The Track Your Plaque guide to getting grotesquely overweight

15. August 2006 William Davis (0)
If you'd like to gain huge quantities of weight, here's a number of helpful tips:

1) Follow the advice of food manufacturers and eat the products they label "healthy", or "heart healthy", or "part of a nutritious breakfast" etc., like Shredded Wheat cereal, pretzels ("a low-fat snack"!), low- or non-fat salad dressings.

2) Cut your morning calorie intake by skipping breakfast.

3) Hang around with other heavy people. They will confirm that it's okay to be overweight.

4) Call walking your dog "exercise".

5) Get a sedentary desk job. Use your swivel desk chair to scoot about whenever possible, rather than getting up to do things.

6) Say "I've worked hard all week long. Weekends are for relaxing, not for physical activities. I deserve a rest."

7) Eat foods without thinking about it: Eat chips while watching football, eat while on the phone, daydream over the sink.

8) Eat to provide comfort when stressed.

9) Eat foods that have sentimental value, whether or not they're good for you: Freshly-baked cakes that remind you of Mom, Pop Tarts that you used to carry in your lunchbox when you were a kid, hot dogs just like Dad would buy at the baseball stadium.

10) Cut back on sleep and generate insatiable starch cravings.

11) Stack your shelves at home with great variety. That way, you'll always have something to suit your mood.

12) Say to your spouse: "It's none of your damn business what I eat! I'm a grown man/woman!" Prove it by over-indulging in obviously unhealthy foods.

13) Tell yourself that you're just too busy to pay attention to food choices. Just grab whatever you can out of a convenience store or vending machine.

See, it's easy! And that just a start.

Of course, I don't really want you to do any of these things. But if you see yourself in any of the above, and you're struggling with weight, you should seriously rethink your approach.

Your heart scan is just a "false positive"

15. August 2006 William Davis (0)
I've seen this happen many times. Despite the great media exposure and the growing acceptance of my colleagues, heart scans still trigger wrong advice. I had another example in the office today.

Henry got a CT heart scan in 2004. His score: 574. In his mid-50s, this placed him in the 90th percentile, with a heart attack risk of 4% per year. Henry was advised to see a cardiologist.

The cardiologist advised Henry, "Oh, that's just a 'false positive'. It's not true. You don't have any heart disease. Sometimes calcium just accumulates on the outside of the arteries and gives you these misleading tests. I wish they'd stop doing them." He then proceeded to advise Henry that he needed a nuclear stress test every two years ($4000 each time, by the way). No attempt was made to question why his heart scan score was high, since the entire process was outright dismissed as nonsense.

I'm still shocked when I hear this, despite having heard these inane responses for the past decade. Of course, Henry's heart scan was not a false positive, it was a completely true positive. I'm grateful that nothing bad happened to Henry through two years of negligence, though his heart scan score is likely around 970, given the expected, untreated rate of increase of 30%.

The cardiologist did a grave disservice to Henry: He misled him due to his ignorance and lack of understanding. I wish Henry had asked the cardiologist whether he had read any of the thousands of studies now available validating CT heart scans. I doubt he's bothered to read more than the title. The cardiologist is lucky (as is Henry) that nothing bad happened in those two years.

Do false positives occur as the cardiologist suggested? They do, but they're very rare. There's a rare phenomenon of "medial calcification" that occurs in smokers and others, but it is quite unusual. >99% of the time, coronary calcium means you have coronary plaque--even if the doctor is too poorly informed to recognize it.

What's better than a heart scan?

13. August 2006 William Davis (0)

Do you know what's better than a heart scan?

Two heart scans. No other method can provide better feedback on the results of your program.

Say you've made efforts to correct high LDL; lost weight to raise HDL and reduce small LDL; added soluble fibers, nuts, and dramatically reduced wheat products; take fish oil, vitamin D, and follow a flavonoid-rich diet. Has it worked?

After a year or so of your program, that's when another heart scan can give you invaluable feedback on whether it's been successful. I tell my patients that it's relatively easy to correct lipid and lipoprotein abnormalities. The difficult part is to know when it's good enough. Is your LDL of 67 mg/dl and HDL of 50 mg/dl good enough? Another heart scan score is the best way I know of to find out.

Variation in plaque growth differs hugely from one person to another, even at equivalent lipoprotein values. Why? Lots of reasons. Humans are inconsistent day to day. Lipoproteins, being a snapshot in time and not a cumulative value, change somewhat from day to day. There's also the possibility of unmeasured, unrecognized factors that influence coronary plaque growth. We may not be smart enough to identify these hidden factors yet. But your heart scan score will incorporate the effects of these hidden factors.

Ideally, we aim for zero growth in plaque (no change in score) or a reduction. But, particularly in the first year, 10% or less plaque growth is still a good result that predicts much reduced risk of heart attack. More than 20% per year and your program needs more work--or else you know what's ahead.

Lipids are snapshots in time; heart scans are cumulative

12. August 2006 William Davis (0)
Let me paint a picture. It's fictional, though a very real portrait of how things truly happen in life.

Michael is an unsuspecting 40-year old man. He hasn't undergone any testing: no heart scan, no lipids or lipoproteins. But we have x-ray vision, and we can see what's going on inside of him. (We can't, of course, but we're just pretending.) Average build, average lifestyle habits, nothing extraordinary about him. His lipids/lipoproteins at age 40:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

At age 40, with this panel, his heart scan score is 100. That's high for a 40-year old male.

Fast forward 10 years. Michael is now 50 years old. Michael prides himself on the fact that, over the past 10 years, he's felt fine, hasn't gained a single pound, and remains as active at 50 as he did in 40. In other words, nothing has changed except that he's 10 years older. His lipids and lipoproteins:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

Some of you might correctly point out that just simple aging can cause some deterioration in lipids and lipoproteins, but we're going to ignore these relatively modest issues for now.)

Lipids and lipoproteins are, therefore, unchanged. Michael's heart scan score: 1380, or an approximate 30% annual increase in score. (Since Michael didn't know about his score, he took no corrective/preventive action.)

My point: If we were to make our judgment about Michael's heart disease risk by looking at lipids or lipoproteins, they would'nt tell us where he stood with regards to heart disease risk. His lipids and lipoproteins were, in fact, the same at age 50 as they were at age 40. That's because measures of risk like this are snapshots in time.

In contrast, the heart scan score reflects the cumulative effects of life and lipids/lipoproteins up until the day you got your scan.

Which measure do you think is a better gauge of heart attack risk? I think the answer's obvious.

11. August 2006 William Davis (0)
The recognition of the metabolic syndrome as a distinct collection of factors that raise heart disease risk has been a great step forward in helping us understand many of the causes behind heart disease.

Curiously, there's not complete agreement on precisely how to define metabolic syndrome. The American Heart Association and the National Heart, Lung, and Blood Institute issued a concensus statement in 2005 that "defined" metabolic syndrome as anyone having any 3 of the 5 following signs:





Waist size 40 inches or greater in men; 35 inches or greater in women

Triglycerides 150 mg/dL or greater (or treatment for high triglycerides)

HDL-C <40 mg/dL in men; <50 mg/dL in women (or treatment for reduced HDL-C)

Blood Pressure >130 mmHg systolic; or >85 mmHg diastolic (or drug treatment for hypertension)

Glucose (fasting) >100 mg/dL (or drug treatment for elevated glucose)


Using this definition, it has become clear that meeting these criteria triple your risk of heart attack.

But can you have the risk of metabolic syndrome even without meeting the criteria? What if your waste size (male) is, 36 inches, not the 40 inches required to meet that criterion; and your triglycerides are 160, but you meet none of the other requirements?

In our experience, you certainly can carry the same risk. Why? The crude criteria developed for the primary practitioner tries to employ pedestrian, everyday measures.

We see people every day who do not meet the criteria of the metabolic syndrome yet have hidden factors that still confer the same risk. This includes small LDL; a lack of healthy large HDL despite a normal total HDL; postprandial IDL; exercise-induced high blood pressure; and inflammation. These are all associated with the metabolic syndrome, too, but they are not part of the standard definition.

I take issue in particular with the waist requirement. This one measure has, in fact, gotten lots of press lately. Some people have even claimed that waist size is the only requirement necessary to diagnose metabolic syndrome.

Our experience is that features of the metabolic syndrome can occur at any waist size, though it increases in likelihood and severity the larger the waist size. I have seen hundreds of instances in which waist size was 32-38 inches in a male, far less than 35 inches in a female, yet small LDL is wildly out of control, IDL is sky high, and C-reactive protein is markedly increased. These people obtain substantial risk from these patterns, though they don't meet the standard definition.

To me, having to meet the waist requirement for recogition of metabolic syndrome is like finally accepting that you have breast cancer when you feel the two-inch mass in your breast--it's too late.

Recognize that the standard definition when you seen it is a crude tool meant for broad consumption. You and I can do far better.

What role DHEA?

9. August 2006 William Davis (2)



DHEA, the adrenal gland hormone, has suffered its share of ups and downs over the years.

Initially, DHEA was held up as the fountain of youth with hopes of turning back the clock 20 years. Such extravagant dreams have not held up. But DHEA can still be helpful for your program.

All of us had oodles of DHEA in our bodies when we were in our 20s and 30s. Gradually diminishing levels usually reach nearly blood levels of around zero by age 70.



In our heart disease prevention program, of course, we aim to stop or reduce your CT heart scan score. Does DHEA reduce your score? No, it most certainly does not. But it can be helpful for gaining control over some of the causes behind coronary plaque.

For instance, DHEA can:

--Help reduce abdominal fat and increase muscle mass (slightly)
--Provide more physical stamina.
--Boost mood.
--It may modestly reduce some of the phenomena associated with the metabolic syndrome (high blood pressure, high blood sugar, high insulin, low HDL, small LDL, etc.)

In my experience, people who feel better do better on their overall program. If you're always tired and run down and run out of steam by 3 pm, I won't see you riding your bicycle outdoors or at the aerobics class. But if you're bursting with energy until you put your head on the pillow, you're more inclined to walk, bike, dance, play with the kids, dance, take Tai Chi, etc.

Some downsides to DHEA: Some people experience aggression. Backing off on the dose usually relieves it. Also, sleeplessness. Taking your DHEA in the morning usually fixes it.



The dose is best tailored to your age and blood levels. People less than 40 years old should not take DHEA. The older you are, the higher the dose, though we rarely ever have to exceed 50 mg per day. If you've never had a blood level and your doctor refuses to obtain one, 25 mg per day is a reasonable dose (10-15 mg in women 40-50 years old). It's always best to discuss your supplement use, particularly agents like DHEA, with your doctor.

Track Your Plaque Members: Stay tuned to the www.cureality.com website for a Special Report more completely detailing the hows and whys behind DHEA.

Brainwashed!

9. August 2006 William Davis (0)
At a social gathering this weekend, as we humans like to do, someone asked me what I did for a living. I told him I was a cardiologist.

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

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

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

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

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

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

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

The Fanatic Cook: A fabulous Blog about food and nutrition

7. August 2006 William Davis (0)
I came across this Blog authored by a nutritionist when it was highlighted on Blogger as an interesting site:

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

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

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

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

Eggs: Good, bad, or indifferent?

5. August 2006 William Davis (3)
Eggs have been in the center of the cholesterol controversy almost from the very start.

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





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

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

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

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

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

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

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

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

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




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

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

Diabetes is Track Your Plaque's Kryptonite!

3. August 2006 William Davis (0)

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

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

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

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

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

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

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

The best protection from diabetes is to never get it in the first place. (See my earlier Blog, "Diabetes is a choice you make".)
A tan does not equal vitamin D

A tan does not equal vitamin D

14. May 2008 William Davis (8)
The sun is getting stronger and the days are getting longer, even here in Wisconsin.

Some people are coming to the office with nice tans obtained by sunning themselves for several hours. Others have come back from winter getaways to Florida, Arizona, or the tropics, also sporting nice, dark tans.

Several people, in fact, were so confident that sunning themselves provided sufficient vitamin D that they reduced their usual dose. Some even stopped their vitamin D altogether.

But, when blood levels of 25(OH) vitamin D were checked, they were virtually all low, sometimes as low as <20 ng/ml. Yet all had nice tans.

Why does this happen? Why would people with dark tans remain deficient in vitamin D?

One big factor is age: Anyone over 40 years old is fooling themselves if they think that a tan ensures raising vitamin D levels to a desirable range. Also, the more you tan, the more melanin skin pigment accumulates, and the more vitamin D activation in the skin is blocked.

Weight is another factor: Heavier people need more vitamin D, sometimes three- or four-fold more than slender people.

Why does aging result in inefficient skin activation of vitamin D? It seems that, once we are beyond our reproductively useful years, this ticking clock of aging gets triggered. The older we get, the less activation of vitamin D occurs in our skin, the less of the youth-maintaining, disease-preventing benefits of vitamin D we obtain with sun exposure.

The message: Don't rely on a tan to gauge the adequacy of vitamin D. Maybe that works when you're 16 years old, but not at age 50 or 60. There's only one way to know your vitamin D status: a blood level of 25(OH) vitamin D.


Copyright 2008 William Davis, MD
Tags :

Comments (8) -

  • Anonymous

    5/14/2008 10:03:00 AM |

    It's all about UVB exposure and amount of pigment and cholesterol in the skin.

  • ethyl d

    5/14/2008 4:36:00 PM |

    Just to clarify, I assume therefore, that, even if sunshine exposure does not guarantee adequate vitamin D levels as one ages, dietary vitamin D through D-rich foods or gel capsules do?

  • Ross

    5/14/2008 5:23:00 PM |

    Still another factor is that tanning lotions and sunscreens selectively block UVB rays, which are the higher-energy rays our bodies need to synthesize Vitamin D.  The lower-energy UVA rays that cause tanning but don't help with Vitamin D are permitted through in much higher quantities by all sunscreen chemistries.

    Like many things in this world, when we humans interfere with the natural, we tend to screw it up.  Just like we're better off with whole milk, whole eggs, whole meats (leave the skin on the chicken, it's the best part!), etc.  We also benefit most from the whole spectrum of sunlight.  Not so much that we burn, but definitely not filtered of the best and most useful components.

    If you want a tan to count towards your Vitamin D, repeatedly get outside for short periods of time without sunscreen.  I'd still recommend a supplement, since your body has all sorts of ways to manage too much, and very few ways to manage not enough.

  • Anonymous

    5/14/2008 11:32:00 PM |

    Dr. Davis, thank you for reminding us of the importance of vitamin D supplementation.   When addressing vit. D supplementation, please, we need to keep on stressing that it needs to be D3 in GEL CAPS.   There are lots of people who are hearing the vit D supplementation message, run to the drugstore and buy D tablets (often 1000 IU D2).  Their doctors and pharmacists are saying they are doing the right thing.  But from what I understand it is rather useless.  Oil based D3 in the right, larger, quantity, is what matters, because that is what the digestive system can absorb.

    Could you provide a medical research reference that clearly shows why D3 in gel caps is the only way to go?  I would like to print lots of copies to give to my friends, parents, etc....

  • Anonymous

    5/16/2008 1:11:00 PM |

    A test comparing D2 to D3:

    http://www.nutraingredients.com/news/ng.asp?id=82331

  • Anna

    5/16/2008 6:50:00 PM |

    Check out the Vitamin D Council for a wealth of research on Vit D supplementation:  http://www.vitamindcouncil.org/

    I was so impressed with this non-profit's work that I added them to my list of charitable causes.

  • Anne

    6/9/2008 7:56:00 PM |

    Dear Dr Davis,

    I just got back from my holidays in France and am catching up with your blogs. This one interested me. I just received the results of my vitamin D test taken before I went away, the 25(OH)vitamin D3 test, and my levels are 384 nmol/L (153 ng/ml) which I understand is much, much too high.

    I am mystified at this result as I live in the UK where there isn't usually much sun and I don't sunbathe anyway and I've been taking 4,000iu D3 only since January. Obviously I am stopping the supplements right away but am very concerned.

    Anne

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Can you say "sugar"?

Can you say "sugar"?

20. April 2008 William Davis (11)
All of these products bear the American Heart Association Check Mark of approval emblem, signifying that they are "heart healthy":


Kellogg's Frosted Mini-Wheats cereal

Ingredients:WHOLE GRAIN WHEAT, SUGAR, STRAWBERRY FLAVORED CRUNCHLETS (SUGAR, CORN CEREAL, CORN SYRUP, MODIFIED CORN STARCH, PARTIALLY HYDROGENATED COTTONSEED AND/OR SOYBEAN OIL, CITRIC ACID, GLYCERIN, NATURAL AND ARTIFICIAL FLAVOR, RED #40, BLUE #2), NATURAL AND ARTIFICIAL STRAWBERRY AND CREME FLAVOR, SORBITOL, GELATIN, REDUCED IRON, NIACINAMIDE, ZINC OXIDE, RED #40, PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), RIBOFLAVIN (VITAMIN B2), THIAMIN HYDROCHLORIDE (VITAMIN B1), FOLIC ACID, BLUE #1, AND VITAMIN B12. TO MAINTAIN QUALITY, BHT HAS BEEN ADDED TO THE PACKAGING.










Orville Redenbacher popcorns









Dora the Explorer Cereal
























Cheerios
























The following requirements must be met to gain approval of the Check Mark program:

1) total fat 3.0 grams or less per serving

2) saturated fat 1.0 gram or less per serving

3) 20 grams or less cholesterol per serving

4) 480 mg or less sodium per serving

5) "Jelly Bean Rule": 10% of the Daily Value of 6 nutrients (e.g., fiber, vitamins A and C, etc.) must also be contained in each serving.


Had the Check Mark program focused on genuine nutrition and rated products by:

1) Healthy oil content

2) Sugar content or sugar-equivalents, i.e., glycemic index or load

3) Impact on HDL, small LDL, triglycerides

none of these products would have made the list, not even close.
Tags :

Comments (11) -

  • Anna

    4/20/2008 4:14:00 PM |

    A measured bowl of Cheerios and a bit of milk (whole, because it's what I had), equal to 75 grams of  carbohydrate, gave me the highest ever blood glucose reading from a food (not counting glucose solution from a Glucose Tolerance Test).  I was attempting a "homemade" version of a 3 hr GTT before going to my doctor with my concerns about my BG.  

    My BG started to rise very fast within 15 minutes after eating the cereal, peaked at about 250 mg/dL at 45 minutes, then slowly dropped.  By about 60-75 minutes, I experienced strong hunger and carb cravings as the BG began to slowly drop, and by about 2.5 hours after eating, my BG had suddenly dropped quite low (in the low 70s) and I had developed  a nasty hypoglycemic feeling (shaky, irritable, craving sugary foods, headache, etc.).

    It's hard for me to see "heart healthy" Cheerios (or any other highly processed breakfast cereal) as anything other than a bowl of pre-digested sugar that contributes to roller coaster blood glucose and insulin levels, which a great way to start anyone's day.  Certainly, I don't do well with Cheerios because I clearly have a damaged glucose regulatory system (probably a diminished or absent first phase insulin response, but I can't imagine that it is doing any good for people with healthy glucose regulation, either.  

    I banned prepared cold cereals from our house.  If my 9 yr old son gets cereal at all at home, it's whole groats (not even rolled or steel cut because those aren't truly "whole grain" anymore), soaked overnight in some water and a tsp of plain yogurt  (soaking neutralizes phytates and reduces cooking time), then cooked about 8-10 minutes (water added as necessary).  Sometimes I add a bit of quinoa or almond meal prior to soaking to boost the protein content a bit.  I garnish with a pat of butter, some heavy cream, and a dusting of cinnamon.  If I'm feeling *really* indulgent, I drizzle about 1 tsp of Grade B maple syrup on top (Grade B is stronger in flavor and so less can be used).  I don't eat this cereal myself, and truthfully, I'd rather my son not, either, but he sometimes wants cereal.  It's the least damaging compromise I can come up with that we can both live with.

  • Jenny

    4/20/2008 7:18:00 PM |

    The sugar is ridiculous. But what about those TRANS FATS?

    You're a cardiologist, why don't you write to JAMA or some other prestigious journal and and demand other cardiologists put a stop to the marketing of dangerous foods to children as "healthy?"

  • Anonymous

    4/20/2008 10:30:00 PM |

    Last week there were food riots in several locations around the world.  The protests were over the steep rise in price for grains in particular.  Papers blamed several areas for the rise in price, the main two being the use of biofuels and also the economic growth in Asia.  The "problem" papers said is that in Asia people are "upgrading" their diet to a western, sugary diet.  Having work with Chinese companies since the early 90s, I've seen the western food growth in that country.  I have a Chinese friend that will sometimes e-mail me about his visits with his son to a local KFC.  Good American eating he tells me.  

    Unlike the AHA, which remains silent, I hope Asian health agencies catch onto the health problems western sugar foods like pop, bread, fried potatoes, etc can cause and warn their peoples soon.               The old traditional Asian diet of  vegetables, beans and fruits is better than the new.  

    I don't mind seeing sugar burnt as fuel.

  • Dr. William Davis

    4/21/2008 12:33:00 AM |

    Anna--

    Your comments are so telling that I'd like to feature them in a post. Thanks!

  • Anna

    4/21/2008 6:51:00 PM |

    Be my guest!

  • Dr. William Davis

    4/22/2008 12:39:00 AM |

    Hi, Jenny--

    I've voiced my objections only by phone. I will indeed be more vocal to the people in charge of the Heart Check Mark program. I've been planning to do so for some time.

  • Anonymous

    4/22/2008 1:56:00 PM |

    Call me confused.  According to the nutritional information listed on the Cheerios package the total amount of sugar is 1 gram.  Isn't that minimal?  It seems as though the overwhelming bulk of the product is whole oats.  Why would oats (even if pulverized into tiny little shapes) cause such a rise in BG levels?  Something doesn't add up.

    FYI, hard to imagine that any cereal with partially hydrogenated oil can be called heart healthy - that is crazy!

  • Anna

    4/23/2008 9:08:00 PM |

    anonymous,

    You're making a common label reading mistake.  

    You can't just look at the "sugar" content on the label, which only measures simple sugars.  

    You have to look at the total carbohydrate content (though some people subtract the indigestible fiber content) to see how much starch is in the product, too.  That starch is simply chains of simple sugars bonded together, and when broken down by digestive enzymes, yields simple sugar.  Starch in a pulverized grain, will break down into simple sugars super fast, nearly as fast as eating plain table sugar.   All the sugars and starches (carbohydrates) end up as glucose in the blood stream eventually, and enough insulin has to be secreted to handle it.  

    This business of "whole grain" is a big marketing ploy, a wolf in sheep's clothing.  The grain isn't "whole" and intact anymore if it is processed into flour or extruded (like Cheerios), even if the fiber is left in the flour.    I consider it "pre-chewed" or "predigested" Smile.

    Your own saliva has the enzyme to break starch into simple sugar, too, amylase, so digestion starts right in the mouth while chewing.  When I was in junior high school biology one of the experiments was chewing a saltine cracker very well and holding it in our mouths a few moments, well mixed with saliva.  Within a very short time, it began to taste sweet from the starch broken down into sugar.  That's how fast the starch in Cheerios becomes glucose.

    The slowest and lowest rise in BG I have seen with *any* oat cereal (using a glucose meter) is with cooked whole groats (bought from the bulk bin at the natural foods store).  Whole, not rolled, not steel cut.   Cooked whole groats are very nutty in texture, each groat kernal remains distinct, and they takes a lot more chewing than cooked oatmeal - rolled oats or steel cut.   The body still has to cover all the glucose those groats eventually become, but it will be much slower and easier for the body to manage it (assuming healthy insulin production).  For those of us with impaired insulin production, even whole groats might be too much of a burden on the system.

  • Red Sphynx

    4/23/2008 10:42:00 PM |

    You may have left out the most important thing!
    > The following requirements must be met to gain approval of the Check Mark program ...

    Isn't there a fee to the American Heart Association involved?

  • Helen Kopp

    3/5/2009 5:52:00 PM |

    How can I find healthy whole grains?  Aside from true whole wheat pasta (not the fake whole wheat pasta), brown rice, plain oatmeal... whole grains are so hard to find.  I've yet to find a bread or cereal without all kinds of sugar and additives.  I'm a runner, and cereal with milk is such a convinient snack or even meal for me, but what kind of cereal is actually healthy for me? And what kind of bread can I use to make a sandwich? Suggestions?

  • Megan

    5/14/2009 2:20:00 AM |

    Helen- most reading this blog are probably pretty careful about carbs, including me - but many won't have any bread or cereal go near their mouths!  I occasionally (a couple times a week) will have a slice of Light bread (containing 8 grams of carbs a slice or less) to put my peanut butter on, or fold in half and stuff with turkey or whatever.  Another choice would be one of those Toufayan (spelling?) low carb pitas that have 11 grams of protein!  Protein helps slow those carbs down.  Also, the only cereal I occasionally will eat is Special K-PROTEIN PLUS cereal; it has 9 net grams of carbs and 10 grams of protein/ serving.  I only eat 1 serving when I do have it.

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Sugar for breakfast

Sugar for breakfast

2. September 2007 William Davis (17)
We were reviewing Stuart's diet because of his persistent small LDL, low HDL, modestly elevated triglycerides, and blood sugar of 107 mg/dl.

"I've changed my diet, doc. No kidding. We never fry our foods. No butter, no goodies. I don't know what else I can possibly do."

"Okay. Let's review your diet. What did you have for breakfast?"

"Orange juice, a big glass. Gotta get my potassium. Then cereal like Cheerios or Shredded Wheat, sometimes Kashi or Raisin Bran, always in skim milk. Gotta have my one slice of toast, no butter. I'll put some fruit preserves on it. You know, real fruit. Only whole wheat bread, never white. On Sundays, we always go out for pancakes, but now we order only whole wheat."

Many of us have gotten into a peculiar habit: Having what amounts to pure sugar for breakfast. Perhaps there's a little fiber thrown in with it, but many people indulge in breakfasts that are sugar and plenty of it. That's precisely what Stuart is doing: A breakfast that, while it doesn't contain a huge amount of sugar outside of the orange juice, is promptly converted to sugar. If we were to check his blood sugar just after his standard breakfast, it would rise substantially.

This pattern has become deeply ingrained into the American psyche. Some people will act like I've suggested we overthrow the government when I suggest that breakfast cereals need to be eliminated from their lives. We all share memories of Tony the Tiger, the leprechaun on Lucky Charms ("They're magically delicious!), reading the brightly colored boxes often including games and prizes. Breakfast cereals seem as American as apple pie. But the wheat and corn content ensures a big rise in blood sugar, the sort that create small LDL, low HDL, etc.--all the patterns Stuart is showing--and make us fat.

Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

Toast? Any diabetic who monitors their blood sugar after meals will tell you: Even one slice of bread, ANY bread, skyrockets blood sugar. Add the fruit preserves made with sugar syrup and it's doubly worse.

Pancakes? Even if made with plenty of fiber, blood sugars go absolutely berserk after a meal like this, especially if maple syrup is added.

In other words, the seemingly healthy breakfast Stuart eats guarantees that he fails to control all his patterns that contribute to his coronary plaque growth.

After I pointed out Stuart's dietary faux pas, he asked, "Then what the heck can I eat?"

"There's actually lots of good choices: Eggs (preferably free-range, if available, or the 'omega-3' enriched) or Egg Beaters; oat products, but true oat products like slow-cooked oatmeal, or the best of all, oat bran, used as a hot cereal; ground flaxseed as a hot cereal with added fruit, berries, nuts; a handful of raw almonds, walnuts, pecans; some cheese, preferably traditional fermented cheese and not processed; low-fat cottage cheese; low-fat yogurt that you flavor yourself with berries and nuts; raw seeds like sunflower and pumpkin.

"Try and save some of your dinner foods for breakfast. For instance, save some green peppers and onions from your salad and put it in your scrambled eggs along with some olive oil. Save some of the chicken and add it to your breakfast. Save some of the cooked vegetables and have them as they are. You'll be surprised how filling dinner foods can be when eaten for breakfast."

It's not that tough. But Stuart and many other people need to break the hold that the food manufacturers have created. If you're hoping to seize hold of your heart scan score, get rid of the sugar foods in your morning, even the ones cleverly disguised as healthy.
Tags :

Comments (17) -

  • Anonymous

    9/3/2007 3:30:00 PM |

    This is such good advice. My mildly diabetic mother's blood sugar is 210 mg/dL two hours after a breakfast consisting of a small bowl of cornflakes, skim milk, banana, and orange juice. For anyone with blood sugar problems or insulin resistance, glucose tolerance is at its absolute worst in the morning, and improves later in the day. Even in the absence of other dietary changes, avoiding the all-sugar breakfast is a good first step toward getting hunger, weight, and lipid abnormalities under control.

  • Anne

    9/3/2007 10:26:00 PM |

    What about brown rice? I fix brown rice with cinnomon and raisins and nuts(no sugar is added). I react to egg white so sadly eggs are out for me.

    I have found soup for breakfast is great too. My favorite is a home made chicken and vegetable.
    Anne

  • Dr. Davis

    9/3/2007 11:42:00 PM |

    Excellent point.

  • Dr. Davis

    9/3/2007 11:45:00 PM |

    Hi, Anne--

    The soup idea is great.

    However, the brown rice depends on how severe your patterns are. If you are a small LDL, low HDL, higher blood sugar person, or have excessive tummy weight, then the more you reduce high or moderate glycemic index foods, the better will be your response.

  • DietKing2

    9/4/2007 12:19:00 AM |

    It's also very tempting to reach for that bowl of cereal because even with the added cup of skim milk the calorie count barely touches 200--many think they're doing themselves a favor by going this route instead of two large eggs (any style) which ironically will pull you just above the 150 calorie range, will satisfy your hunger better, and keep your blood sugar steady, if not on the lowerish side.  I've learned to really enjoy them, too.
    Adam

  • DietKing2

    9/4/2007 12:31:00 PM |

    Dr. Davis,
    Saw this article this morning and thought of you and your site;
    better to not have to deal with any of this in the first place, nu?
    Unreal how this issue keeps going back and forth.
    Adam

    http://apnews.myway.com/article/20070902/D8RDE7500.html

  • Anonymous

    9/4/2007 2:28:00 PM |

    Great breakfast post- very helpful! Can we get a post about lunch, dinner, dessert and snacks?
    Thanks- Greg

  • Dr. Davis

    9/4/2007 9:40:00 PM |

    Yes. If there's one conclusion I favor, if given a choice, the best stent is NO stent.

  • Ortcloud

    9/5/2007 1:36:00 AM |

    Amen, thank you for this post. Whenever I go out to breakfast I look around and I am in shock at what people eat for breakfast. Big stack of pancakes, fruit, fruit juice syrup, just like you said. This is not breakfast, this is dessert ! It has the same sugar and nutrition as a birthday cake, would anyone think cake is ok for breakfast ? No, but that is exactly the equivalent of what they are eating. Somehow we have been duped to think this is ok. For me, I typically eat an omelette when I go out, low carb and no sugar. I dont eat wheat but invariably it comes with the meal and I try to tell the waitress no thanks, they are stunned. They try to push some other type of wheat or sugar product on me instead, finally I have to tell them I dont eat wheat and they are doubly stunned. They cant comprehend it. We have a long way to go in terms of re-education so keep up the good work doc.

    -ortcloud

  • Anonymous

    9/6/2007 6:04:00 AM |

    Hmmm...I've read in many places that egg yolk is GOOD for you...as long as it isn't cooked (much).  They say that it oxidizes the cholesterol.  I've found that softboiled eggs or even fried (low temp, only good oil (very small amount) to be best.  

    What do you know about the health effects of cooked eggs...or over cooked proteins in general?  Thanks!
    Pete

  • Dr. Davis

    9/6/2007 12:10:00 PM |

    Pete--
    Sorry, not familiar with that issue. Do you have any further info?

  • Bix

    9/7/2007 3:03:00 PM |

    "Then what the heck can I eat?"

    That sentence right there.  That's the crux.

    You gave some excellent alternatives.  But the breakfast cereal mindset runs deep.  Deep.

  • Anna in San Diego, CA

    9/22/2007 7:29:00 AM |

    Amen to the advice to get rid of the converting-to-sugar breakfast foods.  But why do you recommend reduced fat foods?    Fat is a good source of energy for the day and holds off mid-morning hunger pangs.

    Like others, I became bored with bland supermarket eggs every day, even premium so-called free-range eggs.  But now I get truly free range eggs from a little hobby farm in my county and I love 3 eggs every day!   The taste is fantastic because the chickens don't eat vegetarian chow all day, instead they eat grasses and run around chasing down grasshoppers, etc.  

    Over-easy in plenty of good butter, lowish heat with a lid until the white are just set and the yolks are still runny.  The day just isn't right without them.

  • Dr. Davis

    9/22/2007 12:46:00 PM |

    Great point with your free-range--truly free-range--eggs.

    I only specify the low-fat with regard to the dairy products, principally because of caloric density.

  • Anonymous

    9/23/2007 8:47:00 PM |

    I have a question about Liver cleansing.  I saw an AD on the internet about a product to cleanse the liver and wonder if it is a good idea.  I have small LDL.
    Peg

  • Dr. Davis

    9/23/2007 11:40:00 PM |

    Sorry, Peg, but these products tend to be scams.

  • buy jeans

    11/2/2010 7:59:39 PM |

    Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

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Quantum leaps

Quantum leaps

29. June 2008 William Davis (6)
A reader of The Heart Scan Blog and member of the Track Your Plaque program posted this comment on The Heart.org:

*The facts speak for themselves.*

Dr. William Davis and Dr. William Blanchet, your patients thank you for the low cost PREVENTIVE care you prescribe. The published facts speak for themselves. It is indeed a sad state of affairs, that the larger cardiology community does not take the time to research the data and results you have been reporting. Unfortunately it is the patients who are the victims of the mainstream, inappropriate, treatment protocols, as evidenced with the ongoing high rate of CV death rate.

I am dumbfounded by the lack of open-minded inquisitive curiosity to thoroughly research your claims by many/most cardiologists. Understood, we are all busy, but that is no excuse to stick with practices that do not result in major breakthrough improvements in patient outcomes.

Then again, we are all humans, and when "we" are convinced that "our" approach is correct, "we" tend to conveniently ignore any evidence to the contrary. "We" like to believe "we" have been right all along.

A very insightful book, recently published, says it all in its title: "Mistakes were made (but not by me)."

From the intensity of the comments on this topic, it is clear that we are in the middle of a battlefield. It is to be hoped that the facts will become visible before too much smoke obscures the field, and before the patients are all dead.

George Orwell said it correctly, back in 1946:

“We are all capable of believing things which we know to be untrue, and then, when we are finally proved wrong, imprudently twisting the facts so as to show that we were right. Intellectually, it is possible to carry on this process for an indefinite time: the only check on it is that sooner or later a false belief bumps up against solid reality usually on a battlefield.”

And, after several posts that preventive care with EBT would be too costly.....

*Heroic*

Prevention is what matters, but it is not very heroic. A hospital that advertises the highest volumes in heart bypasses and other heart "repair" procedures, sounds to many like a go-to place when one gets into trouble with one's heart.

Cardiologists who perform impressive surgical procedures are heroes. Not unlike fire-fighters. We celebrate them (deservedly!) for rescues and life saving heroic actions.

We tend to not pay much attention to the folks that work hard to minimize risk of calamities in the first place.

Similarly, we recently learned that it is too costly to build schools that are earthquake resistant in China. Parents had to look at their children's bodies, crushed.

Is it too graphic to imagine 20,000 American bodies, who died of heart disease, piled up on a field?

What will it take before we make prevention our first priority?

AL, Ann Arbor, Michigan


The reader also tells me that, prompted by his father's death from heart attack while following conventional advice after heart catheterization, he has lost 50 lbs and corrected his lipid patterns on the Track Your Plaque program. The reader is currently struggling with full correction of his severe small LDL pattern and is following some of the advice we discussed on our webinar recently.

Another Heart Scan Blog reader, Stan the Heretic, posted this quote from scientist, Max Planck, in his comment:


"A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." - M. Planck

(Max Planck was a German physicist who developed quantum theory, a disruptive set of ideas that supplanted other explanations of energy mechanics of the day.)


I fear that may prove to be the case for heart disease. The revenue-generating formula for heart disease management that dominates practice in cardiovascular medicine today is so deeply ingrained into the thinking and revenue expectations of practicing cardiologists that a preventive or reversal approach just won't cut it--even if it is vastly superior.

That's why it is important for you to take control yourself. You will be the one who obtains and applies the information that saves your life or the lives of those around you. It is, in all likelihood, NOT your doctor who will save your life, but YOU.
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Comments (6) -

  • Anonymous

    6/29/2008 8:01:00 PM |

    Planck most certainly was correct, but TYP is probably not taught in schools.  

    That's because I can't imagine you have the marketing $$$ to compete with the General Electric scanner peddlers and Big Pharma statin-pushers who have infiltrated medical education...as they have the rest of medicine!

    Change will have to happen at the grassroots - by the internet empowering patients to ask their doctors, "This expensive test you're prescribing -- you wouldn't happen to own the machine that performs it, do you?"

  • Anonymous

    6/30/2008 3:44:00 PM |

    This whole situation is very difficult!  Many of us either are stuck with doctors we don't trust or can't find a doctor who is brave enough to flaunt conventional thinking and practice.  

    It is not pleasant (very much an understatement) to challenge your doctor's orders or question his/her financial motives!

  • Anonymous

    6/30/2008 8:20:00 PM |

    With the high Return on Investment of TYP, European high end socialized medicine  should be early mass adopters.

    Matt

  • Dr. B G

    7/1/2008 2:57:00 AM |

    Matt,

    I think you are right.

    Only Europeans have the sensibilities to adopt TYP!

    (And perhaps Japan as well -- did you know they are working to reduce obesity and dangers of Metabolic Syndrome -- NY Times)

    -G

  • Dr. B G

    7/1/2008 2:57:00 AM |

    Matt,

    I think you are right.

    Only Europeans have the sensibilities to adopt TYP!

    (And perhaps Japan as well -- did you know they are working to reduce obesity and dangers of Metabolic Syndrome -- NY Times)

    -G

  • ALANSD

    7/1/2008 5:07:00 PM |

    this article from Emory Hospital in Atlanta, tells of a man who had his life literally saved by having a heart calcium scan done.
    http://www.emoryhealthcare.org/ehchomepage/featured_stories/feature20080624a.html

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Hospitals are a hell of a place to get sick

Hospitals are a hell of a place to get sick

29. October 2009 William Davis (19)
I answered a page from a hospital nurse recently one evening while having dinner with the family.

RN: "This is Lonnie. I'm a nurse at _____ Hospital. I've got one of your patients here, Mrs. Carole Simpson. She's here for a knee replacement with Dr. Johnson. She says she's taking 12,000 units of vitamin D every day. That can't be right! So I'm calling to verify."

WD: "That's right. We gauge patients' vitamin D needs by blood levels of vitamin D. Carole has had perfect levels of vitamin D on that dose."

RN: "The pharmacist says he can replace it with a 50,000 unit tablet."

WD: "Well, go ahead while Carole's in the hospital. I'll just put her back on the real stuff when she leaves."

RN: "But the pharmacist says this is better and she won't have to take so many capsules. She takes six 2,000 unit capsules a day."

WD: "The 50,000 units you and the pharmacist are talking about is vitamin D2, or ergocalciferol, a non-human form. Carole is taking vitamin D3, or cholecalciferol, the human form. The last time I checked, Carole was human."

RN: (Long pause.) Can we just give her the 50,000 unit tablet?

WD: "Yes, you can. But you actually don't need to. In fact, it probably won't hurt anything to just hold the vitamin D altogether for the 3 days she's in the hospital, since the half-life of vitamin D is about 8 weeks. Her blood level will barely change by just holding it for 3 days, then resuming when she's discharged."

RN: (Another long pause.) Uh, okay. Can we just give her the 50,000 units?"

WD: "Yes, you can. No harm will be done. It's simply a less effective form. To be honest, once Carole leaves the hospital, I will just put her back on the vitamin D that she was taking."

RN: "Dr. Johnson was worried that it might make her bleed during surgery. Shouldn't we just stop it?"

WD: "No. Vitamin D has no effect on blood coagulation. So there's no concern about perioperative bleeding."

RN: "The pharmacist said the 50,000 unit tablet was better, also, because it's the prescription form, not an over-the-counter form."

WD: "I can only tell you that Carole has had perfect blood levels on the over-the-counter preparation she was taking. It works just fine."

RN: "Okay. I guess we''ll just give her the 50,000 unit tablet."


From the alarm it raises trying to administer nutritional supplements in a hospital, you'd think that Osama Bin Laden had been spotted on the premises.

I laugh about this every time it happens: A patient gets hospitalized for whatever reason and the hospital staff see the supplement list with vitamin D, fish oil at high doses, iodine, etc. and they panic. They tell the patient about bleeding, cancer, and death, issue stern warnings about how unreliable and dangerous nutritional supplements can be.

My view is the exact opposite: Nutritional supplements are a wonderful, incredibly varied, and effective array of substances that, when used properly, can provide all manner of benefits. While there are selected instances in which nutritional supplements do, indeed, have interactions with treatments provided in hospitals (e.g., Valerian root and general anesthesia), the vast majority of supplements have none.
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Comments (19) -

  • Jessica

    10/29/2009 12:25:04 AM |

    We use an EMR and recently on the online forum for the EMR, an MD posted a question about an error message he received when he transmitted an rx electronically to the pharmacy.

    He said he had written for 50,000 IU of Vitamin D (weekly x 8 weeks) and during the transmission, the comma was dropped so the pharmacist received a RX that only read "50 IU."

    The MD posted the issue b/c he wanted to know if others were having the same problem with RXs that contained a comma.

    I replied to the post and answered his technical question, but was disappointed in his choice for intervention. I didn't reply with any info about D2 versus D3 (who am I to educate a physician about medicine?) but in hindsight, I probably should have. Who knows how many other people will receive suboptimal Vitamin D treatment.

    P.S. If you need a good laugh, grab a copy of the latest AFP magazine and read the D article. Their suggested intervention for D deficiency....50,000 IU D2 for 8 weeks. Yauzers.

    I might keep the article for historical significance. My hope is that in just a few short years, we'll look back on such non-sense and be proud of how far we've come with treating D.

    P.P.S. I'm going to the Vitamin D conf in Toronto on Tuesday! I cannot wait!!

  • Anonymous

    10/29/2009 2:40:01 AM |

    The way the nurse kept asking if it was okay to have the patient take the D2 tablets, I couldn't help wonder if the pharmacist was getting a kick back for those tablets. What also bugged me was how she didn't want to "hear" or honor what you had to say even though you are the patient's doctor. Not good.

  • Dots

    10/29/2009 5:00:34 AM |

    I'd LOL if it weren't so sad.

    BTW, I've gotten two doctor neighbors and family on vitamin D and probiotics.  One is egotistical, the other grateful.  Thanks for all you do.

  • Mark K. Sprengel

    10/29/2009 5:25:16 AM |

    So they needlessly increased her costs? Great :/

  • moblogs

    10/29/2009 10:31:29 AM |

    You know, I don't bother telling doctors exactly how much D3 I'm taking. I just get them to check my blood levels and they see no problems with the results. But they would probably balk at the fact I take 10k per day.

  • Helena

    10/29/2009 1:38:59 PM |

    I am a bit disgusted about this whole thing. This shows ones again how stupid the whole industry is… I was just recently at my doctor to take a few tests after some horrible years on the birth control pill Yasmin (it had basically taken me 7 years to put two and two together because no doctor would believe my symptoms well at least not connect them to the birth control). He asked me why I was taking all these vitamins and supplements – Preventive maintenance, was my answer. No comment back except for a smirk. Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???

  • Anonymous

    10/29/2009 1:54:06 PM |

    Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop
    The National Institutes of Health (NIH) Office of Dietary Supplements (ODS) is sponsoring the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop on Wednesday, December 16, 2009 at the Bethesda North Marriott Hotel & Conference Center, Bethesda, Maryland.


    Workshop Summary
    Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

    Serum concentration of 25(OH)D is the best indicator of exposure to vitamin D from all sources. It reflects vitamin D produced cutaneously and that obtained from food and supplements. There is considerable discussion of the serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and optimal overall health. In fact, different assay methods are used to assess 25(OH)D. The methods themselves vary and there are considerable differences among laboratory results even when they use the same method.

    Given the uncertainties in vitamin D measurement, the NIH/ODS will host this one-day workshop to evaluate the state of analytical methods. The intent of the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop is to develop strategies for resolving inconsistencies between results obtained following quantitative determination of selected nutrients in biological materials such as serum when different measurement techniques are used. The desired outcomes of this meeting are to identify strengths and weaknesses of analytical approaches available for the quantification of the nutritional biomarker of Vitamin D status, circulating 25(OH)D in biological samples and to discuss analytical methods, including criteria for selection of method(s); role of reference methods and samples; sample preparation and interpretation of results.

    The workshop will consist of a series of short, focused podium presentations interspersed with open discussion sessions on the currently available analytical methods and interpretation of findings. A final session will summarize the discussions, identify knowledge gaps, and suggest a research agenda for future studies.


    Registration
    Space is limited and will be filled on a first-come first-served basis. There is no registration fee to attend the workshop. To register please forward your name and complete mailing address including phone number via e-mail to Ms. Tricia Wallich at twallich@csionweb.com. Ms. Wallich will be coordinating the registration for this meeting. If you wish to make an oral presentation during the meeting, you must indicate this when you register and submit the following information: (1) a brief written statement of the general nature of the comments that you wish to present, (2) the name and address of the person(s) who will give the presentation, and (3) the approximate length of time that you are requesting for your presentation. Depending on the number of people who register to make presentations, we may have to limit the time allotted for each presentation. If you don't have access to e-mail please call Ms. Wallich at 301-670-0270.


    Workshop Details
    Agenda

    Meeting Location:

    Bethesda North Marriott Hotel & Conference Center
    5701 Marinelli Road
    North Bethesda, MD 20852
    Phone: 301-822-9200
    Website: http://bethesdanorthmarriott.com

    http://ods.od.nih.gov
    What profit is there for one to gain the whole world yet lose or forfeit himself? Luke 9:25

  • Adam Wilk

    10/29/2009 5:17:57 PM |

    Dr. Davis,
    Great post, I enjoyed the way you wrote the dialogue between you and the nurse at the hospital--very, very realistic, and kind of spooky at the same time.  Unfortunately, this is just the tip of the iceberg--from my own personal experiences with my type 2 diabetic father in the hospital, getting insulin right is a total nightmare.  They use this arbitrary sliding scale which in some cases is totally ineffective and makes for unnecessarily high sugars--I remember how my father was merely 2 days post-op and was sitting there furious because the staff thought it was okay for him to be lying there with sugars in the low 200's, based on their scales and protocols.  
    You've got to stay out of hospitals.
    Great post.
    Adam

  • Anonymous

    10/29/2009 9:57:08 PM |

    Well good luck getting anything "health promoting" while in a hospital!

    Last year, while hospitalized for a bout of Takotsubo syndrome,  they wouldn't let me use my own: fish oil, Vitamin D3, Vitamin K, multi-vitamin, compounded bi-est or progesterone, and so on...

    They did manage to have Armour thyroid available to dispense to me.  Instead of the bi-est and progesterone they offered me Prempro... shudder, and these two meds could be had at the hospitals nifty pharmacy prices.

    So 4 days without the vitamins probably did no harm... but the hormones???  Yikes, by the 2.5 day mark my husband was forced (by me) to become a criminal and smuggle the compounded meds in to me during the night.  What could they do to me that would be worse than hormone withdrawl on top of Takatsubo syndrome?  HA... don't answer that!

    I got better as quickly as I could, and got the Heck out of there.  BTW, I don't think anyone on the nursing staff understood the difference between a heart attack and Takatsubo syndrome... BIG difference!

    Oh... and I got rid of the "precipitating event" that caused the whole thing, and that has greatly de-stressed my life.

    My advice: stay away from hospitals if at all possible... unless you are a doctor, nurse or hospital administrator.

    madcook

  • Jim Purdy

    10/30/2009 6:13:46 AM |

    Great post, and great comments, especially this one from Helena:
    "Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???"

    That sounds so familiar. If I could just go directly to a lab without doctor's orders, I would almost drop completely out of the whole doctor and hospital system.

  • renegadediabetic

    10/30/2009 1:07:45 PM |

    I hope I never have to go in the hospital.  They will probably feed me the standard "diabetic diet," low fat-high carb, and send my blood sugar into orbit.

    They do seem very reluctant to tell you the numbers.  After my last blood test, the nurse called and said my cholesterol was "high" and the doctor prescribed simvastatin.  I had to pry the numbers out of her:  LDL - 128, trigs - 55.  I consider the "high" LDL to be a case of skewed freidenwald and haven't bothered with the simvastatin.

  • JPB

    10/30/2009 4:49:49 PM |

    Note to Jim Purdy:  You can get your own tests.  
    www.MedLabUSA.com
    www.MyLab.com
    www.HealthCheckUSA.com (I think the .com is correct but not sure.)

  • Rich S

    10/30/2009 6:53:22 PM |

    Jim-

    Try these self-directed lab test companies:

    www.directlabs.com

    or

    www.privatemdlabs.com

    I've used both of them a lot.  PrivateMDlabs even gives you a 15% discount on top of their reasonable lab test prices.

    Rich

  • Lacey

    10/30/2009 8:19:41 PM |

    JPB,

    You make a good point.  In most states, it is possible for people to go directly to labs.  However, I want to point out that a few states, including NY, prohibit people from dealing directly with labs unless you are a licensed medical practitioner. New Yorkers can't even participate in the Vitamin D project.  It's infuriating, and I think it encroaches on basic liberty.

  • Red Sphynx

    10/31/2009 1:24:19 PM |

    Any guess on how much the hospital charged the insurance company for that single pill of second rate Vit D?

  • Rich S

    10/31/2009 2:09:21 PM |

    Living in New Jersey, I too suffer from "nanny-state" laws which prohibit me from getting my blood drawn for direct-to-consumer testing in New Jersey.

    However, it is perfectly legal to order the tests and get the labwork done at a Labcorp (usually the draw site used) in a neighboring, less-restrictive state.

    I am fortunate to live in southern New Jersey 20 miles from Philadelphia, so I get my lab draws by going over the bridge to Pennsylvania.  BTW, the other nanny-states which restrict direct-to-consumer lab tests are New York and Rhode Island.

    New York even restricts "blood-spot" testing (finger-prick) done at home and mailed in, which can be used for HbA1c, vitamin D, and other tests. To get around that, folks have had the tests mailed to friends or family in other states, who then forward it.  Our politicians are truly moronic.

    Rich

  • Helena

    11/1/2009 12:17:41 AM |

    Jim, I am right there with you... and Rich - thanks for the links I will be taking a look at that since I want to make sure I stay in good range without over doing my supplements.

    Thanks Dr Davis for a great post, once again.

  • Ursula

    11/3/2009 6:46:33 PM |

    I'm a little concerned (as an RN), that the RN and the Pharm were under the impression D affected coagulation. Working in managed care, I see a ton of misconception. Im always astounded at how much a non issue nutrition is, with the exception of diabetics, renals, and your bariatric surgery patients. The only places that get it are centers like Memorial Sloan Kettering, taking a whole body approach. But even there, wrong MD on your case, and your sunk. Do not get sick, and if you do, don't try to heal in the average hospital.

  • kc

    12/5/2009 6:04:03 PM |

    I'm allergic to corn so I live in fear of having to be hospitalized. You can't even imagine all the ways they could make me sicker. The worst part is that my own doctor has told me that I couldn't possibly be reacting to a corn derivative because all the corn protein had been processed out. I can almost guarantee that they wouldn't have a medicine to treat me that didn't contain corn.

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Be smarter than your cardiologist

Be smarter than your cardiologist

12. July 2006 William Davis (0)
“Do you need a stent?”

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

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

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



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

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

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

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

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

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