CIS: Carbohydrate intolerance syndrome 28. January 2009 William Davis (28) Carbohydrate intolerance comes in many shades and colors, shapes and sizes. I call all of its varieties the Carbohydrate Intolerance Syndrome, or CIS. (Not to be confused with CSI, or Crime Scene Investigation . . . though, come to think of it, perhaps there are some interesting parallels!)At its extreme, it is called type II diabetes, in which any carbohydrate generates an extravant increase in blood sugar, followed by the domino effect of increased triglycerides, reduction in HDL, creation of small LDL, heightened inflammation, etc. and eventually to kidney disease, coronary atherosclerosis, neuropathies, etc. An intermediate form of carbohydrate intolerance is called metabolic syndrome, or pre-diabetes. These people, for the most part, look and act like diabetics, though their reaction to carbohydrate intake is not as bad. Blood sugar, for instance, might be 125 mg/dl fasting, 160 mg/dl after eating. The semi-arbitrary definition of metabolic syndrome includes at least three of the following: HDL <40 mg/dl in men, <50 mg/dl in women; triglycerides 150 mg/dl or greater; BP 135/80 or greater; waist circumference >40 inches in men, >35 inches in women; fasting glucose >100 mg/dl. This is where the conventional definitions stop: Either you are diabetic or have metabolic syndrome, or you have nothing at all. Unfortunately, this means that the millions of people with patterns not severe enough to match the standard definition of metabolic syndrome are often neglected.How about Kevin? Kevin, a 56 year old financial planner, is 5 ft 7 inches, 180 lbs (BMI 28.2). His basic measures:HDL 36 mg/dlTriglycerides 333 mg/dlBP 132/78Waist circumference 34 inchesBlood sugar 98 mg/dlKevin meets the criteria for metabolic syndrome on only two of the five criteria and therefore does not "qualify" for the diagnosis. Kevin's basic lipids showed LDL 170 mg/dl, HDL 36 mg/dl, triglycerides 333 mg/dl.But take a look at his underlying lipoprotein patterns (NMR):LDL particle number 2231 nmol/L (equivalent to a "true" LDL of 223 mg/dl)Small LDL 1811 nmol/l Large HDL 0.0 mg/dlIn other words, small LDL constitutes 81% of all LDL particles (1811/2231), a severe pattern. Large HDL is the healthy, protective fraction and Kevin has none. These are high-risk patterns for heart disease. These, too, are patterns of carbohydrate intolerance.Foods that trigger small LDL and reduction in healthy, large HDL include sugars, wheat, and cornstarch. Kevin is carbohydrate-intolerant, although he lacks the (fasting) blood sugar aspect of carbohydrate intolerance. But he shows all the underlying lipoprotein and other metabolic phenomena associated with carbohydrate intolerance. We could also cast all three conditions under the umbrella of "insulin resistance." But I prefer Carbohydrate Intolerance Syndrome, or CIS, since it immediately suggests the basic underlying cause: eating carbohydrates, especially those that trigger rapid and substantial surges in blood sugar. CIS is the Disease of the Century, judging by the figures (both numbers and humans) we are seeing. It will dominate healthcare in its various forms for many years to come. The first treatment for the Carbohydrate Intolerance Syndrome? Some would say the TZD class of drugs like Avandia. Others would say a DASH or TLC (American Heart Association) diet. How about liposuction, twice-daily Byetta injections, or even the emerging class of drugs to manipulate leptin and adiponectin? How do "heart healthy" foods like Cheerios and Cocoa Puffs fit into this? (Don't believe me? The American Heart Association says they're heart healthy!)The first treatment for the Carbohydrate Intolerance Syndrome is elimination of carbohydrates, except those that come from raw nuts and seeds, vegetables, occasional real fruit (not those green fake grapes), wine, and dark chocolates.
Making sense out of lipid changes 27. January 2009 William Davis (9) Maggie had been doing well on her program, enjoying favorable lipids near our 60-60-60 targets (HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less). Last fall, her last set of values were:Total cholesterol: 149 mg/dlLDL cholesterol: 67 mg/dlHDL cholesterol: 73 mg/dlTriglycerides: 43 mg/dl The holidays, as with most people, involved a frenzy of indulgent eating: Christmas cookies, cakes, pies, stuffing, potatoes, candies, etc.Maggie returned to the office 6 pounds heavier with these values: Total cholesterol: 210 mg/dlLDL cholesterol: 124 mg/dlHDL cholesterol: 57 mg/dlTriglycerides: 144 mg/dl In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol. What happened? At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy. Having done thousands of lipoprotein panels, I can tell you that, beneath the surface, the following has occurred:--Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood. --Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via cholesteryl-ester transfer protein (CETP) activity.--Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL. The critical factor is carbohydrate intake. This triggered a domino effect that is often misintepreted as excessive fat intake or a genetic predisposition. It is nothing of the kind. I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future and will revert promptly back to her 60-60-60 values.
How to Give Yourself Hashimoto's Thyroiditis: 101 25. January 2009 William Davis (18) I borrowed this from the enormously clever Dr. BG at The Animal Pharm Blog. How to Give Yourself Hashimoto's Thyroiditis: 101--lack of sunlight/vitamin D/indoor habitation--mental stress--more mental stress--sleep deprivation... (excessive mochas/lattes at Berkeley cafes)--excessive 'social' calendar--inherent family history of autoimmune disorders (who doesn't??)--wheat, wheat, and more wheat ingestion ('comfort foods' craved in times of high cortisol/stress, right? how did I know the carbs were killing me?)--lack of nutritious food containing EPA DHA, vitamin A, sat fats, minerals, iodine, etc--lack of play, exercise, movement (or ?overtraining perhaps for Oprah's case)--weight gain -- which begins an endless self-perpetuating vicous cycle of all the above (Is it stressful to balloon out for no apparent reason? YES)If you haven't done so already, take a look at Animal Pharm you will get a real kick out of Dr. BG's quick-witted take on things. We are systematically looking for low thyroid (hypothyroidism) in everyone and findings oodles of it, far more than I ever expected. Much of the low thyroid phenomena is due to active or previous Hashimoto's thyroiditis, the inflammatory process that exerts destructive effects on the delicate thyroid gland. It is presently unclear how much is due to iodine deficiency in this area, though iodine supplementation by itself (i.e., without thyroid hormone replacement) has not been yielding improved thyroid measures.I find this bothersome: Is low thyroid function the consequence of direct thyroid toxins (flame retardants like polybrominated diphenyl ethers, pesticide residues in vegetables and fruits, bisphenol A from polycarbonate plastics) or indirect toxins such as wheat via an autoimmune process (similar to that seen in celiac disease)? I don't know, but we've got to deal with the thyroid-destructive aftermath: Look for thyroid dysfunction, even in those without symptoms, and correct it. This has become a basic tenet of the Track Your Plaque approach for intensive reduction of coronary risk.
Framing 24. January 2009 William Davis (0) Heart health without a 12" incisionHeart health for less than $44,483 (Cost of a coronary stent according to the American Heart Association 2008 Update)Track Your Plaque: A drug-free zone
Why an RDA for vitamin D? 24. January 2009 William Davis (10) The Food and Nutrition Board (FNB) of the Institute of Medicine is charged with setting the values for the Recommended Daily Allowances of various essential nutrients. However, when it comes to vitamin D, the FNB decided that "evidence is insufficient to develop an RDA and [an Adequate Intake, AI] is set at a level assumed to ensure nutritional adequacy."The National Institutes of Health Office of Dietary Supplements lists the AI's for various groups of people:14-18 years Male 200 IUFemale 200 IU 19-50 years Male 200 IUFemale 200 IU 51-70 years Male 400 IUFemale 400 IU 71+ years Male 600 IUFemale 600 IU A reconsideration is apparently being planned in near-future that will (hopefully) incorporate the newest clinical data on vitamin D. My question: Who cares what the FNB decides? Let me explain. I monitor blood levels of 25-hydroxy vitamin D to assess the 1) starting level of vitamin D without supplementation, and 2) levels while on supplementation, preferably every 6 months (during sunny weather, during cold weather). I have done for the past 3 years in over 1000 people. The requirement for vitamin D dose in adults, in my experience, ranges from as low as 1000 units per day to as high as 20,000 units per day, rarely more. The vast majority of women require 5000 units per day, males 6000 units per day to maintain a blood level in the desirable range. (I aim for 60-70 ng/ml.) A graph of the distribution of vitamin D needs in my area (Milwaukee, Wisconsin) is a bell curve, a curve more heavily weighted towards the upper vitamin D dose range. Need for vitamin D to achieve the same blood level is influenced by age, sex, body size, race, presence or absence of a gallbladder, as well as other factors. But needs vary, even among similar people. For instance, a 50-year old woman weighing 140 lbs might need 4000 units per day to achieve a blood level of 25-hydroxy vitamin D of 65 ng/ml. Another 50-year old woman weighing 140 lbs might need 8000 units to achieve the same level, and 4000 units might increase her level to only 38 ng/ml. Two similar women, very different vitamin D needs. The differences can be striking. Being a hormone--not a vitamin, as it was incorrectly labeled--vitamin D needs to be tightly regulated. We should have neither too little nor too much. I would liken it to thyroid hormones, which need to be tightly regulated for ideal health. Now the FNB, in light of new data, wants to set new AI's, or even RDA's, for vitamin D for the U.S. This is an impossible--impossible--task. There is no way a broad policy can be crafted that serves everyone. It is impossible to state that all men or women, categorized by age, require X units vitamin D. This is pure folly and it is misleading. The only rational answer for the FNB to provide is to declare that:It is not possible to establish the precise need for vitamin D in a specific individual because of the multiplicity of factors, only some of which are known, that determine vitamin D needs. Individual need can only be determined by assessing the blood level of 25-hydroxy vitamin D prior to initiation of replacement and periodically following replacement to assess the adequacy of replacement dose. Continuing reassessment is recommended (e.g., every 6-12 months), as needs change with weight, lifestyle, and age. Sure, it adds around $100-150 per year per person for lab testing to assess vitamin D levels. But the health gains made--reduced fractures, reduced incidence of diabetes, reduced colon, breast, and prostate cancer, less depression, reduced heart attack and heart procedures--will more than compensate.
Bargains for Armour Thyroid 23. January 2009 William Davis (10) We use Armour thyroid almost exclusively. I take it myself. I am thoroughly convinced that, for at least 70% of people requiring thyroid replacement, the added T3 component makes a world of difference compared to isolated T4: More energy, greater alertness, better mental clarity, better weight loss, larger effects on lipoprotein(a). However, there are substantial price disparities in different pharmacies. For instance, in Milwaukee, a one month supply of 1 grain (60 mg) tablets costs:Walgreen's: $36.00Walmart: $9.54That's a considerable price difference of nearly 400%. It therefore always pays to do a little bit of shopping.
Heart scan mis-information on WebMD 22. January 2009 William Davis (3) If you want information on how prescription drugs fit into your life, then go to WebMD. But, if you are looking for information that cuts through the bullcrap, is untainted by the heavy-handed tactics of the drug industry, or doesn't support the "a heart catheterization for everyone" mentality, then don't go there. A Heart Scan Blog reader turned up this gem on the WebMD site:Should I have a coronary calcium scan to check for heart disease?In their report, they list some reasons why a heart scan should not be obtained: Most of the time, a physical exam and other tests can give your doctor enough information about your risk for heart disease.You've got to be kidding me. What tests are they talking about? EKG? An EKG is a crude test that tells us virtually nothing about the coronary arteries or risk for heart attack. It is helpful for heart rhythm disorders and other abnormalities, but virtually useless for coronary disease unless a heart attack is underway or has already occurred. Cholesterol? What level of cholesterol tells you whether you have heart disease? Tim Russert, for instance, had the same cholesterol values 5 years before his death as on the day of his death. How would cholesterol have told his doctor that heart disease was present? Does an LDL cholesterol of 180 mg/dl tell you that someone has heart disease, while a value of 130 mg/dl does not?Stress test? You mean like the normal stress test Bill Clinton had 3 months before his near-fatal collapse? Stress tests are a gauge of coronary flow, not of coronary atherosclerosis. Huge amounts of coronary plaque can be present while a stress test--flow--remains normal.No, a physical exam does not uncover hidden heart disease. The annual physical is, in fact, a miserable failure for detection of hidden heart disease. You already know that your risk for heart disease is low or high. The test works best in people who are at medium risk but have no symptoms. This bit of fiction comes from a compromise statement in the American College of Cardiology and American Heart Association "consensus" document detailing the role of heart scans in heart disease detection. Because conventional thinkers don't like the idea of very early detection in seemingly "low risk" people, nor do they like the idea of diabetics and smokers getting a heart scan because it's "obvious" that they are already at high risk, the middle ground was taken: Scan only people at "intermediate risk." What the heck is "intermediate risk"? Are you intermediate risk? In real life, using standard criteria (e.g., Framingham scoring) to decide who is low-, intermediate-, or high-risk fails to identify over 1/3 of people with heart disease, while subjecting many without heart disease (plaque) to needless treatment (meaning statins, since that's the only real preventive treatment on most doc's armamentarium).Another fact: Heart scans are quantitative, not just normal or abnormal. Your heart scan score could be 5, it could be 150, it could be 500, or 5000---it makes a world of difference. The risk of someone with a score of 5000 is at very different risk than someone with a score of 5. It also provides much greater precision in determining a specific individual's risk. The test could give a high score even if your arteries aren't blocked. This might lead to extra tests that you don't need.This is true--if you doctor has no idea what he's doing. This is like saying that you should never take your car to the repair shop because all mechanics are crooks. If you have an unscrupulous cardiologist who tells you that your heart scan score of 25 means you are a "walking time bomb" and heart catheterization is necessary to determine whether you "need" a stent . . . well, this is no different than the shady mechanic who advises you that your car's engine needs to be rebuilt for $3000, when all you really needed was a few new spark plugs. Coronary plaque is coronary plaque, and all coronary plaque has potential for rupture (heart attack)--even if it doesn't block flow. This is true at a score of 10, or 100, or 1000--all plaque is potentially rupture-prone, though the more plaque you have, the greater the likelihood. Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk. They're missing the point: ANY calcium score carries risk, so a low score should not be interpreted as having no risk. But, just because a procedure like stenting or bypass surgery is not necessary to restore flow, it does not mean that risk for plaque rupture is not present--it is. Any heart scan score should be taken seriously, meaning sufficient reason to engage in a program of heart disease prevention. Although not perfect, coronary calcium scoring remains the easiest, most accessible, and least expensive means for identifying and quantifying coronary atherosclerosis--whether or not WebMD and drug industry money endorse them.
Heart disease prevention for the helpless, ignorant, or non-compliant 19. January 2009 William Davis (9) The media outlets are gushing with the "research"/marketing spinoff of the JUPITER trial, an analysis conducted by Dr. Erica Spatz of Yale University, that suggests that statin use should be expanded to many millions more Americans. USA Today: Study: 11M more should get statinsMedPage: JUPITER Findings Could Boost Statin Use by 20%Health Day: Millions More Americans Might Be Placed on StatinsWebMD: More May Benefit From Cholesterol Drugs: Study Shows More Would Qualify for Statin Treatment if Levels of C-Reactive Protein Are ConsideredYou may recall that the JUPITER trial (discussed previously in a Heart Scan Blog post) studied the cardiovascular event risk in people with "normal" LDL cholesterols (calculated, of course, not measured) of 130 mg/dl or less, along with increased c-reactive protein, a crude inflammatory measure, of 2.0 mg/dl or greater. A 54% (relative) reduction in cardiovascular events occured in the group taking Crestor 20 mg per day.What I see is a confluence of events that have brought us to the "statin drugs are necessary for everybody" mentality: --The low-fat diet advice of the last 40 years has increased non-fat or low-fat foods that increase LDL, since removing fat from the diet provokes small LDL particle production and increases the inflammatory measure, c-reactive protein (CRP). --The proliferation of "healthy whole grains" in the diet have also caused an enormous boom in small LDL particles, which is interpreted to the uninformed as "high cholesterol." It has also provoked CRP substantially. --The advice to reduce salt intake has brought a broad re-emergence of iodine deficiency. When thyroid hormone production flags due to lack of iodine, LDL cholesterol (both large and small) increase. --Our lives, which are increasingly conducted indoors, have worsened the already substantial vitamin D deficiency. While deficiency of vitamin D primarily reduces HDL cholesterol and increases triglycerides, it can also cause an increase in small LDL and a large increase in CRP. In other words, a collection of events have converged to provide the appearance of high LDL cholesterol and high CRP. This creates the appearance of a "need" for statin drugs. The JUPITER trial now exploits both the LDL-reducing and CRP-decreasing effects of statins.I view the foisting of Crestor via the JUPITER argument on the public as taking full advantage of the helpless situation many Americans find themselves in: Reduce fat intake, eat more healthy whole grains and . . . cholesterol and CRP skyrocket! "You need Crestor! See, I told you it was genetic," says the doctor after attending the nice AstraZeneca-sponsored drug dinner. The notion of using a drug like Crestor to suppress inflammatory patterns is absurd. There are far better, easier, cheaper ways to achieve this goal, along with dramatic reduction in cardiovascular risk. But, to the ignorant, the helpless, or non-compliant with real change in diet and lifestyle, then Crestor does serve a purpose. I can only hope that the excessive pushing of statin drugs on the public will sooner or later trigger a revolt.
Dangerous mis-information on vitamin D 16. January 2009 William Davis (12) Please be aware of the ignorant propagating information they have no business talking about. This is one such example, a newsletter from pop exercise guru, Denise Austin. Although I'm sure she means well, I have a problem with people who have little to no experience acting as experts, often simply repeating something they heard or read somewhere else. This has become particular problem with the internet, in which bad information can get repeated thousands of times, gaining a veil of "truth" through its repetition. I don't mean to pick specifically on Ms. Austin, since she joins a growing rank of pseudo-experts on vitamin D and other topics, but she provides a good example of how far wrong mainstream information can be. Simple StepsDo Your D!Calcium often gets all the glory when it comes to bone health. But calcium wouldn't benefit your bones much without its partner, vitamin D!Why? Vitamin D helps your body absorb calcium and keeps your bones strong; without enough vitamin D, the bones become weak and brittle, a condition called rickets in children, and osteomalacia in adults. Adults from 19 to 50 need 200 IU (international units) per day, while those from 51 to 70 need 400 IU daily. Those over 70 need 600 IU per day.Unfortunately, not too many foods contain vitamin D naturally. (Tuna and sardines canned in oil are exceptions.) The good news is that many foods are now regularly fortified with vitamin D, including milk, some yogurts, margarines, and cereals. You can check the Nutrition Facts panel on packages and containers to see which products contain vitamin D. It should be listed after vitamins A and C, along with the percentage of the Daily Value that a serving of the food contains. The Daily Value (a standardized amount) for vitamin D is 400 IU, so if your milk has 25 percent of the Daily Value, it provides 100 IU per serving.Your skin can also make vitamin D using sunlight — you need about a half hour of exposure to the midday sun twice a week to make enough. However, because of the increasing incidence of skin cancer in recent years, many experts are wary about recommending sun exposure.So take a closer look at milk, yogurt, cereal, and margarine selections when you're doing your weekly shopping, and stock up on brands that are fortified with vitamin D. Challenge yourself to consume one source of vitamin D at least three days in the coming week! If you cannot eat or do not like any foods that contain vitamin D or are fortified with it, talk with your health care provider ASAP about taking a supplement. Your bones will thank you for it!Let me list the mistakes in this piece: Adults from 19 to 50 need 200 IU (international units) per day, while those from 51 to 70 need 400 IU daily. Those over 70 need 600 IU per day.This is the same non-information that was the advice originally offe>Was The Inferno nothing more than Danté’s prediction for the state of the U.S. diet circa 2009? I’m kidding on The Inferno allusion, but the American diet nonetheless sure does create an inferno of unhealthy phenomena. If we define hell on earth as constant, nagging pain and discomfort; energy depleted sufficient to impair daily function; chronic bloating and diarrhea; leg swelling, peculiar rashes; progression of a multitude of diseases ranging from annoying all the way to fatal . . . well, that’s a pretty bleak picture. I have indeed witnessed it all. Inclusion of wheat products in the human diet in many (not all--I'd estimate 70% of people) yields devastating health effects. In a few, it shortens life. In the majority, it leads to a slow, miserable hell of inflammatory diseases like arthritis, coronary disease, and cancer.I have also witnessed dramatic reversal of these phenomena with complete removal of wheat from the diet. (For clarity, I am not only referring to gluten sensitivity, the immune reaction gone haywire that plagues people with celiac disease. Celiac disease is indeed another variety of wheat-induced hell on earth, but there’s far more to it than that.) Among the effects I’ve seen with wheat removal: --Increased clarity of thought—I can vouch for this effect personally. Focus, concentration, the capacity for prolonged application of effort is restored with elimination of wheat. --ADHD—Marked improvement in attention deficit disorder can occur in children and adults with this focus-depriving condition. Elimination of sugars and cornstarch may be necessary for full effect. While it doesn’t seem to work in everybody, the effect is powerful enough?and the implications so profound?that it is worthy of consideration in any child with this condition.--Improved bowel health?Many people plagued by chronic bloating, diarrhea, and urgency experience complete relief. In its most extreme form, it is expressed as celiac disease. But there are a larger number of people who do not have celiac who are plagued by this lesser form of intestinal intolerance. --Weight loss?Patients have told me that they were actually frightened when they eliminated wheat, meaning weight dropped so rapidly that they thought something was wrong. Nothing is wrong. The weight loss simply represents the removal of this bizarre, unphysiologic trigger of appetite, blood sugar, insulin, and weight gain. Relevant to heart health, wheat elimination effects include: --LDL cholesterol reduction?Yes, I know that it’s not what the “official” agencies say. “Reduce fat, reduce saturated fat and cholesterol will drop.” That’s barely true; reductions of saturated fat reduce LDL cholesterol, but rarely more than 20 mg/dl. In contrast, elimination of wheat yields LDL reductions of 40, 50, even 100 mg/dl. And the type of LDL reduced is the small particle variety, the kind mostly likely to lead to heart disease. (Cutting fat generally reduces large LDL, the more benign form.)--Triglyceride reduction?Triglyceride reductions of 50, 100, even 1000 mg/dl can be achieved with elimination of wheat (though elimination of cornstarch, sugars, and other processed carbohydrates may be necessary for full benefit). --HDL increase?A variable response, but increase of 5-10 mg/dl are common. --Reduced inflammation?This phenomenon expresses itself in a number of ways, including dramatic reductions of the common inflammatory marker, c-reactive protein. While the media focuses on the JUPITER trial of rosuvastatin’s (Crestor) ability to reduce CRP 50-60%, wheat elimination can easily match this?without drugs.What's more, you just feel better. Less commonly, I've seen arthritis (both common osteoarthritis and rheumatoid arthritis), skin rashes, and sleep disorders improve. I've had pre-diabetics become non-pre-diabetics, diabetics become non-diabetics. It's not so much whether that food is carbohydrate-rich or protein-rich. It really comes down to calories, a very simple message.'— Dr. Frank SacksWhile some advocate the notion that only calories count and diet composition makes no difference, I offer this possibility: Whether or not weight is lost by diet, there can be enormous health effects independent of weight based on the composition of diet. Inclusion or exclusion of wheat is one such crucial factor. Image courtesy Wikipedia, The Eighth Circle of Hell.
Unique vitamin D observations 21. February 2009 William Davis (47) It seems not a single day passes that I don’t learn something new about this unique hormone (mis)named “vitamin D.” From its humble beginnings recognized only as the factor responsible for bone maturation (with deficiency leading to childhood rickets), vitamin D now commands a recognized role in almost every conceivable aspect of health and disease. Among the unique observations I’ve made over the past several years, having corrected vitamin D in well over 1000 people: --Ankylosing spondylitis—This fairly rare genetic disease programs a peculiar solidification of the spinal column that leads to disabling restriction of spinal mobility, accompanied by incapacitating pain. A physician came to my office after reading my Life Extension summary of vitamin D’s cardiovascular benefits, After reading it, he put himself on vitamin D 10,000 units per day and verified “therapeutic” levels with a blood test. He came to my office (he requested a consultation) and proudly showed me his near-normal spine flexibility that, until approximately 2 months earlier, had left him rigid and unable to even tie his shoes. He also reported that the chronic pain that had left him completely dependent on anti-inflammatory agents and narcotics was nearly entirely gone. --Aortic valve disease—The list of people with either aortic valve stenosis (stiffness) or insufficiency (leakiness) that develops later in life (not congenitally deformed or bicuspid aortic valves) continues to grow. Not everyone responds, but some of the cases I’ve seen have been nothing short of miraculous. One man had severe aortic valve insufficiency (severe leakiness). After one year of vitamin D, 8000 units per day that yielded a blood level of 67 ng/ml, the insufficiency was down to a minimal level. Before vitamin D, I had never witnessed “spontaneous” reversal of aortic valve disease before. --Chest pain—Not the chest pain of heart disease, but a chronic gnawing, toothache-like pain in the sternum that is relieved within days of initiating vitamin D. I don’t know precisely why this happens, but I speculate that, with vitamin D deficiency, there is disordered calcium metabolism, and perhaps the sternal pain represents cellular (osteoclastic) activity that is eroding sternal calcium for the purpose of maintaining blood calcium, since intestinal absorption of calcium is poor. Replace vitamin D and the abnormal calcium uptake ceases. Just my guess. --Relief from claustrophobia—This one has me stumped. But one man’s vivid description of his previously terrifying experiences in elevators and other enclosed spaces, now entirely gone raises some fascinating questions. For instance, how much psychological disease is nothing more than the expression of disordered metabolism from vitamin D deficiency? --Immunity from viral infections--I first learned of this association from Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com). Dr. Cannell recounts his experience with the 2006 flu epidemic in the hospital in northern California, where he is a psychiatrist charged with the health of 200 inpatients held in closed wards. While the flu spread like wildfire to the patients in all the other wards, the 200 patients in Dr. Cannell’s ward failed to contract a single episode of flu while taking 2000 units of vitamin D per day. I was a little skeptical at first, having been disappointed by the failure of several nutritional agents like zinc, vitamin C (perhaps, at best, a minimal effect). Now, three years into my vitamin D experience, I am absolutely convinced that Dr. Cannells’ early observation was correct: Vitamin D enhances immunity enormously. Not only have I personally not had a virus in several years, the majority of my staff and patients have been happily free of viral infections. There have been a few, to be sure. But the usual winters of hacking, coughing, and sneezing in the office have become largely a memory. It is a rare person who comes to the office with viral symptoms. With new lessons being learned every day, it is inevitable that other fascinating new vitamin D observations have yet to be made.
Dr. Michael Eades on the Paleolithic diet 18. February 2009 William Davis (16) Dr. Michael Eades has posted an absolutely spectacular commentary on the Paleolithic diet concept: Rapid health improvements with a Paleolithic dietThe post was prompted by publication of a study that tried to recreate a Paleolithic-like diet experience over a brief study period:Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.Dr. Eades discussion is wonderfully insightful and comprehensive and there's little to say to improve on his discussion. I'd make one small point: From what I see in my experience, the improvements in lipid patterns seen in the brief period of this study are very likely to have been primarily due to the removal of wheat. Followers of this blog know that wheat elimination is among the most powerful cholesterol-reducing strategies available.
What vitamin D form? 15. February 2009 William Davis (36) In response to questions regarding why don't vitamin D tablets work, here are my observations. When I first started correcting vitamin D levels around 3 1/2 years ago, people would begin with starting 25-hydroxy vitamin D blood levels of around 20 ng/ml. Taking, say, 6000 units vitamin D as tablets over 3 months yielded blood levels of 24-30 ng/ml. Taking 6000 units in an oil-based form, and blood levels would commonly be 60-70 ng/ml. In other words, tablets are very poorly absorbed. I also saw very erratic absorption with tablets, with tremendous variation in blood levels. I witnessed this effect many times. I finally began telling patients to avoid the tablets altogether. It's simply not worth it. Taking dose X of tablets, you cannot predict what the blood level of vitamin D will be. Now, you can sometimes make the tablets get absorbed by either taking with a teaspoon of oil (e.g., olive, flaxseed) or taking with an oil-rich meal. However, I am uncertain just how consistent the absorption is under these circumstances, not having done this enough times to know. Oil-filled gelcaps are no more expensive than tablets (or perhaps a dollar more). Health food store employees and pharmacists don't know this. I have had many patients come to the office claiming they changed to tablets because that's all their health food store or pharmacy carried and the person behind the counter assured them it was the same. Blood level of vitamin D to confirm: right back down to the starting level or near it--little or no absorption. The only way to know whether a preparation is absorbed is to check a blood level. But, in my experience, having checked vitamin D blood levels thousands of times, gelcaps never fail; tablets fail over 80% of the time.
Vitamin D for the pharmaceutically challenged 14. February 2009 William Davis (20) Most Heart Scan Blog readers already know: Your doctor has been brainwashed by the pharmaceutical industry. Your doctor more than likely has spent the better part of his or her career in the Guantanamo Bay of healthcare, water-boarded by seductive sales representatives, enticed with promises of fame and riches, threatened with ostracism from the clubby internal halls of healthcare if--gasp!--he or she didn't subscribe to the "rule" that only drugs are good, anything else is bad. The same FDA-approval-is-necessary-to-be-good brand of nonsense is gaining popularity among my colleagues who, having caught some mention (on the Today Show, Oprah, or similar source of medical information), hope to join the vitamin D hoopla.People will proudly declare that they are taking a high dose of vitamin D: 50,000 units once per week. No. They are taking a barely useful form: D2, ergocalciferol. Studies examining the reliability of the D2 form differ: There's the Heaney study suggesting that D2 is less effective than D3: Vitamin D2 is much less effective than vitamin D3 in humansThen there's the Holick study showing they are equivalent:Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D.My experience is more in line with the Heaney study: Little or no real effect with D2. One particularly illustrative case I witnessed was a woman who was mistakenly prescribed D2 at 50,000 units per day. She told me that she'd been taking it for a year. I fully expected to see clear-cut signs of toxicity (e.g., high blood calcium levels). Curiously, she showed no signs of toxicity. Nor did she show any vitamin D at all in her blood: 25-hydroxy D level of zero--literally zero.I've witnessed similar phenomena several times: plenty of vitamin D2 . . . very little vitamin D in the blood. All in all, I suppose that D2 is better than No-D at all. But you are far better off joining the ranks of the pharmaceutically challenged and go with the stuff that really works: D3. D3, or cholecalciferol, yields confident increases in blood levels. It is inexpensive, safe, and an exact copy of the human form of vitamin D. (Of course, gelcap or drops only, NEVER tablets.) There is absolute NO reason to take vitamin D2, the form that sometimes works, sometimes doesn't, the facsimile plant form issued by the drug industry.
Why don't stents prevent heart attack? 12. February 2009 William Davis (11) No study has ever documented that stents prevent future heart attack. But, in day-to-day practice, stents are frequently implanted for just this reason. A little clarification. Stents do prevent heart attack--if the heart attack is already underway, either as an "acute myocardial infarction" or "unstable angina." In other words, a plaque in a coronary artery can rupture just like a little volcano. Rather than spewing lava, the underlying plaque contents--fibrous tissue, inflammatory cells, cholesterol crystals, fatty material, debris--are exposed to flowing blood and trigger spasm of the artery and blood clot formation. A ruptured plaque is typically found in people who go to the emergency room with severe chest pain or have difficulty breathing. A heart catheterization is performed, a severe (e.g., 90-100%--completely closed) is found. A stent in this situation is of clear-cut benefit. What is not clearly beneficial is someone with no symptoms, symptoms only with physical activity that has been present for at least several months, or someone with a high heart scan score and no symptoms. In these circumstances, stent implantation does not reduce risk for future heart attack. Why?Take a look at this angiogram of a right coronary artery. You can seen plaque all along the artery (represented by areas that appear pinched off. There are at least 4 visible.) Putting one 15 millimeter stent in the artery will only affect the area of artery stented. (Stents vary in length, but typically are 12-18 millimeters in length.) The right coronary artery is about 10 times or more this length. There are also two other arteries of similar length. A stent at one location will do nothing to affect the potential for rupture in any of the other plaque-laden areas. Say a stent is implanted in the "worst" blockage in this right coronary artery, the plaque located at around 9 o'clock. What about all the other plaques? They can still rupture. Why not put in many stents, say, 4 or 5, and stent all the visible plaques? Two reasons: 1) Plaque you can't even see on an angiogram can still rupture, and 2) it is very costly (easily $30,000 at the very least), 3) incurs greater procedural risk, and 4) messes up the artery for future procedures, since a steel-lined artery that develops more disease in future will be more difficult to re-implant stents, bypass, or perform other procedural manipulations. The point: Putting in stents does not reduce potential for plaque rupture in the entire artery. What can prevent plaque rupture? That's the whole point of following an effective prevention program: prevent plaque rupture. (Of course, this discussion cannot encompass the wide variety of potential situations that may cause your doctor to individualize your approach. Nonetheless, when advised to have an elective heart procedure, a healthy dose of skepticism and is clearly a good practice.) Top image courtesy National Heart, Lung, and Blood Institute.