Wheat hip 10. August 2010 William Davis (39) You've heard of wheat belly. How about wheat hip?Recall that the innocent appearing wheat belly is actually a hotbed of inflammatory activity beneath the surface. The visceral fat of the wheat belly, i.e., fat kidneys, fat liver, fat intestines, fat pancreas, produces abnormal inflammatory signals, such as various interleukins, tumor necrosis factor, and leptin. These are the inflammatory signals that create insulin resistance and diabetes, heart disease, hypertension, and cancer. These same inflammatory mediators are able to enter the joint spaces, such as those in your hips, knees, and hands. This leads to osteoarthritis, the exceptionally common form of arthritis that affects 1 in 7 Americans. In particular, the level of leptin in joints mirrors that in blood, a phenomenon that has been associated with joint destruction. The previously widely-held notion that arthritis is simply a wear-and-tear phenomenon due to the mechanical stress of excess weight is proving to be an oversimplification. Arthritis is also part of the carbohydrate-driven, weight-increasing, inflammatory condition of insulin resistance or metabolic syndrome. Throw into this cytokine storm the fact that glycation, i.e., glucose modification of proteins, also causes cartilage destruction. The cells of human cartilage lack the ability to divide, so the cartilage cells you had at age 18 are the cartilage cells that you will hopefully still have at age 80. However, high blood sugars (glucose) glycate the proteins in cartilage. (Wheat raises blood glucose higher than almost all other foods, higher than a Milky Way bar, higher than a Snickers bar.) The process is irreversible and cumulative. Because cartilage has next to no capacity for repair or regeneration, it becomes brittle. Over years, it essentially crumbles, leading to the "bone on bone" that prompts conversations about total hip and total knee replacement. So that ciabatta or blueberry muffin in your mouth takes you a step or two closer to joint destruction via heightened inflammation arising from the visceral fat of the wheat belly, worsened by glycation of high blood sugars after carbohydrate consumption. My solution: Lose the ciabatta.
Men's lingerie is on the second floor 7. August 2010 William Davis (33) Consume wheat products, like poppyseed muffins, raisin bagels, and whole grain bread, and you trigger the 90- to 120-minute glucose-insulin cycle. Blood glucose goes way up (more than almost any other known food), triggering insulin release from the pancreas. Glucose enters cells as a result, blood glucose plummets. You get hungry, shaky, and crabby, reach for another wheat or other sugar-generating food to start the roller coaster ride all over again. Repetitive insulin triggering grows this thing I call a "wheat belly," the protuberant, hang-over-the-belt fat you see everywhere nowadays. Wheat belly fat is really visceral fat. Visceral fat means you have fat kidneys, fat intestines, fat pancreas, and fat liver, all causing the belly to protrude in the familiar way we've all come to recognize. Visceral fat is special fat. Unlike the fat in the backside, thighs, or arms, visceral fat triggers inflammatory responses that are evident in such measures as tumor necrosis factor, interleukins, and leptin, as well as drops in the protective hormone, adiponectin. Visceral fat also, oddly, triggers estrogen release. Estrogen triggers growth of breast tissue. That's why females with wheat bellies have up to four-fold (400%) greater likelihood of breast cancer. Men also experience excess estrogen from the visceral fat wheat belly, causing "man boobs." This B-cup phenomenon means that inflammation is raging beneath the surface, all due to this thing you're wearing around your waist. I wasn't aware until recently that male breast reduction surgery is a booming business growing at double-digit rates. So are special clothes to help men conceal their expansive breasts. Perhaps the USDA is in cahoots with Playtex.
10,000 units of vitamin D 3. August 2010 William Davis (47) Joanne started with a 25-hydroxy vitamin D level of 23 ng/ml--severe deficiency. What made this starting value even worse was that it was drawn in August after a moderately sunny summer spent outdoors. (Last summer, not this summer.) It therefore represented her high for the year, since vitamin D levels trend lower as fall and winter set in. This suggests that her winter level was likely in the teens or even single digits. In addition, note that, at age 43, Joanne has lost much of her ability to activate vitamin D in the skin. So I advised that she take 6000 units of an oil-based gelcap per day, a dose likely to generate the desired blood level, which I believe is 60-70 ng/ml. Four months later, her 25-hydroxy vitamin D level: 39.9 ng/ml--still too low. So I advised her to increase her dose to 10,000 units per day. Several months later, her 25-hydroxy vitamin D level: 63.8 ng/ml--perfect. However, on hearing that she was taking 10,000 units vitamin D per day, Joanne's primary care physician was shocked: "What? Stop that immediately! You're taking a toxic dose!" So Joanne called me to find out if this was true. No, of course it's not true. It's not the dose that's toxic, but the blood level it generates. Although it varies, vitamin D toxicity, as evidenced by increased blood calcium levels, generally does not even begin to get underway until at least 120-130 ng/ml, perhaps higher. Rarely, a dose of 2000 units per day will generate a level this high. In others, it may require 24,000 or more units per day to generate such a high level. So it's not the dose that's toxic, but the blood level of 25-hydroxy vitamin D it generates. Provided you and/or your doctor are monitoring 25-hydroxy vitamin D blood levels, the dose is immaterial. It's the blood level you're interested in.
No more Lovaza 30. July 2010 William Davis (45) That's it: I will NEVER ever write another prescription for Lovaza. I actually very rarely write a prescription for Lovaza, i.e., prescription fish oil. But this was the last straw.I advised a patient that we've had good success using high-doses of fish oil to reduce lipoprotein(a), Lp(a). 6000 mg per day of the omega-3 component (EPA + DHA) from fish oil reduces Lp(a) in 60% of people after one year. (Recall that Lp(a) is the most aggressive known lipid-related cause of heart disease.) The two preparations I generally suggest are either the very affordable Sam's Club Members Mark Triple-Strength Fish Oil with 900 mg EPA + DHA per capsule: 7 capsules per day. Another great product (my personal favorite because of its extreme purity--it doesn't even smell like fish oil): Pharmax Finest Pure Fish Oil with 1800 mg EPA + DHA per teaspoon: 3 to 3 1/2 teaspoons per day. Both preparations work great and are quite affordable, given the high dose. For the Sam's Club preparation, it will cost around $30 per month, while the Pharmax liquid will run around $49 per month. Well, the woman's husband insisted on a prescription for Lovaza. One Lovaza capsule contains 784 mg EPA + DHA per capsule: 7 to 8 capsules per day. Here are some prices for Lovaza from online pharmacy discounters:Prescription Giant: $78.99 for 30 capsules ($2.63 per capsule)Planet Drugs Direct: $135 for 100 capsules ($1.35 per capsule)These are lower than the prices I obtained in past by calling local pharmacies in my area, quite a bit lower, in fact. Filling the Lovaza prescription at Prescription Giant will therefore cost $552.93 to $631.92 per month; at Planet Drugs Direct it will cost $283.50 to $324.00 per month. At local pharmacies, a similar 7 to 9 capsules Lovaza per day will cost upwards of $800 to $900 per month. The patient's husband insisted on the Lovaza prescription because he knew that his insurance would cover it. When I pointed out that this was a large cost that would have to be borne by others in their healthcare premiums, he said that didn't matter to him. I hesitated, but ended up writing the prescription for 7 Lovaza capsules per day. As soon as I handed to him, I regretted it. In fact, I am embarassed and angry at myself for having given in. So I vowed: I will NEVER EVER write another prescription for Lovaza. I do not believe that we should spread the excessive profiteering of the pharmaceutical industry around on the backs of people who pay their healthcare insurance premiums, just so that a few people, like this selfish couple, can save a few dollars a month.
This is your brain on wheat II 29. July 2010 William Davis (24) In the original Heart Scan Blog post, This is your brain on wheat, I discussed how opioid peptides (i.e., small proteins that act like opiates such as heroine or morphine) that result from digestion of wheat cause unique effects on the human brain, particularly addictive behaviors. I also briefly reviewed how elimination of wheat has been shown to reduce auditory hallucinations and other psychotic behaviors in a subset of people with paranoid schizophrenia. These two phenomena, addictions and schizophrenia, are most likely the result of exorphins that cross the blood-brain barrier. Exorphins--exogenous morphine-like compounds--can be blocked by opiate-blocking drugs like naloxone and naltrexone. Naloxone is used in hospitals to reverse morphine or heroine overdoses; naltrexone is being repackaged into a weight loss drug, since blocking wheat-derived exorphins reduces appetite. (Yes: The USDA tells us to eat more wheat, the drug industry sells us the antidote.) There's another way that wheat can affect the brain and nervous system: immune-activated damage. This is similar to the effect seen in celiac. There's even overlap with some of the antibody markers used to diagnose celiac, like the anti-gliadin antibodies and the anti-endomysium antibodies. The most common immune neurological syndrome consequent to wheat consumption is cerebellar ataxia, a condition in which an immune response causes damage to the Purkinje cells of the cerebellum, the portion of the brain responsible for balance and coordination. This results in stumbling, incoordination, incontinence, and eventually leads to reliance on a cane or walker and wearing a diaper. Average age of onset: 53 years. A shrunken, atrophied cerebellum can be seen on an MRI of the brain.Problem: Most people with central nervous system damage caused by wheat do not have any intestinal symptoms, like diarrhea and abdominal pain, the sort of symptoms usually associated with celiac disease. It means the first sign of wheat-induced brain damage may be bumping into walls and wetting your pants.
There's no such thing as a "no-carb" diet 27. July 2010 William Davis (24) When I tell patients how I advise a wheat-free, cornstarch-free, sugar-free diet on the background of a low-carbohydrate diet, some people ask: "But can I live on a no-carb diet?"Well, there's no such thing as a "no-carb" diet. Low-carb, yes. No-carb, no.Here are the carbohydrate contents of various "low-carb" foods:Gouda cheese--3 oz contains 1.65 grams carbohydratesMozzarella cheese--1 cup contains 2.89 grams carbohydrates Walnuts--4 oz (56 nuts) contains 2.96 grams carbohydratesAlmonds--4 oz contains 1.38 grams carbohydratesSour cream--one-half cup contains 3.31 grams carbohydratesRed wine--3.5 oz glass contains 2.69 grams carbohydratesEggplant--1 cup cooked contains 8.33 grams carbohydratesGreen pepper--1 medium-sized raw contains 5.52 grams carbohydratesCucumber--1 medium contains 4.34 grams carbohydratesTomato--1 medium contains 4.82 grams carbohydrates (Nutrition data from USDA Nutrient Database)In other words, foods thought to be "low-carb" actually contain a modest quantity of carbohydrates. Such modest quantities of carbohydrates may not be enough to trip your blood sugar. But add up all the "low-carb" foods you consume over the course of a day and you can easily achieve 30 grams or more carbohydrates per day even without consuming any higher carbohydrate foods.
Why doesn't your doctor try to CURE diabetes? 21. July 2010 Toggle navigation Home Blog Home Archive Join Now Log in 200 point drop in heart scan score 11. August 2007 William Davis (0) Some of the math-savvy will have noticed that we often report drops in CT heart scan scores on a percentage basis. Unfortunately, it this were a competition (which, of course, it is not), this would be unfair. A score of 50, for instance, that drops "only" 25 points would represent a 50% drop in score. But someone with a score of 1050 who drops his or her score the same quantity, or 25, will have dropped their score less than 5%. In other words, the magnitude of your starting score determines how large a percentage drop you achieve, even when the absolute, or real, quantity of plaque reversal is the same as someone who begins with a lower score. I qualify this discussion in this vein because of Grady's story. Grady, a soon-to-retire attorney, started with a heart scan score of 1151. On the Track Your Plaque program, he saw his score drop nearly 200 points--200 points! But, if we gauged Grady's success just on a percentage basis, he dropped his score only a measly 17% or so. (Imagine the headlines if this program were sponsored by a drug manufacturer. The Track Your Plaque program proudly has nothing to do with the drug industry.) Of course, the Track Your Plaque program is not a competition. It is an effort to help everyone possible, the more the better. Even if Grady failed to set a new Track Your Plaque record gauged on a percentage basis, he will have achieved an extraordinary advantage in health: the virtual elimination of the dangers of heart disease. With this drop in score, Grady's risk for heart attack plummets from a spine-chilling 25% per year to nearly zero. (I know of NO other program that can claim such a track record.)Grady's full story will be reported in the August, 2007 Track Your Plaque newsletter. To subscribe or to just view when it is posted, go to www.cureality.com website, click on the upper right hand corner What Does My Heart Scan Show? graphic, which then takes you to the page to view the newsletter. Or, Track Your Plaque Members can just go to the Library and click on newsletter archives. How tough is the Track Your Plaque 60-60-60 target? 9. August 2007 William Davis (3) One of the basic requirements that stack the odds in your favor of stopping or dropping your CT heart scan score is to achieve basic lipid targets of 60-60-60. In other words, we generally see best results when LDL is reduced to 60 mg/dl, HDL raised to 60 mg/dl, triglycerides reduced to 60 mg/dl. Now, these are not absolute requirements. Someone can have a spectacular drop in heart scan score even with an HDL of 56, LDL of 71. But the "Rule of 60" provides a useful target that is easy to remember, packs real power, and is clearly beyond that achieved with conventional approaches.People often ask, "Just how tough is it to get to these targets?" It's really not that tough. Interestingly, whenever I tell my cardiologist or primary care colleagues that I advocate these 60-60-60 targets, they declare that it's tough, perhaps impossible, except for the most highly motivated. I agree that it requires motivation. A cigarette-smoking, TV-addicted, 70-lb overweight, chip- and pretzel-eating couch potato is not going to achieve them. On the other hand, you don't have to be a marathon running vegetarian to do it, either. Most people, in fact, engaged in the Track Your Plaque program achieve the 60-60-60 targets---or exceed them. It's not uncommon, for instance, for HDL to skyrocket to 80 or 90 mg/dl with many of our strategies. (Of course, if your starting HDL is 20 or 25 mg/dl, 80 or 90 is not possible with current technology.)But it certainly does require more than the "Take Lipitor and stick to your low-fat diet" approach that is the mantra repeated in the vast majority of medical offices across the U.S. For instance, reducing LDL to 60 mg/dl when starting at 170 mg/dl will require addition of oat bran and other soluble or viscous fibers; raw almonds and walnuts; perhaps the use of Benecol butter substitute; reduction or elimination of wheat products if small LDL comprises a substantial proportion of LDL particles. Reducing triglycerides requires the generous use of omega-3 fatty acids from fish oil. Attention to vitamin D must be a part of the effort. So, yes, it is not as simple as the conventional approach. But the results are far superior in reducing or eliminating heart attack and in dropping your heart scan score. But it can be done. We do it every day. Vitamin D2 belongs in the garbage 8. August 2007 William Davis (15) It happened yet again. Mel came to the office. CT heart scan score: 799--quite high, enough to pose a real threat very soon. Thus, no time to lose in instituting an effective prevention program. We do the usual--identify the six causes of coronary plaque; begin fish oil, show him how to correct his plaque causes. You've heard it before. Vitamin D blood level in March: 17 ng/ml--severe deficiency. Vitamin D replacement needs to be a part of his coronary plaque control program. So I suggested 6000 units per day of an oil-based preparation of vitamin D3 (cholecalciferol). Conveniently, there is a Vitamin Shoppe outlet across the street from my office. I just point and tell people to go across the street. Mel did just that. However, he also informed his primary care physician about his vitamin D deficiency. His primary physician promptly told him he needed to take a prescription form of vitamin D and not to bother with just a supplement. So Mel stopped his vitamin D capsules and started taking vitamin D prescription "medication." Mel figured, naturally, that if it requires a prescription, it must be better. Unfortunately, Mel and his doctor failed to pass the change in strategy onto us. So, four months later, Mel got repeat vitamin D blood level: 19 ng/ml. I've seen this too many times. The prescription form of vitamin D is nonsense. There's hardly any effect on blood levels of vitamin D3 at all. The body's conversion of this non-human form of D is extremely inefficient and therefore virtually useless. While it raises the blood level of vitamin D2 (ergocalciferol) and thereby total D (D3 + D2), there is negligible effect on the real human and active form, D3. How and why this preparation got through the FDA process to obtain approval as a drug is beyond me, though I am not a defender of FDA practices and politics. This notion that "if it's a prescription, it must be better" is a fiction perpetuated by the drug industry. The same principle gets tossed around with fish oil, hormones like estrogens and testosterone, and others. Often, the principal difference between prescription and non-prescription is patent protection. Patent protection provides profit protection. Selling a product without patent protection can be risky business. It's certainly less profitable. As always, getting at the truth is sometimes the most difficult job of all. Prescription vitamin D belongs in the garbage. Vitamin D capsules (gelcaps) do the job and do it well, over and over, with reliable, consistent and substantial rises in blood levels of 25-OH-vitamin D3. I take 6000 units per day (3 2000 unit capsules) that cost me $5.99 for a bottle of 120 capsules, or about $4.50 a month. And nobody--nobody--pays me to say this. I say it because I believe it's true. Angioplasty vs. Track Your Plaque 5. August 2007 William Davis (10) What does angioplasty have over the Track Your Plaque program?Well, first of all, the Track Your Plaque program has a lot to boast about. What other approach can claim to have reduced heart disease 30, 40, 51, and now 63%? That's as close to a cure that's ever--EVER--been achieved. Statin drug manufacturers can talk about an occasional 1, 2, or 5% reversal. We're talking 10 times more. The Track Your Plaque program also uses as little prescription medication as necessary. Fish oil, vitamin D, coenzyme Q10, niacin--some of the frequent tools used for plaque reversal in our program. Yes, we do use prescription medications, but only when there is truly a benefit and nutritional strategies have failed to achieve the goals we're seeking. We do not endorse shotgun prescription approaches conceived of by some marketing department at a pharmaceutical company.So what possible advantage can coronary angioplasty have? Why don't more people embrace a program like Track Your Plaque that has already proven itself enormously effective?Because angioplasty is easy. There's little worrying ahead of time. Just wait for the symptoms or other problem to appear, go to the hospital and get your procedure. You can live the free and easy life beforehand--no exercise, no diet efforts, no nutritional supplements. Just be sure to go to the hospital when suspicious symptoms strike. (Of course, you gamble that you survive the appearance of symptoms, a process 30-50% of people fail to survive.)That means you can eat all you want, drink all you want, save the money you otherwise might have thrown away on supplements, pocket the monthly costs of an exercise club membership, etc. Go to the hospital when you experience the sensation of an anvil on your chest or of suffocation, let the emergency room do their thing, meet your cardiologist, go to the catheterization laboratory, get two or three stents, go home the next day!Why bother with a prevention program, especially one that requires involvement, learning, and effort like Track Your Plaque? Because it's your way to stack the odds enormously in your favor of 1) surviving the appearance of symptoms, 2) avoiding the prospect of heart procedures, which are not as clean and easy as they often seem, 3) have a longer lasting durability than a stent which could buy you a couple of years before your next procedure or heart catastrophe, and 4) it's the right thing to do for the sake of the huge societal cost of heart disease. Many of you have the equivalent of a cure for heart disease at your fingertips. Unless you have a soft spot in your heart for hospitals, cardiologists, or the pharmaceutical or medical device industry, there isn't a choice. Plaque is like money 3. August 2007 William Davis (0) In case anyone missed this in the June, 2007 Track Your Plaque Newsletter, I'm again posting how we calculate the annual rate of score increase, should it occur.For instance, say your score in January, 2005, is 100. In November, 2006, you undergo another scan and the score is 140. Obviously, your score has increased an undesirable 40%. But what is the annual rate of score increase, the amount of increase per year?In this example, the annual rate of score increase is 19%--not anywhere near as bad as the 40% that can scare the heck out of you.Obviously, the best rate of heart scan score increase is a negative number, i.e., a drop in score from, say 100, to 60. You might even eliminate the need for this calculation altogether if you drop your score. Nonetheless, whenever there is a score increase over an uneven period of time, a fraction of year(s), this is the method we use to annualize the calculation. The equation we use is a modified form of the annual compound interest equation using continuous compounding, since that’s how coronary atherosclerotic plaque grows--just like money. The difference is, of course, is that while you might want more money, you certainly don't want more plaque. You will need a calculator for this calculation, one with an exponential “y to the power x” function. For ease, calculate "1/t first, then use it as the “x” exponent on your yx function and "(score 2 / score 1)" as the "y".Annual rate of plaque growth (APG) = ( score 2 / score 1 ) 1/t - 1Multiply the result by 100 to yield a percent.“Score 1” is your 1st heart scan score, “score 2” is your 2nd (or any subsequent heart scan score); “t” is the amount of time between the two scans expressed in years in decimal form. Time between scans should be expressed in years or fractions of years. To obtain the time interval in fractions of years, simply divide the number of months between scans by 12 (e.g., 18 months / 12 = 1.5 years ; 22 months / 12 = 1.83 years).It’s not as tricky as it looks. For example, if your first heart scan score is 300 and your next scan 16 months later (or 16/12 = 1.33 years) is 372, then:Annual rate of plaque growth (APG) = ( 372 / 300 ) 1/1.33 - 1 = 0.175Multiply 0.175 x 100 = 17.5% annual rate of plaque growthSome scan centers will do the calculation for you as part of a repeat scan. However, the equation can be used if you're left on your own, or if you go to a different scan center. If this is too much effort, perhaps it's just another reason to add to the list of reasons to drop your heart scan score! Triglycerides: What is normal? 1. August 2007 William Davis (2) In The Track Your Plaque program, we advocate decreasing triglycerides to 60 mg/dl or less. That's the level of triglycerides that minimize the presence of triglyceride-containing undesirable lipoproteins causing plaque, such as small LDL, VLDL, and the after-eating persistence of IDL (intermediate-density lipoprotein, a bad player). (The enzyme, cholesteryl-ester transfer protein, or CETP, is responsible for exchanging one triglyceride molecule for one cholesterol molecule between HDL and other lipoprotein particles. Thus, an excess of triglyceride availability permits CETP to operate unrestrained, creating more undesirable lipoproteins. This was the basis for Pfizer's now defunct CETP inhibitor, torcetrapib.)Of course, this triglyceride target is far below that of the conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests a triglyceride level of 150 mg/dl is okay. In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth. In short, triglycerides of 150 are awful. Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl. We have seen many people drop their heart scan scores just by achieving a triglyceride level of 60 mg/dl or less. So achieving a lower level below 60 is not necessarily a requirement for coronary plaque regression. But it makes me wonder if a triglycere level of 30s or 40s is the level for perfect health. These are levels ordinarily regarded as impossibly low. When colleagues see the numbers we readily and routinely achieve, they declare that the numbers are spurious, temporary, or just flukes. "No way you can do that all the time!" This level also seems to, in virtually all cases, eliminate the triglyceride-containing undesirable lipoproteins small LDL, IDL, etc., and allow full conversion of HDL into the healthy, large fraction. Should we move the Track Your Plaque triglyceride target to below 45 mg/dl or even lower? I don't think so, but it makes me wonder. The processed food battlefield 31. July 2007 William Davis (4) If you have any remaining doubts that the processed food industry is a cutthroat, go-for-the-jugular, organized effort to extract every possible penny from your pocket, even at the expense of health, take a gander at a quote from Marion Nestle's wonderful book, Food Politics.In Nestle's description on how food conglomerate, Archer Daniels Midland (ADM), conspired to fix prices on some basic agricultural compounds, she quotes an ADM executive captured on videotape and presented in court:"We have a saying at this company . . . our competitors are our friends and our customers are our enemies."In other words, ADM's competitors help establish what prices should be charged for basic foodstuffs, while its customers are the ones to do battle with. Food is a necessary commodity. You and I only need so much of it. So how does a 40 billion dollar food manufacturer extract greater and greater profits and grow their market? Motivate people to eat more. It's that simple. Eat less? Are you kidding? Eat spinach, green peppers, beets, and other low-margin products? Get real. Why not take 8 cents worth of wheat flour, add some sugar, food coloring, and some other enticing flavorings like high fructose corn syrup? Put it all in a cleverly illustrated package, maybe even develop an entire story line about the product, complete with clever slogans and songs and . . . ouila! You now have a food that sells for many, many times its intrinsic value. How to make the health nuts happy? Easy: Add some fiber. Now it's healthy! And it's now part of a "balanced diet". What if it's full of corn starch, wheat flour, and sugar of the sort that make HDL cholesterols plummet, fan the flames of small LDL, increase inflammatory measures like C-reactive protein, push people closer and closer to diabetes, and make them fat? Then be sure it's low in saturated fat! It might even qualify as "Heart Healthy" by the American Heart Association! Processed foods have no role in the Track Your Plaque program. If you want to see your CT heart scan score skyrocket, go to your grocery store and stray into the aisles outside of the produce aisle. But stick to the produce aisle and watch your wallet grow, your health improve, your appetite shrink, all while food processor profits plummet. Heart Scan debate 29. July 2007 William Davis (4) A few years back when the book form of Track Your Plaque was first released, I did a bunch of radio and interviews to raise awareness of the book and of CT heart scanning in general. I'd forgotten about this interview I did for National Public Radio (NPR), in which I debate Dr. Graboys from Harvard. Though I've had this debate countless other times, usually on a less formal basis, I didn't know what to expect at the start of the interview. After all, I knew of Dr. Graboys' reputation as a respected Harvard cardiologist. So I was expecting that at least he would argue that, being relatively new at the time, CT heart scanning was largely unproven in large clinical trials. (This was not entirely true then, however, as at least 1000 trials had already been performed, many of them involving thousands of participants. However, despite that much validation, the concept of CT heart scanning had still not entered the consciousness of most practicing physicians. After all, heart scanning is not part of the "crash and repair" equation that most have invested their career in.)Heart Hawk re-discovered the debate, still on the NPR website. So here it is. When I re-listened to the debate, I was surprised at how little Dr. Graboys had to offer. He argues that examining left ventricular function should suffice as an important measure of mortality. In other words, if you have experienced a drop in the strength of heart muscle, that can be used to stratify your risk of death. I tried to convey to the audience (NOT convince Dr. Graboys to believe, as most of my colleagues are stubbornly adherent to their way of thinking until someone tosses a big carrot in front of them) that CT heart scanning provides a means to detect coronary atherosclerosis years, even decades, before questions of mortality (death) became necessary. Heart scanning identifies disease in its early stages so that a program of prevention can be followed and tracked. Dr. Graboys expressed concern that heart scanning devices could be mis-used to increase hospital procedures. He's absolutely right here. By that same line of thinking, say your crooked auto mechanic on the corner scams most of his customers by doing unnecessary car repairs. Does this mean that we should ban all auto mechanics from repairing cars? I hope not. I believe it does mean that we should all be educated on distinguishing scams from an honest businessman. Same with heart scans. The key is not to ban heart scanning. We should try to educate the public and physicians to prevent these sorts of scams and decisions based on ignorance from occurring. Nonetheless, make your own judgments. CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play) Break the addiction 28. July 2007 William Davis (8) "But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep. Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict. Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:You no longer crave these foods. Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more. It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction. Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible. You will be impressed with the results. Are we done here? 27. July 2007 William Davis (4) Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy. Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart. Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before. I explained to Les that having normal coronary blood flow was just one aspect of the issue. "But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack."With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him. Now, if we could only transform Les into an optimist . . . << Older posts Newer posts >> Newer posts12...808182838485868788...123124Older posts
200 point drop in heart scan score 11. August 2007 William Davis (0) Some of the math-savvy will have noticed that we often report drops in CT heart scan scores on a percentage basis. Unfortunately, it this were a competition (which, of course, it is not), this would be unfair. A score of 50, for instance, that drops "only" 25 points would represent a 50% drop in score. But someone with a score of 1050 who drops his or her score the same quantity, or 25, will have dropped their score less than 5%. In other words, the magnitude of your starting score determines how large a percentage drop you achieve, even when the absolute, or real, quantity of plaque reversal is the same as someone who begins with a lower score. I qualify this discussion in this vein because of Grady's story. Grady, a soon-to-retire attorney, started with a heart scan score of 1151. On the Track Your Plaque program, he saw his score drop nearly 200 points--200 points! But, if we gauged Grady's success just on a percentage basis, he dropped his score only a measly 17% or so. (Imagine the headlines if this program were sponsored by a drug manufacturer. The Track Your Plaque program proudly has nothing to do with the drug industry.) Of course, the Track Your Plaque program is not a competition. It is an effort to help everyone possible, the more the better. Even if Grady failed to set a new Track Your Plaque record gauged on a percentage basis, he will have achieved an extraordinary advantage in health: the virtual elimination of the dangers of heart disease. With this drop in score, Grady's risk for heart attack plummets from a spine-chilling 25% per year to nearly zero. (I know of NO other program that can claim such a track record.)Grady's full story will be reported in the August, 2007 Track Your Plaque newsletter. To subscribe or to just view when it is posted, go to www.cureality.com website, click on the upper right hand corner What Does My Heart Scan Show? graphic, which then takes you to the page to view the newsletter. Or, Track Your Plaque Members can just go to the Library and click on newsletter archives.
How tough is the Track Your Plaque 60-60-60 target? 9. August 2007 William Davis (3) One of the basic requirements that stack the odds in your favor of stopping or dropping your CT heart scan score is to achieve basic lipid targets of 60-60-60. In other words, we generally see best results when LDL is reduced to 60 mg/dl, HDL raised to 60 mg/dl, triglycerides reduced to 60 mg/dl. Now, these are not absolute requirements. Someone can have a spectacular drop in heart scan score even with an HDL of 56, LDL of 71. But the "Rule of 60" provides a useful target that is easy to remember, packs real power, and is clearly beyond that achieved with conventional approaches.People often ask, "Just how tough is it to get to these targets?" It's really not that tough. Interestingly, whenever I tell my cardiologist or primary care colleagues that I advocate these 60-60-60 targets, they declare that it's tough, perhaps impossible, except for the most highly motivated. I agree that it requires motivation. A cigarette-smoking, TV-addicted, 70-lb overweight, chip- and pretzel-eating couch potato is not going to achieve them. On the other hand, you don't have to be a marathon running vegetarian to do it, either. Most people, in fact, engaged in the Track Your Plaque program achieve the 60-60-60 targets---or exceed them. It's not uncommon, for instance, for HDL to skyrocket to 80 or 90 mg/dl with many of our strategies. (Of course, if your starting HDL is 20 or 25 mg/dl, 80 or 90 is not possible with current technology.)But it certainly does require more than the "Take Lipitor and stick to your low-fat diet" approach that is the mantra repeated in the vast majority of medical offices across the U.S. For instance, reducing LDL to 60 mg/dl when starting at 170 mg/dl will require addition of oat bran and other soluble or viscous fibers; raw almonds and walnuts; perhaps the use of Benecol butter substitute; reduction or elimination of wheat products if small LDL comprises a substantial proportion of LDL particles. Reducing triglycerides requires the generous use of omega-3 fatty acids from fish oil. Attention to vitamin D must be a part of the effort. So, yes, it is not as simple as the conventional approach. But the results are far superior in reducing or eliminating heart attack and in dropping your heart scan score. But it can be done. We do it every day.
Vitamin D2 belongs in the garbage 8. August 2007 William Davis (15) It happened yet again. Mel came to the office. CT heart scan score: 799--quite high, enough to pose a real threat very soon. Thus, no time to lose in instituting an effective prevention program. We do the usual--identify the six causes of coronary plaque; begin fish oil, show him how to correct his plaque causes. You've heard it before. Vitamin D blood level in March: 17 ng/ml--severe deficiency. Vitamin D replacement needs to be a part of his coronary plaque control program. So I suggested 6000 units per day of an oil-based preparation of vitamin D3 (cholecalciferol). Conveniently, there is a Vitamin Shoppe outlet across the street from my office. I just point and tell people to go across the street. Mel did just that. However, he also informed his primary care physician about his vitamin D deficiency. His primary physician promptly told him he needed to take a prescription form of vitamin D and not to bother with just a supplement. So Mel stopped his vitamin D capsules and started taking vitamin D prescription "medication." Mel figured, naturally, that if it requires a prescription, it must be better. Unfortunately, Mel and his doctor failed to pass the change in strategy onto us. So, four months later, Mel got repeat vitamin D blood level: 19 ng/ml. I've seen this too many times. The prescription form of vitamin D is nonsense. There's hardly any effect on blood levels of vitamin D3 at all. The body's conversion of this non-human form of D is extremely inefficient and therefore virtually useless. While it raises the blood level of vitamin D2 (ergocalciferol) and thereby total D (D3 + D2), there is negligible effect on the real human and active form, D3. How and why this preparation got through the FDA process to obtain approval as a drug is beyond me, though I am not a defender of FDA practices and politics. This notion that "if it's a prescription, it must be better" is a fiction perpetuated by the drug industry. The same principle gets tossed around with fish oil, hormones like estrogens and testosterone, and others. Often, the principal difference between prescription and non-prescription is patent protection. Patent protection provides profit protection. Selling a product without patent protection can be risky business. It's certainly less profitable. As always, getting at the truth is sometimes the most difficult job of all. Prescription vitamin D belongs in the garbage. Vitamin D capsules (gelcaps) do the job and do it well, over and over, with reliable, consistent and substantial rises in blood levels of 25-OH-vitamin D3. I take 6000 units per day (3 2000 unit capsules) that cost me $5.99 for a bottle of 120 capsules, or about $4.50 a month. And nobody--nobody--pays me to say this. I say it because I believe it's true.
Angioplasty vs. Track Your Plaque 5. August 2007 William Davis (10) What does angioplasty have over the Track Your Plaque program?Well, first of all, the Track Your Plaque program has a lot to boast about. What other approach can claim to have reduced heart disease 30, 40, 51, and now 63%? That's as close to a cure that's ever--EVER--been achieved. Statin drug manufacturers can talk about an occasional 1, 2, or 5% reversal. We're talking 10 times more. The Track Your Plaque program also uses as little prescription medication as necessary. Fish oil, vitamin D, coenzyme Q10, niacin--some of the frequent tools used for plaque reversal in our program. Yes, we do use prescription medications, but only when there is truly a benefit and nutritional strategies have failed to achieve the goals we're seeking. We do not endorse shotgun prescription approaches conceived of by some marketing department at a pharmaceutical company.So what possible advantage can coronary angioplasty have? Why don't more people embrace a program like Track Your Plaque that has already proven itself enormously effective?Because angioplasty is easy. There's little worrying ahead of time. Just wait for the symptoms or other problem to appear, go to the hospital and get your procedure. You can live the free and easy life beforehand--no exercise, no diet efforts, no nutritional supplements. Just be sure to go to the hospital when suspicious symptoms strike. (Of course, you gamble that you survive the appearance of symptoms, a process 30-50% of people fail to survive.)That means you can eat all you want, drink all you want, save the money you otherwise might have thrown away on supplements, pocket the monthly costs of an exercise club membership, etc. Go to the hospital when you experience the sensation of an anvil on your chest or of suffocation, let the emergency room do their thing, meet your cardiologist, go to the catheterization laboratory, get two or three stents, go home the next day!Why bother with a prevention program, especially one that requires involvement, learning, and effort like Track Your Plaque? Because it's your way to stack the odds enormously in your favor of 1) surviving the appearance of symptoms, 2) avoiding the prospect of heart procedures, which are not as clean and easy as they often seem, 3) have a longer lasting durability than a stent which could buy you a couple of years before your next procedure or heart catastrophe, and 4) it's the right thing to do for the sake of the huge societal cost of heart disease. Many of you have the equivalent of a cure for heart disease at your fingertips. Unless you have a soft spot in your heart for hospitals, cardiologists, or the pharmaceutical or medical device industry, there isn't a choice.
Plaque is like money 3. August 2007 William Davis (0) In case anyone missed this in the June, 2007 Track Your Plaque Newsletter, I'm again posting how we calculate the annual rate of score increase, should it occur.For instance, say your score in January, 2005, is 100. In November, 2006, you undergo another scan and the score is 140. Obviously, your score has increased an undesirable 40%. But what is the annual rate of score increase, the amount of increase per year?In this example, the annual rate of score increase is 19%--not anywhere near as bad as the 40% that can scare the heck out of you.Obviously, the best rate of heart scan score increase is a negative number, i.e., a drop in score from, say 100, to 60. You might even eliminate the need for this calculation altogether if you drop your score. Nonetheless, whenever there is a score increase over an uneven period of time, a fraction of year(s), this is the method we use to annualize the calculation. The equation we use is a modified form of the annual compound interest equation using continuous compounding, since that’s how coronary atherosclerotic plaque grows--just like money. The difference is, of course, is that while you might want more money, you certainly don't want more plaque. You will need a calculator for this calculation, one with an exponential “y to the power x” function. For ease, calculate "1/t first, then use it as the “x” exponent on your yx function and "(score 2 / score 1)" as the "y".Annual rate of plaque growth (APG) = ( score 2 / score 1 ) 1/t - 1Multiply the result by 100 to yield a percent.“Score 1” is your 1st heart scan score, “score 2” is your 2nd (or any subsequent heart scan score); “t” is the amount of time between the two scans expressed in years in decimal form. Time between scans should be expressed in years or fractions of years. To obtain the time interval in fractions of years, simply divide the number of months between scans by 12 (e.g., 18 months / 12 = 1.5 years ; 22 months / 12 = 1.83 years).It’s not as tricky as it looks. For example, if your first heart scan score is 300 and your next scan 16 months later (or 16/12 = 1.33 years) is 372, then:Annual rate of plaque growth (APG) = ( 372 / 300 ) 1/1.33 - 1 = 0.175Multiply 0.175 x 100 = 17.5% annual rate of plaque growthSome scan centers will do the calculation for you as part of a repeat scan. However, the equation can be used if you're left on your own, or if you go to a different scan center. If this is too much effort, perhaps it's just another reason to add to the list of reasons to drop your heart scan score!
Triglycerides: What is normal? 1. August 2007 William Davis (2) In The Track Your Plaque program, we advocate decreasing triglycerides to 60 mg/dl or less. That's the level of triglycerides that minimize the presence of triglyceride-containing undesirable lipoproteins causing plaque, such as small LDL, VLDL, and the after-eating persistence of IDL (intermediate-density lipoprotein, a bad player). (The enzyme, cholesteryl-ester transfer protein, or CETP, is responsible for exchanging one triglyceride molecule for one cholesterol molecule between HDL and other lipoprotein particles. Thus, an excess of triglyceride availability permits CETP to operate unrestrained, creating more undesirable lipoproteins. This was the basis for Pfizer's now defunct CETP inhibitor, torcetrapib.)Of course, this triglyceride target is far below that of the conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests a triglyceride level of 150 mg/dl is okay. In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth. In short, triglycerides of 150 are awful. Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl. We have seen many people drop their heart scan scores just by achieving a triglyceride level of 60 mg/dl or less. So achieving a lower level below 60 is not necessarily a requirement for coronary plaque regression. But it makes me wonder if a triglycere level of 30s or 40s is the level for perfect health. These are levels ordinarily regarded as impossibly low. When colleagues see the numbers we readily and routinely achieve, they declare that the numbers are spurious, temporary, or just flukes. "No way you can do that all the time!" This level also seems to, in virtually all cases, eliminate the triglyceride-containing undesirable lipoproteins small LDL, IDL, etc., and allow full conversion of HDL into the healthy, large fraction. Should we move the Track Your Plaque triglyceride target to below 45 mg/dl or even lower? I don't think so, but it makes me wonder.
The processed food battlefield 31. July 2007 William Davis (4) If you have any remaining doubts that the processed food industry is a cutthroat, go-for-the-jugular, organized effort to extract every possible penny from your pocket, even at the expense of health, take a gander at a quote from Marion Nestle's wonderful book, Food Politics.In Nestle's description on how food conglomerate, Archer Daniels Midland (ADM), conspired to fix prices on some basic agricultural compounds, she quotes an ADM executive captured on videotape and presented in court:"We have a saying at this company . . . our competitors are our friends and our customers are our enemies."In other words, ADM's competitors help establish what prices should be charged for basic foodstuffs, while its customers are the ones to do battle with. Food is a necessary commodity. You and I only need so much of it. So how does a 40 billion dollar food manufacturer extract greater and greater profits and grow their market? Motivate people to eat more. It's that simple. Eat less? Are you kidding? Eat spinach, green peppers, beets, and other low-margin products? Get real. Why not take 8 cents worth of wheat flour, add some sugar, food coloring, and some other enticing flavorings like high fructose corn syrup? Put it all in a cleverly illustrated package, maybe even develop an entire story line about the product, complete with clever slogans and songs and . . . ouila! You now have a food that sells for many, many times its intrinsic value. How to make the health nuts happy? Easy: Add some fiber. Now it's healthy! And it's now part of a "balanced diet". What if it's full of corn starch, wheat flour, and sugar of the sort that make HDL cholesterols plummet, fan the flames of small LDL, increase inflammatory measures like C-reactive protein, push people closer and closer to diabetes, and make them fat? Then be sure it's low in saturated fat! It might even qualify as "Heart Healthy" by the American Heart Association! Processed foods have no role in the Track Your Plaque program. If you want to see your CT heart scan score skyrocket, go to your grocery store and stray into the aisles outside of the produce aisle. But stick to the produce aisle and watch your wallet grow, your health improve, your appetite shrink, all while food processor profits plummet.
Heart Scan debate 29. July 2007 William Davis (4) A few years back when the book form of Track Your Plaque was first released, I did a bunch of radio and interviews to raise awareness of the book and of CT heart scanning in general. I'd forgotten about this interview I did for National Public Radio (NPR), in which I debate Dr. Graboys from Harvard. Though I've had this debate countless other times, usually on a less formal basis, I didn't know what to expect at the start of the interview. After all, I knew of Dr. Graboys' reputation as a respected Harvard cardiologist. So I was expecting that at least he would argue that, being relatively new at the time, CT heart scanning was largely unproven in large clinical trials. (This was not entirely true then, however, as at least 1000 trials had already been performed, many of them involving thousands of participants. However, despite that much validation, the concept of CT heart scanning had still not entered the consciousness of most practicing physicians. After all, heart scanning is not part of the "crash and repair" equation that most have invested their career in.)Heart Hawk re-discovered the debate, still on the NPR website. So here it is. When I re-listened to the debate, I was surprised at how little Dr. Graboys had to offer. He argues that examining left ventricular function should suffice as an important measure of mortality. In other words, if you have experienced a drop in the strength of heart muscle, that can be used to stratify your risk of death. I tried to convey to the audience (NOT convince Dr. Graboys to believe, as most of my colleagues are stubbornly adherent to their way of thinking until someone tosses a big carrot in front of them) that CT heart scanning provides a means to detect coronary atherosclerosis years, even decades, before questions of mortality (death) became necessary. Heart scanning identifies disease in its early stages so that a program of prevention can be followed and tracked. Dr. Graboys expressed concern that heart scanning devices could be mis-used to increase hospital procedures. He's absolutely right here. By that same line of thinking, say your crooked auto mechanic on the corner scams most of his customers by doing unnecessary car repairs. Does this mean that we should ban all auto mechanics from repairing cars? I hope not. I believe it does mean that we should all be educated on distinguishing scams from an honest businessman. Same with heart scans. The key is not to ban heart scanning. We should try to educate the public and physicians to prevent these sorts of scams and decisions based on ignorance from occurring. Nonetheless, make your own judgments. CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play)
Break the addiction 28. July 2007 William Davis (8) "But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep. Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict. Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:You no longer crave these foods. Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more. It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction. Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible. You will be impressed with the results.
Are we done here? 27. July 2007 William Davis (4) Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy. Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart. Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before. I explained to Les that having normal coronary blood flow was just one aspect of the issue. "But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack."With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him. Now, if we could only transform Les into an optimist . . .