We supplement vitamin D, for instance, because most of us don’t eat liver, work indoors unexposed to sunlight, and insist on wearing clothes in public. We supplement magnesium because we filter drinking water to remove sewage contamination and farm runoff, efforts that remove toxins but also all magnesium.
Each and every nutritional supplement on this list is essential for healthy human life and serves an intrinsic human need. Compare this to, say, ashwagandha or turmeric—they can be helpful, but do not meet intrinsic human needs. (Nobody starts with an ashwagandha deficiency.) Accordingly, the supplements on our list can be expected to yield greater benefits (and expectations for something like ashwagandha should be much less), just as vitamin C miraculously cures the wounds of scurvy.
We also need to take a few extra steps to correct disrupted bowel flora, dysbiosis, that was caused by prior wheat/grain and sugar consumption, not to mention chlorinated water, antibiotics, herbicides and pesticides in foods, Bt toxin and glyphosate of genetically modified foods, emotional stress, as well as factors that reach far back into childhood such as being delivered by C-section or not breastfeeding. We are learning that, if you take measures to keep the trillions of organisms living in your colon well fed, they will work to keep you healthy, slender, and happy, too. We are as reliant on them as they are on us, and we need to make a daily effort to keep them content.
A fascinating and powerful synergy develops when you put these efforts together, an effect that, even after years of observing people engaged in this program, still amazes me. I call it the “2 + 2 = 11 effect”—i.e., the total is greater than the sum of its parts. Don’t bother to correct the arithmetic because you will be too busy enjoying your new flat tummy, shopping at the left end of the dress rack (where the single-digit sizes hang), and answering questions from friends and neighbors who wonder why you look so darned good and were able to tell the doctor to take those prescriptions and shove them you-know-where.
VITAMIN D: RUN NAKED AND EAT LIVER, NOT NECESSARILY IN THAT ORDER
What, you don’t want to run naked outside in a tropical sun and eat more liver? Instead, you insist on wearing clothes and get queasy at the mention of liver and onions or liverwurst with mustard. But why?
Such is the dilemma we face with this crucial hormone—yes, hormone—called vitamin D, no less necessary than growth hormone, testosterone, or estrogen. And, because you are a member of the species Homo sapiens, we have to make sure that you only take the form of hormone intended for humans, not some impostor that your doctor hands you out of ignorance or indifference, like he did with horse estrogens for human females. To make up for your clothed and liver-deprived ways, we’ve therefore got to talk about vitamin D.
You probably work indoors under fluorescent lights most of the day, wear tops, bottoms, and shoes when outdoors. Perhaps you migrated to a climate where heavy clothing is a necessity and sunlight is faint much of the year. And you’re getting older. We gradually lose the ability to activate vitamin D in the skin, especially over age forty. It all adds up to widespread and common deficiency with substantial implications for health. In fact, I believe that restoration of vitamin D is second only to grain elimination as among the most powerful of health strategies.
Deficiency of vitamin D is not pretty:1, 2, 3
Greater inflammation, reflected by higher C-reactive protein and tumor necrosis factor
Higher blood sugar and resistance to insulin and thereby greater potential for type 2 diabetes
Injury to pancreatic beta cells that produce insulin and thereby dramatically greater risk for type 1 diabetes
Weight gain
Greater risk for osteoporosis and fractures
Periodontal disease
Higher risk for cancer, especially breast, prostate, colon, ovarian, melanoma
Higher risk for heart attack, heart failure, and cardiovascular mortality
Pre-eclampsia and eclampsia of pregnancy
Depression and seasonal affective disorder
Autoimmune conditions
For many of the conditions listed, the association of lower levels of vitamin D and disease is powerful. For example, vitamin D deficiency increases risk for type 2 diabetes by as much as 50 percent.4
Achieving an ideal level of vitamin D is key, an issue often bungled by doctors because they adhere to the woefully outdated blood levels for the blood test for vitamin D, 25-hydroxy vitamin D, quoted by most laboratories as 10 to 30 ng/ml. What level of vitamin D, measured as 25-hydroxy vitamin D, is ideal?
Epidemiological observations on vitamin D levels that are associated with reductions in cancer and other health conditions, combined with studies that demonstrate the least amount of bone weakening (as reflected by reductions in parathyroid hormone [PTH]), suggest that a 25-hydroxy vitamin D of 60 to 70 ng/ml (150 to 180 nmol/L) is the ideal range.5 This is a level readily achieved by a twenty-something in a bathing suit on a tropical beach, but not by you forty-somethings and older with abbreviated tan lines, suggesting that levels of 60, 70, 80, or even 90 ng/ml are perfectly safe and physiological levels to obtain. Too much vitamin D is also not a good idea. Besides provoking abnormal calcium deposition in tissues, 25-hydroxy vitamin D levels that exceed 100 mg/dl (250 nmol/L) are associated with increased potential for abnormal heart rhythms.6
Most people require doses of 4,000 to 8,000 units in oil-based gelcap form to achieve our target 25-hydroxy vitamin D value. Because I assume that readers of Wheat Belly are not mushrooms, you should take the D3, or cholecalciferol, form that your body recognizes, not the non-human form found in cremini or morels, D2 or ergocalciferol, the form in prescription vitamin D. (I hope that you are no longer shocked that the doctor dispenses second-best at best, hopelessly confused by promises from sexy sales reps and days focused on insurance forms and quarterly bonuses.) Ideally, a 25-hydroxy vitamin level should be re-assessed every six to twelve months to maintain desired levels, as needs change over time and dose adjustments become necessary.
People with a history of Crohn’s disease, malabsorption, or celiac disease may have difficulty absorbing vitamin D. They usually start with more severe degrees of vitamin D deficiency and may not respond to usual doses, particularly in the beginning of a grain-free journey before intestinal healing has occurred.7, 8 Higher doses may therefore be required, guided by monitoring 25-hydroxy vitamin D blood levels.
Getting vitamin D perfect is crucial to overall health, so be sure to:
Choose oil-based gelcaps or liquid drops of vitamin D3, never tablets. Most tablets are erratically absorbed or not absorbed at all, while gelcaps and drops are reliably absorbed.
Take only vitamin D3 (cholecalciferol), the human form. D3 is widely available in health food and big box stores, providing no excuse to take the mushroom prescription form.
Consider checking your 25-hydroxy vitamin D blood level at the start of your program, before vitamin D replacement, then no sooner than three months after supplementation, as it takes that long to rise and plateau (reach “steady state”). The baseline level prior to starting vitamin D can give you a sense of your individual need—the lower the starting level, the higher the dose you are likely to need. (With a starting level of, say, 10 ng/ml—profound deficiency—a higher dosage of 10,000 or 12,000 units per day should be considered.) If you do not have a pre-supplementation level, just obtain a level no sooner than three months after starting and adjust your dose as needed.
If you enjoy sun exposure for at least some of your vitamin D, do not burn, as this increases risk for skin cancer. (You can also appreciate that conventional advice to severely restrict sun exposure is bad advice that increases overall risk for cancer.) But don’t be fooled into thinking that sun exposure and a tan are sufficient to restore vitamin D. If you are y
ounger than forty years old and get plenty of sun over a large surface area, have your 25-hydroxy vitamin D level checked to assess whether these efforts are sufficient. If you are over age forty, such exposure is typically insufficient and supplementation is almost always required. Also, consider obtaining at least one midsummer and one midwinter 25-hydroxy vitamin D value to give you an idea of whether sun exposure causes an increased level, since there is individual variation. An occasional person will need to adjust dosage to accommodate the change in season, i.e., lower dose in sunny months, higher dose in non-sunny months.
If you are substantially overweight at the start of your program, it is common to require twice as much or more vitamin D to achieve the target level because fat cells oddly sequester vitamin D, making it unavailable to the rest of you. For people who fall into the obese range with low 25-hydroxy vitamin D levels of, say, 10 to 20 ng/ml, doses of 10,000 to 12,000 units per day or more of D3 gelcaps may be required, guided by blood levels. As you lose weight, a reduction in dose is almost always required over time.
If your health insurance covers the cost of this blood test (which they nearly always do), then going to your doctor and insisting on a 25-hydroxy vitamin D level will get you the information you need. If your doctor refuses and you don’t want to get another doctor, you can do the test on your own. Fingerstick test kits are available from the Vitamin D Council (www.vitamindcouncil.org) and ZRT Laboratory (www.zrtlab.com), as well as the many direct-to-consumer labs found online.
As powerful as vitamin D can be, you can further compound its benefits by combining it with sun exposure every day. The body perceives sunlight and amplifies all the benefits of vitamin D restoration. It may always be sunny in Philadelphia, but you obtain even greater benefits by combining vitamin D with walking, working, or just relaxing outdoors.
CALCIUM: THROW IT OUT WITH THE DINNER ROLLS
Despite being touted by doctors for decades, calcium supplements have no role in the Wheat Belly lifestyle. Throw your calcium tablets into the trash along with the dinner rolls and Italian bread crumbs.
For years, doctors have advised people to supplement calcium to prevent bone thinning and osteoporotic fractures based on the simple reasoning that, if something is lacking, taking more of it must be the solution. But clinical trials have repeatedly demonstrated virtually no benefit with calcium supplementation—no reduction of bone thinning nor reduction of fractures. Likewise, people who consume plentiful dairy products containing calcium do not have better bone health. One thing that people who supplement calcium do have is more death from heart disease.9
Just taking calcium supplements does not mean it will go where it belongs, just as throwing a pile of bricks in the back yard does not mean that they will magically form a brick patio, sidewalk, and barbecue. It may even end up where you don’t want it to go, such as your arteries and heart valves.
People deficient in vitamin D start with low blood levels of calcium due to poor intestinal calcium absorption. Parathyroid hormone, PTH, levels increase to compensate by drawing calcium out of bone, leading to weakened bones over time. Eat a diet rich in “healthy whole grains” and urinary loss of calcium goes berserk. Disrupt bowel flora with grains, sugars, and all the other factors we’ve discussed, and intestinal calcium absorption is further reduced. In other words, modern life is a calcium-depleted disaster, not remedied by pouring more calcium into the process.
Restore vitamin D, which increases intestinal calcium absorption, and blood calcium rises and PTH levels drop, leading to improved bone health, reduced fractures, and reduced heart attacks.10 The solution is not more calcium, but more vitamin D, and calcium naturally follows. Throw in the reduction of urinary calcium loss that results from removing the gliadin protein of wheat, removing the grain phytates that bind calcium and prevent absorption, and increasing the calcium absorption that results from cultivation of healthy bowel flora, and your body naturally obtains all the calcium it needs from foods like broccoli and kale.
IODINE: “USE MORE IODIZED SALT–KEEP YOUR FAMILY GOITER-FREE!”
Iodine is an essential trace mineral that everyone requires. Just as deficiency in vitamin C will lead to the loose teeth, open sores, and inflamed joints of scurvy, so does iodine deficiency lead to serious health problems. If iodine intake is insufficient, production of thyroid hormones, T3 and T4, begins to suffer and hypothyroidism (underactive thyroid) ensues and, with it, low body temperature, feeling cold, weight gain or failure to lose weight, even increased risk for cardiovascular death. More severe degrees of iodine deficiency cause the thyroid to enlarge, forming a goiter. However, it is not necessary to have a goiter for thyroid dysfunction to develop.
Most people have forgotten that, throughout human history up until the early twentieth century, disfiguring goiters occurred in 20 percent of the population, an especially serious problem in inland areas far away from ocean sources of iodine. Iodine deficiency was a public health problem on a par with tuberculosis or smallpox. The connection between goiter and iodine deficiency was finally recognized, which led to the introduction of iodized salt in 1924. The FDA then urged the public to use more salt. Morton salt’s original slogan: “Use more iodized salt—keep your family goiter-free!” It worked: Goiters disappeared as enthusiastic use of iodized salt became the rule. Even today, iodized salt is counted as one of the greatest public health success stories of all time, along with municipal water treatment and the smallpox vaccine. Most people younger than fifty years old have never even seen a goiter, despite being common throughout human history until your grandma was in diapers.
The choice of salt as the vehicle for iodine led to health issues from excessive salt consumption in susceptible individuals (especially those fooled into thinking that wheat consumption was healthy), prompting FDA advice to reduce salt and sodium exposure. Now, in the twenty-first century, health conscious people declare their proud avoidance of iodized table salt. Others have turned to alternative salts such as sea salt, Kosher salt, and salt substitutes, none of which provide iodine. And, of course, modern people, squeamish as they are about consuming animal organs, refuse to eat thyroid glands containing iodine. As a result, iodine deficiency and goiters are staging a comeback.
Iodine deficiency is common. Judged even by the low intake advised by the FDA, a recent national survey found that 28 percent of the population is deficient.11 Athletes and persons engaged in frequent heavy physical effort lose greater quantities of iodine through perspiration and are therefore at higher risk for iodine deficiency.12 Iodine deficiency has implications beyond the thyroid, also, as it has been associated with fibrocystic breast disease and other conditions.13
How much iodine do we need for optimal health, not just to prevent goiter? Is there an intake of iodine that can further improve thyroid function, above and beyond that required to prevent goiter? To complicate the question even more, what is the quantity of iodine required in the presence of ubiquitous environmental blockers of thyroid function and iodine, such as industrial chemicals that block production of thyroid hormones (e.g., triclosan in hand sanitizers, bisphenol A in polycarbonate plastics, perfluorooctanoic acid [PFOA] from Teflon, etc.)?14, 15
Simply adhering to the RDA of 150 mcg per day for adults is just enough for most people not to develop a goiter. The ideal intake, however, I believe is 400 to 500 mcg per day, the level that allows the thyroid gland to do its job making thyroid hormones, protecting breast tissue, and blocking entry of toxic industrial compounds into the thyroid and elsewhere; this is well within the intake of populations, such as people in Japan where more seaweed and seafood are consumed, in which the consequences of iodine deficiency are less common.16
While it worked when families enthusiastically consumed iodized salt and mom had to replace a canister every few weeks, iodized salt today is an unreliable method of obtaining iodine, since iodine is volatile, evaporating from the container within four weeks of o
pening.17 The canister of iodized salt that’s been sitting in your cupboard for six months therefore contains little to no iodine. Iodine is more assuredly obtained from an iodine supplement, such as potassium iodide drops or kelp (dried seaweed) tablets, a form that approximates the natural, ocean-derived source.
Note that iodine deficiency is not the only cause for hypothyroidism and that iodine supplementation will work to reverse hypothyroidism only if iodine deficiency is the cause. Grain consumption over years, for instance, can activate autoimmune thyroid gland inflammation, Hashimoto’s thyroiditis, or Graves’ disease, which can result in a damaged thyroid that underproduces thyroid hormone, hypothyroidism, a situation that does not respond to iodine supplementation.
Rarely, someone with hypothyroidism or goiter will develop an abnormal hyperthyroid response to iodine. This occurs because the iodine deficiency present before correction distorts thyroid function; adding iodine can temporarily worsen the situation by activating hyperthyroidism with palpitations, sleeplessness, and anxiety. Anyone with a history of Hashimoto’s thyroiditis, Graves’ disease, thyroid cancer, or thyroid nodules should therefore supplement iodine under supervision of a knowledgeable healthcare provider once autoimmune inflammation has been subdued.
Once again, recognize deficiency of a crucial nutrient whose need is programmed into your genetics, unlike garcinia cambogia or rap music, and wonderful days are ahead.
Wheat Belly (Revised and Expanded Edition) Page 28
