Wheat Belly (Revised and Expanded Edition)

by William Davis

  Pancreatic injury is further worsened by inflammatory phenomena, such as oxidative injury, leptin, various interleukins, and tumor necrosis factor, all resulting from the visceral fat hotbed of inflammation, all characteristic of prediabetic and diabetic states.16

  Over time and repeated sucker punches from glucotoxicity, lipotoxicity, and inflammatory destruction, beta cells wither and die, gradually reducing the number of beta cells to less than 50 percent of the normal starting number.17 That’s when diabetes is irreversibly established and insulin injections become unavoidable.

  In short, carbohydrates, especially those such as wheat products that increase blood sugar and insulin most dramatically, initiate a series of metabolic phenomena that ultimately lead to irreversible loss of the pancreas’s ability to manufacture insulin: diabetes. Your poor pancreas doesn’t stand a chance, suffering vicious daily beatings from fiber-rich breakfast cereals and plates heaped high with low-fat pasta.

  FIGHT CARBOHYDRATES WITH CARBOHYDRATES

  A Paleolithic or Neolithic human breakfast might have consisted of wild fish, reptiles, birds or other game (not always cooked), birds’ eggs, leaves, roots, berries, or insects. Today it will more likely be a bowl of breakfast cereal containing wheat flour, cornstarch, oats, high-fructose corn syrup, and sucrose. It won’t be called “wheat flour, cornstarch, oats, high-fructose corn syrup, and sucrose,” of course, but something catchy like Crunchy Health Clusters or Fruity Munchy Squares. Or it might be waffles and pancakes with maple syrup. Or a toasted English muffin spread with jam or a pumpernickel bagel with low-fat cream cheese. For most people, extreme carbohydrate indulgence starts early and continues throughout the day.

  We shouldn’t be one bit shocked that, as our physical lives have become less demanding—when’s the last time you skinned an animal, butchered it, chopped wood to last the winter, or washed your loincloth in the river by hand?—and rapidly metabolized foods of convenience and indulgence proliferate, diseases of excess result.

  Nobody becomes diabetic by gorging on too much wild boar they’ve hunted, or wild garlic and berries they’ve gathered…or too many veggie omelets, too much salmon, or too much kale, pepper slices, and cucumber dip. But plenty of people develop diabetes because of too many muffins, bagels, breakfast cereals, pancakes, waffles, pretzels, crackers, cakes, cupcakes, croissants, donuts, and pies.

  As we’ve discussed, foods that increase blood sugar the most also cause diabetes. The sequence is simple: Carbohydrates trigger insulin release from the pancreas, causing growth of visceral fat; visceral fat causes insulin resistance and inflammation. High blood sugars, triglycerides, fatty acids, and inflammation damage the pancreas. After years of overwork, the pancreas succumbs to the thrashing it has taken from glucotoxicity, lipotoxicity, and inflammation, essentially “burning out,” leaving a deficiency of insulin and an increase in blood glucose—diabetes.

  Treatments for diabetes reflect this progression. Medications such as pioglitazone (Actos) to reduce insulin resistance are prescribed in the early phase of diabetes. The drug metformin, also prescribed in the early phase, reduces glucose production by the liver. Once the pancreas is exhausted from years of glucotoxic, lipotoxic, and inflammatory pummeling, it is no longer able to make insulin, and insulin injections are prescribed.

  Part of the prevailing standard of care to prevent and treat diabetes, a disease caused in large part by carbohydrate consumption…is to advise increased consumption of carbohydrates.

  Years ago, I used the American Diabetes Association (ADA) diet in diabetic patients. Following the carbohydrate intake advice of the ADA, I watched patients gain weight, experience deteriorating blood glucose control and increased need for medication, and develop diabetic complications such as kidney disease and neuropathy. Just as Ignaz Semmelweis caused the incidence of childbed fever in his practice to nearly vanish by washing his hands, ignoring ADA diet advice and cutting carbohydrate intake leads to improved blood sugar control, reduced HbA1c, dramatic weight loss, and improvement in all the metabolic messiness of diabetes such as high blood pressure and triglycerides.

  The ADA advises diabetics to cut fat, reduce saturated fat, and include 45 to 60 grams of carbohydrate—preferably “healthy whole grains”—in each meal, or 135 to 180 grams of carbohydrates per day, not including snacks. It is, in essence, a fat-phobic, carbohydrate-centered diet, with 55 to 65 percent of calories from carbohydrates. If I were to sum up the views of the ADA toward diet, it would be: Go ahead and eat sugar and foods that increase blood sugar, just be sure to adjust your medication to compensate.

  But while “fighting fire with fire” may work with pest control and passive-aggressive neighbors, you can’t charge your way out of credit card debt and you can’t carbohydrate-stuff your way out of diabetes.

  The ADA exerts heavy influence in crafting national attitudes toward nutrition. When someone is diagnosed with diabetes, they are sent to a diabetes educator or nurse who counsels them in the ADA diet principles. If a patient enters the hospital and has diabetes, the doctor orders an “ADA diet.” Such dietary “guidelines” can, in effect, be enacted into health “law.” I’ve seen smart diabetes nurses and educators who, coming to understand that carbohydrates cause diabetes, buck ADA advice and counsel patients to curtail carbohydrate consumption. Because such advice flies in the face of ADA guidelines, the medical establishment demonstrates its incredulity by firing these rogue employees. Never underestimate the convictions of the conventional, particularly in medicine.

  The list of ADA-recommended foods includes:

  whole grain breads, such as whole wheat or rye

  whole grain, high-fiber cereal

  cooked cereal such as oatmeal, grits, hominy, or cream of wheat

  rice, pasta, tortillas

  cooked beans and peas, such as pinto beans or black-eyed peas

  potatoes, green peas, corn, lima beans, sweet potatoes, winter squash

  low-fat crackers and snack chips, pretzels, and fat-free popcorn

  In short, eat wheat, wheat, corn, rice, and wheat.

  GOOD-BYE TO WHEAT, GOOD-BYE TO DIABETES

  Maureen, a sixty-three-year-old mother of three grown children and grandmother to five, came to my office for an opinion regarding her heart disease prevention program. She’d undergone two heart catheterizations and received three stents in the past two years, despite taking a cholesterol-reducing statin drug.

  Maureen’s laboratory evaluation included lipoprotein analysis that, in addition to low HDL cholesterol of 39 mg/dl and high triglycerides of 233 mg/dl, uncovered an excess of small LDL particles; 85 percent of all Maureen’s LDL particles were classified as small—a severe abnormality.

  Maureen had also been diagnosed with diabetes two years earlier, first identified during one of the hospitalizations. She had received counseling on the restrictions of both the “heart healthy” diet of the American Heart Association and the American Diabetes Association diet. Her first introduction to diabetes medication was metformin. However, after a few months she required the addition of one, then another, medication (this most recent drug a twice-a-day injection) to keep her blood sugars in the desired range. Recently, Maureen’s doctor had started talking about the possibility of insulin injections.

  Because the small LDL pattern, along with low HDL and high triglycerides, are closely linked to diabetes, I counseled Maureen on how to apply diet to correct the entire spectrum of abnormalities. The cornerstone of the diet: wheat elimination. Because of the severity of her small LDL pattern and diabetes, I also asked her to further restrict other carbohydrates, especially cornstarch and other corn products, oats, rice, and potatoes, as well as sugar.

  Within the first three months of starting her diet, Maureen lost 28 pounds off her starting weight of 247. This early weight loss allowed her to stop the twice-dail
y injection. Three more months and 16 more pounds gone, and Maureen cut her medication down to the initial metformin.

  After a year, Maureen lost a total of 51 pounds, tipping the scale below 200 for the first time in twenty years. Because Maureen’s blood glucose values were consistently below 100 mg/dl, I then asked her to stop the metformin. She maintained the diet, followed by continued gradual weight loss. She maintained blood glucose values comfortably in the non-diabetic range.

  One year, 51 pounds lost, and Maureen said good-bye to diabetes. Provided she doesn’t return to her old ways, including “healthy whole grains,” she is essentially cured.

  Ask any diabetic who tracks their own finger stick blood sugars about the effects of this diet approach, and they will tell you that all of these foods increase blood sugar up to the 200 to 300 mg/dl range or higher. According to ADA advice, this is just fine…but be sure to track your blood sugars and speak to your doctor about adjustments in insulin or medication.

  Does the ADA diet contribute to a diabetes cure? There’s the gratuitious ADA marketing claim of “working toward the cure.” But real talk about a cure?

  In their defense, I don’t believe that most of the people behind the ADA are evil; many, in fact, are devoted to helping fund the effort to discover the cure for childhood diabetes. But I believe they got sidetracked by the low-fat dietary blunder that set the entire United States off course. Don’t feel sorry for them—there’s all that money they receive from Sanofi, Novo Nordisk, Merck, and Eli Lilly to brighten their lives.

  To this day, the notion of treating diabetes by increasing consumption of the foods that caused the disease in the first place, then managing the blood sugar mess with medications, persists.

  We have the advantage, of course, of 20/20 hindsight, able to view the effects of this enormous dietary faux pas, like a bad B-movie video on the VCR. Let’s rewind the entire grainy, shakily filmed show: Remove carbohydrates, especially those from “healthy whole grains,” and an entire constellation of modern conditions reverse themselves.

  DÉJÀ VU ALL OVER AGAIN

  Fifth-century BC Indian physician Sushruta prescribed exercise for his obese patients with diabetes at a time when his colleagues looked to omens from nature or the position of the stars to diagnose the afflictions of their patients. Nineteenth-century French physician Apollinaire Bouchardat observed that sugar in the urine of his patients diminished during the four-month-long siege of Paris by the Prussian army in 1870 when food, especially bread, was in short supply; after the siege was over, he mimicked the effect by advising patients to reduce consumption of breads and other starches and to fast intermittently to treat diabetes, despite the practice of other physicians who advised increased consumption of starches.

  Into the twentieth century, the authoritative The Principles and Practice of Medicine, authored by Dr. William Osler, iconic medical educator and among the four founders of the Johns Hopkins Hospital, advised a diet for diabetics of 2 percent carbohydrate. In Dr. Frederick Banting’s original 1922 publication describing his initial experiences injecting pancreatic extract into diabetic children, he notes that the hospital diet used to help control urinary glucose was a strict limitation of carbohydrates to 10 grams per day.18

  It may be impossible to divine a cure based on primitive methods such as watching whether flies gather around urine, methods conducted without modern tools such as blood glucose testing and hemoglobin A1c. Had such testing methods been available, I believe that improved diabetic results would indeed have been in evidence. The modern cut-your-fat, eat-more-healthy-whole-grains era caused us to forget the lessons learned by astute observers such as Osler and Banting. Like many lessons, the notion of carbohydrate restriction to treat diabetes is a lesson that will need to be relearned.

  I do see a glimmer of light at the end of the tunnel. The concept that diabetes should be regarded as a disease of carbohydrate intolerance is gaining ground in the medical community. Vocal physicians and researchers such as Dr. Eric Westman of Duke University and Dr. Jeff Volek of Ohio State University have both conducted a number of studies on the value of carbohydrate limitation. Dr. Westman reports, for instance, that he typically needs to reduce insulin dose by 50 percent the first day a patient engages in reducing carbohydrates to avoid excessively low blood sugars.19 Dr. Volek and his team have repeatedly demonstrated, in both humans and animals, that sharp reduction in carbohydrates reverses insulin resistance and visceral fat.20, 21

  In one of Dr. Westman’s studies, eighty-four obese diabetics followed a strict low-carbohydrate diet—no wheat, cornstarch, sugars, potatoes, rice, or fruit, reducing carbohydrate intake to 20 grams per day (similar to Drs. Osler and Banting’s early twentieth-century practices). After six months, waistlines (representative of visceral fat) were reduced by more than 5 inches, triglycerides dropped by 70 mg/dl, weight dropped 24.5 pounds, and HbA1c was reduced from 8.8 to 7.3 percent; 95 percent of participants were able to reduce diabetes medications, while 25 percent were able to eliminate medications, including insulin, altogether.22

  In another study, the effects of a low-carbohydrate diet were compared to the American Diabetes Association diet in overweight type 2 diabetics. After eight months, HbA1c of 55 percent of the low-carb group was no longer in the diabetic range, while no one on the ADA diet dropped into the non-diabetic range.23

  A number of additional studies conducted over the past two decades have demonstrated that reduction in carbohydrates leads to weight loss and improved blood sugars in people with diabetes.24, 25, 26, 27 A Temple University study of obese diabetics showed that reduction of carbohydrates to 21 grams per day led to an average of 3.6 pounds of weight loss over two weeks, along with reduction in HbA1c from 7.3 to 6.8 percent and 75 percent improvement in insulin responses.28 A recent combined (“meta-”) analysis of eleven studies confirmed these findings: People with type 2 diabetes who sharply curtailed carbohydrate intake from grains, fruit, and sugars enjoyed greater weight loss and reduction in HbA1c compared to restricting fat.29

  WHEAT AND CHILDHOOD (TYPE 1) DIABETES

  Prior to the discovery of insulin, childhood (type 1) diabetes was fatal within a few months of onset. Dr. Frederick Banting’s discovery of insulin was truly a breakthrough of historic significance. But why do children develop diabetes in the first place?

  Antibodies to insulin, beta cells, and other “self” proteins result in autoimmune destruction of the pancreas. Children with diabetes also develop antibodies to other organs of the body. One study revealed that 24 percent of children with type 1 diabetes had increased levels of “autoantibodies,” i.e., antibodies against “self” proteins, compared to 6 percent in children without diabetes.30

  The incidence of so-called adult (type 2) diabetes is increasing in children due to overweight, obesity, and inactivity, the very same reasons it is skyrocketing in adults. However, the incidence of type 1 diabetes is also increasing. The National Institutes of Health and the Centers for Disease Control and Prevention cosponsored the SEARCH for Diabetes in Youth study, which demonstrated that, from 1978 to 2004, the incidence of newly diagnosed type 1 diabetes increased by 2.7 percent per year. The fastest rate of increase is being seen in children under the age of four.31 Disease registries from the interval between 1990 and 1999 in Europe, Asia, and South America show similar increases.32

  Why would type 1 diabetes be on the rise? Our children are likely being exposed to something that sets off a broad abnormal immune response in these children. Some authorities have proposed that a viral infection ignites the process, while others have pointed their finger at factors that trigger autoimmune responses in the genetically susceptible.

  Could it be wheat?

  The changes in the genetics of wheat since 1960, such as that of high-yield semi-dwarf strains, could conceivably account for the recent increased incidence of type 1 diabetes. Its appearance also coincides with t
he increase in celiac disease and other diseases.

  One clear-cut connection stands out: Children with celiac disease are ten times more likely to develop type 1 diabetes; children with type 1 diabetes are ten to twenty times more likely to have antibodies to wheat and/or have celiac disease.33, 34 The two conditions share fates with much higher likelihood than chance alone would explain.

  The cozy relationship of type 1 diabetes and celiac disease also increases over time. While some diabetic children show evidence of celiac disease when diabetes is first diagnosed, more will show celiac signs over the ensuing years.35

  A tantalizing question: Can avoidance of wheat starting at birth avert the development of type 1 diabetes? After all, studies in mice susceptible to type 1 diabetes show that elimination of gluten reduces the development of diabetes from 64 percent to 15 percent36 and prevents intestinal damage characteristic of celiac disease.37 The same study has not been performed in human infants or children, so the answer to this crucial question is still incomplete.

  Though I disagree with many of the policies of the American Diabetes Association, on this point we agree: Children diagnosed with type 1 diabetes should be tested for celiac disease. I would add that they should be retested every few years to determine whether celiac disease develops later in childhood, even adulthood. Although no official agency advises it, I don’t believe it would be a stretch to suggest that parents of children with diabetes should strongly consider wheat gluten elimination, along with elimination of other gluten sources and grains.

  Should families with type 1 diabetes in one or more family members avoid wheat and related grains from the start of life to avoid triggering the autoimmune effect that leads to this lifetime disease? It’s a question that needs answering, as the increasing incidence of the condition is going to make the issue more urgent in coming years. But you know my answer: Because wheat and related grains are so destructive in so many ways in both children and adults, there is virtually no downside, but plenty of upside, to avoiding the seeds of grasses for a lifetime.