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."
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Comments (25) -

  • kris

    5/20/2009 1:36:55 PM |

    Here is the list of over 20 publications about iodine consumption, trials, findings etc. the normal intake may be between 6 to 12.5 mg. it depends on the individual. when i started taking iodine, i took 50 mg a day for a week before i felt any uneasiness. now one drop of lugol's iodine every second day and i can feel it. according to these studies some vitamins along with iodine play major role in coping with iodine.  
    http://www.optimox.com/pics/Iodine/opt_Research_I.shtml

  • Andrew

    5/20/2009 1:46:23 PM |

    What's your opinion of potassium salt?  I've been using an iodized mixture of sodium and potassium chloride lately, and it seems to be working well.

  • Anna

    5/20/2009 3:20:08 PM |

    I use sea salt that contains iodine naturally.  I also eat a little seaweed a couple of times a week.  Is this sufficient?  Who knows, I guess.  I definitely do not have any trace of a goiter.  I eat fish, too, and live on the East Coast, so I assume I'm okay.

  • StephenB

    5/20/2009 4:25:04 PM |

    The full text of the article "Iodine: deficiency and therapeutic considerations" (Altern Med Rev 13 (2): 116–27. PMID 18590348) published last year can be found here.

    From that article: "The safety of therapeutic doses of iodine above the established safe upper limit of 1 mg is evident in the lack of toxicity in the Japanese population that consumes 25 times the median intake of iodine consumption in the United States. Japan’s population suffers no demonstrable increased incidence of autoimmune thyroiditis or hypothyroidism."

    StephenB

  • Anna

    5/20/2009 7:12:55 PM |

    This is the second time in a week the volatility of iodine has come to my attention.  I'm wondering now about the iodine content in the dried kelp and sea vegetable I have in my cupboards.  Anyone have any idea how stable that iodine is?

  • Lena

    5/20/2009 9:49:59 PM |

    What do you reckon about "Celtic" salt (unprocessed sea salt)? I know there's a lot of websites out there granting it near-magical health properties, about which I am extremely skeptical, however it does have a notable amount of minerals in it (about 8% I believe) whereas regular salt is refined to 99.99% purity. So it seems if you switched to using that kind of salt in your diet (including avoiding processed food which uses pure salt) it may have some benefit. It does contain iodine naturally, too.

    I'm taking Lugol's solution too, about 10 drops a day. My iodine was measured at "<1" by the lab four months ago.

    Australian readers should note that Australian soil has an extremely low iodine content (it's official), so our food is unlikely to be a source of pretty much any iodine at all. A case where being a "localvore" won't help your health.

  • David

    5/20/2009 10:46:21 PM |

    I take Iosol iodine, which I get from iherb.com for $12 a bottle (http://bit.ly/6qLtp). Each drop has 1,830 mcg of iodine, and there are over 600 drops per bottle. Great price, and seems to be working well for me. My feet aren't nearly as cold as they used to be, and my usually low morning temperature has started increasing a bit, too.

  • k1wuk

    5/20/2009 11:11:47 PM |

    My sense is that goiter is the least of the problems with iodine deficiency.  Kris has pointed to the optimox link.  Optimox manufactures Iodoral which is iodine in convenient tablet form.  The liquid form, Lugol's Solution is available here: http://www.jcrows.com/iodine.html

    My sister began taking iodine supplements last year at my suggestion.  She had experienced 5 years of bad mammograms so she was delighted to have a flawless mammogram three months after starting iodine.  It seems that iodine is so important to the baby that breasts concentrate iodine as well as thyroid glands.  Fibrocystic breast disease seems to be the equivalent of goiter in breast tissue.

    She also reports better sleep, fresh moist skin, quicker reactions, more energy and most recently, iodine applied to poison ivy stopped the itch.  

    Dr Flechas reports here, http://iodine4health.com/disease/diabetes/flechas_diabetes.htm, that half of his diabetic patients are no longer diabetic when they get enough iodine.  The other half improve, needing less medication.  It seems to me that iodine should be the first step in treating diabetes of either form.

    Iodine deficiency is reported to be the number one preventable cause of mental retardation in the world.  Looking around, goiter is not the most visible evidence of iodine deficiency.

    Having read the papers at Optimox and others, iodine looks to be under appreciated and quite valuable.

  • Anonymous

    5/20/2009 11:20:12 PM |

    I cut out all salt from my 'nutritarian'-style diet a few weeks ago.  But as a result of reading this blog, I started taking 4 kelp tablets a day at about the same time. I'm thinking of taking even more tablets to try to help increase my low (according to the endocrinologists and this blog, not my doctor) thyroid numbers.

  • mongander

    5/21/2009 2:59:31 AM |

    I rarely use salt except when I make popcorn.  I do occasionally take an Iodoral and sometimes add a drop of aquarium Lugols iodine in my 7 gallon water jugs of thermal spring water.

    When I run in 90°+ weather I do take salt.  So far, at age 70, no goiter.

  • Anonymous

    5/21/2009 3:41:24 AM |

    You might want to let Michael Bloomberg know that cutting back on salt will increase iodine deficiency.  His health commissioner, Thomas Frieden, was picked to head the CDC.

  • Anonymous

    5/21/2009 1:07:58 PM |

    Remember to reduce bromine exposure which competes with iodine.

  • maxthedog

    5/21/2009 7:36:42 PM |

    Thanks for conducting the poll - very interesting.
    We use kosher and sea salt at home - about a year ago, this late realization (regarding iodine) led me to a bit of a panic, as my pregnant wife was nearing full term...  I was especially worried because I had been all along encouraging heavy broccoli consumption as well, and brassica vegetables are known to have goitrogenic properties (as do many other types of plants).  I then learned she was taking a multi-supplement that contained a fair amount of iodine. Whew.  Our 10 month old is doing great now, fortunately. Smile  
    We consume a fair amount of garlic and seafood as well, though I don't really know what the variance is when it comes to garlic's iodine content - presumably it depends quite a bit on the soil and water supply (Apparently, California garlic and broccoli assimilate a fair amount of selenium from the water used for irrigation, for instance).

  • Anna

    5/22/2009 12:28:23 AM |

    k1wuk,

    I'd love ot know if you have any more info on iodine and breast health.

  • Trinkwasser

    5/22/2009 1:23:41 PM |

    I checked the Lo-Salt I've been using since I decided I might not be getting enough potassium (a good guess as electrolytes came back spot on) and realise it is NOT iodised.

    Not a problem personally I suspect as I eat plenty of fish and shellfish but I'm now trialling various seaweeds, sea vegetables etc. Even without a deficiency these are tasty!

    Goiter is not common in the UK AFAIK, nowhere near as common as hypothyroid. However when young my father was hyperthyroid, which damaged his heart before being treated. Didn't stop the tough old goat from living into his eighties, but in retrospect I believe he may well have become hypothyroid in later life as a result of the operation (not diagnosed), and probably also became Type 2 (not diagnosed)in his last years.

    Probably wouldn't have lengthened his life but diagnosis and treatment would certainly have improved the quality a lot. All power to you for continuing your posts on these issues. They will suffice until Endocrine System SP1 is released.

  • kris

    5/22/2009 6:10:49 PM |

    Anna

    Here are few links to dr. david derry's answer to patients(in case you haven't found it your self). My wife had painted lugol's iodine externally for breast lumps, with unbelievable results only after applying it twice. she was having hard time sleeping on one side. her mother passed away few years ago with Breast cancer. just being extra careful now.
    http://thyroid.about.com/library/derry/bl1a.htm

    http://thyroid.about.com/library/derry/bl2a.htm

  • Leslie

    5/22/2009 9:54:39 PM |

    My endo told me to avoid iodine because it exacerbates goiter in hypothyroid.  Also, those of you who know nursing mothers, PLEASE be aware of this risk:

    from pubmed:
    1: Hypothyroidism in a breast-fed preterm infant resulting from maternal topical iodine exposure.
    Smith VC, Svoren BM, Wolfsdorf JI.
    Pediatr. 2006 Oct;149(4):566-7.
    PMID: 17011335 [PubMed - indexed for MEDLINE]

    2: Transient hypothyroidism in a breastfed infant after maternal use of iodoform gauze.
    L'Italien A, Starceski PJ, Dixit NM.
    J Pediatr Endocrinol Metab. 2004 Apr;17(4):665-7.
    PMID: 15198299 [PubMed - indexed for MEDLINE]

    3: Early childhood caries: an overview with reference to our experience in California.
    DenBesten P, Berkowitz R.
    J Calif Dent Assoc. 2003 Feb;31(2):139-43. Review.
    PMID: 12636318 [PubMed - indexed for MEDLINE]

    4: Transient neonatal hypothyroidism during breastfeeding after post-natal maternal topical iodine treatment.
    Casteels K, Pünt S, Brämswig J.
    Eur J Pediatr. 2000 Sep;159(9):716-7. No abstract available.
    PMID: 11014479 [PubMed - indexed for MEDLINE]

    5: [Iodine antiseptics are not harmless]
    Arena Ansotegui J, Emparanza Knörr JI.
    An Esp Pediatr. 2000 Jul;53(1):25-9. Review. Spanish.
    PMID: 10998400 [PubMed - indexed for MEDLINE]

    6: The newborn should be protected from dangerous transient induced hypothyroidism.
    López-Sastre JB, Rivas-Crespo MF.
    Acta Paediatr. 1995 Oct;84(10):1211. No abstract available.
    PMID: 8563243 [PubMed - indexed for MEDLINE]

    7: [Thyroid function disturbances in an infant following maternal topical use of polydine]
    Rakover Y, Adar H.
    Harefuah. 1989 May 10; 116(10):527-9. Hebrew.
    PMID: 2792927 [PubMed - indexed for MEDLINE]

    8: Topical iodine, breastfeeding, and neonatal hypothyroidism.
    Delange F, Chanoine JP, Abrassart C, Bourdoux P.
    Arch Dis Child. 1988 Jan;63(1):106-7. No abstract available.
    PMID: 3348642 [PubMed - indexed for MEDLINE]

  • kris

    5/23/2009 2:32:32 AM |

    Leslie.
    here is another study from the same site search. i just copied the whole paragraph.

    1: Public Health Nutr. 2007 Dec;10(12A):1600-1.Click here to read Links
        Iodine nutrition of pregnant and lactating women in Hong Kong, where intake is of borderline sufficiency.
        Kung AW.

        Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.

        OBJECTIVE: To describe the iodine nutrition of pregnant and lactating women in Hong Kong, where intake is of borderline sufficiency.DESIGN: Review of cross-sectional and prospective studies.SETTING: China, Hong Kong Special Administrative Region (SAR).SUBJECTS: Pregnant and lactating women.RESULTS: Studies of pregnant women in Hong Kong SAR have revealed an increase in the urinary iodine (UI) concentration as pregnancy advances. A significant percentage of women had a sub-normal serum thyroid hormone concentration at full term. Although iodine is concentrated by the mammary gland, 19% of all mothers had low iodine concentrations in their breast milk. The moderate correlation between the concentrations of iodine in breast milk and urine suggests that an adequate maternal urinary iodine concentration cannot reliably indicate that an infant is getting enough iodine in breast milk. Therefore, some breast-fed infants may still be at risk of low iodine intake, and additional iodine supplements, other than salt iodisation, would be warranted in this population.CONCLUSIONS: The currently recommended intake of iodine through universal salt iodisation may not be adequate for pregnant and lactating women, and supplementation during pregnancy and lactation should be further considered in light of the latest recommendations.

    here is another one.

    1: J Am Coll Nutr. 2004 Apr;23(2):97-101.Click here to read Links
        Maternal thiocyanate and thyroid status during breast-feeding.
        Dorea JG.

        Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.

        Cyanogenic glucosides are naturally present in plant foods especially in staple foods (cassava) consumed by millions of people in tropical countries. Most traditional processing methods are effective in detoxifying such goitrogens to safe levels of consumption. Nevertheless, residual cyanide (CN) is rapidly metabolized to thiocyanate (SCN) by existing metabolic pathways. There are concerns that goitrogens may reach the nursing infants through breast feeding or cow's milk based formulas. SCN adverse effects are commonly observed in relation to cigarette smoking. Breast-feeding is effective in protecting infants from anti-thyroid effects of eventual or habitual maternal exposure to CN exposure in food (cassava) or recreation habits (cigarette smoking). SCN goitrogenic effects occur secondary to iodine deficiency in special circumstances of high consumption of incomplete detoxified cassava and insufficient protein intake. Only during inadequate protein nutrition can SCN aggravate endemic iodine-deficient disorders (IDD).

    More and more one reads about these, more and more it becomes a muddy and confusing subject.
    despite the fact that we have all sorts of studies and experts to educate people, all it takes is few drug profit driven experts studies to confuse the less money spending route.
    Please read this
    "The Wolff-Chaikoff Effect"
    "crying wolf".
    http://www.optimox.com/pics/Iodine/IOD-04/IOD_04.html
    Please don't take me wrong. i am not trying to contradict the studies that you have posted here. i am merely trying to show as to what else is available out there.

  • TedHutchinson

    5/23/2009 9:10:04 AM |

    The Safe and Effective Implementation of Orthoiodosupplementation In Medical Practice

    This section had me laughing out loud. Much the same applies to the use of effective amounts of D3.
    Medicoiodophobes suffer from: A) a split personality which results in iodophobia within the orthoiodosupplementation range previously used safely and successfully in medical practice and iodophylia for megadoses of iodide (up to 12 gm/day); B) double standards, which render those physicians intolerant to the minor side effects of the inorganic forms and extremely tolerant to the severe side effects of the radioactive and organic forms; C) amnesia pertaining to the inorganic, non-radioactive forms when making therapeutic decisions; D) confusion, attributing the severe side effects of organic iodine-containing drugs to inorganic iodine/iodide; and E) an altered state of consciousness, allowing doublethink, doublespeak, and contradictory logic to become acceptable. Although the factors involved in medical iodophobia are still unknown, decreased cognition seems involved. Since low iodine intake is associated with intellectual impairment, deficiency of this essential element cannot be ruled out, and if present, would create a self-perpetuating phenomenon. Needless to say, medical iodophobia is contagious and can be transmitted to patients and other physicians (iatrogenic iodophobia). Medical iodophobia will remain a syndrome until the causes are discovered and effective therapy implemented. It is very likely however, that medical iodophobia will eventually be classified as an iodine-deficiency disease.

  • Anne

    5/23/2009 11:33:53 AM |

    My endo told me not to take iodine because he said living in the UK, it being an island, people here get enough iodine from their diets.

    He also said that because I eat a lot of fish (once or twice per day) that gives me additional iodine.

    He said some of his German patients take iodine against his wishes (must be a popular supplement among Germans), and if they are pregnant it's really bad for the fetus.

    Anne

  • kris

    5/23/2009 7:37:08 PM |

    Fish.
    according to Dr. david derry,"Fish of the great lakes still shows Goiter formation".
    http://books.google.ca/books?id=PVWOyP68OMsC&pg=PP1&dq=dr+david+derry&client=firefox-a#PPA6,M1
    So even fish's origin is important. apart from fluoride in the tooth paste and fluoride added municipal water which depletes us from iodine. never mind chlorine in the water and bromine in the food and many other goods around us, helps to deplete iodine.

  • Anna

    5/24/2009 7:10:45 PM |

    I wonder about the huge amount of food that is imported into the UK from distant locations One can't assume enough iodine universally throughout the UK based on UK soil content.

  • Anne

    5/25/2009 8:12:10 AM |

    Kris - you should eat sea fish and shell fish.

  • kris

    5/25/2009 7:03:50 PM |

    Anne,
    Thank you for your advise.
    now i am eating sea fish twice a week. but iodine is must for me. my mother's right side elbow and knee was in bad shape for 35 years. The knee joint was so bad that the joint would come off of it's position. we had to learn our to self to place it back. as usual, she went to many doctors but no help. she is vegetarian all her life. about six months ago she started applying lugol's iodine externally on the knee. she was applying religiously 3 times a day for 2 weeks on and one week off. at the end of the two weeks application, the knee would look like war zone. after about month and half, the knee starting to look like normal knee. now she is able to walk about mile and a half every day on the tread mill. she also been taking 3 drops a day internally too. i personally believe in more iodine than we can find in our the food.

  • Anonymous

    7/31/2009 2:43:32 AM |

    Anna:
    "Breast Cancer and Iodine" by Dr David M. Derry, Canada

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Beware the "false positive" stress test

4. March 2007 William Davis (11)
There's a widely-known (among cardiologists) problem with nuclear stress tests. It's called the "false positive." (Nuclear stress tests are known as stress Cardiolites, stress thalliums, stress Myoviews, persantine stress tests, adenosine stress tests)

Stress tests, nuclear and otherwise, are helpful for identifying areas of poor blood flow. If an area of poor blood flow is detected and the area is substantial, then there may be greater risk of heart attack and other undesirable events in the relatively near future.

What "false positive" means is a stress test that shows an abnormality but it's not true--it is falsely abnormal. There are a number of reasons why this can happen. The problem is that this phenomenon is very common. Up to 20% of nuclear stress tests are false positives.

There are indeed situations where there may an abnormality and it is not clear whether it is true or false. This may lead to a justifiable heart catheterization or CT coronary angiogram. But, given the extraordinary number of false positives, there's a lot of gray in interpreting these tests. Hospital staff, in fact, call nuclear medicine "unclear" medicine. It's common knowledge that you can often see just about anything you want to see on a nuclear image of the heart. Abnormalities in the bottom of the heart, the "inferior" wall, are especially common due to the overlap of the diaphragm with the heart muscle, yielding the appearance of reduced blood flow. Defects in the front of the heart heart are common in females with large breasts for the same reasons.

The problem: The uncertainty inherent in nuclear stress tests opens the door to the unscrupulous or lazy practitioner. Any blip, tick, or imperfection on the nuclear images serve as carte blanche to drag you into the hospital for procedures.

This abusive practice is, in my experience, shockingly common for two reasons: 1) It pays better to do heart catheterizations, and 2) Defensive medicine.

What's the disincentive? Only doing the right thing and maintaining a clear conscience. Slim reasons for many of my colleagues--and a lot less money.

If you are without symptoms and feel fine, and a nuclear stress test is advised by your doctor, followed by a discussion of an abnormality, insist on a discussion of exactly what is abnormal, just how abnormal, and what the alternatives might be. If you receive unsatisfactory or incomplete answers despite your best effort, it's time for another opinion.

Don't neglect your magnesium

3. March 2007 William Davis (3)
Magnesium is kind of boring. So most people don't pay too much attention to it.

Magnesium can be important, however. I saw an interesting phenomenon recently. A type I diabetic patient of mine (that is, an adult who developed diabetes as a child), Mitch, was experiencing wide swings in blood sugar: low low's and very high high's (300-400 mg/dl). Mitch's magnesium was only marginally low at 2.0 mEq/L. (Ranges for normal magnesium blood levels are usually 1.3–2.1 mEq/L or 0.65–1.05 mmol/L.) Note that Mitch's blood levels fall within "normal." I do not agree with these "normal" ranges. I shoot for 2.1 to 2.4 mEq/L, which I think is the truly normal range.

In addition to eating plenty of raw nuts and green vegetables, Mitch began supplementing magnesium with magnesium citrate, 200 mg twice a day (our preferred supplement form). He reported that the wide swings in blood sugar were nearly eliminated.

Mitch's dramatic benefit is just a great illustration of how magnesium can help control blood sugar metabolism. A type I diabetic is more sensitive to the effects, but anyone with type II (adult) diabetes, metabolic syndrome, or just a slightly high blood sugar could benefit from magnesium supplementation.

There's a number of ways to accomplish getting sufficient magnesium in your daily regimen. Track Your Plaque members, Be sure to read:


Your water may be killing you at
http://www.cureality.com/library/fl_03-002magnesium.asp

Magnesium: Water to the rescue! at http://www.cureality.com/library/fl_03-010magnesium2.asp

Third heart scan a charm

1. March 2007 William Davis (0)
It struck me recently that, for many people, it's not the second but the third heart scan that more commonly shows a reduction in score.

I think this is because many people's reaction to their first heart scan is "This can't be. There's no way my arteries have that much plaque." They then follow a half-hearted program to correct their patterns.

When the second heart scan shows a significantly higher score, that really catches their attention. This is when they finally buckle down and give it their all.

Only the occasional person will, after the first heart scan, seize full control and take their program very seriously. These tend to be highly motivated people.

Don't feel too bad if your second heart scan score shows an increase. Look at it for what it represents: feedback on the adequacy of your program.

Metabolic syndrome--cured

27. February 2007 William Davis (0)
Peter started out at age 59 at 248 lbs, standing 6 ft tall (BMI = 33.6!).

Along with his weight, Peter had the entire panel of phenemena of the so-called "metabolic syndrome", or pre-diabetes:

--Triglycerides 238 mg/dl and associated with extremes of excess VLDL and IDL
--High blood pressure
--Blood sugar 115 mg/dl
--High c-reactive protein
--Small LDL particles 99% of total LDL

Interestingly, Peter's HDL was a surprisingly favorable 58 mg/dl (HDL is usually low in this syndrome). However, when broken down by size, he had nearly zero large, healthy HDL (sometimes called HDL2b). Though total HDL was favorable, most of it was simply ineffective.

Peter eliminated snacks and processed foods, particularly bread; increased his reliance on healthy oils and lean proteins; incorporated soy protein; increased vegetables. He added 30 minutes of a rapid walk on a treadmill every day. He added vitamin D to achieve a blood level of 50 ng/dml. He added a magnesium supplement.

Peter has lost 31 lbs. in the last year. Weight 207 lbs., BMI 28.1 (desirable <25). Blood sugar: 96 mg/dl; triglycerides: 56 mg/dl; HDL 71 mg/dl with 35% in the large fraction; small LDL 45% of total. Not perfect, but a damn site better.

Control of metabolic syndrome is an achievable goal for over 90% of people, just with these simple efforts. We haven't yet had a chance to assess the effect on the progression or regression of Peter's heart scan score, but he has, at the very least, spared himself a future of diabetes and all its complications.

Heart Scan Curiosities #6

27. February 2007 William Davis (0)















This is a "slice" from a normal heart scan in a 58 year old woman. Heart scan score zero. Look at the lungs, the dark areas left and right of the heart in the center. The lungs are also normal. Black represents normal density, healthy lung tissue. The white streaking is just normal lung blood vessels. This person doesn't smoke.


















This woman smokes a pack of cigarettes a day and has done so for 45 years ("45 pack-years"). She had a surprisingly low heart scan score (at age 64) of only 71, despite the smoking. However, look at this woman's lungs. It's a little tough to make out, since the computer graphics loses some of the resolution. But you can see the near absence of lung tissue on both sides. This is an advanced phase of the destructive lung disease, emphysema, from smoking. Even if she quit smoking today, the destroyed lung tissue never grows back. She literally has huge gaps or holes in her lungs where lung tissue used to be.

Smoking is among the most destructive, terrible things you can do to your body, short of swallowing strychnine or jumping off a building. Stay as far the heck away from cigarettes as you possibly can. If you are exposed to "secondary" smoke, insist that the person never smoke in your presence. It's not the smell that destroys your lungs or causes coronary plaque (though it is indeed foul), it's the actual smoke.

Should you become a vegetarian?

24. February 2007 William Davis (0)
Do you need to become a vegetarian in order to reduce your heart scan score?

No. Plain and simple. We’ve had many non-vegetarians drop their scores.

That said, are there still advantages to following a vegetarian diet, or some variation on the vegetarian theme?

Yes, there are. Let’s put aside the moral or religious arguments in favor of not eating animals—the need to eliminate killing animals for food, elimination of suffering common in modern livestock practices, Kosher considerations, etc. (Not that there aren’t real arguments here. Our focus for this conversation is not, however, the moral dilemma, but the health argument.)

Some of the most unhealthy people I’ve ever met, mostly males, are proud carnivores who boast of their prodigious capacities to eat meat. Unfortunately, it’s hard to tease out the ill-effects of excessive meat eating, since these same men also tend to be substantially overweight, smoke, drink excessively, and fail to get exercise unless their job is physically demanding. You know the type.

What advantages does a vegetarian obtain? A number of studies have suggested that the reduced saturated fat, reduced exposure to parasites, as well as reduced exposure to the antibiotics and hormones now used routinely in livestock-raising practices, do indeed provide benefits to the vegetarian. Thus, vegetarians tend to be substantially thinner, experience less bowel cancer, have less diabetes and heart disease, and live longer.

(If you are interested in reading or seeing more about just how inhumane modern livestock practices are, take a look at the video, "Meet Your Meat" at meat.org. Be sure not to view this after dinner.)

Of course, some of the disadvantages of eating animal products diminish when free-range livestock are eaten, i.e., livestock not raised in the inhumane cramped, filthy conditions of livestock factories, but in the open, grazing or rooting freely. These animals tend to have different fat compositions and taste different.

The advantages of vegetarianism, however, have blurred in recent years, since many so-called vegetarians have failed to maintain the distinction between naturally-occurring foods and processed foods. So, Ritz Crackers, Oreo cookies, whole wheat bread, and Raisin Bran fit into a vegetarian program, but they’re awful for your health. I’ll occasionally meet a self-proclaimed vegetarian who looks every bit as unhealthy as a conventionally eating American, that is, overweight, pre-diabetic person with a developing heart scan score.

So it is not necessary to be vegetarian to reduce your score. You might consider vegetarianism for other reasons, such as moral considerations, or to reduce your risk for cancer. But it is not necessary to drop your heart scan score. A non-processed food diet? Now that's is worth giving serious consideration.

Let's make it a lot easier

24. February 2007 William Davis (0)
The American Heart Association just released a new set of consensus guidelines on heart disease prevention in women: Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update

For those of you following the Heart Scan Blog and the Track Your Plaque program, there will be little new in the guidelines. In fact, you'll wonder if the date on the front of the report should be 1987, rather than 2007. Did you know that you should exercise and eat healthy?

Take a look at the list of risk factors for coronary vascular disease (CVD) listed in the report:

Major risk factors for CVD, including:
Cigarette smoking
Poor diet
Physical inactivity
Obesity, especially central adiposity
Family history of premature CVD (CVD at <55>

Progress: You'll notice that buried inside the list is "Evidence of subclinical vascular disease (e.g., coronary calcification)". Just a few short years ago that wouldn't have even been included.

The Track Your Plaque contention is that, for the great majority of women, this list could be shortened to one item: coronary calcification. As time goes on, the people who argue and draft these guidelines will come to the realization that coronary calcification is the disease--it's not a risk for the disease, a predictor of the disease. Coronary calcification is the disease itself. The other items on the list recede way into the background when you know whether or not coronary atherosclerosis is present, i.e., you know your heart scan score (of coronary calcium).

The report goes to say such things as taking a little bit of fish oil is a good idea, maintaining a normal blood pressure is desirable. . . yada yada yada. You've heard this all before.

A major part of the treatment guidelines are devoted to LDL cholesterol reduction with statin agents. You shouldn't be surprised. It's amazing what $22 billion dollars in revenues will buy.

A closing paragraph reads:

'Population-wide strategies are necessary to combat the
pandemic of CVD in women, because individually tailored
interventions alone are likely insufficient to maximally prevent
and control CVD. Public policy as an intervention to
reduce gender-based disparities in CVD preventive care and
improve cardiovascular outcomes among women must become
an integral strategy to reduce the global burden of
CVD.'

Say that again? If you understood that bit of gobbledygook, you're a lot smarter than me.

Don't look to the American Heart Association report for any new ideas. It reminds me of the politician who reminds everybody of what a devoted family man he is: It has nothing to do with his policies. It just makes him look good. If compared to prior report, the 2007 report does indeed represent progress--but just oh so little.

No wonder nobody talks about real prevention

23. February 2007 William Davis (0)
Take a look at this eye-opening statement taken from a well-written NY Times article about Dr. Arthur Agatston, the South Beach Diet and now South Beach Heart Program books:


'We have made major improvements in prevention,” Dr. Gregg W. Stone, the director of cardiovascular research at Columbia University, says. “But it’s difficult. It takes frequent visits, a close relationship between a physician and a patient and a very committed patient.'

Which is exactly the atmosphere Dr. Agatston’s practice tries to create. Nurses there give patients specific cholesterol goals to meet and help them deal with the side effects of the drugs they are taking. A nutritionist, Marie Almon, meets with patients frequently enough to discuss real-life issues like how to stick to a high-fiber Mediterranean diet even on a cruise or a business trip.

There is only one problem with this shining example of a medical practice: it is losing money.


From NY Times, January 24, 2007. What’s a Pound of Prevention Really Worth? (Find the full text at http://www.nytimes.com/2007/01/24/business/24leonhardt.html?ex=1172379600&en=4268a738e82857da&ei=5070.)

It gets at one of the fundamental reasons why your cardiologist will probably never talk to you about an intense approach to prevention: it doesn't pay. Because John Q. Cardiologist focuses, instead, on how to increase procedural volume, train how to put in the next best defibrillator, etc., there is little consciousness about preventive issues. Just the simple matter of taking fish oil causes their eyes to glaze over.

That's why the Track Your Plaque program exists: it is a portal for the kind of information you cannot get. Of course, you could read all the scientific studies, attempt years of trial and error, and try to gain a sense of how to do this yourself. Or you could follow this program. We are proud to not worry about generating procedural profits. We ar unbiased by drug or medical device money. We say exactly what we mean.

By the way, we are on a current push to really "beef-up" our online discussions via real-time chat. Long-term, we'd like to be able to offer chat with our staff many hours every day. Be patient. It will happen, but not today.

HDL and vitamin D

22. February 2007 William Davis (5)
I know of no published reports on this question, but I've now seen numerous people experience significant jumps in HDL with raising blood vitamin D to 25-OH-vitamin D3.

Last week, for example, I had a man who had struggled with raising HDL from a starting level of 28 mg/dl. On niacin, exercise, weight loss, fish oil, red wine, and cilostazol (a prescription agent that I use occasionally that raises HDL), his HDL rose to 41 mg/dl--better, but hardly to our goal.

I added vitamin D, 4000 units, and raised his 25-OH-vitamin D3 level from 22 ng/ml to 53 ng/ml. Next HDL: 73 mg/dl! Small LDL improves along with a rise in HDL.

Not everybody's response is this dramatic. I see more typical rises of 5 to 10 mg/dl every day. I'm uncertain of why the response is inconsistent, though people who begin with lower vitamin D levels seem to experience a larger HDL increase. I wonder if the partial normalization of insulin and glucose responses is at work, or some anti-inflammatory effect.

Vitamin D provides so many other benefits, as well as HDL-raising. I hope you've gone to the effort to have your blood level checked to determine your replacement need. If not, now's the time. February represents your nadir (lowest point) for 25-OH-vitamin D3 blood levels.

Even more Michael Pollan

20. February 2007 William Davis (0)
"Eat food. Not too much. Mostly plants.

That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy. I hate to give away the game right here at the beginning of a long essay, and I confess that I’m tempted to complicate matters in the interest of keeping things going for a few thousand more words. I’ll try to resist but will go ahead and add a couple more details to flesh out the advice. Like: A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat."

Michael Pollan, author of my latest favorite book, The Omnivore's Dilemma, wrote a wonderful piece for the New York Times entitled "Unhappy Meals". You can find the full text at http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?ex=1172120400&en=a78c20f4da0cdc7b&ei=5070. (Another favorite read of mine, The Fanatic Cook's Blog at , alerted me to Pollan's article. Incidentally, take a look at the Fanatic Cook's latest posts--very entertaining and informative. She's got incisive insight into foods as well as a great sense of humor.)

Pollan goes on to say that...

"...typical real food has more trouble competing under the rules of nutritionism, if only because something like a banana or an avocado can’t easily change its nutritional stripes (though rest assured the genetic engineers are hard at work on the problem). So far, at least, you can’t put oat bran in a banana. So depending on the reigning nutritional orthodoxy, the avocado might be either a high-fat food to be avoided (Old Think) or a food high in monounsaturated fat to be embraced (New Think). The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated. That’s why when the Atkins mania hit the food industry, bread and pasta were given a quick redesign (dialing back the carbs; boosting the protein), while the poor unreconstructed potatoes and carrots were left out in the cold.

Of course it’s also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness."

Not everything Pollan says is new, but he says it so eloquently and cleverly that he's worth reading. If you haven't yet read Omnivore's Dilemma, or just want a condensed version of the book, the New York Times piece is a great piece of the world according to Michael Pollan.