I lost 37 lbs with a fingerstick

30. December 2010 William Davis (34)

Jack needed to lose weight.

At 5 ft 7 inches, he weighed in at 273 lbs, putting his BMI at a sobering 42.8. (A BMI of 30 or above is classified as "obese.") In addition to lipoprotein(a), Jack had an extravagant quantity of small LDL (the evil "partner" of lipoprotein(a)), high triglycerides, and blood sugars in the diabetic range. With a heart scan score of 1670, Jack had little room for compromises.

Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order.

So I taught Jack how to check his blood sugars using a fingerstick device, what I call the most important weight loss tool available. I asked Jack to check his pre-meal blood glucose and his one-hour after-meal blood glucose and not allow the after-meal blood glucose to rise any higher than the pre-meal. For example, if blood glucose pre-meal was 115 mg/dl, after-meal blood glucose should be no higher than 115 mg/dl.

If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.

Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.

What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise.

Six months later, Jack came back 37 lbs lighter. And he got there without calorie-counting, without regulating portion sizes, without hunger.

Is it mainstream or alternative?

24. May 2006 William Davis (0)

A question I get about once a week: "Is your program a kind of alternative medicine?"

Our program for control and reversal of coronary plaque using CT heart scans applies an eclectic panel of tools to achieve its goals. We use high-tech methods like lipoprotein analysis and CT heart scans; nutritional supplements like fish oil, vitamin D, and l-arginine; diet strategies and "functional foods" (using foods as a therapeutic tool); and conventional medication.

I don't consider this approach "alternative" in the sense that it uses unmeasurable or spiritual strategies. But I don't consider it mainstream, either, since current mainstream practice of heart disease prevention is far less rigorous with far less satisfactory results.

I think I can sum up the Track Your Plaque approach by saying that we use tools that work. Our measure of success is whether or not your heart scan score is stopped or reduced--that's hard to fudge. You can call it what you will, but I call it the best program for heart disease prevention I know of, alternative or mainstream.

Want to see someone turn diabetic?

24. May 2006 William Davis (0)

If you want to witness the transformation of someone into a pre-diabetic or diabetic, put them on a low fat diet.

Dr. Dean Ornish's program, detailed in his books, Dr. Dean Ornish's Program for Reversal of Heart Disease and Eat More, Weigh Less , are woefully outdated in 2006. Yet the low fat notion continues to show up in the consciousness of people I talk to about heart disease reversal.

"I'm already on a low fat diet. Do you think my heart scan score has reversed?"

Highly unlikely. What Dr. Ornish (as a non-cardiologist, by the way) failed to recognize is that what he did manage to reverse in a small number of people is something called "endothelial dysfunction", but he did not reverse or shrink coronary plaque.

Given the limitations of technology when the Ornish concept got its start, it appeared as if reversal was obtained. In reality, all his approach accomplished was a relaxation in tone of abnormally constricted arteries, thus giving the appearance of reversal. Increased artery tone, or endothelial dysfunction, is extremely common when atherosclerotic plaque is present.

Any cardiologist will tell you that there are many ways to reverse endothelial dysfunction: exercise, weight loss, cholesterol drugs, drugs for high blood pressure, fish oil, hormonal therapy, vitamin C, l-arginine, etc. There is nothing special about a low fat diet.

In fact, Track Your Plaque followers will recognize that a low fat diet is, in fact, potentially harmful, particularly when low HDL or small LDL is part of your pattern.

Let's bury the outdated ideas of the Ornish low fat diet once and for all. It doesn't work. All it may do is confuse you and set you back from your real coronary plaque reversal program.

Inulin: A fiber for weight loss

23. May 2006 William Davis (10)

Here's an interesting product that seems to be gaining some popularity for weight loss: Inulin.

Not to be confused with "insulin", with which it is completely unrelated, inulin is a naturally-occurring plant fiber. It's found in broccoli, asparagus, celery, etc. Like beta-glucan from oats or pectin, inulin is a so-called soluble fiber, a fiber that assumes a gel-like consistency when exposed to water.

Inulin has the effect of increasing satiety, or the sensation of fullness. This cuts your craving for foods. I've tried it recently and I prefer it over glucomannan, another soluble fiber for satiety.

The people at Stonyfield Farms have been adding inulin to their yogurts from some time. The nutritionist at the company tells me that there's 2-3 grams of inulin per 6 ounce container of their yogurt.

You can also find inulin as a supplement that you can add to foods, available from some health food stores and online supplement companies. I came across a neat product called Fiber Choice that's now being distributed widely throughout the U.S. I tried their Weight Management version. It was a delicous strawberry taste. The label says take two chewable tablets twice a day, but I found that two tablets three times a day somewhat better. It's best taken around 30-60 minutes prior to each meal and it causes you to be fuller with less food. One caution: It'll cause loads of gas, especially in the beginning. For that reason, you might try starting with a smaller dose, or start on the weekends when you have the option of some privacy!

More info on the Fiber Choice product can be found at their website, http://www.fiberchoice.com.

Disclaimer: I have no relationship with the manufacturer of this product. I'm simply passing on some thoughts on my experience with this interesting possibility for weight loss.

Will you recognize the truth when you see it?

23. May 2006 William Davis (0)

Do you ever wonder that, if the truth were given to you, that you'd recognize it as such? Or would you dismiss it as just another bunch of nonsense?

After all, you and I live in the Information Age. It means that we have access to mountains of information like never before in human history. But it also means that the truth is often drowned out by an avalanche of mis-truths, sales pitches and marketing, and just plain nonsense.

This struck me the other day when I was talking to a patient.

64 years old with a high heart scan score placing her at significant risk, she looked confused. I'd just described the multitude of causes of coronary plaque that we'd uncovered. The heart scan alone had been a shocker.

"I don't understand. My doctor told me that I had nothing to worry about. I've known him for years and he knows me really well. He did a stress test. That was fine. I don't get all this other stuff you're telling me--lipoprotein whatever..."

Despite my efforts to help her gain an understanding of our intensive approach, she just became increasingly more frustrated. "I just don't think I can do this."

That's the last I've heard from her. As far as I know, she's returned to the comfort of her family doctor who has reassured her over the years. And perhaps there's some good in that. But I do fear for the day when, unexpectedly, she suffers some catastrophe that we told her was coming sooner or later unless real preventive efforts were started.

You could say that she failed to recognize the truth when it was given to her-- boldly, unadorned, and with far greater scientific certainty than the casual reassurances she was accustomed to. But, unfortunately, that's all that some people want.

Don't neglect the basics in your heart disease reversal program

23. May 2006 William Davis (0)

Carl loved new ideas and novel approaches. You could tell by the sheer number of nutritional supplements he took. His list had grown to 18 different supplements over the past two years.

Carl came to me for coronary plaque regression. Lipoprotein analysis did uncover several previously unsuspected abnormalties, most notably small LDL particles and lipoprotein(a). In addition, Carl's LDL cholesterol ranged between 111 mg-156 mg and he was clearly hypertensive, with systolic blood pressures consistently around 150-160. (Recall that people with Lp(a) are more prone to hypertension.)

Carl was more than willing to have his lipoprotein(a) reduced. We did so with niacin and testosterone and the level dropped to near zero. Likewise, we corrected his small LDL pattern with niacin, fish oil, and a reduction in processed carbohydrates.

But Carl really resisted doing much about his LDL cholesterol and high blood pressure. I got the sense that these "boring" issues simply didn't interest him. After all, LDL cholesterol and blood pressure were the stuff of TV commercials and the popular conversation propagated by drug companies.

Carl's follow-up heart scan, however, finally persuaded him: a 24% increase in one year, likely due to the neglect of the basic issues.

I liken Carl's case to being like the teenager with a new car who polishes the paint to a bright finish, puts new wheels and tires on it, spruces up the interior with various doodads--but then fails to change the oil. Sometimes it's the most basic issues that can diminish your success.

Issues like LDL cholesterol and high blood pressure aren't the most glamorous, but they do count in your coronary plaque control program.

Is your doctor a hospital employee?

21. May 2006 William Davis (0)

There's a disturbing trend that's growing--silently but rapidly.

In Milwaukee, three hospital systems compete for the local health care dollar. To gain more control over revenues and the routing of patients, the hospitals are aggressively hiring physicians to work for them. I've witnessed many of my cardiology colleagues, primary care doctors, and a substantial number of procedural specialists enticed by the offers made by hospital employers.

This phenomenon is not unique to Milwaukee but is being used in many, perhaps most, major cities in the U.S.

This means that physicians are employees of the hospital. That way, employee-physicians are obliged to use only the hospital system that employs them. In the old days, your doctor could use any hospital he/she desired, depending on the quality, location, facilities, etc. Now, many physician-employees are given no choice but to use the hospital that pays their salary.

That by itself is not necessarily bad. But combine salary with incentives for bringing in patients for hospitalization and procedures--that the rub. In other words, physician-employees are incentivized to generate more revenue for the system, just as employees in many other industries.

If you're a salesman for an insurance company, your job is to bring in more business. If you're a worker on an auto production line, you're expected to meet certain quotas. These same principles are now being applied to many physicians.

How does this affect you? Well, if your physician--especially procedure-driven specialists like cardiologists, general surgeons, orthopedists, etc.--is a hospital employee, BEWARE! Do you really need that procedure, or is your doctor suggesting you have a procedure because it will add to his track record?

Prevention? In this model of health care, why bother? It certainly doesn't pay for a hospital to keep you well. Then why should your physician-employee?

Be careful who you're dealing with. If your physician is a hospital-employee, don't bet on getting preventive care. It's more likely you're that just a future source of revenue when it's time for your bypass operation, hip replacement, carotid endarterectomy, etc.

What more powerful argument is there for increased self-empowerment and information for health care consumers?

Take a walking vacation

20. May 2006 William Davis (1)

If you're planning a vacation, why not consider a walking vacation?

The concept is really taking off. All you need is a pair of comfortable shoes and an interesting locale. More and more services are popping up to help you plan fun and interesting destinations and itineraries. One such catalog can be found at http://walking.about.com/od/tours/a/walkingvacation_3.htm

Lengthier walks may require some advance planning and toting some supplies. Don't forget the water!

From a health viewpoint, a walking vacation sure beats the heck out of a cruise that packs on 12 pounds of extra weight from the 24-hour a day buffet. If you're in the midst of a weight loss effort, several hours of walking through interesting locales and scenery can make it effortless.

There's loads of neat places to visit from a walker's perspective. One interesting website is www.waterfallwalks.com that lists trails that provide spectacular views of waterfalls.

Another variation on this theme is biking vacations. My wife and I are trying to set the time aside for a biking tour of wineries in the French countryside. That's our kind of multi-tasking!

"Expanded indications for implantable defibrillators"

19. May 2006 William Davis (0)

So reads the headline on a magazine I received recently (along with thousands of my colleagues) from a major hospital system.

It goes on to say: "In January 2005, indications for implantable cardioverter-defibrillators (ICDs) were substantially broadened [emphasis ours] to include most patients with a left ventricular ejection fraction (EF) of 35% or less. This change translates into a 2- to 3-fold increase in the number of Medicare beneficiariries eligible for ICDs."

Ka-ching!!! Hear the money piling up in the bank?

The device manufacturers are constantly churning data and lobbying for reimbursement to expand the use of their devices to more and more people. Defibrillators in particularly are generally a $25,000 to $50,000 opportunity for the device manufacturer alone, not counting the costs incurred at the hospital for implantation.

Beware. As reimbursement for stents and other procedures diminishes, expect a sudden "demand" for more and more people to get implantable defibrillators. Better yet, stay away from the whole issue by preventing your heart attack.

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

19. May 2006 William Davis (2)

I just came from one of the local hospitals after having performed a heart catheterization on a patient I met earlier this week.

Jack had gotten a heart scan a year ago with a score of 246, placing him in the 76th percentile. The "event" rate with this percentile rank is around 3% per year--not very high but enough to pose risk over a long period.

Jack chose to ignore his score. After all, the pressures of work at the University, maintaining his home and yard, etc. consumed all his energies. He came to my office--now one year after his scan--and told me about the chest pressure he was getting. Initially, his chest pains occurred with extended walking. In the past week, however, Jack was experiencing chest pressure with just walking 30 feet.

This pattern of increasing symptoms is called "accelerated angina", meaning that Jack was rapidly heading towards a heart attack. So I advised a heart catheterization in near future.

Jack's catheterization showed extensive plaque including a 50% blockage in the mainstem artery and 90% in the artery to the front of the heart (left anterior descending artery). Jack is going to have a bypass operation tomorrow.

What if Jack hadn't ignored his heart scan from a year ago? Well, I'd be very confident in saying that he would not be undergoing bypass surgery tomorrow.

The lesson: Don't dilly-dally on taking action to keep your plaque from growing. While it's not an emergency, it can easily become one if you choose to ignore your scan.

Feel that nudge in your back?

17. May 2006 William Davis (0)

You feel that nudge in your back? That's your local hospitals competing for your bypass surgery business.

Just this morning while watching a morning news show, I saw three advertisements for hospital bypass surgery programs. One ad featured a man in his 50s telling his story:"The cardiologist determined immediately that I needed a triple bypass operation. My family and I are very grateful to _____ hospital!"

In what other field is failure celebrated so prominently? When I see these ads, I hear "My doctors failed to provide early detection and then prevent what became a life-threatening condition, even though heart disease is a chronic process that requires decades to develop." What if our man said instead,"I had a heart scan and my score was high. So I was shown why I had so much plaque. They then showed me how to control and even reduce the amount of plaque I had. I'm living safely and symptom-free without need for surgery or procedures."

Of course, the hospital is out $60,000-100,000 for the surgery. How else could they afford ad campaigns costing several million dollars a year? See these advertisements for what they are: Marketing generated by profit-seeking businesses competing for your dollars--lots of them.

Stents, defibrillators, and other profit-making opportunities

16. April 2006 William Davis (2)

As a practicing cardiologst, every day I receive a dozen or more magazines or newspapers targeting practicing physicians, not to mention the hundreds of letters, postcards, invitations to "talks", etc. that I receive. All of these materials share one common goal: To get the practicing cardiologist/physician to insert more of a manufacturer's stents, defibrillators, prescribe more of their drugs, etc.

This is a highly effective and profitable area. Pfizer's Lipitor, for instance, generated $12.2 billion just last year alone. This kind of money will fund an extraordinary amount of marketing.

I'm on the www.heart.org mailing list, a website for cardiologists. I'd estimate that 90% or more of their content is device-related: discussions of situations in which to insert stents, the expanding world of implantable devices, the ups and downs of various drugs. Rarely are discussions of healthy lifestyles, exercise, nutritional supplements, part of the dialogue.

How can you protect yourself from the brainwashed physician, flooded with visions of all the devices he can put in you, all the drugs that can "cure" your disease? Simple: information. Be better informed. Ask pointed questions. The idiotic lay press tells you to ask a doctor about his education. That's not generally the problem. Some of the best educated doc's I know are also the most flagrantly guilty of profiteering medicine.

Ask your doctor about his/her philosphy about the use of medications, devices, etc. If their word is God, take it or leave it, run the other way.

Will radiation kill you?

16. April 2006 William Davis (4)

Pre-diabetes: An explanation for explosive coronary plaque growth

1. June 2006 William Davis (0)

Art's first CT heart scan in March, 2006 yielded a concerning score of 1336. He felt fine--no chest discomfort, no breathlessness, etc.

Art agreed to take the statin cholesterol drug his primary care doctor prescribed. He also agreed to take the fish oil, niacin, and some of the nutritional supplements that we advised. But Art just couldn't bring himself to make the commitment to lose weight.

At the start of his program, Art--at 5 ft. 8 inches--was 40 lbs overweight (212 lb). This was important since his blood sugar wavered in the pre-diabetic range, going as high as 130 mg. (The American Diabetes Assn. defines diabetes as a blood glucose of 126 mg or greater.)

One year later, Art's lipid and lipoprotein values were corrected to perfection. But he still weighed in at a hefty 209 lbs--essentially no change. His blood sugar likewise hovered in the 120's.

I felt Art need to be prodded, so I asked him to undergo another heart scan. His score: 1935--a 600 point increase, or 45%!

Only now has Art begun to comprehend to power of diabetes and pre-diabetes to fan the flames of plaque growth. Recent published data, in fact, show that the majority of recently diagnosed diabetics already have well-established coronary artery disease.

Don't let this happen to you. Do not dismiss diabetic patterns as they will catch up to you. If Art can lose the 30-40 lbs in the abdominal weight that is creating the diabetic pattern, he will likely succeed in stopping plaque growth. Otherwise, it's just a matter of time before his heart attack, stent, or bypass.

Who cares if you're pre-diabetic?

31. May 2006 William Davis (0)

Marta is a smart lady. She's worked in hospital laboratories for the last 23 years and knows many of the ins and outs of lab tests and their implications.

After years of being told that her cholesterol was acceptable, she needed to undergo urgent bypass surgery after experiencing severe breathlessness that proved to be a small warning heart attack at age 57. But this made Marta skeptical of relying on cholesterol to identify heart disease risk.

I met Marta two years after her bypass surgery when she was seeking better answers. And, indeed, she proved to have several concealed sources of heart disease: small LDL particles, Lipoprotein(a), intermediate-density lipoprotein (IDL--a very important abnormality that means she is unable to clear dietary fats from her blood), among others. But she was also mildly diabetic with a blood sugar of 131 mg (normal < or = 100 mg). This had not been previously recognized.

As I'm a cardiologist and our program focuses on reversal and control of coronary plaque, I asked Marta to return to her primary care doctor to continue the conversation about diabetes. She was a bit frightened but followed through.

"Well, you're not urinating excessively. And your long-term measure of blood sugar, hemoglobin A1C, is still normal. I wouldn't worry about it. We'll just watch it."

I guess I should know better. What the poor primary care doctor doesn't know is that pre-diabetes and mild diabetes are potent risks for heart disease. In fact, some of the most explosive rates of plaque growth occur when these patterns are present. It's well established that risk for heart attack in a diabetic is the same as that of someone who's already suffered a prior heart attack--very high risk, in other words.

Marta's primary care doctor's advice would be like inquiring about cancer and the doctor says "Let's just wait until it's metastatic--then we'll start to worry." Of course, this is insane.

Pre-diabetes and mild diabetes should not be ignored or just "watched". Even though the blood sugar itself may not be high enough to endanger you, the hidden patterns underlying your body's unresponsiveness to insulin creates a torrent of hidden coronary risk.

For better answers, Track Your Plaque members can read "Shutting Off Metabolic Syndrome" at http://www.cureality.com/library/fl_dp001metabolic.asp on the www.cureality.com website. ("Metabolic syndrome" is the name commonly given to the constellation of abnormalities associated with pre-diabetes and diabetes.)

Don't get smug!

31. May 2006 William Davis (2)

It may sound silly, but after someone succeeds in stopping their heart scan score from increasing or reduces their score, I warn them to not get smug. Let me explain.

I'll tell you about Jack. I met Jack a few years ago after he had a heart scan at age 39. His score: 1441! A score this high at his age obviously puts him in the 99th percentile. Also recall that a score >1000 carries a 25% annual risk for heart attack.

This captured Jack's attention. At the start, his lipoproteins were disastrous with numerous abnormal patterns. Jack committed to the program. After one year, his lipoproteins were around 80-90% corrected towards perfection. He'd lost 27 lbs, was exercising six days a week, and felt great.

Jack's repeat score one year later: 1107--over a 300 point drop! A huge success. He was ecstatic.

Unfortunately, work and life in general distracted him. Jack allowed himself to drift back to old habits, indulging in fast food 2 or 3 times a week, slacking on exercise such that it became sporadic, half-hearted efforts, and regained 15 lbs. He even failed to show up for appointments and we lost contact for two years.

One day, Jack simply decided to see where he stood, so he got himself another heart scan. The score: 2473--over a doubling from his reduced score.

The message: Long-term consistency is key, even after you've achieved control over your score. Stick with your program--and don't get smug!

Holidays are dangerous!

29. May 2006 William Davis (0)

If you're on holiday from work today, make sure you're not on holiday from your health, too.

Too often, people come back to the office telling me that the holidays simply got out of hand--cookouts, picnics, family gatherings, etc.--and they simply couldn't avoid overeating, overdrinking, sitting around--and gaining 3-5 lbs in a weekend. (Our record is 10 lbs in a weekend!)

I don't want to harp on this issue and ruin your holiday, but I can't stress how important it is that you don't allow this to happen to you. Weight gained in a brief space of time has exceptionally destructive effects. Ever see the movie "Super Size Me"? It's an entertaining and well-done yet graphic portrayal of the damaging effects of rapid weight gain.

Enjoy your time off. Relax, enjoy your family and friends--but continue to pay attention to choosing the right foods, don't overeat, take time out to do something (or several things) physical. It'll pay off hugely in the long run.

More on carotid plaque...

29. May 2006 William Davis (1)

Although not a perfect test, carotid ultrasound is an exceptionally easy and accessible test. Using high-frequency sound, clear images are available for most people.

I say it's not perfect because the way it's done in 2006 makes it a non-quantitative test. It is a qualitative test. In other words, you may find out that there's a 30% blockage ("stenosis"), at the far end of the common carotid artery on the right side. Unfortunately, this gives you an isolated measure of diameter of the plaque compared to the artery. What it does not tell you is what the volume of the entire plaque is. That's a far more accurate measure (and one that is incorporated into your heart scan score, by the way).

Nonetheless, carotid ultrasound is easy, very safe, and available in most hospitals and many clinics. One difficulty: most insurance companies will not allow you to go through a carotid ultrasound scan as a "screening" procedure, i.e., a test just to see if you have a carotid plaque. They will generally pay if you're having symptoms of a stroke or "mini-stroke" (transient ischemic attack, or "TIA"), have an abnormal sound in your carotid ultrasound detected by your doctor (a carotid "bruit"), or some other unusual indications. Sometimes, a resourceful physician will muster up a diagnosis based on something in your history (e.g., left arm numbness, a common and often benign complaint that can also signal stroke).

Another option are the mobile scanners or some hospital services that offer carotid screening, usually for a very modest price. Drawback: Sporadic availability, difficulty in obtaining serial scans, and imprecise reporting since it's viewed as a screening test. But it's better than nothing.

My hope is that, as screening services using safe imaging techniques like ultrasound propagate and increase in direct availability to the public, you'll be able to circumvent the obstacles imposed by your insurance company and even, sometimes, your doctor. But try your doctor first.

Carotid plaque can be shrunk

28. May 2006 William Davis (1)

Rose, a 64-year old woman, just had a 70% carotid blockage identified by a screening ultrasound. When the result was given to her doctor, he prescribed Lipitor and told Rose that an ultrasound would be required every year. She would need carotid surgery, an "endarterectomy", if the blockage worsened.

"Can't I reduce the amount of blockage I have?" asked Rose.

"No. Once you've got it, it doesn't get any better."

Is this true? Once you've got carotid plaque, you can only expect it to get worse and it can't be reduced?

This is absolutely not true. In fact, compared to coronary plaque, carotid plaque is easier to reduce!

Of course, the Track Your Plaque program is designed to help you control or reduce coronary plaque. But, in our experience, people who have both coronary and carotid plaque will show far greater and faster reduction of carotid plaque. Dramatic reductions are sometimes seen. I've personally seen 50-70% blockages reduced to <30% on many occasions.

The requirements to achieve reduction of carotid plaque are very similar to the approach we use to reduce coronary plaque. One difference is that hypertension may play a more important role with carotid plaque and needs to be reduced confidently to the normal range before carotid plaque is controlled.

I find it shocking that the attitude like the one provided by this physician continue to prevail. Unlike coronary plaque, which has a relatively small body of scientific literature documenting how it can be reduced, carotid plaque actually enjoys a substantial clinical literature. Part of the reason is that the carotids are more easily imaged using ultrasound. (Heart structures can be seen with ultrasound, but not the coronary arteries.)

Numerous agents have been shown to contribute to reduction of carotid plaque: statin drugs, niacin, fish oil, the anti-diabetic "TZD" drugs (Actos, Avandia), several anti-hypertensive drugs, vitamin E, pomegranate juice, and several others.

It outrages me to hear stories like this. Rose is not the only one.

Don't accept the flip dismissals or the over-enthusiastic referral for carotid procedures. Insist on a conversation about plaque regression.

Note: Although I am a vigorous advocate of atherosclerotic plaque regression, this does not mean that if you have a severe (70% blockage or greater), or if there are symptoms from your carotid disease, that you should engage in a program of reversal. You must always take the advice of your doctor if your safety is in question.

Vitamin D--A coronary risk factor

27. May 2006 William Davis (1)

Look up "coronary risk factors" in any text and you'll find high cholesterol, smoking, diabetes, and high blood pressure listed. You won't find deficiency of vitamin D listed.

Ask 99% of physicians if a deficiency of vitamin D is a coronary risk factor and you'll get rolling eyes and a sigh.

Yet, in the Track Your Plaque experience, vitamin D is emerging as a very important factor in coronary plaque development. We have observed that there are a substantial number of people whose lipids and lipoproteins are not abnormal enough to fully explain their heart scan score. In other words, there seems to be something else necessary to satisfactorily explain the magnitude of coronary plaque.

I believe that severe vitamin D deficiency is at least one of the most important factors. We've seen many people with blood levels of vitamin in the range of severe deficiency (<20 ng/ml of 25-OH-Vitamin D3) yet bland lipids and lipoproteins.

Correcting vitamin D blood levels to 50 ng/ml also seems to be among the required factors in stopping coronary plaque growth, or stopping your heart scan score from increasing.

Keep your eye on this extremely important and exciting issue. Sadly, it won't be propelled into the media like the conversation about cholesterol or high-tech procedures, since no company stands to profit from it. But you and I don't have to play that game.

Cholesterol is dead!

26. May 2006 William Davis (0)

I saw a patient in the office yesterday. He came to me for an opinion regarding his high heart scan score of 525, putting him in the 90th percentile (5% annual risk of heart attack).

His doctor had been puzzled because his LDL cholesterols had ranged from 110 to 131 mg--actually below average. (The average LDL for the U.S. is 132 mg.) Likewise, HDL was a favorable 63 mg.

Lipoprotein analysis told the story loud and clear. His LDL particle number, a far more precise measure of LDL, was 2448 nmol/l. This means that his true LDL was more like 240-250 mg! (You can get a sense for what the true LDL is from LDL particle number by dropping the last digit: 2448 becomes 244.) Conventional LDL was therefore inaccurate by over 100 mg.

He also had a severe small LDL particle pattern. The cause of his coronary plaque was a large excess of small LDL particles. LDL cholesterol (and total cholesterol, likewise) didn't even hint at this pattern. Nor did his favorable HDL.

Think of LDL particle number as an actual count of LDL particles per volume, e.g., number of particles per cc of blood. This makes it easier to conceptualize. LDL particle number is the measure you get when you have an NMR lipoprotein profile, our preferred method of lipoprotein testing. If this is unavailable to you, apoprotein B is a reasonable second choice, though not as accurate in my view. More info on NMR is available at their website, www.lipoprofile.com.

How to make a $1 million in cardiology

26. May 2006 William Davis (0)

Want to make a $1,000,000 as a cardiologist in the next year? It's easy. All you have to do is:

1) Perform heart catheterizations or other procedures on anybody you can, even if it's not necessary. Perform them even if the patient has no symptoms and the stress test is normal.

2) Perform heart catheterizations if the patient is too timid or ill-informed to object.

3) Insert coronary stents in blockages, even when they're minor and it's not necessary.

4) Turn every heart procedure into a revenue-producing stream by looking for other profit opportunties, such as minor kidney artery blockages.

5) Heart disease is frightening. Scare the heck out of patients by exagerrating the dangers so they'll go through testing and procedures gratefully.

Sound absurd? Well, it would be if these weren't all true.

These are real examples, as awful as it sounds. I've witnessed all these behaviors. Not just occasionally, but with regularity.

Just today, I encountered a colleague who performs heart catheterizations routinely (up to several per day) when any symptom is present and the stress test is entirely normal. This is grossly inappropriate.

Your protection is being better-informed and avoid being sucked into the vast and frightening cardiovascular machine of revenue-yielding procedures. Part of your protection is to get a CT heart scan, then engage in a program of heart disease prevention.

Doctor, do I have lipoprotein (a)?

25. May 2006 William Davis (0)

I met Joyce today for a 2nd opinion. She told me about this conversation she'd had with her cardiologist:

"Doctor, do you think I could have lipoprotein (a)? I read about how it can cause heart attacks even when cholesterol is controlled."

"What does it matter? Even if you have it, there's nothing we can do about it. There's no treatment for it."

Joyce was understandably groping for some means to prevent her coronary disease from causing more danger. At 56, she'd already survived a heart attack that resulted in two stents to her left anterior descending. Around 9 months later, she received a 3rd stent to another artery.

Her doctor had put her on Pravachol and said that was enough. "We know that cholesterol causes heart disease and the Pravachol reduces it. Why do we need to know anything more?"

So Joyce came to me for another view. I explained to her that there are, in fact, several ways to deal with lipoprotein(a). It is, without a doubt, among the more difficult patterns to manage--but not impossible. In fact, we have a growing list of participants in the Track Your Plaque program who have stopped or reduced their heart scan scores.

I continue to be horrified at the level of ignorance that prevails among my colleagues, the cardiologists, and the primary care community. If your doctor gives you advice like this, get a new doctor.

Martin Levac
12/30/2010 5:14:00 AM |

6 months, 37 lbs. That's pretty good. Immediate feedback is a strong tool for pretty much anything we do. When all we have is a scale, it takes a while for the result to show up. And we're never sure what we did that did it. But when we check blood sugar, we have the result right there and then. Like you said, we know exactly what's the cause and can act on it with total confidence.

Anonymous
12/30/2010 3:37:50 PM |

No problem with this but for the cost.
At six (one before, one after, more if you're "grazing") sticks a day @.40 usd each test strip, we're spending $72/mo.
This must be lowered somehow.

Anonymous
12/30/2010 6:07:28 PM |

To Anonymous,

$72 / mo is only possible if you are eating different for different meals for the entire month. This is highly unlikely.

Jeff Consiglio
12/30/2010 11:01:26 PM |

Diabetics or pre-diabetics making dietary adjustments based on an objectively measured parameter, such as this, is genius. (I believe constant blood-sugar monitoring is what led Dr. Bernstein to adopt a low-carb diet.)

But what about someone who's not diabetic...a person prone to hypoglycemic episodes for instance.

Seems such an individual's tendency to "overshoot" insulin output in response to incoming carbohydrates would quickly (too quickly)lower blood-sugar levels...giving the false appearance that all is well. Even though much of that glucose got partitioned into fat cells.

Keep up the good work Doc! I'm a personal trainer who regularly sends low-carb disbelieving physician clients of mine to your site. They can obviously receive this kind of info with a more open-mind from a fellow physician than from me.

Ensues
12/31/2010 1:44:01 AM |

I have a very similar story! I lost 30 lbs in just over two months and this blog and Dr. Davis was the entire reason. Total cholesterol down over 30% and triglycerides down over 50%. LDL is much reduced too. My only concern now is HDL. It will not move an inch! Started fish oil, then waited then started vitamin D supplementation. Waited another couple months and earlier this week I started Niacin. My HDL actually went down as Dr. Davis said it would while I was losing weight. Then went right back up to 22 were it's been for years. Might try wine and dark chocolate in moderation and if ALL ELSE fails I will have to submit to exercise. My most sincere thanks Dr. Davis and keep posting actual patient experience. It's very motivating. Can't wait to read about a patient with a "stuck" HDL marker.

Anonymous
12/31/2010 3:50:06 AM |

It costs too much money to buy the strips. I know doctors can get give you prescriptions for the strips at lower costs, but that isn't something my doctor would do.Too bad, it sounds interesting.

Anonymous
12/31/2010 4:53:31 AM |

For those having issues with the cost, ask yourself this: what is my health worth? This motivational tool is key to losing weight and changing your lifestyle intelligently.

Daniel A. Clinton, RN, BSN
12/31/2010 7:05:33 AM |

With 25.1% of Americans either diabetic or prediabetic, it's about time we start thoroughly and intelligently educating patients about how to maintain normal blood glucose levels. The reality is most Americans continue to eat an American diet, conclude blood sugar control thru diet to be impossible, and fall into a never-ending cycle of insulin resistance, pessimism, false comfort in high levels, and an exaggerated concern of hypoglycemia which they use to rationalize running around with blood sugars in the 200s. Proper education and a glucometer the two best tools to combat these epidemics, and yet only a tiny percentage of the population really understands the disease process and proper regimen to maintain good glycemic control. And it's no wonder with the ADA telling people who consider themselves "moderately active" (as most overweight, inactive people do) to eat 45 grams of carbs per meal.
Dr. Davis, do you have any suggestions on how to develop a glucose tolerance test patients could perform on themselves at home simply using a fingerstick? Do you think there's value in something as simple as checking a fasting blood sugar, drinking a 20 oz Coke, and then taking fingerstick readings at 1 hour and 2 hours?

Peter
12/31/2010 11:22:24 AM |

What I learned from testing was that brown rice and black beans raise my blood sugar 60 or 70 points, and that if I stayed away from grains, beans, and sugars, my blood sugar doesn't budge. It didn't take many strips to figure this out, the bigger expense is that rice and beans were way cheaper than fish, meat, and cheese.

Anonymous
12/31/2010 2:36:40 PM |

Concern for one's health is a straw man, it's usually everyone's concern; however cost IS an arbiter, otherwise we'd all have "Cadillac" health plans. Technology will lower the strip costs, or eliminate them. In the meantime some do without.

Anne
12/31/2010 2:48:04 PM |

It is easy to find a free meter and it will come with at least 10 strips. This is enough to tell you if your blood sugar is spiking after eating. That is what I did and then I was able to convince my doctor that, in spite of my "normal" fasting BG, I needed a prescription for testing supplies as my postprandial blood glucose was spiking over 200.

Once I figured out what foods were causing my blood sugar to go high, and totally eliminated these foods, testing became much less frequent. The only time I test now is if I add in a new food. I will also test throughout the day every once in a while to be sure my BG is not creeping up even with the low carb lifestyle.

When I started doing this a little over 2 years ago, I lost 15-20 lbs and have remained stable. I no longer have daily episodes of hypoglycemia caused by crashes after a blood sugar spike.

gkamp
12/31/2010 3:43:19 PM |

To penny-wise, pound foolish anonymous,

I would tend to bet that the price of strips is kept artificially high and it is not lack of technology that is the problem. However, think of what you'd spend on a dinner out, a movie, or even a doctor's visit--and a doctor's visit won't give you half of the information about your health that a canister of strips will give you. Anything a doctor does is a single snapshot in time, not ultimately helpful on a day-to-day basis. Testing your blood sugar systematically for various foods works if you pay attention to what it tells you and modify your behavior accordingly.

Derek S.
12/31/2010 5:57:18 PM |

Anonymous,

No, health concern is most definitely not a straw man.  Yes, most people will give lip service to their health being a top priority but words mean little.  If you observe the hierarchy of priorities in that person's life based on their ACTIONS you will usually quickly see the truth of the matter is that health is NOT one of their top priorities.  It is called cognitive dissonance and it is endemic to our society, unfortunately.

If someone is not willing to give up their Starbucks, movies, pricey wines, or any number of other extras in their life in order to obtain something that has tremendous possibilities for improving their health then by their actions they are stating clearly their priorities.  Words mean little at that point except to misdirect, evade or confuse the issue.  The actions tell the tale.

I would end by saying that your statement about health usually being everyone's concern is simply not true...not because most everyone doesn't say it, because they do, but because most everyone doesn't act according to their words.  It has always been true that you can tell a tree by it's fruit.

Derek S.
12/31/2010 6:03:56 PM |

I also want to point out that the old biblical term for cognitive dissonance is "hypocrisy". I usually avoid that term nowadays, though, since it cuts too close to the heart of the matter and therefore makes people very uncomfortable if not downright offended.

Dr. William Davis
12/31/2010 8:10:55 PM |

Thanks, Anne, for making a crucial point: Keep costs low by only assessing a previously untested food or combination of foods.

In other words, if you know that a 3-egg omelette with olive oil and green peppers results in an excellent blood sugar response, don't bother to check it again.

Might-o'chondri-AL
1/1/2011 12:43:45 AM |

"Stuck" HDL was posted 30 Dec. so this may still interest some.

The Linosa study gives low HDL as 54% heritable, and low HDL accompanied with concurrent high Triglycerides as 31% heritable.

The Erasmus Ruchpen study classes HDL as 43% heritable; with both sexes having the same HDL and Triglyceride genetic pre-disposition.

The Healthy Twin (Korea) study classes low HDL as 77% heritable and Triglycerides as 46% heritable.

Our individual genetics are probably not from those study pools. However, it has been theorized that the genetic tendency for most Caucasians (like the Korean twins)is to low HDL.

The ratio of Apoliprotein B to Apoliprotein A1 has an inverse effect on HDL. Doc has described to us how he clinically deals with ApoB; HDL reading might not "move" much but being pro-active is preventative.

e4e
1/1/2011 4:46:55 AM |

@Ensues,

You might try increasing sat fat a little. Coconut oil, butter, lard used in cooking can help drive up HDL. It also drives up total cholesterol, but as a ratio, HDL goes up more.

Anonymous
1/1/2011 11:13:25 AM |

Metformin can help with weight loss in the Non Diabetic patient. A great addition to the glucose meter

Anonymous
1/1/2011 12:10:20 PM |

$72 a month is cheaper than weight watchers.

Anonymous
1/1/2011 12:49:28 PM |

Taking niacin to raise HDL worked for me, but it raised my fasting GLU to over 160. Another dangerous side effect for me is that even a small dose will cause me to fly into a rage with the least provocation.

Wal-mart sells a test kit with 50 test strips for under $20 (side-kick).

steve
1/1/2011 4:47:20 PM |

This raises a good question: what is the ideal weight for any individual?

Anne
1/1/2011 5:28:01 PM |

Ensues, Here is a post on Inhuman Experiment about hibiscus tea increasing HDL and lowering LDL.

Roberto
1/2/2011 7:51:17 PM |

Dr. Davis

I had my HbA1C checked while I was eating roughly 60% of my calories from carbohydrate and it was 4.9%. After 3 months on a low-carb diet I had it checked again and it had risen slightly to 5.0%. How could this possibly happen?

Ensues
1/2/2011 11:47:58 PM |

@Many...

Thanks for the tips. I never cease to be amazed by how supportive this community is. I was a SAD poster child always "trying" to follow government guidelines. I made a list of all of the "little" changes I made to conform better. Whole wheat pasta, skim milk, whole wheat bread, no chicken skin etc etc etc. My damaged metabolism took hit after hit after hit. My triglycerides were over 1000. My PCP advised to avoid greasy fried foods. It's comical (and sad) looking back on it. My glucose meter has a permanent place in my laptop bag and my weight goes down every week AND my health improves. Thanks again for the suggestions and data.

Ensues

Anonymous
1/3/2011 12:14:39 AM |

I eat the same foods everyday, so I don't have to test my blood sugar very much. I save money on test strips (I use freestyle lite) and I save money since I buy food in bulk.
I think it's important to not eliminate foods just because they raise blood sugar. It's also the combination of foods that affects the glycemic response. There are ways to eat oats and other potentially high glycemic foods with minimal glycemic response. I don't like elevated sugar, but after trying to live on flax alone, I became too depressed to continue. Flax is ok for 1 meal, but that's it for me. One example. I eat semi-pureed sauerkraut with glucomannan and dulse flakes and I get less glycemic response than with sauerkraut alone.

Anonymous
1/3/2011 1:09:19 AM |

I forgot to post my other example of food combining. Quick oats can be processed in a food processor for 2-3 minutes and added to nut butters or perhaps even added to eggs and meats, although I've only tried oats with nut butters. If I eat oats alone once daily, I spike to 150. If I eat oats twice daily, I don't go above 120, so it's about previous meals and also the time of day for me.

Travis Culp
1/3/2011 9:21:33 PM |

Though it's bizarre to me that spending money on health isn't widely accepted as being a good investment, there is a fairly easy way to avoid doing so and still get this information.
Why doesn't the good doctor create a central repository that lists various foods/meals and the BG response to them. There must be variation between individuals, but generally speaking, a "bad" food is a bad food. I understand that the point of the process is to rein in recalcitrant patients who need to see what the food is doing, but for those who don't want to spend the money or don't want to do this for another reason, but who do have self-control, we could just share info on which foods cause the biggest response. Presumably they would be grains, sweeteners, high-lactose dairy and fruit eaten on an empty stomach. Meals comprised of mostly meat and green veggies with a serving of carbs (25g or so) should not elicit such a response.

Anonymous
1/5/2011 4:44:12 PM |

Travis Culp,
The 'Glycemic Index' may be what you are looking for. To see a very good listing and discussion check out www.mendosa.com
At his site there is a link to Excell listing of GI, this is nice as you can reorder it in assending /desending order. There are also a book.
Ed

Cathy
1/5/2011 5:00:32 PM |

My husband was diagnosed as a diabetic and I am prediabetic so I read Dr. Bernstein's book and started testing, testing, testing as suggested. When I went to get the testing strips refilled the pharmacy said I could not get more yet as I was using them too often! After explaining what I had done and that I did not know I was only allowed to use a certain number of sticks a day (two), they refilled it but I think that is wrong for the insurance companies to restrict that. I was glad to read the posts that once you know a food combination does not elevate sugars then you don't need to test then. That helps a lot. Thanks for all of your input. It is a big help to me.

Complications of Diabetes
1/7/2011 9:25:08 AM |

Really liked the way you used to help Jack loose his weight. The results are pretty good and appreciable.
Thanks for the post and awaiting to read more.

jem
1/12/2011 6:53:14 PM |

Is it really possible to get NO increase in BG?

I am using this plan and have stopped testing that a m fasting (which is always elevated, for some reason).
This has made me way less crazy.

So back to my question....
Yesterday my pre breakfast was 70; pp was 96.
Lunch was 92; 102

I seem to always have some increase so when peop say they have none, do they really mean none?

The other question; Is the 1 hr pp enough?
When I was testing 2 hr the reading was always higher.

So, as you can see, there's much less stress involved w 1 hr pp testing...but am I kidding myself?

Dr. William Davis
1/12/2011 7:29:15 PM |

Jem--

Some people digest and process carbohydrates more slowly, or the mix of foods slows the process.

Find your peak by performing every 30 minute checks, then use that time in future.

Anonymous
1/13/2011 4:38:12 PM |

Does anyone have any experience with Mulberry Zuccarin for glucose control? I read an article about it and came back here to find this thread, hoping for some insight. Just snake oil, or is there something to it?

Karen
2/28/2011 1:17:44 AM |

For people concerned about cost. I bought a walmart store brand meter for 9.00 and 50 strips is 20.00 This meter/strips is a good brand, have no trouble with it. the pharmacist told me she used it personally with no issues. I don't test every day every meal, Great price.

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Comments (34) -

Martin Levac

Anonymous

Anonymous

Jeff Consiglio

Ensues

Anonymous

Anonymous

Daniel A. Clinton, RN, BSN

Peter

Anonymous

Anne

gkamp

Derek S.

Derek S.

Dr. William Davis

Might-o'chondri-AL

e4e

Anonymous

Anonymous

Anonymous

steve

Anne

Roberto

Ensues

Anonymous

Anonymous

Travis Culp

Anonymous

Cathy

Complications of Diabetes

jem

Dr. William Davis

Anonymous

Karen

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