Green coffee bean extract in AGF Factor I

Track Your Plaque's new and proprietary formulation, AGF Factor I, is designed to to support a program to achieve low levels of endogenous glycation.

Endogenous glycation, discussed at length in a recent Track Your Plaque Special Report, makes LDL particles (especially small LDL particles) more prone to oxidation and thereby more atherogenic, i.e., more likely to contribute to atherosclerotic plaque. Endogenous glycation also exerts unhealthy effects on long-lived proteins in the body, such as the proteins in the lenses of your eyes (cataracts), the lining of arteries (hypertension), and the cartilage cells of joints (brittle cartilage and arthritis).

Endogenous glycation is reduced by slashing carbohydrates in the diet, especially the most offensive carbohydrates of all, the amylopectin A of wheat, sucrose, high-fructose corn syrup and other fructose sources. Endogenous glycation can also be blocked by using blockers of the glycation reaction, such as benfotiamine (lipid-soluble thiamine), pyridoxal-5'-phosphate (a form of vitamin B6 with greater glycation blocking effect), and chlorogenic acid from green coffee beans, all components of AGF Factor I, which also contains Portulaca oleracea (Portusana), or purslane, for reduction of glucose.

Green coffee bean extract, and thereby chlorogenic acid, is receiving increased attention, most recently due to a study demonstrating substantial weight loss with 750-1050 mg green coffee bean extract, providing approximately 325-500 mg chlorogenic acid per day. Participants lost 15.4 pounds over 8 weeks at the higher dose (500 mg chlorogenic acid per day), while participants lost 8.8 pounds over 8 weeks at the lower dose (325 mg chlorogenic acid per day).

AGF Factor I was not formulated for weight loss but, taken twice or three times per day, does indeed mimic the dose of chlorogenic acid from green coffee bean extract used in the weight loss study. If you wish to take advantage of this application of chlorogenic acid/green coffee bean extract, while also maximizing protection from endogenous glycation, our AGF Factor I is one excellent choice to do so.

Lessons learned from the 2012 Low-carb Cruise

I just returned from Jimmy Moore's Low-carb Cruise, a 7-day excursion to Jamaica, Grand Cayman Island, and Cozumel aboard the Carnival Magic. During our 7 wonderful days, a number of authors and experts spoke, each offering their unique perspective on the low-carb world. The focus was the science, experience, and practical application of low-carbohydrate diets.

The event kicked off with a roast by Tom Naughton of Fat Head fame, who entertained with his insightful low-carb humor and predictions of my demise at the hands of Monsanto!

Among the most important lessons provided:

Dr. Andreas Eenfeldt of the Diet Doctor blog discussed how Sweden is leading the world as the nation with the most vigorous low-carbohydrate following, witnessing incredible weight loss and reversal of carbohydrate-related diseases way ahead of the U.S. experience. I spent several hours with Dr. Eenfeldt who, besides being an engaging speaker, is a new father and an all-around gentleman. At 6 ft, 7 inches, he also towered high above all of us.

Dr. Eric Westman of Duke University and author of The New Atkins for a New You, debunked low-carbohydrate myths, such as "low-carb diets are high-protein diets that make your kidneys explode."

Dr. John Briffa, creator of the popular blog, Dr. John Briffa: A Good Look at Good Health, and author of the wonderfully straightforward primer to low-carbohydrate eating, Escape the Diet Trap, stressed the importance of never allowing hunger to rule behavior. Dr. Briffa's serious writing tone conceals an incredible charm and wit that took me by surprise, having spent several thoroughly engaging hours over breakfast, lunch, and dinner with him over the week.

Fred Hahn, exercise expert, founder of Serious Strength and author of Slow Burn Fitness Revolution and Strong Kids, Healthy Kids, debunked a number of trendy exercise methods, boiling many of the purported benefits of exercise down to that of increased strength.

Dr. Chris Masterjohn of The Daily Lipid and supporter of the Weston A. Price Foundation program, provided a comprehensive overview of the data that fails to link saturated fat with heart disease. He also helped me understand the analytical techniques used in studies of advanced glycation end-products.

Denise Minger, brilliant young usurper of China Study dogma and blogger at Raw Foods SOS, proved an engaging speaker and a truly real person (since some critics of her analyses have actually questioned whether there was even such a person!). She also proved every bit as likable as she seems in her captivating blog discussions.

Dr. Jeff Volek, prolific researcher from University of Connecticut, author of over 200 studies validating low-carbohydrate diet effects, and author of the recently released book with Dr. Stephen Phinney, The Art and Science of Low Carbohydrate Living, debunked myths behind carbohydrate dependence and "loading" by athletes. He also talked about how assessing blood ketones may be the gold standard method to ensure low-grade ketosis on a long-term low-carb effort.

Over a bottle of wine, Jimmy Moore and I reminisced over how his modest start with no experience in blogging or media has now ballooned to an audience of over 100,000 readers/viewers.

All in all, Jimmy's Low-carb Cruise experience was worth every minute, with many wonderful lessons and memories!

Chili Sesame Crackers

Looking for something hot and crunchy?

These chili sesame crackers are perfect for dipping into hummus or salsa. As written, the recipe yields a moderately spicy cracker that you can modify readily by increasing or decreasing quantities of cayenne pepper and Tabasco sauce.

This recipe uses sesame seeds as the "flour." Either brown sesame seeds or the lighter version work, though the lighter seeds yield a slightly less bitter flavor with the spices.

For ease of baking, a shallow baking pan measuring 11 x 17 inches works best, as it allows the batter to fill the pan and spread to a cracker thickness. With a smaller pan, you may have to bake in two batches.

Makes approximately 30 chips

2 cups raw sesame seeds
1 cup shredded Parmesan cheese
2 tablespoons extra-virgin olive oil
1 tablespoon chili powder
½ teaspoon cayenne pepper
2 teaspoons onion powder
1 teaspoon garlic powder
1 teaspoon dry mustard
1 teaspoon sea salt
1 teaspoon Tabasco sauce
1¼ cups water

Preheat oven to 350º F.

In food chopper or food processor, grind 1¼ cups sesame seeds to fine meal. Remove and place in large bowl.

Place shredded Parmesan cheese in food chopper or food processor and pulse briefly until reduced to granular consistency. Add to sesame seed meal and mix. Stir in olive oil.

Add remaining (unground) sesame seeds, chili powder, cayenne pepper, onion and garlic powder, mustard, sea salt and mix thoroughly. Add Tabasco sauce and water and mix. Add additional water, if necessary, one tablespoon at a time, to obtain a consistency similar to pancake batter.

Pour mixture into baking pan and smooth to fill pan and obtain a thickness of a cracker. If too thick, remove some batter and re-smooth. Optionally, roll a clean cylindrical glass or bottle over top to smooth and yield a consistent thickness.

Bake for 30 minutes or until edges browned and center firm. If a dry, extra crunchy cracker is designed, bake an additional 10-15 minutes at 250 degrees F.

Remove and allow to cool. Cut with pizza cutter to desired size.

Opiate of the masses

Although it is a central premise of the whole Wheat Belly argument and the starting strategy in the New Track Your Plaque Diet, I fear that some people haven't fully gotten the message:

Modern wheat is an opiate.

And, of course, I don't mean that wheat is an opiate in the sense that you like it so much that you feel you are addicted. Wheat is truly addictive.

Wheat is addictive in the sense that it comes to dominate thoughts and behaviors. Wheat is addictive in the sense that, if you don't have any for several hours, you start to get nervous, foggy, tremulous, and start desperately seeking out another "hit" of crackers, bagels, or bread, even if it's the few stale 3-month old crackers at the bottom of the box. Wheat is addictive in the sense that there is a distinct withdrawal syndrome characterized by overwhelming fatigue, mental "fog," inability to exercise, even depression that lasts several days, occasionally several weeks. Wheat is addictive in the sense that the withdrawal process can be provoked by administering an opiate-blocking drug such as naloxone or naltrexone.

But the "high" of wheat is not like the high of heroine, morphine, or Oxycontin. This opiate, while it binds to the opiate receptors of the brain, doesn't make us high. It makes us hungry.

This is the effect exerted by gliadin, the protein in wheat that was inadvertently altered by geneticists in the 1970s during efforts to increase yield. Just a few shifts in amino acids and gliadin in modern high-yield, semi-dwarf wheat became a potent appetite stimulant.

Wheat stimulates appetite. Wheat stimulates calorie consumption: 440 more calories per day, 365 days per year, for every man, woman, and child. (440 calories per person per day is the average.) We experience this, sense the weight gain that is coming and we push our plate away, settle for smaller portions, increase exercise more and more . . . yet continue to gain, and gain, and gain. Ask your friends and neighbors who try to include more "healthy whole grains" in their diet. They exercise, eat a "well-balanced diet" . . . yet gained 10, 20, 30, 70 pounds over the past several years. Accuse your friends of drinking too much Coca Cola by the liter bottle, or being gluttonous at the all-you-can-eat buffet and you will likely receive a black eye. Many of these people are actually trying quite hard to control impulse, appetite, portion control, and weight, but are losing the battle with this appetite-stimulating opiate in wheat.

Ignorance of the gliadin effect of wheat is responsible for the idiocy that emits from the mouths of gastroenterologists like Dr. Peter Green of Columbia University who declares:

"We tell people we don't think a gluten-free diet is a very healthy diet . . . Gluten-free substitutes for food with gluten have added fat and sugar. Celiac patients often gain weight and their cholesterol levels go up. The bulk of the world is eating wheat. The bulk of people who are eating this are doing perfectly well unless they have celiac disease."

In the simple minded thinking of the gastroenterology and celiac world, if you don't have celiac disease, you should eat all the wheat you want . . . and never mind about the appetite-stimulating effects of gliadin, not to mention the intestinal disruption and leakiness generated by wheat lectins, or the high blood sugars and insulin of the amylopectin A of wheat, or the new allergies being generated by the new alpha amylases of modern wheat.

Jelly beans and ice cream

What if I said: "Eliminate all wheat from your diet and replace it with all the jelly beans and ice cream you want."

That would be stupid, wouldn't it? Eliminate one rotten thing in diet--modern high-yield, semi-dwarf wheat products that stimulate appetite (via gliadin), send blood sugar through the roof (via amylopectin A), and disrupt the normal intestinal barriers to foreign substances (via the lectin, wheat germ agglutinin)--and replace it with something else that has its own set of problems, in this case sugary foods. How about a few other stupid replacements: Replace your drunken, foul-mouthed binges with wife beating? Replace cigarette smoking with excessive bourbon?

Sugary carbohydrate-rich foods like jelly beans and ice cream are not good for us because:

1) High blood sugar causes endogenous glycation, i.e, glucose modification of long-lived proteins in the body. Glycate the proteins in the lenses of your eyes, you get cataracts. Glycate cartilage proteins in the cartilage of your hips and knees, you get brittle cartilage that erodes and causes arthritis. Glycate structural proteins in your arteries and you get hypertension (stiff arteries) and atherosclerosis. Small LDL particles--the #1 cause of heart disease in the U.S. today--are both triggered by blood sugar rises and are 8-fold more prone to glycation (and thereby oxidation).

2) High blood sugar is inevitably accompanied by high blood insulin. Repetitive surges in insulin lead to <em>insulin resistance</em>, i.e., muscles, liver, and fat cells unresponsive to insulin. This forces your poor tired pancreas to produce even more insulin, which causes even more insulin resistance, and round and round in a vicious cycle. This leads to visceral fat accumulation (Jelly Bean Belly!), which is highly inflammatory, further worsening insulin resistance via various inflammatory mediators like tumor necrosis factor.

3) Sugary foods, i.e., sucrose- or high-fructose corn syrup-sweetened, are sources of fructose, a truly very, very bad sugar that is metabolized via a completely separate pathway from glucose. Fructose is 10-fold more likely to induce glycation of proteins than glucose. It also provokes a (delayed) rise in insulin resistance, accumulation of triglycerides, marked increase in formation of small LDL particles, and delayed postprandial (after-eating) clearance of the lipoprotein byproducts of meals, all of which leads to diabetes, hypertension, and atherosclerosis.

I think we can all agree that replacing wheat with jelly beans and ice cream is not a good solution. And, no, we shouldn't have drunken binges, wife beating, smoking or bourbon to excess. So why does the "gluten-free" community advocate replacing wheat with products made with:

rice starch, tapioca starch, potato starch, and cornstarch?

These powdered starches are among the few foods that increase blood sugar (and thereby provoke glycation and insulin) higher than even the amylopectin A of wheat! For instance, two slices of whole wheat bread typically increase blood sugar in a slender, non-diabetic person to around 170 mg/dl. Two slices of gluten-free, multigrain bread will increase blood sugar typically to 180-190 mg/dl.

The fatal flaw in thinking surrounding gluten-free junk carbohydrates is this: If a food lacks some undesirable ingredient, then it must be good. This is the same fatally flawed thinking that led people to believe, for instance, that Snack Well low-fat cookies were healthy: because they lacked fat. Or processed foods made with hydrogenated oils were healthy because they lacked saturated fat.

So gluten-free foods made with junk carbohydrates are good because they lack gluten? No. Gluten-free foods made with rice starch, tapioca starch, potato starch, and cornstarch are destructive foods that NOBODY should be eating.

This is why the recipes for muffins, cupcakes, cookies, etc. in this blog, the Track Your Plaque website, and the Track Your Plaque Cookbook are wheat- and gluten-free and free of gluten-free junk carbohydrates. And put that bottle of Jim Beam down!

Diet by LDL

Conventional notions of heart healthy diets, such as that advocated by the American Heart Association, are largely based on observations of total and LDL cholesterol.

So, cut the saturated fat in the diet, cut the overall fat content, and replace them with polyunsaturated oils like safflower, corn, and vegetable oils and increase consumption of whole grains and total and LDL cholesterol show a modest downturn. Thus, diets like the American Heart Association Total Lifestyle Change approach advocate limiting total fat to no more 25 to 35% of calories and saturated fat to no more than 7% of calories.

Orange Cream Cookies

If you loved Creamsicles as a kid, you'll love these Orange Cream Cookies. (Sorry, no photo: We ate them up before I realized we hadn't taken the photo. And, worse, we did it twice!)

Ingredients:
2 cups almond meal
2 tablespoons coconut flour
1 teaspoon baking soda
½ teaspoon sea salt
¼ cup golden raisins
½ cup chopped pecans
Sweetener equivalent to 1 cup sugar
2 tablespoons finely-grated orange rind
1 large egg
2 tablespoons coconut oil, melted
½ cup whipping cream (or coconut milk)
1 tablespoon vanilla extract

Preheat oven to 350º F.

Combine almond meal, coconut flour, baking soda, salt, raisins, pecans, sweetener and orange zest in bowl and mix.

In separate bowl, whisk egg, then add coconut oil, whipping cream, vanilla extract and mix together. Pour wet mix into dry and blend by hand thoroughly.

Spoon onto parchment paper-lined baking pan (or oiled pan) and flatten with spoon to ½-¾ inch thickness. Bake for 20-25 minutes or until toothpick withdraws dry.

Why are heart attacks still happening?

I'm a cardiologist. I see patients with heart disease in the form of coronary artery disease every day.

These are people who have undergone bypass surgery, received one or more stents or undergone other forms of angioplasty, have survived heart attacks or sudden cardiac death, or have high heart scan scores. In short, I see patients every day who are at high-risk for heart attack and death from heart disease.

But I see virtually no heart attacks. And nobody is dying from heart disease. (I'm referring to the people who follow the strategies I advocate, not the guy who thinks that smoking a pack of cigarettes a day is still okay, or the woman who thinks the diet is unnecessary because she's slender.)

Two high-profile deaths from heart attacks occurred this week:

Davy Jones--The iconic singer from the 1960s pop group, the Monkees, suffered sudden cardiac death after a large heart attack, just hours after experiencing chest pain.

Andrew Breitbart--The conservative blogger and controversy-generating media personality suffered what was believed to be sudden cardiac death while walking.

It's a darn shame and it shouldn't happen. The tools to identify the potential for heart attack are available, inexpensive, and simple. The strategies to reduce, even eliminate, risk are likewise available, inexpensive, and cultivate overall health.

The followers of the Track Your Plaque program who

1) get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
2) identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
3) correct the causes

enjoy virtual elimination of risk.

My letter to the Wall Street Journal: It's NOT just about gluten

The Wall Street Journal carried this report of a new proposed classification of the various forms of gluten sensitivity: New Guide to Who Really Shouldn't Eat Gluten

This represents progress. Progress in understanding of wheat-related illnesses, as well as progress in spreading the word that there is a lot more to wheat-intolerance than celiac disease. But, as I mention in the letter, it falls desperately short on several crucial issues.

Ms. Beck--

Thank you for writing the wonderful article on gluten sensitivity.

I'd like to bring several issues to your attention, as they are often neglected
in discussions of "gluten sensitivity":

1) The gliadin protein of wheat has been modified by geneticists through their
work to increase yield. This work, performed mostly in the 1970s, yielded a form
of gliadin that is several amino acids different, but increased the
appetite-stimulating properties of wheat. Modern wheat, a high-yield, semi-dwarf
strain (not the 4 1/2-foot tall "amber waves of grain" everyone thinks of) is
now, in effect, an appetite-stimulant that increases calorie intake 400 calories
per day. This form of gliadin is also the likely explanation for the surge in
behavioral struggles in children with autism and ADHD.
2) The amylopectin A of wheat is the underlying explanation for why two slices
of whole wheat bread raise blood sugar higher than 6 teaspoons of table sugar or
many candy bars. It is unique and highly digestible by the enzyme amylase.
Incredibly, the high glycemic index of whole wheat is simply ignored, despite
being listed at the top of all tables of glycemic index.
3) The lectins of wheat may underlie the increase in multiple autoimmune and
inflammatory diseases in Americans, especially rheumatoid arthritis and
inflammatory bowel diseases (ulcerative colitis, Crohn's).

In other words, if someone is not gluten-sensitive, they may still remain
sensitive to the many non-gluten aspects of modern high-yield semi-dwarf wheat,
such as appetite-stimulation and mental "fog," joint pains in the hands, leg
edema, or the many rashes and skin disorders. This represents one of the most
important examples of the widespread unintended effects of modern agricultural
genetics and agribusiness.

William Davis, MD
Author: Wheat Belly: Lose the wheat, lose the weight and find your path back to health
All posts by william-davis

Summer in Wisconsin

It's been a glorious summer in Wisconsin.

For weeks straight, we've enjoyed bright, sunny days with temperatures in the 70s and 80s. Even now, in late September, our windows are wide open and the days are warm and sunny. Yesterday, it was 84 degrees. Yes, it did rain for a stretch of about 10 days in August, but for the most part it has been a wonderfully sunny summer.

So it struck Andy as a big surprise when we checked his 25-OH-vitamin D3 blood level: 15 ng/ml--severe deficiency.

"I don't get it. I'm outside almost every day. Look at me! How do you think I got this tan?"

Indeed, Andy sported a nice dark tan over exposed areas.

In fact, Andy was among the dozen or so people this month with deficiencies of this magnitude.

Deficiency is not the exception; it is the rule. Of course, if Andy's blood level is at the level of severe deficiency in September, he will only trend lower over the next few weeks and months. He would likely have shown vitamin D blood levels of <10 ng/ml by January--profound deficiency.

With deficiency of this severity, Andy has been exposing himself to risk for prostate and colon cancer, diabetes and metabolic syndrome, low HDL, higher triglycerides, higher blood sugars, higher C-reactive protein, osteoporosis, arthritis . . .

Correcting the deficiency is easy. But, as you can see, getting sun is not always the answer. Even with an active, outdoor lifestyle and a tan, Andy still remained significantly deficient. Oral replacement with vitamin D3, or cholecalciferol, is an absolute necessity.

Wacky statin effects

In general, I try to exhaust possibilities before resorting to the statin drugs. But we still do use them, both in general practice and the Track Your Plaque program.

There are indeed a number of ways to reduce, minimize, or eliminate the need for these drugs. For instance, if your LDL is 150 mg/dl but comprised of 90% small particles, then a reduction in wheat and other high-glycemic index foods, weight loss, fish oil, and niacin can yield big drops in LDL.

But sometimes we need them. Say LDL is 225 mg/dl and is a mix of large and small. Exercise, weight loss, niacin, oat bran, ground flaxseed, Benecol, etc. and LDL: 198 mg/dl. Alright, that's when statins may be unavoidable. There's also many people who are not as motivated as all of us trying to reverse heart disease. Some just want the easy way out. Statins do indeed provide that option in some people.

So in truth, we end up using these drugs fairly regularly. How common are muscle aches and fatigue? In my experience, they are universal . If taken long enough, or if high doses are used, muscle complaints are inevitable. Most of the time, thankfully, they're modest and often relieved with a change in drug or with coenzyme Q10 supplementation.












But there's more to statin side effects than muscle aches. Among the wacky effects that I have witnessed with statin drugs:

--Insomnia-especially with simvastatin (Zocor and Vytorin). Insomnia can be quite severe, in fact, with difficulty sleeping more than 3-4 hours a night.

--Bone aches--I don't know why this happens, unless it's somehow related to muscle aches. I've seen this with all the statins, but more commonly with Crestor.

--Memory impairment--a la Dr. Duane Graveline's wacky book, Lipitor: Thief of Memory. I've seen this with Lipitor, though it's uncommon, and less commonly with simvastatin (Zocor, Vytorin).

--Diarrhea--More common with Zetia and Vytorin (which contains Zetia), because of the inhibition of bile acid reabsorption.

--Migraine headaches--This I certainly do not understand, but the cause-effect relationship is undoubtedly true in an occasional person.

--Low libido--In men more than women, though it may be more due to men being more willing to admit to it.

--Increased appetite--Rare, though I've seen dramatic instances.

--Tinnitus--Ringing in the ears. I've only seen it with Lipitor and Zocor.


In their defense (and in general I am no defender of the drug manufacturers), most people do fine with statin drugs, though the majority do eventually require coenzyme Q10 in my experience. By the way, coenzyme Q10 can be an indispensable aid to help tolerate statin agents.

I'd love to hear about your wacky experiences.

Track Your Plaque goes global

I don't use this space to toot my horn (at least I don't too often), but we were looking at the listings of our viewers and members. I was surprised to learn that we now have Track Your Plaque followers in 15 different countries around the world!

We have members from Europe including England, Ireland, Switzerland, Belgium, and the Czech Republic. We have members from as far away as South Africa, Australia, India, Singapore, Thailand, and China.

I see the entire Track Your Plaque process as a grand experiment. Never before in history has a system of health been delivered via a communication medium like the web. The internet provides more interactivity than television, it's more fluid than a book, it's more dynamic and evolves more rapidly than a face-to-face interaction. While we cannot be hands-on over the internet, we can still deliver all the crucial information and, hopefully, the knowledge on how to get it done.



Track Your Plaque is part of an even grander experiment: The movement to shift control over health away from the medical system, doctors, and hospitals and back to individuals. When you think about it, the idea that "health" (more acurately sickness) should be managed by people and institutions (e.g., hospitals and insurance companies) outside of the individual is a 20th century concept. I predict that this notion will also become a relic of the 20th century.

Someday, we will look back and laugh at the folly of the 20th century style of paternalistic health care. Perhaps it was a necessary step in the sequence to transform health to a better system that returns control to the individual. But it's clearly time for a change.

Track Your Plaque is an example of the extraordinary power that can be taken by a lone individual with only minimal assistance of a health care provider. I see Track Your Plaque members who understand heart disease (at least the coronary disease aspect) far better than 95% of my cardiology colleagues, 100% of my internal medicine and family practice colleagues. Physicians maintain a role, but their role has shrunk and receded. They should be facilitators of success in health, educators, a resource to turn to when we need help. It's not that way today. It will be in 50 years.

But, right now, we can get started on this wonderfully self-empowering--liberating-- movement by participating in this global experiment known as Track Your Plaque, the program with the goofy name that has the potential to usurp and unravel this enormous institutionalized system of health care the world has created.

Go to your corners

There's a heated debate being waged on the Heart Hawk Blog

Dr. Melissa Walton-Shirley authored an editorial entitled It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome .

Heart Hawk's response:

Dr. Walton-Shirley feels the best use of time, talent, and money is to build more cath labs and train more people in how to use them so that IF you have a heart attack, you stand a better chance of being pulled back from the brink of death. Unfortunately, you have to first let people get so sick that they are about to die. My position is to use those same resources to prevent such disasters from happening in the first place. Take your pick. You cannot spend the money twice.

I am no stranger to "direct angioplasty," meaning performing immediate coronary angioplasty (with stenting) for heart attack. Since 1990, I have personally performed hundreds, perhaps over a thousand of these procedures, particularly when I was younger and my practice was procedurally-focused. But, after a few years, I quickly recognized the futility of this approach. Yes, you might have aborted a heart attack ,perhaps even saved a life at the brink of death. But wouldn't it have been better to have prevented the entire episode in the first place?

In my mind, putting a cath lab on every corner, as Dr. Walton-Shirley suggests, is like having a fire truck on every street to prevent a house from burning down. It's an enormously expensive proposition that provides no incentive to prevent fires. Why not spend the money on preventing the fires?

Expanding access to cath lab procedures is putting the fox in the henhouse. Procedures yield money--big money--for hospitals and cardiologists. Guess what happens when you build facilities that exceed the need? Yes--the number of procedures grows, whether or not they were needed.

In my view, Dr. Shirley-Walton's opinions are symptomatic of the profit-driven, procedurally-focused quick-fixes that divert money that would be far better spent on effective dissemination of preventive practices.

When niacin doesn't work

Dan had the usual collection of metabolic syndrome lipoprotein abnormalities:

low HDL of 28 mg/dl, triglycerides 280 mg/dl, 90% of his LDL particles were small.

Along with elimination of wheat and junk foods, exercise, and fish oil, I asked Dan to add niacin. I usually ask people to buy SloNiacin and begin at 500 mg per day with dinner, increased to 1000 mg per day at dinner after 4 weeks.

Dan came back several months later. His lab results:

HDL 40 mg/dl, triglycerides 76 mg/dl.

(We didn't repeat the full lipoprotein analysis, so no small LDL value was available.) Better, though still some room for improvement. I urged Dan to stick to his program, lose some more weight off his 260 lb frame, exercise, be strict about the wheat products.

Dan returned another few months later. Lab results:

HDL 29 mg/dl, triglycerides 130 mg/dl.

Dan had lost another 8 lbs and was reasonably compliant with his diet.

What's going on here? Why would he backtrack on HDL and triglycerides despite sticking to his program?

I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

Aha! It's no wonder. "No-flush" niacin, or inositol hexaniacinate, is an outright scam. It has virtually no effect on lipids or lipoproteins in humans. It's therefore no surprise that, by replacing real niacin with the no-flush variety, Dan's blood patterns began to revert back to their original state.

Let me be straight on this: No-flush niacin is a scam. It does not work: it does not raise HDL, reduce triglycerides, nor reduce small LDL. It's expensive, too, far more expensive than the real thing. It has no business being sold by stores like Sam's Club or your health food store.

SloNiacin (Upsher Smith) has become our preferred preparation. (I obtain no compensation of any sort for saying so.) We buy it at Walgreen's.

Niacin and blood sugar

We've been engaging in a conversation on the Track Your Plaque Forum on whether niacin raises blood sugar.

Yes, it does. In the vast majority of instances, however, the rise is trivial and without consequence. Typically, someone will start with a borderline elevated blood sugar of, say, 108 mg/dl. Niacin, 1000 mg per day, then raises blood sugar to 112 mg/dl. This small increase does not oblige any specific action, nor does it pose any excess risk.

Blood sugars in the normal range of <100 mg/dl tend not to show this effect. Higher blood sugars, e.g., 130 mg/dl, may show a more exagerrated effect but it is also rarely of great consequence. People who take medications for adult type II diabetes, or people with childhood-onset, type I diabetes will also experience rises in blood sugar. This is a somewhat larger issue in these people.

Niacin is best undertaken with a change in diet, specifically a reduction in processed carbohydrate foods, particularly evil and ubiquitous wheat products.This will often compensate for the blood sugar effect.

Niacin also shares many of the benefits of weight loss: rise in HDL, drop in triglycerides and small LDL.

Keep it all in perspective: If HDL is low, e.g., 30 mg/dl, or there is a significant small LDL pattern, or you have Lp(a), using niacin--vitamin B3--is quite safe and the most effective treatment we have. It's also a vitamin. Also recall the famous HATS Trial of simvastatin and niacin: simvastatin (Zocor) reduced heart attack risk 30%; adding niacin reduced heart attack risk an astounding 90%.

Very few strategies can yield the enormous benefits, both as a stand-alone treatment or in combination with others, that niacin can, whether or not blood sugar creeps up a few milligrams.

Statin drugs and Coenzyme Q10

I am continually impressed at how few of my colleagues take advantage of a wonderful nutritional supplement, Coenzyme Q10 (CoQ10).

Despite some of the recent backlash against statin agents, I do believe that they serve a role. I take issue with the pharmaceutical industry's endless advertising and force-feeding of drugs to the public and to physicians. Nonetheless, statin agents do serve a purpose.

If you go to your doctor with a fever of 103 degrees, coughing up thick yellow sputum, and you are struggling to breathe, would you refuse an antibiotic for pneumonia? Probably not. But an antibiotic for a sore throat may be a different matter.

So it goes with the statin drugs, too. An otherwise healthy 50-year-old woman with an LDL cholesterol of 140 mg/dl probably does not need a statin drug. A 35-year-old man with heterozygous hypercholesterolemia with an LDL cholesterol of 280 mg/dl, who will develop his first heart attack within the next 2 or 3 years, does need these drugs. The rub, of course, is deciding who in between also needs them.

Let's just accept that some people do indeed need a statin drug for one reason or another. How common are the muscle aches?



In my experience, muscle aches are inevitable. The longer you take a statin drug, the more likely you will develop them. The higher the dose, the more likely.

Thankfully, for most people muscle aches are more of a nuisance than a real danger. Usually, a reduced dose of the drug, periodic breaks from the drug (we often advise one or two weeks off every three months), or a change to another agent helps.

However, in my view, coenzyme Q10 provides a virtual antidote to most of the muscle aches and weakness. A recent review was published in the Journal of the American College of Cardiologist that concluded that there was insufficient evidence to support the use of CoQ10 for this purpose. Obviously, the authors do not use CoQ10 in everyday practice. If they did, they would have no doubt whatsoever that CoQ10 provides the majority of people with complete relief of the muscle complaints.

Time and time again, I have witnessed complete relief from muscle aches and muscle weakness from statin drugs using CoQ10. However, in our experience, a dose of at least 100 mg per day needs to be maintained. Occasionally, a higher dose will be necessary, e.g., 300 mg per day. The preparation also must--MUST--be an oil-based gelcap to work (just like vitamin D). The capsules that contain powder are so poorly absorbed that they usually fail to yield the needed effects.

Pictured is the Sam's Club (Members' Mark brand) that has served us well, providing reliable effects at a reasonable price. (CoQ10 is expensive, no matter where you buy it. That's the only drawback I'm aware of.) GNC has a great preparation, as does Life Extension. Just be sure it is a gelcap, not a capsule filled with powder.

There's more to CoQ10 than relief of statin muscle aches. More about that in future.

More Andy Kessler



I can't help but quote a few more passages from Andy Kessler's irreverent but nonetheless insightful book, The End of Medicine. I find his quotes irresistible because I believe that he is (unintentionally) describing precisely what we are doing in the Track Your Plaque program:


"Maybe the jig is up on the cholesterol conspiracy. Any real scientist running studies on cholesterol drugs would not just check to see if participants in the study had a heart attack. You would scan, check for plaque, provide drugs, scan again, see if the plaque increased or decreased, repeat. Instead, we have a multibillion-dollar statin business based on vagaries and deception."


Kessler cuts to the chase on that one. Except we do it with a lot of things beyond drugs.


"256-slice scanners, faster than your heartbeat, just might be the magic pill of diagnosis. It's as if doctors will be saying I was blind before i could see. . . Six blind doctors feeling around an elephant and describing a wall, spear, snake, tree, fan and a rope. Looking for clues in all the wrong places. Measuring cholesterol and blood pressure is like reading the outside temperature and humidity from inside your house and guessing if it's raining. Open the window, stick your goddamn hand outside and know for sure.

How much do these scans have to cost to become widespread? $500? $100? $20? It almost doesn't matter. The savings come over time. Spread the R&D over millions and you get scale. It works.

. . . what if the spending was on detection instead of intervention? With some breakthrough, the economic consequences can be staggering. if medicine as we know it is replaced by health monitoring, hmmmm . . ."



Get beyond his humor and you see that Kessler shares our appreciation of the futility of cholesterol testing for predicting your heart's future. He advocates early detection, no surprise.


And lastly:

"I go to conferences about wikis and Wi-Fis, podcasts and blogs, and I always leave with an empty feeling, bored to tears. It's all great stuff, but technology somehow seems gripped with incrementalism. It's all really neat and cool and wow, but somehow predictable. Gee, in five years we'll have cheap terabyte drives so that we can, what, watch Simpsons reruns and shop more efficiently?

Forget that. It's all about taking control. One by one, industries are being democratized. Power is shifting from producers and service providers to users. . . Power to the people--everywhere except medicine . . . With the right tools, we'll all take control."


Amen. He's right. Taking control of health care out of the hands of the doctors and putting it in your own hands. But you are going to need better tools, more information, and guidance.

I couldn't have said it any better.

The End of Medicine




"It's not about staying young--it's about staying healthy. They say 60 is the new 50. If you stay healthy, got a good ticker lay off tobacco, are lucky enough to avoid some weird cancer, you can kick up your heels, keep running your company, or better yet, travel the world, hike a mountain, ski Zermatt--heck, Tony Randall even started a new family.




But that's a big if. We pump ourselves with cholesterol-lowering drugs as if that was the magic elixir. Not so simple.

Instead, our skin is getting peeled back for a quick look inside. This is the end of medicine as we know it. Don't guess that I might have hardening of the arteries. Open me up and take a look. Don't guess that I don't have cancer because I'm not spitting up blood or growing a tumor the size of a grapefruit out my side."



If you can get beyond some of the frat-boy joking in the book, you will see that the author, Andy Kessler, actually acquires some pretty canny insights into the future of medicine in his book, The End of Medicine.

It's a book not about the end of medicine, but about the end of medicine as we know it today: the doctor by the bedside, the treating-when-symptoms-appear approach that characterizes current practice.

Instead, Kessler predicts that new technology will supplant the role of doctor-as-gatekeeper and decision-maker. Early detection is key. He picked up on that right away, as his quote above shows.

Despite the sophomoric humor, I was impressed that much of the Track Your Plaque approach--online, self-empowered, based on the concept of early detection followed by practical and effective tools for correction, involving your doctor only peripherally--is what Kessler is trying to articulate.

In actuality, I would not necessarily recommend his book, unless you need a light moment and some fodder for thinking about our health future. But he does have some startling insights for a guy who just invests money and has no real health background.


Another excerpt:

CT Anxiety

I always feel a certain anxiety when I walk into the Hyatt Regency at the bottom of California Avenue in San Francisco. The cutsie Trolley car outside, the Embarcadero tile pattern on the sidewalk — they are all part of the package. But as I've done every time I've been there, I head straight into the lobby, tilt my head back and scan the Escher-like floors, starting at the top and then down and outwards to the bottom until I start feeling dizzy. I thank Mel Brooks for this.

This guy was zooming through someone's brain like it was a Sunday drive. More like a Sunday afternoon video game.

With my head spinning from this "High Anxiety" flashback, I stroll into the conference, half expecting to be given a barium enema by a cross between Nurse Diesel from Mel Brooks' flick and Nurse Ratched from One Flew Over The Cuckoo's Nest. I really gotta switch to decaf on days like this.

The 7th International Multi-Detector Row Computed Tomography Symposium sounded innocuous enough. I assumed it would be a bunch of technical papers on the future of scanning, where I would read the paper in the darkened hall until lunchtime and then head off for some hot Hunan and home.

Instead, the place was like a carnival for cardiologists.



Kessler has, in Silicon Valley style, left a wide wake of electronic content to get a better view of his ideas. There is a podcast located on the InstaPundit site that you can listen to at: http://podcasts.instapundit.com/AndyKessler.mp3, that provides some more of this irreverent but out-of-the-box thinker's thoughts.

Life Extension article on vitamin D


For anyone looking for a discussion about the emerging role of vitamin D as a cause for coronary disease, see my recent article, Vitamin D’s Crucial Role in Cardiovascular Protection, in Life Extension Magazine, now posted online at:

http://www.lef.org/magazine/mag2007/sep2007_report_vitamind_01.htm.




Vitamin D has assumed an absolutely critical role in the Track Your Plaque program for coronary plaque reversal and dropping CT heart scan scores. Since adding vitamin D and aiming for blood levels of 50-60 ng/ml, our success rate has skyrocketed. In fact, I wonder just how well our two most recent record holders--51% and 63% drops in heart scan scores--would have fared without it. (They probably would have dropped, but no where near as much.)

Also, a full-length booklet that contains just about everything you want to know about vitamin D (or at least a right-this-moment summary of what is known about it) will be available to Track Your Plaque Members for free before the end of the year.

If you haven't done so already, DO THE D!!