Diabetes: Better than hedge funds

7. March 2011 William Davis (23)
Diabetes is where the action is.

While, for virtually all of history, type 2 diabetes was an uncommon condition of adults, the disease has spread so much to all levels of American society that even kids are now developing the adult form. Researchers from the Center for Disease Control and Prevention predict that, by 2050, one in three adults will be diabetic.

The diabetes market is booming, handily surpassing growth of the oil industry, the housing market, even technology. It makes Bernie Madoff’s billions look like small potatoes. In health, few markets are growing as fast as diabetes—-not osteoporosis, not heart disease, not cancer.

Americans are getting fat from carbohydrate consumption, becoming diabetic along with it. While kids hanging around the convenience store gulp down 26 teaspoons of sugar in 32-ounce sodas and 56-grams-of-sugar in 16-ounce frozen ices, health-minded adults are more likely eating two slices of 6-teaspoons sugar-equivalent “healthy whole grain” bread, wondering why last year’s jeans are too tight.

The U.S. is not the only nation affected. Globally, 2.8% of the world’s population are diabetic, a number expected to double over the next 20 years.

Pharmaceutical companies boast double-digit growth for diabetes drugs, growth rates that keep profit-hungry investors happy. Merck’s Januvia, for instance, introduced in 2006, recently catalogued 30% growth in sales, with annual sales approaching $1 billion. Recently FDA-approved Victoza, requiring once-a-day injection, is expected to reap $4 billion in sales per year for manufacturer Novo Nordisk. Such numbers can only warm a drug company CEO’s heart.

Most diabetics don’t just take one medication, but several. A typical regimen for an adult diabetic after a couple of years of treatment and following the dietary advice of the American Diabetes Association includes metformin, Januvia, and Actos, a triple-drug treatment that costs around $420 per month. Two forms of insulin (slow- and fast-acting), along with two or three oral medications, is not at all uncommon.

“Collateral” revenues from the other health conditions that develop from a diet rich in “healthy whole grains,” such as drugs for hypertension, drugs to slow the progression of kidney disease in diabetes, drugs for “high cholesterol,” and drugs for high triglycerides, and you have a pharmaceutical drug bonanza. You, too, would throw all-expenses-paid, fly-the-entire-sales-force-to-the-Caribbean sales meetings.

The global diabetes market has already topped $25 billion and is growing at double-digit rates. Forget the Internet, gold stocks, or solar energy—-diabetes is where the money is. This fact has not been lost on the very market-savvy pharmaceutical industry. As with any successful business, they have devoted substantial resources to develop and grow this booming business.

270 lb man in diapers

5. March 2011 William Davis (20)
Alex is a big guy: 6 ft 4 inches, 273 lbs.

On 10,000 units per day of vitamin D in gelcap form, his 25-hydroxy vitamin D level was 38.4 ng/ml. One year earlier, his 25-hydroxy vitamin D level, prior to any vitamin D supplementation was 9.8 ng/ml.

According to the latest assessment offered by the Institute of Medicine (IOM):

Vitamin D need for a 13-month old infant: 600 units per day

Vitamin D need for a 6 ft 4 in, 273 lb male: 600 units per day

I paint this picture to highlight some of the absurdity built into the smug assumptions of the IOM's report. It would be like trying to fit a large, full-grown man into the diapers of a 13-month old. Few nutrients or hormones (in fact, I can't think of a single one) are required in similar quantity by an infant or toddler and a full grown adult. However, according to the IOM's logic, their vitamin D needs are identical, regardless of age, body size, skin color, genetics, etc. One size fits all.

Just as the original RDA assessment by the Institute of Medicine kept thinking about vitamin D somewhere in the Stone Age, so does this most recent assessment.

90% small LDL: Good news, bad news

4. March 2011 William Davis (11)
Chris has 90% small LDL particles.

On his (NMR) lipoprotein panel, of the total 2432 nmol/L LDL particles ("LDL particle number"), 2157 nmol/L are small, approximately 90% (2157/2432).

Bad news: Having this severe excess of small LDL particles virtually guarantees heart attack and stroke in Chris' future.

Good news: It means that Chris potentially has spectacular control over his lipoprotein and lipid values, achieving statin-like values without statin drugs.

Typically, extravagant quantities of small LDL particles are accompanied by low HDL, high triglycerides, and pre-diabetes or diabetes. Chris' HDL is 26 mg/dl, triglycerides 204 mg/dl; HbA1c 5.9% (a reflection of prior 60-90 days average blood glucose; desirable 4.8% or less), fitting neatly into the expected pattern.

Chris' pattern tells me several things:

1) He overconsumes carbohydrates, since carbohydrates trigger this pattern.
2) He likely has a genetic susceptibility to this effect (e.g., a variant of the gene for cholesteryl ester transfer protein, perhaps hepatic lipase). Only the most gluttonous and overweight carbohydrate consumers can generate this high a percentage small LDL without an underlying genetic susceptibility.
3) Provided he follows the diet advised, i.e., elimination of all wheat, cornstarch, oats, and sugars, he is likely to have an extavagant drop in LDL particle number. Should he achieve the goal I set of small LDL of 300 nmol/L or less, his LDL particle number will likely be around 500 nmol/L. This translates to an LDL cholesterol of 50 mg/dl . . . 50 mg/dl.

In many people, this notion of taking statin drugs for "high cholesterol" is an absurd oversimplification. But it is a situation that, for many, is wonderfully controllable with the right diet.

The American Heart Association has a PR problem

2. March 2011 William Davis (17)
The results of the latest Heart Scan Blog poll are in. The poll was prompted by yet another observation that the American Heart Association diet is a destructive diet that, in this case, made a monkey fat.

Because I am skeptical of "official" organizations that purport to provide health advice, particularly nutritional advice, I thought this poll might provide some interesting feedback.

I asked:

The American Heart Association is an organization that:

The responses:
Tries to maintain the procedural and medication status quo to benefit the medical system and pharmaceutical industry for money
240 (64%)

Doesn't know its ass from a hole in the ground
121 (32%)

Is generally helpful but is misguided in some of its advice
79 (21%)

Accomplishes tremendous good and you people are nuts
6 (1%)


Worrisome. Now, perhaps the people reading this blog are a skeptical bunch. Or perhaps they are better informed.

Nonetheless, one thing is clear: The American Heart Association (and possibly other organizations like the American Diabetes Association and USDA) have a serious PR problem. They are facing an increasingly critical and skeptical public.

Just telling people to "cut the fat and cholesterol" is beginning to fall on deaf ears. After all, the advice to cut fat, cut saturated fat, cut cholesterol and increase consumption of "healthy whole grains" in 1985 began the upward ascent of body weight and diabetes in the American public.

Believe it or not, my vote would be for something between choices 1 and 3. I believe that the American Heart Association achieves a lot of good. But I also believe that there are forces within organizations that are there to serve their own agendas. In this case, I believe there is a substantial push to maintain the procedural and medication status quo, the "treatments" that generate the most generous revenues.

I believe that I will forward these poll results to the marketing people at the American Heart Association. That'll be interesting!

The formula for aortic valve disease?

28. February 2011 William Davis (60)
I've discussed this question before:

Can aortic valve stenosis be stopped or reversed using a regimen of nutritional supplements?

I had a striking experience this past week. Don has coronary plaque and began the Track Your Plaque program. However, discovery of a murmur led to an echocardiogram that measured his effective aortic valve area at 1.5 cm2. (Normal is between 2.5-3.0 cm2.)

Because of his aortic valve issue, I suggested that, in addition to the 10,000 units of vitamin D required to increase his 25-hydroxy vitamin D level to 70 ng/ml, he also add vitamin K2, 1000 mcg per day, along with elimination of all calcium supplements. (I asked Don to use a K2 supplement that contained both forms, short-acting MK-4 and long-acting MK-7.)

One year later, another echocardiogram: aortic valve area 2.6 cm2--an incredible increase.

This is not supposed to happen. By conventional thinking, aortic valve stenosis can only get worse, never get better. But I've now witnessed this in approximately 10% of the people with aortic valve stenosis. The majority just stop getting worse, an occasional person gets worse, while a few, like Don, get better.

Aortic valve stenosis is to the aortic valve as degenerative arthritis is to your knees: A form of wear-and-tear that leads to progressive dysfunction. When the aortic valve becomes stiff enough (i.e., "stenotic"), then it leads to chest pains, lightheadedness or losing consciousness, heart failure, and, eventually, death. Bad problem.

Aortic stenosis typically starts in your 50s with calcification of the valve, getting worse and worse until the calcium makes the valve "leaflets" unable to move. The treatment: a new valve, a major undertaking involving an open heart procedure.

What if taking vitamins D and K2 and avoiding calcium do not just reverse or stop aortic valve stenosis once established, but prevents it in the first place? Tantalizing possibility.

Pressures on my time being what they are, I've not had the freedom to put together a prospective study to further examine this fascinating question. But it is definitely worth pursuing.

Blood glucose 160

26. February 2011 William Davis (28)
What happens when blood glucose hits 160 mg/dl?

A blood glucose at this level is typical after, say, a bowl of slow-cooked oatmeal with no added sugar, a small serving of Cheerios, or even an apple in the ultra carb-sensitive. Normal blood sugar with an empty stomach, i.e., fasting; high blood sugars after eating.

Conventional wisdom is that a blood sugar of 160 mg/dl is okay, since your friendly primary care doctor says that any postprandial glucose of 200 mg/dl or less is fine because you don't "need" medication.

But what sort of phenomena occur when blood sugars are in this range? Here's a list:

--Glycation (i.e., glucose modification of proteins) of various tissues, including the lens of your eyes (cataracts), kidney tissue leading to kidney disease, skin leading to wrinkles, cartilage leading to stiffness, degeneration, and arthritis.
--Glycation of LDL particles. Glycated LDL particles are more prone to oxidation.
--VLDL and triglyceride production by the liver, i.e., de novo lipogenesis.
--Small LDL particle formation--The increased VLDL/triglyceride production leads to the CETP-mediated reaction that creates small LDL particles which are, in turn, more glycation- and oxidation-prone.
--Glucotoxicity--i.e., a direct toxic effect of high blood glucose. This is especially an issue for the vulnerable beta cells of the pancreas that produce insulin. Repeated glucotoxic poundings by high glucose levels lead to fewer functional beta cells.

A blood glucose of 160 mg/dl is definitely not okay. While it is not an immediate threat to your health, repeated exposures will lead you down the same path that diabetics tread with all of its health problems.

Indian buffet

24. February 2011 William Davis (56)
I took my family to a local all-you-can-eat Indian buffet. It was delicious.

I confined my food choices mostly to vegetables and soups. Within about 30 minutes, I started to get that odd buzz in my head that usually signals a high blood sugar.

When I got home, my fingerstick blood glucose: 173 mg/dl. Darn it! Must have been cornstarch or other sugars in the sauces.

I got on my supine stationary bike and pedaled for 40 minutes at a moderate pace while I played Modern Warfare on XBox. (A great way, by the way, to fit in some low- to moderate-intensity exercise while occupying your brain. My wife often has to yell at me to get off, it's so much fun.)

Blood glucose at the conclusion of exercise: 93 mg/dl-- a nice 80 mg/dl drop.

This is a useful strategy to use in a pinch when you've either been inadvertently exposed to more carbohydrate than you can tolerate, or if you'd like to blunt the adverse glucose effects of a bowl of ice cream or other carbohydrate indulgence.

Should we explore the idea of a "morning-after" pill, or actually a "meal-after" pill, a supplement pill or liquid that blunts or eliminates the blood glucose rise after a meal? I've considered such an idea, but have been fearful that people would start to use it habitually. Thoughts?

American Heart Association diet makes a monkey out of you

21. February 2011 William Davis (38)
Heart Scan Blog reader, Roger, brought this New York Times article to my attention.

In an effort to develop a better experimental model for obesity than mice, scientists have turned to monkeys and other primates. The emerging observations are eerily reminiscent of what you and I witness just by going to the local grocery store or fast food outlet:

"'It wasn’t until we added those carbs that we got all those other changes, including those changes in body fat,' said Anthony G. Comuzzie, who helped create an obese baboon colony at the Southwest National Primate Research Center in San Antonio."

"Fat Albert, one of her monkeys who she said was at one time the world’s heaviest rhesus, at 70 pounds, ate “nothing but American Heart Association-recommended diet,” she said."

Yes, indeed: The American Heart Association diet makes monkeys fat. Extrapolate this a little higher on the evolutionary ladder and guess what?

This is one of the many reasons why, when I have a patient who is counseled by the hospital dietitian on the American Heart Association diet, I advise them to 1) ignore everything the dietitian told them, and then 2) follow the wheat-free, cornstarch-free, sugar-free, whole food diet I advocate.

Not unexpectedly, much of this primate research is not being devoted to just manipulating diet to achieve weight loss and health, but to develop new drugs to "treat" obesity.

Would you like a banana?

Construct your glucose curve

19. February 2011 William Davis (24)
In a previous Heart Scan Blog post, I discussed how to make use of postprandial (after-meal) blood sugars to reduce triglycerides, reduce small LDL, increase HDL, reduce blood pressure and inflammatory measures, and accelerate weight loss.

In that post, I suggested checking blood glucose one hour after finishing a meal. However, this is a bit of an oversimplification. Let me explain.

A number of factors influence the magnitude of blood glucose rise after a meal:

--Quantity of carbohydrates
--Digestibility of carbohydrates--The amylopectin A of wheat, for example, is among the most digestible of all, increasing blood sugar higher and faster.
--Fat and protein, both of which blunt the glucose rise (though only modestly).
--Inclusion of foods that slow gastric emptying, such as vinegar and fibers.
--Body weight, age, recent exercise

Just to name a few. Even if 10 people are fed identical meals, each person will have a somewhat different blood glucose pattern.

So it can be helpful to not just assume that 60 minutes will be your peak, but to establish your individual peak. It will vary from meal-to-meal, day-to-day, but you can get a pretty good sense of blood glucose behavior by constructing your own postprandial glucose curve.

Say I have a breakfast of oatmeal: slow-cooked, stoneground oatmeal with skim milk, a few walnuts, blueberries. Blood glucose prior: 95 mg/dl. Blood glucose one-hour postprandial: 160 mg/dl.

Rather than taking a one-hour blood glucose, let's instead take it every 15 minutes after you finish eating your oatmeal:


In this instance, the glucose peak occurred at 90-minutes after eating. 90-minute postprandial checks may therefore better reflect postprandial glucose peaks for this theoretical individual.

I previously picked 60-minutes postprandial to approximate the peak. You have the option of going a step better by, at least one time, performing your own every-15-minute glucose check to establish your own curve.

Why is type 1 diabetes on the rise?

16. February 2011 William Davis (43)
Type 1 diabetes, also called "childhood" or "insulin-dependent" diabetes, is on the rise.

Type 2 diabetes, or "adult," diabetes, is also sharply escalating. But the causes for this are easy-to-identify: overconsumption of carbohydrates and resultant weight gain/obesity, inactivity, as well as genetic predisposition. A formerly rare disease is rapidly becoming the scourge of the century, expected to affect 1 in 3 adults within the next several decades.

Type 1 diabetes, on the other hand, generally occurs in young children, not uncommonly age 3 or 4. Type 1 diabetes also shares a genetic basis to some degree. But the genetic predisposition should be a constant. Obviously, lifestyle issues cannot be blamed in young children.
Then why would type 1 diabetes be on the rise?

For instance, this study by Vehik et al from the University of Colorado documents the approximate 3% per year increase in incidence in children with type 1 diabetes between 1978 and 2004:


(From Vehik 2007)

(For an excellent discussion of the increase in type 1 diabetes in the 20th century, see this review.)

This is no small matter. Just ask any parent of a child diagnosed with type 1 diabetes who, after recovering from hearing the devastating diagnosis, then has to stick her child's fingers to check glucose several times per day, mind carefully what he or she eats or doesn't eat, watch carefully for signs of life-threatening hypoglycemic episodes, not to mention worry about her child's long-term health. Type 1 diabetes is a life-changing diagnosis for both child and parents.

Various explanations have been offered to account for this disturbing trend. Some attribute it to the increase in breast feeding since 1980 (highly unlikely), exposure to some unidentified virus, or other exposures.

I'd like to offer another explanation: wheat.

Lest you accuse me of becoming obsessed with this issue, let me point out the four observations that lead me to even consider such an association:

1) Children diagnosed with celiac disease, i.e., the immune disease of wheat gluten exposure, have 10-fold greater likelihood of developing type 1 diabetes.

2) Children diagnosed with type 1 diabetes are 10-fold more likely to have abnormal levels of antibodies (e.g., transglutaminase antibodies) to wheat gluten.

3) Experimental models, such as in these mice genetically susceptible to type 1 diabetes, showed a reduction of type 1 diabetes from 64% to 15% with avoidance of wheat.

4) The increase in type 1 diabetes corresponds to the introduction of new strains of wheat that resulted from the extensive genetics research and hybridizations carried out on this plant in the 1960s. In particular, unique protein antigens (immune-provoking sequences) were introduced with the dwarf variant attributable to alterations in the "D" genome of modern Triticum aestivum.

Proving the point is tough: Would you enroll your newborn in a study of wheat-containing diet versus no wheat, then watch for 10 years to see which group develops more type 1 diabetes? It is a doable study, just a logistical nightmare. Perhaps the point will be settled as more and more people catch onto the fact that modern wheat--or this thing we are being sold called "wheat"--is a corrupt and destructive "foodstuff" and eliminate it from their lives and the lives of their young children from birth onwards. Then a comparison of wheat-consuming versus non-wheat-consuming populations could be made. But it will be many years before this crucial question is settled.

Yet again, however, the footprints in the sand seem to lead back to wheat as potentially underlying an incredible amount of human illness and suffering. Yes, the stuff our USDA puts at the bottom, widest part of the food pyramid.
The ultimate insurance company cost savings

The ultimate insurance company cost savings

29. September 2010 William Davis (48)
I had a very disturbing conversation with a physician who is employed by an insurance company last week.

I admitted a patient in the hospital for very clear-cut reasons. She is one of my few non-compliant patients, doing none of the strategies I advocate--no fish oil, no vitamin D, no correction of her substantial lipoprotein abnormalities, not even medication. Much of this was because of difficult finances, some of it is because she is from the generation (she is in her late 70s) that tends to ignore preventive health, some of it is because she is a kind of happy-go-lucky personality. So her disease has been progressive and, now, life-threatening, including an abdominal aneurysm near-bursting in size (well above the 5.5 cm cutoff). The patient is also a sweet, cuddly grandmother. I have a hard time bullying nice little old ladies.

While she was in the hospital, the social worker told me that her case was being reviewed by her insurer and would likely be denied. Their medical officer wanted to speak to me.

So the medical officer called me and started asking pointed questions. "Why did you do that test? You know that she's not been compliant. Are you sure you want to do that? I don't think that's a good idea." In other words, this was not just a review of the case. This was an opportunity for the insurance company to intervene in the actual care of the patient.

Then the kicker: "Have you considered not doing anything and . . . just letting nature take its course?"

At first, I was stunned. "You mean let the patient die?"

Expressed in such blatant terms, while he was trying to be diplomatic, made him back down. "Well, uh, no, but she is a high-risk patient."

Anyway, this was the first instance I've encountered in which the insurance company is not just in the business of reviewing a case, but actually trying to intervene during the hospital stay, to the point of making the ultimate healthcare cost savings: Letting the patient die.

Unfortunately, never having had an experience like this before, I did not think to record the conversation or take notes. I am wondering if this is an issue to be taken up by the Insurance Board . . . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?
Tags :

Comments (48) -

  • Apra -- The Shaman

    9/29/2010 5:34:45 PM |

    There's no reason to blame this on health care legislation yet, it hasn't taken effect yet. It sounds like it is the usual coldhearted, profiteering insurance companies have engaged in.

  • Anonymous

    9/29/2010 5:50:58 PM |

    Who needs Death Panels -- the insurance industry has been doing this stuff for years and will continue under Obamacare.

  • Jon

    9/29/2010 5:53:16 PM |

    Wow. I'm stunned. I cannot believe they basically would come in to the hospital and ask you to let her die so they can save money...

    -Goes to show how out of wack peoples' values have become these days.

  • aek

    9/29/2010 6:02:09 PM |

    As stunning as that was, it does bring up an interesting point:  if this patient is essentially refusing interventions aimed at reversal/control of disease, is it appropriate to have an end of life discussion with her?  Is she opting for palliative care or hospice type care?  What are her goals?  Pain management? ADL function?  Some quality of life issue?

    I don't think that "bullying", scare tactics, coercive tactics, disease curative advocacy tactics  etc. are useful here.

    Having a frank discussion about her health aims and her knowledge in order to partner in achieving her health/quality of life goals may actually be where the utility will be.

    Great post.  Thanks for writing this.

  • Dawn

    9/29/2010 6:27:23 PM |

    I think the whole point of this episode is that Obamacare has nothing to do with "death panels" and that insurance companies have already been intervening (read: rationing) care for years.

  • David Csonka

    9/29/2010 7:19:44 PM |

    This is the kind of situation that got so many people riled up, when the topic of "death panels" arose during the health care reform debates.

  • Elenor

    9/29/2010 7:43:34 PM |

    No one is willing to point this out  -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization.  

    People are all up in arms about "oooohhh. Death panels!!" There is no human life that does not end in death. It is a REASONABLE economic consideration whether "society" (that is, you and I) owe anyone 'free' health care when they refuse to follow their medical practitioner's advice. (Yes, that means I pay for my own medical care, because I'm not insured, and I don't always agree with my doctor's advice.)  

    No one is "owed" full medical coverage when they're not willing to participate in their own health.  And society (you and I) CANNOT afford to pay for everyone's health care. Period. It's not possible.  There is not that much money on the planet!  

    I dislike the insurance companies -- but their attempt to protect their shareholders' money is a REASONSABLE financial decision based on rational grounds. Sorry that granny isn't able or willing to take care of herself, but we CANNOT afford to pay for everything for everyone.

  • Anonymous

    9/29/2010 8:05:20 PM |

    This is nothing new.  Insurance companies exist to make money.  They're neither good nor evil.  They're not interested in patient care.  They're interested in taking in more money than they give back out.

    Not sure what else you'd expect.

  • Tax Sale Property Jim

    9/29/2010 8:21:52 PM |

    Wow. Reading this chilled my blood to the point that I wondered for a split second if you made it up (nothing personal, was just that shocked).

    Shocking, and appalling.

  • Anonymous

    9/29/2010 8:26:58 PM |

    Given the complexity of the health care legislation, is it really possible to say that it will make the situation with insurers better or worse?  Some provisions aimed at limiting cost could make the situation worse, but the standardization of plans that the exchanges are likely to cause could make the situation better.  From my point of view, it seems to hard to answer without going into the details, and I have yet to see a detailed analysis.  Does anyone know of one?

    Even then, the full effects of the legislation is likely to be unpredictable due to the hybrid nature of our health care.  (See "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" for a description of various health care systems and how ours compare).

  • Chuck

    9/29/2010 8:27:03 PM |

    I tend to agree that if she refuses to make attempts to improve her health that a real "end of life" discussion is warranted.  maybe that was had and that what precipitated the test requests.

  • Barkeater

    9/29/2010 8:31:36 PM |

    If she has insurance, it is not "society" that should determine her care, it is her individual contractual right.  The insurance company is stuck with her and needs to pay for her care in accordance with the contract.  Trying to persuade her doctor not to prescribe the care he ought to is dealing off of the bottom of the deck.  

    She should be compliant, of course, but I am certain she cannot be denied further care under the policy just because she made some poor choices in the past.

    I think the reason "death panels" is such a scary concept (and insurance companies rationing care too) is that as individuals we want the right to the best care, and we thought we were getting it and paying for it through insurance.  Sadly, the entire system (as is and as will be) is skewed toward top-down decision-making, rather than patient empowerment (and responsibility).

    If her regular doctor were someone other than Dr. Davis, the care she might have gotten might not have done any good anyway.  God sent her a rowboat as the flood waters lapped at her feet, and she did not get in.

  • Anonymous

    9/29/2010 9:57:30 PM |

    As long as health insurance is a "for profit" business, this situation is bound to happen. Why should this surprise anyone ? Like any for profit business, they are in it for the money. It unfortunately for us, the paying public, involves our lives. I don't see anything changing unless the insurance industry is changed over to a non-profit one. Not likely to happen in the US.

  • Ellen

    9/29/2010 10:06:29 PM |

    ". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"


    Yes.

  • TJ

    9/29/2010 10:15:48 PM |

    >>>  No one is willing to point this out -- but if she is NOT willing to do anything to try to ameliorate her health, then perhaps "society" should not have to pay for her hospitalization

    -----

    Well the irony here is that the prescription of many docs for being "compliant" (ie. eating whole grains and takings statins etc) actually makes their health WORSE and costs society more money in the end (all the while lining the pockets of big pharma.)

    I agree in principle with your point about self-responsibility, but we have to be careful because few docs are as enlightened on this topic as Dr Davis are.

  • scall0way

    9/29/2010 10:41:33 PM |

    Hmm, well in many ways I *also* reuse to follow my medical practitioner's advice - by following a low carb diet, and refusing to take statins. So does that make me also "non-compliant" and ready for the death squad?

  • Anonymous

    9/30/2010 1:37:28 AM |

    I'm not sure how insurance works for the elderly, but remember for my father he didn't have a choice.  Once he reached the age of 65 he had to join the government plan.   I remember, he wasn't too happy about it.  Was the insurance firm for your patient Medicare?  Is there other insurance?  Scary tale regardless.

  • Anonymous

    9/30/2010 1:44:02 AM |

    Doesn't want to follow advice, change her diet, but likes to visit doctors a lot. Sounds like Elderly Munchausen syndrome.

  • rdyck

    9/30/2010 1:49:23 AM |

    No one has a right to health care and no one has a right to force care on another that refuses such care. Whether or not her decisions are "right" as judged by others is immaterial.

  • Anonymous

    9/30/2010 4:52:40 AM |

    Doesn't this woman have Medicare (i.e., govt health insurance for the elderly)?  

    Also, the health care law HAS taken effect as companies and insurance companies seek to adjust to its many diktats.  See today's news that McDonald's is thinking of dropping its (admittedly paltry) coverage and the "reform" has added much extra cost to many company bottom lines, not to mention additional tax reporting obligations.  Think what you will about the current system, but it will get worse with this reform.  Long lines, fewer specialists, no cutting-edge testing like the doctor advocates.  I know; I have lived in Canada.

  • Medical Insurance

    9/30/2010 5:31:35 AM |

    Group health insurance policies are always beneficial and the premiums for health insurance quotations are lowest when opted for a group health insurance policy, since it’s important to cover the health first.

  • Jack M.

    9/30/2010 9:21:31 AM |

    Thanks for being so transparent!  Do the drug companies offer you money to write prescriptions?  Have you heard about that from your colleagues?

  • Dr. William Davis

    9/30/2010 4:03:28 PM |

    Although I was frustrated by this (very nice) woman's inability or unwillingness to follow a preventive effort, my primary concern here is the aggressive effort to intervene by the insurance doctor.

    This is not the only instance of the clamp-down they have been exerting; we've been seeing it in many others ways. For instance, for most of the routine tests we run, including lab work, we have to get the okay of the insurer. Sounds fine, except my staff spends hours every day on the phone telling the insurance person things like "Their last HDL was 67," or nonsense that has nothing to do with justification of testing.

  • Anonymous

    9/30/2010 8:15:09 PM |

    Some of the comments here emphasize the problem of looking at health care of an individual as some sort of collective enterprise where society or some other collective claiming an interest should have its say in life or death decisions of the individual, rather than the individual, with the counsel of family and physician, retaining sole autonomy. For those of you advocating the right of the "collective," however viewed, to cast its vote on your treatment consider this: 1) by any objective standard, none of you took perfect care of your health, either, (glass houses & stones) 2) by even being on this website, you advertise your dissent from many prevailing opinions of "correct" medicine; maybe the collective would conclude that your suspect medical practices ought not to be rewarded with treatment in a crunch 3) e.g., maybe because you refused that statin & now you've had a CVA, nature ought to be allowed to take its course since you refused "best practice." I could say a lot more, but maybe you collectivists can figure it out from here.

  • Anonymous

    10/1/2010 10:31:32 AM |

    Welcome to "Obama Care"....

  • eh

    10/1/2010 4:11:26 PM |

    Happens all the time, in one way or another. My mother was sent home from the hospital in hospice care with morphine prescribed for "shortness of breath" (she had lung cancer). Clearly they didn't think there was anything more they could (or TBH, probably wanted -- she was 84) to do for her, but I guess they couldn't quite conscience doing nothing for someone experiencing difficulty breathing.

  • Anonymous

    10/1/2010 6:40:38 PM |

    Adopting unconventional approaches to health do not imply unconventional political or philosophical views. Please take these sorts of debates elsewhere.

  • Anonymous

    10/1/2010 11:43:22 PM |

    Another Anonymous said:

    "welcome to Obamacare"

    This will be the outcry going forward even though it is patently false.

    I say welcome to the culture of greed.


    2007 Total CEO Compensation

    Aetna - Ronald A. Williams: $23,045,834

    Cigna - H. Edward Hanway: $25,839,777

    Coventry - Dale B. Wolf: $14,869,823

    Health Net - Jay M. Gellert: $3,686,230

    Humana - Michael McCallister: $10,312,557

    U.Health - Grp Stephen J. Hemsley: $13,164,529

    WellPoint - Angela Braly (2007): $9,094,271

    These people do not earn this money.  There is nothing about them that is that special or irreplaceable.
    A whole lot of healthcare could have been provided in place of these bloated compensation packages.

    Let's look at H. Edward Hanway at Cigna as the poster child of egregiousness.  He makes just under a half million dollars EVERY WEEK!!!!  Now a half million dollars would buy a nice house (since it's not buying healthcare).  Something that many people would like to be able to afford on a 15 or 30 year mortgage.  But not H. Edward Hanway, he can pay cash for his house and buy himself another one every week if he wants.  That granny has to die early so H. Edward Hanway can have a new house every week is a small price to pay don't you think?

    So Anonymous who blames this on Obamacare, do us a favor and stay home on election day.  We can't afford YOU!  Sheesh

  • Anonymous

    10/2/2010 12:59:44 AM |

    Welcome to a taste of the coming Obama-care health era. This case is an example of something that no one will even raises an eyebrow about. Ahhhhhhh, the people's paradise. The joys of socialism, right here in America.

    And Apra, you're mistaken about the legislation not haven taken effect yet.

  • Anonymous

    10/2/2010 11:40:53 AM |

    Socialism? What a laugh. The "Affordable Care Act" is corporate welfare in the same way Medicare Part D was corporate welfare. Big Pharma got theirs, and now the insurance industry will get theirs. (like they were suffering before)

    And let's not forget Big Agra who gets to design the food pyramid with all those "heart healthy grains" at the top.I'm really surprised the corn industry couldn't buy a place for HFCS in the corporate pyramid.

    It's not socialism, it's an oligarchy, get used to it.

  • Anonymous

    10/2/2010 2:16:18 PM |

    Why am I not surprized?  If more doctors spoke out when insurance companies do this kind of thing, I'd be willing to bet that the insurance companies would soon stop doing it.

  • helene edwards

    10/2/2010 10:59:32 PM |

    Why don't you draft up a declaration in highly detailed form, and submit it to your state's Trial Lawyers' Association for future use?  The hardest thing to do in law is prove that an insurer has a "pattern" of acting badly.  You  could provide the starting point.

  • Cheryl

    10/3/2010 2:08:09 AM |

    Dr. Davis,

    Aren't you "intervening" in the care of this patient?  Aren't you taking her (or her insurance company's money) for treatment that she rejects?

    Maybe this is a patient you should decline to treat. Sounds like if she is a lovable old lady there is a doctor who will assist her in the way she wants, clearing your schedule to accept patients who want your style of care.

    Sounds harsh, but why try to push someone into something they don't want?  She's heard you, and doesn't want to listen. she wants to live her life they way she wants.  that "living" includes her eventual death.

    That's the way it goes birth-life-death. We don't typically choose our birth, and we're sometimes asleep during our life and death.  Still though, choice is ours.

  • Principal Quattrano

    10/3/2010 4:20:32 AM |

    The real issue is that a great many Americans cling desperately to absolutely horrible diets. I'm not even talking about that vast gray area of controversy, but of those who only occasionally eat fruit or vegetables and consume mostly wheat or corn, truly a third world diet.

    How does one motivate someone who clings desperately (in a quasi-religious cultish fashion) to something that not only may hurt them in the distant future, but actually does hurt them right now? Many celiacs continue to eat wheat even though they experience immediate symptoms.

    It is as though Americans have confused the diet they may need to continue living healthy lives with an imposition on their freedom of expression.

  • Anonymous

    10/3/2010 4:56:21 AM |

    happens all the time in Neurosurgery my friend.  Welcome to our world.

  • Anonymous

    10/3/2010 1:08:05 PM |

    I'm Canadian. Like most of Europe, we have national health care. If you are ill, you get care. It is only primary care.  Each Province has its own flavor so in some cases drugs are covered across the board and in other cases, like Ontario, it is only in hospital and if you don't have a drug plan and need expensive drugs....you are no better off than in the US. Anyone with financial means can,and does, go out of country if they want.  The government will pay for private care out-of country if they have emergency needs where a patient is at risk.

    Friends of mine from Boston visited recently (I lived there for 5 years) and I was surprised to hear the question of economic value for treatment of an at-risk patient come up.

    Insurance companies get no say in who gets health care, it is Universal and is part of who we are as a nation.  

    Having a profit layer in the middle does not sound like a good place to be. Sure people are covered, but the insurance company forced to take on "bad risk" will look to minimize the loss potential.

    Trev

  • John Townsend

    10/3/2010 3:40:23 PM |

    Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demoEdit  John Townsend said...nstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
    She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
    “pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

  • John Townsend

    10/3/2010 3:44:19 PM |

    Noting here a number of comments about the pushing of “heart healthy grains" on an unwitting public, I was intrigued this morning by the host of the Rachael Ray show (CBS)devoting a whole program on this very topic. While demonstrating various grain-based dishes, Rachael quite unabashedly pronounces that grains in the diet are very healthy, reducing the risk of heart disease by 25%, followed by a gleeful applause endorsement by the TV audience.
    She provided no backup source, nor an explanation of how this is so. This sort of irresponsible
    “pushing” of what is clearly a doubtful contention by celebrities of this ilk on mainstream media is appallingly reprehensible.

  • Anne

    10/4/2010 11:40:32 AM |

    Thankgoodness I don't live in the USA - that's all I can say !

  • f0xpawz

    10/7/2010 4:35:03 PM |

    ". . or is this a taste of things to come as the health insurers fall under increasing pressure with the legislative changes underway?"

    You nailed it.

    The redeeming feature of the free market is when one company is being a jerk, customers can take their business elsewhere. If they are big enough jerks they get sued and have to change their policies or at least get bad publicity.

    When the government is in charge of insurance, there is no elsewhere, they can arrest you for not paying your permium, they cannot be sued, and no amount of bad publicity will make them clean up their act.

  • Anonymous

    10/8/2010 2:27:48 PM |

    It’s annoying how some people such as f0xpawz use an otherwise importantly informative
    web-site and discussion board as a bully pulpit for their unlettered views on subjects entirely
    irrelevant to what the site is all about. This kind of behavior is straight up unseemly and offensive.

  • Anonymous

    10/25/2010 5:38:05 AM |

    I this happened to my mother last year.  

    The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

    I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

    All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

    Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

  • Anonymous

    10/25/2010 5:38:29 AM |

    I this happened to my mother last year.  

    The hospital and then nursing home staff were clearly driving her into the ground with bad food and defective medicines.  The doctor was a social climbing medical deity, the head nurse a borderline psychotic.  

    I was able to find more knowledgeable, broad minded doctors, cut the meds, improved the food, aded supplements over the nursing home's many obstructions, and we eventually escaped without mortality.  Mom got better, after eliminating a number of drugs and their horrid side effects (including nausea and vomiting, Parkinsonism).

    All the nursing homes in the locale exhibited the (sub)standard American diet syndrome.  I have since come to view US nursing homes as death traps.

    Also my wife's cousin died in UK last year under NHS cost control.  Her sister, an American MD, on the phone, recognized her sister had a systemic infection that needed IV antibiotic, stat.  NHS guidelines delayed treatment.  Dead in 48 hrs.

  • ash17

    11/9/2010 4:01:24 PM |

    Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
    -----------
    marqgibs
    Savings

  • zeeshan ali

    12/3/2010 8:31:36 AM |

    I found your blog very informative about insurance policies and plans.

  • Dana Seilhan

    12/11/2010 9:50:02 AM |

    I get angry every time I hear a don't-wanna-be-a-socialist RED-stater griping and complaining about "Obamacare" and how they don't want to be forced to pay for other people's bad health choices.  Then they bleat about death panels.  Have these kind souls ever BEEN without insurance?  Boy, I sure have.  Nothing says "death panel" like "sorry, we require payment up front and by the way, you don't qualify for Medicaid."

    Paying for someone's dumb decision to leave their front door unlocked at night when they suffer a burglary and have to call the cops?  No problem.  Paying for someone's dumb decision when they fall asleep in bed with a lit cigarette and need the fire department?  No problem.  What's the difference then?

    I do not understand and I will never understand.  Yet they go on about "death panels" and "un-American" and so on and so forth.  What, are fat people and chronically ill people not alive or something?  Or not American?

  • commercial insurance quote

    1/27/2011 2:31:50 PM |

    I am really shocked to read the whole post. In my opinion the real cause is the increasing number of fraud that people are doing by showing false information so that they will get the claim. This just results into the poor people who are true, suffers a lot.

  • Anonymous

    3/10/2011 1:23:55 AM |

    To: Dana Seilhan

    VERY WELL said!

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What Mr. Clinton did NOT do

12. February 2010 William Davis (36)
You've likely already heard that former President Bill Clinton underwent a heart catheterization today during which one of the bypass grafts to his coronary arteries was found to be occluded. The original coronary artery was therefore stented.

Dr. Alan Schwartz, Mr. Clinton's cardiologist, announced to the gathered press that Mr. Clinton had followed a good diet, had adopted a regular exercise program, but that his condition is a "chronic disease" like hypertension that is not cured by these efforts.



Needing a stent just 6 years after four bypass grafts are inserted is awfully soon. I would propose that it has less to do with having a "chronic disease" and more to do with all the things that Mr. Clinton likely is NOT doing. (In addition to all the other things that Mr. Clinton did not do.) In other words, in the Track Your Plaque world, procedures are a rarity, heart attacks virtually unheard of. I would wager that Mr. Clinton has been doing none of the following:

--Taking fish oil. Or, if his doctor was "advanced" enough to have advised him to take fish oil, not taking enough.
--Vitamin D--Followers of the Heart Scan Blog already know that vitamin D is the most incredible health find of the last 50 years, including its effects on reducing heart disease risk. Unless Mr. Clinton runs naked in a tropical sun, he is vitamin D deficient. A typical dose for a man his size is 8000 units per day (gelcap only!).
--Eating a true heart healthy diet. I'll bet Mr. Clinton's doctor, trying to do the "right" thing, follows the prudent course of advising a "balanced diet" that is low in fat--you know, the diet that causes heart disease. Judging by Mr. Clinton's body shape (central body fat), it is a virtual certainty that he conceals a severe small LDL pattern, the sort that is worsened by grains, improved with their elimination.
--Making sure that hidden causes are addressed--In addition to the "hidden" small LDL, lipoprotein(a) is another biggie. Lp(a) tends to be the province of people with greater than average intelligence. I believe Mr. Clinton qualifies in this regard. I would not be at all surprised if Mr. Clinton conceals a substantial lipoprotein(a) pattern, worsened in the presence of small LDL.
--Controlling after-meal blood sugars--Postprandial (after-eating) blood sugars are a major trigger for atherosclerotic plaque growth. There are easy-to-follow methods to blunt the after-meal rise of blood sugar. (This will be the subject of an in-depth upcoming Track Your Plaque Special Report.)
--Thyroid normalization--It might be as simple as taking iodine; it might involve a little more effort, such as supplemental T3. Regardless, thyroid normalization is an easy means to substantially reduce coronary risk and slow or stop coronary plaque growth.


It's not that tough to take a few steps to avoid bypass surgery in the first place. Or, if you've already had a procedure, a few additional steps (of the sort your doctor will likely not tell you about) and you can make your first bypass your only bypass.

Magnesium and arrhythmia

11. February 2010 William Davis (35)
Because magnesium is removed during municipal water treatment and is absent from most bottled water, deficiency of this crucial mineral is a growing problem.

Magnesium deficiency can manifest itself in a wide variety of ways, from muscle cramps (usually calves, toes, and fingers), erratic blood sugars, higher blood pressure, to heart rhythm problems. The abnormal heart rhythms that can arise due to magnesium deficiency include premature atrial contractions, premature ventricular contractions, multifocal atrial tachycardia, atrial fibrillation, and even ventricular tachycardia, fibrillation, and Torsade de Pointes (all potentially fatal). Magnesium is important!

Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

Here is a Heart Scan Blog reader's dramatic rhythm-correcting response to magnesium supplementation:



Dr. Davis,

A few months ago, I contacted you inquiring if you had written any articles on arrhythmia. You were generous enough to answer and guide me to an LEF article you'd written in which you stressed fish oil and magnesium. I had been suffering with bad PVCs [premature ventricular contractions] for over 20 years, and they had gotten so bad recently that I was told my next options were ablation or pacemaker!

I was already on fish oil and had not seen any difference, and so I researched the magnesium you suggested more thoroughly and found a huge body of studies supportng its effect on arrhythmia. I also read many posts on heart forums with people having success with it. After getting advice from various bloggers, I tried magnesium taurate in the morning and Natural Calm (an ionized form of mag citrate) in the afternoon and evening. Within three days the PVCs were quite diminished and by 2 weeks totally gone! As long as I keep taking it, they never return---not even one irregular blip---even when I drink strong coffee! The magnesium also cleared up my restless leg syndrome, my eye twitching, and insomnia. (Apparently, I was the poster-girl for magnesium deficiency.)

I am so angry that after all these years of suffering, trying various medications, and seeing at least 4 different cardiologists that NOT ONE ever even mentioned trying magnesium. The generosity of the few minutes you took to answer my email and steer me in a helpful direction brought me total relief.

Thank you SO MUCH!

Warmly,
Catherine C.

Video teleconference with Dr. Davis

10. February 2010 William Davis (4)

Dr. Davis is available for personal
one-on-one video teleconferencing

to discuss your heart health issues.


You can obtain Dr. Davis' expertise on issues important to your health, including:

Lipoprotein assessment

Heart scans and coronary calcium scores

Diet and nutrition

Weight loss

Vitamin D supplementation for optimal health

Proper use of omega-3 fatty acids/fish oil


Each personalized session is 30 minutes long and by appointment only. To arrange for a Video Teleconference, go to our Contact Page and specify Video Teleconference in your e-mail. We will contact you as soon as possible on how to arrange the teleconference.


The cost for each 30-minute session is $375, payable in advance. 30-minute follow-up sessions are $275.

(Track Your Plaque Members: Our Member cost is $300 for a 30-minute session; 30-minute follow-up sessions are $200.)

After the completion of your Video Teleconference session, a summary of the important issues discussed will be sent to you.

The Video Teleconference is not meant to replace the opinion of your doctor, nor diagnose or treat any condition. It is simply meant to provide additional discussion about your health issues that should be discussed further with your healthcare provider. Prescriptions cannot be provided.

Note: For an optimal experience, you will need a computer equipped with a microphone and video camera. (Video camera is optional; you will be able to see Dr. Davis, but he will not be able to see you if you lack a camera.)

We use Skype for video teleconferencing. If you do not have Skype or are unfamiliar with this service, our staff will walk you through the few steps required.

Thinner by Thursday

10. February 2010 William Davis (0)
You want to lose a few pounds . . . Okay, maybe 50 or 75.

Should you exercise? Lengthen you workout? Push the plate away, deny yourself seconds, use a smaller plate?

Of all the weight loss strategies I've tried in patients, there's only one that stands out as a means of obtaining immediate--meaning within 3 days--weight reduction.

Wheat elimination.

Omega-3 Index: 10% or greater?

9. February 2010 William Davis (19)
We've previously considered the question:

What is an ideal level of omega-3 fatty acids in the blood?

Recall that omega-3 levels in red blood cells (RBCs), a measure called the "omega-3 index," have been associated with risk for sudden cardiac death:





In a recent analysis, 265 people experiencing sudden death during a heart attack (ventricular fibrillation, successfully resuscitated) showed an omega-3 index of 4.88%, while 185 people not experiencing sudden death during a heart attack showed an omega-3 index of 6.08%.

We have more ambitious goals than just avoiding sudden death, of course! How about the omega-3 index associated with reduced risk for heart attack? A recent analysis of females from the Harvard School of Public Health suggested that RBC omega-3 levels as high as 8.99% were still associated with non-fatal heart attack (myocardial infarction), compared to 9.36% in those without heart attacks, suggesting that even higher levels are necessary to prevent non-fatal events.

Most recently, another study comparing 50 people after heart attack with 50 controls showed that people with heart attack had an omega-3 index of 9.57% vs 11.81% in controls--even higher. (This study was in a Korean population with higher fish consumption. There was also a powerful contribution to risk from trans fat RBC levels.) The investigators concluded: "The area under the receiver operating characteristic curve of fatty acid profiles was larger than that for traditional risk factors, suggesting that fatty acid profiles make a higher contribution to the discrimination of MI cases from controls compared with modified Framingham risk factors."

The data suggest that, while an omega-3 index of 7.3% is associated with reduced risk for sudden cardiac death, a higher level of 10% or greater is associated with less risk for heart attack. Surprisingly, fish consumption and fish oil intake account for only 47% of the variation in omega-3 index.

I believe the emerging data are becoming increasingly clear: If you desire maximal control over heart health, know your omega-3 index and keep it 10% or higher.

Let's soak 'em with fish oil

8. February 2010 William Davis (12)
If you don't think that charging drug prices for fish oil is wrong, take a look at a letter from an angry Heart Scan Blog reader:


Hello Dr. Davis,

My 44 year old brother had an MI [myocardial infarction, or heart attack] in June. He got pushed around due to "bad government insurance," a state-run program for the "uninsured": government pays 1/3, job pays 1/3, and individual pays 1/3.

What they didn't tell him is that there is no major medical coverage and little to no prescription coverage. We fought for 4 months to get him open heart surgery that the insurance was not going to pay for.

Now, with no assistance, terrible insurance, and no disability he has little to no income. He is a heavy equipment mechanic and is trying to be the "good American"-- take care of his bills, not file bankruptcy, etc.

Anyway, the doctors never seem to pay attention to what they prescribe. Lipitor was not working for him, due to side effects. Now they want to give him Zetia and Lovaza....Zetia at $114, and Lovoza is $169.85! Wow! For dead fish???? I think this is a little fishy! I looked up Lovaza, gee how nice, they will give you a $20 coupon....

Forget it, he can't afford this stuff. So I am enrolling in the Zetia program for him. And trying to get him OTC [over-the-counter] fish oil. The most prevalent fish oil around here (that I take myself is) Omega 3 Fish Oil that has EPA 410mg, DHA 274.

Thanks for your blog. It made me feel better that I wasn't the only one outraged by this stuff. I 've been a nurse for 20 years and it just never seems to get better. Thank you for your wisdom.

Sincerely JP, Tennessee


Had this reader not been aware that her brother could take fish oil as a nutritional supplement, he likely would have been denied the benefit of omega-3 fatty acids in slashing the risk for recurrent cardiovascular events. You and I can buy wonderfully safe and effective fish oil as a nutritional supplement, but there won't be a sexy drug representative to sell it, nor an expensive dinner and payment for a trip to Orlando to hear about it.

Heart scan gone wrong

6. February 2010 William Davis (9)
Those of you reading the Heart Scan Blog, I hope, have come to appreciate the power in measuring atherosclerotic plaque, the stuff of coronary artery disease, and not relying on indirect potential "risk factors," especially the fictitious LDL cholesterol.

However, like all things, even a great thing like heart scans can be misused. Here's a story of how a heart scan should NOT be used, submitted by a reader.


Dr. Davis,

First of all, let me start out by commending you on all of the work you are doing with your website, blogs, etc. You are truly a breath of fresh air at a time when conventional medicine is no longer making any sense. In the last 3 years or so, I have spent a lot of time using the internet to try and find answers . . . and just about every time, when I find things that make "sense," it coincides which the recommendations you provide. Thank You!!

I am 56 years old, and roughly 5 years ago I bought your book, Track Your Plaque, primarily because I had asked my then Internal Medicine physician about why we weren't more "proactive" about determining the state of our cardiovascular health...since the means to do so existed (scans). He was trying to get me to go on a statin because my cholesterol #'s were a little high and at the time I smoked. Other than that, I was in perfectly good health with no side effects or issues. The following year at my annual physical, we again discussed this and he gave me a few options and I ended up having a calcium score done, which showed some blockage, but again, I never had any pains, sweats, or any other symptoms whatsoever, and I am a very active former athlete. This is when I bought your book to try and set a course of plan that wouldn't just include pharmaceuticals.

At the same time, my father was in his last months of life dealing with prostate cancer and the multiple radiation and chemo treatments, so I was making many trips from my home to be with him . . . a 4 hour drive, and very disruptive to family, as I still have 3 kids at home. At what I thought was going to be my last visit with him, I stopped at the cemetery he had planned on being buried to confirm details and such and then started home.

As I was driving, a symptom hit me which I was unfamiliar with (pretty sure it was an anxiety attack now) and I stopped at a friend's house in Chicago, as I didn't want this to be a heart attack while I was driving. This is when I began thinking about the heart scan and the blockage, and ended up driving back later that night and went right to the ER....not because I had any chest pains, but thought it best to be checked out because I did not want to go before my dad did. I ended up staying the night. In the morning the cardiologist PA [physician's assistant] came in with a copy of my calcium scoring and said it was best to have a heart cath...which I was in total agreement with since it would definitively tell me the current condition of my coronary vessels. As I was getting ready to be wheeled into the cath lab, they approached me with a form that would allow them to treat (stent). This is where I became very uncomfortable, in that I had never even met the cardiologist . . . and I didn't like this. No one ever had asked if I was experiencing pains or anything else . . . but I buckled and signed the form.

Before you knew it, I was awake watching my heart being cathed and the cardiologist angry because they did not have all the right sizes of stents, so he had to use a couple extra and I ended up w/5 total . . . and my life changed forever! In looking back, I can't necessarily argue the need for intervention, but in hindsight, it would have been nice to have tried an alternative method of reversing my plaque, especially since I had never experienced any symptoms and didn't appear to be in any imminent danger.

Upon release from the hospital I was put on a cocktail of drugs that typically follow and I then began to search and research. No one talked to me about lifestyle changes other that smoking....but nothing on diet or other means of cholesterol control, etc....in fact, when I had to pick out my meals in the hospital, they wouldn't let me have cheese....but the rice crispy treat was fine....how stupid! They originally told me the Plavix had to last 6 months....and then 12....and then 2 years....I stayed on it for 1-1/2 years and it was the only thing other than a baby aspirin. I went to another cardiologist out of town and he wanted me back on 5 or 6 medications and said that now I had the stents....I would have to be on these for life.....and he was the expert that talked at several main conferences.....my last trip to him.

Now, fast forward to about 6 months ago: I was participating in a father-son soccer scrimmage and was playing goalie. It was wet out and I couldn't catch very well. So being the competitive person I am, I resorted to using my chest on several of the saves and also took a direct blow to my eye ( I wear glasses) and the eye started swelling up pretty good. We then finished and went inside to have pizza and everyone was concerned about my eye. About 30 minutes later I excused myself as i felt some pretty significant sweats and subsequently a pretty severe pain directly in the middle of my chest....I was having a heart attack! Called 911 and went to hospital (2-1/2 years since original stents) and my local cardiologist removed the blockage that was at the anterior portion of my 1st stent causing the blockage. The huge disappointment to me is that I had taken many steps to improve my overall health. But now that I have foreign bodies in my vessels, the chance of further clotting is something that i will most likely always have to live with.

BU, Michigan



This is an example of how heart scans should NOT be used. They should NEVER be used to justify a procedure, no matter how high the score or where the plaque is located. The "need" for procedures is determined by symptoms (BU's symptoms were hardly representative of heart disease), blood findings, EKG, stress testing, and perhaps CT coronary angiography. "Need" for procedures can never be justified simply on the basis of the presence of plaque by a heart scan calcium score.

Unnecessary procedures like the one BU underwent are not entirely benign, as his experience at the soccer game demonstrated.

Heart scans are truly helpful things. But, like many good things, they are subject to misuse in the hands of the uncaring or greedy.

Blood sugar: Fasting vs. postprandial

5. February 2010 William Davis (23)
Peter's fasting blood glucose: 89 mg/dl--perfect.

After one whole wheat bagel, apple, black coffee: 157 mg/dl--diabetic-range.

How common is this: Normal fasting blood sugar with diabetic range postprandial (after-eating) blood sugar?

It is shockingly common.

The endocrinologists have known this for some years, since a number of studies using oral glucose tolerance testing (OGTT) have demonstrated that fasting glucose is not a good method of screening people for diabetes or pre-diabetes, nor does it predict the magnitude of postprandial glucose. (In an OGTT, you usually drink 75 grams of glucose as a cola drink, followed by blood sugar checks. The conventional cut off for "impaired glucose tolerance" is 140-200 mg/dl; diabetes is 200 mg/dl or greater.) People with glucose levels during OGTT as high as 200 mg/dl may have normal fasting values below 100 mg/dl.

High postprandial glucose values are a coronary risk factor. While conventional guidelines say that a postprandial glucose (i.e., during OGTT) of 140 mg/dl or greater is a concern, coronary risk starts well below this. Risk is increased approximately 50% at 126 mg/dl. Risk may begin with postprandial glucoses as low as 100 mg/dl.

For this reason, postprandial (not OGTT) glucose checks are becoming an integral part of the Track Your Plaque program. We encourage postprandial blood glucose checks, followed by efforts to reduce postprandial glucose if they are high. More on this in future.

Diabetes from fruit

2. February 2010 William Davis (38)
Mitch sat in my office, looking much the same as he had on prior visits.

At 5 ft 7 inches, he weighed a comfortable 159 lb, though he did have a small visible "paunch" above his beltline.

I had been seeing Mitch for his heart scan score of 1157 caused by low HDL of 38 mg/dl, severe small LDL (87% of total LDL), and lipoprotein (a).

Part of Mitch's therapeutic program was elimination of wheat, cornstarch, and sugars, the three most flagrant triggers of small LDL particles, and weighing his diet in favor of oils and fats to reduce Lp(a). However, Mitch somehow failed to follow our restriction on fruit, which we limit to no more than two 4 oz servings per day, preferably berries. He thought we said "Eat all the fruit you want." And so he did.

Mitch had a banana, orange, and blueberries for breakfast. For lunch, along with some tuna or soup, he'd typically have half a melon, a pear, and red grapes. For snacks, he'd have an apple or nectarine. After dinner, it wasn't unusual for Mitch to have another piece of fruit for dessert.

Up until Mitch's last visit, he'd had blood glucose levels of 100-112 mg/dl, above normal and reflecting mild insulin resistance and pre-diabetes. Today, on his unlimited fruit diet, his blood sugar: 166 mg/dl--well into diabetes territory.

I helped Mitch understand the principles of our diet better and advised him to reduce his fruit intake to no more than the 2 small servings per day, as well as sticking to our "no wheat, no cornstarch, no sugar" principles.

While fruit is certainly better than, say, a half-cup of gummy bears (84.06 g carbohydrates, 50.12 g sugars), fruit is unavoidably high in carbohydrates and sugars.

Take a look at the carbohydrate content of some common fruits:

Apple, 1 medium (2-3/4" dia)
19.06 g carbohydrate (14.34 g sugar)

Banana, 1 medium (7" to 7-7/8" long)
26.95 g carbohydrate (14.43 g sugar)

Grapes, 1 cup
27.33 g carbohydrate (23.37 g sugar)

Pear, 1 medium
25.66 g carbohydrate (16.27 g sugar)

Source: USDA Food and Nutrient Database

Fruit has many healthy components, of course, such as fiber, flavonoids, and vitamin C. But it also comes with plenty of sugar. This is especially true of modern fruit, the sort that has been cultivated, hybridized, fertilized, gassed, etc. for size and sugar content.

When you hear such conventional advice like "eat plenty of fruits and vegetables," you should hear instead: "eat plenty of vegetables. Eat a small quantity of fruit."

The sniff test

31. January 2010 William Davis (0)
It is well established that omega-3 fatty acids from fish oil are free of mercury, PCBs, furans, and other pesticide residues. Several independent analyses have all agreed: little to none are contained in fish oil. In the Consumer Lab series of assessments, for example, no fish oil supplement failed because of any heavy metal or pesticide residue.

However, oxidative byproducts are a problem. Just as fish that sits on the store shelf or your refrigerator too long starts to smell "fishy," so will fish oil. When fish or fish oil becomes rancid, smelling like rotten fish at its worst, it means that