And you thought gasoline was expensive

2. June 2009 William Davis (5)

In 1995, the Palmaz coronary stent was introduced, the brainchild of Drs. Julio Palmaz and Richard Schatz. Medical device manufacturer, Johnson & Johnson, priced the device at $2500 per stent.

Let's put this into perspective: At just 0.05 grams per 15 millimeter stent, that put the price of the common stainless steel used to manufacture the stent at $22,650,000 per pound.

Only after several competing stents finally made it to market did J&J reduce its price to its bargain price of $1200, or $10,872,000 per pound. And to think that most of us were shocked to find out that the U.S. military paid $200 for a hammer.

Since 1995, a competitive market for stents has developed, pushing prices down. Now, you can purchase a brand-new coronary stent for as little as $4,000,000 per pound.

Medical device manufacturers have been guilty of a degree of greed that would make many Wall Street bankers blush. That's why I call medical devices "the industry of infinite markups."

"Hey buddy, wanna buy some exorphins?"

31. May 2009 William Davis (18)

Dr. Christine Zioudrou and colleagues at the National Institutes of Mental Health got this conversation going back in 1979 with their paper, Opioid peptides derived from food proteins: The exorphins.

Exorphins are exogenously-derived peptides (i.e., short amino acid sequences obtained from outside the body) that exert morphine-like properties. Mimicking the digestive process that occurs in the gastrointestinal tract using the gastric enzyme, pepsin, and hydrochloric acid (stomach acid), Zioudrou et al isolated peptides from wheat gluten with morphine-like activity. They followed this research path because of the apparent association of wheat and mental illness.

In the bioassays used, wheat-derived exorphins competed successfully with the endogenous opiate, met-enkephalin. Interestingly, casein-derived (i.e., casein milk protein) exorphins were also identified that also displayed opiate-binding activity, though less powerfully. The morphine-like activity was also blocked by the drug, naloxone (the same stuff given to people exposed to morphine overdose).

Among the many devastating effects of celiac disease , the immune disease that develops from wheat gluten exposure, are mental and emotional effects, such as anxiety, fatigue, mental "fog," depression, bipolar illness, and schizophrenia, that disappear with removal of gluten. Many parents of autistic children also advocate wheat-free diets for similar reasons.

Among the many wonderful comments posted on the last Heart Scan Blog post, "I can't do it," was Anne's:

I am not the Anne in your post, but I was addicted to wheat. It was my favorite food. I lived on and for breads. Then I discovered I was gluten sensitive and I did go through a withdrawal of about 4 days. After 4 days I noticed my health problems were disappearing. Depression, brain fog and joint pain are 3 of the many symptoms that disappeared. That was 6 yrs ago.

Tell Anne that I had dreams about bread in the beginning - they will pass. Now the donuts, breads, cookies and cakes in the stores and at work don't even look good. In fact, I don't like the smell of bread anymore. It takes time, but the cravings do pass.

Combine wheat"s exorphin-driven addictive potential with its flagrant blood sugar-increasing properties, and you have a formula that:

1) makes you fat
2) increases likelihood of diabetes, and
3) makes you want to keep on doing it.

Reminds me of nicotine.

My personal view: I have absolutely no remaining doubt that wheat products have no place in the human diet. Not only does the research provide a plausible basis for its adverse health effects, but having asked hundreds of people to remove it from their habits has yielded consistent and remarkable health benefits. Just read the reader comments here and here.

"I can't do it"

30. May 2009 William Davis (20)

Anne sat across from me, bent over and sobbing.

"I can't do it. I just can't do it! I cut out the breads and pasta for two days, then I start dreaming about it!

"And my husband is no help. He knows I'm trying to get off the wheat. But then he brings home a bunch of Danish or something. He knows I can't help myself!"

Having asked hundreds of people to completely remove wheat from their diet, I witness 30% of them go through such emotional and physical turmoil, not uncommonly to the point of tears. For about 10-20% of people who try, it is as hard as quitting cigarettes.

Make no mistake about it: For many people, wheat is addictive. It meets all the criteria for an addictive product: People crave it, consuming it creates a desire for more, lacking it triggers a withdrawal phenomenon. If wheat were illegal, there would surely be an active underground trafficking illicit bagels and pretzels.

Withdrawal consists of fatigue and mental fogginess that usually lasts 5-7 days. Just like quitting smoking, wheat withdrawal is harmless but no less profound in severity.

People who lack an addictive relationship with wheat usually have no idea what I'm talking about. To them, wheat is simply a grain, no different than oats.

But wheat addicts immediately know who they are. They are the ones who can't resist the warm dinner rolls served at the Italian restaurant, need to include something made of wheat at every meal, and crave it every 2 hours (matching the cycle of blood sugar peaks and valleys, the "valley" triggering the craving). When they stop the flow of immediately-released glucose that comes from wheat (with blood sugar peaks that occur higher and faster than table sugar), irresistible cravings kick in. Then watch out: They'll bite your hand off if you reach for that roll before they do.

Break the cycle and the body is confused: Where's the sugar? The body is accustomed to receiving a constant flow of easily-digested sugars.

Once the constant influx of sugars ceases, it takes 5-7 days for metabolism to shift towards fat mobilization as a source of energy. But along with fat mobilization comes a shrinking tummy, reducing the characteristic wheat belly.

If you try to quit smoking, you've got "crutches" like nicotine patches and gum, Zyban, Chantix, hypnosis, and group therapy sessions. If you try and quit wheat, what have you got? Nothing, to my knowledge. Nothing but sheer will power to divorce yourself from this enormously destructive, diabetes-causing, small LDL-increasing, inflammation-provoking, and addictive substance.

Spontaneous combustion, vampires, and goitrogens

26. May 2009 William Davis (17)

What do the following have in common:

Lima beans
Flaxseed
Broccoli
Cabbage
Kale
Soy
Millet
Sorghum?

They are all classified as goitrogens, or foods that have been shown to trigger goiter, or thyroid gland enlargement. Most of them do this either by blocking iodine uptake in the thyroid gland or by blocking the enzyme, thyroid peroxidase. This effect can lead to reduction in thyroid hormone output by the thyroid gland, which then triggers increased thyroid stimulating hormone (TSH) by the pituitary; increased TSH acts as a growth factor on the thyroid, thus goiter.

Add to this list of goitrogens the flavonoid, quercertin, found in abundance in red wine, grapes, apples, capers, tomatoes, cherries, raspberries, teas, and onions. Most of us obtain around 30 mg per day from our diet. Quercetin, often touted as a healthy flavonoid alongside resveratrol (e.g., Yang JY et al 2008), has been shown to be associated with reduced risk for heart disease and cancer. Many people even take quercetin as a nutritional supplement.

Quercetin has also been identified as a goitrogen (Giuliani C et al 2008).

What to make of all this?

Most of these observations have been made in in vitro ("test tube") preparations or in mice. Rabbits who consume a cabbage-only diet can develop goiter.

How about humans? The few trials conducted in humans have shown little or no effect. In most instances, the adverse effects of goitrogens have been eliminated with supplemental iodine. In other words, goitrogens seem to exert their ill thyroid effects when iodine deficiency is present. Restore iodine . . . no more goitrogens (with rare exceptions).

Should we as humans adopt a diet that avoids apples, grapes, tomatoes, red wine, tea, onions, soy etc. on the small chance that we will develop goiter?

I believe that we should avoid these common food-sourced goitrogens with as much enthusiasm as we should be worried about spontaneous combustion of humans or the appearance of vampires on our front porches. We are as likely to suffer low thyroid activity from quercetin or other "goitrogens" as we are to experience the "mitochondrial explosions" that are purported to set innocent people afire.

Magnesium and you-Part II

25. May 2009 William Davis (17)

Blood magnesium levels are a poor barometer for true body (intracellular) magnesium.

Only 1% of the body’s magnesium is in the blood, the remaining 99% stored in various body tissues, particularly bone and muscle. If blood magnesium is low, cellular magnesium levels are indeed low—very low.

If blood magnesium is normal, cellular or tissue levels of magnesium may still be low. Unfortunately, tissue magnesium levels are not easy to obtain in living, breathing humans. In all practicality, a blood magnesium test only helps if it’s low, while normal levels don’t necessarily mean anything and may provide false reassurance.

Short of performing a biopsy to measure tissue magnesium levels, several signs provide a tip-off that magnesium may be low:

• Heart arrhythmias—Having any sort of heart rhythm disorder should cause you to question whether magnesium levels in your body are adequate, since low magnesium levels trigger abnormal heart rhythms. In fact, in the hospital we give intravenous magnesium to quiet down abnormal rhythms.
• Low potassium— Low magnesium commonly accompanies low potassium. Potassium is another electrolyte depleted by diuretic use and is commonly deficient in many conditions (e.g., excessive alcohol use, hypertension, loss from malabsorption or diarrhea). Like magnesium, potassium may not be fully replenished by modern diets.
• Muscle cramps— Magnesium regulates muscle contraction. Leg cramps, or “charlie-horses”, painful vise-like cramps in calves, fingers, or other muscles, are a common symptom of magnesium deficiency. (Leg cramps that occur with physical activity, such as walking, are usually due to atherosclerotic blockages in the leg or abdominal arteries, not low magnesium.)
• Migraine headaches—Reflective of magnesium’s role in regulating blood vessel tone, low magnesium can trigger vascular spasm in the blood vessels of the brain. In some emergency rooms, they will actually administer intravenous magnesium to break a migraine.
• Metabolic syndrome—Magnesium plays a fundamental role in regulating insulin responses. Metabolic syndrome (low HDL, high triglycerides, small LDL, high blood pressure, increased blood sugar, excessive abdominal fat, etc.) is triggered by insulin responses gone awry and is clearly linked to low magnesium levels.

The absence of any of these tell-tale signs does not necessarily mean that tissue levels of magnesium are normal.

Then how do you really know? There really is no easy, available method to gauge body magnesium. As a practical solution, we therefore have aimed for maintaining serum levels of >2.1 mg/dl or RBC magnesium (a surrogate for tissue levels) of >6.0 mg/dl. (Going too high is not good either, so occasional monitoring really helps. However, I've only seen this once in a psychotic woman who drank ungodly amounts of magnesium-containing antacids for no apparent reason; she almost ended up on a respirator due to respiratory suppression by the magnesium level of 11 mg/dl!)

In all practicality, because of magnesium’s crucial role in health, its widespread deficiency in Americans, and the growing depletion of magnesium in water, supplemental magnesium is necessary for nearly everyone to ensure healthy levels.

More on magnesium to come.

Lethal Lipids II

22. May 2009 William Davis (7)

I call the combination of low HDL, small LDL, and lipoprotein(a) "lethal lipids," since the trio is an exceptionally potent predictor for heart disease. Uncorrected, the combination is a virtual guarantee of heart disease.

Ed is a perfect example of someone who came to my office recently with this pattern. His starting values:

HDL: 34 mg/dl

Small LDL: 78% of total LDL
NMR: Small LDL 1655 nmol/L; total LDL particle number 2122 nmol/L)

Lipoprotein(a): 205 nmol/L

The atherogenicity, or plaque-causing potential, of this pattern was reflected in Ed's heart scan score of 2133.

You can readily see that, of this combination, only HDL cholesterol would be adequately identified through conventional lipid testing. Small LDL and lipoprotein(a) need to be specifically measured via lipoprotein testing.

And, contrary to the drug industry's "statin drugs for everybody" motto, this pattern, while improved with statin therapy, is not shut off.

Specific correction of each abnormality is required. For instance, niacin addresses all three: increases HDL, reduces small LDL, and (usually) reduces lipoprotein(a). A standard low-fat diet makes this pattern worse by reducing HDL, increasing small LDL, and (usually) increasing lipoprotein(a).

"You've got 10 minutes"

20. May 2009 William Davis (0)

There's a new trend in office healthcare in Milwaukee: Time-restricted office visits.

I'm told by several physicians who are employed by a major healthcare system here in town that they are peridically watched--physically watched by an administrator--to make sure that they do not exceed the allotted 10 minutes of time. My cardiologist colleagues, I gather, were at first incredulous at such intrusions into their practices, but apparently had no choice: They were employees.

Goiter, goiter everywhere

20. May 2009 William Davis (25)

The results of the recent Heart Scan Blog poll are in.

The question:

Do you used iodized salt?

The responses:

Yes, I use iodized salt every day
94 (28%)

Yes, I use iodized salt occasionally
56 (16%)

No, I do not use any iodized salt
41 (12%)

No, I use a non-iodized salt (sea salt, Kosher)
126 (37%)

No, I use a non- or low-sodium substitute
15 (4%)

Thanks for your responses.

If only 28% of people are regular users of iodized salt, that means that the remainder--72%--are at risk for iodine deficiency if they are not getting iodine from an alternative source, such as a multivitamin or multimineral.

Even the occasional users of salt can be at risk. The common perception is that occasional use is probably sufficient to provide iodine. This is probably not true and not just because of the lower quantity of ingestion. Occasional users of salt tend to have their salt canister on the shelf for extended periods. The iodine is then lost, since iodine is volatile. In fact, iodine is virtually undetectable four weeks after a package is opened.

In my office, now that I'm looking for them much more systematically and carefully, I am finding about 2 people with goiters every day. They are not the obvious grotesque goiters of the early 20th century (when quack therapies like the last post, the Golden Medical Discovery, were popular). The goiters I am detecting are small and spongy. Yesterday alone I found 5 people with goiters, one of them visible to the eye and very distressing to the patient.

It seems to me that iodine deficiency is more prevalent than I ever thought. It is also something that is so simple to remedy, though not by increasing salt intake. Kelp tablets--cheap, available--have been working quite well in the office population. My sense is that the Recommended Daily Allowance of 150 mcg per day for adults is low and that many benefit from greater quantities, e.g., 500 mcg. What is is the ideal dose? To my knowledge, nobody has yet generated that data.

Thyroid issues being relatively new to my thinking, I now find it incredible that endocrinologists and the American Thyroid Association are not broadcasting this problem at the top of their lungs. This issue needs to be brought to the top of everyone's attention, or else we'll have history repeating itself and have goiters and thyroid dysfunction galore.

For more on this topic, see the previous Heart Scan Blog post, "Help keep your family goiter free."

Goiter and the Golden Medical Discovery

17. May 2009 William Davis (19)

Thick neck, or goitre . . . consists of an enlargement of the thyroid gland, which lies over and on each side of the trachea, or windpipe, between the prominence known as "Adam's apple" and the breast bone. The tumor gradually increases in front and laterally, until it produces great deformity, and often interferes with respiration and the act of swallowing. From its pressure on the great blood vessels running to and from the head, there is a constant liability to engorgement of blood in the brain, and to apoplexy, epilepsy, etc.

The causes of the affection are not well understood. The use of snow water, or water impregnated with some particular saline or calcareous matter, has been assigned as a cause. It has also been attributed to the use of water in which there is not a trace of iron, iodine, or bromine. . . The disease is often due to an impeded circulation in the large veins of the neck, from pressure of the clothing, or from the head being bent forward, a position which is often seen in school children.

Treatment

We have obtained excellent results in many cases, not too far advanced, by a method of treatment which consists in the employment of electrolysis. . . Many cases at the present time are operated upon with entire success.

Those who are afflicted with this disease and unable to avail themselves of special treatment cannot do better than to take Doctor Pierce's Alterative Extract, or Golden Medical Discovery, and apply over the skin around the tumor, night and morning, the following, which may be prepared at any drug store:

Resublimed Iodine--One dram
Iodide of Potassium--Four drams
Soft Water--Three ounces

Apply to the tumor, twice daily, with feather or camel hair pencil.

From The People's Common Sense Medical Adviser by R.V. Pierce, MD; 1918.

Magnesium and you-Part I

15. May 2009 William Davis (11)

If this were 10,000 B.C., you'd get your drinking water from streams, rivers, and lakes, all rich in mineral content. Humans became reliant on obtaining a considerable proportion of daily mineral needs from natural water sources.

21st century: We obtain drinking water from a spigot or plastic bottle. Pesticides and other chemicals seep into the water supply. Municipal water purification facilities have intensified water purification in most communities to remove contaminants like lead, pesticide residues, and nitrates. (For a really neat listing of the water quality of various cities, the University of Cincinnati makes this data available.)

But intensive water treatment also removes minerals like calcium and magnesium.

Many people have added water filters or purifiers to their homes,, like reverse osmosis and distillation, that are efficient at extracting any remaining minerals, converting “hard” into “soft” water. In fact, manufacturers of such devices boast of their power to yield pure water free of any “contaminant,” minerals like magnesium included. The magnesium content of water after passing through most commercial filters is zero.

Modern enthusiasm for bottled water has compounded the problem. Americans consumed a lot of bottled water, nearly 8 billion gallons last year. In the U.S., nearly all bottled water has little or no magnesium.

The result is that we can no longer rely on drinking water to provide magnesium. The Recommended Daily Allowance (RDA)—the amount required to prevent severe deficiency—for magnesium is 420 mg per day for men, 320 mg/day for women. In cities with the highest magnesium water content, only 30% of the RDA can be obtained by drinking two liters of tap water per day. In most cities, only a meager 10–20% of the daily requirement can be obtained. That leaves between 70–90% that needs to come from other sources. As a result, the average American ingests substantially less than the RDA.

Wheat belly

23. July 2007 William Davis (31)

You've heard of "beer bellies," the protuberant, sagging abdomen of someone who drinks excessive quantities of beer.

How about "wheat belly"?

That's the same protuberant, sagging abdomen that develops when you overindulge in processed wheat products like pretzels, crackers, breads, waffles, pancakes, breakfast cereals and pasta.

(By the way, this image, borrowed from the wonderful people at Wikipedia, is that of a teenager, who supplied a photo of himself.)

It represents the excessive visceral fat that laces the intestines and triggers a drop in HDL, rise in triglycerides, inflames small LDL particles, C-reactive protein, raises blood sugar, raises blood pressure, creates poor insulin responsiveness, etc.

How common is it? Just look around you and you'll quickly recognize it in dozens or hundreds of people in the next few minutes. It's everywhere.

Wheat bellies are created and propagated by the sea of mis-information that is delivered to your door every day by food manufacturers. It's the same campaign of mis-information that caused the wife of a patient of mine who was in the hospital (one of my rare hospitalizations) to balk in disbelief when I told her that her husband's 18 lb weight gain over the past 6 months was due to the Shredded Wheat Cereal for breakfast, turkey sandwiches for lunch, and whole wheat pasta for dinner.

"But that's what they told us to eat after Dan left the hospital after his last stent!"

Dan, at 260 lbs with a typical wheat belly, had small LDL, low HDL, high triglycerides, etc.

I hold the food companies responsible for this state of affairs, selling foods that are clearly causing enormous weight gain nationwide. Unfortunately, the idiocy that emits from Nabisco, Kraft, and Post (AKA Philip Morris); General Mills; Kelloggs; and their kind is aided and abetted by organizations like the American Heart Association, with the AHA stamp of approval on Cocoa Puffs, Cookie Crisp Cereal, and Berry Kix; and the American Diabetes Association, whose number one corporate sponsor is Cadbury Schweppes, the biggest soft drink and candy manufacturer in the world.

As I've said many times before, if you don't believe it, try this experiment: Eliminate all forms of wheat for a 4 week period--no breakfast cereals, no breads of any sort, no pasta, no crackers, no pretzels, etc. Instead, increase your vegetables, healthy oils, lean proteins (raw nuts, seeds, lean red meats, chicken, fish, turkey, eggs, Egg Beaters, low-fat yogurt and cottage cheese), fruits. Of course, avoid fruit drinks, candy, and other garbage foods, even if they're wheat-free.

Most people will report that a cloud has been lifted from their brains. Thinking is clearer, you have more energy, you don't poop out in the afternoon, you sleep more deeply, some rashes disappear. You will also notice that hunger ratchets down substantially. Most people lose the insatiable hunger pangs that occur 2-3 hours after a wheat-containing meal. Instead, hunger is a soft signal that gently prods you that it's time to consider eating again.

You will also make considerable gains towards gaining control over your risk for heart disease and your heart scan score, a crucial step in the Track Your Plaque program.

If health won't motivate them, maybe money will

23. July 2007 William Davis (0)

As part of our ongoing effort to educate everyone about the value of heart scans and how they can serve to start a program of heart disease prevention (or elimination), we occasionally distribute press releases on one facet of this discussion or another.

Here's the one we released on our Cost Calculator, the one we developed that showed that $20 billion would be saved annually just by applying the program to men, ages 40-59.

Accurate Detection and Prevention of Heart Disease Can Reduce Healthcare Costs, According to New Cost Analysis

A new cost analysis developed by cardiologist Dr. William Davis and his colleagues suggests that healthcare costs can be reduced by billions of dollars with the application of a simple program for heart disease detection and prevention.

Milwaukee, WI (PRWEB) July 23, 2007 -- Billions of dollars in healthcare could be saved every year by applying a simple program of heart disease detection and prevention on a wide scale in the U.S., suggests a new cost analysis developed by cardiologist Dr. William Davis and colleagues. Davis and his colleagues are the developers of the Track Your Plaque program for heart disease detection and prevention.

In the next 24 hours, 10,000 major heart procedures will be performed in hospitals across the U.S. The tab for this bill will top $400 billion in 2007 alone, nearly twice the sum spent on the war on cancer.

As costs escalate at an alarming rate, tools for prevention of disease are also advancing. While drugs like Lipitor® make headlines and dominate direct-to-consumer TV ads, a quiet revolution is taking place among physicians and the public eager to find better answers, some of which also pose opportunities for stretching the healthcare dollar.

“We’re essentially throwing away billions of dollars each and every year by ignoring the savings power of preventive strategies for heart disease,” proclaims Davis, a Milwaukee cardiologist. Davis is author of several books on heart disease detection and prevention, has been a vocal advocate for preventive strategies and is founder of www.cureality.com.

Davis and his colleagues developed a cost model to predict how much money could be saved by the adoption of new preventive strategies on a broad scale in the U.S. “The cost savings are startling. If males in the 40–59-year-old age group, for instance, were to undergo a simple CT heart scan for early detection of coronary heart disease, followed by a purposeful yet focused program of prevention using widely available tools, our cost model shows that we would save the American public over $20 billion annually. Extending this calculation to the broader population would multiply savings several-fold.”

Heart care is already the single largest healthcare category in the U.S. As costs go up by double-digit percentages, fewer people can afford healthcare. Those who can afford it spend an increasingly greater portion of their disposable income to maintain it. The Agency for Healthcare Research and Quality predicts that, at the current rate of growth, healthcare costs will balloon to absorb 20 percent of American Gross Domestic Product (GDP), about $4 trillion, in the next 10 years.

Davis points out that reducing the annual U.S. expenditure for heart disease by 20 to 30 percent could save between $80 and $120 billion each year. That marginal savings exceeds the sum the U.S. spends on the domestic war on terror.

Davis and his group have dubbed the conventional procedure-based approach to heart disease management the “crash and repair model” because of its focus on urgent procedural intervention that takes place in hospitals.

The crash and repair model is costly. According to the American Heart Association, a heart catheterization (performed 3,553 times per day, seven days a week) costs an average of $24,893; a coronary bypass operation (performed 1,170 times every day, seven days a week) costs an average of $67,823 (hospital costs, 2004, the latest year for which data are available). These figures don’t incorporate long-term costs incurred in the years following the procedure or time lost from work.

The relatively high payment to physicians and hospitals for performing high-tech heart procedures provides a disincentive to redirect patients to a less costly prevention model. The exceptional costs of high-tech, high-ticket heart procedures would become increasingly unnecessary if better heart disease preventive practices were delivered on a broad scale. “Like seatbelts, preventive measures for heart disease are more cost effective and extract a far lower toll in human suffering than the ‘crash and repair’ approach. Our cost calculations bear out the enormous savings possible. In fact, all of the tools necessary to deliver a method of early heart disease detection and prevention are already available throughout the U.S. We’ve just got to encourage physicians and the public to take advantage of them.”

The cost calculator program can be found at http://cureality.com/library/fl_hh005bankrupt.asp on the cureality.com Web site.

Track Your Plaque is an informational and educational Web site devoted to showing people how CT heart scans can be used as a starting point for a program of heart disease prevention and reversal.

What role calcium supplements?

22. July 2007 William Davis (8)

A frequent question in the Track Your Plaque program is whether taking calcium supplements to reduce risk for osteoporosis adds to calcium in arteries and raises CT heart scan scores.

No, calcium supplementation does not add to coronary calcium. Thankfully, there is some wisdom to calcium metabolism. Calcium deposition or resorption is under independent local control in bone, as it is in the artery wall. Taking calcium has no effect on calcium deposition in your coronary arteries.

However, there's a lot more to it. Taking calcium has only a modest effect on bone health. Most women can only hope to slow or stop calcium loss from bone by taking calcium supplements. Calcium supplements do not increase bone calcium. The reason why calcium supplementation works at all is, when calcium is absorbed into the blood, it provides a feedback signal to the parathyroid gland to shut down parathyroid hormone production, the hormone responsible for extracting calcium from bone. But the calcium itself does not end up deposited in bone.

Likewise, calcium supplements have essentially no effect on the artery wall. But vitamin D controls calcium absorption and, curiously, appears to exert a dramatic effect on calcium depostion in coronary arteries. In fact, I would credit vitamin D as among the most important factors in regulating arterial health that I've encountered in a long time.

Thus, bone health and arterial health do indeed intersect via calcium, but not through calcium supplements. Instead, the control exerted by vitamin D connects the seemingly unconnected processes.

Vitamin K2 provides another unexpected juxtaposition of the two processes. Deficiency of K2, which is proving to be a lot more common than previously thought, permits an enzyme in bone to exert unrestrained calcium extraction. Deficiency of K2 in artery walls allow another enzyme to deposit calcium and grow plaque without restraint. Yet another intersection between bone health and coronary health that involves calcium, but as a passive participant.

Stay tuned for a comprehensive Track Your Plaque Special Report on these topics coming in the next couple of weeks. I'm very excited about the emerging appreciation of calcium as an active ingredient in plaque, not a dumb, passive marker as previously thought. Vitamins D3 and K2 are among the keys to this phenomenon.

"Heart scans" are not always heart scans

18. July 2007 William Davis (6)

Beware of the media reports now being issued that warn that "CT heart scans" pose a risk for cancer.

One report can be viewed at
http://www.webmd.com/cancer/news/20070717/ct-heart-scan-radiation-cancer-risk.

This was triggered by a Columbia University study of risk for cancer based on the dose of radiation used in CT coronary angiograms. Theoretically, exposure to the radiation dose of CT coronary angiography can raise risk for cancer by 1 in 143 women if radiated in their 20s just from that single exposure.

If you've been following the Track Your Plaque discussion, as well as my diatribes in the Heart Scan Blog, you know that the media got it all wrong. The "heart scans" they are referring to are not the same as the heart scans that we discuss for the Track Your Plaque program.

A conventional heart scan (of the sort we refer to) exposes the recipient to 4 chest x-rays of radiation if an EBT device is used, around 8-10 chest x-rays of radiation if a 64-slice CT scanner is used. For the quality of information we obtain from these screening heart scans, we feel that it's an acceptable exposure.

The "heart scan" this study and subsequent reports refer to is not truly a screening heart scan, but a CT coronary angiogram, or CTA. CTAs are performed on the same CT or EBT devices, but involve far more radiation. CTA exposes the recipient to about 100 chest x-rays of radiation on a 64-slice device (more or less, depending on the way it is performed.) Just a couple of years ago, some centers were performing CTA on 16-slice devices, a practice I and the Track Your Plaque program vocally opposed, since up to 400 chest-rays of radiation were required! I even called a number of centers advising them that they were putting the public in jeopardy. CTAs also require injection of x-ray dye, just like any conventional angiogram.

CTA on 64-slice CT scanners require the same radiation exposure as a conventional heart catheterization, an issue glossed over in most conversations. In other words, the test that many of my colleageus so casually recommend poses a similar risk.

The message: the test I advocate for screening for coronary heart disease is a CT or EBT heart scan, not a CT coronary angiogram. CTA is a useful test and will get better and better as the engineers discover ways to reduce radiation exposure. But, in 2007, CTA is a diagnostic device, not a screening device. If you require an abdominal CT scan because your doctor suspects pancreatic cancer, or a CT scan of the brain because you might have a life-threatening aneurysm causing double-vision or seizures, it would be silly to not undergo the scan because of long-term and theoretical cancer risk.

But undergoing a CT coronary angiogram for screening purposes is ridiculous with present technology. I've said it before and I will say it--shout it--again:

CT coronary angiograms are not screening procedures; they are diagnostic procedures that should be taken seriously and do indeed pose measurable risk for cancer, a risk that is presently unacceptable for a screening test.

You wouldn't undergo a mammogram to screen for breast cancer if it exposed you to 100 chest x-rays of radiation, would you? Screening tests should be safe, reliable, accurate, and inexpensive. CT coronary angiography is none of these things. Genuine heart scans--the kind the Track Your Plaque program talks about and relies on--is all of those things.

Heavy traffic and heart scans

17. July 2007 William Davis (4)

A German study just reported in Circulation showed a graded response of EBT heart scan scores and proximity to traffic.

Living 50 meters (around 150 feet) from traffic increased the likelihood of a higher coronary calcium score by 63% compared to those living 200 meters (around 600 feet or two football fields) away from traffic.

A sample news story can be found at http://healthday.com/Article.asp?AID=606431.

The German investigators speculated that either the heightened exposure to exhaust fumes and/or the increased stress triggered by the constant noise might be the culprits behind the phenomenon.

I think the study is interesting in a number of ways from the Track Your Plaque viewpoint:

--Sometimes, there are factors that extend beyond lipoproteins, vitamin D restoration, optimism vs. pessimism, etc. that influence heart scan scoring. Are these factors powerful enough to overcome the adverse effects of traffic or other environmental effects? Can your proximity to traffic make or break your heart scan score-controlling efforts? This remains to be established.

--How much of a role does the stress issue play? Is this just a variation of the optimism vs. pessimism theme? I know when I'm in traffic in a car or on a bicycle, it often feels like I am at the mercy of hordes of people in a hurry, the soccer Moms on cell phones, applying makeup and eating, the hormonal teenager, the occasional drunk. Living in the midst of it must be demoralizing, a sense that you are lost in a sea of uncaring humanity stripped of individuality. When I look outside my den window right now, I see the lawn that I cut and water and the flowers and evergreen trees I've planted over the years. It provides a sense of life, belonging, and earth. What if instead I saw anonymous cars buzzing by, dozens of unfamiliar faces every minute, none of which plays any palpable role in my life?

--This simple observation will add to the healthy-consciousness and Green movements, since it is just one more piece of evidence that congestion and urbanization do indeed take their toll. In an obtuse way, I think this is one step closer to increasing disillusionment over the "over-processing" of human experience: processed foods, depersonalization and alienation in neighborhoods and homes, the dissolution of the American family.

Lastly, notice how the conversation about CT (in this case, EBT) heart scanning has seamlessly worked its way into conversation? Just ten years ago, a long-winded explanation would have been required in press reports on just what CT heart scanning was. Now, the information is presented and--well, we all know what heart scanning is, right?

A small study but one that comes at an important time. Good things will come from this one study. It will work its way into discussions about where to locate schools, how to situate homes in relation to heavy traffic, it will help "legitimize" this wonderful tool called heart scanning. How many medical tests beyond blood work can be easily performed in 4500 study participants?

I always like to take some simple observation and see how it fits into developing trends. Few studies or other human-generated experiences by themselves change the world. Instead, it happens in little incremental bits and pieces.

Digging for the truth

15. July 2007 William Davis (9)

I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth".

For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:

Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE.

Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations.

Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE.

Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.

Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips?

Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND.

Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY.

I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda.

I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information.

A new Track Your Plaque record: 63% reduction

14. July 2007 William Davis (3)

Stress can booby-trap the best efforts at reducing your CT heart scan score.

But Amy, our newest Track Your Plaque record holder, defied the effects of an overwhelmingly life stress to drop her heart scan score from 117 to 43--an amazing 63% reduction.

Amy beat our previous record holder, Neal, who achieved a 51% reduction. Though Neal had dropped his score from 339 to 161, a drop of 178 and more than Amy's 74 point drop, on a percentage basis Amy holds the record.

I'm also especially gratified that a woman now holds our record. I'm uncertain why, but the ladies have been shy and the men remain the dominant and vocal participants in our program. Speak up, ladies!

Amy's complete story can be found in our latest Track Your Plaque Newsletter to be released later this week, as well as an upcoming feature on the www.cureality.com website. (We've got to toot our horn about successes like this!)

The Ornish diet made me fat

13. July 2007 William Davis (16)

I got that kind of question today that tempts me to roll my eyes and say, "Not again!"

"If I want to reverse my heart scan score, should I do the Ornish diet?" You know, the one by Dr. Dean Ornish: Dr. Dean Ornish's Program for Reversal of Heart Disease.

I personally followed the Ornish program way back in the early 1990s. I reduced fat intake of all sorts to <10% of calories; eliminated all fish and meats, vegetable oils, and nuts; ate vegetables and fruits; and upped my reliance on whole grains. I used many of his recipes. I exercised by running 5 miles per day. (Far more than I do now!) I avoided sweets like candies and fruit juices.

What happened?

I gained 31 lbs, going from 155 to 186 lbs (I'm 5 ft 8 inches tall), my abdomen developed that loose, fleshy look, hanging over my beltline. My HDL plummeted to 28 mg/dl, triglycerides skyrocketed to 336 mg/dl, and I developed a severe small LDL pattern. I experienced a mental fogginess every afternoon. I felt tired and crabby much of the time. I sometimes struggled to suppress an irrational anger and frustration over the silliest things. I required huge amounts of coffee just to function day to day.

Hundreds of my patients suffered similar phenomena.

Few of us wear bell-bottomed jeans, tie-dyed t-shirts, or say "groovy". Rowan and Martin's Laugh-in is an "oldie", it's no longer cool to hold your index and middle fingers up in the "V" sign of peace. Even Ladybird Johnson has passed.

So should go the misadventures of the ultra low-fat diet, as articulated by Dr. Ornish. His day came and went. We learned from our mistakes. Now let's do something better.

Keep your eyes open for the New Track Your Plaque Diet.

Do lower heart scan scores grow faster?

11. July 2007 William Davis (0)

If Mary's heart scan score increases from 2 to 4 in one year, it represents a 100% increase in score.

If Jane's heart scan score increases from 1002 to 1004 over the same period, it represents <1% increase, even though the true growth is the same: 2 points.

This quirk of arithmetic needs to be factored in whenever you and your doctor try to puzzle out the meaning of an increasing CT heart scan score. Lower numbers, particularly those <100, can grow at seemingly much faster rates if viewed by percent per year increase. If no effort is taken to stop the growth in your coronary plaque, then scores of 10, 20, 30, or the like can easily grow 50-100% per year.

In contrast, scores of 1000, 1500, and 2000 tend to grow at "slower" rates of 20% or so per year without corrective efforts, even though the absolute growth may be substantial. (Obviously, this bit of confusion can be best eliminated by reducing your heart scan score, but it doesn't always work out that way.)

If we were all adept at advanced math, we should probably rely on logarithmic measures of plaque increase, rather than percent increase. Or, you can just keep in mind that the rate of plaque growth must always be viewed in the context of the absolute score.

Mr. Salazar: Check your Lp(a)

9. July 2007 William Davis (8)

Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.

At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending.

Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye.

But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.

I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).

It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.

I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why?

The answer is almost certain to be Lp(a).