When meat is not just meat 18. December 2007 William Davis (7) The edgy nutrition advocate, Mike Adams, over at NewsTarget.com came up with this scary photo tour of a processed meat product from Oscar Mayer: Mystery Meat Macrophotography: A NewsTarget PhotoTour by Mike Adams Along with increasingly close-up photographs of this meat-product, Adams lists the ingredients in Oscar Mayer's Cotto Salami: Beef hearts PorkWaterCorn syrupBeefContains less than 2% of:SaltSodium lactateFlavorSodium phosphatesSodium diacetateSodium erythorbate DextroseSodium nitriteSoy lecithinPotassium phosphatePotassium chlorideSugarAs I reconsider the role of saturated fat in diet, given the startlingly insightful discussion by Gary Taubes of Good Calories, Bad Calories, I am reminded that not all meat is meat, not all saturated fat sources are equal. I am concerned in particular about sodium nitrite content, a color-fixer added to cured meats that caused a stir in the 1970s when data suggesting a carcinogenic effect surfaced. The public's effort to remove sodium nitrite from the food supply was vigorously opposed by the meat council and it remains in cured meats like sausage, hot dogs, and processed meats like Cotto Salami. A 2006 meta-analysis (combined analysis of studies) of 63 studies did indeed suggest that sodium nitrite was related to increased risk of gastric cancer. This argument is plausible from animal models of cancer risk, as 40 animal models have likewise suggested the same carcinogenic association. Also, fructose? This is most likely added for sweetness. Recall that fructose heightens appetite and raises triglycerides substantially. I personally have a natural aversion to meat. I don't like the taste, the look, smell, and the thought of what the animal went through to make it to the supermarket. But, considered from the cold, carnivorous viewpoint of the question, "Is meat okay to eat?", among the issues to consider is whether the meat has been cured or processed, and does that process include addition of sodium nitrite. Cotto Salami and similar products are not, of course, what carnivorous humans in the wild ate. This is a processed, modified product created from factory farm animals raised in cramped conditions and fed corn and other cheap, available foods. It is not created from free-ranging animals wandering their pastures or pens, eating diets nature intended. This results in modified fat composition, not to mention hormones and antibiotics added. These are not listed on the ingredients. Wild meat does not contain fructose or color-fixers, either. So don't mistake "meat" in your grocery store for meat. It might look and smell the same--until you look a little closer. Copyright 2007 William Davis, MD
Don't lament no OTC mevacor 17. December 2007 William Davis (4) After Merck's third go at FDA approval for over-the-counter (OTC) status for its statin cholesterol drug, Mevacor (lovastatin), the FDA advisory board suggested that its request be denied. They expressed concern that too many people would not understand how the drugs would be used and that misuse would be common. Similar sentiments were echoed by Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen; the American Medical Association (though the AMA always fights anything that threatens to erode physician control over health); and the de facto spokesman for cardiologists, Dr. Steven Nissen of the Cleveland Clinic. Although I am a supporter for tools and legislation that yield greater self-empowerment in health care to the public, there is no need to lament the failed OTC status for Mevacor. For one, Merck had no plans to reduce the price on its OTC preparation. For many people, this would have meant an increase in cost, since health insurers would surely not cover a non-prescription agent. Second, OTC status sends the implicit message that cholesterol is the most common cause of heart disease; it is not. (Small LDL particles are the number one cause, a pattern only partially addressed by any statin drug and a pattern largely responsible for the failure of statin drugs to "cure" heart disease despite pharmaceutical manufacturer's attempts to increase doses to take up any slack in effect.) Thirdly, you can achieve the same effect--no, a superior effect--by incorporating several simple strategies into your life. These strategies are superior to Mevacor because they do more than just reduce LDL cholesterol. You can achieve similar LDL-reducing effect to Mevacor, 20 mg, just by adding:--2 tablespoons oat bran or ground flaxseed per day (choose flaxseed if you have sugar problems or small LDL; flaxseed contains no digestible sugars, only protein and fiber)--Raw almonds or walnuts--at least a handful, though more is fine and will not make you fat. (It's nuts like party mixes, mixed nuts roasted in unhealthy oils, and honey-roasted nuts that make us fat, not raw.)--Soy protein sources--probably the weakest effect of all foods listed, but a contributor that can be obtained in a variety of forms, such as tofu, soy protein powders, and soy milk. --Other foods that reduce LDL include pectin sources (e.g., citrus rind), flavonoids (e.g., green tea); stanol esters found in butter substitute Benecol (recall that sterol-containing products like Take Control and the flood of new products on the market like HeartWise orange juice might have potential for allowing sterol esters to enter the blood, so I do NOT recommend them); and, of course, niacin. Many of these strategies also reduce small LDL, raise HDL, reduce triglycerides, and reduce blood sugar, effects that go beyond that achieved with Mevacor. Of course, a combination strategy is not as easy as popping one pill a day, it's better for you. I will certainly not shed any tears for Merck and its relentless efforts to gain a stronger foothold in the "transform conditions into diseases" marketing strategy, the same strategy that classifies shyness, toe fungus, and sadness into medical conditions necessitating medication. While I do generally support efforts to increase public access to strategies that increase their health care power, this one was not necessarily all good. Members of Track Your Plaque can read the complete report, Unique nutritional strategies to Reduce cholesterol naturally on the Track Your Plaque website. Copyright 2007 William Davis, MD
Damage control 15. December 2007 William Davis (5) Medical device manufacturer, Cordis, is launching a new marketing program to promote its Cypher drug-coated stent. You can view the details at www.CypherUSA.com , including the slick TV commercial that HeartHawk posted a blog about.The campaign opens with:When you open up your heart, you open up your life.Lives hampered by angina. By shortness of breath. By restricted blood flow. These lives are changing. Because of a state-of-the-art advancement. One that can have a huge impact on arteries around your heart. The CYPHER® Stent. It can open up your arteries. Increase flow of blood and oxygen. And change your restricted life. To an active life worth living. Your new life is...Life Wide OpenDirect-to-consumer drug advertising has been around for a few years. While it has increased awareness of drugs and the "conditions" they are supposed to treat, it has also highlighted the aggressive profit-motive of the drug industry. This is not health care for the needy and sick, but health care for profit.So now we're beginning to see the emergence of direct-to-consumer (DTC) advertising for medical devices. There was also a brief, though unsuccessful, foray into DTC advertising for implantable defibrillators, of all things, by Medtronic a couple of years ago, also.What is the purpose of Cordis' marketing effort? Is it to educate and inform the public who might unknowingly receive non-drug coated stents and be deprived of the restenosis-inhibiting advantage of a drug-coated device? Is it meant to right a systematic wrong, a failure of cardiologists to insert the technologically, biologically, and ethically superior coated stents?I find that doubtful. A more likely motive is damage control. With some of the (both deserved and undeserved) negative press the drug-coated stents have received lately, Cordis, eager to protect their $20 billion (annual revenues, 2006) medical device franchise, came up with this DTC strategy. After viewing the smiling faces of people , elated because of their "wide open" arteries and lives, Cordis hopes to see people going to their doctors insisting on the stent that is "opening millions of lives," since, "when your arteries narrow, so does your life." Cool, trendy, liberating. That's the message they wish to deliver. Cool music, beautiful people, flashy high-tech images. Who wouldn't want a Cypher stent?Beyond damage control, it's a familiar marketing theme: You're slender, glamorous, and sexy if you drink Coke, you're a caring mother if you feed your children Jif peanut butter, you're health conscious and smart if you eat Total cereal . . . you're cool and know what you want from life if you insist on a Cypher stent.I don't object to advertising. It's part of the capitalistic economic system. It drives awareness and grows businesses. I do get concerned when advertising is so slick and effective that the people who are not properly armed with information can be duped into thinking that they need something that they don't really need. Or, for which there are powerful, viable alternatives. Even hear about "prevent the disease in the first place?"
Low expectations 12. December 2007 William Davis (6) The Framingham Risk Calculator is a standard method used by many physicians to predict risk for heart attack or death from heart disease over a 10-year period. Low-risk is defined as <10% risk of heart attack or cardiac death over 10 years; high-risk is defined as 20% or more over 10 years; intermediate-risk is in between. Let's put it to the test:Amy is a 53-year old businesswoman. She is 5 ft 4 inches, weighs 150 lbs. Her father had a heart attack in his early 50s followed by the usual list of hospital procedures including bypass surgery at age 60. What is Amy's risk for heart attack or death from heart disease over the next 10 years? If we enter her data into the Framingham risk calculator, the following result is returned:Information about your risk score: Age: 53 Gender: female Total Cholesterol: 198 mg/dL HDL Cholesterol: 74 mg/dL Smoker: No Systolic Blood Pressure: 120 mm/Hg On medication for HBP: No Risk Score: 1% Means 1 of 100 people with this level of risk will have a heart attack in the next 10 years. So, according to the Framingham calculation, Amy has <1% risk for heart attack or death from heart disease over the next 10 years. Most primary care physicians would, at most, prescribe a statin drug and talk about a reduction in saturated fat. Thankfully, Amy didn't fall for that bit of conventional mis-information. She instead got a CT heart scan, principally because of her father's history. Her score: 117. At age 53, this put her into 90th percentile, in the worst 10% of scores for women in her age group (50-55). By heart scan criteria, her risk for heart attack is probably more like 4-5% per year, or approximately 40-50% over the next 10 years. Let's do just a bit more math. If Amy hadn't known about her heart scan score and no preventive action was taken, the expected progression of her heart scan scores would likely be:Start: 117Year 1: 152Year 2: 198Year 3: 257Year 4: 335Year 5: 436Year 6: 567Year 7: 737Year 8: 958Year 9: 1245Year 10: 1618In fact, given Amy's starting heart scan score of 117, it is highly unlikely that she survives the next 10 years without heart attack or a fatal heart event. Yet the Framingham risk calculator puts Amy's risk at less than 1%. Could anything be more wrong? The folly of the Framingham calculator was highlighted by a recent publication from the large Multi-Ethnic Study of Atherosclerosis (MESA), in which 3600 women (45-84 years), all of whom fell into the "low-risk" category by the Framingham calculator--just like Amy--were tracked over approximately 3 3/4 years. This study generated several observations:1) 30% of the "low-risk" women had positive heart scan scores.2) 5% of the "low-risk" women had scores of 300 or greater (very significant for a woman). 8.6% of these women experienced a cardiovascular event like heart attack or death over the period. Women with a heart scan score of 300 or greater had a 22-fold greater event risk compared to women with zero heart scan scores.3) Women with heart scan scores of 1 to 299 had a cardiovascular event risk of approximately 5-fold greater risk over the period. Across the U.S., 90% of women younger than 70 years old fall into the Framingham "low-risk" category. Yet this fiction is accepted as the prevailing standard, along with LDL and total cholesterol, for determination of risk in women and men.In my view, using the Framingham risk calculator is a misguided, misleading path, one that will mis-classify a substantial number of women who could otherwise be spared from heart attack and catastrophe. By the way, Amy is also the Track Your Plaque program record holder (by percentage drop), with a 63% drop in heart scan score over a 15 month period.
Niacin vs. low-carb weight loss 10. December 2007 William Davis (28) Niacin:--Raises HDL and shifts HDL towards the healthier large (HDL2b) subclass.--Reduces total LDL.--Reduces small LDL particles.--Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein). --Reduces fibrinogen.--Reduces inflammatory responses. Weight loss achieved through a low-carbohydrate (read "wheat-free") diet: --Raises HDL and shifts HDL towards the healthier large (HDL2b) subclass.--Reduces total LDL.--Reduces small LDL particles.--Reduces triglycerides and triglyceride-containing particles like VLDL and IDL (intermediate-density lipoprotein). --Reduces fibrinogen.--Reduces inflammatory responses.Curious, isn't it? Niacin achieves virtually the same effect as weight loss achieved through a low-carbohydrate diet, particularly if free of wheat products. The only major difference is that niacin also reduces lipoprotein(a), though even that distinction shrinks if monounsaturated fat sources like almonds are included in a low-carbohydrate program. So which should you do first if you have any of the above patterns? Well, it's a question of 1) severity, 2) how carbohydrate-rich your starting diet is, 3) how much weight you could stand to lose, and 4) how urgent your program is (determined largely by your heart scan score). Niacin can also be very helpful if you've taken full advantage of weight loss through a carbohydrate-restricted program, yet still retain some of the abnormal lipoprotein patterns that could continue to grow coronary plaque. For instance, if HDL cholesterol rises from 28 to 40 mg/dl by eliminating wheat and reducing carbohydrates and losing weight, niacin could raise HDL to 50 mg/dl or higher. As much as I love and use niacin for its broad array of plaque-controlling effects, a low-carbohydrate, wheat-free diet can achieve many of the same effects. Use this strategy to full advantage.
Explosive plaque growth 10. December 2007 William Davis (3) Every once in a while, we will see someone experience more-than-expected rate of coronary plaque growth, a sudden jump in heart scan scores. I'm talking about increases in score of 50%, even 100%, sometimes despite favorable lipid and lipoprotein patterns.It's not always easy to pin this phenomenon down, since we often detect it after a year or more on a repeat heart scan. It would be wonderfully insightful to perform heart scans more frequently and track plaque growth more precisely, but of course, radiation exposure is the most important limiting factor, as is cost.So this list is, admittedly, speculative. It is based on observation, on presumptive associations between events and heart scan scores. But, judging from what we do confidently know about coronary atherosclerotic plaque, I think these observations make physiologic sense.These are the sorts of increases in heart scan score that can scare the heck out of you, silent yet explosive growth of coronary atherosclerotic plaque that can grow with no warning whatsoever.Image courtesy Wikipedia and the United States Geological Survey.Factors which I have observed to possibly be responsible for explosive plaque growth include:--Overwhelming tragedy such as death of a loved one, financial ruin, divorce. One of my early and catastrophic failures was a young man in his early 40s who, in the space of just a few months, suffered the loss of his mother, a brother, and his mother-in-law, while working a high-stress job. His heart scan score doubled from around 100 to 200 in one year, despite perfect lipoproteins. He had a heart attack shortly after the second score, despite a normal stress test just months earlier. (Pessimism is tragedy's weak cousin, but one that still holds power to corrupt our otherwise best efforts at plaque reversal.) --Substantial weight gain. In the early years of the Track Your Plaque program, before it was even called "Track Your Plaque," I witnessed a man more than double his score from 1100 to 2400 in 18 months just by allowing himself to gain 40 lbs. (I don't know what became of him. His life apparently suffered other disasters, as well, and we lost track of him.)--Poorly-controlled diabetes. High blood sugars out of control have yielded explosive growth.--Kidney disease--However, I am uncertain of how much this overlaps with a deficiency of vitamin D's active form, 1,25-OH-vitamin D3, the form that is often deficient in people with dysfunctional kidneys.--An inflammatory disease that is out of control, e.g., rheumatoid arthritis.--This is very speculative, but I've witnessed explosive growth after vaccine administration that yielded strange viral-like symptoms. In this one instance, the man was getting heart scans (on his own) every three to six months and described a severe illness following a vaccine administered in preparation for travel out of the U.S.--Unrecognized low thyroid function--i.e., hypothyroidism. This is easily corrected with thyroid hormone replacement. These factors can also be relative and they can be overcome. Look at our current Track Your Plaque reversal record-holder: a 53-year old woman who dropped her heart scan score an amazing 63% despite the loss of a loved one during the 15 months of her program. Despite an overwhelming tragedy, she overcame the potential adverse effects and set a record, probably a record for the entire world.
Dr. Cannell on "How much vitamin D?" 6. December 2007 William Davis (14) In his most recent Vitamin D Council Newsletter (reprinted in its entirety below, minus clickable links, as Dr. Cannell apparently lost his webmaster and this issue of the newsletter is therefore not posted on the Vitamin D Council website; if you would like to either donate money to the Vitamin D Council or pitch in with help with his website, go to www.vitamindcouncil.com), Dr. John Cannell once again enlightens us with some new insights into vitamin D and its enormous role in health. In this issue, he discusses the role of vitamin D in people diagnosed with cancer (treatment, not prevention). While cancer is not our focus on the Heart Scan Blog, Dr. Cannell's always insightful comments provide some helpful thoughts for our management of vitamin D doses and blood levels. Dr. Cannell cites a recent study from vitamin D research expert, Dr. Bruce Hollis:In the first study of its kind, Professor Bruce Hollis of the Medical University of South Carolina gave all of us something to think about. He asked and answered a simple question: How much vitamin D do you have to take to normalize the metabolism of vitamin D? Remember, unlike other steroid hormones, vitamin D has very unusual metabolism in most modern humans, called first-order, mass action, kinetics. All this means is that the more vitamin D you take, the higher the 25(OH)D level in your blood, and the higher the 25(OH)D level in your blood, the higher the levels of activated vitamin D in your tissues. No other steroid hormone in the body behaves like this. Think about it: would you like your estrogen level to be dependent on how much cholesterol you ate? Or your cortisol level? (I'd ask the same about testosterone levels but I know men well enough not to ask.) No, the body must tightly regulate powerful steroid hormones through substrate inhibition, that is, if an enzyme turns A into B, when the body has enough B, B inhibits the enzyme and so limits its own production. Not so with vitamin D, at least at modern human vitamin D levels. Professor Reinhold Vieth was the first to write about this and Vieth's Chapter 61 in Feldman, Pike, and Glorieux's wonderful textbook, Vitamin D (Elsevier, 2005, second edition), is a great reason to buy the textbook or have your library do so. (I'm glad to see Amazon is out of stock of the new ones (someone must be reading about vitamin D) but you can still buy used editions.) Why would the kinetics of vitamin D be different from all other steroids? Maybe they are not, Hollis reasoned, like Vieth before him. Maybe vitamin D levels are so low in modern humans that its metabolic system is on full blast all the time in an attempt to give the body all the vitamin D metabolites it craves. So Hollis asked, Is vitamin D's metabolism different in populations in the upper end of 25(OH)D levels (a population of sun-exposed people and a group of women prescribed 7,000 IU per day)? Note, the Hollis study is free on Medline, you can download the entire paper on the right hand of the PubMed page below. Hollis BW, et al. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-634.If you look at the two graphs, Figures 1 and 2 of Hollis' paper, you find vitamin D's kinetics can be normalized, made just like all other steroid hormones in the body, but you have to get enough sunshine or take enough vitamin D to get your 25(OH)D level above 50 ng/ml, and 60 ng/ml would be better. Then your body starts to store cholecalciferol in the body without much further increase in 25(OH)D levels. The reaction becomes saturable. This is a remarkable discovery and it implies levels of 30 and 40 ng/ml are usually not sufficient. It also implies actual vitamin D levels (cholecalciferol levels), not just 25(OH)D levels, may be useful in diagnosing and treating deficiency. Note, that not all of the sun-exposed individuals or women prescribed 7,000 IU/day achieved such levels. That's because the sun-exposed individuals were tested after an Hawaiian winter and because prescribing and taking are two different things.In answer to the question, "How much vitamin D should someone with cancer take?," Dr. Cannell advises:"Take enough to get your 25(OH)D level above 60 ng/ml, summer and winter." In doing so, you will have normalized the kinetics of vitamin D and stored the parent compound, cholecalciferol, in your tissues. In the absence of sunshine, you need to take about 1,000 IU/day per 30 pounds of body weight to do this. A 150 pound cancer patient may need to take 5,000 IU per day, a 210 pound cancer patient about 7,000 IU per day, all this in the absence of sunlight. Dr. Cannell, no stranger to the resisitance among many practicing physicians unaware of the expanding and robust literature on vitamin D, advises people with cancer that: In the end, if you have cancer and your physician won't do a risk/benefit analysis, do it yourself. The risk side of that equation is easy. Both Quest Diagnostics and Lab-Corp, the two largest reference labs in the USA, report the upper limit of 25(OH)D normal is 100 ng/ml and toxic is above 150 ng/ml, so 60 ng/ml is well below both. The reason levels up to 100 ng/ml are published normals is because there is no credible evidence in the literature that levels of 100 ng/ml do any harm and because sun worshipers often have such levels. (If you don't believe me, go to the beach in the summer for one month, sunbath every day for 30 minutes on each side in your bathing suit, and go home and have a 25(OH)D level.) By getting your level above 60 ng/ml, all you are doing is getting your levels into the mid to upper range of laboratory reference normals. Little or no risk.For readers wishing to read the entire text of Dr. Cannell's newsletter, it is reprinted below:The Vitamin D NewsletterJanuary, 2008 The January newsletter is coming early as I will be out of touch for awhile. If you remember, the last newsletter was on preventing cancer, not treating it. Below is a sampling of the tragic emails the last newsletter generated: "Dr. Cannell, I was just diagnosed with breast cancer, how much vitamin D should I take?""My mother has colon cancer, how much vitamin D should she take?" "I've had prostate cancer for four years, is there any reason to think vitamin D would help?" "Dr. Cannell, my son has leukemia, should I give him vitamin D?"It's one thing to talk about evide Cureality | Real People Seeking Real Cures Toggle navigation Home Blog Home Archive Join Now Log in Grasscutting, fertilizer, and healthcare 25. August 2009 William Davis (23) A guy named Jeff, a 60-something, taciturn, "How 'bout dem Brewers?" kind of guy, cuts my grass. Once a week, Jeff drives over his rust-rimmed 1994 Chevy pickup and trailer, unloads his ride mower, and cuts the grass. For his 40 minutes of work, I pay him $35. For $35, all he does is cut the grass--no trimming, no picking up debris, no working in the garden, no fertilizing, no weeding. Just cutting the grass. Occasionally, Jeff has proven to be a useful resource for peculiar problems. Last year, I had a drainage problem that he helped solve and two years ago he helped diagnose a tree disease that was killing a tree in the backyard; it's now recovered. To save money, and because I like to work in the yard, I do the rest. I trim the edges, I fertilize the grass, plant new flowers and trees, fix damaged areas, trim wild branches.In my view, my relationship with Jeff, a limited, as-needed relationship, in which I ask him to help with specific issues but I manage the rest myself, is how I believe that healthcare should also be conducted. Your doctor should be like Jeff: Perhaps not taciturn, but an as-needed resource available while you do much of the work. My simple relationship with Jeff is, I believe, the healthcare model of the future. You manage your own cholesterol issues, your own basic thyroid issues, supplement and monitor your vitamin D levels, use diet to suit your needs, order blood tests when necessary, even obtain basic imaging tests like heart scans, carotid ultrasound, bone density testing. Your doctor is a resource, near by when and if you need him or her: guidance when needed, an occasional review of what you are doing, someone to consult when you fracture an ankle. What your doctor is NOT is a paternal, "do what I say, I'm the doctor," or a "You need these tests whether you like it or not" holder of your health fate. It is a model of healthcare that will evolve over the next 20-30 years, only in its infancy now. While we started Track Your Plaque as just a resource for in-depth information on prevention and reversal of coronary heart disease, I now see it as something much greater: a prototype for the emerging concept of self-directed health. Enough for now. I've got some tomatoes to pick. Iodine deficiency is REAL 21. August 2009 William Davis (30) Like many health-conscious people, Kurt avoids salt. In fact, he has assiduously avoided salt ever since his heart attack back in 1995. Lately, Kurt had become tired, often for little or no reason. His thyroid panel:TSH 4.2 mIU/L (0.27-4.20)Free T3 1.74 pg/ml (2.50-4.30)Free T4 1.05 ng/dl (0.9-1.7)Kurt's TSH of 4.2 mIU/L is sufficient to increase LDL cholesterol by 20-30% and increase the (relative) risk for heart attack 3-fold. Kurt's thyroid was also palpably enlarged. While it was just barely visible--just a minor bulge in the neck (in the shape of a bowtie), it could be clearly felt when I examined him. I asked Kurt to add 500 mcg of iodine every day. Three months later, another thyroid panel showed:TSH 0.14 mIU/L (0.27-4.20)Free T3 2.50 pg/ml (2.50-4.30)Free T4 1.1 ng/dl (0.9-1.7)Kurt's thyroid function normalized to nearly ideal levels just with iodine replacement. (The free T3, while improved, remains low; an issue for another day!) I see this response with some frequency: low-grade goiter and apparent hypothyroidism (low thyroid function) that responds, at least partially, to iodine replacement. In Kurt's case, iodine replacement alone normalized his thyroid measures completely. With improved thyroid measures, Kurt also felt better with renewed energy and a 22 mg/dl reduction in LDL cholesterol. Make no mistake: Iodine deficiency is real. While most of my colleagues have dismissed iodine deficiency as a relic of the early 20th century and third world countries, you can also find it in your neighborhood. Fish oil for $780 per bottle 19. August 2009 William Davis (16) At prevailing pharmacy prices, one capsule of prescription Lovaza fish oil costs $4.33 each. Yes, you heard right: $4.33 per capsule. What do you get for $4.33 per capsule? By omega-3 fatty acid content, you get 842 mg EPA + DHA per capsule. I can also go to Sam's Club and buy a bottle of their Triple-Strength fish oil with 900 mg omega-3 fatty acids per capsule at $18.99 per bottle of 180 capsules. That comes to 10.5 cents per capsule. That puts the price of fish oil from Sam's Club at 97.6% less cost compared to Lovaza for an equivalent quantity of omega-3 fatty acids. What if we repriced Sam's Club's Triple-Strength and brought it "in line" with what we pay for Lovaza? That would put the value of one bottle of Sam's Club Triple-Strength fish oil at $780 per bottle. I take patients off Lovaza every chance I get. Organic really IS better 16. August 2009 William Davis (18) If you have any doubts about the value of organic foods vs. conventionally-grown foods, then take a look at the findings from a USDA--Yes, USDA--sponsored study. In this study, the nutritional content of organic vs. conventionally-grown blueberries were compared. Ironically, these observations come from the USDA's Genetic Improvement of Fruits and Vegetables Laboratory of the Produce Quality and Safety Laboratory. Their findings (all values expressed as weight per 100 grams fresh weight blueberries, or a bit less than 1/4 cup):Total phenol content (e.g, flavonoids):Organic: 319.3 mgConventional: 190.3 mgOrganic blueberries had 68% greater phenol content.Total anthocyanins (an important class of flavonoids):Organic: 131.2 mgConventional: 82.4 mgOrganic blueberries had 59% greater anthocyanin content.Antioxidant capacity (ORAC): Organic: 46.14 mgConventional: 30.8Organic blueberries had 50% greater antioxidant capacity. Flavonoids suspected to carry unusually potent health effects--malvidin, delphinidin, myricetin, and quercetin--were all contained in greater proportions in the organically-grown blueberries, also. These flavonoids are demonstrating pharmacologic-level health effects in preliminary studies. Why a genetics laboratory? After all , the study findings came out heavily in favor of non-genetic, organic farming methods of growing produce. It certainly must have at least given pause to the vocal group within agriculture and the USDA that have long argued that organic produce is no different. I suspect that the laboratory will now try to recreate the nutritional value of organic through genetic manipulation of cultivars grown using conventional methods. Regardless of the motivations behind the study, we see that there is no comparison: organic blueberries are superior in nutritional value to those grown with conventional pesticides and herbicides. While the study addressed only blueberries, the dramatic difference makes it likely that similar differences exist in other fruits and vegetables. Coming on the Track Your Plaque website: An in-depth Special Report on the health effects of anthocyanins. Do you really need calcium? 12. August 2009 William Davis (0) Why are we advised to take calcium supplements?Men and women are advised to take calcium because it has been shown to reduce blood pressure modestly. Women, in particular, can stall the deterioration of bone strength (mineralization) by taking calcium supplements, 1200-1300 mg per day, and eating calcium-rich foods like dairy products. Is that all true?It is true insofar as we remain vitamin D deficient. A funny thing happens when you fully replete vitamin D: Intestinal absorption of calcium as much as quadruples. That means your body will efficiently absorb the calcium in broccoli and spinach. Is it still necessary to force-feed your body megadoses of calcium once vitamin D has been repleted? I don’t think so. While the evidence is indirect, several observations point towards the lack of necessity of calcium once vitamin D is addressed. For instance:Women who take calcium, 1200 mg per day, with vitamin D, 800 units per day, double their five-year risk for heart attack, according to a New Zealand study. Men who take calcium, 1200 mg per day, with vitamin D, 800 units per day, also may substantially increase heart attack risk. Bone density increases more with vitamin D than with calcium. Calcium may not even be necessary to increase bone mineralization, since there are data to suggest that vitamin D can accomplish this by itself. Calcium suppresses parathyroid hormone, PTH. That is, in fact, how calcium stalls (usually does not reverse) bone mineral loss-not by adding calcium to bone, but by suppressing PTH release. (PTH causes bone demineralization.) Vitamin D suppresses PTH to a far greater degree than calcium.What is needed is a broad reconsideration of the advice everyone is getting to take calcium. In an age when more and more people are appreciating the power of vitamin D supplementation to achieve normal blood levels, there may be danger ahead for those who fail to address their calcium overdosing. The case against vitamin D2 11. August 2009 William Davis (40) Why would vitamin D be prescribed when vitamin D3 is available over-the-counter?Let's review the known differences between vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol):--D3 is the human form; D2 is the non-human form found in plants.--Dose for dose, D3 is more effective at raising blood levels of 25-hydroxy vitamin D than D2. It requires roughly twice to 250% of the dose of D2 to match that of D3 (Trang H et al 1998).--D2 blood levels don't yield long-term sustained levels of 25-hydroxy vitamin D as does D3. When examined as a 28-day area under the curve (AUC--a superior measure of biologic exposure), D3 yields better than a 300% increased potency compared to D2. This means that it requires around 50,000 units D2 to match the effects of 15,000 units D3 (Armas LA et al 2004). --D2 has lower binding affinity for vitamin D-binding protein, compared to D3--Mitochondrial vitamin D 25-hydroxylase converts D3 to the 25-hydroxylated form five times more rapidly than D2. --As we age, the ability to metabolize D2 is dramatically reduced, while D3 is not subject to this phenomenon (Harris SS et al 2002). From Armas LA, Hollis BW, Heaney RP 2004While there are dissenters on this view, the bulk of evidence suggests that D2 is an inferior form of D3. Then why is D2 prescribed by many doctors when the natural, human, and superior D3 is available over-the-counter? You already know the answer: Much of your doctor's education did not come from scientific lectures nor from reading scientific studies. It came from the pretty drug representative in the waiting room who hands the doctor reprints of the "studies" performed by the drug industry to support the use of their drugs. There is no such nutritional supplement representative in the waiting room. This preference for the "drug" D2 over the supplement D3 also stems from the inherent preference of physicians for things they can control, whether or not there is proof of superiority. In my view, there is absolutely no reason to take vitamin D2 over D3 except to enrich the drug industry. Honey: More fructose than high-fructose corn syrup 11. August 2009 William Davis (21) Honey: It’s natural. Mom probably gave it to you, either straight or in tea for a sore throat when you were a kid. Even today, honey is touted as possessing almost supernatural qualities for promoting health. Honey contains B vitamins, minerals, and a handful of antioxidants. It also contains . . . fructose. 60% of honey, in fact, is fructose. While the average per capita intake of honey is only a modest 1.29 lb per year (National Honey Board; 2008) and therefore contributes only 0.77 lb of fructose per year, there are people who, believing honey to be healthy, use it to excess and use far more than 1.29 lb per year. How does that compare to table sugar, or sucrose? Sucrose is 50:50 glucose to fructose. How about high-fructose corn syrup, the sweetener found in virtually all processed foods that has replaced sucrose as the most common sweetener? Depending on the variety, high-fructose corn syrup is generally 42-55% fructose. Many of us (including me) believe that the proliferation of high-fructose corn syrup in processed foods is a big part of the reason Americans are fat and diabetic. Yes: Judged by its fructose content, honey is worse than high-fructose corn syrup. It is also worse than sucrose. It means that honey can also contribute to the adverse health effects of fructose, as detailed in this prior Heart Scan Blog post. Sun, fish, and seaweed 8. August 2009 William Davis (9) Extraordinary heart health springs from three basic sources in our environment: Sun, fish, and seaweed. Sun: Sunlight exposure is nature's intended source of vitamin D. Humans were meant to run naked, or at least scantily clad, in tropical or sub-tropical climates. The large surface area of skin ensured plenty of skin activation of vitamin D, along with long days of intense sun (unlike the seasonal variation of day length and less intense sun further north).Fish: Fish are the principal source of omega-3 fatty acids, as are, to a lesser degree, wild land animals. Humans as hunter-gatherers tracked, captured, and slaughtered fish and wild game, eaten immediately, since there was no means of storage. Omega-3-rich game was the principal source of fat for primitive cultures. Seaweed: Seaweed is the world’s most concentrated source of iodine. While seafood like fish and shellfish also contain iodine, seaweed contains, on average, a thousand-fold greater quantity. Seaweed, like plants found on land, are also rich in phytonutrients. The healthiest cultures on earth follow this simple recipe for health. The unhealthiest population on earth-meaning Americans (i.e., without benefit of bail-out medications and procedures that keep us alive, or vaccinations that protect us from infectious diseases)--neglect all three. Witness the Okinawans, whose daily meals nearly always contain some form of fish and seaweed, and whose sub-tropical climate provides greater sun exposure. It is not unusual for Okinawans to live to 100 years of age, not as an exception, but the rule. Heart disease was virtually unknown except in 90-year olds and older-that is, until the recent adoption of Western practices like fast food and snacks.It's pretty incredible when you think about it: Simple practices can markedly reduce your likelihood of heart attack and developing heart disease. Perhaps you’d rather not run naked along a semi-tropical beach, spear fish, and gather seaweed. You could always do the modern equivalents and achieve similar benefits. Glycemic index: A flawed concept 7. August 2009 William Davis (0) Kallio P et al Am J Clin Nutr 2008Squares = rye bread, circles = oat bread Fructose is a coronary risk factor 4. August 2009 William Davis (21) As discussed in a previous Heart Scan Blog post, Say Goodbye to Fructose, a carefully-conducted University of California study demonstrated that, compared to glucose, fructose induces:1) Four-fold greater intra-abdominal fat accumulation2) 13.9% increase in LDL cholesterol, doubled Apoprotein B 3) 44.9% increase in small LDL, 3-fold more than glucose 4) Increased postprandial triglycerides 99.2%.Other studies have shown that fructose:--Increases uric acid--No longer is red meat the cause for increased uric acid; fructose has taken its place. Uric acid may act as an independent coronary risk factor and increases high blood pressure and kidney disease. --Induces insulin resistance, the situation that creates diabetes--Increases glycation (fructose linked to proteins) and protein cross-linking, processes that underlie atherosclerosis, liver disease, and cataracts. Make no mistake: Fructose is a powerful coronary risk factor. There is no doubt whatsoever that a diet rich in fructose from fruit drinks, honey, raisins and other dried fruit like cranberries, sucrose (table sugar), and high-fructose corn syrup is a high-risk path to heart disease. Also note that many foods labeled "heart healthy" because of low-fat, low saturated fat, addition of sterol esters, or fiber, also contain fructose sources, especially high-fructose corn syrup. << Older posts Newer posts >> Newer posts12...373839404142434445...123124Older posts
Grasscutting, fertilizer, and healthcare 25. August 2009 William Davis (23) A guy named Jeff, a 60-something, taciturn, "How 'bout dem Brewers?" kind of guy, cuts my grass. Once a week, Jeff drives over his rust-rimmed 1994 Chevy pickup and trailer, unloads his ride mower, and cuts the grass. For his 40 minutes of work, I pay him $35. For $35, all he does is cut the grass--no trimming, no picking up debris, no working in the garden, no fertilizing, no weeding. Just cutting the grass. Occasionally, Jeff has proven to be a useful resource for peculiar problems. Last year, I had a drainage problem that he helped solve and two years ago he helped diagnose a tree disease that was killing a tree in the backyard; it's now recovered. To save money, and because I like to work in the yard, I do the rest. I trim the edges, I fertilize the grass, plant new flowers and trees, fix damaged areas, trim wild branches.In my view, my relationship with Jeff, a limited, as-needed relationship, in which I ask him to help with specific issues but I manage the rest myself, is how I believe that healthcare should also be conducted. Your doctor should be like Jeff: Perhaps not taciturn, but an as-needed resource available while you do much of the work. My simple relationship with Jeff is, I believe, the healthcare model of the future. You manage your own cholesterol issues, your own basic thyroid issues, supplement and monitor your vitamin D levels, use diet to suit your needs, order blood tests when necessary, even obtain basic imaging tests like heart scans, carotid ultrasound, bone density testing. Your doctor is a resource, near by when and if you need him or her: guidance when needed, an occasional review of what you are doing, someone to consult when you fracture an ankle. What your doctor is NOT is a paternal, "do what I say, I'm the doctor," or a "You need these tests whether you like it or not" holder of your health fate. It is a model of healthcare that will evolve over the next 20-30 years, only in its infancy now. While we started Track Your Plaque as just a resource for in-depth information on prevention and reversal of coronary heart disease, I now see it as something much greater: a prototype for the emerging concept of self-directed health. Enough for now. I've got some tomatoes to pick.
Iodine deficiency is REAL 21. August 2009 William Davis (30) Like many health-conscious people, Kurt avoids salt. In fact, he has assiduously avoided salt ever since his heart attack back in 1995. Lately, Kurt had become tired, often for little or no reason. His thyroid panel:TSH 4.2 mIU/L (0.27-4.20)Free T3 1.74 pg/ml (2.50-4.30)Free T4 1.05 ng/dl (0.9-1.7)Kurt's TSH of 4.2 mIU/L is sufficient to increase LDL cholesterol by 20-30% and increase the (relative) risk for heart attack 3-fold. Kurt's thyroid was also palpably enlarged. While it was just barely visible--just a minor bulge in the neck (in the shape of a bowtie), it could be clearly felt when I examined him. I asked Kurt to add 500 mcg of iodine every day. Three months later, another thyroid panel showed:TSH 0.14 mIU/L (0.27-4.20)Free T3 2.50 pg/ml (2.50-4.30)Free T4 1.1 ng/dl (0.9-1.7)Kurt's thyroid function normalized to nearly ideal levels just with iodine replacement. (The free T3, while improved, remains low; an issue for another day!) I see this response with some frequency: low-grade goiter and apparent hypothyroidism (low thyroid function) that responds, at least partially, to iodine replacement. In Kurt's case, iodine replacement alone normalized his thyroid measures completely. With improved thyroid measures, Kurt also felt better with renewed energy and a 22 mg/dl reduction in LDL cholesterol. Make no mistake: Iodine deficiency is real. While most of my colleagues have dismissed iodine deficiency as a relic of the early 20th century and third world countries, you can also find it in your neighborhood.
Fish oil for $780 per bottle 19. August 2009 William Davis (16) At prevailing pharmacy prices, one capsule of prescription Lovaza fish oil costs $4.33 each. Yes, you heard right: $4.33 per capsule. What do you get for $4.33 per capsule? By omega-3 fatty acid content, you get 842 mg EPA + DHA per capsule. I can also go to Sam's Club and buy a bottle of their Triple-Strength fish oil with 900 mg omega-3 fatty acids per capsule at $18.99 per bottle of 180 capsules. That comes to 10.5 cents per capsule. That puts the price of fish oil from Sam's Club at 97.6% less cost compared to Lovaza for an equivalent quantity of omega-3 fatty acids. What if we repriced Sam's Club's Triple-Strength and brought it "in line" with what we pay for Lovaza? That would put the value of one bottle of Sam's Club Triple-Strength fish oil at $780 per bottle. I take patients off Lovaza every chance I get.
Organic really IS better 16. August 2009 William Davis (18) If you have any doubts about the value of organic foods vs. conventionally-grown foods, then take a look at the findings from a USDA--Yes, USDA--sponsored study. In this study, the nutritional content of organic vs. conventionally-grown blueberries were compared. Ironically, these observations come from the USDA's Genetic Improvement of Fruits and Vegetables Laboratory of the Produce Quality and Safety Laboratory. Their findings (all values expressed as weight per 100 grams fresh weight blueberries, or a bit less than 1/4 cup):Total phenol content (e.g, flavonoids):Organic: 319.3 mgConventional: 190.3 mgOrganic blueberries had 68% greater phenol content.Total anthocyanins (an important class of flavonoids):Organic: 131.2 mgConventional: 82.4 mgOrganic blueberries had 59% greater anthocyanin content.Antioxidant capacity (ORAC): Organic: 46.14 mgConventional: 30.8Organic blueberries had 50% greater antioxidant capacity. Flavonoids suspected to carry unusually potent health effects--malvidin, delphinidin, myricetin, and quercetin--were all contained in greater proportions in the organically-grown blueberries, also. These flavonoids are demonstrating pharmacologic-level health effects in preliminary studies. Why a genetics laboratory? After all , the study findings came out heavily in favor of non-genetic, organic farming methods of growing produce. It certainly must have at least given pause to the vocal group within agriculture and the USDA that have long argued that organic produce is no different. I suspect that the laboratory will now try to recreate the nutritional value of organic through genetic manipulation of cultivars grown using conventional methods. Regardless of the motivations behind the study, we see that there is no comparison: organic blueberries are superior in nutritional value to those grown with conventional pesticides and herbicides. While the study addressed only blueberries, the dramatic difference makes it likely that similar differences exist in other fruits and vegetables. Coming on the Track Your Plaque website: An in-depth Special Report on the health effects of anthocyanins.
Do you really need calcium? 12. August 2009 William Davis (0) Why are we advised to take calcium supplements?Men and women are advised to take calcium because it has been shown to reduce blood pressure modestly. Women, in particular, can stall the deterioration of bone strength (mineralization) by taking calcium supplements, 1200-1300 mg per day, and eating calcium-rich foods like dairy products. Is that all true?It is true insofar as we remain vitamin D deficient. A funny thing happens when you fully replete vitamin D: Intestinal absorption of calcium as much as quadruples. That means your body will efficiently absorb the calcium in broccoli and spinach. Is it still necessary to force-feed your body megadoses of calcium once vitamin D has been repleted? I don’t think so. While the evidence is indirect, several observations point towards the lack of necessity of calcium once vitamin D is addressed. For instance:Women who take calcium, 1200 mg per day, with vitamin D, 800 units per day, double their five-year risk for heart attack, according to a New Zealand study. Men who take calcium, 1200 mg per day, with vitamin D, 800 units per day, also may substantially increase heart attack risk. Bone density increases more with vitamin D than with calcium. Calcium may not even be necessary to increase bone mineralization, since there are data to suggest that vitamin D can accomplish this by itself. Calcium suppresses parathyroid hormone, PTH. That is, in fact, how calcium stalls (usually does not reverse) bone mineral loss-not by adding calcium to bone, but by suppressing PTH release. (PTH causes bone demineralization.) Vitamin D suppresses PTH to a far greater degree than calcium.What is needed is a broad reconsideration of the advice everyone is getting to take calcium. In an age when more and more people are appreciating the power of vitamin D supplementation to achieve normal blood levels, there may be danger ahead for those who fail to address their calcium overdosing.
The case against vitamin D2 11. August 2009 William Davis (40) Why would vitamin D be prescribed when vitamin D3 is available over-the-counter?Let's review the known differences between vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol):--D3 is the human form; D2 is the non-human form found in plants.--Dose for dose, D3 is more effective at raising blood levels of 25-hydroxy vitamin D than D2. It requires roughly twice to 250% of the dose of D2 to match that of D3 (Trang H et al 1998).--D2 blood levels don't yield long-term sustained levels of 25-hydroxy vitamin D as does D3. When examined as a 28-day area under the curve (AUC--a superior measure of biologic exposure), D3 yields better than a 300% increased potency compared to D2. This means that it requires around 50,000 units D2 to match the effects of 15,000 units D3 (Armas LA et al 2004). --D2 has lower binding affinity for vitamin D-binding protein, compared to D3--Mitochondrial vitamin D 25-hydroxylase converts D3 to the 25-hydroxylated form five times more rapidly than D2. --As we age, the ability to metabolize D2 is dramatically reduced, while D3 is not subject to this phenomenon (Harris SS et al 2002). From Armas LA, Hollis BW, Heaney RP 2004While there are dissenters on this view, the bulk of evidence suggests that D2 is an inferior form of D3. Then why is D2 prescribed by many doctors when the natural, human, and superior D3 is available over-the-counter? You already know the answer: Much of your doctor's education did not come from scientific lectures nor from reading scientific studies. It came from the pretty drug representative in the waiting room who hands the doctor reprints of the "studies" performed by the drug industry to support the use of their drugs. There is no such nutritional supplement representative in the waiting room. This preference for the "drug" D2 over the supplement D3 also stems from the inherent preference of physicians for things they can control, whether or not there is proof of superiority. In my view, there is absolutely no reason to take vitamin D2 over D3 except to enrich the drug industry.
Honey: More fructose than high-fructose corn syrup 11. August 2009 William Davis (21) Honey: It’s natural. Mom probably gave it to you, either straight or in tea for a sore throat when you were a kid. Even today, honey is touted as possessing almost supernatural qualities for promoting health. Honey contains B vitamins, minerals, and a handful of antioxidants. It also contains . . . fructose. 60% of honey, in fact, is fructose. While the average per capita intake of honey is only a modest 1.29 lb per year (National Honey Board; 2008) and therefore contributes only 0.77 lb of fructose per year, there are people who, believing honey to be healthy, use it to excess and use far more than 1.29 lb per year. How does that compare to table sugar, or sucrose? Sucrose is 50:50 glucose to fructose. How about high-fructose corn syrup, the sweetener found in virtually all processed foods that has replaced sucrose as the most common sweetener? Depending on the variety, high-fructose corn syrup is generally 42-55% fructose. Many of us (including me) believe that the proliferation of high-fructose corn syrup in processed foods is a big part of the reason Americans are fat and diabetic. Yes: Judged by its fructose content, honey is worse than high-fructose corn syrup. It is also worse than sucrose. It means that honey can also contribute to the adverse health effects of fructose, as detailed in this prior Heart Scan Blog post.
Sun, fish, and seaweed 8. August 2009 William Davis (9) Extraordinary heart health springs from three basic sources in our environment: Sun, fish, and seaweed. Sun: Sunlight exposure is nature's intended source of vitamin D. Humans were meant to run naked, or at least scantily clad, in tropical or sub-tropical climates. The large surface area of skin ensured plenty of skin activation of vitamin D, along with long days of intense sun (unlike the seasonal variation of day length and less intense sun further north).Fish: Fish are the principal source of omega-3 fatty acids, as are, to a lesser degree, wild land animals. Humans as hunter-gatherers tracked, captured, and slaughtered fish and wild game, eaten immediately, since there was no means of storage. Omega-3-rich game was the principal source of fat for primitive cultures. Seaweed: Seaweed is the world’s most concentrated source of iodine. While seafood like fish and shellfish also contain iodine, seaweed contains, on average, a thousand-fold greater quantity. Seaweed, like plants found on land, are also rich in phytonutrients. The healthiest cultures on earth follow this simple recipe for health. The unhealthiest population on earth-meaning Americans (i.e., without benefit of bail-out medications and procedures that keep us alive, or vaccinations that protect us from infectious diseases)--neglect all three. Witness the Okinawans, whose daily meals nearly always contain some form of fish and seaweed, and whose sub-tropical climate provides greater sun exposure. It is not unusual for Okinawans to live to 100 years of age, not as an exception, but the rule. Heart disease was virtually unknown except in 90-year olds and older-that is, until the recent adoption of Western practices like fast food and snacks.It's pretty incredible when you think about it: Simple practices can markedly reduce your likelihood of heart attack and developing heart disease. Perhaps you’d rather not run naked along a semi-tropical beach, spear fish, and gather seaweed. You could always do the modern equivalents and achieve similar benefits.
Glycemic index: A flawed concept 7. August 2009 William Davis (0) Kallio P et al Am J Clin Nutr 2008Squares = rye bread, circles = oat bread
Fructose is a coronary risk factor 4. August 2009 William Davis (21) As discussed in a previous Heart Scan Blog post, Say Goodbye to Fructose, a carefully-conducted University of California study demonstrated that, compared to glucose, fructose induces:1) Four-fold greater intra-abdominal fat accumulation2) 13.9% increase in LDL cholesterol, doubled Apoprotein B 3) 44.9% increase in small LDL, 3-fold more than glucose 4) Increased postprandial triglycerides 99.2%.Other studies have shown that fructose:--Increases uric acid--No longer is red meat the cause for increased uric acid; fructose has taken its place. Uric acid may act as an independent coronary risk factor and increases high blood pressure and kidney disease. --Induces insulin resistance, the situation that creates diabetes--Increases glycation (fructose linked to proteins) and protein cross-linking, processes that underlie atherosclerosis, liver disease, and cataracts. Make no mistake: Fructose is a powerful coronary risk factor. There is no doubt whatsoever that a diet rich in fructose from fruit drinks, honey, raisins and other dried fruit like cranberries, sucrose (table sugar), and high-fructose corn syrup is a high-risk path to heart disease. Also note that many foods labeled "heart healthy" because of low-fat, low saturated fat, addition of sterol esters, or fiber, also contain fructose sources, especially high-fructose corn syrup.