Genetic vs. lifestyle small LDL

19. February 2010 William Davis (59)
Let me explain what I mean by "genetic small LDL." I think it helps to illustrate with two common examples.

Ollie is 50 years old, 5 ft 10 inches tall, and weighs 253 lbs. BMI = 36.4 (obese). Starting lipoproteins (NMR):

LDL particle number 2310 nmol/L
Small LDL: 1893 nmol/L (1893/2310 = 81.9% of total, a severe small LDL pattern)


Stan is 50 years old, also, 5 ft 10 inches tall, and weighs 148 lbs. BMI = 21.3. Starting lipoproteins:

LDL particle number 1424 nmol/L
Small LDL 1288 nmol/L (1288/1424 = 90.4% of total, also severe)


Both Ollie and Stan go on the New Track Your Plaque diet and eliminate wheat, cornstarch, and sugars, while increasing oils, meats and fish, unlimited raw nuts, and vegetables. They add fish oil and vitamin D and achieve perfect levels of both. Six months later, Ollie has lost 55 lbs, Stan has lost 4 lbs. A second round of lipoproteins:

Ollie:

LDL particle number 1810 nmol/L
Small LDL: 193 nmol/L (193/1810 = 10.6% of total)


Stan:

LDL particle number 1113 nmol/L
Small LDL 729 nmool/L (729/1113 = 65.4% of total)


Ollie has reduced, nearly eliminated, small LDL through elimination of wheat, cornstarch, and sugars, along with weight loss, fish oil, and vitamin D.

Stan, beginning at a much more favorable weight, reduced both total and small LDL with the same efforts, but retains a substantial proportion (65.4%) of small LDL.

Stan's pattern is what I call "genetic small LDL." Of course, this is a presumptive designation, since we've not identified the specific gene(s) that allow this (e.g., gene for variants of cholesteryl ester transfer protein, hepatic lipase, lipoprotein lipase, and others). But it is such a sharp distinction that I am convinced that people like Stan have this persistent pattern as a genetically-determined trait.

Carbohydrate sins of the past

17. February 2010 William Davis (15)
Fifty years ago, diabetes was a relatively uncommon disease. Today, the latest estimates are that 50% of Americans are now diabetic or pre-diabetic.

There are some obvious explanations: excess weight, inactivity, the proliferation of fructose in our diets. It is also my firm belief that the diets advocated by official agencies, like the USDA, the American Heart Association, the American Dietetic Association, and the American Diabetes Association, have also contributed with their advice to eat more “healthy whole grains.”

When I was a kid, I ate Lucky Charms® or Cocoa Puffs® for breakfast, carried Hoho’s® and Scooter Pies® in my lunchbox, along with a peanut butter sandwich on white bread. We ate TV dinners, biscuits, instant mashed potatoes for dinner. Back then, it was a matter of novelty, convenience, and, yes, taste.

What did we do to our pancreases eating such insulin-stimulating foods through childhood, teenage years, and into early adulthood? Did our eating habits as children and young adults create diabetes many years later? Could sugary breakfast cereals, snacks, and candy in virtually unlimited quantities have impaired our pancreas’ ability to produce insulin, leading to pre-diabetes and diabetes many years later?

A phenomenon called glucose toxicity underlies the development of diabetes and pre-diabetes. Glucose toxicity refers to the damaging effect that high blood sugars (glucose) have on the delicate beta cells of the pancreas, the cells that produce insulin. This damage isirreversible: once it occurs, it cannot be undone, and the beta cells stop producing insulin and die. The destructive effect of high glucose levels on pancreatic beta cells likely occurs through oxidative damage, with injury from toxic oxidative compounds like superoxide anion and peroxide. The pancreas is uniquely ill-equipped to resist oxidative injury, lacking little more than rudimentary anti-oxidative protection mechanisms.

Glucose toxicity that occurs over many years eventually leaves you with a pancreas that retains only 50% or less of its original insulin producing capacity. That’s when diabetes develops, when impaired pancreatic insulin production can no longer keep up with the demands put on it.

(Interesting but unanswered question: If oxidative injury leads to beta cell dysfunction and destruction, can antioxidants prevent such injury? Studies in cell preparations and animals suggest that anti-oxidative agents, such as astaxanthin and acetylcysteine, may block beta cell oxidative injury. However, no human studies have yet been performed. This may prove to be a fascinating area for future.)

Now that 50% of American have diabetes or pre-diabetes, how much should we blame on eating habits when we were younger? I would wager that eating habits of youth play a large part in determining potential for diabetes or pre-diabetes as an adult.

The lesson: Don’t allow children to repeat our mistakes. Letting them indulge in a lifestyle of soft drinks, candy, pretzels, and other processed junk carbohydrates has the potential to cause diabetes 20 or 30 years later, shortening their life by 10 years. Kids are not impervious to the effects of high sugar, including the cumulative damaging effects of glucose toxicity.

Saturated fat and large LDL

16. February 2010 William Davis (44)
Here's a half-truth I often encounter in low-carb discussions:

Saturated fat increases large LDL particles


For those of you unfamiliar with the argument, I advocate a low-carbohydrate approach, specifically elimination of all wheat, cornstarch, and sugars, to reduce expression of the small LDL pattern (not to mention reduction of triglycerides, relief from acid reflux and irritable bowel, weight loss, various rashes, diabetes, etc). Small LDL particles have become the most common cause for heart disease in the U.S., exploding on the scene ever since agencies like the USDA and American Heart Association have been advising the public to increase consumption of "healthy whole grains."

This has led some to make the pronouncement that saturated fat increases large LDL, thereby representing a benign effect.

Is this true?

It is true, but only partly. Let me explain.

There are two general categories of factors causing small LDL particles: lifestyle (overweight, excess carbohydrates) and genetics (e.g., variants of the gene coding for cholesteryl-ester transfer protein, or CETP).

If small LDL is purely driven by excess carbohydrates, then adding saturated fat will reduce small LDL and increase large LDL.

If, on the other hand, your small LDL is genetically programmed, then saturated fat will increase small LDL. In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL. If your dominant genetically-determined form is small, then saturated fat increases small LDL particles.

So to say that saturated fat increases large LDL is an oversimplification, one that can have dire consequences in the wrong situation.

Is glycemic index irrelevant?

14. February 2010 William Davis (20)


University of Toronto nutrition scientist, Dr. David Jenkins, was the first to quantify the phenomenon of "glycemic index," describing how much blood sugar increased over 90 minutes compared to glucose. The graph is from their 1981 study, The glycemic index of foods: a physiologic basis for carbohydrate exchange. The research originated with an effort to characterize carbohydrates for diabetics to gain better control over blood sugar.

Since Dr. Jenkins’ original work, thousands of clinical studies have been performed by others exploring this concept. The food industry has also devoted plenty of effort exploiting it (e.g., low-glycemic index noodles, low-glycemic index cereals, etc.).

Most Americans are now familiar with the concept of glycemic index. You likely know that table sugar has a high glycemic index (60), increasing blood sugar to a similar degree as white bread (glycemic index 71). Oatmeal (slow-cooked) has a lower glycemic index (48), since it increases blood sugar less than white bread.

A number of studies have shown that when low glycemic index foods replace high glycemic index foods (e.g., whole wheat bread in place of cupcakes), people are healthier: less diabetes, less heart attack, less high blood pressure. Books have been written about glycemic index, touting its benefits for health and weight control. Health-conscious people will try to substitute low-glycemic index foods for high-glycemic index foods.

So what’s not to like here?

There are several fundamental flaws with the notion that low-glycemic index foods are good for you:

1) Check your blood sugar after a low-glycemic index food like oatmeal. Most non-diabetic adults will show blood sugars in the 140 to 200 mg/dl range. The more central (visceral) fat you have, the higher the value will be. In other words, an apparently “healthy” whole grain food like oatmeal can generate extravagantly high blood sugars. Repeated high blood sugars of 125 mg/dl or greater after eating increase heart disease risk by 50%.

2) Foods like whole wheat pasta have a low glycemic index because the blood sugar effect over the usual 90 minutes is increased to a lesser degree. The problem is that it remains increased for an extended period of up to several hours. In other words, the blood sugar-increasing effect of pasta, even whole grain, is long and sustained.

3) Low-glycemic index foods trigger other abnormalities, such as small LDL particles, triglycerides, and c-reactive protein (a measure of inflammation). While they are not as bad as high-glycemic index foods, they are still quite potent triggers.

Low-glycemic index foods trigger the very same responses as high-glycemic index foods—they’re just less bad. But less bad does not equate to good. Low-glycemic index foods cause weight gain, trigger appetite, increase blood pressure, and lead to the patterns that cause heart disease.

High-glycemic index foods are bad for you. This includes foods made with white flour (bagels, white bread, pretzels). Low-glycemic foods (whole grain bread, whole wheat crackers, whole wheat pasta) are less bad for you—but they are not necessarily good.

Don’t be falsely reassured by foods because they are billed as “low-glycemic index.” View low-glycemic index foods as indulgences, something you might have once in a while, since a slice of whole grain bread is really not that different from a icing-covered cupcake.

What Mr. Clinton did NOT do

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

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



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

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


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

Magnesium and arrhythmia

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

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

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

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



Dr. Davis,

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

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

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

Thank you SO MUCH!

Warmly,
Catherine C.

Video teleconference with Dr. Davis

10. February 2010 William Davis (4)

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

to discuss your heart health issues.


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

Lipoprotein assessment

Heart scans and coronary calcium scores

Diet and nutrition

Weight loss

Vitamin D supplementation for optimal health

Proper use of omega-3 fatty acids/fish oil


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


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

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

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

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

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

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

Thinner by Thursday

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

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

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

Wheat elimination.

Omega-3 Index: 10% or greater?

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

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

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





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

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

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

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

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

Let's soak 'em with fish oil

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


Hello Dr. Davis,

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

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

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

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

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

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

Sincerely JP, Tennessee


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

Heart health for stupid people

4. October 2007 William Davis (3)
I'm kidding.

What I'm referring to is the incredibly lame information I come across that passes as "heart health" on the internet, magazines, and other media. Just to keep abreast of what is being said, I subscribe to multiple newsletters and magazines and I witness the sorts of advice offered to the reading public.

A recent long-winded article on a popular website listed the "exciting" strategies available for a healthy heart:

Eat healthy--by eating a "balanced" diet low in saturated fat

Don't smoke

Exercise

Don't ignore chest pain symptoms or breathlessness

Know your numbers! meaning your cholesterol numbers. "If your cholesterol is high, you may need to speak to your doctor about medication to reduce it."


Surely they must all believe we're stupid. Otherwise, why would they repeat the same obvious information over and over again? Quit smoking? Gee, you think so?

How about some real heart healthy advice:

Get a heart scan--since we have to accept that cholesterol values are a miserable failure in detecting hidden heart disease. So is waiting for symptoms to appear.

If you have any measure of coronary plaque, ask your doctor to assess lipoproteins, not lipids (cholesterol).

Take fish oil for omega-3 fatty acids--At a dose of 1000 mg or more of EPA + DHA, heart attack risk is reduced by at least 28%.

Eliminate wheat and other processed carbohydrates --Small LDL has emerged as the number one cause of coronary plaque, not high cholesterol from saturated fat.

Get vitamin D assessed--The effects are huge--HUGE. There's already a study in a kidney disease population that showed a substantial reduction in mortality with vitamin D supplementation. More data are coming, including our own.


That's a start--truly effective, practical heart healthy strategies that go way beyond the conventional bland advice.


Copyright 2007 William Davis, MD

Money, money, money, money

3. October 2007 William Davis (3)
I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.


Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.

The many faces of LDL

3. October 2007 William Davis (13)
Ginnie came in for an opinion about her heart scan score of 393. At age 57, this put her in the 99th percentile, a high score.

As usual, we did a lipoprotein analysis by NMR (Liposcience). Some numbers:

LDL cholesterol: 96 mg/dl
This value puts Ginnie's LDL in the most favorable 25% in the country.


LDL particle number: 2140 nmol/l
This value is in the worst 25% of the country and is the equivalent of an LDL cholesterol of 214 mg/dl (take off the zero).

In addition, over 90% of Ginnie's LDL particles fell into the small class.

Had we run some other values, how would they have turned out? These are my estimates (since we didn't actually run them in Ginnie), but having run side-by-side numbers in past, reasonable estimates would have put:

Apoprotein B somewhere in the 120 to 140 mg/dl range

Direct LDL 100-130 mg/dl range.


In other words, conventional calculated LDL is the least reliable of all the ways of examining low-density lipoprotein.

It can also go the other way: High calculated LDL, low LDL particle number or ApoB or direct LDL. And, indeed, these other measures have proven superior in their ability to predict "events" like heart attack over conventional calculated LDL.

Unfortunately, relying on conventional LDL is like a broken speedometer on your car. You really can't gauge accurately how fast you're going; sometimes you could be way off. While insurance companies and many physicians still continue to balk at this argument, the data have already been generated that show that lipoprotein analysis (my bias is NMR) is not just superior, but enormously superior for accuracy and event prediction.

In addition, lipoprotein analysis has proven a crucial tool that accounts for our extraordinary success in reducing and controlling CT heart scan scores in the Track Your Plaque program. I doubt that we could have achieved the same level of success using conventional lipids.

I'm also aware of the logistical difficulties obtaining lipoprotein testing in a world enthusiastically supportive of hospital procedures and smugly ignorant of superior prevention tools like lipoprotein analysis. I've learned just how difficult it can be in our Track Your Plaque Member Forum; I've also learned about some strategies for obtaining these tests that I hadn't been aware of, thanks to the resourcefulness of our Members.

We will be working on some solutions in the coming months.


Copyright 2007 William Davis, MD

What does "Success" mean in the Track Your Plaque program?

2. October 2007 William Davis (11)
Say you begin with a CT heart scan score of 400.

You correct your lipoprotein pattterns, take fish oil, correct 25-OH-vitamin D3 to 50 ng/ml, correct your other hidden patterns, follow a diet suited to your patterns.

One year later, you get another heart scan. What score would constitute "success"?

With all of our recent talk about record-setting reductions in heart scan scores, is it really necessary to drop your score that much to succeed?

For instance, is our latest record-setting 63% drop in score better than "only" a 10% drop in score? Both represent reversal of coronary plaque. Both signify huge reductions in risk for plaque rupture, or heart attack.

You can read about how we view the various forms of success in the program by reading our latest Track Your Plaque Special Report, Winning Your Personal War with Heart Disease: The Track Your Plaque 5 Stages of Success.

We are making the Report available to everyone. Just go to the www.cureality.com homepage.

Is health the absence of disease?

30. September 2007 William Davis (2)
It sounds like a word game, but is health the absence of disease?

In other words, if you're not sick, you must be well. If you don't have cancer, heart disease (overtly, that is, like angina and heart attack), the flu, diarrhea, fevers, pain someplace . . . well then, you must be well.

Of course, most of us would disagree. You can be quite unhealthy yet have no overt, explicit disease. Yet this is the philosophy followed in conventional medicine when it comes to many aspects of health.

With regards to heart disease, if you have no chest pain or breathlessness, you don't have heart disease. "Oh, all right, we'll perform a stress test to be sure." Track Your Plaque followers, as well as former President Bill Clinton, recognize the enormous pitfalls of this approach: It fails to identify the vast majority of hidden heart disease. In heart disease, the apparent lack of overt, sympatomatic "disease" does NOT equal the true absence of disease, even life-threatening.

How about nutritional supplements? Vitamin D is a perfect example. Blood levels of vitamin D of 10 ng/ml--profound deficiency--are common, yet people feel fine. Beneath the surface, blood sugar rises because of poor insulin response, hidden inflammatory responses are magnified, HDL is lower and triglycerides are higher, coronary plaque grows at an accelerated rate, colon cancer activity is heightened . . . Though you feel fine.

Can an abnormal "endothelial response" be present while you feel fine? You bet it can. This refers to the abnormal constrictive behavior of arteries that is present in many people who have hidden coronary plaque or risk for coronary plaque, but is entirely beneath consciousness.

How about a triglyceride level of 200 mg/dl, fatally high from the Track Your Plaque experience? (We aim for <60 mg/dl.) This is typical in people who follow the diets endorsed by agencies like the American Heart Association and the American Diabetes Association, organizations too eager to keep the money flowing from corporate sponsors and thereby offer us their advice based more on politics and less on health. Triglyceride levels of 200 mg/dl cause no symptoms.


At so many levels, the absence of disease is NOT the same as health. Health is something that is expressed by, yes, feeling good, but it's also measured by so many other factors hidden beneath the surface. An annual physical is one lame effort to address this aspect of "health." But it needs to go farther, much farther.

Heart scan, lipoprotein testing, vitamin D blood level--those are the basic requirements to go beyond the shortsighted practice of the conventional approach in the world of heart disease.

Cuckoo for Cocoa Puffs

30. September 2007 William Davis (8)




Take a look at the list of ingredients in Cocoa Puffs: corn, sugar, corn syrup--all high glycemic index foods.

In other words, Cocoa Puffs is the physiologic equivalent of pure table sugar. Sure, it comes packaged with this wacky bird and the back of the box usually has fun games and offers. There's also the clever, fast-paced TV commercials to remind you of how fun Cocoa Puffs can be.


What is the actual consequence of a breakfast of a food like Cocoa Puffs in a cup of skim milk? That's easy: A big surge in insulin and blood sugar (from the corn and sugar), a drop in HDL cholesterol, surge in triglycerides (from the sugar and sugar-equivalents), increase in small LDL. Beyond this, you raise blood pressure and experience an insatiable increase in appetite. Then you get fat.

Obviously, none of this is desirable. Then why does the American Heart Association allow its Heart CheckMark endorsement on the package?

The Heart Association is trapped in 1982. Low-fat was in, saturated fat was the sole enemy of heart disease.

In 1982, the evils of small LDL, for instance, were unappreciated. LDL cholesterol was LDL cholesterol--all of it was bad and saturated fats seem to raise LDL. But the story has evolved enormously since then: LDL is not all the same. Small LDL is among the principal culprits in heart disease, the same small LDL hugely magnified by Cocoa Puffs and other similar products that fill 70% of supermarket shelves.

The American Heart Association needs to get with the times. The conversation on healthy diets has progressed considerably. Yet garbage foods that wreak havoc on health like Cocoa Puffs continue to be endorsed by an organization that still carries substantial clout with the American consumer.

My advice: Until they change their tune, anything that carries the endorsement of the American Heart Association should be eliminated from your diet.

Further validation of the Track Your Plaque 60:60:60 targets

29. September 2007 William Davis (3)
The latest analysis of the data from Treat to New Targets (TNT) Trial shows that higher HDL cholesterol values are associated with reduced risk of heart attack, even in those with low LDL cholesterol values.

This counters the argument that some have made that, if a person takes a statin drug, raising HDL adds no additional benefit.

In the 9770-participant trial (randomized, double-blind), participants were given atorvastatin (Lipitor®) 10 mg or 80 mg per day. The study was sponsored by Pfizer, the manufacturer of Lipitor®. All participants were survivors of heart attacks, significant coronary disease by heart catheterization, or had previously undergone coronary angioplasty, stent placement, or bypass surgery—a high-risk group.

At the third month of enrollment, lipid (cholesterol panel) values were obtained and used as the basis for analysis. Participants on 80 mg atorvastatin achieved an average LDL cholesterol (Friedewald) of 77 mg/dl; participants taking 10 mg achieved a level of 101 mg/dl. Using these values, 8.7% of participants taking the higher dose of drug experienced an event, compared to 10.9% on the lower dose (which the investigators called a 22% relative reduction).

However, when the groups were re-analyzed by HDL cholesterol levels, higher HDLs remained predictive of less heart attack and other events, with the group having the highest HDL of =55 mg/dl experiencing 25% less events. Most interestingly, this effect was upheld even in participants with very low LDL cholesterols of <70 mg/dl.

I'm always a bit leery of drug company-sponsored studies, especially ones in which virtually all the participants tolerated a drug like Lipitor 80 mg, a dose in my experience that is very poorly tolerated for more than a few months. (Muscle aches are, in my experience, inevitable. I do not even recommend this dose.) In other words, the data are, in that respect, too good to believe.

Anyway, despite my reservations about these big money studies, there was nothing to gain from the HDL observation. (Of course, at one time, there would have been, given Pfizer's efforts to commercialize the now-kaput torcetrapib, scrapped because of excess mortality in phase II trials.)

Thankfully, there's other data that likewise suggest that the higher the HDL, the better. Yet more validation for the Track Your Plaque lipid targets of LDL 60 mg/dl, triglycerides 60 mg/dl or less, HDL 60 mg/dl or greater.



Copyright 2007 William Davis,MD

My sister called today . . .

28. September 2007 William Davis (5)
My younger sister, aged 48 years (sorry, sis), called this morning.

"I'm going to my doctor today. What labs should I tell him to draw?" she asked.

"Why do you have to tell him? Can't you just ask him what he thinks should be drawn?"

"No," she said. "He just draws what I tell him to."


Maybe my sister is bossier than most. But I've heard this from many patients, as well. They go to their primary care physician and end up requesting this or that test. Sometimes their doctor complies. Often, they resist and refuse to do so.

I've heard many complaints from patients about doctors refusing to order even fairly benign tests like a vitamin D blood level or lipoproteins, even a C-reactive protein.

The number of these sorts of complaints seems to be growing. Ten years ago, it rarely happened. Today, I hear this nearly every day.

I think it is symptomatic of the growing discontent we all have with the status quo in healthcare. We are all expected to submit to the paternalistic, what-can-you-possibly-know mentality that still rules the day in medical offices. Only 40-50 years ago, if you wanted to look at a medical book, you'd have to ask the librarian for special permission so that they could make sure you weren't just a pervert trying to look at naked bodies. Today, every manner of medical and health information can be found online. Quite a contrast.

We are entering a new age, one in which people are far better informed, have surfed the internet and read media reports on health topics, have been exposed to drug company advertising, and know a fair amount about nutritional supplements. I think the system needs to change to accommodate this rapidly growing hyper-knowledgeable society.

In past, when a health problem turned up, you'd turn to your doctor first. I predict that,in the next few years, we will use the doctor as a place of last resort, the person we turn to when all else has failed, after you've exhausted your information sources.

I hope that the Track Your Plaque process will become one of the engines of change, an information resource that provides empowering tools that don't replace your doctor, but provide many information tools that are superior and may minimize your reliance on a health care provider.


Copyright 2007 William Davis, MD

Failure to diagnose

27. September 2007 William Davis (6)
I picked up a hospital publication today. Featured prominently on the cover was a glossy photo of an attorney and his wife, both smiling.

The headline: "Atorney grateful for the lifesaving work of the ______ Hospital."

The story detailed the near-tragic story of how this 59-year old man was exercising at his local gym, only to lose consciousness after stepping off one of the exercise machines. Bystanders--hospital employees, as luck would have it--checked the man's pulse: none. They performed CPR. Ambulance called, blah blah blah.

Severe coronary disease discovered, extensive atherosclerotic plaque in all three coronary arteries, a 12-inch chest incision later and he and his wife are eternally grateful for the fine work done at X hospital. And so they should be for a job well done.

But wait a minute. After the urgent hospital dust settled, did anyone ask the one crucial question: Why wasn't this man's far-advanced heart disease identified? Why did he have to die and be resuscitated before his disease was recognized?

If this man was an indigent, homeless alcoholic . . . well, perhaps it would be no surprise. Health is neglected in this population. But a successful attorney?

Detecting hidden coronary atherosclerotic plaque simply isn't that tough. In Milwaukee, $199 would have diagnosed his disease unequivocally.

Unfortunately, we still have to set off drumrolls and crash cymbals to even begin to get the attention of the practicing physicians around us who continue to fail to diagnose hidden coronary disease. I wouldn't be at all surprised to hear if this man had a $4000 nuclear stress recently that was normal. Why would a nuclear stress test be normal? Easy: Wrong test.

The hidden message: The failure to diagnose paid somebody and some hospital over $100,000. So, why bother detecting disease before the payoff?

The profit motive in all this is all too obvious. The only other explanation is the enormous, repetitive, and systematic stupidity of the conventional approach to heart disease detection. You have the solution, at least for you and the people around you, in a CT heart scan and in the Track Your Plaque program.


Copyright 2007 William Davis, MD

Interview with world heart scan authority, Dr. John Rumberger

26. September 2007 William Davis (1)











Dr. John Rumberger has, from its start, been a good friend of the Track Your Plaque program.

We are very proud to have his friendship. Dr. Rumberger is not only a world-renowned scientist in the world of cardiac imaging and heart scanning, but also a humanitarian and gentleman. From the very first day I met Dr. Rumberger many years ago, when he answered my many silly and naive questions about heart scans, I came to appreciate his deep and genuine interest in improving the world of heart disease detection.

I tracked Dr. Rumberger down from his busy schedule, now on a new project at the Princeton Longevity Center in Princeton, New Jersey.




TYP: Dr. Rumberger, we understand that your career has taken a new direction. Can you tell us about your current project?

Dr. Rumberger: I have not really taken a new direction, but further expanded on my opportunities.

I remain Medical Director of PrevaHealth Wellness Diagnostic Center (formerly Healthwise) in Columbus, Ohio. At that center, we see patients referred by their doctors for further refinement in cardiac risk stratification using heart and body scanning. However, by only doing scans alone there are limited opportunities for me to react in a meaningful way with the individual patients and thus I miss opportunities to do direct one-on-one teaching.

Currently, I spend most of my time in Princeton, NJ as Director of Cardiac Imaging for the Princeton Longevity Center. At the PLC, we perform comprehensive medical examinations along with screening CT scans, blood work, fitness and diet consultation to affect a more thorough one-on-one experience. Each patient then receives a comprehensive de-briefing.

In addition, since I have been involved with cardiac CT for now nearly 24 years, the PLC also affords me an opportunity to develop a CT coronary angiography training program for cardiologists and radiologists (www.cardiaccta.us). Together, these new efforts are merely an extension of my interests in prevention, patient care, and teaching.



TYP: Based on your book, The Way Diet, we understand that you advocate gravitating away from processed foods and incorporating more nuts, monounsaturated oils, lean proteins like fish, and a reduction in processed carbohydrates. You’ve also been a proponent of the Mediterranean diet that demonstrated a dramatic reduction in cardiovascular events in the Lyon Heart Study.

Has your philosophy or practice regarding nutritional strategies evolved or changed in any way since your book was published?

Dr. Rumberger: No, the strategies put forward in The Way Diet have, if anything, been reinforced by further and further research in selecting foods that are naturally high in anti-oxidants with lean sources of protein and reduced intake of processed sugar-containing preparations. The book, however, is what I call a ‘philosophy’ book which looks at three major aspects: proper diet, adequate exercise, and stress management. I also include some recipes which follow the dietary plans, but are done using ingredients that are commonly found in the average home.



TYP: We regard you as the source of much of the wisdom in heart scanning as the basis for early heart disease detection. Much of the original and subsequent scientific data, in fact, bears your name. Can you touch on some of the new directions your research has taken over the past couple of years?

Dr. Rumberger: We have come a long way from the beginning and there is a long way to go to get this incorporated into routine preventive care in the United States.

The most recent research has provided not so much more information as continuing to reinforce the old research. As I always say: if your research continues to show the same thing, then maybe there is a clear pattern here! The biggest challenge is getting this message into the mainstream and also trying to get cardiologists (and internists and, in fact, the general public) away from ‘stenosis’ detection to define the real cause of heart attacks (plaque) and into ‘plaque detection.’ This is where basic heart scanning has the greatest potential to reduce the expanding burden of heart disease.

You may be aware of our SHAPE initiave in which an international group of cardiologists and scientists have advocated getting a heart scan FIRST and then, if abnormal, checking your cholesterol values; rather than using cholesterol (which is valuable, but highly variable in predictive power) to determine who needs medications or further testing. The heart scan can define the current level of plaque and THEN you can determine what to do about it. [See the Track Your Plaque report on the release of the Shape Guidelines at SHAPE Guidelines]



TYP: We understand that you are performing CT coronary angiography in your center. What are your thoughts on the role of CTA in 1) screening for coronary disease, and 2) its role in the diagnostic process?

Dr. Rumberger: CT coronary angiography (CTA) is an incredible method to really define the extent of disease, beyond just coronary calcium. Its role is most appropriate in ruling OUT a significant ‘stenosis’ while really defining the absence or presence (and thus ‘how much’) of plaque. It is the ultimate ‘plaque detector’. CTA is best used in patients who have some symptoms, but in whom the clinician feels may NOT have clear cardiac chest pain. By risk-stratifying using CTA, we also gain information about heart size, heart function, whether there is prior heart damage, as well as other important information. This then becomes a very universal means to risk-stratifying individuals.



TYP: Thanks for your wonderful insights, Dr. Rumberger! We look forward to hearing about your future projects and research directions.





About John Rumberger, PhD, MD:
Dr. Rumberger is among the world's leading authorities on cardiac and vascular imaging using EBT and CT Scanning. Dr. Rumberger was among the first to pioneer the use of new CT technologies for heart scanning. He currently serves as Director of Cardiac Imaging at the Princeton Longevity Center, Princeton, NJ.

Dr. Rumberger is formerly Professor of Medicine and Consultant in the Department of Cardiovascular Diseases at the Mayo Clinic in Rochester, Minnesota. Dr. Rumberger received his doctorate in engineering from The Ohio State University in 1976 and graduated from the University of Miami School of Medicine in 1978.

During his over 20 year career as a clinician, educator, and researcher, Dr. Rumberger has published nearly 500 scientific papers and book chapters. He has lectured worldwide on EBT, early heart disease diagnosis, and wellness. He is an Established Investigator of the American Heart Association and a Founding Member of the International Society of Atherosclerosis Imaging. Dr Rumberger is an active Reviewer for the Journal of the American Medical Association, Archives of Internal Medicine, and the New England Journal of Medicine.