Posts tagged: glycemic index

Wheat Belly Book Review

By , September 6, 2011

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.

Knockout: Low Carb vs. Low Fat

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By , November 26, 2010

The New England Journal of Medicine noted the results of a study examining the best way to maintain weight loss:

We enrolled overweight adults from eight European countries who had lost at least 8% of their initial body weight with a 3.3-MJ (800-kcal) low-calorie diet. Participants were randomly assigned, in a two-by-two factorial design, to one of five ad libitum diets to prevent weight regain over a 26-week period:

  • a low-protein and low-glycemic-index diet
  • a low-protein and high-glycemic-index diet
  • a high-protein and low-glycemic-index diet
  • a high-protein and high-glycemic-index diet
  • or a control diet

Low carb diets generally fit into the two “low glycemic index” diets, with most low carbers getting toward the relative high end of protein.

One of the interesting facts about the study is that the low carb dieters adhered to the diet at a much greater rate than their counterparts; the study says about 26% of the dieters eating a low carb variant dropped out, compared to 37% who dropped out of the higher glycemic-index diets. And these were diets where the people could eat until satisfied, not adhere to a limit imposed by the study authors. You would think a diet that allowed you to eat foods rating higher on the gycemic-index would be easier, right?

Not so, and Dr. John Briffa notes the reason:

This helps to explain why individuals who adopt lower-carbohydrate approaches (generally low-GI and usually quite-rich in protein) find they’re less hungry, and eat less as a result. Never mind that – having worked with literally thousands of real people over 20 years I have become convinced that this way of eating really does, overall, trump others (e.g. low-calorie, low-fat) in terms of sustainable weight loss. And this is why it forms the basis of the advice I offered in my latest book Waist Disposal

I have seen countless individuals get on and off ‘diets’ and therefore suffer cycles of weight loss and weight gain. What is it that causes individuals to default back to their original diet? Lots of things, but one factor that almost always plays a part is hunger. It’s a plain and simple fact that unless forced, individuals tend not to tolerate hunger at all well in the long term.

So which diet was the least successful in maintaining the weight loss? As the study tells it:

In the analysis of participants who completed the study, only the low-protein–high-glycemic-index diet was associated with subsequent significant weight regain (1.67 kg; 95% confidence interval [CI], 0.48 to 2.87).

That “low-protein-high-glycemic-index diet” is the standard American diet, with 60 to 70% of calories from foods high on the glycemic index, like whole grains, whole wheat bread, pasta, fruit juices, etc.

For most people, a diet that focuses on adequate protein, higher fat intake and reduced carbohydrates satisfies hunger more. And as Dr. Briffa notes, hunger just isn’t tolerated well. Even if you can eat all the “whole grains” you want.

The Glycemic Index Fraud

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By , July 20, 2010

People are often alarmed at my low carb diet, predicting all sorts of dire consequences for my future health. Often, the well meaning recommendations come in the form of platitudes like “eat a balanced diet”, yet the people can rarely tell me what that means. Would a balanced diet be one exactly equal in the percentage of calories from the three macronutrients? If so, that would be a relatively low carb diet, with about half the carbohydrates the low fat devotees recommend. Usually people use this term interchangeably with “normal diet”, another meaningless term.

But the more informed about nutrition will prescribe specific foods they think are appropriate. The new favorite is to recommend “low glycemic index” foods. The idea is that you need carbohydrates so you eat the good ones, not the bad ones. And that might work for some people, even though you don’t really “need” carbohydrates.

People consuming the standard American diet of 400 or so grams of carbohydrates might benefit from thinking about the type of carbs they are consuming. But it isn’t an appropriate substitute for reducing total carbohydrates. Especially for someone overweight, with metabolic syndrome, high triglycerides or blood sugar issues.

The reason is the very nature of how the glycemic index is created. As Dr. Eades explains:

Young, healthy subjects consume a test dose of glucose (or sometimes 50 grams of carb from white bread, which is also a common standard) and have their blood sugar curves measured. They then come in on subsequent days and consume the test foods (the potato, beans, tomatoes, whatever) and have their blood sugar checked over the next two hours to create the blood sugar curves driven by the carbs in these foods. These curves are compared to the pure glucose curves and a glycemic index is created.

I am no longer a “young healthy subject”, so the glycemic index isn’t appropriate for me. Not only that, but even if you are a “young healthy subject” (or think you are), it might not apply to you either. The index itself is an average of hundreds of people, and in every study and trial you always have “outliers”, those who fall out of the average range of responses. Humans are complex beings, and we react differently to foods. Starches like potato might send your blood sugar into the stratosphere, as could be expected, but so might oatmeal. Diabetics, who test their blood sugar regularly, can tell you the foods that trigger an increase in blood sugar in them, but may not in others.

A study published in the American Journal of Clinical Nutrition noted that the glycemic index was not useful in improving the markers for metabolic syndrome. The following is a slightly edited conclusion from the report (the original is at the link, and includes the exact lab values of each marker mentioned in the quote):

At the end of the 11-wk intervention periods, the decreased GL test foods did not change fasting plasma glucose … or insulin concentrations compared with increased GL test foods. Serum total cholesterol, LDL-cholesterol, HDL-cholesterol, and triacylglycerol concentrations were also not significantly different for decreased and increased GL test foods, respectively. Finally, proinflammatory (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-{alpha}, monocyte chemoattractant protein 1) and prothrombotic (plasminogen activator inhibitor 1) markers were not affected. Glucose and lipids were also analyzed after 1 and 5 wk of intervention and were not affected by the intervention.

What does work to reduce these markers? Total carbohydrate restriction:

The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS [metabolic syndrome] and cardiovascular risk.

The glycemic index may have its uses, but it is no substitute for carbohydrate reduction in those trying to improve weight, metabolic syndrome or blood sugar issues.

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