All posts by william-davis

Here's a telling situation.

Liz had been on prescription niacin, Niaspan, 1500 mg per day (3 x 500 mg tablets) for several years to treat her severe small LDL pattern and familial hypertriglyceridemia (triglycerides 500-1000 mg/dl). Because her health insurance had been paying for the "drug," she insisted on taking the prescription form.

A change in insurance, however, meant that the Niaspan was no longer covered. Her pharmacy wanted to charge $227 per month.

Liz came to the office in tears, worried that she was going to have to choke up $227 per month. I reminded her that, as I had told her several years ago, she could easily replace the Niaspan with over-the-counter Sloniacin or Enduracin. Both release niacin over approximately 6 hours, just like Niaspan.

Here are the prices I've seen with Sloniacin, 100 tablets of 500 mg:

Walgreens: $15.99
Walmart: $12.99
Costco: $8.99

So the most expensive source, Walgreens, would cost Liz just under $15.99 per month to take 1500 mg per day.

$15.99 versus $227.00 per month for preparations that are highly similar. Hmmmmmm.

I wonder what the $211.01 extra per month goes towards? Admittedly, Abbott Labs, the current company selling Niaspan (after Abbott acquired Kos), has invested in a few clinical trials, such as ARBITER-HALTS6. But does supporting research justify this much difference, a difference that amounts to $2532 over a year? If just 100,000 patients are prescribed Niaspan at this dose (a typical dose), this generates $253 million.

Is the cost of developing and marketing a supplement-turned-drug that great? Is this justifiable? Is it any wonder that our health insurance premiums continue to balloon?

I use Sloniacin and Enduracin almost exclusively.

A crucial component of self-empowerment in healthcare is to be able to measure various health parameters. More and more measurement tools are entering the direct-to-consumer arena.

Quantification of various phenomena is important in managing many aspects of health. Imagine a carpenter trying to build a house without the use of a tape measure, level, or other measuring tools. In health, as in building a house, measurement, adjustment, and correction are critical.

Among the most helpful health measurement tools:

Blood glucose meters--Blood glucose meters aren't just for diabetics. They are among the most powerful weight loss tools available.

Blood pressure cuffs--There's no better way to assess blood pressure than to assess it under all the varied conditions of life: When you're tired, when you're excited, when you're upset, when you're happy, hungry, stomach full, morning, night. This is a lot better than the one isolated measure in the doctor's office.

Digital thermometers--Your first a.m. oral temperature is a great way to assess thyroid status. We aim to maintain first a.m. oral temperature around 97.3 degrees F, the normal human temperature upon arising that reflects normal thyroid function. (No, Dr. Broda Barnes fans, axillary temperatures should NOT be used due to flagrant variation from right armpit to left armpit, modifying effects of clothing and ambient temperature, etc. Oral temperature tracks internal, "core," temperature fluctuations reliably, including circadian variation, far better than axillary temperatures.)

Fingerstick blood tests--An incredible number of blood tests are now available just by performing a simple fingerstick in your kitchen or bathroom. You can get 25-hydroxy vitamin D, lipids, thyroid measures (TSH, free T3, free T4), hormones (DHEA, testosterone, estrogens). And the list is growing rapidly. Salivary tests are also growing in number for many of the same measures.

A variation on fingerstick blood tests are devices like CardioChek that allow you to do a fingerstick, but also run the test on your own device at home. (The CardioChek device tests total cholesterol, triglycerides, and HDL.)

Urine pH--You can dipstick your own urine to assess the relative acidity or alkalinity of your lifestyle. Acid pH (7 or below) suggests that diet is weighed too heavily in favor of animal products and grains. An alkaline pH (above 7) suggests plentiful vegetables and fruits, not counteracted by animal products and grains.

There are many more, including the ZEO device to monitor sleep quality, RESPeRATE for reduction of blood pressure, HeartMath to manage stress and augment the parasympathatic (relaxation) response. We've come a long way compared to the health monitoring devices of just 25-30 years ago.

Anyway, that's a partial list. Given the rapid advances in technology that allow such home tests, I anticipate a much longer list in the coming few years.

For some perspective on how far these devices have come, here's a great graphic of an early sphygmomanometer, or blood pressure gauge.

Courtesy Wellcome Library, London

Jack needed to lose weight.

At 5 ft 7 inches, he weighed in at 273 lbs, putting his BMI at a sobering 42.8. (A BMI of 30 or above is classified as "obese.") In addition to lipoprotein(a), Jack had an extravagant quantity of small LDL (the evil "partner" of lipoprotein(a)), high triglycerides, and blood sugars in the diabetic range. With a heart scan score of 1670, Jack had little room for compromises.

Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order.

So I taught Jack how to check his blood sugars using a fingerstick device, what I call the most important weight loss tool available. I asked Jack to check his pre-meal blood glucose and his one-hour after-meal blood glucose and not allow the after-meal blood glucose to rise any higher than the pre-meal. For example, if blood glucose pre-meal was 115 mg/dl, after-meal blood glucose should be no higher than 115 mg/dl.

If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.

Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.

What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise.

Six months later, Jack came back 37 lbs lighter. And he got there without calorie-counting, without regulating portion sizes, without hunger.

You won't find this in any publication nor description (at least ones that I've come across) about the ubiquitous small LDL particles. It's an observation I've made having obtained thousands of advanced lipoprotein panels of the sort that break lipoproteins down by size. I've discussed this issue previously here. But small LDL is so ubiquitous, not addressed by conventional strategies like statin drugs or fat restriction (it is made worse, in fact, by reducing fat in the diet), that it is worth keeping at the top of everyone's consciousness.

(Because most of the lipoprotein analyses performed in my office are done via NMR, I will discuss in terms relevant to NMR. This does not necessarily mean that similar observations cannot be made with centrifugation, i.e, VAP from Atherotech, or gel electropheresis from Berkeley, Boston Heart Lab, Spectracell, and others).

There are two basic varieties of small LDL particles:

1) Genetically-programmed--e.g., via cholesteryl-ester transfer protein (CETP) activity
2) Acquired--via carbohydrate consumption

It means that people with acquired small LDL from carbohydrate consumption can reduce small LDL to zero with reduction of carbohydrates, especially the most small LDL-provoking foods of all: wheat, cornstarch, and sucrose.

It also means that people who have small LDL for genetically-determined reasons can only minimize, not eliminate, small LDL. By NMR, we struggle to keep small LDL in the 300-600 nmol/L range when genetically-determined. (People typically start with 1400-3000 nmol/L small LDL particles prior to diet changes and other efforts.) We can only presumptively identify genetically-determined small LDL when all the appropriate efforts have been made, including reduction in weight to ideal, yet small LDL persists.

Here is where we need better tools: when you've done everything possible, yet small LDL persists.

While we break LDL particles (NOT LDL cholesterol, the crude and misleading way of viewing atherosclerosis causation) down by size, it's really about all the undesirable characteristics that accompany small size:

--Distortion of Apo B conformation--i.e., the primary protein that directs LDL particle fate is distorted, making it less likely to be cleared by the liver but more likely to be taken up by inflammatory (macrophages) in the artery wall, creating plaque. It means that small LDL particles linger for a longer time than larger particles.

--Small LDLs are more oxidation-prone. Oxidized LDL are more avidly taken up by inflammatory macrophages.

--Small LDLs are more glycation-prone.

--Small LDLs are more adherent to structural tissues, e.g., glycosaminoglycans, that reside in the artery wall.

You and I cannot measure such phenomena, so we resort to distinguishing LDL particles by size.

The drug industry believes it may have a solution to small LDL in the form of CETP-inhibiting drugs, like anacetrapib. In the way of nutritional solutions beyond carbohydrate reduction, weight loss/exercise, niacin, vitamin D normalization, and omega-3 fatty acid supplementation, there are exciting but very preliminary data surrounding the possibility that anthocyanins may inhibit CETP activity. Having toyed with this concept for the past 6 months, I remain uncertain how meaningful the effect truly is, but it is harmless, since we obtain anthocyanins from foods colored purple or purplish, such as blackberries, blueberries, cherries, red leaf lettuce, red cabbage, etc.

I welcome any unique observations on this issue.

Ooops!

Anyone who receives this blog via RSS feed may have received the Wheat-free pumpkin bread recipe in which I failed to list the pumpkin in the list of ingredients.

Here's the recipe with all the ingredients.

Try this recipe for a wheat-free, gluten-free yet healthy "bread." Unlike many gluten-free foods that send blood sugar skyward, this will not.

Ingredients:
2 cups ground almond meal (Buy it from Trader Joe's--70% cheaper than other grocery stores.)
1/2 cup ground flaxseed
1/2 cup sour cream (full-fat, of course)
15 oz canned pumpkin (Trader Joe's is bisphenol A-free)
2 medium to large eggs
1/2 cup chopped walnuts or pecans
4 tablespoons butter, melted
2 teaspoons baking powder
2 teaspoons cinnamon
1 teaspoon nutmeg or allspice
Dash of salt
Choice of non-nutritive sweetener (I used 3 teaspoons Trader Joe's stevia extract powder, the one mixed with lactose. Two tablespoons of Truvia, 1/2 teaspoon of the more concentrated stevia extract, or 1/2 cup Splenda are other choices. You can taste the mixed batter to gauge sweetness if in doubt.)

Preheat oven to 350 degrees F. Grease baking pan (e.g., 10 x 6 inch). The pan should be big enough so that the mix will not be more than 2 inches deep, else it will require much longer to bake. (If you have only smaller pans, you will need to cook longer while the pan is covered with aluminum foil.)

Mix all ingredients thoroughly in large bowl. Pour mix into greased baking pan.

Cover with aluminum foil and bake for 30 minutes. Remove foil and bake for additional 30 minutes or until inserted toothpick or knife comes out dry.

Serve with cream cheese or as is.

(I'd have some pictures, but the kids and I ate it up before I thought to take any photographs.)

Dr. James Dowd of the Vitamin D Cure posted his insightful comments regarding the Institute of Medicine's inane evaluation of vitamin D.

Dr. Dowd hits a bullseye with this remark:

The IOM is focusing on deficiency when it should be focusing on optimal health values for vitamin D. The scientific community continues to argue about the lower limit of normal when we now have definitive pathologic data showing that an optimal vitamin D level is at or above 30 ng/mL. Moreover, if no credible toxicity has been reported for vitamin D levels below 200 ng/mL, why are we obsessing over whether our vitamin D level should be 20 ng/mL or 30 ng/mL?

Yes, indeed. Have no doubts: Vitamin D deficiency is among the greatest public health problems of our age; correction of vitamin D (using the human form of vitamin D, i.e., D3 or cholecalciferol, not the invertebrate or plant form, D2 or ergocalciferol) is among the most powerful health solutions.

I have seen everything from relief from winter "blues," to reversal of arthritis, to stopping the progression of aortic valve disease, to partial reversal of dementia by achieving 25-hydroxy vitamin D levels of 50 ng/ml or greater. (I aim for 60-70 ng/ml.)

The IOM's definition of vitamin D adequacy rests on what level of 25-hydroxy vitamin D reverses hyperparathyroidism (high PTH levels) and rickets. Surely there is more to health than that.

Dr. Dowd and vocal vitamin D advocate, Dr. John Cannell, continue to champion the vitamin D cause that, like many health issues, conradicts the "wisdom" of official organizations like the IOM.

Chad is a 43-year old father of five kids.

Earlier this year, he developed chest pain that got worse and worse. He ended up with a total of five stents in all three coronary arteries. After a devastating experience with Lipitor that resulted from a ruptured tendon, he came to me for an option.

Chad's lipoproteins:

I have been impressed with the results I've been obtaining with Fred Hahn's Slow Burn strength training technique.

Because I have limited time to hang around the gym, any technique that provides outsized results in a limited amount of time, I have to admit, appeals to me. In past, I'd be lucky to squeeze in one or two strength training sessions per week, devoting the rest of the time to biking outdoors, biking on a sedentary bike (while playing XBox), jogging, or doing strenuous yard work like digging trenches and planting shrubs.

Over the years, I've gradually lost muscle, since the strength training effort suffered with my time limitations.

So Fred's time-efficient Slow Burn idea struck a chord. Having now done it with some regularity, usually 1-2 times per week since mid-September, I have gradually added back visible muscle. My Slow Burn workouts, involving 8-10 different movements, seem to have restored the muscle I've lost, with a very modest time effort.

It took a little getting used to. After Fred showed me how to do the movements--slow motion movement in both the "positive" and "negative" directions, with smooth, non-jerking transitions, one set per muscle group, each taken to muscle exhaustion--it left me unusually tired and sore the next day. This surprised me, given the limited time involved. Breathing is also very important; the usual exhale-during-the-positive, inhale-during-the-negative pattern is replaced by breathing freely during the entire set. I didn't get this at first and ended up with headaches that got worse with each set. Breathing freely relieved me from the effect.

I have strength trained since I was around 15 years old. Back in the early 1970s, I had about 2000 lbs of barbells and dumbbells in my garage in New Jersey, while also driving back and forth to the Morristown, NJ, YMCA to train with friends. The Slow Burn movements forced me to break habits established over nearly 40 years of conventional strength training.

I've also played around with mixing conventional movements with Slow Burn movements to keep it fresh. This also seems to work.

If you're interested in giving it a try, here's an animation that demonstrates what Slow Burn movements look like. Fred has also produced an excellent 3-DVD set of videos that more fully describe the practice.

While many of the factors that drive the relentless increase in health care costs are beyond individual control, you are still able to exert personal influence over costs. Just as in political elections, your one vote alone may not count; it's the collective effort of many people who share similar opinions that results in real change.

I just got the new monthly premium for my high-deductible health insurance: Up $300 per month, putting my family's total premium over $2000 per month---for four healthy people. (My son fractured his wrist playing high school hockey earlier this year; that may explain at least some of the increase.)

I'm going to shop around for a better deal. However, shopping is likely to only stall the process. It will not address the systemic problems with healthcare that continue to drive premiums up and up and up.

So what can you do to help keep costs down? Here are a few thoughts:

Never accept a prescription for fish oil, i.e., Lovaza. Just buy far less costly over-the-counter fish oil. I treat complex hyperlipidemias, including familial hypertriglyceridemia, ever day. I NEVER use prescription fish oil. A typical 4 capsule per day Lovaza prescription adds around $280 to $520 per month to overall health costs (though your direct out-of-pocket costs may be less, since you shove the costs onto others in your plan).

Never accept a prescription for vitamin D. Prescription vitamin D is the mushroom or invertebrate form anyway. Just buy the human (cholecalciferol, D3) form from your health food store or "big box" store. They yield consistent increases in 25-hydroxy vitamin D levels, superior to the prescription form. And they're wonderfully inexpensive.

Eliminate wheat from your diet. If there is a dietary strategy that yields unexpected and outsized benefits across a wide spectrum of health, it's elimination of this thing we're sold called "wheat," you know, the genetically-transformed, high-yield dwarf mutant that now represents 99% of all wheat sold. Blood sugar drops, pre-diabetics become non-prediabetics, diabetics reduce need for medication or become non-diabetic, cholesterol values plummet, arthritis improves, acid reflux and irritable bowel symptoms improve or disappear, just to mention a few. Wheat elimination alone, I believe, would result in incalculable savings in both healthcare costs and lives saved.

Be sure to obtain iodine. In the fuss to cut salt use, everyone forgot about iodine. Lack of iodine leads to thyroid disease, usually hypothyroidism, that, in turn, causes cholesterol values to increase, weight to increase, and heart disease risk to double, triple, or quadruple. Iodine supplementation is easy and wonderfully inexpensive.

Over time, I hope that all of us can help develop the effort to self-direct more and more of our own health. Our Track Your Plaque program has shown me that, not only can people take the initiative to direct aspects of their own health, they can do it better than 99% of doctors.

I'm sure there are many, many other ways to help reduce costs. Any suggestions?

As a practicing cardiologst, every day I receive a dozen or more magazines or newspapers targeting practicing physicians, not to mention the hundreds of letters, postcards, invitations to "talks", etc. that I receive. All of these materials share one common goal: To get the practicing cardiologist/physician to insert more of a manufacturer's stents, defibrillators, prescribe more of their drugs, etc.

This is a highly effective and profitable area. Pfizer's Lipitor, for instance, generated $12.2 billion just last year alone. This kind of money will fund an extraordinary amount of marketing.

I'm on the www.heart.org mailing list, a website for cardiologists. I'd estimate that 90% or more of their content is device-related: discussions of situations in which to insert stents, the expanding world of implantable devices, the ups and downs of various drugs. Rarely are discussions of healthy lifestyles, exercise, nutritional supplements, part of the dialogue.

How can you protect yourself from the brainwashed physician, flooded with visions of all the devices he can put in you, all the drugs that can "cure" your disease? Simple: information. Be better informed. Ask pointed questions. The idiotic lay press tells you to ask a doctor about his education. That's not generally the problem. Some of the best educated doc's I know are also the most flagrantly guilty of profiteering medicine.

Ask your doctor about his/her philosphy about the use of medications, devices, etc. If their word is God, take it or leave it, run the other way.

Several people have asked me lately if radiation is truly dangerous. These conversations were sparked by an editorial comment made on a column I wrote for Life All posts by william-davis

Vitamin D deficiency is rampant

12. May 2006 William Davis (0)

Today alone I've seen several people with severe deficiencies of vitamin D.

We're now checking everyone's blood vitamin D level at the start of the program. The measure that most accurately reflects your vitamin D status is 25-OH-vitamin D3. This is very confusing to many physicians, who traditionally have thought of 1,25-di-Hydroxy vitamin D3 as the standard test to measure. What they're failing to recognize is that this second measure is a kidney product, not a reflection of vitamin D status.

Using 25-OH-vitamin D3, several people today alone had levels of <10 ng/ml, clearly in the category of severe deficiency (generally regarded as <20ng/ml).

The majority of people we see in the office are Wisconsin residents. It's no wonder they're deficient. Although it's mid-May, we've seen the sun only a handful of days this year. And most of the days have been too chilly to wear short sleeves and shorts to permit sufficient surface area for UV exposure.

Living in a sunny climate, however, is no guarantee that you have sufficient blood vitamin D levels. Two recent studies have shown that 30-50% of the residents of sunny southern Florida and Hawaii are also deficient. (Why, I'm not sure.)

Although our experience thus far is anecdotal in several hundred people, my impression is that people who have normal blood levels of vitamin D (we regard normal as 45-50 ng/ml) have a far easier time of halting or regressing coronary plaque.

Vitamin D is among the most exciting nutritional tools we've come across in a long time. The conversation is making the media, which impresses me tremendously, given the fact that nobody stands to profit financially to any significant degree through vitamin D supplementation.

For a wonderful collection of discussions on vitamin D, go to Dr. John Cannell's website, www.vitaminDcouncil.com. You'll find a huge quantity of scientific background and conversation on the whole idea. I believe you will be thoroughly impressed with just how powerful the argument in favor of vitamin D has become.

What if wheat products were illegal?

11. May 2006 William Davis (3)

Imagine if anything made of wheat were illegal: bread, bagels, crackers, pasta, pretzels, donuts, Shredded Wheat cereal, Raisin Bran, pastry, cookies, cakes, cupcakes. . . Your grocery store would then be unable to carry any of these products.

How empty would the grocery store shelves be?

There would be very little. The stores would be filled instead with vegetables and fruits, meats, and dairy products. But aisle after aisle would be empty. There'd be no cereal aisle. There'd be no snack chip aisle. The ordinarily overcrowded bread shelves wouldn't be there.

Bakery? Nope, not there either. Pasta and noodles? Empty. How about cakes and pastries? Also gone.

Getting the picture? American groceries are dominated by wheat products. What would happen to your health and the health of your family if wheat were abruptly removed from your choices? Would you be less healthy?

No. In fact, your health would be hugely improved. You'd lose a significant quantity of weight. Extraordinary numbers of people would lose diabetic or pre-diabetic tendencies. Feelings of sluggishness, sleepiness, and moodiness would dissolve. Blood pressure would be reduced. The incidence of cancer, skin disease, and inflammatory diseases would plumet.

From a plaque control perspective, your HDL cholesterol would rise, triglycerides drop. Small LDL would improve dramatically.

The message: Slash wheat products from your diet. Yes, you'll miss the smell and taste of freshly baked bread. But you'll do it for many more healthy years. And you may do it without a 14 inch scar in your chest.

The sobering tale of small LDL

10. May 2006 William Davis (0)

Every day, I learn to respect small LDL more and more.

Small LDL particles, and its evil partner, low HDL, is among the most common reasons why someone fails to fully gain control of coronary plaque and heart disease risk.

Just yesterday, I saw a slender businessman (6 feet 1 inch in height, 186 lb.) whose small pattern persisted despite niacin, fish oil, oat bran, and raw almonds. We generally think of small LDL as an overweight person's pattern, but in some people the genetics are quite powerful and it can be expressed even in slender people.

The solution: More physical activity and exercise; cut back on processed carbohydrates, particularly wheat products like breads, pasta, crackers, breakfast cereals; think about magnesium (see our two recent reports on magnesium on the www.cureality.com membership website, the latest report to be posted this week); be sure sleep is adequate (gauge this by whether you're energetic during the day and don't fall asleep watching TV or movies). Lack of sufficient physical activity in people with sedentary jobs is probably among the most common reason the small LDL pattern persists.

Ignore small LDL and it can be like a hidden cancer in your body, growing and metastasizing (not literally, of course), fueling coronary plaque growth. Be sure your doctor assesses whether you have small LDL if you hope to gain control of your coronary risk.

Burn off the fat

9. May 2006 William Davis (0)

If you've ever wondered just how many calories you're burning with various activities like yard work, driving, climbing stairs, etc. go to this great website that will calculate it for you: http://www.caloriecontrol.org/exercalc.html.

Here are some examples:

Dancing for 30 minutes(fast, e.g., tango): 193 calories
Yoga for 30 minutes: 204 calories
Washing the car for 30 minutes: 173 calories
Vacuuming for 30 minutes: 88 calories

(All are for a 170 lb person.)

As you see, physical activity does not necessarily have to consist of exercise. It doesn't require fancy equipment or expensive outfits. But it does require you to keep moving. Sedentary work is among the most common reasons I see in my patients for failing to control weight and its associated lipoprotein patterns, like low HDL and small LDL.

If your work is sedentary, then a minimum of 60 minutes of physical activity per day is necessary to begin to correct weight-related patterns. If you gauge by calories burned, then a useful goal is 500 calories per day in physical activity--at a minimum.

Go the distance!

8. May 2006 William Davis (0)

How long should it take to stop or reverse coronary plaque growth? How long will it require to stop your heart scan score of, say, 350, from increasing at the expected rate of 30% per year, slow it down (we say "decelerate") to less than 30%, or stop it altogether? Or, actually reduce your score?

It can vary widely. Several simple patterns do seem to emerge, however. Our experience is that lower scores, particularly less than 100 at the start, are easier to gain control over. Scores of 50 or less, in fact, commonly can return to zero.

Higher scores, particularly those >1000, are more difficult to slow or reduce, though we've done it many times. You'll generally have to try harder and it may take longer. It's not uncommon to not stop plaque growth with a starting score this high until your 2nd or 3rd year of effort.

Sometimes it may take even longer. An occasional person requires four or five years to gain control. And there are, unfortunately, some people who never really gain complete control. They slow plaque growth compared to what it would have been with conventional efforts, but never completely halt growth. Why? Sometimes it's a matter of less than full commitment. Other times, we just don't know. Thankfully, these especially difficult cases are few and the majority enjoy substantial slowing or reversal.

Since, in some people, success may take time, you've got to stick it out. Have you ever gotten lost in a strange city only to find out later that the place you were looking for was right around the corner? It can be the same way with stopping coronary plaque growth. If you start with a score of 1000 and, after two years of effort, you've only slowed growth to 11% per year and then give up in frustration, you may have missed the opportunity to have stopped growth entirely in your third year.

All we can do is tip the scales heavily in your favor. We provide you with the best tools known. You've got to provide the commitment, the consistent effort of taking your supplements or medication, making the lifestyle changes, choosing the right foods and avoiding the wrong ones. But you've got to go the distance and not give up too easily.

What you need is an expert in health!

5. May 2006 William Davis (0)

Where can you find an expert in health?

In my experience, they're hard--very hard--to find.

Your hospital? Certainly not the hospitals I know. The hospitals I know are experts in disease, but not in health. Hospitals are helpful when you're sick. But if you're well and would like to stay that way, there's no reason to hang around a hospital. Prevent cancer, prevent heart disease, stay well? There's no place for this conversation in a hospital.

In fact, hospital staff are among the most unhealthy people I come across. Obesity is a nationwide problem affecting millions of Americans. But it's especially a problem among people who work in hospitals. I shudder in horror when I go to a hospital cafeteria and witness the sorts of food they serve in hospitals and see what the staff eat. Should they be regarded as experts in health?

How about doctors? If you associate with physicians like the ones I know, most have lots of knowledge about disease, but little understanding of health. A rare one has insight and interest in health.

I went to a recent meeting with my cardiology colleagues. Food served: pizza, Coca-Cola, spaghetti, fried onion rings, white bread with butter. They all dug in without hesitation. Over half were miserably overweight. Several were, in fact, diabetic; several more, pre-diabetic. I know that at least several are smokers. Experts in health?

Drug companies? Well, they're interested in health only as far as it provides profits. But health for its own sake? Ask anybody from a drug manufacturer about their views on the nutritional supplement movement and watch them sneer.

Food manufacturers? You mean like Coca-Cola, Pepsi-Cola, Nabisco, and General Mills? How about fast-food operations like McDonald's, Pizza Hut, and KFC?

The message: Know where to look for genuine information on health. You won't get it from hospitals. You won't get it from drug company marketing. For the most part, you can't even get it from your physician.

Instead, you're going to witness a broad movement towards self-empowerment in health, fueled by the internet and services like ours (Track Your Plaque). These are information resources that are not driven by profit, intent on providing truth, and not afraid to reject prevailing views.

It does not mean that hospitals are unnecessary, or that food manufacturers are evil, or that fast food should be legislated out of existence. We live in a capitalistic society, driven by supply and demand. Hopefully, demand is borne from educated choices from informed consumers. That's where information that's reliable, credible, and not profit driven come in.

Lipoprotein(a) and small LDL

4. May 2006 William Davis (1)

It's been my suspicion for some time that the combination of lipoprotein(a), or Lp(a), in combination with small LDL particles is a really bad risk for heart disease. People with this combination seem to have much higher heart scan scores for age than others. This seems to be a pattern that we'll see in the occasional woman less than 50 years old who already has a high heaert scan score. (It's unusual for women to have detectable coronary plaque before age 50.)

Very little data exists to support this idea and we are in the process of performing a small study to see whether it's true or not. My gut sense: it's among the most potent causes of coronary plaque around.

Case in point: Even though I spend a great deal of my time and energy advocating heart disease prevention, I still maintain my hospital privileges and skills. I had to cover one of the emergency rooms in town this past weekend (a requirement to maintain my hospital privileges).

One of the patients I saw was a 40-year old man--we'll call him Roland-- suffering a very large heart attack, a so-called "anterior myocardial infarction", or a heart attack involving the most important front portion of the heart. Thankfully, he came to the ER within 45 minutes after his chest pain started. The situation was immediately obvious and I was called to the ER. We quickly took him to the cardiac catheterization laboratory and put a stent in the left anterior descending artery and flow was restored. His chest pain dissipated over the next few minutes.

Nonetheless, Roland was left with a large area of reduced contraction of his heart muscle. Only time will tell how much recovery he'll have.

Roland was extremely lucky. The majority of people with closure of the artery that he'd experienced die within minutes. He did, in fact, "arrest" briefly, i.e., his heart became electrically unstable, though he recovered promptly.

Along with the multiple tubes of blood we required to run tests for his heart attack management, we had Roland's lipids and other measures sent off, as well. Wouldn't you know: Lp(a) and small LDL. This may have accounted for a heart attack at age 40.

Keep a lookout for this when you have lipoprotein testing. Conveniently, niacin can be used to treat both patterns, though higher doses are generally required for the Lp(a) part of the pattern. It's also my belief that the sort of Lp(a) measurement performed by the Liposcience laboratory (www.liposcience.com) is superior. They use a particle number based measure, not a weight-based measure. It is therefore independent of particle size, which can vary. Further work will, I believe, reveal some very important insights into the dreaded Lp(a).

"Please don't tell my doctor I had a heart scan!"

30. April 2006 William Davis (1)

I overheard this recent conversation between a CT technologist and a 53-year old woman (who I'll call Joan) who just had a scan at a heart scan center:

CT Tech: It appears to me that you have a moderate quantity of coronary plaque. But you should know that this is a lot of plaque for a woman in your age group. A cardiologist will review your scan after it's been put through a software program that allows us to score your images.

Joan: (Sighing) I guess now I know. I've always suspected that I would have some plaque because of my mother. I just don't want to go through what she had to.

CT Tech: Then it's really important that you discuss these results with your doctor. If you wrote your doctor's name on the information sheet, we'll send him the results.

Joan: Oh, no! Don't send my doctor the results! I already asked him if I should get a scan and he said there was no reason to. He said he already knew that my cholesterol was kind of high and that was everything he needed to know. He actually got kind of irritated when I asked. So I think it's best that he doesn't get involved.

This is a conversation that I've overheard many times. (I'm not intentionally an eavesdropper; the physician reading station at the scan center where I interpret scans--Milwaukee Heart Scan--is situated so that I easily overhear conversations between the technologists and patients as they review images immediately after undergoing a scan.)

If Joan feels uncomfortable discussing her heart scan results with her doctor, where can she turn? Get another opinion? Rely on family and friends? Keep it a secret? Read up about heart disease on the internet? Ignore her heart scan?

I've seen people do all of these things. Ideally, people like Joan would simply tell their doctor about their scan and review the results. He/she would then 1) Discuss the implications of the scan, 2) Identify all concealed causes of plaque, and then 3) Help construct an effective program to gain control of plaque to halt or reverse its growth. Well, in my experience, fat chance. 98% of the time it won't happen.

I think it will happen in 10-20 years as public dissatisfaction with the limited answers provided through conventional routes grows and compels physicians to sit up and take notice that people are dying around them every day because of ignorance, misinformation, and greed.

But in 2006, if you're in a situation like Joan--your doctor is giving you lame answers to your questions or dismissing your concerns as neurotic--then PLEASE, PLEASE, PLEASE take advantage of the universe of tools in the Track Your Plaque program.

People tell me sometimes that our program is not that easy--it requires reading, thinking, follow-through, and often asking (persuading?) your doctor that some extra steps (like blood work) need to be performed. The alternative? Take Lipitor and keep your mouth shut? Just accept your fate, grin and bear it, hoping luck will hold out? To me, there's no rational choice here.

Doctor, why do I have heart disease?

30. April 2006 William Davis (0)

I see a great many people in my practice who come for a 2nd opinion regarding their coronary disease.

When I ask patients whether they ever asked their primary doctor or cardiologist why they have heart disease in the first place, I get one of several responses:

1) My doctor said it from high cholesterol.

2) My doctor said it was "genetic" or "part of your family history" and so unidentifiable and uncorrectable. Tough luck.

3) I didn't ask and they didn't tell me.

Let's talk about each of these.

Can heart disease be only from high cholesterol and, if so, can taking a statin cholesterol drug be a "cure"? In the vast majority of cases, in my experience, cholesterol by itself is rarely the only identifiable cause of coronary disease.

Most people have a multitude of causes (e.g., small LDL, low HDL, vitamin D deficiency, concealed pre-diabetic patterns, etc.). This explains why many people with high LDL don't have heart disease and why others with low HDL do have heart disease. High LDL cholesterol is only part of the cause.

Does "genetic" or being part of your family's history also mean unidentifiable and uncorrectable? Absolutely not.

What your doctor is really saying is "I don't know enough to diagnose the causes because I haven't kept up with the scientific literature", or "I don't want to be bothered with this because it takes a lot of time and pays me very little money; I'd rather wait until you need a stent ", or "The drug representatives haven't told me about any new drugs". This is ignorance and laziness at best, greed and profiteering at worst. Don't fall for it. I hope that by now you recognize that the great majority of causes of heart disease are identifiable and correctable.

If you didn't think to ask, now you know that you should. If you and your doctor don't think about why you have coronary plaque in the first place, how can you develop a program to control it?

You need to ask. And you need to get confident answers. "I don't know" or "It's genetic" and the like are unacceptable.

Pill pushers

28. April 2006 William Davis (1)

Have you read the latest cover story from Forbes magazine? It's entitled "Pill Pushers: How the drug industry abandoned science for salesmanship".

It's great reading. (A condensed version is available at the www.forbes.com website: http://www.forbes.com/business/forbes/2006/0508/094a.html. They require you to provide your e-mail address though it's free.)

Drug industry advertising has raised consciousness of all the prescription therapies available for us--that's good. However, they've gone so far overboard trying to squeeze more and more revenues out of drugs that they've cost this country a huge amount in increased health care costs and even lost lives. (Forbes does a great job of summarizing some of these instances.)

Drugs like Lipitor, Crestor, Zocor; diabetes agents; anti-hypertensive agents, etc., that is, medications taken chronically, a huge financial bonanzas for drug companies. Not only do they get $100-200 per month, but they get it month after month after month. That's per drug.

Now not all medications are bad or unnecessary. There are times when they can be truly necessary and beneficial. But don't rely on drug company advertising to tell us when.

The costs of doing drug business?

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