If you’ve watched the news over the past year, you know that doubt has been cast over the idea that reducing homocysteine blood levels with high doses of B vitamins (B6, B12, and folic acid, or B9) results in reduced risk for heart attack.

Is the homocysteine concept dead? Shall we empty our bottles of costly B vitamins into the trash and move on?

I don’t think so. As detailed in one of our Track Your Plaque Special Reports from a few months ago, I think the homocysteine issue still deserves lots of respect and further investigation. After all, hundreds of clinical studies have connected higher homocysteine levels with greater risk for heart disease, stroke, and aneurysm. Numerous studies, for example, have repeatedly and consistently demonstrated a tripling of heart attack risk when homocysteine levels exceed 14 ?mol/l. Can we dismiss this association because several more recent studies—NORVIT, HOPE, and VISP—suggested that, when starting homocysteine levels are 12.5, that B vitamin supplementation does not reduce heart attack risk?

I think there’s lots more to know about the homocysteine connection. That said, I have never seen a patient who I thought had heart disease strictly because homocysteine was increased.

I believe that we can at least use homocysteine as an index of lifestyle: the higher the homocysteine, the poorer the diet, or the less effective the absorption of B vitamins (especially vitamins B12 and folic acid). Homocysteine levels of <9 micromol/l suggest both adequate intake and absorption of these B vitamins.

If homocysteine is tightly connected with risk for heart disease, yet supplementation of B vitamins fails to reduce risk, might there be another means of connection? Or, could both homocysteine and heart disease be connected in some way that has nothing to do with B vitamins?

Don’t close the book on homocysteine. Just because conventional experience fails to draw connection does not necessarily mean that none exists. If it’s any consolation, taking B vitamins has been correlated with better memory, concentration, and other health benefits, even if no reduction in heart disease develops.

High heart scan scores of, say, greater than 1000 are more difficult to reduce than lower scores.

I learned this lesson early in the experience of trying to drop scores. In the first few years of trying to drop scores, I saw relatively modest scores of 20, 50, or 100 drop readily, even when the usual targets were not fully achieved, and even before the incorporation of some of the more exciting recent additions to the Track Your Plaque program, like vitamin D.

But big scores of 1000, 2000, or 3000 are a tougher nut to crack. In the first few years, what I usually saw was a slowing , or "deceleration," of growth from the expected rate of annual score increase of 30% that would continue for a year or two, followed by zero change. In the first year of effort, for example, a score increase of 18% was common. 10% was common in year two, then finally zero change in year three. Somehow, the more plaque you begin with, the more "momentum" in growth is present and the longer it takes to stop it. Kind of like stopping a compact car versus stopping a freight train.

But more recently, I'm seeing faster drops. Today, Charlie came to the office to discuss his second heart scan. 18 months earlier, Charlie's first scan showed a score of 3,112, high by anybody's standard.

His repeat score: 3,048. While the drop is relatively small on a percentage basis and may even fall within the expected rate of error for heart scans (which tends to be <2% at this high a score), I told Charlie that it still represented a huge success. Not only did he not increase his score by the expected 30% per year, he also brought a charging locomotive to a rapid stop.

Next year, Charlie is targeting a big drop. Given the tools he now has available, I'm optimistic that he will succeed.

Watch for the Track Your Plaque May, 2007 Newsletter in which we will detail Charlie's story further.

If you have a heart attack and land in the hospital where, invariably, you will have a heart procedure. Or, if you get a stent or coronary bypass operation, sometime before your discharge from the hospital, a well-meaning hospital staff dietitian will provide instruction in the American Heart Association (AHA) diet.

Does this diet reduce the risk of heart disease?

The answer depends on where you start. If you begin with a conventional American diet that is enormously influenced by convenience, food manufacturers like Nabisco, General Mills, Quaker Oats, ADM, and Cargill, or food distributors like McDonald’s, Pizza Hut, and Taco Bell, then the American Heart Association diet is indeed an improvement. But just a small one. If LDL cholesterol is the yardstick, the average reduction in LDL is between 10 and 15 mg/dl. This is the same amount of change you’d experience by adding 1 tablespoon of oat bran to your diet. Hardly worth boasting about. HDL, triglycerides, blood glucose, and body weight do not change.

The diet could be substantially better. After all, it’s become common knowledge that other diets, such as the so-called Mediterranean diet, the South Beach Diet, and similar broad projects result in far greater changes than the AHA diet dispensed by your hospital and cardiologist. These diets more effectively reduce LDL, raise HDL, reduce triglycerides, reduce C-reactive protein, reduce blood pressure. Diets like South Beach also yield substantial weight loss and reversal of diabetic tendencies, with the magnitude of benefit dependent on the amount of weight lost.

Why this stubborn adherence to the outdated concepts articulated in the AHA diet? Cardiologists would argue that insufficient data has been generated to permit widespread application of these diets. They also differ on whether they really work. Of course, the majority remain ignorant and dismiss them as fad diets.

A little digging into the financial disclosures of the AHA suggests another, more malignant influence: who is paying the bills? Until recently, drug manufacturers were major contributors to the AHA. However, more recently AHA administrators have become sensitive to the public perception that they might be nothing more than a voice box for the drug industry. They have since limited contributions from the drug companies to 8% of annual charitable revenues.

The drug manufacturers have been replaced by the food industry. In addition to food manufacturers that make the cereals on your grocery shelf, it includes the multi-national conglomerates that produce unimaginable revenues and carry enormous political clout, like ADM and Cargill. Ever wonder how it is that Honey Nut Cheerios received a “Heart Healthy” endorsement from the AHA?

The AHA diet does not provide the answers we’re looking for, not even close. It is a perversion from an organization that has its strings pulled by industry. The answers to health will not come from the AHA, AMA, the American College of Cardiology, the American Hospital Association, and it won’t come from your doctor. It won’t come from a titillating report on the evening news or Good Morning America. It will come from collective and expanding wisdom placed directly into the hands of the public. It will be untainted by the temptation of drug industry dollars. It will not be dirtied by million dollar contributions, or the multi-million dollar behind-closed-doors lobbying of the food manufacturers. It will come from the truth relayed to the healthcare-consuming public. I hope you recognize it when you see it.

If you want a healthy diet for your heart, throw away the pamphlets from the AHA unless you are partial to bread, breakfast cereals, corn, and the supporters of their misguided nutritional advice.

The vitamin K2 story, though still preliminary, is becoming increasingly interesting from the perspective of CT heart score reduction.

The origin of this concept came from some unexpected observations. One, the observation that osteoporosis (lack of bone calcium that leads to fractures) arises from deficiency of vitamin K2. Two, deficiency of K2 leads to unrestrained calcium deposition in animal models, leading to heart attack in just weeks.

Vitamin K2 has been largely ignored for years, since the more widely understood K1 is rarely deficient. K1 deficiency can occur from prolonged antibiotic use, or from severe malnutrition. But deficiency in otherwise well people is very uncommon. Vitamin K2, however, may be a different story. Deficiency may be common.

The Rotterdam Heart Study of cheese-eating Dutch showed that greater K2 intakes resulted in a halving of heart attacks. Cheese (traditional varieties, not Velveeta or other make-believe cheese products) is a modest source of K2, as is the Japanese native food, natto. (If you've ever seen natto, I dare you to eat it. I have a pretty strong stomach and curiousity for food, but natto is the one thing I could not eat--it is truly horrible.)

The weight of evidence suggests that vitamin K2 supplementation may prove to be a useful addition to your coronary plaque control program. Clearly, more data are needed, particulary therapeutic obserations, i.e., observing people who take dose X of a K2 prepartion and tracking some feedback measure, e.g., bone density, CT heart scan score, "events" like heart attack, etc.

Nonetheless, the K2 story is clearly worth reading about, perhaps even considering supplementation. Please watch for the Special Report on the www.cureality.com website in the coming days.

The media has gotten a hold of a case report from the University of Maryland describing a 51-year old physician who, despite being a long distance runner, had a high heart scan score.

An example of the report can be found at

Heart Disease In A Marathon Runner: Is Too Much Exercise A Bad Thing?

http://www.sciencedaily.com/releases/2007/03/070315091100.htm in Science Daily.

"The mystery was all the more intriguing because his resting blood pressure and fasting cholesterol levels, the usual measures of cardiovascular health, were in the normal range."

When this man was put on a treadmill for a stress test, his blood pressure skyrocketed from a normal 118/78 to 230/78--extremely high, even for exercise. The physicians reporting the case raised the question of whether long-distance running represents a risk for heart disease and if the high blood pressure with exercise is a contributor or cause of the high heart scan score.

These are phenomena we are very familiar with. We have stressed the importance of exercise blood pressure as a trigger for coronary plaque for years. While 230/78 is clearly too high, we find that any blood pressure over 170/80 with exercise adds to the fire and can trigger plaque growth.

However, I think it is absurd to suggest that marathon running itself is a trigger of coronary plaque. I think it is far more likely that the person described in the report had lipoprotein(a), a potent trigger for both exercise-induced hypertension and high CT heart scan scores in seemingly well people. He likely also suffered from a deficiency of vitamin D deficiency, another contributor. There's no need to indict exercise.

If you are in the Track Your Plaque program, you know that stress tests are of questionable helpfulness for the detection of hidden heart disease. But they are useful for assessment of blood pressure responses during exercise. If BP exceeds 170/80 at 10 mets (a measure of exercise effort achieved by walking 3.4 mph at a 14% grade for 3 minutes), then blood pressure may be a contributor to your heart scan score.

"Fish oil is a waste of time and money. It's stupid. Just stop it."

So a patient of mine was advised by another physician when he complained that he occasionally experienced a fishy aftertaste.

This attitude perplexes me. After all the confirmatory data that support the enormous health benefits of omega-3 fatty acid supplementation, including the 11,000 participant GISSI-Prevenzione Trial, you'd think this attitude would be history. What's a little fish aftertaste when heart attack risk is slashed 28%?

Perhaps the tendency to pooh-pooh fish oil is because it's available as a nutritional supplement. This shouldn't make fish oil appear inconsequential. Far from it.

If you witness the extraordinary power for fish oil to reduce triglycerides, you will be immediately convinced of its effectiveness. The ability of omega-3 fatty acids from fish to eliminate intermediate-density lipoprotein (IDL), the persistent abnormal lipoprotein which signals an inability to clear dietary fats from the blood, can also convince you. More than 90% of people with excessive IDL have it completely eliminated by 4000-6000 mg of fish oil (providing 1200-1800 mg EPA + DHA) per day.

The fact that fish oil is available as a prescription "medication," as well as an over-the-counter supplement, causes some physicians to dismiss the power of the supplemental form. This is nonsense. The over-the-counter form is every bit as effective as the prescription form.

The makers of prescription Omacor also make the claim that their preparation is safer and purer. That may be true, but I'd like to see independent verification from the FDA, USDA, or an unbiased organization like Consumer Reports before I accept their marketing as fact--particularly at $120 to $240 per month! If Omacor proves to contain substantially less mercury and pesticide residues, then that will need to be factored in. (Please note that both Consumer Reports and Consumer Labs measured no substantial mercury or pesticide residues in their analyses of 16 and 41 brands, respectively.)

I try to persuade my colleagues that the idea of taking supplements is a wonderful trend that allows people to express ownership of their own health. What people need is guidance, not salesmanship for a more expensive version, nor dismissal of nutritional preparations that actually possess considerable benefits.

I’m seeing more and more of it and I am convinced that there is a relationship: significant boosts in HDL cholesterol from vitamin D supplementation.

To my knowledge this remains an undescribed and uncharacterized phenomenon. There have been several observers over the last two decades who have noticed that total cholesterol shows a seasonal fluctuation: cholesterol goes up in fall and winter, down in spring and summer; year in, year out. This phenomenon was unexplained but makes perfect sense if you factor in vitamin D fluctuations from sun exposure.

I have come across no other substantiating evidence about fluctuations of HDL. But I am convinced that I am seeing it. Replace vitamin D to a blood level of 50 ng/ml, and HDL goes up if it is low to begin with. If HDL is high to begin with, say, 63 mg/dl, it doesn’t seem to change.

But, say, starting HDL is 36 mg/dl. You take niacin, 1000 mg; reduce high-glycemic index foods like breakfast cereals, breads, cookies, bagels, and other processed carbohydrate foods; exercise four days a week; add a glass of red wine a day; even add 2 oz of dark chocolate. You shed 15 lbs towards your ideal weight. After 6 months, HDL: 46 mg/dl. Better but hardly great.

Add vitamin D at a dose of, say, 4000-6000 units per day (oil-based gelcap, of course!), and re-check HDL two or three months later: 65 mg/dl.

I’ve seen it happen over and over. It doens't occur in everybody but occurs with such frequency that it’s hard to ignore or attribute to something else. What I’m not clear about is whether this effect only occurs in the presence of the other strategies we use to raise HDL, a “facilitating” effect, or whether this is an independent benefit of HDL that would occur regardless of whatever else you do. Time will help clarify.

We are tracking our experience to see if it holds up, how, and to what degree on a more formal basis. Until then, a rising HDL is yet another reason—-among many!-—to be absolutely certain your 25-OH-vitamin D3 level is at 50 ng/ml or greater.

How high is an ideal vitamin D blood level? If 50 ng is good, is 60 or 70 ng even better? Probably not, but there are no data. We have to wait and see. Unlike a drug that enjoys plentiful “dose-response” data, there are no such observations for vitamin D into this higher, though still “physiologic,” range.

How long can an industry built on ignorance and deception continue its practices in the new Information Age?

I don’t think it can for long. I talk to hospital administrators who believe that their source of competition is the hospital across town, battling for the same patients. I speak to my colleagues, the cardiologists, who believe that the current model is sustainable—take every willing body to the catheterization laboratory or operating room for heart procedures, the revenue-generating engine of income and expanding heart programs.

I speak to primary care physicians, who are dumbfounded and perplexed and have no idea which way things are going. They are trapped in a peculiar position: most have signed contracts and are employees of the hospital. They are legally bound to support the cardiologists who take anybody possible to the catheterization laboratory or direct patients to other profit-making procedures.

Much of this system depends on the willingness of the participant, meaning you and the health care seeking public. What happens when the truth comes out and disseminates widely through the thinking populace? What happens to hospitals and physicians and the vast structures they’ve built when the bottom drops out for 50% of their “market?

The proverbial cow manure will hit the fan. Upheavals in the medical industry will rival the changes that the automobile or telephone brought early in the last century. Cardiologists, immense hospital heart programs, and the vast economic infrastructure they spawned will go the way of stage coach manufacturers and the telegraph.

What form will the broad exposure of detailed information in health take? I’m not sure, but it will certainly come. The collaborative efforts that created the Linux operating system and have challenged the monopoly of Microsoft Windows, or the emergence of the extraordinary Wikipedia as a repository of human knowledge that dwarfs the venerated Encylopedia Brittanica, will eventually overtake the American medical system, the heart disease industry in particular.

If you base your future on the welfare of your local hospital or the manufacturers of stents, operating room equipment for heart bypass, or similar industries, watch out. The ice is thin. And as the spring warms the air around you, it gets thinner.

The Track Your Plaque program is our first step in broadcasting the message of self-empowerment in heart health care and an attempt to wrestle control away from the profit-seeking forces that dominate. As we grow, we not only hope to broadcast the message more widely, but expand the message to other areas of health. I predict that the collaborative, let’s-all-pitch-in-and-help spirit of the Information Age, “version 2.0,” will spark the change.

Although this is a Blog about heart scans and heart disease, I came across a helpful video from Dr. Joseph Mercola about vitamin D and cancer that's worth viewing. Though I do not agree with many of Dr. Mercola's on-the-edge views, he does come up with some good thoughts and, in this instance, a useful educational tool about vitamin D.

You can view his video (which he claims crashed his server, due to the excessive demand for downloads) by cutting and pasting the address into your URL bar (above):

http://v.mercola.com/blogs/public_blog/How-to-Reduce-Your-Risk-of-Cancer-By-50--8790.aspx

Also, for my many patients who I've directed to look in my Blog for Dr. Reinhold Vieth's webcast presentation on vitamin D, here's the address:

http://tinyurl.com/f93vl

Perhaps I carry on too much about vitamin D. But I've come to respect this "nutrient" as among the most powerful strategies I've seen for dramatically improving control over coronary plaque growth as well as other aspects of health, as Drs. Mercola and Vieth eloquently detail.

Lipoprotein(a) is a curious lipoprotein. Not only is it a genetic pattern with numerous variations, it is also one that shows a predictable age-dependent rise.

Women in particular are prone to this effect, men to a lesser degree. As we age, many hormones recede, particularly growth hormone, testosterone, the estrogens (estradiol, estriol, estrone), progesterone, and DHEA, among others. This is not a disease but the process of senescence, or aging.

When we're young, estrogens, testosterone, and DHEA all exert suppressive effects to keep lipoprotein(a), Lp(a), at bay. But as a woman proceeds through her pre-menopausal and menopausal years, and as a male passes through his fourth decade, there is an accelerated decline of these hormones. As a result, Lp(a) crawls out of its cave and starts to sniff around.

Typically, a woman might have a Lp(a) of 75 nmol/l (approximately 30 mg/dl) at age 38. Ten years later, at age 48, her Lp(a) might be 125 nmol/l (app. 50 mg/dl), all due to the decline of estrogens and DHEA. A parallel situation develops in males due to the drop in testosterone. For this reason, it may be necessary to re-check Lp(a) once after the fourth decade of life if you've had a level checked in your younger years.

This opens up some interesting therapeutic possibilities. If receding hormones are responsible for unleashing Lp(a), hormones can be replenished to reduce it. In males, this is relatively straightforward: supplement human testosterone and Lp(a) drops about 25%.

In women, however, it's a bit murkier, thanks to the negative experince reported using horse estrogens (AKA Premarin) in the HERS Trial and Women's Health Initiative. You'll recall that women who take horse estrogens and progestins (synthetic progesterone) do not experience less heart attack and develop a slightly increased risk of endometrial and breast cancer. There was, however, a poorly-publicized sub-study that showed that women with Lp(a) experience up to 50% fewer heart attacks on the horse/synthetic combination.

Wouldn't it be nice to have a large trial examining the safety/advisability of human estrogens and progesterone? To my knowledge, no such confident study in a significant number of women exists, since there's so little money to be made with human hormonal preparations.

For these reasons, we use lots of DHEA, generally at doses of 25 to 50 mg per day. It makes most people feel good, boosts energy modestly, increases muscle, and reduces Lp(a) up to 18% in women, a lesser quantity in men.

NY Times' health columnist, Jane Brody, recently wrote a bit of fluff for her paper:

"CT Scans of the Heart Come With Trade-Offs

In her report, she says:

Coronary CT scans are being sold directly to the public, and they have found a market in health-conscious people who can afford them. But screening exams can have downsides. They can cause needless worry, and they sometimes reveal other potential conditions that require invasive procedures like biopsies to diagnose.

I soon learned that among the strongest proponents of CT scans of coronary arteries were physicians with financial ties to drug companies that make statins and others connected to imaging centers that would profit directly from widespread CT screenings.

She then goes on to discuss how the Framingham scoring calculation can tell you whether or not you are at low-, intermediate-, or high-risk for heart disease. She therefore concludes that heart scans are therefore irrelevant for the majority of people. She then proceeds to take a statin agent.

This sort of nonsense continues to get published, despite the clear lack of real "digging" for the truth. She clearly fell for the conventional arguments that continue to mis-guide the majority of people, myths like:

--the Framingham scoring system is reliable--Reliable it is NOT; it is susceptible to substantial "misclassification" bias, meaning people who appear low risk can actually be high risk, and people at high risk can actually be low risk. Among the latest studies that question the scoring system is Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). This study pointed out how the Framingham scoring system, which leaves out family history, can cause people classified as low risk to actually have substantial heart scan scores. This is crucial. A heart scan gets beyond the uncertainties and shows with >95% certainty whether or not hidden coronary atherosclerotic plaque is present.

--"Coronary risk" is a dynammic phenomenon, subject to changes in a person's life. What if, for instance, a person smoked for 20 years, quit 10 years ago, lost 30 lbs, dropped their blood pressure as a result of the weight loss, then relied on the Framingham Risk Calculator to determine risk. They would likely be classified as low- risk, since risk factors now appear favorable. This person could easily have a heart scan score of 500, or 700, or 1000, levels that carry a cardiovascular event risk of 5-25% per year, hardly low-risk, because much of their risk accumulated earlier in life and is no longer revealed by an assessment of risk factors.

--There are sources of risk that have nothing to do with Framingham, such as lipoprotein(a), which is often revealed by family history; the presence of small LDL, which co-varies with HDL and triglycerides, but can behave independently also; and, my favorite, deficiency of vitamin D. This would explain part of the 60-70% of people who are typically mis-classified by Framingham.

Where did Ms. Brody get the idea that proponents of heart scans had ties to drug companies? I think she's barking up the wrong tree on that one. Of course, she ends up on a statin drug. For my part, I am a critic of statin drugs. Yes, they play a role, but they are miserably misused and abused by practicing physicians, based on the endless onslaught of drug company-sponsored trials that have served to distort their usefulness.

If I were Ms. Brody, I would be quaking in my shoes, not knowing what my true risk for heart disease was, relying on the--at best--30% reduction in heart attack risk of Lipitor or other statin drug. Ms. Brody: You are not cured, you're simply wearing a superficial Band-Aid. If you want to know your true risk for heart attack, and you want a precise value that you can track over time, the answer is simple: Reject the conventional notion and get a heart scan.

Neal is our current male record holder for greatest reduction in heart scan score. (Yes, the ladies have the lead!)

You may remember that this 40-year old man reduced his heart scan score from 339 to 161--a 51% drop. If you haven't yet read his story, go to

http://www.cureality.com/library/fl_07-001nealt51.asp

Neal reminded me of the experience he had when he underwent his second heart scan. Both scans had been performed at the same scanning center. At this center, the radiologists provide the added service of sitting down with people and actually going over the images and results.

After the scan, the radiologist pulled up the result from Neal's first scan for comparison. "There must be a mistake! This score is lower. Scores never drop."

The radiologist was apparently stumped, unable to provide an explanation. However, Neal then proceeded to tell the radiologist that we had warned Neal that this could happen and that he might even be told that it was due to error of some sort. This yielded a puzzled look on the radiologist but no further comment.

Of course it's not a mistake. It's something we achieve on purpose. Curiously, I still get comments that this is impossible, heart scan scores never drop, etc. Of course, those of you following this conversation know this is completely untrue. Heart scan scores DO drop, and sometimes drop enormous amounts, as it did for Neal.

I would have liked the radiologist to have had the lightbulb of understanding go off in his head when he realized that a reduction in heart scan score is a cause for celebration. Unfortunately, this radiologist's reaction is all too common: disbelief, confusion, dismissal.

Heart disease reversal is simply not in the realm of understanding of most doctors, radiologists and cardiologists alike. By conventional thought, if you have it, it just gets worse. "Maybe some high-dose Lipitor might help."

Ironically, when they see it right in front of their eyes, plain as day on the computer screen, they don't understand what has happened. It's Greek to them.

Should this happen to you, don't be surprised. Just bite your tongue, because you know better.

Enter "weight loss" or "low carb" in your web search and you can't help but stumble across the prolific and widely-connected Jimmy Moore.

On his Blog, Livin' la Vida Lo Carb , Jimmy conducts a wide-ranging and informative discussion of the benefits of a low carbohydrate diet, a la Atkins. Though his initial claim to fame was the 180 lbs he lost in his first year of dieting on this approach, Jimmy has extended the conversation and built a considerable community of like-minded individuals, all of whom are participating in this grand "experiment."

Anybody who looks at lipoproteins and associated factors in health will quickly come to the conclusion that processed carbohydrates are the culprits in much of heart disease, diabetes, and heart disease. But I have had a hard time dismissing the ill-effects of saturated fat. After all, we've all been taught--drilled--with the idea that saturated fats cause LDL cholesterol to go higher, cause arterial constriction, growth of atherosclerotic plaque, inflammation, even cancer.

But there does indeed seem to be a growing sentinment that this long-held dogma may not be true. So I went to the ever-entertaining and informative Jimmy Moore, an able spokesman for these concepts.

TYP: It's certainly impossible to argue with the success you had in weight loss and the health you've regained on your program.

I think that the approach we use in diet in the Track Your Plaque program and the nutrition approach you advocate overlap to a great extent. We both emphasize plenty of vegetables, fruits, healthy oils, nuts, etc. The major point of difference seems to lie in saturated fat: We say restrict it, you say don't restrict it. Could you elaborate?

JM: Thank you for inviting me to your blog today, Dr. Davis. I have nothing but deep respect and admiration for the work you are doing to help educate others about how to keep their heart health in tip-top shape. Keep fighting the good fight, my friend.

While we do agree on probably 99% of the basic tenets of what I describe as
"livin' la vida low-carb," the issue of saturated fat to me is one where we
indeed do not. It's not a deal breaker regarding my support for what you do
just as I'm sure you would say the same regarding your backing of what I do. If
we all agreed on everything, then what a boring world this would be!

My thinking on saturated fat has evolved since I started eating this way nearly
four years ago. Like most people, I was terrified to eat ANY fat at all because
of the abject fear that people like Dr. Dean Ornish and other so-called health
"experts" instilled in me about how dangerously unhealthy it is to consume it.
This fat phobia is arguably the single biggest contributor to the ongoing
obesity crisis our world faces today.

With that said, you and I both know fat consumption is a part of a healthy
lifestyle. There are just too many benefits to the body that come from the
consumption of fats and even saturated fats such as coconut oil, butter, lard,
nuts, seeds, and animal fat when it is combined with a restricted carbohydrate
intake.

An intriguing study was presented at a scientific conference in November 2006 by two highly-respected researchers--Dr. Stephen Phinney from the University of California at Davis and Dr. Jeff Volek from the University of Connecticut--who conducted a side-by-side comparison of the amount of saturated fat in the blood of people on a low-carb diet with those following those highly-touted low-fat diets. What they found was the low-carb study participants had "significantly less" saturated fat in their blood than the low-fatties did.

Here are the actual numbers from the study:

- LOW-FAT/HIGH-CARB DIETERS: lowered saturated fat by 24%
- LOW-CARB/HIGH-FAT DIETERS: lowered saturated fat by 57%
- Eating 3X the saturated fat cut the amount in the blood in half

In an interview I conducted at my blog with Dr. Volek last year (here's the
link: http://livinlavidalocarb.blogspot.com/2006/09/volek-high-carb-low-fat-diet-useless-to.html),
he said the conventional wisdom regarding fat, especially saturate fat, is dead
wrong while the significance of carbs is all but ignored by those who claim to
understand the metabolic response mechanism.

Here's what Dr. Volek said in my interview:

"Eating fat does not make you fat, storing fat makes you fat. And carbohydrates play a major role in storing fat. So the level of dietary carbohydrate is really the most important factor to control because it dictates what happens to fat. Carbs are dominant and fat is passive. When carbohydrates are low, fat tends to be burned, and when carbohydrates are high dietary fat tends to be stored. The same holds true for the atherogenic effects of saturated fat. The body handles saturated fat better when carbohydrates are low."

Long-time low-carb practitioner and current President of the American Society of Bariatric Physicians (ASBP) Dr. Mary C. Vernon from Lawrence, Kansas confirms the findings of Dr. Volek and Dr. Phinney in a succinct recap of what their research showed.

Here's what she said:

"Eating fat (whatever kind) does not make you fat. It does not increase blood
stream saturated fat. Eating carbs does make you fat. Eating carbs does put
saturated fat in your blood stream."

To me, as a simple layperson with no medical background, it's all a matter of who you believe. Do we continue to buy into the low-fat propaganda machine and assume that what they are telling us about saturated fat is true? Or do we instead start paying closer attention to the latest research that is coming out about saturated fat that doesn't exactly line up with the edicts of the last three decades? The choice for me is a simple one.

And if you haven't read the brand new Gary Taubes book entitled GOOD CALORIES, BAD CALORIES yet, then it is REQUIRED reading to arm yourself with the research studies about fat. After you read that book, it will be almost impossible for ANYONE to believe fat, including saturated fat, is unhealthy.

TYP: In our program, we advocate a wheat-free approach for many people, because of the addictive potential of wheat products, as well as the flagrant creation of the small LDL pattern that wheat products create, thereby adding to atherosclerotic plaque growth. However, many people express a concern over a lack of fiber in their diets if they eliminate whole wheat bread, pasta, Fiber One, Raisin Bran cereal, etc.

Have you encountered any phenomena of low-fiber on your approach?

JM: What an excellent question and I even wrote a humorous blog post about the importance of fiber intake called "Allow Your Bowel To Shake, Rattle, And Roll" (http://livinlavidalocarb.blogspot.com/2006/06/allow-your-bowel-to-shake-rattle-and.html).

Fiber consumption is another one of those issues that not everyone who advocates
a controlled-carb approach agrees is necessary. I'm on the side that it IS a healthy part of your diet and should be consumed in high enough quantities to keep you regular...something many people think is impossible on a low-carb diet.
Not true! I take a fiber supplement like FiberCon, eat plenty of high-fiber vegetables, drink lots of water, and even consume high-fiber, low-carb products that help me maintain high levels of fiber in my diet (see my favorite ones in this post: http://livinlavidalocarb.blogspot.com/2007/04/there-are-plenty-of-low-carb-fiber.html).

As for consuming the highly-touted "healthy whole grain" cereals that you
mentioned, what a travesty that would be for people trying to manage their
weight and health. While the cereal manufacturers have had a heyday in their
marketing efforts promoting their whole grain content, it's all just a big fat
ruse on the public trying to convince them that these cereals are somehow healthy for their bodies. Sure, they're better than the sugary cereals, but all those grains are metabolized as sugar inside the body, so you might as well be eating Lucky Charms and Fruit Loops!

Many of these "healthy" cereals contain as many carbohydrates in a single bowl
without the milk as I would eat in an entire day. Raisin Bran, for example, which used to be my favorite cereal before my low-carb lifestye, has a whopping 47 grams of carbohydrates. Needless to say, I don't touch that with a ten-foot pole nowadays because I would surely gain weight and get back on the blood sugar rollercoaster ride that I was on prior to beginning the Atkins diet on January 1, 2004. Plus, all those carbs just make you hungrier sooner, so it's better just to eat some delicious eggs cooked in butter, a couple of slices of sausage, and tomato slices to start your day off right. You'll get enough fiber in your body the rest of your day.

TYP: 180 lbs of weight loss in your first year is absolutely astounding.

I take it that you've continued this trend and have lost more weight since your early success. What role did exercise play during your first year and subsequently?
How are your food choices today different from that first year?

JM: Yes, that weight loss was indeed one of the greatest accomplishments I have ever experienced in my life. It was a hard-fought battle that even included a 10-week period where I was stalled with no weight loss. But I knew my chosen diet was the right one for me because I felt better than I ever had on a diet, was never hungry because I ate every 2-3 hours, and could see myself doing this for the rest of my life. So far, so good!

It has been close to four years since I began this journey and I am indeed continuing this pathway to better health. My low weight in 2004 was 230 pounds and I currently weigh 225 pounds. As long as I keep my carbs reduced, I am able to maintain my weight right where it is. I've had minor fluctuations in both directions where I got down to as low as 215 pounds at one point (but didn't feel good at that weight) and as high as 252 pounds (when I was allowing myself one too many high-carb foods here and there).

There's a balance that people need to find for themselves and it's different for
all of us. I am one of the unlucky people who has to keep his carbohydrate
intake below 50g daily or I gain. It's just a fact of life that I've come to
grips with and realize is a necessity in order to manage my weight for the rest
of my life. But I wouldn't have it any other way!

Exercise was indeed a part of my low-carb weight loss success in 2004 as I
forced myself to do cardio every single day as a commitment to this journey. In
hindsight, that was probably not the best thing for me to do since the body has
a rather peculiar way of telling you it needs to wiggle and move spontaneously
on its own rather than forcing the issue. But I consider the exercise I did to
be such an integral part of my success that I dedicated an entire chapter of my
book to the subject.

Today, my daily cardio routine is out the window and I choose instead to engage
in activities outside the gym that let me burn calories and have some fun in the
process. I regularly play volleyball, basketball, and referee flag football at
my church which all give me quite a workout. I'm very physically active and fit
on my 6'3" body and just enjoy burning off all this excess energy that I have
been given since losing nearly have my weight! I do want to get into a little
more organized resistance training routine soon to try to shape and tone some
areas of my body that still show signs of that 410-pound man I used to be
(although the loose, hanging skin in my abdomen and inner thighs isn't going to
get any better with exercise since the elasticity has been ruined from being
stretched out so far). Here is a link to some posts and pictures I have written
about this subject:
http://lowcarblinks.blogspot.com/2007/04/theme-based-low-carb-links-loose-skin.html

As for my food choices today compared to my weight loss year in 2004, they
haven't really changed a whole lot. This was a lifestyle change in every sense
of the phrase and I've learned to implement this way of eating into a permanent
and healthy diet that I can and will gladly live with forever and ever amen. I
probably eat more berries, melons, and nuts today than I did then, but otherwise
it's the identical diet.

TYP: I'm sure that you are as impressed as I am that much of the wisdom in healthy eating doesn't always come from doctors or clinical studies, but from the collective wisdom that emerges from this national experiment (inadvertent, for the most part) in eating. Your Livin' La Vida Low-Carb is, in my view, a perfect example of the sort of wisdom that is helping all of us understand what happened to our health over the last 20 years.

Does the approach you advocate today differ in any substantial way from the diet as originally articulated by Dr. Atkins?

JM: Actually, my personal diet is precisely based on the teaching of the late great Dr. Robert C. Atkins in his classic bestseller DR. ATKINS' NEW DIET REVOLUTION (DANDR) book. But most people are surprised when they learn I do not necessarily advocate the Atkins diet as the nutritional approach for everyone.

Nope, I sure don't!

Instead, my philosophy is simple: Find the diet plan that will work for YOU, read and research everything you can about that chosen plan, follow that plan exactly as prescribed by the author of that book, and then KEEP doing that plan for the rest of your life. If you do that, then there's no reason why you can't succeed just like I did.

Anyone interested in doing the low-carb lifestyle and needs help finding which
plan is right for them, let me HIGHLY encourage you to pick up a copy of Dr. Jonny Bowden's LIVING THE LOW-CARB LIFE (read my review: http://livinlavidalocarb.blogspot.com/2005/05/must-have-book-for-everybody-doing-low.html).
It's the perfect overview of low-carb living with a comparison and recap of the
major plans.

THANK YOU again for allowing me to share my story with you and your readers, Dr.
Davis!

TYP: And thanks to you, Jimmy!

For more on Jimmy Moore's lively and informative discussion of these issues, go to

Livin' la Vida Lo Carb

Also, watch "Livin' La Vida Low-Carb on YouTube"

Join the conversation at Jimmy's new low-carb forum called "Livin' La Vida
Low-Carb Discussion" at LowCarbDiscussion.com

Also, Jimmy's 2005 book on his weight loss experience:
"Livin' La Vida Low-Carb: My Journey From Flabby Fat To
Sensationally Skinny In One Year"

Some people have called CT heart scans the "mammogram of the heart." The analogy contains a lot of wisdom.

First of all, both--mammograms and CT heart scans--are screening tests, one for cancer, of course, the other for coronary atherosclerotic plaque. Both are performed in specific age groups, mammograms in women 40 years and over (generally), heart scans in women 50 years and over (generally).

Mammograms: Left, normal; right, a small mass. (Courtesy Nat'l Institutes of Health and Wikipedia.)

Both are also meant to be repeated periodically when normal as a surveillance process.

Both use low quantities of radiation of about 0.3-0.4 mSv (the most real-life measure of total body exposure), a modest quantity of radiation.

Both are good for their purposes, though not perfect. Can a mammogram performed properly miss a small cancerous mass? Sure it can, but it's still unusual. Can a CT heart scan miss the non-calcified plaque prone to rupture? Sure it can, but this is also unlikely (<5% probability).

Given the exorbitant costs of medical tests, both are quite inexpensive. On the flip side, they are both also quite unprofitable for the centers providing the tests. Unfortunately, this means that mammography centers and heart scan centers come and go because of the difficulties of the profit-side of these services.

Both tests initially struggled to gain acceptance among the medical community. In 1960, for instance, mammograms were performed on standard x-ray devices, the same as that used to perform chest x-rays--low precision, high radiation back then. In 1969, dedicated mammography devices made the scene. However, it took over 10 years for even these new dedicated devices to become widely used. Use of mammograms has gradually increased over the ensuing 20 years. In other words, 47 years have passed since the introduction of mammography.

CT heart scans, of course, have had a shorter history of approximately 20 years, since engineer, Dr. Douglas Boyd, first invented the "ultra-fast" EBT devices, the first devices with sufficient scanning speed to scan the heart and coronary arteries.

One interesting difference between the two: In a woman between the age of 50 and 60, the likelihood of detecting cancer is 1 in 237. The likelihood of detecting coronary atherosclerotic plaque? About 1 in 4. Coronary disease eventually kills 1 in 3 females, hugely overshadowing breast cancer in frequency.

Progress on both fronts, one in cancer detection, the other in atherosclerotic coronary plaque detection. But still lots more progress to go.

I’m fascinated by the perspectives that nutritionists (free-thinking ones, at least), food scientists, and biochemists bring on nutrition and nutritional supplements.

A few months ago, I met a fascinating nutritionist/biochemist named Susie Rockway, PhD. Dr. Rockway brings a world of experience in the world of nutritional supplements, clinical trials with supplements, and their development. She has special expertise in conjugated linoleic acid (CLA), having been among the scientists who initially developed CLA as a supplement. We are also exploring CLA as a possible addition to the Track Your Plaque program and wanted to get Dr. Rockway’s perspectives.

So I asked Dr. Rockway if she’d answer a few questions for us.

TYP: Dr. Rockway, we understand that you are particularly excited about the prospects of CLA for FAT loss and perhaps for regression of atherosclerosis. Can you tell us about the origins of your interest in CLA and why you're so enthusiastic?

Dr. Rockway: I have been fascinated with this unique fatty acid since the early 1990’s when CLA was first being discussed as nature’s most potent anti-carcinogen. I was then working in the granting/funding section of the National Dairy Council and saw this molecule as truly one of the future functional fats that would likely benefit people (next to omega-3’s!)

I think the benefits of CLA have just begun to be investigated—animal studies are extraordinary for showing fat reduction, lean mass (muscle) increases, immune enhancements, blood glucose normalization, anti-inflammatory properties and plaque reduction!

Human data to date is very encouraging for fat reduction. As a nutritionist seeing the massive increase in abdominal fat (stomach fat) in the world population and the direct relationship to cardiovascular disease, I see CLA as a great supplement to take to help this. Of course eating lots of vegetables, fruit, lean protein and whole grain products is also a must for maximizing good health.

I am studying the impact of CLA in reducing muscle loss in aging women—a condition known as sarcopenia. As we lose muscle with age, we lose strength, falls increase, we become frailer, and eventually many of us lose our independence. Along with the muscle atrophy, most people gain fat—never a good thing! So, if CLA can reduce fat and increase muscle, our bodies are more likely to withstand the hurdles that life throws at us much more efficiently.

So, how can you not be excited about this very bioactive molecule?

TYP: What are your specific areas of interest in nutrition and health?

Dr. Rockway: I strive to understand the role of bioactive molecules that can be taken to improve the aging process and enhance health.

As a trained nutritional biochemist, we tend to look at cell metabolism in a very ideal sense: what we learned in our biochemistry texts years ago where all substrates, proteins, enzymes, etc. are made exactly when we need them, where all cells behave as they should.

Unfortunately, little research has been devoted to understanding the changes in metabolism as we age. Do we still produce everything as efficiently as when we were 20? I suspect not. So, I think we need a little help, and supplements are a key to getting there.

Two nutrients that I think are emerging as “super nutrients” are the fatty acids found in fish oil (EPA and DHA) and vitamin D. Where we know these two nutrients are essential for life, we are seeing that they play a huge role in the QUALITY of life. Mood, depression, PMS, wound healing, bone growth, atherosclerosis, and arthritis are clinical areas where we see a direct benefit with doses of omega-3 and Vitamin D that are probably much greater than the RDA. Our current requirements for nutrients are really based on fixing deficiencies and not maximizing health, and maximizing health is where I’m at.

Thus, I am very interested molecules like CLA as mentioned above, and other bioactive ingredients such as plant derived ingredients (phytochemicals) called flavonoids that may well help explain why people who have diets high in fruits and vegetables are less likely to have certain cancers and heart disease. Reducing oxidative stress through foods that provide these active molecules (think colored fruits and veggies) is a new and exciting area of research.

TYP:The big "diet experiment" in America has clearly steered people in the wrong direction, usually by 50 or more pounds. As a scientist in nutrition, what are your thoughts?

Dr. Rockway: The American Heart Association was keen 20 years ago to promote the low-fat diet for all Americans as the key way to reduce cholesterol levels and decrease chance of heart disease, the number one killer of men and women. However, I must admit the nutritional community bought into this one, too. Unfortunately, the general public took this message to reduce percent fat in their diet (and they did a bit), but increased overall calories instead—and a large portion of the increased calories was from simple carbohydrates. I’m convinced that this in itself has been part of the huge rise in obesity…we simply eat more food and it’s not the healthy kind of food either.

When you increase sugar intake beyond what you burn off, you will store some of it as glycogen in the liver and muscles, but you will convert most of the excess into fat—and that we can store very efficiently! The fat that is made in the liver is sent to the blood as VLDL’s which are the precursor to the class of lipids called low density lipoproteins (LDL) that are the “lethal” type of cholesterol circulating in our blood.

So, Americans now have to listen to a new message that they need to eat more fruits and vegetables in hopes they will cut down on fast foods—tending to be high in fat (saturated particularly), low in fiber and low in nutrients and other high calorie dense foods. We nutritionists have our work cut out for us, that’s for sure.

TYP: We are especially excited that nutritionists are assuming a leading role in shining light on the confusion in diet and nutrition that has characterized the last 40 years. Do you have a sense for the emerging important issues for the next 10 years?

Dr. Rockway: Certainly, the scientists in the nutritional field are well aware of the problems facing this nation—it’s in fixing them that we fall short!

We aren’t very well coordinated to get a single message out, nor do we all agree on what that message should be. I feel that people need to eat healthy MOST OF THE TIME, exercise all of the time, and take supplements that have clear evidence of benefit. Lots of my colleagues would not concur with supplement use. Our bodies were designed to move a lot and eat a lot…we just do the latter now and are paying the price!

One emerging and very exciting area that we have to teach Americans is that all fat is not bad. The different types of fat—omega-6 vs. omega-3, are where we need to focus our education.

Decreasing the corn oil we pour on everything needs to go out the window! Consume olive oil and eat fish or take fish oil supplements—we simply have tons and tons of research showing the benefits of reducing the ratio of omega-6 to omega-3. Did you know that cattle that are grass fed actually have less omega-6 in their tissues and more CLA? But most cattle are fed corn-based diets, so we have perturbed their natural selection of food and their fat composition.

See, it all comes back to CLA!

TYP: Thanks, Susie!

Susie Rockway, Ph.D., C.N.S.

Dr. Susie Rockway is an experienced scientist with accomplishments in both the academic and food and supplement industry business directing science/technology research. Her background includes faculty appointments at the graduate level in teaching and research at Rush University Medical Center and industrial experience managing basic and applied research studies.

Dr. Rockway received her Ph.D. in Nutritional Sciences, Biochemistry from the University of Arizona. Dr. Rockway has authored several publications in journals such as the Physiological Genomics, Journal of Nutrition, the Journal of Food Science, International Archives of Occupational and Environmental Health and has published chapters on nutrition on inflammatory bowel diseases. She is a member of the American Society for Nutrition, American Oil Chemists Society, the Institute of Food Technology, American College of Nutrition and is a Certified Nutrition Specialist.

We're also proud to add Dr. Rockway to our panel of Track Your Plaque Experts.

If you have the common pattern of high LDL particle number (NMR) with small LDL--a pattern highly related to coronary plaque--which is better:

Lipitor or a combination of fish oil, vitamin D, and elimination of wheat?

Lipitor quite effectively reduces LDL particle number, usually on the order of 40% or so. Effect on LDL particle size: None. Side-effects: plenty, including muscle aches (inevitable in my experience, not the ridiculous 2% they claim) and occasionally mental effects such as impaired short-term memory.

Lipitor does seem to exert a modest effect on reduction of C-reactive protein, around 30%. It also reduces cardiovascular events by 30%.

A combination of fish oil, vitamin D, and elimination of wheat:

Reduces LDL particle number commonly by a similar 40% (though variable, depending on body weight). There is substantial improvement in LDL particle size, a large drop in C-reactive protein, often >50%, a 30% or more reduction in cardiovacular events.

On this combination, however, you also:

--Lose weight, often substantially.

--Improve bone health, esp. osteoporosis and arthritis.

--Reduce cancer risk from the vit D supplementation.

--Reduce risk of stroke.

--Reduce postprandial (after-eating) abnormalities like intermediate-density lipoprotein.

--Reduce winter blues.

--Experience more energy.

--Obtain increased clarity of thought (from elimination of wheat).

--Reduce blood pressure.

Oh, and there's no muscle aches.

I'm kidding.

What I'm referring to is the incredibly lame information I come across that passes as "heart health" on the internet, magazines, and other media. Just to keep abreast of what is being said, I subscribe to multiple newsletters and magazines and I witness the sorts of advice offered to the reading public.

A recent long-winded article on a popular website listed the "exciting" strategies available for a healthy heart:

Eat healthy--by eating a "balanced" diet low in saturated fat

Don't smoke

Exercise

Don't ignore chest pain symptoms or breathlessness

Know your numbers! meaning your cholesterol numbers. "If your cholesterol is high, you may need to speak to your doctor about medication to reduce it."

Surely they must all believe we're stupid. Otherwise, why would they repeat the same obvious information over and over again? Quit smoking? Gee, you think so?

How about some real heart healthy advice:

Get a heart scan--since we have to accept that cholesterol values are a miserable failure in detecting hidden heart disease. So is waiting for symptoms to appear.

If you have any measure of coronary plaque, ask your doctor to assess lipoproteins, not lipids (cholesterol).

Take fish oil for omega-3 fatty acids--At a dose of 1000 mg or more of EPA + DHA, heart attack risk is reduced by at least 28%.

Eliminate wheat and other processed carbohydrates --Small LDL has emerged as the number one cause of coronary plaque, not high cholesterol from saturated fat.

Get vitamin D assessed--The effects are huge--HUGE. There's already a study in a kidney disease population that showed a substantial reduction in mortality with vitamin D supplementation. More data are coming, including our own.

That's a start--truly effective, practical heart healthy strategies that go way beyond the conventional bland advice.

Copyright 2007 William Davis, MD

I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.

Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.

Ginnie came in for an opinion about her heart scan score of 393. At age 57, this put her in the 99th percentile, a high score.

As usual, we did a lipoprotein analysis by NMR (Liposcience). Some numbers:

LDL cholesterol: 96 mg/dl
This value puts Ginnie's LDL in the most favorable 25% in the country.

LDL particle number: 2140 nmol/l
This value is in the worst 25% of the country and is the equivalent of an LDL cholesterol of 214 mg/dl (take off the zero).

In addition, over 90% of Ginnie's LDL particles fell into the small class.

Had we run some other values, how would they have turned out? These are my estimates (since we didn't actually run them in Ginnie), but having run side-by-side numbers in past, reasonable estimates would have put:

Apoprotein B somewhere in the 120 to 140 mg/dl range

Direct LDL 100-130 mg/dl range.

In other words, conventional calculated LDL is the least reliable of all the ways of examining low-density lipoprotein.

It can also go the other way: High calculated LDL, low LDL particle number or ApoB or direct LDL. And, indeed, these other measures have proven superior in their ability to predict "events" like heart attack over conventional calculated LDL.

Unfortunately, relying on conventional LDL is like a broken speedometer on your car. You really can't gauge accurately how fast you're going; sometimes you could be way off. While insurance companies and many physicians still continue to balk at this argument, the data have already been generated that show that lipoprotein analysis (my bias is NMR) is not just superior, but enormously superior for accuracy and event prediction.

In addition, lipoprotein analysis has proven a crucial tool that accounts for our extraordinary success in reducing and controlling CT heart scan scores in the Track Your Plaque program. I doubt that we could have achieved the same level of success using conventional lipids.

I'm also aware of the logistical difficulties obtaining lipoprotein testing in a world enthusiastically supportive of hospital procedures and smugly ignorant of superior prevention tools like lipoprotein analysis. I've learned just how difficult it can be in our Track Your Plaque Member Forum; I've also learned about some strategies for obtaining these tests that I hadn't been aware of, thanks to the resourcefulness of our Members.

We will be working on some solutions in the coming months.

Copyright 2007 William Davis, MD

Say you begin with a CT heart scan score of 400.

You correct your lipoprotein pattterns, take fish oil, correct 25-OH-vitamin D3 to 50 ng/ml, correct your other hidden patterns, follow a diet suited to your patterns.

One year later, you get another heart scan. What score would constitute "success"?

With all of our recent talk about record-setting reductions in heart scan scores, is it really necessary to drop your score that much to succeed?

For instance, is our latest record-setting 63% drop in score better than "only" a 10% drop in score? Both represent reversal of coronary plaque. Both signify huge reductions in risk for plaque rupture, or heart attack.

You can read about how we view the various forms of success in the program by reading our latest Track Your Plaque Special Report, Winning Your Personal War with Heart Disease: The Track Your Plaque 5 Stages of Success.

We are making the Report available to everyone. Just go to the www.cureality.com homepage.

Homocysteine and coronary plaque

Big heart scan scores drop

Does the American Heart Association diet reduce heart disease?

Vitamin K2 and coronary plaque

Exercise and blood pressure

"Fish oil is stupid"

More Vitamin D and HDL

Thin ice

Vitamin D and cancer

Lipoprotein(a), menopause, and andropause

NY Times Jane Brody misses the mark

"There must be a mistake"

Jimmy Moore Interview: Is saturated fat the villain we thought?

Mammogram of the heart

Dr. Susie Rockway on conjugated linoleic acid (CLA)

Which is better?

Heart health for stupid people

Money, money, money, money

The many faces of LDL

What does "Success" mean in the Track Your Plaque program?