Category Archives: Metabolic Syndrome

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.

Leptin Resistance

What is Leptin?

Leptin is a hormone released by fat cells that helps regulate hunger. And it may hold the key to why a low carb / paleo diet works for so many people.

Role of Leptin in Hunger Signals
Leptin and Hunger
(Click Image to Enlarge)

Success on a low carb / paleo diet is often attributed to “never feeling hungry”, an effect not seen on other diets. People point to the satiating aspects of fat or protein in eliminating hunger, but dieters may be suffering from a rarely diagnosed condition called leptin resistance that is corrected by the low carb diet.

Leptin circulates through the bloodstream in an amount directly proportional to the amount of fat you have. In theory, the more leptin you have circulating the less you will eat, because it signals that you have enough stored energy for all your metabolic processes. When leptin levels dip, it signals the brain that you are hungry.

So, that means fat people should never be hungry, right? Not so fast, grasshopper.

Resistance is Futile

Most low carbers are familiar with the concept of insulin resistance in those with type two diabetes and metabolic syndrome. In a healthy individual, insulin signals the cells that glucose is available, and the cells respond and allow the glucose to enter the cell (if they need the energy). Insulin resistance is a condition where the cells become resistant to the effects of insulin, requiring more and more insulin to deal with blood sugar levels. If a regular cell opens the door to a gentle knock, the insulin resistant cells respond only to ferocious pounding on the door with a battering-ram’s worth of insulin. The pancreas, which produces insulin, cannot keep up with the demand for more and more insulin, and dangerously high levels of blood glucose result.

A similar thing happens with leptin resistance, but through a different mechanism. There’s no shortage of leptin in an otherwise healthy obese person, and the fat cells never grow tired of producing it. But the circulating leptin is blocked and cannot turn off the hunger signal. The fat person remains hungry. And hungry people eat.

What Causes Leptin Resistance?

Some have theorized that dietary fat and blood glucose levels interfere with leptin. While there is a link between leptin resistance and the levels of fat circulating in the blood (triglycerides), eating dietary fat doesn’t seem to have an effect. Recent evidence showing a diet high in fructose contributes to leptin resistance adds to the growing body of evidence against high levels of fructose in the diet. The amount of fat in the diet did not matter; leptin resistance peaked with the high fructose diet, and reversed itself to normal levels when the rats ate a sugar free diet, no matter how much fat they had. Lucky rats.

We know that leptin signals our brain that enough energy is present, and the body does not need any more food. Leptin is able to cross the “blood brain barrier” (BBB) to do this. The BBB is a protective system of small capillaries that protects the brain from most chemicals but allows the important ones through. It works like a filter. So what causes the curious case of leptin resistance, where this essential hormone is blocked by the BBB? As Dr. Mike Eades explains:

Research done a couple of years ago in St. Louis and in Japan pinpointed the problem. Triglycerides – fat circulating in the blood – interrupts the passage of leptin across the BBB. If trigylcerides are high, which they are in most obese people, then, basically, they block the movement of leptin into the brain. So, leptin levels are elevated in the blood, and triglycerides keep the leptin from getting to where it needs to get to shut off hunger.

One Solution

Controlling trigylceride levels can reverse leptin resistance. In my own experience, hunger evaporated on my low carb diet as my triglycerides fell from 344 to 105. Before that, I was often hungry, even after eating past the feeling of fullness and often to discomfort. On my low fat diet 15 years before, I was miserable because I was always hungry. But that, as they say, is a personal testimony and not a scientific finding. Too bad I’m not a rat.

The easiest way for most people to lower triglyceride levels is to adopt a very low carb diet (less than 50 grams of carbohydrate per day), then transition to a moderate carb diet devoid of most grains. Niacin and fish oil have also proven to be effective in many people, even those with genetic reasons for high triglycerides (familial hypertriglyceridemia). I combine all three approaches, and have found the eliminating any one of those results in my triglycerides rising again. Management of triglycerides in this way is done in concert with a physician and blood tests. Those with chronic health problems should check with their doctors first, of course, especially those with reduced liver or kidney function, or those suffering from conditions such as gout that require specific diets.

Resisting Resistance

Humans are adapted to eat a certain diet, and in terms of adaptation, the modern agricultural era is a blip on the radar screen. We simply haven’t had time to adapt to large quantities of grain and other carbohydrates in our diets. The inexpensive access to readily available carbohydrates is new, barely 10,000 years old, and our biological machinery is not able to handle it. That’s the philosophical framework under girding the modern low carb / paleo diet movement. The rise of leptin resistance is just one more metabolic condition that supports the effectiveness of a low carb / paleo lifestyle.

Other Resources

MegaSearch: Leptin Resistance

Heart Scan Blog: Niacin

Heart Scan Blog: Fish Oil

Conquer Diabetes and Prediabetes

Dr. Steve Parker is a leading expert on the Mediterranean diet. With two decades experience treating patients with diabetes, pre-diabetes and metabolic syndrome, Dr. Parker has developed a modified version of the Mediterranean diet. His new book Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet provides a comprehensive overview of the diet.

Dr. Parker is no stranger to the low carb lifestyle, and has seen dramatic health improvement from it in some of his patients. His low-carb Mediterranean diet is an attempt to marry the heart-healthy benefits of the traditional Mediterranean diet, with its emphasis on natural foods, omega-3 rich olive oil and plenty of complex carbs, with the superior blood sugar control and weight loss of a low carbohydrate lifestyle.

How can these two diets, seemingly incompatible, come together without compromising both? I was concerned that Dr. Parker might give a pass to “complex carbs” in the same way the American Diabetic Association does. But he doesn’t mince any words about carbohydrates:

We’ve done an atrocious job for type 2 diabetics and prediabetics.

We’ve recommended they eat precisely what their bodies can’t handle: carbohydrates. We’ve urged them to take poison: carbohydrates. We’ve cooperated with the drug companies to encourage diabetics to eat foods that increase drug company profits: carbohydrates.

Dr. Parker relates that how, over the past 10 years, the medical literature and his clinical experience has led to a change in his thinking, and better treatment of his patients.

The book is a medium format, 5.5″ x 9″, quality paperback with 216 pages. It is economically priced at $16.95. The last 26 pages are devoted to a list of print and on-line resources, an annotated bibliography complete with URLs to medical journal articles, and a five page index.



Dr. Parker’s low-carb Mediterranean diet follows a familiar pattern: a very low carb starting phase called the Ketogenic Mediterranean Diet (KMD), and a maintenance phase dubbed the Low-Carb Mediterranean Diet (LCMD). He includes a week of meals suitable for the KMD, with a list of additional foods that can be added, slowly, once weight loss and blood sugar levels are in control.

What is different about Dr. Parker’s book? He includes a robust list of drugs and possible interactions during the ketogenic phase of the diet. Other specific recommendations for diabetics, such as the chapter devoted to the dangers of hypoglycemia, are a must read for someone looking to control blood sugar via diet. And I found the book eminently readable. Dr. Parker writes in a conversational style, explaining terms in a way that does not come across as condescending.

His chapter on “Daily Life with Low-Carb Eating” addresses several issues, including “cheating”. What do you do when presented with that Cinnabon you can’t resist? His answer is surprising, but workable. If you must indulge, compensate by replacing a meal with the treat, adding extra exercise or medication, or reverting to the KMD diet for a few days after. While purists will insist they never cheat, I did exactly this on a recent European cruise, and came back weighing less than when we set sail. (As Dr. Parker points out, you have to know your limits; just as a reformed alcoholic never tastes alcohol again, some “carbohydrate addicts” can’t afford to cheat.)

Dr. Parker’s easy approach to developing a reasonable exercise program might get me started in that direction. (Niacin, taken to help lower my triglyceride levels, also increases insulin resistance, and the antidote for that is exercise.) I loathe exercise, but Dr. Parker’s no-nonsense approach to the subject may get me walking in the evenings.

I found another personal benefit. While not diabetic, I do struggle with blood sugar control, and have been diagnosed with metabolic syndrome (now abated with low carb living). We often get stuck in our choice of foods, and simply removing carbs from our standard diet can get boring. Dr. Parker notes that the popularity of the standard Mediterranean diet includes the benefit of both taste and variety. Adopting a low carb Mediterranean diet approach could introduce some variety to what has become a routine diet. And as my wife tells me, variety in everything in life, except partners, is a good thing.

Disclaimer: Dr. Parker provided a complimentary review copy of the book, but did not attach any editorial restrictions to the review. Low Carb Daily is also listed as an on-line resource in the Resources section of the book.

Metabolic Syndrome and Cancer

Metabolic syndrome, the combination of risk factors that 1 in 5 Americans share, may be implicated in the development of cancer in the digestive system.

Known by several different names, such as syndrome X, insulin resistance syndrome, Reaven’s syndrome, and even CHAOS in Australia, metabolic syndrome (MetS) is usually diagnosed if the patient has three or more of the following: obesity (measured by BMI greater than 29 or a waist to hip ratio), triglyceride levels above 150 mg/dL, HDL cholesterol below 40 mg/dL, high blood pressure (diastolic greater than 130), and fasting blood sugar over 100. Other factors, such as insulin resistance, may be used to determine the diagnosis.

The Cooper Clinic in Dallas, TX provided 33,230 men for the study on digestive system cancers. The men were followed for over 14 years. Adjustments were made for cardiorespiratory fitness to remove a common difference between the physically fit and those with MetS. The study concluded that having MetS did correlate strongly with cancer of the digestive system. In particular, two of the common MetS factors, obesity and high blood sugar, were associated with cancer:

Our results support the hypothesis that metabolic syndrome is positively associated with mortality from cancers of the digestive system. Interventions that reduce abnormalities associated with the syndrome could reduce risk of premature death from these cancers.

Treatment for MetS is varied; many doctors try a reduced calorie, low fat diet to reduce one or more of the risk factors (usually, weight and blood pressure). A high failure rate is seen, usually attributed to “lack of compliance” by the participants. Drugs for blood pressure control, cholesterol, and triglycerides are often used. In my case, those attempts failed to achieve a good result. But a low carbohydrate diet combined with niacin (to help reduce triglyceride levels which did not respond to diet alone) removed all of the risk factors.

Low carbohydrate diets seem to work better for most people. Many, myself included, are not inclined to cheat on the diet because they never feel hunger. One study in the journal Nutrition & Metabolism noted:

Carbohydrate (CHO) restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure.