All posts by william-davis

At a social gathering this weekend, as we humans like to do, someone asked me what I did for a living. I told him I was a cardiologist.

"What hospital do you work at?" he asked.

This is invariably the response I get whenever I tell people what I do. I wouldn't make much of it except that it happens just about every time.

This indicates to me just how successful hospitals, my colleagues, cardiac device manufacturers, and others supporting the status quo in heart care, have been in persuading us that the place for heart disease is the hospital--period.

Tense families, drama, high-tech...It all takes place in the hospital.

Yet the people destined to be the fodder for hospital heart care are presently well, mostly unaware of what the future holds. Also unaware that heart disease is readily, easily, inexpensively, and accurately identifiable. Ask anyone in the Track Your Plaque program who's had a CT heart scan.

We all need to rid ourselves of the idea that the hospital is the place for heart disease. If the coronary plaque behind heart attack is easy to detect and controllable, there's little or no need for the hospital for the vast majority of us.

In the majority of instances of coronary disease, the hospital should be the place for the non-compliant and the ill-informed, and not for those of us sufficiently motivated to know and do better. The formula is simple: 1) Quantify plaque with a CT heart scan, 2) Identify the causes, then 3) Correct the causes.

I came across this Blog authored by a nutritionist when it was highlighted on Blogger as an interesting site:

The Fanatic Cook at http://fanaticcook.blogspot.com/

I was thoroughly impressed with the insightful and entertaining commentary. I'd highly recommend this site to you for reading on nutrition. In particular, her coenzyme Q10 column was exceptionally well written and clear.(http://fanaticcook.blogspot.com/2005/02/statins-and-not-well-publicized-side.html)

Also read her column, Super NonFoods at http://fanaticcook.blogspot.com/2005/07/super-nonfoods.html.

There's also oodles of recipes, all for the taking.

Eggs have been in the center of the cholesterol controversy almost from the very start.

The traditional argument against eggs went that eggs, high in cholesterol (210-275 mg per egg)and with some saturated fat (1.5-2.5 grams per egg), raised blood cholesterol (and LDL). Out went the daily fried, scrambled, poached eggs that many Americans indulged in most mornings. (We replaced it with more breakfast cereals and other carbohydrate conveniences, then got enormously overweight.)

A large Harvard epidemiologic study in 1999 called this observation into question. They tracked the fate of 117,000 thousand people and then compared the rate of heart attack, death, and other cardiovascular events among various people correlated to the "dose" of eggs they ate. Egg intake varied from none to 7 or more per week. Lo and behold, people who ate more eggs appeared to not suffer more events.

This study, large and well-conducted by an internationally respected group of investigators, seem to reopen the gates for more egg consumption, though most Americans still consume eggs cautiously.

Deeper down in this study, however, was another observation: People with diabetes who ate 1 egg per day had double the risk of heart attack. Because this study was observational, no specific conclusion as to why could be drawn.

A new study conducted by a Brazilian group may shed some light. Healthy (non-diabetic) men were fed an emulsion of several eggs. Inclusion of plentiful yolks caused a dramatic slowing of fat clearance from the blood. Specifically, "chylomicron remnants" were abnormally persistent in the blood. Chylomicron remnants are potent causes of coronary plaque. (Chylomicron remnants can be measured fairly well by intermediate-density lipoprotein and VLDL by NMR, or IDL by VAP.)

Diabetics are know to have substantial disorders of after-meal fat clearance, including an excess of chylomicron remnants. Could the Brazilian observation be the explanation for the increased event rate in diabetics in the Harvard study? Interesting to speculate.

We continue to tell our patients that eating eggs in moderation is probably safe. After all, there are good things in eggs: the high protein in the egg white, lecithin in the yolk. It is the yolk's contents that are in question, not the white. Thus, you and I can eat all the egg whites (e.g., Egg Beaters) we want. It's the safety of yolks that are uncertain.

The abnormal after-eating effect suggested by the Brazilians opens up some very interesting questions and confirms that we should still be cautious in our intake of egg yolks. One yolk per day is clearly too much. What is safe? The exisitng information would suggest that, if you have diabetes, pre-diabetes, or a postprandial disorder (IDL, VLDL), you should minimize your egg yolk use, perhaps no more than 3 or so per week, preferably not all at one but spaced out to avoid the after-eating effect.

Others without postprandial disorders may safely eat more, perhaps 5 per week, but also not all at one but spaced out.

Track Your Plaque Members: Be sure to read our upcoming Special Report on Postprandial Disorders. It contains lots of info on what this important pattern is all about. Postprandial disorders are largely unexplored territory that hold great promise for tools to inhibit coronary plaque growth and drop your heart scan score. The Brazilian study is just one of many future studies that are likely to be released in future about this very fascinating area.

Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC.A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999 Apr 21;281(15):1387-94.

Cesar TB, Oliveira MR, Mesquita CH, Maranhao RC. High cholesterol intake modifies chylomicron metabolism in normolipidemic young men. J Nutr. 2006 Apr;136(4):971-6.

If there's one thing I truly fear from a heart scan score reduction/coronary plaque regression standpoint, it's diabetes.

I saw a graphic illustration of this today. Roy came into the office after his 2nd heart scan. His first scan 14 months ago showed a score of 162. Roy started out weighing well over 300 lbs and with newly-diagnosed adult diabetes.

Roy put extraordinary effort into his program. He lost nearly 70 lbs by walking; cutting processed carbohydrates, greasy foods, and slashing overall calories. His lipoproteins, disastrous in the beginning, were falling into line, though HDL was still lagging in the low 40s, as Roy remains around 60 lbs overweight, even after the initial 70 lb loss.

Unfortunately, despite the huge loss in weight, Roy remains diabetic. On a drug called Actos, which enhances sensitivity to insulin, along with vitamin D to also enhance insulin response, his blood sugars remained in the overtly diabetic range.

Roy's repeat heart scan showed a score of 482--a tripling of his original score.

Obviously, major changes in Roy's program are going to be required to keep this rate of growth from continuing. But I tell Roy's story to illustrate the frightening power of diabetes to trigger coronary plaque growth.

Like Kryptonite to Superman (remember George Reeves crumbling and falling to his knees when the bad guys got a hold of some?), diabetes is the one thing I fear greatly when it comes to reducing your heart scan score. As you see with Roy's case, diabetes can be responsible for explosive plaque growth, more than anything else I know.

The best protection from diabetes is to never get it in the first place. (See my earlier Blog, "Diabetes is a choice you make".)

Around 10 years ago, I was talking to a balloon and stent manufacturer's representative, who was raving about some new device that was due for release to the market. Back then, the sky seemed the limit to cardiac device manufacturers, who were falling over themselves scrambling to design and market the next new device.

The angioplasty market then had ballooned (no pun intended) from nothing to a multi-billion dollar industry. Stents were just getting underway but clearly had potential for being at least as large.

But this was a time when preventive therapies were also beginning to get quite powerful. We had just gotten started doing CT heart scans and were excited about the possibilities, statin drugs were gaining evidence through clinical trials, and the power of many nutritional supplements was finally achieving validation. We were even learning the error of our prior low-fat ways.

So I broadly pronounced to the enthusiastic product representative, "In 10 years, balloons, angioplasty, and stents will occupy this little corner of cardiac care because prevention will have become so powerful. We won't talk about heart procedures. We'll talk about coronary plaque regression!"

I even advised the representative that he should consider a career change in anticipation of the coming wave of preventive strategies.

Was I ever wrong. Despite the power of heart disease prevention--which is indeed true--cardiac device and procedure technology has boomed, both in popularity as well as in revenue success. Device manufacturing and sales are hugely successful. Implanting devices into people is a hugely profitable enterprise.

Since my ill-timed comments to the salesman, Boston Scientific, a major manufacturer of stents and other cardiac devices, reported revenues of $6.2 billiondollars in 2005, a 12% increase over the prior year. Medtronic reported 2005 revenues of $11.3 billion, growing at 15% per year. Clearly, cardiac procedures are still quite popular--and profitable.

My timing was off, but not for long. The huge crest of change in preventive therapies is upon us. That's the premise behind the Track Your Plaque concept: heart disease prevention can't be found in a hospital, is not supported by cardiac device manufacturers, and is not being advocated by most cardiologists or primary care physicians. Yet the tools are getting better and better every day.

Those of you who succeed in halting or reducing your heart scan score are extremely unlikely to add to Boston Scientific's or Medtronic's revenues. Help me spread the word.

Sometimes it's easy to get smug when coronary plaque is a reversible process.

When you see people day in, day out, week in, week out, drop their heart scan scores, reversing what could be a dangerous disease, you can sometimes lose sight of just how dangerous coronary disease can be.

Whether I like it or not, I maintain a reasonably active role in hospitals out of necessity. I do need their services occasionally for people with advanced heart disease when I meet them (when regression is not the initial conversation for safety reasons), or valve disease is diagnosed, or someone shows up with congenital or heart muscle diseases. In other words, although we focus on coronary issues, there's more to heart disease than just coronary disease.

This unfortunate case just served to remind me how powerful coronary disease can be. Elizabeth, an active 67-year old, finally came to the hospital after suffering 6 months of chest pain and increasing breathlessness. She hated hospitals and hadn't seen a doctor in 30 years since she was successfully treated for cancer.

In those 30 years, she'd been quite active with family and a small business. But she also smoked 2 packs of cigarettes most of those years.

After she was admitted to the hospital, it became clear that Elizabeth had experienced one, if not several, heart attacks along the way. The entire front 2/3 of her heart was non-functional. If that wasn't bad enough, two of her heart valves were severely diseased and dysfunctional: Her aortic valve barely opened (aortic valve "stenosis", or stiffness) and the mitral valve leaked severely (mitral valve "insufficiency", or leakiness). All of this was confirmed with conventional testing in the hospital, including a heart catheterization.

Elizabeth ended up in emergency surgery--very unusual, by the way, for valve surgery of the sort she had--but died in the first few hours after her procedure. Her heart had simply been too damaged from her heart attacks, and the extraordinary stress of surgery that included two valves was too much. She died on the ventilator.

Coronary disease is a very serious matter. When I see cases like Elizabeth, it boosts my commitment to tell everyone that heart disease--when identified early enough--is a controllable, preventable, even reversible process. For poor Elizabeth, she was much too far down the path of severe, irreversible disease that control or reversal was simply not an option. She was in imminent danger of dying even upon arrival.

It's exciting yet sometimes frightening to know what you have in your hands: The means to control this monster called coronary disease. Use it wisely. But don't lose sight of what it can do it you permit it to grow, fester, and explode.

I came across this shockingly silly report on AOL, who obtained their info courtesy Health Magazine:

The Best New Healthy Foods for Busy People
from Health

The foods on their list:

Kettle Brand Bakes Hickory Honey BBQ--the healthy claim is based on the lack of trans-fatty acids and low-fat.

Post Healthy Classics Raisin Bran Cereal Bars, Cranberry--Likewise, low-fat, sweet, and addictive means healthy to these people.

Amy’s Mediterranean Pizza With Cornmeal Crust --Please!!

Horizon Organic Colby Cheese Sticks --Because it's made by cattle without use of growth hormone or antibiotics, they declare this healthy. I guess we can ignore the saturated fat content and high total fat content.

100% Whole Grain Chips Ahoy! Cookies --You mean we can add the bran back to wheat products and make it healthy?!

This kind of mass-market marketing trickery leaves me incredulous. Don't believe it for a moment. This is typical of the food industry: Take one aspect of nutrition that is truly healthy, such as high-fiber, or low-fat, or organic. Then add undesirable, unhealthy ingredients. The current fad is to add lots of sugar and or sugar-equivalents (usually flour and other wheat products). Because there's one healthy ingredient, they'll call the end-product healthy, too.

If you want to see what health looks like if you indulge in "healthy" products like this, just look up and down the grocery aisles at your neighborhood grocery store. You're likely to see the results: Gross obesity, diabetes, and arthritis.

You won't, of course, see the huge acceleration of growth in coronary plaque, but it's there, ticking away.

Jack was skeptical. At 273 lbs, 5 ft 11 inches, he felt that he was "just right".

"I feel fine. I don't see why you think I should lose weight," he declared. "In fact, when I lost 25 lbs a couple of years ago, everyone said I was too skinny!"

I showed Jack why: He had an HDL of 35 mg/dl, small LDL (over 90% of all LDL particles), an elevated blood sugar of 123 mg/dl (diabetes is officially 126 mg/dl or greater), high blood pressure, and increased inflammation (C-reactive protein). These were all manifestations that his body weight was too much for it to handle.

So I told Jack that we've all forgotten what ideal weight should look like. Our perception of "normal" has been so utterly and dramatically distorted by the appearance of our friends, family, co-workers, and other people around us that we've all lost a sense of what a desirable weight for health should be.

So I suggested to Jack that, if he wanted to rememember what ideal weight is and what people are supposed to look like, just watch old movies.

Old movies, like the 1942 production of Casablanca, or the 1952 production of Singin' in the Rain, show the body build that was prevalent in those days. Look at Humphrey Bogart or Gene Kelly--men with average builds, weighing 140-160 lbs--that's how humans were meant to look.

A report this morning on the Today Show showed the "after" photos of several people following bariatric (weight reduction) surgery. The "after" pictures, from the perspective of ideal weight and ideal health, remain hugely overweight.

We need to readjust our perceptions of weight. The average woman in the U.S. now weighs 172 lbs(!!!). Don't confuse average with desirable.

Tim had heart disease identified as a young man. He had his first heart attack followed by a quadruple bypass surgery at age 38. Recurrent anginal chest pain and another small heart attack led to several stents over three procedures in the first four years after bypass.

Tim finally came to us, interested in improving his prevention program. You name it, he had it: small LDL, low HDL (28 mg/dl), lipoprotein(a), etc. The problem was that Tim was also clearly pre-diabetic. At 5 ft 10 inches, he weighed 272 lbs--easily 80 or more pounds overweight.

Tim was willing to make the medication and nutritional supplement changes to gain control over his seeminglly relentless disease. He even turned up his exercise program and lost 28 lbs in the beginning. But as time passed and no symptoms recurred, he became lax.

Tim regained all the weight he'd lost and some more. Now Tim was diabetic.

"I don't get it. I eat good foods that shouldn't raise my insulin. I almost never eat sweets."

I stressed to Tim that diabetes and pre-diabetes, while provoked acutely by sugar-equivalent foods (wheat products, breads, breakfast cereals, crackers, etc.), is caused chronically by excess weight. If Tim wants to regain control over his heart disease, he needed to lost the weight.

Unlike, say, leukemia, an unfortunate disease that has little to do with lifestyle choices, diabetes is a choice you make over 90% of the time. In other words, if you become diabetic (adult variety, not children's variety) as an adult, that's because you've chosen to follow that path. You've neglected physical activity, or indulged in too many calories or poor food choices, or simply allowed weight to balloon out of control.

But diabetes is also a path most people can choose not to take. And it is a painfully common choice: Nearly two-thirds of the adults in my office have patterns of pre-diabetes or diabetes when I first meet them.

Let me stress this: For the vast majority of adults, diabetes is a choice, not an inevitability.

Max just had his heart scan. He sat down with the x-ray technologist at the work console while she pointed out the white areas in his coronary arteries that represented plaque.

"It looks like you're going to have a fairly high score," the technologist commented. "The final report will be available after one of our cardiologists reviews your images."

Max shrugged. "Well, I don't feel anything. I'm always running around with work, with my kids, stuff like that. That's better than any stress test. I guess I'll worry about it if it starts to bother me."

You'd be surprised how common this view remains: If it's not bothering you, then just forget about it. It's easy to do, since you have no symptoms, nothing to impair your physical activities. But what are the potential consequences of ignoring your heart scan? Here's a few:

--Prevention and plaque reversal efforts are most effective the earlier you start. From a heart scan score viewpoint, the lower your starting score, the easier it is to gain control over it. More people will succeed in reducing their score when the starting score is lower.

--The role of prevention of heart disease instantly crystallizes when you know your score. Your LDL cholesterol of 142 mg/dl or HDL of 41 mg/dl no longer seem like just numbers of borderline signficance. Instead, they become useful tools to gain control over plaque. They cast your numbers in a new and clear light.

--Knowing your heart scan score today gives you a basis for comparison in future. Your score of, say 250, today, can be 220 in one year. Without your preventive efforts, it will be 30% higher: 325. That's a big difference!

--Sudden death or heart attack--can occur in up to 35-40% of people with hidden heart disease--without warning.

Don't even bother getting a heart scan if you're going to ignore it. I've said it before and I'll say it again: A heart scan is the most important health test you can get--but only if you do something about it.

I ran into a cardiology colleague this weekend. He was aware of my interest in CT heart scanning and plaque reversal.

Out of the blue, he declared "I don't care about hard plaque! I only care about soft plaque." He then proceeded to describe to me how everyone--EVERYONE--needs a CT coronary angiogram to identify "soft plaque".

Is there any truth to this view? Are we only identifying "hard plaques" by focusing on calcium and calcium scores on simple CT heart scans?

Several issues deserve clarification. First of all, CT heart scans don't identify hard plaque. They identify total plaque. Because calcium is a component of the majority of atherosclerotic plaque, comprising approximately 20% of its volume, a calcium "score" can be used to indirectly quantify total plaque, both "hard" and "soft".

Anyone cardiologist who performs a lot of the procedure, intracoronary ultrasound, knows that most human plaque is also not purely soft or hard, it is mixture of both. (I've been performing this procedure since 1995.) Quantifying only soft or only hard plaque is therefore only possible in theory, not in practice.

I believe my colleague does have a valid point in one regard, however. There is indeed a small percentage of people, probably around 5% of all people who have CT heart scans, who have scores of zero yet have a modest quantity of pure "soft" plaque. These people may be misled by having a zero score. How can these people benefit from better information?

Several ways. First, people like this tend to have very high LDL cholesterols, generally 180 mg/dl or greater. They may have a very worrisome family history, e.g., father with heart attack in his 30s or 40s. This small proportion of people with zero heart scan scores may benefit from receiving X-ray dye with their heart scan, i.e., a CT coronary angiogram. Keep in mind that we're assuming everyone is without symptoms, also. If symptoms are part of the picture, everything changes.

But should everybody get a CT coronary angiogram? I don't believe so. A CT coronary angiogram involves far more radiation exposure, greater expense (usually $1800 to $4000), and, with present day technology, does not yield quantitative (measurable) information that is useful for longitudinal use for repeated scans. You don't want to undergo yearly CT coronary angiograms, for instance.

Stay tuned for more on this issue. In the meantime, I continue to try and inform my colleagues about what is right, what is wrong, what is preferable for patient safety and yields truly empowering information, and try to impress on them that the practice of cardiology is not just about enriching their retirement accounts.

Years back, I'd heard some people argue that wheat-based products were detrimental to health. At the time, I thought they were nuts. After all, wheat is the principal ingredient in a huge number of American staples like breakfast cereals and bread.

What changed my mind was the low-fat movement of the 1980s and 1990s. Proponents of low-fat diets claim that heart disease is caused by excess fat in the diet. A diet that is severely restricted in fat therefore might cure or reverse heart disease.

But low-fat diets evolve into high-carbohydrate diets. This nearly always means an over-reliance on wheat products. People will say to me "I had a healthy breakfast: shredded wheat cereal in skim milk and two slices of whole wheat toast." Yes, it is low-fat, but is it healthy?

Absolutely not. Followers of the Track Your Plaque program know that low-fat diets ignite the formation of small LDL particles (a VERY potent trigger of coronary plaque growth), drops HDL, raises triglycerides, causes resistance to insulin and thereby diabetes, raises blood pressure. They also make you fat, with preferential accumulation of abdominal visceral (intestinal lining) fat.

Look at people with gluten enteropathy, a marked intolerance to wheat products that results in violent bowel problems, arthritis, etc. if unrecognized. These people, if the diagnosis is made early, are strikingly slender and commonly unusually healthy otherwise. There's a message here.

If you need convincing, try an experiment. Eliminate--not reduce, but eliminate wheat products from your diet, whether or not the fancy label on the package says it's healthy, high in fiber, a "healthy low-fat snack", etc. This means no bread, pasta, crackers, cookies, breads, chips, breading on chicken, rolls, bagels, cakes, breakfast cereal...Whew!

You won't be hungry if you replace the lost calories with plentiful raw almonds, walnuts, pecans, sunflower and pumpkin seeds; more liberal use of healthy olive oil, canola oil and flaxseed oil; adding ground flaxseed and oat bran to yogurt, cottage cheese, etc.; and more lean proteins like lean beef, chicken, turkey, and fish.

I predict that, not only will you lose weight, sometimes dramatically, but you will feel better: more energy, more alertness, sleep better, less moody. Time and again, people who try this will tell me that the daytime grogginess they've suffered and lived with for years, and would treat with loads of caffeine, is suddenly gone. They cruise through their day with extra energy.

Success at this can yield great advantage for your heart scan score control and reversal efforts. It will give you greater control over small LDL and pre-diabetic patterns, in particular.

Perhaps it's too early to tell whether it's true, but believe that we're seeing coronary plaque reversal--i.e., reduction of CT heart scan score--that is BIGGER and FASTER than ever before. We are now witnessing 20-30% reductions in score, even in the first year.

Early in our experience, I was thrilled with a slowing of plaque growth. Recall that coronary plaque grows at the rate of 30% per year. We would often seen slowing to 10-15% per year in the first year, then a levelling off to little or no increase in the 2nd or 3rd year. Regression, or reduction of score, was less common.

Now, with some further tweaking of our program, we are seeing these large magnitudes of coronary plaque reversal routinely. Not in everybody, of course. There are exceptions that mostly includes people who are less motivated and occasional people with more difficult to control lipoprotein patterns.

I believe that part, or perhaps most, of our recent success is from normalizing blood levels of 25-OH-vitamin D3 levels to 50-70 ng/ml. I'm unable to tell you why this occurs, but I am convinced that it has added huge advantage. Raising blood vitamin D levels to normal carries enormous implication: reduction of colon and prostate cancer risk, reduction of blood pressure, sensitization to insulin, prevention of arthritis and multiple sclerosis, and--I believe--control over coronary plaque calcification and growth.

Watch for a profile of one of our latest success stories, a physician who was experiencing 20% per year plaque growth three years in a row until he followed the Track Your Plaque approach and promptly experienced an 18% reduction in heart scan score. You'll find it in our next newsletter. To subscribe, go to the www.cureality.com homepage and click on the free book download.

I sat next to a cardiology colleague of mine last evening at a dinner. He was lamenting the fact that, because of changes in hospital affiliations of his several-member cardiology group, he'd seen a drop in the volume of heart catheterizations he was performing.

"I'm used to doing 5 cases a day! Now I'm down to 3 or 4 a day." He went on to tell me how he's working to increase his volume. "I'm branching out into doing carotid stents and anything I can find in the legs." He also described how he was cultivating referring physicians to send him more procedural patients.

Now, this colleague, I believe, is a hard-working, conscientious physician. But his attitude reflects the perverse logic of many physicians: I need to do more procedures, not because it benefits patients, but because that's what I want to do--to be busy, make more money, acquire more experience, build my ego, etc.

Doing more procedures has nothing to do with an altruistic goal of doing more good for society. It is purely for selfish reasons. Beware of this shockingly common, pervasive attitude. There's a proper time and place for heart procedures, or any procedure, for that matter. But feeding your doctor's ambitions is not a good reason.

Such was the title of Dr. William Roberts' editorial back in 1987 discussing the health effects of fast foods.

If you need a graphic illustration of the extraordinarily damaging health effects of fast foods, take a look at trends in mainland China. A recent editorial in the American Journal of Cardiology written by Dr. Tsung Cheng of George Washington University makes several points:

--The popularity of fast food in China is booming, with Chinese now more likely than Americans to eat in a fast food restaurant. Each week, 41% of Chinese eat in a fast food restaurant at least once, compared to 35% in the U.S.

--Average total cholesterol levels have skyrocketed from 150 mg/dl in 1958 to 230 mg/dl in 2003.

--50% of Chinese with normal blood pressure in 1992 are now hypertensive.

--Hospitalization for heart disease rose from the 5th most common diagnosis to #1, now constituting nearly 50% of all hospital admissions.

McDonald's and KFC dominate the fast food landscape in China, but up and coming competitors are growing at exponential rates. A media conversation that will surely be reported in the near future is the boom in obesity and diabetes in China as these trends express themselves in weight gain, as it has in the U.S.

I hope you've all seen the entertaining but frightening documentary, Supersize Me chronicling the travails of 30-something Morgan Spurlock as he eats all his meals for one month at McDonald's restaurants in 20 cities. Though focusing on McDonald's, the movie is about a lot more than that. It paints a picture of how fast food as well as food manufacturers in general have changed--distorted--our eating habits.

If you haven't yet seen it, I would urge you to do so and watch it with the rest of the family. My kids (ages 8, 12, and 14) were shocked (and entertained) and they haven't set food in a fast food restaurant since.

Ted is a 74-year old physician, still conducting a busy practice. He came to me because of some vague fatigue and breathlessness. He also got himself a CT heart scan. His score: 1277.

When he came to my office, he clearly became breathless with just minimal effort. A stress test confirmed an area of much reduced blood flow to the front of his heart muscle. A heart catheterization identified a severe blockage of 95% in the left anterior descending artery and a stent was inserted. This resulted in relief of Ted's symptoms.

When Ted returned to the office after his discharge from the hospital, I advised him that some major changes in his prevention program were overdue. "After all, Ted, you were lucky this time. You were provided some warning. It doesn't always work that way." So I advised Ted to make a number of changes in his diet (he was following an old-fashioned, and quite self-destructive, low-fat diet), have lipoproteins assessed to identify hidden causes of coronary plaque, and take fish oil.

"Fish oil? I don't think so. That's pretty drastic!" he exclaimed. He felt that all the nutrition he needed was contained in the food he ate. Even after several lipoprotein abnormalities were uncovered like small LDL and excessive after-eating (post-prandial) patterns, he still resisted any changes. "I'm going to just wait and see how I feel. But I will take aspirin."

Such is the state of mind of the older physician: procedures are okay, low-fat diets prevent heart disease, and the Beatles are touring America. But fish oil? No way!

Unfortunately, Ted's attitude encapsulates the attitudes of many of my medical colleagues who don't share the excuse of age. They still practice the woefully outdated ways of physicians like Ted, clinging to notions of "balanced diets", nitroglycerin representing a rational treatment for coronary disease, and adequate rest being curative for heart conditions.

The world is changing. We're entering an exciting age of self-empowerment. The ridiculous notions of health practiced in the last half of the 20th century are withering and dying. Poor Ted. He must view the current healthcare landscape as increasingly incomprehensible to a guy who started out delivering babies at home. Perhaps, in some respects his world was better. But, in coronary disease prevention, attitudes like this need to go the way of steam engines and racial segregation--good riddens!

John received a coronary stent in 2003 following a small heart attack. The artery causing the heart attack was a diagonal artery, a branch of the important left anterior descending coronary artery (in the front of the heart). His cardiologist at the time advised him, "Take Lipitor and we'll do stress tests every year. Come back if you have any more chest pain." That was the full extent of John's preventive care.

He came to me for a second opinion and, naturally, we enrolled him in our program. We began by obtaining a CT heart scan score, though we had to exclude the stented diagonal artery. His score: 471. At age 51 and physically active, John had 7 additional abnormal lipoprotein patterns identified. We counseled John on better approaches to food choices, his weight target, fish oil, and correction of all lipoprotein patterns.

Two years later, John's repeat heart scan score: 511 . John was initially disappointed with the increase. But a closer look yielded something entirely different: the right coronary artery and circumflex (no stents) showed 20-30% reduction in their scores. The increase in total score was entirely due to substantial increase in score just outside the stent, in the left anterior descending artery. In other words, all of the increase in score was due to growth of a plaque at the mouth of the stent in the diagonal artery.

This is curious: profound regression of plaque with a big drop in score in the "un-instrumented" arteries, but tremendous growth of plaque and an increase in score in the "instrumented", or stented, artery, all in the same person's heart.

I don't know how controllable this specific situation in the left anterior descending and stented diagonal will be, and I'm unaware of any specific strategies to impact on this situation. The whole world of tissue growth within or around stents is littered with high hopes followed by failures. The drug-coated stents have been the only partial solution to this problem, though that's precisely the sort of stent John received.

Is there a message here? The message I take from this is that you and I should work like mad to keep from receiving a stent. Once they're implanted, we have less control over our coronary future. We can indeed regress ("reverse") coronary plaque. But we may not be able to regress the sort of tissue that grows in response to a stent implantation.

Imagine two people.

Tom is a 50-year old man. Tom's initial heart scan score is 500--a bad score that carries a 5% or more risk for heart attack per year.

Harry is also 50 years old. His heart scan score is 100--also a concerning score but not with the same dangers of Tom's much higher score.

Tom follows a powerful heart disease prevention program like the Track Your Plaque program. He achieves the 60:60:60 lipid targets; chooses healthy foods; takes fish oil; raises his blood vitamin D level to >50 ng/ml, etc. One year later, Tom's heart scan score is 400, a 20% reduction from his starting score.

Harry, on the other hand, doesn't understand the implications of his score. Neither does his doctor. He's casually provided a prescription for a cholesterol drug by his doctor but nothing else. One year later, Harry's heart scan score is 200, a doubling (100% increase) of the original score.

At this point, we're left with Tom having a score of 400, Harry with a score of 200. That is, Tom has twice the score, or 200 points higher, compared to Harry. Who's better off?

Tom is better off. Even though he has a significantly higher score, Tom's plaque is regressing. It is therefore quiescent with its components being extracted, inflammation subsiding, the artery is in a more relaxed state, etc.

Harry's plaque, in contrast, is active and growing: inflammatory cells are abundant and producing enzymes that degrade supportive tissue, excessive constrictive factors are constantly causing the artery to pinch partially closed, fatty materials are accumulating and triggering a cascade of abnormal responses.

This is therefore a peculiar situation in which a higher score is actually better than a lower score. It reflects the power of adhering to a preventive program. It also demonstrates how two scans are better than one because they show the rate of increase given a particular preventive approach.

Warren had a moderately high LDL cholesterol for years and took a statin drug sporadically over the past 7 years. Finally retired from a successful real estate investment business, he had a CT heart scan to assess his heart disease status.

Warren's score: 49. At age 59, this put him in the lowest 25%, with an estimated heart attack risk of 1% per year or less--a relatively low risk. At this heart scan score, the likelihood of an abnormal stress test was less than 3%, or a 97% likelihood of a normal stress test. Most would argue that a stress test would be unproductive, given its low probability of yielding useful information. In other words, there would be a 97% probability of normal blood flow through Warren's coronary plaque, and less than 3% likelihood that a stent or bypass surgery would be necessary.

Warren was also without symptoms. He hiked and biked without any chest discomfort or breathlessness. A prevention program like Track Your Plaque to gain control over future coronary plaque growth was all that was necessary and Warren had high hopes for a life free of heart attack and major heart procedures.

Then why did he go through a heart catheterization?

Warren did indeed undergo a heart catheterization on the advice of his cardiologist. When I met Warren for another opinion, it became immediately obvious that the heart catheterization was completely unnecessary. Then why was this invasive procedure done? There can only be a few reasons:

--The cardiologist didn't truly understand the meaning of the heart scan score. "We need to do a 'real' test."

--The cardiologist was terrified of malpractice risk for underdiagnosing or undertreating any condition, no matter how mild.

--The cardiologist wanted to make more money. Talking about heart disease prevention is a money-saving, not a money-making, approach.

Regardless of which of the three motivations was at work here, they're all inexcusable. A disservice was done to this man: he had an unnecessary procedure, incurred some risk of complication in the process, and gained nothing.

An ignorant or profit-seeking cardiologist is worse than the unscrupulous car mechanic who, when presented with an unknowing car repair customer, proceeds to replace the carburetor and rebuild the engine when a simple 5-minute adjustment would have taken care of the problem.

I estimate that no more than 10% of my colleagues follow such practices, but it's often hard to know who is in that 10%. Ask pointed questions: Why is the catheterization necessary? What is the likelihood of finding information useful to my health? What are the alternatives? (By the way, the emerging CT coronary angiograms can be a useful alternative in some situations like this.)

Track Your Plaque is your source for credible information. Be well armed.

Art undeniably had high blood pressure.

At age 53, he had all the “footprints” of high blood pressure that’d been present for at least several years: abnormal patterns by EKG, abnormally thick heart muscle, and an enlarged aorta by an echocardiogram. These sorts of changes require many years to develop. Art’s blood pressure was 140/85 sitting quietly in the office.

“That’s about what my primary care doc gets, too. Whenever it’s high, he takes it again after a few minutes and it always comes down.”

Art tried to persuade me that his blood pressure was high today only because of the traffic on the way into the office. When I dismissed this as a cause, he insisted that stress he’d been suffering because of his teenage son was the cause. “I just know I don’t have high blood pressure!”

Who’s right here? Well, Art is not here to defend himself. But one fact is crystal clear: you cannot develop complications of high blood pressure unless you truly have high blood pressure!

In other words, Art’s abnormal changes in heart structure (thickened heart muscle and enlarged aorta) are serious changes that develop only with years and years of sustained blood pressure at least as high as the one in the office. His blood pressure almost certainly ranged much higher at other times, particularly during stressful situations like waiting in the check-out line at the grocery store, watching a suspenseful TV show, petty irritations at his job, and on and on.

Blood pressure does not have to be high all the time to generate complications of high blood pressure. It can be sporadic, variable, even occasional. Clearly, sustained high blood pressure is the worst situation that creates adverse consequences more quickly. But blood pressure that wavers from low to high only some of the time can still, given sufficient time, cause the very same unwanted effects.

Control of blood pressure is crucial to your coronary plaque control program. Blood pressure may be boring: not as exotic, say, as lipoproteins, and not as fun as talking about nutritional supplements. But neglect blood pressure issues and you will not gain full control over coronary plaque growth—-your heart scan score will increase.

Watch for an upcoming Special Report on the Track Your Plaque Membership website, a full detailed discussion of how to recognize when blood pressure is an important issue, along with a full discussion of nutritional methods to reduce it, often sufficient to minimize or eliminate the need for medication.

In 1994, the Lyon Heart Study demonstrated a 50-70% reduction in coronary events in participants who followed a diet rich in vegetables, olive oil, fish, nuts, red wine, and enjoyed meals as a family activity. Various other studies have documented similar phenomena with less metabolic syndrome, better lipid patterns, less obesity with the Mediterranean lifestyle.

There are two fundamental differences between the Mediterranean diet and the diet advocated by the American Heart Association (AHA) for people with heart disease: the Mediterranean diet uses olive oil more liberally, such that fat calories can reach 40% of total; and, unlike the AHA diet, processed foods are not a part of the Mediterranean diet. Greeks, for instance, are far less likely to eat Count Chocula cereal for breakfast, or snack on Healthy Choice Premium Caramel Swirl Sandwich (ice cream sandwiches) or Malt-O-Meal Honey Nut Scooters. All three of these foods on listed on the AHA Heart-Check Mark heart-healthy program.

In other words, remove all the processed foods, and the AHA diet pretty closely resembles the Mediterranean diet. There are differences but they tend to be relatively small. If the only major difference is the presence of processed foods, wouldn't you therefore expect the AHA to embrace the Mediterranean diet?

Here's what their official stand on the Mediterranean diet states:

Does a Mediterranean-style diet follow American Heart Association dietary recommendations?

Mediterranean-style diets are often close to our dietary recommendations, but they don’t follow them exactly. In general, the diets of Mediterranean peoples contain a relatively high percentage of calories from fat. This is thought to contribute to the increasing obesity in these countries, which is becoming a concern.

The AHA is actually lukewarm towards the diet that was the first to show a dramatic decrease in heart attack and death. Why?

The answer is obvious, once cast in this light. To wholeheartedly endorse the Mediterranean diet might be seen as an indirect rejection of American processed foods. You know, the foods that have caused an extraordinary and unprecedented epidemic of obesity in the U.S., the foods that are manufactured by ConAgra, General Mills, Kelloggs--all also major financial contributors to the AHA, according to the AHA Annual Report.

I tell my patients: If you want heart disease, follow the American Heart Association diet. In my view, it is a diet founded on politics and money, not on health. How else could Cocoa Puffs be regarded as heart healthy?

Imagine we could send you back in a time machine to 50,000 BC.

However, our agreement: no modern tools or equipment. Just your brain, hands, and legs. And your landing spot will be tropical or semi-tropical, the same climate that humans spent much of their evolutionary time in.

Not only might you rub elbows with contemporaries like homo erectus and neanderthalensis, you'd also have to fend for your life and survival.

To eat, you will have to chase and kill wild game, all with your bare hands or crude tools crafted from sticks and stones. You will have to learn what wild berries, roots, and plants are edible and distingusih them from those that make you retch, make your bowels run, or kill you. You won't be able to cultivate grain, at least for a good long time, since you don't have a community that makes such an undertaking easier.

Instead, you are constantly on the run, from the moment you awake until you finally settle back as the sun sets, hopefully with a full stomach, but often empty and growling, anticipating the hunt and forage of tomorrow.

You are outdoors all day, except for the period when you hide in your cave or self-made shelter. You wear what little clothing you can make yourself from your kills, a skin or two. Your skin becomes a dark brown, a 5 foot 10 inch male will weigh 140 lbs, a 5 foot 5 inch woman 95 lbs. There are obvious downsides: your teeth will rot, you will be prone to infections, and predators view you as fair game.

But the result will be that many chronic diseases of modern life will no longer be worries for you. Heart disease? Highly unlikely. Do you need vitamin D? No, because you are outdoors virtually all day with most of your body surface area exposed to sun. Omega-3 fatty acids? You get those from the wild game you eat, since they have higher omega-3 content feeding in the wild, not eating corn like modern livestock. Since your body fat is minimal, just enough for survival, you don't need niacin.

In other words, many of the strategies of the Track Your Plaque program are modern necessities, responses to the "deficiencies" of modern life. Of course, I don't really have a time machine. I also doubt that you wish to hunt wild game every day, forage for plants and roots, run nearly-naked in the sun. You probably also have become accustomed to brushing your teeth and not viewing every animal as a potential threat to your life.

Nonetheless, I find this an interesting exercise for understanding the role of all the tools we use in the Track Your Plaque program for plaque control.

When I first met Hank, I immediately sensed it: anger, hostility, fear. His heart scan score of 685 just made it worse.

He didn't want to be there talking to me. His wife was giving him a hard time. Work was a constant source of irritation. The receptionist at the front desk screwed up his paperwork. Our office charges were too much.

In short, Hank was a pessimist. A bad one.

All the nutrition information out there is bunk. Only he knew how he should eat right. It's stupid to take a lot of fish oil. "You want me to grow gills?"

Among the parameters we use in the Track Your Plaque program is blood pressure during exercise, which provides a surrogate measure of blood pressure during emotional stress, anxiety, etc. "No, I don't need that. I already exercise." No amount of justification could change his mind. "A guy at work had a stress test. They said everything was fine, then Bang! He drops dead. What good is that?"

Hank did go along with a few pieces of advice.

A repeat heart scan 12 months after the first: 870, a 27% per year rate of increase. That's about what would happen if Hank had done nothing, had taken no action to try and stop or reduce his heart scan score.

I don't know if Hank will ever succeed in dropping his score. In fact, I suspect that he will fail, meaning that plaque will grow and he will eventually, perhaps in a year, two or three, require several stents, heart bypass, or have a heart attack. In other words, Hank's pessimism is a self-fulfilling phenomenon: If he believes he will fail, he will. If he believes the world is a rotten place, it is.

Is it possible to "cure" someone like Hank of his deeply-rooted pessimistic attitudes? I don't know of any easy solutions for someone with attitudes as deeply-ingrained as Hank's. (See my prior post, "Cure for pessimism?" at http://heartscanblog.blogspot.com/2007_05_01_archive.html.)

I believe it does help to make someone aware of their attitudes and that it does indeed exert ill health-effects--if they will believe it. But this is a very tough nut to crack.

A review of the effects of Coenzyme Q10 (CoQ10) on the muscle aches and weakness (myopathy) of statin drug therapy was just published in the Journal of the American College of Cardiology.

(Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy. J Amer Coll Cardiol 2007;49(23):2231-2237.)

This is not a study, but a review of the existing scientific and clinical data available on this topic. The study authors conclude with a lukewarm statement:

". . .there is insufficient evidence to prove the etiologic [causal] role of CoQ10 deficiency in statin-associated myopathy and that large, well-designed clinical trials are required to address this issue. The routine use of CoQ10 cannot be recommended in statin-treated patients. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot besatisfactorily treated with other agents. Some patients may respond, if only via placebo effect."

Should the media get hold of this report, be prepared for the usual "Nutritional supplement no help for drug toxicity" headlines, or "Yet another nutritional supplement shows no benefit" with parallels drawn to vitamin C or E.

There are several issue that need to be factored into the discussion:

1) This is not a study, just a review. Thus, any biases of the authors are more likely to exert themselves.

2) The understanding of CoQ10 absorption among different preparations may be an issue. I just received a mailing from Life Extension that made extravagant claims about the superior absorption of ubiquinol, to be distinguished from ubiquinone, the more common form. They claim that eight-fold increased absorption and blood levels of CoQ10 are achievable with ubiquinol. Unfortunately, virtually all the supportive data are unpublished, proprietary observations, i.e., generated by companies who make or sell it. This is as reliable as drug manufacturers who publish glowing reports on their own drugs--perhaps it's true, but it requires unbiased corroboration.

3) Despite the lack of a large, well-funded clinical trial (all are small), the issue continues to live and breathe because of the powerful anecdotal experience.

In our experience, CoQ10 does work. It doesn't work all of the time, perhaps just 80-90% of the time. It does generally require higher doses (100 mg per day, occasionally more). It very clearly must be an oil-based gelcap (just like vitamin D) to work; capsules containing powder do not work.

It's difficult to doubt when someone starts a statin drug, develops the muscle aches and weakness, begins CoQ10 and obtains distinct relief, stops CoQ10 and aches and weakness return, then only to go away again with resumption of CoQ10 . I've seen this countless times.

We do need better information on CoQ10. There's no doubt about it. For people who obtain benefit from statin therapy, I think CoQ10 remains a useful solution. A better solution would be to get rid of the offending drug. But that's not always possible--e.g., LDL cholesterol 190 mg/dl despite the best diet and "adjunctive" food effort. Then CoQ10 can be very useful.

Take a look at the list of foods on the American Heart Association's (AHA) Check Mark endorsement program (below). After I saw the list, I was convinced either that the people who designed the program are either startlingly ignorant, or the AHA simply does this for money.

Many of these foods have nothing to do with health, heart or otherwise. In fact, many of these foods are prominent culprits that contribute to the American epidemic of obesity. There are cured meats with sodium nitrite (a potent cause of colon cancer). Some of these companies have been accused of unhealthy food manufacturing practices. Tyson Foods, for instance, has been in court many times defending their brutal factory farm practices and were the focus of a federal investigation for paying bribe money to USDA Secretary, Mike Espy. (Espy was acquitted but two Tyson executives were convicted, only to be later pardoned by then President Bill Clinton.)

This is a smarmy list to be included on. Though there are some rare healthy exceptions on the list, from the Track Your Plaque viewpoint, this is a list of shame, foods that have no place in a genuinely heart healthy nutrition program.

8th Continent, LLC
8th Continent Fat Free Premium Original Soymilk
8th Continent Fat Free Premium Vanilla Soymilk
8th Continent Light Chocolate Soymilk
8th Continent Light Original Soymilk
8th Continent Light Vanilla Soymilk
8th Continent Premium Chocolate Soymilk
8th Continent Premium Original Soymilk
8th Continent Premium Vanilla Soymilk

American Italian Pasta Company
Golden Grain Mission Whole Grain Penne Rigate
Golden Grain Mission Whole Grain Rotini
Golden Grain Mission Whole Grain Spaghetti
Heartland Whole Grain Penne
Heartland Whole Grain Rotini
Heartland Whole Grain Spaghetti
Heartland Whole Wheat Angel Hair
Heartland Whole Wheat Elbow Macaroni
Heartland Whole Wheat Penne
Heartland Whole Wheat Rotini
Heartland Whole Wheat Spaghetti
Mueller's Whole Grain Penne
Mueller's Whole Grain Rotini
Mueller's Whole Grain Spaghetti

Atalanta Corporation
Celebrity 99% Fat Free Premium Imported Healthy Ham

Beefmaster Cattlemen, L.P.
Nolan Ryan's All Natural Ground Beef Round 96/4, 4% Fat

Bimbo Bakeries USA
Bimbo's 100% Integral/Bimbo 100% Whole Wheat Bread
Mrs. Baird's 100% Whole Wheat Bread
Oroweat 100% Whole Wheat Bread
Oroweat Country 100% Whole Wheat Bread
Oroweat Double Fiber Bread
Oroweat Original Health Nut Bread
Boar's Head Provisions Company, Inc.
Boar's Head Aroastica Seasoned Boneless Skinless Chicken Breast
Boar's Head Blazing Buffalo Style Boneless Skinless Roasted Chicken Breast
Boar's Head Branded Deluxe 42% Lower Sodium Ham
Boar's Head Cracked Pepper Mill Smoked Turkey Breast
Boar's Head Golden Classic Oven Roasted Boneless Skinless Chicken Breast
Boar's Head Hickory Smoked Black Forest Turkey Breast - 43% Lower Sodium
Boar's Head Hickory Smoked Boneless Skinless Chicken Breast
Boar's Head Italian Style Oven Roasted Seasoned Beef with Classic Braciole Seasoning
Boar's Head Lemon Pepper Boneless Skinless Roasted Chicken Breast
Boar's Head Londonport Top Round Seasoned Roast Beef
Boar's Head Maple Glazed Honey Coat Cured Turkey Breast
Boar's Head Mesquite Wood Smoked Skinless Roasted Breast of Turkey
Boar's Head Our Deluxe Low Sodium Low Fat Oven Roasted Choice Beef Cap Off Top Round
Boar's Head Our Premium Oven Roasted 47% Lower Sodium Turkey Breast - Skinless
Boar's Head Our Premium Oven Roasted 50% Lower Sodium Turkey Breast
Boar's Head Ovengold Roast Breast of Turkey
Boar's Head Ovengold Roast Breast of Turkey - Skinless
Boar's Head Pastrami Seasoned Turkey Breast
Boar's Head Salsalito Roasted Breast of Turkey
Bryan Foods, Inc.
Bryan 97% Fat Free Butcher Fresh Pork Tenderloin

Bumble Bee Foods LLC
Kirkland Signature Solid White Albacore Tuna in Water
Member's Mark Solid White Albacore Tuna in Water

California Giant
California Giant Strawberries
California Strawberry Commission
California Fresh Strawberries
California Frozen Strawberries

Campbell Soup Company
Calcium Enriched V8 100% Vegetable Juice
Campbell's Chunky Healthy Request Chicken Noodle
Campbell's Chunky Healthy Request Classic Chicken Noodle Microwaveable Bowl
Campbell's Chunky Healthy Request Grilled Chicken and Sausage Gumbo
Campbell's Chunky Healthy Request Grilled Chicken and Sausage Gumbo Microwaveable Bowl
Campbell's Chunky Healthy Request Hearty Beef Barley
Campbell's Chunky Healthy Request New Englad Clam Chowder
Campbell's Chunky Healthy Request Old Fashioned Vegetable Beef
Campbell's Chunky Healthy Request Vegetable
Campbell's Healthy Request Condensed Chicken Noodle Soup
Campbell's Healthy Request Condensed Chicken Noodle Soup (Food Service)
Campbell's Healthy Request Condensed Chicken Rice Soup
Campbell's Healthy Request Condensed Cream of Celery Soup
Campbell's Healthy Request Condensed Cream of Chicken Soup
Campbell's Healthy Request Condensed Cream of Mushroom Soup
Campbell's Healthy Request Condensed Homestyle Chicken Noodle
Campbell's Healthy Request Condensed Minestrone Soup
Campbell's Healthy Request Condensed Tomato Soup
Campbell's Healthy Request Condensed Vegetable Beef Soup
Campbell's Healthy Request Condensed Vegetable Soup
Campbell's Healthy Request Tomato Juice
Campbell's Low Sodium Tomato Juice
Campbell's Select Healthy Request Chicken and Egg Noodles
Campbell's Select Healthy Request Italian Style Wedding Microwaveable Bowl
Campbell's Select Healthy Request Italian-Style Wedding
Campbell's Select Healthy Request Mexican Style Chicken Tortilla
Campbell's Select Healthy Request Mexican Style Chicken Tortilla Microwaveable Bowl
Campbell's Select Healthy Request Savory Chicken and Long Grain Rice
Campbell's V8 Fusion Strawberry Banana
Campbell's V8 Fusion Tropical Orange
Campbell's V8 Regular Vegetable Juice
Campbell's V8 V.Fusion Light Peach Mango
Campbell's V8 V.Fusion Light Strawberry Banana
Campbell's V8 V.Fusion Pomegranate Blueberry
Essential Antioxidants V8 100% Vegetable Juice
Low Sodium V8 100% Vegetable Juice
Prego Heart Smart Mushroom Italian Sauce
Prego Heart Smart Traditional Italian Sauce

Cargill Meat Solutions
96/4 All Natural Extra Lean Ground Beef
Excel's Tender Choice 97% Fat Free Pork Tenderloins
Excel's Tender Choice Extra Lean Boneless Pork Loin
Our Certified 100% Pure All Natural Ground Beef 96/4
Sterling Silver Extra Lean Pork Tenderloins - 12% Marination
Sterling Silver Lean Boneless Pork Loin - 12% Marination

Chiquita Brands Company, N.A.
Chiquita Bananas

Clearwater Seafoods Limited Partnership
Clearwater Frozen Arctic Surf Clams

Cliffstar Corporation
Deerfield Farms No Sugar Added 100% Grape Juice (Purple)
Safeway 100% Grape Juice (Purple)
Sam's Choice 100% Grape Juice (Purple)
Walgreens 100% Grape Juice (Purple)

Clougherty Packing Company
Farmer John® California Natural® 4% Fat Extra Lean Ground Pork
Farmer John® California Natural® Premium Extra Lean Boneless Pork Tenderloins

Minute Maid Premium Blends - Orange Passion Calcium Juice-Frozen
Minute Maid Premium Blends - Orange Tangerine Calcium Juice - Frozen
Minute Maid Premium Country Style Orange Juice
Minute Maid Premium Country Style Orange Juice - Frozen
Minute Maid Premium Extra Vitamins C and E Plus Zinc Orange Juice - Frozen
Minute Maid Premium Home Squeezed Style Calcium + Vitamin D Orange Juice
Minute Maid Premium Low Acid Orange Juice
Minute Maid Premium Low Acid Orange Juice - Frozen
Minute Maid Premium Original Calcium + Vitamin D Orange Juice
Minute Maid Premium Original Calcium Orange Juice - Frozen
Minute Maid Premium Original Orange Juice
Minute Maid Premium Original Orange Juice - Frozen
Minute Maid Premium Pulp Free Calcium + Vitamin D Orange Juice
Minute Maid Premium Pulp Free Orange Juice
Minute Maid Premium Pulp Free Orange Juice - Frozen
Simply Orange Calcium Pulp Free 100% Orange Juice
Simply Orange Country Stand Calcium Medium Pulp 100% Orange Juice
Simply Orange Grove Made High Pulp 100% Orange Juice
Simply Orange Original Pulp Free 100% Orange Juice

Colleen Strawberries, Inc. / EKT Farms
Colleen Strawberries

ConAgra Dairy Foods
Egg Beaters 99% Real Eggs-Frozen
Egg Beaters 99% Real Eggs-Refrigerated
Egg Beaters Cheese & Chive
Egg Beaters Egg Whites
Egg Beaters Garden Vegetable
Egg Beaters Ham & Cheese
Egg Beaters Southwestern

ConAgra Food Service
Lamb Weston Sweet Things Mashed Sweet Potatoes, Frozen

ConAgra Frozen Foods
Healthy Choice Café Selections Apple Glazed Pork Medallions
Healthy Choice Café Selections Beef Merlot
Healthy Choice Café Selections Cajun Style Chicken & Shrimp
Healthy Choice Café Selections Chicken Fried Rice
Healthy Choice Café Selections Chicken Margherita
Healthy Choice Café Selections Chicken Tuscany
Healthy Choice Café Selections Creamy Dill Salmon
Healthy Choice Café Selections Four Cheese Pizza
Healthy Choice Café Selections General Tso's Spicy Chicken
Healthy Choice Café Selections Gourmet Supreme Pizza
Healthy Choice Café Selections Grilled Basil Chicken
Healthy Choice Café Selections Grilled Chicken & Roasted Red Pepper Alfredo
Healthy Choice Café Selections Grilled Chicken Baja
Healthy Choice Café Selections Grilled Chicken Caesar
Healthy Choice Café Selections Grilled Chicken Marinara
Healthy Choice Café Selections Grilled Whiskey Steak
Healthy Choice Café Selections Italian Style Pepperoni Pizza
Healthy Choice Café Selections Roasted Chicken Chardonnay
Healthy Choice Café Selections Roasted Chicken Marsala
Healthy Choice Complete Selections Asiago Chicken Portabello
Healthy Choice Complete Selections Beef Pot Roast
Healthy Choice Complete Selections Beef Stroganoff
Healthy Choice Complete Selections Beef Tips Portabello
Healthy Choice Complete Selections Beef with Classic BBQ Sauce
Healthy Choice Complete Selections Blackened Chicken
Healthy Choice Complete Selections Chicken Broccoli Alfredo
Healthy Choice Complete Selections Chicken Parmigiana
Healthy Choice Complete Selections Chicken Teriyaki
Healthy Choice Complete Selections Classic Grilled Chicken BBQ
Healthy Choice Complete Selections Country Breaded Chicken
Healthy Choice Complete Selections Country Herb Chicken
Healthy Choice Complete Selections Creamy Garlic Shrimp
Healthy Choice Complete Selections Fiesta Chicken
Healthy Choice Complete Selections Four Cheese Manicotti
Healthy Choice Complete Selections Glazed Chicken
Healthy Choice Complete Selections Grilled Chicken Monterey
Healthy Choice Complete Selections Grilled Turkey Breast
Healthy Choice Complete Selections Grilled White Meat Chicken with Smokehouse BBQ Sauce
Healthy Choice Complete Selections Honey Balsamic Chicken
Healthy Choice Complete Selections Lemon Pepper Fish
Healthy Choice Complete Selections Meatloaf
Healthy Choice Complete Selections Mushroom Roasted Beef
Healthy Choice Complete Selections Roasted Chicken
Healthy Choice Complete Selections Salisbury Steak
Healthy Choice Complete Selections Sweet Bourbon Steak
Healthy Choice Complete Selections Sweet and Sour Chicken
Healthy Choice Complete Selections Traditional Turkey Breast
Healthy Choice Low Fat Premium Sorbet & Cream Bars-Orange or Strawberry
Healthy Choice Premium Caramel Swirl Sandwich
Healthy Choice Premium Fudge Sandwich
Healthy Choice Premium Fudge Swirl Sandwich
Healthy Choice Premium Low Fat Ice Cream Bar
Healthy Choice Premium Vanilla Sandwich
Healthy Choice Simple Selections Breaded Chicken Breast Strips with Gravy
Healthy Choice Simple Selections Cheese French Bread Pizza
Healthy Choice Simple Selections Cheesy Chicken and Rice
Healthy Choice Simple Selections Chicken Enchilada
Healthy Choice Simple Selections Chicken Fettuccini Alfredo
Healthy Choice Simple Selections Chicken Rigatoni
Healthy Choice Simple Selections Four Cheese Manicotti
Healthy Choice Simple Selections Glazed Chicken
Healthy Choice Simple Selections Grilled Chicken White Meat Chicken & Pasta
Healthy Choice Simple Selections Grilled White Meat Chicken & Gravy
Healthy Choice Simple Selections Lasagna Bake
Healthy Choice Simple Selections Macaroni & Cheese
Healthy Choice Simple Selections Mandarin Chicken
Healthy Choice Simple Selections Pepperoni French Bread Pizza
Healthy Choice Simple Selections Roast Turkey Breastin Savory Sauce with Mushrooms
Healthy Choice Simple Selections Salisbury Steak
Healthy Choice Simple Selections Sesame Chicken
Healthy Choice Simple Selections Slow Roasted Turkey Breast with Gravy
Healthy Choice Simple Selections Spaghetti
Healthy Choice Simple Selections Supreme French Bread Pizza

ConAgra Grocery Foods
ACT II 94% Fat Free Butter Microwave Popcorn
ACT II 94% Fat Free Butter Mini Bags Microwave Popcorn
ACT II 94% Fat Free Kettle Corn Microwave Popcorn
Healthy Choice Bean & Ham Soup
Healthy Choice Beef Pot Roast Microwavable Bowl Soup
Healthy Choice Chicken & Dumplings Soup
Healthy Choice Chicken Tortilla Soup
Healthy Choice Chicken with Rice Microwavable Bowl Soup
Healthy Choice Chicken with Rice Soup
Healthy Choice Country Vegetable Microwavable Bowl Soup
Healthy Choice Country Vegetable Soup
Healthy Choice Fiesta Chicken Soup
Healthy Choice Garden Vegetable Soup
Healthy Choice Garlic & Herb Pasta Sauce
Healthy Choice Hearty Chicken Soup
Healthy Choice New England Clam Chowder Soup
Healthy Choice Old Fashioned Chicken Noodle Microwavable Bowl Soup
Healthy Choice Old Fashioned Chicken Noodle Soup
Healthy Choice Split Pea & Ham Soup
Healthy Choice Traditional Pasta Sauce
Healthy Choice Vegetable Beef Soup
Healthy Choice Zesty Gumbo with Chicken & Sausage Soup
Hunt's Family Favorites Seasoned Tomato Sauce for Lasagna
Hunt's Organic Crushed Tomatoes
Hunt's Organic Diced Tomatoes
Hunt's Organic Pasta Sauce Roasted Garlic
Hunt's Organic Whole Tomatoes
Hunt's Tomatoes Crushed in Thick Tomato Puree
Hunt's Tomatoes Diced
Hunt's Tomatoes Diced in Sauce
Hunt's Tomatoes Diced with Mild Green Chilies
Hunt's Tomatoes Diced-Green Pepper, Celery & Onions
Hunt's Tomatoes Petite Diced
Hunt's Tomatoes Stewed-No Salt Added
Hunt's Tomatoes Whole
Hunt's Tomatoes Whole-No Salt Added
Orville Redenbacher's Mini Bags Smart Pop Butter Microwave Popcorn
Orville Redenbacher's Mini Bags Smart Pop Butter/Kettle Corn Microwave Popcorn Variety Pack
Orville Redenbacher's Mini Bags Smart Pop Kettle Corn Microwave Popcorn
Orville Redenbacher's Organic Kernal Jar
Orville Redenbacher's Organic Smart Pop Butter Microwave Popcorn
Orville Redenbacher's Original Kernal Jar
Orville Redenbacher's Original Kernal Jug
Orville Redenbacher's Smart Pop Butter Microwave Popcorn
Orville Redenbacher's Smart Pop Kettle Corn Microwave Popcorn
Orville Redenbacher's Smart Pop Movie Theater Butter Microwave Popcorn
Orville Redenbacher's White Kernal Jar
Rosarita Diced Green Chilies
Rosarita Green Chilies Strips
Rosarita Whole Green Chilies

ConAgra Refrigerated Foods
Healthy Choice Deli Thin Baked Cooked Ham
Healthy Choice Deli Thin Honey Ham
Healthy Choice Deli Thin Honey Ham & Honey Roasted & Smoked Turkey Breast Variety Pack
Healthy Choice Deli Thin Honey Roasted & Smoked Turkey Breast
Healthy Choice Deli Thin Mesquite Turkey Breast
Healthy Choice Deli Thin Oven Roasted Chicken Breast
Healthy Choice Deli Thin Oven Roasted Turkey Breast
Healthy Choice Deli Thin Pastrami
Healthy Choice Deli Thin Smoked Ham
Healthy Choice Deli Thin Smoked Turkey Breast
Healthy Choice Deli-97% Fat Free Honey Ham
Healthy Choice Deli-97% Fat Free Honey Maple Ham
Healthy Choice Deli-97% Fat Free Medium Cooked Roast Beef-20% Marination
Healthy Choice Deli-97% Fat Free Mesquite Smoked Honey Ham
Healthy Choice Deli-97% Fat Free Roast Beef-20% Marination
Healthy Choice Deli-97% Fat Free Smoked Ham
Healthy Choice Deli-97% Fat Free Virginia Brand Ham
Healthy Choice Deli-98% Fat Free Browned Chicken Breast
Healthy Choice Deli-98% Fat Free Chicken Breast
Healthy Choice Deli-98% Fat Free Golden Oven Roasted Turkey Breast
Healthy Choice Deli-98% Fat Free Honey Roasted & Smoked Turkey Breast with Broth
Healthy Choice Deli-98% Fat Free Mesquite Smoked Chicken Breast
Healthy Choice Deli-98% Fat Free Mesquite Smoked Turkey Breast
Healthy Choice Deli-98% Fat Free Smoked Turkey Breast
Healthy Choice Deli-98% Fat Free Southwest Grill Turkey Breast
Healthy Choice Deli-Honey Cured Ham
Healthy Choice Deli-Honey Roasted & Smoked Turkey Breast
Healthy Choice Deli-Oven Roasted Chicken Breast
Healthy Choice Deli-Oven Roasted Turkey Breast
Healthy Choice Deli-Roast Beef-20% Marination
Healthy Choice Deli-Virginia Brand Cooked Ham
Healthy Choice Deluxe Thin-Sliced Baked Cooked Ham
Healthy Choice Deluxe Thin-Sliced Honey Ham
Healthy Choice Deluxe Thin-Sliced Honey Ham/Oven Roasted Turkey Breast Variety Pack
Healthy Choice Deluxe Thin-Sliced Oven Roasted Turkey Breast
Healthy Choice Honey Ham
Healthy Choice Low Fat Smoked Sausage
Healthy Choice Pre-Sliced Sandwich Solutions Roast Beef
Healthy Choice Pre-Sliced Sandwich Solutions Skinless Oven Roasted Turkey Breast
Healthy Choice Pre-Sliced Sandwich Solutions Skinless Smoked Turkey Breast
Healthy Choice Pre-Sliced Sandwich Solutions Virginia Brand Ham
Healthy Choice Virginia Brand Ham
Healthy Choice Zip Pack Cooked Ham
Healthy Choice Zip Pack Honey Ham
Healthy Choice Zip Pack Oven Roasted Chicken Breast
Healthy Choice Zip Pack Oven Roasted Turkey Breast
Hebrew National 97% Fat Free Beef Franks

ConAgra Retail Foods
Healthy Choice Hearty 100% Whole Grain Bread
Healthy Choice Hearty 7-Grain Bread

Coolham Holdings, Inc. DBA SunMilk Dairy Co.
SunMilk-Fat Free Milk with Sunflower Oil (The Taste of 1%)
SunMilk-Fat Free Milk with Sunflower Oil (The Taste of 2%)

Cooper Farms
Cooper Farms All Natural Turkey Breast Fillet

Crider, Inc.
Kirkland Signature Premium 99% Fat Free Chunk Chicken Breast

Dare Foods Incorporated
Breton Reduced Fat & Sodium Wheat Crackers

El Aguila Food Products, Inc.
El Aguila Stoneground Corn Tortillas

Eurofresh Inc.
Eurofresh Campari Tomatoes

FPL Foods, LLC
96/4 All Natural Extra Lean Ground Beef

Farmland Foods
Farmland 97% Fat Free Fresh Ground Pork
Farmland Nutrition Wise 97% Fat Free Boneless Center Cut Pork Loin Filet
Farmland Nutrition Wise Boneless Butterfly Cut Pork Loin Chops
Farmland Nutrition Wise Boneless Center Cut Pork Loin
Farmland Nutrition Wise Boneless Center Cut Pork Loin Chops
Farmland Nutrition Wise Boneless Center Cut Pork Loin Roast
Farmland Nutrition Wise Boneless Pork Chops - America's Cut
Farmland Nutrition Wise Boneless Pork Tenderloin
Farmland Nutrition Wise Boneless Pork Top Round Roast
Farmland Nutrition Wise Boneless Pork Top Round Steak
Farmland Nutrition Wise Boneless Sirloin Tip Pork Roast
Farmland Nutrition Wise Pork Cube Steak
Farmland Nutrition Wise Pork Cubes
Farmland Nutrition Wise Pork Scallopini
Farmland Nutrition Wise Pork Strips

Fieldale Farms Corporation
Jewel All Natural 99% Fat Free Boneless Skinless Chicken Breasts with Rib Meat
Jewel All Natural 99% Fat Free Chicken Breast Tenders
Our Premium 98% Fat Free Boneless Skinless Breast with Rib Meat - 15% Marination
Springer Mountain Farms All Natural 98% Fat Free Boneless Skinless Breasts

Florida's Natural Growers
Florida's Natural Calcium & Vitamin D No Pulp Orange Juice
Florida's Natural Growers Style Most Pulp Orange Juice
Florida's Natural Home Squeezed Calcium & Vitamin D with Pulp Orange Juice
Florida's Natural Home Squeezed with Pulp Orange Juice
Florida's Natural Original No Pulp Orange Juice

FoodTech International
Veggie Patch California Veggie Burgers

Foster Poultry Farms
Foster Farms 98% Fat Free Honey Roasted & Smoked Breast of Turkey
Foster Farms 98% Fat Free Oven Roasted Breast of Turkey
Foster Farms 98% Fat Free Oven Roasted Chicken Breast
Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Fillets
Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Steaks
Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Tenders
Foster Farms 99% Fat Free Honey Roasted & Smoked Turkey Breast
Foster Farms 99% Fat Free Oven Roasted Turkey Breast
Foster Farms All Natural 99% Fat Free Boneless & Skinless Chicken Breast Tenders (8% Marination)
Foster Farms Fresh & Easy 99% Fat Free 100% Natural Boneless & Skinless Breast Fillets
Kirkland Signature/Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breasts
Kirkland Signature/Foster Farms All Natural 99% Fat Free Boneless & Skinless Chicken Breasts (8% Marination)

Fresh Express Incorporated
Chiquita Apple Bites
Fresh Express American Salad
Fresh Express Hearts of Romaine Salad
Fresh Express Italian Salad
Fresh Express Triple Hearts Salad

GFA Brands, Inc.
Smart Balance Smart 'N Healthy Deluxe Microwave Popcorn
Smart Beat Healthy Fat Free Non-Dairy Slices - American Flavor
Smart Beat Healthy Fat Free Non-Dairy Slices - Lactose Free
Smart Beat Smart Squeeze Nonfat Margarine Spread

General Mills, Inc.
Apple Cinnamon Cheerios
Berry Berry Kix
Berry Burst Cheerios-Strawberry Banana
Berry Burst Cheerios-Triple Berry
Berry Lucky Charms
Cheerios
Cheerios Crunch
Chocolate Lucky Charms
Cocoa Puffs
Cookie Crisp
Count Chocula
Dora The Explorer
Frosted Cheerios
Fruity Cheerios
Heart Smart Bisquick
Honey Nut Cheerios
Kix
Lucky Charms
Multi-Grain Cheerios
Oatmeal Crisp Crunchy Almond
Oatmeal Crisp Hearty Raisin
Oatmeal Crisp Maple Brown Sugar
Pillsbury Oven-Baked Whole Wheat Dinner Rolls
Progresso Healthy Favorites Chicken & Wild Rice Soup
Progresso Healthy Favorites Chicken Gumbo Soup
Progresso Healthy Favorites Chicken Noodle Soup
Progresso Healthy Favorites Garden Vegetable Soup
Progresso Healthy Favorites Italian-Style Wedding Soup
Progresso Healthy Favorites Minestrone Soup
Total Cranberry Crunch
Total Honey Clusters
Total Raisin Bran
Total with Strawberries
Trix
Whole Grain Total
Yogurt Burst Cheerios Strawberry
Yogurt Burst Cheerios Vanilla

Hain Celestial Group, Inc., The
DeBoles Organic Ancient Grain Penne
Health Valley Empower Cereal
Hodgson Mill, Inc.
Hodgson Mill Oat Bran All Natural Hot Cereal
Hodgson Mill Whole Wheat Angel Hair
Hodgson Mill Whole Wheat Fettuccine
Hodgson Mill Whole Wheat Lasagna
Hodgson Mill Whole Wheat Penne
Hodgson Mill Whole Wheat Spinach Spaghetti
Hodgson Mill Whole Wheat Whole Grain Elbows
Hodgson Mill Whole Wheat Whole Grain Spaghetti

Indiana Packers Corp.
Indiana Kitchen All Natural Boneless Pork Sirloin Roast
Indiana Kitchen All Natural Pork Tenderloin

Interstate Brands Corporation
Home Pride Whole Grains 100% Honey Whole Wheat Bread
Home Pride Whole Grains 100% Whole Wheat Bread
Merita Country Whole Grains 100% Whole Wheat Bread

KFP International, Ltd.
Kedem 100% Pure Concord Grape Juice-No Sugar Added

Kansas City Steak Company
Kansas City Seasoned Beef Chuck Tender Steak
Kansas City Seasoned Beef Medallions

Kashi Company
Kashi Heart to Heart Honey Oat Waffles
Kashi Heart to Heart Honey Toasted Cereal
Kashi Heart to Heart Instant Oatmeal - Apple Cinnamon
Kashi Heart to Heart Instant Oatmeal - Golden Brown Maple
Kashi Heart to Heart Instant Oatmeal - Raisin Spice
Kashi Heart to Heart Oat Flakes & Wild Blueberry Clusters

Kellogg USA, Inc.
Kellogg's All-Bran Bran Buds
Kellogg's All-Bran Extra Fiber
Kellogg's All-Bran Original
Kellogg's Frosted Mini-Wheats - Strawberry Delight
Kellogg's Frosted Mini-Wheats - Vanilla Creme
Kellogg's Frosted Mini-Wheats Big Bite
Kellogg's Frosted Mini-Wheats Bite Size
Kellogg's Frosted Mini-Wheats Maple & Brown Sugar
Kellogg's Smart Start Antioxidants - Original
Kellogg's Smart Start Healthy Heart - Maple & Brown Sugar
Kellogg's Smart Start Healthy Heart - Original
Kellogg's Smart Start Healthy Heart Cinnamon Raisin

King Soopers
Ground Beef 96/4 Extra Lean

Kroger Company, The
Kroger Moist & Tender Silver Platter Pork Tenderloin

Laura's Lean Beef Company
Laura's Lean Beef - Beef Pot Roast Au Jus
Laura's Lean Beef - Shredded Beef with Barbecue Sauce
Laura's Lean Beef 4% Fat Ground Round
Laura's Lean Beef 4% Ground Sirloin
Laura's Lean Beef Sirloin Steak

LiDestri Foods, Inc.
Francesco Rinaldi No Salt Added Traditional Pasta Sauce

Lido Veal & Lamb Inc.
Veal USA Boneless Veal Shoulder Roast from Lido Veal
Veal USA Low Fat Ground Veal from Lido Veal
Veal USA Veal Leg Cutlets from Lido Veal
Veal USA Veal Stew from Lido Veal

M & I Seafood Manufacturing Inc.
Chesapeake Bay Gourmet Crab Cakes

MW Polar Foods
Polar All Natural Chunk Light Tuna in Water
Polar All Natural Solid White Albacore in Water
Polar Chunk Light Tuna in Water
Polar Solid White Albacore Tuna in Water

Malt-O-Meal Company
Malt-O-Meal Balance
Malt-O-Meal Crispy Rice
Malt-O-Meal Frosted Mini Spooners
Malt-O-Meal Honey & Oat Blenders
Malt-O-Meal Honey Nut Scooters
Malt-O-Meal Hot Wheat Cereal - Chocolate
Malt-O-Meal Hot Wheat Cereal - Maple & Brown Sugar
Malt-O-Meal Hot Wheat Cereal - Original
Malt-O-Meal Maple & Brown Sugar Mini Spooners
Malt-O-Meal Mom's Best 100% Natural Quick Oats
Malt-O-Meal Mom's Best Instant Oatmeal - Apples & Cinnamon
Malt-O-Meal Mom's Best Instant Oatmeal - Maple & Brown Sugar
Malt-O-Meal Mom's Best Instant Oatmeal Variety Pack - Maple & Brown Sugar/Apples & Cinnamon/Cinnamon & Spice
Malt-O-Meal Raisin Bran
Malt-O-Meal Scooters

Maple Leaf Consumer Foods
Maple Leaf Sodium Reduced 98% Fat Free Cooked Ham with Natural Juices

Maverick Ranch Association
Maverick Ranch 96/4 Extra Lean Grass Fed Organic Ground Beef
Maverick Ranch 96/4 Extra Lean Natural Ground Buffalo
Maverick Ranch 96/4 Extra Lean Natural Ground Pork Sirloin
Maverick Ranch Free-Range Chicken-All Natural Air Chilled Boneless Skinless Chicken Breast
Maverick Ranch NaturaLite 96/4 Extra Lean Ground Beef Round
Maverick Ranch NaturaLite Beef - 96/4 Extra Lean Ground Beef Chuck
Maverick Ranch NaturaLite Beef - 96/4 Extra Lean Ground Beef Sirloin
Maverick Ranch Natural Beef Cubed Steak
Maverick Ranch Natural Beef Top Sirloin Steak
Maverick Ranch Natural Buffalo Top Sirloin Steak
Maverick Ranch Natural Center Cut Pork Loin Chops
Maverick Ranch Natural Lite 96/4 Extra Lean Natural Ground Beef
Maverick Ranch Natural Pork 4% Fat Extra Lean Pork Tenderloin
Maverick Ranch Natural Skinless Chicken Drumsticks
Maverick Ranch Natural Skinless Chicken Thighs
Maverick Ranch Organic Air-Chilled Boneless Skinless Chicken Breasts

Mayoli Inc.
Mayoli All Natural Reduced Fat Mayonnaise Dressing with Pure Olive Oil

McNeil Nutritionals, LLC
LACTAID® Calcium-Fortified Fat Free Milk
LACTAID® Fat Free Milk

Meijer Distribution, Inc.
Meijer Purple Grape Juice

Michael Foods, Inc.
All Whites Egg Whites - White Cheddar
Better 'n Eggs Ham & Cheese
Better 'n Eggs Plus
Better 'n Eggs Three Cheese
Kirkland Signature Egg Starts
Kroger Break-Free 100% Liquid Egg Whites
Kroger Break-Free Real Egg Product
Papetti Foods All Whites - 100% Liquid Egg Whites
Papetti Foods Better 'n Eggs

Mills Family Farms
Mills Family Farms Green Cascade Mix-Baby Romaine & Baby Green Leaf
Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Green Leaf
Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Red Leaf
Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Romaine
Milton's Baking Company
Milton's Baking Classics Cinnamon Raisin Wheat Bread
Milton's Baking Classics Corn Bread
Milton's Baking Classics Oat Bran Bread
Milton's Baking Classics Wheat Bread
Milton's Healthy Multi-Grain Plus Bread
Milton's Healthy Whole Grain Plus Bread
Milton's Original Healthy Multi-Grain Bread
Milton's Whole Grains 100% Whole Wheat Bread

Motts LLP
Yoo-hoo Lite Chocolate Drink

Murray's Free Roaming Chicken, Inc.
Murray's Extra Lean 99% Fat Free Boneless & Skinless Chicken

New World Pasta Company
Ronzoni Healthy Harvest Multi-Grain Pasta-Fusilli
Ronzoni Healthy Harvest Multigrain Pasta - Spaghetti Style
Ronzoni Healthy Harvest Whole Wheat Blend Extra Wide Noodle - Style
Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Linguine
Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Penne Rigate
Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Rotini
Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Spaghetti Style
Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Thin Spaghetti
Ronzoni Healthy Harvest Whole Wheat Blend Pasta-Lasagna
Ronzoni Healthy Harvest Whole Wheat Blend Wide Noodle - Style

Nonna's Kitchen, Inc.
Columbus Reduced Sodium Turkey Breast

North American Beverage Company
Chocolate Moose - All Natural Premium Milk Chocolate Drink
Chocolate Moose - Cookies & Cream Premium Milk Chocolate Drink
Mega Moose Energy Drink-Strawberry Blast

Nulaid Foods Inc.
Nulaid ReddiEgg Real Egg Product

Oberto Sausage Company
Kirkland Signature Premium Brisket Roast Beef

Old Orchard Brands LLC
Old Orchard 100% Grape Juice
Old Orchard 100% Grape Juice - Frozen Concentrate

POM Wonderful, LLC
POM Wonderful Fresh Pomegranate Arils
POM Wonderful Frozen Pomegranate Arils
POM Wonderful Pomegranates

Packerland Processing Co., Inc.
Meijer Extra Lean Ground Beef 96/4

Peco Foods, Inc.
Member's Mark All Natural Boneless Skinless Chicken Breasts with Rib Meat
Member's Mark All Natural Boneless Skinless Chicken Tenderloins

Pepperidge Farm, Inc.
Pepperidge Farm 100% Natural 100% Whole Wheat Bread
Pepperidge Farm 100% Natural 9 Grain Bread
Pepperidge Farm 100% Natural German Dark Wheat Bread
Pepperidge Farm 100% Natural Honey Flax Bread
Pepperidge Farm 100% Whole Wheat Bagels
Pepperidge Farm 100% Whole Wheat English Muffins
Pepperidge Farm 100% Whole Wheat Hearty Texture Whole Grain Bread
Pepperidge Farm 100% Whole Wheat Mini Bagels
Pepperidge Farm 15 Grain Hearty Texture Whole Grain Bread
Pepperidge Farm Farmhouse Soft 100% Whole Wheat Bread
Pepperidge Farm Golden Harvest Grains Hearty Texture Whole Grain Bread
Pepperidge Farm Light Style 7 Grain Bread
Pepperidge Farm Light Style Soft Wheat Bread
Pepperidge Farm Oatmeal Hearty Texture Whole Grain Bread
Pepperidge Farm Soft Honey Oat Smooth Texture Whole Grain Bread
Pepperidge Farm Soft Honey Whole Wheat Smooth Texture Whole Grain Bread
Pepperidge Farm Very Thin Soft 100% Whole Wheat Bread
Pepperidge Farm Whole Grain Multi-Grain Bagels
Pepperidge Farm Whole Grain Swirl Bread - Cinnamon
Pepperidge Farm Whole Grain Swirl Bread - Cinnamon with Raisins

Perdue Farms, Inc.
Perdue Individually Frozen All Natural 99% Fat Free Chicken Tenderloins
Perdue Tender & Tasty 99% Fat Free Individually Frozen Boneless Skinless Chicken Breasts
Perdue Tender & Tasty 99% Fat Free Individually Wrapped Boneless Skinless Chicken Breasts
Perdue/Kirkland Signature Individually Frozen All Natural 99% Fat Free Boneless Skinless Chicken Breasts

Pilgrim's Pride Corporation
Eat Well Stay Healthy Chicken Breast Salad
Eat Well Stay Healthy Fresh Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
Eat Well Stay Healthy Fresh Boneless Skinless Chicken Thin Sliced Breasts with Rib Meat (15% Chicken Broth)
Eat Well Stay Healthy Fresh Chicken Breast Tenderloins (15% Chicken Broth)
Eat Well Stay Healthy Fully Cooked Rotisserie Skinless Chicken Split Breasts - Garden Herb
Gold Kist Farms 100% Natural 99% Fat Free Boneless Skinless Chicken Breast
Gold Kist Farms All Natural 99% Fat Free Boneless Skinless Breasts
Gold Kist Farms/Kirkland Signature All Natural 99% Fat Free Boneless Skinless Breasts
HyVee/Country Pride 97% Fat Free Boneless Skinless Chicken Breast Fillets with Rib Meat (15% Chicken Broth)
HyVee/Country Pride 97% Fat Free Skinless Split Chicken Breasts with Ribs (12% Chicken Broth)
HyVee/Country Pride 99% Fat Free Boneless Skinless Chicken Breast Tenderloins (15% Chicken Broth)
Meijer Fresh Boneless Skinless Chicken Breast Tenderloins (15% Marination)
Meijer Fresh Boneless Skinless Chicken Breasts with Rib Meat (15% Marination)
Pilgrim's Pride Eat Well Stay Healthy Grilled Chicken Breast Fillets
Pilgrim's Pride Eat Well Stay Healthy Grilled Chicken Breast Strips
Pilgrim's Pride Eat Well Stay Healthy Italian Style Grilled Chicken Breast Fillets
Pilgrim's Pride Eat Well Stay Healthy Key Lime Flavor Chicken Breast Fillets
Pilgrim's Pride Eat Well Stay Healthy Kids Fully Cooked Breaded Chicken Nuggets
Pilgrim's Pride Eat Well Stay Healthy Kids Fully Cooked Breaded Popcorn Chicken
Pilgrim's Pride Eat Well Stay Healthy Lemon Herb Chicken Breast Fillets
Pilgrim's Pride Eat Well Stay Healthy Savory Chicken Breast Fillets
Pilgrim's Pride Eat Well Stay Healthy Szechwan Chicken Breast Tenderloins
Pilgrim's Pride Fresh Boneless Skinless Chicken Breasts with Rib Meat Individually Wrapped (15% Chicken Broth)
Pilgrim's Pride Fresh Chicken 100% Natural Boneless Skinless Breasts with Rib Meat
Pilgrim's Pride Fresh Chicken 100% Natural Boneless Skinless Breasts with Rib Meat (15% Chicken Broth)
Pilgrim's Pride Fresh Chicken 100% Natural Breast Tenderloins
Pilgrim's Pride Fresh Chicken 100% Natural Breast Tenderloins (15% Chicken Broth)
Pilgrim's Pride Fresh Chicken 100% Natural Skinless Split Breasts with Ribs
Pilgrim's Pride Fresh Chicken 100% Natural Skinless Split Breasts with Ribs (12% Chicken Broth)
Pilgrim's Pride Fresh Chicken Breast Tenderloins Individually Wrapped (15% Chicken Broth)
Pilgrim's Pride Individually Frozen Fully Trimmed 99% Fat Free All Natural Boneless Skinless Chicken Breasts (15% Chicken Broth)
Schnucks 99% Fat Free Chicken Breast Tenderloins
Schnucks 99% Fat Free Skinless Chicken Breast Fillets
Schnucks 99% Fat Free Thin Sliced Skinless Chicken Breast Fillets

Quaker Oats Company/Tropicana Products, Inc., The
Crystal Wedding Oats
Old-Fashioned Quaker Oats
Quaker Cinnamon Life
Quaker Essentials Oat Bran
Quaker Essentials Oatmeal Squares - Brown Sugar
Quaker Essentials Oatmeal Squares - Cinnamon
Quaker Essentials Toasted Oatmeal - Brown Sugar
Quaker Essentials Toasted Oatmeal - Honey Nut
Quaker Honey Graham Life
Quaker Instant Oatmeal - Apple Crisp
Quaker Instant Oatmeal - Apples & Cinnamon
Quaker Instant Oatmeal - Cinnamon & Spice
Quaker Instant Oatmeal - Cinnamon Roll
Quaker Instant Oatmeal - Flavor Variety
Quaker Instant Oatmeal - Maple & Brown Sugar
Quaker Instant Oatmeal - Raisins & Spice
Quaker Instant Oatmeal - Regular Flavor
Quaker Instant Oatmeal Bakery Favorites Variety Pack (Apple Crisp/Cinnamon Roll/Banana Bread)
Quaker Instant Oatmeal Crunch - Apples & Cinnamon
Quaker Instant Oatmeal Crunch - Magicolor Cinnamon
Quaker Instant Oatmeal Crunch - Maple & Brown Sugar
Quaker Instant Oatmeal Crunch - Mixed Berry
Quaker Instant Oatmeal Lower Sugar - Apples & Cinnamon
Quaker Life
Quaker Life Chocolate Oat Crunch
Quaker MultiGrain Hot Cereal
Quaker Oat Bran Hot Cereal
Quaker Take Heart Instant Oatmeal - Blueberry
Quaker Take Heart Instant Oatmeal - Golden Maple
Quick 1 Minute Quaker Oats
Tropicana Pure Premium Calcium + Vitamin D No Pulp Orange Juice
Tropicana Pure Premium Fiber Some Pulp Orange Juice
Tropicana Pure Premium Golden No Pulp Grapefruit Juice
Tropicana Pure Premium Grovestand Calcium + Vitamin D Lots of Pulp Orange Juice
Tropicana Pure Premium Grovestand Lots of Pulp Orange Juice
Tropicana Pure Premium Healthy Heart No Pulp Orange Juice with Omega 3
Tropicana Pure Premium Homestyle Some Pulp Orange Juice
Tropicana Pure Premium Light 'n Healthy Calcium No Pulp Orange Juice
Tropicana Pure Premium Light 'n Healthy Calcium No Pulp Orange Juice
Tropicana Pure Premium Low Acid No Pulp Orange Juice
Tropicana Pure Premium Original No Pulp Orange Juice
Tropicana Pure Premium Ruby Red Some Pulp Grapefruit Juice

R.A.B. Food Group LLC
Manischewitz Premium 100% Grape Juice

Rader Farms, Inc.
Rader Farms Nature's Three Berries

Red Gold, LLC
Sacramento Tomato Juice from Concentrate with Enhanced Tomato Flavor

Ruprecht Company
Sommers 100% Organic Extra Lean Beef Burgers

Sal & Judy's Products, LLC
Sal & Judy's Heart Smart Italian Sauce

Sealord North America, Inc.
Sealord Deep Sea Dory Fillets
Sealord Orange Roughy Fillets

Setton International Foods, Inc.
Setton Farms Heart Healthy Mix

Simmons Foods, Inc.
Member's Mark All Natural 99% Fat Free Boneless Skinless Chicken Breast

Smithfield Lean Generation Cuts
SLG: All Natural Pork Tenderloin
SLG: Marinated Hickory Sweet Center Cut Boneless Pork Loin
SLG: Marinated Hickory Sweet Pork Chops
SLG: Marinated Hickory Sweet Pork Loin Filet
SLG: Marinated Hickory Sweet Pork Tenderloin
SLG: Marinated Peppercorn & Garlic Pork Tenderloin
SLG: Marinated Pork Loin Fillet - Peppercorn & Garlic
SLG: Self-Basting Boneless Pork Loin Center Cut Chops
SLG: Self-Basting Boneless Whole Pork Loin
SLG: Self-Basting Pork Tenderloin

Smithfield Lean Generation Deli
SLG Deli: 98% Fat Free Canadian Brand Maple Ham
SLG Deli: 98% Fat Free Cooked Ham
SLG Deli: 98% Fat Free Honey Cured Ham
SLG Deli: 98% Fat Free Tavern Ham
SLG Deli: 98% Fat Free Virginia Brand Ham

Smithfield Premium Cuts
Smithfield: Self-Basting Pork Tenderloin

Solis Brands, Inc.
ZOIC Belgian Chocolate Nutrition Drink
ZOIC French Vanilla Nutrition Drink

Springerhill Ranch Meat Products
Springerhill Ranch Brand All Natural 98% Fat Free Beef Tenderloin Steaks
Springerhill Ranch Brand All Natural Ground Beef-98% Lean 2% Fat

StarKist Seafood Company
StarKist Chunk Light Tuna in Water
StarKist Chunk White Albacore Tuna in Water
StarKist Gourmet Choice Albacore Tuna Fillet in Water
StarKist Gourmet Choice Chunk Light Tuna in Water
StarKist Gourmet Choice Solid Light Tuna Fillet in Water
StarKist Low Sodium Chunk Light Tuna in Water
StarKist Solid White Albacore Tuna in Water
StarKist Very Low Sodium Chunk White Albacore Tuna in Water

Sunrise Growers, Inc.
Sunrise Growers California Strawberries

Swift Foods dba Swift & Company
Extra Lean Ground Pork
Swift Boneless Pork Sirloin Cutlets
Swift Natural Fresh Pork-Boneless Pork Center Cut Loin Chops
Swift Natural Fresh Pork-Boneless Pork Leg for London Broil
Swift Natural Fresh Pork-Boneless Pork Top Loin Roast
Swift Natural Fresh Pork-Pork Strips for Barbecue
Swift Pork Center Cut Loin
Swift Pork Sirloin Tip Roast
Swift Pork Tenderloin
Swift Premium Guaranteed Tender Pork-Boneless Bottom Round
Swift Premium Guaranteed Tender Pork-Boneless Center Cut Loin Chops
Swift Premium Guaranteed Tender Pork-Boneless Pork Loin Filet
Swift Premium Guaranteed Tender Pork-Boneless Pork Tenderloin
Swift Premium Guaranteed Tender Pork-Boneless Sirloin Cutlets
Swift Premium Guaranteed Tender Pork-Boneless Strips for Barbecue
Swift Premium Guaranteed Tender Pork-Pork Top Round
Swift/Kirkland Signature Pork Sirloin Tip Roast
Trader Joe's Butcher Shop - Pork Sirloin Tri Tip
Trader Joe's Butcher Shop Boneless Center Cut Pork Loin Cutlets
Trader Joe's Butcher Shop Natural Pork-Boneless Pork Loin Chops
Trader Joe's Butcher Shop Natural Pork-Pork Shoulder Boneless Strips
Trader Joe's Butcher Shop-Pork Tenderloin

T. J. Kraft, Ltd.
Hawaiian Pacific Ahi Tuna Steaks

Taylor Packing Co., Inc.
Century Farm 96/4 Extra Lean Ground Beef

The Baker
The Baker 7-Grain Sourdough Whole Wheat Bread

Thumann's Inc
Thumann's All Natural Black Forest Brand Ham
Thumann's All Natural Capless Roast Beef
Thumann's All Natural Oven Roasted Gourmet Chicken Breast
Thumann's All Natural Oven Roasted Gourmet Turkey Breast
Thumann's Buffalo Style Oven Roasted Chicken Breast
Thumann's Capless Roast Beef
Thumann's Golden Roasted Filet of Turkey - Rotisserie Flavor
Thumann's Golden Roasted Gourmet Turkey
Thumann's Our Short Cut Deluxe Cooked Ham - Lower Sodium
Thumann's Oven Roasted Premium Chicken Breast

Tony Downs Foods Company
Member's Mark 98% Fat Free Premium Chunk Chicken Breast in Water

Topco Associates, LLC
Food Club Individually Frozen Boneless Skinless Chicken Breasts-15% Seasoned Chicken Broth
Food Club Individually Frozen Chicken Tenderloins-15% Seasoned Chicken Broth

Tumaro's Inc.
Tumaro's Chipotle Chili & Peppers Healthy Flour Tortillas
Tumaro's Garden Spinach & Vegetables Healthy Flour Tortillas
Tumaro's Honey Wheat Healthy Flour Tortillas
Tumaro's Jalapeno & Cilantro Healthy Flour Tortillas
Tumaro's Pesto & Garlic Healthy Flour Tortillas
Tumaro's Premium White Healthy Flour Tortillas
Tumaro's Sun-Dried Tomato & Basil Healthy Flour Tortillas

Tyson Foods, Inc.
Tastybird Individually Frozen Chicken-Boneless, Skinless Breast Portions with Rib Meat
Tastybird Individually Quick Frozen Chicken-Boneless, Skinless Tenderloins
Tyson 100% All Natural Thin 'N Fancy Boneless Skinless Chicken Breasts with Rib Meat (<3% Water)
Tyson 100% All Natural Boneless Skinless Chicken Breasts with Rib Meat (<1%/,2% Water)
Tyson 100% All Natural Boneless Skinless Chicken Thighs (15% Natural Chicken Broth)
Tyson 100% All Natural Chicken Breast Tenderloins (15% Natural Chicken Broth)
Tyson 100% All Natural Chicken Breast Tenderloins (<1% Water)
Tyson 100% All Natural Premium Boneless Skinless Chicken Breasts with Rib Meat (15% Natural Chicken Broth)
Tyson 100% All Natural Skinless Split Chicken Breasts with Ribs (12% Natural Chicken Broth)
Tyson 100% All Natural Skinless Split Chicken Breasts with Ribs (>3% Water)
Tyson 100% All Natural Thin 'N Fancy Boneless Skinless Chicken Breasts with Rib Meat (15% Natural Chicken Broth)
Tyson Ice Glazed Chicken Individually Frozen 99% Fat Free Boneless, Skinless Breast Tenderloins (8% Seasoned Chicken Broth)
Tyson Individually Fresh Frozen All Natural 99% Fat Free Boneless Skinless Chicken Tenderloins (8% Water & Kosher Salt)
Tyson Individually Fresh Frozen Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
Tyson Individually Fresh Frozen Chicken Tenderloins (15% Chicken Broth)
Tyson Individually Frozen 100% All Natural Individually Wrapped Boneless Skinless Chicken Breasts (15% Natural Chicken Broth)
Tyson Individually Frozen All Natural 99% Fat Free Boneless Skinless Chicken Breast Tenderloins (8% Chicken Broth)
Tyson Individually Frozen All Natural Boneless Skinless Chicken Breasts with Rib Meat (8% Broth Glaze & 15% Seasoned Chicken Broth)
Tyson Individually Frozen All Natural Extra Lean Boneless Skinless Chicken Breast with Rib Meat (8% Chicken Broth)
Tyson Individually Frozen Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
Tyson/Kirkland Signature All Natural 99% Fat Free Boneless Skinless Chicken Breast (8% Water & Kosher Salt)
Tyson/Tastybird Individually Frozen Boneless Skinless Breasts with Rib Meat (10% Seasoned Chicken Broth)
Tyson/Tastybird Individually Frozen Chicken-Boneless Skinless Breasts with Rib Meat (10% Natural Chicken Broth)

Tyson Fresh Meats, Inc.
100% Pure Extra Lean Ground Beef 96/4
96/4 All Natural Extra Lean Ground Beef

United Food Group, LLC
Miller's 100% Pure Ground Beef - 4% Fat
Moran's All Natural 4% Fat 100% Ground Beef Hamburger Patties
Moran's All Natural 4% Fat Ground Beef
Trader Joe's Butcher Shop 4% Fat Ground Beef

Welch Foods, Inc.
Welch's 100% Grape Juice (Purple)
Welch's 100% Grape Juice (Purple) - Frozen Concentrate
Welch's 100% Grape Juice (Purple) - Pourable Concentrate
Welch's 100% Grape Juice Calcium (Purple)
Welch's 100% Grape Juice with Fiber
Welch's Organic 100% Concord Grape Juice
Welch's Organic 100% Concord Grape Juice - Frozen Concentrate

West Liberty Foods, LLC
Honey Roasted & Smoked Breast of Turkey - 98% Fat Free
Kirkland Signature All Natural Fully Cooked Sliced Turkey Breast
Oven Roasted Breast of Turkey Browned in Soybean Oil - 98% Fat Free

I'm very troubled by the American Heart Association's (AHA) willingness to lend its logo and stamp of approval to a multitude of garbage foods like Cocoa Puffs and Berry Kix cereals.

So I contacted the AHA and spoke to the manager of the Food Certification Program, Ms. Linda Rupp. Ms. Rupp proved very helpful in helping me to understand.

I originally called her to find out just how many products were turned down. In view of 768 products on the approved list, I wondered how many had been rejected to generate this "select" group.

Unfortunately, she said that the number of products rejected was not tracked, though she did intimate that it was not a lot. Sometimes, she added, a rejected product will undergo a few "improvements" to help it achieve the criteria necessary for AHA approval.

What exactly is considered in an application for the Food Certification Program?

A food must have 1)total fat 3.0 grams or less, 2) saturated fat 1.0 gram or less, 3) 20 grams or less cholesterol, 4) 480 mg or less sodium, all per serving.

She also pointed out that, given the fact that a food as useless and lacking in health qualitites as jelly beans could meet this criteria, the AHA employs a special "Jelly Bean Rule" that stipulates that 10% of the Daily Value of 6 nutrients (e.g., fiber, vitamins A and C, etc.) must also be contained in a serving.

So those are the startlingly lax requirements to gain the privilege of affixing the AHA Heart Check Mark on your product and informing the public that your box of Cocoa Puffs, Cookie Crisp cereal, or Berry Kix is "heart healthy."

There is an epidemic of obesity in the U.S. I don't believe that the AHA endorsement helps. In fact, I believe that it has been a contributor to obesity.

Pardon me while I eat this bag of M&M's for my heart.

Stan did everything right.

He followed the Track Your Plaque "Rule of 60". He was slender, had run a marathon a few months earlier, in fact. He included fish oil at therapeutic doses. He replenished vitamin D to a blood level of 57 ng/ml 25-OH-vitamin D3. Though ambitious and hard-working, he was a generally happy, optimistic person.

Yet his CT heart scan score increased 28% in one year, from a starting score of 379 to 485.

What did he do wrong?

Well, Stan did nothing wrong. But I suggested to him that one "hole" in his program could be exercise-induced high blood pressure. I've witnessed this effect many times. Blood pressure normal or "borderline" high while seated and relaxed, sky-high with exercise.

So we put Stan on a treadmill. Starting blood pressure: 123/76. Blood pressure with exericse (13 mets): 220/78--sky high. That's why Stan's heart scan score went up. A good pressure with this level of exercise: 150/70, but certainly no higher than 170/80.

If blood pressure is high with exercise, it's probably high with emotional upset, anxiety, being in a hurry, etc., also, all the irritations and pressures of life.

We'll see in future how much of a role reducing Stan's blood pressure will play in gaining better control over his heart scan score. A practical difficulty will be in assessing the adequacy of blood pressure control in Stan, since its full potential only becomes evident with exerise. It means that future blood pressure assessments are more likely to be on a treadmill.

It would also explain why Stan's thoracic aorta was mildly enlarged and his aortic valve was mildly leaky when I met him, both potential consequences of intermittent high blood pressure.

If you've been following the Track Your Plaque conversation, you know that, contrary to prevailing opinion among many cardiologists, there is an emerging notion that coronary calcification is an active process, a true part of the disease.

Vitamin D3 is an important aspect of this question. So is vitamin K2. Not to be confused with K1 that plays a role in blood coagulation, K2 has an important role in calcium metabolism. Thus, vitmain K2 deficiency is related to osteoporosis and to coronary calcification.

Getting K2, like getting D, is difficult from food sources. The choices for K2 sources includes:

--Natto--generally, an impalatable choice. I've had it and it was intolerably gooey and weird-tasting. It is, nonetheless, the most concentrated food source of K2.

--Pate--Though liver products have the potential for containing many other unhealthy things, like pesticide residues, since the liver acts as a filter for the blood.

--Fermented cheeses--Since K2 is a product of fermentation of cheese, as it is in Natto.

For years, we've advised people to avoid or minimize cheese because of saturated fat or cholesterol content. I think that there's reason to re-think this advice based on the emerging data.

How can you tell the difference between fermented and non-fermented cheese? First, look for the holes in the cheese. The holes are the remnants of gas pockets created during fermentation. Second, look for the word "cultures" on the label, meaning organisms for fermentation were added. If "processed cheese" is anywhere on the label, this is a dairy product that has been chemically coagulated and is not fermented.

Fermented cheeses are generally "gourmet" cheeses, not eaten a pound at a time on a pizza, but meant to be eaten in small portions.

How much fermented cheese is necessary for its presumed inhibitory benefits on coronary calcification and osteoporsis? Are some fermented cheeses better than others? These issues remain unsettled. Stay tuned.

Anyone following the Track Your Plaque conversation know that we are rabid fans of normalizing blood vitamin D blood levels (25-OH-vitamin D3).

A wonderful report on vitamin D was aired this morning on the NBC Today show. The interviewed guests did a good job of describing the health effects of vitamin D, thought the focus was on some new data on the use of vitamin D for breast and prostate cancer.

I learned that shiitake mushrooms have some vitamin D--I didn't know that! (They contain 260 units per 4 mushrooms.)

Unfortunately, the closing comments from the guests, among whom was nutritionist and author, Joy Bauer,MS, was that you should get vitamin D from your multivitamin or your calcium with vit D.

That is absolutely wrong. When you check blood levels of vitamin D, as we do in everybody we see, you quickly learn what works and what doesn't.

Vitamin D in multivitamins is very poorly absorbed, if at all. Likewise, about 90% of the D in most calcium preparations is not absorbed. The vast majority of tablet or powder preparations, such as those in calcium tablets, are not absorbed to any significant extent. Take all you want and you remain vit D-deficient with osteoporosis, growing coronary plaque, low HDL, and exposed to risk for prostate and colon cancer.

If you take vitamin D in supplement form, it must--MUST--be in an oil-based capsule. The tablets are simply much too poorly and erratically absorbed to be reliable. There's nothing more frustrating to take, for instance, 4000 units of vitamin D in tablet form, only to have a blood level of 12 ng/ml--severe deficiency. Take the same 4000 unit dose in capsule form and blood level skyrockets to 58 ng/ml. And it's no more expensive.

One other thing: If you want to waste time and money, take the prescription vitamin D prescribed by many doctors. This is vitamin D2, also known as "ergocalciferol". Why use the synthetic vitamin D2 when D3 is the form your body needs? Because the D2 is patent-protectable and profitable to the drug manufacturer, similar to using Premarin (horse estrogens) when human preparations would suffice--or be superior. I saw a woman today taking 50,000 of prescription D2 once per week. Her blood level of 25-OH-vitamin D3? 17 ng/ml--severe deficiency. Don't waste your time with this garbage.

I am continually amazed at the amount of time and energy we all expend in the search for truth.

Rely on your hospital and you will be steered towards strategies that, at worst, aim to increase your use of hospital procedures. At best, they steer you towards physicians who are often under their employ.

How about your doctor? This is a source of immense frustration. Doctors remain interested in treating the catastrophic illness. They remain lukewarm towards prevention and self-empowerment. Thus, supplements are dangerous, everything requires a doctor's endorsement.

Drug companies? That's like relying on a used car salesman for truth. Exagerration, slick talk, and plain deception might be better descriptions of what you can count on from the drug manufacturers.

The internet? Perhaps, if you're selective. WebMD? An obvious voice-box for the drug industry. Just look at the proliferation of drugs ads that accompany each report. In fact, the majority (80%) of WebMD's revenues come from drug manufacturers.

The profit motive has created a mountain of good information. It has also created a sea of mis-information, all created to provide personal financial enrichment.

But I continue to be optimistic that the internet will also become a forum for truth, particularly through its capacity for networked interaction among participants. As our collective wisdom permits us to more effectively separate the wheat from the chaff in looking for the truth, I believe that we will zigzag towards a system of healthcare that is self-empowering, self-directed, and resorts to hospitals and procedures only in the most dire circumstances, saving billions of dollars every year.

Today's discussions at the Society for Cardiovascular Computed Tomography (SCCT) focused on atherosclerotic "plaque characterization".

As CT scanners get better and better at imaging the various components of plaque, some fascinating issues emerge:

--CT heart scans provide insights into what exactly is contained in an individual's atherosclerotic plaque that are not often provided even during heart catheterization. In other words, CT heart scanning is, in many instances, superior to heart catheterization, since it provides images of the artery wall, not just the internal contents.

--Progression (i.e., increase) in heart scan score is a powerful predicter of heart attack risk. Dr. Matthew Budoff of UCLA argued persuasively that the annual rate of increase in score is probably the most accurate measure of risk available, superior to cholesterol and calculated measures like the Framingham risk score.

--Coronary calcium scoring remains the best method to gauge total plaque throughout the entire coronary tree. In a person free of symptoms, the risk of a cardiac "event" (heart attack, death, procedures) is low and additional imaging (like CT angiography) is generally unnecessary.

Dr. Budoff, among the true thought leaders in CT heart scanning, also recounted his perspective on the history of heart scans. He noted that the questions asked through the years have evolved:

1995-2000 Should we do coronary calcium scans?

2000-2002 Do high or low risk patients benefit from coronary calcium scoring?

2003-2004 What is the better scanner, EBT or MDCT?

2006 How often should we perform coronary calcium imaging?

I believe that Dr. Budoff summarizes wonderfully where the Track Your Plaque programs fits into the overall scheme of things: Serial (repeated)CT heart scans to gauge progression or reversal is the wave of the future. We shouldn't just be interested in identifying persons at risk for heart attack. We should also be interested in showing the person at risk exactly how to reduce or eliminate that risk.

I'm presently attending the Society for Cardiovascular Computed Tomography meetings in Washington, DC, along with 500 of my colleagues. It's exciting to see how interest in CT scanning for heart disease has balloonned in the past couple of years.

Several trends are noticeable today, based on the content and tone of the discussions:

--CT scanning of the heart, and imaging in general, is just getting started. In other words, the capabilities for CT scanners and other devices to detect heart disease (coronary and otherwise) are where the gasoline engine was in the 19th century. Scanning is getting faster, easier, safer, and more precise. Just as few people in 1905 could have predicted that automobiles would be computer-enhanced, high-speed, ubiquitous devices with several per household, the potential for CT imaging for heart disease is truly in its infancy.

--CT coronary angiography (so-called "64-slice CT scans") are not screening tests for hidden coronary disease in people without symptoms. I was grateful that this point has been made and reiterated by several speakers, as this is consistent with our views. Simple CT heart scans for coronary calcium scoring, in contrast, are screening tests. When the radiation exposure of CT angiograms are reduced to tolerable levels, then they may be used as screening tests. We are probably 3-4 years away from this point.

--Both stress testing and heart catheterizations will be partially replaced by CT scanning. In particular, over the next decade, you will see a dramatic drop in unnecessary catheterizations, i.e,, far less people saying "I had a heart cath but they told me that it was normal."

There has been heavy focus on applications of CT scanning for acute settings, particularly the emergency room and hospitals.

What has surprised me is that there is virtually no conversation whatsoever about the preventive uses of CT heart scanning. So far, only Dr. Daniel Berman of UCLA has shown that he has "seen the light": CT scans are a crucial tool for identification of early coronary plaque, and this tells us whether prevention is necessary and with what intensity.

There has been, however, no discussion at all about quantification of plaque in a program of reversal. Perhaps that should come as no surprise, given the imaging-technology focus of this convention. For most of my colleagues, prevention is also not terribly interesting. Identification and treatment of acute disease like impending heart attack is.

Of course, applying the information from your CT heart scan to empower you in a program and reversal is what the Track Your Plaque program is all about. I hope you see the light. I admit that it's not always easy to follow what we are advocating here. Perhaps not too different than telling someone in his horse-drawn buggy that one day he'll be driving a sleek car with onboard computerized mapping, air-conditioning, and micro-chips to modulate engine performance. He's probably tell us we're nuts.

I'll continue to update if any news relevant to our interests crops up in these meetings.

I’d love to tell you that the Track Your Plaque program track record is of 100% success. It’s not.

It is very successful. But we’ve had some people who have failed and failed BIG. These are the people who've undergone bypass surgery, received one or more stents, or had heart attacks. Lesser failures are the people who’ve had large, undesirable increases in heart scan scores of >30% in one year. (The expected rate of increase in your heart scan score without preventive efforts is 30% per year, on average.)

What can we learn from those failures? There were several characteristics that stand out among this small group:

· Non-compliance--meaning they just didn’t stick with it. They started out right but then rapidly lost interest in maintaining all the pieces of the program and neglected their fish oil, niacin, gain weight, etc. Matthew did this and ended up with three stents to his left anterior descending. His slow start was due to skepticism that the program worked and just plain forgetfulness.

· Extreme stress--One of our earliest failures was a 38-year old man whose heart scan score doubled in one year, despite doing everything right. But three family members, all close to him, died within the space of six months, including his mother and a brother. I regard this as one of those instances in which we were powerless, unfortunately, though it is a graphic example of the power of unresolved stress and grief.

· Having a “better way”--These are the couple of people who were convinced that they had a better way to control their heart scan score. David firmly believed that his two dozen supplements and exercise program would drop his score. Instead, they permitted a 42% increase. Lee relied exclusively on chelation, along with several supplements of his own design. Lee had three-vessel bypass surgery.

· Starting too late--Gerome started with a score of 1179, but also was having chest pressure with emotional stress. His stress test was abnormal, with the entire upper half of his heart not receiving blood with exercise on a stress nuclear study (“anterior ischemia”). Gerome received four bypass grafts. Unfortunately, Gerome never really had a chance to engage in the Track Your Plaque program, since his health and safety were in jeopardy as soon as he started.

Have we had any big failures of people who did everything right, were compliant, were not subject to extreme stress (more than just job stress, or financial worries), didn’t neglect the basic requirements of the Track Your Plaque program, and had sufficient time (at least 6 months to 1 year)? No, thankfully, we have not.

No one who has stuck to the program has had a big failure.

“Do you need a stent?”

Sad to say, but that sentence condenses the wisdom of over 90% of practicing cardiologists.

Prevention of heart disease means take Lipitor or some other statin and cutting the saturated fat in your diet. That’s it. Maybe throw in exercise.

Regression of coronary plaque? That phrase has only entered the conversation since the AstraZeneca-supported trial of Crestor succeeded in achieving 8% regression of plaque (Track Your Plaque Members: See News) as demonstrated by intracoronary ultrasound.

In other words, in the minds of my colleagues, it can’t be true until a drug company tells them it’s true. It’s beyond me why this brainwashing of otherwise intelligent people has occurred, but it is blatantly evident in practice.

Fish oil is another example. The spectacular benefits of fish oil have been known for 20 years. But only recently has it become a “mainstream” practice to recommend fish oil, largely because a drug manufacturer has put a preparation through the rigors of FDA approval (Omacor) and is now marketing directly to physicians. All of a sudden, fish oil is a good thing? No, it’s just achieved legitimacy in the eyes of practitioners because it graces marketing literature.

If you’re reading this, you’re likely interested in coronary plaque regression using the only tool available for you to measure, track, and regress coronary plaque: CT heart scans. Intracoronary ultrasound will achieve the same goal, but it is an invasive procedure performed at heart catheterization, involves threading a wire and imaging probe all the way down the artery, involves real risk of tearing the inner lining of the artery, and is costly (around $14,000-$20,000 for the entire package). Do it every year? That’d be nuts.

If you’re thinking about coronary plaque regression, using fish oil, concerned about patterns like low HDL and small LDL, aware of the vitamin D deficiency issue as a coronary risk factor, etc., you are far more aware than the vast majority of practicing cardiologists. They are interested in what new brand of anti-coagulant to use during their heart catheterization (because the product representative gushes about the new agent—only $1200 a dose!). Or, they are interested in gaining the procedural skills to put in a new device like a biventricular pacemaker. Regress/reverse coronary plaque? What for?

You already know that a conversation about coronary plaque reversal will not be obtained in your cardiologist’s office. Your family practice doctor or internist? Fat chance! Knee arthritis, pap smears, pneumovax inoculations, sore throats, gout, back pain—they’re spread far too thin to know anything more than the most superficial amount about coronary plaque control. Most know nothing.

That’s where we come in. That’s our mission: Educate people about the extraordinary tools that you have available to you, all in the cause of control or reversal of coronary plaque.

Frank came to the office for an opinion, sent by his (proactive) family physician.

"I really don't know why I'm here, to be honest."

Two years earlier, Frank had a heart attack, survived and received two stents to his circumflex coronary artery. He now took Zocor and his LDL cholesterol was a reasonably favorable 89 mg, total cholesterol 183 mg.

"I walk with my wife every other day. I've been avoiding fish fries. You'll never see me eat fast food."

Frank was correct: If we were going to engage in the conventional approach to coronary disease, Frank was on the right track. We would have postponed his next heart attack or procedure by a couple of years. Stroke, aneurysm, and other atherosclerotic manifestations would be set back, likewise, a few years.

Would Frank have profound control over his disease? Absolutely not. In fact, his disease had probably advanced a huge amount just in the two years since his stents were placed and he was on his "prevention" program. Without his current effort, his coronary plaque would be expected to grow 30% per year. On Zocor and his modest lifestyle efforts, plaque growth was probably in the 14-28% per year range.

So I explained the unique Track Your Plaque approach to Frank. First, we start with a CT heart scan to establish where he was starting. Although he had two stents in his circumflex artery, we still had two other arteries (LAD, right coronary) to score and track.

We then attempt to identify all hidden causes of his heart disease and then correct them.

Of course, Frank had multiple hidden causes:

--HDL too low at 38 mg/dl
--Small LDL-severe, in fact, with 95% of all LDL particles in the small category
--Triglycerides too high
--Excesses of several triglyceride-containing particles (VLDL, IDL)
--Pre-diabetes--Frank had both a borderline high blood sugar and a high insulin level. This is a sure-fire stimulus to coronary plaque growth.
--A severe deficiency of vitamin D (<20 ng/ml)
--An excessivelyhigh blood pressure during exercise--With a blood pressure of 190/102 on the treadmill.

There were others(!), but that was the bulk of the causes behind Frank's coronary disease.

Once Frank recognized that there was indeed a huge panel of hidden causes for heart disease, not just too much fat in his diet and LDL cholesterol, he jumped into the program head first.

The message: The conventional approach is absurdly oversimplified, a certain path to failure for the majority of people. Even if you don't have known coronary disease like Frank, but just have a heart scan score >zero, the same principles apply to you.

Gary is an avid jogger. On an average day, he runs 5-6 miles at a good clip. On two occasions recently, however, Gary experienced an ache in his left shoulder at mile 4. It was a toothache-like feeling, but he kept on going without difficulty.

Gary also had a heart scan score of 370.

Upon hearing of Gary’s score and his shoulder sensation, the cardiologist who saw him advised a heart catheterization “to define coronary anatomy”. (This is a real incident.)

What exactly does that mean? Why would Gary’s cardiologist need to define it?

In my view, this is an absurd notion. No one needs to “define coronary anatomy”. This catch-all phrase is commonly used to justify heart procedures. I believe what the cardiologist is saying is that it’s the easiest (for the cardiologist) and perhaps most generously reimbursed method to determine whether Gary’s symptoms are warning of an impending heart attack or not.

The problem is that the question can also be answered quite well by doing a stress test. Though not perfect diagnostic tests, stress tests are useful when symptoms are present that are doubtful in nature. Gary’s left shoulder ache could have been related to his heart, but the likelihood was that it was not. A stress test would have answered the diagnostic question quite adequately.

Instead, this man was subjected to an invasive test that was likely unnecessary. This happens dozens, if not hundreds, of times per day just around here. Nationwide, it is an epidemic of malpractice.

There are, indeed, times when a person should proceed directly to a heart catheterization. This is commonly and appropriately performed when a person develops unstable heart symptoms, such as chest discomfort or breathlessness at rest while not doing anything physical, or if the frequency is increasing, or if a stress test shows an important abnormality. There is no question that heart procedures can be lifesaving at times.

The problem is that thousands of people every year are scared into these procedures inappropriately. Beware!

"How are your food choices?" I asked.

"What does it matter, doc? I take Lipitor. Doesn't that take care of it? I eat what I want!"

So declared Matthew. What he "wanted" was pretty much the diet of a teenager: pizza, cheeseburgers, soft drinks, snacks. His "beer belly" (visceral fat) gave it away. So did his blood work that showed flagrant lipoprotein abnormalities--small LDL, an HDL of 37 mg, and a severe after-eating flood of fat represented by increased "intermediate-density lipoprotein" (IDL).

Like many people, Matthew had been persuaded (or chose to believe) that LDL cholesterol was the sole cause for heart disease. Lipitor was therefore was all he needed. It must be great--how else could they afford all those slick TV commercials?

Well, it is definitely not true. In fact, with the persistence of Matthew's abnormal lipoprotein patterns, we should expect his heart scan score to continue to grow by 30%--the very same rate of increase as if he were taking nothing.

Specifically, Lipitor and drugs like it do not:

--Raise HDL.

--Correct or reduce the proportion of small LDL.

--Block after-eating flood of fat, nor do they accelerate clearance of unhealthy fats persisting in the bloodstream after eating.

Yes, what you eat does have real consequences, even if you take a statin drugs. In fact, the foods you ingest have a remarkably rapid and dramatic effect on what your blood contains. Any diabetic who checks his/her blood sugar knows this. They eat a slice of whole wheat toast and watch their blood sugar skyrocket.

Mind what you eat. Make it enjoyable, of course. But drugs do not provide impunity.

Sam is a 69-year retired physician. He was thoroughly enjoying retirement: golf, travelling, going out to dinner two or three times a week, spending weekends with his grandchildren. His lifestyle tended towards overindulgence, but he managed to stay fit and trim. At 6 ft 1 inch, he weighed 194 lbs and could still run 3 miles without too much difficulty. Not as good as his marathon-running days, but still not too bad for 69.

Sam's heart scan score in 2003 was a concerning 1983--extensive plaque. His doctor wasn't much help in interpreting the scan and so Sam simply chose to ignore it.

A chance conversation with a physician friend 18 months later made Sam think that perhaps this shouldn't be ignored. That's when he came to my office.

I find that sometimes the best way to motivate someone to take action is to demonstrate just how fast plaque grows if action isn't taken. So I advised Sam to get another scan first, since 18 months had passed. His score: 2441, or a 23% increase.

Sam was now starting to catch on. We made several changes in his prevention program (starting from virtually nothing). He did undergo a stress nuclear (thallium type) of test, which he passed without difficulty--normal blood flow in all heart territories despite the extensive plaque.

But, for some reason, Sam simply allowed himself to drift back to old habits: poor choices in food, overindulging in hard liquor, missing his fish oil and other supplements, and his medication, sometimes up to several days a week.

Sam started having unusual feelings in his chest. He described a sort of nervousness along with skipped heart beats. So we repeated a stress test. This time, a large area of reduced blood flow in the front of his heart ("anterior left ventricle") was detected. Sam ended up receiving three stents in a difficult procedure.

The moral: If you're starting out with a lower heart scan score of, say, 100 or 200, maybe you'll get by without trying too hard--maybe. But if your score is higher, say, several hundred or in the thousands, you got to try harder.

You're starting later in the process. Your disease will allow you very little slack. Let your guard down and it will get you. Control over your plaque is, indeed, very possible--we do it all the time. Score reduction is also possible. But your effort must be more serious and consistent.

Fallen Enron CEO, Kenneth Lay, was pronounced dead early this a.m. after suffering a heart attack.

Mr. Lay apparently had no history of heart disease and there's been no indication that symptoms provided any warning. His death was therefore classified as "sudden cardiac death".

Yet here's a man previously worth hundreds of millions of dollars with access to any test or medical system he desired--many times over. Even more recently, with his wealth reduced following his legal troubles, he and his wife managed to put away $4 million dollars to ensure an income from the interest through annuities, untouchable by the courts.

Detecting Mr. Lay's heart disease would have cost him around a few hundred dollars or whatever it costs for a CT heart scan in his city. This would have alerted his (hopefully knowledgeable) doctor that he was a time-bomb. Pile on all the stress he'd been suffering, whether deserved or no, and the diagnosis would have required little thought.

Instead, Mr. Lay has joined the thousands of Americans who will die this year because of failing to get a simple, 30-second test that costs one-tenth the cost of a stress test. Mr. Lay wasn't as lucky as former President Bill Clinton, whose doctors likewise blundered their way through and missed obvious levels of heart disease.

All Mr. Lay needed was better information: get a heart scan, then follow a program of prevention like the Track Your Plaque program. You may not have hundreds of millions of dollars, but you have the information on how to not follow in Ken Lay's footsteps. Track Your Plaque--and stay alive.

Sometimes it's hard to know what is really important in your plaque-control or plaque-reducing efforts.

There are, indeed, crucial make-it-or-break-it factors that are necessary to gain control over plaque. If you hope to stack the odds of reducing your heart scan score as much as possible in your favor, then fish oil, vitamin D, 60-60-60 in the way of standard lipids, elimination of small LDL, etc. -- all the elements of the Track Your Plaque program--are necessary.

But there's lots of things that sidetrack people. I spend much of my day fielding questions from patients about all the things that either provide very little benefit for plaque control, or provide none at all.

Among the things that we have found to be too weak or useless for plaque control, or are "non-issues", include:

--Caffeine--Go ahead and enjoy a couple cups a day (though not a pot). The effect is too trivial to make much difference.

--Hawthorne--Yes, it may dilate coronary arteries modestly, but not enough to make any difference.

--Garlic--with the possible exception of a specific preparation called Aged Garlic Extract (an acqueous, non-oil-based, extract from Kyolic), garlic's effects are too tiny to help, e.g., drop in blood pressure 1-2 points. Use it, but don't expect much. Aged Garlic Extract may be an exception, in that a single study from UCLA suggested specific effects on slowing coronary plaque growth. We await more info on this.

--Anti-oxidants--There is no shortage of extravagant claims about the benefits of anti-oxidants. Unfortunately, there's very little human exerience with pine bark extract, pycnogenol, grapeseed extract, and so on. Is the purported benefit from anti-oxidation or through some other means, e.g., enhancement of nitric oxide synthase? No data.

--Policosanol--If you've followed the Track Your Plaque Special Reports, you already know what a disappointment this agent has been, despite the too-good-to-be-true clinical data. It doesn't work.

--"No-flush niacin"--Unfortunately, no flush, no effect. This high-priced supplement is still sold widely in the U.S. despite its complete lack of efficacy. It does not work in humans. (It works great in rats!)

Track Your Plaque continues to try to be the arbiter of truth in what works, what doesn't in truly stopping or reversing your coronary plaque. The proof positive? Stopping or dropping your heart scan score.

What causes coronary heart disease or coronary atherosclerotic plaque, this thing that we track with heart scans?

Well, here are a few little-publicized facts about heart disease that you are unlikely to hear from your When's-the-next-stent? cardiologist or the What is there besides statins? primary care doctor.

(Since everybody knows that smoking is a modifiable risk for heart disease that can be readily identified, let's focus on the blood tests that reveal heart disease causes.)

What's the number one most common cause for heart disease?

Small LDL particles. The proliferation and popularity of the snack food/processed food culture, compounded with the "eat more healthy whole grain " propaganda has launched small LDL solidly to first place as the most common reason to have heart attacks, stents, and bypass. All that advice to increase your "healthy whole grain" intake? It increases heart attack risk.

What's the number one most aggressive cause for heart disease?

That's lipoprotein(a), or Lp(a). It's certainly not high cholesterol, though the drug industry loves that you think that. We could argue over whether smoking is more aggressive, but the two are pretty darned close. Combine the two--Lp(a) in a smoker--and the combination is an explosively powerful trigger for heart disease and stroke.

What's the number two cause for heart disease?

After small LDL comes low HDL cholesterol. Ask anyone who has had a heart attack: What was your cholesterol panel like? 9 out of 10 will say "My LDL cholesterol was 135 mg/dl" while knowing little or nothing about HDL, which is commonly in the 30-42 mg/dl range--sufficient to contribute to heart disease risk considerably.

Can "normal" thyroid hormone tests still contribute to heart disease?

Yes. Hypothyroidism is an exceptionally powerful risk factor for heart disease. Many people have been told that their thyroid tests are "normal," when in reality risk for heart disease may be as much as tripled from low thyroid with thyroid blood tests in the "normal" range.

Does a "balanced, healthy diet" prevent heart disease?

No, it does not. In fact, the modern notion of a "balanced, healthy diet" increases risk for heart disease. Of course, the dangers of such diets vary, depending on how you define it. If it's the diet advocated by the USDA Food Pyramid, then it is an enormously destructive diet that causes your health to careen towards both diabetes and heart disease. The American Heart Association TLC diet is little better.

Does eating fish twice a month reduce heart attack risk?

Yes, it does--but just barely. Unfortunately, large studies that show that eating fish as infrequently as twice per month reduce risk for dying from heart attack have led some authorities to suggest that's all you need to do. What they fail to understand is that the benefit is dose-dependent--the greater the intake of omega-3 fatty acids, the greater the benefit (within reason, of course). So, while the effect can be detected by eating fish twice per month, it doesn't mean that full benefits are achieved with this "dose." Full benefits are obtained by mimicking the omega-3 intake of the Japanese.

Do nutritional supplements reduce risk for heart attack?

If you are referring to vitamin D, then, yes, nutritional supplements reduce risk for heart attack . . . enormously. We need more data to validate this phenomenon, though epidemiologic observations strongly bear this out, including the Health Professionals Follow-up Study, the Framingham Heart Study and NHANES, all of which demonstrate a graded effect: the lower the vitamin D blood level, the greater the risk for heart attack.

Over the years, we've experienced more than our share of disappointments in nutritional supplements for heart disease, including vitamin E and B vitamins to reduce homocysteine. But I believe that nothing approaches the solid feel of vitamin D--no other nutritional supplement raises HDL, reduces triglycerides, reduces blood sugar, enhances insulin responses, reduces the inflammatory C-reactive protein, reduces blood pressure like vitamin D. Vitamin D is here to stay--and I'm very grateful.

And don't forget omega-3 fatty acids from fish oil, yet another supplement with unquestioned benefits for reduction of heart attack and death from heart attack.

Why didn't your doctor counsel you on the importance of these issues?

The primary reasons your doctor didn't tell you any of the above:

1) He/she has been persuaded that only drugs are of any real use in health. Nutritional supplements? Hah!

2) Neither the number one cause of heart disease in the U.S.--small LDL particles--nor the most aggressive cause for heart disease--Lp(a)--are corrected by patent-protectable, high profit pharmaceutical agents promoted to your doctor. Instead, these abnormalities can be corrected inexpensively, without prescription. That means no expensive commercials, no media spots, no write-ups in magazines.

3) Your doctor's business is to treat crisis: sore throat, broken ankle, lung tumor, heart attack. Prevent heart disease 10 or 20 years before it shows itself? Heck, no (unless the marketing pull of the drug industry is involved, of course).

It's best that you bear in mind: What your doctor doesn't know can kill you.

Thanks to some readers of The Heart Scan Blog, I've become acquainted with Dr. Michael Eades' wonderful blog, Health and Nutrition by Dr. Michael R. Eades, MD.

Dr. Eades is co-author (with his wife, Mary Dan Eades, MD) of Protein Power

In one of his conversations, I stumbled on this exchange between Dr. Eades and one of his readers:

Reader: Regarding EBT scans, I looked up the topic on Google and read an informative 5-page article: EBT (Ultrafast CT) Scans - Godsend, or Scam? Dr. Fogoros says that false positives (where the EBT shows the presence of calcium, but the patient has little coronary artery blockage) occur about 50 percent of the time. The next step, if the EBT is positive, is to do a heart catherterization to find out whether there actually is coronary artery blockage. So the odds are that I’d have to worry!

Dr. Michael Eades: The info you got from Google is one of the reasons one shouldn’t get medical information online. As far as I’m concerned the EBT is the BEST way to determine the presence of plaque. If you have a positive calcium score, you have plaque, and there’s an end on’t (as Samuel Johnson would say). Now you may have a low calcium score for your age or you may have a calcium score that doesn’t change, which means you have stable plaque, but if you have a positive calcium score, you have some amount of plaque in your coronary arteries.

And whoever says that the next step to take if you receive a positive calcium score is a coronary artery cath is a real moron. That’s probably the last thing you would want to do if you are asymptomatic. All the cath procedure does is shows whether or not you have a blockage - you can have huge amounts of plaque (which are a disaster waiting to happen) and have a normal cardiac cath.

If you want to get a little more information on the validity of EBT than what you find on Google, take a look at Dr. Davis’ blog or get a copy of his book: Track Your Plaque. I’m not crazy about all of Dr. Davis’ dietary recommendations because he comes to diet from a different perspective than I, but the EBT info in his book is terrific.

Cheers–

Dr. Eades "gets" it. He understands that quantification of coronary plaque is a tool for prevention, not something to be subverted into the service of procedures for the financial benefit of my colleagues.

And I think that he is absolutely correct on the diet discussed in Track Your Plaque--it's due for a revision. I wrote the book in 2003, while we were still locked into the low-fat mindset. Much has changed.

Since then, our enormous experience in metabolic manipulation and lipoprotein analysis has shown that there is a far better way to correct the causes of coronary plaque and seizing hold of heart scan scores. In particular, the explosion of small LDL has prompted major changes in the diet, specifically removal of wheat and cornstarch, the foods that trigger small LDL particles.

(I am still in the midst of negotiations for release of a bigger and better Track Your Plaque II. In the meantime, Track Your Plaque Members can refer to the New Track Your Plaque Diet, Parts I, II, and III.)

If wheat is so bad, what about all the other grains?

First of all, I demonize wheat because of its top-of-the-list role in triggering:

--Appetite--Wheat increases hunger dramatically
--Insulin
--Blood sugar--Wheat is worse than table sugar in triggering a rapid, large rise in blood sugar
--Triglycerides
--Small LDL particles--the number one cause for heart disease in the U.S.
--Reduced HDL
--Diabetes
--Autoimmune diseases--Most notably celiac disease and thyroiditis.

Most other "healthy, whole grains" aren't quite as bad. It's a matter of degree.

Millet, quinoa, oats, sorghum, bulghur, spelt, barley, cornmeal--While they don't trigger appetite nor autoimmune diseases like wheat does (oat can in some people), they still pose a significant carbohydrate load sufficient to generate the other phenomena like excessive insulin and blood sugar responses. The grams of carbohydrate of these grains are virtually identical to wheat: 43.5 grams per 1/2 cup (uncooked). The exceptions are barley, which is especially loaded with carbohydrates: 104 grams per 1/2 cup, while oats are lower: 33 g per 1/2 cup.

It's all a matter of degree. Some people who are exceptionally carbohydrate-sensitive (like me) can have diabetic blood sugars with just slow-cooked oatmeal or quinoa. Others aren't quite so sensitive and can get away with eating them.

People with high blood sugars (100 mg/dl or greater) can be very sensitive to the blood sugar effects of these grain carbohydrates. The best marker of all are small LDL particles measured on a lipoprotein panel, such as NMR. Small LDL particles are exquisitely sensitive to your carbohydrate intake: small LDL gets worse with excessive sensitivity to grain carbohydrates, gets better with reduction or elimination.

Flagrant small LDL, in combination with low HDL, high triglycerides, and pre-diabetic or diabetic patterns all develop from carbohydrate indulgence, along with "wheat belly."

Don't believe it? The prove it to yourself: Go to Walmart and buy an inexpensive glucose meter and check your blood sugar one hour after eating. You can gauge the health of these foods by observing the blood sugar increases. (Small LDL closely parallels blood sugar rises.)

The grain that fails to trigger any of these abnormal patterns? Flaxseed. Flaxseed is entirely protein, fiber, and healthy oils, with virtually no digestible starches. In fact, flaxseed is one of the few foods that reduces the quantity of small LDL particles.

I assume you answered no. Then why would you consider taking the plant form of vitamin D (ergocalciferol)? That's the prescription form of vitamin D, often dispensed as 50,000 unit tablets.

There's nothing wrong with plants. Some of my favorite foods are plants, full of nutritional value.

Then why shouldn't vitamin D2 from plants be every bit as good as the human form of vitamin D?

I believe the issue boils down to taking hormones from non-human sources. (Remember: Vitamin D is a hormone, a very powerful one at that.) Plants can be wonderful sources of flavonoids, fibers, protein, fats, vitamins, minerals, and other healthy components. But hormones?

There are other examples of non-human hormones being given to humans with undesirable or unpredictable effects:

--Xenoestrogens, phytoestrogens, and non-human mammalian estrogens--While non-human estrogens may partially mimic human estrogens, they can also block estrogen effects, or exert altogether novel effects. Non-human mammalian estrogens like Premarin can exert very peculiar (side-)effects, despite their role as prescription estrogen supplementation in humans.

--Progestins--The synthetic versions of human progesterone, like their non-human estrogen counterparts, exert weird effects that are a world apart from real progesterone.

--Sterols--Similar in structure to human cholesterol (while not a hormone, a building block for hormones), sterols have been used to reduce intestinal cholesterol absorption. However, if sterols are absorbed into the blood, they can enormously accelerate growth of atherosclerotic plaque.

--Anabolic steroids--These modifications of the testosterone molecule build muscle, but also cause liver cancer, kidney failure, violent behavior, suicide and homicidal behavior. That's not normal.

Outside of a pharmacologic effect (e.g., prednisone in place of human cortisol), there is no reason to take a non-human hormone in place of a human hormone. For that same reason, there is NO reason to take plant vitamin D2 (prescription or over-the-counter) in place of human vitamin D3.

If the non-human hormone is identical to the human form, then there is no difficulty. The best example of this are thyroid hormones from pigs. That's what Armour Thyroid is, a thyroid hormone replacement that works wonderfully well.

You will notice that virtually all of the examples of non-human hormones substituted for human hormones share one common motivation: profit. Synthetic or modified versions are more readily patent-protectable, unlike their natural counterparts which are not.

Vitamin D2 is an anemic facsimile of the real human hormone, vitamin D3 (cholecalciferol). Stay away from it.

Lack of sleep makes you crabby.

But can staying up late make you fat? Or diabetic? Or increase heart disease risk?

Can forcing your body to ignore its evolutionarily-programmed day-night/sleep-wakefulness cycle also distort health, even when sleep is adequate?

Yet another study adds to the growing clinical literature documenting the lack of sleep, or, in this case, the "violation" of circadian rhythms that occurs with unpredictable or shifting sleep patterns.

In this small study of 10 men and women, forcing them to sleep on an unnatural 28-hour per "day" schedule, causing a dyssynchrony with natural day-night cycles, yielded increased glucose (blood sugar) levels, poor response to insulin, increased blood pressure. It also led to a decrease in leptin levels, a phenomenon that can trigger increased appetite.

Such circadian misalignment was meant to recreate the distorted day-night cycles of shift workers, a group that is unusually prone to diabetes and heart disease. This study further confirms that there are indeed unhealthy physiologic consequences of defying normal day-night sleep cycles.

This study suggests that, not only is sufficient sleep important for health, but the predictability and concordance with normal circadian cycles is also important.

Add to this previous studies demonstrating an association with sleep deprivation and low HDL/high triglycerides (Kaneita Y, et al 2008) and increased likelihood of having a positive heart scan (coronary calcium) score (King CR et al 2008), and it is increasingly clear that sleep is a crucial factor for overall health. It may even be a helpful strategy to control weight.

A full report on the importance of sleep is planned for the Track Your Plaque website.

Here's an interesting project a Track Your Plaque Member brought to my attention: Grassroots Health.

Carole Baggerly, Director of GrassrootsHealth, is a breast cancer survivor who has engineered an impressive project to collect and tabulate vitamin D blood levels in thousands, perhaps millions of people, over the next 5 years. Anyone can participate at a cost of $30 twice a year to get a vitamin D home test kit. (A fingerprick is required. I've tried the test kit--it's easy and painless to use.) They simply ask you to provide some basic health information that will be accumulated and analyzed.

Here's a graph they feature on their website showing the vitamin D blood levels distributed among the first 300 participants:

(Click to enlarge.)

Ms. Baggerly is apparently working with vitamin D pioneer, Dr. Reinhold Vieth, of the University of Toronto.

This sounds like a really great idea. Should you enroll, please come back here and let us know about your experience.

Here are a sampling of some of the comments I've received from people taking statin drugs:

Barkeater said:

On Lipitor since 1997, and pretty sure I had no side effects. Hey, I am a man, I don't complain.

Work has gotten real challenging (but they pay me well). At age 52, 2 years ago, I was fed up with working hard, cranky, and wanted to quit. Very low tolerance for frustration. A year ago, I hit a low spot again, but knowing that quitting was not an option, I started pestering my wife about things married people quarrel about other than money. No matter how great she was, every month or so I would get in a complete funk about it. Meanwhile, my brother had an MI, freaking me out, so at my doctor's suggestion I doubled the Lipitor dose (to 40 mg a day), bringing LDL below 100 and total chol. to 162 (40% below what God's original design of me produced). Plus, I ached a lot after exercise with severe "arthritis" in my hip, and these pains took days to go away, and still I got mad every few weeks at my wife and otherwise into a depressed funk (one morning I wrote an essay about suicide, which was much on my mind). Mood swings could be sudden.

She finally asked whether it might be the Lipitor, which I dismissed as very unlikely because I wanted to believe I was controlling my anger and depression better at that point (not really so) and besides everyone knows that statins have very few side effects. But, I did poke around a bit, and saw that kooky internet people seemed to have a lot of statin side effects, including depression. So, I thought I would quit, as an experiment. Like the JUPITER study, the results were so stunning I had to end the experiment in just 48 hours, except unlike JUPTIER, the clear result was that statins are nasty poisins that were ruining my life. I quickly concluded that no statin would again pass my lips. Depression, gone immediately (I am now 45 days off Lipitor). Relationship with wife, great (maybe "saved" is the word). Athletic performance, vastly better (adjusted for my modest natural abilities), with aches reduced vastly. Ability to withstand frustration, zoomed way way up. I feel totally different, and better; I think of my high cholesterol as my friend, protecting my from the abyss.

The other exciting thing is that I was depending on Lipitor to prevent heart disease, but I see now that it was only a raffle in which I had one ticket, with 75 or 100 other ticket holders in the NNT raffle (to prevent a survivable coronary in the next ten years, but not to prevent death -- that is not a prize in this raffle). There are obviously way better things I can do for prevention, at low cost and no negative side effects (plenty of positive ones, though).

I feel ten years younger. I refer to quitting Lipitor as my "miracle cure." I feel a moral obligation to warn others.

Anonymous said:

It was the craziest thing, my elbows felt like they needed to pop but couldn't. I was taking 20mgs of Zocor, and the first couple of months the elbows were fine, but one day I realized they hurt and wouldn't pop. I enjoy tennis and will occasionally shoot baskets with the boys - working elbows are a requirement for both sports. I told my doctor the problem and he said to stop taking Zocor, and after two weeks he will have me try a different statin. Avoiding Zocor brought relief. After a week of being statin free the elbows stopped aching.

I havn't gone back to my doctor to receive a prescription for that new statin. After learning more about heart disease prevention from this site and others, my starting LDL was low to begin with right around 80, and so decided to take a different natural approach to lower my LDL and more importantly for me raise HDL. I cleaned up my diet and began taking nutritional supplements. It worked, today cholesterol levels are great, and I have working elbows.

Tom said:

Two weeks after I started 10mg/day of Lipitor I developed tinnitus. I had never noticed a ringing in my ears before and now all of a sudden it was LOUD. After three months I saw my doctor for a cholesterol retest (it went way down) and complained of the tinnitus. He said he hadn't heard of this side effect, but I told him the web said 2% complain of it. He suggested I go to 5mg/day to see if it helped. I tried this for a few months, then went totally off for a few weeks, and the tinnitus got better, but never went away. I'm still on a 5mg dose after 9 months and I still have tinnitus. My fear is that the damage is done and the tinnitus will never go away.

Veedubmom said:

I got sun sensitivity from taking Simvastatin. Wherever my skin is exposed to the sun, it turns red and starts itching intensely and my skin looks like giant hives. I have to wear long sleeves, gloves, turtlenecks, etc.

Jegan said:

I was on Lipitor, but as a result of a recent study, asked to go on Simvastatin. I too have never suffered tinnitus until taking statins. I perceive it most at night. It sounds either like a pure high pitched white noise, or often like being stuck in an aviary with a million high pitched birds. I did not suffer any pains, but I clearly am more forgetful. I also feel depressed, and really don;t care about anything... Paying bills, family, cleaning, you name it. Also, my rosacea seems to act up a lot more.

Terri SL said:

Statin side effects are, in my personal experience, vastly under-reported. What Dr. in practice takes the time to fill out FDA complaint forms or contacts independent researchers about a pts. side effects? What pt. even knows that they can do so, whether their Dr. wants them to or not? No surprise about that 80% if you've taken statins!

I've personally taken two different statins (Pravachol, Zocor/Vytorin) and developed horrendous muscle aches even while taking CoQ-10 200 mgs. daily in divided dose. I also experienced mental fuzziness, gait instability and near complete GI shutdown, when Dr. doubled statin dosage against my protests. Stop the drug = complete reversal within ~three days!

What seems to be consistent is the dosage of the statin... the higher the dose, or the more potent the statin (Lipitor, Crestor), the greater the chance of adverse side effects. The other consistency is that Drs. out there in practice are not recommending CoQ-10 to their patients on statins, or at least that has been my experience.

Am I advocating that everyone stop their statin drug? No, I am not.

What I am advocating is that statins be used carefully, after all efforts at correction of lipid/lipoprotein patterns have been made, with an assessment of true coronary risk (not such nonsense as the Framingham score). A more reasonable application of statin drug prescription would shrink the market from its current $27 billion to a tiny fraction of that.

These drugs can be useful but are miserably and tragically overused.
For a discussion of an alternative to statins for LDL cholesterol reduction, see my post, Which is better?

John from California left this comment recently on my Wacky statin effects post. He tells such a vivid, compelling story that I had to pass it on.

I started taking statins a couple of years ago. A friend told me that he heard that they caused Alzheimers-like symptoms. I didn't think that I exhibited any effects like that, so I pretty much ignored it, except to raise the issue with my doctor.

During the last two years, I gradually lost interest in pretty much everything. It wasn't that I was forgetful, I just didn't much care about anything. Didn't care about my hobbies, quit my job, only paid bills when I felt like it, left a rental property vacant for 1 1/2 years and other similar issues.

I am normally a pretty active person with lots of pursuits. When I spoke to my doctor about my 'lack of interest and motivation', she suggested putting me on testosterone and later a mood enhancer. (I'm 60 and I lost my wife to breast cancer about 3 years ago, so I guess the thinking was either that I was going through male menopause or just depressed over her passing.)

Although I never had the muscle aches or liver problems that are considered the side effects of statins, gradually I began to feel weaker (not uncommon at 60) and more lackadaisical in my approach to bills and responsibilities. I also began suffering continual intense tinnitus and insomnia. I became crankier and more vehement in my dealings with other people and dangerously aggressive while driving.

Oddly enough, my lack of concern with paying bills led to the pharmacist telling me that Blue Shield had canceled me. Although I could easily have called the doctor for a prescription for $5 statins through KMart, I just couldn't be bothered, so I discontinued my medication.

It's been about 2 1/2 weeks since my prescription ran out. Within 4 days I began feeling better and my thinking became clearer. I no longer have tinnitus, my good mood has returned and I actually accept life's small annoyances again. Finally, I feel better physically and am more motivated. (Unfortunately, now I have to clean up all the financial garbage I've accumulated in the last year or so.)

If you take statins and begin to suffer any of the symptoms that I've noted above. Tell your doctor to take you off for a month. If your symptoms improve, you'll know why.

Although I no longer have medical insurance, one requirement of the coverage was that my cholesterol be controllable with statins. I'd rather have a heart attack or stroke and die than to go back to being the useless walking zombie that I was.

Imagine the consequences of of everyone take a statin drug, even "putting it in the water," advocated by some of my colleagues.

Make no mistake about it: The widespread, indiscriminate use of statin drugs is not without profound implications for many people. The popular notion of "the more statin agent, the better" that has propagated, thanks to the billions of dollars spent on marketing and "research," will lead to more unfortunate experiences like John.

Statins are drugs with real effects and very real side-effects.

Can including wheat in your diet create hell on earth?

Was The Inferno nothing more than Danté’s prediction for the state of the U.S. diet circa 2009?

I’m kidding on The Inferno allusion, but the American diet nonetheless sure does create an inferno of unhealthy phenomena.

If we define hell on earth as constant, nagging pain and discomfort; energy depleted sufficient to impair daily function; chronic bloating and diarrhea; leg swelling, peculiar rashes; progression of a multitude of diseases ranging from annoying all the way to fatal . . . well, that’s a pretty bleak picture.

I have indeed witnessed it all. Inclusion of wheat products in the human diet in many (not all--I'd estimate 70% of people) yields devastating health effects. In a few, it shortens life. In the majority, it leads to a slow, miserable hell of inflammatory diseases like arthritis, coronary disease, and cancer.

I have also witnessed dramatic reversal of these phenomena with complete removal of wheat from the diet.

(For clarity, I am not only referring to gluten sensitivity, the immune reaction gone haywire that plagues people with celiac disease. Celiac disease is indeed another variety of wheat-induced hell on earth, but there’s far more to it than that.)

Among the effects I’ve seen with wheat removal:

--Increased clarity of thought—I can vouch for this effect personally. Focus, concentration, the capacity for prolonged application of effort is restored with elimination of wheat.

--ADHD—Marked improvement in attention deficit disorder can occur in children and adults with this focus-depriving condition. Elimination of sugars and cornstarch may be necessary for full effect. While it doesn’t seem to work in everybody, the effect is powerful enough?and the implications so profound?that it is worthy of consideration in any child with this condition.

--Improved bowel health?Many people plagued by chronic bloating, diarrhea, and urgency experience complete relief. In its most extreme form, it is expressed as celiac disease. But there are a larger number of people who do not have celiac who are plagued by this lesser form of intestinal intolerance.

--Weight loss?Patients have told me that they were actually frightened when they eliminated wheat, meaning weight dropped so rapidly that they thought something was wrong. Nothing is wrong. The weight loss simply represents the removal of this bizarre, unphysiologic trigger of appetite, blood sugar, insulin, and weight gain.

Relevant to heart health, wheat elimination effects include:

--LDL cholesterol reduction?Yes, I know that it’s not what the “official” agencies say. “Reduce fat, reduce saturated fat and cholesterol will drop.” That’s barely true; reductions of saturated fat reduce LDL cholesterol, but rarely more than 20 mg/dl. In contrast, elimination of wheat yields LDL reductions of 40, 50, even 100 mg/dl. And the type of LDL reduced is the small particle variety, the kind mostly likely to lead to heart disease. (Cutting fat generally reduces large LDL, the more benign form.)

--Triglyceride reduction?Triglyceride reductions of 50, 100, even 1000 mg/dl can be achieved with elimination of wheat (though elimination of cornstarch, sugars, and other processed carbohydrates may be necessary for full benefit).

--HDL increase?A variable response, but increase of 5-10 mg/dl are common.

--Reduced inflammation?This phenomenon expresses itself in a number of ways, including dramatic reductions of the common inflammatory marker, c-reactive protein. While the media focuses on the JUPITER trial of rosuvastatin’s (Crestor) ability to reduce CRP 50-60%, wheat elimination can easily match this?without drugs.

What's more, you just feel better. Less commonly, I've seen arthritis (both common osteoarthritis and rheumatoid arthritis), skin rashes, and sleep disorders improve. I've had pre-diabetics become non-pre-diabetics, diabetics become non-diabetics.

It's not so much whether that food is carbohydrate-rich or protein-rich. It really comes down to calories, a very simple message.'
— Dr. Frank Sacks

While some advocate the notion that only calories count and diet composition makes no difference, I offer this possibility: Whether or not weight is lost by diet, there can be enormous health effects independent of weight based on the composition of diet. Inclusion or exclusion of wheat is one such crucial factor.

Image courtesy Wikipedia, The Eighth Circle of Hell.

It seems not a single day passes that I don’t learn something new about this unique hormone (mis)named “vitamin D.”

From its humble beginnings recognized only as the factor responsible for bone maturation (with deficiency leading to childhood rickets), vitamin D now commands a recognized role in almost every conceivable aspect of health and disease.

Among the unique observations I’ve made over the past several years, having corrected vitamin D in well over 1000 people:

--Ankylosing spondylitis—This fairly rare genetic disease programs a peculiar solidification of the spinal column that leads to disabling restriction of spinal mobility, accompanied by incapacitating pain. A physician came to my office after reading my Life Extension summary of vitamin D’s cardiovascular benefits, After reading it, he put himself on vitamin D 10,000 units per day and verified “therapeutic” levels with a blood test. He came to my office (he requested a consultation) and proudly showed me his near-normal spine flexibility that, until approximately 2 months earlier, had left him rigid and unable to even tie his shoes. He also reported that the chronic pain that had left him completely dependent on anti-inflammatory agents and narcotics was nearly entirely gone.

--Aortic valve disease—The list of people with either aortic valve stenosis (stiffness) or insufficiency (leakiness) that develops later in life (not congenitally deformed or bicuspid aortic valves) continues to grow. Not everyone responds, but some of the cases I’ve seen have been nothing short of miraculous. One man had severe aortic valve insufficiency (severe leakiness). After one year of vitamin D, 8000 units per day that yielded a blood level of 67 ng/ml, the insufficiency was down to a minimal level. Before vitamin D, I had never witnessed “spontaneous” reversal of aortic valve disease before.

--Chest pain—Not the chest pain of heart disease, but a chronic gnawing, toothache-like pain in the sternum that is relieved within days of initiating vitamin D. I don’t know precisely why this happens, but I speculate that, with vitamin D deficiency, there is disordered calcium metabolism, and perhaps the sternal pain represents cellular (osteoclastic) activity that is eroding sternal calcium for the purpose of maintaining blood calcium, since intestinal absorption of calcium is poor. Replace vitamin D and the abnormal calcium uptake ceases. Just my guess.

--Relief from claustrophobia—This one has me stumped. But one man’s vivid description of his previously terrifying experiences in elevators and other enclosed spaces, now entirely gone raises some fascinating questions. For instance, how much psychological disease is nothing more than the expression of disordered metabolism from vitamin D deficiency?

--Immunity from viral infections--I first learned of this association from Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com). Dr. Cannell recounts his experience with the 2006 flu epidemic in the hospital in northern California, where he is a psychiatrist charged with the health of 200 inpatients held in closed wards. While the flu spread like wildfire to the patients in all the other wards, the 200 patients in Dr. Cannell’s ward failed to contract a single episode of flu while taking 2000 units of vitamin D per day.

I was a little skeptical at first, having been disappointed by the failure of several nutritional agents like zinc, vitamin C (perhaps, at best, a minimal effect). Now, three years into my vitamin D experience, I am absolutely convinced that Dr. Cannells’ early observation was correct: Vitamin D enhances immunity enormously. Not only have I personally not had a virus in several years, the majority of my staff and patients have been happily free of viral infections. There have been a few, to be sure. But the usual winters of hacking, coughing, and sneezing in the office have become largely a memory. It is a rare person who comes to the office with viral symptoms.

With new lessons being learned every day, it is inevitable that other fascinating new vitamin D observations have yet to be made.