Goodbye, Dr. Jarvik 29. February 2008 William Davis (0) HeartWire, the news service of www.theheart.org, posted the following report: Pfizer pulls Lipitor ads featuring Dr Robert Jarvik in HeartWire New York, NY - After a series of questions and attacks over its choice of Dr Robert Jarvik to endorse Lipitor in a series of TV commercials, Pfizer has announced that it is withdrawing the ads. As previously reported by heartwire, Jarvik invented the first artificial heart, but he is not a cardiologist, nor does he hold a medical license—factors that drew criticism from detractors and made him and Pfizer a target of a US House Committee on Energy and Commerce investigation into celebrity endorsements in direct-to-consumer advertisements.In a January 2008 statement, committee chair Rep John D Dingell (D-MI) observed: "Dr Jarvik's appearance in the ads could influence consumers into taking the medical advice of someone who may not be licensed to practice medicine in the United States. Americans with heart disease should make medical decisions based on consultations with their doctors, not on paid advertisements during a commercial break."Complaints about Jarvik went up a notch this month when the latest ad in the series depicted the inventor rowing a racing scull across a lake, despite the fact that Jarvik himself does not row and the commercial used a body double.This is typical pharmaceutical industry sleight-of-hand, now you see it, now you don't, that has come to define their policies. And this is just the stuff that comes to light because of some obvious blunders. We can only begin to imagine what sorts of other shenanigans have been swept under the rug, especially adverse effects of drugs that never made it to the light of publication. Is this just another example of how direct-to-consumer advertising has backfired? I now have patient after patient tell me that they have been so overwhelmed and fed up with TV and magazine ads for drugs that they Other media outlets have reported that Jarvik was guaranteed $1.35 million for the ads and that Pfizer spent $258 million on Lipitor advertisements between January 2006 and September 2007.
Hammers and nails 28. February 2008 William Davis (4) I'm sure you've heard the old saying that, To a man with a hammer, everything looks like a nail. It couldn't be truer than in heart procedures (the man with the hammer) and heart disease (the nail). What does it take in 2008 to become an interventional cardiologist trained in all the techniques of angioplasty, stenting, intracoronary ultrasound, etc.? Start with your undergraduate degree (4 years), then medical school (another 4 years), then training in internal medicine (3 years), then general cardiology taining (3 years), then an additional year in interventional cardiology. Each step along the way also involves competing for these spaces, a process that requires much time, money, and sweat. The total time investment is 15 years after high school. Many if not most college students graduate with debt. Pile on the substantial cost of medical school. Training after medical school pays a modest salary, enough for a single person. Many trainees by then have spouses and a family, would like to buy a house, have bills to pay. (I managed to buy my first house for $69,000 in Columbus, Ohio and paid my mortgage by sleeping only every other night and moonlighting on my off nights.) By the time the interventional cardiologist-in-training finishes his/her 15 years, they are hungry for a hefty increase in income. After such a time and money investment, I do believe that there is at least some justification for generous income for the years of work involved. Back to our hammer and nail metaphor. Not only do we now have a man or woman with a hammer, but a really expensive hammer that required a substantial amount of effort to obtain. Now, our hapless hammer-bearer is desperate to see everything in sight as a nail. You're seen in consultation by this fresh interventional cardiologist in practice for only a few years. Guess what he/she advises? Go straight to the catheterization laboratory, of course. Throw in the fact that insurance reimbursement is most generous for heart procedures, far more than for consulting in the office, doing a stress test, or other simpler, non-invasive tests, and the incentives are clear. The system, you see, is set up to follow such a path. The path to the cath lab is heavily incentivized, paths in the other direction discouraged, disparaged, or just ignored. My message: Don't get nailed.
What is abnormal? 27. February 2008 William Davis (1) What is abnormal?You'd think that the answer would be easy and straightforward. However, consider these instances of medical findings that I have witnessed fall repeatedly into the "normal" category:Diameter of the thoracic aorta: 4.5 cmMild coronary plaque by heart catheterizationCarotid plaque of 30-50%Why isn't a thoracic aorta (the big artery in your chest) of 4.5 cm normal? Because it can be expected to increase in diameter by about 2.5 mm (0.25 cm) per year. Even at its current diameter, it means that stroke risk is greater, since enlarged aortas are diseased aortas that commonly accumulate atherosclerotic plaque with potential to fragment and shower debris to the brain. It means that high blood pressure and/or cholesterol/lipoprotein abnormalities have been uncorrected for years that have allowed the aorta to enlarge. How about "mild coronary plaque"? Followers of the Track Your Plaque program already know the answer to this one. Mild plaque does not mean mild risk. In fact, most plaques that cause heart attack are mild plaques, not severe blockages. While severe blockages can provide symptom warning and are detected by stress tests, it's the mild blockages that rupture without symptom warning and cause heart attack. So "mild coronary plaque" is no less dangerous than severe coronary plaque. Likewise, carotid plaque of 30-50%, while it doesn't justify surgery, can grow within just a few years to a severity that allows it to fragment and shower debris to the brain, i.e., a stroke. As with the enlarged aorta, it means that multiple causes of carotid plaque are likely active, including high blood pressure and cholesterol or lipoprotein abnormalities. Then why would any of these findings be labeled "normal"? Simple. In the minds of many physicians, if a condition doesn't pose immediate risk, or if it doesn't qualify for surgical "correction," then it is labeled "normal" or "mild." Thus, an aorta of 4.5 cm cannot justify surgical replacement until it achieves a diameter of 5.5 cm. It is therefore labeled "normal.""Mild coronary plaque" does not justify insertion of stents or performance of bypass surgery. It must therefore be "normal."Carotid plaque over 70% is surgically removed, but not 30-50%. 30-50% is therefore "normal." The tragedy is that many "normal" or "mild" findings, if cast in the proper light, could lead to corrective strategies that could prevent danger long-term or keep surgery from becoming necessary. The enlarged aorta, for instance, could be stopped and an aneurysm (defined as 5.5 cm or greater) could be prevented, along with dramatically reducing risk for stroke. Carotid plaque, more so than coronary plaque, is a controllable and manipulable condition that should trigger a program of prevention and reversal. Instead, it usually generates advice to have another ultrasound in a year to see if it has yet achieved severity sufficient to justify surgery. Of course, "mild coronary plaque" is the reason for the Track Your Plaque approach, a chance to seize control over this disease years or decades before procedures are necessary and reduce danger now, not years from now.Copyright 2008 William Davis, MD
Niacin and hydration 27. February 2008 William Davis (12) Many people know about niacin's curious effect of the "hot flush," a feeling of warmth that covers the chest and neck, occasionally the entire body. However, many people are unaware of the fact that hydration can block this effect. In fact, many people who were not advised of this will come to the office describing miserable experiences with niacin--hot flushes that last for hours, intolerable itching, etc.--only to experience little or none of these effects with generous hydration. The vast majority of the time, two 8-12 oz glasses of water when the hot flush occurs will eliminate the flush within a few minutes. Sometimes, the hot flush will occur many hours after taking niacin. Nine times out of ten, this delayed effect is also due to poor hydration. For instance, you might be engrossed in your work and forget to keep up with fluid demands. Or, it may be warm and you've lost fluids through sweating. That's when you begin to feel the hot flush creep up on you. The cure: Lots of water. In this situation, in which you have allowed dehydration to develop, it may require more than two big glasses. Relief from the flush may also take more time, but it still works nearly every time. On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief. Why go to some much bother? Well, niacin remains the best agent we have for reduction of small LDL, raising HDL (although vitamin D is proving to be a powerful competitor in this arena), and reducing lipoprotein(a). How much do statin drugs contribute to these effects? Very little, if at all. Several drug manufacturers are also working on "antidotes" to the hot flush effect of niacin that will be packaged within the niacin tablet. Naturally, it will also boost the cost up many times higher. In the meantime, if or when you experience the niacin hot flush, just think: Put out the "fire" with plenty of water.
Let me float an idea 25. February 2008 William Davis (0) I'd like to float an idea. The Track Your Plaque program is a fee-for-membership website. We chose this method of covering our costs--website development, graphics, software coding, etc.--since we do not accept advertising. I do believe that not having any advertising on our website has kept us impartial and unbiased--we mean what we say and not because we are selling something. But there's a downside to assessing a membership fee: It limits the number of people who are willing or able to access the information. It also limits the dissemination of these concepts, due to such phenomena as limited content exposure to internet search engines.
Actos, Avandia, and vitamin D 22. February 2008 William Davis (16) Up until a few years ago, if a patient showed signs of the metabolic syndrome/pre-diabetes, or early diabetes, I would often prescribe one of the drugs, Actos (pioglitazone) or Avandia (rosiglitazone), known as the thiazolidinediones, or TZD's for short. Although I do not manage diabetes, I was witnessing a flood of patients with pre-diabetic patterns that inhibited correction of lipoprotein patterns. So I saw the TZD's as a means of potentially assisting with correction of these abnormalities. My rationale back then was that many people with metabolic syndrome struggled to raise HDL cholesterol, reduce triglycerides, reduce small LDL, reduce the inflammatory measure c-reactive protein (CRP), as well as reduce blood sugars towards the normal range. The TZD's partially corrected these phenomena. But over the last 2 1/2 years, I haven't written a single prescription for these agents since I've added vitamin D to the regimen. Vitamin D in my experience in the Track Your Plaque approach:--Raises HDL--far more than the TZD's ever did. --Reduces small LDL--Reduces triglycerides--Reduces c-reactive protein--Reduces blood pressure--Reduces blood sugarIn other words, vitamin D appears to not only reproduce many of the effects of the TZD's, but exceeds the effects. The effects are often so wonderful that I've taken many people off their TZD's. Vitamin D, of course, also provides numerous benefits for bone health, reduction of cancer risk, and other health benefits that the TZD's simply cannot compete with. Vitamin D also lacks the quite substantial side-effects of TZD's: water retention and weight gain (around 8 lbs in the first year of treatment), possible increase in risk for heart attack (Avandia), definite increased likelihood of congestive heart failure in those prone to it. How about cost? Actos goes for about $2 per pill (30 mg tablet). Vitamin D in the gelcap form (the only form we use) costs around $0.05 per capsule--5 cents. That's a 40-fold difference in price for what I would regard as an inferior--substantially inferior--product. Throw into the mix a dramatic reduction or elimination of wheat products and other high-glycemic index foods, and all the phenomena of the metabolic syndrome and its associated lipoprotein patterns show even more improvement or full reversal. In fact, with this approach we are seeing record-setting magnitudes of correction of these parameters every day. Getting HDL, for instance, into the 60 mg/dl or 70 mg/dl range has never been so easy.
What if heart scans become obsolete? Cureality | Real People Seeking Real Cures Toggle navigation Home Blog Home Archive Join Now Log in Boy, was I wrong! 1. August 2006 William Davis (0) Around 10 years ago, I was talking to a balloon and stent manufacturer's representative, who was raving about some new device that was due for release to the market. Back then, the sky seemed the limit to cardiac device manufacturers, who were falling over themselves scrambling to design and market the next new device. The angioplasty market then had ballooned (no pun intended) from nothing to a multi-billion dollar industry. Stents were just getting underway but clearly had potential for being at least as large. But this was a time when preventive therapies were also beginning to get quite powerful. We had just gotten started doing CT heart scans and were excited about the possibilities, statin drugs were gaining evidence through clinical trials, and the power of many nutritional supplements was finally achieving validation. We were even learning the error of our prior low-fat ways. So I broadly pronounced to the enthusiastic product representative, "In 10 years, balloons, angioplasty, and stents will occupy this little corner of cardiac care because prevention will have become so powerful. We won't talk about heart procedures. We'll talk about coronary plaque regression!"I even advised the representative that he should consider a career change in anticipation of the coming wave of preventive strategies. Was I ever wrong. Despite the power of heart disease prevention--which is indeed true--cardiac device and procedure technology has boomed, both in popularity as well as in revenue success. Device manufacturing and sales are hugely successful. Implanting devices into people is a hugely profitable enterprise. Since my ill-timed comments to the salesman, Boston Scientific, a major manufacturer of stents and other cardiac devices, reported revenues of $6.2 billiondollars in 2005, a 12% increase over the prior year. Medtronic reported 2005 revenues of $11.3 billion, growing at 15% per year. Clearly, cardiac procedures are still quite popular--and profitable.My timing was off, but not for long. The huge crest of change in preventive therapies is upon us. That's the premise behind the Track Your Plaque concept: heart disease prevention can't be found in a hospital, is not supported by cardiac device manufacturers, and is not being advocated by most cardiologists or primary care physicians. Yet the tools are getting better and better every day. Those of you who succeed in halting or reducing your heart scan score are extremely unlikely to add to Boston Scientific's or Medtronic's revenues. Help me spread the word. Don't forget how dangerous heart disease can be 29. July 2006 William Davis (0) Sometimes it's easy to get smug when coronary plaque is a reversible process. When you see people day in, day out, week in, week out, drop their heart scan scores, reversing what could be a dangerous disease, you can sometimes lose sight of just how dangerous coronary disease can be. Whether I like it or not, I maintain a reasonably active role in hospitals out of necessity. I do need their services occasionally for people with advanced heart disease when I meet them (when regression is not the initial conversation for safety reasons), or valve disease is diagnosed, or someone shows up with congenital or heart muscle diseases. In other words, although we focus on coronary issues, there's more to heart disease than just coronary disease. This unfortunate case just served to remind me how powerful coronary disease can be. Elizabeth, an active 67-year old, finally came to the hospital after suffering 6 months of chest pain and increasing breathlessness. She hated hospitals and hadn't seen a doctor in 30 years since she was successfully treated for cancer. In those 30 years, she'd been quite active with family and a small business. But she also smoked 2 packs of cigarettes most of those years. After she was admitted to the hospital, it became clear that Elizabeth had experienced one, if not several, heart attacks along the way. The entire front 2/3 of her heart was non-functional. If that wasn't bad enough, two of her heart valves were severely diseased and dysfunctional: Her aortic valve barely opened (aortic valve "stenosis", or stiffness) and the mitral valve leaked severely (mitral valve "insufficiency", or leakiness). All of this was confirmed with conventional testing in the hospital, including a heart catheterization. Elizabeth ended up in emergency surgery--very unusual, by the way, for valve surgery of the sort she had--but died in the first few hours after her procedure. Her heart had simply been too damaged from her heart attacks, and the extraordinary stress of surgery that included two valves was too much. She died on the ventilator. Coronary disease is a very serious matter. When I see cases like Elizabeth, it boosts my commitment to tell everyone that heart disease--when identified early enough--is a controllable, preventable, even reversible process. For poor Elizabeth, she was much too far down the path of severe, irreversible disease that control or reversal was simply not an option. She was in imminent danger of dying even upon arrival. It's exciting yet sometimes frightening to know what you have in your hands: The means to control this monster called coronary disease. Use it wisely. But don't lose sight of what it can do it you permit it to grow, fester, and explode. How many ways can you disguise sugar? 28. July 2006 William Davis (0) I came across this shockingly silly report on AOL, who obtained their info courtesy Health Magazine: The Best New Healthy Foods for Busy Peoplefrom HealthThe foods on their list: Kettle Brand Bakes Hickory Honey BBQ--the healthy claim is based on the lack of trans-fatty acids and low-fat.Post Healthy Classics Raisin Bran Cereal Bars, Cranberry--Likewise, low-fat, sweet, and addictive means healthy to these people.Amy’s Mediterranean Pizza With Cornmeal Crust --Please!!Horizon Organic Colby Cheese Sticks --Because it's made by cattle without use of growth hormone or antibiotics, they declare this healthy. I guess we can ignore the saturated fat content and high total fat content. 100% Whole Grain Chips Ahoy! Cookies --You mean we can add the bran back to wheat products and make it healthy?! This kind of mass-market marketing trickery leaves me incredulous. Don't believe it for a moment. This is typical of the food industry: Take one aspect of nutrition that is truly healthy, such as high-fiber, or low-fat, or organic. Then add undesirable, unhealthy ingredients. The current fad is to add lots of sugar and or sugar-equivalents (usually flour and other wheat products). Because there's one healthy ingredient, they'll call the end-product healthy, too. If you want to see what health looks like if you indulge in "healthy" products like this, just look up and down the grocery aisles at your neighborhood grocery store. You're likely to see the results: Gross obesity, diabetes, and arthritis.You won't, of course, see the huge acceleration of growth in coronary plaque, but it's there, ticking away. To remind us what ideal body weight is: Watch an old movie! 26. July 2006 William Davis (0) Jack was skeptical. At 273 lbs, 5 ft 11 inches, he felt that he was "just right". "I feel fine. I don't see why you think I should lose weight," he declared. "In fact, when I lost 25 lbs a couple of years ago, everyone said I was too skinny!" I showed Jack why: He had an HDL of 35 mg/dl, small LDL (over 90% of all LDL particles), an elevated blood sugar of 123 mg/dl (diabetes is officially 126 mg/dl or greater), high blood pressure, and increased inflammation (C-reactive protein). These were all manifestations that his body weight was too much for it to handle. So I told Jack that we've all forgotten what ideal weight should look like. Our perception of "normal" has been so utterly and dramatically distorted by the appearance of our friends, family, co-workers, and other people around us that we've all lost a sense of what a desirable weight for health should be.So I suggested to Jack that, if he wanted to rememember what ideal weight is and what people are supposed to look like, just watch old movies. Old movies, like the 1942 production of Casablanca, or the 1952 production of Singin' in the Rain, show the body build that was prevalent in those days. Look at Humphrey Bogart or Gene Kelly--men with average builds, weighing 140-160 lbs--that's how humans were meant to look.A report this morning on the Today Show showed the "after" photos of several people following bariatric (weight reduction) surgery. The "after" pictures, from the perspective of ideal weight and ideal health, remain hugely overweight. We need to readjust our perceptions of weight. The average woman in the U.S. now weighs 172 lbs(!!!). Don't confuse average with desirable. Diabetes is a choice you make 24. July 2006 William Davis (0) Tim had heart disease identified as a young man. He had his first heart attack followed by a quadruple bypass surgery at age 38. Recurrent anginal chest pain and another small heart attack led to several stents over three procedures in the first four years after bypass. Tim finally came to us, interested in improving his prevention program. You name it, he had it: small LDL, low HDL (28 mg/dl), lipoprotein(a), etc. The problem was that Tim was also clearly pre-diabetic. At 5 ft 10 inches, he weighed 272 lbs--easily 80 or more pounds overweight. Tim was willing to make the medication and nutritional supplement changes to gain control over his seeminglly relentless disease. He even turned up his exercise program and lost 28 lbs in the beginning. But as time passed and no symptoms recurred, he became lax. Tim regained all the weight he'd lost and some more. Now Tim was diabetic. "I don't get it. I eat good foods that shouldn't raise my insulin. I almost never eat sweets."I stressed to Tim that diabetes and pre-diabetes, while provoked acutely by sugar-equivalent foods (wheat products, breads, breakfast cereals, crackers, etc.), is caused chronically by excess weight. If Tim wants to regain control over his heart disease, he needed to lost the weight. Unlike, say, leukemia, an unfortunate disease that has little to do with lifestyle choices, diabetes is a choice you make over 90% of the time. In other words, if you become diabetic (adult variety, not children's variety) as an adult, that's because you've chosen to follow that path. You've neglected physical activity, or indulged in too many calories or poor food choices, or simply allowed weight to balloon out of control. But diabetes is also a path most people can choose not to take. And it is a painfully common choice: Nearly two-thirds of the adults in my office have patterns of pre-diabetes or diabetes when I first meet them.Let me stress this: For the vast majority of adults, diabetes is a choice, not an inevitability. I'll call the doctor when I feel bad! 24. July 2006 William Davis (0) Max just had his heart scan. He sat down with the x-ray technologist at the work console while she pointed out the white areas in his coronary arteries that represented plaque."It looks like you're going to have a fairly high score," the technologist commented. "The final report will be available after one of our cardiologists reviews your images."Max shrugged. "Well, I don't feel anything. I'm always running around with work, with my kids, stuff like that. That's better than any stress test. I guess I'll worry about it if it starts to bother me."You'd be surprised how common this view remains: If it's not bothering you, then just forget about it. It's easy to do, since you have no symptoms, nothing to impair your physical activities. But what are the potential consequences of ignoring your heart scan? Here's a few: --Prevention and plaque reversal efforts are most effective the earlier you start. From a heart scan score viewpoint, the lower your starting score, the easier it is to gain control over it. More people will succeed in reducing their score when the starting score is lower.--The role of prevention of heart disease instantly crystallizes when you know your score. Your LDL cholesterol of 142 mg/dl or HDL of 41 mg/dl no longer seem like just numbers of borderline signficance. Instead, they become useful tools to gain control over plaque. They cast your numbers in a new and clear light. --Knowing your heart scan score today gives you a basis for comparison in future. Your score of, say 250, today, can be 220 in one year. Without your preventive efforts, it will be 30% higher: 325. That's a big difference! --Sudden death or heart attack--can occur in up to 35-40% of people with hidden heart disease--without warning. Don't even bother getting a heart scan if you're going to ignore it. I've said it before and I'll say it again: A heart scan is the most important health test you can get--but only if you do something about it. Coenzyme Q10 and statin drugs 23. July 2006 William Davis (0) Although drug manufacturers claim that muscle side effects from statin drugs occurs in only around 2% or people or less, my experience is very different. I see muscle weakness and achiness develop in the majority of people taking Lipitor, Crestor, Zocor, Vytorin, etc. I'd estimate that nearly 90% of people get these feelings sooner or later. Thankfully, the majority of the time these feelings are annoyances and do not lead to any impairment. Full-blown muscle destruction is truly rare--I've seen it once in over 10 years and thousands of patients. The higher the dose of statin drug and the longer you take it, the more likely you're going to have muscle aches. I experienced a strange phemomenon myself today. I worked outdoors for about 4 hours, pulling weeds, digging in the dirt, spreading topsoil. (I have an area of overgrowth in the front yard.) Admittedly, I worked pretty hard and it was a warm, humid day. I was sore, as you'd expect at age 49. But, much more than that, I was exhausted--my muscles ached and I had barely enough strength to get up the stairs. Hoping for some relief, I took an extra dose of coenzyme Q10. I usually take 50-100 mg per day. Today, when I felt this overwhelming muscle fatigue, I took an additional 200 mg. Within 10 minutes, I felt a surge of energy. It was, in fact, a perceptible, quite dramatic feeling. I am thoroughly convinced, through my own experiences on Lipitor (I have a high LDL particle number despite a healthy lifestyle, among other abnormalities), and the experiences of many other people, that coenzyme Q10 can be an extremely useful tool to minimize the muscle aches and weakness of the statin drugs. If you do indeed need to take one of these agents, coenzyme Q10 is worth knowing about. Supplementing coenzyme Q10 has, for me, been a real lifesaver. For many people, LDL reduction is a crucial part of their heart scan score control program. In my experience, many of them would not be able to take the drug without eozyme Q10. Blast your LDL with oat bran and almonds 21. July 2006 William Davis (1) Nearly all of us can use an extra boost in reducing LDL cholesterol. We have a large number of people, in fact, who have reduced LDL into the Track Your Plaque range of 60 mg/dl or less without the use of statin cholesterol-reducing drugs. Oat bran is among my favorite ways to reduce LDL. Three tablespoons per day is a really effective method to drop your LDL around 20 points. There's twice the beta glucan (soluble, or "viscous", fiber)in oat bran, as compared to the more popular oatmeal. Add oat bran to anything you can think of: yogurt, cottage cheese, vegetarian chili, oatmeal, top desserts with it, etc. Some people struggle to find oat bran in the grocery store. Most health food stores that sell bulk products will have oat bran, usually less than a $1 per pound. Many grocery stores will also have an oat bran hot cereal along with the Cream of Wheat and oatmeal. That's okay, provided the only ingredient is oat bran--no added sugars, etc.Another dynamite method to reduce LDL 10-20 points is adding raw almonds to your daily food choices. One or two handfuls per day works great. We find it at Sam's Club for around $12.99 for a 3 lb. bag. The plentiful fibers and monounsaturates in almonds keep you full and satisified, take the edge off your sweet tooth, and even blunt the blood sugar rise caused by other foods.Both these foods are also great ways to combat the metabolic syndrome. Since both fiber-rich oat bran and almonds slow the release of sugars into the blood, blood insulin level is also reduced. This results in a happy cascade of less small LDL, increased HDL, and a reduction in inflammation.All these wonderful effects contribute to inching you closer to success: dropping your heart scan score. Pre-diabetes with normal blood sugar 20. July 2006 William Davis (0) We pay special attention to pre-diabetes, in all its varied manifestations, in the Track Your Plaque program. This is because these factors are potent instigators of coronary plaque growth. Early in the Track Your Plaque program we ignored these measures. After all, this is a program for heart disease risk reduction, not for mangement of diabetes. But we saw explosive rates of plaque growth when pre-diabetic factors were not controlled--even when cholesterol and related factors were under excellent control. It became increasingly clear that factors associated with pre-diabetes needed to be managed, as well. This includes small LDL, increased blood sugar, high blood pressure, increased inflammation (as CRP). Many people, however, have normal blood sugars (100 mg/dl or less) with a high blood insulin level (>10 microunits/ml). (This blood test is available in most laboratories.) This means that they have early resistance to insulin. The pancreas, the source of insulin, responds to the body's unresponsiveness to insulin by increasing insulin production.Increased blood insulin with normal blood sugar will drive production of higher triglycerides, a drop in HDL, creation of small LDL, and inflammation--and coronary plaque growth, as evidenced by increasing CT heart scan score.Blood insulin levels can be very effectively dropped by weight loss; exercise; reduction of processed carbohydrates like breads, pretzels, and breakfast cereals; and increased raw nuts and oat products; and vitamin D replacement to normal levels. Drug manufacturers are desperately trying to make this a mandate for drug treatment (Actos, Avandia), but are encountering resistance, since most people without overt diabetes don't want to take diabetic medication (rightly so!). You and your doctor should consider insulin as a factor to track, especially if you have small LDL, low HSL, or high triglycerides, or any of the other manifestations listed above. Sometimes small LDL is the only abnormality 19. July 2006 William Davis (0) Janet is a 58-year old schoolteacher. At 5 ft 3 inches and 104 lbs, she had barely an ounce of fat on her size-2 body. For years, Janet's primary care physician complimented her on her cholesterol numbers: LDL cholesterol values ranging from 100 to 130 mg/dl; HDL cholesterol of 50-53 mg/dl.Yet she had coronary disease. Her heart scan score: 195. Lipoprotein analysis uncovered a single cause: small LDL. 95% of all of Janet's LDL particles were in the small category. What was surprising was that this pattern occurred despite her slender build. Weight is a powerful influence on the small LDL pattern and the majority of people with it are overweight to some degree. But not Janet. How did she get small LDL if she was already at or below her ideal weight? Genetics. Among the genetic patterns that can account for this pattern is a defect of an enzyme called cholesteryl-ester transfer protein, or CETP. This is the exact step, by the way, that is blocked by torcetrapib, the new agent slated for release sometime in future (The manufacturer, Pfizer, is apparently going to sell this agent only packaged in the same tablet as Lipitor. This has triggered an enormous amount of criticism against the company and they are, as a result discussing marketing torcetrapib separately.)Also note that Janet had a severe excess of small LDL despite an HDL in the "favorable" range. (See my earlier conversation on this issue, The Myth of Small LDL at http://drprevention.blogspot.com/2006/06/myth-of-small-ldl.html.)With Janet, weight loss to reduce small LDL was not an option. So we advised her to take fish oil, 4000 mg per day; niacin, 1000 mg per day; vitamin D, 2000 units per day; use abundant oat bran and raw almonds, both of which suppress small LDL. This regimen has--surprisingly--only partially suppressed her small LDL pattern by a repeat lipoprotein analysis we just performed. We're hoping this may do it, i.e., stop progression or reduce her heart scan score. The lesson: Small LDL is a very potent pattern that can be responsible for heart disease, even if it occurs in isolation. And, contrary to conventional thinking, small LDL can occur as an independent abnormality, even when HDL is at favorable levels. << Older posts Newer posts >> Newer posts12...109110111112113114115116117...123124Older posts
Boy, was I wrong! 1. August 2006 William Davis (0) Around 10 years ago, I was talking to a balloon and stent manufacturer's representative, who was raving about some new device that was due for release to the market. Back then, the sky seemed the limit to cardiac device manufacturers, who were falling over themselves scrambling to design and market the next new device. The angioplasty market then had ballooned (no pun intended) from nothing to a multi-billion dollar industry. Stents were just getting underway but clearly had potential for being at least as large. But this was a time when preventive therapies were also beginning to get quite powerful. We had just gotten started doing CT heart scans and were excited about the possibilities, statin drugs were gaining evidence through clinical trials, and the power of many nutritional supplements was finally achieving validation. We were even learning the error of our prior low-fat ways. So I broadly pronounced to the enthusiastic product representative, "In 10 years, balloons, angioplasty, and stents will occupy this little corner of cardiac care because prevention will have become so powerful. We won't talk about heart procedures. We'll talk about coronary plaque regression!"I even advised the representative that he should consider a career change in anticipation of the coming wave of preventive strategies. Was I ever wrong. Despite the power of heart disease prevention--which is indeed true--cardiac device and procedure technology has boomed, both in popularity as well as in revenue success. Device manufacturing and sales are hugely successful. Implanting devices into people is a hugely profitable enterprise. Since my ill-timed comments to the salesman, Boston Scientific, a major manufacturer of stents and other cardiac devices, reported revenues of $6.2 billiondollars in 2005, a 12% increase over the prior year. Medtronic reported 2005 revenues of $11.3 billion, growing at 15% per year. Clearly, cardiac procedures are still quite popular--and profitable.My timing was off, but not for long. The huge crest of change in preventive therapies is upon us. That's the premise behind the Track Your Plaque concept: heart disease prevention can't be found in a hospital, is not supported by cardiac device manufacturers, and is not being advocated by most cardiologists or primary care physicians. Yet the tools are getting better and better every day. Those of you who succeed in halting or reducing your heart scan score are extremely unlikely to add to Boston Scientific's or Medtronic's revenues. Help me spread the word.
Don't forget how dangerous heart disease can be 29. July 2006 William Davis (0) Sometimes it's easy to get smug when coronary plaque is a reversible process. When you see people day in, day out, week in, week out, drop their heart scan scores, reversing what could be a dangerous disease, you can sometimes lose sight of just how dangerous coronary disease can be. Whether I like it or not, I maintain a reasonably active role in hospitals out of necessity. I do need their services occasionally for people with advanced heart disease when I meet them (when regression is not the initial conversation for safety reasons), or valve disease is diagnosed, or someone shows up with congenital or heart muscle diseases. In other words, although we focus on coronary issues, there's more to heart disease than just coronary disease. This unfortunate case just served to remind me how powerful coronary disease can be. Elizabeth, an active 67-year old, finally came to the hospital after suffering 6 months of chest pain and increasing breathlessness. She hated hospitals and hadn't seen a doctor in 30 years since she was successfully treated for cancer. In those 30 years, she'd been quite active with family and a small business. But she also smoked 2 packs of cigarettes most of those years. After she was admitted to the hospital, it became clear that Elizabeth had experienced one, if not several, heart attacks along the way. The entire front 2/3 of her heart was non-functional. If that wasn't bad enough, two of her heart valves were severely diseased and dysfunctional: Her aortic valve barely opened (aortic valve "stenosis", or stiffness) and the mitral valve leaked severely (mitral valve "insufficiency", or leakiness). All of this was confirmed with conventional testing in the hospital, including a heart catheterization. Elizabeth ended up in emergency surgery--very unusual, by the way, for valve surgery of the sort she had--but died in the first few hours after her procedure. Her heart had simply been too damaged from her heart attacks, and the extraordinary stress of surgery that included two valves was too much. She died on the ventilator. Coronary disease is a very serious matter. When I see cases like Elizabeth, it boosts my commitment to tell everyone that heart disease--when identified early enough--is a controllable, preventable, even reversible process. For poor Elizabeth, she was much too far down the path of severe, irreversible disease that control or reversal was simply not an option. She was in imminent danger of dying even upon arrival. It's exciting yet sometimes frightening to know what you have in your hands: The means to control this monster called coronary disease. Use it wisely. But don't lose sight of what it can do it you permit it to grow, fester, and explode.
How many ways can you disguise sugar? 28. July 2006 William Davis (0) I came across this shockingly silly report on AOL, who obtained their info courtesy Health Magazine: The Best New Healthy Foods for Busy Peoplefrom HealthThe foods on their list: Kettle Brand Bakes Hickory Honey BBQ--the healthy claim is based on the lack of trans-fatty acids and low-fat.Post Healthy Classics Raisin Bran Cereal Bars, Cranberry--Likewise, low-fat, sweet, and addictive means healthy to these people.Amy’s Mediterranean Pizza With Cornmeal Crust --Please!!Horizon Organic Colby Cheese Sticks --Because it's made by cattle without use of growth hormone or antibiotics, they declare this healthy. I guess we can ignore the saturated fat content and high total fat content. 100% Whole Grain Chips Ahoy! Cookies --You mean we can add the bran back to wheat products and make it healthy?! This kind of mass-market marketing trickery leaves me incredulous. Don't believe it for a moment. This is typical of the food industry: Take one aspect of nutrition that is truly healthy, such as high-fiber, or low-fat, or organic. Then add undesirable, unhealthy ingredients. The current fad is to add lots of sugar and or sugar-equivalents (usually flour and other wheat products). Because there's one healthy ingredient, they'll call the end-product healthy, too. If you want to see what health looks like if you indulge in "healthy" products like this, just look up and down the grocery aisles at your neighborhood grocery store. You're likely to see the results: Gross obesity, diabetes, and arthritis.You won't, of course, see the huge acceleration of growth in coronary plaque, but it's there, ticking away.
To remind us what ideal body weight is: Watch an old movie! 26. July 2006 William Davis (0) Jack was skeptical. At 273 lbs, 5 ft 11 inches, he felt that he was "just right". "I feel fine. I don't see why you think I should lose weight," he declared. "In fact, when I lost 25 lbs a couple of years ago, everyone said I was too skinny!" I showed Jack why: He had an HDL of 35 mg/dl, small LDL (over 90% of all LDL particles), an elevated blood sugar of 123 mg/dl (diabetes is officially 126 mg/dl or greater), high blood pressure, and increased inflammation (C-reactive protein). These were all manifestations that his body weight was too much for it to handle. So I told Jack that we've all forgotten what ideal weight should look like. Our perception of "normal" has been so utterly and dramatically distorted by the appearance of our friends, family, co-workers, and other people around us that we've all lost a sense of what a desirable weight for health should be.So I suggested to Jack that, if he wanted to rememember what ideal weight is and what people are supposed to look like, just watch old movies. Old movies, like the 1942 production of Casablanca, or the 1952 production of Singin' in the Rain, show the body build that was prevalent in those days. Look at Humphrey Bogart or Gene Kelly--men with average builds, weighing 140-160 lbs--that's how humans were meant to look.A report this morning on the Today Show showed the "after" photos of several people following bariatric (weight reduction) surgery. The "after" pictures, from the perspective of ideal weight and ideal health, remain hugely overweight. We need to readjust our perceptions of weight. The average woman in the U.S. now weighs 172 lbs(!!!). Don't confuse average with desirable.
Diabetes is a choice you make 24. July 2006 William Davis (0) Tim had heart disease identified as a young man. He had his first heart attack followed by a quadruple bypass surgery at age 38. Recurrent anginal chest pain and another small heart attack led to several stents over three procedures in the first four years after bypass. Tim finally came to us, interested in improving his prevention program. You name it, he had it: small LDL, low HDL (28 mg/dl), lipoprotein(a), etc. The problem was that Tim was also clearly pre-diabetic. At 5 ft 10 inches, he weighed 272 lbs--easily 80 or more pounds overweight. Tim was willing to make the medication and nutritional supplement changes to gain control over his seeminglly relentless disease. He even turned up his exercise program and lost 28 lbs in the beginning. But as time passed and no symptoms recurred, he became lax. Tim regained all the weight he'd lost and some more. Now Tim was diabetic. "I don't get it. I eat good foods that shouldn't raise my insulin. I almost never eat sweets."I stressed to Tim that diabetes and pre-diabetes, while provoked acutely by sugar-equivalent foods (wheat products, breads, breakfast cereals, crackers, etc.), is caused chronically by excess weight. If Tim wants to regain control over his heart disease, he needed to lost the weight. Unlike, say, leukemia, an unfortunate disease that has little to do with lifestyle choices, diabetes is a choice you make over 90% of the time. In other words, if you become diabetic (adult variety, not children's variety) as an adult, that's because you've chosen to follow that path. You've neglected physical activity, or indulged in too many calories or poor food choices, or simply allowed weight to balloon out of control. But diabetes is also a path most people can choose not to take. And it is a painfully common choice: Nearly two-thirds of the adults in my office have patterns of pre-diabetes or diabetes when I first meet them.Let me stress this: For the vast majority of adults, diabetes is a choice, not an inevitability.
I'll call the doctor when I feel bad! 24. July 2006 William Davis (0) Max just had his heart scan. He sat down with the x-ray technologist at the work console while she pointed out the white areas in his coronary arteries that represented plaque."It looks like you're going to have a fairly high score," the technologist commented. "The final report will be available after one of our cardiologists reviews your images."Max shrugged. "Well, I don't feel anything. I'm always running around with work, with my kids, stuff like that. That's better than any stress test. I guess I'll worry about it if it starts to bother me."You'd be surprised how common this view remains: If it's not bothering you, then just forget about it. It's easy to do, since you have no symptoms, nothing to impair your physical activities. But what are the potential consequences of ignoring your heart scan? Here's a few: --Prevention and plaque reversal efforts are most effective the earlier you start. From a heart scan score viewpoint, the lower your starting score, the easier it is to gain control over it. More people will succeed in reducing their score when the starting score is lower.--The role of prevention of heart disease instantly crystallizes when you know your score. Your LDL cholesterol of 142 mg/dl or HDL of 41 mg/dl no longer seem like just numbers of borderline signficance. Instead, they become useful tools to gain control over plaque. They cast your numbers in a new and clear light. --Knowing your heart scan score today gives you a basis for comparison in future. Your score of, say 250, today, can be 220 in one year. Without your preventive efforts, it will be 30% higher: 325. That's a big difference! --Sudden death or heart attack--can occur in up to 35-40% of people with hidden heart disease--without warning. Don't even bother getting a heart scan if you're going to ignore it. I've said it before and I'll say it again: A heart scan is the most important health test you can get--but only if you do something about it.
Coenzyme Q10 and statin drugs 23. July 2006 William Davis (0) Although drug manufacturers claim that muscle side effects from statin drugs occurs in only around 2% or people or less, my experience is very different. I see muscle weakness and achiness develop in the majority of people taking Lipitor, Crestor, Zocor, Vytorin, etc. I'd estimate that nearly 90% of people get these feelings sooner or later. Thankfully, the majority of the time these feelings are annoyances and do not lead to any impairment. Full-blown muscle destruction is truly rare--I've seen it once in over 10 years and thousands of patients. The higher the dose of statin drug and the longer you take it, the more likely you're going to have muscle aches. I experienced a strange phemomenon myself today. I worked outdoors for about 4 hours, pulling weeds, digging in the dirt, spreading topsoil. (I have an area of overgrowth in the front yard.) Admittedly, I worked pretty hard and it was a warm, humid day. I was sore, as you'd expect at age 49. But, much more than that, I was exhausted--my muscles ached and I had barely enough strength to get up the stairs. Hoping for some relief, I took an extra dose of coenzyme Q10. I usually take 50-100 mg per day. Today, when I felt this overwhelming muscle fatigue, I took an additional 200 mg. Within 10 minutes, I felt a surge of energy. It was, in fact, a perceptible, quite dramatic feeling. I am thoroughly convinced, through my own experiences on Lipitor (I have a high LDL particle number despite a healthy lifestyle, among other abnormalities), and the experiences of many other people, that coenzyme Q10 can be an extremely useful tool to minimize the muscle aches and weakness of the statin drugs. If you do indeed need to take one of these agents, coenzyme Q10 is worth knowing about. Supplementing coenzyme Q10 has, for me, been a real lifesaver. For many people, LDL reduction is a crucial part of their heart scan score control program. In my experience, many of them would not be able to take the drug without eozyme Q10.
Blast your LDL with oat bran and almonds 21. July 2006 William Davis (1) Nearly all of us can use an extra boost in reducing LDL cholesterol. We have a large number of people, in fact, who have reduced LDL into the Track Your Plaque range of 60 mg/dl or less without the use of statin cholesterol-reducing drugs. Oat bran is among my favorite ways to reduce LDL. Three tablespoons per day is a really effective method to drop your LDL around 20 points. There's twice the beta glucan (soluble, or "viscous", fiber)in oat bran, as compared to the more popular oatmeal. Add oat bran to anything you can think of: yogurt, cottage cheese, vegetarian chili, oatmeal, top desserts with it, etc. Some people struggle to find oat bran in the grocery store. Most health food stores that sell bulk products will have oat bran, usually less than a $1 per pound. Many grocery stores will also have an oat bran hot cereal along with the Cream of Wheat and oatmeal. That's okay, provided the only ingredient is oat bran--no added sugars, etc.Another dynamite method to reduce LDL 10-20 points is adding raw almonds to your daily food choices. One or two handfuls per day works great. We find it at Sam's Club for around $12.99 for a 3 lb. bag. The plentiful fibers and monounsaturates in almonds keep you full and satisified, take the edge off your sweet tooth, and even blunt the blood sugar rise caused by other foods.Both these foods are also great ways to combat the metabolic syndrome. Since both fiber-rich oat bran and almonds slow the release of sugars into the blood, blood insulin level is also reduced. This results in a happy cascade of less small LDL, increased HDL, and a reduction in inflammation.All these wonderful effects contribute to inching you closer to success: dropping your heart scan score.
Pre-diabetes with normal blood sugar 20. July 2006 William Davis (0) We pay special attention to pre-diabetes, in all its varied manifestations, in the Track Your Plaque program. This is because these factors are potent instigators of coronary plaque growth. Early in the Track Your Plaque program we ignored these measures. After all, this is a program for heart disease risk reduction, not for mangement of diabetes. But we saw explosive rates of plaque growth when pre-diabetic factors were not controlled--even when cholesterol and related factors were under excellent control. It became increasingly clear that factors associated with pre-diabetes needed to be managed, as well. This includes small LDL, increased blood sugar, high blood pressure, increased inflammation (as CRP). Many people, however, have normal blood sugars (100 mg/dl or less) with a high blood insulin level (>10 microunits/ml). (This blood test is available in most laboratories.) This means that they have early resistance to insulin. The pancreas, the source of insulin, responds to the body's unresponsiveness to insulin by increasing insulin production.Increased blood insulin with normal blood sugar will drive production of higher triglycerides, a drop in HDL, creation of small LDL, and inflammation--and coronary plaque growth, as evidenced by increasing CT heart scan score.Blood insulin levels can be very effectively dropped by weight loss; exercise; reduction of processed carbohydrates like breads, pretzels, and breakfast cereals; and increased raw nuts and oat products; and vitamin D replacement to normal levels. Drug manufacturers are desperately trying to make this a mandate for drug treatment (Actos, Avandia), but are encountering resistance, since most people without overt diabetes don't want to take diabetic medication (rightly so!). You and your doctor should consider insulin as a factor to track, especially if you have small LDL, low HSL, or high triglycerides, or any of the other manifestations listed above.
Sometimes small LDL is the only abnormality 19. July 2006 William Davis (0) Janet is a 58-year old schoolteacher. At 5 ft 3 inches and 104 lbs, she had barely an ounce of fat on her size-2 body. For years, Janet's primary care physician complimented her on her cholesterol numbers: LDL cholesterol values ranging from 100 to 130 mg/dl; HDL cholesterol of 50-53 mg/dl.Yet she had coronary disease. Her heart scan score: 195. Lipoprotein analysis uncovered a single cause: small LDL. 95% of all of Janet's LDL particles were in the small category. What was surprising was that this pattern occurred despite her slender build. Weight is a powerful influence on the small LDL pattern and the majority of people with it are overweight to some degree. But not Janet. How did she get small LDL if she was already at or below her ideal weight? Genetics. Among the genetic patterns that can account for this pattern is a defect of an enzyme called cholesteryl-ester transfer protein, or CETP. This is the exact step, by the way, that is blocked by torcetrapib, the new agent slated for release sometime in future (The manufacturer, Pfizer, is apparently going to sell this agent only packaged in the same tablet as Lipitor. This has triggered an enormous amount of criticism against the company and they are, as a result discussing marketing torcetrapib separately.)Also note that Janet had a severe excess of small LDL despite an HDL in the "favorable" range. (See my earlier conversation on this issue, The Myth of Small LDL at http://drprevention.blogspot.com/2006/06/myth-of-small-ldl.html.)With Janet, weight loss to reduce small LDL was not an option. So we advised her to take fish oil, 4000 mg per day; niacin, 1000 mg per day; vitamin D, 2000 units per day; use abundant oat bran and raw almonds, both of which suppress small LDL. This regimen has--surprisingly--only partially suppressed her small LDL pattern by a repeat lipoprotein analysis we just performed. We're hoping this may do it, i.e., stop progression or reduce her heart scan score. The lesson: Small LDL is a very potent pattern that can be responsible for heart disease, even if it occurs in isolation. And, contrary to conventional thinking, small LDL can occur as an independent abnormality, even when HDL is at favorable levels.