms. Numerous cultures have been found in great health eating high glycemic index carbohydrates such as potatos. So I find it a little hard to believe that the glycemic index of wheat initiates metabolic derangement and weight gain.

    As far as your 'cycles of satiety and hunger' and 'high glucose and high insulin' points, those too would indicate a problem with carbohydrate in general, not just wheat. So I would think 'carb belly' would be a more intellectually honest title to your book. Especially, when one considers that you improve most of your patient's health with a low-carb diet - not too mention the supplements and exercise you recommend.

    Also, Stephan Guyenet recently wrote a post outlining why insulin levels have nothing to do with fat mass.
    http://wholehealthsource.blogspot.com/2011/08/carbohydrate-hypothesis-of-obesity.html
    He presents very convincing arguments. Having read it, I personally am not swayed by your claim that wheat promotes weight gain by greatly increasing insulin levels - I dount anyone one who read that article is. He presents far more evidence that insulin levels are not relevant to weight gain than you do claiming they are. Given your claims, I think you are obligated to respond to this article.

    This post offers nothing to single wheat as a unique cause of weight gain.

  • Roberto

    10/4/2011 6:54:46 PM |

    Also...
    I recently had a debate with Tom Naughton regarding the validity of your claims. I made the following points: You claim that wheat is the greatest cause of weight gain, and removal of it from your patient's diets has yielded incredible results. But you don't treat your patients with simply a wheat-free diet. You place your patients on a low-carb, vegetable oil free, refined sugar free, processed food free diet. You also prescribe very important supplements, like omega-3 and vitamin-d, which have been shown to be beneficial independent of other changes. There are innumerable uncontrolled variables in your lifestyle recommendations - far beyond wheat removal - that could be bringing these results.

    Tom's response to me was that you have had an undisclosed (by him) number of your patients try eliminating wheat alone. Apparently, you still saw improvements. Once again, the level of improvement remained undisclosed by Tom. I would like to know how many of your patients you had advised to just eliminate wheat, and what improvements you saw. Of all the patients you've treated, if 99% have undergone your complete recommendations, it is absurd to use their improvements as a case against wheat when you have left countless uncontrolled variables.

    If you have seen improvements with strictly wheat elimination, that too cannot be effectively used as a case against wheat. Eliminating wheat creates far-reaching changes in ones diet that go beyond simply eliminating wheat. The vast majority of highly-palatable, engineered, processed junk food becomes inaccesible. No more doughnuts, no more McDonalds, no more cake. That alone is very significant. Also, when you advise your patients to eliminate wheat alone, I seriously doubt they carried on eating wheat-free junk food like deep-fried factory farm chicken wings, ice cream, and french fries in abundance. They likely embraced a healthier diet altogether that happened to disclude wheat.

  • Dr. William Davis

    10/5/2011 1:37:23 AM |

    No doubt, Roberto. The majority of real world patients in my clinic, as well as the online experience, have followed more than a wheat-free diet. Anecdotally, the people who have followed low-carb yet included wheat continued to experience issues like acid reflux, persistent small LDL, high HbA1c, etc. But anecdotal experiences cannot be used as sole proof.

    If you've read the book, you will see that there is much more to this argument than my anecdotal experience. The fact that overweight celiac patients, for instance, lose on average 26 pounds in the first six months while not restricting calories, fats, polyunsaturates, etc. is among the arguments that are consistent with this proposition, that wheat underlies many health problems, including overweight.

    No doubt: We need more data to fully document the full range of health effects of this incredibly unhealthy creation of geneticists.

  • Dr. William Davis

    10/5/2011 1:39:33 AM |

    Noted. I disagree.

    Do one thing: Eliminate wheat. Do not limit calories or portion size.

    Weight drops, usually at the rate of one pound per day. I can speculate why and I believe it is partly due to the unusually high glycemic index/insulin triggering. It might be the effects of wheat lectin on leptin receptors. But it is a very real effect.

  • Dr. William Davis

    10/5/2011 1:42:41 AM |

    Hi, Barb-

    The most common weight confounder I see is low free T3 values, i.e., low T3 thyroid hormone.

    Assess this by checking free T3, as well as reverse T3, along with TSH and free T4. I aim to keep TSH, by the way, 1.0 mIU or lower to maximize weight control, and keep free T3 and free T4 in the upper half of the quoted range, higher for T3 if reverse T3 is high.

    The cortisol curve can also uncover high cortisol levels that can counteract the effects of your otherwise excellent diet.

  • Roberto

    10/5/2011 3:49:21 AM |

    "Weight drops, usually at the rate of one pound per day."

    I'm having a very tough time envisioning that, especially if a person eliminates wheat without altering calorie intake and portion size. Let's assume the average sedentary obese person requires 2500 calories a day - a reasonable estimate I would say. If they stopped eating completely, a 2500 calorie deficit would amount to less than 3/4 of a pound weight loss per day. So how could they possibly maintain portion size and lose an entire pound per day? Perhaps if wheat was causing them sever water retention, and avoidance of wheat remedied that and led to massive amount of weight loss from water. But I doubt that is what you meant.
    Did you mean to say a pound per week?

  • Barb

    10/5/2011 6:09:05 AM |

    Thank you so much Dr. Davis!
    I will take this information in to my docs... I have a feeling that I will get further with my ND than I will with my MD.

    Thanks so much, and do not be discouraged by the naysayers. Cognitive dissonance can be a very unpleasant thing!

    Barb

  • Dr. William Davis

    10/5/2011 12:11:19 PM |

    Nope. Literally a pound per day. I know it sounds crazy.

    I don't know why. It certainly defies the "calorie in, calorie out idea." Calorie intake drops, on average, only 400 calories per day, so why would someone lose the equivalent of 3500 calories? It is definitely partly water weight, but there is a visible loss of abdominal fat for most people.

    It's not everyone, of course, but a substantial proportion of people.

  • tammy

    10/8/2011 10:14:48 PM |

    I was diagnosed with PreDiabetes in August and having a rough time Changing from eating Carbs, like that Bagel you referred to or a few cookies a day, to High Fat and High Protein. I am underweight and Still have around 7 pounds to gain  before I am at my goal. I have only My Diabetic MD who by the way is Diabetic Herself, Promoting me to Give Up the Grains and roots. All other MD's on my team have been against this saying that I am on the Cusp of Prediabetes at 5.7 and should not worry about it. I want to PREVENT being Diabetic, not come to them AFTER the fact. By the way, I have very HIGH cholesterol, so what you are saying sure seems to go right along with my Diabetic. MD. I feel torn because I know I need to gain weight and How Possibly DO I GAIN WHEN I LEAVE OFF FOODS THAT WILL HELP ME GAIN? Please respond if ANYONE has any advice. I am OPEN TO LISTEN.  I also dont feel the best after eating Sugars, but Crave them. Once I eat them, then I feel worse. CYCLE BEGINS AGAIN.

  • Dr. William Davis

    10/9/2011 11:03:38 PM |

    Hi, Tammy--

    Tough situation.

    While slashing carbs will reduce HbA1c and blood glucose, the fact that you are underweight yet still diabetic raises some unique issues. This may not be the run of the mill diabetes, but another condition such as the so-called late-onset diabetes of adulthood, a form of diabetes with features that overlap with type 1. So the comments directed at the very common overweight type 2 may not fully apply to you.

    Let us know what you learn.

  • Andrew

    11/3/2011 2:51:27 PM |

    Dr D

    I was wondering when you advise to eliminate wheat, does the same go for oats and oat bran too? Does this effect prediabetics the same way as wheat. I am very interested in your response.
    thank you

    Andrew

  • Dr. William Davis

    11/4/2011 12:49:57 PM |

    Hi, Andrew--

    The problem with oats is somewhat different: It is a blood sugar and carbohydrate issue.

    If you were to check a blood sugar 1-hour after a bowl of unsweetened whole oats, you would see sky-high blood sugars. So we do not include oat products in any form in the diet.

  • Andrew

    11/4/2011 2:29:36 PM |

    Here I was thinking that oat bran for breakfast was a good choice. Thanks Doctor D for the response

  • N

    11/7/2011 4:26:30 AM |

    Hi Doc,

    While I've significantly reduced the amount of carbs/wheat I eat, I often still find myself in situations where I can't avoid it (out with coworkers, and the run, etc).

    My resting blood glucose was a little high on my last physical (105), so I want to keep an eye on things.

    My question is this:   If you are stuck eating a meal that is going to spike your blood sugar, when would be the best time to take a 15-30min walk to try to help your muscles absorb some of the glucose?  I know insulin peaks around 90min afterwards or so.

    Would I be better off walking immediately after eating (to start the glucose absorption right away), or delaying around an hour and then walking?

  • David German

    11/16/2011 4:07:33 AM |

    Could there be a beneficial increasing metabolic rate accounting for at least some of this weight loss? I used to be able to eat untold numbers of calories when I was (much) younger, without gaining weight. Quite a typical situation.
    Now, if I could just get that quicker metabolism again  Smile

  • David

    11/16/2011 4:57:06 AM |

    Question - so, if I eliminate the modern wheat you are talkiing about, what about some of
    the other grains that are being used? For example:
    "Ancient grains", such as kamut and spelt. They taste great and if they are truly ancient grains
    they wouldn't have the integral problems.

  • Gary Mullennix

    3/8/2013 1:46:27 PM |

    I've lost 52# and maintained the loss for 16 months. My total cholesterol went from 243 to 285. My HDL went from 58 to 91. Doctor wanted to put me on a statin. I said no because I don't tolerate them (muscle pain and very poor test results) and wanted a diagnosis of CHD if I was to undergo medical treatment for that condition. A coronary calcium scan showed 0 in 2, a 100 in one and 329 in the left anterior descending. Cardiologist ordered nuclear and treadmill stress tests with neither showing any restrictions in flow or supply to the heart. So, he says to exercise vigorously 5x week/1hr daily and exercise is 70% of my treatment, diet 20% and medication would be 10% if I took the statin which I am not.  Neither my Doc or the Cardiologist knew what the VAP scores of the fractionated LDL scores meant (117 1-2, 43 3-4) but the both recommended a low fat diet and the cardiologist told me to buy and follow Dean Ornish's newest book Spectrum.
    1. Are all fractionated LDL tests of the same quality or is there one best?
    2.  Why is this called a disease and not a condition?  How am I to know if any treatment is proceeding successfully other than I'm not dead?  
    3. Years ago a physician put me on a synthetic Throid supplement to eliminate the possibility of thyroid cancer since he thought he could feel the thyroid and I had been treated with X-Ray to the head in 1946 for ringworm. My TSH scores have remained within the boundaries pretty well although my T4Free was 244.  Any comment.
    4. I was diagnosed 33 years ago as being hypoglycemic and carried sugar with me to treat low blood sugar while exercising etc.  my CRP score is just over 1, well within the test limits of the tests I take. But that is 2x your recommendation of no more tham .5. BTW, since low carb, I've not had low blood sugar event and my tested glucose runs 90.  Is it likely that this hypoglycemic condition related to inflammation and arteriosclerosis?
    5.  I'm taking antioxidant supplements, lumbrokinase, L-Carnitine, no flush Niacin, Vit D3 (6000 IU)
    6.  I'm 73, no illnesses of consequence, blood pressure of 105/65.  I live in Naples FL. There are no cardiologistts I've heard of down here willing to discuss any regimen other than low fat and statins along with exercise. Do you have a colleague within 200 miles?  

    Thank you for your work. I think my promoting your work along with Gary Taubes has caused a 500 lb weight loss for me and our friends and a nice, fat increase in HDL.

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