Dr. Cannell comments on vitamin D lab tests 14. July 2008 William Davis (9) As always, Dr. John Cannell of The Vitamin D Council continues to teach us new lessons about vitamin D. Apparently, Dr. Cannell is swamped with the attention that vitamin D is drawing, largely due to his efforts to publicize the enormous deficiency of Americans and his great talent for articulating the science. The most current newsletter, while a bit haphazard, makes some excellent new points that I reprint here. (I did not reprint his conversation about "any form of vitamin D" being acceptable. My experience differs: In nearly 1000 patients who have taken vitamin D supplements, my experience is that most tablet forms are inconsistently absorbed, sometimes not absorbed at all. I therefore advocate only use of gelcaps or liquids. I'm told by members of Track Your Plaque, however, that they are witnessing reliable increases in blood levels of vitamin D by taking the powdered form of Bio Tech Pharmacal's product.) Does it matter what reference lab my doctor uses?Yes, it might make a huge difference. A number of methods exist to measure 25(OH)D in commercial labs. The two most common are mass spectrometry and a chemiluminescence method, LIAISON. The first, mass spectrometry, is highly accurate in the hands of experienced technicians given enough time to do the test properly. However, in the hands of a normally trained technician at a commercial reference lab overwhelmed with 25(OH)D tests, it may give falsely elevated readings, that is, it tells you are OK when in fact you are vitamin D deficient. The second method, chemiluminescence, LIAISON, was recently developed and is the most accurate of the screening, high throughput, methods; LabCorp uses it. Quest Diagnostics reference lab uses mass spec. Again, both Quest and LabCorp are overwhelmed by 25(OH)D requests. The problem is that the faster the technicians do the mass spec test, the more inaccurate it is likely to be. If your 25(OH)D blood test says "Quest Diagnostics" on the top, do not believe you have an adequate level (> 50 ng/ml). You may or may not; the test may be falsely elevated. Let me give you an example. A doctor at my hospital had Quest Diagnostics do a 25(OH)D. It came back as 99 ng/ml of ergocalciferol. He is not taking ergocalciferol (D2), he has never taken ergocalciferol, only cholecalciferol, and he is not taking enough to get a level of 99 ng/ml, 50 ng/ml at the most. His email to Dr. Brett Holmquist at Quest about why Quest identified a substance he was not taking went unanswered other than to say "any friend of Dr. Cannell's is a friend of ours."Long story short: if your lab report says "LabCorp" on the top, it is probably accurate; if it says Quest Diagnostic, it may be falsely elevated. While LabCorp has also been overwhelmed with 25(OH)D requests, the LIAISON method they use is relatively easy to do and does not rely on technician skill as much as the mass spec methods do. I'm not saying this because I'm a consultant for DiaSorin, who makes LIAISON, I'm saying it because it is true. If you don't believe me, get Quest to make me an offer to be their consultant at 10 times what DiaSorin is supposed to be paying me ($10,000 per year) and see how fast I turn Quest down. If Quest fixes their test, I'd love to consult. The ironic thing: I've made both Quest and LabCorp lots of money via this newsletter, the website, and by repeatedly telling the press that people need to know their 25(OH)D level, which has contributed to the skyrocketing sales of 25(OH)D blood tests.Demand for vitamin D tests soars as nutrient's potential benefits touted.Here you can help. Find out which labs in your town use Quest Diagnostics and which use LabCorp. Have a 25(OH)D test at both labs the same day (you will have to pay for them yourself). Then send both results to the Vitamin D Council address below. If Quest Diagnostics does not fix their 25(OH)D test, the Vitamin D Council will fix it for them.My doctor prescribed Drisdol, 50,000 IU per week. What is it?Drisdol is a prescription of 50,000 IU tablets of ergocalciferol or D2. Ergocalciferol is not vitamin D but it is similar. It is made by irradiating ergosterol, which is found in many living things, such as yeast. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as human vitamin D (cholecalciferol or D3) does. However, Drisdol is a lot better than nothing. The best thing to do, if you are vitamin D deficient, and a human, is to take human vitamin D, cholecalciferol, A.K.A. vitamin D3.What is the ideal level of 25(OH)D?We don't know. However, thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml. In a recent study, Heaney et al enlarged on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound, cholecalciferol, and 25(OH)D levels were measured. It turn out that the body does not reliably begin storing the parent compound (cholecalciferol) in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml. The average person starts to store cholecalciferol at 40 ng/ml, but at 50 ng/ml, virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml, the body is usually using up the vitamin D as fast as you make it or take it, indicating chronic substrate starvation, not a good thing. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4.Heaney RP, Armas LA, Shary JR, Bell NH, Binkley N, Hollis BW. 25-Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am J Clin Nutr. 2008 Jun;87(6):1738-42.I have advanced renal failure and I'm on dialysis, how much vitamin D should I take? The same as everyone else. Since I have told you about commercial labs ripping you off, let's add some drug companies. Patients with advanced renal failure need activated vitamin D or one of it's analogs, available by prescription. This is very important as their kidneys cannot make enough 1,25-dihydroxy-vitamin D (calcitriol) to maintain serum calcium. However, the rest of their tissues activate vitamin D just fine and when those tissues get enough, and when the kidneys get more vitamin D, the calcitriol spills out into the blood, lowering their need for prescription calcitriol or one of its analogs. The companies that make the analogs don't like that, it means reduced sales. So these companies do nothing, the scientists behind these companies say nothing, and renal failure patients die prematurely from one of the vitamin D deficiency diseases. Vieth R. Vitamin D toxicity, policy, and science. J Bone Miner Res. 2007 Dec;22 Suppl 2:V64-8.When I asked my doctor for a 25(OH)D blood test, he just laughed and said it was all idiotic. What can I do? Help me unleash the dogs of war, the plaintiff attorneys. If you read about past nutritional epidemics caused by society, such as beriberi or pellagra, you will realize that education alone will take decades. Physicians successfully fought against the idea that thiamine deficiency caused beriberi for decades. However, things are different now. The agents of change in modern America, as obnoxious as they are, are plaintiff attorneys. Once the first malpractice lawsuits claiming undiagnosed and untreated vitamin D deficiency led to breast cancer, autism, heart disease, etc., get past summary judgment, and they will, and end up in front of a jury, and they will, things will change rapidly. One of the main reason physicians do what they do is fear of lawsuits. In a matter of months, arrogance and ignorance will give way to 25(OH)D tests and vitamin D supplementation.Goodwin JS, Tangum MR. Battling quackery: attitudes about micronutrient supplements in American academic medicine. Arch Intern Med. 1998 Nov 9;158(20):2187-91.And, to help support Dr. Cannell's efforts (I sent him a check for $250 a few months back; time for more), here is his contact info:John Cannell, MDThe Vitamin D Council Send your tax-deductible contributions to:The Vitamin D Council9100 San Gregorio RoadAtascadero, CA 93422
Privileged information 12. July 2008 William Davis (9) In 1910, taking a person's blood pressure was considered revolutionary, a high-tech practice that was of uncertain benefit. Dr. Harvey Cushing of Johns Hopkins Hospital in Baltimore had observed a blood pressure device while traveling in Europe, developed by Dr. Sciopione Riva-Rocci. Cushing brought this new technology back with him to the U.S. and promptly promoted its use, convinced that this insight into gauging the forcefulness of blood pressure would yield useful clinical insights. But, in 1910, practicing physicians rejected this new technology, preferring to use their well-established and widely practiced technique of pulse palpation (feeling the pulse), skeptical that the new tool added value. Medical practice of the day was rich with descriptions of the strength and character of the pulse: pulsus parvus et tardus (the slow rising pulse of aortic valve stenosis), the dicrotic notch of aortic valve closure transmitted to the pulse, the "water-hammer" pulse of aortic valve insufficiency.Over the next 20 years, however, the medical community finally gave way to the new technique, although only physicians were allowed to use blood pressure devices, as nurses were regarded as incapable of mastering the skills required to perform the procedure properly. Stethoscopes were also gaining in popularity in the early 20th century, but were also the exclusive province of physicians trained in their use. Nurses were not allowed to use stethoscopes until the 1960s. Even then, nurses were not allowed to call them "stethoscopes," but "nurse-o-scopes" or "assistoscopes," and the nurses' version of the device was manufactured to look different to avoid confusion with the "real" doctor's tool.And just half a century ago, if you wanted to look at a medical textbook, you would have to go to the library and ask for special permission. The librarian would lower her glasses and look you up and down to determine whether or not you were some kind of pervert. Only then might you be granted permission to peer into the pictures of organs and naked bodies. Such has been the spirit of medicine for centuries: Medicine and its practices are meant to be secret, the insider knowledge of a privileged few. Fast forward to 2008: The Information Age has overturned the rules of privileged information. Now you have access to the same information as I do, the same information available to practicing physicians. The playing field has been levelled. Curiously, while information access has advanced at an instantaneous digital pace, attitudes in medicine continue to evolve at the traditional analog crawl. Many of my colleagues continue to be dismayed at the new public access to health information, belittle patients for excessive curiosity about their health, lament the erosion of their healthcare-directing authority. And while new concepts race ahead as we race towards a wiki-like collective growth in healthcare knowledge, physicians are still mired by their reluctance to abdicate their once-lofty positions as chief holders of secrets. I believe that this is part of the reason why family doctors and cardiologists have been slow to adopt technologies like heart scans and self-empowering programs like Track Your Plaque: processes that take heart disease prevention away from the hands of physicians and place more control into the hands of the people. Imagine the horror felt by physicians in 1935 of a young upstart nurse boldly trying to use a stethoscope to take a patient's blood pressure. You can imagine the internal horror now being felt as you and I dare to take control over heart disease and deny them the chance to put in four stents, three bypass grafts, then direct our future health habits.But technology has a way of marching on. It will encounter resistance, bumps, and blind-alleys, but it will go on.
Dr. Jeffrey Dach on the Track Your Plaque program 10. July 2008 William Davis (5) Dr. Jeffrey Dach posted a great piece on his blog, Bioidentical Hormone Blog , about his perspective on the Track Your Plaque program. It's worth reading even for those familiar with the program, just to see a slightly different perspective. He also included many great graphics to illustrate his points. CAT Coronary Calcium Scoring, Reversing Heart DiseaseAlso, see Dr. Dach's Heart Disease: Part 2, for some novel thoughts.
Vitamin D and programmed aging? 9. July 2008 William Davis (8) As we age, we lose the capacity to activate vitamin D in the skin.Studies suggest that, between ages 20 and 70, there is a 75% reduction in the ability to activate vitamin D. The capacity of conversion from 25 (OH) vitamin D to 1,25 di(OH) vitamin D also diminishes.Holick M. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. From Holick, M. 2006This would explain why 70-year olds come to the office, just back from the Caribbean sporting dark brown tans, are still deficient, often severely, in blood levels of vitamin D (25(OH) vitamin D). A tan does not equal vitamin D. Courtesy IpanemicA practical way of looking at it is that anyone 40 years old or older has lost the majority of ability for vitamin D activation. This often makes me wonder if the loss of vitamin D activating potential is nature's way to get rid of us. After all, after 40, we've pretty much had our opportunity to recreate and make our contribution to the species (at least in a primitive world in which humans evolved): we've exhausted our reproductive usefulness to the species.Is the programmed decline of vitamin D skin activation a way to ensure that we develop diseases of senescence (aging)? The list of potential consequences of vitamin D deficiency includes: osteoporosis, poor balance and coordination, falls and fractures; cancer of the breast, bladder, colon, prostate, and blood; reductions in HDL, increases in triglycerides; increased inflammation (C-reactive protein, CRP); declining memory and mentation; coronary heart disease.Isn't that also pretty much a list that describes aging?A fascinating argument in support of this idea came from study from St Thomas’ Hospital and the London School of Medicine:Higher serum vitamin D concentrations are associated with longer leukocyte telomere length in womenTelomeres are the "tails" of DNA that were formerly thought to be mistakes, just coding for nonsense. But more recent thinking has proposed that telomeres may provide a counting mechanism that shortens with aging and accelerates with stress and illness. This study suggests that both vitamin D and inflammation (CRP) impact telomere length: the lower the vitamin D, the shorter the telomere length, particularly when inflammation is greater.Data supporting vitamin D's effects on preventing or treating cancer, osteoporosis, lipid abnormalities, inflammation, cardiovascular disease, etc., is developing rapidly.Now the big question: If declining vitamin D is nature's way of ensuring our decline and death, does maintaining higher vitamin D also maintain youthfulness?I don't have an answer, but it's a really intriguing idea.
Synthroid, Armour Thyroid, and the battle for T3 6. July 2008 William Davis (2) In the last Heart Scan Blog post on thyroid issues, Is normal TSH too high?, the provocative findings of the the HUNT Study were discussed. The text of the study can be found at:The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT StudyHypothyroidism, or low thyroid that is signaled by high thyroid-stimulating hormone, TSH, is proving far more prevalent an issue than previously thought. While previous estimates put hypothyroidism as affecting only about 3% of younger populations, 10-20% of older populations (women more so), data like the HUNT Study suggest that, if lower and lower TSH levels (higher thyroid) are necessary for perfect heart health, then many more people stand to benefit than we used to think.But another crucial issue in the world of hypothyroidism: Is T4 (thyroxine) enough? Or should we be supplementing T3 (triiodothyronine) along with T4?Your friendly neighborhood primary care doctor or endocrinologist would likely argue vehemently that T4 (as Synthroid, Levoxyl, levothyroxine, and others) is adequate and not subject to the impurities and contaminants of natural thyroid extracts. They would also argue that T4 is effectively converted to T3 at the tissue level, and exogenous supplementation is unnecessary.Others--most of all thyroid patients themselves, along with thyroid advocates like Mary Shomon and Janie Bowthorpe, along with some physicians--argue that supplementing T3 along with T4 can be very important. They argue that people feel better, have more physical energy, lose weight more effectively, and more completely resolve many of the phenomena of hypothryoidism with T3 added. There are also some data that argue the same.Adding T3 to the mix may address the presumed poor conversion of T4 to T3 that is peculiar to some people. It may overcome the "reverse T3" phenomenon, the production of a useless look-alike T3 that occurs in some people. It may also (anecdotally) exert greater effects on some lipid/lipoprotein parameters, such as Lp(a).My experiences adding T3 to T4 have been mixed: Some feel better, others do not. Some show objective improvements, others do not.Nonetheless, hypothyroidism, or incompletely corrected hypothryoidism by way of inadequate T3, is an issue to consider in your plaque-control program.More on this somewhat complex issue, along with practical solutions to consider, can be found on the Special Report to be released this week on the Track Your Plaque website.
Letter to New York Times 3. July 2008 William Davis (9) All right. I sent a Letter to the Editor to the New York Times. No word from them; it's no longer news.So here is what I tried to convey.While the authors overall did a credible job of talking to my colleagues and laying out the issues, they made the crucial and boneheaded mistake of confusing CT heart scans with CT coronary angiograms. Sadly, many people who may have been considering having a simple screening heart scan may be scared away by the confused authors, Alexn Berenson and Reed Abelson. They do correctly point out that, while CT coronary angiograms are fascinating examples of technology and a way of visualizing coronary arteries, this test all too often is being subverted into the "let's make money from high-tech testing" medical model. It's also a test that frequently leads to the "real" test, heart catheterization, since the "time bomb" you have in your arteries might "need" a stent. CT coronary angiograms are also virtually useless for purposes of tracking disease, since they are not longitudinally (along the length of the artery) quantitative, nor should anyone be exposed to this much radiation repeatedly. A simple heart scan, on the hand, provides a longitudinal summation of coronary plaque volume. Radiation exposure is sufficiently low that repeated scanning can be performed for purposes of tracking . . .yes, track your plaque. Poorly-informed reporters can do a lot of damage. As always, you and I must dig a little deeper for the truth. Dear Editor,Re: Weighing the Costs of a CT Scan’s Look Inside the HeartThe Times featured an article on June 29th that discussed rapidly expanding use of CT scans for the heart:Weighing the Costs of a CT Scan’s Look Inside the Heart. The authors, Alex Berenson and Reed Abelson, stated that CT heart scans “expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.”I’d like to offer a clarification. Though the authors discuss both CT heart scans and CT coronary angiograms, they confuse the two and use the terms interchangeably. A heart scan is a simple screening test for coronary atherosclerotic plaque. It detects the presence of calcium in the heart’s arteries, provided as a “score.” (Because calcium occupies 20% of total plaque volume, knowing the amount of calcium tells you how much total coronary plaque is present by applying this simple proportion.) Just having a high score should not prompt heart procedures, since people undergoing simple screening heart scans are without symptoms. However, a stress test may yield some useful information. On present-day CT devices, heart scans expose a patient to 0.4 mSv of radiation on an electron-beam, or EBT, device, and on up to 1.2 mSv on a 64-slice multi-detector, or MDCT, device, compared to 0.1 mSv during a standard chest x-ray. CT heart scans are therefore performed with about the same quantity of radiation as a mammogram done to screen women for breast cancer, or about the equivalent of four chest x-rays on an EBT scanner, up to 12 chest-xrays on a MDCT scanner. CT coronary angiograms, while performed on the same devices as heart scans, require x-ray dye to fill the contours of the coronary arteries. It also requires up to several hundred times more radiation. While new engineering innovations are being introduced that promise to reduce this exposure, the current devices being used today do indeed require a radiation dose equivalent to 100 to 400 chest x-rays (usually in the range of 10-15 mSv), a value that equals or exceeds that obtained during a conventional heart catheterization. While heart scans are most useful to detect and quantify plaque that can help determine the intensity of a heart disease prevention program, CT coronary angiograms are generally used as prelude to hospital procedures like catheterizations, stents and bypass surgery. That’s because they are performed to look for (or rule out) “severe” blockages. CT heart scans and CT coronary angiography are therefore two different tests that yield two different kinds of information, and yield two entirely different levels of radiation exposure. This confusion from a major and respected media outlet like the New York Times is unfortunate, because it could persuade millions of people who otherwise could benefit from simple heart scans to avoid them because of misleading information on radiation exposure of a different test. Thank you. William Davis, MD
Red yeast rice alert 2. July 2008 William Davis (9) While there have been some positive reports in the media lately about the cholesterol-reducing effects of red yeast rice, Consumer Lab has issued a very concerning report. Because Consumer Lab is a subscription website (incidentally, the $20 per year membership fee is money well spent for insightful tests on many supplements, though new reports only come out a handful of times per year), I won't discuss the results of their red yeast rice in its entirety. However, Consumer Lab testing uncovered several disturbing findings:--The lovastatin content varied by a factor of 100, from 0.1 mg per tablet/capsule in one brand up to 10.6 mg in another brand. By FDA regulations, lovastatin is a drug and NO red yeast rice preparation is supposed to contain ANY lovastatin. Nonetheless, despite the marketing of supplement manufacturers, it is probably the lovastatin that is largely responsible for the LDL-reducing effect. The monacolins or mevinolins in red yeast rice add little, if any, further LDL-reducing effect. --Several preparations contain a potential kidney toxin called citrinin. The Walgreen's product, specifically, contained substantial quantities of this toxin.Interestingly, the FDA has taken repeated action against red yeast rice manufacturers and distributors because they continue to contain lovastatin. In the FDA's most recent action in August, 2007, for instance, Swanson's product and Sunburst Biorga Toggle navigation Home Blog Home Archive Join Now Log in Heart Scan Curiosities #8: Fat heart 8. July 2007 William Davis (2) Here's a curious incidental finding on a heart scan: an unusual fat accumulation around the heart. The arrows point to an unusually large accumulation of fat tissue on either side of the heart. This man was mildly but not excessively overweight at 5 ft 10 inches and 201 lbs. I know of no specific implications of this curiosity. It makes me wonder if he was very obese at one time and has since lost the weight. Chocolate and blood pressure 7. July 2007 William Davis (1) A recent very detailed and clean study on the effects of a small serving of dark chocolate on blood pressure was just published in the Journal of the American Medical Association. I was going to do a little Blogging on this interesting study but I read the Fanatic Cook's wonderfully insightful comments. I'd direct you to her discussion, instead: A small daily dose of dark chocalate lowers blood pressure at http://fanaticcook.blogspot.com/. I couldn't have said it any better. By the way, the authors of the study had no financial ties to the chocolate or cocoa industry. Refreshing. Does prevention save money? 7. July 2007 William Davis (2) Prevention and reversal of heart disease are undoubtedly preferable to the current crash and repair model currently followed by doctors and hospital, the model that has created an enormous medical device industry to support it. But does it save money? This debate often boils down to a metric of "lives saved per $100,000". Thus, the statin drugs (of course) have been subjected to such analyses and have been shown to be "cost-effective." But how does a powerful heart disease prevention and reversal program like Track Your Plaque compare to the current crash and repair procedural approach to heart disease? This is a very difficult analysis, one that is subject to enormous variation, depending on the population studied and the prevalence of disease, the local practice habits (e.g., in the northwest Cleveland suburb of Lorain, virtually everybody going to the hospital for any heart problem gets one or several heart catheterizations), and other factors. There's also the difficulty of what should constitute a prevention program. Is it like that used in the COURAGE Trial of "optimal medical therapy" that included nitroglycerin, aspirin, a beta blocker, and statin drug (which we regard as a laughably silly approach), or one like Track Your Plaque in which we try to correct the causes of heart disease, not just palliate (BandAid) them? Costs vary. The "optimal medical therapy" is very costly due to its reliance on medications to treat symptoms. Our program is somewhat costly because of the reliance on a CT heart scan and lipoprotein analysis (though, in the long perspective, our costs are modest). We asked this question and came up with a lengthy analysis. Bottom line: Following the Track Your Plaque program saves enormous sums of money. Because of the complexity of the analysis, which is theoretical and not a real-world test, we confined our analysis to men in the 40-59 year old age group. If this group alone were to subscribe to a intensive but rational program of prevention like Track Your Plaque, over $20 billion dollars per year would be saved. If the analysis were extended to women of all ages and men older than 59, the numbers would balloon to many more tens of billions of dollars. Such a savings wouldn't cure the healthcare system's growing financial crisis, but it sure would be a big help. Sort of like converting to a hydrid car--you don't eliminate the need for gas, but you'll save a lot in fuel costs. The Track Your Plaque approach makes sense because it is, bar none, the most powerful approach to gaining hold of heart disease risk available. But it also makes sense from a financial standpoint. Now, if we can only convince the hospitals, the $30 million annual salary device manufacturer CEO, and my procedure-crazy colleagues that this way makes more sense. Watch for our analysis on an upcoming Track Your Plaque Special Report. Where should fiber come from? 7. July 2007 William Davis (1) Ray had the usual protuberant belly overhanging his beltline of someone who was over-reliant on processed starches, particularly wheat. After all, he ran a sandwich bakery. He sheepishly admitted that he ate the products of his own production line every day while at work, even bringing a few sandwiches home.At 5 ft 10 inches, 201 lbs, he wasn't terribly overweight, but all the excess was in his beltline. He had the lipoproteins to match: HDL 38 mg/dl, triglycerides 180 mg/dl, 83% of all LDL particles were small, excess VLDL and IDL. Blood pressure: 140/88. Blood sugar: 112 mg/dl. With a CT heart scan score of 698, Ray had some work to do. Among the strategies we discussed was a need to dramatically reduce, perhaps eliminate, wheat products and other high-glycemic index foods. "You've got to be kidding me!" Besides the inconsistency with his business, he was puzzled on what foods were edible for his pattern. We discussed how he could easily replace his reliance on wheat and breads with more vegetables, more fruits, more lean proteins, and more healthy oils. "But I won't get any fiber!" he declared. That was why he tried to choose whole wheat bread for his sandwiches. This is a common concern when we discuss how grains, particuarly wheat, need to be sharply reduced. In the most recent edition of his Paleo Diet Newsletter, Dr. Loren Cordain has laid out a wonderful graph that beautifully illustrates the issue: (From The Paleo Diet Newsletter at http://www.thepaleodiet.com/newsletter/back_issues.shtml)In other words, reducing or eliminating "fiber-rich" grains and replacing their calories dramatically increases fiber content of your diet.For Ray, whose livelihood depends on promoting and perpetuating the use of wheat breads, it will be tough to keep him on the right track. My prediction: the results he will see will be substantial and it will become difficult to return to eating his own products. There's no doubt that this concept can be economically disruptive for many people, including Ray. It's a tough situation we've created: a huge industrial complex based on growing grains and wheat, processing it into breakfast cereals, bagels, pretzels, crackers, and sandwiches. But it has also contributed to the epidemic of obesity and the patterns that people like Ray have. But the startling fact remains: If replaced with vegetables and fruits, reducing grains increases the fiber content of your diet, and not jsut a little bit, but enormously. If green peppers and spinach had brand names like "Fiber One" and "Smart Start" along with flashy boxes, then maybe it would be an easier concept to grasp. To sign up for Dr. Cordain's wonderfully informative newsletter, go to http://www.thepaleodiet.com/newsletter/back_issues.shtml. The Detection Gap 5. July 2007 William Davis (3) You've heard of the Generation Gap, the Income Gap, the Technology Gap, the Gender Gap, and the Achievement Gap.How about the Detection Gap? Haven't heard of it? That's the gap between coronary heart disease detected by conventional methods widely practiced in the community and the real prevalence of the disease.The standard approach to coronary heart disease detection is a relatively simple formula. One of three things are sought:1) Symptoms of heart disease like chest pain or breathlessness. 2) An abnormal EKG or abnormal stress test.3) A catastrophe like heart attack or sudden cardiac death. By this equation, the American Heart Association (AHA) estimates that 36% of American men and women have coronary disease. However, we say the number is more like 48%. That's the number we arrive at when we ask: How many men and women have CT heart scan scores above zero?The difference is the Detection Gap. Though only around 12%, it amounts to millions of people. The problem is that, by the conventional approach to detection of heart disease, you often don't know you have it until you're lying on a hospital gurney being wheeled off to a major procedure. Or your friends, family or neighbors find your body.If heart disease is detected by a CT heart scan, it tends to be early, before catastrophe strikes. You can use tools like niacin, vitamin D, flaxseed, etc., all the components of the Track Your Plaque approach. If heart disease is detected by waiting for the appearance of symptoms, then a stress test (usually nuclear) is followed by a heart catheterization, stents, bypass, etc. So there's more than a Detection Gap. There's also a difference in the sorts of therapies chosen. There's certainly a difference in cost. In my view, there is no rational reason not to close the Detection Gap. While CT heart scan scores aren't perfect, they're damn close. The Detection Gap could be closed to around 2%. We'd also save billions of dollars. Apoprotein B on VAP 3. July 2007 William Davis (3) We've just received an announcement that, if your Vertical Auto Profile lipoprotein test (Atherotech) is provided through the national Quest laboratories (a large national laboratory company), they will include an apoprotein B. This represents an improvement over the previous "direct LDL," a measured LDL cholesterol. Recall that standard lipid panels obtained in hospitals and doctors' offices is a calculated LDL, based on the 40-some year old Friedewald calculation. In my view, the Friedewald calculated LDL is a dinosaur that is virtually useless and needs to be retired. Direct, or measured, LDL is a slight improvement. It removes some of the inaccuracy introduced by the assumptions built into the calculated value. Apoprotein B (also called apoprotein B100) is yet another improvement. Apo B's have been available for years, but was not provided on the VAP. The Atherotech people have done a good job of making VAP more broadly available through "drawing stations" and proponents like Life Extension. Adding an ApoB is a favorable development, since it incorporates the risk of other ApoB-containing particles, like VLDL, IDL, and Lp(a). Several studies like the Quebec Cardiovascular Study have shown that ApoB is a superior predictor of heart disease compared to calculated LDL. I still believe that the gold standard for assessing risk from an LDL standpoint is the LDL particle number along with the other measures provided by the NMR assay (Liposcience). However, the addition of the ApoB to VAP adds greater confidence to the measures provided by this technique. Those of you who rely on the VAP assay provided by Quest for your Track Your Plaque program for control of CT heart scan scores therefore have access to this improved panel. Estrogens and CT heart scan scores 2. July 2007 William Davis (1) A recent study from the Women's Health Initiative (WHI), the large study that originally showed no reduction in heart attack with use of estrogens in postmenopausal females, has just published a new study.In this new effort, women who took Premarin (horse estogens) had up to 61% lower CT heart scan scores. This new study was co
Heart Scan Curiosities #8: Fat heart 8. July 2007 William Davis (2) Here's a curious incidental finding on a heart scan: an unusual fat accumulation around the heart. The arrows point to an unusually large accumulation of fat tissue on either side of the heart. This man was mildly but not excessively overweight at 5 ft 10 inches and 201 lbs. I know of no specific implications of this curiosity. It makes me wonder if he was very obese at one time and has since lost the weight.
Chocolate and blood pressure 7. July 2007 William Davis (1) A recent very detailed and clean study on the effects of a small serving of dark chocolate on blood pressure was just published in the Journal of the American Medical Association. I was going to do a little Blogging on this interesting study but I read the Fanatic Cook's wonderfully insightful comments. I'd direct you to her discussion, instead: A small daily dose of dark chocalate lowers blood pressure at http://fanaticcook.blogspot.com/. I couldn't have said it any better. By the way, the authors of the study had no financial ties to the chocolate or cocoa industry. Refreshing.
Does prevention save money? 7. July 2007 William Davis (2) Prevention and reversal of heart disease are undoubtedly preferable to the current crash and repair model currently followed by doctors and hospital, the model that has created an enormous medical device industry to support it. But does it save money? This debate often boils down to a metric of "lives saved per $100,000". Thus, the statin drugs (of course) have been subjected to such analyses and have been shown to be "cost-effective." But how does a powerful heart disease prevention and reversal program like Track Your Plaque compare to the current crash and repair procedural approach to heart disease? This is a very difficult analysis, one that is subject to enormous variation, depending on the population studied and the prevalence of disease, the local practice habits (e.g., in the northwest Cleveland suburb of Lorain, virtually everybody going to the hospital for any heart problem gets one or several heart catheterizations), and other factors. There's also the difficulty of what should constitute a prevention program. Is it like that used in the COURAGE Trial of "optimal medical therapy" that included nitroglycerin, aspirin, a beta blocker, and statin drug (which we regard as a laughably silly approach), or one like Track Your Plaque in which we try to correct the causes of heart disease, not just palliate (BandAid) them? Costs vary. The "optimal medical therapy" is very costly due to its reliance on medications to treat symptoms. Our program is somewhat costly because of the reliance on a CT heart scan and lipoprotein analysis (though, in the long perspective, our costs are modest). We asked this question and came up with a lengthy analysis. Bottom line: Following the Track Your Plaque program saves enormous sums of money. Because of the complexity of the analysis, which is theoretical and not a real-world test, we confined our analysis to men in the 40-59 year old age group. If this group alone were to subscribe to a intensive but rational program of prevention like Track Your Plaque, over $20 billion dollars per year would be saved. If the analysis were extended to women of all ages and men older than 59, the numbers would balloon to many more tens of billions of dollars. Such a savings wouldn't cure the healthcare system's growing financial crisis, but it sure would be a big help. Sort of like converting to a hydrid car--you don't eliminate the need for gas, but you'll save a lot in fuel costs. The Track Your Plaque approach makes sense because it is, bar none, the most powerful approach to gaining hold of heart disease risk available. But it also makes sense from a financial standpoint. Now, if we can only convince the hospitals, the $30 million annual salary device manufacturer CEO, and my procedure-crazy colleagues that this way makes more sense. Watch for our analysis on an upcoming Track Your Plaque Special Report.
Where should fiber come from? 7. July 2007 William Davis (1) Ray had the usual protuberant belly overhanging his beltline of someone who was over-reliant on processed starches, particularly wheat. After all, he ran a sandwich bakery. He sheepishly admitted that he ate the products of his own production line every day while at work, even bringing a few sandwiches home.At 5 ft 10 inches, 201 lbs, he wasn't terribly overweight, but all the excess was in his beltline. He had the lipoproteins to match: HDL 38 mg/dl, triglycerides 180 mg/dl, 83% of all LDL particles were small, excess VLDL and IDL. Blood pressure: 140/88. Blood sugar: 112 mg/dl. With a CT heart scan score of 698, Ray had some work to do. Among the strategies we discussed was a need to dramatically reduce, perhaps eliminate, wheat products and other high-glycemic index foods. "You've got to be kidding me!" Besides the inconsistency with his business, he was puzzled on what foods were edible for his pattern. We discussed how he could easily replace his reliance on wheat and breads with more vegetables, more fruits, more lean proteins, and more healthy oils. "But I won't get any fiber!" he declared. That was why he tried to choose whole wheat bread for his sandwiches. This is a common concern when we discuss how grains, particuarly wheat, need to be sharply reduced. In the most recent edition of his Paleo Diet Newsletter, Dr. Loren Cordain has laid out a wonderful graph that beautifully illustrates the issue: (From The Paleo Diet Newsletter at http://www.thepaleodiet.com/newsletter/back_issues.shtml)In other words, reducing or eliminating "fiber-rich" grains and replacing their calories dramatically increases fiber content of your diet.For Ray, whose livelihood depends on promoting and perpetuating the use of wheat breads, it will be tough to keep him on the right track. My prediction: the results he will see will be substantial and it will become difficult to return to eating his own products. There's no doubt that this concept can be economically disruptive for many people, including Ray. It's a tough situation we've created: a huge industrial complex based on growing grains and wheat, processing it into breakfast cereals, bagels, pretzels, crackers, and sandwiches. But it has also contributed to the epidemic of obesity and the patterns that people like Ray have. But the startling fact remains: If replaced with vegetables and fruits, reducing grains increases the fiber content of your diet, and not jsut a little bit, but enormously. If green peppers and spinach had brand names like "Fiber One" and "Smart Start" along with flashy boxes, then maybe it would be an easier concept to grasp. To sign up for Dr. Cordain's wonderfully informative newsletter, go to http://www.thepaleodiet.com/newsletter/back_issues.shtml.
The Detection Gap 5. July 2007 William Davis (3) You've heard of the Generation Gap, the Income Gap, the Technology Gap, the Gender Gap, and the Achievement Gap.How about the Detection Gap? Haven't heard of it? That's the gap between coronary heart disease detected by conventional methods widely practiced in the community and the real prevalence of the disease.The standard approach to coronary heart disease detection is a relatively simple formula. One of three things are sought:1) Symptoms of heart disease like chest pain or breathlessness. 2) An abnormal EKG or abnormal stress test.3) A catastrophe like heart attack or sudden cardiac death. By this equation, the American Heart Association (AHA) estimates that 36% of American men and women have coronary disease. However, we say the number is more like 48%. That's the number we arrive at when we ask: How many men and women have CT heart scan scores above zero?The difference is the Detection Gap. Though only around 12%, it amounts to millions of people. The problem is that, by the conventional approach to detection of heart disease, you often don't know you have it until you're lying on a hospital gurney being wheeled off to a major procedure. Or your friends, family or neighbors find your body.If heart disease is detected by a CT heart scan, it tends to be early, before catastrophe strikes. You can use tools like niacin, vitamin D, flaxseed, etc., all the components of the Track Your Plaque approach. If heart disease is detected by waiting for the appearance of symptoms, then a stress test (usually nuclear) is followed by a heart catheterization, stents, bypass, etc. So there's more than a Detection Gap. There's also a difference in the sorts of therapies chosen. There's certainly a difference in cost. In my view, there is no rational reason not to close the Detection Gap. While CT heart scan scores aren't perfect, they're damn close. The Detection Gap could be closed to around 2%. We'd also save billions of dollars.
Apoprotein B on VAP 3. July 2007 William Davis (3) We've just received an announcement that, if your Vertical Auto Profile lipoprotein test (Atherotech) is provided through the national Quest laboratories (a large national laboratory company), they will include an apoprotein B. This represents an improvement over the previous "direct LDL," a measured LDL cholesterol. Recall that standard lipid panels obtained in hospitals and doctors' offices is a calculated LDL, based on the 40-some year old Friedewald calculation. In my view, the Friedewald calculated LDL is a dinosaur that is virtually useless and needs to be retired. Direct, or measured, LDL is a slight improvement. It removes some of the inaccuracy introduced by the assumptions built into the calculated value. Apoprotein B (also called apoprotein B100) is yet another improvement. Apo B's have been available for years, but was not provided on the VAP. The Atherotech people have done a good job of making VAP more broadly available through "drawing stations" and proponents like Life Extension. Adding an ApoB is a favorable development, since it incorporates the risk of other ApoB-containing particles, like VLDL, IDL, and Lp(a). Several studies like the Quebec Cardiovascular Study have shown that ApoB is a superior predictor of heart disease compared to calculated LDL. I still believe that the gold standard for assessing risk from an LDL standpoint is the LDL particle number along with the other measures provided by the NMR assay (Liposcience). However, the addition of the ApoB to VAP adds greater confidence to the measures provided by this technique. Those of you who rely on the VAP assay provided by Quest for your Track Your Plaque program for control of CT heart scan scores therefore have access to this improved panel.
Estrogens and CT heart scan scores 2. July 2007 William Davis (1) A recent study from the Women's Health Initiative (WHI), the large study that originally showed no reduction in heart attack with use of estrogens in postmenopausal females, has just published a new study.In this new effort, women who took Premarin (horse estogens) had up to 61% lower CT heart scan scores. This new study was co