Category Archives: Coronary Heart Disease

Wheat Belly Book Review

Wheat Belly

About the Author

Dr. William Davis is a practicing cardiologist in Milwaukee, WI with over 25 years of experience treating patients. Dr. Davis has impressive credentials: he is a graduate of St. Louis University School of Medicine and the Ohio State University Hospitals, with additional training in advanced cardiac catheterization techniques and coronary angioplasty at the Case-Western Reserve University system in Cleveland. But along the way, Dr. Davis discovered that his heart patients had a host of other problems, including obesity, gout, GERD, IBS, celiac disease, unexplained rashes and other mystifying symptoms.

There is no one as certain of the truth as a scientist cloistered in academia, performing tests on cells in a petri dish, or a researcher running computer programs to find patterns in data. While doctors share the same training in the scientific method they also live in the real world, and they often see their patients reacting very differently than popular studies and national dietary standards describe.

Dr. Davis’ Journey

Like many other medical doctors, Dr. Davis found that low carb diets were most effective in lowering his patient’s weight and improving lipid panel results. But he is aware of the exceptions, where a person’s genetic makeup can require a different approach. It is this relentless pursuit of truth and frank discussion of exceptions that makes his Track Your Plaque / Heart Scan Blog so valuable.

Dr. Davis noted his patients had dramatic improvements in other health issues after restricting carbohydrates. After thousands of years of eating carbohydrates, why would the last 50 years see such a dramatic increase in GERD, pre-diabetes, type 2 diabetes, obesity and celiac disease? Not satisfied with simply knowing the facts, Dr. Davis sought the cause of the rapid increase.

Wheat Belly

His new book, Wheat Belly provides his answer: wheat. Yes, that golden grain, enshrined in our mythology and patriotic songs, is killing us. But humans have eaten wheat for thousands of years.

So why has this seemingly benign plant that sustained generations of humans suddenly turned on us? For one thing, it is not the same grain our forebears ground into their daily bread. Wheat naturally evolved to only a modest degree over the centuries, but it has changed dramatically in the past fifty years under the influence of agricultural scientists.

William Davis, MD, Wheat Belly, (New York: Rodale Inc., 2011), 13.

About Wheat Belly, the Book

Eminently readable, Wheat Belly is written in a conversational style, suitable for any audience. Extensive footnotes are gathered together in the References section at the end of the book, where they don’t interfere with the text. Sidebars include fascinating details; patient success stories, insights into heirloom wheat, etc.

The book is just under 300 pages, divided into three main sections:

  • Wheat, The Unhealthy Whole Grain
  • Wheat and its Head-to-Toe Destruction of Health
  • Say Goodbye to Wheat

The first section gives the history of wheat, from the heirloom wheat mentioned in the Bible (einkorn, gathered by semi-nomadic tribes such as the Natufians as far back as 8500 BCE) to the modern, genetically altered variety created by aggressive cross breeding in the past 50 years.

Differences between the wheat of the Natufians and what we call wheat in the twenty-first century would be evident to the naked eye. Original einkorn and emmer wheat were “hulled” forms, in which the seeds clung tightly to the stem. Modern wheats are “naked” forms, in which the seeds depart from the stem more readily, a characteristic that makes threshing (separating the edible grain from the inedible chaff) easier and more efficient, determined by mutations at the Q and Tg (tenacious glume) genes . . . But other differences are even more obvious.

William Davis, MD, Wheat Belly, (New York: Rodale Inc., 2011), 21.
Note: the ellipsis indicates I removed a reference to a study mentioned previously in the text.

The differences in modern and ancient wheat is more than “skin deep”. On the glycemic index, whole wheat bread exceeds table sugar, scoring 72 versus sugar’s 59 on the scale. Because the carbohydrates in modern wheat are so easily digestible, eating whole grain results in the same blood sugar impact as an equivalent amount of highly processed flour. White bread, with less of the whole wheat grain, comes in at 70. A Snickers candy bar comes in lower, with a glycemic index of 41.

Interestingly, Dr. Davis’ self-experiment with baking bread showed his own blood sugar rise from 84 mg/dl to 110 mg/dl with 4 ounces of bread made with einkorn wheat. He also baked bread with modern wheat, keeping all other ingredients the same, and consumed the same four ounces. His blood sugar shot up from 84 mg/dl to 167 mg/dl.

Dr. Davis provides more detail on the genetic differences that carry unknown effects including the increase in chromosomes from 14 to 42.

Wheat and Modern Health

After establishing why modern wheat is different, Dr. Davis lists the health impact this new, genetically modified food product has introduced. First among impacts is the addictive property of modern wheat, and how it stimulates hunger. Then an extensive treatment of each health condition:

  • Obesity
  • Celiac Disease
  • Diabetes and Insulin Resistance
  • Acid Reflux and Stomach pH
  • Cataracts, Wrinkles, and the aging process
  • Heart Disease
  • Wheat’s effect on the brain
  • Acne, rashes and other skin problems
Note: I have reworded the actual chapter titles to reflect the contents.

Each chapter in this section includes footnotes to studies, as well as examples from Dr. Davis’ practice. Each topic is fully developed, and written in an easy-to-read style without excessive medical terminology (Dr. Davis explains the medical terms he does use).

Practical Application of Wheat Elimination

In the third section, Dr. Davis deconstructs the modern “eat healthy whole grains” advice. If you eliminate all wheat, do you end up with vitamin and mineral deficiency? Not if you follow his basic (and very easy) guidelines. Dr. Davis comments on the true effect of eliminating wheat:

Let me describe a typical person with wheat deficiency: slender, flat tummy, low triglycerides, high HDL (“good”) cholesterol, normal blood sugar, normal blood pressure, high energy, good sleep, normal bowel function.

William Davis, MD, Wheat Belly, (New York: Rodale Inc., 2011), 188.

The book devotes 37 pages to Dr. Davis’ simple method for eliminating wheat and replacing it with unlimited vegetables, raw nuts, grass fed beef, chicken and fish, and other whole, nutritious foods. He departs from the usual low carb / paleo prescription to warn about eating too much processed meat, with its chemical soup of seasoning, nitrates and other potentially harmful chemicals. And, a special note is made regarding the proliferation of “gluten free” products that substitute fructose and “chemical soup” in place of wheat that may still pose health risks. Instead, Dr. Davis provides a variety of great wheat free recipes to provide an insight into managing a diet without wheat, introducing wonderful variety and enjoying the journey.

My Conclusions

I am by nature a skeptical person, but my personal experience with low carb dieting led me to believe, long before I discovered Dr. Davis’ blog, that I may have a “hidden” wheat allergy. After suffering from painful GERD for over a decade, I noted a rapid decrease in symptoms when I started a low carb diet. My GERD does not return when I have the occasional indulgence of ice cream while on a cruise, but comes back with a vengeance when I consume wheat products. My personal experience is not scientific proof, of course, any more than the sidebar stories of dramatic cures are scientific proof in Wheat Belly.

I suspect I will still eat bacon and other processed meats, and I don’t share the enthusiasm for grass fed organic beef and free range chickens and eggs. But those quibbles aside, Dr. Davis’ clinical experience, supported by his scientific research as revealed in 16 pages of references, make a powerful argument that I find hard to refute.

It is easy to do your own experiment; there are no adverse health effects to eliminating wheat and eating according to Dr. Davis’ easy prescription. Two weeks is usually sufficient to notice differences in some conditions. I can heartily recommend Wheat Belly as a practical guide to seeing if you also have a “hidden” wheat allergy.

Resources

Other Reviews:
Book Review: Wheat Belly, by Tom Naughton at Fathead.
Review: Wheat Belly by Dr.William Davis, by Dana Carpender at Hold the Toast.
Wheat Belly Book Review, by Joe Lindley at Stop Craving Sugar.

Dr. Davis’ Blogs:
Track Your Plaque / Heart Scan Blog
Wheat Belly Blog

Disclaimer: Dr. Davis provided a complimentary review copy of the book, but did not attach any editorial restrictions to the review.

Low Carb Poses No Arterial Health Risks

Will a Low-carb, High-fat Diet Clog Your Arteries?

The evidence against dietary fat has always been flimsy, and based mainly on studies more suited to developing a hypothesis than coming to a conclusion. Now evidence is mounting that much of what we have heard is wrong. A report in the Johns Hopkins University Gazette states:

Overweight and obese people looking to drop some pounds and considering one of the popular low-carbohydrate diets, along with moderate exercise, need not worry that the higher proportion of fat in such a program compared to a low-fat, high-carb diet may harm their arteries, suggests a pair of new studies by heart and vascular researchers at Johns Hopkins.

“Overweight and obese people appear to really have options when choosing a weight-loss program, including a low-carb diet, and even if it means eating more fat,” said the studies’ lead investigator, exercise physiologist Kerry Stewart.

Johns Hopkins and Low Carb Diets

Johns Hopkins has been at the forefront of research into various low carb diets, and has been successful in treating various conditions with a low carb, high fat ketogenic diet. They have found them safe in their studies of children with seizure disorder.

Low Carb Age first reported on the new study in our June report on the growing mass media acceptance of low carb diets.

The researchers stress that the direct comparison of a low carb and low fat diet in this study included moderate exercise for both groups. Like many modern press accounts conceding that a low carb diet works, the authors stress the efficiency of the low carb diet in losing weight without killing you. Unspoken, but implied, is the suggestion that once you lose the weight you can return to a higher carb diet.

Why Not Abandon Low Carb After Reaching your Weight Goal?

Abandoning the low carb way of eating after reaching your weight goal is a prescription for disaster, causing the familiar American model of yo-yo dieting. A much better approach is to view a low carb, high fat diet as being a permanent change in lifestyle.

That’s already the case for Hollywood stars like Courtney Thorne-Smith and country singers like Dolly Parton. The significance of Courtney and Dolly is that they represent the top two groups of people who biologically have the hardest time losing and then maintaining weight: pre- and post-menopausal women.

Eventually, mass media will recognize the long term benefits of reducing carbs, eating mainly foods you prepare yourself, and avoiding highly process, artificially sweetened frankenfoods.

Salt is the New Scapegoat

Will Salt Kill You?

The newest dire warnings about a common food … table salt … are growing, and about to result in legislation. Busy bodies everywhere are clucking that “something has to be done!”

Scapegoats

Adopting a villain is reassuring, as it absolves us of personal responsibility. It explains away some inconvenient facts that might not fit in with our preconceptions. In the seminal story that gave us the term “scapegoat”, the accumulated sins of the people are transferred to the goat, and the goat is sent to the wilderness, presumably to die for the community’s sins. This solves a big problem; the tabernacle that holds the sins transferred by weekly sacrifices is only so big. So you have to get them out of there somehow. It works great, unless you’re the goat. Vaya con Dios, goat.

What is Salt’s Role as a Scapegoat?

The list of errors in public health policy is long and dominated by scapegoats. Dietary cholesterol has no bearing on serum cholesterol levels, despite the scapegoating of eggs. Fat in the diet does not lead to extra fat in the body, yet the scapegoating of red meat and other dietary fat continues. Salt has joined the list because what we are doing isn’t solving our problems. Load up that scapegoat with heart disease, hypertension, and premature death and send it into the wilderness!

Why is Milk White When Cows Eat Green Grass?

Sometimes a childish question is too easily dismissed. Of course everyone knows that eating something green doesn’t make milk, urine or feces green. We know this because the body breaks down the food, and digests it, and we console ourselves that this process is too complex to explain to our children. The truth is, few of us really understand it, and we know that eating green grass does not lead to green milk because … milk is always white.

But often the science, as reported in the media, is something akin to the conclusion a child would come to without noticing that the milk is white. The cow eats green grass. What color is the milk? It must be green. Grass and milk have a close correlation … in one end, out the other. Without grass, there is no milk.

Salt is often associated with hypertension, and hypertension with heart disease and kidney failure. Ergo, salt causes heart disease and kidney failure, leading to early death. The milk is green.

Does Salt Consumption Lead to Early Death?

A meta-analysis of studies on salt consumption and hypertension, covering 6,489 participants with both high and normal blood pressure, with and without heart disease showed no benefit from salt reduction. None.

Despite collating more event data than previous systematic reviews of randomised controlled trials (665 deaths in some 6,250 participants), there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations.

Are They Trying to Kill Us?

The problem with scapegoats is that they take our attention away from the real problem. And sometimes, the goat is dangerous. The study found that there was a slight, and probably statistically insignificant increase in deaths when salt was reduced in patients with heart failure. Get that? Not only did reducing salt intake NOT increase the life of those with heart failure, but it increased it slightly. In the study’s words:

Further RCT evidence is needed to confirm whether restriction of sodium is harmful for people with heart failure.

Reducing salt can lower blood pressure a bit. That is because salt helps retain water, and the excess water in the bloodstream increases blood pressure. Reducing salt can decrease blood pressure a bit, but usually doctors prescribe a diuretic like hydrochlorothiazide (HCZT) as a first step in blood pressure management. It really reduces the excess water in your bloodstream, as long as you take the drug.

One of the criticisms of low carb diets is that much of the initial weight loss is water, and thought to be temporary. Dieters starting out on a low carb diet are warned about this effect:

If you are currently under a doctor’s care for these disorders or taking medications to control them – especially if you are a diabetic on insulin or oral medications to control blood sugar or on diuretics to control blood pressure – you must consult with your physician before beginning this plan! This nutritional strategy is potent and will rapidly cause changes in blood pressure and blood sugar that will make your current doses of medication far too high.
– Drs. Mary Dan and Michael Eades in Protein Power Lifeplan

The criticism that water loss is temporary isn’t valid; a low carb diet is not a temporary diet to lose weight, but a new way of eating that resolves many health issues. As long as you don’t overdose on carbs, you don’t retain the water, and your HCZT stays in the bottle.

Expect to Hear More

Judging from past media scapegoats, expect the drumbeat of uninformed, erroneous news stories to continue scapegoating salt. As we don’t know the effects of a society-wide reduction in salt consumption as proposed by New York City, it will be decades before a rise in deaths attributable to lower salt consumption. Just remember that cows eat green grass, yet their milk is white. Correlation is not cause, and more study should be done before legislation bans salt shakers from our tables.

Mass Media Acceptance

The evidence that the Low Carb Age is upon us keeps amassing, albeit with the usual caveats to assuage guilt. As the authors of Mistakes Were Made (But Not by Me) tell us, people in positions of authority rarely admit they were wrong.

Nevertheless, the truth begins to squeak out. This week the NY Times’ Tara Parker-Pope’s Phys Ed column reports on a significant new study from Johns Hopkins to be published this Friday:

With the memory of Memorial Day cheeseburgers and bratwursts still lingering, many of us may be relieved to hear that a new study suggests that a meaty, high-fat, Atkins-style diet can do more than contribute to rapid weight loss. It may also be less unhealthy for the heart than many scientists had feared — provided you chase the sausage with a brisk walk.

So Close, Yet So Far

Parker-Pope makes the mistake of insisting exercise was proven to be part of the solution, but the study shows no such thing. It specifically compares a low fat to a “low carb” diet, both with the same amount of exercise. As The Behavioral Medicine Report explains:

Low-carb dieters showed no harmful vascular changes, but also on average dropped 10 pounds in 45 days, compared to an equal number of study participants randomly assigned to a low-fat diet. The low-fat group, whose diets consisted of no more than 30 percent from fat and 55 percent from carbs, took on average nearly a month longer, or 70 days, to lose the same amount of weight.

Both groups had an exercise component. In the absence of a correlating study showing that the same diets without exercise has a different outcome, Parker-Pope’s assertion is without any foundation. Pre-conceived notions are hard to shake.

How Low is Low

As we’ve seen in other studies, the term “low carb” used here is inexact. The low carbohydrate group consumed up to 30% of their calories from carbs. Considering this a low carb diet is a bit of a stretch. Most people adhering to a low carb diet to lose weight start with about 40 grams of carbohydrates per day, or 160 calories from carbs. For a healthy man consuming 2,500 calories per day, carbs during Induction on Atkins represent about 7% of calories. That same man on the test diet in this study would be consuming about 185 grams of carbs. That’s higher than many people on a low carb maintenance diet.

This study did reduce calorie content by about 700 calories over the baseline for each individual. Even for a 2,000 calorie diet, the “low carb” dieter is consuming 150 grams of carbs.

Why Calories Don’t Matter

This study provides yet another example why the “calories in / calories out” model is flawed, as the low carb group lost weight 30% faster than the low fat group. They both consumed 700 fewer calories per day than before, but the low carb group lost weight faster. If the body reacts to all food the same way, as a strict “calories in / calories out” model suggests, then both groups would have lost weight at the same rate. But in study after study, we find that the low carb group loses weight faster and with less hunger than the low fat group. What you eat matters as much as how much you eat.

The Original Purpose

The trial was designed to test the differences in vascular function for people on both diets, and both showed no change. It is the first study to actually test vascular function among a group of people. That is good news for people considering a low carb diet. As lead investigator exercise physiologist Kerry Stewart, Ed.D, says:

“Our study should help allay the concerns that many people who need to lose weight have about choosing a low-carb diet instead of a low-fat one, and provide re-assurance that both types of diet are effective at weight loss and that a low-carb approach does not seem to pose any immediate risk to vascular health,” says Stewart. “More people should be considering a low-carb diet as a good option,” he adds.

The study is due to be published Friday, June 3.

No Link Between Fat and CHD

A new “meta analysis” of existing studies purports to find no link between fat intake and coronary heart disease (CHD):

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

The problem with this study is that it is a meta analysis, which as Dr. Eades explains:

For those who don’t know, meta-analyses are compilation studies in which researchers comb the medical literature for papers on a particular subject and then combine all the data from the individual studies together into one large study. This combining is often done to bring together a collection of studies, none of which contain data that has reached statistical significance, to see if the aggregate of all the data in the studies reaches statistical significance. I think these types of meta-analyses are highly suspect, because they can lead to conclusions not warranted by the actual data.

Those same concerns apply to this study, of course. But one thing this study does is help counter the other meta analysis studies that purport to show a link between dietary fat intake and heart disease.

Meanwhile, we find another study that says butter ain’t so bad:

Now a new study from Lund University in Sweden shows that butter leads to considerably less elevation of blood fats after a meal compared with olive oil and a new type of canola and flaxseed oil. The difference was clear above all in men, whereas in women it was more marginal.

Seems that about 20 percent of the fat in butter consists of short and medium-length fatty acids which are metabolized for energy and don’t contribute to blood lipid levels.

Good news for me. Butter is one of my favorite foods.

Low Carb Better than Low Fat

Another article has been posted to our Research pages, this time recapping a study that compared a standard LCD (low carb diet) to the American Heart Association diet that emphasizes low fat. The study was published in the Nutrition, Metabolism and Cardiovascular Diseases journal, and is posted here.

The study selected 39 individuals and divided them into two groups. One group ate a carb-restricted diet for 12 weeks. The other group ate a carb-restricted diet for 6 weeks, and then switched to the AHA diet for the remaining 6 weeks.

In this study, the low carbohydrate diet followed the recommendations of most of the low carb diets: 20 to 25% of calories from carbs. The AHA diet, by comparison, doubles that amount with 50 to 55% of the calories from carbs.

One concern often expressed about eating low carb and increasing saturated fat in the diet is that LDL can rise using the normal calculated value. This study looks specifically at the type of LDL that each of the diets produces, using direct measurements rather than an inaccurate calculation.

The short version of the results is that the low carb diet “had a better effect on atherogenic VLDL and HDL than the low fat diet recommended by AHA.” Atherogenic VLDL and HDL are particles that lead to the formation of atheromas on the walls of the arteries, or what we commonly call atherosclerosis.

This is just one study, and won’t immediately change the dietary recommendations of nutritionists, doctors and the American Heart Association. But the “Low Fat Age” is seeing its reign come to an end, and the Low Carb Age is upon us.

Monday Round-up

Tom Naughton of the Fat Head Blog has another funny article, this time about low carb enthusiast Jimmy Moore and his surprising cholesterol numbers. In the post, he talks about the worldwide study of average cholesterol rate and heart disease. This short video shows the concept (and Tom expands on it quite a bit in his blog piece):

Laura Dolson at Low Carb Diets takes a look at a new study in the Annuals of Internal Medicine comparing a semi-low carb Mediterranean-style diet with a low fat diet. Oh, the study calls it “low carb” but as Laura points out, getting 50% of your calories from carbs is not low carb in the same sense as a Protein Power or Atkins diet.

What was the outcome? Well, as the diets weren’t extremely different, it’s not surprising that in most ways there wasn’t a huge difference. Both groups lost and kept off a relatively small amount of weight, averaging 7-8 pounds by the end of the study. (This is interesting in an of itself, as the participants reported that they continued on their low-calorie diets.) Additionally, on average the participants had (mostly small) improvements in most of the markers they were looking for in the study – markers of blood glucose control and heart disease risk. But on each one of those markers (there were 13 in all) the lower-carb Mediterranean group had more improvement. And on perhaps the most important marker of all – how many participants required medications for diabetes, there was a huge difference. By the end of the study, 70% of the people on the low-fat diet were taking diabetes medication, whereas only 44% of the people on the lower-carb were.

The study would have been more interesting if they had included a third group, a real low carb, higher fat diet utilizing the same type of fats as a Mediterranean-style diet (olive oil, saturated fats, etc.)

Low Carb Diets – Evidence Mounts

We added a few more links to our Research Pages, including two new studies showing that a low carb diet works better than the traditional low fat diet for metabolic syndrome (scroll to bottom for the section on metabolic syndrome).

I found these studies through a column that is good, but not great. The LA Examiner online has an article about low carb diets and CHD (coronary heart disease). The studies they link to regarding inflammation at the Cleveland Clinic do not mention high carbohydrate diets at all. It is a bit misleading; the author states categorically that inflammation is caused by several factors including “over consumption of processed carbohydrates”, and then links to the Cleveland Clinic article. But I cannot find that sentiment on any of the Cleveland Clinic’s linked pages; they advocate the low fat, high complex carbohydrate diet instead.

The article is valuable for the links to other studies and resources that do connect a low carb diet to reduced inflammation. If the reader checked the Cleveland Clinic source and went no further, he would have to conclude the author is incorrect and may dismiss the article. So check out the other links and information provided.