What role cholesterol medication?

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

CT heart scans can mean different things to different people.


What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.


Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

All in the family--What to do if there's heart disease in your family

What should you do if a close relative of yours is diagnosed with coronary disease?
This question came up recently with a patient of mine. The patient--a strapping, 47 year old businessman who looked the absolute picture of health--was undergoing bypass surgery. Although I'd met him for the purposes of plaque reversal, he was already having symptoms and his stress test was flagrantly abnormal, all discovered after a heart scan score of 765. On the day after the patient's bypass, the patient's brother came to me. Understandably concerned about his own health, he asked what he should do. The answer: get a heart scan.
Measure the disease with the easiest test available. If his heart scan score is zero, great--he's at exceptionally low (near zero) risk for heart attack. A modest program of long-term prevention is all that's necessary. What if his score is like his brother, should he get in line for his bypass? No, absolutely not! But he will need two things: 1) a stress test to ascertain whether or not he's safe (60% likelihood a stress test would be normal), and 2) an effort to determine how the heck he got so much plaque. (We favor lipoprotein testing, of course, for greatest diagnostic certainty.)
Message: Learn from the lessons your own family provides. Don't let this valuable information go to waste.
Are you more like a dog or a rabbit?

Are you more like a dog or a rabbit?

Dr. William Roberts, editor of the American Journal of Cardiology and cardiovascular pathologist, is a perennial source of clever ideas on heart disease.
In a recent editorial, Dr. Roberts comments:








"Because humans get atherosclerosis, and atherosclerosis is a disease only of herbivorers, humans also must be herbivores. Most humans, of course, eat flesh, but that act does not make us carnivores. Carnivores and herbivores have different characteristics. (1) The teeth of carnivores are sharp; those of herbivores, flat (humans have some sharp teeth but most are flat for grinding the fruits, vegetables, and grains we are built to eat). (2) The intestinal tract of carnivores is short (about 3 times body length); that of herbivores, long (about 12 times body length). (Since I am 6 feet tall my intestinal tract should be about 60 feet long. As a consequence, if I eat bovine muscle [steak], it could take 5 days to course through those 20 yards.) (3) Body cooling for carnivores is done by panting because they have no ability to seat; although herbivores also can pant, they cool their bodies mainly by sweating. (4) Drinking fluids is by lapping them for the carnivore; it is by sipping them for the herbivore. (5) Vitamin C is made by the carnivore's own body; herbivores obtain their ascorbic acid only from their diet. Thus, although most human beings think we are carnivores or at least conduct their lives as if we were, basically humans are herbivores. If we could decrease our flesh intake to as few as 5 to 7 meals a week our health would improve substantially."



You can always count on Dr. Bill Roberts to come up with some clever observations.

I think he's right. Some of the most unhealthy people I've known have been serious meat eaters. Most of the vegetarians have been among the healthiest. (I say most because if a vegetarian still indulges in plenty of junk foods like chips, crackers, breakfast cereals, breads, etc., then they can be every bit as unhealthy as a meat eater.)

Should you become a vegetarian to gain control over coronary plaque and other aspects of health? I don't believe you have to. However, modern livestock raising practices have substantially modified the composition of meats. A steak in 2006, for instance, is not the same thing as a steak in 1896. The saturated and monounsaturated fat content are different, the pattern of fat "marbling" is different, the lean protein content is different. Meat is less healthy today than 100 years ago.

Take a lesson from Dr. Roberts' tongue-in-cheek but nonetheless provocative thoughts. Pardon me while I chew on some carrots.

Comments (11) -

  • Jeff

    12/20/2006 4:48:00 AM |

    Fascinating and funny. Thanks for the post. I'm glad I found your blog

    Jeff Brailey
    http://wordworks2001.blogspot.com

    Check my blog and find out why I refused to have a quintuple coronary artery bypass in the spring of 2004 and am alive to tell about it almost three years later.

  • Regina Wilshire

    12/20/2006 8:52:00 PM |

    Dr. William Roberts, editor of the American Journal of Cardiology and cardiovascular pathologist, is a perennial source of clever ideas on heart disease.


    He's also on the advisory board of the Physicians Committee for Responsible Medicine (PCRM) - an organization with a very clear agenda.

  • Anonymous

    12/21/2006 11:06:00 PM |

    (2) The intestinal tract of carnivores is short (about 3 times body length); that of herbivores, long (about 12 times body length). (Since I am 6 feet tall my intestinal tract should be about 60 feet long. As a consequence, if I eat bovine muscle [steak], it could take 5 days to course through those 20 yards.)

    I can't believe a physician thinks the human intestine is "about 60 feet long". At most, it's about 25 feet long.

  • Terri

    12/22/2006 3:00:00 PM |

    Provocative thoughts, yes....

    By way of full disclosure, the leadership and advisory board of the Physicians Committee for Responsible Medicine (PCRM) includes:

    PCRM Board of Directors: Neal D. Barnard, M.D., President; Roger Galvin, Esq., Secretary; Andrew Nicholson, M.D., Director.

    PCRM’s advisory board includes 11 health care professionals from a broad range of specialties:

    T. Colin Campbell, Ph.D. Cornell University
    Caldwell B. Esselstyn, Jr., M.D. The Cleveland Clinic
    Suzanne Havala Hobbs, Dr.PH., M.S., R.D. The Vegetarian Resource Group
    Henry J. Heimlich, M.D., Sc.D. The Heimlich Institute
    Lawrence Kushi, Sc.D. Division of Research, Kaiser Permanente
    Virginia Messina, M.P.H., R.D. Nutrition Matters, Inc.
    John McDougall, M.D. McDougall Program, St. Helena Hospital
    Milton Mills, M.D. Gilead Medical Group
    Myriam Parham, R.D., L.D., C.D.E. East Pasco Medical Center
    William Roberts, M.D. Baylor Cardiovascular Institute
    Andrew Weil, M.D. University of Arizona

    Clearly, as a comment mentioned, they have a viewpoint or agenda, however that doesn't mean they are wrong, anymore than carnivore-type programs may be right for everyone.

    In my opinion, there's plenty of room for 'novel' thoughts in the field of preventive cardiology and I appreciate Dr. Davis bringing them forward.

    And most clearly of all, there's plenty wrong with the conventional "standard American diet" no matter which end of the dietary spectrum one embraces.

    Whatever WORKS to help with plaque reversal!

  • petite américaine

    12/31/2006 3:08:00 AM |

    "However, modern livestock raising practices have substantially modified the composition of meats."

    Is patient education difficult on such subject matter?  Curious; had to ask.

  • Sue

    1/5/2007 1:38:00 AM |

    And how about the flesh of grass fed beef and wild game?  Is that good, better, more acceptable but still bad?  How about the folks who believe anthropologically we were meant to to eat a hunters and gatherers diet?

  • d.rosart

    11/15/2007 5:42:00 PM |

    Polar bears have the longest intestine of all the bears. I'm like a polar bear.

  • Anonymous

    6/22/2008 8:38:00 PM |

    Hi Dr. Davis,
    Your favorite internet TYP promoter checking in. : )  Thought to mention a possible opportunity - a friend of mine mentioned that he printed out and passed on a copy of your latest blog posting, the Big Squeeze, to his friend, Congressman Jim Marshall.  http://en.wikipedia.org/wiki/Jim_Marshall_%28U.S._politician%29
    Don't know if much will come of it, but being an opportunity thought to bring to your attention.  
    You might want to delete my mentioning of this.

  • Anonymous

    4/4/2009 5:53:00 AM |

    Just found your blog and am enjoying it.

    On this topic, I read such a comparison by a veterinarian who had cared for sheep, dogs and cows for 30 years.  Unfortunately I can't find it at the moment

    His take was the opposite.  

    Some things I remember were that humans, like carnivores, can swallow very large chunks of food that would kill a herbivore.

    Humans don't have 4 stomachs and don't chew cud.

    Human stereo vision is much more like all types of predators (eagles, cats, dogs, hawks, predatory fish) than almost any herbivore (eyes almost on the sides of the head)

    If you look at human hands, they look a lot like the Bonobo monkey's hands and NOT at all like a gorilla's hands.  Bonobos eat a lot of meat - insects, rodents, birds, and gorillas eat a lot of fruit and vegetables.

    That's basically what I remember.

    I'll post a link later to the fill thing if I can find it.

    Sam in Toronto

  • Anonymous

    4/5/2009 5:04:00 AM |

    Another thing I remember - the intestine length argument goes both ways - some carnivores do have long intestines.

    Something that does not go both ways - human intestines have the enzyme systems needed to degest lots of chemicals that ONLY exist in MEAT.

    As far as I know, you cannot get these from plants, or from only 1 or 2 plants in the world  

    Heme iron (not a big deal these days, but this was huge in the past, where every human, even kings, had dozens of blood-extracting parasites on the skin, in the hair and intestines)

    creatine (vegetarians can be synthesize this out of plant methionine)

    EPA/DHA (from fish oil - in ancient times, in meat - none in vegetables - there's no plant source for EPA, and only seaweed for DHA)

    B12

    also, as an efficiency measure over and above the efficiency of digesting individual amino acids, human digestion can grab large chunks of protein, many of which occur only in meat ( very, very large peptices -  but I forget what these are called - globulins or antigens)  

    Sam in Toronto (that's me, the author, not a chemical that humans can digest and that does not occur in vegetables)

  • Tuck

    7/2/2010 1:39:24 AM |

    Robert's comment is interesting, it's also grossly in error.  

    We're not rabbits or dogs, we're humans, and we're omnivores.

    The anthropological record is quite clear at this point.  We evolved large brains to hunt prey, and the fat of that prey allowed our brain to get larger, making us better hunters.  We sweat because we could outrun our herbivorous prey, using our naked skin as a superior cooing mechanism.  We have smaller teeth because we've been cooking our food for 1.5 million years, or so.

    We do seem to need some vegetable matter in our diets.  Even the Eskimos eat some.  But we do fine on a primarily animal diet.  A cow would not.

    It'd be nice if a physician was a little more familiar with the species he's treating.  A veterinarian couldn't get away with this degree of ignorance.

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