China fiction?

10. July 2010 William Davis (39)
Dr. Colin Campbell caused a stir with publication of his 2005 book, The China Study. Dr. Campbell, after extensive animal and epidemiologic research conducted in China over 20 years, concluded that a diet high in animal protein, especially casein, was associated with increased cancer, osteoporosis, and heart disease risk.

Richard Nikoley of Free the Animal and Stephan Guyenet of Whole Health Source have been talking about an analysis of the China Study raw data performed by a young woman named Denise Minger.

Denise's analysis is nothing short of brilliant, absolutely "must" reading for anyone interested in nutrition.

Her comments on the relationship of wheat to heart disease:

Why does Campbell indict animal foods in cardiovascular disease (correlation of +1 for animal protein and -11 for fish protein), yet fail to mention that wheat flour has a correlation of +67 with heart attacks and coronary heart disease, and plant protein correlates at +25 with these conditions?

Speaking of wheat, why doesn’t Campbell also note the astronomical correlations wheat flour has with various diseases: +46 with cervix cancer, +54 with hypertensive heart disease, +47 with stroke, +41 with diseases of the blood and blood-forming organs, and the aforementioned +67 with myocardial infarction and coronary heart disease?
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Comments (39) -

  • aqf

    7/10/2010 4:27:14 PM |

    Thanks so much for this. I'm a T2 diabetic controlling my blood sugar with a low carb diet. The only thing in my recent lab work that my GP is unhappy with is an elevated vitamin D level. A few years ago, a friend gave me a copy of The China Study (along with Fuhrman's Eat to Live, because they had "changed [her] life" and she hoped they would change my life as well. Based on my experience and reading about blood sugar regulation and insulin levels, what both had to say just felt wrong to me, over and beyond the simplification one might expect in a mass-audience book. So, I was skeptical about their broader health-related claims, though I wasn't concerned enough to investigate further (and have actually considered the ethics of regifting books that I think make dangerous recommendations). Because of this, it's quite gratifying to find my initial suspicions confirmed by detailed analysis.

  • Anonymous

    7/10/2010 5:26:19 PM |

    When I looked up The China Study on Amazon, I found this statistical analysis of the China Study dataset under the comment section.  This is simply amazing and backs up pretty much everything you've said in your blog.  I hope someone can do an analysis to confirm this analysis.

    http://www.amazon.com/Analyzing-the-China-Study-Dataset/forum/Fx1YJPR95OHW08P/TxY4S5EZD8Y2XE/1/ref=cm_cd_dp_ef_tft_tp?_encoding=UTF8&s=books&asin=1932100660&store=books

  • Anna

    7/10/2010 5:32:50 PM |

    Very glad to see this analysis featured here, too.  I groan every time someone recommends The China Study to me as a great authoritative book, so Minger's detailed review was most welcome.

    We must keep in mind however, Minger's review and different conclusions not withstanding, that The China Study is epidemiological data and it can only show association, not causation.   It still doesn't prove in any way that consuming wheat is harmful to health.  Don't get me wrong, I'm no fan of wheat anymore and no longer consume it myself or serve it to my family.  But it *is* fuel for the argument that considerably more study is needed before the government and health agencies continue to push wheat consumption on the public as matter of policy.

  • nielso

    7/10/2010 8:32:15 PM |

    Perhaps the most astonishing thing about this analysis is that is is done by an "amateur" without any axes to grind.  It is a telling comment on the dihonesty and/or stupidity of most government and industry funded research.

  • David

    7/11/2010 1:45:27 AM |

    Campbell doesn't deny that processed refined wheat flour (which is what they eat in china) is unhealthy.  He advocates eating whole plant foods.

  • Peter

    7/11/2010 4:06:22 PM |

    Whole wheat, brown rice, beans, and steel-cut oats all seem to raise my blood sugar about the same amount, which is quite a lot depending on how much I eat.  Are they equally problematic?

  • Anonymous

    7/11/2010 5:36:59 PM |

    happy to see denise mingers study featured here. Smile

        wheat asides, milk pasteurised or uht causes a pretty massive immune system flare up for me.

  • Anonymous

    7/11/2010 7:15:10 PM |

    How do we explain the positive correlation between plant protein and cancer?  I'm not ready to give up my kale and chard just yet!

  • kellgy

    7/11/2010 10:18:17 PM |

    Denise's astute analysis gives rise to the importance "digging a little deeper". I have always thought the benefit of eggs was contrary to the "official" line of thought. Little did I know the controversial aspects of wheat until stumbling along Dr. Davis' musings.

  • ramon25

    7/12/2010 3:08:10 AM |

    Sorry to come off topic here but i dont have the program in my  computer to email you. Dr. what do you think of this http://www.westonaprice.org/blogs/are-some-people-pushing-their-vitamin-d-levels-too-high.html

  • Anonymous

    7/12/2010 3:45:30 PM |

    ramon25-

    Very interesting study.  I would love to hear a reply as well.

  • Evan

    7/12/2010 6:50:57 PM |

    Here is the T Colin Campbell's response to Denise's debunking of the China Study:

    http://tynan.net/chinastudyresponse

  • sonagi92

    7/13/2010 12:13:36 AM |

    Some commenters have wondered whether the wheat flour assessed in the study was refined wheat.  Chinese today eat mostly refined wheat products, but in the 70s, rural Chinese on collectives might have eaten differently, so I emailed a few Chinese professors of nutrition to ask.  It's morning now in China, and I got one response from Dr. Duo Li of Zhejiang University.  He told me in a brief reply that rural Chinese ate whole wheat products and the refined wheat was rare.

  • 30BaD

    7/13/2010 12:13:02 PM |

    Denise's analysis of The China Study is heavily flawed and therefore invalid.  Debunked by a cancer epidemiologist...

    Here it is...
    http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/a-cancer-epidemiologist

    The proper testing procedure as stated by an expert on analysing stats...
    http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/my-response-to-denises

    Campbells response to Denise..
    http://www.30bananasaday.com/group/debunkingthechinastudycritics/forum/topics/campbells-response-to-denises

  • Peter

    7/13/2010 1:08:44 PM |

    Campbell, in his response, thinks Minger is probably an undercover agent in a larger conspiracy.  The  debunking epidemiologist, in his, points out that correlation and association aren't the same, which will probably not come as news to Minger.  Could be Minger has kicked the hornets' nest.

  • Anonymous

    7/13/2010 8:28:57 PM |

    What I'd like to know is how correlations > 1 and < -1 are being generated, since that's impossible.

  • EMR

    7/14/2010 3:56:15 AM |

    Thanks for sharing the research point of view,yes with the obesity that is hitting America it is necessary to learn that the cause of obesity is eating more of high protein diets and fats over vegetables and fruits.

  • Peter

    7/14/2010 4:50:54 PM |

    Gary Taubes says Campbell's co-worker on the original study, Oxford professor of epidemiology and statistics Richard Peto also thought the data did not support Campbell's hypotheses.

  • Pallav

    7/14/2010 5:51:15 PM |

    Dr. Davis

    The way wheat is consumed  in the west is very different from the way it is consumed in the east(fermenting/sprouting/sourdough etc.).

    This post might be helpful to 300 million americans but mislead 4 billion asians.

    With due respect I'd suggest you consider the above before going all guns blazing against global wheat consumption.

  • Martin Levac

    7/14/2010 6:12:43 PM |

    But Pallav, how can the Chinese be mislead when it's the Chinese's own wheat consumption that is being looked at in The China Study?

    In reality, that study can only generate ideas, it can't test them. So even if it generates the idea that wheat is bad for humans, we must test that idea before it becomes the truth. As far as I know, Dr Davis did test this idea and came with the conclusion that it was the type of wheat that made the difference. Maybe the Chinese ate the bad wheat and that's why it shows up that way?

  • Anonymous

    7/14/2010 6:45:47 PM |

    Anonymous wrote: "What I'd like to know is how correlations > 1 and < -1 are being generated, since that's impossible."

    Denise says right in the post that she gave the numbers in percentage rather than decimals to make it easier to read. I.E. +33 = 33% = .33

  • Pallav

    7/14/2010 7:00:16 PM |

    Martin,
    The way Dr. Davis tested einkorn and wheat currently generally available in usa (http://heartscanblog.blogspot.com/2010/06/in-search-of-wheat-einkorn-and-blood.html) is probably is what brings real value to this blog.
    The subhead Europe:Sourdough bread http://wholehealthsource.blogspot.com/2010/06/fermented-grain-recipes-from-around.html is very close to how wheat is consumed in India. This process very likely breaksdown a large part of the offending ingredients such as gluten and phytic acid from a cursory search i did on google scholar.
    I would trust a test on this process by Dr. Davis than on statistics, which as you rightly said generate ideas but need testing.
    However, when Dr Davis goes on to implicate wheat in general for all sorts of diseases like in this blogpost, that applies to americans (the specific way of consuming wheat) and not necessarily to those who process grain differently like in asia.
    That is the point where things get icky and can be misleading for those consuming wheat in asia and reading such posts.
    Perhaps we can all come to a better way of processing grains than cutting them out from the diet altogether?

  • David M Gordon

    7/15/2010 11:23:28 AM |

    "a diet high in animal protein, especially casein"

    Quickly, briefly, because my story is only tangentially related to this post by means of Dr Davis's almost stray remark I quote above...

    I am ~5 weeks into my wheat free diet -- to zero success. I do not measure myself daily in any way, but the obvious one: do I lose weight? Yes, but only ~5lbs, which represents 2% of my total body weight. I should have lost that amount easily within 1 week, if I were proceeding on this diet correctly.

    And then the other stray remarks began to pile up:
    1) The 20 year old girl with celiac disease who dropped wheat AND 20lbs in 2 months. (What about me?!)
    2) The dinner at PF Changs. I ordered the chicken lettuce wraps and skip the rice noodle thingees. Good job, I thought. Then I lingered over the menu, saw the restaurant offers an entire page of gluten free items, and the dish I just ordered was not one of them. I called for the waiter. He explained the sauce...
    3) I drink protein shakes. A lot. As fate would have it, I migrated to casein protein because it broke down more slowly thus causing satiety to last longer. Until I read this post from Dr Davis with his stray remark, did my homework, and discovered to my chagrin that on a cellular level casein protein is so similar to gluten that it might as well be the same. (In essence.)

    Okay, lesson learned. This gluten free, wheat free, grain free, carb free diet is not as easy as it looks at first glance. There is way more to it than skipping bread, and pasta, etc. But now I think I have it. So Sunday is Day 1. Shame I lost those first 4 or 5 weeks, but this time...

  • Peter

    7/15/2010 12:23:12 PM |

    It may be true that wheat is a major cause of heart disease, but I'm not sure the high correspondence between wheat and cvd in this study makes that case.  Richard Peto, the Oxford professor of epidemiology who was part of the original study said what the data showed was that in places where people started adopting more of a western diet their health deteriorated.  I doubt the study spells out which parts of the western diet did the harm, wheat might be a marker for western diet.

  • lassen

    7/15/2010 9:52:47 PM |

    People feel threatened when facts are released that go against the standard, cultural beliefs. We are raised as children to eat animals and animal secretions and so it is understandable why so many people feel threatened when they find out that the food mama gave them is helping to promote heart disease, cancer, diabetes, obesity, autoimmune diseases, digestive disorders, etc. The China Study is the longest, most unbiased studies ever conducted and show statistically significant results, worldwide, that ingesting animal foods create chronic ill heath in humans. I have helped 400 people in the last 4 years to eat a healthy, low fat, plant based diet and they have all rid themselves of the diseases listed above. Now, I have also some Kaiser doctors who, instead of handing pills or surgery, are handing out this book and getting the same results. Thank you Dr. T. Colin Campbell for your 35 year long work. And, I know that you went into this study trying to prove the opposite results!
    When people hear that their upbringing needs to be challenge, they lash out with untruths….just as yound, 23 yr old Mindy has done.

  • lassen

    7/15/2010 9:53:10 PM |

    People feel threatened when facts are released that go against the standard, cultural beliefs. We are raised as children to eat animals and animal secretions and so it is understandable why so many people feel threatened when they find out that the food mama gave them is helping to promote heart disease, cancer, diabetes, obesity, autoimmune diseases, digestive disorders, etc. The China Study is the longest, most unbiased studies ever conducted and show statistically significant results, worldwide, that ingesting animal foods create chronic ill heath in humans. I have helped 400 people in the last 4 years to eat a healthy, low fat, plant based diet and they have all rid themselves of the diseases listed above. Now, I have also some Kaiser doctors who, instead of handing pills or surgery, are handing out this book and getting the same results. Thank you Dr. T. Colin Campbell for your 35 year long work. And, I know that you went into this study trying to prove the opposite results!
    When people hear that their upbringing needs to be challenge, they lash out with untruths….just as yound, 23 yr old Mindy has done.

  • Anne

    7/16/2010 3:22:40 AM |

    To David M Gordon - how much of the lettuce wraps did you eat. PF Changs has nutritional info on the website and says this dish has 4 servings of 5oz. Each serving is 11 carbs so if you ate the whole thing yourself, that was 44 carbs.

    It is very easy to underestimate carb counts. I have found a scale can be very useful. Mine measures carbs and other stuff.

  • David M Gordon

    7/16/2010 3:27:05 PM |

    That little dish is 4 servings?  C'mon! You bet, I bet I ate the whole thing, Anne. Smile

    What is in it that weighs so much? Some iceberg lettuce leaves, chicken, the rice noodle thingees I did without, and the sauce -- which is NOT gluten free, but I changed to a gluten free sauce. I bet that swap changes the calorie count etc. (Hey, I can hope! Smile

    Sure I want to lose weight -- okay, I must lose weight -- but my issue is visceral fat and its resulting potential problems: diabetes and heart issues (inflammation).

    Thank you for your comments.

  • MikeTee

    7/16/2010 5:26:31 PM |

    Instead of driving yourself with all these numbers why not just look for visable proof in REAL people.  I decided to try plant based eating and here is what happened:  (the numbers have actually gotten better since this was published last October)  Why I'm a believer in Dr. Campbell's advice:
    http://www.drmcdougall.com/stars/mike_teehan.htm

  • MikeTee

    7/16/2010 5:26:56 PM |

    Instead of driving yourself with all these numbers why not just look for visable proof in REAL people.  I decided to try plant based eating and here is what happened:  (the numbers have actually gotten better since this was published last October)  Why I'm a believer in Dr. Campbell's advice:
    http://www.drmcdougall.com/stars/mike_teehan.htm

  • Martin Levac

    7/17/2010 12:51:43 AM |

    Mike, good for you. See this:
    http://www.proteinpower.com/drmike/ketones-and-ketosis/low-carb-gaining-a-foothold-with-the-mainstream/

    If Campbell is right that a plant-based diet is best for most humans, why did the low carb group do better than the other two groups (Ornish and LEARN diets) in the intervention study above? Not only did the low carb group do better in weight loss, they did better in all things measured.

  • Anonymous

    7/17/2010 1:45:09 PM |

    Denise Minger wrote:

    "Here we have evidence that areas in China with the highest rates of Western-type diseases also eat the most processed starch and sugar. Maybe not in the grotesque amounts that Americans eat them, but then again, China’s “affluent disease” rates were also lower than America’s"

    This could easily be the headline "Minger accuses Americans of grotesque eating habits"

    Debate is good but be healthy, not paranoid
    Trevor

  • Anonymous

    7/22/2010 5:18:41 PM |

    How can anyone tell anyone else what to eat?  We all NEED plants to survive.  However, some do better with wheat in their diet and some do better with meat in their diet.  It all depends on the person.  I wouldn't go bashing The China Study until you try the whole foods plant-based diet.  Dr. Campbell also stresses that nutrition is NOT about a single nutrient or food group.  It's all about the synergy of everything working together.  I would love to see Denise's analysis of the aflatoxin rat studies.  Everyone needs to take control of their own health.  No one should rely solely on the china study as what they should do.  I personally believe in what the china study is saying, but it might not work for everyone - especially when people are raised to eat animal protein.  I know I have issues with animal protein, but others might be able to tolerate it.  Don't go bashing Dr. Campbell for trying to help people.

  • Bill

    7/22/2010 5:58:09 PM |

    Dr. Bill Misner Ph.D. said:
    The BMI body mass index of rural Chinese is 21.0 supported by a daily calorie intake of over 2600k/cal/day from largely plant foods.
    Americans on the other hand consume largely animal sourced foods of 1989 calories per day resulting in an obese BMI of over 27.0! All one has to do is compare the source of total calories with resulting BMI.

    Eating 2600 calories whole plant foods that contribute to a lean healthy BMI of 21.0 is preferred to eating 1989 calories from largely animal sources resulting in an obese 27.0 BMI.

    Elevated Body Mass Index associated with food category choice are also associated with the typical disease patterns in obese persons.  The China Study shows these numerical correlations precisely.

    I confirm the report that overweight exists more in cultures consuming largely animal source calories than in those whose diet is primarily whole plant foods.

    Interestingly, I have observed all of the above in Americans who change their menu from animal source to whole plant source food protocols.

    Warm regards,

    Bill Misner Ph.D.

  • Alex

    7/22/2010 11:31:11 PM |

    "I would love to see Denise's analysis of the aflatoxin rat studies."

    You can read an excellent analysis HERE. In a nutshell, what those rat studies prove is that complete protein provides better nourishment than incomplete protein. Wheat is naturally deficient in lysine, and when lysine was added to the wheat protein diet, it behaved just like the casein.

    Cancers are very fast growing cells, so of course they're going to grow a whole lot better if they're better nourished. I'd wager that if the rats had been fed a complete vegetable protein blend, e.g. rice and pea protein in the correct ratio, the tumor growth would have matched both the casein and wheat plus lysine.

  • Parag

    7/27/2010 12:07:56 PM |

    Friends,

      You don’t need to believe Dr. Campbell. Just read The China Study, slowly and completely, and figure out the truth for yourself. Facts speak for themselves.

      I, and a few of my acquaintances, tried a whole-foods plant-based diet (coupled with biweekly exposure to sunlight in noon and some physical activity) for a few months (strict compliance), and it is working wonders for us, so we continue to be on it. Some of my friends failed, because they were mostly eating junk (plant-based) foods.

      The China Study book is not just about Dr. Campbell’s work, but more than that it describes the work and results of numerous other research studies, independent and unbiased, that point to the undeniable benefits of a whole-foods plant-based diet.

      Denise has adopted a detailed but very narrow view that is insufficient to relate to the larger context. This approach will only add to confusion and misleading conclusions.

  • Anonymous

    7/29/2010 6:52:54 PM |

    As a physician with the health of your patients at stake, Would you accept conclusions that were not peer reviewed?

  • Jay

    9/3/2010 3:02:01 AM |

    Wonderful post... Very informational and educational as usual!

    Acai Berry Optimum

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Heart disease reversal a big "No No"

11. November 2007 William Davis (7)
I dare you: Ask your doctor whether coronary heart disease can be reversed.

My prediction is that the answer will be a flat "NO." Or, something like "rarely, in extraordinary cases," kind of like spontaneous cure of cancer.

There are indeed discussions that have developed over the years in the conventional scientific and medical literature about reversal of heart disease, like Dean Ornish's Lifestyle Heart Trial, the REVERSAL Trial of atorvastatin (Lipitor) and the ASTEROID Trial of rosuvastatin (Crestor). Reversal of atherosclerotic plaque in these trials tends to be small in scale and sporadic.

Of course, the medical literature is swamped with studies that have nothing to do with reversal, like what stent is best, what platelet-inhibiting intravenous drug is best, when should angioplasty or stents be used and when, do implantable defibrillators save lives, improvements in coronary bypass techniques, etc. There are tens of thousands of these studies for every study that focuses on the question of atherosclerotic plaque reversal.

The concept of reversal of heart disease has simply not gained a foothold in the lexicon nor in the thinking of practicing physicians. Heart disease is a relentlessly, unavoidably, and helplessly progressive disease in their way of thinking. Perhaps we can reduce the likelihood of cardiovascular events like heart attack and death with statin drugs and beta blockers. But reverse heart disease ? In your dreams!

We need to change this mentality. Heart disease is a reversible phenomenon. Atherosclerosis in other territories like the carotid arteries is also a reversible pheneomenon. Rather than throwing medicines and (ineffective) diets at you (like the ridiculous American Heart Association program), what if your doctor set out from the start not just to reduce events, but to purposefully reduce your heart's plaque? While it might not succeed in everyone, it would certainly change the focus dramatically.

After all, isn't this the theme followed in cancer treatment? If you had a tumor, isn't cure the goal? Would we accept an oncologist's advice to simply reduce the likelihood of death from cancer but ignore the idea of ridding yourself completely of the disease? I don't think so.

Then why accept "event reduction" as a goal in heart disease? We shouldn't have to. Heart disease reversal--elimination--should be the goal.

Demystification

11. November 2007 William Davis (2)
Once upon a time, remember how medical information was mysterious, hospitals were places where frightening, inscrutable things happened, diseases were strange maladies that struck without reason, and obtaining information about health was like hunting for buried treasure? The full extent of many peoples' understanding of health came through relatively anemic sources like Readers' Digest. (Remember "I am Joe's Colon"?)

Compare this to what we have now. If I wanted to obtain information about ankylosing spondylitis (a rare genetic disease of the spine), a Google search yields 1.46 million citations. Not all the information, of course, is helpful or relevant, but there's certain to be a bounty of information that far exceeds what you could have uncovered 40 years ago.




Suppose you enter the search phrase "antithrombin III" into your Google search. Citations: over 900,000. (The number of search citations, in fact, exceeds the number of Americans with a deficiency of this blood clotting protein!)

The same is true with heart disease. There was a time, not more than 30-40 years ago, when information about the heart and heart disease was hard to come by. The most you would find were superficial discussions about heart attacks, what chest pain means, descriptions of bypass surgery. Ask your doctor, you'd likely receive a brief, cursory response about how you probably shouldn't worry it.

Even during medical school in the 1980s, I remember struggling to get answers to my questions from faculty during medical school and medical training. It was as if providing too much information would eliminate the advantage superiors wielded over trainees.

The same selfish sentiment, the "I know something you don't know" mentality reminiscent of a schoolboy's "naa na na naa naa!" unfortunately persists. But it is rapidly disintegrating. Soon it will join the junk heap of medical mis-information accumulated over the years (a big pile, to be sure). The internet and, I'll admit (grudgingly), the media, have been responsible for demystifying the formerly mysterious and indecipherable world of health.

You now have, at a moment's disposal, access to an extraordinary array and breadth of health information that was inconceivable just a few years ago.

Times are changing. Doctors no longer hold the monopoly over health information. The public--YOU--are rapidly becoming the arbiters of health, the informed consumers of a soon-to-be retail product called health care, and the increasingly savvy judges of what should join the mainstream path of health. It is all part of this wave of change that I've been advocating: the emerging concept of self-empowerment in healthcare.

Added to the junk heap of health-mistakes-of-years-past will be medical protectionism over health information, heart procedures, drug industry excesses, nutritional mis-information, among others. The demystification of health information will open the floodgates of individual insight into health. It delivers control over your own health destiny straight into your own lap.

Everything has omega-3

8. November 2007 William Davis (5)
Walking the supermarket aisles, you may have lately noticed that numerous new products are appearing sporting "omega-3s" on the label.

Some products simply contain alpha-linolenic acid, a tiny amount of which is converted to the biologically active omega-3s, EPA and DHA. Natural Ovens' Brainy Bagel, for instance, carries a claim of "620 omega-3."



I find this confusing and misleading, since people will often interpret such a claim to mean that it contains 620 of EPA and DHA, similar to two capsules of standard fish oil (1000 mg capsules). Of course, it does NOT. I find this especially troublesome when people will actually stop or reduce their fish oil, since they've been misled into thinking that products like this bread contain active omega-3 fatty acids that yield all the benefits of the "real stuff."


Other products actually contain the omega-3, DHA, though usually in small quantities. Breyer's Smart with DHA is an example, with 32 mg DHA per container.


I find products with actual DHA (from algae) a more credible claim. However, the Center for Science in the Public Interest (CSPI) has looked at the actual contents of DHA in some of these products and found some discrepancies, including amounts of DHA less than the labeled amount and claims of omega-3 wihtout specifying DHA vs. linolenic acid. (It's probably linolenic acid, if it's not specified.)

All in all, the addition of DHA to food products is a nice way to boost your intake of this healthy omega-3. However, keep in mind that these are processed, often highly processed, foods and you will likely pay a premium for the little boost. For now, stick to fish oil, the real thing.

For a brief summary of the CSPI report and a link to the Nutrition Action Newsletter, see Omega-3 Madness: Fish Oil or Snake Oil.

Are cardiologists the enemy?

7. November 2007 William Davis (12)
I'm sitting at dinner with two colleagues. One is a cardiology colleague, another an internist who, in addition to practicing general internal medicine, also takes heart disease prevention very seriously. He has, in fact, participated in the Track Your Plaque program and dropped his heart scan score substantially.

"Why don't we see you in the cath lab much?" my cardiology colleague asked me. He was puzzled, since he knew my background in cath lab work from years before, spending day and night doing procedure after procedure. He spends virtually all his days there.

"Well, my patients simply don't have events any more. Heart attacks and angina among people in my program are just about non-existent. They don't have symptoms and they don't have to go to the hospital. I can't remember the last time that I was woken up in the middle of the night for an urgent procedure for one of my patients."

The internist across the table smiled and expressed his agreement. "That's the same thing I'm seeing: No heart attacks, very few if any referrals to cardiologists for procedures. I remember when it was a several times a week thing. Now, almost never. "

Looking at my cardiology colleague, I saw the usual cardiologist reaction: Eyes searching left and right and behind us for something more interesting. Certainly, talking about a virtual cure for coronary heart disease was just too damn dull.

Such is the attitude of 98% of my colleagues: If it doesn't generate a revenue-producing procedure, why bother? Prevention is for general practitioners, the line of thinking goes. "And anyway, I'm too busy doing procedures! I don't ahve time to talk about prevention and health!" Of course, the poor general practitioner is already overloaded with caring for arthritis, flu, diabetes and all the new drugs for diabetes, headaches, vaccinations, diarrhea, and . . .oh, yes, heart disease prevention.

Are cardiologists the enemy? No, of course they are are not. But they often act like they are. Talking to cardiologists is like going to the car dealer with your checkbook out, pen in hand. The salesman gets to write the check himself and you just sign it. Talk to a cardiologist and more often than not you will end up with a heart procedure--whether or not you need it.

Unfortunately--tragically--they often forget what they are supposed to be doing: Taking care of a disease by preventing it. Putting in a defibrillator is not preventing a disease. Putting in three stents, laser angioplasty, and thrombectomy are not ways of preventing a disease.

I'm thankful for my internist friend who sees the light. Coronary heart disease is a an easily measurable, quantifiable, preventable, and REVERSIBLE process for many, if not most, people when provided the right tools. But don't ask your neighborhood cardiologists to give you those tools.

Are CETP inhibitors kaput?

6. November 2007 William Davis (9)
Was torcetrapib’s crash and burn fatal for this class of drug?

At the 2007 American Heart Association meetings in Orlando, Florida, Dr. Philip Barter of Sydney, Australia, presented an update of the ILLUMINATE drug trial for the once-promising drug, torcetrapib, the billion-dollar bet that Pfizer made on its first entry into the new drug class.

You may recall that the crash and burn of Pfizer’s torcetrapib in December 2006 made headlines and prompted enormous disappointment for many patients and doctors who had hoped for a new drug choice to raise HDL cholesterol. Pfizer executives (heads flew!) and investors were also disappointed, anticipating release of a drug that might have become the number one biggest selling drug in the world—ever, surpassing even Lipitor's® $13 billion annual sales.

Torcetrapib is the first among the “cholesteryl-ester transfer protein inhibitors,” or CETP-inhibitors, drugs that block the exchange of cholesterol and triglycerides between HDL and VLDL particles and prevent formation of the unwanted small LDL particles. Preliminary efforts suggested that effects were positively enormous.

However, the 15,000-participant trial was abruptly terminated after 550 days when an excess of deaths were identified among the group taking the experimental drug: 59 deaths in control group; 93 deaths in the torcetrapib group.

In addition, cardiovascular events were 24% greater in the torcetrapib group, numbering 373 compared to 464 in the no-torcetrapib group, including a substantially greater number of heart attacks and hospitalizations. Another surprise came in the way of cause of death among some of the torcetrapib patients, with an excess of deaths due to cancers (twice as many in the torcetrapib group), strokes, and infections.

Why the divergence: enormous improvements in cholesterol values, yet increase in adverse effects including more heart attack? Deeper digging by the principal investigators uncovered unexpected distortions of electrolytes like sodium and potassium. They then re-analyzed blood samples from participants on both sides of the trial and discovered that participants taking torcetrapib experienced significant rise in the blood pressure hormone, aldosterone. This, they surmised, also likely accounted for the 4 mmHg average rise in blood pressure among those taking the experimental drug. (This is the same pathway blocked by blood pressure drugs like ACE inhibitors lisinopril and enalapril, ARBs like losartan.)

Simultaneously (what a coincidence!) with the torcetrapib data, investigators at competing drug manufacturer, Merck, reported encouraging data with their version of CETP inhibitor, anacetrapib. In a phase II FDA trial of 589 patients, anacetrapib reduced LDL-C levels by up to 40% and increased HDL-C up to 139%.


Spokesman Daniel Bloomfield, M.D., of Merck Research Laboratories reported that "The favorable lipid effects seen in this study with multiple doses of anacetrapib were significant, and confirm the continued evaluation of the clinical benefits of CETP inhibitors in the treatment of dyslipidemia." Quick to distinguish this drug from torcetrapib’s track record of dangerous effects on blood pressure, he added that "the decreased LDL-C concentrations, increased HDL-C concentrations and no demonstrable increase in blood pressure seen with anacetrapib are particularly encouraging results of this study."

However, the data reported only an 8 week expereince. Given the experience with torcetrapib, longer term data will obviously be required to assess safety. After Pfizer spent over $1 billion and sacrificed lives to obtain this experience, Merck will need to tread carefully.

It will clearly be many years before we have a confident answer on whether the CETP-inhibitor class of drugs will be a safe choice for correction of cholesterol abnormalities, especially low HDL. Are we helpless until then?

Though CETP inhibitors offer the potential for a one-stop opportunity to raise HDL substantially, there are still many strategies available to raise HDL.

Strategies that raise HDL and are available today include:
• Weight loss—to your ideal weight. A very effective strategy.
• Reduction in processed carbohydrates—like breads, pasta, cookies, pretzels, etc. Note that very low-fat diets reduce HDL. Often a huge effect.
• Fish oil—A small effect, more dramatic when triglycerides are high.
• Niacin—Vitamin B3, the best we have at present. Doses of 500-1500 mg per day raise HDL 20–50%; work with your doctor if you are contemplating niacin. We use this agent everyday and have had great success; good hydration is key to minimize the annoying “hot-flush” effect.
• Dark chocolate—40 grams, or about 2 inches square, a delicious way to squeeze out a little rise in HDL.
• Alcoholic beverages—Red wines are almost certainly the preferred route, rich in flavonoids.
• Exercise—HDL-raising effects vary, but can sometimes be as much as 10–20 mg.
• Other drugs—Though not commonly used for this effect, drugs like pioglitazone (for diabetes and pre-diabetes); fibrates (Tricor® or fenofibrate; Lopid® or gemfibrozil); and Pletal® or cilostazol are occasionally prescribed.
• Vitamin D—You won’t find validation of this effect in any scientific study, but our emerging experience in our heart disease reversal program is suggesting that this neglected nutrient can exert powerful HDL-raising effects. In fact, supplementing vitamin D has made my life much easier.


And, last I checked, none of these HDL-raising strategies are ever fatal.

Roto Rooter for plaque

4. November 2007 William Davis (4)



Joe, a machinist, was frightened and frustrated.

With a heart scan score of 1644 at age 61, his eyes bulged when I advised him that, if preventive efforts weren't instituted right away, his risk for heart attack was a high as 25% per year. Joe had "passed" a stress test, thus suggesting that, while coronary plaque was present--oodles of it, in fact--coronary blood flow was normal. Thus, there would be no benefit to inserting three stents, say, or a bypass operation.


(Illustration courtesy Wikipedia)

"I don't get it, doc. Why can't you just take it out? You know, like Roto-Rooter it out? Or give me something to dissolve it!"

Of course, if there were such a thing, I'd give it to him. But, of course, there is not. It doesn't mean that there haven't been efforts in this direction over the years. Among the various attempts made to "Roto-Rooter" atherosclerotic plaque have included:

Coronary endarterectomy
This is a drastic procedure rarely performed anymore but enjoyed some popularity in the 1980s and 1990s. Coronary endarterectomy was performed during coronary bypass surgery, but few thoracic surgeons performed it. Milwaukee's Dr. Dudley Johnson was the foremost practitioner of this procedure (retired a few years ago after his own bypass operation) with a mortality in excess of 25%. A very dangerous procedure, indeed. The technical hurdle, beyond the tedium and length of time required to remove plaque that had a tendency to fragment, was blood clot formation after tissue was exposed upon plaque removal. I saw many lengthy hospital stays and deaths following this procedure.

Coronary atherectomy
This is an angioplasty-type procedure that has gone through several variations over the years.

In the early 1990s, transluminal extraction atherectomy (TEC) was a technique involving low-rpm drill bits with a suction apparatus that was used to clear soft debris, usually from large coronary arteries or, more commonly, bypass grafts. Then came direction atherectomy, in which a steel housing contained a sharp drill bit that captured atherosclerotic plaque in an aperture along the housing length and stuffed it into a nosecone, retrieved once the device was removed.

Then came high-speed rotational atherectomy in which a diamond-tipped drill bit rotated up to 200,000 rpm and essentially pulverized plaque to flow downstream and, presumably, eventually captured by the liver for disposal. Rotational atherectomy is still in use on occasion. Laser angioplasty, usually using the excimer wavelength, vaporizes plaque. I did plenty of all of these back in the early and mid-1990s.

While all atherectomy procedures sound clever, they are all plagued by the same problem: vigorous return of plaque. Remove plaque, it grows back. There are few instances today in which atherectomy is still performed.

Chelation
This involves a metal-binding, or "chelating," agent like EDTA normally used in conventional practice for lead poisoning. Usually administered IV, some have also advocated oral use. People who use chelation also tend to believe in faith healing and other practices based on faith, not science. There is an international trial that is nearing completion that should provide the final word on whether there is any role to intravenous chelation.

There are numerous other oral treatments that claim a Roto-Rooter-like effect. Nattokinase, for example--an outright, unadulterated, and unqualified scam.

Unfortunately, the helpless, ignorant, and gullible are many. When frightened by the specter of heart disease, there are plenty of people who will willingly pay for the hope provided by clever ads, fast-talking salespeople, and unscrupulous practitioners.

So, Joe, there is no Roto-Rooter for coronary atherosclerotic plaque, at least one that is safe, doesn't involve a life-threatening effort, provides results that endure beyond a few months, and truly works.

The Track Your Plaque program may not be easy. There are obvious common hurdles to adhering to these concepts: obtaining lipoprotein testing, getting intelligent interepretation of the results, persuading your doctor to measure vitamin D blood levels, battling the onslaught of prevailing food propaganda that confuses and misleads. The Track Your Plaque program also requires time, at least a year.

But it's the best program there is. Do you know of anything better?

"Beware nutritional supplements"

4. November 2007 William Davis (0)


In our effort to expand the reach for the nationwide conversation on heart disease reversal, I'd like to welcome the newest contributor to the Track Your Plaque family, a new Member blogger, Heart Cipher.

We first came to appreciate the insights of Heart Cipher on our Member Forum. His curiousity and ability to cut through the bull--- have won over our hearts and minds. I think you will appreciate his unique perspective as someone who has experienced first hand the inadequacies of the present procedure-focused, drug-obsessed standard of medical care that dominates, yet has the intelligence and worldliness to recognize that there are better ways.

Read his post about meeting a new cardiologist for the first time and the reaction he receives when he describes the Track Your Plaque program here.

http://www.heartcipher.com/

The rules of reversal

4. November 2007 William Davis (12)

For the last few years, most practicing physicians have followed a rough blueprint for cholesterol management provided by the Adult Treatment Panel-III “consensus” guidelines, or ATP-III, a lengthy document last released in 2001, updated in 2004.

For instance, ATP-III suggests reducing LDL cholesterol to 100 mg/dl or less for those deemed to be at high risk for future heart disease, arbitrarily defined as a risk of 20% over a 10-year period. It also suggests that a desirable triglyceride level is no more than 150 mg/dl. The ATP-III guidelines have been the topic of discussion in thousands of medical meetings, editorials, and reports. They have served as the basis for many dinners at nice restaurants, weeks in Vegas or Honolulu, many, many lunches catered by pharmaceutical representatives. For most internists, family doctors, cardiologists, and lipid clinics, ATP-III is the Bible for cholesterol management.

AT-III has also become the de facto standard that could conceivably held up as the prevailing "standard of care" in a court of law in cases of presumed negligence to treat cholesterol values. “Doctor, would you agree that the consensus guidelines issued by the National Institutes of Health and endorsed by the American Heart Association state that LDL cholesterol should be reduced to 100? You do? Then why was Mr. Jones’ LDL not addressed according to these guidelines?”

Who was on the ATP-III panel and on what scientific evidence were the guidelines based? Several problems:

1) Of the 9 physician members of the panel, 8 had ties to industry, some of them quite intimate.

2) The studies upon which the guidelines were based and figure prominently, such as the Heart Protection Study, PROVE IT, and 4S, were all funded by the pharmaceutical industry. Of course, it would be unreasonable to expect anyone other than the pharmaceutical industry to fund drug studies. But prominently neglected or understated in the guidelines are all the other insights and treatments for coronary atherosclerotic risk available that were NOT funded by industry.

Of course, there’s money to be made in reducing LDL cholesterol. Lots of it--$23 billion last year alone, in fact. Just keeping that fact in mind makes the ATP-III guidelines make far better sense.

ATP-III is really not a blueprint for heart disease prevention. It is a blueprint--by industry, for industry--on how and when to treat LDL cholesterol.


But what if ATP-III had been a map for navigating coronary plaque reversal instead? What if it were not obsessed with just reducing LDL cholesterol, but was focused on providing the corner internist, family doctor, or cardiologist a roadmap for navigating the highways and byways of reversal?

That would be interesting. Mainstream reversal. Imagine that.

Among the difficulties is that the path to reversal is not lined with deep pockets. Treat LDL and who gains? That's easy. Reverse heart disease and who gains? Beyond LDL reduction, very few (beyond you and me, of course).

That’s why the call for a new Age of Self-Empowerment in healthcare is necessary now more than ever. In my view, in the foreseeable future, we will not have an ATP-III-like blueprint for heart disease control or reversal, nor will we witness a boom of nationwide appreciation that coronary atherosclerosis is a reversible process.

It’s time to take the control back and put it in our own hands. Don't expect the American Heart Association to do it. Don't expect the pharmaceutical industry to do it. If there's anyone who's going to do it, it's YOU.

Incurable wheataholics

2. November 2007 William Davis (22)
Greg slumped back in his chair.

"I'm sorry, doc. I feel like the world's biggest schlump!"

He was referring to the fact that he had gone wheat-free for two months--eliminated all breads, bagels, donuts, pasta, breakfast cereals, crackers, pretzels--and promptly lost 30 lbs. He felt great, discovered new levels of energy he thought he'd lost long ago.

Then some friends convinced him to have some cheeseburgers at a fast food restaurant.

"After that, it was downhill. I couldn't get enough. My wife made chile and I had to have four slices of bread with it. Then I'd have two more. I just couldn't stop."

Now, having regained the 30 lbs in the space of another two months, Greg was expressing his disgust.

And it's not the first time. Greg has struggled with his wheat-alholism for as long as I've known him. I've tried motivating him by showing him the flagrant lipoprotein patterns that his wheat habit and excess weight caused: markedly elevated LDL particle number, severe small LDL, low HDL, high triglycerides, high C-reactive protein, high blood sugar, high blood pressure. Greg has received a total of 7 stents over the past 5 years. His next stop is the operating room for a bypass if he can't bring his patterns and impulses under control.

But for some reason, Greg seems to always return to the wheat trough, gorging on breads, pretzels, cake, often in great quantities.

I'm not entirely sure what to do with someone with Greg's severe degree of wheat-aholism. I view wheat-aholism as similar to alcoholism. For some, it can be as addictive.

The only strategy that I know can work is to make a clean break and drop wheat products altogether. Just as an alcoholic cannot just satisfy him/herself with a drink or two a day, so a wheataholic can't be satified with just a couple of wheat crackers. It inevitably leads to the avalanche of wheat indulgences.

Perhaps we should form a new group: Wheataholics Anonymous. "Hi. My name is Greg and I'm a wheataholic."

The battle for asymptomatic disease

31. October 2007 William Davis (10)
The heart disease revenue pie is shrinking. So is the "serving size" being shared by competing hospitals.

In other words, as more hospitals open heart programs, there is more competition for the same heart patient. Throw into the mix the drop in "acute" presentations of disease, probably due to the now widespread prescribing of statin drugs. When I first started cardiology practice 15 years ago, for instance, days and nights spent taking care of heart attacks coming through the emergency room was a common event. It still happens, but far less frequently. (I don't mean to suggest that the actual prevalence of coronary heart disease has decreased, just the acute, catastrophic version of it.)

Throw into this mix the results of the COURAGE Trial that has put a damper on the value of stents and angioplasty vs. "optimal" medical therapy in people with stable anginal symptoms, since there was little advantage of procedures. Though it has not stopped the practice, it has reduced the enthusiasm for procedures. Though data are hard to come by, I've heard talk of 10% or greater drops in total procedural volume over the past year.

It's not uncommon for hospitals to have overbuilt heart facilities in anticipation of continued growth of this--until recently--growth industry called heart disease. However, factors are converging that may provide a new profit opportunity for hospitals.

One such opportunity is CT coronary angiography. The usual scenario: Man or woman without symptoms is persuaded somehow--an ad, primary care physician, next door neighbor with a scary event, Dr. Mehmet Oz gushing about this sexy new technology on yet another Oprah episode--to undergo a CT coronary angiogram. A "severe" blockage is found, despite the lack of symptoms, and voila! A stent patient or bypass patient is created out of nothing! Do this repeatedly and systematically, and a hospital can regain its former high-procedural volume glory.

Heart scans, though I believe deeply in them and they are the basis for the Track Your Plaque prevention and reversal program, can also be used and abused this way. Asymptomatic person has a score 150. Concerned, they go to their physician who orders a nuclear stress test. An "inferior perfusion defect" is seen, presumably representing poor flow through the right coronary artery (but often just means that the diaphragm overlaps the heart muscle and yields this apparition, a "false positive" or misleading result). "But--wink--we've got to find out if there's a severe blockage, don't we? You don't want to end up in an early grave!"

Thus, the battle for new patients with asymptomatic disease is getting underway in earnest. The scramble for cardiologists to learn how to use CT coronary angiograms is proceeding at breakneck speed, with new training courses being offered nationwide several times and places every month. CT coronary angiography is a useful test, but it is also subject to enormous abuse. It also provides the ticket for the unscrupulous physician and the revenue-hungry hospital eager to expand its patient volume.

Many people believe that this cannot happen commonly in 2007, given scrutiny of practices, litigiousness, and the expectation of a moral sense in medicine. However, I've witnessed such incidents several times this month alone. If you need graphic proof of just how far this can go before action is taken, read Coronary, Stephen Klaidman's chilling tale of a cardiologist and cardiothoracic surgeon in small-town northern California who built an enormous heart center based on fabricated heart disease diagnoses. You'll also find their story in Shannon Brownlee's recently released Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.





Of course, the Track Your Plaque program is meant principally for people without symptoms, also. But we are advocating that asymptomatic disease is a reason for prevention, not procedures. There's a difference.

By the way, the two practitioners who engineered the escapade detailed in these books, cardiologist Chae Hyun Moon and cardiac surgeon Fidel Realyvasquez, walked away with a monetary fine and suspension of their California medical licenses. It is likely that many people died because of their abusive practices, but the state struggled to make a sufficiently persuasive case for reasons that I still don't understand.