All posts by william-davis

Harry's case is typical. For years, his doctor told him his LDL cholesterol of 123 mg was okay. But a heart scan score of 490 (90th percentile at age 52) made him question just where his coronary plaque came from.

Lipoprotein analysis told a very different story: His LDL particle number was 2400 nmol, meaning his trueLDL was more like 240 mg, nearly double the value of LDL obtained through his doctor. Harry had other sources of risk, too, but the LDL particle number was a clear stand-out.

Why does this happen? How can LDL cholesterol be so terribly inaccurate?

LDL cholesterols obtained in virtually all labs are not measured, they're calculated. The calculation was developed in the 1960s by Dr. Friedewald at the National Institutes of Health and therefore goes by his name (the Friedewald calculation). Dr. Friedewald derived this simple calculation to permit doctors across the U.S. to obtain LDL cholesterols, which were technically difficult to measure in those days by using measured HDL, total cholesterol and triglycerides.

Doctors were told that the only time that the Friedewald calculated LDL was inaccurate was when triglycerides exceeded 400 mg. So most family practitioners and internists still believe that calculated LDL's are, for the most part, quite accurate.

Nothing could be further from the truth. When LDL's are actually meaured, you find that LDL is rarely accurate. In fact, in our experience, inaccuracy of 30-50% is the rule, sometimes 100%. The one telltale hint that calculated LDL is wrong is when HDL is <50 mg--that's nearly everybody.

So what's your LDL? You won't really know unless it's measured. Our preferred method is NMR (LipoScience) LDL particle number, probably the most accurate of all. Seco All posts by william-davis

The processed food battlefield

31. July 2007 William Davis (4)

If you have any remaining doubts that the processed food industry is a cutthroat, go-for-the-jugular, organized effort to extract every possible penny from your pocket, even at the expense of health, take a gander at a quote from Marion Nestle's wonderful book, Food Politics.

In Nestle's description on how food conglomerate, Archer Daniels Midland (ADM), conspired to fix prices on some basic agricultural compounds, she quotes an ADM executive captured on videotape and presented in court:

"We have a saying at this company . . . our competitors are our friends and our customers are our enemies."

In other words, ADM's competitors help establish what prices should be charged for basic foodstuffs, while its customers are the ones to do battle with.

Food is a necessary commodity. You and I only need so much of it. So how does a 40 billion dollar food manufacturer extract greater and greater profits and grow their market? Motivate people to eat more. It's that simple.

Eat less? Are you kidding? Eat spinach, green peppers, beets, and other low-margin products? Get real.

Why not take 8 cents worth of wheat flour, add some sugar, food coloring, and some other enticing flavorings like high fructose corn syrup? Put it all in a cleverly illustrated package, maybe even develop an entire story line about the product, complete with clever slogans and songs and . . . ouila! You now have a food that sells for many, many times its intrinsic value.

How to make the health nuts happy? Easy: Add some fiber. Now it's healthy! And it's now part of a "balanced diet".

What if it's full of corn starch, wheat flour, and sugar of the sort that make HDL cholesterols plummet, fan the flames of small LDL, increase inflammatory measures like C-reactive protein, push people closer and closer to diabetes, and make them fat? Then be sure it's low in saturated fat! It might even qualify as "Heart Healthy" by the American Heart Association!

Processed foods have no role in the Track Your Plaque program. If you want to see your CT heart scan score skyrocket, go to your grocery store and stray into the aisles outside of the produce aisle.

But stick to the produce aisle and watch your wallet grow, your health improve, your appetite shrink, all while food processor profits plummet.

Heart Scan debate

29. July 2007 William Davis (4)

A few years back when the book form of Track Your Plaque was first released, I did a bunch of radio and interviews to raise awareness of the book and of CT heart scanning in general.

I'd forgotten about this interview I did for National Public Radio (NPR), in which I debate Dr. Graboys from Harvard. Though I've had this debate countless other times, usually on a less formal basis, I didn't know what to expect at the start of the interview. After all, I knew of Dr. Graboys' reputation as a respected Harvard cardiologist. So I was expecting that at least he would argue that, being relatively new at the time, CT heart scanning was largely unproven in large clinical trials. (This was not entirely true then, however, as at least 1000 trials had already been performed, many of them involving thousands of participants. However, despite that much validation, the concept of CT heart scanning had still not entered the consciousness of most practicing physicians. After all, heart scanning is not part of the "crash and repair" equation that most have invested their career in.)

Heart Hawk re-discovered the debate, still on the NPR website. So here it is. When I re-listened to the debate, I was surprised at how little Dr. Graboys had to offer. He argues that examining left ventricular function should suffice as an important measure of mortality. In other words, if you have experienced a drop in the strength of heart muscle, that can be used to stratify your risk of death.

I tried to convey to the audience (NOT convince Dr. Graboys to believe, as most of my colleagues are stubbornly adherent to their way of thinking until someone tosses a big carrot in front of them) that CT heart scanning provides a means to detect coronary atherosclerosis years, even decades, before questions of mortality (death) became necessary. Heart scanning identifies disease in its early stages so that a program of prevention can be followed and tracked.

Dr. Graboys expressed concern that heart scanning devices could be mis-used to increase hospital procedures. He's absolutely right here. By that same line of thinking, say your crooked auto mechanic on the corner scams most of his customers by doing unnecessary car repairs. Does this mean that we should ban all auto mechanics from repairing cars? I hope not. I believe it does mean that we should all be educated on distinguishing scams from an honest businessman.

Same with heart scans. The key is not to ban heart scanning. We should try to educate the public and physicians to prevent these sorts of scams and decisions based on ignorance from occurring.

Nonetheless, make your own judgments.

CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play)

Break the addiction

28. July 2007 William Davis (8)

"But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"

This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep.

Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict.

Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.

But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:

You no longer crave these foods.

Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more.

It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!

Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction.

Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible.

You will be impressed with the results.

Are we done here?

27. July 2007 William Davis (4)

Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.

Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy.

Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart.

Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before.

I explained to Les that having normal coronary blood flow was just one aspect of the issue.

"But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"

I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack.

"With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."

So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him.

Now, if we could only transform Les into an optimist . . .

Wheat belly

23. July 2007 William Davis (31)

You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer.

How about "wheat belly"?

That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta.

(By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.)

It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc.

How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere.

Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner.

"But that's what they told us to eat after Dan left the hospital after his last stent!"

Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc.

I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world.

As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.

Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.

You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.

If health won't motivate them, maybe money will

23. July 2007 William Davis (0)

As part of our ongoing effort to educate everyone about the value of heart scans and how they can serve to Cureality | Real People Seeking Real Cures

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 sugar

In 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?

19. February 2008 William Davis (3)

What will we do if or when CT heart scans become outdated and something better comes along?

Heart scans are, after all, our principal tool for detection and precise quantification of coronary atherosclerotic plaque. They provide the basis for the Track Your Plaque program: serial heart scans to track progression or regression of coronary plaque.

So what the heck will we do if heart scans become obsolete, if some other technology proves superior for precise lengthwise quantification of coronary plaque?

Simple: Then we will convert to that measure.

Say, for instance, that in 5 years, MRI advances to the point where it is quick and precise, despite the rapid motion of the heart that has, in past, caused this technology to stumble for plaque quantification. Instead of obtaining a heart scan score of, say, 350, instead an MRI might yield information like:

Calcium volume: 350 cubic mm
Soft plaque elements: 200 cubic mm
Fibrous tissue: 700 cubic mm

In other words, while a CT heart scan provides a calcium score that serves as a surrogate measure of total plaque volume, perhaps the next wave of technology will directly measure total plaque volume.

Don't CT coronary angiograms already measure total plaque volume?

No, they definitely do not. At present, the best they can do is visualize the non-calcific elements and suggest the diameter reduction created by plaque at a specific point. Thus, results like "50% blockage in the mid-left anterior descending." What they do not provide is a lengthwise total volume of plaque and all its elements. Perhaps some software manipulation in future will yield such information (and I think it will, though I personally have been unable to accomplish it).

So neither the Track Your Plaque program nor the Heart Scan Blog are necessarily bound to heart scans. But heart scans, in 2008, remain the number one best tool for plaque quantification that is easy, precise, available, and inexpensive. For those reasons, CT heart scans continue to serve as the basis for these programs, and not CT angiograms, MRI, or other non-quantitative technology.

Scare tactics

19. February 2008 William Davis (17)

Does the media engage in scare tactics?

Read the headlines in local newspapers, and you'd believe that your friends and neighbors are dropping like flies, all victims of heart attacks.

I occasionally peruse the headlines run in newspapers and magazines around the U.S. by subscribing to a feed service through Google. For the phrase, "heart attack," you can get a sample of what is being said around the country about people having heart attacks.

What continues to impress me is just how far off a truly constructive and helpful message the media provides every day. Not only are they guilty of delivering a flawed message, they also favor headlines and stories that scare the heck out of people. "This could happen to you!"

Is it just the quest for headlines that grab readers' attentions? Is there some complicity with the medical systems that pay significant advertising revenues for their heart disease programs and hospitals?

I doubt such complicity exists to any substantial degree. But the fact remains: Every day across the U.S., the media does an effective job of scaring the heck out of the public--enough for you to run to your doctor or hospital to find out if you, too, could fall victim to heart disease. A stress test, perhaps heart catheterization, three stents or bypass often results.

In effect, these headlines make great hospital PR, an inducement that flushes out the patient highly motivated to pursue further costly heart testing--whether or not it's needed.

A sampling:

Stress test could help prevent sudden heart attack

DAWN ZERA Times Leader Correspondent

Bob Schultz, 67, was feeling a persistent pain in his back, which he was pretty sure was caused by working on a deck for his son’s home.

But after the deck was finished, the pain was still there.

“It was nagging, but not enough to hurt,” Schultz said.

He visited his primary care physician, thinking maybe some muscle relaxants would be prescribed. The doctor sent him to a clinic in Tunkhannock to do a complete body CAT scan, and then had Schultz do a stress test. The on-site cardiac stress testing at a Geisinger Medical Group office in Tunkhannock showed that things did not look good: Schultz had a blockage. He was scheduled for a cardiac catheterization.

It was a surprise; a heart problem had not even crossed Schultz’s mind as a possible cause of his back pain.

“I had good cholesterol, have been the same weight for years, and had excellent blood pressure,” Schultz said.

He went for the catheterization at Geisinger Wyoming Valley, and there doctors discovered Schultz’s condition was even more serious. He had three blockages – 99 percent, 95 percent and between 80 and 90 percent.

“It shocked the living daylights out of everyone. It was surreal,” Schultz said.

The catheterization turned into open heart surgery that very same day.

The surgery was on a Tuesday, and he was home by Sunday. He never even had time to fully think about having the operation. And he had never experienced the typical warning signs of a heart problem, such as chest pain or shortness of breath.

“The doctors said I had the worst alarm system they’d ever seen,” Schultz said. “They probably saved my life, with me not knowing I had a problem.”

It also made him think about his brother, who had had been in good health but suddenly died in his 40s of a suspected heart attack.

“We never had any heart problems in our family, so we never believed it. But now I think, geez, it probably was true,” Schultz said.

His experience has served as a cautionary tale for friends and family. Just this past month, a friend specifically requested a stress test for himself.

“It sets off alarms in your circle. People think ‘if it can happen to him, it could happen to me,’ ” Schultz said. “It triggered people to think about what could happen to them.”

Firefighter Saves Heart-Attack Victim on D.C. Court

ABC News

A 30-year-old man suffered a heart attack while playing basketball on a D.C. court.

That's when a Brian Long's firefighter training kicked into action. The 25-year-old D.C. firefighter's team had just finished their pick-up league game Friday evening at Lafayette Elementary School's basketball court when the man stumble to the ground.

"He ran a few feet and collapsed again so I turned him over and I looked at him his eyes rolled back and he just stopped breathing," Long said.

Long began performing chest compressions and soon he was joined by Anthony Gadson, a pharmaceutical sales representative, who learned CPR years ago and starting assisting with mouth to mouth resuscitation.

"If that were me, somebody would've done the same thing for me, so I feel like I did what I was supposed to do," Gadson explained.

While Long and Gadson worked to keep the victim's heart going, all the players and spectators, including teammate and league commissioner Bob Johnson, gathered around the lifesaving effort.

"We gathered in a circle and one of the wives of one of the players just led us in this huge prayer," said Johnson.

"It makes me feel great," Long told ABC 7/NewsChannel 8. "I am just glad that I am a D.C. Firefighter."

Free Drugs After Heart Attack Would Save Money, Lengthen Lives
More patients would take recommended medications, study says

By Ed Edelson

MONDAY, Feb. 18 (HealthDay News) -- Eliminating the cost of medications for people who have heart attacks would lead to longer lives and lower overall medical costs, new research suggests.

"These are highly effective medications that are relatively inexpensive, and the events they are designed to prevent are extremely expensive," said study author Dr. Niteesh K. Choudhry, a researcher in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston and an assistant professor at Harvard Medical School. His report is published in the Feb. 19 issue of Circulation.

The study covered four drugs commonly prescribed after heart attacks -- aspirin, beta blockers, ACE inhibitors or angiotensin receptor blockers (ARBs), and statins. Use of those drugs is relatively low under the current system, in which people share the cost with Medicare or other health insurance plans, Choudhry said. For example, only 46 percent of people take beta blockers after heart attacks, and only 50 percent take cholesterol-lowering statins. Less than 20 percent of heart patients used all four of the medications, according to the study.

The model set up by Choudhry and his colleagues doesn't assume a major increase in compliance with prescriptions, because "cost is just one reason why patients do not take medications," he said, adding that relying on previous studies of drug cost and use, the model assumes an increase of about 14 percent, with perhaps 64 percent of people taking the medicines if they were free.

The result would be an increase in average survival after a heart attack, from the present 8.21 quality-adjusted life years to 8.56 years. "That is small in an absolute sense, but in an aggregate sense, it is very large," Choudhry said.

And medical costs over a lifetime would go down, from the current $114,000 to $111,600, the study added.

"This study adds to a growing body of research showing how important it is to reduce or eliminate patient co-payment for drugs," said Robert M. Hayes, president of the Medicare Rights Center in New York. "Medicare should take the lead in forging the creation of drug coverage that allows patients to get the medications their doctors consider vital."

"It certainly makes sense from the medical point of view," said Dr. Richard A. Stein, a professor of medicine at New York University. "Studies have shown that giving even middle-income people free drugs improves outcome. The greatest benefit will go to people in the lower socioeconomic and immigrant population."

But the study is theoretical, Stein noted. "One would like to see some real-world trial to determine whether this works in fact, whether providing free drugs without co-payment would make a difference, he said.

Such a study has begun at Harvard, Choudhry noted. His group is working with a major health insurer, not Medicare, in a trial that assigns some people to get medications without cost, while others will get the standard co-payment.

"It will take several years for us to get answers," Choudhry said. But similar investigations are being started by other medical insurers and corporations, he added.

The idea is potentially applicable to some other chronic conditions, such as congestive heart failure and diabetes, Choudhry noted. And, if the use of recommended medications after a heart attack goes up more than predicted by the model, "the cost savings would be phenomenal," he said.

More information

To learn about how to stay on your statins, consult the National Heart, Lung, and Blood Institute.

Heart Attack Threatens Young, Old

BAKERSFIELD, Calif. -- Nearly 1.2 million men and women suffer a heart attack every year in the United States, according to the American Heart Association. However, not all of the victims are old.

Brian Connell considers himself a lucky guy. At the age of 39, he's physically active, he has a high-level job, and he is also a heart attack survivor. "I know I was overweight and obviously had some other risk factors against me," said Connell. "I wish I did more to prevent it, certainly."

Connell is doing plenty of things now. He met with a nutritionist and changed his diet. He gets regular exercise and takes medication to control his cholesterol. He also gets regular checkups.
Click here to find out more!

Cardiologist Jeffrey Popma said it's not unusual to see younger heart attack patients. "We have dozens of patients in our system every year who have been under 40 years old who have suffered a major heart attack," said Dr. Popma.

Popma said getting medical help quickly is the key to survival. Connell said that is what made all the difference for him. And when people ask him if that was his first heart attack, Connell said he is quick to tell them it was his last heart attack.

Copyright 2008 by TurnTo23.com. The Associated Press contributed to this report. All rights reserved.

The messages I take from such stories:

1) Get yourself to a hospital ASAP for any symptoms even vaguely suspicious of heart disease, because they will know what to do. You'll be doomed if you don't.

2) Hospitals and doctors are expert at saving you from the brink of disaster. The process, once you enter, is rapid and smooth and you will be eternally grateful.

3) Medicines save lives. You're going to die if you don't take medication.

As I've often said, one of the toughest battles of all in health and heart disease is sorting out fact from fiction. Unfortunately, the media continues to propagate the scare tactics that support the status quo of procedural heart care. Wittingly or unwittingly, they serve a $400 billion dollar a year gargantuan industry that remains hungry for growth.

Lost in the headlines are the messages that could have been included, like:

Heart disease detectable decades before disaster

Or:

"Heart disease preventable, reversible, and--curable?"

Copyright 2008 William Davis, MD

Which statin is best?

17. February 2008 William Davis (6)

The statin drugs can indeed play a role in a program of coronary plaque control and regression.

However, thanks to the overwhelming marketing (and lobbying and legislative) clout of the drug manufacturing industry, they play an undeserved, oversized role. I get reminded of this whenever I'm pressed to answer the question: "Which statin drug is best?"

In trying to answer this question, we encounter several difficulties:

1) The data nearly all use statins drugs by themselves, as so-called monotherapy. Other than the standard diet--you know, the American Heart Association diet, the one that causes heart disease--it is a statin drug alone that has been studied in the dozens of major trials "validating" statin drug use. The repeated failure of statin drugs to eliminate heart disease and associated events like heart attack keeps being answered by the "lower is better" argument, i.e., if 70% of heart attacks destined to occur still take place, then reduce LDL even further. This is an absurd argument that inevitably encounters a wall of limited effects.

2) The great bulk of clinical data examining both the incidence of cardiovascular events as well as plaque progression or regression have all been sponsored by the drug's manufacturer. It has been well-documnted that, when a drug manufacturer sponsors a trial, the outcome is highly likely to be in favor of that drug. Imagine Ford sponsors a $30 million study to prove that their cars are more reliable and safer. What is the likelihood that the outcome will be in favor of the competition? Very unlikely. Such is human nature.

If we were to accept the clinical trial data at face value and ignore the above issues, then I would come to the conclusion that we should be using Crestor at a dose of 40 mg per day, since that was the regimen used in the ASTEROID Trial that achieved modest reversal of coronary atherosclerotic plaque by intravascular ultrasound.

But I do not advocate such an ASTEROID-like approach for several reasons:

1) In my experience, nobody can tolerate 40 mg of Crestor for more than few weeks, a few months at most. Show me someone who can survive and tolerate Crestor 40 mg per day and I'll show you somebody who survived a 40 foot fall off his roof--sure, it happens, but it's a fluke.

2) The notion that only one drug is necessary to regress this disease is, in my view, absurd. It ignores issues like hypertension, metabolic syndrome, inflammatory phenomena, lipoprotein(a), post-prandial (after-eating) phenomena, LDL particle size, triglycerides, etc. You mean that Crestor 40 mg per day, or other high-intensity statin monotherapy should be enough to overcome all of these patterns and provide maximal potential for coronary plaque reversal? No way.

3) Plaque reversal can occur without a statin agent. While statin drugs may provide some advantage in the reduction of LDL, much of the benefit ends there. All of the other dozens of causes of coronary atherosclerotic plaque need to be addressed.

So which statin is best? This question is evidence of the brainwashing that has seized the public and my colleagues. The question is not which statin is best. The question should be: What steps do I take to maximize my chances of reversing coronary atherosclerotic plaque?

The answer may or may not involve a statin drug, regardless of the subtle differences among them.

Copyright 2008 William Davis, MD

Lipoprotein(a)--neglected and unappreciated

16. February 2008 William Davis (2)

Lipoprotein(a), or just Lp(a) to its close friends and neighbors, is among the most underappreciated and neglected of causes of coronary plaque. It's the Rodney Dangerfield of lipoproteins.

Lp(a) rarely gets diagnosed before people come to my office. They've often been through the ringer: doctors have thrown their hands up in frustration because of poor response to "standard" treatment (AKA statin drugs); the patient doesn't understand why they might be thin and active yet have the high blood pressure of someone 70 lbs heavier; they have heart disease despite wonderful cholesterol values.

One blood test and the answer becomes clear: They have Lp(a). It explains all these phenomena.

They why don't more physicians order this simple test? Why don't we hear more about this prevalent (1 in 5 people with coronary plaque have it) genetic pattern that accelerates risk for heart disease?

There are a number of reasons. But I believe the most powerful reason is simply that there is no big revenue-generating drug to treat it. Statins reduce LDL cholesterol to the tune of $27 billion dollars a year (2007 revenue). There's no such blockbuster for Lp(a). Of course, Niaspan represents the relatively anemic attempt to commercialize a pharmaceutical treatment for Lp(a), but side-effects and the lack of FDA trials for the Lp(a)-reducing indication have stalled its commercial success. (Efforts to block the flush with various products, by the way, may re-invigorate niacin as a pharmaceutical agent. The drug companies smell money here.)

Another reason for Lp(a)'s unpopularity: Though there are mounds of data that document--without question--that Lp(a) is an important risk for coronary disease and other forms of atherosclerotic disease, we lack treatment trials. For instance, niacin vs. placebo for 5 years, then count the number of heart attacks and deaths. We have numerous, repetitive, overlapping, redundant trials with statins adhering to this design. We have none for niacin and the treatment of Lp(a).

Niacin is also a pain in the neck for your doctor. He/she rapidly tires of the calls about the crazy and disconcerting flushing with niacin. Most are unaware that proper hydration reduces or eliminates the flush for the majority of people. It takes too much time and energy to educate people. (By the way, prescription Niaspan makes no mention of purposeful hydration. They only suggest the nonsensical "Take with a low-fat snack," i.e., snacks that actually counter the therpaeutic effects of niacin. What they should be saying is "take with a high-fat snack" like raw almonds, foods that facilatate the benefits of niacin.)

Should someone concoct a successful pharmaceutical treatment for Lp(a), it will make the news, headlines in health magazines and health sections of the newspaper will blare about how important Lp(a) is. Yet it has been there all along, frustrating people and their physicians.

In the Track Your Plaque experience, Lp(a) clearly 1) correlates with heart scan scores, 2) correlates with progression of heart scan scores without treatment, and 3) poses special challenges for treatment. Interestingly, some of our biggest failures have been with Lp(a), as well as some of our biggest successes. (Our current record holder for the largest percentage reduction in heart scan score has Lp(a).)

If you have coronary plaque, or if there is family risk of heart disease, then Lp(a), in my view, is an absolutely essential factor to test for. Yes, treatment poses challenges. But once you know who your enemy is, then you can focus your efforts on it. Not knowing whether or not you have it leaves your efforts unfocused and generally flawed.

Track Your Plaque Members, be sure to read our in-depth Special Report, Unique Treatments for Lipoprotein(a) Reduction.

Copyright 2008 William Davvis, MD

Wheat-free and still fat

15. February 2008 William Davis (14)

Readers of The Heart Scan Blog know that I preach a diet that contains foods with low glycemic index to control weight, raise HDL, and reduce triglycerides, blood sugar, and small LDL.

A crucial aspect of a low glycemic index approach is to sharply reduce, preferably eliminate, wheat products.

I pick on wheat specifically because it has come to dominate the American diet. Look at the shelves in the supermarket: aisle after aisle of processed wheat products. The bread shelves alone in some of the grocery stores in my neighborhood are 40 feet long, six shelves high. There's also breakfast cereals, granola products, cookies, cakes, baking products, pretzels, crackers, pasta, and on and on.

Wheat products like these are tasty and they're addicting--literally. Test animals given processed wheat will eat more and gain more weight. Wheat fails to trigger satiety. So laboratory mice--and you and I--eat and eat, because eating wheat stimulates appetite, creates a hunger for more wheat, and a vicious cycle ensues. Eliminating wheat, on the other hand, results in dramatic drop in appetite, substantial weight loss, followed by correction of the metabolic disruptions it created.

A quick Google search for "gluten-free" turns up a startling array of wheat-free, gluten-free, yet high glycemic index products. The breakfast cereal pictured, for instance, can do as much damage as most wheat containing products--though it won't cause gluten enteropathy (also known as "celiac disease").

The product shown contains:

Brown rice flakes, rice bran, evaporated cane juice, brown rice syrup, raisins, cinnamon, gum arabic, vanilla, molasses, ground flaxseed, rosemary extract.

A 1/2-cup serving contains:
Total Carbohydrate 31g
Dietary Fiber 5g
Sugars 8g

And I'll bet that most people eat a lot more than a half-cup serving.

But you and I are not laboratory mice. If deprived of wheat, many people will then seek out processed rice products (rice cakes, Rice Krispies), processed cornstarch or cornmeal products (tacos, cornbread, many processed foods using these products for texture or thickness), or other products labeled "gluten-free."

Going wheat-free for our purposes is not about avoiding the gluten in wheat. It is about seizing control of appetite, eliminating a food that disrupts insulin responses, reduces HDL, raises triglycerides, and creates small LDL particles. But this applies to processed corn, rice, and other high glycemic index foods, as well.

So, occasionally, someone will declare, "I've eliminated wheat! Now I only eat rice, corn, and I've discovered all the gluten-free alternatives!"

Unfortunately, they've traded one evil for another. So it's not just about wheat. It's really about reducing or minimizing foods that mess up metabolic responses and lead to coronary plaque growth. Wheat is the biggest culprit and so I focus on it. However, you could easily transfer far less popular rice and corn products into center stage and allow them to wreak all the health damage of wheat.

Going wheat-free for our atherosclerotic plaque-control purposes is not the same as going gluten-free. So be careful of the distinction.

Wheat-free gummi bears:

Contents:
Organic dehydrated cane juice, organic corn malt syrup, organic juice concentrates (may contain organic apple, organic apricot, organic aronia, organic carrot, organic cranberry, organic elderberry, organic lemon or organic red beet), organic spinach powder, organic apple pectin, citric acid, natural fruit flavors.

Virtually pure sugar--yet wheat-free.

Wheat-free rice bread

Ingredients:
White rice flour, water, honey, soy oil, natural gum, salt, yeast, natural gum

Copyright 2008 William Davis, MD

Heart disease is reversible

13. February 2008 William Davis (10)

In a previous post, Take this survey: I double-dare you, I posed a challenge:

Ask your doctor: Is heart disease reversible? Their answer:

1) No. Heart disease is definitely not reversible.

2) Yes, in rare instances, like lightning striking twice.

3) Yes, of course it is! Let's talk about how to do it!

I predicted that few readers of this blog would respond. I also predicted that the few who did would respond with the first answer, Heart disease is definitely not reversible. After all, in nearly all medical practices, the only parameters routinely followed to track risk for heart disease are LDL cholesterol and blood pressure. A measure of the disease itself (i.e., coronary atherosclerotic plaque) is not followed. So how can your doctor actually tell whether heart disease is reversed or not? When I engage in this conversation with colleagues, it goes no farther than rolled eyes or a snort. In my experience, talking about reversal of heart disease is a wasted effort.

To my great surprise, this simple survey received a total of 177 responses. Even more surprising, 122 (69%) of respondents chose number 3, claiming that their doctor said that heart disease is reversible.

Overall results:

1--31 responses (17.5%)

2--24 responses (13.5%)

3--122 responses (69%)

Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

Anyway, this simple survey cannot settle the why or how, nor can it suggest just how prevalent this opinion is.

I am encouraged by these results. If true, it means that the message that heart disease is a reversible process is spreading. It may be make-believe heart disease reversal as preached by Dr. Dean Ornish or claimed by statin drug manufacturers. It may be the hocus-pocus of practices like chelation, or scams like nattokinase. But perhaps the seed of this notion has been planted in the minds of the medical community.

I'd be interested in hearing from the respondents who reported that their doctor said heart disease is reversible. How exactly are they going about achieving reversal?

Looking for health in all the wrong places

12. February 2008 William Davis (11)

The American public now has unprecedented freedom to explore new directions in health.

Never before have we had the enormous resources now available to add to our health experience: nutritional supplements, endless books on health and diet, the internet, online discussion groups, insurance products to permit spending on self-directed health services like medical savings accounts and flex-spending. The Track Your Plaque program is just one facet of this emerging and exciting area of self-empowerment in health. Compare what you can achieve with such a program with the situation of just 25 years ago, when the most you might get to reduce your risk for heart disease was to take the (largely ineffective) drug cholestyramine, probucol, and a low-cholesterol, low-fat diet.

Unfortunately, it also means that people have unrestrained potential to be tripped up, to be misled down some dead end of health that fails to accomplish desired goals, maybe even dangerous. The more freedom we have, the greater the choices, the more room we have to screw up.

Among the unproductive strategies I've witnessed recently:

--Nattokinase--The staying power of this scam continues to shock me. There is no rational basis for its use. A woman today declared that she would like to stop the warfarin that she was taking to prevent stroke from atrial fibrillation by taking nattokinase. This would be a mistake that could cost her a major and disabling, even fatal, stroke. Though warfarin is far from perfect, it at least achieves its goal of reducing stroke risk. Nattokinase does not. Nattokinase does nothing but make money for the people who sell it.

--Poly-nutritional supplements. You've heard of polypharmacy, the phenomenon of taking numerous medications with overlapping effects and side-effects, usually because of multiple doctors, each prescribing drugs without knowledge or interest in what colleagues are prescribing. I'm seeing the same phenomenon with supplements: 20,30, or more supplements per day, all in the hopes of heightening health. A focused few supplements is, in my view, superior to a shotgun approach of trying to improve health by taking hawthorne, silymarin, chrysin, calcium, Chinese herbs, and 25 other supplements.

--Chelation--Based on the notion that heavy metal toxicity causes heart disease; removal of heavy metals cures it. I've read some of the books on chelation, in addition to the slim scientific data, to decide whether there was anything to it. In my view, it is a complete and utter scam. It does make money for its practitioners, however. That's not to say that heavy-metal chelation doesn't have a role in health--it does. But it serves no purpose in coronary disease prevention and control.

--Colonic purges--Achieved by a number of routes, some oral, others via enema. Promotions for purging are often accompanied by a pile of scum that apparently lined somebody's intestinal tract. Purges purportedly, well, purge it from the intestine. This is also plain nonsense. There is no such toxic scum lining anybody's intestinal tract. However, if calorie restriction or a fast results inadvertently from the effort, perhaps some good comes from it.

--Statin drug alternatives--The unprecedented $27 billion dollar a year success of the statin drug industry, accompanied by the enormous marketing push by their manufacturers, has spawned an entire industry of statin alternatives. They range from red yeast rice, to guggulipid, to various concoctions of sterol esters, Chinese herbs, chitosan, and a variety of others. Some actually do reduce cholesterol a few points. Preparations like red yeast rice even pose a side-effect profile not too different from the prescription statin agents. Unfortunately, even among those agents that work, the effects tend to be small to trivial. While I am no lover of statin drugs nor the statin drug industry, I find these preparations to be anemic imitators. You'd be better off with raw nuts and ground flaxseed than wasting your money on these cheap imitations.

--Worries about liver toxicity--A day doesn't go by that I don't have at least several questions about suffering toxic liver effects from niacin, vitamin D, statin drugs, etc. I have treated thousands of patients for heart disease in its various stages and forms and have used many different strategies. How many times have I seen serious liver toxicity? A handful of times and usually from either mis-use of the agent or drug, or in a person with several other coexisting diseases. (Other serious health conditions, like kidney failure, raise the toxicity of drugs and supplements.) Liver toxicity in the vast majority of otherwise healthy people is close to being a non-concern.

Readers of The Heart Scan Blog and of the Track Your Plaque website know that I celebrate expansion of knowledge and information access to the public. However, I am concerned that the flip side of this growing self-empowerment is expanding potential for mistakes. It reminds me of an attorney friend, who, when diagnosed with prostate cancer, explored all manner of alternative treatments, from laetrile to heavy metal chelation to high-dose lycopene tablets. At the initial stage of diagnosis, his cancer was readily treatable. He now has widely metastatic cancer.

Maintain an open mind, but think before you commit to some crazed claim of cure, some "secret" to health, somebody's brazen but concealed attempt at steering profits in their direction.

With freedom comes responsibility. Otherwise, you might be looking for love . . .oops, I mean health . . . in all the wrong places.

Track Your Plaque APB

9. February 2008 William Davis (7)

I'm posting this intriguing comment from the Track Your Plaque Member Forum because I would like to speak to the Member who posted it.

The Member said:

I tested at 965 last year, and while I have followed the TYP diet and nutraceutical recommendations, I was totally unprepared for my first repeat scan (at the same lab/machine) on January 29, 2008. My result was 4.0, and at first I assumed the rating scale had been changed.

I then noted that 3 of the big four arteries received scores of 0, which means the same in any scale, and that four nodules had disappeared from the scan field.

Wow!!

If this is true, it would represent the biggest success in the Track Your Plaque program--ever! It would be an incredible story to tell, to convince the public and medical community that it is indeed possible, and a cause for popping a bottle of champagne! It would also represent what I would regard as essentially a cure for coronary atherosclerosis, a virtual elimination.

While we have plenty of success in stopping the progression or reducing heart scan scores, we do not have 100% success. I wish we did. The Track Your Plaque program is, to some degree, a work in progress. We learn from experiences, continually adjust to obtain the results we desire. Even as it stands today, the Track Your Plaque program is superior to any program of heart disease prevention known--by a long stretch. But it's not infallible, it's not foolproof.

That's all the more reason I would like to communicate with the Track Your Plaque Member who posted this comment. I would also like permission to view the heart scans themselves. (I can't obtain them nor view them without the individual's permission.) While we often have difficulty judging reversal just by looking at heart scans, presumed reversal to this profound degree should be obvious, even to the naked eye.

I would like to know--in detail--precisely what steps were taken and whether there was anything unique about this person's medical history or in the program they followed. This is all in an effort to learn and help others do the same.

If you are the Member who posted this comment, I would like to hear more. Please post your further thoughts on the Track Your Plaque Member Forum, or privately through our Contact page . Or e-mail us at contact@cureality.com.

Take a walking vacation

"Expanded indications for implantable defibrillators"

Get a heart scan--but then don't delay taking action!

Feel that nudge in your back?

Throw away total cholesterol!

Smart Start not so smart

Does anybody have a normal vitamin D level?

Don't believe your LDL cholesterol!