Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
The Guardrails of Diet
Here are what I call "The Guardrails of Diet,' i.e.., metabolic markers that tell you whether your diet is genuinely healthy or not. Too many people put too much stock in either a single marker like blood glucose, or the wrong marker like LDL cholesterol that takes you down the path of health disruptions: weight gain, visceral fat expansion, protein glycation, insulin resistance, formation of VLDL particles, cause you to rely on unhealthy foods, even increased risk for heart disease and other conditions.
In this episode of the Defiant Health podcast, Let’s therefore discuss how to identify the markers that keep you on course for an ideal diet.
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Here are what I call the guardrails of diet, that is, metabolic markers that tell you whether your diet is genuinely healthy or not. Too many people put too much stock in either a single marker, like blood glucose, or the wrong marker, like LDL cholesterol. That takes you down the path of health disruptions weight gain, visceral fat expansion, protein glycation and acceleration of aging, insulin resistance, formation of VLDL particles, causing you to rely on unhealthy foods, even increased risk for heart disease and other conditions. In this episode of the Defiant Health Podcast, let's therefore discuss how to identify the markers that keep you on course for ideal diet. Let's discuss something I call the guardrails of diet. What I mean by that are these are blood markers that tell you whether you're on the right course for a genuinely healthy diet. Now, there's a number of these markers, because no single marker tells you everything, but I'm talking about this because I see people using the wrong markers or focusing on a single marker and using that as their only means of feedback on diet, and if you do that, it's going to lead you down some paths that can lead to health problems. So, among the guardrails, the markers the blood marks can help you decide whether your diet is truly healthy or not. Well, one easy one, of course, is fasting blood glucose, and we want that to be ideal. So all these markers I'll tell you what the ideal levels are that is ideal for long-term health.
William Davis, MD:A lot of these values would differ from what the laboratory tells you, the reference range they quote. It may be different from the values that many doctors quote. Remember, doctors and laboratories typically quote values that are averages for a population. Well, what if the population studied is very unhealthy? What if they're obese or inflamed or all share some sort of nutrient deficiencies? You're going to get misleading normal or reference ranges quoted by both the lab as well as by doctors. So we're going to aim for optimal or ideal. So, when it comes to fasting glucose, ideal or optimal is 60 to 90 milligrams per deciliter. Anything outside that range, particularly high values, tells you that something is wrong, that you have insulin resistance, you're eating too many carbohydrates, you have some other factors that are disrupting your ability to handle blood glucose. So we aim for 60 to 90 milligrams per deciliter.
William Davis, MD:Whenever you draw blood glucose a venous blood draw, that is insist that you get a fasting blood insulin. Also, ideally, we would track insulin after a meal, but no one does that anymore. It's too laborious and most doctors refuse to do that. So you're stuck with getting a single fasting insulin that accompanies your fasting glucose, and we want an ideal insulin. We want your pancreas to extract as much benefit out of as little insulin as possible, so we want insulin levels to be between 0 and 4 microunits per liter. What we don't want is insulin levels of 50, 60, 90, 130, which is very common in people who are insulin resistant. That is, their muscle, brain, liver don't respond to insulin properly. That is insulin to drive glucose into the cells of the body, and the pancreas compensates by hugely overproducing insulin. Well, that has adverse effects, including increased potential for type 2 diabetes, coronary disease, cognitive impairment, dementia, risk for cancer. So having a high insulin is not a good thing. We want insulin to be very, very low, thereby reflecting your body's ability to respond to insulin Insulin sensitivity, not insulin resistance.
William Davis, MD:Another useful blood glucose measure is a postprandial blood glucose. That is, what's your blood glucose after eating, that is, 30 to 60 minutes after the start of a meal. Because that gives us an idea what the peak blood glucose is. Because it's not just fasting blood glucose that introduces issues or suggests issues, it's also the postprandial glucose also. So ideally we want no change. I call that my blood glucose no change rule. So if you're starting blood glucose before the meal was 90 milligrams and after the meal is 145, you know something is wrong.
William Davis, MD:That peak blood glucose is damaging because blood glucose that high glycates or glucose modifies proteins in the body. That has all kinds of consequences. If you glycate the proteins in the lenses of your eyes, for instance, over time you get opacities, cataracts. If you glycate LDL particles in your bloodstream, it makes them much more likely to cause heart disease. It makes them more atherogenic, we say more likely to cause atherosclerosis. If you glycate the collagen in your dermal layer of skin, it thins your skin and you get wrinkles and acceleration of skin aging. If you glycate the collagen in your joint cartilage, it makes it brittle and it fragments and breaks down over time, leading to bone-on-bone arthritis. On and on and on.
William Davis, MD:So the process of glycation is suggested whenever blood glucose ranges above 100 milligrams per deciliter. So we try to keep that postprandial 30 to 60 minutes after the start of a meal to no higher than 100 milligrams per deciliter or no change. So if you're a person with a high blood glucose say it's starting 125, you want to go no higher than 125 and as time goes on, as you maintain that, you'll see both the fasting and the postprandial blood glucose values drift downward over time as you gain more insulin. Whether you're using finger-sick blood glucoses which are very easy to do, by the way, very inexpensive or a continuous glucose monitor, these devices are accurate to about plus or minus 10 milligrams. In other words, a value of 90 milligrams is really 80 to 100. But if you do this repeatedly you'll get an idea where the values cluster and despite its imprecision you will get a good idea.
William Davis, MD:But the key here is recognize that postprandial blood glucose above 100 can be very destructive. That process of glycation that leads to arthritis, skin aging, cataracts, heart disease etc. Is irreversible. You cannot undo glycation. Now that leads us to a related measure and that's hemoglobin A1c, that very common measure, often done routinely, and the doctor may tell you something like hemoglobin A1c of 5.7% and higher is prediabetes, 6.5% higher is type 2 diabetes. So you can track that also. That gives you insight mostly into the postprandials.
William Davis, MD:Just like the postprandial glucose we talked about, hemoglobin A1c gives you a kind of a running gauge of postprandial glucose Downside. It's very slow to respond. Those of you who invest your money know what a moving average is. So hemoglobin A1c is a 90-day moving average, meaning it's very slow to respond. It only begins to respond at about 60 to 90 days six months or so, for full effect. So it is helpful, but don't use it for rapid feed, getting rapid feedback, because it's not fast enough. That postprandial glucose is better and an ideal hemoglobin A1c is 5.0% or less, contrary to what you're often told, which is, your hemoglobin A1c of 5.6%, say, is okay because you're still glycating at an accelerated rate Not as bad, say, as a diabetic with a 6.9 or 11.2, but even at 5.6, you're still glycating at an accelerated rate. So we want your hemoglobin A1c ideally to be at 5.0% or less and, by the way, that is very doable.
William Davis, MD:We do it every day and I should mention that the way we do postprandial glucoses that is, 30 to 60 minutes after the start of a meal, is very different from what your primary care doctor or endocrinologist might tell you. They might say things like this take your blood glucose prior to a meal and then two hours later. Why would they tell you that? Well, they're trying to see whether your blood glucose reverts back to its baseline on insulin or medication to reduce blood glucose. That's not what we're talking about here, right? We're talking about trying to identify the peak blood glucose as shown by that 30 to 60 minute postprandial or less so by the hemoglobin A1c, to identify whether you're glycating proteins. We don't care about whether reverting back to baseline. That's not what we're after on drugs, that is. So my advice is very different from what many doctors are going to tell you.
William Davis, MD:Another really important guardrail to tell you the quality of your diet is triglycerides, one of the most powerful indexes of all. It's one of the four measures on a basic lipid cholesterol panel. Along with right HDL cholesterol, total cholesterol, ldl cholesterol, triglycerides are typically the most neglected, yet it's the most important, most powerful feedback you can get in a lipid panel. The other measures are almost worthless, except for the HDL cholesterol we'll talk about. The triglycerides are very helpful, but you cannot pay attention, you cannot follow what the laboratory says is acceptable. The laboratory will say 150 milligrams per deciliter or less is okay. Is that true? Absolutely not. That is complete, utter fiction. It's nonsense.
William Davis, MD:You can be a metabolic mess with a triglyceride level of 125 milligrams per deciliter. So what we want. Follow me here. You want a fasting triglyceride level of 60 milligrams per deciliter or less, because that's the low level that we know. You stop causing distortions in other lipoproteins that cause heart disease. So VLDL very low density lipoproteins, vldl are triglyceride rich. So the triglyceride level in your blood reflects the level of VLDL and a level of 60 milligrams per deciliter or less tells you we have very little VLDL that's contributing to causing heart disease and very little VLDL interacting with LDL particles that lead to small LDL particles, the real, most potent cause for coronary disease, not LDL cholesterol. So that triglyceride level of 60 milligrams per deciliter or less tells you you don't have much VLDL. You're not creating heart disease with VLDL, nor with small LDL.
William Davis, MD:It also gives you feedback on whether your liver is engaging in a very important process the liver de novo lipogenesis process. All that means de novo newogenesis fats, making new fats. And so when you feed your liver any carbohydrate or sugar, it could be fructose, it could be the amylopectin A, unique to wheat and grains, it could be high fructose corn syrup, whatever sugars, or amylopectin A, carbohydrates of grains. Your liver is very good, very capable of converting those carbs and sugars into triglycerides. Now some of those triglycerides, by the way, stay in the liver. That's one of the factors that leads to fatty liver. Some of those triglycerides are released into the bloodstream as VLDL particles. But you can identify how much VLDL you have by this very simple marker triglycerides, fasting triglycerides. So we want as little of these processes as possible and that all gets subdued or is occurring at a very minimal rate when you have triglycerides of 60 milligrams per deciliter or less.
William Davis, MD:Another measure that you need to follow as a guardrail of diet small LDL particle quantification. Typically we use the nuclear magnetic resonance. Nmr Sounds complicated. I've been doing it for over 30 years. It's widely available.
William Davis, MD:If you ask your doctor and say, hey, I want an NMR lipoprotein panel, if the doctor says, oh, we don't do that here, it's experimental, insurance doesn't cover it. Those are all lies. None of that is true. Insurance covers it, including Medicare. It's widely available, labs will draw it for you and it's very inexpensive. While conventional lipid cholesterol panel might be $12, this one might be $80 or $90. It won't break the bank. So there may be a little bit more in a copay say, but it is available and the information is far more valuable than the nonsense that comes from a standard cholesterol panel and you want to know how many small ldl particles you have. Remember small ldl, created by consumption of carbohydrates and sugars, though amplified by insulin resistance and inflammation. See my other videos about that, my podcast, defiant Health, of course, my thousands of blog posts, williamdavismdcom and, of course, my membership website where we discuss these things innercircledrdavisinfinitehealthcom.
William Davis, MD:We quantify small LDL, the real cause of heart disease, not the fairytale fictitious LDL cholesterol. That's not even measured. So small LDL and we want it to be no higher than 200 nanomoles per liter. Particle count per volume ideally zero. So that tells you the quality of your diet and whether you have some measure of insulin resistance or inflammation driving the formation of small LDL.
William Davis, MD:Very easy to get. The biggest hurdle is getting your doctor to order it. If your doctor won't order it, you can actually get it done yourself. Life Extension is one of the laboratories that makes it, one of the places that makes it available to you. Without a doctor's order, for instance, there are ways to get it done, or find a doctor who will do it, because the doctor is too lazy. Most of the time, what they're saying to you is I can't be bothered gaining the extra education to understand what that NMR lipoprotein panel means. So I'm going to stick to the pharmaceutical model and that is just talk about cholesterol values and that lead to statin cholesterol drugs and related drugs, which of course is absolute, utter nonsense.
William Davis, MD:Now another guardrail of diet is not so precise. It's looking for hints of small intestinal bacterial overgrowth. We say SIBO, s-i-b-o. That's a situation where fecal microbes in the colon way, way down have over proliferated, then ascended into the small intestine, into the 24 feet of small intestine where they live and die rapidly. Microbes only live for a few hours. When they die they shed some of their components, mostly of their cell walls, into the intestinal lumen, into into the intestines. That then gains entry into the bloodstream Because the small intestine is naturally and expectantly and normally very permeable Because that's where we absorb nutrients like amino acids, fatty acids, vitamins and minerals. But when you have fecal microbes infesting the 24 feet of small intestine, have fecal microbes infesting the 24 feet of small intestine, that that top it's called.
William Davis, MD:It's called endotoxin. It's a toxic component of the cell walls of fecal microbes enters the bloodstream. That's called endotoxemia and that can result in hints that you have SIBO. Thereby you know your diet is probably being a contributor to your SIBO. So so look for a low HDL HDL cholesterol. So while lipid panel is largely worthless, except for triglycerides, hdl cholesterol is useful as an index of metabolic health. But it can suggest to you that SIBO is a driver of a low HDL. So if your HDL cholesterol is 60 milligrams per deciliter or less, think about SIBO is a driver of a low HDL. So if your HDL cholesterol is 60 milligrams per deciliter or less, think about SIBO as a driver. So most of us following my programs have HDLs in the 80s and 90s or higher, which in other words, great metabolic health.
William Davis, MD:C-reactive protein a marker, a non-specific marker of inflammation. If your C-reactive protein is above 1.0 milligrams per deciliter, it suggests, it suggests it hints at SIBO and endotoxemia being a driver. If you have a stool test and it includes a fecal calprotectin, that's a measure of inflammation that can suggest SIBO if it's high. If you have a low fecal calprotectin, it doesn't mean you don't have SIBO, so it's only helpful when it's positive.
William Davis, MD:Now markers that are not useful as guardrails cholesterol values, total cholesterol, ldl cholesterol for a variety of reasons. First of all, ldl cholesterol is not a real number. You may notice when you have your cholesterol tested that it says LDL cholesterol, let's say 130 milligrams per deciliter, in parentheses CALC or calculated. It's calculated, it's not even measured. They calculate it using an equation. It's called the Friedewald calculation. That is miserably outdated. It's about 60 years old. It should have been discarded a long time ago. It's such an accrued approximation of LDL particle counts.
William Davis, MD:It was very difficult to count a number of particles in the bloodstream in 1958, 1960, when that calculation was derived. And so what they did was they used a marker for those lipoproteins. In this case they used cholesterol. But people interpret they used cholesterol. But people interpret that to mean cholesterol is the cause of heart disease. Cholesterol is not the cause of heart disease. It was meant to be a crude and indirect marker for the particles that do cause heart disease. But we can measure those, like that NMR lipoprotein panel I told you about, you can measure the small LDL particle number and some other measures also. So ignore LDL cholesterol, ignore total cholesterol, I tell people, get a big, thick, black magic marker and cross those numbers out. They are meaningless.
William Davis, MD:The tragedy of focusing on LDL and total cholesterol as markers for cardiovascular risk is that it takes everyone's attention off the real causes of heart disease. Now, if that interests, you, see my other videos, podcasts, blogs, books etc. That talk to you how to really gain control over cardiovascular risk. But in this case we're talking about so-called guardrails of diet. Be aware of these factors. They give you feedback on the quality of your diet. So don't focus on one thing, like fasting glucose. Focus on the entire picture. That's the way to gain insight into the value of your diet.
