Can procedures alone keep you alive?

My days in the hospital remind me of what heart disease can be like when no preventive efforts are taken--what it used to be like even with my patients before taking a vigorous approach to prevention (though over 12 years ago).

Several cardiologists in my hospital, for instance, express skepticism that heart disease prevention works at all. Yes, they know about the statin cholesterol drug trials. But they claim that, given their experience with the power of coronary disease to overpower an individual's control, statin drugs are just "fluff". Coronary disease is a powerful process that can only begin to be harnessed with major procedures, i.e., a mechanical approach.

So these cardiologists routinely have their patients in the hospital, often once a year, sometimes more, for heart catheterization and "fixing" whatever requires fixing: balloon angioplasty, stents, various forms of atherectomy. Year in, year out, these patients return for their "maintenance" procedures. Their cardiologists maintain that this approach works. The patients go on eating what they like, taking little or no nutritional supplements, and medications prescribed by their primary care physicians for blood pressure, etc. But no real effort towards heart disease prevention beyond these minimal steps.

Can this work? Very little at-home, preventive efforts, but periodic "maintenance" procedures?

It can, perhaps, for a relatively short time of a few years, maybe up to 10 years. But it crumbles after this. The disease eventaully overwhelms the cardiologist's ability to stent or balloon this or that, since it has progressed and plaque has growth diffusely the entire period that maintenance procedures have been performed. In addition, acute illness still occurs with some frequency--in other words, plaque rupture is not affected just because there's a stent in the artery upstream or downstream.

Not to mention this can be misery on you and your life, with risk incurred during each procedure. It's also terribly expensive, with hospitalization easily costing $25,000-$50,000 or more each time. (Compare that to a $250 or so CT heart scan.)


As people become more aware of the potential tools for prevention of heart disease, fewer are willing to submit to the archaic and barbaric practice of "maintenance" heart procedures in lieu of prevention. But it still goes on. If you, or anybody you know, are on this pointless and doomed path, find a new doctor.




Bloodletting, another antiquated health practice
Loading
Cholesterol reduction and wheat

Cholesterol reduction and wheat

In my previous post, Identical twins and the explosive influence of weight , we witnessed an excellent example of the profound influence of food choices and weight control on lipoproteins. The heavier twin among these 35-year old male twins (Steve) had an LDL particle number over two-fold higher than his more slender counterpart (Alfred).

The heavier twin, Steve, got here through numerous and longstanding dietary excesses: fast foods, saturated fats, sweets, processed foods. The conventional answer to Steve's lipid dilemma would be to modestly reduce his reliance on saturated fat, exercise, and limit snacks.

How far would that get Steve? Not very far at all. With regards to his high LDL particle number of 2256 nmol/l (representing an "effective" LDL cholesterol of around 225 mg/dl), it would be reduced a little, perhaps 10%.

Notice, however, that 72% of all Steve's LDL particles are small (1639/2256). This is the pattern that responds dramatically to a sharp reduction in processed carbohydrates, especially wheat-containing products.

If Steve were to eliminate all wheat products--all breads, breakfast cereals, pretzels, cookies, cakes, pasta, crackers--LDL particle number will drop dramatically, perhaps 50%, often more depending on the magnitude of weight loss. Small LDL will respond most obviously and will be sharply reduced, perhaps disappear. Incidentally, these changes might not be well reflected by the conventional calculated LDL cholesterol, since small LDL particles are well-concealed by standard measures.

Reducing corn products, white and brown rice, and potatoes would also add to the effect. But, in 2007, wheat products represent 90% of the problem for the majority of people. Reducing or eliminating wheat therefore yields the biggest effect by a long shot.

Steve therefore represents an excellent example of how reducing processed carbohydrates, esp. wheat-containing products, can yield an unexpected and paradoxical reduction in LDL cholesterol as evidenced by the highly accurate LDL particle number (or apoprotein B). Reducing saturated fat sources also helps, but it certainly will not yield the kind of results most people need. You've got to be smarter than the simple-minded conventional advice.
Loading
The perfect Frankengrain

The perfect Frankengrain

Pretend I'm a mad food scientist. I'd like to create a food that:

1) Wreaks gastrointestinal havoc and cause intractable diarrhea, cramps, and anemia.
2) Kills some people who consume it after a long, painful course of illness.
3) Damages the brain and nervous system such that some people wet their pants, lose balance, and lose the ability to feel their feet and legs.
4) Brings out the mania of bipolar illness.
5) Amplifies auditory hallucinations in people with paranoid schizophrenia.
6) Makes people diabetic by increasing blood sugars.
7) Worsens arthritis, such as osteoarthritis and rheumatoid arthritis.
8) Triggers addictive eating behavior.
9) Punishes you with a withdrawal process if you try to remove it from your diet.

I will develop a strain that is exceptionally hardy and tolerates diverse conditions so that it can grow in just about any climate. It should also be an exceptionally high yield crop, so that I can sell it cheaply to the masses.

Now, if my evil scheme goes as planned, I will then persuade the USDA that not only is my food harmless, but it is good for health. If they really take the bait, they might even endorse it, create a diet program around it.

Dag nabit! Such a plan has already been implemented. Another evil food scientist already beat me to the punch. The food is called wheat.

Comments (25) -

  • Anonymous

    2/3/2011 9:03:26 PM |

    Interesting story from the UK:

    How can a fit, clean-living 32-year-old have a heart attack? For Martin the answer was in his genes. Like thousands he suffers from INHERITED high cholesterol

    "He was diagnosed with familial hypercholesterolaemia (FH), an inherited condition where the body cannot clear ‘bad’ LDL cholesterol from the blood."

    His arteries were so clogged that he needed a triple heart bypass — where blood vessels are taken from elsewhere in the body, usually the chest and legs, and used to create a new route for the blood to flow around the blockages.

    An estimated 100,000 people in Britain are living with FH but don’t know it, according to a report published last week by the Royal College of Physicians.

    The condition could kill them at any moment.

    So how could an apparently healthy man have such dangerous levels of cholesterol? Cholesterol is a waxy ­substance produced by the liver from the saturated fat we eat.

    It plays a vital role in the function of cells and production of hormones and vitamin D.

    Once it has done its job in the body, it’s also the liver’s job to remove it. In healthy people, this happens automatically.

    ‘The liver has “finger receptors” that reach out and grab hold of “bad” LDL cholesterol particles as they pass,’ says Professor Steve Humphries, the new report’s author and director of the Centre for Cardiovascular Genetics at University College London.

    ‘Good’ HDL cholesterol travels to the ­arteries to help unblock them before it also goes back to the liver to be removed by another set of receptors.

    ‘Once inside the liver, the cholesterol gets broken down, sent to the intestines and is then passed out of the body,’ says ­Professor Humphries.

    ‘But in people with FH, these receptors don’t work properly, so the cholesterol builds up in the blood.’

    (With the more common form of high cholesterol, the problem is that the patient has too much LDL for the receptors to cope with.)

    Over time, cholesterol deposits build up in the arteries, restricting blood flow to the heart and increasing the risk of heart attacks and strokes.

    By the age of 55, if left untreated, half of men with FH will have developed heart disease, while a third of women with it will develop heart disease by 60.

    While most FH sufferers have heart attacks in their 50s and 60s, some, such as Martin, can be affected in their 30s and 40s — with no warning signs."

    http://www.dailymail.co.uk/health/article-1352284/How-fit-clean-living-32-year-old-heart-attack.html

  • chaim

    2/3/2011 9:35:02 PM |

    Dr
    what is better to use regular glutten bread or whole wheat?

  • Anonymous

    2/3/2011 9:55:31 PM |

    Doc Davis,

    I am a fan of your blog, follow it religiously and have commented many times. You provide great advice and we are all thankful for it.

    That being said it, the content has become repetitive. Wheat is unhealthy. It has many negative side effects. It hates puppies and kittens. And babies. We get it.

    I'd love to read more content about other health subjects.

    Please take this in the spirit it was intended.
    -WheatFreeSince2003NotReallyButItRhymes

  • chaim

    2/3/2011 10:09:57 PM |

    Anon

    there are new ppl in this blog like me ,that did not reed all the posts

    For me ,it is a new thing as for many newcomers

    I never liked wheat, but I thought that was healthy

    We eat challah every Friday, my wife wanted to change it for whole wheat challah


    I dunno if to keep the same challah or to change for whole wheat

  • Dr. William Davis

    2/3/2011 11:47:58 PM |

    Hi, Chaim--

    Makes no difference. All the same.


    Hi, Anonymous--

    I hear you. However, as Chaim points out, there are usually several hundred new people here per day who still ask questions like "why no wheat?" So I re-explore some of the most common concerns.

  • terrence

    2/3/2011 11:56:37 PM |

    Dr Davis - I read your blog regularly, and have for a year or two now.

    I do NOT find your posts about the ills of wheat to be at all repetitive. What you have to say is always informative and often very funny.

    Please do NOT stop posting about wheat.

  • Might-o'chondri-AL

    2/4/2011 12:18:28 AM |

    Bedside manners may not be Doc's strong point. Once he almost   insulted Frankengrain's Aunt Butter (newbies can scroll blog's Labels, click "butter" & view comments).

  • DK

    2/4/2011 1:08:28 AM |

    Any evidence for any of this? And I mean real and solid evidence, not a bunch of anecdotes.

  • revelo

    2/4/2011 1:13:15 AM |

    You still haven't explained why the traditional people of Sardinia and Crete were so long-lived and healthy in old age (shepherds carrying heavy loads up steep mountain trails at the age of 90, etc), despite eating huge amounts of wheat (we're talking upwards of 750 grams of wheat bread per day for an active worker). For poor folk, the diet was mostly wheat, olive oil and wine, plus fruits, nuts and vegetables in season. Those with some money supplemented with dairy products, fish and meat. The Cretans and Sardinians were notoriously healthy, but the other traditional people of the Mediterranean basin plus the mountains of central Asia were also quite healthy on this wheat-based diet.

    Note that I use the past tense, because now that most of these peoples have moved to the cities, they are all becoming obese and diabetic and plagued with heart disease and other ailments.

  • Dr. William Davis

    2/4/2011 1:57:14 AM |

    Hi, Revelo--

    I don't know for certain, but I suspect that they are consuming a different genetic strain, e.g., emmer or a different, non-dwarf, variant.

    Wheat is literally 25,000+ different strains. While the majority are quite destructive, there are likely a few less destructive forms. This is one of the reasons I discuss the appeal of einkorn.


    DK and others--

    The evidence for much of this is actually overwhelming. It will be fully articulated in my forthcoming book from Rodale, Wheat Belly,

  • Jim White

    2/4/2011 2:09:07 AM |

    Thanks for the tip on Einkorn wheat. I have now added pasta back into my diet. I had eliminated it due to the huge blood sugar spikes. After eating pasta made from Einkorn wheat my blood sugar tests 100-108 just one hour after eating.  Traditional durem wheat pasta was producing 140+ even 2 hours later. Plus it is good.

  • Amy Dungan

    2/4/2011 4:31:53 AM |

    This is great! I'll be sure to share with the doubters. Smile

  • Anonymous

    2/4/2011 5:55:10 AM |

    Here's what would be more helpful: what to eat once you swear off wheat?
    What are we supposed to do for carbs? Potatoes and rice are glycemic bombs, we're told. Corn doesn't belong in a human diet either. High fructose corn syrup is in absolutely everything. Too much fruit is no good.  Short of somehow becoming a traditional Inuit or living in the induction phase of Atkins the rest of my life, I'm at a loss for ideas. I allow myself some pizza each week and a nice bowl of breakfast cereal, but I'm not extravagant with wheat, yet I have a trigylceride level of 292, HDL of 35, even with fish oil and niacin, and three days a week in the gym.

  • Anonymous

    2/4/2011 8:12:46 AM |

    Anonymous, my own Triglyceride levels came down from 214 just a year ago (at some point they were in the 300s) to 89 just before Christmas. This was by seriously cutting down on all sorts of carbs, I.e, only minimal amounts of bread, pasta, rice, etc. Hilariously, the doctor commented: “but remember, you don't need to cut fat from your diet completely!”. I just grinned. Having said that, I know exactly what you mean. If you go out for food, it is virtually impossible to avoid refined carbs in huge amounts in just about any dish. If you prepare your own food, you will have to discard the bulk of your favorite recipes from the past, and focus on stews etc. It's not easy. Regards, neuroscan.

  • majkinetor

    2/4/2011 2:30:33 PM |

    There is lot of CH in vegetables.

    For instance, 100g of brussels sprout has around 4g of CH.
    Its so delicious when cooked for few minutes in olive oil and/or butter that you can easily eat around 300g per day which gives you 16g.

    Potato is good alternative. Its hi GI (and GL) but, high GI foods in small amounts don't rise sugar. Amount is important. One boiled potato for instance.

    Other stuff: carrot, black chocolate (75%++ cocoa), oat brans, cashews, cranberries.

    Those are extremely healthy foods with good amount of slow carbs.

  • Might-o'chondri-AL

    2/4/2011 4:32:03 PM |

    Hi Revelo,
    Twice here I've seen mention of Crete & Sicily intake. Those islands' heat and humidity foster unique symbionts.

    Temperature will influence the varieties of soil bacteria. Based on the prophylactic gastro-intestinal affect of Japan's Natto I'd look to a local strain of Bacillus subtilis found on the drying wheat stalks.

    Humidity will influence the varieties of mycotic (fungi) strains post-harvest grain is exposed to. Rural storage isn't hermeticly controlled conditions.
    Based on human prophylactic gastro-intestinal affect of Japan's Koji (Amazake)I'd look for fungal mycellium of a local Aspergillus strain.

    Swine, whether kept as pigs or feral boars, expose country folk to non-symptomatic helminths (worms). Human immune system modulates away from auto-immune response in reaction to them. I'd look at the swine Whipworm species interaction.

    Robust rural 90 year olds are gaunt and conditioned. Carbohydrate based diets facilitate this by producing triglycerides to send out from the liver. In between the muscle cell's, and not fat, these are stored as di-acyl-glycerides.

    A genetic/epigentic determined copy number variation of an enzyme influences our ability to convert "di-" back into tri-acyl-glyceride (triglycerides). The muscle then "burns" this on site for a lot of energy. My 2000 decade co-villagers relied on tubers (carbohydrate); one reputedly closing in on 100 years regularly walked many kilometers.

  • thehurricane

    2/4/2011 6:59:00 PM |

    That pretty much sums it up...  I love this blog.

  • thehurricane

    2/4/2011 7:01:03 PM |

    Anonymous...
    It might be repetitive but he does update his blog EVERY day... this in addition to being a doctor, husband, parent.  The fact is that wheat really is so destructive and addictive for some people that it's worth repeating every day.  
    Keep at it Doc and I am looking forward to your book!

  • Patricia D.

    2/4/2011 7:50:30 PM |

    Regarding the connection between Urinary incontinence and wheat ...

    A connection has also been noted between Vitamin D3 deficiency and urinary incontinence.  There was a study from SUNY Upstate Medical University in Syracuse, N.Y from March 2010:
    http://www.webmd.com/urinary-incontinence-oab/news/20100322/low-vitamin-d-linked-incontinence

    I began to optimize my VD3 levels late in 2009 and this was one of the first benefits I realized - within a few months this situation had improved dramatically for me.  

    Then we started to cut way back on our wheat consumption in the fall of last year.

    It would be hard at this point for me to determine that having cut back on wheat is also having an impact - but there has been no obvious improvement.  Perhaps complete wheat elimination would have a more telling effect - but I do feel my situation now is near normal, whereas before it was an inconvenient problem of considerable concern.
    *

  • Patricia D.

    2/4/2011 8:02:49 PM |

    I know Dr. Davis did some baking (experiments) with Einkorn wheat.  I've found a few other sites for "heirloom wheat" flours ....
    Anson Mills:
    http://www.ansonmills.com/wheatflour.htm
    and ...
    Kamut: Ancient Grain in Modern Times:
    http://www.suite101.com/content/kamut-ancient-grain-in-modern-times-a89648

    ... and I'm sure there are more.

    These grains also predate the dwarf wheat mutant, and I wonder if anyone here has any experience with these flours?

    I now consider that cutting back on wheat consumption is a lifestyle choice for us and we won't be going back.  But I do occasionally bake a cake, or use a bit of flour to thicken a sauce, and sometimes bake bread.  

    I would like to have an alternate flour in the house that I feel comfortable cooking with.

  • paleoish

    2/5/2011 1:10:12 AM |

    Dr Davis, you have the patience of a saint to humour anonymous coward(s). I DO like reading the reminders of how bad wheat is, because people like me with ambiguous symptoms may or may not ever get a diagnosis of gluten intolerance or celiac disease. My last wheat cheat involved blood, so it's very possible that I have CD, but I dread the diagnostic process. Either way, it is emotionally draining to swim against the tide! Your posts help keep me on the straight and narrow.

    Doc, are there any references or further info on the issue of wheat triggering bipolar manic episodes? I'm having a major "a-ha" moment over this one. I'd love to read more about it. I've been reading your blog and that of Dr Emily for a while, and I don't recall seeing any info on that. Pardon me if I missed it.

  • Kevin

    2/5/2011 8:18:07 PM |

    I can't give up wheat products.  Because if this website I've drastically reduced my intake but haven't been able to make a total break.  Dr D's continual wheat-is-bad theme is pushing me toward my goal.  I do not want him to change this web's focus.  Without it I'd probably revert.  

    kevin

  • skcubrats

    2/9/2011 2:26:15 AM |

    Aren't corn and soybeans just as bad?  I thought he was going to end up with corn.  Remember, 95% aren't eating enough whole grains!  Zero is enough for me!

  • Josh

    2/9/2011 2:51:15 PM |

    Chaim -

    Shalom!  If you make your own hallah try to find some emmer or einkorn and see if that helps.

    If not try making sourdough, since at least the phytic acid is removed by the fermenation.

    It is possible that many Jews are not as sensitive to wheat since we have been eating it for a long time (of cource that was einkorn and emmer).

    Keep in mind you only need to eat a cbeya to wash with a bracha and czayit to bench on.  That's 2oz of bread - really not such a big deal if you're not eating wheat the rest of the week.

    I will also point out that Abraham served cream, butter, and organ meats to his guests.

Loading
Low Thyroid and Plaque

Low Thyroid and Plaque

Having now tested the thyroid status of several hundred patients over the last few months, I have come to appreciate:

1) That thyroid dysfunction is rampant, affecting at least 25% of everyone I see.
2) It is an enormously effective means to reduce cardiovascular risk.


I'm not talking about flagrant low thyroid dysfunction, the sort that triggers weight gain of 30 lbs, gallons of water retention, baggy eyes, sleeping 14 hours a day. I'm talking about the opposite extreme: the earliest, subtle, and often asymptomatic degrees of thyroid dysfunction that raises LDL cholesterol, lipoprotein(a) (Lp(a), a huge effect!), and adds to coronary plaque growth.

Correcting the subtle levels of low thyroid:

1) Makes LDL reduction much easier

2) Facilitates weight loss

3) Reduces Lp(a)--best with inclusion of the T3 fraction of thyroid hormone.

Recall that, 100 years ago, the heart implications of low thyroid weren't appreciated until autopsy, when the unfortunate victim would be found to have coronary arteries packed solid with atherosclerotic plaque. It takes years of low thyroid function to do this. I advise you to not wait until you get to this point or anywhere near it.

I find it fascinating that many of the most potent strategies we are now employing in the Track Your Plaque process are hormonal: thyroid hormones, T3 and T4; vitamin D (the hormone cholecalciferol); testosterone; progesterone; DHEA, pregnenolone. Omega-3 fatty acids, while not hormones themselves, exert many of their beneficial effects via the eicosanoid hormone pathway. Elimination of wheat and cornstarch exert their benefits via a reduction in the hormone insulin's wide fluctuations.

We haven't yet had sufficient time to gauge an effect on coronary plaque and heart scan scores. In other words, will perfect thyroid function increase our success rate in stopping or reversing coronary plaque? I don't know for sure, but I predict that it will. In fact, I believe that we are filling a large "hole" in the program by adding this new aspect.

Comments (12) -

  • Stephan

    12/2/2008 10:17:00 PM |

    I suspect gluten sensitivity could play a role in many thyroid cases.  Celiac disease associates with autoimmune thyroid problems.  About 12% of Americans are verifiably gluten sensitive.  The number may actually be much higher if you include people who have a less pronounced immune reaction to gluten.  What do you think of this idea?

  • Fitness blogger

    12/3/2008 2:58:00 AM |

    That is very concerning. What are the typical symptoms of a low thyroid. I must get it checked.

  • Anonymous

    12/3/2008 3:03:00 AM |

    Dr.Davis,
       This post has convinced me that
    your eventual protocol will be THE
    standard MO in just a few short
    years.Many thanks for your blog.

  • Anonymous

    12/3/2008 2:34:00 PM |

    Now the question is, how to get a doctor to treat you for low thyroid function?  I went from doctor to doctor for a number of years complaining of most of the clinical symptoms of low thyroid.  Since my labs were "within the normal range", not one of them would prescribe any form of thyroid.

    Finally, in desperation, I went to a "wellness" doctor who did put me on a trial of Armour thyroid.  MAGIC!  I suddenly had some energy, the gray clouds lifted, and I was finally able to begin to lose some weight... which eventually led to a 50 pound weight loss, which had been impossible before treatment.

    Unfortunately, by then I had achieved a heart scan score which put me in the high 90th percentile for a 55 year old woman.  Thanks docs!!!

    The average doctor out there seeing patients is still treating based solely on lab numbers, NOT on the (obvious) clinical symptoms sitting in front of them.  Such a patient is far more likely to be given a script for an antidepressant... I had plenty of doctors who were MORE than willing to write scripts for those!

    I hope the TYP treatment protocol will eventually begin to make a dent in this situation.  I now know that years of untreated low thyroid certainly contributed to my high heart scan score.

    Thank you, Dr. Davis, for Track Your Plaque!

  • rnikoley

    12/3/2008 6:24:00 PM |

    Dr:

    I have recently been reading your blog lately, and referring lots of readers from my own blog.

    I'd be interested to get your "take" on this -- not diagnosis.

    'Bout 18 months ago, I was at 230 (5'10) and looked awful. I was on Omeprezol for years for gastric reflux, a variety of prescription meds since early 20s for seasonal sinus allergies, culminating finally in the daily, year round squirts of Flonaise-esque sprays (the best for control without noticeable side-effects), and finally, Levothroid for about the last 7 years or so, as I had elevated TSH (around 9ish).

    My BP was regularly 145-160 / 95-110.

    I decided to get busy. I modified diet somewhat, cutting lots of junk carbs, and began working out -- brief, intense, heavy twice per week. BP began coming down immediately, such that within only a couple of weeks I was borderline rather than full blown high. Then after about six months, a year ago, I went to full blown low-carb, high fat, cutting out all grains, sugar, veg oils, etc, and replacing with animal fats, coconut, olive oil. You know the drill. Then, first of the year I felt great and simply stopped all meds, including the thyroid. I also began intermittent fasting, twice per week, and for a twist, I always do my weight lifting in some degree of fast, even as much as 30 hours.

    That's when the weight really started pouring off. Take a look:

    http://www.freetheanimal.com/root/2008/09/periodic-photo-progress-update.html

    http://www.freetheanimal.com/root/2008/08/faceoff.html

    In July I figured it's about time for a physical. Here's the lipid panel, demonstrating am HDL of 106 and Try of 47, great ratios all around:

    http://www.freetheanimal.com/root/2008/07/lipid-pannel.html

    However, my TSH was even higher -- 16ish. It seems odd that I was able to lose 40-50 pounds of fat (10-15 pounds of lean gain for a 30 pound net loss at that time -- now an additional 10 pounds net loss).

    One disclosure is that I was drinking too much, almost daily, and quite a bit (gotta save some vices...). Anyway, I'm at the point now where I want to drill down. I know I need to see an endocrinologist and have T3 and T4 looked at, but in advance, I wanted to see if the recent changes I've made could make a difference:

    1. Stopped all alcohol.
    2. Stopped most dairy, except ghee and heavy cream, and cheese is now used as a "spice," i.e., tiny quantities -- no more milk.
    3. 6,000 IU Vit D per day.
    4. 3 grams salmon oil, 2 grams cod liver oil.
    5. Vit K2 Menatetrenone (MK-4) -- side story: getting off grains reversed gum disease for which I have had two surgeries, then supplementing the K2 DISSOLVED calculus on my teeth within days -- hygienist and dentist are dumbfounded. Stephan (Whole Health Source), who comments here, has an amazing series on K2.

    Well, that's about it. I'd be interested in your general take on this.

  • Dr. William Davis

    12/3/2008 8:26:00 PM |

    Stephan--

    I suspect that there is indeed a connection.

    I personally feel that wheat, for a variety of reasons, has NO place in the diet whatsoever.

  • Hannah

    12/4/2008 3:18:00 AM |

    I agree with anonymous. It is incredibly difficult to find a doctor who'll will diagnose and treat hypothyroid, whether mild or not. There are many people whose FT3 and FT4 levels are low (whether the lab considers them in range or not) yet their TSH is "normal" either because their pituitary gland has not responded to the situation yet or because the lab range for normal is outdated.

    Many labs still use a TSH range of 0.3 - 5.0, when the American Association of Endocrinologists has recommended 3.5 be the upper limit, with many individual thyroid specialists pointing out that the healthy population's TSH readings have a mode of about 1.0 and a TSH of 2.0, or even 1.5 in older people, can be considered suspect when there are symptoms. And of course if someone has hypopituitarism the TSH range has no meaning at all.

    So we have an unknown number of people in various stages of dysfunction because many doctors aren't knowledgeable about what the TSH reading means. Not to mention issues like T3 resistance. They are often misdiagnosed as having chronic fatigue, fibromyalgia, depression, and so on, or just told to go lose weight. I know personally of one lady who went to her doctor - she is overweight, 46, had the symptoms of early hypothyroid, and tested for high cholesterol and elevated blood sugar. The doctor told her she had diabetes and wanted her to begin metformin. Luckily, she went for a second opinion and low thyroid levels were found. She's feeling much better now with T4/T3 combo therapy.

    There are also a lot of hypothyroid cases that aren't receiving adequate treatment. Some people receive relief with synthetic T4 replacement, some need a combination of T3 and T4, and others seem to need dessicated thyroid (eg Armour). Go to any thyroid support group and you will find people desperate for relief, their doctors are telling them their Synthroid is adequate, they must just be depressed or not eating well. Often the person will need to be treated for adrenal or pituitary function as well - as you have stated the hormones are all linked.

    If anyone believes they are having thyroid problems, do your best to shop around for a doctor who believes in testing Free T3 and Free T4 thyroid hormones and treating based on symptoms not strict lab results. Doctors who are both traditional practitioners as well as having an interest in "holistic" or "alternative" medicine may be the best place to look. But be wary of alternative health practitioners who claim they can cure hypothyroid with diet or homeopathic remedies, etc. A certain diet free of goitrogens will certainly help support your recovery but treating your hormones is necessary.

  • Dr. B G

    12/4/2008 5:50:00 AM |

    R Nikoley,

    Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

    Your experience with butter oil and vitamins ADEK2 are esp informative for me.

    Your TG + HDLs ROCK!

    I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

    I have some questions for you:
    --Have you considered getting a heartscan eval?
    --Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
    --Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
    --Have you had iodine testing? Deficiency leads to Hypothyroidism
    --Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
    --Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
    --Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

    Hope that helps! I find it spectacular you cured your own gum disease.

    -G

  • Dr. B G

    12/4/2008 5:50:00 AM |

    R Nikoley,

    Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

    Your experience with butter oil and vitamins ADEK2 are esp informative for me.

    Your TG + HDLs ROCK!

    I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

    I have some questions for you:
    --Have you considered getting a heartscan eval?
    --Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
    --Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
    --Have you had iodine testing? Deficiency leads to Hypothyroidism
    --Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
    --Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
    --Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

    Hope that helps! I find it spectacular you cured your own gum disease.

    -G

  • Anonymous

    12/5/2008 12:59:00 AM |

    Dr.Davis no where on your site do I see the importance of Vitamin C mentioned.Are you aware of the work of Linus Pauling concerning Vit C and the amino acid Lysine on calcification?
    Paulibng summarised that subliminal Scurvy was to blame and the RDA for Vitamin C is far too low.
    Ps. He did win a Nobel Prize for his research.
    Many thanks for a very interesting and informative site.

    http://www.vitamincfoundation.org/vitcheart.htm

  • Ryan W.

    3/1/2010 6:42:44 AM |

    Two things;

    1. Dr. Davis, can you provide any evidence that supplementing D3 will decrease arterial calcification? From what I've read, increased D3 (especially absent K1 menaquinone/K2) leads to increased calcification. It seems quite likely that the low levels of 25D3 observed in people with heart disease may be due to overconversion to calcitriol rather than lack of intake.  

    2. Anon wrote; "Dr.Davis no where on your site do I see the importance of Vitamin C mentioned."

    Ascorbate uses the same transporter as glucose (sodium mediated, IIRC.) Most animals make ascorbate from glucose and if your blood sugar is high, your body won't absorb vitamin C. So while mild scurvy may very well be a component of diabetes, it's questionable how well increasing oral intake will fix that problem, if the nutrient is simply not absorbed.

  • Anonymous

    3/11/2010 3:53:04 PM |

    I've come to believe my MANY health problems are hormone related but it's extremely difficult getting effectively tested and treated. I finally have some symptoms lessened by desiccated thyroid and am trying to sneak bioidentical low-dose estradiol, progesterone, DHEA past my migraine sensors. Hormones seem to be the most basic part of your system--if they could be in proper balance.

Loading
Do stents kill?

Do stents kill?

There's apparently a lively conversation going on at the HeartHawk Blog (www.hearthawk.blogspot.com). Among the hot topics raised was just how bad it is to have a stent.

I think that my comments some time back may have started this controversy. I've lately noticed that having a stent screws up your heart scan scoring in the vicinity of the stent. I was referring to the fact that I've now seen several people in the Track Your Plaque program do everything right and then show what I call "regional reversal": unstented arteries show dramatic drops in score of 18-30%, but the artery with a stent shows significant increase in score.

This is consistent with what we observe in the world outside Track Your Plaque when stents are inserted. Someone will get a stent, for instance, in the left anterior descending artery. A year later, there will be a "new" plaque at the mouth of the stent or just beyond the far end. This is generally treated by inserting another stent. Use of a drug-coated stent seems to have no effect on this issue.

Now, my smart friends in the Track Your Plaque program would immediately ask, "Does this mean you continually end up chasing these plaques that arise as a result of stents? Do you create an endless loop of procedures?"

Thankfully, the majority of times you do not. Rarely, this does happen and can lead to need for bypass surgery to circumvent the response. But it is unusual. The tissue that grows above and below stents does seem to be unusually impervious to the preventive efforts we institute.

Perhaps there's some new supplement, medication, or other strategy that will address this curious new brand of plaque growth. Until then, you and I can only take advantage of what is known. If it's any consolation, the plaque that seems to grow because of a previously inserted stent seems to lack the plaque "rupture" capacity of "naturally-occuring" plaque. It is, indeed, somehow different. It is more benign, less likely to cause heart attack. It's always been my feeling that this tissue behaves more like the "scar" tissue that grows within stents, causing "re-stenosis", a more benign, less rupture-prone kind of tissue.

Comments (5) -

  • madcook

    2/6/2007 5:17:00 AM |

    "If it's any consolation, the plaque that seems to grow because of a previously inserted stent seems to lack the plaque "rupture" capacity of "naturally-occuring" plaque. It is, indeed, somehow different. It is more benign, less likely to cause heart attack."

    Dr. Davis:

    You'll pardon my obvious question:  Has anybody actually looked at this phenomenon both in structure and composition at (pardon the word) autopsy?  I would wonder if it's a hyper-reaction to a foreign object, a kind of 'normal' scarring, as you mentioned, or something else.  Obviously there is calcium in this plaque, else it wouldn't be visible on scan. Very curious...

    madcook

  • Dr. Davis

    2/6/2007 8:46:00 PM |

    Madcook--
    The phenomenon is known as "edge restenosis". When examined at autopsy, or in years past when plaque was actually extracted by procedures like directional atherectomy, the material is the same as that occuring within the stent, known as "neointimal hyperplasia."

    The million dollar question is: Can anything modify neointimal hyperplasia? This is the whole dilemma of stent restenosis, the growth of tissue into stents. Of course, the procedural answer tends to involve drug coated stents. However, I know of no specific preventive strategy that has demonstrated substantial impact on the edge restenosis phemenonon. I've tried several agents, including cilostazol, which holds modest promise.

  • madcook

    2/6/2007 11:14:00 PM |

    Thank you for that information... I look forward to hearing more about the use of these agents as time goes by.

    "Of course, the procedural answer tends to involve drug coated stents."

    I just wonder how many people, who 'flunk' a treadmill test, or having an 'equivocal' result, end up in the cath lab and emerge with stent(s)... Are they _really_ aware beforehand that a lot of stent use is "off label" and they just might end up with a year or two (or a lifetime) on Plavix and aspirin?

    I lasted a week on Plavix before I refused anymore... after nearly bleeding to death in the kitchen from a cut (where else would a madcook hang out?).  But then I was very lucky, too as I escaped the cath lab without needing stenting.  A rare event I understand... and aspirin will always be my daily friend (along with most of the other TYP recommendations).

    Regards and thank you for the Heart Scan Blog.  It is a tremendous resource and very informative.

    madcook

  • John Townsend

    2/7/2007 9:15:00 PM |

    RE: "A year later, there will be a "new" plaque at the mouth of the stent or just beyond the far end."

    I'm curious whether or not this is a regular or typical occurrence and if there are symptoms one should be sensitive to that indicate such a development. Also does the size of the stent have a baring on the condition? Does vigorous exercise exasperate the condition?

    I appreciate your blog. It's very informative and helpful.

  • Dr. Davis

    2/7/2007 9:42:00 PM |

    John--
    It is, unfortunately, a very common occurrence, though the majority of times it does not result in any specific symptom or clinical consequence. Among the 30% or so of people who do re-develop chest pain, breathlessness, or have a new abnormality on a stress test, most of the time another stent is implanted at the area of tissue growth.

    Though this is really outside the realm of the Track Your Plaque program, it is yielding confusing results for people who engage in the program yet have a stent or two. It's my believe that the stent modifies the process of scoring in the stented artery. That's why we can see score reduction in arteries without stents, while the artery with a stent shows substantial increase in score.

    The larger the artery, the less likely this occurs. Large means 3.5 mm or greater in diameter.

Loading
Heart scan curiosities 3

Heart scan curiosities 3



This is a sample image from the heart scan of a 54-year old, 212 lb, 5 ft 2 inch woman. The heart is the whitish-gray in the center; lungs are the dark (air-filled) areas on either side of the heart. Note the massive amount of surrounding gray tissues that encircles the heart and lungs. This is fat. At this weight, the diameter of total fat exceeds the combined diameter of the heart and lungs. If we were to show the abdomen, there would be even more fat. (The image shows the body not well centered because the technologist centers the heart, since this is, after all, a heart scan.)





This is a 55-year old, 151 lb, 5 ft 4 inch woman. Note the contrast in the quantity of fat tissue surrounding the chest, a much more normal appearance. Note that this woman is still around 25 lb over ideal weight, but not to the extreme degree of the woman above.

Another curious observation: Note the more whitish streaking in the heavier woman's lungs. Heart scans are performed while holding a deep inspiration (a deep breath inwards), mostly to eliminate lung respiratory motion during image acquisition. Nonetheless, the heavier woman's lungs are not as fully expanded as the more slender woman. In other words, the heavier woman cannot inflate her lungs as effectively as the thinner woman. Ever notice how breathless heavy people are? Some of this effect is just being out of shape. But there's also the added effect of the abdominal fat exerting upwards compression on the lung tissues, and the constrictive effect of the encircling fat mass. At the beginning of inspiration, the chest fat exerts the resistance of inertia to inspiration that is absent, or less, in a slender person. With each breath, the heavy woman must move 50 lbs or so of surrounding fat mass just to inhale.

The heavier woman is, in effect, suffocating herself in fat.

The distortions to the human body incurred by extreme weight gain are both fascinating and shocking. I hope you're breathing easily.

Comments (7) -

  • Anonymous

    12/14/2006 4:55:00 PM |

    Exactly what triggers people to choose to be obese or even 20 lbs overweight? I find it disgusting.  People have to realize being overweight is unhealthly and puts that person at extreme risk for health problems. How sad it must be for young children not to have parents that can run with them in the park or worse yet lose one to heart disease, stroke or cancer.

  • Soundhunter

    1/1/2007 7:04:00 AM |

    hmmm. Me again, commenting twice.

    My 5 month old daughter has "pectus excavatum ", the docs said it's mild and won't show when she's an adult, they only seemed concerned with it for cosmetic reasons.

    I also have thought that the roof of her mouth seemed "deeper" or higher I guess you could say, than my other daughter's was in infancy. But, 5 monther with pectus excavatum doesn't have slender fingers, though she is quite long, repeated ultrasounds showed she had long legs. Is she possibly at higher risk for heart problems as an adult? Why wouldn't 2 different family docs know this, or tell me about it?

  • Dr. Davis

    1/1/2007 2:30:00 PM |

    An ultrasound of the heart, or echocardiogram, would settle the question. It's a harmless test that requires just a few minutes. If your daughter's doctor won't order it, find one that will.

  • Mo D.

    2/27/2007 2:54:00 AM |

    I'm saddened but not surprised that a doctor would call pectus excavatum just a curiosity.  I have quite a number of heart and lung ailments from my PE.  Had my doctor felt differently about PE when I was a kid and had suggested surgery, I would have suffered less than I have to having the surgery in my 30s. They say the teen years are the best time for surgical repair of PE. So yes, PE does cause heart and lung problems in adults.  At least this adult.

  • Anonymous

    2/28/2007 3:55:00 PM |

    Here's a relevant cite:
    Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis.

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16899852&query_hl=2&itool=pubmed_docsum

  • Paul Höppener MD Phd

    11/16/2007 6:32:00 PM |

    I am a 69 year old retired fysician.With a moderate congenital pectus excavatum. For more than 10 years I suffered from complaints like shorness of breath, fatigue and arythmia.Even a catheter ablation has been performed 4 years ago to stop Supraventricular tachycardia of 220.min. After 3 months a more moderate tachycardia returned. My complaints where posture dependent: bending or pressure on the upper abdomen or the pectus cavity did increase the problems.
    CT showed cardiocompression!
    To go short: after corrective surgery (Ravitch) my complaints have totally disappeared. I could stop with all medicines, can walk uphill agian and cycle with proper speed. Reborn without reincarnation.
    Lesson: symptomatic pectus excavatum can also happen to senior people an dcorrective surgery is worth while.
    See also:  http://www.spesweb.nl/SPES_English.htm

  • buy jeans

    11/3/2010 2:54:30 PM |

    It could mean that some attention and exploration of how floppy his mitral valve might be could be useful, e.g., an ultrasound or echocardiogram. He might even require oral antibiotics at the time of any oral or some gastrointestinal procedures, since floppy valve are more susceptible to blood infections when potentially "dirty" orifices are instrumented.

Loading
Can you break the “Rule of 60”

Can you break the “Rule of 60”

In the Track Your Plaque program, we aim for conventional lipid values (LDL cholesterol, HDL cholesterol, and triglycerides) of 60—60—60, i.e., LDL 60 mg/dl, HDL 60 mg/dl or greater, triglycerides 60 mg/dl. Most participants do indeed reach these target values.

When I tell this to colleagues, they’re stunned. “You can’t possibly get those numbers in most people.” And I can sympathize with their plight. After all, they are stuck with relatively lame tools: statin drugs, the American Heart Association diet. I’d be surprised if they ever achieved 60—60—60.

But can you drop your heart scan score even if you don’t reach the 60—60—60 targets? Yes, you can. The Rule of 60 is only a guideline, a tool that helps more people achieve our goals. The Rule of 60 does not guarantee reversal (drop in heart scan score), nor does not achieving the targets completely destroy your chances.

We have had many people drop their scores even if they haven’t reached the targets. On the other hand, we’ve also had people who failed at first, only to see success once they achieved the 60 mg/dl targets.

But which one are you? That’s the problem. We possess limited capacity to predict who will or who will not drop their scores from the start. We know that there are factors that stack the odds in your favor (e.g., optimism, lack of Lp(a), ideal weight, vitamin D >50 ng/ml, etc.). We know that there are factors that make it tougher (overweight, Lp(a), pessimistic attitude, underappreciated hypertension, higher heart scan scores, etc.) But at the start, we just don’t know who truly needs to adhere to the Rule of 60. So we suggest that everyone, at least in the beginning, aim to achieve it.

I had an exception the other day. Rich did everything by the Track Your Plaque book. However, a starting low HDL of 27 only rose to 37 after one year of effort—way below our 60 mg/dl target. Yet a repeat heart scan showed 23% reduction.

Why would Rich be so successful despite a persistently very low HDL? There may be a number of reasons. One explanation could be that conventional measures of HDL fail to distinguish between what HDLs truly work and what do not. Look at ApoA1 Milano; remember this story? The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective.

Yes, large HDL seem to be more healthy and effective than small HDL, but perhaps there’s more to it. However, nobody has a HDL effectiveness test ready for us to use.

In the meantime, we continue to suggest that the Track Your Plaque Rule of 60 be considered as a means of making plaque reversal as likely as possible. You and your doctor can always adjust in future, depending on your heart scan score results.

Comments (1) -

  • Anonymous

    7/8/2008 4:45:00 AM |

    "The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective."

    Isn't further investigation warranted?  Some other dietary factor
    or lifestyle habit may be the reason and not because "what little HDL they have is super-effective."
    this assumption could be missing something previously unknown.

Loading
Sometimes small LDL is the only abnormality

Sometimes small LDL is the only abnormality

Janet is a 58-year old schoolteacher. At 5 ft 3 inches and 104 lbs, she had barely an ounce of fat on her size-2 body. For years, Janet's primary care physician complimented her on her cholesterol numbers: LDL cholesterol values ranging from 100 to 130 mg/dl; HDL cholesterol of 50-53 mg/dl.

Yet she had coronary disease. Her heart scan score: 195.

Lipoprotein analysis uncovered a single cause: small LDL. 95% of all of Janet's LDL particles were in the small category. What was surprising was that this pattern occurred despite her slender build. Weight is a powerful influence on the small LDL pattern and the majority of people with it are overweight to some degree. But not Janet.

How did she get small LDL if she was already at or below her ideal weight? Genetics. Among the genetic patterns that can account for this pattern is a defect of an enzyme called cholesteryl-ester transfer protein, or CETP. This is the exact step, by the way, that is blocked by torcetrapib, the new agent slated for release sometime in future (The manufacturer, Pfizer, is apparently going to sell this agent only packaged in the same tablet as Lipitor. This has triggered an enormous amount of criticism against the company and they are, as a result discussing marketing torcetrapib separately.)

Also note that Janet had a severe excess of small LDL despite an HDL in the "favorable" range. (See my earlier conversation on this issue, The Myth of Small LDL at http://drprevention.blogspot.com/2006/06/myth-of-small-ldl.html.)

With Janet, weight loss to reduce small LDL was not an option. So we advised her to take fish oil, 4000 mg per day; niacin, 1000 mg per day; vitamin D, 2000 units per day; use abundant oat bran and raw almonds, both of which suppress small LDL. This regimen has--surprisingly--only partially suppressed her small LDL pattern by a repeat lipoprotein analysis we just performed. We're hoping this may do it, i.e., stop progression or reduce her heart scan score.

The lesson: Small LDL is a very potent pattern that can be responsible for heart disease, even if it occurs in isolation. And, contrary to conventional thinking, small LDL can occur as an independent abnormality, even when HDL is at favorable levels.
Loading