The formula for aortic valve disease?

I've discussed this question before:

Can aortic valve stenosis be stopped or reversed using a regimen of nutritional supplements?

I had a striking experience this past week. Don has coronary plaque and began the Track Your Plaque program. However, discovery of a murmur led to an echocardiogram that measured his effective aortic valve area at 1.5 cm2. (Normal is between 2.5-3.0 cm2.)

Because of his aortic valve issue, I suggested that, in addition to the 10,000 units of vitamin D required to increase his 25-hydroxy vitamin D level to 70 ng/ml, he also add vitamin K2, 1000 mcg per day, along with elimination of all calcium supplements. (I asked Don to use a K2 supplement that contained both forms, short-acting MK-4 and long-acting MK-7.)

One year later, another echocardiogram: aortic valve area 2.6 cm2--an incredible increase.

This is not supposed to happen. By conventional thinking, aortic valve stenosis can only get worse, never get better. But I've now witnessed this in approximately 10% of the people with aortic valve stenosis. The majority just stop getting worse, an occasional person gets worse, while a few, like Don, get better.

Aortic valve stenosis is to the aortic valve as degenerative arthritis is to your knees: A form of wear-and-tear that leads to progressive dysfunction. When the aortic valve becomes stiff enough (i.e., "stenotic"), then it leads to chest pains, lightheadedness or losing consciousness, heart failure, and, eventually, death. Bad problem.

Aortic stenosis typically starts in your 50s with calcification of the valve, getting worse and worse until the calcium makes the valve "leaflets" unable to move. The treatment: a new valve, a major undertaking involving an open heart procedure.

What if taking vitamins D and K2 and avoiding calcium do not just reverse or stop aortic valve stenosis once established, but prevents it in the first place? Tantalizing possibility.

Pressures on my time being what they are, I've not had the freedom to put together a prospective study to further examine this fascinating question. But it is definitely worth pursuing.

If you'd like to reduce LDL cholesterol with nearly as much power as a statin drug, think thyroid.

When thyroid is corrected to ideal levels, LDL cholesterol drops 20, 30, 40 mg/dl or more, depending on how poor thyroid function and how high LDL are at the start. The poorer the thyroid function (the higher the TSH or the lower the T3 and T4) and the higher the LDL cholesterol, the more LDL drops with thyroid correction.

(For those of you minding LDL particle size, such as Track Your Plaque Members, the "dominant" LDL species will drop: If you are genetic small LDL, small LDL will drop. If you have mostly large LDL because of being wheat-free and sugar-free, then large LDL will drop.)

One of the problems is that many healthcare providers blindly follow what the laboratory says is "normal" or the "reference range," which is usually nothing more than a population average (actually the mean +/- 2 standard deviations, a common method of developing references ranges). In other words, a substantial degree of low thyroid function, or hypothyroidism, can be present when your doctor adheres to the reference range provided by the laboratory.

What does it mean to achieve ideal thyroid status? My list includes:

--Normal oral temperature of 97.3 F first upon arising. (The thyroid is the body's thermoregulatory organ.)
--TSH 1.0 mIU/L or less
--Free T3 upper half "normal" range
--Free T4 upper half "normal" range
--You feel good: mental clarity, energy, upbeat mood. You lose weight when you try.

Iodine replacement should be part of any thyroid health effort. Iodine is not an optional trace mineral, no more than vitamin C is optional (else your teeth fall out). The only dangers to iodine replacement are to those who have been starved of iodine for many years; increase iodine and the thyroid can over-respond. I've seen this happen in 2 of the last 300 people who have supplemented iodine.

In my view, neglecting T3 replacement is absurd. While it is not clear to me why many otherwise healthy people have low T3 at the low range of "normal" or even in the below-normal range, people feel better and have better health--faster weight loss, reduced LDL, reduced triglycerides, they are happier and enjoy more energy--when T3 is increased to the upper half of the reference range. (Crucial question: Why is the 5'-deiodinase enzyme that converts T4 to T3 inhibited, resulting in reduced free T3? What is in our diets or environment that is exerting this effect? I don't have answer, but we sorely need one.)

It pays to be a perfectionist when it comes to thyroid. Not only do you feel better, but LDL cholesterol can drop with a statin-like magnitude, but with none of the adverse effects.

If interested, Track Your Plaque offers fingerstick blood spot testing that you can perform in your own home. Each test kit will test for: TSH, free T3, free T4, along with a thyroid peroxidase antibody (a marker for Hashimoto's thyroiditis, an autoimmune inflammatory condition of the thyroid).

What do you think of these chains of logic?

Cyanide is a potent lethal poison; carbon monoxide is a less lethal poison.
Therefore: plenty of carbon monoxide is good.

Having uterine cancer is a bad thing. Having uterine fibroids is a less bad thing.
Therefore: plenty of uterine fibroids are good.

These are obvious examples of seriously flawed logic. Students of logic and philosophy will recognize the above erroneous sequences as examples of the twisted arguments often used to persuade an argumentative opponent of the logic of a premise. As long ago as 335 B.C., Greek philosopher, Aristotle, recognized the pitfalls of thinking in such arguments. You think we’d know better by now.

Try this one:

White enriched flour is a bad for health; whole grains are less bad for health.
Therefore: plenty of whole grains are good for health.

Ouch!

In the 1960s, we all ate hot dogs on white buns, white flour Wonder Bread® sandwiches, Mom made cookies and cupcakes with white flour. Then, during the 1970s and 1980s, clinical studies were performed demonstrating that whole wheat and whole grains reduced colon cancer, high blood pressure, diabetes, and heart disease compared to white flour. In other words, add back fiber and B vitamins and health benefits develop: No argument here.

Therefore: whole grains must be good for health. Further, lots of whole grains?unlimited quantities of whole grains many times per day, every day?must be even better. Even the USDA says so on their nutrition pyramid, with 8-11 servings of grains per day, 4 of which should be whole grains, at the widest portion of the pyramid.

But what happens when you follow this logic through and fill your diet with whole grains?

Look around you and it’s easy to see: Appetite increases, people become obese, blood sugar increases, diabetes develops, HDL cholesterol plummets, triglycerides skyrocket, inflammatory patterns (e.g., c-reactive protein, or CRP) increase, small LDL (the number one cause for heart disease in the obese U.S.!) shoots through the roof.

I would no more fill my diet with “healthy whole grains” than I would close my garage door with the car running.

Pomegranate juice, 8 oz:

Sugars, total 31.50 g

Sucrose 0.00 g

Glucose (dextrose) 15.64 g

Fructose 15.86 g

In your quest to increase the flavonoids in your diet, do you overexpose yourself to fructose?

Remember: Fructose increases LDL cholesterol, apoprotein B, small LDL, triglycerides, and substantially increases deposition of visceral fat (fructose belly?). How about a slice of whole grain bread with that glass of pomegranate juice? The Heart Association says it's all low-fat!

(Coming on the Track Your Plaque website: A full in-depth Special Report on fructose in all its glorious forms and whether this is truly an issue for your health. Fructose tables and the scientific data to establish a safe "threshold" value will be included.)

Image courtesy Wikipedia

Honeydew melon:

Sugars, total 51.97 g

Sucrose 15.87 g

Glucose 17.15 g

Fructose 18.94 g

Because sucrose is half fructose (the other half is glucose), there are approximately 26 grams of fructose per one-half honeydew melon.

Image courtesy Wikipedia

Apple, 1 medium: Fructose 10.74 g

Honey: Fructose 17.19 grams per 2 tablespoons

Barbecue Sauce: HFCS number 1 ingredient

Ingredients: High Fructose Corn Syrup, Vinegar, Concentrated Tomato Juice (Water, Tomato Paste), Water, Modified Food Starch, Salt, Honey, Contains Less Than 2% of Molasses, Natural Flavor, Paprika, Spice, Mustard Flour, Guar Gum, Red 40.

A1 Steak Sauce: HFCS number 2 ingredient

Ingredients: Tomato puree (water, tomato paste), high fructose corn syrup, vinegar, salt, water dried onions, contains less than 2% of black pepper, modified food starch, citric acid, dried parsley, dried garlic, xanthan gum, caramel color, potassium sorbate and calcium disodium EDTA as preservatives, molasses, corn syrup, sugar, spices, tamarind, natural flavor

Another in a series of data extrapolations that attempt to predict long-term cancer risk from medical radiation exposure was published in the July 13, 2009 Archives of Internal Medicine, viewable here.

Over the years, I've fussed about the radiation dose used by some centers for CT heart scans. (Note: I'm talking about CT heart scans, not CT coronary angiograms, an entirely different test with different radiation exposure.) In the "old" days, when electron-beam devices (EBT) were the best on the block, the old single-slice CT scanners (the predecessor of the current 64-slice MDCT scanners) exposed patients to ungodly quantities of radiation, while the EBT devices required very small quantities (0.5 mSv or about the equivalent of 4 standard chest x-rays or one mammogram).

But CT technology has advanced considerably. While EBT has been phased out (although it was an exceptional technology, GE acquired the small California manufacturer, then promptly scrapped the operation; you can guess why), multi-detector CT (MDCT) technology has improved in speed, image quality, and radiation exposure.

While it has improved, radiation exposure still remains an issue. The authors of the study applied the scanning protocols used at three hospitals and those in several CT heart scan studies, then calculated radiation exposure. They found a more than ten-fold range of exposure, from 0.8 mSv to 10.5 mSv. (All scanners were MDCT, none EBT.)

That's precisely what I've been worrying about: In the rapid rush to develop new devices, radiation exposure has often been a neglected issue. While some scan centers do an excellent job and take steps to minimize exposure, others barely lift a finger and consequently expose their patients to unnecessary radiation.

However, it's not as bad as it sounds. For one, the study included 16-slice MDCT scanners, a scanner type that I warned people to not use because of radiation. On the current most popular 64-slice devices, much lower radiation exposure is possible, on the order of 0.8-1.2 mSv routinely--if the center takes the effort.

This study, while eye-opening, will achieve some good: CT heart scans are here to stay. But the day-to-day practice of heart scanning should be:

1) standardized
2) conducted with radiation exposure as low as possible, preferably <0.8 mSv

To read more about this issue, below I've reprinted a 2007 full Track Your Plaque Special Report, CT Heart Scans and Radiation: The Real Story.

CT heart scans and radiation: The real story

“My personal opinion is that many patients today who are receiving multiple CT scans may well be getting at least comparable doses to subjects that have now developed malignancies from x-ray radiation received in the 1930s and '40s. And, similar to those days when the doses were unknown, the dose that patients receive today over a course of years of multiple CT scans is also completely unknown . . .

“I recommend that all healthcare providers become familiar with the concept that 1 in 1000 CT studies of the chest, abdomen, or pelvis may result in cancer.”

Richard C. Semelka, MD

Professor and Vice Chairman, Department of Radiology

University of North Carolina–Chapel Hill

Is this just hype to generate headlines? Or is the truth buried in the enormous marketing clout of the medical device industry, among which the imaging device manufacturers reign supreme?

It’s been over 110 years since radiation was first used for medical imaging. Over those years, it has had its share of misadventures.

In the 1930s and 1940s, before the dangers of radiation were recognized, shoe shoppers had shoes fitted using an x-ray device of the foot to assess fit. High doses of radiation were used to shrink enlarged tonsils and extinguish overactive thyroid glands. Attitudes towards radiation were so lax that doctors commonly permitted themselves to be exposed without protection day after day, year after year, until an unexpected rise in blood cancers like leukemia was observed. As recently as the 1970s and 1980s, cancers like Hodgkins’ disease were treated with high doses of radiation, also leading to radiation-induced diseases decades later.

Not all radiation is bad. Radiation can also be used as a therapeutic tool and even today remains a useful and reasonably effective method to reduce the size, sometimes eliminate, certain types of cancer. Forty percent of people with cancer now receive some form of radiation as part of their treatment (Ron E 2003).

Just how much does medical radiation add to our exposure?

Estimates vary, but most experts estimate that medical imaging provides approximately 15% of total lifetime exposure. In other words, radiation exposure from medical imaging is simply a small portion of total exposure that develops over the years of life. Exposure can be much higher, however, in a specific individual who undergoes repeated radiation imaging or treatment of one sort or another.

For all of us, exposure to medical radiation is part of lifetime exposure from multiple sources, added to the radiation we receive from the world around us. Just by living on earth, we are exposed to radiation from space and naturally-occurring radioactive compounds, and receive somewhere around 3.0 mSv per year (U.S. Nuclear Regulatory Commission). (Doses for radiation exposure are commonly expressed in milliSieverts, mSv, a measure that reflects whole-body radiation exposure.) People living in high-altitude locales like Colorado get exposed to an additional 30–50% ambient radiation (1.0–1.5 mSv more per year).

Much of the information on radiation exposure comes from studies like the Life Span Study that, since 1961, has tracked 120,000 Japanese exposed to radiation from the atomic bombs dropped in 1945 (Preston DL et al 2003). Although regarded as a high-dose exposure study for obvious reasons, there are actually thousands of people in this study who were exposed to lesser quantities of radiation (because of distance from the bomb sites) who still display a “dose-response” increased risk for cancer many years later in life. Radiation exposures of as little as 5–20 mSv showed a slight increase in lifetime risk.

Occupational and excessive medical exposure to radiation also provides a “laboratory” to examine radiation risk. Miners exposed to radon gas; patients exposed to the imaging agent, Thorotrast, containing radioactive isotope thorium dioxide and used as an x-ray contrast agent in the 1930s and 1940s and possesses the curious property of lingering in the body for over 30 years after administration; radium injections administered between 1945 and 1955 to treat diseases like ankylosing spondylitis and tuberculosis, all provide researchers an opportunity to study the long-term effects of various types of radiation exposure over many years (Harrison JD et al 2003).

The excess exposure of workers and several hundred thousand nearby residents to the Mayak nuclear plant in Russia has also revealed a “dose-response” relationship, with increasing exposure leading to more cancers, including leukemia and solid cancers of the bone, liver, and lung (Shilnikova NS et al 2003). Nuclear waste released into the Techa river between 1948 and 1956 contaminated drinking water used by over 100,000 Russians. A plant explosion in 1957 also released an excess of radiation into the atmosphere, yielding exposure via inhalation. Some sources estimate that at least 272,000 people have been affected by radiation from the Mayak plant. This unfortunate situation has, however, yielded plenty of data on radiation exposure and its long-term effects.

It’s also been known for several decades that people who receive therapeutic radiation for treatment of cancer, even with the reduced doses now employed, are subject to increased risk of a second cancer consequent to the radiation treatment.

From experiences like this, radiation experts estimate that an exposure of 10 mSv increases a population’s risk for cancer by 1 in 1000 (Semelka RC et al 2007).

This question was recently thrust into the spotlight with publication of a study from Columbia University in New York suggesting that a 20-year old woman would be exposed to a lifetime risk of cancer as high as 1 in 143 consequent to the radiation received during a CT coronary angiogram. (Important note: This was estimated risk from a CT coronary angiogram, not a simple heart scan that we advocate for the Track Your Plaque program.) The risk at the low end of the spectrum would be in an 80-year old man (because of the shorter period of time to develop cancer), with a risk of 1 in 5017. If “gating” to the EKG is added (which many scan centers do indeed perform nowadays), risk for a 60-year old woman is estimated at 1 in 715; risk for a 60-year old male, 1 in 1911 (Einstein AJ et al 2007). This study generated some criticism, since it did not directly involve human subjects, but used “phantoms” or x-ray dummies to simulate x-ray exposure. Nonetheless, the point was made: CT coronary angiograms in current practice do indeed expose the patient to substantial quantities of radiation, sufficient to pose a lifetime risk of cancer.

The media frenzy

The NY Times ran an article called With Rise in Radiation Exposure, Experts Urge Caution on Tests in which they stated:

"According to a new study, the per-capita dose of ionizing radiation from clinical imaging exams in the United States increased almost 600 percent from 1980 to 2006. In the past, natural background radiation was the leading source of human exposure; that has been displaced by diagnostic imaging procedures, the authors said."

“This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”

Radiation is a widely used imaging tool in medicine. Although CT scans of the brain, bones, chest, abdomen, and pelvis account for only 5% of all medical radiation procedures, they are responsible for nearly 50% of medical radiation used. It’s been known for years that increasing radiation exposure increases cancer risk over many years, but the boom of newer, faster devices that provide more detailed images has opened the floodgates to expanded use of CT scanners.

But before we join in the hysteria, let's first take a look at exposure measured for different sorts of tests:

Typical effective radiation dose values for common tests

Computed Tomography

Head CT 1 – 2 mSv
Pelvis CT 3 – 4 mSv
Chest CT 5 – 7 mSv
Abdomen CT 5 – 7 mSv
Abdomen/pelvis CT 8 – 11 mSv
Coronary CT angiography 5 – 12 mSv

Non-CT

Hand radiograph Less than 0.1 mSv
Chest radiograph Less than 0.1 mSv
Mammogram 0.3 – 0.6 mSv
Barium enema exam 3 – 6 mSv
Coronary angiogram 5 – 10 mSv
Sestamibi myocardial perfusion (per injection) 6 – 9 mSv
Thallium myocardial perfusion (per injection) 26 – 35 mSv

Source: Cynthia H. McCullough, Ph.D., Mayo Clinic, Rochester, MN

A plain, everyday chest x-ray, providing less than 0.1 mSv exposure, provides about the same quantity of radiation exposure as flying in an airplane for four hours, or the same amount of radiation from exposure to our surroundings for 11–12 days. Similar exposure arises from dental x-rays.

If you have a heart scan on an EBT device, then your exposure is 0.5-0.6 mSv, roughly the same as a mammogram or several standard chest x-rays.

With a heart scan on a 16- or 64-slice multidetector device, exposure is ideally around 1.0-2.0 mSv, about the same as 2-3 mammograms, though dose can vary with this technology depending on how it is performed (gated to the EKG, device settings, etc.)

CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 or more chest x-rays or 20 mammograms. Now, that's a problem.

The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legitimate medical questions. They are not screening tests to be applied broadly and used year after year.

It’s also worth giving second thought to any full body scan you might be considering. These screening studies include scans of the chest, abdomen, and pelvis. These scans, performed for screening, expose the recipient to approximately 10 mSv of radiation (Radiological Society of North American, 2007). Debate continues on whether the radiation exposure is justified, given the generally asymptomatic people who generally undergo these tests.

Always be mindful of your radiation exposure, as the NY Times article rightly advises. However, don't be so frightened that you are kept from obtaining truly useful information from, for instance, a CT heart scan (not angiography) at a modest radiation cost.

Heart scans, CT coronary angiograms and the future

Unfortunately, practicing physicians and those involved in providing CT scans are generally unconcerned with radiation exposure. The majority, in fact, are entirely unaware of the dose of radiation required for most CT scan studies and unaware of the cancer risk involved. It is therefore up to the individual to insist on a discussion of the type of scanner being used, the radiation dose delivered (at least in general terms), the necessity of the test, alternative methods to obtain the same diagnostic information, all in the context of lifetime radiation exposure.

Our concerns about radiation exposure all boil down to concern over lifetime risk for cancer, a disease that strikes approximately 20% of all Americans. Many factors contribute to cancer risk, including obesity, excessive saturated fat intake, low fiber intake, lack of vitamin D, repeated sunburns, excessive alcohol use, smoking, exposure to pesticides and other organochemicals, asbestos and other industrial exposures, electromagnetic wave exposure, and genetics. Radiation is just one source of risk, though to some degree a controllable one.

Some people, on hearing this somewhat disturbing discussion, refuse to ever have another medical test requiring radiation. That’s the wrong attitude. It makes no more sense than wearing lead shielding on your body 24 hours a day to reduce exposure from the atmosphere. Taken in the larger context of life, radiation exposure is just one item on a list of potentially harmful factors.

It is, however, worth some effort to minimize radiation exposure over your lifetime, particularly before age 60, and by submitting to high-dose testing only when truly necessary, or when the potential benefits outweigh the risks. Thus, with heart scans and CT coronary angiography, some thought to the potential benefits of knowing your score or the information gained from the CT angiogram need to be considered before undergoing the test. Often the practical difficulty, of course, is that your risk for heart disease simply cannot be known until after the test.

In our view, in the vast majority of instances a simple CT heart scan can serve the simple but crucial role of quantifying risk for heart attack and atherosclerotic plaque. CT heart scans yield this information with less than a tenth of the radiation exposure of a CT coronary angiogram. In people without symptoms and a normal stress test, there is rarely a need for CT coronary angiography with present day levels of radiation exposure. Perhaps as technology advances and the radiation required to generate images is reduced, then we should reconsider.

Early experiences are suggesting that the newest 256-slice scanners, now being developed but not yet available, will cut the dose exposure of 64-slice CT angiograms in half (from 27.8 mSv to 14.1 mSv in a recent Japanese study). The 256-slice scanners will allow scanning that is faster over a larger area in a given period of time.

Thankfully, the scanner manufacturers are increasingly sensitive to the radiation issue and have been working on methods to reduce radiation exposure. However, it still remains substantial.

References:
Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007 Jul 18;298(3):317–323.

Harrison JD, Muirhead CR. Quantitative comparisons of cancer induction in humans by internally deposited radionuclides and external radiation. Int J Radiat Biol 2003 Jan;79(1):1–13.

Hausleiter J, Meyer T, Hadamitzyky M et al. Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates. Circulation 2006;113:1305–1310.

Kalra MK, Maher MM, Toth TL, Hamberg LM, Blake MA, Shepard J, Saini S. Strategies for CT radiation dose optimization. Radiology 2004;230:619–628.

Mayo JR, Aldrich J, Müller NL. Radiation exposure at chest CT: A statement of the Fleischner Society. Radiology 2003; 228:15–21.

Mori S, Nishizawa K, Kondo C, Ohno M, Akahane K, Endo M. Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner. Eur J Radiol 2007 Jul 10; [Epub ahead of print].

Preston DL, Pierce DA, Shimizu Y, Ron E, Mabuchi K. Dose response and temporal patterns of radiation-associated solid cancer risks. Health Phys 2003 Jul;85(1):43–46.

Ron E. Cancer risks from medical radiation. Health Phys 2003 Jul;85(1):47–59.

Shilnikova NS, Preston DL, Ron E et al. Cancer mortality risk among workers at the Mayak nuclear complex. Radiation Res 2003 Jun;159(6):787–798.

Semelka RC, Armao DM, Elias J Jr, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007 May;25(5):900–9090.

Copyright 2007, Track Your Plaque.

A carefully-conducted study by a collaborative research group at University of California-Berkeley has finally closed the lid on the fuss over fructose vs. glucose and its purported adverse effects.

The study is published in its entirety here.

Compared to glucose, fructose induced:

1) Four-fold greater intra-abdominal fat accumulation--3% increased intra-abdominal fat with glucose; 14.4% with fructose. (Intraabdominal fat is the variety that blocks insulin responses and causes diabetes and inflammation.)

2) 13.9% increase in LDL cholesterol but double the increase for Apoprotein B (an index of the number of LDL particles, similar to NMR LDL particle number).

3) 44.9% increase in small LDL, compared to 13.3% with glucose.

4) While glucose (curiously) reduced the net postprandial (after-eating) triglyceride response (area under the curve, AUC), fructose increased postprandial triglycerides 99.2%.

The authors propose that fructose specifically increases liver VLDL production, the lipoprotein particle that yields abnormal after-eating particles, increased LDL, and provides building blocks to manufacture small LDL particles. The authors also persuasively propose that fructose metabolism, unlike glucose, is not inhibited (via feedback loop) by energy intake, i.e., it's as if you are always starving.

Add to this the data that show that fructose increases uric acid (that causes gout and may act as a coronary risk factor), induces leptin resistance, causes metabolic syndrome (pre-diabetes), and increases appetite, and it is clear that fructose is yet another common food additive that, along with wheat, is likely a big part of the reason Americans are fat and diabetic.

Fructose is concentrated, of course, in high-fructose corn syrup, comprising anywhere from 42-90% of total weight. Fructose also composes 50% of sucrose (table sugar). Fructose also figures prominently in many fruits; among the worst culprits are raisins (30% fructose) and honey (41% fructose).

Also, beware of low-fat or non-fat salad dressings (rich with high-fructose corn syrup), ketchup, beer, fruit drinks, fruit juices, all of which are rich sources of this exceptionally fattening, metabolism-bypassing, LDL cholesterol/small LDL/ApoB increasing compound. Ironically, this means that many low-fat foods meant to reduce cholesterol actually increase it when they contain fructose in any form.

When you hear or say "fructose," run the other way, regardless of what the Corn Refiners Association says.

Matt came to me because his doctor couldn't reduce his LDL cholesterol.

His doctor had prescribed Zocor (simvastatin), Lipitor, Crestor, even pravastatin, all of which resulted in incapacitating muscle aches and weakness within a week of starting. No surprise, Matt had a jaundiced view of statin drugs.

We started out by characterizing his lipoprotein patterns:

--LDL 155 mg/dl

--72% of LDL was small LDL, a moderately severe pattern. (This means that small LDL comprised 112 mg/dl of the total 155 mg/dl LDL; large LDL comprised 43 mg/dl--small LDL was the problem.)

--HDL 42 mg/dl --Triglycerides 133 mg/dl

--No lipoprotein(a)

Beyond lipoproteins, Matt proved severely deficient in vitamin D with a starting level of 18 ng/ml.

Matt's doctor had advised that he avoid salt, as his blood pressure had been borderline high. His thyroid assessment disclosed a TSH of 3.89 mIU/ml with thyroid hormones free T3 and free T4 in the lower half of the normal range.

I therefore asked Matt to:

--Eliminate wheat, cornstarch, and sugars to reduce small LDL
--Add iodine
--Supplement 6000 units of an oil-based vitamin D preparation
--Take fish oil to provide at least 1800 mg EPA + DHA per day
--Take Armour Thyroid 1 grain per day

Several months later on this program, Matt had a repeat basic lipid panel:

--LDL 82 mg/dl--a 47% reduction

--HDL 52 mg/dl a 24% increase

--Triglycerides 60 mg/dl--a 55% decrease

In addition, vitamin D was 66 ng/ml, TSH was <1.0 mIU/ml with free T3 and free T4 in the upper half of the "reference range." Matt also felt great.

While the numbers could be slightly better, Matt had made tremendous progress towards achieving perfect values.

There you have it: Marked correction of cholesterol values, no statin drugs involved.

Even if you’re not interested in building big muscles like a bodybuilder, there are health benefits to increasing muscle mass: increased bone density, better balance, and fewer injuries. Greater muscle mass means higher metabolic rate, improved insulin responsiveness, lower blood sugar. The inevitable loss of muscle mass of aging can lead to frailty, an increasingly common situation for the elderly. Muscle loss be reversed, health improved as a result.

Since its introduction in 1994, creatine has exploded in popularity, particularly among bodybuilders and athletes interested in gaining muscle mass and strength. But creatine is not just for young weight lifters. If you are just interested in increasing muscle mass for its health benefits, then creatine is something to consider.

A study of creatine supplementation in men, average age 70 years, demonstrated that, when creatine was combined with strength training, it increased muscle mass 250% better than placebo (7.26 lb muscle vs 2.86 lb muscle), along with improved leg strength and endurance. The same group also demonstrated 3.2% increased bone density (measured using dual energy X-ray absorptiometry) after 12 weeks in participants taking creatine with strength training, while the control (no strength training, no creatine) group decreased by 1.0%.

Benefits are not confined to men. Similar results were observed in another study that included women (age 65 and older), with outcomes in females comparable to males. This is especially important for females, given the common development of osteopenia and osteoporosis in postmenopausal females.

Other studies have shown that benefits are maintained after stopping creatine supplementation.

The most popular form of creatine is the monohydrate, generally taken as a “loading” phase of 15-20 grams per day (generally split into 3-4 doses of 5 grams) for 5-7 days, followed by weeks to months of 2-5 grams per day.

An alternative form, polyethylene glycosylated creatine (PEG-creatine) provides similar effects at one-fourth to one-half the dose of creatine, i.e., 1.25-2.5 grams per day.

Despite previous concerns about kidney toxicity with prolonged use, another study showed that athletes taking creatine for up to 21 months have shown no adverse effects on kidney function, lipid (cholesterol) values, or other basic health measures.

Having healthy muscle mass doesn't make you bulge like a bodybuilder. With modest efforts at strength training, augmented with creatine supplementation, you have a wonderful tool to feel better, reduce injury, increase bone density, and combat abnormal insulin resistance, not to mention accelerate weight loss, since lean muscle mass consumes energy.

There has been a lot of debate over whether or not “bio-identical” hormones, i.e., hormones identical to the human form, are superior to non-human forms dispensed by the drug industry.

The FDA is currently taking steps to clamp down on availability of bioidentical hormones and their claims of superiority, despite a groundswell of grassroot support for them. The argument has pitted anti-aging practitioners and the public, as well as the likes of Oprah and Suzanne Somers, against Big Pharma and the FDA, the two forces trying to squash the bioidentical hormone movement.

Regardless of what heavy-handed approach the FDA takes, we already have access to hormones identical to the original human form. It requires no prescription and yields downstream hormones that the human body recognizes as human.

That "bioidentical" hormone is pregnenolone.

Pregnenolone is the first biochemical step in the conversion of dietary cholesterol (yes-cholesterol!) to numerous other hormones. Pregnenolone is the source of the hormones that lie at the center of the bioidentical hormone controversy: estrogens, progesterone, and testosterone. We therefore already have our own over-the-counter, non-prescription form of bioidentical hormones.

Supplemental pregnenolone increases estrogens (mildly), progesterone, and testosterone. Prenenonlone supplementation simply provide more of the basic substrate for hormone production. The increase in hormones is usually modest, not as vigorous as direct hormone replacement like, say, testosterone or progesterone topical creams. But pregnenolone can be useful when small to moderate increases are desired, such as for reduction of Lp(a). A theoretical downside is that pregnenonlone can also convert to cortisol, the adrenal gland hormone that regulates fluid and blood pressure. However, I've not seen any measurable increase in cortisol with low doses of pregnenonlone and limited data suggest that it does not. Pregnenolone also converts to the other adrenal gland hormone, DHEA; I call DHEA "the hormone of assertiveness," since some people who take too much pregnenolone (or direct DHEA) acquire excessive assertiveness.

The key to pregnenolone supplementation is to proceed gradually and begin with a small dose, e.g., 5 mg every morning. Hormonal assessment is best conducted periodically to assess the effects and to determine whether a dose adjustment is in order.

Might-o'chondri-AL
2/28/2011 1:03:38 AM |

Aortic stenosis is +/- 2% once age 65 and +/-4% for those over
85; but that's still
+/-300,000 valve replacements done yearly for it. I'm not passing myself as the doctor here, so following is what I think is relevant science.

The cytokine TGF-B1 (transforming growth factor beta)is seen in the blood progressively more as the aortic stenosis pathology worsens. Other elevated indicators
are fibronectin, collagen I & II, plus sarcomeric protein myosin light-chain 2.

All of the preceeding seem to be driven by TGF-B1 kinase-1 (TAK1) pathway, &/or TGF/SMAD transcription factors. The obstructive build up involves TGF-B1 inducing a pheno-type alteration of the local fibroblasts into more of a matix.

It's altered the valvular cells' environment, so to speak, and so extra cellular matrix (ECM) components acrue. Calcium in circulation is capable of depositing in the aged valve matrix; which, scaffolding matrix, youth don't have to "trap" the calcium.

The treatment of very high
vitamin D would down-regulate the cytokine TGF-B1, high vitamin K2 encourage matrix solubility and restricted calcium mineral with it's ion dynamics take the load off valve.

Jim
2/28/2011 1:16:04 AM |

Doc, this is a phenomenal result!! Thanks should be given to your keen medical insight and willingness to try alternative medicine in helping your patients! You have what I consider to be probably the best website of its kind on the internet.
I live in a Chicago S/W suburb, which is really not that far, from your Milwaukee Office. I have gone to your city a few times on business over the past couple of years and I regret not making an appointment in getting an exam. One of these days I will make the trip to see you with or without an accompanying business trip. Maybe this will spur more folks from the Chicago area to make the trip up North.

Ken
2/28/2011 3:39:12 AM |

Excellent work Dr.Davis.Vitamin K2 ensures that calcium ends up where we want it.The combination of vitamins D3
and K2 has many benefits.

Anonymous
2/28/2011 4:06:40 AM |

I am thrilled to read this thread. I am a 64 y/o woman diagnosed w/"mild to moderate" aortic stenosis with some regurgitation as well as some mitral valve regurg. As a child I had several severe strep throats, had a total hysterectomy at 42, and subsequently have been diagnosed with hypothyroidism, all of which I have read might be causative. My MGH cardiologist says I'm not "bad enough" for surgery,and of course I don't want it, but I feel really awful--very tired, some chest pain at times, and occasional feelings that I can't get my breath.
I need a plan--and would appreciate any help.
Laura

Anne
2/28/2011 7:33:02 AM |

Ever since I came across Dr Davis's heart scan blog four years ago I have been waiting for more more info on this. I have aortic valve stenosis - not due to degenerative changes but due to congenital aortic valve defect - a bicuspid aortic valve - and I have been supplementing with high dose vitamin D ever since.

Anonymous
2/28/2011 9:52:57 AM |

Maybe for those who have severe calcification, they should avoid calcium. However, for the rest of the population, ensuring enough K2+D3+retinol(natural form)+magnesium and other nutrients is probably a better approach. Calcium itself protects against the heavy metal burden the body has been shown to accumulate with age. Calcium has also been proven to result in lessened inflammation (CRP), less genomic damage, longer telomeres, and lessened mortality. In the end, I would say, don't avoid calcium. Just make sure you don't get too much ***in relation*** to the other nutrients you are getting.

Anonymous
2/28/2011 11:17:02 AM |

Echocardiograms can have substantial variability, certain assumptions are built into the mathematical formulas used to evaluate aortic valve stenosis. Was there any differences noted in the doppler velocity (Lvot, cw)or outflow tract dimension? Small differences in these measurements can yield large variability in aortic valve area. Just playing devils advocate here.......

Ken
2/28/2011 2:01:33 PM |

I read some comments by a doctor on a website.He said,"Vitamin K2 decreased calcium deposits in aortic valves.Some of my patients' stenotic aortic valve systolic gradients decreased by about 20mm mercury."

Intestinal absorption of calcium can double or even quadruple when vitamin D levels approach desirable levels.Therefore, calcium supplements are not required.Hypercalcemia can lead to heart attacks, kidney stones , atherosclerosis and arthritis over long periods of time.There is plenty of calcium in food.

Anonymous
2/28/2011 3:28:34 PM |

So you're saying my knees won't get better?!

Anonymous
2/28/2011 3:34:11 PM |

1000 mcg per day! Is that 1000 of MK-4 or MK-7.
For about 6 months a while backmI ws taking 1000 of MK-7
the-kid

PeterVermont
2/28/2011 6:19:42 PM |

I found out about K2 when my Dad was diagnosed with aortic stenosis. I tried to convince him to try Vitamin D and K2 but he went the conventional route and now has a cow's aortic valve.

I have been taking 200mcg K2 every day along with my ~4000 IU/day Vitamin D. I have never had a scan and always wonder how blocked my arteries are and whether the vitamin k2 is regressing any blockage.

A nice blog post from Nephropal on Vitamin K2

Anonymous
2/28/2011 6:26:26 PM |

Thanks again Dr. Davis, your dedication to your job is incredible!
I have looked for K2 supplements containing both MK-4 and MK-7 but can't find them anywhere? They are not to be found in your own online shop at https://shop.trackyourplaque.com/ - where can I buy them in this proposed heavy duty dose (is's like 20 x 50mcg pills a day, quite a lot)? And what is the right balance between MK-4 and MK-7? Anyone?
Thanks - The Viking.

Paul
2/28/2011 9:45:42 PM |

Viking,

I have searched long and hard for such a supplement with no success.  My guess is it doesn't exist because these two forms of K2 come from two completely different sources.

K2-MK4 (menatetrenone) is the animal form. The richest natural food source is found in green grass-fed cow's butter.  Supplements made from the natural source of menatetrenone are hard to find. The only one I'm aware of is a product called X-Factor Butter Oil made by Radiant Life.  There are less expensive synthetic forms of menatetrenone sold by Carlson Labs and Thorne Research.

K2-MK7 (menaquinone-7) is the plant form. Its richest food source is fermented soy beans, also called "natto".  Supplements made from a natural source of menaquinone-7 are widely available.

Anonymous
2/28/2011 10:37:38 PM |

Life Extension's 'Super K' formula contains MK4 & MK7 and is available everywhere - try iherb.com

Might-o'chondri-AL
2/28/2011 11:11:51 PM |

Natto is fermenting here at home; it's remarkably easy and cheap. Doc's posted data is for each 100 grams Natto (3.5 oz., +/- 2 shot glasses volume) Mk-7 = 1,000 mcg, plus Mk-8 = 84 mcg.

Home preparations won't exactly match commercial products analysis. Previously Doc stated that Natto raises serum Mk-4 & is active inside us for up to 4 hours; Mk-7 potent longer.

G.E.M. Cultures (now in Washington state) sell pure Japanese Natto spores by mail order. I've no financial interest here, just their long term customer. (Natto's poly-glutamic acid was a melting stabilizer in a tropical dairy development project's ice cream manufacturing.)

Buying the "commercial" size spore vial will let your learning curve be cheap. Online are plenty of variations on how to make Natto; G.E.M. ships with instructions in English and Japanese original.

To make 1 pound soy bean batch you just need to incubate a dish +/- 10 inches by 10 inches and less than 2 inches deep. It'll last a person weeks refrigerated.

Ken
2/28/2011 11:37:32 PM |

I take one Life Extension Super K with Advanced K2 Complex softgel capsule per day.
Each capsule contains 1000 micrograms Vitamin K2 as menaquinone-4, 100 micrograms
Vitamin K2 as menaquinone-7 and 1000 micrograms of vitamin K1. I buy the capsules
at iHerb.com but other places sell them including Life Extension.
Invite K2 capsules contain 500mcg of MK-4,500mcg of MK7 and 1000mcg of vitamin K1.

Dr. William Davis
2/28/2011 11:58:58 PM |

Hi, Might'--

Thanks, as always, for your incredibly insightful comments. I, too, suspect that there are discrete, identifiable pathways that would provide a plausible basis for a D3/K2 effect on aortic valve pathology.

Anonymous with questions about the echo Doppler data--

The aortic valve areas were obtained with 3 views on the maximal aortic supravalvular velocity, using both the standard transducer as well as the Pedoff. On both studies, the LV outflow tract diameter was 2.1 cm. The second aortic valve diameter was also confirmed with planimetry.

Notably, peak aortic valve velocity dropped from 20 mmHg to 9 mmHg. I watched the echo tech (a very capable one, by the way) while he interrogated the valve. I am confident that we obtained the maximal peak velocity.

All in all, I believe it is a real effect.

Dr. William Davis
3/1/2011 12:00:15 AM |

Anonymous and Paul--

I have been advising the Life Extension "Super K."

Super K contains 900 mcg MK-4, 100 mcg MK-7, as well as 1000 mcg vitamin K1.

Anonymous
3/1/2011 12:34:09 AM |

Have you seen any results like this on any of the other heart valves?
My Dad has severe mitral valve stenosis. I am taking D and K2 and trying to convince him to do the same.

Paul
3/1/2011 1:27:34 AM |

Thank you, Dr. Davis.

Looks like I'm in need of sharpening my search skills.

Super K looks like a good deal. I'll have to check it out when my supply of K2 runs low.

Anonymous
3/1/2011 1:44:15 AM |

In the Life Extension Super K, is the 1000 mcg of K1 a problem as far as causing clotting?

I always understood that K2 (both MK-4 & MK-7) do not cause clotting like K1 does.

Would love to see some calcium scoring results (and/or angiogram) before and after K2 administration, as well as carotid ultrasound results.

Thanks for this blog, I visit it often.

Davide
3/1/2011 2:19:58 AM |

I'm curious if the addition of large doses of fish oil to the formula would also help decrease stenosis.

AllanF
3/1/2011 3:59:15 AM |

FWIW, another source of K2: http://www.vitacost.com/NSI-Ultra-Vitamin-K-with-Advanced-K2-Complex/?ntt=844197013470

I don't have the links at hand, but I remember reading second-hand a study that showed excess K1 does NOT up-regulate clotting. Unless you are on Warfarin, K1 is completely safe, even for stroke patients.

Good luck.

Anonymous
3/1/2011 5:28:12 AM |

Off topic but amusing considering...

http://www.sciencedaily.com/releases/2011/02/110223122425.htm

High Vitamin-D Bread Could Help Solve Widespread Insufficiency Problem

ScienceDaily (Feb. 24, 2011) â€” With most people unable to get enough vitamin D from sunlight or foods, scientists are suggesting that a new vitamin D-fortified food -- bread made with high-vitamin D yeast -- could fill that gap. Their study, confirming that the approach works in laboratory tests, appears in ACS' Journal of Agricultural and Food Chemistry.

Anonymous
3/1/2011 5:40:59 AM |

Wow, to any regular reader of this (wonderful) blog that (i.e., the vitamin D bread) is hilarious!!!

Might-o'chondri-AL
3/1/2011 6:47:14 AM |

Measured my just finished Natto yield from 1 pound dry soy beans. Digital scale here is down, so spring scale reading is ~ 875 grams Natto made.

Spores cost $14 (plus shipping) and are enough to make +/- 86 pounds of finished Natto. That's 39,000 grams of Natto.

If 100 grams Natto offering 1,000mcg Mk-7 is fine, then that's 390days worth. Dry soybean substrate for 390 days Natto is 45 pounds of soy (using my spring scale yield data).

Elsewhere in this blog, Doc I think, stated 32.7 mcg K2 decreased aorta calcification. Maybe the decimal got misplaced in my notes. Or reversal, verses prevention, demands mega-dose vitamin K.

I fork mash +/- 50 gr. Natto and blend it in with +/- 50 gr. Hummus. That amount of Natto will fit on 2 rice cakes as well.

Anonymous
3/1/2011 2:31:54 PM |

Dr. Davis, my greatest respect for your work. Two questions to your groundbreaking observations on D3/K2:
1) Did the patient in question have a biscupid or triscupid valve?
2) Was the patient exposed to any other lifestyle changes apart from D3/K2 that could explain the remarkable change?
3) I have seen some sites selling K2 warning against taking them together with high fibre meals. Why is that, and what is the best time/frequency to take D3/K2?
Regards, Louis

Anonymous
3/1/2011 6:05:12 PM |

I'm curious if Dr. Davis has seen any improvements in his patients using vit D3 alone.

I expect K2 (MK-7 to be exact) helped, but was just wondering how he knows what helps or doesn't, when his patients are doing several protocols at one time (D3, fish oil, no-wheat/low carbs, perhaps niacin)...

Paul
3/1/2011 7:35:41 PM |

Might-o'chondri-AL,

Your notes are correct. The 32.7 mcg K2 data point comes from the Rotterdam Heart Study. It was the minimum dose in participants showing a lower risk of both heart attack and aortic calcification.

Diana
3/1/2011 8:23:43 PM |

I use Life Extension Super K with Advanced K2 Complex that I buy from iherb. You can also get K-2 (MK-4)from High vitamin butter oil from green pastures. (You can buy it alone or with Fermented Cod Liver Oil)
Use this code to save $5.00 off your 1st order with iherb: ROV990

Dr. William Davis
3/4/2011 3:01:31 PM |

Hi, Louis--

The fundamental problem with retrospective observations is that you never know with absolute certainty what was done to achieve the observed effect.

However, everybody in the Track Your Plaque program and coming through my office do nearly the same thing, i.e., fish oil, vit D, diet, etc. I NEVER witnessed regression of aortic stenosis until we added vitamin D. I am speculating whether K2 adds yet another level of control over aortic valve disease.

This is still in the world of anecdotal observation. This is, of course, nothing even close to a clinical trial. But this can be how new ideas get their start.

C.J. Bahnsen
3/4/2011 10:25:31 PM |

Hi Doctor Davis,

I am new to your HS blog and, after reading a few, I'm glad I signed on. Great info. Quick question regarding this idea of "cleaning" or adding flexibility to the arteries: Do you put any value in Chelation therapy? I took oral chelation supplements for a time and it seemed to lower my triglyceride and cholesterol levels. Any thoughts on this, especially as it pertains to the oral version versus the IV method?

Thanks, Chris

bodylift
3/5/2011 9:43:55 AM |

This is been amazing. I am take it seriously. Thanks for this information.

Jack
3/9/2011 6:55:39 PM |

Chances are the calcium supplement you are taking now is a rock source of calcium. The label will say "calcium carbonate", which is nothing more than limestone. AlgaeCal Plus contains an organic, plant-sourced calcium form derived from a unique South American marine algae called Algas Calcareasâ„¢.

Karen
6/5/2011 8:18:39 PM |

Dear Dr. Davis,

Thank you for your website.  I am a 68-yr female with AS.  My aortic valve area is 0.69.  I weigh 118, and fast-walk/jog for an hour 4 days/wk.  I am asymptomatic, and my cardiologist advises watchful waiting.

How much Vit.D would you advise.  Is the amount weight related?

Thanks again.

Karen

nose surgery
7/6/2011 5:33:09 PM |

Intestinal absorption of calcium can double or even quadruple, when vitamin D levels levels.Therefore desirable approach, calcium can not required.Hypercalcemia to heart attacks, kidney stones, atherosclerosis and arthritis over a long period have lead tours is a lot of calcium in food.

varicose veins
7/6/2011 6:06:28 PM |

Dr. Davis's heart scan blog ever since I met four years ago, I have been waiting for more information on this. I have aortic stenosis - not because of degenerative changes, but because of congenital aortic valve defect - bicuspid aortic valve - I have been using high doses of vitamin D supplements since.

Eric
8/16/2011 6:49:42 PM |

Dr. Davis,

Do you mean to say that you put him on 1,000mcg of K2 MK-7 per day? (or was the 1,000mcg a combined total of all forms?)

Adam
10/8/2011 4:28:38 PM |

Dear Dr. Davis, a Final Guidance question.....

I know Life extensions Super K is a good supplement, but the question that seems to have been asked a few times on this blog is..."what is a good & ideal target daily does combination of both MK-4 and MK-7" ?

We have heard you say that 1000 mg a day of mk4 & mk7 is a good target...but in what ratio? Just like Omega3 has good target ratio of EPA/DHA....can you suggest some guidance as to what a good target ratio
of mk4 & mk7 would be ?

Thank you!

Adam

Dr. William Davis
10/9/2011 11:00:50 PM |

HI, Adam--

I wish I knew! This is the difficulty with K2: too little known.

Sure, there are plenty of opinions, but little fact. You and I can only continue to follow the emerging evidence and make our decisions as the evidence unfolds. Right now, it is simply not clear what the ideal regimen is.

Tom
12/8/2011 4:33:42 PM |

Dear Dr,

I just came across your blog. Mind-blowing stuff. Especially because I have mild-moderate stenosis. Moderately calcified and bi-cusped. I wanted to know if any of your patients had bicusped aortic stenosis and your treatment with D3 and K2 might have seen reversals?

also, do you suggest K2 with Mk-4 and Mk-7 or is just MK-7 sufficient?
I am taking just about 2000 IU D3 and 100 MK-7 K2, fish oil and veggies, fruits, walking.

Hope you can respond.

As always, thank you for all the good work you do.

Tom.

Sandra Broussard
12/20/2011 9:00:24 PM |

life extention vitmin k2 is from GMO soy. Shame on them for trying to poison us.

Rita
1/25/2012 5:08:47 PM |

Can you tell me how you found out that Super K contain GMO soy?

jane cook atkins
3/5/2012 4:06:52 AM |

My father was just diagnosed with aortic stenosis and I had to go to a friend who is a biochemist to discuss some nutritional options for an 83 year old man. I have used Isotonix supplements or the Nutrametrix line of same product since 1995. Personally I wanted to go in that direction with a scientific mind to talk with. My Dad''s doctor told me he personally uses supplements but was not allowed to direct my father on them. He is basically following a check list. My Dad is a player and I have him on a great regimen. After finding your blog, I am looking to add d with k2 in Isotonix. I have him on an Isotonix Calcium supplement that has d3 in it. Not junk calcium or tums.
http://dwithk2.blogspot.com/
this is my blog and you can go to the bottom of it to see label on the product.
Our next stop is the cardio doc who we were advised would want to replace his aortic valve. I really think that should be a very last resort.
Really, I believe some lifestyle changes and bumping some Isotonix supplements to heavy dosing is a better option.

Dr. William Davis
3/6/2012 3:52:23 AM |

The key, in my view, for control over aortic stenosis (thought I have not YET published the observations) is:

1) Supplement vitamin D to achieve a 25-hydroxy vitamin D level of 60-70 ng/ml, and
2) Vitamin K2 supplementation to provide 1000 mcg MK-4 or at least 100 mcg MK-7, and
3) Take NO supplemental calcium, as calcium is passive "mortar" that will calcify the aortic valve.

Dr. J. Edwards
3/16/2012 6:18:32 PM |

Pertaining to myself (aortic valve stenosis and stenosis of the spine) and my wine (parathyroid adenoma (non malignant) on Sinsipar to control without surgery.

If we eliminate calcium supplements (which this makes me consider), can I forget about getting too much in food (I also take buffered Vitamin C, which will be a problem, since I have gastritis).

Also wonder if magnesium, boron & strontium are good or bad to take??????

Last, can you give me a link for natural treatment of parathyroid adenoma. My wife also refuses to take Boniva and her bone density is bad.

Thanks in advance.

Dr. Davis
3/26/2012 4:52:09 PM |

Dr. Edwards--

Unfortunately, no data.

You are venturing further into the world of "normalizing" calcium metabolism. I'd like to believe that all this makes sense, as they tend to benefit osteoporosis/osteopenia, and removal of calcium as a supplement is likely a good thing, given its contribution to cardiovascular risk.

But we lack real data on the effects. I will tell you that the vitamin D, however, is very real, having now done this in around 60+ patients.

Rita C.
5/3/2012 7:38:41 PM |

Dr. Davis,
     I'm 67, female with CAVD.  Heart murmur, dizziness, exhaustion since holidays led to apt with cardiologist resulting in mild aortic stenosis diagnosis in early April.
     I have taken Vitamin D3 over last two years after Welcome to Medicare physical showed low levels.  I have now added CoQ10.  After stumbling upon your blog, I'm now adding 135 mcg K-2 Mk7.
     Despite the fact that I'm symptomatic, I'm hoping to avoid heart surgery until the new trans-vascular technique is approved for a wider range of patients.  I return to my cardiologist in early August and I will be most interested in comparing new test results against my April numbers--call it a personal clinical trial of one.
     A few years ago I observed open heart surgery at a major surgical center in Houston.  I vowed I would never have it myself, but here I am now, staring it squarely in the face.  I can't thank you enough for your website. It's given me a small measure of hope.

John Wilsonf
5/25/2012 9:22:58 PM |

Dr Davis:
I am a 70 year old slim athletic male with a bicuspid aortic valve that has been stable for about 6 years with echo area measurements showing 1.2 to 1.3 sq cm. When I got my first echo 6 yrs ago I searched published literature and decided to start 200mg MK-7 daily and I take quite a few supplements, including vit D, niacin, and about 3 gms fish oil (EPA+DHA). My cardiologist is surprised to not see a reduction in area, and valve replacement seems to have been put off successfully. This year, however, my ascending aorta was measured at 48 mm by echo, up from 44 (MRI measurement) a year ago. Surgery was recommended, based on the aneurysm, not the valve, but of course both would be done at the same time. A cardiac CT scan was ordered by the potential surgeon and the radiologist report indicated a maximum ascending aortic diameter of 45mm, but the surgeon said he looked at the 3-D CT images and it looked more like 47-48 mm to him. Search for coronary artery plaque indicated all arteries "normal" except for the "1st Obtuse marginal: Tiny focal calcified plaque causing no luminal narrowing" .Beginning January, 2012, I have eliminated wheat and calcium supplements and have actually gone low-carb, high fat, adequate protein to the extent to be in "nutritional ketosis". Ketones range from 0.5 to 1.9, depending on time of day and whether it is before or after exercize, etc. I feel great! Given that I am "on the boarder line" where surgery is recommended, I have thought about giving this more stringent diet a year to see if the aneurysm shrinks.

My question is this: Some time ago you posted your experience of seeing patients ("Jake") where diet/supplements contributed to reducing the size of an aneurysm, but I cannot find any follow-up information in your excellent blog (or publications). What is the best diet/supplement regime that would optimize reduction of an aneurysm? If the mechanism for the aortic wall degredation is the same as for artery plaque, then I know your answer because of your writings on this subject. My interest in writing is to determine if there are other dietary or supplement changes I should make that would optimize my chances of improvement in my one-year trial, should I decide to do it. Also, do you agree that nutritional ketosis (which I have no problem staying on) should be advantageous?

Gaurav
8/17/2012 11:23:56 PM |

Dr. Davis,
I chanced upon your blog while searching for content of MK7 in natto! What a fortuitous discovery for me.

I started taking a Vitamin D3 supplement last year when my level was diagnosed at 20 ng/ml. I took about 3000 IU per day for 9 months and my level rose to 27 ng/ml. I did so using a D3 spray in coconut oil sprayed under my tongue.

Recently, I came across research that D3 supplementation, even in the 2000-3000 IUs a day dosage, without K2 supplementation will cause calcification of arteries and soft-tissues.

Wanted to ask for your input on this:
- How much K2 should I take, especially to reverse calcification? Seems like 100 mcg of MK7 and 1000 mcg of MK4 are common doses.
- Can I take K2 just 2-3 times a week, just to be conservative. How about if I just eat Natto for MK7 and stay away from the supplements?
- Would you still recommend D3 along with K2? If so, what is a safe D3 dose to go with 100 mcg of MK7?
- Is calcification observed in those who were taking Calcium with D3 or it can be seen even without Calcium supplementation? I eat a pretty low-carb, high-fat, decent amount of proteins, less red meat diet. Also, I take no dairy, calcium supplement or calcium fortified foods.

Thanks so much for your time.

Rita C..
9/16/2012 4:35:50 PM |

Update to my first comment after six months.

After six months of K2/D3, CoQ10, and Niacin supplements, I had my first nuclear stress test at my cardiologist's office.  Photos were picture perfect--strong, well functioning heart.  Efficiency percentage was mid 60s in March, but went to 87% in late August.  Primary Care physician had difficulty locating murmur that was pronounced in March.  I'm now scheduled for a second echocardiogram in early February.  That will be the acid test.

Despite excellent test results, I'm still experiencing some fatigue and dizziness, but not nearly so much as when first diagnosed.  I remain hopeful that with continued supplement therapy and good eating habits, I'll be one of the lucky ten percent who experience remission from AS with K2/D3 therapy.

Mel
10/12/2012 9:29:25 AM |

Hi Rita I thought to mention that I've been going through the comments here and really appreciate that you are giving us updates of your progress. Hoping for good results for you next round!

Holly
12/18/2012 4:39:24 PM |

Dear Dr.Davis,
I came across your blog by chance and very interested in your opinion regarding valve problems. I would be most grateful if you can advice me on my situation:
I always believed that I have a strong heart as I excercised a lot--swimming and hiking, never expected that the first thing knocked me down is my heart. Starting this year from January, I went to Hospital Emergency 8 times, 4 in Jan, 2 in Feb and 1 in April and anthor 1 in Nov, all because of very fast heartbeat. The first 4 made me hard to breath and thought I was dying. All the blood tests at the hopsital came out normal. However, the ecogram showed that I had moderate aortic valve regurgitation. As meantime I was suffering from gastric problems of not being able to eat much, my heart condition gave me scaring experience of being extreme fatigue, dizzy, chest pain, neck and should pain. Doctors said I do not need to do anything.
Even the fast beat of my heart is getting better recently, constant fatigue and dizziness and neck pain prevents from living a normal life.

I am also scared to see my 4 year ecogram with only "traces of aortic valve regurgitation," now changed to moderate.

I would likfe to know why my valve degenerate so fast? what can I do to stop the process. After seeing your blog, I bought vitamin D (my level is 43) and K2 (both mk4 and 7), how much dose should I take, will these vitamins alone help stop the degeneration process?

I also considering coming down to see you if you give appointments for consultation.

Thanks for your help!

Holly

Holly
12/18/2012 4:43:39 PM |

by the way, I am 50 years old and have a stressful job.
HOlly

Karen
2/10/2013 9:47:04 PM |

Dr Davis,

Any research on a wheat less diet and lipoproteins and their affects on Aeortic stenosis? If elemenating them will prevent or reverse this condition?

Thank you,

Karen

John Wagner
5/11/2013 6:16:00 PM |

There are several different causes of aortic stenosis. Congenital (ie bicuspid aortic valve) and rheumatic fever start at younger ages. ASc or sclerosis is a disease of older people, same age risk as ASHD or coronary disease (atherosclerosis) and is nothing more than a variant manisfectation of the same risk factors that causes myocardial infractions., high blood pressure, smoking, obesity, diabetes and lipid disorders from high carb diets or a combination commonly called Metabolic syndrome. All of these risk factors cause coronary artery disease and/or ASc, it is just a crap shoot as to which one may show up first...but, treat both the same. Does that mean Vit D doesn't work? Of course not, newer studies beginning to show high Vit D levels are Importent in atherosclerosis Ann cancer prevention.

Courtney Janak
7/31/2013 3:08:56 PM |

My husband has a coronary calcium score of over 900. His cholesterol levels were: total:217, HDL:44, LDL:147, trigyclerides:167. His cardiologist wanted to put him on Provastatin and scheduled him for an echo-cardiogram stress test. He has chosen to put off taking the statins and has started taking K2 and magnesium supplements. Is this ok? Should statins be recommended for his score?

Is there a cardiologist in or near Santa Fe, NM, who has an understanding of nutrient issues similar to yours?

Lisa D
7/31/2013 5:15:57 PM |

I stumbled upon your blog a year ago when researching how to reverse aortic valve calcification.  At the time I was 49 and had just gotten my echo results.  I was told that I had abnormal relaxation of my left ventricle consistent with diastolic dysfunction, a trileaflet aortic valve with a trace of regurgitation and mild calcification.  My aortic root is borderline in size.  Well that was a heck of a blow because my echo the previous year was normal.  (I have echos done because I had chest pain several years ago that turned out to be esophageal spasm.  However, everyone in my family died from heart disease and my father had his major MI at age 47.  My grandmother died from aortic stenosis... so they do yearly echos on me.  I also have hypothyroidism, polycystic ovary syndrome and my ApoE genotype is 3/4)

After I read your blog, I went out and bought Life Extension Super K.  I have been taking it for over one year--since last July.  I found in my research that people with the ApoE4 allele don't hold on to vitamin K2 as well as those who do not have this genotype, so I didn't know if one pill a day was enough.  After a gigantic hassle trying to find a lab that runs the undercarboxylated osteocalcin test, I finally had my level drawn.  It came back at 3.8.  (Normal was anything below 12.1).  The results provided a graph which showed I am in the low normal end of the spectrum.  It showed that 80% of the population is lower than me--which surprises me because I bet most of the population doesn't take vitamin K2.  Maybe the only people having this test done are those who do supplement with vitamin K...   In any case, that lab was drawn in mid May, and since that time I doubled my dose to 2 capsules per day.  What should my undercarboxylated osteocalcin level be?  I can't find any data about what level is acceptable to reverse calcification.  I have also been taking vitamin D for several years--my level was originally 9.  I take 50,000 units once a week.  My last D level was 87.4, so I'm pretty close to the 70 that you suggest.  I also throw in about 8,000 u of vitamin A twice a month because I read that it's necessary to downregulate the D.  My D had gotten as high as 115 last year but has been in the mid 60s-80s since.  I also take CoQ10 200mg per day and fish oil. (I was taking it daily, but what do you think about the new study out saying it increases the incidence of prostate cancer?  I didn't want to increase my possibility of any kind of cancer, so I'm only taking it twice a week now... thoughts?)

I had an echo and a Lexiscan (because I couldn't walk on the treadmill due to foot problems and foot surgery 1.5 yrs ago) done last week.  I get my results tomorrow and am hoping that the calcification is gone... When I had my echo done last year I was overweight (BMI 38.8) with some sleep apnea.  After that appointment, I walked out of that office and changed my life.  I have been on basically a "no white" diet--no sugar, flour, pasta, rice, bread, sweets, etc.  Because of my PCOS, I can't even eat complex carbs without gaining weight.  (I have done strict Atkins before but couldn't sustain it because it was so strict.  This is working for me.  My carbs come from low glycemic fruits and vegetables primarily.  I do eat meat, dairy and nuts).  I went back to the gym and go every other day.  I lift weights (my son is a personal trainer), climb the stair master for 20 minutes and then go home to ride my exercise bike for 45 minutes every day.  I ride my exercise bike every day for at least 45 minutes and sometimes do double cardio days on weekends.  I have lost 63 pounds in the last year.  I would like to lose another 20 pounds.  I have an oral appliance for the sleep apnea and will have another sleep study done after I lose the last 20 lbs.  I know that I didn't used to snore when I was thin (pre-pregnancy).  I'm only 11 lbs above my pre-pregnant weight now.  I know that the sleep apnea can lead to diastolic dysfunction.  I'm hoping I'm reversing that!

Any other suggestions for me?  I'm especially interested to know how much vitamin K2 I need to take to potentially reverse this darn calcification.  I've mentioned the K2 to my other doctors and so far they're all in the dark and don't even seem to care about it... I'm shocked, because there are big studies out there that back it up.  I don't know about my cardiologist because I don't see him until tomorrow.  I'm shocked that my endocrinologist didn't seem to care because he does bone density scans in his office.  I'm getting one done in a couple months.  In my past 2 scans, I was dropping towards osteopenia.  I'm hoping with the vitamin K2 that I show dramatic improvement so that I can show him I was right about the K.

Thank you for any help,
Lisa D. RN

Marsha
8/25/2013 12:40:59 AM |

Oh come on Jim, try google every once in awhile. This isn't Dr. Davis' discovery...it's been studied and written about for at least 8 years now.

Michael
8/25/2013 12:51:35 AM |

Isn't that the brand that everyone over on the Inspire.com site is having problems with? Seriously, there's been quite a discussion about it. Many found that once they switched to Carlson's K2 only, that their palpitations, etc., went away.

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