More on aortic valve disease and vitamin D

22. August 2007 William Davis (22)
I hope I'm not getting my hopes up prematurely, but I believe that I've seen it once again: Dramatic reversal of aortic valve disease.

This 64-year old man came to me because of a heart scan score of 212. Jack proved to have small LDL, lipoprotein(a), and pre-diabetes. But there was a wrench in the works: Because of a new murmur, we obtain an echocardiogram that revealed a mildly stiff ("stenotic") aortic valve, one of the heart valves within the heart that can develop abnormal stiffness with time.

You can think of aortic valve disease as something like arthritis--a phenomenon of "wear and tear" that progresses over time, but doesn't just go away. In fact, the usual history is that, once detected, we expect it to get worse over the next few years. The stiff aortic valve eventually causes symptoms like chest pains, breathlessness, lightheadedness, and in very severe cases, passing out. For this reason, when symptoms appear, most cardiologists recommend surgical aortic valve replacement with a mechanical or a bio-prosthetic ("pig") valve.

Now, Jack's first aortic valve area (the parameter we follow by echocardiogram representing the effective area of the valve opening when viewed end on) was 1.6 cm2. A year later: 1.4 cm2. One year later again: 1.1 cm2.

In other words, progressive deterioration and a shrinking valve area. Most people begin to develop symptoms when they drop below 1.0 cm2.

Resigned to a new valve sometime in the next year or two, Jack underwent yet another echocardiogram: Valve area 1.8 cm2.

Is this for real? I had Jack come into the office. Lo and behold, to my shock and amazement, the prominent heart murmur he had all along was now barely audible.

I'm quite excited. However, it remains too early to get carried away. I've now seen this in a handful of people, all with aortic valve disease.

Aortic valve stenosis is generally regarded as a progressive disease that must eventually be corrected with surgery--period. The only other strategy that has proven to be of any benefit is Crestor 40 mg per day, an intolerable dose in my experience.

If the vitamin D effect on aortic valve disease proves consistent in future, even in a percentage of people, then hallelujah! We will be tracking this experience in future.
Tags :

Comments (22) -

  • Mike

    8/22/2007 1:19:00 PM |

    What does vitamin D have to do with the improved heart valve?

  • Richard A.

    8/22/2007 9:42:00 PM |

    Maybe a little vitamin k with the vitamin d would give even better results for aortic valve disease.

  • Dr. Davis

    8/22/2007 9:46:00 PM |

    If this is true, I can only speculate on the mechanism for vitamin D's effect. It might include anti-inflammatory effects, suppression or modification of calcium deposition, and lipid (cholesterol) effects. However, this is just my speculation.

    I also agree that adding vitamin K2 may exert an effect, particularly in view of the valve disease that develops when people take the vitamin K blocker, Coumadin.

  • Anonymous

    8/31/2007 2:48:00 PM |

    Why do you stress Vitamin D3 supplements be in gel cap form?  Many of these contain Vitamin A in addition to the D.  If capsules of D are taken after a meal containing some fat, woulden't that suffce?

  • Dr. Davis

    8/31/2007 3:25:00 PM |

    If you want consistent absorption of vitamin D, gelcaps are best. Tablets are, in my view, next to worthless because of the erratic absorption, even when taken with a fatty meal.

    You can find D without A. Go to Vitamin Shoppe or buy Carlsons'brand.

  • Jim Chinnis

    9/10/2007 2:31:00 AM |

    Dr. Davis, I think you neglected to mention vitamin D in your blog article. Take a look at what you wrote!

  • Dr. Davis

    9/10/2007 4:17:00 AM |

    Whoops!

    Yes. It was vitamin D supplementation that I presume was the factor behind the effect on valve disease.

  • Adam

    9/13/2007 12:52:00 AM |

    Dr. Davis,

    Thanks for the thoughts. And, I really like your blog.  Thanks for sharing. I'm definitely coming back!

    Cheers,

    Adam
    Adam's Heart Valve Surgery Blog

  • Anonymous

    10/2/2007 4:16:00 PM |

    Any suggestions on dosage requirements of D3 gel caps?

  • Dr. Davis

    10/2/2007 6:22:00 PM |

    We've used anywhere from 4000-8000 units per day of an oil-based gelcap to achieve this effect.
    Please see my numerous prior posts on vit D dosing, along with commentary on our website, www.trackyourplaque.com.

  • William Ball, Pharm.D.

    9/30/2008 5:38:00 AM |

    I'm 60 and just this week was diagnosed by echo as having a bicuspid aortic valve that is clacified, sclerosed and fused with a valve area of 1.1cm.  I'm asymptomatic, but my reading shows I'm headed for valve replacement within a few years at most.  I read you anecdotal reports of vitmain D apparent reversal of aortic stenosis.  However, I am aware that vitamin D can increase calcium deposition in tissues.  Are you sure this is safe for patients like me?  You are aware that nothing to date has been proven to change the natural history of this disease, so I find your blog posts to be provocative at best and perhaps rather reckless despite your medical credentials.  Do you have any recent follow-up on your initial anecdotal report?

  • Anonymous

    12/18/2008 5:11:00 PM |

    Hell of a way to ask for help, Bill!

  • William Ball

    5/5/2009 3:40:00 AM |

    Being as I see no further follow-up on this one patient back in 2007, I'll just add that I had my vitamin D levels checked in September and they were low, so I decided to try Dr. Davis's idea.  On 10K IU of D3 I achieved normal vitmain D levels.  Unfortunately, in the last 6 months my AS has progressed with my valve opening going down from 1.1 to 0.9cm.  I still am asymptomatic but will have another echo in 4 months.  My cardiologist is concerned as my left ventricle also increased in size from 5.6 to 6.8cm in 6 months. I'll give the D3 another 4 months, but so far, it appears not to be helping at best and perhaps is accelerating the progression of my AS.

  • William Ball

    7/8/2009 2:28:57 AM |

    Further follow-up on my case.  Today I just got back from Stanford where I had another echo and met with Dr. Craig Miller, Chief of Cardiothoracic Surgery, to discuss my options.  My valve has further stenosed down to 0.7cm from 0.9 only 3 months earlier.  So, despite healthy doses of vitamin D, it looks like, if anything, the calcification of my valve has accelerated. This really points out how a single anecdotal report can be rather misleading.  Although I can believe that the patient's AS in the original report may have receded, there is no way you can attribute this to vitamin D.  It could be a completely unrepeatable coincidence.  Dr, Davis, with all due respect for your good intentions and the benefit you may otherwise provide to your patients, you really ought to remove your case report until you have some more concrete, repeateable evidence.  It not only may not have helped me, but it may have harmed me.

  • Dr. William Davis

    7/8/2009 12:29:17 PM |

    William--

    Sorry to hear about your valve "progression."

    My experience is not one patient, but around 20. Most have shown either modest reversal of aortic valve stenosis or stabilization (i.e., no change); two have progressed.

    So your experience is the exception, not the rule, compared to what I am seeing. I cannot claim that vitamin D is the "cure all," but I believe this phenomenon can teach us some interesting lessons.

    By the way, your disease, I believe is just showing the natural progression. Small leaps in severity like this are not uncommon in the absence of vitamin D.

  • Anonymous

    7/28/2009 8:39:00 PM |

    There are some people who's bodies are predisposed to use vitamin d the wrong way. Here's a link to one page that can take you to the research on this subject.
    http://www.examiner.com/x-7160-Sacramento-Nutrition-Examiner~y2009m4d15-Will-taking-vitaminD3-calcify-your-aorta-if-you-have-a-certain-genetic-variation

  • Anonymous

    10/19/2009 11:41:50 AM |

    Dr. Davis,
    Following the previous post from 'anonymous' I would add this comment in support of Bills thoughts that your posts may be 'reckless'.

    There is some evidence that vitamin D can actually CAUSE aortic valve calcification, both in animal models (see The Journal of the American College of Cardiology 2003, Volume 41, Issue 7, Pages 1211-1217: Experimental aortic valve stenosis in rabbits) and in human patients (see Heart 2001, Volume 85, pages 635-638: The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis). In this case, you should be very careful in extrapolating your observations of one patient (perhaps with unusually low LDL) to a blanket 'vitamin D restoration' model. It could cause deterioration in the health status of those who seek your expertise without a proper diagnosis.
    A good PubMed search will provide the necessary literature for you to research (rather than speculate) on the mechanism for vitamin D's effect, and may help you to follow the ongoing debate about the validity of the animal model.

  • Dr. William Davis

    10/19/2009 8:51:52 PM |

    Anon--

    I believe you are confusing two things: vitamin D at physiologic replacement levels (as we do in humans) and vitamin D at toxic, supraphysiologic levels (as in rats and mice).

    Like any hormone, too little is not good, too much is not good. We want just right to obtain the benefits.

  • Anonymous

    10/20/2009 10:12:52 AM |

    Hi again Dr. Williams,

    forgive me for pushing you on this, but I am not confusing two things at all.

    One should, of course, always be cautious when extrapolating animal studies to humans and, while the supraphysiological (toxic) levels shown in some animal models is a potential issue (though also debatable, as physiological - or nutritionally relevant - levels CAN induce valve stenosis in mice with sub-optimal lipid metabolism), the main issue is that we are beginning to understand the complexity and potential danger of untested 'nutritional supplements' because of the wide genetic variation that exists in any population (see the second reference I provided for you comparing 630 HUMAN patients). Further, there is very little data on what actually represents 'toxic' levels in humans who take complex multivitamin mixtures, regardless of geographic considerations, environmental load and preexisting baseline blood concentrations (e.g., would you advise selenium supplementation for someone living in Nebraska?).

    This is perhaps demonstrated by your own reports of "around 20" patients (the complete statistics for which I would be interested to see). What is meant by "modest reversal or stabilization in most"? Is not the "around" 10% who have regressed worthy of your interest? I would have thought that without a recovery in all of your patients, you may consider that you are indeed "getting your hopes up prematurely" and that you may be more keen to understand the biochemistry behind the failures. Perhaps you could secure funding to follow these patients in a well designed scientific study? There must be other doctors with similar experiences who would be keen to push the science forward and take it out of the realm of anecdote?

    While I absolutely agree with you that prevention is better than intervention (I saw an excellent seminar just yesterday from professor Richard Cooper [from Loyola Chicago] demonstrating how just reducing salt intake can have dramatic effects on heart health in most people, and Professor Valentin Fuster [Mount Sinai] knows how a good exercise regime can reverse coronary desease). And while I also don't like the 'statin-and-stent' mentality (do statins work at all in women??), I also believe that drug disposition and pharmacokinetics are incredibly important.

    I simply think that you should place an enormous caveat on any of your posts that suggest that supplements such as vitamin D (and perhaps K, A, E, C, selenium etc. etc.) might be a 'magic bullet'. None of them is when applied across the board. In fact, there is strong, reputable and repeatable science that demonstrates potential damage caused by some of these unregulated concoctions that are marketed as 'healthy' (the topic of another of your 'scam' posts when applied to health foods).

    You are absolutely correct that the vitamin D phenomenon "can teach us some interesting lessons", but you are not the first person to have noted this idea and it is being investigated in fairly comprehensive studies. When the results are in, perhaps we will have a better understanding of the types of patient for whom it would work (and those for whom it may be dangerous).

    As with other eminent 'web-doctors' (e.g., Dr. Mercola, who advises vitamin D instead of the flu vaccine, or those who push "vitamin B17" instead of cancer chemotherapy), I would suggest that a blog is not a good place to practice science or medicine and I would hope you would regularly advise your readers to go to a good doctor in their area who perhaps agrees with your alternative methodologies for a full and well considered diagnosis.

  • Dr. William Davis

    10/21/2009 2:15:12 AM |

    Thank you, Anonymous.

    First of all, it's Dr. Davis, not Williams.

    Second of all, I agree with one of your points: This is the Heart Scan BLOG, not the Heart Scan Journal, not the Heart Scan List of Facts. It is a BLOG--pure and simple.  

    I hope anyone coming here for my musings and thoughts realize that's all they are. If anyone is stupid enough to make more of it than that, well that's not my problem.

  • Anonymous

    10/21/2009 9:09:51 AM |

    Hi Dr. Davis (apologies for the previous mistake),

    I wanted to point out that I enjoy your Blog and I share your interest in a nutritional basis for the prevention of cardiovascular disease. However, you allude in your various blogs to several of the unanswered issues behind our understanding of a highly complex topic. Salt reduction, resveratrol, caloric restriction and the enormous array of vitamins provide clear benefits for some people and yet seem to have almost no effect (or, when combined carelessly, even a detrimental effect) on others.

    Based on your last response, I have a final comment on this "more on aortic valve disease and vitamin D" post on your 'blog - not advice'. Then you can choose to be incensed by it, or take it as it is meant - a comment from a concerned cardiovascular research scientist who would dearly like to see these alternative approaches brought into the mainstream.

    Whether you accept responsibility for it or not, it is clear that some people read your postings and act on your "musings". You are, after all, a cardiologist and seen as an expert in medical matters. Further, you and I both know that the vast majority of people neither have access to nor the potential to understand the scientific literature, so the internet has become a frequently dangerous tool by which millions get their information and advice.

    In this thread alone, there are people asking for (and receiving) specific advice on the type of vitamin D to acquire (gel caps) and the purported optimum dosage (anywhere from 4000-8000 units per day). Further, while you don't actually tell him to, William Ball was clearly following what he perceives as 'Doctor's advice' when he "decided to try Dr. Davis's idea".

    His subsequent decline was then 'diagnosed' by you as likely being a "natural progression", even though he states that his vitamin D levels were "normal". This was apparently after taking 10,000 IU per day? Perhaps Mr. Ball would have been interested to know that 10,000 IU is the figure proposed by Hathcock et al., in 2007 as being the upper tolerance limit for humans [Am. J. Clin. Nutr. 85 (1): 6–18] - and should perhaps raise alarm bells.

    There were several opportunities for you to make more clear that this is just "a blog" and should not be used as an alternative for sound medical advice. There is a lot still unknown about this topic and while "not your problem" (and to use your words) there are plenty of people "stupid enough to make more of" your post that you might wish.

    I have several friends for whom I have great concerns because they follow potentially dangerous alternative health approaches based on the "knowledge" they glean from the internet. One friend takes potentially toxic doses of the cyanide compound 'vitamin' B17 to prevent cancer. I have family members who have not vaccinated their children because they KNOW vaccines cause autism. Another refuses to use toothpaste and spends a fortune on bottled water because fluoride will reduce his IQ and give him cancer.

    Big Pharma is now seen almost universally as demonic and conspiracy theories abound. According to such theories, without the influence of doctors, scientists and pharmaceutical companies, we would already be living in a world without cancer and cardiovascular disease - but we are hiding the answers for the sake of profit. While you clearly hold some cynical views about the profitability of the 'conventional treatment' of heart disease, most doctors are doing the best they can under hugely difficult circumstances (and in the face of patients refusing to change bad behavior). We can only hope that the future is brighter as a result of the research being conducted on the alternative preventive measures to which you subscribe.

    In the meantime, as a doctor, you should perhaps be more aware of your influence and how blindly some people will follow your advice, whether you think you have given it or otherwise.

  • buy jeans

    11/3/2010 8:43:50 PM |

    Aortic valve stenosis is generally regarded as a progressive disease that must eventually be corrected with surgery--period. The only other strategy that has proven to be of any benefit is Crestor 40 mg per day, an intolerable dose in my experience.

Add comment

Loading
Cureality | Real People Seeking Real Cures

How old are you?

17. October 2009 William Davis (21)
George walks into my office. I ask him his age.

"I'm 21 years old," he declares.

Yet I look at George. He's got gray thinning hair, his posture is slumped forward rather than erect, the flesh on his upper arms hangs loosely, he's got wrinkles on his hands and face, brown spots on the back of his hands and arms. He looks more like 70 years old to me. "I don't think you're 21 years old. I think you're 70."

"Prove it," he says.

Okay. What now? Minus any formal identification like a driver's license, how do I prove that George is really 70-something and not 20-something? Not an easy thing, when you think about it. If George were a tree, I'd cut him down and count his rings. Is there such a phenomenon in humans?

This is actually a fascinating area of research, looking for reliable biomarkers of aging.

Among the most quantitative markers of aging is telomere length. Telomeres were once dismissed as nonsense sequences in DNA. However, more recent thought among geneticists is that telomeres shorten with aging and provide the body's cells a timeline of aging. This way, George's cells act like they are 70, not 13, and don't start producing gobs of growth hormone and testosterone in preparation for puberty.

What can slow or stall the shortening of telomere length? There are two I'm aware of:

1) Caloric deprivation--i.e., taking in fewer calories. This was among the theories explored by Dr. Roy Walford during his Biosphere2 experience, based on his work in mice that showed that caloric deprivation nearly doubled lifespan.

2) Vitamin D--Richards et al (2007) found that, the higher the vitamin D, the longer the telomere length. The highest vitamin D levels conferred a 5-year effective difference in telomere length.

So, if I could look inside George's cells and count his telomeres, I could judge with confidence whether he was 21 or 70. Or, he could take vitamin D sufficient to increase blood levels to a healthy range and be more like 65.

No high blood pressure

14. October 2009 William Davis (20)
Primitive cultures that were, until recently, unexposed to the modern world, reveal some important insights into blood pressure.

The Yanomamo of South American, the Xingu Indians of Brazil, rural Kenyans, and the natives of Papua, New Guinea have average blood pressures of 103/63 mmHg. Even more incredibly, while 90% of modern Americans will develop high blood pressure as they age, the members of these primitive cultures do not develop age-related hypertension.

What's the secret? Perhaps the full "secret" of their remarkably low blood pressure has not been fully unraveled, but several observations have emerged:

--They are not exposed to modern processed foods like pretzels, crackers, and breakfast cereals.
--Low-carbohydrate foods. Carbohydrates are largely the product of the food industry, convenience foods bought in stores. No such thing in the jungle.
--Living outdoors, having to forage and hunt, walk to your destination, not drive or wait in line for food.
--Outdoor lives, wearing little more than a few strands of clothing, exposes you to plentiful vitamin D activation from sunlight exposure.
--Consuming wild game, rich in omega-3 fatty acids, enhances endothelial health and reduces blood pressure.
--Wild plants, roots, and berries, as well as wild game, along the coast, are richer in iodine.

The studies examining the habits of the Yanomamo and other primitive cultures focused principally on sodium intake. Indeed, the very low sodium intake of primitive cultures was associated with lower blood pressure--up to 6 mmHg reduction. But there's clearly more to learn than "cut your salt."

Name that food

13. October 2009 William Davis (30)
What common food can:

• Cause destructive intestinal damage that, if unrecognized, can lead to disability and death?
• Increase blood sugar higher and faster than table sugar?
• Trigger an autoimmune inflammatory condition in the thyroid (Hashimoto’s thyroiditis)?
• Create intestinal bloating, cramps, and alternating diarrhea and constipation, often labeled irritable bowel syndrome?
• Trigger schizophrenia in susceptible individuals?
• Cause behavioral outbursts in children with autism?
• Cause various inflammatory diseases such as rheumatoid arthritis, ulcerative colitis, dermatitis herpetiformis, systemic lupus, pancreatic destruction, and increase measures of inflammation like c-reactive protein?
• Cause unexplained anemia, mood swings, fatigue, fibromyalgia, eczema, and osteoporosis?


The food is wheat. Yes, the ubiquitous grain we are urged to eat more and more of by the USDA (8-11 servings per day, according to the USDA food pyramid), American Heart Association, American Dietetic Association, and the American Diabetes Association. Wheat is among the most destructive ingredients in the modern diet, worse than sugar, worse than high-fructose corn syrup, worse than any fat.

What other common food can result in such an extensive list of diseases, even death?

Celiac disease alone, a severe intestinal inflammatory condition from wheat gluten, affects an estimated 3 million Americans (Celiac Disease Foundation). The medical literature is filled with case reports of deaths from this disease, often after many years of struggle with incapacitating intestinal dysfunction and the sufferer's last days plagued by encephalopathy (brain inflammation).

What happens when you remove wheat from the diet?

The majority of people quickly shed 20-30 lbs in the first few weeks, selectively lost from the abdomen (what I call “wheat belly”); blood sugar plummets; triglycerides drop up to several hundred milligrams, HDL increases, LDL drops (yes, wheat elimination is a means of achieving marked reduction in LDL cholesterol, especially the small, heart disease-causing variety); c-reactive protein plummets. In addition to this, intestinal complaints improve or disappear, rashes improve, inflammatory conditions like rheumatoid arthritis improve, diabetes can improve or be cured, and behavioral disorders and mood improve.

Along with the ill-fated low-fat dietary advice of the last 40 years, the advice to eat plenty of "healthy whole grains" is responsible for untold disease and suffering. Yes, if you start with a fast food and junk diet and replace some of the calories with whole grains, you will be better off. (That was the logic--the Nutritional Syllogism--of the studies that established the benefits of whole grains over processed, "white" grains.)

But eliminate wheat grains and health takes a huge leap forward. And, no, there is no such thing as wheat deficiency--B vitamins, insoluble fiber, some protein--can easily be replaced by other foods.

Heart Defects Simplified

12. October 2009 William Davis (0)


For as long as I've known him, echocardiography technologist, Ken Heiden, has had a deep fascination with congenital heart disease. Ken has just written a wonderful book on congenital heart disease called Heart Defects Simplified.

While this is a bit off-topic for the Heart Scan Blog, I know that there is a serious lack of helpful information for people with congenital heart disease and parents of children with congenital heart defects. So I asked Ken to tell us something about his book.



WD: I've reviewed your book and have been thoroughly impressed with the clarity and detail with which you handle a complicated topic. You somehow manage to make it easy to grasp, far more than any other resource I've used in past. Do you feel that your book serves a previously unmet need?

KH: This book serves an unmet need in that it presents the complex subject of congenital heart defects in a simplified manner. Most books on this subject are anywhere from 300-1700 pages in length and tend to be written for doctors. Further, most of these books have very few diagrams, and they rely upon their explanations to describe these defects.

Heart Defects Simplified is 104 pages in length, describes the most common defects, including surgical repairs, in a two-page format with full-color diagrams on the left and complete descriptions on the right of each chapter. The book is particularly written for sonographers, nurses and parents, but it is valuable for anyone interested in this subject. It is particularly useful in clinical situations because it is convenient to lay out at your side with a coil-bound format and durable pages. Further, there are appendixes which include "Surgical Procedures in Alphabetical Order," "Prevalence of Congenital Heart Disease," "Scanning Protocols for Echocardiographers," "Imaging Tips," a glossary and a worksheet for echocardiographers.


WD: I know that many people with loved ones who have congenital heart defects, particularly parents of children with such conditions, are often kept in the dark about the details of the condition. Is your book suitable for the non-technical reader, such as parents?

KH: This book is an excellent resource for parents. It is written in language that is understandable by parents as well as technologists and nurses. The full-color diagrams provide invaluable insight into this very complex world. Most importantly, this book attempts to make the subject of congenital heart defects accessible to anyone who wishes to comprehend this subject.


WD: I understand that people with congenital heart defects and parents are active participants in online discussion groups. Will your book serve as a resource for people who participate in these groups?

KH: This book is not only a resource for sonographers and parents, but the book is accompanied by a blog (HeartDefectsforEveryone.blogspot.com) that attempts to address many of the concerns commonly encountered with congenital heart defects. This blog is a work in progress, but I hope to provide a forum for parents, healthcare personnel, and others to share their questions and concerns about congenital heart disease.

My experience with the omega-3 index

8. October 2009 William Davis (23)
I just got back my own results from the Gene Smart laboratory reporting my omega-3 index and omega-6:omega-3 ratio.

My results:

Omega-3 index: 8.2%

Omega-6:omega-3 index: 3.2 to 1

Not too bad, but not as good as I'd expected. Hmmm.

Although the omega-3 index of 8.2% puts me in the lower risk category for sudden cardiac death, I was hoping for a level of 10% or slightly greater, the level that I believe is more likely to be related to plaque inactivation or reversal. I obtained this level of omega-3 averaging an intake of EPA and DHA of about 2500 mg per day.

I was somewhat disappointed by the omega-6:omega-3 index. Although it's clearly better than the American average range of 20:1, it is short of the ideal of 2:1 or even 1:1. Since I purposely avoid omega-6-rich sources like corn oil, vegetable oils, sunflower or safflower oils, I wonder if I've overdone the nuts. The two ways to improve the omega-6:omega-3 ratio are to 1) decrease omega-6, or 2) increase omega-3. I'm going to do both.

So I thought I was doing pretty well. But there's clearly room for improvement.

Remember: If just reduction of cardiovascular risk is your interest, then a lackadaisical attitude towards these issues might work. But if your interest is elimination of risk and reversal of atherosclerotic plaque, then it pays to go the extra mile. In this case, knowing your omega-3 index and omega-6:omega-3 ratio might tighten up your program.

The Omega-3 Index: The higher, the better?

6. October 2009 William Davis (26)
So you take a few fish oil capsules every day and eat fish once or twice a week. What is the blood and tissue level of omega-3 fatty acids generated by your habits?

A number of variables enter into the equation. For instance, if you take fish oil capsules, what is the concentration of omega-3 fatty acids? How well are they absorbed? After absorption, how effectively are omega-3 fatty acids incorporated into cell membranes?

Even if you take fish oil supplements, it is hard to know just how much you’ve increased blood levels. It is now possible to measure the amount of omega-3 fatty acids in your bloodstream, a value called the omega-3 index. Too little and you might still be at high risk for cardiovascular events.


The Omega-3 index and sudden cardiac death

Two large studies have demonstrated that higher omega-3 blood (the level in red blood cells, or RBCs) levels were associated with reduced likelihood of sudden cardiac death. The risk for sudden cardiac death was 10-fold higher for the lowest omega-3 RBC levels compared to the highest.



Harris WS 2008; adapted from Siscovick DS et al 1995 and Albert CM et al 2002
(The omega-3 Index was derived from whole blood omega-3 levels, which correlate with RBC omega-3 levels, and are thus “estimated.”)


What’s the average omega-3 RBC level for Americans? Most Americans have omega-3 RBC levels in the 2.5-4.0% range, consistent with the tallest bars at the left and associated with greatest risk for sudden cardiac death. People with heart disease can have levels less than 1%. Some authorities propose that this new measure be called the omega-3 index.

Subsequent studies have shown that the omega-3 index has greater power to discriminate who will have a heart attack or die from sudden cardiac death better than any other common laboratory measure of coronary risk, including LDL cholesterol, HDL cholesterol, triglycerides, total cholesterol to HDL ratio, homocysteine, and c-reactive protein.

Just as hemoglobin A1c offers a 3-month look into blood glucose levels, the omega-3 index reflects your long-term omega-3 intake. The quantity of RBC omega-3s also closely parallels the quantity of omega-3s in heart tissues.


What is an ideal omega-3 index?

The above studies relating RBC omega-3 levels and sudden cardiac death suggest that a level of 6.3-7.3% is associated with far fewer fatal events?but events are not eliminated at this level. Is there even greater benefit with levels higher than 6.3-7.3%?

A recent analysis of females from the Harvard School of Public Health suggested that RBC omega-3 levels as high as 8.99% were still associated with non-fatal heart attack (myocardial infarction), compared to 9.36% in those without heart attacks. This suggests that even higher levels are necessary to prevent non-fatal events.

Should we target 10%? 12%? Maybe higher? Any higher and we are toeing the level achieved by the Inuits, the “Eskimoes” of Greenland, northern Canada and Alaska who have been observed to have a low rate of heart disease.


What’s your omega-3 index?

The appreciation of the importance of omega-3 fatty acids marks one of the greatest health revelations of the last 50 years. We can now measure it.

The ability to measure the proportion of omega-3 fatty acids in red blood cells may provide yet another means for all of us to further reduce risk for cardiovascular events.

If you are interested in knowing your omega-3 index, we are now making the fingerstick test kits available by going here.

Vitamin D increased my cholesterol

2. October 2009 William Davis (38)
A friend told me this story.

Her friend, Linda, had added vitamin D to her daily supplements. Because she'd had a vitamin D blood level of 22 ng/ml, she was taking 6000 units per day.

However, Linda also had a high cholesterol value with a total cholesterol of 231 mg/dl. After several months on the vitamin D, she had another cholesterol panel. Total cholesterol: 256 mg/dl.

"It must have been the vitamin D! So I stopped it right away."

Is this true? Does vitamin D raise the level of blood cholesterol? Yes, it does. But it's a good thing. Let me explain.

Followers of The Heart Scan Blog know that total cholesterol is really a mix of 3 other factors:

Total cholesterol = LDL cholesterol + HDL cholesterol + triglycerides/5

This is the Friedewald equation, still used today in over 95% of cholesterol panels. So, by the Friedewald equation, anything that increases LDL, HDL, or triglycerides will increase total cholesterol.

One of the spectacular changes that develops over a year of taking vitamin D is that HDL cholesterol skyrockets. While sensitivity to this effect varies (probably on a genetic basis), HDL increases of 10, 20, even 30 mg/dl are common. A starting HDL, for instance, of 45 mg/dl can jump up to 65 or 70 mg/dl, though the effect requires up to a year, sometimes longer.

Vitamin D can also reduce triglycerides, though the effect is relatively small, usually no more than 20 mg/dl or so. Likewise, the effect on LDL is minor, with a modest reduction in the small type of LDL.

So the dominant effect of vitamin D from a cholesterol standpoint is a substantial increase in HDL. Looking at the equation, you can see that an increase in HDL is accompanied by a commensurate increase in total cholesterol. If HDL goes up 25 mg/dl, total cholesterol goes up 25 mg/dl.

So Linda is absolutely correct: Vitamin D increases cholesterol--but it's a good thing that reduces risk for heart disease and is an important part of a coronary plaque-reversal program.

This is yet another reason why I advocate elimination of total cholesterol on lipid panels. There is no useful information in the total cholersterol value, only the potential for misinformation.

Nutrtional ignorance is not unique to the U.S.

28. September 2009 William Davis (20)
Heart Scan Blog reader from Australia, Michaela, also a mother of a son with a complex congenital heart defect, wrote this series of e-mails to me. (Published with Michaela's permission.)


I've been reading the article, Valve disease and Vitamin D from April '07, by Dr William Davis. I'm hoping you may have some information on the topic. I'm hoping someone will have time to help me.

I have been supplementing my 15 year old son with Vit D for 4 months but only 1000 (U) per day. I would like to increase the dosage but am not sure if I would do him more harm than good.

I have been researching vitamins and supplements on the net for a few months and have been amazed at what I have found. I only wish I had done it years ago. My son has been let down by the Australian Medical Profession and it's a race against time now to keep him well and avoid a heart transplant.

My son was born with aortic stenosis and had a valvotomy at 4 weeks of age. This damaged the aortic valve and he had a Ross Repair procedure at aged 3. This left him with a damaged heart muscle and leaking aortic & pulmonary valves. In May '08, his heart grew more enlarged, causing the mitral & tricuspid valves to also leak.

I took him to Bangkok in Feb this year where he had 70 million of his own Adult Stem Cells directly injected into his heart muscle with the hope of strengthening the muscle and eventually valve replacement.

My son has recovered from the surgery and is once again symptom-free, thanks to the wonderful advice followed by the Author & Cardiologist, Stephen T. Sinatra. I have followed his supplement regime and what a difference! Of course, this won't last while my son's valves continue to leak.

My son has also developed secondary hyperparathyroidism, bone thinning and hypothyrodism. Vit D & Calcium have something to do with this I believe.

My Australian Doctors have never made mention of any vitamins or supplements .... EVER! Transplant is all they will consider and we are not having it.

If you have any info or links to any sites which may be useful to me, could you email them to me? I would be grateful for any help I could get.

Sincerely
Michaela


I responded to Michaela's e-mail:

Hi, Michaela--

Vitamin D is extremely important. Sometimes, hyperparathyroidism and calcium derangements are caused by vitamin D deficiency. You might be able to get help with this from an endocrinologist, since they are the ones who deal with hyperparathyroidism. An endocrinologist might even be familiar with several recent studies that document this phenomenon:

Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

Vitamin D deficiency and primary hyperparathyroidism

Also, see the discussions at www.vitamindcouncil.org from Dr. John Cannell.

Because of the complexity of your son's health, it might be hazardous to stray too far away from conventional care though you and I know that there are limitations to that perspective. For that reason, I would urge you to press for answers from a knowledgeable endocrinologist.

I hope you find the answers you need.

William Davis, MD


Several months later, Michaela provided this update:

Hi Dr Davis,

I wrote to you back in July regarding my 15 year old son's need for a Heart Transplant through a failed Ross Repair and the possible Vitamin D connection. You sent me some valuable links and I thank you again for that.

I just wanted to let you know, I think you have given me the answers. I increased Lee's Vitamin D supplement to 6000U a day and, along with the recommended nutritional supplements of US Cardiologist Dr Stephen T Sinatra, there have been remarkable improvements! Lee also had 70 million of his own Adult Stem Cells injected into his heart in February. As we know, Stem Cell Therapy takes time and Lee was looking like time was quickly running out.

I have removed him from the transplant list. He is now reading normal Kidney function, the BNP (Brain Natriuretic Peptide, a measure of heart failure] has dropped by 7000 and his liver size has reduced to where it no longer causes him discomfort. The liver tests show it's still affected but it's function is improving each month. His last Echo was in early July and there had been a reduction in the size of his heart, which is so important.

To the Doc's, Lee can't get better, there is only transplant or death so you can imagine the surprise on their faces to see him looking and feeling so well with their tests to back it up. Still, even though it's staring them in the face, they don't want to know about it. They have no interest in what supplements he is on or Stem Cell therapy. God help their other patients. I view them in the waiting room and think of them as lambs to the slaughter.

We are not spoiled for choice with Doc's here in Western Australia. I have to take what I can get and there is not many who would take on Lee's case. He was number 1 on the transplant list and a most urgent case. Not many were willing to even look at him with his cardiac history and all I had to help was the arrogant Doc's at the Advanced Heart Failure Unit. They were not at all interested in his secondary hyperparathyroidism. I suppose it didn't matter what else he had compared to his heart problems.

Anyway, I'm writing to thank you. Lee would be transplanted or dead now if it wasn't for Dr's like you sharing their knowledge online. I wish I had researched things years ago, Lee might not have sunk so low if I had. I don't know if the transplant can be held off indefinitely, but like I tell Lee, "Stay well. There are amazing people out there doing amazing things, if you can just hang on. The miracle is around the corner." He's so well, you'd have to see him to believe it. But I have 7 kids and Lee is as physically active and as well as the other 6! For how long he can stay like this, I don't know but if his ejection fraction [a measure of left ventricular strength] can keep climbing and his body gets stronger, I have hope for another attempt at valve replacement.

I'm still shocked and angry that nutritional supplements have never been mentioned in the 15 years I've been dealing with cardiologists. Surely they know about them. I have read through dozens of reports online of the benefits of them--Why haven't they?! Thank God for the online Doc's such as yourself, the valuable info would never make it out of a Doctor's office in Western Australia! I've had to leave my country for Stem Cell therapy and then implore overseas Doc's for advice and information. What does that say for the Australian Medical Profession? Not a lot! They put him in the position he is in yet don't want to help get him out.

I'm so very grateful to you, thank you and God bless.

Michaela


Note: The above is not meant to be an implicit endorsement of stem cell therapy. This was just part of Michaela's story about her son.

Eat cranberries

24. September 2009 William Davis (17)
Most people already know that cranberries are useful for preventing urinary tract infections. Cranberries can also be useful for preventing other sorts of infections, such as dental cavities and stomach ulcers because of cranberry's ability to block bacterial adhesion.

Cranberries can also be a useful component of a heart healthy program.

Several unique properties of cranberries contribute to various aspects of heart health:

• Cranberries are a rich source of pectin--Pectin is a soluble fiber, the sort that binds bile acids in the intestinal tract and naturally reduces LDL cholesterol.
• Cranberries are a rich source of polyphenols and flavonoids--Including the wonderfully fascinating anthocyanins, the flavonoids that confer the beautiful red color. Surprisingly, cranberries are richer in polyphenols and flavonoids than blueberries, strawberries, and grapes. Cranberry juice is also rich in these compounds. However, beware of cranberry juice "cocktail," which is diluted with other liquids such as high-fructose corn syrup. Like grapes, cranberries are a source of resveratrol, the polyphenol also found in red wines that some believe is responsible for reduced risk for heart disease and extending life.
• Cranberries have high antioxidant activity--Cranberries are among the highest in antioxidant capacity against superoxide radicals, hydrogen peroxide, and hydroxyl radicals, oxidizing factors believed to underlie heart disease, cancer, and aging. Cranberries also reduce the oxidation of LDL cholesterol particles.
• Cranberries block uric acid production--Cranberries have the unique ability to block the activity of an enzyme, xanthine oxidase, that converts xanthine to uric acid. Uric acid is believed to add to heart disease risk and is the factor responsible for gout.
• Cranberries increase HDL cholesterol--Cranberry juice increases HDL by 3-4 mg/dl.

Cranberries are only modest sources of sugars, with 7.19 grams “net” carbohydrates (total carbohydrates minus fiber content) per cup of whole raw cranberries.

The best way to eat cranberries is to consume the real thing: eat the whole berry, as in sugar-free cranberry sauce or added to baked dishes like chicken. Second best are dried cranberries. However, be careful of the overly-sweetened dried cranberries that contain added sugar (for a total of 78 grams sugar per cup--far too much). Unsweetened dried cranberries can be purchased, or you can dry them yourself.

Cranberry juice is another way to obtain the health benefits of cranberries; the unsweetened juice, while quite tart, is the best with 30.5 grams sugar per 8 oz--so don't drink more than 4 oz at a time. The more common cranberry juice “cocktails” are generally too sugary and/or too dilute for full health benefit.

The cranberry harvest season in Wisconsin, Michigan, Oregon, Massachusetts, and New Jersey is just getting underway, so we should be seeing fresh cranberries on store shelves or farmers' markets any day now.

Procedures 'R Us

23. September 2009 William Davis (20)
Kay came to the office for an opinion.

Over the past 8 months, she'd received a stent to the left anterior descending coronary artery and, during a separate procedure, a stent to the left subclavian artery.

"My cardiologist was very capable doing procedures. But when I asked, 'What do I do now?' he barely said a word and handed me a presciption for Crestor."

This kind of incredible neglect is the norm: Write a prescription for statin drug, delegate dietary advice to the hospital dietitian who advocates a heart disease-causing low-fat diet, followed by hospital discharge. You are expected to report any recurrent symptoms (which are inevitable), at which point you might "qualify" for another procedure.

It would be malpractice if it were not the prevailing standard in the community. Yes, the prevailing standard is neglect--neglect to identify, quantify, and correct all the identifiable causes of heart disease; neglect to discuss the nutritional methods that actually correct the abnormal patterns that cause heart disease; neglect to discuss nutritional supplements or medications beyond statins that further reduce heart disease risk and "need" for more procedures. In other words, the prevailing community standard is to stent, bypass, prescribe statin. It is not to understand why the disease occurred in the first place, correct the causes and minimize or eliminate any future danger or need for procedures.

I see consultation after consultation involving stories just like Kay's. People are frightened and they sense intuitively that nobody raised the question of why they have a potentially fatal disease.

Don't allow yourself to fall victim to this incredibly neglectful mode of practice, the one that has enriched hospitals, the drug industry, many cardiologists, but does little to address the actual disease.