The Russert Protocol at work

25. June 2008 William Davis (6)
Without a concerted effort at prevention, heart scan scores (coronary calcium scores) grow like weeds. The average rate of growth is 30% per year.

Keith is an illustrative case. At age 39, Keith's heart scan score was 29, in the 99th percentile due to his young age. (In other words, young people before age 40 have no business having plaque. If they do, it's bad.)

True to conventional practice, Keith's doctor prescribed a cholesterol drug (Zocor), asked him to take a baby aspirin, and prescribed a blood pressure medicine. He asked Keith to cut the fat in his diet. His doctor even exceeded conventional (ATP-III) LDL cholesterol treatment targets.

Keith, an intelligent and motivated businessman, happily complied with his doctor's instructions. Eighteen months later, a 2nd heart scan showed a score of 68, representing an increase of 135%, or 76% per year.

This is the very same approach that the late Mr. Tim Russert's doctors employed: treat (calculated) LDL cholesterol with a statin drug, treat high blood pressure, reduce saturated fat, take aspirin. It was a miserable failure in Keith, whose plaque continued to grow at a frightening rate of 76% per year. It was also an obvious failure in poor Tim Russert.

Further investigation in Keith uncovered:

--Severe small LDL--80% of all LDL was small (despite a favorable HDL of 58 mg/dl)
--Measured LDL particle number (NMR) showed that "true" LDL was actually about 60 mg/dl higher than suggested by the crude calculated LDL
--An after-eating (postprandial) disorder (IDL)
--A pre-diabetic blood sugar and insulin
--Severe vitamin D deficiency
--Very low testosterone

All these patterns were present despite the steps Keith and his doctor had instituted. It's no wonder his plaque was undergoing explosive growth.

The conventional approach to coronary disease prevention is inadequate, more often than not a mindless adherence to one-size-fits-all template crafted to a great degree by drug industry interests and "experts" who often stand at arm's length from real live patients.

Keith's "residual" abnormalities are all readily correctable. He has since made dramatic improvements in all parameters. Among the strategies used is a wheat- and cornstarch-free diet that resulted in 12 lbs lost within the first few weeks of effort.

If you are on the "Russert Protocol," have a serious conversation with your doctor about the continued advisability of remaining on this half-assed approach to heart disease. Or, consider finding another doctor.
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Comments (6) -

  • Anonymous

    6/25/2008 10:23:00 AM |

    Testosterone deficiency is indeed another important factor, perhaps before vitamin D for some men.

    I guess it's no co-incidence that men's sperm rates are declining due to the range of chemicals in our environment which have an adverse affect on testosterone levels.

  • Stargazey

    6/25/2008 1:24:00 PM |

    I don't normally leave comments at your blog, but I wanted you to know that I read it regularly. Thanks for the all work you put into your posts and for the inspiration you provide!

  • Anonymous

    6/25/2008 3:01:00 PM |

    Except that for people with low testosterone (and I am one of those)when you try to correct the low testosterone with testosterone it lowers HDL. Its almost a "choose your poison" proposition.

  • Anonymous

    6/26/2008 9:44:00 AM |

    "However, only testosterone pills have been shown to lower blood levels of the good HDL cholesterol and cause heart attacks. Testosterone injections and skin patches do not (5,6,9)."
    http://www.drmirkin.com/men/M169.htm

  • Anonymous

    6/27/2008 3:09:00 PM |

    You don't mention testosterone cream, I'm on that and my testosterone went from 66 to 50,with no other changes in eating, weight, medicine . . . not a good trend.

  • Anonymous

    6/29/2008 10:37:00 AM |

    You should try Nebido (if available in the US), it's an injection that lasts up to 12 weeks - give or take a few weeks according to how you feel. It seems to be the most popular treatment in Europe due to being something you only think about 4x a year and achieves steady state levels.

    "The observed changes in the lipid profile under treatment with Nebido® were assessed as beneficial. Serum concentrations of total cholesterol, LDL cholesterol and apolipoproteins A1 and B were lowered, while HDL cholesterol, triglycerides and lipoprotein A remained unchanged.1,2,3"
    http://www.nebido.com/scripts/en/professionals/productinfo/lipid.php

    Where trigylcerides and HDL remain unchanged I guess this is where vit D and fish oil steps in.

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What is "normal"?

What is "normal"?

1. May 2007 William Davis (2)
When it comes to laboratory values and medical testing, a common dilemma is knowing what is "normal." Let me explain.

First of all, when you receive a laboratory result for a test, a "reference range" or "normal range" is usually provided. Where did that range come from?

It varies from test to test. For instance, a low potassium is easy, because low potassium levels can lead to life threatening consequences, e.g., dangerous heart rhythms. High potassium likewise, because dangerous phenomena develop when potassium generally exceeds 5.5 mg/dl or so.

But what about something like HDL or LDL. Here's where confusion reigns. Often, "normal" is obtained by taking the average and saying that any value plus or minus two standard deviations (remember that painful class?) represents normal or reference range.

If that were true, what if we applied that principle to body weight. If we weighed several thousand adult women, the average would be in the neighborhood of 172 lbs (no kidding). Does that mean that 172 lbs plus or minus two standard deviations is normal? No, of course not.

There is therefore a distinction between "normal" and "desirable". For HDL cholesterol, your laboratory report might say that an HDL cholesterol of 40-60 mg/dl is normal. But is it desirable? I don't think so. The most frequent HDL level for a male with a heart attack is 42 mg/dl--hardly desirable.

Let's take triglycerides. The average triglyceride level in the U.S. is somewhere around 140 mg/dl. For those of us who do a lot of lipoprotein testing, we can tell you that triglycerides at this level, though generally regarded as being within the normal range, are associated with flagrant and obvious excesses of several abnormal lipoprotein particles that contribute to coronary plaque growth (VLDL and often IDL; small LDL; drop in HDL and shift towards small HDL).

So, always take the so-called "normal" or "reference" values on a lab report as crude guidelines that often have little or nothing to do with health or desirability. Unfortunately, many physicians are not aware of this and will declare any value within the normal or reference range as okay. An HDL of 40 mg is not okay. A triglyceride level of 140 mg is also not okay.

What is okay? What is desirable? That depends on the parameter being examined. From a basic lipid standpoint, of course, we regard desirable as 60-60-60. Desirability from a lipoprotein standpoint we will cover in a more thorough Track Your Plaque Special Report in future.
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Comments (2) -

  • Anonymous

    5/12/2007 10:15:00 PM |

    A brief aside, if I may. You speak about the dangers of serum potassium of over 5.5; I was diagnosed as a Type 2 diabetic in December, and my serum potassium is 6.0. What can I do? I know you can't diagnose someone online, but any suggestions would be hugely appreciated.

  • Dr. Davis

    5/13/2007 3:30:00 AM |

    A potassium of 6.0 is potentially life-threatening within a relatively short time. Medical attention is needed ASAP. Unfortunately, this is entirely unrelated to the issues we discuss here.

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